2014 formulary -...

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P.O. Box 52424, Phoenix, AZ 85072-2424 SilverScript (Employer PDP) sponsored by Kellogg Company 2014 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN This formulary was updated on 08/29/2013. For more recent information or other questions, please contact SilverScript (Employer PDP), at 1-866-693-4614 or, for TTY users, 1-866-236-1069, 24 hours a day, 7 days a week. Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to “we”, “us”, or “our”, it means SilverScript ® Insurance Company. When it refers to “plan” or “our plan,” it means SilverScript (Employer PDP). This document includes a list of the drugs (formulary) for our plan which is current as of 01/01/2014. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2015. Y0080_FORM_Comp_10002CLT_2014_9425_2180_801

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P.O. Box 52424, Phoenix, AZ 85072-2424

SilverScript (Employer PDP) sponsored by KelloggCompany

2014 Formulary(List of Covered Drugs)

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WECOVER IN THIS PLAN

This formulary was updated on 08/29/2013. For more recent information or other questions, pleasecontact SilverScript (Employer PDP), at 1-866-693-4614 or, for TTY users, 1-866-236-1069, 24 hours aday, 7 days a week.

Note to existing members: This formulary has changed since last year. Please review this document tomake sure that it still contains the drugs you take.

When this drug list (formulary) refers to “we”, “us”, or “our”, it means SilverScript® InsuranceCompany. When it refers to “plan” or “our plan,” it means SilverScript (Employer PDP).

This document includes a list of the drugs (formulary) for our plan which is current as of 01/01/2014.For an updated formulary, please contact us. Our contact information, along with the date we lastupdated the formulary, appears on the front and back cover pages.

You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary,pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2015.

Y0080_FORM_Comp_10002CLT_2014_9425_2180_801

What is the SilverScript (Employer PDP) formulary?

A formulary is a list of covered drugs selected by SilverScript (Employer PDP) in consultation with ateam of health care providers, which represents the prescription therapies believed to be a necessary partof a quality treatment program.

SilverScript (Employer PDP) will generally cover the drugs listed in our formulary as long as the drug ismedically necessary, the prescription is filled at a SilverScript (Employer PDP) network pharmacy, andother plan rules are followed. For more information on how to fill your prescriptions, please review yourEvidence of Coverage.

Can the formulary (drug list) change?

Generally, if you are taking a drug on our 2014 formulary that was covered at the beginning of the year,we will not discontinue or reduce coverage of the drug during the 2014 coverage year except when anew, less expensive generic drug becomes available or when new adverse information about the safetyor effectiveness of a drug is released.

Other types of formulary changes, such as removing a drug from our formulary, will not affect memberswho are currently taking the drug. It will remain available at the same cost-sharing for those memberstaking it for the remainder of the coverage year.

We feel it is important that you have continued access for the remainder of the coverage year to theformulary drugs that were available when you chose our plan, except for cases in which you can saveadditional money or we can ensure your safety.

If we remove drugs from our formulary, or move a drug to a higher cost-sharing tier, we must notifyaffected members of the change at least 60 days before the change becomes effective, or at the time themember requests a refill of the drug, at which time the member will receive a 60-day supply of the drug.

If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’smanufacturer removes the drug from the market, we will immediately remove the drug from ourformulary and provide notice to members who take the drug.

The enclosed formulary is current as of January 1, 2014. To get updated information about the drugscovered by SilverScript (Employer PDP), please contact us. Our contact information appears on thefront and back cover pages.

If we have a mid-year non-maintenance formulary change (i.e. remove drugs from our formulary, addprior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a highercost-sharing tier), we will notify you by mail. We will also update our print formulary by reprinting itwith the new information. The updated formulary may be obtained by calling us. Our contactinformation appears on the front and back cover pages.

II

How do I use the formulary?

There are two ways to find your drug within the formulary:

Medical ConditionThe formulary begins after this introduction on page 1. The drugs in this formulary are groupedinto categories depending on the type of medical conditions that they are used to treat. Forexample, drugs used to treat a heart condition are listed under the category, “Cardiovascular”. Ifyou know what your drug is used for, look for the category name in the list that begins on page 1.Then look under the category name for your drug.

Alphabetical ListingIf you are not sure what category to look under, you should look for your drug in the Index at theback of this document. The Index provides an alphabetical list of all of the drugs included in thisdocument. Both brand-name drugs and generic drugs are listed in the Index. Look in the Indexand find your drug. Next to your drug, you will see the page number where you can findcoverage information. Turn to the page listed in the Index and find the name of your drug in thefirst column of the list.

What are generic drugs?

SilverScript (Employer PDP) covers both brand-name drugs and generic drugs. A generic drug isapproved by the FDA as having the same active ingredient as the brand name drug. Generally, genericdrugs cost less than brand name drugs.

Are there any restrictions on my coverage?

Some covered drugs may have additional requirements or limits on coverage.

You can find out if your drug has any additional requirements or limits by looking in the formulary thatbegins on page 1. Our contact information, along with the date we last updated the formulary, appears onthe front and back cover pages.

You can ask us to make an exception to these restrictions or limits or for a list of other, similar drugsthat may treat your health condition. See the section, “How do I request an exception to the SilverScript(Employer PDP) formulary?” below for information about how to request an exception.

What if my drug is not on the formulary?

If your drug is not included in this formulary (list of covered drugs), you should first contact CustomerCare and ask if your drug is covered.

III

If you learn that SilverScript (Employer PDP) does not cover your drug, you have two options

§ You can ask Customer Care for a list of similar drugs that are covered by our plan. When youreceive the list, show it to your doctor and ask him or her to prescribe a similar drug that iscovered by our plan.

§ You can ask us to make an exception and cover your drug. See below for information about howto request an exception.

SilverScript (Employer PDP) does not cover drugs that are covered under Medicare Part B as prescribedand dispensed. Generally, we only cover drugs, vaccines, biological products and medical supplies thatare covered under the Medicare Prescription Drug Benefit (Part D) and that are on our drug list.

How do I request an exception to the SilverScript (Employer PDP) formulary?

You can ask us to make an exception to our coverage rules. There are several types of exceptions thatyou can ask us to make.

§ You can ask us to cover your drug even if it is not on our formulary. If approved, this drug willbe covered at a pre-determined cost-sharing level, and you would not be able to ask us toprovide the drug at a lower cost-sharing level.

§ You can ask us to cover a formulary drug at a lower cost-sharing level if this drug is not on thespecialty tier. If approved this would lower the amount you must pay for your drug.

Please note, if we grant your request to cover a drug that is not on our formulary, you may not ask us toprovide a higher level of coverage for the drug.

Generally, SilverScript (Employer PDP) will only approve your request for an exception if thealternative drug is included on the plan’s formulary, the lower cost-sharing drug or additional utilizationrestrictions would not be as effective in treating your condition and/or would cause you to have adversemedical effects.

You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilizationrestriction exception. When you request a formulary, tiering or utilization restriction exception youshould submit a statement from your prescriber or physician supporting your request.

Generally, we must make our decision within 72 hours of getting your prescriber’s supporting statement.You can request an expedited (fast) exception if you or your doctor believe that your health could beseriously harmed by waiting up to 72 hours for a decision.

If your request to expedite is granted, we must give you a decision no later than 24 hours after we get asupporting statement from your doctor or other prescriber.

What do I do before I can talk to my doctor about changing my drugs or requesting anexception?

As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or,you may be taking a drug that is on our formulary but your ability to get it is limited. You should talk to

IV

your doctor to decide if you should switch to an appropriate drug that we cover or request a formularyexception so that we will cover the drug you take.

While you talk to your doctor to determine the right course of action for you, we may cover your drug incertain cases during the first 90 days you are a member of our plan.

For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we willcover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go toa network pharmacy.

After your first 30-day supply, we will not pay for these drugs, even if you have been a member of theplan less than 90 days.

If you are a resident of a long-term care facility, we will allow you to refill your prescription until wehave provided you with a 31-day transition supply, consistent with the dispensing increment, (unlessyou have a prescription written for fewer days). We will cover more than one refill of these drugs for thefirst 90 days you are a member of our plan. If you need a drug that is not on our formulary or if yourability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we willcover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while youpursue a formulary exception.

If you experience a change in your level of care, such as a move from a hospital to a home setting, andyou need a drug that is not on our formulary (or if your ability to get your drugs is limited), we maycover a one-time temporary supply from a network pharmacy for up to 30 days (or 31 days if you are along-term care resident) unless you have a prescription for fewer days. You should use the plan'sexception process if you wish to have continued coverage of the drug after the temporary supply isfinished.

For more information

For more detailed information about your SilverScript (Employer PDP) prescription drug coverage,please review your Evidence of Coverage.

If you have questions about our plan, please contact us. Our contact information, along with the date welast updated the formulary, appears on the front and back cover pages.

If you have general questions about Medicare prescription drug coverage, please call Medicare at1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call1-877-486-2048. Or, visit www.medicare.gov.

SilverScript (Employer PDP)'s Formulary

The formulary that begins on page 1 provides coverage information about some of the drugs covered byour plan. If you have trouble finding your drug in the list, turn to the Index at the back of this book.

The first column of the chart lists the drug name. Brand-name drugs are capitalized (e.g., SYNTHROID)and generic drugs are listed in lowercase italics (e.g., levothyroxine).

V

The information in the Notes column tells you if SilverScript (Employer PDP) has any specialrequirements for coverage of your drug.

NM Not available at our mail-order pharmacies.

LA Limited Access. This prescription may be available only at certain pharmacies. For moreinformation consult your Pharmacy Directory or call Customer Care at 1-866-693-4614,24 hours a day, 7 days a week. TTY Users should call 1-866-236-1069.

HR High Risk Drug. According to medical experts, these drugs may cause more side effectsif you are 65 years of age or older. If you are taking one of these drugs, ask your doctor ifthere are safer options available.

B/D This drug may be covered under Medicare Part B or D depending upon thecircumstances. Information may need to be submitted describing the use and setting ofthe drug to make the determination.

GC We provide coverage of this prescription drug in the coverage gap. Please refer to yourEvidence of Coverage for more information about this coverage.

VI

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 1

2014 602 4T Platinum BvD Comm_NT (Effective January 1)

Drug Name Requirements/Limits

ANALGESICS GOUT allopurinol inj 500mg (generic of ALOPRIM)

allopurinol tab (generic of ZYLOPRIM)

colchicine w/ probenecid COLCRYS probenecid ULORIC

MISCELLANEOUS diclofenac w/ misoprostol (generic of ARTHROTEC 50)

diclofenac w/ misoprostol (generic of ARTHROTEC 75)

DUEXIS VIMOVO

NSAIDS CELEBREX diclofenac potassium (generic of CATAFLAM)

diclofenac sodium (generic of VOLTAREN-XR) TB24

diclofenac sodium TBEC diflunisal etodolac CAPS; TABS etodolac er fenoprofen calcium TABS flurbiprofen TABS ibuprofen SUSP ibuprofen TABS 400mg, 600mg, 800mg

ketoprofen CAPS; CP24 mefenamic acid (generic of PONSTEL) CAPS

MELOXICAM SUSP 7.5 MG/5ML meloxicam tabs (generic of MOBIC)

nabumetone TABS NALFON NAPRELAN naproxen (generic of NAPROSYN) SUSP; TABS

naproxen (generic of EC-NAPROSYN) TBEC

Drug Name Requirements/Limits

naproxen sodium (generic of ANAPROX) TABS 275mg

naproxen sodium (generic of ANAPROX DS) TABS 550mg

oxaprozin (generic of DAYPRO) piroxicam (generic of FELDENE) CAPS

sulindac TABS 150mg sulindac (generic of CLINORIL) TABS 200mg

tolmetin sodium ZIPSOR

OPIOID ANALGESICS acetaminophen w/ codeine SOLN

acetaminophen w/ codeine TABS

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #3) TABS

acetaminophen w/ codeine (generic of TYLENOL/CODEINE #4) TABS

butorphanol nasal spray butorphanol tartrate SOLN BUTRANS 5mcg/hr BUTRANS 10mcg/hr BUTRANS 20mcg/hr capital and codeine co-gesic 5-500mg (generic of LORTAB)

CONZIP 100mg CONZIP 200mg CONZIP 300mg hydrocodone-acetaminophen hydrocodone-acetaminophen 2.5-325mg

hydrocodone-acetaminophen 2.5-500mg

hydrocodone-acetaminophen 5-300mg (generic of XODOL)

hydrocodone-acetaminophen 5-325mg (generic of NORCO)

hydrocodone-acetaminophen 5-500mg (generic of LORTAB)

hydrocodone-acetaminophen 7.5-300mg (generic of XODOL)

hydrocodone-acetaminophen 7.5-325 mg/15ml (generic of HYCET)

1

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 2

Drug Name Requirements/Limits

hydrocodone-acetaminophen 7.5-325mg (generic of NORCO)

hydrocodone-acetaminophen 7.5-500mg (generic of LORTAB)

hydrocodone-acetaminophen 7.5-500mg/15ml (generic of LORTAB)

hydrocodone-acetaminophen 7.5-650mg (generic of ANEXSIA)

hydrocodone-acetaminophen 7.5-750mg

hydrocodone-acetaminophen 10-300mg (generic of XODOL)

hydrocodone-acetaminophen 10-500mg (generic of LORTAB)

hydrocodone-acetaminophen 10-650mg (generic of LORCET 10/650)

hydrocodone-acetaminophen 10-660mg

hydrocodone-acetaminophen 10-750mg (generic of MAXIDONE)

hydrocodone-acetaminophen tab 10-325mg (generic of NORCO)

hydrocodone-ibuprofen 2.5-200mg

hydrocodone-ibuprofen 7.5-200mg (generic of VICOPROFEN)

ibudone tab 5-200mg (generic of REPREXAIN)

reprexain 10/200 stagesic 500-5mg SYNALGOS-DC tramadol hcl er (generic of ULTRAM ER) TB24 100mg

tramadol hcl er (generic of ULTRAM ER) TB24 200mg

TRAMADOL HCL ER TB24 300mg

TRAMADOL HCL ER (BIPHASIC) 100MG

TRAMADOL HCL ER (BIPHASIC) 200MG

tramadol hcl er (biphasic) 300mg tramadol hcl tab 50 mg (generic of ULTRAM)

tramadol-acetaminophen (generic of ULTRACET)

vicodin (generic of XODOL)

Drug Name Requirements/Limits

vicodin es (generic of XODOL) vicodin hp (generic of XODOL)

OPIOID ANALGESICS, CII ABSTRAL NM

AVINZA CODEINE SULFATE TABS DILAUDID-HP INJ B/D

DURAMORPH B/D

endocet 5/325 (generic of PERCOCET)

endocet 7.5/325 (generic of PERCOCET)

endocet 10/325 (generic of PERCOCET)

ENDODAN EXALGO 8mg, 12mg EXALGO 16mg, 32mg NM

fentanyl citrate (generic of ACTIQ) LPOP

NM

fentanyl patch (generic of DURAGESIC)

FENTORA NM

hydromorphone hcl (generic of DILAUDID-5) LIQD

hydromorphone hcl (generic of DILAUDID-HP) SOLN 500mg/50ml

B/D

hydromorphone hcl (generic of DILAUDID) TABS

INFUMORPH 200 B/D

INFUMORPH 500 B/D

KADIAN LAZANDA NM

levorphanol tartrate TABS methadone hcl CONC methadone hcl SOLN methadone hcl (generic of DOLOPHINE HCL) TABS 5mg

methadone hcl (generic of DOLOPHINE) TABS 10mg

METHADONE INJ 10MG/ML MORPHINE SUL 20MG/ML ORAL SOL

MORPHINE SULFATE SOLN 10mg/5ml, 20mg/5ml

morphine sulfate SOLN .5mg/ml, 1mg/ml

B/D

MORPHINE SULFATE TABS

2

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 3

Drug Name Requirements/Limits

morphine sulfate ext-rel tab (generic of MS CONTIN) 15mg, 30mg, 60mg, 100mg

morphine sulfate ext-rel tab (generic of MS CONTIN) 200mg

MORPHINE SULFATE INJ 1mg/ml, 4mg/ml, 8mg/ml, 10mg/ml, 15mg/ml

B/D

morphine sulfate inj .5mg/ml, 1mg/ml

B/D

NUCYNTA NUCYNTA ER 50mg, 100mg NUCYNTA ER 150mg, 200mg, 250mg

ONSOLIS NM

OPANA ER (CRUSH RESISTANT

OXECTA OXYCODONE HCL CAPS OXYCODONE HCL CONC OXYCODONE HCL SOLN oxycodone hcl (generic of ROXICODONE) TABS 5mg, 15mg, 30mg

oxycodone hcl TABS 10mg, 20mg

oxycodone w/ acetaminophen SOLN

oxycodone w/ acetaminophen (generic of PERCOCET) TABS

oxycodone w/ acetaminophen (generic of PERCOCET) TABS

oxycodone w/ acetaminophen 2.5-325mg (generic of PERCOCET)

oxycodone w/ acetaminophen 5-325mg (generic of PERCOCET)

oxycodone w/ acetaminophen 5-500mg

oxycodone w/ acetaminophen 7.5-325mg (generic of PERCOCET)

oxycodone w/ acetaminophen 7.5-500mg (generic of PERCOCET)

oxycodone w/ acetaminophen 10-325mg (generic of PERCOCET)

Drug Name Requirements/Limits

oxycodone w/ acetaminophen 10-650mg (generic of PERCOCET)

oxycodone-aspirin (generic of PERCODAN)

oxycodone-ibuprofen OXYCONTIN oxymorphone hcl (generic of OPANA) TABS

SUBSYS NM

ANESTHETICS LOCAL ANESTHETICS lidocaine hcl (local anesth.) (generic of XYLOCAINE-MPF) 4%

lidocaine hcl (local anesth.) (generic of XYLOCAINE) .5%

B/D

lidocaine inj 0.5% (generic of XYLOCAINE-MPF)

B/D

lidocaine inj 1% (generic of XYLOCAINE) 1%

B/D

lidocaine inj 1% (generic of XYLOCAINE-MPF) 1%

B/D

lidocaine inj 1.5% (generic of XYLOCAINE-MPF)

B/D

lidocaine inj 2% (generic of XYLOCAINE) 2%

B/D

lidocaine inj 2% (generic of XYLOCAINE-MPF) 2%

B/D

ANTI-INFECTIVES ANTI-BACTERIALS - MISCELLANEOUS amikacin sulfate SOLN gentamicin in saline 0.9mg/ml gentamicin in saline 1.4mg/ml gentamicin in saline 60mg gentamicin in saline 80mg gentamicin in saline 100mg gentamicin sulfate SOLN neomycin sulfate TABS paromomycin sulfate CAPS streptomycin sulfate SOLR sulfadiazine TABS TOBI NEB B/D NM

tobramycin sulfate SOLN; SOLR tobramycin sulfate in saline

ANTI-INFECTIVES - MISCELLANEOUS ALBENZA ALINIA SUSR ALINIA TABS

3

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 4

Drug Name Requirements/Limits

AZACTAM 2gm AZACTAM/DEX INJ 1GM AZACTAM/DEX INJ 2GM NM

aztreonam (generic of AZACTAM)

BILTRICIDE clindamycin hcl (generic of CLEOCIN) CAPS

clindamycin palmitate hydrochloride (generic of CLEOCIN PEDIATRIC GRANULE)

clindamycin phosphate SOLN 150mg/ml

clindamycin phosphate (generic of CLEOCIN PHOSPHATE) SOLN 150mg/ml, 300mg/2ml, 600mg/4ml, 900mg/6ml, 9000mg/60ml

clindamycin phosphate in d5w (generic of CLEOCIN IN D5W)

colistimethate sodium (generic of COLY-MYCIN M) SOLR

CUBICIN B/D NM

dapsone TABS DARAPRIM DORIBAX erythromycin-sulfisoxazole FLAGYL CAPS FLAGYL ER imipenem-cilastatin (generic of PRIMAXIN IV)

INVANZ MACRODANTIN 25mg MEPRON NM

meropenem (generic of MERREM)

methenamine hippurate (generic of HIPREX)

METRO IV metronidazole (generic of FLAGYL) TABS

metronidazole inj NEBUPENT B/D

nitrofurantoin (generic of FURADANTIN) SUSP

nitrofurantoin macrocrystal (generic of MACRODANTIN)

nitrofurantoin monohyd macro (generic of MACROBID)

Drug Name Requirements/Limits

PENTAM 300 polymyxin b sulfate SOLR PRIMSOL SOL 50MG/5ML STROMECTOL sulfamethoxazole-trimethoprim SUSP

sulfamethoxazole-trimethoprim (generic of BACTRIM) TABS

sulfamethoxazole-trimethoprim (generic of BACTRIM DS) TABS

sulfamethoxazole-trimethoprim inj SYNERCID NM

trimethoprim TABS TYGACIL NM

vancomycin hcl (generic of VANCOCIN HCL) CAPS

NM

vancomycin hcl SOLR 10gm, 500mg, 1000mg, 5000mg

B/D

vancomycin hcl SOLR 750mg B/D

VIBATIV XIFAXAN TAB 200MG NM

ZYVOX NM

ANTIFUNGALS ABELCET B/D NM

AMBISOME B/D NM

AMPHOTEC B/D

amphotericin b SOLR B/D

CANCIDAS NM

ERAXIS NM

fluconazole (generic of DIFLUCAN) SUSR; TABS

fluconazole in dextrose fluconazole in nacl 100mg fluconazole in nacl 200mg fluconazole in nacl 400mg flucytosine (generic of ANCOBON) CAPS

NM

griseofulvin microsize SUSP griseofulvin microsize (generic of GRIFULVIN V) TABS

griseofulvin ultramicrosize (generic of GRIS-PEG)

itraconazole (generic of SPORANOX) CAPS

ketoconazole TABS LAMISIL PACK MYCAMINE 50mg MYCAMINE 100mg NM

NOXAFIL NM

4

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 5

Drug Name Requirements/Limits

nystatin TABS ONMEL SPORANOX SOL 10MG/ML NM

terbinafine hcl (generic of LAMISIL) TABS

VFEND SUS 40MG/ML NM

voriconazole (generic of VFEND) TABS

NM

voriconazole inj 200mg (generic of VFEND IV)

ANTIMALARIALS ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG

atovaquone-proguanil hcl tab 250-100 mg (generic of MALARONE)

chloroquine phosphate TABS 250mg

chloroquine phosphate (generic of ARALEN) TABS 500mg

COARTEM mefloquine hcl PRIMAQUINE PHOSPHATE quinine sulfate (generic of QUALAQUIN) CAPS

ANTIRETROVIRAL AGENTS abacavir sulfate (generic of ZIAGEN)

APTIVUS NM

CRIXIVAN didanosine (generic of VIDEX EC)

EDURANT NM

EMTRIVA EPIVIR SOL 10MG/ML FUZEON NM

INTELENCE 25mg INTELENCE 100mg, 200mg NM

INVIRASE CAPS INVIRASE TABS NM

ISENTRESS CHEW 25mg ISENTRESS CHEW 100mg NM

ISENTRESS TABS NM

lamivudine (generic of EPIVIR) LEXIVA SUSP LEXIVA TABS NM

NEVIRAPINE SUSP nevirapine (generic of VIRAMUNE) TABS

Drug Name Requirements/Limits

NORVIR PREZISTA SUSP NM

PREZISTA TABS 75mg, 150mg PREZISTA TABS 400mg, 600mg, 800mg

NM

RESCRIPTOR RETROVIR IV INFUSION REYATAZ 100mg REYATAZ 150mg, 200mg, 300mg

NM

SELZENTRY NM

stavudine (generic of ZERIT) SUSTIVA VIDEX PEDIATRIC VIRACEPT NM

VIRAMUNE SUSP VIRAMUNE XR VIREAD NM

ZIAGEN SOLN zidovudine (generic of RETROVIR) CAPS; SYRP

zidovudine TABS

ANTIRETROVIRAL COMBINATION AGENTS ATRIPLA NM

COMPLERA NM

EPZICOM NM

KALETRA SOL NM

KALETRA TAB 100-25MG KALETRA TAB 200-50MG NM

lamivudine-zidovudine (generic of COMBIVIR)

NM

STRIBILD NM

TRIZIVIR NM

TRUVADA NM

ANTITUBERCULAR AGENTS CAPASTAT SULFATE NM

cycloserine CAPS ethambutol hcl (generic of MYAMBUTOL) TABS

isoniazid SOLN; SYRP isoniazid & rifampin isoniazid tabs MYCOBUTIN paser 4gm PRIFTIN pyrazinamide

5

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 6

Drug Name Requirements/Limits

rifampin (generic of RIFADIN) CAPS; SOLR

RIFATER SIRTURO NM LA

TRECATOR

ANTIVIRALS acyclovir (generic of ZOVIRAX) CAPS; SUSP; TABS

acyclovir sodium SOLN B/D

acyclovir sodium SOLR B/D

BARACLUDE SOLN BARACLUDE TABS NM

cidofovir (generic of VISTIDE) EPIVIR HBV famciclovir (generic of FAMVIR) foscarnet sodium ganciclovir inj 500mg (generic of CYTOVENE)

B/D

HEPSERA NM

INCIVEK NM

REBETOL SOLN NM

RELENZA DISKHALER ribapak NM

ribapak mis 600/day NM

ribasphere 400mg NM

ribasphere 600mg NM

ribasphere 200mg (generic of REBETOL) CAPS

NM

ribasphere 200mg (generic of COPEGUS) TABS

NM

ribavirin 200mg (generic of REBETOL) CAPS

NM

ribavirin 200mg (generic of COPEGUS) TABS

NM

rimantadine hydrochloride (generic of FLUMADINE)

TAMIFLU TYZEKA NM

valacyclovir hcl (generic of VALTREX) TABS

VALCYTE NM

VICTRELIS NM

CEPHALOSPORINS CEDAX cefaclor cefaclor monohydrate cefadroxil cefazolin inj cefazolin sodium 1gm, 20gm

Drug Name Requirements/Limits

cefazolin/dextrose cefdinir CEFEPIME 1GM SOLN CEFEPIME 2GM SOLN cefepime inj 1gm (generic of MAXIPIME)

cefepime inj 2gm (generic of MAXIPIME)

cefixime cefotaxime sodium (generic of CLAFORAN)

cefotetan disodium cefoxitin sodium CEFOXITIN SODIUM IN DEXTROSE

cefpodoxime proxetil cefprozil ceftazidime (generic of FORTAZ) SOLR 1gm, 2gm, 6gm

CEFTAZIDIME/DEXTROSE CEFTIN SUSR ceftriaxone sodium SOLR 1gm, 2gm, 10gm, 250mg

ceftriaxone sodium (generic of ROCEPHIN) SOLR 1gm, 500mg

cefuroxime axetil (generic of CEFTIN) TABS

cefuroxime sodium (generic of ZINACEF) 1.5gm, 7.5gm, 750mg

cefuroxime sodium 7.5mg soln cephalexin (generic of KEFLEX) CAPS 250mg, 500mg

cephalexin SUSR cephalexin TABS claforan 1gm, 2gm FORTAZ SOLN FORTAZ SOLR 500mg MAXIPIME SUPRAX CAPS suprax CHEW SUPRAX SUSR tazicef vial (generic of FORTAZ) TEFLARO

ERYTHROMYCINS/MACROLIDES AZITHROMYCIN PACK

6

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 7

Drug Name Requirements/Limits

azithromycin (generic of ZITHROMAX) SOLR 500mg

azithromycin (generic of ZITHROMAX) SUSR

azithromycin (generic of ZITHROMAX) TABS

clarithromycin SUSR 125mg/5ml

clarithromycin (generic of BIAXIN) SUSR 250mg/5ml

clarithromycin (generic of BIAXIN) TABS

clarithromycin (generic of BIAXIN XL) TB24

DIFICID NM

E.E.S. GRANULES ERYPED 200 ERYPED 400 erythromycin base CPEP; TABS erythromycin base TBEC erythromycin ethylsuccinate erythromycin lactobionate erythromycin stearate PCE ZMAX

FLUOROQUINOLONES AVELOX SOLN AVELOX TABS AVELOX ABC PACK CIPRO SUSR ciprofloxacin SOLN 200mg/20ml ciprofloxacin er (generic of CIPRO XR)

ciprofloxacin hcl TABS 100mg, 750mg

ciprofloxacin hcl (generic of CIPRO) TABS 250mg, 500mg

ciprofloxacin in d5w (generic of CIPRO I.V.-IN D5W)

ciprofloxacn inj FACTIVE levofloxacin SOLN 25mg/ml levofloxacin (generic of LEVAQUIN) SOLN 25mg/ml

levofloxacin (generic of LEVAQUIN) TABS

levofloxacin in d5w (generic of LEVAQUIN)

NOROXIN

Drug Name Requirements/Limits

PENICILLINS amoxicillin amoxicillin & pot clavulanate CHEW

amoxicillin & pot clavulanate (generic of AUGMENTIN) CHEW

amoxicillin & pot clavulanate SUSR

amoxicillin & pot clavulanate (generic of AUGMENTIN) SUSR

amoxicillin & pot clavulanate (generic of AUGMENTIN ES-600) SUSR

amoxicillin & pot clavulanate TABS

amoxicillin & pot clavulanate (generic of AUGMENTIN) TABS

amoxicillin & pot clavulanate (generic of AUGMENTIN XR) TB12

ampicillin ampicillin & sulbactam sodium ampicillin & sulbactam sodium (generic of UNASYN)

ampicillin & sulbactam sodium (generic of UNASYN BULK PACK)

ampicillin inj ampicillin sodium AUGMENTIN SUSR BACTOCILL IN DEXTROSE BICILLIN C-R BICILLIN L-A dicloxacillin sodium MOXATAG nafcillin sodium 1gm nafcillin sodium 2gm, 10gm NM

NALLPEN ISO-OSMOTIC IN DE NALLPEN/DEXTROSE oxacillin sodium 1gm, 2gm oxacillin sodium 10gm NM

PENICILLIN G POT IN DEXTROSE

PENICILLIN G POTASSIUM SOLN

penicillin g potassium SOLR penicillin g procaine penicillin g sodium

7

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 8

Drug Name Requirements/Limits

penicillin v potassium pfizerpen piperacillin sodium-tazobactam sodium (generic of ZOSYN)

TIMENTIN TIMENTIN INJ 3.1GM ZOSYN SOLN

TETRACYCLINES demeclocycline hcl DORYX doxycycline (monohydrate) CAPS 50mg

doxycycline (monohydrate) (generic of MONODOX) CAPS 75mg, 100mg

doxycycline (monohydrate) (generic of ADOXA) CAPS 150mg

doxycycline (monohydrate) (generic of VIBRAMYCIN) SUSR

doxycycline (monohydrate) (generic of ADOXA) TABS 50mg, 75mg, 100mg

doxycycline (monohydrate) (generic of ADOXA PAK 1/150) TABS 150mg

doxycycline hyclate CAPS 50mg doxycycline hyclate (generic of VIBRAMYCIN) CAPS 100mg

doxycycline hyclate SOLR doxycycline hyclate TABS doxycycline hyclate TBEC 75mg, 100mg

doxycycline hyclate (generic of DORYX) TBEC 150mg

minocycline hcl (generic of MINOCIN) CAPS 50mg, 100mg

minocycline hcl CAPS 75mg minocycline hcl TABS minocycline hcl (generic of SOLODYN) TB24

SOLODYN 55mg, 65mg, 80mg, 105mg, 115mg

NM

VIBRAMYCIN SUSR; SYRP

ANTINEOPLASTIC AGENTS ALKYLATING AGENTS BICNU B/D

BUSULFEX B/D

Drug Name Requirements/Limits

CEENU cyclophosphamide SOLR B/D

cyclophosphamide TABS B/D

dacarbazine 200mg B/D

EMCYT HEXALEN NM

IFEX INJ 3GM B/D

ifosfamide (generic of IFOSFAMIDE) SOLN

B/D

ifosfamide (generic of IFEX) SOLR 1gm

B/D

LEUKERAN melphalan hcl (generic of ALKERAN)

B/D NM

MUSTARGEN B/D

thiotepa SOLR B/D

TREANDA B/D NM

ZANOSAR B/D

ANTHRACYCLINES adriamycin 20mg B/D

adriamycin inj 2mg/ml B/D

daunorubicin hcl INJ B/D

daunorubicin hcl (generic of CERUBIDINE) SOLR

B/D

DOXIL B/D NM

doxorubicin hcl SOLN B/D

doxorubicin hcl SOLR 50mg B/D

EPIRUBICIN INJ 50MG B/D

epirubicin inj 50mg/25ml (generic of ELLENCE)

B/D

epirubicin inj 200mg (generic of ELLENCE)

B/D

idarubicin hcl (generic of IDAMYCIN PFS)

B/D NM

ANTIBIOTICS bleomycin sulfate B/D

COSMEGEN B/D NM

mitomycin SOLR 20mg B/D

ANTIMETABOLITES adrucil B/D

ALIMTA B/D NM

ARRANON B/D

cladribine B/D NM

CLOLAR B/D

cytarabine inj B/D

DACOGEN B/D NM

fludarabine phosphate SOLN B/D

fludarabine phosphate (generic of FLUDARA) SOLR

B/D

fluorouracil SOLN B/D

8

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 9

Drug Name Requirements/Limits

GEMCITABINE B/D NM

gemcitabine hcl (generic of GEMZAR) 1gm, 200mg

B/D NM

gemcitabine hcl 2gm B/D NM

mercaptopurine (generic of PURINETHOL) TABS

methotrexate sodium inj B/D

pentostatin (generic of NIPENT) B/D NM

TABLOID VIDAZA B/D NM

ANTIMITOTIC, TAXOIDS ABRAXANE B/D NM

DOCETAXEL CONC 20mg/0.5ml, 20mg/ml, 80mg/4ml

B/D NM

docetaxel CONC 140mg/7ml B/D NM

DOCETAXEL SOLN 80mg/8ml B/D NM

paclitaxel B/D

TAXOTERE B/D NM

ANTIMITOTIC, VINCA ALKALOIDS vinblastine sulfate SOLR B/D

vincristine sulfate B/D

vinorelbine tartrate (generic of NAVELBINE)

B/D

BIOLOGIC RESPONSE MODIFIERS AVASTIN B/D NM

ERBITUX B/D NM

ERIVEDGE NM LA

HERCEPTIN B/D NM

ISTODAX B/D NM

KADCYLA B/D NM

ONTAK B/D NM

PROLEUKIN B/D NM

RITUXAN NM

TORISEL B/D NM

VECTIBIX B/D NM

VELCADE B/D NM

ZOLINZA NM

HORMONAL ANTINEOPLASTIC AGENTS anastrozole (generic of ARIMIDEX) TABS

ARZERRA B/D NM

bicalutamide (generic of CASODEX)

DEPO-PROVERA INJ 400/ML B/D

ELIGARD 7.5mg, 22.5mg, 30mg B/D NM

ELIGARD 45mg B/D NM

exemestane (generic of AROMASIN)

FARESTON NM

FASLODEX B/D NM

Drug Name Requirements/Limits

FIRMAGON 80mg B/D NM

FIRMAGON 120mg B/D NM

flutamide letrozole (generic of FEMARA) TABS

leuprolide acetate KIT NM

LUPR DEP-PED INJ 11.25MG (3-MONTH)

NM

LUPR DEP-PED INJ 30MG (3-MONTH)

NM

LUPRON DEPOT 3.75mg, 7.5mg, 11.25mg

NM

LUPRON DEPOT INJ 22.5MG (3-MONTH)

NM

LUPRON DEPOT INJ 30MG (3-MONTH)

NM

LUPRON DEPOT-PED NM

LYSODREN MEGACE ES megestrol acetate (generic of MEGACE ORAL) SUSP

megestrol acetate TABS NILANDRON NM

SOLTAMOX tamoxifen citrate TABS TRELSTAR DEPOT MIXJECT NM

TRELSTAR LA MIXJECT NM

TRELSTAR MIXJECT NM

XTANDI NM LA

ZYTIGA NM

KINASE INHIBITORS AFINITOR NM

AFINITOR DISPERZ NM

BOSULIF NM

CAPRELSA NM LA

COMETRIQ NM

GLEEVEC NM

ICLUSIG NM

INLYTA NM LA

IRESSA NM

JAKAFI NM LA

MEKINIST NM

NEXAVAR NM LA

SPRYCEL NM

STIVARGA NM LA

SUTENT NM

TAFINLAR NM

TARCEVA NM

TASIGNA NM

TYKERB NM LA

9

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 10

Drug Name Requirements/Limits

VOTRIENT NM

XALKORI NM LA

ZELBORAF NM LA

MISCELLANEOUS DROXIA ELSPAR B/D NM

HALAVEN B/D NM

hydroxyurea (generic of HYDREA) CAPS

IXEMPRA KIT B/D NM

MATULANE NM

mitoxantrone hcl B/D NM

POMALYST CAP NM LA

SYLATRON NM

TARGRETIN CAPS NM

tretinoin CAPS NM

TRISENOX B/D NM

UVADEX B/D

PLATINUM-BASED AGENTS carboplatin SOLN B/D

cisplatin SOLN B/D

ELOXATIN B/D NM

oxaliplatin B/D NM

PROTECTIVE AGENTS amifostine crystalline (generic of ETHYOL)

B/D NM

dexrazoxane (generic of ZINECARD)

B/D NM

ELITEK B/D NM

KEPIVANCE B/D NM

leucovor ca inj B/D

leucovorin calcium SOLN B/D

leucovorin calcium SOLR 50mg, 200mg

B/D

leucovorin calcium SOLR 500mg

B/D

leucovorin calcium TABS mesna (generic of MESNEX) B/D

MESNEX TABS NM

TOPOISOMERASE INHIBITORS CAMPTOSAR 300mg/15ml B/D

ETOPOPHOS B/D

etoposide SOLN B/D

irinotecan hcl (generic of CAMPTOSAR) 40mg/2ml, 100mg/5ml

B/D NM

irinotecan hcl 500mg/25ml B/D NM

topotecan hcl (generic of HYCAMTIN) SOLR

B/D NM

CARDIOVASCULAR

Drug Name Requirements/Limits

ACE INHIBITOR COMBINATIONS amlodipine besylate-benazepril hcl (generic of LOTREL)

benazepril & hydrochlorothiazide benazepril & hydrochlorothiazide (generic of LOTENSIN HCT)

captopril & hydrochlorothiazide enalapril maleate & hydrochlorothiazide

enalapril maleate & hydrochlorothiazide (generic of VASERETIC)

fosinopril sodium & hydrochlorothiazide

lisinopril & hydrochlorothiazide (generic of PRINZIDE)

lisinopril & hydrochlorothiazide (generic of ZESTORETIC)

moexipril-hydrochlorothiazide (generic of UNIRETIC)

quinapril-hydrochlorothiazide (generic of ACCURETIC)

TARKA

ACE INHIBITORS benazepril hcl TABS 5mg benazepril hcl (generic of LOTENSIN) TABS 10mg, 20mg, 40mg

captopril TABS enalapril maleate (generic of VASOTEC) TABS

fosinopril sodium lisinopril (generic of ZESTRIL) TABS 2.5mg, 30mg, 40mg

lisinopril (generic of PRINIVIL) TABS 5mg, 10mg, 20mg

moexipril hcl (generic of UNIVASC)

perindopril erbumine 2mg perindopril erbumine (generic of ACEON) 4mg, 8mg

quinapril hcl (generic of ACCUPRIL)

ramipril (generic of ALTACE) trandolapril (generic of MAVIK)

ALDOSTERONE RECEPTOR ANTAGONISTS eplerenone (generic of INSPRA) spironolactone (generic of ALDACTONE) TABS

10

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 11

Drug Name Requirements/Limits

ALPHA BLOCKERS doxazosin mesylate (generic of CARDURA)

prazosin hcl (generic of MINIPRESS)

terazosin hcl

ANGIOTENSIN II RECEPTOR ANTAGONIST COMBINATIONS AZOR BENICAR HCT candesartan cilexetil-hydrochlorothiazide (generic of ATACAND HCT)

EDARBYCLOR EXFORGE EXFORGE HCT irbesartan-hydrochlorothiazide (generic of AVALIDE)

losartan potassium & hydrochlorothiazide (generic of HYZAAR)

MICARDIS HCT TEVETEN HCT TRIBENZOR TWYNSTA valsartan-hydrochlorothiazide (generic of DIOVAN HCT)

ANGIOTENSIN II RECEPTOR ANTAGONISTS ATACAND BENICAR candesartan cilexetil (generic of ATACAND)

DIOVAN EDARBI eprosartan mesylate (generic of TEVETEN)

irbesartan (generic of AVAPRO) losartan potassium (generic of COZAAR)

MICARDIS TEVETEN 400mg

ANTIARRHYTHMICS amiodarone hcl SOLN amiodarone hcl TABS 100mg amiodarone hcl (generic of CORDARONE) TABS 200mg

amiodarone hcl TABS 400mg

Drug Name Requirements/Limits

amiodarone inj 50mg/ml disopyramide phosphate (generic of NORPACE)

flecainide acetate (generic of TAMBOCOR)

mexiletine hcl MULTAQ NORPACE CR propafenone hcl (generic of RYTHMOL SR) CP12

propafenone hcl (generic of RYTHMOL) TABS 150mg, 225mg

propafenone hcl TABS 300mg quinidine gluconate er quinidine sulfate sotalol hcl (generic of BETAPACE) 80mg, 120mg, 160mg

sotalol hcl 240mg sotalol hcl (afib/afl) (generic of BETAPACE AF)

TIKOSYN NM

ANTILIPEMICS, HMG-CoA REDUCTASE INHIBITORS ALTOPREV atorvastatin calcium (generic of LIPITOR)

CRESTOR fluvastatin sodium (generic of LESCOL)

LESCOL XL LIVALO lovastatin 10mg lovastatin (generic of MEVACOR) 20mg, 40mg

pravastatin sodium 10mg pravastatin sodium (generic of PRAVACHOL) 20mg, 40mg, 80mg

simvastatin (generic of ZOCOR) TABS 5mg, 10mg, 20mg, 40mg

simvastatin (generic of ZOCOR) TABS 80mg

ANTILIPEMICS, MISCELLANEOUS ADVICOR cholestyramine (generic of QUESTRAN)

11

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 12

Drug Name Requirements/Limits

cholestyramine light (generic of QUESTRAN LIGHT)

choline fenofibrate (generic of TRILIPIX)

colestipol hcl (generic of COLESTID)

fenofibrate (generic of TRICOR) 48mg, 145mg

fenofibrate (generic of LOFIBRA) 54mg, 160mg

FENOFIBRATE MICRONIZED 43mg, 130mg

fenofibrate micronized (generic of LOFIBRA) 67mg, 134mg, 200mg

FENOFIBRIC ACID FENOGLIDE gemfibrozil (generic of LOPID) TABS

LIPOFEN LOVAZA niacor NIASPAN SIMCOR TRIGLIDE TRILIPIX VASCEPA VYTORIN WELCHOL ZETIA

BETA-BLOCKER/DIURETIC COMBINATIONS atenolol & chlorthalidone (generic of TENORETIC 50)

atenolol & chlorthalidone (generic of TENORETIC 100)

bisoprolol & hydrochlorothiazide (generic of ZIAC)

metoprolol & hctz tab 50-25mg (generic of LOPRESSOR HCT)

metoprolol & hctz tab 100-25mg (generic of LOPRESSOR HCT)

metoprolol & hctz tab 100-50mg nadolol & bendroflumethiazide (generic of CORZIDE)

propranolol & hydrochlorothiazide

BETA-BLOCKERS acebutolol hcl (generic of SECTRAL) CAPS

Drug Name Requirements/Limits

atenolol (generic of TENORMIN) TABS

betaxolol hcl (generic of KERLONE)

bisoprolol fumarate (generic of ZEBETA)

BYSTOLIC carvedilol (generic of COREG) COREG CR labetalol hcl SOLN labetalol hcl (generic of TRANDATE) TABS

LEVATOL metoprolol succinate (generic of TOPROL XL)

metoprolol tartrate (generic of LOPRESSOR) SOLN

metoprolol tartrate TABS 25mg metoprolol tartrate (generic of LOPRESSOR) TABS 50mg, 100mg

nadolol (generic of CORGARD) TABS

pindolol propranolol hcl er (generic of INDERAL LA)

propranolol inj 1mg/ml propranolol sol propranolol tab timolol maleate TABS

CALCIUM CHANNEL BLOCKER/ANTILIPEMIC COMBINATIONS AMLODIPINE BESYLATE/ATORV

CALCIUM CHANNEL BLOCKERS amlodipine besylate (generic of NORVASC) TABS

CARDIZEM LA 120mg cartia xt (generic of CARDIZEM CD)

dilt-cd (generic of CARDIZEM CD)

dilt-xr 120mg, 180mg dilt-xr (generic of DILACOR XR) 240mg

diltiazem cap 120mg/24hr diltiazem cap er/12hr diltiazem hcl SOLN diltiazem hcl SOLR

12

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 13

Drug Name Requirements/Limits

diltiazem hcl (generic of CARDIZEM) TABS

diltiazem hcl coated beads (generic of CARDIZEM CD)

diltiazem hcl er (generic of TIAZAC)

diltiazem hcl extended release beads (generic of TIAZAC)

diltzac (generic of TIAZAC) felodipine isradipine matzim la (generic of CARDIZEM LA)

nicardipine hcl CAPS nifedipine (generic of ADALAT CC) TB24

nifedipine cc tab 90mg er (generic of ADALAT CC)

nifedipine cr (generic of ADALAT CC)

nifedipine er (generic of PROCARDIA XL)

nifedipine xl (generic of PROCARDIA XL)

nimodipine (generic of NIMOTOP) CAPS

nisoldipine (generic of SULAR) 8.5mg, 17mg, 34mg

nisoldipine 20mg, 25.5mg, 30mg, 40mg

NYMALIZE NM

taztia xt (generic of TIAZAC) verapamil hcl (generic of VERELAN PM) CP24 100mg, 200mg, 300mg

verapamil hcl (generic of VERELAN) CP24 120mg, 180mg, 240mg

VERAPAMIL HCL CP24 360mg verapamil hcl SOLN verapamil hcl TABS 40mg verapamil hcl (generic of CALAN) TABS 80mg, 120mg

verapamil hcl (generic of CALAN SR) TBCR

DIGITALIS GLYCOSIDES digoxin (generic of LANOXIN) TABS

digoxin inj (generic of LANOXIN) DIGOXIN SOL 50MCG/ML

Drug Name Requirements/Limits

LANOXIN PEDIATRIC LANOXIN TAB

DIRECT RENIN INHIBITORS/COMBINATIONS AMTURNIDE TEKAMLO TEKTURNA TEKTURNA HCT

DIURETICS acetazolamide (generic of DIAMOX) CP12

acetazolamide TABS acetazolamide sodium ALDACTAZIDE amiloride & hydrochlorothiazide amiloride hcl bumetanide chlorothiazide chlorthalidone 25mg, 50mg DIURIL SUS 250/5ML DYRENIUM EDECRIN furosemide SOLN furosemide (generic of LASIX) TABS

furosemide inj furosemide oral soln 8 mg/ml hydrochlorothiazide (generic of MICROZIDE) CAPS

hydrochlorothiazide TABS indapamide TABS methazolamide (generic of NEPTAZANE) TABS

methyclothiazide metolazone (generic of ZAROXOLYN) 2.5mg, 5mg

metolazone 10mg spironolactone & hydrochlorothiazide (generic of ALDACTAZIDE)

torsemide inj torsemide tabs (generic of DEMADEX)

triamterene & hydrochlorothiazide cap 37.5-25 mg (generic of DYAZIDE)

13

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 14

Drug Name Requirements/Limits

triamterene & hydrochlorothiazide tab 37.5-25 mg (generic of MAXZIDE-25)

triamterene & hydrochlorothiazide tab 75-50 mg (generic of MAXZIDE)

MISCELLANEOUS BIDIL clonidine & chlorthalidone clonidine hcl (generic of CATAPRES-TTS-1) PTWK .1mg/24hr

clonidine hcl (generic of CATAPRES-TTS-2) PTWK .2mg/24hr

clonidine hcl (generic of CATAPRES-TTS-3) PTWK .3mg/24hr

clonidine hcl (generic of CATAPRES) TABS

DEMSER NM

DIBENZYLINE hydralazine hcl SOLN; TABS midodrine hcl minoxidil TABS RANEXA

NITRATES DILATRATE SR ISORDIL TITRADOSE 40mg isosorbide dinitrate SUBL isosorbide dinitrate (generic of ISORDIL TITRADOSE) TABS 5mg

isosorbide dinitrate TABS 10mg, 20mg, 30mg

isosorbide dinitrate TBCR isosorbide mononitrate TABS isosorbide mononitrate (generic of IMDUR) TB24

minitran (generic of NITRO-DUR) NITRO-DUR .3mg/hr, .8mg/hr nitroglycerin OINT NITROGLYCERIN SOLN .4mg/spray

NITROGLYCERIN LINGUAL nitroglycerin patches NITROLINGUAL SPR PUMPSPRA

NITROMIST

Drug Name Requirements/Limits

NITROSTAT

PULMONARY ARTERIAL HYPERTENSION ADCIRCA NM

LETAIRIS NM LA

REMODULIN B/D NM LA

sildenafil citrate (pulmonary hypertension) (generic of REVATIO)

NM

TRACLEER NM LA

VENTAVIS B/D NM

CENTRAL NERVOUS SYSTEM ANTIANXIETY alprazolam CONC alprazolam (generic of XANAX) TABS 2mg

alprazolam (generic of XANAX) TABS .25mg, .5mg, 1mg

buspirone hcl TABS fluvoxamine maleate fluvoxamine maleate er (generic of LUVOX CR)

fluvoxamine tabs lorazepam CONC lorazepam (generic of ATIVAN) SOLN

lorazepam (generic of ATIVAN) TABS

ANTICONVULSANTS BANZEL SUSP NM

BANZEL TABS 200mg BANZEL TABS 400mg NM

carbamazepine CHEW carbamazepine (generic of CARBATROL) CP12

carbamazepine (generic of TEGRETOL) SUSP; TABS

carbamazepine (generic of TEGRETOL-XR) TB12

CELONTIN clonazepam (generic of KLONOPIN) TABS 1mg

clonazepam (generic of KLONOPIN) TABS 2mg

clonazepam (generic of KLONOPIN) TABS .5mg

clonazepam TBDP 1mg clonazepam TBDP 2mg clonazepam TBDP .5mg

14

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 15

Drug Name Requirements/Limits

clonazepam TBDP .25mg clonazepam TBDP .125mg clorazepate dipotassium (generic of TRANXENE T) 3.75mg, 7.5mg

clorazepate dipotassium (generic of TRANXENE T) 15mg

diazepam CONC diazepam SOLN diazepam (generic of VALIUM) TABS

DIAZEPAM GEL diazepam inj dilantin CHEW DILANTIN SUSP divalproex sodium (generic of DEPAKOTE SPRINKLES) CPSP

divalproex sodium (generic of DEPAKOTE ER) TB24

divalproex sodium (generic of DEPAKOTE) TBEC

ethosuximide (generic of ZARONTIN) CAPS; SOLN

felbamate (generic of FELBATOL) SUSP

NM

felbamate (generic of FELBATOL) TABS 400mg

felbamate (generic of FELBATOL) TABS 600mg

NM

gabapentin (generic of NEURONTIN) CAPS 100mg

gabapentin (generic of NEURONTIN) CAPS 300mg

gabapentin (generic of NEURONTIN) CAPS 400mg

gabapentin (generic of NEURONTIN) SOLN

gabapentin (generic of NEURONTIN) TABS 600mg

gabapentin (generic of NEURONTIN) TABS 800mg

GABITRIL 12mg, 16mg LAMICTAL ODT LAMICTAL STARTER LAMICTAL XR KIT lamotrigine (generic of LAMICTAL CHEWABLE DISPERS) CHEW

Drug Name Requirements/Limits

lamotrigine (generic of LAMICTAL) TABS

lamotrigine (generic of LAMICTAL XR) TB24

levetiracetam (generic of KEPPRA) SOLN; TABS

levetiracetam (generic of KEPPRA XR) TB24

LYRICA CAPS 25mg, 50mg, 75mg, 100mg, 150mg

LYRICA CAPS 200mg LYRICA CAPS 225mg, 300mg LYRICA SOLN ONFI TABS oxcarbazepine (generic of TRILEPTAL)

PEGANONE phenobarbital ELIX; TABS PHENOBARBITAL SODIUM 65mg/ml

phenobarbital sodium 130mg/ml phenytoin (generic of DILANTIN INFATABS) CHEW

phenytoin (generic of DILANTIN) SUSP

phenytoin inj 50mg/ml phenytoin sodium extended 30mg, 100mg

phenytoin sodium extended (generic of DILANTIN) 100mg

phenytoin sodium extended 200mg, 300mg

phenytoin sodium extended (generic of PHENYTEK) 200mg, 300mg

POTIGA primidone (generic of MYSOLINE) TABS

SABRIL NM LA

STAVZOR TEGRETOL TEGRETOL-XR tiagabine hcl (generic of GABITRIL)

topiramate (generic of TOPAMAX SPRINKLE) CPSP

topiramate (generic of TOPAMAX) TABS

TRILEPTAL SUSP

15

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 16

Drug Name Requirements/Limits

valproate sodium (generic of DEPACON) SOLN

valproate sodium (generic of DEPAKENE) SYRP

valproic acid (generic of DEPAKENE) CAPS

VIMPAT zonisamide (generic of ZONEGRAN) 25mg, 100mg

zonisamide 50mg

ANTIDEMENTIA ARICEPT 23mg donepezil odt 5mg (generic of ARICEPT ODT)

donepezil odt 10mg (generic of ARICEPT ODT)

donepezil tabs 5mg (generic of ARICEPT)

donepezil tabs 10mg (generic of ARICEPT)

EXELON SOLN EXELON PATCHES galantamine hydrobromide (generic of RAZADYNE ER) CP24

galantamine hydrobromide (generic of RAZADYNE) SOLN; TABS

NAMENDA NAMENDA TITRATION PAK NAMENDA XR NAMENDA XR TITRATION PACK

rivastigmine tartrate (generic of EXELON)

ANTIDEPRESSANTS amitriptyline hcl TABS amoxapine APLENZIN bupropion hcl (generic of WELLBUTRIN) TABS

bupropion hcl (generic of WELLBUTRIN SR) TB12

bupropion hcl (generic of WELLBUTRIN XL) TB24

citalopram hydrobromide SOLN citalopram hydrobromide (generic of CELEXA) TABS

clomipramine hcl (generic of ANAFRANIL) CAPS

Drug Name Requirements/Limits

CYMBALTA desipramine hcl (generic of NORPRAMIN) TABS

doxepin hcl CAPS; CONC EMSAM escitalopram oxalate (generic of LEXAPRO)

fluoxetine hcl (generic of PROZAC) CAPS

fluoxetine hcl (generic of PROZAC WEEKLY) CPDR

fluoxetine hcl SOLN fluoxetine hcl TABS 10mg, 20mg

FLUOXETINE HCL TABS 60mg FORFIVO XL imipramine hcl (generic of TOFRANIL) TABS

imipramine pamoate (generic of TOFRANIL-PM)

maprotiline hcl MARPLAN mirtazapine TABS 7.5mg mirtazapine (generic of REMERON) TABS 15mg, 30mg, 45mg

mirtazapine (generic of REMERON SOLTAB) TBDP

nefazodone hcl nortriptyline hcl (generic of PAMELOR) CAPS

nortriptyline hcl SOLN OLEPTRO paroxetine er tab (generic of PAXIL CR)

paroxetine hcl (generic of PAXIL) PAXIL SUSP PEXEVA phenelzine sulfate (generic of NARDIL) TABS

PRISTIQ protriptyline hcl (generic of VIVACTIL)

sertraline hcl (generic of ZOLOFT) CONC; TABS

tranylcypromine sulfate (generic of PARNATE)

trazodone hcl TABS

16

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 17

Drug Name Requirements/Limits

trimipramine maleate (generic of SURMONTIL)

venlafaxine cap er (generic of EFFEXOR XR)

venlafaxine tab venlafaxine tab er (generic of VENLAFAXINE HCL ER)

VIIBRYD

ANTIPARKINSONIAN AGENTS amantadine hcl CAPS; SYRP; TABS

APOKYN NM LA

AZILECT benztropine mesylate (generic of COGENTIN) SOLN

benztropine mesylate TABS bromocriptine mesylate CAPS bromocriptine mesylate (generic of PARLODEL) TABS

carbidopa-levodopa (generic of SINEMET) TABS

carbidopa-levodopa (generic of SINEMET CR) TBCR

carbidopa-levodopa (generic of PARCOPA) TBDP

CARBIDOPA/LEVODOPA/ENTACA

CARBIDOPA/LEVODOPA/ENTACA

CARBIDOPA/LEVODOPA/ENTACA

CARBIDOPA/LEVODOPA/ENTACA

CARBIDOPA/LEVODOPA/ENTACA

CARBIDOPA/LEVODOPA/ENTACA

ENTACAPONE LODOSYN MIRAPEX .75mg MIRAPEX ER NEUPRO PARLODEL CAPS pramipexole dihydrochloride .75mg

pramipexole dihydrochloride (generic of MIRAPEX) .125mg, .25mg, .5mg, 1mg, 1.5mg

ropinirole hydrochloride (generic of REQUIP) TABS

Drug Name Requirements/Limits

ropinirole hydrochloride (generic of REQUIP XL) TB24

selegiline hcl (generic of ELDEPRYL) CAPS

selegiline hcl TABS ZELAPAR

ANTIPSYCHOTICS ABILIFY SOLN NM

ABILIFY TABS 2mg, 5mg, 10mg, 15mg

ABILIFY TABS 20mg, 30mg NM

ABILIFY DISCMELT NM

ABILIFY INJ ABILIFY MAINTENA NM

chlorpromaz inj 25mg/ml chlorpromazine hcl TABS CLOZAPINE ODT clozapine tab (generic of CLOZARIL) 25mg, 100mg

clozapine tab 50mg, 200mg FANAPT FANAPT TITRATION PACK FAZACLO fluphenazine decanoate SOLN fluphenazine hcl GEODON INJ haloperidol TABS haloperidol decanoate (generic of HALDOL DECANOATE 50) SOLN 50mg/ml

haloperidol decanoate (generic of HALDOL DECANOATE 100) SOLN 100mg/ml

haloperidol lactate CONC haloperidol lactate (generic of HALDOL) SOLN

INVEGA INVEGA SUSTENNA 39mg/0.25ml, 78mg/0.5ml

INVEGA SUSTENNA 117mg/0.75ml, 156mg/ml, 234mg/1.5ml

NM

LATUDA loxapine succinate (generic of LOXITANE) CAPS 5mg, 25mg, 50mg

loxapine succinate CAPS 10mg olanzapine (generic of ZYPREXA) SOLR

17

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 18

Drug Name Requirements/Limits

olanzapine (generic of ZYPREXA) TABS

olanzapine odt (generic of ZYPREXA ZYDIS) 5mg, 10mg, 15mg

olanzapine odt (generic of ZYPREXA ZYDIS) 20mg

NM

ORAP perphenazine TABS quetiapine fumarate (generic of SEROQUEL)

RISPERDAL CONSTA 12.5mg, 25mg

RISPERDAL CONSTA 37.5mg, 50mg

NM

risperidone (generic of RISPERDAL)

risperidone odt (generic of RISPERDAL M-TAB) .5mg, 1mg, 2mg, 3mg, 4mg

risperidone odt .25mg SAPHRIS SEROQUEL XR thioridazine hcl TABS thiothixene trifluoperazine hcl ziprasidone hcl (generic of GEODON)

ATTENTION DEFICIT HYPERACTIVITY DISORDER amphetamine-dextroamphetamine cap sr 24hr 5 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 10 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 15 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 20 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 25 mg (generic of ADDERALL XR)

amphetamine-dextroamphetamine cap sr 24hr 30 mg (generic of ADDERALL XR)

Drug Name Requirements/Limits

amphetamine-dextroamphetamine tab 5 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 7.5 mg

amphetamine-dextroamphetamine tab 10 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 12.5 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 15 mg

amphetamine-dextroamphetamine tab 20 mg (generic of ADDERALL)

amphetamine-dextroamphetamine tab 30 mg (generic of ADDERALL)

DAYTRANA 10mg/9hr, 20mg/9hr, 30mg/9hr

DAYTRANA 15mg/9hr INTUNIV metadate tab 20mg er METHYLIN CHEW TAB methylphenidate hcl (generic of RITALIN LA) CP24 20mg, 30mg

methylphenidate hcl (generic of RITALIN LA) CP24 40mg

methylphenidate hcl (generic of METADATE CD) CPCR 10mg, 20mg, 30mg

methylphenidate hcl (generic of METADATE CD) CPCR 40mg, 50mg, 60mg

methylphenidate hcl (generic of METHYLIN) SOLN 5mg/5ml

methylphenidate hcl (generic of METHYLIN) SOLN 10mg/5ml

methylphenidate hcl (generic of RITALIN) TABS 5mg, 10mg

methylphenidate hcl (generic of RITALIN) TABS 20mg

METHYLPHENIDATE HCL ER 18mg

methylphenidate hcl er (generic of CONCERTA) 27mg, 36mg

methylphenidate hcl er (generic of CONCERTA) 54mg

methylphenidate tab 10mg er methylphenidate tab 20mg er

18

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 19

Drug Name Requirements/Limits

QUILLIVANT XR RITALIN LA 10mg STRATTERA 10mg, 18mg, 25mg

STRATTERA 40mg STRATTERA 60mg, 80mg, 100mg

VYVANSE 20mg, 30mg VYVANSE 40mg, 50mg, 60mg, 70mg

HYPNOTICS EDLUAR INTERMEZZO LUNESTA ROZEREM SILENOR 3mg SILENOR 6mg zaleplon (generic of SONATA) zolpidem tartrate (generic of AMBIEN) TABS

zolpidem tartrate (generic of AMBIEN CR) TBCR

ZOLPIMIST

MIGRAINE ALSUMA AXERT cafergot tab 1-100mg dihydroergotamine mesylate (generic of D.H.E. 45) 1mg/ml

DIHYDROERGOTAMINE MESYLATE 4mg/ml

ergomar ergotamine w/ caffeine FROVA TAB 2.5MG naratriptan hcl (generic of AMERGE)

RELPAX rizatriptan benzoate (generic of MAXALT) TABS

rizatriptan benzoate (generic of MAXALT-MLT) TBDP

SUMATRIPTAN SUCCINATE SOLN

sumatriptan succinate (generic of IMITREX) TABS

SUMATRIPTAN SUCCINATE INJ 4mg/0.5ml

sumatriptan succinate inj (generic of IMITREX) 6mg/0.5ml

Drug Name Requirements/Limits

SUMAVEL DOSEPRO TREXIMET zolmitriptan (generic of ZOMIG) zolmitriptan odt (generic of ZOMIG ZMT)

ZOMIG SOLN ZOMIG TABS ZOMIG ZMT

MISCELLANEOUS EQUETRO GRALISE 300mg GRALISE 600mg GRALISE STARTER HORIZANT lithium carbonate CAPS lithium carbonate TABS lithium carbonate (generic of LITHOBID) TBCR 300mg

lithium carbonate TBCR 450mg LITHIUM CITRATE MESTINON SYRUP MESTINON TIMESPAN NUEDEXTA pyridostigmine bromide (generic of MESTINON) TABS

REGONOL RILUTEK NM

riluzole (generic of RILUTEK) SAVELLA 12.5mg SAVELLA 25mg SAVELLA 50mg SAVELLA 100mg SAVELLA TITRATION PACK XENAZINE NM LA

MULTIPLE SCLEROSIS AGENTS AMPYRA NM LA

AUBAGIO NM

AVONEX NM

AVONEX PEN NM

BETASERON NM

COPAXONE NM

EXTAVIA NM

GILENYA NM

REBIF NM

REBIF TITRATION PACK NM

TECFIDERA 120mg NM

TECFIDERA 240mg NM

TECFIDERA STARTER PACK NM

19

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 20

Drug Name Requirements/Limits

TYSABRI NM LA

MUSCULOSKELETAL THERAPY AGENTS AMRIX 15mg AMRIX 30mg baclofen TABS chlorzoxazone (generic of PARAFON FORTE DSC) TABS

cyclobenzaprine hcl (generic of FLEXERIL) TABS 5mg, 10mg

cyclobenzaprine hcl (generic of FEXMID) TABS 7.5mg

dantrolene sodium (generic of DANTRIUM) CAPS

methocarbamol (generic of ROBAXIN) TABS 500mg

methocarbamol (generic of ROBAXIN-750) TABS 750mg

tizanidine (generic of ZANAFLEX) CAPS

tizanidine TABS 2mg tizanidine (generic of ZANAFLEX) TABS 4mg

NARCOLEPSY/CATAPLEXY modafinil (generic of PROVIGIL) 100mg

modafinil (generic of PROVIGIL) 200mg

NM

NUVIGIL XYREM NM LA

PSYCHOTHERAPEUTIC-MISC buprenorphine hcl SUBL buprenorphine hcl-naloxone hcl sl (generic of SUBOXONE)

bupropion hcl (smoking deterrent) (generic of ZYBAN)

CAMPRAL CHANTIX CHANTIX STARTER PACK disulfiram (generic of ANTABUSE) TABS

naloxone hcl SOLN naltrexone hcl (generic of REVIA) TABS

NICOTROL INHALER NICOTROL NS SARAFEM SUBOXONE MIS 2-0.5MG SUBOXONE MIS 4-1MG SUBOXONE MIS 8-2MG

Drug Name Requirements/Limits

SUBOXONE MIS 12-3MG VIVITROL NM

ENDOCRINE AND METABOLIC ANDROGENS ANDRODERM ANDROGEL 1% ANDROGEL 1.62% AXIRON fluoxymesterone TABS FORTESTA oxandrolone (generic of OXANDRIN) TABS

STRIANT TESTIM testosterone cypionate OIL testosterone enanthate (generic of DELATESTRYL) OIL

ANTIDIABETICS, INJECTABLE ALCOHOL PREPS PADS APIDRA APIDRA SOLOSTAR BYDUREON BYETTA GAUZE PADS 2X2 HUMALOG HUMALOG KWIKPEN HUMALOG MIX 50/50 HUMALOG MIX 50/50 KWIKPEN HUMALOG MIX 75/25 HUMALOG MIX 75/25 KWIKPEN HUMULIN 70/30 HUMULIN 70/30 PEN HUMULIN N HUMULIN N U-100 PEN HUMULIN R HUMULIN R U-500 (CONCENTRATE)

B/D NM

INSULIN PEN NEEDLES INSULIN SAFETY NEEDLES INSULIN SYRINGES LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXPEN NOVOLIN 70/30 NOVOLIN 70/30 RELION NOVOLIN N

20

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 21

Drug Name Requirements/Limits

NOVOLIN N RELION NOVOLIN R NOVOLIN R RELION NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70/30 NOVOLOG MIX 70/30 PREFILL SYMLINPEN 60 SYMLINPEN 120 VICTOZA

ANTIDIABETICS, ORAL acarbose (generic of PRECOSE) ACTOPLUS MET XR 15-1000MG ACTOPLUS MET XR 30-1000MG glimepiride (generic of AMARYL) 1mg

glimepiride (generic of AMARYL) 2mg

glimepiride (generic of AMARYL) 4mg

glipizide (generic of GLUCOTROL) TABS 5mg

glipizide (generic of GLUCOTROL) TABS 10mg

glipizide er (generic of GLUCOTROL XL) 2.5mg

glipizide er (generic of GLUCOTROL XL) 5mg

glipizide er (generic of GLUCOTROL XL) 10mg

glipizide-metformin 2.5-250mg (generic of METAGLIP)

glipizide-metformin 2.5-500mg glipizide-metformin 5-500mg GLUMETZA 500mg GLUMETZA 1000mg glyburide 1.25mg glyburide 2.5mg glyburide 5mg glyburide micronized (generic of GLYNASE) 1.5mg

glyburide micronized (generic of GLYNASE) 3mg

glyburide micronized (generic of GLYNASE) 6mg

glyburide-metformin 1.25-250mg (generic of GLUCOVANCE)

glyburide-metformin 2.5-500mg (generic of GLUCOVANCE)

Drug Name Requirements/Limits

glyburide-metformin 5-500mg (generic of GLUCOVANCE)

GLYSET INVOKANA 100mg INVOKANA 300mg JANUMET JANUMET XR TAB 50-500MG JANUMET XR TAB 50-1000 JANUMET XR TAB 100-1000 JANUVIA JENTADUETO JUVISYNC KAZANO KOMBIGLYZE XR 2.5-1000MG KOMBIGLYZE XR 5-500MG KOMBIGLYZE XR 5-1000MG metformin er (generic of GLUCOPHAGE XR) 500mg

metformin er (generic of GLUCOPHAGE XR) 750mg

metformin hcl (generic of GLUCOPHAGE) TABS 500mg

metformin hcl (generic of GLUCOPHAGE) TABS 850mg

metformin hcl (generic of GLUCOPHAGE) TABS 1000mg

metformin hcl (generic of FORTAMET) TB24 500mg

metformin hcl (generic of FORTAMET) TB24 1000mg

nateglinide (generic of STARLIX) NESINA 6.25mg NESINA 12.5mg NESINA 25mg ONGLYZA OSENI TAB 12.5-15MG OSENI TAB 12.5-30MG OSENI TAB 12.5-45MG OSENI TAB 25-15MG OSENI TAB 25-30MG OSENI TAB 25-45MG pioglitazone hcl (generic of ACTOS)

pioglitazone hcl-glimepiride (generic of DUETACT)

pioglitazone hcl-metformin hcl (generic of ACTOPLUS MET)

PRANDIMET

21

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 22

Drug Name Requirements/Limits

PRANDIN 2mg PRANDIN .5mg, 1mg RIOMET TRADJENTA

BISPHOSPHONATES ACTONEL alendronate sodium SOLN alendronate sodium TABS 5mg, 10mg, 35mg, 40mg

alendronate sodium (generic of FOSAMAX) TABS 70mg

ATELVIA BINOSTO BONIVA SOLN B/D

FOSAMAX PLUS D ibandronate sodium (generic of BONIVA)

B/D

pamidronate disodium SOLN 6mg/ml

B/D

pamidronate disodium SOLN 30mg/10ml, 90mg/10ml

B/D

zoledronic inj 4mg/5ml (generic of ZOMETA)

B/D NM

ZOMETA B/D NM

CALCIUM RECEPTOR ANTAGONISTS SENSIPAR 30mg NM

SENSIPAR 60mg, 90mg NM

CHELATING AGENTS CHEMET EXJADE NM LA

FERRIPROX NM

kionex (generic of KAYEXALATE) POWD

kionex SUSP sodium polystyrene sulfonate sps sus 15gm/60ml SYPRINE NM

CONTRACEPTIVES altavera BEYAZ CAMRESE LO TAB DEPO-SUBQ PROVERA 104 desogestrel & ethinyl estradiol (generic of DESOGEN)

desogestrel-ethinyl estradiol (biphasic) (generic of MIRCETTE)

Drug Name Requirements/Limits

desogestrel-ethinyl estradiol (triphasic) (generic of CYCLESSA)

drospirenone-ethinyl estradiol (generic of YASMIN 28)

drospirenone-ethinyl estradiol (generic of YAZ)

ELLA ethynodiol diacet & eth estrad GENERESS FE GIANVI heather tab 0.35mg (generic of NOR-QD)

JOLIVETTE LEENA levonorgestrel & eth estradiol levonorgestrel-eth estradiol (triphasic)

levonorgestrel-ethinyl estradiol (91-day)

levonorgestrel-ethinyl estradiol (91-day) (generic of SEASONIQUE)

levonorgestrel-ethinyl estradiol (continuous)

LO LOESTRIN FE LOESTRIN 24 FE medroxyprogesterone acetate (contraceptive) (generic of DEPO-PROVERA CONTRACEPTIV)

MINASTRIN 24 FE MONONESSA myzilra NECON 1/50-28 NECON 7/7/7 necon 10/11 28 day next choice tab 1.5mg (generic of PLAN B ONE-STEP)

NORA-BE norethin acet & estrad-fe (generic of LOESTRIN FE 1.5/30)

norethin acet & estrad-fe (generic of LOESTRIN FE 1/20)

norethindrone & eth estradiol (generic of BREVICON-28)

norethindrone & eth estradiol (generic of NORINYL 1+35)

22

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 23

Drug Name Requirements/Limits

norethindrone & eth estradiol (generic of OVCON-35)

norethindrone & ethinyl estradiol-fe (generic of FEMCON FE)

norethindrone (contraceptive) (generic of NOR-QD) .35mg

norethindrone (contraceptive) (generic of ORTHO MICRONOR) .35mg

norethindrone acet & eth estra (generic of LOESTRIN 1.5/30-21)

norethindrone acet & eth estra (generic of LOESTRIN 1/20-21)

norethindrone acetate-ethinyl estradiol-fe (generic of ESTROSTEP FE)

norethindrone-eth estradiol (triphasic) (generic of ORTHO-NOVUM 7/7/7)

norethindrone-eth estradiol (triphasic) (generic of TRI-NORINYL 28)

norgestimate-ethinyl estradiol (generic of ORTHO-CYCLEN)

norgestimate-ethinyl estradiol (triphasic) (generic of ORTHO TRI-CYCLEN)

norgestrel & ethinyl estradiol NORINYL 1+50 NUVARING OCELLA ORTHO EVRA ORTHO TRI-CYCLEN LO philith (generic of OVCON-35) QUARTETTE SOLIA syeda (generic of YASMIN 28) TRINESSA vestura (generic of YAZ) viorele (generic of MIRCETTE) zarah (generic of YASMIN 28) zenchent tab (generic of OVCON-35)

zovia

ENDOMETRIOSIS danazol CAPS SYNAREL NM

ENZYME REPLACEMENTS

Drug Name Requirements/Limits

ADAGEN NM LA

ALDURAZYME NM LA

BUPHENYL TAB 500MG NM

CARBAGLU NM LA

CEREZYME NM

CYSTADANE NM

CYSTAGON NM

ELAPRASE NM

ELELYSO NM

FABRAZYME NM

KUVAN NM

levocarnitine (metabolic modifiers) (generic of CARNITOR)

B/D

LUMIZYME NM

MYOZYME NM

NAGLAZYME NM LA

ORFADIN NM LA

PROCYSBI NM LA

sodium phenylbutyrate (generic of BUPHENYL)

NM

VPRIV NM

ZAVESCA NM LA

ESTROGEN/PROGESTINS estradiol & norethindrone acetate (generic of ACTIVELLA)

norethindrone acetate-ethinyl estradiol

ESTROGENS ALORA COMBIPATCH DELESTROGEN 10mg/ml estradiol (generic of CLIMARA) PTWK

estradiol (generic of ESTRACE) TABS

estradiol cypionate OIL estradiol vaginal ESTRADIOL VALERATE OIL 10mg/ml

estradiol valerate (generic of DELESTROGEN) OIL 20mg/ml, 40mg/ml

ESTRING estropipate TABS FEMRING menest MENOSTAR MINIVELLE

23

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 24

Drug Name Requirements/Limits

PREMARIN PREMARIN CREAM PREMARIN INJ PREMPHASE PREMPRO VAGIFEM VIVELLE-DOT

GLUCOCORTICOIDS a-hydrocort inj 100mg CELESTONE cortisone acetate TABS DEPO-MEDROL 20mg/ml dexamethasone CONC dexamethasone ELIX; SOLN; TABS

dexamethasone sodium phosphate

dexpak taperpak 13 day FLO-PRED fludrocortisone acetate TABS hydrocortisone (generic of CORTEF) TABS

MEDROL 2mg methylprednisolone (generic of MEDROL DOSEPAK) TABS 4mg

methylprednisolone (generic of MEDROL) TABS 4mg, 8mg, 16mg, 32mg

methylprednisolone acetate (generic of DEPO-MEDROL)

methylprednisolone sod succ (generic of SOLU-MEDROL)

ORAPRED ODT prednisolone (generic of PRELONE) SOLN

prednisolone TABS prednisolone sodium phosphate (generic of PEDIAPRED) 5mg/5ml

prednisolone sodium phosphate 10mg/5ml

prednisolone sodium phosphate (generic of ORAPRED) 15mg/5ml

prednisolone sodium phosphate 25mg/5ml

prednisone CONC prednisone SOLN; TABS

Drug Name Requirements/Limits

RAYOS SOLU-CORTEF 100MG SOLU-CORTEF 250MG SOLU-CORTEF 500MG SOLU-CORTEF 1000MG SOLU-MEDROL 2gm veripred

GLUCOSE ELEVATING AGENTS GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT PROGLYCEM NM

HUMAN GROWTH HORMONES GENOTROPIN NM

GENOTROPIN MINIQUICK .2mg

NM

GENOTROPIN MINIQUICK .4mg, .6mg, .8mg, 1mg, 1.2mg, 1.4mg, 1.6mg, 1.8mg, 2mg

NM

HUMATROPE NM

HUMATROPE COMBO PACK NM

NORDITROPIN FLEXPRO NM

NORDITROPIN NORDIFLEX PEN

NM

NUTROPIN NM

NUTROPIN AQ NM

NUTROPIN AQ NUSPIN 5 NM

NUTROPIN AQ PEN NM

OMNITROPE 5.8MG NM

OMNITROPE 5MG NM

OMNITROPE 10MG NM

SAIZEN NM

SAIZEN CLICK.EASY NM

SEROSTIM NM

TEV-TROPIN NM

ZORBTIVE NM

MISCELLANEOUS cabergoline calcitonin (salmon) nasal spray (generic of MIACALCIN)

CHORIONIC GONADOTROPIN SOLR

NM

EGRIFTA NM

FORTICAL SPR 200/ACT INCRELEX NM LA

methylergonovine maleate (generic of METHERGINE) TABS

MIACALCIN INJ 200U/ML B/D

NOVAREL INJ 10000UNT NM

24

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 25

Drug Name Requirements/Limits

octreotide acetate (generic of SANDOSTATIN) 50mcg/ml, 100mcg/ml, 200mcg/ml

NM

octreotide acetate (generic of SANDOSTATIN) 500mcg/ml, 1000mcg/ml

NM

PREGNYL W/DILUENT BENZYL NM

PROLIA NM

SAMSCA NM

SANDOSTATIN LAR DEPOT NM

SOMATULINE DEPOT NM

SOMAVERT NM LA

XGEVA NM

PARATHYROID HORMONES FORTEO NM

PHOSPHATE BINDER AGENTS calcium acetate (phosphate binder) (generic of PHOSLO) CAPS

calcium acetate (phosphate binder) (generic of ELIPHOS) TABS

FOSRENOL PHOSLYRA RENAGEL RENVELA

PROGESTINS CRINONE ENDOMETRIN medroxyprogesterone acetate (generic of PROVERA)

norethindrone acetate (generic of AYGESTIN) TABS

progesterone micronized (generic of PROMETRIUM) CAPS

SELECTIVE ESTROGEN RECEPTOR MODULATORS EVISTA

THYROID AGENTS LEVOTHROID levothyroxine sodium (generic of SYNTHROID) TABS

LEVOXYL liothyronine sodium (generic of TRIOSTAT) SOLN

liothyronine sodium (generic of CYTOMEL) TABS

methimazole (generic of TAPAZOLE) TABS

Drug Name Requirements/Limits

propylthiouracil TABS SYNTHROID TIROSINT UNITHROID

VASOPRESSINS DESMOPRESSIN ACETATE SOLN

desmopressin acetate (generic of DDAVP) TABS

desmopressin acetate inj (generic of DDAVP)

desmopressin acetate spray (generic of DDAVP)

desmopressin acetate spray refrigerated

STIMATE NM

GASTROINTESTINAL ANTIEMETICS ALOXI NM

ANTIVERT 50mg CESAMET B/D NM

compro supp dronabinol (generic of MARINOL) 2.5mg, 5mg

B/D

dronabinol (generic of MARINOL) 10mg

B/D NM

EMEND CAPS 40mg EMEND CAPS 80mg B/D

EMEND CAPS 125mg B/D

EMEND PAK 80 & 125 B/D

granisetron hcl SOLN 2mg/10ml B/D NM

granisetron hcl SOLN .1mg/ml, 1mg/ml

granisetron hcl TABS B/D

meclizine hcl (generic of ANTIVERT)

metoclopramide hcl SOLN metoclopramide hcl (generic of REGLAN) TABS

metoclopramide hcl inj 5 mg/ml METOZOLV ODT ondansetron hcl (generic of ZOFRAN) TABS 4mg, 8mg

B/D

ondansetron hcl TABS 24mg B/D

ondansetron hcl inj 4mg/2ml ondansetron hcl inj (generic of ZOFRAN) 40mg/20ml

ondansetron hcl oral soln (generic of ZOFRAN)

B/D

25

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 26

Drug Name Requirements/Limits

ondansetron odt (generic of ZOFRAN ODT)

B/D

prochlorperazine inj 5 mg/ml prochlorperazine maleate TABS prochlorperazine supp promethazine hcl (generic of PHENERGAN) SOLN

promethazine hcl SUPP; SYRP; TABS

SANCUSO NM

TRANSDERM-SCOP

ANTISPASMODICS ATROPINE SULFATE SOLN .05mg/ml, .1mg/ml

BENTYL SOLN CANTIL CUVPOSA dicyclomine hcl (generic of BENTYL) CAPS; TABS

dicyclomine hcl SOLN glycopyrrolate (generic of ROBINUL) SOLN

glycopyrrolate (generic of ROBINUL) TABS 1mg

glycopyrrolate (generic of ROBINUL FORTE) TABS 2mg

methscopolamine bromide (generic of PAMINE) TABS 2.5mg

methscopolamine bromide (generic of PAMINE FORTE) TABS 5mg

H2-RECEPTOR ANTAGONISTS cimetidine TABS cimetidine inj 150mg/ml cimetidine sol 300/5ml famotidine SOLN famotidine (generic of PEPCID) SUSR

famotidine (generic of PEPCID) TABS 20mg, 40mg

nizatidine CAPS 150mg nizatidine (generic of AXID) CAPS 300mg

nizatidine (generic of AXID) SOLN

ranitidine hcl CAPS ranitidine hcl (generic of ZANTAC) SOLN

Drug Name Requirements/Limits

ranitidine hcl (generic of ZANTAC) SYRP

ranitidine hcl (generic of ZANTAC) TABS 150mg, 300mg

INFLAMMATORY BOWEL DISEASE APRISO ASACOL ASACOL HD balsalazide disodium (generic of COLAZAL)

budesonide (generic of ENTOCORT EC) CP24

NM

CANASA DELZICOL DIPENTUM NM

GIAZO hydrocortisone (intrarectal) (generic of CORTENEMA) 100mg/60ml

HYDROCORTISONE (INTRARECTAL) 100mg/60ml

LIALDA mesalamine enema mesalamine enema kit (generic of ROWASA)

PENTASA SFROWASA sulfasalazine dr (generic of AZULFIDINE EN-TABS)

sulfasalazine ir (generic of AZULFIDINE)

UCERIS

LAXATIVES COLYTE-FLAVOR PACKS GOLYTELY HALFLYTELY BOWEL PREP/FLA

kristalose pak lactulose lactulose (encephalopathy) MOVIPREP NULYTELY/FLAVOR PACKS OSMOPREP peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of COLYTE-FLAVOR PACKS)

PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE

26

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 27

Drug Name Requirements/Limits

peg 3350-kcl-sod bicarb-sod chloride-sod sulfate (generic of GOLYTELY)

peg 3350-potassium chloride-sod bicarbonate-sod chloride (generic of NULYTELY/FLAVOR PACKS)

polyethylene glycol 3350 PACK; POWD

PREPOPIK RELISTOR SUCLEAR SUPREP BOWEL PREP VISICOL

MISCELLANEOUS AMITIZA CARAFATE SUSP cromolyn sodium (mastocytosis) (generic of GASTROCROM)

NM

diphenoxylate w/ atropine LIQD diphenoxylate w/ atropine (generic of LOMOTIL) TABS

GATTEX NM LA

HELIDAC NM

LINZESS CAP 145MCG LINZESS CAP 290MCG loperamide hcl CAPS LOTRONEX NM

misoprostol (generic of CYTOTEC)

OMECLAMOX-PAK PREVPAC PYLERA SUCRAID NM

sucralfate (generic of CARAFATE) TABS

ursodiol (generic of ACTIGALL) CAPS

ursodiol (generic of URSO 250) TABS 250mg

ursodiol (generic of URSO FORTE) TABS 500mg

XIFAXAN TAB 550MG NM

PANCREATIC ENZYMES CREON PANCREAZE PERTZYE ULTRESA VIOKACE 10440 UNIT VIOKACE 20880 UNIT NM

Drug Name Requirements/Limits

ZENPEP

PROTON PUMP INHIBITORS ACIPHEX DEXILANT lansoprazole (generic of PREVACID) CPDR

NEXIUM NEXIUM GRANULES 2.5MG DR NEXIUM GRANULES 5MG DR NEXIUM GRANULES 10MG DR NEXIUM GRANULES 20MG DR NEXIUM GRANULES 40MG DR NEXIUM I.V. omeprazole (generic of PRILOSEC) CPDR 10mg, 40mg

omeprazole (generic of PRILOSEC) CPDR 20mg

pantoprazole sodium (generic of PROTONIX) SOLR

pantoprazole sodium (generic of PROTONIX) TBEC

PREVACID SOLUTAB PROTONIX PACK ZEGERID PACK

GENITOURINARY BENIGN PROSTATIC HYPERPLASIA alfuzosin hcl (generic of UROXATRAL)

AVODART CARDURA XL finasteride (generic of PROSCAR) TABS 5mg

JALYN RAPAFLO tamsulosin hcl (generic of FLOMAX)

MISCELLANEOUS bethanechol chloride (generic of URECHOLINE) TABS

ELMIRON POTASSIUM CITRATE (ALKALINIZER) 540mg

POTASSIUM CITRATE (ALKALINIZER) 1080mg

UROCIT-K

URINARY ANTISPASMODICS DETROL LA ENABLEX

27

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 28

Drug Name Requirements/Limits

GELNIQUE MYRBETRIQ oxybutynin chloride SYRP; TABS

oxybutynin chloride (generic of DITROPAN XL) TB24

OXYTROL tolterodine tartrate (generic of DETROL)

TOVIAZ trospium chloride (generic of SANCTURA XR) CP24

trospium chloride (generic of SANCTURA) TABS

VESICARE

VAGINAL ANTI-INFECTIVES CLEOCIN VAG SUPP 100MG clindamycin cre 2% vag (generic of CLEOCIN)

metronidazole vaginal (generic of METROGEL-VAGINAL)

miconazole nitrate vaginal terconazole vaginal (generic of TERAZOL 7) CREA .4%

terconazole vaginal (generic of TERAZOL 3) CREA .8%

terconazole vaginal (generic of TERAZOL 3) SUPP

VANDAZOLE ZAZOLE

HEMATOLOGIC ANTICOAGULANTS COUMADIN COUMADIN INJ ELIQUIS enoxaparin sodium (generic of LOVENOX) 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 80mg/0.8ml, 300mg/3ml

enoxaparin sodium (generic of LOVENOX) 100mg/ml, 120mg/0.8ml, 150mg/ml

NM

fondaparinux sodium (generic of ARIXTRA) 2.5mg/0.5ml

fondaparinux sodium (generic of ARIXTRA) 5mg/0.4ml, 7.5mg/0.6ml, 10mg/0.8ml

NM

FRAGMIN 2500unit/0.2ml, 5000unit/0.2ml

Drug Name Requirements/Limits

FRAGMIN 7500unit/0.3ml, 10000unit/ml, 12500unit/0.5ml, 15000unit/0.6ml, 18000unt/0.72ml, 25000unit/ml

NM

HEP SOD/NACL INJ 25000 HEPARIN (PORCINE) IN SODIUM CHLORIDE 100U/ML

heparin sod inj 1000u/ml B/D

HEPARIN SOD INJ 2000U/ML B/D

HEPARIN SOD INJ 2500U/ML B/D

heparin sod inj 5000u/0.5ml B/D

heparin sod inj 5000u/ml B/D

heparin sod inj 10000u/ml B/D

heparin sod inj 20000u/ml B/D

HEPARIN SODIUM/D5W HEPARIN SODIUM/SODIUM CHL

PRADAXA warfarin sodium (generic of COUMADIN)

XARELTO

HEMATOPOIETIC GROWTH FACTORS ARANESP ALBUMIN FREE 25mcg/0.42ml, 25mcg/ml, 40mcg/0.4ml, 40mcg/ml, 60mcg/0.3ml, 60mcg/ml

NM

ARANESP ALBUMIN FREE 100mcg/0.5ml, 100mcg/ml, 150mcg/0.3ml, 150mcg/0.75ml, 200mcg/0.4ml, 200mcg/ml, 300mcg/0.6ml, 300mcg/ml, 500mcg/ml

NM

EPOGEN NM

LEUKINE NM

MOZOBIL NM

NEULASTA NM

NEUMEGA NM

NEUPOGEN NM

PROCRIT 2000unit/ml, 3000unit/ml, 4000unit/ml, 10000unit/ml

NM

PROCRIT 20000unit/ml, 40000unit/ml

NM

MISCELLANEOUS anagrelide hcl 1mg anagrelide hcl (generic of AGRYLIN) .5mg

cilostazol (generic of PLETAL) pentoxifylline (generic of TRENTAL) TBCR

28

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 29

Drug Name Requirements/Limits

PROMACTA NM LA

tranexamic acid (generic of CYKLOKAPRON) SOLN

tranexamic acid (generic of LYSTEDA) TABS

PLATELET AGGREGATION INHIBITORS AGGRENOX BRILINTA clopidogrel bisulfate (generic of PLAVIX)

dipyridamole (generic of PERSANTINE) TABS

EFFIENT

IMMUNOLOGIC AGENTS DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS) ACTEMRA NM

CIMZIA NM

ENBREL NM

HUMIRA NM

HUMIRA PEN NM

HUMIRA PEN-CROHNS STARTER KIT

NM

HUMIRA PEN-PSORIASIS STARTER KIT

NM

hydroxychloroquine sulfate (generic of PLAQUENIL)

KINERET NM

leflunomide (generic of ARAVA) TABS

methotrexate sodium B/D

methotrexate sodium tabs ORENCIA NM

REMICADE NM

RHEUMATREX SIMPONI 50mg/0.5ml NM

XELJANZ NM

IMMUNOGLOBULINS CARIMUNE NANOFILTERED NM

FLEBOGAMMA NM

FLEBOGAMMA DIF NM

GAMASTAN S/D B/D NM

GAMMAGARD LIQUID NM

GAMMAGARD S/D NM

GAMMAKED NM

GAMMAPLEX NM

GAMUNEX NM

GAMUNEX-C NM

GAMUNEX-C 1GM/10ML NM

Drug Name Requirements/Limits

OCTAGAM NM

PRIVIGEN NM

IMMUNOMODULATORS ACTIMMUNE NM LA

ARCALYST NM

INFERGEN NM

INTRON-A B/D NM

INTRON-A W/DILUENT B/D NM

PEG-INTRON NM

PEG-INTRON REDIPEN NM

PEGASYS NM

PEGASYS PROCLICK NM

REVLIMID NM LA

THALOMID NM

IMMUNOSUPPRESSANTS ATGAM B/D

azathioprine (generic of IMURAN) TABS 50mg

B/D

azathioprine TABS 75mg, 100mg

B/D

azathioprine inj 100mg B/D

CELLCEPT SUSR B/D NM

CELLCEPT INTRAVENOUS B/D

cyclosporine (generic of SANDIMMUNE) CAPS; SOLN

B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) CAPS 25mg, 100mg

B/D

cyclosporine modified (for microemulsion) CAPS 50mg

B/D

cyclosporine modified (for microemulsion) (generic of NEORAL) SOLN

B/D

mycophenolate mofetil (generic of CELLCEPT)

B/D

MYFORTIC 180mg B/D

MYFORTIC 360mg B/D NM

NEORAL B/D

NULOJIX B/D NM

PROGRAF CAPS 5mg B/D NM

PROGRAF CAPS .5mg, 1mg B/D

PROGRAF SOLN B/D

RAPAMUNE SOLN B/D NM

RAPAMUNE TABS 1mg, 2mg B/D NM

RAPAMUNE TABS .5mg B/D

SANDIMMUNE CAPS B/D

SANDIMMUNE SOLN B/D

SIMULECT B/D

tacrolimus (generic of PROGRAF) CAPS 5mg

B/D NM

29

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 30

Drug Name Requirements/Limits

tacrolimus (generic of PROGRAF) CAPS .5mg, 1mg

B/D

THYMOGLOBULIN B/D NM

ZORTRESS B/D NM

VACCINES ACTHIB ADACEL BOOSTRIX CERVARIX COMVAX DAPTACEL DECAVAC B/D

DIPHTHERIA/TETANUS TOXOID

B/D

ENGERIX-B SUSP B/D

GARDASIL HAVRIX HIBERIX IMOVAX RABIES (H.D.C.V.) INFANRIX IPOL INACTIVATED IPV IXIARO M-M-R II W/DILUENT 10 DOS MENACTRA MENHIBRIX MENOMUNE-A/C/Y/W-135 MENVEO PEDVAX HIB PROQUAD RABAVERT RECOMBIVAX HB B/D

ROTATEQ SYNAGIS NM

TETANUS TOXOID ADSORBED B/D

TETANUS/DIPHTHERIA TOXOID

B/D

TWINRIX B/D

TYPHIM VI VAQTA VARIVAX YF-VAX ZOSTAVAX

NUTRITIONAL/SUPPLEMENTS ELECTROLYTES ammonium chloride SOLN KLOR-CON 8 KLOR-CON 10

Drug Name Requirements/Limits

klor-con m15 klor-con m20 MAGNESIUM SULFATE SOLN 40mg/ml, 80mg/ml

magnesium sulfate SOLN 50% MAGNESIUM SULFATE IN D5W 1%

MAGNESIUM SULFATE IN D5W 2%

POTASSIUM CHLORIDE TBCR potassium chloride caps er (generic of MICRO-K)

potassium chloride microencapsulated crystals cr

SOD FLUORIDE 2.2MG TAB SODIUM CHLORIDE SOLN 2.5meq/ml

TPN ELECTROLYTES B/D

IV NUTRITION AMINOSYN B/D

AMINOSYN 7%/ELECTROLYTES

B/D

AMINOSYN II B/D

AMINOSYN II 8.5%/ELECTROL B/D

AMINOSYN INJ 8.5/LYTE B/D

AMINOSYN M B/D

AMINOSYN-HBC B/D

AMINOSYN-PF B/D

AMINOSYN-PF 7% B/D

AMINOSYN-RF B/D

CLINIMIX 2.75%/DEXTROSE 5% B/D

CLINIMIX 4.25%/DEXTROSE 5% B/D

CLINIMIX 4.25%/DEXTROSE 10%

B/D

CLINIMIX 4.25%/DEXTROSE 20%

B/D

CLINIMIX 4.25%/DEXTROSE 25%

B/D

CLINIMIX 5%/DEXTROSE 15% B/D

CLINIMIX 5%/DEXTROSE 20% B/D

CLINIMIX 5%/DEXTROSE 25% B/D

CLINIMIX E 2.75%/DEXTROSE 5%

B/D

CLINIMIX E 2.75%/DEXTROSE 10%

B/D

CLINIMIX E 4.25%/DEXTROSE B/D

CLINIMIX E 4.25%/DEXTROSE 5%

B/D

CLINIMIX E 4.25%/DEXTROSE 25%

B/D

30

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 31

Drug Name Requirements/Limits

CLINIMIX E 5%/DEXTROSE 15%

B/D

CLINIMIX E 5%/DEXTROSE 20%

B/D

CLINIMIX E 5%/DEXTROSE 25%

B/D

clinisol sf 15% B/D

FREAMINE HBC 6.9% B/D

FREAMINE III B/D

HEPATAMINE B/D

hepatasol 8 B/D

INTRALIPID INJ 20% B/D

INTRALIPID INJ 30% B/D

NEPHRAMINE B/D

premasol 6% B/D

premasol 10% B/D

PROCALAMINE B/D

PROSOL B/D

travasol B/D

TROPHAMINE B/D

IV REPLACEMENT SOLUTIONS DEXTROSE SOLN 50% dextrose SOLN 70% DEXTROSE 2.5%/NACL 0.45% DEXTROSE 5% DEXTROSE 5% /ELECTROLYTE DEXTROSE 5%/LACTATED RING

DEXTROSE 5%/NACL 0.2% DEXTROSE 5%/NACL 0.3% DEXTROSE 5%/NACL 0.9% DEXTROSE 5%/NACL 0.33% DEXTROSE 5%/NACL 0.45% DEXTROSE 5%/NACL 0.225% DEXTROSE 5%/POTASSIUM CHL

DEXTROSE 10% FLEX CONTAIN

DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%

DEXTROSE 10%/NACL 0.45% electrolyte-m in dextrose ELECTROLYTE-M IN DEXTROSE

ELECTROLYTE-R IN DEXTROSE

IONOSOL-B/DEXTROSE 5% IONOSOL-MB/DEXTROSE 5% ISOLYTE P

Drug Name Requirements/Limits

isolyte s KCL0.15%/D5W/NACL0.2% KCL0.15%/D5W/NACL0.225% kcl 0.3%/d5w/lr iv lac ri KCL 0.3%/D5W/NACL 0.9% KCL 0.3%/D5W/NACL 0.45% KCL 0.15%/D5W/LR KCL 0.15%/D5W/NACL 0.9% KCL 0.075%/D5W/NACL 0.45% KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ

kcl 20 meq/l (0.15%) in nacl 0.45% inj

KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ

KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ

KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ

KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ

LACTATED RINGERS VIAFLEX NORMOSOL-R PLASMA-LYTE A PLASMA-LYTE-56/D5W PLASMA-LYTE-148 POTASSIUM CHLORIDE SOLN 10meq/100ml, 20meq/100ml, 30meq/100ml

potassium chloride (generic of POTASSIUM CHLORIDE) SOLN 40meq/100ml

potassium chloride SOLN .4meq/ml, 2meq/ml, 10meq/50ml

POTASSIUM CHLORIDE 0.3%/D POTASSIUM CHLORIDE 0.15% POTASSIUM CHLORIDE 0.22% RINGER'S SODIUM CHLORIDE SOLN .9%, 3%, 5%

SODIUM CHLORIDE 0.45% VIA

VITAMINS calcitriol (generic of ROCALTROL) CAPS

B/D

calcitriol SOLN 1mcg/ml B/D

31

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 32

Drug Name Requirements/Limits

calcitriol (generic of ROCALTROL) SOLN 1mcg/ml

B/D

HECTOROL CAPS B/D

HECTOROL SOLN B/D

PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC)

ZEMPLAR CAPS 1mcg, 2mcg B/D

ZEMPLAR CAPS 4mcg B/D NM

ZEMPLAR SOLN B/D

OPHTHALMIC ANTI-INFECTIVE/ANTI-INFLAMMATORY bacitracin-poly-neomycin-hc blephamide OINT BLEPHAMIDE SUSP neomycin-polymy-dexameth (generic of MAXITROL)

neomycin-polymyxin-hc (ophth) PRED-G PRED-G S.O.P. sulfacetamide sod-prednisolone TOBRADEX OINT TOBRADEX ST tobramycin-dexamethasone (generic of TOBRADEX)

ZYLET

ANTI-INFECTIVES AZASITE bacitracin (ophthalmic) bacitracin-polymyxin b (ophth) BESIVANCE CILOXAN OIN 0.3% OP ciprofloxacin hcl (ophth) (generic of CILOXAN)

erythromycin (ophth) gentamicin sulfate (ophth) OINT gentamicin sulfate (ophth) (generic of GARAMYCIN) SOLN

levofloxacin (ophth) MOXEZA NATACYN neomycin-bacitracin zn-polymyxin neomycin-polymy-gramicid (generic of NEOSPORIN)

ofloxacin (ophth) (generic of OCUFLOX)

polymyxin b-trimethoprim (generic of POLYTRIM)

Drug Name Requirements/Limits

sulfacetamide sodium (ophth) OINT

sulfacetamide sodium (ophth) (generic of BLEPH-10) SOLN

tobramycin sulfate (ophth) (generic of TOBREX)

TOBREX OINT 0.3% trifluridine (generic of VIROPTIC) SOLN

VIGAMOX ZIRGAN ZYMAXID

ANTI-INFLAMMATORIES ACUVAIL ALREX BROMDAY bromfenac sodium (ophth) dexamethasone sodium phosphate (ophth)

diclofenac sodium (ophth) DUREZOL FLAREX FLUOROMETHOLONE SUSP FLUOROMETHOLONE (OPHTH) flurbiprofen sodium (generic of OCUFEN)

FML FML FORTE ILEVRO ketorolac tromethamine (ophth) (generic of ACULAR LS) .4%

ketorolac tromethamine (ophth) (generic of ACULAR) .5%

LOTEMAX MAXIDEX NEVANAC PRED MILD PREDNISOLONE ACETATE SUSP

prednisolone sodium phosphate (ophth)

VEXOL

ANTIALLERGICS ALOCRIL ALOMIDE azelastine hcl (ophth) (generic of OPTIVAR)

BEPREVE

32

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 33

Drug Name Requirements/Limits

cromolyn sodium (ophth) EMADINE epinastine hcl (ophth) (generic of ELESTAT)

LASTACAFT PATADAY PATANOL

ANTIGLAUCOMA ALPHAGAN P 0.1% AZOPT betaxolol hcl (ophth) BETIMOL BETOPTIC-S brimonidine sol 0.2% BRIMONIDINE SOL 0.15% carteolol hcl (ophth) COMBIGAN COSOPT PF dorzolamide hcl (generic of TRUSOPT)

dorzolamide hcl-timolol maleate (generic of COSOPT)

ISOPTO CARPINE ISTALOL latanoprost (generic of XALATAN)

levobunolol hcl (generic of BETAGAN) .5%

LEVOBUNOLOL HCL .25% LUMIGAN .01% metipranolol (generic of OPTIPRANOLOL)

PHOSPHOLINE IODIDE PILOCARPINE HCL SOLN PILOPINE HS timolol maleate (ophth) (generic of TIMOPTIC)

TIMOLOL MALEATE GEL TIMOPTIC OCUDOSE TRAVATAN Z ZIOPTAN

MISCELLANEOUS ak-con BOTOX 100unit NM

LACRISERT PROLENSA proparacaine hcl (generic of ALCAINE) SOLN

Drug Name Requirements/Limits

RESTASIS XEOMIN NM

RESPIRATORY ANTICHOLINERGIC/BETA AGONIST COMBINATIONS COMBIVENT COMBIVENT RESPIMAT ipratropium-albuterol (generic of DUONEB)

B/D

ANTICHOLINERGICS ATROVENT HFA ipratropium bromide (nasal) (generic of ATROVENT)

ipratropium sol inhal B/D

SPIRIVA HANDIHALER TUDORZA PRESSAIR

ANTIHISTAMINE/DECONGESTANT COMBINATIONS CLARINEX-D SEMPREX-D

ANTIHISTAMINES ASTEPRO azelastine hcl (generic of ASTELIN)

cetirizine syrup CLARINEX SYRP cyproheptadine hcl SYRP; TABS

desloratadine (generic of CLARINEX) TABS

desloratadine (generic of CLARINEX REDITABS) TBDP

diphenhydram inj 50mg/ml hydroxyzine hcl SOLN; TABS hydroxyzine pamoate (generic of VISTARIL) CAPS 25mg, 50mg

hydroxyzine pamoate CAPS 100mg

levocetirizine soln 2.5mg/5ml (generic of XYZAL)

levocetirizine tab 5 mg (generic of XYZAL)

PATANASE

BETA AGONISTS albuterol sulfate (generic of ACCUNEB) NEBU .63mg/3ml, 1.25mg/3ml

B/D

albuterol sulfate NEBU .083%, .5%

B/D

33

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 34

Drug Name Requirements/Limits

albuterol sulfate SYRP albuterol sulfate TABS albuterol sulfate er (generic of VOSPIRE ER)

ARCAPTA NEOHALER BROVANA B/D

FORADIL AEROLIZER levalbuterol conc 1.25mg/0.5ml (generic of XOPENEX CONCENTRATE)

B/D

LEVALBUTEROL HCL NEBU B/D

PERFOROMIST B/D

PROAIR HFA PROVENTIL HFA SEREVENT DISKUS terbutaline sulfate SOLN; TABS VENTOLIN HFA XOPENEX HFA

LEUKOTRIENE RECEPTOR ANTAGONISTS montelukast sodium (generic of SINGULAIR) CHEW; PACK; TABS

zafirlukast (generic of ACCOLATE)

ZYFLO CR NM

MAST CELL STABILIZERS cromolyn sodium NEBU B/D

MISCELLANEOUS acetylcysteine SOLN 10%, 20% B/D

ADRENACLICK ARALAST NP NM LA

AUVI-Q CAYSTON NM LA

DALIRESP DYMISTA EPIPEN 2-PAK EPIPEN-JR 2-PAK GLASSIA NM LA

PROLASTIN-C NM LA

PULMOZYME B/D NM

tetrahydrozoline hcl SOLN tyzine pediatric nasal dr XOLAIR NM LA

ZEMAIRA NM LA

NASAL STEROIDS BECONASE AQ flunisolide (nasal)

Drug Name Requirements/Limits

fluticasone propionate (nasal) (generic of FLONASE)

NASONEX OMNARIS QNASL RHINOCORT AQUA triamcinolone acetonide (nasal) (generic of NASACORT AQ)

VERAMYST ZETONNA

STEROID INHALANTS ALVESCO ASMANEX ASMANEX 14 METERED DOSES

budesonide (inhalation) (generic of PULMICORT)

B/D

FLOVENT DISKUS 50mcg/blist, 100mcg/blist

FLOVENT DISKUS 250mcg/blist

FLOVENT HFA PULMICORT FLEXHALER PULMICORT INH SUSP B/D NM

QVAR 40mcg/act QVAR 80mcg/act

STEROID/BETA-AGONIST COMBINATIONS ADVAIR DISKUS ADVAIR HFA DULERA SYMBICORT

XANTHINES aminophylline inj LUFYLLIN theo-24 theophylline ELIX theophylline TB12; TB24

TOPICAL DERMATOLOGY, ACNE ABSORICA NM

ACANYA ACZONE adapalene (generic of DIFFERIN) AKNE-MYCIN ATRALIN AVITA CREA

34

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 35

Drug Name Requirements/Limits

AVITA GEL AZELEX benzoyl peroxide-erythromycin (generic of BENZAMYCIN)

CLINDAGEL clindamycin phosphate (topical) (generic of EVOCLIN) FOAM

clindamycin phosphate (topical) (generic of CLEOCIN-T) GEL; LOTN; SOLN; SWAB

clindamycin phosphate-benzoyl peroxide (generic of BENZACLIN)

DIFFERIN GEL .3% DIFFERIN LOTN EPIDUO erythromycin (acne aid) isotretinoin cap 10 mg myorisan sulfacetamide sodium (acne) (generic of KLARON)

tretin x tretinoin (generic of RETIN-A) CREA; GEL

TRETINOIN MICROSPHERE .1%

TRETINOIN MICROSPHERE .04%

VELTIN zenatane ZIANA

DERMATOLOGY, ACTINIC KERATOSIS CARAC FLUOROPLEX fluorouracil (topical) (generic of EFUDEX) CREA

fluorouracil (topical) SOLN PICATO SOLARAZE

DERMATOLOGY, ANTIBIOTICS ALTABAX BACTROBAN NASAL CORTISPORIN CREA; OINT gentamicin sulfate (topical) mafenide acetate (generic of SULFAMYLON) PACK

mupirocin (generic of BACTROBAN) OINT

Drug Name Requirements/Limits

mupirocin calcium (topical) (generic of BACTROBAN)

PHISOHEX SILVER SULFADIAZINE CREA SSD SULFAMYLON CREA THERMAZENE

DERMATOLOGY, ANTIFUNGALS ciclopirox (generic of LOPROX) GEL

ciclopirox cre 0.77% ciclopirox shampoo 1% (generic of LOPROX SHAMPOO)

ciclopirox sus 0.77% clotrimazole (topical) econazole nitrate CREA EXELDERM ketoconazole (topical) CREA ketoconazole (topical) (generic of EXTINA) FOAM

MENTAX NAFTIN CREA NAFTIN GEL 1% nystatin (topical) nystatin pow 100000 OXISTAT

DERMATOLOGY, ANTIPRURITIC CORTIFOAM hydrocortisone (rectal) (generic of ANUSOL-HC)

procto-pak cre 1% proctozone cre -hc 2.5% (generic of ANUSOL-HC)

PRUDOXIN CRE 5% ZONALON

DERMATOLOGY, ANTIPSORIATICS calcipotriene (generic of DOVONEX) CREA

calcipotriene OINT; SOLN CALCITRIOL OINT 8-MOP OXSORALEN ULTRA NM

SORIATANE NM

SORILUX STELARA NM

TAZORAC

DERMATOLOGY, ANTISEBORRHEICS

35

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 36

Drug Name Requirements/Limits

ketoconazole shampoo (generic of NIZORAL)

selenium sulfide (generic of SELSUN SHAMPOO) LOTN

DERMATOLOGY, ANTIVIRALS acyclovir topical (generic of ZOVIRAX)

DENAVIR XERESE ZOVIRAX CREA

DERMATOLOGY, CORTICOSTEROIDS alclometasone dipropionate (generic of ACLOVATE) CREA

alclometasone dipropionate OINT

amcinonide CREA; LOTN amcinonide OINT betamethasone dipropionate (topical)

betamethasone dipropionate augmented (generic of DIPROLENE AF) CREA

betamethasone dipropionate augmented GEL

betamethasone dipropionate augmented (generic of DIPROLENE) LOTN; OINT

betamethasone valerate CREA; LOTN; OINT

betamethasone valerate (generic of LUXIQ) FOAM

CAPEX clobetasol propionate (generic of TEMOVATE) CREA; GEL; OINT; SOLN

clobetasol propionate (generic of OLUX) FOAM

clobetasol propionate (generic of CLOBEX) LOTN; SHAM

clobetasol propionate emollient base (generic of TEMOVATE E)

clobetasol propionate emulsion (generic of OLUX-E)

CLOBEX LIQD CLODERM PUMP CORDRAN DESONATE DESONIDE CREA desonide (generic of DESOWEN) LOTN; OINT

Drug Name Requirements/Limits

desowen oint kit 0.05% desoximetasone (generic of TOPICORT) CREA

desoximetasone (generic of TOPICORT) GEL

DESOXIMETASONE OINT .05%

desoximetasone (generic of TOPICORT) OINT .25%

diflorasone diacetate fluocinolone acetonide CREA .01%

fluocinolone acetonide (generic of SYNALAR) CREA .025%

fluocinolone acetonide (generic of DERMA-SMOOTHE/FS BODY) OIL

fluocinolone acetonide (generic of SYNALAR) OINT

fluocinolone acetonide (generic of SYNALAR) SOLN

fluocinonide CREA; GEL; OINT; SOLN

fluocinonide emulsified base fluticasone propionate (generic of CUTIVATE) CREA; LOTN; OINT

halobetasol propionate (generic of ULTRAVATE)

HALOG hydrocortisone (topical) hydrocortisone butyrate (generic of LOCOID)

hydrocortisone valerate CREA hydrocortisone valerate (generic of WESTCORT) OINT

KENALOG LOCOID LOTN LOCOID LIPOCREAM LOKARA LOTN 0.05% mometasone furoate (generic of ELOCON) CREA; OINT; SOLN

PANDEL PREDNICARBATE CREA prednicarbate (generic of DERMATOP) OINT

TACLONEX texacort TOPICORT LIQD

36

NM - Not available at mail-order B/D - Covered under Medicare B or D LA - Limited Access 37

Drug Name Requirements/Limits

triamcinolone acetonide (topical) urea-hc acetate (generic of CARMOL-HC)

VANOS VERDESO

DERMATOLOGY, LOCAL ANESTHETICS lidocaine OINT lidocaine hcl GEL lidocaine hcl (generic of XYLOCAINE) SOLN 4%

lidocaine-prilocaine (generic of EMLA)

B/D

LIDODERM SYNERA

DERMATOLOGY, MISCELLANEOUS SKIN AND MUCOUS MEMBRANE ammonium lactate (generic of LAC-HYDRIN) CREA; LOTN

CONDYLOX GEL ELIDEL FINACEA imiquimod (generic of ALDARA) CREA

laclotion lotn 12% (generic of LAC-HYDRIN)

METROGEL metronidazole (topical) (generic of METROCREAM) CREA

metronidazole (topical) (generic of METROGEL) GEL 1%

metronidazole (topical) GEL .75%

metronidazole (topical) (generic of METROLOTION) LOTN

ORACEA OXSORALEN PANRETIN NM

PENNSAID podofilox (generic of CONDYLOX) SOLN

PROTOPIC RECTIV rosadan cre 0.75% (generic of METROCREAM)

TARGRETIN GEL NM

VOLTAREN GEL 1% ZYCLARA NM

DERMATOLOGY, SCABICIDES AND PEDICULIDES

Drug Name Requirements/Limits

EURAX malathion (generic of OVIDE) permethrin (generic of ELIMITE) CREA

SKLICE ULESFIA

DERMATOLOGY, WOUND CARE AGENTS acetic acid .25% neomycin/polymyxin b gu (generic of NEOSPORIN GU IRRIGANT)

SANTYL SODIUM CHLORIDE 0.9% STERILE WATER IRRIGATION

MOUTH/THROAT/DENTAL AGENTS cevimeline hcl (generic of EVOXAC)

chlorhexidine gluconate (mouth-throat) (generic of PERIDEX)

clotrimazole TROC lidocaine hcl (mouth-throat) nystatin (mouth-throat) periogard sol 0.12% (generic of PERIDEX)

pilocarpine hcl (oral) (generic of SALAGEN)

triamcinolone acetonide (mouth)

OTIC acetic acid (otic) acetic acid sol/hc (generic of VOSOL HC)

acetic acid-aluminum acetate CIPRO HC CIPRODEX COLY-MYCIN S CORTISPORIN-TC fluocinolone acetonide (otic) (generic of DERMOTIC)

hydrocortisone w/acetic acid (generic of VOSOL HC)

neomycin-polymyxin-hc (otic) (generic of CORTISPORIN) SOLN

neomycin-polymyxin-hc (otic) SUSP

ofloxacin (otic)

37

38

Index 8 8-MOP .............................. 35 A abacavir sulfate ...................5 ABELCET............................4 ABILIFY............................. 17 ABILIFY DISCMELT ......... 17 ABILIFY INJ ...................... 17 ABILIFY MAINTENA ......... 17 ABRAXANE ........................9 ABSORICA ....................... 34 ABSTRAL............................2 ACANYA ........................... 34 acarbose ........................... 21 ACCOLATE

see zafirlukast ............... 34 ACCUNEB

see albuterol sulfate ...... 33 ACCUPRIL

see quinapril hcl ............ 10 ACCURETIC

see quinapril-hydrochlorothiazide .................................. 10

acebutolol hcl .................... 12 ACEON

see perindopril erbumine ...................................... 10

acetaminophen w/ codeine .1 acetazolamide ................... 13 acetazolamide sodium ...... 13 acetic acid ......................... 37 acetic acid (otic) ................ 37 acetic acid sol/hc ............... 37 acetic acid-aluminum acetate .......................................... 37 acetylcysteine ................... 34 ACIPHEX .......................... 27 ACLOVATE

see alclometasone dipropionate ................... 36

ACTEMRA ........................ 29 ACTHIB ............................. 30 ACTIGALL

see ursodiol ................... 27 ACTIMMUNE .................... 29 ACTIQ

see fentanyl citrate ..........2 ACTIVELLA

see estradiol & norethindrone acetate ... 23

ACTONEL ......................... 22 ACTOPLUS MET

see pioglitazone hcl-metformin hcl ........... 21

ACTOPLUS MET XR 15-1000MG ....................... 21 ACTOPLUS MET XR 30-1000MG ....................... 21 ACTOS

see pioglitazone hcl ....... 21 ACULAR

see ketorolac tromethamine (ophth) .... 32

ACULAR LS see ketorolac tromethamine (ophth) .... 32

ACUVAIL .......................... 32 acyclovir .............................. 6 acyclovir sodium ................. 6 acyclovir topical ................ 36 ACZONE ........................... 34 ADACEL ........................... 30 ADAGEN ........................... 23 ADALAT CC

see nifedipine ................ 13 see nifedipine cc tab 90mg er ................................... 13 see nifedipine cr ............ 13

adapalene ......................... 34 ADCIRCA .......................... 14 ADDERALL

see amphetamine-dextroamphetamine tab 10 mg......... 18 see amphetamine-dextroamphetamine tab 12.5 mg...... 18 see amphetamine-dextroamphetamine tab 20 mg......... 18 see amphetamine-dextroamphetamine tab 30 mg......... 18 see amphetamine-dextroamphetamine tab 5 mg .......... 18

ADDERALL XR

see amphetamine-dextroamphetamine cap sr 24hr 10 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 15 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 20 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 25 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 30 mg ...................................... 18 see amphetamine-dextroamphetamine cap sr 24hr 5 mg ...................................... 18

ADOXA see doxycycline (monohydrate) ................. 8

ADOXA PAK 1/150 see doxycycline (monohydrate) ................. 8

ADRENACLICK ................ 34 adriamycin .......................... 8 adriamycin inj 2mg/ml ......... 8 adrucil ................................. 8 ADVAIR DISKUS .............. 34 ADVAIR HFA .................... 34 ADVICOR ......................... 11 AFINITOR ........................... 9 AFINITOR DISPERZ .......... 9 AGGRENOX ..................... 29 AGRYLIN

see anagrelide hcl ......... 28 a-hydrocort inj 100mg ....... 24 ak-con ............................... 33 AKNE-MYCIN ................... 34 ALBENZA ........................... 3 albuterol sulfate .......... 33, 34 albuterol sulfate er ............ 34 ALCAINE

38

39

see proparacaine hcl ..... 33 alclometasone dipropionate .......................................... 36 ALCOHOL PREPS ............ 20 ALDACTAZIDE ................. 13

see spironolactone & hydrochlorothiazide ....... 13

ALDACTONE see spironolactone ........ 10

ALDARA see imiquimod ............... 37

ALDURAZYME ................. 23 alendronate sodium .......... 22 alfuzosin hcl ...................... 27 ALIMTA ...............................8 ALINIA ................................3 ALKERAN

see melphalan hcl ...........8 allopurinol inj 500mg ...........1 allopurinol tab ......................1 ALOCRIL........................... 32 ALOMIDE .......................... 32 ALOPRIM

see allopurinol inj 500mg .1 ALORA .............................. 23 ALOXI ............................... 25 ALPHAGAN P 0.1% .......... 33 alprazolam ........................ 14 ALREX .............................. 32 ALSUMA ........................... 19 ALTABAX .......................... 35 ALTACE

see ramipril .................... 10 altavera ............................. 22 ALTOPREV ....................... 11 ALVESCO ......................... 34 amantadine hcl .................. 17 AMARYL

see glimepiride .............. 21 AMBIEN

see zolpidem tartrate ..... 19 AMBIEN CR

see zolpidem tartrate ..... 19 AMBISOME .........................4 amcinonide ........................ 36 AMERGE

see naratriptan hcl ......... 19 amifostine crystalline ......... 10 amikacin sulfate ..................3 amiloride &

hydrochlorothiazide ........... 13 amiloride hcl ...................... 13 aminophylline inj ............... 34 AMINOSYN ....................... 30 AMINOSYN 7%/ELECTROLYTES ....... 30 AMINOSYN II .................... 30 AMINOSYN II 8.5%/ELECTROL .............. 30 AMINOSYN INJ 8.5/LYTE 30 AMINOSYN M ................... 30 AMINOSYN-HBC .............. 30 AMINOSYN-PF ................. 30 AMINOSYN-PF 7% ........... 30 AMINOSYN-RF ................. 30 amiodarone hcl ................. 11 amiodarone inj 50mg/ml.... 11 AMITIZA ............................ 27 amitriptyline hcl ................. 16 amlodipine besylate .......... 12 AMLODIPINE BESYLATE/ATORV .......... 12 amlodipine besylate-benazepril hcl ..... 10 ammonium chloride .......... 30 ammonium lactate ............ 37 amoxapine ........................ 16 amoxicillin ........................... 7 amoxicillin & pot clavulanate ............................................ 7 amphetamine-dextroamphetamine cap sr 24hr 10 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 15 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 20 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 25 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 30 mg .. 18 amphetamine-dextroamphetamine cap sr 24hr 5 mg .... 18 amphetamine-dextroamphetamine tab 10 mg ............... 18 amphetamine-dextroamphetamine tab 12.5 mg ............ 18 amphetamine-dextroamphetamine tab 15 mg ............... 18 amphetamine-dextroamphetamine tab 20 mg ............... 18

amphetamine-dextroamphetamine tab 30 mg ............... 18 amphetamine-dextroamphetamine tab 5 mg ................. 18 amphetamine-dextroamphetamine tab 7.5 mg .............. 18 AMPHOTEC ....................... 4 amphotericin b .................... 4 ampicillin ............................. 7 ampicillin & sulbactam sodium ................................ 7 ampicillin inj ........................ 7 ampicillin sodium ................ 7 AMPYRA .......................... 19 AMRIX .............................. 20 AMTURNIDE .................... 13 ANAFRANIL

see clomipramine hcl .... 16 anagrelide hcl ................... 28 ANAPROX

see naproxen sodium ...... 1 ANAPROX DS

see naproxen sodium ...... 1 anastrozole ......................... 9 ANCOBON

see flucytosine ................ 4 ANDRODERM .................. 20 ANDROGEL 1% ............... 20 ANDROGEL 1.62% .......... 20 ANEXSIA

see hydrocodone-acetaminophen 7.5-650mg .................. 2

ANTABUSE see disulfiram ................ 20

ANTIVERT ........................ 25 see meclizine hcl ........... 25

ANUSOL-HC see hydrocortisone (rectal) ...................................... 35 see proctozone cre -hc 2.5% .............................. 35

APIDRA ............................ 20 APIDRA SOLOSTAR ........ 20 APLENZIN ........................ 16 APOKYN ........................... 17 APRISO ............................ 26 APTIVUS ............................ 5 ARALAST NP ................... 34 ARALEN

39

40

see chloroquine phosphate ........................5

ARANESP ALBUMIN FREE .......................................... 28 ARAVA

see leflunomide ............. 29 ARCALYST ....................... 29 ARCAPTA NEOHALER .... 34 ARICEPT .......................... 16

see donepezil tabs 10mg ...................................... 16 see donepezil tabs 5mg 16

ARICEPT ODT see donepezil odt 10mg 16 see donepezil odt 5mg .. 16

ARIMIDEX see anastrozole ...............9

ARIXTRA see fondaparinux sodium ...................................... 28

AROMASIN see exemestane ..............9

ARRANON ..........................8 ARTHROTEC 50

see diclofenac w/ misoprostol ......................1

ARTHROTEC 75 see diclofenac w/ misoprostol ......................1

ARZERRA ...........................9 ASACOL ........................... 26 ASACOL HD ..................... 26 ASMANEX ........................ 34 ASMANEX 14 METERED DOSES ............................. 34 ASTELIN

see azelastine hcl .......... 33 ASTEPRO ......................... 33 ATACAND ......................... 11

see candesartan cilexetil ...................................... 11

ATACAND HCT see candesartan cilexetil-hydrochlorothiazide .................................... 11

ATELVIA ........................... 22 atenolol ............................. 12 atenolol & chlorthalidone ... 12 ATGAM ............................. 29 ATIVAN

see lorazepam ............... 14 atorvastatin calcium .......... 11 atovaquone-proguanil hcl tab 250-100 mg ......................... 5 ATOVAQUONE-PROGUANIL HCL TAB 62.5-25 MG ...... 5 ATRALIN ........................... 34 ATRIPLA ............................. 5 ATROPINE SULFATE ...... 26 ATROVENT

see ipratropium bromide (nasal) ........................... 33

ATROVENT HFA .............. 33 AUBAGIO ......................... 19 AUGMENTIN ...................... 7

see amoxicillin & pot clavulanate ...................... 7

AUGMENTIN ES-600 see amoxicillin & pot clavulanate ...................... 7

AUGMENTIN XR see amoxicillin & pot clavulanate ...................... 7

AUVI-Q ............................. 34 AVALIDE

see irbesartan-hydrochlorothiazide ................................ 11

AVAPRO see irbesartan ............... 11

AVASTIN ............................ 9 AVELOX ............................. 7 AVELOX ABC PACK .......... 7 AVINZA ............................... 2 AVITA ......................... 34, 35 AVODART ........................ 27 AVONEX ........................... 19 AVONEX PEN .................. 19 AXERT .............................. 19 AXID

see nizatidine ................ 26 AXIRON ............................ 20 AYGESTIN

see norethindrone acetate ...................................... 25

AZACTAM ........................... 4 see aztreonam ................ 4

AZACTAM/DEX INJ 1GM ... 4 AZACTAM/DEX INJ 2GM ... 4 AZASITE ........................... 32

azathioprine ...................... 29 azathioprine inj 100mg ...... 29 azelastine hcl .................... 33 azelastine hcl (ophth) ........ 32 AZELEX ............................ 35 AZILECT ........................... 17 azithromycin ....................... 7 AZITHROMYCIN ................ 6 AZOPT .............................. 33 AZOR ................................ 11 aztreonam ........................... 4 AZULFIDINE

see sulfasalazine ir ........ 26 AZULFIDINE EN-TABS

see sulfasalazine dr ...... 26 B bacitracin (ophthalmic) ...... 32 bacitracin-polymyxin b (ophth) .............................. 32 bacitracin-poly-neomycin-hc.......................................... 32 baclofen ............................ 20 BACTOCILL IN DEXTROSE............................................ 7 BACTRIM

see sulfamethoxazole-trimethoprim ................................. 4

BACTRIM DS see sulfamethoxazole-trimethoprim ................................. 4

BACTROBAN see mupirocin ................ 35 see mupirocin calcium (topical) ......................... 35

BACTROBAN NASAL ....... 35 balsalazide disodium ........ 26 BANZEL ............................ 14 BARACLUDE ...................... 6 BECONASE AQ................ 34 benazepril & hydrochlorothiazide ........... 10 benazepril hcl ................... 10 BENICAR .......................... 11 BENICAR HCT ................. 11 BENTYL ............................ 26

see dicyclomine hcl ....... 26 BENZACLIN

see clindamycin

40

41

phosphate-benzoyl peroxide......................... 35

BENZAMYCIN see benzoyl peroxide-erythromycin ... 35

benzoyl peroxide-erythromycin ...... 35 benztropine mesylate ........ 17 BEPREVE ......................... 32 BESIVANCE ..................... 32 BETAGAN

see levobunolol hcl ........ 33 betamethasone dipropionate (topical) ............................. 36 betamethasone dipropionate augmented ........................ 36 betamethasone valerate ... 36 BETAPACE

see sotalol hcl ................ 11 BETAPACE AF

see sotalol hcl (afib/afl) .. 11 BETASERON .................... 19 betaxolol hcl ...................... 12 betaxolol hcl (ophth) .......... 33 bethanechol chloride ......... 27 BETIMOL .......................... 33 BETOPTIC-S .................... 33 BEYAZ .............................. 22 BIAXIN

see clarithromycin ...........7 BIAXIN XL

see clarithromycin ...........7 bicalutamide ........................9 BICILLIN C-R ......................7 BICILLIN L-A .......................7 BICNU .................................8 BIDIL ................................. 14 BILTRICIDE ........................4 BINOSTO .......................... 22 bisoprolol & hydrochlorothiazide ........... 12 bisoprolol fumarate ........... 12 bleomycin sulfate ................8 BLEPH-10

see sulfacetamide sodium (ophth) ........................... 32

blephamide ....................... 32 BLEPHAMIDE ................... 32 BONIVA ............................ 22

see ibandronate sodium 22

BOOSTRIX ....................... 30 BOSULIF ............................ 9 BOTOX ............................. 33 BREVICON-28

see norethindrone & eth estradiol ......................... 22

BRILINTA .......................... 29 BRIMONIDINE SOL 0.15% .......................................... 33 brimonidine sol 0.2%......... 33 BROMDAY ........................ 32 bromfenac sodium (ophth) 32 bromocriptine mesylate ..... 17 BROVANA ........................ 34 budesonide ....................... 26 budesonide (inhalation) ..... 34 bumetanide ....................... 13 BUPHENYL

see sodium phenylbutyrate ...................................... 23

BUPHENYL TAB 500MG .. 23 buprenorphine hcl ............. 20 buprenorphine hcl-naloxone hcl sl.................................. 20 bupropion hcl .................... 16 bupropion hcl (smoking deterrent) .......................... 20 buspirone hcl .................... 14 BUSULFEX ......................... 8 butorphanol nasal spray ...... 1 butorphanol tartrate ............ 1 BUTRANS ........................... 1 BYDUREON ..................... 20 BYETTA ............................ 20 BYSTOLIC ........................ 12 C cabergoline ....................... 24 cafergot tab 1-100mg ........ 19 CALAN

see verapamil hcl .......... 13 CALAN SR

see verapamil hcl .......... 13 calcipotriene ...................... 35 calcitonin (salmon) nasal spray ................................. 24 calcitriol ....................... 31, 32 CALCITRIOL ..................... 35 calcium acetate (phosphate binder) ............................... 25 CAMPRAL ........................ 20

CAMPTOSAR ................... 10 see irinotecan hcl .......... 10

CAMRESE LO TAB .......... 22 CANASA ........................... 26 CANCIDAS ......................... 4 candesartan cilexetil ......... 11 candesartan cilexetil-hydrochlorothiazide.......................................... 11 CANTIL ............................. 26 CAPASTAT SULFATE ........ 5 CAPEX ............................. 36 capital

and codeine .................... 1 CAPRELSA ........................ 9 captopril ............................ 10 captopril & hydrochlorothiazide ........... 10 CARAC ............................. 35 CARAFATE ...................... 27

see sucralfate ................ 27 CARBAGLU ...................... 23 carbamazepine ................. 14 CARBATROL

see carbamazepine ....... 14 CARBIDOPA/LEVODOPA/ENTACA ............................. 17 carbidopa-levodopa .......... 17 carboplatin ........................ 10 CARDIZEM

see diltiazem hcl ............ 13 CARDIZEM CD

see cartia xt ................... 12 see dilt-cd ...................... 12 see diltiazem hcl coated beads ............................ 13

CARDIZEM LA.................. 12 see matzim la ................ 13

CARDURA see doxazosin mesylate 11

CARDURA XL .................. 27 CARIMUNE NANOFILTERED .............. 29 CARMOL-HC

see urea-hc acetate ...... 37 CARNITOR

see levocarnitine (metabolic modifiers) ..... 23

carteolol hcl (ophth) .......... 33 cartia xt ............................. 12

41

42

carvedilol ........................... 12 CASODEX

see bicalutamide .............9 CATAFLAM

see diclofenac potassium 1 CATAPRES

see clonidine hcl ............ 14 CATAPRES-TTS-1

see clonidine hcl ............ 14 CATAPRES-TTS-2

see clonidine hcl ............ 14 CATAPRES-TTS-3

see clonidine hcl ............ 14 CAYSTON ......................... 34 CEDAX ...............................6 CEENU ...............................8 cefaclor ...............................6 cefaclor monohydrate .........6 cefadroxil.............................6 cefazolin inj .........................6 cefazolin sodium .................6 cefazolin/dextrose ...............6 cefdinir ................................6 CEFEPIME 1GM SOLN ......6 CEFEPIME 2GM SOLN ......6 cefepime inj 1gm .................6 cefepime inj 2gm .................6 cefixime ...............................6 cefotaxime sodium ..............6 cefotetan disodium ..............6 cefoxitin sodium ..................6 CEFOXITIN SODIUM IN DEXTROSE ........................6 cefpodoxime proxetil ...........6 cefprozil...............................6 ceftazidime ..........................6 CEFTAZIDIME/DEXTROSE ............................................6 CEFTIN ...............................6

see cefuroxime axetil .......6 ceftriaxone sodium ..............6 cefuroxime axetil .................6 cefuroxime sodium ..............6 cefuroxime sodium 7.5mg soln .....................................6 CELEBREX .........................1 CELESTONE .................... 24 CELEXA

see citalopram hydrobromide ................ 16

CELLCEPT ....................... 29 see mycophenolate mofetil ...................................... 29

CELLCEPT INTRAVENOUS .......................................... 29 CELONTIN ........................ 14 cephalexin ........................... 6 CEREZYME ...................... 23 CERUBIDINE

see daunorubicin hcl ....... 8 CERVARIX ....................... 30 CESAMET ........................ 25 cetirizine syrup .................. 33 cevimeline hcl ................... 37 CHANTIX .......................... 20 CHANTIX STARTER PACK .......................................... 20 CHEMET ........................... 22 chlorhexidine gluconate (mouth-throat) ................... 37 chloroquine phosphate........ 5 chlorothiazide .................... 13 chlorpromaz inj 25mg/ml ... 17 chlorpromazine hcl ............ 17 chlorthalidone ................... 13 chlorzoxazone ................... 20 cholestyramine .................. 11 cholestyramine light .......... 12 choline fenofibrate ............ 12 CHORIONIC GONADOTROPIN ............ 24 ciclopirox ........................... 35 ciclopirox cre 0.77% .......... 35 ciclopirox shampoo 1% ..... 35 ciclopirox sus 0.77% ......... 35 cidofovir .............................. 6 cilostazol ........................... 28 CILOXAN

see ciprofloxacin hcl (ophth) ........................... 32

CILOXAN OIN 0.3% OP ... 32 cimetidine .......................... 26 cimetidine inj 150mg/ml .... 26 cimetidine sol 300/5ml ...... 26 CIMZIA .............................. 29 CIPRO ................................ 7

see ciprofloxacin hcl ........ 7 CIPRO HC ........................ 37 CIPRO I.V.-IN D5W

see ciprofloxacin in d5w .. 7

CIPRO XR see ciprofloxacin er ......... 7

CIPRODEX ....................... 37 ciprofloxacin ........................ 7 ciprofloxacin er ................... 7 ciprofloxacin hcl .................. 7 ciprofloxacin hcl (ophth) .... 32 ciprofloxacin in d5w ............ 7 ciprofloxacn inj .................... 7 cisplatin ............................. 10 citalopram hydrobromide .. 16 cladribine ............................ 8 claforan ............................... 6 CLAFORAN

see cefotaxime sodium ... 6 CLARINEX ........................ 33

see desloratadine .......... 33 CLARINEX REDITABS

see desloratadine .......... 33 CLARINEX-D .................... 33 clarithromycin ..................... 7 CLEOCIN

see clindamycin cre 2% vag ................................ 28 see clindamycin hcl ......... 4

CLEOCIN IN D5W see clindamycin phosphate in d5w ............ 4

CLEOCIN PEDIATRIC GRANULE

see clindamycin palmitate hydrochloride................... 4

CLEOCIN PHOSPHATE see clindamycin phosphate ....................... 4

CLEOCIN VAG SUPP 100MG .............................. 28 CLEOCIN-T

see clindamycin phosphate (topical) ........ 35

CLIMARA see estradiol .................. 23

CLINDAGEL ..................... 35 clindamycin cre 2% vag .... 28 clindamycin hcl ................... 4 clindamycin palmitate hydrochloride ...................... 4 clindamycin phosphate ....... 4 clindamycin phosphate (topical) ............................. 35

42

43

clindamycin phosphate in d5w .....................................4 clindamycin phosphate-benzoyl peroxide .......................................... 35 CLINIMIX 2.75%/DEXTROSE 5% ..... 30 CLINIMIX 4.25%/DEXTROSE 10% ... 30 CLINIMIX 4.25%/DEXTROSE 20% ... 30 CLINIMIX 4.25%/DEXTROSE 25% ... 30 CLINIMIX 4.25%/DEXTROSE 5% ..... 30 CLINIMIX 5%/DEXTROSE 15% ................................... 30 CLINIMIX 5%/DEXTROSE 20% ................................... 30 CLINIMIX 5%/DEXTROSE 25% ................................... 30 CLINIMIX E 2.75%/DEXTROSE 10% ... 30 CLINIMIX E 2.75%/DEXTROSE 5% ..... 30 CLINIMIX E 4.25%/DEXTROSE ........... 30 CLINIMIX E 4.25%/DEXTROSE 25% ... 30 CLINIMIX E 4.25%/DEXTROSE 5% ..... 30 CLINIMIX E 5%/DEXTROSE 15% ................................... 31 CLINIMIX E 5%/DEXTROSE 20% ................................... 31 CLINIMIX E 5%/DEXTROSE 25% ................................... 31 clinisol sf 15% ................... 31 CLINORIL

see sulindac ....................1 clobetasol propionate ........ 36 clobetasol propionate emollient base ................... 36 clobetasol propionate emulsion............................ 36 CLOBEX ........................... 36

see clobetasol propionate ...................................... 36

CLODERM PUMP ............. 36 CLOLAR..............................8

clomipramine hcl ............... 16 clonazepam ................ 14, 15 clonidine & chlorthalidone . 14 clonidine hcl ...................... 14 clopidogrel bisulfate .......... 29 clorazepate dipotassium ... 15 clotrimazole ....................... 37 clotrimazole (topical) ......... 35 CLOZAPINE ODT ............. 17 clozapine tab ..................... 17 CLOZARIL

see clozapine tab .......... 17 COARTEM .......................... 5 codeine

and capital ....................... 1 CODEINE SULFATE .......... 2 COGENTIN

see benztropine mesylate ...................................... 17

co-gesic 5-500mg ............... 1 COLAZAL

see balsalazide disodium ...................................... 26

colchicine w/ probenecid ..... 1 COLCRYS .......................... 1 COLESTID

see colestipol hcl ........... 12 colestipol hcl ..................... 12 colistimethate sodium ......... 4 COLY-MYCIN M

see colistimethate sodium ........................................ 4

COLY-MYCIN S ................ 37 COLYTE-FLAVOR PACKS .......................................... 26

see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 26

COMBIGAN ...................... 33 COMBIPATCH .................. 23 COMBIVENT .................... 33 COMBIVENT RESPIMAT . 33 COMBIVIR

see lamivudine-zidovudine ........................................ 5

COMETRIQ ........................ 9 COMPLERA ........................ 5 compro supp ..................... 25 COMVAX .......................... 30 CONCERTA

see methylphenidate hcl er ...................................... 18

CONDYLOX ..................... 37 see podofilox ................. 37

CONZIP .............................. 1 COPAXONE ..................... 19 COPEGUS

see ribasphere 200mg .... 6 see ribavirin 200mg ......... 6

CORDARONE see amiodarone hcl ....... 11

CORDRAN ....................... 36 COREG

see carvedilol ................ 12 COREG CR ...................... 12 CORGARD

see nadolol .................... 12 CORTEF

see hydrocortisone ........ 24 CORTENEMA

see hydrocortisone (intrarectal) .................... 26

CORTIFOAM .................... 35 cortisone acetate .............. 24 CORTISPORIN ................. 35

see neomycin-polymyxin-hc (otic) .............................. 37

CORTISPORIN-TC ........... 37 CORZIDE

see nadolol & bendroflumethiazide ...... 12

COSMEGEN ....................... 8 COSOPT

see dorzolamide hcl-timolol maleate ........ 33

COSOPT PF ..................... 33 COUMADIN ...................... 28

see warfarin sodium ...... 28 COUMADIN INJ ................ 28 COZAAR

see losartan potassium . 11 CREON ............................. 27 CRESTOR ........................ 11 CRINONE ......................... 25 CRIXIVAN ........................... 5 cromolyn sodium............... 34 cromolyn sodium (mastocytosis) .................. 27 cromolyn sodium (ophth) .. 33

43

44

CUBICIN .............................4 CUTIVATE

see fluticasone propionate ...................................... 36

CUVPOSA ........................ 26 CYCLESSA

see desogestrel-ethinyl estradiol (triphasic) ........ 22

cyclobenzaprine hcl .......... 20 cyclophosphamide ..............8 cycloserine ..........................5 cyclosporine ...................... 29 cyclosporine modified (for microemulsion) .................. 29 CYKLOKAPRON

see tranexamic acid ...... 29 CYMBALTA ....................... 16 cyproheptadine hcl ............ 33 CYSTADANE .................... 23 CYSTAGON ...................... 23 cytarabine inj .......................8 CYTOMEL

see liothyronine sodium . 25 CYTOTEC

see misoprostol ............. 27 CYTOVENE

see ganciclovir inj 500mg 6 D D.H.E. 45

see dihydroergotamine mesylate ........................ 19

dacarbazine ........................8 DACOGEN ..........................8 DALIRESP ........................ 34 danazol ............................. 23 DANTRIUM

see dantrolene sodium .. 20 dantrolene sodium ............ 20 dapsone ..............................4 DAPTACEL ....................... 30 DARAPRIM .........................4 daunorubicin hcl ..................8 DAYPRO

see oxaprozin ..................1 DAYTRANA ...................... 18 DDAVP

see desmopressin acetate ...................................... 25 see desmopressin acetate inj ................................... 25

see desmopressin acetate spray ............................. 25

DECAVAC ........................ 30 DELATESTRYL

see testosterone enanthate ...................... 20

DELESTROGEN ............... 23 see estradiol valerate .... 23

DELZICOL ........................ 26 DEMADEX

see torsemide tabs ........ 13 demeclocycline hcl .............. 8 DEMSER .......................... 14 DENAVIR .......................... 36 DEPACON

see valproate sodium .... 16 DEPAKENE

see valproate sodium .... 16 see valproic acid ........... 16

DEPAKOTE see divalproex sodium ... 15

DEPAKOTE ER see divalproex sodium ... 15

DEPAKOTE SPRINKLES see divalproex sodium ... 15

DEPO-MEDROL ............... 24 see methylprednisolone acetate .......................... 24

DEPO-PROVERA CONTRACEPTIV

see medroxyprogesterone acetate (contraceptive) .. 22

DEPO-PROVERA INJ 400/ML ................................ 9 DEPO-SUBQ PROVERA 104 .................................... 22 DERMA-SMOOTHE/FS BODY

see fluocinolone acetonide ...................................... 36

DERMATOP see prednicarbate ......... 36

DERMOTIC see fluocinolone acetonide (otic) .............................. 37

desipramine hcl ................. 16 desloratadine .................... 33 desmopressin acetate ....... 25 DESMOPRESSIN ACETATE .......................................... 25

desmopressin acetate inj .. 25 desmopressin acetate spray.......................................... 25 desmopressin acetate spray refrigerated ....................... 25 DESOGEN

see desogestrel & ethinyl estradiol ........................ 22

desogestrel & ethinyl estradiol ............................ 22 desogestrel-ethinyl estradiol (biphasic) .......................... 22 desogestrel-ethinyl estradiol (triphasic) .......................... 22 DESONATE ...................... 36 desonide ........................... 36 DESONIDE ....................... 36 DESOWEN

see desonide ................. 36 desowen oint kit 0.05% ..... 36 desoximetasone................ 36 DESOXIMETASONE ........ 36 DETROL

see tolterodine tartrate .. 28 DETROL LA ...................... 27 dexamethasone ................ 24 dexamethasone sodium phosphate ......................... 24 dexamethasone sodium phosphate (ophth)............. 32 DEXILANT ........................ 27 dexpak taperpak 13 day ... 24 dexrazoxane ..................... 10 dextrose ............................ 31 DEXTROSE ...................... 31 DEXTROSE 10% FLEX CONTAIN ......................... 31 DEXTROSE 10% W/ SODIUM CHLORIDE 0.2%.......................................... 31 DEXTROSE 10%/NACL 0.45% ............................... 31 DEXTROSE 2.5%/NACL 0.45% ............................... 31 DEXTROSE 5% ................ 31 DEXTROSE 5% /ELECTROLYTE ............... 31 DEXTROSE 5%/LACTATED RING ................................. 31 DEXTROSE 5%/NACL 0.2%

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45

.......................................... 31 DEXTROSE 5%/NACL 0.225% .............................. 31 DEXTROSE 5%/NACL 0.3% .......................................... 31 DEXTROSE 5%/NACL 0.33% ................................ 31 DEXTROSE 5%/NACL 0.45% ................................ 31 DEXTROSE 5%/NACL 0.9% .......................................... 31 DEXTROSE 5%/POTASSIUM CHL ...... 31 DIAMOX

see acetazolamide ........ 13 diazepam .......................... 15 DIAZEPAM GEL ............... 15 diazepam inj ...................... 15 DIBENZYLINE .................. 14 diclofenac potassium ..........1 diclofenac sodium ...............1 diclofenac sodium (ophth) . 32 diclofenac w/ misoprostol ....1 dicloxacillin sodium .............7 dicyclomine hcl .................. 26 didanosine...........................5 DIFFERIN ......................... 35

see adapalene ............... 34 DIFICID ...............................7 diflorasone diacetate ......... 36 DIFLUCAN

see fluconazole ...............4 diflunisal ..............................1 digoxin .............................. 13 digoxin inj .......................... 13 DIGOXIN SOL 50MCG/ML .......................................... 13 dihydroergotamine mesylate .......................................... 19 DIHYDROERGOTAMINE MESYLATE ....................... 19 DILACOR XR

see dilt-xr ....................... 12 dilantin .............................. 15 DILANTIN.......................... 15

see phenytoin ................ 15 see phenytoin sodium extended........................ 15

DILANTIN INFATABS see phenytoin ................ 15

DILATRATE SR ................ 14 DILAUDID

see hydromorphone hcl ... 2 DILAUDID-5

see hydromorphone hcl ... 2 DILAUDID-HP

see hydromorphone hcl ... 2 DILAUDID-HP INJ .............. 2 dilt-cd ................................ 12 diltiazem cap 120mg/24hr . 12 diltiazem cap er/12hr......... 12 diltiazem hcl ................ 12, 13 diltiazem hcl coated beads 13 diltiazem hcl er .................. 13 diltiazem hcl extended release beads ................... 13 dilt-xr ................................. 12 diltzac ................................ 13 DIOVAN ............................ 11 DIOVAN HCT

see valsartan-hydrochlorothiazide .................................. 11

DIPENTUM ....................... 26 diphenhydram inj 50mg/ml 33 diphenoxylate w/ atropine . 27 DIPHTHERIA/TETANUS TOXOID ............................ 30 DIPROLENE

see betamethasone dipropionate augmented 36

DIPROLENE AF see betamethasone dipropionate augmented 36

dipyridamole ..................... 29 disopyramide phosphate ... 11 disulfiram .......................... 20 DITROPAN XL

see oxybutynin chloride . 28 DIURIL SUS 250/5ML ....... 13 divalproex sodium ............. 15 docetaxel ............................ 9 DOCETAXEL ...................... 9 DOLOPHINE

see methadone hcl .......... 2 DOLOPHINE HCL

see methadone hcl .......... 2 donepezil odt 10mg .......... 16 donepezil odt 5mg ............ 16 donepezil tabs 10mg ......... 16

donepezil tabs 5mg ........... 16 DORIBAX ........................... 4 DORYX ............................... 8

see doxycycline hyclate .. 8 dorzolamide hcl................. 33 dorzolamide hcl-timolol maleate ............................. 33 DOVONEX

see calcipotriene ........... 35 doxazosin mesylate .......... 11 doxepin hcl ....................... 16 DOXIL ................................. 8 doxorubicin hcl .................... 8 doxycycline (monohydrate) . 8 doxycycline hyclate ............. 8 dronabinol ......................... 25 drospirenone-ethinyl estradiol ............................ 22 DROXIA ............................ 10 DUETACT

see pioglitazone hcl-glimepiride ............... 21

DUEXIS .............................. 1 DULERA ........................... 34 DUONEB

see ipratropium-albuterol ...................................... 33

DURAGESIC see fentanyl patch ........... 2

DURAMORPH .................... 2 DUREZOL ........................ 32 DYAZIDE

see triamterene & hydrochlorothiazide cap 37.5-25 mg .................... 13

DYMISTA .......................... 34 DYRENIUM ...................... 13 E E.E.S. GRANULES ............. 7 EC-NAPROSYN

see naproxen .................. 1 econazole nitrate .............. 35 EDARBI ............................ 11 EDARBYCLOR ................. 11 EDECRIN ......................... 13 EDLUAR ........................... 19 EDURANT .......................... 5 EFFEXOR XR

see venlafaxine cap er .. 17 EFFIENT ........................... 29

45

46

EFUDEX see fluorouracil (topical) 35

EGRIFTA .......................... 24 ELAPRASE ....................... 23 ELDEPRYL

see selegiline hcl ........... 17 electrolyte-m in dextrose ... 31 ELECTROLYTE-M IN DEXTROSE ...................... 31 ELECTROLYTE-R IN DEXTROSE ...................... 31 ELELYSO.......................... 23 ELESTAT

see epinastine hcl (ophth) ...................................... 33

ELIDEL ............................. 37 ELIGARD ............................9 ELIMITE

see permethrin .............. 37 ELIPHOS

see calcium acetate (phosphate binder) ........ 25

ELIQUIS ............................ 28 ELITEK ............................. 10 ELLA ................................. 22 ELLENCE

see epirubicin inj 200mg ..8 see epirubicin inj 50mg/25ml .......................8

ELMIRON.......................... 27 ELOCON

see mometasone furoate ...................................... 36

ELOXATIN ........................ 10 ELSPAR ............................ 10 EMADINE.......................... 33 EMCYT ...............................8 EMEND ............................. 25 EMEND PAK 80 & 125 ..... 25 EMLA

see lidocaine-prilocaine . 37 EMSAM ............................. 16 EMTRIVA ............................5 ENABLEX ......................... 27 enalapril maleate ............... 10 enalapril maleate & hydrochlorothiazide ........... 10 ENBREL............................ 29 endocet 10/325 ...................2 endocet 5/325 .....................2

endocet 7.5/325 .................. 2 ENDODAN .......................... 2 ENDOMETRIN .................. 25 ENGERIX-B ...................... 30 enoxaparin sodium ........... 28 ENTACAPONE ................. 17 ENTOCORT EC

see budesonide ............. 26 EPIDUO ............................ 35 epinastine hcl (ophth)........ 33 EPIPEN 2-PAK ................. 34 EPIPEN-JR 2-PAK ............ 34 epirubicin inj 200mg ............ 8 EPIRUBICIN INJ 50MG ...... 8 epirubicin inj 50mg/25ml ..... 8 EPIVIR

see lamivudine ................ 5 EPIVIR HBV ........................ 6 EPIVIR SOL 10MG/ML ....... 5 eplerenone ........................ 10 EPOGEN .......................... 28 eprosartan mesylate ......... 11 EPZICOM ........................... 5 EQUETRO ........................ 19 ERAXIS ............................... 4 ERBITUX ............................ 9 ergomar ............................ 19 ergotamine w/ caffeine ...... 19 ERIVEDGE ......................... 9 ERYPED 200 ...................... 7 ERYPED 400 ...................... 7 erythromycin (acne aid) .... 35 erythromycin (ophth) ......... 32 erythromycin base .............. 7 erythromycin ethylsuccinate 7 erythromycin lactobionate ... 7 erythromycin stearate ......... 7 erythromycin-sulfisoxazole .. 4 escitalopram oxalate ......... 16 ESTRACE

see estradiol .................. 23 estradiol ............................ 23 estradiol & norethindrone acetate .............................. 23 estradiol cypionate ............ 23 estradiol vaginal ................ 23 estradiol valerate .............. 23 ESTRADIOL VALERATE .. 23 ESTRING .......................... 23 estropipate ........................ 23

ESTROSTEP FE see norethindrone acetate-ethinyl estradiol-fe ...................................... 23

ethambutol hcl .................... 5 ethosuximide .................... 15 ethynodiol diacet & eth estrad ................................ 22 ETHYOL

see amifostine crystalline ...................................... 10

etodolac .............................. 1 etodolac er .......................... 1 ETOPOPHOS ................... 10 etoposide .......................... 10 EURAX ............................. 37 EVISTA ............................. 25 EVOCLIN

see clindamycin phosphate (topical) ........ 35

EVOXAC see cevimeline hcl ......... 37

EXALGO ............................. 2 EXELDERM ...................... 35 EXELON ........................... 16

see rivastigmine tartrate 16 EXELON PATCHES ......... 16 exemestane ........................ 9 EXFORGE ........................ 11 EXFORGE HCT ................ 11 EXJADE ............................ 22 EXTAVIA .......................... 19 EXTINA

see ketoconazole (topical) ...................................... 35

F FABRAZYME .................... 23 FACTIVE ............................ 7 famciclovir ........................... 6 famotidine ......................... 26 FAMVIR

see famciclovir ................ 6 FANAPT ........................... 17 FANAPT TITRATION PACK.......................................... 17 FARESTON ........................ 9 FASLODEX ........................ 9 FAZACLO ......................... 17 felbamate .......................... 15 FELBATOL

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47

see felbamate ................ 15 FELDENE

see piroxicam ..................1 felodipine........................... 13 FEMARA

see letrozole ....................9 FEMCON FE

see norethindrone & ethinyl estradiol-fe ......... 23

FEMRING ......................... 23 fenofibrate ......................... 12 fenofibrate micronized ....... 12 FENOFIBRATE MICRONIZED ................... 12 FENOFIBRIC ACID ........... 12 FENOGLIDE ..................... 12 fenoprofen calcium ..............1 fentanyl citrate .....................2 fentanyl patch ......................2 FENTORA ...........................2 FERRIPROX ..................... 22 FEXMID

see cyclobenzaprine hcl 20 FINACEA .......................... 37 finasteride ......................... 27 FIRMAGON .........................9 FLAGYL ..............................4

see metronidazole ...........4 FLAGYL ER ........................4 FLAREX ............................ 32 FLEBOGAMMA ................. 29 FLEBOGAMMA DIF .......... 29 flecainide acetate .............. 11 FLEXERIL

see cyclobenzaprine hcl 20 FLOMAX

see tamsulosin hcl ......... 27 FLONASE

see fluticasone propionate (nasal) ........................... 34

FLO-PRED ........................ 24 FLOVENT DISKUS ........... 34 FLOVENT HFA ................. 34 fluconazole ..........................4 fluconazole in dextrose .......4 fluconazole in nacl 100mg...4 fluconazole in nacl 200mg...4 fluconazole in nacl 400mg...4 flucytosine ...........................4 FLUDARA

see fludarabine phosphate ........................................ 8

fludarabine phosphate ........ 8 fludrocortisone acetate...... 24 FLUMADINE

see rimantadine hydrochloride ................... 6

flunisolide (nasal) .............. 34 fluocinolone acetonide ...... 36 fluocinolone acetonide (otic) .......................................... 37 fluocinonide ....................... 36 fluocinonide emulsified base .......................................... 36 FLUOROMETHOLONE .... 32 FLUOROMETHOLONE (OPHTH) ........................... 32 FLUOROPLEX .................. 35 fluorouracil .......................... 8 fluorouracil (topical) .......... 35 fluoxetine hcl ..................... 16 FLUOXETINE HCL ........... 16 fluoxymesterone ............... 20 fluphenazine decanoate .... 17 fluphenazine hcl ................ 17 flurbiprofen .......................... 1 flurbiprofen sodium ........... 32 flutamide ............................. 9 fluticasone propionate ....... 36 fluticasone propionate (nasal) ............................... 34 fluvastatin sodium ............. 11 fluvoxamine maleate ......... 14 fluvoxamine maleate er ..... 14 fluvoxamine tabs ............... 14 FML................................... 32 FML FORTE ..................... 32 fondaparinux sodium......... 28 FORADIL AEROLIZER ..... 34 FORFIVO XL .................... 16 FORTAMET

see metformin hcl .......... 21 FORTAZ ............................. 6

see ceftazidime ............... 6 see tazicef vial ................. 6

FORTEO ........................... 25 FORTESTA ....................... 20 FORTICAL SPR 200/ACT . 24 FOSAMAX

see alendronate sodium 22

FOSAMAX PLUS D .......... 22 foscarnet sodium ................ 6 fosinopril sodium ............... 10 fosinopril sodium & hydrochlorothiazide ........... 10 FOSRENOL ...................... 25 FRAGMIN ......................... 28 FREAMINE HBC 6.9% ..... 31 FREAMINE III ................... 31 FROVA TAB 2.5MG .......... 19 FURADANTIN

see nitrofurantoin ............ 4 furosemide ........................ 13 furosemide inj ................... 13 furosemide oral soln 8 mg/ml.......................................... 13 FUZEON ............................. 5 G gabapentin ........................ 15 GABITRIL ......................... 15

see tiagabine hcl ........... 15 galantamine hydrobromide 16 GAMASTAN S/D............... 29 GAMMAGARD LIQUID ..... 29 GAMMAGARD S/D ........... 29 GAMMAKED ..................... 29 GAMMAPLEX ................... 29 GAMUNEX ....................... 29 GAMUNEX-C .................... 29 GAMUNEX-C 1GM/10ML . 29 ganciclovir inj 500mg .......... 6 GARAMYCIN

see gentamicin sulfate (ophth) ........................... 32

GARDASIL ....................... 30 GASTROCROM

see cromolyn sodium (mastocytosis) ............... 27

GATTEX ........................... 27 GAUZE PADS 2X2 ........... 20 GELNIQUE ....................... 28 GEMCITABINE ................... 9 gemcitabine hcl ................... 9 gemfibrozil ........................ 12 GEMZAR

see gemcitabine hcl ........ 9 GENERESS FE ................ 22 GENOTROPIN.................. 24 GENOTROPIN MINIQUICK.......................................... 24

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48

gentamicin in saline 0.9mg/ml .............................3 gentamicin in saline 1.4mg/ml .............................3 gentamicin in saline 100mg.3 gentamicin in saline 60mg...3 gentamicin in saline 80mg...3 gentamicin sulfate ...............3 gentamicin sulfate (ophth) . 32 gentamicin sulfate (topical) .......................................... 35 GEODON

see ziprasidone hcl ........ 18 GEODON INJ .................... 17 GIANVI .............................. 22 GIAZO ............................... 26 GILENYA .......................... 19 GLASSIA........................... 34 GLEEVEC ...........................9 glimepiride......................... 21 glipizide ............................. 21 glipizide er ......................... 21 glipizide-metformin 2.5-250mg ......................... 21 glipizide-metformin 2.5-500mg ......................... 21 glipizide-metformin 5-500mg .......................................... 21 GLUCAGEN HYPOKIT ..... 24 GLUCAGON EMERGENCY KIT .................................... 24 GLUCOPHAGE

see metformin hcl .......... 21 GLUCOPHAGE XR

see metformin er ........... 21 GLUCOTROL

see glipizide ................... 21 GLUCOTROL XL

see glipizide er .............. 21 GLUCOVANCE

see glyburide-metformin 1.25-250mg ................... 21 see glyburide-metformin 2.5-500mg ..................... 21 see glyburide-metformin 5-500mg ........................ 21

GLUMETZA ...................... 21 glyburide ........................... 21 glyburide micronized ......... 21 glyburide-metformin

1.25-250mg ....................... 21 glyburide-metformin 2.5-500mg ......................... 21 glyburide-metformin 5-500mg ............................ 21 glycopyrrolate ................... 26 GLYNASE

see glyburide micronized ...................................... 21

GLYSET ............................ 21 GOLYTELY ....................... 26

see peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ............................ 27

GRALISE .......................... 19 GRALISE STARTER......... 19 granisetron hcl .................. 25 GRIFULVIN V

see griseofulvin microsize ........................................ 4

griseofulvin microsize.......... 4 griseofulvin ultramicrosize ... 4 GRIS-PEG

see griseofulvin ultramicrosize .................. 4

H HALAVEN ......................... 10 HALDOL

see haloperidol lactate .. 17 HALDOL DECANOATE 100

see haloperidol decanoate ...................................... 17

HALDOL DECANOATE 50 see haloperidol decanoate ...................................... 17

HALFLYTELY BOWEL PREP/FLA ........................ 26 halobetasol propionate...... 36 HALOG ............................. 36 haloperidol ........................ 17 haloperidol decanoate....... 17 haloperidol lactate ............. 17 HAVRIX ............................ 30 heather tab 0.35mg ........... 22 HECTOROL ...................... 32 HELIDAC .......................... 27 HEP SOD/NACL INJ 25000 .......................................... 28 HEPARIN (PORCINE) IN SODIUM CHLORIDE

100U/ML ........................... 28 heparin sod inj 10000u/ml . 28 heparin sod inj 1000u/ml ... 28 heparin sod inj 20000u/ml . 28 HEPARIN SOD INJ 2000U/ML ......................... 28 HEPARIN SOD INJ 2500U/ML ......................... 28 heparin sod inj 5000u/0.5ml.......................................... 28 heparin sod inj 5000u/ml ... 28 HEPARIN SODIUM/D5W . 28 HEPARIN SODIUM/SODIUM CHL .... 28 HEPATAMINE .................. 31 hepatasol 8 ....................... 31 HEPSERA .......................... 6 HERCEPTIN ....................... 9 HEXALEN ........................... 8 HIBERIX ........................... 30 HIPREX

see methenamine hippurate ......................... 4

HORIZANT ....................... 19 HUMALOG ....................... 20 HUMALOG KWIKPEN ...... 20 HUMALOG MIX 50/50 ...... 20 HUMALOG MIX 50/50 KWIKPEN ......................... 20 HUMALOG MIX 75/25 ...... 20 HUMALOG MIX 75/25 KWIKPEN ......................... 20 HUMATROPE ................... 24 HUMATROPE COMBO PACK ................................ 24 HUMIRA ........................... 29 HUMIRA PEN ................... 29 HUMIRA PEN-CROHNS STARTER KIT .................. 29 HUMIRA PEN-PSORIASIS STARTER KIT .................. 29 HUMULIN 70/30 ............... 20 HUMULIN 70/30 PEN ....... 20 HUMULIN N ...................... 20 HUMULIN N U-100 PEN ... 20 HUMULIN R ...................... 20 HUMULIN R U-500 (CONCENTRATE) ............ 20 HYCAMTIN

see topotecan hcl .......... 10

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HYCET see hydrocodone-acetaminophen 7.5-325 mg/15ml ........1

hydralazine hcl .................. 14 HYDREA

see hydroxyurea ............ 10 hydrochlorothiazide ........... 13 hydrocodone-acetaminophen ............................................1 hydrocodone-acetaminophen 10-300mg ............................2 hydrocodone-acetaminophen 10-500mg ............................2 hydrocodone-acetaminophen 10-650mg ............................2 hydrocodone-acetaminophen 10-660mg ............................2 hydrocodone-acetaminophen 10-750mg ............................2 hydrocodone-acetaminophen 2.5-325mg ...........................1 hydrocodone-acetaminophen 2.5-500mg ...........................1 hydrocodone-acetaminophen 5-300mg ..............................1 hydrocodone-acetaminophen 5-325mg ..............................1 hydrocodone-acetaminophen 5-500mg ..............................1 hydrocodone-acetaminophen 7.5-300mg ...........................1 hydrocodone-acetaminophen 7.5-325 mg/15ml .................1 hydrocodone-acetaminophen 7.5-325mg ...........................2 hydrocodone-acetaminophen 7.5-500mg ...........................2 hydrocodone-acetaminophen 7.5-500mg/15ml ..................2 hydrocodone-acetaminophen 7.5-650mg ...........................2 hydrocodone-acetaminophen 7.5-750mg ...........................2 hydrocodone-acetaminophen tab 10-325mg ......................2 hydrocodone-ibuprofen 2.5-200mg ...........................2 hydrocodone-ibuprofen 7.5-200mg ...........................2

hydrocortisone .................. 24 hydrocortisone (intrarectal) .......................................... 26 HYDROCORTISONE (INTRARECTAL) .............. 26 hydrocortisone (rectal) ...... 35 hydrocortisone (topical) ..... 36 hydrocortisone butyrate .... 36 hydrocortisone valerate..... 36 hydrocortisone w/acetic acid .......................................... 37 hydromorphone hcl ............. 2 hydroxychloroquine sulfate .......................................... 29 hydroxyurea ...................... 10 hydroxyzine hcl ................. 33 hydroxyzine pamoate ........ 33 HYZAAR

see losartan potassium & hydrochlorothiazide ....... 11

I ibandronate sodium .......... 22 ibudone tab 5-200mg .......... 2 ibuprofen ............................. 1 ICLUSIG ............................. 9 IDAMYCIN PFS

see idarubicin hcl ............ 8 idarubicin hcl ....................... 8 IFEX

see ifosfamide ................. 8 IFEX INJ 3GM ..................... 8 ifosfamide ........................... 8 IFOSFAMIDE

see ifosfamide ................. 8 ILEVRO ............................. 32 IMDUR

see isosorbide mononitrate ................... 14

imipenem-cilastatin ............. 4 imipramine hcl ................... 16 imipramine pamoate ......... 16 imiquimod ......................... 37 IMITREX

see sumatriptan succinate ...................................... 19 see sumatriptan succinate inj................................... 19

IMOVAX RABIES (H.D.C.V.) .......................................... 30 IMURAN

see azathioprine ............ 29 INCIVEK ............................. 6 INCRELEX ........................ 24 indapamide ....................... 13 INDERAL LA

see propranolol hcl er .... 12 INFANRIX ......................... 30 INFERGEN ....................... 29 INFUMORPH 200 ............... 2 INFUMORPH 500 ............... 2 INLYTA ............................... 9 INSPRA

see eplerenone ............. 10 INSULIN PEN NEEDLES . 20 INSULIN SAFETY NEEDLES ......................... 20 INSULIN SYRINGES ........ 20 INTELENCE ....................... 5 INTERMEZZO .................. 19 INTRALIPID INJ 20% ....... 31 INTRALIPID INJ 30% ....... 31 INTRON-A ........................ 29 INTRON-A W/DILUENT .... 29 INTUNIV ........................... 18 INVANZ .............................. 4 INVEGA ............................ 17 INVEGA SUSTENNA ........ 17 INVIRASE ........................... 5 INVOKANA ....................... 21 IONOSOL-B/DEXTROSE 5% .................................... 31 IONOSOL-MB/DEXTROSE 5% .................................... 31 IPOL INACTIVATED IPV .. 30 ipratropium bromide (nasal).......................................... 33 ipratropium sol inhal .......... 33 ipratropium-albuterol ......... 33 irbesartan .......................... 11 irbesartan-hydrochlorothiazide........................................ 11 IRESSA .............................. 9 irinotecan hcl .................... 10 ISENTRESS ....................... 5 ISOLYTE P ....................... 31 isolyte s ............................. 31 isoniazid .............................. 5 isoniazid & rifampin ............. 5 isoniazid tabs ...................... 5 ISOPTO CARPINE ........... 33

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ISORDIL TITRADOSE ...... 14 see isosorbide dinitrate . 14

isosorbide dinitrate ............ 14 isosorbide mononitrate ...... 14 isotretinoin cap 10 mg ....... 35 isradipine........................... 13 ISTALOL ........................... 33 ISTODAX ............................9 itraconazole .........................4 IXEMPRA KIT ................... 10 IXIARO .............................. 30 J JAKAFI ................................9 JALYN ............................... 27 JANUMET ......................... 21 JANUMET XR TAB 100-1000 ........................... 21 JANUMET XR TAB 50-1000 .......................................... 21 JANUMET XR TAB 50-500MG ......................... 21 JANUVIA ........................... 21 JENTADUETO .................. 21 JOLIVETTE ....................... 22 JUVISYNC ........................ 21 K KADCYLA ...........................9 KADIAN...............................2 KALETRA SOL ...................5 KALETRA TAB 100-25MG ..5 KALETRA TAB 200-50MG ..5 KAYEXALATE

see kionex ..................... 22 KAZANO ........................... 21 KCL 0.075%/D5W/NACL 0.45% ................................ 31 KCL 0.15%/D5W/LR ......... 31 KCL 0.15%/D5W/NACL 0.9% .................................. 31 kcl 0.3%/d5w/lr iv lac ri ...... 31 KCL 0.3%/D5W/NACL 0.45% ................................ 31 KCL 0.3%/D5W/NACL 0.9% .......................................... 31 KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 31 kcl 20 meq/l (0.15%) in nacl 0.45% inj ........................... 31 KCL 20 MEQ/L (0.15%) IN

NACL 0.45% INJ ............... 31 KCL 30 MEQ/L (0.224%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 31 KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.2% INJ ........................... 31 KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ ................. 31 KCL0.15%/D5W/NACL0.2% .......................................... 31 KCL0.15%/D5W/NACL0.225% ...................................... 31 KEFLEX

see cephalexin ................ 6 KENALOG ........................ 36 KEPIVANCE ..................... 10 KEPPRA

see levetiracetam .......... 15 KEPPRA XR

see levetiracetam .......... 15 KERLONE

see betaxolol hcl ........... 12 ketoconazole ....................... 4 ketoconazole (topical) ....... 35 ketoconazole shampoo ..... 36 ketoprofen ........................... 1 ketorolac tromethamine (ophth) .............................. 32 KINERET .......................... 29 kionex ............................... 22 KLARON

see sulfacetamide sodium (acne) ............................ 35

KLONOPIN see clonazepam ............ 14

KLOR-CON 10 .................. 30 KLOR-CON 8 .................... 30 klor-con m15 ..................... 30 klor-con m20 ..................... 30 KOMBIGLYZE XR 2.5-1000MG ...................... 21 KOMBIGLYZE XR 5-1000MG ......................... 21 KOMBIGLYZE XR 5-500MG .......................................... 21 kristalose pak .................... 26 KUVAN ............................. 23 L labetalol hcl ....................... 12

LAC-HYDRIN see ammonium lactate .. 37 see laclotion lotn 12% ... 37

laclotion lotn 12%.............. 37 LACRISERT ..................... 33 LACTATED RINGERS VIAFLEX ........................... 31 lactulose ........................... 26 lactulose (encephalopathy).......................................... 26 LAMICTAL

see lamotrigine .............. 15 LAMICTAL CHEWABLE DISPERS

see lamotrigine .............. 15 LAMICTAL ODT................ 15 LAMICTAL STARTER ...... 15 LAMICTAL XR .................. 15

see lamotrigine .............. 15 LAMISIL .............................. 4

see terbinafine hcl ........... 5 lamivudine .......................... 5 lamivudine-zidovudine ........ 5 lamotrigine ........................ 15 LANOXIN

see digoxin .................... 13 see digoxin inj ............... 13

LANOXIN PEDIATRIC ...... 13 LANOXIN TAB .................. 13 lansoprazole ..................... 27 LANTUS ........................... 20 LANTUS SOLOSTAR ....... 20 LASIX

see furosemide.............. 13 LASTACAFT ..................... 33 latanoprost ........................ 33 LATUDA ........................... 17 LAZANDA ........................... 2 LEENA .............................. 22 leflunomide ....................... 29 LESCOL

see fluvastatin sodium ... 11 LESCOL XL ...................... 11 LETAIRIS .......................... 14 letrozole .............................. 9 leucovor ca inj ................... 10 leucovorin calcium ............ 10 LEUKERAN ........................ 8 LEUKINE .......................... 28 leuprolide acetate ............... 9

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levalbuterol conc 1.25mg/0.5ml .................... 34 LEVALBUTEROL HCL ...... 34 LEVAQUIN

see levofloxacin ...............7 see levofloxacin in d5w....7

LEVATOL .......................... 12 LEVEMIR .......................... 20 LEVEMIR FLEXPEN ......... 20 levetiracetam ..................... 15 levobunolol hcl .................. 33 LEVOBUNOLOL HCL ....... 33 levocarnitine (metabolic modifiers) .......................... 23 levocetirizine soln 2.5mg/5ml .......................................... 33 levocetirizine tab 5 mg ...... 33 levofloxacin .........................7 levofloxacin (ophth) ........... 32 levofloxacin in d5w ..............7 levonorgestrel & eth estradiol .......................................... 22 levonorgestrel-eth estradiol (triphasic) .......................... 22 levonorgestrel-ethinyl estradiol (91-day) .............. 22 levonorgestrel-ethinyl estradiol (continuous) ........ 22 levorphanol tartrate .............2 LEVOTHROID ................... 25 levothyroxine sodium ........ 25 LEVOXYL.......................... 25 LEXAPRO

see escitalopram oxalate ...................................... 16

LEXIVA ...............................5 LIALDA ............................. 26 lidocaine ............................ 37 lidocaine hcl ...................... 37 lidocaine hcl (local anesth.) .3 lidocaine hcl (mouth-throat) .......................................... 37 lidocaine inj 0.5% ................3 lidocaine inj 1% ...................3 lidocaine inj 1.5% ................3 lidocaine inj 2% ...................3 lidocaine-prilocaine ........... 37 LIDODERM ....................... 37 LINZESS CAP 145MCG ... 27 LINZESS CAP 290MCG ... 27

liothyronine sodium ........... 25 LIPITOR

see atorvastatin calcium 11 LIPOFEN .......................... 12 lisinopril ............................. 10 lisinopril & hydrochlorothiazide ........... 10 lithium carbonate .............. 19 LITHIUM CITRATE ........... 19 LITHOBID

see lithium carbonate .... 19 LIVALO ............................. 11 LO LOESTRIN FE ............ 22 LOCOID ............................ 36

see hydrocortisone butyrate ......................... 36

LOCOID LIPOCREAM ...... 36 LODOSYN ........................ 17 LOESTRIN 1.5/30-21

see norethindrone acet & eth estra ........................ 23

LOESTRIN 1/20-21 see norethindrone acet & eth estra ........................ 23

LOESTRIN 24 FE ............. 22 LOESTRIN FE 1.5/30

see norethin acet & estrad-fe ........................ 22

LOESTRIN FE 1/20 see norethin acet & estrad-fe ........................ 22

LOFIBRA see fenofibrate .............. 12 see fenofibrate micronized ...................................... 12

LOKARA LOTN 0.05%...... 36 LOMOTIL

see diphenoxylate w/ atropine ......................... 27

loperamide hcl .................. 27 LOPID

see gemfibrozil .............. 12 LOPRESSOR

see metoprolol tartrate .. 12 LOPRESSOR HCT

see metoprolol & hctz tab 100-25mg ...................... 12 see metoprolol & hctz tab 50-25mg ........................ 12

LOPROX

see ciclopirox ................ 35 LOPROX SHAMPOO

see ciclopirox shampoo 1% ................................. 35

lorazepam ......................... 14 LORCET 10/650

see hydrocodone-acetaminophen 10-650mg ................... 2

LORTAB see co-gesic 5-500mg ..... 1 see hydrocodone-acetaminophen 10-500mg ................... 2 see hydrocodone-acetaminophen 5-500mg ..................... 1 see hydrocodone-acetaminophen 7.5-500mg .................. 2 see hydrocodone-acetaminophen 7.5-500mg/15ml ......... 2

losartan potassium ............ 11 losartan potassium & hydrochlorothiazide ........... 11 LOTEMAX ........................ 32 LOTENSIN

see benazepril hcl ......... 10 LOTENSIN HCT

see benazepril & hydrochlorothiazide ....... 10

LOTREL see amlodipine besylate-benazepril hcl . 10

LOTRONEX ...................... 27 lovastatin .......................... 11 LOVAZA ........................... 12 LOVENOX

see enoxaparin sodium . 28 loxapine succinate ............ 17 LOXITANE

see loxapine succinate .. 17 LUFYLLIN ......................... 34 LUMIGAN ......................... 33 LUMIZYME ....................... 23 LUNESTA ......................... 19 LUPR DEP-PED INJ 11.25MG (3-MONTH) ......... 9 LUPR DEP-PED INJ 30MG

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(3-MONTH) .........................9 LUPRON DEPOT ................9 LUPRON DEPOT INJ 22.5MG (3-MONTH) ...........9 LUPRON DEPOT INJ 30MG (3-MONTH) .........................9 LUPRON DEPOT-PED .......9 LUVOX CR

see fluvoxamine maleate er ................................... 14

LUXIQ see betamethasone valerate.......................... 36

LYRICA ............................. 15 LYSODREN ........................9 LYSTEDA

see tranexamic acid ...... 29 M MACROBID

see nitrofurantoin monohyd macro ...............4

MACRODANTIN .................4 see nitrofurantoin macrocrystal ....................4

mafenide acetate .............. 35 magnesium sulfate ............ 30 MAGNESIUM SULFATE ... 30 MAGNESIUM SULFATE IN D5W 1% ............................ 30 MAGNESIUM SULFATE IN D5W 2% ............................ 30 MALARONE

see atovaquone-proguanil hcl tab 250-100 mg ..........5

malathion .......................... 37 maprotiline hcl ................... 16 MARINOL

see dronabinol ............... 25 MARPLAN ......................... 16 MATULANE ...................... 10 matzim la........................... 13 MAVIK

see trandolapril .............. 10 MAXALT

see rizatriptan benzoate 19 MAXALT-MLT

see rizatriptan benzoate 19 MAXIDEX .......................... 32 MAXIDONE

see

hydrocodone-acetaminophen 10-750mg ................... 2

MAXIPIME .......................... 6 see cefepime inj 1gm ...... 6 see cefepime inj 2gm ...... 6

MAXITROL see neomycin-polymy-dexameth .................................... 32

MAXZIDE see triamterene & hydrochlorothiazide tab 75-50 mg ....................... 14

MAXZIDE-25 see triamterene & hydrochlorothiazide tab 37.5-25 mg .................... 14

meclizine hcl ..................... 25 MEDROL .......................... 24

see methylprednisolone 24 MEDROL DOSEPAK

see methylprednisolone 24 medroxyprogesterone acetate .............................. 25 medroxyprogesterone acetate (contraceptive) ..... 22 mefenamic acid ................... 1 mefloquine hcl ..................... 5 MEGACE ES ...................... 9 MEGACE ORAL

see megestrol acetate ..... 9 megestrol acetate ............... 9 MEKINIST ........................... 9 MELOXICAM SUSP 7.5 MG/5ML .............................. 1 meloxicam tabs ................... 1 melphalan hcl ...................... 8 MENACTRA ...................... 30 menest .............................. 23 MENHIBRIX ...................... 30 MENOMUNE-A/C/Y/W-135 .......................................... 30 MENOSTAR ..................... 23 MENTAX ........................... 35 MENVEO .......................... 30 MEPRON ............................ 4 mercaptopurine ................... 9 meropenem ......................... 4 MERREM

see meropenem .............. 4

mesalamine enema .......... 26 mesalamine enema kit ...... 26 mesna ............................... 10 MESNEX .......................... 10

see mesna .................... 10 MESTINON

see pyridostigmine bromide ......................... 19

MESTINON SYRUP ......... 19 MESTINON TIMESPAN ... 19 METADATE CD

see methylphenidate hcl 18 metadate tab 20mg er ....... 18 METAGLIP

see glipizide-metformin 2.5-250mg ..................... 21

metformin er ..................... 21 metformin hcl .................... 21 methadone hcl .................... 2 METHADONE INJ 10MG/ML............................................ 2 methazolamide ................. 13 methenamine hippurate ...... 4 METHERGINE

see methylergonovine maleate ......................... 24

methimazole ..................... 25 methocarbamol ................. 20 methotrexate sodium ........ 29 methotrexate sodium inj ...... 9 methotrexate sodium tabs 29 methscopolamine bromide 26 methyclothiazide ............... 13 methylergonovine maleate 24 METHYLIN

see methylphenidate hcl 18 METHYLIN CHEW TAB .... 18 methylphenidate hcl .......... 18 methylphenidate hcl er ...... 18 METHYLPHENIDATE HCL ER ..................................... 18 methylphenidate tab 10mg er.......................................... 18 methylphenidate tab 20mg er.......................................... 18 methylprednisolone ........... 24 methylprednisolone acetate.......................................... 24 methylprednisolone sod succ.......................................... 24

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metipranolol ...................... 33 metoclopramide hcl ........... 25 metoclopramide hcl inj 5 mg/ml ................................ 25 metolazone ....................... 13 metoprolol & hctz tab 100-25mg .......................... 12 metoprolol & hctz tab 100-50mg .......................... 12 metoprolol & hctz tab 50-25mg ............................ 12 metoprolol succinate ......... 12 metoprolol tartrate ............. 12 METOZOLV ODT .............. 25 METRO IV ...........................4 METROCREAM

see metronidazole (topical).......................... 37 see rosadan cre 0.75% . 37

METROGEL ...................... 37 see metronidazole (topical).......................... 37

METROGEL-VAGINAL see metronidazole vaginal ...................................... 28

METROLOTION see metronidazole (topical).......................... 37

metronidazole .....................4 metronidazole (topical) ...... 37 metronidazole inj .................4 metronidazole vaginal ....... 28 MEVACOR

see lovastatin ................ 11 mexiletine hcl .................... 11 MIACALCIN

see calcitonin (salmon) nasal spray .................... 24

MIACALCIN INJ 200U/ML. 24 MICARDIS ........................ 11 MICARDIS HCT ................ 11 miconazole nitrate vaginal. 28 MICRO-K

see potassium chloride caps er........................... 30

MICROZIDE see hydrochlorothiazide 13

midodrine hcl ..................... 14 MINASTRIN 24 FE ............ 22 MINIPRESS

see prazosin hcl ............ 11 minitran ............................. 14 MINIVELLE ....................... 23 MINOCIN

see minocycline hcl ......... 8 minocycline hcl ................... 8 minoxidil ............................ 14 MIRAPEX .......................... 17

see pramipexole dihydrochloride .............. 17

MIRAPEX ER .................... 17 MIRCETTE

see desogestrel-ethinyl estradiol (biphasic) ........ 22 see viorele ..................... 23

mirtazapine ....................... 16 misoprostol ....................... 27 mitomycin ............................ 8 mitoxantrone hcl ............... 10 M-M-R II W/DILUENT 10 DOS .................................. 30 MOBIC

see meloxicam tabs......... 1 modafinil ........................... 20 moexipril hcl ...................... 10 moexipril-hydrochlorothiazide ........................................ 10 mometasone furoate ......... 36 MONODOX

see doxycycline (monohydrate) ................. 8

MONONESSA .................. 22 montelukast sodium .......... 34 MORPHINE SUL 20MG/ML ORAL SOL .......................... 2 morphine sulfate ................. 2 MORPHINE SULFATE ....... 2 morphine sulfate ext-rel tab 3 morphine sulfate inj ............. 3 MORPHINE SULFATE INJ . 3 MOVIPREP ....................... 26 MOXATAG .......................... 7 MOXEZA ........................... 32 MOZOBIL .......................... 28 MS CONTIN

see morphine sulfate ext-rel tab ........................ 3

MULTAQ ........................... 11 mupirocin .......................... 35 mupirocin calcium (topical) 35

MUSTARGEN ..................... 8 MYAMBUTOL

see ethambutol hcl .......... 5 MYCAMINE ........................ 4 MYCOBUTIN ...................... 5 mycophenolate mofetil ...... 29 MYFORTIC ....................... 29 myorisan ........................... 35 MYOZYME ....................... 23 MYRBETRIQ .................... 28 MYSOLINE

see primidone................ 15 myzilra .............................. 22 N nabumetone ........................ 1 nadolol .............................. 12 nadolol & bendroflumethiazide ......... 12 nafcillin sodium ................... 7 NAFTIN ............................. 35 NAGLAZYME ................... 23 NALFON ............................. 1 NALLPEN ISO-OSMOTIC IN DE ....................................... 7 NALLPEN/DEXTROSE ....... 7 naloxone hcl ..................... 20 naltrexone hcl ................... 20 NAMENDA ........................ 16 NAMENDA TITRATION PAK.......................................... 16 NAMENDA XR .................. 16 NAMENDA XR TITRATION PACK ................................ 16 NAPRELAN ........................ 1 NAPROSYN

see naproxen .................. 1 naproxen ............................. 1 naproxen sodium ................ 1 naratriptan hcl ................... 19 NARDIL

see phenelzine sulfate .. 16 NASACORT AQ

see triamcinolone acetonide (nasal) ........... 34

NASONEX ........................ 34 NATACYN ........................ 32 nateglinide ........................ 21 NAVELBINE

see vinorelbine tartrate .... 9 NEBUPENT ........................ 4

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NECON 1/50-28 ................ 22 necon 10/11 28 day .......... 22 NECON 7/7/7 .................... 22 nefazodone hcl .................. 16 neomycin sulfate .................3 neomycin/polymyxin b gu .. 37 neomycin-bacitracin zn-polymyxin ..................... 32 neomycin-polymy-dexameth .......................................... 32 neomycin-polymy-gramicid .......................................... 32 neomycin-polymyxin-hc (ophth) .............................. 32 neomycin-polymyxin-hc (otic) .......................................... 37 NEORAL ........................... 29

see cyclosporine modified (for microemulsion) ........ 29

NEOSPORIN see neomycin-polymy-gramicid ...................................... 32

NEOSPORIN GU IRRIGANT see neomycin/polymyxin b gu .................................. 37

NEPHRAMINE .................. 31 NEPTAZANE

see methazolamide ....... 13 NESINA............................. 21 NEULASTA ....................... 28 NEUMEGA ........................ 28 NEUPOGEN ..................... 28 NEUPRO........................... 17 NEURONTIN

see gabapentin .............. 15 NEVANAC ......................... 32 nevirapine ...........................5 NEVIRAPINE ......................5 NEXAVAR ...........................9 NEXIUM ............................ 27 NEXIUM GRANULES 10MG DR ..................................... 27 NEXIUM GRANULES 2.5MG DR ..................................... 27 NEXIUM GRANULES 20MG DR ..................................... 27 NEXIUM GRANULES 40MG DR ..................................... 27 NEXIUM GRANULES 5MG

DR..................................... 27 NEXIUM I.V. ..................... 27 next choice tab 1.5mg ....... 22 niacor ................................ 12 NIASPAN .......................... 12 nicardipine hcl ................... 13 NICOTROL INHALER ....... 20 NICOTROL NS ................. 20 nifedipine .......................... 13 nifedipine cc tab 90mg er .. 13 nifedipine cr ...................... 13 nifedipine er ...................... 13 nifedipine xl ....................... 13 NILANDRON ....................... 9 nimodipine ........................ 13 NIMOTOP

see nimodipine .............. 13 NIPENT

see pentostatin ................ 9 nisoldipine ......................... 13 NITRO-DUR ...................... 14

see minitran ................... 14 nitrofurantoin ....................... 4 nitrofurantoin macrocrystal .. 4 nitrofurantoin monohyd macro .................................. 4 nitroglycerin ...................... 14 NITROGLYCERIN ............ 14 NITROGLYCERIN LINGUAL .......................................... 14 nitroglycerin patches ......... 14 NITROLINGUAL SPR PUMPSPRA ...................... 14 NITROMIST ...................... 14 NITROSTAT ..................... 14 nizatidine ........................... 26 NIZORAL

see ketoconazole shampoo ....................... 36

NORA-BE ......................... 22 NORCO

see hydrocodone-acetaminophen 5-325mg ..................... 1 see hydrocodone-acetaminophen 7.5-325mg .................. 2 see hydrocodone-acetaminophen tab 10-325mg ............. 2

NORDITROPIN FLEXPRO.......................................... 24 NORDITROPIN NORDIFLEX PEN ............. 24 norethin acet & estrad-fe .. 22 norethindrone & eth estradiol.................................... 22, 23 norethindrone & ethinyl estradiol-fe ........................ 23 norethindrone (contraceptive) .................. 23 norethindrone acet & eth estra .................................. 23 norethindrone acetate ....... 25 norethindrone acetate-ethinyl estradiol ............................ 23 norethindrone acetate-ethinyl estradiol-fe ........................ 23 norethindrone-eth estradiol (triphasic) .......................... 23 norgestimate-ethinyl estradiol ............................ 23 norgestimate-ethinyl estradiol (triphasic) ........... 23 norgestrel & ethinyl estradiol.......................................... 23 NORINYL 1+35

see norethindrone & eth estradiol ........................ 22

NORINYL 1+50 ................. 23 NORMOSOL-R ................. 31 NOROXIN ........................... 7 NORPACE

see disopyramide phosphate ..................... 11

NORPACE CR .................. 11 NORPRAMIN

see desipramine hcl ...... 16 NOR-QD

see heather tab 0.35mg 22 see norethindrone (contraceptive) .............. 23

nortriptyline hcl ................. 16 NORVASC

see amlodipine besylate 12 NORVIR .............................. 5 NOVAREL INJ 10000UNT 24 NOVOLIN 70/30................ 20 NOVOLIN 70/30 RELION . 20 NOVOLIN N ...................... 20

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NOVOLIN N RELION ........ 21 NOVOLIN R ...................... 21 NOVOLIN R RELION ........ 21 NOVOLOG ........................ 21 NOVOLOG FLEXPEN ...... 21 NOVOLOG MIX 70/30 ...... 21 NOVOLOG MIX 70/30 PREFILL ........................... 21 NOXAFIL.............................4 NUCYNTA ...........................3 NUCYNTA ER .....................3 NUEDEXTA ...................... 19 NULOJIX ........................... 29 NULYTELY/FLAVOR PACKS .............................. 26

see peg 3350-potassium chloride-sod bicarbonate-sod chloride ...................................... 27

NUTROPIN ....................... 24 NUTROPIN AQ ................. 24 NUTROPIN AQ NUSPIN 5 24 NUTROPIN AQ PEN ......... 24 NUVARING ....................... 23 NUVIGIL............................ 20 NYMALIZE ........................ 13 nystatin ...............................5 nystatin (mouth-throat) ...... 37 nystatin (topical) ................ 35 nystatin pow 100000 ......... 35 O OCELLA ............................ 23 OCTAGAM ........................ 29 octreotide acetate ............. 25 OCUFEN

see flurbiprofen sodium . 32 OCUFLOX

see ofloxacin (ophth) ..... 32 ofloxacin (ophth) ............... 32 ofloxacin (otic) ................... 37 olanzapine................... 17, 18 olanzapine odt ................... 18 OLEPTRO ......................... 16 OLUX

see clobetasol propionate ...................................... 36

OLUX-E see clobetasol propionate emulsion ........................ 36

OMECLAMOX-PAK .......... 27

omeprazole ....................... 27 OMNARIS ......................... 34 OMNITROPE 10MG ......... 24 OMNITROPE 5.8MG ........ 24 OMNITROPE 5MG ........... 24 ondansetron hcl ................ 25 ondansetron hcl inj ............ 25 ondansetron hcl oral soln .. 25 ondansetron odt ................ 26 ONFI ................................. 15 ONGLYZA ......................... 21 ONMEL ............................... 5 ONSOLIS ............................ 3 ONTAK ............................... 9 OPANA

see oxymorphone hcl ...... 3 OPANA ER (CRUSH RESISTANT ........................ 3 OPTIPRANOLOL

see metipranolol ............ 33 OPTIVAR

see azelastine hcl (ophth) ...................................... 32

ORACEA ........................... 37 ORAP ................................ 18 ORAPRED

see prednisolone sodium phosphate ..................... 24

ORAPRED ODT ............... 24 ORENCIA ......................... 29 ORFADIN .......................... 23 ORTHO EVRA .................. 23 ORTHO MICRONOR

see norethindrone (contraceptive) .............. 23

ORTHO TRI-CYCLEN see norgestimate-ethinyl estradiol (triphasic) ........ 23

ORTHO TRI-CYCLEN LO . 23 ORTHO-CYCLEN

see norgestimate-ethinyl estradiol ......................... 23

ORTHO-NOVUM 7/7/7 see norethindrone-eth estradiol (triphasic) ........ 23

OSENI TAB 12.5-15MG .... 21 OSENI TAB 12.5-30MG .... 21 OSENI TAB 12.5-45MG .... 21 OSENI TAB 25-15MG ....... 21 OSENI TAB 25-30MG ....... 21

OSENI TAB 25-45MG ....... 21 OSMOPREP ..................... 26 OVCON-35

see norethindrone & eth estradiol ........................ 23 see philith ...................... 23 see zenchent tab ........... 23

OVIDE see malathion ................ 37

oxacillin sodium .................. 7 oxaliplatin .......................... 10 OXANDRIN

see oxandrolone............ 20 oxandrolone ...................... 20 oxaprozin ............................ 1 oxcarbazepine .................. 15 OXECTA ............................. 3 OXISTAT .......................... 35 OXSORALEN ................... 37 OXSORALEN ULTRA ....... 35 oxybutynin chloride ........... 28 oxycodone hcl ..................... 3 OXYCODONE HCL ............ 3 oxycodone w/ acetaminophen ................... 3 oxycodone w/ acetaminophen 10-325mg .. 3 oxycodone w/ acetaminophen 10-650mg .. 3 oxycodone w/ acetaminophen 2.5-325mg . 3 oxycodone w/ acetaminophen 5-325mg .... 3 oxycodone w/ acetaminophen 5-500mg .... 3 oxycodone w/ acetaminophen 7.5-325mg . 3 oxycodone w/ acetaminophen 7.5-500mg . 3 oxycodone-aspirin............... 3 oxycodone-ibuprofen .......... 3 OXYCONTIN ...................... 3 oxymorphone hcl ................ 3 OXYTROL ........................ 28 P paclitaxel ............................. 9 PAMELOR

see nortriptyline hcl ....... 16 pamidronate disodium ...... 22 PAMINE

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see methscopolamine bromide ......................... 26

PAMINE FORTE see methscopolamine bromide ......................... 26

PANCREAZE .................... 27 PANDEL............................ 36 PANRETIN ........................ 37 pantoprazole sodium ......... 27 PARAFON FORTE DSC

see chlorzoxazone ........ 20 PARCOPA

see carbidopa-levodopa 17 PARLODEL ....................... 17

see bromocriptine mesylate ........................ 17

PARNATE see tranylcypromine sulfate ............................ 16

paromomycin sulfate ...........3 paroxetine er tab ............... 16 paroxetine hcl .................... 16 paser 4gm ...........................5 PATADAY ......................... 33 PATANASE ....................... 33 PATANOL ......................... 33 PAXIL ................................ 16

see paroxetine hcl ......... 16 PAXIL CR

see paroxetine er tab ..... 16 PCE ....................................7 PEDIAPRED

see prednisolone sodium phosphate ...................... 24

PEDVAX HIB .................... 30 peg 3350-kcl-sod bicarb-sod chloride-sod sulfate ..... 26, 27 PEG 3350-KCL-SOD BICARB-SOD CHLORIDE-SOD SULFATE .......................................... 26 peg 3350-potassium chloride-sod bicarbonate-sod chloride ............................. 27 PEGANONE ...................... 15 PEGASYS ......................... 29 PEGASYS PROCLICK ..... 29 PEG-INTRON ................... 29 PEG-INTRON REDIPEN... 29 PENICILLIN G POT IN

DEXTROSE ........................ 7 penicillin g potassium .......... 7 PENICILLIN G POTASSIUM ............................................ 7 penicillin g procaine ............ 7 penicillin g sodium .............. 7 penicillin v potassium .......... 8 PENNSAID ....................... 37 PENTAM 300 ...................... 4 PENTASA ......................... 26 pentostatin .......................... 9 pentoxifylline ..................... 28 PEPCID

see famotidine ............... 26 PERCOCET

see endocet 10/325 ......... 2 see endocet 5/325 ........... 2 see endocet 7.5/325 ........ 2 see oxycodone w/ acetaminophen ................ 3 see oxycodone w/ acetaminophen 10-325mg ........................................ 3 see oxycodone w/ acetaminophen 10-650mg ........................................ 3 see oxycodone w/ acetaminophen 2.5-325mg ........................................ 3 see oxycodone w/ acetaminophen 5-325mg . 3 see oxycodone w/ acetaminophen 7.5-325mg ........................................ 3 see oxycodone w/ acetaminophen 7.5-500mg ........................................ 3

PERCODAN see oxycodone-aspirin .... 3

PERFOROMIST ............... 34 PERIDEX

see chlorhexidine gluconate (mouth-throat) ...................................... 37 see periogard sol 0.12% 37

perindopril erbumine ......... 10 periogard sol 0.12% .......... 37 permethrin ......................... 37 perphenazine .................... 18 PERSANTINE

see dipyridamole ........... 29 PERTZYE ......................... 27 PEXEVA ........................... 16 pfizerpen ............................. 8 phenelzine sulfate ............. 16 PHENERGAN

see promethazine hcl .... 26 phenobarbital .................... 15 phenobarbital sodium ....... 15 PHENOBARBITAL SODIUM.......................................... 15 PHENYTEK

see phenytoin sodium extended ....................... 15

phenytoin .......................... 15 phenytoin inj 50mg/ml ....... 15 phenytoin sodium extended.......................................... 15 philith ................................ 23 PHISOHEX ....................... 35 PHOSLO

see calcium acetate (phosphate binder) ........ 25

PHOSLYRA ...................... 25 PHOSPHOLINE IODIDE .. 33 PICATO ............................ 35 PILOCARPINE HCL ......... 33 pilocarpine hcl (oral) ......... 37 PILOPINE HS ................... 33 pindolol ............................. 12 pioglitazone hcl ................. 21 pioglitazone hcl-glimepiride.......................................... 21 pioglitazone hcl-metformin hcl ..................................... 21 piperacillin sodium-tazobactam sodium 8 piroxicam ............................ 1 PLAN B ONE-STEP

see next choice tab 1.5mg ...................................... 22

PLAQUENIL see hydroxychloroquine sulfate ........................... 29

PLASMA-LYTE A.............. 31 PLASMA-LYTE-148 .......... 31 PLASMA-LYTE-56/D5W ... 31 PLAVIX

see clopidogrel bisulfate 29 PLETAL

56

57

see cilostazol ................. 28 podofilox............................ 37 polyethylene glycol 3350 ... 27 polymyxin b sulfate .............4 polymyxin b-trimethoprim .. 32 POLYTRIM

see polymyxin b-trimethoprim ............... 32

POMALYST CAP .............. 10 PONSTEL

see mefenamic acid ........1 potassium chloride ............ 31 POTASSIUM CHLORIDE 30, 31

see potassium chloride .. 31 POTASSIUM CHLORIDE 0.15% ................................ 31 POTASSIUM CHLORIDE 0.22% ................................ 31 POTASSIUM CHLORIDE 0.3%/D .............................. 31 potassium chloride caps er .......................................... 30 potassium chloride microencapsulated crystals cr ....................................... 30 POTASSIUM CITRATE (ALKALINIZER) ................. 27 POTIGA ............................ 15 PRADAXA ......................... 28 pramipexole dihydrochloride .......................................... 17 PRANDIMET ..................... 21 PRANDIN .......................... 22 PRAVACHOL

see pravastatin sodium.. 11 pravastatin sodium ............ 11 prazosin hcl ....................... 11 PRECOSE

see acarbose ................. 21 PRED MILD ...................... 32 PRED-G ............................ 32 PRED-G S.O.P. ................ 32 prednicarbate .................... 36 PREDNICARBATE ........... 36 prednisolone ..................... 24 PREDNISOLONE ACETATE .......................................... 32 prednisolone sodium phosphate ......................... 24

prednisolone sodium phosphate (ophth) ............. 32 prednisone ........................ 24 PREGNYL W/DILUENT BENZYL ............................ 25 PRELONE

see prednisolone ........... 24 PREMARIN ....................... 24 PREMARIN CREAM ......... 24 PREMARIN INJ ................ 24 premasol 10% ................... 31 premasol 6% ..................... 31 PREMPHASE ................... 24 PREMPRO ........................ 24 PRENATAL VITAMIN/FOLIC ACID > 0.8 MG (GENERIC) .......................................... 32 PREPOPIK ....................... 27 PREVACID

see lansoprazole ........... 27 PREVACID SOLUTAB ...... 27 PREVPAC ......................... 27 PREZISTA .......................... 5 PRIFTIN .............................. 5 PRILOSEC

see omeprazole ............. 27 PRIMAQUINE PHOSPHATE ............................................ 5 PRIMAXIN IV

see imipenem-cilastatin ... 4 primidone .......................... 15 PRIMSOL SOL 50MG/5ML . 4 PRINIVIL

see lisinopril .................. 10 PRINZIDE

see lisinopril & hydrochlorothiazide ....... 10

PRISTIQ ........................... 16 PRIVIGEN ......................... 29 PROAIR HFA .................... 34 probenecid .......................... 1 PROCALAMINE ................ 31 PROCARDIA XL

see nifedipine er ............ 13 see nifedipine xl ............ 13

prochlorperazine inj 5 mg/ml .......................................... 26 prochlorperazine maleate . 26 prochlorperazine supp ...... 26 PROCRIT .......................... 28

procto-pak cre 1%............. 35 proctozone cre -hc 2.5% ... 35 PROCYSBI ....................... 23 progesterone micronized .. 25 PROGLYCEM ................... 24 PROGRAF ........................ 29

see tacrolimus ......... 29, 30 PROLASTIN-C.................. 34 PROLENSA ...................... 33 PROLEUKIN ....................... 9 PROLIA ............................ 25 PROMACTA ..................... 29 promethazine hcl .............. 26 PROMETRIUM

see progesterone micronized ..................... 25

propafenone hcl ................ 11 proparacaine hcl ............... 33 propranolol & hydrochlorothiazide ........... 12 propranolol hcl er .............. 12 propranolol inj 1mg/ml ...... 12 propranolol sol .................. 12 propranolol tab .................. 12 propylthiouracil ................. 25 PROQUAD ....................... 30 PROSCAR

see finasteride ............... 27 PROSOL ........................... 31 PROTONIX ....................... 27

see pantoprazole sodium ...................................... 27

PROTOPIC ....................... 37 protriptyline hcl ................. 16 PROVENTIL HFA ............. 34 PROVERA

see medroxyprogesterone acetate .......................... 25

PROVIGIL see modafinil ................. 20

PROZAC see fluoxetine hcl .......... 16

PROZAC WEEKLY see fluoxetine hcl .......... 16

PRUDOXIN CRE 5% ........ 35 PULMICORT

see budesonide (inhalation) .................... 34

PULMICORT FLEXHALER.......................................... 34

57

58

PULMICORT INH SUSP ... 34 PULMOZYME ................... 34 PURINETHOL

see mercaptopurine .........9 PYLERA ............................ 27 pyrazinamide .......................5 pyridostigmine bromide ..... 19 Q QNASL .............................. 34 QUALAQUIN

see quinine sulfate ..........5 QUARTETTE .................... 23 QUESTRAN

see cholestyramine ....... 11 QUESTRAN LIGHT

see cholestyramine light 12 quetiapine fumarate .......... 18 QUILLIVANT XR ............... 19 quinapril hcl ....................... 10 quinapril-hydrochlorothiazide .......................................... 10 quinidine gluconate er ....... 11 quinidine sulfate ................ 11 quinine sulfate .....................5 QVAR ................................ 34 R RABAVERT ....................... 30 ramipril .............................. 10 RANEXA ........................... 14 ranitidine hcl ...................... 26 RAPAFLO ......................... 27 RAPAMUNE ...................... 29 RAYOS ............................. 24 RAZADYNE

see galantamine hydrobromide ................ 16

RAZADYNE ER see galantamine hydrobromide ................ 16

REBETOL ...........................6 see ribasphere 200mg .....6 see ribavirin 200mg .........6

REBIF ............................... 19 REBIF TITRATION PACK . 19 RECOMBIVAX HB ............ 30 RECTIV ............................. 37 REGLAN

see metoclopramide hcl. 25 REGONOL ........................ 19 RELENZA DISKHALER ......6

RELISTOR ........................ 27 RELPAX ............................ 19 REMERON

see mirtazapine ............. 16 REMERON SOLTAB

see mirtazapine ............. 16 REMICADE ....................... 29 REMODULIN .................... 14 RENAGEL ......................... 25 RENVELA ......................... 25 REPREXAIN

see ibudone tab 5-200mg 2 reprexain 10/200 ................. 2 REQUIP

see ropinirole hydrochloride ................. 17

REQUIP XL see ropinirole hydrochloride ................. 17

RESCRIPTOR .................... 5 RESTASIS ........................ 33 RETIN-A

see tretinoin ................... 35 RETROVIR

see zidovudine ................ 5 RETROVIR IV INFUSION ... 5 REVATIO

see sildenafil citrate (pulmonary hypertension) ...................................... 14

REVIA see naltrexone hcl ......... 20

REVLIMID ......................... 29 REYATAZ ........................... 5 RHEUMATREX ................. 29 RHINOCORT AQUA ......... 34 ribapak ................................ 6 ribapak mis 600/day ............ 6 ribasphere ........................... 6 ribasphere 200mg ............... 6 ribavirin 200mg ................... 6 RIFADIN

see rifampin ..................... 6 rifampin ............................... 6 RIFATER ............................ 6 RILUTEK ........................... 19

see riluzole .................... 19 riluzole .............................. 19 rimantadine hydrochloride ... 6 RINGER'S ......................... 31

RIOMET ............................ 22 RISPERDAL

see risperidone.............. 18 RISPERDAL CONSTA ..... 18 RISPERDAL M-TAB

see risperidone odt ........ 18 risperidone ........................ 18 risperidone odt .................. 18 RITALIN

see methylphenidate hcl 18 RITALIN LA ...................... 19

see methylphenidate hcl 18 RITUXAN ............................ 9 rivastigmine tartrate .......... 16 rizatriptan benzoate .......... 19 ROBAXIN

see methocarbamol ....... 20 ROBAXIN-750

see methocarbamol ....... 20 ROBINUL

see glycopyrrolate ......... 26 ROBINUL FORTE

see glycopyrrolate ......... 26 ROCALTROL

see calcitriol ............ 31, 32 ROCEPHIN

see ceftriaxone sodium ... 6 ropinirole hydrochloride .... 17 rosadan cre 0.75% ............ 37 ROTATEQ ........................ 30 ROWASA

see mesalamine enema kit ...................................... 26

ROXICODONE see oxycodone hcl .......... 3

ROZEREM ........................ 19 RYTHMOL

see propafenone hcl ...... 11 RYTHMOL SR

see propafenone hcl ...... 11 S SABRIL ............................. 15 SAIZEN ............................. 24 SAIZEN CLICK.EASY ....... 24 SALAGEN

see pilocarpine hcl (oral) ...................................... 37

SAMSCA .......................... 25 SANCTURA

see trospium chloride .... 28

58

59

SANCTURA XR see trospium chloride .... 28

SANCUSO ........................ 26 SANDIMMUNE

see cyclosporine ............ 29 SANDIMMUNE CAPS ....... 29 SANDIMMUNE SOLN ....... 29 SANDOSTATIN

see octreotide acetate ... 25 SANDOSTATIN LAR DEPOT ............................. 25 SANTYL ............................ 37 SAPHRIS .......................... 18 SARAFEM ......................... 20 SAVELLA .......................... 19 SAVELLA TITRATION PACK ................................ 19 SEASONIQUE

see levonorgestrel-ethinyl estradiol (91-day) .......... 22

SECTRAL see acebutolol hcl .......... 12

selegiline hcl ..................... 17 selenium sulfide ................ 36 SELSUN SHAMPOO

see selenium sulfide ...... 36 SELZENTRY .......................5 SEMPREX-D ..................... 33 SENSIPAR ........................ 22 SEREVENT DISKUS ........ 34 SEROQUEL

see quetiapine fumarate 18 SEROQUEL XR ................ 18 SEROSTIM ....................... 24 sertraline hcl ...................... 16 SFROWASA ..................... 26 sildenafil citrate (pulmonary hypertension) .................... 14 SILENOR .......................... 19 SILVER SULFADIAZINE... 35 SIMCOR............................ 12 SIMPONI ........................... 29 SIMULECT ........................ 29 simvastatin ........................ 11 SINEMET

see carbidopa-levodopa 17 SINEMET CR

see carbidopa-levodopa 17 SINGULAIR

see montelukast sodium 34

SIRTURO ............................ 6 SKLICE ............................. 37 SOD FLUORIDE 2.2MG TAB ................................... 30 SODIUM CHLORIDE .. 30, 31 SODIUM CHLORIDE 0.45% VIA .................................... 31 SODIUM CHLORIDE 0.9% .......................................... 37 sodium phenylbutyrate ...... 23 sodium polystyrene sulfonate .......................................... 22 SOLARAZE ....................... 35 SOLIA ............................... 23 SOLODYN .......................... 8

see minocycline hcl ......... 8 SOLTAMOX ........................ 9 SOLU-CORTEF 1000MG . 24 SOLU-CORTEF 100MG ... 24 SOLU-CORTEF 250MG ... 24 SOLU-CORTEF 500MG ... 24 SOLU-MEDROL ............... 24

see methylprednisolone sod succ ........................ 24

SOMATULINE DEPOT ..... 25 SOMAVERT ...................... 25 SONATA

see zaleplon .................. 19 SORIATANE ..................... 35 SORILUX .......................... 35 sotalol hcl .......................... 11 sotalol hcl (afib/afl) ............ 11 SPIRIVA HANDIHALER .... 33 spironolactone .................. 10 spironolactone & hydrochlorothiazide ........... 13 SPORANOX

see itraconazole .............. 4 SPORANOX SOL 10MG/ML ............................................ 5 SPRYCEL ........................... 9 sps sus 15gm/60ml ........... 22 SSD .................................. 35 stagesic 500-5mg ............... 2 STARLIX

see nateglinide .............. 21 stavudine ............................ 5 STAVZOR ......................... 15 STELARA ......................... 35 STERILE WATER

IRRIGATION ..................... 37 STIMATE .......................... 25 STIVARGA ......................... 9 STRATTERA .................... 19 streptomycin sulfate ............ 3 STRIANT .......................... 20 STRIBILD ........................... 5 STROMECTOL ................... 4 SUBOXONE

see buprenorphine hcl-naloxone hcl sl ......... 20

SUBOXONE MIS 12-3MG 20 SUBOXONE MIS 2-0.5MG.......................................... 20 SUBOXONE MIS 4-1MG .. 20 SUBOXONE MIS 8-2MG .. 20 SUBSYS ............................. 3 SUCLEAR ......................... 27 SUCRAID ......................... 27 sucralfate .......................... 27 SULAR

see nisoldipine .............. 13 sulfacetamide sodium (acne).......................................... 35 sulfacetamide sodium (ophth) .............................. 32 sulfacetamide sod-prednisolone .............. 32 sulfadiazine ......................... 3 sulfamethoxazole-trimethoprim ......................................... 4 sulfamethoxazole-trimethoprim inj .................................... 4 SULFAMYLON ................. 35

see mafenide acetate .... 35 sulfasalazine dr ................. 26 sulfasalazine ir .................. 26 sulindac .............................. 1 sumatriptan succinate ....... 19 SUMATRIPTAN SUCCINATE ..................... 19 sumatriptan succinate inj .. 19 SUMATRIPTAN SUCCINATE INJ............... 19 SUMAVEL DOSEPRO ...... 19 suprax ................................. 6 SUPRAX ............................. 6 SUPREP BOWEL PREP .. 27 SURMONTIL

see trimipramine maleate

59

60

...................................... 17 SUSTIVA.............................5 SUTENT..............................9 syeda ................................ 23 SYLATRON ....................... 10 SYMBICORT ..................... 34 SYMLINPEN 120 .............. 21 SYMLINPEN 60 ................ 21 SYNAGIS .......................... 30 SYNALAR

see fluocinolone acetonide ...................................... 36

SYNALGOS-DC ..................2 SYNAREL ......................... 23 SYNERA ........................... 37 SYNERCID .........................4 SYNTHROID ..................... 25

see levothyroxine sodium ...................................... 25

SYPRINE .......................... 22 T TABLOID.............................9 TACLONEX ....................... 36 tacrolimus.................... 29, 30 TAFINLAR ...........................9 TAMBOCOR

see flecainide acetate .... 11 TAMIFLU.............................6 tamoxifen citrate ..................9 tamsulosin hcl ................... 27 TAPAZOLE

see methimazole ........... 25 TARCEVA ...........................9 TARGRETIN ............... 10, 37 TARKA .............................. 10 TASIGNA ............................9 TAXOTERE .........................9 tazicef vial ...........................6 TAZORAC ......................... 35 taztia xt ............................. 13 TECFIDERA ...................... 19 TECFIDERA STARTER PACK ................................ 19 TEFLARO ...........................6 TEGRETOL ....................... 15

see carbamazepine ....... 14 TEGRETOL-XR ................ 15

see carbamazepine ....... 14 TEKAMLO ......................... 13 TEKTURNA ....................... 13

TEKTURNA HCT .............. 13 TEMOVATE

see clobetasol propionate ...................................... 36

TEMOVATE E see clobetasol propionate emollient base ............... 36

TENORETIC 100 see atenolol & chlorthalidone ................ 12

TENORETIC 50 see atenolol & chlorthalidone ................ 12

TENORMIN see atenolol ................... 12

TERAZOL 3 see terconazole vaginal . 28

TERAZOL 7 see terconazole vaginal . 28

terazosin hcl ...................... 11 terbinafine hcl ..................... 5 terbutaline sulfate ............. 34 terconazole vaginal ........... 28 TESTIM ............................. 20 testosterone cypionate ...... 20 testosterone enanthate ..... 20 TETANUS TOXOID ADSORBED ...................... 30 TETANUS/DIPHTHERIA TOXOID ............................ 30 tetrahydrozoline hcl ........... 34 TEVETEN ......................... 11

see eprosartan mesylate ...................................... 11

TEVETEN HCT ................. 11 TEV-TROPIN .................... 24 texacort ............................. 36 THALOMID ....................... 29 theo-24 .............................. 34 theophylline ....................... 34 THERMAZENE ................. 35 thioridazine hcl .................. 18 thiotepa ............................... 8 thiothixene ........................ 18 THYMOGLOBULIN ........... 30 tiagabine hcl ...................... 15 TIAZAC

see diltiazem hcl er........ 13 see diltiazem hcl extended release beads ................ 13

see diltzac ..................... 13 see taztia xt ................... 13

TIKOSYN .......................... 11 TIMENTIN ........................... 8 TIMENTIN INJ 3.1GM ......... 8 timolol maleate ................. 12 timolol maleate (ophth) ..... 33 TIMOLOL MALEATE GEL 33 TIMOPTIC

see timolol maleate (ophth) ........................... 33

TIMOPTIC OCUDOSE ..... 33 TIROSINT ......................... 25 tizanidine .......................... 20 TOBI NEB ........................... 3 TOBRADEX ...................... 32

see tobramycin-dexamethasone .................................... 32

TOBRADEX ST ................ 32 tobramycin sulfate............... 3 tobramycin sulfate (ophth) 32 tobramycin sulfate in saline 3 tobramycin-dexamethasone.......................................... 32 TOBREX

see tobramycin sulfate (ophth) ........................... 32

TOBREX OINT 0.3% ........ 32 TOFRANIL

see imipramine hcl ........ 16 TOFRANIL-PM

see imipramine pamoate ...................................... 16

tolmetin sodium................... 1 tolterodine tartrate............. 28 TOPAMAX

see topiramate .............. 15 TOPAMAX SPRINKLE

see topiramate .............. 15 TOPICORT ....................... 36

see desoximetasone ..... 36 topiramate ......................... 15 topotecan hcl .................... 10 TOPROL XL

see metoprolol succinate ...................................... 12

TORISEL ............................ 9 torsemide inj ..................... 13 torsemide tabs .................. 13

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61

TOVIAZ ............................. 28 TPN ELECTROLYTES ..... 30 TRACLEER ....................... 14 TRADJENTA ..................... 22 tramadol hcl er ....................2 TRAMADOL HCL ER ..........2 TRAMADOL HCL ER (BIPHASIC) 100MG ............2 TRAMADOL HCL ER (BIPHASIC) 200MG ............2 tramadol hcl er (biphasic) 300mg .................................2 tramadol hcl tab 50 mg .......2 tramadol-acetaminophen ....2 TRANDATE

see labetalol hcl ............. 12 trandolapril ........................ 10 tranexamic acid ................. 29 TRANSDERM-SCOP ........ 26 TRANXENE T

see clorazepate dipotassium ................... 15

tranylcypromine sulfate ..... 16 travasol ............................. 31 TRAVATAN Z .................... 33 trazodone hcl .................... 16 TREANDA ...........................8 TRECATOR ........................6 TRELSTAR DEPOT MIXJECT.............................9 TRELSTAR LA MIXJECT....9 TRELSTAR MIXJECT .........9 TRENTAL

see pentoxifylline ........... 28 tretin x ............................... 35 tretinoin ....................... 10, 35 TRETINOIN MICROSPHERE ............... 35 TREXIMET ........................ 19 triamcinolone acetonide (mouth) ............................. 37 triamcinolone acetonide (nasal) ............................... 34 triamcinolone acetonide (topical) ............................. 37 triamterene & hydrochlorothiazide cap 37.5-25 mg ........................ 13 triamterene & hydrochlorothiazide tab

37.5-25 mg ........................ 14 triamterene & hydrochlorothiazide tab 75-50 mg ........................... 14 TRIBENZOR ..................... 11 TRICOR

see fenofibrate .............. 12 trifluoperazine hcl .............. 18 trifluridine .......................... 32 TRIGLIDE ......................... 12 TRILEPTAL ....................... 15

see oxcarbazepine ........ 15 TRILIPIX ........................... 12

see choline fenofibrate .. 12 trimethoprim ........................ 4 trimipramine maleate ........ 17 TRINESSA ........................ 23 TRI-NORINYL 28

see norethindrone-eth estradiol (triphasic) ........ 23

TRIOSTAT see liothyronine sodium . 25

TRISENOX ....................... 10 TRIZIVIR ............................. 5 TROPHAMINE .................. 31 trospium chloride .............. 28 TRUSOPT

see dorzolamide hcl ...... 33 TRUVADA ........................... 5 TUDORZA PRESSAIR ..... 33 TWINRIX ........................... 30 TWYNSTA ........................ 11 TYGACIL ............................ 4 TYKERB ............................. 9 TYLENOL/CODEINE #3

see acetaminophen w/ codeine ............................ 1

TYLENOL/CODEINE #4 see acetaminophen w/ codeine ............................ 1

TYPHIM VI ........................ 30 TYSABRI .......................... 20 TYZEKA .............................. 6 tyzine pediatric nasal dr .... 34 U UCERIS ............................ 26 ULESFIA ........................... 37 ULORIC .............................. 1 ULTRACET

see

tramadol-acetaminophen 2 ULTRAM

see tramadol hcl tab 50 mg ................................... 2

ULTRAM ER see tramadol hcl er .......... 2

ULTRAVATE see halobetasol propionate ..................... 36

ULTRESA ......................... 27 UNASYN

see ampicillin & sulbactam sodium ............................ 7

UNASYN BULK PACK see ampicillin & sulbactam sodium ............................ 7

UNIRETIC see moexipril-hydrochlorothiazide .................................. 10

UNITHROID ...................... 25 UNIVASC

see moexipril hcl ........... 10 urea-hc acetate ................. 37 URECHOLINE

see bethanechol chloride ...................................... 27

UROCIT-K ........................ 27 UROXATRAL

see alfuzosin hcl ............ 27 URSO 250

see ursodiol ................... 27 URSO FORTE

see ursodiol ................... 27 ursodiol ............................. 27 UVADEX ........................... 10 V VAGIFEM ......................... 24 valacyclovir hcl.................... 6 VALCYTE ........................... 6 VALIUM

see diazepam ................ 15 valproate sodium .............. 16 valproic acid ...................... 16 valsartan-hydrochlorothiazide........................................ 11 VALTREX

see valacyclovir hcl ......... 6 VANCOCIN HCL

see vancomycin hcl ......... 4

61

62

vancomycin hcl ...................4 VANDAZOLE .................... 28 VANOS ............................. 37 VAQTA .............................. 30 VARIVAX .......................... 30 VASCEPA ......................... 12 VASERETIC

see enalapril maleate & hydrochlorothiazide ....... 10

VASOTEC see enalapril maleate .... 10

VECTIBIX............................9 VELCADE ...........................9 VELTIN ............................. 35 venlafaxine cap er ............. 17 VENLAFAXINE HCL ER

see venlafaxine tab er ... 17 venlafaxine tab .................. 17 venlafaxine tab er .............. 17 VENTAVIS ........................ 14 VENTOLIN HFA ................ 34 VERAMYST ...................... 34 verapamil hcl ..................... 13 VERAPAMIL HCL ............. 13 VERDESO ........................ 37 VERELAN

see verapamil hcl .......... 13 VERELAN PM

see verapamil hcl .......... 13 veripred ............................. 24 VESICARE ........................ 28 vestura .............................. 23 VEXOL .............................. 32 VFEND

see voriconazole .............5 VFEND IV

see voriconazole inj 200mg .............................5

VFEND SUS 40MG/ML .......5 VIBATIV ..............................4 VIBRAMYCIN ......................8

see doxycycline (monohydrate) .................8 see doxycycline hyclate ...8

vicodin .................................2 vicodin es ............................2 vicodin hp ............................2 VICOPROFEN

see hydrocodone-ibuprofen

7.5-200mg ....................... 2 VICTOZA .......................... 21 VICTRELIS ......................... 6 VIDAZA ............................... 9 VIDEX EC

see didanosine ................ 5 VIDEX PEDIATRIC ............. 5 VIGAMOX ......................... 32 VIIBRYD ........................... 17 VIMOVO ............................. 1 VIMPAT ............................ 16 vinblastine sulfate ............... 9 vincristine sulfate ................ 9 vinorelbine tartrate .............. 9 VIOKACE 10440 UNIT...... 27 VIOKACE 20880 UNIT...... 27 viorele ............................... 23 VIRACEPT .......................... 5 VIRAMUNE ......................... 5

see nevirapine ................. 5 VIRAMUNE XR ................... 5 VIREAD .............................. 5 VIROPTIC

see trifluridine ................ 32 VISICOL ............................ 27 VISTARIL

see hydroxyzine pamoate ...................................... 33

VISTIDE see cidofovir .................... 6

VIVACTIL see protriptyline hcl ....... 16

VIVELLE-DOT .................. 24 VIVITROL ......................... 20 VOLTAREN GEL 1% ........ 37 VOLTAREN-XR

see diclofenac sodium ..... 1 voriconazole ........................ 5 voriconazole inj 200mg ....... 5 VOSOL HC

see acetic acid sol/hc .... 37 see hydrocortisone w/acetic acid .................. 37

VOSPIRE ER see albuterol sulfate er .. 34

VOTRIENT ........................ 10 VPRIV ............................... 23 VYTORIN .......................... 12 VYVANSE ......................... 19

W warfarin sodium ................ 28 WELCHOL ........................ 12 WELLBUTRIN

see bupropion hcl .......... 16 WELLBUTRIN SR

see bupropion hcl .......... 16 WELLBUTRIN XL

see bupropion hcl .......... 16 WESTCORT

see hydrocortisone valerate ......................... 36

X XALATAN

see latanoprost.............. 33 XALKORI .......................... 10 XANAX

see alprazolam .............. 14 XARELTO ......................... 28 XELJANZ .......................... 29 XENAZINE ........................ 19 XEOMIN ........................... 33 XERESE ........................... 36 XGEVA ............................. 25 XIFAXAN TAB 200MG ........ 4 XIFAXAN TAB 550MG ...... 27 XODOL

see hydrocodone-acetaminophen 10-300mg ................... 2 see hydrocodone-acetaminophen 5-300mg ..................... 1 see hydrocodone-acetaminophen 7.5-300mg .................. 1 see vicodin ...................... 2 see vicodin es ................. 2 see vicodin hp ................. 2

XOLAIR ............................ 34 XOPENEX CONCENTRATE

see levalbuterol conc 1.25mg/0.5ml ................ 34

XOPENEX HFA ................ 34 XTANDI .............................. 9 XYLOCAINE

see lidocaine hcl ............ 37 see lidocaine hcl (local anesth.) ........................... 3 see lidocaine inj 1% ........ 3

62

63

see lidocaine inj 2% .........3 XYLOCAINE-MPF

see lidocaine hcl (local anesth.) ...........................3 see lidocaine inj 0.5% ......3 see lidocaine inj 1% .........3 see lidocaine inj 1.5% ......3 see lidocaine inj 2% .........3

XYREM ............................. 20 XYZAL

see levocetirizine soln 2.5mg/5ml ...................... 33 see levocetirizine tab 5 mg ...................................... 33

Y YASMIN 28

see drospirenone-ethinyl estradiol ......................... 22 see syeda ...................... 23 see zarah ....................... 23

YAZ see drospirenone-ethinyl estradiol ......................... 22 see vestura .................... 23

YF-VAX ............................. 30 Z zafirlukast .......................... 34 zaleplon ............................ 19 ZANAFLEX

see tizanidine ................ 20 ZANOSAR ...........................8 ZANTAC

see ranitidine hcl ........... 26 zarah ................................. 23 ZARONTIN

see ethosuximide .......... 15 ZAROXOLYN

see metolazone ............. 13 ZAVESCA ......................... 23 ZAZOLE ............................ 28 ZEBETA

see bisoprolol fumarate . 12 ZEGERID .......................... 27 ZELAPAR.......................... 17

ZELBORAF ....................... 10 ZEMAIRA .......................... 34 ZEMPLAR ......................... 32 zenatane ........................... 35 zenchent tab ..................... 23 ZENPEP ........................... 27 ZERIT

see stavudine .................. 5 ZESTORETIC

see lisinopril & hydrochlorothiazide ....... 10

ZESTRIL see lisinopril .................. 10

ZETIA ................................ 12 ZETONNA ......................... 34 ZIAC

see bisoprolol & hydrochlorothiazide ....... 12

ZIAGEN .............................. 5 see abacavir sulfate ........ 5

ZIANA ............................... 35 zidovudine ........................... 5 ZINACEF

see cefuroxime sodium ... 6 ZINECARD

see dexrazoxane ........... 10 ZIOPTAN .......................... 33 ziprasidone hcl .................. 18 ZIPSOR .............................. 1 ZIRGAN ............................ 32 ZITHROMAX

see azithromycin ............. 7 ZMAX .................................. 7 ZOCOR

see simvastatin ............. 11 ZOFRAN

see ondansetron hcl ...... 25 see ondansetron hcl inj . 25 see ondansetron hcl oral soln ................................ 25

ZOFRAN ODT see ondansetron odt...... 26

zoledronic inj 4mg/5ml ...... 22 ZOLINZA ............................. 9

zolmitriptan ....................... 19 zolmitriptan odt ................. 19 ZOLOFT

see sertraline hcl ........... 16 zolpidem tartrate ............... 19 ZOLPIMIST ....................... 19 ZOMETA ........................... 22

see zoledronic inj 4mg/5ml ...................................... 22

ZOMIG .............................. 19 see zolmitriptan ............. 19

ZOMIG ZMT ..................... 19 see zolmitriptan odt ....... 19

ZONALON ........................ 35 ZONEGRAN

see zonisamide ............. 16 zonisamide ....................... 16 ZORBTIVE ........................ 24 ZORTRESS ...................... 30 ZOSTAVAX ...................... 30 ZOSYN ............................... 8

see piperacillin sodium-tazobactam sodium ............................ 8

zovia ................................. 23 ZOVIRAX .......................... 36

see acyclovir ................... 6 see acyclovir topical ...... 36

ZYBAN see bupropion hcl (smoking deterrent) ....... 20

ZYCLARA ......................... 37 ZYFLO CR ........................ 34 ZYLET .............................. 32 ZYLOPRIM

see allopurinol tab ........... 1 ZYMAXID .......................... 32 ZYPREXA

see olanzapine ........ 17, 18 ZYPREXA ZYDIS

see olanzapine odt ........ 18 ZYTIGA ............................... 9 ZYVOX ............................... 4

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This formulary was updated on 08/29/2013. For more recent information or other questions, please contactSilverScript (Employer PDP), at 1-866-693-4614 or, for TTY users, 1-866-236-1069, 24 hours a day, 7 daysa week.

This information is available for free in other languages. Please call our Customer Care number at1-866-693-4614 (TTY: 1-866-236-1069), 24 hours a day, 7 days a week. Esta información estádisponible gra1-866-236-1069tuitamente en otros idiomas. Llame a nuestro Servicio al Miembro, al1-866-693-4614 (teléfono de texto (TTY): 1-866-236-1069), las 24 horas del día, los 7 días de lasemana.

SilverScript (Employer PDP) is a Prescription Drug Plan. This plan is offered by SilverScript InsuranceCompany, which has a Medicare contract. Enrollment depends on contract renewal.

P.O. Box 52424, Phoenix, AZ 85072-2424