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An Introduction to Independent Health’s MediSource and ... · Max imu Dly ose( ) Certain...

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The following information applies to Independent Health’s New York State Sponsored Plans, Child Health Plus and MediSource (Medicaid). Check your summary of benefits to ensure this formulary is associated with your plan prior to using your prescription drug benefit. This drug formulary lists covered generic and brand-name drugs covered under our Managed Medicaid Plans, MediSource and Child Health Plus. Independent Health makes every attempt to provide you with as accurate a listing of medications as possible. However the list of drugs and availability of generic medications can change frequently. When a generic medication becomes available for a formulary brand-name medication, the generic medication will be covered and the brand-name medication will become non-formulary and will require prior authorization to be covered. Please discuss any questions you may have about the formulary with your provider. Prior-Authorization Independent Health requires you to get prior authorization for certain medications. To obtain coverage for a medication requiring prior authorization, a prior authorization request for medical exception must be submitted by your health care provider and approved by Independent Health’s Medical Director. Medications that require Prior Authorization are listed with a “PA” in the formulary. Step Therapy In some cases, Independent Health requires you to first try certain medications to treat your medical condition before we cover another medication for that condition. Step therapy is a way to help you get the best quality and value from your prescription medication benefit. This usually means that an equally effective generic medication is prescribed before a more expensive brand-name medication. Step therapy may also ensure that two medications are used together if they are more effective. Medications that require Step Therapy are listed with a “ST” in the formulary. Quantity Limitations Quantity limitations may apply to certain medications. Some medications are covered up to a specific quantity per 30 days. Some examples of medications with a quantity limitation are: sumatriptan (generic Imitrex ® ) and zolpidem tartrate (generic Ambien ® ). Medications with quantity limitations are listed with a “QL” in the formulary. Age Restriction Some prescription medications are restricted by age due to safety reasons or Food and Drug Administration (FDA) recommended labeling. Medications with an Age Limit are listed with an “AL” in the formulary. Maximum Daily Dose (MDD) Certain medications are dose limited by a maximum daily dose (MDD) as recommended by the Food and Drug Administration (FDA) for safety reasons. Limits may be set by the number of tablets/capsules per day or the total daily dose. Over-the-Counter (OTC) Medications Certain medications listed in the formulary are available over the counter. A prescription is required for coverage of the OTC products. Sedative/Hypnotic Medications Sedative/hypnotic medications are limited for all prescribers except sleep specialists to 14 tablets/capsules per month with a maximum of 3 fills per year (3 fills/365 days). Compounded Prescription Medications Compounded prescriptions (medications that are not commercially manufactured) must be prepared by a participating pharmacy and contain at least one prescription component. The An Introduction to Independent Health’s MediSource and Child Health Plus Formulary
Transcript
Page 1: An Introduction to Independent Health’s MediSource and ... · Max imu Dly ose( ) Certain medications are dose limited by a maximum daily dose (MDD) as recommended by ... An Introduction

The following information applies to Independent Health’s New York State Sponsored Plans, Child Health Plus and MediSource (Medicaid). Check your summaryof benefits to ensure this formulary is associated with your plan prior to using yourprescription drug benefit.

This drug formulary lists covered generic andbrand-name drugs covered under our ManagedMedicaid Plans, MediSource and Child Health Plus.Independent Health makes every attempt to provide you with as accurate a listing of medications as possible. However the list of drugsand availability of generic medications can changefrequently. When a generic medication becomesavailable for a formulary brand-name medication,the generic medication will be covered and thebrand-name medication will become non-formulary and will require prior authorizationto be covered. Please discuss any questions youmay have about the formulary with your provider.

Prior-AuthorizationIndependent Health requires you to get prior authorization for certain medications. To obtaincoverage for a medication requiring prior authorization, a prior authorization request formedical exception must be submitted by yourhealth care provider and approved by IndependentHealth’s Medical Director. Medications that require Prior Authorization are listed with a “PA” inthe formulary.

Step TherapyIn some cases, Independent Health requires you tofirst try certain medications to treat your medicalcondition before we cover another medication forthat condition. Step therapy is a way to help youget the best quality and value from your prescription medication benefit. This usually meansthat an equally effective generic medication is prescribed before a more expensive brand-name

medication. Step therapy may also ensure that twomedications are used together if they are more effective. Medications that require Step Therapyare listed with a “ST” in the formulary.

Quantity LimitationsQuantity limitations may apply to certain medications. Some medications are covered up toa specific quantity per 30 days. Some examples ofmedications with a quantity limitation are: sumatriptan (generic Imitrex®) and zolpidem tartrate (generic Ambien®). Medications withquantity limitations are listed with a “QL” in theformulary.

Age RestrictionSome prescription medications are restricted byage due to safety reasons or Food and Drug Administration (FDA) recommended labeling.Medications with an Age Limit are listed with an“AL” in the formulary.

Maximum Daily Dose (MDD)Certain medications are dose limited by a maximum daily dose (MDD) as recommended bythe Food and Drug Administration (FDA) for safetyreasons. Limits may be set by the number oftablets/capsules per day or the total daily dose.

Over-the-Counter (OTC) MedicationsCertain medications listed in the formulary areavailable over the counter. A prescription isrequired for coverage of the OTC products.

Sedative/Hypnotic MedicationsSedative/hypnotic medications are limited for allprescribers except sleep specialists to 14tablets/capsules per month with a maximum of 3fills per year (3 fills/365 days).

Compounded Prescription MedicationsCompounded prescriptions (medications that arenot commercially manufactured) must be prepared by a participating pharmacy and containat least one prescription component. The

An Introduction to Independent Health’s MediSource and Child Health Plus Formulary

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dispensing pharmacy is required to submit for priorapproval and when covered, will take the applicable copayment. Coverage is provided in accordance with our Compounding MedicationProducts Policy. Bulk products and powders are excluded from coverage because they are not prescription medication products that are approved under sections 505, 505(j) or 507 of theFederal Food Drug and Cosmetic Act.

Diabetic Supplies/MedicationsProducts listed in this section are a covered benefitbased on your plan. Products not listed requireprior authorization. Copayments vary by plan.

Accu-Check and OneTouch glucose meters,lancets, test strips, and supplies are our preferreddiabetic supplies and do not require prior authorization.

The following manufacturers will provide a glucosemeter to you with no copayment. Quantities arelimited by each manufacturer to one meter permember. Please have your ID number availablewhen you contact the manufacturer:

• Accu-Check Glucose Meters can be obtained bycalling Roche Diagnostics at 1-888-744-3671.

• One Touch Glucose Meters can be obtained bycalling LifeScan, Inc. at 1-888-377-5227, pleasereference offer code 289IHA001.

Antibiotic MedicationsAntibiotics are generally limited to a 10-day supplywith one refill within 15 days after the original fill.

Affordable Care Act (ACA) Preventive ServicesMedications listed on the formulary that are covered as preventive services under the Affordable Care Act may be covered. Certain restrictions may apply.

Dental Formulary Drugs covered on our Dental Formulary are available when prescribed by a dental provider. Unless otherwise specified, all products are limitedto a 10-day supply with one refill. Drugs included

in our Dental Formulary are listed with a “DF” onthe formulary. Drugs without a “DF” will not becovered when written by a Dental Provider.

Lost/Stolen/Damaged Medications and Vacation SuppliesReplacement of any lost, stolen or damaged medications is the responsibility of the member.Vacation supplies are not covered under this benefit. Prior authorization cannot be used to obtain early refills for lost, stolen, or damagedmedications; or for extended supplies or vacationsupplies.

Emergency Room PrescriptionsEmergency Room prescriptions are limited to a 10-day supply.

Enteral and Parenteral Nutritional Formulas Enteral Nutritional Formula and Parenteral Nutritional Formula benefit coverage is based onmedical necessity and prior authorization is required. Supplies that are necessary to administerthe specific type of feeding, and maintain the feeding site are covered. This includes, but is notlimited to: syringes, measuring containers, tipadapters, anchoring devices, gauze pads, protective-dressing wipes, tape, and tube cleaningbrushes.

Pharmacy Administered Immunizations Influenza and pneumococcal vaccinations are covered when administered by licensed pharmacists who obtain additional certification toadminister influenza and pneumococcal vaccinations to adults 18 years of age and older.

Additional Formulary Information:• Appetite suppressants/weight-loss medicationsare excluded from coverage.

• Medications used for cosmetic purposes are excluded from coverage.

• Medical foods other than PKU supplements(which may or may not require a prescription)are excluded from coverage.

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• Prenatal vitamins classified as medical foods arenot covered.

• Medications used for the treatment of erectiledysfunction are not covered.

• Medications used to promote fertility are notcovered.

• Medications or supplies used for gender reassignment are not covered.

• Growth hormones are excluded from coveragewhen prescribed for the treatment of shortstature.

In order to ensure the safest and most appropriatecare, Independent Health’s drug coverage criteriais limited to medically-accepted indications basedon FDA approved labeling and guidelines, that isnot otherwise excluded from New York State Medicaid.

Medications listed on the drug formulary as covered without restriction may require prior authorization or may not be covered if it is determined that they are being used in conjunction with a procedure or treatment notcovered under the members Health Contract.

Medications not recognized by the FDA without aNational Drug Code (NDC) are excluded fromcoverage.

Generic substitution is used only as required bystate pharmacy laws. Therapeutic interchange isnot utilized.

Prescriptions are generally limited to a maximumof a 30-day supply per fill.

Diabetic Test Strips are limited to a maximum of100 per fill/30 days.

Key AL – Age LimitDF – Dental FormularyPA – Prior Authorization RequiredQL – Quantity Limits ApplyRF – Restricted to FemalesRM – Restricted to MalesST – Step TherapyXCHP – Not covered for Child Health Plus

Additional Services for MediSource Members on Next Page

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Adhesive Tape/RemoverAdhesive remover or solvent (for tape, cement orother adhesive), per ounce; tape, non-waterproof,per 18 square inches; tape, waterproof, per 18square inches

AntisepticsAlcohol or peroxide, per pint; alcohol wipes, perbox (100’s); Betadine® or pHisohex® solution, perpint

Breast PumpBreast pump, electric (AC/DC), any type; breastpump, manual, any type

Canes/Crutches/AccessoriesCane, includes canes of all materials, adjustable orfixed, with tip; crutch forearm, includes crutches ofvarious materials; crutch underarm; replacementhandgrip, cane, crutch or walker; replacement tip,cane, crutch or walker; underarm pad, crutch replacement

Commode AccessoriesBed pan, standard/fracture metal or plastic pail orpan for use with commode chair; sitz type bath orequipment; portable urinal; female jug-type, anymaterial; male jug-type, any material

Diabetic Daily CareAlcohol or peroxide, per pint; alcohol wipes, perbox (100’s); infusion set for external insulin pump,needle and non-needle type; infusion set for external insulin pump, non-needle cannula type

Ostomy SuppliesOstomy supplies; pouch, belt, clamp, filter, vent,ring, face, plate, deodorant, skin barrier, misc.; adhesive remover, wipes, any type; adhesive, liquidor equal, any type, per ounce; continent devices;enema bags; irrigation supply lubricant, per ounce;stoma cap

Respiratory/Tracheostomy Care SuppliesAdministration set, with small volume non-filteredpneumatic nebulizer; aerosol mark, used with DMEnebulizer; canister, disposable, used with suctionpump; cannula nasal face tent; cleaning device usedwith tracheoesophageal voice prosthesis, pipet,brush or equal, replacement only; filter, disposableand non-disposable, used with aerosol compressor,airway pressure device; holding chamber or spacerfor use with an inhaler or nebulizer; nebulizer, disposable; oropharyngeal suction catheter; peakexpiratory flow rate meter, hand-held; tracheostomy care kit for new tracheostomy; tracheostomy cleaning brush; tracheostomy mask;tracheostomy supplies; vaporizer, room type

Heat ApplicationElectric heat pad, moist or standard; hot water bottle, ice cap or collar; non-electric heating pad,moist; surgical dressing holder, reusable; surgicalstockings, below knee length; surgical stockings, fulllength; surgical stockings, thigh length; heel orelbow protector

Synthetic Sheep Skin and Decubiti’s CareSynthetic sheepskin pad

ThermometersOral thermometer, reusable, any type; rectal thermometer, reusable, any type; basal thermometer

Support GoodsCervical, flexible, non-adjustable foam collar; slings;splint

MEDICAL SUPPLIES FOR MEDISOURCE MEMBERS ONLY(NOT APPLICABLE TO CHILD HEALTH PLUS)

Covered medical supplies must have a prescription.Formulary restrictions, quantity limits, or coverage limits may apply.

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Underpads/Diapers/LinersAdult disposable incontinence product, brief/diaper; disposable incontinence product,brief/diaper bariatric; adhesive, liquid or equal, anytype, per ounce; disposable liner, shield, guard orpad undergarment for incontinence; disposableunderpads, all sizes; incontinence product, diaper/brief, reusable, any size; incontinence product, protective underpad, reusable, chair size;stoma cap; pediatric sized disposable incontinenceproduct, brief/diaper; youth sized disposable incontinence product, brief/diaper

Incontinence Appliances and Care SuppliesBedside drainage bag; extension urethral clamp orcompression device; incontinence supply, misc.; indwelling catheter, Foley type; insertion tray withor without drainage bag; intermittent urinarycatheter, with insertion supplies; irrigation syringe,bulb or piston; irrigation tray with bulb or pistonsyringe, any purpose; male external catheter; urinary catheter anchoring device, adhesive skin attachment; oral thermometer, reusable, any type;urinary catheter anchoring device, leg strap; urinarydrainage bag; adhesive or non-adhesive disk orfoam pad; appliance cleaner, incontinence and ostomy appliances; leg strap, foam or fabric replacement; leg strap, latex, replacement only, perset; percutaneous catheter/tube anchoring device,adhesive

Family Planning ProductsContraceptive supply, condom, female; contraceptive supply, condom, male; diaphragm kit

GlovesGloves, sterile and non-sterile

Diabetic DiagnosticsInsulin pen, reusable; insulin syringes; lancets; needle, sterile, any-size; spring-powered device forlancet; supplies for self-administration; syringe withneedle, sterile; syringe, sterile; syringe, with orwithout needle; blood ketone test or reagent strip;urine test or reagent strips or tablets; normal, lowand high calibrator solution/chips; replacementbattery for use with home blood glucose monitor

Hearing Aids Battery for use in hearing device; zinc air batteryfor cochlear

Mastectomy CareBreast prosthesis, mastectomy bra; breast prosthesis, mastectomy foam; breast prosthesis, silicone or equal, with integral adhesive; camisole,post-mastectomy

Various Miscellaneous:Automatic blood pressure monitor; incentivespirometer; nasal aspirator; plastic strips; restraints,any type (body, chest, wrist, ankle); misc. DMSsupply or accessory not otherwise specified; sterile6-inch wood applicator w/cotton tips; surgical supply misc.; sphygmomanometer/blood pressureapparatus with cuff and stethoscope, kit;syringe/cartridge for external drug infusion pump;sterile water, saline and/or dextrose (diluent); sterile water/saline 500ml; supplies for maintenance of drug infusion catheter; alginate orother fiber gel dressing; collagen-based woundfiller; collagen dressing, sterile; composite dressing,sterile; conforming bandages; contact layer, sterile;eye pad, sterile and non-sterile; eye patch, occlusive; roam dressing, wound cover; gauze pads,sterile and non-sterile; gauze, impregnated andnon-impregnated; high compression bandage, elastic, knitted/woven; hydrocolloid dressing,wound cover; hydrocolloid dressing, wound filler;light compression bandage, elastic; packing strips,non-impregnated; padding bandage; self-adherentbandage, elastic; specialty absorptive dressing,wound cover; transparent film, sterile; tubulardressing, with or without elastic; zinc paste impregnated bandage

IH21114 REV0615

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Table of Contents

Table of Contents

*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants* ................................................................................................................................................................................................................................ 3*Amebicides* ...................................................................................................................................................................................................................................................................................................................... 3*Aminoglycosides* ......................................................................................................................................................................................................................................................................................................... 3*Analgesics - Anti-Inflammatory* ........................................................................................................................................................................................................................................................................ 3*Analgesics - Nonnarcotic* ...................................................................................................................................................................................................................................................................................... 3*Analgesics - Opioid* ................................................................................................................................................................................................................................................................................................... 3*Androgens-Anabolic* ................................................................................................................................................................................................................................................................................................. 4*Anorectal Agents* ........................................................................................................................................................................................................................................................................................................ 4*Antacids* ............................................................................................................................................................................................................................................................................................................................. 4*Anthelmintics* ................................................................................................................................................................................................................................................................................................................. 4*Antianginal Agents* ..................................................................................................................................................................................................................................................................................................... 4*Antianxiety Agents* ..................................................................................................................................................................................................................................................................................................... 4*Antiarrhythmics* ............................................................................................................................................................................................................................................................................................................ 4*Antiasthmatic And Bronchodilator Agents* ............................................................................................................................................................................................................................................... 4*Anticoagulants* .............................................................................................................................................................................................................................................................................................................. 5*Anticonvulsants* ............................................................................................................................................................................................................................................................................................................ 5*Antidepressants* ........................................................................................................................................................................................................................................................................................................... 5*Antidiabetics* ................................................................................................................................................................................................................................................................................................................... 6*Antidiarrheals* ................................................................................................................................................................................................................................................................................................................. 6*Antidotes* ........................................................................................................................................................................................................................................................................................................................... 6*Antiemetics* ...................................................................................................................................................................................................................................................................................................................... 6*Antifungals* ....................................................................................................................................................................................................................................................................................................................... 6*Antihistamines* .............................................................................................................................................................................................................................................................................................................. 6*Antihyperlipidemics* ................................................................................................................................................................................................................................................................................................... 7*Antihypertensives* ....................................................................................................................................................................................................................................................................................................... 7*Anti-Infective Agents - Misc.* ............................................................................................................................................................................................................................................................................... 7*Antimalarials* ................................................................................................................................................................................................................................................................................................................... 7*Antimyasthenic Agents* ........................................................................................................................................................................................................................................................................................... 7*Antimyasthenic/Cholinergic Agents* .............................................................................................................................................................................................................................................................. 7*Antimycobacterial Agents* ..................................................................................................................................................................................................................................................................................... 7*Antineoplastics And Adjunctive Therapies* .............................................................................................................................................................................................................................................. 7*Antiparkinson Agents* ............................................................................................................................................................................................................................................................................................... 8*Antipsychotics/Antimanic Agents* .................................................................................................................................................................................................................................................................... 8*Antiseptics & Disinfectants* .................................................................................................................................................................................................................................................................................. 8*Antivirals* ............................................................................................................................................................................................................................................................................................................................ 8*Assorted Classes* ........................................................................................................................................................................................................................................................................................................ 9*Beta Blockers* ................................................................................................................................................................................................................................................................................................................ 9*Calcium Channel Blockers* .................................................................................................................................................................................................................................................................................. 9*Cardiotonics* ................................................................................................................................................................................................................................................................................................................. 10*Cardiovascular Agents - Misc.* ....................................................................................................................................................................................................................................................................... 10*Cephalosporins* ......................................................................................................................................................................................................................................................................................................... 10*Contraceptives* ........................................................................................................................................................................................................................................................................................................... 10*Corticosteroids* ........................................................................................................................................................................................................................................................................................................... 10*Cough/Cold/Allergy* ................................................................................................................................................................................................................................................................................................ 10*Dermatologicals* ........................................................................................................................................................................................................................................................................................................ 11*Dietary Products/Dietary Management Products* ............................................................................................................................................................................................................................ 12*Digestive Aids* ............................................................................................................................................................................................................................................................................................................ 12*Diuretics* .......................................................................................................................................................................................................................................................................................................................... 12*Endocrine And Metabolic Agents - Misc.* ............................................................................................................................................................................................................................................... 12*Estrogens* ...................................................................................................................................................................................................................................................................................................................... 12*Fluoroquinolones* ..................................................................................................................................................................................................................................................................................................... 13*Gastrointestinal Agents - Misc.* ..................................................................................................................................................................................................................................................................... 13*Genitourinary Agents - Miscellaneous* ..................................................................................................................................................................................................................................................... 13*Gout Agents* ................................................................................................................................................................................................................................................................................................................. 13*Hematological Agents - Misc.* ......................................................................................................................................................................................................................................................................... 13*Hematopoietic Agents* .......................................................................................................................................................................................................................................................................................... 13

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Table of Contents

*Hypnotics* ....................................................................................................................................................................................................................................................................................................................... 13*Hypnotics/Sedatives/Sleep Disorder Agents* ...................................................................................................................................................................................................................................... 13*Laxatives* ........................................................................................................................................................................................................................................................................................................................ 13*Macrolides* .................................................................................................................................................................................................................................................................................................................... 14*Medical Devices* ....................................................................................................................................................................................................................................................................................................... 14*Migraine Products* ................................................................................................................................................................................................................................................................................................... 14*Minerals & Electrolytes* ........................................................................................................................................................................................................................................................................................ 14*Mouth/Throat/Dental Agents* ........................................................................................................................................................................................................................................................................... 14*Multivitamins* ............................................................................................................................................................................................................................................................................................................... 14*Musculoskeletal Therapy Agents* ................................................................................................................................................................................................................................................................. 14*Nasal Agents - Systemic And Topical* ...................................................................................................................................................................................................................................................... 14*Neuromuscular Agents* ........................................................................................................................................................................................................................................................................................ 14*Nutrients* ......................................................................................................................................................................................................................................................................................................................... 14*Ophthalmic Agents* ................................................................................................................................................................................................................................................................................................. 14*Otic Agents* ................................................................................................................................................................................................................................................................................................................... 15*Passive Immunizing Agents* ............................................................................................................................................................................................................................................................................ 15*Penicillins* ....................................................................................................................................................................................................................................................................................................................... 15*Pharmaceutical Adjuvants* ................................................................................................................................................................................................................................................................................ 15*Progestins* ..................................................................................................................................................................................................................................................................................................................... 15*Psychotherapeutic And Neurological Agents - Misc.* .................................................................................................................................................................................................................... 15*Respiratory Agents - Misc.* ............................................................................................................................................................................................................................................................................... 16*Sulfonamides* .............................................................................................................................................................................................................................................................................................................. 16*Tetracyclines* ............................................................................................................................................................................................................................................................................................................... 16*Thyroid Agents* .......................................................................................................................................................................................................................................................................................................... 16*Ulcer Drugs* .................................................................................................................................................................................................................................................................................................................. 16*Urinary Anti-Infectives* .......................................................................................................................................................................................................................................................................................... 16*Urinary Antispasmodics* ...................................................................................................................................................................................................................................................................................... 16*Vaginal Products* ...................................................................................................................................................................................................................................................................................................... 16*Vasopressors* .............................................................................................................................................................................................................................................................................................................. 16*Vitamins* .......................................................................................................................................................................................................................................................................................................................... 16

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*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants*amphetamine-dextroamphet er 1 ALamphetamine-dextroamphetamine

1 AL

dexmethylphenidate hcl 1 ALdextroamphetamine sulfate er 1 ALdextroamphetamine sulfate oral tablet

1 AL

methylphenidate hcl er (la) 1 ALmethylphenidate hcl er oral tablet extendedrelease* 10 mg, 20 mg

1 AL

methylphenidate hcl oral solution

1 AL

methylphenidate hcl oral tablet 1 ALmodafinil 1 PASTRATTERA 2 PA; AL

*Amebicides*YODOXIN 2

*Aminoglycosides*neomycin sulfate oral 1paromomycin sulfate oral 1TOBI PODHALER 2 PA; QLtobramycin inhalation 1 PA; QL

*Analgesics - Anti-Inflammatory*ARCALYST 2 PAcelecoxib oral 1diclofenac potassium 1diclofenac sodium er 1diclofenac sodium oral 1ENBREL SUBCUTANEOUS* KIT

2 PA

ENBREL SURECLICK 2 PAetodolac oral 1fenoprofen calcium oral capsule 1fenoprofen calcium oral tablet 2flurbiprofen oral 1HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS* 40 MG/0.8ML

2 PA; AL

HUMIRA PEN SUBCUTANEOUS* 40 MG/0.8ML

2 PA; AL

HUMIRA PEN-CROHNS STARTER SUBCUTANEOUS*40 MG/0.8ML

2 PA; AL

HUMIRA PEN-PSORIASIS STARTER SUBCUTANEOUS*40 MG/0.8ML

2 PA; AL

HUMIRA SUBCUTANEOUS*10 MG/0.2ML, 20 MG/0.4ML, 40 MG/0.8ML

2 PA; AL

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

1

INDOCIN 2INDOCIN ORAL 2indomethacin er 1indomethacin oral 1ketoprofen er 1

ketoprofen oral 1ketorolac tromethamine oral 1 PAleflunomide oral 1 PAmeclofenamate sodium oral 1meloxicam oral tablet 1nabumetone oral 1naproxen dr 1naproxen oral 1piroxicam oral 1RIDAURA 2sulindac oral 1

*Analgesics - Nonnarcotic*butalbital-acetaminophen 1butalbital-apap-caffeine oral capsule 50-325-40 mg

1

butalbital-apap-caffeine oral tablet 50-325-40 mg

1

butalbital-asa-caffeine 1choline-mag trisalicylate 1diflunisal oral 1duraxin 1salsalate oral 1

*Analgesics - Opioid*acetaminophen-codeine #2 1acetaminophen-codeine #3 1acetaminophen-codeine #4 1acetaminophen-codeine oral solution

1

buprenorphine hcl sublingual 1 PAbutalbital-apap-caff-cod oral capsule 50-325-40-30 mg

1

butalbital-asa-caff-codeine 1butorphanol tartrate nasal 1 PAcodeine sulfate oral tablet 1fentanyl citrate buccal 1 PAfentanyl transdermal patch 72 hr 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

1 ST

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

1

hydrocodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1

hydrocodone-ibuprofen oral tablet 7.5-200 mg

1

hydromorphone hcl oral 1 SThydromorphone hcl suppository 1 STlevorphanol tartrate oral 1methadone hcl oral 1morphine sulfate (concentrate) oral solution 20 mg/ml

1

morphine sulfate er oral capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 50 mg, 60 mg

1

morphine sulfate er oral capsule extended release 24 hour 100 mg, 80 mg

1 ST

morphine sulfate er oral tablet extendedrelease* 100 mg, 200 mg

1 ST

Drug Tier Notes Drug Tier Notes

Last Updated 10.01.2015

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morphine sulfate er oral tablet extendedrelease* 15 mg, 30 mg, 60 mg

1

morphine sulfate intramuscular* 1morphine sulfate oral solution 10 mg/5ml, 20 mg/5ml

1

morphine sulfate oral tablet 1morphine sulfate suppository 1oxycodone hcl er oral 10 mg, 20 mg, 40 mg

1

oxycodone hcl er oral 80 mg 1 SToxycodone hcl oral tablet 1oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

1

oxycodone-aspirin 1oxycodone-ibuprofen 1oxymorphone hcl 1 PAoxymorphone hcl er oral tablet extended release 12 hr* 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 7.5 mg

1 ST

pentazocine-naloxone hcl 1tramadol hcl er (biphasic) 1 STtramadol hcl er oral capsule extended release 24 hour 150 mg

1 ST

tramadol hcl er oral tablet extended release 24 hr*

1 ST

tramadol hcl oral 1tramadol-acetaminophen 1 PAZUBSOLV 2 PA

*Androgens-Anabolic*ANDROGEL PUMP TRANSDERMAL 20.25 MG/ACT (1.62%)

2 PA; RM

ANDROGEL TRANSDERMAL25 MG/2.5GM (1%), 50 MG/5GM (1%)

2 PA; RM

danazol oral 1methitest 2 PA; RMoxandrolone oral 1testosterone cypionate intramuscular* solution 100 mg/ml, 200 mg/ml

1 PA; RM

testosterone enanthate intramuscular*

1 PA; RM

testosterone transdermal 12.5 mg/act (1%)

1 PA; RM

*Anorectal Agents*hydrocortisone acetate suppository

1

hydrocortisone enema 1lidocaine-hydrocortisone ace cream

1

lidocaine-hydrocortisone ace kit 3-0.5 %, 3-1 %, 3-2.5 %

1

PROCTO-PAK 1PROCTOSOL HC 1PROCTOZONE-HC 1

*Antacids*aluminum hydroxide gel oral suspension 320 mg/5ml

1 XCHP

calcium carbonate antacid oral tablet chewable 500 mg

1 XCHP

mag-al 1 XCHPsodium bicarbonate oral tablet 325 mg

1 XCHP

*Anthelmintics*ALBENZA 2ivermectin oral 1

*Antianginal Agents*ISORDIL TITRADOSE ORAL TABLET 40 MG

2

isosorbide dinitrate er 1isosorbide dinitrate oral 1isosorbide mononitrate 1isosorbide mononitrate er 1NITRO-BID 2nitroglycerin er 1nitroglycerin transdermal 1NITROSTAT 2

*Antianxiety Agents*alprazolam er 1ALPRAZOLAM INTENSOL 2alprazolam oral 1alprazolam xr 1buspirone hcl oral 1chlordiazepoxide hcl 1clorazepate dipotassium 1DIAZEPAM INTENSOL 2diazepam oral solution 1 mg/ml 1diazepam oral tablet 1hydroxyzine hcl oral 1 ALhydroxyzine pamoate oral 1 ALlorazepam oral 1meprobamate 1oxazepam 1

*Antiarrhythmics*amiodarone hcl oral tablet 200 mg, 400 mg

1

disopyramide phosphate oral 1flecainide acetate 1mexiletine hcl oral 1NORPACE CR 2PACERONE ORAL TABLET100 MG, 200 MG

1

propafenone hcl 1propafenone hcl er 1quinidine gluconate er 1quinidine sulfate er 1quinidine sulfate oral 1TIKOSYN 2

*Antiasthmatic And Bronchodilator Agents*ADVAIR DISKUS 2ADVAIR HFA 2albuterol sulfate er 1albuterol sulfate inhalation 1albuterol sulfate oral 1ANORO ELLIPTA 2 AL

Drug Tier Notes Drug Tier Notes

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ARNUITY ELLIPTA 2 ALASMANEX 120 METERED DOSES

2

ASMANEX 14 METERED DOSES

2

ASMANEX 30 METERED DOSES

2

ASMANEX 60 METERED DOSES

2

ASMANEX 7 METERED DOSES

2

ASMANEX HFA 2ATROVENT HFA 2budesonide inhalation 1 ALCOMBIVENT RESPIMAT 2cromolyn sodium inhalation 1 PAFLOVENT DISKUS 2FLOVENT HFA 2FORADIL AEROLIZER 2 STipratropium bromide inhalation 1ipratropium-albuterol 1levalbuterol hcl inhalation nebulization solution 1.25 mg/0.5ml

1

metaproterenol sulfate oral 1montelukast sodium oral 1PULMICORT FLEXHALER 2SEREVENT DISKUS 2 STSPIRIVA HANDIHALER 2 ALSPIRIVA RESPIMAT INHALATION AEROSOL, SOLUTION 2.5 MCG/ACT

2 AL

STIOLTO RESPIMAT 2 ALSYMBICORT 2terbutaline sulfate oral 1theophylline er 1theophylline oral solution 1VENTOLIN HFA 2

*Anticoagulants*ELIQUIS 2enoxaparin sodium 1 PA; QLfondaparinux sodium 1 PA; QLFRAGMIN SUBCUTANEOUS* SOLUTION 10000 UNIT/ML, 12500 UNIT/0.5ML, 15000 UNIT/0.6ML, 18000 UNT/0.72ML, 2500 UNIT/0.2ML, 5000 UNIT/0.2ML, 7500 UNIT/0.3ML, 95000 UNIT/3.8ML

2 PA; QL

JANTOVEN 1PRADAXA 2warfarin sodium oral 1XARELTO 2XARELTO STARTER PACK 2

*Anticonvulsants*BANZEL ORAL SUSPENSION 2 PABANZEL ORAL TABLET 400 MG

2 PA

carbamazepine er 1carbamazepine oral 1

CELONTIN 2clonazepam oral 1DILANTIN ORAL CAPSULE 30 MG

2

divalproex sodium 1divalproex sodium er 1ethosuximide oral 1felbamate 1gabapentin oral 1GABITRIL ORAL TABLET 12 MG, 16 MG

2 PA

lamotrigine oral tablet 1lamotrigine oral tablet chewable 1levetiracetam er 1levetiracetam oral 1ONFI ORAL SUSPENSION 2 PA; ALONFI ORAL TABLET 10 MG, 20 MG

2 PA; AL

oxcarbazepine oral tablet 1phenytoin infatabs 1phenytoin oral suspension 125 mg/5ml

1

phenytoin oral tablet chewable 1phenytoin sodium extended oral capsule 100 mg

1

primidone oral 1SABRIL 2 PA; Must be

obtained through CuraScript only

tiagabine hcl 1 PAtopiramate oral 1valproic acid oral 1VIMPAT ORAL 2 PA; ALzonisamide oral 1 PA

*Antidepressants*amitriptyline hcl oral 1amoxapine 1bupropion hcl er (sr) 1bupropion hcl er (xl) 1bupropion hcl oral 1citalopram hydrobromide 1clomipramine hcl oral 1desipramine hcl oral 1doxepin hcl oral 1duloxetine hcl oral 1 PAescitalopram oxalate 1fluoxetine hcl oral capsule 40 mg

1

fluoxetine hcl oral capsule delayed release

1

fluoxetine hcl oral solution 1fluvoxamine maleate 1imipramine hcl oral 1imipramine pamoate 1maprotiline hcl 1 PAmirtazapine oral 1nortriptyline hcl oral 1paroxetine hcl 1paroxetine hcl er 1 STPAXIL ORAL SUSPENSION 2phenelzine sulfate oral 1

Drug Tier Notes Drug Tier Notes

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protriptyline hcl 1sertraline hcl oral 1tranylcypromine sulfate 1trazodone hcl oral 1venlafaxine hcl 1venlafaxine hcl er oral capsule extended release 24 hour

1

venlafaxine hcl er oral tablet extended release 24 hr* 150 mg, 37.5 mg, 75 mg

1

*Antidiabetics*acarbose 1ACTOPLUS MET XR 2BYDUREON SUBCUTANEOUS* SUSPENSION RECONSTITUTED

2 ST

BYETTA 5 MCG PEN 2 STchlorpropamide 1 PAglimepiride 1glipizide er 1glipizide oral 1glipizide-metformin hcl 1GLUCAGON EMERGENCY 1glyburide micronized 1glyburide oral 1glyburide-metformin 1HUMALOG 2HUMALOG KWIKPEN SUBCUTANEOUS* 100 UNIT/ML

2

HUMALOG MIX 50/50 2HUMALOG MIX 50/50 KWIKPEN

2

HUMALOG MIX 75/25 2HUMALOG MIX 75/25 KWIKPEN

2

HUMULIN 70/30 2 XCHPHUMULIN 70/30 KWIKPEN 2HUMULIN N 2 XCHPHUMULIN N KWIKPEN 2HUMULIN R 2 XCHPHUMULIN R U-500 (CONCENTRATED)

2

INVOKAMET 2INVOKANA 2JANUMET 2JANUMET XR 2JANUVIA 2JENTADUETO 2KORLYM 2 PALANTUS 2LANTUS SOLOSTAR 2LEVEMIR 2LEVEMIR FLEXTOUCH 2metformin hcl er 1metformin hcl oral 1nateglinide 1 PANOVOLIN 70/30 2 XCHPNOVOLIN N 2 XCHPNOVOLIN R 2 XCHP

NOVOLOG 2NOVOLOG FLEXPEN 2NOVOLOG MIX 70/30 2NOVOLOG MIX 70/30 FLEXPEN

2

NOVOLOG PENFILL 2ONGLYZA 2pioglitazone hcl 1pioglitazone hcl-glimepiride 1pioglitazone hcl-metformin hcl 1PRANDIMET 2repaglinide 1RIOMET 2SYMLINPEN 120 2 PAtolbutamide 2TOUJEO SOLOSTAR 2TRADJENTA 2VICTOZA 2 ST

*Antidiarrheals*anti-diarrheal oral capsule 1 XCHPdiphenoxylate-atropine 1opium 1

*Antidotes*EXJADE 2 PAnaltrexone hcl oral 1 PA

*Antiemetics*DICLEGIS 2 QLdronabinol 1EMEND ORAL CAPSULE 125 MG, 40 MG, 80 & 125 MG, 80 MG

2 ST; QL

granisetron hcl oral 1 ST; QLmeclizine hcl oral tablet 1 XCHPondansetron 1 QLondansetron hcl oral solution 1ondansetron hcl oral tablet 24 mg, 4 mg, 8 mg

1 QL

trimethobenzamide hcl oral 1 AL

*Antifungals*fluconazole oral 1griseofulvin ultramicrosize 1itraconazole oral 1 PAketoconazole oral 1 PANOXAFIL ORAL 2 PAnystatin oral tablet 1terbinafine hcl oral 1 PAvoriconazole oral tablet 1 PA

*Antihistamines*carbinoxamine maleate oral tablet

1 AL

cetirizine hcl allergy child 1 XCHPcetirizine hcl childrens 1 XCHPcetirizine hcl childrens alrgy oral syrup 1 mg/ml

1 XCHP

cetirizine hcl oral tablet 1 XCHPcyproheptadine hcl oral 1diphenhydramine hcl oral capsule 50 mg

1 XCHP; AL

fexofenadine hcl oral tablet 60 mg

1 XCHP

Drug Tier Notes Drug Tier Notes

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levocetirizine dihydrochloride oral

1 PA

loratadine childrens oral solution 1 XCHPloratadine oral tablet 1 XCHP

*Antihyperlipidemics*atorvastatin calcium oral 1cholestyramine light 1cholestyramine oral 1colestipol hcl 1fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg

1

fenofibrate oral tablet 160 mg, 54 mg

1

gemfibrozil oral 1lovastatin 1micronized colestipol hcl 1pravastatin sodium 1simvastatin oral 1WELCHOL 2ZETIA 2 PA

*Antihypertensives*amlodipine besy-benazepril hcl 1atenolol-chlorthalidone 1benazepril hcl oral 1benazepril-hydrochlorothiazide 1bisoprolol-hydrochlorothiazide 1candesartan cilexetil 1 STcandesartan cilexetil-hctz 1 STcaptopril oral 1captopril-hydrochlorothiazide 1clonidine hcl oral 1clonidine hcl transdermal 1DIBENZYLINE 2 PAdoxazosin mesylate 1enalapril maleate oral 1enalaprilat 1enalapril-hydrochlorothiazide 1eplerenone 1 PAeprosartan mesylate 1 STfosinopril sodium 1fosinopril sodium-hctz 1guanfacine hcl oral 1hydralazine hcl oral 1irbesartan 1irbesartan-hydrochlorothiazide 1lisinopril oral 1lisinopril-hydrochlorothiazide 1losartan potassium 1losartan potassium-hctz 1methyldopa oral 1methyldopa-hydrochlorothiazide 1metoprolol-hydrochlorothiazide 1minoxidil oral 1moexipril hcl 1moexipril-hydrochlorothiazide 1nadolol-bendroflumethiazide 1perindopril erbumine 1phenoxybenzamine hcl oral 1 PAprazosin hcl oral 1propranolol-hctz 1quinapril hcl 1

quinapril-hydrochlorothiazide 1ramipril 1reserpine oral 2TEKTURNA 2 STTEKTURNA HCT 2 STtelmisartan 1 STtelmisartan-hctz 1 STterazosin hcl oral 1trandolapril 1valsartan 1valsartan-hydrochlorothiazide 1

*Anti-Infective Agents - Misc.*ALINIA 2 PAatovaquone oral 1 PACAYSTON 2 PA; ALclindamycin hcl oral 1clindamycin palmitate hcl 1dapsone oral 1metronidazole oral tablet 1NEBUPENT 2 PAsulfamethoxazole-trimethoprim oral suspension 200-40 mg/5ml

1

sulfamethoxazole-trimethoprim oral tablet 400-80 mg

1

tinidazole oral 1trimethoprim oral 1vancomycin hcl oral 1 PA

*Antimalarials*atovaquone-proguanil hcl 1chloroquine phosphate oral 1COARTEM 2DARAPRIM 2hydroxychloroquine sulfate oral 1mefloquine hcl 1primaquine phosphate oral 1quinine sulfate oral 1 PA; AL

*Antimyasthenic Agents*guanidine hcl oral 1MESTINON ORAL SYRUP 2

*Antimyasthenic/Cholinergic Agents*neostigmine methylsulfate injection

1

pyridostigmine bromide er 1pyridostigmine bromide oral 1

*Antimycobacterial Agents*ethambutol hcl oral 1isoniazid oral 1pyrazinamide oral 1rifabutin 1 PArifampin oral 1RIFATER 2

*Antineoplastics And Adjunctive Therapies*AFINITOR 2 PAALKERAN ORAL 2anastrozole oral 1 PA; RFbicalutamide 1 RMcapecitabine 1 PACAPRELSA 2 PAcyclophosphamide oral capsule 1EMCYT 2

Drug Tier Notes Drug Tier Notes

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etoposide oral 1exemestane 1 PA; RFFARESTON 2 RFFIRMAGON 2 PAflutamide 1 RMGLEEVEC 2 PAHEXALEN 2hydroxyurea oral 1JAKAFI 2 PAletrozole oral 1 PA; RFleucovorin calcium oral 1LEUKERAN 2lomustine 1LYSODREN 2MATULANE 2megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml

1

megestrol acetate oral tablet 1mercaptopurine oral 1MESNEX ORAL 2 PAmethotrexate oral 1MYLERAN 2NILANDRON 2 PASPRYCEL 2 STSUTENT 2 PATABLOID 2tamoxifen citrate oral 1TARCEVA 2 PATASIGNA 2 STtemozolomide 1tretinoin oral 1TREXALL 2ZOLINZA 2 PAZYTIGA 2 PA

*Antiparkinson Agents*amantadine hcl oral 1AZILECT 2 PAbenztropine mesylate oral 1bromocriptine mesylate oral 1carbidopa-levodopa er 1carbidopa-levodopa oral tablet 1carbidopa-levodopa oral tablet dispersible

1 ST

carbidopa-levodopa-entacapone 1entacapone 1pramipexole dihydrochloride 1 PAropinirole hcl 1 PAselegiline hcl oral 1STALEVO 100 2STALEVO 125 2STALEVO 150 2STALEVO 200 2STALEVO 50 2STALEVO 75 2trihexyphenidyl hcl 1ZELAPAR 2 PA

*Antipsychotics/Antimanic Agents*chlorpromazine hcl oral 1clozapine oral tablet 1 PAfluphenazine hcl oral tablet 1

haloperidol lactate oral 1haloperidol oral 1lithium 1lithium carbonate er 1lithium carbonate oral 1loxapine succinate oral 1olanzapine oral tablet 1olanzapine oral tablet dispersible

1 PA

perphenazine oral 1prochlorperazine 1prochlorperazine maleate oral 1quetiapine fumarate 1risperidone oral solution 1risperidone oral tablet 1risperidone oral tablet dispersible

1 PA

thioridazine hcl oral 1thiothixene oral 1trifluoperazine hcl oral 1ziprasidone hcl 1

*Antiseptics & Disinfectants*benzalkonium chloride external solution 50 %

2

*Antivirals*abacavir sulfate 1abacavir-lamivudine-zidovudine 1 PAacyclovir oral 1adefovir dipivoxil 1APTIVUS 2ATRIPLA 2BARACLUDE ORAL SOLUTION

2 PA

COMPLERA 2CRIXIVAN 2didanosine 1EMTRIVA 2entecavir 1 PAEPIVIR HBV ORAL SOLUTION 2EPZICOM 2famciclovir oral tablet 125 mg, 250 mg, 500 mg

1

FUZEON SUBCUTANEOUS* SOLUTION RECONSTITUTED

2 PA

HARVONI 2 PAINTELENCE ORAL TABLET100 MG, 200 MG

2

INVIRASE 2ISENTRESS 2KALETRA 2lamivudine 1lamivudine-zidovudine 1LEXIVA 2nevirapine 1nevirapine er 1NORVIR 2PEGASYS PROCLICK 2 PAPEGASYS SUBCUTANEOUS* SOLUTION

2 PA

PEG-INTRON 2 PAPEG-INTRON REDIPEN 2 PA

Drug Tier Notes Drug Tier Notes

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PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS* KIT 120 MCG/0.5ML

2 PA

PREZISTA ORAL SUSPENSION

2 ST

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

2 ST

RELENZA DISKHALER 2RESCRIPTOR 2REYATAZ ORAL CAPSULE150 MG, 200 MG, 300 MG

2

ribavirin oral 1 PArimantadine hcl 1SELZENTRY 2SOVALDI 2 PAstavudine oral capsule 1STRIBILD 2SUSTIVA 2TAMIFLU ORAL CAPSULE 2TAMIFLU ORAL SUSPENSION RECONSTITUTED 6 MG/ML

2

TIVICAY 2TRIUMEQ 2 PATRUVADA 2TYBOST 2 STTYZEKA 2 PAvalacyclovir hcl oral 1VALCYTE ORAL SOLUTION RECONSTITUTED

2 PA; PA except Infectious Disease,

Renal Transplant Surgeons and

Nephrologyvalganciclovir hcl 1 PA; PA except

Infectious Disease, Renal Transplant

Surgeons and Nephrology

VICTRELIS 2 PAVIDEX 2VIRACEPT 2VIREAD ORAL TABLET 300 MG

2

VITEKTA 2 STZIAGEN ORAL SOLUTION 2zidovudine 1

*Assorted Classes*ARGYLE STERILE WATER 1AZASAN 2azathioprine oral 1CUPRIMINE 2cyclosporine modified 1cyclosporine oral 1DEPEN TITRATABS 2GENGRAF 1KIONEX 1lactated ringers irrigation 1mycophenolate mofetil oral capsule

1 PA

mycophenolate mofetil oral tablet

1 PA

mycophenolic acid 1 PA

PHYSIOLYTE 1PHYSIOSOL IRRIGATION 2RAPAMUNE ORAL SOLUTION 2 PA; PA except

Renal Transplant Surgeons and

NephrologyREVLIMID ORAL CAPSULE 10 MG, 15 MG, 25 MG, 5 MG

2 PA

ringers irrigation 1sirolimus oral 1 PAsodium polystyrene sulfonate oral

1

sterile water for irrigation 1SYPRINE 2 PAtacrolimus oral 1THALOMID 2ZORTRESS 2 PA

*Beta Blockers*acebutolol hcl oral 1atenolol oral 1betaxolol hcl oral 1bisoprolol fumarate 1carvedilol 1labetalol hcl oral 1metoprolol succinate er 1metoprolol tartrate oral 1nadolol oral 1pindolol 1propranolol hcl er 1propranolol hcl oral 1sotalol hcl (af) 1sotalol hcl oral 1timolol maleate oral 1

*Calcium Channel Blockers*AFEDITAB CR 1amlodipine besylate oral 1CARTIA XT 1diltiazem hcl er 1diltiazem hcl er beads 1diltiazem hcl er coated beads oral capsule extended release 24 hour

1

diltiazem hcl er coated beads oral tablet extended release 24 hr* 180 mg

1

diltiazem hcl oral 1dilt-xr 1felodipine er 1isradipine 1MATZIM LA 1nicardipine hcl oral 1NIFEDIAC CC ORAL TABLET EXTENDED RELEASE 24 HR*30 MG, 60 MG

1

NIFEDICAL XL 1nifedipine er 1nifedipine er osmotic release 1nifedipine oral capsule 10 mg 1nimodipine oral 1 PAnisoldipine er 1TAZTIA XT 1

Drug Tier Notes Drug Tier Notes

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verapamil hcl er 1verapamil hcl oral 1

*Cardiotonics*DIGOX 1digoxin oral 1

*Cardiovascular Agents - Misc.*ADCIRCA 2 PALETAIRIS 2 PAsildenafil citrate oral 1 PATRACLEER 2 PA

*Cephalosporins*cefaclor er 1cefaclor oral capsule 1cefadroxil 1cefdinir 1cefixime 1 QLcefpodoxime proxetil 1cefprozil 1CEFTIN ORAL SUSPENSION RECONSTITUTED 250 MG/5ML

2

cefuroxime axetil oral tablet 1cephalexin oral capsule 250 mg, 500 mg

1

cephalexin oral suspension reconstituted

1

SUPRAX ORAL CAPSULE 2SUPRAX ORAL TABLET CHEWABLE 100 MG, 200 MG

2

*Contraceptives*alyacen 1/35 1AMETHIA 1AMETHYST 1ARANELLE 1AZURETTE 1briellyn 1CAMILA 1CAMRESE 1CAZIANT 1CESIA 1CRYSELLE-28 1CYCLAFEM 7/7/7 1desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

1

drospirenone-ethinyl estradiol oral tablet 3-0.03 mg

1

ELLA 2 QLENPRESSE-28 1ERRIN 1GIANVI 1GILDESS FE 1.5/30 1GILDESS FE 1/20 1HEATHER 1INTROVALE 1JOLESSA 1JOLIVETTE 1JUNEL FE 1.5/30 1JUNEL FE 1/20 1KARIVA 1LEENA 1

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

1

LO LOESTRIN FE 2LOW-OGESTREL 1MICROGESTIN 1.5/30 1MICROGESTIN FE 1.5/30 1MICROGESTIN FE 1/20 1NECON 1/50 (28) 2NECON 10/11 (28) 2NECON 7/7/7 1NORA-BE 1norethindrone acet-ethinyl est 1norethindrone oral 1norgestimate-eth estradiol 1norgestim-eth estrad triphasic 1NORTREL 7/7/7 1NUVARING 2ORTHO TRI-CYCLEN LO 2QUASENSE 1TILIA FE 1TRI-LEGEST FE 1TRINESSA (28) 1TRI-PREVIFEM 1TRI-SPRINTEC 1TRIVORA (28) 1VELIVET 1XULANE 1

*Corticosteroids*budesonide er 1 PAcortisone acetate oral 1DEXAMETHASONE INTENSOL

2

dexamethasone oral 1DEXPAK 10 DAY 2DEXPAK 13 DAY 2DEXPAK 6 DAY 2fludrocortisone acetate oral 1hydrocortisone oral 1methylprednisolone (pak) 1methylprednisolone oral 1prednisolone oral solution 1prednisolone sodium phosphate oral solution 15 mg/5ml, 6.7 (5 base) mg/5ml

1

prednisone (pak) 1PREDNISONE INTENSOL 2prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg

1

*Cough/Cold/Allergy*acetylcysteine inhalation 1benzonatate oral capsule 100 mg, 200 mg

1

biotuss 1BIOTUSS PEDIATRIC 1GILTUSS PED-C 2guaifenesin dac 1 XCHPguaifenesin oral solution 200 mg/10ml

1 XCHP

guaifenesin-codeine oral solution

1 XCHP

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hydrocod polst-cpm polst er 1 ALNEOTUSS PLUS 2phenylephrine-chlorphen-dm oral liquid† 1.75-0.75-2.75 mg/ml

1

promethazine vc/codeine 1promethazine-codeine 1promethazine-dm 1 ALpseudoeph-chlorphen-hydrocod 1REZIRA 2sodium chloride inhalation nebulization solution 10 %, 3 %, 7 %

1

*Dermatologicals*acitretin 1 PAacyclovir external 1adapalene external 1adapalene external cream 1ALA-QUIN 2alclometasone dipropionate 1amcinonide 1AMNESTEEM 1 PAANACAINE 2benzoyl peroxide external 10 %, 5 %

1 XCHP

benzoyl peroxide-erythromycin 1betamethasone dipropionate aug

1

betamethasone dipropionate external

1

betamethasone valerate external cream

1

betamethasone valerate external lotion

1

betamethasone valerate external ointment

1

calcipotriene external 1 PAcalcipotriene-betameth diprop 1 PAcalcitriol external 1 PACAPEX 2ciclopirox 1ciclopirox olamine external 1ciclopirox-vitamin e 1CLARAVIS 1 PAclindamycin phos-benzoyl perox external 1-5 %

1

clindamycin phosphate external 1clotrimazole af 1 XCHPclotrimazole external 1 XCHPclotrimazole-betamethasone 1coal tar external solution 2CONDYLOX EXTERNAL 2CORDRAN EXTERNAL TAPE 2desonide external 1desoximetasone external 1desoximetasone external cream 1desoximetasone external ointment 0.25 %

1

econazole nitrate external 1ELIDEL 2 PAerythromycin external 1

ethyl chloride 2EURAX 2FABIOR 2 PA; QLfluocinonide external 1fluocinonide external cream 0.05 %

1

fluocinonide external ointment 1fluocinonide external solution 1fluocinonide-e 1fluorouracil external cream 5 % 1fluorouracil external solution 1fluticasone propionate external 1gentamicin sulfate external 1halac 1halobetasol propionate 1HALOG 2hydrocortisone butyr lipo base 1hydrocortisone butyrate external ointment

1

hydrocortisone butyrate external solution

1

hydrocortisone external cream 1 %

1 XCHP

hydrocortisone external cream 2.5 %

1

hydrocortisone external lotion 2.5 %

1

hydrocortisone external ointment 1 %

1 XCHP

hydrocortisone external ointment 2.5 %

1

hydrocortisone valerate 1imiquimod external 1 PAketoconazole external cream 1ketoconazole external shampoo 1lidocaine external ointment 1lidocaine external patch 1lidocaine hcl external 1lidocaine hcl external cream 1lidocaine hcl external solution 1lidocaine-prilocaine external cream

1

lindane external 1malathion external 1metronidazole external 1mometasone furoate external 1mupirocin calcium 1mupirocin external 1MYORISAN 1 PAnystatin external cream 1nystatin external ointment 1nystatin external powder 100000 unit/gm

1

nystatin-triamcinolone 1permethrin external cream 1podofilox external 1prednicarbate 1salicylic acid external 1salicylic acid external cream 1salicylic acid external foam 1salicylic acid external liquid† 26 %

1

Drug Tier Notes Drug Tier Notes

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salicylic acid external lotion 1salicylic acid external shampoo 1salicylic acid wart remover 1salicylic acid-cleanser 1scalacort 1selenium sulfide external lotion 1selenium sulf-pyrithione-urea 1silver nitrate external 1silver sulfadiazine external 1sulfacetamide sodium (acne) 1sulfacetamide sodium external liquid†

1

sulfacetamide sodium external suspension

1

sulfacetamide sodium-sulfur external foam

1

sulfacetamide sodium-sulfur external liquid† 9-4 %, 9.8-4.8 %

1

sulfacetamide sodium-sulfur external pad 10-4 %

1

sulfacetamide sodium-sulfur external suspension 8-4 %

1

sulfacetamide-sulfur in urea external emulsion

1

tacrolimus external 1 PAtretinoin external 0.01 %, 0.025 %

1

tretinoin external cream 1tretinoin microsphere external 0.1 %

1

tretinoin microsphere pump external 0.1 %

1

triamcinolone acetonide external cream

1

triamcinolone acetonide external lotion

1

triamcinolone acetonide external ointment

1

VEREGEN 2VOLTAREN TRANSDERMAL 2

*Dietary Products/Dietary Management Products*FOLBIC 1

*Digestive Aids*CREON 2PANCREAZE 2SUCRAID 2 PA; Must be

obtained through Accredo only

ZENPEP 2

*Diuretics*acetazolamide er 1acetazolamide oral 1ALDACTAZIDE ORAL TABLET50-50 MG

2

amiloride hcl oral 1amiloride-hydrochlorothiazide 1bumetanide oral 1chlorothiazide oral 1chlorthalidone oral tablet 25 mg, 50 mg

1

DIURIL 2furosemide oral solution 10 mg/ml

1

furosemide oral tablet 1hydrochlorothiazide oral 1indapamide oral 1methazolamide oral 1methyclothiazide oral 1metolazone 1spironolactone oral 1spironolactone-hctz 1torsemide oral 1triamterene-hctz oral capsule 37.5-25 mg

1

triamterene-hctz oral tablet 1

*Endocrine And Metabolic Agents - Misc.*alendronate sodium oral tablet 1cabergoline 1 PA; QLcalcitonin (salmon) 1calcitriol oral 1CARBAGLU 2 PACYSTADANE 2 PAdesmopressin ace rhinal tube 1desmopressin ace spray refrig 1desmopressin acetate oral 1desmopressin acetate spray 1etidronate disodium oral tablet 400 mg

1

FORTEO 2 PAFORTICAL 2FOSAMAX PLUS D 2INCRELEX 2 PAKUVAN 2 PAlevocarnitine oral tablet 1 PANORDITROPIN FLEXPRO 2 PAoctreotide acetate injection solution 100 mcg/ml, 1000 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml

1 PA

ORFADIN 2 PAparicalcitol oral 1raloxifene hcl 1risedronate sodium oral tablet 150 mg

1

risedronate sodium oral tablet delayed release

1

SENSIPAR 2SOMAVERT SUBCUTANEOUS* SOLUTION RECONSTITUTED 20 MG

2 PA; Must be obtained through

CuraScript onlySTIMATE 2SYNAREL 2 PA

*Estrogens*COMBIPATCH 2est estrogens-methyltest ds 1est estrogens-methyltest hs 1estradiol oral 1estradiol transdermal 1estradiol-norethindrone acet 1estropipate oral 1JINTELI 1

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MENOSTAR 2norethindrone-eth estradiol 1PREMARIN ORAL 2 ALPREMPRO 2 AL

*Fluoroquinolones*ciprofloxacin hcl oral 1ciprofloxacin-ciproflox hcl er 1levofloxacin oral 1moxifloxacin hcl oral 1ofloxacin oral tablet 400 mg 1

*Gastrointestinal Agents - Misc.*APRISO 2ASACOL HD 2balsalazide disodium 1calcium acetate (phos binder) 1calcium acetate oral capsule 1CANASA 2cromolyn sodium oral 1FOSRENOL ORAL TABLET CHEWABLE

2

generlac 1infants simethicone 1 XCHPlactulose encephalopathy 1mesalamine enema 1mesalamine-cleanser 1metoclopramide hcl oral solution 1metoclopramide hcl oral tablet 1PENTASA 2PHOSLYRA 2RELISTOR SUBCUTANEOUS* SOLUTION 12 MG/0.6ML

2

RENAGEL 2RENVELA 2SFROWASA 2simethicone oral capsule 125 mg

1 XCHP

sulfasalazine oral 1SULFAZINE 1SULFAZINE EC 1ursodiol oral 1

*Genitourinary Agents - Miscellaneous*acetic acid irrigation 1alfuzosin hcl er 1 RMaminoacetic acid 1AVODART 2 RMcitric acid-sodium citrate 1ELMIRON 2 PAfinasteride oral tablet 5 mg 1 RMglycine irrigation 1glycine urologic 1neomycin-polymyxin b gu 1ORACIT 2phenazopyridine hcl oral tablet 100 mg, 200 mg

1

potassium citrate er 1potassium citrate-citric acid 1RENACIDIN 2sorbitol irrigation 2sorbitol-mannitol 2tamsulosin hcl 1THIOLA 2 PA

tricitrates 2

*Gout Agents*allopurinol oral 1colchicine oral tablet 1colchicine-probenecid 1probenecid oral 1

*Hematological Agents - Misc.*AGGRENOX 2 PAanagrelide hcl oral capsule 0.5 mg

1 PA; PA except Hematology or

Oncologyanagrelide hcl oral capsule 1 mg 1 PAaspirin-dipyridamole er 1 PABRILINTA 2cilostazol 1clopidogrel bisulfate 1dipyridamole oral 1EFFIENT 2FIRAZYR 2 PApentoxifylline er 1

*Hematopoietic Agents*ARANESP (ALBUMIN FREE) INJECTION SOLUTION 10 MCG/0.4ML, 100 MCG/ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML

2 PA

CORVITA 150 1cyanocobalamin injection 1EPOGEN 2 PAfa-vitamin b-6-vitamin b-12 1FE C PLUS 1ferrex 150 forte 1 XCHPfolic acid oral tablet 1 mg 1 XCHPHEMATOGEN FORTE 1NEUPOGEN INJECTION SOLUTION

2 PA

polysaccharide iron forte 1PROCRIT 2 PAPROMACTA 2 PAZARXIO 2 PA

*Hypnotics*BUTISOL SODIUM ORAL TABLET

2

estazolam 1phenobarbital oral elixir 1phenobarbital oral solution 1

*Hypnotics/Sedatives/Sleep Disorder Agents*flurazepam hcl 1 QL; ALmidazolam hcl oral 1phenobarbital oral tablet 16.2 mg, 32.4 mg, 64.8 mg, 97.2 mg

1

temazepam 1 QLtriazolam 1 QLzaleplon 1 QLzolpidem tartrate 1 QL; ALzolpidem tartrate er 1 ST; QL; AL

*Laxatives*GAVILYTE-N WITH FLAVOR PACK

1

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KRISTALOSE 2lactulose oral 1OSMOPREP 2peg 3350/electrolytes 1peg 3350-kcl-na bicarb-nacl 1peg-3350/electrolytes 1polyethylene glycol 3350-grx 1 XCHPSUPREP BOWEL PREP 2

*Macrolides*azithromycin oral suspension reconstituted

1

azithromycin oral tablet 1clarithromycin er 1clarithromycin oral 1ERYTHROCIN STEARATE 2erythromycin base oral tablet 1erythromycin ethylsuccinate oral 1

*Medical Devices*V-GO 20 2V-GO 30 2V-GO 40 2

*Migraine Products*dihydroergotamine mesylate nasal

2 PA; QL

ERGOMAR 2isometheptene-apap-dichloral 1MIGRANAL 2 PAnaratriptan hcl 1 QLrizatriptan benzoate oral tablet 1 QLsumatriptan succinate oral 1 QLsumatriptan succinate refill subcutaneous* 6 mg/0.5ml

1 QL

sumatriptan succinate subcutaneous* 6 mg/0.5ml

1 QL

sumatriptan succinate subcutaneous* solution

1 QL

zolmitriptan oral tablet 1 QL

*Minerals & Electrolytes*effervescent pot chloride 1GALZIN 2pot bicarb-pot chloride 1potassium bicarbonate oral 1potassium chloride crys er 1potassium chloride er 1potassium chloride oral solution 20 meq/15ml (10%)

1

sodium fluoride oral tablet chewable

1

virt-phos 250 neutral 1

*Mouth/Throat/Dental Agents*cevimeline hcl 1 QLchlorhexidine gluconate mouth/throat

1

clotrimazole mouth/throat 1lidocaine viscous 1nystatin mouth/throat 1pilocarpine hcl oral 1triamcinolone acetonide mouth/throat

1

*Multivitamins*CITRANATAL RX 2DIALYVITE 1 PA; PA except

NephrologyNESTABS ABC 2 ALprenatabs fa 2prenatal 19 oral tablet chewable 2prenatal plus iron 2prenatal plus/iron 2rena-vite rx 1 PA; PA except

Nephrologytriple-vitamin/fluoride 1

*Musculoskeletal Therapy Agents*baclofen oral 1carisoprodol oral tablet 350 mg 1carisoprodol-aspirin 1carisoprodol-aspirin-codeine 1chlorzoxazone oral 1 ALcyclobenzaprine hcl oral 1 ALdantrolene sodium oral 1metaxalone 1 ALmethocarbamol oral 1orphenadrine citrate er 1orphenadrine-aspirin-caffeine oral tablet 25-385-30 mg

1

tizanidine hcl oral tablet 1

*Nasal Agents - Systemic And Topical*azelastine hcl nasal 1fluticasone propionate nasal 1 XCHPipratropium bromide nasal 1NASACORT ALLERGY 24HR 2 XCHP

*Neuromuscular Agents*riluzole 1

*Nutrients*levocarnitine fumarate 1 PA; XCHP

*Ophthalmic Agents*ACUVAIL 2 PA; PA except

OphthalmologyALOMIDE 2 PAALPHAGAN P OPHTHALMIC SOLUTION 0.1 %

2

ALREX 2 PAapraclonidine hcl 1azelastine hcl ophthalmic 1AZOPT 2bacitracin-polymyxin b ophthalmic

1

bacitra-neomycin-polymyxin-hc 1balanced salt intraocular 1BETIMOL OPHTHALMIC SOLUTION 0.25 %

2

BETOPTIC-S 2bimatoprost ophthalmic 1 ALBLEPHAMIDE 2BLEPHAMIDE S.O.P. 2brimonidine tartrate ophthalmic 1bromfenac sodium 1carteolol hcl 1CILOXAN OPHTHALMIC OINTMENT

2

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ciprofloxacin hcl ophthalmic 1COMBIGAN 2cromolyn sodium ophthalmic 1CYSTARAN 2 PA; QLdexamethasone sodium phosphate ophthalmic

1

diclofenac sodium ophthalmic 1 PAdorzolamide hcl 1dorzolamide hcl-timolol mal 1epinastine hcl 1erythromycin ophthalmic 1FLAREX 2fluorometholone ophthalmic 1flurbiprofen sodium 1FML 2FML FORTE 2gentamicin sulfate ophthalmic solution

1

homatropine hbr ophthalmic 1ILEVRO 2 PA; QLketorolac tromethamine ophthalmic

1 PA; PA except Ophthalmology

LACRISERT 2latanoprost ophthalmic 1 ALlevobunolol hcl 1levofloxacin ophthalmic 1LOTEMAX OPHTHALMIC OINTMENT

2

LOTEMAX OPHTHALMIC SUSPENSION

2

LUMIGAN OPHTHALMIC SOLUTION 0.01 %

2 AL

metipranolol 1NATACYN 2 PAneomycin-bacitracin zn-polymyx 1neomycin-polymyxin-dexameth ophthalmic ointment

1

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

1

neomycin-polymyxin-gramicidin 1neomycin-polymyxin-hc ophthalmic

1

NEVANAC 2 PA; QLofloxacin ophthalmic 1 PAphenylephrine hcl ophthalmic solution 10 %, 2.5 %

1

PHOSPHOLINE IODIDE 2pilocarpine hcl ophthalmic 1polymyxin b-trimethoprim 1PRED MILD 2prednisolone acetate ophthalmic 1prednisolone sodium phosphate ophthalmic

1

SIMBRINZA 2sulfacetamide sodium ophthalmic solution

1

sulfacetamide-prednisolone ophthalmic solution

1

timolol maleate ophthalmic 1tobramycin ophthalmic 1tobramycin-dexamethasone 1

TRAVATAN Z 2 ALtrifluridine ophthalmic 1tropicamide ophthalmic solution 1 %

1

VEXOL 2

*Otic Agents*acetic acid otic 1acetic acid-aluminum acetate 1CIPRODEX 2 PAciprofloxacin hcl otic 1hydrocortisone-acetic acid 1neomycin-polymyxin-hc otic 1ofloxacin otic 1 PA

*Passive Immunizing Agents*SYNAGIS 2 PA

*Penicillins*amoxicillin 1amoxicillin-pot clavulanate er 1amoxicillin-pot clavulanate oral 1ampicillin 1dicloxacillin sodium 1penicillin v potassium 1

*Pharmaceutical Adjuvants*cherry flavor liquid† 2 XCHPpolyethylene glycol 3350 powder

1 XCHP

*Progestins*medroxyprogesterone acetate oral

1

norethindrone acetate oral 1progesterone micronized oral 1

*Psychotherapeutic And Neurological Agents - Misc.*acamprosate calcium 1 PAAVONEX 2 PABUPROBAN 1 QLbupropion hcl er (smoking det) 1CHANTIX 2CHANTIX CONTINUING MONTH PAK

2

CHANTIX STARTING MONTH PAK

2

chlordiazepoxide-amitriptyline 1disulfiram oral 1 PAdonepezil hcl oral tablet 10 mg, 5 mg

1

donepezil hcl oral tablet 23 mg 1 STdonepezil hcl oral tablet dispersible

1

ergoloid mesylates oral 1galantamine hydrobromide 1galantamine hydrobromide er 1GLATOPA 1 PAmemantine hcl oral tablet 1NAMENDA ORAL SOLUTION 2NAMENDA XR 2nicotine polacrilex mouth/throat gum 4 mg

1 XCHP; QL

nicotine polacrilex mouth/throat lozenge 2 mg

1 XCHP; QL

nicotine transdermal patch 24 hr 1 XCHP; QL

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NUEDEXTA 2 PAORAP 2perphenazine-amitriptyline 1rivastigmine tartrate 1tetrabenazine oral tablet 12.5 mg, 25 mg

1 PA; QL

XYREM 2 PA

*Respiratory Agents - Misc.*KALYDECO ORAL PACKET 2 PA; ALKALYDECO ORAL TABLET 2 PAORKAMBI 2 PA; ALPULMOZYME 2

*Sulfonamides*sulfadiazine oral 1

*Tetracyclines*doxycycline hyclate oral capsule 1minocycline hcl oral capsule 1tetracycline hcl oral 1

*Thyroid Agents*ARMOUR THYROID 2levothyroxine sodium oral 1LEVOXYL 1liothyronine sodium oral 1methimazole oral 1np thyroid 1propylthiouracil oral 1SYNTHROID 2UNITHROID 2

*Ulcer Drugs*ATROPEN INTRAMUSCULAR* DEVICE 0.5 MG/0.7ML, 1 MG/0.7ML, 2 MG/0.7ML

2

AXID AR 1 XCHPbelladonna alkaloids-opium 2belladonna-opium 2chlordiazepoxide-clidinium 1cimetidine hcl 1cimetidine oral tablet 200 mg 1 XCHPcimetidine oral tablet 300 mg, 400 mg, 800 mg

1

dicyclomine hcl oral 1DONNATAL EXTENTABS 2famotidine oral suspension reconstituted

1

famotidine oral tablet 20 mg, 40 mg

1

glycopyrrolate injection 1glycopyrrolate oral 1hyoscyamine sulfate oral elixir 1 ALhyoscyamine sulfate oral solution

1 AL

hyoscyamine sulfate oral tablet 1 ALlansoprazole oral capsule delayed release 30 mg

1

methscopolamine bromide oral 1misoprostol oral 1nizatidine oral solution 1omeprazole oral capsule delayed release

1

pantoprazole sodium oral 1

propantheline bromide oral 1PYLERA 2 PArabeprazole sodium 1ranitidine hcl oral syrup 1ranitidine hcl oral tablet 150 mg 1 XCHPranitidine hcl oral tablet 300 mg 1sucralfate oral tablet 1

*Urinary Anti-Infectives*methenamine mandelate oral tablet 1 gm

1

nitrofurantoin 1 ALnitrofurantoin macrocrystal oral 1 ALnitrofurantoin monohyd macro 1 AL

*Urinary Antispasmodics*bethanechol chloride oral 1flavoxate hcl 1oxybutynin chloride er 1oxybutynin chloride oral 1tolterodine tartrate 1 STtolterodine tartrate er 1 STtrospium chloride 1 STtrospium chloride er 1 ST

*Vaginal Products*CLEOCIN VAGINAL SUPPOSITORY

2

clindamycin phosphate vaginal 1ESTRING 2FEMRING 2metronidazole vaginal 1terconazole 1VAGIFEM 2

*Vasopressors*AUVI-Q 2EPIPEN 2-PAK 2EPIPEN JR 2-PAK 2midodrine hcl 1

*Vitamins*ergocalciferol oral capsule 1niacin er oral tablet extendedrelease* 500 mg

1 XCHP

vitamin d (ergocalciferol) 1

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Index

Index

abacavir sulfate ................................................................. 8abacavir-lamivudine-zidovudine ........................... 8acamprosate calcium ................................................. 15acarbose ................................................................................. 6acebutolol hcl ...................................................................... 9acetaminophen-codeine ............................................. 3acetaminophen-codeine #2 ...................................... 3acetaminophen-codeine #3 ...................................... 3acetaminophen-codeine #4 ...................................... 3acetazolamide ................................................................. 12acetazolamide er ........................................................... 12acetic acid ................................................................. 13, 15acetic acid-aluminum acetate .............................. 15acetylcysteine .................................................................. 10acitretin ................................................................................. 11ACTOPLUS MET XR ................................................... 6ACUVAIL ............................................................................ 14acyclovir ......................................................................... 8, 11adapalene ........................................................................... 11ADCIRCA ........................................................................... 10adefovir dipivoxil ............................................................... 8ADVAIR DISKUS ............................................................ 4ADVAIR HFA ..................................................................... 4AFEDITAB CR .................................................................. 9AFINITOR ............................................................................. 7AGGRENOX .................................................................... 13ALA-QUIN ......................................................................... 11ALBENZA ............................................................................. 4albuterol sulfate ................................................................. 4albuterol sulfate er .......................................................... 4alclometasone dipropionate .................................. 11ALDACTAZIDE ............................................................. 12alendronate sodium .................................................... 12alfuzosin hcl er ................................................................ 13ALINIA ..................................................................................... 7ALKERAN ............................................................................ 7allopurinol ........................................................................... 13ALOMIDE ........................................................................... 14ALPHAGAN P ................................................................ 14alprazolam ............................................................................ 4alprazolam er ...................................................................... 4ALPRAZOLAM INTENSOL .................................... 4alprazolam xr ...................................................................... 4ALREX ................................................................................. 14aluminum hydroxide gel .............................................. 4alyacen 1/35 ..................................................................... 10amantadine hcl .................................................................. 8amcinonide ........................................................................ 11AMETHIA ........................................................................... 10AMETHYST ...................................................................... 10amiloride hcl ..................................................................... 12amiloride-hydrochlorothiazide ............................. 12aminoacetic acid ............................................................ 13amiodarone hcl .................................................................. 4amitriptyline hcl .................................................................. 5amlodipine besy-benazepril hcl ............................. 7amlodipine besylate ....................................................... 9AMNESTEEM ................................................................. 11amoxapine ............................................................................ 5amoxicillin ........................................................................... 15amoxicillin-pot clavulanate ..................................... 15amoxicillin-pot clavulanate er .............................. 15amphetamine-dextroamphet er ............................. 3amphetamine-dextroamphetamine ..................... 3ampicillin .............................................................................. 15ANACAINE ....................................................................... 11anagrelide hcl .................................................................. 13anastrozole ........................................................................... 7

Index

ANDROGEL ........................................................................ 4ANDROGEL PUMP ....................................................... 4ANORO ELLIPTA ........................................................... 4anti-diarrheal ....................................................................... 6apraclonidine hcl ........................................................... 14APRISO ............................................................................... 13APTIVUS ............................................................................... 8ARANELLE ...................................................................... 10ARANESP (ALBUMIN FREE) ........................... 13ARCALYST ......................................................................... 3ARGYLE STERILE WATER ................................... 9ARMOUR THYROID .................................................. 16ARNUITY ELLIPTA ....................................................... 5ASACOL HD .................................................................... 13ASMANEX 120 METERED DOSES ................. 5ASMANEX 14 METERED DOSES .................... 5ASMANEX 30 METERED DOSES .................... 5ASMANEX 60 METERED DOSES .................... 5ASMANEX 7 METERED DOSES ....................... 5ASMANEX HFA ............................................................... 5aspirin-dipyridamole er ............................................. 13atenolol .................................................................................... 9atenolol-chlorthalidone ................................................ 7atorvastatin calcium ....................................................... 7atovaquone ........................................................................... 7atovaquone-proguanil hcl .......................................... 7ATRIPLA ............................................................................... 8ATROPEN ......................................................................... 16ATROVENT HFA ............................................................ 5AUVI-Q ................................................................................. 16AVODART ......................................................................... 13AVONEX ............................................................................. 15AXID AR .............................................................................. 16AZASAN ................................................................................ 9azathioprine ......................................................................... 9azelastine hcl ................................................................... 14AZILECT ................................................................................ 8azithromycin ..................................................................... 14AZOPT ................................................................................. 14AZURETTE ....................................................................... 10bacitracin-polymyxin b .............................................. 14bacitra-neomycin-polymyxin-hc ......................... 14baclofen ............................................................................... 14balanced salt .................................................................... 14balsalazide disodium .................................................. 13BANZEL ................................................................................. 5BARACLUDE ..................................................................... 8belladonna alkaloids-opium .................................. 16belladonna-opium ......................................................... 16benazepril hcl ..................................................................... 7benazepril-hydrochlorothiazide ............................. 7benzalkonium chloride ................................................. 8benzonatate ...................................................................... 10benzoyl peroxide ........................................................... 11benzoyl peroxide-erythromycin .......................... 11benztropine mesylate ................................................... 8betamethasone dipropionate ............................... 11betamethasone dipropionate aug ..................... 11betamethasone valerate .......................................... 11betaxolol hcl ......................................................................... 9bethanechol chloride .................................................. 16BETIMOL ........................................................................... 14BETOPTIC-S ................................................................... 14bicalutamide ........................................................................ 7bimatoprost ........................................................................ 14biotuss ................................................................................... 10BIOTUSS PEDIATRIC ............................................. 10bisoprolol fumarate ......................................................... 9

Index

bisoprolol-hydrochlorothiazide ............................... 7BLEPHAMIDE ................................................................ 14BLEPHAMIDE S.O.P. ............................................... 14briellyn ................................................................................... 10BRILINTA ........................................................................... 13brimonidine tartrate ..................................................... 14bromfenac sodium ....................................................... 14bromocriptine mesylate ............................................... 8budesonide ........................................................................... 5budesonide er .................................................................. 10bumetanide ........................................................................ 12buprenorphine hcl ............................................................ 3BUPROBAN ..................................................................... 15bupropion hcl ...................................................................... 5bupropion hcl er (smoking det) ........................... 15bupropion hcl er (sr) ...................................................... 5bupropion hcl er (xl) ....................................................... 5buspirone hcl ....................................................................... 4butalbital-acetaminophen .......................................... 3butalbital-apap-caff-cod .............................................. 3butalbital-apap-caffeine ............................................... 3butalbital-asa-caff-codeine ....................................... 3butalbital-asa-caffeine .................................................. 3BUTISOL SODIUM ..................................................... 13butorphanol tartrate ........................................................ 3BYDUREON ........................................................................ 6BYETTA 5 MCG PEN .................................................. 6cabergoline ........................................................................ 12calcipotriene ..................................................................... 11calcipotriene-betameth diprop ............................. 11calcitonin (salmon) ....................................................... 12calcitriol ....................................................................... 11, 12calcium acetate .............................................................. 13calcium acetate (phos binder) ............................. 13calcium carbonate antacid ........................................ 4CAMILA ............................................................................... 10CAMRESE ......................................................................... 10CANASA ............................................................................. 13candesartan cilexetil ...................................................... 7candesartan cilexetil-hctz .......................................... 7capecitabine ........................................................................ 7CAPEX ................................................................................. 11CAPRELSA ......................................................................... 7captopril .................................................................................. 7captopril-hydrochlorothiazide .................................. 7CARBAGLU ..................................................................... 12carbamazepine .................................................................. 5carbamazepine er ............................................................ 5carbidopa-levodopa ....................................................... 8carbidopa-levodopa er ................................................. 8carbidopa-levodopa-entacapone ......................... 8carbinoxamine maleate ............................................... 6carisoprodol ...................................................................... 14carisoprodol-aspirin ..................................................... 14carisoprodol-aspirin-codeine ................................ 14carteolol hcl ....................................................................... 14CARTIA XT .......................................................................... 9carvedilol ................................................................................ 9CAYSTON ............................................................................ 7CAZIANT ............................................................................ 10cefaclor ................................................................................. 10cefaclor er ........................................................................... 10cefadroxil ............................................................................. 10cefdinir .................................................................................. 10cefixime ................................................................................ 10cefpodoxime proxetil .................................................. 10cefprozil ................................................................................ 10CEFTIN ................................................................................ 10

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Index

cefuroxime axetil ........................................................... 10celecoxib ................................................................................ 3CELONTIN ........................................................................... 5cephalexin .......................................................................... 10CESIA ................................................................................... 10cetirizine hcl ......................................................................... 6cetirizine hcl allergy child ........................................... 6cetirizine hcl childrens .................................................. 6cetirizine hcl childrens alrgy ..................................... 6cevimeline hcl .................................................................. 14CHANTIX ............................................................................ 15CHANTIX CONTINUING MONTH PAK ...... 15CHANTIX STARTING MONTH PAK ............ 15cherry flavor ...................................................................... 15chlordiazepoxide hcl ...................................................... 4chlordiazepoxide-amitriptyline ............................. 15chlordiazepoxide-clidinium .................................... 16chlorhexidine gluconate ........................................... 14chloroquine phosphate ................................................ 7chlorothiazide .................................................................. 12chlorpromazine hcl ......................................................... 8chlorpropamide .................................................................. 6chlorthalidone .................................................................. 12chlorzoxazone ................................................................. 14cholestyramine .................................................................. 7cholestyramine light ....................................................... 7choline-mag trisalicylate ............................................. 3ciclopirox ............................................................................. 11ciclopirox olamine ......................................................... 11ciclopirox-vitamin e ...................................................... 11cilostazol .............................................................................. 13CILOXAN ........................................................................... 14cimetidine ........................................................................... 16cimetidine hcl ................................................................... 16CIPRODEX ........................................................................ 15ciprofloxacin hcl .................................................... 13, 15ciprofloxacin-ciproflox hcl er ................................. 13citalopram hydrobromide ........................................... 5CITRANATAL RX ........................................................ 14citric acid-sodium citrate .......................................... 13CLARAVIS ........................................................................ 11clarithromycin .................................................................. 14clarithromycin er ............................................................ 14CLEOCIN ........................................................................... 16clindamycin hcl .................................................................. 7clindamycin palmitate hcl ........................................... 7clindamycin phos-benzoyl perox ....................... 11clindamycin phosphate .................................... 11, 16clomipramine hcl .............................................................. 5clonazepam .......................................................................... 5clonidine hcl ......................................................................... 7clopidogrel bisulfate .................................................... 13clorazepate dipotassium ............................................. 4clotrimazole .............................................................. 11, 14clotrimazole af ................................................................. 11clotrimazole-betamethasone ................................ 11clozapine ................................................................................ 8coal tar .................................................................................. 11COARTEM ........................................................................... 7codeine sulfate .................................................................. 3colchicine ............................................................................ 13colchicine-probenecid ................................................ 13colestipol hcl ........................................................................ 7COMBIGAN ...................................................................... 15COMBIPATCH ............................................................... 12COMBIVENT RESPIMAT ......................................... 5COMPLERA ........................................................................ 8CONDYLOX ..................................................................... 11CORDRAN ........................................................................ 11cortisone acetate ........................................................... 10CORVITA 150 ................................................................. 13

Index

CREON ................................................................................ 12CRIXIVAN ............................................................................. 8cromolyn sodium ............................................ 5, 13, 15CRYSELLE-28 ............................................................... 10CUPRIMINE ........................................................................ 9cyanocobalamin ............................................................. 13CYCLAFEM 7/7/7 ........................................................ 10cyclobenzaprine hcl .................................................... 14cyclophosphamide .......................................................... 7cyclosporine ......................................................................... 9cyclosporine modified ................................................... 9cyproheptadine hcl ......................................................... 6CYSTADANE .................................................................. 12CYSTARAN ...................................................................... 15danazol .................................................................................... 4dantrolene sodium ....................................................... 14dapsone .................................................................................. 7DARAPRIM .......................................................................... 7DEPEN TITRATABS .................................................... 9desipramine hcl ................................................................. 5desmopressin ace rhinal tube ............................. 12desmopressin ace spray refrig ........................... 12desmopressin acetate ............................................... 12desmopressin acetate spray ................................ 12desogestrel-ethinyl estradiol ................................. 10desonide .............................................................................. 11desoximetasone ............................................................ 11dexamethasone ............................................................. 10DEXAMETHASONE INTENSOL ..................... 10dexamethasone sodium phosphate ................ 15dexmethylphenidate hcl .............................................. 3DEXPAK 10 DAY ......................................................... 10DEXPAK 13 DAY ......................................................... 10DEXPAK 6 DAY ............................................................ 10dextroamphetamine sulfate ...................................... 3dextroamphetamine sulfate er ............................... 3DIALYVITE ........................................................................ 14diazepam ............................................................................... 4DIAZEPAM INTENSOL .............................................. 4DIBENZYLINE ................................................................... 7DICLEGIS ............................................................................. 6diclofenac potassium .................................................... 3diclofenac sodium ................................................... 3, 15diclofenac sodium er ..................................................... 3dicloxacillin sodium ...................................................... 15dicyclomine hcl ............................................................... 16didanosine ............................................................................. 8diflunisal .................................................................................. 3DIGOX .................................................................................. 10digoxin ................................................................................... 10dihydroergotamine mesylate ................................ 14DILANTIN .............................................................................. 5diltiazem hcl ......................................................................... 9diltiazem hcl er ................................................................... 9diltiazem hcl er beads ................................................... 9diltiazem hcl er coated beads ................................. 9dilt-xr .......................................................................................... 9diphenhydramine hcl ..................................................... 6diphenoxylate-atropine ................................................ 6dipyridamole ..................................................................... 13disopyramide phosphate ............................................ 4disulfiram ............................................................................. 15DIURIL .................................................................................. 12divalproex sodium ........................................................... 5divalproex sodium er ..................................................... 5donepezil hcl .................................................................... 15DONNATAL EXTENTABS ................................... 16dorzolamide hcl .............................................................. 15dorzolamide hcl-timolol mal .................................. 15doxazosin mesylate ....................................................... 7doxepin hcl ........................................................................... 5

Index

doxycycline hyclate ..................................................... 16dronabinol .............................................................................. 6drospirenone-ethinyl estradiol ............................. 10duloxetine hcl ...................................................................... 5duraxin ..................................................................................... 3econazole nitrate ........................................................... 11effervescent pot chloride ......................................... 14EFFIENT ............................................................................. 13ELIDEL ................................................................................. 11ELIQUIS ................................................................................. 5ELLA ...................................................................................... 10ELMIRON ........................................................................... 13EMCYT .................................................................................... 7EMEND ................................................................................... 6EMTRIVA .............................................................................. 8enalapril maleate .............................................................. 7enalaprilat .............................................................................. 7enalapril-hydrochlorothiazide .................................. 7ENBREL ................................................................................. 3ENBREL SURECLICK ................................................ 3enoxaparin sodium ......................................................... 5ENPRESSE-28 ............................................................... 10entacapone ........................................................................... 8entecavir ................................................................................. 8epinastine hcl ................................................................... 15EPIPEN 2-PAK .............................................................. 16EPIPEN JR 2-PAK ...................................................... 16EPIVIR HBV ........................................................................ 8eplerenone ............................................................................ 7EPOGEN ............................................................................. 13eprosartan mesylate ...................................................... 7EPZICOM .............................................................................. 8ergocalciferol .................................................................... 16ergoloid mesylates ....................................................... 15ERGOMAR ........................................................................ 14ERRIN ................................................................................... 10ERYTHROCIN STEARATE ................................. 14erythromycin ............................................................ 11, 15erythromycin base ........................................................ 14erythromycin ethylsuccinate ................................. 14escitalopram oxalate ..................................................... 5est estrogens-methyltest ds .................................. 12est estrogens-methyltest hs .................................. 12estazolam ........................................................................... 13estradiol ............................................................................... 12estradiol-norethindrone acet ................................. 12ESTRING ............................................................................ 16estropipate ......................................................................... 12ethambutol hcl .................................................................... 7ethosuximide ....................................................................... 5ethyl chloride .................................................................... 11etidronate disodium ..................................................... 12etodolac .................................................................................. 3etoposide ............................................................................... 8EURAX ................................................................................. 11exemestane ......................................................................... 8EXJADE ................................................................................. 6FABIOR ............................................................................... 11famciclovir ............................................................................. 8famotidine ........................................................................... 16FARESTON ......................................................................... 8fa-vitamin b-6-vitamin b-12 .................................... 13FE C PLUS ........................................................................ 13felbamate ............................................................................... 5felodipine er ......................................................................... 9FEMRING ........................................................................... 16fenofibrate ............................................................................. 7fenofibrate micronized .................................................. 7fenoprofen calcium ......................................................... 3fentanyl .................................................................................... 3fentanyl citrate .................................................................... 3

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Index

ferrex 150 forte ............................................................... 13fexofenadine hcl ............................................................... 6finasteride ........................................................................... 13FIRAZYR ............................................................................ 13FIRMAGON ......................................................................... 8FLAREX .............................................................................. 15flavoxate hcl ...................................................................... 16flecainide acetate ............................................................. 4FLOVENT DISKUS ........................................................ 5FLOVENT HFA ................................................................. 5fluconazole ........................................................................... 6fludrocortisone acetate ............................................. 10fluocinonide ....................................................................... 11fluocinonide-e .................................................................. 11fluorometholone ............................................................. 15fluorouracil ......................................................................... 11fluoxetine hcl ....................................................................... 5fluphenazine hcl ................................................................ 8flurazepam hcl ................................................................. 13flurbiprofen ............................................................................ 3flurbiprofen sodium ...................................................... 15flutamide ................................................................................. 8fluticasone propionate ...................................... 11, 14fluvoxamine maleate ..................................................... 5FML ......................................................................................... 15FML FORTE ..................................................................... 15FOLBIC ................................................................................ 12folic acid ............................................................................... 13fondaparinux sodium ..................................................... 5FORADIL AEROLIZER .............................................. 5FORTEO ............................................................................. 12FORTICAL ........................................................................ 12FOSAMAX PLUS D ................................................... 12fosinopril sodium .............................................................. 7fosinopril sodium-hctz ................................................... 7FOSRENOL ...................................................................... 13FRAGMIN .............................................................................. 5furosemide ......................................................................... 12FUZEON ................................................................................. 8gabapentin ............................................................................ 5GABITRIL ............................................................................. 5galantamine hydrobromide .................................... 15galantamine hydrobromide er .............................. 15GALZIN ................................................................................ 14GAVILYTE-N WITH FLAVOR PACK ........... 13gemfibrozil ............................................................................. 7generlac ............................................................................... 13GENGRAF ............................................................................ 9gentamicin sulfate ............................................... 11, 15GIANVI ................................................................................. 10GILDESS FE 1.5/30 ................................................... 10GILDESS FE 1/20 ........................................................ 10GILTUSS PED-C .......................................................... 10GLATOPA ......................................................................... 15GLEEVEC ............................................................................. 8glimepiride ............................................................................. 6glipizide ................................................................................... 6glipizide er ............................................................................. 6glipizide-metformin hcl ................................................. 6GLUCAGON EMERGENCY ................................... 6glyburide ................................................................................. 6glyburide micronized ..................................................... 6glyburide-metformin ....................................................... 6glycine ................................................................................... 13glycine urologic ............................................................... 13glycopyrrolate .................................................................. 16granisetron hcl ................................................................... 6griseofulvin ultramicrosize ......................................... 6guaifenesin ........................................................................ 10guaifenesin dac .............................................................. 10guaifenesin-codeine ................................................... 10

Index

guanfacine hcl .................................................................... 7guanidine hcl ....................................................................... 7halac ....................................................................................... 11halobetasol propionate ............................................. 11HALOG ................................................................................ 11haloperidol ............................................................................ 8haloperidol lactate ........................................................... 8HARVONI .............................................................................. 8HEATHER .......................................................................... 10HEMATOGEN FORTE ............................................. 13HEXALEN ............................................................................. 8homatropine hbr ............................................................ 15HUMALOG ........................................................................... 6HUMALOG KWIKPEN ................................................ 6HUMALOG MIX 50/50 ................................................. 6HUMALOG MIX 50/50 KWIKPEN ...................... 6HUMALOG MIX 75/25 ................................................. 6HUMALOG MIX 75/25 KWIKPEN ...................... 6HUMIRA ................................................................................. 3HUMIRA PEDIATRIC CROHNS START ...... 3HUMIRA PEN ..................................................................... 3HUMIRA PEN-CROHNS STARTER ................ 3HUMIRA PEN-PSORIASIS STARTER .......... 3HUMULIN 70/30 ............................................................... 6HUMULIN 70/30 KWIKPEN .................................... 6HUMULIN N ........................................................................ 6HUMULIN N KWIKPEN ............................................. 6HUMULIN R ........................................................................ 6HUMULIN R U-500 (CONCENTRATED) ...... 6hydralazine hcl ................................................................... 7hydrochlorothiazide ..................................................... 12hydrocod polst-cpm polst er ................................. 11hydrocodone-acetaminophen ................................. 3hydrocodone-ibuprofen ............................................... 3hydrocortisone ................................................. 4, 10, 11hydrocortisone acetate ................................................ 4hydrocortisone butyr lipo base ............................ 11hydrocortisone butyrate ........................................... 11hydrocortisone valerate ............................................ 11hydrocortisone-acetic acid ..................................... 15hydromorphone hcl ......................................................... 3hydroxychloroquine sulfate ....................................... 7hydroxyurea ......................................................................... 8hydroxyzine hcl .................................................................. 4hydroxyzine pamoate ................................................... 4hyoscyamine sulfate ................................................... 16ibuprofen ................................................................................ 3ILEVRO ................................................................................ 15imipramine hcl .................................................................... 5imipramine pamoate ...................................................... 5imiquimod ........................................................................... 11INCRELEX ........................................................................ 12indapamide ........................................................................ 12INDOCIN ................................................................................ 3indomethacin ....................................................................... 3indomethacin er ................................................................ 3infants simethicone ...................................................... 13INTELENCE ........................................................................ 8INTROVALE ..................................................................... 10INVIRASE ............................................................................. 8INVOKAMET ...................................................................... 6INVOKANA .......................................................................... 6ipratropium bromide .............................................. 5, 14ipratropium-albuterol ..................................................... 5irbesartan ............................................................................... 7irbesartan-hydrochlorothiazide .............................. 7ISENTRESS ........................................................................ 8isometheptene-apap-dichloral ............................. 14isoniazid .................................................................................. 7ISORDIL TITRADOSE ................................................ 4isosorbide dinitrate ......................................................... 4

Index

isosorbide dinitrate er ................................................... 4isosorbide mononitrate ................................................ 4isosorbide mononitrate er .......................................... 4isradipine ................................................................................ 9itraconazole .......................................................................... 6ivermectin .............................................................................. 4JAKAFI ................................................................................... 8JANTOVEN ......................................................................... 5JANUMET ............................................................................. 6JANUMET XR .................................................................... 6JANUVIA ............................................................................... 6JENTADUETO .................................................................. 6JINTELI ................................................................................ 12JOLESSA ........................................................................... 10JOLIVETTE ...................................................................... 10JUNEL FE 1.5/30 ......................................................... 10JUNEL FE 1/20 .............................................................. 10KALETRA ............................................................................. 8KALYDECO ..................................................................... 16KARIVA ............................................................................... 10ketoconazole .............................................................. 6, 11ketoprofen ............................................................................. 3ketoprofen er ....................................................................... 3ketorolac tromethamine ..................................... 3, 15KIONEX .................................................................................. 9KORLYM ............................................................................... 6KRISTALOSE ................................................................. 14KUVAN ................................................................................. 12labetalol hcl .......................................................................... 9LACRISERT ..................................................................... 15lactated ringers .................................................................. 9lactulose .............................................................................. 14lactulose encephalopathy ....................................... 13lamivudine ............................................................................. 8lamivudine-zidovudine ................................................. 8lamotrigine ............................................................................ 5lansoprazole ..................................................................... 16LANTUS ................................................................................. 6LANTUS SOLOSTAR ................................................. 6latanoprost ......................................................................... 15LEENA ................................................................................. 10leflunomide ........................................................................... 3LETAIRIS ........................................................................... 10letrozole .................................................................................. 8leucovorin calcium .......................................................... 8LEUKERAN ......................................................................... 8levalbuterol hcl ................................................................... 5LEVEMIR ............................................................................... 6LEVEMIR FLEXTOUCH ............................................ 6levetiracetam ....................................................................... 5levetiracetam er ................................................................ 5levobunolol hcl ................................................................ 15levocarnitine ..................................................................... 12levocarnitine fumarate ............................................... 14levocetirizine dihydrochloride ................................. 7levofloxacin ............................................................... 13, 15levonorgestrel-ethinyl estrad ................................ 10levorphanol tartrate ........................................................ 3levothyroxine sodium ................................................. 16LEVOXYL ........................................................................... 16LEXIVA ................................................................................... 8lidocaine .............................................................................. 11lidocaine hcl ...................................................................... 11lidocaine viscous ........................................................... 14lidocaine-hydrocortisone ace .................................. 4lidocaine-prilocaine ...................................................... 11lindane .................................................................................. 11liothyronine sodium ..................................................... 16lisinopril ................................................................................... 7lisinopril-hydrochlorothiazide ................................... 7lithium ....................................................................................... 8

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Index

lithium carbonate .............................................................. 8lithium carbonate er ....................................................... 8LO LOESTRIN FE ....................................................... 10lomustine ................................................................................ 8loratadine ............................................................................... 7loratadine childrens ........................................................ 7lorazepam .............................................................................. 4losartan potassium ......................................................... 7losartan potassium-hctz .............................................. 7LOTEMAX ......................................................................... 15lovastatin ................................................................................ 7LOW-OGESTREL ........................................................ 10loxapine succinate .......................................................... 8LUMIGAN ........................................................................... 15LYSODREN ......................................................................... 8mag-al ...................................................................................... 4malathion ............................................................................ 11maprotiline hcl .................................................................... 5MATULANE ........................................................................ 8MATZIM LA ......................................................................... 9meclizine hcl ........................................................................ 6meclofenamate sodium ............................................... 3medroxyprogesterone acetate ............................ 15mefloquine hcl .................................................................... 7megestrol acetate ............................................................ 8meloxicam ............................................................................. 3memantine hcl ................................................................. 15MENOSTAR ..................................................................... 13meprobamate ..................................................................... 4mercaptopurine ................................................................. 8mesalamine ....................................................................... 13mesalamine-cleanser ................................................ 13MESNEX ................................................................................ 8MESTINON .......................................................................... 7metaproterenol sulfate ................................................. 5metaxalone ........................................................................ 14metformin hcl ...................................................................... 6metformin hcl er ................................................................ 6methadone hcl ................................................................... 3methazolamide ............................................................... 12methenamine mandelate ........................................ 16methimazole ..................................................................... 16methitest ................................................................................. 4methocarbamol ............................................................... 14methotrexate ....................................................................... 8methscopolamine bromide .................................... 16methyclothiazide ............................................................ 12methyldopa ........................................................................... 7methyldopa-hydrochlorothiazide .......................... 7methylphenidate hcl ....................................................... 3methylphenidate hcl er ................................................ 3methylphenidate hcl er (la) ....................................... 3methylprednisolone ..................................................... 10methylprednisolone (pak) ....................................... 10metipranolol ...................................................................... 15metoclopramide hcl ..................................................... 13metolazone ........................................................................ 12metoprolol succinate er ............................................... 9metoprolol tartrate ........................................................... 9metoprolol-hydrochlorothiazide ............................. 7metronidazole ................................................... 7, 11, 16mexiletine hcl ...................................................................... 4MICROGESTIN 1.5/30 ............................................. 10MICROGESTIN FE 1.5/30 ..................................... 10MICROGESTIN FE 1/20 ......................................... 10micronized colestipol hcl ............................................ 7midazolam hcl ................................................................. 13midodrine hcl .................................................................... 16MIGRANAL ....................................................................... 14minocycline hcl ............................................................... 16minoxidil .................................................................................. 7

Index

mirtazapine ........................................................................... 5misoprostol ........................................................................ 16modafinil ................................................................................. 3moexipril hcl ......................................................................... 7moexipril-hydrochlorothiazide ................................. 7mometasone furoate .................................................. 11montelukast sodium ....................................................... 5morphine sulfate ............................................................... 4morphine sulfate (concentrate) .............................. 3morphine sulfate er ................................................... 3, 4moxifloxacin hcl .............................................................. 13mupirocin ............................................................................ 11mupirocin calcium ......................................................... 11mycophenolate mofetil ................................................. 9mycophenolic acid .......................................................... 9MYLERAN ............................................................................ 8MYORISAN ....................................................................... 11nabumetone ......................................................................... 3nadolol ..................................................................................... 9nadolol-bendroflumethiazide ................................... 7naltrexone hcl ..................................................................... 6NAMENDA ........................................................................ 15NAMENDA XR ............................................................... 15naproxen ................................................................................ 3naproxen dr .......................................................................... 3naratriptan hcl .................................................................. 14NASACORT ALLERGY 24HR ........................... 14NATACYN ......................................................................... 15nateglinide ............................................................................. 6NEBUPENT ......................................................................... 7NECON 1/50 (28) ......................................................... 10NECON 10/11 (28) ...................................................... 10NECON 7/7/7 ................................................................... 10neomycin sulfate .............................................................. 3neomycin-bacitracin zn-polymyx ....................... 15neomycin-polymyxin b gu ....................................... 13neomycin-polymyxin-dexameth ......................... 15neomycin-polymyxin-gramicidin ........................ 15neomycin-polymyxin-hc ........................................... 15neostigmine methylsulfate ........................................ 7NEOTUSS PLUS .......................................................... 11NESTABS ABC ............................................................. 14NEUPOGEN ..................................................................... 13NEVANAC ......................................................................... 15nevirapine .............................................................................. 8nevirapine er ........................................................................ 8niacin er ............................................................................... 16nicardipine hcl .................................................................... 9nicotine ................................................................................. 15nicotine polacrilex ......................................................... 15NIFEDIAC CC .................................................................... 9NIFEDICAL XL .................................................................. 9nifedipine ................................................................................ 9nifedipine er ......................................................................... 9nifedipine er osmotic release .................................. 9NILANDRON ...................................................................... 8nimodipine ............................................................................. 9nisoldipine er ....................................................................... 9NITRO-BID ........................................................................... 4nitrofurantoin .................................................................... 16nitrofurantoin macrocrystal .................................... 16nitrofurantoin monohyd macro ............................ 16nitroglycerin .......................................................................... 4nitroglycerin er ................................................................... 4NITROSTAT ........................................................................ 4nizatidine ............................................................................. 16NORA-BE ........................................................................... 10NORDITROPIN FLEXPRO ................................... 12norethindrone .................................................................. 10norethindrone acetate ............................................... 15norethindrone acet-ethinyl est ............................. 10

Index

norethindrone-eth estradiol ................................... 13norgestimate-eth estradiol ..................................... 10norgestim-eth estrad triphasic ............................. 10NORPACE CR .................................................................. 4NORTREL 7/7/7 ............................................................ 10nortriptyline hcl .................................................................. 5NORVIR .................................................................................. 8NOVOLIN 70/30 ............................................................... 6NOVOLIN N ......................................................................... 6NOVOLIN R ......................................................................... 6NOVOLOG ........................................................................... 6NOVOLOG FLEXPEN ................................................. 6NOVOLOG MIX 70/30 ................................................. 6NOVOLOG MIX 70/30 FLEXPEN ....................... 6NOVOLOG PENFILL ................................................... 6NOXAFIL ............................................................................... 6np thyroid ............................................................................ 16NUEDEXTA ...................................................................... 16NUVARING ....................................................................... 10nystatin .................................................................. 6, 11, 14nystatin-triamcinolone ............................................... 11octreotide acetate ......................................................... 12ofloxacin ..................................................................... 13, 15olanzapine ............................................................................. 8omeprazole ........................................................................ 16ondansetron ......................................................................... 6ondansetron hcl ................................................................ 6ONFI .......................................................................................... 5ONGLYZA ............................................................................ 6opium ........................................................................................ 6ORACIT ............................................................................... 13ORAP .................................................................................... 16ORFADIN ........................................................................... 12ORKAMBI .......................................................................... 16orphenadrine citrate er ............................................. 14orphenadrine-aspirin-caffeine .............................. 14ORTHO TRI-CYCLEN LO ..................................... 10OSMOPREP ..................................................................... 14oxandrolone ......................................................................... 4oxazepam .............................................................................. 4oxcarbazepine .................................................................... 5oxybutynin chloride ...................................................... 16oxybutynin chloride er ............................................... 16oxycodone hcl .................................................................... 4oxycodone hcl er .............................................................. 4oxycodone-acetaminophen ...................................... 4oxycodone-aspirin ........................................................... 4oxycodone-ibuprofen .................................................... 4oxymorphone hcl .............................................................. 4oxymorphone hcl er ....................................................... 4PACERONE ........................................................................ 4PANCREAZE .................................................................. 12pantoprazole sodium .................................................. 16paricalcitol .......................................................................... 12paromomycin sulfate ..................................................... 3paroxetine hcl ..................................................................... 5paroxetine hcl er ............................................................... 5PAXIL ....................................................................................... 5peg 3350/electrolytes ................................................ 14peg 3350-kcl-na bicarb-nacl ................................. 14peg-3350/electrolytes ................................................ 14PEGASYS ............................................................................. 8PEGASYS PROCLICK ............................................... 8PEG-INTRON ..................................................................... 8PEG-INTRON REDIPEN ........................................... 8PEG-INTRON REDIPEN PAK 4 .......................... 9penicillin v potassium ................................................. 15PENTASA .......................................................................... 13pentazocine-naloxone hcl .......................................... 4pentoxifylline er .............................................................. 13perindopril erbumine ...................................................... 7

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Index

permethrin .......................................................................... 11perphenazine ...................................................................... 8perphenazine-amitriptyline .................................... 16phenazopyridine hcl .................................................... 13phenelzine sulfate ........................................................... 5phenobarbital ................................................................... 13phenoxybenzamine hcl ................................................ 7phenylephrine hcl ......................................................... 15phenylephrine-chlorphen-dm ............................... 11phenytoin ............................................................................... 5phenytoin infatabs ........................................................... 5phenytoin sodium extended ..................................... 5PHOSLYRA ...................................................................... 13PHOSPHOLINE IODIDE ........................................ 15PHYSIOLYTE ..................................................................... 9PHYSIOSOL IRRIGATION ...................................... 9pilocarpine hcl ........................................................ 14, 15pindolol .................................................................................... 9pioglitazone hcl .................................................................. 6pioglitazone hcl-glimepiride ...................................... 6pioglitazone hcl-metformin hcl ............................... 6piroxicam ................................................................................ 3podofilox .............................................................................. 11polyethylene glycol 3350 ......................................... 15polyethylene glycol 3350-grx ............................... 14polymyxin b-trimethoprim ....................................... 15polysaccharide iron forte ......................................... 13pot bicarb-pot chloride .............................................. 14potassium bicarbonate ............................................. 14potassium chloride ....................................................... 14potassium chloride crys er ..................................... 14potassium chloride er ................................................ 14potassium citrate er ..................................................... 13potassium citrate-citric acid ................................... 13PRADAXA ............................................................................ 5pramipexole dihydrochloride ................................... 8PRANDIMET ....................................................................... 6pravastatin sodium ......................................................... 7prazosin hcl .......................................................................... 7PRED MILD ...................................................................... 15prednicarbate ................................................................... 11prednisolone ..................................................................... 10prednisolone acetate .................................................. 15prednisolone sodium phosphate .............. 10, 15prednisone ......................................................................... 10prednisone (pak) ........................................................... 10PREDNISONE INTENSOL ................................... 10PREMARIN ....................................................................... 13PREMPRO ........................................................................ 13prenatabs fa ...................................................................... 14prenatal 19 ......................................................................... 14prenatal plus iron .......................................................... 14prenatal plus/iron .......................................................... 14PREZISTA ............................................................................ 9primaquine phosphate ................................................. 7primidone ............................................................................... 5probenecid ......................................................................... 13prochlorperazine ............................................................... 8prochlorperazine maleate .......................................... 8PROCRIT ........................................................................... 13PROCTO-PAK .................................................................. 4PROCTOSOL HC ........................................................... 4PROCTOZONE-HC ....................................................... 4progesterone micronized ........................................ 15PROMACTA ..................................................................... 13promethazine vc/codeine ........................................ 11promethazine-codeine .............................................. 11promethazine-dm .......................................................... 11propafenone hcl ................................................................ 4propafenone hcl er .......................................................... 4propantheline bromide .............................................. 16

Index

propranolol hcl ................................................................... 9propranolol hcl er ............................................................. 9propranolol-hctz ................................................................ 7propylthiouracil ............................................................... 16protriptyline hcl .................................................................. 6pseudoeph-chlorphen-hydrocod ........................ 11PULMICORT FLEXHALER ..................................... 5PULMOZYME ................................................................. 16PYLERA .............................................................................. 16pyrazinamide ....................................................................... 7pyridostigmine bromide ............................................... 7pyridostigmine bromide er ......................................... 7QUASENSE ..................................................................... 10quetiapine fumarate ....................................................... 8quinapril hcl .......................................................................... 7quinapril-hydrochlorothiazide .................................. 7quinidine gluconate er .................................................. 4quinidine sulfate ................................................................ 4quinidine sulfate er ......................................................... 4quinine sulfate .................................................................... 7rabeprazole sodium .................................................... 16raloxifene hcl .................................................................... 12ramipril ..................................................................................... 7ranitidine hcl ..................................................................... 16RAPAMUNE ........................................................................ 9RELENZA DISKHALER ............................................ 9RELISTOR ........................................................................ 13RENACIDIN ...................................................................... 13RENAGEL ......................................................................... 13rena-vite rx ......................................................................... 14RENVELA .......................................................................... 13repaglinide ............................................................................ 6RESCRIPTOR ................................................................... 9reserpine ................................................................................ 7REVLIMID ............................................................................. 9REYATAZ ............................................................................. 9REZIRA ................................................................................ 11ribavirin .................................................................................... 9RIDAURA .............................................................................. 3rifabutin .................................................................................... 7rifampin .................................................................................... 7RIFATER ............................................................................... 7riluzole ................................................................................... 14rimantadine hcl .................................................................. 9ringers irrigation ................................................................ 9RIOMET .................................................................................. 6risedronate sodium ...................................................... 12risperidone ............................................................................ 8rivastigmine tartrate .................................................... 16rizatriptan benzoate .................................................... 14ropinirole hcl ........................................................................ 8SABRIL ................................................................................... 5salicylic acid ............................................................. 11, 12salicylic acid wart remover ..................................... 12salicylic acid-cleanser ................................................ 12salsalate ................................................................................. 3scalacort .............................................................................. 12selegiline hcl ........................................................................ 8selenium sulfide ............................................................. 12selenium sulf-pyrithione-urea .............................. 12SELZENTRY ....................................................................... 9SENSIPAR ........................................................................ 12SEREVENT DISKUS .................................................... 5sertraline hcl ........................................................................ 6SFROWASA .................................................................... 13sildenafil citrate ............................................................... 10silver nitrate ....................................................................... 12silver sulfadiazine ......................................................... 12SIMBRINZA ...................................................................... 15simethicone ....................................................................... 13simvastatin ............................................................................ 7

Index

sirolimus ................................................................................. 9sodium bicarbonate ........................................................ 4sodium chloride .............................................................. 11sodium fluoride ............................................................... 14sodium polystyrene sulfonate ................................. 9SOMAVERT ..................................................................... 12sorbitol .................................................................................. 13sorbitol-mannitol ............................................................ 13sotalol hcl ............................................................................... 9sotalol hcl (af) ..................................................................... 9SOVALDI ............................................................................... 9SPIRIVA HANDIHALER ............................................ 5SPIRIVA RESPIMAT .................................................... 5spironolactone ................................................................. 12spironolactone-hctz ..................................................... 12SPRYCEL ............................................................................. 8STALEVO 100 ................................................................... 8STALEVO 125 ................................................................... 8STALEVO 150 ................................................................... 8STALEVO 200 ................................................................... 8STALEVO 50 ...................................................................... 8STALEVO 75 ...................................................................... 8stavudine ................................................................................ 9sterile water for irrigation ............................................ 9STIMATE ............................................................................ 12STIOLTO RESPIMAT .................................................. 5STRATTERA ...................................................................... 3STRIBILD .............................................................................. 9SUCRAID ........................................................................... 12sucralfate ............................................................................ 16sulfacetamide sodium ....................................... 12, 15sulfacetamide sodium (acne) ............................... 12sulfacetamide sodium-sulfur ................................. 12sulfacetamide-prednisolone .................................. 15sulfacetamide-sulfur in urea ................................. 12sulfadiazine ....................................................................... 16sulfamethoxazole-trimethoprim ............................. 7sulfasalazine ..................................................................... 13SULFAZINE ..................................................................... 13SULFAZINE EC ............................................................ 13sulindac ................................................................................... 3sumatriptan succinate ............................................... 14sumatriptan succinate refill .................................... 14SUPRAX ............................................................................. 10SUPREP BOWEL PREP ........................................ 14SUSTIVA ............................................................................... 9SUTENT ................................................................................. 8SYMBICORT ...................................................................... 5SYMLINPEN 120 ............................................................. 6SYNAGIS ........................................................................... 15SYNAREL .......................................................................... 12SYNTHROID .................................................................... 16SYPRINE ............................................................................... 9TABLOID ............................................................................... 8tacrolimus ..................................................................... 9, 12TAMIFLU ............................................................................... 9tamoxifen citrate ............................................................... 8tamsulosin hcl .................................................................. 13TARCEVA ............................................................................. 8TASIGNA .............................................................................. 8TAZTIA XT ........................................................................... 9TEKTURNA ......................................................................... 7TEKTURNA HCT ............................................................ 7telmisartan ............................................................................ 7telmisartan-hctz ................................................................. 7temazepam ........................................................................ 13temozolomide ..................................................................... 8terazosin hcl ........................................................................ 7terbinafine hcl ..................................................................... 6terbutaline sulfate ............................................................ 5terconazole ........................................................................ 16

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Page 27: An Introduction to Independent Health’s MediSource and ... · Max imu Dly ose( ) Certain medications are dose limited by a maximum daily dose (MDD) as recommended by ... An Introduction

Index

testosterone ......................................................................... 4testosterone cypionate ................................................ 4testosterone enanthate ................................................ 4tetrabenazine ................................................................... 16tetracycline hcl ................................................................ 16THALOMID .......................................................................... 9theophylline .......................................................................... 5theophylline er .................................................................... 5THIOLA ................................................................................ 13thioridazine hcl ................................................................... 8thiothixene ............................................................................. 8tiagabine hcl ........................................................................ 5TIKOSYN ............................................................................... 4TILIA FE .............................................................................. 10timolol maleate ......................................................... 9, 15tinidazole ................................................................................ 7TIVICAY ................................................................................. 9tizanidine hcl ..................................................................... 14TOBI PODHALER .......................................................... 3tobramycin ................................................................... 3, 15tobramycin-dexamethasone ................................. 15tolbutamide ........................................................................... 6tolterodine tartrate ........................................................ 16tolterodine tartrate er .................................................. 16topiramate ............................................................................. 5torsemide ............................................................................ 12TOUJEO SOLOSTAR ................................................. 6TRACLEER ...................................................................... 10TRADJENTA ...................................................................... 6tramadol hcl ......................................................................... 4tramadol hcl er ................................................................... 4tramadol hcl er (biphasic) .......................................... 4tramadol-acetaminophen ........................................... 4trandolapril ............................................................................ 7tranylcypromine sulfate ............................................... 6TRAVATAN Z ................................................................. 15trazodone hcl ...................................................................... 6tretinoin ........................................................................... 8, 12tretinoin microsphere ................................................. 12tretinoin microsphere pump .................................. 12TREXALL .............................................................................. 8triamcinolone acetonide .................................. 12, 14triamterene-hctz ............................................................. 12triazolam .............................................................................. 13tricitrates .............................................................................. 13trifluoperazine hcl ............................................................ 8trifluridine ............................................................................ 15trihexyphenidyl hcl .......................................................... 8TRI-LEGEST FE ........................................................... 10trimethobenzamide hcl ................................................ 6trimethoprim ......................................................................... 7TRINESSA (28) ............................................................. 10triple-vitamin/fluoride .................................................. 14TRI-PREVIFEM .............................................................. 10TRI-SPRINTEC .............................................................. 10TRIUMEQ .............................................................................. 9TRIVORA (28) ................................................................ 10tropicamide ........................................................................ 15trospium chloride ........................................................... 16trospium chloride er .................................................... 16TRUVADA ............................................................................ 9TYBOST ................................................................................. 9TYZEKA ................................................................................. 9UNITHROID ...................................................................... 16ursodiol ................................................................................. 13VAGIFEM ........................................................................... 16valacyclovir hcl .................................................................. 9VALCYTE .............................................................................. 9valganciclovir hcl .............................................................. 9valproic acid ......................................................................... 5valsartan ................................................................................. 7

Index

valsartan-hydrochlorothiazide ................................ 7vancomycin hcl .................................................................. 7VELIVET ............................................................................. 10venlafaxine hcl ................................................................... 6venlafaxine hcl er ............................................................. 6VENTOLIN HFA ............................................................... 5verapamil hcl .................................................................... 10verapamil hcl er .............................................................. 10VEREGEN ......................................................................... 12VEXOL ................................................................................. 15V-GO 20 .............................................................................. 14V-GO 30 .............................................................................. 14V-GO 40 .............................................................................. 14VICTOZA ............................................................................... 6VICTRELIS ........................................................................... 9VIDEX ....................................................................................... 9VIMPAT .................................................................................. 5VIRACEPT ........................................................................... 9VIREAD .................................................................................. 9virt-phos 250 neutral ................................................... 14vitamin d (ergocalciferol) ......................................... 16VITEKTA ................................................................................ 9VOLTAREN ...................................................................... 12voriconazole ........................................................................ 6warfarin sodium ................................................................. 5WELCHOL ........................................................................... 7XARELTO ............................................................................. 5XARELTO STARTER PACK ................................. 5XULANE .............................................................................. 10XYREM ................................................................................. 16YODOXIN .............................................................................. 3zaleplon ................................................................................ 13ZARXIO ............................................................................... 13ZELAPAR ............................................................................. 8ZENPEP .............................................................................. 12ZETIA ....................................................................................... 7ZIAGEN .................................................................................. 9zidovudine ............................................................................. 9ziprasidone hcl ................................................................... 8ZOLINZA ............................................................................... 8zolmitriptan ........................................................................ 14zolpidem tartrate ............................................................ 13zolpidem tartrate er ..................................................... 13zonisamide ........................................................................... 5ZORTRESS ......................................................................... 9ZUBSOLV ............................................................................. 4ZYTIGA ................................................................................... 8

Last Updated 10.01.2015

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