1 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
A ACARBOSE
ACCOLATE
ACCUPRIL
ACCURETIC
ACEBUTOLOL HCL
ACEON
ACETAZOLAMIDE
ACIPHEX
ACIPHEX SPRINKLE
ACTIGALL
ACTIVE OB
ACTIVELLA
ACTONEL
ACTOPLUS MET
ACTOPLUS MET XR
ACTOS
ADALAT CC
ADLYXIN
ADVAIR DISKUS
ADVAIR HFA
ADVANCED AM/PM
ADVICOR
ADYNOVATE
AEROSPAN
AFEDITAB CR
AFREZZA
AGGRENOX
AGRYLIN
ALBUTEROL SULFATE
ALDACTAZIDE
ALDACTONE
ALENDRONATE SODIUM
ALFUZOSIN HCL ER
ALLOPURINOL
ALOGLIPTIN
ALOGLIPTIN-METFORMIN
ALOGLIPTIN-PIOGLITAZONE
ALORA
ALPHAGAN P
ALTACE
ALTAVERA
ALTOPREV
ALVESCO
ALYACEN
AMABELZ
AMARYL
AMETHIA
AMETHIA LO
AMETHYST
AMILORIDE HCL
AMILORIDE HCL W/HCTZ
AMIODARONE HCL
AMITIZA
AMLODIPINE BESYLATE
AMLODIPINE BESYLATE-BENAZEPRIL
AMLODIPINE-ATORVASTATIN
AMLODIPINE-OLMESARTAN
AMLODIPINE-VALSARTAN
AMLODIPINE-VALSARTAN-HCTZ
AMTURNIDE
ANAGRELIDE HYDROCHLORIDE
ANAPROX
ANAPROX DS
ANASTROZOLE
ANGELIQ
ANIMI-3
ANSAID
ANTARA
APIDRA
APIDRA SOLOSTAR
APLENZIN
APRI
APRISO
ARANELLE
ARAVA
ARCAPTA NEOHALER
ARICEPT
ARICEPT ODT
ARIMIDEX
ARMOUR THYROID
ARNUITY ELLIPTA
AROMASIN
ARTHROTEC
ASACOL HD
ASHLYNA
ASMANEX
ASMANEX HFA
ASPIRIN E.C.
ASPIRIN-DIPYRIDAMOLE ER
ATABEX EC
ATACAND
ATACAND HCT
ATELVIA
ATENOLOL
ATENOLOL W/CHLORTHALIDONE
ATORVASTATIN CALCIUM
ATROVENT
ATROVENT HFA
AUBRA
AVALIDE
AVANDAMET
AVANDARYL
AVANDIA
AVAPRO
AVIANE
AVODART
AV-VITE FB
AV-VITE FB FORTE
AYGESTIN
AZILECT
AZOPT
AZOR
AZULFIDINE
AZURETTE B BACLOFEN
BACMIN
BAL-CARE DHA
BAL-CARE DHA ESSENTIAL
BALZIVA
BASAGLAR KWIKPEN U-100
BECONASE AQ
BEKYREE
BENAZEPRIL HCL
2 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
BENAZEPRIL HCL-HCTZ
BENICAR
BENICAR HCT
BETAGAN
BETAPACE
BETAPACE AF
BETAXOLOL HCL
BETIMOL
BETOPTIC S
BEYAZ
BICALUTAMIDE
BIDIL
BIMATOPROST
BINOSTO
BISOPROLOL FUMARATE
BISOPROLOL FUMARATE/HCTZ
BLISOVI 24 FE
BLISOVI FE
BONIVA
BP VIT 3 PLUS
BREO ELLIPTA
BREVICON
BRIELLYN
BRILINTA
BRIMONIDINE TARTRATE
BRINTELLIX
BROMOCRIPTINE MESYLATE
BROVANA
BUDEPRION SR
BUDESONIDE
BUMETANIDE
BUPHENYL
BUPROPION HCL
BUPROPION HCL ER
BUPROPION HCL XL
BUPROPION SR
BUSPIRONE HCL
BYDUREON
BYDUREON PEN
BYETTA
BYSTOLIC
BYVALSON
C CABERGOLINE
CADEAU DHA
CADUET
CALAN
CALAN SR
CALCITONIN-SALMON
CALCITRIOL
CALCIUM PNV
CALCIUM-FOLIC ACID PLUS D
CAMILA
CAMRESE
CAMRESE LO
CANDESARTAN CILEXETIL
CANDESARTAN-HYDROCHLOROTHIAZID
CAPTOPRIL
CAPTOPRIL/HYDROCHLOROTHIAZIDE
CARAFATE
CARBIDOPA
CARBIDOPA/LEVODOPA
CARBIDOPA-LEVODOPA ER
CARBIDOPA-LEVODOPA-ENTACAPONE
CARDENE SR
CARDIZEM
CARDIZEM CD
CARDIZEM LA
CARDURA
CARDURA XL
CARNITOR
CARNITOR SF
CARTEOLOL HCL
CARTIA XT
CARVEDILOL
CASODEX
CATAFLAM
CATAPRES
CATAPRES-TTS
CAVAN-EC SOD DHA
CAVERJECT
CAZIANT
CELEBREX
CELECOXIB
CELEXA
CENESTIN
CEVIMELINE HCL
CHATEAL
CHLOROTHIAZIDE
CHLORPROPAMIDE
CHLORTHALIDONE
CHOICE-OB + DHA
CHOICE-TABS
CHOLESTYRAMINE
CHOLESTYRAMINE LIGHT
CHOLINE MAG TRISALICYLATE
CIALIS
CILOSTAZOL
CIMETIDINE
CITALOPRAM HBR
CITRANATAL 90 DHA
CITRANATAL ASSURE
CITRANATAL B-CALM
CITRANATAL DHA
CITRANATAL HARMONY
CITRANATAL RX
CLIMARA
CLIMARA PRO
CLINPRO 5000
CLONIDINE HCL
CLONIDINE HCL ER
CLOPIDOGREL
CLORPRES
C-NATE DHA
COLCHICINE
COLCRYS
COLESTID
COLESTIPOL HCL
COMBIGAN
COMBIPATCH
COMPLETE NATAL DHA
COMPLETENATE
COMTAN
CONCEPT DHA
CONCEPT OB
CONSTULOSE
3 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
CONTRAVE ER
CORDARONE
COREG
COREG CR
CORGARD
CORLANOR
CORVITA
CORVITE
CORZIDE
COSOPT
COSOPT PF
COZAAR
CRESTOR
CROMOLYN SODIUM
CRYSELLE
CUPRIMINE
CYANOCOBALAMIN
CYCLAFEM
CYCLESSA
CYCLOSET
CYMBALTA
CYRED
CYTOMEL
CYTOTEC D DALIRESP
DANTRIUM
DANTROLENE SODIUM
DARIFENACIN ER
DASETTA
DAYPRO
DAYSEE
DEBLITANE
DELYLA
DELZICOL
DEMADEX
DENTA 5000 PLUS
DENTAGEL
DEPEN
DEPO-PROVERA
DEPO-SUBQ PROVERA
DESMOPRESSIN ACETATE
DESOGEN
DESOGESTREL-ETHINYL ESTRADIOL
DESOGESTR-ETH ESTRAD ETH ESTRA
DESVENLAFAXINE ER
DESVENLAFAXINE FUMARATE ER
DETROL
DETROL LA
DEXILANT
DIABETA
DIALYVITE
DIALYVITE 800 WITH IRON
DIAMOX SEQUELS
DICLOFENAC POTASSIUM
DICLOFENAC SODIUM
DICLOFENAC SODIUM-MISOPROSTOL
DIFIL-G
DIFLUNISAL
DIGITEK
DIGOX
DIGOXIN
DILACOR XR
DILATRATE-SR
DILT-CD
DILTIAZEM 24HR CD
DILTIAZEM ER
DILTIAZEM HCL
DILT-XR
DILTZAC ER
DIOVAN
DIOVAN HCT
DIPENTUM
DIPYRIDAMOLE
DISALCID
DISOPYRAMIDE PHOSPHATE
DITROPAN XL
DIURIL
DIVIGEL
DONEPEZIL HCL
DORZOLAMIDE HCL
DORZOLAMIDE-TIMOLOL
DOTHELLE DHA
DOXAZOSIN MESYLATE
DOXERCALCIFEROL
DRISDOL
DROSPIRENONE-ETH ESTRA-LEVOMEF
DROSPIRENONE-ETHINYL ESTRADIOL
DUAVEE
DUET DHA
DUET DHA BALANCED
DUET DHA EC
DUETACT
DUEXIS
DULERA
DULOXETINE HCL
DURLAZA
DUTASTERIDE
DUTASTERIDE-TAMSULOSIN
DUTOPROL
DYAZIDE
DYRENIUM E EC-NAPROSYN
EDARBI
EDARBYCLOR
EDECRIN
EDEX
EFFER-K
EFFEXOR XR
EFFIENT
ELDEPRYL
ELDERCAPS
ELESTRIN
ELINEST
ELIQUIS
ELITE OB
ELITE-OB
ELITE-OB 400
ELIXOPHYLLIN
EMOQUETTE
ENABLEX
ENALAPRIL MALEATE
ENALAPRIL MALEATE/HCTZ
4 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
ENBRACE HR
ENJUVIA
ENPRESSE
ENSKYCE
ENTACAPONE
ENTRESTO
ENULOSE
EPANED
EPLERENONE
EPROSARTAN MESYLATE
ERGOCALCIFEROL
ERGOLOID MESYLATES
ERRIN
ESCAVITE
ESCAVITE D
ESCAVITE LQ
ESCITALOPRAM OXALATE
ESOMEPRAZOLE MAGNESIUM
ESOMEPRAZOLE STRONTIUM
ESTARYLLA
ESTRACE
ESTRADIOL
ESTRADIOL-NORETHINDRONE ACETAT
ESTRASORB
ESTRING
ESTROGEL
ESTROPIPATE
ESTROSTEP FE
ETHACRYNIC ACID
ETHYNODIOL-ETHINYL ESTRADIOL
ETIDRONATE DISODIUM
ETODOLAC
ETODOLAC ER
EVAMIST
EVISTA
EVOXAC
EXELON
EXEMESTANE
EXFORGE
EXFORGE HCT
EXTRA-VIRT PLUS DHA
EZETIMIBE
F FABB
FALMINA
FAMOTIDINE
FARESTON
FARXIGA
FASLODEX
FELDENE
FELODIPINE ER
FEMARA
FEMCON FE
FEMHRT
FEMRING
FEMYNOR
FENOFIBRATE
FENOFIBRIC ACID
FENOGLIDE
FENOPROFEN CALCIUM
FENORTHO
FETZIMA
FIBRICOR
FINASTERIDE
FLAVOXATE HCL
FLECAINIDE ACETATE
FLOMAX
FLONASE
FLORIVA
FLORIVA PLUS
FLOVENT DISKUS
FLOVENT HFA
FLUDROCORTISONE ACETATE
FLUNISOLIDE
FLUORABON
FLUOR-A-DAY
FLUORIDE
FLUORIDEX DAILY DEFENSE
FLUORIDEX SENSITIVITY RELIEF
FLUORITAB
FLUOXETINE DR
FLUOXETINE HCL
FLURA-DROPS
FLURBIPROFEN
FLUTAMIDE
FLUTICASONE PROPIONATE
FLUVASTATIN ER
FLUVASTATIN SODIUM
FLUVOXAMINE MALEATE
FOCALGIN 90 DHA
FOCALGIN CA
FOCALGIN-B
FOLBECAL
FOLBEE
FOLBEE PLUS
FOLBIC
FOLCAL DHA
FOLCAPS OMEGA-3
FOLET DHA
FOLET ONE
FOLGARD OS
FOLGARD RX
FOLIC ACID
FOLIC ACID-CYANCOBAL-PYRIDOXIN
FOLINATAL PLUS B
FOLIVANE-OB
FOLIVANE-PRX DHA NF
FOLPLEX 2.2
FORADIL
FORFIVO XL
FORTAMET
FORTAVIT
FORTICAL
FOSAMAX
FOSAMAX PLUS D
FOSINOPRIL SODIUM
FOSINOPRIL-HYDROCHLOROTHIAZIDE
FUROSEMIDE
FYAVOLV G GABAPENTIN
GABLOFEN
GALANTAMINE
GASTROCROM
GELNIQUE
5 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
GEMFIBROZIL
GENERESS FE
GENERLAC
GESTICARE DHA
GIANVI
GILDAGIA
GILDESS
GILDESS 24 FE
GILDESS FE
GLIMEPIRIDE
GLIPIZIDE
GLIPIZIDE ER
GLIPIZIDE XL
GLIPIZIDE-METFORMIN
GLUCOPHAGE
GLUCOPHAGE XR
GLUCOTROL
GLUCOTROL XL
GLUCOVANCE
GLUMETZA
GLYBURIDE
GLYBURIDE MICRONIZED
GLYBURIDE-METFORMIN HCL
GLYCATE
GLYCOPYRROLATE
GLYNASE
GLYSET
GLYXAMBI
GUANFACINE HCL
GUANFACINE HCL ER H HEATHER
HECTOROL
HEMENATAL OB
HEMENATAL OB + DHA
HONEY BEE VENOM PROTEIN
HORIZANT
HUMALOG
HUMALOG MIX 50-50
HUMALOG MIX 75-25
HUMULIN 70/30 KWIKPEN
HUMULIN 70-30
HUMULIN N
HUMULIN N KWIKPEN
HUMULIN R
HUMULIN R U-500 KWIKPEN
HYDRALAZINE HCL
HYDROCHLOROTHIAZIDE
HYDROXYCHLOROQUINE SULFATE
HYZAAR I IBANDRONATE SODIUM
IBUPROFEN
IMDUR
INATAL ADVANCE
INATAL ULTRA
INCRUSE ELLIPTA
INDAPAMIDE
INDERAL LA
INDERAL XL
INDOCIN
INDOMETHACIN
INFANATE BALANCE
INFANATE PLUS
INNOPRAN XL
INSPRA
INTROVALE
INTUNIV
INVOKAMET
INVOKAMET XR
INVOKANA
IPRATROPIUM BROMIDE
IRBESARTAN
IRBESARTAN-HYDROCHLOROTHIAZIDE
IRENKA
ISOCHRON
ISOPTO CARBACHOL
ISOPTO CARPINE
ISORDIL
ISOSORBIDE DINITRATE
ISOSORBIDE MONONITRATE
ISOXSUPRINE HCL
ISRADIPINE
ISTALOL J JALYN
JANUMET
JANUMET XR
JANUVIA
JARDIANCE
JENCYCLA
JENTADUETO
JENTADUETO XR
JEVANTIQUE LO
JINTELI
JOLESSA
JOLIVETTE
JULEBER
JUNEL
JUNEL FE K K EFFERVESCENT
KAITLIB FE
KAPVAY
KARIVA
KAZANO
KELNOR 1-35
KETOPROFEN
KHEDEZLA
KIMIDESS
KLOR-CON
KLOR-CON M
KLOR-CON SPRINKLE
KLOR-CON-EF
KOMBIGLYZE XR
KOSHER PRENATAL PLUS IRON
KRISTALOSE
K-SOL
K-TAB KURVELO L LABETALOL HCL
6 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
LACTULOSE
LANOXIN
LANSOPRAZOLE
LANTUS
LANTUS SOLOSTAR
LARIN
LARIN FE
LARISSIA
LASIX
LATANOPROST
LAYOLIS FE
LEENA
LEFLUNOMIDE
LESCOL
LESCOL XL
LESSINA
LETROZOLE
LEVATOL
LEVEMIR
LEVEMIR FLEXTOUCH
LEVITRA
LEVOBUNOLOL HCL
LEVOCARNITINE
LEVOMEFOLATE DHA
LEVONEST
LEVONORGESTREL-ETH ESTRADIOL
LEVONORG-ETH ESTRAD ETH ESTRAD
LEVORA
LEVO-T
LEVOTHYROXINE SODIUM
LEVOXYL
LEXAPRO
LIALDA
LINZESS
LIORESAL
LIOTHYRONINE SODIUM
LIPITOR
LIPOFEN
LIPTRUZET
LISINOPRIL
LISINOPRIL-HCTZ
LIVALO
LO LOESTRIN FE
LO MINASTRIN FE
LODINE
LODOSYN
LOESTRIN
LOESTRIN FE
LOFIBRA
LOMEDIA 24 FE
LOPID
LOPREEZA
LOPRESSOR
LOPRESSOR HCT
LORYNA
LOSARTAN POTASSIUM
LOSARTAN-HYDROCHLOROTHIAZIDE
LOSEASONIQUE
LOTENSIN
LOTENSIN HCT
LOTREL
LOVASTATIN
LOVAZA
LOW-OGESTREL
LOZI-FLUR
LUDENT FLUORIDE
LUFYLLIN
LUMIGAN
LUTERA
LUVOX CR
LYZA M MACNATAL CN DHA
MACUVEX
MACUZIN
MARLISSA
MARNATAL-F
MATZIM LA
MAVIK
MAXINATE
MAXZIDE
MEBOLIC
MECLOFENAMATE SODIUM
MEDROXYPROGESTERONE ACETATE
MELOXICAM
MEMANTINE HCL
MENEST
MENOSTAR
MESALAMINE
METAPROTERENOL SULFATE
METFORMIN HCL
METFORMIN HCL ER
METHAZOLAMIDE
METHIMAZOLE
METHYCLOTHIAZIDE
METHYLDOPA
METHYLDOPA/HYDROCHLOROTHIAZIDE
METIPRANOLOL
METOLAZONE
METOPROLOL SUCCINATE
METOPROLOL SUCCINATE-HCTZ ER
METOPROLOL TARTRATE
METOPROLOL-HYDROCHLOROTHIAZIDE
MEVACOR
MEXILETINE HCL
MIACALCIN
MICARDIS
MICARDIS HCT
MICROGESTIN
MICROGESTIN 24 FE
MICROGESTIN FE
MICROZIDE
MIGLITOL
MIMVEY
MIMVEY LO
MINASTRIN 24 FE
MINIPRESS
MINITRAN
MINIVELLE
MINOXIDIL
MIRAPEX
MIRAPEX ER
MIRCETTE
MIRTAZAPINE
MISOPROSTOL
7 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
MITIGARE
MIXED VESPID VENOM PROTEIN
MOBIC
MODICON
MOEXIPRIL HCL
MOEXIPRIL-HYDROCHLOROTHIAZIDE
MOMETASONE FUROATE
MONO-LINYAH
MONONESSA
MONTELUKAST SODIUM
MULTAQ
MULTICHEW
MULTIVITAMIN W/FLUORIDE & IRON
MULTIVITAMIN WITH FLUORIDE
MULTIVITAMINS
MULTIVITAMINS-A,B,D,E,K,ZN
MUSE
MVC-FLUORIDE
M-VIT
MYKIDZ IRON FL
MYNATAL
MYNATAL ADVANCE
MYNATAL PLUS
MYNATAL-Z
MYNATE 90 PLUS
MYNEPHROCAPS
MYRBETRIQ
MYZILRA N NABUMETONE
NADOLOL
NADOLOL-BENDROFLUMETHIAZIDE
NALFON
NAMENDA
NAMENDA XR
NAMZARIC
NAPRELAN
NAPROSYN
NAPROXEN
NAPROXEN SODIUM
NAPROXEN SODIUM DS
NAPROXEN SODIUM ER
NASACORT AQ
NASCOBAL
NASONEX
NATACHEW
NATAFORT
NATAL-V RX
NATALVIRT 90 DHA
NATALVIRT CA
NATALVIT
NATAZIA
NATEGLINIDE
NATELLE ONE
NATURE-THROID
NECON
NEEVO DHA
NEFAZODONE HCL
NEPHPLEX RX
NEPHROCAPS
NEPHRO-VITE RX
NEPTAZANE
NESINA
NESTABS
NESTABS ABC
NESTABS DHA
NEUPRO
NEURONTIN
NEWGEN
NEXA PLUS
NEXIUM RX
NIACIN ER
NIACOR
NIASPAN
NICARDIPINE HCL
NICOMIDE
NIFEDICAL XL
NIFEDIPINE
NIFEDIPINE ER
NIKKI
NILANDRON
NILUTAMIDE
NISOLDIPINE
NITRO-BID
NITRO-DUR
NITROGLYCERIN
NITRO-TIME
NIVA-FOL
NIVA-PLUS
NIZATIDINE
NORA-BE
NORETHINDRONE ACETATE
NORETHINDRONE-ETHIN ESTRADIOL
NORETHIN-ETH ESTRA FERROUS FUM
NORGESTIMATE-ETHINYL ESTRADIOL
NORGESTREL-ETHINY ESTRA
NORINYL
NORLYROC
NORPACE
NORPACE CR
NOR-Q-D
NORTREL
NORVASC
NOVOLIN 70-30
NOVOLIN N
NOVOLIN R
NOVOLOG
NOVOLOG FLEXPEN
NOVOLOG MIX 70-30
NP THYROID
NUTRICAP
NUVARING O OB COMPLETE
OB COMPLETE DHA
OB COMPLETE GOLD
OB COMPLETE ONE
OB COMPLETE PETITE
OB COMPLETE PREMIER
OBSTETRIX DHA
OBSTETRIX EC
OBSTETRIX ONE
OBTREX
OBTREX DHA
8 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
O-CAL FA
O-CAL PRENATAL
OCELLA
OGESTREL
OLEPTRO ER
OLMESARTAN MEDOXOMIL
OLMESARTAN-AMLODIPINE-HCTZ
OLMESARTAN-HYDROCHLOROTHIAZIDE
OMEGA-3 ACID ETHYL ESTERS
OMEPRAZOLE
OMEPRAZOLE+SYRSPEND SF ALKA
OMEPRAZOLE-SODIUM BICARBONATE
OMNARIS
ONGLYZA
ORSYTHIA
ORTHO EVRA
ORTHO MICRONOR
ORTHO TRI-CYCLEN
ORTHO TRI-CYCLEN LO
ORTHO-CEPT
ORTHO-CYCLEN
ORTHO-NOVUM
OSENI
OTREXUP
OVCON
OXAPROZIN
OXYBUTYNIN CHLORIDE
OXYBUTYNIN CHLORIDE ER
OXYTROL P PACERONE
PAIRE OB PLUS DHA
PANTOPRAZOLE SODIUM
PAPAVERINE HCL
PARCOPA
PARICALCITOL
PARLODEL
PAROXETINE ER
PAROXETINE HCL
PAXIL
PAXIL CR
PENTASA
PENTOXIFYLLINE
PEPCID
PERFOROMIST
PERINDOPRIL ERBUMINE
PERSANTINE
PEXEVA
PHILITH
PHOSPHOLINE IODIDE
PILOCARPINE HCL
PIMTREA
PINDOLOL
PIOGLITAZONE HCL
PIOGLITAZONE-GLIMEPIRIDE
PIOGLITAZONE-METFORMIN
PIRMELLA
PIROXICAM
PLAQUENIL
PLAVIX
PLETAL
PNV 29-1
PNV FOLIC ACID + IRON
PNV OB+DHA
PNV-DHA
PNV-DHA + DOCUSATE
PNV-FERROUS FUMARATE-DOCU-FA
PNV-FIRST
PNV-OMEGA
PNV-SELECT
PNV-TOTAL
PNV-VP-U
POLY-VI-FLOR
POLY-VI-FLOR FS
POLY-VI-FLOR W/IRON
POLY-VITAMIN WITH FLUORIDE
PORTIA
POTABA
POTASSIUM BICARBONATE
POTASSIUM CHLORIDE
POTASSIUM CITRATE ER
PR NATAL 400
PR NATAL 400 EC
PR NATAL 430
PR NATAL 430 EC
PRADAXA
PRAMIPEXOLE DI-HCL
PRAMIPEXOLE ER
PRANDIMET
PRANDIN
PRAVACHOL
PRAVASTATIN SODIUM
PRAZOSIN HCL
PRECOSE
PREFERA-OB
PREFERA-OB ONE
PREFERA-OB PLUS DHA
PREFEST
PREFOL-DHA
PREMARIN
PREMPHASE
PREMPRO
PRENA1
PRENA1 CHEW
PRENA1 PEARL
PRENA1 PLUS
PRENA1 TRUE
PRENAISSANCE
PRENAISSANCE 90 DHA
PRENAISSANCE BALANCE
PRENAISSANCE DHA
PRENAISSANCE HARMONY DHA
PRENAISSANCE NEXT
PRENAISSANCE NEXT-B
PRENAISSANCE PLUS
PRENAISSANCE PROMISE
PRENAPLUS
PRENATA
PRENATABS FA
PRENATABS RX
PRENATAL 19
PRENATAL AD
PRENATAL LOW IRON
PRENATAL PLUS
PRENATAL PLUS-DHA
9 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
PRENATAL VITAMIN PLUS LOW IRON
PRENATAL-U
PRENATE
PRENATE AM
PRENATE DHA
PRENATE ELITE
PRENATE ENHANCE
PRENATE ESSENTIAL
PRENATE MINI
PRENATE PIXIE
PRENATE RESTORE
PRENATE STAR
PREPLUS
PREQUE 10
PRESTALIA
PRETAB
PREVACID RX
PREVALITE
PREVIDENT
PREVIDENT 5000 ENAMEL PROTECT
PREVIDENT 5000 SENSITIVE
PREVIFEM
PRILOSEC RX
PRIMACARE
PRINIVIL
PRISTIQ
PROBENECID
PROBENECID W/COLCHICINE
PROCARDIA
PROCARDIA XL
PROGESTERONE
PROGLYCEM
PROMETRIUM
PROPAFENONE HCL
PROPECIA
PROPRANOLOL HCL
PROPRANOLOL HCL ER
PROPRANOLOL HCL-HCTZ
PROPYLTHIOURACIL
PROSCAR
PROTECT IRON
PROTONIX
PROVERA
PROVIDA DHA
PROVIDA OB
PROZAC
PROZAC WEEKLY
PULMICORT
PULMICORT FLEXHALER
PUREFE OB PLUS
PUREFE PLUS Q QBRELIS
QNASL
QUARTETTE
QUASENSE
QUESTRAN
QUESTRAN LIGHT
QUFLORA
QUFLORA FE
QUINAPRIL
QUINAPRIL-HYDROCHLOROTHIAZIDE
QUINIDINE GLUCONATE
QUINIDINE SULFATE
QVAR R RABEPRAZOLE SODIUM
RAJANI
RALOXIFENE HCL
RAMIPRIL
RANEXA
RANITIDINE HCL
RAPAFLO
RASAGILINE MESYLATE
RASUVO
RAYALDEE
RAZADYNE
RAZADYNE ER
RECLIPSEN
RELNATE DHA
REMERON
RENAL CAPS
RENA-VITE RX
RENO CAPS
REPAGLINIDE
REPAGLINIDE-METFORMIN HCL
REQ49+
REQUIP
REQUIP XL
RESCULA
RESERPINE
RESTASIS
RESTASIS MULTIDOSE
RHINOCORT AQUA
RIDAURA
RIOMET
RISEDRONATE SODIUM
RISEDRONATE SODIUM DR
RIVASTIGMINE
R-NATAL OB
ROBINUL
ROBINUL FORTE
ROCALTROL
ROPINIROLE HCL
ROSUVASTATIN CALCIUM
RULAVITE DHA
RYTARY
RYTHMOL
RYTHMOL SR S SAFYRAL
SALAGEN
SALSALATE
SANCTURA
SANCTURA XR
SARAFEM
SAVAYSA
SAVELLA
SAXENDA
SEASONIQUE
SECTRAL
SEEBRI NEOHALER
SELECT-OB
SELECT-OB + DHA
10 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
SELEGILINE HCL
SE-NATAL 19
SEREVENT DISKUS
SERTRALINE HCL
SE-TAN DHA
SETLAKIN
SETONET
SETONET-EC
SF
SF 5000 PLUS
SHAROBEL
SIMBRINZA
SIMCOR
SIMVASTATIN
SINEMET
SINEMET CR
SINGULAIR
SODIUM FLUORIDE
SODIUM PHENYLBUTYRATE
SOLIQUA 100-33
SOLTAMOX
SORINE
SOTALOL
SOTALOL AF
SOTYLIZE
SPIRIVA
SPIRIVA RESPIMAT
SPIRONOLACTONE
SPIRONOLACTONE W/HCTZ
SPRINTEC
SRONYX
STALEVO
STANNOUS FLUORIDE
STARLIX
STAXYN
STENDRA
STRATTERA
STRIVERDI RESPIMAT
STROVITE FORTE
STROVITE ONE
STROVITE PLUS
SUCRALFATE
SULAR
SULFASALAZINE
SULFASALAZINE DR
SULFAZINE
SULINDAC
SUPERVITE
SYEDA
SYMBICORT
SYMLINPEN 120
SYMLINPEN 60
SYNJARDY
SYNTHROID T TAMOXIFEN CITRATE
TAMSULOSIN HCL
TANZEUM
TAPAZOLE
TARINA FE
TARKA
TARON PRENATAL
TARON-BC
TARON-C DHA
TASMAR
TAYTULLA
TAZTIA XT
TEKAMLO
TEKTURNA
TEKTURNA HCT
TELMISARTAN
TELMISARTAN-AMLODIPINE
TELMISARTAN-HYDROCHLOROTHIAZID
TENEX
TENORETIC
TENORMIN
TERAZOSIN HCL
TERBUTALINE SULFATE
TEVETEN
TEVETEN HCT
TEXAVITE LQ
THEO-24
THEOCHRON
THEOPHYLLINE ANHYDROUS
THERAPEUTIC HEMATINIC
THRIVITE 19
THRIVITE RX
THYROLAR
TIAZAC
TICANASE
TICASPRAY
TICLOPIDINE HCL
TILIA FE
TIMOLOL MALEATE
TIMOPTIC
TIMOPTIC-XE
TIROSINT
TL FOLATE
TL GARD RX
TL G-FOL OS
TL-CARE DHA
TL-FLUORIVITE
TL-SELECT
TL-SELECT DHA
TOLAZAMIDE
TOLBUTAMIDE
TOLCAPONE
TOLMETIN SODIUM
TOLTERODINE TARTRATE
TOLTERODINE TARTRATE ER
TOPROL XL
TORSEMIDE
TOUJEO SOLOSTAR
TOVIAZ
TRADJENTA
TRANDATE
TRANDOLAPRIL
TRANDOLAPRIL-VERAPAMIL
TRAVATAN Z
TRAVOPROST
TRAZODONE HCL
TRESIBA FLEXTOUCH U-100
TRESIBA FLEXTOUCH U-200
TRIADVANCE
TRIAMCINOLONE ACETONIDE
11 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
TRIAMTERENE W/HCTZ
TRIBENZOR
TRICARE
TRICARE PRENATAL
TRICARE PRENATAL COMPLEAT
TRICARE PRENATAL DHA ONE
TRICARE PRENATAL WITH DHA
TRICOR
TRI-ESTARYLLA
TRIFERIC
TRIGLIDE
TRI-LEGEST FE
TRI-LINYAH
TRILIPIX
TRI-LO-ESTARYLLA
TRI-LO-MARZIA
TRI-LO-SPRINTEC
TRINATAL GT
TRINATAL RX 1
TRINATAL ULTRA
TRINATE
TRINESSA
TRINESSA LO
TRI-NORINYL
TRINTELLIX
TRIPHROCAPS
TRIPLE-VITAMIN W-FLUORIDE
TRI-PREVIFEM
TRI-SPRINTEC
TRISTART DHA
TRI-TABS DHA
TRIVEEN-DUO DHA
TRIVEEN-ONE
TRIVEEN-PRX RNF
TRI-VI-FLOR
TRI-VI-FLORO
TRI-VITAMIN WITH FLUORIDE
TRI-VITAMIN WITH IRON-FLUORIDE
TRIVORA
TROSPIUM CHLORIDE
TRULANCE
TRULICITY
TRUSOPT
TRUST NATAL DHA
TUDORZA PRESSAIR
TWYNSTA U UDAMIN SP
ULORIC
ULTIMATE OB DHA
ULTIMATECARE ONE
ULTIMATECARE ONE NF
UNIRETIC
UNITHROID
UNIVASC
UROCIT-K
UROXATRAL
URSO
URSO FORTE
URSODIOL V VAGIFEM
VALSARTAN
VALSARTAN-HYDROCHLOROTHIAZIDE
VASCEPA
VASERETIC
VASOTEC
V-C FORTE
VELIVET
VEMAVITE-PRX 2
VENA-BAL DHA
VENATAL-FA
VENLAFAXINE HCL
VENLAFAXINE HCL ER
VENLAFAXINE HCL ER BRAND
VERAMYST
VERAPAMIL ER
VERAPAMIL ER PM
VERAPAMIL HCL
VERELAN
VERELAN PM
VESICARE
VESTURA
VIAGRA
VI-C FORTE
VICTOZA
VIENVA
VIIBRYD
VIMOVO
VINACAL
VINATE
VINATE DHA
VINATE DHA RF
VINATE GT
VINATE II
VINATE ONE
VINATE ULTRA
VINATE-M
VIORELE
VIRT NATE
VIRT-ADVANCE
VIRT-BAL DHA
VIRT-BAL DHA PLUS
VIRT-C DHA
VIRT-CAPS
VIRT-CARE ONE
VIRT-GARD
VIRT-NATE DHA
VIRT-PN
VIRT-PN DHA
VIRT-PN PLUS
VIRTPREX
VIRT-SELECT
VIRT-VITE
VIRT-VITE FORTE
VIRT-VITE GT
VIT 3
VITAFOL
VITAFOL FE+
VITAFOL NANO
VITAFOL ULTRA
VITAFOL-OB
VITAFOL-OB+DHA
VITAFOL-ONE
VITAFOL-PN
12 | P a g e
Maintenance Medication Drug List Drug Level_231267_Updated February 2017
VITAMAX
VITAMED MD ONE RX
VITAMED MD PLUS RX
VITAMEDMD REDICHEW RX
VITAMIN D2
VITAMINS A,C,D & FLUORIDE
VITAPEARL
VITATRUE
VIVA DHA
VIVELLE- DOT
VIVLODEX
VOL-CARE RX
VOL-NATE
VOL-PLUS
VOL-TAB RX
VOLTAREN-XR
VOSPIRE ER
VP CH ULTRA
VP-CH PLUS
VP-CH-PNV
VP-ERA OB PLUS
VP-GGR-B6
VP-HEME OB
VP-HEME OB + DHA
VP-HEME ONE
VP-PNV-DHA
VP-VITE RX
VYFEMLA
VYTORIN W WASP VENOM PROTEIN
WELCHOL
WELLBUTRIN
WELLBUTRIN SR
WELLBUTRIN XL
WERA
WESTHROID
WHITE FACED HORNET VENOM
WP THYROID
WYMZYA FE
X XALATAN
XARELTO
XENICAL
XIFAXAN
XIGDUO XR
XIIDRA
XULANE
XYZBAC Y YASMIN
YAZ
YELLOW HORNET VENOM PROTEIN
YELLOW JACKET VENOM PROTEIN
YOSPRALA
YUVAFEM Z ZAFIRLUKAST
ZANTAC RX
ZARAH
ZAROXOLYN
ZATEAN-CH
ZATEAN-PN
ZATEAN-PN DHA
ZATEAN-PN PLUS
ZEBETA
ZEGERID RX
ZELAPAR
ZEMPLAR
ZENCHENT
ZENCHENT FE
ZEOSA
ZESTORETIC
ZESTRIL
ZETIA
ZETONNA
ZIAC
ZINBRYTA
ZINGIBER
ZIOPTAN
ZOCOR
ZOLOFT
ZONTIVITY
ZORVOLEX
ZOVIA
ZURAMPIC
ZYFLO
ZYFLO CR
ZYLOPRIM