LIST OF COVERED DRUGS (FORMULARY) 2020 - Cigna

Updated on 12/01/2020. For more recent information or other questions, please contact Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week, 8 a.m. to 8 p.m. Central Time, or visit careplantx.cigna.com. HPMS Approved Formulary File Submission ID 20088, Version Number 19 H8423_20_79522a_FINAL_1o Populated Template © 2019 Cigna

Cigna-HealthSpring® CarePlan (Medicare-Medicaid Plan)

2020

LIST OF COVERED DRUGS (FORMULARY)

Member Services1-877-653-0327 (TTY: 7-1-1)7 days a week8 a.m. to 8 p.m. Central Time

careplantx.cigna.com

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. I ?

Cigna-HealthSpring® CarePlan (Medicare-Medicaid Plan) | 2020 List of Covered Drugs (Formulary)

Introduction

This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter drugs and items are covered by Cigna-HealthSpring CarePlan. The Drug List also tells you if there are any special rules or restrictions on any drugs covered by Cigna-HealthSpring CarePlan. Key terms and their definitions appear in the last chapter of the Member Handbook.

Updated on 12/01/2020. For more recent information or other questions, contact us at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time or visit careplantx.cigna.com.

HPMS Approved Formulary File Submission ID 20088, Version Number 19

Table of Contents

A. Disclaimers ........................................................................................................................................... III

B. Frequently Asked Questions (FAQ)..................................................................................................... III

B1. What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the “Drug List” for short.)................................................................................................. III

B2. Does the Drug List ever change?................................................................................................ IV

B3. What happens when there is a change to the Drug List? ........................................................... V

B4. Are there any restrictions or limits on drug coverage or any required actions to take to get certain drugs? ..................................................................................................................... VI

B5. How will you know if the drug you want has limitations or if there are required actions to take to get the drug? ................................................................................................................. VI

B6. What happens if we change our rules about some drugs (for example, prior authorization (approval), quantity limits, and/or step therapy restrictions)? ................................................. VI

B7. How can you find a drug on the Drug List? ................................................................................ VI

B8. What if the drug you want to take is not on the Drug List? ....................................................... VII

B9. What if you are a new Cigna-HealthSpring CarePlan Member and can’t find your drug on the Drug List or have a problem getting your drug? ............................................................... VII

B10. Can you ask for an exception to cover your drug?................................................................. VIII

B11. How can you ask for an exception? ........................................................................................ VIII

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. II ?

B12. How long does it take to get an exception? ............................................................................ VIII

B13. What are generic drugs? ......................................................................................................... VIII

B14. What are OTC drugs? ............................................................................................................. VIII

B15. Does Cigna-HealthSpring CarePlan cover non-drug OTC products? ..................................... IX

B16. What is your copay? .................................................................................................................. IX

B17. What are drug tiers? .................................................................................................................. IX

C. List of Covered Drugs .......................................................................................................................... X

D. List of Drugs by Medical Condition ....................................................................................................... 1

E. Index of Covered Drugs .................................................................................................................... 103

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. III ?

A. Disclaimers

This is a list of drugs that Members can get in Cigna-HealthSpring CarePlan.

v All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

v Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

v For information on Cigna-HealthSpring CarePlan and other options for your health care, call MAXIMUS at 1-877-782-6440, Monday to Friday, 8 a.m. to 6 p.m. Central Time. TTY users should call 1-800-735-2989.

v For information on the coverage of mosquito repellent products for the prevention of Zika virus, and applicable restrictions, please visit careplantx.cigna.com.

v Other Pharmacies/Physicians/Providers are available in our network.

v Express Scripts Pharmacy is a trademark of Express Scripts Strategic Development, Inc.

v ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-653-0327 (TTY: 7-1-1), los 7 días de la semana, de 8 a.m. a 8 p.m., hora del Centro. La llamada es gratuita.

v You can get this document for free in other formats, such as large print, braille, or audio. Call 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free.

v We will update your personal record and maintain your preferred language or format as a standing request. In the future, when you call Member Services, we will verify this information. You may ask us to update it at any time.

B. Frequently Asked Questions (FAQ)

Find answers here to questions you have about this List of Covered Drugs. You can read all of the FAQ to learn more, or look for a question and answer.

B1. What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the “Drug List” for short.)

The drugs on the List of Covered Drugs that starts on page 1 are the drugs covered by Cigna-HealthSpring CarePlan. These drugs are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as “network pharmacies.”

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. IV ?

• Cigna-HealthSpring CarePlan will cover all medically necessary drugs on the Drug List if:

o your doctor or other prescriber says you need them to get better or stay healthy, and

o you fill the prescription at a Cigna-HealthSpring CarePlan network pharmacy.

• Cigna-HealthSpring CarePlan may have additional steps to access certain drugs (see question B4 below).

You can also see an up-to-date list of drugs that we cover on our website at careplantx.cigna.com or call Member Services at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time.

B2. Does the Drug List ever change? Yes, and Cigna-HealthSpring CarePlan must follow Medicare and Medicaid rules when making changes. We may add or remove drugs on the Drug List during the year.

We may also change our rules about drugs. For example, we could:

• Decide to require or not require prior approval for a drug. (Prior approval is permission from Cigna-HealthSpring CarePlan before you can get a drug.)

• Add or change the amount of a drug you can get (called quantity limits).

• Add or change step therapy restrictions on a drug. (Step therapy means you must try one drug before we will cover another drug.)

For more information on these drug rules, see question B4.

If you are taking a drug Medicare Part D drug that was covered at the beginning of the year, we will generally not remove or change coverage of that drug during the rest of the year unless:

• a new, cheaper drug comes on the market that works as well as a drug on the Drug list now, or

• we learn that a drug is not safe, or

• a drug is removed from the market.

Questions B3 and B6 below have more information on what happens when the Drug List changes.

• You can always check Cigna-HealthSpring CarePlan’s up to date Drug List online at careplantx.cigna.com.

• You can also call Member Services to check the current Drug List at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time.

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. V ?

B3. What happens when there is a change to the Drug List? Some changes to the Drug List will happen immediately. For example:

• A new generic drug becomes available. Sometimes, a new generic drug comes on the market that works as well as a brand name drug on the Drug List now. When that happens, we may remove the brand name drug and add the new generic drug, but your cost for the new drug will stay the same. When we add the new generic drug, we may also decide to keep the brand name drug on the list but change its coverage rules or limits.

o We may not tell you before we make this change, but we will send you information about the specific change we made once it happens.

o You or your provider can ask for an exception from these changes. We will send you a notice with the steps you can take to ask for an exception. Please see question B10 for more information on exceptions.

• A drug is taken off the market. If the Food and Drug Administration (FDA) says a drug you are taking is not safe or the drug’s manufacturer takes a drug off the market, we will take it off the Drug List. If you are taking the drug, we will let you know. If you are notified that your drug is being removed, you should contact your provider to get a new prescription.

We may make other changes that affect the drugs you take. We will tell you in advance about these other changes to the Drug List. These changes might happen if:

• The FDA provides new guidance or there are new clinical guidelines about a drug.

• We add a generic drug that is not new to the market and

o Replace a brand name drug currently on the Drug List or

o Change the coverage rules or limits for the brand name drug.

When these changes happen, we will:

• Tell you at least 30 days before we make the change to the Drug List or

• Let you know and give you a 30-day supply of the drug after you ask for a refill.

This will give you time to talk to your doctor or other prescriber. He or she can help you decide:

• If there is a similar drug on the Drug List you can take instead or

• Whether to ask for an exception from these changes. To learn more about exceptions, see question B10.

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. VI ?

B4. Are there any restrictions or limits on drug coverage or any required actions to take to get certain drugs?

Yes, some drugs have coverage rules or have limits on the amount you can get. In some cases you or your doctor or other prescriber must do something before you can get the drug. For example:

• Prior approval (or prior authorization): For some drugs, you or your doctor or other prescriber must get approval from Cigna-HealthSpring CarePlan before you fill your prescription. Cigna-HealthSpring CarePlan may not cover the drug if you do not get approval.

• Quantity limits: Sometimes Cigna-HealthSpring CarePlan limits the amount of a drug you can get.

• Step therapy: Sometimes Cigna-HealthSpring CarePlan requires you to do step therapy. This means you will have to try drugs in a certain order for your medical condition. You might have to try one drug before we will cover another drug. If your doctor thinks the first drug doesn’t work for you, then we will cover the second.

You can find out if your drug has any additional requirements or limits by looking in the tables on pages 1-102. You can also get more information by visiting our web site at careplantx.cigna.com. We have posted online documents that explain our prior authorization restriction and step therapy restrictions. You may also ask us to send you a copy.

You can ask for an exception from these limits. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception. Please see questions B10- B12 for more information about exceptions.

B5. How will you know if the drug you want has limitations or if there are required actions to take to get the drug?

The List of Covered Drugs on page 1 has a column labeled “Necessary actions, restrictions, or limits on use.”

B6. What happens if we change our rules about some drugs (for example, prior authorization (approval), quantity limits, and/or step therapy restrictions)?

In some cases, we tell you in advance if we add or change prior approval, quantity limits, and/or step therapy restrictions on a drug. See question B3 for more information about this advance notice and situations where we may not be able to tell you in advance when our rules about drugs on the Drug List change.

B7. How can you find a drug on the Drug List? There are two ways to find a drug:

• You can search alphabetically (if you know how to spell the drug), or

• You can search by medical condition.

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. VII ?

To search alphabetically, go to the Index of Covered Drugs section. You can find it on page 103. This section has a list of all the drugs in this book. The drug names are in the first column of the list with the page number across from each name.

To search by medical condition, find the section labeled “List of drugs by medical condition” on page 1. The drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, Cardiovascular Agents. That is where you will find drugs that treat heart conditions.

B8. What if the drug you want to take is not on the Drug List? If you don’t see your drug on the Drug List, call Member Services at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time and ask about it. If you learn that Cigna-HealthSpring CarePlan will not cover the drug, you can do one of these things:

• Ask Member Services for a list of drugs like the one you want to take. Then show the list to your doctor or other prescriber. He or she can prescribe a drug on the Drug List that is like the one you want to take. Or

• You can ask the health plan to make an exception to cover your drug. Please see questions B10-B12 for more information about exceptions.

B9. What if you are a new Cigna-HealthSpring CarePlan Member and can’t find your drug on the Drug List or have a problem getting your drug?

We can help. We may cover a temporary 30-day supply (or 31 days if you live in a long-term care facility) of your drug during the first 90 days you are a Member of Cigna-HealthSpring CarePlan. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception.

If your prescription is written for fewer days, we will allow multiple refills to provide up to a maximum of 30 days of medication (or 31 days if you live in a long-term care facility).

We will cover a 30-day supply of your drug if:

• you are taking a drug that is not on our Drug List, or

• health plan rules do not let you get the amount ordered by your prescriber, or

• the drug requires prior approval by Cigna-HealthSpring CarePlan, or

• you are taking a drug that is part of a step therapy restriction.

If you are in a nursing home or other long-term care facility and need a drug that is not on the Drug List or if you cannot easily get the drug you need, we can help. If you have been in the plan for more than 90 days, live in a long-term care facility, and need a supply right away:

• We will cover one 31-day supply of the drug you need (unless you have a prescription for fewer days), whether or not you are a new Cigna-HealthSpring CarePlan Member.

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. VIII ?

• This is in addition to the temporary supply during the first 90 days you are a Member of Cigna-HealthSpring CarePlan.

We will cover a temporary 30-day supply of your drug if an unexpected move happens. For example, if you are released from the hospital to go home or to a nursing home and you are not able to get your medicine.

B10. Can you ask for an exception to cover your drug? Yes. You can ask Cigna-HealthSpring CarePlan to make an exception to cover a drug that is not on the Drug List.

You can also ask us to change the rules on your drug.

• For example, Cigna-HealthSpring CarePlan may limit the amount of a drug we will cover. If your drug has a limit, you can ask us to change the limit and cover more.

• Other examples: You can ask us to drop step therapy restrictions or prior approval requirements.

B11. How can you ask for an exception? To ask for an exception, call Member Services. A Member Services representative will work with you and your provider to help you ask for an exception. You can also read Chapter 9 of the Member Handbook to learn more about exceptions.

B12. How long does it take to get an exception? First, we must get a statement from your prescriber supporting your request for an exception. After we get the statement, we will give you a decision on your exception request within 72 hours.

If you or your prescriber think your health may be harmed if you have to wait 72 hours for a decision, you can ask for an expedited exception. This is a faster decision. If your prescriber supports your request, we will give you a decision within 24 hours of getting your prescriber’s supporting statement.

B13. What are generic drugs? Generic drugs are made up of the same active ingredients as brand name drugs. They usually cost less than the brand name drug and usually don’t have well-known names. Generic drugs are approved by the Food and Drug Administration (FDA).

Cigna-HealthSpring CarePlan covers both brand name drugs and generic drugs.

B14. What are OTC drugs? OTC stands for “over-the-counter.” Cigna-HealthSpring CarePlan covers some OTC drugs when they are written as prescriptions by your provider.

You can read the Cigna-HealthSpring CarePlan Drug List to see what OTC drugs are covered.

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. IX ?

B15. Does Cigna-HealthSpring CarePlan cover non-drug OTC products? Cigna-HealthSpring CarePlan covers some non-drug OTC products when they are written as prescriptions by your provider.

Examples of non-drug OTC products include Aspirin, some Vitamins and Nicotine containing products such as Nicotine patches, gum and lozenges to help stop smoking.

You can read the Cigna-HealthSpring CarePlan Drug List to see what non-drug OTC products are covered.

B16. What is your copay? As a Cigna-HealthSpring CarePlan Member, you have no copays for prescription and OTC drugs as long as you follow Cigna-HealthSpring CarePlan’s rules.

B17. What are drug tiers? Tiers are groups of drugs on our Drug List. All tiers have no copay.

• Tier 1 drugs are generic drugs.

• Tier 2 drugs are brand name drugs.

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. X ?

C. List of Covered Drugs

The following list of covered drugs gives you information about the drugs covered by Cigna-HealthSpring CarePlan. If you have trouble finding your drug in the list, turn to the Index of Covered Drugs that begins on page 103. The index alphabetically lists all drugs covered by Cigna-HealthSpring CarePlan.

The first column of the chart lists the name of the drug. Brand name drugs are capitalized (e.g., TRELEGY ELLIPTA) and generic drugs are listed in lower-case italics (e.g., candesartan).

The information in the necessary actions, restrictions, or limits on use column tells you if Cigna-HealthSpring CarePlan has any rules for covering your drug.

Abbreviation Explanation

B/D (Part B/Part D) This drug might be covered under Medicare Part B instead of Medicare Part D. More information might be needed for Cigna-HealthSpring CarePlan to decide which plan should cover it.

PA (Prior Authorization) This drug requires prior authorization.

QL (Quantity Limits) This drug has quantity limits.

ST (Step Therapy) This drug has step therapy requirements.

MC (Medicaid Covered) Non-Part D Drugs or OTC items that are covered by Texas Medicaid.

NDS (Non-Extended Day Supply) This drug is only available as a 30-day supply or less. For certain drugs, Cigna-HealthSpring CarePlan limits the amount of the drug that Cigna-HealthSpring CarePlan will cover to only a 30-day supply or less, at one time. For example, Members who have not had any recent fill of opioid pain medications within the past 120 days (referred to as “opioid naïve”) are limited to a maximum of 7 days’ supply of opioid pain medication. Members who have received a recent fill of an opioid pain medication (not opioid naïve), are limited to up to a month’s supply at one time.

Note: The “MC” next to a drug means the drug is not a “Part D drug.” The amount you pay when you fill a prescription for this drug does not count towards your total drug costs (that is, the amount you pay does not help you qualify for catastrophic coverage).

If you have questions, please call Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. The call is free. For more information, visit careplantx.cigna.com. XI ?

• In addition, if you are getting Extra Help to pay for your prescriptions, you will not get any Extra Help to pay for these drugs. For more information on Extra Help, please see the call-out box below.

• These drugs also have different rules for appeals. An appeal is a formal way of asking us to review a coverage decision and to change it if you think we made a mistake. For example, we might decide that a drug that you want is not covered or is no longer covered by Medicare or Texas Medicaid.

• If you or your doctor disagrees with our decision, you can appeal. To ask for instructions on how to appeal, call Member Services at 1-877-653-0327 (TTY: 7-1-1), 7 days a week 8 a.m. to 8 p.m. Central Time. You can also read Chapter 9 of the Member Handbook to learn how to appeal a decision.

Extra Help is a Medicare program that helps people with limited incomes and resources reduce Medicare Part D prescription drug costs, such as premiums, deductibles, and copays. Extra Help is also called the “Low-Income Subsidy,” or “LIS.”

Key: QL = Quantity Limits listed as (qty/days); PA = Prior Authorization may be required; ST = Step Therapy rules apply; B/D = Drug covered under Medicare Part B or Part D; NDS = Non-Extended Day Supply; MC = Non-Part D Drugs, or OTC items that are covered by Medicaid. Generally all medications in the drug list are available through mail order, except when special circumstances or situations prohibit mailing a particular medication to your home. 1

List of Drugs by Medical ConditionThe drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, Cardiovascular, Hypertension/Lipids. That is where you will find drugs that treat heart conditions.

Name of drug What the drug will cost you (tier level)

Necessary actions, restrictions, or limits on use

ANTI - INFECTIVES (DRUGS THAT TREAT INFECTIONS)ANTIFUNGAL AGENTSABELCET 0(Tier 2) PA; NDSAMBISOME 0(Tier 2) PA; NDSamphotericin b 0(Tier 1) PAcaspofungin 0(Tier 1) PA; NDSclotrimazole mucous membrane 0(Tier 1)CRESEMBA ORAL 0(Tier 2) NDSfluconazole 0(Tier 1)fluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml

0(Tier 1)

flucytosine 0(Tier 1) NDSgriseofulvin microsize 0(Tier 1)griseofulvin ultramicrosize 0(Tier 1)itraconazole oral capsule 0(Tier 1) PA; QL (120 EA per 30 days)itraconazole oral solution 0(Tier 1) PA; NDSketoconazole oral 0(Tier 1)micafungin 0(Tier 1) NDSMYCAMINE 0(Tier 2) NDSNOXAFIL ORAL SUSPENSION 0(Tier 2) PA; QL (600 ML per 30 days); NDSNOXAFIL ORAL TABLET,DELAYED RELEASE (DR/EC)

0(Tier 2) PA; QL (96 EA per 30 days); NDS

nystatin oral suspension 0(Tier 1)nystatin oral tablet 0(Tier 1)posaconazole oral tablet,delayed release (dr/ec) 0(Tier 1) PA; QL (96 EA per 30 days); NDSterbinafine hcl oral 0(Tier 1)voriconazole intravenous 0(Tier 1) PA; NDSvoriconazole oral suspension for reconstitution 0(Tier 1) PA; QL (300 ML per 30 days); NDSvoriconazole oral tablet 0(Tier 1) PAANTIVIRALSabacavir oral solution 0(Tier 1) QL (960 ML per 30 days)abacavir oral tablet 0(Tier 1) QL (60 EA per 30 days)abacavir-lamivudine 0(Tier 1) QL (30 EA per 30 days)abacavir-lamivudine-zidovudine 0(Tier 1) QL (60 EA per 30 days); NDSacyclovir oral capsule 0(Tier 1)




acyclovir oral suspension 200 mg/5 ml 0(Tier 1)acyclovir oral tablet 0(Tier 1)acyclovir sodium intravenous solution 0(Tier 1) B/D PAadefovir 0(Tier 1) QL (30 EA per 30 days); NDSamantadine hcl 0(Tier 1)APTIVUS 0(Tier 2) QL (120 EA per 30 days); NDSAPTIVUS (WITH VITAMIN E) 0(Tier 2) QL (285 ML per 28 days); NDSatazanavir oral capsule 150 mg 0(Tier 1) QL (30 EA per 30 days)atazanavir oral capsule 200 mg 0(Tier 1) QL (60 EA per 30 days); NDSatazanavir oral capsule 300 mg 0(Tier 1) QL (30 EA per 30 days); NDSATRIPLA 0(Tier 2) QL (30 EA per 30 days); NDSBARACLUDE ORAL SOLUTION 0(Tier 2) QL (630 ML per 30 days)BIKTARVY 0(Tier 2) QL (30 EA per 30 days); NDSCIMDUO 0(Tier 2) QL (30 EA per 30 days); NDSCOMPLERA 0(Tier 2) QL (30 EA per 30 days); NDSCRIXIVAN ORAL CAPSULE 200 MG 0(Tier 2) QL (270 EA per 30 days)CRIXIVAN ORAL CAPSULE 400 MG 0(Tier 2) QL (180 EA per 30 days)DELSTRIGO 0(Tier 2) QL (30 EA per 30 days); NDSDESCOVY 0(Tier 2) QL (30 EA per 30 days); NDSdidanosine oral capsule,delayed release(dr/ec) 250 mg, 400 mg

0(Tier 1) QL (30 EA per 30 days)

DOVATO 0(Tier 2) QL (30 EA per 30 days); NDSEDURANT 0(Tier 2) QL (30 EA per 30 days); NDSefavirenz oral capsule 200 mg 0(Tier 1) QL (120 EA per 30 days)efavirenz oral capsule 50 mg 0(Tier 1) QL (180 EA per 30 days)efavirenz oral tablet 0(Tier 1) QL (30 EA per 30 days); NDSefavirenz-lamivu-tenofov disop 0(Tier 1) QL (30 EA per 30 days); NDSemtricitabine 0(Tier 1) QL (30 EA per 30 days)EMTRIVA ORAL CAPSULE 0(Tier 2) QL (30 EA per 30 days)EMTRIVA ORAL SOLUTION 0(Tier 2) QL (680 ML per 28 days)entecavir 0(Tier 1) QL (30 EA per 30 days)EPCLUSA ORAL TABLET 200-50 MG 0(Tier 2) PA; NDSEPCLUSA ORAL TABLET 400-100 MG 0(Tier 2) PA; QL (28 EA per 28 days); NDSEPIVIR HBV ORAL SOLUTION 0(Tier 2)EVOTAZ 0(Tier 2) QL (30 EA per 30 days); NDSfamciclovir 0(Tier 1) QL (60 EA per 30 days)fosamprenavir 0(Tier 1) QL (120 EA per 30 days); NDSFUZEON SUBCUTANEOUS RECON SOLN 0(Tier 2) QL (60 EA per 30 days); NDSGENVOYA 0(Tier 2) QL (30 EA per 30 days); NDS




HARVONI ORAL PELLETS IN PACKET 33.75-150 MG


HARVONI ORAL PELLETS IN PACKET 45-200 MG


HARVONI ORAL TABLET 0(Tier 2) PA; QL (28 EA per 28 days); NDSINTELENCE ORAL TABLET 100 MG, 200 MG 0(Tier 2) QL (60 EA per 30 days); NDSINTELENCE ORAL TABLET 25 MG 0(Tier 2) QL (120 EA per 30 days)INVIRASE ORAL TABLET 0(Tier 2) QL (120 EA per 30 days); NDSISENTRESS HD 0(Tier 2) QL (60 EA per 30 days); NDSISENTRESS ORAL POWDER IN PACKET 0(Tier 2) QL (60 EA per 30 days)ISENTRESS ORAL TABLET 0(Tier 2) QL (120 EA per 30 days); NDSISENTRESS ORAL TABLET,CHEWABLE 100 MG

0(Tier 2) QL (180 EA per 30 days); NDS

ISENTRESS ORAL TABLET,CHEWABLE 25 MG


JULUCA 0(Tier 2) NDSKALETRA ORAL TABLET 100-25 MG 0(Tier 2) QL (300 EA per 30 days)KALETRA ORAL TABLET 200-50 MG 0(Tier 2) QL (120 EA per 30 days); NDSlamivudine oral solution 0(Tier 1) QL (900 ML per 30 days)lamivudine oral tablet 100 mg, 300 mg 0(Tier 1) QL (30 EA per 30 days)lamivudine oral tablet 150 mg 0(Tier 1) QL (60 EA per 30 days)lamivudine-zidovudine 0(Tier 1) QL (60 EA per 30 days)LEXIVA ORAL SUSPENSION 0(Tier 2) QL (1575 ML per 28 days)lopinavir-ritonavir 0(Tier 1) QL (480 ML per 30 days)MAVYRET 0(Tier 2) PA; QL (84 EA per 28 days); NDSnevirapine oral suspension 0(Tier 1) QL (1200 ML per 30 days)nevirapine oral tablet 0(Tier 1) QL (60 EA per 30 days)nevirapine oral tablet extended release 24 hr 100 mg


nevirapine oral tablet extended release 24 hr 400 mg


NORVIR ORAL POWDER IN PACKET 0(Tier 2) QL (360 EA per 30 days)NORVIR ORAL SOLUTION 0(Tier 2) QL (480 ML per 30 days)NORVIR ORAL TABLET 0(Tier 2) QL (360 EA per 30 days)ODEFSEY 0(Tier 2) QL (30 EA per 30 days); NDSoseltamivir 0(Tier 1)PIFELTRO 0(Tier 2) QL (30 EA per 30 days); NDSPREZCOBIX 0(Tier 2) QL (30 EA per 30 days); NDSPREZISTA ORAL SUSPENSION 0(Tier 2) QL (400 ML per 30 days); NDSPREZISTA ORAL TABLET 150 MG 0(Tier 2) QL (180 EA per 30 days)




PREZISTA ORAL TABLET 600 MG 0(Tier 2) QL (60 EA per 30 days); NDSPREZISTA ORAL TABLET 75 MG 0(Tier 2) QL (210 EA per 30 days)PREZISTA ORAL TABLET 800 MG 0(Tier 2) QL (30 EA per 30 days); NDSRETROVIR INTRAVENOUS 0(Tier 2)REYATAZ ORAL POWDER IN PACKET 0(Tier 2) QL (180 EA per 30 days); NDSribavirin oral capsule 0(Tier 1) QL (168 EA per 28 days)ribavirin oral tablet 200 mg 0(Tier 1)rimantadine 0(Tier 1)ritonavir 0(Tier 1) QL (360 EA per 30 days)RUKOBIA 0(Tier 2) NDSSELZENTRY ORAL SOLUTION 0(Tier 2) QL (1610 ML per 26 days); NDSSELZENTRY ORAL TABLET 150 MG, 75 MG 0(Tier 2) QL (60 EA per 30 days); NDSSELZENTRY ORAL TABLET 25 MG 0(Tier 2) QL (240 EA per 30 days)SELZENTRY ORAL TABLET 300 MG 0(Tier 2) QL (120 EA per 30 days); NDSstavudine oral capsule 0(Tier 1) QL (60 EA per 30 days)STRIBILD 0(Tier 2) QL (30 EA per 30 days); NDSSYMFI 0(Tier 2) QL (30 EA per 30 days); NDSSYMFI LO 0(Tier 2) QL (30 EA per 30 days); NDSSYMTUZA 0(Tier 2) QL (30 EA per 30 days); NDSSYNAGIS 0(Tier 2) PA; NDStenofovir disoproxil fumarate 0(Tier 1) QL (30 EA per 30 days)TIVICAY ORAL TABLET 10 MG 0(Tier 2) QL (60 EA per 30 days)TIVICAY ORAL TABLET 25 MG, 50 MG 0(Tier 2) QL (60 EA per 30 days); NDSTIVICAY PD 0(Tier 2) QL (180 EA per 30 days); NDSTRIUMEQ 0(Tier 2) QL (30 EA per 30 days); NDSTROGARZO 0(Tier 2) B/D PA; NDSTRUVADA 0(Tier 2) QL (30 EA per 30 days); NDSTYBOST 0(Tier 2) QL (30 EA per 30 days)valacyclovir oral tablet 1 gram 0(Tier 1) QL (120 EA per 30 days)valacyclovir oral tablet 500 mg 0(Tier 1) QL (60 EA per 30 days)valganciclovir 0(Tier 1) NDSVEMLIDY 0(Tier 2) NDSVIRACEPT ORAL TABLET 250 MG 0(Tier 2) QL (270 EA per 30 days); NDSVIRACEPT ORAL TABLET 625 MG 0(Tier 2) QL (120 EA per 30 days); NDSVIREAD ORAL POWDER 0(Tier 2) QL (240 GM per 30 days); NDSVIREAD ORAL TABLET 150 MG, 200 MG, 250 MG


VOSEVI 0(Tier 2) PA; QL (30 EA per 30 days); NDSXOFLUZA 0(Tier 2)




zidovudine oral capsule 0(Tier 1) QL (180 EA per 30 days)zidovudine oral syrup 0(Tier 1) QL (1680 ML per 28 days)zidovudine oral tablet 0(Tier 1) QL (60 EA per 30 days)CEPHALOSPORINScefaclor oral capsule 0(Tier 1)cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml

0(Tier 1)

cefaclor oral tablet extended release 12 hr 0(Tier 1)cefadroxil oral capsule 0(Tier 1)cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

0(Tier 1)

cefadroxil oral tablet 0(Tier 1)cefazolin 0(Tier 1)cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml

0(Tier 1)

CEFAZOLIN IN DEXTROSE (ISO-OS) INTRAVENOUS PIGGYBACK 2 GRAM/100 ML

0(Tier 2)

cefazolin in dextrose (iso-os) intravenous piggyback 2 gram/50 ml

0(Tier 2)

cefdinir 0(Tier 1)CEFEPIME IN DEXTROSE 5% 0(Tier 1)cefepime in dextrose,iso-osm 0(Tier 1)cefepime injection 0(Tier 1)cefixime oral capsule 0(Tier 1) QL (30 EA per 30 days)cefixime oral suspension for reconstitution 0(Tier 1)cefotetan 0(Tier 1)CEFOTETAN IN DEXTROSE, ISO-OSM 0(Tier 1)cefoxitin 0(Tier 1)cefoxitin in dextrose, iso-osm 0(Tier 1)cefpodoxime 0(Tier 1)cefprozil 0(Tier 1)ceftazidime 0(Tier 1)CEFTAZIDIME IN D5W 0(Tier 1)ceftriaxone in dextrose,iso-os 0(Tier 1)ceftriaxone injection recon soln 1 gram, 10 gram, 2 gram, 250 mg, 500 mg

0(Tier 1)

CEFTRIAXONE INJECTION RECON SOLN 100 GRAM

0(Tier 1)

ceftriaxone intravenous 0(Tier 1)cefuroxime axetil oral tablet 0(Tier 1)




cefuroxime sodium injection recon soln 750 mg 0(Tier 1)cefuroxime sodium intravenous 0(Tier 1)cephalexin oral capsule 250 mg, 500 mg 0(Tier 1)cephalexin oral suspension for reconstitution 0(Tier 1)SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 500 MG/5 ML

0(Tier 2)

tazicef 0(Tier 1)TEFLARO 0(Tier 2) NDSERYTHROMYCINS / OTHER MACROLIDESazithromycin intravenous 0(Tier 1)azithromycin oral packet 0(Tier 1)azithromycin oral suspension for reconstitution 0(Tier 1)azithromycin oral tablet 250 mg, 250 mg (6 pack), 500 mg, 500 mg (3 pack)

0(Tier 1)

azithromycin oral tablet 600 mg 0(Tier 1) QL (60 EA per 30 days)clarithromycin 0(Tier 1)DIFICID 0(Tier 2) PA; QL (20 EA per 10 days); NDSe.e.s. 400 oral tablet 0(Tier 1)ERYPED 400 0(Tier 2) NDSery-tab 0(Tier 1)erythrocin (as stearate) oral tablet 250 mg 0(Tier 1)erythrocin intravenous recon soln 500 mg 0(Tier 1)erythromycin ethylsuccinate oral suspension for reconstitution 200 mg/5 ml

0(Tier 1)

erythromycin ethylsuccinate oral suspension for reconstitution 400 mg/5 ml

0(Tier 1) NDS

erythromycin ethylsuccinate oral tablet 0(Tier 1)erythromycin oral tablet 0(Tier 1)erythromycin oral tablet,delayed release (dr/ec) 0(Tier 1)MISCELLANEOUS ANTIINFECTIVESalbendazole 0(Tier 1) NDSALINIA ORAL SUSPENSION FOR RECONSTITUTION

0(Tier 2) QL (180 ML per 30 days); NDS

ALINIA ORAL TABLET 0(Tier 2) QL (20 EA per 10 days); NDSamikacin injection solution 1,000 mg/4 ml, 500 mg/2 ml

0(Tier 1)

ARIKAYCE 0(Tier 2) PA; NDSatovaquone 0(Tier 1)atovaquone-proguanil 0(Tier 1)aztreonam injection recon soln 1 gram 0(Tier 1)




aztreonam injection recon soln 2 gram 0(Tier 1) NDSbacitracin intramuscular 0(Tier 1)CAPASTAT 0(Tier 2)CAYSTON 0(Tier 2) PA; QL (84 ML per 56 days); NDSchloramphenicol sod succinate 0(Tier 1)chloroquine phosphate 0(Tier 1)clindamycin hcl 0(Tier 1)CLINDAMYCIN IN 0.9% SOD CHLOR 0(Tier 1)clindamycin in 5% dextrose 0(Tier 1)clindamycin pediatric 0(Tier 1)clindamycin phosphate injection 0(Tier 1)clindamycin phosphate intravenous solution 600 mg/4 ml

0(Tier 1)

COARTEM 0(Tier 2) QL (24 EA per 30 days)colistin (colistimethate na) 0(Tier 1)CYCLOSERINE 0(Tier 1)dapsone oral 0(Tier 1)DAPTOMYCIN INTRAVENOUS RECON SOLN 350 MG

0(Tier 2) NDS

daptomycin intravenous recon soln 500 mg 0(Tier 1) NDSDARAPRIM 0(Tier 2) QL (90 EA per 30 days); NDSEMVERM 0(Tier 2) NDSertapenem 0(Tier 1)ethambutol 0(Tier 1)FIRVANQ 0(Tier 2)gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 60 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml

0(Tier 1)

GENTAMICIN IN NACL (ISO-OSM) INTRAVENOUS PIGGYBACK 100 MG/50 ML, 120 MG/100 ML

0(Tier 1)

gentamicin injection solution 40 mg/ml 0(Tier 1)gentamicin sulfate (ped) (pf) 0(Tier 1)hydroxychloroquine 0(Tier 1)imipenem-cilastatin 0(Tier 1)isoniazid oral 0(Tier 1)ivermectin oral 0(Tier 1)lincomycin 0(Tier 1)linezolid in dextrose 5% 0(Tier 1)linezolid oral suspension for reconstitution 0(Tier 1) QL (1800 ML per 30 days); NDS




linezolid oral tablet 0(Tier 1) QL (60 EA per 30 days)linezolid-0.9% sodium chloride 0(Tier 1)mefloquine 0(Tier 1)meropenem 0(Tier 1)MEROPENEM-0.9% SODIUM CHLORIDE 0(Tier 1)metro i.v. 0(Tier 1)metronidazole in nacl (iso-os) 0(Tier 1)metronidazole oral tablet 0(Tier 1)NEBUPENT 0(Tier 2) B/D PA; QL (1 EA per 28 days)neomycin 0(Tier 1)ORBACTIV 0(Tier 2) QL (3 EA per 30 days); NDSparomomycin 0(Tier 1)PASER 0(Tier 2)PENTAM 0(Tier 2)pentamidine inhalation 0(Tier 1) B/D PA; QL (1 EA per 28 days)pentamidine injection 0(Tier 1)polymyxin b sulfate 0(Tier 1)praziquantel 0(Tier 1)PRIFTIN 0(Tier 2)PRIMAQUINE 0(Tier 2)pyrazinamide 0(Tier 1)pyrimethamine 0(Tier 1) QL (90 EA per 30 days); NDSquinine sulfate 0(Tier 1) PA; QL (42 EA per 7 days)rifabutin 0(Tier 1)rifampin 0(Tier 1)RIFATER 0(Tier 2)SIRTURO ORAL TABLET 100 MG 0(Tier 2) PA; QL (188 EA per 365 days)SIRTURO ORAL TABLET 20 MG 0(Tier 2) PASIVEXTRO INTRAVENOUS 0(Tier 2) B/D PA; QL (6 EA per 28 days); NDSSIVEXTRO ORAL 0(Tier 2) QL (6 EA per 28 days); NDSstreptomycin 0(Tier 1)SYNERCID 0(Tier 2) NDStigecycline 0(Tier 1) NDSTOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE


tobramycin in 0.225% nacl 0(Tier 1) B/D PA; QL (280 ML per 28 days); NDStobramycin sulfate 0(Tier 1)TRECATOR 0(Tier 2)




VANCOMYCIN IN 0.9% SODIUM CHL INTRAVENOUS PIGGYBACK

0(Tier 1)

VANCOMYCIN IN DEXTROSE 5% INTRAVENOUS PIGGYBACK

0(Tier 1)

VANCOMYCIN INJECTION 0(Tier 1)vancomycin intravenous recon soln 1,000 mg, 10 gram, 250 mg, 5 gram, 500 mg, 750 mg

0(Tier 1)

VANCOMYCIN INTRAVENOUS RECON SOLN 1.25 GRAM, 1.5 GRAM

0(Tier 2)

vancomycin oral capsule 125 mg 0(Tier 1) QL (40 EA per 10 days)vancomycin oral capsule 250 mg 0(Tier 1) QL (80 EA per 10 days)vancomycin oral recon soln 0(Tier 1)VANCOMYCIN-WATER INJECT (PEG) 0(Tier 2)XIFAXAN ORAL TABLET 550 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSPENICILLINSamoxicillin oral capsule 0(Tier 1)amoxicillin oral suspension for reconstitution 0(Tier 1)amoxicillin oral tablet 0(Tier 1)amoxicillin oral tablet,chewable 125 mg, 250 mg 0(Tier 1)amoxicillin-pot clavulanate 0(Tier 1)ampicillin oral capsule 500 mg 0(Tier 1)ampicillin sodium 0(Tier 1)ampicillin-sulbactam 0(Tier 1)BICILLIN L-A 0(Tier 2)dicloxacillin 0(Tier 1)nafcillin 0(Tier 1)nafcillin in dextrose iso-osm 0(Tier 1)oxacillin injection 0(Tier 1)penicillin g potassium 0(Tier 1)penicillin v potassium 0(Tier 1)pfizerpen-g 0(Tier 2)PIPERACILLIN-TAZOBACTAM INTRAVENOUS RECON SOLN 13.5 GRAM

0(Tier 1)

piperacillin-tazobactam intravenous recon soln 2.25 gram, 3.375 gram, 4.5 gram, 40.5 gram

0(Tier 1)

ZOSYN IN DEXTROSE (ISO-OSM) 0(Tier 2)QUINOLONESBAXDELA 0(Tier 2) QL (28 EA per 14 days)ciprofloxacin 0(Tier 1)ciprofloxacin hcl oral 0(Tier 1)




ciprofloxacin in 5% dextrose 0(Tier 1)levofloxacin in d5w 0(Tier 1)levofloxacin intravenous 0(Tier 1)levofloxacin oral 0(Tier 1)moxifloxacin oral 0(Tier 1)MOXIFLOXACIN-SOD.ACE,SUL-WATER 0(Tier 1)moxifloxacin-sod.chloride(iso) 0(Tier 1)SULFAS / RELATED AGENTSsulfadiazine 0(Tier 1)sulfamethoxazole-trimethoprim 0(Tier 1)sulfatrim 0(Tier 1)TETRACYCLINESdemeclocycline 0(Tier 1)doxy-100 0(Tier 1)doxycycline hyclate intravenous 0(Tier 1)doxycycline hyclate oral capsule 0(Tier 1)doxycycline hyclate oral tablet 100 mg, 20 mg 0(Tier 1)doxycycline monohydrate oral capsule 100 mg, 50 mg

0(Tier 1)

DOXYCYCLINE MONOHYDRATE ORAL CAPSULE,IR - DELAY REL,BIPHASE

0(Tier 1)

doxycycline monohydrate oral suspension for reconstitution

0(Tier 1)

doxycycline monohydrate oral tablet 0(Tier 1)minocycline oral capsule 0(Tier 1)minocycline oral tablet 0(Tier 1)mondoxyne nl oral capsule 100 mg, 75 mg 0(Tier 1)morgidox 0(Tier 1)NUZYRA INTRAVENOUS 0(Tier 2) QL (15 EA per 14 days)NUZYRA ORAL 0(Tier 2) QL (30 EA per 14 days)tetracycline 0(Tier 1)URINARY TRACT AGENTSmethenamine hippurate 0(Tier 1)MONUROL 0(Tier 2)nitrofurantoin 0(Tier 1)nitrofurantoin macrocrystal 0(Tier 1)nitrofurantoin monohyd/m-cryst 0(Tier 1)trimethoprim 0(Tier 1)




ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS (DRUGS THAT TREAT CANCER)ADJUNCTIVE AGENTSleucovorin calcium 0(Tier 1)mesna 0(Tier 1) B/D PAMESNEX ORAL 0(Tier 2) NDSXGEVA 0(Tier 2) PA; QL (1.7 ML per 28 days); NDSANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGSabiraterone 0(Tier 1) PA; QL (120 EA per 30 days); NDSABRAXANE 0(Tier 2) PA; NDSAFINITOR 0(Tier 2) PA; QL (28 EA per 28 days); NDSAFINITOR DISPERZ 0(Tier 2) PA; QL (56 EA per 28 days); NDSALECENSA 0(Tier 2) PA; QL (240 EA per 30 days); NDSALIMTA 0(Tier 2) PA; NDSALIQOPA 0(Tier 2) PA; QL (3 EA per 28 days); NDSALKERAN 0(Tier 2)ALUNBRIG ORAL TABLET 180 MG, 90 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSALUNBRIG ORAL TABLET 30 MG 0(Tier 2) PA; QL (180 EA per 30 days); NDSALUNBRIG ORAL TABLETS,DOSE PACK 0(Tier 2) PA; QL (60 EA per 365 days); NDSanastrozole 0(Tier 1)ARSENIC TRIOXIDE INTRAVENOUS SOLUTION 1 MG/ML

0(Tier 1) B/D PA

arsenic trioxide intravenous solution 2 mg/ml 0(Tier 1) B/D PAASTAGRAF XL 0(Tier 2) PAAVASTIN 0(Tier 2) PA; NDSAYVAKIT 0(Tier 2) PA; QL (30 EA per 30 days); NDSAZASAN 0(Tier 2) PAazathioprine 0(Tier 1) PAazathioprine sodium 0(Tier 1) PABALVERSA ORAL TABLET 3 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSBALVERSA ORAL TABLET 4 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSBALVERSA ORAL TABLET 5 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSBAVENCIO 0(Tier 2) PA; NDSBENDEKA 0(Tier 2) B/D PA; QL (8 ML per 21 days); NDSBESPONSA 0(Tier 2) PA; NDSbexarotene 0(Tier 1) PA; NDSbicalutamide 0(Tier 1)BLENREP 0(Tier 2) PA; NDSBORTEZOMIB 0(Tier 2) PA; QL (14 EA per 21 days); NDSBOSULIF 0(Tier 2) PA; NDS




BRAFTOVI 0(Tier 2) PA; QL (180 EA per 30 days); NDSBRUKINSA 0(Tier 2) PA; NDSbusulfan 0(Tier 1) B/D PA; NDSBUSULFEX 0(Tier 2) B/D PA; NDSCABOMETYX ORAL TABLET 20 MG, 60 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSCABOMETYX ORAL TABLET 40 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSCALQUENCE 0(Tier 2) PA; QL (60 EA per 30 days); NDSCAPRELSA ORAL TABLET 100 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSCAPRELSA ORAL TABLET 300 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSCOMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG X1-20 MG X1)


COMETRIQ ORAL CAPSULE 140 MG/DAY(80 MG X1-20 MG X3)


COMETRIQ ORAL CAPSULE 60 MG/DAY (20 MG X 3/DAY)


COPIKTRA 0(Tier 2) PA; QL (60 EA per 30 days); NDSCOSMEGEN 0(Tier 2) B/D PA; NDSCOTELLIC 0(Tier 2) PA; QL (63 EA per 28 days); NDScyclophosphamide intravenous recon soln 0(Tier 1) B/D PA; NDSCYCLOPHOSPHAMIDE INTRAVENOUS SOLUTION

0(Tier 1) B/D PA; NDS

cyclophosphamide oral capsule 0(Tier 1) B/D PAcyclosporine intravenous 0(Tier 1) PAcyclosporine modified 0(Tier 1) PAcyclosporine oral capsule 0(Tier 1) PACYRAMZA 0(Tier 2) PA; NDSDARZALEX 0(Tier 2) PA; NDSDARZALEX FASPRO 0(Tier 2) PA; NDSdaunorubicin intravenous solution 0(Tier 1) B/D PADAURISMO ORAL TABLET 100 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSDAURISMO ORAL TABLET 25 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSDROXIA 0(Tier 2)ELIGARD 0(Tier 2) PA; QL (1 EA per 30 days)ELIGARD (3 MONTH) 0(Tier 2) PA; QL (1 EA per 90 days)ELIGARD (4 MONTH) 0(Tier 2) PA; QL (1 EA per 120 days)ELIGARD (6 MONTH) 0(Tier 2) PA; QL (1 EA per 180 days)ELZONRIS 0(Tier 2) B/D PA; NDSEMCYT 0(Tier 2)ENHERTU 0(Tier 2) PA; NDS




ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 0.75 MG, 1 MG

0(Tier 2) PA

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 4 MG

0(Tier 2) PA; NDS

ERIVEDGE 0(Tier 2) PA; QL (28 EA per 28 days); NDSERLEADA 0(Tier 2) PA; NDSerlotinib oral tablet 100 mg, 150 mg 0(Tier 1) PA; QL (30 EA per 30 days); NDSerlotinib oral tablet 25 mg 0(Tier 1) PA; QL (60 EA per 30 days); NDSetoposide intravenous 0(Tier 1) B/D PAeverolimus (antineoplastic) 0(Tier 1) PA; QL (28 EA per 28 days); NDSeverolimus (immunosuppressive) oral tablet 0.25 mg

0(Tier 1) PA; QL (60 EA per 30 days)

everolimus (immunosuppressive) oral tablet 0.5 mg


everolimus (immunosuppressive) oral tablet 0.75 mg


EVOMELA 0(Tier 2) PA; NDSexemestane 0(Tier 1) QL (60 EA per 30 days)FARYDAK 0(Tier 2) PA; QL (6 EA per 21 days); NDSFASLODEX 0(Tier 2) B/D PA; QL (30 ML per 30 days); NDSFIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 120 MG

0(Tier 2) B/D PA; QL (4 EA per 365 days); NDS

FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG

0(Tier 2) B/D PA; QL (1 EA per 28 days)

fludarabine 0(Tier 1) B/D PAflutamide 0(Tier 1)FOLOTYN 0(Tier 2) B/D PA; NDSfulvestrant 0(Tier 1) B/D PA; QL (30 ML per 30 days); NDSGAVRETO 0(Tier 2) PA; QL (120 EA per 30 days); NDSGAZYVA 0(Tier 2) PA; NDSgemcitabine intravenous recon soln 0(Tier 1) B/D PAgemcitabine intravenous solution 1 gram/26.3 ml (38 mg/ml), 2 gram/52.6 ml (38 mg/ml), 200 mg/5.26 ml (38 mg/ml)

0(Tier 1) B/D PA

GEMCITABINE INTRAVENOUS SOLUTION 100 MG/ML


gengraf oral capsule 100 mg, 25 mg 0(Tier 1) PAgengraf oral solution 0(Tier 1) PAGILOTRIF 0(Tier 2) PA; QL (30 EA per 30 days); NDSGLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG

0(Tier 2)




HALAVEN 0(Tier 2) PA; NDSHERCEPTIN HYLECTA 0(Tier 2) PA; NDSHERCEPTIN INTRAVENOUS RECON SOLN 150 MG

0(Tier 2) PA; NDS

hydroxyurea 0(Tier 1)IBRANCE 0(Tier 2) PA; QL (21 EA per 28 days); NDSICLUSIG ORAL TABLET 15 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSICLUSIG ORAL TABLET 45 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSIDHIFA 0(Tier 2) PA; QL (30 EA per 30 days); NDSimatinib oral tablet 100 mg 0(Tier 1) PA; QL (180 EA per 30 days); NDSimatinib oral tablet 400 mg 0(Tier 1) PA; QL (60 EA per 30 days); NDSIMBRUVICA ORAL CAPSULE 140 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSIMBRUVICA ORAL CAPSULE 70 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSIMBRUVICA ORAL TABLET 0(Tier 2) PA; QL (30 EA per 30 days); NDSIMFINZI 0(Tier 2) PA; NDSINFUGEM 0(Tier 2) B/D PA; NDSINLYTA ORAL TABLET 1 MG 0(Tier 2) PA; QL (180 EA per 30 days); NDSINLYTA ORAL TABLET 5 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSINQOVI 0(Tier 2) PA; QL (5 EA per 28 days); NDSINREBIC 0(Tier 2) PA; QL (120 EA per 30 days); NDSIRESSA 0(Tier 2) PA; QL (30 EA per 30 days); NDSirinotecan 0(Tier 1) B/D PAISTODAX 0(Tier 2) PA; NDSJAKAFI 0(Tier 2) PA; QL (60 EA per 30 days); NDSKADCYLA 0(Tier 2) PA; NDSKANJINTI 0(Tier 2) PA; NDSKEYTRUDA INTRAVENOUS SOLUTION 0(Tier 2) PA; NDSKISQALI 0(Tier 2) PA; QL (63 EA per 28 days); NDSKISQALI FEMARA CO-PACK ORAL TABLET 200 MG/DAY(200 MG X 1)-2.5 MG


KISQALI FEMARA CO-PACK ORAL TABLET 400 MG/DAY(200 MG X 2)-2.5 MG


KISQALI FEMARA CO-PACK ORAL TABLET 600 MG/DAY(200 MG X 3)-2.5 MG


KYPROLIS 0(Tier 2) B/D PA; NDSLENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 4 MG


LENVIMA ORAL CAPSULE 12 MG/DAY (4 MG X 3), 18 MG/DAY (10 MG X 1-4 MG X2), 24 MG/DAY(10 MG X 2-4 MG X 1)





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


letrozole 0(Tier 1)LEUKERAN 0(Tier 2)leuprolide subcutaneous kit 0(Tier 1) PALIBTAYO 0(Tier 2) PA; QL (7 ML per 21 days); NDSLONSURF ORAL TABLET 15-6.14 MG 0(Tier 2) PA; QL (100 EA per 28 days); NDSLONSURF ORAL TABLET 20-8.19 MG 0(Tier 2) PA; QL (80 EA per 28 days); NDSLORBRENA ORAL TABLET 100 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSLORBRENA ORAL TABLET 25 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSLUMOXITI 0(Tier 2) PA; NDSLUPRON DEPOT 0(Tier 2) PA; QL (1 EA per 30 days); NDSLUPRON DEPOT (3 MONTH) 0(Tier 2) PA; QL (1 EA per 84 days); NDSLUPRON DEPOT (4 MONTH) 0(Tier 2) PA; QL (1 EA per 112 days); NDSLUPRON DEPOT (6 MONTH) 0(Tier 2) PA; QL (1 EA per 168 days); NDSLUPRON DEPOT-PED 0(Tier 2) PA; QL (1 EA per 30 days); NDSLUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG


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


LYNPARZA ORAL TABLET 0(Tier 2) PA; QL (120 EA per 30 days); NDSLYSODREN 0(Tier 2) NDSMATULANE 0(Tier 2) NDSmegestrol oral suspension 400 mg/10 ml (10 ml), 400 mg/10 ml (40 mg/ml)

0(Tier 1) PA

megestrol oral tablet 0(Tier 1) PAMEKINIST ORAL TABLET 0.5 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSMEKINIST ORAL TABLET 2 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSMEKTOVI 0(Tier 2) PA; QL (180 EA per 30 days); NDSmelphalan 0(Tier 1) B/D PAmelphalan hcl 0(Tier 1) B/D PA; NDSmercaptopurine 0(Tier 1)methotrexate sodium 0(Tier 1)methotrexate sodium (pf) 0(Tier 1)MONJUVI 0(Tier 2) PA; NDSMVASI 0(Tier 2) PA; NDSmycophenolate mofetil (hcl) 0(Tier 1) PAmycophenolate mofetil oral capsule 0(Tier 1) PA




mycophenolate mofetil oral suspension for reconstitution

0(Tier 1) PA; NDS

mycophenolate mofetil oral tablet 0(Tier 1) PAmycophenolate sodium 0(Tier 1) PAMYLOTARG 0(Tier 2) PA; NDSNERLYNX 0(Tier 2) PA; QL (180 EA per 30 days); NDSNEXAVAR 0(Tier 2) PA; QL (120 EA per 30 days); NDSnilutamide 0(Tier 1) QL (60 EA per 30 days); NDSNINLARO 0(Tier 2) PA; QL (3 EA per 28 days); NDSNUBEQA 0(Tier 2) PA; QL (120 EA per 30 days); NDSNULOJIX 0(Tier 2) PA; QL (26 EA per 28 days); NDSoctreotide acetate injection solution 0(Tier 1) PAODOMZO 0(Tier 2) PA; QL (30 EA per 30 days); NDSOGIVRI 0(Tier 2) PA; NDSONTRUZANT 0(Tier 2) PA; NDSOPDIVO 0(Tier 2) PA; QL (80 ML per 28 days); NDSpaclitaxel 0(Tier 1) B/D PAPADCEV 0(Tier 2) PA; NDSPEMAZYRE 0(Tier 2) PA; QL (14 EA per 21 days); NDSPERJETA 0(Tier 2) PA; NDSPHESGO 0(Tier 2) PA; NDSPIQRAY ORAL TABLET 200 MG/DAY (200 MG X 1)


PIQRAY ORAL TABLET 250 MG/DAY (200 MG X1-50 MG X1), 300 MG/DAY (150 MG X 2)


POMALYST 0(Tier 2) PA; QL (21 EA per 28 days); NDSPOTELIGEO 0(Tier 2) PA; NDSPROGRAF INTRAVENOUS 0(Tier 2) PAPROGRAF ORAL GRANULES IN PACKET 0(Tier 2) PAPURIXAN 0(Tier 2) PA; QL (300 ML per 30 days); NDSQINLOCK 0(Tier 2) PA; NDSRAPAMUNE ORAL SOLUTION 0(Tier 2) PA; NDSRETEVMO 0(Tier 2) PA; NDSREVLIMID ORAL CAPSULE 10 MG, 2.5 MG, 5 MG


REVLIMID ORAL CAPSULE 15 MG, 20 MG, 25 MG


RITUXAN 0(Tier 2) PA; NDSRITUXAN HYCELA 0(Tier 2) PA; NDSROMIDEPSIN INTRAVENOUS SOLUTION 0(Tier 2) PA; NDS




ROZLYTREK ORAL CAPSULE 100 MG 0(Tier 2) PA; QL (150 EA per 30 days); NDSROZLYTREK ORAL CAPSULE 200 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSRUBRACA 0(Tier 2) PA; QL (120 EA per 30 days); NDSRUXIENCE 0(Tier 2) B/D PA; NDSRYDAPT 0(Tier 2) PA; QL (224 EA per 28 days); NDSSANDIMMUNE ORAL SOLUTION 0(Tier 2) PASANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

0(Tier 2) PA; NDS

SARCLISA 0(Tier 2) PA; NDSSIGNIFOR 0(Tier 2) PA; QL (60 ML per 30 days); NDSSIMULECT 0(Tier 2) B/D PA; NDSsirolimus oral solution 0(Tier 1) PA; NDSsirolimus oral tablet 0(Tier 1) PASOLTAMOX 0(Tier 2) NDSSOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5 ML

0(Tier 2) PA; QL (0.5 ML per 28 days); NDS

SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 60 MG/0.2 ML


SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 90 MG/0.3 ML


SPRYCEL 0(Tier 2) PA; QL (30 EA per 30 days); NDSSTIVARGA 0(Tier 2) PA; QL (120 EA per 28 days); NDSSUTENT 0(Tier 2) PA; QL (28 EA per 28 days); NDSSYNRIBO 0(Tier 2) PA; QL (28 EA per 28 days); NDSTABLOID 0(Tier 2)TABRECTA 0(Tier 2) PA; NDStacrolimus oral 0(Tier 1) PATAFINLAR 0(Tier 2) PA; QL (120 EA per 30 days); NDSTAGRISSO 0(Tier 2) PA; QL (30 EA per 30 days); NDSTALZENNA 0(Tier 2) PA; QL (90 EA per 30 days); NDStamoxifen 0(Tier 1)TARGRETIN TOPICAL 0(Tier 2) PA; QL (60 GM per 30 days); NDSTASIGNA ORAL CAPSULE 150 MG, 200 MG 0(Tier 2) PA; QL (112 EA per 28 days); NDSTASIGNA ORAL CAPSULE 50 MG 0(Tier 2) PA; QL (420 EA per 30 days); NDSTAZVERIK 0(Tier 2) PA; NDSTECENTRIQ INTRAVENOUS SOLUTION 1,200 MG/20 ML (60 MG/ML)

0(Tier 2) PA; QL (20 ML per 21 days); NDS

TECENTRIQ INTRAVENOUS SOLUTION 840 MG/14 ML (60 MG/ML)





temsirolimus 0(Tier 1) B/D PA; QL (4 ML per 28 days); NDSTHALOMID ORAL CAPSULE 100 MG, 150 MG, 50 MG


THALOMID ORAL CAPSULE 200 MG 0(Tier 2) PA; QL (56 EA per 28 days); NDSthiotepa 0(Tier 1) PATIBSOVO 0(Tier 2) PA; QL (60 EA per 30 days); NDStoposar 0(Tier 1) B/D PAtopotecan intravenous recon soln 0(Tier 1) NDStoremifene 0(Tier 1) QL (30 EA per 30 days); NDSTORISEL 0(Tier 2) B/D PA; QL (4 ML per 28 days); NDSTRAZIMERA 0(Tier 2) PA; NDSTREANDA INTRAVENOUS RECON SOLN 100 MG


TREANDA INTRAVENOUS RECON SOLN 25 MG

0(Tier 2) B/D PA; QL (8 EA per 21 days); NDS

TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 11.25 MG






tretinoin (antineoplastic) 0(Tier 1) NDSTRIPTODUR 0(Tier 2) PA; QL (1 EA per 168 days); NDSTRISENOX INTRAVENOUS SOLUTION 2 MG/ML

0(Tier 2) B/D PA

TRODELVY 0(Tier 2) PA; NDSTRUXIMA 0(Tier 2) B/D PA; NDSTUKYSA ORAL TABLET 150 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSTUKYSA ORAL TABLET 50 MG 0(Tier 2) PA; QL (300 EA per 30 days); NDSTYKERB 0(Tier 2) PA; QL (180 EA per 30 days); NDSUNITUXIN 0(Tier 2) PA; NDSVECTIBIX 0(Tier 2) PA; NDSVELCADE 0(Tier 2) PA; QL (14 EA per 21 days); NDSVENCLEXTA ORAL TABLET 10 MG 0(Tier 2) PA; QL (60 EA per 30 days)VENCLEXTA ORAL TABLET 100 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSVENCLEXTA ORAL TABLET 50 MG 0(Tier 2) PA; QL (30 EA per 30 days)VENCLEXTA STARTING PACK 0(Tier 2) PA; QL (84 EA per 365 days); NDSVERZENIO 0(Tier 2) PA; QL (60 EA per 30 days); NDSvincasar pfs intravenous solution 1 mg/ml 0(Tier 1) B/D PAvincristine 0(Tier 1) B/D PA




vinorelbine 0(Tier 1) B/D PAVITRAKVI ORAL CAPSULE 100 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSVITRAKVI ORAL CAPSULE 25 MG 0(Tier 2) PA; QL (180 EA per 30 days); NDSVITRAKVI ORAL SOLUTION 0(Tier 2) PA; QL (300 ML per 30 days); NDSVIZIMPRO 0(Tier 2) PA; QL (30 EA per 30 days); NDSVOTRIENT 0(Tier 2) PA; QL (120 EA per 30 days); NDSVYXEOS 0(Tier 2) B/D PA; NDSXALKORI 0(Tier 2) PA; QL (60 EA per 30 days); NDSXATMEP 0(Tier 2) PAXOSPATA 0(Tier 2) PA; QL (90 EA per 30 days); NDSXPOVIO ORAL TABLET 100 MG/WEEK (20 MG X 5)


XPOVIO ORAL TABLET 40 MG/WEEK (20 MG X 2), 60MG TWICE WEEK (120 MG/WEEK)

0(Tier 2) PA; NDS

XPOVIO ORAL TABLET 40MG TWICE WEEK (80 MG/WEEK), 80 MG/WEEK (20 MG X 4)


XPOVIO ORAL TABLET 60 MG/WEEK (20 MG X 3)


XPOVIO ORAL TABLET 80MG TWICE WEEK (160 MG/WEEK)


XTANDI 0(Tier 2) PA; QL (120 EA per 30 days); NDSYERVOY INTRAVENOUS SOLUTION 200 MG/40 ML (5 MG/ML)


YERVOY INTRAVENOUS SOLUTION 50 MG/10 ML (5 MG/ML)

0(Tier 2) PA; NDS

YONDELIS 0(Tier 2) PA; NDSYONSA 0(Tier 2) PA; QL (120 EA per 30 days); NDSZEJULA 0(Tier 2) PA; QL (90 EA per 30 days); NDSZELBORAF 0(Tier 2) PA; QL (240 EA per 30 days); NDSZEPZELCA 0(Tier 2) PA; NDSZIRABEV 0(Tier 2) PA; NDSZOLINZA 0(Tier 2) QL (120 EA per 30 days); NDSZORTRESS ORAL TABLET 0.25 MG 0(Tier 2) PA; QL (60 EA per 30 days)ZORTRESS ORAL TABLET 0.5 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSZORTRESS ORAL TABLET 0.75 MG, 1 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSZYDELIG 0(Tier 2) PA; QL (60 EA per 30 days); NDSZYKADIA ORAL TABLET 0(Tier 2) PA; QL (140 EA per 28 days); NDSZYTIGA ORAL TABLET 500 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDS




AUTONOMIC / CNS DRUGS, NEUROLOGY / PSYCH (DRUGS FOR THE NERVOUS SYSTEM)ANTICONVULSANTSAPTIOM ORAL TABLET 200 MG 0(Tier 2) QL (180 EA per 30 days); NDSAPTIOM ORAL TABLET 400 MG 0(Tier 2) QL (90 EA per 30 days); NDSAPTIOM ORAL TABLET 600 MG, 800 MG 0(Tier 2) QL (60 EA per 30 days); NDSBANZEL ORAL SUSPENSION 0(Tier 2) PA; QL (2400 ML per 30 days); NDSBANZEL ORAL TABLET 0(Tier 2) PA; NDSBRIVIACT ORAL SOLUTION 0(Tier 2) QL (600 ML per 30 days)BRIVIACT ORAL TABLET 0(Tier 2) QL (60 EA per 30 days)carbamazepine oral capsule, er multiphase 12 hr

0(Tier 1)

carbamazepine oral suspension 100 mg/5 ml 0(Tier 1)carbamazepine oral tablet 0(Tier 1)carbamazepine oral tablet extended release 12 hr

0(Tier 1)

carbamazepine oral tablet,chewable 0(Tier 1)CELONTIN ORAL CAPSULE 300 MG 0(Tier 2)clobazam oral suspension 0(Tier 1) QL (480 ML per 30 days); NDSclobazam oral tablet 10 mg 0(Tier 1) QL (60 EA per 30 days)clobazam oral tablet 20 mg 0(Tier 1) QL (60 EA per 30 days); NDSclonazepam oral tablet 0.5 mg, 1 mg 0(Tier 1) QL (120 EA per 30 days)clonazepam oral tablet 2 mg 0(Tier 1) QL (300 EA per 30 days)clonazepam oral tablet,disintegrating 0.125 mg, 0.25 mg, 0.5 mg


clonazepam oral tablet,disintegrating 1 mg 0(Tier 1) QL (120 EA per 30 days)clonazepam oral tablet,disintegrating 2 mg 0(Tier 1) QL (300 EA per 30 days)DIASTAT 0(Tier 2) QL (5 EA per 30 days)DIASTAT ACUDIAL RECTAL KIT 12.5-15-17.5-20 MG


DIASTAT ACUDIAL RECTAL KIT 5-7.5-10 MG 0(Tier 2) QL (20 EA per 30 days)diazepam rectal kit 12.5-15-17.5-20 mg 0(Tier 1) QL (40 EA per 30 days)diazepam rectal kit 2.5 mg 0(Tier 1) QL (5 EA per 30 days)diazepam rectal kit 5-7.5-10 mg 0(Tier 1) QL (20 EA per 30 days)dilantin 30 mg 0(Tier 1)divalproex 0(Tier 1)EPIDIOLEX 0(Tier 2) PA; NDSepitol 0(Tier 1)ethosuximide 0(Tier 1)felbamate oral suspension 0(Tier 1) NDSfelbamate oral tablet 0(Tier 1)




FINTEPLA 0(Tier 2) PA; NDSFYCOMPA ORAL SUSPENSION 0(Tier 2) QL (720 ML per 30 days)FYCOMPA ORAL TABLET 10 MG, 12 MG, 8 MG


FYCOMPA ORAL TABLET 2 MG, 4 MG, 6 MG 0(Tier 2) QL (60 EA per 30 days)gabapentin oral capsule 100 mg, 400 mg 0(Tier 1) QL (270 EA per 30 days)gabapentin oral capsule 300 mg 0(Tier 1) QL (360 EA per 30 days)gabapentin oral solution 0(Tier 1) QL (2160 ML per 30 days)gabapentin oral tablet 600 mg 0(Tier 1) QL (180 EA per 30 days)gabapentin oral tablet 800 mg 0(Tier 1)lamotrigine oral tablet 0(Tier 1)lamotrigine oral tablet extended release 24hr 0(Tier 1)lamotrigine oral tablet, chewable dispersible 0(Tier 1)lamotrigine oral tablet,disintegrating 0(Tier 1)levetiracetam 0(Tier 1)levetiracetam in nacl (iso-os) 0(Tier 1)LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 165 MG, 82.5 MG


LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 330 MG


LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 25 MG, 50 MG


LYRICA ORAL CAPSULE 225 MG, 300 MG 0(Tier 2) QL (60 EA per 30 days)LYRICA ORAL CAPSULE 75 MG 0(Tier 2) QL (120 EA per 30 days)LYRICA ORAL SOLUTION 0(Tier 2) QL (900 ML per 30 days)NAYZILAM 0(Tier 2) PA; QL (10 EA per 30 days); NDSoxcarbazepine 0(Tier 1)PEGANONE 0(Tier 2)PHENOBARBITAL ORAL ELIXIR 0(Tier 2) QL (1500 ML per 30 days)PHENOBARBITAL ORAL TABLET 0(Tier 2) QL (120 EA per 30 days)phenytoin oral suspension 0(Tier 1)phenytoin oral tablet,chewable 0(Tier 1)phenytoin sodium extended 0(Tier 1)pregabalin oral capsule 100 mg, 150 mg, 200 mg, 25 mg, 50 mg


pregabalin oral capsule 225 mg, 300 mg 0(Tier 1) QL (60 EA per 30 days)pregabalin oral capsule 75 mg 0(Tier 1) QL (120 EA per 30 days)pregabalin oral solution 0(Tier 1) QL (900 ML per 30 days)primidone 0(Tier 1)roweepra 0(Tier 1)




roweepra xr 0(Tier 1)SPRITAM ORAL TABLET FOR SUSPENSION 1,000 MG, 250 MG, 500 MG


SPRITAM ORAL TABLET FOR SUSPENSION 750 MG


SYMPAZAN 0(Tier 2) PA; QL (60 EA per 30 days); NDStiagabine 0(Tier 1)topiramate oral capsule, sprinkle 0(Tier 1)topiramate oral tablet 0(Tier 1)TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 100 MG, 25 MG, 50 MG


TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 200 MG


valproic acid 0(Tier 1)valproic acid (as sodium salt) oral solution 0(Tier 1)VALTOCO 0(Tier 2) PA; QL (10 EA per 30 days); NDSvigabatrin 0(Tier 1) PA; QL (180 EA per 30 days); NDSvigadrone 0(Tier 1) PA; QL (180 EA per 30 days); NDSVIMPAT INTRAVENOUS 0(Tier 2) QL (1200 ML per 30 days)VIMPAT ORAL SOLUTION 0(Tier 2) QL (1200 ML per 30 days)VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG


VIMPAT ORAL TABLET 50 MG 0(Tier 2) QL (120 EA per 30 days)XCOPRI 0(Tier 2) PA; NDSXCOPRI MAINTENANCE PACK 0(Tier 2) PA; NDSXCOPRI TITRATION PACK 0(Tier 2) PAzonisamide 0(Tier 1)ANTIPARKINSONISM AGENTSAPOKYN 0(Tier 2) PA; QL (60 ML per 30 days); NDSbenztropine injection 0(Tier 1)benztropine oral 0(Tier 1) PAbromocriptine 0(Tier 1)carbidopa 0(Tier 1)carbidopa-levodopa 0(Tier 1)carbidopa-levodopa-entacapone 0(Tier 1)entacapone 0(Tier 1) QL (240 EA per 30 days)NEUPRO 0(Tier 2)pramipexole oral tablet 0(Tier 1)pramipexole oral tablet extended release 24 hr 0.375 mg, 0.75 mg, 1.5 mg





pramipexole oral tablet extended release 24 hr 2.25 mg, 3 mg, 3.75 mg, 4.5 mg


rasagiline 0(Tier 1)ropinirole oral tablet 0(Tier 1)RYTARY 0(Tier 2) STselegiline hcl 0(Tier 1)tolcapone 0(Tier 1) NDStrihexyphenidyl 0(Tier 1) PAMIGRAINE / CLUSTER HEADACHE THERAPYAIMOVIG AUTOINJECTOR 0(Tier 2) PA; QL (1 ML per 30 days)dihydroergotamine nasal 0(Tier 1) PA; QL (8 ML per 30 days)ergotamine-caffeine 0(Tier 1) QL (40 EA per 28 days)MIGERGOT 0(Tier 2) QL (20 EA per 28 days); NDSnaratriptan 0(Tier 1) QL (18 EA per 28 days)rizatriptan 0(Tier 1) QL (36 EA per 28 days)sumatriptan 0(Tier 1) QL (18 EA per 28 days)sumatriptan succinate oral 0(Tier 1) QL (18 EA per 28 days)sumatriptan succinate subcutaneous cartridge 0(Tier 1) QL (8 ML per 28 days)sumatriptan succinate subcutaneous pen injector

0(Tier 1) QL (8 ML per 28 days)

sumatriptan succinate subcutaneous solution 0(Tier 1) QL (8 ML per 28 days)sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml


MISCELLANEOUS NEUROLOGICAL THERAPYAUSTEDO ORAL TABLET 12 MG, 9 MG 0(Tier 2) PA; QL (120 EA per 30 days); NDSAUSTEDO ORAL TABLET 6 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSCOPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML


COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML


dalfampridine 0(Tier 1) PA; QL (60 EA per 30 days)dimethyl fumarate oral capsule,delayed release(dr/ec) 120 mg


dimethyl fumarate oral capsule,delayed release(dr/ec) 120 mg (14)- 240 mg (46)


dimethyl fumarate oral capsule,delayed release(dr/ec) 240 mg


donepezil oral tablet 10 mg 0(Tier 1) QL (60 EA per 30 days)donepezil oral tablet 23 mg, 5 mg 0(Tier 1) QL (30 EA per 30 days)donepezil oral tablet,disintegrating 10 mg 0(Tier 1) QL (60 EA per 30 days)




donepezil oral tablet,disintegrating 5 mg 0(Tier 1) QL (30 EA per 30 days)FIRDAPSE 0(Tier 2) PA; NDSgalantamine oral capsule,ext rel. pellets 24 hr 0(Tier 1) QL (30 EA per 30 days)galantamine oral solution 0(Tier 1) QL (200 ML per 30 days)galantamine oral tablet 0(Tier 1) QL (60 EA per 30 days)GILENYA ORAL CAPSULE 0.5 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSmemantine oral capsule,sprinkle,er 24hr 0(Tier 1) PA; QL (30 EA per 30 days)memantine oral solution 0(Tier 1) PA; QL (300 ML per 30 days)memantine oral tablet 10 mg 0(Tier 1) PA; QL (60 EA per 30 days)memantine oral tablet 5 mg 0(Tier 1) PA; QL (90 EA per 30 days)MEMANTINE ORAL TABLETS,DOSE PACK 0(Tier 2) PA; QL (98 EA per 365 days)NAMZARIC ORAL CAP,SPRINKLE,ER 24HR DOSE PACK


NAMZARIC ORAL CAPSULE,SPRINKLE,ER 24HR

0(Tier 2) PA

NUEDEXTA 0(Tier 2) PA; QL (60 EA per 30 days)OCREVUS 0(Tier 2) PA; NDSrivastigmine 0(Tier 1) QL (30 EA per 30 days)rivastigmine tartrate 0(Tier 1) QL (60 EA per 30 days)TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG


TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46)


TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 240 MG


tetrabenazine oral tablet 12.5 mg 0(Tier 1) PA; QL (90 EA per 30 days); NDStetrabenazine oral tablet 25 mg 0(Tier 1) PA; QL (120 EA per 30 days); NDSTYSABRI 0(Tier 2) PA; QL (15 ML per 28 days); NDSMUSCLE RELAXANTS / ANTISPASMODIC THERAPYbaclofen oral 0(Tier 1)cyclobenzaprine oral tablet 10 mg, 5 mg 0(Tier 1) PAdantrolene oral 0(Tier 1)methocarbamol oral 0(Tier 1) PApyridostigmine bromide oral syrup 0(Tier 1) NDSpyridostigmine bromide oral tablet 60 mg 0(Tier 1)pyridostigmine bromide oral tablet extended release

0(Tier 1)

regonol 0(Tier 2)tizanidine 0(Tier 1)




NARCOTIC ANALGESICSacetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 300 mg-30 mg /12.5 ml


acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg


acetaminophen-codeine oral tablet 300-60 mg 0(Tier 1) QL (180 EA per 30 days); NDSascomp with codeine 0(Tier 1) PA; QL (180 EA per 30 days)buprenorphine 0(Tier 1) QL (4 EA per 28 days); NDSbuprenorphine hcl injection 0(Tier 1) QL (150 ML per 30 days); NDSbuprenorphine hcl sublingual 0(Tier 1) PA; QL (90 EA per 30 days)butalbital compound w/codeine 0(Tier 1) PA; QL (180 EA per 30 days)butalbital-acetaminop-caf-cod 0(Tier 1) PA; QL (180 EA per 30 days)butalbital-acetaminophen-caff oral capsule 0(Tier 1) PA; QL (180 EA per 30 days)butalbital-acetaminophen-caff oral tablet 50-325-40 mg


butalbital-aspirin-caffeine oral capsule 0(Tier 1) PA; QL (180 EA per 30 days)duramorph (pf) 0(Tier 1) B/D PA; QL (180 ML per 30 days); NDSendocet oral tablet 10-325 mg 0(Tier 1) QL (180 EA per 30 days); NDSendocet oral tablet 2.5-325 mg, 5-325 mg 0(Tier 1) QL (360 EA per 30 days); NDSendocet oral tablet 7.5-325 mg 0(Tier 1) QL (240 EA per 30 days); NDSfentanyl 0(Tier 1) QL (10 EA per 30 days); NDSfentanyl citrate (pf) injection solution 0(Tier 1) B/D PA; NDSfentanyl citrate (pf) intravenous syringe 100 mcg/2 ml (50 mcg/ml)


fentanyl citrate buccal lozenge on a handle 0(Tier 1) PA; QL (120 EA per 30 days); NDShydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml)

0(Tier 1) NDS

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


hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 7.5-300 mg, 7.5-325 mg


hydrocodone-acetaminophen oral tablet 5-325 mg


hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg


hydromorphone (pf) injection solution 10 (mg/ml) (5 ml), 10 mg/ml, 2 mg/ml

0(Tier 1) NDS

hydromorphone injection solution 2 mg/ml 0(Tier 1) NDShydromorphone injection syringe 1 mg/ml, 2 mg/ml, 4 mg/ml

0(Tier 1) NDS




hydromorphone oral liquid 0(Tier 1) QL (1200 ML per 30 days); NDShydromorphone oral tablet 2 mg, 4 mg 0(Tier 1) QL (180 EA per 30 days); NDShydromorphone oral tablet 8 mg 0(Tier 1) QL (120 EA per 30 days); NDSibuprofen-oxycodone 0(Tier 1) QL (28 EA per 30 days); NDSINFUMORPH P/F 0(Tier 1) B/D PA; QL (200 ML per 30 days); NDSlorcet hd 0(Tier 1) QL (180 EA per 30 days); NDSmethadone injection solution 0(Tier 2) QL (150 ML per 30 days); NDSmethadone intensol 0(Tier 1) QL (500 ML per 30 days); NDSmethadone oral concentrate 0(Tier 1) QL (500 ML per 30 days); NDSmethadone oral solution 10 mg/5 ml 0(Tier 1) QL (450 ML per 30 days); NDSmethadone oral solution 5 mg/5 ml 0(Tier 1) QL (600 ML per 30 days); NDSmethadone oral tablet 10 mg 0(Tier 1) QL (120 EA per 30 days); NDSmethadone oral tablet 5 mg 0(Tier 1) QL (180 EA per 30 days); NDSMITIGO (PF) 0(Tier 1) QL (200 ML per 30 days); NDSmorphine (pf) injection solution 0.5 mg/ml, 1 mg/ml

0(Tier 1) B/D PA; QL (180 ML per 30 days); NDS

morphine concentrate oral solution 0(Tier 1) QL (240 ML per 30 days); NDSMORPHINE INJECTION SOLUTION 10 MG/ML 0(Tier 2) B/D PA; QL (240 ML per 30 days); NDSMORPHINE INJECTION SOLUTION 2 MG/ML 0(Tier 2) B/D PA; NDSMORPHINE INJECTION SOLUTION 4 MG/ML 0(Tier 2) B/D PA; QL (480 ML per 30 days); NDSMORPHINE INJECTION SOLUTION 5 MG/ML 0(Tier 2) B/D PA; QL (700 ML per 30 days); NDSmorphine injection solution 8 mg/ml 0(Tier 2) B/D PA; QL (250 ML per 30 days); NDSmorphine injection syringe 10 mg/ml 0(Tier 1) B/D PA; QL (240 ML per 30 days); NDSMORPHINE INJECTION SYRINGE 2 MG/ML 0(Tier 2) B/D PA; QL (1200 ML per 30 days); NDSmorphine injection syringe 4 mg/ml 0(Tier 1) B/D PA; QL (480 ML per 30 days); NDSmorphine injection syringe 5 mg/ml 0(Tier 1) B/D PA; NDSmorphine injection syringe 8 mg/ml 0(Tier 2) B/D PA; QL (250 ML per 30 days); NDSmorphine intravenous solution 10 mg/ml 0(Tier 2) B/D PA; QL (240 ML per 30 days); NDSMORPHINE INTRAVENOUS SOLUTION 4 MG/ML


MORPHINE INTRAVENOUS SOLUTION 8 MG/ML


MORPHINE INTRAVENOUS SYRINGE 10 MG/ML


morphine intravenous syringe 2 mg/ml 0(Tier 2) B/D PA; QL (1200 ML per 30 days); NDSmorphine intravenous syringe 4 mg/ml 0(Tier 2) B/D PA; QL (480 ML per 30 days); NDSMORPHINE INTRAVENOUS SYRINGE 8 MG/ML


morphine oral solution 10 mg/5 ml 0(Tier 1) QL (700 ML per 30 days); NDSmorphine oral solution 20 mg/5 ml (4 mg/ml) 0(Tier 1) QL (900 ML per 30 days); NDS




MORPHINE ORAL TABLET 0(Tier 2) QL (120 EA per 30 days); NDSmorphine oral tablet extended release 0(Tier 1) QL (90 EA per 30 days); NDSoxycodone oral concentrate 0(Tier 1) QL (120 ML per 30 days); NDSoxycodone oral solution 0(Tier 1) QL (1200 ML per 30 days); NDSoxycodone oral tablet 0(Tier 1) QL (180 EA per 30 days); NDSoxycodone-acetaminophen oral tablet 10-325 mg


oxycodone-acetaminophen oral tablet 2.5-300 mg

0(Tier 1) NDS

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


oxycodone-acetaminophen oral tablet 7.5-325 mg


oxycodone-aspirin 0(Tier 1) QL (180 EA per 30 days); NDSoxymorphone oral tablet extended release 12 hr 0(Tier 1) QL (90 EA per 30 days); NDSXTAMPZA ER 0(Tier 2) QL (60 EA per 30 days); NDSzebutal oral capsule 50-325-40 mg 0(Tier 1) PA; QL (180 EA per 30 days)NON-NARCOTIC ANALGESICS8 hour pain reliever 0(Tier 1) MC8hr muscle aches-pain 0(Tier 1) MCacetaminophen oral tablet 325 mg 0(Tier 1) MCacetaminophen oral tablet extended release 0(Tier 1) MCacetaminophen rectal 0(Tier 1) MCadult aspirin regimen 0(Tier 1) MCall day pain relief 0(Tier 1) MCall day relief 0(Tier 1) MCarthritis pain relief (acetam) 0(Tier 1) MCaspirin oral tablet 0(Tier 1) MCaspirin oral tablet,chewable 0(Tier 1) MCaspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg

0(Tier 1) MC

buprenorphine-naloxone sublingual film 12-3 mg 0(Tier 1) QL (60 EA per 30 days)buprenorphine-naloxone sublingual film 2-0.5 mg, 4-1 mg, 8-2 mg


buprenorphine-naloxone sublingual tablet 0(Tier 1) QL (90 EA per 30 days)butorphanol injection solution 1 mg/ml 0(Tier 1) QL (480 ML per 30 days); NDSbutorphanol injection solution 2 mg/ml 0(Tier 1) QL (240 ML per 30 days); NDSbutorphanol nasal 0(Tier 1) QL (5 ML per 30 days); NDScelecoxib 0(Tier 1) QL (60 EA per 30 days)children’s ibuprofen 0(Tier 1) MC




children’s mapap oral tablet,chewable 80 mg 0(Tier 1) MCdiclofenac potassium 0(Tier 1)diclofenac sodium oral 0(Tier 1)diclofenac sodium topical drops 0(Tier 1) QL (450 ML per 28 days)diclofenac sodium topical gel 1% 0(Tier 1) QL (1000 GM per 30 days)diflunisal 0(Tier 1)ec-naproxen 0(Tier 1)ed-apap 0(Tier 1) MCefferves pain relief antacid 0(Tier 1) MCetodolac 0(Tier 1)flurbiprofen oral tablet 100 mg 0(Tier 1)ibu 0(Tier 1)ibu-200 0(Tier 1) MCibuprofen jr strength 0(Tier 1) MCibuprofen oral capsule 0(Tier 1) MCibuprofen oral suspension 0(Tier 1)ibuprofen oral tablet 200 mg 0(Tier 1) MCibuprofen oral tablet 400 mg, 600 mg, 800 mg 0(Tier 1)infant’s ibuprofen 0(Tier 1) MCmapap (acetaminophen) oral capsule 0(Tier 1) MCmapap (acetaminophen) oral liquid 500 mg/15 ml

0(Tier 1) MC

mapap (acetaminophen) oral tablet 0(Tier 1) MCmapap arthritis pain 0(Tier 1) MCmapap extra strength 0(Tier 1) MCmeloxicam oral tablet 0(Tier 1)migraine relief 0(Tier 1) MCm-pap 0(Tier 1) MCnabumetone 0(Tier 1)nalbuphine injection solution 10 mg/ml 0(Tier 1) QL (180 ML per 30 days); NDSnalbuphine injection solution 20 mg/ml 0(Tier 1) QL (90 ML per 30 days); NDSnaloxone injection solution 0(Tier 1)naloxone injection syringe 1 mg/ml 0(Tier 1)naltrexone 0(Tier 1)naproxen 0(Tier 1)naproxen sodium oral tablet 220 mg 0(Tier 1) MCnaproxen sodium oral tablet 275 mg, 550 mg 0(Tier 1)NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION





non-aspirin pm 0(Tier 1) MCoxaprozin 0(Tier 1)salsalate 0(Tier 1)SUBOXONE SUBLINGUAL FILM 12-3 MG 0(Tier 2) QL (60 EA per 30 days)SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG, 8-2 MG


sulindac 0(Tier 1)tramadol oral tablet 50 mg 0(Tier 1) QL (240 EA per 30 days); NDStramadol-acetaminophen 0(Tier 1) QL (240 EA per 30 days); NDSVIVITROL 0(Tier 2) PA; NDSZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 11.4-2.9 MG


ZUBSOLV SUBLINGUAL TABLET 1.4-0.36 MG, 2.9-0.71 MG, 5.7-1.4 MG, 8.6-2.1 MG


PSYCHOTHERAPEUTIC DRUGSABILIFY MAINTENA 0(Tier 2) QL (1 EA per 28 days); NDSalprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg 0(Tier 1) QL (120 EA per 30 days)alprazolam oral tablet 2 mg 0(Tier 1) QL (150 EA per 30 days)alprazolam oral tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg


alprazolam oral tablet,disintegrating 2 mg 0(Tier 1) QL (150 EA per 30 days)amitriptyline 0(Tier 1) PAamoxapine 0(Tier 1)aripiprazole oral solution 0(Tier 1) QL (900 ML per 30 days)aripiprazole oral tablet 0(Tier 1) QL (30 EA per 30 days)aripiprazole oral tablet,disintegrating 0(Tier 1) QL (60 EA per 30 days); NDSARISTADA INITIO 0(Tier 2) QL (4.8 ML per 365 days); NDSARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 1,064 MG/3.9 ML

0(Tier 2) QL (3.9 ML per 56 days); NDS

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML






armodafinil 0(Tier 1) PA; QL (30 EA per 30 days)




atomoxetine oral capsule 10 mg, 18 mg, 25 mg, 40 mg


atomoxetine oral capsule 100 mg, 60 mg, 80 mg 0(Tier 1) QL (30 EA per 30 days)BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG


BELSOMRA ORAL TABLET 5 MG 0(Tier 2) QL (60 EA per 30 days)bupropion hcl oral tablet 100 mg 0(Tier 1) QL (120 EA per 30 days)bupropion hcl oral tablet 75 mg 0(Tier 1) QL (180 EA per 30 days)bupropion hcl oral tablet extended release 24 hr 150 mg


bupropion hcl oral tablet extended release 24 hr 300 mg


bupropion hcl oral tablet sustained-release 12 hr 100 mg, 200 mg


bupropion hcl oral tablet sustained-release 12 hr 150 mg


buspirone 0(Tier 1)CAPLYTA 0(Tier 2) ST; QL (30 EA per 30 days); NDSchlorpromazine 0(Tier 1)citalopram oral solution 0(Tier 1) QL (600 ML per 30 days)citalopram oral tablet 10 mg 0(Tier 1) QL (120 EA per 30 days)citalopram oral tablet 20 mg 0(Tier 1) QL (60 EA per 30 days)citalopram oral tablet 40 mg 0(Tier 1) QL (90 EA per 30 days)clomipramine 0(Tier 1) PAclonidine hcl oral tablet extended release 12 hr 0(Tier 1) QL (120 EA per 30 days)clorazepate dipotassium oral tablet 15 mg, 3.75 mg


clorazepate dipotassium oral tablet 7.5 mg 0(Tier 1) QL (360 EA per 30 days)clozapine oral tablet 0(Tier 1)clozapine oral tablet,disintegrating 100 mg 0(Tier 1) QL (270 EA per 30 days)clozapine oral tablet,disintegrating 12.5 mg, 25 mg

0(Tier 1)

clozapine oral tablet,disintegrating 150 mg 0(Tier 1) QL (180 EA per 30 days)clozapine oral tablet,disintegrating 200 mg 0(Tier 1) QL (120 EA per 30 days); NDSdesipramine 0(Tier 1)desvenlafaxine succinate oral tablet extended release 24 hr 100 mg


desvenlafaxine succinate oral tablet extended release 24 hr 25 mg, 50 mg


dexmethylphenidate oral tablet 10 mg, 2.5 mg 0(Tier 1) QL (60 EA per 30 days)dexmethylphenidate oral tablet 5 mg 0(Tier 1) QL (120 EA per 30 days)




dextroamphetamine oral capsule, extended release 10 mg






dextroamphetamine oral solution 0(Tier 1) QL (1800 ML per 30 days)dextroamphetamine oral tablet 0(Tier 1) QL (180 EA per 30 days)dextroamphetamine-amphetamine oral capsule,extended release 24hr


dextroamphetamine-amphetamine oral tablet 10 mg


dextroamphetamine-amphetamine oral tablet 12.5 mg, 30 mg, 7.5 mg








diazepam injection syringe 0(Tier 1)diazepam oral solution 5 mg/5 ml (1 mg/ml) 0(Tier 1) QL (1200 ML per 30 days)diazepam oral tablet 0(Tier 1) QL (120 EA per 30 days)doxepin oral capsule 0(Tier 1) PAdoxepin oral concentrate 0(Tier 1) PAdoxepin oral tablet 0(Tier 1) QL (30 EA per 30 days)DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 20 MG


DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 30 MG, 40 MG


DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 60 MG


duloxetine oral capsule,delayed release(dr/ec) 20 mg






EMSAM 0(Tier 2) QL (30 EA per 30 days); NDSescitalopram oxalate oral solution 0(Tier 1) QL (600 ML per 30 days)escitalopram oxalate oral tablet 0(Tier 1)FANAPT ORAL TABLET 1 MG, 2 MG, 4 MG 0(Tier 2) ST; QL (60 EA per 30 days)




FANAPT ORAL TABLET 10 MG, 12 MG, 6 MG, 8 MG

0(Tier 2) ST; QL (60 EA per 30 days); NDS

FANAPT ORAL TABLETS,DOSE PACK 0(Tier 2) ST; QL (16 EA per 365 days)FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK

0(Tier 2) ST; QL (56 EA per 365 days)

FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR


fluoxetine oral capsule 0(Tier 1)fluoxetine oral capsule,delayed release(dr/ec) 0(Tier 1) QL (4 EA per 28 days)fluoxetine oral solution 0(Tier 1) QL (600 ML per 30 days)fluoxetine oral tablet 10 mg, 20 mg 0(Tier 1)fluphenazine decanoate 0(Tier 1)fluphenazine hcl 0(Tier 1)fluvoxamine oral tablet 0(Tier 1)GEODON INTRAMUSCULAR 0(Tier 2) QL (6 EA per 30 days)GUANIDINE 0(Tier 2)haloperidol 0(Tier 1)haloperidol decanoate 0(Tier 1)haloperidol lactate injection 0(Tier 1)haloperidol lactate oral 0(Tier 1)HETLIOZ 0(Tier 2) PA; QL (30 EA per 30 days); NDSimipramine hcl 0(Tier 1) PAINVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML


INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ML


INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 234 MG/1.5 ML



0(Tier 2) QL (0.25 ML per 28 days)



INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/0.875 ML











LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG


LATUDA ORAL TABLET 80 MG 0(Tier 2) QL (60 EA per 30 days); NDSlithium carbonate 0(Tier 1)lorazepam injection 0(Tier 1)lorazepam intensol 0(Tier 1) QL (150 ML per 30 days)lorazepam oral concentrate 0(Tier 1) QL (150 ML per 30 days)lorazepam oral tablet 0.5 mg, 1 mg 0(Tier 1) QL (120 EA per 30 days)lorazepam oral tablet 2 mg 0(Tier 1) QL (150 EA per 30 days)loxapine succinate 0(Tier 1)maprotiline 0(Tier 1)MARPLAN 0(Tier 2) QL (180 EA per 30 days)methylphenidate hcl oral tablet 0(Tier 1) QL (90 EA per 30 days)methylphenidate hcl oral tablet extended release


methylphenidate hcl oral tablet extended release 24hr 18 mg, 18 mg (bx rating)


methylphenidate hcl oral tablet extended release 24hr 27 mg, 27 mg (bx rating), 54 mg, 54 mg (bx rating)


methylphenidate hcl oral tablet extended release 24hr 36 mg, 36 mg (bx rating)


mirtazapine oral tablet 0(Tier 1)mirtazapine oral tablet,disintegrating 0(Tier 1) QL (30 EA per 30 days)molindone 0(Tier 1)nefazodone 0(Tier 1)nortriptyline 0(Tier 1)NUPLAZID ORAL CAPSULE 0(Tier 2) PA; QL (30 EA per 30 days); NDSNUPLAZID ORAL TABLET 10 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSolanzapine intramuscular 0(Tier 1) QL (30 EA per 30 days)olanzapine oral tablet 10 mg, 2.5 mg, 5 mg 0(Tier 1) QL (120 EA per 30 days)olanzapine oral tablet 15 mg, 20 mg 0(Tier 1) QL (60 EA per 30 days)olanzapine oral tablet 7.5 mg 0(Tier 1) QL (30 EA per 30 days)olanzapine oral tablet,disintegrating 0(Tier 1) QL (30 EA per 30 days)olanzapine-fluoxetine 0(Tier 1) QL (30 EA per 30 days)oxazepam 0(Tier 1) QL (120 EA per 30 days)paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 9 mg


paliperidone oral tablet extended release 24hr 6 mg





paroxetine hcl oral tablet 10 mg, 30 mg, 40 mg 0(Tier 1) QL (60 EA per 30 days)paroxetine hcl oral tablet 20 mg 0(Tier 1) QL (90 EA per 30 days)paroxetine hcl oral tablet extended release 24 hr 12.5 mg


paroxetine hcl oral tablet extended release 24 hr 25 mg, 37.5 mg


PAXIL ORAL SUSPENSION 0(Tier 2) ST; QL (900 ML per 30 days)perphenazine 0(Tier 1)perphenazine-amitriptyline 0(Tier 1) PAPERSERIS 0(Tier 2) QL (1 EA per 30 days); NDSphenelzine 0(Tier 1)pimozide 0(Tier 1)protriptyline 0(Tier 1)quetiapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg


quetiapine oral tablet 300 mg, 400 mg 0(Tier 1) QL (60 EA per 30 days)quetiapine oral tablet extended release 24 hr 150 mg, 200 mg


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


ramelteon 0(Tier 1)REXULTI 0(Tier 2) QL (30 EA per 30 days); NDSRISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 12.5 MG/2 ML, 25 MG/2 ML, 37.5 MG/2 ML


RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 50 MG/2 ML


risperidone oral solution 0(Tier 1) QL (240 ML per 30 days)risperidone oral tablet 0(Tier 1)risperidone oral tablet,disintegrating 0.25 mg, 1 mg, 2 mg, 3 mg


risperidone oral tablet,disintegrating 0.5 mg, 4 mg


SAPHRIS 0(Tier 2) QL (60 EA per 30 days)SECUADO 0(Tier 2) QL (30 EA per 30 days)sertraline oral concentrate 0(Tier 1) QL (300 ML per 30 days)sertraline oral tablet 100 mg, 25 mg 0(Tier 1) QL (60 EA per 30 days)sertraline oral tablet 50 mg 0(Tier 1) QL (120 EA per 30 days)SILENOR 0(Tier 2) QL (30 EA per 30 days)sleep aid (doxylamine) 0(Tier 1) MC




temazepam 0(Tier 1) QL (60 EA per 365 days)thioridazine 0(Tier 1)thiothixene 0(Tier 1)tranylcypromine 0(Tier 1)trazodone 0(Tier 1)trifluoperazine 0(Tier 1)trimipramine 0(Tier 1) PATRINTELLIX 0(Tier 2) ST; QL (30 EA per 30 days)venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg


venlafaxine oral capsule,extended release 24hr 75 mg


venlafaxine oral tablet 0(Tier 1)VERSACLOZ 0(Tier 2) QL (540 ML per 30 days)VIIBRYD ORAL TABLET 0(Tier 2) ST; QL (30 EA per 30 days)VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23)


VRAYLAR ORAL CAPSULE 0(Tier 2) ST; QL (30 EA per 30 days); NDSVRAYLAR ORAL CAPSULE,DOSE PACK 0(Tier 2) ST; QL (14 EA per 365 days)XYREM 0(Tier 2) PA; QL (540 ML per 30 days); NDSzaleplon oral capsule 10 mg 0(Tier 1) QL (60 EA per 30 days)zaleplon oral capsule 5 mg 0(Tier 1) QL (30 EA per 30 days)ziprasidone hcl 0(Tier 1) QL (60 EA per 30 days)ziprasidone mesylate 0(Tier 1) QL (6 EA per 30 days)zolpidem oral tablet 0(Tier 1) QL (30 EA per 30 days)ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 300 MG


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 405 MG


CARDIOVASCULAR, HYPERTENSION / LIPIDS (DRUGS FOR THE HEART AND BLOOD VESSELS)ANTIARRHYTHMIC AGENTSamiodarone intravenous solution 0(Tier 1) B/D PAamiodarone oral 0(Tier 1)dofetilide 0(Tier 1)flecainide 0(Tier 1)lidocaine (pf) intravenous syringe 0(Tier 1)




mexiletine 0(Tier 1)MULTAQ 0(Tier 2) QL (60 EA per 30 days)pacerone oral tablet 100 mg, 200 mg, 400 mg 0(Tier 1)propafenone 0(Tier 1)quinidine sulfate oral tablet 0(Tier 1)sorine 0(Tier 1)sotalol af 0(Tier 1)sotalol oral 0(Tier 1)SOTYLIZE 0(Tier 2)ANTIHYPERTENSIVE THERAPYacebutolol 0(Tier 1)aliskiren 0(Tier 1) QL (30 EA per 30 days)amiloride 0(Tier 1)amiloride-hydrochlorothiazide 0(Tier 1)amlodipine 0(Tier 1)amlodipine-benazepril 0(Tier 1)amlodipine-valsartan 0(Tier 1)amlodipine-valsartan-hcthiazid 0(Tier 1)atenolol 0(Tier 1)atenolol-chlorthalidone 0(Tier 1)benazepril 0(Tier 1)benazepril-hydrochlorothiazide 0(Tier 1)betaxolol oral 0(Tier 1)BIDIL 0(Tier 2) QL (180 EA per 30 days)bisoprolol fumarate 0(Tier 1)bisoprolol-hydrochlorothiazide 0(Tier 1)bumetanide 0(Tier 1)BYSTOLIC 0(Tier 2)candesartan oral tablet 16 mg, 4 mg, 8 mg 0(Tier 1) QL (60 EA per 30 days)candesartan oral tablet 32 mg 0(Tier 1) QL (30 EA per 30 days)candesartan-hydrochlorothiazid 0(Tier 1)cartia xt 0(Tier 1)carvedilol 0(Tier 1)carvedilol phosphate 0(Tier 1)chlorothiazide oral tablet 500 mg 0(Tier 1)chlorothiazide sodium 0(Tier 1)chlorthalidone oral tablet 25 mg, 50 mg 0(Tier 1)clonidine hcl oral tablet 0(Tier 1)




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


clonidine transdermal patch weekly 0.3 mg/24 hr 0(Tier 1) QL (8 EA per 28 days)DEMSER 0(Tier 2) PA; NDSdiltiazem hcl intravenous 0(Tier 1)diltiazem hcl oral capsule,ext.rel 24h degradable 0(Tier 1)diltiazem hcl oral capsule,extended release 12 hr

0(Tier 1)

diltiazem hcl oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 420 mg

0(Tier 1)

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

0(Tier 1)

diltiazem hcl oral tablet 0(Tier 1)diltiazem hcl oral tablet extended release 24 hr 0(Tier 1)dilt-xr 0(Tier 1)doxazosin 0(Tier 1)EDARBI 0(Tier 2) ST; QL (30 EA per 30 days)EDARBYCLOR 0(Tier 2) STenalapril maleate 0(Tier 1)enalapril-hydrochlorothiazide 0(Tier 1)ethacrynate sodium 0(Tier 1)felodipine 0(Tier 1)fosinopril 0(Tier 1) QL (60 EA per 30 days)fosinopril-hydrochlorothiazide 0(Tier 1) QL (120 EA per 30 days)furosemide injection 0(Tier 1)furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)

0(Tier 1)

furosemide oral tablet 0(Tier 1)hydralazine 0(Tier 1)hydrochlorothiazide 0(Tier 1)indapamide 0(Tier 1)irbesartan oral tablet 150 mg 0(Tier 1) QL (60 EA per 30 days)irbesartan oral tablet 300 mg, 75 mg 0(Tier 1) QL (30 EA per 30 days)irbesartan-hydrochlorothiazide 0(Tier 1) QL (30 EA per 30 days)isradipine 0(Tier 1)labetalol oral 0(Tier 1)lisinopril 0(Tier 1)lisinopril-hydrochlorothiazide 0(Tier 1)losartan 0(Tier 1) QL (60 EA per 30 days)




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


losartan-hydrochlorothiazide oral tablet 50-12.5 mg


matzim la 0(Tier 1)methyldopa 0(Tier 1)metolazone 0(Tier 1)metoprolol succinate 0(Tier 1)metoprolol ta-hydrochlorothiaz 0(Tier 1)metoprolol tartrate oral 0(Tier 1)metyrosine 0(Tier 1) PA; NDSminoxidil oral 0(Tier 1)moexipril 0(Tier 1)nadolol 0(Tier 1)nadolol-bendroflumethiazide oral tablet 80-5 mg 0(Tier 1)nicardipine intravenous solution 0(Tier 1)nicardipine oral 0(Tier 1)nifedipine oral tablet extended release 0(Tier 1) QL (60 EA per 30 days)nifedipine oral tablet extended release 24hr 0(Tier 1) QL (60 EA per 30 days)nimodipine 0(Tier 1)nisoldipine 0(Tier 1)olmesartan 0(Tier 1)olmesartan-hydrochlorothiazide 0(Tier 1)perindopril erbumine 0(Tier 1)phenoxybenzamine 0(Tier 1) NDSpindolol 0(Tier 1)prazosin 0(Tier 1)propranolol oral 0(Tier 1)propranolol-hydrochlorothiazid 0(Tier 1)quinapril 0(Tier 1)quinapril-hydrochlorothiazide 0(Tier 1)ramipril 0(Tier 1)REMODULIN 0(Tier 2) B/D PA; NDSspironolactone 0(Tier 1)spironolacton-hydrochlorothiaz 0(Tier 1)taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg

0(Tier 1)

TEKTURNA HCT 0(Tier 2) QL (30 EA per 30 days)telmisartan oral tablet 20 mg, 40 mg 0(Tier 1) QL (30 EA per 30 days)




telmisartan oral tablet 80 mg 0(Tier 1) QL (60 EA per 30 days)telmisartan-amlodipine 0(Tier 1) QL (30 EA per 30 days)telmisartan-hydrochlorothiazid oral tablet 40-12.5 mg, 80-25 mg


telmisartan-hydrochlorothiazid oral tablet 80-12.5 mg


terazosin 0(Tier 1)tiadylt er 0(Tier 1)timolol maleate oral 0(Tier 1)torsemide oral 0(Tier 1)trandolapril 0(Tier 1)treprostinil sodium 0(Tier 1) B/D PA; NDStriamterene-hydrochlorothiazid oral capsule 37.5-25 mg

0(Tier 1)

triamterene-hydrochlorothiazid oral tablet 0(Tier 1)UPTRAVI 0(Tier 2) PA; NDSvalsartan oral tablet 160 mg, 40 mg, 80 mg 0(Tier 1) QL (60 EA per 30 days)valsartan oral tablet 320 mg 0(Tier 1) QL (30 EA per 30 days)valsartan-hydrochlorothiazide 0(Tier 1) QL (30 EA per 30 days)verapamil intravenous solution 0(Tier 1)verapamil oral capsule, 24 hr er pellet ct 0(Tier 1)verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg

0(Tier 1)

VERAPAMIL ORAL CAPSULE,EXT REL. PELLETS 24 HR 360 MG

0(Tier 2)

verapamil oral tablet 0(Tier 1)verapamil oral tablet extended release 0(Tier 1)COAGULATION THERAPYaminocaproic acid oral 0(Tier 1)aspirin-dipyridamole 0(Tier 1) QL (60 EA per 30 days)BRILINTA 0(Tier 2) QL (60 EA per 30 days)cilostazol 0(Tier 1)clopidogrel oral tablet 300 mg 0(Tier 1) QL (2 EA per 365 days)clopidogrel oral tablet 75 mg 0(Tier 1)dipyridamole oral 0(Tier 1) PAELIQUIS 0(Tier 2)ELIQUIS DVT-PE TREAT 30D START 0(Tier 2)enoxaparin 0(Tier 1)fondaparinux subcutaneous syringe 10 mg/0.8 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml

0(Tier 1) NDS




fondaparinux subcutaneous syringe 2.5 mg/0.5 ml

0(Tier 1)

heparin (porcine) in 5% dex intravenous parenteral solution 20,000 unit/500 ml (40 unit/ml), 25,000 unit/250 ml(100 unit/ml), 25,000 unit/500 ml (50 unit/ml)

0(Tier 1)

heparin (porcine) in nacl (pf) 0(Tier 1)heparin (porcine) injection solution 0(Tier 1)heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml, 25,000 unit/500 ml

0(Tier 1)

heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml

0(Tier 1)

HEPARIN, PORCINE (PF) INJECTION SYRINGE 5,000 UNIT/ML

0(Tier 1)

jantoven 0(Tier 1)MEPHYTON 0(Tier 1) MCpentoxifylline 0(Tier 1)phytonadione (vitamin k1) oral tablet 5 mg 0(Tier 1) MCPRADAXA 0(Tier 2) QL (60 EA per 30 days)prasugrel 0(Tier 1) QL (30 EA per 30 days)PROMACTA ORAL POWDER IN PACKET 12.5 MG


PROMACTA ORAL POWDER IN PACKET 25 MG


PROMACTA ORAL TABLET 0(Tier 2) PA; QL (30 EA per 30 days); NDSvitamin k1 injection 0(Tier 1) MCwarfarin 0(Tier 1)XARELTO 0(Tier 2)XARELTO DVT-PE TREAT 30D START 0(Tier 2)LIPID/CHOLESTEROL LOWERING AGENTSatorvastatin oral tablet 10 mg, 20 mg, 80 mg 0(Tier 1) QL (30 EA per 30 days)atorvastatin oral tablet 40 mg 0(Tier 1) QL (60 EA per 30 days)cholestyramine (with sugar) 0(Tier 1)cholestyramine light 0(Tier 1)colesevelam 0(Tier 1)colestipol 0(Tier 1)endur-acin oral tablet extended release 250 mg, 500 mg

0(Tier 1) MC

ezetimibe 0(Tier 1) QL (30 EA per 30 days)ezetimibe-simvastatin 0(Tier 1) QL (30 EA per 30 days)




fenofibrate micronized 0(Tier 1)fenofibrate nanocrystallized oral tablet 145 mg, 48 mg

0(Tier 1)

fenofibrate oral capsule 0(Tier 1)fenofibrate oral tablet 160 mg, 54 mg 0(Tier 1)fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 mg


fenofibric acid (choline) oral capsule,delayed release(dr/ec) 45 mg


gemfibrozil 0(Tier 1)LIVALO 0(Tier 2) QL (30 EA per 30 days)lovastatin 0(Tier 1) QL (60 EA per 30 days)niacin oral capsule, extended release 250 mg 0(Tier 1) MCniacin oral tablet 100 mg, 50 mg, 500 mg 0(Tier 1) MCniacin oral tablet extended release 24 hr 0(Tier 1)niacin oral tablet extended release 250 mg, 500 mg

0(Tier 1) MC

niacor 0(Tier 1)omega-3 acid ethyl esters 0(Tier 1) QL (120 EA per 30 days)pravastatin oral tablet 10 mg, 20 mg, 80 mg 0(Tier 1) QL (30 EA per 30 days)pravastatin oral tablet 40 mg 0(Tier 1) QL (60 EA per 30 days)prevalite 0(Tier 1)REPATHA 0(Tier 2) PA; QL (3 ML per 28 days)REPATHA PUSHTRONEX 0(Tier 2) PA; QL (3.5 ML per 28 days)REPATHA SURECLICK 0(Tier 2) PA; QL (3 ML per 28 days)rosuvastatin 0(Tier 1) QL (30 EA per 30 days)simvastatin oral tablet 0(Tier 1) QL (30 EA per 30 days)SLO-NIACIN ORAL TABLET EXTENDED RELEASE 250 MG

0(Tier 1) MC

slo-niacin oral tablet extended release 500 mg 0(Tier 1) MCVASCEPA ORAL CAPSULE 0.5 GRAM 0(Tier 2) QL (240 EA per 30 days)VASCEPA ORAL CAPSULE 1 GRAM 0(Tier 2) QL (120 EA per 30 days)MISCELLANEOUS CARDIOVASCULAR AGENTSCORLANOR ORAL TABLET 0(Tier 2) PA; QL (60 EA per 30 days)digitek 0(Tier 1)digox 0(Tier 1)digoxin oral solution 50 mcg/ml (0.05 mg/ml) 0(Tier 1) QL (150 ML per 30 days)digoxin oral tablet 0(Tier 1)ENTRESTO 0(Tier 2) QL (60 EA per 30 days)ranolazine 0(Tier 1) QL (60 EA per 30 days)




NITRATESisosorbide dinitrate oral tablet 0(Tier 1)isosorbide mononitrate 0(Tier 1)minitran 0(Tier 1)nitroglycerin intravenous 0(Tier 1) B/D PAnitroglycerin sublingual 0(Tier 1)nitroglycerin transdermal patch 24 hour 0(Tier 1)nitroglycerin translingual spray,non-aerosol 0(Tier 1)DERMATOLOGICALS/TOPICAL THERAPY (DRUGS USED FOR SKIN PROBLEMS)ANTIPSORIATIC / ANTISEBORRHEICacitretin 0(Tier 1) PAcalcipotriene scalp 0(Tier 1)calcipotriene topical cream 0(Tier 1) QL (120 GM per 30 days)calcipotriene topical ointment 0(Tier 1) QL (120 GM per 30 days)calcitriol topical 0(Tier 1)selenium sulfide topical lotion 0(Tier 1)SKYRIZI SUBCUTANEOUS SYRINGE KIT 0(Tier 2) PA; QL (2 EA per 28 days); NDSSTELARA SUBCUTANEOUS SOLUTION 0(Tier 2) PA; QL (0.5 ML per 28 days); NDSSTELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML


STELARA SUBCUTANEOUS SYRINGE 90 MG/ML


KERATOLYTICScallus removers 0(Tier 1) MCcorn-callus remover topical liquid 17% 0(Tier 1) MCMISCELLANEOUS DERMATOLOGICALSacyclovir topical cream 0(Tier 1) QL (5 GM per 30 days); NDSacyclovir topical ointment 0(Tier 1) QL (30 GM per 30 days)ammonium lactate 0(Tier 1)astringent 0(Tier 1) MCblue gel 0(Tier 1) MCcalamine clear 0(Tier 1) MCcalamine plus (pramox-calamin) 0(Tier 1) MCcapsaicin topical cream 0.025% 0(Tier 1) MCCHEST RUB TOPICAL OINTMENT 0(Tier 1) MCCOATS ALOE MOISTURIZING 0(Tier 1) MCCOATS ALOE TOPICAL CREAM 0(Tier 1) MCCOATS ALOE TOPICAL GEL 0(Tier 1) MCCOZIMA 0(Tier 1) MC




CUTTER BACKWOODS 0(Tier 1) MCCUTTER BACKWOODS DRY 0(Tier 1) MCCUTTER LEMON EUCALYPTUS 0(Tier 1) MCDENAVIR 0(Tier 2) QL (5 GM per 30 days); NDSdiaper rash topical ointment 0(Tier 1) MCdibucaine 0(Tier 1) MCDR. SMITH’S DIAPER 0(Tier 1) MCDR. SMITH’S DIAPER RASH 0(Tier 1) MCDUPIXENT PEN 0(Tier 2) PA; NDSDUPIXENT SYRINGE 0(Tier 2) PA; NDSfluorouracil topical cream 0.5% 0(Tier 1) NDSfluorouracil topical cream 5% 0(Tier 1)fluorouracil topical solution 0(Tier 1)glydo 0(Tier 1) QL (60 ML per 30 days)HEMORRHOIDAL RELIEF 0(Tier 1) MCimiquimod topical cream in metered-dose pump 0(Tier 1) NDSimiquimod topical cream in packet 0(Tier 1)INSECT REPELLENT (PICARIDIN) 0(Tier 1) MClidocaine (pf) injection solution 0(Tier 1)lidocaine hcl injection solution 0(Tier 1)lidocaine hcl laryngotracheal 0(Tier 1)lidocaine hcl mucous membrane jelly 0(Tier 1) QL (60 ML per 30 days)lidocaine hcl mucous membrane jelly in applicator


lidocaine hcl mucous membrane solution 4% (40 mg/ml)

0(Tier 1)

lidocaine topical adhesive patch,medicated 5% 0(Tier 1) PA; QL (90 EA per 30 days)lidocaine topical ointment 0(Tier 1) QL (50 GM per 30 days)lidocaine viscous 0(Tier 1)lidocaine-prilocaine topical cream 0(Tier 1) QL (30 GM per 30 days)MEDI-PADS 0(Tier 1) MCMENTHOL-ZINC OXIDE 0(Tier 1) MCmethoxsalen 0(Tier 1)MOISTUREL THERAPEUTIC 0(Tier 1) MCNATRAPEL 0(Tier 1) MCOFF DEEP WOODS 0(Tier 1) MCOFF DEEP WOODS DRY 0(Tier 1) MCOFF DEEP WOODS SPORTSMEN TOPICAL AEROSOL,SPRAY

0(Tier 1) MC




OFF DEEP WOODS SPORTSMEN TOPICAL SPRAY,NON-AEROSOL 25%

0(Tier 1) MC

PAIN RELIEVING (M-SALIC-MEN) 0(Tier 1) MCPANRETIN 0(Tier 2) NDSPICATO TOPICAL GEL 0.015% 0(Tier 2) QL (3 EA per 56 days)PICATO TOPICAL GEL 0.05% 0(Tier 2) QL (2 EA per 56 days)pimecrolimus 0(Tier 1) QL (100 GM per 90 days)podofilox 0(Tier 1)REGRANEX 0(Tier 2) PA; NDSREPEL HUNTER’S 0(Tier 1) MCREPEL LEMON EUCALYPTUS 0(Tier 1) MCREPEL SPORTSMEN 0(Tier 1) MCREPEL SPORTSMEN DRY 0(Tier 1) MCREPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY

0(Tier 1) MC

SANTYL 0(Tier 2)silver sulfadiazine 0(Tier 1)SSD 0(Tier 2)tacrolimus topical 0(Tier 1) QL (100 GM per 90 days)TOLAK 0(Tier 2)ULTRATHON TOPICAL AEROSOL,SPRAY 0(Tier 1) MCVALCHLOR 0(Tier 2) PA; QL (60 GM per 30 days); NDSvits a and d-white pet-lanolin topical ointment 0(Tier 1) MCwhite petrolatum topical ointment 0(Tier 1) MCZ-BUM 0(Tier 1) MCzinc oxide topical ointment 20%, 25% 0(Tier 1) MCZTLIDO 0(Tier 2) PA; QL (90 EA per 30 days)THERAPY FOR ACNEACNE MEDICATION TOPICAL GEL 10%, 5% 0(Tier 1) MCACNE MEDICATION TOPICAL LOTION 0(Tier 1) MCamnesteem 0(Tier 1)avita 0(Tier 1) PAbenzoyl peroxide topical cleanser 10%, 5% 0(Tier 1) MCbenzoyl peroxide topical gel 10%, 2.5%, 5% 0(Tier 1) MCclaravis 0(Tier 1)clindacin etz topical swab 0(Tier 1)clindacin p 0(Tier 1)clindamycin phosphate topical gel 0(Tier 1)




CLINDAMYCIN PHOSPHATE TOPICAL GEL, ONCE DAILY

0(Tier 1)

clindamycin phosphate topical lotion 0(Tier 1)clindamycin phosphate topical solution 0(Tier 1)clindamycin phosphate topical swab 0(Tier 1)ery pads 0(Tier 1)erythromycin with ethanol topical gel 0(Tier 1)erythromycin with ethanol topical solution 0(Tier 1)erythromycin-benzoyl peroxide 0(Tier 1)isotretinoin 0(Tier 1)metronidazole topical 0(Tier 1)myorisan 0(Tier 1)rosadan topical cream 0(Tier 1)rosadan topical gel 0(Tier 1)tazarotene 0(Tier 1)TAZORAC TOPICAL CREAM 0(Tier 2)TAZORAC TOPICAL GEL 0(Tier 2) QL (100 GM per 30 days)tretinoin microspheres 0(Tier 1) PAtretinoin topical 0(Tier 1) PAzenatane 0(Tier 1)TOPICAL ANTIBACTERIALSbacitracin topical ointment 0(Tier 1) MCbacitracin zinc topical ointment 0(Tier 1) MCDOUBLE ANTIBIOTIC (B.TRACN ZN) TOPICAL OINTMENT

0(Tier 1) MC

gentamicin topical 0(Tier 1)mupirocin 0(Tier 1)mupirocin calcium 0(Tier 1)POLY BACITRACIN (ZINC) 0(Tier 1) MCpovidone-iodine topical ointment 0(Tier 1) MCpovidone-iodine topical solution 10% 0(Tier 1) MCsulfacetamide sodium (acne) 0(Tier 1)triple antibiotic plus 0(Tier 1) MCtriple antibiotic topical ointment 0(Tier 1) MCtriple antibiotic topical ointment in packet 0(Tier 1) MCTOPICAL ANTIFUNGALSantifungal 0(Tier 1) MCantifungal (tolnaftate) topical cream 0(Tier 1) MCantifungal (tolnaftate) topical powder 0(Tier 1) MC




anti-fungal topical powder 0(Tier 1) MCathlete’s foot topical aerosol powder 0(Tier 1) MCciclodan topical solution 0(Tier 1)ciclopirox topical cream 0(Tier 1) QL (90 GM per 28 days)ciclopirox topical shampoo 0(Tier 1) QL (120 ML per 28 days)ciclopirox topical solution 0(Tier 1)ciclopirox topical suspension 0(Tier 1)clotrimazole topical cream 0(Tier 1)clotrimazole topical solution 0(Tier 1) QL (30 ML per 28 days)clotrimazole-betamethasone topical cream 0(Tier 1) QL (45 GM per 28 days)clotrimazole-betamethasone topical lotion 0(Tier 1) QL (60 ML per 28 days)econazole 0(Tier 1) QL (85 GM per 28 days)fungoid tincture topical tincture 0(Tier 1) MCketoconazole topical cream 0(Tier 1) QL (60 GM per 28 days)ketoconazole topical shampoo 0(Tier 1) QL (120 ML per 28 days)miconazole nitrate topical cream 0(Tier 1) MCnaftifine topical cream 0(Tier 1) QL (60 GM per 28 days)NAFTIN TOPICAL GEL 0(Tier 2)nyamyc 0(Tier 1)nystatin topical cream 0(Tier 1) QL (30 GM per 28 days)nystatin topical ointment 0(Tier 1) QL (30 GM per 28 days)nystatin topical powder 0(Tier 1)nystatin-triamcinolone 0(Tier 1) QL (60 GM per 28 days)nystop 0(Tier 1)terbinafine hcl topical 0(Tier 1) MCtolnaftate topical cream 0(Tier 1) MCtolnaftate topical powder 0(Tier 1) MCTOPICAL CORTICOSTEROIDSala-cort topical cream 1% 0(Tier 1)alclometasone 0(Tier 1)betamethasone dipropionate 0(Tier 1)betamethasone valerate 0(Tier 1)betamethasone, augmented 0(Tier 1)clobetasol scalp 0(Tier 1) QL (100 ML per 28 days)clobetasol topical cream 0(Tier 1) QL (120 GM per 28 days)clobetasol topical foam 0(Tier 1) QL (100 GM per 28 days)clobetasol topical gel 0(Tier 1) QL (120 GM per 28 days)clobetasol topical ointment 0(Tier 1) QL (120 GM per 28 days)clobetasol topical shampoo 0(Tier 1) QL (236 ML per 28 days)




clobetasol-emollient topical cream 0(Tier 1) QL (120 GM per 28 days)clobetasol-emollient topical foam 0(Tier 1)clocortolone pivalate 0(Tier 1)clodan 0(Tier 1) QL (236 ML per 28 days)desonide topical cream 0(Tier 1)desonide topical lotion 0(Tier 1)desonide topical ointment 0(Tier 1)desoximetasone topical cream 0(Tier 1)desoximetasone topical gel 0(Tier 1)desoximetasone topical ointment 0(Tier 1)fluocinolone 0(Tier 1)fluocinolone and shower cap 0(Tier 1)fluocinonide topical cream 0(Tier 1)fluocinonide topical gel 0(Tier 1) QL (120 GM per 30 days)fluocinonide topical ointment 0(Tier 1) QL (120 GM per 30 days)fluocinonide topical solution 0(Tier 1) QL (120 ML per 30 days)fluticasone propionate topical cream 0(Tier 1)fluticasone propionate topical ointment 0(Tier 1)halobetasol propionate topical cream 0(Tier 1)halobetasol propionate topical ointment 0(Tier 1)hydrocortisone butyrate topical cream 0(Tier 1)hydrocortisone butyrate topical ointment 0(Tier 1)hydrocortisone butyrate topical solution 0(Tier 1)hydrocortisone butyr-emollient 0(Tier 1)hydrocortisone topical cream 1%, 2.5% 0(Tier 1)hydrocortisone topical lotion 2.5% 0(Tier 1)hydrocortisone topical ointment 1%, 2.5% 0(Tier 1)hydrocortisone valerate 0(Tier 1)hydrocortisone-aloe vera topical cream 1% 0(Tier 1) MCmometasone topical 0(Tier 1)prednicarbate topical ointment 0(Tier 1)triamcinolone acetonide topical cream 0(Tier 1)triamcinolone acetonide topical lotion 0(Tier 1)triamcinolone acetonide topical ointment 0(Tier 1)triderm topical cream 0.1% 0(Tier 1)TOPICAL SCABICIDES / PEDICULICIDESlice killing 0(Tier 1) MClice treatment topical liquid 1% 0(Tier 1) MClindane topical shampoo 0(Tier 1)




malathion 0(Tier 1)permethrin topical cream 0(Tier 1)VANALICE 0(Tier 1) MCDIAGNOSTICS / MISCELLANEOUS AGENTS (OTHER DRUGS/DRUGS TO HELP STOP SMOKING)IRRIGATING SOLUTIONSlactated ringers irrigation 0(Tier 2)neomycin-polymyxin b gu 0(Tier 1)PHYSIOLYTE 0(Tier 2)PHYSIOSOL IRRIGATION 0(Tier 2)ringer’s irrigation 0(Tier 2)tis-u-sol pentalyte 0(Tier 2)MISCELLANEOUS AGENTSacamprosate 0(Tier 1)anagrelide 0(Tier 1)ARALAST NP 0(Tier 2) B/D PA; NDSAURYXIA 0(Tier 2) PA; QL (360 EA per 30 days)CALCIUM WITH BORON 0(Tier 1) MCCARBAGLU 0(Tier 2) PA; NDSCARNITOR INTRAVENOUS 0(Tier 2) B/D PACHEMET 0(Tier 2) NDSCLINIMIX 4.25%/D5W SULFIT FREE 0(Tier 2) B/D PAD10%-0.45% SODIUM CHLORIDE 0(Tier 2) B/D PAD2.5%-0.45% SODIUM CHLORIDE 0(Tier 2) B/D PAD5% AND 0.9% SODIUM CHLORIDE 0(Tier 2)D5%-0.45% SODIUM CHLORIDE 0(Tier 2)deferasirox oral granules in packet 0(Tier 1) NDSdeferasirox oral tablet 0(Tier 1) NDSDEXTROSE 10% AND 0.2% NACL 0(Tier 2) B/D PADEXTROSE 10% IN WATER (D10W) 0(Tier 2) B/D PAdextrose 25% in water (d25w) 0(Tier 2) B/D PAdextrose 30% in water (d30w) 0(Tier 2) B/D PAdextrose 40% in water (d40w) 0(Tier 2) B/D PADEXTROSE 5% IN WATER (D5W) INTRAVENOUS PARENTERAL SOLUTION

0(Tier 2)

dextrose 5% in water (d5w) intravenous piggyback

0(Tier 2)

dextrose 5%-lactated ringers 0(Tier 2) B/D PADEXTROSE 5%-0.2% SOD CHLORIDE 0(Tier 2)dextrose 5%-0.3% sod.chloride 0(Tier 2)




dextrose 50% in water (d50w) intravenous parenteral solution

0(Tier 2) B/D PA

dextrose 50% in water (d50w) intravenous syringe

0(Tier 1) B/D PA

dextrose 70% in water (d70w) 0(Tier 2)disulfiram 0(Tier 1)FERRIPROX 0(Tier 2) PA; NDSFERRIPROX (2 TIMES A DAY) 0(Tier 2) PA; NDSINCRELEX 0(Tier 2) PAJADENU 0(Tier 2) NDSJADENU SPRINKLE 0(Tier 2) NDSkionex (with sorbitol) 0(Tier 1)levocarnitine (with sugar) 0(Tier 1)levocarnitine oral solution 100 mg/ml 0(Tier 1)levocarnitine oral tablet 0(Tier 1)LOKELMA 0(Tier 2)midodrine 0(Tier 1)nitisinone 0(Tier 1) NDSNORTHERA ORAL CAPSULE 100 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSNORTHERA ORAL CAPSULE 200 MG, 300 MG 0(Tier 2) PA; QL (180 EA per 30 days); NDSORFADIN 0(Tier 2) NDSpilocarpine hcl oral 0(Tier 1)PROLASTIN-C 0(Tier 2) B/D PA; NDSRENVELA ORAL POWDER IN PACKET 0(Tier 2) QL (180 EA per 30 days)RENVELA ORAL TABLET 0(Tier 2) QL (540 EA per 30 days)riluzole 0(Tier 1)sevelamer carbonate oral powder in packet 0(Tier 1) QL (180 EA per 30 days)sevelamer carbonate oral tablet 0(Tier 1) QL (540 EA per 30 days)SODIUM CHLORIDE 0.9% INTRAVENOUS PARENTERAL SOLUTION

0(Tier 2)

sodium chloride 0.9% intravenous piggyback 0(Tier 2)SODIUM CHLORIDE IRRIGATION 0(Tier 2)sodium phenylbutyrate 0(Tier 1) PA; NDSsodium polystyrene (sorb free) 0(Tier 1)sodium polystyrene sulfonate oral powder 0(Tier 1)sps (with sorbitol) 0(Tier 1)SUSPENDOL-S 0(Tier 1) MCtrientine 0(Tier 1) QL (240 EA per 30 days); NDSVELPHORO 0(Tier 2) QL (180 EA per 30 days)




VELTASSA 0(Tier 2)water for irrigation, sterile 0(Tier 1)XIAFLEX 0(Tier 2) PA; NDSZEMAIRA 0(Tier 2) B/D PA; NDSzoledronic acid-mannitol-water intravenous piggyback 5 mg/100 ml

0(Tier 1) B/D PA; QL (100 ML per 365 days)

NEUTRACEUTICALScomplete premium vitamin 0(Tier 1) MCcranberry urinary comfort 0(Tier 1) MCSMOKING DETERRENTSbupropion hcl (smoking deter) 0(Tier 1) QL (60 EA per 30 days)CHANTIX 0(Tier 2)CHANTIX CONTINUING MONTH BOX 0(Tier 2)CHANTIX STARTING MONTH BOX 0(Tier 2)NICODERM CQ 0(Tier 1) MCNICORETTE 0(Tier 1) MCnicotine (polacrilex) buccal gum 0(Tier 1) MCNICOTINE (POLACRILEX) BUCCAL LOZENGE 2 MG

0(Tier 1) MC

nicotine (polacrilex) buccal lozenge 4 mg 0(Tier 1) MCnicotine (polacrilex) buccal mini lozenge 2 mg 0(Tier 1) MCNICOTINE (POLACRILEX) BUCCAL MINI LOZENGE 4 MG

0(Tier 1) MC

nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr

0(Tier 1) MC

nicotine transdermal patch, td daily, sequential 0(Tier 1) MCNICOTROL 0(Tier 2)NICOTROL NS 0(Tier 2) QL (30 ML per 30 days)EAR, NOSE / THROAT MEDICATIONS (DRUGS THAT RELIEVE EAR, NOSE/THROAT PROBLEMS)MISCELLANEOUS AGENTSazelastine nasal 0(Tier 1) QL (30 ML per 25 days)chlorhexidine gluconate mucous membrane 0(Tier 1)COUGH DROPS MUCOUS MEMBRANE LOZENGE 5.4 MG, 5.8 MG, 7.6 MG

0(Tier 1) MC

deep sea nasal 0(Tier 1) MCfluoride (sodium) dental paste 0(Tier 1)ipratropium bromide nasal spray,non-aerosol 0.03%


ipratropium bromide nasal spray,non-aerosol 42 mcg (0.06%)





nasal decongestant (oxymetazl) 0(Tier 1) MCnasal spray (oxymetazoline) 0(Tier 1) MCoralone 0(Tier 1)paroex oral rinse 0(Tier 1)sodium fluoride-pot nitrate 0(Tier 1)triamcinolone acetonide dental 0(Tier 1)MISCELLANEOUS OTIC PREPARATIONSacetic acid otic (ear) 0(Tier 1)ear drops (carbamide peroxide) 0(Tier 1) MCear wax removal drops 0(Tier 1) MCear wax removal kit 0(Tier 1) MCflac otic oil 0(Tier 1)fluocinolone acetonide oil 0(Tier 1)hydrocortisone-acetic acid 0(Tier 1)OTIC STEROID / ANTIBIOTICCIPRO HC 0(Tier 2)CIPRODEX 0(Tier 2)ciprofloxacin-dexamethasone 0(Tier 1)CORTISPORIN-TC 0(Tier 2)neomycin-polymyxin-hc otic (ear) 0(Tier 1)ENDOCRINE/DIABETES (DRUGS THAT CONTROL HORMONES/DRUGS THAT CONTROL BLOOD SUGAR)ADRENAL HORMONEScortisone 0(Tier 1)DEPO-MEDROL 0(Tier 2)dexamethasone intensol 0(Tier 1)dexamethasone oral elixir 0(Tier 1)dexamethasone oral solution 0(Tier 1)dexamethasone oral tablet 0(Tier 1)dexamethasone sodium phos (pf) injection solution

0(Tier 1)

dexamethasone sodium phosphate injection solution

0(Tier 1)

fludrocortisone 0(Tier 1)hydrocortisone oral 0(Tier 1)MEDROL ORAL TABLET 2 MG 0(Tier 2)methylprednisolone 0(Tier 1)methylprednisolone acetate 0(Tier 1)methylprednisolone sodium succ injection recon soln 125 mg, 40 mg

0(Tier 1)




methylprednisolone sodium succ intravenous recon soln 1,000 mg


methylprednisolone sodium succ intravenous recon soln 500 mg


prednisolone oral solution 15 mg/5 ml 0(Tier 1)prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 15 mg/5 ml (5 ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)

0(Tier 1)

prednisone intensol 0(Tier 1)prednisone oral solution 0(Tier 1)prednisone oral tablet 0(Tier 1) B/D PAprednisone oral tablets,dose pack 0(Tier 1)SOLU-CORTEF ACT-O-VIAL (PF) 0(Tier 2)triamcinolone acetonide injection 0(Tier 1)ANTITHYROID AGENTSIOSAT 0(Tier 1) MCmethimazole oral tablet 10 mg, 5 mg 0(Tier 1)propylthiouracil 0(Tier 1)THYROSAFE 0(Tier 1) MCDIABETES THERAPYacarbose oral tablet 100 mg, 25 mg 0(Tier 1) QL (90 EA per 30 days)acarbose oral tablet 50 mg 0(Tier 1) QL (180 EA per 30 days)ALCOHOL PADS 0(Tier 1)BAQSIMI 0(Tier 2)BD PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)BYDUREON BCISE 0(Tier 2) QL (4 ML per 28 days)BYDUREON SUBCUTANEOUS PEN INJECTOR


CYCLOSET 0(Tier 2) QL (180 EA per 30 days)diazoxide 0(Tier 1)FARXIGA ORAL TABLET 10 MG 0(Tier 2) QL (30 EA per 30 days)FARXIGA ORAL TABLET 5 MG 0(Tier 2) QL (60 EA per 30 days)GAUZE PADS 2 X 2 0(Tier 1)glimepiride oral tablet 1 mg 0(Tier 1) QL (240 EA per 30 days)glimepiride oral tablet 2 mg 0(Tier 1) QL (120 EA per 30 days)glimepiride oral tablet 4 mg 0(Tier 1) QL (60 EA per 30 days)glipizide oral tablet 10 mg 0(Tier 1) QL (120 EA per 30 days)glipizide oral tablet 5 mg 0(Tier 1) QL (240 EA per 30 days)glipizide oral tablet extended release 24hr 10 mg





glipizide oral tablet extended release 24hr 2.5 mg


glipizide oral tablet extended release 24hr 5 mg 0(Tier 1) QL (120 EA per 30 days)glipizide-metformin oral tablet 2.5-250 mg 0(Tier 1) QL (240 EA per 30 days)glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg


GLUCAGEN HYPOKIT 0(Tier 2)GLUCAGON (HCL) EMERGENCY KIT 0(Tier 2)GLUCAGON EMERGENCY KIT (HUMAN) 0(Tier 2)GLYXAMBI 0(Tier 2) QL (30 EA per 30 days)GVOKE HYPOPEN 1-PACK 0(Tier 2)GVOKE HYPOPEN 2-PACK 0(Tier 2)GVOKE PFS 1-PACK SYRINGE 0(Tier 2)GVOKE PFS 2-PACK SYRINGE 0(Tier 2)HUMALOG JUNIOR KWIKPEN U-100 0(Tier 2)HUMALOG KWIKPEN INSULIN 0(Tier 2)HUMALOG MIX 50-50 INSULN U-100 0(Tier 2)HUMALOG MIX 50-50 KWIKPEN 0(Tier 2)HUMALOG MIX 75-25 KWIKPEN 0(Tier 2)HUMALOG MIX 75-25(U-100)INSULN 0(Tier 2)HUMALOG U-100 INSULIN 0(Tier 2)HUMULIN 70/30 U-100 INSULIN 0(Tier 2)HUMULIN 70/30 U-100 KWIKPEN 0(Tier 2)HUMULIN N NPH INSULIN KWIKPEN 0(Tier 2)HUMULIN N NPH U-100 INSULIN 0(Tier 2)HUMULIN R REGULAR U-100 INSULN 0(Tier 2)HUMULIN R U-500 (CONC) INSULIN 0(Tier 2) B/D PAHUMULIN R U-500 (CONC) KWIKPEN 0(Tier 2)INSULIN PEN NEEDLE 0(Tier 1) QL (200 EA per 30 days)INSULIN SYRINGE (DISP) U-100 0.3 ML, 1 ML, 1/2 ML


INVOKAMET 0(Tier 2) QL (60 EA per 30 days)INVOKAMET XR 0(Tier 2) QL (60 EA per 30 days)INVOKANA 0(Tier 2) QL (30 EA per 30 days)JANUMET 0(Tier 2) QL (60 EA per 30 days)JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG


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


JANUVIA 0(Tier 2) QL (30 EA per 30 days)




JARDIANCE 0(Tier 2) QL (30 EA per 30 days)JENTADUETO 0(Tier 2) QL (60 EA per 30 days)JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG


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


LANTUS SOLOSTAR U-100 INSULIN 0(Tier 2)LANTUS U-100 INSULIN 0(Tier 2)LEVEMIR FLEXTOUCH U-100 INSULN 0(Tier 2)LEVEMIR U-100 INSULIN 0(Tier 2)LYUMJEV KWIKPEN U-100 INSULIN 0(Tier 2)LYUMJEV KWIKPEN U-200 INSULIN 0(Tier 2)LYUMJEV U-100 INSULIN 0(Tier 2)metformin oral solution 0(Tier 1) QL (750 ML per 30 days)metformin oral tablet 1,000 mg 0(Tier 1) QL (75 EA per 30 days)metformin oral tablet 500 mg 0(Tier 1) QL (150 EA per 30 days)metformin oral tablet 850 mg 0(Tier 1) QL (90 EA per 30 days)metformin oral tablet extended release 24 hr 500 mg (generic for Glucophage XR)


metformin oral tablet extended release 24 hr 750 mg (generic for Glucophage XR)


metformin oral tablet extended release (osm) 24 hr 1000mg, 500mg (Generic for Fortamet)


miglitol 0(Tier 1) QL (90 EA per 30 days)nateglinide oral tablet 120 mg 0(Tier 1) QL (90 EA per 30 days)nateglinide oral tablet 60 mg 0(Tier 1) QL (180 EA per 30 days)NEEDLES, INSULIN DISP.,SAFETY 0(Tier 1) QL (200 EA per 30 days)NOVOFINE PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)NOVOTWIST PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)OMNIPOD 5 PACK 0(Tier 2) QL (30 EA per 30 days)OMNIPOD DASH 5 PACK 0(Tier 2) QL (30 EA per 30 days)OMNIPOD STARTER KIT 0(Tier 2) QL (1 EA per 365 days)OZEMPIC 0(Tier 2) QL (3 ML per 28 days)pioglitazone oral tablet 15 mg 0(Tier 1) QL (90 EA per 30 days)pioglitazone oral tablet 30 mg, 45 mg 0(Tier 1) QL (30 EA per 30 days)pioglitazone-metformin 0(Tier 1) QL (90 EA per 30 days)PROGLYCEM 0(Tier 2)repaglinide oral tablet 0.5 mg, 1 mg 0(Tier 1) QL (120 EA per 30 days)repaglinide oral tablet 2 mg 0(Tier 1) QL (240 EA per 30 days)RIOMET 0(Tier 2) QL (750 ML per 30 days)




RIOMET ER 0(Tier 2) QL (600 ML per 30 days)SOLIQUA 100/33 0(Tier 2) QL (18 ML per 30 days)SYMLINPEN 120 0(Tier 2) PA; QL (10.8 ML per 28 days); NDSSYMLINPEN 60 0(Tier 2) PA; QL (6 ML per 30 days); NDSSYNJARDY 0(Tier 2) QL (60 EA per 30 days)SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 5-1,000 MG


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


TECHLITE PEN NEEDLE 0(Tier 2) QL (200 EA per 30 days)TOUJEO MAX U-300 SOLOSTAR 0(Tier 2)TOUJEO SOLOSTAR U-300 INSULIN 0(Tier 2)TRADJENTA 0(Tier 2) QL (30 EA per 30 days)TRESIBA FLEXTOUCH U-100 0(Tier 2)TRESIBA FLEXTOUCH U-200 0(Tier 2)TRESIBA U-100 INSULIN 0(Tier 2)TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-5-1,000 MG, 25-5-1,000 MG


TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 12.5-2.5-1,000 MG, 5-2.5-1,000 MG


TRULICITY 0(Tier 2) QL (2 ML per 28 days)V-GO 20 0(Tier 2)V-GO 30 0(Tier 2)V-GO 40 0(Tier 2)VICTOZA 2-PAK 0(Tier 2) QL (9 ML per 30 days)VICTOZA 3-PAK 0(Tier 2) QL (9 ML per 30 days)XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 10-500 MG


XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG, 5-500 MG


XULTOPHY 100/3.6 0(Tier 2) QL (15 ML per 30 days)MISCELLANEOUS HORMONESALDURAZYME 0(Tier 2) PA; NDSANADROL-50 0(Tier 2) PA; NDScabergoline 0(Tier 1)calcitonin (salmon) 0(Tier 1)calcitriol intravenous solution 1 mcg/ml 0(Tier 1)calcitriol oral 0(Tier 1)




CEREZYME INTRAVENOUS RECON SOLN 400 UNIT


CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR

0(Tier 2) PA

cinacalcet oral tablet 30 mg, 60 mg 0(Tier 1) QL (60 EA per 30 days)cinacalcet oral tablet 90 mg 0(Tier 1) QL (120 EA per 30 days)danazol 0(Tier 1)desmopressin injection 0(Tier 1)desmopressin nasal spray with pump 0(Tier 1)desmopressin nasal spray,non-aerosol 0(Tier 1)desmopressin oral 0(Tier 1)doxercalciferol intravenous 0(Tier 1)doxercalciferol oral capsule 0.5 mcg 0(Tier 1) QL (90 EA per 30 days)doxercalciferol oral capsule 1 mcg 0(Tier 1) QL (240 EA per 30 days)doxercalciferol oral capsule 2.5 mcg 0(Tier 1) QL (120 EA per 30 days)ELAPRASE 0(Tier 2) PA; NDSFABRAZYME 0(Tier 2) B/D PA; NDSKORLYM 0(Tier 2) PA; QL (120 EA per 30 days); NDSKUVAN 0(Tier 2) PA; NDSLUMIZYME 0(Tier 2) PA; NDSMIACALCIN INJECTION 0(Tier 2) NDSmiglustat 0(Tier 1) QL (90 EA per 30 days); NDSNAGLAZYME 0(Tier 2) PA; NDSNATPARA 0(Tier 2) PA; QL (2 EA per 28 days); NDSoxandrolone oral tablet 10 mg 0(Tier 1) PA; QL (60 EA per 30 days)oxandrolone oral tablet 2.5 mg 0(Tier 1) PA; QL (120 EA per 30 days)pamidronate 0(Tier 1) B/D PAparicalcitol oral 0(Tier 1)SAMSCA ORAL TABLET 15 MG 0(Tier 2) PA; QL (30 EA per 30 days); NDSSAMSCA ORAL TABLET 30 MG 0(Tier 2) PA; QL (60 EA per 30 days); NDSsapropterin 0(Tier 1) PA; NDSSENSIPAR ORAL TABLET 30 MG, 60 MG 0(Tier 2) QL (60 EA per 30 days)SENSIPAR ORAL TABLET 90 MG 0(Tier 2) QL (120 EA per 30 days)SOMAVERT 0(Tier 2) PA; QL (30 EA per 30 days); NDSSTIMATE 0(Tier 2) NDSSYNAREL 0(Tier 2) PA; NDStestosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml, 200 mg/ml (1 ml)

0(Tier 1)

testosterone enanthate 0(Tier 1)




testosterone transdermal gel 0(Tier 1) PA; QL (300 GM per 30 days)testosterone transdermal gel in metered-dose pump 12.5 mg/ 1.25 gram (1%)

0(Tier 1) PA; QL (300 GM per 30 days)

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

0(Tier 1) PA; QL (300 GM per 30 days)

tolvaptan oral tablet 30 mg 0(Tier 1) PA; QL (60 EA per 30 days); NDSzoledronic acid intravenous solution 0(Tier 1) B/D PA; QL (15 ML per 21 days)THYROID HORMONESEUTHYROX 0(Tier 2)LEVO-T 0(Tier 2)levothyroxine oral 0(Tier 1)levoxyl oral tablet 100 mcg, 112 mcg, 175 mcg 0(Tier 1)LEVOXYL ORAL TABLET 125 MCG, 137 MCG, 150 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG

0(Tier 2)

liothyronine oral 0(Tier 1)SYNTHROID 0(Tier 2)THYROLAR-1 0(Tier 2)THYROLAR-1/2 0(Tier 2)THYROLAR-1/4 0(Tier 2)THYROLAR-2 0(Tier 2)THYROLAR-3 0(Tier 2)UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

0(Tier 2)

unithroid oral tablet 137 mcg 0(Tier 2)GASTROENTEROLOGY (DRUGS THAT TREAT ISSUES OF THE STOMACH/BOWELS/GALLBLADDER)ANTIDIARRHEALS / ANTISPASMODICSanti-diarrheal (loperamide) oral capsule 0(Tier 1) MCanti-diarrheal (loperamide) oral liquid 1 mg/7.5 ml

0(Tier 1) MC

anti-diarrheal (loperamide) oral tablet 0(Tier 1) MCatropine injection solution 0.4 mg/ml 0(Tier 1)atropine injection syringe 0.05 mg/ml, 0.1 mg/ml 0(Tier 1)bismatrol 0(Tier 1) MCdicyclomine oral capsule 0(Tier 1)dicyclomine oral solution 0(Tier 1)dicyclomine oral tablet 0(Tier 1)diphenoxylate-atropine 0(Tier 1)




GLYCOPYRROLATE (PF) IN WATER INJECTION

0(Tier 1)

glycopyrrolate (pf) in water intravenous syringe 0.4 mg/2 ml (0.2 mg/ml)

0(Tier 1)

glycopyrrolate injection 0(Tier 1)glycopyrrolate oral 0(Tier 1)loperamide oral capsule 0(Tier 1)loperamide oral liquid 1 mg/7.5 ml 0(Tier 1) MCpeptic relief oral tablet,chewable 0(Tier 1) MCpropantheline 0(Tier 1)stomach relief oral suspension 262 mg/15 ml 0(Tier 1) MCstomach relief oral tablet,chewable 0(Tier 1) MCMISCELLANEOUS GASTROINTESTINAL AGENTSacid gone antacid 0(Tier 1) MCactidose/sorbitol oral suspension 50 gram/240 ml

0(Tier 1) MC

almacone-2 0(Tier 1) MCalosetron oral tablet 0.5 mg 0(Tier 1) PA; QL (60 EA per 30 days)alosetron oral tablet 1 mg 0(Tier 1) PA; QL (60 EA per 30 days); NDSaluminum hydroxide gel oral suspension 320 mg/5 ml

0(Tier 1) MC

AMITIZA 0(Tier 2) QL (60 EA per 30 days)antacid 0(Tier 1) MCantacid anti-gas 0(Tier 1) MCantacid exst (mag carb-al hyd) 0(Tier 1) MCantacid plus anti-gas oral suspension 200-200-20 mg/5 ml

0(Tier 1) MC

antacid regular strength 0(Tier 1) MCaprepitant 0(Tier 1) B/D PAAPRISO 0(Tier 2) QL (120 EA per 30 days)AVSOLA 0(Tier 2) PA; NDSbalsalazide 0(Tier 1)bisacodyl 0(Tier 1) MCbudesonide oral capsule,delayed,extend.release 0(Tier 1)budesonide oral tablet,delayed and ext.release 0(Tier 1) NDSclearlax oral powder 0(Tier 1) MCcompro 0(Tier 1)constulose 0(Tier 1)CREON 0(Tier 2)cromolyn oral 0(Tier 1)




CYSTADANE 0(Tier 2) NDSDOCUSOL KIDS 0(Tier 1) MCDOCUSOL PLUS 0(Tier 1) MCdok oral capsule 100 mg 0(Tier 1) MCdok oral tablet 0(Tier 1) MCdriminate 0(Tier 1) MCdronabinol 0(Tier 1) PA; QL (60 EA per 30 days)EMEND ORAL SUSPENSION FOR RECONSTITUTION

0(Tier 2) B/D PA

enema rectal enema 19-7 gram/118 ml 0(Tier 1) MCENEMEEZ 0(Tier 1) MCENEMEEZ PLUS 0(Tier 1) MCenulose 0(Tier 1)fiber (calcium polycarbophil) 0(Tier 1) MCfiber-lax 0(Tier 1) MCFLEET PEDIATRIC 0(Tier 1) MCformula em 0(Tier 1) MCgas relief (simethicone) oral capsule 125 mg 0(Tier 1) MCgas relief (simethicone) oral drops,suspension 0(Tier 1) MCgas relief (simethicone) oral tablet,chewable 80 mg

0(Tier 1) MC

gas relief extra strength 0(Tier 1) MCGATTEX 30-VIAL 0(Tier 2) PA; NDSGATTEX ONE-VIAL 0(Tier 2) PA; NDSgavilyte-c 0(Tier 1)gavilyte-g 0(Tier 1)gavilyte-n 0(Tier 1)generlac 0(Tier 1)granisetron (pf) intravenous solution 1 mg/ml (1 ml)

0(Tier 1) B/D PA

granisetron hcl intravenous 0(Tier 1) B/D PAgranisetron hcl oral 0(Tier 1) B/D PA; QL (30 EA per 30 days)HEMORRHOIDAL (PHENYLEPH-COCOA) RECTAL SUPPOSITORY 0.25-88.44%

0(Tier 1) MC

HEMORRHOIDAL CREAM 0(Tier 1) MCHEMORRHOIDAL(PE-MIN OIL-PETRO) RECTAL OINTMENT 0.25-14-74.9%

0(Tier 1) MC

hydrocortisone rectal 0(Tier 1)hydrocortisone topical cream with perineal applicator

0(Tier 1)




infants gas relief 0(Tier 1) MClactulose oral solution 0(Tier 1)LINZESS 0(Tier 2) QL (30 EA per 30 days)MAGNESIUM L-LACTATE 0(Tier 1) MCmagnesium oral tablet 250 mg 0(Tier 1) MCmagnesium oxide oral tablet 400 mg (241.3 mg magnesium)

0(Tier 1) MC

MAGTAB 0(Tier 1) MCmeclizine oral tablet 12.5 mg, 25 mg 0(Tier 1)mesalamine oral capsule,extended release 24hr 0(Tier 1) QL (120 EA per 30 days)mesalamine oral tablet,delayed release (dr/ec) 1.2 gram


mesalamine rectal enema 0(Tier 1)mesalamine with cleansing wipe 0(Tier 1)metoclopramide hcl injection solution 0(Tier 1)metoclopramide hcl oral solution 0(Tier 1)metoclopramide hcl oral tablet 0(Tier 1)mi-acid 0(Tier 1) MCmi-acid gas relief(simethicon) 0(Tier 1) MCmilk of magnesia 0(Tier 1) MCmilk of magnesia concentrated 0(Tier 1) MCmintox maximum strength 0(Tier 1) MCmintox plus 0(Tier 1) MCmotion sickness relief 0(Tier 1) MCnatural fiber laxative (sugar) oral powder 3.4 gram/7 gram

0(Tier 1) MC

OCALIVA 0(Tier 2) PA; QL (30 EA per 30 days); NDSondansetron 0(Tier 1) B/D PAondansetron hcl (pf) 0(Tier 1)ondansetron hcl intravenous 0(Tier 1)ondansetron hcl oral solution 0(Tier 1) B/D PA; QL (450 ML per 30 days)ondansetron hcl oral tablet 0(Tier 1) B/D PAOSMOPREP 0(Tier 2)palonosetron intravenous solution 0.25 mg/5 ml 0(Tier 1) B/D PA; NDSpeg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram

0(Tier 1)

peg-electrolyte 0(Tier 1)PENTASA 0(Tier 2)PLENVU 0(Tier 2)polyethylene glycol 3350 0(Tier 1) MC




prochlorperazine 0(Tier 1)prochlorperazine edisylate 0(Tier 1)prochlorperazine maleate oral 0(Tier 1)procto-med hc 0(Tier 1)procto-pak 0(Tier 1)proctosol hc topical 0(Tier 1)proctozone-hc 0(Tier 1)RECTIV 0(Tier 2) QL (30 GM per 30 days)RELISTOR SUBCUTANEOUS SOLUTION 0(Tier 2) PA; NDSRELISTOR SUBCUTANEOUS SYRINGE 0(Tier 2) PA; NDSRENFLEXIS 0(Tier 2) PA; NDSSANCUSO 0(Tier 2) QL (4 EA per 28 days); NDSscopolamine base 0(Tier 1) QL (10 EA per 30 days)senna lax 0(Tier 1) MCsenna oral tablet 0(Tier 1) MCsimethicone oral capsule 180 mg 0(Tier 1) MCsimethicone oral drops,suspension 0(Tier 1) MCsodium bicarbonate oral 0(Tier 1) MCstool softener (docusate cal) 0(Tier 1) MCstool softener oral capsule 100 mg 0(Tier 1) MCsulfasalazine 0(Tier 1)SUPREP BOWEL PREP KIT 0(Tier 2)travel sickness 0(Tier 1) MCtravel sickness (meclizine) 0(Tier 1) MCtrilyte with flavor packets 0(Tier 1)TRULANCE 0(Tier 2)ursodiol 0(Tier 1)VIBERZI 0(Tier 2) PA; QL (60 EA per 30 days)VIOKACE ORAL TABLET 10,440-39,150- 39,150 UNIT

0(Tier 2)

VIOKACE ORAL TABLET 20,880-78,300- 78,300 UNIT

0(Tier 2) NDS

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT

0(Tier 2)




ULCER THERAPYacid reducer (famotidine) 0(Tier 1) MCacid reducer (omeprazole) 0(Tier 1) MCacid reducer complete (famot) 0(Tier 1) MCCARAFATE ORAL SUSPENSION 0(Tier 2)esomeprazole magnesium oral capsule,delayed release(dr/ec)


famotidine oral suspension 0(Tier 1)famotidine oral tablet 10 mg 0(Tier 1) MCfamotidine oral tablet 20 mg, 40 mg 0(Tier 1)lansoprazole oral capsule,delayed release(dr/ec)


misoprostol 0(Tier 1)nizatidine oral capsule 0(Tier 1)omeprazole magnesium oral capsule,delayed release(dr/ec)

0(Tier 1) MC

OMEPRAZOLE MAGNESIUM ORAL TABLET,DELAYED RELEASE (DR/EC)

0(Tier 1) MC

omeprazole oral capsule,delayed release(dr/ec) 0(Tier 1) QL (60 EA per 30 days)omeprazole oral tablet,delayed release (dr/ec) 0(Tier 1) MCpantoprazole oral tablet,delayed release (dr/ec) 0(Tier 1) QL (60 EA per 30 days)ranitidine hcl oral syrup 0(Tier 1)ranitidine hcl oral tablet 150 mg, 300 mg 0(Tier 1)sucralfate 0(Tier 1)IMMUNOLOGY, VACCINES / BIOTECHNOLOGY (DRUGS FOR PREVENTION OF DISEASE/INFECTION)BIOTECHNOLOGY DRUGSACTIMMUNE 0(Tier 2) PA; NDSARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 300 MCG/ML, 60 MCG/ML


ARANESP (IN POLYSORBATE) INJECTION SOLUTION 25 MCG/ML, 40 MCG/ML

0(Tier 2) PA; QL (4 ML per 28 days)

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 40 MCG/0.4 ML

0(Tier 2) PA; QL (1.6 ML per 28 days)

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/0.5 ML













ARANESP (IN POLYSORBATE) INJECTION SYRINGE 500 MCG/ML




ARCALYST 0(Tier 2) PA; NDSAVONEX INTRAMUSCULAR PEN INJECTOR KIT


AVONEX INTRAMUSCULAR SYRINGE KIT 0(Tier 2) PA; QL (1 EA per 28 days); NDSBETASERON SUBCUTANEOUS KIT 0(Tier 2) PA; QL (14 EA per 28 days); NDSGENOTROPIN 0(Tier 2) PA; NDSGENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.2 MG/0.25 ML

0(Tier 2) PA

GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.4 MG/0.25 ML, 0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1 MG/0.25 ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6 MG/0.25 ML, 1.8 MG/0.25 ML, 2 MG/0.25 ML

0(Tier 2) PA; NDS

INTRON A INJECTION RECON SOLN 0(Tier 2) NDSINTRON A INJECTION SOLUTION 10 MILLION UNIT/ML

0(Tier 2) NDS

INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML

0(Tier 2)

LEUKINE INJECTION RECON SOLN 0(Tier 2) PA; NDSMOZOBIL 0(Tier 2) QL (9.6 ML per 30 days); NDSREBIF (WITH ALBUMIN) 0(Tier 2) PA; QL (6 ML per 28 days); NDSREBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML


REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 8.8MCG/0.2ML-22 MCG/0.5ML (6)


REBIF TITRATION PACK 0(Tier 2) PA; QL (8.4 ML per 365 days); NDSRETACRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML

0(Tier 2) PA; QL (12 ML per 28 days)

RETACRIT INJECTION SOLUTION 40,000 UNIT/ML


SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG


ZARXIO 0(Tier 2) PA; NDS




ZIEXTENZO 0(Tier 2) PA; NDSVACCINES / MISCELLANEOUS IMMUNOLOGICALSACTHIB (PF) 0(Tier 2)ADACEL(TDAP ADOLESN/ADULT)(PF) 0(Tier 2) QL (0.5 ML per 365 days)ATGAM 0(Tier 2) PABCG VACCINE, LIVE (PF) 0(Tier 2)BEXSERO 0(Tier 2)BOOSTRIX TDAP 0(Tier 2) QL (0.5 ML per 365 days)BOTOX 0(Tier 2) PADAPTACEL (DTAP PEDIATRIC) (PF) 0(Tier 2)ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 0(Tier 2) B/D PA; QL (8 ML per 365 days)ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE


fomepizole 0(Tier 1) NDSGAMMAKED INJECTION SOLUTION 1 GRAM/10 ML (10%), 10 GRAM/100 ML (10%), 20 GRAM/200 ML (10%), 5 GRAM/50 ML (10%)


GAMUNEX-C 0(Tier 2) B/D PA; NDSGARDASIL 9 (PF) 0(Tier 2) QL (1.5 ML per 365 days)HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML

0(Tier 2)

HAVRIX (PF) INTRAMUSCULAR SYRINGE 0(Tier 2)HIBERIX (PF) 0(Tier 2)HIZENTRA 0(Tier 2) B/D PA; NDSIMOVAX RABIES VACCINE (PF) 0(Tier 2) B/D PAINFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION

0(Tier 2)

IPOL 0(Tier 2)IXIARO (PF) 0(Tier 2)KINRIX (PF) 0(Tier 2)MENACTRA (PF) INTRAMUSCULAR SOLUTION

0(Tier 2)

MENVEO A-C-Y-W-135-DIP (PF) 0(Tier 2)M-M-R II (PF) 0(Tier 2) QL (2 EA per 365 days)PEDIARIX (PF) 0(Tier 2)PEDVAX HIB (PF) 0(Tier 2)PENTACEL (PF) INTRAMUSCULAR KIT 15LF-48MCG-62DU -10 MCG/0.5ML

0(Tier 2)

PROQUAD (PF) 0(Tier 2) QL (2 EA per 365 days)QUADRACEL (PF) 0(Tier 2)




RABAVERT (PF) 0(Tier 2) B/D PARECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCG/ML, 40 MCG/ML


RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 5 MCG/0.5 ML

0(Tier 2) B/D PA

RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE


ROTARIX 0(Tier 2)ROTATEQ VACCINE 0(Tier 2)SHINGRIX (PF) 0(Tier 2) QL (2 EA per 999 days)STAMARIL (PF) 0(Tier 2) QL (1 EA per 999 days)TDVAX 0(Tier 2)TENIVAC (PF) INTRAMUSCULAR SYRINGE 0(Tier 2) QL (0.5 ML per 28 days)TETANUS,DIPHTHERIA TOX PED(PF) 0(Tier 2)TRUMENBA 0(Tier 2)TWINRIX (PF) INTRAMUSCULAR SYRINGE 0(Tier 2)TYPHIM VI 0(Tier 2)VAQTA (PF) 0(Tier 2)VARIVAX (PF) 0(Tier 2) QL (1 EA per 365 days)VARIZIG INTRAMUSCULAR SOLUTION 0(Tier 2) QL (12 ML per 30 days)YF-VAX (PF) 0(Tier 2)ZOSTAVAX (PF) 0(Tier 2) QL (1 EA per 999 days)MUSCULOSKELETAL / RHEUMATOLOGY (DRUGS THAT TREAT ISSUES OF THE JOINTS/MUSCLES/BONES)GOUT THERAPYallopurinol 0(Tier 1)colchicine oral capsule 0(Tier 1) QL (60 EA per 30 days)colchicine oral tablet 0(Tier 1) QL (120 EA per 30 days)febuxostat 0(Tier 1) ST; QL (30 EA per 30 days)MITIGARE 0(Tier 2) QL (60 EA per 30 days)probenecid 0(Tier 1)probenecid-colchicine 0(Tier 1)OSTEOPOROSIS THERAPYalendronate oral tablet 10 mg, 5 mg 0(Tier 1) QL (30 EA per 30 days)alendronate oral tablet 35 mg, 70 mg 0(Tier 1) QL (4 EA per 28 days)BINOSTO 0(Tier 2)FORTEO 0(Tier 2) PA; QL (2.4 ML per 28 days); NDSibandronate oral 0(Tier 1) QL (1 EA per 28 days)PROLIA 0(Tier 2) QL (1 ML per 180 days)raloxifene 0(Tier 1) QL (30 EA per 30 days)




risedronate oral tablet 150 mg 0(Tier 1) QL (1 EA per 30 days)risedronate oral tablet 30 mg, 5 mg 0(Tier 1) QL (30 EA per 30 days)risedronate oral tablet 35 mg, 35 mg (12 pack), 35 mg (4 pack)


TYMLOS 0(Tier 2) PA; QL (1.56 ML per 30 days); NDSOTHER RHEUMATOLOGICALSBENLYSTA INTRAVENOUS RECON SOLN 120 MG


BENLYSTA INTRAVENOUS RECON SOLN 400 MG


DEPEN TITRATABS 0(Tier 2) NDSENBREL MINI 0(Tier 2) PA; QL (8 ML per 28 days); NDSENBREL SUBCUTANEOUS RECON SOLN 0(Tier 2) PA; QL (8 EA per 28 days); NDSENBREL SUBCUTANEOUS SOLUTION 0(Tier 2) PA; QL (4 ML per 28 days); NDSENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5 ML (0.5)


ENBREL SUBCUTANEOUS SYRINGE 50 MG/ML (1 ML)


ENBREL SURECLICK 0(Tier 2) PA; QL (8 ML per 28 days); NDSHUMIRA PEN 0(Tier 2) PA; QL (4 EA per 28 days); NDSHUMIRA PEN CROHNS-UC-HS START 0(Tier 2) PA; QL (12 EA per 365 days); NDSHUMIRA PEN PSOR-UVEITS-ADOL HS 0(Tier 2) PA; QL (8 EA per 365 days); NDSHUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML


HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML


HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML


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


HUMIRA(CF) PEN CROHNS-UC-HS 0(Tier 2) PA; QL (6 EA per 365 days); NDSHUMIRA(CF) PEN PSOR-UV-ADOL HS 0(Tier 2) PA; QL (6 EA per 365 days); NDSHUMIRA(CF) PEN SUBCUTANEOUS INJECTOR KIT 40 MG/0.4 ML


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


HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 40 MG/0.4 ML


leflunomide 0(Tier 1)ORENCIA 0(Tier 2) PA; QL (4 ML per 28 days); NDS




ORENCIA CLICKJECT 0(Tier 2) PA; QL (4 ML per 28 days); NDSpenicillamine 0(Tier 1) NDSRIDAURA 0(Tier 2)RINVOQ 0(Tier 2) PA; QL (30 EA per 30 days); NDSXELJANZ 0(Tier 2) PA; QL (60 EA per 30 days); NDSXELJANZ XR 0(Tier 2) PA; QL (30 EA per 30 days); NDSOBSTETRICS / GYNECOLOGY (DRUGS THAT CONTROL OR REPLACE SEX HORMONES)ESTROGENS / PROGESTINSALORA 0(Tier 2) PA; QL (8 EA per 28 days)camila 0(Tier 1)deblitane 0(Tier 1)DELESTROGEN INTRAMUSCULAR OIL 10 MG/ML

0(Tier 2)

DEPO-ESTRADIOL 0(Tier 2)DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML


dotti 0(Tier 1) PA; QL (8 EA per 28 days)DUAVEE 0(Tier 2) PA; QL (30 EA per 30 days)errin 0(Tier 1)estradiol oral 0(Tier 1) PAestradiol transdermal patch semiweekly 0(Tier 1) PA; QL (8 EA per 28 days)estradiol transdermal patch weekly 0(Tier 1) PA; QL (4 EA per 28 days)estradiol vaginal cream 0(Tier 1)estradiol vaginal tablet 0(Tier 1) QL (18 EA per 28 days)estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml

0(Tier 1)

ESTRING 0(Tier 2) QL (1 EA per 90 days)fyavolv 0(Tier 1) PAheather 0(Tier 1)hydroxyprogesterone caproate 0(Tier 1) PA; NDSincassia 0(Tier 1)jencycla 0(Tier 1)lyza 0(Tier 1)medroxyprogesterone 0(Tier 1)MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG

0(Tier 2) PA

MENOSTAR 0(Tier 2) PA; QL (4 EA per 28 days)nora-be 0(Tier 1)norethindrone (contraceptive) 0(Tier 1)norethindrone acetate 0(Tier 1)




norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg

0(Tier 1) PA

PREMARIN 0(Tier 2)progesterone micronized 0(Tier 1)sharobel 0(Tier 1)yuvafem 0(Tier 1) QL (18 EA per 28 days)MISCELLANEOUS OB/GYNclindamycin phosphate vaginal 0(Tier 1)clotrimazole vaginal cream 0(Tier 1) MCmetronidazole vaginal 0(Tier 1)miconazole 7 0(Tier 1) MCmiconazole nitrate vaginal cream 0(Tier 1) MCMICONAZOLE NITRATE VAGINAL KIT 1,200-2 MG-%

0(Tier 1) MC

miconazole-3 vaginal kit 0(Tier 1) MCterconazole 0(Tier 1)TIOCONAZOLE-1 0(Tier 1) MCtranexamic acid oral 0(Tier 1)vandazole 0(Tier 1)ORAL CONTRACEPTIVES / RELATED AGENTSafirmelle 0(Tier 1)altavera (28) 0(Tier 1)alyacen 1/35 (28) 0(Tier 1)alyacen 7/7/7 (28) 0(Tier 1)amethia 0(Tier 1)amethia lo 0(Tier 1)amethyst (28) 0(Tier 1)apri 0(Tier 1)aranelle (28) 0(Tier 1)ashlyna 0(Tier 1)aubra 0(Tier 1)aubra eq 0(Tier 1)aurovela 1.5/30 (21) 0(Tier 1)aurovela 1/20 (21) 0(Tier 1)aurovela 24 fe 0(Tier 1)aurovela fe 1.5/30 (28) 0(Tier 1)aurovela fe 1-20 (28) 0(Tier 1)aviane 0(Tier 1)ayuna 0(Tier 1)




azurette (28) 0(Tier 1)balziva (28) 0(Tier 1)bekyree (28) 0(Tier 1)blisovi 24 fe 0(Tier 1)blisovi fe 1.5/30 (28) 0(Tier 1)blisovi fe 1/20 (28) 0(Tier 1)briellyn 0(Tier 1)camrese 0(Tier 1)camrese lo 0(Tier 1)caziant (28) 0(Tier 1)charlotte 24 fe 0(Tier 1)chateal (28) 0(Tier 1)chateal eq (28) 0(Tier 1)cryselle (28) 0(Tier 1)cyclafem 1/35 (28) 0(Tier 1)cyclafem 7/7/7 (28) 0(Tier 1)cyred 0(Tier 1)cyred eq 0(Tier 1)dasetta 1/35 (28) 0(Tier 1)dasetta 7/7/7 (28) 0(Tier 1)daysee 0(Tier 1)desog-e.estradiol/e.estradiol 0(Tier 1)drospirenone-e.estradiol-lm.fa 0(Tier 1)drospirenone-ethinyl estradiol 0(Tier 1)econtra ez 0(Tier 1) MCelinest 0(Tier 1)ELLA 0(Tier 2)emoquette 0(Tier 1)enpresse 0(Tier 1)enskyce 0(Tier 1)estarylla 0(Tier 1)ethynodiol diac-eth estradiol 0(Tier 1)falmina (28) 0(Tier 1)fayosim 0(Tier 1)femynor 0(Tier 1)gianvi (28) 0(Tier 1)hailey 0(Tier 1)hailey 24 fe 0(Tier 1)hailey fe 1.5/30 (28) 0(Tier 1)




hailey fe 1/20 (28) 0(Tier 1)introvale 0(Tier 1)isibloom 0(Tier 1)jaimiess 0(Tier 1)jasmiel (28) 0(Tier 1)jolessa 0(Tier 1)juleber 0(Tier 1)junel 1.5/30 (21) 0(Tier 1)junel 1/20 (21) 0(Tier 1)junel fe 1.5/30 (28) 0(Tier 1)junel fe 1/20 (28) 0(Tier 1)junel fe 24 0(Tier 1)kaitlib fe 0(Tier 1)kalliga 0(Tier 1)kariva (28) 0(Tier 1)kelnor 1/35 (28) 0(Tier 1)kelnor 1-50 0(Tier 1)kurvelo (28) 0(Tier 1)l norgest/e.estradiol-e.estrad 0(Tier 1)larin 1.5/30 (21) 0(Tier 1)larin 1/20 (21) 0(Tier 1)larin 24 fe 0(Tier 1)larin fe 1.5/30 (28) 0(Tier 1)larin fe 1/20 (28) 0(Tier 1)larissia 0(Tier 1)layolis fe 0(Tier 1)leena 28 0(Tier 1)lessina 0(Tier 1)levonest (28) 0(Tier 1)levonorgestrel oral tablet 1.5 mg 0(Tier 1) MClevonorgestrel-ethinyl estrad 0(Tier 1)levonorg-eth estrad triphasic 0(Tier 1)levora-28 0(Tier 1)lillow (28) 0(Tier 1)lojaimiess 0(Tier 1)loryna (28) 0(Tier 1)low-ogestrel (28) 0(Tier 1)lo-zumandimine (28) 0(Tier 1)lutera (28) 0(Tier 1)




marlissa (28) 0(Tier 1)melodetta 24 fe 0(Tier 1)mibelas 24 fe 0(Tier 1)microgestin 1.5/30 (21) 0(Tier 1)microgestin 1/20 (21) 0(Tier 1)microgestin fe 1.5/30 (28) 0(Tier 1)microgestin fe 1/20 (28) 0(Tier 1)mili 0(Tier 1)mono-linyah 0(Tier 1)my way 0(Tier 1) MCnecon 0.5/35 (28) 0(Tier 1)new day 0(Tier 1) MCnikki (28) 0(Tier 1)noreth-ethinyl estradiol-iron 0(Tier 1)norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg

0(Tier 1)

norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1.5 mg-30 mcg (21)/75 mg (7)

0(Tier 1)

norethindrone-e.estradiol-iron oral tablet,chewable

0(Tier 1)

norgestimate-ethinyl estradiol 0(Tier 1)nortrel 0.5/35 (28) 0(Tier 1)nortrel 1/35 (21) 0(Tier 1)nortrel 1/35 (28) 0(Tier 1)nortrel 7/7/7 (28) 0(Tier 1)ocella 0(Tier 1)opcicon one-step 0(Tier 1) MCorsythia 0(Tier 1)philith 0(Tier 1)pimtrea (28) 0(Tier 1)pirmella 0(Tier 1)portia 28 0(Tier 1)previfem 0(Tier 1)reclipsen (28) 0(Tier 1)rivelsa 0(Tier 1)setlakin 0(Tier 1)simliya (28) 0(Tier 1)simpesse 0(Tier 1)sprintec (28) 0(Tier 1)




sronyx 0(Tier 1)syeda 0(Tier 1)tarina 24 fe 0(Tier 1)tarina fe 1/20 (28) 0(Tier 1)tarina fe 1-20 eq (28) 0(Tier 1)tilia fe 0(Tier 1)tri femynor 0(Tier 1)tri-estarylla 0(Tier 1)tri-legest fe 0(Tier 1)tri-linyah 0(Tier 1)tri-lo-estarylla 0(Tier 1)tri-lo-marzia 0(Tier 1)tri-lo-mili 0(Tier 1)tri-lo-sprintec 0(Tier 1)tri-mili 0(Tier 1)tri-previfem (28) 0(Tier 1)tri-sprintec (28) 0(Tier 1)trivora (28) 0(Tier 1)tri-vylibra 0(Tier 1)tri-vylibra lo 0(Tier 1)tydemy 0(Tier 1)velivet triphasic regimen (28) 0(Tier 1)vienva 0(Tier 1)viorele (28) 0(Tier 1)volnea (28) 0(Tier 1)vyfemla (28) 0(Tier 1)vylibra 0(Tier 1)wera (28) 0(Tier 1)wymzya fe 0(Tier 1)zarah 0(Tier 1)zovia 1/35e (28) 0(Tier 1)zumandimine (28) 0(Tier 1)OPHTHALMOLOGY (DRUGS THAT RELIEVE OR PREVENT EYE PROBLEMS)ANTIBIOTICSak-poly-bac 0(Tier 1)AZASITE 0(Tier 2)bacitracin ophthalmic (eye) 0(Tier 1)bacitracin-polymyxin b ophthalmic (eye) 0(Tier 1)BESIVANCE 0(Tier 2)




CILOXAN OPHTHALMIC (EYE) OINTMENT 0(Tier 2)ciprofloxacin hcl ophthalmic (eye) 0(Tier 1)erythromycin ophthalmic (eye) 0(Tier 1)gentak ophthalmic (eye) ointment 0(Tier 1)gentamicin ophthalmic (eye) drops 0(Tier 1)moxifloxacin ophthalmic (eye) drops 0(Tier 1)NATACYN 0(Tier 2)neomycin-bacitracin-polymyxin 0(Tier 1)neomycin-polymyxin-gramicidin 0(Tier 1)neo-polycin 0(Tier 1)ofloxacin ophthalmic (eye) 0(Tier 1)ofloxacin otic (ear) 0(Tier 1)polycin 0(Tier 1)polymyxin b sulf-trimethoprim 0(Tier 1)tobramycin ophthalmic (eye) 0(Tier 1)TOBREX OPHTHALMIC (EYE) OINTMENT 0(Tier 2)ANTIVIRALStrifluridine 0(Tier 1)ZIRGAN 0(Tier 2)BETA-BLOCKERSbetaxolol ophthalmic (eye) 0(Tier 1)carteolol 0(Tier 1)levobunolol ophthalmic (eye) drops 0.5% 0(Tier 1)timolol maleate ophthalmic (eye) drops 0(Tier 1)timolol maleate ophthalmic (eye) gel forming solution

0(Tier 1)

MISCELLANEOUS OPHTHALMOLOGICSartificial tears (petro/min) 0(Tier 1) MCartificial tears (polyvin alc) 0(Tier 1) MCATROPINE OPHTHALMIC (EYE) DROPS 0(Tier 2)azelastine ophthalmic (eye) 0(Tier 1)BLEPHAMIDE 0(Tier 2)BLEPHAMIDE S.O.P. 0(Tier 2)cromolyn ophthalmic (eye) 0(Tier 1)CYSTARAN 0(Tier 2) PA; QL (60 ML per 28 days); NDSDRY EYE RELIEF 0(Tier 1) MCepinastine 0(Tier 1)EYLEA 0(Tier 2) PA; NDSISOPTO TEARS 0(Tier 1) MC




LACRISERT 0(Tier 2)LUBRICANT EYE (PG-PEG 400) 0(Tier 1) MClubricating plus 0(Tier 1) MClubrifresh pm 0(Tier 1) MCMURO 128 OPHTHALMIC (EYE) DROPS 0(Tier 1) MColopatadine ophthalmic (eye) 0(Tier 1)PAZEO 0(Tier 2)PHOSPHOLINE IODIDE 0(Tier 2)pilocarpine hcl ophthalmic (eye) drops 1%, 2%, 4%

0(Tier 1)

REFRESH CELLUVISC 0(Tier 1) MCREFRESH LACRI-LUBE 0(Tier 1) MCREFRESH OPTIVE MEGA-3 (PF) 0(Tier 1) MCREFRESH PLUS 0(Tier 1) MCRESTASIS 0(Tier 2) QL (60 EA per 30 days)RESTASIS MULTIDOSE 0(Tier 2) QL (11 ML per 30 days)sodium chloride ophthalmic (eye) 0(Tier 1) MCsulfacetamide sodium ophthalmic (eye) drops 0(Tier 1)sulfacetamide-prednisolone 0(Tier 1)ULTRA LUBRICANT EYE 0(Tier 1) MCXIIDRA 0(Tier 2) QL (60 EA per 30 days)NON-STEROIDAL ANTI-INFLAMMATORY AGENTSbromfenac 0(Tier 1)diclofenac sodium ophthalmic (eye) 0(Tier 1)flurbiprofen sodium 0(Tier 1)ketorolac ophthalmic (eye) 0(Tier 1)PROLENSA 0(Tier 2)ORAL DRUGS FOR GLAUCOMAacetazolamide 0(Tier 1)acetazolamide sodium 0(Tier 1)methazolamide 0(Tier 1)OTHER GLAUCOMA DRUGSAZOPT 0(Tier 2)bimatoprost ophthalmic (eye) 0(Tier 1) QL (5 ML per 30 days)COMBIGAN 0(Tier 2)dorzolamide 0(Tier 1)dorzolamide-timolol 0(Tier 1)latanoprost 0(Tier 1)LUMIGAN OPHTHALMIC (EYE) DROPS 0.01% 0(Tier 2)




RHOPRESSA 0(Tier 2) STROCKLATAN 0(Tier 2) STSIMBRINZA 0(Tier 2)TRAVATAN Z 0(Tier 2)travoprost 0(Tier 1)ZIOPTAN (PF) 0(Tier 2) QL (30 EA per 30 days)STEROID-ANTIBIOTIC COMBINATIONSneomycin-bacitracin-poly-hc 0(Tier 1)neomycin-polymyxin b-dexameth 0(Tier 1)neomycin-polymyxin-hc ophthalmic (eye) 0(Tier 1)neo-polycin hc 0(Tier 1)PRED-G 0(Tier 2)PRED-G S.O.P. 0(Tier 2)TOBRADEX OPHTHALMIC (EYE) OINTMENT 0(Tier 2)tobramycin-dexamethasone 0(Tier 1)ZYLET 0(Tier 2)STEROIDSdexamethasone sodium phosphate ophthalmic (eye)

0(Tier 1)

DUREZOL 0(Tier 2)fluorometholone 0(Tier 1)INVELTYS 0(Tier 2)LOTEMAX 0(Tier 2)LOTEMAX SM 0(Tier 2)PRED MILD 0(Tier 2)prednisolone acetate 0(Tier 1)prednisolone sodium phosphate ophthalmic (eye)

0(Tier 1)

SYMPATHOMIMETICSALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1%

0(Tier 2)

apraclonidine 0(Tier 1)brimonidine 0(Tier 1)VASOCONSTRICTOR DECONGESTANTSeye drops (tetrahydrozoline) 0(Tier 1) MCeye drops advanced relief 0(Tier 1) MCREDNESS RELIEF OPHTHALMIC (EYE) DROPS 0.012-0.25%

0(Tier 1) MC




RESPIRATORY AND ALLERGY (DRUGS USED FOR BREATHING PROBLEMS)ANTIHISTAMINE / ANTIALLERGENIC AGENTS12 hour nasal decongest (pse) 0(Tier 1) MC24hr allergy relief 0(Tier 1) MCACETAMINOPHEN CONGESTION-PAIN 0(Tier 1) MCALAHIST CF 0(Tier 1) MCALAHIST DM 0(Tier 1) MCala-hist ir 0(Tier 1) MCall day allergy (cetirizine) oral tablet 0(Tier 1) MCaller-chlor oral tablet 0(Tier 1) MCallergy (chlorpheniramine) 0(Tier 1) MCallergy (diphenhydramine) oral capsule 0(Tier 1) MCallergy multi-symptom 0(Tier 1) MCallergy relief (fexofenadine) oral tablet 180 mg 0(Tier 1) MCallergy relief (loratadine) oral solution 0(Tier 1) MCallergy relief (loratadine) oral tablet 0(Tier 1) MCallergy relief d12 0(Tier 1) MCallergy relief d-24hr 0(Tier 1) MCallergy relief(chlorpheniramn) oral tablet 0(Tier 1) MCallergy relief(diphenhydramin) 0(Tier 1) MCallergy relief-d (cetirizine) 0(Tier 1) MCallergy-congest relief-d(fexo) 0(Tier 1) MCALL-NITE COLD-FLU 0(Tier 1) MCaprodine 0(Tier 1) MCbanophen oral capsule 0(Tier 1) MCbenzonatate 0(Tier 1) MCBROMFED DM 0(Tier 1) MCbrompheniramine-pseudoeph-dm oral syrup 0(Tier 1) MCbrotapp dm 0(Tier 1) MCcetirizine oral solution 1 mg/ml 0(Tier 1) MCcetirizine oral tablet 0(Tier 1) MCcetirizine-pseudoephedrine 0(Tier 1) MCchest congestion relief oral tablet 0(Tier 1) MCCHILD MUCINEX CHEST MINI-MELTS ORAL GRANULES IN PACKET 100 MG

0(Tier 1) MC

CHILD MUCINEX COUGH MINI-MELTS 0(Tier 1) MCCHILD MUCINEX M-S COLD DAY-NTE 0(Tier 1) MCchild mucus relief cough 0(Tier 1) MCchildren’s allergy (diphenhyd) oral liquid 0(Tier 1) MC




children’s allergy relief(lor) oral solution 0(Tier 1) MCchildren’s cetirizine oral solution 0(Tier 1) MCCHILDREN’S CETIRIZINE ORAL TABLET,CHEWABLE 10 MG

0(Tier 1) MC

children’s cetirizine oral tablet,chewable 5 mg 0(Tier 1) MCchildren’s cold and cough (pe) 0(Tier 1) MCchildren’s cold-allergy (pe) 0(Tier 1) MCCHILDREN’S COUGH DM ER 0(Tier 1) MCCHILDREN’S DAYCLEAR ALLERGY 0(Tier 1) MCCHILDREN’S DELSYM COUGH 0(Tier 1) MCCHILDREN’S MUCINEX COLD-FEVER 0(Tier 1) MCCHILDREN’S MUCINEX MULTI-SYMP 0(Tier 1) MCCHILDREN’S MUCINEX NIGHT TIME 0(Tier 1) MCchildren’s silfedrine 0(Tier 1) MCchild’s all day allergy(cetir) 0(Tier 1) MCCHILD’S MUCUS RELIEF M-S COLD 0(Tier 1) MCCHLO TUSS 0(Tier 1) MCcodeine-guaifenesin 0(Tier 1) MCcomplete allergy medicine oral capsule 0(Tier 1) MCCOUGH AND SEVERE COLD 0(Tier 1) MCCOUGH DM ER 0(Tier 1) MCcough syrup dm 0(Tier 1) MCCOUGH-COLD RELIEF HBP 0(Tier 1) MCDAYTIME COLD-FLU RELIEF (PE) 0(Tier 1) MCDECONEX DMX ORAL TABLET 10-17.5-385 MG, 10-17.5-400 MG

0(Tier 1) MC

DECONEX IR ORAL TABLET 10-385 MG 0(Tier 1) MCDELSYM 12 HOUR 0(Tier 1) MCdelsym cough-chest congest dm 0(Tier 1) MCdesloratadine oral tablet 0(Tier 1)DEXBROMPHENIRAMINE-PHENYLEPH 0(Tier 1) MCdextromethorphan polistirex 0(Tier 1) MCdimaphen dm 0(Tier 1) MCdiphenhist oral capsule 0(Tier 1) MCdiphenhydramine hcl injection solution 50 mg/ml 0(Tier 1)diphenhydramine hcl oral capsule 0(Tier 1) MCDIPHENHYDRAMINE HCL ORAL DROPS 0(Tier 1) MCdiphenhydramine hcl oral liquid 0(Tier 1) MCdiphenhydramine hcl oral tablet 25 mg 0(Tier 1) MC




DOXYLAMINE-PHENYLEPHRINE 0(Tier 1) MCDURAFLU ORAL TABLET 60-20-200-325 MG 0(Tier 1) MCed a-hist 0(Tier 1) MCed a-hist dm oral liquid 0(Tier 1) MCED A-HIST DM ORAL TABLET 0(Tier 1) MCed bron gp 0(Tier 1) MCed chlorped jr 0(Tier 1) MCendacof - dm 0(Tier 1) MCepinephrine injection auto-injector 0(Tier 1) QL (2 EA per 30 days)epinephrine injection solution 1 mg/ml 0(Tier 1)EPIPEN 0(Tier 2) QL (2 EA per 30 days)EPIPEN 2-PAK 0(Tier 2) QL (2 EA per 30 days)EPIPEN JR 0(Tier 2) QL (2 EA per 30 days)EPIPEN JR 2-PAK 0(Tier 2) QL (2 EA per 30 days)FEXOFENADINE ORAL SUSPENSION 0(Tier 1) MCfexofenadine oral tablet 180 mg, 60 mg 0(Tier 1) MCfexofenadine-pseudoephedrine 0(Tier 1) MCFLU-SEVERE COLD-COUGH DAYTIME 0(Tier 1) MCguaiatussin ac 0(Tier 1) MCHISTEX (TRIPROLIDINE) ORAL LIQUID 0(Tier 1) MCHISTEX DM 0(Tier 1) MCHISTEX PD 0(Tier 1) MCHISTEX PE 0(Tier 1) MChydrocodone-chlorpheniramine 0(Tier 1) MChydrocodone-homatropine oral syrup 5-1.5 mg/5 ml

0(Tier 1) MC

hydrocodone-homatropine oral tablet 0(Tier 1) MChydromet 0(Tier 1) MChydroxyzine hcl oral tablet 0(Tier 1) PAlevocetirizine oral solution 0(Tier 1) QL (300 ML per 30 days)levocetirizine oral tablet 0(Tier 1) QL (120 EA per 30 days)lohist - d 0(Tier 1) MClohist-dm 0(Tier 1) MClorata-dine d 0(Tier 1) MCloratadine oral solution 0(Tier 1) MCloratadine oral tablet 0(Tier 1) MCloratadine-d 0(Tier 1) MCmapap cold formula 0(Tier 1) MCM-END DMX 0(Tier 1) MC




MUCINEX COLD,FLU,SORE THROAT 0(Tier 1) MCmucinex d 0(Tier 1) MCmucinex d maximum strength 0(Tier 1) MCmucinex dm oral tablet extended release 12 hr 30-600 mg

0(Tier 1) MC

MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR 60-1,200 MG

0(Tier 1) MC

MUCINEX FAST-MAX COLD-SINUS 0(Tier 1) MCMUCINEX FAST-MAX CONGEST-COUGH ORAL TABLET

0(Tier 1) MC

MUCINEX FAST-MAX DAY-NITE CONG ORAL TABLETS, SEQUENTIAL 5 MG (DY)/25 MG -5 MG-325MG(NT)

0(Tier 1) MC

mucinex fast-max dm max 0(Tier 1) MCMUCINEX FAST-MAX NITE COLD-FLU ORAL LIQUID

0(Tier 1) MC

MUCINEX FAST-MAX SEVERE COLD ORAL LIQUID

0(Tier 1) MC

MUCINEX FST-MX DY-NT COLD(DPH) ORAL LIQUID, SEQUENTIAL

0(Tier 1) MC

MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG

0(Tier 1) MC

mucinex oral tablet extended release 12hr 600 mg

0(Tier 1) MC

mucus dm 0(Tier 1) MCmucus dm max er 0(Tier 1) MCmucus relief 0(Tier 1) MCmucus relief d (pseudoephed) oral tablet extended release 12 hr 60-600 mg

0(Tier 1) MC

mucus relief dm cough 0(Tier 1) MCMUCUS RELIEF ER ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG

0(Tier 1) MC

mucus relief er oral tablet extended release 12hr 600 mg

0(Tier 1) MC

mucus relief sinus 0(Tier 1) MCMUCUS-CHEST CONGESTION 0(Tier 1) MCnasal decongestant (pseudoeph) oral tablet 0(Tier 1) MCNASOPEN PE 0(Tier 1) MCnighttime cold-flu 0(Tier 1) MCNIGHTTIME COLD-FLU RELIEF 0(Tier 1) MCnighttime sleep aid (diphen) oral tablet 0(Tier 1) MC




NINJACOF 0(Tier 1) MCNINJACOF-XG 0(Tier 1) MCNITE TIME COLD-FLU RELIEF ORAL CAPSULE

0(Tier 1) MC

nohist-dm 0(Tier 1) MCnohist-lq 0(Tier 1) MCPEDIACLEAR ALLERGY 0(Tier 1) MCPEDIACLEAR COUGH 0(Tier 1) MCPEDIACLEAR PD 0(Tier 1) MCPEDIACLEAR-8 0(Tier 1) MCpediatric cough and cold oral liquid 1-15-5 mg/5 ml

0(Tier 1) MC

PHENYLEPHRINE-DM-GUAIFENESIN ORAL LIQUID 10-18-200 MG/15 ML

0(Tier 1) MC

PHENYLEPHRINE-DM-GUAIFENESIN ORAL TABLET

0(Tier 1) MC

POLY HIST FORTE 0(Tier 1) MCPOLY HIST FORTE (DOXYLAMINE) 0(Tier 1) MCPOLY HIST PD 0(Tier 1) MCPOLY-HIST DM (THONZYLAMINE) 0(Tier 1) MCPOLYTUSSIN DM 0(Tier 1) MCPOLY-VENT DM ORAL TABLET 60-20-380 MG 0(Tier 1) MCPOLY-VENT IR ORAL TABLET 60-380 MG 0(Tier 1) MCpromethazine oral 0(Tier 1) PApromethazine rectal suppository 12.5 mg, 25 mg 0(Tier 1)promethazine-codeine 0(Tier 1) MCpromethazine-dm 0(Tier 1) MCpromethegan rectal suppository 25 mg, 50 mg 0(Tier 1)pseudoephedrine hcl oral tablet 0(Tier 1) MCpseudoephedrine hcl oral tablet extended release

0(Tier 1) MC

PSEUDOEPHEDRINE-GUAIFENESIN ORAL TABLET

0(Tier 1) MC

pseudoephedrine-guaifenesin oral tablet extended release 12 hr

0(Tier 1) MC

RESCON 0(Tier 1) MCRESCON-DM 0(Tier 1) MCrescon-gg 0(Tier 1) MCrobafen 0(Tier 1) MCrobafen cf (phenylephrine) 0(Tier 1) MC




robafen cough 0(Tier 1) MCrobafen dm cough 0(Tier 1) MCrobafen dm cough-chest congest 0(Tier 1) MCrobafen dm peak cold 0(Tier 1) MCRU-HIST D 0(Tier 1) MCRYMED (DEXCHLORPHENIRAMINE-PE) 0(Tier 1) MCrynex dm 0(Tier 1) MCrynex pe 0(Tier 1) MCrynex pse 0(Tier 1) MCSEVERE COLD AND FLU (PE) ORAL TABLET 0(Tier 1) MCSEVERE COLD AND FLU NIGHTTIME 0(Tier 1) MCsiladryl sa 0(Tier 1) MCsiltussin dm das 0(Tier 1) MCsiltussin sa 0(Tier 1) MCsiltussin-dm 0(Tier 1) MCSINUS CONGESTION-PAIN(GUAIF) 0(Tier 1) MCSINUS PAIN-PRESSURE (PE) ORAL TABLET 5-325 MG

0(Tier 1) MC

SLEEP AID (DIPHENHYDRAMINE) ORAL CAPSULE 25 MG

0(Tier 1) MC

SLEEP AID (DIPHENHYDRAMINE) ORAL LIQUID

0(Tier 1) MC

sleep aid (diphenhydramine) oral tablet 0(Tier 1) MCSTAHIST AD ORAL TABLET 0(Tier 1) MCsudogest 0(Tier 1) MCsudogest 12-hour 0(Tier 1) MCsudogest pe 0(Tier 1) MCsudogest sinus and allergy 0(Tier 1) MCTRIPROLIDINE HCL 0(Tier 1) MCtussin cf (pe-dm-guaif) 0(Tier 1) MCtussin dm cough and chest oral liquid 5-100 mg/5 ml

0(Tier 1) MC

tussin dm oral liquid 0(Tier 1) MCtussin dm oral syrup 10-100 mg/5 ml 0(Tier 1) MCtussin mucus-chest congestion 0(Tier 1) MCVANACLEAR PD 0(Tier 1) MCVANACOF 0(Tier 1) MCVANACOF DM 0(Tier 1) MCVANACOF DMX 0(Tier 1) MCVANAMINE PD 0(Tier 1) MC




VANATAB DM 0(Tier 1) MCvirtussin ac 0(Tier 1) MCvirtussin dac 0(Tier 1) MCPULMONARY AGENTSacetylcysteine 0(Tier 1) B/D PAADEMPAS 0(Tier 2) PA; QL (90 EA per 30 days); NDSADVAIR DISKUS 0(Tier 2) QL (60 EA per 30 days)ADVAIR HFA 0(Tier 2) QL (12 GM per 30 days)albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (Generic for ProAir)

0(Tier 1) QL (17 GM per 30 days)

albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (Generic for Proventil)

0(Tier 1) QL (13.4 GM per 30 days)

albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (Generic for Ventolin)


albuterol sulfate inhalation solution for nebulization

0(Tier 1) B/D PA

albuterol sulfate oral 0(Tier 1)ALLERGY RELIEF (FLUTICASONE) 0(Tier 1) MCambrisentan 0(Tier 1) PA; QL (30 EA per 30 days); NDSANORO ELLIPTA 0(Tier 2) QL (60 EA per 30 days)ARNUITY ELLIPTA 0(Tier 2) QL (30 EA per 30 days)ATROVENT HFA 0(Tier 2) QL (25.8 GM per 30 days)bosentan 0(Tier 1) PA; QL (60 EA per 30 days); NDSBREO ELLIPTA 0(Tier 2) QL (60 EA per 30 days)BROVANA 0(Tier 2) B/D PAbudesonide inhalation 0(Tier 1) B/D PAbudesonide nasal 0(Tier 1) MCCINRYZE 0(Tier 2) PA; QL (20 EA per 30 days); NDSCOMBIVENT RESPIMAT 0(Tier 2) QL (8 GM per 30 days)cromolyn inhalation 0(Tier 1) B/D PA; QL (240 ML per 30 days)cromolyn nasal 0(Tier 1) MCDALIRESP 0(Tier 2) PA; QL (30 EA per 30 days)ESBRIET ORAL CAPSULE 0(Tier 2) PA; QL (270 EA per 30 days); NDSESBRIET ORAL TABLET 267 MG 0(Tier 2) PA; QL (270 EA per 30 days); NDSESBRIET ORAL TABLET 801 MG 0(Tier 2) PA; QL (90 EA per 30 days); NDSFLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION


FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ACTUATION





FLOVENT HFA AEROSOL INHALER 110 MCG/ACTUATION





0(Tier 2) QL (10.6 GM per 30 days)

flunisolide nasal spray,non-aerosol 25 mcg (0.025%)


fluticasone propionate nasal 0(Tier 1) QL (16 GM per 30 days)fluticasone propion-salmeterol inhalation blister with device


icatibant 0(Tier 1) PA; QL (18 ML per 30 days); NDSINCRUSE ELLIPTA 0(Tier 2) QL (30 EA per 30 days)ipratropium bromide inhalation 0(Tier 1) B/D PAipratropium-albuterol 0(Tier 1) B/D PAKALYDECO 0(Tier 2) PA; QL (60 EA per 30 days); NDSlevalbuterol hcl 0(Tier 1) B/D PAlevalbuterol tartrate 0(Tier 1) QL (30 GM per 30 days)metaproterenol oral syrup 0(Tier 1)mometasone nasal 0(Tier 1) QL (34 GM per 30 days)montelukast 0(Tier 1) QL (30 EA per 30 days)NASAL ALLERGY 0(Tier 1) MCOFEV 0(Tier 2) PA; QL (60 EA per 30 days); NDSOPSUMIT 0(Tier 2) PA; QL (30 EA per 30 days); NDSORKAMBI ORAL GRANULES IN PACKET 0(Tier 2) PA; QL (56 EA per 28 days); NDSORKAMBI ORAL TABLET 0(Tier 2) PA; QL (120 EA per 30 days); NDSPERFOROMIST 0(Tier 2) B/D PA; QL (120 ML per 30 days)PROAIR HFA 0(Tier 2) QL (17 GM per 30 days)PROAIR RESPICLICK 0(Tier 2) QL (2 EA per 30 days)PULMICORT 0(Tier 2) B/D PAPULMOZYME 0(Tier 2) B/D PA; QL (150 ML per 30 days); NDSRUCONEST 0(Tier 2) PA; QL (8 EA per 30 days); NDSS2 RACEPINEPHRINE 0(Tier 1) MCSEREVENT DISKUS 0(Tier 2) QL (60 EA per 30 days)sildenafil (pulmonary arterial hypertension) oral tablet


terbutaline 0(Tier 1)THEO-24 0(Tier 2)theophylline oral tablet extended release 12 hr 300 mg, 450 mg

0(Tier 1)




theophylline oral tablet extended release 24 hr 0(Tier 1)TRACLEER ORAL TABLET FOR SUSPENSION 0(Tier 2) PA; NDSTRELEGY ELLIPTA 0(Tier 2) QL (60 EA per 30 days)triamcinolone acetonide nasal 0(Tier 1) MCVENTAVIS 0(Tier 2) PA; QL (270 ML per 30 days); NDSVENTOLIN HFA 0(Tier 2) QL (36 GM per 30 days)wixela inhub 0(Tier 1) QL (60 EA per 30 days)XHANCE 0(Tier 2) ST; QL (16 ML per 30 days)XOLAIR SUBCUTANEOUS RECON SOLN 0(Tier 2) PA; QL (6 EA per 28 days); NDSXOLAIR SUBCUTANEOUS SYRINGE 0(Tier 2) PA; QL (5 ML per 28 days); NDSXOPENEX 0(Tier 2) B/D PAXOPENEX CONCENTRATE 0(Tier 2) B/D PAYUPELRI 0(Tier 2) B/D PAzafirlukast 0(Tier 1) QL (60 EA per 30 days)UROLOGICALS (DRUGS THAT TREAT PROBLEMS OF THE URINARY TRACT)ANTICHOLINERGICS / ANTISPASMODICSdarifenacin 0(Tier 1)flavoxate 0(Tier 1)MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG


MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 50 MG


oxybutynin chloride oral syrup 0(Tier 1) QL (600 ML per 30 days)oxybutynin chloride oral tablet 0(Tier 1)oxybutynin chloride oral tablet extended release 24hr


solifenacin 0(Tier 1) QL (30 EA per 30 days)tolterodine oral capsule,extended release 24hr 0(Tier 1) QL (30 EA per 30 days)tolterodine oral tablet 0(Tier 1)TOVIAZ 0(Tier 2) QL (30 EA per 30 days)BENIGN PROSTATIC HYPERPLASIA(BPH) THERAPYalfuzosin 0(Tier 1) QL (30 EA per 30 days)dutasteride 0(Tier 1) QL (30 EA per 30 days)dutasteride-tamsulosin 0(Tier 1) QL (30 EA per 30 days)finasteride oral tablet 5 mg 0(Tier 1) QL (30 EA per 30 days)tamsulosin 0(Tier 1) QL (60 EA per 30 days)MISCELLANEOUS UROLOGICALSbethanechol chloride 0(Tier 1)CYSTAGON 0(Tier 2)




ELMIRON 0(Tier 2)K-PHOS ORIGINAL 0(Tier 2)potassium citrate 0(Tier 1)potassium citrate-citric acid oral solution 0(Tier 1) MCRENACIDIN IRRIGATION SOLUTION 1980.6 MG-59.4 MG-980.4MG/30ML

0(Tier 2)

sodium citrate-citric acid 0(Tier 1) MCtricitrates 0(Tier 1) MCVITAMINS, HEMATINICS / ELECTROLYTES (DRUGS THAT REPLACE NUTRIENTS/ELECTROLYTES)ELECTROLYTESantacid (calcium carbonate) oral tablet,chewable 200 mg calcium (500 mg)

0(Tier 1) MC

antacid ext str (calcium carb) 0(Tier 1) MCantacid ultra strength oral tablet,chewable 400 mg calcium (1,000 mg)

0(Tier 1) MC

calcitrate 0(Tier 1) MCcalcium 500 + d oral tablet 500 mg(1,250mg) -200 unit

0(Tier 1) MC

calcium 500 + d oral tablet,chewable 0(Tier 1) MCcalcium 500 with d 0(Tier 1) MCcalcium 600 0(Tier 1) MCcalcium 600 + d(3) oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit

0(Tier 1) MC

calcium 600 with vitamin d3 oral tablet,chewable 0(Tier 1) MCcalcium acetate(phosphat bind) 0(Tier 1)calcium antacid oral tablet,chewable 200 mg calcium (500 mg), 300 mg (750 mg)

0(Tier 1) MC

calcium carbonate oral suspension 0(Tier 1) MCcalcium carbonate oral tablet 260 mg calcium (648 mg), 500 mg calcium (1,250 mg), 600 mg calcium (1,500 mg)

0(Tier 1) MC

calcium carbonate oral tablet,chewable 500 mg calcium (1,250 mg)

0(Tier 1) MC

calcium carbonate-vitamin d3 oral capsule 600 mg(1,500mg) -400 unit

0(Tier 1) MC

CALCIUM CARBONATE-VITAMIN D3 ORAL TABLET 250-125 MG-UNIT, 500MG (1,250MG) -600 UNIT

0(Tier 1) MC




calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) -400 unit, 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit, 600 mg(1,500mg) -800 unit

0(Tier 1) MC

calcium carbonate-vitamin d3 oral tablet,chewable 500 mg(1,250mg) -400 unit

0(Tier 1) MC

calcium citrate + d 0(Tier 1) MCcalcium citrate oral tablet 200 mg (950 mg) 0(Tier 1) MCcalcium citrate plus (vit b6) 0(Tier 1) MCcalcium citrate-vitamin d3 oral tablet 200 mg-3.125 mcg (125 unit), 315 mg-5 mcg (200 unit)

0(Tier 1) MC

CALCIUM CITRATE-VITAMIN D3 ORAL TABLET 315 MG-6.25 MCG (250 UNIT)

0(Tier 1) MC

calcium with vitamin d 0(Tier 1) MCCALCIUM-MAGNESIUM 0(Tier 1) MCcalcium-magnesium-zinc oral tablet 333-133-5 mg

0(Tier 1) MC

cal-gest antacid 0(Tier 1) MCCALTRATE 600 PLUS D 0(Tier 1) MCCALTRATE WITH VITAMIN D3 0(Tier 1) MCCITRACAL + D MAXIMUM 0(Tier 1) MCelectrolytes-dextrose 0(Tier 1) MCENFAMIL ENFALYTE 0(Tier 1) MChi-cal plus vit d 0(Tier 1) MCklor-con 0(Tier 1)KLOR-CON 10 0(Tier 2)KLOR-CON 8 0(Tier 2)klor-con m10 0(Tier 1)klor-con m20 0(Tier 1)k-phos-neutral 0(Tier 1) MClactated ringers intravenous 0(Tier 2) B/D PAMAGNESIUM (OXIDE/AA CHELATE) 0(Tier 1) MCMAGNESIUM GLUCONATE ORAL TABLET 30 MG (550 MG)

0(Tier 1) MC

MAGNESIUM ORAL TABLET 30 MG 0(Tier 1) MCmagnesium oxide oral capsule 500 mg 0(Tier 1) MCmagnesium oxide oral tablet 420 mg 0(Tier 1) MCMAGNESIUM OXIDE ORAL TABLET 500 MG 0(Tier 1) MC




MAGNESIUM SULFATE IN D5W INTRAVENOUS PIGGYBACK 1 GRAM/100 ML

0(Tier 1) B/D PA

magnesium sulfate in water 0(Tier 1) B/D PAmagnesium sulfate injection 0(Tier 1) B/D PAMG-PLUS-PROTEIN 0(Tier 1) MCMONOCAL 0(Tier 1) MCNORMOSOL-R 0(Tier 2) B/D PANU-MAG 0(Tier 1) MCoralyte 0(Tier 1) MCORAZINC 0(Tier 1) MCOS-CAL 500 + D3 0(Tier 1) MCoysco 500/d oral tablet 0(Tier 1) MCoyster shell + d3 0(Tier 1) MCoyster shell calcium 500 0(Tier 1) MCoyster shell calcium and mag 0(Tier 1) MCOYSTER SHELL CALCIUM-VIT D3 ORAL TABLET 250-125 MG-UNIT

0(Tier 1) MC

oyster shell calcium-vit d3 oral tablet 500 mg(1,250mg) -200 unit, 500 mg(1,250mg) -400 unit

0(Tier 1) MC

oystercal-d 0(Tier 1) MCPEDIALYTE ADVANCED CARE 0(Tier 1) MCpedialyte freezer pops 0(Tier 1) MCpedialyte oral solution 0(Tier 1) MCpedialyte singles 0(Tier 1) MCpediatric electrolyte oral solution 0(Tier 1) MCpediatric freezer pops 0(Tier 1) MCPHILLIPS 0(Tier 1) MCPHOSLYRA 0(Tier 2)phospha 250 neutral 0(Tier 1) MCphosphorous 0(Tier 1) MCphospho-trin 250 neutral 0(Tier 1) MCPOTASSIUM CHLORID-D5-0.45%NACL INTRAVENOUS PARENTERAL SOLUTION 10 MEQ/L, 20 MEQ/L, 40 MEQ/L

0(Tier 2) B/D PA

potassium chlorid-d5-0.45%nacl intravenous parenteral solution 30 meq/l

0(Tier 1) B/D PA

potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l

0(Tier 1) B/D PA




POTASSIUM CHLORIDE IN 5% DEX INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2) B/D PA

potassium chloride in 5% dex intravenous parenteral solution 30 meq/l

0(Tier 2) B/D PA

potassium chloride in 5% dex intravenous parenteral solution 40 meq/l

0(Tier 1) B/D PA

POTASSIUM CHLORIDE IN LR-D5 INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2) B/D PA

potassium chloride in lr-d5 intravenous parenteral solution 40 meq/l

0(Tier 2) B/D PA

potassium chloride in water intravenous piggyback

0(Tier 1) B/D PA

potassium chloride intravenous 0(Tier 1) B/D PApotassium chloride oral capsule, extended release

0(Tier 1)

POTASSIUM CHLORIDE ORAL LIQUID 0(Tier 2)potassium chloride oral packet 0(Tier 1)potassium chloride oral tablet extended release 0(Tier 1)potassium chloride oral tablet,er particles/crystals

0(Tier 1)

potassium chloride-0.45% nacl 0(Tier 1) B/D PAPOTASSIUM CHLORIDE-D5-0.2%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2) B/D PA

potassium chloride-d5-0.2%nacl intravenous parenteral solution 30 meq/l, 40 meq/l

0(Tier 2) B/D PA

potassium chloride-d5-0.3%nacl intravenous parenteral solution 20 meq/l

0(Tier 1) B/D PA

POTASSIUM CHLORIDE-D5-0.9%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L

0(Tier 2) B/D PA

potassium chloride-d5-0.9%nacl intravenous parenteral solution 40 meq/l

0(Tier 1) B/D PA

ringer’s intravenous 0(Tier 2) B/D PAselenium oral tablet 0(Tier 1) MCSLOW-MAG 0(Tier 1) MCsodium bicarbonate intravenous syringe 10 meq/10 ml (8.4%), 7.5% (0.9 meq/ml), 8.4% (1 meq/ml)

0(Tier 1)

SODIUM CHLORIDE 0.45% INTRAVENOUS PARENTERAL SOLUTION

0(Tier 2)




SODIUM CHLORIDE 3% 0(Tier 2)SODIUM CHLORIDE 5% 0(Tier 2)sodium chloride intravenous 0(Tier 1)super calcium 0(Tier 1) MCTPN ELECTROLYTES 0(Tier 2) B/D PAvirt-phos 250 neutral 0(Tier 1) MCzinc 0(Tier 1) MCZINC GLUCONATE ORAL LOZENGE 0(Tier 1) MCzinc gluconate oral tablet 0(Tier 1) MCzinc sulfate oral 0(Tier 1) MCZINC-15 0(Tier 1) MCzinc-220 0(Tier 1) MCMISCELLANEOUS NUTRITION PRODUCTSAMINOSYN II 10% 0(Tier 2) B/D PAAMINOSYN II 15% 0(Tier 2) B/D PAAMINOSYN-PF 7% (SULFITE-FREE) 0(Tier 2) B/D PACALCIUM CITRATE MALATE-VIT D3 0(Tier 1) MCCLINIMIX 5%/D15W SULFITE FREE 0(Tier 2) B/D PACLINIMIX 4.25%/D10W SULF FREE 0(Tier 2) B/D PACLINIMIX 5%-D20W(SULFITE-FREE) 0(Tier 2) B/D PACLINIMIX E 4.25%/D10W SUL FREE 0(Tier 2) B/D PACLINISOL SF 15% 0(Tier 2) B/D PAelectrolyte-48 in d5w 0(Tier 1) B/D PAFORTAVIT 0(Tier 1) MCFREAMINE HBC 6.9% 0(Tier 2) B/D PAfreamine iii 10% 0(Tier 2) B/D PAHEPATAMINE 8% 0(Tier 2) B/D PAINTRALIPID INTRAVENOUS EMULSION 20%, 30%

0(Tier 2) B/D PA

KABIVEN 0(Tier 2) B/D PANEPHRAMINE 5.4% 0(Tier 2) B/D PANORMOSOL-M IN 5% DEXTROSE 0(Tier 2) B/D PANORMOSOL-R PH 7.4 0(Tier 2) B/D PANUTRILIPID 0(Tier 2) B/D PAPERIKABIVEN 0(Tier 2) B/D PAPLENAMINE 0(Tier 2) B/D PAPREMASOL 10% 0(Tier 2) B/D PAPROCALAMINE 3% 0(Tier 2) B/D PAPROSOL 20% 0(Tier 2) B/D PA




TRAVASOL 10% 0(Tier 2) B/D PATROPHAMINE 10% 0(Tier 2) B/D PAVITAMINS / HEMATINICSa thru z 0(Tier 1) MCa thru z advanced formula 0(Tier 1) MCA THRU Z MEN’S ULTIMATE 0(Tier 1) MCa thru z select 50plus formula 0(Tier 1) MCa thru z select oral tablet 500-300-250 mcg 0(Tier 1) MCa thru z select women’s 0(Tier 1) MCABANEU-SL 0(Tier 1) MCabc plus 0(Tier 1) MCactical 0(Tier 1) MCadult one daily multivitamin 0(Tier 1) MCadults 50 plus 0(Tier 1) MCALBA-LYBE 0(Tier 1) MCanimal chews 0(Tier 1) MCapatate forte 0(Tier 1) MCAPETEX 0(Tier 1) MCAPETIGEN 0(Tier 1) MCapetigen plus oral liquid 0(Tier 1) MCAPETIGEN PLUS ORAL TABLET 0(Tier 1) MCAQUADEKS ORAL TABLET,CHEWABLE 0(Tier 1) MCAQUADEKS PEDIATRIC 0(Tier 1) MCascorbic acid (vitamin c) oral capsule, extended release

0(Tier 1) MC

ASCORBIC ACID (VITAMIN C) ORAL GRANULES

0(Tier 1) MC

ascorbic acid (vitamin c) oral syrup 0(Tier 1) MCascorbic acid (vitamin c) oral tablet 0(Tier 1) MCascorbic acid (vitamin c) oral tablet extended release 1,500 mg, 500 mg

0(Tier 1) MC

ASCORBIC ACID (VITAMIN C) ORAL TABLET,CHEWABLE 250 MG

0(Tier 1) MC

ascorbic acid (vitamin c) oral tablet,chewable 500 mg

0(Tier 1) MC

b complex 1 (with folic acid) 0(Tier 1) MCb complex 100 oral 0(Tier 1) MCB COMPLEX W-VIT C 0(Tier 1) MCb complex-vitamin b12 0(Tier 1) MCb complex-vitamin c-folic acid oral tablet 0(Tier 1) MC




b-12 dots 0(Tier 1) MCBACMIN 0(Tier 1) MCbalance b-100 (folic acid) 0(Tier 1) MCbalance b-50 (with folic acid) 0(Tier 1) MCbalanced b-100 oral tablet 0.4 mg 0(Tier 1) MCbalanced b-50 oral tablet 0(Tier 1) MCb-complex with vitamin c oral capsule 0(Tier 1) MCb-complex with vitamin c oral tablet 0(Tier 1) MCb-complex with vitamin c oral tablet extended release

0(Tier 1) MC

beta carotene oral capsule 25,000 unit 0(Tier 1) MCBIOCAL 0(Tier 1) MCbiopetit 0(Tier 1) MCbiotin oral capsule 2,500 mcg, 5 mg 0(Tier 1) MCbiotin oral tablet 1 mg 0(Tier 1) MCC 1000-BIOFLAVONOIDS-ROSE HIPS 0(Tier 1) MCc complex 0(Tier 1) MCc-1000 0(Tier 1) MCc-1000 with rose hips 0(Tier 1) MCc-500 0(Tier 1) MCca-d3-mag ox-zinc-cop-mang-bor oral tablet,chewable 600 mg calcium- 400 unit-40 mg

0(Tier 1) MC

CA-D3-MAG OX-ZINC-COP-MANG-BOR ORAL TABLET,CHEWABLE 600 MG CALCIUM- 800 UNIT-40 MG

0(Tier 1) MC

CALCET PETITES 0(Tier 1) MCcalcidol 0(Tier 1) MCcalcium 600 + minerals 0(Tier 1) MCcalcium carbonate-vit d3-min oral tablet 0(Tier 1) MCcalcium for women 0(Tier 1) MCcalcium soft chew oral tablet,chewable 500-200-40 mg-unit-mcg

0(Tier 1) MC

calcium-folic acid-vitamin d 0(Tier 1) MCcalcium-magnesium-copper-zinc 0(Tier 1) MCcalcium-vitamin d3-vitamin k oral tablet,chewable 500-200-40 mg-unit-mcg

0(Tier 1) MC

CALTRATE 600-D PLUS MINERALS ORAL TABLET

0(Tier 1) MC

centamin 0(Tier 1) MC




CENTRAL-VITE WOMEN’S MATURE 0(Tier 1) MCCENTRAM-CARE 0(Tier 1) MCcentratex 0(Tier 1) MCcentravites 50 plus oral tablet 0.4-300-250 mg-mcg-mcg

0(Tier 1) MC

CENTRUM COMPLETE 0(Tier 1) MCCENTRUM MEN 0(Tier 1) MCCENTRUM ORAL LIQUID 9 MG IRON/15 ML 0(Tier 1) MCCENTRUM SILVER ORAL TABLET 0(Tier 1) MCCENTRUM SILVER WOMEN 0(Tier 1) MCCENTRUM SPECIALIST HEART 0(Tier 1) MCCENTRUM ULTRA MEN’S 0(Tier 1) MCcentrum women 0(Tier 1) MCcentury adults 50 plus 0(Tier 1) MCcentury cardio 0(Tier 1) MCcentury mature oral tablet 0.4-300-250 mg-mcg-mcg

0(Tier 1) MC

century oral tablet 18-400 mg-mcg 0(Tier 1) MCCENTURY ULTIMATE MEN’S ORAL TABLET 8 MG IRON- 200 MCG-600 MCG

0(Tier 1) MC

century ultimate women’s 0(Tier 1) MCCEREFOLIN 0(Tier 1) MCcerovite advanced formula 0(Tier 1) MCcerta plus 0(Tier 1) MCcertavite senior-antioxidant 0(Tier 1) MCCERTAVITE-ANTIOXIDANT 0(Tier 1) MCchildren’s chewable multivitmn 0(Tier 1) MCchildren’s chewable vitamin 0(Tier 1) MCchildren’s chewables 0(Tier 1) MCchildren’s chewables extra c 0(Tier 1) MCchildren’s iron 0(Tier 1) MCchild’s chewable vitamins/iron oral tablet,chewable

0(Tier 1) MC

childs/iron 0(Tier 1) MCCHOLECALCIFEROL (VITAMIN D3) ORAL DROPS 10 MCG/ML (400 UNIT/ML)

0(Tier 1) MC

complete 50 plus 0(Tier 1) MCCOMPLETE MEN 0(Tier 1) MCcomplete multi 0(Tier 1) MCcomplete multi 50+ 0(Tier 1) MC




complete multivitamin oral tablet 0(Tier 1) MCcomplete multivitamin-mineral oral tablet 0(Tier 1) MCcomplete mv adult 50 plus 0(Tier 1) MCcomplete oral tablet 18-500-300-250 mg-mcg-mcg-mcg

0(Tier 1) MC

complete senior oral tablet 0.4-300-250 mg-mcg-mcg

0(Tier 1) MC

complete women 0(Tier 1) MCcomplex b-100 oral tablet extended release 0(Tier 1) MCCORAL CALCIUM ORAL CAPSULE 185-50-100 MG-MG-UNIT

0(Tier 1) MC

corvita 0(Tier 1) MCCORVITE 0(Tier 1) MCCORVITE 150 ORAL TABLET 150 MG IRON- 1 MG

0(Tier 1) MC

CORVITE FE ORAL TABLET 150 MG IRON- 1 MG

0(Tier 1) MC

cyanocobalamin (vitamin b-12) oral tablet 1,000 mcg, 100 mcg, 500 mcg

0(Tier 1) MC

cyanocobalamin (vitamin b-12) oral tablet extended release

0(Tier 1) MC

daily multiple for men 0(Tier 1) MCDAILY MULTIPLE FOR WOMEN 0(Tier 1) MCdaily multiple oral tablet , 18-400 mg-mcg 0(Tier 1) MCDAILY MULTIPLE ORAL TABLET 400-120 MCG-MG

0(Tier 1) MC

daily multiple vitamins/iron 0(Tier 1) MCdaily multi-vitamin 0(Tier 1) MCdaily multivitamin with iron 0(Tier 1) MCdaily multivitamin-minerals 0(Tier 1) MCdaily value 0(Tier 1) MCdaily vitamin formula 0(Tier 1) MCdaily vitamin formula-iron 0(Tier 1) MCdaily vitamin formula-minerals 0(Tier 1) MCdaily vitamin with iron 0(Tier 1) MCdaily vites/iron 0(Tier 1) MCDAILY-VITE 0(Tier 1) MCDEKAS ESSENTIAL ORAL CAPSULE 0(Tier 1) MCDEKAS PLUS (FOLIC ACID) ORAL CAPSULE 0(Tier 1) MCDEKAS PLUS LIQUID 0(Tier 1) MC




dialyvite 0(Tier 1) MCDIALYVITE 3000 0(Tier 1) MCDIALYVITE 5000 0(Tier 1) MCdialyvite 800 oral tablet 0(Tier 1) MCDIALYVITE 800 WITH IRON 0(Tier 1) MCDIALYVITE SUPREME D 0(Tier 1) MCduofer 0(Tier 1) MCd-vi-sol 0(Tier 1) MCELFOLATE PLUS 0(Tier 1) MCendur-c with rose hips 0(Tier 1) MCENLYTE 0(Tier 1) MCergocalciferol (vitamin d2) oral capsule 1,250 mcg (50,000 unit)

0(Tier 1) MC

ergocalciferol (vitamin d2) oral drops 0(Tier 1) MCessentia 0(Tier 1) MCESSENTIAL BALANCE WITH LUTEIN 0(Tier 1) MCessential daily 0(Tier 1) MCezfe 200 0(Tier 1) MCfabb 0(Tier 1) MCfe c 0(Tier 1) MCFEOSOL BIFERA 0(Tier 1) MCfeosol oral tablet 325 mg (65 mg iron) 0(Tier 1) MCferate oral tablet 240 mg (27 mg iron) 0(Tier 1) MCFERGON ORAL TABLET 240 MG (27 MG IRON)

0(Tier 1) MC

FER-IN-SOL 0(Tier 1) MCFERIVA 21-7 0(Tier 1) MCFERIVA FA (WITH SUMALATE) 0(Tier 1) MCferosul oral tablet 0(Tier 1) MCFERRALET 90 DUAL-IRON DELIVERY 0(Tier 1) MCferraplus 90 0(Tier 1) MCferretts 0(Tier 1) MCFERRETTS IPS 0(Tier 1) MCferrex 150 0(Tier 1) MCferrex 150 forte 0(Tier 1) MCferric x-150 0(Tier 1) MCFERRIMIN 150 0(Tier 1) MCferrocite 0(Tier 1) MCferro-time 0(Tier 1) MC




ferrous fumarate oral tablet 324 mg (106 mg iron)

0(Tier 1) MC

ferrous gluconate oral tablet 236 mg (27 mg iron), 240 mg (27 mg iron), 256 mg (28 mg iron), 324 mg (37.5 mg iron), 324 mg (38 mg iron)

0(Tier 1) MC

ferrous sulfate oral drops 0(Tier 1) MCferrous sulfate oral liquid 0(Tier 1) MCferrous sulfate oral solution 0(Tier 1) MCferrous sulfate oral tablet 325 mg (65 mg iron) 0(Tier 1) MCferrous sulfate oral tablet,delayed release (dr/ec)

0(Tier 1) MC

ferrousul 0(Tier 1) MCFLINTSTONES COMPLETE (IRON) ORAL TABLET,CHEWABLE

0(Tier 1) MC

FLINTSTONES MULTIVITAMIN 0(Tier 1) MCFLINTSTONES/EXTRA C ORAL TABLET,CHEWABLE

0(Tier 1) MC

FLORIVA 0(Tier 1) MCFLORIVA (FLUORIDE-VITAMIN D3) 0(Tier 1) MCFLORIVA PLUS 0(Tier 1) MCfluoride (sodium) oral drops 0(Tier 1) MCfluoride (sodium) oral tablet 0(Tier 1)fluoride (sodium) oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

0(Tier 1)

folbee 0(Tier 1) MCfolbee plus 0(Tier 1) MCfolbic 0(Tier 1) MCfolic acid injection 0(Tier 1) MCfolic acid oral tablet 1 mg 0(Tier 1) MCFOLIC ACID-VIT B6-VIT B12 ORAL TABLET 0.5-5-0.2 MG

0(Tier 1) MC

folitab 0(Tier 1) MCfolplex 2.2 0(Tier 1) MCfoltabs 800 0(Tier 1) MCfoltanx 0(Tier 1) MCFOLTRATE 0(Tier 1) MCfosfree 0(Tier 1) MCfruit c-500 0(Tier 1) MCfull spectrum b-vitamin c 0(Tier 1) MCFUSION 0(Tier 1) MC




FUSION PLUS 0(Tier 1) MCgummi bear multivitamin 0(Tier 1) MCgummy dinos oral tablet,chewable 200 mcg 0(Tier 1) MChair vitamins 0(Tier 1) MChair,skin and nails oral tablet 0(Tier 1) MChalls defense 0(Tier 1) MCHARD NAILS 0(Tier 1) MCHEMOCYTE 0(Tier 1) MCHEMOCYTE-F 0(Tier 1) MCHEMOCYTE-PLUS 0(Tier 1) MChigh potency iron oral tablet 134 mg (27 mg iron)

0(Tier 1) MC

HIGH POTENCY IRON ORAL TABLET 27 MG IRON

0(Tier 1) MC

I.L.X. B-12 0(Tier 1) MCICAPS 0(Tier 1) MCICAPS AREDS ORAL TABLET,DELAYED RELEASE (DR/EC)

0(Tier 1) MC

ICAPS MV 0(Tier 1) MCICAR ORAL SUSPENSION 0(Tier 1) MCICAR-C 0(Tier 1) MCiferex 150 0(Tier 1) MCiferex 150 forte 0(Tier 1) MCINFED 0(Tier 1) MCINTEGRA 0(Tier 1) MCINTEGRA F 0(Tier 1) MCINTEGRA PLUS 0(Tier 1) MCiron (ferrous sulfate) 0(Tier 1) MCiron oral tablet 325 mg (65 mg iron) 0(Tier 1) MCiron oral tablet extended release 159 mg (45 mg iron)

0(Tier 1) MC

iron,carbonyl-vitamin c 0(Tier 1) MCIROSPAN 24/6 0(Tier 1) MCKIDS MULTIVITAMIN-MINERALS 0(Tier 1) MCkobee 0(Tier 1) MCLIQUID B-12 0(Tier 1) MClittle animals 0(Tier 1) MClittle animals-iron oral tablet,chewable 0(Tier 1) MCl-methyl-b6-b12 0(Tier 1) MCl-methyl-mc 0(Tier 1) MC




lysiplex plus oral liquid 0(Tier 1) MCMEDTYCHOLL-B COMPLEX-LIVER 0(Tier 1) MCmega multi for women 0(Tier 1) MCmega multiple/chelated mineral 0(Tier 1) MCmega multivitamin for men 0(Tier 1) MCmen’s one daily oral tablet 0(Tier 1) MCMERIBIN 0(Tier 1) MCmetafolbic 0(Tier 1) MCMTX SUPPORT 0(Tier 1) MCmulti complete with iron 0(Tier 1) MCmulti-day with iron 0(Tier 1) MCmulti-delyn with iron 0(Tier 1) MCmultiple vitamin-minerals 0(Tier 1) MCmultiple vitamins 0(Tier 1) MCmulti-vit with fluoride-iron 0(Tier 1) MCmulti-vitamin hp/minerals 0(Tier 1) MCmultivitamin oral tablet 0(Tier 1) MCmulti-vitamin with fluoride oral drops 0(Tier 1) MCmultivitamin with iron 0(Tier 1) MCmultivitamin with minerals 0(Tier 1) MCmultivitamin women 50 plus 0(Tier 1) MCmultivitamins with fluoride 0(Tier 1) MCMULTI-VITE 0(Tier 1) MCMVW COMPLETE FORMUL MULTIVIT 0(Tier 1) MCMVW COMPLETE FORMUL PEDIATRIC 0(Tier 1) MCMVW COMPLETE FORMULATION D3000 0(Tier 1) MCMVW COMPLETE FORMULATION D5000 0(Tier 1) MCmyferon 150 0(Tier 1) MCmyferon 150 forte 0(Tier 1) MCmynephrocaps 0(Tier 1) MCmynephron 0(Tier 1) MCmy-vitalife 0(Tier 1) MCnephplex rx 0(Tier 1) MCNEPHRON FA 0(Tier 1) MCnephronex 0(Tier 1) MCNEPHRO-VITE 0(Tier 1) MCnephro-vite rx 0(Tier 1) MCNEURIN-SL 0(Tier 1) MCNIVA-FOL 0(Tier 1) MC




NU-IRON 0(Tier 1) MCNUTRIVIT 0(Tier 1) MCocutabs 0(Tier 1) MComnicap 0(Tier 1) MConce daily 0(Tier 1) MCONCOVITE 0(Tier 1) MCone daily calcium/iron 0(Tier 1) MCone daily complete 0(Tier 1) MCone daily energy oral tablet 0(Tier 1) MCone daily essential oral tablet , 0.4 mg 0(Tier 1) MCone daily for men 50+ advanced 0(Tier 1) MCone daily for women 0(Tier 1) MCone daily maximum 0(Tier 1) MCone daily men’s 50 plus memory 0(Tier 1) MCone daily multivitamin oral tablet 0(Tier 1) MCone daily multivit-iron(folic) 0(Tier 1) MCone daily plus iron oral tablet 18-400 mg-mcg 0(Tier 1) MCone daily plus minerals 0(Tier 1) MCONE DAILY WOMEN 50 PLUS 0(Tier 1) MCone daily womens 50 plus 0(Tier 1) MCone daily women’s oral tablet 27-0.4 mg 0(Tier 1) MCone-a-day essential 0(Tier 1) MCONE-A-DAY MEN’S 50PLUS(GINKGO) 0(Tier 1) MCone-a-day teen advantage 0(Tier 1) MCONE-A-DAY WOMENS FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG CA

0(Tier 1) MC

PEDIA D-VITE ORAL DROPS 0(Tier 1) MCpedia iron 0(Tier 1) MCPEDIA TRI-VITE 0(Tier 1) MCPERIDIN-C 0(Tier 1) MCpoly-iron 0(Tier 1) MCpoly-iron 150 forte 0(Tier 1) MCpolysaccharide iron complex 0(Tier 1) MCPOLY-VI-FLOR 0(Tier 1) MCPOLY-VI-FLOR WITH IRON 0(Tier 1) MCPOLY-VI-SOL ORAL DROPS 0(Tier 1) MCPOLY-VI-SOL WITH IRON 0(Tier 1) MCPRENATAL VITAMIN ORAL TABLET 0(Tier 2)PREVENT 0(Tier 1) MC




PRO FE 0(Tier 1) MCPROFERRIN ES 0(Tier 1) MCPROFERRIN-FORTE 0(Tier 1) MCPROTECT IRON 0(Tier 1) MCpyridoxine (vitamin b6) oral tablet 100 mg, 25 mg, 50 mg

0(Tier 1) MC

QUFLORA 0(Tier 1) MCQUFLORA FE 0(Tier 1) MCQUFLORA FE (FERROUS SULFATE) 0(Tier 1) MCQUFLORA PEDIATRIC 0(Tier 1) MCQUFLORA PEDIATRIC DROPS 0(Tier 1) MCquintabs-m iron free 0(Tier 1) MCrenal caps 0(Tier 1) MCRENAL VITAMIN 0(Tier 1) MCRENAL-VITE 0(Tier 1) MCrena-vite 0(Tier 1) MCrena-vite rx 0(Tier 1) MCreno caps 0(Tier 1) MCriboflavin (vitamin b2) oral tablet 100 mg 0(Tier 1) MCrisacal-d 0(Tier 1) MCSCOOBY-DOO ONE A DAY 0(Tier 1) MCsenior tabs 0(Tier 1) MCsentry 0(Tier 1) MCsentry senior 0(Tier 1) MCse-tan plus 0(Tier 1) MCSIDEROL ORAL TABLET 0(Tier 1) MCSLOW FE 0(Tier 1) MCSLOW RELEASE IRON ORAL TABLET EXTENDED RELEASE 140 MG (45 MG IRON), 142 MG (45 MG IRON), 143 MG (45 MG IRON), 159 MG (45 MG IRON)

0(Tier 1) MC

SOLUVITA-E 0(Tier 1) MCsoothing pureway-c 0(Tier 1) MCspectravite adult 50 plus 0(Tier 1) MCspectravite advanced formula oral tablet 18-400 mg-mcg

0(Tier 1) MC

spectravite men’s 0(Tier 1) MCspectravite senior oral tablet 500-300-250 mcg 0(Tier 1) MCspectravite ultra women 0(Tier 1) MCspectravite ultra women’s sr 0(Tier 1) MC




spectravite women 0(Tier 1) MCstress b with zinc 0(Tier 1) MCstress formula 0(Tier 1) MCstress formula 600 c 0(Tier 1) MCstress formula with iron 0(Tier 1) MCstress formula with iron(sulf) 0(Tier 1) MCstress formula with zinc 0(Tier 1) MCSTROVITE FORTE 0(Tier 1) MCSTROVITE ONE 0(Tier 1) MCsuper b complex-vitamin c 0(Tier 1) MCsuper b maxi complex 0(Tier 1) MCsuper b/c 0(Tier 1) MCsuper b-50 complex 0(Tier 1) MCsuper multiple oral tablet 0(Tier 1) MCsuper multivitamin 0(Tier 1) MCsuper quints 0(Tier 1) MCsuper thera vite m 0(Tier 1) MCSUPERVITE 0(Tier 1) MCsupport 0(Tier 1) MCSUPPORT-500 0(Tier 1) MCtab-a-vite 0(Tier 1) MCTAB-A-VITE MULTIVITAMIN W-IRON 0(Tier 1) MCtab-a-vite/iron 0(Tier 1) MCTANDEM DUAL ACTION 0(Tier 1) MCTANDEM PLUS 0(Tier 1) MCtaron forte 0(Tier 1) MCthera m plus (ferrous fumarat) 0(Tier 1) MCtheralogix companion 0(Tier 1) MCthera-m oral tablet 27-0.4 mg, 9 mg iron-400 mcg

0(Tier 1) MC

therapeutic liquid 0(Tier 1) MCtherapeutic-m oral tablet 9 mg iron-400 mcg 0(Tier 1) MCtherapeutic-m vitamin/minerals 0(Tier 1) MCthera-tabs 0(Tier 1) MCtheratrum complete 50 plus-lyc 0(Tier 1) MCtheratrum complete with lutein 0(Tier 1) MCtherems-m 0(Tier 1) MCthiamine hcl (vitamin b1) oral tablet 100 mg, 250 mg, 50 mg

0(Tier 1) MC




thiamine mononitrate (vit b1) 0(Tier 1) MCtriphrocaps 0(Tier 1) MCTRI-VI-FLOR 0(Tier 1) MCtri-vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

0(Tier 1) MC

tri-vite with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

0(Tier 1) MC

ultimate women’s complete 50+ 0(Tier 1) MCunicomplex-m 0(Tier 1) MCv-c forte 0(Tier 1) MCvic-forte 0(Tier 1) MCVIRT-CAPS 0(Tier 1) MCvirt-gard 0(Tier 1) MCVIT C(ASCORB.CALCIUM)(MV-MINS) 0(Tier 1) MCVITAL-D RX 0(Tier 1) MCvitalee 0(Tier 1) MCvitalets oral tablet,chewable 0(Tier 1) MCvitamin a oral capsule 10,000 unit, 8,000 unit 0(Tier 1) MCvitamin b complex 0(Tier 1) MCvitamin b complex-folic acid oral tablet 0(Tier 1) MCvitamin b-1 0(Tier 1) MCvitamin b-12 oral tablet 0(Tier 1) MCvitamin b-12 oral tablet extended release 1,000 mcg, 2,000 mcg

0(Tier 1) MC

vitamin b-12 sublingual tablet 2,500 mcg 0(Tier 1) MCvitamin b-2 0(Tier 1) MCvitamin b-6 oral tablet 100 mg, 25 mg, 50 mg 0(Tier 1) MCvitamin c drops 0(Tier 1) MCvitamin c oral capsule, extended release 0(Tier 1) MCvitamin c oral powder 0(Tier 1) MCvitamin c oral tablet 1,000 mg, 250 mg, 500 mg 0(Tier 1) MCvitamin c oral tablet extended release 0(Tier 1) MCvitamin c oral tablet,chewable 250 mg, 500 mg 0(Tier 1) MCvitamin c with rose hips 0(Tier 1) MCvitamin e (dl, acetate) oral capsule 100 unit, 400 unit

0(Tier 1) MC

vitamin e (dl, acetate) oral drops 22.5 mg (50 unit)/ml

0(Tier 1) MC

vitamin e acetate 0(Tier 1) MC




VITAMIN E MIXED ORAL CAPSULE 1,000 UNIT

0(Tier 1) MC

vitamin e mixed oral capsule 400 unit 0(Tier 1) MCvitamin e oral capsule 0(Tier 1) MCVITAMIN E ORAL DROPS 0(Tier 1) MCvitamins a and d 0(Tier 1) MCvitamins a,c,d and fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

0(Tier 1) MC

vitamins and minerals 0(Tier 1) MCvitamins b complex oral capsule 0(Tier 1) MCvitamins b complex oral tablet 0(Tier 1) MCVITAMINS B COMPLEX ORAL TABLET 500 MG-400 MCG- 18 MG IRON

0(Tier 1) MC

vitamins for hair oral tablet 0(Tier 1) MCVITA-RESPA 0(Tier 1) MCvitatrum 0(Tier 1) MCVITRUM SENIOR ORAL TABLET 500-300-250 MCG

0(Tier 1) MC

vp-vite rx 0(Tier 1) MCwee care 0(Tier 1) MCwestab max 0(Tier 1) MCwestab mini 0(Tier 1) MCwestab one 0(Tier 1) MCWEST-VITE WITH FOLIC ACID 0(Tier 1) MCWOMEN’S DAILY FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG CA

0(Tier 1) MC

women’s daily formula oral tablet 27-0.4 mg 0(Tier 1) MCWOMEN’S ONE DAILY 0(Tier 1) MCyelets 0(Tier 1) MCZINC (WITH A AND C) LOZENGES 0(Tier 1) MC

103

INDEX112 hour nasal decongest (pse) . . . 76

224hr allergy relief . . . . . . . . . . . . . . . . 76

88 hour pain reliever . . . . . . . . . . . . . . 278hr muscle aches-pain . . . . . . . . . . . 27

Aabacavir-lamivudine . . . . . . . . . . . . . . 1abacavir-lamivudine-zidovudine . . . 1abacavir oral solution . . . . . . . . . . . . . 1abacavir oral tablet . . . . . . . . . . . . . . . 1ABANEU-SL . . . . . . . . . . . . . . . . . . . . 90abc plus . . . . . . . . . . . . . . . . . . . . . . . . 90ABELCET . . . . . . . . . . . . . . . . . . . . . . . . 1ABILIFY MAINTENA . . . . . . . . . . . . . 29abiraterone . . . . . . . . . . . . . . . . . . . . . . 11ABRAXANE . . . . . . . . . . . . . . . . . . . . . 11acamprosate . . . . . . . . . . . . . . . . . . . . 48acarbose oral tablet 50 mg . . . . . . . 52acarbose oral tablet 100 mg, 25 mg . . . . . . . . . . . . . . . . . . 52acebutolol . . . . . . . . . . . . . . . . . . . . . . . 36acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 300 mg-30 mg /12.5 ml . . . . . . . . . . 25acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg . . . . . 25acetaminophen-codeine oral tablet 300-60 mg . . . . . . . . . . . . . . . . 25ACETAMINOPHEN CONGESTION-PAIN . . . . . . . . . . . . 76acetaminophen oral tablet 325 mg . 27acetaminophen oral tablet extended release . . . . . . . . . . . . . . . . 27acetaminophen rectal . . . . . . . . . . . . 27acetazolamide . . . . . . . . . . . . . . . . . . . 74acetazolamide sodium . . . . . . . . . . . 74acetic acid otic (ear) . . . . . . . . . . . . . 51acetylcysteine . . . . . . . . . . . . . . . . . . . 82

acid gone antacid . . . . . . . . . . . . . . . . 58acid reducer complete (famot) . . . . 62acid reducer (famotidine) . . . . . . . . . 62acid reducer (omeprazole) . . . . . . . 62acitretin . . . . . . . . . . . . . . . . . . . . . . . . . 42ACNE MEDICATION TOPICAL GEL 10%, 5% . . . . . . . . . 44ACNE MEDICATION TOPICAL LOTION . . . . . . . . . . . . . . . 44ACTHIB (PF) . . . . . . . . . . . . . . . . . . . . 64actical . . . . . . . . . . . . . . . . . . . . . . . . . . 90actidose/sorbitol oral suspension 50 gram/240 ml . . . . . . 58ACTIMMUNE . . . . . . . . . . . . . . . . . . . 62acyclovir oral capsule . . . . . . . . . . . . . 1acyclovir oral suspension 200 mg/5 ml . . . . . . . . . . . . . . . . . . . . . . 2acyclovir oral tablet . . . . . . . . . . . . . . . 2acyclovir sodium intravenous solution . . . . . . . . . . . . . . 2acyclovir topical cream . . . . . . . . . . . 42acyclovir topical ointment . . . . . . . . 42ADACEL (TDAP ADOLESN/ADULT)(PF) . . . 64adefovir . . . . . . . . . . . . . . . . . . . . . . . . . . 2ADEMPAS . . . . . . . . . . . . . . . . . . . . . . 82adult aspirin regimen . . . . . . . . . . . . 27adult one daily multivitamin . . . . . . . 90adults 50 plus . . . . . . . . . . . . . . . . . . . 90ADVAIR DISKUS . . . . . . . . . . . . . . . . 82ADVAIR HFA . . . . . . . . . . . . . . . . . . . . 82AFINITOR . . . . . . . . . . . . . . . . . . . . . . 11AFINITOR DISPERZ . . . . . . . . . . . . . 11afirmelle . . . . . . . . . . . . . . . . . . . . . . . . 68AIMOVIG AUTOINJECTOR . . . . . . 23ak-poly-bac . . . . . . . . . . . . . . . . . . . . . 72ala-cort topical cream 1% . . . . . . . . 46ALAHIST CF . . . . . . . . . . . . . . . . . . . . 76ALAHIST DM . . . . . . . . . . . . . . . . . . . . 76ala-hist ir . . . . . . . . . . . . . . . . . . . . . . . . 76ALBA-LYBE . . . . . . . . . . . . . . . . . . . . . 90albendazole . . . . . . . . . . . . . . . . . . . . . . 6

albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (Generic for ProAir) . . . . . . . . . . . . . . 82albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (Generic for Proventil) . . . . . . . . . . . 82albuterol sulfate inhalation hfa aerosol inhaler 90 mcg/actuation (Generic for Ventolin) . . . . . . . . . . . . 82albuterol sulfate inhalation solution for nebulization . . . . . . . . . . 82albuterol sulfate oral . . . . . . . . . . . . . 82alclometasone . . . . . . . . . . . . . . . . . . . 46ALCOHOL PADS . . . . . . . . . . . . . . . . 52ALDURAZYME . . . . . . . . . . . . . . . . . . 55ALECENSA . . . . . . . . . . . . . . . . . . . . . 11alendronate oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 65alendronate oral tablet 35 mg, 70 mg . . . . . . . . . . . . . . . . . . . 65alfuzosin . . . . . . . . . . . . . . . . . . . . . . . . 84ALIMTA . . . . . . . . . . . . . . . . . . . . . . . . . 11ALINIA ORAL SUSPENSION FOR RECONSTITUTION . . . . . . . . . 6ALINIA ORAL TABLET . . . . . . . . . . . . 6ALIQOPA . . . . . . . . . . . . . . . . . . . . . . . 11aliskiren . . . . . . . . . . . . . . . . . . . . . . . . . 36ALKERAN . . . . . . . . . . . . . . . . . . . . . . 11all day allergy (cetirizine) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 76all day pain relief . . . . . . . . . . . . . . . . 27all day relief . . . . . . . . . . . . . . . . . . . . . 27aller-chlor oral tablet . . . . . . . . . . . . . 76allergy (chlorpheniramine) . . . . . . . . 76allergy-congest relief-d(fexo) . . . . . 76allergy (diphenhydramine) oral capsule . . . . . . . . . . . . . . . . . . . . . 76allergy multi-symptom . . . . . . . . . . . . 76allergy relief(chlorpheniramn) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 76allergy relief d12 . . . . . . . . . . . . . . . . . 76allergy relief d-24hr . . . . . . . . . . . . . . 76allergy relief-d (cetirizine) . . . . . . . . 76allergy relief(diphenhydramin) . . . . 76

104

allergy relief (fexofenadine) oral tablet 180 mg . . . . . . . . . . . . . . . 76ALLERGY RELIEF (FLUTICASONE) . . . . . . . . . . . . . . . . 82allergy relief (loratadine) oral solution . . . . . . . . . . . . . . . . . . . . . 76allergy relief (loratadine) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 76ALL-NITE COLD-FLU . . . . . . . . . . . . 76allopurinol . . . . . . . . . . . . . . . . . . . . . . . 65almacone-2 . . . . . . . . . . . . . . . . . . . . . 58ALORA . . . . . . . . . . . . . . . . . . . . . . . . . 67alosetron oral tablet 0.5 mg . . . . . . 58alosetron oral tablet 1 mg . . . . . . . . 58ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1% . . . . . . . . . . . . . 75alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg . . . . . . . . . . . 29alprazolam oral tablet 2 mg . . . . . . 29alprazolam oral tablet, disintegrating 0.25 mg, 0.5 mg, 1 mg . . . . . . . . . . . . . . . . . . . . 29alprazolam oral tablet, disintegrating 2 mg . . . . . . . . . . . . . . 29altavera (28) . . . . . . . . . . . . . . . . . . . . 68aluminum hydroxide gel oral suspension 320 mg/5 ml . . . . . . . . . 58ALUNBRIG ORAL TABLET 30 MG . 11ALUNBRIG ORAL TABLET 180 MG, 90 MG . . . . . . . . . 11ALUNBRIG ORAL TABLETS, DOSE PACK . . . . . . . . . . . . . . . . . . . . 11alyacen 1/35 (28) . . . . . . . . . . . . . . . . 68alyacen 7/7/7 (28) . . . . . . . . . . . . . . . 68amantadine hcl . . . . . . . . . . . . . . . . . . . 2AMBISOME . . . . . . . . . . . . . . . . . . . . . . 1ambrisentan . . . . . . . . . . . . . . . . . . . . . 82amethia . . . . . . . . . . . . . . . . . . . . . . . . . 68amethia lo . . . . . . . . . . . . . . . . . . . . . . . 68amethyst (28) . . . . . . . . . . . . . . . . . . . 68amikacin injection solution 1,000 mg/4 ml, 500 mg/2 ml . . . . . . . 6amiloride . . . . . . . . . . . . . . . . . . . . . . . . 36amiloride-hydrochlorothiazide . . . . 36aminocaproic acid oral . . . . . . . . . . . 39

AMINOSYN II 10% . . . . . . . . . . . . . . 89AMINOSYN II 15% . . . . . . . . . . . . . . 89AMINOSYN-PF 7% (SULFITE-FREE) . . . . . . . . . . . . . . . . 89amiodarone intravenous solution . 35amiodarone oral . . . . . . . . . . . . . . . . . 35AMITIZA . . . . . . . . . . . . . . . . . . . . . . . . 58amitriptyline . . . . . . . . . . . . . . . . . . . . . 29amlodipine . . . . . . . . . . . . . . . . . . . . . . 36amlodipine-benazepril . . . . . . . . . . . 36amlodipine-valsartan . . . . . . . . . . . . . 36amlodipine-valsartan-hcthiazid . . . 36ammonium lactate . . . . . . . . . . . . . . . 42amnesteem . . . . . . . . . . . . . . . . . . . . . 44amoxapine . . . . . . . . . . . . . . . . . . . . . . 29amoxicillin oral capsule . . . . . . . . . . . 9amoxicillin oral suspension for reconstitution . . . . . . . . . . . . . . . . . . 9amoxicillin oral tablet . . . . . . . . . . . . . 9amoxicillin oral tablet, chewable 125 mg, 250 mg . . . . . . . . 9amoxicillin-pot clavulanate . . . . . . . . 9amphotericin b . . . . . . . . . . . . . . . . . . . 1ampicillin oral capsule 500 mg . . . . . 9ampicillin sodium . . . . . . . . . . . . . . . . . 9ampicillin-sulbactam . . . . . . . . . . . . . . 9ANADROL-50 . . . . . . . . . . . . . . . . . . . 55anagrelide . . . . . . . . . . . . . . . . . . . . . . 48anastrozole . . . . . . . . . . . . . . . . . . . . . 11animal chews . . . . . . . . . . . . . . . . . . . 90ANORO ELLIPTA . . . . . . . . . . . . . . . . 82antacid . . . . . . . . . . . . . . . . . . . . . . . . . . 58antacid anti-gas . . . . . . . . . . . . . . . . . 58antacid (calcium carbonate) oral tablet,chewable 200 mg calcium (500 mg) . . . . . . . . . . . . . . . . 85antacid exst (mag carb-al hyd) . . . 58antacid ext str (calcium carb) . . . . . 85antacid plus anti-gas oral suspension 200-200-20 mg/5 ml . . 58antacid regular strength . . . . . . . . . . 58antacid ultra strength oral tablet,chewable 400 mg calcium (1,000 mg) . . . . . . . . . . . . . . 85

anti-diarrheal (loperamide) oral capsule . . . . . . . . . . . . . . . . . . . . . 57anti-diarrheal (loperamide) oral liquid 1 mg/7.5 ml . . . . . . . . . . . 57anti-diarrheal (loperamide) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 57antifungal . . . . . . . . . . . . . . . . . . . . . . . 45antifungal (tolnaftate) topical cream 45antifungal (tolnaftate) topical powder . . . . . . . . . . . . . . . . . . . 45anti-fungal topical powder . . . . . . . . 46apatate forte . . . . . . . . . . . . . . . . . . . . 90APETEX . . . . . . . . . . . . . . . . . . . . . . . . 90APETIGEN . . . . . . . . . . . . . . . . . . . . . . 90apetigen plus oral liquid . . . . . . . . . . 90APETIGEN PLUS ORAL TABLET 90APOKYN . . . . . . . . . . . . . . . . . . . . . . . . 22apraclonidine . . . . . . . . . . . . . . . . . . . . 75aprepitant . . . . . . . . . . . . . . . . . . . . . . . 58apri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68APRISO . . . . . . . . . . . . . . . . . . . . . . . . 58aprodine . . . . . . . . . . . . . . . . . . . . . . . . 76APTIOM ORAL TABLET 200 MG . 20APTIOM ORAL TABLET 400 MG . 20APTIOM ORAL TABLET 600 MG, 800 MG . . . . . . . . . . . . . . . . 20APTIVUS . . . . . . . . . . . . . . . . . . . . . . . . 2APTIVUS (WITH VITAMIN E). . . . . . 2AQUADEKS ORAL TABLET,CHEWABLE . . . . . . . . . . . . 90AQUADEKS PEDIATRIC . . . . . . . . . 90ARALAST NP . . . . . . . . . . . . . . . . . . . 48aranelle (28) . . . . . . . . . . . . . . . . . . . . 68ARANESP (IN POLYSORBATE) INJECTION SOLUTION 25 MCG/ML, 40 MCG/ML . . . . . . . . 62ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 300 MCG/ML, 60 MCG/ML . . . . . . . 62ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 40 MCG/0.4 ML . 62ARANESP (IN POLYSORBATE) INJECTION SYRINGE 25 MCG/0.42 ML . . . . . . . . . . . . . . . . 63

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ARANESP (IN POLYSORBATE) INJECTION SYRINGE 60 MCG/0.3 ML . . . . . . . . . . . . . . . . . 63ARANESP (IN POLYSORBATE) INJECTION SYRINGE 100 MCG/0.5 ML . . . . . . . . . . . . . . . . 62ARANESP (IN POLYSORBATE) INJECTION SYRINGE 150 MCG/0.3 ML . . . . . . . . . . . . . . . . 62ARANESP (IN POLYSORBATE) INJECTION SYRINGE 200 MCG/0.4 ML . . . . . . . . . . . . . . . . 62ARANESP (IN POLYSORBATE) INJECTION SYRINGE 300 MCG/0.6 ML . . . . . . . . . . . . . . . . 63ARANESP (IN POLYSORBATE) INJECTION SYRINGE 500 MCG/ML . . . . . . . . . . . . . . . . . . . . 63ARCALYST . . . . . . . . . . . . . . . . . . . . . 63ARIKAYCE . . . . . . . . . . . . . . . . . . . . . . . 6aripiprazole oral solution . . . . . . . . . 29aripiprazole oral tablet . . . . . . . . . . . 29aripiprazole oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 29ARISTADA INITIO . . . . . . . . . . . . . . . 29ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 1,064 MG/3.9 ML . . . . . . . 29ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML . . . . . . . . . 29ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 662 MG/2.4 ML . . . . . . . . . 29ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 882 MG/3.2 ML . . . . . . . . . 29armodafinil . . . . . . . . . . . . . . . . . . . . . . 29ARNUITY ELLIPTA . . . . . . . . . . . . . . 82ARSENIC TRIOXIDE INTRAVENOUS SOLUTION 1 MG/ML . . . . . . . . . . . . . . . . . . . . . . . . 11arsenic trioxide intravenous solution 2 mg/ml . . . . . . . . . . . . . . . . . 11arthritis pain relief (acetam) . . . . . . 27artificial tears (petro/min) . . . . . . . . . 73artificial tears (polyvin alc) . . . . . . . . 73

ascomp with codeine . . . . . . . . . . . . 25ascorbic acid (vitamin c) oral capsule, extended release . . . 90ASCORBIC ACID (VITAMIN C) ORAL GRANULES . . . . . . . . . . . . . . 90ascorbic acid (vitamin c) oral syrup 90ascorbic acid (vitamin c) oral tablet .90ASCORBIC ACID (VITAMIN C) ORAL TABLET,CHEWABLE 250 MG . . . . . . . . . . . . . . . . . . . . . . . . . 90ascorbic acid (vitamin c) oral tablet,chewable 500 mg . . . . . . . . . . 90ascorbic acid (vitamin c) oral tablet extended release 1,500 mg, 500 mg . . . . . . . . . . . . . . . 90ashlyna . . . . . . . . . . . . . . . . . . . . . . . . . 68aspirin-dipyridamole . . . . . . . . . . . . . 39aspirin oral tablet . . . . . . . . . . . . . . . . 27aspirin oral tablet,chewable . . . . . . 27aspirin oral tablet,delayed release (dr/ec) 325 mg, 81 mg . . . . 27ASTAGRAF XL . . . . . . . . . . . . . . . . . . 11astringent . . . . . . . . . . . . . . . . . . . . . . . 42atazanavir oral capsule 150 mg . . . . 2atazanavir oral capsule 200 mg . . . . 2atazanavir oral capsule 300 mg . . . . 2atenolol . . . . . . . . . . . . . . . . . . . . . . . . . 36atenolol-chlorthalidone . . . . . . . . . . . 36ATGAM . . . . . . . . . . . . . . . . . . . . . . . . . 64athlete’s foot topical aerosol powder . . . . . . . . . . . . . . . . . . 46a thru z . . . . . . . . . . . . . . . . . . . . . . . . . 90a thru z advanced formula . . . . . . . . 90A THRU Z MEN’S ULTIMATE . . . . 90a thru z select 50plus formula . . . . 90a thru z select oral tablet 500-300-250 mcg . . . . . . . . . . . . . . . . 90a thru z select women’s . . . . . . . . . . 90atomoxetine oral capsule 10 mg, 18 mg, 25 mg, 40 mg . . . . . 30atomoxetine oral capsule 100 mg, 60 mg, 80 mg . . . . . . . . . . . 30atorvastatin oral tablet 10 mg, 20 mg, 80 mg . . . . . . . . . . . . 40atorvastatin oral tablet 40 mg . . . . . 40

atovaquone . . . . . . . . . . . . . . . . . . . . . . 6atovaquone-proguanil . . . . . . . . . . . . . 6ATRIPLA . . . . . . . . . . . . . . . . . . . . . . . . . 2atropine injection solution 0.4 mg/ml . . . . . . . . . . . . . . . . . . . . . . . 57atropine injection syringe 0.05 mg/ml, 0.1 mg/ml . . . . . . . . . . . 57ATROPINE OPHTHALMIC (EYE) DROPS . . . . . . . . . . . . . . . . . . 73ATROVENT HFA . . . . . . . . . . . . . . . . 82aubra . . . . . . . . . . . . . . . . . . . . . . . . . . . 68aubra eq . . . . . . . . . . . . . . . . . . . . . . . . 68aurovela 1.5/30 (21) . . . . . . . . . . . . . 68aurovela 1/20 (21) . . . . . . . . . . . . . . . 68aurovela 24 fe . . . . . . . . . . . . . . . . . . . 68aurovela fe 1.5/30 (28) . . . . . . . . . . . 68aurovela fe 1-20 (28) . . . . . . . . . . . . 68AURYXIA . . . . . . . . . . . . . . . . . . . . . . . 48AUSTEDO ORAL TABLET 6 MG . 23AUSTEDO ORAL TABLET 12 MG, 9 MG . . . . . . . . . . . . . . . . . . . . 23AVASTIN . . . . . . . . . . . . . . . . . . . . . . . . 11aviane . . . . . . . . . . . . . . . . . . . . . . . . . . 68avita . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44AVONEX INTRAMUSCULAR PEN INJECTOR KIT . . . . . . . . . . . . . 63AVONEX INTRAMUSCULAR SYRINGE KIT . . . . . . . . . . . . . . . . . . . 63AVSOLA . . . . . . . . . . . . . . . . . . . . . . . . 58ayuna . . . . . . . . . . . . . . . . . . . . . . . . . . . 68AYVAKIT . . . . . . . . . . . . . . . . . . . . . . . . 11AZASAN . . . . . . . . . . . . . . . . . . . . . . . . 11AZASITE . . . . . . . . . . . . . . . . . . . . . . . . 72azathioprine . . . . . . . . . . . . . . . . . . . . . 11azathioprine sodium . . . . . . . . . . . . . 11azelastine nasal . . . . . . . . . . . . . . . . . 50azelastine ophthalmic (eye) . . . . . . 73azithromycin intravenous . . . . . . . . . . 6azithromycin oral packet . . . . . . . . . . 6azithromycin oral suspension for reconstitution . . . . . . . . . . . . . . . . . . 6azithromycin oral tablet 250 mg, 250 mg (6 pack), 500 mg, 500 mg (3 pack) . . . . . . . . . . 6

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azithromycin oral tablet 600 mg . . . . 6AZOPT . . . . . . . . . . . . . . . . . . . . . . . . . 74aztreonam injection recon soln 1 gram . . . . . . . . . . . . . . . . 6aztreonam injection recon soln 2 gram . . . . . . . . . . . . . . . . 7azurette (28) . . . . . . . . . . . . . . . . . . . . 69

Bb-12 dots . . . . . . . . . . . . . . . . . . . . . . . . 91bacitracin intramuscular . . . . . . . . . . . 7bacitracin ophthalmic (eye) . . . . . . . 72bacitracin-polymyxin b ophthalmic (eye) . . . . . . . . . . . . . . . . . 72bacitracin topical ointment . . . . . . . . 45bacitracin zinc topical ointment . . . 45baclofen oral . . . . . . . . . . . . . . . . . . . . 24BACMIN . . . . . . . . . . . . . . . . . . . . . . . . 91balance b-50 (with folic acid) . . . . . 91balance b-100 (folic acid) . . . . . . . . 91balanced b-50 oral tablet . . . . . . . . . 91balanced b-100 oral tablet 0.4 mg 91balsalazide . . . . . . . . . . . . . . . . . . . . . . 58BALVERSA ORAL TABLET 3 MG . 11BALVERSA ORAL TABLET 4 MG . 11BALVERSA ORAL TABLET 5 MG . 11balziva (28) . . . . . . . . . . . . . . . . . . . . . 69banophen oral capsule . . . . . . . . . . . 76BANZEL ORAL SUSPENSION . . . 20BANZEL ORAL TABLET . . . . . . . . . 20BAQSIMI . . . . . . . . . . . . . . . . . . . . . . . . 52BARACLUDE ORAL SOLUTION . . 2BAVENCIO . . . . . . . . . . . . . . . . . . . . . . 11BAXDELA . . . . . . . . . . . . . . . . . . . . . . . . 9BCG VACCINE, LIVE (PF) . . . . . . . 64b complex 1 (with folic acid) . . . . . . 90b complex 100 oral . . . . . . . . . . . . . . 90b complex-vitamin b12 . . . . . . . . . . . 90b complex-vitamin c- folic acid oral tablet . . . . . . . . . . . . . . 90b-complex with vitamin c oral capsule . . . . . . . . . . . . . . . . . . . . . 91b-complex with vitamin c oral tablet . . . . . . . . . . . . . . . . . . . . . . 91

b-complex with vitamin c oral tablet extended release . . . . . . 91B COMPLEX W-VIT C . . . . . . . . . . . 90BD PEN NEEDLE . . . . . . . . . . . . . . . 52bekyree (28) . . . . . . . . . . . . . . . . . . . . 69BELSOMRA ORAL TABLET 5 MG 30BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG . . . . . . . . . . . 30benazepril . . . . . . . . . . . . . . . . . . . . . . . 36benazepril-hydrochlorothiazide . . . 36BENDEKA . . . . . . . . . . . . . . . . . . . . . . 11BENLYSTA INTRAVENOUS RECON SOLN 120 MG . . . . . . . . . . 66BENLYSTA INTRAVENOUS RECON SOLN 400 MG . . . . . . . . . . 66benzonatate . . . . . . . . . . . . . . . . . . . . . 76benzoyl peroxide topical cleanser 10%, 5% . . . . . . . . 44benzoyl peroxide topical gel 10%, 2.5%, 5% . . . . . . . 44benztropine injection . . . . . . . . . . . . . 22benztropine oral . . . . . . . . . . . . . . . . . 22BESIVANCE . . . . . . . . . . . . . . . . . . . . 72BESPONSA . . . . . . . . . . . . . . . . . . . . . 11beta carotene oral capsule 25,000 unit . . . . . . . . . . . . . . . . . . . . . . 91betamethasone, augmented . . . . . . 46betamethasone dipropionate . . . . . 46betamethasone valerate . . . . . . . . . 46BETASERON SUBCUTANEOUS KIT . . . . . . . . . . . 63betaxolol ophthalmic (eye) . . . . . . . 73betaxolol oral . . . . . . . . . . . . . . . . . . . . 36bethanechol chloride . . . . . . . . . . . . . 84bexarotene . . . . . . . . . . . . . . . . . . . . . . 11BEXSERO . . . . . . . . . . . . . . . . . . . . . . 64bicalutamide . . . . . . . . . . . . . . . . . . . . 11BICILLIN L-A . . . . . . . . . . . . . . . . . . . . . 9BIDIL . . . . . . . . . . . . . . . . . . . . . . . . . . . 36BIKTARVY . . . . . . . . . . . . . . . . . . . . . . . 2bimatoprost ophthalmic (eye) . . . . . 74BINOSTO . . . . . . . . . . . . . . . . . . . . . . . 65BIOCAL . . . . . . . . . . . . . . . . . . . . . . . . . 91biopetit . . . . . . . . . . . . . . . . . . . . . . . . . . 91

biotin oral capsule 2,500 mcg, 5 mg . . . . . . . . . . . . . . . . 91biotin oral tablet 1 mg . . . . . . . . . . . . 91bisacodyl . . . . . . . . . . . . . . . . . . . . . . . . 58bismatrol . . . . . . . . . . . . . . . . . . . . . . . . 57bisoprolol fumarate . . . . . . . . . . . . . . 36bisoprolol-hydrochlorothiazide . . . . 36BLENREP . . . . . . . . . . . . . . . . . . . . . . 11BLEPHAMIDE . . . . . . . . . . . . . . . . . . . 73BLEPHAMIDE S.O.P. . . . . . . . . . . . . 73blisovi 24 fe . . . . . . . . . . . . . . . . . . . . . 69blisovi fe 1.5/30 (28) . . . . . . . . . . . . . 69blisovi fe 1/20 (28) . . . . . . . . . . . . . . . 69blue gel . . . . . . . . . . . . . . . . . . . . . . . . . 42BOOSTRIX TDAP . . . . . . . . . . . . . . . 64BORTEZOMIB . . . . . . . . . . . . . . . . . . 11bosentan . . . . . . . . . . . . . . . . . . . . . . . . 82BOSULIF . . . . . . . . . . . . . . . . . . . . . . . 11BOTOX . . . . . . . . . . . . . . . . . . . . . . . . . 64BRAFTOVI . . . . . . . . . . . . . . . . . . . . . . 12BREO ELLIPTA . . . . . . . . . . . . . . . . . 82briellyn . . . . . . . . . . . . . . . . . . . . . . . . . . 69BRILINTA . . . . . . . . . . . . . . . . . . . . . . . 39brimonidine . . . . . . . . . . . . . . . . . . . . . 75BRIVIACT ORAL SOLUTION . . . . . 20BRIVIACT ORAL TABLET . . . . . . . . 20BROMFED DM . . . . . . . . . . . . . . . . . . 76bromfenac . . . . . . . . . . . . . . . . . . . . . . 74bromocriptine . . . . . . . . . . . . . . . . . . . 22brompheniramine- pseudoeph-dm oral syrup . . . . . . . . 76brotapp dm . . . . . . . . . . . . . . . . . . . . . . 76BROVANA . . . . . . . . . . . . . . . . . . . . . . 82BRUKINSA . . . . . . . . . . . . . . . . . . . . . 12budesonide inhalation . . . . . . . . . . . . 82budesonide nasal . . . . . . . . . . . . . . . . 82budesonide oral capsule,delayed,extend.release . . 58budesonide oral tablet, delayed and ext.release . . . . . . . . . . 58bumetanide . . . . . . . . . . . . . . . . . . . . . 36buprenorphine . . . . . . . . . . . . . . . . . . . 25buprenorphine hcl injection . . . . . . . 25

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buprenorphine hcl sublingual . . . . . 25buprenorphine-naloxone sublingual film 2-0.5 mg, 4-1 mg, 8-2 mg . . . . . . . . . . . . . . . . . . 27buprenorphine-naloxone sublingual film 12-3 mg . . . . . . . . . . 27buprenorphine-naloxone sublingual tablet . . . . . . . . . . . . . . . . . 27bupropion hcl oral tablet 75 mg . . . 30bupropion hcl oral tablet 100 mg . . 30bupropion hcl oral tablet extended release 24 hr 150 mg . . . 30bupropion hcl oral tablet extended release 24 hr 300 mg . . . 30bupropion hcl oral tablet sustained-release 12 hr 100 mg, 200 mg . . . . 30bupropion hcl oral tablet sustained-release 12 hr 150 mg . . 30bupropion hcl (smoking deter) . . . . 50buspirone . . . . . . . . . . . . . . . . . . . . . . . 30busulfan . . . . . . . . . . . . . . . . . . . . . . . . 12BUSULFEX . . . . . . . . . . . . . . . . . . . . . 12butalbital-acetaminop-caf-cod . . . . 25butalbital-acetaminophen-caff oral capsule . . . . . . . . . . . . . . . . . . . . . 25butalbital-acetaminophen-caff oral tablet 50-325-40 mg . . . . . . . . . 25butalbital-aspirin-caffeine oral capsule . . . . . . . . . . . . . . . . . . . . . 25butalbital compound w/codeine . . . 25butorphanol injection solution 1 mg/ml . . . . . . . . . . . . . . . . . 27butorphanol injection solution 2 mg/ml . . . . . . . . . . . . . . . . . 27butorphanol nasal . . . . . . . . . . . . . . . 27BYDUREON BCISE . . . . . . . . . . . . . 52BYDUREON SUBCUTANEOUS PEN INJECTOR . . . . . . . . . . . . . . . . . 52BYSTOLIC . . . . . . . . . . . . . . . . . . . . . . 36

Cc-500 . . . . . . . . . . . . . . . . . . . . . . . . . . . 91c-1000 . . . . . . . . . . . . . . . . . . . . . . . . . . 91C 1000-BIOFLAVONOIDS- ROSE HIPS . . . . . . . . . . . . . . . . . . . . . 91c-1000 with rose hips . . . . . . . . . . . . 91

cabergoline . . . . . . . . . . . . . . . . . . . . . 55CABOMETYX ORAL TABLET 20 MG, 60 MG . . . . . . . . . . 12CABOMETYX ORAL TABLET 40 MG . . . . . . . . . . . . . . . . . 12ca-d3-mag ox-zinc-cop-mang- bor oral tablet,chewable 600 mg calcium- 400 unit-40 mg . . . . . . . . . 91CA-D3-MAG OX-ZINC-COP- MANG-BOR ORAL TABLET,CHEWABLE 600 MG CALCIUM- 800 UNIT-40 MG . . . . . 91calamine clear . . . . . . . . . . . . . . . . . . . 42calamine plus (pramox-calamin) . . 42CALCET PETITES . . . . . . . . . . . . . . 91calcidol . . . . . . . . . . . . . . . . . . . . . . . . . 91calcipotriene scalp . . . . . . . . . . . . . . . 42calcipotriene topical cream . . . . . . . 42calcipotriene topical ointment . . . . . 42calcitonin (salmon) . . . . . . . . . . . . . . . 55calcitrate . . . . . . . . . . . . . . . . . . . . . . . . 85calcitriol intravenous solution 1 mcg/ml . . . . . . . . . . . . . . . . 55calcitriol oral . . . . . . . . . . . . . . . . . . . . . 55calcitriol topical . . . . . . . . . . . . . . . . . . 42calcium 500 + d oral tablet 500 mg(1,250mg) -200 unit . . . . . . 85calcium 500 + d oral tablet, chewable . . . . . . . . . . . . . . . . . . . . . . . 85calcium 500 with d . . . . . . . . . . . . . . . 85calcium 600 . . . . . . . . . . . . . . . . . . . . . 85calcium 600 + d(3) oral tablet 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit . . . . . . 85calcium 600 + minerals . . . . . . . . . . 91calcium 600 with vitamin d3 oral tablet,chewable . . . . . . . . . . . . . 85calcium acetate(phosphat bind) . . . 85calcium antacid oral tablet, chewable 200 mg calcium (500 mg), 300 mg (750 mg) . . . . . . 85calcium carbonate oral suspension 85calcium carbonate oral tablet 260 mg calcium (648 mg), 500 mg calcium (1,250 mg), 600 mg calcium (1,500 mg) . . . . . . 85

calcium carbonate oral tablet,chewable 500 mg calcium (1,250 mg) . . . . . . . . . . . . . . 85calcium carbonate-vitamin d3 oral capsule 600 mg(1,500mg) - 400 unit . . . . . . . . . . . . . . . . . . . . . . . . . 85CALCIUM CARBONATE- VITAMIN D3 ORAL TABLET 250-125 MG-UNIT, 500MG (1,250MG) -600 UNIT . . . . . . . . . . . . 85calcium carbonate-vitamin d3 oral tablet 500 mg(1,250mg) - 200 unit, 500 mg(1,250mg) - 400 unit, 600 mg(1,500mg) -200 unit, 600 mg(1,500mg) -400 unit, 600 mg(1,500mg) -800 unit . . . . . . 86calcium carbonate-vitamin d3 oral tablet,chewable 500 mg(1,250mg) -400 unit . . . . . . . . . . . 86calcium carbonate-vit d3-min oral tablet . . . . . . . . . . . . . . . . . . . . . . . 91calcium citrate + d . . . . . . . . . . . . . . . 86CALCIUM CITRATE MALATE-VIT D3 . . . . . . . . . . . . . . . . . 89calcium citrate oral tablet 200 mg (950 mg) . . . . . . . . . . . . . . . . 86calcium citrate plus (vit b6) . . . . . . . 86calcium citrate-vitamin d3 oral tablet 200 mg-3.125 mcg (125 unit), 315 mg-5 mcg (200 unit) . . . . . . . . . 86CALCIUM CITRATE- VITAMIN D3 ORAL TABLET 315 MG-6.25 MCG (250 UNIT) . . . 86calcium-folic acid-vitamin d . . . . . . . 91calcium for women . . . . . . . . . . . . . . . 91CALCIUM-MAGNESIUM . . . . . . . . . 86calcium-magnesium-copper-zinc . 91calcium-magnesium-zinc oral tablet 333-133-5 mg . . . . . . . . . 86calcium soft chew oral tablet,chewable 500-200-40 mg-unit-mcg . . . . . . . . . 91calcium-vitamin d3-vitamin k oral tablet,chewable 500-200-40 mg-unit-mcg . . . . . . . . . 91CALCIUM WITH BORON . . . . . . . . 48calcium with vitamin d . . . . . . . . . . . . 86cal-gest antacid . . . . . . . . . . . . . . . . . 86

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callus removers . . . . . . . . . . . . . . . . . 42CALQUENCE . . . . . . . . . . . . . . . . . . . 12CALTRATE 600-D PLUS MINERALS ORAL TABLET . . . . . . . 91CALTRATE 600 PLUS D . . . . . . . . . 86CALTRATE WITH VITAMIN D3 . . . 86camila . . . . . . . . . . . . . . . . . . . . . . . . . . 67camrese . . . . . . . . . . . . . . . . . . . . . . . . 69camrese lo . . . . . . . . . . . . . . . . . . . . . . 69candesartan-hydrochlorothiazid . . 36candesartan oral tablet 16 mg, 4 mg, 8 mg . . . . . . . . . . . . . . . 36candesartan oral tablet 32 mg . . . . 36CAPASTAT . . . . . . . . . . . . . . . . . . . . . . . 7CAPLYTA . . . . . . . . . . . . . . . . . . . . . . . 30CAPRELSA ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 12CAPRELSA ORAL TABLET 300 MG . . . . . . . . . . . . . . . . 12capsaicin topical cream 0.025% . . 42CARAFATE ORAL SUSPENSION . 62CARBAGLU . . . . . . . . . . . . . . . . . . . . . 48carbamazepine oral capsule, er multiphase 12 hr . . . . . . . . . . . . . . 20carbamazepine oral suspension 100 mg/5 ml . . . . . . . . . 20carbamazepine oral tablet . . . . . . . . 20carbamazepine oral tablet, chewable . . . . . . . . . . . . . . . . . . . . . . . 20carbamazepine oral tablet extended release 12 hr . . . . . . . . . . 20carbidopa . . . . . . . . . . . . . . . . . . . . . . . 22carbidopa-levodopa . . . . . . . . . . . . . . 22carbidopa-levodopa-entacapone . . 22CARNITOR INTRAVENOUS . . . . . 48carteolol . . . . . . . . . . . . . . . . . . . . . . . . 73cartia xt . . . . . . . . . . . . . . . . . . . . . . . . . 36carvedilol . . . . . . . . . . . . . . . . . . . . . . . 36carvedilol phosphate . . . . . . . . . . . . . 36caspofungin . . . . . . . . . . . . . . . . . . . . . . 1CAYSTON . . . . . . . . . . . . . . . . . . . . . . . 7caziant (28) . . . . . . . . . . . . . . . . . . . . . 69c complex . . . . . . . . . . . . . . . . . . . . . . . 91cefaclor oral capsule . . . . . . . . . . . . . . 5

cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml . . . . . . . . . 5cefaclor oral tablet extended release 12 hr . . . . . . . . . . . 5cefadroxil oral capsule . . . . . . . . . . . . 5cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml . . . . . . . . . . . . . . . . . . . . . . 5cefadroxil oral tablet . . . . . . . . . . . . . . 5cefazolin . . . . . . . . . . . . . . . . . . . . . . . . . 5cefazolin in dextrose (iso-os) intravenous piggyback 1 gram/50 ml . . . . . . . . . . . . . . . . . . . . . 5cefazolin in dextrose (iso-os) intravenous piggyback 2 gram/50 ml . . . . . . . . . . . . . . . . . . . . . 5CEFAZOLIN IN DEXTROSE (ISO-OS) INTRAVENOUS PIGGYBACK 2 GRAM/100 ML . . . . 5cefdinir . . . . . . . . . . . . . . . . . . . . . . . . . . . 5CEFEPIME IN DEXTROSE 5% . . . . 5cefepime in dextrose,iso-osm . . . . . 5cefepime injection . . . . . . . . . . . . . . . . 5cefixime oral capsule . . . . . . . . . . . . . 5cefixime oral suspension for reconstitution . . . . . . . . . . . . . . . . . . 5cefotetan . . . . . . . . . . . . . . . . . . . . . . . . . 5CEFOTETAN IN DEXTROSE, ISO-OSM . . . . . . . . . . . 5cefoxitin . . . . . . . . . . . . . . . . . . . . . . . . . . 5cefoxitin in dextrose, iso-osm . . . . . . 5cefpodoxime . . . . . . . . . . . . . . . . . . . . . 5cefprozil . . . . . . . . . . . . . . . . . . . . . . . . . 5ceftazidime . . . . . . . . . . . . . . . . . . . . . . . 5CEFTAZIDIME IN D5W . . . . . . . . . . . 5ceftriaxone in dextrose,iso-os . . . . . 5ceftriaxone injection recon soln 1 gram, 10 gram, 2 gram, 250 mg, 500 mg . . . . . . . . . . . . . . . . . . 5CEFTRIAXONE INJECTION RECON SOLN 100 GRAM . . . . . . . . 5ceftriaxone intravenous . . . . . . . . . . . 5cefuroxime axetil oral tablet . . . . . . . 5cefuroxime sodium injection recon soln 750 mg . . . . . . . . . . . . . . . . 6

cefuroxime sodium intravenous . . . . 6celecoxib . . . . . . . . . . . . . . . . . . . . . . . . 27CELONTIN ORAL CAPSULE 300 MG . . . . . . . . . . . . . . 20centamin . . . . . . . . . . . . . . . . . . . . . . . . 91CENTRAL-VITE WOMEN’S MATURE . . . . . . . . . . . . . 92CENTRAM-CARE . . . . . . . . . . . . . . . 92centratex . . . . . . . . . . . . . . . . . . . . . . . . 92centravites 50 plus oral tablet 0.4-300-250 mg-mcg-mcg . . . . . . . . 92CENTRUM COMPLETE . . . . . . . . . 92CENTRUM MEN . . . . . . . . . . . . . . . . 92CENTRUM ORAL LIQUID 9 MG IRON/15 ML . . . . . . . . . . . . . . . 92CENTRUM SILVER ORAL TABLET . . . . . . . . . . . . . . . . . . 92CENTRUM SILVER WOMEN. . . . . 92CENTRUM SPECIALIST HEART . 92CENTRUM ULTRA MEN’S . . . . . . . 92centrum women . . . . . . . . . . . . . . . . . 92century adults 50 plus . . . . . . . . . . . . 92century cardio . . . . . . . . . . . . . . . . . . . 92century mature oral tablet 0.4-300-250 mg-mcg-mcg . . . . . . . . 92century oral tablet 18-400 mg-mcg . 92CENTURY ULTIMATE MEN’S ORAL TABLET 8 MG IRON- 200 MCG-600 MCG . . . . . . . . . . . . . 92century ultimate women’s . . . . . . . . 92cephalexin oral capsule 250 mg, 500 mg . . . . . . . . . . . . . . . . . . 6cephalexin oral suspension for reconstitution . . . . . . . . . . . . . . . . . . 6CEREFOLIN . . . . . . . . . . . . . . . . . . . . 92CEREZYME INTRAVENOUS RECON SOLN 400 UNIT . . . . . . . . 56cerovite advanced formula . . . . . . . 92certa plus . . . . . . . . . . . . . . . . . . . . . . . 92CERTAVITE-ANTIOXIDANT . . . . . . 92certavite senior-antioxidant . . . . . . . 92cetirizine oral solution 1 mg/ml . . . 76cetirizine oral tablet . . . . . . . . . . . . . . 76cetirizine-pseudoephedrine . . . . . . . 76CHANTIX . . . . . . . . . . . . . . . . . . . . . . . 50

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CHANTIX CONTINUING MONTH BOX . . . . . . . . . . . . . . . . . . . 50CHANTIX STARTING MONTH BOX . . . . . . . . . . . . . . . . . . . 50charlotte 24 fe . . . . . . . . . . . . . . . . . . . 69chateal (28) . . . . . . . . . . . . . . . . . . . . . 69chateal eq (28) . . . . . . . . . . . . . . . . . . 69CHEMET . . . . . . . . . . . . . . . . . . . . . . . 48chest congestion relief oral tablet . 76CHEST RUB TOPICAL OINTMENT . . . . . . . . . . . . . . . . . . . . . 42CHILD MUCINEX CHEST MINI-MELTS ORAL GRANULES IN PACKET 100 MG . . . . . . . . . . . . . 76CHILD MUCINEX COUGH MINI-MELTS . . . . . . . . . . . . . . . . . . . . 76CHILD MUCINEX M-S COLD DAY-NTE . . . . . . . . . . . . . . . . . 76child mucus relief cough . . . . . . . . . 76children’s allergy (diphenhyd) oral liquid . . . . . . . . . . . . . . . . . . . . . . . 76children’s allergy relief(lor) oral solution . . . . . . . . . . . . . . . . . . . . . 77children’s cetirizine oral solution . . 77children’s cetirizine oral tablet,chewable 5 mg . . . . . . . . . . . . 77CHILDREN’S CETIRIZINE ORAL TABLET,CHEWABLE 10 MG . . . . . 77children’s chewable multivitmn . . . 92children’s chewables . . . . . . . . . . . . . 92children’s chewables extra c . . . . . . 92children’s chewable vitamin . . . . . . 92children’s cold-allergy (pe) . . . . . . . 77children’s cold and cough (pe) . . . . 77CHILDREN’S COUGH DM ER . . . 77CHILDREN’S DAYCLEAR ALLERGY . . . . . . . . . . . . . . . . . . . . . . . 77CHILDREN’S DELSYM COUGH . 77children’s ibuprofen . . . . . . . . . . . . . . 27children’s iron . . . . . . . . . . . . . . . . . . . 92children’s mapap oral tablet, chewable 80 mg . . . . . . . . . . . . . . . . . 28CHILDREN’S MUCINEX COLD-FEVER . . . . . . . . . . . . . . . . . . . 77CHILDREN’S MUCINEX MULTI-SYMP . . . . . . . . . . . . . . . . . . . 77

CHILDREN’S MUCINEX NIGHT TIME . . . . . . . . . . . . . . . . . . . . 77children’s silfedrine . . . . . . . . . . . . . . 77child’s all day allergy(cetir) . . . . . . . 77child’s chewable vitamins/iron oral tablet,chewable . . . . . . . . . . . . 92childs/iron . . . . . . . . . . . . . . . . . . . . . . . 92CHILD’S MUCUS RELIEF M-S COLD . . . . . . . . . . . . . . . . . . . . . . 77chloramphenicol sod succinate . . . . 7chlorhexidine gluconate mucous membrane . . . . . . . . . . . . . . 50chloroquine phosphate . . . . . . . . . . . . 7chlorothiazide oral tablet 500 mg . 36chlorothiazide sodium . . . . . . . . . . . . 36chlorpromazine . . . . . . . . . . . . . . . . . . 30chlorthalidone oral tablet 25 mg, 50 mg . . . . . . . . . . . . . . . . . . . 36CHLO TUSS . . . . . . . . . . . . . . . . . . . . 77CHOLECALCIFEROL (VITAMIN D3) ORAL DROPS 10 MCG/ML (400 UNIT/ML) . . . . . . 92cholestyramine light . . . . . . . . . . . . . 40cholestyramine (with sugar) . . . . . . 40CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR . . . . . 56ciclodan topical solution . . . . . . . . . . 46ciclopirox topical cream . . . . . . . . . . 46ciclopirox topical shampoo . . . . . . . 46ciclopirox topical solution . . . . . . . . . 46ciclopirox topical suspension . . . . . 46cilostazol . . . . . . . . . . . . . . . . . . . . . . . . 39CILOXAN OPHTHALMIC (EYE) OINTMENT . . . . . . . . . . . . . . . 73CIMDUO . . . . . . . . . . . . . . . . . . . . . . . . . 2cinacalcet oral tablet 30 mg, 60 mg 56cinacalcet oral tablet 90 mg . . . . . . 56CINRYZE . . . . . . . . . . . . . . . . . . . . . . . 82CIPRODEX . . . . . . . . . . . . . . . . . . . . . 51ciprofloxacin . . . . . . . . . . . . . . . . . . . . . . 9ciprofloxacin-dexamethasone . . . . 51ciprofloxacin hcl ophthalmic (eye) . 73ciprofloxacin hcl oral . . . . . . . . . . . . . . 9ciprofloxacin in 5% dextrose . . . . . . 10

CIPRO HC . . . . . . . . . . . . . . . . . . . . . . 51citalopram oral solution . . . . . . . . . . 30citalopram oral tablet 10 mg . . . . . . 30citalopram oral tablet 20 mg . . . . . . 30citalopram oral tablet 40 mg . . . . . . 30CITRACAL + D MAXIMUM . . . . . . . 86claravis . . . . . . . . . . . . . . . . . . . . . . . . . 44clarithromycin . . . . . . . . . . . . . . . . . . . . 6clearlax oral powder . . . . . . . . . . . . . 58clindacin etz topical swab . . . . . . . . 44clindacin p . . . . . . . . . . . . . . . . . . . . . . 44clindamycin hcl . . . . . . . . . . . . . . . . . . . 7CLINDAMYCIN IN 0.9% SOD CHLOR . . . . . . . . . . . . . . . 7clindamycin in 5% dextrose . . . . . . . 7clindamycin pediatric . . . . . . . . . . . . . 7clindamycin phosphate injection . . . 7clindamycin phosphate intravenous solution 600 mg/4 ml . . 7clindamycin phosphate topical gel 44CLINDAMYCIN PHOSPHATE TOPICAL GEL, ONCE DAILY . . . . 45clindamycin phosphate topical lotion . . . . . . . . . . . . . . . . . . . . . 45clindamycin phosphate topical solution . . . . . . . . . . . . . . . . . . 45clindamycin phosphate topical swab . . . . . . . . . . . . . . . . . . . . . 45clindamycin phosphate vaginal . . . 68CLINIMIX 4.25%/D5W SULFIT FREE . . . . . . . . . . . . . . . . . . . 48CLINIMIX 4.25%/D10W SULF FREE . . . . . . . . . . . . . . . . . . . . . 89CLINIMIX 5%/D15W SULFITE FREE . . . . . . . . . . . . . . . . . 89CLINIMIX 5%-D20W (SULFITE-FREE) . . . . . . . . . . . . . . . . 89CLINIMIX E 4.25%/D10W SUL FREE . . . . . . . . . . . . . . . . . . . . . . 89CLINISOL SF 15% . . . . . . . . . . . . . . 89clobazam oral suspension . . . . . . . . 20clobazam oral tablet 10 mg . . . . . . . 20clobazam oral tablet 20 mg . . . . . . . 20clobetasol-emollient topical cream . 47clobetasol-emollient topical foam . 47

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clobetasol scalp . . . . . . . . . . . . . . . . . 46clobetasol topical cream . . . . . . . . . 46clobetasol topical foam . . . . . . . . . . . 46clobetasol topical gel . . . . . . . . . . . . 46clobetasol topical ointment . . . . . . . 46clobetasol topical shampoo . . . . . . 46clocortolone pivalate . . . . . . . . . . . . . 47clodan . . . . . . . . . . . . . . . . . . . . . . . . . . 47clomipramine . . . . . . . . . . . . . . . . . . . . 30clonazepam oral tablet 0.5 mg, 1 mg . . . . . . . . . . . . . . . . . . . . 20clonazepam oral tablet 2 mg . . . . . 20clonazepam oral tablet, disintegrating 0.125 mg, 0.25 mg, 0.5 mg . . . . . . . . . . . . . . . . . 20clonazepam oral tablet, disintegrating 1 mg . . . . . . . . . . . . . . 20clonazepam oral tablet, disintegrating 2 mg . . . . . . . . . . . . . . 20clonidine hcl oral tablet . . . . . . . . . . . 36clonidine hcl oral tablet extended release 12 hr . . . . . . . . . . 30clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr . 37clonidine transdermal patch weekly 0.3 mg/24 hr . . . . . . . . . . . . . 37clopidogrel oral tablet 75 mg . . . . . 39clopidogrel oral tablet 300 mg . . . . 39clorazepate dipotassium oral tablet 7.5 mg . . . . . . . . . . . . . . . . 30clorazepate dipotassium oral tablet 15 mg, 3.75 mg . . . . . . . 30clotrimazole-betamethasone topical cream . . . . . . . . . . . . . . . . . . . . 46clotrimazole-betamethasone topical lotion . . . . . . . . . . . . . . . . . . . . . 46clotrimazole mucous membrane . . . 1clotrimazole topical cream . . . . . . . . 46clotrimazole topical solution . . . . . . 46clotrimazole vaginal cream . . . . . . . 68clozapine oral tablet . . . . . . . . . . . . . 30clozapine oral tablet, disintegrating 12.5 mg, 25 mg . . . . 30clozapine oral tablet, disintegrating 100 mg . . . . . . . . . . . . 30

clozapine oral tablet, disintegrating 150 mg . . . . . . . . . . . . 30clozapine oral tablet, disintegrating 200 mg . . . . . . . . . . . . 30COARTEM . . . . . . . . . . . . . . . . . . . . . . . 7COATS ALOE MOISTURIZING . . . 42COATS ALOE TOPICAL CREAM . 42COATS ALOE TOPICAL GEL . . . . 42codeine-guaifenesin . . . . . . . . . . . . . 77colchicine oral capsule . . . . . . . . . . . 65colchicine oral tablet . . . . . . . . . . . . . 65colesevelam . . . . . . . . . . . . . . . . . . . . . 40colestipol . . . . . . . . . . . . . . . . . . . . . . . . 40colistin (colistimethate na) . . . . . . . . . 7COMBIGAN . . . . . . . . . . . . . . . . . . . . . 74COMBIVENT RESPIMAT . . . . . . . . 82COMETRIQ ORAL CAPSULE 60 MG/DAY (20 MG X 3/DAY) . . . . 12COMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG X1-20 MG X1) 12COMETRIQ ORAL CAPSULE 140 MG/DAY(80 MG X1-20 MG X3) 12COMPLERA . . . . . . . . . . . . . . . . . . . . . 2complete 50 plus . . . . . . . . . . . . . . . . 92complete allergy medicine oral capsule . . . . . . . . . . . . . . . . . . . . . 77COMPLETE MEN . . . . . . . . . . . . . . . 92complete multi . . . . . . . . . . . . . . . . . . . 92complete multi 50+ . . . . . . . . . . . . . . 92complete multivitamin-mineral oral tablet . . . . . . . . . . . . . . . . . . . . . . . 93complete multivitamin oral tablet . . 93complete mv adult 50 plus . . . . . . . 93complete oral tablet 18-500- 300-250 mg-mcg-mcg-mcg . . . . . . . 93complete premium vitamin . . . . . . . 50complete senior oral tablet 0.4-300-250 mg-mcg-mcg . . . . . . . . 93complete women . . . . . . . . . . . . . . . . 93complex b-100 oral tablet extended release . . . . . . . . . . . . . . . 93compro . . . . . . . . . . . . . . . . . . . . . . . . . 58constulose . . . . . . . . . . . . . . . . . . . . . . 58COPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML . . . . . . . . . . . . 23

COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML . . . . . . . . . . . . 23COPIKTRA . . . . . . . . . . . . . . . . . . . . . 12CORAL CALCIUM ORAL CAPSULE 185-50-100 MG-MG-UNIT . . . . . . . 93CORLANOR ORAL TABLET . . . . . 41corn-callus remover topical liquid 17% . . . . . . . . . . . . . . . . 42cortisone . . . . . . . . . . . . . . . . . . . . . . . . 51CORTISPORIN-TC . . . . . . . . . . . . . . 51corvita . . . . . . . . . . . . . . . . . . . . . . . . . . 93CORVITE . . . . . . . . . . . . . . . . . . . . . . . 93CORVITE 150 ORAL TABLET 150 MG IRON- 1 MG . . . . . . . . . . . . 93CORVITE FE ORAL TABLET 150 MG IRON- 1 MG . . . . . . . . . . . . 93COSMEGEN . . . . . . . . . . . . . . . . . . . . 12COTELLIC . . . . . . . . . . . . . . . . . . . . . . 12COUGH AND SEVERE COLD. . . . 77COUGH-COLD RELIEF HBP . . . . . 77COUGH DM ER . . . . . . . . . . . . . . . . . 77COUGH DROPS MUCOUS MEMBRANE LOZENGE 5.4 MG, 5.8 MG, 7.6 MG . . . . . . . . . 50cough syrup dm . . . . . . . . . . . . . . . . . 77COZIMA . . . . . . . . . . . . . . . . . . . . . . . . 42cranberry urinary comfort . . . . . . . . 50CREON . . . . . . . . . . . . . . . . . . . . . . . . . 58CRESEMBA ORAL . . . . . . . . . . . . . . . 1CRIXIVAN ORAL CAPSULE 200 MG . . . . . . . . . . . . . . . 2CRIXIVAN ORAL CAPSULE 400 MG . . . . . . . . . . . . . . . 2cromolyn inhalation . . . . . . . . . . . . . . 82cromolyn nasal . . . . . . . . . . . . . . . . . . 82cromolyn ophthalmic (eye) . . . . . . . 73cromolyn oral . . . . . . . . . . . . . . . . . . . . 58cryselle (28) . . . . . . . . . . . . . . . . . . . . . 69CUTTER BACKWOODS . . . . . . . . . 43CUTTER BACKWOODS DRY . . . . 43CUTTER LEMON EUCALYPTUS . 43cyanocobalamin (vitamin b-12) oral tablet 1,000 mcg, 100 mcg, 500 mcg . . . . . . . . . . . . . . . 93

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cyanocobalamin (vitamin b-12) oral tablet extended release . . . . . . 93cyclafem 1/35 (28) . . . . . . . . . . . . . . . 69cyclafem 7/7/7 (28) . . . . . . . . . . . . . . 69cyclobenzaprine oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 24cyclophosphamide intravenous recon soln . . . . . . . . . . . 12CYCLOPHOSPHAMIDE INTRAVENOUS SOLUTION . . . . . 12cyclophosphamide oral capsule . . 12CYCLOSERINE . . . . . . . . . . . . . . . . . . 7CYCLOSET . . . . . . . . . . . . . . . . . . . . . 52cyclosporine intravenous . . . . . . . . . 12cyclosporine modified . . . . . . . . . . . . 12cyclosporine oral capsule . . . . . . . . 12CYRAMZA . . . . . . . . . . . . . . . . . . . . . . 12cyred . . . . . . . . . . . . . . . . . . . . . . . . . . . 69cyred eq . . . . . . . . . . . . . . . . . . . . . . . . 69CYSTADANE . . . . . . . . . . . . . . . . . . . 59CYSTAGON . . . . . . . . . . . . . . . . . . . . . 84CYSTARAN . . . . . . . . . . . . . . . . . . . . . 73

DD2.5%-0.45% SODIUM CHLORIDE . . . . . . . . . . . . . . . . . . . . . 48D5%-0.45% SODIUM CHLORIDE . 48D5% AND 0.9% SODIUM CHLORIDE . . . . . . . . . . . . . . . . . . . . . 48D10%-0.45% SODIUM CHLORIDE 48daily multiple for men . . . . . . . . . . . . 93DAILY MULTIPLE FOR WOMEN . 93daily multiple oral tablet, 18-400 mg-mcg . . . . . . . . . . . . . . . . . 93DAILY MULTIPLE ORAL TABLET 400-120 MCG-MG . . . . . . 93daily multiple vitamins/iron . . . . . . . 93daily multi-vitamin . . . . . . . . . . . . . . . 93daily multivitamin-minerals . . . . . . . 93daily multivitamin with iron . . . . . . . 93daily value . . . . . . . . . . . . . . . . . . . . . . 93daily vitamin formula . . . . . . . . . . . . . 93daily vitamin formula-iron . . . . . . . . . 93daily vitamin formula-minerals . . . . 93daily vitamin with iron . . . . . . . . . . . . 93

DAILY-VITE . . . . . . . . . . . . . . . . . . . . . 93daily vites/iron . . . . . . . . . . . . . . . . . . . 93dalfampridine . . . . . . . . . . . . . . . . . . . . 23DALIRESP . . . . . . . . . . . . . . . . . . . . . . 82danazol . . . . . . . . . . . . . . . . . . . . . . . . . 56dantrolene oral . . . . . . . . . . . . . . . . . . 24dapsone oral . . . . . . . . . . . . . . . . . . . . . 7DAPTACEL (DTAP PEDIATRIC) (PF) . . . . . . . . . 64DAPTOMYCIN INTRAVENOUS RECON SOLN 350 MG . . . . . . . . . . . 7daptomycin intravenous recon soln 500 mg . . . . . . . . . . . . . . . . 7DARAPRIM . . . . . . . . . . . . . . . . . . . . . . 7darifenacin . . . . . . . . . . . . . . . . . . . . . . 84DARZALEX . . . . . . . . . . . . . . . . . . . . . 12DARZALEX FASPRO . . . . . . . . . . . . 12dasetta 1/35 (28) . . . . . . . . . . . . . . . . 69dasetta 7/7/7 (28) . . . . . . . . . . . . . . . . 69daunorubicin intravenous solution 12DAURISMO ORAL TABLET 25 MG 12DAURISMO ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 12daysee . . . . . . . . . . . . . . . . . . . . . . . . . . 69DAYTIME COLD-FLU RELIEF (PE) . . . . . . . . . . . . . . . . . . . . 77deblitane . . . . . . . . . . . . . . . . . . . . . . . . 67DECONEX DMX ORAL TABLET 10-17.5-385 MG, 10-17.5-400 MG . 77DECONEX IR ORAL TABLET 10-385 MG . . . . . . . . . . . . . . . . . . . . . . 77deep sea nasal . . . . . . . . . . . . . . . . . . 50deferasirox oral granules in packet . . . . . . . . . . . . . . . . . . . . . . . . 48deferasirox oral tablet . . . . . . . . . . . . 48DEKAS ESSENTIAL ORAL CAPSULE . . . . . . . . . . . . . . . . 93DEKAS PLUS (FOLIC ACID) ORAL CAPSULE . . . . . . . . . . . . . . . . 93DEKAS PLUS LIQUID . . . . . . . . . . . 93DELESTROGEN INTRAMUSCULAR OIL 10 MG/ML 67DELSTRIGO . . . . . . . . . . . . . . . . . . . . . 2DELSYM 12 HOUR . . . . . . . . . . . . . . 77delsym cough-chest congest dm . . 77

demeclocycline . . . . . . . . . . . . . . . . . . 10DEMSER . . . . . . . . . . . . . . . . . . . . . . . 37DENAVIR . . . . . . . . . . . . . . . . . . . . . . . 43DEPEN TITRATABS . . . . . . . . . . . . . 66DEPO-ESTRADIOL . . . . . . . . . . . . . 67DEPO-MEDROL . . . . . . . . . . . . . . . . 51DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML. . . . . . . 67DESCOVY . . . . . . . . . . . . . . . . . . . . . . . 2desipramine . . . . . . . . . . . . . . . . . . . . . 30desloratadine oral tablet . . . . . . . . . 77desmopressin injection . . . . . . . . . . . 56desmopressin nasal spray, non-aerosol . . . . . . . . . . . . . . . . . . . . . 56desmopressin nasal spray with pump . . . . . . . . . . . . . . . . . . . . . . . 56desmopressin oral . . . . . . . . . . . . . . . 56desog-e.estradiol/e.estradiol . . . . . 69desonide topical cream . . . . . . . . . . 47desonide topical lotion . . . . . . . . . . . 47desonide topical ointment . . . . . . . . 47desoximetasone topical cream . . . 47desoximetasone topical gel . . . . . . 47desoximetasone topical ointment . 47desvenlafaxine succinate oral tablet extended release 24 hr 25 mg, 50 mg . . . . . . . . . . . . . . 30desvenlafaxine succinate oral tablet extended release 24 hr 100 mg . . . . . . . . . . . . . . . . . . . . 30dexamethasone intensol . . . . . . . . . 51dexamethasone oral elixir . . . . . . . . 51dexamethasone oral solution . . . . . 51dexamethasone oral tablet . . . . . . . 51dexamethasone sodium phos (pf) injection solution . . . . . . . 51dexamethasone sodium phosphate injection solution . . . . . . 51dexamethasone sodium phosphate ophthalmic (eye) . . . . . . 75DEXBROMPHENIRAMINE-PHENYLEPH . . . . . . . . . . . . . . . . . . . 77dexmethylphenidate oral tablet 5 mg . . . . . . . . . . . . . . . . . . 30

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dexmethylphenidate oral tablet 10 mg, 2.5 mg . . . . . . . . . 30dextroamphetamine-amphetamine oral capsule,extended release 24hr 31dextroamphetamine-amphetamine oral tablet 5 mg . . . . . . . . . . . . . . . . . . 31dextroamphetamine-amphetamine oral tablet 10 mg . . . . . . . . . . . . . . . . 31dextroamphetamine-amphetamine oral tablet 12.5 mg, 30 mg, 7.5 mg . 31dextroamphetamine-amphetamine oral tablet 15 mg . . . . . . . . . . . . . . . . 31dextroamphetamine-amphetamine oral tablet 20 mg . . . . . . . . . . . . . . . . 31dextroamphetamine oral capsule, extended release 5 mg . . . . . . . . . . . 31dextroamphetamine oral capsule, extended release 10 mg . . . . . . . . . 31dextroamphetamine oral capsule, extended release 15 mg . . . . . . . . . 31dextroamphetamine oral solution . 31dextroamphetamine oral tablet . . . 31dextromethorphan polistirex . . . . . . 77DEXTROSE 5%- 0.2% SOD CHLORIDE . . . . . . . . . . . 48dextrose 5%-0.3% sod.chloride . . . 48DEXTROSE 5% IN WATER (D5W) INTRAVENOUS PARENTERAL SOLUTION . . . . . . . 48dextrose 5% in water (d5w) intravenous piggyback . . . . . . . . . . . 48dextrose 5%-lactated ringers . . . . . 48DEXTROSE 10% AND 0.2% NACL 48DEXTROSE 10% IN WATER (D10W) . . . . . . . . . . . . . . 48dextrose 25% in water (d25w) . . . . 48dextrose 30% in water (d30w) . . . . 48dextrose 40% in water (d40w) . . . . 48dextrose 50% in water (d50w) intravenous parenteral solution . . . 49dextrose 50% in water (d50w) intravenous syringe . . . . . . . 49dextrose 70% in water (d70w) . . . . 49dialyvite . . . . . . . . . . . . . . . . . . . . . . . . . 94dialyvite 800 oral tablet . . . . . . . . . . 94DIALYVITE 800 WITH IRON . . . . . 94

DIALYVITE 3000 . . . . . . . . . . . . . . . . 94DIALYVITE 5000 . . . . . . . . . . . . . . . . 94DIALYVITE SUPREME D . . . . . . . . 94diaper rash topical ointment . . . . . . 43DIASTAT . . . . . . . . . . . . . . . . . . . . . . . . 20DIASTAT ACUDIAL RECTAL KIT 5-7.5-10 MG . . . . . . . . . . . . . . . . 20DIASTAT ACUDIAL RECTAL KIT 12.5-15-17.5-20 MG . . . . . . . . . 20diazepam injection syringe . . . . . . . 31diazepam oral solution 5 mg/5 ml (1 mg/ml) . . . . . . . . . . . . . 31diazepam oral tablet . . . . . . . . . . . . . 31diazepam rectal kit 2.5 mg . . . . . . . 20diazepam rectal kit 5-7.5-10 mg . . 20diazepam rectal kit 12.5-15-17.5-20 mg . . . . . . . . . . . . . . 20diazoxide . . . . . . . . . . . . . . . . . . . . . . . 52dibucaine . . . . . . . . . . . . . . . . . . . . . . . 43diclofenac potassium . . . . . . . . . . . . 28diclofenac sodium ophthalmic (eye) . . . . . . . . . . . . . . . . . 74diclofenac sodium oral . . . . . . . . . . . 28diclofenac sodium topical drops . . 28diclofenac sodium topical gel 1% . 28dicloxacillin . . . . . . . . . . . . . . . . . . . . . . . 9dicyclomine oral capsule . . . . . . . . . 57dicyclomine oral solution . . . . . . . . . 57dicyclomine oral tablet . . . . . . . . . . . 57didanosine oral capsule,delayed release(dr/ec) 250 mg, 400 mg . . . . 2DIFICID . . . . . . . . . . . . . . . . . . . . . . . . . . 6diflunisal . . . . . . . . . . . . . . . . . . . . . . . . 28digitek . . . . . . . . . . . . . . . . . . . . . . . . . . 41digox . . . . . . . . . . . . . . . . . . . . . . . . . . . 41digoxin oral solution 50 mcg/ml (0.05 mg/ml) . . . . . . . . . . 41digoxin oral tablet . . . . . . . . . . . . . . . . 41dihydroergotamine nasal . . . . . . . . . 23dilantin 30 mg . . . . . . . . . . . . . . . . . . . 20diltiazem hcl intravenous . . . . . . . . . 37diltiazem hcl oral capsule, extended release 12 hr . . . . . . . . . . 37

diltiazem hcl oral capsule, extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg . . . . . . . . . 37diltiazem hcl oral capsule, extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg, 420 mg . 37diltiazem hcl oral capsule, ext.rel 24h degradable . . . . . . . . . . . 37diltiazem hcl oral tablet . . . . . . . . . . . 37diltiazem hcl oral tablet extended release 24 hr . . . . . . . . . . 37dilt-xr . . . . . . . . . . . . . . . . . . . . . . . . . . . 37dimaphen dm . . . . . . . . . . . . . . . . . . . 77dimethyl fumarate oral capsule,delayed release (dr/ec) 120 mg . . . . . . . . . . . . . . . . . . 23dimethyl fumarate oral capsule,delayed release (dr/ec) 120 mg (14)- 240 mg (46) . 23dimethyl fumarate oral capsule,delayed release (dr/ec) 240 mg . . . . . . . . . . . . . . . . . . 23diphenhist oral capsule . . . . . . . . . . 77diphenhydramine hcl injection solution 50 mg/ml . . . . . . . . . . . . . . . . 77diphenhydramine hcl oral capsule 77DIPHENHYDRAMINE HCL ORAL DROPS . . . . . . . . . . . . . . . . . . 77diphenhydramine hcl oral liquid . . . 77diphenhydramine hcl oral tablet 25 mg . . . . . . . . . . . . . . . . 77diphenoxylate-atropine . . . . . . . . . . . 57dipyridamole oral . . . . . . . . . . . . . . . . 39disulfiram . . . . . . . . . . . . . . . . . . . . . . . 49divalproex . . . . . . . . . . . . . . . . . . . . . . . 20DOCUSOL KIDS . . . . . . . . . . . . . . . . 59DOCUSOL PLUS . . . . . . . . . . . . . . . . 59dofetilide . . . . . . . . . . . . . . . . . . . . . . . . 35dok oral capsule 100 mg . . . . . . . . . 59dok oral tablet . . . . . . . . . . . . . . . . . . . 59donepezil oral tablet 10 mg . . . . . . . 23donepezil oral tablet 23 mg, 5 mg . 23donepezil oral tablet, disintegrating 5 mg . . . . . . . . . . . . . . 24donepezil oral tablet, disintegrating 10 mg . . . . . . . . . . . . . 23

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dorzolamide . . . . . . . . . . . . . . . . . . . . . 74dorzolamide-timolol . . . . . . . . . . . . . . 74dotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67DOUBLE ANTIBIOTIC (B.TRACN ZN) TOPICAL OINTMENT . . . . . . . 45DOVATO . . . . . . . . . . . . . . . . . . . . . . . . . 2doxazosin . . . . . . . . . . . . . . . . . . . . . . . 37doxepin oral capsule . . . . . . . . . . . . . 31doxepin oral concentrate . . . . . . . . . 31doxepin oral tablet . . . . . . . . . . . . . . . 31doxercalciferol intravenous . . . . . . . 56doxercalciferol oral capsule 0.5 mcg . . . . . . . . . . . . . 56doxercalciferol oral capsule 1 mcg . 56doxercalciferol oral capsule 2.5 mcg . . . . . . . . . . . . . . . . . 56doxy-100 . . . . . . . . . . . . . . . . . . . . . . . . 10doxycycline hyclate intravenous . . 10doxycycline hyclate oral capsule . . 10doxycycline hyclate oral tablet 100 mg, 20 mg . . . . . . . . . . . . . . . . . . 10doxycycline monohydrate oral capsule 100 mg, 50 mg . . . . . . . . . . 10DOXYCYCLINE MONOHYDRATE ORAL CAPSULE,IR - DELAY REL,BIPHASE . . . . . . . . . . . . . . . . . . 10doxycycline monohydrate oral suspension for reconstitution . . . . . 10doxycycline monohydrate oral tablet . . . . . . . . . . . . . . . . . . . . . . . 10DOXYLAMINE-PHENYLEPHRINE . 78driminate . . . . . . . . . . . . . . . . . . . . . . . . 59DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 20 MG . . . . . . . . . . . . . . . 31DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 30 MG, 40 MG . . . . . . . 31DRIZALMA SPRINKLE ORAL CAPSULE, DELAYED REL SPRINKLE 60 MG . . . . . . . . . . . . . . . 31dronabinol . . . . . . . . . . . . . . . . . . . . . . 59drospirenone-e.estradiol-lm.fa . . . . 69drospirenone-ethinyl estradiol . . . . 69DROXIA . . . . . . . . . . . . . . . . . . . . . . . . 12DR. SMITH’S DIAPER . . . . . . . . . . . 43

DR. SMITH’S DIAPER RASH . . . . 43DRY EYE RELIEF . . . . . . . . . . . . . . . 73DUAVEE . . . . . . . . . . . . . . . . . . . . . . . . 67duloxetine oral capsule,delayed release(dr/ec) 20 mg . . . . . . . . . . . . . 31duloxetine oral capsule,delayed release(dr/ec) 30 mg . . . . . . . . . . . . . 31duloxetine oral capsule,delayed release(dr/ec) 60 mg . . . . . . . . . . . . . 31duofer . . . . . . . . . . . . . . . . . . . . . . . . . . 94DUPIXENT PEN . . . . . . . . . . . . . . . . . 43DUPIXENT SYRINGE . . . . . . . . . . . 43DURAFLU ORAL TABLET 60-20-200-325 MG . . . . . . . . . . . . . . 78duramorph (pf) . . . . . . . . . . . . . . . . . . 25DUREZOL . . . . . . . . . . . . . . . . . . . . . . 75dutasteride . . . . . . . . . . . . . . . . . . . . . . 84dutasteride-tamsulosin . . . . . . . . . . . 84d-vi-sol . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Eear drops (carbamide peroxide) . . 51ear wax removal drops . . . . . . . . . . . 51ear wax removal kit . . . . . . . . . . . . . . 51ec-naproxen . . . . . . . . . . . . . . . . . . . . . 28econazole . . . . . . . . . . . . . . . . . . . . . . . 46econtra ez . . . . . . . . . . . . . . . . . . . . . . 69ed a-hist . . . . . . . . . . . . . . . . . . . . . . . . 78ed a-hist dm oral liquid . . . . . . . . . . . 78ED A-HIST DM ORAL TABLET . . . 78ed-apap . . . . . . . . . . . . . . . . . . . . . . . . . 28EDARBI . . . . . . . . . . . . . . . . . . . . . . . . 37EDARBYCLOR . . . . . . . . . . . . . . . . . . 37ed bron gp . . . . . . . . . . . . . . . . . . . . . . 78ed chlorped jr . . . . . . . . . . . . . . . . . . . 78EDURANT . . . . . . . . . . . . . . . . . . . . . . . 2e.e.s. 400 oral tablet . . . . . . . . . . . . . . 6efavirenz-lamivu-tenofov disop . . . . 2efavirenz oral capsule 50 mg . . . . . . 2efavirenz oral capsule 200 mg . . . . . 2efavirenz oral tablet . . . . . . . . . . . . . . . 2efferves pain relief antacid . . . . . . . 28ELAPRASE . . . . . . . . . . . . . . . . . . . . . 56electrolyte-48 in d5w . . . . . . . . . . . . . 89

electrolytes-dextrose . . . . . . . . . . . . . 86ELFOLATE PLUS . . . . . . . . . . . . . . . 94ELIGARD . . . . . . . . . . . . . . . . . . . . . . . 12ELIGARD (3 MONTH) . . . . . . . . . . . 12ELIGARD (4 MONTH) . . . . . . . . . . . 12ELIGARD (6 MONTH) . . . . . . . . . . . 12elinest . . . . . . . . . . . . . . . . . . . . . . . . . . 69ELIQUIS . . . . . . . . . . . . . . . . . . . . . . . . 39ELIQUIS DVT-PE TREAT 30D START . . . . . . . . . . . . . . 39ELLA . . . . . . . . . . . . . . . . . . . . . . . . . . . 69ELMIRON . . . . . . . . . . . . . . . . . . . . . . . 85ELZONRIS . . . . . . . . . . . . . . . . . . . . . . 12EMCYT . . . . . . . . . . . . . . . . . . . . . . . . . 12EMEND ORAL SUSPENSION FOR RECONSTITUTION . . . . . . . . 59emoquette . . . . . . . . . . . . . . . . . . . . . . 69EMSAM . . . . . . . . . . . . . . . . . . . . . . . . . 31emtricitabine . . . . . . . . . . . . . . . . . . . . . 2EMTRIVA ORAL CAPSULE . . . . . . . 2EMTRIVA ORAL SOLUTION . . . . . . 2EMVERM . . . . . . . . . . . . . . . . . . . . . . . . 7enalapril-hydrochlorothiazide . . . . . 37enalapril maleate . . . . . . . . . . . . . . . . 37ENBREL MINI . . . . . . . . . . . . . . . . . . . 66ENBREL SUBCUTANEOUS RECON SOLN . . . . . . . . . . . . . . . . . . 66ENBREL SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . 66ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5 ML (0.5) . . . . 66ENBREL SUBCUTANEOUS SYRINGE 50 MG/ML (1 ML) . . . . . 66ENBREL SURECLICK . . . . . . . . . . . 66endacof - dm . . . . . . . . . . . . . . . . . . . . 78endocet oral tablet 2.5-325 mg, 5-325 mg . . . . . . . . . . . 25endocet oral tablet 7.5-325 mg . . . 25endocet oral tablet 10-325 mg . . . . 25endur-acin oral tablet extended release 250 mg, 500 mg . . . . . . . . . 40endur-c with rose hips . . . . . . . . . . . 94enema rectal enema 19-7 gram/118 ml . . . . . . . . . . . . . . . . 59

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ENEMEEZ . . . . . . . . . . . . . . . . . . . . . . 59ENEMEEZ PLUS . . . . . . . . . . . . . . . . 59ENFAMIL ENFALYTE . . . . . . . . . . . . 86ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE . . . . 64ENGERIX-B (PF) INTRAMUSCULAR SYRINGE . . . . 64ENHERTU . . . . . . . . . . . . . . . . . . . . . . 12ENLYTE . . . . . . . . . . . . . . . . . . . . . . . . 94enoxaparin . . . . . . . . . . . . . . . . . . . . . . 39enpresse . . . . . . . . . . . . . . . . . . . . . . . . 69enskyce . . . . . . . . . . . . . . . . . . . . . . . . . 69entacapone . . . . . . . . . . . . . . . . . . . . . 22entecavir . . . . . . . . . . . . . . . . . . . . . . . . . 2ENTRESTO . . . . . . . . . . . . . . . . . . . . . 41enulose . . . . . . . . . . . . . . . . . . . . . . . . . 59ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 0.75 MG, 1 MG . . . . . . . . . . . . . . . . . . 13ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 4 MG . . . . . . . . . . . . . . . . . . . . . . . . . . . 13EPCLUSA ORAL TABLET 200-50 MG . . . . . . . . . . . . . . . . . . . . . . . 2EPCLUSA ORAL TABLET 400-100 MG . . . . . . . . . . . . . . . . . . . . . . 2EPIDIOLEX . . . . . . . . . . . . . . . . . . . . . 20epinastine . . . . . . . . . . . . . . . . . . . . . . . 73epinephrine injection auto-injector 78epinephrine injection solution 1 mg/ml . . . . . . . . . . . . . . . . . 78EPIPEN . . . . . . . . . . . . . . . . . . . . . . . . . 78EPIPEN 2-PAK . . . . . . . . . . . . . . . . . . 78EPIPEN JR . . . . . . . . . . . . . . . . . . . . . 78EPIPEN JR 2-PAK . . . . . . . . . . . . . . . 78epitol . . . . . . . . . . . . . . . . . . . . . . . . . . . 20EPIVIR HBV ORAL SOLUTION . . . 2ergocalciferol (vitamin d2) oral capsule 1,250 mcg (50,000 unit) . . 94ergocalciferol (vitamin d2) oral drops . . . . . . . . . . . . . . . . . . . . . . . 94ergotamine-caffeine . . . . . . . . . . . . . 23ERIVEDGE . . . . . . . . . . . . . . . . . . . . . 13ERLEADA . . . . . . . . . . . . . . . . . . . . . . 13erlotinib oral tablet 25 mg . . . . . . . . 13

erlotinib oral tablet 100 mg, 150 mg . . . . . . . . . . . . . . . . . 13errin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67ertapenem . . . . . . . . . . . . . . . . . . . . . . . 7ery pads . . . . . . . . . . . . . . . . . . . . . . . . 45ERYPED 400 . . . . . . . . . . . . . . . . . . . . 6ery-tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 6erythrocin (as stearate) oral tablet 250 mg . . . . . . . . . . . . . . . . 6erythrocin intravenous recon soln 500 mg . . . . . . . . . . . . . . . . 6erythromycin-benzoyl peroxide . . . 45erythromycin ethylsuccinate oral suspension for reconstitution 200 mg/5 ml . . . . . . . . . . . . . . . . . . . . . . 6erythromycin ethylsuccinate oral suspension for reconstitution 400 mg/5 ml . . . . . . . . . . . . . . . . . . . . . . 6erythromycin ethylsuccinate oral tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6erythromycin ophthalmic (eye) . . . . 73erythromycin oral tablet . . . . . . . . . . . 6erythromycin oral tablet, delayed release (dr/ec) . . . . . . . . . . . 6erythromycin with ethanol topical gel . . . . . . . . . . . . . . . . . . . . . . . 45erythromycin with ethanol topical solution . . . . . . . . . . . . . . . . . . 45ESBRIET ORAL CAPSULE . . . . . . 82ESBRIET ORAL TABLET 267 MG 82ESBRIET ORAL TABLET 801 MG 82escitalopram oxalate oral solution 31escitalopram oxalate oral tablet . . . 31esomeprazole magnesium oral capsule,delayed release(dr/ec) . . . 62essentia . . . . . . . . . . . . . . . . . . . . . . . . 94ESSENTIAL BALANCE WITH LUTEIN . . . . . . . . . . . . . . . . . . . 94essential daily . . . . . . . . . . . . . . . . . . . 94estarylla . . . . . . . . . . . . . . . . . . . . . . . . 69estradiol oral . . . . . . . . . . . . . . . . . . . . 67estradiol transdermal patch semiweekly . . . . . . . . . . . . . . . 67estradiol transdermal patch weekly . . . . . . . . . . . . . . . . . . . . 67estradiol vaginal cream . . . . . . . . . . 67

estradiol vaginal tablet . . . . . . . . . . . 67estradiol valerate intramuscular oil 20 mg/ml, 40 mg/ml . . . . . . . . . . . 67ESTRING . . . . . . . . . . . . . . . . . . . . . . . 67ethacrynate sodium . . . . . . . . . . . . . . 37ethambutol . . . . . . . . . . . . . . . . . . . . . . . 7ethosuximide . . . . . . . . . . . . . . . . . . . . 20ethynodiol diac-eth estradiol . . . . . . 69etodolac . . . . . . . . . . . . . . . . . . . . . . . . 28etoposide intravenous . . . . . . . . . . . 13EUTHYROX . . . . . . . . . . . . . . . . . . . . . 57everolimus (antineoplastic) . . . . . . . 13everolimus (immunosuppressive) oral tablet 0.5 mg . . . . . . . . . . . . . . . . 13everolimus (immunosuppressive) oral tablet 0.25 mg . . . . . . . . . . . . . . . 13everolimus (immunosuppressive) oral tablet 0.75 mg . . . . . . . . . . . . . . . 13EVOMELA . . . . . . . . . . . . . . . . . . . . . . 13EVOTAZ . . . . . . . . . . . . . . . . . . . . . . . . . 2exemestane . . . . . . . . . . . . . . . . . . . . . 13eye drops advanced relief . . . . . . . . 75eye drops (tetrahydrozoline) . . . . . . 75EYLEA . . . . . . . . . . . . . . . . . . . . . . . . . . 73ezetimibe . . . . . . . . . . . . . . . . . . . . . . . 40ezetimibe-simvastatin . . . . . . . . . . . . 40ezfe 200 . . . . . . . . . . . . . . . . . . . . . . . . 94

Ffabb . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94FABRAZYME . . . . . . . . . . . . . . . . . . . 56falmina (28) . . . . . . . . . . . . . . . . . . . . . 69famciclovir . . . . . . . . . . . . . . . . . . . . . . . 2famotidine oral suspension . . . . . . . 62famotidine oral tablet 10 mg . . . . . . 62famotidine oral tablet 20 mg, 40 mg . . . . . . . . . . . . . . . . . . . 62FANAPT ORAL TABLET 1 MG, 2 MG, 4 MG . . . . . . . . . . . . . . 31FANAPT ORAL TABLET 10 MG, 12 MG, 6 MG, 8 MG . . . . . 32FANAPT ORAL TABLETS, DOSE PACK . . . . . . . . . . . . . . . . . . . . 32FARXIGA ORAL TABLET 5 MG . . 52FARXIGA ORAL TABLET 10 MG . 52

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FARYDAK . . . . . . . . . . . . . . . . . . . . . . 13FASLODEX . . . . . . . . . . . . . . . . . . . . . 13fayosim . . . . . . . . . . . . . . . . . . . . . . . . . 69febuxostat . . . . . . . . . . . . . . . . . . . . . . . 65fe c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94felbamate oral suspension . . . . . . . 20felbamate oral tablet . . . . . . . . . . . . . 20felodipine . . . . . . . . . . . . . . . . . . . . . . . 37femynor . . . . . . . . . . . . . . . . . . . . . . . . . 69fenofibrate micronized . . . . . . . . . . . 41fenofibrate nanocrystallized oral tablet 145 mg, 48 mg . . . . . . . . 41fenofibrate oral capsule . . . . . . . . . . 41fenofibrate oral tablet 160 mg, 54 mg . . . . . . . . . . . . . . . . . . 41fenofibric acid (choline) oral capsule,delayed release (dr/ec) 45 mg . . . . . . . . . . . . . . . . . . . . 41fenofibric acid (choline) oral capsule,delayed release (dr/ec) 135 mg . . . . . . . . . . . . . . . . . . 41fentanyl . . . . . . . . . . . . . . . . . . . . . . . . . 25fentanyl citrate buccal lozenge on a handle . . . . . . . . . . . . . 25fentanyl citrate (pf) injection solution . . . . . . . . . . . . . . . . . 25fentanyl citrate (pf) intravenous syringe 100 mcg/2 ml (50 mcg/ml) 25FEOSOL BIFERA . . . . . . . . . . . . . . . 94feosol oral tablet 325 mg (65 mg iron) . . . . . . . . . . . . . . . . . . . . . 94ferate oral tablet 240 mg (27 mg iron) . . . . . . . . . . . . . . . . . . . . . 94FERGON ORAL TABLET 240 MG (27 MG IRON) . . . . . . . . . . 94FER-IN-SOL . . . . . . . . . . . . . . . . . . . . 94FERIVA 21-7 . . . . . . . . . . . . . . . . . . . . 94FERIVA FA (WITH SUMALATE) . . 94ferosul oral tablet . . . . . . . . . . . . . . . . 94FERRALET 90 DUAL-IRON DELIVERY . . . . . . . . . . . . . . . . . . . . . . 94ferraplus 90 . . . . . . . . . . . . . . . . . . . . . 94ferretts . . . . . . . . . . . . . . . . . . . . . . . . . . 94FERRETTS IPS . . . . . . . . . . . . . . . . . 94ferrex 150 . . . . . . . . . . . . . . . . . . . . . . . 94

ferrex 150 forte . . . . . . . . . . . . . . . . . . 94ferric x-150 . . . . . . . . . . . . . . . . . . . . . . 94FERRIMIN 150 . . . . . . . . . . . . . . . . . . 94FERRIPROX . . . . . . . . . . . . . . . . . . . . 49FERRIPROX (2 TIMES A DAY) . . . 49ferrocite . . . . . . . . . . . . . . . . . . . . . . . . . 94ferro-time . . . . . . . . . . . . . . . . . . . . . . . 94ferrous fumarate oral tablet 324 mg (106 mg iron) . . . . . . . . . . . . 95ferrous gluconate oral tablet 236 mg (27 mg iron), 240 mg (27 mg iron), 256 mg (28 mg iron), 324 mg (37.5 mg iron), 324 mg (38 mg iron) . . . . . . . . . . . . . . . . . . . . . 95ferrous sulfate oral drops . . . . . . . . . 95ferrous sulfate oral liquid . . . . . . . . . 95ferrous sulfate oral solution . . . . . . . 95ferrous sulfate oral tablet 325 mg (65 mg iron) . . . . . . . . . . . . . 95ferrous sulfate oral tablet, delayed release (dr/ec) . . . . . . . . . . 95ferrousul . . . . . . . . . . . . . . . . . . . . . . . . 95FETZIMA ORAL CAPSULE,EXTENDED RELEASE 24 HR . . . . . . . . . . . . . . . . 32FETZIMA ORAL CAPSULE, EXT REL 24HR DOSE PACK. . . . . 32FEXOFENADINE ORAL SUSPENSION . . . . . . . . . . . . 78fexofenadine oral tablet 180 mg, 60 mg . . . . . . . . . . . . . . . . . . 78fexofenadine-pseudoephedrine . . . 78fiber (calcium polycarbophil) . . . . . . 59fiber-lax . . . . . . . . . . . . . . . . . . . . . . . . . 59finasteride oral tablet 5 mg . . . . . . . 84FINTEPLA . . . . . . . . . . . . . . . . . . . . . . 21FIRDAPSE . . . . . . . . . . . . . . . . . . . . . . 24FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 80 MG . . . . . . . . . . . 13FIRMAGON KIT W DILUENT SYRINGE SUBCUTANEOUS RECON SOLN 120 MG . . . . . . . . . . 13FIRVANQ . . . . . . . . . . . . . . . . . . . . . . . . 7flac otic oil . . . . . . . . . . . . . . . . . . . . . . 51flavoxate . . . . . . . . . . . . . . . . . . . . . . . . 84

flecainide . . . . . . . . . . . . . . . . . . . . . . . 35FLEET PEDIATRIC . . . . . . . . . . . . . . 59FLINTSTONES COMPLETE (IRON) ORAL TABLET,CHEWABLE . . . . . . 95FLINTSTONES/EXTRA C ORAL TABLET,CHEWABLE . . . . . . 95FLINTSTONES MULTIVITAMIN . . 95FLORIVA . . . . . . . . . . . . . . . . . . . . . . . 95FLORIVA (FLUORIDE-VITAMIN D3). . . . . . . . 95FLORIVA PLUS . . . . . . . . . . . . . . . . . 95FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION . . . . . . . . . . . . 82FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ACTUATION . . . . . . . . . . 82FLOVENT HFA AEROSOL INHALER 44 MCG/ACTUATION . . 83FLOVENT HFA AEROSOL INHALER 110 MCG/ACTUATION . 83FLOVENT HFA AEROSOL INHALER 220 MCG/ACTUATION 83fluconazole . . . . . . . . . . . . . . . . . . . . . . . 1fluconazole in nacl (iso-osm) intravenous piggyback 200 mg/100 ml, 400 mg/200 ml . . . . 1flucytosine . . . . . . . . . . . . . . . . . . . . . . . 1fludarabine . . . . . . . . . . . . . . . . . . . . . . 13fludrocortisone . . . . . . . . . . . . . . . . . . 51flunisolide nasal spray, non-aerosol 25 mcg (0.025%) . . . . 83fluocinolone . . . . . . . . . . . . . . . . . . . . . 47fluocinolone acetonide oil . . . . . . . . 51fluocinolone and shower cap . . . . . 47fluocinonide topical cream . . . . . . . . 47fluocinonide topical gel . . . . . . . . . . . 47fluocinonide topical ointment . . . . . 47fluocinonide topical solution . . . . . . 47fluoride (sodium) dental paste . . . . 50fluoride (sodium) oral drops . . . . . . 95fluoride (sodium) oral tablet . . . . . . 95fluoride (sodium) oral tablet, chewable 1 mg (2.2 mg sod. fluoride) . . . . . . . . . . . . 95

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fluorometholone . . . . . . . . . . . . . . . . . 75fluorouracil topical cream 0.5% . . . 43fluorouracil topical cream 5% . . . . . 43fluorouracil topical solution . . . . . . . 43fluoxetine oral capsule . . . . . . . . . . . 32fluoxetine oral capsule, delayed release(dr/ec) . . . . . . . . . . . 32fluoxetine oral solution . . . . . . . . . . . 32fluoxetine oral tablet 10 mg, 20 mg 32fluphenazine decanoate . . . . . . . . . . 32fluphenazine hcl . . . . . . . . . . . . . . . . . 32flurbiprofen oral tablet 100 mg . . . . 28flurbiprofen sodium . . . . . . . . . . . . . . 74FLU-SEVERE COLD-COUGH DAYTIME . . . . . . . . . . . . . . . . . . . . . . . 78flutamide . . . . . . . . . . . . . . . . . . . . . . . . 13fluticasone propionate nasal . . . . . . 83fluticasone propionate topical cream . . . . . . . . . . . . . . . . . . . . 47fluticasone propionate topical ointment . . . . . . . . . . . . . . . . . 47fluticasone propion-salmeterol inhalation blister with device . . . . . . 83fluvoxamine oral tablet . . . . . . . . . . . 32folbee . . . . . . . . . . . . . . . . . . . . . . . . . . . 95folbee plus . . . . . . . . . . . . . . . . . . . . . . 95folbic . . . . . . . . . . . . . . . . . . . . . . . . . . . 95folic acid injection . . . . . . . . . . . . . . . . 95folic acid oral tablet 1 mg . . . . . . . . . 95FOLIC ACID-VIT B6-VIT B12 ORAL TABLET 0.5-5-0.2 MG . . . . . 95folitab . . . . . . . . . . . . . . . . . . . . . . . . . . . 95FOLOTYN . . . . . . . . . . . . . . . . . . . . . . 13folplex 2.2 . . . . . . . . . . . . . . . . . . . . . . . 95foltabs 800 . . . . . . . . . . . . . . . . . . . . . . 95foltanx . . . . . . . . . . . . . . . . . . . . . . . . . . 95FOLTRATE . . . . . . . . . . . . . . . . . . . . . . 95fomepizole . . . . . . . . . . . . . . . . . . . . . . 64fondaparinux subcutaneous syringe 2.5 mg/0.5 ml . . . . . . . . . . . . 40fondaparinux subcutaneous syringe 10 mg/0.8 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml . . . . . . . 39formula em . . . . . . . . . . . . . . . . . . . . . . 59

FORTAVIT . . . . . . . . . . . . . . . . . . . . . . 89FORTEO . . . . . . . . . . . . . . . . . . . . . . . . 65fosamprenavir . . . . . . . . . . . . . . . . . . . . 2fosfree . . . . . . . . . . . . . . . . . . . . . . . . . . 95fosinopril . . . . . . . . . . . . . . . . . . . . . . . . 37fosinopril-hydrochlorothiazide . . . . 37FREAMINE HBC 6.9% . . . . . . . . . . . 89freamine iii 10% . . . . . . . . . . . . . . . . . 89fruit c-500 . . . . . . . . . . . . . . . . . . . . . . . 95full spectrum b-vitamin c . . . . . . . . . 95fulvestrant . . . . . . . . . . . . . . . . . . . . . . . 13fungoid tincture topical tincture . . . 46furosemide injection . . . . . . . . . . . . . 37furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) . . 37furosemide oral tablet . . . . . . . . . . . . 37FUSION . . . . . . . . . . . . . . . . . . . . . . . . 95FUSION PLUS . . . . . . . . . . . . . . . . . . 96FUZEON SUBCUTANEOUS RECON SOLN . . . . . . . . . . . . . . . . . . . 2fyavolv . . . . . . . . . . . . . . . . . . . . . . . . . . 67FYCOMPA ORAL SUSPENSION . 21FYCOMPA ORAL TABLET 2 MG, 4 MG, 6 MG . . . . . . . . . . . . . . 21FYCOMPA ORAL TABLET 10 MG, 12 MG, 8 MG . . . . . . . . . . . . 21

Ggabapentin oral capsule 100 mg, 400 mg . . . . . . . . . . . . . . . . . 21gabapentin oral capsule 300 mg . . 21gabapentin oral solution . . . . . . . . . . 21gabapentin oral tablet 600 mg . . . . 21gabapentin oral tablet 800 mg . . . . 21galantamine oral capsule,ext rel. pellets 24 hr . . . . . . . . . . . . . . . . . . . . . 24galantamine oral solution . . . . . . . . . 24galantamine oral tablet . . . . . . . . . . . 24GAMMAKED INJECTION SOLUTION 1 GRAM/10 ML (10%), 10 GRAM/100 ML (10%), 20 GRAM/200 ML (10%), 5 GRAM/50 ML (10%) . . . . . . . . . . . 64GAMUNEX-C . . . . . . . . . . . . . . . . . . . 64GARDASIL 9 (PF) . . . . . . . . . . . . . . . 64

gas relief extra strength . . . . . . . . . . 59gas relief (simethicone) oral capsule 125 mg . . . . . . . . . . . . . 59gas relief (simethicone) oral drops,suspension . . . . . . . . . . . 59gas relief (simethicone) oral tablet,chewable 80 mg . . . . . . . 59GATTEX 30-VIAL . . . . . . . . . . . . . . . . 59GATTEX ONE-VIAL . . . . . . . . . . . . . 59GAUZE PADS 2 X 2 . . . . . . . . . . . . . 52gavilyte-c . . . . . . . . . . . . . . . . . . . . . . . 59gavilyte-g . . . . . . . . . . . . . . . . . . . . . . . 59gavilyte-n . . . . . . . . . . . . . . . . . . . . . . . 59GAVRETO . . . . . . . . . . . . . . . . . . . . . . 13GAZYVA . . . . . . . . . . . . . . . . . . . . . . . . 13gemcitabine intravenous recon soln . . . . . . . . . . . . . . . . . . . . . . . 13gemcitabine intravenous solution 1 gram/26.3 ml (38 mg/ml), 2 gram/52.6 ml (38 mg/ml), 200 mg/5.26 ml (38 mg/ml) . . . . . . . 13GEMCITABINE INTRAVENOUS SOLUTION 100 MG/ML . . . . . . . . . . 13gemfibrozil . . . . . . . . . . . . . . . . . . . . . . 41generlac . . . . . . . . . . . . . . . . . . . . . . . . 59gengraf oral capsule 100 mg, 25 mg . . . . . . . . . . . . . . . . . . 13gengraf oral solution . . . . . . . . . . . . . 13GENOTROPIN . . . . . . . . . . . . . . . . . . 63GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.2 MG/0.25 ML . . . . . . . . . . . . . . . . . 63GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE 0.4 MG/0.25 ML, 0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1 MG/0.25 ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6 MG/0.25 ML, 1.8 MG/0.25 ML, 2 MG/0.25 ML . . . . . . . . . . . . . . . . . . . 63gentak ophthalmic (eye) ointment . 73gentamicin injection solution 40 mg/ml . . . . . . . . . . . . . . . . . 7GENTAMICIN IN NACL (ISO-OSM) INTRAVENOUS PIGGYBACK 100 MG/50 ML, 120 MG/100 ML . . . . . . . . . . . . . . . . . . 7

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gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 60 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml . . . . . . . 7gentamicin ophthalmic (eye) drops 73gentamicin sulfate (ped) (pf) . . . . . . . 7gentamicin topical . . . . . . . . . . . . . . . 45GENVOYA . . . . . . . . . . . . . . . . . . . . . . . 2GEODON INTRAMUSCULAR . . . . 32gianvi (28) . . . . . . . . . . . . . . . . . . . . . . 69GILENYA ORAL CAPSULE 0.5 MG . . . . . . . . . . . . . . . 24GILOTRIF . . . . . . . . . . . . . . . . . . . . . . . 13GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG . . . . . . . . . 13glimepiride oral tablet 1 mg . . . . . . . 52glimepiride oral tablet 2 mg . . . . . . . 52glimepiride oral tablet 4 mg . . . . . . . 52glipizide-metformin oral tablet 2.5-250 mg . . . . . . . . . . . . . . . . 53glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg . . . . . 53glipizide oral tablet 5 mg . . . . . . . . . 52glipizide oral tablet 10 mg . . . . . . . . 52glipizide oral tablet extended release 24hr 2.5 mg . . . . . . . . . . . . . 53glipizide oral tablet extended release 24hr 5 mg . . . . . . . . . . . . . . . 53glipizide oral tablet extended release 24hr 10 mg . . . . . . . . . . . . . . 52GLUCAGEN HYPOKIT . . . . . . . . . . 53GLUCAGON EMERGENCY KIT (HUMAN) . . . . . . . . . . . . . . . . . . . 53GLUCAGON (HCL) EMERGENCY KIT . . . . . . . . . . . . . . . 53glycopyrrolate injection . . . . . . . . . . . 58glycopyrrolate oral . . . . . . . . . . . . . . . 58GLYCOPYRROLATE (PF) IN WATER INJECTION . . . . . . . . . . 58glycopyrrolate (pf) in water intravenous syringe 0.4 mg/2 ml (0.2 mg/ml) . . . . . . . . . . 58glydo . . . . . . . . . . . . . . . . . . . . . . . . . . . 43GLYXAMBI . . . . . . . . . . . . . . . . . . . . . . 53granisetron hcl intravenous . . . . . . . 59granisetron hcl oral . . . . . . . . . . . . . . 59

granisetron (pf) intravenous solution 1 mg/ml (1 ml) . . . . . . . . . . . 59griseofulvin microsize . . . . . . . . . . . . . 1griseofulvin ultramicrosize . . . . . . . . . 1guaiatussin ac . . . . . . . . . . . . . . . . . . . 78GUANIDINE . . . . . . . . . . . . . . . . . . . . . 32gummi bear multivitamin . . . . . . . . . 96gummy dinos oral tablet, chewable 200 mcg . . . . . . . . . . . . . . . 96GVOKE HYPOPEN 1-PACK . . . . . 53GVOKE HYPOPEN 2-PACK . . . . . 53GVOKE PFS 1-PACK SYRINGE. . 53GVOKE PFS 2-PACK SYRINGE. . 53

Hhailey . . . . . . . . . . . . . . . . . . . . . . . . . . . 69hailey 24 fe . . . . . . . . . . . . . . . . . . . . . 69hailey fe 1.5/30 (28) . . . . . . . . . . . . . 69hailey fe 1/20 (28) . . . . . . . . . . . . . . . 70hair,skin and nails oral tablet . . . . . 96hair vitamins . . . . . . . . . . . . . . . . . . . . 96HALAVEN . . . . . . . . . . . . . . . . . . . . . . . 14halls defense . . . . . . . . . . . . . . . . . . . . 96halobetasol propionate topical cream . . . . . . . . . . . . . . . . . . . . 47halobetasol propionate topical ointment . . . . . . . . . . . . . . . . . 47haloperidol . . . . . . . . . . . . . . . . . . . . . . 32haloperidol decanoate . . . . . . . . . . . 32haloperidol lactate injection . . . . . . 32haloperidol lactate oral . . . . . . . . . . . 32HARD NAILS . . . . . . . . . . . . . . . . . . . . 96HARVONI ORAL PELLETS IN PACKET 33.75-150 MG . . . . . . . . 3HARVONI ORAL PELLETS IN PACKET 45-200 MG . . . . . . . . . . . 3HARVONI ORAL TABLET . . . . . . . . . 3HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML . . . . . . . . . . . 64HAVRIX (PF) INTRAMUSCULAR SYRINGE . . . . 64heather . . . . . . . . . . . . . . . . . . . . . . . . . 67HEMOCYTE . . . . . . . . . . . . . . . . . . . . 96HEMOCYTE-F . . . . . . . . . . . . . . . . . . 96

HEMOCYTE-PLUS . . . . . . . . . . . . . . 96HEMORRHOIDAL CREAM . . . . . . . 59HEMORRHOIDAL(PE-MIN OIL-PETRO) RECTAL OINTMENT 0.25-14-74.9% . . . . . . . . . . . . . . . . . . 59HEMORRHOIDAL (PHENYLEPH-COCOA) RECTAL SUPPOSITORY 0.25-88.44% . . . . 59HEMORRHOIDAL RELIEF . . . . . . . 43heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml, 25,000 unit/500 ml . . . . . . . . . . . . . . . 40heparin (porcine) in 5% dex intravenous parenteral solution 20,000 unit/500 ml (40 unit/ml), 25,000 unit/250 ml(100 unit/ml), 25,000 unit/500 ml (50 unit/ml) . . . 40heparin (porcine) injection solution . 40heparin (porcine) in nacl (pf) . . . . . . 40heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml . . . . . . . . . 40HEPARIN, PORCINE (PF) INJECTION SYRINGE 5,000 UNIT/ML . . . . . . . . . . . . . . . . . . 40HEPATAMINE 8% . . . . . . . . . . . . . . . 89HERCEPTIN HYLECTA . . . . . . . . . . 14HERCEPTIN INTRAVENOUS RECON SOLN 150 MG . . . . . . . . . . 14HETLIOZ . . . . . . . . . . . . . . . . . . . . . . . 32HIBERIX (PF) . . . . . . . . . . . . . . . . . . . 64hi-cal plus vit d . . . . . . . . . . . . . . . . . . 86HIGH POTENCY IRON ORAL TABLET 27 MG IRON . . . . . . . . . . . 96high potency iron oral tablet 134 mg (27 mg iron) . . . . . . . . . . . . . 96HISTEX DM . . . . . . . . . . . . . . . . . . . . . 78HISTEX PD . . . . . . . . . . . . . . . . . . . . . 78HISTEX PE . . . . . . . . . . . . . . . . . . . . . 78HISTEX (TRIPROLIDINE) ORAL LIQUID . . . . . . . . . . . . . . . . . . . 78HIZENTRA . . . . . . . . . . . . . . . . . . . . . . 64HUMALOG JUNIOR KWIKPEN U-100 . . . . . . . . . . . . . . . . 53HUMALOG KWIKPEN INSULIN . . 53HUMALOG MIX 50-50 INSULN U-100 . . . . . . . . . . . . . . . . . . 53

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HUMALOG MIX 50-50 KWIKPEN 53HUMALOG MIX 75-25 KWIKPEN 53HUMALOG MIX 75-25 (U-100)INSULN . . . . . . . . . . . . . . . . . 53HUMALOG U-100 INSULIN . . . . . . 53HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML . . . . . 66HUMIRA(CF) PEDI CROHNS STARTER SUBCUTANEOUS SYRINGE KIT 80 MG/0.8 ML- 40 MG/0.4 ML . . . . . . . . . . . . . . . . . . . 66HUMIRA(CF) PEN CROHNS-UC-HS . . . . . . . . . . . . . . . . 66HUMIRA(CF) PEN PSOR-UV-ADOL HS . . . . . . . . . . . . . 66HUMIRA(CF) PEN SUBCUTANEOUS INJECTOR KIT 40 MG/0.4 ML . . . . . . . . . . . . . . . 66HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 10 MG/0.1 ML, 20 MG/0.2 ML . . . . . . . . . . . . . . . . . . . 66HUMIRA(CF) SUBCUTANEOUS SYRINGE KIT 40 MG/0.4 ML . . . . . 66HUMIRA PEN . . . . . . . . . . . . . . . . . . . 66HUMIRA PEN CROHNS- UC-HS START . . . . . . . . . . . . . . . . . . 66HUMIRA PEN PSOR- UVEITS-ADOL HS . . . . . . . . . . . . . . . 66HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML . . . . . . . . . . . . . . . . . . . 66HUMIRA SUBCUTANEOUS SYRINGE KIT 40 MG/0.8 ML . . . . . 66HUMULIN 70/30 U-100 INSULIN . 53HUMULIN 70/30 U-100 KWIKPEN 53HUMULIN N NPH INSULIN KWIKPEN . . . . . . . . . . . . . . . . . . . . . . . 53HUMULIN N NPH U-100 INSULIN 53HUMULIN R REGULAR U-100 INSULN . . . . . . . . . . . . . . . . . . 53HUMULIN R U-500 (CONC) INSULIN . . . . . . . . . . . . . . . . 53HUMULIN R U-500 (CONC) KWIKPEN . . . . . . . . . . . . . . 53hydralazine . . . . . . . . . . . . . . . . . . . . . 37hydrochlorothiazide . . . . . . . . . . . . . . 37

hydrocodone-acetaminophen oral solution 7.5-325 mg/15 ml . . . . . . . . 25hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml) . . 25hydrocodone-acetaminophen oral tablet 5-325 mg . . . . . . . . . . . . . . . . . . 25hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 7.5-300 mg, 7.5-325 mg . . . . . . . . . 25hydrocodone-chlorpheniramine . . . 78hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml . . . . . . . . . 78hydrocodone-homatropine oral tablet . . . . . . . . . . . . . . . . . . . . . . . 78hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg . . . . . . . . . . . . . . . . . . . . . . 25hydrocortisone-acetic acid . . . . . . . 51hydrocortisone-aloe vera topical cream 1% . . . . . . . . . . . . . . . . 47hydrocortisone butyrate topical cream . . . . . . . . . . . . . . . . . . . . 47hydrocortisone butyrate topical ointment . . . . . . . . . . . . . . . . . 47hydrocortisone butyrate topical solution . . . . . . . . . . . . . . . . . . 47hydrocortisone butyr-emollient . . . . 47hydrocortisone oral . . . . . . . . . . . . . . 51hydrocortisone rectal . . . . . . . . . . . . 59hydrocortisone topical cream 1%, 2.5% . . . . . . . . . . . . . . . . . 47hydrocortisone topical cream with perineal applicator . . . . 59hydrocortisone topical lotion 2.5% . . . . . . . . . . . . . . . . . . . . . . 47hydrocortisone topical ointment 1%, 2.5% . . . . . . . . . . . . . . 47hydrocortisone valerate . . . . . . . . . . 47hydromet . . . . . . . . . . . . . . . . . . . . . . . . 78hydromorphone injection solution 2 mg/ml . . . . . . . . . . . . . . . . . 25hydromorphone injection syringe 1 mg/ml, 2 mg/ml, 4 mg/ml . . . . . . . 25hydromorphone oral liquid . . . . . . . . 26hydromorphone oral tablet 2 mg, 4 mg . . . . . . . . . . . . . . . . . . . . . . 26hydromorphone oral tablet 8 mg . . 26

hydromorphone (pf) injection solution 10 (mg/ml) (5 ml), 10 mg/ml, 2 mg/ml . . . . . . . . . . . . . . . 25hydroxychloroquine . . . . . . . . . . . . . . . 7hydroxyprogesterone caproate . . . 67hydroxyurea . . . . . . . . . . . . . . . . . . . . . 14hydroxyzine hcl oral tablet . . . . . . . . 78

Iibandronate oral . . . . . . . . . . . . . . . . . 65IBRANCE . . . . . . . . . . . . . . . . . . . . . . . 14ibu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28ibu-200 . . . . . . . . . . . . . . . . . . . . . . . . . 28ibuprofen jr strength . . . . . . . . . . . . . 28ibuprofen oral capsule . . . . . . . . . . . 28ibuprofen oral suspension . . . . . . . . 28ibuprofen oral tablet 200 mg . . . . . . 28ibuprofen oral tablet 400 mg, 600 mg, 800 mg . . . . . . . . . 28ibuprofen-oxycodone . . . . . . . . . . . . 26ICAPS . . . . . . . . . . . . . . . . . . . . . . . . . . 96ICAPS AREDS ORAL TABLET,DELAYED RELEASE (DR/EC) . . . . . . . . . . . . . . 96ICAPS MV . . . . . . . . . . . . . . . . . . . . . . 96ICAR-C . . . . . . . . . . . . . . . . . . . . . . . . . 96ICAR ORAL SUSPENSION . . . . . . 96icatibant . . . . . . . . . . . . . . . . . . . . . . . . 83ICLUSIG ORAL TABLET 15 MG . . 14ICLUSIG ORAL TABLET 45 MG . . 14IDHIFA . . . . . . . . . . . . . . . . . . . . . . . . . . 14iferex 150 . . . . . . . . . . . . . . . . . . . . . . . 96iferex 150 forte . . . . . . . . . . . . . . . . . . 96I.L.X. B-12 . . . . . . . . . . . . . . . . . . . . . . 96imatinib oral tablet 100 mg . . . . . . . 14imatinib oral tablet 400 mg . . . . . . . 14IMBRUVICA ORAL CAPSULE 70 MG . . . . . . . . . . . . . . . 14IMBRUVICA ORAL CAPSULE 140 MG . . . . . . . . . . . . . . 14IMBRUVICA ORAL TABLET . . . . . . 14IMFINZI . . . . . . . . . . . . . . . . . . . . . . . . . 14imipenem-cilastatin . . . . . . . . . . . . . . . 7imipramine hcl . . . . . . . . . . . . . . . . . . . 32

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imiquimod topical cream in metered-dose pump . . . . . . . . . . . 43imiquimod topical cream in packet . 43IMOVAX RABIES VACCINE (PF) . 64incassia . . . . . . . . . . . . . . . . . . . . . . . . . 67INCRELEX . . . . . . . . . . . . . . . . . . . . . . 49INCRUSE ELLIPTA . . . . . . . . . . . . . . 83indapamide . . . . . . . . . . . . . . . . . . . . . 37INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION 64infants gas relief . . . . . . . . . . . . . . . . . 60infant’s ibuprofen . . . . . . . . . . . . . . . . 28INFED . . . . . . . . . . . . . . . . . . . . . . . . . . 96INFUGEM . . . . . . . . . . . . . . . . . . . . . . . 14INFUMORPH P/F. . . . . . . . . . . . . . . . 26INLYTA ORAL TABLET 1 MG . . . . . 14INLYTA ORAL TABLET 5 MG . . . . . 14INQOVI . . . . . . . . . . . . . . . . . . . . . . . . . 14INREBIC . . . . . . . . . . . . . . . . . . . . . . . . 14INSECT REPELLENT (PICARIDIN) . . . . . . . . . . . . . . . . . . . . 43INSULIN PEN NEEDLE . . . . . . . . . . 53INSULIN SYRINGE (DISP) U-100 0.3 ML, 1 ML, 1/2 ML . . . . . . 53INTEGRA . . . . . . . . . . . . . . . . . . . . . . . 96INTEGRA F . . . . . . . . . . . . . . . . . . . . . 96INTEGRA PLUS . . . . . . . . . . . . . . . . . 96INTELENCE ORAL TABLET 25 MG . 3INTELENCE ORAL TABLET 100 MG, 200 MG . . . . . . . . 3INTRALIPID INTRAVENOUS EMULSION 20%, 30% . . . . . . . . . . . 89INTRON A INJECTION RECON SOLN . . . . . . . . . . . . . . . . . . 63INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML . 63INTRON A INJECTION SOLUTION 10 MILLION UNIT/ML . 63introvale . . . . . . . . . . . . . . . . . . . . . . . . 70INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 39 MG/0.25 ML . . . . . . . 32INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 78 MG/0.5 ML . . . . . . . . . 32

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML . . . . . . 32INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 156 MG/ML . . . . . . . . . . . 32INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 234 MG/1.5 ML . . . . . . . 32INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/0.875 ML . . . . . 32INVEGA TRINZA INTRAMUSCULAR SYRINGE 410 MG/1.315 ML . . . . . 32INVEGA TRINZA INTRAMUSCULAR SYRINGE 546 MG/1.75 ML . . . . . . 32INVEGA TRINZA INTRAMUSCULAR SYRINGE 819 MG/2.625 ML . . . . . 32INVELTYS . . . . . . . . . . . . . . . . . . . . . . 75INVIRASE ORAL TABLET . . . . . . . . 3INVOKAMET . . . . . . . . . . . . . . . . . . . . 53INVOKAMET XR . . . . . . . . . . . . . . . . 53INVOKANA . . . . . . . . . . . . . . . . . . . . . 53IOSAT . . . . . . . . . . . . . . . . . . . . . . . . . . 52IPOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64ipratropium-albuterol . . . . . . . . . . . . . 83ipratropium bromide inhalation . . . 83ipratropium bromide nasal spray,non-aerosol 0.03% . . . . . . . . . 50ipratropium bromide nasal spray,non-aerosol 42 mcg (0.06%) . . . . . . . . . . . . . . . . . 50irbesartan-hydrochlorothiazide . . . 37irbesartan oral tablet 150 mg . . . . . 37irbesartan oral tablet 300 mg, 75 mg . . . . . . . . . . . . . . . . . . 37IRESSA . . . . . . . . . . . . . . . . . . . . . . . . . 14irinotecan . . . . . . . . . . . . . . . . . . . . . . . 14iron,carbonyl-vitamin c . . . . . . . . . . . 96iron (ferrous sulfate) . . . . . . . . . . . . . 96iron oral tablet 325 mg (65 mg iron) . . . . . . . . . . . . . . . . . . . . . 96iron oral tablet extended release 159 mg (45 mg iron) . . . . . 96IROSPAN 24/6 . . . . . . . . . . . . . . . . . . 96ISENTRESS HD . . . . . . . . . . . . . . . . . . 3

ISENTRESS ORAL POWDER IN PACKET . . . . . . . . . . . . 3ISENTRESS ORAL TABLET . . . . . . 3ISENTRESS ORAL TABLET,CHEWABLE 25 MG . . . . . . 3ISENTRESS ORAL TABLET,CHEWABLE 100 MG . . . . . 3isibloom . . . . . . . . . . . . . . . . . . . . . . . . . 70isoniazid oral . . . . . . . . . . . . . . . . . . . . . 7ISOPTO TEARS . . . . . . . . . . . . . . . . . 73isosorbide dinitrate oral tablet . . . . 42isosorbide mononitrate . . . . . . . . . . . 42isotretinoin . . . . . . . . . . . . . . . . . . . . . . 45isradipine . . . . . . . . . . . . . . . . . . . . . . . 37ISTODAX . . . . . . . . . . . . . . . . . . . . . . . 14itraconazole oral capsule . . . . . . . . . . 1itraconazole oral solution . . . . . . . . . . 1ivermectin oral . . . . . . . . . . . . . . . . . . . 7IXIARO (PF) . . . . . . . . . . . . . . . . . . . . 64

JJADENU . . . . . . . . . . . . . . . . . . . . . . . . 49JADENU SPRINKLE . . . . . . . . . . . . . 49jaimiess . . . . . . . . . . . . . . . . . . . . . . . . . 70JAKAFI . . . . . . . . . . . . . . . . . . . . . . . . . 14jantoven . . . . . . . . . . . . . . . . . . . . . . . . 40JANUMET . . . . . . . . . . . . . . . . . . . . . . 53JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-1,000 MG, 50-500 MG . . . . . . . . 53JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG . . . . . . . . . . . . . . . . . . . 53JANUVIA . . . . . . . . . . . . . . . . . . . . . . . 53JARDIANCE . . . . . . . . . . . . . . . . . . . . 54jasmiel (28) . . . . . . . . . . . . . . . . . . . . . 70jencycla . . . . . . . . . . . . . . . . . . . . . . . . . 67JENTADUETO . . . . . . . . . . . . . . . . . . 54JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG . . . . . . . . . . . . . 54JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 5-1,000 MG . . . . . . . . . . . . . . . 54jolessa . . . . . . . . . . . . . . . . . . . . . . . . . . 70

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juleber . . . . . . . . . . . . . . . . . . . . . . . . . . 70JULUCA . . . . . . . . . . . . . . . . . . . . . . . . . 3junel 1.5/30 (21) . . . . . . . . . . . . . . . . . 70junel 1/20 (21) . . . . . . . . . . . . . . . . . . . 70junel fe 1.5/30 (28) . . . . . . . . . . . . . . . 70junel fe 1/20 (28) . . . . . . . . . . . . . . . . 70junel fe 24 . . . . . . . . . . . . . . . . . . . . . . . 70

KKABIVEN . . . . . . . . . . . . . . . . . . . . . . . 89KADCYLA . . . . . . . . . . . . . . . . . . . . . . 14kaitlib fe . . . . . . . . . . . . . . . . . . . . . . . . . 70KALETRA ORAL TABLET 100-25 MG . . . . . . . . . . . . . . 3KALETRA ORAL TABLET 200-50 MG . . . . . . . . . . . . . . 3kalliga . . . . . . . . . . . . . . . . . . . . . . . . . . 70KALYDECO . . . . . . . . . . . . . . . . . . . . . 83KANJINTI . . . . . . . . . . . . . . . . . . . . . . . 14kariva (28) . . . . . . . . . . . . . . . . . . . . . . 70kelnor 1/35 (28) . . . . . . . . . . . . . . . . . 70kelnor 1-50 . . . . . . . . . . . . . . . . . . . . . . 70ketoconazole oral . . . . . . . . . . . . . . . . . 1ketoconazole topical cream . . . . . . 46ketoconazole topical shampoo . . . 46ketorolac ophthalmic (eye) . . . . . . . 74KEYTRUDA INTRAVENOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . 14KIDS MULTIVITAMIN-MINERALS . 96KINRIX (PF) . . . . . . . . . . . . . . . . . . . . . 64kionex (with sorbitol) . . . . . . . . . . . . . 49KISQALI . . . . . . . . . . . . . . . . . . . . . . . . 14KISQALI FEMARA CO-PACK ORAL TABLET 200 MG/DAY (200 MG X 1)-2.5 MG . . . . . . . . . . . . 14KISQALI FEMARA CO-PACK ORAL TABLET 400 MG/DAY (200 MG X 2)-2.5 MG . . . . . . . . . . . . 14KISQALI FEMARA CO-PACK ORAL TABLET 600 MG/DAY (200 MG X 3)-2.5 MG . . . . . . . . . . . . 14klor-con . . . . . . . . . . . . . . . . . . . . . . . . . 86KLOR-CON 8 . . . . . . . . . . . . . . . . . . . 86KLOR-CON 10 . . . . . . . . . . . . . . . . . . 86klor-con m10 . . . . . . . . . . . . . . . . . . . . 86

klor-con m20 . . . . . . . . . . . . . . . . . . . . 86kobee . . . . . . . . . . . . . . . . . . . . . . . . . . . 96KORLYM . . . . . . . . . . . . . . . . . . . . . . . . 56k-phos-neutral . . . . . . . . . . . . . . . . . . . 86K-PHOS ORIGINAL . . . . . . . . . . . . . 85kurvelo (28) . . . . . . . . . . . . . . . . . . . . . 70KUVAN . . . . . . . . . . . . . . . . . . . . . . . . . 56KYPROLIS . . . . . . . . . . . . . . . . . . . . . . 14

Llabetalol oral . . . . . . . . . . . . . . . . . . . . 37LACRISERT . . . . . . . . . . . . . . . . . . . . 74lactated ringers intravenous . . . . . . 86lactated ringers irrigation . . . . . . . . . 48lactulose oral solution . . . . . . . . . . . . 60lamivudine oral solution . . . . . . . . . . . 3lamivudine oral tablet 100 mg, 300 mg . . . . . . . . . . . . . . . . . . 3lamivudine oral tablet 150 mg . . . . . 3lamivudine-zidovudine . . . . . . . . . . . . 3lamotrigine oral tablet . . . . . . . . . . . . 21lamotrigine oral tablet, chewable dispersible . . . . . . . . . . . . 21lamotrigine oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 21lamotrigine oral tablet extended release 24hr . . . . . . . . . . . 21lansoprazole oral capsule, delayed release(dr/ec) . . . . . . . . . . . 62LANTUS SOLOSTAR U-100 INSULIN . . . . . . . . . . . . . . . . . . 54LANTUS U-100 INSULIN . . . . . . . . 54larin 1.5/30 (21) . . . . . . . . . . . . . . . . . 70larin 1/20 (21) . . . . . . . . . . . . . . . . . . . 70larin 24 fe . . . . . . . . . . . . . . . . . . . . . . . 70larin fe 1.5/30 (28) . . . . . . . . . . . . . . . 70larin fe 1/20 (28) . . . . . . . . . . . . . . . . . 70larissia . . . . . . . . . . . . . . . . . . . . . . . . . . 70latanoprost . . . . . . . . . . . . . . . . . . . . . . 74LATUDA ORAL TABLET 80 MG . . 33LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG . . 33layolis fe . . . . . . . . . . . . . . . . . . . . . . . . 70leena 28 . . . . . . . . . . . . . . . . . . . . . . . . 70

leflunomide . . . . . . . . . . . . . . . . . . . . . 66LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1), 4 MG . . 14LENVIMA ORAL CAPSULE 12 MG/DAY (4 MG X 3), 18 MG/DAY (10 MG X 1-4 MG X2), 24 MG/DAY(10 MG X 2-4 MG X 1) . . . . . . . 14LENVIMA ORAL CAPSULE 14 MG/DAY(10 MG X 1-4 MG X 1), 20 MG/DAY (10 MG X 2), 8 MG/DAY (4 MG X 2) . . . . . . . . . . . 15lessina . . . . . . . . . . . . . . . . . . . . . . . . . . 70letrozole . . . . . . . . . . . . . . . . . . . . . . . . 15leucovorin calcium . . . . . . . . . . . . . . . 11LEUKERAN . . . . . . . . . . . . . . . . . . . . . 15LEUKINE INJECTION RECON SOLN . . . . . . . . . . . . . . . . . . 63leuprolide subcutaneous kit . . . . . . 15levalbuterol hcl . . . . . . . . . . . . . . . . . . 83levalbuterol tartrate . . . . . . . . . . . . . . 83LEVEMIR FLEXTOUCH U-100 INSULN . . . . . . . . . . . . . . . . . . 54LEVEMIR U-100 INSULIN . . . . . . . 54levetiracetam . . . . . . . . . . . . . . . . . . . . 21levetiracetam in nacl (iso-os) . . . . . 21levobunolol ophthalmic (eye) drops 0.5% . . . . . . . . . . . . . . . . 73levocarnitine oral solution 100 mg/ml . . . . . . . . . . . . . . 49levocarnitine oral tablet . . . . . . . . . . 49levocarnitine (with sugar) . . . . . . . . . 49levocetirizine oral solution . . . . . . . . 78levocetirizine oral tablet . . . . . . . . . . 78levofloxacin in d5w . . . . . . . . . . . . . . 10levofloxacin intravenous . . . . . . . . . 10levofloxacin oral . . . . . . . . . . . . . . . . . 10levonest (28) . . . . . . . . . . . . . . . . . . . . 70levonorgestrel-ethinyl estrad . . . . . 70levonorgestrel oral tablet 1.5 mg . . 70levonorg-eth estrad triphasic . . . . . 70levora-28 . . . . . . . . . . . . . . . . . . . . . . . . 70LEVO-T . . . . . . . . . . . . . . . . . . . . . . . . . 57levothyroxine oral . . . . . . . . . . . . . . . . 57levoxyl oral tablet 100 mcg, 112 mcg, 175 mcg . . . . . 57

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LEVOXYL ORAL TABLET 125 MCG, 137 MCG, 150 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG . . . . . . . . . . . . . . . 57LEXIVA ORAL SUSPENSION . . . . . 3LIBTAYO . . . . . . . . . . . . . . . . . . . . . . . . 15lice killing . . . . . . . . . . . . . . . . . . . . . . . 47lice treatment topical liquid 1% . . . 47lidocaine hcl injection solution . . . . 43lidocaine hcl laryngotracheal . . . . . 43lidocaine hcl mucous membrane jelly . . . . . . . . . . . . . . . . . . 43lidocaine hcl mucous membrane jelly in applicator . . . . . . 43lidocaine hcl mucous membrane solution 4% (40 mg/ml) . . . . . . . . . . 43lidocaine (pf) injection solution . . . . 43lidocaine (pf) intravenous syringe . 35lidocaine-prilocaine topical cream . 43lidocaine topical adhesive patch,medicated 5% . . . . . . . . . . . . . 43lidocaine topical ointment . . . . . . . . 43lidocaine viscous . . . . . . . . . . . . . . . . 43lillow (28) . . . . . . . . . . . . . . . . . . . . . . . 70lincomycin . . . . . . . . . . . . . . . . . . . . . . . 7lindane topical shampoo . . . . . . . . . 47linezolid-0.9% sodium chloride . . . . 8linezolid in dextrose 5% . . . . . . . . . . . 7linezolid oral suspension for reconstitution . . . . . . . . . . . . . . . . . . 7linezolid oral tablet . . . . . . . . . . . . . . . . 8LINZESS . . . . . . . . . . . . . . . . . . . . . . . . 60liothyronine oral . . . . . . . . . . . . . . . . . 57LIQUID B-12 . . . . . . . . . . . . . . . . . . . . 96lisinopril . . . . . . . . . . . . . . . . . . . . . . . . . 37lisinopril-hydrochlorothiazide . . . . . 37lithium carbonate . . . . . . . . . . . . . . . . 33little animals . . . . . . . . . . . . . . . . . . . . . 96little animals-iron oral tablet,chewable . . . . . . . . . . . . 96LIVALO . . . . . . . . . . . . . . . . . . . . . . . . . 41l-methyl-b6-b12 . . . . . . . . . . . . . . . . . . 96l-methyl-mc . . . . . . . . . . . . . . . . . . . . . 96l norgest/e.estradiol-e.estrad . . . . . 70

lohist - d . . . . . . . . . . . . . . . . . . . . . . . . 78lohist-dm . . . . . . . . . . . . . . . . . . . . . . . . 78lojaimiess . . . . . . . . . . . . . . . . . . . . . . . 70LOKELMA . . . . . . . . . . . . . . . . . . . . . . 49LONSURF ORAL TABLET 15-6.14 MG . . . . . . . . . . . . . 15LONSURF ORAL TABLET 20-8.19 MG . . . . . . . . . . . . . 15loperamide oral capsule . . . . . . . . . . 58loperamide oral liquid 1 mg/7.5 ml . 58lopinavir-ritonavir . . . . . . . . . . . . . . . . . 3lorata-dine d . . . . . . . . . . . . . . . . . . . . . 78loratadine-d . . . . . . . . . . . . . . . . . . . . . 78loratadine oral solution . . . . . . . . . . . 78loratadine oral tablet . . . . . . . . . . . . . 78lorazepam injection . . . . . . . . . . . . . . 33lorazepam intensol . . . . . . . . . . . . . . 33lorazepam oral concentrate . . . . . . 33lorazepam oral tablet 0.5 mg, 1 mg 33lorazepam oral tablet 2 mg . . . . . . . 33LORBRENA ORAL TABLET 25 MG 15LORBRENA ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 15lorcet hd . . . . . . . . . . . . . . . . . . . . . . . . 26loryna (28) . . . . . . . . . . . . . . . . . . . . . . 70losartan . . . . . . . . . . . . . . . . . . . . . . . . . 37losartan-hydrochlorothiazide oral tablet 50-12.5 mg . . . . . . . . . . . . 38losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg . . . 38LOTEMAX . . . . . . . . . . . . . . . . . . . . . . 75LOTEMAX SM . . . . . . . . . . . . . . . . . . 75lovastatin . . . . . . . . . . . . . . . . . . . . . . . 41low-ogestrel (28) . . . . . . . . . . . . . . . . 70loxapine succinate . . . . . . . . . . . . . . . 33lo-zumandimine (28) . . . . . . . . . . . . . 70LUBRICANT EYE (PG-PEG 400) . 74lubricating plus . . . . . . . . . . . . . . . . . . 74lubrifresh pm . . . . . . . . . . . . . . . . . . . . 74LUMIGAN OPHTHALMIC (EYE) DROPS 0.01% . . . . . . . . . . . . 74LUMIZYME . . . . . . . . . . . . . . . . . . . . . 56LUMOXITI . . . . . . . . . . . . . . . . . . . . . . 15LUPRON DEPOT . . . . . . . . . . . . . . . 15

LUPRON DEPOT (3 MONTH) . . . . 15LUPRON DEPOT (4 MONTH) . . . . 15LUPRON DEPOT (6 MONTH) . . . . 15LUPRON DEPOT-PED . . . . . . . . . . 15LUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG . . . . . . . . . 15LUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG . . . . . . . . . . . . 15lutera (28) . . . . . . . . . . . . . . . . . . . . . . . 70LYNPARZA ORAL TABLET . . . . . . . 15LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 165 MG, 82.5 MG . . . . . . . . . 21LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HR 330 MG . . . . . . . . . . . . . . . . . . 21LYRICA ORAL CAPSULE 75 MG . 21LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 25 MG, 50 MG . . . . . . . . . . . . . . . . . . 21LYRICA ORAL CAPSULE 225 MG, 300 MG . . . . . . . . . . . . . . . . 21LYRICA ORAL SOLUTION . . . . . . . 21lysiplex plus oral liquid . . . . . . . . . . . 97LYSODREN . . . . . . . . . . . . . . . . . . . . . 15LYUMJEV KWIKPEN U-100 INSULIN . . . . . . . . . . . . . . . . . . 54LYUMJEV KWIKPEN U-200 INSULIN . . . . . . . . . . . . . . . . . . 54LYUMJEV U-100 INSULIN . . . . . . . 54lyza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

MMAGNESIUM GLUCONATE ORAL TABLET 30 MG (550 MG) . 86MAGNESIUM L-LACTATE . . . . . . . 60MAGNESIUM ORAL TABLET 30 MG . . . . . . . . . . . . . . . . . 86magnesium oral tablet 250 mg . . . 60MAGNESIUM (OXIDE/AA CHELATE) . . . . . . . . . . . 86magnesium oxide oral capsule 500 mg . . . . . . . . . . . . . 86magnesium oxide oral tablet 400 mg (241.3 mg magnesium) . . . 60

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magnesium oxide oral tablet 420 mg . . . . . . . . . . . . . . . 86MAGNESIUM OXIDE ORAL TABLET 500 MG . . . . . . . . . . 86MAGNESIUM SULFATE IN D5W INTRAVENOUS PIGGYBACK 1 GRAM/100 ML . . . 87magnesium sulfate injection . . . . . . 87magnesium sulfate in water . . . . . . 87MAGTAB . . . . . . . . . . . . . . . . . . . . . . . . 60malathion . . . . . . . . . . . . . . . . . . . . . . . 48mapap (acetaminophen) oral capsule . . . . . . . . . . . . . . . . . . . . . 28mapap (acetaminophen) oral liquid 500 mg/15 ml . . . . . . . . . . 28mapap (acetaminophen) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 28mapap arthritis pain . . . . . . . . . . . . . . 28mapap cold formula . . . . . . . . . . . . . . 78mapap extra strength . . . . . . . . . . . . 28maprotiline . . . . . . . . . . . . . . . . . . . . . . 33marlissa (28) . . . . . . . . . . . . . . . . . . . . 71MARPLAN . . . . . . . . . . . . . . . . . . . . . . 33MATULANE . . . . . . . . . . . . . . . . . . . . . 15matzim la . . . . . . . . . . . . . . . . . . . . . . . 38MAVYRET . . . . . . . . . . . . . . . . . . . . . . . 3meclizine oral tablet 12.5 mg, 25 mg . . . . . . . . . . . . . . . . . . 60MEDI-PADS . . . . . . . . . . . . . . . . . . . . . 43MEDROL ORAL TABLET 2 MG . . . 51medroxyprogesterone . . . . . . . . . . . . 67MEDTYCHOLL- B COMPLEX-LIVER . . . . . . . . . . . . . 97mefloquine . . . . . . . . . . . . . . . . . . . . . . . 8mega multi for women . . . . . . . . . . . 97mega multiple/chelated mineral . . . 97mega multivitamin for men . . . . . . . 97megestrol oral suspension 400 mg/10 ml (10 ml), 400 mg/10 ml (40 mg/ml) . . . . . . . . . 15megestrol oral tablet . . . . . . . . . . . . . 15MEKINIST ORAL TABLET 0.5 MG 15MEKINIST ORAL TABLET 2 MG . . 15MEKTOVI . . . . . . . . . . . . . . . . . . . . . . . 15melodetta 24 fe . . . . . . . . . . . . . . . . . . 71

meloxicam oral tablet . . . . . . . . . . . . 28melphalan . . . . . . . . . . . . . . . . . . . . . . . 15melphalan hcl . . . . . . . . . . . . . . . . . . . 15memantine oral capsule, sprinkle,er 24hr . . . . . . . . . . . . . . . . . . 24memantine oral solution . . . . . . . . . . 24memantine oral tablet 5 mg . . . . . . 24memantine oral tablet 10 mg . . . . . 24MEMANTINE ORAL TABLETS,DOSE PACK . . . . . . . . . . 24MENACTRA (PF) INTRAMUSCULAR SOLUTION . . 64M-END DMX . . . . . . . . . . . . . . . . . . . . 78MENEST ORAL TABLET 0.3 MG, 0.625 MG, 1.25 MG . . . . . 67MENOSTAR . . . . . . . . . . . . . . . . . . . . 67men’s one daily oral tablet . . . . . . 97MENTHOL-ZINC OXIDE . . . . . . . . . 43MENVEO A-C-Y-W-135-DIP (PF) . 64MEPHYTON . . . . . . . . . . . . . . . . . . . . 40mercaptopurine . . . . . . . . . . . . . . . . . . 15MERIBIN . . . . . . . . . . . . . . . . . . . . . . . . 97meropenem . . . . . . . . . . . . . . . . . . . . . . 8MEROPENEM- 0.9% SODIUM CHLORIDE . . . . . . . . 8mesalamine oral capsule, extended release 24hr . . . . . . . . . . . 60mesalamine oral tablet,delayed release (dr/ec) 1.2 gram . . . . . . . . . 60mesalamine rectal enema . . . . . . . . 60mesalamine with cleansing wipe . . 60mesna . . . . . . . . . . . . . . . . . . . . . . . . . . 11MESNEX ORAL . . . . . . . . . . . . . . . . . 11metafolbic . . . . . . . . . . . . . . . . . . . . . . . 97metaproterenol oral syrup . . . . . . . . 83metformin oral solution . . . . . . . . . . . 54metformin oral tablet 1,000 mg . . . 54metformin oral tablet 500 mg . . . . . 54metformin oral tablet 850 mg . . . . . 54metformin oral tablet extended release 24 hr 500 mg (generic for Glucophage XR) . . . . . . . . . . . . . . . . . 54metformin oral tablet extended release 24 hr 750 mg (generic for Glucophage XR) . . . . . 54

metformin oral tablet extended release (osm) 24 hr 1000mg, 500mg (Generic for Fortamet) . . . . 54methadone injection solution . . . . . 26methadone intensol . . . . . . . . . . . . . . 26methadone oral concentrate . . . . . . 26methadone oral solution 5 mg/5 ml .26methadone oral solution 10 mg/5 ml . . . . . . . . . . . . . . . . . . . . . . 26methadone oral tablet 5 mg . . . . . . 26methadone oral tablet 10 mg . . . . . 26methazolamide . . . . . . . . . . . . . . . . . . 74methenamine hippurate . . . . . . . . . . 10methimazole oral tablet 10 mg, 5 mg . . . . . . . . . . . . . . . . . . . . . 52methocarbamol oral . . . . . . . . . . . . . 24methotrexate sodium . . . . . . . . . . . . 15methotrexate sodium (pf) . . . . . . . . . 15methoxsalen . . . . . . . . . . . . . . . . . . . . 43methyldopa . . . . . . . . . . . . . . . . . . . . . 38methylphenidate hcl oral tablet . . . 33methylphenidate hcl oral tablet extended release . . . . . . . . . . . . . . . . 33methylphenidate hcl oral tablet extended release 24hr 18 mg, 18 mg (bx rating) . . . . . . . . . . . . . . . . 33methylphenidate hcl oral tablet extended release 24hr 27 mg, 27 mg (bx rating), 54 mg, 54 mg (bx rating) . . . . . . . . . . . . . . . . 33methylphenidate hcl oral tablet extended release 24hr 36 mg, 36 mg (bx rating) . . . . . . . . . . . . . . . . 33methylprednisolone . . . . . . . . . . . . . . 51methylprednisolone acetate . . . . . . 51methylprednisolone sodium succ injection recon soln 125 mg, 40 mg 51methylprednisolone sodium succ intravenous recon soln 1,000 mg . 52methylprednisolone sodium succ intravenous recon soln 500 mg . . . 52metoclopramide hcl injection solution . . . . . . . . . . . . . . . . . 60metoclopramide hcl oral solution . . 60metoclopramide hcl oral tablet . . . . 60metolazone . . . . . . . . . . . . . . . . . . . . . 38

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metoprolol succinate . . . . . . . . . . . . . 38metoprolol ta-hydrochlorothiaz . . . 38metoprolol tartrate oral . . . . . . . . . . . 38metro i.v. . . . . . . . . . . . . . . . . . . . . . . . . . 8metronidazole in nacl (iso-os) . . . . . 8metronidazole oral tablet . . . . . . . . . . 8metronidazole topical . . . . . . . . . . . . 45metronidazole vaginal . . . . . . . . . . . . 68metyrosine . . . . . . . . . . . . . . . . . . . . . . 38mexiletine . . . . . . . . . . . . . . . . . . . . . . . 36MG-PLUS-PROTEIN . . . . . . . . . . . . 87MIACALCIN INJECTION . . . . . . . . . 56mi-acid . . . . . . . . . . . . . . . . . . . . . . . . . . 60mi-acid gas relief(simethicon) . . . . 60mibelas 24 fe . . . . . . . . . . . . . . . . . . . . 71micafungin . . . . . . . . . . . . . . . . . . . . . . . 1miconazole-3 vaginal kit . . . . . . . . . 68miconazole 7 . . . . . . . . . . . . . . . . . . . . 68miconazole nitrate topical cream . . 46miconazole nitrate vaginal cream . 68MICONAZOLE NITRATE VAGINAL KIT 1,200-2 MG-% . . . . . 68microgestin 1.5/30 (21) . . . . . . . . . . 71microgestin 1/20 (21) . . . . . . . . . . . . 71microgestin fe 1.5/30 (28) . . . . . . . . 71microgestin fe 1/20 (28) . . . . . . . . . . 71midodrine . . . . . . . . . . . . . . . . . . . . . . . 49MIGERGOT . . . . . . . . . . . . . . . . . . . . . 23miglitol . . . . . . . . . . . . . . . . . . . . . . . . . . 54miglustat . . . . . . . . . . . . . . . . . . . . . . . . 56migraine relief . . . . . . . . . . . . . . . . . . . 28mili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71milk of magnesia . . . . . . . . . . . . . . . . 60milk of magnesia concentrated . . . 60minitran . . . . . . . . . . . . . . . . . . . . . . . . . 42minocycline oral capsule . . . . . . . . . 10minocycline oral tablet . . . . . . . . . . . 10minoxidil oral . . . . . . . . . . . . . . . . . . . . 38mintox maximum strength . . . . . . . . 60mintox plus . . . . . . . . . . . . . . . . . . . . . . 60mirtazapine oral tablet . . . . . . . . . . . 33mirtazapine oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 33

misoprostol . . . . . . . . . . . . . . . . . . . . . 62MITIGARE . . . . . . . . . . . . . . . . . . . . . . 65MITIGO (PF) . . . . . . . . . . . . . . . . . . . . 26M-M-R II (PF) . . . . . . . . . . . . . . . . . . . 64moexipril . . . . . . . . . . . . . . . . . . . . . . . . 38MOISTUREL THERAPEUTIC . . . . 43molindone . . . . . . . . . . . . . . . . . . . . . . . 33mometasone nasal . . . . . . . . . . . . . . 83mometasone topical . . . . . . . . . . . . . 47mondoxyne nl oral capsule 100 mg, 75 mg . . . . . . . . . . 10MONJUVI . . . . . . . . . . . . . . . . . . . . . . . 15MONOCAL . . . . . . . . . . . . . . . . . . . . . . 87mono-linyah . . . . . . . . . . . . . . . . . . . . . 71montelukast . . . . . . . . . . . . . . . . . . . . . 83MONUROL . . . . . . . . . . . . . . . . . . . . . 10morgidox . . . . . . . . . . . . . . . . . . . . . . . . 10morphine concentrate oral solution 26MORPHINE INJECTION SOLUTION 2 MG/ML . . . . . . . . . . . . 26MORPHINE INJECTION SOLUTION 4 MG/ML . . . . . . . . . . . . 26MORPHINE INJECTION SOLUTION 5 MG/ML . . . . . . . . . . . . 26morphine injection solution 8 mg/ml . . . . . . . . . . . . . . . . . 26MORPHINE INJECTION SOLUTION 10 MG/ML . . . . . . . . . . . 26MORPHINE INJECTION SYRINGE 2 MG/ML . . . . . . . . . . . . . 26morphine injection syringe 4 mg/ml 26morphine injection syringe 5 mg/ml 26morphine injection syringe 8 mg/ml 26morphine injection syringe 10 mg/ml . . . . . . . . . . . . . . . . 26MORPHINE INTRAVENOUS SOLUTION 4 MG/ML . . . . . . . . . . . . 26MORPHINE INTRAVENOUS SOLUTION 8 MG/ML . . . . . . . . . . . . 26morphine intravenous solution 10 mg/ml . . . . . . . . . . . . . . . . 26morphine intravenous syringe 2 mg/ml . . . . . . . . . . . . . . . . . 26morphine intravenous syringe 4 mg/ml . . . . . . . . . . . . . . . . . 26

MORPHINE INTRAVENOUS SYRINGE 8 MG/ML . . . . . . . . . . . . . 26MORPHINE INTRAVENOUS SYRINGE 10 MG/ML . . . . . . . . . . . . 26morphine oral solution 10 mg/5 ml 26morphine oral solution 20 mg/5 ml (4 mg/ml) . . . . . . . . . . . . 26MORPHINE ORAL TABLET . . . . . . 27morphine oral tablet extended release . . . . . . . . . . . . . . . . 27morphine (pf) injection solution 0.5 mg/ml, 1 mg/ml . . . . . . 26motion sickness relief . . . . . . . . . . . . 60moxifloxacin ophthalmic (eye) drops . . . . . . . . . . . . . . . . . . . . . . 73moxifloxacin oral . . . . . . . . . . . . . . . . 10MOXIFLOXACIN-SOD. ACE,SUL-WATER . . . . . . . . . . . . . . . 10moxifloxacin-sod.chloride(iso) . . . . 10MOZOBIL . . . . . . . . . . . . . . . . . . . . . . . 63m-pap . . . . . . . . . . . . . . . . . . . . . . . . . . 28MTX SUPPORT . . . . . . . . . . . . . . . . . 97MUCINEX COLD, FLU,SORE THROAT . . . . . . . . . . . . 79mucinex d . . . . . . . . . . . . . . . . . . . . . . . 79mucinex d maximum strength . . . . 79mucinex dm oral tablet extended release 12 hr 30-600 mg . . . . . . . . . 79MUCINEX DM ORAL TABLET EXTENDED RELEASE 12 HR 60-1,200 MG . . . . . . . . . . . . . 79MUCINEX FAST-MAX COLD-SINUS . . . . . . . . . . . . . . . . . . . 79MUCINEX FAST-MAX CONGEST-COUGH ORAL TABLET . . . . . . . . . . 79MUCINEX FAST-MAX DAY-NITE CONG ORAL TABLETS, SEQUENTIAL 5 MG (DY)/ 25 MG -5 MG-325MG(NT) . . . . . . . 79mucinex fast-max dm max . . . . . . . 79MUCINEX FAST-MAX NITE COLD-FLU ORAL LIQUID . . . . . . . . 79MUCINEX FAST-MAX SEVERE COLD ORAL LIQUID . . . 79MUCINEX FST-MX DY-NT COLD(DPH) ORAL LIQUID, SEQUENTIAL . . . . . . . . . . . . . . . . . . . 79

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MUCINEX ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG . . . . . . . . . . . . . . . . . 79mucinex oral tablet extended release 12hr 600 mg . . . 79MUCUS-CHEST CONGESTION. . 79mucus dm . . . . . . . . . . . . . . . . . . . . . . . 79mucus dm max er . . . . . . . . . . . . . . . 79mucus relief . . . . . . . . . . . . . . . . . . . . . 79mucus relief dm cough . . . . . . . . . . . 79mucus relief d (pseudoephed) oral tablet extended release 12 hr 60-600 mg . . . . . . . . . . . . . . . . . 79MUCUS RELIEF ER ORAL TABLET EXTENDED RELEASE 12HR 1,200 MG . . . . . . 79mucus relief er oral tablet extended release 12hr 600 mg . . . 79mucus relief sinus . . . . . . . . . . . . . . . 79MULTAQ . . . . . . . . . . . . . . . . . . . . . . . . 36multi complete with iron . . . . . . . . . . 97multi-day with iron . . . . . . . . . . . . . . . 97multi-delyn with iron . . . . . . . . . . . . . 97multiple vitamin-minerals . . . . . . . . . 97multiple vitamins . . . . . . . . . . . . . . . . . 97multi-vitamin hp/minerals . . . . . . . . . 97multivitamin oral tablet . . . . . . . . . . . 97multivitamins with fluoride . . . . . . . . 97multi-vitamin with fluoride oral drops . . . . . . . . . . . . . . . 97multivitamin with iron . . . . . . . . . . . . 97multivitamin with minerals . . . . . . . . 97multivitamin women 50 plus . . . . . . 97MULTI-VITE . . . . . . . . . . . . . . . . . . . . . 97multi-vit with fluoride-iron . . . . . . . . . 97mupirocin . . . . . . . . . . . . . . . . . . . . . . . 45mupirocin calcium . . . . . . . . . . . . . . . 45MURO 128 OPHTHALMIC (EYE) DROPS . . . . . . . . . . . . . . . . . . 74MVASI . . . . . . . . . . . . . . . . . . . . . . . . . . 15MVW COMPLETE FORMULATION D3000 . . . . . . . . . . 97MVW COMPLETE FORMULATION D5000 . . . . . . . . . . 97

MVW COMPLETE FORMUL MULTIVIT . . . . . . . . . . . . . 97MVW COMPLETE FORMUL PEDIATRIC . . . . . . . . . . . . 97MYCAMINE . . . . . . . . . . . . . . . . . . . . . . 1mycophenolate mofetil (hcl) . . . . . . 15mycophenolate mofetil oral capsule . . . . . . . . . . . . . . . . . . . . . 15mycophenolate mofetil oral suspension for reconstitution . . . . . 16mycophenolate mofetil oral tablet . 16mycophenolate sodium . . . . . . . . . . 16myferon 150 . . . . . . . . . . . . . . . . . . . . . 97myferon 150 forte . . . . . . . . . . . . . . . . 97MYLOTARG . . . . . . . . . . . . . . . . . . . . . 16mynephrocaps . . . . . . . . . . . . . . . . . . 97mynephron . . . . . . . . . . . . . . . . . . . . . . 97myorisan . . . . . . . . . . . . . . . . . . . . . . . . 45MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG . . . . . . . . . . . . . . . . . . . 84MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 50 MG . . . . . . . . . . . . . . . . . . . 84my-vitalife . . . . . . . . . . . . . . . . . . . . . . . 97my way . . . . . . . . . . . . . . . . . . . . . . . . . 71

Nnabumetone . . . . . . . . . . . . . . . . . . . . . 28nadolol . . . . . . . . . . . . . . . . . . . . . . . . . . 38nadolol-bendroflumethiazide oral tablet 80-5 mg . . . . . . . . . . . . . . . 38nafcillin . . . . . . . . . . . . . . . . . . . . . . . . . . 9nafcillin in dextrose iso-osm . . . . . . . 9naftifine topical cream . . . . . . . . . . . . 46NAFTIN TOPICAL GEL . . . . . . . . . . 46NAGLAZYME . . . . . . . . . . . . . . . . . . . 56nalbuphine injection solution 10 mg/ml . . . . . . . . . . . . . . . . 28nalbuphine injection solution 20 mg/ml . . . . . . . . . . . . . . . . 28naloxone injection solution . . . . . . . 28naloxone injection syringe 1 mg/ml . . . . . . . . . . . . . . . . . 28naltrexone . . . . . . . . . . . . . . . . . . . . . . 28

NAMZARIC ORAL CAP,SPRINKLE,ER 24HR DOSE PACK . . . . . . . . . . . . . . 24NAMZARIC ORAL CAPSULE, SPRINKLE,ER 24HR . . . . . . . . . . . . 24naproxen . . . . . . . . . . . . . . . . . . . . . . . . 28naproxen sodium oral tablet 220 mg . . . . . . . . . . . . . . . 28naproxen sodium oral tablet 275 mg, 550 mg . . . . . . . 28naratriptan . . . . . . . . . . . . . . . . . . . . . . 23NARCAN NASAL SPRAY,NON-AEROSOL 4 MG/ACTUATION . . . 28NASAL ALLERGY . . . . . . . . . . . . . . . 83nasal decongestant (oxymetazl) . . 51nasal decongestant (pseudoeph) oral tablet . . . . . . . . . . 79nasal spray (oxymetazoline) . . . . . . 51NASOPEN PE . . . . . . . . . . . . . . . . . . 79NATACYN . . . . . . . . . . . . . . . . . . . . . . . 73nateglinide oral tablet 60 mg . . . . . 54nateglinide oral tablet 120 mg . . . . 54NATPARA . . . . . . . . . . . . . . . . . . . . . . . 56NATRAPEL . . . . . . . . . . . . . . . . . . . . . 43natural fiber laxative (sugar) oral powder 3.4 gram/7 gram . . . . . 60NAYZILAM . . . . . . . . . . . . . . . . . . . . . . 21NEBUPENT . . . . . . . . . . . . . . . . . . . . . . 8necon 0.5/35 (28) . . . . . . . . . . . . . . . . 71NEEDLES, INSULIN DISP.,SAFETY . . . . . . . . . . . . . . . . . . 54nefazodone . . . . . . . . . . . . . . . . . . . . . 33neomycin . . . . . . . . . . . . . . . . . . . . . . . . 8neomycin-bacitracin-poly-hc . . . . . . 75neomycin-bacitracin-polymyxin . . . 73neomycin-polymyxin b-dexameth . 75neomycin-polymyxin b gu . . . . . . . . 48neomycin-polymyxin-gramicidin . . 73neomycin-polymyxin-hc ophthalmic (eye) . . . . . . . . . . . . . . . . . 75neomycin-polymyxin-hc otic (ear) . 51neo-polycin . . . . . . . . . . . . . . . . . . . . . 73neo-polycin hc . . . . . . . . . . . . . . . . . . . 75nephplex rx . . . . . . . . . . . . . . . . . . . . . 97

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NEPHRAMINE 5.4% . . . . . . . . . . . . . 89nephronex . . . . . . . . . . . . . . . . . . . . . . 97NEPHRON FA . . . . . . . . . . . . . . . . . . 97NEPHRO-VITE . . . . . . . . . . . . . . . . . . 97nephro-vite rx . . . . . . . . . . . . . . . . . . . 97NERLYNX . . . . . . . . . . . . . . . . . . . . . . 16NEUPRO . . . . . . . . . . . . . . . . . . . . . . . 22NEURIN-SL . . . . . . . . . . . . . . . . . . . . . 97nevirapine oral suspension . . . . . . . . 3nevirapine oral tablet . . . . . . . . . . . . . 3nevirapine oral tablet extended release 24 hr 100 mg . . . . . . . . . . . . . 3nevirapine oral tablet extended release 24 hr 400 mg . . . . . . . . . . . . . 3new day . . . . . . . . . . . . . . . . . . . . . . . . 71NEXAVAR . . . . . . . . . . . . . . . . . . . . . . . 16niacin oral capsule, extended release 250 mg . . . . . . . . 41niacin oral tablet 100 mg, 50 mg, 500 mg . . . . . . . . . . 41niacin oral tablet extended release 24 hr . . . . . . . . . . . . . . . . . . . . 41niacin oral tablet extended release 250 mg, 500 mg . . . . . . . . . 41niacor . . . . . . . . . . . . . . . . . . . . . . . . . . . 41nicardipine intravenous solution . . 38nicardipine oral . . . . . . . . . . . . . . . . . . 38NICODERM CQ . . . . . . . . . . . . . . . . . 50NICORETTE . . . . . . . . . . . . . . . . . . . . 50nicotine (polacrilex) buccal gum . . 50NICOTINE (POLACRILEX) BUCCAL LOZENGE 2 MG . . . . . . . 50nicotine (polacrilex) buccal lozenge 4 mg . . . . . . . . . . . . . . . . . . . . 50nicotine (polacrilex) buccal mini lozenge 2 mg . . . . . . . . . . . . . . . 50NICOTINE (POLACRILEX) BUCCAL MINI LOZENGE 4 MG . . 50nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 7 mg/24 hr . . . . . . . . . . 50nicotine transdermal patch, td daily, sequential . . . . . . . . . . . . . . . 50NICOTROL . . . . . . . . . . . . . . . . . . . . . 50NICOTROL NS . . . . . . . . . . . . . . . . . . 50

nifedipine oral tablet extended release . . . . . . . . . . . . . . . . 38nifedipine oral tablet extended release 24hr . . . . . . . . . . . 38nighttime cold-flu . . . . . . . . . . . . . . . . 79NIGHTTIME COLD-FLU RELIEF . 79nighttime sleep aid (diphen) oral tablet . . . . . . . . . . . . . . . 79nikki (28) . . . . . . . . . . . . . . . . . . . . . . . . 71nilutamide . . . . . . . . . . . . . . . . . . . . . . . 16nimodipine . . . . . . . . . . . . . . . . . . . . . . 38NINJACOF . . . . . . . . . . . . . . . . . . . . . . 80NINJACOF-XG . . . . . . . . . . . . . . . . . . 80NINLARO . . . . . . . . . . . . . . . . . . . . . . . 16nisoldipine . . . . . . . . . . . . . . . . . . . . . . 38NITE TIME COLD-FLU RELIEF ORAL CAPSULE . . . . . . . . 80nitisinone . . . . . . . . . . . . . . . . . . . . . . . 49nitrofurantoin . . . . . . . . . . . . . . . . . . . . 10nitrofurantoin macrocrystal . . . . . . . 10nitrofurantoin monohyd/m-cryst . . . 10nitroglycerin intravenous . . . . . . . . . 42nitroglycerin sublingual . . . . . . . . . . . 42nitroglycerin transdermal patch 24 hour . . . . . . . . . . . . . . . . . . . 42nitroglycerin translingual spray,non-aerosol . . . . . . . . . . . . . . . 42NIVA-FOL . . . . . . . . . . . . . . . . . . . . . . . 97nizatidine oral capsule . . . . . . . . . . . 62nohist-dm . . . . . . . . . . . . . . . . . . . . . . . 80nohist-lq . . . . . . . . . . . . . . . . . . . . . . . . 80non-aspirin pm . . . . . . . . . . . . . . . . . . 29nora-be . . . . . . . . . . . . . . . . . . . . . . . . . 67noreth-ethinyl estradiol-iron . . . . . . 71norethindrone acetate . . . . . . . . . . . . 67norethindrone ac-eth estradiol oral tablet 0.5-2.5 mg-mcg . . . . . . . 68norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg, 1.5-30 mg-mcg . . . . . . . . . . . . . . . . . . 71norethindrone (contraceptive) . . . . 67norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (21)/75 mg (7), 1.5 mg- 30 mcg (21)/75 mg (7) . . . . . . . . . . . 71

norethindrone-e.estradiol-iron oral tablet,chewable . . . . . . . . . . . . . 71norgestimate-ethinyl estradiol . . . . 71NORMOSOL-M IN 5% DEXTROSE . . . . . . . . . . . . . . 89NORMOSOL-R . . . . . . . . . . . . . . . . . . 87NORMOSOL-R PH 7.4 . . . . . . . . . . 89NORTHERA ORAL CAPSULE 100 MG . . . . . . . . . . . . . . 49NORTHERA ORAL CAPSULE 200 MG, 300 MG . . . . . 49nortrel 0.5/35 (28) . . . . . . . . . . . . . . . 71nortrel 1/35 (21) . . . . . . . . . . . . . . . . . 71nortrel 1/35 (28) . . . . . . . . . . . . . . . . . 71nortrel 7/7/7 (28) . . . . . . . . . . . . . . . . . 71nortriptyline . . . . . . . . . . . . . . . . . . . . . 33NORVIR ORAL POWDER IN PACKET . . . . . . . . . . . . . . . . . . . . . . 3NORVIR ORAL SOLUTION . . . . . . . 3NORVIR ORAL TABLET . . . . . . . . . . 3NOVOFINE PEN NEEDLE . . . . . . . 54NOVOTWIST PEN NEEDLE . . . . . 54NOXAFIL ORAL SUSPENSION . . . 1NOXAFIL ORAL TABLET, DELAYED RELEASE (DR/EC) . . . . 1NUBEQA . . . . . . . . . . . . . . . . . . . . . . . 16NUEDEXTA . . . . . . . . . . . . . . . . . . . . . 24NU-IRON . . . . . . . . . . . . . . . . . . . . . . . 98NULOJIX . . . . . . . . . . . . . . . . . . . . . . . 16NU-MAG . . . . . . . . . . . . . . . . . . . . . . . . 87NUPLAZID ORAL CAPSULE . . . . . 33NUPLAZID ORAL TABLET 10 MG . 33NUTRILIPID . . . . . . . . . . . . . . . . . . . . . 89NUTRIVIT . . . . . . . . . . . . . . . . . . . . . . . 98NUZYRA INTRAVENOUS . . . . . . . . 10NUZYRA ORAL . . . . . . . . . . . . . . . . . 10nyamyc . . . . . . . . . . . . . . . . . . . . . . . . . 46nystatin oral suspension . . . . . . . . . . 1nystatin oral tablet . . . . . . . . . . . . . . . . 1nystatin topical cream . . . . . . . . . . . . 46nystatin topical ointment . . . . . . . . . 46nystatin topical powder . . . . . . . . . . . 46nystatin-triamcinolone . . . . . . . . . . . . 46nystop . . . . . . . . . . . . . . . . . . . . . . . . . . 46

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OOCALIVA . . . . . . . . . . . . . . . . . . . . . . . 60ocella . . . . . . . . . . . . . . . . . . . . . . . . . . . 71OCREVUS . . . . . . . . . . . . . . . . . . . . . . 24octreotide acetate injection solution 16ocutabs . . . . . . . . . . . . . . . . . . . . . . . . . 98ODEFSEY . . . . . . . . . . . . . . . . . . . . . . . 3ODOMZO . . . . . . . . . . . . . . . . . . . . . . . 16OFEV . . . . . . . . . . . . . . . . . . . . . . . . . . . 83OFF DEEP WOODS . . . . . . . . . . . . . 43OFF DEEP WOODS DRY . . . . . . . . 43OFF DEEP WOODS SPORTSMEN TOPICAL AEROSOL,SPRAY . . . . . 43OFF DEEP WOODS SPORTSMEN TOPICAL SPRAY,NON-AEROSOL 25% . . . . 44ofloxacin ophthalmic (eye) . . . . . . . 73ofloxacin otic (ear) . . . . . . . . . . . . . . . 73OGIVRI . . . . . . . . . . . . . . . . . . . . . . . . . 16olanzapine-fluoxetine . . . . . . . . . . . . 33olanzapine intramuscular . . . . . . . . . 33olanzapine oral tablet 7.5 mg . . . . . 33olanzapine oral tablet 10 mg, 2.5 mg, 5 mg . . . . . . . . . . . . . 33olanzapine oral tablet 15 mg, 20 mg . . . . . . . . . . . . . . . . . . . 33olanzapine oral tablet, disintegrating . . . . . . . . . . . . . . . . . . . . 33olmesartan . . . . . . . . . . . . . . . . . . . . . . 38olmesartan-hydrochlorothiazide . . 38olopatadine ophthalmic (eye) . . . . . 74omega-3 acid ethyl esters . . . . . . . . 41omeprazole magnesium oral capsule,delayed release(dr/ec) . . . 62OMEPRAZOLE MAGNESIUM ORAL TABLET,DELAYED RELEASE (DR/EC) . . . . . . . . . . . . . . 62omeprazole oral capsule, delayed release(dr/ec) . . . . . . . . . . . 62omeprazole oral tablet, delayed release (dr/ec) . . . . . . . . . . 62omnicap . . . . . . . . . . . . . . . . . . . . . . . . 98OMNIPOD 5 PACK . . . . . . . . . . . . . . 54OMNIPOD DASH 5 PACK. . . . . . . . 54OMNIPOD STARTER KIT . . . . . . . . 54

once daily . . . . . . . . . . . . . . . . . . . . . . . 98ONCOVITE . . . . . . . . . . . . . . . . . . . . . 98ondansetron . . . . . . . . . . . . . . . . . . . . . 60ondansetron hcl intravenous . . . . . 60ondansetron hcl oral solution . . . . . 60ondansetron hcl oral tablet . . . . . . . 60ondansetron hcl (pf) . . . . . . . . . . . . . 60one-a-day essential . . . . . . . . . . . . . . 98ONE-A-DAY MEN’S 50PLUS(GINKGO) . . . . . . . . . . . . . . 98one-a-day teen advantage . . . . . . . 98ONE-A-DAY WOMENS FORMULA ORAL TABLET 18 MG IRON-400 MCG-500 MG CA . . . . . 98one daily calcium/iron . . . . . . . . . . . . 98one daily complete . . . . . . . . . . . . . . . 98one daily energy oral tablet . . . . . 98one daily essential oral tablet, 0.4 mg . . . . . . . . . . . . . . . 98one daily for men 50+ advanced . . 98one daily for women . . . . . . . . . . . . . 98one daily maximum . . . . . . . . . . . . . . 98one daily men’s 50 plus memory . . 98one daily multivitamin oral tablet . . 98one daily multivit-iron(folic) . . . . . . . 98one daily plus iron oral tablet 18-400 mg-mcg . . . . . . . . . . . . . . . . . 98one daily plus minerals . . . . . . . . . . . 98ONE DAILY WOMEN 50 PLUS . . . 98one daily womens 50 plus . . . . . . . . 98one daily women’s oral tablet 27-0.4 mg . . . . . . . . . . . . . 98ONTRUZANT . . . . . . . . . . . . . . . . . . . 16opcicon one-step . . . . . . . . . . . . . . . . 71OPDIVO . . . . . . . . . . . . . . . . . . . . . . . . 16OPSUMIT . . . . . . . . . . . . . . . . . . . . . . . 83oralone . . . . . . . . . . . . . . . . . . . . . . . . . 51oralyte . . . . . . . . . . . . . . . . . . . . . . . . . . 87ORAZINC . . . . . . . . . . . . . . . . . . . . . . . 87ORBACTIV . . . . . . . . . . . . . . . . . . . . . . 8ORENCIA . . . . . . . . . . . . . . . . . . . . . . . 66ORENCIA CLICKJECT . . . . . . . . . . 67ORFADIN . . . . . . . . . . . . . . . . . . . . . . . 49

ORKAMBI ORAL GRANULES IN PACKET . . . . . . . . . 83ORKAMBI ORAL TABLET . . . . . . . . 83orsythia . . . . . . . . . . . . . . . . . . . . . . . . . 71OS-CAL 500 + D3 . . . . . . . . . . . . . . . 87oseltamivir . . . . . . . . . . . . . . . . . . . . . . . 3OSMOPREP . . . . . . . . . . . . . . . . . . . . 60oxacillin injection . . . . . . . . . . . . . . . . . 9oxandrolone oral tablet 2.5 mg . . . 56oxandrolone oral tablet 10 mg . . . . 56oxaprozin . . . . . . . . . . . . . . . . . . . . . . . 29oxazepam . . . . . . . . . . . . . . . . . . . . . . . 33oxcarbazepine . . . . . . . . . . . . . . . . . . 21oxybutynin chloride oral syrup . . . . 84oxybutynin chloride oral tablet . . . . 84oxybutynin chloride oral tablet extended release 24hr . . . . . . . . . . . 84oxycodone-acetaminophen oral tablet 2.5-300 mg . . . . . . . . . . . . 27oxycodone-acetaminophen oral tablet 2.5-325 mg, 5-325 mg . 27oxycodone-acetaminophen oral tablet 7.5-325 mg . . . . . . . . . . . . 27oxycodone-acetaminophen oral tablet 10-325 mg . . . . . . . . . . . . 27oxycodone-aspirin . . . . . . . . . . . . . . . 27oxycodone oral concentrate . . . . . . 27oxycodone oral solution . . . . . . . . . . 27oxycodone oral tablet . . . . . . . . . . . . 27oxymorphone oral tablet extended release 12 hr . . . . . . . . . . 27oysco 500/d oral tablet . . . . . . . . . . . 87oystercal-d . . . . . . . . . . . . . . . . . . . . . . 87oyster shell + d3 . . . . . . . . . . . . . . . . . 87oyster shell calcium 500 . . . . . . . . . 87oyster shell calcium and mag . . . . . 87OYSTER SHELL CALCIUM- VIT D3 ORAL TABLET 250-125 MG-UNIT . . . . . . . . . . . . . . . 87oyster shell calcium-vit d3 oral tablet 500 mg(1,250mg) - 200 unit, 500 mg(1,250mg) - 400 unit . . . . . . . . . . . . . . . . . . . . . . . . . 87OZEMPIC . . . . . . . . . . . . . . . . . . . . . . . 54

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Ppacerone oral tablet 100 mg, 200 mg, 400 mg . . . . . . . . . 36paclitaxel . . . . . . . . . . . . . . . . . . . . . . . . 16PADCEV . . . . . . . . . . . . . . . . . . . . . . . . 16PAIN RELIEVING (M-SALIC-MEN) . 44paliperidone oral tablet extended release 24hr 1.5 mg, 3 mg, 9 mg . 33paliperidone oral tablet extended release 24hr 6 mg . . . . . . 33palonosetron intravenous solution 0.25 mg/5 ml . . . . . . . . . . . . 60pamidronate . . . . . . . . . . . . . . . . . . . . . 56PANRETIN . . . . . . . . . . . . . . . . . . . . . . 44pantoprazole oral tablet, delayed release (dr/ec) . . . . . . . . . . 62paricalcitol oral . . . . . . . . . . . . . . . . . . 56paroex oral rinse . . . . . . . . . . . . . . . . 51paromomycin . . . . . . . . . . . . . . . . . . . . . 8paroxetine hcl oral tablet 10 mg, 30 mg, 40 mg . . . . . . . . . . . . 34paroxetine hcl oral tablet 20 mg . . 34paroxetine hcl oral tablet extended release 24 hr 12.5 mg . . 34paroxetine hcl oral tablet extended release 24 hr 25 mg, 37.5 mg . . . . 34PASER . . . . . . . . . . . . . . . . . . . . . . . . . . 8PAXIL ORAL SUSPENSION . . . . . 34PAZEO . . . . . . . . . . . . . . . . . . . . . . . . . 74PEDIACLEAR-8 . . . . . . . . . . . . . . . . . 80PEDIACLEAR ALLERGY . . . . . . . . 80PEDIACLEAR COUGH . . . . . . . . . . 80PEDIACLEAR PD . . . . . . . . . . . . . . . 80PEDIA D-VITE ORAL DROPS . . . . 98pedia iron . . . . . . . . . . . . . . . . . . . . . . . 98PEDIALYTE ADVANCED CARE . . 87pedialyte freezer pops . . . . . . . . . . . 87pedialyte oral solution . . . . . . . . . . . . 87pedialyte singles . . . . . . . . . . . . . . . . . 87PEDIARIX (PF) . . . . . . . . . . . . . . . . . . 64pediatric cough and cold oral liquid 1-15-5 mg/5 ml . . . . . . . . 80pediatric electrolyte oral solution . . 87pediatric freezer pops . . . . . . . . . . . . 87

PEDIA TRI-VITE . . . . . . . . . . . . . . . . . 98PEDVAX HIB (PF) . . . . . . . . . . . . . . . 64peg 3350-electrolytes oral recon soln 236-22.74-6.74 -5.86 gram . . 60PEGANONE . . . . . . . . . . . . . . . . . . . . 21peg-electrolyte . . . . . . . . . . . . . . . . . . 60PEMAZYRE . . . . . . . . . . . . . . . . . . . . . 16penicillamine . . . . . . . . . . . . . . . . . . . . 67penicillin g potassium . . . . . . . . . . . . . 9penicillin v potassium . . . . . . . . . . . . . 9PENTACEL (PF) INTRAMUSCULAR KIT 15LF- 48MCG-62DU -10 MCG/0.5ML . . . 64PENTAM . . . . . . . . . . . . . . . . . . . . . . . . . 8pentamidine inhalation . . . . . . . . . . . . 8pentamidine injection . . . . . . . . . . . . . 8PENTASA . . . . . . . . . . . . . . . . . . . . . . . 60pentoxifylline . . . . . . . . . . . . . . . . . . . . 40peptic relief oral tablet,chewable . . 58PERFOROMIST . . . . . . . . . . . . . . . . . 83PERIDIN-C . . . . . . . . . . . . . . . . . . . . . 98PERIKABIVEN . . . . . . . . . . . . . . . . . . 89perindopril erbumine . . . . . . . . . . . . . 38PERJETA . . . . . . . . . . . . . . . . . . . . . . . 16permethrin topical cream . . . . . . . . . 48perphenazine . . . . . . . . . . . . . . . . . . . 34perphenazine-amitriptyline . . . . . . . 34PERSERIS . . . . . . . . . . . . . . . . . . . . . . 34pfizerpen-g . . . . . . . . . . . . . . . . . . . . . . . 9phenelzine . . . . . . . . . . . . . . . . . . . . . . 34PHENOBARBITAL ORAL ELIXIR . 21PHENOBARBITAL ORAL TABLET 21phenoxybenzamine . . . . . . . . . . . . . . 38PHENYLEPHRINE-DM-GUAIFENESIN ORAL LIQUID 10-18-200 MG/15 ML . . . . . . . . . . . . 80PHENYLEPHRINE-DM-GUAIFENESIN ORAL TABLET . . . 80phenytoin oral suspension . . . . . . . 21phenytoin oral tablet,chewable . . . 21phenytoin sodium extended . . . . . . 21PHESGO . . . . . . . . . . . . . . . . . . . . . . . 16philith . . . . . . . . . . . . . . . . . . . . . . . . . . . 71PHILLIPS . . . . . . . . . . . . . . . . . . . . . . . 87

PHOSLYRA . . . . . . . . . . . . . . . . . . . . . 87phospha 250 neutral . . . . . . . . . . . . . 87PHOSPHOLINE IODIDE . . . . . . . . . 74phosphorous . . . . . . . . . . . . . . . . . . . . 87phospho-trin 250 neutral . . . . . . . . . 87PHYSIOLYTE . . . . . . . . . . . . . . . . . . . 48PHYSIOSOL IRRIGATION . . . . . . . 48phytonadione (vitamin k1) oral tablet 5 mg . . . . . . . . . . . . . . . . . . 40PICATO TOPICAL GEL 0.05% . . . 44PICATO TOPICAL GEL 0.015% . . 44PIFELTRO . . . . . . . . . . . . . . . . . . . . . . . 3pilocarpine hcl ophthalmic (eye) drops 1%, 2%, 4% . . . . . . . . . 74pilocarpine hcl oral . . . . . . . . . . . . . . . 49pimecrolimus . . . . . . . . . . . . . . . . . . . . 44pimozide . . . . . . . . . . . . . . . . . . . . . . . . 34pimtrea (28) . . . . . . . . . . . . . . . . . . . . . 71pindolol . . . . . . . . . . . . . . . . . . . . . . . . . 38pioglitazone-metformin . . . . . . . . . . . 54pioglitazone oral tablet 15 mg . . . . 54pioglitazone oral tablet 30 mg, 45 mg . . . . . . . . . . . . . . . . . . . 54piperacillin-tazobactam intravenous recon soln 2.25 gram, 3.375 gram, 4.5 gram, 40.5 gram . . 9PIPERACILLIN-TAZOBACTAM INTRAVENOUS RECON SOLN 13.5 GRAM . . . . . . . . . . . . . . . . . . . . . . 9PIQRAY ORAL TABLET 200 MG/DAY (200 MG X 1) . . . . . . 16PIQRAY ORAL TABLET 250 MG/DAY (200 MG X1-50 MG X1), 300 MG/DAY (150 MG X 2) . . 16pirmella . . . . . . . . . . . . . . . . . . . . . . . . . 71PLENAMINE . . . . . . . . . . . . . . . . . . . . 89PLENVU . . . . . . . . . . . . . . . . . . . . . . . . 60podofilox . . . . . . . . . . . . . . . . . . . . . . . . 44POLY BACITRACIN (ZINC) . . . . . . 45polycin . . . . . . . . . . . . . . . . . . . . . . . . . . 73polyethylene glycol 3350 . . . . . . . . . 60POLY-HIST DM (THONZYLAMINE) . . . . . . . . . . . . . . 80POLY HIST FORTE . . . . . . . . . . . . . . 80

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POLY HIST FORTE (DOXYLAMINE) . . . . . . . . . . . . . . . . . 80POLY HIST PD . . . . . . . . . . . . . . . . . . 80poly-iron . . . . . . . . . . . . . . . . . . . . . . . . 98poly-iron 150 forte . . . . . . . . . . . . . . . 98polymyxin b sulfate . . . . . . . . . . . . . . . 8polymyxin b sulf-trimethoprim . . . . 73polysaccharide iron complex . . . . . 98POLYTUSSIN DM . . . . . . . . . . . . . . . 80POLY-VENT DM ORAL TABLET 60-20-380 MG . . . . . . . . . . 80POLY-VENT IR ORAL TABLET 60-380 MG . . . . . . . . . . . . . 80POLY-VI-FLOR . . . . . . . . . . . . . . . . . . 98POLY-VI-FLOR WITH IRON . . . . . . 98POLY-VI-SOL ORAL DROPS . . . . . 98POLY-VI-SOL WITH IRON . . . . . . . 98POMALYST . . . . . . . . . . . . . . . . . . . . . 16portia 28 . . . . . . . . . . . . . . . . . . . . . . . . 71posaconazole oral tablet, delayed release (dr/ec) . . . . . . . . . . . 1POTASSIUM CHLORID-D5-0.45%NACL INTRAVENOUS PARENTERAL SOLUTION 10 MEQ/L, 20 MEQ/L, 40 MEQ/L . . . . 87potassium chlorid-d5-0.45%nacl intravenous parenteral solution 30 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 87potassium chloride-0.45% nacl . . . 88POTASSIUM CHLORIDE-D5-0.2%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . . . . . . . . . . . . . 88potassium chloride-d5-0.2%nacl intravenous parenteral solution 30 meq/l, 40 meq/l . . . . . . . . . . . . . . . 88potassium chloride-d5-0.3%nacl intravenous parenteral solution 20 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 88POTASSIUM CHLORIDE-D5-0.9%NACL INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . . . . . . . . . . . . . 88potassium chloride-d5-0.9%nacl intravenous parenteral solution 40 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 88

potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l . . . . . . . . . . . . . . . 87POTASSIUM CHLORIDE IN 5% DEX INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . . . . . . . . . . . . . 88potassium chloride in 5% dex intravenous parenteral solution 30 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 88potassium chloride in 5% dex intravenous parenteral solution 40 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 88POTASSIUM CHLORIDE IN LR-D5 INTRAVENOUS PARENTERAL SOLUTION 20 MEQ/L . . . . . . . . . . . 88potassium chloride in lr-d5 intravenous parenteral solution 40 meq/l . . . . . . . . . . . . . . . . . . . . . . . . 88potassium chloride intravenous . . . 88potassium chloride in water intravenous piggyback . . . . . . . . . . . 88potassium chloride oral capsule, extended release . . . . . . . 88POTASSIUM CHLORIDE ORAL LIQUID . . . . . . . . . . . . . . . . . . . 88potassium chloride oral packet . . . 88potassium chloride oral tablet, er particles/crystals . . . . . . . . . . . . . . 88potassium chloride oral tablet extended release . . . . . . . . . . . . . . . . 88potassium citrate . . . . . . . . . . . . . . . . 85potassium citrate-citric acid oral solution . . . . . . . . . . . . . . . . . . . . . 85POTELIGEO . . . . . . . . . . . . . . . . . . . . 16povidone-iodine topical ointment . . 45povidone-iodine topical solution 10% . . . . . . . . . . . . . 45PRADAXA . . . . . . . . . . . . . . . . . . . . . . 40pramipexole oral tablet . . . . . . . . . . . 22pramipexole oral tablet extended release 24 hr 0.375 mg, 0.75 mg, 1.5 mg . . . . . . . . . . . . . . . . . . . . . . . . . . 22pramipexole oral tablet extended release 24 hr 2.25 mg, 3 mg, 3.75 mg, 4.5 mg . . . . . . . . . . . . . . . . . 23prasugrel . . . . . . . . . . . . . . . . . . . . . . . . 40

pravastatin oral tablet 10 mg, 20 mg, 80 mg . . . . . . . . . . . . 41pravastatin oral tablet 40 mg . . . . . 41praziquantel . . . . . . . . . . . . . . . . . . . . . . 8prazosin . . . . . . . . . . . . . . . . . . . . . . . . 38PRED-G . . . . . . . . . . . . . . . . . . . . . . . . 75PRED-G S.O.P. . . . . . . . . . . . . . . . . . 75PRED MILD . . . . . . . . . . . . . . . . . . . . . 75prednicarbate topical ointment . . . . 47prednisolone acetate . . . . . . . . . . . . 75prednisolone oral solution 15 mg/5 ml . . . . . . . . . . . . . . . . . . . . . . 52prednisolone sodium phosphate ophthalmic (eye) . . . . . . . . . . . . . . . . . 75prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 15 mg/5 ml (5 ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml) . . . . 52prednisone intensol . . . . . . . . . . . . . . 52prednisone oral solution . . . . . . . . . . 52prednisone oral tablet . . . . . . . . . . . . 52prednisone oral tablets,dose pack 52pregabalin oral capsule 75 mg . . . . 21pregabalin oral capsule 100 mg, 150 mg, 200 mg, 25 mg, 50 mg . . . 21pregabalin oral capsule 225 mg, 300 mg . . . . . . . . . . . . . . . . . 21pregabalin oral solution . . . . . . . . . . 21PREMARIN . . . . . . . . . . . . . . . . . . . . . 68PREMASOL 10% . . . . . . . . . . . . . . . . 89PRENATAL VITAMIN ORAL TABLET . . . . . . . . . . . . . . . . . . 98prevalite . . . . . . . . . . . . . . . . . . . . . . . . 41PREVENT . . . . . . . . . . . . . . . . . . . . . . 98previfem . . . . . . . . . . . . . . . . . . . . . . . . 71PREZCOBIX . . . . . . . . . . . . . . . . . . . . . 3PREZISTA ORAL SUSPENSION . . 3PREZISTA ORAL TABLET 75 MG . 4PREZISTA ORAL TABLET 150 MG 3PREZISTA ORAL TABLET 600 MG 4PREZISTA ORAL TABLET 800 MG 4PRIFTIN . . . . . . . . . . . . . . . . . . . . . . . . . 8PRIMAQUINE . . . . . . . . . . . . . . . . . . . . 8

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primidone . . . . . . . . . . . . . . . . . . . . . . . 21PROAIR HFA . . . . . . . . . . . . . . . . . . . 83PROAIR RESPICLICK . . . . . . . . . . . 83probenecid . . . . . . . . . . . . . . . . . . . . . . 65probenecid-colchicine . . . . . . . . . . . . 65PROCALAMINE 3% . . . . . . . . . . . . . 89prochlorperazine . . . . . . . . . . . . . . . . 61prochlorperazine edisylate . . . . . . . 61prochlorperazine maleate oral . . . . 61procto-med hc . . . . . . . . . . . . . . . . . . . 61procto-pak . . . . . . . . . . . . . . . . . . . . . . 61proctosol hc topical . . . . . . . . . . . . . . 61proctozone-hc . . . . . . . . . . . . . . . . . . . 61PRO FE . . . . . . . . . . . . . . . . . . . . . . . . 99PROFERRIN ES . . . . . . . . . . . . . . . . 99PROFERRIN-FORTE . . . . . . . . . . . . 99progesterone micronized . . . . . . . . . 68PROGLYCEM . . . . . . . . . . . . . . . . . . . 54PROGRAF INTRAVENOUS . . . . . . 16PROGRAF ORAL GRANULES IN PACKET . . . . . . . . . 16PROLASTIN-C . . . . . . . . . . . . . . . . . . 49PROLENSA . . . . . . . . . . . . . . . . . . . . . 74PROLIA . . . . . . . . . . . . . . . . . . . . . . . . . 65PROMACTA ORAL POWDER IN PACKET 12.5 MG . . . . . . . . . . . . 40PROMACTA ORAL POWDER IN PACKET 25 MG . . . . . . . . . . . . . . 40PROMACTA ORAL TABLET . . . . . . 40promethazine-codeine . . . . . . . . . . . 80promethazine-dm . . . . . . . . . . . . . . . . 80promethazine oral . . . . . . . . . . . . . . . 80promethazine rectal suppository 12.5 mg, 25 mg . . . . . . 80promethegan rectal suppository 25 mg, 50 mg . . . . . . . . 80propafenone . . . . . . . . . . . . . . . . . . . . 36propantheline . . . . . . . . . . . . . . . . . . . 58propranolol-hydrochlorothiazid . . . 38propranolol oral . . . . . . . . . . . . . . . . . . 38propylthiouracil . . . . . . . . . . . . . . . . . . 52PROQUAD (PF) . . . . . . . . . . . . . . . . . 64PROSOL 20% . . . . . . . . . . . . . . . . . . . 89

PROTECT IRON . . . . . . . . . . . . . . . . 99protriptyline . . . . . . . . . . . . . . . . . . . . . 34PSEUDOEPHEDRINE-GUAIFENESIN ORAL TABLET . . . 80pseudoephedrine-guaifenesin oral tablet extended release 12 hr . 80pseudoephedrine hcl oral tablet . . 80pseudoephedrine hcl oral tablet extended release . . . . . . . . . . . . . . . . 80PULMICORT . . . . . . . . . . . . . . . . . . . . 83PULMOZYME . . . . . . . . . . . . . . . . . . . 83PURIXAN . . . . . . . . . . . . . . . . . . . . . . . 16pyrazinamide . . . . . . . . . . . . . . . . . . . . . 8pyridostigmine bromide oral syrup . . . . . . . . . . . . . . . . . . . . . . . 24pyridostigmine bromide oral tablet 60 mg . . . . . . . . . . . . . . . . 24pyridostigmine bromide oral tablet extended release . . . . . . 24pyridoxine (vitamin b6) oral tablet 100 mg, 25 mg, 50 mg . 99pyrimethamine . . . . . . . . . . . . . . . . . . . 8

QQINLOCK . . . . . . . . . . . . . . . . . . . . . . . 16QUADRACEL (PF) . . . . . . . . . . . . . . 64quetiapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg . . . 34quetiapine oral tablet 300 mg, 400 mg . . . . . . . . . . . . . . . . . 34quetiapine oral tablet extended release 24 hr 150 mg, 200 mg . . . . 34quetiapine oral tablet extended release 24 hr 300 mg, 400 mg, 50 mg . . . . . . . . . . . . . . . . . . 34QUFLORA . . . . . . . . . . . . . . . . . . . . . . 99QUFLORA FE . . . . . . . . . . . . . . . . . . . 99QUFLORA FE (FERROUS SULFATE) . . . . . . . . . . . . . . . . . . . . . . 99QUFLORA PEDIATRIC . . . . . . . . . . 99QUFLORA PEDIATRIC DROPS . . 99quinapril . . . . . . . . . . . . . . . . . . . . . . . . 38quinapril-hydrochlorothiazide . . . . . 38quinidine sulfate oral tablet . . . . . . . 36quinine sulfate . . . . . . . . . . . . . . . . . . . . 8quintabs-m iron free . . . . . . . . . . . . . 99

RRABAVERT (PF) . . . . . . . . . . . . . . . . 65raloxifene . . . . . . . . . . . . . . . . . . . . . . . 65ramelteon . . . . . . . . . . . . . . . . . . . . . . . 34ramipril . . . . . . . . . . . . . . . . . . . . . . . . . 38ranitidine hcl oral syrup . . . . . . . . . . 62ranitidine hcl oral tablet 150 mg, 300 mg . . . . . . . . . . . . . . . . . 62ranolazine . . . . . . . . . . . . . . . . . . . . . . . 41RAPAMUNE ORAL SOLUTION . . 16rasagiline . . . . . . . . . . . . . . . . . . . . . . . 23REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 8.8MCG/0.2ML- 22 MCG/0.5ML (6) . . . . . . . . . . . . . . . 63REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML . 63REBIF TITRATION PACK . . . . . . . . 63REBIF (WITH ALBUMIN) . . . . . . . . . 63reclipsen (28) . . . . . . . . . . . . . . . . . . . 71RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 5 MCG/0.5 ML . . . . 65RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCG/ML, 40 MCG/ML . . . . . . . . 65RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE . . . . 65RECTIV . . . . . . . . . . . . . . . . . . . . . . . . . 61REDNESS RELIEF OPHTHALMIC (EYE) DROPS 0.012-0.25% . . . . . . 75REFRESH CELLUVISC . . . . . . . . . . 74REFRESH LACRI-LUBE . . . . . . . . . 74REFRESH OPTIVE MEGA-3 (PF) 74REFRESH PLUS . . . . . . . . . . . . . . . . 74regonol . . . . . . . . . . . . . . . . . . . . . . . . . 24REGRANEX . . . . . . . . . . . . . . . . . . . . 44RELISTOR SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . 61RELISTOR SUBCUTANEOUS SYRINGE . . . . . . . . . . . . . . . . . . . . . . . 61REMODULIN . . . . . . . . . . . . . . . . . . . . 38RENACIDIN IRRIGATION SOLUTION 1980.6 MG- 59.4 MG-980.4MG/30ML . . . . . . . . . 85

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renal caps . . . . . . . . . . . . . . . . . . . . . . . 99RENAL VITAMIN . . . . . . . . . . . . . . . . 99RENAL-VITE . . . . . . . . . . . . . . . . . . . . 99rena-vite . . . . . . . . . . . . . . . . . . . . . . . . 99rena-vite rx . . . . . . . . . . . . . . . . . . . . . . 99RENFLEXIS . . . . . . . . . . . . . . . . . . . . . 61reno caps . . . . . . . . . . . . . . . . . . . . . . . 99RENVELA ORAL POWDER IN PACKET . . . . . . . . . . . 49RENVELA ORAL TABLET . . . . . . . . 49repaglinide oral tablet 0.5 mg, 1 mg . . . . . . . . . . . . . . . . . . . . 54repaglinide oral tablet 2 mg . . . . . . 54REPATHA . . . . . . . . . . . . . . . . . . . . . . . 41REPATHA PUSHTRONEX . . . . . . . 41REPATHA SURECLICK . . . . . . . . . . 41REPEL HUNTER’S . . . . . . . . . . . . . . 44REPEL LEMON EUCALYPTUS . . 44REPEL SPORTSMEN . . . . . . . . . . . 44REPEL SPORTSMEN DRY . . . . . . 44REPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY . . . . . 44RESCON . . . . . . . . . . . . . . . . . . . . . . . 80RESCON-DM . . . . . . . . . . . . . . . . . . . 80rescon-gg . . . . . . . . . . . . . . . . . . . . . . . 80RESTASIS . . . . . . . . . . . . . . . . . . . . . . 74RESTASIS MULTIDOSE . . . . . . . . . 74RETACRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML . . 63RETACRIT INJECTION SOLUTION 40,000 UNIT/ML . . . . . 63RETEVMO . . . . . . . . . . . . . . . . . . . . . . 16RETROVIR INTRAVENOUS . . . . . . 4REVLIMID ORAL CAPSULE 10 MG, 2.5 MG, 5 MG . . . . . . . . . . . 16REVLIMID ORAL CAPSULE 15 MG, 20 MG, 25 MG . . . . . . . . . . . 16REXULTI . . . . . . . . . . . . . . . . . . . . . . . . 34REYATAZ ORAL POWDER IN PACKET . . . . . . . . . . . . . . . . . . . . . . 4RHOPRESSA . . . . . . . . . . . . . . . . . . . 75ribavirin oral capsule . . . . . . . . . . . . . . 4ribavirin oral tablet 200 mg . . . . . . . . 4

riboflavin (vitamin b2) oral tablet 100 mg . . . . . . . . . . . . . . . 99RIDAURA . . . . . . . . . . . . . . . . . . . . . . . 67rifabutin . . . . . . . . . . . . . . . . . . . . . . . . . . 8rifampin . . . . . . . . . . . . . . . . . . . . . . . . . . 8RIFATER . . . . . . . . . . . . . . . . . . . . . . . . . 8riluzole . . . . . . . . . . . . . . . . . . . . . . . . . . 49rimantadine . . . . . . . . . . . . . . . . . . . . . . 4ringer’s intravenous . . . . . . . . . . . . . . 88ringer’s irrigation . . . . . . . . . . . . . . . . . 48RINVOQ . . . . . . . . . . . . . . . . . . . . . . . . 67RIOMET . . . . . . . . . . . . . . . . . . . . . . . . 54RIOMET ER . . . . . . . . . . . . . . . . . . . . . 55risacal-d . . . . . . . . . . . . . . . . . . . . . . . . 99risedronate oral tablet 30 mg, 5 mg 66risedronate oral tablet 35 mg, 35 mg (12 pack), 35 mg (4 pack) . 66risedronate oral tablet 150 mg . . . . 66RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 12.5 MG/2 ML, 25 MG/2 ML, 37.5 MG/2 ML . . . . . . 34RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 50 MG/2 ML . . . . . . . . 34risperidone oral solution . . . . . . . . . . 34risperidone oral tablet . . . . . . . . . . . . 34risperidone oral tablet, disintegrating 0.5 mg, 4 mg . . . . . . 34risperidone oral tablet, disintegrating 0.25 mg, 1 mg, 2 mg, 3 mg . . . . . . . . . . . . . . . . 34ritonavir . . . . . . . . . . . . . . . . . . . . . . . . . . 4RITUXAN . . . . . . . . . . . . . . . . . . . . . . . 16RITUXAN HYCELA . . . . . . . . . . . . . . 16rivastigmine . . . . . . . . . . . . . . . . . . . . . 24rivastigmine tartrate . . . . . . . . . . . . . . 24rivelsa . . . . . . . . . . . . . . . . . . . . . . . . . . 71rizatriptan . . . . . . . . . . . . . . . . . . . . . . . 23robafen . . . . . . . . . . . . . . . . . . . . . . . . . 80robafen cf (phenylephrine) . . . . . . . 80robafen cough . . . . . . . . . . . . . . . . . . . 81robafen dm cough . . . . . . . . . . . . . . . 81

robafen dm cough-chest congest . 81robafen dm peak cold . . . . . . . . . . . . 81ROCKLATAN . . . . . . . . . . . . . . . . . . . . 75ROMIDEPSIN INTRAVENOUS SOLUTION . . . . . 16ropinirole oral tablet . . . . . . . . . . . . . . 23rosadan topical cream . . . . . . . . . . . 45rosadan topical gel . . . . . . . . . . . . . . 45rosuvastatin . . . . . . . . . . . . . . . . . . . . . 41ROTARIX . . . . . . . . . . . . . . . . . . . . . . . 65ROTATEQ VACCINE . . . . . . . . . . . . 65roweepra . . . . . . . . . . . . . . . . . . . . . . . . 21roweepra xr . . . . . . . . . . . . . . . . . . . . . 22ROZLYTREK ORAL CAPSULE 100 MG . . . . . . . . . . . . . . 17ROZLYTREK ORAL CAPSULE 200 MG . . . . . . . . . . . . . . 17RUBRACA . . . . . . . . . . . . . . . . . . . . . . 17RUCONEST . . . . . . . . . . . . . . . . . . . . 83RU-HIST D . . . . . . . . . . . . . . . . . . . . . . 81RUKOBIA . . . . . . . . . . . . . . . . . . . . . . . . 4RUXIENCE . . . . . . . . . . . . . . . . . . . . . 17RYDAPT . . . . . . . . . . . . . . . . . . . . . . . . 17RYMED (DEXCHLORPHENIRAMINE-PE) 81rynex dm . . . . . . . . . . . . . . . . . . . . . . . . 81rynex pe . . . . . . . . . . . . . . . . . . . . . . . . 81rynex pse . . . . . . . . . . . . . . . . . . . . . . . 81RYTARY . . . . . . . . . . . . . . . . . . . . . . . . 23

SS2 RACEPINEPHRINE . . . . . . . . . . 83salsalate . . . . . . . . . . . . . . . . . . . . . . . . 29SAMSCA ORAL TABLET 15 MG . . 56SAMSCA ORAL TABLET 30 MG . . 56SANCUSO . . . . . . . . . . . . . . . . . . . . . . 61SANDIMMUNE ORAL SOLUTION 17SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON . . . . . . . . . . . . . . . . . . . . 17SANTYL . . . . . . . . . . . . . . . . . . . . . . . . 44SAPHRIS . . . . . . . . . . . . . . . . . . . . . . . 34sapropterin . . . . . . . . . . . . . . . . . . . . . . 56

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SARCLISA . . . . . . . . . . . . . . . . . . . . . . 17SCOOBY-DOO ONE A DAY . . . . . . 99scopolamine base . . . . . . . . . . . . . . . 61SECUADO . . . . . . . . . . . . . . . . . . . . . . 34selegiline hcl . . . . . . . . . . . . . . . . . . . . 23selenium oral tablet . . . . . . . . . . . . . . 88selenium sulfide topical lotion . . . . 42SELZENTRY ORAL SOLUTION . . . 4SELZENTRY ORAL TABLET 25 MG 4SELZENTRY ORAL TABLET 150 MG, 75 MG . . . . . . . . . . 4SELZENTRY ORAL TABLET 300 MG . . . . . . . . . . . . . . . . . 4senior tabs . . . . . . . . . . . . . . . . . . . . . . 99senna lax . . . . . . . . . . . . . . . . . . . . . . . 61senna oral tablet . . . . . . . . . . . . . . . . . 61SENSIPAR ORAL TABLET 30 MG, 60 MG . . . . . . . . . . 56SENSIPAR ORAL TABLET 90 MG . 56sentry . . . . . . . . . . . . . . . . . . . . . . . . . . . 99sentry senior . . . . . . . . . . . . . . . . . . . . 99SEREVENT DISKUS . . . . . . . . . . . . 83sertraline oral concentrate . . . . . . . . 34sertraline oral tablet 50 mg . . . . . . . 34sertraline oral tablet 100 mg, 25 mg . . . . . . . . . . . . . . . . . . 34se-tan plus . . . . . . . . . . . . . . . . . . . . . . 99setlakin . . . . . . . . . . . . . . . . . . . . . . . . . 71sevelamer carbonate oral powder in packet . . . . . . . . . . . . 49sevelamer carbonate oral tablet . . 49SEVERE COLD AND FLU NIGHTTIME . . . . . . . . . . . . . . . . . . . . . 81SEVERE COLD AND FLU (PE) ORAL TABLET . . . . . . . . . . . . . 81sharobel . . . . . . . . . . . . . . . . . . . . . . . . 68SHINGRIX (PF) . . . . . . . . . . . . . . . . . 65SIDEROL ORAL TABLET . . . . . . . . 99SIGNIFOR . . . . . . . . . . . . . . . . . . . . . . 17siladryl sa . . . . . . . . . . . . . . . . . . . . . . . 81sildenafil (pulmonary arterial hypertension) oral tablet . . . . . . . . . 83SILENOR . . . . . . . . . . . . . . . . . . . . . . . 34siltussin-dm . . . . . . . . . . . . . . . . . . . . . 81

siltussin dm das . . . . . . . . . . . . . . . . . 81siltussin sa . . . . . . . . . . . . . . . . . . . . . . 81silver sulfadiazine . . . . . . . . . . . . . . . 44SIMBRINZA . . . . . . . . . . . . . . . . . . . . . 75simethicone oral capsule 180 mg . 61simethicone oral drops,suspension 61simliya (28) . . . . . . . . . . . . . . . . . . . . . 71simpesse . . . . . . . . . . . . . . . . . . . . . . . 71SIMULECT . . . . . . . . . . . . . . . . . . . . . . 17simvastatin oral tablet . . . . . . . . . . . . 41SINUS CONGESTION- PAIN(GUAIF) . . . . . . . . . . . . . . . . . . . . 81SINUS PAIN-PRESSURE (PE) ORAL TABLET 5-325 MG . . . 81sirolimus oral solution . . . . . . . . . . . . 17sirolimus oral tablet . . . . . . . . . . . . . . 17SIRTURO ORAL TABLET 20 MG . . 8SIRTURO ORAL TABLET 100 MG . 8SIVEXTRO INTRAVENOUS . . . . . . . 8SIVEXTRO ORAL . . . . . . . . . . . . . . . . 8SKYRIZI SUBCUTANEOUS SYRINGE KIT . . . . . . . . . . . . . . . . . . . 42SLEEP AID (DIPHENHYDRAMINE) ORAL CAPSULE 25 MG . . . . . . . . . 81SLEEP AID (DIPHENHYDRAMINE) ORAL LIQUID . . . . . . . . . . . . . . . . . . . 81sleep aid (diphenhydramine) oral tablet . . . . . . . . . . . . . . . . . . . . . . . 81sleep aid (doxylamine) . . . . . . . . . . . 34SLO-NIACIN ORAL TABLET EXTENDED RELEASE 250 MG . . 41slo-niacin oral tablet extended release 500 mg . . . . . . . . 41SLOW FE . . . . . . . . . . . . . . . . . . . . . . . 99SLOW-MAG . . . . . . . . . . . . . . . . . . . . . 88SLOW RELEASE IRON ORAL TABLET EXTENDED RELEASE 140 MG (45 MG IRON), 142 MG (45 MG IRON), 143 MG (45 MG IRON), 159 MG (45 MG IRON) . . . 99sodium bicarbonate intravenous syringe 10 meq/10 ml (8.4%), 7.5% (0.9 meq/ml), 8.4% (1 meq/ml) . . . 88sodium bicarbonate oral . . . . . . . . . 61

SODIUM CHLORIDE 0.9% INTRAVENOUS PARENTERAL SOLUTION . . . . . . . 49sodium chloride 0.9% intravenous piggyback . . . . . . 49SODIUM CHLORIDE 0.45% INTRAVENOUS PARENTERAL SOLUTION . . . . . . . 88SODIUM CHLORIDE 3% . . . . . . . . 89SODIUM CHLORIDE 5% . . . . . . . . 89sodium chloride intravenous . . . . . . 89SODIUM CHLORIDE IRRIGATION . . . . . . . . . . . . . . . . . . . . 49sodium chloride ophthalmic (eye) . 74sodium citrate-citric acid . . . . . . . . . 85sodium fluoride-pot nitrate . . . . . . . . 51sodium phenylbutyrate . . . . . . . . . . . 49sodium polystyrene (sorb free) . . . 49sodium polystyrene sulfonate oral powder . . . . . . . . . . . . . . . . . . . . . 49solifenacin . . . . . . . . . . . . . . . . . . . . . . 84SOLIQUA 100/33 . . . . . . . . . . . . . . . . 55SOLTAMOX . . . . . . . . . . . . . . . . . . . . . 17SOLU-CORTEF ACT-O-VIAL (PF) 52SOLUVITA-E . . . . . . . . . . . . . . . . . . . . 99SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 60 MG/0.2 ML . . . . . . . . . . . . . . . . . . . 17SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 90 MG/0.3 ML . . . . . . . . . . . . . . . . . . . 17SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5 ML . . . . . . . . . . . . . . . . . . 17SOMAVERT . . . . . . . . . . . . . . . . . . . . . 56soothing pureway-c . . . . . . . . . . . . . . 99sorine . . . . . . . . . . . . . . . . . . . . . . . . . . . 36sotalol af . . . . . . . . . . . . . . . . . . . . . . . . 36sotalol oral . . . . . . . . . . . . . . . . . . . . . . 36SOTYLIZE . . . . . . . . . . . . . . . . . . . . . . 36spectravite adult 50 plus . . . . . . . . . 99spectravite advanced formula oral tablet 18-400 mg-mcg . . . . . . . 99spectravite men’s . . . . . . . . . . . . . . . . 99spectravite senior oral tablet 500-300-250 mcg . . . . . . . . . . . . . . . . 99

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SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG . . . . . . . . . 63SYMFI . . . . . . . . . . . . . . . . . . . . . . . . . . . 4SYMFI LO . . . . . . . . . . . . . . . . . . . . . . . 4SYMLINPEN 60 . . . . . . . . . . . . . . . . . 55SYMLINPEN 120 . . . . . . . . . . . . . . . . 55SYMPAZAN . . . . . . . . . . . . . . . . . . . . . 22SYMTUZA . . . . . . . . . . . . . . . . . . . . . . . 4SYNAGIS . . . . . . . . . . . . . . . . . . . . . . . . 4SYNAREL . . . . . . . . . . . . . . . . . . . . . . 56SYNERCID . . . . . . . . . . . . . . . . . . . . . . 8SYNJARDY . . . . . . . . . . . . . . . . . . . . . 55SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 12.5-1,000 MG, 5-1,000 MG . . . . . . 55SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 25-1,000 MG 55SYNRIBO . . . . . . . . . . . . . . . . . . . . . . . 17SYNTHROID . . . . . . . . . . . . . . . . . . . . 57

Ttab-a-vite . . . . . . . . . . . . . . . . . . . . . . . 100tab-a-vite/iron . . . . . . . . . . . . . . . . . . 100TAB-A-VITE MULTIVITAMIN W-IRON . . . . . . . . . . . . . . . . . . . . . . . 100TABLOID . . . . . . . . . . . . . . . . . . . . . . . 17TABRECTA . . . . . . . . . . . . . . . . . . . . . 17tacrolimus oral . . . . . . . . . . . . . . . . . . 17tacrolimus topical . . . . . . . . . . . . . . . . 44TAFINLAR . . . . . . . . . . . . . . . . . . . . . . 17TAGRISSO . . . . . . . . . . . . . . . . . . . . . . 17TALZENNA . . . . . . . . . . . . . . . . . . . . . 17tamoxifen . . . . . . . . . . . . . . . . . . . . . . . 17tamsulosin . . . . . . . . . . . . . . . . . . . . . . 84TANDEM DUAL ACTION . . . . . . . . 100TANDEM PLUS . . . . . . . . . . . . . . . . 100TARGRETIN TOPICAL . . . . . . . . . . 17tarina 24 fe . . . . . . . . . . . . . . . . . . . . . . 72tarina fe 1/20 (28) . . . . . . . . . . . . . . . 72tarina fe 1-20 eq (28) . . . . . . . . . . . . 72taron forte . . . . . . . . . . . . . . . . . . . . . . 100TASIGNA ORAL CAPSULE 50 MG 17TASIGNA ORAL CAPSULE 150 MG, 200 MG . . . . . . . . . . . . . . . . 17

SUBOXONE SUBLINGUAL FILM 12-3 MG . . . . . . . . . . . . . . . . . . . 29sucralfate . . . . . . . . . . . . . . . . . . . . . . . 62sudogest . . . . . . . . . . . . . . . . . . . . . . . . 81sudogest 12-hour . . . . . . . . . . . . . . . . 81sudogest pe . . . . . . . . . . . . . . . . . . . . . 81sudogest sinus and allergy . . . . . . . 81sulfacetamide-prednisolone . . . . . . 74sulfacetamide sodium (acne) . . . . . 45sulfacetamide sodium ophthalmic (eye) drops . . . . . . . . . . . 74sulfadiazine . . . . . . . . . . . . . . . . . . . . . 10sulfamethoxazole-trimethoprim . . . 10sulfasalazine . . . . . . . . . . . . . . . . . . . . 61sulfatrim . . . . . . . . . . . . . . . . . . . . . . . . 10sulindac . . . . . . . . . . . . . . . . . . . . . . . . . 29sumatriptan . . . . . . . . . . . . . . . . . . . . . 23sumatriptan succinate oral . . . . . . . 23sumatriptan succinate subcutaneous cartridge . . . . . . . . . . 23sumatriptan succinate subcutaneous pen injector . . . . . . . 23sumatriptan succinate subcutaneous solution . . . . . . . . . . . 23sumatriptan succinate subcutaneous syringe 6 mg/0.5 ml 23super b-50 complex . . . . . . . . . . . . . 100super b/c . . . . . . . . . . . . . . . . . . . . . . . 100super b complex-vitamin c . . . . . . 100super b maxi complex . . . . . . . . . . . 100super calcium . . . . . . . . . . . . . . . . . . . 89super multiple oral tablet . . . . . . . . 100super multivitamin . . . . . . . . . . . . . . 100super quints . . . . . . . . . . . . . . . . . . . . 100super thera vite m . . . . . . . . . . . . . . 100SUPERVITE . . . . . . . . . . . . . . . . . . . 100support . . . . . . . . . . . . . . . . . . . . . . . . 100SUPPORT-500 . . . . . . . . . . . . . . . . . 100SUPRAX ORAL SUSPENSION FOR RECONSTITUTION 500 MG/5 ML . 6SUPREP BOWEL PREP KIT . . . . . 61SUSPENDOL-S . . . . . . . . . . . . . . . . . 49SUTENT . . . . . . . . . . . . . . . . . . . . . . . . 17syeda . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

spectravite ultra women . . . . . . . . . . 99spectravite ultra women’s sr . . . . . . 99spectravite women . . . . . . . . . . . . . . 100spironolactone . . . . . . . . . . . . . . . . . . 38spironolacton-hydrochlorothiaz . . . 38sprintec (28) . . . . . . . . . . . . . . . . . . . . . 71SPRITAM ORAL TABLET FOR SUSPENSION 1,000 MG, 250 MG, 500 MG . . . . . . . . . . . . . . . . 22SPRITAM ORAL TABLET FOR SUSPENSION 750 MG . . . . . 22SPRYCEL . . . . . . . . . . . . . . . . . . . . . . 17sps (with sorbitol) . . . . . . . . . . . . . . . . 49sronyx . . . . . . . . . . . . . . . . . . . . . . . . . . 72SSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44STAHIST AD ORAL TABLET . . . . . 81STAMARIL (PF) . . . . . . . . . . . . . . . . . 65stavudine oral capsule . . . . . . . . . . . . 4STELARA SUBCUTANEOUS SOLUTION . . . . . . . . . . . . . . . . . . . . . 42STELARA SUBCUTANEOUS SYRINGE 45 MG/0.5 ML . . . . . . . . . 42STELARA SUBCUTANEOUS SYRINGE 90 MG/ML . . . . . . . . . . . . 42STIMATE . . . . . . . . . . . . . . . . . . . . . . . 56STIVARGA . . . . . . . . . . . . . . . . . . . . . . 17stomach relief oral suspension 262 mg/15 ml . . . . . . . . . . . . . . . . . . . 58stomach relief oral tablet, chewable . . . . . . . . . . . . . . . . . . . . . . . 58stool softener (docusate cal) . . . . . 61stool softener oral capsule 100 mg 61streptomycin . . . . . . . . . . . . . . . . . . . . . 8stress b with zinc . . . . . . . . . . . . . . . 100stress formula . . . . . . . . . . . . . . . . . . 100stress formula 600 c . . . . . . . . . . . . 100stress formula with iron . . . . . . . . . 100stress formula with iron(sulf) . . . . . 100stress formula with zinc . . . . . . . . . 100STRIBILD . . . . . . . . . . . . . . . . . . . . . . . . 4STROVITE FORTE . . . . . . . . . . . . . 100STROVITE ONE . . . . . . . . . . . . . . . 100SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 4-1 MG, 8-2 MG . 29

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THYROLAR-1/4 . . . . . . . . . . . . . . . . . 57THYROLAR-2 . . . . . . . . . . . . . . . . . . . 57THYROLAR-3 . . . . . . . . . . . . . . . . . . . 57THYROSAFE . . . . . . . . . . . . . . . . . . . 52tiadylt er . . . . . . . . . . . . . . . . . . . . . . . . 39tiagabine . . . . . . . . . . . . . . . . . . . . . . . . 22TIBSOVO . . . . . . . . . . . . . . . . . . . . . . . 18tigecycline . . . . . . . . . . . . . . . . . . . . . . . 8tilia fe . . . . . . . . . . . . . . . . . . . . . . . . . . . 72timolol maleate ophthalmic (eye) drops . . . . . . . . . . . . . . . . . . . . . . 73timolol maleate ophthalmic (eye) gel forming solution . . . . . . . . 73timolol maleate oral . . . . . . . . . . . . . . 39TIOCONAZOLE-1 . . . . . . . . . . . . . . . 68tis-u-sol pentalyte . . . . . . . . . . . . . . . . 48TIVICAY ORAL TABLET 10 MG . . . 4TIVICAY ORAL TABLET 25 MG, 50 MG . . . . . . . . . . . . . . . . . . . 4TIVICAY PD . . . . . . . . . . . . . . . . . . . . . . 4tizanidine . . . . . . . . . . . . . . . . . . . . . . . 24TOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE . . . . . . . . . 8TOBRADEX OPHTHALMIC (EYE) OINTMENT . . . . . . . . . . . . . . . 75tobramycin-dexamethasone . . . . . . 75tobramycin in 0.225% nacl . . . . . . . . 8tobramycin ophthalmic (eye) . . . . . 73tobramycin sulfate . . . . . . . . . . . . . . . . 8TOBREX OPHTHALMIC (EYE) OINTMENT . . . . . . . . . . . . . . . 73TOLAK . . . . . . . . . . . . . . . . . . . . . . . . . 44tolcapone . . . . . . . . . . . . . . . . . . . . . . . 23tolnaftate topical cream . . . . . . . . . . 46tolnaftate topical powder . . . . . . . . . 46tolterodine oral capsule, extended release 24hr . . . . . . . . . . . 84tolterodine oral tablet . . . . . . . . . . . . 84tolvaptan oral tablet 30 mg . . . . . . . 57topiramate oral capsule, sprinkle . 22topiramate oral tablet . . . . . . . . . . . . 22toposar . . . . . . . . . . . . . . . . . . . . . . . . . 18topotecan intravenous recon soln . 18

testosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml, 200 mg/ml (1 ml) . . . . . 56testosterone enanthate . . . . . . . . . . 56testosterone transdermal gel . . . . . 57testosterone transdermal gel in metered-dose pump 12.5 mg/ 1.25 gram (1%) . . . . . . . . . 57testosterone transdermal gel in packet 1% (25 mg/2.5gram), 1% (50 mg/5 gram) . . . . . . . . . . . . . . 57TETANUS,DIPHTHERIA TOX PED(PF) . . . . . . . . . . . . . . . . . . . . . . . . 65tetrabenazine oral tablet 12.5 mg . 24tetrabenazine oral tablet 25 mg . . . 24tetracycline . . . . . . . . . . . . . . . . . . . . . . 10THALOMID ORAL CAPSULE 100 MG, 150 MG, 50 MG . . . . . . . . 18THALOMID ORAL CAPSULE 200 MG . . . . . . . . . . . . . . . . . . . . . . . . . 18THEO-24 . . . . . . . . . . . . . . . . . . . . . . . 83theophylline oral tablet extended release 12 hr 300 mg, 450 mg . . . . 83theophylline oral tablet extended release 24 hr . . . . . . . . . . 84theralogix companion . . . . . . . . . . . 100thera-m oral tablet 27-0.4 mg, 9 mg iron-400 mcg . . . 100thera m plus (ferrous fumarat) . . . 100therapeutic liquid . . . . . . . . . . . . . . . 100therapeutic-m oral tablet 9 mg iron-400 mcg . . . . . . . . . . . . . . 100therapeutic-m vitamin/minerals . . 100thera-tabs . . . . . . . . . . . . . . . . . . . . . . 100theratrum complete 50 plus-lyc . . 100theratrum complete with lutein . . . 100therems-m . . . . . . . . . . . . . . . . . . . . . 100thiamine hcl (vitamin b1) oral tablet 100 mg, 250 mg, 50 mg . . . 100thiamine mononitrate (vit b1) . . . . 101thioridazine . . . . . . . . . . . . . . . . . . . . . 35thiotepa . . . . . . . . . . . . . . . . . . . . . . . . . 18thiothixene . . . . . . . . . . . . . . . . . . . . . . 35THYROLAR-1 . . . . . . . . . . . . . . . . . . . 57THYROLAR-1/2 . . . . . . . . . . . . . . . . . 57

tazarotene . . . . . . . . . . . . . . . . . . . . . . 45tazicef . . . . . . . . . . . . . . . . . . . . . . . . . . . 6TAZORAC TOPICAL CREAM . . . . 45TAZORAC TOPICAL GEL . . . . . . . . 45taztia xt oral capsule,extended release 24 hr 120 mg, 180 mg, 240 mg, 300 mg . . . . . . . . . . . . . . . . . 38TAZVERIK . . . . . . . . . . . . . . . . . . . . . . 17TDVAX . . . . . . . . . . . . . . . . . . . . . . . . . 65TECENTRIQ INTRAVENOUS SOLUTION 1,200 MG/20 ML (60 MG/ML) . . . . . . . . . . . . . . . . . . . . . 17TECENTRIQ INTRAVENOUS SOLUTION 840 MG/14 ML (60 MG/ML) . . . . . . . . . . . . . . . . . . . . . 17TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG . . . . . . 24TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46) . . . . . . . 24TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 240 MG . . . . . . 24TECHLITE PEN NEEDLE . . . . . . . . 55TEFLARO . . . . . . . . . . . . . . . . . . . . . . . . 6TEKTURNA HCT . . . . . . . . . . . . . . . . 38telmisartan-amlodipine . . . . . . . . . . . 39telmisartan-hydrochlorothiazid oral tablet 40-12.5 mg, 80-25 mg . 39telmisartan-hydrochlorothiazid oral tablet 80-12.5 mg . . . . . . . . . . . . 39telmisartan oral tablet 20 mg, 40 mg . . . . . . . . . . . . . . . . . . . 38telmisartan oral tablet 80 mg . . . . . 39temazepam . . . . . . . . . . . . . . . . . . . . . 35temsirolimus . . . . . . . . . . . . . . . . . . . . 18TENIVAC (PF) INTRAMUSCULAR SYRINGE . . . . 65tenofovir disoproxil fumarate . . . . . . 4terazosin . . . . . . . . . . . . . . . . . . . . . . . . 39terbinafine hcl oral . . . . . . . . . . . . . . . . 1terbinafine hcl topical . . . . . . . . . . . . 46terbutaline . . . . . . . . . . . . . . . . . . . . . . 83terconazole . . . . . . . . . . . . . . . . . . . . . 68

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tri-previfem (28) . . . . . . . . . . . . . . . . . 72TRIPROLIDINE HCL. . . . . . . . . . . . . 81TRIPTODUR . . . . . . . . . . . . . . . . . . . . 18TRISENOX INTRAVENOUS SOLUTION 2 MG/ML . . . . . . . . . . . . 18tri-sprintec (28) . . . . . . . . . . . . . . . . . . 72TRIUMEQ . . . . . . . . . . . . . . . . . . . . . . . . 4TRI-VI-FLOR . . . . . . . . . . . . . . . . . . . 101tri-vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml . . . . . . 101tri-vite with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml . . . . . . 101trivora (28) . . . . . . . . . . . . . . . . . . . . . . 72tri-vylibra . . . . . . . . . . . . . . . . . . . . . . . . 72tri-vylibra lo . . . . . . . . . . . . . . . . . . . . . 72TRODELVY . . . . . . . . . . . . . . . . . . . . . 18TROGARZO . . . . . . . . . . . . . . . . . . . . . 4TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 100 MG, 25 MG, 50 MG . . . 22TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 200 MG . . . . . . . . 22TROPHAMINE 10% . . . . . . . . . . . . . 90TRULANCE . . . . . . . . . . . . . . . . . . . . . 61TRULICITY . . . . . . . . . . . . . . . . . . . . . 55TRUMENBA . . . . . . . . . . . . . . . . . . . . 65TRUVADA . . . . . . . . . . . . . . . . . . . . . . . 4TRUXIMA . . . . . . . . . . . . . . . . . . . . . . . 18TUKYSA ORAL TABLET 50 MG . . 18TUKYSA ORAL TABLET 150 MG . 18tussin cf (pe-dm-guaif) . . . . . . . . . . . 81tussin dm cough and chest oral liquid 5-100 mg/5 ml . . . . . . . . . 81tussin dm oral liquid . . . . . . . . . . . . . 81tussin dm oral syrup 10-100 mg/5 ml . . . . . . . . . . . . . . . . . . 81tussin mucus-chest congestion . . . 81TWINRIX (PF) INTRAMUSCULAR SYRINGE . . . . 65TYBOST . . . . . . . . . . . . . . . . . . . . . . . . . 4tydemy . . . . . . . . . . . . . . . . . . . . . . . . . . 72TYKERB . . . . . . . . . . . . . . . . . . . . . . . . 18TYMLOS . . . . . . . . . . . . . . . . . . . . . . . . 66

tretinoin topical . . . . . . . . . . . . . . . . . . 45triamcinolone acetonide dental . . . 51triamcinolone acetonide injection . 52triamcinolone acetonide nasal . . . . 84triamcinolone acetonide topical cream . . . . . . . . . . . . . . . . . . . . 47triamcinolone acetonide topical lotion . . . . . . . . . . . . . . . . . . . . . 47triamcinolone acetonide topical ointment . . . . . . . . . . . . . . . . . 47triamterene-hydrochlorothiazid oral capsule 37.5-25 mg . . . . . . . . . 39triamterene-hydrochlorothiazid oral tablet . . . . . . . . . . . . . . . . . . . . . . . 39tricitrates . . . . . . . . . . . . . . . . . . . . . . . . 85triderm topical cream 0.1% . . . . . . . 47trientine . . . . . . . . . . . . . . . . . . . . . . . . . 49tri-estarylla . . . . . . . . . . . . . . . . . . . . . . 72tri femynor . . . . . . . . . . . . . . . . . . . . . . 72trifluoperazine . . . . . . . . . . . . . . . . . . . 35trifluridine . . . . . . . . . . . . . . . . . . . . . . . 73trihexyphenidyl . . . . . . . . . . . . . . . . . . 23TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-5-1,000 MG, 25-5-1,000 MG . . 55TRIJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR 12.5- 2.5-1,000 MG, 5-2.5-1,000 MG . . . 55tri-legest fe . . . . . . . . . . . . . . . . . . . . . . 72tri-linyah . . . . . . . . . . . . . . . . . . . . . . . . 72tri-lo-estarylla . . . . . . . . . . . . . . . . . . . . 72tri-lo-marzia . . . . . . . . . . . . . . . . . . . . . 72tri-lo-mili . . . . . . . . . . . . . . . . . . . . . . . . 72tri-lo-sprintec . . . . . . . . . . . . . . . . . . . . 72trilyte with flavor packets . . . . . . . . . 61trimethoprim . . . . . . . . . . . . . . . . . . . . . 10tri-mili . . . . . . . . . . . . . . . . . . . . . . . . . . . 72trimipramine . . . . . . . . . . . . . . . . . . . . . 35TRINTELLIX . . . . . . . . . . . . . . . . . . . . 35triphrocaps . . . . . . . . . . . . . . . . . . . . . 101triple antibiotic plus . . . . . . . . . . . . . . 45triple antibiotic topical ointment . . . 45triple antibiotic topical ointment in packet . . . . . . . . . . . . . . . . . . . . . . . . 45

toremifene . . . . . . . . . . . . . . . . . . . . . . 18TORISEL . . . . . . . . . . . . . . . . . . . . . . . 18torsemide oral . . . . . . . . . . . . . . . . . . . 39TOUJEO MAX U-300 SOLOSTAR . . . . . . . . . . . . . . 55TOUJEO SOLOSTAR U-300 INSULIN . . . . . . . . . . . . . . . . . . 55TOVIAZ . . . . . . . . . . . . . . . . . . . . . . . . . 84TPN ELECTROLYTES . . . . . . . . . . . 89TRACLEER ORAL TABLET FOR SUSPENSION . . . . . . . . . . . . . 84TRADJENTA . . . . . . . . . . . . . . . . . . . . 55tramadol-acetaminophen . . . . . . . . . 29tramadol oral tablet 50 mg . . . . . . . 29trandolapril . . . . . . . . . . . . . . . . . . . . . . 39tranexamic acid oral . . . . . . . . . . . . . 68tranylcypromine . . . . . . . . . . . . . . . . . 35TRAVASOL 10% . . . . . . . . . . . . . . . . 90TRAVATAN Z . . . . . . . . . . . . . . . . . . . . 75travel sickness . . . . . . . . . . . . . . . . . . 61travel sickness (meclizine) . . . . . . . 61travoprost . . . . . . . . . . . . . . . . . . . . . . . 75TRAZIMERA . . . . . . . . . . . . . . . . . . . . 18trazodone . . . . . . . . . . . . . . . . . . . . . . . 35TREANDA INTRAVENOUS RECON SOLN 25 MG . . . . . . . . . . . 18TREANDA INTRAVENOUS RECON SOLN 100 MG . . . . . . . . . . 18TRECATOR . . . . . . . . . . . . . . . . . . . . . . 8TRELEGY ELLIPTA . . . . . . . . . . . . . 84TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 3.75 MG . . . . 18TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 11.25 MG . . . 18TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 22.5 MG . . . . 18treprostinil sodium . . . . . . . . . . . . . . . 39TRESIBA FLEXTOUCH U-100 . . . 55TRESIBA FLEXTOUCH U-200 . . . 55TRESIBA U-100 INSULIN . . . . . . . . 55tretinoin (antineoplastic) . . . . . . . . . . 18tretinoin microspheres . . . . . . . . . . . 45

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verapamil oral capsule, ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg . . . . . . . . . 39VERAPAMIL ORAL CAPSULE, EXT REL. PELLETS 24 HR 360 MG . . . . . . . . . . . . . . . . . . 39verapamil oral tablet . . . . . . . . . . . . . 39verapamil oral tablet extended release . . . . . . . . . . . . . . . . 39VERSACLOZ . . . . . . . . . . . . . . . . . . . 35VERZENIO . . . . . . . . . . . . . . . . . . . . . 18V-GO 20 . . . . . . . . . . . . . . . . . . . . . . . . 55V-GO 30 . . . . . . . . . . . . . . . . . . . . . . . . 55V-GO 40 . . . . . . . . . . . . . . . . . . . . . . . . 55VIBERZI . . . . . . . . . . . . . . . . . . . . . . . . 61vic-forte . . . . . . . . . . . . . . . . . . . . . . . . 101VICTOZA 2-PAK . . . . . . . . . . . . . . . . . 55VICTOZA 3-PAK . . . . . . . . . . . . . . . . . 55vienva . . . . . . . . . . . . . . . . . . . . . . . . . . 72vigabatrin . . . . . . . . . . . . . . . . . . . . . . . 22vigadrone . . . . . . . . . . . . . . . . . . . . . . . 22VIIBRYD ORAL TABLET . . . . . . . . . 35VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23) . . . . 35VIMPAT INTRAVENOUS . . . . . . . . . 22VIMPAT ORAL SOLUTION . . . . . . . 22VIMPAT ORAL TABLET 50 MG . . . 22VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG . . . . . . . 22vincasar pfs intravenous solution 1 mg/ml . . . . . . . . . . . . . . . . . 18vincristine . . . . . . . . . . . . . . . . . . . . . . . 18vinorelbine . . . . . . . . . . . . . . . . . . . . . . 19VIOKACE ORAL TABLET 10,440-39,150- 39,150 UNIT . . . . . 61VIOKACE ORAL TABLET 20,880-78,300- 78,300 UNIT . . . . . 61viorele (28) . . . . . . . . . . . . . . . . . . . . . . 72VIRACEPT ORAL TABLET 250 MG . 4VIRACEPT ORAL TABLET 625 MG . 4VIREAD ORAL POWDER . . . . . . . . . 4VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG . . . . . . . . 4VIRT-CAPS . . . . . . . . . . . . . . . . . . . . 101virt-gard . . . . . . . . . . . . . . . . . . . . . . . . 101

vancomycin intravenous recon soln 1,000 mg, 10 gram, 250 mg, 5 gram, 500 mg, 750 mg . . . . . . . . . . 9VANCOMYCIN INTRAVENOUS RECON SOLN 1.25 GRAM, 1.5 GRAM . . . . . . . . . . . . . . . . . . . . . . . 9vancomycin oral capsule 125 mg . . 9vancomycin oral capsule 250 mg . . 9vancomycin oral recon soln . . . . . . . 9VANCOMYCIN-WATER INJECT (PEG) . . . . . . . . . . . . . . . . . . . 9vandazole . . . . . . . . . . . . . . . . . . . . . . . 68VAQTA (PF) . . . . . . . . . . . . . . . . . . . . . 65VARIVAX (PF) . . . . . . . . . . . . . . . . . . . 65VARIZIG INTRAMUSCULAR SOLUTION . . . . . . . . . . . . . . . . . . . . . 65VASCEPA ORAL CAPSULE 0.5 GRAM . . . . . . . . . . . . 41VASCEPA ORAL CAPSULE 1 GRAM . . . . . . . . . . . . . . 41v-c forte . . . . . . . . . . . . . . . . . . . . . . . . 101VECTIBIX . . . . . . . . . . . . . . . . . . . . . . . 18VELCADE . . . . . . . . . . . . . . . . . . . . . . 18velivet triphasic regimen (28) . . . . . 72VELPHORO . . . . . . . . . . . . . . . . . . . . . 49VELTASSA . . . . . . . . . . . . . . . . . . . . . . 50VEMLIDY . . . . . . . . . . . . . . . . . . . . . . . . 4VENCLEXTA ORAL TABLET 10 MG . . . . . . . . . . . . . . . . . 18VENCLEXTA ORAL TABLET 50 MG . . . . . . . . . . . . . . . . . 18VENCLEXTA ORAL TABLET 100 MG . . . . . . . . . . . . . . . . 18VENCLEXTA STARTING PACK . . 18venlafaxine oral capsule, extended release 24hr 75 mg . . . . 35venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg . . . . 35venlafaxine oral tablet . . . . . . . . . . . . 35VENTAVIS . . . . . . . . . . . . . . . . . . . . . . 84VENTOLIN HFA . . . . . . . . . . . . . . . . . 84verapamil intravenous solution . . . 39verapamil oral capsule, 24 hr er pellet ct . . . . . . . . . . . . . . . . . 39

TYPHIM VI . . . . . . . . . . . . . . . . . . . . . . 65TYSABRI . . . . . . . . . . . . . . . . . . . . . . . 24

Uultimate women’s complete 50+ . 101ULTRA LUBRICANT EYE . . . . . . . . 74ULTRATHON TOPICAL AEROSOL,SPRAY . . . . . . . . . . . . . . 44unicomplex-m . . . . . . . . . . . . . . . . . . 101UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG . . . . . . . . . . . . . . . 57unithroid oral tablet 137 mcg . . . . . 57UNITUXIN . . . . . . . . . . . . . . . . . . . . . . 18UPTRAVI . . . . . . . . . . . . . . . . . . . . . . . 39ursodiol . . . . . . . . . . . . . . . . . . . . . . . . . 61

Vvalacyclovir oral tablet 1 gram . . . . . 4valacyclovir oral tablet 500 mg . . . . 4VALCHLOR . . . . . . . . . . . . . . . . . . . . . 44valganciclovir . . . . . . . . . . . . . . . . . . . . . 4valproic acid . . . . . . . . . . . . . . . . . . . . . 22valproic acid (as sodium salt) oral solution . . . . . . . . . . . . . . . . . . . . . 22valsartan-hydrochlorothiazide . . . . 39valsartan oral tablet 160 mg, 40 mg, 80 mg . . . . . . . . . . . 39valsartan oral tablet 320 mg . . . . . . 39VALTOCO . . . . . . . . . . . . . . . . . . . . . . . 22VANACLEAR PD . . . . . . . . . . . . . . . . 81VANACOF . . . . . . . . . . . . . . . . . . . . . . 81VANACOF DM . . . . . . . . . . . . . . . . . . 81VANACOF DMX . . . . . . . . . . . . . . . . . 81VANALICE . . . . . . . . . . . . . . . . . . . . . . 48VANAMINE PD . . . . . . . . . . . . . . . . . . 81VANATAB DM . . . . . . . . . . . . . . . . . . . 82VANCOMYCIN IN 0.9% SODIUM CHL INTRAVENOUS PIGGYBACK . 9VANCOMYCIN IN DEXTROSE 5% INTRAVENOUS PIGGYBACK . . . . . 9VANCOMYCIN INJECTION . . . . . . . 9

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westab mini . . . . . . . . . . . . . . . . . . . . 102westab one . . . . . . . . . . . . . . . . . . . . 102WEST-VITE WITH FOLIC ACID . 102white petrolatum topical ointment . 44wixela inhub . . . . . . . . . . . . . . . . . . . . . 84WOMEN’S DAILY FORMULA ORAL TABLET 18 MG IRON- 400 MCG-500 MG CA . . . . . . . . . . 102women’s daily formula oral tablet 27-0.4 mg . . . . . . . . . . . . 102WOMEN’S ONE DAILY . . . . . . . . . 102wymzya fe . . . . . . . . . . . . . . . . . . . . . . 72

XXALKORI . . . . . . . . . . . . . . . . . . . . . . . 19XARELTO . . . . . . . . . . . . . . . . . . . . . . . 40XARELTO DVT-PE TREAT 30D START . . . . . . . . . . . . . . 40XATMEP . . . . . . . . . . . . . . . . . . . . . . . . 19XCOPRI . . . . . . . . . . . . . . . . . . . . . . . . 22XCOPRI MAINTENANCE PACK . . 22XCOPRI TITRATION PACK . . . . . . 22XELJANZ . . . . . . . . . . . . . . . . . . . . . . . 67XELJANZ XR . . . . . . . . . . . . . . . . . . . 67XGEVA . . . . . . . . . . . . . . . . . . . . . . . . . 11XHANCE . . . . . . . . . . . . . . . . . . . . . . . . 84XIAFLEX . . . . . . . . . . . . . . . . . . . . . . . . 50XIFAXAN ORAL TABLET 550 MG . 9XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG, 5-1,000 MG, 5-500 MG . . . . . . . . . . . . . . . . . . . . . . . 55XIGDUO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 10-1,000 MG, 10-500 MG . . . . . . . . 55XIIDRA . . . . . . . . . . . . . . . . . . . . . . . . . 74XOFLUZA . . . . . . . . . . . . . . . . . . . . . . . . 4XOLAIR SUBCUTANEOUS RECON SOLN . . . . . . . . . . . . . . . . . . 84XOLAIR SUBCUTANEOUS SYRINGE . . . . . . . . . . . . . . . . . . . . . . . 84XOPENEX . . . . . . . . . . . . . . . . . . . . . . 84XOPENEX CONCENTRATE . . . . . 84XOSPATA . . . . . . . . . . . . . . . . . . . . . . . 19

vitamins a,c,d and fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml 102vitamins and minerals . . . . . . . . . . . 102vitamins b complex oral capsule . 102vitamins b complex oral tablet . . . 102VITAMINS B COMPLEX ORAL TABLET 500 MG- 400 MCG- 18 MG IRON . . . . . . . . 102vitamins for hair oral tablet . . . . . 102VITA-RESPA . . . . . . . . . . . . . . . . . . . 102vitatrum . . . . . . . . . . . . . . . . . . . . . . . . 102VIT C(ASCORB.CALCIUM)(MV-MINS) . . . . . . . . . . . . . . . . . . . . . 101VITRAKVI ORAL CAPSULE 25 MG . . . . . . . . . . . . . . . 19VITRAKVI ORAL CAPSULE 100 MG . . . . . . . . . . . . . . 19VITRAKVI ORAL SOLUTION . . . . . 19VITRUM SENIOR ORAL TABLET 500-300-250 MCG . . . . . 102vits a and d-white pet- lanolin topical ointment . . . . . . . . . . . 44VIVITROL . . . . . . . . . . . . . . . . . . . . . . . 29VIZIMPRO . . . . . . . . . . . . . . . . . . . . . . 19volnea (28) . . . . . . . . . . . . . . . . . . . . . . 72voriconazole intravenous . . . . . . . . . . 1voriconazole oral suspension for reconstitution . . . . . . . . . . . . . . . . . . 1voriconazole oral tablet . . . . . . . . . . . 1VOSEVI . . . . . . . . . . . . . . . . . . . . . . . . . 4VOTRIENT . . . . . . . . . . . . . . . . . . . . . . 19vp-vite rx . . . . . . . . . . . . . . . . . . . . . . . 102VRAYLAR ORAL CAPSULE . . . . . . 35VRAYLAR ORAL CAPSULE, DOSE PACK . . . . . . . . . . . . . . . . . . . . 35vyfemla (28) . . . . . . . . . . . . . . . . . . . . . 72vylibra . . . . . . . . . . . . . . . . . . . . . . . . . . 72VYXEOS . . . . . . . . . . . . . . . . . . . . . . . . 19

Wwarfarin . . . . . . . . . . . . . . . . . . . . . . . . . 40water for irrigation, sterile . . . . . . . . 50wee care . . . . . . . . . . . . . . . . . . . . . . . 102wera (28) . . . . . . . . . . . . . . . . . . . . . . . 72westab max . . . . . . . . . . . . . . . . . . . . 102

virt-phos 250 neutral . . . . . . . . . . . . . 89virtussin ac . . . . . . . . . . . . . . . . . . . . . . 82virtussin dac . . . . . . . . . . . . . . . . . . . . . 82VITAL-D RX . . . . . . . . . . . . . . . . . . . . 101vitalee . . . . . . . . . . . . . . . . . . . . . . . . . 101vitalets oral tablet,chewable . . . . . 101vitamin a oral capsule 10,000 unit, 8,000 unit . . . . . . . . . . 101vitamin b-1 . . . . . . . . . . . . . . . . . . . . . 101vitamin b-2 . . . . . . . . . . . . . . . . . . . . . 101vitamin b-6 oral tablet 100 mg, 25 mg, 50 mg . . . . . . . . . . 101vitamin b-12 oral tablet . . . . . . . . . . 101vitamin b-12 oral tablet extended release 1,000 mcg, 2,000 mcg . . 101vitamin b-12 sublingual tablet 2,500 mcg . . . . . . . . . . . . . . . . . . . . . 101vitamin b complex . . . . . . . . . . . . . . 101vitamin b complex-folic acid oral tablet . . . . . . . . . . . . . . . . . . . . . . 101vitamin c drops . . . . . . . . . . . . . . . . . 101vitamin c oral capsule, extended release . . . . . . . . . . . . . . . 101vitamin c oral powder . . . . . . . . . . . 101vitamin c oral tablet 1,000 mg, 250 mg, 500 mg . . . . . . 101vitamin c oral tablet, chewable 250 mg, 500 mg . . . . . . 101vitamin c oral tablet extended release . . . . . . . . . . . . . . . 101vitamin c with rose hips . . . . . . . . . 101vitamin e acetate . . . . . . . . . . . . . . . 101vitamin e (dl, acetate) oral capsule 100 unit, 400 unit . . . . . . . 101vitamin e (dl, acetate) oral drops 22.5 mg (50 unit)/ml . . . . . . 101VITAMIN E MIXED ORAL CAPSULE 1,000 UNIT . . . . . . . . . . 102vitamin e mixed oral capsule 400 unit . . . . . . . . . . . . . . . . 102vitamin e oral capsule . . . . . . . . . . . 102VITAMIN E ORAL DROPS . . . . . . 102vitamin k1 injection . . . . . . . . . . . . . . 40vitamins a and d . . . . . . . . . . . . . . . . 102

137

ZOSYN IN DEXTROSE (ISO-OSM) . . . . . . . . . . . . . . . . . . . . . . . 9zovia 1/35e (28) . . . . . . . . . . . . . . . . . 72ZTLIDO . . . . . . . . . . . . . . . . . . . . . . . . . 44ZUBSOLV SUBLINGUAL TABLET 0.7-0.18 MG, 11.4-2.9 MG . . . . . . . 29ZUBSOLV SUBLINGUAL TABLET 1.4-0.36 MG, 2.9-0.71 MG, 5.7-1.4 MG, 8.6-2.1 MG . . . . . . . . . . 29zumandimine (28) . . . . . . . . . . . . . . . 72ZYDELIG . . . . . . . . . . . . . . . . . . . . . . . 19ZYKADIA ORAL TABLET . . . . . . . . 19ZYLET . . . . . . . . . . . . . . . . . . . . . . . . . . 75ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG . . . . . . . . . . . . . . . . . . . . . . . . . 35ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 300 MG . . . . . . . . . . . . . . . . . . . . . . . . . 35ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 405 MG . . . . . . . . . . . . . . . . . . . . . . . . . 35ZYTIGA ORAL TABLET 500 MG . . 19

ZENPEP ORAL CAPSULE, DELAYED RELEASE(DR/EC) 10,000-32,000 -42,000 UNIT, 15,000-47,000 -63,000 UNIT, 20,000-63,000- 84,000 UNIT, 25,000-79,000- 105,000 UNIT, 3,000-10,000 -14,000-UNIT, 40,000-126,000- 168,000 UNIT, 5,000-17,000- 24,000 UNIT . . . . . . 61ZEPZELCA . . . . . . . . . . . . . . . . . . . . . 19zidovudine oral capsule . . . . . . . . . . . 5zidovudine oral syrup . . . . . . . . . . . . . 5zidovudine oral tablet . . . . . . . . . . . . . 5ZIEXTENZO . . . . . . . . . . . . . . . . . . . . 64zinc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89ZINC-15 . . . . . . . . . . . . . . . . . . . . . . . . 89zinc-220 . . . . . . . . . . . . . . . . . . . . . . . . 89ZINC GLUCONATE ORAL LOZENGE . . . . . . . . . . . . . . . . 89zinc gluconate oral tablet . . . . . . . . . 89zinc oxide topical ointment 20%, 25% . . . . . . . . . . . . . . 44zinc sulfate oral . . . . . . . . . . . . . . . . . . 89ZINC (WITH A AND C) LOZENGES . . . . . . . . . . . . . . . . . . . . 102ZIOPTAN (PF) . . . . . . . . . . . . . . . . . . . 75ziprasidone hcl . . . . . . . . . . . . . . . . . . 35ziprasidone mesylate . . . . . . . . . . . . 35ZIRABEV . . . . . . . . . . . . . . . . . . . . . . . 19ZIRGAN . . . . . . . . . . . . . . . . . . . . . . . . 73zoledronic acid intravenous solution . . . . . . . . . . . . . 57zoledronic acid-mannitol-water intravenous piggyback 5 mg/100 ml . . . . . . . . . . . . . . . . . . . . . 50ZOLINZA . . . . . . . . . . . . . . . . . . . . . . . 19zolpidem oral tablet . . . . . . . . . . . . . . 35zonisamide . . . . . . . . . . . . . . . . . . . . . . 22ZORTRESS ORAL TABLET 0.5 MG . . . . . . . . . . . . . . . . . 19ZORTRESS ORAL TABLET 0.25 MG . . . . . . . . . . . . . . . . 19ZORTRESS ORAL TABLET 0.75 MG, 1 MG . . . . . . . . . 19ZOSTAVAX (PF) . . . . . . . . . . . . . . . . . 65

XPOVIO ORAL TABLET 40MG TWICE WEEK (80 MG/WEEK), 80 MG/WEEK (20 MG X 4) . . . . . . . 19XPOVIO ORAL TABLET 40 MG/WEEK (20 MG X 2), 60MG TWICE WEEK (120 MG/WEEK) . . . . . . . . . . . . . . . . 19XPOVIO ORAL TABLET 60 MG/WEEK (20 MG X 3) . . . . . . . 19XPOVIO ORAL TABLET 80MG TWICE WEEK (160 MG/WEEK) . . 19XPOVIO ORAL TABLET 100 MG/WEEK (20 MG X 5) . . . . . . 19XTAMPZA ER . . . . . . . . . . . . . . . . . . . 27XTANDI . . . . . . . . . . . . . . . . . . . . . . . . . 19XULTOPHY 100/3.6 . . . . . . . . . . . . . 55XYREM . . . . . . . . . . . . . . . . . . . . . . . . . 35

Yyelets . . . . . . . . . . . . . . . . . . . . . . . . . . 102YERVOY INTRAVENOUS SOLUTION 50 MG/10 ML (5 MG/ML) . . . . . . . . . . . . . . . . . . . . . . 19YERVOY INTRAVENOUS SOLUTION 200 MG/40 ML (5 MG/ML) . . . . . . . . . . . . . . . . . . . . . . 19YF-VAX (PF) . . . . . . . . . . . . . . . . . . . . 65YONDELIS . . . . . . . . . . . . . . . . . . . . . . 19YONSA . . . . . . . . . . . . . . . . . . . . . . . . . 19YUPELRI . . . . . . . . . . . . . . . . . . . . . . . 84yuvafem . . . . . . . . . . . . . . . . . . . . . . . . 68

Zzafirlukast . . . . . . . . . . . . . . . . . . . . . . . 84zaleplon oral capsule 5 mg . . . . . . . 35zaleplon oral capsule 10 mg . . . . . . 35zarah . . . . . . . . . . . . . . . . . . . . . . . . . . . 72ZARXIO . . . . . . . . . . . . . . . . . . . . . . . . 63Z-BUM . . . . . . . . . . . . . . . . . . . . . . . . . . 44zebutal oral capsule 50-325-40 mg . . . . . . . . . . . . . . . . . . . 27ZEJULA . . . . . . . . . . . . . . . . . . . . . . . . 19ZELBORAF . . . . . . . . . . . . . . . . . . . . . 19ZEMAIRA . . . . . . . . . . . . . . . . . . . . . . . 50zenatane . . . . . . . . . . . . . . . . . . . . . . . . 45

Updated on 12/01/2020. For more information or other questions, please contact Cigna-HealthSpring CarePlan at 1-877-653-0327 (TTY: 7-1-1), 7 days a week, 8 a.m. to 8 p.m. Central Time, or visit careplantx.cigna.com.HPMS Approved Formulary File Submission ID 20088, Version Number 19 923613 p 12/19

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LIST OF COVERED DRUGS (FORMULARY) 2020 - Cigna

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