FEHB Managed Formulary - aultcare.com

2022Managed Formulary 5-Tier

AultCare’s formulary is designed to provide value. Only specific drugs in each therapeutic class are covered. The formulary design provides adequate options in each therapeutic category and includes most generics and selected brands. Medications not listed on our formulary are not covered under the plan. Medications not on our formulary must meet criteria through an exception process in order to be considered for coverage under plan benefits. Certain medications may be covered under medical, require prior authorization, have step therapy, and/or may have plan limitations. Prior authorization may limit the number of days supply for certain medications. Tier exceptions are not applicable. For example, a higher tier (Non-Preferred) medication may not be requested at a lower tier (Preferred) copay. Please refer to the Pharmacy Summary of Benefits to review copays/coinsurance. You can visit the AultCare website at www.aultcare.com or call AultCare Customer Service at 330-363-6360 or 1-800-344-8858 (TTY: 711) for any questions regarding these processes.

FEHB Managed Formulary (5-Tier Plans)

1 = Preventive Maintenance List drugs (Tier 1)

2 = Most Preferred Generic drugs (Tier 2)

3 = Preferred Brand and PreferredGeneric drugs (Tier 3)

4 = Non- Preferred Brand and Non- Preferred Generic drugs (Tier 4)

5 = Preferred Brand and Generic Specialty Medications (Tier 5)

FEHB Managed FEHB Managed FormularyFormulary

7362/21

Alphabetical Listing

A24 HOUR NASAL ALLERGY NASAL AEROSOL,SPRAY 55 MCG QL 2abacavir oral solution 20 mg/ml 5abacavir oral tablet 300 mg 5abacavir-lamivudine oral tablet 600-300 mg 5abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg 5abiraterone oral tablet 250 mg PA; QL 5ABREVA TOPICAL CREAM 10 % 2acamprosate oral tablet,delayed release (dr/ec) 333 mg 3acarbose oral tablet 100 mg, 25 mg, 50 mg 1acebutolol oral capsule 200 mg, 400 mg 1acetaminophen-codeine oral solution 120-12 mg/5 ml QL 2acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg, 300-60 mg QL 2acetazolamide oral capsule, extended release 500 mg 2acetazolamide oral tablet 125 mg, 250 mg 2acetic acid otic (ear) solution 2 % 2acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %) 1acitretin oral capsule 10 mg, 17.5 mg, 25 mg 4ACTEMRA ACTPEN SUBCUTANEOUS PEN INJECTOR 162 MG/0.9 ML PA; QL 5

PA;QL 5ACTEMRA SUBCUTANEOUS SYRINGE 162 MG/0.9 ML PA; QL 5ACTIMMUNE SUBCUTANEOUS SOLUTION 100 MCG/0.5 ML PA 5acyclovir oral capsule 200 mg 2acyclovir oral suspension 200 mg/5 ml 2acyclovir oral tablet 400 mg, 800 mg 2acyclovir topical ointment 5 % QL 4adapalene topical OTC 2adapalene topical cream 0.1 % ST 2adapalene topical gel 0.1 %, 0.3 % ST 2adapalene topical gel with pump 0.3 % ST 2adapalene topical solution 0.1 % ST 2adapalene topical swab 0.1 % ST 2adapalene-benzoyl peroxide topical gel with pump 0.1-2.5 % ST 3adefovir oral tablet 10 mg PA 2ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG PA; QL 5adult aspirin regimen oral tablet,delayed release (dr/ec) 81 mg 1ADVAIR DISKUS INHALER 100/50, 250/50, 500/50 QL 3ADVAIR HFA QL 3AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG PA; QL 5afirmelle oral tablet 0.1-20 mg-mcg 2

3

3

3AFTERA ORAL TABLET 1.5 MG 2AIRDUO DIGIHALER ST 4AIRDUO RESPICLICK ST 4AJOVY INJ 225 MG/1.5 PA 3ak-poly-bac ophthalmic (eye) ointment 500-10,000 unit/gram 2AKYNZEO (NETUPITANT) ORAL CAPSULE 300-0.5 MG PA; QL 5

1

1albuterol sulfate oral syrup 2 mg/5 ml 1

ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20 MG/ML), 400 MG/20 ML (20 MG/ML), 80 MG/4 ML (20 MG/ML)

AFLURIA QD 2020-21(3YR UP)(PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

AFLURIA QD 2020-21(6-35MO)(PF) INTRAMUSCULAR SYRINGE 30 MCG (7.5 MCG X 4)/0.25 ML

AFLURIA QUAD 2020-21(6MO UP) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

ALBUTEROL SULFATE INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION

albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 2.5 mg/0.5 ml, 5 mg/ml

albuterol sulfate oral tablet 2 mg, 4 mg 1alclometasone topical cream 0.05 % 3alclometasone topical ointment 0.05 % 3alendronate oral tablet 10 mg, 35 mg, 5 mg, 70 mg QL 1alfuzosin oral tablet extended release 24 hr 10 mg 2ALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML 4ALINIA ORAL TABLET 500 MG 4aliskiren oral tablet 150 mg, 300 mg 3all day allergy (cetirizine) oral capsule 10 mg 2all day allergy (cetirizine) oral solution 1 mg/ml 2all day allergy (cetirizine) oral tablet 10 mg QL 2allerclear oral tablet 10 mg QL 2allergy relief (cetirizine) oral capsule 10 mg 2allergy relief (cetirizine) oral solution 1 mg/ml 2allergy relief (cetirizine) oral tablet 10 mg QL 2allergy relief (loratadine) oral solution 5 mg/5 ml 2allergy relief (loratadine) oral tablet 10 mg QL 2allergy relief (loratadine) oral tablet,disintegrating 10 mg 2aller-tec oral tablet 10 mg QL 2allopurinol oral tablet 100 mg, 300 mg 2almotriptan malate oral tablet 12.5 mg, 6.25 mg QL; ST 4ALOCRIL OPHTHALMIC (EYE) DROPS 2 % ST 3ALOMIDE OPHTHALMIC (EYE) DROPS 0.1 % ST 3alophen oral tablet,delayed release (dr/ec) 5 mg 2alosetron oral tablet 0.5 mg, 1 mg 3alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg 2ALREX OPHTHALMIC (EYE) DROPS,SUSPENSION 0.2 % ST 4ALTABAX TOPICAL OINTMENT 1 % ST 4altavera (28) oral tablet 0.15-0.03 mg 2ALVESCO AER 80MCG, 160MCG PA; QL 4alyacen 1/35 (28) oral tablet 1-35 mg-mcg 2alyacen 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2ALYQ 20MG PA; QL 5amabelz oral tablet 2amantadine hcl oral capsule 100 mg 2amantadine hcl oral solution 50 mg/5 ml 2amantadine hcl oral tablet 100 mg 2ambrisentan oral tablet 10 mg, 5 mg PA; QL 5amcinonide topical cream 0.1 % 3amethia lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7) 2amethia oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2amethyst (28) oral tablet 90-20 mcg (28) 2amiloride oral tablet 5 mg 2aminophylline intravenous solution 250 mg/10 ml 2amiodarone oral tablet 100 mg, 200 mg, 400mg 2AMITIZA ORAL CAPSULE 24 MCG, 8 MCG 3amitriptyline oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg 2amlodipine oral tablet 10 mg, 2.5 mg, 5 mg 1

1ammonium lactate topical cream 12 % 2ammonium lactate topical lotion 12 % 2amnesteem oral capsule 10 mg, 20 mg, 40 mg 2amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg 2amoxicillin oral capsule 250 mg, 500 mg 2

2amoxicillin oral tablet 875 mg 2

amlodipine-benazepril oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg

amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml

Alphabetical Listing

PA = Prior AuthorizationQL = Quantity Limits Per Prescription Days SupplyST = Step Therapy

5 Tier Plan Design Formulary Coding1 = Preventive Maintenance List drugs (tier 1)2 = Most Preferred Generic drugs (tier 2)3 = Preferred Brand and Preferred Generic drugs (tier 3)4 = Non- Preferred Brand and Non- Preferred Generic drugs (tier 4)5 = Preferred Brand and Generic Specialty Medications (tier 5)

This list is subject to change. For an up-to-date listing please visit www.aultcare.com Pg. 2

amoxicillin oral tablet,chewable 125 mg, 250 mg 2

2

2amoxicillin-pot clavulanate oral tablet,chewable 200-28.5 mg, 400-57 mg 2amphetamine oral tablet 5mg, 7.5mg, 10mg 2ampicillin oral capsule 500 mg 2anagrelide oral capsule 0.5 mg, 1 mg 2anastrozole oral tablet 1 mg 2

QL 3

ST 4APIDRA U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML ST 4APOKYN SUBCUTANEOUS CARTRIDGE 10 MG/ML PA 5APO-VARENICLINE ORAL TABLET 0.5MG, 1MG ST 3apraclonidine ophthalmic (eye) drops 0.5 % 2aprepitant oral capsule 125 mg, 40 mg, 80 mg 4aprepitant oral capsule,dose pack 125 mg (1)- 80 mg (2) 4apri oral tablet 0.15-0.03 mg 2APTIOM ORAL TABLET 200 MG, 400 MG, 600 MG, 800 MG 4APTIVUS ORAL CAPSULE 250 MG 5ARAKODA ORAL TABLET 100 MG 4aranelle (28) oral tablet 0.5/1/0.5-35 mg-mcg 2

PA; QL 5ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML PA; QL 5

PA; QL 5aripiprazole oral solution 1 mg/ml QL 2aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg QL 2armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg 3

QL 3artificial tears ophthalmic oint 2ashlyna oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2

QL 3

QL 3aspir-81 oral tablet,delayed release (dr/ec) 81 mg 1aspirin low dose oral tablet,delayed release (dr/ec) 81 mg 1aspirin oral tablet 325 mg 1aspirin oral tablet,chewable 81 mg 1aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg 1aspirin-dipyridamole oral capsule, er multiphase 12 hr 25-200 mg 1aspir-low oral tablet,delayed release (dr/ec) 81 mg 1aspir-trin oral tablet,delayed release (dr/ec) 325 mg 1atazanavir oral capsule 150 mg, 200 mg, 300 mg QL 5atenolol oral tablet 100 mg, 25 mg, 50 mg 1

3atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg QL 1atovaquone oral suspension 750 mg/5 ml 4

amoxicillin-pot clavulanate oral suspension for reconstitution 200-28.5 mg/5 ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml

amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125 mg

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE 62.5-25 MCG/ACTUATION

APIDRA SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML

ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 150 MCG/0.75 ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4 ML, 500 MCG/ML, 60 MCG/0.3 ML

ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 200 MCG/ACTUATION, 50MCG

ASMANEX HFA INHALATION HFA AEROSOL INHALER 100 MCG/ACTUATION, 200 MCG/ACTUATION

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

atomoxetine oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg

atovaquone-proguanil oral tablet 250-100 mg, 62.5-25 mg 1ATRIPLA ORAL TABLET 600-200-300 MG 5atropine ophthalmic (eye) drops 1 % 2ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCG/ACTUATION QL 3AUBAGIO ORAL TABLET 14 MG, 7 MG PA; QL 5aubra eq oral tablet 0.1-20 mg-mcg 2aubra oral tablet 0.1-20 mg-mcg 2aurovela 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2aurovela 1/20 (21) oral tablet 1-20 mg-mcg 2aurovela 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2aurovela fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2aurovela fe 1-20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2aviane oral tablet 0.1-20 mg-mcg 2avidoxy oral tablet 100mg 2AVONEX INTRAMUSCULAR PEN INJECTOR KIT 30 MCG/0.5 ML PA; QL 5AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG/0.5 ML PA; QL 5ayuna oral tablet 0.15-0.03 mg 2AZASITE OPHTHALMIC (EYE) DROPS 1 % 4azathioprine oral tablet 50 mg 5azelaic acid topical gel 15 % ST 3azelastine nasal aerosol,spray 137 mcg (0.1 %) QL 2azelastine nasal spray,non-aerosol 0.15 % (205.5 mcg) ST 3azelastine ophthalmic (eye) drops 0.05 % 2azithromycin oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml 2azithromycin oral tablet 250 mg, 500 mg, 600 mg 2AZOPT OPHTHALMIC (EYE) DROPS,SUSPENSION 1 % ST 4azurette (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2

Bbacitracin ophthalmic (eye) ointment 500 unit/gram 3bacitracin-polymyxin b ophthalmic (eye) ointment 500-10,000 unit/gram 2baclofen oral tablet 10 mg, 20 mg 2BAFIERTAM ORAL CAPSULE 95MG PA; QL 5balsalazide oral capsule 750 mg 2balziva (28) oral tablet 0.4-35 mg-mcg 2BAQSIMI NASAL SPRAY,NON-AEROSOL 3 MG/ACTUATION 3bayer aspirin oral tablet 325 mg 1belrapzo soln 100/4ml PA 5BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG, 5 MG ST; QL 4benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1bendeka inj 100/4ml PA 5benzonatate oral capsule 100 mg, 150 mg, 200 mg 2benztropine oral tablet 0.5 mg, 1 mg, 2 mg 2BEPREVE OPHTHALMIC (EYE) DROPS 1.5 % ST 4beser lotion 0.05% 2BESIVANCE OPHTHALMIC (EYE) DROPS,SUSPENSION 0.6 % 4betamethasone dipropionate topical cream 0.05 % 2betamethasone dipropionate topical lotion 0.05 % 2betamethasone dipropionate topical ointment 0.05 % 2betamethasone valerate topical cream 0.1 % 2betamethasone valerate topical lotion 0.1 % 2betamethasone valerate topical ointment 0.1 % 2betamethasone, augmented topical cream 0.05 % 2betamethasone, augmented topical gel 0.05 % 2betamethasone, augmented topical lotion 0.05 % 2betamethasone, augmented topical ointment 0.05 % 2BETASERON SUBCUTANEOUS KIT 0.3 MG PA; QL 5betaxolol ophthalmic (eye) drops 0.5 % 2

Alphabetical ListingAlphabetical Listing



Pg. 3 This list is subject to change. For an up-to-date listing please visit www.aultcare.com

betaxolol oral tablet 10 mg, 20 mg 1bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg 2bexarotene oral capsule 75 mg 5bicalutamide oral tablet 50 mg 2bimatoprost ophthalmic (eye) drops 0.03 % ST 3bisacodyl oral tablet,delayed release (dr/ec) 5 mg 2bisa-lax oral tablet,delayed release (dr/ec) 5 mg 2bisoprolol fumarate oral tablet 10 mg, 5 mg 1

1blisovi 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2blisovi fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2blisovi fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2bosentan oral tablet 125 mg, 62.5 mg PA; QL 5

QL 3BREZTRI AERO AER SPHERE ST 3briellyn oral tablet 0.4-35 mg-mcg 2BRILINTA ORAL TABLET 60 MG, 90 MG 3brimonidine ophthalmic (eye) drops 0.15 %, 0.2 % 2brinzolamide susp 1% ST 3bromfenac ophthalmic (eye) drops 0.09 % 2bromocriptine oral capsule 5 mg 4bromocriptine oral tablet 2.5 mg 4budesonide/formoterol fumarate aer 80-4.5, 160-4.5 ST; QL 4

QL 1budesonide inhalation suspension for nebulization 1 mg/2 ml QL 1budesonide nasal spray,non-aerosol 32 mcg/actuation QL 2budesonide oral capsule,delayed,extend.release 3 mg 2bumetanide oral tablet 0.5 mg, 1 mg, 2 mg 3buprenorphine hcl sublingual tablet 2 mg, 8 mg 2

ST; QL 2BUPRENORPHINE TRANSDERMAL PATCH WEEKLY 7.5 MCG/HOUR ST; QL 2buprenorphine-naloxone sublingual tablet 2-0.5 mg, 8-2 mg QL 3bupropion hcl (smoking deter) oral tablet extended release 12 hr 150 mg 1bupropion hcl oral tablet 100 mg, 75 mg 2bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg QL 2bupropion hcl oral tablet sustained-release 12 hr 100 mg, 150 mg, 200 mg QL 2buspirone oral tablet 10 mg, 15 mg, 5 mg 2butalbital-acetaminop-caf-cod oral capsule 50-300-40-30 mg QL 4butalbital-acetaminophen oral tablet 50-325 mg QL 3butalbital-acetaminophen-caff oral tablet 50-325-40 mg 2butenafine cream 1% ST 3butorphanol tartrate nasal spray,non-aerosol 10 mg/ml QL 3BYDUREON BCISE SUBCUTANEOUS AUTO-INJECTOR 2 MG/0.85 ML 3

QL 3BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, 20 MG, 5 MG ST 4

Ccabergoline oral tablet 0.5 mg QL 2calcipotriene scalp solution 0.005 % PA 2calcipotriene topical cream 0.005 % PA; Q: 2calcipotriene topical ointment 0.005 % PA 2calcipotriene-betamethasone topical ointment 0.005-0.064 % PA 4calcitonin (salmon) nasal spray,non-aerosol 200 unit/actuation 4

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

BREO ELLIPTA INHALATION BLISTER WITH DEVICE 100-25 MCG/DOSE, 200-25 MCG/DOSE

budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml

buprenorphine transdermal patch weekly 10 mcg/hour, 15 mcg/hour, 20 mcg/hour, 5 mcg/hour

BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML, 5 MCG/DOSE (250 MCG/ML) 1.2 ML

calcitriol oral capsule 0.25 mcg, 0.5 mcg 2calcitriol oral solution 1 mcg/ml 2calcium 500 + d oral tablet,chewable 500 mg(1,250mg) -400 unit 2

2calcium 600 with vitamin d3 oral capsule 600 mg(1,500mg) -500 unit 2calcium acetate oral capsule 667 mg 2calcium acetate oral tablet 667 mg 2calcium citrate-vitamin d2 oral tablet 1,500-200 mg-unit 2calcium citrate-vitamin d3 oral tablet 315-200 mg-unit 2camila oral tablet 0.35 mg 2camrese lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7) 2camrese oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2candesartan oral tablet 16 mg, 32 mg, 4 mg, 8 mg 1capecitabine oral tablet 150 mg, 500 mg PA; QL 5CAPRELSA ORAL TABLET 100 MG, 300 MG QL 5captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg 1carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, 300 mg 2carbamazepine oral suspension 100 mg/5 ml 2carbamazepine oral tablet 200 mg 2

2carbamazepine oral tablet,chewable 100 mg 2carbidopa oral tablet 25 mg 3carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg 2carbidopa-levodopa oral tablet extended release 25-100 mg, 50-200 mg 2

2carbinoxamine maleate oral liquid 4 mg/5 ml 2carbinoxamine maleate oral tablet 4 mg, 6 mg 2carisoprodol oral tablet 350 mg 2carisoprodol oral tablet aspirin/cod PA; QL 4carteolol ophthalmic (eye) drops 1 % 2

1carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg 2

ST 3cavarest gel 1.1% 1CAYSTON INHALATION SOLUTION FOR NEBULIZATION 75 MG/ML QL 5caziant (28) oral tablet 0.1/.125/.15-25 mg-mcg 2cdp/amitrip oral tablet 10-25mg, 5-12.5mg 2cefaclor oral capsule 250 mg, 500 mg 2cefaclor oral suspension for reconstitution 250 mg/5 ml 2cefadroxil oral capsule 500 mg 2cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml 2cefdinir oral capsule 300 mg 2cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml 2cefixime oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml 4cefpodoxime oral tablet 100mg, 200mg 2cefpodoxime proxetil susp 100/5ml, 50/ml 2cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml 2cefprozil oral tablet 250 mg, 500 mg 2cefuroxime axetil oral tablet 250 mg, 500 mg 2celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg 2CELONTIN ORAL CAPSULE 300 MG 4cephalexin oral capsule 250 mg, 500 mg 2cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml 2

calcium 600 + d(3) oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit

carbamazepine oral tablet extended release 12 hr 100 mg, 200 mg, 400 mg

carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg, 18.75-75-200 mg, 25-100-200 mg, 31.25-125-200 mg, 37.5-150-200 mg, 50-200-200 mg

cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg

carvedilol phosphate oral capsule, er multiphase 24 hr 10 mg, 20 mg, 40 mg, 80 mg






cetirizine oral solution 1 mg/ml, 5 mg/5 ml 2cetirizine oral tablet 10 mg, 5 mg QL 2cetirizine oral tablet,chewable 10 mg, 5 mg QL 2CETROTIDE SUBCUTANEOUS KIT 0.25 MG 3cevimeline oral capsule 30 mg 2CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG ST 3CHANTIX ORAL TABLET 0.5 MG, 1 MG ST 3

ST 3charlotte 24 chw fe 1/20 2chateal (28) oral tablet 0.15-0.03 mg 2chateal eq (28) oral tablet 0.15-0.03 mg 2child allergy relf(cetirizine) oral solution 1 mg/ml 2children's allergy relief(lor) oral solution 5 mg/5 ml 2children's allergy(cetirizine) oral solution 1 mg/ml 2children's aller-tec oral solution 1 mg/ml 2children's cetirizine oral solution 1 mg/ml 2children's cetirizine oral tablet,chewable 10 mg, 5 mg 2children's wal-zyr oral solution 1 mg/ml 2children's wal-zyr oral tablet,chewable 10 mg 2child's all day allergy(cetir) oral solution 1 mg/ml 2chlordiazepoxide hcl oral capsules 10mg, 25mg, 5mg 3chlorhexidine gluconate mucous membrane mouthwash 0.12 % 2chloroquine phosphate oral tablet 250 mg, 500 mg 1chlorpromazine oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg 2chlorthalidone oral tablet 25 mg, 50 mg 1chlorzoxazone oral tablet 500 mg 2cholestyramine (with sugar) oral powder 4 gram 1cholestyramine (with sugar) oral powder in packet 4 gram 1cholestyramine light oral powder 4 gram 1cholestyramine light oral powder in packet 4 gram 1

PA; QL 5ciclodadn sol 8% 2ciclopirox topical cream 0.77 % 2ciclopirox topical gel 0.77 % 2ciclopirox topical shampoo 1 % 2ciclopirox topical solution 8 % 2ciclopirox topical suspension 0.77 % 2cilostazol oral tablet 100 mg, 50 mg 2CIMDUO ORAL TABLET 300-300 MG 5cimetidine hcl oral solution 300 mg/5 ml 2cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg 2

PA; QL 5CIMZIA SUBCUTANEOUS SYRINGE KIT 400 MG/2 ML (200 MG/ML X 2) PA; QL 5cinacalcet oral tablet 30 mg, 60 mg, 90 mg QL 4CIPRO HC OTIC (EAR) DROPS,SUSPENSION 0.2-1 % 4ciprofloxacin hcl ophthalmic (eye) drops 0.3 % 2ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg 2ciprofloxacin/dexameth otic suspension 0.3-0.1% 2citalopram oral solution 10 mg/5 ml 1citalopram oral tablet 10 mg, 20 mg, 40 mg QL 1citroma oral solution 2claravis oral capsule 10 mg, 20 mg, 30 mg, 40 mg 2

2clarithromycin oral tablet 250 mg, 500 mg 2

CIMZIA POWDER FOR RECONST SUBCUTANEOUS KIT 400 MG (200 MG X 2 VIALS)

clarithromycin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK 0.5 MG (11)- 1 MG (42)

CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR RECON SOLN 10,000 UNIT

clarithromycin oral tablet extended release 24 hr 500 mg 2clearlax oral powder 17 gram/dose 2clemastine oral tablet 2.68 mg 2clindacin etz external swab 1% 2clindacin-p pad 1% 2CLINDAGEL GEL 1% 2clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg 2clindamycin palmitate hcl oral recon soln 75 mg/5 ml 2clindamycin pediatric oral recon soln 75 mg/5 ml 2clindamycin phosphate topical gel 1 % 2clindamycin phosphate topical lotion 1 % 2clindamycin phosphate topical solution 1 % 2clindamycin phosphate topical swab 1 % 2clindamycin phosphate vaginal cream 2 % 3clindamycin-benzoyl peroxide topical gel 1.2 %(1 % base) -5 % ST 2clindamycin-benzoyl peroxide topical gel 1-5 % 2clindamycin-tretinoin topical gel 1.2-0.025 % PA 4clobazam susp 2.5mg/ml 3clobazam oral tablet 10mg, 20mg 3clobetasol scalp solution 0.05 % QL 2clobetasol topical cream 0.05 % QL 2clobetasol topical foam 0.05 % QL 2clobetasol topical gel 0.05 % QL 2clobetasol topical lotion 0.05 % QL 2clobetasol topical ointment 0.05 % QL 2clobetasol topical shampoo 0.05 % QL 2clobetasol-emollient topical cream 0.05 % QL 2clodan shampoo 0.05% QL 2clomiphene citrate oral tablet 50 mg 2clomipramine oral capsule 25 mg, 50 mg, 75 mg ST 3clonazepam oral tablet 0.5 mg, 1 mg, 2 mg 2clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg 2clonidine hcl oral tablet 0.1mg ER ST 3

QL 2clopidogrel oral tablet 300 mg, 75 mg 1clorazepate dipotassium oral tablet 3.75mg, 7.5mg, 15mg 2clotrimazole mucous membrane troche 10 mg 2clotrimazole topical cream 1 % 2clotrimazole topical solution 1 % 2clotrimazole-betamethasone topical cream 1-0.05 % 2clotrimazole-betamethasone topical lotion 1-0.05 % 2clovique oral capsule 250mg PA 5clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg 2

codeine sulfate oral tablet 15 mg, 30 mg, 60 mg QL 2

COLCHICINE ORAL CAPSULE 0.6 MG 3COLCHICINE ORAL TABLET 0.6 MG 3colesevelam oral powder in packet 3.75 gram 1colesevelam oral tablet 625 mg 1colestipol oral granules 5 gram 1colestipol oral packet 5 gram 1colestipol oral tablet 1 gram 1COMBIGAN OPHTHALMIC (EYE) DROPS 0.2-0.5 % ST 4COMBIVENT RESPIMAT INHALATION MIST 20-100 MCG/ACTUATION QL 3compro rectal suppository 25 mg 2constulose oral solution 10 gram/15 ml 2COPAXONE INJ 20MG/ML, 40MG/ML PA; QL 5CORLANOR ORAL TABLET 5 MG, 7.5 MG 4

clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 mg/24 hr





cortisone oral tablet 25 mg 2CORTISPORIN SUSP TC OTIC 4COSENTYX (2 SYRINGES) SUBCUTANEOUS SYRINGE 150 MG/ML PA; QL 5COSENTYX PEN (2 PENS) SUBCUTANEOUS PEN INJECTOR 150 MG/ML PA; QL 5COSENTYX PEN SUBCUTANEOUS PEN INJECTOR 150 MG/ML PA; QL 5COSENTYX SUBCUTANEOUS SYRINGE 150 MG/ML PA; QL 5

3CRIXIVAN ORAL CAPSULE 400 MG 5cromolyn inhalation solution for nebulization 20 mg/2 ml 1cromolyn ophthalmic (eye) drops 4 % ST 2cromolyn oral concentrate 100 mg/5 ml 2cryselle (28) oral tablet 0.3-30 mg-mcg 2cyclafem 1/35 (28) oral tablet 1-35 mg-mcg 2cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2cyclobenzaprine oral tablet 10 mg, 5 mg 2cyclophosphamide oral capsule 25 mg, 50 mg 5CYCLOSERINE ORAL CAPSULE 250 MG 4CYCLOSET ORAL TABLET 0.8 MG 4cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg 5cyclosporine modified oral solution 100 mg/ml 5cyclosporine oral capsule 100 mg, 25 mg 5cyproheptadine oral syrup 2 mg/5 ml 2cyproheptadine oral tablet 4 mg 2cyred eq oral tablet 0.15-0.03 mg 2cyred oral tablet 0.15-0.03 mg 2

DD3-50 CHOLECALCIFEROL ORAL CAPSULE 50,000 UNIT 2dalfampridine oral tablet extended release 12 hr 10 mg PA; QL 5danazol oral capsule 100 mg, 200 mg, 50 mg 2dantrolene oral capsule 100 mg, 25 mg, 50 mg 2dapsone oral tablet 100 mg, 25 mg 3darifenacin oral tablet extended release 24 hr 15 mg, 7.5 mg ST 3dasetta 1/35 (28) oral tablet 1-35 mg-mcg 2dasetta 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2daysee oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2

ST; QL 4DEBACTEROL MUCOUS MEMBRANE SOLUTION 30-50 % 3deblitane oral tablet 0.35 mg 2DECARA CAP 1.25mg (50000 UNT) 4deferiprone oral tablet 500 mg PA 4delyla (28) oral tablet 0.1-20 mg-mcg 2demeclocycline oral tablet 150mg, 300mg ST 3DESCOVY ORAL TABLET 200-25 MG 5desipramine oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg ST 3desloratadine oral tablet 5 mg QL 4desloratadine oral tablet,disintegrating 2.5 mg QL 4desloratadine oral tablet,disintegrating 5 mg QL 4desmopressin nasal spray,non-aerosol 10 mcg/spray (0.1 ml) 2desmopressin oral tablet 0.1 mg, 0.2 mg 2desog-e.estradiol/e.estradiol oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2desogestrel-ethinyl estradiol oral tablet 0.15-0.03 mg 2desonide topical cream 0.05 % ST; QL 4desonide topical ointment 0.05 % ST 4desoximetasone topical cream 0.25 % ST 2

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000 -60,000 UNIT, 24,000-76,000 -120,000 UNIT, 3,000-9,500- 15,000 UNIT, 36,000-114,000- 180,000 UNIT, 6,000-19,000 -30,000 UNIT

DAYTRANA TRANSDERMAL PATCH 24 HOUR 10 MG/9 HR, 15 MG/9 HR, 20 MG/9 HR, 30 MG/9 HR

desoximetasone topical gel 0.05 % ST 3desoximetasone topical ointment 0.25 % ST 2

QL 2dexamethasone oral elixir 0.5 mg/5 ml 2dexamethasone oral solution 0.5 mg/5 ml 2

2dexamethasone sodium phosphate ophthalmic (eye) drops 0.1 % 2dexchlorpheniramine oral soln 2mg/5ml 2DEXILANT ORAL CAPSULE 30MG DR PA; QL 4

3dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5 mg 2dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg 3dextroamphetamine oral tablet 10 mg, 5 mg 2

2

2dialyvite 800 oral tablet 0.8 mg 2diazepam intensol oral concentrate 5 mg/ml 2diazepam oral solution 5 mg/5 ml (1 mg/ml) 2diazepam oral tablet 10 mg, 2 mg, 5 mg 2diazepam rectal kit 12.5-15-17.5-20 mg, 2.5 mg, 5-7.5-10 mg 3diclofenac misoprostol oral tablet 50-0.2mg, 75-0.2mg 2diclofenac potassium oral tablet 50 mg 2diclofenac sodium ophthalmic (eye) drops 0.1 % 2diclofenac sodium oral tablet extended release 24 hr 100 mg 2diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg, 50 mg, 75 mg 2diclofenac sodium topical gel 1 % QL 2diclofenac sodium topical gel 3 % PA; QL 4dicloxacillin oral capsule 250 mg, 500 mg 2dicyclomine oral capsule 10 mg 2dicyclomine oral solution 10 mg/5 ml 2dicyclomine oral tablet 20 mg 2DIFFERIN GEL 0.1% 2DIFFERIN LOTION 0.1% ST 4DIFICID ORAL TABLET 200 MG PA 4diflorasone topical cream 0.05 % 4diflorasone topical ointment 0.05 % ST 4diflunisal oral tablet 500 mg 2digitek oral tablet 125 mcg, 250 mcg 3digox oral tablet 125 mcg, 250 mcg 3digoxin oral solution 50 mcg/ml 3digoxin oral tablet 125 mcg, 250 mcg 3dihydroergotamine injection solution 1 mg/ml PA 4diltiazem hcl oral capsule,ext.rel 24h degradable 120 mg, 180 mg, 240 mg 1diltiazem hcl oral capsule,extended release 12 hr 120 mg, 60 mg, 90 mg 1diltiazem hcl oral capsule,extended release 24 hr 180 mg, 240 mg, 300 mg 1

1diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg 1dilt-xr oral capsule,ext.rel 24h degradable 120 mg, 180 mg, 240 mg 1dimethyl fumarate oral dr 120mg, 240mg PA; QL 5DIPENTUM ORAL CAPSULE 250 MG ST 4diphenhydramine hcl injection syringe 50 mg/ml 2diphenoxylate-atropine oral liquid 2.5-0.025 mg/5 ml 2

DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24 HR 100 MG, 50 MG, 25 MG

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

dexmethylphenidate oral capsule,er biphasic 50-50 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg

dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg

dextroamphetamine-amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg






diphenoxylate-atropine oral tablet 2.5-0.025 mg 2dipyridamole oral tablet 25 mg, 50 mg, 75 mg 1disopyramide phosphate oral capsule 100 mg, 150 mg 2disulfiram oral tablet 250 mg, 500 mg 3divalproex oral capsule, delayed rel sprinkle 125 mg 2divalproex oral tablet extended release 24 hr 250 mg, 500 mg 2divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 mg 2dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg 3dolishale tablet 90-20mcg 2donepezil oral tablet 10 mg, 5 mg 2dorzolamide ophthalmic (eye) drops 2 % 2dorzolamide-timolol ophthalmic (eye) drops 22.3-6.8 mg/ml 2

QL 2doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg QL 2doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg 2doxepin oral concentrate 10 mg/ml 2doxepin oral tablet 3mg, 6mg QL 4doxepin topical cream 5 % PA; QL 4doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg 3doxycycline hyclate oral capsule 100 mg, 50 mg 2doxycycline hyclate oral tablet 100 mg 2doxycycline monohydrate oral capsule 100 mg, 50 mg 2doxycycline monohydrate oral suspension for reconstitution 25 mg/5 ml 2doxycycline oral tablet 20 mg 2dronabinol oral capsule 10 mg, 2.5 mg, 5 mg 3

2drospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 mg 2DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG 4DUAVEE ORAL TABLET 0.45-20 MG 4ducodyl oral tablet,delayed release (dr/ec) 5 mg 2DUEXIS TAB 800-26.6MG PA 4

ST; QL 4duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg QL 2DUPIXENT SUBCUTANEOUS SYRINGE 300 MG/2 ML PA 5DUREZOL OPHTHALMIC (EYE) DROPS 0.05 % ST 4DUROLANE INJ 60MG/3ML PA 5dutasteride oral capsule 0.5 mg 3dutasteride-tamsulosin oral capsule 0.5mg-0.4mg 2DYMISTA PA; QL 4

Ee.e.s. 400 oral tablet 400 mg 3econazole topical cream 1 % ST 3econtra ez oral tablet 1.5 mg 2econtra one-step oral tablet 1.5 mg 2ecotrin low strength oral tablet,delayed release (dr/ec) 81 mg 1ecotrin oral tablet,delayed release (dr/ec) 325 mg 1EDARBI ORAL TABLET 40 MG, 80 MG ST 4EDURANT ORAL TABLET 25 MG 5efavirenz oral capsule 200 mg, 50 mg 5efavirenz oral tablet 600 mg 5efavirenz-emtricitab-tenofovir 5efavirenz-lamivudine-tenofovir 5effer-k oral tablet, effervescent 25 meq 3EGATEN 4

drospirenone-e.estradiol-lm.fa oral tablet 3-0.02-0.451 mg (24) (4), 3-0.03-0.451 mg (21) (7)

DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION

dotti transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

eletriptan oral tablet 20 mg, 40 mg ST; QL 3ELIGARD (3 MONTH) SUBCUTANEOUS SYRINGE 22.5 MG PA; QL 5ELIGARD (4 MONTH) SUBCUTANEOUS SYRINGE 30 MG PA; QL 5ELIGARD (6 MONTH) SUBCUTANEOUS SYRINGE 45 MG PA; QL 5ELIGARD SUBCUTANEOUS SYRINGE 7.5 MG (1 MONTH) PA 5elinest oral tablet 0.3-30 mg-mcg 2ELIQUIS ORAL TABLET 2.5 MG, 5 MG 3ELIQUIS ORAL TABLETS,DOSE PACK 5 MG (74 TABS) 3ELLA ORAL TABLET 30 MG 3ELMIRON ORAL CAPSULE 100 MG 3eluryng 2EMCYT ORAL CAPSULE 140 MG PA 5EMGALITY INJ 120MG/ML PA 3emoquette oral tablet 0.15-0.03 mg 2emtricitabine-tenofovir QL 5EMTRIVA ORAL CAPSULE 200MG 5EMTRIVA SOLN 10MG/ML 5enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg 1enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg 1endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg PA; QL 2ENDOMETRIN VAGINAL INSERT 100 MG 5enoxaparin subcutaneous solution 300 mg/3 ml 5

5enpresse oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2enskyce oral tablet 0.15-0.03 mg 2entacapone oral tablet 200 mg 2entecavir oral tablet 0.5 mg, 1 mg PA 5ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG QL 3enulose oral solution 10 gram/15 ml 2EPIDIOLEX ORAL SOLUTION 100 MG/ML PA 5epinastine ophthalmic (eye) drops 0.05 % ST 2epinephrine injection auto-injector 0.15 mg/0.3 ml QL 2epinephrine injection auto-injector 0.3 mg/0.3 ml QL 2epitol oral tablet 200mg 2eplerenone oral tablet 25 mg, 50 mg 2ergoloid oral tablet 1 mg 2erlotinib oral tablet 100 mg, 150 mg, 25 mg PA; QL 5errin oral tablet 0.35 mg 2ERTACZO TOPICAL CREAM 2 % 4ery pads topical swab 2 % 2erythromycin ethylsuccinate oral tablet 400 mg 3erythromycin ophthalmic (eye) ointment 5 mg/gram (0.5 %) 2erythromycin oral tablet 250 mg, 500 mg 3erythromycin oral tablet,delayed release (dr/ec) 250 mg, 333 mg, 500 mg 3erythromycin with ethanol topical gel 2 % 2erythromycin with ethanol topical solution 2 % 2erythromycin with ethanol topical swab 2 % 2erythromycin-benzoyl peroxide topical gel 3-5 % 4ESBRIET ORAL CAPSULE 267 MG PA; QL 5ESBRIET ORAL TABLET 267 MG, 801 MG PA 5escitalopram oxalate oral solution 5 mg/5 ml 1escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg QL 1ESKATA SOL 40% 4esomeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg QL 3esomeprazole magnesium oral capsule,delayed release(dr/ec) 40 mg 3estarylla oral tablet 0.25-35 mg-mcg 2estazolam oral tablet 1mg, 2mg QL 2

enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml





estradiol oral tablet 0.5 mg, 1 mg, 2 mg 2

QL 2estradiol transdermal patch weekly 0.025 mg/24 hr QL 2

2estradiol vaginal cream 0.01 % (0.1 mg/gram) 2estradiol vaginal tablet 10 mcg 2estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml 2estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg 2ESTRING VAGINAL RING 2 MG (7.5 MCG /24 HOUR) 4eszopiclone oral tablet 1 mg, 2 mg, 3 mg QL 2ethacrynic acid oral tablet 25 mg 4ethambutol oral tablet 100 mg, 400 mg 2ethosuximide oral capsule 250 mg 2ethosuximide oral solution 250 mg/5 ml 2ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg, 1-50 mg-mcg 2etodolac oral capsule 200 mg, 300 mg ST 3etodolac oral tablet 400 mg, 500 mg ST 3etodolac oral tablet extended release 24 hr 400 mg, 500 mg, 600 mg ST 3etonogestrel mis ethy est 2

2everolimus oral tablet 0.25mg, 0.5mg, 0.75mg, 2.5mg, 5mg, 7.5mg QL 5EXELDERM TOPICAL CREAM 1 % ST 4EXELDERM TOPICAL SOLUTION 1 % ST 4exemestane oral tablet 25 mg 5ezetimibe oral tablet 10 mg 1ezetimine-simvastatin oral tablet 10-10mg, 10-20mg, 10-40mg, 10-80mg QL 2

Ffalmina (28) oral tablet 0.1-20 mg-mcg 2famciclovir oral tablet 125 mg, 250 mg, 500 mg QL 2famotidine (pf) intravenous solution 20 mg/2 ml 2famotidine (pf)-nacl (iso-os) intravenous piggyback 20 mg/50 ml 2famotidine intravenous solution 10 mg/ml 2famotidine oral suspension 40 mg/5 ml (8 mg/ml) 2famotidine oral tablet 20 mg, 40 mg 2FARXIGA ORAL TABLET 10 MG, 5 MG QL 3fayosim oral tablets,dose pack,3 month 0.15 mg-20 mcg/ 0.15 mg-25 mcg 2febuxostat oral tablet 40 mg, 80 mg ST 2felbamate oral suspension 600 mg/5 ml 2felbamate oral tablet 400 mg, 600 mg 2felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg 1FEMRING VAGINAL RING 0.05 MG/24 HR, 0.1 MG/24 HR 4femynor oral tablet 0.25-35 mg-mcg 2fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg 1fenofibrate nanocrystallized oral tablet 145 mg, 48 mg 1fenofibrate oral tablet 160 mg, 54 mg 1fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg, 45 mg 1fenofibric acid oral tablet 105 mg, 35 mg 1fenoprofen oral tablet 600 mg ST 3

PA; QL 2

QL 2FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK 20 MG (2)- 40 MG (26) ST; QL 4

estradiol transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

estradiol transdermal patch weekly 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

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

fentanyl citrate buccal lozenge on a handle 1,200 mcg, 1,600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

ST; QL 4finasteride oral tablet 1 mg PA 3finasteride oral tablet 5 mg 3FIRMAGON INJ 80MG, 120MG PA 5FIRVANQ ORAL RECON SOLN 25 MG/ML, 50 MG/ML 2flavoxate oral tablet 100 mg 2flecainide oral tablet 100 mg, 150 mg, 50 mg 2

QL 3

QL 3

3

3

3

3fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml 2fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg 2flucytosine oral capsule 250 mg, 500 mg 2fludarabine intravenous recon soln 50 mg 4fludrocortisone oral tablet 0.1 mg 2

3

3

3flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) QL 2fluocinolone acetonide oil otic (ear) drops 0.01 % 2fluocinolone and shower cap scalp oil 0.01 % 2fluocinolone topical cream 0.01 %, 0.025 % 2fluocinolone topical oil 0.01 % 2fluocinolone topical ointment 0.025 % 2fluocinolone topical solution 0.01 % 2fluocinonide topical cream 0.05 % QL 2fluocinonide topical gel 0.05 % QL 2fluocinonide topical ointment 0.05 % QL 2fluocinonide topical solution 0.05 % 2fluocinonide-e topical cream 0.05 % 2

1

1fluorometholone ophthalmic (eye) drops,suspension 0.1 % 2fluorouracil topical cream 5 % 2fluorouracil topical solution 2 %, 5 % 2fluoxetine oral capsule 10 mg, 20 mg, 40 mg 1fluoxetine oral solution 20 mg/5 ml (4 mg/ml) 1fluphenazine hcl oral concentrate 5 mg/ml 2fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg 2flurandrenolide topical cream 0.05 % ST 4flurazepam oral capsule 15mg, 30mg QL 2flurbiprofen oral tablet 100 mg, 50 mg 2flurbiprofen sodium ophthalmic (eye) drops 0.03 % 2

FLUBLOK QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 180 MCG (45 MCG X 4)/0.5 ML

FLUCELVAX QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

FLUCELVAX QUAD 2021-2022 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLULAVAL QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

FLULAVAL QUAD 2021-2022 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLUMIST QUAD 2021-2022 NASAL NASAL SPRAY SYRINGE 10EXP6.5-7.5 FF UNIT/0.2 ML

FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR 120 MG, 20 MG, 40 MG, 80 MG

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 250 MCG/ACTUATION, 50 MCG/ACTUATION

FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION, 220 MCG/ACTUATION, 44 MCG/ACTUATION

FLUARIX QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

fluoride (sodium) oral tablet,chewable 0.25 mg(0.55 mg sod. fluoride), 0.5 mg (1.1 mg sodium fluorid), 1 mg (2.2 mg sod. fluoride)

fluoritab oral tablet,chewable 0.5 mg (1.1 mg sodium fluorid), 1 mg (2.2 mg sod. fluoride)






flutamide oral capsule 125 mg 2fluticasone propionate nasal spray,suspension 50 mcg/actuation QL 2fluticasone propionate topical cream 0.05 % 2fluticasone propionate topical lotion 0.05 % 2fluticasone propionate topical ointment 0.005 % 2FLUTICASONE PROPION-SALMETEROL AEROSOL 100/50, 250/50, 500/50 QL 2

2fluvastatin oral capsule 20 mg, 40 mg PA; QL 1fluvoxamine oral tablet 100 mg, 25 mg, 50 mg QL 1

3

3

3

3folic acid oral tablet 400 mcg, 800 mcg 1folic acid oral tablet 1mg 2foltabs 800 oral tablet 0.8-10-115 mg-mg-mcg 2

5FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE - 600 MCG/2.4 ML PA; QL 5fosamprenavir oral tablet 700 mg 5fosinopril oral tablet 10 mg, 20 mg, 40 mg 1frovatriptan oral tablet 2.5 mg ST; QL 4full spectrum b-vitamin c oral tablet 0.8 mg 2FULPHILA SUBCUTANEOUS SYRINGE 6 MG/0.6 ML PA 5furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) 2furosemide oral tablet 20 mg, 40 mg, 80 mg 2FUZEON SUBCUTANEOUS RECON SOLN 90 MG PA; QL 5fyavolv oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg 2

Ggabapentin oral capsule 100 mg, 300 mg, 400 mg 2gabapentin oral solution 250 mg/5 ml, 300 mg/6 ml (6 ml) 2gabapentin oral tablet 600 mg, 800 mg 2galantamine oral capsule,ext rel. pellets 24 hr 16 mg, 24 mg, 8 mg 2galantamine oral solution 4 mg/ml 2galantamine oral tablet 12 mg, 4 mg, 8 mg 2ganirelix ac inj PA 5gatifloxacin ophthalmic (eye) drops 0.5 % 3gavilax oral powder 17 gram/dose 2gavilyte-c oral recon soln 240-22.72-6.72 -5.84 gram 1gavilyte-g oral recon soln 236-22.74-6.74 -5.86 gram 1gavilyte-n oral recon soln 420 gram 1gemfibrozil oral tablet 600 mg 1generlac oral solution 10 gram/15 ml 2gengraf oral capsule 25mg, 100mg 5gengraf solution 100mg/ml 5GENOTROPIN INJ PA 5gentak ophthalmic (eye) ointment 0.3 % (3 mg/gram) 2gentamicin ophthalmic (eye) drops 0.3 % 2gentamicin topical cream 0.1 % 2gentamicin topical ointment 0.1 % 2gentle laxative oral tablet,delayed release (dr/ec) 5 mg 2

FLUZONE QUAD PEDI 2021-22 (PF) INTRAMUSCULAR SYRINGE 30 MCG (7.5 MCG X 4)/0.25 ML

fondaparinux subcutaneous syringe 10 mg/0.8 ml, 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml

FLUTICASONE PROPION-SALMETEROL INHALATION AEROSOL POWDR BREATH ACTIVATED 113-14 MCG/ACTUATION, 232-14 MCG/ACTUATION, 55-14 MCG/ACTUATION

FLUZONE QUAD 2021-2022 (PF) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLUZONE QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

FLUZONE QUAD 2021-2022 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

gentlelax oral powder 17 gram/dose 2GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG PA; QL 5glatiramer subcutaneous syringe 20 mg/ml, 40 mg/ml PA; QL 5glatopa subcutaneous syringe 20 mg/ml, 40 mg/ml PA; QL 5glimepiride oral tablet 1 mg, 2 mg, 4 mg 1glipizide oral tablet 10 mg, 5 mg 1glipizide oral tablet extended release 24hr 10 mg, 2.5 mg, 5 mg 1glipizide XL tablet 2.5mg, 5mg, 10mg 1glipizide-metformin oral tablet 2.5-250 mg, 2.5-500 mg, 5-500 mg 1glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg 1glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg 1glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, 5-500 mg 1glycate oral tablet 1.5mg ST 2glycolax oral powder 17 gram/dose 2glycopyrrolate oral tablet 1 mg, 2 mg 2glycopyrrolate oral tablet 1.5 mg ST 2GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG QL 3

PA 5granisetron hcl oral tablet 1 mg 3griseofulvin microsize oral suspension 125 mg/5 ml 2griseofulvin microsize oral tablet 500 mg 2griseofulvin ultramicrosize oral tablet 125 mg, 250 mg 2guaiatussin ac liquid 100-10/5 2guanfacine oral tablet 1 mg, 2 mg 2guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg 3GYNAZOLE-1 VAGINAL CREAM 2 % 3

Hhabitrol dis 21mg/24hr 1hailey oral tablet 1.5/30 2hailey 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2hailey fe oral tablet 1.5/30, 1/20 2halcinonide topical cream 0.1 % ST 2halobetasol propionate topical cream 0.05 % 2halobetasol propionate topical ointment 0.05 % 2haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml 2haloperidol lactate oral concentrate 2 mg/ml 2haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg 2heather oral tablet 0.35 mg 2HELIDAC MIS THERAPY QL 3

2

3

3

3

3

3

3HUMALOG U-100 INSULIN SUBCUTANEOUS CARTRIDGE 100 UNIT/ML 3HUMALOG U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML 3

GONAL-F RFF REDI-JECT SUBCUTANEOUS PEN INJECTOR 300/0.5 UNIT/ML, 450/0.75 UNIT/ML, 900/1.5 UNIT/ML

heparin sodium injection 1000/ml, 10000/ml, 20000/ml, 5000/0.5ml, 5000/ml

HUMALOG JUNIOR KWIKPEN U-100 SUBCUTANEOUS INSULIN PEN, HALF-UNIT 100 UNIT/ML

HUMALOG KWIKPEN INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML, 200 UNIT/ML (3 ML)

HUMALOG MIX 50-50 INSULN U-100 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (50-50)

HUMALOG MIX 50-50 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (50-50)


HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (75-25)





PA; QL 5

PA; QL 5

PA; QL 5HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML PA; QL 5

PA; QL 5

PA; QL 5

PA; QL 5

PA; QL 5HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML PA; QL 5

PA; QL 5

3

3

3

3HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION 100 UNIT/ML 3

3

3hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg 2hydrochlorothiazide oral capsule 12.5 mg 1hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg 1hydrocodone-acetaminophen oral solution 7.5-325 mg/15 ml, 10-325mg QL 2hydrocodone-acetaminophen oral tablet 10-325 mg, 5-325 mg, 7.5-325 mg QL 2hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml 3hydrocodone-ibuprofen oral tablet 7.5-200 mg QL 2hydrocortisone acetic acid solution otic 3hydrocortisone butyrate topical cream 0.1 % 3hydrocortisone butyrate topical ointment 0.1 % 3hydrocortisone oral tablet 10 mg, 20 mg, 5 mg 2hydrocortisone rectal enema 100 mg/60 ml 2hydrocortisone topical cream 1 %, 2.5 % 2hydrocortisone topical lotion 2.5 % 2hydrocortisone topical ointment 1 %, 2.5 % 2hydrocortisone valerate topical cream 0.2 % 3hydrocortisone valerate topical ointment 0.2 % 4hydrocortisone-pramoxine rectal cream 1-1 %, 2.5-1 %, 2.5-1 % (4g) 2hydrocortisone-pramoxine topical cream 2.5-1 % 2hydromet oral syrup 5-1.5 mg/5 ml 3hydromorphone oral liquid 1 mg/ml QL 2hydromorphone oral tablet 2 mg, 4 mg, 8 mg QL 2

QL 4hydroxychloroquine oral tablet 200 mg 2hydroxyurea oral capsule 500 mg 2hydroxyzine hcl oral solution 10 mg/5 ml 2

HUMIRA PEN PSOR-UVEITS-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

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

HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML, 80 MG/0.8 ML-40 MG/0.4 ML

HUMIRA(CF) PEN CROHNS-UC-HS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML

HUMIRA(CF) PEN PSOR-UV-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML-40 MG/0.4 ML

HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 20 MG/0.2 ML, 40 MG/0.4 ML

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML

HUMIRA PEN CROHNS-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

hydromorphone oral tablet extended release 24 hr 12 mg, 16 mg, 32 mg, 8 mg

HUMULIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (70-30)

HUMULIN 70/30 U-100 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70-30)

HUMULIN N NPH INSULIN KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML

HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION 500 UNIT/ML

HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML (3 ML)

hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg 2hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg 2hyoscyamine sulfate oral tablet 0.125 mg 2hyoscyamine sulfate oral tablet extended release 12 hr 0.375 mg 2hyoscyamine sulfate sublingual tablet 0.125 mg 2

PA 5

QL 4

Iibandronate oral tablet 150 mg QL 1IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG PA; QL 5ibu oral tablet 400 mg, 600 mg, 800 mg 2ibuprofen oral suspension 100 mg/5 ml 2ibuprofen oral tablet 400 mg, 600 mg, 800 mg 2ICATIBANT INJ 30 MG/3 ML PA 5iclevia oral tablet 2ICLUSIG ORAL TABLET 15 MG, 45 MG PA; QL 5imatinib oral tablet 100 mg, 400 mg PA; QL 5imipramine hcl oral tablet 10 mg, 25 mg, 50 mg 2imiquimod topical cream in packet 5 % 2IMPAVIDO ORAL CAPSULE 50 MG 4incassia oral tablet 0.35 mg 2

QL 3indapamide oral tablet 1.25 mg, 2.5 mg 1indomethacin oral capsule 25 mg, 50 mg 2indomethacin oral capsule, extended release 75 mg 2INSULIN SYRINGE-NEEDLE U-100 SYRINGE 3INTELENCE ORAL TABLET 100 MG, 200 MG, 25 MG QL 5INTRAROSA SUP 6.5MG 4 INTRON A INJ 10MU, 18MU, 25MU, 50MU PA; QL 5introvale oral tablets,dose pack,3 month 0.15 mg-30 mcg (91) 2

ST 4INVIRASE ORAL TABLET 500 MG QL 5ipratropium bromide inhalation solution 0.02 % 1ipratropium bromide nasal spray,non-aerosol 0.03 %, 42 mcg (0.06 %) QL 2

QL 1irbesartan oral tablet 150 mg, 300 mg, 75 mg 1irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg 1irinotecan inj 40mg/2ml PA 5ISENTRESS HD ORAL TABLET 600 MG 5ISENTRESS ORAL TABLET 400 MG 5isibloom oral tablet 0.15-0.03 mg 2isoniazid oral solution 50 mg/5 ml 2isoniazid oral tablet 100 mg, 300 mg 2isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg, 40mg 3isosorbide mononitrate oral tablet 10 mg, 20 mg 2

2isotretinoin oral capsule 10 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg 2isradipine oral capsule 2.5 mg, 5 mg 1itraconazole oral capsule 100 mg QL 2ivermectin lotion 0.5% 3

HYQVIA SUBCUTANEOUS SOLUTION 10 GRAM /100 ML (10 %), 2.5 GRAM /25 ML (10 %), 20 GRAM /200 ML (10 %), 30 GRAM /300 ML (10 %), 5 GRAM /50 ML (10 %)

HYSINGLA ER ORAL TABLET,ORAL ONLY,EXT.REL.24 HR 100 MG, 120 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG

INCRUSE ELLIPTA INHALATION BLISTER WITH DEVICE 62.5 MCG/ACTUATION

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML, 156 MG/ML, 234 MG/1.5 ML, 39 MG/0.25 ML, 78 MG/0.5 ML

ipratropium-albuterol inhalation solution for nebulization 0.5 mg-3 mg(2.5 mg base)/3 ml

isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60 mg






ivermectin oral tablet 3 mg 3

Jjaimiess oral tablets 2

1JANUMET ORAL TABLET 50-1,000 MG, 50-500 MG QL 3

QL 3JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG QL 3JARDIANCE ORAL TABLET 10 MG, 25 MG QL 3jasmiel (28) oral tablet 3-0.02 mg 2jencycla oral tablet 0.35 mg 2JENTADUETO ORAL TABLET 2.5-1,000 MG, 2.5-500 MG, 2.5-850 MG QL 3

QL 3jinteli oral tablet 1-5 mg-mcg 2jolessa oral tablets,dose pack,3 month 0.15 mg-30 mcg (91) 2juleber oral tablet 0.15-0.03 mg 2junel 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2junel 1/20 (21) oral tablet 1-20 mg-mcg 2junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2junel fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2junel fe 24 oral tablet 1 mg-20 mcg (24)/75 mg (4) 2

Kkaitlib fe oral tablet,chewable 0.8mg-25mcg(24) and 75 mg (4) 2KALETRA ORAL TABLET 100-25 MG, 200-50 MG PA 5kalliga oral tablet 0.15-0.03 mg 2kariva (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2kelnor 1/35 (28) oral tablet 1-35 mg-mcg 2kelnor 1-50 oral tablet 1-50 mg-mcg 2KERYDIN TOPICAL SOLUTION WITH APPLICATOR 5 % PA 4KESIMPTA INJ 20/.4ML PA 5ketoconazole oral tablet 200 mg 2ketoconazole topical cream 2 % 2ketoconazole topical shampoo 2 % 2ketoprofen oral capsule 25 mg QL 3ketorolac ophthalmic (eye) drops 0.4 % 2ketorolac ophthalmic (eye) drops 0.5 % 2ketorolac oral tablet 10 mg QL 2KEVZARA INJ 150/1.14, 200/1.14 PA; QL 5klor-con 10 oral tablet extended release 10 meq 2klor-con 8 oral tablet extended release 8 meq 2klor-con m10 oral tablet,er particles/crystals 10 meq 2klor-con m15 oral tablet,er particles/crystals 15 meq 2klor-con m20 oral tablet,er particles/crystals 20 meq 2klor-con/ef oral tablet, effervescent 25 meq 3KLOXXADO LIQ 3k-phos-neutral oral tablet 250 mg 2KRINTAFEL ORAL TABLET 150 MG 4kurvelo (28) oral tablet 0.15-0.03 mg 2

Llabetalol oral tablet 100 mg, 200 mg, 300 mg 2lactulose oral solution 10 gram/15 ml, 20 gram/30 ml 2lamivudine oral solution 10 mg/ml 5lamivudine oral tablet 100 mg 5

jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG, 50-1,000 MG, 50-500 MG

JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG

lamivudine oral tablet 150 mg, 300 mg 5lamivudine-zidovudine oral tablet 150-300 mg 5lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg 2lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg 2lamotrigine oral tablet kit start 35, 49, 98 2lansoprazole oral capsule,delayed release(dr/ec) 15 mg, 30 mg 2lansoprazole oral susp 3mg/ml 3lanthanum chw 100mg, 500mg 3

3LANTUS U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML 3lapatinib oral tablet 250mg PA; QL 5larin 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2larin 1/20 (21) oral tablet 1-20 mg-mcg 2larin 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2larin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2larin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2larissia oral tablet 0.1-20 mg-mcg 2LASTACAFT OPHTHALMIC (EYE) DROPS 0.25 % ST 4latanoprost ophthalmic (eye) drops 0.005 % 2LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG, 80 MG ST; QL 4laxaclear oral powder 17 gram/dose 2laxative (bisacodyl) oral tablet 5 mg 2laxative (bisacodyl) oral tablet,delayed release (dr/ec) 5 mg 2laxative feminine oral tablet 5 mg 2laxative peg 3350 oral powder 17 gram/dose 2layolis fe oral tablet,chewable 0.8mg-25mcg(24) and 75 mg (4) 2leena 28 oral tablet 0.5/1/0.5-35 mg-mcg 2leflunomide oral tablet 10 mg, 20 mg QL 2

PA; QL 5LENVIMA ORAL CAPSULE 12 MG/DAY (4 MG X 3), 4 MG PA; 5lessina oral tablet 0.1-20 mg-mcg 2letrozole oral tablet 2.5 mg 2leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg 2LEUKERAN ORAL TABLET 2 MG 3

1

QL 4

3LEVEMIR U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML 3levetiracetam oral solution 100 mg/ml, 500 mg/5 ml (5 ml) 2levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg 2levetiracetam oral tablet extended release 24 hr 500 mg, 750 mg 2levobunolol ophthalmic (eye) drops 0.5 % 4levocarnitine (with sugar) oral solution 100 mg/ml 3levocarnitine oral tablet 330 mg 3levocetirizine oral solution 2.5 mg/5 ml 4levofloxacin ophthalmic (eye) drops 0.5 % 2levofloxacin oral solution 250 mg/10 ml 2levofloxacin oral tablet 250 mg, 500 mg, 750 mg 2levonest (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2levonorgestrel oral tablet 1.5 mg 2

2

levalbuterol hcl inhalation solution for nebulization 0.31 mg/3 ml, 0.63 mg/3 ml, 1.25 mg/0.5 ml, 1.25 mg/3 ml

LEVALBUTEROL TARTRATE INHALATION HFA AEROSOL INHALER 45 MCG/ACTUATION

LEVEMIR FLEXTOUCH U-100 INSULN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-0.03 mg, 90-20 mcg (28)

LANTUS SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 14 MG/DAY(10 MG X 1-4 MG X 1), 18 MG/DAY (10 MG X 1-4 MG X2), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1), 8 MG/DAY (4 MG X 2)





2levonorg-eth estrad triphasic oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2levora-28 oral tablet 0.15-0.03 mg 2levorphanol tartrate oral tablet 2 mg QL 2

2

2

2LEXIVA ORAL SUSPENSION 50 MG/ML 5lice killing shampoo 2lice killing (permethrin) topical liquid 1 % 2lice treatment (permethrin) topical liquid 1 % 2lice treatment topical liquid 1 % 2lidocaine hcl laryngotracheal solution 4 % 2lidocaine hcl mucous membrane jelly 2 % QL 2lidocaine hcl mucous membrane jelly in applicator 2 % 2lidocaine hcl mucous membrane solution 4 % (40 mg/ml) 2lidocaine pad 4% 2lidocaine topical adhesive patch,medicated 5 % ST 4lidocaine viscous mucous membrane solution 2 % 2lidocaine-prilocaine topical cream 2.5-2.5 % QL 2lidocaine-prilocaine topical kit 2.5-2.5 % 2lidopril topical kit 2.5-2.5 % QL 2lillow (28) oral tablet 0.15-0.03 mg 2lindane topical shampoo 1 % 3linezolid oral suspension for reconstitution 100 mg/5 ml 3linezolid oral tablet 600 mg 3LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG 3liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg 2lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg 1

1lithium carbonate oral capsule 150 mg, 300 mg, 600 mg 2lithium carbonate oral tablet 300 mg 2lithium carbonate oral tablet extended release 300 mg, 450 mg 2LIVALO ORAL TABLET 1 MG, 2 MG, 4 MG PA; QL 4lojaimiess oral tablet 2LOKELMA PAK 10GM, 5GM 4lopinavir-ritonavir oral solution 400-100 mg/5 ml QL 5loradamed oral tablet 10 mg QL 2loratadine oral capsule 10 mg QL 2loratadine oral solution 5 mg/5 ml 2loratadine oral tablet 10 mg QL 2lorazepam intensol oral concentrate 2 mg/ml 2lorazepam oral concentrate 2 mg/ml 2lorazepam oral tablet 0.5 mg, 1 mg, 2 mg 2loryna (28) oral tablet 3-0.02 mg 2losartan oral tablet 100 mg, 25 mg, 50 mg 1

1LOTEMAX OPHTHALMIC (EYE) DROPS,GEL 0.5 % ST 4LOTEMAX OPHTHALMIC (EYE) OINTMENT 0.5 % ST 4loteprednol etabonate ophthalmic (eye) drops,suspension 0.5 % ST 3lovastatin oral tablet 10 mg, 20 mg, 40 mg PA; QL 1low-ogestrel (28) oral tablet 0.3-30 mg-mcg 2

levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month 0.15 mg-30 mcg (91)

levo-t oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

levothyroxine oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

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

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg 2lo-zumandimine (28) oral tablet 3-0.02 mg 2LUBIPROSTONE CAP 24MCG, 8MCG 3lubricant eye (pg-peg 400) ophthalmic (eye) drops 0.4-0.3 % 2lubricant eye ophthalmic (eye) ointment 56.8-41.5 %, 57.3-42.5 % 2LUMIGAN OPHTHALMIC (EYE) DROPS 0.01 % ST 4

PA; QL 5LUPRON DEPOT (4 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG PA; QL 5LUPRON DEPOT (6 MONTH) INTRAMUSCULAR SYRINGE KIT 45 MG PA; QL 5LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 3.75 MG, 7.5 MG PA; QL 5

PA; QL 5

PA; QL 5lutera (28) oral tablet 0.1-20 mg-mcg 2lyleq otal tablet 0.35mg 2lyllana dis 0.025mg, 0.0375mg, 0.05mg, 0.075mg, 0.1mg QL 2LYNPARZA ORAL TABLET 100 MG, 150 MG PA 5LYSODREN ORAL TABLET 500 MG 3lyza oral tablet 0.35 mg 2

Mmagnesium citrate oral solution 2malathion topical lotion 0.5 % 3marlissa (28) oral tablet 0.15-0.03 mg 2MARPLAN ORAL TABLET 10 MG 4MATULANE ORAL CAPSULE 50 MG 5MAVYRET ORAL TABLET 100-40 MG PA; QL 5MAXIDEX OPHTHALMIC (EYE) DROPS,SUSPENSION 0.1 % 4meclizine oral tablet 12.5 mg, 25 mg 2meclofenamate oral capsule 100 mg 2medroxyprogesterone intramuscular suspension 150 mg/ml QL 2medroxyprogesterone intramuscular syringe 150 mg/ml QL 2medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5 mg 2mefenamic acid oral capsule 250 mg ST 3mefloquine oral tablet 250 mg 1megestrol oral suspension 400 mg/10 ml (40 mg/ml) 2megestrol oral tablet 20 mg, 40 mg 2MEKINIST ORAL TABLET 0.5 MG, 2 MG PA; QL 5meloxicam oral tablet 15 mg 2meloxicam oral tablet 7.5 mg QL 2memantine oral capsule,sprinkle,er 24hr 14 mg, 21 mg, 28 mg, 7 mg QL 3memantine oral solution 2 mg/ml, 10mg/5ml 2memantine oral tablet 10 mg, 5 mg 2MEMANTINE ORAL TABLETS,DOSE PACK 5-10 MG 2MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG 4MENTAX TOPICAL CREAM 1 % ST 3meperidine oral solution 50 mg/5 ml QL 2meperidine oral tablet 50 mg QL 2meprobamate oral tablet 200mg, 400mg 3mercaptopurine oral tablet 50 mg 2mesalamine oral tablet,delayed release (dr/ec) 1.2 gram, 800 mg 4mesalamine rectal enema 4 gram/60 ml 2mesalamine with cleansing wipe rectal enema kit 4 gram/60 ml 2metaxalone oral tablet 800 mg ST; Q: 3metformin oral tablet 1,000 mg, 500 mg, 850 mg 1metformin oral tablet extended release 24 hr 500 mg, 750 mg 1

LUPRON DEPOT-PED INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG (PED)

LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG, 22.5 MG

LUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG, 30 MG






methadone oral concentrate 10 mg/ml QL 2methadone oral solution 10 mg/5 ml, 5 mg/5 ml QL 2methadone oral tablet 10 mg, 5 mg QL 2methadone oral tablet,soluble 40 mg QL 2methadose oral concentrate 10 mg/ml QL 2methadose oral tablet,soluble 40 mg QL 2methamphetamine oral tablet 5 mg 2methazolamide oral tablet 25 mg, 50 mg 2methenamine hippurate oral tablet 1 gram 2METHERGINE ORAL TABLET 0.2MG 4methimazole oral tablet 10 mg, 5 mg 2METHITEST ORAL TABLET 10 MG 4methocarbamol oral tablet 500 mg, 750 mg 2methotrexate sodium oral tablet 2.5 mg 2methoxsalen oral capsule,liqd-filled,rapid rel 10 mg QL 4methscopolamine oral tablet 2.5 mg, 5 mg 2methyldopa oral tablet 250 mg, 500 mg 2methylergonovine oral tablet 0.2 mg 4

2

2methylphenidate hcl oral solution 10 mg/5 ml, 5 mg/5 ml 2methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg 2methylphenidate hcl oral tablet extended release 10 mg, 20 mg 2

2methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml 2methylprednisolone oral tablet 4 mg 2methylprednisolone oral tablets,dose pack 4 mg 2metoclopramide hcl oral solution 5 mg/5 ml 2metoclopramide hcl oral tablet 10 mg, 5 mg 2metolazone oral tablet 10 mg, 2.5 mg, 5 mg 1

1metoprolol tartrate oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg 1metronidazole oral tablet 250 mg, 500 mg 2metronidazole topical cream 0.75 % 2metronidazole topical gel 0.75 %, 1 % 2metronidazole topical gel with pump 1 % 2metronidazole topical lotion 0.75 % 2metronidazole vaginal gel 0.75 % 3mexiletine oral capsule 150 mg, 200 mg, 250 mg 2mibelas 24 fe oral tablet,chewable 1 mg-20 mcg(24) /75 mg (4) 2miconazole-3 vaginal suppository 200 mg 2microgestin 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2microgestin 1/20 (21) oral tablet 1-20 mg-mcg 2microgestin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2microgestin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2midodrine oral tablet 10 mg, 2.5 mg, 5 mg 2MIGERGOT SUPPOSITORY 3miglitol oral tablet 100 mg, 25 mg, 50 mg 1miglustat oral capsule 100 mg PA; QL 5mili oral tablet 0.25-35 mg-mcg 2milk of magnesia concentrated oral suspension 2,400 mg/10 ml 2milk of magnesia oral suspension 400 mg/5 ml 2mimvey oral tablet 1-0.5 mg 2minitran dis 0.1mg/hr, 0.2mg/hr, 0.4mg/hr, 0.6mg/hr 2

methylphenidate hcl oral capsule, er biphasic 30-70 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

methylphenidate hcl oral capsule,er biphasic 50-50 10 mg, 20 mg, 30 mg, 40 mg, 60 mg

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

metoprolol succinate oral tablet extended release 24 hr 100 mg, 200 mg, 25 mg, 50 mg

minocycline oral capsule 100 mg, 50 mg, 75 mg 2minoxidil oral tablet 10 mg, 2.5 mg 2mirtazapine oral tablet 15 mg, 30 mg, 45 mg 2misoprostol oral tablet 100 mcg, 200 mcg 2MITIGARE ORAL CAPSULE 0.6 MG 3modafinil oral tablet 100 mg, 200 mg 4moexipril oral tablet 15 mg, 7.5 mg 1mometasone topical cream 0.1 % 2mometasone topical ointment 0.1 % 2mometasone topical solution 0.1 % 2mometasone spray 50mcg QL 2mondoxyne oral capsule 100mg 2mono-linyah oral tablet 0.25-35 mg-mcg 2montelukast oral granules in packet 4 mg 1montelukast oral tablet 10 mg 1montelukast oral tablet,chewable 4 mg, 5 mg 1MONUROL ORAL PACKET 3 GRAM 4morgidox 2morphine concentrate oral solution 100 mg/5 ml (20 mg/ml) QL 2

QL 4

QL 4morphine oral solution 10 mg/5 ml, 20 mg/5 ml (4 mg/ml) QL 2morphine oral tablet 15 mg, 30 mg QL 2

QL 2MOTOFEN ORAL TABLET 1-0.025 MG 4MOVANTIK ORAL TABLET 12.5 MG, 25 MG 3MOVIPREP ORAL POWDER IN PACKET 100-7.5-2.691 GRAM ST 4moxifloxacin ophthalmic (eye) drops 0.5 % 3moxifloxacin oral tablet 400 mg ST 3MULTAQ ORAL TABLET 400 MG 4multi-vitamin with fluoride oral drops 0.25 mg/ml, 0.5 mg/ml 2multi-vitamin with fluoride oral tablet,chewable 0.25 mg, 0.5 mg, 1 mg 2mupirocin topical ointment 2 % 2my choice oral tablet 1.5 mg 2my way oral tablet 1.5 mg 2MYALEPT SUBCUTANEOUS RECON SOLN 5 MG/ML (FINAL CONC.) 5mycophenolate mofetil oral capsule 250 mg 5mycophenolate mofetil oral suspension for reconstitution 200 mg/ml 5mycophenolate mofetil oral tablet 500 mg 5

PA 5myorisan oral capsule 10 mg, 20 mg, 30 mg, 40 mg 2MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG, 50 MG 4

Nnabumetone oral tablet 500 mg, 750 mg 2nadolol oral tablet 20 mg, 40 mg, 80 mg 1nafrinse chw 1mg f 1naftifine topical cream 1 %, 2 % ST 2naltrexone oral tablet 50 mg 2naproxen oral suspension 125 mg/5 ml 2naproxen oral tablet 250 mg, 375 mg, 500 mg 2naproxen oral tablet,delayed release (dr/ec) 375 mg, 500 mg ST 2naproxen sodium oral tablet 275 mg, 550 mg ST 4naproxen-esomeprazole oral tablet 375mg-20mg, 500mg-20mg PA 4

morphine oral capsule, er multiphase 24 hr 120 mg, 30 mg, 45 mg, 60 mg, 75 mg, 90 mg

morphine oral capsule,extend.release pellets 100 mg, 20 mg, 30 mg, 50 mg, 60 mg, 80 mg

morphine oral tablet extended release 100 mg, 15 mg, 200 mg, 30 mg, 60 mg

mycophenolate sodium oral tablet,delayed release (dr/ec) 180 mg, 360 mg





naratriptan oral tablet 1 mg, 2.5 mg QL 2NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION 3nasal allergy nasal aerosol,spray 55 mcg QL 2NATACYN OPHTHALMIC (EYE) DROPS,SUSPENSION 5 % 4natura-lax oral powder 17 gram/dose 2

2NEBUPENT INHALATION RECON SOLN 300 MG 4necon 0.5/35 (28) oral tablet 0.5-35 mg-mcg 2nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg 2neomycin oral tablet 500 mg 2

2

2

2

2

2

2

2neomycin-polymyxin-hc otic (ear) solution 3.5-10,000-1 mg/ml-unit/ml-% 2neo-polycin hc ophthalmic (eye) ointment 3.5-400-10,000 mg-unit/g-1% 2neo-polycin ophthalmic (eye) ointment 3.5-400-10,000 mg-unit-unit/g 2neuac gel 1.2-5% ST 2NEUPRO DISC 2MG/24HR PA 4NEVANAC OPHTHALMIC (EYE) DROPS,SUSPENSION 0.1 % ST 4nevirapine oral tablet 100mg, 200 mg 5nevirapine oral tablet extended release 24 hr 400 mg 5new day oral tablet 1.5 mg 2NEXAVAR ORAL TABLET 200 MG PA; QL 5NEXIUM 24HR ORAL TABLET,DELAYED RELEASE (DR/EC) 20 MG 2niacin oral tablet 500mg 4NIACOR ORAL TABLET 500 MG 4nicardipine oral capsule 20 mg, 30 mg 1

1nicorelief buccal gum 2 mg, 4 mg 1NICORETTE BUCCAL GUM 2 MG 1nicorette buccal gum 4 mg 1NICORETTE BUCCAL LOZENGE 2 MG, 4 MG 1NICORETTE BUCCAL MINI LOZENGE 2 MG 1NICORETTE BUCCAL MINI LOZENGE 4 MG 1nicotine (polacrilex) buccal gum 2 mg, 4 mg 1nicotine (polacrilex) buccal lozenge 2 mg, 4 mg 1nicotine (polacrilex) buccal mini lozenge 2 mg, 4 mg 1nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr 1nicotine transdermal patch, td daily, sequential 21-14-7 mg/24 hr 1NICOTROL INHALATION CARTRIDGE 10 MG ST 4NICOTROL NS NASAL SPRAY,NON-AEROSOL 10 MG/ML ST 4nifedipine oral capsule 10 mg, 20 mg 1nifedipine oral tablet extended release 24hr 30 mg, 60 mg, 90 mg 1nifedipine oral tablet extended release 30 mg, 60 mg, 90 mg 1

neomycin-polymyxin b-dexameth ophthalmic (eye) drops,suspension 3.5mg/ml-10,000 unit/ml-0.1 %

neomycin-polymyxin b-dexameth ophthalmic (eye) ointment 3.5 mg/g-10,000 unit/g-0.1 %

neomycin-polymyxin-gramicidin ophthalmic (eye) drops 1.75 mg-10,000 unit-0.025mg/ml

neomycin-polymyxin-hc ophthalmic (eye) drops,suspension 3.5-10,000-10 mg-unit-mg/ml

neomycin-polymyxin-hc otic (ear) drops,suspension 3.5-10,000-1 mg/ml-unit/ml-%

NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 MG/24 HR, 21 MG/24 HR, 7 MG/24 HR

nature-throid oral tablet 113.75 mg, 130 mg, 146.25 mg, 16.25 mg, 162.5 mg, 195 mg, 260 mg, 32.5 mg, 325 mg, 48.75 mg, 65 mg, 81.25 mg, 97.5 mg

neomycin-bacitracin-poly-hc ophthalmic (eye) ointment 3.5-400-10,000 mg-unit/g-1%

neomycin-bacitracin-polymyxin ophthalmic (eye) ointment 3.5-400-10,000 mg-unit-unit/g

nikki (28) oral tablet 3-0.02 mg 2NILUTAMIDE TABLET 150 MG PA 5nimodipine oral capsule 30 mg 2

1nitisinone oral capsule 2 mg, 5 mg, 10 mg PA 5nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 50 mg 2nitrofurantoin monohyd/m-cryst oral capsule 100 mg 2nitrofurantoin oral suspension 25 mg/5 ml 2nitroglycerin sublingual tablet 0.3 mg, 0.4 mg, 0.6 mg 2

2NIVESTYM INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6 ML PA; QL 5NIVESTYM SUBCUTANEOUS SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML PA; QL 5nizatidine oral capsule 150 mg, 300 mg 2nizatidine oral solution 150 mg/10 ml 2nolix cream 0.05% ST 4nora-be oral tablet 0.35 mg 2

PA; QL 5

2norethindrone (contraceptive) oral tablet 0.35 mg 2norethindrone acetate oral tablet 5 mg 2norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg 2norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg 2norethindrone ac-eth estradiol oral tablet 1-5 mg-mcg 2

2

2

2norlyda oral tablet 0.35 mg 2norlyroc oral tablet 0.35 mg 2nortrel 0.5/35 (28) oral tablet 0.5-35 mg-mcg 2nortrel 1/35 (21) oral tablet 1-35 mg-mcg (21) 2nortrel 1/35 (28) oral tablet 1-35 mg-mcg 2nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg 2nortriptyline oral solution 10 mg/5 ml 2NORVIR ORAL SOLUTION 80 MG/ML 5NOVAREL INTRAMUSCULAR RECON SOLN 10,000 UNIT, 5,000 UNIT PA; QL 5np thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg 2

QL 4nuvakaan kit 2.5-2.5% 2nyamyc topical powder 100,000 unit/gram 2nylia oral tablet 7/7/7 2nymyo oral tablet 0.25-35 2nystatin oral suspension 100,000 unit/ml 2nystatin oral tablet 500,000 unit 2nystatin topical cream 100,000 unit/gram 2nystatin topical ointment 100,000 unit/gram 2nystatin-triamcinolone topical cream 100,000-0.1 unit/g-% 2nystatin-triamcinolone topical ointment 100,000-0.1 unit/gram-% 2nystop topical powder 100,000 unit/gram 2

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg, 0.18/0.215/0.25 mg-35 mcg (28), 0.25-35 mg-mcg

NUCYNTA ER ORAL TABLET EXTENDED RELEASE 12 HR 100 MG, 150 MG, 200 MG, 250 MG, 50 MG

nisoldipine oral tablet extended release 24 hr 17 mg, 20 mg, 25.5 mg, 34 mg, 40 mg, 8.5 mg

nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 10 MG/1.5 ML (6.7 MG/ML), 15 MG/1.5 ML (10 MG/ML), 30 MG/3 ML (10 MG/ML), 5 MG/1.5 ML (3.3 MG/ML)

noreth-ethinyl estradiol-iron oral tablet,chewable 0.4mg-35mcg(21) and 75 mg (7), 0.8mg-25mcg(24) and 75 mg (4)

norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1 mg-20 mcg (24)/75 mg (4)

norethindrone-e.estradiol-iron oral tablet,chewable 1 mg-20 mcg(24) /75 mg (4)






Oocella oral tablet 3-0.03 mg 2

PA 5

PA 5ofloxacin ophthalmic (eye) drops 0.3 % 2ofloxacin oral tablet 300 mg, 400 mg 4ofloxacin otic (ear) drops 0.3 % 2olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg QL 2olanzapine-fluoxetine 12-25mg, 12-50mg, 6-25mg, 6-50mg ST 2OLINVYK SOL 1MG/ML, 2MG/2ML, 30MG/30ML 4olmesartan oral tablet 20 mg, 40 mg, 5 mg 1

1olopatadine nasal spray,non-aerosol 0.6 % ST; QL 4olopatadine ophthalmic (eye) drops 0.1 %, 0.2 % ST 2omega-3 acid ethyl esters oral capsule 1 gram 3omeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg 2omeprazole oral capsule,delayed release(dr/ec) 10 mg, 20 mg QL 2omeprazole oral capsule,delayed release(dr/ec) 40 mg 2omeprazole oral tablet,delayed release (dr/ec) 20 mg 2OMNITROPE INJ 10 MG/1.5 ML, 5.8 MG, 5 MG/1.5 ML PA; QL 5ondansetron hcl (pf) injection solution 4 mg/2 ml 2ondansetron hcl intravenous solution 2 mg/ml 2ondansetron hcl oral solution 4 mg/5 ml QL 2ondansetron hcl oral tablet 24 mg 2ondansetron hcl oral tablet 4 mg, 8 mg QL 2ondansetron oral tablet,disintegrating 4 mg, 8 mg QL 2opcicon one-step oral tablet 1.5 mg 2OPSUMIT ORAL TABLET 10 MG PA 5option-2 oral tablet 1.5 mg 2oralone dental paste 0.1 % 2ORAVIG BUCCAL MUCO-ADHESIVE BUCCAL TABLET 50 MG 4ORENCIA (WITH MALTOSE) INTRAVENOUS RECON SOLN 250 MG PA 5

PA; QL 5

PA; QL 5ORILISSA ORAL TABLET 150MG, 200MG PA 4orphenadrine citrate oral tablet extended release 100 mg 2orsythia oral tablet 0.1-20 mg-mcg 2oscimin 2oscimin sr 2oseltamivir oral capsule 30 mg, 45 mg, 75 mg QL 4oseltamivir oral suspension for reconstitution 6 mg/ml 4OSMOPREP ORAL TABLET 1.5GM 4OSPHENA ORAL TABLET 60MG 4OTEZLA ORAL TABLET 30 MG PA; QL 5

PA; QL 5OTIPRIO INTRATYMPANIC SUSPENSION 6 % (6 MG/0.1 ML) 4oxandrolone oral tablet 10 mg, 2.5 mg 3oxaprozin oral tablet 600 mg ST 3oxazepam oral capsule 10 mg, 30 mg 3oxcarbazepine oral suspension 300 mg/5 ml (60 mg/ml) 2oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg 2

octreotide acetate injection solution 1,000 mcg/ml, 100 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml

octreotide acetate injection syringe 100 mcg/ml (1 ml), 50 mcg/ml (1 ml), 500 mcg/ml (1 ml)

olmesartan-hydrochlorothiazide oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg

ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML, 50 MG/0.4 ML, 87.5 MG/0.7 ML

ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG, 0.25 MG, 1 MG, 2.5 MG, 5 MG

OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG (47), 10 MG (4)-20 MG (4)-30 MG(19)

oxiconazole topical cream 1 % ST 4oxybutynin chloride oral syrup 5 mg/5 ml 2oxybutynin chloride oral tablet 5 mg 2oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg, 5 mg 2oxycodone oral tablet 10 mg, 15 mg, 20 mg, 30 mg, 5 mg QL 2

QL 3

QL 2

QL 4oxymorphone oral tablet 10 mg, 5 mg QL 3

QL 3OXYTROL FOR WOMEN TRANSDERMAL PATCH 4 DAY 3.9 MG/24 HOUR QL 2oyster shell calcium-vit d3 oral tablet 500 mg(1,250mg) -400 unit 2OZEMPIC INJ 2/1.5ML QL 3OZEMPIC INJ 4MG/3ML 3OZOBAX ORAL SOLN 5 MG/5 ML PA 4

Ppacerone oral tablet 100mg, 400mg 2paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 6 mg, 9 mg QL 3pamidronate inj 2pantoprazole oral tablet,delayed release (dr/ec) 20 mg QL 2pantoprazole oral tablet,delayed release (dr/ec) 40 mg 2paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg 3paromomycin oral capsule 250 mg 2paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg QL 1paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 25 mg, 37.5 mg QL 1PASER ORAL GRANULES DR FOR SUSP IN PACKET 4 GRAM 4PATADAY OTC OPHTH (EYE) DROPS 2

2PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML PA; QL 5PEGASYS SUBCUTANEOUS SYRINGE 180 MCG/0.5 ML PA; QL 5peg-electrolyte soln oral recon soln 420 gram 1PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5 ML PA; QL 5peg-prep oral kit 5-210 mg-gram 1PEN NEEDLE, DIABETIC NEEDLE 3penicillin v potassium oral recon soln 125 mg/5 ml, 250 mg/5 ml 2penicillin v potassium oral tablet 250 mg, 500 mg 2pentamidine inh 300mg 4PENTASA ORAL CAPSULE, EXTENDED RELEASE 250 MG, 500 MG 4pentazocine-naloxone oral tablet 50-0.5 mg QL 4pentoxifylline oral tablet extended release 400 mg 2perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg 1periogard mucous membrane mouthwash 0.12 % 2permethrin topical cream 5 % 2perphenazine amitriptyline 2-10mg, 2-25mg, 4-10mg, 4-25mg 2perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg 2phenazo oral tablet 200mg 2phenazopyridine oral tablet 100 mg, 200 mg 2phenelzine oral tablet 15 mg 2phenobarbital oral elixir 20 mg/5 ml (4 mg/ml) 2phenobarbital oral tablet 16.2 mg, 32.4 mg, 64.8 mg, 97.2 mg 2phenoxybenzamine oral capsule 10 mg 4phentermine oral tablet 37.5 mg PA 2

peg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram, 240-22.72-6.72 -5.84 gram

OXYCODONE ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 20 MG, 40 MG, 80 MG

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

OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG

oxymorphone oral tablet extended release 12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 5 mg, 7.5 mg





phenytoin oral suspension 100 mg/4 ml, 125 mg/5 ml 2phenytoin oral tablet,chewable 50 mg 2phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg 2philith oral tablet 0.4-35 mg-mcg 2PHOSPHOLINE IODIDE OPHTHALMIC (EYE) DROPS 0.125 % 4phosphorous oral tablet 250 mg 3phytonadione (vitamin k1) oral tablet 5 mg 3pilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 % 2pilocarpine hcl oral tablet 5 mg 3pilocarpine hcl oral tablet 7.5 mg 3pimecrolimus topical cream 1 % ST; QL 4pimozide oral tablet 1 mg, 2 mg 4pimtrea (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2pindolol oral tablet 10 mg, 5 mg 1pioglitazone oral tablet 15 mg, 30 mg, 45 mg QL 1PIQRAY 200MG, 300MG PA 5pirmella oral tablet 0.5/0.75/1 mg- 35 mcg, 1-35 mg-mcg 2piroxicam oral capsule 10 mg, 20 mg ST 3PLAN B ONE-STEP ORAL TABLET 1.5 MG 2podofilox topical solution 0.5 % 2polycin ophthalmic (eye) ointment 500-10,000 unit/gram 2polyethylene glycol 3350 oral powder 17 gram/dose 2polymyxin b sulf-trimethoprim ophthalmic (eye) drops 10,000 unit- 1 mg/ml 2POMALYST ORAL CAPSULE 1MG, 2MG, 3MG, 4MG PA 5portia 28 oral tablet 0.15-0.03 mg 2Posaconazole 100mg DR tablet 4potassium chloride oral capsule, extended release 10 meq, 8 meq 2potassium chloride oral liquid 20 meq/15 ml, 40 meq/15 ml 3potassium chloride oral tablet extended release 10 meq, 20 meq, 8 meq 2potassium chloride oral tablet,er particles/crystals 10 meq, 20 meq 2

2powderlax oral powder 17 gram/dose 2powderlax oral powder in packet 17 gram 2pramipexole oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg 2prasugrel oral tablet 10 mg, 5 mg 1pravastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg QL 1praziquantel oral tablet 600 mg 4prazosin oral capsule 1 mg, 2 mg, 5 mg 2prednicarbate topical cream 0.1 % 2prednicarbate topical ointment 0.1 % 2prednisolone acetate ophthalmic (eye) drops,suspension 1 % 2prednisolone oral solution 15 mg/5 ml 2prednisolone sodium phosphate ophthalmic (eye) drops 1 % 2

2prednisone intensol oral concentrate 5 mg/ml 2prednisone oral solution 5 mg/5 ml 2prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg 2prednisone oral tablets,dose pack 5 mg 2

2pregabalin oral solution 20 mg/ml 2PREGNYL INTRAMUSCULAR RECON SOLN 10,000 UNIT PA; QL 5PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25 MG ST 4prevalite oral powder 4 gram 1prevalite oral powder in packet 4 gram 1preventeza oral tablet 1.5mg 2

potassium citrate oral tablet extended release 10 meq (1,080 mg), 15 meq, 5 meq (540 mg)

prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 25 mg/5 ml (5 mg/ml)

pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 300 mg, 50 mg, 75 mg

previfem oral tablet 0.25-35 mg-mcg 2PREVNAR 13 (PF) INTRAMUSCULAR SYRINGE 0.5 ML 3PREZISTA ORAL SUSPENSION 100 MG/ML QL 5PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG QL 5PRIFTIN ORAL TABLET 150 MG 3primaquine oral tablet 26.3 mg 1primidone oral tablet 250 mg, 50 mg 2PROAIR HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION 3

QL 3probenecid oral tablet 500 mg 2probenecid-colchicine oral tablet 500-0.5 mg 2prochlorperazine maleate oral tablet 10 mg, 5 mg 2prochlorperazine rectal suppository 25 mg 2procto-med hc topical cream with perineal applicator 2.5 % 2procto-pak topical cream with perineal applicator 1 % 2proctozone-hc topical cream with perineal applicator 2.5 % 2progesterone micronized oral capsule 100 mg, 200 mg 2PROGESTERONE VAGINAL SUPP 100MG, 200MG 3PROMACTA ORAL POWDER IN PACKET 12.5 MG PA; QL 5PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG PA; QL 5promethazine oral syrup 6.25 mg/5 ml 2promethazine oral tablet 12.5 mg, 25 mg, 50 mg 2promethazine rectal suppository 12.5 mg, 25 mg 2promethegan rectal suppository 12.5 mg, 25 mg 2propafenone oral tablet 150 mg, 225 mg, 300 mg 2proparacaine ophthalmic (eye) drops 0.5 % 2

1propranolol oral solution 20 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml) 1propranolol oral tablet 10 mg, 20 mg, 40 mg, 80 mg 1propylthiouracil oral tablet 50 mg 2protriptyline oral tablet 10 mg, 5 mg 3PROVENTIL AER HFA 3prudoxin topical cream 5 % PA; QL 4

ST; QL 4PULMOZYME INHALATION SOLUTION 1 MG/ML PA 5pyrazinamide oral tablet 500 mg 2pyridostigmine bromide oral tablet 60 mg 2pyridostigmine bromide oral tablet extended release 180 mg 4

QQBREXZA PAD 2.4% PA 4QNASL AER 80MCG QL 4QNASL CHILD SPRAY 40MCG QL 4quazepam oral tablet 15mg PA; QL 4quetiapine oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg QL 2

ST; QL 4quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1quinidine sulfate oral tablet 200 mg, 300 mg 2quinine sulfate oral capsule 324 mg 4

Rrabeprazole oral tablet,delayed release (dr/ec) 20 mg 3raloxifene oral tablet 60 mg 1ramelteon oral tablet 8 mg ST; QL 3

PROAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 90 MCG/ACTUATION

propranolol oral capsule,extended release 24 hr 120 mg, 160 mg, 60 mg, 80 mg

PULMICORT FLEXHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 180 MCG/ACTUATION, 90 MCG/ACTUATION

quetiapine oral tablet extended release 24 hr 150 mg, 200 mg, 300 mg, 400 mg, 50 mg






ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg 1ranolazine oral tablet extended release 12 hr 1,000 mg, 500 mg 3rasagiline oral tablet 0.5 mg, 1 mg 3react oral tablet 1.5mg 2reclipsen (28) oral tablet 0.15-0.03 mg 2RECTIV RECTAL OINTMENT 0.4 % (W/W) 4

QL 4RENACIDIN IRRIGATION SOLUTION 1980.6 MG-59.4 MG-980.4MG/30ML 3RENFLEXIS INTRAVENOUS RECON SOLN 100 MG PA 5repaglinide oral tablet 0.5 mg, 1 mg, 2 mg 1RESTASIS MULTIDOSE OPHTHALMIC (EYE) DROPS 0.05 % ST; QL 4RESTASIS OPHTHALMIC (EYE) DROPPERETTE 0.05 % ST; QL 4

PA; QL 5REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG PA, QL 5REXULTI ORAL TABLET 0.25 MG, 0.5 MG, 1 MG, 2 MG, 3 MG, 4 MG ST; QL 4REYVOW ORAL TABLET 50MG, 100MG PA; QL 4ribavirin inhalation recon soln 6 gram 5ribavirin oral capsule 200 mg 5ribavirin oral tablet 200 mg 5RIDAURA ORAL CAPSULE 3 MG 5rifabutin oral capsule 150 mg 4rifampin oral capsule 150 mg, 300 mg 2riluzole oral tablet 50 mg PA 5rimantadine oral tablet 100 mg 3RINVOQ ORAL TABLET 15MG ER PA; QL 5risedronate oral tablet 150 mg QL 1risedronate oral tablet 30 mg QL 1risedronate oral tablet 35 mg, 5 mg QL 1risperidone oral solution 1 mg/ml 2risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg QL 2ritonavir oral tablet 100 mg 5rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg 2

4rivelsa oral tablets,dose pack,3 month 0.15 mg-20 mcg/ 0.15 mg-25 mcg 2rizatriptan oral tablet 10 mg, 5 mg QL 2rizatriptan oral tablet,disintegrating 10 mg, 5 mg QL 2ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg 2

2rosadan cream 0.75% 2rosadan gel 0.75% 2rosuvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg QL 1roweepra oral tablet 500 mg 2RYBELSUS ORAL TABLET 14MG, 3MG, 7MG 3ryvent oral tablet 6mg 2

Ssalicylic acid er-ceramides topical kit,cleanser and cream er 6 % 2salicylic acid topical cream 6 % 2salicylic acid topical cream,extended release 6 % 2salicylic acid topical film forming liquid w/appl 27.5 % 2salicylic acid topical film-forming soln er w/ appl 28.5 % 2salicylic acid topical foam 6 % 2salicylic acid topical gel 6 % 2salicylic acid topical liquid 26 % 2

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MG/ACTUATION

RETACRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML, 40,000 UNIT/ML

rivastigmine transdermal patch 24 hour 13.3 mg/24 hour, 4.6 mg/24 hr, 9.5 mg/24 hr

ropinirole oral tablet extended release 24 hr 12 mg, 2 mg, 4 mg, 6 mg, 8 mg

salicylic acid topical lotion 6 % 2salicylic acid topical lotion,extended release 6 % 2salicylic acid topical shampoo 6 % 2salimez topical cream 6 % 2salvax topical foam 6 % 2SAPHRIS SUBLINGUAL TABLET 10 MG, 2.5 MG, 5 MG ST; QL 4sapropterin oral tablet 100mg PA 5SAVAYSA ORAL TABLET 15 MG, 30 MG, 60 MG 4SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG QL 4SAVELLA ORAL TABLETS,DOSE PACK 12.5 MG (5)-25 MG(8)-50 MG(42) QL 4scopolamine base transdermal patch 3 day 1 mg over 3 days 4selegiline hcl oral capsule 5 mg 2selegiline hcl oral tablet 5 mg 2selenium sulfide topical lotion 2.5 % 2SELZENTRY ORAL TABLET 150 MG, 25 MG, 300 MG, 75 MG QL 5SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCG/DOSE QL 3sertraline oral concentrate 20 mg/ml 1sertraline oral tablet 100 mg, 25 mg, 50 mg QL 1setlakin oral tablets,dose pack,3 month 0.15 mg-30 mcg (91) 2sevelamer carbonate oral powder in packet 0.8 gram, 2.4 gram 4sevelamer carbonate oral tablet 800 mg 4sevelamer hcl oral tablet 400 mg, 800 mg 4sf 5000 plus dental cream 1.1 % 1sf dental gel 1.1 % 1sharobel oral tablet 0.35 mg 2

4sildenafil (antihypertensive) oral tablet 20 mg PA; QL 5sildenafil oral tablet 100 mg, 25 mg, 50 mg PA 3silodosin oral capsule 4 mg, 8 mg ST 3silver sulfadiazine topical cream 1 % 2SIMBRINZA OPHTHALMIC (EYE) DROPS,SUSPENSION 1-0.2 % ST 4simliya (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2simpesse oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2SIMPONI SUBCUTANEOUS PEN INJECTOR 100 MG/ML, 50 MG/0.5 ML PA; QL 5SIMPONI SUBCUTANEOUS SYRINGE 100 MG/ML, 50 MG/0.5 ML PA; QL 5SIMULECT INJ 10MG, 20MG PA; QL 5simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg QL 1sirolimus oral tablet 0.5 mg, 1 mg, 2 mg 5SIRTURO ORAL TABLET 100 MG, 20 MG 4SKYRIZI INJ 150 MG PA; QL 5smoothlax oral powder 17 gram/dose 2sodium fluoride cream 5000 1sodium fluoride gel 1.1% 1sodium phenylbutyrate oral tablet 500mg 5sodium polystyrene sulfonate oral powder 3solifenacin oral tablet 5 mg, 10 mg ST 4SOLIQUA 100/33 SUBCUTANEOUS INSULIN PEN 100 UNIT-33 MCG/ML QL 3

PA; QL 5

PA 5sorine oral tablet 120mg, 160mg, 240mg, 80mg 2sotalol af oral tablet 120 mg, 160 mg, 80 mg 2sotalol oral tablet 120 mg, 160 mg, 240 mg, 80 mg 2spinosad topical suspension 0.9 % 4

QL 3

SHINGRIX (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 50 MCG/0.5 ML

SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5 ML, 60 MG/0.2 ML, 90 MG/0.3 ML

SOMAVERT SUBCUTANEOUS RECON SOLN 10 MG, 15 MG, 20 MG, 25 MG, 30 MG

SPIRIVA RESPIMAT INHALATION MIST 1.25 MCG/ACTUATION, 2.5 MCG/ACTUATION





QL 3spironolactone oral tablet 100 mg, 25 mg, 50 mg 2sprintec (28) oral tablet 0.25-35 mg-mcg 2SPRYCEL ORAL TABLET 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG PA; QL 5sps (with sorbitol) oral suspension 15-20 gram/60 ml 3sronyx oral tablet 0.1-20 mg-mcg 2ssd topical cream 1 % 2st joseph aspirin oral tablet,chewable 81 mg 1stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg 5STELARA SUBCUTANEOUS SOLUTION 45 MG/0.5 ML PA 5STELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML, 90 MG/ML PA; QL 5STIOLTO RESPIMAT INHALATION MIST 2.5-2.5 MCG/ACTUATION QL 3stop smoking aid buccal lozenge 2 mg, 4 mg 1STRIBILD ORAL TABLET 150-150-200-300 MG QL 5STRIVERDI RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION QL 3

PA; QL 4subvenite oral tablet 100 mg, 150 mg, 200 mg, 25 mg 2subvenite starter (blue) kit oral tablets,dose pack 25 mg (35) 2subvenite starter (green) kit oral tablets,dose pack 25 mg (84) -100 mg (14) 2subvenite starter (orange) kit oral tablets,dose pack 25 mg (42) -100 mg (7) 2SUCRAID SOL 8500/ML PA 5sucralfate oral tablet 1 gram 2sucralfate suspension 1gm/10ml 2sulconazole 1% cream, solution ST 4sulfacetamide sodium (acne) topical suspension 10 % 2sulfacetamine sodium-sulfur external emulsion 10-5% 4sulfacetamide sodium ophthalmic (eye) drops 10 % 2sulfacetamide-prednisolone ophthalmic (eye) drops 10 %-0.23 % (0.25 %) 2sulfadiazine oral tablet 500 mg 2sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5 ml 2sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg 2SULFAMYLON TOPICAL CREAM 85 MG/G 3sulfasalazine oral tablet 500 mg 2sulfasalazine oral tablet,delayed release (dr/ec) 500 mg 2sulfatrim oral suspension 200-40 mg/5 ml 2sulindac oral tablet 150 mg, 200 mg 2sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg QL 2sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml, 6 mg/0.5 ml QL 3sumatriptan succinate subcutaneous pen injector 4 mg/0.5 ml, 6 mg/0.5 ml QL 3sumatriptan succinate subcutaneous solution 6 mg/0.5 ml QL 3sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml 3SUNOSI ORAL TABLET 150MG, 75MG PA 4SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML 4SUPREP BOWEL PREP KIT ORAL RECON SOLN 17.5-3.13-1.6 GRAM ST 4SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG PA; QL 5syeda oral tablet 3-0.03 mg 2

QL 3SYMFI LO ORAL TABLET 400-300-300 MG 5SYMFI ORAL TABLET 600-300-300 MG 5SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR 2,700 MCG/2.7 ML QL 4SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR 1,500 MCG/1.5 ML QL 4SYNAREL NASAL SPRAY,NON-AEROSOL 2 MG/ML 4

QL 3

SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE 18 MCG

SUBSYS SUBLINGUAL SPRAY,NON-AEROSOL 1,200 MCG (600 MCG/SPRAY X 2), 1,600 MCG (800 MCG/SPRAY X 2), 100 MCG/SPRAY, 200 MCG/SPRAY, 400 MCG/SPRAY, 600 MCG/SPRAY, 800 MCG/SPRAY

SYMBICORT INHALATION HFA AEROSOL INHALER 160-4.5 MCG/ACTUATION, 80-4.5 MCG/ACTUATION

SYNJARDY ORAL TABLET 12.5-1,000 MG, 12.5-500 MG, 5-1,000 MG, 5-500 MG

QL 3

TTABLOID ORAL TABLET 40 MG 4TABRECTA ORAL TABLET 150MG, 200MG PA 5tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg 5tacrolimus topical ointment 0.03 %, 0.1 % QL 3tadalafil (antihypertensive) oral tablet 20 mg PA; QL 5tadalafil oral tablet 2.5 mg, 5 mg PA; ST; QL 3TAFINLAR ORAL CAPSULE 50 MG, 75 MG PA; QL 5TAKE ACTION ORAL TABLET 1.5 MG 2TALTZ INJ 80 MG/ML PA; QL 5tamoxifen oral tablet 10 mg, 20 mg 2tamsulosin oral capsule 0.4 mg 2TARGRETIN TOPICAL GEL 1 % PA 5tarina 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2tarina fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2TASIGNA ORAL CAPSULE 150 MG, 200 MG PA; QL 5TASIGNA ORAL CAPSULE 50 MG PA 5tazarotene topical cream 0.1 % 3

1telmisartan oral tablet 20 mg, 40 mg, 80 mg 1temazepam oral capsule 15 mg, 30 mg QL 2TEMIXYS TABLET 300-300 5temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 mg, 250 mg, 5 mg PA 5temsirolimus inj 25mg/ml PA 5tenofovir disoproxil fumarate oral tablet 300 mg PA; QL 5terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg QL 2terbinafine hcl oral tablet 250 mg 2terbutaline oral tablet 2.5 mg, 5 mg 1terconazole vaginal cream 0.4 %, 0.8 % 2terconazole vaginal suppository 80 mg 2testosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml 2testosterone enanthate intramuscular oil 200 mg/ml 2testosterone transdermal gel 50 mg/5 gram (1 %) 3

3

3tetrabenazine oral tablet 12.5 mg, 25 mg PA; QL 5tetracycline oral capsule 250 mg, 500 mg 4THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG PA; QL 5theophylline oral tablet extended release 12 hr 100 mg, 200 mg 1

1thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg 2thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg 2tiadylt cap 120mg/24, 180mg/24, 240mg/24, 300mg/24, 360mg/24 1tilia fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) 2timolol maleate ophthalmic (eye) drops 0.25 %, 0.5 % 2timolol maleate ophthalmic (eye) gel forming solution 0.25 %, 0.5 % 2timolol maleate oral tablet 10 mg, 20 mg, 5 mg 1tinidazole tablet 250mg, 500mg 2

2TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG 5

theophylline oral tablet extended release 24 hr 300 mg, 400 mg, 450 mg, 600 mg

tis-u-sol pentalyte irrigation irrigation solution 800-40-20-8.75- 6.25 mg/100 ml

SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 25-1,000 MG, 5-1,000 MG

taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

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

testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1 % (50 mg/5 gram)






tizanidine oral tablet 2 mg, 4 mg 2TOBRADEX OPHTHALMIC (EYE) OINTMENT 0.3-0.1 % 4tobramycin ophthalmic (eye) drops 0.3 % 2

PA; QL 5tobramycin-dexamethasone ophthalmic (eye) drops,suspension 0.3-0.1 % 2TOBREX OPHTHALMIC (EYE) OINTMENT 0.3 % 4tolbutamide oral tablet 500 mg 1tolcapone oral tablet 100 mg 4tolterodine oral capsule,extended release 24hr 2 mg, 4 mg 3tolterodine oral tablet 1 mg, 2 mg 2tolvaptan oral tablet 15mg, 30mg PA; QL 5topiramate oral capsule, sprinkle 15 mg, 25 mg 2

3topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg 2toremifene oral tablet 60 mg 3torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg 2

3

3tovet aerosol 0.05% QL 2TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HR 4 MG, 8 MG ST 4TRADJENTA ORAL TABLET 5 MG QL 3tramadol oral tablet 50 mg QL 2tramadol oral tablet extended release 24 hr 100 mg, 200 mg, 300 mg QL 3tramadol oral tablet, er multiphase 24 hr 100 mg, 200 mg, 300 mg QL 3tramadol/apap tab 37.5-325 QL 2trandolapril oral tablet 1 mg, 2 mg, 4 mg 1tranexamic acid intravenous solution 1,000 mg/10 ml (100 mg/ml) 2tranexamic acid oral tablet 650 mg 2tranylcypromine oral tablet 10 mg 2travoprost drops 0.004% ST 3trazodone oral tablet 100 mg, 150 mg, 50 mg 2TRELEGY ELLIPTA INHALATION BLISTER WITH DEVICE 100-62.5-25 MCG 3TREMFYA SUBCUTANEOUS SYRINGE 100 MG/ML PA; QL 5

ST 4

ST 4tretinoin (chemotherapy) oral capsule 10 mg 5tretinoin topical cream 0.025 %, 0.1 % 2tretinoin topical cream 0.05 % 2tretinoin topical gel 0.01 %, 0.025 %, 0.05 % 2tri femynor oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2triamcinolone acetonide dental paste 0.1 % 2triamcinolone acetonide nasal aerosol,spray 55 mcg QL 2triamcinolone acetonide topical cream 0.025 %, 0.1 %, 0.5 % 2triamcinolone acetonide topical lotion 0.025 %, 0.1 % 2triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 % 2triamterene oral capsule 100 mg, 50 mg 3triamterene-hydrochlorothiazid oral capsule 37.5-25 mg 2triamterene-hydrochlorothiazid oral tablet 37.5-25 mg, 75-50 mg 2triazolam tablet 0.125mg, 0.25mg QL 2triderm cream 0.1%, 0.5% 2trientine capsule 250mg PA 5tri-estarylla oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2

TOBRAMYCIN WITH NEBULIZER INHALATION SOLUTION FOR NEBULIZATION 300 MG/5 ML

TOPIRAMATE ORAL CAPSULE,SPRINKLE,ER 24HR 100 MG, 150 MG, 200 MG, 25 MG, 50 MG

TOUJEO MAX U-300 SOLOSTAR SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (3 ML)

TOUJEO SOLOSTAR U-300 INSULIN SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (1.5 ML)

TRESIBA FLEXTOUCH U-100 SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)


trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5 mg 2trifluridine ophthalmic (eye) drops 1 % 2trihexyphenidyl oral elixir 0.4 mg/ml 2trihexyphenidyl oral tablet 2 mg, 5 mg 2TRIJARDY XR TAB QL 3tri-legest fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) 2tri-linyah oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tri-lo-estarylla oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-lo-marzia oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-lo-mili oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-lo-sprintec oral tablet 0.18/0.215/0.25 mg-25 mcg 2trimethobenzamide oral capsule 300 mg 2trimethoprim oral tablet 100 mg 2tri-mili oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2trimipramine oral capsule 100 mg, 25 mg, 50 mg ST 4TRINTELLIX ORAL TABLET 10 MG, 20 MG, 5 MG ST; QL 4tri-nymyo oral tablet 2tri-previfem (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tri-sprintec (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2TRIUMEQ ORAL TABLET 600-50-300 MG 5

2trivora (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2tri-vylibra lo oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-vylibra oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tropicamide ophthalmic (eye) drops 0.5 %, 1 % 2trospium oral capsule,extended release 24hr 60 mg 2trospium oral tablet 20 mg 2

QL 3TRUVADA TABLET 200-300 QL 5tulana oral tablet 0.35 mg 2TUZISTRA XR ORAL SUSPENSION,EXTENDED REL 12 HR 14.7-2.8 MG/5 ML 4TYBOST ORAL TABLET 150 MG 5tydemy oral tablet 3-0.03-0.451 mg (21) (7) 2TYKERB ORAL TABLET 250 MG PA; QL 5TYMLOS SUBCUTANEOUS PEN INJECTOR 80 MCG (3,120 MCG/1.56 ML) PA 5

UUDENYCA SUBCUTANEOUS SYRINGE 6 MG/0.6 ML PA 5

2urea topical cream 40 % 2ursodiol oral tablet 250 mg, 500 mg 3

Vvalacyclovir oral tablet 1 gram, 500 mg QL 2valganciclovir oral recon soln 50 mg/ml 4valganciclovir oral tablet 450 mg 4valproic acid (as sodium salt) oral solution 250 mg/5 ml 2valproic acid oral capsule 250 mg 2valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg 1

1vancomycin oral capsule 125 mg, 250 mg ST 2vandazole vaginal gel 0.75 % 3VASCEPA ORAL CAPSULE 0.5 GRAM, 1 GRAM 4VECAMYL ORAL TABLET 2.5 MG PA 3

tri-vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml, 0.5 mg fluoride (1.1 mg)/ml

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

unithroid 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 25mcg, 300mcg, 50mcg, 75mcg, 88mcg,

valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg





velivet triphasic regimen (28) oral tablet 0.1/.125/.15-25 mg-mcg 2VELPHORO CHW 500MG PA 4VEMLIDY ORAL TABLET 25 MG PA 5venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg, 75 mg QL 2venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg QL 2VENTAVIS INHALATION SOLUTION FOR NEBULIZATION 20 MCG/ML PA; QL 5VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION 3verapamil oral capsule, 24 hr er pellet ct 100 mg, 200 mg, 300 mg 1

1verapamil oral tablet 120 mg, 40 mg, 80 mg 1verapamil oral tablet extended release 120 mg, 180 mg, 240 mg 1vestura tablet 3-0.02mg 2vexatrol kit 2.5-2.5% 2VIBRAMYCIN ORAL SYRUP 50 MG/5 ML 4VICTOZA INJ 18MG/3ML QL 3viekira pak tab PA; QL 5vienva oral tablet 0.1-20 mg-mcg 2vigabatrin oral powder in packet 500 mg PA; QL 5vigabatrin oral tablet 500 mg PA; QL 5vigadrone oral powder in packet 500 mg PA; QL 5VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG ST; ST; QL 4VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23) QL 4VIMPAT ORAL SOLUTION 10 MG/ML 3VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG 3viorele (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2VIRACEPT ORAL TABLET 250 MG, 625 MG 5VIRAZOLE INHALATION RECON SOLN 6 GRAM 5VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG PA; QL 5virtussin AC liquid 100-10/5 2vitamin d3 oral capsule 400 unit 2vitamin d3 oral tablet 400 unit 2vitamin d3 oral tablet,chewable 1,000 unit 2VIVITROL INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 380 MG PA 5volnea oral tablet 2VOLTAREN OTC ARTHRITIS 1% GEL QL 2voriconazole oral tablet 200 mg, 50 mg 4VOTRIENT ORAL TABLET 200 MG PA; QL 5VUMERITY CAP 231MG PA; QL 5vyfemla (28) oral tablet 0.4-35 mg-mcg 2vylibra oral tablet 0.25-35 mg-mcg 2

Wwal-itin oral solution 5 mg/5 ml 2wal-itin oral tablet 10 mg QL 2wal-zyr (cetirizine) oral capsule 10 mg 2wal-zyr (cetirizine) oral solution 1 mg/ml 2wal-zyr (cetirizine) oral tablet 10 mg QL 2

1wera (28) oral tablet 0.5-35 mg-mcg 2westhroid oral tablet 130 mg, 195 mg, 32.5 mg, 65 mg, 97.5 mg 2wixela inhub aer 100/50, 250/50, 500/50 QL 2woman's laxative oral tablet,delayed release (dr/ec) 5 mg 2women's gentle laxative(bisac) oral tablet,delayed release (dr/ec) 5 mg 2women's laxative (bisacodyl) oral tablet 5 mg 2

2

verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg, 360 mg

warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

wp thyroid tablet 113.75mg, 130mg, 16.25mg, 32.5mg, 48.75mg, 65mg, 81.25mg, 97.5mg

wymzya fe oral tablet,chewable 0.4mg-35mcg(21) and 75 mg (7) 2

XXALKORI ORAL CAPSULE 200 MG, 250 MG PA; QL 5XARELTO ORAL TABLET 10 MG, 15 MG, 2.5 MG, 20 MG 3XARELTO ORAL TABLETS,DOSE PACK 15 MG (42)- 20 MG (9) 3XELJANZ ORAL TABLET 10 MG, 5 MG PA; QL 5XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HR 11 MG, 22 MG PA; QL 5XIFAXAN ORAL TABLET 200 MG, 550 MG PA; QL 4

QL 3XOFLUZA ORAL TABLET 20 MG, 40 MG 4XOLAIR SUBCUTANEOUS RECON SOLN 150 MG PA 5XOLAIR SUBCUTANEOUS SYRINGE 150 MG/ML PA 5XOLAIR SUBCUTANEOUS SYRINGE 75 MG/0.5 ML PA 5XOPENEX HFA INHALATION HFA AEROSOL INHALER 45 MCG/ACTUATION QL 4xulane transdermal patch weekly 150-35 mcg/24 hr 2

YYOSPRALA ORAL TABLET,IR,DELAYED REL,BIPHASIC 325-40 MG, 81-40 MG PA 4yuvafem vaginal tablet 10 mcg 2

Zzafemy dis 150/35 2zafirlukast oral tablet 10 mg, 20 mg 1zaleplon oral capsule 10 mg, 5 mg QL 2zarah oral tablet 3-0.03 mg 2zenatane oral capsule 10 mg, 20 mg, 30 mg, 40 mg 2

4ZETONNA NASAL HFA AEROSOL INHALER 37 MCG/ACTUATION ST; QL 4zidovudine oral capsule 100 mg 5zidovudine oral syrup 50 mg/5 ml 5zidovudine oral tablet 300 mg 5ZIEXTENZO INJ 6 MG/0.6 ML PA; QL 5zileuton oral tablet, er multiphase 12 hr 600 mg PA 3ZIOPTAN DROPS 0.0015% ST 4ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg QL 2ZIRGAN OPHTHALMIC (EYE) GEL 0.15 % 4zoledronic acid intravenous recon soln 4 mg 5zoledronic acid intravenous solution 4 mg/5 ml 5zoledronic acid-mannitol-water intravenous piggyback 5 mg/100 ml 5ZOLINZA ORAL CAPSULE 100 MG PA 5zolmitriptan oral tablet 2.5 mg, 5 mg QL 3zolmitriptan spray 2.5mg, 5mg QL 4zolpidem oral tablet 10 mg, 5 mg QL 2zolpidem oral tablet,ext release multiphase 12.5 mg, 6.25 mg ST; QL 3ZOMIG NASAL SPRAY,NON-AEROSOL 2.5 MG, 5 MG ST; QL 4zonisamide oral capsule 100 mg, 25 mg, 50 mg 2ZONTIVITY ORAL TABLET 2.08 MG 3ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG, 1 MG 5zovia 1/35e (28) oral tablet 1-35 mg-mcg 2zumandimine (28) oral tablet 3-0.03 mg 2ZYLET SUS 0.5-0.3% ST 4

XIGDUO XR ORAL TABLET 5-500 MG, 10-500 MG, 2.5-1000 MG, 10-1000 MG

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT






Therapeutical Category Listing




Therapeutical Category ListingANTI-INFECTIVESANTIFUNGAL AGENTS

clotrimazole mucous membrane troche 10 mg 2fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml 2fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg 2flucytosine oral capsule 250 mg, 500 mg 2griseofulvin microsize oral suspension 125 mg/5 ml 2griseofulvin microsize oral tablet 500 mg 2griseofulvin ultramicrosize oral tablet 125 mg, 250 mg 2itraconazole oral capsule 100 mg QL 2ketoconazole oral tablet 200 mg 2nystatin oral suspension 100,000 unit/ml 2nystatin oral tablet 500,000 unit 2ORAVIG BUCCAL MUCO-ADHESIVE BUCCAL TABLET 50 MG 4Posaconazole 100mg DR tablet 4terbinafine hcl oral tablet 250 mg 2voriconazole oral tablet 200 mg, 50 mg 4

ANTIVIRALSabacavir oral solution 20 mg/ml 5abacavir oral tablet 300 mg 5abacavir-lamivudine oral tablet 600-300 mg 5abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg 5acyclovir oral capsule 200 mg 2acyclovir oral suspension 200 mg/5 ml 2acyclovir oral tablet 400 mg, 800 mg 2adefovir oral tablet 10 mg PA 2amantadine hcl oral capsule 100 mg 2amantadine hcl oral solution 50 mg/5 ml 2amantadine hcl oral tablet 100 mg 2APTIVUS ORAL CAPSULE 250 MG 5APTIVUS ORAL SOLUTION 100 MG/ML 5atazanavir oral capsule 150 mg, 200 mg, 300 mg QL 5ATRIPLA ORAL TABLET 600-200-300 MG 5CIMDUO ORAL TABLET 300-300 MG 5CRIXIVAN ORAL CAPSULE 400 MG 5DESCOVY ORAL TABLET 200-25 MG 5EDURANT ORAL TABLET 25 MG 5efavirenz oral capsule 200 mg, 50 mg 5efavirenz oral tablet 600 mg 5efavirenz-emtricitab-tenofovir 5efavirenz-lamivudine-tenofovir 5emtricitabine-tenofovir QL 5EMTRIVA ORAL CAPSULE 200MG 5EMTRIVA SOLN 10MG/ML 5entecavir oral tablet 0.5 mg, 1 mg PA 5famciclovir oral tablet 125 mg, 250 mg, 500 mg QL 2fosamprenavir oral tablet 700 mg 5FUZEON SUBCUTANEOUS RECON SOLN 90 MG PA; QL 5INTELENCE ORAL TABLET 100 MG, 200 MG, 25 MG QL 5INTRON A INJ 10MU, 18MU, 25MU, 50MU PA; QL 5INVIRASE ORAL TABLET 500 MG QL 5ISENTRESS HD ORAL TABLET 600 MG 5ISENTRESS ORAL TABLET 400 MG 5KALETRA ORAL TABLET 100-25 MG, 200-50 MG PA 5lamivudine oral solution 10 mg/ml 5lamivudine oral tablet 100 mg 5lamivudine oral tablet 150 mg, 300 mg 5

lamivudine-zidovudine oral tablet 150-300 mg 5LEXIVA ORAL SUSPENSION 50 MG/ML 5lopinavir-ritonavir oral solution 400-100 mg/5 ml QL 5MAVYRET ORAL TABLET 100-40 MG PA; QL 5nevirapine oral tablet 100mg, 200 mg 5nevirapine oral tablet extended release 24 hr 400 mg 5NORVIR ORAL SOLUTION 80 MG/ML 5oseltamivir oral capsule 30 mg, 45 mg, 75 mg QL 4oseltamivir oral suspension for reconstitution 6 mg/ml 4PREZISTA ORAL SUSPENSION 100 MG/ML QL 5PREZISTA ORAL TABLET 150 MG, 600 MG, 75 MG, 800 MG QL 5

QL 4ribavirin inhalation recon soln 6 gram 5rimantadine oral tablet 100 mg 3ritonavir oral tablet 100 mg 5SELZENTRY ORAL TABLET 150 MG, 25 MG, 300 MG, 75 MG QL 5stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg 5STRIBILD ORAL TABLET 150-150-200-300 MG QL 5SYMFI LO ORAL TABLET 400-300-300 MG 5SYMFI ORAL TABLET 600-300-300 MG 5TEMIXYS TABLET 300-300 5tenofovir disoproxil fumarate oral tablet 300 mg PA; QL 5TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG 5TRIUMEQ ORAL TABLET 600-50-300 MG 5TRUVADA TABLET 200-300 QL 5TYBOST ORAL TABLET 150 MG 5valacyclovir oral tablet 1 gram, 500 mg QL 2valganciclovir oral recon soln 50 mg/ml 4valganciclovir oral tablet 450 mg 4VEMLIDY ORAL TABLET 25 MG PA 5viekira pak tab PA; QL 5VIRACEPT ORAL TABLET 250 MG, 625 MG 5VIRAZOLE INHALATION RECON SOLN 6 GRAM 5VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG PA; QL 5XOFLUZA ORAL TABLET 20 MG, 40 MG 4zidovudine oral capsule 100 mg 5zidovudine oral syrup 50 mg/5 ml 5zidovudine oral tablet 300 mg 5

CEPHALOSPORINScefaclor oral capsule 250 mg, 500 mg 2cefaclor oral suspension for reconstitution 250 mg/5 ml 2cefadroxil oral capsule 500 mg 2cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml 2cefdinir oral capsule 300 mg 2cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml 2cefixime oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml 4cefpodoxime oral tablet 100mg, 200mg 2cefpodoxime proxetil susp 100/5ml, 50/ml 2cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml 2cefprozil oral tablet 250 mg, 500 mg 2cefuroxime axetil oral tablet 250 mg, 500 mg 2cephalexin oral capsule 250 mg, 500 mg 2cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml 2SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML 4

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MG/ACTUATION


ERYTHROMYCINS & OTHER MACROLIDESazithromycin oral suspension for reconstitution 100 mg/5 ml, 200 mg/5 ml 2azithromycin oral tablet 250 mg, 500 mg, 600 mg 2

2clarithromycin oral tablet 250 mg, 500 mg 2clarithromycin oral tablet extended release 24 hr 500 mg 2DIFICID ORAL TABLET 200 MG PA 4e.e.s. 400 oral tablet 400 mg 3erythromycin ethylsuccinate oral tablet 400 mg 3erythromycin oral tablet 250 mg, 500 mg 3erythromycin oral tablet,delayed release (dr/ec) 250 mg, 333 mg, 500 mg 3

MISCELLANEOUS ANTIINFECTIVESALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML 4ALINIA ORAL TABLET 500 MG 4ARAKODA ORAL TABLET 100 MG 4atovaquone oral suspension 750 mg/5 ml 4atovaquone-proguanil oral tablet 250-100 mg, 62.5-25 mg 1CAYSTON INHALATION SOLUTION FOR NEBULIZATION 75 MG/ML QL 5chloroquine phosphate oral tablet 250 mg, 500 mg 1clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg 2clindamycin palmitate hcl oral recon soln 75 mg/5 ml 2clindamycin pediatric oral recon soln 75 mg/5 ml 2CYCLOSERINE ORAL CAPSULE 250 MG 4dapsone oral tablet 100 mg, 25 mg 3EGATEN 4ethambutol oral tablet 100 mg, 400 mg 2hydroxychloroquine oral tablet 200 mg 2IMPAVIDO ORAL CAPSULE 50 MG 4isoniazid oral solution 50 mg/5 ml 2isoniazid oral tablet 100 mg, 300 mg 2ivermectin oral tablet 3 mg 3KRINTAFEL ORAL TABLET 150 MG 4linezolid oral suspension for reconstitution 100 mg/5 ml 3linezolid oral tablet 600 mg 3mefloquine oral tablet 250 mg 1metronidazole oral tablet 250 mg, 500 mg 2NEBUPENT INHALATION RECON SOLN 300 MG 4neomycin oral tablet 500 mg 2paromomycin oral capsule 250 mg 2PASER ORAL GRANULES DR FOR SUSP IN PACKET 4 GRAM 4pentamidine inh 300mg 4praziquantel oral tablet 600 mg 4PRIFTIN ORAL TABLET 150 MG 3primaquine oral tablet 26.3 mg 1pyrazinamide oral tablet 500 mg 2quinine sulfate oral capsule 324 mg 4rifabutin oral capsule 150 mg 4rifampin oral capsule 150 mg, 300 mg 2SIRTURO ORAL TABLET 100 MG, 20 MG 4tinidazole tablet 250mg, 500mg 2

PA; QL 5XIFAXAN ORAL TABLET 200 MG, 550 MG PA; QL 4

PENICILLINSamoxicillin oral capsule 250 mg, 500 mg 2

clarithromycin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

TOBRAMYCIN WITH NEBULIZER INHALATION SOLUTION FOR NEBULIZATION 300 MG/5 ML

2amoxicillin oral tablet 875 mg 2amoxicillin oral tablet,chewable 125 mg, 250 mg 2

2

2amoxicillin-pot clavulanate oral tablet,chewable 200-28.5 mg, 400-57 mg 2ampicillin oral capsule 500 mg 2dicloxacillin oral capsule 250 mg, 500 mg 2penicillin v potassium oral recon soln 125 mg/5 ml, 250 mg/5 ml 2penicillin v potassium oral tablet 250 mg, 500 mg 2

QUINOLONESciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg 2levofloxacin oral solution 250 mg/10 ml 2levofloxacin oral tablet 250 mg, 500 mg, 750 mg 2moxifloxacin oral tablet 400 mg ST 3ofloxacin oral tablet 300 mg, 400 mg 4

SULFA'S & RELATED AGENTSsulfadiazine oral tablet 500 mg 2sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5 ml 2sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg 2sulfatrim oral suspension 200-40 mg/5 ml 2

TETRACYCLINESavidoxy oral tablet 100mg 2doxycycline hyclate oral capsule 100 mg, 50 mg 2doxycycline hyclate oral tablet 100 mg 2doxycycline monohydrate oral capsule 100 mg, 50 mg 2doxycycline monohydrate oral suspension for reconstitution 25 mg/5 ml 2doxycycline oral tablet 20 mg 2minocycline oral capsule 100 mg, 50 mg, 75 mg 2morgidox 2tetracycline oral capsule 250 mg, 500 mg 4VIBRAMYCIN ORAL SYRUP 50 MG/5 ML 4

URINARY TRACT AGENTSmethenamine hippurate oral tablet 1 gram 2mondoxyne oral capsule 100mg 2MONUROL ORAL PACKET 3 GRAM 4nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 50 mg 2nitrofurantoin monohyd/m-cryst oral capsule 100 mg 2nitrofurantoin oral suspension 25 mg/5 ml 2trimethoprim oral tablet 100 mg 2

VANCOMYCINFIRVANQ ORAL RECON SOLN 25 MG/ML, 50 MG/ML 2vancomycin oral capsule 125 mg, 250 mg 2

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGSADJUNCTIVE AGENTS

leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg 2

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGSabiraterone oral tablet 250 mg PA; QL 5

amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml

amoxicillin-pot clavulanate oral suspension for reconstitution 200-28.5 mg/5 ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml

amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125 mg



Therapeutical Category ListingTherapeutical Category Listing





Therapeutical Category ListingTherapeutical Category ListingAFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG PA; QL 5anastrozole oral tablet 1 mg 2azathioprine oral tablet 50 mg 5belrapzo soln 100/4ml PA 5bendeka inj 100/4ml PA 5bexarotene oral capsule 75 mg 5bicalutamide oral tablet 50 mg 2capecitabine oral tablet 150 mg, 500 mg PA; QL 5CAPRELSA ORAL TABLET 100 MG, 300 MG QL 5cyclophosphamide oral capsule 25 mg, 50 mg 5cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg 5cyclosporine modified oral solution 100 mg/ml 5cyclosporine oral capsule 100 mg, 25 mg 5DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG 4ELIGARD (3 MONTH) SUBCUTANEOUS SYRINGE 22.5 MG PA; QL 5ELIGARD (4 MONTH) SUBCUTANEOUS SYRINGE 30 MG PA; QL 5ELIGARD (6 MONTH) SUBCUTANEOUS SYRINGE 45 MG PA; QL 5ELIGARD SUBCUTANEOUS SYRINGE 7.5 MG (1 MONTH) PA 5EMCYT ORAL CAPSULE 140 MG PA 5erlotinib oral tablet 100 mg, 150 mg, 25 mg PA; QL 5everolimus oral tablet 0.25mg, 0.5mg, 0.75mg, 2.5mg, 5mg, 7.5mg QL 5exemestane oral tablet 25 mg 5fludarabine intravenous recon soln 50 mg 4flutamide oral capsule 125 mg 2gengraf oral capsule 25mg, 100mg 5gengraf solution 100mg/ml 5GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG PA; QL 5hydroxyurea oral capsule 500 mg 2IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG PA; QL 5ICLUSIG ORAL TABLET 15 MG, 45 MG PA; QL 5imatinib oral tablet 100 mg, 400 mg PA; QL 5irinotecan inj 40mg/2ml PA 5lapatinib oral tablet 250mg PA; QL 5

PA; QL 5LENVIMA ORAL CAPSULE 12 MG/DAY (4 MG X 3), 4 MG PA; 5letrozole oral tablet 2.5 mg 2LEUKERAN ORAL TABLET 2 MG 3

PA; QL 5LUPRON DEPOT (4 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG PA; QL 5LUPRON DEPOT (6 MONTH) INTRAMUSCULAR SYRINGE KIT 45 MG PA; QL 5LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 3.75 MG, 7.5 MG PA; QL 5

PA; QL 5

PA; QL 5LYNPARZA ORAL TABLET 100 MG, 150 MG PA 5LYSODREN ORAL TABLET 500 MG 3MATULANE ORAL CAPSULE 50 MG 5megestrol oral suspension 400 mg/10 ml (40 mg/ml) 2megestrol oral tablet 20 mg, 40 mg 2MEKINIST ORAL TABLET 0.5 MG, 2 MG PA; QL 5mercaptopurine oral tablet 50 mg 2methotrexate sodium oral tablet 2.5 mg 2mycophenolate mofetil oral capsule 250 mg 5mycophenolate mofetil oral suspension for reconstitution 200 mg/ml 5

LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 14 MG/DAY(10 MG X 1-4 MG X 1), 18 MG/DAY (10 MG X 1-4 MG X2), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1), 8 MG/DAY (4 MG X 2)

LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG, 22.5 MG

LUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG, 30 MG

LUPRON DEPOT-PED INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG (PED)

mycophenolate mofetil oral tablet 500 mg 5

PA 5NEXAVAR ORAL TABLET 200 MG PA; QL 5NILUTAMIDE TABLET 150 MG PA 5

PA 5

PA 5PIQRAY 200MG, 300MG PA 5sirolimus oral tablet 0.5 mg, 1 mg, 2 mg 5

PA; QL 5SPRYCEL ORAL TABLET 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG PA; QL 5SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG PA; QL 5TABLOID ORAL TABLET 40 MG 4TABRECTA ORAL TABLET 150MG, 200MG PA 5tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg 5TAFINLAR ORAL CAPSULE 50 MG, 75 MG PA; QL 5tamoxifen oral tablet 10 mg, 20 mg 2TARGRETIN TOPICAL GEL 1 % PA 5TASIGNA ORAL CAPSULE 150 MG, 200 MG PA; QL 5TASIGNA ORAL CAPSULE 50 MG PA 5

PA 5THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG PA; QL 5toremifene oral tablet 60 mg 3tretinoin (chemotherapy) oral capsule 10 mg 5TYKERB ORAL TABLET 250 MG PA; QL 5VOTRIENT ORAL TABLET 200 MG PA; QL 5XALKORI ORAL CAPSULE 200 MG, 250 MG PA; QL 5ZOLINZA ORAL CAPSULE 100 MG PA 5ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG, 1 MG 5

AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCHANTICONVULSANTS

APTIOM ORAL TABLET 200 MG, 400 MG, 600 MG, 800 MG 4carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, 300 mg 2carbamazepine oral suspension 100 mg/5 ml 2carbamazepine oral tablet 200 mg 2

2carbamazepine oral tablet,chewable 100 mg 2CELONTIN ORAL CAPSULE 300 MG 4clobazam susp 2.5mg/ml 3clobazam oral tablet 10mg, 20mg 3clonazepam oral tablet 0.5 mg, 1 mg, 2 mg 2diazepam rectal kit 12.5-15-17.5-20 mg, 2.5 mg, 5-7.5-10 mg 3divalproex oral capsule, delayed rel sprinkle 125 mg 2divalproex oral tablet extended release 24 hr 250 mg, 500 mg 2divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 mg 2EPIDIOLEX ORAL SOLUTION 100 MG/ML PA 5epitol oral tablet 200mg 2ethosuximide oral capsule 250 mg 2ethosuximide oral solution 250 mg/5 ml 2felbamate oral suspension 600 mg/5 ml 2felbamate oral tablet 400 mg, 600 mg 2gabapentin oral capsule 100 mg, 300 mg, 400 mg 2

mycophenolate sodium oral tablet,delayed release (dr/ec) 180 mg, 360 mg

octreotide acetate injection solution 1,000 mcg/ml, 100 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml

octreotide acetate injection syringe 100 mcg/ml (1 ml), 50 mcg/ml (1 ml), 500 mcg/ml (1 ml)

SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5 ML, 60 MG/0.2 ML, 90 MG/0.3 ML

temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 mg, 250 mg, 5 mg

carbamazepine oral tablet extended release 12 hr 100 mg, 200 mg, 400 mg


gabapentin oral solution 250 mg/5 ml, 300 mg/6 ml (6 ml) 2gabapentin oral tablet 600 mg, 800 mg 2lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg 2lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg 2lamotrigine oral tablet kit start 35, 49, 98 2levetiracetam oral solution 100 mg/ml, 500 mg/5 ml (5 ml) 2levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg 2levetiracetam oral tablet extended release 24 hr 500 mg, 750 mg 2oxcarbazepine oral suspension 300 mg/5 ml (60 mg/ml) 2oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg 2phenobarbital oral elixir 20 mg/5 ml (4 mg/ml) 2phenobarbital oral tablet 16.2 mg, 32.4 mg, 64.8 mg, 97.2 mg 2phenytoin oral suspension 100 mg/4 ml, 125 mg/5 ml 2phenytoin oral tablet,chewable 50 mg 2phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg 2

2pregabalin oral solution 20 mg/ml 2primidone oral tablet 250 mg, 50 mg 2roweepra oral tablet 500 mg 2subvenite oral tablet 100 mg, 150 mg, 200 mg, 25 mg 2subvenite starter (blue) kit oral tablets,dose pack 25 mg (35) 2

2

2topiramate oral capsule, sprinkle 15 mg, 25 mg 2

3topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg 2valproic acid (as sodium salt) oral solution 250 mg/5 ml 2valproic acid oral capsule 250 mg 2vigabatrin oral powder in packet 500 mg PA; QL 5vigabatrin oral tablet 500 mg PA; QL 5vigadrone oral powder in packet 500 mg PA; QL 5VIMPAT ORAL SOLUTION 10 MG/ML 3VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG 3zonisamide oral capsule 100 mg, 25 mg, 50 mg 2

ANTIPARKINSONISM AGENTSAPOKYN SUBCUTANEOUS CARTRIDGE 10 MG/ML PA 5benztropine oral tablet 0.5 mg, 1 mg, 2 mg 2bromocriptine oral capsule 5 mg 4bromocriptine oral tablet 2.5 mg 4carbidopa oral tablet 25 mg 3carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg 2carbidopa-levodopa oral tablet extended release 25-100 mg, 50-200 mg 2

2entacapone oral tablet 200 mg 2NEUPRO DISC 2MG/24HR PA 4

2rasagiline oral tablet 0.5 mg, 1 mg 3ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg 2

2selegiline hcl oral capsule 5 mg 2

subvenite starter (orange) kit oral tablets,dose pack 25 mg (42) -100 mg (7)

TOPIRAMATE ORAL CAPSULE,SPRINKLE,ER 24HR 100 MG, 150 MG, 200 MG, 25 MG, 50 MG

carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg, 18.75-75-200 mg, 25-100-200 mg, 31.25-125-200 mg, 37.5-150-200 mg, 50-200-200 mg

pramipexole oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

ropinirole oral tablet extended release 24 hr 12 mg, 2 mg, 4 mg, 6 mg, 8 mg

pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 300 mg, 50 mg, 75 mg

subvenite starter (green) kit oral tablets,dose pack 25 mg (84) -100 mg (14)

selegiline hcl oral tablet 5 mg 2tolcapone oral tablet 100 mg 4trihexyphenidyl oral elixir 0.4 mg/ml 2trihexyphenidyl oral tablet 2 mg, 5 mg 2

MIGRAINE & CLUSTER HEADACHE THERAPYAJOVY INJ 225 MG/1.5 PA 3almotriptan malate oral tablet 12.5 mg, 6.25 mg QL; ST 4dihydroergotamine injection solution 1 mg/ml PA 4eletriptan oral tablet 20 mg, 40 mg ST; QL 3EMGALITY INJ 120MG/ML PA 3frovatriptan oral tablet 2.5 mg ST; QL 4MIGERGOT SUPPOSITORY 3naratriptan oral tablet 1 mg, 2.5 mg QL 2REYVOW ORAL TABLET 50MG, 100MG PA; QL 4rizatriptan oral tablet 10 mg, 5 mg QL 2rizatriptan oral tablet,disintegrating 10 mg, 5 mg QL 2sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg QL 2sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml, 6 mg/0.5 ml QL 3

QL 3sumatriptan succinate subcutaneous solution 6 mg/0.5 ml QL 3sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml 3zolmitriptan oral tablet 2.5 mg, 5 mg QL 3zolmitriptan spray 2.5mg, 5mg QL 4ZOMIG NASAL SPRAY,NON-AEROSOL 2.5 MG, 5 MG ST; QL 4

MISCELLANEOUS NEUROLOGICAL THERAPYdalfampridine oral tablet extended release 12 hr 10 mg PA; QL 5donepezil oral tablet 10 mg, 5 mg 2galantamine oral capsule,ext rel. pellets 24 hr 16 mg, 24 mg, 8 mg 2galantamine oral solution 4 mg/ml 2galantamine oral tablet 12 mg, 4 mg, 8 mg 2memantine oral capsule,sprinkle,er 24hr 14 mg, 21 mg, 28 mg, 7 mg QL 3memantine oral solution 2 mg/ml, 10mg/5ml 2memantine oral tablet 10 mg, 5 mg 2MEMANTINE ORAL TABLETS,DOSE PACK 5-10 MG 2rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg 2

4tetrabenazine oral tablet 12.5 mg, 25 mg PA; QL 5

MUSCLE RELAXANTS & ANTISPASMODIC THERAPYbaclofen oral tablet 10 mg, 20 mg 2carisoprodol oral tablet 350 mg 2chlorzoxazone oral tablet 500 mg 2cyclobenzaprine oral tablet 10 mg, 5 mg 2dantrolene oral capsule 100 mg, 25 mg, 50 mg 2metaxalone oral tablet 800 mg ST; Q: 3methocarbamol oral tablet 500 mg, 750 mg 2orphenadrine citrate oral tablet extended release 100 mg 2OZOBAX ORAL SOLN 5 MG/5 ML PA 4pyridostigmine bromide oral tablet 60 mg 2pyridostigmine bromide oral tablet extended release 180 mg 4tizanidine oral tablet 2 mg, 4 mg 2

NARCOTIC ANALGESICSacetaminophen-codeine oral solution 120-12 mg/5 ml QL 2

sumatriptan succinate subcutaneous pen injector 4 mg/0.5 ml, 6 mg/0.5 ml

rivastigmine transdermal patch 24 hour 13.3 mg/24 hour, 4.6 mg/24 hr, 9.5 mg/24 hr








Therapeutical Category ListingTherapeutical Category Listingacetaminophen-codeine oral tablet 300-15 mg, 300-30 mg, 300-60 mg QL 2buprenorphine hcl sublingual tablet 2 mg, 8 mg 2

ST; QL 2BUPRENORPHINE TRANSDERMAL PATCH WEEKLY 7.5 MCG/HOUR ST; QL 2butalbital-acetaminop-caf-cod oral capsule 50-300-40-30 mg QL 4butalbital-acetaminophen oral tablet 50-325 mg QL 3butalbital-acetaminophen-caff oral tablet 50-325-40 mg 2carisoprodol oral tablet aspirin/cod PA; QL 4codeine sulfate oral tablet 15 mg, 30 mg, 60 mg QL 2endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg PA; QL 2

PA; QL 2

QL 2hydrocodone-acetaminophen oral solution 7.5-325 mg/15 ml, 10-325mg QL 2

QL 2hydrocodone-ibuprofen oral tablet 7.5-200 mg QL 2hydromorphone oral liquid 1 mg/ml QL 2hydromorphone oral tablet 2 mg, 4 mg, 8 mg QL 2

QL 4

QL 4levorphanol tartrate oral tablet 2 mg QL 2meperidine oral solution 50 mg/5 ml QL 2meperidine oral tablet 50 mg QL 2methadone oral concentrate 10 mg/ml QL 2methadone oral solution 10 mg/5 ml, 5 mg/5 ml QL 2methadone oral tablet 10 mg, 5 mg QL 2methadone oral tablet,soluble 40 mg QL 2methadose oral concentrate 10 mg/ml QL 2methadose oral tablet,soluble 40 mg QL 2morphine concentrate oral solution 100 mg/5 ml (20 mg/ml) QL 2

QL 4

QL 4morphine oral solution 10 mg/5 ml, 20 mg/5 ml (4 mg/ml) QL 2morphine oral tablet 15 mg, 30 mg QL 2

QL 2OLINVYK SOL 1MG/ML, 2MG/2ML, 30MG/30ML 4oxycodone oral tablet 10 mg, 15 mg, 20 mg, 30 mg, 5 mg QL 2

QL 3

QL 2

QL 4oxymorphone oral tablet 10 mg, 5 mg QL 3

QL 3

QL 4

HYSINGLA ER ORAL TABLET,ORAL ONLY,EXT.REL.24 HR 100 MG, 120 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG

morphine oral capsule, er multiphase 24 hr 120 mg, 30 mg, 45 mg, 60 mg, 75 mg, 90 mg

morphine oral capsule,extend.release pellets 100 mg, 20 mg, 30 mg, 50 mg, 60 mg, 80 mg

morphine oral tablet extended release 100 mg, 15 mg, 200 mg, 30 mg, 60 mg

OXYCODONE ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 20 MG, 40 MG, 80 MG

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

buprenorphine transdermal patch weekly 10 mcg/hour, 15 mcg/hour, 20 mcg/hour, 5 mcg/hour

fentanyl citrate buccal lozenge on a handle 1,200 mcg, 1,600 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr

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

hydromorphone oral tablet extended release 24 hr 12 mg, 16 mg, 32 mg, 8 mg

OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG

oxymorphone oral tablet extended release 12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 5 mg, 7.5 mg

SUBSYS SUBLINGUAL SPRAY,NON-AEROSOL 1,200 MCG (600 MCG/SPRAY X 2), 1,600 MCG (800 MCG/SPRAY X 2), 100 MCG/SPRAY, 200 MCG/SPRAY, 400 MCG/SPRAY, 600 MCG/SPRAY, 800 MCG/SPRAY

NON-NARCOTIC ANALGESICSadult aspirin regimen oral tablet,delayed release (dr/ec) 81 mg 1aspir-81 oral tablet,delayed release (dr/ec) 81 mg 1aspirin low dose oral tablet,delayed release (dr/ec) 81 mg 1aspirin oral tablet 325 mg 1aspirin oral tablet,chewable 81 mg 1aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg 1aspir-low oral tablet,delayed release (dr/ec) 81 mg 1aspir-trin oral tablet,delayed release (dr/ec) 325 mg 1bayer aspirin oral tablet 325 mg 1buprenorphine-naloxone sublingual tablet 2-0.5 mg, 8-2 mg QL 3butorphanol tartrate nasal spray,non-aerosol 10 mg/ml QL 3celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg 2diclofenac misoprostol oral tablet 50-0.2mg, 75-0.2mg 2diclofenac potassium oral tablet 50 mg 2diclofenac sodium oral tablet extended release 24 hr 100 mg 2diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg, 50 mg, 75 mg 2diclofenac sodium topical gel 1 % QL 2diflunisal oral tablet 500 mg 2DUEXIS TAB 800-26.6MG PA 4ecotrin low strength oral tablet,delayed release (dr/ec) 81 mg 1ecotrin oral tablet,delayed release (dr/ec) 325 mg 1etodolac oral capsule 200 mg, 300 mg ST 3etodolac oral tablet 400 mg, 500 mg ST 3etodolac oral tablet extended release 24 hr 400 mg, 500 mg, 600 mg ST 3fenoprofen oral tablet 600 mg ST 3flurbiprofen oral tablet 100 mg, 50 mg 2ibu oral tablet 400 mg, 600 mg, 800 mg 2ibuprofen oral suspension 100 mg/5 ml 2ibuprofen oral tablet 400 mg, 600 mg, 800 mg 2indomethacin oral capsule 25 mg, 50 mg 2indomethacin oral capsule, extended release 75 mg 2ketoprofen oral capsule 25 mg QL 3ketorolac oral tablet 10 mg QL 2KLOXXADO LIQ 3meclofenamate oral capsule 100 mg 2mefenamic acid oral capsule 250 mg ST 3meloxicam oral tablet 15 mg 2meloxicam oral tablet 7.5 mg QL 2nabumetone oral tablet 500 mg, 750 mg 2naltrexone oral tablet 50 mg 2naproxen oral suspension 125 mg/5 ml 2naproxen oral tablet 250 mg, 375 mg, 500 mg 2naproxen oral tablet,delayed release (dr/ec) 375 mg, 500 mg ST 2naproxen sodium oral tablet 275 mg, 550 mg ST 4naproxen-esomeprazole oral tablet 375mg-20mg, 500mg-20mg PA 4NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION 3

QL 4oxaprozin oral tablet 600 mg ST 3pentazocine-naloxone oral tablet 50-0.5 mg QL 4piroxicam oral capsule 10 mg, 20 mg ST 3st joseph aspirin oral tablet,chewable 81 mg 1sulindac oral tablet 150 mg, 200 mg 2tramadol oral tablet 50 mg QL 2tramadol oral tablet extended release 24 hr 100 mg, 200 mg, 300 mg QL 3tramadol oral tablet, er multiphase 24 hr 100 mg, 200 mg, 300 mg QL 3tramadol/apap tab 37.5-325 QL 2

NUCYNTA ER ORAL TABLET EXTENDED RELEASE 12 HR 100 MG, 150 MG, 200 MG, 250 MG, 50 MG


VOLTAREN OTC ARTHRITIS 1% GEL QL 2VIVITROL INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 380 MG PA 5

PSYCHOTHERAPEUTIC DRUGSalprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg 2amitriptyline oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg 2amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg 2amphetamine oral tablet 5mg, 7.5mg, 10mg 2aripiprazole oral solution 1 mg/ml QL 2aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg QL 2armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg 3

3BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG, 5 MG ST; QL 4bupropion hcl oral tablet 100 mg, 75 mg 2bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg QL 2bupropion hcl oral tablet sustained-release 12 hr 100 mg, 150 mg, 200 mg QL 2buspirone oral tablet 10 mg, 15 mg, 5 mg 2cdp/amitrip oral tablet 10-25mg, 5-12.5mg 2chlordiazepoxide hcl oral capsules 10mg, 25mg, 5mg 3chlorpromazine oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg 2citalopram oral solution 10 mg/5 ml 1citalopram oral tablet 10 mg, 20 mg, 40 mg QL 1clomipramine oral capsule 25 mg, 50 mg, 75 mg ST 3clonidine hcl oral tablet 0.1mg ER ST 3clorazepate dipotassium oral tablet 3.75mg, 7.5mg, 15mg 2clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg 2

ST; QL 4desipramine oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg ST 3

QL 2

3dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5 mg 2dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg 3dextroamphetamine oral tablet 10 mg, 5 mg 2

2

2diazepam intensol oral concentrate 5 mg/ml 2diazepam oral solution 5 mg/5 ml (1 mg/ml) 2diazepam oral tablet 10 mg, 2 mg, 5 mg 2doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg 2doxepin oral concentrate 10 mg/ml 2doxepin oral tablet 3mg, 6mg QL 4duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg QL 2DUROLANE INJ 60MG/3ML PA 5ergoloid oral tablet 1 mg 2escitalopram oxalate oral solution 5 mg/5 ml 1escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg QL 1estazolam oral tablet 1mg, 2mg QL 2eszopiclone oral tablet 1 mg, 2 mg, 3 mg QL 2FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK 20 MG (2)- 40 MG (26) ST; QL 4

ST; QL 4fluoxetine oral capsule 10 mg, 20 mg, 40 mg 1

DESVENLAFAXINE ORAL TABLET EXTENDED RELEASE 24 HR 100 MG, 50 MG, 25 MG

dexmethylphenidate oral capsule,er biphasic 50-50 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 5 mg

dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg

dextroamphetamine-amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR 120 MG, 20 MG, 40 MG, 80 MG

atomoxetine oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg

DAYTRANA TRANSDERMAL PATCH 24 HOUR 10 MG/9 HR, 15 MG/9 HR, 20 MG/9 HR, 30 MG/9 HR

fluoxetine oral solution 20 mg/5 ml (4 mg/ml) 1fluphenazine hcl oral concentrate 5 mg/ml 2fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg 2flurazepam oral capsule 15mg, 30mg QL 2fluvoxamine oral tablet 100 mg, 25 mg, 50 mg QL 1guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg 3haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml 2haloperidol lactate oral concentrate 2 mg/ml 2haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg 2imipramine hcl oral tablet 10 mg, 25 mg, 50 mg 2

ST 4LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG, 80 MG ST; QL 4lithium carbonate oral capsule 150 mg, 300 mg, 600 mg 2lithium carbonate oral tablet 300 mg 2lithium carbonate oral tablet extended release 300 mg, 450 mg 2lorazepam intensol oral concentrate 2 mg/ml 2lorazepam oral concentrate 2 mg/ml 2lorazepam oral tablet 0.5 mg, 1 mg, 2 mg 2loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg 2MARPLAN ORAL TABLET 10 MG 4meprobamate oral tablet 200mg, 400mg 3methamphetamine oral tablet 5 mg 2METHERGINE ORAL TABLET 0.2MG 4

2

2methylphenidate hcl oral solution 10 mg/5 ml, 5 mg/5 ml 2methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg 2methylphenidate hcl oral tablet extended release 10 mg, 20 mg 2

2mirtazapine oral tablet 15 mg, 30 mg, 45 mg 2modafinil oral tablet 100 mg, 200 mg 4nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg 2nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg 2nortriptyline oral solution 10 mg/5 ml 2olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg QL 2olanzapine-fluoxetine 12-25mg, 12-50mg, 6-25mg, 6-50mg ST 2oxazepam oral capsule 10 mg, 30 mg 3paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 6 mg, 9 mg QL 3paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg QL 1paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 25 mg, 37.5 mg QL 1perphenazine amitriptyline 2-10mg, 2-25mg, 4-10mg, 4-25mg 2perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg 2phenelzine oral tablet 15 mg 2pimozide oral tablet 1 mg, 2 mg 4protriptyline oral tablet 10 mg, 5 mg 3quazepam oral tablet 15mg PA; QL 4quetiapine oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg QL 2

ST; QL 4ramelteon oral tablet 8 mg ST; QL 3REXULTI ORAL TABLET 0.25 MG, 0.5 MG, 1 MG, 2 MG, 3 MG, 4 MG ST; QL 4risperidone oral solution 1 mg/ml 2risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg QL 2SAPHRIS SUBLINGUAL TABLET 10 MG, 2.5 MG, 5 MG ST; QL 4

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML, 156 MG/ML, 234 MG/1.5 ML, 39 MG/0.25 ML, 78 MG/0.5 ML

methylphenidate hcl oral capsule, er biphasic 30-70 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

methylphenidate hcl oral capsule,er biphasic 50-50 10 mg, 20 mg, 30 mg, 40 mg, 60 mg

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

quetiapine oral tablet extended release 24 hr 150 mg, 200 mg, 300 mg, 400 mg, 50 mg








Therapeutical Category ListingTherapeutical Category Listingsertraline oral concentrate 20 mg/ml 1sertraline oral tablet 100 mg, 25 mg, 50 mg QL 1SUNOSI ORAL TABLET 150MG, 75MG PA 4temazepam oral capsule 15 mg, 30 mg QL 2thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg 2thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg 2tranylcypromine oral tablet 10 mg 2trazodone oral tablet 100 mg, 150 mg, 50 mg 2triazolam tablet 0.125mg, 0.25mg QL 2trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5 mg 2trimipramine oral capsule 100 mg, 25 mg, 50 mg ST 4TRINTELLIX ORAL TABLET 10 MG, 20 MG, 5 MG ST; QL 4venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg, 75 mg QL 2venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg QL 2VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG ST; ST; QL 4VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23) QL 4zaleplon oral capsule 10 mg, 5 mg QL 2ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg QL 2zolpidem oral tablet 10 mg, 5 mg QL 2zolpidem oral tablet,ext release multiphase 12.5 mg, 6.25 mg ST; QL 3

CARDIOVASCULAR, HYPERTENSION & LIPIDSANTIARRHYTHMIC AGENTS

amiodarone oral tablet 100 mg, 200 mg, 400mg 2disopyramide phosphate oral capsule 100 mg, 150 mg 2dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg 3flecainide oral tablet 100 mg, 150 mg, 50 mg 2mexiletine oral capsule 150 mg, 200 mg, 250 mg 2MULTAQ ORAL TABLET 400 MG 4propafenone oral tablet 150 mg, 225 mg, 300 mg 2quinidine sulfate oral tablet 200 mg, 300 mg 2sorine oral tablet 120mg, 160mg, 240mg, 80mg 2sotalol af oral tablet 120 mg, 160 mg, 80 mg 2sotalol oral tablet 120 mg, 160 mg, 240 mg, 80 mg 2

ANTIHYPERTENSIVE THERAPYacebutolol oral capsule 200 mg, 400 mg 1aliskiren oral tablet 150 mg, 300 mg 3amiloride oral tablet 5 mg 2amlodipine oral tablet 10 mg, 2.5 mg, 5 mg 1

1atenolol oral tablet 100 mg, 25 mg, 50 mg 1benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1betaxolol oral tablet 10 mg, 20 mg 1bisoprolol fumarate oral tablet 10 mg, 5 mg 1

1bumetanide oral tablet 0.5 mg, 1 mg, 2 mg 3BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, 20 MG, 5 MG ST 4candesartan oral tablet 16 mg, 32 mg, 4 mg, 8 mg 1captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg 1

1carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg 2

ST 3chlorthalidone oral tablet 25 mg, 50 mg 1

cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg

carvedilol phosphate oral capsule, er multiphase 24 hr 10 mg, 20 mg, 40 mg, 80 mg

amlodipine-benazepril oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg 2

QL 2diltiazem hcl oral capsule,ext.rel 24h degradable 120 mg, 180 mg, 240 mg 1diltiazem hcl oral capsule,extended release 12 hr 120 mg, 60 mg, 90 mg 1diltiazem hcl oral capsule,extended release 24 hr 180 mg, 240 mg, 300 mg 1

1diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg 1dilt-xr oral capsule,ext.rel 24h degradable 120 mg, 180 mg, 240 mg 1doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg QL 2EDARBI ORAL TABLET 40 MG, 80 MG ST 4enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg 1enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg 1eplerenone oral tablet 25 mg, 50 mg 2ethacrynic acid oral tablet 25 mg 4felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg 1fosinopril oral tablet 10 mg, 20 mg, 40 mg 1furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) 2furosemide oral tablet 20 mg, 40 mg, 80 mg 2guanfacine oral tablet 1 mg, 2 mg 2hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg 2hydrochlorothiazide oral capsule 12.5 mg 1hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg 1indapamide oral tablet 1.25 mg, 2.5 mg 1irbesartan oral tablet 150 mg, 300 mg, 75 mg 1irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg 1isradipine oral capsule 2.5 mg, 5 mg 1labetalol oral tablet 100 mg, 200 mg, 300 mg 2lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg 1

1losartan oral tablet 100 mg, 25 mg, 50 mg 1

1methyldopa oral tablet 250 mg, 500 mg 2metolazone oral tablet 10 mg, 2.5 mg, 5 mg 1

1metoprolol tartrate oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg 1minoxidil oral tablet 10 mg, 2.5 mg 2moexipril oral tablet 15 mg, 7.5 mg 1nadolol oral tablet 20 mg, 40 mg, 80 mg 1nicardipine oral capsule 20 mg, 30 mg 1nifedipine oral capsule 10 mg, 20 mg 1nifedipine oral tablet extended release 24hr 30 mg, 60 mg, 90 mg 1nifedipine oral tablet extended release 30 mg, 60 mg, 90 mg 1nimodipine oral capsule 30 mg 2

1olmesartan oral tablet 20 mg, 40 mg, 5 mg 1

1

PA; QL 5pacerone oral tablet 100mg, 400mg 2perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg 1phenoxybenzamine oral capsule 10 mg 4

clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 mg/24 hr

diltiazem hcl oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg

lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg

metoprolol succinate oral tablet extended release 24 hr 100 mg, 200 mg, 25 mg, 50 mg

nisoldipine oral tablet extended release 24 hr 17 mg, 20 mg, 25.5 mg, 34 mg, 40 mg, 8.5 mg

olmesartan-hydrochlorothiazide oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg

ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG, 0.25 MG, 1 MG, 2.5 MG, 5 MG


pindolol oral tablet 10 mg, 5 mg 1prazosin oral capsule 1 mg, 2 mg, 5 mg 2

1propranolol oral solution 20 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml) 1propranolol oral tablet 10 mg, 20 mg, 40 mg, 80 mg 1quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg 1ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg 1spironolactone oral tablet 100 mg, 25 mg, 50 mg 1

1telmisartan oral tablet 20 mg, 40 mg, 80 mg 1terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg QL 2tiadylt cap 120mg/24, 180mg/24, 240mg/24, 300mg/24, 360mg/24 1timolol maleate oral tablet 10 mg, 20 mg, 5 mg 1torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg 2trandolapril oral tablet 1 mg, 2 mg, 4 mg 1triamterene oral capsule 100 mg, 50 mg 3triamterene-hydrochlorothiazid oral capsule 37.5-25 mg 2triamterene-hydrochlorothiazid oral tablet 37.5-25 mg, 75-50 mg 2valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg 1

1VECAMYL ORAL TABLET 2.5 MG PA 3verapamil oral capsule, 24 hr er pellet ct 100 mg, 200 mg, 300 mg 1

1verapamil oral tablet 120 mg, 40 mg, 80 mg 1verapamil oral tablet extended release 120 mg, 180 mg, 240 mg 1

CARDIAC GLYCOSIDESdigitek oral tablet 125 mcg, 250 mcg 3digox oral tablet 125 mcg, 250 mcg 3digoxin oral solution 50 mcg/ml 3digoxin oral tablet 125 mcg, 250 mcg 3

COAGULATION THERAPYaspirin-dipyridamole oral capsule, er multiphase 12 hr 25-200 mg 1BRILINTA ORAL TABLET 60 MG, 90 MG 3cilostazol oral tablet 100 mg, 50 mg 2clopidogrel oral tablet 300 mg, 75 mg 1dipyridamole oral tablet 25 mg, 50 mg, 75 mg 1ELIQUIS ORAL TABLET 2.5 MG, 5 MG 3ELIQUIS ORAL TABLETS,DOSE PACK 5 MG (74 TABS) 3enoxaparin subcutaneous solution 300 mg/3 ml 5

5

5

2

1pentoxifylline oral tablet extended release 400 mg 2phytonadione (vitamin k1) oral tablet 5 mg 3prasugrel oral tablet 10 mg, 5 mg 1PROMACTA ORAL POWDER IN PACKET 12.5 MG PA; QL 5PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG PA; QL 5

valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg

verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg, 360 mg

enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml

fondaparinux subcutaneous syringe 10 mg/0.8 ml, 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml

heparin sodium injection 1000/ml, 10000/ml, 20000/ml, 5000/0.5ml, 5000/ml

jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

propranolol oral capsule,extended release 24 hr 120 mg, 160 mg, 60 mg, 80 mg

taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

SAVAYSA ORAL TABLET 15 MG, 30 MG, 60 MG 4tranexamic acid intravenous solution 1,000 mg/10 ml (100 mg/ml) 2

1XARELTO ORAL TABLET 10 MG, 15 MG, 2.5 MG, 20 MG 3XARELTO ORAL TABLETS,DOSE PACK 15 MG (42)- 20 MG (9) 3

PA 4ZONTIVITY ORAL TABLET 2.08 MG 3

LIPID/CHOLESTEROL LOWERING AGENTSatorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg QL 1cholestyramine (with sugar) oral powder 4 gram 1cholestyramine (with sugar) oral powder in packet 4 gram 1cholestyramine light oral powder 4 gram 1cholestyramine light oral powder in packet 4 gram 1colesevelam oral powder in packet 3.75 gram 1colesevelam oral tablet 625 mg 1colestipol oral granules 5 gram 1colestipol oral packet 5 gram 1colestipol oral tablet 1 gram 1ezetimibe oral tablet 10 mg 1ezetimine-simvastatin oral tablet 10-10mg, 10-20mg, 10-40mg, 10-80mg QL 2fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg 1fenofibrate nanocrystallized oral tablet 145 mg, 48 mg 1fenofibrate oral tablet 160 mg, 54 mg 1fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg, 45 mg 1fenofibric acid oral tablet 105 mg, 35 mg 1fluvastatin oral capsule 20 mg, 40 mg PA; QL 1gemfibrozil oral tablet 600 mg 1LIVALO ORAL TABLET 1 MG, 2 MG, 4 MG PA; QL 4lovastatin oral tablet 10 mg, 20 mg, 40 mg PA; QL 1niacin oral tablet 500mg 4NIACOR ORAL TABLET 500 MG 4omega-3 acid ethyl esters oral capsule 1 gram 3pravastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg QL 1prevalite oral powder 4 gram 1prevalite oral powder in packet 4 gram 1rosuvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg QL 1simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg, 80 mg QL 1VASCEPA ORAL CAPSULE 0.5 GRAM, 1 GRAM 4

MISCELLANEOUS CARDIOVASCULAR AGENTSCORLANOR ORAL TABLET 5 MG, 7.5 MG 4ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG QL 3ranolazine oral tablet extended release 12 hr 1,000 mg, 500 mg 3

NITRATESisosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg, 40mg 3isosorbide mononitrate oral tablet 10 mg, 20 mg 2

2minitran dis 0.1mg/hr, 0.2mg/hr, 0.4mg/hr, 0.6mg/hr 2nitroglycerin sublingual tablet 0.3 mg, 0.4 mg, 0.6 mg 2

2

warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

YOSPRALA ORAL TABLET,IR,DELAYED REL,BIPHASIC 325-40 MG, 81-40 MG

isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60 mg

nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr








Therapeutical Category ListingTherapeutical Category ListingDERMATOLOGICALS/TOPICAL THERAPYANTIPSORIATIC/ANTISEBORRHEIC

acitretin oral capsule 10 mg, 17.5 mg, 25 mg 4calcipotriene scalp solution 0.005 % PA 2calcipotriene topical cream 0.005 % PA; Q: 2calcipotriene topical ointment 0.005 % PA 2calcipotriene-betamethasone topical ointment 0.005-0.064 % PA 4COSENTYX (2 SYRINGES) SUBCUTANEOUS SYRINGE 150 MG/ML PA; QL 5COSENTYX PEN (2 PENS) SUBCUTANEOUS PEN INJECTOR 150 MG/ML PA; QL 5COSENTYX PEN SUBCUTANEOUS PEN INJECTOR 150 MG/ML PA; QL 5COSENTYX SUBCUTANEOUS SYRINGE 150 MG/ML PA; QL 5hydrocortisone-pramoxine topical cream 2.5-1 % 2selenium sulfide topical lotion 2.5 % 2SKYRIZI INJ 150 MG PA; QL 5STELARA SUBCUTANEOUS SOLUTION 45 MG/0.5 ML PA 5STELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML, 90 MG/ML PA; QL 5TALTZ INJ 80 MG/ML PA; QL 5temsirolimus inj 25mg/ml PA 5TREMFYA SUBCUTANEOUS SYRINGE 100 MG/ML PA; QL 5

BURN THERAPYsilver sulfadiazine topical cream 1 % 2ssd topical cream 1 % 2

KERATOLYTICSsalicylic acid er-ceramides topical kit,cleanser and cream er 6 % 2salicylic acid topical cream 6 % 2salicylic acid topical cream,extended release 6 % 2salicylic acid topical film forming liquid w/appl 27.5 % 2salicylic acid topical film-forming soln er w/ appl 28.5 % 2salicylic acid topical foam 6 % 2salicylic acid topical gel 6 % 2salicylic acid topical liquid 26 % 2salicylic acid topical lotion 6 % 2salicylic acid topical lotion,extended release 6 % 2salicylic acid topical shampoo 6 % 2salimez topical cream 6 % 2salvax topical foam 6 % 2

MISCELLANEOUS DERMATOLOGICALSammonium lactate topical cream 12 % 2ammonium lactate topical lotion 12 % 2diclofenac sodium topical gel 3 % PA; QL 4doxepin topical cream 5 % PA; QL 4DUPIXENT SUBCUTANEOUS SYRINGE 300 MG/2 ML PA 5ESKATA SOL 40% 4fluorouracil topical cream 5 % 2fluorouracil topical solution 2 %, 5 % 2methoxsalen oral capsule,liqd-filled,rapid rel 10 mg QL 4pimecrolimus topical cream 1 % ST; QL 4podofilox topical solution 0.5 % 2prudoxin topical cream 5 % PA; QL 4QBREXZA PAD 2.4% PA 4tacrolimus topical ointment 0.03 %, 0.1 % QL 3urea topical cream 40 % 2

THERAPY FOR ACNEadapalene topical OTC 2

adapalene topical cream 0.1 % ST 2adapalene topical gel 0.1 %, 0.3 % ST 2adapalene topical gel with pump 0.3 % ST 2adapalene topical solution 0.1 % ST 2adapalene topical swab 0.1 % ST 2adapalene-benzoyl peroxide topical gel with pump 0.1-2.5 % ST 3amnesteem oral capsule 10 mg, 20 mg, 40 mg 2azelaic acid topical gel 15 % ST 3claravis oral capsule 10 mg, 20 mg, 30 mg, 40 mg 2clindacin etz external swab 1% 2clindacin-p pad 1% 2CLINDAGEL GEL 1% 2clindamycin phosphate topical gel 1 % 2clindamycin phosphate topical lotion 1 % 2clindamycin phosphate topical solution 1 % 2clindamycin phosphate topical swab 1 % 2clindamycin-benzoyl peroxide topical gel 1.2 %(1 % base) -5 % ST 2clindamycin-benzoyl peroxide topical gel 1-5 % 2clindamycin-tretinoin topical gel 1.2-0.025 % PA 4DIFFERIN GEL 0.1% 2DIFFERIN LOTION 0.1% ST 4ery pads topical swab 2 % 2erythromycin with ethanol topical gel 2 % 2erythromycin with ethanol topical solution 2 % 2erythromycin with ethanol topical swab 2 % 2erythromycin-benzoyl peroxide topical gel 3-5 % 4isotretinoin oral capsule 10 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg 2metronidazole topical cream 0.75 % 2metronidazole topical gel 0.75 %, 1 % 2metronidazole topical gel with pump 1 % 2metronidazole topical lotion 0.75 % 2myorisan oral capsule 10 mg, 20 mg, 30 mg, 40 mg 2neuac gel 1.2-5% ST 2rosadan cream 0.75% 2rosadan gel 0.75% 2tazarotene topical cream 0.1 % 3tretinoin topical cream 0.025 %, 0.1 % 2tretinoin topical cream 0.05 % 2tretinoin topical gel 0.01 %, 0.025 %, 0.05 % 2zenatane oral capsule 10 mg, 20 mg, 30 mg, 40 mg 2

TOPICAL ANESTHETICSlidocaine hcl laryngotracheal solution 4 % 2lidocaine hcl mucous membrane jelly 2 % QL 2lidocaine hcl mucous membrane jelly in applicator 2 % 2lidocaine hcl mucous membrane solution 4 % (40 mg/ml) 2lidocaine pad 4% 2lidocaine topical adhesive patch,medicated 5 % ST 4lidocaine viscous mucous membrane solution 2 % 2lidocaine-prilocaine topical cream 2.5-2.5 % QL 2lidocaine-prilocaine topical kit 2.5-2.5 % 2lidopril topical kit 2.5-2.5 % QL 2nuvakaan kit 2.5-2.5% 2vexatrol kit 2.5-2.5% 2

TOPICAL ANTIBACTERIALSALTABAX TOPICAL OINTMENT 1 % ST 4gentamicin topical cream 0.1 % 2


gentamicin topical ointment 0.1 % 2mupirocin topical ointment 2 % 2sulfacetamide sodium (acne) topical suspension 10 % 2sulfacetamine sodium-sulfur external emulsion 10-5% 4SULFAMYLON TOPICAL CREAM 85 MG/G 3

TOPICAL ANTIFUNGALSbutenafine cream 1% ST 3ciclodadn sol 8% 2ciclopirox topical cream 0.77 % 2ciclopirox topical gel 0.77 % 2ciclopirox topical shampoo 1 % 2ciclopirox topical solution 8 % 2ciclopirox topical suspension 0.77 % 2clotrimazole topical cream 1 % 2clotrimazole topical solution 1 % 2clotrimazole-betamethasone topical cream 1-0.05 % 2clotrimazole-betamethasone topical lotion 1-0.05 % 2econazole topical cream 1 % ST 3ERTACZO TOPICAL CREAM 2 % 4EXELDERM TOPICAL CREAM 1 % ST 4EXELDERM TOPICAL SOLUTION 1 % ST 4KERYDIN TOPICAL SOLUTION WITH APPLICATOR 5 % PA 4ketoconazole topical cream 2 % 2ketoconazole topical shampoo 2 % 2MENTAX TOPICAL CREAM 1 % ST 3naftifine topical cream 1 %, 2 % ST 2nyamyc topical powder 100,000 unit/gram 2nystatin topical cream 100,000 unit/gram 2nystatin topical ointment 100,000 unit/gram 2nystatin-triamcinolone topical cream 100,000-0.1 unit/g-% 2nystatin-triamcinolone topical ointment 100,000-0.1 unit/gram-% 2nystop topical powder 100,000 unit/gram 2oxiconazole topical cream 1 % ST 4sulconazole 1% cream, solution ST 4

TOPICAL ANTIVIRALSABREVA TOPICAL CREAM 10 % 2acyclovir topical ointment 5 % QL 4

TOPICAL CORTICOSTEROIDSalclometasone topical cream 0.05 % 3alclometasone topical ointment 0.05 % 3amcinonide topical cream 0.1 % 3beser lotion 0.05% 2betamethasone dipropionate topical cream 0.05 % 2betamethasone dipropionate topical lotion 0.05 % 2betamethasone dipropionate topical ointment 0.05 % 2betamethasone valerate topical cream 0.1 % 2betamethasone valerate topical lotion 0.1 % 2betamethasone valerate topical ointment 0.1 % 2betamethasone, augmented topical cream 0.05 % 2betamethasone, augmented topical gel 0.05 % 2betamethasone, augmented topical lotion 0.05 % 2betamethasone, augmented topical ointment 0.05 % 2clobetasol scalp solution 0.05 % QL 2clobetasol topical cream 0.05 % QL 2clobetasol topical foam 0.05 % QL 2

clobetasol topical gel 0.05 % QL 2clobetasol topical lotion 0.05 % QL 2clobetasol topical ointment 0.05 % QL 2clobetasol topical shampoo 0.05 % QL 2clobetasol-emollient topical cream 0.05 % QL 2clodan shampoo 0.05% QL 2desonide topical cream 0.05 % ST; QL 4desonide topical ointment 0.05 % ST 4desoximetasone topical cream 0.25 % ST 2desoximetasone topical gel 0.05 % ST 3desoximetasone topical ointment 0.25 % ST 2diflorasone topical cream 0.05 % 4diflorasone topical ointment 0.05 % ST 4fluocinolone and shower cap scalp oil 0.01 % 2fluocinolone topical cream 0.01 %, 0.025 % 2fluocinolone topical oil 0.01 % 2fluocinolone topical ointment 0.025 % 2fluocinolone topical solution 0.01 % 2fluocinonide topical cream 0.05 % QL 2fluocinonide topical gel 0.05 % QL 2fluocinonide topical ointment 0.05 % QL 2fluocinonide topical solution 0.05 % 2fluocinonide-e topical cream 0.05 % 2flurandrenolide topical cream 0.05 % ST 4fluticasone propionate topical cream 0.05 % 2fluticasone propionate topical lotion 0.05 % 2fluticasone propionate topical ointment 0.005 % 2halcinonide topical cream 0.1 % ST 2halobetasol propionate topical cream 0.05 % 2halobetasol propionate topical ointment 0.05 % 2hydrocortisone butyrate topical cream 0.1 % 3hydrocortisone butyrate topical ointment 0.1 % 3hydrocortisone topical cream 1 %, 2.5 % 2hydrocortisone topical lotion 2.5 % 2hydrocortisone topical ointment 1 %, 2.5 % 2hydrocortisone valerate topical cream 0.2 % 3hydrocortisone valerate topical ointment 0.2 % 4mometasone topical cream 0.1 % 2mometasone topical ointment 0.1 % 2mometasone topical solution 0.1 % 2nolix cream 0.05% ST 4prednicarbate topical cream 0.1 % 2prednicarbate topical ointment 0.1 % 2tovet aerosol 0.05% QL 2triamcinolone acetonide topical cream 0.025 %, 0.1 %, 0.5 % 2triamcinolone acetonide topical lotion 0.025 %, 0.1 % 2triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 % 2triderm cream 0.1%, 0.5% 2

TOPICAL SCABICIDES/PEDICULICIDESivermectin lotion 0.5% 3lice killing shampoo 2lice killing (permethrin) topical liquid 1 % 2lice treatment (permethrin) topical liquid 1 % 2lice treatment topical liquid 1 % 2lindane topical shampoo 1 % 3malathion topical lotion 0.5 % 3permethrin topical cream 5 % 2








Therapeutical Category ListingTherapeutical Category Listingspinosad topical suspension 0.9 % 4

DIAGNOSTICS & MISCELLANEOUS AGENTSANOREXIANTS

phentermine oral tablet 37.5 mg PA 2

IRRIGATING SOLUTIONS

2

MISCELLANEOUS AGENTSacamprosate oral tablet,delayed release (dr/ec) 333 mg 3anagrelide oral capsule 0.5 mg, 1 mg 2cevimeline oral capsule 30 mg 2disulfiram oral tablet 250 mg, 500 mg 3finasteride oral tablet 1 mg PA 3levocarnitine (with sugar) oral solution 100 mg/ml 3levocarnitine oral tablet 330 mg 3midodrine oral tablet 10 mg, 2.5 mg, 5 mg 2pilocarpine hcl oral tablet 5 mg 3riluzole oral tablet 50 mg PA 5risedronate oral tablet 30 mg QL 1zoledronic acid-mannitol-water intravenous piggyback 5 mg/100 ml 5

SMOKING DETERRENTSAPO-VARENICLINE ORAL TABLET 0.5MG, 1MG ST 3bupropion hcl (smoking deter) oral tablet extended release 12 hr 150 mg 1CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG ST 3CHANTIX ORAL TABLET 0.5 MG, 1 MG ST 3

ST 3habitrol dis 21mg/24hr 1

1nicorelief buccal gum 2 mg, 4 mg 1NICORETTE BUCCAL GUM 2 MG 1nicorette buccal gum 4 mg 1NICORETTE BUCCAL LOZENGE 2 MG, 4 MG 3NICORETTE BUCCAL MINI LOZENGE 2 MG 3NICORETTE BUCCAL MINI LOZENGE 4 MG 1nicotine (polacrilex) buccal gum 2 mg, 4 mg 1nicotine (polacrilex) buccal lozenge 2 mg, 4 mg 1nicotine (polacrilex) buccal mini lozenge 2 mg, 4 mg 1nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr 1nicotine transdermal patch, td daily, sequential 21-14-7 mg/24 hr 1NICOTROL INHALATION CARTRIDGE 10 MG ST 4NICOTROL NS NASAL SPRAY,NON-AEROSOL 10 MG/ML ST 4stop smoking aid buccal lozenge 2 mg, 4 mg 1

EAR, NOSE & THROAT MEDICATIONSMISCELLANEOUS AGENTS

azelastine nasal aerosol,spray 137 mcg (0.1 %) QL 2azelastine nasal spray,non-aerosol 0.15 % (205.5 mcg) ST 3cavarest gel 1.1% 1chlorhexidine gluconate mucous membrane mouthwash 0.12 % 2DEBACTEROL MUCOUS MEMBRANE SOLUTION 30-50 % 3ipratropium bromide nasal spray,non-aerosol 0.03 %, 42 mcg (0.06 %) QL 2olopatadine nasal spray,non-aerosol 0.6 % ST; QL 4

NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 MG/24 HR, 21 MG/24 HR, 7 MG/24 HR

tis-u-sol pentalyte irrigation irrigation solution 800-40-20-8.75- 6.25 mg/100 ml

CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK 0.5 MG (11)- 1 MG (42)

oralone dental paste 0.1 % 2periogard mucous membrane mouthwash 0.12 % 2pilocarpine hcl oral tablet 7.5 mg 3sf 5000 plus dental cream 1.1 % 1sf dental gel 1.1 % 1sodium fluoride cream 5000 1sodium fluoride gel 1.1% 1triamcinolone acetonide dental paste 0.1 % 2

MISCELLANEOUS OTIC PREPARATIONSacetic acid otic (ear) solution 2 % 2CORTISPORIN SUSP TC OTIC 4fluocinolone acetonide oil otic (ear) drops 0.01 % 2ofloxacin otic (ear) drops 0.3 % 2OTIPRIO INTRATYMPANIC SUSPENSION 6 % (6 MG/0.1 ML) 4

OTIC STEROID / ANTIBIOTICCIPRO HC OTIC (EAR) DROPS,SUSPENSION 0.2-1 % 4ciprofloxacin/dexameth otic suspension 0.3-0.1% 2hydrocortisone acetic acid solution otic 3

2neomycin-polymyxin-hc otic (ear) solution 3.5-10,000-1 mg/ml-unit/ml-% 2

ENDOCRINE / DIABETESADRENAL HORMONES

cortisone oral tablet 25 mg 2dexamethasone oral elixir 0.5 mg/5 ml 2dexamethasone oral solution 0.5 mg/5 ml 2

2fludrocortisone oral tablet 0.1 mg 2hydrocortisone oral tablet 10 mg, 20 mg, 5 mg 2methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml 2methylprednisolone oral tablet 4 mg 2methylprednisolone oral tablets,dose pack 4 mg 2prednisolone oral solution 15 mg/5 ml 2

2prednisone intensol oral concentrate 5 mg/ml 2prednisone oral solution 5 mg/5 ml 2prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg 2prednisone oral tablets,dose pack 5 mg 2

ANTITHYROID AGENTSmethimazole oral tablet 10 mg, 5 mg 2propylthiouracil oral tablet 50 mg 2

DIABETES, SUPPLIES, AND DURABLE MEDICAL EQUIPMENTINSULIN SYRINGE-NEEDLE U-100 SYRINGE 3

GLUCOSE ELEVATING AGENTSBAQSIMI NASAL SPRAY,NON-AEROSOL 3 MG/ACTUATION 3

INSULIN SYRINGES/MISCELLANEOUS DURABLE MEDICAL EQUPEN NEEDLE, DIABETIC NEEDLE 3

neomycin-polymyxin-hc otic (ear) drops,suspension 3.5-10,000-1 mg/ml-unit/ml-%

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 25 mg/5 ml (5 mg/ml)


INSULIN THERAPY

ST 4APIDRA U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML ST 4

3

3

3

3

3

3HUMALOG U-100 INSULIN SUBCUTANEOUS CARTRIDGE 100 UNIT/ML 3HUMALOG U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML 3

3

3

3

3HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION 100 UNIT/ML 3

3

3

3LANTUS U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML 3

3LEVEMIR U-100 INSULIN SUBCUTANEOUS SOLUTION 100 UNIT/ML 3SOLIQUA 100/33 SUBCUTANEOUS INSULIN PEN 100 UNIT-33 MCG/ML QL 3

3

3

ST 4

ST 4

MISCELLANEOUS HORMONEScabergoline oral tablet 0.5 mg QL 2calcitonin (salmon) nasal spray,non-aerosol 200 unit/actuation 4calcitriol oral capsule 0.25 mcg, 0.5 mcg 2calcitriol oral solution 1 mcg/ml 2CETROTIDE SUBCUTANEOUS KIT 0.25 MG 3

PA; QL 5cinacalcet oral tablet 30 mg, 60 mg, 90 mg QL 4clomiphene citrate oral tablet 50 mg 2danazol oral capsule 100 mg, 200 mg, 50 mg 2

APIDRA SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML

HUMALOG JUNIOR KWIKPEN U-100 SUBCUTANEOUS INSULIN PEN, HALF-UNIT 100 UNIT/ML

HUMULIN 70/30 U-100 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70-30)

HUMULIN N NPH INSULIN KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML

HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION 500 UNIT/ML

HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML (3 ML)

LANTUS SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

HUMALOG KWIKPEN INSULIN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML, 200 UNIT/ML (3 ML)

HUMALOG MIX 50-50 INSULN U-100 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (50-50)



HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (75-25)

HUMULIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION 100 UNIT/ML (70-30)

LEVEMIR FLEXTOUCH U-100 INSULN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

TOUJEO MAX U-300 SOLOSTAR SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (3 ML)

TOUJEO SOLOSTAR U-300 INSULIN SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (1.5 ML)



CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR RECON SOLN 10,000 UNIT

desmopressin nasal spray,non-aerosol 10 mcg/spray (0.1 ml) 2desmopressin oral tablet 0.1 mg, 0.2 mg 2doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg 3FIRMAGON INJ 80MG, 120MG PA 5ganirelix ac inj PA 5

PA 5METHITEST ORAL TABLET 10 MG 4miglustat oral capsule 100 mg PA; QL 5MYALEPT SUBCUTANEOUS RECON SOLN 5 MG/ML (FINAL CONC.) 5nitisinone oral capsule 2 mg, 5 mg, 10 mg PA 5NOVAREL INTRAMUSCULAR RECON SOLN 10,000 UNIT, 5,000 UNIT PA; QL 5ORILISSA ORAL TABLET 150MG, 200MG PA 4oxandrolone oral tablet 10 mg, 2.5 mg 3paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg 3PREGNYL INTRAMUSCULAR RECON SOLN 10,000 UNIT PA; QL 5

PA 5SYNAREL NASAL SPRAY,NON-AEROSOL 2 MG/ML 4testosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml 2testosterone enanthate intramuscular oil 200 mg/ml 2testosterone transdermal gel 50 mg/5 gram (1 %) 3

3

3zoledronic acid intravenous recon soln 4 mg 5zoledronic acid intravenous solution 4 mg/5 ml 5

NON-INSULIN HYPOGLYCEMIC AGENTSacarbose oral tablet 100 mg, 25 mg, 50 mg 1BYDUREON BCISE SUBCUTANEOUS AUTO-INJECTOR 2 MG/0.85 ML 3

QL 3CYCLOSET ORAL TABLET 0.8 MG 4FARXIGA ORAL TABLET 10 MG, 5 MG QL 3glimepiride oral tablet 1 mg, 2 mg, 4 mg 1glipizide oral tablet 10 mg, 5 mg 1glipizide oral tablet extended release 24hr 10 mg, 2.5 mg, 5 mg 1glipizide XL tablet 2.5mg, 5mg, 10mg 1glipizide-metformin oral tablet 2.5-250 mg, 2.5-500 mg, 5-500 mg 1glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg 1glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg 1glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, 5-500 mg 1GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG QL 3JANUMET ORAL TABLET 50-1,000 MG, 50-500 MG QL 3

QL 3JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG QL 3JARDIANCE ORAL TABLET 10 MG, 25 MG QL 3JENTADUETO ORAL TABLET 2.5-1,000 MG, 2.5-500 MG, 2.5-850 MG QL 3

QL 3metformin oral tablet 1,000 mg, 500 mg, 850 mg 1metformin oral tablet extended release 24 hr 500 mg, 750 mg 1

miglitol oral tablet 100 mg, 25 mg, 50 mg 1OZEMPIC INJ 2/1.5ML QL 3OZEMPIC INJ 4MG/3ML 3

GONAL-F RFF REDI-JECT SUBCUTANEOUS PEN INJECTOR 300/0.5 UNIT/ML, 450/0.75 UNIT/ML, 900/1.5 UNIT/ML

SOMAVERT SUBCUTANEOUS RECON SOLN 10 MG, 15 MG, 20 MG, 25 MG, 30 MG

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

testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1 % (50 mg/5 gram)

BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML, 5 MCG/DOSE (250 MCG/ML) 1.2 ML

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG, 50-1,000 MG, 50-500 MG

JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG








Therapeutical Category ListingTherapeutical Category Listingpioglitazone oral tablet 15 mg, 30 mg, 45 mg QL 1repaglinide oral tablet 0.5 mg, 1 mg, 2 mg 1RYBELSUS ORAL TABLET 14MG, 3MG, 7MG 3SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR 2,700 MCG/2.7 ML QL 4SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR 1,500 MCG/1.5 ML QL 4

QL 3

QL 3tolbutamide oral tablet 500 mg 1TRADJENTA ORAL TABLET 5 MG QL 3TRIJARDY XR TAB QL 3

QL 3VICTOZA INJ 18MG/3ML QL 3

QL 3

THYROID HORMONES

2

2

2

2liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg 2

2np thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg 2

2westhroid oral tablet 130 mg, 195 mg, 32.5 mg, 65 mg, 97.5 mg 2

2

GASTROENTEROLOGYANTIDIARRHEALS & ANTISPASMODICS

dicyclomine oral capsule 10 mg 2dicyclomine oral solution 10 mg/5 ml 2dicyclomine oral tablet 20 mg 2diphenoxylate-atropine oral liquid 2.5-0.025 mg/5 ml 2diphenoxylate-atropine oral tablet 2.5-0.025 mg 2glycopyrrolate oral tablet 1 mg, 2 mg 2glycopyrrolate oral tablet 1.5 mg ST 2hyoscyamine sulfate oral tablet 0.125 mg 2hyoscyamine sulfate oral tablet extended release 12 hr 0.375 mg 2hyoscyamine sulfate sublingual tablet 0.125 mg 2methscopolamine oral tablet 2.5 mg, 5 mg 2MOTOFEN ORAL TABLET 1-0.025 MG 4oscimin 2oscimin sr 2

MISCELLANEOUS GASTROINTESTINAL AGENTSAKYNZEO (NETUPITANT) ORAL CAPSULE 300-0.5 MG PA; QL 5alophen oral tablet,delayed release (dr/ec) 5 mg 2

levo-t oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

levothyroxine oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

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

nature-throid oral tablet 113.75 mg, 130 mg, 146.25 mg, 16.25 mg, 162.5 mg, 195 mg, 260 mg, 32.5 mg, 325 mg, 48.75 mg, 65 mg, 81.25 mg, 97.5 mg

unithroid 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 25mcg, 300mcg, 50mcg, 75mcg, 88mcg,

wp thyroid tablet 113.75mg, 130mg, 16.25mg, 32.5mg, 48.75mg, 65mg, 81.25mg, 97.5mg

SYNJARDY ORAL TABLET 12.5-1,000 MG, 12.5-500 MG, 5-1,000 MG, 5-500 MG

SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 25-1,000 MG, 5-1,000 MG

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

XIGDUO XR ORAL TABLET 5-500 MG, 10-500 MG, 2.5-1000 MG, 10-1000 MG

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

alosetron oral tablet 0.5 mg, 1 mg 3AMITIZA ORAL CAPSULE 24 MCG, 8 MCG 3aprepitant oral capsule 125 mg, 40 mg, 80 mg 4aprepitant oral capsule,dose pack 125 mg (1)- 80 mg (2) 4balsalazide oral capsule 750 mg 2bisacodyl oral tablet,delayed release (dr/ec) 5 mg 2bisa-lax oral tablet,delayed release (dr/ec) 5 mg 2budesonide oral capsule,delayed,extend.release 3 mg 2calcium acetate oral capsule 667 mg 2calcium acetate oral tablet 667 mg 2

PA; QL 5CIMZIA SUBCUTANEOUS SYRINGE KIT 400 MG/2 ML (200 MG/ML X 2) PA; QL 5citroma oral solution 2clearlax oral powder 17 gram/dose 2compro rectal suppository 25 mg 2constulose oral solution 10 gram/15 ml 2

3cromolyn oral concentrate 100 mg/5 ml 2DIPENTUM ORAL CAPSULE 250 MG ST 4dronabinol oral capsule 10 mg, 2.5 mg, 5 mg 3ducodyl oral tablet,delayed release (dr/ec) 5 mg 2enulose oral solution 10 gram/15 ml 2gavilax oral powder 17 gram/dose 2gavilyte-c oral recon soln 240-22.72-6.72 -5.84 gram 1gavilyte-g oral recon soln 236-22.74-6.74 -5.86 gram 1gavilyte-n oral recon soln 420 gram 1generlac oral solution 10 gram/15 ml 2gentle laxative oral tablet,delayed release (dr/ec) 5 mg 2gentlelax oral powder 17 gram/dose 2glycate oral tablet 1.5mg ST 2glycolax oral powder 17 gram/dose 2granisetron hcl oral tablet 1 mg 3HELIDAC MIS THERAPY QL 3hydrocortisone rectal enema 100 mg/60 ml 2hydrocortisone-pramoxine rectal cream 1-1 %, 2.5-1 %, 2.5-1 % (4g) 2lactulose oral solution 10 gram/15 ml, 20 gram/30 ml 2laxaclear oral powder 17 gram/dose 2laxative (bisacodyl) oral tablet 5 mg 2laxative (bisacodyl) oral tablet,delayed release (dr/ec) 5 mg 2laxative feminine oral tablet 5 mg 2laxative peg 3350 oral powder 17 gram/dose 2LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG 3LUBIPROSTONE CAP 24MCG, 8MCG 3magnesium citrate oral solution 2meclizine oral tablet 12.5 mg, 25 mg 2mesalamine oral tablet,delayed release (dr/ec) 1.2 gram, 800 mg 4mesalamine rectal enema 4 gram/60 ml 2mesalamine with cleansing wipe rectal enema kit 4 gram/60 ml 2metoclopramide hcl oral solution 5 mg/5 ml 2metoclopramide hcl oral tablet 10 mg, 5 mg 2milk of magnesia concentrated oral suspension 2,400 mg/10 ml 2milk of magnesia oral suspension 400 mg/5 ml 2MOVANTIK ORAL TABLET 12.5 MG, 25 MG 3MOVIPREP ORAL POWDER IN PACKET 100-7.5-2.691 GRAM ST 4natura-lax oral powder 17 gram/dose 2

CIMZIA POWDER FOR RECONST SUBCUTANEOUS KIT 400 MG (200 MG X 2 VIALS)

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000 -60,000 UNIT, 24,000-76,000 -120,000 UNIT, 3,000-9,500- 15,000 UNIT, 36,000-114,000- 180,000 UNIT, 6,000-19,000 -30,000 UNIT


ondansetron hcl (pf) injection solution 4 mg/2 ml 2ondansetron hcl intravenous solution 2 mg/ml 2ondansetron hcl oral solution 4 mg/5 ml QL 2ondansetron hcl oral tablet 24 mg 2ondansetron hcl oral tablet 4 mg, 8 mg QL 2ondansetron oral tablet,disintegrating 4 mg, 8 mg QL 2OSMOPREP ORAL TABLET 1.5GM 4

2peg-electrolyte soln oral recon soln 420 gram 1peg-prep oral kit 5-210 mg-gram 1PENTASA ORAL CAPSULE, EXTENDED RELEASE 250 MG, 500 MG 4polyethylene glycol 3350 oral powder 17 gram/dose 2powderlax oral powder 17 gram/dose 2powderlax oral powder in packet 17 gram 2prochlorperazine maleate oral tablet 10 mg, 5 mg 2prochlorperazine rectal suppository 25 mg 2procto-med hc topical cream with perineal applicator 2.5 % 2procto-pak topical cream with perineal applicator 1 % 2proctosol hc topical cream with perineal applicator 2.5 % 2proctozone-hc topical cream with perineal applicator 2.5 % 2RECTIV RECTAL OINTMENT 0.4 % (W/W) 4RENFLEXIS INTRAVENOUS RECON SOLN 100 MG PA 5sapropterin oral tablet 100mg PA 5scopolamine base transdermal patch 3 day 1 mg over 3 days 4sevelamer carbonate oral powder in packet 0.8 gram, 2.4 gram 4sevelamer carbonate oral tablet 800 mg 4sevelamer hcl oral tablet 400 mg, 800 mg 4smoothlax oral powder 17 gram/dose 2sodium phenylbutyrate oral tablet 500mg 5sodium polystyrene sulfonate oral powder 3sps (with sorbitol) oral suspension 15-20 gram/60 ml 3SUCRAID SOL 8500/ML PA 5sulfasalazine oral tablet 500 mg 2sulfasalazine oral tablet,delayed release (dr/ec) 500 mg 2SUPREP BOWEL PREP KIT ORAL RECON SOLN 17.5-3.13-1.6 GRAM ST 4trimethobenzamide oral capsule 300 mg 2ursodiol oral tablet 250 mg, 500 mg 3woman's laxative oral tablet,delayed release (dr/ec) 5 mg 2women's gentle laxative(bisac) oral tablet,delayed release (dr/ec) 5 mg 2women's laxative (bisacodyl) oral tablet 5 mg 2

4

ULCER THERAPYcimetidine hcl oral solution 300 mg/5 ml 2cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg 2DEXILANT ORAL CAPSULE 30MG DR PA; QL 4esomeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg QL 3esomeprazole magnesium oral capsule,delayed release(dr/ec) 40 mg 3famotidine (pf) intravenous solution 20 mg/2 ml 2famotidine (pf)-nacl (iso-os) intravenous piggyback 20 mg/50 ml 2famotidine intravenous solution 10 mg/ml 2famotidine oral suspension 40 mg/5 ml (8 mg/ml) 2famotidine oral tablet 20 mg, 40 mg 2lansoprazole oral capsule,delayed release(dr/ec) 15 mg, 30 mg 2lansoprazole oral susp 3mg/ml 3

peg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram, 240-22.72-6.72 -5.84 gram

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT

misoprostol oral tablet 100 mcg, 200 mcg 2NEXIUM 24HR ORAL TABLET,DELAYED RELEASE (DR/EC) 20 MG 2nizatidine oral capsule 150 mg, 300 mg 2nizatidine oral solution 150 mg/10 ml 2omeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg 2omeprazole oral capsule,delayed release(dr/ec) 10 mg, 20 mg QL 2omeprazole oral capsule,delayed release(dr/ec) 40 mg 2omeprazole oral tablet,delayed release (dr/ec) 20 mg 2pantoprazole oral tablet,delayed release (dr/ec) 20 mg QL 2pantoprazole oral tablet,delayed release (dr/ec) 40 mg 2rabeprazole oral tablet,delayed release (dr/ec) 20 mg 3sucralfate oral tablet 1 gram 2sucralfate suspension 1gm/10ml 2

IMMUNOLOGY, VACCINES & BIOTECHNOLOGYBIOTECHNOLOGY DRUGS

PA; QL 5ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML PA; QL 5

PA; QL 5FULPHILA SUBCUTANEOUS SYRINGE 6 MG/0.6 ML PA 5ICATIBANT INJ 30 MG/3 ML PA 5NIVESTYM INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6 ML PA; QL 5NIVESTYM SUBCUTANEOUS SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML PA; QL 5

PA; QL 5UDENYCA SUBCUTANEOUS SYRINGE 6 MG/0.6 ML PA 5ZIEXTENZO INJ 6 MG/0.6 ML PA; QL 5

GROWTH HORMONESGENOTROPIN INJ PA 5

PA; QL 5OMNITROPE INJ 10 MG/1.5 ML, 5.8 MG, 5 MG/1.5 ML PA; QL 5

INTERFERONSAUBAGIO ORAL TABLET 14 MG, 7 MG PA; QL 5AVONEX INTRAMUSCULAR PEN INJECTOR KIT 30 MCG/0.5 ML PA; QL 5AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG/0.5 ML PA; QL 5BAFIERTAM ORAL CAPSULE 95MG PA; QL 5BETASERON SUBCUTANEOUS KIT 0.3 MG PA; QL 5COPAXONE INJ 20MG/ML, 40MG/ML PA; QL 5dimethyl fumarate oral dr 120mg, 240mg PA; QL 5glatiramer subcutaneous syringe 20 mg/ml, 40 mg/ml PA; QL 5glatopa subcutaneous syringe 20 mg/ml, 40 mg/ml PA; QL 5KESIMPTA INJ 20/.4ML PA 5PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML PA; QL 5PEGASYS SUBCUTANEOUS SYRINGE 180 MCG/0.5 ML PA; QL 5PEGINTRON SUBCUTANEOUS KIT 50 MCG/0.5 ML PA; QL 5POMALYST ORAL CAPSULE 1MG, 2MG, 3MG, 4MG PA 5REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG PA, QL 5ribavirin oral capsule 200 mg 5ribavirin oral tablet 200 mg 5VUMERITY CAP 231MG PA; QL 5

RETACRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML, 40,000 UNIT/ML

NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 10 MG/1.5 ML (6.7 MG/ML), 15 MG/1.5 ML (10 MG/ML), 30 MG/3 ML (10 MG/ML), 5 MG/1.5 ML (3.3 MG/ML)

ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 150 MCG/0.75 ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4 ML, 500 MCG/ML, 60 MCG/0.3 ML









INTERLEUKINSACTIMMUNE SUBCUTANEOUS SOLUTION 100 MCG/0.5 ML PA 5imiquimod topical cream in packet 5 % 2

VACCINES & MISCELLANEOUS IMMUNOLOGICALS

3

3

3

3

3

3

3

3

3

3

3

3

3

3

PA 5PREVNAR 13 (PF) INTRAMUSCULAR SYRINGE 0.5 ML 3

4

MUSCULOSKELETAL & RHEUMATOLOGYGOUT THERAPY

allopurinol oral tablet 100 mg, 300 mg 2COLCHICINE ORAL CAPSULE 0.6 MG 3COLCHICINE ORAL TABLET 0.6 MG 3febuxostat oral tablet 40 mg, 80 mg ST 2MITIGARE ORAL CAPSULE 0.6 MG 3probenecid oral tablet 500 mg 2probenecid-colchicine oral tablet 500-0.5 mg 2

OSTEOPOROSIS THERAPYalendronate oral tablet 10 mg, 35 mg, 5 mg, 70 mg QL 1

PA; QL 5ibandronate oral tablet 150 mg QL 1OSPHENA ORAL TABLET 60MG 4pamidronate inj 2

AFLURIA QD 2020-21(3YR UP)(PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

AFLURIA QD 2020-21(6-35MO)(PF) INTRAMUSCULAR SYRINGE 30 MCG (7.5 MCG X 4)/0.25 ML

AFLURIA QUAD 2020-21(6MO UP) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLUARIX QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

FLUZONE QUAD 2021-2022 (PF) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLUZONE QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

FLUZONE QUAD 2021-2022 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLUZONE QUAD PEDI 2021-22 (PF) INTRAMUSCULAR SYRINGE 30 MCG (7.5 MCG X 4)/0.25 ML

HYQVIA SUBCUTANEOUS SOLUTION 10 GRAM /100 ML (10 %), 2.5 GRAM /25 ML (10 %), 20 GRAM /200 ML (10 %), 30 GRAM /300 ML (10 %), 5 GRAM /50 ML (10 %)

SHINGRIX (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 50 MCG/0.5 ML

FLUBLOK QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 180 MCG (45 MCG X 4)/0.5 ML

FLUCELVAX QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

FLUCELVAX QUAD 2021-2022 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLULAVAL QUAD 2021-2022 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

FLULAVAL QUAD 2021-2022 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

FLUMIST QUAD 2021-2022 NASAL NASAL SPRAY SYRINGE 10EXP6.5-7.5 FF UNIT/0.2 ML

FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE - 600 MCG/2.4 ML

raloxifene oral tablet 60 mg 1risedronate oral tablet 150 mg QL 1risedronate oral tablet 35 mg, 5 mg QL 1TYMLOS SUBCUTANEOUS PEN INJECTOR 80 MCG (3,120 MCG/1.56 ML) PA 5

OTHER RHEUMATOLOGICALSACTEMRA ACTPEN SUBCUTANEOUS PEN INJECTOR 162 MG/0.9 ML PA; QL 5

PA;QL 5ACTEMRA SUBCUTANEOUS SYRINGE 162 MG/0.9 ML PA; QL 5

PA; QL 5

PA; QL 5

PA; QL 5HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML PA; QL 5

PA; QL 5

PA; QL 5

PA; QL 5

PA; QL 5HUMIRA(CF) PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.4 ML PA; QL 5

PA; QL 5KEVZARA INJ 150/1.14, 200/1.14 PA; QL 5leflunomide oral tablet 10 mg, 20 mg QL 2ORENCIA (WITH MALTOSE) INTRAVENOUS RECON SOLN 250 MG PA 5

PA; QL 5OTEZLA ORAL TABLET 30 MG PA; QL 5

PA; QL 5RIDAURA ORAL CAPSULE 3 MG 5RINVOQ ORAL TABLET 15MG ER PA; QL 5SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG QL 4SAVELLA ORAL TABLETS,DOSE PACK 12.5 MG (5)-25 MG(8)-50 MG(42) QL 4SIMPONI SUBCUTANEOUS PEN INJECTOR 100 MG/ML, 50 MG/0.5 ML PA; QL 5SIMPONI SUBCUTANEOUS SYRINGE 100 MG/ML, 50 MG/0.5 ML PA; QL 5SIMULECT INJ 10MG, 20MG PA; QL 5XELJANZ ORAL TABLET 10 MG, 5 MG PA; QL 5XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HR 11 MG, 22 MG PA; QL 5

OBSTETRICS & GYNECOLOGYESTROGENS & PROGESTINS

camila oral tablet 0.35 mg 2deblitane oral tablet 0.35 mg 2dolishale tablet 90-20mcg 2

QL 2DUAVEE ORAL TABLET 0.45-20 MG 4ENDOMETRIN VAGINAL INSERT 100 MG 5errin oral tablet 0.35 mg 2estradiol oral tablet 0.5 mg, 1 mg, 2 mg 2

HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML, 80 MG/0.8 ML-40 MG/0.4 ML

HUMIRA(CF) PEN CROHNS-UC-HS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML

HUMIRA(CF) PEN PSOR-UV-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT 80 MG/0.8 ML-40 MG/0.4 ML

HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 20 MG/0.2 ML, 40 MG/0.4 ML

ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML, 50 MG/0.4 ML, 87.5 MG/0.7 ML

OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG (47), 10 MG (4)-20 MG (4)-30 MG(19)

ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20 MG/ML), 400 MG/20 ML (20 MG/ML), 80 MG/4 ML (20 MG/ML)

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML

HUMIRA PEN CROHNS-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

HUMIRA PEN PSOR-UVEITS-ADOL HS SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

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

dotti transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr


QL 2estradiol transdermal patch weekly 0.025 mg/24 hr QL 2

2estradiol vaginal cream 0.01 % (0.1 mg/gram) 2estradiol vaginal tablet 10 mcg 2estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml 2estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg 2ESTRING VAGINAL RING 2 MG (7.5 MCG /24 HOUR) 4etonogestrel mis ethy est 2FEMRING VAGINAL RING 0.05 MG/24 HR, 0.1 MG/24 HR 4fyavolv oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg 2heather oral tablet 0.35 mg 2iclevia oral tablet 2incassia oral tablet 0.35 mg 2jencycla oral tablet 0.35 mg 2jinteli oral tablet 1-5 mg-mcg 2lyleq otal tablet 0.35mg 2lyllana dis 0.025mg, 0.0375mg, 0.05mg, 0.075mg, 0.1mg QL 2lyza oral tablet 0.35 mg 2medroxyprogesterone intramuscular suspension 150 mg/ml QL 2medroxyprogesterone intramuscular syringe 150 mg/ml QL 2medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5 mg 2MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG 4mimvey oral tablet 1-0.5 mg 2nora-be oral tablet 0.35 mg 2norethindrone (contraceptive) oral tablet 0.35 mg 2norethindrone acetate oral tablet 5 mg 2norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg 2norethindrone ac-eth estradiol oral tablet 1-5 mg-mcg 2norlyda oral tablet 0.35 mg 2norlyroc oral tablet 0.35 mg 2PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25 MG ST 4progesterone micronized oral capsule 100 mg, 200 mg 2PROGESTERONE VAGINAL SUPP 100MG, 200MG 3sharobel oral tablet 0.35 mg 2tulana oral tablet 0.35 mg 2yuvafem vaginal tablet 10 mcg 2

MISCELLANEOUS OB/GYNclindamycin phosphate vaginal cream 2 % 3GYNAZOLE-1 VAGINAL CREAM 2 % 3metronidazole vaginal gel 0.75 % 3miconazole-3 vaginal suppository 200 mg 2terconazole vaginal cream 0.4 %, 0.8 % 2terconazole vaginal suppository 80 mg 2tranexamic acid oral tablet 650 mg 2vandazole vaginal gel 0.75 % 3xulane transdermal patch weekly 150-35 mcg/24 hr 2

ORAL CONTRACEPTIVES & RELATED AGENTSafirmelle oral tablet 0.1-20 mg-mcg 2AFTERA ORAL TABLET 1.5 MG 2altavera (28) oral tablet 0.15-0.03 mg 2alyacen 1/35 (28) oral tablet 1-35 mg-mcg 2alyacen 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2amabelz oral tablet 2

estradiol transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

estradiol transdermal patch weekly 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

2amethia oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2amethyst (28) oral tablet 90-20 mcg (28) 2apri oral tablet 0.15-0.03 mg 2aranelle (28) oral tablet 0.5/1/0.5-35 mg-mcg 2ashlyna oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2aubra eq oral tablet 0.1-20 mg-mcg 2aubra oral tablet 0.1-20 mg-mcg 2aurovela 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2aurovela 1/20 (21) oral tablet 1-20 mg-mcg 2aurovela 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2aurovela fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2aurovela fe 1-20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2aviane oral tablet 0.1-20 mg-mcg 2ayuna oral tablet 0.15-0.03 mg 2azurette (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2balziva (28) oral tablet 0.4-35 mg-mcg 2blisovi 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2blisovi fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2blisovi fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2briellyn oral tablet 0.4-35 mg-mcg 2

2camrese oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2caziant (28) oral tablet 0.1/.125/.15-25 mg-mcg 2charlotte 24 chw fe 1/20 2chateal (28) oral tablet 0.15-0.03 mg 2chateal eq (28) oral tablet 0.15-0.03 mg 2cryselle (28) oral tablet 0.3-30 mg-mcg 2cyclafem 1/35 (28) oral tablet 1-35 mg-mcg 2cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2cyred eq oral tablet 0.15-0.03 mg 2cyred oral tablet 0.15-0.03 mg 2dasetta 1/35 (28) oral tablet 1-35 mg-mcg 2dasetta 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2daysee oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2delyla (28) oral tablet 0.1-20 mg-mcg 2desog-e.estradiol/e.estradiol oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2desogestrel-ethinyl estradiol oral tablet 0.15-0.03 mg 2

2drospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 mg 2econtra ez oral tablet 1.5 mg 2econtra one-step oral tablet 1.5 mg 2elinest oral tablet 0.3-30 mg-mcg 2ELLA ORAL TABLET 30 MG 3eluryng 2emoquette oral tablet 0.15-0.03 mg 2enpresse oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2enskyce oral tablet 0.15-0.03 mg 2estarylla oral tablet 0.25-35 mg-mcg 2ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg, 1-50 mg-mcg 2falmina (28) oral tablet 0.1-20 mg-mcg 2fayosim oral tablets,dose pack,3 month 0.15 mg-20 mcg/ 0.15 mg-25 mcg 2femynor oral tablet 0.25-35 mg-mcg 2hailey oral tablet 1.5/30 2hailey 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2

amethia lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7)

camrese lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7)

drospirenone-e.estradiol-lm.fa oral tablet 3-0.02-0.451 mg (24) (4), 3-0.03-0.451 mg (21) (7)








Therapeutical Category ListingTherapeutical Category Listinghailey fe oral tablet 1.5/30, 1/20 2introvale oral tablets,dose pack,3 month 0.15 mg-30 mcg (91) 2isibloom oral tablet 0.15-0.03 mg 2jaimiess oral tablets 2jasmiel (28) oral tablet 3-0.02 mg 2jolessa oral tablets,dose pack,3 month 0.15 mg-30 mcg (91) 2juleber oral tablet 0.15-0.03 mg 2junel 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2junel 1/20 (21) oral tablet 1-20 mg-mcg 2junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2junel fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2junel fe 24 oral tablet 1 mg-20 mcg (24)/75 mg (4) 2kaitlib fe oral tablet,chewable 0.8mg-25mcg(24) and 75 mg (4) 2kalliga oral tablet 0.15-0.03 mg 2kariva (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2kelnor 1/35 (28) oral tablet 1-35 mg-mcg 2kelnor 1-50 oral tablet 1-50 mg-mcg 2kurvelo (28) oral tablet 0.15-0.03 mg 2larin 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2larin 1/20 (21) oral tablet 1-20 mg-mcg 2larin 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2larin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2larin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2larissia oral tablet 0.1-20 mg-mcg 2layolis fe oral tablet,chewable 0.8mg-25mcg(24) and 75 mg (4) 2leena 28 oral tablet 0.5/1/0.5-35 mg-mcg 2lessina oral tablet 0.1-20 mg-mcg 2levonest (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2levonorgestrel oral tablet 1.5 mg 2

2

2levonorg-eth estrad triphasic oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2levora-28 oral tablet 0.15-0.03 mg 2lillow (28) oral tablet 0.15-0.03 mg 2lojaimiess oral tablet 2loryna (28) oral tablet 3-0.02 mg 2low-ogestrel (28) oral tablet 0.3-30 mg-mcg 2lo-zumandimine (28) oral tablet 3-0.02 mg 2lutera (28) oral tablet 0.1-20 mg-mcg 2marlissa (28) oral tablet 0.15-0.03 mg 2mibelas 24 fe oral tablet,chewable 1 mg-20 mcg(24) /75 mg (4) 2microgestin 1.5/30 (21) oral tablet 1.5-30 mg-mcg 2microgestin 1/20 (21) oral tablet 1-20 mg-mcg 2microgestin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) 2microgestin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2mili oral tablet 0.25-35 mg-mcg 2mono-linyah oral tablet 0.25-35 mg-mcg 2my choice oral tablet 1.5 mg 2my way oral tablet 1.5 mg 2necon 0.5/35 (28) oral tablet 0.5-35 mg-mcg 2new day oral tablet 1.5 mg 2nikki (28) oral tablet 3-0.02 mg 2

2norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg 2

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg, 0.15-0.03 mg, 90-20 mcg (28)

levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month 0.15 mg-30 mcg (91)

noreth-ethinyl estradiol-iron oral tablet,chewable 0.4mg-35mcg(21) and 75 mg (7), 0.8mg-25mcg(24) and 75 mg (4)

2

2

2nortrel 0.5/35 (28) oral tablet 0.5-35 mg-mcg 2nortrel 1/35 (21) oral tablet 1-35 mg-mcg (21) 2nortrel 1/35 (28) oral tablet 1-35 mg-mcg 2nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg 2nylia oral tablet 7/7/7 2nymyo oral tablet 0.25-35 2ocella oral tablet 3-0.03 mg 2opcicon one-step oral tablet 1.5 mg 2option-2 oral tablet 1.5 mg 2orsythia oral tablet 0.1-20 mg-mcg 2philith oral tablet 0.4-35 mg-mcg 2pimtrea (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2pirmella oral tablet 0.5/0.75/1 mg- 35 mcg, 1-35 mg-mcg 2PLAN B ONE-STEP ORAL TABLET 1.5 MG 2portia 28 oral tablet 0.15-0.03 mg 2preventeza oral tablet 1.5mg 2previfem oral tablet 0.25-35 mg-mcg 2react oral tablet 1.5mg 2reclipsen (28) oral tablet 0.15-0.03 mg 2rivelsa oral tablets,dose pack,3 month 0.15 mg-20 mcg/ 0.15 mg-25 mcg 2setlakin oral tablets,dose pack,3 month 0.15 mg-30 mcg (91) 2simliya (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2simpesse oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) 2sprintec (28) oral tablet 0.25-35 mg-mcg 2sronyx oral tablet 0.1-20 mg-mcg 2syeda oral tablet 3-0.03 mg 2TAKE ACTION ORAL TABLET 1.5 MG 2tarina 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) 2tarina fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) 2tilia fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) 2tri femynor oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tri-estarylla oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tri-legest fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) 2tri-linyah oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tri-lo-estarylla oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-lo-marzia oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-lo-mili oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-lo-sprintec oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-mili oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tri-nymyo oral tablet 2tri-previfem (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tri-sprintec (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2trivora (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10) 2tri-vylibra lo oral tablet 0.18/0.215/0.25 mg-25 mcg 2tri-vylibra oral tablet 0.18/0.215/0.25 mg-35 mcg (28) 2tydemy oral tablet 3-0.03-0.451 mg (21) (7) 2velivet triphasic regimen (28) oral tablet 0.1/.125/.15-25 mg-mcg 2vestura tablet 3-0.02mg 2vienva oral tablet 0.1-20 mg-mcg 2viorele (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 2volnea oral tablet 2vyfemla (28) oral tablet 0.4-35 mg-mcg 2

norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1 mg-20 mcg (24)/75 mg (4)

norethindrone-e.estradiol-iron oral tablet,chewable 1 mg-20 mcg(24) /75 mg (4)

norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg, 0.18/0.215/0.25 mg-35 mcg (28), 0.25-35 mg-mcg


vylibra oral tablet 0.25-35 mg-mcg 2wera (28) oral tablet 0.5-35 mg-mcg 2wymzya fe oral tablet,chewable 0.4mg-35mcg(21) and 75 mg (7) 2zafemy dis 150/35 2zarah oral tablet 3-0.03 mg 2zovia 1/35e (28) oral tablet 1-35 mg-mcg 2zumandimine (28) oral tablet 3-0.03 mg 2

OXYTOCICSmethylergonovine oral tablet 0.2 mg 4

OPHTHALMOLOGYANTIBIOTICS

ak-poly-bac ophthalmic (eye) ointment 500-10,000 unit/gram 2AZASITE OPHTHALMIC (EYE) DROPS 1 % 4bacitracin ophthalmic (eye) ointment 500 unit/gram 3bacitracin-polymyxin b ophthalmic (eye) ointment 500-10,000 unit/gram 2BESIVANCE OPHTHALMIC (EYE) DROPS,SUSPENSION 0.6 % 4ciprofloxacin hcl ophthalmic (eye) drops 0.3 % 2erythromycin ophthalmic (eye) ointment 5 mg/gram (0.5 %) 2gatifloxacin ophthalmic (eye) drops 0.5 % 3gentak ophthalmic (eye) ointment 0.3 % (3 mg/gram) 2gentamicin ophthalmic (eye) drops 0.3 % 2levofloxacin ophthalmic (eye) drops 0.5 % 2moxifloxacin ophthalmic (eye) drops 0.5 % 3NATACYN OPHTHALMIC (EYE) DROPS,SUSPENSION 5 % 4

2

2neo-polycin ophthalmic (eye) ointment 3.5-400-10,000 mg-unit-unit/g 2ofloxacin ophthalmic (eye) drops 0.3 % 2polycin ophthalmic (eye) ointment 500-10,000 unit/gram 2

2tobramycin ophthalmic (eye) drops 0.3 % 2TOBREX OPHTHALMIC (EYE) OINTMENT 0.3 % 4

ANTIVIRALStrifluridine ophthalmic (eye) drops 1 % 2ZIRGAN OPHTHALMIC (EYE) GEL 0.15 % 4

BETA-BLOCKERSbetaxolol ophthalmic (eye) drops 0.5 % 2carteolol ophthalmic (eye) drops 1 % 2levobunolol ophthalmic (eye) drops 0.5 % 4timolol maleate ophthalmic (eye) drops 0.25 %, 0.5 % 2timolol maleate ophthalmic (eye) gel forming solution 0.25 %, 0.5 % 2

CHOLINESTERASE INHIBITOR MIOTICSPHOSPHOLINE IODIDE OPHTHALMIC (EYE) DROPS 0.125 % 4

CYCLOPLEGIC MYDRIATICSatropine ophthalmic (eye) drops 1 % 2tropicamide ophthalmic (eye) drops 0.5 %, 1 % 2

DIRECT ACTING MIOTICSpilocarpine hcl ophthalmic (eye) drops 1 %, 2 %, 4 % 2

neomycin-bacitracin-polymyxin ophthalmic (eye) ointment 3.5-400-10,000 mg-unit-unit/g

neomycin-polymyxin-gramicidin ophthalmic (eye) drops 1.75 mg-10,000 unit-0.025mg/ml

polymyxin b sulf-trimethoprim ophthalmic (eye) drops 10,000 unit- 1 mg/ml

MISCELLANEOUS OPHTHALMOLOGICSALOCRIL OPHTHALMIC (EYE) DROPS 2 % ST 3ALOMIDE OPHTHALMIC (EYE) DROPS 0.1 % ST 3artificial tears ophthalmic oint 2azelastine ophthalmic (eye) drops 0.05 % 2BEPREVE OPHTHALMIC (EYE) DROPS 1.5 % ST 4cromolyn ophthalmic (eye) drops 4 % ST 2epinastine ophthalmic (eye) drops 0.05 % ST 2LASTACAFT OPHTHALMIC (EYE) DROPS 0.25 % ST 4lubricant eye (pg-peg 400) ophthalmic (eye) drops 0.4-0.3 % 2lubricant eye ophthalmic (eye) ointment 56.8-41.5 %, 57.3-42.5 % 2olopatadine ophthalmic (eye) drops 0.1 %, 0.2 % 2PATADAY OTC OPHTH (EYE) DROPS 2proparacaine ophthalmic (eye) drops 0.5 % 2RESTASIS MULTIDOSE OPHTHALMIC (EYE) DROPS 0.05 % ST; QL 4RESTASIS OPHTHALMIC (EYE) DROPPERETTE 0.05 % ST; QL 4ZYLET SUS 0.5-0.3% ST 4

NON-STEROIDAL ANTI-INFLAMMATORY AGENTSbromfenac ophthalmic (eye) drops 0.09 % 2diclofenac sodium ophthalmic (eye) drops 0.1 % 2flurbiprofen sodium ophthalmic (eye) drops 0.03 % 2ketorolac ophthalmic (eye) drops 0.4 % 2ketorolac ophthalmic (eye) drops 0.5 % 2NEVANAC OPHTHALMIC (EYE) DROPS,SUSPENSION 0.1 % ST 4

ORAL DRUGS FOR GLAUCOMAacetazolamide oral capsule, extended release 500 mg 2acetazolamide oral tablet 125 mg, 250 mg 2methazolamide oral tablet 25 mg, 50 mg 2

OTHER GLAUCOMA DRUGSAZOPT OPHTHALMIC (EYE) DROPS,SUSPENSION 1 % ST 4bimatoprost ophthalmic (eye) drops 0.03 % ST 3brinzolamide susp 1% ST 3COMBIGAN OPHTHALMIC (EYE) DROPS 0.2-0.5 % ST 4dorzolamide ophthalmic (eye) drops 2 % 2dorzolamide-timolol ophthalmic (eye) drops 22.3-6.8 mg/ml 2latanoprost ophthalmic (eye) drops 0.005 % 2LUMIGAN OPHTHALMIC (EYE) DROPS 0.01 % ST 4SIMBRINZA OPHTHALMIC (EYE) DROPS,SUSPENSION 1-0.2 % ST 4travoprost drops 0.004% ST 3ZIOPTAN DROPS 0.0015% ST 4

STEROID-ANTIBIOTIC COMBINATIONS

2

2

2

2neo-polycin hc ophthalmic (eye) ointment 3.5-400-10,000 mg-unit/g-1% 2TOBRADEX OPHTHALMIC (EYE) OINTMENT 0.3-0.1 % 4tobramycin-dexamethasone ophthalmic (eye) drops,suspension 0.3-0.1 % 2

neomycin-polymyxin-hc ophthalmic (eye) drops,suspension 3.5-10,000-10 mg-unit-mg/ml

neomycin-bacitracin-poly-hc ophthalmic (eye) ointment 3.5-400-10,000 mg-unit/g-1%

neomycin-polymyxin b-dexameth ophthalmic (eye) drops,suspension 3.5mg/ml-10,000 unit/ml-0.1 %

neomycin-polymyxin b-dexameth ophthalmic (eye) ointment 3.5 mg/g-10,000 unit/g-0.1 %








Therapeutical Category ListingTherapeutical Category ListingSTEROIDS

ALREX OPHTHALMIC (EYE) DROPS,SUSPENSION 0.2 % ST 4dexamethasone sodium phosphate ophthalmic (eye) drops 0.1 % 2DUREZOL OPHTHALMIC (EYE) DROPS 0.05 % ST 4fluorometholone ophthalmic (eye) drops,suspension 0.1 % 2LOTEMAX OPHTHALMIC (EYE) DROPS,GEL 0.5 % ST 4LOTEMAX OPHTHALMIC (EYE) OINTMENT 0.5 % ST 4loteprednol etabonate ophthalmic (eye) drops,suspension 0.5 % ST 3MAXIDEX OPHTHALMIC (EYE) DROPS,SUSPENSION 0.1 % 4prednisolone acetate ophthalmic (eye) drops,suspension 1 % 2prednisolone sodium phosphate ophthalmic (eye) drops 1 % 2

STEROID-SULFONAMIDE COMBINATIONSsulfacetamide-prednisolone ophthalmic (eye) drops 10 %-0.23 % (0.25 %) 2

SULFONAMIDESsulfacetamide sodium ophthalmic (eye) drops 10 % 2

SYMPATHOMIMETICSapraclonidine ophthalmic (eye) drops 0.5 % 2brimonidine ophthalmic (eye) drops 0.15 %, 0.2 % 2

RESPIRATORY, ALLERGY, COUGH & COLDANTIHISTAMINE & ANTIALLERGENTIC AGENTS

all day allergy (cetirizine) oral capsule 10 mg 2all day allergy (cetirizine) oral solution 1 mg/ml 2all day allergy (cetirizine) oral tablet 10 mg QL 2allerclear oral tablet 10 mg QL 2allergy relief (cetirizine) oral capsule 10 mg 2allergy relief (cetirizine) oral solution 1 mg/ml 2allergy relief (cetirizine) oral tablet 10 mg QL 2allergy relief (loratadine) oral solution 5 mg/5 ml 2allergy relief (loratadine) oral tablet 10 mg QL 2allergy relief (loratadine) oral tablet,disintegrating 10 mg QL 2aller-tec oral tablet 10 mg QL 2carbinoxamine maleate oral liquid 4 mg/5 ml 2carbinoxamine maleate oral tablet 4 mg, 6 mg 2cetirizine oral solution 1 mg/ml, 5 mg/5 ml 2cetirizine oral tablet 10 mg, 5 mg QL 2cetirizine oral tablet,chewable 10 mg, 5 mg QL 2child allergy relf(cetirizine) oral solution 1 mg/ml 2children's allergy relief(lor) oral solution 5 mg/5 ml 2children's allergy(cetirizine) oral solution 1 mg/ml 2children's aller-tec oral solution 1 mg/ml 2children's cetirizine oral solution 1 mg/ml 2children's cetirizine oral tablet,chewable 10 mg, 5 mg 2children's wal-zyr oral solution 1 mg/ml 2children's wal-zyr oral tablet,chewable 10 mg 2child's all day allergy(cetir) oral solution 1 mg/ml 2clemastine oral tablet 2.68 mg 2cyproheptadine oral syrup 2 mg/5 ml 2cyproheptadine oral tablet 4 mg 2desloratadine oral tablet 5 mg QL 4desloratadine oral tablet,disintegrating 2.5 mg QL 4desloratadine oral tablet,disintegrating 5 mg QL 4dexchlorpheniramine oral soln 2mg/5ml 2diphenhydramine hcl injection syringe 50 mg/ml 2epinephrine injection auto-injector 0.15 mg/0.3 ml QL 2

epinephrine injection auto-injector 0.3 mg/0.3 ml QL 2hydroxyzine hcl oral solution 10 mg/5 ml 2hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg 2hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg 2levocetirizine oral solution 2.5 mg/5 ml 4loradamed oral tablet 10 mg QL 2loratadine oral capsule 10 mg QL 2loratadine oral solution 5 mg/5 ml 2loratadine oral tablet 10 mg QL 2promethazine oral syrup 6.25 mg/5 ml 2promethazine oral tablet 12.5 mg, 25 mg, 50 mg 2promethazine rectal suppository 12.5 mg, 25 mg 2promethegan rectal suppository 12.5 mg, 25 mg 2ryvent oral tablet 6mg 2wal-itin oral solution 5 mg/5 ml 2wal-itin oral tablet 10 mg QL 2wal-zyr (cetirizine) oral capsule 10 mg 2wal-zyr (cetirizine) oral solution 1 mg/ml 2wal-zyr (cetirizine) oral tablet 10 mg QL 2

COUGH & COLD THERAPYbenzonatate oral capsule 100 mg, 150 mg, 200 mg 2guaiatussin ac liquid 100-10/5 2hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml 3hydromet oral syrup 5-1.5 mg/5 ml 3TUZISTRA XR ORAL SUSPENSION,EXTENDED REL 12 HR 14.7-2.8 MG/5 ML 4virtussin AC liquid 100-10/5 2

PULMONARY AGENTS24 HOUR NASAL ALLERGY NASAL AEROSOL,SPRAY 55 MCG QL 2acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %) 1ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG PA; QL 5ADVAIR DISKUS INHALER 100/50, 250/50, 500/50 QL 3ADVAIR HFA QL 3AIRDUO DIGIHALER ST 4AIRDUO RESPICLICK ST 4

1

1albuterol sulfate oral syrup 2 mg/5 ml 1albuterol sulfate oral tablet 2 mg, 4 mg 1ALVESCO AER 80MCG, 160MCG PA; QL 4ALYQ 20MG PA; QL 5ambrisentan oral tablet 10 mg, 5 mg PA; QL 5aminophylline intravenous solution 250 mg/10 ml 2

QL 3

QL 3

QL 3

QL 3

QL 3bosentan oral tablet 125 mg, 62.5 mg PA; QL 5

albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 2.5 mg/0.5 ml, 5 mg/ml

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE 62.5-25 MCG/ACTUATION

ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 200 MCG/ACTUATION, 50MCG

ASMANEX HFA INHALATION HFA AEROSOL INHALER 100 MCG/ACTUATION, 200 MCG/ACTUATION

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

ALBUTEROL SULFATE INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION

ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCG/ACTUATION


QL 3BREZTRI AERO AER SPHERE ST 3

QL 1budesonide inhalation suspension for nebulization 1 mg/2 ml QL 1budesonide nasal spray,non-aerosol 32 mcg/actuation QL 2COMBIVENT RESPIMAT INHALATION MIST 20-100 MCG/ACTUATION QL 3cromolyn inhalation solution for nebulization 20 mg/2 ml 1

ST; QL 4DYMISTA PA; QL 4ESBRIET ORAL CAPSULE 267 MG PA; QL 5ESBRIET ORAL TABLET 267 MG, 801 MG PA 5

QL 3

QL 3flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) QL 2fluticasone propionate nasal spray,suspension 50 mcg/actuation QL 2FLUTICASONE PROPION-SALMETEROL AEROSOL 100/50, 250/50, 500/50 QL 2

2

QL 3ipratropium bromide inhalation solution 0.02 % 1

QL 1

1

QL 4mometasone spray 50mcg QL 2montelukast oral granules in packet 4 mg 1montelukast oral tablet 10 mg 1montelukast oral tablet,chewable 4 mg, 5 mg 1nasal allergy nasal aerosol,spray 55 mcg QL 2OPSUMIT ORAL TABLET 10 MG PA 5PROAIR HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION 3

QL 3PROVENTIL AER HFA 3

ST; QL 4PULMOZYME INHALATION SOLUTION 1 MG/ML PA 5QNASL AER 80MCG QL 4QNASL CHILD SPRAY 40MCG QL 4SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCG/DOSE QL 3sildenafil (antihypertensive) oral tablet 20 mg PA; QL 5

QL 3

QL 3STIOLTO RESPIMAT INHALATION MIST 2.5-2.5 MCG/ACTUATION QL 3STRIVERDI RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION QL 3

QL 3

FLUTICASONE PROPION-SALMETEROL INHALATION AEROSOL POWDR BREATH ACTIVATED 113-14 MCG/ACTUATION, 232-14 MCG/ACTUATION, 55-14 MCG/ACTUATION

INCRUSE ELLIPTA INHALATION BLISTER WITH DEVICE 62.5 MCG/ACTUATION

ipratropium-albuterol inhalation solution for nebulization 0.5 mg-3 mg(2.5 mg base)/3 ml

levalbuterol hcl inhalation solution for nebulization 0.31 mg/3 ml, 0.63 mg/3 ml, 1.25 mg/0.5 ml, 1.25 mg/3 ml

LEVALBUTEROL TARTRATE INHALATION HFA AEROSOL INHALER 45 MCG/ACTUATION

PROAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 90 MCG/ACTUATION

BREO ELLIPTA INHALATION BLISTER WITH DEVICE 100-25 MCG/DOSE, 200-25 MCG/DOSE

budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml

DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 250 MCG/ACTUATION, 50 MCG/ACTUATION

FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION, 220 MCG/ACTUATION, 44 MCG/ACTUATION

PULMICORT FLEXHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 180 MCG/ACTUATION, 90 MCG/ACTUATION

SPIRIVA RESPIMAT INHALATION MIST 1.25 MCG/ACTUATION, 2.5 MCG/ACTUATION

SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE 18 MCG

SYMBICORT INHALATION HFA AEROSOL INHALER 160-4.5 MCG/ACTUATION, 80-4.5 MCG/ACTUATION

tadalafil (antihypertensive) oral tablet 20 mg PA; QL 5terbutaline oral tablet 2.5 mg, 5 mg 1theophylline oral tablet extended release 12 hr 100 mg, 200 mg 1

1TRELEGY ELLIPTA INHALATION BLISTER WITH DEVICE 100-62.5-25 MCG 3triamcinolone acetonide nasal aerosol,spray 55 mcg QL 2VENTAVIS INHALATION SOLUTION FOR NEBULIZATION 20 MCG/ML PA; QL 5VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION 3wixela inhub aer 100/50, 250/50, 500/50 QL 2XOLAIR SUBCUTANEOUS RECON SOLN 150 MG PA 5XOLAIR SUBCUTANEOUS SYRINGE 150 MG/ML PA 5XOLAIR SUBCUTANEOUS SYRINGE 75 MG/0.5 ML PA 5XOPENEX HFA INHALATION HFA AEROSOL INHALER 45 MCG/ACTUATION QL 4zafirlukast oral tablet 10 mg, 20 mg 1ZETONNA NASAL HFA AEROSOL INHALER 37 MCG/ACTUATION ST; QL 4zileuton oral tablet, er multiphase 12 hr 600 mg PA 3

UROLOGICALSANTICHOLINERGICS & ANTISPASMODICS

darifenacin oral tablet extended release 24 hr 15 mg, 7.5 mg ST 3flavoxate oral tablet 100 mg 2INTRAROSA SUP 6.5MG 4 lanthanum chw 100mg, 500mg 3MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG, 50 MG 4oxybutynin chloride oral syrup 5 mg/5 ml 2oxybutynin chloride oral tablet 5 mg 2oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg, 5 mg 2OXYTROL FOR WOMEN TRANSDERMAL PATCH 4 DAY 3.9 MG/24 HOUR QL 2solifenacin oral tablet 5 mg, 10 mg ST 4tolterodine oral capsule,extended release 24hr 2 mg, 4 mg 3tolterodine oral tablet 1 mg, 2 mg 2TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HR 4 MG, 8 MG ST 4trospium oral capsule,extended release 24hr 60 mg 2trospium oral tablet 20 mg 2VELPHORO CHW 500MG PA 4

BENIGN PROSTATIC HYPERPLASIA (BPH) THERAPYalfuzosin oral tablet extended release 24 hr 10 mg 2dutasteride oral capsule 0.5 mg 3dutasteride-tamsulosin oral capsule 0.5mg-0.4mg 2finasteride oral tablet 5 mg 3silodosin oral capsule 4 mg, 8 mg ST 3tadalafil oral tablet 2.5 mg, 5 mg PA; ST; QL 3tamsulosin oral capsule 0.4 mg 2

CHOLINERGIC STIMULANTSbethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg 2

MISCELLANEOUS UROLOGICALSELMIRON ORAL CAPSULE 100 MG 3

2RENACIDIN IRRIGATION SOLUTION 1980.6 MG-59.4 MG-980.4MG/30ML 3sildenafil oral tablet 100 mg, 25 mg, 50 mg PA 3tadalafil oral tablet 20 mg PA; ST 5

theophylline oral tablet extended release 24 hr 300 mg, 400 mg, 450 mg, 600 mg

potassium citrate oral tablet extended release 10 meq (1,080 mg), 15 meq, 5 meq (540 mg)








Therapeutical Category ListingTherapeutical Category ListingURINARY ANESTHETICS

phenazo oral tablet 200mg 2phenazopyridine oral tablet 100 mg, 200 mg 2

VITAMINS, HEMATINICS & ELECTROLYTESELECTROLYTES

calcium 500 + d oral tablet,chewable 500 mg(1,250mg) -400 unit 2

2calcium 600 with vitamin d3 oral capsule 600 mg(1,500mg) -500 unit 2calcium citrate-vitamin d2 oral tablet 1,500-200 mg-unit 2calcium citrate-vitamin d3 oral tablet 315-200 mg-unit 2clovique oral capsule 250mg PA 5DECARA CAP 1.25mg (50000 UNT) 4deferiprone oral tablet 500 mg PA 4effer-k oral tablet, effervescent 25 meq 3klor-con 10 oral tablet extended release 10 meq 2klor-con 8 oral tablet extended release 8 meq 2klor-con m10 oral tablet,er particles/crystals 10 meq 2klor-con m15 oral tablet,er particles/crystals 15 meq 2klor-con m20 oral tablet,er particles/crystals 20 meq 2klor-con/ef oral tablet, effervescent 25 meq 3k-phos-neutral oral tablet 250 mg 2LOKELMA PAK 10GM, 5GM 4oyster shell calcium-vit d3 oral tablet 500 mg(1,250mg) -400 unit 2phosphorous oral tablet 250 mg 3potassium chloride oral capsule, extended release 10 meq, 8 meq 2potassium chloride oral liquid 20 meq/15 ml, 40 meq/15 ml 3potassium chloride oral tablet extended release 10 meq, 20 meq, 8 meq 2potassium chloride oral tablet,er particles/crystals 10 meq, 20 meq 2tolvaptan oral tablet 15mg, 30mg PA; QL 5trientine capsule 250mg PA 5

VITAMINS & HEMATINICSD3-50 CHOLECALCIFEROL ORAL CAPSULE 50,000 UNIT 2dialyvite 800 oral tablet 0.8 mg 2

1

1folic acid oral tablet 400 mcg, 800 mcg 1folic acid oral tablet 1mg 2foltabs 800 oral tablet 0.8-10-115 mg-mg-mcg 2full spectrum b-vitamin c oral tablet 0.8 mg 2multi-vitamin with fluoride oral drops 0.25 mg/ml, 0.5 mg/ml 2multi-vitamin with fluoride oral tablet,chewable 0.25 mg, 0.5 mg, 1 mg 2nafrinse chw 1mg f 1

2

calcium 600 + d(3) oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit

fluoride (sodium) oral tablet,chewable 0.25 mg(0.55 mg sod. fluoride), 0.5 mg (1.1 mg sodium fluorid), 1 mg (2.2 mg sod. fluoride)

fluoritab oral tablet,chewable 0.5 mg (1.1 mg sodium fluorid), 1 mg (2.2 mg sod. fluoride)

tri-vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml, 0.5 mg fluoride (1.1 mg)/ml


AultCare/Aultra General Tag Lines Revised 6/2021 (TTY) 616/16

AultCare/Aultra General Tag Lines for the State of Ohio

EnglishIf you, or someone you are helping, have questions about AultCare/Aultra you have the right to get help and information in your

language at no cost. To speak with an interpreter, call Local: 330.363.6360 Outside Stark County: 1.800.344.8858 TTY Local: 711Outside Stark County: 711

Spanish EspañolSi usted, o alguien a quien usted está ayudando, tiene preguntas acerca AultCare/Aultra tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al Local : 330.363.6360 Fuera del condado de Stark : 1.800.344.8858 TTY Local : 711 Fuera del condado de Stark : 711

Chinese

AultCare/Aultra

330.363.6360 1.800.344.8858 TTY 711 711

GermanDeutscheFalls Sie oder jemand, dem Sie helfen, Fragen zum AultCare/Aultra haben, haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer Local: 330.363.6360 Außerhalb von Stark County : 1.800.344.8858 TTY –Linie Local: 711 Außerhalb von Stark County : 711 an.

Arabicالعربیة

فة. للتحدث مع مترجم اتصل ب ، لدیك الحق في الحصول على المساعدة والمعلومات الضروریة بلغتك من دون ایة تكلالعربیةشركة التأمین إن كان لدیك أو لدى شخص تساعده أسئلة بخصوص AultCare/Aultra

1.800.344.8858 330.363.6360خارج مقاطعة ستارك : TTYالخط 711المحلي: 711 .خارج مقاطعة ستارك

Pennsylvania DutchDeitschWann du hoscht en Froog, odder ebber, wu du helfscht, hot en Froog baut AultCare/Aultra hoscht du es Recht fer Hilf un Information in deinre eegne Schprooch griege, un die Hilf koschtet nix. Wann du mit me Interpreter schwetze witt, kannscht du Local: 330.363.6360 Außerhalb von Stark County: 1.800.344.8858 TTY –Linie Local: 711 Außerhalb von Stark County : 711 uffrufe.

RussianрусскийЕсли у вас или лица, которому вы помогаете, имеются вопросы по поводу Страховая компания AultCare/Aultra, то вы имеетеправо на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефонуМестный: 330.363.6360 Вне Старка County : 1.800.344.8858 TTY линия Местный: 711 Вне Старка County : 711.

FrenchFrançaisSi vous, ou quelqu'un que vous êtes en train d’aider, a des questions à propos de Compagnie d'Assurance AultCare/Aultra, vous avez le droit d'obtenir de l'aide et l'information dans votre langue à aucun coût. Pour parler à un interprète, Appelez Locale 330.363.6360 En dehors du comté de Stark : 1.800.344.8858 ligne ATS Local : 711 En dehors du comté de Stark : 711.

VietnameseViệt NamNếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Công ty Bảo hiểm AultCare/Aultra quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi Địa phương: 330.363.6360 Bên ngoài của Stark County : 1.800.344.8858 TTY đường dây Địa phương: 711 Bên ngoài của Stark County : 711.

Cushite-OromoIsin yookan namni biraa isin deeggartan AultCare/Aultra, irratti gaaffii yo qabaattan, kaffaltii irraa bilisa haala ta’een afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabdu. Nama isiniif ibsu argachuuf, lakkoofsa bilbilaa Local: 330.363.6360 Outside of Stark County: 1.800.344.8858 TTY Line Local: 711 Outside of Stark County: 711 tiin bilbilaa.



AultCare/Aultra General Tag Lines for the State of Ohio

EnglishIf you, or someone you are helping, have questions about AultCare/Aultra you have the right to get help and information in your

language at no cost. To speak with an interpreter, call Local: 330.363.6360 Outside Stark County: 1.800.344.8858 TTY Local: 711Outside Stark County: 711

Spanish EspañolSi usted, o alguien a quien usted está ayudando, tiene preguntas acerca AultCare/Aultra tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al Local : 330.363.6360 Fuera del condado de Stark : 1.800.344.8858 TTY Local : 711 Fuera del condado de Stark : 711

Chinese

AultCare/Aultra

330.363.6360 1.800.344.8858 TTY 711 711

GermanDeutscheFalls Sie oder jemand, dem Sie helfen, Fragen zum AultCare/Aultra haben, haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer Local: 330.363.6360 Außerhalb von Stark County : 1.800.344.8858 TTY –Linie Local: 711 Außerhalb von Stark County : 711 an.

Arabicالعربیة

فة. للتحدث مع مترجم اتصل ب ، لدیك الحق في الحصول على المساعدة والمعلومات الضروریة بلغتك من دون ایة تكلالعربیةشركة التأمین إن كان لدیك أو لدى شخص تساعده أسئلة بخصوص AultCare/Aultra

1.800.344.8858 330.363.6360خارج مقاطعة ستارك : TTYالخط 711المحلي: 711 .خارج مقاطعة ستارك

Pennsylvania DutchDeitschWann du hoscht en Froog, odder ebber, wu du helfscht, hot en Froog baut AultCare/Aultra hoscht du es Recht fer Hilf un Information in deinre eegne Schprooch griege, un die Hilf koschtet nix. Wann du mit me Interpreter schwetze witt, kannscht du Local: 330.363.6360 Außerhalb von Stark County: 1.800.344.8858 TTY –Linie Local: 711 Außerhalb von Stark County : 711 uffrufe.

RussianрусскийЕсли у вас или лица, которому вы помогаете, имеются вопросы по поводу Страховая компания AultCare/Aultra, то вы имеетеправо на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефонуМестный: 330.363.6360 Вне Старка County : 1.800.344.8858 TTY линия Местный: 711 Вне Старка County : 711.

FrenchFrançaisSi vous, ou quelqu'un que vous êtes en train d’aider, a des questions à propos de Compagnie d'Assurance AultCare/Aultra, vous avez le droit d'obtenir de l'aide et l'information dans votre langue à aucun coût. Pour parler à un interprète, Appelez Locale 330.363.6360 En dehors du comté de Stark : 1.800.344.8858 ligne ATS Local : 711 En dehors du comté de Stark : 711.

VietnameseViệt NamNếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Công ty Bảo hiểm AultCare/Aultra quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi Địa phương: 330.363.6360 Bên ngoài của Stark County : 1.800.344.8858 TTY đường dây Địa phương: 711 Bên ngoài của Stark County : 711.

Cushite-OromoIsin yookan namni biraa isin deeggartan AultCare/Aultra, irratti gaaffii yo qabaattan, kaffaltii irraa bilisa haala ta’een afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabdu. Nama isiniif ibsu argachuuf, lakkoofsa bilbilaa Local: 330.363.6360 Outside of Stark County: 1.800.344.8858 TTY Line Local: 711 Outside of Stark County: 711 tiin bilbilaa.


Korean

AultCare/Aultra. : 330.363.6360

: 1.800.344.8858 TTY : 711 : 711

.

ItalianItalianoSe tu o qualcuno che stai aiutando avete domande su AultCare/Aultra, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, puoi chiamare Locale: 330.363.6360 Al di fuori di Stark County : 1.800.344.8858 TTY linea Locale: 711 Al di fuori di Stark County : 711.

Japanese

AultCare/Aultra

330.363.6360 1.800.344.8858 TTY 711 711

DutchNederlandsAls u, of iemand die u helpt, vragen heeft over AultCare/Aultra, heeft u het recht om hulp en informatie te krijgen in uw taal zonder kosten. Om te praten met een tolk, bel Local : 330.363.6360 Buiten Stark County : 1.800.344.8858 TTY Line Local : 711 BuitenStark County : 711.

UkrainianукраїнськийЯкщо у Вас чи у когось, хто отримує Вашу допомогу, виникають питання про Страхова компанія AultCare/Aultra, у Вас є право отримати безкоштовну допомогу та інформацію на Вашій рідній мові. Щоб зв’язатись з перекладачем, задзвоніть на Місцевий : 330.363.6360 Поза Старка County : 1.800.344.8858 TTY лінія Місцевий : 711 Поза Старка County : 711.

RomanianRomânăDacă dumneavoastră sau persoana pe care o asistați aveți întrebări privind Compania de Asigurari AultCare/Aultra, aveți dreptul de a obține gratuit ajutor și informații în limba dumneavoastră. Pentru a vorbi cu un interpret, sunați la Locale : 330.363.6360 In afara Stark Judet : 1.800.344.8858 TTY linie Locale : 711 In afara Stark Judet : 711.

Non-Discrimination Notice:

AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. AultCare/Aultra provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). AultCare/Aultra provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages.

If you need these services, or if you believe that AultCare/Aultra has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can contact or file a grievance with the: AultCare/Aultra Civil Rights Coordinator, 2600 6th St. S.W. Canton, OH 44710, 330-363-7456, [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Civil Rights staff is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 202011-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.


Korean

AultCare/Aultra. : 330.363.6360

: 1.800.344.8858 TTY : 711 : 711

.

ItalianItalianoSe tu o qualcuno che stai aiutando avete domande su AultCare/Aultra, hai il diritto di ottenere aiuto e informazioni nella tua lingua gratuitamente. Per parlare con un interprete, puoi chiamare Locale: 330.363.6360 Al di fuori di Stark County : 1.800.344.8858 TTY linea Locale: 711 Al di fuori di Stark County : 711.

Japanese

AultCare/Aultra

330.363.6360 1.800.344.8858 TTY 711 711

DutchNederlandsAls u, of iemand die u helpt, vragen heeft over AultCare/Aultra, heeft u het recht om hulp en informatie te krijgen in uw taal zonder kosten. Om te praten met een tolk, bel Local : 330.363.6360 Buiten Stark County : 1.800.344.8858 TTY Line Local : 711 BuitenStark County : 711.

UkrainianукраїнськийЯкщо у Вас чи у когось, хто отримує Вашу допомогу, виникають питання про Страхова компанія AultCare/Aultra, у Вас є право отримати безкоштовну допомогу та інформацію на Вашій рідній мові. Щоб зв’язатись з перекладачем, задзвоніть на Місцевий : 330.363.6360 Поза Старка County : 1.800.344.8858 TTY лінія Місцевий : 711 Поза Старка County : 711.

RomanianRomânăDacă dumneavoastră sau persoana pe care o asistați aveți întrebări privind Compania de Asigurari AultCare/Aultra, aveți dreptul de a obține gratuit ajutor și informații în limba dumneavoastră. Pentru a vorbi cu un interpret, sunați la Locale : 330.363.6360 In afara Stark Judet : 1.800.344.8858 TTY linie Locale : 711 In afara Stark Judet : 711.

Non-Discrimination Notice:

AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. AultCare/Aultra provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). AultCare/Aultra provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages.

If you need these services, or if you believe that AultCare/Aultra has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can contact or file a grievance with the: AultCare/Aultra Civil Rights Coordinator, 2600 6th St. S.W. Canton, OH 44710, 330-363-7456, [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Civil Rights staff is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 202011-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Date post:	28-Feb-2022
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