Preferred Drug List - Passportpassporthealthplan.com/wp-content/uploads/2014/12/... · KETOROLAC...

Preferred Drug List (List of Covered Drugs)

This document includes Passport Health Plan’s complete 2016 formulary.

What is the Passport Health Plan formulary?

The formulary is a list of preferred drugs covered by Passport. To get a drug on our formulary, you must:

• BeaPassportmember;

• Needadrugthatismedicallynecessary;

• GettheprescriptionfilledataPassportHealthPlannetworkpharmacy.AnetworkpharmacyisonethatissignedupwithPassport;and

• FollowallPassportrules(seelimitsbelow).

The formulary is not a complete list of covered drugs by Passport. Some drugs not listed may be covered, if medically necessary. These drugs may or may not need prior-authorization.

How do I find my drug on the formulary?

• Youcansearchforadrugusingtheonlinesearchableformularyonourwebsiteatwww.passporthealthplan.com.

Are there any limits to the drugs you have been prescribed?

Some covered drugs may have limits on them. This could include:

• Prior-Authorization:SomemedicinesmustbeapprovedbyPassportbeforePassportwillcoverorpayforthem.Thismeansyourproviderwillneedtogetapprovalbeforeyoucanhaveyourprescriptionsfilled.Ifyoudonotgetapproval,Passportmaynot cover the drug.

• Quantity Limits:Forsomedrugs,therearelimitsontheamountPassportwillcover.Thismeansyoumaynotgetthestandard one month supply.

• Step Therapy:SometimesPassportrequiresyoutotrycertaindrugsfirsttotreatyourmedicalconditionbeforewewillcoveranotherdrugforthatcondition.Forexample,ifDrugAandDrugBbothtreatyourmedicalcondition,PassportmaynotcoverdrugBunlessyoutryDrugAfirst.IfDrugAdoesnotworkforyou,PassportwillthencoverDrugB.

• Too Early to Refill:Ifyouaregivenamonthsupplyofamedicine,Passportwillnotcoverarefilloftheprescriptionuntil30 days has passed.

What if my drug is not on the formulary?

Remember,notalldrugsarelistedontheformulary.IfPassportdoesnotcoveryourdrug,youhave3options:

1. Workwithyourpharmacyorprovidertofindthepreferreddrug.

2. YoucancallMemberServicesat1-800-578-0603andaskforalistofsimilardrugsthatareonPassport’sPreferredDrugList.

3. IfadrugisnotcoveredbyPassportorisnotlistedonourPreferredDrugList,yourdoctorcanrequestapprovalforit.

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Can the formulary change?

Yes.Passportmayaddorremovedrugsfromtheformularyduringtheyear.Togetupdatedinformationaboutcovereddrugs,pleasevisitourwebsiteatwww.passporthealthplan.comorcallMemberServicesat1-800-578-0603.

What are generic drugs?

Passportcoversbothbrand-nameandgenericdrugs.Agenericdrughasthesameactiveingredientasthebrand-namedrug.Thismeanstheyworkthesameandhavethesameeffect.GenericdrugsusuallycostlessthanbrandnamedrugsandareapprovedbytheFoodandDrugAdministration(FDA).

How much are my copays?

Aslongasyoutakegenericmedicines,youwillpay$0.Ifyoutakeapreferredbrandnamemedicine,yourcopaywillbe$2.Ifyoutakeanon-preferrednamebrandmedicine,yourcopaywillbe$4.

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LEGEND

TYPE DESCRIPTION

QL Quantity LimitThere is a limit on the amount of this drug that is covered perprescription, or within a specific time frame.

PA Prior AuthorizationYour provider is required to get prior authorization before you fill yourprescription, which ensures appropriate use of the selected drug.Without prior approval, we may not cover this drug.

ST Step TherapyIn some cases, you may be required to first try certain drugs to treatyour medical condition before you move up a “step” to other drugoptions.

GL Gender Limit This prescription drug is restricted for a single gender. .

AL Age LimitThis prescription drug may only be covered if you meet the minimumor maximum age limit.

C Custom This drug has unique restrictions.

S Specialty DrugSpecialty drugs are high-cost drugs used to treat complex or rareconditions. Some examples of the diseases include; multiple sclerosis,rheumatoid arthritis, hepatitis C, and hemophilia.

MED Medical DrugThis medication is not on our drug list. Click on the THERAPEUTICCLASS or sub class to find covered alternative medications. If youhave questions, please contact member services.

PAGE 4 LAST UPDATED 02/2016

LIST OF COVERED PRESCRIPTION MEDICATIONS DRUG DESCRIPTION (RX) BRAND/GEN LIMITS & RESTRICTIONS

ANALGESICS

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

CELEBREX 50 MG CAPSULEcelecoxib

BRAND PA

choline sal/mag salicylate 500 mg/5ml liquid generic

diclofenac potassium 50 mg tablet generic

DICLOFENAC SODIUM (50 MG TABLET DR, 100 MGTAB ER 24H, 25 MG TABLET DR, 75 MG TABLET DR)

generic

DICLOFENAC SODIUM/MISOPROSTOL (50 IR, 75 IR) genericQL

PA

diflunisal 500 mg tablet generic

ETODOLAC (200 MG CAPSULE, 400 MG TAB ER 24H,400 MG TABLET, 300 MG CAPSULE, 500 MG TABLET,500 MG TAB ER 24H, 600 MG TAB ER 24H)

generic

FENOPROFEN CALCIUM (400 MG CAPSULE, 600 MGTABLET)

generic

FLURBIPROFEN (50 MG, 100 MG) generic

IBUPROFEN (400 MG, 600 MG, 800 MG) generic

INDOMETHACIN (25 MG, 75 MG ER, 50 MG) generic

indomethacin sodium 1 mg vial generic

KETOPROFEN (75 MG CAPSULE, 50 MG CAPSULE, 200MG CAP24H PEL)

generic

KETOROLAC TROMETHAMINE (15 MG/ML VIAL,30MG/ML(1) VIAL, 30 MG/ML CARTRIDGE, 10 MGTABLET, 30 MG/ML VIAL, 15 MG/ML CARTRIDGE, 60MG/2 ML VIAL, 60 MG/2 ML SYRINGE)

generic

MECLOFENAMATE SODIUM (50 MG, 100 MG) generic

mefenamic acid 250 mg capsule generic

MELOXICAM (7.5 MG TABLET, 7.5 MG/5ML ORALSUSP)

generic

meloxicam 15 mg tablet generic GL Male

NABUMETONE (500 MG, 750 MG) generic

NAPROXEN (125 MG/5ML ORAL SUSP, 500 MG TABLETDR, 250 MG TABLET, 375 MG TABLET, 500 MG TABLET,375 MG TABLET DR)

generic


DRUG DESCRIPTION (RX) BRAND/GEN LIMITS & RESTRICTIONS

NAPROXEN SODIUM (550 MG, 275 MG) generic

oxaprozin 600 mg tablet generic

PIROXICAM (20 MG, 10 MG) generic

SALSALATE (750 MG, 500 MG) generic

SULINDAC (200 MG, 150 MG) generic

TOLMETIN SODIUM (600 MG TABLET, 400 MGCAPSULE, 200 MG TABLET)

generic

OPIOID ANALGESICS, LONG-ACTING

DISKETS 40 MG TABLET DISPRmethadone hcl

BRAND QL

FENTANYL (100, 12) genericPA

C 12 patches/28 days

FENTANYL (37.5MCG/HR, 87.5MCG/HR, 62.5MCG/HR) generic

QL

PA


FENTANYL (50MCG/HR, 25MCG/HR, 75MCG/HR) generic

QL

PA


HYDROMORPHONE HCL (16 MG ER, 12 MG ER) generic QL

hydromorphone hcl 32 mg tab er 24h generic QL

hydromorphone hcl 8 mg tab er 24h generic QL

levorphanol tartrate 2 mg tablet generic

methadone hcl 10 mg tablet generic QL

methadone hcl 10 mg/5 ml solution genericQL

C 40ml/day

methadone hcl 10 mg/ml oral conc genericQL

C 80ml/day

methadone hcl 10 mg/ml syringe generic QL

methadone hcl 10 mg/ml vial generic

methadone hcl 40 mg tablet sol generic QL

methadone hcl 5 mg tablet generic QL



methadone hcl 5 mg/5 ml solution genericQL

C 80ml/day

METHADONE INTENSOL 10 MG/MLmethadone hcl

BRAND QL

METHADOSE 10 MG/ML ORAL CONCmethadone hcl

BRAND QL

METHADOSE 40 MG TABLET DISPRmethadone hcl

BRAND QL

MORPHINE SULFATE (100 MG ER, 200 MG ER) genericQL

PA

MORPHINE SULFATE (100 MG ER, 80 MG ER) generic QL

MORPHINE SULFATE (30 MG CPMP 24HR, 30 MG CAPER PEL)

generic QL

MORPHINE SULFATE (60 MG CPMP 24HR, 60 MG CAPER PEL, 50 MG CAP ER PEL)

generic QL

MORPHINE SULFATE (90 MG CPMP 24HR, 45 MGCPMP 24HR, 120 MG CPMP 24HR, 60 MG TABLET ER,75 MG CPMP 24HR)

genericQL

PA

morphine sulfate 10 mg cap er pel generic QL

morphine sulfate 15 mg tablet er genericQL

PA

morphine sulfate 20 mg cap er pel generic QL

morphine sulfate 30 mg tablet er genericQL

PA

oxycodone hcl 10 mg tab er 12h genericQL

PA


PA


PA


PA

OXYCONTIN (30 MG, 40 MG)oxycodone hcl

BRANDQL

PA



OXYCONTIN (60 MG, 80 MG)oxycodone hcl

BRANDQL

PA

OXYCONTIN 10 MG TABLEToxycodone hcl

BRANDQL

PA


BRANDQL

PA


BRANDQL

PA

OXYMORPHONE HCL (20 MG ER, 15 MG ER) genericQL

PA

OXYMORPHONE HCL (40 MG ER, 30 MG ER) genericQL

PA

oxymorphone hcl 10 mg tab er 12h genericQL

PA

oxymorphone hcl 5 mg tab er 12h genericQL

PA

oxymorphone hcl 7.5 mg tab er 12h genericQL

PA

TRAMADOL HCL (100 MG CPBP 25-75, 100 MG TAB ER24H)

generic QL

TRAMADOL HCL (200 MG TBMP 24HR, 150 MG CPBP25-75, 100 MG TBMP 24HR, 300 MG TBMP 24HR)

genericQL

PA

TRAMADOL HCL (300 MG TAB ER 24H, 300 MG CPBP17-83, 200 MG TAB ER 24H, 200 MG CPBP 25-75)

generic QL

OPIOID ANALGESICS, SHORT-ACTING

acetaminophen with codeine 300mg-15mg tablet generic QL



ACETAMINOPHEN WITH CODEINE PHOSPHATE(300MG/12.5, 120-12MG/5)

generic C 150 ml/day

alfentanil hcl 500 mcg/ml ampul generic

ASCOMP WITH CODEINE CAPSULE BRAND QL



codeine phosphate/butalbital/aspirin/caffeine

ASTRAMORPH-PF 1 MG/ML AMPULmorphine sulfate/pf

BRAND

BUTALBITAL/ACETAMINOPHEN/CAFFEINE/CODEINEPHOSPHATE (50-325-30, 50-300-30)

generic QL

BUTORPHANOL TARTRATE (2 MG/ML, 1 MG/ML) generic

butorphanol tartrate 10 mg/ml spray genericQL

C 2 nasal sprayers or5ml/month

codeine sulfate 15 mg tablet generic QL



codeine/butalbital/asa/caffein 30-50-325 capsule generic QL

dhcodeine bt/acetaminophn/caff 16-320.5mg capsule generic

dihydrocodeine/aspirin/caffein 16-356-30 capsule generic QL

DURAMORPH (5 ML, 10 ML)morphine sulfate/pf

BRAND

ENDOCET (5-325, 2.5-325 MG)oxycodone hcl/acetaminophen

BRAND QL

ENDOCET 10-325 MG TABLEToxycodone hcl/acetaminophen

BRAND QL

ENDOCET 7.5-325 MG TABLEToxycodone hcl/acetaminophen

BRAND QL

ENDODAN 4.8355-325 MG TABLEToxycodone hcl/aspirin

BRAND QL

FENTANYL CITRATE (800 MCG, 1600 MCG, 1200 MCG) generic QL

fentanyl citrate 200 mcg lozenge hd generic QL



FENTANYL CITRATE IN 0.9 % SODIUM CHLORIDE/PF(10 MCG/ML SYRINGE, 20 MCG/ML PLAST. BAG)

generic

FENTANYL CITRATE/BUPIVACAINE HCL IN 0.9 %SODIUM CHLORIDE/PF (4MCG/ML-.1, 2MCG/ML-.1, 2-625MCG/1, 2-1250MCG)

generic GL Female

FENTANYL CITRATE/PF (50 MCG/ML AMPUL,100MCG/2ML SYRINGE, 50 MCG/ML VIAL)

generic



HYDROCODONE BITARTRATE/ACETAMINOPHEN (2.5-167/5, 7.5-325/15, 5-217MG/10, 2.5-108/5)

generic C 32ml/day

HYDROCODONE BITARTRATE/ACETAMINOPHEN (5MG-325MG, 10MG-325MG, 5MG-300MG, 10MG-300MG,7.5-325MG, 7.5-300MG)

generic QL

hydrocodone/acetaminophen 2.5-325mg tablet generic QL

HYDROCODONE/IBUPROFEN (10MG-200MG, 5MG-200MG)

generic

hydrocodone/ibuprofen 2.5-200mg tablet generic QL

hydrocodone/ibuprofen 7.5-200 mg tablet generic QL

HYDROMORPHONE HCL (1 MG/ML SYRINGE, 2 MG/MLSYRINGE, 4 MG/ML SYRINGE, 2 MG/ML VIAL)

generic

hydromorphone hcl 1 mg/ml liquid generic QL

hydromorphone hcl 2 mg tablet generic QL

hydromorphone hcl 3 mg supp.rect generic QL



HYDROMORPHONE HCL/PF (1 MG/ML AMPUL, 10MG/ML AMPUL, 2 MG/ML AMPUL, 10 MG/ML VIAL, 4MG/ML AMPUL)

generic

ibuprofen/oxycodone hcl 400mg-5mg tablet generic QL

LORCET 5-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

LORCET HD 10-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

LORCET PLUS 7.5-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

LORTAB (10-325 MG, 5-325 MG, 7.5-325 MG)hydrocodone bitartrate/acetaminophen

BRAND QL

meperidine hcl 50 mg/5 ml solution genericQL

C 20ml/day

MORPHINE SULFATE (2 MG/ML CARTRIDGE,250MG/10ML VIAL PORT, 8 MG/ML VIAL, 4 MG/ML VIAL,25 MG/ML VIAL, 10 MG SUPP.RECT, 30 MGSUPP.RECT, 10 MG/ML VIAL, 10 MG/ML SYRINGE, 100MG/4ML VIAL PORT, 20 MG SUPP.RECT, 50 MG/MLVIAL, 15 MG/ML CARTRIDGE, 5 MG/ML VIAL, 15 MG/ML

generic



VIAL, 8 MG/ML SYRINGE, 4 MG/ML SYRINGE, 4 MG/MLCARTRIDGE, 2 MG/ML SYRINGE, 10 MG/MLCARTRIDGE, 30 MG/30ML PCA SYRING, 5 MG/MLSYRINGE, 5 MG SUPP.RECT)

morphine sulfate 10 mg/5 ml solution genericQL

C 45ml/day

morphine sulfate 100 mg/5ml solution genericQL

C 9ml/day

morphine sulfate 15 mg tablet generic QL

morphine sulfate 20 mg/5 ml solution genericQL

C 45ml/day

morphine sulfate 30 mg tablet generic QL

MORPHINE SULFATE/PF (0.5 MG/ML, 1 MG/ML, 30MG/30ML PCA, 150MG/30ML PCA)

generic

morphine sulfate/pf 1 mg/2 ml syringe generic GL Male

NALBUPHINE HCL (10 MG/ML VIAL, 20 MG/ML VIAL, 10MG/ML AMPUL, 20 MG/ML AMPUL)

generic

OPIUM/BELLADONNA ALKALOIDS (60-16.2MG, 30-16.2MG)

generic

OXYCODONE HCL (5 MG CAPSULE, 5 MG TABLET) generic QL

oxycodone hcl 10 mg tablet generic QL



oxycodone hcl 20 mg/ml oral conc genericQL

C 8ml/day


oxycodone hcl 5 mg/5 ml solution genericQL

C 80ml/day

OXYCODONE HCL/ACETAMINOPHEN (2.5-325MG, 5MG-325MG)

generic QL

oxycodone hcl/acetaminophen 10mg-325mg tablet generic QL

oxycodone hcl/acetaminophen 7.5-325mg tablet generic QL

oxycodone hcl/aspirin 4.8355-325 tablet generic QL



oxymorphone hcl 10 mg tablet generic QL

oxymorphone hcl 5 mg tablet generic QL

pentazocine hcl/naloxone hcl 50mg-0.5mg tablet generic QL

REPREXAIN (10-200 MG, 2.5-200 MG, 5-200 MG)hydrocodone/ibuprofen

BRAND QL

ROXICET 5-325 TABLEToxycodone hcl/acetaminophen

BRAND QL

SUBLIMAZE 50 MCG/ML AMPULEfentanyl citrate/pf

BRAND

SUFENTA (50 MCG/ML AMPUL, 250 MCG/5 MLAMPULE, 100 MCG/2 ML AMPUL)sufentanil citrate

BRAND

sufentanil citrate 50 mcg/ml ampul generic

tramadol hcl 50 mg tablet generic QL

tramadol hcl/acetaminophen 37.5-325mg tablet generic QL

VERDROCET 2.5-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

VICODIN 5-300 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

VICODIN ES 7.5-300 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

VICODIN HP 10-300 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

ZAMICET 10-325 MG/15 ML SOLNhydrocodone bitartrate/acetaminophen

BRAND C 32ml/day

ANESTHETICS

LOCAL ANESTHETICS

BUFFERED LIDOCAINE 1% SYRINGElidocaine hcl buffered with 8.4 % sodium bicarbonate

BRAND

BUPIVACAINE HCL (2.5 MG/ML, 5 MG/ML) generic

bupivacaine hcl/dex-water/pf 0.75 % ampul generic

BUPIVACAINE HCL/EPINEPHRINE (0.25-.0005, 0.5-1:200K)

generic

BUPIVACAINE HCL/EPINEPHRINE/PF (0.5-1:200K, 0.25-.0005)

generic



BUPIVACAINE HCL/PF (2.5 MG/ML VIAL, 2.5 MG/MLAMPUL, 7.5 MG/ML VIAL, 5 MG/ML VIAL, 5 MG/MLAMPUL, 7.5 MG/ML AMPUL)

generic

CARBOCAINE 1.5% VIALmepivacaine hcl/pf

BRAND

CHLOROPROCAINE HCL/PF (30 MG/ML, 20 MG/ML) generic

COMPOUND 347 INHALATIONenflurane

BRAND

etomidate 2 mg/ml vial generic

FORANE LIQUIDisoflurane

BRAND

isoflurane 99.9 % liquid generic

KETAMINE HCL (10 MG/ML, 50 MG/ML, 100 MG/ML) generic

LIDOCAINE HCL (20 MG/ML DISP SYRIN, 40 MG/MLSOLUTION, 100MG/10ML DISP SYRIN, 10 MG/ML DISPSYRIN, 30 MG/3 ML SYRINGE, 2 % SOLUTION)

generic

lidocaine hcl/d7.5w/pf 5 % ampul generic

LIDOCAINE HCL/DEXTROSE 5%-WATER/PF (8 MG/ML,4 MG/ML)

generic

LIDOCAINE HCL/EPINEPHRINE (2 %-1:100K, 1%-1:100K, 0.5-1:200K)

generic

LIDOCAINE HCL/EPINEPHRINE/PF (2%-1:200K VIAL,1.5-1:200K VIAL, 1.5-1:200K AMPUL)

generic

LIDOCAINE HCL/PF (50 MG/5 ML SYRINGE, 15 MG/MLAMPUL, 5 MG/ML VIAL, 10 MG/ML VIAL, 20 MG/MLAMPUL LUER, 100 MG/5ML SYRINGE, 10 MG/MLAMPUL, 40 MG/ML AMPUL, 20 MG/ML VIAL)

generic

NAROPIN (2 MG/ML INFUSION, 200 MG/100 ML INF,0.2% 400 MG/200 ML)ropivacaine hcl/pf

BRAND

POLOCAINE 1% VIALmepivacaine hcl

BRAND

POLOCAINE-MPF (1.5%, 2%, 1%)mepivacaine hcl/pf

BRAND

propofol 10 mg/ml vial generic

SENSORCAINE 0.5% VIALbupivacaine hcl

BRAND

SENSORCAINE-EPINEPHRINE (0.25%-EPI 1:200000,0.5%-EPI 1:200,000)bupivacaine hcl/epinephrine

BRAND



SENSORCAINE-MPF 0.5% VIALbupivacaine hcl/pf

BRAND

sevoflurane liquid generic

SOJOURN INHALATION LIQUIDsevoflurane

BRAND

TERRELL LIQUIDisoflurane

BRAND

tetracaine hcl/pf 10 mg/ml ampul generic

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

ALCOHOL DETERRENTS/ANTI-CRAVING

acamprosate calcium 333 mg tablet dr generic

DEPADE 50 MG TABLETnaltrexone hcl

BRAND

DISULFIRAM (500 MG, 250 MG) generic

naltrexone hcl 50 mg tablet generic

OPIOID DEPENDENCE TREATMENTS

BUPRENORPHINE HCL (2 MG, 8 MG) genericQL

PA

buprenorphine hcl 0.3 mg/ml syringe generic PA

buprenorphine hcl 0.3 mg/ml vial generic

BUPRENORPHINE HCL/NALOXONE HCL (/NALOXONE8 MG-2 MG, /NALOXONE 2 MG-0.5MG)

genericQL

PA

SUBOXONE (12 MG-3 MG, 2 MG-0.5 MG, 4 MG-1 MG, 8MG-2 MG)buprenorphine hcl/naloxone hcl

BRANDQL

PA

OPIOID REVERSAL AGENTS

NALOXONE HCL (1 MG/ML, 0.4 MG/ML) generic QL

SMOKING CESSATION AGENTS

BUPROBAN 150 MG TABLETbupropion hcl

BRAND

bupropion hcl 150 mg tablet er generic

CHANTIX (0.5 MG, 1 MG)varenicline tartrate

BRAND QL

CHANTIX (1 MG CONT, STARTING)varenicline tartrate

BRAND



ANTIBACTERIALS

AMINOGLYCOSIDES

AMIKACIN SULFATE (1000MG/4ML, 500 MG/2ML) generic

GENTAMICIN SULFATE (20 MG/2 ML, 40 MG/ML) generic

GENTAMICIN SULFATE IN SODIUM CHLORIDE, ISO-OSMOTIC (GENTAMIC90MG/100ML,GENTAMIC100MG/0.1L, GENTAMIC80 MG/50ML,GENTAMIC80MG/100ML, GENTAMIC60 MG/50ML,GENTAMIC70 MG/50ML)

generic

GENTAMICIN SULFATE/PF (20 MG/2 ML, 100MG/10MLPORT)

generic

neomycin sulfate 500 mg tablet generic

paromomycin sulfate 250 mg capsule generic

TOBRAMYCIN SULFATE (10 MG/ML, 40 MG/ML, 1.2 G) generic S Specialty Drug

TOBRAMYCIN SULFATE/SODIUM CHLORIDE (60MG/50ML, 80MG/100ML)

generic S Specialty Drug

ANTIBACTERIALS, OTHER

acetic acid 0.25 % irrig soln generic

BACIIM 50,000 UNITS VIALbacitracin

BRAND

bacitracin 50000 unit vial generic

BACTROBAN NASAL 2% OINTMENTmupirocin calcium

BRAND

chloramphenicol sod succ 1 g vial generic

CLINDAMYCIN HCL (150 MG, 75 MG, 300 MG) generic

clindamycin palmitate hcl 75 mg/5 ml soln recon generic

CLINDAMYCIN PHOSPHATE (300 MG/2ML VIAL PORT,2 % CREAM/APPL, 900MG/6ML VIAL PORT, 600MG/4ML VIAL PORT, 150 MG/ML VIAL)

generic

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % INWATER (300MG/50ML, 900MG/50ML, 600MG/50ML)

generic

colistin (colistimethate na) 150 mg vial generic

HYOPHEN TABLETmethenamine/methylene blue/benzoicacid/salicylate/hyoscy

BRAND

lincomycin hcl 300 mg/ml vial generic

LINEZOLID (600MG/300 IV SOLN, 600 MG TABLET, 100 generic



MG/5ML SUSP RECON)

linezolid-0.9% sodium chloride 600mg/300 iv soln generic PA

methenamine hippurate 1 g tablet generic

METHENAMINE MANDELATE (500 MG, 1 G) generic

METRO IV 500 MG/100 MLmetronidazole in sodium chloride

BRAND

METRONIDAZOLE (250 MG TABLET, 0.75 % GELW/APPL, 500 MG TABLET, 375 MG CAPSULE)

generic

metronidazole/sodium chloride 500mg/0.1l piggyback generic

NEOMYCIN SULFATE/POLYMYXIN B SULFATE(AMPUL, VIAL)

generic

NITROFURANTOIN (25 MG/5 ML ORAL SUSP, 50 MGCAPSULE)

generic

NITROFURANTOIN MACROCRYSTAL (50 MG, 25 MG,100 MG)

generic

nitrofurantoin monohyd/m-cryst 100 mg capsule generic

PHOSPHASAL TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

polymyxin b sulfate 500k unit vial generic

SULFAMYLON 8.5% CREAMmafenide acetate

BRAND

TINIDAZOLE (250 MG, 500 MG) generic

trimethoprim 100 mg tablet generic

TYGACIL 50 MG VIALtigecycline

BRAND

UR N-C TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

URETRON D-S TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

URIMAR-T TABLETmethenamine/methylene blue/salicylate/sodiumphos/hyoscy

BRAND

URIN D.S. TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

URO-BLUE TABLETS BRAND



methenamine/sodium phosphate,monobasic/methblue/hyosc sul

UROGESIC-BLUE TABLETmethenamine/sodium phosphate,monobasic/methblue/hyosc sul

BRAND

UROLET MB TABLETmethenamine/sodium phosphate,monobasic/methblue/hyosc sul

BRAND

UROPHEN MB TABLETmethenamine/methylene blue/benzoicacid/salicylate/hyoscy

BRAND

URYL TABLETmethenamine/sodium phosphate,monobasic/methblue/hyosc sul

BRAND

USTELL CAPSULEmethenamine/methylene blue/salicylate/sodiumphos/hyoscy

BRAND

UTIRA-C TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

VANCOMYCIN HCL (10 G VIAL, 250 MG CAPSULE, 500MG VIAL, 750 MG VIAL PORT, 125 MG CAPSULE, 1 GVIAL, 750 MG VIAL, 5 G VIAL, 1 G VIAL PORT, 500 MGVIAL PORT)

generic

VANCOMYCIN HCL/DEXTROSE 5 % IN WATER(500MG/0.1L FROZ.PIGGY, 1G/200ML FROZ.PIGGY,1.25 G/250 PLAST. BAG, 1.5G/250ML PLAST. BAG)

generic

VANCOMYCIN IN 0.9 % SODIUM CHLORIDE(1.5G/250ML, 750MG/.15L, 1.25 G/250)

generic

vancomycin in dextrose,iso-osm 750mg/.15l froz.piggy generic

VANDAZOLE VAGINAL 0.75% GELmetronidazole

BRAND

XIFAXAN (550 MG, 200 MG)rifaximin

BRAND

ZYVOX 100 MG/5 ML SUSPENSIONlinezolid

BRAND PA

BETA-LACTAM, CEPHALOSPORINS

CEFACLOR (500 MG TAB ER 12H, 125 MG/5ML SUSPRECON, 500 MG CAPSULE, 250 MG/5ML SUSP RECON,250 MG CAPSULE, 375 MG/5ML SUSP RECON)

generic

CEFADROXIL (500 MG CAPSULE, 500 MG/5ML SUSPRECON, 250 MG/5ML SUSP RECON, 1 G TABLET)

generic



CEFAZOLIN SODIUM (300G BULKBAGINJ, 1 G VIAL, 20G VIAL, 10 G VIAL, 500 MG VIAL, 1 G VIAL PORT, 100 GBULKBAGINJ)

generic

CEFAZOLIN SODIUM IN 0.9 % SODIUM CHLORIDE (0.92 G/100 ML PLAST. BAG, 0.9 2 G/50 ML PIGGYBACK,0.9 2 G/10 ML SYRGE)

generic

cefazolin sodium/d5w 2 g/100 ml plast. bag generic

CEFAZOLIN SODIUM/DEXTROSE, ISO-OSMOTIC (2 MLPIGGYBACK, 1 ML FROZ.PIGGY, 1 ML PIGGYBACK)

generic

CEFDINIR (125 MG/5ML SUSP RECON, 300 MGCAPSULE, 250 MG/5ML SUSP RECON)

generic

CEFDITOREN PIVOXIL (200 MG, 400 MG) generic

CEFEPIME HCL (2, 1) generic

CEFEPIME HCL/DEXTROSE, ISO-OSMOTIC (1 G/50 ML,2 G/100 ML)

generic

CEFIXIME (200, 100) generic

CEFOTAXIME SODIUM (10 G, 2 G, 1 G, 500 MG) generic

CEFOTETAN DISODIUM (2, 10, 1) generic

CEFOXITIN SODIUM (2, 1, 10) generic

CEFOXITIN SODIUM/DEXTROSE, ISO-OSMOTIC (2 ML,1 ML)

generic

CEFPODOXIME PROXETIL (100 MG TABLET, 100MG/5ML SUSP RECON, 50 MG/5 ML SUSP RECON, 200MG TABLET)

generic

CEFPROZIL (250 MG TABLET, 250 MG/5ML SUSPRECON, 125 MG/5ML SUSP RECON, 500 MG TABLET)

generic

CEFTAZIDIME (1, 2, 6) generic

CEFTIBUTEN (400 MG CAPSULE, 180 MG/5ML SUSPRECON)

generic

CEFTRIAXONE SODIUM (1 G, 2 G PORT, 1 G PORT, 10G, 500 MG, 250 MG, 2 G)

generic

CEFTRIAXONE SODIUM/DEXTROSE, ISO-OSMOTIC (2ML FROZ.PIGGY, 2 ML PIGGYBACK, 1 ML PIGGYBACK,1 ML FROZ.PIGGY)

generic

CEFUROXIME AXETIL (250 MG, 500 MG) generic

CEFUROXIME SODIUM (7.5G, 750 MG, 7.5 G, 1.5 G) generic

CEFUROXIME SODIUM/DEXTROSE, ISO-OSMOTIC(750MG/50ML, 1.5G/50ML)

generic

CEPHALEXIN (250 MG TABLET, 250 MG CAPSULE, 750 generic



MG CAPSULE, 500 MG TABLET, 250 MG/5ML SUSPRECON, 125 MG/5ML SUSP RECON, 500 MG CAPSULE)

BETA-LACTAM, OTHER

AZTREONAM (2, 1) generic

IMIPENEM/CILASTATIN SODIUM (250 MG, 500 MG) generic

MEROPENEM (500 MG, 1 G) generic

MEROPENEM IN 0.9 % SODIUM CHLORIDE (1 G/50 ML,500MG/50ML)

generic

BETA-LACTAM, PENICILLINS

AMOXICILLIN (250 MG CAPSULE, 500 MG TABLET, 400MG/5ML SUSP RECON, 500 MG CAPSULE, 125 MG TABCHEW, 250 MG TAB CHEW, 125 MG/5ML SUSP RECON,875 MG TABLET, 250 MG/5ML SUSP RECON, 200MG/5ML SUSP RECON)

generic

AMOXICILLIN/POTASSIUM CLAVULANATE (600-42.9/5SUSP RECON, 400-57MG TAB CHEW, 200-28.5MG TABCHEW, 875-125 MG TABLET, 400-57MG/5 SUSPRECON, 250-62.5/5 SUSP RECON, 250-125 MGTABLET, 200-28.5/5 SUSP RECON, 1000-62.5 TAB ER12H, 500-125 MG TABLET)

generic

AMPICILLIN SODIUM (500 MG, 10 G, 1 G, 2 G PORT, 2G, 1 G PORT, 250 MG, 125 MG)

generic

AMPICILLIN SODIUM/SULBACTAM SODIUM (15, 1.5PORT, 3, 3 PORT, 1.5)

generic

AMPICILLIN TRIHYDRATE (250 MG CAPSULE, 500 MGCAPSULE, 250 MG/5ML SUSP RECON, 125 MG/5MLSUSP RECON)

generic

DICLOXACILLIN SODIUM (500 MG, 250 MG) generic

NAFCILLIN IN DEXTROSE, ISO-OSMOTIC (1 G/50 ML, 2G/100 ML)

generic

NAFCILLIN SODIUM (2 PORT, 2, 1 PORT, 1, 10) generic

OXACILLIN SODIUM (10, 2 PORT, 1, 2, 1 PORT) generic

OXACILLIN SODIUM/DEXTROSE, ISO-OSMOTIC (2 ML,1 ML)

generic

PENICILLIN G POTASSIUM (5MM, 20MM) generic

PENICILLIN G PROCAINE (1.2MM/2 ML SYRINE,600000/ML SYRINE)

generic

penicillin g sodium 5mm unit vial generic

PENICILLIN V POTASSIUM (500 MG TABLET, 250 MGTABLET, 250 MG/5ML SOLN RECON, 125 MG/5ML generic



SOLN RECON)

PFIZERPEN (20 UNIT, 5 UNITS)penicillin g potassium

BRAND

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM (40.5,4.5, 3.375, 4.5 PORT, 3.375 PORT, 2.25 PORT, 2.25)

generic

MACROLIDES

AZITHROMYCIN (200 MG/5ML SUSP RECON, 500 MGVIAL PORT, 100 MG/5ML SUSP RECON, 500 MG VIAL, 1G PACKET, 250 MG TABLET)

generic

AZITHROMYCIN (500 MG, 600 MG) generic QL

CLARITHROMYCIN (250, 125) generic C 150ml/fill

CLARITHROMYCIN (500 MG TAB ER 24H, 500 MGTABLET, 250 MG TABLET)

generic QL

E.E.S. 200 MG/5 ML GRANULESerythromycin ethylsuccinate

BRAND

E.E.S. 400 FILMTABerythromycin ethylsuccinate

BRAND

ery e-succ/sulfisoxazole 200-600/5 susp recon generic

ERY-TAB (250 MG, 500 MG, 333 MG)erythromycin base

BRAND

ERYPED 200 MG/5 ML SUSPENSIONerythromycin ethylsuccinate

BRAND

ERYPED 400 MG/5 ML SUSPENSIONerythromycin ethylsuccinate

BRAND

ERYTHROCIN 250 MG FILMTABerythromycin stearate

BRAND

ERYTHROMYCIN BASE (500 MG TABLET, 250 MGTABLET, 250 MG CAPSULE DR)

generic

erythromycin ethylsuccinate 400 mg tablet generic

QUINOLONES

AVELOX IV 400 MG/250 MLmoxifloxacin hcl/sodium chloride, iso-osmotic

BRAND

CIPRO (5%, 10%)ciprofloxacin

BRAND C 10ml/day; 150ml/fill

CIPROFLOXACIN HCL (100 MG, 500 MG, 750 MG) generic QL

ciprofloxacin hcl 0.2 % droperette generic

ciprofloxacin hcl 250 mg tablet generic QL



CIPROFLOXACIN LACTATE (400MG/40ML,200MG/20ML)

generic

CIPROFLOXACIN LACTATE/DEXTROSE 5 % IN WATER(400MG/0.2L, 200MG/0.1L)

generic

CIPROFLOXACIN/CIPROFLOXACIN HCL (500 MG, 1000MG)

generic QL

LEVOFLOXACIN (500 MG, 750 MG, 250 MG) generic C 5 tablets/30 days

levofloxacin 25 mg/ml vial generic

levofloxacin 250mg/10ml solution generic C 480ml/fill

LEVOFLOXACIN/DEXTROSE 5 % IN WATER(750MG/.15L, 250MG/50ML, 500MG/0.1L)

generic

moxifloxacin hcl 400 mg tablet generic QL

moxifloxacin/sod.ace,sul/water 400mg/.25l piggyback generic

OFLOXACIN (400 MG, 300 MG, 200 MG) generic

SULFONAMIDES

sulfadiazine 500 mg tablet generic

SULFAMETHOXAZOLE/TRIMETHOPRIM (800-160/20ORAL SUSP, 200-40MG/5 ORAL SUSP, 80-16MG/MLVIAL, 400MG-80MG TABLET, 800-160 MG TABLET)

generic

SULFATRIM PEDIATRIC SUSPENSIONsulfamethoxazole/trimethoprim

BRAND

TETRACYCLINES

AVIDOXY 100 MG TABLETdoxycycline monohydrate

BRAND

DEMECLOCYCLINE HCL (150 MG, 300 MG) generic

DOXYCYCLINE MONOHYDRATE (150 MG TABLET, 75MG CAPSULE, 50 MG CAPSULE, 100 MG TABLET, 75MG TABLET, 100 MG CAPSULE, 40 MG CAP IR DR, 150MG CAPSULE, 50 MG TABLET, 25 MG/5 ML SUSPRECON)

generic

MINOCYCLINE HCL (135 MG TAB ER 24H, 100 MGCAPSULE, 90 MG TAB ER 24H, 75 MG CAPSULE, 45MG TAB ER 24H, 100 MG TABLET, 50 MG TABLET, 75MG TABLET, 50 MG CAPSULE)

generic

MONDOXYNE NL (50 MG, 75 MG, 100 MG)doxycycline monohydrate

BRAND

OCUDOX CONVENIENCE KITdoxycycline hyclate/eyelid clns no.3/eyelid emollient no.1

BRAND



TETRACYCLINE HCL (500 MG, 250 MG) generic

ANTICONVULSANTS

ANTICONVULSANTS, OTHER

LEVETIRACETAM (1000 MG TABLET, 500 MG/5MLSOLUTION, 500 MG TAB ER 24H, 100 MG/MLSOLUTION, 500 MG TABLET, 750 MG TABLET, 750 MGTAB ER 24H, 500 MG/5ML VIAL, 250 MG TABLET)

generic

POTIGA (50 MG, 300 MG, 200 MG, 400 MG)ezogabine

BRAND

CALCIUM CHANNEL MODIFYING AGENTS

CELONTIN 300 MG KAPSEALmethsuximide

BRAND

ETHOSUXIMIDE (250 MG/5ML SOLUTION, 250 MGCAPSULE)

generic

ZONISAMIDE (50 MG, 100 MG, 25 MG) generic

GAMMA-AMINOBUTYRIC ACID (GABA) AUGMENTING AGENTS

DIAZEPAM (12.5-15-20, 2.5 MG, 5-7.5-10MG) generic C 2 kits/30 days

DIVALPROEX SODIUM (125 MG TABLET DR, 250 MGTAB ER 24H, 125 MG CAP SPRINK, 500 MG TABLETDR, 500 MG TAB ER 24H, 250 MG TABLET DR)

generic

GABAPENTIN (250 MG/5ML SOLUTION, 800 MGTABLET, 100 MG CAPSULE, 300 MG/6ML SOLUTION,300 MG CAPSULE, 600 MG TABLET, 400 MG CAPSULE)

generic

GABITRIL (12 MG, 16 MG)tiagabine hcl

BRAND

ONFI (2.5 MG/ML SUSPENSION, 5 MG TABLET, 20 MGTABLET, 10 MG TABLET)clobazam

BRAND

PHENOBARBITAL (60 MG TABLET, 15 MG TABLET, 100MG TABLET, 64.8 MG TABLET, 30 MG TABLET, 97.2MGTABLET, 16.2 MG TABLET, 32.4 MG TABLET, 20 MG/5ML ELIXIR)

generic

PHENOBARBITAL SODIUM (130MG/ML, 65 MG/ML) generic

PRIMIDONE (250 MG, 50 MG) generic

SABRIL (500 MG TABLET, 500 MG POWDER PACKET)vigabatrin

BRAND S Specialty Drug

TIAGABINE HCL (4 MG, 2 MG) generic

VALPROIC ACID (AS SODIUM SALT) (VALPROATESODIUM) (500 MG/5ML VIAL, 250 MG/5ML SOLUTION, generic



500MG/10ML SOLUTION)

valproic acid 250 mg capsule generic

GLUTAMATE REDUCING AGENTS

FELBAMATE (400 MG TABLET, 600 MG TABLET, 600MG/5ML ORAL SUSP)

generic

LAMOTRIGINE (50 MG TAB RAPDIS, 100 MG TAB ER24, 25-50-100 TB RD DSPK, 300 MG TAB ER 24, 5 MGTB CHW DSP, 100 MG TAB RAPDIS, 25MG (35) TAB DSPK, 200 MG TABLET, 200 MG TAB ER 24, 25(21)-50 TBRD DSPK, 150 MG TABLET, 50 MG TAB ER 24, 100 MGTABLET, 25 MG TABLET, 25 MG TAB ER 24, 250 MGTAB ER 24, 200 MG TAB RAPDIS, 25 MG TAB RAPDIS,50(42)-100 TB RD DSPK, 25 MG TB CHW DSP)

generic

TOPIRAGEN (200 MG, 50 MG, 25 MG, 100 MG)topiramate

BRAND

TOPIRAMATE (25 MG CAP SPRINK, 200 MG TABLET,50 MG TABLET, 25 MG TABLET, 100 MG TABLET, 15MG CAP SPRINK)

generic

SODIUM CHANNEL AGENTS

BANZEL (400 MG TABLET, 40 MG/ML SUSPENSION,200 MG TABLET)rufinamide

BRAND

CARBAMAZEPINE (400 MG TAB ER 12H, 200 MGTABLET, 300 MG CPMP 12HR, 200 MG TAB ER 12H, 200MG CPMP 12HR, 100 MG CPMP 12HR, 100 MG/5MLORAL SUSP, 100 MG TAB CHEW)

generic

DILANTIN 30 MG CAPSULEphenytoin sodium extended

BRAND

EPITOL 200 MG TABLETcarbamazepine

BRAND

FOSPHENYTOIN SODIUM (500 PE/10, 100MG PE/2) generic

OXCARBAZEPINE (150 MG TABLET, 300 MG TABLET,600 MG TABLET, 300 MG/5ML ORAL SUSP)

generic

PEGANONE 250 MG TABLETethotoin

BRAND

PHENYTOIN (50 MG TAB CHEW, 125 MG/5ML ORALSUSP, 100 MG/4ML ORAL SUSP)

generic

PHENYTOIN SODIUM (50 MG/ML SYRINGE, 50 MG/MLVIAL, 50 MG/ML AMPUL)

generic

PHENYTOIN SODIUM EXTENDED (300 MG, 100 MG,200 MG)

generic



TEGRETOL XR 100 MG TABLETcarbamazepine

BRAND

VIMPAT (200 MG/20 ML VIAL, 10 MG/ML SOLUTION, 150MG TABLET, 100 MG TABLET, 200 MG TABLET, 50 MGTABLET)lacosamide

BRAND

ANTIDEMENTIA AGENTS

ANTIDEMENTIA AGENTS, OTHER

ergoloid mesylates 1 mg tablet generic

ISOXSUPRINE HCL (20 MG, 10 MG) generic

papaverine hcl 30 mg/ml vial generic

CHOLINESTERASE INHIBITORS

DONEPEZIL HCL (10 MG TABLET, 5 MG TAB RAPDIS,10 MG TAB RAPDIS, 23 MG TABLET, 5 MG TABLET)

generic

GALANTAMINE HBR (12 MG TABLET, 24 MG CAP24HPEL, 4 MG TABLET, 8 MG CAP24H PEL, 8 MG TABLET,16 MG CAP24H PEL, 4 MG/ML SOLUTION)

generic

RIVASTIGMINE (13.3MG/24H, 9.5MG/24HR,4.6MG/24HR)

generic

RIVASTIGMINE TARTRATE (1.5 MG, 6 MG, 4.5 MG, 3MG)

generic

N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST

MEMANTINE HCL (10 MG, 5 MG) generic GL Male

MEMANTINE HCL (5 MG-10 MG TAB DS PK, 2 MG/MLSOLUTION)

generic

NAMENDA (10 MG TABLET, 5-10 MG TITRATION PK, 5MG TABLET, 2 MG/ML SOLUTION)memantine hcl

BRAND

ANTIDEPRESSANTS

ANTIDEPRESSANTS, OTHER

AMITRIPTYLINE HCL/CHLORDIAZEPOXIDE (25 MG-10MG, 12.5MG-5MG)

generic

BUDEPRION XL 300 MG TABLETbupropion hcl

BRAND QL

BUPROPION HCL (75 MG TABLET, 200 MG TABLET ER,150 MG TABLET ER, 100 MG TABLET ER, 300 MG TABER 24H, 100 MG TABLET)

generic



bupropion hcl 150 mg tab er 24h generic QL

MIRTAZAPINE (15 MG TABLET, 45 MG TABLET, 7.5 MGTABLET, 45 MG TAB RAPDIS, 15 MG TAB RAPDIS, 30MG TABLET, 30 MG TAB RAPDIS)

generic

OLANZAPINE/FLUOXETINE HCL (6MG-50MG, 6MG-25MG, 12MG-25MG, 12MG-50MG, 3 MG-25 MG)

generic

PERPHENAZINE/AMITRIPTYLINE HCL (4 MG-25 MG,4MG-10MG, 2 MG-10 MG, 4 MG-50 MG, 2 MG-25 MG)

generic

MONOAMINE OXIDASE INHIBITORS

phenelzine sulfate 15 mg tablet generic

tranylcypromine sulfate 10 mg tablet generic

SSRIS/SNRIS (SELECTIVE SEROTONIN REUPTAKE INHIBITORS/SEROTONIN AND NOREPINEPHRINEREUPTAKE INHIBITOR

CITALOPRAM HYDROBROMIDE (40 MG TABLET, 10MG TABLET, 20 MG TABLET, 10 MG/5 ML SOLUTION)

generic

ESCITALOPRAM OXALATE (20 MG TABLET, 10 MGTABLET, 5 MG/5 ML SOLUTION, 5 MG TABLET)

generic

FLUOXETINE HCL (20 MG TABLET, 40 MG CAPSULE,20 MG/5 ML SOLUTION, 90 MG CAPSULE DR, 10 MGTABLET, 20 MG CAPSULE, 10 MG CAPSULE)

generic

FLUVOXAMINE MALEATE (150 MG CAP ER 24H, 100MG CAP ER 24H, 25 MG TABLET, 100 MG TABLET, 50MG TABLET)

generic

MAPROTILINE HCL (25 MG, 75 MG, 50 MG) generic

PAROXETINE HCL (12.5 MG TAB ER 24H, 10 MGTABLET, 25 MG TAB ER 24H, 20 MG TABLET, 40 MGTABLET, 30 MG TABLET, 37.5 MG TAB ER 24H)

generic

SERTRALINE HCL (50 MG TABLET, 25 MG TABLET, 20MG/ML ORAL CONC, 100 MG TABLET)

generic

TRAZODONE HCL (100 MG, 50 MG, 300 MG, 150 MG) generic

VENLAFAXINE HCL (37.5 MG ER, 150 MG ER) generic

VENLAFAXINE HCL (50 MG, 25 MG, 37.5 MG, 100 MG) generic QL

venlafaxine hcl 225 mg tab er 24 generic QL

venlafaxine hcl 75 mg cap er 24h generic QL

venlafaxine hcl 75 mg tablet generic QL

TRICYCLICS



AMITRIPTYLINE HCL (50 MG, 75 MG, 100 MG, 25 MG,10 MG, 150 MG)

generic

AMOXAPINE (25 MG, 100 MG, 50 MG, 150 MG) generic

CLOMIPRAMINE HCL (50 MG, 75 MG, 25 MG) generic

DESIPRAMINE HCL (10 MG, 75 MG, 100 MG, 25 MG, 50MG, 150 MG)

generic

DOXEPIN HCL (150 MG CAPSULE, 75 MG CAPSULE, 50MG CAPSULE, 25 MG CAPSULE, 100 MG CAPSULE, 10MG/ML ORAL CONC, 10 MG CAPSULE)

generic

IMIPRAMINE HCL (25 MG, 10 MG, 50 MG) generic

IMIPRAMINE PAMOATE (150 MG, 75 MG, 100 MG, 125MG)

generic

NORTRIPTYLINE HCL (50 MG CAPSULE, 10 MG/5 MLSOLUTION, 25 MG CAPSULE, 10 MG CAPSULE, 75 MGCAPSULE)

generic

PROTRIPTYLINE HCL (5 MG, 10 MG) generic

ANTIEMETICS

ANTIEMETICS, OTHER

COMPRO 25 MG SUPPOSITORYprochlorperazine

BRAND

dimenhydrinate 50 mg/ml vial generic

MECLIZINE HCL (25 MG, 12.5 MG) generic

METOCLOPRAMIDE HCL (10 MG TABLET, 5 MG TABRAPDIS, 5 MG TABLET, 10 MG/10ML SOLUTION, 10 MGTAB RAPDIS, 5 MG/ML VIAL, 5 MG/5 ML SOLUTION)

generic

PERPHENAZINE (16 MG, 2 MG, 4 MG, 8 MG) generic

prochlorperazine 25 mg supp.rect generic

PROCHLORPERAZINE EDISYLATE (10 MG/2 ML, 5MG/ML)

generic

PROCHLORPERAZINE MALEATE (5 MG, 10 MG) generic

TRIMETHOBENZAMIDE HCL (300 MG CAPSULE, 100MG/ML VIAL)

generic

EMETOGENIC THERAPY ADJUNCTS

DRONABINOL (10 MG, 2.5 MG, 5 MG) generic

EMEND (TRIPACK, 40 MG CAPSULE, 125 MGCAPSULE, 80 MG CAPSULE, 150 MG VIAL)aprepitant




GRANISETRON HCL (1 MG/ML(1), 1 MG/ML) genericPA

S Specialty Drug

granisetron hcl 1 mg tablet generic S Specialty Drug

GRANISETRON HCL/PF (100 MCG/ML, 1 MG/ML(1)) genericPA

S Specialty Drug

GRANISOL 2 MG/10 ML SOLUTIONgranisetron hcl

BRANDPA

C 50ml/30 days

ONDANSETRON (8 MG, 4 MG) generic QL

ONDANSETRON HCL (4 MG/5 ML SOLUTION, 24 MGTABLET)

generic

ONDANSETRON HCL (8 MG, 4 MG) generic QL

ondansetron hcl 2 mg/ml vial generic PA

ondansetron hcl/pf 4 mg/2 ml syringe genericPA

S Specialty Drug

ondansetron hcl/pf 4 mg/2 ml vial generic S Specialty Drug

ANTIFUNGALS

amphotericin b 50 mg vial generic

CANCIDAS (70 MG, 50 MG)caspofungin acetate

BRAND

CICLODAN 0.77% CREAMciclopirox olamine

BRAND

CICLOPIROX (1 SHAMPOO, 0.77 GEL (GRAM), 8SOLUTION)

generic

CICLOPIROX OLAMINE (0.77 CREAM (G), 0.77SUSPENSION)

generic

ciclopirox/ure/camph/menth/euc 8 % solution generic

econazole nitrate 1 % cream (g) generic

FIRST-BXN MOUTHWASHnystatin/lidocaine hcl/diphenhydramine hcl

BRAND

FLUCONAZOLE (10 MG/ML SUSP RECON, 50 MGTABLET, 40 MG/ML SUSP RECON, 100 MG TABLET)

generic

FLUCONAZOLE (150 MG, 200 MG) generic QL

FLUCONAZOLE IN DEXTROSE, ISO-OSMOTIC(400MG/0.2L, 200MG/0.1L)

generic



FLUCONAZOLE IN SODIUM CHLORIDE, ISO-OSMOTIC(200MG/0.1L PGGYBK BTL, 400MG/0.2L PGGYBK BTL,100MG/50ML PGGYBK BTL, 200MG/0.1L PIGGYBACK,400MG/0.2L PIGGYBACK)

generic

FLUCYTOSINE (500 MG, 250 MG) generic

GRISEOFULVIN ULTRAMICROSIZE (125 MG, 250 MG) generic

GRISEOFULVIN, MICROSIZE (500 MG TABLET, 125MG/5ML ORAL SUSP)

generic

GYNAZOLE 1 2% CREAMbutoconazole nitrate

BRAND

itraconazole 100 mg capsule generic

KETOCONAZOLE (2 CREAM (G), 2 FOAM, 2 SHAMPOO) generic

ketoconazole 200 mg tablet generic QL

KETODAN (KIT, )ketoconazole/skin cleanser combination no.28

BRAND

LAMISIL (187.5 MG PACK, 125 MG PACKET)terbinafine hcl

BRAND

miconazole nitrate 200 mg supp.vag generic

MYCAMINE (50 MG, 100 MG)micafungin sodium

BRAND

NATACYN EYE DROPSnatamycin

BRAND

NOXAFIL (40 MG/ML SUSPENSION, 300 MG/16.7 MLVIAL, DR 100 MG TABLET)posaconazole

BRAND

NYAMYC 100,000 UNITS/GM POWDERnystatin

BRAND

NYSTATIN (100000/ML ORAL SUSP, 500MM UNITPOWDER(EA), 150MM UNIT POWDER(EA), 100000/GPOWDER, 100000/G CREAM (G), 100000/G OINT. (G),50MM UNIT POWDER(EA), 500K UNIT TABLET)

generic

NYSTATIN/TRIAMCINOLONE ACETONIDE (CREAM,OINT.)

generic

NYSTOP 100,000 UNITS/GM POWDERnystatin

BRAND

PEDI-DRI TOPICAL POWDERnystatin

BRAND

SPORANOX 10 MG/ML SOLUTIONitraconazole

BRAND

terbinafine hcl 250 mg tablet generic C max 84 days



therapy/365 days

TERCONAZOLE (0.4 % CREAM/APPL, 80 MGSUPP.VAG, 0.8 % CREAM/APPL)

generic

triacetin 100 % liquid generic

VORICONAZOLE (200 MG VIAL, 200 MG/5ML SUSPRECON, 50 MG TABLET)

generic

voriconazole 200 mg tablet generic QL

ANTIGOUT AGENTS

ALLOPURINOL (300 MG, 100 MG) generic

allopurinol sodium 500 mg vial generic

ALOPRIM 500 MG VIALallopurinol sodium

BRAND

COLCHICINE (0.6 MG CAPSULE, 0.6 MG TABLET) generic

colchicine/probenecid 0.5-500mg tablet generic

COLCRYS 0.6 MG TABLETcolchicine

BRAND PA

probenecid 500 mg tablet generic

ULORIC (40 MG, 80 MG)febuxostat

BRAND

ANTIMIGRAINE AGENTS

ERGOT ALKALOIDS

DIHYDROERGOTAMINE MESYLATE (1 MG/ML AMPUL,1 MG/ML VIAL, 0.5MG/SPRY SPRAY/PUMP)

generic

ergotamine tartrate/caffeine 1 mg-100mg tablet generic

MIGERGOT SUPPOSITORYergotamine tartrate/caffeine

BRAND

SEROTONIN (5-HT) 1B/1D RECEPTOR AGONISTS

ALMOTRIPTAN MALATE (12.5 MG, 6.25 MG) generic

NARATRIPTAN HCL (2.5 MG, 1 MG) generic QL

RIZATRIPTAN BENZOATE (10 MG TABLET, 5 MGTABLET, 5 MG TAB RAPDIS, 10 MG TAB RAPDIS)

generic

SUMATRIPTAN (20 MG, 5 MG) generic C 6 nasal sprayers/month

SUMATRIPTAN SUCCINATE (50 MG, 100 MG, 25 MG) generic

SUMATRIPTAN SUCCINATE (6 PEN INJCTR, 6 generic C 4 injections (2



SYRINGE, 6 CARTRIDGE, 4 PEN INJCTR, 4CARTRIDGE, 6 VIAL)

kits)/month

ZOLMITRIPTAN (5 MG TAB RAPDIS, 2.5 MG TABRAPDIS, 5 MG TABLET, 2.5 MG TABLET)

generic

ZOMIG (2.5 MG, 5 MG)zolmitriptan

BRAND C 6 nasal sprayers/month

ANTIMYASTHENIC AGENTS

PARASYMPATHOMIMETICS

ENLON 10 MG/ML VIALedrophonium chloride

BRAND

guanidine hcl 125 mg tablet generic

MESTINON (180 MG TIMESPAN, 60 MG/5 ML SYRUP)pyridostigmine bromide

BRAND

NEOSTIGMINE METHYLSULFATE (4 MG/4 MLSYRINGE, 1 MG/ML VIAL, 2 MG/2 ML SYRINGE, 1:2000VIAL, 1:1000 VIAL, 3 MG/3 ML SYRINGE, 0.5 MG/MLVIAL)

generic

PROSTIGMIN 15 MG TABLETneostigmine bromide

BRAND

PYRIDOSTIGMINE BROMIDE (180 MG ER, 60 MG) generic

REGONOL 10 MG/2 ML AMPULpyridostigmine bromide

BRAND

ANTIMYCOBACTERIALS

ANTIMYCOBACTERIALS, OTHER

DAPSONE (100 MG, 25 MG) generic

MYCOBUTIN 150 MG CAPSULErifabutin

BRAND

rifabutin 150 mg capsule generic

ANTITUBERCULARS

ETHAMBUTOL HCL (100 MG, 400 MG) generic

ISONIAZID (50 MG/5 ML SOLUTION, 100 MG/ML VIAL,300 MG TABLET, 100 MG TABLET)

generic

PRIFTIN 150 MG TABLETrifapentine

BRAND

pyrazinamide 500 mg tablet generic

RIFAMPIN (600 MG VIAL, 150 MG CAPSULE, 300 MGCAPSULE)

generic



SIRTURO 100 MG TABLETbedaquiline fumarate

BRAND

ANTINEOPLASTICS

ALKYLATING AGENTS

ALKERAN 2 MG TABLETmelphalan

BRAND

BICNU 100 MG VIALcarmustine

BRAND

BUSULFEX 60 MG/10 ML VIALbusulfan

BRAND

CYCLOPHOSPHAMIDE (25 MG TABLET, 2 G VIAL, 50MG TABLET, 500 MG VIAL, 1 G VIAL)

generic

DACARBAZINE (200 MG, 100 MG) generic

DAUNOXOME (2 MG/ML, 50 MG (2 MG/ML))daunorubicin citrate liposomal

BRAND

GLEOSTINE (40 MG, 100 MG, 10 MG, 5 MG)lomustine

BRAND

HEXALEN 50 MG CAPSULEaltretamine


IFOSFAMIDE (1 G/20 ML, 3G/60ML, 3 G, 1 G) generic

IFOSFAMIDE/MESNA (1G-1G, 3G-1G) generic

LEUKERAN 2 MG TABLETchlorambucil


LOMUSTINE (100 MG, 10 MG, 40 MG) generic S Specialty Drug

MATULANE 50 MG CAPSULEprocarbazine hcl


melphalan hcl 50 mg vial generic

MUSTARGEN 10 MG VIALmechlorethamine hcl

BRAND MED Medical Drug

MYLERAN 2 MG TABLETbusulfan

BRAND

TEMODAR 100 MG VIALtemozolomide


TEMOZOLOMIDE (5 MG, 20 MG, 140 MG, 100 MG, 180MG, 250 MG)


TREANDA (100 MG, 25 MG)bendamustine hcl

BRAND

VALCHLOR 0.016% GEL BRAND



mechlorethamine hcl

ZANOSAR 1 GM POWDER VIALstreptozocin

BRAND

ANTIANDROGENS

bicalutamide 50 mg tablet generic S Specialty Drug

flutamide 125 mg capsule generic

NILANDRON 150 MG TABLETnilutamide


XTANDI 40 MG CAPSULEenzalutamide


ZYTIGA 250 MG TABLETabiraterone acetate


ANTIANGIOGENIC AGENTS

POMALYST (3 MG, 2 MG, 4 MG, 1 MG)pomalidomide


REVLIMID (2.5 MG, 15 MG, 5 MG, 10 MG, 25 MG, 20 MG)lenalidomide


THALOMID (50 MG, 150 MG, 100 MG, 200 MG)thalidomide


ANTIESTROGENS/MODIFIERS

EMCYT 140 MG CAPSULEestramustine phosphate sodium

BRAND

FARESTON 60 MG TABLETtoremifene citrate


TAMOXIFEN CITRATE (10 MG, 20 MG) generic

ANTIMETABOLITES

ADRUCIL (2,500 MG/50 ML, 500 MG/10 ML, 5 GRAM/100ML)fluorouracil


ALIMTA (500 MG, 100 MG)pemetrexed disodium

BRAND

CAPECITABINE (500 MG, 150 MG) generic S Specialty Drug

cladribine 10 mg/10ml vial generic

cytarabine 20 mg/ml vial generic S Specialty Drug

CYTARABINE/PF (2 G/20 ML, 100 MG, 1 G, 500 MG, 20MG/ML, 100 MG/5ML)


DROXIA (400 MG, 200 MG, 300 MG) BRAND



hydroxyurea

ELITEK (1.5 MG, 7.5 MG)rasburicase

BRAND

floxuridine 500 mg vial generic MED Medical Drug

FLUOROURACIL (2.5 G/50ML, 1 G/20 ML, 5 G/100 ML,500MG/10ML)


FLUOROURACIL (5 SOLUTION, 2 SOLUTION, 5 CREAM(G))

generic

FOLOTYN (20 MG/ML, 40 MG/2 ML)pralatrexate

BRAND

GEMCITABINE HCL (200 MG, 2 G, 1 G, 2 G/52.6ML,200MG/5.26, 1 G/26.3ML)

generic

hydroxyurea 500 mg capsule generic

mercaptopurine 50 mg tablet generic

pentostatin 10 mg vial generic

PURINETHOL 50 MG TABLETmercaptopurine

BRAND PA

TABLOID 40 MG TABLETthioguanine


ANTINEOPLASTICS, OTHER

ABRAXANE 100 MG VIALpaclitaxel protein-bound

BRAND

ADRIAMYCIN (50 MG, 10 MG, 2 MG/ML, 200 MG/100 ML,20 MG)doxorubicin hcl

BRAND

amifostine crystalline 500 mg vial generic

ARRANON 250 MG VIALnelarabine

BRAND

CARBOPLATIN (10 MG/ML, 150 MG) generic

CERUBIDINE 20 MG VIALdaunorubicin hcl

BRAND

cisplatin 1 mg/ml vial generic

dactinomycin 0.5 mg vial generic

DAUNORUBICIN HCL (20 MG, 5 MG/ML) generic

decitabine 50 mg vial generic

DEXRAZOXANE HCL (250 MG, 500 MG) generic

DOCETAXEL (20 MG/2 ML, 160 MG/8ML, FNL 20MG/2, generic



20MG/ML(1), 200MG/20ML, 160MG/16ML, 140 MG/7ML,80 MG/8 ML, 80 MG/4 ML, FNL 80MG/8)

DOXIL 2 MG/ML VIALdoxorubicin hcl pegylated liposomal

BRAND

DOXORUBICIN HCL (50 MG, 10 MG, 50 MG/25ML, 20MG/10ML, 2 MG/ML, 10 MG/5 ML)

generic

doxorubicin hcl peg-liposomal 2 mg/ml vial generic

ELOXATIN (200 MG/40 ML, 100 MG/20 ML, 50 MG/10ML)oxaliplatin

BRAND

EPIRUBICIN HCL (50 MG, 50 MG/25ML, 200 MG,200MG/0.1L)

generic

FLUDARABINE PHOSPHATE (50 MG, 50 MG/2 ML) generic

FUSILEV I.V. 50 MG VIALlevoleucovorin calcium

BRAND

idarubicin hcl 1 mg/ml vial generic

IRINOTECAN HCL (40 MG/2 ML, 100 MG/5ML,500MG/25ML)

generic

ISTODAX 10 MG VIALromidepsin

BRAND

IXEMPRA (15 MG, 45 MG)ixabepilone

BRAND

LEUCOVORIN CALCIUM (100 MG VIAL, 500MG/50MLVIAL, 500 MG VIAL, 50 MG VIAL, 200 MG VIAL, 350 MGVIAL, 10 MG TABLET, 5 MG TABLET, 25 MG TABLET, 15MG TABLET)


leucovorin calcium 10 mg/ml vial generic

levoleucovorin calcium 10 mg/ml vial generic

LIPODOX 2 MG/ML VIALdoxorubicin hcl pegylated liposomal

BRAND

LIPODOX 50 2 MG/ML VIALdoxorubicin hcl pegylated liposomal

BRAND

LYSODREN 500 MG TABLETmitotane


MARQIBO KITvincristine sulfate liposomal

BRAND

mesna 100 mg/ml vial generic

MESNEX 400 MG TABLETmesna

BRAND

MITOMYCIN (5 MG, 40 MG, 20 MG) generic



mitoxantrone hcl 2 mg/ml vial generic

ONXOL 30 MG/5 ML VIALpaclitaxel

BRAND

OXALIPLATIN (50 MG, 100 MG, 50 MG/10ML,100MG/20ML)

generic

paclitaxel 6 mg/ml vial generic

PHOTOFRIN 75 MG VIALporfimer sodium

BRAND

SYLATRON (200 MCG, 600 MCG, 300 MCG)peginterferon alfa-2b


SYLATRON 4-PACK (300 MCG, 200 MCG)peginterferon alfa-2b


SYLATRON 888 MCG 4-PACKpeginterferon alfa-2b

BRAND

teniposide 50 mg/5 ml ampul generic

THERACYS 81 MG VIALbcg live

BRAND MED Medical Drug

thiotepa 15 mg vial generic

TRISENOX 10 MG/10 ML AMPULEarsenic trioxide

BRAND

VINBLASTINE SULFATE (1 MG/ML, 10 MG) generic

VINCASAR PFS (2 MG/2 ML, 1 MG/ML)vincristine sulfate

BRAND

VINCRISTINE SULFATE (2 MG/2 ML, 1 MG/ML) generic

VINORELBINE TARTRATE (50 MG/5 ML, 10 MG/ML) generic

VUMON 50 MG/5 ML AMPULEteniposide

BRAND

ZOLINZA 100 MG CAPSULEvorinostat


AROMATASE INHIBITORS, 3RD GENERATION

anastrozole 1 mg tablet generic S Specialty Drug

exemestane 25 mg tablet generic S Specialty Drug

letrozole 2.5 mg tablet generic S Specialty Drug

ENZYME INHIBITORS

ETOPOSIDE (20 MG/ML VIAL, 50 MG CAPSULE) generic S Specialty Drug

TOPOSAR (100 MG/5 ML, 500 MG/25 ML, 1,000 MG/50 BRAND S Specialty Drug



ML)etoposide

MOLECULAR TARGET INHIBITORS

AFINITOR (10 MG, 7.5 MG, 2.5 MG, 5 MG)everolimus


AFINITOR DISPERZ (2 MG, 5 MG, 3 MG)everolimus


BOSULIF (500 MG, 100 MG)bosutinib


CAPRELSA (300 MG, 100 MG)vandetanib


ERIVEDGE 150 MG CAPSULEvismodegib


GILOTRIF (20 MG, 40 MG, 30 MG)afatinib dimaleate


GLEEVEC (100 MG, 400 MG)imatinib mesylate


IBRANCE (125 MG, 100 MG, 75 MG)palbociclib

BRANDPA

S Specialty Drug

ICLUSIG 15 MG TABLETponatinib hcl


ICLUSIG 45 MG TABLETponatinib hcl

BRAND

IMATINIB MESYLATE (400 MG, 100 MG) generic S Specialty Drug

IMBRUVICA 140 MG CAPSULEibrutinib

BRAND

QL

PA

S Specialty Drug

INLYTA (5 MG, 1 MG)axitinib


JAKAFI (10 MG, 15 MG, 5 MG, 25 MG, 20 MG)ruxolitinib phosphate


MEKINIST (2 MG, 0.5 MG)trametinib dimethyl sulfoxide


NEXAVAR 200 MG TABLETsorafenib tosylate


SPRYCEL (80 MG, 20 MG, 140 MG, 70 MG, 100 MG, 50MG)dasatinib




STIVARGA 40 MG TABLETregorafenib


SUTENT (50 MG, 12.5 MG, 25 MG)sunitinib malate


TAFINLAR (50 MG, 75 MG)dabrafenib mesylate


TARCEVA (150 MG, 100 MG, 25 MG)erlotinib hcl


TASIGNA (150 MG, 200 MG)nilotinib hcl


TORISEL 25 MG KITtemsirolimus

BRAND

TYKERB 250 MG TABLETlapatinib ditosylate

BRANDPA

S Specialty Drug

VOTRIENT 200 MG TABLETpazopanib hcl


XALKORI (200 MG, 250 MG)crizotinib


ZELBORAF 240 MG TABLETvemurafenib


ZYDELIG (100 MG, 150 MG)idelalisib

BRANDPA

S Specialty Drug

ZYKADIA 150 MG CAPSULEceritinib

BRAND

QL

PA

S Specialty Drug

MONOCLONAL ANTIBODIES

ARZERRA (1,000 MG/50 ML, 100 MG/5 ML)ofatumumab

BRAND

AVASTIN (100 MG/4 ML, 400 MG/16 ML)bevacizumab

BRAND

BEXXAR (14 MG/ML DOSIMETRIC, 14 MG/MLTHERAPEUTIC)tositumomab (with maltose)

BRAND

ERBITUX (100 MG/50 ML, 200 MG/100 ML)cetuximab

BRAND

HERCEPTIN 440 MG VIALtrastuzumab

BRAND PA

KADCYLA (160 MG, 100 MG) BRAND PA



ado-trastuzumab emtansine

PERJETA 420 MG/14 ML VIALpertuzumab

BRAND

RITUXAN 10 MG/ML VIALrituximab

BRAND PA

VECTIBIX (100 MG/5 ML, 400 MG/20 ML)panitumumab

BRAND

ZEVALIN Y-90 VIALkit for prep yttrium-90/ibritumomab tiuxetan/albumin human

BRAND

RETINOIDS

bexarotene 75 mg capsule generic

TARGRETIN (1% GEL, 75 MG CAPSULE)bexarotene


TARGRETIN 75 MG SOFTGELbexarotene

BRAND

tretinoin 10 mg capsule generic

ANTIPARASITICS

ANTIHELMINTHICS

ALBENZA 200 MG TABLETalbendazole

BRAND

STROMECTOL 3 MG TABLETivermectin

BRAND

ANTIPROTOZOALS

ALINIA (500 MG TABLET, 100 MG/5 ML SUSPENSION)nitazoxanide

BRAND

atovaquone 750 mg/5ml oral susp generic

ATOVAQUONE/PROGUANIL HCL (250-100 MG, 62.5-25MG)

generic

CHLOROQUINE PHOSPHATE (500 MG, 250 MG) generic

COARTEM TABLETSartemether/lumefantrine

BRAND

DARAPRIM 25 MG TABLETpyrimethamine

BRAND

hydroxychloroquine sulfate 200 mg tablet generic

mefloquine hcl 250 mg tablet generic

MEPRON 750 MG/5 ML SUSPENSIONatovaquone

BRAND



NEBUPENT 300 MG INHAL POWDERpentamidine isethionate

BRAND

quinine sulfate 324 mg capsule generic

PEDICULICIDES/SCABICIDES

EURAX (CREAM, LOTION)crotamiton

BRAND

malathion 0.5 % lotion generic

ST

C

60ml/fill; must trypermethrin andpiperonylbutoxide/pyrethrins

ANTIPARKINSON AGENTS

ANTICHOLINERGICS

BENZTROPINE MESYLATE (2 MG/2 ML VIAL, 2 MG/2 MLAMPUL, 1 MG TABLET, 2 MG TABLET, 0.5 MG TABLET)

generic

TRIHEXYPHENIDYL HCL (2 MG/5 ML ELIXIR, 2 MGTABLET, 5 MG TABLET)

generic

ANTIPARKINSON AGENTS, OTHER

AMANTADINE HCL (100 MG TABLET, 100 MGCAPSULE, 50 MG/5 ML SOLUTION)

generic

CARBIDOPA/LEVODOPA/ENTACAPONE (50-200-200,37.5-150MG, 18.75-75MG, 25-100-200, 31.25-125, 12.5-50 MG)

generic

entacapone 200 mg tablet generic

TASMAR 100 MG TABLETtolcapone

BRAND

tolcapone 100 mg tablet generic

DOPAMINE AGONISTS

APOKYN 30 MG/3 ML CARTRIDGEapomorphine hcl


BROMOCRIPTINE MESYLATE (2.5 MG TABLET, 5 MGCAPSULE)

generic

PRAMIPEXOLE DI-HCL (0.375 MG TAB ER 24H, 1.5 MGTABLET, 0.125 MG TABLET, 2.25 MG TAB ER 24H, 0.5MG TABLET, 1.5 MG TAB ER 24H, 4.5 MG TAB ER 24H,0.25 MG TABLET, 0.75 MG TAB ER 24H, 3 MG TAB ER24H, 0.75 MG TABLET, 1 MG TABLET)

generic

ROPINIROLE HCL (3 MG TABLET, 2 MG TAB ER 24H, 8MG TAB ER 24H, 1 MG TABLET, 5 MG TABLET, 12 MG generic



TAB ER 24H, 6 MG TAB ER 24H, 0.5 MG TABLET, 4 MGTABLET, 4 MG TAB ER 24H, 0.25 MG TABLET, 2 MGTABLET)

DOPAMINE PRECURSORS/L-AMINO ACID DECARBOXYLASE INHIBITORS

carbidopa 25 mg tablet generic

CARBIDOPA/LEVODOPA (25MG-250MG TAB RAPDIS,25MG-250MG TABLET, 25MG-100MG TAB RAPDIS,25MG-100MG TABLET ER, 10MG-100MG TAB RAPDIS,50MG-200MG TABLET ER, 10MG-100MG TABLET,25MG-100MG TABLET)

generic

MONOAMINE OXIDASE B (MAO-B) INHIBITORS

SELEGILINE HCL (5 MG TABLET, 5 MG CAPSULE) generic

ANTIPSYCHOTICS

1ST GENERATION/TYPICAL

CHLORPROMAZINE HCL (100 MG TABLET, 200 MGTABLET, 25 MG TABLET, 10 MG TABLET, 25 MG/MLAMPUL, 50 MG TABLET)

generic

DROPERIDOL (2.5 MG/ML AMPUL, 2.5 MG/ML VIAL) generic

fluphenazine decanoate 25 mg/ml vial generic

FLUPHENAZINE HCL (2.5 MG/5ML ELIXIR, 10 MGTABLET, 5 MG TABLET, 2.5 MG TABLET, 5 MG/MLORAL CONC, 2.5 MG/ML VIAL, 1 MG TABLET)

generic

HALOPERIDOL (20 MG, 0.5 MG, 2 MG, 10 MG, 1 MG, 5MG)

generic

HALOPERIDOL DECANOATE (50 MG/ML VIAL, 100MG/ML AMPUL, 50 MG/ML AMPUL, 100 MG/ML VIAL)

generic

HALOPERIDOL LACTATE (2 MG/ML ORAL CONC, 5MG/ML VIAL, 5 MG/ML AMPUL)

generic

LOXAPINE SUCCINATE (10 MG, 5 MG, 50 MG, 25 MG) generic

MOLINDONE HCL (10 MG, 5 MG, 25 MG) generic GL Male

PIMOZIDE (2 MG, 1 MG) generic

THIORIDAZINE HCL (50 MG, 10 MG, 25 MG, 100 MG) generic

THIOTHIXENE (1 MG, 10 MG, 2 MG, 5 MG) generic

TRIFLUOPERAZINE HCL (10 MG, 1 MG, 2 MG, 5 MG) generic

2ND GENERATION/ATYPICAL

ABILIFY (10 MG, 30 MG, 20 MG, 15 MG, 5 MG)aripiprazole

BRAND QL



ABILIFY 1 MG/ML SOLUTIONaripiprazole

BRAND C 30ml/DAY

ABILIFY 2 MG TABLETaripiprazole

BRAND QL

ABILIFY 9.7 MG/1.3 ML VIALaripiprazole

BRAND C 30ml/day

ABILIFY DISCMELT (10 MG, 15 MG)aripiprazole

BRAND QL

ABILIFY MAINTENA ER 300 MG SYRaripiprazole

BRANDQL

PA

ABILIFY MAINTENA ER 300 MG VLaripiprazole

BRANDPA

C 30ml/day

ABILIFY MAINTENA ER 400 MG SYRaripiprazole

BRANDQL

PA

ABILIFY MAINTENA ER 400 MG VLaripiprazole

BRANDPA

C 30ml/DAY

ARIPIPRAZOLE (15 MG, 10 MG) generic QL

ARIPIPRAZOLE (15 MG, 10 MG, 30 MG, 5 MG, 20 MG, 2MG)

generic QL

aripiprazole 1 mg/ml solution generic QL

GEODON 20 MG/ML VIALziprasidone mesylate

BRAND

INVEGA SUSTENNA (156 MG SY, 117 MG SY, 39 MGSYR, 234 MG SY, 78 MG SYR)paliperidone palmitate

BRANDPA

C must try 1 oralantipsychotic

INVEGA TRINZA (819 MG/2.625 ML, 546 MG/1.75 ML)paliperidone palmitate

BRAND

QL

PA

ST

INVEGA TRINZA 273 MG/0.875 MLpaliperidone palmitate

BRAND

QL

PA

ST

INVEGA TRINZA 410 MG/1.315 MLpaliperidone palmitate

BRAND

QL

PA

ST

OLANZAPINE (10 MG, 5 MG, 20 MG) generic QL



PA

OLANZAPINE (15 MG TAB RAPDIS, 10 MG VIAL) generic QL

OLANZAPINE (20 MG, 10 MG, 5 MG, 2.5 MG, 7.5 MG, 15MG)

generic QL

PALIPERIDONE (9 MG ER 24, 6 MG ER 24, 1.5 MG ER24, 3 MG ER 24)

generic

QUETIAPINE FUMARATE (200 MG, 50 MG, 400 MG, 25MG, 300 MG, 100 MG)

generic QL

RISPERDAL CONSTA (25 MG, 12.5 MG, 50 MG, 37.5MG)risperidone microspheres

BRAND PA

RISPERIDONE (1 MG TAB RAPDIS, 2 MG TABLET, 4 MGTAB RAPDIS, 4 MG TABLET, 0.25 MG TABLET, 1 MG/MLSOLUTION, 2 MG TAB RAPDIS, 0.25 MG TAB RAPDIS, 3MG TAB RAPDIS, 0.5 MG TAB RAPDIS, 1 MG TABLET, 3MG TABLET, 0.5 MG TABLET)

generic

SEROQUEL XR (200 MG, 150 MG, 400 MG, 300 MG)quetiapine fumarate

BRAND

QL

C

dosage <150mg/daybeyond initial 30 dayswill require PA forthosebetween 13-64yrs ofage

SEROQUEL XR 50 MG TABLETquetiapine fumarate

BRAND

QL

C

dosage <150mg/daybeyond initial 30 dayswill require PA forthosebetween 13-64yrs ofage

SEROQUEL XR SAMPLE KITquetiapine fumarate

BRAND

ZIPRASIDONE HCL (80 MG, 60 MG, 20 MG, 40 MG) generic QL

TREATMENT-RESISTANT

CLOZAPINE (50 MG TABLET, 12.5 MG TAB RAPDIS, 200MG TABLET, 25 MG TABLET, 100 MG TABLET, 150 MGTAB RAPDIS, 25 MG TAB RAPDIS, 200 MG TABRAPDIS, 100 MG TAB RAPDIS)

generic

ANTIVIRALS

ANTI-CYTOMEGALOVIRUS (CMV) AGENTS

cidofovir 75 mg/ml vial generic



foscarnet sodium 24 mg/ml infus. btl generic

ganciclovir sodium 500 mg vial generic

VALCYTE (450 MG TABLET, 50 MG/ML SOLUTION)valganciclovir hcl

BRAND

valganciclovir hcl 450 mg tablet generic

ANTI-HEPATITIS B (HBV) AGENTS

adefovir dipivoxil 10 mg tablet generic

BARACLUDE 0.05 MG/ML SOLUTIONentecavir


ENTECAVIR (0.5 MG, 1 MG) generic QL

EPIVIR HBV 25 MG/5 ML SOLNlamivudine

BRAND

lamivudine 100 mg tablet generic

TYZEKA 600 MG TABLETtelbivudine

BRAND

ANTI-HEPATITIS C (HCV) AGENTS

HARVONI 90-400 MG TABLETledipasvir/sofosbuvir

BRAND

QL

PA

S Specialty Drug

INCIVEK 375 MG TABLETtelaprevir

BRANDPA

S Specialty Drug

INFERGEN (15 MCG/0.5 ML, 9 MCG/0.3 ML)interferon alfacon-1

BRANDPA

S Specialty Drug

INTRON A (50 UNITS VIL, 6 UNIT/ML VL, 10 UNIT/ML, 18UNITS VIL, 10 UNITS VIL)interferon alfa-2b,recomb.

BRAND

MODERIBA 200 MG TABLETribavirin

BRANDPA

S Specialty Drug

PEGASYS (180 MCG/ML VIAL, 180 MCG/0.5 MLSYRINGE)peginterferon alfa-2a

BRANDPA

S Specialty Drug

PEGASYS PROCLICK (180, 135)peginterferon alfa-2a

BRANDPA

S Specialty Drug

RIBASPHERE (600 MG TABLET, 400 MG TABLET, 200MG TABLET, 200 MG CAPSULE)ribavirin

BRANDPA

S Specialty Drug



RIBASPHERE RIBAPAK (200-400 MG, 600-600 MG, 600-400 MG, 400-400 MG)ribavirin

BRANDPA

S Specialty Drug

RIBAVIRIN (200 MG CAPSULE, 200 MG TABLET) genericPA

S Specialty Drug

SOVALDI 400 MG TABLETsofosbuvir

BRAND

QL

PA

S Specialty Drug

TECHNIVIE DOSE PACKombitasvir/paritaprevir/ritonavir

BRAND

QL

PA

S Specialty Drug

VICTRELIS 200 MG CAPSULEboceprevir

BRANDPA

S Specialty Drug

VIEKIRA PAKombitasvir/paritaprevir/ritonavir/dasabuvir sodium

BRAND

QL

PA

S Specialty Drug

ANTI-HIV AGENTS, INTEGRASE INHIBITORS (INSTI)

ISENTRESS (100 MG POWDER PACKET, 25 MGTABLET CHEW, 400 MG TABLET, 100 MG TABLETCHEW)raltegravir potassium

BRAND PA

STRIBILD TABLETelvitegravir/cobicistat/emtricitabine/tenofovir

BRAND

TIVICAY 50 MG TABLETdolutegravir sodium

BRAND

ANTI-HIV AGENTS, NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTI)

ATRIPLA TABLETefavirenz/emtricitabine/tenofovir disoproxil fumarate

BRAND

COMPLERA TABLETemtricitabine/rilpivirine hcl/tenofovir disoproxil fumarate

BRAND

EDURANT 25 MG TABLETrilpivirine hcl

BRAND

INTELENCE (25 MG, 200 MG, 100 MG)etravirine

BRAND

NEVIRAPINE (100 MG TAB ER 24H, 50 MG/5 ML ORALSUSP, 200 MG TABLET, 400 MG TAB ER 24H)

generic

RESCRIPTOR (100 MG, 200 MG) BRAND



delavirdine mesylate

SUSTIVA (200 MG CAPSULE, 600 MG TABLET, 50 MGCAPSULE)efavirenz

BRAND

VIRAMUNE XR (400 MG, 100 MG)nevirapine

BRAND

ANTI-HIV AGENTS, NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)

abacavir sulfate 300 mg tablet generic

abacavir/lamivudine/zidovudine 150-300mg tablet generic

DIDANOSINE (250 MG, 400 MG, 200 MG, 125 MG) generic

EMTRIVA (10 MG/ML SOLUTION, 200 MG CAPSULE)emtricitabine

BRAND

EPIVIR 10 MG/ML ORAL SOLNlamivudine

BRAND

EPZICOM TABLETabacavir sulfate/lamivudine

BRAND

LAMIVUDINE (300 MG TABLET, 10 MG/ML SOLUTION,150 MG TABLET)

generic

lamivudine/zidovudine 150-300mg tablet generic

STAVUDINE (30 MG CAPSULE, 40 MG CAPSULE, 15MG CAPSULE, 20 MG CAPSULE, 1 MG/ML SOLNRECON)

generic

TRUVADA 200 MG-300 MG TABLETemtricitabine/tenofovir disoproxil fumarate

BRAND

VIDEX (2, 4)didanosine

BRAND

VIREAD (POWDER, 300 MG TABLET, 200 MG TABLET,150 MG TABLET, 250 MG TABLET)tenofovir disoproxil fumarate

BRAND

ZIAGEN 20 MG/ML SOLUTIONabacavir sulfate

BRAND

ZIDOVUDINE (10 MG/ML SYRUP, 300 MG TABLET, 100MG CAPSULE)

generic

ANTI-HIV AGENTS, OTHER

FUZEON (90 MG VIAL, CONVENIENCE KIT)enfuvirtide

BRAND

SELZENTRY (300 MG, 150 MG)maraviroc

BRAND PA

ANTI-HIV AGENTS, PROTEASE INHIBITORS



APTIVUS (100 MG/ML SOLUTION, 250 MG CAPSULE)tipranavir

BRAND

CRIXIVAN (400 MG, 200 MG)indinavir sulfate

BRAND

INVIRASE (500 MG TABLET, 200 MG CAPSULE)saquinavir mesylate

BRAND

KALETRA (100-25 MG TABLET, 400-100/5 ML ORALSOLU, 200-50 MG TABLET)lopinavir/ritonavir

BRAND

LEXIVA (50 MG/ML SUSPENSION, 700 MG TABLET)fosamprenavir calcium

BRAND

NORVIR (80 MG/ML SOLUTION, 100 MG TABLET, 100MG SOFTGEL CAP)ritonavir

BRAND

PREZISTA (600 MG TABLET, 100 MG/ML SUSPENSION,150 MG TABLET, 400 MG TABLET, 800 MG TABLET, 75MG TABLET)darunavir ethanolate

BRAND

REYATAZ (200 MG, 100 MG, 300 MG, 150 MG)atazanavir sulfate

BRAND

VIRACEPT (625 MG, 250 MG)nelfinavir mesylate

BRAND

ANTI-INFLUENZA AGENTS

RELENZA 5 MG DISKHALERzanamivir

BRANDQL

C max 10 day supply/fill

rimantadine hcl 100 mg tablet generic

TAMIFLU (45 MG, 30 MG)oseltamivir phosphate

BRAND

TAMIFLU 6 MG/ML SUSPENSIONoseltamivir phosphate

BRAND C 25ml/day

TAMIFLU 75 MG CAPSULEoseltamivir phosphate

BRAND C 20 capsules/180 days

ANTIHERPETIC AGENTS

ACYCLOVIR (200 MG CAPSULE, 400 MG TABLET, 800MG TABLET, 200 MG/5ML ORAL SUSP)

generic

acyclovir 5 % oint. (g) generic C 15gm/fill

ACYCLOVIR SODIUM (500 MG, 50 MG/ML, 1000 MG) generic

FAMCICLOVIR (500 MG, 250 MG, 125 MG) generic

trifluridine 1 % drops generic



VALACYCLOVIR HCL (500 MG, 1000 MG) generic

ZOVIRAX 5% CREAMacyclovir

BRAND C 5gm/fill

ANXIOLYTICS

ANXIOLYTICS, OTHER

BUSPIRONE HCL (5 MG, 30 MG, 7.5 MG, 10 MG, 15 MG) generic

MIDAZOLAM HCL (5 MG/ML(1) VIAL, 2 MG/ML SYRUP, 2MG/2 ML VIAL, 5 MG/ML VIAL, 5 MG/5 ML VIAL, 10 MG/2ML VIAL, 10 MG/10ML VIAL)

generic

MIDAZOLAM HCL/PF (5 MG/ML SYRINGE, 5 MG/MLCARTRIDGE, 5 MG/5 ML VIAL, 2 MG/2 ML CARTRIDGE,10 MG/2 ML VIAL, 2 MG/2 ML VIAL, 10 MG/2 MLSYRINGE, 5 MG/ML(1) VIAL, 2 MG/2 ML SYRINGE)

generic

BENZODIAZEPINES

ALPRAZOLAM (2 MG TAB RAPDIS, 1 MG TABLET, 0.25MG TAB RAPDIS, 0.5 MG TAB RAPDIS, 0.5 MG TAB ER24H, 2 MG TABLET, 3 MG TAB ER 24H, 1 MG TABRAPDIS, 1 MG TAB ER 24H, 0.25 MG TABLET, 2 MGTAB ER 24H, 0.5 MG TABLET)

generic

ALPRAZOLAM 1 MG/ML ORAL CONCalprazolam

BRAND

CHLORDIAZEPOXIDE HCL (25 MG, 5 MG, 10 MG) generic

CLONAZEPAM (0.125 MG TAB RAPDIS, 0.5 MGTABLET, 1 MG TAB RAPDIS, 0.25 MG TAB RAPDIS, 1MG TABLET, 0.5 MG TAB RAPDIS, 2 MG TAB RAPDIS, 2MG TABLET)

generic

CLORAZEPATE DIPOTASSIUM (7.5 MG, 3.75 MG, 15MG)

generic

DIAZEPAM (2 MG TABLET, 10 MG TABLET, 5 MG/5 MLSOLUTION, 5 MG/ML SYRINGE, 5 MG/ML ORAL CONC,5 MG TABLET, 5 MG/ML VIAL)

generic

LORAZEPAM (4 MG/ML SYRINGE, 2 MG/ML SYRINGE,0.5 MG TABLET, 4 MG/ML VIAL, 2 MG/ML VIAL, 1 MGTABLET, 2 MG/ML ORAL CONC, 2 MG TABLET)

generic

LORAZEPAM INTENSOL 2 MG/MLlorazepam

BRAND

OXAZEPAM (10 MG, 15 MG, 30 MG) generic

BIPOLAR AGENTS

MOOD STABILIZERS



LITHIUM CARBONATE (300 MG TABLET ER, 300 MGTABLET, 300 MG CAPSULE, 600 MG CAPSULE, 150 MGCAPSULE, 450 MG TABLET ER)

generic

lithium citrate 8 meq/5 ml solution generic

BLOOD GLUCOSE REGULATORS

ANTIDIABETIC AGENTS

ACARBOSE (50 MG, 25 MG, 100 MG) generic

ACTOPLUS MET XR (30-1,000 MG, 15-1,000 MG)pioglitazone hcl/metformin hcl

BRAND PA

BYDUREON 2 MG PEN INJECTexenatide microspheres

BRANDPA

C 1 unit/7 days

BYDUREON 2 MG VIALexenatide microspheres

BRANDPA

C 1 unit/7 days

BYETTA (5 MCG, 10 MCG)exenatide

BRANDQL

PA

GLIMEPIRIDE (1 MG, 4 MG, 2 MG) generic

GLIPIZIDE (10 MG TAB ER 24, 5 MG TABLET, 10 MGTABLET, 5 MG TAB ER 24, 2.5 MG TAB ER 24)

generic

GLIPIZIDE/METFORMIN HCL (2.5-250 MG, 5 MG-500MG,2.5-500 MG)

generic

GLYBURIDE (2.5 MG, 5 MG, 1.25 MG) generic

GLYBURIDE,MICRONIZED (3 MG, 6 MG, 1.5 MG) generic

GLYBURIDE/METFORMIN HCL (2.5-500 MG, 1.25-250MG, 5 MG-500MG)

generic

INVOKAMET (50-1,000 MG, 50-500 MG, 150-500 MG,150-1,000 MG)canagliflozin/metformin hcl

BRANDQL

C must try metformin for6 months

INVOKANA (100 MG, 300 MG)canagliflozin

BRAND

JANUMET (50-1,000 MG, 50-500 MG)sitagliptin phosphate/metformin hcl

BRANDST

C must try metformin for6 mos

JANUMET XR (50-500 MG, 50-1,000 MG, 100-1,000 MG)sitagliptin phosphate/metformin hcl

BRANDST


JANUVIA (25 MG, 100 MG)sitagliptin phosphate

BRAND ST




JANUVIA 50 MG TABLETsitagliptin phosphate

BRAND

PA

ST


JENTADUETO (2.5 MG-850 MG, 2.5 MG-1000 MG, 2.5MG-500 MG)linagliptin/metformin hcl

BRANDST


METFORMIN HCL (850 MG TABLET, 750 MG TAB ER24H, 1000 MG TABLET, 500 MG TAB ER 24, 500 MGTAB ER 24H)

generic

metformin hcl 500 mg tablet generic GL Male

NATEGLINIDE (120 MG, 60 MG) generic PA

PIOGLITAZONE HCL (30 MG, 15 MG, 45 MG) generic

PIOGLITAZONE HCL/GLIMEPIRIDE (30 MG-4 MG, 30MG-2 MG)

generic

PIOGLITAZONE HCL/METFORMIN HCL (15MG-500MG,15MG-850MG)

generic

REPAGLINIDE (1 MG, 2 MG, 0.5 MG) generic

REPAGLINIDE/METFORMIN HCL (1MG-500MG, 2 MG-500MG)

generic

RIOMET 500 MG/5 ML SOLUTIONmetformin hcl

BRAND

SYMLINPEN 120 PEN INJECTORpramlintide acetate

BRAND PA

SYMLINPEN 60 PEN INJECTORpramlintide acetate

BRAND PA

TOLAZAMIDE (250 MG, 500 MG) generic

tolbutamide 500 mg tablet generic

TRADJENTA 5 MG TABLETlinagliptin

BRANDST


VICTOZA 2-PAK 18 MG/3 ML PENliraglutide

BRANDQL

PA

VICTOZA 3-PAK 18 MG/3 ML PENliraglutide

BRANDQL

PA



GLYCEMIC AGENTS

GLUCAGEN (1 MG HYPOKIT, DIAGNOSTIC 1 MG VIAL,1 MG HYPOKIT 2-PACK)glucagon,human recombinant

BRAND

GLUCAGON 1 MG EMERGENCY KITglucagon,human recombinant

BRAND

glucagon hcl 1 mg vial generic

PROGLYCEM 50 MG/ML ORAL SUSPdiazoxide

BRAND

INSULINS

HUMALOG 200 UNITS/ML KWIKPENinsulin lispro

BRAND

HUMULIN R 500 UNITS/ML VIALinsulin regular, human

BRAND

LANTUS 100 UNITS/ML VIALinsulin glargine,human recombinant analog

BRAND

LANTUS SOLOSTAR 100 UNITS/MLinsulin glargine,human recombinant analog

BRAND

LEVEMIR 100 UNITS/ML VIALinsulin detemir

BRAND

LEVEMIR FLEXPEN 100 UNITS/MLinsulin detemir

BRAND

LEVEMIR FLEXTOUCH 100 UNITS/MLinsulin detemir

BRAND

BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS

ANTICOAGULANTS

ACD INJECTION SOLUTIONdextrose-water/sodium citrate/citric acid

BRAND

ACD-A SOLUTIONcitrate dextrose solution

BRAND

argatroban in nacl,iso-osmotic 50 mg/50ml vial generic

citrate phosphate dextros soln 2.63 g/100 solution generic

ENOXAPARIN SODIUM (300MG/3ML VIAL, 150 MG/MLSYRINGE, 120MG/.8ML SYRINGE, 100 MG/MLSYRINGE, 40MG/0.4ML SYRINGE, 30MG/0.3MLSYRINGE, 80MG/0.8ML SYRINGE, 60MG/0.6MLSYRINGE)

generic C PA required if days'supply > or =11 days

FONDAPARINUX SODIUM (10MG/0.8ML, 2.5 MG/0.5,5MG/0.4ML, 7.5MG/0.6)

genericPA

C PA required if days'



supply > or =11 days

S Specialty Drug

HEPARIN 50 UNITS/5 ML (10/ML)heparin sodium,porcine/pf

BRAND

HEPARIN SODIUM,PORCINE (20000/ML VIAL, 10UNIT/ML VIAL, 1000/ML VIAL, 100/ML (1) SYRINGE, 10UNIT/ML SYRINGE, 300/3 ML SYRINGE, 100/ML VIAL,5000/ML VIAL, 200/2 ML SYRINGE, 5000/ML(1)CARTRIDGE, 500/5 ML SYRINGE, 10000/ML VIAL)

generic

HEPARIN SODIUM,PORCINE IN 0.45 % SODIUMCHLORIDE (HEPAR25000/500, HEPAR25000/250)

generic

HEPARIN SODIUM,PORCINE IN 0.9 % SODIUMCHLORIDE (1K/1000 ML IV SOLN, 100/ML KIT, 10UNIT/ML KIT, 6K/1000 ML IV SOLN)

generic

HEPARIN SODIUM,PORCINE IN 0.9 % SODIUMCHLORIDE/PF (2K/1000ML, 1000/500ML)

generic

HEPARIN SODIUM,PORCINE/DEXTROSE 5 % INWATER (25000/250, 20K/500ML, 12500/250, 25000/500)

generic

HEPARIN SODIUM,PORCINE/PF (5000/0.5ML SYRINGE,500/5 ML SYRINGE, 300/3 ML SYRINGE, 100/ML (1)VIAL, 10 UNIT/ML SYRINGE, 100/ML (1) SYRINGE,5000/0.5ML VIAL, 1000/10 ML SYRINGE, 200/2 MLSYRINGE, 1000/ML VIAL, 10 UNIT/ML VIAL, 1 UNIT/MLSYRINGE)

generic

JANTOVEN (7.5 MG, 6 MG, 5 MG, 2.5 MG, 2 MG, 4 MG, 3MG, 1 MG, 10 MG)warfarin sodium

BRAND

MONOJECT PREFILL ADVANCED (500 UNIT/5 ML(100/ML), 50 UNITS/5 ML (10/ML), 30 UNITS/3 ML(10/ML), 300 UNIT/3 ML (100/ML), 1,000 UNIT/10(100/ML), 100 UNIT/10 ML (10/ML))heparin sodium,porcine/pf

BRAND

PRADAXA (75 MG, 150 MG)dabigatran etexilate mesylate

BRAND PA

protamine sulfate 10 mg/ml vial generic

TRICITRASOL 46.7% VIALsodium citrate dihydrate

BRAND

WARFARIN SODIUM (5 MG, 2.5 MG, 7.5 MG, 1 MG, 2MG, 10 MG, 6 MG, 3 MG, 4 MG)

generic

XARELTO (15 MG, 20 MG, 10 MG)rivaroxaban

BRAND

BLOOD FORMATION MODIFIERS



ANAGRELIDE HCL (1 MG, 0.5 MG) generic

LEUKINE (250 MCG, 500 MCG/ML)sargramostim

BRANDPA

S Specialty Drug

MOZOBIL (24 MG/1.2 ML, 20 MG/ML)plerixafor

BRAND

NEULASTA (6 ML SYRINGE, ONPRO 6 ML KIT)pegfilgrastim

BRANDPA

S Specialty Drug

NEUMEGA 5 MG VIALoprelvekin


PROCRIT (20,000, 10,000, 2,000, 3,000, 40,000, 4,000)epoetin alfa

BRANDPA

S Specialty Drug

PROMACTA (75 MG, 50 MG, 25 MG, 12.5 MG)eltrombopag olamine


COAGULANTS

ADVATE (801-1,200, 401-800, 200-400, 3,601-4,800,1,201-1,800, 1,801-2,400)antihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 1,201-1,800 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 1,801-2,400 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 200-400 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 401-800 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 801-1,200 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ALPHANATE (1,500-600, 1,000-400, 250-100, 500-200,2,000-800)antihemophilic factor, human/von willebrand factor,human


AMINOCAPROIC ACID (250 MG/ML VIAL, 250 MG/MLSOLUTION, 500 MG TABLET)

generic

BEBULIN 200-1,200 UNITS VIALfactor ix complex, prothrombin cplx conc(pcc) no.6, 3-factor

BRAND

BEBULIN VH IMMU 200-1,200 UNITfactor ix complex human


BENEFIX (3,000 KIT, 2,000 VIAL, 1,000 KIT, 250 KIT,2,000 KIT, 1,000 VIAL, 500 KIT, 250 VIAL, 500 VIAL)factor ix human recombinant




CORIFACT KITfactor xiii

BRAND

ELOCTATE (1,000, 250, 2,000, 3,000, 500, 1,500, 750)antihemophilic factor (fviii) recombinant, fc fusion protein

BRANDPA

S Specialty Drug

FEIBA NF (651-1,200 VIAL, 500 (NOMINAL), 1,750-3,250VIAL, 1,000 (NOMINAL), 2,500 (NOMINAL), 400-650VIAL)anti-inhibitor coagulant complex

BRAND

FEIBA VH IMMUNO 651-1,200 UNITanti-inhibitor coagulant complex

BRAND

HELIXATE FS (1,000, 250, 500, 2,000)antihemophilic factor viii, human recombinant

BRANDPA

S Specialty Drug

HELIXATE FS 3,000 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


HUMATE-P (2,400, 1,200, 600)antihemophilic factor, human/von willebrand factor,human


IXINITY (1,000, 1,000 -2 VLS, 1,500, 1,500 -2 VLS, 500)factor ix human recombinant, threonine 148


KOATE-DVI (250 VIAL, 1,000 VIAL, 500 KIT)antihemophilic factor, human


KOATE-DVI 500 UNITS VIALantihemophilic factor, human

BRANDPA

S Specialty Drug

KOGENATE FS (2,000 UNIT VIAL, 1,000 UNIT-ADAPTER, 2,000 UNIT-ADAPTER, 3,000 UNITS VIAL,250 UNIT VL-BIOSET, 500 UNIT VIAL, 1,000 UNIT-BIOSET, 500 UNIT VL-ADAPTR, 500 UNIT VL-BIOSET,1,000 UNITS VIAL)antihemophilic factor (fviii) recomb,full length (alb-free)

BRANDPA

S Specialty Drug

KOGENATE FS (250 UNIT VIAL, 250 UNIT VL-ADAPTR,2,000 UNIT-BIOSET)antihemophilic factor (fviii) recomb,full length (alb-free)


MONONINE 1,000 UNITS KITfactor ix


MONSEL'S FERRIC SUBSULFATE SOLferric subsulfate

BRAND

NOVOEIGHT (250, 2,000, 1,000, 1,500, 500, 3,000)antihemophilic factor viii recombinant, b-domain truncated

BRAND

NOVOSEVEN RT (8 MG, 5 MG, 1 MG, 2 MG)coagulation factor viia (recombinant)

BRAND

PROFILNINE (500, 1,500, 1,000) BRAND PA



factor ix complex, prothrombin cplx conc(pcc) no.4, 3-factor S Specialty Drug

PROFILNINE SD (1,500, 1,000, 500)factor ix complex human

BRANDPA

S Specialty Drug

RECOMBINATE (1,801-2,400, 1,241-1,800)antihemophilic factor viii, human recombinant

BRAND

RECOMBINATE (801-1,240 VL, 401-800 VIAL, 220-400VIAL)antihemophilic factor viii, human recombinant


RIASTAP VIALfibrinogen

BRAND

tranexamic acid 650 mg tablet generic

TRETTEN 2,500 UNIT VIALfactor xiii a-subunit, recombinant

BRAND

XYNTHA (500, 2,000, 250, 1,000)antihemophilic factor (factor viii) recomb,b-domain deleted

BRAND

XYNTHA SOLOFUSE (500 KIT, 3,000 KIT, 1,000 SYR,500 SYR, 3,000 SYR, 1,000 KIT, 2,000 SYR, 250 SYR,250 KIT, 2,000 KIT)antihemophilic factor (factor viii) recomb,b-domain deleted

BRAND

PLATELET MODIFYING AGENTS

aspirin/dipyridamole 25mg-200mg cpmp 12hr generic

BRILINTA (90 MG, 60 MG)ticagrelor

BRAND

CILOSTAZOL (50 MG, 100 MG) generic

CLOPIDOGREL BISULFATE (75 MG, 300 MG) generic

DIPYRIDAMOLE (75 MG TABLET, 25 MG TABLET, 50MG TABLET, 5 MG/ML VIAL)

generic

EFFIENT (10 MG, 5 MG)prasugrel hcl

BRAND

EPTIFIBATIDE (0.75 MG/ML, 2 MG/ML) generic PA

ZONTIVITY 2.08 MG TABLETvorapaxar sulfate

BRANDQL

PA

CARDIOVASCULAR AGENTS

ALPHA-ADRENERGIC AGONISTS

CLONIDINE (0.1MG/24HR, 0.2MG/24HR, 0.3MG/24HR) generic

CLONIDINE HCL (0.3 MG, 0.2 MG, 0.1 MG) generic



CLONIDINE HCL/PF (1000MCG/10, 5000MCG/10) generic

GUANFACINE HCL (2 MG, 1 MG) generic

METHYLDOPA (500 MG, 250 MG) generic

methyldopate hcl 250 mg/5ml vial generic

MIDODRINE HCL (5 MG, 2.5 MG, 10 MG) generic

ALPHA-ADRENERGIC BLOCKING AGENTS

DIBENZYLINE 10 MG CAPSULEphenoxybenzamine hcl

BRAND

DOXAZOSIN MESYLATE (4 MG, 1 MG, 2 MG, 8 MG) generic

phenoxybenzamine hcl 10 mg capsule generic

phentolamine mesylate 5 mg vial generic

PRAZOSIN HCL (1 MG, 2 MG, 5 MG) generic

RESERPINE (0.1 MG, 0.25 MG) generic

ANGIOTENSIN II RECEPTOR ANTAGONISTS

CANDESARTAN CILEXETIL (4 MG, 32 MG, 16 MG, 8MG)

generic

eprosartan mesylate 600 mg tablet generic

IRBESARTAN (75 MG, 300 MG, 150 MG) generic

LOSARTAN POTASSIUM (50 MG, 100 MG, 25 MG) generic

TELMISARTAN (80 MG, 20 MG, 40 MG) generic

VALSARTAN (80 MG, 320 MG, 40 MG, 160 MG) generic

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS

BENAZEPRIL HCL (20 MG, 5 MG, 40 MG, 10 MG) generic

CAPTOPRIL (50 MG, 25 MG, 100 MG, 12.5 MG) generic

ENALAPRIL MALEATE (5 MG, 20 MG, 2.5 MG, 10 MG) generic

enalaprilat dihydrate 1.25 mg/ml vial generic

FOSINOPRIL SODIUM (40 MG, 20 MG, 10 MG) generic

LISINOPRIL (10 MG, 30 MG, 40 MG, 2.5 MG, 5 MG, 20MG)

generic

MOEXIPRIL HCL (15 MG, 7.5 MG) generic

PERINDOPRIL ERBUMINE (4 MG, 8 MG, 2 MG) generic

QUINAPRIL HCL (5 MG, 10 MG, 40 MG, 20 MG) generic

RAMIPRIL (5 MG, 10 MG, 2.5 MG, 1.25 MG) generic



TRANDOLAPRIL (2 MG, 4 MG, 1 MG) generic

ANTIARRHYTHMICS

ADENOSINE (3 MG/ML SYRINGE, 3 MG/ML VIAL) generic

AMIODARONE HCL (50 MG/ML VIAL, 200 MG TABLET,100 MG TABLET, 50 MG/ML AMPUL, 400 MG TABLET,150 MG/3ML SYRINGE)

generic

FLECAINIDE ACETATE (50 MG, 150 MG, 100 MG) generic

ibutilide fumarate 0.1 mg/ml vial generic

MEXILETINE HCL (150 MG, 200 MG, 250 MG) generic

PACERONE (100 MG, 200 MG, 400 MG)amiodarone hcl

BRAND

PROCAINAMIDE HCL (500 MG/ML, 100 MG/ML) generic

PROPAFENONE HCL (300 MG TABLET, 425 MG CAPER 12H, 225 MG CAP ER 12H, 325 MG CAP ER 12H, 225MG TABLET, 150 MG TABLET)

generic

QUINIDINE GLUCONATE (80 MG/ML VIAL, 324 MGTABLET ER)

generic

QUINIDINE SULFATE (300 MG ER, 300 MG, 200 MG) generic

SORINE (80 MG, 160 MG, 240 MG, 120 MG)sotalol hcl

BRAND

SOTALOL HCL (240 MG, 160 MG, 120 MG, 80 MG) generic

TIKOSYN (500 MCG, 250 MCG, 125 MCG)dofetilide

BRAND

BETA-ADRENERGIC BLOCKING AGENTS

ACEBUTOLOL HCL (400 MG, 200 MG) generic

ATENOLOL (25 MG, 50 MG, 100 MG) generic

BETAXOLOL HCL (20 MG, 10 MG) generic

BISOPROLOL FUMARATE (5 MG, 10 MG) generic

CARVEDILOL (12.5 MG, 25 MG, 6.25 MG, 3.125 MG) generic

esmolol hcl 100mg/10ml vial generic

LABETALOL HCL (100 MG TABLET, 20 MG/4 MLSYRINGE, 5 MG/ML VIAL, 200 MG TABLET, 300 MGTABLET)

generic

METOPROLOL SUCCINATE (25 MG ER, 50 MG ER, 100MG ER, 200 MG ER)

generic

METOPROLOL TARTRATE (5 MG/5 ML SYRINGE, 5MG/5 ML AMPUL, 5 MG/5 ML VIAL, 50 MG TABLET, 25 generic



MG TABLET, 100 MG TABLET)

NADOLOL (20 MG, 80 MG, 40 MG) generic

PINDOLOL (5 MG, 10 MG) generic

PROPRANOLOL HCL (60 MG CAP SA 24H, 80 MGTABLET, 80 MG CAP SA 24H, 60 MG TABLET, 10 MGTABLET, 20 MG/5 ML SOLUTION, 40 MG TABLET, 20MG TABLET, 120 MG CAP SA 24H, 1 MG/ML VIAL, 160MG CAP SA 24H, 40MG/5ML SOLUTION)

generic

TIMOLOL MALEATE (10 MG, 20 MG, 5 MG) generic

CALCIUM CHANNEL BLOCKING AGENTS

AFEDITAB CR (30 MG, 60 MG)nifedipine

BRAND

AMLODIPINE BESYLATE (5 MG, 2.5 MG, 10 MG) generic

CARTIA XT (120 MG, 300 MG, 180 MG, 240 MG)diltiazem hcl

BRAND

DILT-XR (120 MG, 180 MG, 240 MG)diltiazem hcl

BRAND

DILTIAZEM HCL (120 MG CAP ER 12H, 180 MG CAP ER24H, 30 MG TABLET, 120 MG CAP ER 24H, 420MGCAPSULE ER, 60 MG CAP ER 12H, 240 MG TAB ER24H, 5 MG/ML VIAL, 240 MG CAP ER DEG, 240 MG CAPER 24H, 100 MG VIAL PORT, 300 MG CAP ER 24H, 60MG TABLET, 120 MG CAP ER DEG, 240 MG CAPSULEER, 180 MG CAP ER DEG, 300 MG CAPSULE ER, 180MG TAB ER 24H, 180 MG CAPSULE ER, 420MG TAB ER24H, 300 MG TAB ER 24H, 360 MG CAP ER 24H, 90 MGCAP ER 12H, 360 MG CAPSULE ER, 120 MG CAPSULEER, 90 MG TABLET, 360 MG TAB ER 24H, 120 MGTABLET)

generic

FELODIPINE (5 MG ER, 2.5 MG ER, 10 MG ER) generic

ISRADIPINE (2.5 MG, 5 MG) generic

MATZIM LA (180 MG, 300 MG, 360 MG, 240 MG, 420MG)diltiazem hcl

BRAND

NICARDIPINE HCL (25 MG/10ML VIAL, 25 MG/10MLAMPUL, 20 MG CAPSULE, 30 MG CAPSULE)

generic

nicardipine hcl in 0.9% nacl 1 mg/10 ml syringe generic

NIFEDIAC CC 30 MG TABLETnifedipine

BRAND

NIFEDICAL XL (30 MG, 60 MG)nifedipine

BRAND



NIFEDIPINE (60 MG TABLET ER, 30 MG TAB ER 24, 60MG TAB ER 24, 30 MG TABLET ER, 90 MG TAB ER 24,90 MG TABLET ER)

generic

nimodipine 30 mg capsule generic

NISOLDIPINE (25.5 MG ER, 30 MG ER, 8.5MG ER, 40MG ER, 17 MG ER, 20 MG ER, 34 MG ER)

generic

TAZTIA XT (300 MG, 120 MG, 180 MG, 240 MG)diltiazem hcl

BRAND

VERAPAMIL HCL (300 MG CAP24H PCT, 2.5 MG/MLAMPUL, 2.5 MG/ML VIAL, 240 MG CAP24H PEL, 200 MGCAP24H PCT, 2.5 MG/ML SYRINGE, 180 MG TABLETER, 120 MG CAP24H PEL, 40 MG TABLET, 80 MGTABLET, 120 MG TABLET, 120 MG TABLET ER, 240 MGTABLET ER, 180 MG CAP24H PEL, 360 MG CAP24HPEL, 100 MG CAP24H PCT)

generic

CARDIOVASCULAR AGENTS, OTHER

alprostadil 500 mcg/ml vial generic

amiloride/hydrochlorothiazide 5 mg-50 mg tablet generic

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM (10MG-80MG, 10 MG-20MG, 2.5MG-20MG, 5 MG-20 MG,2.5MG-40MG, 2.5MG-10MG, 5 MG-80 MG, 10 MG-40MG,5 MG-40 MG, 5 MG-10 MG, 10 MG-10MG)

generic

AMLODIPINE BESYLATE/BENAZEPRIL HCL (2.5MG-10MG, 10 MG-40MG, 5 MG-40 MG, 10 MG-20MG, 5 MG-10 MG, 5 MG-20 MG)

generic

AMLODIPINE BESYLATE/VALSARTAN (10MG-160MG,5MG-320MG, 10MG-320MG)

generic QL

AMLODIPINEBESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE (5-160-25MG, 10MG-160MG, 5-160-12.5, 10-320-25, 10-160-25)

generic

amlodipine/valsartan 5 mg-160mg tablet generic

ATENOLOL/CHLORTHALIDONE (50 MG-25MG, 100MG-25MG)

generic

BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE (20-12.5MG, 10-12.5MG, 20-25MG, 5-6.25MG)

generic

BISOPROLOL FUMARATE/HYDROCHLOROTHIAZIDE(10-6.25MG, 2.5-6.25MG, 5-6.25MG)

generic

CANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE(16-12.5MG, 32-12.5MG, 32MG-25MG)

generic

CAPTOPRIL/HYDROCHLOROTHIAZIDE (25 MG-25MG,25 MG-15MG, 50 MG-15MG, 50 MG-25MG)

generic



cardioplegic solution no.1 k+=16meq/l plst bg pf generic

CLORPRES (0.1-15, 0.2-15)clonidine hcl/chlorthalidone

BRAND

CORLANOR (5 MG, 7.5 MG)ivabradine hcl

BRAND QL

DEMSER 250 MG CAPSULEmetyrosine

BRAND

DIGITEK 250 MCG TABLETdigoxin

BRAND

DIGOX (250 MCG, 125 MCG)digoxin

BRAND

DIGOXIN (250 MCG/ML AMPUL, 125 MCG TABLET, 50MCG/ML SOLUTION, 250 MCG TABLET, 250 MCG/MLSYRINGE)

generic

DOBUTAMINE HCL (500MG/40ML, 250MG/20ML) generic

DOBUTAMINE HCL/DEXTROSE 5 % IN WATER(500MG/250, 250MG/250, 500 MG/500, 1000MG/250)

generic

DOPAMINE HCL (200 MG/5ML, 400 MG/5ML,800MG/10ML, 400MG/10ML, 800MG/5ML)

generic

DOPAMINE HCL/DEXTROSE 5 % IN WATER(400MG/0.5L, 200MG/.25L, 800MG/0.5L, 400MG/.25L,800MG/.25L)

generic

ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE(5MG-12.5MG, 10 MG-25MG)

generic

ephedrine sulfate 50 mg/ml vial generic

FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE (20-12.5 MG, 10-12.5MG)

generic

IRBESARTAN/HYDROCHLOROTHIAZIDE (300-12.5MG,150-12.5MG)

generic

LISINOPRIL/HYDROCHLOROTHIAZIDE (20-12.5 MG, 10-12.5MG, 20-25MG)

generic

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE(50-12.5 MG, 100-12.5MG, 100MG-25MG)

generic

MANNITOL (25 VIAL, 20 IV SOLN, 5 IV SOLN, 10 IVSOLN)

generic

METHYLDOPA/HYDROCHLOROTHIAZIDE (250MG-25MG, 250MG-15MG)

generic

METOPROLOL TARTRATE/HYDROCHLOROTHIAZIDE(50 MG-25MG, 100MG-50MG, 100MG-25MG)

generic

milrinone lactate 1 mg/ml vial generic



MILRINONE LACTATE/DEXTROSE 5 % IN WATER(40MG/200ML, 20MG/100ML)

generic

MOEXIPRIL HCL/HYDROCHLOROTHIAZIDE (15-25MG,15-12.5MG, 7.5-12.5MG)

generic

NADOLOL/BENDROFLUMETHIAZIDE (40 MG, 80 MG) generic

NOREPINEPHRINE BITARTRATE (1 MG/ML AMPUL, 1MG/ML VIAL)

generic

NOREPINEPHRINE BITARTRATE IN 0.9 % SODIUMCHLORIDE (8 MG/250ML, 4MG/250ML)

generic

NORTHERA (200 MG, 300 MG, 100 MG)droxidopa

BRANDQL

PA

OSMITROL (20%, 15%)mannitol

BRAND

pentoxifylline 400 mg tablet er generic

phenylephrine hcl 10 mg/ml vial generic

PHENYLEPHRINE HCL IN 0.9 % SODIUM CHLORIDE/PF(1 MG/10 ML SYRINGE, 80MG/250ML PLAST. BAG)

generic

phenylephrine hcl in 0.9% nacl 1 mg/10 ml syringe generic

PROPRANOLOL HCL/HYDROCHLOROTHIAZIDE (80,40)

generic

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE (10-12.5MG, 20-12.5 MG, 20-25MG)

generic

spironolact/hydrochlorothiazid 25 mg-25mg tablet generic

TELMISARTAN/AMLODIPINE BESYLATE (80 MG-10MG,40 MG-10MG, 80 MG-5 MG, 40 MG-5 MG)

generic

TELMISARTAN/HYDROCHLOROTHIAZIDE (40-12.5 MG,80-12.5MG, 80 MG-25MG)

generic

TRANDOLAPRIL/VERAPAMIL HCL (1-240MG, 4-240MG,2-240MG, 2 MG-180MG)

generic

TRIAMTERENE/HYDROCHLOROTHIAZIDE (50 MG-25MG CAPSULE, 37.5-25 MG CAPSULE, 75 MG-50MGTABLET, 37.5-25 MG TABLET)

generic

VALSARTAN/HYDROCHLOROTHIAZIDE (160-12.5MG,160-25MG, 320MG-25MG, 80-12.5MG, 320-12.5MG)

generic

DIURETICS, CARBONIC ANHYDRASE INHIBITORS

ACETAZOLAMIDE (125 MG TABLET, 500 MG CAPSULEER, 250 MG TABLET)

generic

acetazolamide sodium 500 mg vial generic



DIURETICS, LOOP

BUMETANIDE (1 MG TABLET, 0.5 MG TABLET, 2 MGTABLET, 0.25 MG/ML VIAL)

generic

ethacrynate sodium 50 mg vial generic

FUROSEMIDE (80 MG TABLET, 20 MG TABLET, 10MG/ML SYRINGE, 40 MG TABLET, 10 MG/MLSOLUTION, 40MG/5ML SOLUTION, 10 MG/ML VIAL)

generic

TORSEMIDE (5 MG TABLET, 20 MG/2 ML VIAL, 10 MGTABLET, 20 MG TABLET, 100 MG TABLET)

generic

DIURETICS, POTASSIUM-SPARING

amiloride hcl 5 mg tablet generic

EPLERENONE (25 MG, 50 MG) generic

SPIRONOLACTONE (50 MG, 100 MG, 25 MG) generic

DIURETICS, THIAZIDE

CHLOROTHIAZIDE (250 MG, 500 MG) generic

chlorothiazide sodium 500 mg vial generic

CHLORTHALIDONE (25 MG, 50 MG) generic

HYDROCHLOROTHIAZIDE (12.5 MG CAPSULE, 50 MGTABLET, 12.5 MG TABLET, 25 MG TABLET)

generic

INDAPAMIDE (2.5 MG, 1.25 MG) generic

methyclothiazide 5 mg tablet generic

METOLAZONE (10 MG, 2.5 MG, 5 MG) generic

DYSLIPIDEMICS, FIBRIC ACID DERIVATIVES

FENOFIBRATE (50 MG CAPSULE, 40 MG TABLET, 54MG TABLET, 160 MG TABLET, 150 MG CAPSULE, 120MG TABLET)

generic

FENOFIBRATE NANOCRYSTALLIZED (145MG, 48 MG) generic

FENOFIBRATE,MICRONIZED (43 MG, 130 MG, 67 MG,134MG, 200 MG)

generic

FENOFIBRIC ACID (35 MG, 105 MG) generic

FENOFIBRIC ACID (CHOLINE) (45 MG, 135 MG) generic

gemfibrozil 600 mg tablet generic

DYSLIPIDEMICS, HMG COA REDUCTASE INHIBITORS

ATORVASTATIN CALCIUM (20 MG, 40 MG, 80 MG, 10MG)

generic



FLUVASTATIN SODIUM (40 MG CAPSULE, 80 MG TABER 24H, 20 MG CAPSULE)

generic

LOVASTATIN (10 MG, 40 MG, 20 MG) generic

PRAVASTATIN SODIUM (20 MG, 80 MG, 40 MG, 10 MG) generic

SIMVASTATIN (20 MG, 40 MG, 5 MG, 80 MG, 10 MG) generic

DYSLIPIDEMICS, OTHER

CHOLESTYRAMINE (WITH SUGAR) (SUAR) 4 POWDER,SUAR) 4 POWD PACK)

generic

CHOLESTYRAMINE/ASPARTAME (4 POWD PACK, 4POWDER)

generic

COLESTIPOL HCL (5 PACKET, 1 TABLET, 5 RANULES) generic

JUXTAPID (60 MG, 40 MG, 30 MG, 5 MG, 20 MG, 10 MG)lomitapide mesylate

BRANDPA

S Specialty Drug

NIACIN (1000 MG ER, 750 MG ER, 500 MG ER) generic

omega-3 acid ethyl esters 1 g capsule generic

PREVALITE (PACKET, POWDER)cholestyramine/aspartame

BRAND

VASCEPA 1 GM CAPSULEicosapent ethyl

BRAND

ZETIA 10 MG TABLETezetimibe

BRAND PA

VASODILATORS, DIRECT-ACTING ARTERIAL

CORLOPAM 10 MG/ML VIALfenoldopam mesylate

BRAND

HYDRALAZINE HCL (50 MG TABLET, 10 MG TABLET, 25MG TABLET, 20 MG/ML VIAL, 100 MG TABLET)

generic

MINOXIDIL (10 MG, 2.5 MG) generic

VASODILATORS, DIRECT-ACTING ARTERIAL/VENOUS

amyl nitrite 0.3 ml ampul generic

ISOSORBIDE DINITRATE (40 MG ER, 5 MG, 10 MG, 20MG, 30 MG)

generic

ISOSORBIDE MONONITRATE (10 MG TABLET, 60 MGTAB ER 24H, 30 MG TAB ER 24H, 20 MG TABLET, 120MG TAB ER 24H)

generic

NITRO-BID 2% OINTMENTnitroglycerin

BRAND

NITRO-TIME (ER 9 MG, ER 6.5 MG, ER 2.5 MG) BRAND



nitroglycerin

NITROGLYCERIN (2.5 MG CAPSULE ER, 0.2MG/HRPATCH TD24, 0.6MG/HR PATCH TD24, 400MCG/SPRSPRAY, 50 MG/10ML VIAL, 9 MG CAPSULE ER,0.4MG/HR PATCH TD24, 6.5 MG CAPSULE ER,0.1MG/HR PATCH TD24)

generic

NITROGLYCERIN/DEXTROSE 5 % IN WATER(50MG/500ML, 100MG/250, 200MG/500, 25MG/250ML,50MG/250ML)

generic

NITROSTAT (0.4 MG, 0.6 MG, 0.3 MG)nitroglycerin

BRAND

CENTRAL NERVOUS SYSTEM AGENTS

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, AMPHETAMINES

DEXEDRINE 10 MG TABLETdextroamphetamine sulfate

BRAND

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE (30MG TABLET, 20 MG TABLET, 10 MG TABLET, 30 MGCAP ER 24H, 7.5 MG TABLET, 12.5 MG TABLET, 15 MGTABLET, 10 MG CAP ER 24H, 20 MG CAP ER 24H, 15MG CAP ER 24H, 5 MG CAP ER 24H, 25 MG CAP ER24H, 5 MG TABLET)

generic

DEXTROAMPHETAMINE SULFATE (15 MG CAPSULEER, 5 MG/5 ML SOLUTION, 5 MG TABLET, 5 MGCAPSULE ER, 10 MG TABLET, 10 MG CAPSULE ER)

generic

methamphetamine hcl 5 mg tablet generic PA

PROCENTRA 5 MG/5 ML SOLUTIONdextroamphetamine sulfate

BRAND

VYVANSE (60 MG, 20 MG, 50 MG, 30 MG, 10 MG, 70MG, 40 MG)lisdexamfetamine dimesylate

BRAND

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON-AMPHETAMINES

clonidine hcl 0.1 mg tab er 12h generic

DEXMETHYLPHENIDATE HCL (30 MG CPBP 50-50, 5MG TABLET, 20 MG CPBP 50-50, 15 MG CPBP 50-50, 10MG CPBP 50-50, 40 MG CPBP 50-50, 5 MG CPBP 50-50,10 MG TABLET, 2.5 MG TABLET)

generic

GUANFACINE HCL (1 MG ER, 3 MG ER, 4 MG ER, 2 MGER)

generic

METADATE ER 20 MG TABLETmethylphenidate hcl

BRAND



METHYLPHENIDATE HCL (54 MG TAB ER 24, 10 MGTABLET, 10 MG TABLET ER, 27 MG TAB ER 24, 20 MGCPBP 30-70, 50 MG CPBP 30-70, 5 MG TABLET, 30 MGCPBP 50-50, 10 MG/5 ML SOLUTION, 5 MG/5 MLSOLUTION, 10 MG CPBP 30-70, 5 MG TAB CHEW, 40MG CPBP 50-50, 20 MG TABLET, 20 MG CPBP 50-50,2.5 MG TAB CHEW, 18 MG TAB ER 24, 40 MG CPBP 30-70, 10 MG TAB CHEW, 36 MG TAB ER 24, 60 MG CPBP30-70, 20 MG TABLET ER, 30 MG CPBP 30-70)

generic

STRATTERA (100 MG, 25 MG, 40 MG, 18 MG, 80 MG, 60MG, 10 MG)atomoxetine hcl

BRAND

CENTRAL NERVOUS SYSTEM, OTHER

ALAGESIC LQ ORAL SOLUTIONbutalbital/acetaminophen/caffeine

BRAND QL

atracurium besylate 10 mg/ml vial generic

benzphetamine hcl 50 mg tablet generic PA

butalbital/acetaminophen 50mg-325mg tablet generic

BUTALBITAL/ACETAMINOPHEN/CAFFEINE (50-300-40CAPSULE, 50-325-40 TABLET, 50-325-40 CAPSULE)

generic QL

butalbital/aspirin/caffeine 50-325-40 capsule generic QL

CAPACET CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

DIETHYLPROPION HCL (75 MG ER, 25 MG) generic PA

ESGIC CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

MARGESIC CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

MARTEN-TAB 325-50 TABLETbutalbital/acetaminophen

BRAND

metformin hcl 1000 mg tab er 24 generic

NUEDEXTA 20-10 MG CAPSULEdextromethorphan hbr/quinidine sulfate

BRAND

pancuronium bromide 1 mg/ml vial generic

PHENDIMETRAZINE TARTRATE (35 MG TABLET, 105MG CAPSULE ER)

generic PA

PHENTERMINE HCL (30 MG CAPSULE, 37.5 MGCAPSULE, 15 MG CAPSULE, 37.5 MG TABLET)

generic PA

riluzole 50 mg tablet generic



ROCURONIUM BROMIDE (10 MG/ML VIAL,100MG/10ML SYRINGE, 50 MG/5 ML SYRINGE)

generic

succinylcholine chloride 200mg/10ml syringe generic

TENCON 50-325 MG TABLETbutalbital/acetaminophen

BRAND

TETRABENAZINE (12.5 MG, 25 MG) generic

VECURONIUM BROMIDE (20 MG, 10 MG) generic

XENAZINE (25 MG, 12.5 MG)tetrabenazine


ZEBUTAL 50-325-40 MG CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

FIBROMYALGIA AGENTS

DULOXETINE HCL (30 MG, 20 MG) generic

PA

ST

CPA depends onindicaton. 60mg maxdaily

duloxetine hcl 60 mg capsule dr generic

PA

ST

C 2/ day .

LYRICA (50 MG CAPSULE, 100 MG CAPSULE, 300 MGCAPSULE, 225 MG CAPSULE, 150 MG CAPSULE, 200MG CAPSULE, 20 MG/ML ORAL SOLUTION, 75 MGCAPSULE, 25 MG CAPSULE)pregabalin

BRAND PA

SAVELLA (50 MG TABLET, 100 MG TABLET, TITRATIONPACK, 25 MG TABLET, 12.5 MG TABLET)milnacipran hcl

BRAND PA

MULTIPLE SCLEROSIS AGENTS

AMPYRA ER 10 MG TABLETdalfampridine

BRANDPA

S Specialty Drug

AVONEX (30 MCG KT, 30 MCG)interferon beta-1a

BRANDPA

S Specialty Drug

AVONEX ADMIN PACK 30 MCG VLinterferon beta-1a/albumin human

BRANDPA

S Specialty Drug

AVONEX PEN (30 ML, 30 ML KIT)interferon beta-1a

BRANDPA

S Specialty Drug



COPAXONE (20 MG/ML, 40 MG/ML)glatiramer acetate

BRANDPA

S Specialty Drug

EXTAVIA 0.3 MG KITinterferon beta-1b

BRANDPA

S Specialty Drug

GILENYA 0.5 MG CAPSULEfingolimod hcl

BRAND

QL

PA

S Specialty Drug

GLATOPA 20 MG/ML SYRINGEglatiramer acetate

BRANDPA

S Specialty Drug

REBIF (TITRATION PACK, 44 MCG/0.5 ML SYRINGE)interferon beta-1a/albumin human

BRANDPA

S Specialty Drug

REBIF 22 MCG/0.5 ML SYRINGEinterferon beta-1a/albumin human


REBIF REBIDOSE (44 ML, 22 ML)interferon beta-1a/albumin human


REBIF REBIDOSE TITRATION PACKinterferon beta-1a/albumin human

BRANDPA

S Specialty Drug

TECFIDERA (DR 240 MG CAPSULE, STARTER PACK,DR 120 MG CAPSULE)dimethyl fumarate

BRANDPA

S Specialty Drug

DENTAL AND ORAL AGENTS

cevimeline hcl 30 mg capsule generic

chlorhexidine gluconate 0.12 % mouthwash generic

DEBACTEROL SOLUTIONsulfuric acid/sulfonated phenol

BRAND

FIRST-MOUTHWASH BLM SUSPENSIONmag hydroxide/alhydroxide/simeth/diphenhydramine/lidocaine

BRAND

KEPIVANCE 6.25 MG VIALpalifermin

BRAND

lidocaine hcl 4 % solution generic

PAROEX 0.12% ORAL RINSEchlorhexidine gluconate

BRAND

PERIOGARD 0.12% ORAL RINSEchlorhexidine gluconate

BRAND



PILOCARPINE HCL (7.5 MG, 5 MG) generic

PRE-ATTACHED LTA KITlidocaine hcl

BRAND

DERMATOLOGICAL AGENTS

8-MOP 10 MG CAPSULEmethoxsalen

BRAND

ABSORICA (30 MG, 20 MG, 10 MG, 40 MG)isotretinoin

BRAND

ACITRETIN (17.5 MG, 10 MG, 25 MG) generic

ADAPALENE (0.1 (GRAM), 0.3 W/PUMP) genericQL

C 45gm/30 days

ADAPALENE (0.3 GEL (GRAM), 0.1 CREAM (G)) generic C 45gm/30 days

adapalene 0.1 % lotion generic C 59gm/30 days

ALCLOMETASONE DIPROPIONATE (0.05 OINT., 0.05CREAM)

generic

ALPHAQUIN HP 4% CREAMoxybenzone/octinoxate/hydroquinone

BRAND

AMCINONIDE (0.1 CREAM (G), 0.1 LOTION, 0.1 OINT.(G))

generic

ammonium lactate 12 % cream (g) generic

AMNESTEEM (10 MG, 20 MG, 40 MG)isotretinoin

BRAND

APEXICON 0.05% OINTMENTdiflorasone diacetate

BRAND

APEXICON E 0.05% CREAMdiflorasone diacetate/emollient base

BRAND

AVAR CLEANSERsulfacetamide sodium/sulfur

BRAND

AVITA 0.025% CREAMtretinoin

BRAND C 20gm/30 days

BENZEPRO (6% FOAMING CLOTHS, 7% CREAMYWASH)benzoyl peroxide microspheres

BRAND

BENZOYL PEROXIDE (5 % GEL (GRAM), 7 %CLEANSER, 5 % GEL ALCOHL, 9.8 % FOAM, 5.3%FOAM)

generic

BETAMETHASONE DIPROPIONATE (0.05 LOTION, 0.05GEL (GRAM), 0.05 CREAM (G), 0.05 OINT. (G))

generic



BETAMETHASONE DIPROPIONATE/PROPYLENEGLYCOL (0.05 CREAM (G), 0.05 OINT. (G), 0.05 LOTION)

generic

BETAMETHASONE VALERATE (0.1 CREAM (G), 0.1LOTION, 0.12 FOAM, 0.1 OINT. (G))

generic

BP 10-1 WASHsulfacetamide sodium/sulfur

BRAND

BP CLEANSING WASHsulfacetamide sodium/sulfur/urea

BRAND

BP-50% UREA EMULSIONurea/lactic acid/zinc undecylenate

BRAND

BPO (8% GEL, 4% GEL, 3% FOAMING CLOTHS, 9%FOAMING CLOTHS, 6% FOAMING CLOTHS)benzoyl peroxide

BRAND

CALCIPOTRIENE (0.005 CREAM (G), 0.005 OINT. (G),0.005 SOLUTION)

generic

calcipotriene/betamethasone 0.005-.064 oint. (g) generic

CALCITRENE 0.005% OINTMENTcalcipotriene

BRAND

calcitriol 3 mcg/g oint. (g) generic

CARB-O-PHILIC (GEL, CREAM)urea

BRAND

CEM-UREA 45% PRE-FILLED APPLurea

BRAND

CLARAVIS (40 MG, 30 MG, 20 MG, 10 MG)isotretinoin

BRAND

CLARIS CLARIFYING WASHsulfacetamide sodium/sulfur/urea

BRAND

CLINDACIN ETZ 1% PLEDGETclindamycin phosphate

BRAND

CLINDACIN P 1% PLEDGETSclindamycin phosphate

BRAND

CLINDAMYCIN PHOSPHATE (1 FOAM, 1 LOTION, 1MED. SWAB, 1 GEL (GRAM), 1 SOLUTION)

generic

CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE (1%-5 %, 1.2(1)%-5%)

generic

CLOBETASOL PROPIONATE (0.05 SOLUTION, 0.05LOTION, 0.05 SHAMPOO, 0.05 SPRAY, 0.05 CREAM (G),0.05 FOAM, 0.05 OINT. (G), 0.05 GEL (GRAM))

generic

CLOBETASOL PROPIONATE/EMOLLIENT BASE (0.05FOAM, 0.05 CREAM (G))

generic



CLODAN 0.05% SHAMPOOclobetasol propionate

BRAND

CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE (1-0.05 LOTION, 1 -0.05 CREAM (G))

generic

cocaine hcl 4 % solution generic

CORMAX 0.05% SOLUTIONclobetasol propionate

BRAND

DERMAZENE CREAMhydrocortisone/iodoquinol

BRAND

DESONIDE (0.05 LOTION, 0.05 CREAM (G), 0.05 OINT.(G))

generic

DESOXIMETASONE (0.05 CREAM (G), 0.25 OINT. (G),0.25 CREAM (G), 0.05 GEL (GRAM), 0.05 OINT. (G))

generic

DICLOFENAC SODIUM (1.5 DROPS, 3 GEL (GRAM)) generic

DIFLORASONE DIACETATE (0.05 OINT., 0.05 CREAM) generic

DRITHOCREME HP 1% CREAManthralin

BRAND

DRYSOL (DAB-O-MATIC, )aluminum chloride

BRAND

ERY 2% PADSerythromycin base/ethyl alcohol

BRAND

ERYGEL 2% GELerythromycin base/ethyl alcohol

BRAND

ERYTHROMYCIN BASE/ETHYL ALCOHOL (2 MED.SWAB, 2 SOLUTION, 2 GEL (GRAM))

generic

erythromycin/benzoyl peroxide 3 %-5 % gel (gram) generic

ethyl chloride 100 % spray generic

FLUOCINOLONE ACETONIDE (0.025 OINT. (G), 0.01CREAM (G), 0.025 CREAM (G), 0.01 OIL, 0.01SOLUTION)

generic

fluocinolone/shower cap 0.01 % oil generic

FLUOCINONIDE (0.05 GEL (GRAM), 0.05 SOLUTION, 0.1CREAM (G), 0.05 CREAM (G), 0.05 OINT. (G))

generic

fluocinonide/emollient base 0.05 % cream (g) generic

FLUTICASONE PROPIONATE (0.005 OINT. (G), 0.05LOTION, 0.05 CREAM (G))

generic

FORMA-RAY 20% SOLUTIONformaldehyde

BRAND

GENTAMICIN SULFATE (0.1 OINT., 0.1 CREAM) generic



GLYDO 2% JELLY SYRINGElidocaine hcl

BRAND

HALOBETASOL PROPIONATE (0.05 OINT., 0.05CREAM)

generic

HALONATE COMBO PACKhalobetasol propionate/ammonium lactate

BRAND

HALONATE PAC COMBO PACKhalobetasol propionate/ammonium lactate

BRAND

hc/mineral oil/petrolat,wht 1 % oint. (g) generic

HYDROCORTISONE (2.5 LOTION, 2.5 CREAM (G), 1CREAM (G), 2.5 OINT. (G))

generic

hydrocortisone acetate/aloe v 2 % gel (gram) generic

HYDROCORTISONE ACETATE/LIDOCAINE HCL/ALOEVERA (2 %-2 % KIT, 0.55%-2.8% GEL W/APPL, 2.5-3%(7G) KIT)

generic

HYDROCORTISONE ACETATE/PRAMOXINE HCL (1 %-1% CREAM/APPL, 2.5 %-1 % CREAM/APPL, 2.5 %-1 %CREAM (G), 2.5-1%(4G) CREAM/APPL)

generic

HYDROCORTISONEACETATE/PRAMOXINE/EMOLLIENT/PRAMOXINECOMB#1 (2.5%-1%-1%, 2.5-1%(4G))

generic

HYDROCORTISONE BUTYRATE (0.1 OINT. (G), 0.1SOLUTION, 0.1 CREAM (G))

generic

hydrocortisone butyrate/emoll 0.1 % cream (g) generic

HYDROCORTISONE VALERATE (0.2 CREAM, 0.2 OINT.) generic

hydrocortisone/iodoquinol 1 %-1 % cream (g) generic

hydroquinone 4 % cream (g) generic

hydroquinone microspheres 4 % crm er (g) generic

HYPERCARE 20% SOLUTIONaluminum chloride

BRAND

imiquimod 5 % cream pack generic

LACLOTION 12% LOTIONammonium lactate

BRAND

LATRIX 50% TOPICAL SUSPENSIONurea/lactic acid/salicylic acid

BRAND

LATRIX XM 45% EMULSIONurea/lactic acid/zinc undecylenate

BRAND

lidocaine 5 % adh. patch generic PA

lidocaine 5 % oint. (g) generic



LIDOCAINE HCL (3 CREAM (G), 2 JEL/PF APP, 3LOTION, 2 JEL (ML))

generic

LIDOCAINE HCL/HYDROCORTISONE ACETATE (3 %-0.5 % KIT, 3%-1%(7 G) KIT, 3 %-0.5 % CREAM (G), 3 %-0.5 % CREAM/APPL)

generic

LIDOCAINE/PRILOCAINE (2.5 CREAM (G), 2.5 KIT) generic

LINDANE (1 LOTION, 1 SHAMPOO) generic

ST

C

60ml/fill; must trypermethrin andpiperonylbutoxide/pyrethrins

LORENZA 4%-1% PATCHlidocaine/menthol

BRAND

LUSTRA-ULTRA 4% CREAMvitamin a/vitamin e/avobenzone/octinoxate/hydroquinone

BRAND

mafenide acetate 50 g packet generic

MELPAQUE HP 4% CREAMhydroquinone/ferric oxide

BRAND

MELQUIN HP 4% CREAMhydroquinone

BRAND

MELQUIN-3 SOLUTIONhydroquinone

BRAND

METRONIDAZOLE (0.75 GEL (GRAM), 0.75 CREAM (G),1 GEL W/PUMP, 0.75 LOTION, 1 GEL (GRAM))

generic

MOMETASONE FUROATE (0.1 CREAM (G), 0.1 OINT.(G), 0.1 SOLUTION)

generic

mupirocin 2 % oint. (g) generic

mupirocin calcium 2 % cream (g) generic

MYORISAN (10 MG, 30 MG, 20 MG, 40 MG)isotretinoin

BRAND

NEUAC GELclindamycin phosphate/benzoyl peroxide

BRAND

NU-DERM (BLENDER, CLEAR)hydroquinone

BRAND

NUQUIN HP (GEL, CREAM)dioxybenzone/padimate o/hydroquinone

BRAND

OBAGI ELASTIDERM SKIN 4% CREAMhydroquinone

BRAND

OXSORALEN-ULTRA 10 MG CAPmethoxsalen, rapid

BRAND



PAIN RELIEF 5%-1% PATCHlidocaine hcl/menthol

BRAND

permethrin 5 % cream (g) generic C 120ml/fill

podofilox 0.5 % solution generic

PR BENZOYL PEROXIDE 7% WASHbenzoyl peroxide microspheres

BRAND

PR CREAM KITprotectives combination no.2/ceramides 1,3,6-11

BRAND

PRAMCORT 1% CREAMhydrocortisone acetate/pramoxine hcl

BRAND

PREDNICARBATE (0.1 CREAM, 0.1 OINT.) generic

REA LO 39 CREAMurea

BRAND

REA LO 40 (40 CM, 40 TION)urea

BRAND

RECTIV 0.4% OINTMENTnitroglycerin

BRAND

REGRANEX 0.01% GELbecaplermin

BRAND

RELADOR PAK 2.5-2.5% CRM-DRESSlidocaine/prilocaine

BRAND

RELADOR PAK PLUS 2.5%-2.5%lidocaine/prilocaine

BRAND

REMEVEN 50% CREAMurea

BRAND

ROSADAN (GEL, CREAM)metronidazole

BRAND

ROSULA 10%-5% CLOTHSsulfacetamide sodium/sulfur

BRAND

SALACYN (CREAM, LOTION)salicylic acid

BRAND

SALICYLIC ACID (6 CREAM (G), 28.5 LIQ-FILM, 6 GEL(GRAM), 6 SHAMPOO, 27.5 LIQ-FILM, 6 CRM ER (G), 26LIQUID, 6 LOTION ER, 6 LOTION)

generic

salicylic acid/ammon lact/aloe 6 % foam generic

SALICYLIC ACID/CERAMIDES 1,3,6-11 (6 KIT CLCMER,6 COMBO. PKG)

generic

SALVAX 6% FOAMsalicylic acid

BRAND



SANTYL OINTMENTcollagenase clostridium histolyticum

BRAND

SCALACORT 2% LOTIONhydrocortisone

BRAND

SE 10-5 SS CREAMsulfacetamide sodium/sulfur/witch hazel

BRAND

SE BPO 7% WASHbenzoyl peroxide microspheres

BRAND

SEB-PREV 10% WASHsulfacetamide sodium

BRAND

SELENIUM SULFIDE (2.5 SUSPENSION, 2.5 LOTION,2.25 SHAMPOO)

generic

SILVER NITRATE (50 SOLUTION, 10 OINT. (G), 10SOLUTION, 0.5 SOLUTION, 25 SOLUTION)

generic

silver nitrate applicator 75%-25% stick (ea) generic

silver sulfadiazine 1 % cream (g) generic

spinosad 0.9 % suspension generic

ST

C

1420ml/fill; must trypermethrin andpiperonyl butoxide/pyrethrins andmalathion

SS 10-2 CLEANSERsulfacetamide sodium/sulfur

BRAND

SSD 1% CREAMsilver sulfadiazine

BRAND

SSS 10-5 (FOAM, CREAM)sulfacetamide sodium/sulfur

BRAND

sulfacetamide sod/sulfur/urea 10%-5%-10% cleanser generic

SULFACETAMIDE SODIUM (10 SUSPENSION, 10CLNSGEL ER, 10 SHAMPOO, 10 CLEANSER)

generic

SULFACETAMIDE SODIUM/SULFUR (10 %-4 % MED.PAD, 8 %-4 % SUSPENSION, 10 %-5 % MED. PAD,9.8%-4.8% CLEANSER, 9 %-4.5 % CLEANSER, 10-5%(W/W) LOTION, 10-5%(W/V) LOTION, 10-5%(W/W)CREAM (G), 10-5%(W/W) CLEANSER, 10-5%(W/W)SUSPENSION, 9 %-4 % CLEANSER, 10 %-2 %CLEANSER, 10 %-5 % FOAM)

generic

sulfacetamide/sulfur/cleansr23 9 %-4.5 % kit generic

SULFACLEANSE 8-4 SUSPENSIONsulfacetamide sodium/sulfur

BRAND

TACROLIMUS (0.1, 0.03) generic QL



PA

TAZORAC (0.05% CREAM, 0.1% GEL, 0.05% GEL, 0.1%CREAM)tazarotene

BRAND

THERMAZENE 1% CREAMsilver sulfadiazine

BRAND

TRETINOIN (0.025 GEL (GRAM), 0.05 GEL (GRAM),0.025 CREAM (G), 0.01 GEL (GRAM))

generic QL

TRETINOIN (0.05, 0.1) generic QL

TRETINOIN MICROSPHERES (0.1 (GRAM), 0.04W/PUMP, 0.1 W/PUMP, 0.04 (GRAM))

generic QL

TRI-CHLOR 80% SOLUTIONtrichloroacetic acid

BRAND

TRIAMCINOLONE ACETONIDE (0.5 % OINT. (G), 0.1 %LOTION, 0.025 % CREAM (G), 0.5 % CREAM (G), 0.1 %OINT. (G), 0.1 % CREAM (G), 0.147MG/G AEROSOL,0.025 % OINT. (G), 0.025 % LOTION)

generic

TRIANEX 0.05% OINTMENTtriamcinolone acetonide

BRAND

TRIDERM 0.1% CREAMtriamcinolone acetonide

BRAND

UMECTA 40% MOUSSEurea

BRAND

UREA (35 FOAM, 45 LOTION, 45 GEL (ML), 45 CREAM(G), 40 LOTION, 39 CREAM (G), 50 SOL/PF APP, 40 GEL(ML), 40 CREAM (G), 40 NL FM SUSP, 50 CREAM (G))

generic

urea/hyaluronate sodium 40%-0.2% kit generic

urea/lactic ac/zn undecylenate 50 % emulsn(g) generic

urea/lactic acid/salicylic ac 50 % suspension generic

VASHE WOUND THERAPY SOLUTIONsodium chloride irrigating solution/hypochlorous acid

BRAND

VASOLEX OINTMENTtrypsin/balsam peru/castor oil

BRAND

VIRTI-SULF EMOLLIENT CREAMsulfacetamide sodium/sulfur

BRAND

X-VIATE (CREAM, LOTION, GEL)urea

BRAND

ZENCIA WASHsulfacetamide sodium/sulfur

BRAND



ENZYME REPLACEMENT/MODIFIERS

ALDURAZYME 2.9 MG/5 ML VIALlaronidase

BRAND

BUPHENYL 500 MG TABLETsodium phenylbutyrate

BRAND

CREON (12,000, 36,000, 24,000, 6,000, 3,000)lipase/protease/amylase

BRAND

CYSTADANE POWDERbetaine

BRAND

CYSTAGON (150 MG, 50 MG)cysteamine bitartrate


ELAPRASE 6 MG/3 ML VIALidursulfase

BRAND

ELELYSO 200 UNITS VIALtaliglucerase alfa

BRAND

FABRAZYME (35 MG, 5 MG)agalsidase beta

BRAND

KUVAN (100 MG TABLET, 100 MG POWDER PACKET,500 MG POWDER PACKET)sapropterin dihydrochloride

BRANDPA

S Specialty Drug

LUMIZYME 50 MG VIALalglucosidase alfa

BRAND

MYOZYME 50 MG VIALalglucosidase alfa

BRAND

NAGLAZYME 5 MG/5 ML VIALgalsulfase

BRAND

ORFADIN (5 MG, 2 MG, 10 MG)nitisinone

BRAND

RAVICTI 1.1 GRAM/ML LIQUIDglycerol phenylbutyrate

BRAND

sodium phenylbutyrate 0.94 g/g powder generic

STRENSIQ (18 MG/0.45 ML, 28 MG/0.7 ML, 80 MG/0.8ML, 40 MG/ML)asfotase alfa

BRANDPA

S Specialty Drug

SUCRAID 8,500 UNITS/ML SOLNsacrosidase


VPRIV 400 UNITS VIALvelaglucerase alfa

BRAND

ZAVESCA 100 MG CAPSULEmiglustat




GASTROINTESTINAL AGENTS

ANTISPASMODICS, GASTROINTESTINAL

ANASPAZ 0.125 MG TABLET ODThyoscyamine sulfate

BRAND

ATROPINE SULFATE (1 MG/ML VIAL, 0.4 MG/ML VIAL,0.1 MG/ML DISP SYRIN, 0.05MG/ML SYRINGE, 0.1MG/ML SYRINGE)

generic

B-DONNA TABLETphenobarbital/hyoscyamine sulf/atropine sulf/scopolaminehb

BRAND

chlordiazepoxide/clidinium br 5 mg-2.5mg capsule generic

DICYCLOMINE HCL (10 MG CAPSULE, 10 MG/5 MLSOLUTION, 20 MG TABLET)

generic

ED-SPAZ 0.125 MG ODThyoscyamine sulfate

BRAND

GLYCOPYRROLATE (1 MG/5 ML SYRINGE, 0.2 MG/MLVIAL, 0.6MG/3ML SYRINGE, 0.4MG/2ML SYRINGE, 1MG TABLET, 2 MG TABLET)

generic

HYOSCYAMINE SULFATE (125MCG/5ML ELIXIR,0.125MG/ML DROPS, 0.125 MG TABLET, 0.375 MG TABER 12H, 0.125 MG TAB RAPDIS)

generic

HYOSYNE (125 MCG/5 ML ELIXIR, 0.125 MG/ML DROP)hyoscyamine sulfate

BRAND

ME-PB-HYOS TABLETphenobarbital/hyoscyamine sulf/atropine sulf/scopolaminehb

BRAND

OSCIMIN (0.125 MG TABLET, 0.125 MG ODT)hyoscyamine sulfate

BRAND

OSCIMIN SL 0.125 MG TABLEThyoscyamine sulfate

BRAND

OSCIMIN SR 0.375 MG TABLEThyoscyamine sulfate

BRAND

SYMAX FASTABS 0.125 MG TABLEThyoscyamine sulfate

BRAND

SYMAX-SL 0.125 MG TABLET SLhyoscyamine sulfate

BRAND

SYMAX-SR 0.375 MG TABLEThyoscyamine sulfate

BRAND

GASTROINTESTINAL AGENTS, OTHER



CHENODAL 250 MG TABLETchenodiol

BRAND

cromolyn sodium 20 mg/ml oral conc generic

dexpanthenol 250 mg/ml vial generic

DIPHENOXYLATE HCL/ATROPINE SULFATE (2.5-.025MG TABLET, 2.5-.025/5 LIQUID)

generic

GASTROCROM 100 MG/5 ML CONCcromolyn sodium

BRAND

lansoprazole/amoxiciln/clarith 30-500-500 combo. pkg generic

opium tincture 10 mg/ml tincture generic

paregoric 2 mg/5 ml liquid generic

RELISTOR (12 MG/0.6 ML KIT, 12 MG/0.6 ML VIAL, 12MG/0.6 ML SYRINGE, 8 MG/0.4 ML SYRINGE)methylnaltrexone bromide

BRAND

URSODIOL (250 MG TABLET, 300 MG CAPSULE, 500MG TABLET)

generic

VSL#3 DS PACKETlactobacillus combination no.2/s.thermophl/bif cmb no.1

BRAND

HISTAMINE2 (H2) RECEPTOR ANTAGONISTS

CIMETIDINE (300 MG, 800 MG, 400 MG) generic

cimetidine hcl 300 mg/5ml solution generic

FAMOTIDINE (40MG/5ML ORAL SUSP, 10 MG/ML VIAL,40 MG TABLET)

generic

famotidine/pf 20 mg/2 ml vial generic

NIZATIDINE (150MG/10ML SOLUTION, 300 MGCAPSULE, 150 MG CAPSULE)

generic

RANITIDINE HCL (25 MG/ML VIAL, 150 MG CAPSULE,50 MG/2 ML VIAL, 300 MG TABLET, 300 MG CAPSULE,150 MG TABLET, 15 MG/ML SYRUP)

generic

IRRITABLE BOWEL SYNDROME AGENTS

ALOSETRON HCL (0.5 MG, 1 MG) generic

LINZESS (290 MCG, 145 MCG)linaclotide

BRAND

LOTRONEX (1 MG, 0.5 MG)alosetron hcl

BRAND

LAXATIVES

ENULOSE 10 GM/15 ML SOLUTIONlactulose

BRAND



GAVILYTE-H AND BISACODYL KITbisacodyl/sodium chlor/sodium bicarb/potassium chl/peg3350

BRAND

GENERLAC 10 GM/15 ML SOLUTIONlactulose

BRAND

POLYETHYLENE GLYCOL 3350 (3350 17G POWDPACK, 3350 17G/DOSE POWDER)

generic

PROTECTANTS

CARAFATE 1 GM/10 ML SUSPsucralfate

BRAND

MISOPROSTOL (200 MCG, 100 MCG) generic

sucralfate 1 g tablet generic

PROTON PUMP INHIBITORS

esomeprazole magnesium 20 mg capsule dr generic

esomeprazole magnesium 40 mg capsule dr generic C

must try 3 wks oftherapy within the last12 mos of omeprazole,omeprazole OTC orpantoprazole

ESOMEPRAZOLE SODIUM (20 MG, 40 MG) generic

esomeprazole strontium 49.3 mg capsule dr generic

FIRST-LANSOPRAZOLE 3 MG/MLlansoprazole

BRAND

ST

C

no STEP required if<12 yrs old; must try 3weeks of therapy withinlast 12 months ofomeprazole,omeprazole OTC orpantoprazole

FIRST-OMEPRAZOLE 2 MG/ML SUSPomeprazole

BRAND

ST

C

no PA required if <12yrs old; must try 3weeks of therapy withinlast 12 months ofomeprazole,omeprazole OTC orpantoprazole

lansoprazole 15 mg capsule dr genericPA

ST

lansoprazole 30 mg capsule dr generic

ST

C

must try 3 weeks oftherapy withinthe last 12months of



omeprazole,omeprazole OTC orpantoprazole

OMEPRAZOLE (10 MG, 40 MG, 20 MG) generic

OMEPRAZOLE/SODIUM BICARBONATE (20MG-1.1G,40MG-1.1G)

generic

PA

ST

C

must try 3 weeks oftherapy withinthe last 12months ofomeprazole,omeprazole OTC orpantoprazole

PANTOPRAZOLE SODIUM (20 MG TABLET DR, 40 MGVIAL, 40 MG TABLET DR)

generic

rabeprazole sodium 20 mg tablet dr generic

PA

ST

C

must try 3 weeks oftherapy withinthe last 12months ofomeprazole,omeprazole OTC orpantoprazole

GENITOURINARY AGENTS

ANTISPASMODICS, URINARY

flavoxate hcl 100 mg tablet generic

OXYBUTYNIN CHLORIDE (5 MG/5 ML SYRUP, 10 MGTAB ER 24, 5 MG TABLET, 5 MG TAB ER 24, 15 MG TABER 24)

generic

TOLTERODINE TARTRATE (4 MG CAP ER 24H, 1 MGTABLET, 2 MG TABLET, 2 MG CAP ER 24H)

generic

TROSPIUM CHLORIDE (60 MG CAP ER 24H, 20 MGTABLET)

generic

BENIGN PROSTATIC HYPERTROPHY AGENTS

alfuzosin hcl 10 mg tab er 24h generic

dutasteride 0.5 mg capsule generic QL

dutasteride/tamsulosin hcl 0.5-0.4 mg cpmp 24hr generic

finasteride 5 mg tablet generic

tamsulosin hcl 0.4 mg cap er 24h generic

TERAZOSIN HCL (5 MG, 10 MG, 1 MG, 2 MG) generic



GENITOURINARY AGENTS, OTHER

AMINOACETIC ACID 1.5% IRRIGglycine urologic solution

BRAND

BETHANECHOL CHLORIDE (5 MG, 25 MG, 10 MG, 50MG)

generic

citric acid/sodium citrate 334-500mg solution generic

CUPRIMINE 250 MG CAPSULEpenicillamine

BRAND

CYTRA-2 ORAL SOLUTIONcitric acid/sodium citrate

BRAND

CYTRA-3 SYRUPsodium/potassium/potassium citrate/sodium citrate/cit ac

BRAND

CYTRA-K (ORAL SOLUTION, CRYSTALS PACKET)potassium citrate/citric acid

BRAND

ELMIRON 100 MG CAPSULEpentosan polysulfate sodium

BRAND

FEM PH VAGINAL JELLYacetic acid/oxyquinoline sulfate

BRAND

glycine urologic solution 1.5 % irrig soln generic

HEMABATE 250 MCG/ML AMPULcarboprost tromethamine

BRAND

K-PHOS #2 TABLETsodium phosphate,monobasic/potassiumphosphate,monobasic

BRAND

K-PHOS NEUTRAL TABLETphosphorus #1

BRAND

PHENAZOPYRIDINE HCL (200 MG, 100 MG) generic

PHOSPHA 250 NEUTRAL TABLETphosphorus #1

BRAND

POTASSIUM CITRATE (15 ER, 10 ER, 5 ER) generic

POTASSIUM CITRATE/CITRIC ACID (1100-334/5SOLUTION, 3300-1002 PACKET)

generic

RENACIDIN IRRIGATION SOLNcitric acid/gluconolactone/magnesium carbonate

BRAND

sod/pot/k cit/sod cit/cit acid 500-550/5 solution generic

sodium chloride irrig solution 0.9 % irrig soln generic

TARON-CRYSTALS PACKETpotassium citrate/citric acid

BRAND

TRICITRATES ORAL SOLUTION BRAND



sodium/potassium/potassium citrate/sodium citrate/cit ac

VIRT-PHOS 250 NEUTRAL TABLETphosphorus #1

BRAND

VIRTRATE-2 SOLUTIONcitric acid/sodium citrate

BRAND

VIRTRATE-3 SOLUTIONsodium/potassium/potassium citrate/sodium citrate/cit ac

BRAND

VIRTRATE-K SOLUTIONpotassium citrate/citric acid

BRAND

PHOSPHATE BINDERS

CALCIUM ACETATE (667 MG CAPSULE, 667 MGTABLET)

generic

ELIPHOS 667 MG TABLETcalcium acetate

BRAND

RENVELA (800 MG TABLET, 0.8 GM POWDER PACKET,2.4 GM POWDER PACKET)sevelamer carbonate

BRAND

sevelamer carbonate 800 mg tablet generic

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (ADRENAL)

A-HYDROCORT 100 MG VIALhydrocortisone sod succinate

BRAND

A-METHAPRED 40 MG UNIVIALmethylprednisolone sodium succinate

BRAND

betamet acet/betamet na ph 6 mg/ml vial generic

cortisone acetate 25 mg tablet generic

DELTASONE 20 MG TABLETprednisone

BRAND

DEXAMETHASONE (6 MG TABLET, 0.5 MG TABLET, 2MG TABLET, 0.75 MG TABLET, 4 MG TABLET, 1.5 MGTABLET, 0.5 MG/5ML ELIXIR, 1 MG TABLET, 0.5MG/5ML SOLUTION)

generic

DEXAMETHASONE INTENSOL 1MG/1MLdexamethasone

BRAND

DEXAMETHASONE SOD PHOSPHATE (10 MG/ML VIAL,4 MG/ML VIAL, 4 MG/ML SYRINGE)

generic

dexamethasone sod phosphate/pf 10 mg/ml vial generic

fludrocortisone acetate 0.1 mg tablet generic

GRX HICORT 25 MG SUPPOSITORYhydrocortisone acetate

BRAND



HEMMOREX-HC (25 MG, 30 MG)hydrocortisone acetate

BRAND

HEMRIL-30 30 MG SUPPOSITORYhydrocortisone acetate

BRAND

HYDROCORTISONE (5 MG, 10 MG, 20 MG) generic

hydrocortisone acetate 25 mg supp.rect generic C only non-DESI NDCsare covered

hydrocortisone acetate 30 mg supp.rect generic

METHYLPREDNISOLONE (4 MG TABLET, 16 MGTABLET, 8 MG TABLET, 4 MG TAB DS PK, 32 MGTABLET)

generic

METHYLPREDNISOLONE ACETATE (80 MG/ML, 40MG/ML)

generic

METHYLPREDNISOLONE SODIUM SUCCINATE (40 MG,1000 MG, 125 MG)

generic

MILLIPRED DP (5 MG 6-DAY, 5 MG 12-DAY)prednisolone

BRAND

prednisolone 15 mg/5 ml solution generic

PREDNISOLONE SOD PHOSPHATE (5 MG/5 MLSOLUTION, 10 MG TAB RAPDIS, 15 MG TAB RAPDIS,15 MG/5 ML SOLUTION, 30 MG TAB RAPDIS, 25 MG/5ML SOLUTION)

generic

PREDNISONE (2.5 MG TABLET, 5 MG TABLET, 1 MGTABLET, 50 MG TABLET, 5 MG/5 ML SOLUTION, 20 MGTABLET, 10 MG TABLET, 10 MG TAB DS PK, 5 MG TABDS PK)

generic

PREDNISONE 5 MG/ML SOLUTIONprednisone

BRAND

RECTACORT-HC 25 MG SUPPOSITORYhydrocortisone acetate

BRAND

TRIAMCINOLONE ACETONIDE (10 MG/ML, 40 MG/ML) generic

VERIPRED 20 20 MG/5 ML SOLNprednisolone sod phosphate

BRAND

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY)

chorionic gonadotropin, human 10000 unit vial generic

cosyntropin 0.25 mg vial generic

desmopressin (nonrefrigerated) 10/spray spray/pump generic

DESMOPRESSIN ACETATE (4MCG/ML AMPUL, 0.1 MGTABLET, 0.2 MG TABLET, 0.1 MG/ML SOLUTION,4MCG/ML VIAL, 10/SPRAY SPRAY/PUMP)

generic



GONAL-F RFF (900, 450, 300)follitropin alfa, recomb

BRAND

GONAL-F RFF REDI-JECT (900, 300, 450)follitropin alfa, recomb


HP ACTHAR GEL 80 UNIT/ML VIALcorticotropin

BRANDPA

S Specialty Drug

INCRELEX 40 MG/4 ML VIALmecasermin

BRANDPA

S Specialty Drug

NORDITROPIN (5 ML, 15 ML)somatropin

BRANDPA

S Specialty Drug

NORDITROPIN FLEXPRO (10 MG/1.5, 5 MG/1.5, 30MG/3 ML, 15 MG/1.5)somatropin

BRANDPA

S Specialty Drug

NORDITROPIN NORDIFLEX (NORDIFLX 15 MG/1.5,NORDIFLX 10 MG/1.5, NORDIFLEX 5 MG/1.5,NORDIFLEX 30 MG/3)somatropin

BRANDPA

S Specialty Drug

NOVAREL 10,000 UNITS VIALchorionic gonadotropin, human

BRAND

STIMATE 1.5 MG/ML NASAL SPRAYdesmopressin acetate


vasopressin 20 unit/ml vial generic

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS)

ANDROGENS

ANDROGEL (1%(5G) PACKET, 1% PUMP)testosterone

BRAND QL

ANDROGEL (1.62%(1.25G) PCKT, 1.62% PUMP,1.62%(2.5G) PCKT, 1%(2.5G) PACKET)testosterone

BRAND

ANDROXY 10 MG TABLETfluoxymesterone


DANAZOL (200 MG, 50 MG, 100 MG) generic

METHITEST 10 MG TABLETmethyltestosterone

BRAND

methyltestosterone 10 mg capsule generic GL Male

OXANDROLONE (2.5 MG, 10 MG) generic

TESTOPEL 75 MG PELLETS BRAND



testosterone

TESTOSTERONE (1.25G (1%) MD PMP, 50 MG (1%)PACKET, 25MG(1%) PACKET)

generic QL

testosterone 10 mg (2%) gel md pmp generic PA

TESTOSTERONE CYPIONATE (100 MG/ML, 200 MG/ML) generic

testosterone enanthate 200 mg/ml vial generic

ESTROGENS

ALTAVERA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

ALYACEN (7-7-7-28, 1-35-28)norethindrone-ethinyl estradiol

BRAND

AMETHIA 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

AMETHIA LO TABLETlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

AMETHYST 90-20 MCG TABLETlevonorgestrel-ethinyl estradiol

BRAND

APRI 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

ARANELLE 28 TABLETnorethindrone-ethinyl estradiol

BRAND

ASHLYNA 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

AUBRA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

AVIANE-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

AZURETTE 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

BALZIVA 28 TABLETnorethindrone-ethinyl estradiol

BRAND

BEKYREE 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

BLISOVI 24 FE TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

BLISOVI FE (1.5-30, 1-20)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

BRIELLYN TABLETnorethindrone-ethinyl estradiol

BRAND



CAMRESE 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

CAMRESE LO TABLETlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

CAZIANT 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

CHATEAL-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

CRYSELLE-28 TABLETnorgestrel-ethinyl estradiol

BRAND

CYCLAFEM (7-7-7-28, 1-35-28)norethindrone-ethinyl estradiol

BRAND

CYRED 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

DASETTA (7/7/7-28, 1-35-28)norethindrone-ethinyl estradiol

BRAND

DAYSEE 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

DELYLA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

desog-e.estradiol/e.estradiol 21-5 tablet generic

desogestrel-ethinyl estradiol 0.15-0.03 tablet generic

ELINEST-28 TABLETnorgestrel-ethinyl estradiol

BRAND

EMOQUETTE 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

ENPRESSE-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

ENSKYCE 28 TABLETdesogestrel-ethinyl estradiol

BRAND

ESTARYLLA 0.25-0.035 MG TABLETnorgestimate-ethinyl estradiol

BRAND

ESTRADIOL (.0375MG/24 PATCH TDWK, 0.05MG/24HPATCH TDSW, .075MG/24H PATCH TDWK, 2 MGTABLET, .025MG/24H PATCH TDWK, 0.5 MG TABLET,.025MG/24H PATCH TDSW, 0.06MG/24H PATCH TDWK,0.1MG/24HR PATCH TDWK, 1 MG TABLET, .0375MG/24PATCH TDSW, 0.05MG/24H PATCH TDWK, .075MG/24HPATCH TDSW)

generic

ESTRADIOL VALERATE (40 MG/ML, 20 MG/ML, 10MG/ML)

generic



ESTRADIOL/NORETHINDRONE ACETATE (0.5-0.1MG, 1MG-0.5MG)

generic

ESTROPIPATE (0.75 MG, 3 MG, 1.5 MG) generic

ETHINYL ESTRADIOL/DROSPIRENONE (0.03MG-3MG,0.02-3(24))

generic

FALMINA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

GIANVI 3 MG-0.02 MG TABLETethinyl estradiol/drospirenone

BRAND

GILDAGIA 0.4 MG-0.035 MG TABnorethindrone-ethinyl estradiol

BRAND

GILDESS (1.5 MG-30 MCG, 1 MG-20 MCG)norethindrone acetate-ethinyl estradiol

BRAND

GILDESS 24 FE 1-0.02 MG TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

GILDESS FE (1-20, 1.5-30)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

INTROVALE 0.15-0.03 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

JINTELI 1 MG-5 MCG TABLETnorethindrone acetate-ethinyl estradiol

BRAND

JOLESSA 0.15 MG-0.03 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

JUNEL (1 MG-20 MCG, 1.5 MG-30 MCG)norethindrone acetate-ethinyl estradiol

BRAND

JUNEL FE (1.5 MG-30 MCG, 1 MG-20 MCG)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

JUNEL FE 24 TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

KAITLIB FE CHEWABLE TABLETnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

KARIVA 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

KELNOR 1-35 28 TABLETethynodiol diacetate-ethinyl estradiol

BRAND

KIMIDESS 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

KURVELO TABLETlevonorgestrel-ethinyl estradiol

BRAND

LARIN (21 1-20, 1.5 MG-30 MCG) BRAND



norethindrone acetate-ethinyl estradiol

LARIN 24 FE 1 MG-20 MCG TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

LARIN FE (1.5-30, 1-20)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

LEENA 28 TABLETnorethindrone-ethinyl estradiol

BRAND

LESSINA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

LEVONEST-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

LEVONORGESTREL (1.5 MG, 0.75 MG) generic

LEVONORGESTREL-ETHINYL ESTRADIOL (90-20MCGTABLET, 0.15-0.03 TBDSPK 3MO, 0.1-0.02 TABLET, 6-5-10 TABLET, 0.15-0.03 TABLET)

generic

LEVONORGESTREL/ETHINYL ESTRADIOL ANDETHINYL ESTRADIOL (150-30(84), 100-20(84))

generic

LEVORA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

LOMEDIA 24 FE 1 MG-20 MCG TABnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

LOPREEZA 1 MG-0.5 MG TABLETestradiol/norethindrone acetate

BRAND

LORYNA 3 MG-0.02 MG TABLETethinyl estradiol/drospirenone

BRAND

LOW-OGESTREL-28 TABLETnorgestrel-ethinyl estradiol

BRAND

LUTERA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

MARLISSA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

MENEST (1.25 MG, 0.625 MG, 2.5 MG, 0.3 MG)estrogens,esterified

BRAND

MICROGESTIN (21 1.5-30 TAB, 21 1-20 TABLET)norethindrone acetate-ethinyl estradiol

BRAND

MICROGESTIN 24 FE 1 MG-20 MCGnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

MICROGESTIN FE 1-20 TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

MIMVEY 1-0.5 MG TABLET BRAND



estradiol/norethindrone acetate

MIMVEY LO 0.5-0.1 MG TABLETestradiol/norethindrone acetate

BRAND

MONO-LINYAH 28 TABLETnorgestimate-ethinyl estradiol

BRAND

MONONESSA 28 TABLETnorgestimate-ethinyl estradiol

BRAND

MY WAY 1.5 MG TABLETlevonorgestrel

BRAND

MYZILRA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

NECON (1-35-28, 7-7-7-28, 10-11-28, 1-50-28, 0.5-35-28)norethindrone-ethinyl estradiol

BRAND

NEXT CHOICE ONE DOSE 1.5 MG TBlevonorgestrel

BRAND

NIKKI 3 MG-0.02 MG TABLETethinyl estradiol/drospirenone

BRAND

noreth-ethinyl estradiol/iron 0.8-25(24) tab chew generic

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL(0.5MG-2.5, 1MG-20MCG, 1MG-5MCG)

generic

NORETHINDRONE ACETATE-ETHINYLESTRADIOL/FERROUS FUMARATE (1MG-20(24), 1MG-20(21))

generic

NORGESTIMATE-ETHINYL ESTRADIOL (0.25-0.035,7DAYSX3 28, 7DAYSX3 LO)

generic

NORTREL (7-7-7-28, 1-35, 0.5-35)norethindrone-ethinyl estradiol

BRAND

OCELLA 3 MG-0.03 MG TABLETethinyl estradiol/drospirenone

BRAND

OGEN 2.5 TABLETestropipate

BRAND

OGESTREL TABLETnorgestrel-ethinyl estradiol

BRAND

ORSYTHIA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

PHILITH 0.4-0.035 MG TABLETnorethindrone-ethinyl estradiol

BRAND

PIMTREA 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

PIRMELLA (1-35-28, 7-7-7-28) BRAND



norethindrone-ethinyl estradiol

PORTIA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

PREMPHASE 0.625-5 MG TABLETestrogens, conjugated/medroxyprogesterone acetate

BRAND

PREMPRO (0.625-5 MG, 0.625-2.5 MG, 0.45-1.5 MG, 0.3MG-1.5 MG)estrogens, conjugated/medroxyprogesterone acetate

BRAND

PREVIFEM TABLETnorgestimate-ethinyl estradiol

BRAND

QUASENSE 0.15-0.03 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

RECLIPSEN 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

SETLAKIN 0.15 MG-0.03 MG TABlevonorgestrel-ethinyl estradiol

BRAND

SPRINTEC 28 DAY TABLETnorgestimate-ethinyl estradiol

BRAND

SRONYX 0.10-0.02 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

SYEDA 28 TABLETethinyl estradiol/drospirenone

BRAND

TARINA FE 1-20 TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

TRI-ESTARYLLA TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LEGEST FE-28 DAY TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

TRI-LINYAH TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LO-ESTARYLLA TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LO-MARZIA TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LO-SPRINTEC TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-PREVIFEM TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-SPRINTEC TABLETnorgestimate-ethinyl estradiol

BRAND



TRINESSA TABLETnorgestimate-ethinyl estradiol

BRAND

TRIVORA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

VAGIFEM 10 MCG VAGINAL TABestradiol

BRAND

VELIVET 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

VESTURA 3 MG-0.02 MG TABLETethinyl estradiol/drospirenone

BRAND

VIENVA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

VIORELE 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

VYFEMLA 28 TABLETnorethindrone-ethinyl estradiol

BRAND

WERA 0.5/0.035 MG 28 TABLETnorethindrone-ethinyl estradiol

BRAND

WYMZYA FE CHEWABLE TABLETnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

ZARAH TABLETethinyl estradiol/drospirenone

BRAND

ZENCHENT 0.4 MG-35 MCG TABLETnorethindrone-ethinyl estradiol

BRAND

ZENCHENT FE TABLET CHEWABLEnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

ZEOSA CHEWABLE TABLETnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

ZOVIA 1-35E TABLETethynodiol diacetate-ethinyl estradiol

BRAND

ZOVIA 1-50E TABLETethynodiol diacetate-ethinyl estradiol

BRAND

PROGESTINS

CAMILA TABLETnorethindrone

BRAND

DEBLITANE 0.35 MG TABLETnorethindrone

BRAND

DEPO-PROVERA 400 MG/ML VIALmedroxyprogesterone acetate

BRAND

ENDOMETRIN 100 MG SUPPOSITORY BRAND S Specialty Drug



progesterone,micronized

ERRIN 0.35 MG TABLETnorethindrone

BRAND

HEATHER TABLETnorethindrone

BRAND

IMPLANON 68 MG IMPLANTetonogestrel

BRAND

JENCYCLA 0.35 MG TABLETnorethindrone

BRAND

JOLIVETTE TABLETnorethindrone

BRAND

LYZA 0.35 MG TABLETnorethindrone

BRAND

MAKENA 1,250 MG/5 ML VIALhydroxyprogesterone caproate

BRANDPA

GL Male

MEDROXYPROGESTERONE ACETATE (2.5 MGTABLET, 150 MG/ML VIAL, 5 MG TABLET, 150 MG/MLSYRINGE, 10 MG TABLET)

generic

MEGESTROL ACETATE (20 MG TABLET, 625MG/5MLORAL SUSP, 400MG/10ML ORAL SUSP, 40 MGTABLET)

generic

NORA-BE TABLETnorethindrone

BRAND

norethindrone 0.35 mg tablet generic

norethindrone acetate 5 mg tablet generic

NORLYROC 0.35 MG TABLETnorethindrone

BRAND

progesterone 50 mg/ml vial generic

PROGESTERONE,MICRONIZED (100 MG, 200 MG) generic

SHAROBEL 0.35 MG TABLETnorethindrone

BRAND

SELECTIVE ESTROGEN RECEPTOR MODIFYING AGENTS

raloxifene hcl 60 mg tablet generic

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (THYROID)

ARMOUR THYROID (60 MG, 300 MG, 120 MG, 30 MG,90 MG, 240 MG, 180 MG, 15 MG)thyroid,pork

BRAND

LEVOTHYROXINE SODIUM (75 MCG, 300 MCG, 25 generic



MCG, 112 MCG, 137 MCG, 125 MCG, 100 MCG, 200MCG, 50 MCG, 175MCG, 88 MCG, 150 MCG)

LEVOXYL (112 MCG, 125 MCG, 88 MCG, 50 MCG, 200MCG, 137 MCG, 75 MCG, 100 MCG, 150 MCG, 175 MCG,25 MCG)levothyroxine sodium

BRAND

LIOTHYRONINE SODIUM (25 MCG TABLET, 5 MCGTABLET, 50 MCG TABLET, 10 MCG/ML VIAL)

generic

NATURE-THROID (146.25 MG, 65 MG, 113.75 MG, 32.5MG, 81.25 MG, 162.5 MG, 130 MG, 16.25 MG, 325 MG,195 MG, 97.5 MG, 48.75 MG, 260 MG)thyroid,pork

BRAND

NP THYROID (90 MG, 30 MG, 60 MG)thyroid,pork

BRAND

THYROLAR-1 STRENGTH TABLETliotrix

BRAND

THYROLAR-1/2 STRENGTH TABliotrix

BRAND

THYROLAR-1/4 STRENGTH TABliotrix

BRAND


BRAND


BRAND

UNITHROID (137 MCG, 88 MCG)levothyroxine sodium

BRAND

WESTHROID (130 MG, 97.5 MG, 16.25 MG, 65 MG, 48.75MG, 32.5 MG, 195 MG)thyroid,pork

BRAND

HORMONAL AGENTS, SUPPRESSANT (PARATHYROID)

SENSIPAR (30 MG, 60 MG)cinacalcet hcl

BRAND

QL

PA

S Specialty Drug

SENSIPAR 90 MG TABLETcinacalcet hcl

BRAND

QL

PA

S Specialty Drug

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

cabergoline 0.5 mg tablet generic



EGRIFTA 1 MG VIALtesamorelin acetate

BRAND PA

EGRIFTA 2 MG VIALtesamorelin acetate


LEUPROLIDE ACETATE (1 KIT, 1 VIAL) generic

LUPRON DEPOT (DEPOT 7.5 MG, DEPOT 22.5 MG3MO, DEPOT 11.25 MG 3MO, DEPOT-4 MONTH, DEPOT3.75 MG, DEPOT 45 MG 6MO)leuprolide acetate

BRANDPA

S Specialty Drug

LUPRON DEPOT-PED (11.25 MG 3MO, 30 MG 3MO KIT,7.5 MG KIT, 11.25 MG KIT, 15 MG KIT)leuprolide acetate

BRANDPA

S Specialty Drug

OCTREOTIDE ACETATE (500 MCG/ML, 50 MCG/ML, 100MCG/ML)

genericPA

S Specialty Drug

SIGNIFOR (0.6 MG/ML, 0.9 MG/ML, 0.3 MG/ML)pasireotide diaspartate


VANTAS 50 MG KIThistrelin acetate

BRAND PA

HORMONAL AGENTS, SUPPRESSANT (THYROID)

ANTITHYROID AGENTS

METHIMAZOLE (5 MG, 10 MG) generic

propylthiouracil 50 mg tablet generic

IMMUNOLOGICAL AGENTS

ANGIOEDEMA (HAE) AGENTS

FIRAZYR 30 MG/3 ML SYRINGEicatibant acetate

BRAND

IMMUNE SUPPRESSANTS

AZASAN (75 MG, 100 MG)azathioprine

BRAND

azathioprine 50 mg tablet generic

CELLCEPT (200 MG/ML ORAL SUSP, 500 MG VIAL)mycophenolate mofetil hcl

BRAND

CYCLOSPORINE (100 MG CAPSULE, 250 MG/5ML VIAL,250 MG/5ML AMPUL, 25 MG CAPSULE)

generic

CYCLOSPORINE, MODIFIED (50 MG CAPSULE, 100MG/ML SOLUTION, 100 MG CAPSULE, 25 MGCAPSULE)

generic



ENBREL (50 MG/ML SYRINGE, 25 MG KIT, 50 MG/MLSURECLICK SYR, 25 MG/0.5 ML SYRINGE)etanercept

BRANDPA

S Specialty Drug

GENGRAF (25 MG CAPSULE, 100 MG/ML SOLUTION,100 MG CAPSULE)cyclosporine, modified

BRAND

HECORIA (1 MG, 5 MG, 0.5 MG)tacrolimus

BRAND

HUMIRA (10 MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML)adalimumab

BRANDPA

S Specialty Drug

HUMIRA 40 MG/0.8 ML PENadalimumab

BRANDPA

S Specialty Drug

HUMIRA PEDIATRIC CROHN'S STARTadalimumab

BRANDPA

S Specialty Drug

HUMIRA PEN CROHN'S-UC-HS STARTadalimumab

BRANDPA

S Specialty Drug

HUMIRA PEN PSORIASIS START PKadalimumab

BRANDPA

S Specialty Drug

METHOTREXATE SODIUM (25 MG/ML VIAL, 2.5 MGTABLET)

generic

methotrexate sodium/pf 1 g vial generic

methotrexate sodium/pf 25 mg/ml vial generic S Specialty Drug

MYCOPHENOLATE MOFETIL (500 MG TABLET, 250 MGCAPSULE)

generic

MYCOPHENOLATE SODIUM (180 MG, 360 MG) generic

MYFORTIC (360 MG, 180 MG)mycophenolate sodium

BRAND

NULOJIX 250 MG VIALbelatacept

BRAND

PROGRAF 5 MG/ML AMPULEtacrolimus

BRAND

RAPAMUNE (1 MG TABLET, 1 MG/ML ORAL SOLN, 2MG TABLET)sirolimus

BRAND

REMICADE 100 MG VIALinfliximab

BRAND PA

SIROLIMUS (1 MG, 0.5 MG) generic



TACROLIMUS (1 MG, 5 MG, 0.5 MG) generic

TREXALL (15 MG, 10 MG, 7.5 MG, 5 MG)methotrexate sodium

BRAND

ZORTRESS (0.75 MG, 0.5 MG, 0.25 MG)everolimus


IMMUNIZING AGENTS, PASSIVE

BIVIGAM LIQUID 10% VIALimmune globulin,gamm(igg)/glycine/iga greater than 50mcg/ml

BRAND PA

FLEBOGAMMA DIF (10%, 5%)immune globulin,gamma (igg)/sorbitol/iga 0 to 50 mcg/ml

BRAND PA

GAMMAGARD LIQUID 10% VIALimmune globulin,gamm(igg)/glycine/iga greater than 50mcg/ml

BRAND PA

GAMMAPLEX 5% VIALimmune globulin,gamm(igg)/sorbitol/glycin/iga 0 to 50mcg/ml

BRAND PA

GAMUNEX 10% VIALimmune globulin,gamma caprylate (igg)

BRAND PA

GAMUNEX-C (2.5 GRAM/25 ML, 1 GRAM/10 ML, 10GRAM/100 ML, 20 GRAM/200 ML, 5 GRAM/50 ML)immune globulin,gamm(igg)/glycine/iga greater than 50mcg/ml

BRAND PA

HIZENTRA (10 GRAM/50 ML, 2 GRAM/10 ML, 1 GRAM/5ML, 4 GRAM/20 ML)immune globulin,gamma (igg)/proline/iga 0 to 50 mcg/ml

BRAND

HYPERRHO S-D 250 UNITS SYRINGErho(d) immune globulin

BRAND

PRIVIGEN 10% VIALimmune globulin,gamma (igg)/proline/iga 0 to 50 mcg/ml

BRAND PA

VARIZIG 125 UNIT VIALvaricella-zoster immune globulin (human)

BRAND

IMMUNOMODULATORS

ACTEMRA 162 MG/0.9 ML SYRINGEtocilizumab

BRAND PA

ACTIMMUNE 100 MCG/0.5 ML VIALinterferon gamma-1b,recomb.


ARCALYST 220 MG INJECTIONrilonacept


BENLYSTA (120 MG, 400 MG)belimumab

BRAND



ILARIS 180 MG VIALcanakinumab/pf

BRAND

LEFLUNOMIDE (20 MG, 10 MG) generic

RIDAURA 3 MG CAPSULEauranofin

BRAND

SYNAGIS (50 MG/0.5 ML, 100 MG/1 ML)palivizumab

BRAND PA

VACCINES

ADACEL TDAP VIALdiphtheria,pertussis(acell),tetanus vaccine/pf

BRAND

EZ FLU 2015-16 (FLUVIRIN) KITinfluenza virus vaccine trivalnt 2015-2016 (4 yr & older)/pf

BRAND

PNEUMOVAX 23 SYRINGEpneumococcal 23-valent polysaccharide vaccine

BRAND

PNEUMOVAX 23 VIALpneumococcal 23-valent polysaccharide vaccine

BRAND AL 1 to 65 yrs old

ZOSTAVAX VIALzoster vaccine live/pf

BRAND

INFLAMMATORY BOWEL DISEASE AGENTS

AMINOSALICYLATES

APRISO ER 0.375 GRAM CAPSULEmesalamine

BRAND

balsalazide disodium 750 mg capsule generic

CANASA 1,000 MG SUPPOSITORYmesalamine

BRAND

mesalamine 4 g/60 ml enema generic

mesalamine w/cleansing wipes 4 g/60 ml enema kit generic

PENTASA (500 MG, 250 MG)mesalamine

BRAND

GLUCOCORTICOIDS

budesonide 3 mg capdr - er generic

COLOCORT 100 MG ENEMAhydrocortisone

BRAND

CORTIFOAM 10% AEROSOLhydrocortisone acetate

BRAND

hydrocortisone 100mg/60ml enema generic

PROCTO-PAK 1% CREAM BRAND



hydrocortisone

PROCTOSOL-HC 2.5% CREAMhydrocortisone

BRAND

PROCTOZONE-HC 2.5% CREAMhydrocortisone

BRAND

UCERIS 9 MG ER TABLETbudesonide

BRAND

SULFONAMIDES

SULFASALAZINE (500 MG, 500 MG DR) generic

SULFAZINE 500 MG TABLETsulfasalazine

BRAND

SULFAZINE EC 500 MG TABsulfasalazine

BRAND

METABOLIC BONE DISEASE AGENTS

ALENDRONATE SODIUM (10 MG TABLET, 70 MG/75MLSOLUTION, 40 MG TABLET, 35 MG TABLET, 70 MGTABLET, 5 MG TABLET)

generic

calcitonin,salmon,synthetic 200/spray spray/pump generic

CALCITRIOL (1 MCG/ML SOLUTION, 0.5 MCGCAPSULE, 0.25 MCG CAPSULE, 1 MCG/ML AMPUL)

generic

DOXERCALCIFEROL (1 MCG, 2.5 MCG, 0.5 MCG) generic S Specialty Drug

ETIDRONATE DISODIUM (200 MG, 400 MG) generic

FORTEO 600 MCG/2.4 ML PEN INJteriparatide

BRANDPA

S Specialty Drug

FORTICAL 200 UNITS NASAL SPRAYcalcitonin,salmon,synthetic

BRAND

HECTOROL (2 MCG/ML, 4 MCG/2 ML)doxercalciferol


ibandronate sodium 150 mg tablet generic

PARICALCITOL (2 MCG/ML VIAL, 2 MCG CAPSULE, 5MCG/ML VIAL, 4MCG CAPSULE, 1 MCG CAPSULE)

generic

RISEDRONATE SODIUM (5 MG, 30 MG, 35 MG DR, 150MG, 35 MG)

generic

MISCELLANEOUS THERAPEUTIC AGENTS

acetylcysteine 200 mg/ml vial generic PA

ALBUTEIN 25% VIAL BRAND



albumin human

APLIGRAF DISKcult skin subst,human-bovine

BRAND

AVITENE SHEET 70MMX70MMmicrofibrillar collagen

BRAND

coal tar 20 % solution generic

DEFEROXAMINE MESYLATE (2 G, 500 MG) generic

dexmedetomidine hcl 200mcg/2ml vial generic

ENDO-AVITENE 5MM SHEETmicrofibrillar collagen

BRAND

EUFLEXXA 20 MG/2 ML SYRINGEhyaluronate sodium

BRAND PA

flumazenil 0.1 mg/ml vial generic

fomepizole 1 g/ml vial generic

FORMADON 10% SOLUTIONformaldehyde

BRAND

formaldehyde 10 % sol w/appl generic

glutaraldehyde 25 % solution generic

glycine/sod/water/sod hydrox vial generic S Specialty Drug

IC GREEN 25 MG VIALindocyanine green

BRAND

isomethept/dichlphn/acetaminop 65-100-325 capsule generic

isomethepten/caf/acetaminophen 65-20-325 tablet generic

isosulfan blue 1 % vial generic

LMD 10% WITH 0.9% SOD CHL SOLNdextran 40 in 0.9 % sodium chloride

BRAND

LMD 10% WITH 5% DEXT SOLNdextran 40/dextrose 5 % in water

BRAND

LUGOL'S SOLUTIONpotassium iodide/iodine

BRAND

MD-GASTROVIEW 66%-10% SOLNdiatrizoate meglumine/diatrizoate sodium

BRAND

METHYLENE BLUE (1 VIAL, 1 AMPUL) generic

METHYLERGONOVINE MALEATE (0.2 MG TABLET,.2MG/ML(1) AMPUL)

generic

MIGRAGESIC IDA CAPSULEisometheptene mucate/dichloralphenazone/acetaminophen

BRAND



NODOLOR CAPSULEisometheptene mucate/dichloralphenazone/acetaminophen

BRAND

oxytocin 10 unit/ml vial generic

PANHEMATIN 313 MG VIALhemin

BRAND

phenol liquid generic

physostigmine salicylate 1 mg/ml ampul generic

potassium iodide/iodine 5 % solution generic

PROTOPAM CHLORIDE 1 GM VIALpralidoxime chloride

BRAND

SITZMARKS CAPSULEradiopaque pvc markers/barium sulfate

BRAND

sodium morrhuate 50 mg/ml vial generic

SODIUM THIOSULFATE (1 G/10 ML, 12.5G/50ML) generic

SOLIRIS 300 MG/30 ML VIALeculizumab

BRAND PA

SOTRADECOL 3% VIALsodium tetradecyl sulfate

BRAND

water for inj.,bacteriostatic vial generic

WATER FOR INJECTION,STERILE (IVSOLN, AMPUL,VIAL)

generic

water for irrigation,sterile irrig soln generic

water/me-paraben/propylparaben vial generic

OPHTHALMIC AGENTS

OPHTHALMIC AGENTS, OTHER

AKORN BALANCED SALT SOLNbalanced salt irrig soln no.2

BRAND

ALTACAINE 0.5% EYE DROPStetracaine hcl

BRAND

ALTAFLUOR EYE DROPSbenoxinate hcl/fluorescein sodium

BRAND

ATROPINE CARE 1% EYE DROPSatropine sulfate

BRAND

ATROPINE SULFATE (1 DROPS, 1 OINT. (G)) generic

balanced salt irrig soln no.2 irrig soln generic

benoxinate hcl/fluorescein na 0.4%-0.25% drops generic



BIOGLO 1 MG OPHTHALMIC STRIPSfluorescein sodium

BRAND

BSS EYE SOLUTIONbalanced salt irrig soln no.2

BRAND

ciprofloxacin hcl 0.3 % drops generic

CYCLOPENTOLATE HCL (2, 1) generic

CYSTARAN 0.44% EYE DROPScysteamine hcl

BRAND

ERYTHROMYCIN BASE (5 MG/G, 5MG/G) generic

FLUCAINE EYE DROPSproparacaine hcl/fluorescein sodium

BRAND

FLUOR-I-STRIP ATfluorescein sodium

BRAND

FLUORESCITE 10% VIALfluorescein sodium

BRAND

FLUORETS 1 MG OPTH STRIPSfluorescein sodium

BRAND

FLUROX EYE DROPSbenoxinate hcl/fluorescein sodium

BRAND

FUL-GLO 1 MG OPTH STRIPSfluorescein sodium

BRAND

GARAMYCIN (0.3%, 3 MG/ML)gentamicin sulfate

BRAND

gatifloxacin 0.5 % drops generic

GENTAK 0.3 % EYE OINTMENTgentamicin sulfate

BRAND

GENTAMICIN SULFATE (0.3 OINT. (G), 0.3 DROPS) generic

HOMATROPAIRE 5% EYE DROPShomatropine hbr

BRAND

homatropine hbr 5 % drops generic

levofloxacin 0.5 % drops generic

MOXEZA 0.5% EYE DROPSmoxifloxacin hcl

BRAND

naphazoline hcl 0.1 % drops generic

NEO-POLYCIN EYE OINTMENTneomycin sulfate/bacitracin/polymyxin b

BRAND

NEO-POLYCIN HC EYE OINTMENTneomycin sulfate/bacitracin zinc/polymyxinb/hydrocortisone

BRAND



neomycin su/baci zn/poly/hc 3.5-10k-1 oint. (g) generic

neomycin su/bacitra/polymyxin 3.5mg-400 oint. (g) generic

neomycin/polymyxin b sulf/hc 3.5-10k-10 drops susp generic

NEOMYCIN/POLYMYXIN BSULFATE/DEXAMETHASONE (0.1 % DROPS SUSP, 3.5-10K-.1 OINT. (G))

generic

neomycin/polymyxn b/gramicidin 1.75mg-10k drops generic

OCUCOAT VISCOADHERENT SYRINGEhypromellose

BRAND

ofloxacin 0.3 % drops generic

PHENYLEPHRINE HCL (10, 2.5) generic

POLYCIN EYE OINTMENTbacitracin/polymyxin b sulfate

BRAND

polymyxin b sulf/trimethoprim 10000-1/ml drops generic

proparacaine hcl 0.5 % drops generic

proparacaine/fluorescein sod 0.5%-0.25% drops generic

RESTASIS 0.05% EYE EMULSIONcyclosporine

BRAND

SULFACETAMIDE SODIUM (10 DROPS, 10 OINT. (G)) generic

sulfacetamide/prednisolone sp 10 %-0.23% drops generic

TETCAINE 0.5% EYE DROPStetracaine hcl

BRAND

tetracaine hcl 0.5 % drops generic

tetracaine hcl/pf 0.5 % drops generic

tobramycin 0.3 % drops generic

tobramycin/dexamethasone 0.3 %-0.1% drops susp generic

TROPICAMIDE (0.5, 1) generic

OPHTHALMIC ANTI-ALLERGY AGENTS

azelastine hcl 0.05 % drops generic

cromolyn sodium 4 % drops generic

epinastine hcl 0.05 % drops generic

olopatadine hcl 0.1 % drops generic

OPHTHALMIC ANTI-INFLAMMATORIES

bromfenac sodium 0.09% drops generic

dexamethasone sod phosphate 0.1 % drops generic



diclofenac sodium 0.1 % drops generic

fluorometholone 0.1 % drops susp generic

flurbiprofen sodium 0.03 % drops generic

KETOROLAC TROMETHAMINE (0.5, 0.4) generic

PRED MILD 0.12% EYE DROPSprednisolone acetate

BRAND

prednisolone acetate 1 % drops susp generic

prednisolone sod phosphate 1 % drops generic

OPHTHALMIC ANTIGLAUCOMA AGENTS

ALPHAGAN P 0.1% DROPSbrimonidine tartrate

BRAND

apraclonidine hcl 0.5 % drops generic

betaxolol hcl 0.5 % drops generic

BRIMONIDINE TARTRATE (0.2, 0.15) generic

carteolol hcl 1 % drops generic

dorzolamide hcl 2 % drops generic

dorzolamide hcl/timolol maleat 22.3-6.8/1 drops generic

levobunolol hcl 0.5 % drops generic

METHAZOLAMIDE (50 MG, 25 MG) generic

metipranolol 0.3 % drops generic

MIOSTAT VIALcarbachol

BRAND

PHOSPHOLINE IODIDE 0.125%echothiophate iodide

BRAND

PILOCARPINE HCL (4, 2, 1) generic

TIMOLOL MALEATE (0.25 DROPS, 0.5 SOL-GEL, 0.5DROPS, 0.25 SOL-GEL)

generic

OPHTHALMIC PROSTAGLANDIN AND PROSTAMIDE ANALOGS

bimatoprost 0.03 % drops generic

latanoprost 0.005 % drops generic

travoprost (benzalkonium) 0.004 % drops generic

OTIC AGENTS

ACETASOL HC EAR DROPSacetic acid/hydrocortisone

BRAND



acetic acid 2 % solution generic

acetic acid/aluminum acetate 2 % drops generic

acetic acid/hydrocortisone 2 %-1 % drops generic

AERO OTIC HC EAR DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

ANTIPYRINE/BENZOCAINE (5.4, 5.5) generic

AURODEX OTIC SOLUTIONantipyrine/benzocaine

BRAND

AUROGUARD OTIC SOLUTIONantipyrine/benzocaine

BRAND

CIPRODEX OTIC SUSPENSIONciprofloxacin hcl/dexamethasone

BRAND

CORTANE-B OTIC DROPShydrocortisone/pramoxine hcl/chloroxylenol/water

BRAND

EXOTIC-HC EAR DROPhydrocortisone/pramoxine hcl/chloroxylenol

BRAND

fluocinolone acetonide oil 0.01 % drops generic

NEOMYCIN SULFATE/POLYMYXIN BSULFATE/HYDROCORTISONE (SOLUTION, DROPSSUSP)

generic

ofloxacin 0.3 % drops generic

OTICIN HC DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

OTO-END 10 EAR DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

OTOMAX-HC EAR DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

OTOZIN EAR DROPSantipyrine/benzocaine/glycerin/zinc acetate

BRAND

PRAMOXINE-HC OTIC DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

RESPIRATORY TRACT/PULMONARY AGENTS

ANTI-INFLAMMATORIES, INHALED CORTICOSTEROIDS

ARNUITY ELLIPTA (200 MCG, 100 MCG)fluticasone furoate

BRAND QL

BUDESONIDE (1 MG/2 ML AMPUL-NEB, 32MCGSPRAY/PUMP)

generic

budesonide 0.25mg/2ml ampul-neb generic QL



C 2 vials (4ml)/day

budesonide 0.5 mg/2ml ampul-neb generic C 2 vials (4ml)/day

flunisolide 25 mcg spray generic

fluticasone propionate 50 mcg spray susp generic

PULMICORT FLEXHALER (90 MCG, 180 MCG)budesonide

BRAND

QVAR (80 MCG, 40 MCG)beclomethasone dipropionate

BRAND

triamcinolone acetonide 55 mcg spray generic

ANTIHISTAMINES

ARBINOXA (4 MG TABLET, 4 MG/5 ML LIQUID)carbinoxamine maleate

BRAND

AZELASTINE HCL (205.5MCG, 137 MCG) generic

CARBINOXAMINE MALEATE (4 MG TABLET, 4 MG/5 MLLIQUID)

generic

CLEMASTINE FUMARATE (2.68 MG TABLET,0.67MG/5ML SYRUP)

generic

CYPROHEPTADINE HCL (4 MG TABLET, 2 MG/5 MLSYRUP)

generic

DESLORATADINE (2.5 MG, 5 MG) generic

ST

C

must trycetirizine,cetirizine/pseudoephedrine,loratadine,loratadine/pseudoephedrine

desloratadine 5 mg tablet generic

PA

ST

C

must trycetirizine,cetirizine/pseudoephedrine,loratadine,loratadine/pseudoephedrine

diphenhydramine hcl 50 mg/ml vial generic

HYDROXYZINE HCL (10 MG TABLET, 50 MG/ML VIAL,25 MG/ML VIAL, 50 MG/25ML SOLUTION, 10 MG/5 MLSOLUTION, 50 MG TABLET, 25 MG TABLET)

generic

HYDROXYZINE PAMOATE (100 MG, 50 MG, 25 MG) generic



levocetirizine dihydrochloride 2.5 mg/5ml solution generic

PA

ST

C

must try cetirizine,cetirizine/pseudoephedrine, loratadine,loratadine/pseudoephedrine

levocetirizine dihydrochloride 5 mg tablet generic

PA

ST

C

must try cetirizine,cetirizine/pseudoephedrine, loratadine,loratadine/pseudoephedrine

olopatadine hcl 0.6 % spray/pump generic

PALGIC (4 MG/5 ML LIQUID, 4 MG TABLET)carbinoxamine maleate

BRAND

PHENADOZ (12.5 MG, 25 MG)promethazine hcl

BRAND

PHENERGAN (50 MG, 12.5 MG, 25 MG)promethazine hcl

BRAND

PROMETHAZINE HCL (25 MG/ML VIAL, 25 MG TABLET,50 MG/ML AMPUL, 50 MG SUPP.RECT, 12.5 MGSUPP.RECT, 50 MG TABLET, 12.5 MG TABLET, 25MG/ML AMPUL, 25 MG SUPP.RECT, 6.25MG/5MLSYRUP, 50 MG/ML VIAL)

generic

PROMETHEGAN (50 MG SUPPOSITORY, 25 MG SUPP,12.5 MG SUPPOS)promethazine hcl

BRAND

ANTILEUKOTRIENES

MONTELUKAST SODIUM (4 MG GRAN PACK, 10 MGTABLET, 4 MG TAB CHEW, 5 MG TAB CHEW)

generic

zafirlukast 10 mg tablet generic PA

zafirlukast 20 mg tablet generic

BRONCHODILATORS, ANTICHOLINERGIC

ATROVENT HFA INHALERipratropium bromide

BRAND

IPRATROPIUM BROMIDE (42 MCG SPRAY, 21 MCGSPRAY, 0.2 MG/ML SOLUTION)

generic

SPIRIVA 18 MCG CP-HANDIHALERtiotropium bromide

BRAND

SPIRIVA RESPIMAT 1.25 MCG INH BRAND



tiotropium bromide

TUDORZA PRESSAIR 400 MCG INHaclidinium bromide

BRAND

BRONCHODILATORS, SYMPATHOMIMETIC

ADRENALIN 1 MG/ML VIALepinephrine

BRAND C 2 kits/fill

ADRENALIN CL 1 MG/ML VIALepinephrine

BRAND C 2 kits/fill

ALBUTEROL SULFATE (2 MG/5 ML SYRUP,1.25MG/3ML VIAL-NEB, 8 MG TAB ER 12H, 2.5 MG/3MLVIAL-NEB, 2.5 MG/0.5 VIAL-NEB, 4 MG TAB ER 12H, 2MG TABLET, 0.63MG/3ML VIAL-NEB, 5 MG/MLSOLUTION, 4 MG TABLET)

generic

EPINEPHRINE (1 MG/ML VIAL, 0.1 MG/ML SYRINGE,0.3MG/0.3 AUTO INJCT, 1 MG/ML(1) AMPUL, 0.15/0.15AUTO INJCT)

generic C 2 kits/fill

epinephrine hcl/pf 1 mg/ml(1) ampul generic C 2 kits/fill

epinephrine/pf 1 mg/ml(1) ampul generic C 2 kits/fill

EPIPEN 2-PAK 0.3 MG AUTO-INJCTepinephrine

BRAND C 2 kits/fill

EPIPEN JR 2-PAK 0.15 MG INJCTRepinephrine

BRAND C 2 kits/fill

LEVALBUTEROL HCL (0.63MG/3ML, 1.25MG/0.5,1.25MG/3ML, 0.31MG/3ML)

generic C 24 vials/month

METAPROTERENOL SULFATE (10 MG TABLET, 20 MGTABLET, 10 MG/5 ML SYRUP)

generic

PERFOROMIST 20 MCG/2 ML SOLNformoterol fumarate

BRAND

STRIVERDI RESPIMAT INHAL SPRAYolodaterol hcl

BRAND QL

TERBUTALINE SULFATE (5 MG TABLET, 2.5 MGTABLET, 1 MG/ML VIAL)

generic

VENTOLIN HFA 90 MCG INHALERalbuterol sulfate

BRAND QL

CYSTIC FIBROSIS AGENTS



CAYSTON 75 MG INHAL SOLUTIONaztreonam lysine

BRAND

QL

PA

C 3 vials/day; max 84vials/56 days

S Specialty Drug

KALYDECO (75 MG, 50 MG)ivacaftor

BRAND

QL

PA

C 2 packets/day

S Specialty Drug

KALYDECO 150 MG TABLETivacaftor

BRAND

QL

PA

S Specialty Drug

TOBI 300 MG/5 ML SOLUTIONtobramycin in 0.225 % sodium chloride

BRAND

QL

PA

C 2 vials/day

S Specialty Drug

TOBI PODHALER 28 MG INHALE CAPtobramycin

BRAND

QL

PA

C 8 capsules/day

S Specialty Drug

tobramycin in 0.225% nacl 300 mg/5ml ampul-neb generic

QL

PA

C 2 vials/day

S Specialty Drug

tobramycin/nebulizer 300 mg/5ml ampul-neb generic

QL

PA

S Specialty Drug

PHOSPHODIESTERASE INHIBITORS, AIRWAYS DISEASE

AMINOPHYLLINE (500MG/20ML VIAL, 250MG/10MLVIAL, 250MG/10ML AMPUL)

generic

CAFFEINE CITRATED (60 ML VIAL, 60 ML SOLUTION) generic

DIFIL-G 400 TABLETguaifenesin/dyphylline

BRAND

THEOCHRON (ER 300 MG, ER 200 MG, ER 100 MG)theophylline anhydrous

BRAND



THEOPHYLLINE ANHYDROUS (80 MG/15ML ELIXIR,300 MG TAB ER 12H, 600 MG TABLET ER, 400 MGTABLET ER, 100 MG TAB ER 12H, 450 MG TAB ER 12H,80 MG/15ML SOLUTION, 200 MG TAB ER 12H)

generic

THEOPHYLLINE/DEXTROSE 5 % IN WATER(800MG/.25L, 400MG/0.5L, 200MG/0.1L, 200MG/50ML,400MG/.25L)

generic

PULMONARY ANTIHYPERTENSIVES

ADCIRCA 20 MG TABLETtadalafil

BRANDPA

S Specialty Drug

ADEMPAS (0.5 MG, 1.5 MG, 1 MG, 2 MG, 2.5 MG)riociguat

BRANDPA

S Specialty Drug

EPOPROSTENOL SODIUM (GLYCINE) (1.5 MG, 0.5 MG) generic

LETAIRIS (5 MG, 10 MG)ambrisentan

BRANDPA

S Specialty Drug

OPSUMIT 10 MG TABLETmacitentan

BRANDPA

S Specialty Drug

REMODULIN (10 MG/ML, 5 MG/ML, 2.5 MG/ML, 1MG/ML)treprostinil sodium

BRANDPA

S Specialty Drug

REVATIO 10 MG/12.5 ML VIALsildenafil citrate

BRANDPA

S Specialty Drug

sildenafil citrate 10 mg/12.5 vial genericPA

S Specialty Drug

sildenafil citrate 20 mg tablet generic

QL

PA

S Specialty Drug

TRACLEER (125 MG, 62.5 MG)bosentan

BRANDPA

S Specialty Drug

TYVASO (INHALATION REFILL KIT, INSTITUTIONALSTART KIT, INHALATION STARTER KIT, 1.74 MG/2.9 MLSOLUTION)treprostinil/nebulizer/nebulizer accessories

BRANDPA

S Specialty Drug

VELETRI (1.5 MG, 0.5 MG)epoprostenol sodium (arginine)

BRANDPA

S Specialty Drug

PA



VENTAVIS (10 ML, 20 ML)iloprost tromethamine

BRANDS Specialty Drug

RESPIRATORY TRACT AGENTS, OTHER

ACETYLCYSTEINE (100 MG/ML, 200 MG/ML) generic

ARALAST 1,000 MG VIALalpha-1-proteinase inhibitor

BRAND

ARALAST NP (1,000 MG, 500 MG)alpha-1-proteinase inhibitor

BRAND

BENZONATATE (150 MG, 200 MG, 100 MG) generic

BREO ELLIPTA (200-25 MCG, 100-25 MCG)fluticasone furoate/vilanterol trifenatate

BRAND

CENTERGY PEDIATRIC DROPSchlorpheniramine maleate/phenylephrine hcl

BRAND

COMBIVENT RESPIMAT INHAL SPRAYipratropium bromide/albuterol sulfate

BRAND

cromolyn sodium 20 mg/2 ml ampul-neb generic

doxapram hcl 20 mg/ml vial generic

DULERA (200 MCG, 100 MCG)mometasone furoate/formoterol fumarate

BRAND

fexofenadine/pseudoephedrine 180-240mg tab er 24h generic

PA

ST

C

must try cetirizine,cetirizine/pseudoephedrine,loratadine, loratadine/pseudoephedrine

hydrocodone/chlorphen p-stirex 10-8mg/5ml sus er 12h generic

ipratropium/albuterol sulfate 0.5-3mg/3 ampul-neb generic

phenylephrine hcl/prometh hcl 5-6.25mg/5 syrup generic

PROLASTIN (500 MG, 1,000 MG)alpha-1-proteinase inhibitor

BRAND

PROLASTIN C 1,000 MG VIALalpha-1-proteinase inhibitor

BRAND

promethazine hcl/codeine 6.25-10/5 syrup generic

promethazine/dextromethorphan 6.25-15/5 syrup generic

PULMOZYME 1 MG/ML AMPULdornase alfa

BRANDPA

S Specialty Drug



sodium chloride for inhalation 7 % vial-neb generic

STIOLTO RESPIMAT INHAL SPRAYtiotropium bromide/olodaterol hcl

BRAND QL

SYMBICORT (80-4.5 MCG, 160-4.5 MCG)budesonide/formoterol fumarate

BRAND

TUSSIGON 5-1.5 MG TABLEThydrocodone bitartrate/homatropine methylbromide

BRAND

XOLAIR 150 MG VIALomalizumab

BRANDPA

S Specialty Drug

ZEMAIRA 1,000 MG VIALalpha-1-proteinase inhibitor

BRAND

SKELETAL MUSCLE RELAXANTS

ANECTINE 20 MG/ML VIALsuccinylcholine chloride

BRAND

BACLOFEN (20 MG, 10 MG) generic

carisoprodol 250 mg tablet generic

chlorzoxazone 500 mg tablet generic

CYCLOBENZAPRINE HCL (10 MG, 5 MG, 7.5 MG) generic

DANTROLENE SODIUM (100 MG, 50 MG, 25 MG) generic

GABLOFEN (50 MCG/ML SYRINGE, 40,000 MCG/20 MLVIAL, 10,000 MCG/20 ML VIAL)baclofen


METAXALONE (800 MG, 400 MG) generic

METHOCARBAMOL (750 MG, 500 MG) generic

ORPHENADRINE CITRATE (100 MG TABLET ER, 30MG/ML AMPUL, 30 MG/ML VIAL)

generic

orphenadrine/aspirin/caffeine 50-770-60 tablet generic

REVONTO 20 MG VIALdantrolene sodium

BRAND

TIZANIDINE HCL (6 MG CAPSULE, 4 MG TABLET, 2 MGCAPSULE, 4 MG CAPSULE, 2 MG TABLET)

generic

SLEEP DISORDER AGENTS

GABA RECEPTOR MODULATORS

ESTAZOLAM (1 MG, 2 MG) generic

ESZOPICLONE (2 MG, 1 MG, 3 MG) generic



quazepam 15 mg tablet generic

TEMAZEPAM (7.5 MG, 15 MG, 30 MG, 22.5 MG) generic

TRIAZOLAM (0.25 MG, 0.125 MG) generic

ZALEPLON (10 MG, 5 MG) generic C

must try zolpidem andzaleplon for at least 2weeks of therapy in thepast 90 days

ZOLPIDEM TARTRATE (6.25 MG TAB MPHASE, 10 MGTABLET, 12.5 MG TAB MPHASE, 5 MG TABLET)

generic

SLEEP DISORDERS, OTHER

caffeine/sodium benzoate 250 mg/ml vial generic

FLURAZEPAM HCL (15 MG, 30 MG) generic

HETLIOZ 20 MG CAPSULEtasimelteon

BRAND

QL

PA

S Specialty Drug

MODAFINIL (100 MG, 200 MG) generic PA

ROZEREM 8 MG TABLETramelteon

BRAND

ST

C

must try zolpidem andzoleplon for at least 2weeks of therapy in thepast 90 days

SECONAL SODIUM 100 MG CAPSULEsecobarbital sodium

BRAND

XYREM 500 MG/ML ORAL SOLUTIONsodium oxybate


THERAPEUTIC NUTRIENTS/MINERALS/ELECTROLYTES

ELECTROLYTE/MINERAL MODIFIERS

CHEMET 100 MG CAPSULEsuccimer

BRAND

EXJADE (500 MG, 250 MG, 125 MG)deferasirox

BRAND PA

FERRIPROX 500 MG TABLETdeferiprone


KIONEX (15 GM/60 ML SUSPENSION, POWDER)sodium polystyrene sulfonate

BRAND

MARLEXATE POWDERsodium polystyrene sulfonate

BRAND

SAMSCA (30 MG, 15 MG) BRAND S Specialty Drug



tolvaptan

SODIUM POLYSTYRENE SULFONATE (POWDER,30G/120ML ENEMA, 15 G/60 ML ORAL SUSP)

generic

SPS (15 GM/60 ML SUSPENSION, 30 GM/120 MLENEMA)sodium polystyrene sulfonate

BRAND

ELECTROLYTE/MINERAL REPLACEMENT

0.9 % SODIUM CHLORIDE (0.9 0.9 IV SOLN, 0.9 0.9SYRINGE, 0.9 PGGYBK PRT, 0.9 0.9 VIAL, 0.9 PGY VLPRT)

generic

CALCIUM CHLORIDE (100 MG/ML VIAL, 100 MG/MLSYRINGE)

generic

calcium gluconate 100 mg/ml vial generic

calcium/mag/d3/b12/fa/b6/boron 500-300-1 wafer generic

CARBAGLU 200 MG DISPER TABLETcarglumic acid


CENTRATEX CAPSULEferrous fumarate/folic acid/multivitamins with min no. 15

BRAND

chromic chloride 4mcg/ml vial generic

CORVITA 150 TABLETiron,carbonyl/folic acid/vit c/pyridoxine hcl/vit b12/zinc

BRAND

cupric chloride 0.4 mg/ml vial generic

DELFLEX WITH 1.5% DEXTROSEperitoneal dialysis no.6 with dextrose 1.5 %

BRAND


BRAND


BRAND

DEXTROSE 10 % AND 0.2 % SODIUM CHLORIDE (100.2 10 DEHP FR BG, 10 0.2 10 IV SOLN)

generic

dextrose 10 % and 0.45 % nacl 10%-0.45% iv soln generic

dextrose 10 % and 0.9 % nacl 10 %-0.9 % iv soln generic

dextrose 2.5 % and 0.45 % nacl 2.5%-0.45% iv soln generic



dextrose 5 %-0.2 % nacl 5 %-0.2 % iv soln generic

dextrose 5 %-0.45 % nacl 5 %-0.45 % iv soln generic



dextrose 5% in ringers 5 % iv soln generic

dextrose 5%-lactated ringers 5 % iv soln generic

EFFER-K 25 MEQ TABLET EFFpotassium bicarbonate/citric acid

BRAND

electrolyte-48 solution/d5w 5 % iv soln generic

FE 90 PLUS TABLETiron carbonyl,gluc/folic acid/vit b12/vit c/docusate sodium

BRAND

FE C PLUS TABLETiron,carbonyl/ascorbic acid/cyanocobalamin/folic acid

BRAND

FEROCON CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

FEROTRINSIC CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

FERRAPLUS 90 TABLETiron,carbonyl/folic acid/vitamin b12/vitamin c/docusate na

BRAND

FERREX 150 FORTE CAPSULEiron polysaccharide complex/cyanocobalamin/folic acid

BRAND

FERREX 150 FORTE PLUS CAPSULEiron asp gly&ps cmplx/ascorb.cal/vit b12/fa/ca-thr/succ.acid

BRAND

FERREX 28 TABLETiron asp.glycin & fumarate /vit c/fa/mv comb 11/ca-threonate

BRAND

FERROCITE PLUS TABLETiron/folic acid/vitamin b comp and c/minerals

BRAND

FERROGELS FORTE SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND

FOCALGIN DSS TABLETiron carbonyl,gluc/folic acid/vit b12/vit c/docusate sodium

BRAND

FOLIVANE-F CAPSULEiron fumarate & polysac comp/folic acid/vitamin c/niacin

BRAND

FOLIVANE-PLUS CAPSULEiron fumarate,polysac cplex/folic acid/vit b comp with c #9

BRAND

HEMATINIC-FOLIC ACID TABLETferrous fumarate/folic acid

BRAND

HEMATINIC-VITAMIN-MINERAL TABiron/folic acid/vitamin b comp and c/minerals

BRAND

HEMATOGEN FA SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND

HEMATOGEN FORTE SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND



HEMATOGEN SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/stomachconc

BRAND

HEMETAB IRON SUPPLEMENT TABLETiron polysacchar complx/iron heme polypeptide/folicacid/b12

BRAND

K EFFERVESCENT 25 MEQ TABLETpotassium bicarbonate/citric acid

BRAND

K-PHOS ORIGINAL TABLETpotassium phosphate,monobasic

BRAND

K-SOL (10% (20, 20% (40)potassium chloride

BRAND

K-TAB ER 8 MEQ TABLETpotassium chloride

BRAND

KLOR-CON (25, 20)potassium chloride

BRAND

KLOR-CON 10 MEQ TABLETpotassium chloride

BRAND

KLOR-CON 8 MEQ TABLETpotassium chloride

BRAND

KLOR-CON M10 TABLETpotassium chloride

BRAND


BRAND


BRAND

KLOR-CON SPRINKLE (ER 8 CAP, ER 10 CP)potassium chloride

BRAND

KLOR-CON-EF 25 MEQ TAB EFFpotassium bicarbonate/citric acid

BRAND

magnesium chloride 200 mg/ml vial generic

MAGNESIUM SULFATE (4 SYRINGE, 4 VIAL) generic

MAGNESIUM SULFATE IN STERILE WATER (4 G/50 MLPIGGYBACK, 20 G/500ML IV SOLN, 4 G/100 MLPIGGYBACK, 40G/1000ML IV SOLN, 2 G/50 MLPIGGYBACK)

generic

manganese chloride 0.1 mg/ml vial generic

manganese sulfate 0.1 mg/ml vial generic

molybdenum(ammonium molybdate) 25 mcg/ml vial generic

MONOJECT 0.9% SODIUM CL SYRING BRAND



0.9 % sodium chloride

MONOJECT PREFILL 0.9% FLUSH0.9 % sodium chloride

BRAND

MONOJECT PREFILL 0.9% NA SYR0.9 % sodium chloride

BRAND

MULTIGEN CAPLETiron aspgly/ascorb.cal/vit b12/calciumthr/succ.acid/stomach

BRAND

MULTIGEN FOLIC CAPLETiron asp gly/ascorb.cal/vit b12/fa/ca-threonte/succinic acid

BRAND

MULTIGEN PLUS CAPLETiron fumarte &asp gly/ascorb.cal/vit b12/fa/ca-thr/succ.acid

BRAND

MULTITRACE-4 CONC VIALzinc sulfate/cupric sulfate/manganese sulf/chromic chloride

BRAND

MULTITRACE-5 CONC VIALzinc sulfate heptahydrate/cuso4 p-hyd/manganese/chromium/se

BRAND

NATALVIRT FLT TABLETiron carbonyl,gluc/folic acid/vit b12/vit c/docusate sodium

BRAND

NUTRILYTE II VIALsodium/potassium/magnesium/calcium/chloride/acetate

BRAND

NUTRILYTE VIALsodium/potassium/magnes/calcium/chloride/acetate/gluconate

BRAND

POLYSACCHARIDE IRON FORTEiron polysaccharide complex/cyanocobalamin/folic acid

BRAND

pot chloride/pot bicarb/cit ac 25 meq tablet eff generic

POTASSIUM ACETATE (2, 4) generic

potassium bicarbonate/cit ac 25 meq tablet eff generic

POTASSIUM CHLORIDE (40MEQ/0.1L PIGGYBACK, 10MEQ TAB ER PRT, 8 MEQ CAPSULE ER, 8 MEQTABLET ER, 10 MEQ CAPSULE ER, 10MEQ/50MLPIGGYBACK, 2 MEQ/ML VIAL, 20MEQ/50MLPIGGYBACK, 20 MEQ PACKET, 20MEQ/15ML LIQUID,10 MEQ TABLET ER, 30MEQ/0.1L PIGGYBACK,20MEQ/0.1L PIGGYBACK, 2 MEQ/ML IV SOLN, 20 MEQTABLET ER, 20 MEQ TAB ER PRT, 40MEQ/15MLLIQUID, 10MEQ/0.1L PIGGYBACK)

generic

POTASSIUM CHLORIDE IN 0.9 % SODIUM CHLORIDE(20, 40)

generic

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN WATER(40, 20, 30)

generic



POTASSIUM CHLORIDE IN DEXTROSE 5 % AND 0.9 %SODIUM CHLORIDE (40, 20)

generic

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 %SODIUM CHLORIDE (20, 10, 30, 40)

generic

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 %SODIUM CHLORIDE (10, 20, 40, 30)

generic

POTASSIUM CHLORIDE IN LACTATED RINGERS AND 5% DEXTROSE (40, 20)

generic

potassium chloride-0.45% nacl 20 meq/l iv soln generic

potassium chloride/d5-0.3%nacl 20 meq/l iv soln generic

potassium phos in 0.9 % nacl 15mmol/250 plast. bag generic

potassium phos,m-basic-d-basic 3mmol/ml vial generic

PROFERRIN-FORTE TABLETiron heme polypeptide/folic acid

BRAND

PUREVIT DUALFE PLUS CAPSULEiron fumarate-iron polysacchar/folic acid/mv comb18

BRAND

ringers solution iv soln generic

ringers solution,lactated iv soln generic

SE-TAN PLUS CAPSULEiron fumarate-iron polysacchar/folic acid/mv comb18

BRAND

selenium 40 mcg/ml vial generic

SODIUM ACETATE (4, 2) generic

SODIUM BICARBONATE (1 MEQ/ML SYRINGE,0.5MEQ/ML SYRINGE, 0.9MEQ/ML SYRINGE, 1 MEQ/MLVIAL, 10MEQ/10ML SYRINGE, 0.5MEQ/ML VIAL)

generic

SODIUM CHLORIDE 0.45 % (0.45 PGGYBK PRT, 0.450.45 IV SOLN)

generic

sodium chloride 3 % 3 % iv soln generic

sodium chloride 5 % 5 % iv soln generic

sodium lactate 5 meq/ml vial generic

sodium phos,m-basic-d-basic 3mmol/ml vial generic

SYREX SODIUM CHL 0.9% SYR0.9 % sodium chloride

BRAND

TARON FORTE CAPSULEiron bisgly,pscmplx/ascorbate calc/b12/folic acid/calc-threo

BRAND

TL ICON CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

TL-HEM 150 CAPLET BRAND



iron,carbonyl/docusate sodium/b12-if/folic acid/multivit-min

TRICON CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

TRIGELS-F FORTE SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND

zinc chloride 1 mg/ml vial generic

ZINC SULFATE (1 MG/ML VIAL, 5 MG/ML VIAL,220(50)MG CAPSULE)

generic

AMINO ACIDS 15% SOLUTIONparenteral amino acid 15% combination no.1

BRAND

ascorbic acid 500 mg/ml vial generic

BAL-CARE DHA COMBO PACKprenatal vitamin no.81/sodium feredetate-ironpoly/fa/omega3

BRAND PA

cyanocobalamin (vitamin b-12) 1000mcg/ml vial generic

cysteine hcl 50 mg/ml vial generic

DEXTROSE 10 % IN WATER (10 10 IV SOLN, 10 10DEHP FR BG)

generic

dextrose 2.5 % in water 2.5 % iv soln generic

dextrose 20 % in water 20 % iv soln generic

dextrose 25 % in water 25 % syringe generic



DEXTROSE 5 % IN WATER (5 5 IV SOLN, 5 PGY VLPRT, 5 5 VIAL, 5 PGGYBK PRT)

generic

DEXTROSE 50 % IN WATER (50 50 IV SOLN, 50 50VIAL, 50 50 SYRGE)

generic


DIALYVITE TABLETfolic acid/vitamin b comp and c

BRAND

ergocalciferol (vitamin d2) 50000 unit capsule generic

ethyl alcohol 98 % ampul generic

FLUOR-A-DAY (1 MG TABLET, 0.25 MG TAB, 0.5 MGTAB)sodium fluoride/xylitol

BRAND

FOLBEE PLUS TABLETfolic acid/vitamin b comp and c

BRAND

FOLIC ACID (5 MG/ML VIAL, 1 MG TABLET) generic



FREAMINE III 10% IV SOLN.parenteral amino acid 10% combination no. 4

BRAND

INFED 100 MG/2 ML VIALiron dextran complex

BRANDPA

S Specialty Drug

levocarnitine (with sugar) 100 mg/ml solution generic

levocarnitine 330 mg tablet generic

LEVOMEFOLATE CALCIUM/SCHIZOCHYTRIUM ALGALOIL (7.5-90.314, 15-90.314)

generic

LIPOSYN III (20%, 10%, 30%)fat emulsions

BRAND

MEPHYTON 5 MG TABLETphytonadione

BRAND

MYNATAL PLUS CAPTABprenatal vitamins with calcium/ferrous fumarate/folic acid

BRAND

MYNATAL-Z CAPTABprenatal vitamins with calcium/ferrous fumarate/folic acid

BRAND

MYNEPHROCAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

NEPHPLEX RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin/znox

BRAND

NEPHRO-VITE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND

NIVA-PLUS TABLETprenatal vits with calcium #74/ferrous fumarate/folic acid

BRAND

NUTRILIPID 20% IV FAT EMULSIONfat emulsions

BRAND

pedi mv #75/fluoride/iron 0.25-10/ml drops generic

PHYTONADIONE (10 MG/ML, 1MG/0.5ML) generic

PNV 29-1 TABLETprenatal vits with calcium #76/iron,carbonyl/folic acid

BRAND

pnv with ca,no.72/iron/fa 27 mg-1 mg tablet generic

pnv with ca,no.74/iron/fa 27 mg-1 mg tablet generic

PNV-SELECT TABLETprenatal vit with calcium no. 40/iron fumarate/fa cmb no.1

BRAND

PNV-VP-U CAPSULEprenatal vits without calc no5/ferrous fumarate/folic acid

BRAND

PREMASOL 10% IV SOLUTIONparenteral amino acid 10% combination no.7

BRAND



PRENA1 CHEW TABLETprenatal vitamins combination no.42/folic acid

BRAND

PRENAPLUS TABLETprenatal vits with calcium #74/ferrous fumarate/folic acid

BRAND

PRETAB 29 MG-1 MG TABLETprenatal vits with calcium #78/ferrous fumarate/folic acid

BRAND

RENA-VITE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND

RENAL CAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

RENO CAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

ringers solution irrig soln generic

ringers solution,lactated irrig soln generic

sodium fluoride 0.25(0.55) tab chew generic

THERAPEUTIC VIT-MINERAL CAPmultivitamins with min no.7/folic acid

BRAND

thiamine hcl 100 mg/ml vial generic

THRIVITE RX TABLETprenatal vits with calcium #76/iron,carbonyl/folic acid

BRAND

TL G-FOL OS TABLETcalcium carb/mag oxide/vitamin d3/vit b12/fa/vit b6/boron

BRAND

TRAVASOL 10% SOLN VIAFLEXparenteral amino acid 10% combination no. 6

BRAND

ULTIMATE OB DHA COMBO PACKprenatal vitamin combo no.8/iron ps cmplx & aspgl/fa/dha

BRAND

VENA-BAL DHA COMBO PACKprenatal vitamin no.81/sodium feredetate-ironpoly/fa/omega3

BRAND PA

VIRT NATE TABLETprenatal vits with calcium #73/ferrous fumarate/folic acid

BRAND

VIRT-ADVANCE TABLETprenatal vitamin no.15/iron,carbonyl/folic acid/docusate sod

BRAND

VIRT-CAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

VIRT-NATE DHA SOFTGELprenatal vitamins no.11/ferrous fumarate/folic acid/omega-3

BRAND

VIRT-NATE TABLETprenatal vits with calcium #73/ferrous fumarate/folic acid

BRAND



VIRT-PN TABLETprenatal vit with calcium no. 40/iron fumarate/fa cmb no.1

BRAND

VIRT-VITE GT TABLETprenatal vitamin no.16/iron,carbonyl/folic acid/docusate sod

BRAND

VIRTPREX CAPSULEprenatal vit with calcium no.66/iron fum/folic acid/dss/dha

BRAND

VITAFOL-OB CAPLETprenatal vitamins comb 10/ferrous fumarate/folic acid

BRAND

VITAFOL-PN CAPLETprenatal vit with calcium cmb 11/ferrous fumarate/folic acid

BRAND

VOL-CARE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND

VOL-PLUS TABLETprenatal vits with calcium #74/ferrous fumarate/folic acid

BRAND

VP-VITE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND


Index of covered drugs00.9 % SODIUM CHLORIDE 116

88-MOP 67

AA-HYDROCORT 81

A-METHAPRED 81

ABACAVIR SULFATE 45

ABACAVIR SULFATE/LAMIVUDINE 45

ABACAVIR SULFATE/LAMIVUDINE/ZIDOVUDINE 45

ABILIFY 41

ABILIFY DISCMELT 41

ABILIFY MAINTENA 41

ABIRATERONE ACETATE 32

ABRAXANE 33

ABSORICA 67

ACAMPROSATE CALCIUM 14

ACARBOSE 48

ACD 50

ACD-A 50

ACEBUTOLOL HCL 56

ACETAMINOPHEN WITH CODEINE PHOSPHATE 8

ACETASOL HC 102

ACETAZOLAMIDE 60

ACETAZOLAMIDE SODIUM 60

ACETIC ACID 102

ACETIC ACID/ALUMINUM ACETATE 103

ACETIC ACID/HYDROCORTISONE 103

ACETIC ACID/OXYQUINOLINE SULFATE 80

ACETYLCYSTEINE 109

ACITRETIN 67

ACLIDINIUM BROMIDE 106

ACTEMRA 95

ACTIMMUNE 95

ACTOPLUS MET XR 48

ACYCLOVIR 47

ACYCLOVIR SODIUM 46

ADACEL TDAP 96

ADALIMUMAB 94

ADAPALENE 67

ADCIRCA 108

ADEFOVIR DIPIVOXIL 43

ADEMPAS 108

ADENOSINE 56

ADO-TRASTUZUMAB EMTANSINE 37

ADRENALIN 106

ADRENALIN CHLORIDE 106

ADRIAMYCIN 33

ADRUCIL 32

ADVATE 52

ADVATE H 52

ADVATE L 52

ADVATE M 52

ADVATE SH 52

ADVATE UH 52

AERO OTIC HC 103

AFATINIB DIMALEATE 36

AFEDITAB CR 57

AFINITOR 36

AFINITOR DISPERZ 36

AGALSIDASE BETA 75

AKORN BALANCED SALT 99

ALAGESIC LQ 64

ALBENDAZOLE 38

ALBENZA 38

ALBUMIN HUMAN 97

ALBUTEIN 97

ALBUTEROL SULFATE 106

ALCLOMETASONE DIPROPIONATE 67

ALDURAZYME 74

ALENDRONATE SODIUM 97

ALFENTANIL HCL 8

ALFUZOSIN HCL 79

ALGLUCOSIDASE ALFA 75

ALIMTA 32

ALINIA 38

ALKERAN 31

ALLOPURINOL 29

ALLOPURINOL SODIUM 29


ALMOTRIPTAN MALATE 29

ALOPRIM 29

ALOSETRON HCL 77

ALPHA-1-PROTEINASE INHIBITOR 110

ALPHAGAN P 102

ALPHANATE 52

ALPHAQUIN HP 67

ALPRAZOLAM 47

ALPRAZOLAM INTENSOL 47

ALPROSTADIL 58

ALTACAINE 99

ALTAFLUOR 99

ALTAVERA 84

ALTRETAMINE 31

ALUMINUM CHLORIDE 70

ALYACEN 84

AMANTADINE HCL 39

AMBRISENTAN 108

AMCINONIDE 67

AMETHIA 84

AMETHIA LO 84

AMETHYST 84

AMIFOSTINE CRYSTALLINE 33

AMIKACIN SULFATE 14

AMILORIDE HCL 61

AMILORIDE HCL/HYDROCHLOROTHIAZIDE 58

AMINO ACIDS 117

AMINOACETIC ACID 79

AMINOCAPROIC ACID 52

AMINOPHYLLINE 107

AMIODARONE HCL 56

AMITRIPTYLINE HCL 25

AMITRIPTYLINE HCL/CHLORDIAZEPOXIDE 24

AMLODIPINE BESYLATE 57

AMLODIPINE BESYLATE/ATORVASTATIN

CALCIUM 58

AMLODIPINE BESYLATE/BENAZEPRIL HCL 58

AMLODIPINE BESYLATE/VALSARTAN 58

AMLODIPINE

BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE

58

AMMONIUM LACTATE 70

AMNESTEEM 67

AMOXAPINE 26

AMOXICILLIN 19

AMOXICILLIN/POTASSIUM CLAVULANATE 19

AMPHOTERICIN B 27

AMPICILLIN SODIUM 19

AMPICILLIN SODIUM/SULBACTAM SODIUM 19

AMPICILLIN TRIHYDRATE 19

AMPYRA 65

AMYL NITRITE 62

ANAGRELIDE HCL 51

ANASPAZ 75

ANASTROZOLE 35

ANDROGEL 83

ANDROXY 83

ANECTINE 110

ANTHRALIN 69

ANTI-INHIBITOR COAGULANT COMPLEX 53

ANTIHEMOPHILIC FACTOR (FACTOR VIII)

RECOMB,B-DOMAIN DELETED 54

ANTIHEMOPHILIC FACTOR (FVIII) RECOMB,FULL

LENGTH (ALB-FREE) 53

ANTIHEMOPHILIC FACTOR (FVIII) RECOMBINANT,

FC FUSION PROTEIN 53

ANTIHEMOPHILIC FACTOR VIII RECOMBINANT, B-

DOMAIN TRUNCATED 53

ANTIHEMOPHILIC FACTOR VIII, HUMAN

RECOMBINANT 54

ANTIHEMOPHILIC FACTOR, HUMAN 53

ANTIHEMOPHILIC FACTOR, HUMAN/VON

WILLEBRAND FACTOR,HUMAN 53

ANTIPYRINE/BENZOCAINE 103

ANTIPYRINE/BENZOCAINE/GLYCERIN/ZINC

ACETATE 103

APEXICON 67

APEXICON E 67

APLIGRAF 98

APOKYN 39

APOMORPHINE HCL 39

APRACLONIDINE HCL 102


APREPITANT 26

APRI 84

APRISO 96

APTIVUS 45

ARALAST 109

ARALAST NP 109

ARANELLE 84

ARBINOXA 104

ARCALYST 95

ARGATROBAN IN SODIUM CHLORIDE, ISO-

OSMOTIC 50

ARIPIPRAZOLE 41

ARMOUR THYROID 91

ARNUITY ELLIPTA 103

ARRANON 33

ARSENIC TRIOXIDE 35

ARTEMETHER/LUMEFANTRINE 38

ARZERRA 37

ASCOMP WITH CODEINE 8

ASCORBIC ACID 117

ASFOTASE ALFA 75

ASHLYNA 84

ASPIRIN/DIPYRIDAMOLE 54

ASTRAMORPH-PF 9

ATAZANAVIR SULFATE 46

ATENOLOL 56

ATENOLOL/CHLORTHALIDONE 58

ATOMOXETINE HCL 64

ATORVASTATIN CALCIUM 61

ATOVAQUONE 38

ATOVAQUONE/PROGUANIL HCL 38

ATRACURIUM BESYLATE 64

ATRIPLA 44

ATROPINE CARE 99

ATROPINE SULFATE 99

ATROVENT HFA 105

AUBRA 84

AURANOFIN 96

AURODEX 103

AUROGUARD 103

AVAR 67

AVASTIN 37

AVELOX IV 20

AVIANE 84

AVIDOXY 21

AVITA 67

AVITENE 98

AVONEX 65

AVONEX ADMINISTRATION PACK 65

AVONEX PEN 65

AXITINIB 36

AZASAN 93

AZATHIOPRINE 93

AZELASTINE HCL 104

AZITHROMYCIN 20

AZTREONAM 19

AZTREONAM LYSINE 106

AZURETTE 84

BB-DONNA 76

BACIIM 15

BACITRACIN 15

BACITRACIN/POLYMYXIN B SULFATE 101

BACLOFEN 110

BACTROBAN NASAL 15

BAL-CARE DHA 117

BALANCED SALT IRRIG SOLN NO.2 100

BALSALAZIDE DISODIUM 96

BALZIVA 84

BANZEL 23

BARACLUDE 43

BCG LIVE 35

BEBULIN 52

BEBULIN VH IMMUNO 52

BECAPLERMIN 72

BECLOMETHASONE DIPROPIONATE 104

BEDAQUILINE FUMARATE 30

BEKYREE 84

BELATACEPT 94

BELIMUMAB 95

BENAZEPRIL HCL 55


BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE 58

BENDAMUSTINE HCL 31

BENEFIX 52

BENLYSTA 95

BENOXINATE HCL/FLUORESCEIN SODIUM 100

BENZEPRO 67

BENZONATATE 109

BENZOYL PEROXIDE 68

BENZOYL PEROXIDE MICROSPHERES 73

BENZPHETAMINE HCL 64

BENZTROPINE MESYLATE 39

BETAINE 75

BETAMETHASONE ACETATE/BETAMETHASONE

SODIUM PHOSPHATE 81

BETAMETHASONE DIPROPIONATE 67

BETAMETHASONE DIPROPIONATE/PROPYLENE

GLYCOL 67

BETAMETHASONE VALERATE 68

BETAXOLOL HCL 102

BETHANECHOL CHLORIDE 80

BEVACIZUMAB 37

BEXAROTENE 38

BEXXAR 37

BICALUTAMIDE 32

BICNU 31

BIMATOPROST 102

BIOGLO 99

BISACODYL/SODIUM CHLOR/SODIUM

BICARB/POTASSIUM CHL/PEG 3350 77

BISOPROLOL FUMARATE 56

BISOPROLOL

FUMARATE/HYDROCHLOROTHIAZIDE 58

BIVIGAM 95

BLISOVI 24 FE 84

BLISOVI FE 84

BOCEPREVIR 44

BOSENTAN 108

BOSULIF 36

BOSUTINIB 36

BP 10-1 68

BP-50% UREA 68

BPO 68

BREO ELLIPTA 109

BRIELLYN 84

BRILINTA 54

BRIMONIDINE TARTRATE 102

BROMFENAC SODIUM 101

BROMOCRIPTINE MESYLATE 39

BSS 100

BUDEPRION XL 24

BUDESONIDE 104

BUDESONIDE/FORMOTEROL FUMARATE 110

BUFFERED LIDOCAINE 12

BUMETANIDE 60

BUPHENYL 75

BUPIVACAINE HCL 13

BUPIVACAINE HCL/DEXTROSE-WATER/PF 12

BUPIVACAINE HCL/EPINEPHRINE 13

BUPIVACAINE HCL/EPINEPHRINE/PF 12

BUPIVACAINE HCL/PF 13

BUPRENORPHINE HCL 14

BUPRENORPHINE HCL/NALOXONE HCL 14

BUPROBAN 14

BUPROPION HCL 24

BUSPIRONE HCL 47

BUSULFAN 31

BUSULFEX 31

BUTALBITAL/ACETAMINOPHEN 65

BUTALBITAL/ACETAMINOPHEN/CAFFEINE 65

BUTALBITAL/ACETAMINOPHEN/CAFFEINE/CODEIN

E PHOSPHATE 9

BUTALBITAL/ASPIRIN/CAFFEINE 64

BUTOCONAZOLE NITRATE 28

BUTORPHANOL TARTRATE 9

BYDUREON 48

BYDUREON PEN 48

BYETTA 48

CCABERGOLINE 92

CAFFEINE CITRATED 107

CAFFEINE/SODIUM BENZOATE 111


CALCIPOTRIENE 68

CALCIPOTRIENE/BETAMETHASONE

DIPROPIONATE 68

CALCITONIN,SALMON,SYNTHETIC 97

CALCITRENE 68

CALCITRIOL 97

CALCIUM ACETATE 81

CALCIUM CARB/MAG OXIDE/VITAMIN D3/VIT

B12/FA/VIT B6/BORON 119

CALCIUM CHLORIDE 112

CALCIUM GLUCONATE 112

CAMILA 90

CAMRESE 84

CAMRESE LO 85

CANAGLIFLOZIN 48

CANAGLIFLOZIN/METFORMIN HCL 48

CANAKINUMAB/PF 95

CANASA 96

CANCIDAS 27

CANDESARTAN CILEXETIL 55

CANDESARTAN

CILEXETIL/HYDROCHLOROTHIAZIDE 58

CAPACET 64

CAPECITABINE 32

CAPRELSA 36

CAPTOPRIL 55

CAPTOPRIL/HYDROCHLOROTHIAZIDE 58

CARAFATE 78

CARB-O-PHILIC 68

CARBACHOL 102

CARBAGLU 112

CARBAMAZEPINE 23

CARBIDOPA 40

CARBIDOPA/LEVODOPA 40

CARBIDOPA/LEVODOPA/ENTACAPONE 39

CARBINOXAMINE MALEATE 105

CARBOCAINE 13

CARBOPLATIN 33

CARBOPROST TROMETHAMINE 80

CARDIOPLEGIC SOLUTION NO.1 58

CARGLUMIC ACID 112

CARISOPRODOL 110

CARMUSTINE 31

CARTEOLOL HCL 102

CARTIA XT 57

CARVEDILOL 56

CASPOFUNGIN ACETATE 27

CAYSTON 106

CAZIANT 85

CEFACLOR 17

CEFADROXIL 17

CEFAZOLIN SODIUM 17

CEFAZOLIN SODIUM IN 0.9 % SODIUM

CHLORIDE 18

CEFAZOLIN SODIUM/DEXTROSE 5 % IN WATER 18

CEFAZOLIN SODIUM/DEXTROSE, ISO-OSMOTIC 18

CEFDINIR 18

CEFDITOREN PIVOXIL 18

CEFEPIME HCL 18

CEFEPIME HCL/DEXTROSE, ISO-OSMOTIC 18

CEFIXIME 18

CEFOTAXIME SODIUM 18

CEFOTETAN DISODIUM 18

CEFOXITIN SODIUM 18

CEFOXITIN SODIUM/DEXTROSE, ISO-OSMOTIC 18

CEFPODOXIME PROXETIL 18

CEFPROZIL 18

CEFTAZIDIME 18

CEFTIBUTEN 18

CEFTRIAXONE SODIUM 18

CEFTRIAXONE SODIUM/DEXTROSE, ISO-

OSMOTIC 18

CEFUROXIME AXETIL 18

CEFUROXIME SODIUM 18

CEFUROXIME SODIUM/DEXTROSE, ISO-

OSMOTIC 18

CELEBREX 5

CELECOXIB 5

CELLCEPT 93

CELONTIN 22

CEM-UREA 68

CENTERGY 109


CENTRATEX 112

CEPHALEXIN 18

CERITINIB 37

CERUBIDINE 33

CETUXIMAB 37

CEVIMELINE HCL 66

CHANTIX 14

CHATEAL 85

CHEMET 111

CHENODAL 76

CHENODIOL 76

CHLORAMBUCIL 31

CHLORAMPHENICOL SOD SUCC 15

CHLORDIAZEPOXIDE HCL 47

CHLORDIAZEPOXIDE/CLIDINIUM BROMIDE 76

CHLORHEXIDINE GLUCONATE 66

CHLOROPROCAINE HCL/PF 13

CHLOROQUINE PHOSPHATE 38

CHLOROTHIAZIDE 61

CHLOROTHIAZIDE SODIUM 61

CHLORPHENIRAMINE MALEATE/PHENYLEPHRINE

HCL 109

CHLORPROMAZINE HCL 40

CHLORTHALIDONE 61

CHLORZOXAZONE 110

CHOLESTYRAMINE (WITH SUGAR) 62

CHOLESTYRAMINE/ASPARTAME 62

CHOLINE SALICYLATE/MAGNESIUM SALICYLATE 5

CHORIONIC GONADOTROPIN, HUMAN 83

CHROMIC CHLORIDE 112

CICLODAN 27

CICLOPIROX 27

CICLOPIROX OLAMINE 27

CICLOPIROX/UREA/CAMPHOR/MENTHOL/EUCALY

PTOL 27

CIDOFOVIR 42

CILOSTAZOL 54

CIMETIDINE 77

CIMETIDINE HCL 77

CINACALCET HCL 92

CIPRO 20

CIPRODEX 103

CIPROFLOXACIN 20

CIPROFLOXACIN HCL 100

CIPROFLOXACIN HCL/DEXAMETHASONE 103

CIPROFLOXACIN LACTATE 20

CIPROFLOXACIN LACTATE/DEXTROSE 5 % IN

WATER 21

CIPROFLOXACIN/CIPROFLOXACIN HCL 21

CISPLATIN 33

CITALOPRAM HYDROBROMIDE 25

CITRATE DEXTROSE SOLUTION 50

CITRATE PHOSPHATE DEXTROS SOLN 50

CITRIC ACID/GLUCONOLACTONE/MAGNESIUM

CARBONATE 80

CITRIC ACID/SODIUM CITRATE 81

CLADRIBINE 32

CLARAVIS 68

CLARIS 68

CLARITHROMYCIN 20

CLEANSING WASH 68

CLEMASTINE FUMARATE 104

CLINDACIN ETZ 68

CLINDACIN P 68

CLINDAMYCIN HCL 15

CLINDAMYCIN PALMITATE HCL 15

CLINDAMYCIN PHOSPHATE 68

CLINDAMYCIN PHOSPHATE/BENZOYL

PEROXIDE 71

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN

WATER 15

CLOBAZAM 22

CLOBETASOL PROPIONATE 69

CLOBETASOL PROPIONATE/EMOLLIENT BASE 68

CLODAN 68

CLOMIPRAMINE HCL 26

CLONAZEPAM 47

CLONIDINE 54

CLONIDINE HCL 63

CLONIDINE HCL/CHLORTHALIDONE 59

CLONIDINE HCL/PF 54

CLOPIDOGREL BISULFATE 54


CLORAZEPATE DIPOTASSIUM 47

CLORPRES 59

CLOTRIMAZOLE/BETAMETHASONE

DIPROPIONATE 69

CLOZAPINE 42

COAGULATION FACTOR VIIA (RECOMBINANT) 53

COAL TAR 98

COARTEM 38

COCAINE HCL 69

CODEINE

PHOSPHATE/BUTALBITAL/ASPIRIN/CAFFEINE 9

CODEINE SULFATE 9

COLCHICINE 29

COLCHICINE/PROBENECID 29

COLCRYS 29

COLESTIPOL HCL 62

COLISTIN (AS COLISTIMETHATE SODIUM) 15

COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 72

COLOCORT 96

COMBIVENT RESPIMAT 109

COMPLERA 44

COMPOUND 347 13

COMPRO 26

COPAXONE 65

CORIFACT 52

CORLANOR 59

CORLOPAM 62

CORMAX 69

CORTANE-B 103

CORTICOTROPIN 83

CORTIFOAM 96

CORTISONE ACETATE 81

CORVITA 150 112

COSYNTROPIN 82

CREON 75

CRIXIVAN 46

CRIZOTINIB 37

CROMOLYN SODIUM 109

CROTAMITON 39

CRYSELLE 85

CULT SKIN SUBST,HUMAN-BOVINE 98

CUPRIC CHLORIDE 112

CUPRIMINE 80

CYANOCOBALAMIN (VITAMIN B-12) 117

CYCLAFEM 85

CYCLOBENZAPRINE HCL 110

CYCLOPENTOLATE HCL 100

CYCLOPHOSPHAMIDE 31

CYCLOSPORINE 101

CYCLOSPORINE, MODIFIED 94

CYPROHEPTADINE HCL 104

CYRED 85

CYSTADANE 75

CYSTAGON 75

CYSTARAN 100

CYSTEAMINE BITARTRATE 75

CYSTEAMINE HCL 100

CYSTEINE HCL 117

CYTARABINE 32

CYTARABINE/PF 32

CYTRA-2 80

CYTRA-3 80

CYTRA-K 80

DDABIGATRAN ETEXILATE MESYLATE 51

DABRAFENIB MESYLATE 37

DACARBAZINE 31

DACTINOMYCIN 33

DALFAMPRIDINE 65

DANAZOL 83

DANTROLENE SODIUM 110

DAPSONE 30

DARAPRIM 38

DARUNAVIR ETHANOLATE 46

DASATINIB 36

DASETTA 85

DAUNORUBICIN CITRATE LIPOSOMAL 31

DAUNORUBICIN HCL 33

DAUNOXOME 31

DAYSEE 85

DEBACTEROL 66


DEBLITANE 90

DECITABINE 33

DEFERASIROX 111

DEFERIPRONE 111

DEFEROXAMINE MESYLATE 98

DELAVIRDINE MESYLATE 44

DELFLEX WITH 1.5% DEXTROSE 112



DELTASONE 81

DELYLA 85

DEMECLOCYCLINE HCL 21

DEMSER 59

DEPADE 14

DEPO-PROVERA 90

DERMAZENE 69

DESIPRAMINE HCL 26

DESLORATADINE 104

DESMOPRESSIN ACETATE 83

DESMOPRESSIN ACETATE (NON-

REFRIGERATED) 82

DESOGESTREL-ETHINYL ESTRADIOL 90

DESOGESTREL-ETHINYL ESTRADIOL/ETHINYL

ESTRADIOL 90

DESONIDE 69

DESOXIMETASONE 69

DEXAMETHASONE 81

DEXAMETHASONE INTENSOL 81

DEXAMETHASONE SOD PHOSPHATE 101

DEXAMETHASONE SODIUM PHOSPHATE/PF 81

DEXEDRINE 63

DEXMEDETOMIDINE HCL 98

DEXMETHYLPHENIDATE HCL 63

DEXPANTHENOL 77

DEXRAZOXANE HCL 33

DEXTRAN 40 IN 0.9 % SODIUM CHLORIDE 98

DEXTRAN 40/DEXTROSE 5 % IN WATER 98

DEXTROAMPHETAMINE SULF-

SACCHARATE/AMPHETAMINE SULF-

ASPARTATE 63

DEXTROAMPHETAMINE SULFATE 63

DEXTROMETHORPHAN HBR/QUINIDINE

SULFATE 64

DEXTROSE 10 % AND 0.2 % SODIUM

CHLORIDE 112


CHLORIDE 112


CHLORIDE 112

DEXTROSE 10 % IN WATER 117

DEXTROSE 2.5 % AND 0.45 % SODIUM

CHLORIDE 112

DEXTROSE 2.5 % IN WATER 117





DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE 112



CHLORIDE 112


DEXTROSE 5 % IN LACTATED RINGERS 113


DEXTROSE 5% IN RINGERS 112



DEXTROSE-WATER/SODIUM CITRATE/CITRIC

ACID 50

DIALYVITE 117

DIATRIZOATE MEGLUMINE/DIATRIZOATE

SODIUM 98

DIAZEPAM 47

DIAZOXIDE 50

DIBENZYLINE 55

DICLOFENAC POTASSIUM 5

DICLOFENAC SODIUM 101

DICLOFENAC SODIUM/MISOPROSTOL 5

DICLOXACILLIN SODIUM 19

DICYCLOMINE HCL 76

DIDANOSINE 45

DIETHYLPROPION HCL 64


DIFIL-G 400 107

DIFLORASONE DIACETATE 69

DIFLORASONE DIACETATE/EMOLLIENT BASE 67

DIFLUNISAL 5

DIGITEK 59

DIGOX 59

DIGOXIN 59

DIHYDROCODEINE

BITARTRATE/ACETAMINOPHEN/CAFFEINE 9

DIHYDROCODEINE

BITARTRATE/ASPIRIN/CAFFEINE 9

DIHYDROERGOTAMINE MESYLATE 29

DILANTIN 23

DILT-XR 57

DILTIAZEM HCL 58

DIMENHYDRINATE 26

DIMETHYL FUMARATE 66

DIOXYBENZONE/PADIMATE O/HYDROQUINONE 71

DIPHENHYDRAMINE HCL 104

DIPHENOXYLATE HCL/ATROPINE SULFATE 77

DIPHTHERIA,PERTUSSIS(ACELL),TETANUS

VACCINE/PF 96

DIPYRIDAMOLE 54

DISKETS 6

DISULFIRAM 14

DIVALPROEX SODIUM 22

DOBUTAMINE HCL 59

DOBUTAMINE HCL/DEXTROSE 5 % IN WATER 59

DOCETAXEL 33

DOFETILIDE 56

DOLUTEGRAVIR SODIUM 44

DONEPEZIL HCL 24

DOPAMINE HCL 59

DOPAMINE HCL/DEXTROSE 5 % IN WATER 59

DORNASE ALFA 109

DORZOLAMIDE HCL 102

DORZOLAMIDE HCL/TIMOLOL MALEATE 102

DOXAPRAM HCL 109

DOXAZOSIN MESYLATE 55

DOXEPIN HCL 26

DOXERCALCIFEROL 97

DOXIL 34

DOXORUBICIN HCL 34

DOXORUBICIN HCL PEGYLATED LIPOSOMAL 34

DOXYCYCLINE HYCLATE/EYELID CLNS

NO.3/EYELID EMOLLIENT NO.1 21

DOXYCYCLINE MONOHYDRATE 21

DRITHOCREME HP 69

DRONABINOL 26

DROPERIDOL 40

DROXIA 32

DROXIDOPA 60

DRYSOL 69

DULERA 109

DULOXETINE HCL 65

DURAMORPH 9

DUTASTERIDE 79

DUTASTERIDE/TAMSULOSIN HCL 79

EE.E.S. 200 20

E.E.S. 400 20

ECHOTHIOPHATE IODIDE 102

ECONAZOLE NITRATE 27

ECULIZUMAB 99

ED-SPAZ 76

EDROPHONIUM CHLORIDE 30

EDURANT 44

EFAVIRENZ 45

EFAVIRENZ/EMTRICITABINE/TENOFOVIR

DISOPROXIL FUMARATE 44

EFFER-K 113

EFFIENT 54

EGRIFTA 93

ELAPRASE 75

ELASTIDERM 71

ELECTROLYTE-48 SOLUTION/DEXTROSE 5 % IN

WATER 113

ELELYSO 75

ELINEST 85

ELIPHOS 81

ELITEK 33


ELMIRON 80

ELOCTATE 53

ELOXATIN 34

ELTROMBOPAG OLAMINE 52

ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TEN

OFOVIR 44

EMCYT 32

EMEND 26

EMOQUETTE 85

EMTRICITABINE 45

EMTRICITABINE/RILPIVIRINE HCL/TENOFOVIR

DISOPROXIL FUMARATE 44

EMTRICITABINE/TENOFOVIR DISOPROXIL

FUMARATE 45

EMTRIVA 45

ENALAPRIL MALEATE 55

ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE 59

ENALAPRILAT DIHYDRATE 55

ENBREL 93

ENDO-AVITENE 98

ENDOCET 9

ENDODAN 9

ENDOMETRIN 90

ENFLURANE 13

ENFUVIRTIDE 45

ENLON 30

ENOXAPARIN SODIUM 50

ENPRESSE 85

ENSKYCE 85

ENTACAPONE 39

ENTECAVIR 43

ENULOSE 77

ENZALUTAMIDE 32

EPHEDRINE SULFATE 59

EPINASTINE HCL 101

EPINEPHRINE 106

EPINEPHRINE HCL/PF 106

EPINEPHRINE/PF 106

EPIPEN 2-PAK 106

EPIPEN JR 2-PAK 106

EPIRUBICIN HCL 34

EPITOL 23

EPIVIR 45

EPIVIR HBV 43

EPLERENONE 61

EPOETIN ALFA 52

EPOPROSTENOL SODIUM (ARGININE) 108

EPOPROSTENOL SODIUM (GLYCINE) 108

EPROSARTAN MESYLATE 55

EPTIFIBATIDE 54

EPZICOM 45

ERBITUX 37

ERGOCALCIFEROL (VITAMIN D2) 117

ERGOLOID MESYLATES 24

ERGOTAMINE TARTRATE/CAFFEINE 29

ERIVEDGE 36

ERLOTINIB HCL 37

ERRIN 91

ERY 69

ERY-TAB 20

ERYGEL 69

ERYPED 200 20

ERYPED 400 20

ERYTHROCIN STEARATE 20

ERYTHROMYCIN BASE 100

ERYTHROMYCIN BASE/BENZOYL PEROXIDE 69

ERYTHROMYCIN BASE/ETHYL ALCOHOL 69

ERYTHROMYCIN ETHYLSUCCINATE 20

ERYTHROMYCIN

ETHYLSUCCINATE/SULFISOXAZOLE ACETYL 20

ERYTHROMYCIN STEARATE 20

ESCITALOPRAM OXALATE 25

ESGIC 64

ESMOLOL HCL 56

ESOMEPRAZOLE MAGNESIUM 78

ESOMEPRAZOLE SODIUM 78

ESOMEPRAZOLE STRONTIUM 78

ESTARYLLA 85

ESTAZOLAM 110

ESTRADIOL 90

ESTRADIOL VALERATE 85

ESTRADIOL/NORETHINDRONE ACETATE 88


ESTRAMUSTINE PHOSPHATE SODIUM 32

ESTROGENS,

CONJUGATED/MEDROXYPROGESTERONE

ACETATE 89

ESTROGENS,ESTERIFIED 87

ESTROPIPATE 88

ESZOPICLONE 110

ETANERCEPT 93

ETHACRYNATE SODIUM 61

ETHAMBUTOL HCL 30

ETHINYL ESTRADIOL/DROSPIRENONE 90

ETHOSUXIMIDE 22

ETHOTOIN 23

ETHYL ALCOHOL 117

ETHYL CHLORIDE 69

ETHYNODIOL DIACETATE-ETHINYL ESTRADIOL 90

ETIDRONATE DISODIUM 97

ETODOLAC 5

ETOMIDATE 13

ETONOGESTREL 91

ETOPOSIDE 35

ETRAVIRINE 44

EUFLEXXA 98

EURAX 39

EVEROLIMUS 95

EXEMESTANE 35

EXENATIDE 48

EXENATIDE MICROSPHERES 48

EXJADE 111

EXOTIC-HC 103

EXTAVIA 66

EZ FLU 2015-2016 (FLUVIRIN) 96

EZETIMIBE 62

EZOGABINE 22

FFABRAZYME 75

FACTOR IX 53

FACTOR IX COMPLEX HUMAN 54

FACTOR IX COMPLEX, PROTHROMBIN CPLX

CONC(PCC) NO.4, 3-FACTOR 53

FACTOR IX COMPLEX, PROTHROMBIN CPLX

CONC(PCC) NO.6, 3-FACTOR 52

FACTOR IX HUMAN RECOMBINANT 52

FACTOR IX HUMAN RECOMBINANT, THREONINE

148 53

FACTOR XIII 52

FACTOR XIII A-SUBUNIT, RECOMBINANT 54

FALMINA 86

FAMCICLOVIR 46

FAMOTIDINE 77

FAMOTIDINE/PF 77

FARESTON 32

FAT EMULSIONS 118

FE 90 PLUS 113

FE C PLUS 113

FEBUXOSTAT 29

FEIBA NF 53

FEIBA VH IMMUNO 53

FELBAMATE 23

FELODIPINE 57

FEM PH 80

FENOFIBRATE 61

FENOFIBRATE NANOCRYSTALLIZED 61

FENOFIBRATE,MICRONIZED 61

FENOFIBRIC ACID 61

FENOFIBRIC ACID (CHOLINE) 61

FENOLDOPAM MESYLATE 62

FENOPROFEN CALCIUM 5

FENTANYL 6

FENTANYL CITRATE 9

FENTANYL CITRATE IN 0.9 % SODIUM

CHLORIDE/PF 9

FENTANYL CITRATE/BUPIVACAINE HCL IN 0.9 %

SODIUM CHLORIDE/PF 9

FENTANYL CITRATE/PF 12

FEROCON 113

FEROTRINSIC 113

FERRAPLUS 90 113

FERREX 150 FORTE 113

FERREX 150 FORTE PLUS 113

FERREX 28 113


FERRIC SUBSULFATE 53

FERRIPROX 111

FERROCITE PLUS 113

FERROGELS FORTE 113

FERROUS FUMARATE/ASCORBIC ACID/B12-

IF/FOLIC ACID 117

FERROUS FUMARATE/ASCORBIC

ACID/CYANOCOBALAMIN/FOLIC ACID 117

FERROUS FUMARATE/ASCORBIC

ACID/CYANOCOBALAMIN/STOMACH CONC 113

FERROUS FUMARATE/FOLIC ACID 113

FERROUS FUMARATE/FOLIC

ACID/MULTIVITAMINS WITH MIN NO. 15 112

FEXOFENADINE HCL/PSEUDOEPHEDRINE HCL 109

FIBRINOGEN 54

FINASTERIDE 79

FINGOLIMOD HCL 66

FIRAZYR 93

FIRST-BXN 27

FIRST-LANSOPRAZOLE 78

FIRST-MOUTHWASH BLM 66

FIRST-OMEPRAZOLE 78

FLAVOXATE HCL 79

FLEBOGAMMA DIF 95

FLECAINIDE ACETATE 56

FLOXURIDINE 33

FLUCAINE 100

FLUCONAZOLE 27

FLUCONAZOLE IN DEXTROSE, ISO-OSMOTIC 27

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-

OSMOTIC 27

FLUCYTOSINE 28

FLUDARABINE PHOSPHATE 34

FLUDROCORTISONE ACETATE 81

FLUMAZENIL 98

FLUNISOLIDE 104

FLUOCINOLONE ACETONIDE 69

FLUOCINOLONE ACETONIDE OIL 103

FLUOCINOLONE ACETONIDE/SHOWER CAP 69

FLUOCINONIDE 69

FLUOCINONIDE/EMOLLIENT BASE 69

FLUOR-A-DAY 117

FLUOR-I-STRIP AT 100

FLUORESCEIN SODIUM 100

FLUORESCITE 100

FLUORETS 100

FLUOROMETHOLONE 102

FLUOROURACIL 33

FLUOXETINE HCL 25

FLUOXYMESTERONE 83

FLUPHENAZINE DECANOATE 40

FLUPHENAZINE HCL 40

FLURAZEPAM HCL 111

FLURBIPROFEN 5

FLURBIPROFEN SODIUM 102

FLUROX 100

FLUTAMIDE 32

FLUTICASONE FUROATE 103

FLUTICASONE FUROATE/VILANTEROL

TRIFENATATE 109

FLUTICASONE PROPIONATE 104

FLUVASTATIN SODIUM 61

FLUVOXAMINE MALEATE 25

FOCALGIN DSS 113

FOLBEE PLUS 117

FOLIC ACID 117

FOLIC ACID/VITAMIN B COMP AND C 117

FOLIVANE-F 113

FOLIVANE-PLUS 113

FOLLITROPIN ALFA, RECOMB 83

FOLOTYN 33

FOMEPIZOLE 98

FONDAPARINUX SODIUM 50

FORANE 13

FORMA-RAY 69

FORMADON 98

FORMALDEHYDE 98

FORMOTEROL FUMARATE 106

FORTEO 97

FORTICAL 97

FOSAMPRENAVIR CALCIUM 46

FOSCARNET SODIUM 42


FOSINOPRIL SODIUM 55

FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE 59

FOSPHENYTOIN SODIUM 23

FREAMINE III 117

FUL-GLO 100

FUROSEMIDE 61

FUSILEV 34

FUZEON 45

GGABAPENTIN 22

GABITRIL 22

GABLOFEN 110

GALANTAMINE HBR 24

GALSULFASE 75

GAMMAGARD LIQUID 95

GAMMAPLEX 95

GAMUNEX 95

GAMUNEX-C 95

GANCICLOVIR SODIUM 43

GARAMYCIN 100

GASTROCROM 77

GATIFLOXACIN 100

GAVILYTE-H AND BISACODYL 77

GEMCITABINE HCL 33

GEMFIBROZIL 61

GENERLAC 78

GENGRAF 94

GENTAK 100

GENTAMICIN SULFATE 100

GENTAMICIN SULFATE IN SODIUM CHLORIDE,

ISO-OSMOTIC 15

GENTAMICIN SULFATE/PF 15

GEODON 41

GIANVI 86

GILDAGIA 86

GILDESS 86

GILDESS 24 FE 86

GILDESS FE 86

GILENYA 66

GILOTRIF 36

GLATIRAMER ACETATE 66

GLATOPA 66

GLEEVEC 36

GLEOSTINE 31

GLIMEPIRIDE 48

GLIPIZIDE 48

GLIPIZIDE/METFORMIN HCL 48

GLUCAGEN 49

GLUCAGON EMERGENCY KIT 50

GLUCAGON HCL 50

GLUCAGON,HUMAN RECOMBINANT 50

GLUTARALDEHYDE 98

GLYBURIDE 48

GLYBURIDE,MICRONIZED 48

GLYBURIDE/METFORMIN HCL 48

GLYCEROL PHENYLBUTYRATE 75

GLYCINE UROLOGIC SOLUTION 80

GLYCINE/SODIUM/WATER FOR

INJECTION,STERILE/SODIUM HYDROXIDE 98

GLYCOPYRROLATE 76

GLYDO 69

GONAL-F RFF 82

GONAL-F RFF REDI-JECT 83

GRANISETRON HCL 27

GRANISETRON HCL/PF 27

GRANISOL 27

GRISEOFULVIN ULTRAMICROSIZE 28

GRISEOFULVIN, MICROSIZE 28

GRX HICORT 25 81

GUAIFENESIN/DYPHYLLINE 107

GUANFACINE HCL 63

GUANIDINE HCL 30

GYNAZOLE 1 28

HH.P. ACTHAR 83

HALOBETASOL PROPIONATE 70

HALOBETASOL PROPIONATE/AMMONIUM

LACTATE 70

HALONATE 70

HALONATE PAC 70


HALOPERIDOL 40

HALOPERIDOL DECANOATE 40

HALOPERIDOL LACTATE 40

HARVONI 43

HEATHER 91

HECORIA 94

HECTOROL 97

HELIXATE FS 53

HEMABATE 80

HEMATINIC PLUS 113

HEMATINIC WITH FOLIC ACID 113

HEMATOGEN 113

HEMATOGEN FA 113

HEMATOGEN FORTE 113

HEMETAB 114

HEMIN 99

HEMMOREX-HC 81

HEMRIL 82

HEPARIN SODIUM,PORCINE 51

HEPARIN SODIUM,PORCINE IN 0.45 % SODIUM

CHLORIDE 51


CHLORIDE 51


CHLORIDE/PF 51

HEPARIN SODIUM,PORCINE/DEXTROSE 5 % IN

WATER 51

HEPARIN SODIUM,PORCINE/PF 51

HERCEPTIN 37

HETLIOZ 111

HEXALEN 31

HISTRELIN ACETATE 93

HIZENTRA 95

HOMATROPAIRE 100

HOMATROPINE HBR 100

HUMALOG KWIKPEN U-200 50

HUMATE-P 53

HUMIRA 94

HUMIRA PEDIATRIC CROHN'S 94

HUMIRA PEN 94

HUMIRA PEN CROHN'S-UC-HS 94

HUMIRA PEN PSORIASIS 94

HUMULIN R U-500 50

HYALURONATE SODIUM 98

HYDRALAZINE HCL 62

HYDROCHLOROTHIAZIDE 61

HYDROCODONE

BITARTRATE/ACETAMINOPHEN 12

HYDROCODONE BITARTRATE/HOMATROPINE

METHYLBROMIDE 110

HYDROCODONE

POLISTIREX/CHLORPHENIRAMINE POLISTIREX109

HYDROCODONE/IBUPROFEN 12

HYDROCORTISONE 97

HYDROCORTISONE ACETATE 96

HYDROCORTISONE ACETATE/ALOE VERA 70

HYDROCORTISONE ACETATE/LIDOCAINE

HCL/ALOE VERA 70

HYDROCORTISONE ACETATE/PRAMOXINE HCL 72

HYDROCORTISONE

ACETATE/PRAMOXINE/EMOLLIENT/PRAMOXINE

COMB#1 70

HYDROCORTISONE BUTYRATE 70

HYDROCORTISONE BUTYRATE/EMOLLIENT

BASE 70

HYDROCORTISONE SOD SUCCINATE 81

HYDROCORTISONE VALERATE 70

HYDROCORTISONE/IODOQUINOL 70

HYDROCORTISONE/MINERAL

OIL/PETROLATUM,WHITE 70

HYDROCORTISONE/PRAMOXINE

HCL/CHLOROXYLENOL 103

HYDROCORTISONE/PRAMOXINE

HCL/CHLOROXYLENOL/WATER 103

HYDROMORPHONE HCL 10

HYDROMORPHONE HCL/PF 10

HYDROQUINONE 71

HYDROQUINONE MICROSPHERES 70

HYDROQUINONE/FERRIC OXIDE 71

HYDROXYCHLOROQUINE SULFATE 38

HYDROXYPROGESTERONE CAPROATE 91

HYDROXYUREA 33


HYDROXYZINE HCL 104

HYDROXYZINE PAMOATE 104

HYOPHEN 15

HYOSCYAMINE SULFATE 76

HYOSYNE 76

HYPERCARE 70

HYPERRHO S-D 95

HYPROMELLOSE 101

IIBANDRONATE SODIUM 97

IBRANCE 36

IBRUTINIB 36

IBUPROFEN 5

IBUPROFEN/OXYCODONE HCL 10

IBUTILIDE FUMARATE 56

IC GREEN 98

ICATIBANT ACETATE 93

ICLUSIG 36

ICOSAPENT ETHYL 62

IDARUBICIN HCL 34

IDELALISIB 37

IDURSULFASE 75

IFOSFAMIDE 31

IFOSFAMIDE/MESNA 31

ILARIS 95

ILOPROST TROMETHAMINE 108

IMATINIB MESYLATE 36

IMBRUVICA 36

IMIPENEM/CILASTATIN SODIUM 19

IMIPRAMINE HCL 26

IMIPRAMINE PAMOATE 26

IMIQUIMOD 70

IMMUNE GLOBULIN,GAMM(IGG)/GLYCINE/IGA

GREATER THAN 50 MCG/ML 95

IMMUNE

GLOBULIN,GAMM(IGG)/SORBITOL/GLYCIN/IGA 0

TO 50 MCG/ML 95

IMMUNE GLOBULIN,GAMMA (IGG)/PROLINE/IGA 0

TO 50 MCG/ML 95

IMMUNE GLOBULIN,GAMMA (IGG)/SORBITOL/IGA 0

TO 50 MCG/ML 95

IMMUNE GLOBULIN,GAMMA CAPRYLATE (IGG) 95

IMPLANON 91

INCIVEK 43

INCRELEX 83

INDAPAMIDE 61

INDINAVIR SULFATE 46

INDOCYANINE GREEN 98

INDOMETHACIN 5

INDOMETHACIN SODIUM 5

INFED 118

INFERGEN 43

INFLIXIMAB 94

INFLUENZA VIRUS VACCINE TRIVALNT 2015-2016

(4 YR & OLDER)/PF 96

INLYTA 36

INSULIN DETEMIR 50

INSULIN GLARGINE,HUMAN RECOMBINANT

ANALOG 50

INSULIN LISPRO 50

INSULIN REGULAR, HUMAN 50

INTELENCE 44

INTERFERON ALFA-2B,RECOMB. 43

INTERFERON ALFACON-1 43

INTERFERON BETA-1A 65

INTERFERON BETA-1A/ALBUMIN HUMAN 66

INTERFERON BETA-1B 66

INTERFERON GAMMA-1B,RECOMB. 95

INTRON A 43

INTROVALE 86

INVEGA SUSTENNA 41

INVEGA TRINZA 41

INVIRASE 46

INVOKAMET 48

INVOKANA 48

IPRATROPIUM BROMIDE 105

IPRATROPIUM BROMIDE/ALBUTEROL

SULFATE 109

IRBESARTAN 55

IRBESARTAN/HYDROCHLOROTHIAZIDE 59


IRINOTECAN HCL 34

IRON ASP GLY&PS CMPLX/ASCORB.CAL/VIT

B12/FA/CA-THR/SUCC.ACID 113

IRON ASP GLY/ASCORB.CAL/VIT B12/FA/CA-

THREONTE/SUCCINIC ACID 115

IRON ASP.GLYCIN & FUMARATE /VIT C/FA/MV

COMB 11/CA-THREONATE 113

IRON ASPGLY/ASCORB.CAL/VIT B12/CALCIUM

THR/SUCC.ACID/STOMACH 115

IRON BISGLY,PSCMPLX/ASCORBATE

CALC/B12/FOLIC ACID/CALC-THREO 116

IRON CARBONYL,GLUC/FOLIC ACID/VIT B12/VIT

C/DOCUSATE SODIUM 115

IRON DEXTRAN COMPLEX 118

IRON FUMARATE & POLYSAC COMP/FOLIC

ACID/VITAMIN C/NIACIN 113

IRON FUMARATE,POLYSAC CPLEX/FOLIC

ACID/VIT B COMP WITH C #9 113

IRON FUMARATE-IRON POLYSACCHAR/FOLIC

ACID/MV COMB18 116

IRON FUMARTE &ASP GLY/ASCORB.CAL/VIT

B12/FA/CA-THR/SUCC.ACID 115

IRON HEME POLYPEPTIDE/FOLIC ACID 116

IRON POLYSACCHAR COMPLX/IRON HEME

POLYPEPTIDE/FOLIC ACID/B12 114

IRON POLYSACCHARIDE

COMPLEX/CYANOCOBALAMIN/FOLIC ACID 115

IRON,CARBONYL/ASCORBIC

ACID/CYANOCOBALAMIN/FOLIC ACID 113

IRON,CARBONYL/DOCUSATE SODIUM/B12-

IF/FOLIC ACID/MULTIVIT-MIN 116

IRON,CARBONYL/FOLIC ACID/VIT C/PYRIDOXINE

HCL/VIT B12/ZINC 112

IRON,CARBONYL/FOLIC ACID/VITAMIN

B12/VITAMIN C/DOCUSATE NA 113

IRON/FOLIC ACID/VITAMIN B COMP AND

C/MINERALS 113

ISENTRESS 44

ISOFLURANE 14

ISOMETHEPTENE

MUCATE/CAFFEINE/ACETAMINOPHEN 98

ISOMETHEPTENE

MUCATE/DICHLORALPHENAZONE/ACETAMINOPH

EN 98

ISONIAZID 30

ISOSORBIDE DINITRATE 62

ISOSORBIDE MONONITRATE 62

ISOSULFAN BLUE 98

ISOTRETINOIN 71

ISOXSUPRINE HCL 24

ISRADIPINE 57

ISTODAX 34

ITRACONAZOLE 28

IVABRADINE HCL 59

IVACAFTOR 107

IVERMECTIN 38

IXABEPILONE 34

IXEMPRA 34

IXINITY 53

JJAKAFI 36

JANTOVEN 51

JANUMET 48

JANUMET XR 48

JANUVIA 49

JENCYCLA 91

JENTADUETO 49

JINTELI 86

JOLESSA 86

JOLIVETTE 91

JUNEL 86

JUNEL FE 86

JUNEL FE 24 86

JUXTAPID 62

KK EFFERVESCENT 114

K-PHOS NEUTRAL 80

K-PHOS NO.2 80

K-PHOS ORIGINAL 114

K-SOL 114


K-TAB ER 114

KADCYLA 37

KAITLIB FE 86

KALETRA 46

KALYDECO 107

KARIVA 86

KELNOR 1-35 86

KEPIVANCE 66

KETAMINE HCL 13

KETOCONAZOLE 28

KETOCONAZOLE/SKIN CLEANSER COMBINATION

NO.28 28

KETODAN 28

KETOPROFEN 5

KETOROLAC TROMETHAMINE 102

KIMIDESS 86

KIONEX 111

KIT FOR PREP YTTRIUM-90/IBRITUMOMAB

TIUXETAN/ALBUMIN HUMAN 38

KLOR-CON 114

KLOR-CON 10 114

KLOR-CON 8 114

KLOR-CON M10 114

KLOR-CON M15 114

KLOR-CON M20 114

KLOR-CON SPRINKLE 114

KLOR-CON-EF 114

KOATE-DVI 53

KOGENATE FS 53

KURVELO 86

KUVAN 75

LLABETALOL HCL 56

LACLOTION 70

LACOSAMIDE 24

LACTOBACILLUS COMBINATION

NO.2/S.THERMOPHL/BIF CMB NO.1 77

LACTULOSE 78

LAMISIL 28

LAMIVUDINE 45

LAMIVUDINE/ZIDOVUDINE 45

LAMOTRIGINE 23

LANSOPRAZOLE 78

LANSOPRAZOLE/AMOXICILLIN

TRIHYDRATE/CLARITHROMYCIN 77

LANTUS 50

LANTUS SOLOSTAR 50

LAPATINIB DITOSYLATE 37

LARIN 86

LARIN 24 FE 87

LARIN FE 87

LARONIDASE 74

LATANOPROST 102

LATRIX 70

LATRIX XM 70

LEDIPASVIR/SOFOSBUVIR 43

LEENA 87

LEFLUNOMIDE 96

LENALIDOMIDE 32

LESSINA 87

LETAIRIS 108

LETROZOLE 35

LEUCOVORIN CALCIUM 34

LEUKERAN 31

LEUKINE 52

LEUPROLIDE ACETATE 93

LEVALBUTEROL HCL 106

LEVEMIR 50

LEVEMIR FLEXPEN 50

LEVEMIR FLEXTOUCH 50

LEVETIRACETAM 22

LEVOBUNOLOL HCL 102

LEVOCARNITINE 118

LEVOCARNITINE (WITH SUGAR) 118

LEVOCETIRIZINE DIHYDROCHLORIDE 105

LEVOFLOXACIN 100

LEVOFLOXACIN/DEXTROSE 5 % IN WATER 21

LEVOLEUCOVORIN CALCIUM 34

LEVOMEFOLATE CALCIUM/SCHIZOCHYTRIUM

ALGAL OIL 118

LEVONEST 87


LEVONORGESTREL 88

LEVONORGESTREL-ETHINYL ESTRADIOL 90

LEVONORGESTREL/ETHINYL ESTRADIOL AND

ETHINYL ESTRADIOL 87

LEVORA-28 87

LEVORPHANOL TARTRATE 6

LEVOTHYROXINE SODIUM 92

LEVOXYL 92

LEXIVA 46

LIDOCAINE 70

LIDOCAINE HCL 70

LIDOCAINE HCL BUFFERED WITH 8.4 % SODIUM

BICARBONATE 12

LIDOCAINE HCL/DEXTROSE 5%-WATER/PF 13

LIDOCAINE HCL/DEXTROSE 7.5%-WATER/PF 13

LIDOCAINE HCL/EPINEPHRINE 13

LIDOCAINE HCL/EPINEPHRINE/PF 13

LIDOCAINE HCL/HYDROCORTISONE ACETATE 71

LIDOCAINE HCL/MENTHOL 71

LIDOCAINE HCL/PF 13

LIDOCAINE/MENTHOL 71

LIDOCAINE/PRILOCAINE 72

LINACLOTIDE 77

LINAGLIPTIN 49

LINAGLIPTIN/METFORMIN HCL 49

LINCOMYCIN HCL 15

LINDANE 71

LINEZOLID 17

LINEZOLID IN 0.9 % SODIUM CHLORIDE 16

LINZESS 77

LIOTHYRONINE SODIUM 92

LIOTRIX 92

LIPASE/PROTEASE/AMYLASE 75

LIPODOX 34

LIPODOX 50 34

LIPOSYN III 118

LIRAGLUTIDE 49

LISDEXAMFETAMINE DIMESYLATE 63

LISINOPRIL 55

LISINOPRIL/HYDROCHLOROTHIAZIDE 59

LITHIUM CARBONATE 47

LITHIUM CITRATE 48

LMD 10% WITH 0.9% SOD CHLORIDE 98

LMD 10% WITH 5% DEXTROSE 98

LOMEDIA 24 FE 87

LOMITAPIDE MESYLATE 62

LOMUSTINE 31

LOPINAVIR/RITONAVIR 46

LOPREEZA 87

LORAZEPAM 47

LORAZEPAM INTENSOL 47

LORCET 10

LORCET HD 10

LORCET PLUS 10

LORENZA 71

LORTAB 10

LORYNA 87

LOSARTAN POTASSIUM 55

LOSARTAN

POTASSIUM/HYDROCHLOROTHIAZIDE 59

LOTRONEX 77

LOVASTATIN 62

LOW-OGESTREL 87

LOXAPINE SUCCINATE 40

LUGOL'S 98

LUMIZYME 75

LUPRON DEPOT 93

LUPRON DEPOT-PED 93

LUSTRA-ULTRA 71

LUTERA 87

LYRICA 65

LYSODREN 34

LYZA 91

MMACITENTAN 108

MAFENIDE ACETATE 71

MAG HYDROXIDE/AL

HYDROXIDE/SIMETH/DIPHENHYDRAMINE/LIDOCAI

NE 66

MAGNESIUM CHLORIDE 114

MAGNESIUM SULFATE 114


MAGNESIUM SULFATE IN STERILE WATER 114

MAKENA 91

MALATHION 39

MANGANESE CHLORIDE 114

MANGANESE SULFATE 114

MANNITOL 60

MAPROTILINE HCL 25

MARAVIROC 45

MARGESIC 64

MARLEXATE 111

MARLISSA 87

MARQIBO 34

MARTEN-TAB 64

MATULANE 31

MATZIM LA 57

MD-GASTROVIEW 98

ME-PB-HYOS 76

MECASERMIN 83

MECHLORETHAMINE HCL 31

MECLIZINE HCL 26

MECLOFENAMATE SODIUM 5

MEDROXYPROGESTERONE ACETATE 91

MEFENAMIC ACID 5

MEFLOQUINE HCL 38

MEGESTROL ACETATE 91

MEKINIST 36

MELOXICAM 5

MELPAQUE HP 71

MELPHALAN 31

MELPHALAN HCL 31

MELQUIN HP 71

MELQUIN-3 71

MEMANTINE HCL 24

MENEST 87

MEPERIDINE HCL 10

MEPHYTON 118

MEPIVACAINE HCL 13

MEPIVACAINE HCL/PF 13

MEPRON 38

MERCAPTOPURINE 33

MEROPENEM 19

MEROPENEM IN 0.9 % SODIUM CHLORIDE 19

MESALAMINE 96

MESALAMINE WITH CLEANSING WIPES 96

MESNA 34

MESNEX 34

MESTINON 30

METADATE ER 63

METAPROTERENOL SULFATE 106

METAXALONE 110

METFORMIN HCL 64

METHADONE HCL 7

METHADONE INTENSOL 7

METHADOSE 7

METHAMPHETAMINE HCL 63

METHAZOLAMIDE 102

METHENAMINE HIPPURATE 16

METHENAMINE MANDELATE 16

METHENAMINE/METHYLENE BLUE/BENZOIC

ACID/SALICYLATE/HYOSCY 17

METHENAMINE/METHYLENE

BLUE/SALICYLATE/SODIUM PHOS/HYOSCY 17

METHENAMINE/METHYLENE BLUE/SODIUM

PHOS/PNYL SAL/HYOSC SUL 17

METHENAMINE/SODIUM

PHOSPHATE,MONOBASIC/METH BLUE/HYOSC

SUL 17

METHIMAZOLE 93

METHITEST 83

METHOCARBAMOL 110

METHOTREXATE SODIUM 95

METHOTREXATE SODIUM/PF 94

METHOXSALEN 67

METHOXSALEN, RAPID 71

METHSUXIMIDE 22

METHYCLOTHIAZIDE 61

METHYLDOPA 55

METHYLDOPA/HYDROCHLOROTHIAZIDE 59

METHYLDOPATE HCL 55

METHYLENE BLUE 98

METHYLERGONOVINE MALEATE 98

METHYLNALTREXONE BROMIDE 77


METHYLPHENIDATE HCL 63

METHYLPREDNISOLONE 82

METHYLPREDNISOLONE ACETATE 82

METHYLPREDNISOLONE SODIUM SUCCINATE 82

METHYLTESTOSTERONE 83

METIPRANOLOL 102

METOCLOPRAMIDE HCL 26

METOLAZONE 61

METOPROLOL SUCCINATE 56

METOPROLOL TARTRATE 56

METOPROLOL

TARTRATE/HYDROCHLOROTHIAZIDE 59

METRO IV 16

METRONIDAZOLE 72

METRONIDAZOLE IN SODIUM CHLORIDE 16

METYROSINE 59

MEXILETINE HCL 56

MICAFUNGIN SODIUM 28

MICONAZOLE NITRATE 28

MICROFIBRILLAR COLLAGEN 98

MICROGESTIN 87

MICROGESTIN 24 FE 87

MICROGESTIN FE 87

MIDAZOLAM HCL 47

MIDAZOLAM HCL/PF 47

MIDODRINE HCL 55

MIGERGOT 29

MIGLUSTAT 75

MIGRAGESIC IDA 98

MILLIPRED DP 82

MILNACIPRAN HCL 65

MILRINONE LACTATE 59

MILRINONE LACTATE/DEXTROSE 5 % IN WATER59

MIMVEY 87

MIMVEY LO 88

MINOCYCLINE HCL 21

MINOXIDIL 62

MIOSTAT 102

MIRTAZAPINE 25

MISOPROSTOL 78

MITOMYCIN 34

MITOTANE 34

MITOXANTRONE HCL 34

MODAFINIL 111

MODERIBA 43

MOEXIPRIL HCL 55

MOEXIPRIL HCL/HYDROCHLOROTHIAZIDE 60

MOLINDONE HCL 40

MOLYBDENUM (AMMONIUM MOLYBDATE) 114

MOMETASONE FUROATE 71

MOMETASONE FUROATE/FORMOTEROL

FUMARATE 109

MONDOXYNE NL 21

MONO-LINYAH 88

MONOJECT 0.9% SODIUM CHLORIDE 114

MONOJECT PREFILL 115

MONOJECT PREFILL ADVANCED 115

MONONESSA 88

MONONINE 53

MONSEL'S 53

MONTELUKAST SODIUM 105

MORPHINE SULFATE 11

MORPHINE SULFATE/PF 11

MOXEZA 100

MOXIFLOXACIN HCL 100

MOXIFLOXACIN HCL IN SODIUM ACETATE AND

SULFATE,WATER,ISO-OSM 21

MOXIFLOXACIN HCL/SODIUM CHLORIDE, ISO-

OSMOTIC 20

MOZOBIL 52

MULTIGEN 115

MULTIGEN FOLIC 115

MULTIGEN PLUS 115

MULTITRACE-4 115

MULTITRACE-5 115

MULTIVITAMINS WITH MIN NO.7/FOLIC ACID 119

MUPIROCIN 71

MUPIROCIN CALCIUM 71

MUSTARGEN 31

MY WAY 88

MYCAMINE 28

MYCOBUTIN 30


MYCOPHENOLATE MOFETIL 94

MYCOPHENOLATE MOFETIL HCL 93

MYCOPHENOLATE SODIUM 94

MYFORTIC 94

MYLERAN 31

MYNATAL PLUS 118

MYNATAL-Z 118

MYNEPHROCAPS 118

MYORISAN 71

MYOZYME 75

MYZILRA 88

NNABUMETONE 5

NADOLOL 57

NADOLOL/BENDROFLUMETHIAZIDE 60

NAFCILLIN IN DEXTROSE, ISO-OSMOTIC 19

NAFCILLIN SODIUM 19

NAGLAZYME 75

NALBUPHINE HCL 11

NALOXONE HCL 14

NALTREXONE HCL 14

NAMENDA 24

NAPHAZOLINE HCL 100

NAPROXEN 5

NAPROXEN SODIUM 5

NARATRIPTAN HCL 29

NAROPIN 13

NATACYN 28

NATALVIRT FLT 115

NATAMYCIN 28

NATEGLINIDE 49

NATURE-THROID 92

NEBUPENT 38

NECON 88

NELARABINE 33

NELFINAVIR MESYLATE 46

NEO-POLYCIN 100

NEO-POLYCIN HC 100

NEOMYCIN SULFATE 15

NEOMYCIN SULFATE/BACITRACIN

ZINC/POLYMYXIN B/HYDROCORTISONE 100

NEOMYCIN SULFATE/BACITRACIN/POLYMYXIN

B 101

NEOMYCIN SULFATE/POLYMYXIN B SULFATE 16

NEOMYCIN SULFATE/POLYMYXIN B

SULFATE/GRAMICIDIN D 101

NEOMYCIN SULFATE/POLYMYXIN B

SULFATE/HYDROCORTISONE 103

NEOMYCIN/POLYMYXIN B

SULFATE/DEXAMETHASONE 101

NEOSTIGMINE BROMIDE 30

NEOSTIGMINE METHYLSULFATE 30

NEPHPLEX RX 118

NEPHRO-VITE RX 118

NEUAC 71

NEULASTA 52

NEUMEGA 52

NEVIRAPINE 45

NEXAVAR 36

NEXT CHOICE ONE DOSE 88

NIACIN 62

NICARDIPINE HCL 57

NICARDIPINE HCL IN 0.9 % SODIUM CHLORIDE 57

NIFEDIAC CC 57

NIFEDICAL XL 57

NIFEDIPINE 57

NIKKI 88

NILANDRON 32

NILOTINIB HCL 37

NILUTAMIDE 32

NIMODIPINE 58

NISOLDIPINE 58

NITAZOXANIDE 38

NITISINONE 75

NITRO-BID 62

NITRO-TIME 62

NITROFURANTOIN 16

NITROFURANTOIN MACROCRYSTAL 16

NITROFURANTOIN

MONOHYDRATE/MACROCRYSTALS 16


NITROGLYCERIN 72

NITROGLYCERIN/DEXTROSE 5 % IN WATER 63

NITROSTAT 63

NIVA-PLUS 118

NIZATIDINE 77

NODOLOR 98

NORA-BE 91

NORDITROPIN 83

NORDITROPIN FLEXPRO 83

NORDITROPIN NORDIFLEX 83

NOREPINEPHRINE BITARTRATE 60

NOREPINEPHRINE BITARTRATE IN 0.9 % SODIUM

CHLORIDE 60

NORETHINDRONE 91

NORETHINDRONE ACETATE 91

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL 88

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL/FERROUS FUMARATE 89

NORETHINDRONE-ETHINYL ESTRADIOL 90

NORETHINDRONE-ETHINYL

ESTRADIOL/FERROUS FUMARATE 90

NORGESTIMATE-ETHINYL ESTRADIOL 89

NORGESTREL-ETHINYL ESTRADIOL 88

NORLYROC 91

NORTHERA 60

NORTREL 88

NORTRIPTYLINE HCL 26

NORVIR 46

NOVAREL 83

NOVOEIGHT 53

NOVOSEVEN RT 53

NOXAFIL 28

NP THYROID 92

NU-DERM 71

NUEDEXTA 64

NULOJIX 94

NUQUIN HP 71

NUTRILIPID 118

NUTRILYTE 115

NUTRILYTE II 115

NYAMYC 28

NYSTATIN 28

NYSTATIN/LIDOCAINE HCL/DIPHENHYDRAMINE

HCL 27

NYSTATIN/TRIAMCINOLONE ACETONIDE 28

NYSTOP 28

OOCELLA 88

OCTREOTIDE ACETATE 93

OCUCOAT 101

OCUDOX 21

OFATUMUMAB 37

OFLOXACIN 103

OGEN 88

OGESTREL 88

OLANZAPINE 42

OLANZAPINE/FLUOXETINE HCL 25

OLODATEROL HCL 106

OLOPATADINE HCL 105

OMALIZUMAB 110

OMBITASVIR/PARITAPREVIR/RITONAVIR 44

OMBITASVIR/PARITAPREVIR/RITONAVIR/DASABU

VIR SODIUM 44

OMEGA-3 ACID ETHYL ESTERS 62

OMEPRAZOLE 79

OMEPRAZOLE/SODIUM BICARBONATE 79

ONDANSETRON 27

ONDANSETRON HCL 27

ONDANSETRON HCL/PF 27

ONFI 22

ONXOL 35

OPIUM TINCTURE 77

OPIUM/BELLADONNA ALKALOIDS 11

OPRELVEKIN 52

OPSUMIT 108

ORFADIN 75

ORPHENADRINE CITRATE 110

ORPHENADRINE CITRATE/ASPIRIN/CAFFEINE 110

ORSYTHIA 88

OSCIMIN 76


OSCIMIN SL 76

OSCIMIN SR 76

OSELTAMIVIR PHOSPHATE 46

OSMITROL 60

OTICIN HC 103

OTO-END 10 103

OTOMAX-HC 103

OTOZIN 103

OXACILLIN SODIUM 19

OXACILLIN SODIUM/DEXTROSE, ISO-OSMOTIC 19

OXALIPLATIN 35

OXANDROLONE 83

OXAPROZIN 6

OXAZEPAM 47

OXCARBAZEPINE 23

OXSORALEN-ULTRA 71

OXYBENZONE/OCTINOXATE/HYDROQUINONE 67

OXYBUTYNIN CHLORIDE 79

OXYCODONE HCL 11

OXYCODONE HCL/ACETAMINOPHEN 12

OXYCODONE HCL/ASPIRIN 11

OXYCONTIN 8

OXYMORPHONE HCL 12

OXYTOCIN 99

PPACERONE 56

PACLITAXEL 35

PACLITAXEL PROTEIN-BOUND 33

PAIN RELIEF 71

PALBOCICLIB 36

PALGIC 105

PALIFERMIN 66

PALIPERIDONE 42

PALIPERIDONE PALMITATE 41

PALIVIZUMAB 96

PANCURONIUM BROMIDE 64

PANHEMATIN 99

PANITUMUMAB 38

PANTOPRAZOLE SODIUM 79

PAPAVERINE HCL 24

PAREGORIC 77

PARENTERAL AMINO ACID 10% COMBINATION

NO. 4 117


NO. 6 119


NO.7 118


NO.1 117

PARICALCITOL 97

PAROEX 66

PAROMOMYCIN SULFATE 15

PAROXETINE HCL 25

PASIREOTIDE DIASPARTATE 93

PAZOPANIB HCL 37

PEDI-DRI 28

PEDIATRIC MULTIVITAMIN COMBO

NO.75/FLUORIDE/FERROUS SULFATE 118

PEGANONE 23

PEGASYS 43

PEGASYS PROCLICK 43

PEGFILGRASTIM 52

PEGINTERFERON ALFA-2A 43

PEGINTERFERON ALFA-2B 35

PEMETREXED DISODIUM 32

PENICILLAMINE 80

PENICILLIN G POTASSIUM 20

PENICILLIN G PROCAINE 19

PENICILLIN G SODIUM 19

PENICILLIN V POTASSIUM 19

PENTAMIDINE ISETHIONATE 38

PENTASA 96

PENTAZOCINE HCL/NALOXONE HCL 12

PENTOSAN POLYSULFATE SODIUM 80

PENTOSTATIN 33

PENTOXIFYLLINE 60

PERFOROMIST 106

PERINDOPRIL ERBUMINE 55

PERIOGARD 66

PERITONEAL DIALYSIS NO.6 WITH DEXTROSE 1.5

% 112


PERITONEAL DIALYSIS NO.7 WITH DEXTROSE 2.5

% 112

PERITONEAL DIALYSIS NO.8 WITH DEXTROSE

4.25 % 112

PERJETA 38

PERMETHRIN 72

PERPHENAZINE 26

PERPHENAZINE/AMITRIPTYLINE HCL 25

PERTUZUMAB 38

PFIZERPEN 20

PHENADOZ 105

PHENAZOPYRIDINE HCL 80

PHENDIMETRAZINE TARTRATE 64

PHENELZINE SULFATE 25

PHENERGAN 105

PHENOBARBITAL 22

PHENOBARBITAL SODIUM 22

PHENOBARBITAL/HYOSCYAMINE SULF/ATROPINE

SULF/SCOPOLAMINE HB 76

PHENOL 99

PHENOXYBENZAMINE HCL 55

PHENTERMINE HCL 64

PHENTOLAMINE MESYLATE 55

PHENYLEPHRINE HCL 101

PHENYLEPHRINE HCL IN 0.9 % SODIUM

CHLORIDE 60

PHENYLEPHRINE HCL IN 0.9 % SODIUM

CHLORIDE/PF 60

PHENYLEPHRINE HCL/PROMETHAZINE HCL 109

PHENYTOIN 23

PHENYTOIN SODIUM 23

PHENYTOIN SODIUM EXTENDED 23

PHILITH 88

PHOSPHA 250 NEUTRAL 80

PHOSPHASAL 16

PHOSPHOLINE IODIDE 102

PHOSPHORUS #1 81

PHOTOFRIN 35

PHYSOSTIGMINE SALICYLATE 99

PHYTONADIONE 118

PILOCARPINE HCL 102

PIMOZIDE 40

PIMTREA 88

PINDOLOL 57

PIOGLITAZONE HCL 49

PIOGLITAZONE HCL/GLIMEPIRIDE 49

PIOGLITAZONE HCL/METFORMIN HCL 49

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 20

PIRMELLA 88

PIROXICAM 6

PLERIXAFOR 52

PNEUMOCOCCAL 23-VALENT POLYSACCHARIDE

VACCINE 96

PNEUMOVAX 23 96

PNV 29-1 118

PNV-SELECT 118

PNV-VP-U 118

PODOFILOX 72

POLOCAINE 13

POLOCAINE-MPF 13

POLYCIN 101

POLYETHYLENE GLYCOL 3350 78

POLYMYXIN B SULFATE 16

POLYMYXIN B SULFATE/TRIMETHOPRIM 101

POLYSACCHARIDE IRON FORTE 115

POMALIDOMIDE 32

POMALYST 32

PONATINIB HCL 36

PORFIMER SODIUM 35

PORTIA 89

POSACONAZOLE 28

POTASSIUM ACETATE 115

POTASSIUM BICARBONATE/CITRIC ACID 115

POTASSIUM CHLORIDE 115

POTASSIUM CHLORIDE IN 0.45 % SODIUM

CHLORIDE 116

POTASSIUM CHLORIDE IN 0.9 % SODIUM

CHLORIDE 115

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN

WATER 115

POTASSIUM CHLORIDE IN DEXTROSE 5 % AND 0.9

% SODIUM CHLORIDE 115


POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 %

SODIUM CHLORIDE 116

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 %

SODIUM CHLORIDE 116

POTASSIUM CHLORIDE IN DEXTROSE 5% AND 0.3

% SODIUM CHLORIDE 116

POTASSIUM CHLORIDE IN LACTATED RINGERS

AND 5 % DEXTROSE 116

POTASSIUM CHLORIDE/POTASSIUM

BICARBONATE/CITRIC ACID 115

POTASSIUM CITRATE 80

POTASSIUM CITRATE/CITRIC ACID 81

POTASSIUM IODIDE/IODINE 99

POTASSIUM PHOS,M-BASIC-D-BASIC 116

POTASSIUM PHOSPHATE IN 0.9 % SODIUM

CHLORIDE 116

POTASSIUM PHOSPHATE,MONOBASIC 114

POTIGA 22

PR BENZOYL PEROXIDE 72

PR CREAM 72

PRADAXA 51

PRALATREXATE 33

PRALIDOXIME CHLORIDE 99

PRAMCORT 72

PRAMIPEXOLE DI-HCL 39

PRAMLINTIDE ACETATE 49

PRAMOXINE-HC 103

PRASUGREL HCL 54

PRAVASTATIN SODIUM 62

PRAZOSIN HCL 55

PRE-ATTACHED LTA KIT 67

PRED MILD 102

PREDNICARBATE 72

PREDNISOLONE 82

PREDNISOLONE ACETATE 102

PREDNISOLONE SOD PHOSPHATE 102

PREDNISONE 82

PREDNISONE INTENSOL 82

PREGABALIN 65

PREMASOL 118

PREMPHASE 89

PREMPRO 89

PRENA1 CHEW 118

PRENAPLUS 119

PRENATAL VIT WITH CALCIUM CMB 11/FERROUS

FUMARATE/FOLIC ACID 120

PRENATAL VIT WITH CALCIUM NO. 40/IRON

FUMARATE/FA CMB NO.1 119

PRENATAL VIT WITH CALCIUM NO.66/IRON

FUM/FOLIC ACID/DSS/DHA 120

PRENATAL VITAMIN COMBO NO.8/IRON PS CMPLX

& ASPGL/FA/DHA 119

PRENATAL VITAMIN

NO.15/IRON,CARBONYL/FOLIC ACID/DOCUSATE

SOD 119

PRENATAL VITAMIN

NO.16/IRON,CARBONYL/FOLIC ACID/DOCUSATE

SOD 120

PRENATAL VITAMIN NO.81/SODIUM FEREDETATE-

IRON POLY/FA/OMEGA3 119

PRENATAL VITAMINS COMB 10/FERROUS


PRENATAL VITAMINS COMBINATION NO.42/FOLIC

ACID 118

PRENATAL VITAMINS NO.11/FERROUS

FUMARATE/FOLIC ACID/OMEGA-3 119

PRENATAL VITAMINS WITH CALCIUM/FERROUS


PRENATAL VITS WITH CALCIUM #72/FERROUS






PRENATAL VITS WITH CALCIUM

#76/IRON,CARBONYL/FOLIC ACID 119



PRENATAL VITS WITHOUT CALC NO5/FERROUS


PRETAB 119

PREVALITE 62


PREVIFEM 89

PREZISTA 46

PRIFTIN 30

PRIMIDONE 22

PRIVIGEN 95

PROBENECID 29

PROCAINAMIDE HCL 56

PROCARBAZINE HCL 31

PROCENTRA 63

PROCHLORPERAZINE 26

PROCHLORPERAZINE EDISYLATE 26

PROCHLORPERAZINE MALEATE 26

PROCRIT 52

PROCTO-PAK 96

PROCTOSOL-HC 97

PROCTOZONE-HC 97

PROFERRIN-FORTE 116

PROFILNINE 53

PROFILNINE SD 54

PROGESTERONE 91

PROGESTERONE,MICRONIZED 91

PROGLYCEM 50

PROGRAF 94

PROLASTIN 109

PROLASTIN C 109

PROMACTA 52

PROMETHAZINE HCL 105

PROMETHAZINE HCL/CODEINE 109

PROMETHAZINE HCL/DEXTROMETHORPHAN

HBR 109

PROMETHEGAN 105

PROPAFENONE HCL 56

PROPARACAINE HCL 101

PROPARACAINE HCL/FLUORESCEIN SODIUM 101

PROPOFOL 13

PROPRANOLOL HCL 57

PROPRANOLOL HCL/HYDROCHLOROTHIAZIDE 60

PROPYLTHIOURACIL 93

PROSTIGMIN 30

PROTAMINE SULFATE 51

PROTECTIVES COMBINATION NO.2/CERAMIDES

1,3,6-11 72

PROTOPAM CHLORIDE 99

PROTRIPTYLINE HCL 26

PULMICORT FLEXHALER 104

PULMOZYME 109

PUREVIT DUALFE PLUS 116

PURINETHOL 33

PYRAZINAMIDE 30

PYRIDOSTIGMINE BROMIDE 30

PYRIMETHAMINE 38

QQUASENSE 89

QUAZEPAM 110

QUETIAPINE FUMARATE 42

QUINAPRIL HCL 55

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE 60

QUINIDINE GLUCONATE 56

QUINIDINE SULFATE 56

QUININE SULFATE 39

QVAR 104

RRABEPRAZOLE SODIUM 79

RADIOPAQUE PVC MARKERS/BARIUM SULFATE 99

RALOXIFENE HCL 91

RALTEGRAVIR POTASSIUM 44

RAMELTEON 111

RAMIPRIL 55

RANITIDINE HCL 77

RAPAMUNE 94

RASBURICASE 33

RAVICTI 75

REA LO 39 72

REA LO 40 72

REBIF 66

REBIF REBIDOSE 66

RECLIPSEN 89

RECOMBINATE 54

RECTACORT-HC 82


RECTIV 72

REGONOL 30

REGORAFENIB 36

REGRANEX 72

RELADOR PAK 72

RELADOR PAK PLUS 72

RELENZA 46

RELISTOR 77

REMEVEN 72

REMICADE 94

REMODULIN 108

RENA-VITE RX 119

RENACIDIN 80

RENAL CAPS 119

RENO CAPS 119

RENVELA 81

REPAGLINIDE 49

REPAGLINIDE/METFORMIN HCL 49

REPREXAIN 12

RESCRIPTOR 44

RESERPINE 55

RESTASIS 101

REVATIO 108

REVLIMID 32

REVONTO 110

REYATAZ 46

RHO(D) IMMUNE GLOBULIN 95

RIASTAP 54

RIBASPHERE 43

RIBASPHERE RIBAPAK 43

RIBAVIRIN 44

RIDAURA 96

RIFABUTIN 30

RIFAMPIN 30

RIFAPENTINE 30

RIFAXIMIN 17

RILONACEPT 95

RILPIVIRINE HCL 44

RILUZOLE 64

RIMANTADINE HCL 46

RINGERS SOLUTION 119

RINGERS SOLUTION,LACTATED 119

RIOCIGUAT 108

RIOMET 49

RISEDRONATE SODIUM 97

RISPERDAL CONSTA 42

RISPERIDONE 42

RISPERIDONE MICROSPHERES 42

RITONAVIR 46

RITUXAN 38

RITUXIMAB 38

RIVAROXABAN 51

RIVASTIGMINE 24

RIVASTIGMINE TARTRATE 24

RIZATRIPTAN BENZOATE 29

ROCURONIUM BROMIDE 64

ROMIDEPSIN 34

ROPINIROLE HCL 39

ROPIVACAINE HCL/PF 13

ROSADAN 72

ROSULA 72

ROXICET 12

ROZEREM 111

RUFINAMIDE 23

RUXOLITINIB PHOSPHATE 36

SSABRIL 22

SACROSIDASE 75

SALACYN 72

SALICYLIC ACID 72

SALICYLIC ACID/AMMONIUM LACTATE/ALOE

VERA 72

SALICYLIC ACID/CERAMIDES 1,3,6-11 72

SALSALATE 6

SALVAX 72

SAMSCA 111

SANTYL 72

SAPROPTERIN DIHYDROCHLORIDE 75

SAQUINAVIR MESYLATE 46

SARGRAMOSTIM 52

SAVELLA 65


SCALACORT 73

SE 10-5 SS 73

SE BPO 73

SE-TAN PLUS 116

SEB-PREV 73

SECOBARBITAL SODIUM 111

SECONAL SODIUM 111

SELEGILINE HCL 40

SELENIUM 116

SELENIUM SULFIDE 73

SELZENTRY 45

SENSIPAR 92

SENSORCAINE 13

SENSORCAINE-EPINEPHRINE 13

SENSORCAINE-MPF 13

SEROQUEL XR 42

SERTRALINE HCL 25

SETLAKIN 89

SEVELAMER CARBONATE 81

SEVOFLURANE 14

SHAROBEL 91

SIGNIFOR 93

SILDENAFIL CITRATE 108

SILVER NITRATE 73

SILVER NITRATE/POTASSIUM NITRATE 73

SILVER SULFADIAZINE 74

SIMVASTATIN 62

SIROLIMUS 94

SIRTURO 30

SITAGLIPTIN PHOSPHATE 49

SITAGLIPTIN PHOSPHATE/METFORMIN HCL 48

SITZMARKS 99

SODIUM ACETATE 116

SODIUM BICARBONATE 116

SODIUM CHLORIDE 0.45 % 116

SODIUM CHLORIDE 3 % 116

SODIUM CHLORIDE 5 % 116

SODIUM CHLORIDE FOR INHALATION 109

SODIUM CHLORIDE IRRIGATING SOLUTION 80

SODIUM CHLORIDE IRRIGATING

SOLUTION/HYPOCHLOROUS ACID 74

SODIUM CITRATE DIHYDRATE 51

SODIUM FLUORIDE 119

SODIUM FLUORIDE/XYLITOL 117

SODIUM LACTATE 116

SODIUM MORRHUATE 99

SODIUM OXYBATE 111

SODIUM PHENYLBUTYRATE 75

SODIUM PHOS,M-BASIC-D-BASIC 116

SODIUM PHOSPHATE,MONOBASIC/POTASSIUM

PHOSPHATE,MONOBASIC 80

SODIUM POLYSTYRENE SULFONATE 112

SODIUM TETRADECYL SULFATE 99

SODIUM THIOSULFATE 99

SODIUM/POTASSIUM/MAGNES/CALCIUM/CHLORID

E/ACETATE/GLUCONATE 115

SODIUM/POTASSIUM/MAGNESIUM/CALCIUM/CHLO

RIDE/ACETATE 115

SODIUM/POTASSIUM/POTASSIUM

CITRATE/SODIUM CITRATE/CIT AC 81

SOFOSBUVIR 44

SOJOURN 14

SOLIRIS 99

SOMATROPIN 83

SORAFENIB TOSYLATE 36

SORINE 56

SOTALOL HCL 56

SOTRADECOL 99

SOVALDI 44

SPINOSAD 73

SPIRIVA 105

SPIRIVA RESPIMAT 105

SPIRONOLACTONE 61

SPIRONOLACTONE/HYDROCHLOROTHIAZIDE 60

SPORANOX 28

SPRINTEC 89

SPRYCEL 36

SPS 112

SRONYX 89

SS 10-2 73

SSD 73

SSS 10-5 73


STAVUDINE 45

STIMATE 83

STIOLTO RESPIMAT 110

STIVARGA 36

STRATTERA 64

STRENSIQ 75

STREPTOZOCIN 32

STRIBILD 44

STRIVERDI RESPIMAT 106

STROMECTOL 38

SUBLIMAZE 12

SUBOXONE 14

SUCCIMER 111

SUCCINYLCHOLINE CHLORIDE 110

SUCRAID 75

SUCRALFATE 78

SUFENTA 12

SUFENTANIL CITRATE 12

SULFACETAMIDE SODIUM 101

SULFACETAMIDE SODIUM/PREDNISOLONE

SODIUM PHOSPHATE 101

SULFACETAMIDE SODIUM/SULFUR 74

SULFACETAMIDE SODIUM/SULFUR/SKIN

CLEANSER COMB NO.23 73

SULFACETAMIDE SODIUM/SULFUR/UREA 73

SULFACETAMIDE SODIUM/SULFUR/WITCH

HAZEL 73

SULFACLEANSE 8-4 73

SULFADIAZINE 21

SULFAMETHOXAZOLE/TRIMETHOPRIM 21

SULFAMYLON 16

SULFASALAZINE 97

SULFATRIM 21

SULFAZINE 97

SULFAZINE EC 97

SULFURIC ACID/SULFONATED PHENOL 66

SULINDAC 6

SUMATRIPTAN 29

SUMATRIPTAN SUCCINATE 29

SUNITINIB MALATE 37

SUSTIVA 45

SUTENT 37

SYEDA 89

SYLATRON 35

SYLATRON 4-PACK 35

SYMAX 76

SYMAX-SL 76

SYMAX-SR 76

SYMBICORT 110

SYMLINPEN 120 49

SYMLINPEN 60 49

SYNAGIS 96

SYREX 116

TTABLOID 33

TACROLIMUS 94

TADALAFIL 108

TAFINLAR 37

TALIGLUCERASE ALFA 75

TAMIFLU 46

TAMOXIFEN CITRATE 32

TAMSULOSIN HCL 79

TARCEVA 37

TARGRETIN 38

TARINA FE 89

TARON FORTE 116

TARON-CRYSTALS 80

TASIGNA 37

TASIMELTEON 111

TASMAR 39

TAZAROTENE 74

TAZORAC 74

TAZTIA XT 58

TECFIDERA 66

TECHNIVIE 44

TEGRETOL XR 23

TELAPREVIR 43

TELBIVUDINE 43

TELMISARTAN 55

TELMISARTAN/AMLODIPINE BESYLATE 60

TELMISARTAN/HYDROCHLOROTHIAZIDE 60


TEMAZEPAM 111

TEMODAR 31

TEMOZOLOMIDE 31

TEMSIROLIMUS 37

TENCON 65

TENIPOSIDE 35

TENOFOVIR DISOPROXIL FUMARATE 45

TERAZOSIN HCL 79

TERBINAFINE HCL 28

TERBUTALINE SULFATE 106

TERCONAZOLE 29

TERIPARATIDE 97

TERRELL 14

TESAMORELIN ACETATE 93

TESTOPEL 83

TESTOSTERONE 84

TESTOSTERONE CYPIONATE 84

TESTOSTERONE ENANTHATE 84

TETCAINE 101

TETRABENAZINE 65

TETRACAINE HCL 101

TETRACAINE HCL/PF 101

TETRACYCLINE HCL 21

THALIDOMIDE 32

THALOMID 32

THEOCHRON 107

THEOPHYLLINE ANHYDROUS 107

THEOPHYLLINE/DEXTROSE 5 % IN WATER 108

THERACYS 35

THERAPEUTIC VITAMIN W-MINERALS 119

THERMAZENE 74

THIAMINE HCL 119

THIOGUANINE 33

THIORIDAZINE HCL 40

THIOTEPA 35

THIOTHIXENE 40

THRIVITE RX 119

THYROID,PORK 92

THYROLAR-1 92

THYROLAR-1/2 92

THYROLAR-1/4 92

THYROLAR-2 92

THYROLAR-3 92

TIAGABINE HCL 22

TICAGRELOR 54

TIGECYCLINE 16

TIKOSYN 56

TIMOLOL MALEATE 102

TINIDAZOLE 16

TIOTROPIUM BROMIDE 105

TIOTROPIUM BROMIDE/OLODATEROL HCL 110

TIPRANAVIR 45

TIVICAY 44

TIZANIDINE HCL 110

TL G-FOL OS 119

TL ICON 116

TL-HEM 150 116

TOBI 107

TOBI PODHALER 107

TOBRAMYCIN 107

TOBRAMYCIN IN 0.225 % SODIUM CHLORIDE 107

TOBRAMYCIN SULFATE 15

TOBRAMYCIN SULFATE/SODIUM CHLORIDE 15

TOBRAMYCIN/DEXAMETHASONE 101

TOBRAMYCIN/NEBULIZER 107

TOCILIZUMAB 95

TOLAZAMIDE 49

TOLBUTAMIDE 49

TOLCAPONE 39

TOLMETIN SODIUM 6

TOLTERODINE TARTRATE 79

TOLVAPTAN 111

TOPIRAGEN 23

TOPIRAMATE 23

TOPOSAR 35

TOREMIFENE CITRATE 32

TORISEL 37

TORSEMIDE 61

TOSITUMOMAB (WITH MALTOSE) 37

TRACLEER 108

TRADJENTA 49

TRAMADOL HCL 12


TRAMADOL HCL/ACETAMINOPHEN 12

TRAMETINIB DIMETHYL SULFOXIDE 36

TRANDOLAPRIL 55

TRANDOLAPRIL/VERAPAMIL HCL 60

TRANEXAMIC ACID 54

TRANYLCYPROMINE SULFATE 25

TRASTUZUMAB 37

TRAVASOL 119

TRAVOPROST (BENZALKONIUM) 102

TRAZODONE HCL 25

TREANDA 31

TREPROSTINIL SODIUM 108

TREPROSTINIL/NEBULIZER/NEBULIZER

ACCESSORIES 108

TRETINOIN 74

TRETINOIN MICROSPHERES 74

TRETTEN 54

TREXALL 95

TRI-CHLOR 74

TRI-ESTARYLLA 89

TRI-LEGEST FE 89

TRI-LINYAH 89

TRI-LO-ESTARYLLA 89

TRI-LO-MARZIA 89

TRI-LO-SPRINTEC 89

TRI-PREVIFEM 89

TRI-SPRINTEC 89

TRIACETIN 29

TRIAMCINOLONE ACETONIDE 104

TRIAMTERENE/HYDROCHLOROTHIAZIDE 60

TRIANEX 74

TRIAZOLAM 111

TRICHLOROACETIC ACID 74

TRICITRASOL 51

TRICITRATES 80

TRICON 117

TRIDERM 74

TRIFLUOPERAZINE HCL 40

TRIFLURIDINE 46

TRIGELS-F FORTE 117

TRIHEXYPHENIDYL HCL 39

TRIMETHOBENZAMIDE HCL 26

TRIMETHOPRIM 16

TRINESSA 89

TRISENOX 35

TRIVORA-28 90

TROPICAMIDE 101

TROSPIUM CHLORIDE 79

TRUVADA 45

TRYPSIN/BALSAM PERU/CASTOR OIL 74

TUDORZA PRESSAIR 106

TUSSIGON 110

TYGACIL 16

TYKERB 37

TYVASO 108

TYZEKA 43

UUCERIS 97

ULORIC 29

ULTIMATE OB DHA 119

UMECTA 74

UNITHROID 92

UR N-C 16

UREA 74

UREA/HYALURONATE SODIUM 74

UREA/LACTIC ACID/SALICYLIC ACID 74

UREA/LACTIC ACID/ZINC UNDECYLENATE 74

URETRON D-S 16

URIMAR-T 16

URIN D.S. 16

URO-BLUE 16

UROGESIC-BLUE 17

UROLET MB 17

UROPHEN MB 17

URSODIOL 77

URYL 17

USTELL 17

UTIRA-C 17

VVAGIFEM 90


VALACYCLOVIR HCL 46

VALCHLOR 31

VALCYTE 43

VALGANCICLOVIR HCL 43

VALPROIC ACID 23

VALPROIC ACID (AS SODIUM SALT) (VALPROATE

SODIUM) 22

VALSARTAN 55

VALSARTAN/HYDROCHLOROTHIAZIDE 60

VANCOMYCIN HCL 17

VANCOMYCIN HCL/DEXTROSE 5 % IN WATER 17

VANCOMYCIN IN 0.9 % SODIUM CHLORIDE 17

VANCOMYCIN IN DEXTROSE, ISO-OSMOTIC 17

VANDAZOLE 17

VANDETANIB 36

VANTAS 93

VARENICLINE TARTRATE 14

VARICELLA-ZOSTER IMMUNE GLOBULIN

(HUMAN) 95

VARIZIG 95

VASCEPA 62

VASHE WOUND THERAPY 74

VASOLEX 74

VASOPRESSIN 83

VECTIBIX 38

VECURONIUM BROMIDE 65

VELAGLUCERASE ALFA 75

VELETRI 108

VELIVET 90

VEMURAFENIB 37

VENA-BAL DHA 119

VENLAFAXINE HCL 25

VENTAVIS 108

VENTOLIN HFA 106

VERAPAMIL HCL 58

VERDROCET 12

VERIPRED 20 82

VESTURA 90

VICODIN 12

VICODIN ES 12

VICODIN HP 12

VICTOZA 2-PAK 49

VICTOZA 3-PAK 49

VICTRELIS 44

VIDEX 45

VIEKIRA PAK 44

VIENVA 90

VIGABATRIN 22

VIMPAT 24

VINBLASTINE SULFATE 35

VINCASAR PFS 35

VINCRISTINE SULFATE 35

VINCRISTINE SULFATE LIPOSOMAL 34

VINORELBINE TARTRATE 35

VIORELE 90

VIRACEPT 46

VIRAMUNE XR 45

VIREAD 45

VIRT NATE 119

VIRT-ADVANCE 119

VIRT-CAPS 119

VIRT-NATE 119

VIRT-NATE DHA 119

VIRT-PHOS 250 NEUTRAL 81

VIRT-PN 119

VIRT-VITE GT 120

VIRTI-SULF 74

VIRTPREX 120

VIRTRATE-2 81

VIRTRATE-3 81

VIRTRATE-K 81

VISMODEGIB 36

VITAFOL-OB 120

VITAFOL-PN 120

VITAMIN A/VITAMIN

E/AVOBENZONE/OCTINOXATE/HYDROQUINONE 71

VITAMIN B COMPLEX & VITAMIN C NO.20/FOLIC

ACID 119

VITAMIN B COMPLX NO.3/FOLIC ACID/ASCORBIC

ACID/BIOTIN 120

VITAMIN B COMPLX NO.3/FOLIC ACID/ASCORBIC

ACID/BIOTIN/ZNOX 118


VOL-CARE RX 120

VOL-PLUS 120

VORAPAXAR SULFATE 54

VORICONAZOLE 29

VORINOSTAT 35

VOTRIENT 37

VP-VITE RX 120

VPRIV 75

VSL#3 DS 77

VUMON 35

VYFEMLA 90

VYVANSE 63

WWARFARIN SODIUM 51

WATER FOR INJ.,BACTERIOSTATIC 99

WATER FOR

INJ.,BACTERIOSTATIC/METHYLPARABEN/PROPYL

PARABEN 99

WATER FOR INJECTION,STERILE 99

WATER FOR IRRIGATION,STERILE 99

WERA 90

WESTHROID 92

WYMZYA FE 90

XX-VIATE 74

XALKORI 37

XARELTO 51

XENAZINE 65

XIFAXAN 17

XOLAIR 110

XTANDI 32

XYNTHA 54

XYNTHA SOLOFUSE 54

XYREM 111

ZZAFIRLUKAST 105

ZALEPLON 111

ZAMICET 12

ZANAMIVIR 46

ZANOSAR 32

ZARAH 90

ZAVESCA 75

ZEBUTAL 65

ZELBORAF 37

ZEMAIRA 110

ZENCHENT 90

ZENCHENT FE 90

ZENCIA 74

ZEOSA 90

ZETIA 62

ZEVALIN 38

ZIAGEN 45

ZIDOVUDINE 45

ZINC CHLORIDE 117

ZINC SULFATE 117

ZINC SULFATE HEPTAHYDRATE/CUSO4 P-

HYD/MANGANESE/CHROMIUM/SE 115

ZINC SULFATE/CUPRIC SULFATE/MANGANESE

SULF/CHROMIC CHLORIDE 115

ZIPRASIDONE HCL 42

ZIPRASIDONE MESYLATE 41

ZOLINZA 35

ZOLMITRIPTAN 30

ZOLPIDEM TARTRATE 111

ZOMIG 30

ZONISAMIDE 22

ZONTIVITY 54

ZORTRESS 95

ZOSTAVAX 96

ZOSTER VACCINE LIVE/PF 96

ZOVIA 1-35E 90

ZOVIA 1-50E 90

ZOVIRAX 47

ZYDELIG 37

ZYKADIA 37

ZYTIGA 32

ZYVOX 17


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