Kaiser Permanente 2017 FEHB Formulary MAS...2017 Kaiser Permanente Federal Employees Health Beneit...

2017 Kaiser Permanente Federal Employees Health Benefit

FEHB Drug Formulary

Member ServicesMaryland, Virginia, and Monday through Friday, 8 a.m. to 5 p.m. District of Columbia Region 1-877-KP4-FEDS (1-877-574-3337)711 TTY

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2017 Kaiser Permanente Federal Employees Health Benefit Formulary (Mid-Atlantic States Region)

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2017 Kaiser Permanente Federal Employees Health Benefit (FEHB) Drug Formulary Mid-Atlantic States Region This document contains information about the drugs we cover when you participate in a Federal Employees Health Benefits (FEHB) plan offered by Kaiser Permanente.

This formulary is effective October 1, 2017.

What is the Kaiser Permanente FEHB Drug Formulary? A formulary is a list of drugs determined to be safe and effective for our members by our Pharmacy and Therapeutics Committee. Use of formulary drugs enables Kaiser Permanente to provide high quality care to you and your family at reasonable costs. Kaiser Permanente continually updates the formulary throughout the year based on new medical evidence, considering the recommendations of appropriate physician experts.

How much will I pay for covered drugs? The cost-sharing you will pay for most drugs depends on:

• the tier in which your drug is categorized, and • whether your drug is included in our formulary. Preferred drugs are included in our formulary. Non-

preferred drugs are not included in our formulary.

We categorize prescription drugs into four tiers:

Drug Tier

Type Description

Tier 1 Generic drugs Generic drugs are produced and sold under their generic names after the patent on the brand-name drug expires. Although the price is usually lower, the quality of generic drugs is the same as brand-name drugs. Generic drugs are also just as effective as brand-name drugs. The U.S. Food and Drug Administration (FDA) requires that a generic drug contain the same active drug ingredient in the same amount as the brand-name drug.

Tier 2 Preferred brand-name drugs

Brand-name drugs are produced and sold under the original manufacturer's brand name. Preferred brand-name drugs are listed on our drug formulary.

Tier 3 Non-preferred brand-name drugs

Non-preferred brand-name drugs are not listed on our drug formulary and are not covered unless approved through the exception process.


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Drug Tier

Type Description

Tier 4 Specialty drugs Specialty drugs are high-cost drugs that are on our specialty drug list. Kaiser Permanente adopts the model used by most Medicare plans to determine which drugs are in the specialty tier.

The amount you pay and other coverage information is determined by the outpatient prescription drug benefit in your FEHB brochure (RI 73-047, See Section 5(f) Prescription drug benefits).

Some drugs may be covered at no cost or a different cost-sharing amount. Examples of these include tobacco cessation medications, women’s contraceptive drugs and devices and oral chemotherapy drugs at no cost; fertility drugs and sexual dysfunction drugs have different cost-sharing amounts. Cost-sharing for these drugs is listed in your FEHB brochure.

All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. To get a copy of your FEHB brochure or if you have questions, please visit our website at kp.org/feds or call Member Services at 1-877-KP4-FEDS (1-877-574-3337) (TTY 711), Monday through Friday, 8 a.m. to 5 p.m.

How do I use the FEHB Drug Formulary? Our formulary drugs are listed in this formulary by medical condition and alphabetically. We consider drugs not listed on our formulary to be “non-preferred drugs”. You may pay higher cost-sharing for non-formulary drugs that are medically necessary.

The cost-sharing you pay and other coverage information is determined by the outpatient prescription drug benefit in your FEHB brochure (RI 73-047, See Section 5(f) Prescription drug benefits).

Formulary Drugs by Medical Condition The formulary begins on page 4. The drugs in this formulary are grouped into categories depending on the type of medical condition that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, “Cardiovascular Agents.” If you know the medical condition your drug is used for, simply look for the category name in the list. Then look under the category name for your drug.

Formulary Drugs by Alphabetical Listing If you are not sure what category to look under, the Index starting on page 26, provides an alphabetical list of all of the drugs included in this document. Both brand-name drugs and generic drugs are listed. Look in the Index to find the drug name and the page number where you can locate coverage information. Turn to the page listed in the Index and find the name of the drug on the list. If you are using a computer to view this document, you also use the search function (Ctrl F) to find the medication by name.

https://healthplans.kaiserpermanente.org/federalemployees/


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Columns on Medical Condition and Alphabetical Listings There are three columns in the attached chart.

• The first column lists the drug name. Brand-name drugs are capitalized (e.g. ALBENZA) and generic drugs are listed in lower-case italics (e.g. amoxicillin). Some drugs include different dosage forms and strengths. All dosage forms and strengths for a particular drug listed may not be on the Formulary. Some drugs have multiple dosage forms. In such cases, some dosages may be on the Formulary and others not. Some of these drugs may be available only in a clinic setting.

• The second column indicates drug tier. Some drugs may have more than one tier listed in this column. This means that the amount you pay may vary based on the dosage or the way the drug is administered. You will find cost-sharing for your drug in your FEHB brochure. To get a copy of your FEHB brochure or if you have questions, please visit our website at kp.org/feds or call Member Services at 1-877-KP4-FEDS (1-877-574-3337) (TTY 711), Monday through Friday, 8 a.m. to 5 p.m.

• The third column indicates additional requirements or limits on coverage. These requirements and limits may include:

PA = Prior Authorization. You need to get approval from Kaiser Permanente to fill your prescription. If you don’t get approval, we may not cover the drug.

QL = Quantity Limit. For certain drugs, we may limit the amount of the drug you can receive. Additionally, when there is a national shortage of a drug, we may limit the quantity of the drug dispensed.

LD = Limited distribution. Some drugs may be subject to limited distribution or restricted access. A drug that is a limited distribution drug may only be available at one or a limited number of pharmacies.

Does the FEHB Drug Formulary ever change? Yes, Kaiser Permanente continually updates the formulary based on new medical evidence, considering the recommendations of appropriate physician experts and notifies our doctors, pharmacists, and other clinicians about any changes. If a change in the formulary affects any of your prescriptions, your doctor or pharmacist will let you know.

Our online formulary at kp.org/formulary is updated on a regular basis. To get updated information about the drugs covered by Kaiser Permanente or if you have questions, please visit our website at kp.org/feds or call Member Services at 1-877-KP4-FEDS (1-877-574-3337) (TTY 711), Monday through Friday, 8 a.m. to 5 p.m.


https://www.kaiserpermanente.org/formulary



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Formulary Drugs by Medical Condition

Name of drug Drug Tier

Requirements / Limits

ANTI-INFECTIVE AGENTS ANTHELMINTICS ALBENZA 2 YODOXIN 2 ANTIBACTERIALS amikacin sulfate 1 amoxicillin 1, 2 amoxicillin & pot clavulanate 1, 2 ampicillin 1 ampicillin & sulbactam sodium 1

ampicillin sodium 1 AVELOX 2 azithromycin 1, 2 aztreonam 1 bacitracin 1 BICILLIN L-A 2 cefaclor 1 cefazolin sodium 1 CEFAZOLIN IN D5W 1 cefdinir 1 cefepime hcl 1 CEFEPIME-DEXTROSE 2 cefixime 1 cefoxitin sodium 1 ceftazidime 1 CEFTAZIDIME AND DEXTROSE 2

ceftriaxone sodium 1 CEFTRIAXONE SODIUM IN DEXTROSE 1

CEFTRIAXONE SODIUM-DEXTROSE 2

cefuroxime axetil 1, 2 cefuroxime sodium 1 cephalexin 1 ciprofloxacin 1 ciprofloxacin hcl 1 ciprofloxacin in d5w 1 CLAFORAN 2



clarithromycin 1 clindamycin hcl 1 clindamycin palmitate hydrochloride 1

clindamycin phosphate 1 colistimethate sodium 1 daptomycin 1 dicloxacillin sodium 1 doxycycline (monohydrate) 1 doxycycline hyclate 1 ERYTHROCIN LACTOBIONATE 1, 2

erythromycin base 1 erythromycin ethylsuccinate 1 erythromycin-sulfisoxazole 1 gentamicin sulfate 1 imipenem-cilastatin 1 INVANZ 2 levofloxacin 1 levofloxacin in d5w 1 linezolid 1, 4 LINEZOLID IN SODIUM CHLORIDE 2

meropenem 1 minocycline hcl 1 nafcillin sodium 1 neomycin sulfate 1, 2 ORBACTIV 4 penicillin g potassium 1 PENICILLIN G PROCAINE 1 PENICILLIN G SODIUM 1 penicillin v potassium 1 piperacillin sodium-tazobactam sodium 1

STREPTOMYCIN SULFATE 1 SULFADIAZINE 1 sulfamethoxazole-trimethoprim 1

sulfasalazine 1 TIMENTIN 2


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tobramycin 1 TOBRAMYCIN SULFATE 1 vancomycin hcl 1 VANCOMYCIN HCL IN DEXTROSE 2

ANTIFUNGALS AMPHOTERICIN B 1 fluconazole 1 fluconazole in dextrose 1 fluconazole in nacl 1 griseofulvin microsize 1, 2 griseofulvin ultramicrosize 1 itraconazole 1, 2 PA ketoconazole 1 nystatin 1 nystatin (mouth-throat) 1 terbinafine hcl 1 voriconazole 1 ANTIMYCOBACTERIALS dapsone 1 ethambutol hcl 1 isoniazid 1 pyrazinamide 1 rifabutin 1 rifampin 1 ANTIPROTOZOALS atovaquone 1 atovaquone-proguanil hcl 1 chloroquine phosphate 1 COARTEM 2 DARAPRIM 2 LD hydroxychloroquine sulfate 1 mefloquine hcl 1 metronidazole 1 metronidazole in nacl 1 NEBUPENT 2 PRIMAQUINE PHOSPHATE 1, 2 ANTIVIRALS abacavir sulfate 1, 2 abacavir sulfate-lamivudine 1 abacavir sulfate-lamivudine-zidovudine 1

acyclovir 1 acyclovir sodium 1 adefovir dipivoxil 1 amantadine hcl 1



APTIVUS 2 ATRIPLA 2 COMPLERA 2 CRIXIVAN 2 CYTOVENE 2 DAKLINZA 4 QL DESCOVY 2 didanosine 1, 2 EDURANT 2 EMTRIVA 2 entecavir 1, 2 EPCLUSA 4 QL FOSCARNET SODIUM 2 GENVOYA 2 HARVONI 4 QL INTELENCE 2 INVIRASE 2 ISENTRESS 2 lamivudine 1 lamivudine (hbv) 1 lamivudine-zidovudine 1 LEXIVA 2 lopinavir-ritonavir 1, 2 nevirapine 1, 2 NORVIR 2 ODEFSEY 2 oseltamivir phosphate 1, 2 QL PEG-INTRON 4 QL PEGASYS 2, 4 QL PREZCOBIX 2 PREZISTA 2 RELENZA DISKHALER 2 QL RESCRIPTOR 2 REYATAZ 2 ribavirin (hepatitis c) 1 rimantadine hydrochloride 1 SELZENTRY 2 SOVALDI 4 QL stavudine 1 STRIBILD 2 SUSTIVA 2 SYNAGIS 4 TIVICAY 2 TRIUMEQ 2 TRUVADA 2 valganciclovir hcl 1


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VIRACEPT 2 VIREAD 2 zidovudine 1 URINARY ANTI-INFECTIVES methenamine hippurate 1 nitrofurantoin 1 nitrofurantoin macrocrystal 1 nitrofurantoin monohyd macro 1 trimethoprim 1 ANTIHISTAMINE DRUGS FIRST GENERATION ANTIHISTAMINES cyproheptadine hcl 1 diphenhydramine hcl 1 promethazine hcl 1 ANTINEOPLASTIC AGENTS ANTINEOPLASTIC AGENTS AFINITOR 4 ALIMTA 2 ALUNBRIG 4 anastrozole 1 AVASTIN 2 Azacitidine 1 BENDEKA 2, 4 bexarotene 4 bicalutamide 1 BICNU 2 bleomycin sulfate 1 CABOMETYX 4 CAMPATH 2 LD capecitabine 1 CAPRELSA 2 LD carboplatin 1 CEENU 2 CERUBIDINE 2 cisplatin 1 cladribine 1 cyclophosphamide 1, 2 PA CYRAMZA 4 cytarabine 1 dacarbazine 1 dactinomycin 1 decitabine 1 DIETHYLSTILBESTROL 2 doxorubicin hcl 1 doxorubicin hcl liposomal 1 EMCYT 2



epirubicin hcl 1, 2 ERBITUX 2 etoposide 1 exemestane 1 FASLODEX 2, 4 floxuridine 1 fludarabine phosphate 1 fluorouracil 1 flutamide 1 GAZYVA 4 gemcitabine hcl 1 HALAVEN 2 HERCEPTIN 2 HEXALEN 4 hydroxyurea 1 IBRANCE 4 ICLUSIG 4 ifosfamide 1, 2 imatinib mesylate 1 IMBRUVICA 4 INLYTA 4 IRESSA 4 irinotecan hcl 1 IXEMPRA KIT 2, 4 JAKAFI 4 JEVTANA 2 KADCYLA 4 LENVIMA 4 LD letrozole 1 LEUKERAN 2 leuprolide acetate 1, 2 PA, QL LUPRON DEPOT (3-MONTH) 2 QL LUPRON DEPOT (4-MONTH) 2 QL LUPRON DEPOT (6-MONTH) 2 QL LUPRON DEPOT-PED (1-MONTH) ) 2 QL

LUPRON DEPOT-PED (3-MONTH) 2 QL LYSODREN 2 MARQIBO 4 MATULANE 4 megestrol acetate 1 melphalan 1, 2 mercaptopurine 1, 4 methotrexate sodium 1 QL mitomycin 1


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mitoxantrone hcl 1 MUSTARGEN 2 MYLERAN 2 NEXAVAR 4 NINLARO 4 ONCASPAR 2 oxaliplatin 1 paclitaxel 1 PROLEUKIN 4 RITUXAN 2 SPRYCEL 4 SUTENT 4 SYLVANT 4 TABLOID 2 tamoxifen citrate 1 PA TARCEVA 4 TASIGNA 4 TAXOTERE 2 temozolomide 1, 2 TENIPOSIDE 2 topotecan hcl 1, 2 TORISEL 2 tretinoin (chemotherapy) 1 TYKERB 4 UNITUXIN 4 VECTIBIX 2 VELCADE 2 VENCLEXTA 2, 4 VINBLASTINE SULFATE 1 vincristine sulfate 1 vinorelbine tartrate 1 VOTRIENT 4 XALKORI 4 XTANDI 4 YERVOY 2 ZELBORAF 4 ZOLADEX 2 ZOLINZA 4 ZYKADIA 4 ZYTIGA 4 ANXIOLYTICS, SEDATIVES, AND HYPNOTICS BENZODIAZEPINES alprazolam 1 QL chlordiazepoxide hcl 1 QL clonazepam 1 QL clorazepate dipotassium 1 QL



diazepam 1 QL lorazepam 1 QL midazolam hcl 1 QL oxazepam 1 QL temazepam 1 QL AUTONOMIC DRUGS ANTICHOLINERGIC AGENTS atropine sulfate 1, 2 ATROVENT HFA 2 benztropine mesylate 1 dicyclomine hcl 1 hyoscyamine 1 hyoscyamine sulfate 1 ipratropium bromide 1 SPIRIVA RESPIMAT 2 trihexyphenidyl hcl 1 AUTONOMIC DRUGS, MISCELLANEOUS ERGOLOID MESYLATES 1 NICOTROL 2 phenoxybenzamine hcl 1 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS bethanechol chloride 1 donepezil hydrochloride 1 galantamine hydrobromide 1 NEOSTIGMINE METHYLSULFATE 2

pilocarpine hcl (oral) 1 pyridostigmine bromide 1, 2 SKELETAL MUSCLE RELAXANTS baclofen 1 cyclobenzaprine hcl 1 dantrolene sodium 1, 2 methocarbamol 1 SYMPATHOMIMETIC (ADRENERGIC) AGENTS ADVAIR DISKUS 2 albuterol sulfate 1, 2 COMBIVENT RESPIMAT 2 EPINEPHRINE 2 QL epinephrine hcl 1 QL lidocaine w/ epinephrine 1 metaproterenol sulfate 1, 2 SEREVENT DISKUS 2 STIOLTO RESPIMAT 2 STRIVERDI RESPIMAT 2 terbutaline sulfate 1


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BLOOD FORMATION, COAGULATION, AND THROMBOSIS COAGULANTS AND ANTICOAGULANTS ALPROLIX 2 AMICAR 2 anagrelide hcl 1 aspirin-dipyridamole 1 BRILINTA 2 cilostazol 1 clopidogrel bisulfate 1 dipyridamole 1 ELOCTATE 2 fondaparinux sodium 1 QL heparin sodium (porcine) 1 QL heparin sodium (porcine) lock flush 1 QL LOVENOX 2 QL pentoxifylline 1 PRADAXA 2 prasugrel 1, 2 warfarin sodium 1 HEMATOPOIETIC AGENTS LEUKINE 2 QL NEUPOGEN 4 QL PROCRIT 2 QL PROMACTA 4 LD ZARXIO 4 QL CARDIOVASCULAR DRUGS ALPHA-ADRENERGIC BLOCKING AGENTS terazosin hcl 1 ANTILIPEMIC AGENTS atorvastatin calcium 1 cholestyramine 1 cholestyramine light 1 colestipol hcl 1 fenofibrate 1 gemfibrozil 1 lovastatin 1 NIACOR 1 pravastatin sodium 1 rosuvastatin calcium 1 simvastatin 1 BETA-ADRENERGIC BLOCKING AGENTS atenolol 1 atenolol & chlorthalidone 1 bisoprolol & hydrochlorothiazide 1



bisoprolol fumarate 1 carvedilol 1 esmolol hcl 1 labetalol hcl 1 metoprolol succinate 1 metoprolol tartrate 1 propranolol hcl 1 sotalol hcl 1 CALCIUM-CHANNEL BLOCKING AGENTS amlodipine besylate 1 CARDENE IV 2 CLEVIPREX 2 diltiazem hcl 1 diltiazem hcl coated beads 1 nicardipine hcl 1 nifedipine 1 verapamil hcl 1 CARDIAC DRUGS adenosine 1 amiodarone hcl 1 digoxin 1, 2 disopyramide phosphate 1 dobutamine hcl 1 dofetilide 1 flecainide acetate 1 lidocaine hcl (cardiac) 1 mexiletine hcl 1 PROCAINAMIDE HCL 1 propafenone hcl 1 quinidine gluconate 1 QUINIDINE SULFATE 1 HYPOTENSIVE AGENTS acetazolamide 1 acetazolamide sodium 1 clonidine hcl 1 guanfacine hcl 1 hydralazine hcl 1 methazolamide 1 methyldopa 1 minoxidil 1 RESERPINE 2 RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS enalapril maleate 1, 2 ENTRESTO 2 lisinopril 1


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lisinopril & hydrochlorothiazide 1 losartan potassium 1 losartan potassium & hydrochlorothiazide 1

spironolactone 1 spironolactone & hydrochlorothiazide 1

valsartan 1 valsartan hydrochlorothiazide 1 VASODILATING AGENTS ADEMPAS 4 LD AMYL NITRITE 2 isosorbide dinitrate 1 isosorbide mononitrate 1 nitroglycerin 1, 2 OPSUMIT 4 LD papaverine hcl 1 sildenafil citrate (pulmonary hypertension) 1 PA, QL

CENTRAL NERVOUS SYSTEM AGENTS ANALGESICS AND ANTIPYRETICS acetaminophen w/ codeine 1 QL buprenorphine hcl-naloxone hcl dihydrate 1 QL butalbital-acetaminophen-caffeine 1

butalbital-aspirin-caffeine 1 butorphanol tartrate 1 QL choline & mag salicylate 1 clonidine-hcl-(analgesia) 1 CODEINE PHOSPHATE 2 QL CODEINE SULFATE 2 QL diclofenac sodium 1 EMBEDA 2 QL etodolac 1 fentanyl 1 QL fentanyl citrate 1, 2 QL hydrocodone-acetaminophen 1 QL hydromorphone hcl 1, 2 QL ibuprofen 1 indomethacin 1 ketorolac tromethamine 1 meloxicam 1 meperidine hcl 1 QL methadone hcl 1 QL morphine sulfate 1, 2 QL nabumetone 1



naproxen 1 OFIRMEV 2 oxycodone hcl 1, 2 QL oxycodone w/ acetaminophen 1 QL sulindac 1 tramadol hcl 1 QL ANOREXIGENIC AGENTS AND RESPIRATORY AND CEREBRAL STIMULANTS amphetamine-dextroamphetamine 1, 2

caffeine citrate 1 dextroamphetamine sulfate 1 methylphenidate hcl 1, 2 ANTICONVULSANTS BANZEL 2 carbamazepine 1 CELONTIN 2 divalproex sodium 1 ethosuximide 1 fosphenytoin sodium 1 gabapentin 1 lamotrigine 1 levetiracetam 1 magnesium sulfate 1 oxcarbazepine 1 phenobarbital 1, 2 PHENOBARBITAL SODIUM 2 phenytoin 1 phenytoin sodium 1 phenytoin sodium extended 1 primidone 1 topiramate 1 valproate sodium 1 valproic acid 1, 2 ANTIMIGRAINE AGENTS dihydroergotamine mesylate 1 QL MIGERGOT 1 naratriptan hcl 1 QL rizatriptan benzoate 1 QL sumatriptan 1 QL sumatriptan succinate 1 QL ANXIOLYTICS, SEDATIVES, AND HYPNOTICS buspirone hcl 1 dexmedetomidine hcl 1 DIASTAT ACUDIAL 2 QL droperidol 1


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etomidate 1 hydroxyzine hcl 1 hydroxyzine pamoate 1 ketamine hcl 1 PRECEDEX 2 propofol 1, 2 zaleplon 1 QL zolpidem tartrate 1 QL CENTRAL NERVOUS SYSTEM AGENTS, MISCELLANEOUS acamprosate calcium 1 bupropion hcl 1 carbidopa 1 carbidopa-levodopa 1 cisatracurium besylate 1 entacapone 1 flumazenil 1 guanfacine hcl (adhd) 1 ketamine hcl 1 memantine hcl 1 pramipexole dihydrochloride 1 QUELICIN 2 riluzole 1 rocuronium bromide 1 ropinirole hydrochloride 1 selegiline hcl 1 sevoflurane 1 SUPRANE 2 vecuronium bromide 1 OPIATE ANTAGONISTS naloxone hcl 1, 2 QL naltrexone hcl 1 PSYCHOTHERAPEUTIC AGENTS amitriptyline hcl 1 aripiprazole 1 bupropion hcl 1 PA chlorpromazine hcl 1 citalopram hydrobromide 1 clozapine 1 QL desipramine hcl 1 doxepin hcl 1 duloxetine hcl 1 escitalopram oxalate 1 fluoxetine hcl 1 fluphenazine decanoate 1 fluphenazine hcl 1



fluvoxamine maleate 1 haloperidol 1 haloperidol decanoate 1 haloperidol lactate 1 imipramine hcl 1 LITHIUM 2 lithium carbonate 1, 2 mirtazapine 1 nefazodone hcl 1 nortriptyline hcl 1 olanzapine 1 paroxetine hcl 1 perphenazine 1 phenelzine sulfate 1 pimozide 1 prochlorperazine edisylate 1 prochlorperazine maleate 1 protriptyline hcl 1 quetiapine fumarate 1 risperidone 1 sertraline hcl 1 thioridazine hcl 1 thiothixene 1 trazodone hcl 1 trifluoperazine hcl 1 venlafaxine hcl 1 ziprasidone hcl 1 DIABETIC SUPPLIES DIABETIC SUPPLIES ADVOCATE CONTROL SOLUTION 2

AUTOPEN 2 BD AUTOSHIELD DUO 2 BD DISP NEEDLES 2 BD INSULIN SYR ULTRAFINE II 2 BD INSULIN SYRINGE 2 BD INSULIN SYRINGE U-500 2 BD LANCET ULTRAFINE 30G 2 FREESTYLE TEST 2 QL MINIMED SYRINGE RESERVOIR/3ML/22G X 1/2" 2

ONETOUCH VERIO FLEX SYSTEM 2

PENLET II BLOOD SAMPLER 2 PRECISION XTRA KETONE 2


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ELECTROLYTIC, CALORIC, AND WATER BALANCE ACIDIFYING AND ALKALINIZING AGENTS K-PHOS NO 2 2 pot & sod citrates w/citric ac 1, 2 potassium citrate (alkalinizer) 1 potassium citrate-citric acid 1 sodium acetate 1 sodium bicarbonate 1 sodium citrate & citric acid 1 AMMONIA DETOXICANTS lactulose 1 lactulose (encephalopathy) 1 CALORIC AGENTS amino acid infusion 1, 2

CLINIMIX E/DEXTROSE (5/15) 2

CLINIMIX E/DEXTROSE (5/20) 2

CLINIMIX/DEXTROSE (5/15) 2

dextrose 1 fat emulsion 1 PROCALAMINE 2 DIURETICS amiloride & hydrochlorothiazide 1 amiloride hcl 1 bumetanide 1 chlorothiazide 1 chlorthalidone 1 ethacrynate sodium 1 furosemide 1 hydrochlorothiazide 1 indapamide 1 mannitol 1 metolazone 1 torsemide 1 triamterene & hydrochlorothiazide 1

ION-REMOVING AGENTS RENVELA 2 sodium polystyrene sulfonate 1 IRRIGATING SOLUTIONS acetic acid 1 sodium chloride (gu irrigant) 1 water for irrigation, sterile 1



REPLACEMENT PREPARATIONS calcium acetate (phosphate binder) 1, 2

calcium chloride (dihydrate) 1 calcium gluconate 1 dextrose in lactated ringers 1 dextrose w/ sodium chloride 1 K-PHOS 2 K-PHOS-NEUTRAL 2 KCL-LACTATED RINGERS-D5W 2

lactated ringer's 1 potassium acetate 1 potassium bicarbonate 1 potassium chloride 1, 2 potassium chloride in dextrose & sodium chloride 1, 2

potassium chloride in nacl 1 potassium chloride microencapsulated crystals cr 1, 2

potassium phosphates 1 sodium chloride 1 sodium phosphates (sodium phosphate dibasic & monobasic) 1

ZINC TRACE METAL 2 URICOSURIC AGENTS probenecid 1 ENZYMES ENZYMES ADAGEN 2 LD FABRAZYME 4 PULMOZYME 4 VIMIZIM 4 VPRIV 4 EYE, EAR, NOSE, AND THROAT (EENT) PREPARATIONS ANTI-INFECTIVES BACITRACIN 1 bacitracin-polymyxin b (ophth) 1 BETADINE OPHTHALMIC PREP 2

ciprofloxacin hcl (ophth) 1, 2 erythromycin (ophth) 1 gatifloxacin (ophth) 1 gentamicin sulfate (ophth) 1 NATACYN 2


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neomycin-bacitracin zn-polymyxin 1

neomycin-polymyxin-gramicidin 1 ofloxacin (ophth) 1 ofloxacin (otic) 1 polymyxin b-trimethoprim 1 sulfacetamide sodium (ophth) 1 tobramycin (ophth) 1, 2 trifluridine 1 ANTI-INFLAMMATORY AGENTS bacitracin-poly-neomycin-hc 1 CIPRODEX 2 CORTISPORIN-TC 2 dexamethasone sodium phosphate (ophth) 1

diclofenac sodium (ophth) 1 FLUNISOLIDE 1 fluorometholone (ophth) 1, 2 flurbiprofen sodium 1 fluticasone propionate (nasal) 1 hydrocortisone w/acetic acid 1 ketorolac tromethamine (ophth) 1 neomycin-polymy-dexameth 1 NEOMYCIN-POLYMYXIN-HC 1 neomycin-polymyxin-hc (otic) 1 PRED-G 2 prednisolone acetate (ophth) 1, 2 PREDNISOLONE SODIUM PHOSPHATE 1

sulfacetamide sod-prednisolone 1, 2 tobramycin-dexamethasone 1, 2 VEXOL 2 ANTIALLERGIC AGENTS azelastine hcl 1 cromolyn sodium (ophth) 1 olopatadine hcl 1 ANTIGLAUCOMA AGENTS timolol maleate (ophth) 1 EENT DRUGS, MISCELLANEOUS acetic acid (otic) 1 ACETIC ACID-ALUMINUM ACETATE 1

betaxolol hcl (ophth) 1 brimonidine tartrate 1 dorzolamide hcl 1 dorzolamide hcl-timolol maleate 1 ipratropium bromide (nasal) 1



latanoprost 1 levobunolol hcl 1 METIPRANOLOL 1 ophthalmic irrigation solution - intraocular 1, 2 PHOTREXA VISCOUS 2 pilocarpine hcl 1 timolol maleate (ophth) 1 LOCAL ANESTHETICS ALCAINE 1 fluorescein w/ benoxinate 1 lidocaine hcl (mouth-throat) 1 tetracaine hcl (ophth) 1 MYDRIATICS atropine sulfate (ophthalmic) 1 CYCLOMYDRIL 1 cyclopentolate hcl 1 homatropine hbr 1 tropicamide 1 VASOCONSTRICTORS phenylephrine hcl (ophth) 1 GASTROINTESTINAL DRUGS ANTI-INFLAMMATORY AGENTS balsalazide disodium 1 mesalamine 1, 2 ANTIEMETICS AKYNEO 2 aprepitant 1 ondansetron 1 ondansetron hcl 1 prochlorperazine 1 TRANSDERM-SCOP(1.5 MG) 2 ANTIULCER AGENTS AND ACID SUPPRESSANTS famotidine 1 misoprostol 1 omeprazole 1 pantoprazole sodium 1, 2 ranitidine hcl 1 sucralfate 1 DIGESTANTS CREON 2 PANCRELIPASE 16000 2 GI DRUGS, MISCELLANEOUS diphenoxylate w/ atropine 1 LIBRAX 2 metoclopramide hcl 1


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peg 3350-kcl-sod bicarb-sod chloride-sod sulfate 1 Ursodiol 1 GOLD COMPOUNDS GOLD COMPOUNDS MYOCHRYSINE 2 HEAVY METAL ANTAGONISTS HEAVY METAL ANTAGONISTS deferoxamine mesylate 1 DEPEN TITRATABS 2 EXJADE 2, 4 HORMONES AND SYNTHETIC SUBSTITUTES ADRENALS budesonide 1 budesonide (inhalation) 1 CELESTONE SOLUSPAN 2 CORTISONE ACETATE 1 dexamethasone 1 dexamethasone sodium phosphate 1

DULERA 2 FLOVENT HFA 2 fludrocortisone acetate 1 hydrocortisone 1 KENALOG 2 methylprednisolone 1, 2 methylprednisolone acetate 1, 2 methylprednisolone sod succ 1, 2 prednisolone 1 prednisolone sodium phosphate 1 prednisone 1 QVAR 2 SOLU-CORTEF 2 ANDROGENS danazol 1 testosterone cypionate 1 QL testosterone enanthate 1 QL CONTRACEPTIVES desogestrel & ethinyl estradiol 1 drospirenone-ethinyl estradiol 1 ELLA 2 ethynodiol diacet & eth estrad 1 levonorgestrel & eth estradiol 1 levonorgestrel-eth estradiol (triphasic) 1

NECON 1/50 (28) 2 NECON 10/11 (28) 1



norethin acet & estrad-fe 1 norethindrone & eth estradiol 1 norethindrone (contraceptive) 1 norethindrone acet & eth estra 1 norethindrone-eth estradiol (triphasic) 1

norgestimate-ethinyl estradiol (triphasic) 1

NUVARING 2 PLAN B ONE-STEP 2 XULANE 1 DIABETIC AGENTS acarbose 1 glipizide 1 GLUCAGON EMERGENCY 2 HUMALOG 2 HUMULIN 70/30 2 HUMULIN N 2 HUMULIN R 2 LANTUS 2 metformin hcl 1 pioglitazone hcl 1 ESTROGENS AND ANTIESTROGENS esterified estrogens & methyltestosterone 1

estradiol 1, 2 estradiol vaginal 1 PREMARIN 2 raloxifene hcl 1 GONADOTROPINS BRAVELLE 2 QL CHORIONIC GONADOTROPIN 1 QL CLOMIPHENE CITRATE 1 FOLLISTIM AQ 2 QL GANIRELIX ACETATE 2 QL GONAL-F 2 QL MENOPUR 2 QL IUD MIRENA 52 MG 2 NEXPLANON 2 PARATHYROID FORTICAL 2 PITUITARY desmopressin acetate 1, 2 desmopressin acetate refrigerated 1 desmopressin acetate spray 1


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desmopressin acetate spray refrigerated 1 PROGESTINS DEPO-PROVERA 2 HYDROXYPROGESTERONE CAPROATE 1

MAKENA 2 medroxyprogesterone acetate 1 medroxyprogesterone acetate (contraceptive) 1 QL

norethindrone acetate 1 progesterone 1 PA, QL progesterone micronized 1 PA SOMATROPIN AGONISTS-ANTAGONISTS OMNITROPE 2 QL THYROID AND ANTITHYROID AGENTS levothyroxine sodium 1 liothyronine sodium 1 methimazole 1 propylthiouracil 1 thyroid 1 MEDICAL DEVICE DIAPHRAGM WIDE-SEAL DIAPHRAGM 60 2 IUD PARAGARD INTRAUTERINE COPPER 2 MEDICAL DEVICE AEROCHAMBER Z-STAT PLUS 2 AEROGEAR ACTION ASTHMA KIT 2

CATHFLO ACTIVASE 2 DEVILBISS COMPACT COMPRESSOR 2 DEVILBISS DISPOSABLE NEBULIZER 2 PIKO 1 2 MISCELLANEOUS THERAPEUTIC AGENTS MISCELLANEOUS THERAPEUTIC AGENTS ACTIMMUNE 4 QL, LD albumin, human 1 ALBUSTIX 2 alendronate sodium 1 ALFERON N 2 QL ALLERGIST TRAY 2 allopurinol 1 AVONEX 4 QL



azathioprine 1 BACTERIOSTATIC WATER(BENZ ALC) 2

BD DISP NEEDLE 2 BD DISP NEEDLES 2 BD DISP NEEDLES 2 BD DISP NEEDLES 2 BD DISP NEEDLES 2 BD FILTER NEEDLE/5 MICRON 2

BD INSULIN SYR ULTRAFINE II 2

BD LUER-LOK SYRINGE 2 BD LUER-LOK SYRINGE 2 BD LUER-LOK SYRINGE 2 BD LUER-LOK SYRINGE 2 BD SYRINGE BLUNT CANNULA 17G 2

BD SYRINGE/NEEDLE SLIP TIP 2

BOTOX 2 BRIDION 2 bromocriptine mesylate 1 bupivacaine hcl 1 bupivacaine in dextrose 1 bupivacaine w/ epinephrine 1 CAMPHOR 2 CERDELGA 4 LD CHLORAMPHENICOL 2 COAL TAR EXTRACT 2 COLCHICINE 2 CORTROSYN 2 cromolyn sodium (mastocytosis) 1 cyclosporine 1, 2 cyclosporine modified (for microemulsion) 1

dexrazoxane 1 DIASTIX 2 disulfiram 1 dobutamine in d5w 1 dopamine in d5w 1 ELMIRON 2 ENBREL 4 QL EOVIST 2 ETIDRONATE DISODIUM 1 EXPAREL 2 EXTAVIA 2 QL


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finasteride 1 FIRAZYR 4 QL GADAVIST 2 GELFOAM SPONGE 2 glatiramer acetate 1 QL GRASTEK 2 HESPAN 2 HUMIRA 4 QL INFLECTRA 4 INTRON A 2, 4 QL KETO-DIASTIX 2 KETOSTIX 2 KETOPROFEN 2 leflunomide 1 LETS 2 leucovorin calcium 1, 2 LIDOCAINE 2 LIDOCAINE HCL 2 lidocaine hcl (local anesth.) 1, 2 LUCENTIS 2 LD MAGNEVIST 2 MENTHOL 2 mesna 1, 2 MONOJECT SYRINGE 2 mycophenolate mofetil 1 octreotide acetate 1, 4 QL OMNITROPE PEN 5 INJ DEVICE 2 QL

ORENCIA 4 QL OTEZLA 4 QL oxytocin 1, 2 pamidronate disodium 1 PCCA LIPODERM BASE 2 PHENOL 2 PROVOCHOLINE 2 RAGWITEK 2 RASUVO 2 QL READI-CAT 2 2 REMICADE 4 REVLIMID 4 PA, LD RIMSO-50 2 saline, bacteriostatic 1 SCULPTRA 2 SENSIPAR 2, 4 sodium chloride flush 1 sodium fluoride 1, 2



SSKI 2 SULFAMETHOXAZOLE 2 SULFUR PRECIPITATED 2 tacrolimus 1, 2 tamsulosin hcl 1 THALOMID 4 PA, LD THYMOL 2 THYROGEN 2 TUBERSOL 2 URISTIX 2 water for injection, sterile 1 XELJANZ 4 zoledronic acid 1, 2 MUSCULOSKELETAL THERAPY HYALGAN 2 VITAMINS AQUASOL A 2 ascorbic acid 1 cyanocobalamin 1 QL ergocalciferol 1 folic acid 1 iron polysaccharide complex-vit b12-folic acid 1 multiple vitamins w/ minerals 1 phytonadione 1, 2 potassium aminobenzoate 1, 2 PRENATAL PLUS IRON 2 pyridoxine hcl 1 SSKI 2 trace minerals (cr-cu-mn-se-zn) 1 VENOFER 2 OXYTOCICS OXYTOCICS methylergonovine maleate 1 MIFEPREX 2 RESPIRATORY TRACT AGENTS ANTI-INFLAMMATORY AGENTS CROMOLYN SODIUM 1 montelukast sodium 1 ANTITUSSIVES benzonatate 1 DURATUSS HD 2 guaifenesin-codeine 1 QL hydrocodone w/ homatropine 1 QL phenyleph-cpm w/ hydrocod 1 QL


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phenylephrine-ephedrine-chlorpheniramine w/ carbetapentane

1

RESPIRATORY AGENTS, MISCELLANEOUS acetylcysteine 1 ASMANEX 120 METERED DOSES 2 brompheniramine & phenyleph 1 ORKAMBI 4 LD sodium chloride (inhalant) 1 SERUMS, TOXOIDS, AND VACCINES SERUMS FLEBOGAMMA DIF 2 GAMASTAN S/D 2 QL GAMMAGARD 2 QL HYPERRHO S/D 2 IMOGAM RABIES-HT 2 IXIARO 2 NABI-HB 2 TOXOIDS ADACEL 2 INFANRIX 2 KINRIX 2 PROQUAD 2 TE ANATOXAL BERNA 2 TENIVAC 2 VACCINES ACTHIB 2 AFLURIA 2 AFLURIA PRESERVATIVE FREE 2

BEXSERO 2 ENGERIX-B 2 FLUARIX QUADRIVALENT 2 FLUBLOK 2 FLUCELVAX QUADRIVALENT 2 FLUMIST QUADRIVALENT 2 FLUVIRIN 2 FLUZONE HIGH-DOSE 2 GAMUNEX 2 GARDASIL 9 2 HAVRIX 2 IMOVAX RABIES 2 IPOL 2 JE-VAX 2 M-M-R II 2 MENOMUNE 2



MENVEO 2 MERUVAX II W/DILUENT 10 DOSE 2

MUMPSVAX W/DILUENT 10 DOSE 2

PEDIARIX 2 PNEUMOVAX 23 2 PREVNAR 13 2 RABAVERT 2 ROTARIX 2 ROTATEQ 2 TICE BCG 2 TYPHIM VI 2 VARIVAX 2 VAXCHORA 2 VIVOTIF 2 YF-VAX 2 ZOSTAVAX 2 SKIN AND MUCOUS MEMBRANE AGENTS ANTI-INFECTIVES ARZOL SILVER NIT APPLICATORS 2

benzoyl peroxide-erythromycin 1 ciclopirox olamine 1 clindamycin phosphate (topical) 1 clindamycin phosphate vaginal 1 clotrimazole 1 erythromycin (acne aid) 1 gentamicin sulfate (topical) 1 ketoconazole (topical) 1 metronidazole (topical) 1 metronidazole vaginal 1 mupirocin 1 mupirocin calcium (topical) 1 nystatin (topical) 1 NYSTATIN VAGINAL 2 permethrin 1 selenium sulfide 1 silver sulfadiazine 1 sulfacetamide sodium (acne) 1 terbinafine hcl 1 PA ANTI-INFLAMMATORY AGENTS betamethasone dipropionate (topical) 1

betamethasone dipropionate augmented 1

betamethasone valerate 1


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CLIOQUINOL/HYDROCORTISONE 2

clobetasol propionate 1, 2 desoximetasone 1 DIFLORASONE DIACETATE 1 fluocinolone acetonide 1 fluocinonide 1 fluocinonide emulsified base 1 hydrocortisone (intrarectal) 1 hydrocortisone (rectal) 1 hydrocortisone (topical) 1 hydrocortisone butyrate 1 hydrocortisone valerate 1 iodoquinol-hc 1 mometasone furoate 1 nystatin-triamcinolone 1 PROCTOFOAM HC 1 triamcinolone acetonide (mouth) 1 triamcinolone acetonide (topical) 1, 2 urea-hc acetate 1 CELL STIMULANTS AND PROLIFERANTS tretinoin 1, 2 SKIN AND MUCOUS MEMBRANE AGENTS, MISCELLANEOUS 8-MOP 2 acitretin 1 adapalene 1, 2 aluminum chloride 1 AZELEX 2 calcipotriene 1 diclofenac sodium (topical) 1 EPIDUO 2 FINACEA 2 fluorouracil (topical) 1 imiquimod 1 isotretinoin 1 lidocaine hcl 1 lidocaine-prilocaine 1



methoxsalen rapid 1 OXSORALEN 2 podofilox 1, 2 salicylic acid 1, 2 SANTYL 2 tacrolimus (topical) 1 urea 1 VECTICAL 2 SMOOTH MUSCLE RELAXANTS GENITOURINARY SMOOTH MUSCLE RELAXANTS aminophylline 1, 2 oxybutynin chloride 1 oxybutynin chloride 1 theophylline 1 trospium chloride 1 VASODILATING AGENTS MISCELLANEOUS THERAPEUTIC AGENTS yohimbine hcl 1 PHOSPHODIESTERASE INHIBITORS CAVERJECT 2 QL VITAMINS VITAMINS calcitriol 1, 2 INFED 2 INFUVITE PEDIATRIC 2 INFUVITE 2 pediatric vitamins w/fl & iron 1, 2 pediatric multivitamins w/fl 1 pediatric vitamins acd fluoride & iron 1

pediatric vitamins acd w/ fluoride 1 prenatal vit w/ ferrous fumarate-folic acid 1, 2

prenatal vit w/ iron carbonyl-folic acid 1

prenatal vit w/ selenium-fe fumarate-folic acid 1

thiamine hcl 1 QL


Page 18


Page 19

8 8-MOP ............................................................................................. 17

A abacavir sulfate ................................................................................ 5 abacavir sulfate-lamivudine ............................................................... 5 abacavir sulfate-lamivudine ............................................................ 5 abacavir sulfate-lamivudine-zidovudine ........................................ 5 acamprosate calcium .................................................................... 10 acarbose ......................................................................................... 13 acetaminophen w/ codeine ............................................................. 9 acetazolamide .................................................................................. 8 acetazolamide sodium .................................................................... 8 acetic acid ................................................................................. 11, 12 acetic acid (otic) ............................................................................. 12 ACETIC ACID-ALUMINUM ACETATE ....................................... 12 acetylcysteine ................................................................................. 16 acitretin ............................................................................................ 17 ACTHIB ........................................................................................... 16 ACTIMMUNE .................................................................................. 14 acyclovir ............................................................................................ 5 acyclovir sodium ............................................................................... 5 ADACEL .......................................................................................... 16 ADAGEN ......................................................................................... 11 adapalene ....................................................................................... 17 adefovir dipivoxil ............................................................................... 5 ADEMPAS ........................................................................................ 9 adenosine.......................................................................................... 8 ADVAIR DISKUS ............................................................................. 7 ADVOCATE CONTROL SOLUTION .......................................... 10 AEROCHAMBER Z-STAT PLUS ................................................ 14 AEROGEAR ACTION ASTHMA KIT........................................... 14 AFINITOR ......................................................................................... 6 AFLURIA ......................................................................................... 16 AFLURIA PRESERVATIVE FREE .............................................. 16 AKYNEO ......................................................................................... 12 ALBENZA ...................................................................................... 3, 4 albumin, human .............................................................................. 14 ALBUSTIX ....................................................................................... 14 albuterol sulfate ................................................................................ 7 ALCAINE ......................................................................................... 12 alendronate sodium ....................................................................... 14 ALFERON N ................................................................................... 14 ALIMTA ............................................................................................. 6 ALLERGIST TRAY ........................................................................ 14 allopurinol ........................................................................................ 14 alprazolam ........................................................................................ 7 ALPROLIX ........................................................................................ 8 aluminum chloride .......................................................................... 17 ALUNBRIG ........................................................................................ 6

amantadine hcl ................................................................................. 5 AMICAR ............................................................................................ 8 amikacin sulfate ............................................................................... 4 amiloride & hydrochlorothiazide .................................................. 11 amiloride hcl ................................................................................... 11 amino acid infusion .......................................................................... 11 amino acid infusion ........................................................................ 11 aminophylline ................................................................................. 17 amiodarone hcl ................................................................................ 8 amitriptyline hcl .............................................................................. 10 amlodipine besylate......................................................................... 8 amoxicillin ..................................................................................... 3, 4 amoxicillin & pot clavulanate .......................................................... 4 amphetamine-dextroamphetamine ............................................... 9 AMPHOTERICIN B ......................................................................... 5 ampicillin ........................................................................................... 4 ampicillin & sulbactam sodium....................................................... 4 ampicillin sodium ............................................................................. 4 AMYL NITRITE ................................................................................ 9 anagrelide hcl ................................................................................... 8 anastrozole ....................................................................................... 6 aprepitant ........................................................................................ 12 APTIVUS........................................................................................... 5 AQUASOL A ................................................................................... 15 aripiprazole ..................................................................................... 10 ARZOL SILVER NIT APPLICATORS ......................................... 16 ascorbic acid .................................................................................. 15 ASMANEX 120 METERED DOSES ........................................... 16 aspirin ............................................................................................. 8, 9 aspirin-dipyridamole .......................................................................... 8 aspirin-dipyridamole ........................................................................ 8 ASTHMAPACK I ............................................................................ 14 atenolol .............................................................................................. 8 atenolol & chlorthalidone ................................................................ 8 atorvastatin calcium......................................................................... 8 atovaquone ....................................................................................... 5 atovaquone-proguanil hcl ............................................................... 5 ATRIPLA ........................................................................................... 5 atropine sulfate .......................................................................... 7, 12 atropine sulfate (ophthalmic) ........................................................ 12 ATROVENT HFA ............................................................................. 7 AUTOPEN ...................................................................................... 10 AVASTIN........................................................................................... 6 AVELOX ............................................................................................ 4 AVONEX ......................................................................................... 14 azacitidine ......................................................................................... 6 azathioprine .................................................................................... 14 azelastine hcl.................................................................................. 12 AZELEX .......................................................................................... 17 azithromycin ..................................................................................... 4 aztreonam ......................................................................................... 4


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B bacitracin ............................................................................... 4, 11, 12 BACITRACIN .................................................................................. 11 bacitracin-polymyxin b (ophth) ..................................................... 11 bacitracin-poly-neomycin-hc ......................................................... 12 baclofen ............................................................................................. 7 BACTERIOSTATIC WATER(BENZ ALC) .................................. 14 balsalazide disodium ..................................................................... 12 BANZEL ............................................................................................ 9 BD AUTOSHIELD DUO ................................................................ 10 BD DISP NEEDLE ................................................................... 10, 14 BD DISP NEEDLES ................................................................ 10, 14 BD FILTER NEEDLE/5 MICRON ................................................ 14 BD INSULIN SYR ULTRAFINE II ................................................ 14 BD INSULIN SYRINGE ................................................................. 10 BD INSULIN SYRINGE U-500 ..................................................... 10 BD INSULIN SYRINGE U-500 .............................................................. 10 BD LANCET ULTRAFINE 30G .................................................... 10 BD LUER-LOK SYRINGE............................................................. 14 BD SYRINGE BLUNT CANNULA 17G ....................................... 14 BD SYRINGE/NEEDLE SLIP TIP ................................................ 14 BENDEKA ......................................................................................... 6 benzonatate .................................................................................... 15 benzoyl peroxide-erythromycin .................................................... 16 benztropine mesylate ...................................................................... 7 BETADINE OPHTHALMIC PREP ............................................... 11 betamethasone dipropionate (topical) ......................................... 16 betamethasone dipropionate augmented ................................... 16 betamethasone valerate ............................................................... 16 betaxolol hcl ..................................................................................... 12 betaxolol hcl (ophth) ...................................................................... 12 bethanechol chloride ....................................................................... 7 bexarotene ........................................................................................ 6 BEXSERO ....................................................................................... 16 bicalutamide ...................................................................................... 6 BICILLIN L-A .................................................................................... 4 BICNU ............................................................................................... 6 bisoprolol & hydrochlorothiazide .................................................... 8 bisoprolol fumarate .......................................................................... 8 bleomycin sulfate ............................................................................. 6 BOTOX .............................................................................................. 14 BRAVELLE ..................................................................................... 13 BRIDION ......................................................................................... 14 BRILINTA .......................................................................................... 8 brimonidine tartrate ........................................................................ 12 bromocriptine mesylate ................................................................. 14 bronpheniramine & phenyleph ..................................................... 16 budesonide ..................................................................................... 13 budesonide (inhalation) ................................................................. 13 bumetanide ..................................................................................... 11 bupivacaine hcl............................................................................... 14 bupivacaine in dextrose ................................................................ 14 bupivacaine w/ epinephrine .......................................................... 14

buprenorphine hcl .............................................................................. 9 buprenorphine hcl-naloxone hcl dihydrate ................................... 9 bupropion hcl .................................................................................. 10 buspirone hcl .................................................................................... 9 butalbital-acetaminophen-caffeine ................................................ 9 butalbital-aspirin-caffeine................................................................ 9 butorphanol tartrate ......................................................................... 9

C CABOMETYX ................................................................................... 6 caffeine citrate .................................................................................. 9 calcipotriene ................................................................................... 17 calcitriol ........................................................................................... 17 calcium acetate (phosphate binder) ............................................ 11 calcium chloride (dihydrate) ......................................................... 11 calcium gluconate .......................................................................... 11 CAMPATH ........................................................................................ 6 CAMPHOR ..................................................................................... 14 capecitabine ..................................................................................... 6 CAPRELSA ...................................................................................... 6 carbamazepine ................................................................................ 9 carbidopa ........................................................................................ 10 carbidopa-levodopa ....................................................................... 10 carboplatin ........................................................................................ 6 CARDENE IV ................................................................................... 8 carvedilol ........................................................................................... 8 CATHFLO ACTIVASE .................................................................. 14 CAVERJECT .................................................................................. 17 CEENU .............................................................................................. 6 cefaclor .............................................................................................. 4 CEFAZOLIN IN D5W ...................................................................... 4 cefazolin sodium .............................................................................. 4 cefdinir ............................................................................................... 4 cefepime hcl ..................................................................................... 4 CEFEPIME-DEXTROSE ................................................................ 4 cefixime ............................................................................................. 4 cefoxitin sodium ............................................................................... 4 ceftazidime ....................................................................................... 4 CEFTAZIDIME AND DEXTROSE ................................................. 4 ceftriaxone sodium .......................................................................... 4 CEFTRIAXONE SODIUM IN DEXTROSE ................................... 4 CEFTRIAXONE SODIUM-DEXTROSE ....................................... 4 cefuroxime axetil .............................................................................. 4 cefuroxime sodium .......................................................................... 4 CELESTONE SOLUSPAN ........................................................... 13 CELONTIN ....................................................................................... 9 cephalexin......................................................................................... 4 CERDELGA .................................................................................... 14 CERUBIDINE ................................................................................... 6 CHLORAMPHENICOL ................................................................. 14 chlordiazepoxide hcl ........................................................................ 7 chloroquine phosphate ................................................................... 5 chlorothiazide ................................................................................. 11


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chlorpromazine hcl ......................................................................... 10 chlorthalidone ............................................................................... 8, 11 cholestyramine ................................................................................. 8 cholestyramine light ......................................................................... 8 choline & mag salicylate ................................................................. 9 CHORIONIC GONADOTROPIN .................................................. 13 ciclopirox ........................................................................................... 16 ciclopirox olamine .......................................................................... 16 cilostazol............................................................................................ 8 CIPRODEX ..................................................................................... 12 ciprofloxacin ................................................................................ 4, 11 ciprofloxacin hcl .......................................................................... 4, 11 ciprofloxacin hcl (ophth) ................................................................ 11 ciprofloxacin in d5w ......................................................................... 4 cisatracurium besylate .................................................................. 10 cisplatin ............................................................................................. 6 citalopram hydrobromide .............................................................. 10 cladribine ........................................................................................... 6 CLAFORAN ...................................................................................... 4 clarithromycin ................................................................................... 4 CLEVIPREX ...................................................................................... 8 clindamycin hcl ................................................................................. 4 clindamycin palmitate hydrochloride ............................................. 4 clindamycin phosphate .............................................................. 4, 16 clindamycin phosphate (topical) .................................................. 16 clindamycin phosphate vaginal .................................................... 16 CLINIMIX ......................................................................................... 11 CLINIMIX E/DEXTROSE (5/15) ........................................................... 11 CLINIMIX E/DEXTROSE (5/20) ........................................................... 11 CLINIMIX/DEXTROSE .................................................................. 11 CLINIMIX/DEXTROSE (5/15) .............................................................. 11 CLIOQUINOL/HYDROCORTISONE........................................... 17 clobetasol propionate .................................................................... 17 CLOMIPHENE CITRATE .............................................................. 13 clonazepam ...................................................................................... 7 clonidine hcl ...................................................................................... 8 clonidine-hcl-(analgesia) ................................................................. 9 clopidogrel bisulfate ......................................................................... 8 clorazepate dipotassium ................................................................. 7 clotrimazole ..................................................................................... 16 clozapine ......................................................................................... 10 COAL TAR EXTRACT .................................................................. 14 COARTEM ........................................................................................ 5 CODEINE PHOSPHATE ................................................................ 9 CODEINE SULFATE ....................................................................... 9 COLCHICINE ................................................................................. 14 colestipol hcl ..................................................................................... 8 colistimethate sodium ...................................................................... 4 COMBIVENT RESPIMAT ............................................................... 7 COMPLERA ...................................................................................... 5 CORTISONE ACETATE ............................................................... 13 CORTISPORIN .................................................................................... 12 CORTISPORIN-TC ........................................................................ 12 CORTROSYN................................................................................. 14

CREON ........................................................................................... 12 CRIXIVAN ......................................................................................... 5 cromolyn sodium ...................................................................... 12, 14 CROMOLYN SODIUM .................................................................. 15 cromolyn sodium (mastocytosis) ................................................. 14 cromolyn sodium (ophth) .............................................................. 12 cyanocobalamin ............................................................................. 15 cyclobenzaprine hcl ......................................................................... 7 CYCLOMYDRIL ............................................................................. 12 cyclopentolate hcl .......................................................................... 12 cyclophosphamide ........................................................................... 6 cyclosporine ................................................................................... 14 cyclosporine modified (for microemulsion) ................................. 14 cyproheptadine hcl .......................................................................... 6 CYRAMZA ........................................................................................ 6 cytarabine ......................................................................................... 6 CYTOVENE ...................................................................................... 5

D dacarbazine ...................................................................................... 6 dactinomycin .................................................................................... 6 DAKLINZA ........................................................................................ 5 danazol ............................................................................................ 13 dantrolene sodium ........................................................................... 7 dapsone .............................................................................................. 5 DAPSONE ........................................................................................ 5 daptomycin ....................................................................................... 4 DARAPRIM ....................................................................................... 5 decitabine ......................................................................................... 6 deferoxamine mesylate ................................................................. 13 DEPEN TITRATABS ..................................................................... 13 DEPO-PROVERA .......................................................................... 14 DESCOVY ........................................................................................ 5 desipramine hcl .............................................................................. 10 desmopressin acetate ............................................................. 13, 14 desmopressin acetate refrigerated.............................................. 13 desmopressin acetate spray .................................................. 13, 14 desmopressin acetate spray refrigerated ................................... 14 desogestrel & ethinyl estradiol ..................................................... 13 desoximetasone ............................................................................. 17 DEVILBISS COMPACT COMPRESSOR ................................... 14 DEVILBISS DISPOSABLE NEBULIZER .................................... 14 dexamethasone ....................................................................... 12, 13 dexamethasone sodium phosphate ...................................... 12, 13 dexamethasone sodium phosphate (ophth) .............................. 12 dexmedetomidine hcl ...................................................................... 9 dexrazoxane ................................................................................... 14 dexrazoxane ..................................................................................... 14 dextroamphetamine sulfate ............................................................ 9 dextrose ................................................................................ 5, 11, 14 dextrose in lactated ringers .......................................................... 11 dextrose w/ sodium chloride ........................................................ 11 DIASTAT ACUDIAL......................................................................... 9


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DIASTIX .......................................................................................... 14 diazepam ........................................................................................... 7 diclofenac sodium ................................................................ 9, 12, 17 diclofenac sodium (ophth)............................................................. 12 diclofenac sodium (topical) ........................................................... 17 dicloxacillin sodium .......................................................................... 4 dicyclomine hcl ................................................................................. 7 didanosine ......................................................................................... 5 DIETHYLSTILBESTROL ................................................................ 6 DIFLORASONE DIACETATE ...................................................... 17 digoxin ............................................................................................... 8 dihydroergotamine mesylate .......................................................... 9 diltiazem hcl ...................................................................................... 8 diltiazem hcl coated beads ............................................................. 8 diphenhydramine hcl ....................................................................... 6 diphenoxylate w/ atropine ............................................................. 12 dipyridamole ..................................................................................... 8 disopyramide phosphate ................................................................. 8 disulfiram ......................................................................................... 14 divalproex sodium ............................................................................ 9 dobutamine hcl ................................................................................. 8 dobutamine in d5w ......................................................................... 14 dofetilide ............................................................................................ 8 donepezil hydrochloride .................................................................. 7 dopamine in d5w ............................................................................ 14 dorzolamide hcl .............................................................................. 12 dorzolamide hcl-timolol maleate .................................................. 12 doxepin hcl ...................................................................................... 10 doxorubicin hcl ................................................................................. 6 doxorubicin hcl liposomal ................................................................ 6 doxycycline (monohydrate) ............................................................. 4 doxycycline hyclate .......................................................................... 4 droperidol .......................................................................................... 9 drospirenone-ethinyl estradiol ...................................................... 13 DULERA .......................................................................................... 13 duloxetine hcl .................................................................................. 10 DURATUSS HD ............................................................................. 15

E EDURANT ......................................................................................... 5 ELLA ................................................................................................ 13 ELMIRON ........................................................................................ 14 ELOCTATE ....................................................................................... 8 EMBEDA ........................................................................................... 9 EMCYT .............................................................................................. 6 EMTRIVA .......................................................................................... 5 enalapril maleate .............................................................................. 8 ENBREL .......................................................................................... 14 ENGERIX-B .................................................................................... 16 entacapone ..................................................................................... 10 entecavir ............................................................................................ 5 ENTRESTO ...................................................................................... 8 ENTRESTO ........................................................................................... 8

EOVIST ........................................................................................... 14 EPCLUSA ......................................................................................... 5 EPIDUO .......................................................................................... 17 EPINEPHRINE ................................................................................. 7 epinephrine hcl ................................................................................. 7 epirubicin hcl .................................................................................... 6 ERBITUX .......................................................................................... 6 ergocalciferol .................................................................................. 15 ERGOLOID MESYLATES .............................................................. 7 ERYTHROCIN LACTOBIONATE .................................................. 4 erythromycin (acne aid) ................................................................ 16 erythromycin (ophth) ..................................................................... 11 erythromycin base ........................................................................... 4 erythromycin ethylsuccinate ........................................................... 4 erythromycin-sulfisoxazole ............................................................. 4 escitalopram oxalate ..................................................................... 10 esmolol hcl ........................................................................................ 8 esterified estrogens & methyltestosterone ................................. 13 estradiol .......................................................................................... 13 estradiol vaginal ............................................................................. 13 ethacrynate sodium ....................................................................... 11 ethacrynate sodium .......................................................................... 11 ethambutol hcl .................................................................................. 5 ethosuximide .................................................................................... 9 ethynodiol diacet & eth estrad ..................................................... 13 ETIDRONATE DISODIUM ........................................................... 14 etodolac ............................................................................................ 9 etomidate ........................................................................................ 10 etoposide .......................................................................................... 6 exemestane ...................................................................................... 6 EXJADE .......................................................................................... 13 EXPAREL ....................................................................................... 14 EXTAVIA ......................................................................................... 14

F FABRAZYME ................................................................................. 11 famotidine ....................................................................................... 12 FASLODEX ...................................................................................... 6 fat emulsion .................................................................................... 11 fenofibrate ......................................................................................... 8 fentanyl .............................................................................................. 9 fentanyl citrate .................................................................................. 9 FINACEA ........................................................................................ 17 finasteride ....................................................................................... 15 FIRAZYR......................................................................................... 15 FLEBOGAMMA DIF ...................................................................... 16 flecainide acetate ............................................................................. 8 FLOVENT HFA .............................................................................. 13 floxuridine ......................................................................................... 6 FLUARIX QUADRIVALENT ......................................................... 16 FLUBLOK ....................................................................................... 16 FLUCELVAX QUADRIVALENT ................................................... 16 FLUCELVAX QUADRIVALENT ............................................................. 16


Page 23

fluconazole ........................................................................................ 5 fluconazole in dextrose ................................................................... 5 fluconazole in nacl ........................................................................... 5 fludarabine phosphate ..................................................................... 6 fludrocortisone acetate .................................................................. 13 flumazenil ........................................................................................ 10 FLUMIST QUADRIVALENT ......................................................... 16 FLUNISOLIDE ................................................................................ 12 fluocinolone acetonide .................................................................. 17 fluocinonide ..................................................................................... 17 fluocinonide emulsified base ........................................................ 17 fluorescein w/ benoxinate ............................................................. 12 fluorometholone (ophth) ................................................................ 12 fluorouracil .................................................................................. 6, 17 fluorouracil (topical) ....................................................................... 17 fluoxetine hcl ................................................................................... 10 fluphenazine decanoate ................................................................ 10 fluphenazine hcl ............................................................................. 10 flurbiprofen ....................................................................................... 12 flurbiprofen sodium ........................................................................ 12 flutamide ............................................................................................ 6 fluticasone propionate ...................................................................... 12 fluticasone propionate (nasal) ...................................................... 12 FLUVIRIN ........................................................................................ 16 fluvoxamine maleate...................................................................... 10 FLUZONE HIGH-DOSE ................................................................ 16 folic acid .................................................................................... 15, 17 FOLLISTIM AQ............................................................................... 13 fondaparinux sodium ....................................................................... 8 FORTICAL ...................................................................................... 13 FOSCARNET SODIUM................................................................... 5 fosphenytoin sodium........................................................................ 9 FREESTYLE TEST ................................................................................ 10 furosemide ...................................................................................... 11

G gabapentin ........................................................................................ 9 GADAVIST ...................................................................................... 15 galantamine hydrobromide ............................................................. 7 GAMASTAN S/D ............................................................................ 16 GAMMAGARD ............................................................................... 16 GAMUNEX ...................................................................................... 16 GANIRELIX ACETATE ................................................................. 13 GARDASIL ...................................................................................... 16 GARDASIL 9 .................................................................................. 16 gatifloxacin (ophth) ........................................................................ 11 GAZYVA ............................................................................................ 6 GELFOAM SPONGE .................................................................... 15 gemcitabine hcl ................................................................................ 6 gemfibrozil ......................................................................................... 8 gentamicin sulfate ................................................................ 4, 11, 16 gentamicin sulfate (ophth) ............................................................ 11 gentamicin sulfate (topical) ........................................................... 16

GENVOYA ........................................................................................ 5 glatiramer acetate .......................................................................... 15 glipizide ........................................................................................... 13 GLUCAGON EMERGENCY ........................................................ 13 GONAL-F ........................................................................................ 13 GRASTEK ....................................................................................... 15 griseofulvin microsize ...................................................................... 5 griseofulvin ultramicrosize .............................................................. 5 guaifenesin-codeine ...................................................................... 15 guanfacine hcl .................................................................................. 8 guanfacine hcl (adhd) ................................................................... 10

H HALAVEN ......................................................................................... 6 haloperidol ...................................................................................... 10 haloperidol decanoate ................................................................... 10 haloperidol lactate ......................................................................... 10 HARVONI ......................................................................................... 5 HAVRIX ........................................................................................... 16 heparin sodium (porcine) ................................................................ 8 heparin sodium (porcine) lock flush .............................................. 8 HERCEPTIN ..................................................................................... 6 HESPAN ......................................................................................... 15 HEXALEN ......................................................................................... 6 homatropine hbr ............................................................................. 12 HUMALOG ..................................................................................... 13 HUMIRA .......................................................................................... 15 HUMULIN 70/30 ............................................................................ 13 HUMULIN N ................................................................................... 13 HUMULIN R ................................................................................... 13 HYALGAN ....................................................................................... 15 hydralazine hcl ................................................................................. 8 hydrochlorothiazide ............................................................... 8, 9, 11 hydrocodone w/ homatropine....................................................... 15 hydrocodone-acetaminophen ........................................................ 9 hydrocortisone.................................................................... 12, 13, 17 hydrocortisone (intrarectal) .......................................................... 17 hydrocortisone (rectal) .................................................................. 17 hydrocortisone (topical) ................................................................ 17 hydrocortisone butyrate ................................................................ 17 hydrocortisone valerate ................................................................ 17 hydrocortisone w/acetic acid ........................................................ 12 hydromorphone hcl .......................................................................... 9 hydroxychloroquine sulfate ............................................................ 5 HYDROXYPROGESTERONE CAPROATE .............................. 14 HYDROXYPROGESTERONE CAPROATE.............................................. 14 hydroxyurea ...................................................................................... 6 hydroxyzine hcl .............................................................................. 10 hydroxyzine pamoate .................................................................... 10 hyoscyamine .................................................................................... 7 hyoscyamine sulfate ........................................................................ 7 HYPERRHO S/D ........................................................................... 16


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I IBRANCE .......................................................................................... 6 ibuprofen ........................................................................................... 9 ICLUSIG ............................................................................................ 6 ifosfamide .......................................................................................... 6 imatinib mesylate ............................................................................. 6 imatinib mesylate ............................................................................... 6 IMBRUVICA ...................................................................................... 6 imipenem-cilastatin .......................................................................... 4 imipramine hcl ................................................................................ 10 imiquimod ........................................................................................ 17 IMOGAM RABIES-HT ................................................................... 16 IMOVAX RABIES ........................................................................... 16 indapamide ..................................................................................... 11 indomethacin .................................................................................... 9 INFANRIX ....................................................................................... 16 INFED .............................................................................................. 17 INFLECTRA ........................................................................................ 15 INFUVITE ........................................................................................... 17 INFUVITE PEDIATRIC .................................................................. 17 INLYTA .............................................................................................. 6 INTELENCE ...................................................................................... 5 INTRON A ....................................................................................... 15 INVANZ ............................................................................................. 4 INVIRASE ......................................................................................... 5 iodoquinol-hc .................................................................................. 17 IPOL ................................................................................................. 16 ipratropium bromide ................................................................... 7, 12 ipratropium bromide (nasal) ......................................................... 12 IRESSA ............................................................................................. 6 irinotecan hcl .................................................................................... 6 iron polysaccharide complex-vit b12-folic acid .......................... 15 ISENTRESS ..................................................................................... 5 isoniazid ............................................................................................ 5 isosorbide dinitrate ........................................................................... 9 isosorbide mononitrate .................................................................... 9 isotretinoin ....................................................................................... 17 itraconazole ...................................................................................... 5 IXEMPRA KIT ................................................................................... 6 IXIARO ............................................................................................ 16

J JAKAFI .............................................................................................. 6 JE-VAX ............................................................................................ 16 JEVTANA .......................................................................................... 6

K KADCYLA ......................................................................................... 6 KCL-LACTATED RINGERS-D5W ............................................... 11 KENALOG ....................................................................................... 13 ketamine hcl .................................................................................... 10

ketoconazole .............................................................................. 5, 16 ketoconazole (topical) ................................................................... 16 KETO-DIASTIX .............................................................................. 15 KETOPROFEN .............................................................................. 15 ketorolac tromethamine ............................................................ 9, 12 ketorolac tromethamine (ophth) ................................................... 12 KETOSTIX ...................................................................................... 15 KINRIX ............................................................................................ 16 K-PHOS .......................................................................................... 11 K-PHOS NO 2 ................................................................................ 11 K-PHOS-NEUTRAL....................................................................... 11

L labetalol hcl ....................................................................................... 8 lactated ringer's .............................................................................. 11 lactulose .......................................................................................... 11 lactulose (encephalopathy) .......................................................... 11 lamivudine......................................................................................... 5 lamivudine......................................................................................... 5 lamivudine (hbv) .............................................................................. 5 lamivudine-zidovudine .................................................................... 5 lamotrigine ........................................................................................ 9 LANTUS .......................................................................................... 13 latanoprost ...................................................................................... 12 leflunomide ..................................................................................... 15 LENVIMA .......................................................................................... 6 letrozole ............................................................................................ 6 LETS................................................................................................ 15 leucovorin calcium ......................................................................... 15 LEUKERAN ...................................................................................... 6 LEUKINE........................................................................................... 8 leuprolide acetate ............................................................................ 6 levetiracetam .................................................................................... 9 levobunolol hcl ............................................................................... 12 levofloxacin ....................................................................................... 4 levofloxacin in d5w .......................................................................... 4 levonorgestrel & eth estradiol ...................................................... 13 levonorgestrel-eth estradiol (triphasic) ....................................... 13 levothyroxine sodium .................................................................... 14 LEXIVA .............................................................................................. 5 LIBRAX ........................................................................................... 12 lidocaine ....................................................................... 7, 8, 12, 15, 17 LIDOCAINE .................................................................................... 15 lidocaine hcl .................................................................... 8, 12, 15, 17 LIDOCAINE HCL ........................................................................... 15 lidocaine hcl (cardiac) ..................................................................... 8 lidocaine hcl (local anesth.) .......................................................... 15 lidocaine hcl (mouth-throat) .......................................................... 12 lidocaine w/ epinephrine ................................................................. 7 lidocaine-prilocaine ........................................................................ 17 linezolid ............................................................................................. 4 LINEZOLID ....................................................................................... 4 LINEZOLID IN SODIUM CHLORIDE ............................................ 4


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liothyronine sodium ........................................................................ 14 lisinopril ......................................................................................... 8, 9 lisinopril & hydrochlorothiazide ...................................................... 9 LITHIUM .......................................................................................... 10 lithium carbonate ............................................................................ 10 lopinavir-ritonavir .............................................................................. 5 lopinavir-ritonavir ............................................................................... 5 lorazepam ......................................................................................... 7 losartan potassium ........................................................................... 9 losartan potassium & hydrochlorothiazide.................................... 9 lovastatin ........................................................................................... 8 LOVENOX ......................................................................................... 8 LUCENTIS ...................................................................................... 15 LUPRON DEPOT (3-MONTH) ....................................................... 6 LUPRON DEPOT (4-MONTH) ....................................................... 6 LUPRON DEPOT (6-MONTH) ....................................................... 6 LUPRON DEPOT-PED (1-MONTH) ....................................................... 6 LUPRON DEPOT-PED (3-MONTH) ....................................................... 6 LUPRON DEPOT-PED (3-MONTH) ............................................. 6 LYSODREN ...................................................................................... 6

M magnesium sulfate ........................................................................... 9 MAGNEVIST .................................................................................. 15 MAKENA ......................................................................................... 14 mannitol ........................................................................................... 11 MARQIBO ......................................................................................... 6 MATULANE ...................................................................................... 6 medroxyprogesterone acetate ..................................................... 14 medroxyprogesterone acetate (contraceptive) .......................... 14 mefloquine hcl .................................................................................. 5 megestrol acetate ............................................................................ 6 meloxicam ......................................................................................... 9 melphalan.......................................................................................... 6 memantine hcl ................................................................................ 10 MENOMUNE .................................................................................. 16 MENOPUR ...................................................................................... 13 MENTHOL ...................................................................................... 15 MENVEO ......................................................................................... 16 meperidine hcl .................................................................................. 9 mercaptopurine ................................................................................ 6 meropenem ....................................................................................... 4 MERUVAX II W/DILUENT 10 DOSE .................................................... 16 mesalamine .................................................................................... 12 mesna .............................................................................................. 15 metaproterenol sulfate .................................................................... 7 metformin hcl .................................................................................. 13 methadone hcl .................................................................................. 9 methazolamide ................................................................................. 8 methenamine hippurate .................................................................. 6 methimazole ................................................................................... 14 methocarbamol................................................................................. 7 methotrexate sodium ....................................................................... 6

methoxsalen rapid ......................................................................... 17 methyldopa ....................................................................................... 8 methylergonovine maleate ........................................................... 15 methylphenidate hcl ........................................................................ 9 methylprednisolone ....................................................................... 13 methylprednisolone acetate ......................................................... 13 methylprednisolone sod succ....................................................... 13 methyltestosterone .......................................................................... 13 METIPRANOLOL .......................................................................... 12 metoclopramide hcl ....................................................................... 12 metolazone ..................................................................................... 11 metoprolol succinate ....................................................................... 8 metoprolol tartrate ........................................................................... 8 metronidazole ............................................................................. 5, 16 metronidazole (topical) ................................................................. 16 metronidazole in nacl ...................................................................... 5 metronidazole vaginal ................................................................... 16 mexiletine hcl.................................................................................... 8 midazolam hcl .................................................................................. 7 MIFEPREX ..................................................................................... 15 MIGERGOT ...................................................................................... 9 MINIMED SYRINGE RESERVOIR/3ML/22G X 1/2 ................. 10 minocycline hcl ................................................................................. 4 minoxidil ............................................................................................ 8 MIRENA 52 MG ............................................................................. 13 mirtazapine ..................................................................................... 10 misoprostol ..................................................................................... 12 mitomycin .......................................................................................... 6 mitoxantrone hcl .............................................................................. 7 M-M-R II .......................................................................................... 16 mometasone furoate ..................................................................... 17 MONOJECT SYRINGE ................................................................ 15 montelukast sodium ...................................................................... 15 morphine sulfate .............................................................................. 9 multiple vitamin .............................................................................. 15 multiple vitamins w/ minerals ....................................................... 15 MUMPSVAX W/DILUENT 10 DOSE ................................................... 16 mupirocin ........................................................................................ 16 mupirocin calcium (topical) ........................................................... 16 MUSTARGEN .................................................................................. 7 mycophenolate mofetil .................................................................. 15 MYLERAN ........................................................................................ 7 MYOCHRYSINE ............................................................................ 13

N NABI-HB ......................................................................................... 16 nabumetone ..................................................................................... 9 nafcillin sodium ................................................................................ 4 naloxone hcl ............................................................................... 9, 10 naltrexone hcl ................................................................................. 10 naproxen ........................................................................................... 9 naratriptan hcl .................................................................................. 9 NATACYN ....................................................................................... 11


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NEBUPENT ...................................................................................... 5 NECON 1/50 (28) ........................................................................... 13 NECON 10/11 (28) ........................................................................ 13 nefazodone hcl ............................................................................... 10 neomycin sulfate .............................................................................. 4 neomycin-bacitracin zn-polymyxin............................................... 12 neomycin-polymy-dexameth ........................................................ 12 neomycin-polymyxin-gramicidin ................................................... 12 NEOMYCIN-POLYMYXIN-HC ..................................................... 12 neomycin-polymyxin-hc (otic) ....................................................... 12 NEOSTIGMINE METHYLSULFATE ............................................. 7 NEUPOGEN ..................................................................................... 8 nevirapine.......................................................................................... 5 NEXAVAR ......................................................................................... 7 NEXPLANON ................................................................................. 13 NIACOR ............................................................................................ 8 nicardipine hcl................................................................................... 8 NICOTROL ....................................................................................... 7 nifedipine ........................................................................................... 8 NINLARO .......................................................................................... 7 nitrofurantoin ..................................................................................... 6 nitrofurantoin macrocrystal ............................................................. 6 nitrofurantoin monohyd macro ....................................................... 6 nitroglycerin ...................................................................................... 9 norethin acet & estrad-fe............................................................... 13 norethindrone & eth estradiol ....................................................... 13 norethindrone (contraceptive) ...................................................... 13 norethindrone acet & eth estra ..................................................... 13 norethindrone acetate ................................................................... 14 norethindrone-eth estradiol (triphasic) ........................................ 13 norgestimate-ethinyl estradiol ......................................................... 13 norgestimate-ethinyl estradiol (triphasic) .................................... 13 nortriptyline hcl ............................................................................... 10 NORVIR ............................................................................................ 5 NUVARING ..................................................................................... 13 nystatin .................................................................................. 5, 16, 17 nystatin (mouth-throat) .................................................................... 5 nystatin (topical) ............................................................................. 16 NYSTATIN VAGINAL .................................................................... 16 NYSTATIN VAGINAL .......................................................................... 16 nystatin-triamcinolone ................................................................... 17

O octreotide acetate .......................................................................... 15 ODEFSEY ......................................................................................... 5 OFIRMEV .......................................................................................... 9 ofloxacin ........................................................................................... 12 ofloxacin (ophth)............................................................................. 12 ofloxacin (otic) ................................................................................ 12 olanzapine ....................................................................................... 10 olopatadine hcl ............................................................................... 12 omeprazole ..................................................................................... 12 OMNITROPE ............................................................................ 14, 15

OMNITROPE PEN 5 INJ DEVICE .............................................. 15 ONCASPAR ..................................................................................... 7 ondansetron ................................................................................... 12 ondansetron hcl ............................................................................. 12 ONETOUCH VERIO FLEX SYSTEM ......................................... 10 ophthalmic irrigation solution - intraocular ................................. 12 OPSUMIT ......................................................................................... 9 ORBACTIV ....................................................................................... 4 ORENCIA ....................................................................................... 15 ORKAMBI ....................................................................................... 16 oseltamivir phosphate ..................................................................... 5 oseltamivir phosphate ........................................................................ 5 OTEZLA .......................................................................................... 15 oxaliplatin .......................................................................................... 7 oxazepam ......................................................................................... 7 oxcarbazepine .................................................................................. 9 OXSORALEN ................................................................................. 17 oxybutynin chloride ........................................................................ 17 oxycodone hcl .................................................................................. 9 oxycodone w/ acetaminophen ....................................................... 9 oxytocin ........................................................................................... 15

P paclitaxel ........................................................................................... 7 pamidronate disodium ................................................................... 15 PANCRELIPASE 16000 ............................................................... 12 pantoprazole sodium ..................................................................... 12 papaverine hcl .................................................................................. 9 PARAGARD INTRAUTERINE COPPER ................................... 14 paroxetine hcl ................................................................................. 10 PCCA LIPODERM BASE ............................................................. 15 PEDIARIX ....................................................................................... 16 pediatric multivitamins w/fl ............................................................ 17 pediatric vitamins acd fluoride & iron .......................................... 17 pediatric vitamins acd w/ fluoride ................................................ 17 pediatric vitamins w/fl & iron ........................................................ 17 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate .................... 13 PEGASYS......................................................................................... 5 PEG-INTRON ................................................................................... 5 penicillin g potassium ...................................................................... 4 PENICILLIN G PROCAINE ............................................................ 4 PENICILLIN G SODIUM ................................................................. 4 penicillin v potassium ...................................................................... 4 PENLET II BLOOD SAMPLER .................................................... 10 pentoxifylline ..................................................................................... 8 permethrin....................................................................................... 16 perphenazine ................................................................................. 10 phenelzine sulfate .......................................................................... 10 phenobarbital ................................................................................... 9 PHENOBARBITAL SODIUM ......................................................... 9 PHENOL ......................................................................................... 15 phenoxybenzamine hcl ....................................................................... 7 phenyleph-cpm w/ hydrocod ........................................................ 15


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phenylephrine hcl (ophth) ............................................................. 12 phenylephrine-ephedrine-chlorpheniramine w/ carbetapentane

.................................................................................................... 16 phenytoin ........................................................................................... 9 phenytoin sodium ............................................................................. 9 phenytoin sodium extended ........................................................... 9 PHOTREXA VISCOUS ................................................................. 12 phytonadione .................................................................................. 15 PIKO 1 ............................................................................................. 14 pilocarpine hcl............................................................................. 7, 12 pilocarpine hcl (oral) ........................................................................ 7 pimozide .......................................................................................... 10 pioglitazone hcl............................................................................... 13 piperacillin sodium-tazobactam sodium ........................................ 4 PLAN B ONE-STEP ...................................................................... 13 PNEUMOVAX 23 ........................................................................... 16 podofilox .......................................................................................... 17 polymyxin b-trimethoprim .............................................................. 12 pot & sod citrates w/citric ac ......................................................... 11 potassium acetate .......................................................................... 11 potassium aminobenzoate ............................................................ 15 potassium bicarbonate .................................................................. 11 potassium chloride ......................................................................... 11 potassium chloride in dextrose ......................................................... 11 potassium chloride in dextrose & sodium chloride .................... 11 potassium chloride in nacl ............................................................ 11 potassium chloride microencapsulated crystals cr .................... 11 potassium citrate (alkalinizer) ....................................................... 11 potassium citrate-citric acid .......................................................... 11 potassium phosphates .................................................................. 11 PRADAXA ......................................................................................... 8 pramipexole dihydrochloride ........................................................ 10 prasugrel ........................................................................................... 8 pravastatin sodium ........................................................................... 8 PRECEDEX .................................................................................... 10 PRECISION XTRA KETONE ....................................................... 10 PRED-G .......................................................................................... 12 prednisolone ............................................................................. 12, 13 prednisolone acetate (ophth) ....................................................... 12 prednisolone sodium phosphate .................................................. 13 PREDNISOLONE SODIUM PHOSPHATE ................................ 12 prednisone ...................................................................................... 13 PREMARIN ..................................................................................... 13 PRENATAL PLUS IRON............................................................... 15 prenatal vit w/ ferrous fumarate-folic acid ................................... 17 prenatal vit w/ iron carbonyl-folic acid ......................................... 17 prenatal vit w/ selenium-fe fumarate-folic acid........................... 17 PREVNAR 13 ................................................................................. 16 PREZCOBIX ..................................................................................... 5 PREZISTA ........................................................................................ 5 PRIMAQUINE PHOSPHATE ......................................................... 5 primidone .......................................................................................... 9 probenecid ...................................................................................... 11 PROCAINAMIDE HCL .................................................................... 8

PROCALAMINE ............................................................................. 11 prochlorperazine ...................................................................... 10, 12 prochlorperazine edisylate ........................................................... 10 prochlorperazine maleate ............................................................. 10 PROCRIT .......................................................................................... 8 PROCTOFOAM HC ...................................................................... 17 progesterone .................................................................................. 14 progesterone micronized .............................................................. 14 PROLEUKIN ..................................................................................... 7 PROMACTA ..................................................................................... 8 promethazine hcl ............................................................................. 6 propafenone hcl ............................................................................... 8 propofol ........................................................................................... 10 propranolol hcl.................................................................................. 8 propylthiouracil ............................................................................... 14 PROQUAD ..................................................................................... 16 protriptyline hcl ............................................................................... 10 PROVOCHOLINE .......................................................................... 15 PULMOZYME ................................................................................ 11 pyrazinamide .................................................................................... 5 pyridostigmine bromide ................................................................... 7 pyridoxine hcl ................................................................................. 15

Q QUELICIN ....................................................................................... 10 quetiapine fumarate....................................................................... 10 quinidine gluconate ......................................................................... 8 quinidine sulfate ............................................................................... 8 QUINIDINE SULFATE .................................................................... 8 QVAR .............................................................................................. 13

R RABAVERT .................................................................................... 16 RAGWITEK .................................................................................... 15 raloxifene hcl .................................................................................. 13 ranitidine hcl ................................................................................... 12 RASUVO ......................................................................................... 15 READI-CAT 2 ................................................................................. 15 RELENZA DISKHALER .................................................................. 5 REMICADE ..................................................................................... 15 RENVELA ....................................................................................... 11 RESCRIPTOR.................................................................................. 5 RESERPINE ..................................................................................... 8 REVLIMID ....................................................................................... 15 REYATAZ ......................................................................................... 5 ribavirin (hepatitis c) ........................................................................ 5 rifabutin ............................................................................................. 5 rifampin ............................................................................................. 5 riluzole ............................................................................................. 10 rimantadine hydrochloride .............................................................. 5 RIMSO-50 ....................................................................................... 15 risperidone ...................................................................................... 10


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RITUXAN .......................................................................................... 7 rizatriptan benzoate ......................................................................... 9 rocuronium bromide ....................................................................... 10 ropinirole hydrochloride ................................................................. 10 rosuvastatin calcium ........................................................................ 8 rosuvastatin calcium ........................................................................... 8 ROTARIX ........................................................................................ 16 ROTATEQ ....................................................................................... 16

S salicylic acid .................................................................................... 17 saline, bacteriostatic ...................................................................... 15 SANTYL .......................................................................................... 17 SCULPTRA ..................................................................................... 15 selegiline hcl ................................................................................... 10 selenium sulfide ............................................................................. 16 SELZENTRY .................................................................................... 5 SENSIPAR ...................................................................................... 15 SEREVENT DISKUS ....................................................................... 7 sertraline hcl ................................................................................... 10 sevoflurane ..................................................................................... 10 sildenafil ............................................................................................. 9 sildenafil citrate (pulmonary hypertension) ................................... 9 silver sulfadiazine ........................................................................... 16 simvastatin ........................................................................................ 8 sodium acetate ............................................................................... 11 sodium bicarbonate ....................................................................... 11 sodium chloride .................................................................. 11, 15, 16 sodium chloride (gu irrigant) ......................................................... 11 sodium chloride (inhalant)............................................................. 16 sodium chloride flush ..................................................................... 15 sodium citrate & citric acid ............................................................ 11 sodium fluoride ............................................................................... 15 sodium phosphate ................................................................... 12, 13 sodium phosphates ........................................................................... 11 sodium phosphates (sodium phosphate dibasic & monobasic)

.................................................................................................... 11 sodium polystyrene sulfonate ....................................................... 11 SOLU-CORTEF ............................................................................. 13 sotalol hcl .......................................................................................... 8 SOVALDI ........................................................................................... 5 SPIRIVA RESPIMAT ....................................................................... 7 spironolactone .................................................................................. 9 spironolactone & hydrochlorothiazide ........................................... 9 SPRYCEL ......................................................................................... 7 SSKI ................................................................................................. 15 stavudine ........................................................................................... 5 STIOLTO RESPIMAT ...................................................................... 7 STREPTOMYCIN SULFATE.......................................................... 4 STRIBILD .......................................................................................... 5 STRIVERDI RESPIMAT ................................................................. 7 sucralfate ......................................................................................... 12 sulfacetamide sodium (acne) ....................................................... 16

sulfacetamide sodium (ophth) ...................................................... 12 sulfacetamide sod-prednisolone .................................................. 12 SULFADIAZINE ............................................................................... 4 SULFAMETHOXAZOLEI .............................................................. 15 sulfamethoxazole-trimethoprim ..................................................... 4 sulfasalazine ..................................................................................... 4 SULFUR PRECIPITATED ............................................................ 15 sulindac ............................................................................................. 9 sumatriptan ....................................................................................... 9 sumatriptan succinate ..................................................................... 9 SUPRANE ...................................................................................... 10 SUSTIVA........................................................................................... 5 SUTENT ............................................................................................ 7 SYLVANT ......................................................................................... 7 SYNAGIS .......................................................................................... 5

T TABLOID........................................................................................... 7 tacrolimus ................................................................................. 15, 17 tacrolimus (topical) ........................................................................ 17 tamoxifen citrate .............................................................................. 7 tamsulosin hcl ................................................................................ 15 TARCEVA ......................................................................................... 7 TASIGNA .......................................................................................... 7 TAXOTERE ...................................................................................... 7 TE ANATOXAL BERNA................................................................ 16 temazepam ....................................................................................... 7 temozolomide ................................................................................... 7 TENIPOSIDE.................................................................................... 7 TENIVAC ........................................................................................ 16 terazosin hcl ..................................................................................... 8 terbinafine hcl ............................................................................. 5, 16 terbutaline sulfate ............................................................................ 7 testosterone ..................................................................................... 13 testosterone cypionate .................................................................. 13 testosterone enanthate ................................................................. 13 tetracaine hcl (ophth) .................................................................... 12 THALOMID ..................................................................................... 15 theophylline .................................................................................... 17 thiamine hcl .................................................................................... 17 thioridazine hcl ............................................................................... 10 thiothixene ...................................................................................... 10 THYMOL ......................................................................................... 15 THYROGEN ................................................................................... 15 thyroid .............................................................................................. 14 TICE BCG ....................................................................................... 16 TIMENTIN ......................................................................................... 4 timolol maleate (ophth) ................................................................. 12 TIVICAY ............................................................................................ 5 tobramycin .................................................................................. 5, 12 TOBRAMYCIN ................................................................................. 5 tobramycin (ophth)......................................................................... 12 TOBRAMYCIN SULFATE .............................................................. 5


Page 29

tobramycin-dexamethasone ......................................................... 12 topiramate ......................................................................................... 9 topotecan hcl .................................................................................... 7 TORISEL ........................................................................................... 7 torsemide ........................................................................................ 11 trace minerals (cr-cu-mn-se-zn) ................................................... 15 tramadol hcl ...................................................................................... 9 TRANSDERM-SCOP (1.5 MG) .................................................... 12 trazodone hcl .................................................................................. 10 tretinoin ........................................................................................ 7, 17 tretinoin (chemotherapy) ................................................................. 7 triamcinolone acetonide (mouth) ................................................. 17 triamcinolone acetonide (topical) ................................................. 17 triamterene & hydrochlorothiazide ............................................... 11 trifluoperazine hcl ........................................................................... 10 trifluridine ......................................................................................... 12 trihexyphenidyl hcl ........................................................................... 7 trimethoprim ............................................................................ 4, 6, 12 TRIUMEQ.......................................................................................... 5 tropicamide ..................................................................................... 12 trospium chloride ............................................................................ 17 TRUVADA ......................................................................................... 5 TUBERSOL .................................................................................... 15 TYKERB ............................................................................................ 7 TYPHIM VI ...................................................................................... 16

U UNITUXIN ......................................................................................... 7 urea .................................................................................................. 17 urea-hc acetate .............................................................................. 17 URISTIX .......................................................................................... 15 Ursodiol ........................................................................................... 13

V valganciclovir hcl .............................................................................. 5 valproate sodium .............................................................................. 9 valproic acid ...................................................................................... 9 valsartan ............................................................................................ 9 valsartan hydrochlorothiazide ........................................................ 9 vancomycin hcl ................................................................................. 5 VANCOMYCIN HCL IN DEXTROSE ............................................ 5 VARIVAX ......................................................................................... 16 VAXCHORA .................................................................................... 16 VECTIBIX .......................................................................................... 7 VECTICAL ...................................................................................... 17 vecuronium bromide ...................................................................... 10 VELCADE ......................................................................................... 7 VENCLEXTA .................................................................................... 7 venlafaxine hcl ................................................................................ 10

VENOFER ...................................................................................... 15 verapamil hcl .................................................................................... 8 VEXOL ............................................................................................ 12 VIMIZIM........................................................................................... 11 VINBLASTINE SULFATE ............................................................... 7 vincristine sulfate ............................................................................. 7 vinorelbine tartrate ........................................................................... 7 VIRACEPT ........................................................................................ 6 VIREAD ............................................................................................. 6 VIVOTIF .......................................................................................... 16 VIVOTIF BERNA VACCINE ......................................................... 16 voriconazole ..................................................................................... 5 VOTRIENT ....................................................................................... 7 VPRIV .............................................................................................. 11

W warfarin sodium ................................................................................ 8 water for injection, sterile .............................................................. 15 water for irrigation, sterile ............................................................. 11 WIDE-SEAL DIAPHRAGM 60 ..................................................... 14

X XALKORI .......................................................................................... 7 XELJANZ ........................................................................................ 15 XTANDI ............................................................................................. 7 XULANE .......................................................................................... 13

Y YERVOY ........................................................................................... 7 YF-VAX ........................................................................................... 16 YODOXIN ......................................................................................... 4 yohimbine hcl ................................................................................. 17

Z zaleplon ........................................................................................... 10 ZARXIO ............................................................................................. 8 ZELBORAF ....................................................................................... 7 zidovudine ...................................................................................... 5, 6 ZINC TRACE METAL ................................................................... 11 ziprasidone hcl ............................................................................... 10 ZOLADEX ......................................................................................... 7 zoledronic acid ............................................................................... 15 ZOLINZA ........................................................................................... 7 zolpidem tartrate ............................................................................ 10 ZOSTAVAX .................................................................................... 16 ZYKADIA........................................................................................... 7 ZYTIGA ............................................................................................. 7

Please recycle. 60684212 10/2017

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60505711

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Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-777-5536 (TTY: 711).

Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-777-5536 (TTY: 711).

Korean 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.

1-888-777-5536 (TTY: 711)번으로 전화해 주십시오.

Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-777-5536 (телетайп: 711).

Japanese 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。

1-888-777-5536（TTY:711）まで、お電話にてご連絡ください。

Thai เรียน: ถา้คุณพดูภาษาไทยคุณสามารถใชบ้ริการช่วยเหลือทางภาษาไดฟ้รี โทร 1-888-777-5536 (TTY: 711).

Amharic ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-888-777-5536 (መስማት ለተሳናቸው: 711).

Farsi ی م راھمف شمای برا گانیرا بصورتی زبان التیتسھ د،یکنی م گفتگو فارسی زبان بھ اگر: توجھ یریبگ تماس (TTY: 711) 5536-777-888-1 با. باشد

Arabic رقماتصل ب ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان.

).711- (رقم ھاتف الصم والبكم: 1-888-777-5536German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-888-777-5536 (TTY: 711).

French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-888-777-5536 (ATS : 711).

Yoruba AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-888-777-5536 (TTY: 711).

Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-888-777-5536 (TTY: 711).

Italian ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-888-777-5536 (TTY: 711).

Urdu خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں

1-888-777-5536 (TTY: 711). French Creole ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-888-777-5536 (TTY: 711).

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