Aetna 2010 3 Tier Formulary List[1]

Includes generic and brand-name medications on Aetna’s Preferred Drug List

©2009 Aetna Inc.

2010 Aetna Preferred Drug Guide3-Tier/Open Formulary Plan

Questions?

Call the toll-free Member Services number listed on your Member ID card. Member Services representatives are available to take your call Monday – Friday, 9:00 am – 5:00 pm.*

Visit www.aetna.com for the most up-to-date information.

TDD for hearing or speech impaired please call 1-800-628-3323.

* Depending on your geographic location, some Member Services call centers may offer extended hours for your convenience.

Dear Member:

To help you know how medications are covered by your plan, we are pleased to provide you with a copy of our 2010 Preferred Drug Guide. The drugs on the Preferred Drug List were selected based on their effectiveness, safety, cost and other factors.

This guide provides helpful information on the Aetna Preferred Drug List and your pharmacy benefits plan. You may want to take this guide with you when you see your doctor to talk about what is covered under your plan.

Many commonly prescribed medications are listed in this guide. Please remember that this is not a complete list of medications covered under your plan. Because there are thousands of medications included in your pharmacy benefits plan, we only list the most commonly prescribed ones. Visit www.aetna.com/formulary for the most up-to-date information.

In accordance with state law, California HMO members who are receiving coverage for medications that are added to the Precertification or Step-Therapy Lists will continue to have those medications covered for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee’s medical condition. Nothing in this material shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this material be construed to prohibit generic drug substitutions.

For members in Texas, additions to the 2010 Preferred Drug List will be effective no later than January 1, 2010. In accordance with state law, full-risk members in Texas who receive coverage for medications that are removed from the Preferred Drug List during the plan year will continue to have those medications covered at the same benefit level until their plan renewal date.

Step-therapy, precertification and quantity limits do not apply in all service areas. For example, step-therapy does not apply to fully insured members in New Jersey and Indiana. Please refer to your plan documents or call the Member Services number on your ID card for further information.

www.aetna.com/formulary 1

Table of Contents

What Pharmacy Benefits Plan Do I Have? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

What is the Aetna Preferred Drug List? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Who Reviews Medications for the Preferred Drug List? . . . . . . . . . . . . . . . . . . . . . . . 3

How is the Preferred Drug List Developed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Why is the Preferred Drug List Subject to Change? . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Why Do Some Medications Require Prior Authorization or Precertification? . . . . . 4

Why Do Some Medications Have Quantity Limits? . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

What is Step-Therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

What is Therapeutic Duplication? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What are Generic Medications? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

How Can I Save Money on Prescriptions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What is Aetna Rx Home Delivery®? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

How Do I Contact Aetna Rx Home Delivery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What is Aetna Specialty Pharmacy®? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Therapeutic Class List Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Preferred Drug List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Antineoplastic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Blood Products – Modifiers – Volume Expanders . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Dermatological Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Gastrointestinal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Genitourinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Infections and Infestations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Musculoskeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Ophthalmic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Otic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Respiratory Tract Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Therapeutic Nutrients – Minerals – Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Toxicologic Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Vaccines, Toxoids and Biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Precertification List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Quantity Limit List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Step-Therapy List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

2 www.aetna.com/formulary

What Pharmacy Benefits Plan Do I Have?You are enrolled in a three-tier/ open formulary plan.*Open formulary means your pharmacy benefit covers medications that are on the Preferred Drug List (formulary), as well as many that are not. Your plan may not cover some medications listed in this guide, such as contraceptives, infertility medications, erectile dysfunction medications and diabetic supplies. Please see your plan documents for a complete description of your pharmacy benefit. Or call the Member Services number on your ID card.

Three-tier means you have three different copay (or coinsurance) levels that you pay out-of-pocket for your covered prescription medications.

Your plan may have a “mandatory generic cost-sharing requirement.” This means that if you receive a brand-name medication when a generic is available, you pay the difference in cost between the brand-name and generic medication, in addition to your copayment (or coinsurance). For a summary of your pharmacy benefits plan, including out-of-pocket costs, please log in to Aetna Navigator®, your secure member website, at www.aetna.com. Or call the Member Services number on your ID card.

What is the Aetna Preferred Drug List?The Aetna Preferred Drug List (or formulary) is a list of preferred, drugs which have been approved by the Food and Drug Administration (FDA), and are considered safe and cost-effective. This list includes both brand-name and generic medications and is updated regularly. Aetna will generally cover the drugs listed on our Preferred Drug List as long as the drug is medically necessary and plan rules are followed. Coverage is not limited to drugs on the Preferred Drug List.

* Your enrollment in an Aetna three-tier/open formulary plan was based on information available at the time of this mailing. If your pharmacy benefits plan changes, the costs and coverage of certain medications detailed in this guide may no longer apply. ** If your plan has a deductible, copay or coinsurance levels based on a percentage of Aetna’s negotiated charge with the participating pharmacy, rebates that Aetna receives from drug manufacturers do not reduce the amount you pay to the pharmacy for an individual prescription drug. Also, in some cases, if you need to pay a percentage of the cost of a drug or an amount to meet a deductible, your costs may be higher for a preferred drug than they would be for a non-preferred drug. *** If you are enrolled in a PPO plan, all covered generic medications may be available at the lowest (tier 1) copay (or coinsurance), regardless of whether they are preferred. In most HMO plans, non-preferred generic medications may be available at the highest (tier 3) copay (or coinsurance). Refer to your plan documents, visit Aetna Navigator or call Member Services for information about your benefits plan.

Copay (Coinsurance) Tier**

Type of Drug

Tier 1 (Low)

Covered generic medications***

Tier 2 (Middle)

Covered preferred brand-name medications

Tier 3 (High)

Covered non-preferred generic or brand-name medications***


Some plans have different coverage tiers for brand-name, generic, preferred and non-preferred medications. Usually drugs that are preferred are covered at a lower copay (or coinsurance) tier, which means you pay less out of pocket for those drugs.

The Preferred Drug List is subject to change. We choose drugs for the Preferred Drug List based on reliable medical data, safety and cost. Many medications, including drugs on the Preferred Drug List, are subject to rebate arrangements between Aetna and the manufacturer of those medications.*

For the most up-to-date information, visit www.aetna.com/formulary. It is important to note that you and your physician are responsible for making the final decision on your drug therapy.

Who Reviews Medications for the Preferred Drug List?Aetna’s Pharmaceutical and Therapeutics (P&T) Committee reviews available clinical literature for medications that have been approved by the FDA.

How is the Preferred Drug List Developed? Aetna’s Pharmacy and Therapeutics (P&T) Committee meets regularly to review new drugs and new information about drugs that are already on the market. It reviews available information concerning safety, effectiveness and current use in therapy. The P&T Committee reviews the scientific evidence from DrugPoints®, American Hospital Formulary Service Drug Information (AHFS-DI), DRUGDEX®, Medline and other databases, including relevant findings of federal government agencies, pharmaceutical manufacturers, medical professional associations, national commissions and peer-reviewed journals.**

Our P&T Committee includes licensed pharmacists and doctors, including those who are currently in practice and others who are Aetna employees. All committee members must tell us if they are in a situation that can create a conflict of interest or if they have a financial stake that might affect their decisions.

Once the P&T Committee completes its clinical review, we also consider overall value (including cost and manufacturer rebate arrangements) and other factors before adding or removing a drug from the Preferred Drug List.

* Rebates that Aetna receives from drug manufacturers do not reduce the amount you pay to the pharmacy for an individual prescription drug. Our online cost estimator tools on Aetna Navigator may help you decide which drug will cost you less.

** DrugPoints® and DRUGDEX® are registered trademarks of Thomson.


Why is the Preferred Drug List Subject to Change?We may add or remove drugs from the Preferred Drug List at any time. We might also move a drug from one coverage tier to another.

Here are some reasons why we may make changes to the Preferred Drug List.n As brand-name medications lose their

patents and generic versions become available, the brand-name medication may be covered at a higher copayment (or coinsurance) while the generic medication may be covered at a lower copayment (or coinsurance). Preferred medications likely to become available generically in 2010 are identified in this guide with a “#” symbol.

n The Preferred Drug List may change because the FDA approves many new medications throughout the year. Open formulary plans generally cover new FDA-approved medications before they have completed Aetna’s new drug review process; however, you may pay a higher copayment (or coinsurance). The new medication also may be subject to precertification or step-therapy requirements.

n The Preferred Drug List also may change if a medication is withdrawn from the market or becomes available without a prescription. Over-the-counter (OTC) drugs are not generally covered under a prescription plan.

Why Do Some Medications Require Prior Authorization or Precertification?Precertification encourages the appropriate and cost-effective use of medications by allowing coverage only when certain conditions are met. For example, precertification promotes compliance with dosing guidelines. It also helps healthcare providers avoid inappropriate duplicate therapies and check that a medication is being used based on generally accepted medical criteria. The precertification program is based upon current medical findings, FDA-approved manufacturer labeling information and cost and manufacturer rebate arrangements.

If your plan requires precertification, you will find a list of drugs that are subject to precertification in the back of this guide. n You, your doctor or the person you

appoint to manage your care must contact Aetna to request approval for coverage of the precertified medication.

n If we approve the request, we will notify you or your doctor. The medication will then be covered at the applicable copayment (or coinsurance) under your plan. You will also be notified of approvals where the state requires notification to members.

n If the request is denied, you and your doctor will be notified. You can still purchase the medication for the full price.


For information on whether precertification applies to your plan, please refer to your plan documents or call the Member Services number on your ID card. Refer to pages 38-39 for further details on which medications require precertification.

Why Do Some Medications Have Quantity Limits?The precertification program also limits coverage of quantities for certain drugs. These limits help your doctor and pharmacist check that the medications are used appropriately and promote patient safety. We use medical guidelines and FDA-approved recommendations from drug makers to set these coverage limits. The quantity limits program includes:n Dose Efficiency Edits – Limits coverage

of prescriptions to one dose per day for drugs that are approved for once-daily dosing.

n Maximum Daily Dose – A message is sent to the pharmacy if a prescription is less than the minimum or higher than the maximum allowed dose.

n Quantity Limits Over Time – Limits coverage of prescriptions to a specific number of units in a defined amount of time.

To get coverage for amounts over the allowed quantity, you, your doctor or the person you appoint to manage your care must request a medical exception. Refer to pages 40-45 for further details on which medications have quantity limits.

What is Step-Therapy? With this program, trying one or more “prerequisite” drugs is required before a step-therapy medication will be covered under your pharmacy benefits plan. Prerequisite drugs are FDA-approved and treat the same condition as the corresponding step-therapy drugs.

Step-therapy promotes the appropriate use of equally effective but lower-cost drugs first. You, your doctor or the person you appoint to manage your care can ask for an exception if it is medically necessary for you to use a drug on the step-therapy list. If the request is approved, we will notify you or your doctor. The medication will then be covered at the applicable copayment (or coinsurance) under your plan. You will also be notified of approvals where states require it. If the request is denied, we will notify you and your doctor.n For information on whether

step-therapy applies to your plan, please refer to your plan documents or call the Member Services number on your ID card.

n Refer to pages 46-48 for further details on which medications require step-therapy.

The list of medications requiring precertification, quantity limits or step-therapy is subject to change. Find the most up-to-date information at www.aetna.com/formulary. Or call the Member Services number on your ID card.


What is Therapeutic Duplication?Therapeutic duplication occurs when two drugs of the same type are prescribed at the same time. Rarely are two drugs from the same category necessary to treat a medical condition.

Sometimes therapeutic duplication results when two physicians are prescribing medications for the same person. This can also happen when a physician changes from one medication to another within the same therapeutic class but does not discontinue the first medication. In either situation, the person may end up taking two drugs with similar actions, potentially leading to serious side effects.

If a therapeutic duplication is identified, your pharmacist may ask you and/or your physician about the medications you are supposed to be taking. He or she can then help determine if both medications are necessary, or whether one of the medications should be discontinued.

Medications subject to the therapeutic duplication program include: n Selective Serotonin Reuptake Inhibitors

(SSRI) used to treat depressionn Proton Pump Inhibitors (PPIs) used

to treat ulcersn Triptan drugs used to treat

migraine headachesn Inhaled steroids for the treatment

of asthman Statin medications (HMGs) used

to treat high cholesterol

What are Generic Medications?Drug manufacturers develop and release new drugs under a brand name. When the patent expires, other manufacturers are free to make their own duplicate versions of the same drug. Generic drugs are chemically the same as their branded counterparts and are the same in dosage, safety, strength, form and intended use. They are only available after the FDA approves them. Generic drugs usually cost less than brand-name drugs.

When filling your prescription, your pharmacist generally can substitute a generic medication for a brand-name medication when the generic is rated by the FDA as equivalent and where substitution is permitted by law and by your doctor.

How Can I Save Money on Prescriptions?Ask your doctor to consider prescribing medications on the Preferred Drug List whenever appropriate. Medications on the Preferred Drug List generally cost you less money with a lower copayment (or coinsurance).

In many plans, covered generic medications on the Preferred Drug List are available at the lowest copayment (or coinsurance). Ask your doctor or pharmacist whether generic medications are appropriate for you.

www.aetna.com/formulary �

What is Aetna Rx Home Delivery®?Aetna Rx Home Delivery is our mail-order prescription service. Aetna Rx Home Delivery is an ideal way to obtain your medications that are taken regularly to treat a chronic condition such as arthritis, diabetes or heart disease. These medications are delivered right to your door.

Check Aetna Navigator® or your plan documents to see if your plan includes our Aetna Rx Home Delivery mail-order service. Features include:n Savings – Depending on your Aetna

pharmacy benefits plan, you could save money by using Aetna Rx Home Delivery, and standard shipping is always free.

n Convenience – Reorder only once every three months – Aetna Rx Home Delivery’s website and automated toll-free number let you order a refill, track your order and more!

n Privacy – Prescriptions are sent in plain packages.

n Peace of mind – Pharmacists check orders for accuracy and are available to answer member questions.

How Do I Contact Aetna Rx Home Delivery?Aetna Rx Home Delivery has two pharmacy locations – Florida and Missouri. Not sure which pharmacy you should use? Contact Member Services at the toll-free phone number on your ID card. If you know which one serves your pharmacy plan, contact that facility as shown below:

Florida Mail-order Pharmacy- Aetna Rx Home Delivery

P.O. Box 829518 Pembroke Pines, FL 33082-9913

( 1-800-227-5720

8 www.Aetna.com/AetnaRxhomeDelivery

Hours: Monday – Friday, 7:00 am – 11:00 pm EST Saturday, 8:00 am – 9:30 pm EST Sunday, 8:00 am – 6:00 pm EST

Missouri Mail-order Pharmacy- Aetna Rx Home Delivery

P.O. Box 417019 Kansas City, MO 64179-9892

( 1-866-612-3862

8 www.AetnaRxhomeDelivery.com

Hours: Monday – Friday, 7:00 am – 11:00 pm EST Saturday, 7:00 am – 9:30 pm EST Sunday, 8:00 am – 5:30 pm EST


What is Aetna Specialty Pharmacy®? Aetna Specialty Pharmacy is available to fill your specialty injectable medication needs. A specialty pharmacy provides self-injectable, infused, compounded and select oral drugs that require special handling or refrigeration. These drugs are for treating conditions like hemophilia, hepatitis or multiple sclerosis. They can be expensive, and retail pharmacies often do not carry them. Some specialty drugs have side effects, so a pharmacist or nurse should closely monitor their use.

With Aetna Specialty Pharmacy, you can get convenient delivery for these drugs. Plus, Aetna Specialty Pharmacy’s clinical support team can help you manage your therapy and health condition.

Depending on your benefits plan, you may have a copayment (or coinsurance) for specialty medications. Check Aetna Navigator, your plan documents or contact Member Services at the number on your ID card for further information. For more information on Aetna Specialty Pharmacy, call toll free at 1-866-782-ASRX (2779) or visit www.AetnaSpecialtyRx.com.

THERAPEUTIC CLASS LIST KEY

UPPERCASE – Brand-name medication

lower case italics – Generic medication

NC – Not covered

PR – Precertification required under most plans

ST – Step-therapy applies under most plans

QL – Quantity limit applies under most plans

PMED – Preferred injectable medication that may be covered under the medical benefit

MED – Injectable medication that may be covered under the medical benefit

# – Brand-name medication expected to become available generically in the near future. After the generic medication becomes available, the brand-name medication may be covered at a higher non-preferred copay (or coinsurance). The brand-name medication may also be subject to precertification and/or step-therapy.

1, 2, 3 – The numbers found in the drug lists represent copay (coinsurance) tiers.

MEDICATION NAME Copa

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Antineoplastic AgentsAdrenal Steroid InhibitorsCYTADREN 3

Alkylating AgentsALKERAN 2

CEENU 2

cyclophosphamide 1

HEXALEN 2

LEUKERAN 2

MYLERAN 2

TEMODAR ** 2 3

Antimetabolitesmercaptopurine 1

methotrexate 1

PURINETHOL 3

TABLOID 2

TREXALL 3

XELODA ** 2 3

Antineoplastic – AntibodiesERBITUX MED 3

RITUXAN MED 3

VECTIBIX MED 3

Antineoplastic – Hormonal AgentsARIMIDEX # 2 3

AROMASIN 2 3

bicalutamide 1

CASODEX 3 3 3

DEPO-PROVERA 3

ELIGARD ** 3

EMCYT 2

EULEXIN 3

FARESTON 3

FASLODEX ** 3

FIRMAGON 3 3 3

FEMARA 2 3

flutamide 1

leuprolide 1

LUPRON DEPOT ** 2

LYSODREN 3

MEGACE 3

MEGACE ES 3

Antineoplastic – Hormonal Agents (continued)

megestrol 1

NILANDRON 2

PLENAXIS ** 3

tamoxifen 1

TRELSTAR DEPOT ** 3

TRELSTAR LA ** 3

VANTAS ** 3

ZOLADEX ** 3Antineoplastic Enzyme InhibitorsAFINITOR ** 3 3 3

GLEEVEC ** 2 3

IRESSA 3

NEXAVAR ** 2 3

SPRYCEL ** 3 3 3

SUTENT ** 2 3 3

TARCEVA ** 2 3

TASIGNA ** 3 3 3

ZOLINZA ** 3 3

Antineoplastics – MiscellaneousACTIMMUNE 3

ALFERON N ** 3

HYDREA 3

hydroxyurea 1

INTRON-A 3

MATULANE 2

MYLOCEL 3

TARGRETIN 2

tretinoin 10 mg ** 1 3

TYKERB ** 3 3

VESANOID ** 3 3

Chemotherapy Rescue/Antidote Agentsleucovorin calcium 1

MESNEX 3ImmunomodulatorsREVLIMID ** 3

THALOMID ** 3Mitotic Inhibitorsetoposide 1

VEPESID 3

3-Tier Commercial Member Guide

**This medication will be added to the Aetna Specialty CareRx list in April 2010. It may be covered under a medical benefit before then.


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Topoisomerase I Inhibitors

HYCAMTIN ** 3 3

Blood Products – Modifiers – Volume Expanders

Anticoagulants – Coumarin

COUMADIN 3

warfarin 1

Anticoagulants – Heparins

ARIXTRA 3

FRAGMIN 2

heparin sodium PMED

INNOHEP 3

LOVENOX 3

Antiinhibitor Coagulant Complex

FEIBA VH IMMUNO 2 3

Blood Clotting Factor VIIa

NOVOSEVEN 2 3

Blood Clotting Factor VIII Human

ALPHANATE 3 3

HEMOFIL M 3 3

HUMATE-P 3 3

KOATE-DVI 3 3

MONARC-M 3 3

MONOCLATE-P 2 3

Blood Clotting Factor VIII Recombinant

ADVATE 3 3

HELIXATE FS 3 3

KOGENATE FS 3 3

RECOMBINATE 3 3

REFACTO 3 3

XYNTHA 3 3

Blood Clotting Factor IX Non-Recombinant

ALPHANINE SD 3 3

MONONINE 2 3

PROFILNINE 3 3

Blood Clotting Factor IX Complex

BEBULIN VH 3 3

PROPLEX T 3 3

Blood Clotting Factor IX Recombinant

BENEFIX 3 3

Fibrinogen Concentrate (human)RIASTAP ** 2Gaucher DiseaseCEREZYME ** 2ZAVESCA ** 3 3

Hereditary AngioedemaCINRYZE ** 2Hematopoietic Growth FactorsARANESP 2 3

EPOGEN 3 3

LEUKINE ** 3NEULASTA 2NEUMEGA 3NEUPOGEN 3NPLATE ** 3PROCRIT 2 3

PROMACTA 3Paroxysmal Nocturnal Hemoglobinuria (PNH)SOLIRIS ** 2Platelet Aggregation InhibitorsAGGRENOX 2AGRYLIN 3anagrelide 1cilostazol 1dipyridamole 1PERSANTINE 3PLAVIX # 2PLETAL 3TICLID 3ticlopidine 1Cardiovascular SystemAlpha-Beta Blockerscarvedilol 1COREG 3COREG CR # 2labetalol 1TRANDATE 3Anaphylaxis Therapy Agentsepinephrine 1EPIPEN 2EPIPEN-JR 2TWINJECT 3


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Angiotensin Converting Enzyme (ACE) Inhibitors and CombinationsACCUPRIL 3ACCURETIC 3ACEON # 3ALTACE 3 3

benazepril 1benazepril/ hydrochlorothiazide 1

CAPOTEN 3CAPOZIDE 3captopril 1captopril/hydrochlorothiazide 1enalapril 1enalapril/hydrochlorothiazide 1fosinopril 1fosinopril/hydrochlorothiazide 1lisinopril 1lisinopril/hydrochlorothiazide 1moexipril 1moexipril/hydrochlorothiazide 1LOTENSIN 3LOTENSIN HCT 3MAVIK 3MONOPRIL 3MONOPRIL HCT 3PRINIVIL 3PRINZIDE 3quinapril 1quinaretic 1ramipril 1trandolapril 1UNIRETIC 3UNIVASC 3VASERETIC 3VASOTEC 3ZESTORETIC 3ZESTRIL 3

Angiotensin II Receptor Antagonists and CombinationsATACAND 3 3 3

ATACAND HCT 3 3 3

Angiotensin II Receptor Antagonists and Combinations (continued)

AVAPRO 3 3 3

AVALIDE 3 3 3

AZOR 3 3

BENICAR 3 3 3

BENICAR HCT 3 3 3

COZAAR # (Step-therapy will not be implemented until some time after generic becomes available)

2 3 3

DIOVAN 2 3

DIOVAN HCT 2 3

EXFORGE 2 3

EXFORGE HCT 2 3

HYZAAR # (Step-therapy will not be implemented until some time after generic becomes available)

2 3 3

MICARDIS 3 3

MICARDIS HCT 3 3

TEVETEN 3 3 3

TEVETEN HCT 3 3

Antiadrenergic AntihypertensivesCARDURA 3

CARDURA XL 3

CATAPRES 3

CATAPRES-TTS 3

clonidine 1

doxazosin 1

guanabenz 1

guanfacine 1

HYTRIN 3

methyldopa 1

MINIPRESS 3

prazosin 1

reserpine 1

TENEX 3

terazosin 1Antianginals – Nitratesamyl nitrite 1

DILATRATE SR 3

IMDUR 3


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Antianginals – Nitrates (continued)

ISMO 3ISORDIL 3isosorbide dinitrate 1isosorbide mononitrate 1MONOKET 3NITROBID 3NITRO-DUR 3nitroglycerin 1nitroglycerin CR 1nitroglycerin SL 1NITROLINGUAL 3NITROSTAT 2nitro-transderm 1Antianginals – OtherRANEXA 3 3 3

Antiarrhythmics Type I-Adisopyramide 1NORPACE 3procainamide 1procainamide ER 1PRONESTYL 3PRONESTYL SR 3quinidine gluconate 1quinidine sulfate 1Antiarrhythmics Type I-Bmexiletine 1Antiarrhythmics Type I-Cflecainide 1propafenone 1RYTHMOL 3RYTHMOL SR 3TAMBOCOR 3Antiarrhythmics Type IIIamiodarone 1CORDARONE 3PACERONE 3TIKOSYN 3Antihyperlipidemics – Bile Sequestrantscholestyramine 1COLESTID 3colestipol 1

Antihyperlipidemics – Bile Sequestrants (continued)

prevalite 1

QUESTRAN 3

WELCHOL 2Antihyperlipidemics – Fibric Acid DerivativesANTARA 2

fenofibrate 1

FENOGLIDE 3 3

gemfibrozil 1

LOFIBRA 3 3

LOPID 3 3

LIPOFEN 3 3

TRICOR # 3

TRIGLIDE 3 3

TRILIPIX 2

Antihyperlipidemics – HMG CoA Reductase Inhibitors

ADVICOR 2 3

ALTOPREV 3 3 3

CADUET 3 3 3

CRESTOR 5 mg 2 3 3

CRESTOR (all other strengths) 2 3

LESCOL 2 3

LESCOL XL 2 3

LIPITOR 3 3 3

lovastatin 1 3

MEVACOR 3 3

PRAVACHOL 3 3

pravastatin 1 3

SIMCOR 2 3

simvastatin 1 3

VYTORIN 10 mg / 10 mg 2 3 3

VYTORIN (all other strengths) 2 3

ZOCOR 3 3

Antihyperlipidemics – Intestinal Cholesterol Absorption Inhibitors

ZETIA 2 3 3

Antihyperlipidemics – MiscellaneousLIPEX 3

LOVAZA 2


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Antihyperlipidemics – Nicotinic Acid DerivativesNIASPAN 2

Beta Blockers Cardioselective and Combinationsacebutolol 1

atenolol 1

atenolol/chlorthalidone 1

betaxolol 1

bisoprolol fumarate 1

bisoprolol/hydrochlorothiazide 1

BYSTOLIC 2

KERLONE 3

LOPRESS HCT 3

LOPRESSOR 3

metoprolol 1

metoprolol succinate SR 3

SECTRAL 3

TENORMIN 3

TENORETIC 3

TOPROL XL 3

ZEBETA 3

ZIAC 3

Beta Blockers Non-Selective and CombinationsBETAPACE 3BETAPACE AF 3CARTROL 3CORGARD 3CORZIDE 3INDERAL 3INDERAL LA 3INDERIDE 3INNOPRAN XL 3LEVATOL 3metoprolol/ hydrochlorothiazide 1

nadolol 1nadolol bendroflumethiazide 1pindolol 1propranolol 1propranolol SR 1

Beta Blockers Non-Selective and Combinations (continued)

propranolol/ hydrochlorothiazide 1

sorine 1sotalol 1sotalol AF 1TIMOLIDE 3timolol maleate 1Calcium BlockersADALAT CC 3

afeditab 1

amlodipine 1

CALAN 3

CALAN SR 3

CARDENE 3

CARDENE SR 3

CARDIZEM 3

CARDIZEM CD 3

CARDIZEM LA # 2

cartia XT 1

COVERA-HS 3

DILACOR XR 3

diltia XT 1

diltiazem 1

diltiazem CD/ER/CR/XT 1diltiazem SR extended release beads 1

DYNACIRC CR 3felodipine 1ISOPTIN SR 3isradipine 1nicardipine 1nifediac CC 1nifedical XL 1nifedipine 1nifedipine CR/ER/SR 1nimodipine 1nisoldipine 1NIMOTOP 3NORVASC 3

PLENDIL 3


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Calcium Blockers (continued)

PROCARDIA 3

PROCARDIA XL 3

SULAR 3

taztia XT 1

TIAZAC 3

verapamil 1

verapamil CE/ER/SR 1

VERELAN 3

VERELAN PM 3Cardiac Glycosidesdigitek 1

digoxin 1

LANOXICAPS 3

LANOXIN 3Cardiovascular Combinations – Miscellaneousamlodipine/benazepril 1BIDIL 3CLORPRES 3hydralazine/ hydrochlorothiazide 1

LOTREL 3 3

methyldopa/ hydrochlorothiazide 1

rauwolfia/ bendroflumethiazide 1

TARKA 3Direct Renin InhibitorTEKTURNA 2 3

TEKTURNA HCT 2 3

Diuretics – Carbonic Anhydrase Inhibitorsacetazolamide 1

DIAMOX 3

methazolamide 1Diuretics – Loopbumetanide 1

BUMEX 3

DEMADEX 3

EDECRIN 3

furosemide 1

LASIX 3

torsemide 1

Diuretics – Potassium Sparing and CombinationsALDACTAZIDE 3ALDACTONE 3amiloride 1amiloride/hydrochlorothiazide 1DYAZIDE 3DYRENIUM 3MAXZIDE 3spironolactone 1spironolactone/ hydrochlorothiazide 1

triamterene/ hydrochlorothiazide 1

Diuretics – Selective Aldosterone Receptor Antagonists (SARAs)eplerenone 1INSPRA 3Diuretics – Thiazide and Thiazide-Likechlorothiazide 1chlorthalidone 1DIURIL 3hydrochlorothiazide 1indapamide 1methychlothiazide 1metolazone 1MICROZIDE 3NATURETIN 3THALITONE 3ZAROXOLYN 3Pheochromocytoma AgentsDEMSER 3DIBENZYLINE 2Pulmonary Hypertension AgentsADCIRCA ** 3 3

FLOLAN ** 3LETAIRIS ** 2REMODULIN ** 3REVATIO ** 2 3

TRACLEER ** 2VENTAVIS ** 3Vasodilatorshydralazine 1isoxsuprine 1


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www.aetna.com/formulary 15**This medication will be added to the Aetna Specialty CareRx list in April 2010. It may be covered under a medical benefit before then.

Vasodilators (continued)

minoxidil 1papaverine ER 1VASODILAN 3Central Nervous SystemALS AgentsRILUTEK 2 3

Analgesic-Non-NarcoticPRIALT ** 3Alzheimer’s Disease – AntidementiaARICEPT # 3ARICEPT ODT 3COGNEX 3EXELON (cap/patch/soln) 2galantamine 1galantamine SR 1NAMENDA 2RAZADYNE 3RAZADYNE ER 3Antianxiety – Benzodiazepinesalprazolam 1alprazolam ER 1alprazolam ODT 1chlordiazepoxide 1clorazepate 1diazepam 1lorazepam 1NIRAVAM 3oxazepam 1XANAX XR 3Antianxiety – Miscellaneousbuspirone 1hydroxyzine hcl 1hydroxyzine pamoate 1meprobamate 1Anticonvulsants – Benzodiazepinesclonazepam 1clonazepam orally disintegrating tab 1

DIASTAT # 3KLONOPIN 3KLONOPIN WAFER 3

Anticonvulsants – CarbamatesFELBATOL 3Anticonvulsants – GABA ModulatorsGABITRIL 3 3

Anticonvulsants – HydantoinsDILANTIN 3phenytoin extended 1phenytoin sodium 1Anticonvulsants – MiscellaneousBANZEL 3 3

carbamazepine 1carbamazepine XR 1CARBATROL 3gabapentin 1 3

GABARONE 3 3

KEPPRA 2KEPPRA XR 2LAMICTAL 3 3

LAMICTAL ODT 3 3

LAMICTAL XR 3 3

lamotrigine 1levetiracetam 1LYRICA 3 3 3 3

NEURONTIN 3 3

oxcarbazepine 1primidone 1TEGRETOL 3TEGRETOL XR 3TOPAMAX 3 3

topiramate 1TRILEPTAL 3VIMPAT 3 3 3

ZONEGRAN 3 3

zonisamide 1 3

Anticonvulsants – SuccinimidesCELONTIN 3ethosuximide 1ZARONTIN 3Anticonvulsants – Valproic AcidDEPAKOTE 3 3

DEPAKOTE ER 3 3

DEPAKOTE sprinkle 3 3


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Anticonvulsants – Valproic Acid (continued)

divalproex sodium delayed release 1

divalproex sodium sprinkle 1

divalproex sodium SR 1

STAVZOR 3

valproic acid 1

Antidepressants – Alpha-2 Receptor Antagonists

mirtazapine 1 3

mirtazapine ODT 1 3

REMERON 3 3 3

REMERON SOLUTAB 3 3 3

Antidepressants – MAO Inhibitors

EMSAM 3 3

MARPLAN 3

NARDIL 3

PARNATE 3

tranylcypromine sulfate 1

Antidepressants – Miscellaneous

APLENZIN 3 3 3

budeprion 1 3

budeprion XL 1 3

bupropion 1 3

bupropion SR 1 3

maprotiline 1 3

WELLBUTRIN 3 3 3

WELLBUTRIN SR 3 3 3

WELLBUTRIN XL 2 3 3

Antidepressants – Modified Cyclics

nefazodone 3 3

trazodone 1

Antidepressants – Serotonin-Norepinephrine Reuptake Inhibitors

CYMBALTA 2 3 3

EFFEXOR 3 3 3

EFFEXOR XR # 2 3 3

PRISTIQ 2 3 3

venlafaxine 1 3

VENLAFAXINE ER 3 3 3

Antidepressants – Selective Serotonin Reuptake InhibitorsCELEXA 3 3 3

citalopram 1 3

fluoxetine 1 3

fluvoxamine 1 3

LEXAPRO 3 3 3

LUVOX CR 3 3 3

paroxetine 1 3

paroxetine ER 1 3

PAXIL 3 3 3

PAXIL CR 3 3 3

PEXEVA 3 3 3

PROZAC 3 3 3

PROZAC WEEKLY 3 3 3

RAPIFLUX 3 3 3

sertraline 1 3

ZOLOFT 3 3 3

Antidepressants – Tricyclic Agentsamitriptyline 1

amoxapine 1

clomipramine 1

desipramine 1

doxepin hcl 1

imipramine hcl 1

nortriptyline 1

vanatrip 1Antiparkinsonian AdjuvantsLODOSYN 3

Antiparkinsonian AnticholinergicAKINETON 3

benztropine 1

COGENTIN 3

KEMADRIN 3

trihexyphenidyl 1Antiparkinsonian COMT InhibitorsCOMTAN 2

TASMAR 3Antiparkinsonian Dopaminergicamantadine 1

atamet 1


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www.aetna.com/formulary 1�

Antiparkinsonian Dopaminergic (continued)

bromocriptine 1

carbidopa/levodopa 1

carbidopa/levodopa ODT 1

carbidopa/levodopa SR 1

MIRAPEX # 2

PARCOPA 3

PARLODEL 3

REQUIP 3

REQUIP XL 3 3

ropinirole hcl 1

SINEMET 3

SINEMET CR 3

STALEVO 3

SYMMETREL 3

Antiparkinsonian Monoamine Oxidase Inhibitor

AZILECT 2

ELDEPRYL 3

selegiline 1

Antipsychotics – Atypical

ABILIFY 3 3 3

ABILIFY DISC 3 3 3

clozapine 1 3

CLOZARIL 3 3

FAZACLO 3 3

GEODON 3 3 3

INVEGA 3 3 3

RISPERDAL 3 3 3

RISPERDAL M 3 3 3

risperidone 1 3

risperidone ODT 1 3

SEROQUEL 2 3

SEROQUEL XR 2 3

ZYPREXA 2 3

ZYPREXA ZYDIS 2 3

Antipsychotics – Combinations

chlordiazepoxide/amitriptyline 1

perphenazine/amitriptyline 1

SYMBYAX 3 3

Antipsychotics – First Generationchlorpromazine 1

compro 1

fluphenazine 1

haloperidol 1

loxapine 1

perphenazine 1

prochlorperazine 1

thioridazine 1

thiothixene 1

trifluoperazine 1Antipsychotics – MiscellaneousEQUETRO 3

Chemical DependencyANTABUSE 3

CAMPRAL 3

naltrexone 1FibromylagiaCYMBALTA 2 3 3

LYRICA 3 3 3 3

SAVELLA 2 3

Huntington’s Disease – ChoreaXENAZINE 2 3

Lithiumlithium carbonate 1

lithium carbonate CR 1

lithium citrate 1

LITHOBID 3Migraine ProductsAMERGE # 2 3

AXERT 3 3 3

FROVA 3 3 3

IMITREX 3 3 3

MAXALT # 2 3

MAXALT MLT # 2 3

MIGRANAL 3 3 3

RELPAX 3 3 3

sumatriptan 1 3

TREXIMET 3 3 3

ZOMIG 3 3 3

ZOMIG ZMT 3 3 3


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Multiple Sclerosis AgentsAVONEX 2

BETASERON 3 3

COPAXONE 2

REBIF 2

TYSABRI ** 3 3

Narcotic AgonistsACTIQ 3 3 3

AVINZA 2

codeine phosphate 1

codeine sulfate 1

DARVON-N 3

DAZIDOX 3

DEMEROL 3

DILAUDID 3

DURAGESIC 3 3 3

fentanyl lozenge 1 3 3

fentanyl patch 1 3

FENTORA 3 3 3

hydromorphone 1

KADIAN 2

levorphanol 1

meperidine 1

methadone 1

methadose 1

morphine sulfate 1

morphine sulfate CR 1

MS CONTIN 3

NUCYNTA 3 3 3

OPANA 3

OPANA ER 2

ORAMORPH SR 3

oxycodone 1

oxycodone SR 1 3

OXYCONTIN CR 2 3

oxyfast 1

OXYIR 3

propoxyphene 1

RYZOLT 3 3

tramadol 1

ULTRAM 3

Narcotic Agonists (continued)

ULTRAM ER 3 3

XOLOX 3Narcotic Combinationsacetaminophen/codeine 1ALCET 3aspirin/codeine 1butalbital/acetaminophen/ caffeine/codeine 1

butalbital/aspirin/caffeine/ codeine 1

CAPITAL/CODEINE 3COCET 3COMBUNOX 3 3 3

DARVOCET-N 3FIORICET/CODEINE 3FIORINAL/CODEINE 3hydrocodone/acetaminophen 1hydrocodone/ibuprofen 1IBUDONE 3LIQUICET 3LORCET 3LORCET PLUS 3LORTAB 3LYNOX 3MAGNACET 3MAXIDONE 3meperidine/promethazine 1 3

meprozine 1NORCO 3oxycodone/acetaminophen 1oxycodone/aspirin 1oxycodone/ibuprofen 1 3

pentazocine/acetaminophen 1PERCOCET 3PERCODAN 3phrenilin/caffeine/codeine 1PRIMALEV 3propoxyphene/ acetaminophen 1

propoxyphene-N/ acetaminophen 1

REPREXAIN 3



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Narcotic Combinations (continued)

ROXICET 3

STAGESIC 1

STAFLEX 3

SYNALGOS DC 3

TALACEN 3

tramadol/acetaminophen 1

TRYCET 3

TYLENOL/CODEINE 3

TYLOX 3

ULTRACET 3

VICODIN 3

VICODIN ES 3

vicodin HP 1

VICOPROFEN 3

VOPAC 3

XODOL 3

ZYDONE 3

Narcotic Partial Agonistsbutorphanol 1 3

pentazocine/naloxone 1

SUBOXONE 3

SUBUTEX 3

TALWIN NX 3

Prementrual Dysphoric DisorderSARAFEM 3 3

selfemra 1 3

Psychotherapeutic and Neurological Agentsergoloid mesylate 1

ORAP 3

NUVIGIL 2 3 3

PROVIGIL 3 3 3 3

STRATTERA 3 3 3

XYREM 3 3

Sedative/Hypnotics – Barbiturate BUTISOL SODIUM 3

MEBARAL 3

mephobarbital 1

phenobarbital 1

SECONAL 3

Sedative/Hypnotics – NonbarbituratesAMBIEN 3 3 3

AMBIEN CR # 2 3 3

chloral hydrate 1DORAL 3EDLUAR 3 3 3

estazolam 1flurazepam 1LUNESTA 3 3 3

midazolam 1ROZEREM 3 3 3

SONATA 3 3 3

temazepam 1triazolam 1zaleplon 1 3

zolpidem 1 3

Stimulants – AmphetaminesADDERALL 3 3

ADDERALL XR 3 3 3

amphetamine/ dextroamphetamine 1 3

amphetamine/ dextroamphetamine SR 1 3

DESOXYN 3 3 3

DEXEDRINE 3 3

dextroamphetamine 1 3

dextroamphetamine CR 1 3

dextrostat 3 3

LIQUADD 3 3 3

PROCENTRA 3 3 3

VYVANSE 2 3

Stimulants – MethylphenidateCONCERTA 3 3 3

DAYTRANA 2 3

dexmethylphenidate 1 3

FOCALIN 3 3 3

FOCALIN XR 3 3 3

METADATE CD 3 3 3

metadate ER 1 3

methylin 1 3

METHYLIN chew/soln 3 3 3

methylin ER 1 3


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Stimulants – Methylphenidate (continued)

methylphenidate 1 3

methylphenidate CD 1 3

methylphenidate ER 1 3

methylphenidate SR 1 3

RITALIN 3 3 3

RITALIN LA 3 3 3

RITALIN SR 3 3 3

Dermatological Agents

Acne Products

ACANYA 3

ACZONE 3

AKNE-MYCIN 3

amnesteem 1 3

ATRALIN 3 3

AVAR 3

AVAR GREEN 3

avita 1 3

AZELEX 3

bencort 1

BENZACLIN 2

BENZAMYCIN 3

BENZIQ 3

BENZIQ LS 3

BENZIQ wash 3

benzoyl peroxide 1

benzoyl peroxide/urea cream 1

BINORA 3

BREVOXYL 3

BREZE 3

CLARIFOAM EF 3

claravis 1 3

CLEANSE/TREAT PAD 3

clindamax 1

clindamycin 1

DIFFERIN gel/cream # 2 3

DUAC CS 2

EPIDUO 3

erythromycin 1

Acne Products (continued)

erythromycin/ benzoyl peroxide 1

EVOCLIN 3

isotretinoin 1 3

KLARON 3

LAVOCLEN 3

METROCREAM 3

METROGEL 1% only 2

METROLOTION 3

metronidazole 1

NEOBENZ 3

NORITATE 3

NUOX 3

pacnex wash 1

PLEXION cloth 3

PLEXION emulsion 3

PLEXION SCT 3

PLEXION TS 3

RETIN-A 3 3

RETIN-A MICRO 2 3

ROSAC 3

ROSULA 3

ROZEX 3

sodium sulfacetamide/sulfur 1

sotret 1 3

SULFACET-R 3

sulfatol 1

SULFOXYL 3

SUMAXIN PAD 3

tretinoin 1 3

TRIAZ 3

VANOXIDE 3

Z-CLINZ 3

ZACARE 3

ZIANA 2 3

ZODERM 3


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Antibiotics – TopicalALTABAX 3BACTROBAN 3CENTANY 3gentamicin 1mupirocin 1Antifungals – Topicalciclopirox 1 3

clotrimazole/betamethasone 1econazole 1ERTACZO 3EXELDERM 3HALOTIN 3hydrocortisone/clioquinol 1hydrocortisone/iodoquinol 1ketoconazole 1LOPROX 3LOTRISONE 3NAFTIN 3nystatin 1nystatin/triamcinolone 1OXISTAT 3PENLAC 3 3

VUSION 3XOLEGEL 3Antineoplastics and Keratolytics – TopicalCARAC 3 3

EFUDEX 3 3

FLUOROPLEX 3 3

fluorouracil 1 3

LEVULAN KERA 3PANRETIN 2SOLARAZE 3 3

TARGRETIN 2Antipruritics and Topical Anestheticscocaine hcl 1lidocaine 1lidocaine/prilocaine 1LIDODERM 2prudoxin 1SYNERA 3ZONALON 3

Antipsoriatics8-MOP 3AMEVIVE ** 3anthralin 1calcipotriene 1DOVONEX 3DRITHO-SCALP 3ENBREL 2HUMIRA 2KINERET 3OXSORALEN-UL 3PSORIATEC 3REMICADE ** 2SIMPONI 2SORIATANE 2TACLONEX 3TAZORAC 2 3

VECTICAL 3 3

Antiseborrheic ProductsCAPITROL lotion/shampoo/spray 3

EXTINA 3OVACE 3PROMISEB 3ROSULA NS 3SCALACORT DK 3SEBIZON 3selenium sulfide 1sulfacetamide sodium 1Antiviral – TopicalDENAVIR 3ZOVIRAX 3Corticosteroids – Topicalalclometasone 1amcinonide 1augmented betamethasone dipropionate 1

betamethasone valerate 1clobetasol 1clobevate 1CLOBEX lotion/shampoo/spray 2

CLODERM 3CORDRAN 3


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Corticosteroids – Topical (continued)

DERMATOP 3DESONATE 3desonide 1DESOWEN KIT 3desoximetasone 1diflorasone 1DIPROLENE AF 3ELOCON 3fluocinolone acetonide 1fluocinonide 1fluticasone 1HALOG 3hydrocortisone 1hydrocortisone butyrate 1hydrocortisone valerate 1hydrocortisone/pramoxine 1lacticare/hydrocortisone 1LIDAMANTLE HC 3lidocaine/hydrocortisone 1LUXIQ 3 3

mometasone 1NUTRICORT 3NUZON 3OLUX 3 3

OLUX-E 3 3

OLUX OLUX-E 3 3

prednicarbate 1TACLONEX 3triamcinolone 1ULTRAVATE 3VANOS 2VERDESO 3Immunomodulating Agents – TopicalALDARA # 2 3

ELIDEL 2 3

PROTOPIC 2 3

Keratolytic/Antimimetic AgentsCONDYLOX 3 3

podofilox 1 3

Rosacea AgentsFINACEA 3metronidazole 1ORACEA 3 3 3

Scabicides & PediculicidesEURAX 3

lindane 1

permethrin 1

sulfurated lime solution 1

ULESFIA 3SinecatechinsVEREGEN 3 3

Endocrine SystemAcromegalyoctreotide 1

SANDOSTATIN 3

SANDOSTATIN LAR 3

SOMAVERT 3

SOMATULINE 3

ZORBTIVE 3 3

Antidiabetics – Alpha-Glucosidase Inhibitorsacarbose 1

GLYSET # 3

PRECOSE 3Antidiabetics – Amylin AnalogsSYMLIN 2 3

SYMLINPEN 2 3

Antidiabetics – Biguanides and CombinationsFORTAMET 3

glipizide/metformin 1

GLUCOPHAGE 3

GLUCOPHAGE XR 3

GLUCOVANCE 3

GLUMETZA 3

glyburide/metformin 1

METAGLIP 3

metformin 1

metformin ER 1

RIOMET 3

Antidiabetics – DPP-IV Inhibitors and Combinations

JANUVIA 2

JANUMET 2

Antidiabetics – Incretin Mimetic Agents

BYETTA 2 3


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Antidiabetics – InsulinAPIDRA 3HUMALOG products 2HUMULIN products 2LANTUS 2LEVEMIR 2LEVEMIR FLEXPEN 2NOVOLIN products 3 3

NOVOLOG products 2RELION products 3 3

Antidiabetics – Meglitinides and CombinationsSTARLIX # 2PRANDIMET 3PRANDIN # 2Antidiabetics – SulfonylureasAMARYL 3chlorpropamide 1glimepiride 1glipizide 1glipizide ER 1glipizide XL 1glyburide 1glyburide micronized 1glycron 1tolazamide 1tolbutamide 1Antidiabetics – Thiazolidinediones (TZDs) and CombinationsACTOS 2ACTOPLUS MET 2AVANDAMET 2AVANDARYL 2AVANDIA 2DUETACT 2Antidiuretic AgentsDDAVP PR < 17 yr old 3 3 3

desmopressin PR < 17 yr old 1 3

minirin PR < 17 yr old 1 3

STIMATE PR < 17 yr old 3 3

Contraceptives – Injectable Progestinsmedroxyprogesterone 1DEPO-PROVERA 3

Contraceptives – OralALESSE 3apri 1aranelle 1aviane 1BREVICON 3cesia 1cryselle 1CYCLESSA 3DEMULEN 1/35 3DEMULEN 1/50 3DESOGEN 3enpresse 1ESTROSTEP FE 3FEMCON 3gildess FE 1jolessa 1junel 1.5/30 1junel 1/20 1junel FE 1.5/30 1junel FE 1/20 1kariva 1kelnor 1leena 1lessina 1LEVLEN 3LEVLITE 3levora 1LO/OVRAL 3LOESTRIN 1.5/30 3LOESTRIN 1/20 3LOESTRIN FE 3LOESTRIN FE 1.5/30 3LOESTRIN-24 3LOSEASONIQUE 2low-ogestrel 1lutera 1LYBREL 2microgestin 1.5/30 1microgestin 1/20 1microgestin FE 1.5/30 1microgestin FE1/20 1


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Contraceptives – Oral (continued)

tri-sprintec 1trivora 1velivet 1YAZ 3YASMIN 3zovia 1/35E 1zovia 1/50E 1Contraceptives – Oral Progestinscamila 1errin 1jolivette 1nora-be 1NOR-QD 3ORTHO MICRONOR 3Contraceptives – TransdermalORTHO EVRA 3Contraceptives – VaginalNUVARING 3CorticotropinACTHAR HP ** 3 3

Diabetic Suppliesalcohol swabs NCBD insulin syringes 2BD pen needles 2FREESTYLE glucose test strips 2FREESTYLE LITE glucose test strips 2

gauze pad NCglucose test strips (all other brands) 3 3

insulin syringes (all syringes other than BD brand)

3

lancets 1ONE TOUCH BASIC/PROFILE/ ONE TOUCH II glucose test strips

2

ONE TOUCH FAST TAKE glucose test strips 2

ONE TOUCH SURE STEP glucose test strips 2

ONE TOUCH ULTRA glucose test strips 2

PRECISION QID glucose test strips 2

Contraceptives – Oral (continued)

MIRCETTE 3MODICON 0.5/35 3mononessa 1necon 0.5/35 1necon 1/35 1necon 1/50 1necon 10/11 1necon 7/7/7 1NORDETTE 3NORINYL 1+35 3NORINYL 1+50 3nortrel 0.5/35 1nortrel 1/35 1nortrel 7/7/7 1ocella 3ogestrel 1ORTHO TRI-CYCLEN 3ORTHO TRI-CYCLEN LO 3ORTHO-CEPT 3ORTHO-CYCLEN 3ORTHO-NOVUM 1/35 3ORTHO-NOVUM 1/50 3ORTHO-NOVUM 10/11 3ORTHO-NOVUM �/�/� 3OVCON 35 3OVCON 50 3portia 1previfem 1quasense 1reclipsen 1SEASONALE 3SEASONIQUE 2solia 1sprintec 1sronyx 1TRI-LEVLEN 3tri-lo-sprintec 3trinessa 1TRI-NORINYL 3TRIPHASIL 3tri-previfem 1



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Growth Hormone Agents (continued)

NUTROPIN 2 3

NUTROPIN AQ 2 3

OMNITROPE 3 3 3

SAIZEN 2 3

SEROSTIM 3 3

SOMAVERT 3 3

TEV-TROPIN 2 3

Growth Factors, Insulin-likeINCRELEX 3 3

Hereditary TyrosinemiaORFADIN ** 2HomocystinuriaCYSTADANE ** 2Hormone Replacement – AndrogensANDRODERM 2ANDROGEL 2danazol 1FIRST-TESTOSTERONE 3 3

STRIANT 3 3

TESTIM 3 3

testosterone inj. PMEDHormone Replacement – EstrogensALORA 3 3

CENESTIN 2CLIMARA 3 3

DIVIGEL 2ELESTRIN 3ENJUVIA 2ESCLIM 3 3

ESTRACE 3ESTRADERM 3 3

estradiol tab 1estradiol patch 1 3

ESTRASORB 3ESTROGEL 3estropipate 1EVAMIST 2gynodiol 1MENEST 2MENOSTAR 3 3

OGEN 3

Diabetic Supplies (continued)

PRECISION SOF-TACT glucose test strips 2

PRECISION XTRA glucose test strips 2

PRECISION XTRA ketone test strips 2

Diagnostic Test

THYROGEN ** 2

Fabry Disease

FABRAZYME ** 2

Fertility Agents

BRAVELLE 2 3

CETROTIDE 3 3

chorionic gonadotropin 1 3

FOLLISTIM 2 3

FOLLISTIM AQ 2 3

GANIRELIX 3 3

GONAL-F 2 3

GONAL-F RFF 2 3

leuprolide 1

LUVERIS 3 3

MENOPUR 2 3

novarel 1 3

OVIDREL 3 3

pregnyl 1 3

REPRONEX 3 3

Glucose Elevating Agents

GLUCAGON 3

PROGLYCEM 2

Gout Agents

allopurinol 1

colchicine 1

probenecid 1

probenecid/colchicine 1

ULORIC 3 3

ZYLOPRIM 3

Growth Hormone Agents

GENOTROPIN 3 3 3

HUMATROPE 2 3

NORDITROPIN 3 3 3



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Hormone Replacement – Estrogens (continued)

ortho-est 1PREMARIN 3VIVELLE 3 3

VIVELLE-DOT 3 3

Hormone Replacement – Estrogen CombinationsACTIVELLA 3ANGELIQ 3CLIMARA PRO 3 3

COMBIPATCH 3 3

estradiol/ norethindrone acetate 1

FEMHRT 3

FEMHRT LOW DOSE 3

FEMTRACE 3

PREFEST 3

PREMPHASE 3

PREMPRO 3

syntest D.S. 1

syntest H.S. 1Hormone Replacement – Progestinsmedroxyprogesterone acetate 1

norethindrone acetate 1

PROMETRIUM 2Hunter SyndromeELAPRASE ** 2

Hyperammonemia AMMONUL ** 3

BUPHENYL ** 3HyperparathroidismHECTOROL ** 3

SENSIPAR ** 3

ZEMPLAR ** 2

LHRH/GnRH Agonist Analog Pituitary SuppressantsSUPPRELIN LA ** 3SYNAREL ** 3Metabolic ModifiersCARNITOR 3SUCRAID 3

Mucopolysaccharidosis IALDURAZYME ** 2Mucopolysaccharidosis VINAGLAZYME ** 2PhenylketonuriaKUVAN ** 2Pompe DiseaseMYOZYME ** 2Steroids – GlucocorticosteroidsCELESTONE 3cortisone AC 1dexamethasone 1ENTOCORT EC 3hydrocortisone 1methylprednisolone 1MILLIPRED 3ORAPRED 3prednisolone 1prednisone 1VERIPRED 3Steroids – Mineralocorticoidsfludrocort 1Thyroid HormonesARMOUR THYROID 3BIO-THROID 3CYTOMEL 3levothroid 1levothyroxine 1levoxyl 1liothyronine sodium 1SYNTHROID 3THYROLAR 3unithroid 1Thyroid – Antithyroid Agentsmethimazole 1propylthiouracil 1TAPAZOLE 3Vasopressin Receptor AntagonistsSAMSCA ** 2 3 3

Gastrointestinal SystemAcid Supressants – H-2 AntagonistsAXID 3cimetidine 1


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Bowel EvacuantsCOLYTE 3gavilyte-g 1GOLYTELY 3HALFLYTELY 3MOVIPREP 2NULYTELY 3OSMOPREP 2peg 3350 1polyethylene glycol 1trilyte 1VISICOL 3Chronic Constipation AgentAMITIZA 3 3

Gallstone Solubilizing AgentsURSO 250 2URSO FORTE 2ursodiol 1GI Antiallergy AgentsGASTROCROM 3GI Stimulantsmetoclopramide hcl 1H. pylori AgentsHELIDAC 3 3

PREVPAC 3 3

PYLERA 2 3

Inflammatory Bowel AgentsAPRISO 2 3

ASACOL 2 3

ASACOL HD 2 3

AZULFIDINE 3 3

AZULFIDINE ENTABS 3 3

balsalazide 1 3

CANASA 2 3

COLAZAL 3 3

DIPENTUM 3 3

LIALDA 2 3

mesalamine 1PENTASA 3 3

ROWASA 3sulfasalazine 1 3

sulfasalazine ER 1 3

Acid Supressants – H-2 Antagonists (continued)famotidine 1nizatidine 1PEPCID 3PEPCID RPD 3ranitidine 1TAGAMET 3ZANTAC 3Acid Supressants – Proton Pump InhibitorsACIPHEX 3 3 3 3

KAPIDEX 2 3 3

NEXIUM 2 3 3

omeprazole 1 3 3

pantoprazole 3 3 3

PREVACID (Step-therapy will not be implemented until some time after generic becomes available)

3 3 3 3

PREVACID SOLUTAB 3 3 3

PRILOSEC 3 3 3 3

PROTONIX 3 3 3 3

ZEGERID 3 3 3 3

Antiemetics – 5-HT3 Receptor AntagonistsANZEMET 3 3

granisetron 1 3

KYTRIL 3 3

ondansetron 1 3

ondansetron ODT 1 3

SANCUSO PAD 3 3 3

ZOFRAN 3 3

ZOFRAN ODT 3 3

Antiemetics – Anticholinergicmaldemar 1

TRANSDERM-SCOP 3

trimethobenzamide 1Antiemetics – MiscellaneousCESAMET 3 3

EMEND 2 3

tebamide 1Anti-Ulcer Drugsmisoprostol 1

sucralfate 1


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Inflammatory Bowel Agents (continued)

sulfazine 1 3

sulfazine EC 1 3

Irritable Bowel Syndrome (IBS) AgentsLOTRONEX 3 3

Laxativesglycolax 1KRISTALOSE 3lactulose 1Opioid Induced ConstipationRELISTOR 2 3 3

Pancreatic EnzymesCREON 2DIGEX 3KU-ZYME 3KU-ZYME-HP 3LIPRAM 3LIPRAM CR 3LIPRAM PN 3PALCAPS 3PANCRELIPASE 3PANOCAPS 3ULTRACAPS 3ULTRASE 2ULTRASE MT 2VIOKASE 2Rectal Steroidscolocort 1CORTIFOAM 3Genitourinary SystemCystinosis AgentsCYSTAGON 3Interstitial Cystitis AgentsELMIRON 2RIMSO 3Phosphate BindersFOSRENOL 2PHOSLO 2RENAGEL 2RENVELA 2Prostatic Hypertrophy AgentsAVODART 2 3

finasteride 1 3

FLOMAX # 2 3

Prostatic Hypertrophy Agents (continued)

PROSCAR 3 3

RAPAFLO 3 3

UROXATRAL 2 3

Urinary Antispasmodicsbethanechol 1DETROL 3 3

DETROL LA 3 3

DITROPAN 3DITROPAN XL 3 3

ENABLEX 2

flavoxate 1hyoscyamine 1oxybutynin 1oxybutynin SR 1GELNIQUE 2OXYTROL 2SANCTURA 3 3

SANCTURA XR 3 3

TOVIAZ 3 3

URECHOLINE 3URISPAS 3VESICARE 2

Urinary Anti-infectives and CombinationsMACROBID 3methenamine hippurate 1methenamine mandelate 1MONUROL 3nitrofurantoin 1nitrofurantoin monohydrate macrocrystal 1

UREX 3URELLE 3UTA 3Vaginal Anti-infectivesCLEOCIN VAGINAL 3clindamax 1CLINDESSE 3GYNAZOLE-1 3METROGEL VAGINAL 3nystatin vaginal 1TERAZOL 3


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Vaginal Anti-infectives (continued)

terconazole 1tioconazole 1vandazole 1zazole 1Vaginal EstrogensESTRACE VAGINAL 3ESTRING 3FEMRING 2PREMARIN VAGINAL 3VAGIFEM 3Vaginal ProgestinsCRINONE 3PROCHIEVE 3PROGESTERONE VAGINAL 3Infections and InfestationsAntibacterials – Aminoglycosidesneomycin 1paromomycin 1

Antibacterials – Ampicillins and Combinationsamoxicillin 1amoxicillin/K clavulanate 1AMOXIL 3ampicillin 1AUGMENTIN 3AUGMENTIN ES 3AUGMENTIN XR 3DISPERMOX 3MOXATAG 3principen 1trimox 1

Antibacterials – Cephalosporins, 1st Generationcefadroxil 1cephalexin 1DURICEF 3PANIXINE 3

Antibacterials – Cephalosporins, 2nd Generationcefaclor 1cefaclor ER 1

Antibacterials – Cephalosporins, 2nd Generation (continued)

cefprozil 1CEFTIN 3cefuroxime 1CEFZIL 3RANICLOR 3

Antibacterials – Cephalosporins, 3rd GenerationCEDAX 3cefdinir 1cefpodoxime 1OMNICEF 3SPECTRACEF 3SUPRAX 3VANTIN 3Antibacterials – FluoroquinolonesAVELOX 2 3

AVELOX ABC 2 3

CIPRO 3 3

CIPRO XR 3 3

ciprofloxacin 1 3

ciprofloxacin ER 1 3

FACTIVE 3 3

LEVAQUIN 3 3

NOROXIN 3 3

ofloxacin 1 3

PROQUIN XR 3 3

Antibacterials – KetolidesKETEK 3Antibacterials – Macrolidesazithromycin 1BIAXIN 3BIAXIN XL 3clarithromycin 1clarithromycin SR 1DYNABAC 3e.e.s. 1erythrocin 1erythromycin 1erythromycin delayed release particles 1


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Antibacterials – Macrolides (continued)

erythromycin ethylsuccinate 1PCE 3ZITHROMAX 3ZMAX 3Antibacterials – Miscellaneousclindamycin 1metronidazole 1metronidazole SR 1NEBUPENT 2TINDAMAX 3tinidazole 1trimethoprim 1XIFAXAN 3 3 3

ZYVOX 2 3

Antibacterials – Penicillinsdicloxacillin sodium 1penicillin VK 1veetids 1Antibacterials – Sulfonamidessulfadiazine 1sulfisoxazole 1Antibacterials – TetracyclinesADOXA 3 3 3

ALODOX 3 3

AVIDOXY DK 3 3

DECLOMYCIN 3 3

demeclocycline 1 3

DORYX 3 3

doxy-caps 1 3

doxycycline hyclate 1 3

doxycycline monohydrate 1 3

DYNACIN 3 3

MINOCIN 3 3

minocycline 1 3

MONODOX 3 3

myrac 1 3

NUTRIDOX 3 3

ORAXYL 3 3

PERIOSTAT 3 3

SOLODYN 3 3

SUMYCIN 3 3

Antibacterials – Tetracyclines (continued)

tetracycline 1 3

VIBRAMYCIN 3 3

VIBRATAB 3 3

AntifungalsANCOBON 3BIO-STATIN 3DIFLUCAN (all other strengths) 3 3

DIFLUCAN 150 mg 3 3

fluconazole (all other strengths) 1 3

fluconazole 150 mg 1 3

GRIFULVIN V 3GRIS-PEG 3itraconazole 1 3

ketoconazole 1LAMISIL 3 3

NOXAFIL 3nystatin 1SPORANOX 3 3

terbinafine 1 3

VFEND 3Anti-Infective Agents- Miscellanouscolistimethate sodium 1

COLY-MYCIN M 3Antimalarials and CombinationsARALEN 3 3

COARTEM 3 3

chloroquine 1 3

DARAPRIM 3 3

FANSIDAR 3 3

hydroxychloroquine 1 3

LARIAM 3 3

MALARONE 3 3

mefloquine 1 3

primaquine 1quinerva 1quinine sulfate 1Antimycobacterial Agentsdapsone 1

ethambutol 1


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Antimycobacterial Agents (continued)

isonarif 1isoniazid 1MYAMBUTOL 2pyrazinamide 1RIFAMATE 3rifampin 1RIFATER 3Antiprotozoal AgentsALINIA 3MEPRON 2Antiretrovirals – Chemokine Receptor AntagonistSELZENTRY 3Antiretrovirals – Fusion InhibitorsFUZEON 3Antiretrovirals – Integrase InhibitorsISENTRESS 3Antiretrovirals – NRTI/NNRTI CombinationATRIPLA 3Antiretrovirals – Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)INTELENCE 3RESCRIPTOR 3SUSTIVA 2VIRAMUNE 2

Antiretrovirals – Nucleoside (NRTI) and Nucleotide (NtRTI) AnalogsCOMBIVIR 2didanosine delayed release 1EMTRIVA 2EPIVIR # 2EPZICOM 3RETROVIR 3stavudine 1TRIZIVIR 3TRUVADA 2VIDEX 2VIDEX EC 3VIREAD 2ZERIT 3ZIAGEN 2zidovudine 1

Antiretrovirals – Protease InhibitorsAPTIVUS 3

CRIXIVAN 2

INVIRASE 2

KALETRA 2

LEXIVA 2

NORVIR 2

PREZISTA 3

REYATAZ 2

VIRACEPT 2Antivirals – CMV Agentsganciclovir 1

VALCYTE 2Antivirals – Hepatitis AgentsBARACLUDE ** 3

COPEGUS ** 3

EPIVIR HBV ** 3

HEPSERA ** 2

INFERGEN ** 3 3

PEGASYS ** 2 3

PEG-INTRON ** 2 3

REBETOL ** 3

ribasphere ** 1

ribavirin ** 1

TYZEKA ** 2Antivirals – Herpes Agentsacyclovir 1

FAMVIR 3

famciclovir 1

VALTREX (Step-therapy will not be implemented until some time after generic becomes available)

3 3

ZOVIRAX 3Antivirals – Influenza AgentsFLUMADINE 3RELENZA 3 3

rimantadine 1TAMIFLU 3 3

Antivirals – Respiratory Syncytial Virus (RSV) AgentsVIRAZOLE 3


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Cytomegalovirus (CMV)CYTOGAM ** 2

CYTOVENE ** 3

FOSCARNET ** 3

ganciclovir ** 1

VALCYTE ** 2VISTIDE ** 3Musculoskeletal SystemAntimyasthenic AgentsMESTINON 2MESTINON TIMESPAN 2pyridostigmine 1Antirheumatic AgentsARAVA 3leflunomide 1RHEUMATREX 3RIDAURA 3Calcium RegulatorsACTONEL 2 3

ACTONEL with CALCIUM 2 3

alendronate 1 3

BONIVA 3 3 3

calcitonin salmon nasal 1DIDRONEL 3FORTEO 2fortical 1FOSAMAX 3 3 3

FOSAMAX PLUS D (Step-therapy will not be implemented until some time after generic becomes available)

3 3 3

MIACALCIN inj. 3MIACALCIN NASAL 3pamidronate 1SKELID 3ImmunomodulatorsCIMZIA ** 2ENBREL 2HUMIRA 2KINERET 3ORENCIA ** 3REMICADE ** 2SIMPONI 2Interleukin-1 BlockersARCALYST ** 3

Muscle Relaxants and Combinationsbaclofen 1carisoprodol 1carisoprodol/aspirin 1carisoprodol/aspirin/codeine 1chlorzoxazone 1cyclobenzaprine hcl 1DANTRIUM 3FEXMID 3methocarbamol 1orphenadrine cpd 1orphenadrine ER 1orphenadrine/aspirin/caffeine 1orphengesic 1orphengesic forte 1SKELAXIN # 2tizanidine 1ZANAFLEX 3NSAIDsARTHROTEC 3CELEBREX 3 3 3

DAYPRO 3diclofenac 1diclofenac potassium 1diclofenac sodium XR 3etodolac 1etodolac ER 3fenoprofen 1FLECTOR patch 3 3

flurbiprofen 1ibuprofen 1indomethacin 1indomethacin ER 1ketoprofen 1ketoprofen ER 3ketorolac 1 3

meclofenamate sodium 1mefenamic acid 1meloxicam 1MOBIC 3nabumetone 3NAPRELAN 3


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NSAIDs (continued)

naproxen 1

oxaprozin 3

piroxicam 1

PONSTEL 3

PREVACID NAPRAPAC 3 3

sulindac 1

tolmetin sodium 3

VOLTAREN 3

VOLTAREN GEL 2 3 3

VOLTAREN XR 3Neuromuscular Blocking Agent – NeurotoxinsBOTOX ** 3 3

MYOBLOC ** 3 3

OsteoarthritisEUFLEXXA ** 3

HYALGAN ** 3

ORTHOVISC ** 3

SUPARTZ ** 3

SYNVISC ** 3OsteoporosisAREDIA ** 3

BONIVA (inj. only) ** 3

FORTEO 2

GANITE ** 3

RECLAST ** 3

ZOMETA ** 3

Selective Estrogen Receptor Modulator (SERM)EVISTA 2

Ophthalmic AgentsGlaucoma – Adrenergic AgentsALPHAGAN P 2

brimonidine 1

COMBIGAN 3

dipivefrin 1

IOPIDINE 3

PROPINE 3Glaucoma – Beta-blockersbetaxolol 1

BETIMOL 3

Glaucoma – Beta-blockers (continued)

BETOPTIC-S 3carteolol 1ISTALOL 3levobunolol 1metipranolol 3OPTIPRANOLOL 3timolol 1timolol maleate ophth 1Glaucoma – Carbonic Anhydrase InhibitorsAZOPT 3 3

dorzolamide 1dorzolamide/timolol 1COSOPT 3 3

TRUSOPT 3 3

Glaucoma – Mioticscarboptic 1ISO CARBACHOL 3ISOPTO CARPINE 3PHOSPHOLINE 3pilocar 1pilocarpine 1PILOPINE HS 3piloptic 1REV-EYES 3Glaucoma – Prostaglandins LUMIGAN 2TRAVATAN 3TRAVATAN Z 3XALATAN 3Macular DegenerationLUCENTIS ** 3MACUGEN ** 3VISUDYNE ** 3Ophthalmic Antihistamines and NSAIDsACULAR 3ACULAR LS 3ACULAR PF 3ALAMAST 3ALOCRIL 3ALOMIDE 3cromolyn sodium ophth 1


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Ophthalmic Antihistamines and NSAIDs (continued)

diclofenac ophth 1ELESTAT 3EMADINE 3flurbiprofen 1NEVANAC 3OPTIVAR # 2PATADAY 2PATANOL 3VOLTAREN 3XIBROM 3Ophthalmic Anti-infectivesAZASITE 2bacitracin 1bacitracin/neomycin/ polymyxin 1

bacitracin/polymyxin 1BESIVANCE 3ciprofloxacin 1erythromycin 1gentamicin 1IQUIX 3neomycin/polymyxin/ gramicidin 1

ofloxacin 1polymyxin B/trimethoprim 1QUIXIN 3sulfacetamide sodium 1tobramycin 1trifluridine 1triple antibiotic 1VIGAMOX 3ZYMAR 3Ophthalmic ImmunomodulatorsRESTASIS 2

Ophthalmic Steroidal Anti-inflammatory Drugsak-pred 1ALREX 2bacitracin/polymyxin/ neomycin/hydrocortisone 1

BLEPHAMIDE S.O.P. 3

Ophthalmic Steroidal Anti-inflammatory Drugs (continued)

dexacidin 1

dexamethasone phosphate 1dexamethasone/neomycin/ polymyxin 1

dexasol 1

dexasporin 1

DUREZOL 3

fluorometholone 1

fluor-op 1

FML FORTE 3

FML LIQUIFILM 3

FML S.O.P. 3

HMS 3

LOTEMAX 2neomycin/polymyxin/ hydrocortisone 1

poly-dex 1

POLY-PRED 3

PRED-G 3

PRED-G S.O.P 3

prednisolone 1sulfacetamide sodium/ prednisolone 1

tobramycin/dexamethasone 1

TOBRADEX 3

VEXOL 3

ZYLET 3

Otic AgentsOtic Anti-infectivesFLOXIN OTIC 3

ofloxacin otic 1

Otic Combinationsacetic acid/antipyrine/ benzocaine/polycosanol 1

antipyrine/benzocaine 1

CETRAXAL 3

CIPRO HC 3

CIPRODEX 2

COLY-MYCIN S 3

cortomycin 1


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Otic Combinations (continued)

neomycin/polymyxin/ hydrocortisone 1

NEOTIC 3

TREAGAN 3

TRIOXIN 3

ZINOTIC 3

ZINOTIC ES 3Respiratory Tract AgentsAntiasthmatics – AnticholinergicsATROVENT HFA 3

ipratropium inhaler 1

SPIRIVA 2Antiasthmatic – Monocolonal AntibodiesXOLAIR 2 3

Anti-Inflammatory Agents (nebulizer)cromolyn sodium nebulizer 1

Bronchodilators – SympathomimeticsACCUNEB 3

ADVAIR DISKUS # 2

ADVAIR HFA 2

albuterol 1

albuterol/ipratropium 1

ALUPENT 3

BROVANA 3 3

COMBIVENT 3

DUONEB 3

FORADIL 2 3

MAXAIR AUTOHALER 2

metaproterenol 3

micronefrin 1

PERFOROMIST 2 3

PROAIR 2

PROVENTIL HFA # 2

SEREVENT DISKUS # 2 3

SYMBICORT 2

terbutaline 1

VENTOLIN HFA 3

VOSPIRE ER 3

XOPENEX 3 3

XOPENEX HFA 3

Bronchodilators – Xanthinesaminophylline 1

BRONCAP 3THEO-24 3theocap 1theochron 1theophylline ER 1

UNIPHYL 3Cystic Fibrosis Agentscolistimethate sodium ** 1

COLY-MYCIN M ** 3PULMOZYME ** 2

TOBI ** 3Inhaled CorticosteroidsAEROBID 3

AEROBID-M 3ALVESCO 3ASMANEX 2AZMACORT 3FLOVENT DISKUS 2FLOVENT HFA 2PULMICORT FLEXHALER 3

PULMICORT RESPULES # 2

QVAR 3Leukotriene ModulatorsACCOLATE 3 3

SINGULAIR 2 3

ZYFLO CR 3 3

Mouth and Throat ProductsEVOXAC 2

pilocarpine 1

SALAGEN 3Nasal AntiallergyASTELIN NASAL # 2

ASTEPRO 2

PATANASE 3Nasal Anti-infectivesBACTROBAN NASAL 3Nasal AnticholinergicsATROVENT NASAL 3

ipratropium nasal 1


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Nasal Steroids

BECONASE AQ 3

FLONASE 3

flunisolide 1

fluticasone nasal 1

NASACORT AQ 3 3

NASAREL 3

NASONEX 2

OMNARIS 3

RHINOCORT AQ 3 3

VERAMYST 2

Non-Sedating Antihistamines and Combinations

ALLEGRA 3 3 3

ALLEGRA-D 3 3 3

CLARINEX 3 3 3

CLARINEX-D 3 3 3

CLARINEX REDITAB 3 3 3

fexofenadine 3 3 3

XYZAL 3 3 3

Respiratory Syncytial Virus – Monocolonal AntibodiesSYNAGIS ** 2 3

Upper Respiratory – Cough/Cold/Allergy Combinations

SEMPREX-D 3 3 3

TUSSIONEX 2

Therapeutic Nutrients – Minerals – Electrolytes

FERRLECIT ** 3

VENOFER ** 3

Toxicologic Agents

Alcohol Dependence

VIVITROL ** 3

Antidotes

DESFERAL ** 3

deferoxamine mesylate ** 1

EXJADE ** 3

Vaccines, Toxoids and Biologics

Immune Globulin – Cytomegalovirus (CMV)

CYTOGAM ** 2

Immune Globulin – Immune Disorders (IVIG)ADAGEN ** 3CARIMUNE NANOFILTERED ** 3FLEBOGAMMA ** 3GAMASTAN S/D ** 3GAMMAGARD ** 3GAMMAGARD S/D ** 3GAMUNEX ** 3OCTAGAM ** 3POLYGAM S/D ** 3PRIVIGEN ** 3VIVAGLOBIN ** 3Immune Globulin – Hepatitis BHEPAGAM B ** 3HYPERHEP B ** 3NABI-HB ** 3NOVAPLUS NABI-HB ** 3Immune Globulin – RabiesHYPERRASB S/D ** 3IMOGAM RABIE ** 3Immune Globulin – Rh isoimmunizationHYPERRHO S/D ** 3MICRHOGAM ULTRA-FILTERED ** 3

RHOGAM ULTRA-FILTERED PLUS ** 3

RHOPHYLAC ** 3WINRHO SDF ** 3Immune Globulin – TetanusHYPERTET S/D ** 2Wilson’s DiseaseDEPEN TITRATABS 2SYPRINE 3CUPRIMINE 3MiscellaneousImmunosuppressive AgentsATGAM ** 3AZASAN 3azathioprine 1azathioprine (inj only) ** 1CELLCEPT 3 3

cyclosporine 1

www.aetna.com/formulary 3�**This medication will be added to the Aetna Specialty CareRx list in April 2010. It may be covered under a medical benefit before then.


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Immunosuppressive Agents (continued)

cyclosporine (inj only) ** 1cyclosporine modified 1gengraf ** 1IMURAN 3MYFORTIC ** 3mycophenolate 1NEORAL ** 3ORTHOCLONE OKT3 ** 3PROGRAF ** 3RAPAMUNE # ** 3SANDIMMUNE ** 3SIMULECT ** 3THYMOGLOBULN ** 3ZENAPAX ** 3

Precertification List


THERAPEUTIC CLASS PRECERTIFICATION DRUG(S)

Anticonvulsants GABITRIL VIMPAT ZONEGRAN zonisamideLYRICA

Acne amnesteem claravis isotretinoin sotretATRALIN PR > 36 yr old tretinoin PR > 36 yr old avita PR > 36 yr old TRETIN-X PR > 36 yr oldDIFFERIN PR > 36 yr old ZIANA PR > 36 yr oldRETIN-A PR > 36 yr oldRETIN-A MICRO PR > 36 yr old

ALS Agents RILUTEK

Anti-Asthmatic – Monoclonal Antibodies

XOLAIR

Antidiabetics – Amylin Analogs

SYMLIN SYMLINPEN

Antihistamines and Decongestants

ALLEGRA cetirizine CLARINEX-D SEMPREX-DALLEGRA-D CLARINEX fexofenadine XYZAL

All promethazine/codeine and phenylephrine/promethazine/codeine containing products PR < 6 yr old

All other promethazine containing products PR < 2 yr old

Antihyperlipidemics – Intestinal Cholesterol Absorption Inhibitors

ZETIA

Antipsoriatics TAZORAC PR > 36 yr old

Bacterial Infections ORACEA VIBRATAB ZYVOXFluoroquinolone antibiotics PR < 10 yr old

AVELOX ciprofloxacin LEVAQUIN ofloxacin CIPRO FACTIVE MAXAQUIN PROQUIN XRCIPRO XR FLOXIN NOROXIN TEQUIN

Tetracycline antibiotics PR < 8 yr oldADOXA doxycycline MONODOX oxytetracyclineDECLOMYCIN DYNACIN NUTRIDOC SOLODYNdemeclocycline MINOCIN ORACEA tetracyclineDORYX minocycline ORAXYL

Benign Prostatic Hyperplasia (PR for females only)

AVODART FLOMAX RAPAFLOCASODEX PROSCAR PR < 50 yr old UROXATRAL

Blood Clotting Factors Antiinhibitor Coagulant ComplexFEIBA VH IMMUNO

Blood Clotting Factor VIIaNOVOSEVEN

Blood Clotting Factor VIII HumanALPHANATE HUMATE-P MONARC-M MONOCLATE-PHEMOFIL M KOATE-DVI

Blood Clotting Factor VIII RecombinantADVATE KOGENATE FS REFACTO XYNTHAHELIXATE FS RECOMBINATE

Blood Clotting Factor IX Non-RecombinantALPHANINE SD MONONINE PROFILNINE


THERAPEUTIC CLASS PRECERTIFICATION DRUG(S)

Blood Clotting Factors(continued)

Blood Clotting Factor IX ComplexBEBULIN VH PROPLEX T

Blood Clotting Factor IX RecombinantBENEFIX

Cataplexy XYREM

Corticotropin ACTHAR HP

Fungal Infections ciclopirox itraconazole SPORANOXDIFLUCAN LAMISIL terbinafinefluconazole PENLAC

Gaucher Disease ZAVESCA

Growth Hormone GENOTROPIN NORDITROPIN OMNITROPE SEROSTIMHUMATROPE NUTROPIN PROTROPIN TEV-TROPININCRELEX NUTROPIN AQ SAIZEN ZORBTIVE

Hematopoietic Growth Factor

ARANESP EPOGEN PROCRIT

Huntington’s Disease – Chorea

XENAZINE

Immune Globulin IV IMMUNE GLOBULIN (IVIG)

Irritable Bowel LOTRONEX

Laxatives AMITIZA

Malaria (covered for active treatment only – not covered for prophylactic treatment)

ARALENchloroquineCOARTEM

DARAPRIMFANSIDARhydroxychloroquine

LARIAMMALARONE

mefloquinePLAQUENIL

Miscellaneous Anti-Infectives

XIFAXAN

Miscellaneous Endocrine PR < 17 yr old

DDAVP (all forms) desmopressin minirin STIMATE

Multiple Sclerosis TYSABRI

Oncology AFINITORARIMIDEXAROMASIN

ERBITUXFEMARAFIRMAGON

RITUXANSPRYCELSUTENT

TASIGNAVECTIBIX

Pain (Analgesics) and Inflammation

ACTIQ fentanyl lozenges PREVACID NAPRAPACCELEBREX FENTORA

Pulmonary Artery Hypertension

ADCIRCA REVATIO

Respiratory Syncytial Virus

SYNAGIS

Stimulant/ Attention Deficit

NUVIGIL PROVIGIL

Typhoid VIVOTIF BERNIA EC

Ulcer/Heartburn/Reflux

ACIPHEX omeprazole PREVACID PROTONIXKAPIDEX pantoprazole PRILOSEC ZEGERIDNEXIUM

Vasopressin Receptor Antagonists

SAMSCA

Viral Infections/Immune System Enhancers

INFERGEN INTRON-A PEGASYS PEG-INTRON


Quantity Limit List

THERAPEUTIC CLASS QUANTITY LIMIT DRUG QUANTITY LIMIT(S)

Anti-anginal RANEXA 500 mg = 3 tablets/day1000 mg = 2 tablets/day

Anticonvulsants gabapentin NEURONTIN All strengths = 180 tablets/ 30 day supplyGABARONE

LYRICA 25, 50, �5, 100, 150 and 200 mg = 3 caps/day225 and 300 mg = 2 capsules/day

VIMPAT 50 mg = 6 tablets/day100 mg, 150 mg and 200 mg = 2 tablets/day

Antidiabetics – Incretin Mimetic Agents

BYETTA Limit = 1 pen/30 day supply

Antihistamines and Decongestants

ALLEGRA fexofenadine 30 mg and 60 mg = 2 tablets/day180 mg = 1 tablet/day30 mg/5 ml = 10 ml/day

ALLEGRA-D 12 hour = 2 tablets/day24 hour = 1 tablet/day

CLARINEX 2.5 mg and 5 mg = 1 tablet or reditab/day Syrup = 10ml/day

CLARINEX-D 2.5mg/120mg = 2 tablets/day5mg/240mg = 1 tablet/day

SEMPREX-D 4 capsules/dayXYZAL Limit = 1 tablet/day

2.5 mg/5ml solution = 10ml/dayAntineoplastic and Keratolytics

CARAC FLUOROPLEX 8 weeks treatment/yearEFUDEX SOLARAZE 12 weeks treatment/yearfluorouracil

Asthma ACCOLATE 10 mg and 20 mg = 2 tablets/daySINGULAIR 4 mg granules = 1 packet/day

10 mg = 1 tablet/day4 mg and 5 mg chewable = 1 tablet/day

ZYFLO CR Limit = 4 tablets/dayBlood Pressure and Heart Failure

ATACAND 4 mg, 8 mg and 16 mg = 2 tablets/dayATACAND HCT 16-12.5 mg = 2 tablets/dayAVALIDE 150-12.5 mg = 1 tablet/dayAVAPRO �5 mg and 150 mg = 2 tablets/dayAZOR All strengths = 1 tablet/dayBENICAR 5 mg and 20 mg = 1 tablet/dayBENICAR HCT 20-12.5 mg = 1 tablet/dayCOZAAR 25 mg and 50 mg = 2 tablets/day DIOVAN 40 mg, 80 mg and 160 mg =

2 caps or tablets/dayDIOVAN HCT 80-12.5 mg, 160-12.5 mg, and

160-25 mg = 1 tablet/dayEXFORGE EXFORGE HCT All strengths = 1 tablet/dayHYZAAR 50-12.5 mg = 1 tablet/day MICARDIS 20 mg and 40 mg = 1 tablet/dayMICARDIS HCT 40-12.5 mg = 1 tablet/dayTEKTURNA 150 mg and 300 mg = 1 tablet/dayTEKTURNA HCT 150/12.5 mg and 150/25 mg =

1 tablet/dayTEVETEN 400 mg = 2 tablets/day



Cholesterol Lowering ADVICOR All strengths = 2 tablets/day ALTOPREV 10 mg, 20 mg, and 60 mg =

1 tablet/day 40 mg = 2 tablets/day

CADUET All strengths = 1 tablet/dayCRESTOR All strengths = 1 tablet/dayLESCOL All strengths = 2 tablets/dayLESCOL XL 80 mg = 1 tablet /dayLIPITOR All strengths= 1 tablet/daylovastatin MEVACOR All strengths = 2 tablets/dayPRAVACHOL pravastatin All strengths = 1 tablet/daySIMCOR All strengths = 2 tablets/daysimvastatin ZOCOR All strengths = 1 tablet/day VYTORIN All strengths = 1 tablet/dayZETIA 10 mg = 1 tablet/day

Colon/Rectal APRISO 0.3�5 gm = 4 capsules/dayASACOL 400 mg = 12 tablets/dayASACOL HD 6 tablets/dayAZULFIDINE sulfasalazine EC 500 mg = 12 tablets/dayAZULFIDINE ENTABS sulfazinesulfasalazine sulfazine ECCANASA ROWASA 500 mg = 3 suppositories/day

1000mg = 2 suppository/dayCOLAZAL balsalazide �50 mg = 9 capsules/dayDIPENTUM 250 mg = 12 capsules/dayLIALDA 4 tablets/dayPENTASA 250 mg = 20 capsules/day

500 mg = 10 capsules/day

Depression APLENZIN All strengths = 1 tablet/daybudeprion WELLBUTRIN �5 mg = 6 tablets/day

100 mg = 6 tablets/daybupropionbudeprion SR WELLBUTRIN SR 100 mg, 150 mg and 200 mg =

2 tablets/daybupropion SRbudeprion XL WELLBUTRIN XL All strengths = 1 tablet/dayCELEXA citalopram 10 mg, 20 mg and 40 mg =

1 tablet/dayCYMBALTA 20 mg and 30 mg = 2 capsules/day

60 mg = 1 capsule/dayEMSAM 1 patch/day all strengthsfluoxetine RAPIFLUX 10 mg = 1 tablet or capsule/day

20 mg = 4 tablets or capsules/day40 mg = 2 tablets or capsules/dayLiquid 20 mg/5 ml = 10 ml/dayWeekly = 4 tablets/28 day supply

PROZAC

fluoxetine (PMDD) 10mg 14 tablets or capsules/30 daysfluvoxamine 25 mg and 50 mg = 1 tablet/day

100 mg = 3 tablets/dayLEXAPRO 5 mg, 10 mg and 20 mg = 1 tablet/day

5 mg/5 ml solution = 20 ml/dayLUVOX CRmaprotiline

100 mg and 150 mg = 2 capsules/day25 mg = 1 tablet/day50 mg = 2 tablets/day�5 mg = 3 tablets/day


Quantity Limit List


Depression (continued)

paroxetine PEXEVA 10 mg and 20 mg = 1 tablet/day30 mg and 40 mg = 2 tablets/daySuspension 10 mg/5 ml = 30 ml/day

PAXIL

PAXIL CR All strengths = 2 tablets/dayPRISTIQ 50 mg and 100 mg = 1 tablet/daymirtazapine REMERON All strengths = 1 tablet/dayfluoxetine (PMDD)SARAFEM

selfemra 10 mg or 20 mg = 14 tablets/30 days

sertraline ZOLOFT 25 mg = 1 tablet/day50 mg = 1 ½ tablets/day100 mg = 2 tablets/dayLiquid = 10 ml/day

venlafaxine EFFEXOR 25 mg and 100 mg = 3 tablets/day3�.5 mg = 4 tablets/day50 mg = 6 tablets/day�5 mg = 5 tablets/day

VENLAFAXINE ER EFFEXOR XR 3�.5 mg = 1 capsule/day�5 mg = 1 capsule/day150 mg = 2 capsules/day225 mg = 1 capsule/day

Estrogen/Combinations ALORA ESTRADERM All strengths = 8 patches/28 day supplyCOMBIPATCH VIVELLEESCLIM VIVELLE-DOTCLIMARACLIMARA PROestradiol patchMENOSTAR

All strengths = 4 patches/28 day supply

Fibromyalgia SAVELLA 12.5 mg, 25 mg, 50 mg, and 100 mg = 2 tabs/day Titration pack = 1 kit/30 day

Flu RELENZA 2 treatments (units)/yearTAMIFLU All strengths = 2 treatments

(20 capsules)/year12 mg/ml suspension = 6 bottles (150 ml)/year

Immunomodulating Agents – Topical

ALDARA 16 weeks treatment/year

Keratolytic/ Antimitotic Agents

CONDYLOX podofilox 4 weeks treatment/year

Malaria ARALEN chloroquine All strengths = 1 tablet/dayhydroxychloroquine PLAQUENIL

Mania and Psychosis ABILIFY ABILIFY DISC All strengths = 1 tablet/day Solution = 30 ml/day

clozapine FAZACLO 12.5 mg = 1 tablet/day25 mg and 50 mg = 3 tablets/day100 mg = 9 tablets/day

CLOZARIL

GEODON All strengths = 2 capsules/day INVEGA 3 mg and 6 mg = 2 tablets/day

9 mg = 1 tablet/dayRISPERDAL risperidone

RISPERDAL Mrisperidone ODT

4 mg = 4 tablets/day All other strengths = 2 tablets/day



Mania and Psychosis (continued)

SEROQUEL

25 mg = 6 tablets/day50 mg and 100 mg = 3 tablets/day200 mg = 4 tablets/day300 mg and 400 mg = 2 tablets/day

SEROQUEL XR 50 mg = 6 tablets/day150 mg and 200 mg = 1 tablet/day300 mg and 400 mg = 2 tablets/day

SYMBYAX All strengths = 1 tablet/day ZYPREXA ZYPREXA ZYDIS 2.5mg = 2 tablets/day

All other strengths = 1 tablet/day Migraine AMERGE Total quantity any strength =

9 tablets/30 day supplyAXERT All strengths = 6 tablets/30 day supplyFROVA 2.5 mg = 9 tablets/30 day supplyIMITREX sumatriptan Nasal = 6 sprays/30 day supply

Injection = 4 kits/30 days or 10 vials/30 day supplyTablets (all strengths) = 9 tablets/ 30 day supply

MAXALT MAXALT MLT Total quantity any strength = 12 tabs/ 30 day supply

MIGRANAL 1 box/30 day supplyRELPAX 20 mg and 40 mg = 6 tablets/

30 day supplyTREXIMET Total quantity any strength =

9 tablets/30 day supplyZOMIG ZOMIG ZMT 2.5 mg and 5 mg = 6 tablets/

30 day supplyNasal = 6 sprays/30 day supply

Misc. Anti-Infectives XIFAXAN 9 capsules/ 30 day supplyNausea/vomiting ANZEMET Total quantity any strength =

5 tablets/30 day supplyCESAMET 1 mg = 20 capsules/30 day supplyEMEND 40, 80 mg, 125 mg = 5 tablets/

30 day supply125 mg/80 mg combo pack = 2 packages (6 tablets)/30 day supply

KYTRIL granisetron 1 mg = 10 tablets/30 day supplyLiquid = quantity > 5 bottles/ 30 day supply

ondansetronondansetron ODT

ZOFRANZOFRAN ODT

4 mg and 8 mg = 12 tablets/ 30 day supply24 mg = 5 tablets/30 day supplyLiquid = 1 bottle (50 ml)/30 day supply

SANCUSO PAD 1 patch/30 day supplyOncology AFINITOR TASIGNA All strengths = 30 day supply

GLEEVEC TEMODARHYCAMTIN TYKERBNEXAVAR VESANOIDSPRYCEL tretinoin capsulesSUTENT XELODATARCEVA ZOLINZAFIRMAGON 2 vials/year


Quantity Limit List


Osteoporosis/ Paget Disease

ACTONEL 35 mg = 4 tablets/28 day supply�5 mg = 2 tablets/month150 mg = 3 tablets/90 day supply

ACTONEL with CALCIUM 35 mg/1250 mg = 1 tablet/dayBONIVA 2.5 mg = 1 tablet/day

150 mg = 3 tablets/90 day supplyalendronate FOSAMAX 35 mg = 4 tablets/28 day supply

�0 mg = 4 tablets/28 day supply�0 mg/�5ml solution = 4 doses (�5ml each)/28 day supply

FOSAMAX PLUS D 4 tablets/28 day supplyPain (Analgesics) & Inflammation

ACTIQ fentanyl lozenges All strengths = 15 lollipops/ 30 day supply

FENTORA All strengths = 15 buccal tablets/ 30 day supply

butorphanol nasal STADOL NS 2 vials/30 day supply CELEBREX 50 mg and 100 mg = 60 capsules/

30 day supply200 mg = 30 capsules/30 day supply400 mg = 60 capsules/30 day supply

COMBUNOXoxycodone/ibuprofen

28 tablets/30 days

DURAGESIC fentanyl patch 20 patches/30 day supplyFLECTOR patch Limit = 2 patches/dayketorolac TORADOL 20 tablets/30 day supplyNUCYNTA Quantities up to 180 tabs/30 day supplyoxycodone SR OXYCONTIN CR Quantities up to a total dosage of

320mg/day or 120 tablets/ 30 day supply

VOLTAREN GEL 500 gm (5 tubes)/30 day supplyRosacea Agents ORACEA 1 capsule/daySedatives and Hypnotics

AMBIEN zolpidem 5 mg = 2 tablets/day10 mg = 1 tablet/day

AMBIEN CR 6.25 mg and 12.5 mg = 1 tablet/dayEDLUAR All strengths = 1 tablet/dayLUNESTA All strengths = 1 tablet/dayROZEREM 8 mg = 1 tablet/daySONATA zaleplon 5 mg = 4 tablets/day

10 mg = 2 tablets/daySinecatechins VEREGEN 16 weeks treatment/yearStimulant/ Attention Deficit

ADDERALLamphetamine/dextroamphetamine

5, �.5, 10, 12.5, 15 and 30 mg = 2 tablets/day20 mg = 3 tablets/day

ADDERALL XR All strengths = 2 capsules/dayCONCERTA 18 mg = 3 tablets/day

2� mg, 36 mg and 54 mg = 2 tablets/dayDAYTRANA 1 patch/dayDESOXYN DESOXYN CRmethamphetamine

All strengths = 4 tablets/day



Stimulant/ Attention Deficit (continued)

DEXEDRINEdextroamphetamine

dextrostat All strengths = 4 tablets/day

DEXEDRINE CRdextroamphetamine CR

All strengths = 3 capsules/day

dexmethylphenidate FOCALIN 2.5 mg, 5 mg and 10mg = 2 tablets/day

FOCALIN XR All strengths = 1 capsule/day

LIQUADD PROCENTRA Limit = 40 ml/day

METADATE CDmethylphenidate CD

10 mg, 40 mg, 50 mg, 60 mg = 1 capsule/day20 mg = 3 capsules/day30 mg = 2 capsules/day

metadate ERmethylinmethylin ERmethylphenidatemethylphenidate CR/ER/SRRITALINRITALIN SR

5 mg, 10mg and 20 mg = 3 tablets/day

METHYLIN chew/soln 2.5 mg, 5 mg and 10 mg = 6 tablets/day5 mg/5 ml solution = 60 ml/day10 mg/5 ml solution = 30 ml/day

NUVIGIL 50 mg = 2 tabs/day150 mg, 250 mg = 1 tab/day

PROVIGIL 100 mg and 200 mg = 2 tablets/day

RITALIN LA 10 mg, 20 mg, 30 mg and 40 mg = 2 caps/day

STRATTERA 10 mg, 18 mg, 25 mg, 40 mg and 60 mg = 2 caps/day80 mg and 100 mg = 1 capsule/day

VYVANSE All strengths = 1 capsule/day

Ulcer/Heartburn/ Reflux

ACIPHEXKAPIDEXNEXIUM GRANULESomeprazolepantoprazolePREVACIDPREVACID SOLUTABPRILOSEC cap/tabsPROTONIX

All strengths = 1 tablet, capsule or packet/day

PRILOSEC powder All strengths = 2 packets/day

HELIDAC PREVPAC 1 pack/day for 14 days

PYLERA 1 pack (120 capsules)/day for 10 days

ZEGERID 20 mg and 40 mg packets = 1 packet/day20mg/1100 mg and 40mg/1100mg = 1 cap/day

Vaginal Anti-Infectives DIFLUCAN fluconazole 150 mg only = 1 dose/30 day supply

Vasopressin Receptor Antagonists

SAMSCA 15 mg = 4 tabs/day30 mg = 2 tabs/day

Step-Therapy List


THERAPEUTIC CLASS STEP-THERAPY DRUG REQUIRED PREREQUISITE DRUG(S)Anti-Anginal RANEXA Nitrates and amlodipine and

Beta Blockers (except sotalol)Anti-Convulsant DEPAKOTE divalproex sodium delayed release

DEPAKOTE ER divalproex sodium SR DEPAKOTE sprinkle divalproex sodium sprinkleLAMICTAL LAMICTAL XR LAMICTAL ODT

lamotrigine

LYRICA gabapentin or CYMBALTA

TOPAMAX topiramateAnti-Parkinson REQUIP XL ropinirole hclAntiviral VALTREX valacyclovirBeta-2 Agonist BROVANA PERFOROMIST FORADIL or SEREVENT

FORADIL SEREVENT AEROBID-M, ASMANEX, FLOVENT HFA or PULMICORT

XOPENEX soln/conc. albuterol nebules or concentrateBlood Pressure and Heart Failure

ALTACE ramiprilATACANDATACAND HCTAVALIDEAVAPRO

BENICARBENICAR HCTTEVETENTEVETEN HCT

COZAAR or HYZAAR and DIOVAN or DIOVAN HCT

COZAAR HYZAAR losartan or losartan/hctz and DIOVAN or DIOVAN HCT(Step-therapy will not be implemented

until some time after generic becomes available)

LOTREL amlodipine/benazeprilCholesterol Lowering ALTOPREV lovastatin

CADUET NORVASC (amlodipine) and simvastatin or CRESTOR or VYTORIN

CRESTOR 5 mg onlyVYTORIN 10 mg/10 mg only

simvastatin

LIPITOR simvastatin or pravastatin and CRESTOR and/or VYTORIN

Corticosteroids – Topical LUXIQ beclomethasoneOLUXOLUX-E OLUX OLUX-E Complete Pack

clobetasol

VECTICAL TAZORAC or calcipotrieneDepression CELEXA citalopram

APLENZIN PEXEVACYMBALTA PRISTIQEFFEXOR XR RAPIFLUXLEXAPRO VENLAFAXINE ERLUVOX CR WELLBUTRIN XL nefazodone

Any one of the following:budeprion, bupropion, bupropion SR, budeprion SR, bupropion XL, citalopram, fluoxetine, fluvoxamine, paroxetine, mirtazapine, sertraline or venlafaxine first

EFFEXOR venlafaxinePAXIL paroxetinePAXIL CR paroxetine ERPROZACPROZAC WEEKLY

fluoxetine


THERAPEUTIC CLASS STEP-THERAPY DRUG REQUIRED PREREQUISITE DRUG(S)Depression (continued)

REMERONREMERON SOLUTAB

mirtazapine

WELLBUTRIN bupropionWELLBUTRIN SR bupropion SRZOLOFT sertraline

Diabetes – Insulin NOVOLIN N RELION N HUMULIN N NOVOLIN R RELION R HUMULIN R

Diabetic Test Strips Diabetic test strips (all but those made by Abbott Diabetes Care or Lifescan)

Any preferred blood glucose test strip:FAST TAKE, FREESTYLE, FREESTYLE LITE,ONE TOUCH BASIC/PROFILE, ONE TOUCH ULTRA, PRECISION QID, PRECISION SOF-TACT, PRECISION XTRA, SURESTEP

Fibrates FENOGLIDELOFIBRA LOPID

LIPOFENTRIGLIDE

gemfibrozil, fenofibrate, ANTARA, TRILIPIX

Glaucoma AZOPT COSOPT dorzolamide/timololTRUSOPT dorzolamide

Gout ULORIC allopurinolGrowth Hormone GENOTROPIN

NORDITROPINOMNITROPE Any two of:

HUMATROPE, NUTROPIN, NUTROPIN AQ, SAIZEN or TEV-TROPIN

Immunomodulating Agents – Topical

ELIDEL PROTOPIC Any topical corticosteroid

Immunosuppressive Agents

CELLCEPT mycophenolate

Mania and Psychosis ABILIFYABILIFY DISCGEODON

INVEGARISPERDAL RISPERDAL M

Any one of:risperidone, risperidone ODT, SEROQUEL, SEROQUEL XR, ZYPREXA or ZYPREXA ZYDIS

Migraine AXERT FROVA IMITREXMIGRANAL

RELPAXZOMIG ZOMIG ZMT

sumatriptan

TREXIMET naproxen 500 mg and sumatriptanMisc. Endocrine DDAVP (all forms) desmopressinMultiple Sclerosis BETASERON AVONEX, COPAXONE or REBIFNausea/vomiting SANCUSO PAD granisetron and ondansetron or

ondansetron ODTNon-Barbiturate Hypnotics

AMBIENAMBIEN CREDLUAR

LUNESTAROZEREMSONATA

zolpidem

Osteoporosis/ Paget’s Disease

BONIVA ACTONEL and alendronateFOSAMAX alendronateFOSAMAX PLUS D (Step-therapy will not be implemented until some time after generic becomes available)

alendronate plus D

Step-Therapy List


THERAPEUTIC CLASS STEP-THERAPY DRUG REQUIRED PREREQUISITE DRUG(S)Pain (Analgesics) and Inflammation

COMBUNOX Any oxycodone combinationsDURAGESIC fentanyl patchNUCYNTA Any preferred generic morphine or

oxycodone immediate releaseRYZOLT ULTRAM ER tramadolVOLTAREN GEL Use of one (1) preferred generic NSAID

Psychotherapeutic and Neurological Agents

PROVIGIL NUVIGIL

Steroid – Nasal NASACORT AQRHINOCORT AQ

fluticasone nasal and NASONEX

or VERAMYSTStimulant/ Attention Deficit

ADDERALL XR amphetamine/dextroamphetamine SRCONCERTADESOXYNFOCALINFOCALIN XRLIQUADDMETADATE CD

PROCENTRARITALINRITALIN LARITALIN SRSTRATTERA

Any one of:

amphetamine/dextroamphetamine,

amphetamine/dextroamphetamine SR,

dexmethylphenidate, methylin tab,

methylin ER, methylphenidate,

methylphenidate SR, VYVANSEMETHYLIN chew/soln

Testosterone Replacement FIRST-TESTOSTERONESTRIANT TESTIM

ANDRODERM or ANDROGEL

Tetracyclines ADOXA doxycycline

Ulcer/Heartburn/Reflux ACIPHEXPREVACIDPRILOSEC

PROTONIXZEGERID

Any two of:

omeprazole, KAPIDEX, NEXIUM

Urinary Pain/Spasm DETROLDETROL LADITROPAN XL

SANCTURASANCTURA XRTOVIAZ

Any one of:

oxybutynin, oxybutynin XL, ENABLEX,

VESICARE, OXYTROL, GELNIQUE


Index

#8-MOP . . . . . . . . . . . . . . . . . . .21

AABILIFY . . . . . . . . . . . . 1�, 42, 4�ABILIFY DISC . . . . . . . 1�, 42, 4�ACANYA . . . . . . . . . . . . . . . . .20acarbose . . . . . . . . . . . . . . . . . .22ACCOLATE . . . . . . . . . . . . 35, 40ACCUNEB . . . . . . . . . . . . . . . .35ACCUPRIL . . . . . . . . . . . . . . . .11ACCURETIC . . . . . . . . . . . . . . .11acebutolol . . . . . . . . . . . . . . . .13ACEON . . . . . . . . . . . . . . . . . . .11acetaminophen/codeine . . . . . .18acetazolamide . . . . . . . . . . . . .14acetic acid/antipyrine/ benzocaine/polycosanol . . . .34ACIPHEX. . . . . . . . 2�, 39, 45, 48ACTHAR HP . . . . . . . . . . . 24, 39ACTIMMUNE . . . . . . . . . . . . . . .9ACTIQ . . . . . . . . . . . . 18, 39, 44ACTIVELLA . . . . . . . . . . . . . . . .26ACTONEL . . . . . . . . . . 32, 44, 4�ACTONEL with CALCIUM . 32, 44ACTOPLUS MET . . . . . . . . . . . .23ACTOS . . . . . . . . . . . . . . . . . . .23ACULAR . . . . . . . . . . . . . . . . . .33ACULAR LS. . . . . . . . . . . . . . . .33ACULAR PF. . . . . . . . . . . . . . . .33acyclovir . . . . . . . . . . . . . . . . . .31ACZONE . . . . . . . . . . . . . . . . . .20ADAGEN . . . . . . . . . . . . . . . . .36ADALAT CC . . . . . . . . . . . . . . .13ADCIRCA . . . . . . . . . . . . . 14, 39ADDERALL . . . . . . . . . . . . 19, 44ADDERALL XR . . . . . . 19, 44, 48ADOXA . . . . . . . . . . . 30, 38, 48ADVAIR DISKUS . . . . . . . . . . . .35ADVAIR HFA . . . . . . . . . . . . . .35ADVATE . . . . . . . . . . . . . . 10, 38ADVICOR . . . . . . . . . . . . . 12, 41AEROBID . . . . . . . . . . . . . . . . .35AEROBID-M . . . . . . . . . . . 35, 46afeditab . . . . . . . . . . . . . . . . . .13AFINITOR . . . . . . . . . . . 9, 39, 43AGGRENOX . . . . . . . . . . . . . . .10AGRYLIN . . . . . . . . . . . . . . . . .10ak-pred . . . . . . . . . . . . . . . . . . .34AKINETON . . . . . . . . . . . . . . . .16AKNE-MYCIN . . . . . . . . . . . . . .20ALAMAST . . . . . . . . . . . . . . . . .33albuterol . . . . . . . . . . . . . . . . . .35albuterol/ipratropium . . . . . . . .35albuterol nebules . . . . . . . . . . .46ALCET . . . . . . . . . . . . . . . . . . .18

alclometasone . . . . . . . . . . . . .21alcohol swabs . . . . . . . . . . . . . .24ALDACTAZIDE . . . . . . . . . . . . .14ALDACTONE . . . . . . . . . . . . . .14ALDARA . . . . . . . . . . . . . . 22, 42ALDURAZYME . . . . . . . . . . . . .26alendronate . . . . . . . . 32, 44, 4�alendronate plus D . . . . . . . . . .4�ALESSE . . . . . . . . . . . . . . . . . . .23ALFERON N . . . . . . . . . . . . . . . .9ALINIA . . . . . . . . . . . . . . . . . . .31ALKERAN . . . . . . . . . . . . . . . . . .9ALLEGRA . . . . . . . . . . 36, 38, 40ALLEGRA-D . . . . . . . . 36, 38, 40allopurinol . . . . . . . . . . . . 25, 4�ALOCRIL . . . . . . . . . . . . . . . . . .33ALODOX . . . . . . . . . . . . . . . . .30ALOMIDE . . . . . . . . . . . . . . . . .33ALORA . . . . . . . . . . . . . . . 25, 42ALPHAGAN P . . . . . . . . . . . . . .33ALPHANATE . . . . . . . . . . . 10, 38ALPHANINE SD . . . . . . . . . 10, 38alprazolam . . . . . . . . . . . . . . . .15alprazolam ER. . . . . . . . . . . . . .15alprazolam ODT . . . . . . . . . . . .15ALREX . . . . . . . . . . . . . . . . . . .34ALTABAX . . . . . . . . . . . . . . . . .21ALTACE . . . . . . . . . . . . . . 11, 46ALTOPREV . . . . . . . . . 12, 41, 46ALUPENT . . . . . . . . . . . . . . . . .35ALVESCO . . . . . . . . . . . . . . . . .35amantadine . . . . . . . . . . . . . . .16AMARYL . . . . . . . . . . . . . . . . .23AMBIEN . . . . . . . . . . . 19, 44, 4�AMBIEN CR . . . . . . . . 19, 44, 4�amcinonide . . . . . . . . . . . . . . .21AMERGE . . . . . . . . . . . . . 1�, 43AMEVIVE . . . . . . . . . . . . . . . . .21amiloride . . . . . . . . . . . . . . . . .14amiloride/hydrochlorothiazide .14aminophylline . . . . . . . . . . . . . .35amiodarone . . . . . . . . . . . . . . .12AMITIZA . . . . . . . . . . . . . . 2�, 39amitriptyline . . . . . . . . . . . . . . .16amlodipine . . . . . . . . . . . . 13, 46amlodipine/benazepril . . . 14, 46AMMONUL . . . . . . . . . . . . . . .26amnesteem . . . . . . . . . . . 20, 38amoxapine . . . . . . . . . . . . . . . .16amoxicillin . . . . . . . . . . . . . . . .29amoxicillin/K clavulanate . . . . . .29AMOXIL . . . . . . . . . . . . . . . . . .29amphetamine/ dextroamphetamine . .19, 44, 48amphetamine/ dextroamphetamine SR . . 19, 48

ampicillin . . . . . . . . . . . . . . . . .29amyl nitrite . . . . . . . . . . . . . . . .11anagrelide . . . . . . . . . . . . . . . .10ANCOBON . . . . . . . . . . . . . . . .30ANDRODERM . . . . . . . . . . 25, 48ANDROGEL . . . . . . . . . . . 25, 48ANGELIQ . . . . . . . . . . . . . . . . .26ANTABUSE . . . . . . . . . . . . . . . .1�ANTARA . . . . . . . . . . . . . . 12, 4�anthralin . . . . . . . . . . . . . . . . . .21antipyrine/benzocaine. . . . . . . .34ANZEMET . . . . . . . . . . . . . 2�, 43APIDRA. . . . . . . . . . . . . . . . . . .23APLENZIN . . . . . . . . . . 16, 41, 46apri . . . . . . . . . . . . . . . . . . . . . .23APRISO . . . . . . . . . . . . . . . 2�, 41APTIVUS . . . . . . . . . . . . . . . . . .31ARALEN . . . . . . . . . . . 30, 39, 42aranelle . . . . . . . . . . . . . . . . . .23ARANESP . . . . . . . . . . . . . 10, 39ARAVA . . . . . . . . . . . . . . . . . . .32ARCALYST . . . . . . . . . . . . . . . .32AREDIA. . . . . . . . . . . . . . . . . . .33ARICEPT . . . . . . . . . . . . . . . . . .15ARICEPT ODT . . . . . . . . . . . . . .15ARIMIDEX . . . . . . . . . . . . . . 9, 39ARIXTRA . . . . . . . . . . . . . . . . . .10ARMOUR THYROID . . . . . . . . .26AROMASIN . . . . . . . . . . . . . 9, 39ARTHROTEC . . . . . . . . . . . . . . .32ASACOL . . . . . . . . . . . . . . 2�, 41ASACOL HD . . . . . . . . . . . 2�, 41ASMANEX . . . . . . . . . . . . 35, 46aspirin/codeine . . . . . . . . . . . . .18ASTELIN NASAL . . . . . . . . . . . .35ASTEPRO . . . . . . . . . . . . . . . . .35ATACAND . . . . . . . . . 11, 40, 46ATACAND HCT . . . . . 11, 40, 46atamet . . . . . . . . . . . . . . . . . . .16atenolol . . . . . . . . . . . . . . . . . .13atenolol/chlorthalidone . . . . . . .13ATGAM . . . . . . . . . . . . . . . . . .36ATRALIN . . . . . . . . . . . . . . 20, 38ATRIPLA . . . . . . . . . . . . . . . . . .31ATROVENT HFA . . . . . . . . . . . .35ATROVENT NASAL . . . . . . . . . .35augmented betamethasone dipropionate . . . . . . . . . . . . .21AUGMENTIN . . . . . . . . . . . . . .29AUGMENTIN ES . . . . . . . . . . . .29AUGMENTIN XR . . . . . . . . . . . .29AVALIDE . . . . . . . . . . . 11, 40, 46AVANDAMET . . . . . . . . . . . . . .23AVANDARYL . . . . . . . . . . . . . .23AVANDIA . . . . . . . . . . . . . . . . .23AVAPRO . . . . . . . . . . . 11, 40, 46

Index


AVAR . . . . . . . . . . . . . . . . . . . .20AVAR GREEN . . . . . . . . . . . . . .20AVELOX . . . . . . . . . . . . . . 29, 38AVELOX ABC . . . . . . . . . . . . . .29aviane . . . . . . . . . . . . . . . . . . . .23AVIDOXY DK . . . . . . . . . . . . . .30AVINZA . . . . . . . . . . . . . . . . . .18avita . . . . . . . . . . . . . . . . . 20, 38AVODART . . . . . . . . . . . . 28, 38AVONEX . . . . . . . . . . . . . . 18, 4�AXERT . . . . . . . . . . . . 1�, 43, 4�AXID . . . . . . . . . . . . . . . . . . . . .26AZASAN . . . . . . . . . . . . . . . . . .36AZASITE . . . . . . . . . . . . . . . . . .34azathioprine . . . . . . . . . . . . . . .36azathioprine (inj only) . . . . . . . .36AZELEX . . . . . . . . . . . . . . . . . . .20AZILECT . . . . . . . . . . . . . . . . . .1�azithromycin . . . . . . . . . . . . . . .29AZMACORT . . . . . . . . . . . . . . .35AZOPT . . . . . . . . . . . . . . . 33, 4�AZOR . . . . . . . . . . . . . . . . 11, 40AZULFIDINE . . . . . . . . . . . 2�, 41AZULFIDINE ENTABS . . . . . 2�, 41

Bbacitracin . . . . . . . . . . . . . . . . .34bacitracin/neomycin/ polymyxin . . . . . . . . . . . . . . .34bacitracin/polymyxin . . . . . . . . .34bacitracin/polymyxin/ neomycin/hydrocortisone . . .34baclofen . . . . . . . . . . . . . . . . . .32BACTROBAN . . . . . . . . . . . . . .21BACTROBAN NASAL . . . . . . . .35balsalazide . . . . . . . . . . . . 2�, 41BANZEL . . . . . . . . . . . . . . . . . .15BARACLUDE . . . . . . . . . . . . . . .31BD insulin syringes . . . . . . . . . .24BD pen needles . . . . . . . . . . . .24BEBULIN VH . . . . . . . . . . . 10, 39beclomethasone . . . . . . . . . . . .46BECONASE AQ . . . . . . . . . . . . .36benazepril. . . . . . . . . . . . . . . . .11benazepril/ hydrochlorothiazide . . . . . . .11bencort . . . . . . . . . . . . . . . . . . .20BENEFIX . . . . . . . . . . . . . . 10, 39BENICAR . . . . . . . . . . 11, 40, 46BENICAR HCT . . . . . . . 11, 40, 46BENZACLIN . . . . . . . . . . . . . . . .20BENZAMYCIN . . . . . . . . . . . . . .20BENZIQ . . . . . . . . . . . . . . . . . . .20BENZIQ LS . . . . . . . . . . . . . . . .20BENZIQ wash . . . . . . . . . . . . . .20benzoyl peroxide . . . . . . . . . . .20benzoyl peroxide/urea cream . .20

benztropine . . . . . . . . . . . . . . .16BESIVANCE . . . . . . . . . . . . . . . .34betamethasone valerate . . . . . .21BETAPACE . . . . . . . . . . . . . . . .13BETAPACE AF . . . . . . . . . . . . . .13BETASERON . . . . . . . . . . . 18, 4�betaxolol . . . . . . . . . . . . . 13, 33bethanechol . . . . . . . . . . . . . . .28BETIMOL. . . . . . . . . . . . . . . . . .33BETOPTIC-S . . . . . . . . . . . . . . .33BIAXIN . . . . . . . . . . . . . . . . . . .29BIAXIN XL . . . . . . . . . . . . . . . . .29bicalutamide . . . . . . . . . . . . . . . .9BIDIL . . . . . . . . . . . . . . . . . . . . .14BINORA . . . . . . . . . . . . . . . . . .20BIO-STATIN . . . . . . . . . . . . . . . .30BIO-THROID . . . . . . . . . . . . . . .26bisoprolol/ hydrochlorothiazide . . . . . . .13bisoprolol fumarate . . . . . . . . .13BLEPHAMIDE S.O.P. . . . . . . . . .34BONIVA . . . . . . . . 32, 33, 44, 4�BOTOX . . . . . . . . . . . . . . . . . . .33BRAVELLE . . . . . . . . . . . . . . . . .25BREVICON . . . . . . . . . . . . . . . .23BREVOXYL . . . . . . . . . . . . . . . .20BREZE . . . . . . . . . . . . . . . . . . . .20brimonidine . . . . . . . . . . . . . . .33bromocriptine . . . . . . . . . . . . . .1�BRONCAP . . . . . . . . . . . . . . . . .35BROVANA . . . . . . . . . . . . 35, 46budeprion . . . . . . . . . 16, 41, 46budeprion SR . . . . . . . . . . 41, 46budeprion XL . . . . . . . . . . 16, 41bumetanide . . . . . . . . . . . . . . .14BUMEX . . . . . . . . . . . . . . . . . . .14BUPHENYL . . . . . . . . . . . . . . . .26bupropion . . . . . . 16, 41, 46, 4�bupropion SR . . . . 16, 41, 46, 4�bupropion XL . . . . . . . . . . 41, 46buspirone . . . . . . . . . . . . . . . . .15butalbital/acetaminophen/ caffeine/codeine . . . . . . . . . .18butalbital/aspirin/ caffeine/codeine . . . . . . . . . .18BUTISOL SODIUM . . . . . . . . . . .19butorphanol . . . . . . . . . . . . . . .19butorphanol nasal . . . . . . . . . .44BYETTA . . . . . . . . . . . . . . 22, 40BYSTOLIC . . . . . . . . . . . . . . . . .13

CCADUET . . . . . . . . . . . 12, 41, 46CALAN . . . . . . . . . . . . . . . . . . .13CALAN SR . . . . . . . . . . . . . . . .13calcipotriene . . . . . . . . . . . 21, 46calcitonin salmon nasal. . . . . . .32

camila . . . . . . . . . . . . . . . . . . . .24CAMPRAL . . . . . . . . . . . . . . . .1�CANASA . . . . . . . . . . . . . 2�, 41CAPITAL/CODEINE . . . . . . . . . .18CAPITROL lotion/shampoo/spray . . . . . .21CAPOTEN . . . . . . . . . . . . . . . . .11CAPOZIDE . . . . . . . . . . . . . . . .11captopril . . . . . . . . . . . . . . . . . .11captopril/hydrochlorothiazide . .11CARAC . . . . . . . . . . . . . . . 21, 40carbamazepine . . . . . . . . . . . . .15carbamazepine XR . . . . . . . . . .15CARBATROL . . . . . . . . . . . . . . .15carbidopa/levodopa . . . . . . . . .1�carbidopa/levodopa ODT . . . . .1�carbidopa/levodopa SR . . . . . . .1�carboptic . . . . . . . . . . . . . . . . .33CARDENE . . . . . . . . . . . . . . . . .13CARDENE SR . . . . . . . . . . . . . .13CARDIZEM . . . . . . . . . . . . . . . .13CARDIZEM CD . . . . . . . . . . . . .13CARDIZEM LA . . . . . . . . . . . . .13CARDURA . . . . . . . . . . . . . . . .11CARDURA XL . . . . . . . . . . . . . .11CARIMUNE NANOFILTERED . . .36carisoprodol . . . . . . . . . . . . . . .32carisoprodol/aspirin . . . . . . . . .32carisoprodol/aspirin/codeine . . .32CARNITOR . . . . . . . . . . . . . . . .26carteolol . . . . . . . . . . . . . . . . . .33cartia XT . . . . . . . . . . . . . . . . . .13CARTROL . . . . . . . . . . . . . . . . .13carvedilol . . . . . . . . . . . . . . . . .10CASODEX . . . . . . . . . . . . . . 9, 38CATAPRES . . . . . . . . . . . . . . . .11CATAPRES-TTS . . . . . . . . . . . . .11CEDAX . . . . . . . . . . . . . . . . . . .29CEENU . . . . . . . . . . . . . . . . . . . .9cefaclor . . . . . . . . . . . . . . . . . .29cefaclor ER . . . . . . . . . . . . . . . .29cefadroxil . . . . . . . . . . . . . . . . .29cefdinir . . . . . . . . . . . . . . . . . . .29cefpodoxime . . . . . . . . . . . . . .29cefprozil . . . . . . . . . . . . . . . . . .29CEFTIN . . . . . . . . . . . . . . . . . . .29cefuroxime . . . . . . . . . . . . . . . .29CEFZIL . . . . . . . . . . . . . . . . . . .29CELEBREX . . . . . . . . . . 32, 39, 44CELESTONE . . . . . . . . . . . . . . .26CELEXA . . . . . . . . . . . 16, 41, 46CELLCEPT . . . . . . . . . . . . . 36, 4�CELONTIN . . . . . . . . . . . . . . . .15CENESTIN . . . . . . . . . . . . . . . . .25CENTANY . . . . . . . . . . . . . . . . .21cephalexin . . . . . . . . . . . . . . . .29


CEREZYME . . . . . . . . . . . . . . . .10CESAMET . . . . . . . . . . . . . 2�, 43cesia . . . . . . . . . . . . . . . . . . . . .23cetirizine . . . . . . . . . . . . . . . . . .38CETRAXAL . . . . . . . . . . . . . . . .34CETROTIDE . . . . . . . . . . . . . . . .25chloral hydrate . . . . . . . . . . . . .19chlordiazepoxide . . . . . . . . . . .15chlordiazepoxide/ amitriptyline . . . . . . . . . . . . .1�chloroquine . . . . . . . . 30, 39, 42chlorothiazide . . . . . . . . . . . . . .14chlorpromazine . . . . . . . . . . . .1�chlorpropamide . . . . . . . . . . . .23chlorthalidone . . . . . . . . . . . . .14chlorzoxazone . . . . . . . . . . . . .32cholestyramine . . . . . . . . . . . . .12chorionic gonadotropin . . . . . .25ciclopirox . . . . . . . . . . . . . 21, 39cilostazol . . . . . . . . . . . . . . . . .10cimetidine . . . . . . . . . . . . . . . . .26CIMZIA . . . . . . . . . . . . . . . . . . .32CINRYZE . . . . . . . . . . . . . . . . . .10CIPRO . . . . . . . . . . . . . . . . 29, 38CIPRODEX . . . . . . . . . . . . . . . .34ciprofloxacin . . . . . . . . 29, 34, 38ciprofloxacin ER . . . . . . . . . . . .29CIPRO HC . . . . . . . . . . . . . . . . .34CIPRO XR . . . . . . . . . . . . . 29, 38citalopram . . . . . . . . . 16, 41, 46claravis . . . . . . . . . . . . . . . 20, 38CLARIFOAM EF . . . . . . . . . . . . .20CLARINEX . . . . . . . . . . 36, 38, 40CLARINEX-D . . . . . . . . 36, 38, 40CLARINEX REDITAB . . . . . . . . .36clarithromycin . . . . . . . . . . . . . .29clarithromycin SR . . . . . . . . . . .29CLEANSE/TREAT PAD . . . . . . . .20CLEOCIN VAGINAL. . . . . . . . . .28CLIMARA . . . . . . . . . . . . . 25, 42CLIMARA PRO . . . . . . . . . 26, 42clindamax . . . . . . . . . . . . . 20, 28clindamycin . . . . . . . . . . . 20, 30CLINDESSE . . . . . . . . . . . . . . . .28clobetasol . . . . . . . . . . . . . 21, 46clobevate . . . . . . . . . . . . . . . . .21CLOBEX . . . . . . . . . . . . . . . . . .21CLODERM . . . . . . . . . . . . . . . .21clomipramine . . . . . . . . . . . . . .16clonazepam . . . . . . . . . . . . . . .15clonazepam orally disintegrating tab . . . . . . . . .15clonidine . . . . . . . . . . . . . . . . . .11clorazepate . . . . . . . . . . . . . . . .15CLORPRES . . . . . . . . . . . . . . . .14clotrimazole/betamethasone. . .21

clozapine . . . . . . . . . . . . . 1�, 42CLOZARIL . . . . . . . . . . . . . 1�, 42COARTEM . . . . . . . . . . . . 30, 39cocaine hcl . . . . . . . . . . . . . . . .21COCET . . . . . . . . . . . . . . . . . . .18codeine phosphate . . . . . . . . . .18codeine sulfate . . . . . . . . . . . . .18COGENTIN . . . . . . . . . . . . . . . .16COGNEX . . . . . . . . . . . . . . . . .15COLAZAL . . . . . . . . . . . . . 2�, 41colchicine . . . . . . . . . . . . . . . . .25COLESTID . . . . . . . . . . . . . . . . .12colestipol . . . . . . . . . . . . . . . . .12colistimethate sodium . . . 30, 35colocort . . . . . . . . . . . . . . . . . .28COLY-MYCIN S . . . . . . . . . . . .34COLY-MYCIN M . . . . . . . . 30, 35COLYTE . . . . . . . . . . . . . . . . . .2�COMBIGAN . . . . . . . . . . . . . . .33COMBIPATCH . . . . . . . . . 26, 42COMBIVENT . . . . . . . . . . . . . . .35COMBIVIR . . . . . . . . . . . . . . . .31COMBUNOX . . . . . . . 18, 44, 48compro. . . . . . . . . . . . . . . . . . .1�COMTAN . . . . . . . . . . . . . . . . .16CONCERTA . . . . . . . . 19, 44, 48CONDYLOX . . . . . . . . . . . 22, 42COPAXONE . . . . . . . . . . . 18, 4�COPEGUS . . . . . . . . . . . . . . . . .31CORDARONE . . . . . . . . . . . . . .12CORDRAN . . . . . . . . . . . . . . . .21COREG . . . . . . . . . . . . . . . . . . .10COREG CR . . . . . . . . . . . . . . . .10CORGARD . . . . . . . . . . . . . . . .13corticosteroid . . . . . . . . . . . . . .4�CORTIFOAM . . . . . . . . . . . . . . .28cortisone AC . . . . . . . . . . . . . . .26cortomycin . . . . . . . . . . . . . . . .34CORZIDE. . . . . . . . . . . . . . . . . .13COSOPT . . . . . . . . . . . . . . 33, 4�COUMADIN . . . . . . . . . . . . . . .10COVERA-HS . . . . . . . . . . . . . . .13COZAAR . . . . . . . . . . . 11, 40, 46CREON . . . . . . . . . . . . . . . . . . .28CRESTOR . . . . . . . . . . 12, 41, 46CRINONE . . . . . . . . . . . . . . . . .29CRIXIVAN . . . . . . . . . . . . . . . . .31cromolyn sodium nebulizer . . .35cromolyn sodium ophth . . . . . .33cryselle . . . . . . . . . . . . . . . . . . .23CUPRIMINE . . . . . . . . . . . . . . . .36CYCLESSA . . . . . . . . . . . . . . . .23cyclobenzaprine hcl . . . . . . . . .32cyclophosphamide . . . . . . . . . . .9cyclosporine . . . . . . . . . . . 36, 3�cyclosporine modified . . . . . . . .3�

CYMBALTA . . . . . 16, 1�, 41, 46CYSTADANE . . . . . . . . . . . . . . .25CYSTAGON . . . . . . . . . . . . . . .28CYTADREN . . . . . . . . . . . . . . . . .9CYTOGAM . . . . . . . . . . . . 32, 36CYTOMEL . . . . . . . . . . . . . . . . .26CYTOVENE . . . . . . . . . . . . . . . .32

Ddanazol . . . . . . . . . . . . . . . . . .25DANTRIUM . . . . . . . . . . . . . . . .32dapsone . . . . . . . . . . . . . . . . . .30DARAPRIM . . . . . . . . . . . . 30, 39DARVOCET-N . . . . . . . . . . . . . .18DARVON-N . . . . . . . . . . . . . . . .18DAYPRO . . . . . . . . . . . . . . . . . .32DAYTRANA . . . . . . . . . . . 19, 44DAZIDOX . . . . . . . . . . . . . . . . .18DDAVP . . . . . . . . . . . . 23, 39, 4�DECLOMYCIN . . . . . . . . . 30, 38deferoxamine mesylate. . . . . . .36DEMADEX . . . . . . . . . . . . . . . .14demeclocycline . . . . . . . . . 30, 38DEMEROL . . . . . . . . . . . . . . . . .18DEMSER . . . . . . . . . . . . . . . . . .14DEMULEN 1/35 . . . . . . . . . . . .23DEMULEN 1/50 . . . . . . . . . . . .23DENAVIR . . . . . . . . . . . . . . . . .21DEPAKOTE . . . . . . . . . . . . 15, 46DEPAKOTE ER . . . . . . . . . 15, 46DEPAKOTE sprinkle . . . . . 15, 46DEPEN TITRATABS . . . . . . . . . .36DEPO-PROVERA . . . . . . . . . 9, 23DERMATOP . . . . . . . . . . . . . . .22DESFERAL . . . . . . . . . . . . . . . . .36desipramine . . . . . . . . . . . . . . .16desmopressin . . . . . . . 23, 39, 4�DESOGEN . . . . . . . . . . . . . . . . .23DESONATE . . . . . . . . . . . . . . . .22desonide. . . . . . . . . . . . . . . . . .22DESOWEN KIT . . . . . . . . . . . . .22desoximetasone . . . . . . . . . . . .22DESOXYN . . . . . . . . . . 19, 44, 48DESOXYN CR . . . . . . . . . . . . . .44DETROL . . . . . . . . . . . . . . 28, 48DETROL LA . . . . . . . . . . . . 28, 48dexacidin . . . . . . . . . . . . . . . . .34dexamethasone . . . . . . . . . . . .26dexamethasone/neomycin/ polymyxin . . . . . . . . . . . . . . .34dexamethasone phosphate . . .34dexasol . . . . . . . . . . . . . . . . . . .34dexasporin . . . . . . . . . . . . . . . .34DEXEDRINE . . . . . . . . . . . . 19, 45DEXEDRINE CR . . . . . . . . . . . . .45dexmethylphenidate . . 19, 45, 48dextroamphetamine . . . . . 19, 45

Index


dextroamphetamine CR . . 19, 45dextrostat . . . . . . . . . . . . . 19, 45DIAMOX . . . . . . . . . . . . . . . . . .14DIASTAT . . . . . . . . . . . . . . . . . .15diazepam . . . . . . . . . . . . . . . . .15DIBENZYLINE . . . . . . . . . . . . . .14diclofenac . . . . . . . . . . . . . . . . .32diclofenac ophth . . . . . . . . . . .34diclofenac potassium . . . . . . . .32diclofenac sodium XR . . . . . . . .32dicloxacillin sodium. . . . . . . . . .30didanosine delayed release . . . .31DIDRONEL . . . . . . . . . . . . . . . .32DIFFERIN . . . . . . . . . . . . . . 20, 38diflorasone . . . . . . . . . . . . . . . .22DIFLUCAN . . . . . . . . . 30, 39, 45DIGEX . . . . . . . . . . . . . . . . . . . .28digitek . . . . . . . . . . . . . . . . . . .14digoxin . . . . . . . . . . . . . . . . . . .14DILACOR XR . . . . . . . . . . . . . . .13DILANTIN . . . . . . . . . . . . . . . . .15DILATRATE SR . . . . . . . . . . . . .11DILAUDID . . . . . . . . . . . . . . . . .18diltia XT . . . . . . . . . . . . . . . . . .13diltiazem . . . . . . . . . . . . . . . . . .13diltiazem CD/ER/CR/XT . . . . . . .13diltiazem SR extended release beads . . . . . . . . . . . .13DIOVAN . . . . . . . . . . . 11, 40, 46DIOVAN HCT . . . . . . . 11, 40, 46DIPENTUM . . . . . . . . . . . . 2�, 41dipivefrin . . . . . . . . . . . . . . . . .33DIPROLENE AF . . . . . . . . . . . . .22dipyridamole . . . . . . . . . . . . . .10disopyramide . . . . . . . . . . . . . .12DISPERMOX . . . . . . . . . . . . . . .29DITROPAN . . . . . . . . . . . . . . . .28DITROPAN XL . . . . . . . . . . 28, 48DIURIL . . . . . . . . . . . . . . . . . . .14divalproex sodium delayed release . . . . . . . 16, 46divalproex sodium sprinkle . . . . . . . . . . . . . 16, 46divalproex sodium SR . . . . 16, 46DIVIGEL . . . . . . . . . . . . . . . . . .25DORAL . . . . . . . . . . . . . . . . . . .19DORYX . . . . . . . . . . . . . . . 30, 38dorzolamide . . . . . . . . . . . 33, 4�dorzolamide/timolol . . . . 33, 4�DOVONEX . . . . . . . . . . . . . . . .21doxazosin . . . . . . . . . . . . . . . . .11doxepin hcl . . . . . . . . . . . . . . . .16doxy-caps . . . . . . . . . . . . . . . . .30doxycycline . . . . . . . . . . . . 38, 48doxycycline hyclate . . . . . . . . . .30doxycycline monohydrate . . . . .30

DRITHO-SCALP . . . . . . . . . . . . .21DUAC CS . . . . . . . . . . . . . . . . .20DUETACT . . . . . . . . . . . . . . . . .23DUONEB . . . . . . . . . . . . . . . . . .35DURAGESIC . . . . . . . . 18, 44, 48DUREZOL . . . . . . . . . . . . . . . . .34DURICEF . . . . . . . . . . . . . . . . . .29DYAZIDE. . . . . . . . . . . . . . . . . .14DYNABAC . . . . . . . . . . . . . . . .29DYNACIN . . . . . . . . . . . . . 30, 38DYNACIRC CR . . . . . . . . . . . . .13DYRENIUM . . . . . . . . . . . . . . . .14

Ee.e.s. . . . . . . . . . . . . . . . . . . . .29econazole . . . . . . . . . . . . . . . . .21EDECRIN . . . . . . . . . . . . . . . . . .14EDLUAR . . . . . . . . . . . 19, 44, 4�EFFEXOR . . . . . . . . . . . 16, 42, 46EFFEXOR XR . . . . . . . . 16, 42, 46EFUDEX . . . . . . . . . . . . . . 21, 40ELAPRASE . . . . . . . . . . . . . . . . .26ELDEPRYL . . . . . . . . . . . . . . . . .1�ELESTAT . . . . . . . . . . . . . . . . . .34ELESTRIN . . . . . . . . . . . . . . . . .25ELIDEL . . . . . . . . . . . . . . . 22, 4�ELIGARD . . . . . . . . . . . . . . . . . . .9ELMIRON . . . . . . . . . . . . . . . . .28ELOCON . . . . . . . . . . . . . . . . . .22EMADINE . . . . . . . . . . . . . . . . .34EMCYT . . . . . . . . . . . . . . . . . . . .9EMEND . . . . . . . . . . . . . . . 2�, 43EMSAM . . . . . . . . . . . . . . 16, 41EMTRIVA . . . . . . . . . . . . . . . . .31ENABLEX . . . . . . . . . . . . . 28, 48enalapril . . . . . . . . . . . . . . . . . .11enalapril/hydrochlorothiazide . .11ENBREL . . . . . . . . . . . . . . . 21, 32ENJUVIA . . . . . . . . . . . . . . . . . .25enpresse . . . . . . . . . . . . . . . . . .23ENTOCORT EC . . . . . . . . . . . . .26EPIDUO. . . . . . . . . . . . . . . . . . .20epinephrine . . . . . . . . . . . . . . .10EPIPEN . . . . . . . . . . . . . . . . . . .10EPIPEN-JR . . . . . . . . . . . . . . . . .10EPIVIR . . . . . . . . . . . . . . . . . . . .31EPIVIR HBV . . . . . . . . . . . . . . . .31eplerenone . . . . . . . . . . . . . . . .14EPOGEN . . . . . . . . . . . . . . 10, 39EPZICOM . . . . . . . . . . . . . . . . .31EQUETRO . . . . . . . . . . . . . . . . .1�ERBITUX . . . . . . . . . . . . . . . 9, 39ergoloid mesylate . . . . . . . . . . .19errin . . . . . . . . . . . . . . . . . . . . .24ERTACZO . . . . . . . . . . . . . . . . .21erythrocin . . . . . . . . . . . . . . . . .29erythromycin . . . . . . . 20, 29, 34

erythromycin/benzoyl peroxide . . . . . . . . . . . . . . . .20erythromycin delayed release particles . . . . . . . . . . .29erythromycin ethylsuccinate . . .30ESCLIM . . . . . . . . . . . . . . . 25, 42estazolam . . . . . . . . . . . . . . . . .19ESTRACE . . . . . . . . . . . . . . . . .25ESTRACE VAGINAL. . . . . . . . . .29ESTRADERM . . . . . . . . . . . 25, 42estradiol patch . . . . . . . . . 25, 42estradiol tab . . . . . . . . . . . . . . .25estradiol/ norethindrone acetate. . . . . .26 ESTRASORB . . . . . . . . . . . . . . .25ESTRING . . . . . . . . . . . . . . . . . .29ESTROGEL . . . . . . . . . . . . . . . .25estropipate . . . . . . . . . . . . . . . .25ESTROSTEP FE. . . . . . . . . . . . . .23ethambutol . . . . . . . . . . . . . . .30ethosuximide . . . . . . . . . . . . . .15etodolac . . . . . . . . . . . . . . . . . .32etodolac ER . . . . . . . . . . . . . . .32etoposide . . . . . . . . . . . . . . . . . .9EUFLEXXA . . . . . . . . . . . . . . . .33EULEXIN . . . . . . . . . . . . . . . . . . .9EURAX . . . . . . . . . . . . . . . . . . .22EVAMIST . . . . . . . . . . . . . . . . .25EVISTA . . . . . . . . . . . . . . . . . . .33EVOCLIN. . . . . . . . . . . . . . . . . .20EVOXAC . . . . . . . . . . . . . . . . . .35EXELDERM . . . . . . . . . . . . . . . .21EXELON . . . . . . . . . . . . . . . . . .15EXFORGE . . . . . . . . . . . . . 11, 40EXFORGE HCT . . . . . . . . . 11, 40EXJADE. . . . . . . . . . . . . . . . . . .36EXTINA . . . . . . . . . . . . . . . . . . .21

FFABRAZYME . . . . . . . . . . . . . . .25FACTIVE . . . . . . . . . . . . . . 29, 38famciclovir . . . . . . . . . . . . . . . .31famotidine . . . . . . . . . . . . . . . .2�FAMVIR . . . . . . . . . . . . . . . . . .31FANSIDAR . . . . . . . . . . . . . . . .30FARESTON . . . . . . . . . . . . . . . . .9FASLODEX . . . . . . . . . . . . . . . . .9FAST TAKE . . . . . . . . . . . . . . . .4�FAZACLO . . . . . . . . . . . . . 1�, 42FEIBA VH IMMUNO . . . . . 10, 38FELBATOL . . . . . . . . . . . . . . . . .15felodipine . . . . . . . . . . . . . . . . .13FEMARA . . . . . . . . . . . . . . . 9, 39FEMCON . . . . . . . . . . . . . . . . .23FEMHRT . . . . . . . . . . . . . . . . . .26FEMHRT LOW DOSE . . . . . . . . .26


FEMRING . . . . . . . . . . . . . . . . .29FEMTRACE . . . . . . . . . . . . . . . .26fenofibrate . . . . . . . . . . . . 12, 4�FENOGLIDE . . . . . . . . . . . . 12, 4�fenoprofen . . . . . . . . . . . . . . . .32fentanyl lozenges . . . . 18, 39, 44fentanyl patch . . . . . . 18, 44, 48FENTORA . . . . . . . . . . 18, 39, 44FERRLECIT. . . . . . . . . . . . . . . . .36FEXMID . . . . . . . . . . . . . . . . . .32fexofenadine . . . . . . . 36, 38, 40FINACEA. . . . . . . . . . . . . . . . . .22finasteride . . . . . . . . . . . . . . . .28FIORICET/CODEINE . . . . . . . . . .18FIORINAL/CODEINE . . . . . . . . . .18FIRMAGON . . . . . . . . . . 9, 39, 43FIRST-TESTOSTERONE . . . . 25, 48flavoxate. . . . . . . . . . . . . . . . . .28FLEBOGAMMA . . . . . . . . . . . . .36flecainide . . . . . . . . . . . . . . . . .12FLECTOR patch . . . . . . . . . 32, 44FLOLAN . . . . . . . . . . . . . . . . . .14FLOMAX . . . . . . . . . . . . . . 28, 38FLONASE . . . . . . . . . . . . . . . . .36FLOVENT DISKUS . . . . . . . . . . .35FLOVENT HFA . . . . . . . . . . 35, 46FLOXIN . . . . . . . . . . . . . . . . . . .38FLOXIN OTIC . . . . . . . . . . . . . .34fluconazole . . . . . . . . . 30, 39, 45fludrocort . . . . . . . . . . . . . . . . .26FLUMADINE . . . . . . . . . . . . . . .31flunisolide . . . . . . . . . . . . . . . . .36fluocinolone acetonide . . . . . . .22fluocinonide . . . . . . . . . . . . . . .22fluor-op . . . . . . . . . . . . . . . . . .34fluorometholone . . . . . . . . . . .34FLUOROPLEX . . . . . . . . . . 21, 40fluorouracil . . . . . . . . . . . . 21, 40fluoxetine . . . . . . . 16, 41, 42, 46fluphenazine . . . . . . . . . . . . . .1�flurazepam . . . . . . . . . . . . . . . .19flurbiprofen . . . . . . . . . . . 32, 34flutamide . . . . . . . . . . . . . . . . . .9fluticasone . . . . . . . . . . . . . . . .22fluticasone nasal . . . . . . . . 36, 48fluvoxamine . . . . . . . . 16, 41, 46FML FORTE . . . . . . . . . . . . . . . .34FML LIQUIFILM . . . . . . . . . . . . .34FML S.O.P. . . . . . . . . . . . . . . . .34FOCALIN. . . . . . . . . . . 19, 45, 48FOCALIN XR . . . . . . . . 19, 45, 48FOLLISTIM. . . . . . . . . . . . . . . . .25FOLLISTIM AQ . . . . . . . . . . . . .25FORADIL . . . . . . . . . . . . . . 35, 46FORTAMET . . . . . . . . . . . . . . . .22

FORTEO . . . . . . . . . . . . . . 32, 33fortical . . . . . . . . . . . . . . . . . . .32FOSAMAX . . . . . . . . . 32, 44, 4�FOSAMAX PLUS D . . . 32, 44, 4�FOSCARNET . . . . . . . . . . . . . . .32fosinopril . . . . . . . . . . . . . . . . .11fosinopril/hydrochlorothiazide .11FOSRENOL . . . . . . . . . . . . . . . .28FRAGMIN . . . . . . . . . . . . . . . . .10FREESTYLE . . . . . . . . . . . . 24, 4�FREESTYLE LITE . . . . . . . . . 24, 4�FROVA . . . . . . . . . . . . 1�, 43, 4�furosemide . . . . . . . . . . . . . . . .14FUZEON . . . . . . . . . . . . . . . . . .31

Ggabapentin . . . . . . . . . 15, 40, 46GABARONE . . . . . . . . . . . 15, 40GABITRIL . . . . . . . . . . . . . 15, 38galantamine . . . . . . . . . . . . . . .15galantamine SR . . . . . . . . . . . .15GAMASTAN S/D . . . . . . . . . . . .36GAMMAGARD . . . . . . . . . . . . .36GAMMAGARD S/D . . . . . . . . .36GAMUNEX . . . . . . . . . . . . . . . .36ganciclovir . . . . . . . . . . . . 31, 32GANIRELIX . . . . . . . . . . . . . . . .25GANITE. . . . . . . . . . . . . . . . . . .33GASTROCROM . . . . . . . . . . . . .2�gauze pad . . . . . . . . . . . . . . . .24gavilyte-g . . . . . . . . . . . . . . . . .2�GELNIQUE . . . . . . . . . . . . 28, 48gemfibrozil . . . . . . . . . . . . 12, 4�gengraf . . . . . . . . . . . . . . . . . .3�GENOTROPIN . . . . . . . 25, 39, 4�gentamicin . . . . . . . . . . . . 21, 34GEODON . . . . . . . . . . 1�, 42, 4�gildess FE . . . . . . . . . . . . . . . . .23GLEEVEC . . . . . . . . . . . . . . 9, 43glimepiride . . . . . . . . . . . . . . . .23glipizide . . . . . . . . . . . . . . . . . .23glipizide/metformin . . . . . . . . .22glipizide ER . . . . . . . . . . . . . . . .23glipizide XL . . . . . . . . . . . . . . . .23GLUCAGON . . . . . . . . . . . . . . .25GLUCOPHAGE . . . . . . . . . . . . .22GLUCOPHAGE XR . . . . . . . . . .22glucose test strips . . . . . . . . . . .24GLUCOVANCE . . . . . . . . . . . . .22GLUMETZA . . . . . . . . . . . . . . . .22glyburide . . . . . . . . . . . . . . . . .23glyburide/metformin . . . . . . . . .22glyburide micronized . . . . . . . .23glycolax . . . . . . . . . . . . . . . . . .28glycron . . . . . . . . . . . . . . . . . . .23GLYSET. . . . . . . . . . . . . . . . . . .22GOLYTELY . . . . . . . . . . . . . . . .2�

GONAL-F . . . . . . . . . . . . . . . . .25GONAL-F RFF . . . . . . . . . . . . . .25granisetron . . . . . . . . . 2�, 43, 4�GRIFULVIN V. . . . . . . . . . . . . . .30GRIS-PEG . . . . . . . . . . . . . . . . .30guanabenz . . . . . . . . . . . . . . . .11guanfacine . . . . . . . . . . . . . . . .11GYNAZOLE-1 . . . . . . . . . . . . . .28gynodiol . . . . . . . . . . . . . . . . . .25

HHALFLYTELY . . . . . . . . . . . . . . .2�HALOG . . . . . . . . . . . . . . . . . . .22haloperidol . . . . . . . . . . . . . . . .1�HALOTIN . . . . . . . . . . . . . . . . .21HECTOROL . . . . . . . . . . . . . . . .26HELIDAC. . . . . . . . . . . . . . 2�, 45HELIXATE FS . . . . . . . . . . . 10, 38HEMOFIL M . . . . . . . . . . . 10, 38HEPAGAM B . . . . . . . . . . . . . .36heparin sodium . . . . . . . . . . . .10HEPSERA . . . . . . . . . . . . . . . . .31HEXALEN . . . . . . . . . . . . . . . . . .9HMS . . . . . . . . . . . . . . . . . . . . .34HUMALOG . . . . . . . . . . . . . . . .23HUMATE-P . . . . . . . . . . . . 10, 38HUMATROPE . . . . . . . 25, 39, 4�HUMIRA . . . . . . . . . . . . . . 21, 32HUMULIN . . . . . . . . . . . . . 23, 4�HYALGAN . . . . . . . . . . . . . . . .33HYCAMTIN . . . . . . . . . . . . 10, 43hydralazine . . . . . . . . . . . . . . . .14hydralazine/ hydrochlorothiazide . . . . . . .14HYDREA . . . . . . . . . . . . . . . . . . .9hydrochlorothiazide . . . . . . . . .14hydrocodone/acetaminophen . .18hydrocodone/ibuprofen . . . . . .18hydrocortisone . . . . . . . . . 22, 26hydrocortisone/clioquinol . . . . .21hydrocortisone/iodoquinol . . . .21hydrocortisone/pramoxine . . . .22hydrocortisone butyrate . . . . . .22hydrocortisone valerate . . . . . .22hydromorphone . . . . . . . . . . . .18hydroxychloroquine . . . . . 30, 42hydroxyurea . . . . . . . . . . . . . . . .9hydroxyzine hcl. . . . . . . . . . . . .15hydroxyzine pamoate . . . . . . . .15hyoscyamine . . . . . . . . . . . . . . .28HYPERHEP B . . . . . . . . . . . . . . .36HYPERRASB S/D . . . . . . . . . . . .36HYPERRHO S/D . . . . . . . . . . . . .36HYPERTET S/D . . . . . . . . . . . . .36HYTRIN . . . . . . . . . . . . . . . . . . .11HYZAAR . . . . . . . . . . . 11, 40, 46

Index


IIBUDONE . . . . . . . . . . . . . . . . .18ibuprofen . . . . . . . . . . . . . . . . .32IMDUR . . . . . . . . . . . . . . . . . . .11imipramine hcl . . . . . . . . . . . . .16IMITREX . . . . . . . . . . . 1�, 43, 4�IMOGAM RABIE . . . . . . . . . . . .36IMURAN . . . . . . . . . . . . . . . . . .3�INCRELEX . . . . . . . . . . . . . 25, 39indapamide . . . . . . . . . . . . . . .14INDERAL . . . . . . . . . . . . . . . . . .13INDERAL LA . . . . . . . . . . . . . . .13INDERIDE . . . . . . . . . . . . . . . . .13indomethacin . . . . . . . . . . . . . .32indomethacin ER . . . . . . . . . . .32INFERGEN . . . . . . . . . . . . . 31, 39INNOHEP . . . . . . . . . . . . . . . . .10INNOPRAN XL . . . . . . . . . . . . .13INSPRA . . . . . . . . . . . . . . . . . . .14insulin syringes . . . . . . . . . . . . .24INTELENCE . . . . . . . . . . . . . . . .31INTRON-A . . . . . . . . . . . . . . 9, 39INVEGA . . . . . . . . . . . 1�, 42, 4�INVIRASE . . . . . . . . . . . . . . . . .31IOPIDINE . . . . . . . . . . . . . . . . . .33ipratropium inhaler . . . . . . . . . .35ipratropium nasal . . . . . . . . . . .35IQUIX . . . . . . . . . . . . . . . . . . . .34IRESSA . . . . . . . . . . . . . . . . . . . .9ISENTRESS . . . . . . . . . . . . . . . .31ISMO . . . . . . . . . . . . . . . . . . . .12ISO CARBACHOL . . . . . . . . . . .33isonarif . . . . . . . . . . . . . . . . . . .31isoniazid . . . . . . . . . . . . . . . . . .31ISOPTIN SR . . . . . . . . . . . . . . . .13ISOPTO CARPINE . . . . . . . . . . .33ISORDIL . . . . . . . . . . . . . . . . . .12isosorbide dinitrate . . . . . . . . . .12isosorbide mononitrate . . . . . . .12isotretinoin . . . . . . . . . . . . 20, 38isoxsuprine . . . . . . . . . . . . . . . .14isradipine . . . . . . . . . . . . . . . . .13ISTALOL . . . . . . . . . . . . . . . . . .33itraconazole . . . . . . . . . . . 30, 39IV IMMUNE GLOBULIN (IVIG) . .39

JJANUMET . . . . . . . . . . . . . . . . .22JANUVIA. . . . . . . . . . . . . . . . . .22jolessa . . . . . . . . . . . . . . . . . . .23jolivette . . . . . . . . . . . . . . . . . .24junel 1.5/30 . . . . . . . . . . . . . . .23junel 1/20 . . . . . . . . . . . . . . . . .23junel FE 1.5/30 . . . . . . . . . . . . .23junel FE 1/20 . . . . . . . . . . . . . .23

KKADIAN . . . . . . . . . . . . . . . . . .18KALETRA . . . . . . . . . . . . . . . . .31KAPIDEX . . . . . . . . 2�, 39, 45, 48kariva . . . . . . . . . . . . . . . . . . . .23kelnor . . . . . . . . . . . . . . . . . . . .23KEMADRIN . . . . . . . . . . . . . . . .16KEPPRA . . . . . . . . . . . . . . . . . .15KEPPRA XR . . . . . . . . . . . . . . . .15KERLONE . . . . . . . . . . . . . . . . .13KETEK . . . . . . . . . . . . . . . . . . . .29ketoconazole . . . . . . . . . . 21, 30ketoprofen . . . . . . . . . . . . . . . .32ketoprofen ER . . . . . . . . . . . . .32ketorolac . . . . . . . . . . . . . 32, 44KINERET . . . . . . . . . . . . . . 21, 32KLARON . . . . . . . . . . . . . . . . . .20KLONOPIN . . . . . . . . . . . . . . . .15KLONOPIN WAFER . . . . . . . . . .15KOATE-DVI . . . . . . . . . . . . 10, 38KOGENATE FS . . . . . . . . . 10, 38KRISTALOSE . . . . . . . . . . . . . . .28KU-ZYME . . . . . . . . . . . . . . . . .28KU-ZYME-HP . . . . . . . . . . . . . .28KUVAN . . . . . . . . . . . . . . . . . . .26KYTRIL . . . . . . . . . . . . . . . 2�, 43

Llabetalol . . . . . . . . . . . . . . . . . .10lacticare/hydrocortisone . . . . . .22lactulose . . . . . . . . . . . . . . . . . .28LAMICTAL . . . . . . . . . . . . 15, 46LAMICTAL ODT . . . . . . . . 15, 46LAMICTAL XR . . . . . . . . . . 15, 46LAMISIL . . . . . . . . . . . . . . 30, 39lamotrigine . . . . . . . . . . . . 15, 46lancets . . . . . . . . . . . . . . . . . . .24LANOXICAPS . . . . . . . . . . . . . .14LANOXIN . . . . . . . . . . . . . . . . .14LANTUS . . . . . . . . . . . . . . . . . .23LARIAM . . . . . . . . . . . . . . 30, 39LASIX . . . . . . . . . . . . . . . . . . . .14LAVOCLEN . . . . . . . . . . . . . . . .20leena . . . . . . . . . . . . . . . . . . . .23leflunomide . . . . . . . . . . . . . . .32LESCOL. . . . . . . . . . . . . . . 12, 41LESCOL XL . . . . . . . . . . . . 12, 41lessina . . . . . . . . . . . . . . . . . . .23LETAIRIS . . . . . . . . . . . . . . . . . .14leucovorin calcium . . . . . . . . . . .9LEUKERAN . . . . . . . . . . . . . . . . .9LEUKINE . . . . . . . . . . . . . . . . . .10leuprolide . . . . . . . . . . . . . . 9, 25LEVAQUIN . . . . . . . . . . . . 29, 38LEVATOL . . . . . . . . . . . . . . . . .13LEVEMIR . . . . . . . . . . . . . . . . . .23

LEVEMIR FLEXPEN . . . . . . . . . .23levetiracetam . . . . . . . . . . . . . .15LEVLEN . . . . . . . . . . . . . . . . . . .23LEVLITE . . . . . . . . . . . . . . . . . . .23levobunolol. . . . . . . . . . . . . . . .33levora . . . . . . . . . . . . . . . . . . . .23levorphanol . . . . . . . . . . . . . . .18levothroid . . . . . . . . . . . . . . . . .26levothyroxine . . . . . . . . . . . . . .26levoxyl . . . . . . . . . . . . . . . . . . .26LEVULAN KERA . . . . . . . . . . . .21LEXAPRO . . . . . . . . . . 16, 41, 46LEXIVA . . . . . . . . . . . . . . . . . . .31LIALDA . . . . . . . . . . . . . . . 2�, 41LIDAMANTLE HC . . . . . . . . . . .22lidocaine . . . . . . . . . . . . . . . . . .21lidocaine/hydrocortisone . . . . . .22lidocaine/prilocaine . . . . . . . . . .21LIDODERM . . . . . . . . . . . . . . . .21lindane . . . . . . . . . . . . . . . . . . .22liothyronine sodium . . . . . . . . .26LIPEX . . . . . . . . . . . . . . . . . . . .12LIPITOR . . . . . . . . . . . . 12, 41, 46LIPOFEN . . . . . . . . . . . . . . 12, 4�LIPRAM. . . . . . . . . . . . . . . . . . .28LIPRAM CR . . . . . . . . . . . . . . . .28LIPRAM PN . . . . . . . . . . . . . . . .28LIQUADD . . . . . . . . . . 19, 45, 48LIQUICET . . . . . . . . . . . . . . . . .18lisinopril . . . . . . . . . . . . . . . . . .11lisinopril/hydrochlorothiazide . .11lithium carbonate . . . . . . . . . . .1�lithium carbonate CR . . . . . . . .1�lithium citrate . . . . . . . . . . . . . .1�LITHOBID . . . . . . . . . . . . . . . . .1�LO/OVRAL . . . . . . . . . . . . . . . .23LODOSYN . . . . . . . . . . . . . . . . .16LOESTRIN 1.5/30 . . . . . . . . . . .23LOESTRIN 1/20 . . . . . . . . . . . . .23LOESTRIN FE . . . . . . . . . . . . . . .23LOESTRIN FE 1.5/30 . . . . . . . . .23LOESTRIN-24 . . . . . . . . . . . . . .23LOFIBRA . . . . . . . . . . . . . . 12, 4�LOPID . . . . . . . . . . . . . . . . 12, 4�LOPRESS HCT . . . . . . . . . . . . . .13LOPRESSOR . . . . . . . . . . . . . . .13LOPROX . . . . . . . . . . . . . . . . . .21lorazepam . . . . . . . . . . . . . . . .15LORCET . . . . . . . . . . . . . . . . . .18LORCET PLUS . . . . . . . . . . . . . .18LORTAB . . . . . . . . . . . . . . . . . .18losartan . . . . . . . . . . . . . . . . . .46losartan/hctz . . . . . . . . . . . . . . .46LOSEASONIQUE . . . . . . . . . . . .23LOTEMAX . . . . . . . . . . . . . . . . .34LOTENSIN . . . . . . . . . . . . . . . . .11


LOTENSIN HCT . . . . . . . . . . . . .11LOTREL . . . . . . . . . . . . . . . 14, 46LOTRISONE . . . . . . . . . . . . . . . .21LOTRONEX . . . . . . . . . . . . 28, 39lovastatin . . . . . . . . . . 12, 41, 46LOVAZA . . . . . . . . . . . . . . . . . .12LOVENOX . . . . . . . . . . . . . . . . .10low-ogestrel . . . . . . . . . . . . . . .23loxapine . . . . . . . . . . . . . . . . . .1�LUCENTIS . . . . . . . . . . . . . . . . .33LUMIGAN . . . . . . . . . . . . . . . . .33LUNESTA . . . . . . . . . . 19, 44, 4�LUPRON DEPOT . . . . . . . . . . . . .9lutera . . . . . . . . . . . . . . . . . . . .23LUVERIS . . . . . . . . . . . . . . . . . .25LUVOX CR . . . . . . . . . 16, 41, 46LUXIQ . . . . . . . . . . . . . . . . 22, 46LYBREL . . . . . . . . . . . . . . . . . . .23LYNOX . . . . . . . . . . . . . . . . . . .18LYRICA . . . . . . 15, 1�, 38, 40, 46LYSODREN . . . . . . . . . . . . . . . . .9

MMACROBID . . . . . . . . . . . . . . .28MACUGEN . . . . . . . . . . . . . . . .33MAGNACET . . . . . . . . . . . . . . .18MALARONE . . . . . . . . . . . 30, 39maldemar . . . . . . . . . . . . . . . . .2�maprotiline . . . . . . . . . . . . 16, 41MARPLAN . . . . . . . . . . . . . . . .16MATULANE . . . . . . . . . . . . . . . .9MAVIK . . . . . . . . . . . . . . . . . . .11MAXAIR AUTOHALER . . . . . . .35MAXALT . . . . . . . . . . . . . . 1�, 43MAXALT MLT . . . . . . . . . . 1�, 43MAXAQUIN . . . . . . . . . . . . . . .38MAXIDONE . . . . . . . . . . . . . . .18MAXZIDE . . . . . . . . . . . . . . . . .14MEBARAL . . . . . . . . . . . . . . . . .19meclofenamate sodium . . . . . .32medroxyprogesterone . . . . . . .23medroxyprogesterone acetate .26mefenamic acid . . . . . . . . . . . .32mefloquine . . . . . . . . . . . . 30, 39MEGACE . . . . . . . . . . . . . . . . . .9MEGACE ES . . . . . . . . . . . . . . . .9megestrol . . . . . . . . . . . . . . . . . .9meloxicam . . . . . . . . . . . . . . . .32MENEST . . . . . . . . . . . . . . . . . .25MENOPUR . . . . . . . . . . . . . . . .25MENOSTAR . . . . . . . . . . . 25, 42meperidine . . . . . . . . . . . . . . . .18meperidine/promethazine . . . . .18mephobarbital . . . . . . . . . . . . .19meprobamate . . . . . . . . . . . . . .15MEPRON . . . . . . . . . . . . . . . . .31meprozine . . . . . . . . . . . . . . . .18

mercaptopurine . . . . . . . . . . . . .9mesalamine . . . . . . . . . . . . . . .2�MESNEX . . . . . . . . . . . . . . . . . . .9MESTINON . . . . . . . . . . . . . . . .32MESTINON TIMESPAN . . . . . . .32METADATE CD . . . . . . 19, 45, 48metadate ER . . . . . . . . . . . 19, 45METAGLIP . . . . . . . . . . . . . . . .22metaproterenol . . . . . . . . . . . .35metformin . . . . . . . . . . . . . . . .22metformin ER . . . . . . . . . . . . . .22methadone . . . . . . . . . . . . . . . .18methadose . . . . . . . . . . . . . . . .18methamphetamine . . . . . . . . . .44methazolamide . . . . . . . . . . . . .14methenamine hippurate . . . . . .28methenamine mandelate . . . . .28methimazole . . . . . . . . . . . . . .26methocarbamol . . . . . . . . . . . .32methotrexate . . . . . . . . . . . . . . .9methychlothiazide . . . . . . . . . .14methyldopa . . . . . . . . . . . . . . .11methyldopa/ hydrochlorothiazide . . . . . . .14methylin . . . . . . . . . . . 19, 45, 48METHYLIN chew/soln . 19, 45, 48methylin ER . . . . . . . . 19, 45, 48methylphenidate . . . . 20, 45, 48methylphenidate CD . . . . . 20, 45methylphenidate CR/ER/SR . . . . . . . . . 20, 45, 48methylprednisolone . . . . . . . . .26metipranolol . . . . . . . . . . . . . . .33metoclopramide hcl . . . . . . . . .2�metolazone . . . . . . . . . . . . . . .14metoprolol . . . . . . . . . . . . . . . .13metoprolol/ hydrochlorothiazide . . . . . . .13metoprolol succinate SR . . . . . .13METROCREAM . . . . . . . . . . . . .20METROGEL . . . . . . . . . . . . . . . .20METROGEL VAGINAL . . . . . . . .28METROLOTION . . . . . . . . . . . . .20metronidazole . . . . . . 20, 22, 30metronidazole SR . . . . . . . . . . .30MEVACOR . . . . . . . . . . . . 12, 41mexiletine . . . . . . . . . . . . . . . . .12MIACALCIN inj. . . . . . . . . . . . .32MIACALCIN NASAL . . . . . . . . .32MICARDIS . . . . . . . . . . . . 11, 40MICARDIS HCT . . . . . . . . . 11, 40MICRHOGAM ULTRA-FILTERED . . . . . . . . . .36microgestin 1.5/30 . . . . . . . . . .23microgestin 1/20 . . . . . . . . . . .23microgestin FE 1.5/30 . . . . . . . .23

microgestin FE1/20 . . . . . . . . . .23micronefrin . . . . . . . . . . . . . . . .35MICROZIDE . . . . . . . . . . . . . . .14midazolam . . . . . . . . . . . . . . . .19MIGRANAL . . . . . . . . . 1�, 43, 4�MILLIPRED . . . . . . . . . . . . . . . .26MINIPRESS . . . . . . . . . . . . . . . .11minirin . . . . . . . . . . . . . . . 23, 39MINOCIN . . . . . . . . . . . . . 30, 38minocycline . . . . . . . . . . . 30, 38minoxidil . . . . . . . . . . . . . . . . . .15MIRAPEX . . . . . . . . . . . . . . . . .1�MIRCETTE . . . . . . . . . . . . . . . . .24mirtazapine . . . . . 16, 42, 46, 4�mirtazapine ODT . . . . . . . . . . .16misoprostol. . . . . . . . . . . . . . . .2�MOBIC . . . . . . . . . . . . . . . . . . .32MODICON 0.5/35 . . . . . . . . . . .24moexipril . . . . . . . . . . . . . . . . .11moexipril/hydrochlorothiazide . .11mometasone . . . . . . . . . . . . . .22MONARC-M . . . . . . . . . . . 10, 38MONOCLATE-P . . . . . . . . 10, 38MONODOX . . . . . . . . . . . 30, 38MONOKET . . . . . . . . . . . . . . . .12mononessa . . . . . . . . . . . . . . . .24MONONINE . . . . . . . . . . . 10, 38MONOPRIL . . . . . . . . . . . . . . . .11MONOPRIL HCT . . . . . . . . . . . .11MONUROL . . . . . . . . . . . . . . . .28morphine . . . . . . . . . . . . . . . . .48morphine sulfate . . . . . . . . . . .18morphine sulfate CR . . . . . . . . .18MOVIPREP . . . . . . . . . . . . . . . .2�MOXATAG . . . . . . . . . . . . . . . .29MS CONTIN . . . . . . . . . . . . . . .18mupirocin . . . . . . . . . . . . . . . . .21MYAMBUTOL . . . . . . . . . . . . . .31mycophenolate . . . . . . . . . 3�, 4�MYFORTIC . . . . . . . . . . . . . . . .3�MYLERAN . . . . . . . . . . . . . . . . . .9MYLOCEL . . . . . . . . . . . . . . . . . .9MYOBLOC . . . . . . . . . . . . . . . .33MYOZYME . . . . . . . . . . . . . . . .26myrac . . . . . . . . . . . . . . . . . . . .30

NNABI-HB . . . . . . . . . . . . . . . . . .36nabumetone . . . . . . . . . . . . . . .32nadolol . . . . . . . . . . . . . . . . . . .13nadolol bendroflumethiazide . .13NAFTIN . . . . . . . . . . . . . . . . . . .21NAGLAZYME . . . . . . . . . . . . . .26naltrexone . . . . . . . . . . . . . . . .1�NAMENDA . . . . . . . . . . . . . . . .15NAPRELAN . . . . . . . . . . . . . . . .32naproxen . . . . . . . . . . . . . 33, 4�

Index


NARDIL . . . . . . . . . . . . . . . . . . .16NASACORT AQ . . . . . . . . 36, 48NASAREL . . . . . . . . . . . . . . . . .36NASONEX . . . . . . . . . . . . . 36, 48NATURETIN . . . . . . . . . . . . . . .14NEBUPENT . . . . . . . . . . . . . . . .30necon 0.5/35 . . . . . . . . . . . . . .24necon 1/35 . . . . . . . . . . . . . . . .24necon 1/50 . . . . . . . . . . . . . . . .24necon 10/11 . . . . . . . . . . . . . . .24necon 7/7/7 . . . . . . . . . . . . . . .24nefazodone . . . . . . . . . . . 16, 46NEOBENZ . . . . . . . . . . . . . . . . .20neomycin . . . . . . . . . . . . . . . . .29neomycin/polymyxin/ gramicidin . . . . . . . . . . . . . . .34neomycin/polymyxin/ hydrocortisone . . . . . . . 34, 35NEORAL . . . . . . . . . . . . . . . . . .3�NEOTIC. . . . . . . . . . . . . . . . . . .35NEULASTA . . . . . . . . . . . . . . . .10NEUMEGA . . . . . . . . . . . . . . . .10NEUPOGEN . . . . . . . . . . . . . . .10NEURONTIN . . . . . . . . . . . 15, 40NEVANAC . . . . . . . . . . . . . . . .34NEXAVAR . . . . . . . . . . . . . . 9, 43NEXIUM . . . . . . . . 2�, 39, 45, 48NIASPAN . . . . . . . . . . . . . . . . .13nicardipine . . . . . . . . . . . . . . . .13nifediac CC . . . . . . . . . . . . . . . .13nifedical XL . . . . . . . . . . . . . . . .13nifedipine . . . . . . . . . . . . . . . . .13nifedipine CR/ER/SR . . . . . . . . .13NILANDRON . . . . . . . . . . . . . . . .9nimodipine . . . . . . . . . . . . . . . .13NIMOTOP . . . . . . . . . . . . . . . . .13NIRAVAM . . . . . . . . . . . . . . . . .15nisoldipine . . . . . . . . . . . . . . . .13NITRO-DUR . . . . . . . . . . . . . . . .12nitro-transderm . . . . . . . . . . . .12NITROBID . . . . . . . . . . . . . . . . .12nitrofurantoin . . . . . . . . . . . . . .28nitrofurantoin monohydrate macrocrystal . . . . . . . . . . . . .28nitroglycerin . . . . . . . . . . . . . . .12nitroglycerin CR . . . . . . . . . . . .12nitroglycerin SL . . . . . . . . . . . . .12NITROLINGUAL . . . . . . . . . . . . .12NITROSTAT . . . . . . . . . . . . . . . .12nizatidine . . . . . . . . . . . . . . . . .2�NOR-QD . . . . . . . . . . . . . . . . . .24nora-be . . . . . . . . . . . . . . . . . .24NORCO . . . . . . . . . . . . . . . . . .18NORDETTE . . . . . . . . . . . . . . . .24NORDITROPIN . . . . . . . 25, 39, 4�norethindrone acetate . . . . . . .26

NORINYL 1+35 . . . . . . . . . . . . .24NORINYL 1+50 . . . . . . . . . . . . .24NORITATE . . . . . . . . . . . . . . . . .20NOROXIN . . . . . . . . . . . . . 29, 38NORPACE . . . . . . . . . . . . . . . . .12nortrel 0.5/35 . . . . . . . . . . . . . .24nortrel 1/35 . . . . . . . . . . . . . . .24nortrel 7/7/7 . . . . . . . . . . . . . . .24nortriptyline . . . . . . . . . . . . . . .16NORVASC . . . . . . . . . . . . 13, 46NORVIR . . . . . . . . . . . . . . . . . .31NOVAPLUS NABI-HB . . . . . . . .36novarel . . . . . . . . . . . . . . . . . . .25NOVOLIN . . . . . . . . . . . . . 23, 4�NOVOLOG . . . . . . . . . . . . . . . .23NOVOSEVEN . . . . . . . . . . 10, 38NOXAFIL . . . . . . . . . . . . . . . . . .30NPLATE. . . . . . . . . . . . . . . . . . .10NUCYNTA . . . . . . . . . 18, 44, 48NULYTELY . . . . . . . . . . . . . . . .2�NUOX . . . . . . . . . . . . . . . . . . . .20NUTRICORT . . . . . . . . . . . . . . .22NUTRIDOC . . . . . . . . . . . . . . . .38NUTRIDOX . . . . . . . . . . . . . . . .30NUTROPIN . . . . . . . . . 25, 39, 4�NUTROPIN AQ . . . . . . 25, 39, 4�NUVARING . . . . . . . . . . . . . . . .24NUVIGIL . . . . . . . . 19, 39, 45, 48NUZON . . . . . . . . . . . . . . . . . . .22nystatin . . . . . . . . . . . . . . 21, 30nystatin/triamcinolone . . . . . . .21nystatin vaginal . . . . . . . . . . . .28

Oocella . . . . . . . . . . . . . . . . . . . .24OCTAGAM . . . . . . . . . . . . . . . .36octreotide . . . . . . . . . . . . . . . . .22ofloxacin. . . . . . . . . . . 29, 34, 38ofloxacin otic . . . . . . . . . . . . . .34OGEN . . . . . . . . . . . . . . . . . . . .25ogestrel . . . . . . . . . . . . . . . . . .24OLUX . . . . . . . . . . . . . . . . 22, 46OLUX-E. . . . . . . . . . . . . . . 22, 46OLUX OLUX-E . . . . . . . . . 22, 46omeprazole . . . . . 2�, 39, 45, 48OMNARIS . . . . . . . . . . . . . . . . .36OMNICEF . . . . . . . . . . . . . . . . .29OMNITROPE . . . . . . . . 25, 39, 4�ondansetron . . . . . . . . 2�, 43, 4�ondansetron ODT . . . . 2�, 43, 4�ONE TOUCH BASIC/PROFILE . . .4�ONE TOUCH BASIC/PROFILE/ ONE TOUCH II . . . . . . . . . . . .24ONE TOUCH FAST TAKE . . . . .24ONE TOUCH SURE STEP . . . . . .24ONE TOUCH ULTRA . . . . . 24, 4�OPANA . . . . . . . . . . . . . . . . . . .18

OPANA ER . . . . . . . . . . . . . . . .18OPTIPRANOLOL . . . . . . . . . . . .33OPTIVAR . . . . . . . . . . . . . . . . . .34ORACEA . . . . . . . . . . . 22, 38, 44ORAMORPH SR . . . . . . . . . . . .18ORAP . . . . . . . . . . . . . . . . . . . .19ORAPRED . . . . . . . . . . . . . . . . .26ORAXYL . . . . . . . . . . . . . . 30, 38ORENCIA . . . . . . . . . . . . . . . . .32ORFADIN . . . . . . . . . . . . . . . . .25orphenadrine/aspirin/caffeine . .32orphenadrine cpd . . . . . . . . . . .32orphenadrine ER . . . . . . . . . . . .32orphengesic . . . . . . . . . . . . . . .32orphengesic forte . . . . . . . . . . .32ORTHO-CEPT . . . . . . . . . . . . . .24ORTHO-CYCLEN . . . . . . . . . . . .24ortho-est . . . . . . . . . . . . . . . . .26ORTHO-NOVUM 1/35 . . . . . . .24ORTHO-NOVUM 1/50 . . . . . . .24ORTHO-NOVUM 10/11 . . . . . .24ORTHO-NOVUM �/�/� . . . . . . .24ORTHOCLONE OKT3 . . . . . . . .3�ORTHO EVRA . . . . . . . . . . . . . .24ORTHO MICRONOR . . . . . . . . .24ORTHO TRI-CYCLEN . . . . . . . . .24ORTHO TRI-CYCLEN LO . . . . . .24ORTHOVISC . . . . . . . . . . . . . . .33OSMOPREP . . . . . . . . . . . . . . . .2�OVACE . . . . . . . . . . . . . . . . . . .21OVCON 35 . . . . . . . . . . . . . . . .24OVCON 50 . . . . . . . . . . . . . . . .24OVIDREL . . . . . . . . . . . . . . . . . .25oxaprozin . . . . . . . . . . . . . . . . .33oxazepam . . . . . . . . . . . . . . . . .15oxcarbazepine . . . . . . . . . . . . .15OXISTAT . . . . . . . . . . . . . . . . . .21OXSORALEN-UL . . . . . . . . . . . .21oxybutynin . . . . . . . . . . . . 28, 48oxybutynin SR. . . . . . . . . . . . . .28oxybutynin XL. . . . . . . . . . . . . .48oxycodone . . . . . . . . . . . . 18, 48oxycodone/acetaminophen . . .18oxycodone/aspirin . . . . . . . . . . .18oxycodone/ibuprofen . . . . 18, 44oxycodone immediate release . .48oxycodone SR . . . . . . . . . . 18, 44OXYCONTIN CR . . . . . . . . 18, 44oxyfast . . . . . . . . . . . . . . . . . . .18OXYIR . . . . . . . . . . . . . . . . . . . .18oxytetracycline . . . . . . . . . . . . .38OXYTROL . . . . . . . . . . . . . 28, 48

PPACERONE . . . . . . . . . . . . . . . .12pacnex wash . . . . . . . . . . . . . .20PALCAPS . . . . . . . . . . . . . . . . .28


pamidronate . . . . . . . . . . . . . . .32PANCRELIPASE . . . . . . . . . . . . .28PANIXINE . . . . . . . . . . . . . . . . .29PANOCAPS . . . . . . . . . . . . . . . .28PANRETIN . . . . . . . . . . . . . . . . .21pantoprazole . . . . . . . 2�, 39, 45papaverine ER. . . . . . . . . . . . . .15PARCOPA . . . . . . . . . . . . . . . . .1�PARLODEL . . . . . . . . . . . . . . . .1�PARNATE . . . . . . . . . . . . . . . . .16paromomycin . . . . . . . . . . . . . .29paroxetine . . . . . . . . . 16, 42, 46paroxetine ER . . . . . . . . . . 16, 46PATADAY . . . . . . . . . . . . . . . . .34PATANASE . . . . . . . . . . . . . . . .35PATANOL . . . . . . . . . . . . . . . . .34PAXIL . . . . . . . . . . . . . 16, 42, 46PAXIL CR . . . . . . . . . . 16, 42, 46PCE . . . . . . . . . . . . . . . . . . . . .30PEG-INTRON . . . . . . . . . . . 31, 39peg 3350 . . . . . . . . . . . . . . . . .2�PEGASYS . . . . . . . . . . . . . 31, 39penicillin VK . . . . . . . . . . . . . . .30PENLAC . . . . . . . . . . . . . . 21, 39PENTASA . . . . . . . . . . . . . 2�, 41pentazocine/acetaminophen . .18pentazocine/naloxone . . . . . . .19PEPCID . . . . . . . . . . . . . . . . . . .2�PEPCID RPD . . . . . . . . . . . . . . .2�PERCOCET . . . . . . . . . . . . . . . .18PERCODAN . . . . . . . . . . . . . . .18PERFOROMIST . . . . . . . . . 35, 46PERIOSTAT . . . . . . . . . . . . . . . .30permethrin . . . . . . . . . . . . . . . .22perphenazine . . . . . . . . . . . . . .1�perphenazine/amitriptyline . . . .1�PERSANTINE . . . . . . . . . . . . . . .10PEXEVA . . . . . . . . . . . 16, 42, 46phenobarbital . . . . . . . . . . . . . .19phenylephrine/promethazine/ codeine . . . . . . . . . . . . . . . . .38phenytoin extended . . . . . . . . .15phenytoin sodium . . . . . . . . . .15PHOSLO . . . . . . . . . . . . . . . . . .28PHOSPHOLINE . . . . . . . . . . . . .33phrenilin/caffeine/codeine . . . .18pilocar . . . . . . . . . . . . . . . . . . .33pilocarpine . . . . . . . . . . . . 33, 35PILOPINE HS . . . . . . . . . . . . . . .33piloptic . . . . . . . . . . . . . . . . . . .33pindolol . . . . . . . . . . . . . . . . . .13piroxicam . . . . . . . . . . . . . . . . .33PLAQUENIL . . . . . . . . . . . . 39, 42PLAVIX . . . . . . . . . . . . . . . . . . .10PLENAXIS . . . . . . . . . . . . . . . . . .9PLENDIL . . . . . . . . . . . . . . . . . .13

PLETAL . . . . . . . . . . . . . . . . . . .10PLEXION . . . . . . . . . . . . . . . . . .20PLEXION SCT . . . . . . . . . . . . . .20PLEXION TS . . . . . . . . . . . . . . .20podofilox . . . . . . . . . . . . . 22, 42poly-dex . . . . . . . . . . . . . . . . . .34POLY-PRED . . . . . . . . . . . . . . . .34polyethylene glycol . . . . . . . . . .2�POLYGAM S/D . . . . . . . . . . . . .36polymyxin B/trimethoprim . . . .34PONSTEL. . . . . . . . . . . . . . . . . .33portia . . . . . . . . . . . . . . . . . . . .24PRANDIMET . . . . . . . . . . . . . . .23PRANDIN . . . . . . . . . . . . . . . . .23PRAVACHOL . . . . . . . . . . 12, 41pravastatin . . . . . . . . . 12, 41, 46prazosin . . . . . . . . . . . . . . . . . .11PRECISION QID . . . . . . . . . 24, 4�PRECISION SOF-TACT . . . . 25, 4�PRECISION XTRA . . . . . . . 25, 4�PRECOSE . . . . . . . . . . . . . . . . .22PRED-G. . . . . . . . . . . . . . . . . . .34PRED-G S.O.P . . . . . . . . . . . . . .34prednicarbate . . . . . . . . . . . . . .22prednisolone . . . . . . . . . . 26, 34prednisone . . . . . . . . . . . . . . . .26PREFEST . . . . . . . . . . . . . . . . . .26pregnyl . . . . . . . . . . . . . . . . . . .25PREMARIN . . . . . . . . . . . . . . . .26PREMARIN VAGINAL . . . . . . . .29PREMPHASE . . . . . . . . . . . . . . .26PREMPRO . . . . . . . . . . . . . . . . .26PREVACID . . . . . . 2�, 39, 45, 48PREVACID NAPRAPAC . . . 33, 39PREVACID SOLUTAB . . . . 2�, 45prevalite . . . . . . . . . . . . . . . . . .12previfem . . . . . . . . . . . . . . . . . .24PREVPAC . . . . . . . . . . . . . 2�, 45PREZISTA . . . . . . . . . . . . . . . . .31PRIALT . . . . . . . . . . . . . . . . . . .15PRILOSEC . . . . . . . 2�, 39, 45, 48PRIMALEV . . . . . . . . . . . . . . . .18primaquine . . . . . . . . . . . . . . . .30primidone . . . . . . . . . . . . . . . . .15principen . . . . . . . . . . . . . . . . .29PRINIVIL . . . . . . . . . . . . . . . . . .11PRINZIDE. . . . . . . . . . . . . . . . . .11PRISTIQ . . . . . . . . . . . . 16, 42, 46PRIVIGEN . . . . . . . . . . . . . . . . .36PROAIR . . . . . . . . . . . . . . . . . . .35probenecid . . . . . . . . . . . . . . . .25probenecid/colchicine . . . . . . . .25procainamide . . . . . . . . . . . . . .12procainamide ER . . . . . . . . . . .12PROCARDIA . . . . . . . . . . . . . . .14PROCARDIA XL . . . . . . . . . . . .14PROCENTRA . . . . . . . . 19, 45, 48

PROCHIEVE . . . . . . . . . . . . . . .29prochlorperazine . . . . . . . . . . .1�PROCRIT . . . . . . . . . . . . . . 10, 39PROFILNINE . . . . . . . . . . . 10, 38PROGESTERONE VAGINAL . . . .29PROGLYCEM . . . . . . . . . . . . . .25PROGRAF . . . . . . . . . . . . . . . . .3�PROMACTA . . . . . . . . . . . . . . .10promethazine . . . . . . . . . . . . . .38promethazine/codeine . . . . . . .38PROMETRIUM. . . . . . . . . . . . . .26PROMISEB . . . . . . . . . . . . . . . .21PRONESTYL . . . . . . . . . . . . . . .12PRONESTYL SR . . . . . . . . . . . . .12propafenone . . . . . . . . . . . . . .12PROPINE . . . . . . . . . . . . . . . . . .33PROPLEX T . . . . . . . . . . . . 10, 39propoxyphene . . . . . . . . . . . . .18propoxyphene-N/ acetaminophen . . . . . . . . . . .18propoxyphene/acetaminophen .18 propranolol . . . . . . . . . . . . . .13propranolol/ hydrochlorothiazide . . . . . . .13propranolol SR . . . . . . . . . . . . .13propylthiouracil . . . . . . . . . . . .26PROQUIN XR . . . . . . . . . . 29, 38PROSCAR . . . . . . . . . . . . . 28, 38PROTONIX . . . . . . 2�, 39, 45, 48PROTOPIC . . . . . . . . . . . . 22, 4�PROTROPIN . . . . . . . . . . . . . . .39PROVENTIL HFA . . . . . . . . . . . .35PROVIGIL . . . . . . . 19, 39, 45, 48PROZAC . . . . . . . . . . . 16, 41, 46PROZAC WEEKLY . . . . . . . 16, 46prudoxin . . . . . . . . . . . . . . . . . .21PSORIATEC . . . . . . . . . . . . . . . .21PULMICORT . . . . . . . . . . . . . . .46PULMICORT FLEXHALER . . . . . .35PULMICORT RESPULES . . . . . . .35PULMOZYME . . . . . . . . . . . . . .35PURINETHOL . . . . . . . . . . . . . . . .9PYLERA. . . . . . . . . . . . . . . 2�, 45pyrazinamide . . . . . . . . . . . . . .31pyridostigmine . . . . . . . . . . . . .32

Qquasense . . . . . . . . . . . . . . . . .24QUESTRAN . . . . . . . . . . . . . . . .12quinapril . . . . . . . . . . . . . . . . . .11quinaretic . . . . . . . . . . . . . . . . .11quinerva . . . . . . . . . . . . . . . . . .30quinidine gluconate . . . . . . . . .12quinidine sulfate . . . . . . . . . . . .12quinine sulfate . . . . . . . . . . . . .30QUIXIN . . . . . . . . . . . . . . . . . . .34QVAR . . . . . . . . . . . . . . . . . . . .35

Index


Rramipril . . . . . . . . . . . . . . . 11, 46RANEXA . . . . . . . . . . . 12, 40, 46RANICLOR . . . . . . . . . . . . . . . .29ranitidine . . . . . . . . . . . . . . . . .2�RAPAFLO . . . . . . . . . . . . . 28, 38RAPAMUNE . . . . . . . . . . . . . . .3�RAPIFLUX . . . . . . . . . . 16, 41, 46rauwolfia/ bendroflumethiazide . . . . . . .14RAZADYNE . . . . . . . . . . . . . . . .15RAZADYNE ER . . . . . . . . . . . . .15REBETOL . . . . . . . . . . . . . . . . . .31REBIF . . . . . . . . . . . . . . . . 18, 4�RECLAST. . . . . . . . . . . . . . . . . .33reclipsen . . . . . . . . . . . . . . . . . .24RECOMBINATE . . . . . . . . . 10, 38REFACTO . . . . . . . . . . . . . 10, 38RELENZA. . . . . . . . . . . . . . 31, 42RELION . . . . . . . . . . . . . . . 23, 4�RELISTOR . . . . . . . . . . . . . . . . .28RELPAX. . . . . . . . . . . . 1�, 43, 4�REMERON . . . . . . . . . 16, 42, 4�REMERON SOLUTAB . . . . 16, 4�REMICADE . . . . . . . . . . . . 21, 32REMODULIN . . . . . . . . . . . . . . .14RENAGEL . . . . . . . . . . . . . . . . .28RENVELA . . . . . . . . . . . . . . . . .28REPREXAIN . . . . . . . . . . . . . . . .18REPRONEX . . . . . . . . . . . . . . . .25REQUIP . . . . . . . . . . . . . . . . . . .1�REQUIP XL . . . . . . . . . . . . 1�, 46RESCRIPTOR . . . . . . . . . . . . . . .31reserpine . . . . . . . . . . . . . . . . .11RESTASIS . . . . . . . . . . . . . . . . .34RETIN-A . . . . . . . . . . . . . . 20, 38RETIN-A MICRO . . . . . . . . 20, 38RETROVIR . . . . . . . . . . . . . . . . .31REV-EYES . . . . . . . . . . . . . . . . .33REVATIO . . . . . . . . . . . . . . 14, 39REVLIMID . . . . . . . . . . . . . . . . . .9REYATAZ . . . . . . . . . . . . . . . . .31RHEUMATREX . . . . . . . . . . . . .32RHINOCORT AQ . . . . . . . . 36, 48RHOGAM ULTRA-FILTERED PLUS . . . . . . . . . . . . . . . . . . .36RHOPHYLAC . . . . . . . . . . . . . .36RIASTAP . . . . . . . . . . . . . . . . . .10ribasphere . . . . . . . . . . . . . . . .31ribavirin . . . . . . . . . . . . . . . . . .31RIDAURA . . . . . . . . . . . . . . . . .32RIFAMATE . . . . . . . . . . . . . . . .31rifampin . . . . . . . . . . . . . . . . . .31RIFATER . . . . . . . . . . . . . . . . . .31RILUTEK . . . . . . . . . . . . . . 15, 38rimantadine . . . . . . . . . . . . . . .31

RIMSO . . . . . . . . . . . . . . . . . . .28RIOMET . . . . . . . . . . . . . . . . . .22RISPERDAL . . . . . . . . . 1�, 42, 4�RISPERDAL M . . . . . . . 1�, 42, 4�risperidone . . . . . . . . . 1�, 42, 4�risperidone ODT . . . . . 1�, 42, 4�RITALIN . . . . . . . . . . . . 20, 45, 48RITALIN LA . . . . . . . . . 20, 45, 48RITALIN SR . . . . . . . . . 20, 45, 48RITUXAN . . . . . . . . . . . . . . 9, 39ropinirole hcl . . . . . . . . . . 1�, 46ROSAC . . . . . . . . . . . . . . . . . . .20ROSULA . . . . . . . . . . . . . . . . . .20ROSULA NS . . . . . . . . . . . . . . .21ROWASA . . . . . . . . . . . . . 2�, 41ROXICET . . . . . . . . . . . . . . . . . .19ROZEREM . . . . . . . . . . 19, 44, 4�ROZEX . . . . . . . . . . . . . . . . . . .20RYTHMOL . . . . . . . . . . . . . . . .12RYTHMOL SR . . . . . . . . . . . . . .12RYZOLT . . . . . . . . . . . . . . 18, 48

SSAIZEN . . . . . . . . . . . . 25, 39, 4�SALAGEN . . . . . . . . . . . . . . . . .35SAMSCA . . . . . . . . . . 26, 39, 45SANCTURA . . . . . . . . . . . . 28, 48SANCTURA XR . . . . . . . . . 28, 48SANCUSO PAD . . . . . . 2�, 43, 4�SANDIMMUNE . . . . . . . . . . . . .3�SANDOSTATIN . . . . . . . . . . . . .22SANDOSTATIN LAR . . . . . . . . .22SARAFEM . . . . . . . . . . . . . 19, 42SAVELLA. . . . . . . . . . . . . . 1�, 42SCALACORT DK . . . . . . . . . . . .21SEASONALE . . . . . . . . . . . . . . .24SEASONIQUE . . . . . . . . . . . . . .24SEBIZON . . . . . . . . . . . . . . . . . .21SECONAL . . . . . . . . . . . . . . . . .19SECTRAL. . . . . . . . . . . . . . . . . .13selegiline . . . . . . . . . . . . . . . . .1�selenium sulfide . . . . . . . . . . . .21selfemra . . . . . . . . . . . . . . 19, 42SELZENTRY . . . . . . . . . . . . . . . .31SEMPREX-D . . . . . . . . 36, 38, 40SENSIPAR . . . . . . . . . . . . . . . . .26SEREVENT . . . . . . . . . . . . . . . . .46SEREVENT DISKUS . . . . . . . . . .35SEROQUEL . . . . . . . . . 1�, 43, 4�SEROQUEL XR . . . . . . 1�, 43, 4�SEROSTIM . . . . . . . . . . . . 25, 39sertraline . . . . . . . 16, 42, 46, 4�SIMCOR . . . . . . . . . . . . . . 12, 41SIMPONI . . . . . . . . . . . . . . 21, 32SIMULECT . . . . . . . . . . . . . . . .3�simvastatin . . . . . . . . . 12, 41, 46SINEMET . . . . . . . . . . . . . . . . . .1�

SINEMET CR . . . . . . . . . . . . . . .1�SINGULAIR . . . . . . . . . . . . 35, 40SKELAXIN . . . . . . . . . . . . . . . . .32SKELID . . . . . . . . . . . . . . . . . . .32sodium sulfacetamide/sulfur . . .20SOLARAZE . . . . . . . . . . . . 21, 40solia . . . . . . . . . . . . . . . . . . . . .24SOLIRIS . . . . . . . . . . . . . . . . . . .10SOLODYN . . . . . . . . . . . . . 30, 38SOMATULINE . . . . . . . . . . . . . .22SOMAVERT . . . . . . . . . . . 22, 25SONATA . . . . . . . . . . . 19, 44, 4�SORIATANE . . . . . . . . . . . . . . .21sorine . . . . . . . . . . . . . . . . . . . .13sotalol . . . . . . . . . . . . . . . 13, 46sotalol AF . . . . . . . . . . . . . . . . .13sotret . . . . . . . . . . . . . . . . 20, 38SPECTRACEF . . . . . . . . . . . . . .29SPIRIVA . . . . . . . . . . . . . . . . . . .35spironolactone . . . . . . . . . . . . .14spironolactone/ hydrochlorothiazide . . . . . . .14SPORANOX . . . . . . . . . . . 30, 39sprintec . . . . . . . . . . . . . . . . . .24SPRYCEL . . . . . . . . . . . . 9, 39, 43sronyx . . . . . . . . . . . . . . . . . . . .24STADOL NS . . . . . . . . . . . . . . .44STAFLEX . . . . . . . . . . . . . . . . . .19STAGESIC . . . . . . . . . . . . . . . . .19STALEVO . . . . . . . . . . . . . . . . .1�STARLIX . . . . . . . . . . . . . . . . . .23stavudine . . . . . . . . . . . . . . . . .31STAVZOR . . . . . . . . . . . . . . . . .16STIMATE . . . . . . . . . . . . . . 23, 39STRATTERA . . . . . . . . 19, 45, 48STRIANT . . . . . . . . . . . . . . 25, 48SUBOXONE . . . . . . . . . . . . . . .19SUBUTEX . . . . . . . . . . . . . . . . .19SUCRAID . . . . . . . . . . . . . . . . .26sucralfate . . . . . . . . . . . . . . . . .2�SULAR . . . . . . . . . . . . . . . . . . .14SULFACET-R . . . . . . . . . . . . . . .20sulfacetamide sodium . . . . 21, 34sulfacetamide sodium/ prednisolone . . . . . . . . . . . . .34sulfadiazine . . . . . . . . . . . . . . .30sulfasalazine . . . . . . . . . . . 2�, 41sulfasalazine EC . . . . . . . . . . . .41sulfasalazine ER . . . . . . . . . . . .2�sulfatol . . . . . . . . . . . . . . . . . . .20sulfazine . . . . . . . . . . . . . . 28, 41sulfazine EC . . . . . . . . . . . 28, 41sulfisoxazole . . . . . . . . . . . . . . .30SULFOXYL . . . . . . . . . . . . . . . .20sulfurated lime solution . . . . . .22sulindac . . . . . . . . . . . . . . . . . .33


sumatriptan . . . . . . . . 1�, 43, 4�SUMAXIN PAD . . . . . . . . . . . . .20SUMYCIN . . . . . . . . . . . . . . . . .30SUPARTZ . . . . . . . . . . . . . . . . .33SUPPRELIN LA . . . . . . . . . . . . . .26SUPRAX . . . . . . . . . . . . . . . . . .29SURESTEP . . . . . . . . . . . . . . . . .4�SUSTIVA . . . . . . . . . . . . . . . . . .31SUTENT . . . . . . . . . . . . 9, 39, 43SYMBICORT . . . . . . . . . . . . . . .35SYMBYAX . . . . . . . . . . . . 1�, 43SYMLIN . . . . . . . . . . . . . . 22, 38SYMLINPEN . . . . . . . . . . . 22, 38SYMMETREL . . . . . . . . . . . . . . .1�SYNAGIS . . . . . . . . . . . . . 36, 39SYNALGOS DC . . . . . . . . . . . . .19SYNAREL . . . . . . . . . . . . . . . . .26SYNERA . . . . . . . . . . . . . . . . . .21syntest D.S. . . . . . . . . . . . . . . .26syntest H.S. . . . . . . . . . . . . . . .26SYNTHROID . . . . . . . . . . . . . . .26SYNVISC . . . . . . . . . . . . . . . . . .33SYPRINE . . . . . . . . . . . . . . . . . .36

TTABLOID . . . . . . . . . . . . . . . . . . .9TACLONEX . . . . . . . . . . . . 21, 22TAGAMET . . . . . . . . . . . . . . . .2�TALACEN . . . . . . . . . . . . . . . . .19TALWIN NX . . . . . . . . . . . . . . .19TAMBOCOR . . . . . . . . . . . . . . .12TAMIFLU. . . . . . . . . . . . . . 31, 42tamoxifen . . . . . . . . . . . . . . . . . .9TAPAZOLE . . . . . . . . . . . . . . . .26TARCEVA . . . . . . . . . . . . . . 9, 43TARGRETIN . . . . . . . . . . . . . 9, 21TARKA . . . . . . . . . . . . . . . . . . .14TASIGNA . . . . . . . . . . . 9, 39, 43TASMAR . . . . . . . . . . . . . . . . . .16TAZORAC . . . . . . . . . . 21, 38, 46taztia XT . . . . . . . . . . . . . . . . . .14tebamide . . . . . . . . . . . . . . . . .2�TEGRETOL . . . . . . . . . . . . . . . .15TEGRETOL XR . . . . . . . . . . . . . .15TEKTURNA . . . . . . . . . . . . 14, 40TEKTURNA HCT . . . . . . . . 14, 40temazepam . . . . . . . . . . . . . . .19TEMODAR . . . . . . . . . . . . . 9, 43TENEX . . . . . . . . . . . . . . . . . . .11TENORETIC . . . . . . . . . . . . . . . .13TENORMIN . . . . . . . . . . . . . . . .13TEQUIN. . . . . . . . . . . . . . . . . . .38TERAZOL . . . . . . . . . . . . . . . . .28terazosin . . . . . . . . . . . . . . . . . .11terbinafine . . . . . . . . . . . . 30, 39terbutaline . . . . . . . . . . . . . . . .35terconazole. . . . . . . . . . . . . . . .29

TESTIM . . . . . . . . . . . . . . . 25, 48testosterone inj. . . . . . . . . . . . .25tetracycline . . . . . . . . . . . . 30, 38TEV-TROPIN . . . . . . . . 25, 39, 4�TEVETEN . . . . . . . . . . . 11, 40, 46TEVETEN HCT . . . . . . . . . . 11, 46THALITONE . . . . . . . . . . . . . . . .14THALOMID . . . . . . . . . . . . . . . . .9THEO-24. . . . . . . . . . . . . . . . . .35theocap . . . . . . . . . . . . . . . . . .35theochron. . . . . . . . . . . . . . . . .35theophylline ER. . . . . . . . . . . . .35thioridazine . . . . . . . . . . . . . . .1�thiothixene . . . . . . . . . . . . . . . .1�THYMOGLOBULN . . . . . . . . . . .3�THYROGEN . . . . . . . . . . . . . . .25THYROLAR . . . . . . . . . . . . . . . .26TIAZAC . . . . . . . . . . . . . . . . . . .14TICLID . . . . . . . . . . . . . . . . . . . .10ticlopidine . . . . . . . . . . . . . . . . .10TIKOSYN. . . . . . . . . . . . . . . . . .12TIMOLIDE . . . . . . . . . . . . . . . . .13timolol . . . . . . . . . . . . . . . . . . .33timolol maleate . . . . . . . . . . . .13timolol maleate ophth . . . . . . .33TINDAMAX . . . . . . . . . . . . . . . .30tinidazole . . . . . . . . . . . . . . . . .30tioconazole . . . . . . . . . . . . . . . .29tizanidine . . . . . . . . . . . . . . . . .32TOBI . . . . . . . . . . . . . . . . . . . . .35TOBRADEX . . . . . . . . . . . . . . . .34tobramycin . . . . . . . . . . . . . . . .34tobramycin/dexamethasone . . .34tolazamide . . . . . . . . . . . . . . . .23tolbutamide . . . . . . . . . . . . . . .23tolmetin sodium . . . . . . . . . . . .33TOPAMAX . . . . . . . . . . . . 15, 46topiramate . . . . . . . . . . . . 15, 46TOPROL XL . . . . . . . . . . . . . . . .13TORADOL . . . . . . . . . . . . . . . . .44torsemide . . . . . . . . . . . . . . . . .14TOVIAZ . . . . . . . . . . . . . . . 28, 48TRACLEER . . . . . . . . . . . . . . . .14tramadol. . . . . . . . . . . . . . 18, 48tramadol/acetaminophen . . . . .19TRANDATE . . . . . . . . . . . . . . . .10trandolapril . . . . . . . . . . . . . . . .11TRANSDERM-SCOP . . . . . . . . .2�tranylcypromine sulfate . . . . . .16TRAVATAN . . . . . . . . . . . . . . . .33TRAVATAN Z . . . . . . . . . . . . . .33trazodone . . . . . . . . . . . . . . . . .16TREAGAN . . . . . . . . . . . . . . . . .35TRELSTAR DEPOT . . . . . . . . . . . .9TRELSTAR LA . . . . . . . . . . . . . . .9TRETIN-X . . . . . . . . . . . . . . . . .38

tretinoin . . . . . . . . . 9, 20, 38, 43TREXALL . . . . . . . . . . . . . . . . . . .9TREXIMET . . . . . . . . . . 1�, 43, 4�TRI-LEVLEN . . . . . . . . . . . . . . . .24tri-lo-sprintec . . . . . . . . . . . . . .24TRI-NORINYL . . . . . . . . . . . . . .24tri-previfem . . . . . . . . . . . . . . . .24tri-sprintec . . . . . . . . . . . . . . . .24triamcinolone . . . . . . . . . . . . . .22triamterene/ hydrochlorothiazide . . . . . . .14TRIAZ . . . . . . . . . . . . . . . . . . . .20triazolam . . . . . . . . . . . . . . . . .19TRICOR . . . . . . . . . . . . . . . . . . .12trifluoperazine . . . . . . . . . . . . .1�trifluridine . . . . . . . . . . . . . . . . .34TRIGLIDE. . . . . . . . . . . . . . 12, 4�trihexyphenidyl . . . . . . . . . . . . .16TRILEPTAL . . . . . . . . . . . . . . . . .15TRILIPIX . . . . . . . . . . . . . . . 12, 4�trilyte . . . . . . . . . . . . . . . . . . . .2�trimethobenzamide . . . . . . . . .2�trimethoprim . . . . . . . . . . . . . .30trimox . . . . . . . . . . . . . . . . . . . .29trinessa . . . . . . . . . . . . . . . . . . .24TRIOXIN . . . . . . . . . . . . . . . . . .35TRIPHASIL . . . . . . . . . . . . . . . . .24triple antibiotic . . . . . . . . . . . . .34trivora . . . . . . . . . . . . . . . . . . . .24TRIZIVIR . . . . . . . . . . . . . . . . . .31TRUSOPT . . . . . . . . . . . . . 33, 4�TRUVADA . . . . . . . . . . . . . . . . .31TRYCET . . . . . . . . . . . . . . . . . .19TUSSIONEX . . . . . . . . . . . . . . . .36TWINJECT . . . . . . . . . . . . . . . . .10TYKERB . . . . . . . . . . . . . . . 9, 43TYLENOL/CODEINE . . . . . . . . . .19TYLOX . . . . . . . . . . . . . . . . . . .19TYSABRI . . . . . . . . . . . . . . 18, 39TYZEKA . . . . . . . . . . . . . . . . . .31

UULESFIA . . . . . . . . . . . . . . . . . .22ULORIC. . . . . . . . . . . . . . . 25, 4�ULTRACAPS . . . . . . . . . . . . . . .28ULTRACET . . . . . . . . . . . . . . . .19ULTRAM . . . . . . . . . . . . . . . . . .18ULTRAM ER . . . . . . . . . . . 18, 48ULTRASE. . . . . . . . . . . . . . . . . .28ULTRASE MT . . . . . . . . . . . . . .28ULTRAVATE . . . . . . . . . . . . . . .22UNIPHYL . . . . . . . . . . . . . . . . . .35UNIRETIC . . . . . . . . . . . . . . . . .11unithroid . . . . . . . . . . . . . . . . .26UNIVASC . . . . . . . . . . . . . . . . .11URECHOLINE . . . . . . . . . . . . . .28URELLE . . . . . . . . . . . . . . . . . . .28

Index


UREX . . . . . . . . . . . . . . . . . . . .28URISPAS . . . . . . . . . . . . . . . . . .28UROXATRAL . . . . . . . . . . . 28, 38URSO 250 . . . . . . . . . . . . . . . .2�ursodiol . . . . . . . . . . . . . . . . . .2�URSO FORTE . . . . . . . . . . . . . .2�UTA . . . . . . . . . . . . . . . . . . . . .28

VVAGIFEM . . . . . . . . . . . . . . . . .29valacyclovir . . . . . . . . . . . . . . . .46VALCYTE . . . . . . . . . . . . . 31, 32valproic acid . . . . . . . . . . . . . . .16VALTREX . . . . . . . . . . . . . 31, 46vanatrip . . . . . . . . . . . . . . . . . .16vandazole . . . . . . . . . . . . . . . . .29VANOS . . . . . . . . . . . . . . . . . . .22VANOXIDE . . . . . . . . . . . . . . . .20VANTAS . . . . . . . . . . . . . . . . . . .9VANTIN . . . . . . . . . . . . . . . . . .29VASERETIC . . . . . . . . . . . . . . . .11VASODILAN . . . . . . . . . . . . . . .15VASOTEC . . . . . . . . . . . . . . . . .11VECTIBIX . . . . . . . . . . . . . . 9, 39VECTICAL . . . . . . . . . . . . . 21, 46veetids . . . . . . . . . . . . . . . . . . .30velivet . . . . . . . . . . . . . . . . . . . .24venlafaxine . . . . . . . . . 16, 42, 46VENLAFAXINE ER . . . . 16, 42, 46VENOFER . . . . . . . . . . . . . . . . .36VENTAVIS . . . . . . . . . . . . . . . . .14VENTOLIN HFA . . . . . . . . . . . . .35VEPESID . . . . . . . . . . . . . . . . . . .9VERAMYST . . . . . . . . . . . . 36, 48verapamil . . . . . . . . . . . . . . . . .14verapamil CE/ER/SR . . . . . . . . . .14VERDESO . . . . . . . . . . . . . . . . .22VEREGEN . . . . . . . . . . . . . 22, 44VERELAN . . . . . . . . . . . . . . . . .14VERELAN PM . . . . . . . . . . . . . .14VERIPRED . . . . . . . . . . . . . . . . .26VESANOID . . . . . . . . . . . . . 9, 43VESICARE . . . . . . . . . . . . . 28, 48VEXOL . . . . . . . . . . . . . . . . . . .34VFEND . . . . . . . . . . . . . . . . . . .30VIBRAMYCIN . . . . . . . . . . . . . .30VIBRATAB . . . . . . . . . . . . . 30, 38VICODIN . . . . . . . . . . . . . . . . . .19VICODIN ES . . . . . . . . . . . . . . .19vicodin HP . . . . . . . . . . . . . . . .19VICOPROFEN . . . . . . . . . . . . . .19VIDEX . . . . . . . . . . . . . . . . . . . .31VIDEX EC . . . . . . . . . . . . . . . . .31VIGAMOX . . . . . . . . . . . . . . . .34

VIMPAT . . . . . . . . . . . 15, 38, 40VIOKASE. . . . . . . . . . . . . . . . . .28VIRACEPT . . . . . . . . . . . . . . . . .31VIRAMUNE . . . . . . . . . . . . . . . .31VIRAZOLE . . . . . . . . . . . . . . . . .31VIREAD . . . . . . . . . . . . . . . . . . .31VISICOL . . . . . . . . . . . . . . . . . .2�VISTIDE . . . . . . . . . . . . . . . . . . .32VISUDYNE . . . . . . . . . . . . . . . .33VIVAGLOBIN . . . . . . . . . . . . . . .36VIVELLE . . . . . . . . . . . . . . 26, 42VIVELLE-DOT . . . . . . . . . . 26, 42VIVITROL . . . . . . . . . . . . . . . . .36VIVOTIF BERNIA EC . . . . . . . . .39VOLTAREN . . . . . . . . . . . . 33, 34VOLTAREN GEL . . . . . 33, 44, 48VOLTAREN XR . . . . . . . . . . . . .33VOPAC . . . . . . . . . . . . . . . . . . .19VOSPIRE ER . . . . . . . . . . . . . . .35VUSION . . . . . . . . . . . . . . . . . .21VYTORIN . . . . . . . . . . 12, 41, 46VYVANSE . . . . . . . . . . 19, 45, 48

Wwarfarin . . . . . . . . . . . . . . . . . .10WELCHOL . . . . . . . . . . . . . . . .12WELLBUTRIN . . . . . . . 16, 41, 4�WELLBUTRIN SR . . . . . 16, 41, 4�WELLBUTRIN XL . . . . . 16, 41, 46WINRHO SDF . . . . . . . . . . . . . .36

XXALATAN . . . . . . . . . . . . . . . . .33XANAX XR . . . . . . . . . . . . . . . .15XELODA . . . . . . . . . . . . . . . 9, 43XENAZINE . . . . . . . . . . . . . 1�, 39XIBROM . . . . . . . . . . . . . . . . . .34XIFAXAN . . . . . . . . . . 30, 39, 43XODOL . . . . . . . . . . . . . . . . . . .19XOLAIR . . . . . . . . . . . . . . . 35, 38XOLEGEL . . . . . . . . . . . . . . . . .21XOLOX . . . . . . . . . . . . . . . . . . .18XOPENEX . . . . . . . . . . . . . 35, 46XOPENEX HFA . . . . . . . . . . . . .35XYNTHA . . . . . . . . . . . . . . 10, 38XYREM . . . . . . . . . . . . . . . 19, 39XYZAL . . . . . . . . . . . . 36, 38, 40

YYASMIN . . . . . . . . . . . . . . . . . .24YAZ . . . . . . . . . . . . . . . . . . . . .24

ZZ-CLINZ . . . . . . . . . . . . . . . . . .20ZACARE . . . . . . . . . . . . . . . . . .20zaleplon . . . . . . . . . . . . . . 19, 44

ZANAFLEX . . . . . . . . . . . . . . . .32ZANTAC . . . . . . . . . . . . . . . . . .2�ZARONTIN . . . . . . . . . . . . . . . .15ZAROXOLYN . . . . . . . . . . . . . .14ZAVESCA . . . . . . . . . . . . . 10, 39zazole . . . . . . . . . . . . . . . . . . . .29ZEBETA . . . . . . . . . . . . . . . . . . .13ZEGERID . . . . . . . . 2�, 39, 45, 48ZEMPLAR . . . . . . . . . . . . . . . . .26ZENAPAX . . . . . . . . . . . . . . . . .3�ZERIT . . . . . . . . . . . . . . . . . . . .31ZESTORETIC . . . . . . . . . . . . . . .11ZESTRIL . . . . . . . . . . . . . . . . . . .11ZETIA . . . . . . . . . . . . . 12, 38, 41ZIAC . . . . . . . . . . . . . . . . . . . . .13ZIAGEN. . . . . . . . . . . . . . . . . . .31ZIANA . . . . . . . . . . . . . . . . 20, 38zidovudine . . . . . . . . . . . . . . . .31ZINOTIC . . . . . . . . . . . . . . . . . .35ZINOTIC ES . . . . . . . . . . . . . . . .35ZITHROMAX . . . . . . . . . . . . . . .30ZMAX . . . . . . . . . . . . . . . . . . . .30ZOCOR . . . . . . . . . . . . . . . 12, 41ZODERM . . . . . . . . . . . . . . . . .20ZOFRAN . . . . . . . . . . . . . . 2�, 43ZOFRAN ODT . . . . . . . . . . 2�, 43ZOLADEX . . . . . . . . . . . . . . . . . .9ZOLINZA . . . . . . . . . . . . . . . 9, 43ZOLOFT . . . . . . . . . . . 16, 42, 4�zolpidem . . . . . . . . . . 19, 44, 4�ZOMETA . . . . . . . . . . . . . . . . . .33ZOMIG . . . . . . . . . . . . 1�, 43, 4�ZOMIG ZMT . . . . . . . . 1�, 43, 4�ZONALON . . . . . . . . . . . . . . . .21ZONEGRAN . . . . . . . . . . . 15, 38zonisamide . . . . . . . . . . . . 15, 38ZORBTIVE . . . . . . . . . . . . . 22, 39zovia 1/35E . . . . . . . . . . . . . . . .24zovia 1/50E . . . . . . . . . . . . . . . .24ZOVIRAX . . . . . . . . . . . . . 21, 31ZYDONE . . . . . . . . . . . . . . . . . .19ZYFLO CR . . . . . . . . . . . . . 35, 40ZYLET . . . . . . . . . . . . . . . . . . . .34ZYLOPRIM . . . . . . . . . . . . . . . .25ZYMAR . . . . . . . . . . . . . . . . . . .34ZYPREXA . . . . . . . . . . 1�, 43, 4�ZYPREXA ZYDIS . . . . . 1�, 43, 4�ZYVOX . . . . . . . . . . . . . . . 30, 38

61www.aetna.com/formulary

Health benefits and health insurance plans are offered, underwritten or administered by: Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford CT 06156. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Aetna Rx Home Delivery and Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC, and Aetna Specialty Pharmacy, LLC, respectively. Aetna Rx Home Delivery and Aetna Specialty Pharmacy are licensed pharmacy subsidiaries of Aetna Inc.

Not all health services are covered. This material is for information only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.

Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. The availability of a plan or program may vary by geographic service area. Some benefits are subject to limitations or visit maximums.

The term precertification means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company’s clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully-insured HMO and PPO members.

Aetna has established a policy to allow exceptions or overrides to certain refill-too-soon limitations. Requests for such exceptions or overrides will be evaluated on a case-by-case basis. While this material is believed to be accurate as of the print date, it is subject to change.

05.05.303.1H (9/09) ©2009 Aetna Inc.

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