PA Drug Name Generic Name PA Summary Name

Epaned enalapril ACE Inhibitors and Combinations

Perindopril perindopril ACE Inhibitors and Combinations

Prestalia perindopril/amlodipine ACE Inhibitors and Combinations

Qbrelis lisinopril ACE Inhibitors and Combinations

Trandolapril/Verapamil ER by Greenstone trandolapril/verapamil ER ACE Inhibitors and Combinations

Acanya clindamycin/benzoyl peroxide Acne and Rosacea Agents Topical

Aczone dapsone Acne and Rosacea Agents Topical

Altreno, Avita, Tretinoin, Retin-A Micro tretinoin Acne and Rosacea Agents Topical

Azelex, Finacea azelaic acid Acne and Rosacea Agents Topical

Clindamycin, Clindacin, Evoclin clindamycin Acne and Rosacea Agents Topical

Neuac Kit, Onexton clindamycin/benzoyl peroxide Acne and Rosacea Agents Topical

Differin, Adapalene adapalene Acne and Rosacea Agents Topical

Epiduo, Epidue Forte adalpalene/benzoyl peroxide Acne and Rosacea Agents Topical

Ery Pad, erythromycin pad erythromycin Acne and Rosacea Agents Topical

Metrogel, Metronidazole, Noritate, Rosadan metronidazole Acne and Rosacea Agents Topical

Fabior, Tazorac tazarotene Acne and Rosacea Agents Topical

Soolantra ivermectin Acne and Rosacea Agents Topical

Veltin, Ziana tretinoin/clindamycin Acne and Rosacea Agents Topical

BPO Cloths benzoyl peroxide Acne and Rosacea Agents Topical

Sumaxin, Sulfacetamide Sodium/Sulfur 9-4%

Washsodium sulfacetamide/sulfur Acne and Rosacea Agents Topical

Octreotide, Sandostatin LAR octreotide/octreotide ER Acromegaly Agents

Signifor LAR pasireotide ER Acromegaly Agents

Somatuline Depot lanreotide ER Acromegaly Agents

Somavert pegvisomant Acromegaly Agents

Afinitor everolimus Afinitor

Carospir spirinolactone suspension Aldosterone Agents

Eplerenone eplerenone Aldosterone Agents

Tekturna aliskiren Aliskiren and Combinations

Tekturna HCT aliskiren/HCTZ Aliskiren and Combinations

Grastek timothy grass pollen allergen extract Allergic Rhinitis Sublingual Immunotherapy

Prior Authorization Drug Criteria Cross Reference

Oralair mixed grass pollen allergen extract Allergic Rhinitis Sublingual Immunotherapy

Ragwitek short ragweed pollen allergen extract Allergic Rhinitis Sublingual Immunotherapy

Aralast-NP alpha-1 proteinase inhibitor Alpha-1 Proteinase Inhibitors

Glassia alpha-1 proteinase inhibitor Alpha-1 Proteinase Inhibitors

Prolastin-C alpha-1 proteinase inhibitor Alpha-1 Proteinase Inhibitors

Zemaira alpha-1 proteinase inhibitor Alpha-1 Proteinase Inhibitors

Donepezil 23 mg donepezil Alzheimer's Agents

Memantine oral solution memantine Alzheimer's Agents

Namenda XR, XR Titration Pak memantine extended-release Alzheimer's Agents

Namzaric, Titration Pak memantine/donepezil Alzheimer's Agents

Tiglutik riluzole Amyotrophic Lateral Sclerosis Agents

Acetaminophen/caffeine/dihydrocodeine acetaminophen/caffeine/dihydrocodeine Analgesics, Narcotics Short

Butalbital/Acetaminophen/Caffeine/Codein

e

butalbital/acetaminophen/caffeine/codein

eAnalgesics, Narcotics Short

Butalbital/Aspirin/Caffeine/Codeine butalbital/aspirin/caffeine/codeine Analgesics, Narcotics Short

Butorphanol Nasal Spray QLL butorphanol Analgesics, Narcotics Short

Dilaudid Oral Liquid, Hydromorphone Rectal

Suppositoryhydromorphone Analgesics, Narcotics Short

Hydrocodone/Ibuprofen, Ibudone hydrocodone/ibuprofen Analgesics, Narcotics Short

Meperidine Tablets meperidine Analgesics, Narcotics Short

Morphine Rectal Suppository morphine Analgesics, Narcotics Short

Nucynta tapentadol Analgesics, Narcotics Short

Oxaydo, Oxycodone QLL, Oxycodone

Concentrate Oral Solutionoxycodone Analgesics, Narcotics Short

Oxycodone/Aspirin oxycodone/aspirin Analgesics, Narcotics Short

Oxycodone/Ibuprofen oxycodone/ibuprofen Analgesics, Narcotics Short

Oxymorphone oxymorphone Analgesics, Narcotics Short

Primlev oxycodone/acetaminophen Analgesics, Narcotics Short

Testosterone Injection testosterone cypionate Androgenic Agents, Injectable

Testosterone Injection, Xyosted testosterone enanthate Androgenic Agents, Injectable

Anadrol-50 oxymetholone Androgenic Agents, Oral

Android, Methitest, Methyltestosterone,

Testredmethyltestosterone Androgenic Agents, Oral

Danazol danazol Androgenic Agents, Oral

Oxandrolone oxandrolone Androgenic Agents, Oral

Androderm, Androgel, Natesto, Striant,

Testosterone Gel and Solutiontestosterone Androgenic Agents, Topical

Benicar, Olmesartan olmesartan Angiotensin Receptor Blockers and Combinations

Candesartan candesartan Angiotensin Receptor Blockers and Combinations

Edarbi azilsartan Angiotensin Receptor Blockers and Combinations

Eprosartan eprosartan Angiotensin Receptor Blockers and Combinations

Micardis, Telmisartan telmisartan Angiotensin Receptor Blockers and Combinations

Amlodipine/Valsartan amlodipine/valsartan Angiotensin Receptor Blockers and Combinations

Amlodipine/Valsartan/HCTZ amlodipine/valsartan/HCTZ Angiotensin Receptor Blockers and Combinations

Amlodipine/olmesartan amlodipine/olmesartan Angiotensin Receptor Blockers and Combinations

Entresto sacubitril/valsartan Angiotensin Receptor Blockers and Combinations

Tribenzor olmesartan/amlodipine/HCTZ Angiotensin Receptor Blockers and Combinations

Benicar HCT, Olmesartan/HCTZ olmesartan/HCTZ Angiotensin Receptor Blockers and Combinations

Candesartan/HCTZ candesartan/HCTZ Angiotensin Receptor Blockers and Combinations

Edarbyclor azilsartan/HCTZ Angiotensin Receptor Blockers and Combinations

Micardis, Telmisartan/HCTZ telmisartan/HCTZ Angiotensin Receptor Blockers and Combinations

Telmisartan/Amlodipine, Twynsta telmisartan/amlodipine Angiotensin Receptor Blockers and Combinations

Albenza albendazole Anthelmintics

Emverm mebendazole Anthelmintics

Stromectol ivermectin Anthelmintics

Erleada apalutamide Antiandrogens

Xtandi enzalutamide Antiandrogens

Yonsa airaterone Antiandrogens

Zytiga abiraterone Antiandrogens

Cleocin Ovules, Clindamycin Vaginal Cream

(7-day)clindamycin Antibiotics, Vaginal

Nuvessa metronidazole Antibiotics, Vaginal

Solosec secnidazole Antibiotics, Vaginal

Cuvposa, Glycate, Glycopyrrolate Injection glycopyrrolate Anticholinergics-Antispasmodics

Savaysa edoxaban Anticoagulants

Enoxaparin Syringes and Vials except by

Winthrop/Fresenius enoxaparin Anticoagulants

Fondaparinux fondaparinux Anticoagulants

Fragmin Syringes dalteparin Anticoagulants

Aptiom eslicarbazepine Anticonvulsants

Banzel rufinamide Anticonvulsants

Briviact brivaracetam Anticonvulsants

Diastat, Diazepam Rectal diazepam rectal Anticonvulsants

Diacomit stiripentol Anticonvulsants

Epidiolex cannabidiol Anticonvulsants

Felbamate felbamate Anticonvulsants

Fycompa perampanel Anticonvulsants

Gabitril, Tiagabine tiagabine Anticonvulsants

Lamictal Kits/ODT, Lamotrigine ER/ODT/kits lamotrigine Anticonvulsants

Levetiracetam ER levetiracetam extended-release Anticonvulsants

Lyrica CR pregabalin extended-release Anticonvulsants

Lyrica Oral Solution pregabalin Anticonvulsants

Onfi, Clobazam, Sympazan clobazam Anticonvulsants

Oxtellar XR oxcarbazepine Anticonvulsants

Qudexy XR, Topiramate ER, Trokendi XR topiramate extended-release Anticonvulsants

Sabril vigabatrin Anticonvulsants

Stavzor, Valproic Acid Capsules valproic acid Anticonvulsants

Vimpat Injection lacosamide Anticonvulsants

Brisdelle, Paxil Suspension, Pexeva paroxetine Antidepressants

Escitalopram Oral Solution escitalopram Antidepressants

Fluoxetine 10 mg, 20 mg Tablets fluoxetine Antidepressants

Fluoxetine 90 mg Delayed-Release fluoxetine DR Antidepressants

Fluoxetine [PMDD], Sarafem fluoxetine [PMDD] Antidepressants

Fluvoxamine ER fluvoxamine extended-release Antidepressants

Paroxetine ER paroxetine extended-release Antidepressants

Desvenlafaxine ER desvenlafaxine extended-release Antidepressants

Duloxetine 40 mg duloxetine Antidepressants

Fetzima levomilnacipran Antidepressants

Savella milnacipran Antidepressants

Trintellix (previously Brintellix) vortioxetine Antidepressants

Venlafaxine ER Tablets venlafaxine extended-release Antidepressants

Nefazodone nefazodone Antidepressants

Trazodone 300 mg trazodone Antidepressants

Viibryd viladazone Antidepressants

Emsam selegiline Antidepressants

Marplan isocarboxazid Antidepressants

Phenylzine phenylzine Antidepressants

Tranylcypromine tranylcypromine Antidepressants

Imipramine Capsules imipramine pamoate Antidepressants

Protriptyline protriptyline Antidepressants

Trimipramine trimipramine Antidepressants

Aplenzin, Forfivo XL bupropion extended-release Antidepressants

Maprotiline maprotiline Antidepressants

Alogliptin 6.25, 12.5mg, Nesina 25mg alogliptin Antidiabetic Agents

Alogliptin/Metformin alogliptin/metformin Antidiabetic Agents

Alogliptin/Pioglitazone alogliptin/pioglitazone Antidiabetic Agents

Janumet XR sitagliptin/metformin ER Antidiabetic Agents

Jentadueto XR linagliptin/metformin ER Antidiabetic Agents

Prandimet, Repaglinide/Metformin repaglinide/metformin Antidiabetic Agents

Fortamet, Glumetza, Metformin ER (generic

Fortamet)metformin ER Antidiabetic Agents

Glyxambi empagliflozin/linagliptin Antidiabetic Agents

Invokamet canagliflozin/metformin Antidiabetic Agents

Invokamet XR canagliflozin/metformin ER Antidiabetic Agents

Segluromet ertugliflozin/metformin Antidiabetic Agents

Steglatro ertugliflozin Antidiabetic Agents

Steglujan ertugliflozin/sitagliptin Antidiabetic Agents

Synjardy, Synjardy XR empaglifozin/metformin, ER Antidiabetic Agents

Xidguo XR dapagliflozin/metformin ER Antidiabetic Agents

Chlorpropamide chlorpropamide Antidiabetic Agents

Tolazamide tolazamide Antidiabetic Agents

Tolbutamide tolbutamide Antidiabetic Agents

Actoplus Met XR pioglitazone/metformin ER Antidiabetic Agents

Avandia rosiglitazone Antidiabetic Agents

Avandamet rosiglitazone/metformin Antidiabetic Agents

Pioglitazone/Glimepride pioglitazone/glimepiride Antidiabetic Agents

Pioglitazone/Metformin pioglitazone/metformin Antidiabetic Agents

Bydureon/Bydureon BCise exenatide ER Antidiabetic Agents

Byetta exenatide Antidiabetic Agents

Symlin Pen pramlintide acetate Antidiabetic Agents

Victoza liraglutide Antidiabetic Agents

Adlyxin lixisenatide Antidiabetic Agents

Cycloset bromocriptine Antidiabetic Agents

Ozempic semaglutide Antidiabetic Agents

Soliqua insulin glargine/lixisenatide Antidiabetic Agents

Tanzeum albiglutide Antidiabetic Agents

Trulicity dulaglutide Antidiabetic Agents

Xultophy insulin degludec/liraglutide Antidiabetic Agents

Akynzeo netupitant/palonosetron Antiemetics

Anzemet dolasetron Antiemetics

Cesamet nabilone Antiemetics

Compro prochlorperazine Antiemetics

Dronabinol, Syndros dronabinol Antiemetics

Emend Suspension aprepitant Antiemetics

Granisetron, Sancuso granisetron Antiemetics

Ondansetron Injection, Zuplenz ondansetron Antiemetics

Promethazine 50 mg Suppositories promethazine Antiemetics

Varubi rolapitant Antiemetics

Trimethobenzamide trimethobenzamide Antiemetics

Ciclodan Kit, CNL8 Kit, Ciclopirox, Loprox Kit ciclopirox Antifungals

Cresemba isavuconazonium Antifungals

Griseofulvin Microsize griseofulvin Antifungals

Lamisil Granules terbinafine Antifungals

Noxafil posaconazole Antifungals

Itraconazole, Omnel, Sporanox Itraconazole Antifungals

Oravig miconazole Antifungals

Vfend Suspension, Voriconazole voriconazole Antifungals

Fluconazole Injection fluconazole Antifungals

Ambisome amphotericin B liposome Antifungals

Cancidas caspofungin Antifungals

Extina, Ketoconazole Foam ketoconazole Antifungals

Jublia efinaconazole Antifungals

Kerydin tavaborole Antifungals

Luzu luliconazole Antifungals

Naftifine naftifine Antifungals

Nystatin/triamcinolone cream and ointment nystatin/triamcinolone Antifungals

Pediaderm AF Kit nystatin/diaper rash cream Antifungals

Vusion miconazole/zinc oxide/petrolatum Antifungals

Clarinex-D desloratadine/pseudoephedrine Antihistamines

Clarinex Syrup, Desloratadine desloratadine Antihistamines

Karbinal ER, Ryvent carbinoxamine ER Antihistamines

Levocetirizine Solution levocetirizine Antihistamines

Ryvent carbinoxamine Antihistamines

Krintafel tafenoquine Antimalarials

Atovaquone/Proguanil, Malarone atovaquone/proguanil Antimalarials

Coartem artemether/lumefantrine Antimalarials

Quinine Sulfate quinine sulfate Antimalarials

Aimovig erenumab-aooe Antimigraine Agents, Other

Ajovy fremanezumab-vfrm Antimigraine Agents, Other

Emgality galcanezumab-gnlm Antimigraine Agents, Other

Carbidopa/Levodopa ODT, Rytary carbidopa/levodopa Antiparkinson Agents

Gocovri amantadine extended-release Antiparkinson Agents

Mirapex ER, Pramipexole ER pramipexole Antiparkinson Agents

Neupro rotigotine Antiparkinson Agents

Requip XL, Ropinirole ER ropinirole Antiparkinson Agents

Tolcapone tolcapone Antiparkinson Agents

Xadago safinamide Antiparkinson Agents

Zelapar selegiline Antiparkinson Agents

Aspirin/Dipyridamole aspirin/dipyridamole Antiplatelet Drugs

Clopidogrel 300 mg clopidogrel Antiplatelet Drugs

Yosprala aspirin/omeprazole Antiplatelet Drugs

Zontivity vorapaxar Antiplatelet Drugs

Alinia Quantity Level Limit nitazoxanide Antiprotozoals

Benznidazole benznidazole Antiprotozoals

Daraprim pyrimethamine Antiprotozoals

Flagyl 375 mg, Metronidazole 375 mg metronidazole Antiprotozoals

Tinidazole tinidazole Antiprotozoals

Doxepin Cream, Prudoxin, Zonalon doxepin Antipruritics Topical

Calcipotriene ointment, Sorilux calcipotriene Antipsoriatic Agents

Calcipotriene/betamethasone, Enstilar,

Taclonexcalcipotriene/betamethasone Antipsoriatic Agents

Calcitriol, Vectical calcitriol Antipsoriatic Agents

Methoxsalen methoxsalen Antipsoriatic Agents

Valacyclovir QLL valacyclovir Antivirals, Oral

Oseltamivir oseltamivir Antivirals, Oral

Sitavig acyclovir Antivirals, Oral

Xofluza baloxivir Antivirals, Oral

Acyclovir Ointment acyclovir Antivirals, Topical

Denavir penciclovir Antivirals, Topical

Xerese acyclovir/hydrocortisone Antivirals, Topical

Meprobamate meprobamate Anxiolytics Benzodiazepines and Barbiturates

Alprazolam, Alprazolam ER, ODT alprazolam Anxiolytics Benzodiazepines and Barbiturates

Chlordiazepoxide chlordiazepoxide Anxiolytics Benzodiazepines and Barbiturates

Clonazepam ODT clonazepam Anxiolytics Benzodiazepines and Barbiturates

Clorazepate clorazepate Anxiolytics Benzodiazepines and Barbiturates

Diazepam diazepam Anxiolytics Benzodiazepines and Barbiturates

Lorazepam lorazepam Anxiolytics Benzodiazepines and Barbiturates

Oxazepam oxazepam Anxiolytics Benzodiazepines and Barbiturates

Estazolam estazolam Anxiolytics Benzodiazepines and Barbiturates

Flurazepam flurazepam Anxiolytics Benzodiazepines and Barbiturates

Midazolam midazolam Anxiolytics Benzodiazepines and Barbiturates

Temazepam temazepam Anxiolytics Benzodiazepines and Barbiturates

Triazolam triazolam Anxiolytics Benzodiazepines and Barbiturates

Amytal amobarbital Anxiolytics Benzodiazepines and Barbiturates

Butisol butabarbital Anxiolytics Benzodiazepines and Barbiturates

Phenobarbital Injection phenobarbital Anxiolytics Benzodiazepines and Barbiturates

Seconal secobarbital Anxiolytics Benzodiazepines and Barbiturates

Arikayce amikacin liposome inhalation suspension Arikayce

Anoro Ellipta umeclidinium/vilanterol Asthma and COPD Agents

Bevespi Aerosphere glycopyrrolate/formoterol Asthma and COPD Agents

Incruse Ellipta umeclidinium Asthma and COPD Agents

Seebri Neohaler glycopyrrolate Asthma and COPD Agents

Spiriva Respimat tiotropium Asthma and COPD Agents

Tudorza Pressair aclidinium Asthma and COPD Agents

Utibron Neohaler glycopyrrolate/indacaterol Asthma and COPD Agents

Albuterol Inhalation 0.021%, 0.042% albuterol Asthma and COPD Agents

Albuterol Tablets albuterol Asthma and COPD Agents

Arcapta Neohaler indacaterol Asthma and COPD Agents

Brovana aformoterol Asthma and COPD Agents

Levalbuterol, Xopenex HFA levalbuterol Asthma and COPD Agents

Metaproterenol metaproterenol Asthma and COPD Agents

Perforomist formoterol Asthma and COPD Agents

Striverdi Respimat oladaterol Asthma and COPD Agents

Terbutaline terbutaline Asthma and COPD Agents

Alvesco ciclesonide Asthma and COPD Agents

Armonair Respiclick fluticasone propionate Asthma and COPD Agents

Arnuity Ellipta fluticasone furoate Asthma and COPD Agents

Asmanex Twisthaler/HFA mometasone Asthma and COPD Agents

Qvar Redihaler beclomethasone Asthma and COPD Agents

AirDuo, Fluticasone/Salmeterol fluticasone/salmeterol Asthma and COPD Agents

Breo Ellipta fluticasone/vilanterol Asthma and COPD Agents

Daliresp roflumilast Asthma and COPD Agents

Abilify Maintena, Aripiprazole,

Aristada/Aristada Initioaripiprazole Atypical Antipsychotics

Clozapine, Clozapine ODT, Fazaclo,

Versaclozclozapine Atypical Antipsychotics

Fanapt iloperidone Atypical Antipsychotics

Invega Sustenna, Invega Trinza,

Paliperidonepaliperidone Atypical Antipsychotics

Latuda lurasidone Atypical Antipsychotics

Nuplazid pimavanserin Atypical Antipsychotics

Olanzapine olanzapine Atypical Antipsychotics

Olanzapine/Fluoxetine olanzapine/fluoxetine Atypical Antipsychotics

Quetiapine, Seroquel XR quetiapine Atypical Antipsychotics

Rexulti brexpiprazole Atypical Antipsychotics

Risperdal Consta, Risperidone risperidone Atypical Antipsychotics

Saphris asenapine Atypical Antipsychotics

Vraylar cariprazine Atypical Antipsychotics

Ziprasidone ziprasidone Atypical Antipsychotics

Zyprexa Relprevv olanzapine Atypical Antipsychotics

Amoxicillin/Clavulanate chewable tablets,

250/125 mg tabletsamoxicillin/clavulanate Augmentin Products

Amoxicillin/Clavulanate ER amoxicillin/clavulanate extended-release Augmentin Products

Amoxicillin/clavulanate 250-62.5 mg/5 ml,

Augmentin 125-31.25 mg/5 mLamoxicillin/clavulanate Augmentin Products

Aztreonam injection, Azactam Injection aztreonam Aztreonam

Balversa larotrectinib Balversa

Erivedge vismodegib Basal Cell Carcinoma Agents

Odomzo sonidegib Basal Cell Carcinoma Agents

Bystolic nebivolol Beta Blockers

Coreg CR carvedilol extended-release Beta Blockers

Corzide nadolol/bendroflurmethiazide Beta Blockers

Innopran XL propranolol extended-release Beta Blockers

Metoprolol/Hydrochlorothiazide metoprolol/hydrochlorothiazide Beta Blockers

Sotylize sotalol Beta Blockers

Timolol timolol Beta Blockers

BiDil isosorbide dinitrate/hydralazine HCl BiDil

Cholestyramine, cholestyramine lite,

Prevalite powder packetscholestyramine Bile Acid Sequestrants

Colestid and colestipol granules and packets colestipol Bile Acid Sequestrants

Welchol colesevelam Bile Acid Sequestrants

Arcalyst rilonacept Biologic Immunomodulators

Benlysta Subcutaneous belimumab Biologic Immunomodulators

Enbrel/Mini/SureClick etanercept Biologic Immunomodulators

Humira adalimumab Biologic Immunomodulators

Ilaris canakinumab Biologic Immunomodulators

Xeljanz tofacitinib Biologic Immunomodulators

Xeljanz XR tofacitinib extended-release Biologic Immunomodulators

Actemra Subcutaneous tocilizumab Biologic Immunomodulators

Cimzia certolizumab Biologic Immunomodulators

Cosentyx secukinumab Biologic Immunomodulators

Dupixent dupilumab Biologic Immunomodulators

Kevzara sarilumab Biologic Immunomodulators

Kineret anakinra Biologic Immunomodulators

Olumiant baricitinib Biologic Immunomodulators

Orencia Subcutaneous abatacept Biologic Immunomodulators

Otezla apremilast Biologic Immunomodulators

Siliq brodalumab Biologic Immunomodulators

Simponi golimumab Biologic Immunomodulators

Stelara ustekinumab Biologic Immunomodulators

Taltz ixekizumab Biologic Immunomodulators

Tremfya guselkumab Biologic Immunomodulators

Enablex darifenacin Bladder Relaxant Preparations

Flavoxate flavoxate Bladder Relaxant Preparations

Gelnique oxybutunin Bladder Relaxant Preparations

Myrbetriq mirabegron Bladder Relaxant Preparations

Sanctura XR, Trospium IR and ER trospium Bladder Relaxant Preparations

Tolterodine IR, Tolterodine ER tolterodine tartrate Bladder Relaxant Preparations

Actonel 5 mg and 30 mg, Atelvia,

Risedronaterisedronate Bone Ossification

Alendronate Oral Solution, Binosto alendronate Bone Ossification

Forteo teriparatide Bone Ossification

Fosamax Plus D alendronate with vitamin D Bone Ossification

Ibandronate ibandronate Bone Ossification

Miacalcin Injection calcitonin-salmon Bone Ossification

Risedronate Delayed-Release risedronate DR Bone Ossification

Tymlos abaloparatide Bone Ossification

Cardura XL doxazosin BPH Agents

Cialis 2.5 mg, 5 mg tadalafil BPH Agents

Dutasteride dutasteride BPH Agents

Dutasteride/Tamsulosin dutasteride/tamsulosin BPH Agents

Rapaflo silodosin BPH Agents

Ibrance palbociclib Breast Cancer Agents

Kisqali riociclib Breast Cancer Agents

Kisqali Femara riociclib/letrozole Breast Cancer Agents

Nerlynx neratinib Breast Cancer Agents

Talzenna talazoparib Breast Cancer Agents

Verzenio abemaciclib Breast Cancer Agents

Cabometyx cabozantinib Cabometyx

Isradipine isradipine Calcium Channel Blockers Dihydropyridines

Nisoldipine ER nisoldipine ER Calcium Channel Blockers Dihydropyridines

Nymalize nimodipine Calcium Channel Blockers Dihydropyridines

Diltiazem CD 360 mg diltiazem ER Calcium Channel Blockers NonDihydropyridines

Verapamil ER PM verapamil ER Calcium Channel Blockers NonDihydropyridines

Calquence acalabrutinib Calquence

Capecitabine capecitabine Capecitabine

Carbaglu carglumic acid Carbaglu

Doribax doripenem Carbapenems

Meropenem meropenem Carbapenems

Meropenem/Sodium Chloride meropenem/sodium chloride Carbapenems

Primaxin, Imipenem/Cilastin imipenem/cilastin Carbapenems

Celestone Soluspan betamethasone Celestone Soluspan

Cefadroxil Tablets cefadroxil Cephalosporins

Cephalexin 750mg and Tablets cephalexin Cephalosporins

Cefaclor ER cefaclor extended-release Cephalosporins

Cefaclor Suspension cefaclor Cephalosporins

Avycaz ceftazidime/avibactam Cephalosporins

Cefixime, Suprax Suspension and Tablets cefixime Cephalosporins

Cefpodoxime cefpodoxime Cephalosporins

Teflaro ceftaroline Cephalosporins

Zerbaxa ceftolozane/tazobactam Cephalosporins

D-Penamine, Depen Titratabs penicillamine Chelating Agents

Ferriprox deferiprone Chelating Agents

Jadenu deferasirox Chelating Agents

Chenodal chenodiol Chenodal

Cholbam cholic acid Cholbam

Clonidine TTS clonidine TTS Clonidine TTS

Fulphila pegfilgrastim-jmdb Colony Stimulating Factors

Granix tbo filgastrim Colony Stimulating Factors

Leukine sargramostim Colony Stimulating Factors

Neulasta pegfilgrastim Colony Stimulating Factors

Neupogen filgrastim Colony Stimulating Factors

Nivestym filgrastim-aafi Colony Stimulating Factors

Zarxio filgrastim-sndz Colony Stimulating Factors

Amethia, Amethia Lo, Amethyst, Camrese,

Camrese Lo, Quartette, genericsethinyl estradiol/levonorgestrel Contraceptives

Aranelle, Leena, Necon , Norinyl, generics ethinyl estradiol/norethindrone Contraceptives

Rajani, generics, Safyralethinyl estradiol/drospirenone/

levomefolate calciumContraceptives

Layolis FE, Wymza FE, Zenchant FE, genericsethinyl estradiol/norethindrone

acetate/ferrous fumarateContraceptives

Gianvi, Ocella, Zarah, generics ethinyl estradiol/drospirenone Contraceptives

Lo Loestrin FE, Minastrin 24 FEethinyl estradiol/norethindrone

acetate/ferrous fumarateContraceptives

Natazia estradiol valerate/dienogest Contraceptives

Tri-Lo Estaryll, Tri-Lo Marzia, Tri-Lo Sprintec,

genericsethinyl estradiol/norgestimate Contraceptives

Xulane, generics ethinyl estradiol/norelgestromin Contraceptives

Zovia 1/50E, generics ethinyl estradiol/ethynodiol Contraceptives

Copiktra duvelisib Copiktra

Corlanor ivabradine Corlanor

Analpram-HC Cream,

Hydrocortisone/Pramoxine, Procorthydrocortisone acetate/pramoxine Corticosteroid Combinations

Dexpak dexamethasone Corticosteroids Oral

Emflaza deflazacort Corticosteroids Oral

Millipred, Orapred ODT, Prednisolone ODT,

10mg/5mL, 20mg/5mL, Veripredprednisolone Corticosteroids Oral

Rayos prednisone delayed-release Corticosteroids Oral

Corvita corvita Corvita

Crinone progesterone Crinone

Kalydeco ivacaftor Cystic Fibrosis Agents

Orkambi lumacaftor/ivacaftor Cystic Fibrosis Agents

Symdeko tezacaftor/ivacaftor and ivacaftor Cystic Fibrosis Agents

Cytovene Injection, Ganciclovir Injection ganciclovir Cytomegalovirus Agents

Prevymis letermovir Cytomegalovirus Agents

Valcyte Powder, Valganciclovir Powder valganciclovir Cytomegalovirus Agents

Daurismo glasdegib Daurismo

Abbott Test Strips blood glucose test strips Diabetic Supplies Insulin Pens

Humalog Pens insulin lispro Diabetic Supplies Insulin Pens

Humulin Pens, Novolin Pens insulin Diabetic Supplies Insulin Pens

Insulin Syringes insulin syringes Diabetic Supplies Insulin Pens

Lancet Device and Lancets lancets Diabetic Supplies Insulin Pens

Pen Needles pen needles Diabetic Supplies Insulin Pens

Precision Ketone Test Strips ketone test strips Diabetic Supplies Insulin Pens

Apidra Pens insulin glulisine Diabetic Supplies Insulin Pens

Basaglar, Toujeo Pens insulin glargine Diabetic Supplies Insulin Pens

Novolog Pens insulin aspart Diabetic Supplies Insulin Pens

Tresiba Pens insulin degludec Diabetic Supplies Insulin Pens

Alosetron alosetron Diarrhea Agents

Mytesi crofelemer Diarrhea Agents

Viberzi eluxadoline Diarrhea Agents

Xermelo telotristat Diarrhea Agents

Doryx, Doryx MCP, Doxycycline Hyclate DR doxycycline hyclate delayed-release Doxycycline Products

Doxycycline Monohydrate 50 mg tablets, 75

mg and 150 mg capsulesdoxycycline monohydrate Doxycycline Products

Doxycycline [rosacea] DR, Oracea doxycycline [rosacea] delayed-release Doxycycline Products

Morgidox Kit doxycycline and cleanser Doxycycline Products

Egrifta tesamorelin Egrifta

Elaprase idursulfase Elaprase

Cerdelga eliglustat Enzymes for Gaucher Disease

Cerezyme imiglucerase Enzymes for Gaucher Disease

Elelyso taliglucerase Enzymes for Gaucher Disease

VPRIV velaglucerase Enzymes for Gaucher Disease

Adrenaclick, Auvi-Q, Epinephrine injection

generics EXCEPT by Mylan, EpiPenepinephrine Epinephrine Injection

Epogen, Procrit epoetin alfa Epoetin

Aranesp darbepoetin alfa Epoetin

Mircera methoxy polyethylene glycol-epoetin beta Epoetin

Retacrit epoetin alfa-epbx Epoetin

Duavee conjugated estrogen/bazedoxifene Estrogen Modifiers

Norethindrone/ethinyl estradiol norethindrone/ethinyl estradiol Estrogen Modifiers

Divigel, Elestrin estradiol topical gel Estrogen Modifiers

Estradiol Patch, Minivelle estradiol transdermal patch Estrogen Modifiers

Evamist estradiol topical spray solution Estrogen Modifiers

Etoposide, Etopophos, Toposar etoposide Etoposide

Galafold migalastat Fabry Disease Agents

Juxtapid lomitapide Familial Hypercholesterolemia Agents

Kynamro mipomersin Familial Hypercholesterolemia Agents

Praluent alirocumab Familial Hypercholesterolemia Agents

Repatha evolocumab Familial Hypercholesterolemia Agents

Femring estradiol acetate Femring QLL

Antara, Fenofibrate, Fenoglide, Triglide fenofibrate Fibric Acid Derivatives

Fenofibric Acid fenofibric acid Fibric Acid Derivatives

Fenofibric Acid DR fenofibric acid delayed-release Fibric Acid Derivatives

Firmagon degarelix Firmagon

Gralise, Horizant gabapentin Gabapentin Products

Gattex teduglitide Gattex

Amitiza lubiprostone GI Motility, Chronic

Kristalose lactulose GI Motility, Chronic

Linzess linaclotide GI Motility, Chronic

Movantik naloxegol GI Motility, Chronic

Relistor methylnaltrexone GI Motility, Chronic

Symproic naldemedine GI Motility, Chronic

Trulance plecanatide GI Motility, Chronic

Dalvance dalbavancin Glycopeptides

Vibativ telavancin Glycopeptides

Lupron Depot, Lupron Depot-Ped leuprolide Gonadotropin-Releasing Hormone Agents

Orilissa elagolix Gonadotropin-Releasing Hormone Agents

Colchicine QLL, Tablets colchicine Gout Agents

Uloric febuxostat Gout Agents

Genotropin, Humatrope, Norditropin,

Nutropin AQ, Omnitrope, Saizen, Zomacton,

Zorbtive

somatotropin (recombinant) Growth Hormone

Helidacbismuth subsalicylate/

metronidazole/tetracyclineH Pylori Agents

Omeclamox amoxicillin/clarithromycin/omeprazole H Pylori Agents

Amoxicillin/Clarithromycin/Lansoprazole amoxicillin/clarithromycin/ lansoprazole H Pylori Agents

Pylerabismuth subcitrate/metronidazole/

tetracyclineH Pylori Agents

Famotidine Oral Suspenion famotidine H2 Antagonists

Nizatidine Capsules, Oral Solution nizatidine H2 Antagonists

Ranitidine Capsules ranitidine H2 Antagonists

Cinryze, Ruconest C1 esterase inhibitor HAE Treatments

Takhzyro lanadelumab-flyo HAE Treatments

Adynovate, Eloctate, Jivi, Kovaltry,

Recombinatefactor VIII recombinant Hemophilia Treatment

Alprolix, Idelvion, Ixinity, Rebinyn, Rixubis factor IX recombinant Hemophilia Treatment

Alphanate, Humate-P von Willebrand factor complex human Hemophilia Treatment

Vonvedi von Willebrand factor recombinant Hemophilia Treatment

FEIBA antiinhibitor factor complex Hemophilia Treatment

Hemlibra emicizumab Hemophilia Treatment

Novoseven RT factor VIIa recombinant Hemophilia Treatment

Tretten factor VIII A-subunit recombinant Hemophilia Treatment

Adefovir adefovir Hepatitis B Agents

Vemlidy tenofovir alafenamide Hepatitis B Agents

Epclusa sofosbuvir/velpatasvir Hepatitis C Agents

Harvoni ledipasvir/sofosbuvir Hepatitis C Agents

Mavyret glecaprevir/pibrentasvir Hepatitis C Agents

Sovaldi sofosbuvir Hepatitis C Agents

Vosevi sofosbuvir/velpatasvir/voxilaprevir Hepatitis C Agents

Zepatier elbasvir/grazoprevir Hepatitis C Agents

Moderiba Pak, Ribapak, Ribasphere ribavirin Hepatitis C Agents

Tegsedi inotersen Hereditary Transthyretin Amloidosis Agents

Abacivir/Lamivudine/Zidovudine abacivir/lamivudine/zidovudine HIV-AIDS

Aptivus tipranavir HIV-AIDS

Complera emtricitabine/rilpivirine/tenofovir HIV-AIDS

Crixivan indinavir HIV-AIDS

Delstrigodoravirine/lamivudine/tenofovir disoproxil

fumurateHIV-AIDS

Edurant rilpivirine HIV-AIDS

Evotaz atazanavir/cobicistat HIV-AIDS

Fuzeon enfuvirtide HIV-AIDS

Intelence etavirine HIV-AIDS

Invirase saquinavir HIV-AIDS

Isentress/Isentress HD raltegravir HIV-AIDS

Juluca dolutegravir/rilpivirine HIV-AIDS

Lexiva fosamprenavir HIV-AIDS

Nevirapine ER nevirapine extended-release HIV-AIDS

Norvir Powder ritonavir HIV-AIDS

Odefseyemtricitabine/rilpivirine/tenofovir

alafenamideHIV-AIDS

Pifeltro doravirine HIV-AIDS

Prezcobix darunavir/cobicistat HIV-AIDS

Prezista darunavir HIV-AIDS

Reyataz Powder atazanavir HIV-AIDS

Ritonavir Tablets ritonavir HIV-AIDS

Selzentry maraviroc HIV-AIDS

Stribildelvitegravir/cobicistat/emtricitabine/tenof

ovir disoproxil fumarateHIV-AIDS

Symfi/Symfi Loefavirenz/lamivudine/tenofovir disoproxil

fumarateHIV-AIDS

Symtuzadarunavir/cobicistat/emtricitabine/tenofov

ir alafenamideHIV-AIDS

Tivicay dolutegravir HIV-AIDS

Tybost cobicistat HIV-AIDS

Videx Solution didanosine HIV-AIDS

Vitekta elvitegravir HIV-AIDS

HP Acthar Gel respiratory corticotropin injection HP Acthar Gel

Amphadase bovine hyaluronidase Hyaluronidase

Hylenex recombinant hyaluronidase Hyaluronidase

Vitrase ovine hyaluronidase Hyaluronidase

Qbrexza glycopyrronium Hyperhidrosis Agents

Lokelma sodium zirconium cyclosilicate Hyperkalemia Agents

Veltassa patiromer Hyperkalemia Agents

Afrezza insulin inhaled Hypoglycemics, Insulin and Related Agents

Apidra vials insulin glulisine Hypoglycemics, Insulin and Related Agents

Novolin vials insulin regular/isophane Hypoglycemics, Insulin and Related Agents

Novolog Mix vials insulin aspart/aspart protamine Hypoglycemics, Insulin and Related Agents

Tresiba vials insulin degludec Hypoglycemics, Insulin and Related Agents

Idhifa enasidenib Idhifa

Imbruvica ibrutinib Imbruvica

CytoGam cytomegalovirus immune globulin Immune Globulins

Bivigam, Carimune, Cutaquig, Cuvitru,

Flebogamma, Gamastan, Gammagard,

Gammaked, Gammaplex, Gamunex,

Hizentra, Hyqvia, Octagam, Panzyga, Privigin

immune globulin Immune Globulins

HepaGam B hepatitis B immune globulin Immune Globulins

Cellcept suspension, mycophenolic mofetil

suspensionmycophenolic mofetil Immunosuppressives Oral

Astagraf XL, Envarsus XR tacrolimus ER Immunosuppressives Oral

Prograf Granules tacrolimus for oral suspension Immunosuppressives Oral

Zortress everolimus Immunosuppressives Oral

Increlex mecasermin Increlex

Inlyta axitinib Inlyta

Invanz ertapenem Invanz

Infed iron dextran Iron Parenteral

Venofer iron sucrose Iron Parenteral

Feraheme ferumoxytol Iron Parenteral

Injectafer ferric carboxymaltose Iron Parenteral

Sodium Ferric Gluconate Complex sodium ferric gluconate complex Iron Parenteral

Absorica, Isotretinoin generics isotretinoin Isotretinoin

Jynarque tolvaptan Jynarque

Keveyis dichlorphenamide Keveyis

Korlym mifepristone Korlym

Firdase amifampridine Lambert-Eaton Myasthenic Syndrome Agents

Lanoxin 0.0625mg, 0.1875mg digoxin Lanoxin

Gavilyte-H polyethylene glycol, electrolytes, bisacodyl Laxatives and Cathartics

Suprep sodium, potassium, magnesium Laxatives and Cathartics

Montelukast Granules montelukast Leukotriene Modifiers

Zafirlukast zafirlukast Leukotriene Modifiers

Zyflo, Zyflo CR zileuton Leukotriene Modifiers

Lidoderm, Lidocaine Patch, Lidocaine

Ointment, ZTLidolidocaine Lidocaine Topical Products

Cubicin, Daptomycin 350 mg daptomycin Lipopeptides

Belbuca buprenorphine Long Acting Narcotics

Fentanyl Patch 37.5, 62.5, 87.5 mcg/hour fentanyl Long Acting Narcotics

Hydromorphone ER hydromorphone ER Long Acting Narcotics

Hysingla ER, Zohydro ER hydrocodone ER Long Acting Narcotics

Levorphanol levorphanol Long Acting Narcotics

Nucynta ER tapentadol ER Long Acting Narcotics

OxyContin oxycodone ER Long Acting Narcotics

Oxymorphone ER oxymorphone ER Long Acting Narcotics

Lonsurf trifluridine/tipiracil Lonsurf

Dificid fidaxomicin Macrolides

Erythromycin suspension 200mg/5mL,

EryPed-400 Suspension, Ery-Tab, Erythrocin,

Erythromycin base, PCE

erythromycin Macrolides

Ketek telithromycin Macrolides

Zmax azithromycin Macrolides

Makena hydroxyprogesterone caproate Makena

Megace ES, Megestrol ES megestrol acetate Megace ES

Braftovi encorafenib Melanoma Agents

Cotellic cobimetinib Melanoma Agents

Mekinist trametinib Melanoma Agents

Mektovi binimetinib Melanoma Agents

Sylatron peginterferon alfa-2b Melanoma Agents

Tafinlar dabrafenib Melanoma Agents

Zelboraf vemurafenib Melanoma Agents

Otrexup, Rasuvo, Xatmep methotrexate Methotrexate Products

Metozolv ODT, Metoclopramide ODT metoclopramide ODT Metozolv ODT

Milrinone milrinone Milrinone

Minocycline IR tablets, Minocycline ER,

Minolira, Solodynminocycline Minocycline Products

Bupap, Butalbital/Acetaminophen 50-300

mg butalbital/acetaminophen Miscellaneous Analgesics

Butalbital/Acetaminophen/Caffeine

Capsules, Zebutal butalbital/acetaminophen/caffeine Miscellaneous Analgesics

Conzip, Tramadol ER tramadol ER Miscellaneous Analgesics

Austedo deutetrabenazine Movement Disorder Agents

Ingrezza valbenazine Movement Disorder Agents

Xenazine tetrabenazine Movement Disorder Agents

Mozobil plerixafor Mozobil

Multaq dronedarone Multaq

Farydak panobinostat Multiple Myeloma Agents

Ninlaro ixazomib Multiple Myeloma Agents

Pomalyst pomalidomide Multiple Myeloma Agents

Dalfampridine dalfampridine Multiple Sclerosis Agents

Copaxone 40mg, Glatiramer 20mg glatiramer Multiple Sclerosis Agents

Extavia interferon beta-1b Multiple Sclerosis Agents

Plegridy peginterferon beta-1a Multiple Sclerosis Agents

Myalept metreleptin Myalept

Narcotic Fill Limit n/a Narcotic Fill Limit

Arymo ER, Kadian, Morphabond ER,

Morphine Sulfate ER capsulesmorphine sulfate ER Narcotics Long Acting

Evzio, Narcan Nasal Spray naloxone Naloxone Products

Azelastine 0.15% azelastine Nasal Antihistamines

Dymista azelastine/fluticasone Nasal Antihistamines

Olopatadine 0.6% olopatadine Nasal Antihistamines

Beconase AQ, Qnasl beclomethasone Nasal Steroids

Budesonide budesonide Nasal Steroids

Flunisolide flunisolide Nasal Steroids

Mometasone Furoate mometasone furoate Nasal Steroids

Omnaris, Zetonna ciclesonide Nasal Steroids

Veramyst fluticasone furoate Nasal Steroids

Xhance fluticasone propionate Nasal Steroids

Natpara parathyroid hormone Natpara

Nexavar sorafenib Nexavar

Niacor niacin Niacin Products

GoNitro, Nitromist nitroglycerin Nitroglycerin Products

Northera droxidopa Northera

Cambia, Zipsor diclofenac potassium NSAIDs and COX II

Celecoxib celecoxib NSAIDs and COX II

Diclofenac/Misoprostol diclofenac/misoprostol NSAIDs and COX II

Diclofenac ER, Zorvolex diclofenac NSAIDs and COX II

Duexis ibuprofen/famotidine NSAIDs and COX II

Etodolac ER etodolac NSAIDs and COX II

Fenoprofen, Nalfon fenoprofen NSAIDs and COX II

Indomethacin ER, Tivorbex indomethacin NSAIDs and COX II

Ketoprofen IR, ER ketoprofen NSAIDs and COX II

Meclofenamate meclofenamate NSAIDs and COX II

Mefenamic Acid mefenamic acid NSAIDs and COX II

Naprelan, Naproxen CR, DR naproxen NSAIDs and COX II

Oxaprozin oxaprozin NSAIDs and COX II

Sprix ketorolac NSAIDs and COX II

Tolmetin tolmetin NSAIDs and COX II

Vimovo naproxen/esomeprazole NSAIDs and COX II

Vivlodex meloxicam NSAIDs and COX II

Nuedexta dextromethorphan/quinidine Nuedexta

Ocaliva obeticholic acid Ocaliva

Omega-3-Acid Ethyl Esters omega-3-acid ethyl esters Omega-3 Acids

Vascepa icosapent ethyl Omega-3 Acids

Lynparza olaparib Oncology, Oral - Ovarian

Rubraca rucaparib Oncology, Oral - Ovarian

Zejula niraparib Oncology, Oral - Ovarian

AzaSite azithromycin Ophthalmic Antibiotics

Bacitracin bacitracin Ophthalmic Antibiotics

Besivance besifloxacin Ophthalmic Antibiotics

Gatifloxacin Ophthalmic gatifloxacin Ophthalmic Antibiotics

Levofloxacin Ophthalmic levofloxacin Ophthalmic Antibiotics

Natacyn natamycin Ophthalmic Antibiotics

Neomycin/Polymyxin B/Gramicidin neomycin/polymyxin B/gramicidin Ophthalmic Antibiotics

Ofloxacin Ophthalmic ofloxacin Ophthalmic Antibiotics

Lotemax Gel, Lotemax SM Gel loteprednol Ophthlamics Antiinflammatories

Acuvail ketorolac Ophthlamics Antiinflammatories

Bromfenac, Bromsite, Prolensa bromfenac Ophthlamics Antiinflammatories

Nevanac nepafanac Ophthlamics Antiinflammatories

Cequa, Restatis Multidose cyclosporine Ophthalmics Antiinflammatory Immunomodulators

Xiidra lifitegrast Ophthalmics Antiinflammatory Immunomodulators

Zirgan ganciclovir Ophthalmic Antivirals

Brimonidine P 0.15% brimonidine Ophthalmic Glaucoma Agents

Betimol, Istalol, Timoptic Ocudose timolol Ophthalmic Glaucoma Agents

Combigan 10mL timolol/brimonidine Ophthalmic Glaucoma Agents

Cosopt PF timolol/dorzolamide Ophthalmic Glaucoma Agents

Bimatoprost 0.03% bimatoprost Ophthalmic Glaucoma Agents

Travaprost travaprost Ophthalmic Glaucoma Agents

Vyzulta latanoprostene bunod Ophthalmic Glaucoma Agents

Rhopressa netarsudil Ophthalmic Glaucoma Agents

Blephamide SOP sulfacetamide/prednisolone ointment Ophthalmic Steroid-Antibiotic Combinations

Neomycin/Polymyxin

B/Bacitracin/Hydrocortisone

neomycin/polymyxin

B/bacitracin/hydrocortisoneOphthalmic Steroid-Antibiotic Combinations

Neomycin/Polymyxin B/Hydrocortisone neomycin/polymyxin B/hydrocortisone Ophthalmic Steroid-Antibiotic Combinations

TobraDex ST, Tobramycin/Dexamethasone tobramycin/dexamethasone Ophthalmic Steroid-Antibiotic Combinations

Alocril nedocromil sodium Ophthalmics for Allergic Conjuctivitis

Alomide lodoxamide tromethamine Ophthalmics for Allergic Conjuctivitis

Azelastine Ophthalmic azelastine Ophthalmics for Allergic Conjuctivitis

Elestat, Epinastine Ophthalmic epinastine Ophthalmics for Allergic Conjuctivitis

Emadine emedastine Ophthalmics for Allergic Conjuctivitis

Lastacaft alcaftadine Ophthalmics for Allergic Conjuctivitis

Olopatadine Ophthalmic, Pataday olopatadine Ophthalmics for Allergic Conjuctivitis

Oxervate cenegermin-bkbj Ophthalmics for Neurotrophic Keratitis

Bunavail, Buprenorphine/Naloxone, Zubsolv buprenorphine/naloxone Opioid Dependency Agents

Lucemyra lofexidine Opioid Dependency Agents

Orfadin Suspension nitisinone Orfadin

Ofloxacin Otic ofloxacin Otic Antiinfectives

Otovel ciprofloxacin/fluocinolone Otic Antiinfectives

Sivextro tedizolid Oxazolidinones

Zyvox, Linezolid linezolid Oxazolidinones

Palynziq pegvaliase-pqpz Palyzniq

Pancreaze, Pertzye, Viokace pancrelipase Pancreatic Enzymes

Panretin alitretinoin Panretin

Kabiven, Perikabiven amino acid/electrolytes/dextrose/lipid Parenteral Nutrition Products

Intralipid, Omegaven, Smoflipid lipid emulsion Parenteral Nutrition Products

Eurax crotamiton Pediculicides and Scabicides

Lindane lindane Pediculicides and Scabicides

Malathion, Ovide malathion Pediculicides and Scabicides

Spinosad spinosad Pediculicides and Scabicides

Phenoxybenzamine phenoxybenzamine Phenoxybenzamine

Auryxia ferric citrate Phosphate Binders

Calcium Acetate Tablets, Phoslyra calcium acetate Phosphate Binders

Lanthanum Carbonate lanthanum carbonate Phosphate Binders

Renvela sevelamer carbonate Phosphate Binders

Velphoro sucroferric oxyhyroxide Phosphate Binders

Procysbi cysteamine DR Procysbi

Aciphex, Raberprazole rabeprazole Proton Pump Inhibitors

Dexilant dexlansoprazole Proton Pump Inhibitors

Esomeprazole Rx, Nexium Rx Granules esomeprazole Proton Pump Inhibitors

Lansoprazole Rx, Prevacid Rx Solutab lansoprazole Proton Pump Inhibitors

Omeprazole Rx, Prilosec Rx Powder for Oral

Suspensionomeprazole Proton Pump Inhibitors

Omeprazole/Sodium Bicarbonate Rx,

Zegerid Rx Powderomeprazole/sodium bicarbonate Proton Pump Inhibitors

Pantoprazole, Protonix Pak pantoprazole Proton Pump Inhibitors

Adcirca tadalafil Pulmonary Arterial Hypertension Agents

Adempas riociguat Pulmonary Arterial Hypertension Agents

Flolan, Veletri epoprostenol Pulmonary Arterial Hypertension Agents

Opsumit macitentan Pulmonary Arterial Hypertension Agents

Orenitram, Remodulin, Tyvaso trepostinil Pulmonary Arterial Hypertension Agents

Revatio Suspension, Sildenafil sildenafil citrate Pulmonary Arterial Hypertension Agents

Tracleer for Oral Suspension bosentan Pulmonary Arterial Hypertension Agents

Uptravi selexipag Pulmonary Arterial Hypertension Agents

Ventavis iloprost Pulmonary Arterial Hypertension Agents

Esbriet pirfenidone Pulmonary Fibrosis Agents

Ofev nintedinab Pulmonary Fibrosis Agents

Purixan mercaptopurine Purixan

Baxdela delafloxacin Quinolones

Levofloxacin oral solution, injection levofloxacin Quinolones

Ranexa ranolazine Ranexa

Ravicti glycerol phenylbutyrate Ravicti

Sodium Phenylbutyrate Powder sodium phenylbutyrate Ravicti

Rectiv nitroglycerin Rectiv

Regranex becaplermin Regranex

Rydapt midostaurin Rydapt

Santyl collagenase Santyl

Ambien, Edular, Zolpidem Sublingual,

Zolpimistzolpidem Sedative Hypnotics

Ambien CR, Zolpidem ER zolpidem ER Sedative Hypnotics

Belsomra suvorexant Sedative Hypnotics

Eszopiclone, Lunesta eszopiclone Sedative Hypnotics

Rozerem ramelteon Sedative Hypnotics

Sonata zaleplon Sedative Hypnotics

Hetlioz tasimelteon Sedative Hypnotics

Silenor doxepin Sedative Hypnotics

Serostim somatotropin(recombinant) Serostim

Almotriptan, Axert almotriptan Serotonin Receptor Agonists (Triptans)

Dihydroergotamine, Migranal dihydroergotamine mesylate Serotonin Receptor Agonists (Triptans)

Frova frovatriptan Serotonin Receptor Agonists (Triptans)

Nazatriptan nazatriptan Serotonin Receptor Agonists (Triptans)

Onzetra Xsail, Sumatriptan Injection,

Sumavel, Zembrace sumatriptan Serotonin Receptor Agonists (Triptans)

Treximet sumatriptan/naproxen Serotonin Receptor Agonists (Triptans)

Zolmitriptan, Zomig, Zomig ZMT zolmitriptan Serotonin Receptor Agonists (Triptans)

Endari l-glutamine Sickle Cell Agents

Sicklos hydroxyurea tablets Sickle Cell Agents

Signifor pasireotide Signifor

Sirturo bedaquiline Sirturo

Amrix cyclobenzaprine ER Skeletal Muscle Relaxants

Carisoprodol 250mg, Soma 250mg carisoprodol Skeletal Muscle Relaxants

Carisoprodol/aspirin/codeine carisoprodol/aspirin/codeine Skeletal Muscle Relaxants

Cyclobenzaprine 7.5mg cyclobenzaprine Skeletal Muscle Relaxants

Lorzone chlorzoxazone Skeletal Muscle Relaxants

Tizanidine Capsules, Zanaflex Capsules tizanidine Skeletal Muscle Relaxants

Simvastatin 80mg, Vytorin 10/80mg simvastatin Statins

Altoprev lovastatin Statins

Amlodipine/Atorvastatin amlodipine/atorvastatin Statins

Crestor rosuvastatin Statins

Fluvastatin Extended-Release fluvastatin ER Statins

Livalo pitavastatin Statins

Adzenys ER/XR, Dyanavel XR, Evekeo amphetamine Stimulants and Related Agents

Amphetamine/Dextroamphetamine IR/ER,

Mydayisamphetamine/dextroamphetamine IR/ER Stimulants and Related Agents

Dextroamphetamine IR/ER, Zenzedi dextroamphetamine IR/ER Stimulants and Related Agents

Aptensio XR, Concerta, Cotempla XR,

Daytrana, Methylin, Methylphenidate

IR/CD/CR/ER/LA/SA/SR, Quillichew,

Quillivant XR, Ritalin LA 10 mg

methylphenidate IR/ER Stimulants and Related Agents

Armodafinil armodafinil Stimulants and Related Agents

Atomoxetine atomoxetine Stimulants and Related Agents

Clonidine ER clonidine ER Stimulants and Related Agents

Desoxyn, Methamphetamine methamphetamine Stimulants and Related Agents

Dexmethylphenidate IR/ER, Focalin/Focalin

XRdexmethylphenidate IR/ER Stimulants and Related Agents

Guanfacine ER guanfacine ER Stimulants and Related Agents

Modafinil modafinil Stimulants and Related Agents

Vyvanse lisdexamfetamine Stimulants and Related Agents

Stivarga regorafenib Stivarga

Strensiq asfotase alfa Strensiq

Sutent sunitinib Sutent

Synagis palivizumab Synagis

Synribo omacetaxine Synribo

Temozolomide temozolomide Temozolomide

Mulpleta lusutrombopag Thrombopoiesis Stimulating Proteins

Promacta eltrombopag Thrombopoiesis Stimulating Proteins

Tavalisse fostamatinib Thrombopoiesis Stimulating Proteins

Doptelet avatrombopag Thrombopoiesis Stimulating Proteins

Nplate romisplostim Thrombopoiesis Stimulating Proteins

Levothyroxine Injection, Tirosint levothyroxine Thyroid Hormones

Liothyronine liothyronine Thyroid Hormones

Tibsovo ivosidenib Tibsovo

Bupropion [smoking deterrent] bupropion SR Tobacco Cessation

Nicotrol Inhaler, Nicotrol Nasal Spray nicotine Tobacco Cessation

Tobi Podhaler, Tobramycin Nebulized tobramycin Tobramcyin Inhaled

Mupirocin Cream mupirocin Topical Antibacterials

Neo-Synalar neomycin/fluocinolone Topical Antibacterials

Neo-Synalar Kit neomycin/fluocinolone/emollient cream Topical Antibacterials

Valchlor mechlorethamine Topical Antineoplastic and Genital Warts Therapy

Diclofenac 3% Gel diclofenac Topical Antineoplastic and Genital Warts Therapy

Picato ingenol mebutate Topical Antineoplastic and Genital Warts Therapy

Podofilox Solution podofilox Topical Antineoplastic and Genital Warts Therapy

Veregen sinecatechins Topical Antineoplastic and Genital Warts Therapy

Zyclara imiquimod Topical Antineoplastic and Genital Warts Therapy

Augmented Betamethasone augmented betamethasone Topical Corticosteroids

Clobetasol, Clobex lotion/shampoo, Clodan

Kit, Olux-Eclobetasol Topical Corticosteroids

Ultravate X Kit halobetasol/lactic acid Topical Corticosteroids

Alclometasone Dipropionate alclometasone dipropionate Topical Corticosteroids

Cloderm, Clocortolone Pivalate clocortolone pivalate Topical Corticosteroids

Dermatop, prednicarbate prednicarbate Topical Corticosteroids

Fluticasone fluticasone Topical Corticosteroids

Halog halcinonide Topical Corticosteroids

Mometasone Furoate mometasone furoate Topical Corticosteroids

Hydrocortisone Butyrate hydrocortisone butyrate Topical Corticosteroids

Betamethasone Dipropionate betamethasone dipropionate Topical Corticosteroids

Luxiq, Betamethasone Valerate betamethasone valerate Topical Corticosteroids

Pandel hydrocortisone probutate Topical Corticosteroids

Apexicon E, Diflorasone Diacetate diflorasone diacetate Topical Corticosteroids

Capex, Synalar/Kit, Fluocinolone Acetonide fluocinolone acetonide Topical Corticosteroids

Texacort hydrocortisone Topical Corticosteroids

Amcinonide amcinonide Topical Corticosteroids

Topicort, Desoximetasone desoximetasone Topical Corticosteroids

Trianex augmented triamcinolone Topical Corticosteroids

Fluocinonide fluocinonide Topical Corticosteroids

Desonide, Desonate desonide Topical Corticosteroids

Cordran Tape flurandrenolide Topical Corticosteroids

Kenalog, Triamcinolone Acetonide triamcinolone acetonide Topical Corticosteroids

Tacrolimus Ointment tacrolimus Topical Immunomodulators

Diclofenac Solution, Pennsaid 2% diclofenac sodium Topical NSAIDs

Tranexamic Acid Injection tranexamic acid Tranexamic Acid Injection

Tranexamic Acid tablets tranexamic acid Tranexamic Acid Oral

Abstral fentanyl citrate sublingual tablets Transmucosal Fentanyl Citrate

Actiq fentanyl citrate oral lozenges Transmucosal Fentanyl Citrate

Fentora fentanyl citrate buccal tablets Transmucosal Fentanyl Citrate

Onsolis fentanyl citrate buccal films Transmucosal Fentanyl Citrate

Subsys fentanyl citrate sublingual spray Transmucosal Fentanyl Citrate

Trelstar Depot, Trelstar LA triptorelin pamoate Trelstar

Tygacil tigecycline Tygacil

Bosulif bosutinib Tyrosine Kinase Inhibitors for CML or ALL

Iclusig ponatinib Tyrosine Kinase Inhibitors for CML or ALL

Sprycel dasatinib Tyrosine Kinase Inhibitors for CML or ALL

Tasigna nilotinib Tyrosine Kinase Inhibitors for CML or ALL

Alecensa alectinib Tyrosine Kinase Inhibitors for NSCLC

Alunbrig brigatinib Tyrosine Kinase Inhibitors for NSCLC

Gilotrif afatinib Tyrosine Kinase Inhibitors for NSCLC

Iressa gefitinib Tyrosine Kinase Inhibitors for NSCLC

Lobrena lorlatinib Tyrosine Kinase Inhibitors for NSCLC

Tagrisso osimertinib Tyrosine Kinase Inhibitors for NSCLC

Tarceva erlotinib Tyrosine Kinase Inhibitors for NSCLC

Vizimpro dacomitinib Tyrosine Kinase Inhibitors for NSCLC

Xalkori crizotinib Tyrosine Kinase Inhibitors for NSCLC

Zykadia ceritinib Tyrosine Kinase Inhibitors for NSCLC

Cometriq cabozantinib Tyrosine Kinase Inhibitors for Thyroid Cancer

Lenvima levatinib Tyrosine Kinase Inhibitors for Thyroid Cancer

Caprelsa vandetanib Tyrosine Kinase Inhibitors for Thyroid Cancer

Mesalamine DR mesalamine delayed-release Ulcerative Colitis Agents

Mesalamine Rectal Enema, SFRowasa mesalamine Ulcerative Colitis Agents

Giazo balsalazide Ulcerative Colitis Agents

Uceris budesonide Ulcerative Colitis Agents

Kerafoam, Kerol, Laxtrix, Umecta, Uralytic,

Uramaxin, Ureaurea Urea Products

Methenamine hippurate methenamine hippurate Urinary Tract Antiinfectives

UR N-C, Urelle, Urimar-T, Urogesic Blue hyoscamine combination Urinary Tract Antiinfectives

Potassium Citrate ER, Urocit-K potassium citrate Urocit-K

Vecamyl mecamylamine Vecamyl

Venclexta venetoclax Venclexta

Vimizim elosulfase alfa Vimizim

Doxercalciferol, Hectorol doxercalciferol Vitamin D and ESRD Products

Paricalcitol 4 mcg paricalcitol Vitamin D and ESRD Products

Rayaldee calcifediol Vitamin D and ESRD Products

Sensipar cinacalet Vitamin D and ESRD Products

Aluminum Hydroxide aluminum hydroxide Vitamin D and ESRD Products

Calcium Carbonate calcium carbonate Vitamin D and ESRD Products

Calcium Lactate calcium lactate Vitamin D and ESRD Products

Docusate Calcium docusate calcium Vitamin D and ESRD Products

Docusate Sodium docusate sodium Vitamin D and ESRD Products

Magnebind calcium carbonate/magnesium carbonate Vitamin D and ESRD Products

Magnesium Carbonate magnesium carbonate Vitamin D and ESRD Products

Niacin niacin Vitamin D and ESRD Products

Pyridoxine pyridoxine Vitamin D and ESRD Products

Sodium Bicarbonate sodium bicarbonate Vitamin D and ESRD Products

Thiamine Hydrochloride thiamine hydrochloride Vitamin D and ESRD Products

Dialyvite, Nephplex Rx, Nephron FA, Renal,

Reno Caps, Triphrocaps, Virt-Caps, Virt-Vite

Plus, Vital-D Rx, Vol-Care Rx

vitamin B complex/folic acid and/or zinc Vitamin D and ESRD Products

Vitrakvi larotrectinib Vitrakvi

Votrient pazopanib Votrient

Vyndaqel, Vyndamax tafamidis Vyndaqel-Vyndamax

Xenical orlistat Xenical

Xifaxan rifamixin Xifaxan

Xospata gilteritinib Xospata

Xyrem sodium oxybate Xyrem

Zolinza vorinostat Zolinza

Zydelig idelalisib Zydelig