2019 wps preferred drugs guide...list of abbreviations aca: affordable care act.la: limited...

2019 WPS Preferred Drugs GuideIndividual and Small Group Formulary

©2019 Wisconsin Physicians Service Insurance Corporation. All rights reserved. JO15050 32772-100-1904

1

Table of Contents

ANTI - INFECTIVES ........................................................................................................................................ 3

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS ....................................................................... 7

AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCH ....................................................................... 12

CARDIOVASCULAR, HYPERTENSION & LIPIDS ................................................................................. 21

DERMATOLOGICALS/TOPICAL THERAPY .......................................................................................... 28

DIAGNOSTICS & MISCELLANEOUS AGENTS ...................................................................................... 34

EAR, NOSE & THROAT MEDICATIONS .................................................................................................. 35

ENDOCRINE/DIABETES .............................................................................................................................. 36

GASTROENTEROLOGY .............................................................................................................................. 41

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY ............................................................................. 46

MUSCULOSKELETAL & RHEUMATOLOGY ......................................................................................... 49

OBSTETRICS & GYNECOLOGY ................................................................................................................ 50

OPHTHALMOLOGY ..................................................................................................................................... 55

RESPIRATORY, ALLERGY, COUGH & COLD ....................................................................................... 58

UROLOGICALS .............................................................................................................................................. 62

VITAMINS, HEMATINICS & ELECTROLYTES ..................................................................................... 63

Index .................................................................................................................................................................. 69

List of Abbreviations

ACA: Affordable Care Act.

LA: Limited Availability. This prescription may be available only at certain pharmacies. For more

information, please call Customer Service.

PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs.

This means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we

may not cover the drug.

QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical

condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat

your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for

you, we will then cover Drug B.

ACA Preventive Drug List

This includes drugs covered at no cost to members for non-grandfathered plans due to ACA mandates.

Coverage is limited to: (1) generic drugs and (2) brand-name drugs when there is no generic equivalent.

1. Aspirin for the prevention of cardiovascular disease if you are age 50 - 69 years.

2. Fluoride supplements if you are older than six months.

3. Folic acid.

4. Oral contraceptives, contraceptive patches, contraceptive devices for example, diaphragms,

sponges, gel and female condoms) and contraceptive vaginal rings for birth control.

5. Nicotine replacements (for example, patches and gum) and covered drugs used for smoking cessation

if you are age 18 years and over.

6. Vitamin D if you are age 65 years and over and are at an increased risk for falls.

7. Tamoxifen or raloxifene for women who are at increased risk for breast cancer and at low risk for

adverse medication effects. A prior authorization is required for coverage under the ACA mandate.

8. Routine immunizations recommended by the Centers for Disease Control Advisory Committee on

Immunization Practices used in pediatrics and adults (not travel immunizations).

9. Bowel preps (limit of 2 prescriptions per year).

10. Statins (low/moderate dose, generic only) if you are age 40 - 75 years.

Drug Tier: identifies the member’s cost sharing requirement

Tier 1A,B Preferred generic drug.

Tier 2 Generic drug.

Tier 3 Preferred brand drug.

Tier 4 Brand drug.

Tier 5 Oral chemotherapy drug.

Tier 6 Specialty drug.

Tier 7 Preventive drug available at no cost to the member. A For Simple Choice copay Plans and Simple Choice HDHP plans, Tier 1 drugs have a member cost share. Only Tier 7

drugs are at no cost to you. B If you have a qualified High Deductible Health Plan (other than a Simple Choice plan), the following Tier 1

preventive drugs listed on the grid below are available to you at no out of pocket cost. Other Tier 1 drugs are subject to deductible and coinsurance.

Tier 1 Preventive Drug List Drug Name Dosage Form

ACEBUTOLOL HCL 200 MG Capsule

ACEBUTOLOL HCL 400 MG Capsule

ALBUTEROL SULFATE 2 MG/5 ML Syrup

ALBUTEROL SULFATE 4 MG Tablet

ALENDRONATE SODIUM 10 MG Tablet



AMILORIDE/

HYDROCHLOROTHIAZIDE

5MG-50MG Tablet

AMLODIPINE BESYLATE 10 MG Tablet

AMLODIPINE BESYLATE 2.5 MG Tablet

AMLODIPINE BESYLATE 5 MG Tablet

ATENOLOL 100 MG Tablet



ATENOLOL/

CHLORTHALIDONE

100MG-

25MG

Tablet

ATENOLOL/

CHLORTHALIDONE

50 MG-

25MG

Tablet

ATORVASTATIN CALCIUM 40 MG Tablet

ATORVASTATIN CALCIUM 80 MG Tablet

BENAZEPRIL HCL 10 MG Tablet




BISOPROLOL FUMARATE 10 MG Tablet

BISOPROLOL FUMARATE 5 MG Tablet

BISOPROLOL FUMARATE/

HCTZ

10-6.25MG Tablet

BISOPROLOL FUMARATE/

HCTZ

5-6.25MG Tablet

CARVEDILOL 12.5 MG Tablet

CARVEDILOL 25 MG Tablet



CHLOROTHIAZIDE 250 MG Tablet

CHLOROTHIAZIDE 500 MG Tablet

CHLORTHALIDONE 25 MG Tablet

CHLORTHALIDONE 50 MG Tablet

CLONIDINE HCL 0.1 MG Tablet



DILTIAZEM HCL 120 MG Tablet




DILTIAZEM 24HR CD 180 MG Capsule




ENALAPRIL MALEATE 10 MG Tablet

ENALAPRIL MALEATE 2.5 MG Tablet



ENALAPRIL/

HYDROCHLOROTHIAZIDE

10 MG-

25MG

Tablet

Drug Name Dosage Form

ENALAPRIL/

HYDROCHLOROTHIAZIDE

5MG-

12.5MG

Tablet

GEMFIBROZIL 600 MG Tablet

GLIMEPIRIDE 1 MG Tablet



GLIPIZIDE 10 MG Tablet

GLIPIZIDE 10 MG Tablet-

24 Hr

GLIPIZIDE 2.5 MG Tablet-

24 Hr

GLIPIZIDE 5 MG Tablet

GLIPIZIDE 5 MG Tablet-

24 Hr

GLYBURIDE 1.25 MG Tablet

GLYBURIDE 2.5 MG Tablet

GLYBURIDE 5 MG Tablet

GLYBURIDE,MICRONIZED 3 MG Tablet

GLYBURIDE,MICRONIZED 6 MG Tablet

HYDROCHLOROTHIAZIDE 12.5 MG Capsule

HYDROCHLOROTHIAZIDE 12.5 MG Tablet

HYDROCHLOROTHIAZIDE 25 MG Tablet

HYDROCHLOROTHIAZIDE 50 MG Tablet

INDAPAMIDE 1.25 MG Tablet

INDAPAMIDE 2.5 MG Tablet

IRBESARTAN 150 MG Tablet



LISINOPRIL 10 MG Tablet

LISINOPRIL 2.5 MG Tablet





LISINOPRIL/

HYDROCHLOROTHIAZIDE

10-12.5MG Tablet

LISINOPRIL/

HYDROCHLOROTHIAZIDE

20-12.5 MG Tablet

LISINOPRIL/

HYDROCHLOROTHIAZIDE

20-25MG Tablet

LOSARTAN POTASSIUM 100 MG Tablet



LOSARTAN/

HYDROCHLOROTHIAZIDE

100-

12.5MG

Tablet

LOSARTAN/

HYDROCHLOROTHIAZIDE

100MG-

25MG

Tablet

LOSARTAN/

HYDROCHLOROTHIAZIDE

50-12.5 MG Tablet

METFORMIN HCL 1000 MG Tablet

METFORMIN HCL 500 MG Tablet-

24 Hr


METFORMIN HCL 750 MG Tablet-

24 Hr



METOLAZONE 10 MG Tablet

METOLAZONE 2.5 MG Tablet

METOLAZONE 5 MG Tablet

METOPROLOL TARTRATE 100 MG Tablet



METOPROLOL/

HYDROCHLOROTHIAZIDE

100MG-

25MG

Tablet

METOPROLOL/

HYDROCHLOROTHIAZIDE

50 MG-

25MG

Tablet

MONTELUKAST SODIUM 10 MG Tablet

MONTELUKAST SODIUM 5 MG Tablet-

Chew

MONTELUKAST SODIUM 4 MG Tablet-

Chew

PROPRANOLOL HCL 10 MG Tablet





QUINAPRIL HCL 10 MG Tablet




RAMIPRIL 10 MG Capsule

RAMIPRIL 1.25 MG Capsule

RAMIPRIL 2.5 MG Capsule

RAMIPRIL 5 MG Capsule

SIMVASTATIN 80 MG Tablet

SODIUM FLUORIDE 1.10% Gel

SODIUM FLUORIDE 1.10% Cream

SPIRONOLACTONE 100 MG Tablet



TRIAMTERENE/

HYDROCHLOROTHIAZIDE

37.5-25 MG Capsule

TRIAMTERENE/

HYDROCHLOROTHIAZIDE

37.5-25 MG Tablet

TRIAMTERENE/

HYDROCHLOROTHIAZIDE

75 MG-

50MG

Tablet

VERAPAMIL HCL 120 MG Tab/Cap-

24hr

VERAPAMIL HCL 120 MG Tablet


24hr

VERAPAMIL HCL 200 MG Capsule-

24hr


24hr

VERAPAMIL HCL 300 MG Capsule-24hr

VERAPAMIL HCL 360 MG Capsule-

24hr



WARFARIN SODIUM 1 MG Tablet




WARFARIN SODIUM 2.5 MG Tablet





WARFARIN SODIUM 7.5 MG Tablet

You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table.

3

Drug Name Drug Tier

Requirements / Limits

ANTI - INFECTIVES

ANTIFUNGAL AGENTS

clotrimazole 2

CRESEMBA 3

fluconazole oral suspension for reconstitution

2

fluconazole oral tablet 100 mg, 200 mg, 50 mg

2

fluconazole oral tablet 150 mg

2 QL

flucytosine 2

griseofulvin microsize

2

griseofulvin ultramicrosize

2

itraconazole oral capsule

2 QL

itraconazole oral solution

2

ketoconazole 2

NOXAFIL 3

nystatin 2

ONMEL 4 QL

ORAVIG 4

terbinafine hcl 2

voriconazole 2

ANTIVIRALS

abacavir 6

abacavir-lamivudine 6

abacavir-lamivudine-zidovudine

6

Drug Name Drug Tier


acyclovir 2

adefovir 2

amantadine hcl 2

APTIVUS 6

atazanavir 6

ATRIPLA 6

BARACLUDE 3 PA

BIKTARVY 6

CIMDUO 6

COMPLERA 6

CRIXIVAN 6

DAKLINZA 6 PA

DESCOVY 6

didanosine 6

EDURANT 6

efavirenz 6

EMTRIVA 6

entecavir 2 PA

EPCLUSA 6 PA

EPIVIR HBV 3

EVOTAZ 6

famciclovir 2 QL

fosamprenavir 6

FUZEON 6

GENVOYA 6

HARVONI 6 PA

INTELENCE 6

INVIRASE 6

ISENTRESS 6

ISENTRESS HD 6

JULUCA 6


4

Drug Name Drug Tier


KALETRA 6

lamivudine oral solution

6

lamivudine oral tablet 100 mg

2

lamivudine oral tablet 150 mg, 300 mg

6

lamivudine-zidovudine

6

LEDIPASVIR-SOFOSBUVIR

6 PA

LEXIVA 6

lopinavir-ritonavir 6

MAVYRET 6 PA

nevirapine 6

NORVIR 6

ODEFSEY 6

oseltamivir 2

PIFELTRO 6 PA

PREVYMIS 3

PREZCOBIX 6

PREZISTA 6

RELENZA DISKHALER

3 QL

RESCRIPTOR 6

REYATAZ 6

ribavirin 2 PA

rimantadine 2

ritonavir 6

SELZENTRY 6

SITAVIG 4

SOFOSBUVIR-VELPATASVIR

6 PA

Drug Name Drug Tier


SOVALDI 6 PA

stavudine 6

STRIBILD 6

SYMFI 6

SYMFI LO 6

SYNAGIS 6 PA; LA

TECHNIVIE 4 PA

tenofovir disoproxil fumarate

6

TIVICAY 6

TRIUMEQ 6

TRUVADA 6

TYBOST 6

valacyclovir 2 QL

valganciclovir 2

VEMLIDY 3 PA

VIDEX 2 GRAM PEDIATRIC

6

VIEKIRA PAK 6 PA

VIRACEPT 6

VIRAZOLE 4 PA

VIREAD 6

VOSEVI 6 PA

XOFLUZA 3

ZEPATIER 6 PA

zidovudine 6

CEPHALOSPORINS

cefaclor 2

cefadroxil 2

cefdinir 2

cefditoren pivoxil 2

cefixime 2


5

Drug Name Drug Tier


cefpodoxime 2

cefprozil 2

cefuroxime axetil 2

cephalexin 2

SUPRAX 4

ERYTHROMYCINS & OTHER MACROLIDES

azithromycin 2

clarithromycin 2

DIFICID 4 PA

e.e.s. 400 2

ERYPED 200 4

ERYPED 400 4

ery-tab oral tablet,delayed release (dr/ec) 250 mg, 333 mg

2

ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 500 MG

4

erythrocin (as stearate)

2

erythromycin 2

erythromycin ethylsuccinate

2

MISCELLANEOUS ANTIINFECTIVES

albendazole 2

ALINIA 3

ARAKODA 4

ARIKAYCE 6 PA; LA

atovaquone 2

atovaquone-proguanil

2

Drug Name Drug Tier


BENZNIDAZOLE 3

BETHKIS 6 PA

CAYSTON 6 PA; LA

chloroquine phosphate

2

clindamycin hcl 2

clindamycin palmitate hcl

2

clindamycin pediatric

2

COARTEM 3

CYCLOSERINE 4

dapsone 2

DARAPRIM 6 PA

EMVERM 3

ethambutol 2

hydroxychloroquine 1

isoniazid 2

ivermectin 2

KITABIS PAK 6 PA

KRINTAFEL 4

linezolid 2

mefloquine 2

metronidazole 2

NEBUPENT 3 QL

neomycin 2

ORBACTIV 3

paromomycin 2

PASER 4

praziquantel 2

PRIFTIN 3

PRIMAQUINE 3


6

Drug Name Drug Tier


pyrazinamide 2

quinine sulfate 2

rifabutin 2

RIFAMATE 4

rifampin 2

RIFATER 4

SIRTURO 3 LA

SIVEXTRO 4

SOLOSEC 4

tinidazole 2

TOBI 6 PA

TOBI PODHALER 6 PA

tobramycin in 0.225 % nacl

6 PA

TOBRAMYCIN WITH NEBULIZER

6 PA

TRECATOR 4

XIFAXAN 3

PENICILLINS

amoxicillin oral capsule

1

amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml

2

amoxicillin oral suspension for reconstitution 250 mg/5 ml, 400 mg/5 ml

1

amoxicillin oral tablet

1

amoxicillin oral tablet,chewable 125 mg

2

Drug Name Drug Tier


amoxicillin oral tablet,chewable 250 mg

1

amoxicillin-pot clavulanate

2

ampicillin 1

AUGMENTIN 3

dicloxacillin 2

MOXATAG 4

penicillin v potassium oral recon soln 125 mg/5 ml

2

penicillin v potassium oral recon soln 250 mg/5 ml

1

penicillin v potassium oral tablet

1

QUINOLONES

BAXDELA 4

ciprofloxacin 2

ciprofloxacin (mixture)

2

ciprofloxacin hcl 2

FACTIVE 4 QL

LEVOFLOXACIN ORAL SOLUTION

4

levofloxacin oral tablet

2

moxifloxacin 2

ofloxacin 2

SULFA'S & RELATED AGENTS

sulfadiazine 2

sulfamethoxazole-trimethoprim oral suspension

2


7

Drug Name Drug Tier


sulfamethoxazole-trimethoprim oral tablet

1

sulfatrim 2

TETRACYCLINES

avidoxy 2

AVIDOXY DK 4 PA

coremino 2

demeclocycline 2

DORYX MPC 4 PA

doxycycline hyclate 2

doxycycline monohydrate

2

minocycline oral capsule 100 mg, 50 mg

1

minocycline oral capsule 75 mg

2

minocycline oral tablet

2

minocycline oral tablet extended release 24 hr 105 mg, 135 mg, 45 mg, 80 mg, 90 mg

2

minocycline oral tablet extended release 24 hr 115 mg, 65 mg

2 PA

mondoxyne nl 2

morgidox 2

MORGIDOX 1X 50 4 PA

MORGIDOX 2X100 4 PA

okebo 2

SOLODYN 3 PA

soloxide 2

Drug Name Drug Tier


TARGADOX 4 PA

tetracycline 2

VIBRAMYCIN 4

URINARY TRACT AGENTS

methenamine hippurate

2

methenamine mandelate

2

MONUROL 4

nitrofurantoin 2

nitrofurantoin macrocrystal

2

nitrofurantoin monohyd/m-cryst

2

PRIMSOL 4

trimethoprim 2

TRIMPEX 4

VANCOMYCIN

FIRVANQ 4

vancomycin 2

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS

ADJUNCTIVE AGENTS

amifostine crystalline

2 PA

ELITEK 3 PA

KEPIVANCE 6 PA

leucovorin calcium 2

MESNEX 3

VORAXAZE 3 PA

XGEVA 6 PA


8

Drug Name Drug Tier


ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS

abiraterone 5 PA

ABRAXANE 6 PA

ADCETRIS 6 PA

adriamycin 2 PA

AFINITOR 5 PA

AFINITOR DISPERZ

5 PA

ALECENSA 5 PA

ALIMTA 3 PA

ALIQOPA 6 PA; LA

ALUNBRIG 5 PA

anastrozole 5

ARRANON 6 PA

ARSENIC TRIOXIDE

4 PA

ARZERRA 6 PA

ASTAGRAF XL 6

AVASTIN 6 PA

azacitidine 6 PA

AZASAN 6

azathioprine 6

BAVENCIO 6 PA; LA

BELEODAQ 6 PA

BENDAMUSTINE 6 PA

BENDEKA 6 PA

BESPONSA 6 PA

bexarotene 5 PA

bicalutamide 5

bleomycin 2 PA

BLINCYTO 6 PA

Drug Name Drug Tier


BORTEZOMIB 6 PA

BOSULIF 5 PA

busulfan 2 PA

CABOMETYX 5 PA; LA

CALQUENCE 5 PA; LA

CAMPTOSAR 4 PA

capecitabine 5 PA

CAPRELSA 5 PA; LA

carboplatin 2 PA

carmustine 2 PA

cladribine 2 PA

clofarabine 2 PA

COMETRIQ 5 PA

COPIKTRA 5 PA; LA

COSMEGEN 4 PA

COTELLIC 5 PA; LA

cyclophosphamide 5

cyclosporine 6

cyclosporine modified

6

CYRAMZA 6 PA

dacarbazine 2 PA

DACOGEN 6 PA

dactinomycin 2 PA

DARZALEX 6 PA; LA

daunorubicin 2 PA

decitabine 6 PA

DOCEFREZ 3 PA


9

Drug Name Drug Tier


docetaxel intravenous solution 160 mg/16 ml (10 mg/ml), 160 mg/8 ml (20 mg/ml), 20 mg/2 ml (10 mg/ml), 20 mg/ml (1 ml), 80 mg/4 ml (20 mg/ml), 80 mg/8 ml (10 mg/ml)

2 PA

DOCETAXEL INTRAVENOUS SOLUTION 20 MG/ML

3 PA

doxorubicin 2 PA

doxorubicin, peg-liposomal

2 PA

DROXIA 3

ELIGARD 6 PA

ELIGARD (3 MONTH)

6 PA

ELIGARD (4 MONTH)

6 PA

ELIGARD (6 MONTH)

6 PA

ELLENCE 4 PA

EMCYT 5

EMPLICITI 6 PA

ENVARSUS XR 6

epirubicin 2 PA

ERBITUX 6 PA

ERIVEDGE 5 PA

ERLEADA 5 PA

etoposide 5

EVOMELA 6 PA

exemestane 5

Drug Name Drug Tier


FARESTON 5 PA

FARYDAK 5 PA

FASLODEX 3 PA

FIRMAGON KIT W DILUENT SYRINGE

6 PA

floxuridine 2 PA

flutamide 5 PA

FOLOTYN 6 PA

GAZYVA 6 PA

gemcitabine intravenous recon soln

2 PA

gemcitabine intravenous solution 1 gram/26.3 ml (38 mg/ml), 2 gram/52.6 ml (38 mg/ml), 200 mg/5.26 ml (38 mg/ml)

2 PA

GEMCITABINE INTRAVENOUS SOLUTION 100 MG/ML

4 PA

gengraf 6

GILOTRIF 5 PA

GLEEVEC 5 PA

GLEOSTINE 5 PA

GLIADEL WAFER 4 PA

HALAVEN 6 PA

HERCEPTIN 6 PA

HYCAMTIN INTRAVENOUS

6 PA

HYCAMTIN ORAL 5 PA

hydroxyurea 5

IBRANCE 5 PA


10

Drug Name Drug Tier


ICLUSIG 5 PA

idarubicin 2 PA

IDHIFA 5 PA; LA

imatinib 5 PA

IMBRUVICA 5 PA

IMFINZI 6 PA; LA

IMLYGIC 6 PA

INLYTA 5 PA

IRESSA 5 PA

irinotecan 2 PA

ISTODAX 6 PA

IXEMPRA 6 PA

JAKAFI 5 PA

JEVTANA 6 PA

KADCYLA 6 PA

KEYTRUDA 6 PA

KISQALI 5 PA

KISQALI FEMARA CO-PACK

5 PA

KYMRIAH 6 PA

KYPROLIS 6 PA

LARTRUVO 6 PA; LA

LENVIMA 5 PA

letrozole 5

LEUKERAN 5

leuprolide 6 PA

LIBTAYO 6 PA

lipodox 2 PA

lipodox 50 2 PA

LONSURF 5 PA

LORBRENA 5 PA

LUPRON DEPOT 6 PA

Drug Name Drug Tier


LUPRON DEPOT (3 MONTH)

6 PA


6 PA


6 PA

LUPRON DEPOT-PED

6 PA

LUPRON DEPOT-PED (3 MONTH)

6 PA

LYNPARZA 5 PA

LYSODREN 5 PA

MARQIBO 6 PA

MATULANE 5 PA

megestrol oral suspension

2

megestrol oral tablet 5

MEKINIST 5 PA

melphalan 5

mercaptopurine 5

methotrexate sodium (pf)

2

methotrexate sodium injection

2

methotrexate sodium oral

5

mitomycin 2 PA

mitoxantrone 6 PA

mycophenolate mofetil

6

mycophenolate sodium

6

MYLERAN 5 PA

MYLOTARG 6 PA; LA

NERLYNX 5 PA; LA


11

Drug Name Drug Tier


NEXAVAR 5 PA; LA

NILANDRON 5 PA

nilutamide 5 PA

NINLARO 5 PA

NIPENT 4 PA

octreotide acetate 6 PA

ODOMZO 5 PA; LA

ONCASPAR 3 PA

ONIVYDE 6 PA

OPDIVO 6 PA

oxaliplatin 2 PA

paclitaxel 2 PA

PERJETA 6 PA

PHOTOFRIN 3 PA

PURIXAN 5 PA

RITUXAN 6 PA

RITUXAN HYCELA

6 PA

ROMIDEPSIN 4 PA

RUBRACA 5 PA; LA

RYDAPT 5 PA

SANDIMMUNE 6

SANDOSTATIN 6 PA

SANDOSTATIN LAR DEPOT

6 PA

SIGNIFOR 6 PA

SIGNIFOR LAR 6 PA

sirolimus 6

SOLTAMOX 5

SOMATULINE DEPOT

6 PA

SPRYCEL 5 PA

Drug Name Drug Tier


STIVARGA 5 PA

SUPPRELIN LA 6 PA

SUTENT 5 PA

SYLVANT 6 PA

SYNRIBO 6 PA

TABLOID 5 PA

tacrolimus 6

TAFINLAR 5 PA

TAGRISSO 5 PA; LA

TALZENNA 5 PA

tamoxifen 5

TARCEVA 5 PA

TARGRETIN ORAL

5 PA

TARGRETIN TOPICAL

6 PA

TASIGNA 5 PA

TECENTRIQ 6 PA; LA

TEMODAR INTRAVENOUS

6 PA

TEMODAR ORAL 5 PA

temozolomide 5 PA

temsirolimus 6 PA

TENIPOSIDE 3 PA

TEPADINA 4 PA

THALOMID 6 PA

thiotepa 2 PA

topotecan 6 PA

toremifene 5 PA

TORISEL 6 PA

TREANDA 6 PA

TRELSTAR 4 PA


12

Drug Name Drug Tier


tretinoin (chemotherapy)

5 PA

TREXALL 5

TRIPTODUR 6 PA

TRISENOX 3 PA

TYKERB 5 PA; LA

UNITUXIN 6 PA

VANTAS 6 PA

VECTIBIX 6 PA

VELCADE 6 PA

VENCLEXTA 5 PA; LA

VENCLEXTA STARTING PACK

5 PA

VERZENIO 5 PA; LA

VIDAZA 6 PA

vinorelbine 2 PA

VIZIMPRO 5 PA

VOTRIENT 5 PA

VYXEOS 6 PA

XALKORI 5 PA

XATMEP 5

XELODA 5 PA

XERMELO 6 PA; LA

XTANDI 5 PA

YERVOY 6 PA

YESCARTA 6 PA

YONDELIS 6 PA

ZALTRAP 6 PA

ZANOSAR 3 PA

ZEJULA 5 PA; LA

ZELBORAF 5 PA

ZEVALIN (Y-90) 3 PA

Drug Name Drug Tier


ZOLADEX 6 PA

ZOLINZA 5 PA

ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG

6

ZORTRESS ORAL TABLET 1 MG

6 PA

ZYDELIG 5 PA

ZYKADIA 5 PA

ZYTIGA 5 PA

AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCH

ANTICONVULSANTS

APTIOM 4

BANZEL 3 PA

BRIVIACT 4

carbamazepine 2

CELONTIN 3

clobazam 2 PA

clonazepam 2

DIASTAT 4

diazepam 2

DILANTIN 3

divalproex 2

EPIDIOLEX 6 PA; LA

epitol 2

EQUETRO 4

ethosuximide 2

felbamate 2

FYCOMPA 3

gabapentin 2

GRALISE 3 ST


13

Drug Name Drug Tier


GRALISE 30-DAY STARTER PACK

3 ST

LAMICTAL XR STARTER (BLUE)

4

LAMICTAL XR STARTER (GREEN)

4

LAMICTAL XR STARTER (ORANGE)

4

lamotrigine 2

levetiracetam 2

LYRICA 3

oxcarbazepine 2

OXTELLAR XR 4

PEGANONE 3

phenobarbital 2

phenytoin 2

phenytoin sodium extended

2

primidone 2

QUDEXY XR 3

roweepra 2

roweepra xr 2

SABRIL 6 PA; LA

SPRITAM 4

subvenite 2

subvenite starter (blue) kit

2

subvenite starter (green) kit

2

subvenite starter (orange) kit

2

SYMPAZAN 4 PA

Drug Name Drug Tier


tiagabine 2

topiramate oral capsule, sprinkle

2

TOPIRAMATE ORAL CAPSULE,SPRINKLE,ER 24HR

4

topiramate oral tablet

2

TROKENDI XR 4

valproic acid 2

valproic acid (as sodium salt)

2

vigabatrin 6 PA; LA

vigadrone 6 PA

VIMPAT 3

zonisamide 2

ANTIPARKINSONISM AGENTS

APOKYN 6 PA; LA

benztropine 2

bromocriptine 2

carbidopa 2

carbidopa-levodopa 2

carbidopa-levodopa-entacapone

2

DUOPA 6

entacapone 2

GOCOVRI 6 PA

NEUPRO 4

pramipexole 2

rasagiline 2

ropinirole 2

RYTARY 4


14

Drug Name Drug Tier


selegiline hcl 2

tolcapone 2

trihexyphenidyl 2

ZELAPAR 4

MIGRAINE & CLUSTER HEADACHE THERAPY

AIMOVIG AUTOINJECTOR

3 PA

AIMOVIG AUTOINJECTOR (2 PACK)

3 PA

almotriptan malate 2 QL

dihydroergotamine injection

2

dihydroergotamine nasal

2 ST; QL

eletriptan 2 QL

EMGALITY PEN 3 PA

EMGALITY SYRINGE

3 PA

ERGOMAR 4

ergotamine-caffeine 2

frovatriptan 2 QL

migergot 2

naratriptan 2 QL

rizatriptan 2 QL

sumatriptan 2 QL

sumatriptan succinate oral

2 QL

sumatriptan succinate subcutaneous cartridge

2 QL

Drug Name Drug Tier


sumatriptan succinate subcutaneous pen injector

2 QL

sumatriptan succinate subcutaneous solution

2 QL

sumatriptan succinate subcutaneous syringe

2

sumatriptan-naproxen

2 ST; QL

zolmitriptan 2 QL

ZOMIG NASAL SPRAY,NON-AEROSOL 2.5 MG

3 ST

ZOMIG NASAL SPRAY,NON-AEROSOL 5 MG

3 ST; QL

MISCELLANEOUS NEUROLOGICAL THERAPY

AMPYRA 6 PA; LA

AUSTEDO 6 PA; LA

dalfampridine 6 PA

donepezil 2

EXONDYS 51 6 PA

galantamine 2

HORIZANT 4 ST

INGREZZA 6 PA; LA

KEVEYIS 6 PA

memantine oral capsule,sprinkle,er 24hr

2

memantine oral solution

2


15

Drug Name Drug Tier


memantine oral tablet

2

MEMANTINE ORAL TABLETS,DOSE PACK

4

NAMENDA TITRATION PAK

4

NUEDEXTA 3

RADICAVA 6 PA

rivastigmine 2

rivastigmine tartrate 2

TEGSEDI 6 PA; LA

tetrabenazine 6 PA

TYSABRI 6 PA; LA

XENAZINE 6 PA; LA

MUSCLE RELAXANTS & ANTISPASMODIC THERAPY

AMRIX 4

baclofen oral tablet 10 mg, 20 mg

1

BACLOFEN ORAL TABLET 5 MG

4

carisoprodol 2

carisoprodol-asa-codeine

2

carisoprodol-aspirin 2

chlorzoxazone 2

cyclobenzaprine oral tablet 10 mg, 5 mg

1

cyclobenzaprine oral tablet 7.5 mg

2

dantrolene 2

LORZONE 4

meprobamate 2

Drug Name Drug Tier


MESTINON 3

metaxall 2

metaxalone 2

methocarbamol 2

orphenadrine citrate 2

pyridostigmine bromide

2

tizanidine 2

NARCOTIC ANALGESICS

acetaminophen-caff-dihydrocod

2

acetaminophen-codeine

2

ALLZITAL 4

ascomp with codeine 2

BELBUCA 3

buprenorphine hcl 2

buprenorphine transdermal patch weekly 10 mcg/hour, 15 mcg/hour, 20 mcg/hour, 5 mcg/hour

2

BUPRENORPHINE TRANSDERMAL PATCH WEEKLY 7.5 MCG/HOUR

4

butalbital compound w/codeine

2

butalbital-acetaminop-caf-cod

2

butalbital-acetaminophen

2

butalbital-acetaminophen-caff

2


16

Drug Name Drug Tier


butalbital-aspirin-caffeine

2

codeine sulfate 2

diskets 2

dvorah 2

endocet 2

fentanyl 2

fentanyl citrate 2

hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml)

2

HYDROCODONE-ACETAMINOPHEN ORAL SOLUTION 7.5-325 MG/15 ML

4

hydrocodone-acetaminophen oral tablet

2

hydrocodone-ibuprofen

2

hydromorphone 2

HYSINGLA ER 3

IBUDONE 4

ibuprofen-oxycodone 2

KADIAN 4

levorphanol tartrate oral tablet 2 mg

2

LEVORPHANOL TARTRATE ORAL TABLET 3 MG

4

lorcet (hydrocodone) 2

lorcet hd 2

lorcet plus 2

LORTAB ELIXIR 4

Drug Name Drug Tier


meperidine 2

methadone 2

methadose 2

morphine 2

morphine concentrate

2

NALOCET 4

OXAYDO 4

oxycodone oral capsule

2

oxycodone oral concentrate

2

oxycodone oral solution

2

oxycodone oral tablet

2

OXYCODONE ORAL TABLET,ORAL ONLY,EXT.REL.12 HR

4

oxycodone-acetaminophen

2

oxycodone-aspirin 2

OXYCONTIN 3

oxymorphone 2

phrenilin forte(with caffeine)

2

PRIMLEV 4

ROXYBOND 4

SUBSYS 4

tencon 2

TREZIX 4

VANATOL LQ 4

VANATOL S 4


17

Drug Name Drug Tier


verdrocet 2

vicodin 2

vicodin es 2

vicodin hp 2

xylon 10 2

zebutal 2

ZOHYDRO ER 4

NON-NARCOTIC ANALGESICS

adult aspirin regimen

7 ACA

aspir-81 7 ACA

aspirin 7 ACA

aspirin low dose 7 ACA

aspir-low 7 ACA

aspir-trin 7 ACA

bayer aspirin 7 ACA

BUNAVAIL 4

buprenorphine-naloxone

2 QL

butorphanol tartrate injection

2

butorphanol tartrate nasal

2 QL

CAMBIA 4 QL

celecoxib 2

children's aspirin 7 ACA

choline,magnesium salicylate

2

CONZIP 4 QL

diclofenac potassium 2

diclofenac sodium 2

diclofenac-misoprostol

2

Drug Name Drug Tier


diflunisal 2

e.c. prin 7 ACA

ecotrin 7 ACA

ecotrin low strength 7 ACA

etodolac 2

fenoprofen 2

FLECTOR 3 QL

flurbiprofen 2

ibu 2

ibuprofen 2

INDOCIN 4

indomethacin 2

ketoprofen 2

ketorolac 2 QL

lite coat aspirin 7 ACA

meclofenamate 2

mefenamic acid 2

meloxicam oral suspension

2

meloxicam oral tablet 15 mg

2

meloxicam oral tablet 7.5 mg

2 QL

nabumetone 2

naloxone 2

naltrexone 2

NAPRELAN CR 4

naproxen 2

naproxen sodium 2

NARCAN 3

NUCYNTA 3 QL

NUCYNTA ER 3


18

Drug Name Drug Tier


oxaprozin 2

PENNSAID 4

pentazocine-naloxone

2

piroxicam 2

salsalate 2

SPRIX 6 QL

st joseph aspirin 7 ACA

sulindac 2

TIVORBEX 4

tolmetin 2

TRAMADOL ORAL CAPSULE,ER BIPHASE 24 HR 17-83

4 QL

TRAMADOL ORAL CAPSULE,ER BIPHASE 24 HR 25-75

4 QL

tramadol oral tablet 2 QL

tramadol oral tablet extended release 24 hr

2 QL

tramadol oral tablet, er multiphase 24 hr

2 QL

tramadol-acetaminophen

2 QL

VIMOVO 4

VIVLODEX 4

ZIPSOR 4

ZORVOLEX 4

ZUBSOLV 3

PSYCHOTHERAPEUTIC DRUGS

Drug Name Drug Tier


ADASUVE 4

ADZENYS ER 4 PA

ADZENYS XR-ODT

4 PA

alprazolam 2

alprazolam intensol 2

amitriptyline 1

amitriptyline-chlordiazepoxide oral tablet 12.5-5 mg

2

amitriptyline-chlordiazepoxide oral tablet 25-10 mg

1

amoxapine 2

amphetamine sulfate 2

APLENZIN 4 PA

APTENSIO XR 4 PA

aripiprazole 2

ARISTADA 3 PA

armodafinil 2 PA

atomoxetine 2

BELSOMRA 4 PA

bupropion hcl oral tablet

2

bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg

2

BUPROPION HCL ORAL TABLET EXTENDED RELEASE 24 HR 450 MG

4 PA

bupropion hcl oral tablet sustained-release 12 hr

2


19

Drug Name Drug Tier


buspirone 2

BUTISOL 4

chlordiazepoxide hcl 2

chlorpromazine 2

citalopram oral solution

2

citalopram oral tablet

1

clomipramine 2

clonidine hcl 2

clorazepate dipotassium

2

clozapine oral tablet 2

clozapine oral tablet,disintegrating 100 mg, 12.5 mg, 25 mg

2

CLOZAPINE ORAL TABLET,DISINTEGRATING 150 MG, 200 MG

4

COTEMPLA XR-ODT

4 PA

DAYTRANA 3 PA

desipramine 2

DESVENLAFAXINE

4 ST

DESVENLAFAXINE FUMARATE

4 ST

desvenlafaxine succinate

2

dexmethylphenidate 2

dextroamphetamine 2

dextroamphetamine-amphetamine

2

Drug Name Drug Tier


diazepam 2

diazepam intensol 2

DORAL 4

doxepin 2

duloxetine 2

DYANAVEL XR 4 PA

EDLUAR 4 PA; QL

EMSAM 4

ergoloid 2

escitalopram oxalate oral solution

2

escitalopram oxalate oral tablet

1

estazolam 2

eszopiclone 2 QL

FANAPT 4

FAZACLO 4

FETZIMA 3 ST

fluoxetine oral capsule

1

fluoxetine oral capsule,delayed release(dr/ec)

2

fluoxetine oral solution

2

fluoxetine oral tablet 10 mg

1

fluoxetine oral tablet 20 mg, 60 mg

2

fluphenazine hcl 2

flurazepam 2

fluvoxamine 2

FORFIVO XL 4 PA

guanfacine 2


20

Drug Name Drug Tier


guanidine 2

haloperidol 2

haloperidol lactate 2

HETLIOZ 6 PA

imipramine hcl 1

imipramine pamoate 2

KHEDEZLA 4 ST

LATUDA 3

lithium carbonate 1

lithium citrate 2

lorazepam 2

lorazepam intensol 2

loxapine succinate 2

maprotiline 2

MARPLAN 4

metadate er 2

methamphetamine 2

methylphenidate hcl oral capsule, er biphasic 30-70

2

methylphenidate hcl oral capsule,er biphasic 50-50

2

methylphenidate hcl oral solution

2

methylphenidate hcl oral tablet

2

methylphenidate hcl oral tablet extended release

2

methylphenidate hcl oral tablet extended release 24hr 18 mg, 27 mg, 36 mg, 54 mg

2

Drug Name Drug Tier


METHYLPHENIDATE HCL ORAL TABLET EXTENDED RELEASE 24HR 72 MG

4 PA

methylphenidate hcl oral tablet,chewable

2

midazolam 2

mirtazapine 2

modafinil 2

molindone 2

MYDAYIS 3 PA

nefazodone 2

nortriptyline oral capsule

1

NORTRIPTYLINE ORAL SOLUTION

4

olanzapine 2

olanzapine-fluoxetine

2

oxazepam 2

paliperidone 2

paroxetine hcl oral tablet

1

paroxetine hcl oral tablet extended release 24 hr

2

paroxetine mesylate(menop.sym)

2

PAXIL 4 PA

perphenazine 2

perphenazine-amitriptyline

2

PEXEVA 4 PA


21

Drug Name Drug Tier


phenelzine 2

pimozide 2

procentra 2

protriptyline 2

quazepam 2

quetiapine 2

QUILLICHEW ER 3 PA

QUILLIVANT XR 3 PA

RELEXXII 4 PA

REXULTI 4

risperidone 2

ROZEREM 3 PA; QL

SAPHRIS 4

seconal sodium 2

sertraline oral concentrate

2

sertraline oral tablet 1

SILENOR 4 PA; QL

temazepam 2

thioridazine 2

thiothixene 2

tranylcypromine 2

trazodone 1

triazolam 2

trifluoperazine 2

trimipramine 2

TRINTELLIX 4 PA

venlafaxine oral capsule,extended release 24hr

1

venlafaxine oral tablet

2

Drug Name Drug Tier


venlafaxine oral tablet extended release 24hr

2

VERSACLOZ 4

VIIBRYD 3 PA

VRAYLAR 4

VYVANSE 3 PA

XYREM 6 PA; LA

zaleplon 2 QL

zenzedi oral tablet 10 mg, 5 mg

2

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG

4

ziprasidone hcl 2

zolpidem 2 QL

ZOLPIMIST 4 PA; QL

CARDIOVASCULAR, HYPERTENSION & LIPIDS

ANTIARRHYTHMIC AGENTS

amiodarone 2

disopyramide phosphate

2

dofetilide 2

flecainide 2

mexiletine 2

MULTAQ 4

NORPACE CR 4

pacerone 2

procainamide 2

propafenone 2

quinidine gluconate 2


22

Drug Name Drug Tier


quinidine sulfate 2

sotalol af 1

sotalol oral tablet 120 mg, 160 mg, 80 mg

1

sotalol oral tablet 240 mg

2

SOTYLIZE 3

ANTIHYPERTENSIVE THERAPY

acebutolol 1

afeditab cr 2

ALDACTAZIDE 4

amiloride 2

amiloride-hydrochlorothiazide

1

amlodipine 1

amlodipine-benazepril

2

amlodipine-olmesartan

2

amlodipine-valsartan

2

amlodipine-valsartan-hcthiazid

2

atenolol 1

atenolol-chlorthalidone

1

benazepril 1

benazepril-hydrochlorothiazide

2

betaxolol 2

BIDIL 4

bisoprolol fumarate 1

Drug Name Drug Tier


bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 5-6.25 mg

1

bisoprolol-hydrochlorothiazide oral tablet 2.5-6.25 mg

2

bumetanide 2

BYSTOLIC 3

candesartan 2

candesartan-hydrochlorothiazid

2

captopril oral tablet 100 mg

2

captopril oral tablet 12.5 mg, 25 mg, 50 mg

1

captopril-hydrochlorothiazide

2

CARDIZEM LA 4

CARDURA XL 4 QL

CAROSPIR 4

cartia xt 1

carvedilol 1

carvedilol phosphate 2

chlorothiazide 1

chlorthalidone 1

clonidine 2 QL

clonidine hcl 1

DEMSER 3

diltiazem hcl oral capsule,ext.rel 24h degradable

2


23

Drug Name Drug Tier


diltiazem hcl oral capsule,extended release 12 hr

2

diltiazem hcl oral capsule,extended release 24 hr

2

diltiazem hcl oral capsule,extended release 24hr

1

diltiazem hcl oral tablet

1

diltiazem hcl oral tablet extended release 24 hr

2

dilt-xr 2

DIURIL 4

doxazosin 1 QL

DUTOPROL 4

DYRENIUM 4

EDARBI 3 ST

EDARBYCLOR 3 ST

enalapril maleate 1

enalapril-hydrochlorothiazide

1

EPANED 4

eplerenone 2

epoprostenol (glycine)

6 PA

eprosartan 2

ethacrynic acid 2

felodipine 2

FLOLAN 6 PA

fosinopril 1

fosinopril-hydrochlorothiazide

2

Drug Name Drug Tier


furosemide oral solution

2

furosemide oral tablet

1

guanfacine 1

HEMANGEOL 6 PA

hydralazine 1

hydrochlorothiazide 1

indapamide 1

INDERAL XL 4

INNOPRAN XL 4

irbesartan 1

irbesartan-hydrochlorothiazide

2

isradipine 2

labetalol 1

lisinopril 1

lisinopril-hydrochlorothiazide

1

losartan 1

losartan-hydrochlorothiazide

1

matzim la 2

methyclothiazide 2

methyldopa 1

methyldopa-hydrochlorothiazide oral tablet 250-15 mg

2

methyldopa-hydrochlorothiazide oral tablet 250-25 mg

1

metolazone 1

metoprolol succinate 2


24

Drug Name Drug Tier


METOPROLOL SU-HYDROCHLOROTHIAZ

4

metoprolol ta-hydrochlorothiaz oral tablet 100-25 mg, 50-25 mg

1

metoprolol ta-hydrochlorothiaz oral tablet 100-50 mg

2

metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg

1

metoprolol tartrate oral tablet 37.5 mg, 75 mg

2

minoxidil 2

moexipril 2

nadolol 2

nadolol-bendroflumethiazide

2

nicardipine 2

nifedipine 2

nimodipine 2

nisoldipine 2

NYMALIZE 4

olmesartan 2

olmesartan-amlodipin-hcthiazid

2

olmesartan-hydrochlorothiazide

2

ORENITRAM 6 PA

perindopril erbumine

2

phenoxybenzamine 2 PA

Drug Name Drug Tier


pindolol 2

prazosin 1

PRESTALIA 4 ST

propranolol oral capsule,extended release 24 hr

2

propranolol oral solution

2

propranolol oral tablet

1

propranolol-hydrochlorothiazid

2

quinapril 1

quinapril-hydrochlorothiazide

2

ramipril 1

REMODULIN 6 PA

spironolactone 1

spironolacton-hydrochlorothiaz

2

taztia xt 2

TEKTURNA 3

TEKTURNA HCT 3

telmisartan 2

telmisartan-amlodipine

2

telmisartan-hydrochlorothiazid

2

terazosin 1 QL

timolol maleate 2

torsemide 2

trandolapril oral tablet 1 mg

2

trandolapril oral tablet 2 mg, 4 mg

1


25

Drug Name Drug Tier


trandolapril-verapamil

2

triamterene-hydrochlorothiazid oral capsule 37.5-25 mg

1

triamterene-hydrochlorothiazid oral capsule 50-25 mg

2

triamterene-hydrochlorothiazid oral tablet

1

UPTRAVI 6 PA; LA

valsartan 2

valsartan-hydrochlorothiazide

2

veletri 6 PA

verapamil oral capsule, 24 hr er pellet ct 100 mg

2

verapamil oral capsule, 24 hr er pellet ct 200 mg, 300 mg

1

verapamil oral capsule,ext rel. pellets 24 hr

1

verapamil oral tablet 1

verapamil oral tablet extended release

1

CARDIAC GLYCOSIDES

digitek 1

digox 1

digoxin oral solution 2

digoxin oral tablet 1

LANOXIN 4

Drug Name Drug Tier


COAGULATION THERAPY

ADVATE 6 PA

ADYNOVATE 6 PA

AFSTYLA 6 PA

ALPHANATE 6 PA

ALPHANINE SD 6 PA

AMICAR 3

aminocaproic acid 2

aspirin-dipyridamole 2

BENEFIX 6 PA

BRILINTA 3

CEPROTIN (BLUE BAR)

6 PA

CEPROTIN (GREEN BAR)

6 PA

cilostazol 2

clopidogrel 2

COAGADEX 6 PA

CORIFACT 6 PA

dipyridamole 2

ELIQUIS 3 PA

ELOCTATE 6 PA

enoxaparin 6

FEIBA NF 6 PA

FIBRYGA 6 PA

fondaparinux 6

FRAGMIN 6

HELIXATE FS 6 PA

HEMLIBRA 6 PA

HEMOFIL M HIGH 6 PA

HEMOFIL M LOW 6 PA

HEMOFIL M MID 6 PA


26

Drug Name Drug Tier


HEMOFIL M SUPER HIGH

6 PA

hep flush-10 (pf) 2

heparin (porcine) 2

HEPARIN (PORCINE) IN 0.9% NACL

4

heparin (porcine) in 5 % dex

2

heparin (porcine) in nacl (pf)

2

heparin flush(porcine)-0.9nacl

2

heparin lock flush 2

heparin lock flush (porcine)

2

heparin lockflush(porcine)(pf)

2

HEPARIN(PORCINE) IN 0.45% NACL INTRAVENOUS PARENTERAL SOLUTION 12,500 UNIT/250 ML

4

heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml, 25,000 unit/500 ml

2

heparin, porcine (pf) 2

HUMATE-P 6 PA

IDELVION 6 PA

IXINITY 6 PA

jantoven 1

JIVI 6 PA

Drug Name Drug Tier


KOATE 6 PA

KOGENATE FS 6 PA

KOVALTRY 6 PA

MONONINE 6 PA

MULPLETA 6 PA

NOVOEIGHT 6 PA

NOVOSEVEN RT 6 PA

NPLATE 6 PA

NUWIQ 6 PA

pentoxifylline 2

PHYTONADIONE (VITAMIN K1) INJECTION

3

phytonadione (vitamin k1) oral

2

prasugrel 2

PROFILNINE 6 PA

PROMACTA 6 PA; LA

REBINYN 6 PA

RECOMBINATE 6 PA

RIASTAP 6 PA

RIXUBIS 6 PA

TRETTEN 6 PA

vitamin k 2

vitamin k1 2

warfarin 1

WILATE 6 PA

XARELTO 3

ZONTIVITY 3

LIPID/CHOLESTEROL LOWERING AGENTS

amlodipine-atorvastatin

2 QL


27

Drug Name Drug Tier


ANTARA 4

atorvastatin oral tablet 10 mg, 20 mg

7 ACA; QL

atorvastatin oral tablet 40 mg, 80 mg

1 QL

cholestyramine (with sugar)

2

cholestyramine light 2

colesevelam 2

COLESTID 4

COLESTID FLAVORED

4

colestipol 2

ezetimibe 2

ezetimibe-simvastatin

2 QL

fenofibrate micronized

2

fenofibrate nanocrystallized

2

FENOFIBRATE ORAL CAPSULE

4

fenofibrate oral tablet

2

fenofibric acid 2

fenofibric acid (choline)

2

FLOLIPID 4 ST

fluvastatin oral capsule 20 mg

7 ACA; QL

fluvastatin oral capsule 40 mg

7 ACA

fluvastatin oral tablet extended release 24 hr

7 ACA; QL

gemfibrozil 1

Drug Name Drug Tier


JUXTAPID 6 PA; LA

LIPOFEN 3

LIVALO 3 ST; QL

lovastatin 7 ACA; QL

niacin 2

NIACOR 4

omega-3 acid ethyl esters

2

PRALUENT PEN 6 PA

pravastatin 7 ACA; QL

prevalite 2

REPATHA SURECLICK

6 PA

REPATHA SYRINGE

6 PA

rosuvastatin oral tablet 10 mg, 5 mg

7 ACA; QL

rosuvastatin oral tablet 20 mg, 40 mg

2 QL

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg

7 ACA; QL

simvastatin oral tablet 80 mg

1 QL

TRIGLIDE 4

triklo 2

VASCEPA 3

MISCELLANEOUS CARDIOVASCULAR AGENTS

CORLANOR 3

ENTRESTO 3 PA

RANEXA 3

VECAMYL 4

NITRATES


28

Drug Name Drug Tier


DILATRATE-SR 3

ISORDIL 4

isosorbide dinitrate 2

isosorbide mononitrate

1

MINITRAN 4

nitro-bid 2

NITRO-DUR 4

nitroglycerin 2

nitro-time 2

DERMATOLOGICALS/TOPICAL THERAPY

ANTIPSORIATIC / ANTISEBORRHEIC

acitretin 2

calcipotriene 2

calcipotriene-betamethasone

2

calcitrene 2

calcitriol 2

COAL TAR 3

COSENTYX 6 PA

COSENTYX (2 SYRINGES)

6 PA

COSENTYX PEN 6 PA

COSENTYX PEN (2 PENS)

6 PA

drithocreme hp 2

EPIFOAM 4

hydrocortisone-pramoxine

2

OVACE PLUS 4

Drug Name Drug Tier


OVACE PLUS SHAMPOO

4

OVACE PLUS WASH

4

PRAMOSONE 4

PROMISEB COMPLETE

4

selenium sulfide 2

SELRX 4

SILIQ 6 PA

SORILUX 4

STELARA 6 PA

sulfacetamide sodium

2

TACLONEX 3

TALTZ AUTOINJECTOR

6 PA

TALTZ AUTOINJECTOR (2 PACK)

6 PA

TALTZ AUTOINJECTOR (3 PACK)

6 PA

TALTZ SYRINGE 6 PA

TERSI FOAM 4

TREMFYA 6 PA

ZITHRANOL 4

BURN THERAPY

silver sulfadiazine 2

ssd 2

KERATOLYTICS

BENSAL HP 4

INOVA 4-1 4

INOVA 8-2 4


29

Drug Name Drug Tier


KERALYT SCALP COMPLETE

4

PODOCON 4

salicylic acid 2

salicylic acid er-ceramides

2

SALKERA 4

salvax 2

SALVAX DUO PLUS

4

ULTRASAL-ER 4

VIRASAL 4

XALIX 4

MISCELLANEOUS DERMATOLOGICALS

CARAC 3

cem-urea 2

CONDYLOX 4

diclofenac sodium 2

doxepin 2

DUPIXENT 6 PA

FLUOROPLEX 4

fluorouracil 2

HYDRO 35 4

IODOFLEX 4

IODOSORB 4

KERAFOAM 4

KERALAC 4

LEVULAN 4

LOUTREX 4

methoxsalen 2

PANRETIN 4 PA

Drug Name Drug Tier


PICATO 3

pimecrolimus 2

podofilox 2

PROMISEB 4

prudoxin 2

QBREXZA 3

REGRANEX 3 QL

silver nitrate 2

silver nitrate applicators

2

tacrolimus 2

TOLAK 4

umecta 2

URAMAXIN 4

urea 2

urea nail stick 2

UTOPIC 4

VALCHLOR 6 PA

VEREGEN 4

ZONALON 4

THERAPY FOR ACNE

ABSORICA 3

adapalene topical cream

2 PA

adapalene topical gel

2 PA

adapalene topical gel with pump

2 PA

ADAPALENE TOPICAL LOTION

4 PA

adapalene topical solution

2 PA


30

Drug Name Drug Tier


adapalene-benzoyl peroxide

2

amnesteem 2

AVAR LS 4

avar topical cleanser 2

AVAR TOPICAL FOAM

4

AVAR TOPICAL PADS, MEDICATED

4

AVAR-E GREEN 4

AVAR-E LS 4

avita topical cream 2 PA

AVITA TOPICAL GEL

4 PA

azelaic acid 2 PA

AZELEX 4 PA

BENZEFOAM 4

BENZEFOAM ULTRA

4

benzepro 2

benzoyl peroxide 2

bp 10-1 2

bpo 2

claravis 2

cleansing wash 2

CLINDACIN ETZ 4

clindacin p 2

CLINDACIN PAC 4

CLINDAGEL 4

clindamycin phosphate topical foam

2

Drug Name Drug Tier


clindamycin phosphate topical gel

2

CLINDAMYCIN PHOSPHATE TOPICAL GEL, ONCE DAILY

4

clindamycin phosphate topical lotion

2

clindamycin phosphate topical solution

2

clindamycin phosphate topical swab

2

clindamycin-benzoyl peroxide

2

clindamycin-tretinoin

2

dapsone 2

DIFFERIN 4 PA

EPIDUO FORTE 3

ery pads 2

erygel 2

erythromycin with ethanol

2

erythromycin-benzoyl peroxide

2

FABIOR 4 PA

FINACEA 3 PA

INOVA 4

isotretinoin 2

metronidazole 2

myorisan 2

neuac 2


31

Drug Name Drug Tier


NEUAC KIT 4

NORITATE 4

ONEXTON 3

PLEXION 4

PLEXION CLEANSING CLOTHS

4

RETIN-A MICRO PUMP

4 PA

rosadan topical cream

2

rosadan topical gel 2

ROSADAN TOPICAL KIT, CLEANSER AND GEL

4

ROSADAN TOPICAL KIT,CLEANSER AND CREAM

4

ROSULA 4

rosula cleansing cloths

2

SOOLANTRA 3

sss 10-5 2

sulfacetamide sodium-sulfur

2

sulfacetamide sod-sulfur-urea

2

sulfacetamide-sulfur-cleansr23

2

sulfacleanse 8-4 2

sulfact na-sul-avobnz-otn-ocsa

2

SUMADAN 4

SUMADAN XLT 4

Drug Name Drug Tier


SUMAXIN 4

SUMAXIN CP 4

SUMAXIN TS 4

tazarotene 2 PA

TAZORAC 3 PA

tretinoin 2 PA

tretinoin microspheres

2 PA

TRETIN-X 4 PA

TRETIN-X CREAM KIT

4 PA

VANOXIDE-HC 4

zenatane 2

TOPICAL ANESTHETICS

BUCALSEP 4

ethyl chloride 2

glydo 2

lidocaine 2

lidocaine hcl 2

lidocaine hcl-hydrocortison ac

2

lidocaine viscous 2

lidocaine-prilocaine 2

lta pre-attached 2

SYNERA 4

ZTLIDO 3

TOPICAL ANTIBACTERIALS

ALTABAX 4

CENTANY 4

CENTANY AT 4

CORTISPORIN 4

gentamicin 2


32

Drug Name Drug Tier


hydrocortisone-iodoquinol-aloe

2

iodoquinol-hc 2

lugols 2

mafenide acetate 2

mupirocin 2

mupirocin calcium 2

NEO-SYNALAR 4

NEO-SYNALAR KIT

4

SILVRSTAT 4

sulfacetamide sodium (acne)

2

SULFAMYLON 3

VYTONE 4

TOPICAL ANTIFUNGALS

ALA-QUIN 4

ciclodan 2

CICLODAN KIT 4

ciclopirox 2

clotrimazole-betamethasone

2

econazole 2

ECOZA 4

ERTACZO 4

EXELDERM 4

EXODERM 4

JUBLIA 4

KERYDIN 4

ketoconazole 2

LUZU 4

Drug Name Drug Tier


MICONAZOLE NITRATE-ZINC OX-PET

4

naftifine 2

NAFTIN 4

nyamyc 2

nystatin 2

nystatin-triamcinolone

2

nystop 2

oxiconazole 2

OXISTAT 4

TRIACETIN 3

TRIPLE DYE 4

VUSION 4

XOLEGEL 4

TOPICAL ANTIVIRALS

acyclovir 2

DENAVIR 4

TOPICAL CORTICOSTEROIDS

alclometasone 2

amcinonide 2

apexicon e 2

AQUA GLYCOLIC HC

4

betamethasone dipropionate

2

betamethasone valerate

2

betamethasone, augmented

2

CAPEX 4

clobetasol 2


33

Drug Name Drug Tier


clobetasol-emollient 2

CLOCORTOLONE PIVALATE

4

clodan 2

CLODAN KIT 4

CLODERM 4

CORDRAN 4

CORDRAN TAPE LARGE ROLL

4 QL

cormax 2

DERMASORB HC COMPLETE KIT

4

DERMASORB TA COMPLETE KIT

4

DESONATE 4

desonide 2

desoximetasone 2

diflorasone 2

fluocinolone 2

fluocinolone and shower cap

2

fluocinonide 2

fluocinonide-emollient

2

flurandrenolide 2

fluticasone propionate

2

halobetasol propionate

2

HALOG 4

hydrocortisone 2

hydrocortisone butyrate

2

Drug Name Drug Tier


hydrocortisone butyr-emollient

2

hydrocortisone valerate

2

hydrocortisone-min oil-wht pet

2

IMPOYZ 4

LOCOID LIPOCREAM

4

mometasone 2

nolix 2

PANDEL 4

prednicarbate 2

scalacort 2

SCALACORT DK 4

SYNALAR CREAM KIT

4

SYNALAR OINTMENT KIT

4

SYNALAR TS 4

TEXACORT 4

triamcinolone acetonide

2

trianex 2

triderm 2

ULTRAVATE 4

ULTRAVATE X 4

TOPICAL ENZYMES

SANTYL 3

TOPICAL SCABICIDES / PEDICULICIDES

crotan 2

EURAX 4

lindane 2


34

Drug Name Drug Tier


malathion 2

permethrin 2

SKLICE 4

spinosad 2

ULESFIA 4

DIAGNOSTICS & MISCELLANEOUS AGENTS

IRRIGATING SOLUTIONS

lactated ringers 2

neomycin-polymyxin b gu

2

ringer's 2

SORBITOL 4

SORBITOL-MANNITOL

4

tis-u-sol pentalyte 2

VASHE WOUND THERAPY

4

MISCELLANEOUS AGENTS

acamprosate 2

acetic acid 2

ADAGEN 6 PA

alendronate 2 QL

anagrelide 2

aqua care sodium chloride

2

aqua care sterile water

2

ARALAST NP 6 PA; LA

caffeine citrate 2

CARBAGLU 6 PA; LA

CARNITOR (SUGAR-FREE)

4

Drug Name Drug Tier


cevimeline 2

CHEMET 3

disulfiram 2

ENDARI 6

etidronate disodium 2

EXJADE 6 PA; LA

FERRIPROX 6 PA

GLASSIA 6 PA; LA

INCRELEX 6 PA; LA

INFASURF 4

JADENU 6 PA

JADENU SPRINKLE

6 PA

levocarnitine 2

levocarnitine (with sugar)

2

LIPOCHOL PLUS 4

LITHOSTAT 4

METOPIRONE 4

midodrine 2

NITYR 6 PA

NORTHERA 6 PA

ORFADIN 6 PA; LA

pilocarpine hcl 2

PROLASTIN-C 6 PA; LA

RAVICTI 6 PA

RECLAST 6 PA

REVCOVI 6 PA

riluzole 2

risedronate 2 QL

sodium chloride 2


35

Drug Name Drug Tier


sodium chloride 0.9 %

2

sodium phenylbutyrate

2

SOLIRIS 6 PA

SURVANTA 4

THIOLA 6 PA

TIGLUTIK 4

trientine 2 PA

water for irrigation, sterile

2

ZEMAIRA 6 PA; LA

zoledronic acid-mannitol-water

6 PA

SMOKING DETERRENTS

bupropion hcl (smoking deter)

7 ACA; QL

CHANTIX 7 ACA; QL

CHANTIX CONTINUING MONTH BOX

7 ACA; QL

CHANTIX STARTING MONTH BOX

7 ACA; QL

nicorelief 7 ACA; QL

nicorette 7 ACA; QL

nicotine 7 ACA; QL

nicotine (polacrilex) 7 ACA; QL

NICOTROL 7 ACA; QL

NICOTROL NS 7 ACA; QL

quit 2 7 ACA; QL

quit 4 7 ACA; QL

stop smoking aid 7 ACA; QL

Drug Name Drug Tier


EAR, NOSE & THROAT MEDICATIONS

MISCELLANEOUS AGENTS

ALZAIR 4

azelastine 2 QL

chlorhexidine gluconate

2

CLINPRO 5000 4

DEBACTEROL 4

denta 5000 plus 1

dentagel 1

EPISIL 4

FLUORIDEX DAILY DEFENSE

4

GELCLAIR 4

GELX 4

ipratropium bromide 2 QL

MUGARD 4

olopatadine 2 QL

oralone 2

ORAMAGICRX 4

paroex oral rinse 2

periogard 2

pilocarpine hcl 2

PREVIDENT 5000 BOOSTER PLUS

4

PREVIDENT 5000 DRY MOUTH

4

PREVIDENT 5000 ENAMEL PROTECT

4

PREVIDENT 5000 SENSITIVE

4


36

Drug Name Drug Tier


Q-CARE RX Q4 4

sf 1

sf 5000 plus 1

triamcinolone acetonide

2

TYZINE 4

MISCELLANEOUS OTIC PREPARATIONS

acetic acid 2

ciprofloxacin hcl 2

flac otic oil 2

fluocinolone acetonide oil

2

hydrocortisone-acetic acid

2

ofloxacin 2

OTIC STEROID / ANTIBIOTIC

CIPRO HC 4

CIPRODEX 3

COLY-MYCIN S 4

neomycin-polymyxin-hc

2

ENDOCRINE/DIABETES

ADRENAL HORMONES

ACTHAR H.P. 6 PA

cortisone 2

decadron 2

deltasone 1

dexamethasone 2

dexamethasone intensol

2

EMFLAZA 6 PA; LA

fludrocortisone 2

Drug Name Drug Tier


hydrocortisone 2

MEDROL 4

methylprednisolone 2

millipred 2

millipred dp 2

prednisolone 2

prednisolone sodium phosphate

2

prednisone intensol 2

prednisone oral solution

2

prednisone oral tablet

1

prednisone oral tablets,dose pack

2

RAYOS 4

TAPERDEX 4

TRIESENCE (PF) 4

veripred 20 2

ANTITHYROID AGENTS

methimazole 2

propylthiouracil 2

SSKI 4

BLOOD GLUCOSE MONITORING DEVICES & SUPPLIES

ONETOUCH ULTRA BLUE TEST STRIP

3

ONETOUCH VERIO

3

DIABETES, SUPPLIES, & DURABLE MEDICAL EQUIPMENT


37

Drug Name Drug Tier


ACE AEROSOL CLOUD ENHANCER

3

AEROCHAMBER MINI

3

AEROCHAMBER PLUS FLOW-VU

3

AEROCHAMBER PLUS Z STAT

3

AEROTRACH PLUS

3

AEROVENT PLUS 3

BREATHERITE MDI SPACER

3

COMPACT SPACE CHAMBER

3

EASIVENT HOLDING CHAMBER

3

E-Z SPACER 3

FLEXICHAMBER 3

GLUCAGEN DIAGNOSTIC KIT

3

INSPIRACHAMBER

3

INSULIN SYRINGE-NEEDLE U-100

4

LITEAIRE MDI CHAMBER

3

MICROCHAMBER 3

MICROSPACER 3

OPTICHAMBER DIAMOND VHC

3

POCKET CHAMBER

3

PRIMEAIRE 3

Drug Name Drug Tier


PROCHAMBER 3

RITEFLO AEROCHAMBER

3

VORTEX HOLDING CHAMBER

3

GLUCOSE ELEVATING AGENTS

GLUCAGEN HYPOKIT

3

GLUCAGON EMERGENCY KIT (HUMAN)

3

PROGLYCEM 3

INSULIN SYRINGES/MISCELLANEOUS DURABLE MEDICAL EQU

ACCU-CHEK COMBO SYSTEM

3

AUTOJECT 2 INJECTION DEVICE

3

AUTOPEN 1 TO 21 UNITS

3

BD MICROTAINER LANCET

3

BD SPECIALTY USE NEEDLES

3

BD ULTRA FINE LANCETS

3

BD ULTRA-FINE NANO PEN NEEDLE

3

INPEN (FOR HUMALOG)

4

INPEN (FOR NOVOLOG)

4


38

Drug Name Drug Tier


LANCETS 3

LANCING DEVICE 3

NOVOPEN ECHO 4

OMNIPOD INSULIN MANAGEMENT

3

ONETOUCH ULTRA2

3 QL

ONETOUCH ULTRAMINI

3 QL

ONETOUCH VERIO FLEX

3

ONETOUCH VERIO IQ METER

3 QL

ONETOUCH VERIO SYSTEM

3

PEN NEEDLE 4

PRECISION XTRA MONITOR

3 QL

V-GO 20 3

V-GO 30 3

V-GO 40 3

INSULIN THERAPY

AFREZZA 4

BASAGLAR KWIKPEN U-100 INSULIN

4

HUMALOG JUNIOR KWIKPEN U-100

3

HUMALOG KWIKPEN INSULIN

3

HUMALOG MIX 50-50 INSULN U-100

3

Drug Name Drug Tier


HUMALOG MIX 50-50 KWIKPEN

3

HUMALOG MIX 75-25 KWIKPEN

3

HUMALOG MIX 75-25(U-100)INSULN

3

HUMALOG U-100 INSULIN

3

HUMULIN 70/30 U-100 INSULIN

3

HUMULIN 70/30 U-100 KWIKPEN

3

HUMULIN N NPH INSULIN KWIKPEN

3

HUMULIN N NPH U-100 INSULIN

3

HUMULIN R REGULAR U-100 INSULN

3

HUMULIN R U-500 (CONC) INSULIN

3

HUMULIN R U-500 (CONC) KWIKPEN

3

LANTUS SOLOSTAR U-100 INSULIN

3

LANTUS U-100 INSULIN

3

LEVEMIR FLEXTOUCH U-100 INSULN

3

LEVEMIR U-100 INSULIN

3

RELION NOVOLIN 70/30

4


39

Drug Name Drug Tier


RELION NOVOLIN N

4

RELION NOVOLIN R

4

TOUJEO MAX U-300 SOLOSTAR

3

TOUJEO SOLOSTAR U-300 INSULIN

3

TRESIBA FLEXTOUCH U-100

3

TRESIBA FLEXTOUCH U-200

3

XULTOPHY 100/3.6

3 QL

MISCELLANEOUS HORMONES

ALDURAZYME 6 PA

ANADROL-50 4

ANDRODERM 3 PA

BRINEURA 6 PA

cabergoline 2 QL

calcitonin (salmon) 2

calcitriol intravenous

2

calcitriol oral capsule

1

calcitriol oral solution

2

CERDELGA 6 PA

CEREZYME 6 PA

CETROTIDE 6 PA

cinacalcet 2

danazol 2

Drug Name Drug Tier


DDAVP 4

DEPO-TESTOSTERONE

4 PA

desmopressin 2

doxercalciferol 2

ELAPRASE 6 PA

ELELYSO 6 PA

FABRAZYME 6 PA

GALAFOLD 6 PA

ganirelix 6 PA

KORLYM 6 PA

KUVAN 6 PA

LUMIZYME 6 PA

MEPSEVII 6 PA

METHITEST 3

methyltestosterone 2

MIACALCIN 3

miglustat 6 PA; LA

MYALEPT 6 PA; LA

NAGLAZYME 6 PA; LA

NATESTO 4 ST

NATPARA 6 PA; LA

oxandrolone 2 PA

paricalcitol 2

RAYALDEE 4

SAMSCA 6 PA

SENSIPAR 3

SOMAVERT 6 PA

STIMATE 6

STRENSIQ 6 PA; LA

STRIANT 4 ST

SYNAREL 3


40

Drug Name Drug Tier


TESTOPEL 6 PA

testosterone 2 PA

testosterone cypionate

2 PA

testosterone enanthate

2 PA

VIMIZIM 6 PA

VOGELXO 4 ST

VPRIV 6 PA

XYOSTED 4 PA

ZAVESCA 6 PA; LA

zoledronic acid 6 PA

zoledronic acid-mannitol-water

6 PA

ZOLEDRONIC AC-MANNITOL-0.9NACL

6 PA

NON-INSULIN HYPOGLYCEMIC AGENTS

acarbose 2

ACTOPLUS MET XR

4 QL

ALOGLIPTIN-PIOGLITAZONE

4 QL

AVANDIA 4 QL

BYDUREON 3 PA; QL

BYDUREON BCISE

3 PA; QL

BYETTA 3 PA; QL

chlorpropamide 2

CYCLOSET 4

FARXIGA 3 ST; QL

glimepiride 1

glipizide 1

Drug Name Drug Tier


glipizide-metformin 2

glyburide 1

glyburide micronized oral tablet 1.5 mg

2

glyburide micronized oral tablet 3 mg, 6 mg

1

glyburide-metformin 2

GLYXAMBI 3 ST; QL

INVOKAMET 3 ST; QL

INVOKAMET XR 3 ST; QL

INVOKANA 3 ST; QL

JANUMET 3 QL

JANUMET XR 3 QL

JANUVIA 3 QL

JARDIANCE 3 ST; QL

JENTADUETO 3 QL

JENTADUETO XR 3 QL

METFORMIN ORAL SOLUTION

4 ST

metformin oral tablet

1

metformin oral tablet extended release 24 hr

1 QL

metformin oral tablet extended release 24hr

2 PA; QL

metformin oral tablet,er gast.retention 24 hr

2 PA; QL

miglitol 2

nateglinide 2

OSENI 4 QL


41

Drug Name Drug Tier


OZEMPIC 3 ST; QL

pioglitazone 2 QL

pioglitazone-glimepiride

2 QL

pioglitazone-metformin

2 QL

QTERN 4 ST

repaglinide 2

repaglinide-metformin

2 QL

RIOMET 4 ST

SEGLUROMET 3 ST; QL

STEGLATRO 3 ST; QL

STEGLUJAN 4 ST; QL

SYMLINPEN 120 3 QL

SYMLINPEN 60 3 QL

SYNJARDY 3 ST; QL

tolazamide 2

tolbutamide 2

TRADJENTA 3 QL

TRULICITY 3 PA; QL

XIGDUO XR 3 ST; QL

THYROID HORMONES

ARMOUR THYROID

3

levothyroxine 1

levoxyl 1

liothyronine 2

Drug Name Drug Tier


nature-throid oral tablet 113.75 mg, 130 mg, 146.25 mg, 16.25 mg, 162.5 mg, 195 mg, 260 mg, 325 mg, 81.25 mg, 97.5 mg

2

nature-throid oral tablet 32.5 mg, 48.75 mg, 65 mg

1

np thyroid oral tablet 120 mg, 15 mg

2

np thyroid oral tablet 30 mg, 60 mg, 90 mg

1

thyroid (pork) oral tablet 120 mg, 15 mg

2

thyroid (pork) oral tablet 30 mg, 60 mg, 90 mg

1

THYROLAR-1 4

THYROLAR-1/2 4

THYROLAR-1/4 4

THYROLAR-2 4

THYROLAR-3 4

TIROSINT 4

unithroid 1

westhroid oral tablet 130 mg, 195 mg, 97.5 mg

2

westhroid oral tablet 32.5 mg, 65 mg

1

WP THYROID 4

GASTROENTEROLOGY

ANTIDIARRHEALS & ANTISPASMODICS

anaspaz 2


42

Drug Name Drug Tier


belladonna alkaloids-opium

2

belladonna-opium 2

chlordiazepoxide-clidinium

2

CUVPOSA 4

dicyclomine oral capsule

1

dicyclomine oral solution

2

dicyclomine oral tablet

1

diphenoxylate-atropine

2

DONNATAL 4

ed-spaz 2

GLYCATE 4

glycopyrrolate 2

hyoscyamine sulfate 2

hyosyne 2

methscopolamine 2

MOTOFEN 4

MYTESI 4

opium tincture 2

oscimin 2

oscimin sl 2

oscimin sr 2

paregoric 2

phenobarb-hyoscy-atropine-scop

2

phenohytro 2

propantheline 2

SYMAX DUOTAB 4

Drug Name Drug Tier


symax fastabs 2

symax-sl 2

symax-sr 2

MISCELLANEOUS GASTROINTESTINAL AGENTS

AKYNZEO (NETUPITANT)

3 PA

alophen 7 ACA

alosetron 2

AMITIZA 3

ANA-LEX KIT 4

ANALPRAM-HC 4

anucort-hc 2

aprepitant 2 PA

APRISO 3

AURYXIA 4

balsalazide 2

bisacodyl 7 ACA

bisa-lax 7 ACA

BONJESTA 4 QL

budesonide 2

calcium acetate 2

CESAMET 4 PA

CHENODAL 6 PA; LA

CHOLBAM 6 PA

CIMZIA 6 PA

CIMZIA POWDER FOR RECONST

6 PA

CINVANTI 3 PA

citrate of magnesia 7 ACA

citroma 7 ACA

clearlax 7 ACA


43

Drug Name Drug Tier


CLENPIQ 7 ACA

colocort 2

constulose 2

CREON 3

cromolyn 2

CYSTADANE 6 PA

DICLEGIS 4 QL

DIPENTUM 4 ST

dronabinol 2

ducodyl 7 ACA

EMEND 4 PA

EMEND (FOSAPREPITANT)

4 PA

ENTEREG 4

ENTYVIO 6 PA

enulose 2

fleet laxative 7 ACA

GATTEX 30-VIAL 6 PA

gavilax 7 ACA

gavilyte-c 7 ACA

gavilyte-g 7 ACA

gavilyte-n 7 ACA

generlac 2

gentle laxative 7 ACA

gentlelax 7 ACA

glycolax 7 ACA

GOLYTELY 7 ACA

granisetron hcl 2

healthylax 7 ACA

hemmorex-hc 2

hydrocortisone 2

Drug Name Drug Tier


hydrocortisone acetate

2

hydrocortisone-pramoxine

2

KRISTALOSE 4

lactulose 2

lanthanum 2

laxaclear 7 ACA

laxative (bisacodyl) 7 ACA

laxative feminine 7 ACA

laxative peg 3350 7 ACA

lidocaine hcl-hydrocortison ac rectal cream

2

LIDOCAINE HCL-HYDROCORTISON AC RECTAL GEL

4

lidocaine hcl-hydrocortison ac rectal kit

2

lidocaine-hydrocortisone-aloe

2

LINZESS 3

LOKELMA 3

magnesium citrate 7 ACA

mesalamine 2

mesalamine with cleansing wipe

2

metoclopramide hcl 2

milk of magnesia 7 ACA

milk of magnesia concentrated

7 ACA

miralax 7 ACA

MOVANTIK 3


44

Drug Name Drug Tier


MOVIPREP 7 ACA

natura-lax 7 ACA

ondansetron 2

ondansetron hcl 2

ONDANSETRON IN 0.9 % SOD CHLOR

4 PA

ONDANSETRON IN D5W

4 PA

oral saline laxative 7 ACA

OSMOPREP 7 ACA

PALONOSETRON INTRAVENOUS SOLUTION 0.25 MG/2 ML

4 PA

palonosetron intravenous solution 0.25 mg/5 ml

2 PA

PALONOSETRON INTRAVENOUS SYRINGE

4 PA

peg 3350-electrolytes

7 ACA

peg-electrolyte soln 7 ACA

peg-prep 7 ACA

PENTASA 3

PHOSLYRA 3

phosphate laxative 7 ACA

PLENVU 7 ACA

polyethylene glycol 3350

7 ACA

powderlax 7 ACA

pramcort 2

PREPOPIK 7 ACA

Drug Name Drug Tier


prochlorperazine maleate

2

PROCORT 4

PROCTOFOAM HC 4

procto-med hc 2

proctosol hc 2

proctozone-hc 2

purelax 7 ACA

RECTIV 3

RELISTOR 3

RENFLEXIS 6 PA

SANCUSO 3 PA

scopolamine base 2

sevelamer carbonate 2

sevelamer hcl 2

smoothlax 7 ACA

sodium polystyrene (sorb free)

2

sodium polystyrene sulfonate oral

2

sodium polystyrene sulfonate rectal enema 30 gram/120 ml

2

SODIUM POLYSTYRENE SULFONATE RECTAL ENEMA 50 GRAM/200 ML

4

SOLESTA 6 PA

sps (with sorbitol) 2

SUCRAID 6 PA

sulfasalazine 2

SUPREP BOWEL PREP KIT

7 ACA


45

Drug Name Drug Tier


SYMPROIC 3

SYNDROS 4

trilyte with flavor packets

7 ACA

trimethobenzamide 2

UCERIS 3

ursodiol 2

VARUBI 3 PA

VELPHORO 3

VELTASSA 3

VIBERZI 3

VIOKACE 3

woman's laxative 7 ACA

women's gentle laxative(bisac)

7 ACA

women's laxative (bisacodyl)

7 ACA

ZENPEP 3

ZUPLENZ 4 PA

ULCER THERAPY

amoxicil-clarithromy-lansopraz

2 QL

CARAFATE 3

cimetidine 2

cimetidine hcl 2

DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 30 MG

4 PA; QL

DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 60 MG

4 PA

Drug Name Drug Tier


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

2 QL

esomeprazole magnesium oral capsule,delayed release(dr/ec) 40 mg

2

ESOMEPRAZOLE STRONTIUM

4 PA

famotidine 2

lansoprazole oral capsule,delayed release(dr/ec) 15 mg

2 QL

lansoprazole oral capsule,delayed release(dr/ec) 30 mg

2

lansoprazole oral tablet,disintegrat, delay rel 15 mg

2 QL

lansoprazole oral tablet,disintegrat, delay rel 30 mg

2

misoprostol 2

NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 10 MG, 2.5 MG, 20 MG, 5 MG

3 QL

NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 40 MG

3

nizatidine 2

OMECLAMOX-PAK

4 QL

omeppi oral capsule 20-1.1 mg-gram

2 ST; QL


46

Drug Name Drug Tier


omeppi oral capsule 40-1.1 mg-gram

2 ST

omeprazole oral capsule,delayed release(dr/ec) 10 mg

2 QL

omeprazole oral capsule,delayed release(dr/ec) 20 mg, 40 mg

2

omeprazole-sodium bicarbonate oral capsule 20-1.1 mg-gram

2 ST; QL

omeprazole-sodium bicarbonate oral capsule 40-1.1 mg-gram

2 ST

omeprazole-sodium bicarbonate oral packet 20-1,680 mg

2 ST; QL

omeprazole-sodium bicarbonate oral packet 40-1,680 mg

2 ST

pantoprazole oral tablet,delayed release (dr/ec) 20 mg

2 QL

pantoprazole oral tablet,delayed release (dr/ec) 40 mg

2

PYLERA 3

rabeprazole 2

ranitidine hcl 2

sucralfate 2

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY

BIOTECHNOLOGY DRUGS

Drug Name Drug Tier


ARANESP (IN POLYSORBATE)

6 PA

EPOGEN 6 PA

FULPHILA 6 PA

GRANIX 6 PA

LEUKINE 6 PA

MACRILEN 6

MIRCERA 6 PA

MOZOBIL 6 PA

NEULASTA 6 PA

NEUPOGEN 6 PA

NIVESTYM 6 PA

PROCRIT 6 PA

ZARXIO 6 PA

GROWTH HORMONES

EGRIFTA 6 PA

GENOTROPIN 6 PA

GENOTROPIN MINIQUICK

6 PA

HUMATROPE 6 PA

NORDITROPIN FLEXPRO

6 PA

NUTROPIN AQ NUSPIN

6 PA

OMNITROPE 6 PA

SAIZEN 6 PA

SAIZEN SAIZENPREP

6 PA

SEROSTIM 6 PA

ZOMACTON 6 PA

ZORBTIVE 6 PA

INTERFERONS

AUBAGIO 6 PA


47

Drug Name Drug Tier


AVONEX 6 PA

AVONEX (WITH ALBUMIN)

6 PA

BETASERON 6 PA; QL

COPAXONE 6 PA

EXTAVIA SUBCUTANEOUS KIT

6 PA; QL

EXTAVIA SUBCUTANEOUS RECON SOLN

6 PA

GILENYA 6 PA

glatiramer 6 PA

glatopa 6 PA

LEMTRADA 6 PA

moderiba 6 PA

moderiba dose pack 6 PA

OCREVUS 6 PA

PEGASYS 6 PA

PEGASYS PROCLICK

6 PA

PEGINTRON 6 PA

PLEGRIDY 6 PA

POMALYST 5 PA; LA

REBETOL 6 PA

REBIF (WITH ALBUMIN)

6 PA; QL

REBIF REBIDOSE 6 PA; QL

REBIF TITRATION PACK

6 PA; QL

REVLIMID 5 PA; LA

ribasphere 6 PA

ribasphere ribapak 6 PA

ribavirin 6 PA

Drug Name Drug Tier


SYLATRON 6 PA

TECFIDERA 6 PA

INTERLEUKINS

ACTIMMUNE 6 PA

ALFERON N 3

ARCALYST 6 PA

ILARIS (PF) 6 PA; LA

imiquimod 2

INTRON A 6 PA

KINERET 6 PA

PROLEUKIN 6 PA

VACCINES & MISCELLANEOUS IMMUNOLOGICALS

ACTHIB (PF) 7 ACA

ADACEL(TDAP ADOLESN/ADULT)(PF)

7 ACA

AFLURIA 2018-2019

7 ACA

AFLURIA 2018-2019 (PF)

7 ACA

AFLURIA QUAD 2018-2019

7 ACA

AFLURIA QUAD 2018-2019 (PF)

7 ACA

ATGAM 3 PA

BEXSERO 7 ACA

BIVIGAM 6 PA

BOOSTRIX TDAP 7 ACA

BOTOX 6 PA

CUVITRU 6 PA

DAPTACEL (DTAP PEDIATRIC) (PF)

7 ACA

DYSPORT 6 PA


48

Drug Name Drug Tier


ENGERIX-B (PF) 7 ACA

ENGERIX-B PEDIATRIC (PF)

7 ACA

FLUAD 2018-2019 (65 YR UP)(PF)

7 ACA

FLUARIX QUAD 2018-2019 (PF)

7 ACA

FLUBLOK QUAD 2018-2019 (PF)

7 ACA

FLUCELVAX QUAD 2018-2019

7 ACA

FLUCELVAX QUAD 2018-2019 (PF)

7 ACA

FLULAVAL QUAD 2018-2019

7 ACA

FLULAVAL QUAD 2018-2019 (PF)

7 ACA

FLUMIST QUAD 2018-2019

7 ACA

FLUZONE HIGH-DOSE 2018-19 (PF)

7 ACA

FLUZONE QUAD 2018-2019

7 ACA

FLUZONE QUAD 2018-2019 (PF)

7 ACA

FLUZONE QUAD PEDI 2018-19 (PF)

7 ACA

GAMMAGARD LIQUID

6 PA

GAMMAPLEX 6 PA

GARDASIL 9 (PF) 7 ACA

GRASTEK 3 PA

HAVRIX (PF) 7 ACA

HEPLISAV-B (PF) 4

HIBERIX (PF) 7 ACA

Drug Name Drug Tier


HIZENTRA 6 PA

HYQVIA 6 PA

INFANRIX (DTAP) (PF)

7 ACA

IPOL 7 ACA

KINRIX (PF) 7 ACA

MENACTRA (PF) 7 ACA

MENVEO A-C-Y-W-135-DIP (PF)

7 ACA

M-M-R II (PF) 7 ACA

MYOBLOC 6 PA

ODACTRA 3 PA

ORALAIR 6 PA

PANZYGA 6 PA

PEDIARIX (PF) 7 ACA

PEDVAX HIB (PF) 7 ACA

PENTACEL (PF) 7 ACA

PENTACEL ACTHIB COMPONENT (PF)

7 ACA

PNEUMOVAX 23 7 ACA

PREVNAR 13 (PF) 7 ACA

PRIVIGEN 6 PA

PROQUAD (PF) 7 ACA

PROVENGE 6 PA

QUADRACEL (PF) 7 ACA

RAGWITEK 3 PA

RECOMBIVAX HB (PF)

7 ACA

ROTARIX 7 ACA

ROTATEQ VACCINE

7 ACA

SHINGRIX (PF) 7 ACA


49

Drug Name Drug Tier


TDVAX 7 ACA

TENIVAC (PF) 7 ACA

TETANUS,DIPHTHERIA TOX PED(PF)

7 ACA

THYMOGLOBULIN

6 PA

TICE BCG 3 PA

TRUMENBA 7 ACA

TWINRIX (PF) 7 ACA

VAQTA (PF) 7 ACA

VARIVAX (PF) 7 ACA

VARIZIG 7 ACA

XEOMIN 6 PA

ZOSTAVAX (PF) 7 ACA

MUSCULOSKELETAL & RHEUMATOLOGY

GOUT THERAPY

allopurinol 1

COLCRYS 3

KRYSTEXXA 6 PA

MITIGARE 3

probenecid 2

probenecid-colchicine

2

ULORIC 3 ST

OSTEOPOROSIS THERAPY

alendronate oral solution

2 QL

alendronate oral tablet 10 mg, 35 mg, 70 mg

1 QL

alendronate oral tablet 5 mg

2 QL

Drug Name Drug Tier


BINOSTO 4 PA; QL

BONIVA 6 PA

FORTEO 6 PA

FOSAMAX PLUS D

4 PA; QL

ibandronate intravenous

6 PA

ibandronate oral 2 QL

PROLIA 6 PA

raloxifene 2

risedronate 2 QL

TYMLOS 6 PA

OTHER RHEUMATOLOGICALS

ACTEMRA 6 PA

BENLYSTA 6 PA

CUPRIMINE 4

DEPEN TITRATABS

3

D-PENAMINE 3

ENBREL 6 PA

ENBREL MINI 6 PA

ENBREL SURECLICK

6 PA

HUMIRA 6 PA

HUMIRA PEDIATRIC CROHNS START

6 PA

HUMIRA PEN 6 PA

HUMIRA PEN CROHNS-UC-HS START

6 PA

HUMIRA PEN PSOR-UVEITS-ADOL HS

6 PA


50

Drug Name Drug Tier


HUMIRA(CF) 6 PA

HUMIRA(CF) PEDI CROHNS STARTER

6 PA

HUMIRA(CF) PEN 6 PA

HUMIRA(CF) PEN CROHNS-UC-HS

6 PA

HUMIRA(CF) PEN PSOR-UV-ADOL HS

6 PA

KEVZARA 6 PA

leflunomide 2 QL

OLUMIANT 6 PA

ORENCIA 6 PA

ORENCIA CLICKJECT

6 PA

OTEZLA 6 PA

OTEZLA STARTER

6 PA

OTREXUP (PF) 3 PA

RASUVO (PF) 3 PA

RIDAURA 3 PA

SAVELLA 3 ST

SIMPONI 6 PA

SIMPONI ARIA 6 PA

XELJANZ 6 PA

XELJANZ XR 6 PA

OBSTETRICS & GYNECOLOGY

DIAPHRAGMS AND OTHER NON-ORAL CONTRACEPTIVES

CAYA CONTOURED

7 ACA

Drug Name Drug Tier


FC2 FEMALE CONDOM

7 ACA

FEMCAP 7 ACA

KYLEENA 7 ACA

LILETTA 7 ACA

MIRENA 7 ACA

PARAGARD T 380A

7 ACA

SKYLA 7 ACA

WIDE-SEAL DIAPHRAGM

7 ACA

ESTROGENS & PROGESTINS

ALORA 4 QL

amabelz 2

ANGELIQ 4

camila 7 ACA; QL

COMBIPATCH 3

covaryx 2

covaryx h.s. 2

deblitane 7 ACA; QL

DELESTROGEN 4

DEPO-ESTRADIOL 3

DEPO-SUBQ PROVERA 104

7 ACA; QL

DIVIGEL TRANSDERMAL GEL IN PACKET 0.25 MG/0.25 GRAM (0.1 %), 0.5 MG/0.5 GRAM (0.1 %), 1 MG/GRAM (0.1 %)

3 QL


51

Drug Name Drug Tier


DIVIGEL TRANSDERMAL GEL IN PACKET 0.75 MG/0.75 GRAM (0.1%)

3

DUAVEE 3

eemt 2

eemt hs 2

ELESTRIN 4 QL

errin 7 ACA; QL

estradiol oral 1

estradiol transdermal

2 QL

estradiol vaginal 2

estradiol valerate 2

estradiol-norethindrone acet

2

ESTRING 3 QL

estrogens-methyltestosterone

2

EVAMIST 4 QL

fyavolv 2

heather 7 ACA; QL

hydroxyprogest(pf)(preg presv)

6 PA

hydroxyprogesterone cap(ppres)

6 PA

hydroxyprogesterone caproate

2 PA

incassia 7 ACA; QL

jencycla 7 ACA; QL

jinteli 2

jolivette 7 ACA; QL

lopreeza 2

Drug Name Drug Tier


lyza 7 ACA; QL

MAKENA (PF) 6 PA

medroxyprogesterone intramuscular

7 ACA; QL

medroxyprogesterone oral

1

MENEST 4

MENOSTAR 4 QL

mimvey 2

mimvey lo 2

nora-be 7 ACA; QL

norethindrone (contraceptive)

7 ACA; QL

norethindrone acetate

2

norethindrone ac-eth estradiol

2

norlyda 7 ACA; QL

norlyroc 7 ACA; QL

PREFEST 4

PREMARIN 3

PREMPHASE 3

PREMPRO 3

progesterone 6 PA

progesterone micronized

2

sharobel 7 ACA; QL

tulana 7 ACA; QL

yuvafem 2

MISCELLANEOUS OB/GYN

AVC VAGINAL 4

CERVIDIL 4

CLEOCIN 4


52

Drug Name Drug Tier


clindamycin phosphate

2

CLINDESSE 4

CONCEPTROL 7 ACA

fem ph 2

GYNAZOLE-1 4

gynol ii 7 ACA

isoxsuprine 2

LUPANETA PACK (1 MONTH)

6 PA

LUPANETA PACK (3 MONTH)

6 PA

metronidazole 2

NEXPLANON 7 ACA

NUVARING 7 ACA; QL

NUVESSA 4

OSPHENA 4

PREPIDIL 4

PROSTIN E2 4

terconazole 2 QL

TODAY CONTRACEPTIVE SPONGE

7 ACA

tranexamic acid 2

TRIMO-SAN JELLY

3

vaginal contraceptive foam

7 ACA

vandazole 2

VCF CONTRACEPTIVE FILM

7 ACA

VCF CONTRACEPTIVE GEL

7 ACA

Drug Name Drug Tier


xulane 7 ACA; QL

ORAL CONTRACEPTIVES & RELATED AGENTS

altavera (28) 7 ACA; QL

alyacen 1/35 (28) 7 ACA; QL

alyacen 7/7/7 (28) 7 ACA; QL

amethia 7 ACA; QL

amethia lo 7 ACA; QL

amethyst (28) 7 ACA; QL

apri 7 ACA; QL

aranelle (28) 7 ACA; QL

ashlyna 7 ACA; QL

aubra 7 ACA; QL

aubra eq 7 ACA; QL

aviane 7 ACA; QL

azurette (28) 7 ACA; QL

balziva (28) 7 ACA; QL

bekyree (28) 7 ACA; QL

blisovi 24 fe 7 ACA; QL

blisovi fe 1.5/30 (28) 7 ACA; QL

blisovi fe 1/20 (28) 7 ACA; QL

briellyn 7 ACA; QL

camrese 7 ACA; QL

camrese lo 7 ACA; QL

caziant (28) 7 ACA; QL

chateal (28) 7 ACA; QL

chateal eq (28) 7 ACA; QL

cryselle (28) 7 ACA; QL

cyclafem 1/35 (28) 7 ACA; QL

cyclafem 7/7/7 (28) 7 ACA; QL

cyred 7 ACA; QL


53

Drug Name Drug Tier


cyred eq 7 ACA; QL

dasetta 1/35 (28) 7 ACA; QL

dasetta 7/7/7 (28) 7 ACA; QL

daysee 7 ACA; QL

delyla (28) 7 ACA; QL

desog-e.estradiol/e.estradiol

7 ACA; QL

desogestrel-ethinyl estradiol

7 ACA; QL

drospirenone-e.estradiol-lm.fa

7 ACA; QL

drospirenone-ethinyl estradiol

7 ACA; QL

econtra ez 7 ACA; QL

econtra one-step 7 ACA; QL

elinest 7 ACA; QL

ELLA 7 ACA; QL

emoquette 7 ACA; QL

enpresse 7 ACA; QL

enskyce 7 ACA; QL

estarylla 7 ACA; QL

ethynodiol diac-eth estradiol

7 ACA; QL

falmina (28) 7 ACA; QL

fayosim 7 ACA; QL

femynor 7 ACA; QL

gianvi (28) 7 ACA; QL

hailey 24 fe 7 ACA; QL

introvale 7 ACA; QL

isibloom 7 ACA; QL

jasmiel (28) 7 ACA; QL

jolessa 7 ACA; QL

Drug Name Drug Tier


juleber 7 ACA; QL

junel 1.5/30 (21) 7 ACA; QL

junel 1/20 (21) 7 ACA; QL

junel fe 1.5/30 (28) 7 ACA; QL

junel fe 1/20 (28) 7 ACA; QL

junel fe 24 7 ACA; QL

kaitlib fe 7 ACA; QL

kariva (28) 7 ACA; QL

kelnor 1/35 (28) 7 ACA; QL

kelnor 1-50 7 ACA; QL

kurvelo (28) 7 ACA; QL

l norgest/e.estradiol-e.estrad

7 ACA; QL

larin 1.5/30 (21) 7 ACA; QL

larin 1/20 (21) 7 ACA; QL

larin 24 fe 7 ACA; QL

larin fe 1.5/30 (28) 7 ACA; QL

larin fe 1/20 (28) 7 ACA; QL

larissia 7 ACA; QL

layolis fe 7 ACA; QL

leena 28 7 ACA; QL

lessina 7 ACA; QL

levonest (28) 7 ACA; QL

levonorgestrel 7 ACA; QL

levonorgestrel-ethinyl estrad

7 ACA; QL

levonorg-eth estrad triphasic

7 ACA; QL

levora-28 7 ACA; QL

lillow (28) 7 ACA; QL

LO LOESTRIN FE 7 ACA; QL

loryna (28) 7 ACA; QL


54

Drug Name Drug Tier


low-ogestrel (28) 7 ACA; QL

lutera (28) 7 ACA; QL

marlissa (28) 7 ACA; QL

melodetta 24 fe 7 ACA; QL

mibelas 24 fe 7 ACA; QL

microgestin 1.5/30 (21)

7 ACA; QL

microgestin 1/20 (21)

7 ACA; QL

microgestin fe 1.5/30 (28)

7 ACA; QL

microgestin fe 1/20 (28)

7 ACA; QL

mili 7 ACA; QL

mono-linyah 7 ACA; QL

mononessa (28) 7 ACA; QL

my choice 7 ACA; QL

my way 7 ACA; QL

myzilra 7 ACA; QL

NATAZIA 7 ACA; QL

necon 0.5/35 (28) 7 ACA; QL

new day 7 ACA; QL

nikki (28) 7 ACA; QL

noreth-ethinyl estradiol-iron

7 ACA; QL

norethindrone ac-eth estradiol

7 ACA; QL

norethindrone-e.estradiol-iron

7 ACA; QL

norgestimate-ethinyl estradiol

7 ACA; QL

nortrel 0.5/35 (28) 7 ACA; QL

nortrel 1/35 (21) 7 ACA; QL

nortrel 1/35 (28) 7 ACA; QL

Drug Name Drug Tier


nortrel 7/7/7 (28) 7 ACA; QL

ocella 7 ACA; QL

ogestrel (28) 7 ACA; QL

opcicon one-step 7 ACA; QL

option-2 7 ACA; QL

orsythia 7 ACA; QL

philith 7 ACA; QL

pimtrea (28) 7 ACA; QL

pirmella 7 ACA; QL

portia 28 7 ACA; QL

previfem 7 ACA; QL

rajani 7 ACA; QL

reclipsen (28) 7 ACA; QL

rivelsa 7 ACA; QL

setlakin 7 ACA; QL

sprintec (28) 7 ACA; QL

sronyx 7 ACA; QL

syeda 7 ACA; QL

tarina fe 1/20 (28) 7 ACA; QL

TAYTULLA 7 ACA; QL

tilia fe 7 ACA; QL

tri femynor 7 ACA; QL

tri-estarylla 7 ACA; QL

tri-legest fe 7 ACA; QL

tri-linyah 7 ACA; QL

tri-lo-estarylla 7 ACA; QL

tri-lo-marzia 7 ACA; QL

tri-lo-sprintec 7 ACA; QL

tri-mili 7 ACA; QL

tri-previfem (28) 7 ACA; QL

tri-sprintec (28) 7 ACA; QL


55

Drug Name Drug Tier


trivora (28) 7 ACA; QL

tri-vylibra 7 ACA; QL

tri-vylibra lo 7 ACA; QL

tydemy 7 ACA; QL

velivet triphasic regimen (28)

7 ACA; QL

vienva 7 ACA; QL

viorele (28) 7 ACA; QL

vyfemla (28) 7 ACA; QL

vylibra 7 ACA; QL

wera (28) 7 ACA; QL

wymzya fe 7 ACA; QL

zarah 7 ACA; QL

zenchent (28) 7 ACA; QL

zovia 1/35e (28) 7 ACA; QL

OXYTOCICS

methergine 2 PA; QL

methylergonovine 2 PA; QL

OPHTHALMOLOGY

ANTIBIOTICS

ak-poly-bac 2

AZASITE 3

bacitracin 2

bacitracin-polymyxin b

2

BESIVANCE 4

BETADINE OPHTHALMIC PREP

4

CILOXAN 4

ciprofloxacin hcl 2

erythromycin 2

Drug Name Drug Tier


gatifloxacin 2

gentak 2

gentamicin 2

levofloxacin 2

MOXEZA 3

moxifloxacin 2

MOXIFLOXACIN IN NACL,ISO-O(PF)

4

NATACYN 3

neomycin-bacitracin-polymyxin

2

neomycin-polymyxin-gramicidin

2

neo-polycin 2

ofloxacin 2

polycin 2

polymyxin b sulf-trimethoprim

2

tobramycin 2

TOBREX 4

ANTIVIRALS

trifluridine 2

ZIRGAN 4

BETA-BLOCKERS

betaxolol 2

BETIMOL 4

BETOPTIC S 4

carteolol 2

levobunolol 2

metipranolol 2


56

Drug Name Drug Tier


timolol maleate ophthalmic (eye) drops

1

timolol maleate ophthalmic (eye) drops, once daily

2

timolol maleate ophthalmic (eye) gel forming solution

2

CHOLINESTERASE INHIBITOR MIOTICS

PHOSPHOLINE IODIDE

3

CYCLOPLEGIC MYDRIATICS

atropine 2

ATROPINE IN 0.9 % SOD CHLORIDE

4

CYCLOGYL 4

cyclopentolate 2

CYCLOPEN-TROPIC-PHENYLEPH-WATR

4

homatropaire 2

homatropine hbr 2

mydriatic3 (trop-cyclopent-pe)

2

PAREMYD 4

tropicamide 2

DIRECT ACTING MIOTICS

MIOCHOL-E 4

pilocarpine hcl 2

MISCELLANEOUS OPHTHALMOLOGICS

AKTEN (PF) 4

Drug Name Drug Tier


ALOCRIL 4

ALOMIDE 4

altacaine 2

azelastine 2

BEPREVE 3

BEVACIZUMAB 4 PA

CEQUA 4

cromolyn 2

CYSTARAN 6 PA

EMADINE 4

epinastine 2

EYLEA 6 PA

flucaine 2

fluorescein-proparacaine

2

JETREA (PF) 6

LACRISERT 4

LASTACAFT 4

LIDOCAINE-PHENYLEPHRN IN WATER

4

LIDOCAN-PHENYLEPH-BSS NO.2(PF)

4

LUCENTIS 6 PA

MACUGEN 6

olopatadine 2

OMIDRIA 4

OXERVATE 6 PA

PAZEO 3

PHOTREXA CROSS-LINKING KIT

4


57

Drug Name Drug Tier


PHOTREXA VISCOUS

4

proparacaine 2

RACEPINEPH-LIDOCAINE-BSS 7(PF)

4

RESTASIS 3 QL

RESTASIS MULTIDOSE

3

tetcaine 2

tetracaine hcl 2

TETRACAINE HCL (PF)

4

TETRAVISC 4

TETRAVISC FORTE

4

VISUDYNE 6 PA

XIIDRA 3 PA

NON-STEROIDAL ANTI-INFLAMMATORY AGENTS

bromfenac 2

BROMSITE 4

diclofenac sodium 2

flurbiprofen sodium 2

ILEVRO 3

ketorolac 2

PROLENSA 3

ORAL DRUGS FOR GLAUCOMA

acetazolamide 2

methazolamide 2

OTHER GLAUCOMA DRUGS

AZOPT 4

bimatoprost 2

Drug Name Drug Tier


COMBIGAN 3

dorzolamide 2

dorzolamide-timolol 2

dorzolamide-timolol (pf)

2

latanoprost 1

LUMIGAN 3 ST

miostat 2

MITOSOL 4 PA

RHOPRESSA 3

SIMBRINZA 4

TRAVATAN Z 3 ST

VYZULTA 4 ST

STEROID-ANTIBIOTIC COMBINATIONS

neomycin-bacitracin-poly-hc

2

neomycin-polymyxin b-dexameth

2

neomycin-polymyxin-hc

2

neo-polycin hc 2

PRED-G 4

PRED-G S.O.P. 4

TOBRADEX 3

TOBRADEX ST 3

tobramycin-dexamethasone

2

ZYLET 3

STEROIDS

ALREX 3

dexamethasone sodium phosphate

2


58

Drug Name Drug Tier


DUREZOL 4

fluorometholone 2

ILUVIEN 6 PA

INVELTYS 3

LOTEMAX 3

OZURDEX 6 PA

prednisolone acetate 2

prednisolone sodium phosphate

2

RETISERT 6

YUTIQ 4

STEROID-SULFONAMIDE COMBINATIONS

BLEPHAMIDE 4

BLEPHAMIDE S.O.P.

4

sulfacetamide-prednisolone

2

SULFONAMIDES

sulfacetamide sodium

2

SYMPATHOMIMETICS

ALPHAGAN P 3

apraclonidine 2

brimonidine 2

IOPIDINE 4

VASOCONSTRICTOR DECONGESTANTS

CYCLOMYDRIL 4

phenylephrine hcl 2

RESPIRATORY, ALLERGY, COUGH & COLD

Drug Name Drug Tier


ANTIHISTAMINE & ANTIALLERGENIC AGENTS

carbinoxamine maleate

2

cetirizine 2

CLARINEX 4

clemastine 2

cyproheptadine 2

desloratadine oral tablet

2

desloratadine oral tablet,disintegrating

2 QL

EPINEPHRINE INJECTION AUTO-INJECTOR 0.15 MG/0.3 ML

3 QL

epinephrine injection auto-injector 0.3 mg/0.3 ml

2 QL

EPIPEN 2-PAK 3 PA; QL

EPIPEN JR 2-PAK 3 PA; QL

hydroxyzine hcl 2

hydroxyzine pamoate

2

KARBINAL ER 4

phenadoz 2

phenergan 2

promethazine 2

promethegan 2

RYVENT 4

COUGH & COLD THERAPY

benzonatate 2

brompheniramine-pseudoeph-dm

2


59

Drug Name Drug Tier


CAPCOF 4

centergy 2

cheratussin ac 2

CLARINEX-D 12 HOUR

4 QL

CODEINE-GUAIFENESIN

4

CODITUSSIN AC 4

CODITUSSIN DAC 4

g tussin ac 2

guaiatussin ac 2

guaifenesin ac 2

guaifenesin dac 2

hydrocodone-chlorpheniramine

2

hydrocodone-cpm-pseudoephed

2

hydrocodone-homatropine

2

hydromet 2

lortuss ex 2

MAR-COF CG 4

MAXI-TUSS CD 4

m-clear wc 2

M-END PE 4

NINJACOF-XG 4

POLY-TUSSIN AC 4

promethazine-codeine

2

promethazine-dm 2

promethazine-phenyleph-codeine

2

promethazine-phenylephrine

2

Drug Name Drug Tier


PRO-RED AC (W/ DEXCHLORPHENIR)

4

robafen ac 2

rydex 2

SEMPREX-D 4

tusnel c 2

TUSNEL PEDIATRIC

4

TUSSICAPS 4

TUZISTRA XR 4

virtussin ac 2

virtussin dac 2

ZODRYL AC 25 4

ZODRYL AC 30 4

ZODRYL AC 35 4

ZODRYL AC 40 4

ZODRYL AC 50 4

ZODRYL AC 60 4

ZODRYL AC 80 4

ZODRYL DAC 25 4

ZODRYL DAC 30 4

ZODRYL DAC 35 4

ZODRYL DAC 40 4

ZODRYL DAC 50 4

ZODRYL DAC 60 4

ZODRYL DAC 80 4

ZODRYL DEC 25 4

ZODRYL DEC 30 4

ZODRYL DEC 35 4

ZODRYL DEC 40 4

ZODRYL DEC 50 4


60

Drug Name Drug Tier


ZODRYL DEC 60 4

ZODRYL DEC 80 4

Z-TUSS AC 4

PULMONARY AGENTS

acetylcysteine 2

ADCIRCA 6 PA; QL

ADEMPAS 6 PA; LA

ADRENALIN 4

ADVAIR HFA 3 QL

AEROSPAN 4 ST

ALBUTEROL SULFATE INHALATION HFA AEROSOL INHALER

4 QL

albuterol sulfate inhalation solution for nebulization

2

albuterol sulfate oral syrup

1

albuterol sulfate oral tablet 2 mg

2

albuterol sulfate oral tablet 4 mg

1

albuterol sulfate oral tablet extended release 12 hr

2

alyq 2 PA; QL

ANORO ELLIPTA 3

ARCAPTA NEOHALER

3 QL

ARMONAIR RESPICLICK

3

ARNUITY ELLIPTA

3

ASMANEX HFA 3

Drug Name Drug Tier


ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES)

3 QL

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 220 MCG (14 DOSES)

3

ATROVENT HFA 3 QL

BERINERT 6 PA

BEVESPI AEROSPHERE

3

BREO ELLIPTA 3

budesonide 2 QL

CINRYZE 6 PA

COMBIVENT RESPIMAT

3 QL

cromolyn 2

CUROSURF 4

DALIRESP 3

DULERA 3 QL

DYMISTA 3 ST; QL

ELIXOPHYLLIN 4

ESBRIET 6 PA

FASENRA 6 PA

FIRAZYR 6 PA

FLOVENT DISKUS 3 QL


61

Drug Name Drug Tier


FLOVENT HFA 3 QL

flunisolide 2 QL

FLUTICASONE PROPION-SALMETEROL INHALATION AEROSOL POWDR BREATH ACTIVATED

3

fluticasone propion-salmeterol inhalation blister with device

2 QL

HAEGARDA 6 PA; LA

HYPER-SAL 4

INCRUSE ELLIPTA

3

ipratropium bromide 2

ipratropium-albuterol

2 QL

KALBITOR 6 PA

KALYDECO 6 PA

LETAIRIS 6 PA; LA

levalbuterol hcl 2

LONHALA MAGNAIR REFILL

4

LONHALA MAGNAIR STARTER

4

metaproterenol 2

mometasone 2 QL

montelukast oral granules in packet

2

montelukast oral tablet

1

montelukast oral tablet,chewable

1

Drug Name Drug Tier


nebusal inhalation solution for nebulization 3 %

2

NEBUSAL INHALATION SOLUTION FOR NEBULIZATION 6 %

4

NUCALA 6 PA; LA

OFEV 6 PA

OPSUMIT 6 PA; LA

ORKAMBI 6 PA

PERFOROMIST 3 QL

PROAIR HFA 3 QL

PROAIR RESPICLICK

3

PULMICORT FLEXHALER

3 QL

pulmosal 2

PULMOZYME 6 PA

QNASL NASAL HFA AEROSOL INHALER 40 MCG/ACTUATION

3 PA

QNASL NASAL HFA AEROSOL INHALER 80 MCG/ACTUATION

3 PA; QL

QVAR REDIHALER

3 QL

REVATIO INTRAVENOUS

6 PA

REVATIO ORAL SUSPENSION FOR RECONSTITUTION

6 PA

REVATIO ORAL TABLET

6 PA; QL


62

Drug Name Drug Tier


RUCONEST 6 PA

SEEBRI NEOHALER

4

SEREVENT DISKUS

3 QL

sildenafil (antihypertensive) intravenous

6 PA

sildenafil (antihypertensive) oral

6 PA; QL

SINUVA 6 PA

sodium chloride 2

SPIRIVA RESPIMAT

3

STIOLTO RESPIMAT

3

STRIVERDI RESPIMAT

3

SYMBICORT 3 QL

SYMDEKO 6 PA

tadalafil (antihypertensive)

6 PA; QL

TAKHZYRO 6 PA

terbutaline 2

THEO-24 4

theochron 2

theophylline 2

TRACLEER 6 PA; LA

TUDORZA PRESSAIR

3 QL

TYVASO 6 PA

TYVASO REFILL KIT

6 PA

Drug Name Drug Tier


TYVASO STARTER KIT

6 PA

UTIBRON NEOHALER

4

VENTAVIS 6 PA

VENTOLIN HFA 3 QL

wixela inhub 2 QL

XOLAIR 6 PA; LA

YUPELRI 3

zafirlukast 2

zileuton 2

ZYFLO 4

UROLOGICALS

ANTICHOLINERGICS & ANTISPASMODICS

darifenacin 2

flavoxate 2

GELNIQUE 3 PA; QL

MYRBETRIQ 3 PA

oxybutynin chloride oral syrup

2

oxybutynin chloride oral tablet

2

oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg

2

oxybutynin chloride oral tablet extended release 24hr 5 mg

2 QL

OXYTROL 4 PA; QL

tolterodine 2

TOVIAZ 3 PA

trospium 2


63

Drug Name Drug Tier


VESICARE 3 PA

BENIGN PROSTATIC HYPERPLASIA (BPH) THERAPY

alfuzosin 2

dutasteride 2

dutasteride-tamsulosin

2

finasteride 2

silodosin 2

tadalafil 2 PA; QL

tamsulosin 1

CHOLINERGIC STIMULANTS

bethanechol chloride 2

MISCELLANEOUS UROLOGICALS

CYSTAGON 6 PA

cytra k crystals 2

ELMIRON 3

hyophen 2

K-PHOS NO 2 4

K-PHOS ORIGINAL

3

methen-sod phos-meth blue-hyos

2

ORACIT 4

phosphasal 2

potassium citrate 2

PROCYSBI 6 PA

RENACIDIN 3

SHOHL'S MODIFIED

4

sildenafil 2 QL

URELLE 4

uretron d-s 2

Drug Name Drug Tier


URIBEL 4

urimar-t 2

urin ds 2

uro-458 2

urogesic-blue 2

uro-mp 2

UROQID-ACID NO.2

4

uryl 2

ustell 2

utira-c 2

vilamit mb 2

vilevev mb 2

URINARY ANESTHETICS

phenazopyridine 2

VITAMINS, HEMATINICS & ELECTROLYTES

ELECTROLYTES

calcium 500 + d 2

calcium 600 + d(3) 2

calcium 600 with vitamin d3

2

calcium citrate-vitamin d2

2

calcium citrate-vitamin d3

2

EFFER-K ORAL TABLET, EFFERVESCENT 10 MEQ, 20 MEQ

4

effer-k oral tablet, effervescent 25 meq

2

GALZIN 4

klor-con 2


64

Drug Name Drug Tier


klor-con 10 2

klor-con 8 2

klor-con m10 2

klor-con m15 2

klor-con m20 2

klor-con sprinkle 2

klor-con/ef 2

K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ, 20 MEQ

4

k-tab oral tablet extended release 8 meq

2

lugols 2

oyster shell calcium-vit d3

2

POTABA 4

potassium chloride 2

strong iodine 2

VITAMINS & HEMATINICS

b complex-vitamin b12

2

b complex-vitamin c-folic acid

2

balance b-100 2

balanced b-100 2

balanced b-100 complex

2

bal-care dha 2

BAL-CARE DHA ESSENTIAL

4

b-complex with vitamin c

2

Drug Name Drug Tier


CADEAU DHA 4

calcium pnv 2

cholecalciferol (vitamin d3)

2

CITRANATAL (DUAL-IRON)

4

CITRANATAL 90 DHA (ALGAL OIL)

4

CITRANATAL ASSURE

4

CITRANATAL B-CALM (FE GLUC)

4

CITRANATAL BLOOM

4

CITRANATAL DHA (ALGAL OIL)

4

CITRANATAL HARMONY (IRON FUM)

4

c-nate dha 2

complete natal dha 2

completenate 2

complex b-100 2

cyanocobalamin (vitamin b-12)

2

dialyvite 800 2

DUET DHA BALANCED

4

DUET DHA WITH OMEGA-3

4

elite-ob 2

ergocalciferol (vitamin d2)

1

EXTRA-VIRT PLUS DHA

4


65

Drug Name Drug Tier


FLORIVA (FLUORIDE-VITAMIN D3)

4

FLUORABON 7 ACA

fluoride (sodium) oral drops

7 ACA

fluoride (sodium) oral tablet,chewable 0.25 mg(0.55 mg sod. fluoride), 0.5 mg (1.1 mg sodium fluorid)

7 ACA

fluoride (sodium) oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

2

fluoritab oral tablet,chewable 0.5 mg (1.1 mg sodium fluorid)

7 ACA

fluoritab oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

2

FLURA-DROPS 7 ACA

FOLET ONE 4

folic acid oral tablet 1 mg

1

folic acid oral tablet 400 mcg, 800 mcg

7 ACA

folivane-ob 2

foltabs 800 2

full spectrum b-vitamin c

2

hemenatal ob 2

hemenatal ob + dha 2

hydroxocobalamin 2

kobee 2

Drug Name Drug Tier


kpn 2

ludent fluoride oral tablet,chewable 0.25 mg(0.55 mg sod. fluoride), 0.5 mg (1.1 mg sodium fluorid)

7 ACA

ludent fluoride oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

2

MARNATAL-F 4

multi-vitamin with fluoride

2

multivitamins with fluoride

2

mvc-fluoride 2

mynatal 2

mynatal advance 2

mynatal plus 2

mynatal-z 2

mynate 90 plus 2

NASCOBAL 3

NATACHEW (FE BIS-GLYCINATE)

4

natural b-100 complex

2

NEEVODHA (WITH ALGAL OIL)

4

NESTABS 4

NESTABS ABC 4

NESTABS DHA 4

NESTABS ONE 4

newgen 2

OB COMPLETE 4


66

Drug Name Drug Tier


OB COMPLETE ONE

4

OB COMPLETE PETITE

4

OB COMPLETE PREMIER

4

OB COMPLETE WITH DHA

4

obstetrix dha 2

OBSTETRIX EC 4

OBSTETRIX ONE 4

OBTREX DHA 4

one daily prenatal 2

oyster shell calcium-vit d2

2

perry prenatal 2

pnv 29-1 2

pnv ob+dha 2

pnv-dha 2

pnv-dha + docusate 2

pnv-ferrous fumarate-docu-fa

2

pnv-omega 2

pnv-select 2

pnv-vp-u 2

pr natal 400 2

pr natal 400 ec 2

pr natal 430 2

pr natal 430 ec 2

PREFERA-OB 4

PREFERA-OB PLUS DHA

4

prena1 chew 2

Drug Name Drug Tier


prena1 pearl 2

prenaissance 2

prenaissance plus 2

PRENATA 4

prenatabs fa 2

prenatabs rx 2

prenatal 2

PRENATAL 19 4

PRENATAL 19 (WITH DOCUSATE)

4

prenatal complete 2

prenatal formula 2

prenatal multi-dha (algal oil)

2

prenatal plus 2

prenatal plus (calcium carb)

2

prenatal vitamin plus low iron

2

prenatal vitamin with minerals

2

prenatal vits96-iron fum-folic

2

prenatal-u 2

PRENATE AM 4

PRENATE CHEWABLE

4

PRENATE DHA (FERR ASP GLYCIN)

4

PRENATE ELITE (IRON ASP GLYC)

4

PRENATE ENHANCE

4


67

Drug Name Drug Tier


PRENATE ESSENTIAL(IRON-ASP-GL)

4

PRENATE MINI (FERR ASP GLYCIN)

4

PRENATE PIXIE 4

PRENATE RESTORE

4

PRENATE STAR 4

preplus 2

pretab 2

PROVIDA OB 4

PUREFE OB PLUS 4

rena-vite 2

R-NATAL OB 4

SELECT-OB 4

SELECT-OB + DHA

4

se-natal 19 2

se-natal 19 (with docusate)

2

stress formula 2

stress formula with iron

2

stress formula with iron(sulf)

2

super b complex-vitamin c

2

super b maxi complex

2

super b-50 complex plus

2

super quints 2

super quints b-50 2

Drug Name Drug Tier


superplex-t 2

taron-c dha 2

taron-prex prenatal-dha

2

THRIVITE RX 4

tl g-fol os 2

total b/c 2

TRICARE 4

trinatal rx 1 2

trinate 2

TRISTART DHA 4

triveen-duo dha 2

tri-vitamin with fluoride

2

trust natal dha 2

ultra b-100 complex 2

vinate care 2

VINATE DHA RF 4

vinate ii 2

vinate m 2

vinate one 2

virt-advance 2

virt-c dha 2

virt-nate dha 2

virt-pn 2

virt-pn dha 2

virt-pn plus 2

VIRTPREX 4

virt-select 2

virt-vite gt 2

VITAFOL NANO 4

VITAFOL ULTRA 4


68

Drug Name Drug Tier


VITAFOL-OB 4

VITAFOL-OB+DHA

4

VITAFOL-ONE 4

VITAMED MD ONE RX

4

vitamin b complex 2

vitamin b complex-folic acid

2

vitamin d3 2

Drug Name Drug Tier


vitamins a,c,d and fluoride

2

VITAPEARL 4

vp-ch plus 2

vp-ch-pnv 2

VP-PNV-DHA 4

zatean-pn dha 2

zatean-pn plus 2

zingiber 2

69

Index

A abacavir .................................. 3 abacavir-lamivudine ............... 3 abacavir-lamivudine-

zidovudine .......................... 3 abiraterone .............................. 8 ABRAXANE .......................... 8 ABSORICA .......................... 29 acamprosate .......................... 34 acarbose ................................ 40 ACCU-CHEK COMBO

SYSTEM .......................... 37 ACE AEROSOL CLOUD

ENHANCER .................... 37 acebutolol ............................. 22 acetaminophen-caff-

dihydrocod ........................ 15 acetaminophen-codeine ........ 15 acetazolamide ....................... 57 acetic acid ....................... 34, 36 acetylcysteine ....................... 60 acitretin ................................. 28 ACTEMRA .......................... 49 ACTHAR H.P. ..................... 36 ACTHIB (PF) ....................... 47 ACTIMMUNE ..................... 47 ACTOPLUS MET XR ......... 40 acyclovir ........................... 3, 32 ADACEL(TDAP

ADOLESN/ADULT)(PF) 47 ADAGEN ............................. 34 adapalene .............................. 29 ADAPALENE ...................... 29 adapalene-benzoyl peroxide . 30 ADASUVE ........................... 18 ADCETRIS ............................ 8 ADCIRCA ............................ 60 adefovir................................... 3 ADEMPAS ........................... 60 ADRENALIN....................... 60 adriamycin .............................. 8 adult aspirin regimen ............ 17 ADVAIR HFA ..................... 60 ADVATE ............................. 25 ADYNOVATE ..................... 25 ADZENYS ER ..................... 18 ADZENYS XR-ODT ........... 18 AEROCHAMBER MINI ..... 37

AEROCHAMBER PLUS FLOW-VU........................ 37

AEROCHAMBER PLUS Z STAT ................................ 37

AEROSPAN ......................... 60 AEROTRACH PLUS ........... 37 AEROVENT PLUS .............. 37 afeditab cr ............................. 22 AFINITOR ............................. 8 AFINITOR DISPERZ ............ 8 AFLURIA 2018-2019 .......... 47 AFLURIA 2018-2019 (PF) .. 47 AFLURIA QUAD 2018-2019

.......................................... 47 AFLURIA QUAD 2018-2019

(PF) ................................... 47 AFREZZA ............................ 38 AFSTYLA ............................ 25 AIMOVIG AUTOINJECTOR

.......................................... 14 AIMOVIG AUTOINJECTOR

(2 PACK) .......................... 14 ak-poly-bac ........................... 55 AKTEN (PF) ........................ 56 AKYNZEO (NETUPITANT)

.......................................... 42 ALA-QUIN .......................... 32 albendazole ............................. 5 albuterol sulfate .................... 60 ALBUTEROL SULFATE .... 60 alclometasone ....................... 32 ALDACTAZIDE .................. 22 ALDURAZYME .................. 39 ALECENSA ........................... 8 alendronate ..................... 34, 49 ALFERON N ........................ 47 alfuzosin ............................... 63 ALIMTA ................................ 8 ALINIA .................................. 5 ALIQOPA .............................. 8 allopurinol ............................ 49 ALLZITAL ........................... 15 almotriptan malate ................ 14 ALOCRIL ............................. 56 ALOGLIPTIN-

PIOGLITAZONE ............. 40 ALOMIDE............................ 56 alophen ................................. 42

ALORA ................................ 50 alosetron ............................... 42 ALPHAGAN P ..................... 58 ALPHANATE ...................... 25 ALPHANINE SD ................. 25 alprazolam ............................ 18 alprazolam intensol ............... 18 ALREX ................................. 57 ALTABAX ........................... 31 altacaine ................................ 56 altavera (28) .......................... 52 ALUNBRIG ........................... 8 alyacen 1/35 (28) .................. 52 alyacen 7/7/7 (28) ................. 52 alyq ....................................... 60 ALZAIR ............................... 35 amabelz ................................. 50 amantadine hcl ........................ 3 amcinonide ........................... 32 amethia ................................. 52 amethia lo ............................. 52 amethyst (28) ........................ 52 AMICAR .............................. 25 amifostine crystalline .............. 7 amiloride ............................... 22 amiloride-hydrochlorothiazide

.......................................... 22 aminocaproic acid ................. 25 amiodarone ........................... 21 AMITIZA ............................. 42 amitriptyline ......................... 18 amitriptyline-chlordiazepoxide

.......................................... 18 amlodipine ............................ 22 amlodipine-atorvastatin ........ 26 amlodipine-benazepril .......... 22 amlodipine-olmesartan ......... 22 amlodipine-valsartan ............ 22 amlodipine-valsartan-hcthiazid

.......................................... 22 amnesteem ............................ 30 amoxapine ............................. 18 amoxicil-clarithromy-lansopraz

.......................................... 45 amoxicillin .............................. 6 amoxicillin-pot clavulanate .... 6 amphetamine sulfate ............. 18 ampicillin ................................ 6

70

AMPYRA ............................. 14 AMRIX................................. 15 ANADROL-50 ..................... 39 anagrelide ............................. 34 ANA-LEX KIT .................... 42 ANALPRAM-HC................. 42 anaspaz ................................. 41 anastrozole .............................. 8 ANDRODERM .................... 39 ANGELIQ ............................ 50 ANORO ELLIPTA .............. 60 ANTARA ............................. 27 anucort-hc ............................. 42 apexicon e ............................. 32 APLENZIN .......................... 18 APOKYN ............................. 13 apraclonidine ........................ 58 aprepitant .............................. 42 apri ........................................ 52 APRISO ................................ 42 APTENSIO XR .................... 18 APTIOM............................... 12 APTIVUS ............................... 3 aqua care sodium chloride .... 34 aqua care sterile water .......... 34 AQUA GLYCOLIC HC....... 32 ARAKODA ............................ 5 ARALAST NP ..................... 34 aranelle (28).......................... 52 ARANESP (IN

POLYSORBATE) ............ 46 ARCALYST ......................... 47 ARCAPTA NEOHALER ..... 60 ARIKAYCE ........................... 5 aripiprazole ........................... 18 ARISTADA .......................... 18 armodafinil ........................... 18 ARMONAIR RESPICLICK 60 ARMOUR THYROID ......... 41 ARNUITY ELLIPTA ........... 60 ARRANON ............................ 8 ARSENIC TRIOXIDE ........... 8 ARZERRA ............................. 8 ascomp with codeine ............ 15 ashlyna .................................. 52 ASMANEX HFA ................. 60 ASMANEX TWISTHALER 60 aspir-81 ................................. 17 aspirin ................................... 17 aspirin low dose .................... 17

aspirin-dipyridamole ............ 25 aspir-low ............................... 17 aspir-trin ............................... 17 ASTAGRAF XL..................... 8 atazanavir................................ 3 atenolol ................................. 22 atenolol-chlorthalidone ......... 22 ATGAM ............................... 47 atomoxetine .......................... 18 atorvastatin ........................... 27 atovaquone.............................. 5 atovaquone-proguanil ............. 5 ATRIPLA ............................... 3 atropine ................................. 56 ATROPINE IN 0.9 % SOD

CHLORIDE ...................... 56 ATROVENT HFA ............... 60 AUBAGIO............................ 46 aubra ..................................... 52 aubra eq ................................ 52 AUGMENTIN ........................ 6 AURYXIA............................ 42 AUSTEDO ........................... 14 AUTOJECT 2 INJECTION

DEVICE ........................... 37 AUTOPEN 1 TO 21 UNITS 37 AVANDIA ........................... 40 avar ....................................... 30 AVAR ................................... 30 AVAR LS ............................. 30 AVAR-E GREEN................. 30 AVAR-E LS ......................... 30 AVASTIN .............................. 8 AVC VAGINAL .................. 51 aviane.................................... 52 avidoxy ................................... 7 AVIDOXY DK....................... 7 avita ...................................... 30 AVITA.................................. 30 AVONEX ............................. 47 AVONEX (WITH ALBUMIN)

.......................................... 47 azacitidine ............................... 8 AZASAN ................................ 8 AZASITE ............................. 55 azathioprine ............................ 8 azelaic acid ........................... 30 azelastine ........................ 35, 56 AZELEX .............................. 30 azithromycin ........................... 5

AZOPT ................................. 57 azurette (28) .......................... 52 B b complex-vitamin b12 ......... 64 b complex-vitamin c-folic acid

.......................................... 64 bacitracin .............................. 55 bacitracin-polymyxin b ......... 55 baclofen ................................ 15 BACLOFEN ......................... 15 balance b-100 ........................ 64 balanced b-100 ...................... 64 balanced b-100 complex ....... 64 bal-care dha .......................... 64 BAL-CARE DHA

ESSENTIAL ..................... 64 balsalazide ............................ 42 balziva (28) ........................... 52 BANZEL .............................. 12 BARACLUDE ........................ 3 BASAGLAR KWIKPEN U-

100 INSULIN ................... 38 BAVENCIO ........................... 8 BAXDELA ............................. 6 bayer aspirin ......................... 17 b-complex with vitamin c ..... 64 BD MICROTAINER

LANCET .......................... 37 BD SPECIALTY USE

NEEDLES ........................ 37 BD ULTRA FINE LANCETS

.......................................... 37 BD ULTRA-FINE NANO

PEN NEEDLE .................. 37 bekyree (28) .......................... 52 BELBUCA ........................... 15 BELEODAQ ........................... 8 belladonna alkaloids-opium .. 42 belladonna-opium ................. 42 BELSOMRA ........................ 18 benazepril ............................. 22 benazepril-hydrochlorothiazide

.......................................... 22 BENDAMUSTINE ................. 8 BENDEKA ............................. 8 BENEFIX ............................. 25 BENLYSTA ......................... 49 BENSAL HP ........................ 28 BENZEFOAM ...................... 30 BENZEFOAM ULTRA ....... 30

71

benzepro ............................... 30 BENZNIDAZOLE ................. 5 benzonatate ........................... 58 benzoyl peroxide .................. 30 benztropine ........................... 13 BEPREVE ............................ 56 BERINERT .......................... 60 BESIVANCE ....................... 55 BESPONSA ........................... 8 BETADINE OPHTHALMIC

PREP ................................ 55 betamethasone dipropionate . 32 betamethasone valerate ........ 32 betamethasone, augmented... 32 BETASERON ...................... 47 betaxolol ......................... 22, 55 bethanechol chloride ............ 63 BETHKIS ............................... 5 BETIMOL ............................ 55 BETOPTIC S........................ 55 BEVACIZUMAB................. 56 BEVESPI AEROSPHERE ... 60 bexarotene .............................. 8 BEXSERO ............................ 47 bicalutamide ........................... 8 BIDIL ................................... 22 BIKTARVY ........................... 3 bimatoprost ........................... 57 BINOSTO............................. 49 bisacodyl............................... 42 bisa-lax ................................. 42 bisoprolol fumarate .............. 22 bisoprolol-hydrochlorothiazide

.......................................... 22 BIVIGAM ............................ 47 bleomycin ............................... 8 BLEPHAMIDE .................... 58 BLEPHAMIDE S.O.P. ......... 58 BLINCYTO ............................ 8 blisovi 24 fe .......................... 52 blisovi fe 1.5/30 (28) ............ 52 blisovi fe 1/20 (28) ............... 52 BONIVA .............................. 49 BONJESTA .......................... 42 BOOSTRIX TDAP .............. 47 BORTEZOMIB ...................... 8 BOSULIF ............................... 8 BOTOX ................................ 47 bp 10-1.................................. 30 bpo ........................................ 30

BREATHERITE MDI SPACER ........................... 37

BREO ELLIPTA .................. 60 briellyn.................................. 52 BRILINTA ........................... 25 brimonidine .......................... 58 BRINEURA.......................... 39 BRIVIACT ........................... 12 bromfenac ............................. 57 bromocriptine ....................... 13 brompheniramine-pseudoeph-

dm ..................................... 58 BROMSITE .......................... 57 BUCALSEP.......................... 31 budesonide ...................... 42, 60 bumetanide ........................... 22 BUNAVAIL ......................... 17 buprenorphine ....................... 15 BUPRENORPHINE ............. 15 buprenorphine hcl ................. 15 buprenorphine-naloxone ....... 17 bupropion hcl ........................ 18 BUPROPION HCL .............. 18 bupropion hcl (smoking deter)

.......................................... 35 buspirone .............................. 19 busulfan .................................. 8 butalbital compound w/codeine

.......................................... 15 butalbital-acetaminop-caf-cod

.......................................... 15 butalbital-acetaminophen ..... 15 butalbital-acetaminophen-caff

.......................................... 15 butalbital-aspirin-caffeine .... 16 BUTISOL ............................. 19 butorphanol tartrate .............. 17 BYDUREON ........................ 40 BYDUREON BCISE ........... 40 BYETTA .............................. 40 BYSTOLIC .......................... 22 C cabergoline ........................... 39 CABOMETYX ....................... 8 CADEAU DHA .................... 64 caffeine citrate ...................... 34 calcipotriene ......................... 28 calcipotriene-betamethasone 28 calcitonin (salmon) ............... 39 calcitrene .............................. 28

calcitriol .......................... 28, 39 calcium 500 + d .................... 63 calcium 600 + d(3)................ 63 calcium 600 with vitamin d3 63 calcium acetate ..................... 42 calcium citrate-vitamin d2 .... 63 calcium citrate-vitamin d3 .... 63 calcium pnv .......................... 64 CALQUENCE ........................ 8 CAMBIA .............................. 17 camila ................................... 50 CAMPTOSAR ........................ 8 camrese ................................. 52 camrese lo ............................. 52 candesartan ........................... 22 candesartan-hydrochlorothiazid

.......................................... 22 CAPCOF ............................... 59 capecitabine ............................ 8 CAPEX ................................. 32 CAPRELSA ............................ 8 captopril ................................ 22 captopril-hydrochlorothiazide

.......................................... 22 CARAC ................................ 29 CARAFATE ......................... 45 CARBAGLU ........................ 34 carbamazepine ...................... 12 carbidopa .............................. 13 carbidopa-levodopa .............. 13 carbidopa-levodopa-

entacapone ........................ 13 carbinoxamine maleate ......... 58 carboplatin .............................. 8 CARDIZEM LA ................... 22 CARDURA XL .................... 22 carisoprodol .......................... 15 carisoprodol-asa-codeine ...... 15 carisoprodol-aspirin .............. 15 carmustine ............................... 8 CARNITOR (SUGAR-FREE)

.......................................... 34 CAROSPIR ........................... 22 carteolol ................................ 55 cartia xt ................................. 22 carvedilol .............................. 22 carvedilol phosphate ............. 22 CAYA CONTOURED ......... 50 CAYSTON ............................. 5 caziant (28) ........................... 52

72

cefaclor ................................... 4 cefadroxil ................................ 4 cefdinir ................................... 4 cefditoren pivoxil ................... 4 cefixime .................................. 4 cefpodoxime ........................... 5 cefprozil .................................. 5 cefuroxime axetil .................... 5 celecoxib............................... 17 CELONTIN .......................... 12 cem-urea ............................... 29 CENTANY ........................... 31 CENTANY AT .................... 31 centergy ................................ 59 cephalexin............................... 5 CEPROTIN (BLUE BAR) ... 25 CEPROTIN (GREEN BAR) 25 CEQUA ................................ 56 CERDELGA......................... 39 CEREZYME ........................ 39 CERVIDIL ........................... 51 CESAMET ........................... 42 cetirizine ............................... 58 CETROTIDE ........................ 39 cevimeline ............................ 34 CHANTIX ............................ 35 CHANTIX CONTINUING

MONTH BOX .................. 35 CHANTIX STARTING

MONTH BOX .................. 35 chateal (28) ........................... 52 chateal eq (28) ...................... 52 CHEMET ............................. 34 CHENODAL ........................ 42 cheratussin ac ....................... 59 children's aspirin ................... 17 chlordiazepoxide hcl ............ 19 chlordiazepoxide-clidinium .. 42 chlorhexidine gluconate ....... 35 chloroquine phosphate............ 5 chlorothiazide ....................... 22 chlorpromazine ..................... 19 chlorpropamide..................... 40 chlorthalidone ....................... 22 chlorzoxazone....................... 15 CHOLBAM .......................... 42 cholecalciferol (vitamin d3) . 64 cholestyramine (with sugar) . 27 cholestyramine light ............. 27

choline,magnesium salicylate .......................................... 17

ciclodan ................................ 32 CICLODAN KIT .................. 32 ciclopirox .............................. 32 cilostazol ............................... 25 CILOXAN ............................ 55 CIMDUO ................................ 3 cimetidine ............................. 45 cimetidine hcl ....................... 45 CIMZIA ................................ 42 CIMZIA POWDER FOR

RECONST ........................ 42 cinacalcet .............................. 39 CINRYZE ............................. 60 CINVANTI ........................... 42 CIPRO HC ............................ 36 CIPRODEX .......................... 36 ciprofloxacin ........................... 6 ciprofloxacin (mixture)........... 6 ciprofloxacin hcl ......... 6, 36, 55 citalopram ............................. 19 CITRANATAL (DUAL-

IRON) ............................... 64 CITRANATAL 90 DHA

(ALGAL OIL) .................. 64 CITRANATAL ASSURE .... 64 CITRANATAL B-CALM (FE

GLUC) .............................. 64 CITRANATAL BLOOM ..... 64 CITRANATAL DHA

(ALGAL OIL) .................. 64 CITRANATAL HARMONY

(IRON FUM) .................... 64 citrate of magnesia................ 42 citroma .................................. 42 cladribine ................................ 8 claravis.................................. 30 CLARINEX .......................... 58 CLARINEX-D 12 HOUR .... 59 clarithromycin ........................ 5 cleansing wash ...................... 30 clearlax ................................. 42 clemastine ............................. 58 CLENPIQ ............................. 43 CLEOCIN ............................. 51 CLINDACIN ETZ ................ 30 clindacin p ............................ 30 CLINDACIN PAC ............... 30 CLINDAGEL ....................... 30

clindamycin hcl ...................... 5 clindamycin palmitate hcl ....... 5 clindamycin pediatric ............. 5 clindamycin phosphate ... 30, 52 CLINDAMYCIN

PHOSPHATE ................... 30 clindamycin-benzoyl peroxide

.......................................... 30 clindamycin-tretinoin ........... 30 CLINDESSE ......................... 52 CLINPRO 5000 .................... 35 clobazam ............................... 12 clobetasol .............................. 32 clobetasol-emollient ............. 33 CLOCORTOLONE

PIVALATE ....................... 33 clodan ................................... 33 CLODAN KIT ...................... 33 CLODERM ........................... 33 clofarabine .............................. 8 clomipramine ........................ 19 clonazepam ........................... 12 clonidine ............................... 22 clonidine hcl ................... 19, 22 clopidogrel ............................ 25 clorazepate dipotassium ........ 19 clotrimazole ............................ 3 clotrimazole-betamethasone . 32 clozapine ............................... 19 CLOZAPINE ........................ 19 c-nate dha .............................. 64 COAGADEX ........................ 25 COAL TAR .......................... 28 COARTEM ............................. 5 codeine sulfate ...................... 16 CODEINE-GUAIFENESIN . 59 CODITUSSIN AC ................ 59 CODITUSSIN DAC ............. 59 COLCRYS ............................ 49 colesevelam .......................... 27 COLESTID ........................... 27 COLESTID FLAVORED .... 27 colestipol ............................... 27 colocort ................................. 43 COLY-MYCIN S ................. 36 COMBIGAN ........................ 57 COMBIPATCH .................... 50 COMBIVENT RESPIMAT .. 60 COMETRIQ ........................... 8

73

COMPACT SPACE CHAMBER ...................... 37

COMPLERA .......................... 3 complete natal dha ................ 64 completenate......................... 64 complex b-100 ...................... 64 CONCEPTROL .................... 52 CONDYLOX ....................... 29 constulose ............................. 43 CONZIP ............................... 17 COPAXONE ........................ 47 COPIKTRA ............................ 8 CORDRAN .......................... 33 CORDRAN TAPE LARGE

ROLL ............................... 33 coremino ................................. 7 CORIFACT .......................... 25 CORLANOR ........................ 27 cormax .................................. 33 cortisone ............................... 36 CORTISPORIN .................... 31 COSENTYX......................... 28 COSENTYX (2 SYRINGES)

.......................................... 28 COSENTYX PEN ................ 28 COSENTYX PEN (2 PENS) 28 COSMEGEN .......................... 8 COTELLIC............................. 8 COTEMPLA XR-ODT ........ 19 covaryx ................................. 50 covaryx h.s. .......................... 50 CREON ................................ 43 CRESEMBA .......................... 3 CRIXIVAN ............................ 3 cromolyn................... 43, 56, 60 crotan .................................... 33 cryselle (28) .......................... 52 CUPRIMINE ........................ 49 CUROSURF ......................... 60 CUVITRU ............................ 47 CUVPOSA ........................... 42 cyanocobalamin (vitamin b-12)

.......................................... 64 cyclafem 1/35 (28) ............... 52 cyclafem 7/7/7 (28) .............. 52 cyclobenzaprine .................... 15 CYCLOGYL ........................ 56 CYCLOMYDRIL................. 58 cyclopentolate....................... 56

CYCLOPEN-TROPIC-PHENYLEPH-WATR...... 56

cyclophosphamide .................. 8 CYCLOSERINE .................... 5 CYCLOSET ......................... 40 cyclosporine............................ 8 cyclosporine modified ............ 8 cyproheptadine ..................... 58 CYRAMZA ............................ 8 cyred ..................................... 52 cyred eq ................................ 53 CYSTADANE ...................... 43 CYSTAGON ........................ 63 CYSTARAN ........................ 56 cytra k crystals ...................... 63 D dacarbazine ............................. 8 DACOGEN ............................ 8 dactinomycin .......................... 8 DAKLINZA ........................... 3 dalfampridine........................ 14 DALIRESP ........................... 60 danazol.................................. 39 dantrolene ............................. 15 dapsone ............................. 5, 30 DAPTACEL (DTAP

PEDIATRIC) (PF) ............ 47 DARAPRIM ........................... 5 darifenacin ............................ 62 DARZALEX .......................... 8 dasetta 1/35 (28) ................... 53 dasetta 7/7/7 (28) .................. 53 daunorubicin ........................... 8 daysee ................................... 53 DAYTRANA........................ 19 DDAVP ................................ 39 DEBACTEROL.................... 35 deblitane ............................... 50 decadron ............................... 36 decitabine................................ 8 DELESTROGEN ................. 50 deltasone ............................... 36 delyla (28)............................. 53 demeclocycline ....................... 7 DEMSER .............................. 22 DENAVIR ............................ 32 denta 5000 plus ..................... 35 dentagel ................................ 35 DEPEN TITRATABS .......... 49 DEPO-ESTRADIOL ............ 50

DEPO-SUBQ PROVERA 104 .......................................... 50

DEPO-TESTOSTERONE .... 39 DERMASORB HC

COMPLETE KIT ............. 33 DERMASORB TA

COMPLETE KIT ............. 33 DESCOVY ............................. 3 desipramine ........................... 19 desloratadine ......................... 58 desmopressin ........................ 39 desog-e.estradiol/e.estradiol . 53 desogestrel-ethinyl estradiol . 53 DESONATE ......................... 33 desonide ................................ 33 desoximetasone ..................... 33 DESVENLAFAXINE .......... 19 DESVENLAFAXINE

FUMARATE .................... 19 desvenlafaxine succinate ...... 19 dexamethasone ..................... 36 dexamethasone intensol ........ 36 dexamethasone sodium

phosphate .......................... 57 DEXILANT .......................... 45 dexmethylphenidate .............. 19 dextroamphetamine .............. 19 dextroamphetamine-

amphetamine ..................... 19 dialyvite 800 ......................... 64 DIASTAT ............................. 12 diazepam ......................... 12, 19 diazepam intensol ................. 19 DICLEGIS ............................ 43 diclofenac potassium ............ 17 diclofenac sodium ..... 17, 29, 57 diclofenac-misoprostol ......... 17 dicloxacillin ............................ 6 dicyclomine .......................... 42 didanosine ............................... 3 DIFFERIN ............................ 30 DIFICID ................................. 5 diflorasone ............................ 33 diflunisal ............................... 17 digitek ................................... 25 digox ..................................... 25 digoxin .................................. 25 dihydroergotamine ................ 14 DILANTIN ........................... 12 DILATRATE-SR ................. 28

74

diltiazem ......................... 22, 23 dilt-xr .................................... 23 DIPENTUM ......................... 43 diphenoxylate-atropine ......... 42 dipyridamole......................... 25 diskets ................................... 16 disopyramide phosphate ....... 21 disulfiram ............................. 34 DIURIL ................................ 23 divalproex ............................. 12 DIVIGEL ........................ 50, 51 DOCEFREZ ........................... 8 docetaxel................................. 9 DOCETAXEL ........................ 9 dofetilide............................... 21 donepezil .............................. 14 DONNATAL ........................ 42 DORAL ................................ 19 DORYX MPC ........................ 7 dorzolamide .......................... 57 dorzolamide-timolol ............. 57 dorzolamide-timolol (pf) ...... 57 doxazosin .............................. 23 doxepin ........................... 19, 29 doxercalciferol ...................... 39 doxorubicin............................. 9 doxorubicin, peg-liposomal .... 9 doxycycline hyclate ................ 7 doxycycline monohydrate ...... 7 D-PENAMINE ..................... 49 drithocreme hp...................... 28 dronabinol............................. 43 drospirenone-e.estradiol-lm.fa

.......................................... 53 drospirenone-ethinyl estradiol

.......................................... 53 DROXIA ................................ 9 DUAVEE ............................. 51 ducodyl ................................. 43 DUET DHA BALANCED ... 64 DUET DHA WITH OMEGA-3

.......................................... 64 DULERA .............................. 60 duloxetine ............................. 19 DUOPA ................................ 13 DUPIXENT .......................... 29 DUREZOL ........................... 58 dutasteride ............................ 63 dutasteride-tamsulosin .......... 63 DUTOPROL......................... 23

dvorah ................................... 16 DYANAVEL XR ................. 19 DYMISTA ............................ 60 DYRENIUM ........................ 23 DYSPORT ............................ 47 E e.c. prin ................................. 17 e.e.s. 400 ................................. 5 EASIVENT HOLDING

CHAMBER ...................... 37 econazole .............................. 32 econtra ez .............................. 53 econtra one-step .................... 53 ecotrin ................................... 17 ecotrin low strength .............. 17 ECOZA ................................. 32 EDARBI ............................... 23 EDARBYCLOR ................... 23 EDLUAR .............................. 19 ed-spaz .................................. 42 EDURANT ............................. 3 eemt ...................................... 51 eemt hs .................................. 51 efavirenz ................................. 3 effer-k ................................... 63 EFFER-K .............................. 63 EGRIFTA ............................. 46 ELAPRASE .......................... 39 ELELYSO ............................ 39 ELESTRIN ........................... 51 eletriptan ............................... 14 ELIGARD .............................. 9 ELIGARD (3 MONTH) ......... 9 ELIGARD (4 MONTH) ......... 9 ELIGARD (6 MONTH) ......... 9 elinest.................................... 53 ELIQUIS .............................. 25 ELITEK .................................. 7 elite-ob .................................. 64 ELIXOPHYLLIN ................. 60 ELLA .................................... 53 ELLENCE .............................. 9 ELMIRON ............................ 63 ELOCTATE ......................... 25 EMADINE............................ 56 EMCYT .................................. 9 EMEND ................................ 43 EMEND (FOSAPREPITANT)

.......................................... 43 EMFLAZA ........................... 36

EMGALITY PEN ................. 14 EMGALITY SYRINGE ....... 14 emoquette ............................. 53 EMPLICITI ............................ 9 EMSAM ............................... 19 EMTRIVA .............................. 3 EMVERM ............................... 5 enalapril maleate ................... 23 enalapril-hydrochlorothiazide

.......................................... 23 ENBREL ............................... 49 ENBREL MINI .................... 49 ENBREL SURECLICK ....... 49 ENDARI ............................... 34 endocet .................................. 16 ENGERIX-B (PF) ................ 48 ENGERIX-B PEDIATRIC

(PF) ................................... 48 enoxaparin ............................ 25 enpresse ................................ 53 enskyce ................................. 53 entacapone ............................ 13 entecavir ................................. 3 ENTEREG ............................ 43 ENTRESTO .......................... 27 ENTYVIO ............................ 43 enulose .................................. 43 ENVARSUS XR .................... 9 EPANED .............................. 23 EPCLUSA .............................. 3 EPIDIOLEX ......................... 12 EPIDUO FORTE .................. 30 EPIFOAM ............................. 28 epinastine .............................. 56 epinephrine ........................... 58 EPINEPHRINE .................... 58 EPIPEN 2-PAK .................... 58 EPIPEN JR 2-PAK ............... 58 epirubicin ................................ 9 EPISIL .................................. 35 epitol ..................................... 12 EPIVIR HBV .......................... 3 eplerenone ............................. 23 EPOGEN .............................. 46 epoprostenol (glycine) .......... 23 eprosartan ............................. 23 EQUETRO ........................... 12 ERBITUX ............................... 9 ergocalciferol (vitamin d2) ... 64 ergoloid ................................. 19

75

ERGOMAR .......................... 14 ergotamine-caffeine .............. 14 ERIVEDGE ............................ 9 ERLEADA ............................. 9 errin ...................................... 51 ERTACZO ........................... 32 ery pads ................................ 30 erygel .................................... 30 ERYPED 200 ......................... 5 ERYPED 400 ......................... 5 ery-tab..................................... 5 ERY-TAB............................... 5 erythrocin (as stearate) ........... 5 erythromycin .................... 5, 55 erythromycin ethylsuccinate .. 5 erythromycin with ethanol ... 30 erythromycin-benzoyl peroxide

.......................................... 30 ESBRIET .............................. 60 escitalopram oxalate ............. 19 esomeprazole magnesium .... 45 ESOMEPRAZOLE

STRONTIUM................... 45 estarylla ................................ 53 estazolam .............................. 19 estradiol ................................ 51 estradiol valerate .................. 51 estradiol-norethindrone acet . 51 ESTRING ............................. 51 estrogens-methyltestosterone 51 eszopiclone ........................... 19 ethacrynic acid...................... 23 ethambutol .............................. 5 ethosuximide ........................ 12 ethyl chloride ........................ 31 ethynodiol diac-eth estradiol 53 etidronate disodium .............. 34 etodolac ................................ 17 etoposide................................. 9 EURAX ................................ 33 EVAMIST ............................ 51 EVOMELA ............................ 9 EVOTAZ ................................ 3 EXELDERM ........................ 32 exemestane ............................. 9 EXJADE ............................... 34 EXODERM .......................... 32 EXONDYS 51 ...................... 14 EXTAVIA ............................ 47 EXTRA-VIRT PLUS DHA . 64

EYLEA ................................. 56 E-Z SPACER ........................ 37 ezetimibe .............................. 27 ezetimibe-simvastatin ........... 27 F FABIOR ............................... 30 FABRAZYME ..................... 39 FACTIVE ............................... 6 falmina (28) .......................... 53 famciclovir.............................. 3 famotidine ............................. 45 FANAPT .............................. 19 FARESTON ........................... 9 FARXIGA ............................ 40 FARYDAK ............................. 9 FASENRA ............................ 60 FASLODEX ........................... 9 fayosim ................................. 53 FAZACLO............................ 19 FC2 FEMALE CONDOM ... 50 FEIBA NF ............................ 25 felbamate .............................. 12 felodipine .............................. 23 fem ph ................................... 52 FEMCAP .............................. 50 femynor ................................ 53 fenofibrate ............................ 27 FENOFIBRATE ................... 27 fenofibrate micronized ......... 27 fenofibrate nanocrystallized . 27 fenofibric acid....................... 27 fenofibric acid (choline) ....... 27 fenoprofen ............................ 17 fentanyl ................................. 16 fentanyl citrate ...................... 16 FERRIPROX ........................ 34 FETZIMA ............................. 19 FIBRYGA ............................ 25 FINACEA ............................. 30 finasteride ............................. 63 FIRAZYR ............................. 60 FIRMAGON KIT W

DILUENT SYRINGE ........ 9 FIRVANQ .............................. 7 flac otic oil ............................ 36 flavoxate ............................... 62 flecainide .............................. 21 FLECTOR ............................ 17 fleet laxative ......................... 43 FLEXICHAMBER ............... 37

FLOLAN .............................. 23 FLOLIPID ............................ 27 FLORIVA (FLUORIDE-

VITAMIN D3) .................. 65 FLOVENT DISKUS ............ 60 FLOVENT HFA ................... 61 floxuridine .............................. 9 FLUAD 2018-2019 (65 YR

UP)(PF) ............................. 48 FLUARIX QUAD 2018-2019

(PF) ................................... 48 FLUBLOK QUAD 2018-2019

(PF) ................................... 48 flucaine ................................. 56 FLUCELVAX QUAD 2018-

2019 .................................. 48 FLUCELVAX QUAD 2018-

2019 (PF) .......................... 48 fluconazole ............................. 3 flucytosine .............................. 3 fludrocortisone ...................... 36 FLULAVAL QUAD 2018-

2019 .................................. 48 FLULAVAL QUAD 2018-

2019 (PF) .......................... 48 FLUMIST QUAD 2018-2019

.......................................... 48 flunisolide ............................. 61 fluocinolone .......................... 33 fluocinolone acetonide oil .... 36 fluocinolone and shower cap 33 fluocinonide .......................... 33 fluocinonide-emollient ......... 33 FLUORABON ...................... 65 fluorescein-proparacaine ...... 56 fluoride (sodium) .................. 65 FLUORIDEX DAILY

DEFENSE ......................... 35 fluoritab ................................ 65 fluorometholone ................... 58 FLUOROPLEX .................... 29 fluorouracil ........................... 29 fluoxetine .............................. 19 fluphenazine hcl .................... 19 FLURA-DROPS ................... 65 flurandrenolide ..................... 33 flurazepam ............................ 19 flurbiprofen ........................... 17 flurbiprofen sodium .............. 57 flutamide ................................. 9

76

fluticasone propionate .......... 33 fluticasone propion-salmeterol

.......................................... 61 FLUTICASONE PROPION-

SALMETEROL ............... 61 fluvastatin ............................. 27 fluvoxamine .......................... 19 FLUZONE HIGH-DOSE

2018-19 (PF) .................... 48 FLUZONE QUAD 2018-2019

.......................................... 48 FLUZONE QUAD 2018-2019

(PF) ................................... 48 FLUZONE QUAD PEDI

2018-19 (PF) .................... 48 FOLET ONE ........................ 65 folic acid ............................... 65 folivane-ob ........................... 65 FOLOTYN ............................. 9 foltabs 800 ............................ 65 fondaparinux......................... 25 FORFIVO XL ...................... 19 FORTEO .............................. 49 FOSAMAX PLUS D ............ 49 fosamprenavir ......................... 3 fosinopril .............................. 23 fosinopril-hydrochlorothiazide

.......................................... 23 FRAGMIN ........................... 25 frovatriptan ........................... 14 full spectrum b-vitamin c ..... 65 FULPHILA........................... 46 furosemide ............................ 23 FUZEON ................................ 3 fyavolv .................................. 51 FYCOMPA .......................... 12 G g tussin ac ............................. 59 gabapentin ............................ 12 GALAFOLD ........................ 39 galantamine .......................... 14 GALZIN ............................... 63 GAMMAGARD LIQUID .... 48 GAMMAPLEX .................... 48 ganirelix ................................ 39 GARDASIL 9 (PF)............... 48 gatifloxacin ........................... 55 GATTEX 30-VIAL .............. 43 gavilax .................................. 43 gavilyte-c .............................. 43

gavilyte-g .............................. 43 gavilyte-n .............................. 43 GAZYVA ............................... 9 GELCLAIR .......................... 35 GELNIQUE .......................... 62 GELX ................................... 35 gemcitabine ............................ 9 GEMCITABINE .................... 9 gemfibrozil ........................... 27 generlac ................................ 43 gengraf .................................... 9 GENOTROPIN .................... 46 GENOTROPIN MINIQUICK

.......................................... 46 gentak ................................... 55 gentamicin ...................... 31, 55 gentle laxative....................... 43 gentlelax ............................... 43 GENVOYA ............................ 3 gianvi (28) ............................ 53 GILENYA ............................ 47 GILOTRIF .............................. 9 GLASSIA ............................. 34 glatiramer.............................. 47 glatopa .................................. 47 GLEEVEC .............................. 9 GLEOSTINE .......................... 9 GLIADEL WAFER ................ 9 glimepiride............................ 40 glipizide ................................ 40 glipizide-metformin .............. 40 GLUCAGEN DIAGNOSTIC

KIT ................................... 37 GLUCAGEN HYPOKIT ..... 37 GLUCAGON EMERGENCY

KIT (HUMAN)................. 37 glyburide ............................... 40 glyburide micronized ............ 40 glyburide-metformin ............ 40 GLYCATE ........................... 42 glycolax ................................ 43 glycopyrrolate ....................... 42 glydo ..................................... 31 GLYXAMBI ........................ 40 GOCOVRI ............................ 13 GOLYTELY ......................... 43 GRALISE ............................. 12 GRALISE 30-DAY STARTER

PACK ............................... 13 granisetron hcl ...................... 43

GRANIX ............................... 46 GRASTEK ............................ 48 griseofulvin microsize ............ 3 griseofulvin ultramicrosize ..... 3 guaiatussin ac ........................ 59 guaifenesin ac ....................... 59 guaifenesin dac ..................... 59 guanfacine ....................... 19, 23 guanidine .............................. 20 GYNAZOLE-1 ..................... 52 gynol ii .................................. 52 H HAEGARDA ........................ 61 hailey 24 fe ........................... 53 HALAVEN ............................. 9 halobetasol propionate .......... 33 HALOG ................................ 33 haloperidol ............................ 20 haloperidol lactate ................ 20 HARVONI .............................. 3 HAVRIX (PF) ...................... 48 healthylax ............................. 43 heather .................................. 51 HELIXATE FS ..................... 25 HEMANGEOL ..................... 23 hemenatal ob ......................... 65 hemenatal ob + dha ............... 65 HEMLIBRA ......................... 25 hemmorex-hc ........................ 43 HEMOFIL M HIGH ............. 25 HEMOFIL M LOW .............. 25 HEMOFIL M MID ............... 25 HEMOFIL M SUPER HIGH26 hep flush-10 (pf) ................... 26 heparin (porcine) .................. 26 HEPARIN (PORCINE) IN

0.9% NACL ...................... 26 heparin (porcine) in 5 % dex 26 heparin (porcine) in nacl (pf) 26 heparin flush(porcine)-0.9nacl

.......................................... 26 heparin lock flush ................. 26 heparin lock flush (porcine) .. 26 heparin lockflush(porcine)(pf)

.......................................... 26 heparin(porcine) in 0.45% nacl

.......................................... 26 HEPARIN(PORCINE) IN

0.45% NACL .................... 26 heparin, porcine (pf) ............. 26

77

HEPLISAV-B (PF) .............. 48 HERCEPTIN .......................... 9 HETLIOZ ............................. 20 HIBERIX (PF)...................... 48 HIZENTRA .......................... 48 homatropaire......................... 56 homatropine hbr ................... 56 HORIZANT ......................... 14 HUMALOG JUNIOR

KWIKPEN U-100 ............ 38 HUMALOG KWIKPEN

INSULIN .......................... 38 HUMALOG MIX 50-50

INSULN U-100 ................ 38 HUMALOG MIX 50-50

KWIKPEN ....................... 38 HUMALOG MIX 75-25

KWIKPEN ....................... 38 HUMALOG MIX 75-25(U-

100)INSULN .................... 38 HUMALOG U-100 INSULIN

.......................................... 38 HUMATE-P ......................... 26 HUMATROPE ..................... 46 HUMIRA .............................. 49 HUMIRA PEDIATRIC

CROHNS START ............ 49 HUMIRA PEN ..................... 49 HUMIRA PEN CROHNS-UC-

HS START ....................... 49 HUMIRA PEN PSOR-

UVEITS-ADOL HS ......... 49 HUMIRA(CF) ...................... 50 HUMIRA(CF) PEDI

CROHNS STARTER ....... 50 HUMIRA(CF) PEN.............. 50 HUMIRA(CF) PEN

CROHNS-UC-HS ............ 50 HUMIRA(CF) PEN PSOR-

UV-ADOL HS.................. 50 HUMULIN 70/30 U-100

INSULIN .......................... 38 HUMULIN 70/30 U-100

KWIKPEN ....................... 38 HUMULIN N NPH INSULIN

KWIKPEN ....................... 38 HUMULIN N NPH U-100

INSULIN .......................... 38 HUMULIN R REGULAR U-

100 INSULN .................... 38

HUMULIN R U-500 (CONC) INSULIN .......................... 38

HUMULIN R U-500 (CONC) KWIKPEN........................ 38

HYCAMTIN .......................... 9 hydralazine ........................... 23 HYDRO 35 ........................... 29 hydrochlorothiazide .............. 23 hydrocodone-acetaminophen 16 HYDROCODONE-

ACETAMINOPHEN........ 16 hydrocodone-chlorpheniramine

.......................................... 59 hydrocodone-cpm-

pseudoephed ..................... 59 hydrocodone-homatropine .... 59 hydrocodone-ibuprofen ........ 16 hydrocortisone .......... 33, 36, 43 hydrocortisone acetate .......... 43 hydrocortisone butyrate ........ 33 hydrocortisone butyr-emollient

.......................................... 33 hydrocortisone valerate ........ 33 hydrocortisone-acetic acid .... 36 hydrocortisone-iodoquinol-aloe

.......................................... 32 hydrocortisone-min oil-wht pet

.......................................... 33 hydrocortisone-pramoxine ... 28,

43 hydromet ............................... 59 hydromorphone .................... 16 hydroxocobalamin ................ 65 hydroxychloroquine................ 5 hydroxyprogest(pf)(preg presv)

.......................................... 51 hydroxyprogesterone

cap(ppres) ......................... 51 hydroxyprogesterone caproate

.......................................... 51 hydroxyurea ............................ 9 hydroxyzine hcl .................... 58 hydroxyzine pamoate ........... 58 hyophen ................................ 63 hyoscyamine sulfate ............. 42 hyosyne ................................. 42 HYPER-SAL ........................ 61 HYQVIA .............................. 48 HYSINGLA ER ................... 16

I ibandronate ........................... 49 IBRANCE ............................... 9 ibu ......................................... 17 IBUDONE ............................ 16 ibuprofen ............................... 17 ibuprofen-oxycodone ............ 16 ICLUSIG .............................. 10 idarubicin .............................. 10 IDELVION ........................... 26 IDHIFA ................................. 10 ILARIS (PF) ......................... 47 ILEVRO ............................... 57 ILUVIEN .............................. 58 imatinib ................................. 10 IMBRUVICA ....................... 10 IMFINZI ............................... 10 imipramine hcl ...................... 20 imipramine pamoate ............. 20 imiquimod ............................. 47 IMLYGIC ............................. 10 IMPOYZ ............................... 33 incassia ................................. 51 INCRELEX .......................... 34 INCRUSE ELLIPTA ............ 61 indapamide ........................... 23 INDERAL XL ...................... 23 INDOCIN ............................. 17 indomethacin ........................ 17 INFANRIX (DTAP) (PF) ..... 48 INFASURF ........................... 34 INGREZZA .......................... 14 INLYTA ............................... 10 INNOPRAN XL ................... 23 INOVA ................................. 30 INOVA 4-1 ........................... 28 INOVA 8-2 ........................... 28 INPEN (FOR HUMALOG) . 37 INPEN (FOR NOVOLOG) .. 37 INSPIRACHAMBER ........... 37 INSULIN SYRINGE-

NEEDLE U-100 ............... 37 INTELENCE .......................... 3 INTRON A ........................... 47 introvale ................................ 53 INVELTYS ........................... 58 INVIRASE ............................. 3 INVOKAMET ...................... 40 INVOKAMET XR ............... 40 INVOKANA ......................... 40

78

IODOFLEX .......................... 29 iodoquinol-hc ....................... 32 IODOSORB ......................... 29 IOPIDINE............................. 58 IPOL ..................................... 48 ipratropium bromide ....... 35, 61 ipratropium-albuterol ........... 61 irbesartan .............................. 23 irbesartan-hydrochlorothiazide

.......................................... 23 IRESSA ................................ 10 irinotecan .............................. 10 ISENTRESS ........................... 3 ISENTRESS HD .................... 3 isibloom ................................ 53 isoniazid ................................. 5 ISORDIL .............................. 28 isosorbide dinitrate ............... 28 isosorbide mononitrate ......... 28 isotretinoin ............................ 30 isoxsuprine ........................... 52 isradipine .............................. 23 ISTODAX ............................ 10 itraconazole ............................ 3 ivermectin ............................... 5 IXEMPRA ............................ 10 IXINITY ............................... 26 J JADENU .............................. 34 JADENU SPRINKLE .......... 34 JAKAFI ................................ 10 jantoven ................................ 26 JANUMET ........................... 40 JANUMET XR ..................... 40 JANUVIA............................. 40 JARDIANCE ........................ 40 jasmiel (28) ........................... 53 jencycla................................. 51 JENTADUETO .................... 40 JENTADUETO XR.............. 40 JETREA (PF) ....................... 56 JEVTANA ............................ 10 jinteli..................................... 51 JIVI ....................................... 26 jolessa ................................... 53 jolivette ................................. 51 JUBLIA ................................ 32 juleber ................................... 53 JULUCA................................. 3 junel 1.5/30 (21) ................... 53

junel 1/20 (21) ...................... 53 junel fe 1.5/30 (28) ............... 53 junel fe 1/20 (28) .................. 53 junel fe 24 ............................. 53 JUXTAPID ........................... 27 K KADCYLA .......................... 10 KADIAN .............................. 16 kaitlib fe ................................ 53 KALBITOR .......................... 61 KALETRA ............................. 4 KALYDECO ........................ 61 KARBINAL ER ................... 58 kariva (28) ............................ 53 kelnor 1/35 (28) .................... 53 kelnor 1-50 ........................... 53 KEPIVANCE ......................... 7 KERAFOAM........................ 29 KERALAC ........................... 29 KERALYT SCALP

COMPLETE ..................... 29 KERYDIN ............................ 32 ketoconazole ..................... 3, 32 ketoprofen ............................. 17 ketorolac ......................... 17, 57 KEVEYIS ............................. 14 KEVZARA ........................... 50 KEYTRUDA ........................ 10 KHEDEZLA ......................... 20 KINERET ............................. 47 KINRIX (PF) ........................ 48 KISQALI .............................. 10 KISQALI FEMARA CO-

PACK ............................... 10 KITABIS PAK ....................... 5 klor-con ................................ 63 klor-con 10 ........................... 64 klor-con 8 ............................. 64 klor-con m10 ........................ 64 klor-con m15 ........................ 64 klor-con m20 ........................ 64 klor-con sprinkle................... 64 klor-con/ef ............................ 64 KOATE ................................ 26 kobee .................................... 65 KOGENATE FS ................... 26 KORLYM ............................. 39 KOVALTRY ........................ 26 K-PHOS NO 2 ...................... 63 K-PHOS ORIGINAL ........... 63

kpn ........................................ 65 KRINTAFEL .......................... 5 KRISTALOSE ...................... 43 KRYSTEXXA ...................... 49 k-tab ...................................... 64 K-TAB .................................. 64 kurvelo (28) .......................... 53 KUVAN ................................ 39 KYLEENA ........................... 50 KYMRIAH ........................... 10 KYPROLIS ........................... 10 L l norgest/e.estradiol-e.estrad . 53 labetalol ................................ 23 LACRISERT ........................ 56 lactated ringers ...................... 34 lactulose ................................ 43 LAMICTAL XR STARTER

(BLUE) ............................. 13 LAMICTAL XR STARTER

(GREEN) .......................... 13 LAMICTAL XR STARTER

(ORANGE) ....................... 13 lamivudine .............................. 4 lamivudine-zidovudine ........... 4 lamotrigine ............................ 13 LANCETS ............................ 38 LANCING DEVICE ............ 38 LANOXIN ............................ 25 lansoprazole .......................... 45 lanthanum ............................. 43 LANTUS SOLOSTAR U-100

INSULIN .......................... 38 LANTUS U-100 INSULIN .. 38 larin 1.5/30 (21) .................... 53 larin 1/20 (21) ....................... 53 larin 24 fe .............................. 53 larin fe 1.5/30 (28) ................ 53 larin fe 1/20 (28) ................... 53 larissia ................................... 53 LARTRUVO ........................ 10 LASTACAFT ....................... 56 latanoprost ............................ 57 LATUDA .............................. 20 laxaclear ................................ 43 laxative (bisacodyl) .............. 43 laxative feminine .................. 43 laxative peg 3350 .................. 43 layolis fe ............................... 53

79

LEDIPASVIR-SOFOSBUVIR ............................................ 4

leena 28 ................................ 53 leflunomide........................... 50 LEMTRADA ........................ 47 LENVIMA ........................... 10 lessina ................................... 53 LETAIRIS ............................ 61 letrozole ................................ 10 leucovorin calcium ................. 7 LEUKERAN ........................ 10 LEUKINE............................. 46 leuprolide .............................. 10 levalbuterol hcl ..................... 61 LEVEMIR FLEXTOUCH U-

100 INSULN .................... 38 LEVEMIR U-100 INSULIN 38 levetiracetam ........................ 13 levobunolol ........................... 55 levocarnitine ......................... 34 levocarnitine (with sugar)..... 34 levofloxacin ...................... 6, 55 LEVOFLOXACIN ................. 6 levonest (28) ......................... 53 levonorgestrel ....................... 53 levonorgestrel-ethinyl estrad 53 levonorg-eth estrad triphasic 53 levora-28............................... 53 levorphanol tartrate .............. 16 LEVORPHANOL

TARTRATE ..................... 16 levothyroxine ........................ 41 levoxyl .................................. 41 LEVULAN ........................... 29 LEXIVA ................................. 4 LIBTAYO ............................ 10 lidocaine ............................... 31 lidocaine hcl ......................... 31 lidocaine hcl-hydrocortison ac

.................................... 31, 43 LIDOCAINE HCL-

HYDROCORTISON AC . 43 lidocaine viscous .................. 31 lidocaine-hydrocortisone-aloe

.......................................... 43 LIDOCAINE-

PHENYLEPHRN IN WATER ............................ 56

lidocaine-prilocaine .............. 31

LIDOCAN-PHENYLEPH-BSS NO.2(PF) .................. 56

LILETTA.............................. 50 lillow (28) ............................. 53 lindane .................................. 33 linezolid .................................. 5 LINZESS .............................. 43 liothyronine .......................... 41 LIPOCHOL PLUS ............... 34 lipodox .................................. 10 lipodox 50 ............................. 10 LIPOFEN.............................. 27 lisinopril................................ 23 lisinopril-hydrochlorothiazide

.......................................... 23 lite coat aspirin ..................... 17 LITEAIRE MDI CHAMBER

.......................................... 37 lithium carbonate .................. 20 lithium citrate ....................... 20 LITHOSTAT ........................ 34 LIVALO ............................... 27 LO LOESTRIN FE ............... 53 LOCOID LIPOCREAM ....... 33 LOKELMA .......................... 43 LONHALA MAGNAIR

REFILL ............................ 61 LONHALA MAGNAIR

STARTER ........................ 61 LONSURF ............................ 10 lopinavir-ritonavir .................. 4 lopreeza ................................ 51 lorazepam ............................. 20 lorazepam intensol ................ 20 LORBRENA ........................ 10 lorcet (hydrocodone) ............ 16 lorcet hd ................................ 16 lorcet plus ............................. 16 LORTAB ELIXIR ................ 16 lortuss ex............................... 59 loryna (28) ............................ 53 LORZONE ........................... 15 losartan ................................. 23 losartan-hydrochlorothiazide 23 LOTEMAX .......................... 58 LOUTREX ........................... 29 lovastatin .............................. 27 low-ogestrel (28) .................. 54 loxapine succinate ................ 20 lta pre-attached ..................... 31

LUCENTIS ........................... 56 ludent fluoride ...................... 65 lugols .............................. 32, 64 LUMIGAN ........................... 57 LUMIZYME ......................... 39 LUPANETA PACK (1

MONTH) .......................... 52 LUPANETA PACK (3

MONTH) .......................... 52 LUPRON DEPOT ................ 10 LUPRON DEPOT (3

MONTH) .......................... 10 LUPRON DEPOT (4

MONTH) .......................... 10 LUPRON DEPOT (6

MONTH) .......................... 10 LUPRON DEPOT-PED ....... 10 LUPRON DEPOT-PED (3

MONTH) .......................... 10 lutera (28) ............................. 54 LUZU ................................... 32 LYNPARZA ......................... 10 LYRICA ............................... 13 LYSODREN ......................... 10 lyza ....................................... 51 M MACRILEN ......................... 46 MACUGEN .......................... 56 mafenide acetate ................... 32 magnesium citrate ................. 43 MAKENA (PF) .................... 51 malathion .............................. 34 maprotiline ............................ 20 MAR-COF CG ..................... 59 marlissa (28) ......................... 54 MARNATAL-F .................... 65 MARPLAN ........................... 20 MARQIBO ........................... 10 MATULANE ........................ 10 matzim la .............................. 23 MAVYRET ............................ 4 MAXI-TUSS CD .................. 59 m-clear wc ............................ 59 meclofenamate ...................... 17 MEDROL ............................. 36 medroxyprogesterone ........... 51 mefenamic acid ..................... 17 mefloquine .............................. 5 megestrol .............................. 10 MEKINIST ........................... 10

80

melodetta 24 fe ..................... 54 meloxicam ............................ 17 melphalan ............................. 10 memantine ...................... 14, 15 MEMANTINE ..................... 15 MENACTRA (PF) ............... 48 M-END PE ........................... 59 MENEST .............................. 51 MENOSTAR ........................ 51 MENVEO A-C-Y-W-135-DIP

(PF) ................................... 48 meperidine ............................ 16 meprobamate ........................ 15 MEPSEVII ........................... 39 mercaptopurine ..................... 10 mesalamine ........................... 43 mesalamine with cleansing

wipe .................................. 43 MESNEX ............................... 7 MESTINON ......................... 15 metadate er ........................... 20 metaproterenol ...................... 61 metaxall ................................ 15 metaxalone ........................... 15 metformin ............................. 40 METFORMIN ...................... 40 methadone ............................ 16 methadose ............................. 16 methamphetamine ................ 20 methazolamide ..................... 57 methenamine hippurate .......... 7 methenamine mandelate ......... 7 methen-sod phos-meth blue-

hyos .................................. 63 methergine ............................ 55 methimazole ......................... 36 METHITEST ........................ 39 methocarbamol ..................... 15 methotrexate sodium ............ 10 methotrexate sodium (pf) ..... 10 methoxsalen .......................... 29 methscopolamine .................. 42 methyclothiazide .................. 23 methyldopa ........................... 23 methyldopa-

hydrochlorothiazide .......... 23 methylergonovine ................. 55 methylphenidate hcl ............. 20 METHYLPHENIDATE HCL

.......................................... 20

methylprednisolone .............. 36 methyltestosterone ................ 39 metipranolol.......................... 55 metoclopramide hcl .............. 43 metolazone............................ 23 METOPIRONE .................... 34 metoprolol succinate............. 23 METOPROLOL SU-

HYDROCHLOROTHIAZ 24 metoprolol ta-hydrochlorothiaz

.......................................... 24 metoprolol tartrate ................ 24 metronidazole ............. 5, 30, 52 mexiletine ............................. 21 MIACALCIN ....................... 39 mibelas 24 fe ........................ 54 MICONAZOLE NITRATE-

ZINC OX-PET ................. 32 MICROCHAMBER ............. 37 microgestin 1.5/30 (21) ........ 54 microgestin 1/20 (21) ........... 54 microgestin fe 1.5/30 (28) .... 54 microgestin fe 1/20 (28) ....... 54 MICROSPACER .................. 37 midazolam ............................ 20 midodrine.............................. 34 migergot................................ 14 miglitol ................................. 40 miglustat ............................... 39 mili........................................ 54 milk of magnesia .................. 43 milk of magnesia concentrated

.......................................... 43 millipred ............................... 36 millipred dp .......................... 36 mimvey ................................. 51 mimvey lo ............................. 51 MINITRAN .......................... 28 minocycline ............................ 7 minoxidil .............................. 24 MIOCHOL-E........................ 56 miostat .................................. 57 miralax .................................. 43 MIRCERA ............................ 46 MIRENA .............................. 50 mirtazapine ........................... 20 misoprostol ........................... 45 MITIGARE .......................... 49 mitomycin ............................. 10 MITOSOL ............................ 57

mitoxantrone ......................... 10 M-M-R II (PF) ...................... 48 modafinil ............................... 20 moderiba ............................... 47 moderiba dose pack .............. 47 moexipril ............................... 24 molindone ............................. 20 mometasone .................... 33, 61 mondoxyne nl ......................... 7 mono-linyah .......................... 54 mononessa (28) ..................... 54 MONONINE ........................ 26 montelukast ........................... 61 MONUROL ............................ 7 morgidox ................................. 7 MORGIDOX 1X 50 ............... 7 MORGIDOX 2X100 .............. 7 morphine ............................... 16 morphine concentrate ........... 16 MOTOFEN ........................... 42 MOVANTIK ........................ 43 MOVIPREP .......................... 44 MOXATAG ............................ 6 MOXEZA ............................. 55 moxifloxacin ..................... 6, 55 MOXIFLOXACIN IN

NACL,ISO-O(PF) ............ 55 MOZOBIL ............................ 46 MUGARD ............................ 35 MULPLETA ......................... 26 MULTAQ ............................. 21 multi-vitamin with fluoride .. 65 multivitamins with fluoride .. 65 mupirocin .............................. 32 mupirocin calcium ................ 32 mvc-fluoride ......................... 65 my choice .............................. 54 my way ................................. 54 MYALEPT ........................... 39 mycophenolate mofetil ......... 10 mycophenolate sodium ......... 10 MYDAYIS ........................... 20 mydriatic3 (trop-cyclopent-pe)

.......................................... 56 MYLERAN .......................... 10 MYLOTARG ....................... 10 mynatal ................................. 65 mynatal advance ................... 65 mynatal plus .......................... 65 mynatal-z .............................. 65

81

mynate 90 plus ..................... 65 MYOBLOC .......................... 48 myorisan ............................... 30 MYRBETRIQ ...................... 62 MYTESI ............................... 42 myzilra .................................. 54 N nabumetone .......................... 17 nadolol .................................. 24 nadolol-bendroflumethiazide 24 naftifine ................................ 32 NAFTIN ............................... 32 NAGLAZYME..................... 39 NALOCET ........................... 16 naloxone ............................... 17 naltrexone ............................. 17 NAMENDA TITRATION

PAK .................................. 15 NAPRELAN CR .................. 17 naproxen ............................... 17 naproxen sodium .................. 17 naratriptan............................. 14 NARCAN ............................. 17 NASCOBAL ........................ 65 NATACHEW (FE BIS-

GLYCINATE) .................. 65 NATACYN .......................... 55 NATAZIA ............................ 54 nateglinide ............................ 40 NATESTO ............................ 39 NATPARA ........................... 39 natural b-100 complex .......... 65 natura-lax .............................. 44 nature-throid ......................... 41 NEBUPENT ........................... 5 nebusal .................................. 61 NEBUSAL ........................... 61 necon 0.5/35 (28).................. 54 NEEVODHA (WITH ALGAL

OIL) .................................. 65 nefazodone ........................... 20 neomycin ................................ 5 neomycin-bacitracin-poly-hc 57 neomycin-bacitracin-

polymyxin......................... 55 neomycin-polymyxin b gu ... 34 neomycin-polymyxin b-

dexameth .......................... 57 neomycin-polymyxin-

gramicidin......................... 55

neomycin-polymyxin-hc 36, 57 neo-polycin ........................... 55 neo-polycin hc ...................... 57 NEO-SYNALAR.................. 32 NEO-SYNALAR KIT .......... 32 NERLYNX ........................... 10 NESTABS ............................ 65 NESTABS ABC ................... 65 NESTABS DHA................... 65 NESTABS ONE ................... 65 neuac ..................................... 30 NEUAC KIT......................... 31 NEULASTA ......................... 46 NEUPOGEN ........................ 46 NEUPRO .............................. 13 nevirapine ............................... 4 new day................................. 54 newgen.................................. 65 NEXAVAR .......................... 11 NEXIUM PACKET ............. 45 NEXPLANON...................... 52 niacin .................................... 27 NIACOR ............................... 27 nicardipine ............................ 24 nicorelief ............................... 35 nicorette ................................ 35 nicotine ................................. 35 nicotine (polacrilex) ............. 35 NICOTROL .......................... 35 NICOTROL NS .................... 35 nifedipine .............................. 24 nikki (28) .............................. 54 NILANDRON ...................... 11 nilutamide ............................. 11 nimodipine ............................ 24 NINJACOF-XG.................... 59 NINLARO ............................ 11 NIPENT ................................ 11 nisoldipine ............................ 24 nitro-bid ................................ 28 NITRO-DUR ........................ 28 nitrofurantoin .......................... 7 nitrofurantoin macrocrystal .... 7 nitrofurantoin monohyd/m-

cryst .................................... 7 nitroglycerin ......................... 28 nitro-time .............................. 28 NITYR .................................. 34 NIVESTYM ......................... 46 nizatidine .............................. 45

nolix ...................................... 33 nora-be .................................. 51 NORDITROPIN FLEXPRO 46 noreth-ethinyl estradiol-iron . 54 norethindrone (contraceptive)

.......................................... 51 norethindrone acetate ............ 51 norethindrone ac-eth estradiol

.................................... 51, 54 norethindrone-e.estradiol-iron

.......................................... 54 norgestimate-ethinyl estradiol

.......................................... 54 NORITATE .......................... 31 norlyda .................................. 51 norlyroc ................................. 51 NORPACE CR ..................... 21 NORTHERA ........................ 34 nortrel 0.5/35 (28) ................. 54 nortrel 1/35 (21) .................... 54 nortrel 1/35 (28) .................... 54 nortrel 7/7/7 (28) ................... 54 nortriptyline .......................... 20 NORTRIPTYLINE ............... 20 NORVIR ................................. 4 NOVOEIGHT ....................... 26 NOVOPEN ECHO ............... 38 NOVOSEVEN RT ................ 26 NOXAFIL ............................... 3 np thyroid .............................. 41 NPLATE ............................... 26 NUCALA ............................. 61 NUCYNTA ........................... 17 NUCYNTA ER .................... 17 NUEDEXTA ........................ 15 NUTROPIN AQ NUSPIN .... 46 NUVARING ......................... 52 NUVESSA ............................ 52 NUWIQ ................................ 26 nyamyc ................................. 32 NYMALIZE ......................... 24 nystatin ............................. 3, 32 nystatin-triamcinolone .......... 32 nystop ................................... 32 O OB COMPLETE .................. 65 OB COMPLETE ONE ......... 66 OB COMPLETE PETITE .... 66 OB COMPLETE PREMIER 66

82

OB COMPLETE WITH DHA .......................................... 66

obstetrix dha ......................... 66 OBSTETRIX EC .................. 66 OBSTETRIX ONE ............... 66 OBTREX DHA .................... 66 ocella .................................... 54 OCREVUS ........................... 47 octreotide acetate .................. 11 ODACTRA........................... 48 ODEFSEY .............................. 4 ODOMZO ............................ 11 OFEV ................................... 61 ofloxacin ..................... 6, 36, 55 ogestrel (28).......................... 54 okebo ...................................... 7 olanzapine............................. 20 olanzapine-fluoxetine ........... 20 olmesartan ............................ 24 olmesartan-amlodipin-

hcthiazid ........................... 24 olmesartan-

hydrochlorothiazide .......... 24 olopatadine ..................... 35, 56 OLUMIANT......................... 50 OMECLAMOX-PAK .......... 45 omega-3 acid ethyl esters ..... 27 omeppi ............................ 45, 46 omeprazole ........................... 46 omeprazole-sodium

bicarbonate ....................... 46 OMIDRIA ............................ 56 OMNIPOD INSULIN

MANAGEMENT ............. 38 OMNITROPE....................... 46 ONCASPAR ........................ 11 ondansetron .......................... 44 ondansetron hcl .................... 44 ONDANSETRON IN 0.9 %

SOD CHLOR ................... 44 ONDANSETRON IN D5W . 44 one daily prenatal ................. 66 ONETOUCH ULTRA BLUE

TEST STRIP .................... 36 ONETOUCH ULTRA2........ 38 ONETOUCH ULTRAMINI 38 ONETOUCH VERIO ........... 36 ONETOUCH VERIO FLEX 38 ONETOUCH VERIO IQ

METER ............................ 38

ONETOUCH VERIO SYSTEM .......................... 38

ONEXTON ........................... 31 ONIVYDE ............................ 11 ONMEL .................................. 3 opcicon one-step ................... 54 OPDIVO ............................... 11 opium tincture....................... 42 OPSUMIT ............................ 61 OPTICHAMBER DIAMOND

VHC.................................. 37 option-2 ................................ 54 ORACIT ............................... 63 oral saline laxative ................ 44 ORALAIR ............................ 48 oralone .................................. 35 ORAMAGICRX ................... 35 ORAVIG ................................ 3 ORBACTIV............................ 5 ORENCIA ............................ 50 ORENCIA CLICKJECT ...... 50 ORENITRAM ...................... 24 ORFADIN ............................ 34 ORKAMBI ........................... 61 orphenadrine citrate .............. 15 orsythia ................................. 54 oscimin ................................. 42 oscimin sl .............................. 42 oscimin sr ............................. 42 oseltamivir .............................. 4 OSENI .................................. 40 OSMOPREP ......................... 44 OSPHENA............................ 52 OTEZLA .............................. 50 OTEZLA STARTER ............ 50 OTREXUP (PF) ................... 50 OVACE PLUS ..................... 28 OVACE PLUS SHAMPOO . 28 OVACE PLUS WASH ......... 28 oxaliplatin ............................. 11 oxandrolone .......................... 39 oxaprozin .............................. 18 OXAYDO ............................. 16 oxazepam .............................. 20 oxcarbazepine ....................... 13 OXERVATE ........................ 56 oxiconazole ........................... 32 OXISTAT ............................. 32 OXTELLAR XR .................. 13 oxybutynin chloride .............. 62

oxycodone ............................. 16 OXYCODONE ..................... 16 oxycodone-acetaminophen ... 16 oxycodone-aspirin ................ 16 OXYCONTIN ...................... 16 oxymorphone ........................ 16 OXYTROL ........................... 62 oyster shell calcium-vit d2 .... 66 oyster shell calcium-vit d3 .... 64 OZEMPIC ............................. 41 OZURDEX ........................... 58 P pacerone ................................ 21 paclitaxel ............................... 11 paliperidone .......................... 20 palonosetron ......................... 44 PALONOSETRON .............. 44 PANDEL .............................. 33 PANRETIN .......................... 29 pantoprazole ......................... 46 PANZYGA ........................... 48 PARAGARD T 380A ........... 50 paregoric ............................... 42 PAREMYD ........................... 56 paricalcitol ............................ 39 paroex oral rinse ................... 35 paromomycin .......................... 5 paroxetine hcl ....................... 20 paroxetine

mesylate(menop.sym) ....... 20 PASER .................................... 5 PAXIL .................................. 20 PAZEO ................................. 56 PEDIARIX (PF) ................... 48 PEDVAX HIB (PF) .............. 48 peg 3350-electrolytes ............ 44 PEGANONE ......................... 13 PEGASYS ............................ 47 PEGASYS PROCLICK ........ 47 peg-electrolyte soln .............. 44 PEGINTRON ....................... 47 peg-prep ................................ 44 PEN NEEDLE ...................... 38 penicillin v potassium ............. 6 PENNSAID .......................... 18 PENTACEL (PF) .................. 48 PENTACEL ACTHIB

COMPONENT (PF) ......... 48 PENTASA ............................ 44 pentazocine-naloxone ........... 18

83

pentoxifylline ....................... 26 PERFOROMIST .................. 61 perindopril erbumine ............ 24 periogard............................... 35 PERJETA ............................. 11 permethrin ............................ 34 perphenazine......................... 20 perphenazine-amitriptyline... 20 perry prenatal........................ 66 PEXEVA .............................. 20 phenadoz............................... 58 phenazopyridine ................... 63 phenelzine............................. 21 phenergan ............................. 58 phenobarb-hyoscy-atropine-

scop................................... 42 phenobarbital ........................ 13 phenohytro ............................ 42 phenoxybenzamine ............... 24 phenylephrine hcl ................. 58 phenytoin .............................. 13 phenytoin sodium extended .. 13 philith ................................... 54 PHOSLYRA ......................... 44 phosphasal ............................ 63 phosphate laxative ................ 44 PHOSPHOLINE IODIDE .... 56 PHOTOFRIN ....................... 11 PHOTREXA CROSS-

LINKING KIT.................. 56 PHOTREXA VISCOUS ...... 57 phrenilin forte(with caffeine) 16 phytonadione (vitamin k1) ... 26 PHYTONADIONE

(VITAMIN K1) ................ 26 PICATO ............................... 29 PIFELTRO ............................. 4 pilocarpine hcl .......... 34, 35, 56 pimecrolimus ........................ 29 pimozide ............................... 21 pimtrea (28) .......................... 54 pindolol................................. 24 pioglitazone .......................... 41 pioglitazone-glimepiride ...... 41 pioglitazone-metformin ........ 41 pirmella................................. 54 piroxicam .............................. 18 PLEGRIDY .......................... 47 PLENVU .............................. 44 PLEXION ............................. 31

PLEXION CLEANSING CLOTHS .......................... 31

PNEUMOVAX 23 ............... 48 pnv 29-1 ................................ 66 pnv ob+dha ........................... 66 pnv-dha ................................. 66 pnv-dha + docusate ............... 66 pnv-ferrous fumarate-docu-fa

.......................................... 66 pnv-omega ............................ 66 pnv-select.............................. 66 pnv-vp-u ............................... 66 POCKET CHAMBER .......... 37 PODOCON ........................... 29 podofilox .............................. 29 polycin .................................. 55 polyethylene glycol 3350 ..... 44 polymyxin b sulf-trimethoprim

.......................................... 55 POLY-TUSSIN AC .............. 59 POMALYST ........................ 47 portia 28 ................................ 54 POTABA .............................. 64 potassium chloride ................ 64 potassium citrate ................... 63 powderlax ............................. 44 pr natal 400 ........................... 66 pr natal 400 ec ...................... 66 pr natal 430 ........................... 66 pr natal 430 ec ...................... 66 PRALUENT PEN................. 27 pramcort................................ 44 pramipexole .......................... 13 PRAMOSONE ..................... 28 prasugrel ............................... 26 pravastatin ............................ 27 praziquantel ............................ 5 prazosin ................................ 24 PRECISION XTRA

MONITOR ....................... 38 PRED-G................................ 57 PRED-G S.O.P. .................... 57 prednicarbate ........................ 33 prednisolone ......................... 36 prednisolone acetate ............. 58 prednisolone sodium phosphate

.................................... 36, 58 prednisone ............................ 36 prednisone intensol ............... 36 PREFERA-OB...................... 66

PREFERA-OB PLUS DHA . 66 PREFEST ............................. 51 PREMARIN ......................... 51 PREMPHASE ....................... 51 PREMPRO ........................... 51 prena1 chew .......................... 66 prena1 pearl .......................... 66 prenaissance .......................... 66 prenaissance plus .................. 66 PRENATA ............................ 66 prenatabs fa ........................... 66 prenatabs rx .......................... 66 prenatal ................................. 66 PRENATAL 19 .................... 66 PRENATAL 19 (WITH

DOCUSATE) ................... 66 prenatal complete .................. 66 prenatal formula .................... 66 prenatal multi-dha (algal oil) 66 prenatal plus .......................... 66 prenatal plus (calcium carb) . 66 prenatal vitamin plus low iron

.......................................... 66 prenatal vitamin with minerals

.......................................... 66 prenatal vits96-iron fum-folic

.......................................... 66 prenatal-u .............................. 66 PRENATE AM ..................... 66 PRENATE CHEWABLE ..... 66 PRENATE DHA (FERR ASP

GLYCIN) .......................... 66 PRENATE ELITE (IRON ASP

GLYC) .............................. 66 PRENATE ENHANCE ........ 66 PRENATE

ESSENTIAL(IRON-ASP-GL) ................................... 67

PRENATE MINI (FERR ASP GLYCIN) .......................... 67

PRENATE PIXIE ................. 67 PRENATE RESTORE ......... 67 PRENATE STAR ................. 67 PREPIDIL ............................. 52 preplus .................................. 67 PREPOPIK ........................... 44 PRESTALIA ......................... 24 pretab .................................... 67 prevalite ................................ 27

84

PREVIDENT 5000 BOOSTER PLUS ................................ 35

PREVIDENT 5000 DRY MOUTH ........................... 35

PREVIDENT 5000 ENAMEL PROTECT ........................ 35

PREVIDENT 5000 SENSITIVE ...................... 35

previfem ............................... 54 PREVNAR 13 (PF) .............. 48 PREVYMIS ............................ 4 PREZCOBIX .......................... 4 PREZISTA ............................. 4 PRIFTIN ................................. 5 PRIMAQUINE ....................... 5 PRIMEAIRE ........................ 37 primidone ............................. 13 PRIMLEV ............................ 16 PRIMSOL............................... 7 PRIVIGEN ........................... 48 PROAIR HFA ...................... 61 PROAIR RESPICLICK ....... 61 probenecid ............................ 49 probenecid-colchicine .......... 49 procainamide ........................ 21 procentra ............................... 21 PROCHAMBER .................. 37 prochlorperazine maleate ..... 44 PROCORT ........................... 44 PROCRIT ............................. 46 PROCTOFOAM HC ............ 44 procto-med hc ....................... 44 proctosol hc .......................... 44 proctozone-hc ....................... 44 PROCYSBI .......................... 63 PROFILNINE....................... 26 progesterone ......................... 51 progesterone micronized ...... 51 PROGLYCEM ..................... 37 PROLASTIN-C .................... 34 PROLENSA ......................... 57 PROLEUKIN ....................... 47 PROLIA ............................... 49 PROMACTA ........................ 26 promethazine ........................ 58 promethazine-codeine .......... 59 promethazine-dm .................. 59 promethazine-phenyleph-

codeine ............................. 59 promethazine-phenylephrine 59

promethegan ......................... 58 PROMISEB .......................... 29 PROMISEB COMPLETE .... 28 propafenone .......................... 21 propantheline ........................ 42 proparacaine ......................... 57 propranolol ........................... 24 propranolol-hydrochlorothiazid

.......................................... 24 propylthiouracil .................... 36 PROQUAD (PF)................... 48 PRO-RED AC (W/

DEXCHLORPHENIR) .... 59 PROSTIN E2 ........................ 52 protriptyline .......................... 21 PROVENGE ......................... 48 PROVIDA OB ...................... 67 prudoxin................................ 29 PULMICORT FLEXHALER

.......................................... 61 pulmosal ............................... 61 PULMOZYME ..................... 61 PUREFE OB PLUS .............. 67 purelax .................................. 44 PURIXAN ............................ 11 PYLERA .............................. 46 pyrazinamide .......................... 6 pyridostigmine bromide ....... 15 Q QBREXZA ........................... 29 Q-CARE RX Q4 ................... 36 QNASL ................................. 61 QTERN ................................. 41 QUADRACEL (PF) ............. 48 quazepam .............................. 21 QUDEXY XR....................... 13 quetiapine ............................. 21 QUILLICHEW ER ............... 21 QUILLIVANT XR ............... 21 quinapril................................ 24 quinapril-hydrochlorothiazide

.......................................... 24 quinidine gluconate .............. 21 quinidine sulfate ................... 22 quinine sulfate ........................ 6 quit 2 ..................................... 35 quit 4 ..................................... 35 QVAR REDIHALER ........... 61 R rabeprazole ........................... 46

RACEPINEPH-LIDOCAINE-BSS 7(PF) ......................... 57

RADICAVA ......................... 15 RAGWITEK ......................... 48 rajani ..................................... 54 raloxifene .............................. 49 ramipril ................................. 24 RANEXA ............................. 27 ranitidine hcl ......................... 46 rasagiline ............................... 13 RASUVO (PF) ...................... 50 RAVICTI .............................. 34 RAYALDEE ......................... 39 RAYOS ................................. 36 REBETOL ............................ 47 REBIF (WITH ALBUMIN) . 47 REBIF REBIDOSE .............. 47 REBIF TITRATION PACK . 47 REBINYN ............................ 26 RECLAST ............................ 34 reclipsen (28) ........................ 54 RECOMBINATE ................. 26 RECOMBIVAX HB (PF) ..... 48 RECTIV ................................ 44 REGRANEX ........................ 29 RELENZA DISKHALER ...... 4 RELEXXII ............................ 21 RELION NOVOLIN 70/30 .. 38 RELION NOVOLIN N ........ 39 RELION NOVOLIN R ......... 39 RELISTOR ........................... 44 REMODULIN ...................... 24 RENACIDIN ........................ 63 rena-vite ................................ 67 RENFLEXIS ......................... 44 repaglinide ............................ 41 repaglinide-metformin .......... 41 REPATHA SURECLICK .... 27 REPATHA SYRINGE ......... 27 RESCRIPTOR ........................ 4 RESTASIS ............................ 57 RESTASIS MULTIDOSE .... 57 RETIN-A MICRO PUMP .... 31 RETISERT ........................... 58 REVATIO ............................. 61 REVCOVI ............................ 34 REVLIMID ........................... 47 REXULTI ............................. 21 REYATAZ ............................. 4 RHOPRESSA ....................... 57

85

RIASTAP ............................. 26 ribasphere ............................. 47 ribasphere ribapak ................ 47 ribavirin ............................ 4, 47 RIDAURA ............................ 50 rifabutin .................................. 6 RIFAMATE ........................... 6 rifampin .................................. 6 RIFATER ............................... 6 riluzole .................................. 34 rimantadine ............................. 4 ringer's .................................. 34 RIOMET............................... 41 risedronate ...................... 34, 49 risperidone ............................ 21 RITEFLO AEROCHAMBER

.......................................... 37 ritonavir .................................. 4 RITUXAN ............................ 11 RITUXAN HYCELA ........... 11 rivastigmine .......................... 15 rivastigmine tartrate.............. 15 rivelsa ................................... 54 RIXUBIS .............................. 26 rizatriptan ............................. 14 R-NATAL OB ...................... 67 robafen ac ............................. 59 ROMIDEPSIN ..................... 11 ropinirole .............................. 13 rosadan ................................. 31 ROSADAN........................... 31 ROSULA .............................. 31 rosula cleansing cloths ......... 31 rosuvastatin........................... 27 ROTARIX ............................ 48 ROTATEQ VACCINE ........ 48 roweepra ............................... 13 roweepra xr ........................... 13 ROXYBOND ....................... 16 ROZEREM ........................... 21 RUBRACA........................... 11 RUCONEST ......................... 62 RYDAPT .............................. 11 rydex ..................................... 59 RYTARY ............................. 13 RYVENT .............................. 58 S SABRIL ................................ 13 SAIZEN ................................ 46 SAIZEN SAIZENPREP ....... 46

salicylic acid ......................... 29 salicylic acid er-ceramides ... 29 SALKERA............................ 29 salsalate ................................ 18 salvax .................................... 29 SALVAX DUO PLUS ......... 29 SAMSCA.............................. 39 SANCUSO ........................... 44 SANDIMMUNE .................. 11 SANDOSTATIN .................. 11 SANDOSTATIN LAR

DEPOT ............................. 11 SANTYL .............................. 33 SAPHRIS.............................. 21 SAVELLA ............................ 50 scalacort ................................ 33 SCALACORT DK ............... 33 scopolamine base .................. 44 seconal sodium ..................... 21 SEEBRI NEOHALER .......... 62 SEGLUROMET ................... 41 SELECT-OB ........................ 67 SELECT-OB + DHA ........... 67 selegiline hcl ......................... 14 selenium sulfide .................... 28 SELRX ................................. 28 SELZENTRY ......................... 4 SEMPREX-D ....................... 59 se-natal 19............................. 67 se-natal 19 (with docusate) ... 67 SENSIPAR ........................... 39 SEREVENT DISKUS .......... 62 SEROSTIM .......................... 46 sertraline ............................... 21 setlakin.................................. 54 sevelamer carbonate ............. 44 sevelamer hcl ........................ 44 sf 36 sf 5000 plus .......................... 36 sharobel ................................ 51 SHINGRIX (PF) ................... 48 SHOHL'S MODIFIED ......... 63 SIGNIFOR............................ 11 SIGNIFOR LAR................... 11 sildenafil ............................... 63 sildenafil (antihypertensive) . 62 SILENOR ............................. 21 SILIQ .................................... 28 silodosin................................ 63 silver nitrate .......................... 29

silver nitrate applicators ....... 29 silver sulfadiazine ................. 28 SILVRSTAT ......................... 32 SIMBRINZA ........................ 57 SIMPONI .............................. 50 SIMPONI ARIA ................... 50 simvastatin ............................ 27 SINUVA ............................... 62 sirolimus ............................... 11 SIRTURO ............................... 6 SITAVIG ................................ 4 SIVEXTRO ............................ 6 SKLICE ................................ 34 SKYLA ................................. 50 smoothlax ............................. 44 sodium chloride .............. 34, 62 sodium chloride 0.9 % .......... 35 sodium phenylbutyrate ......... 35 sodium polystyrene (sorb free)

.......................................... 44 sodium polystyrene sulfonate

.......................................... 44 SODIUM POLYSTYRENE

SULFONATE ................... 44 SOFOSBUVIR-

VELPATASVIR ................. 4 SOLESTA ............................. 44 SOLIRIS ............................... 35 SOLODYN ............................. 7 SOLOSEC .............................. 6 soloxide ................................... 7 SOLTAMOX ........................ 11 SOMATULINE DEPOT ...... 11 SOMAVERT ........................ 39 SOOLANTRA ...................... 31 SORBITOL ........................... 34 SORBITOL-MANNITOL .... 34 SORILUX ............................. 28 sotalol ................................... 22 sotalol af ............................... 22 SOTYLIZE ........................... 22 SOVALDI ............................... 4 spinosad ................................ 34 SPIRIVA RESPIMAT .......... 62 spironolactone ....................... 24 spironolacton-hydrochlorothiaz

.......................................... 24 sprintec (28) .......................... 54 SPRITAM ............................. 13 SPRIX ................................... 18

86

SPRYCEL ............................ 11 sps (with sorbitol) ................. 44 sronyx ................................... 54 ssd ......................................... 28 SSKI ..................................... 36 sss 10-5 ................................. 31 st joseph aspirin .................... 18 stavudine................................. 4 STEGLATRO....................... 41 STEGLUJAN ....................... 41 STELARA ............................ 28 STIMATE............................. 39 STIOLTO RESPIMAT ........ 62 STIVARGA .......................... 11 stop smoking aid................... 35 STRENSIQ ........................... 39 stress formula ....................... 67 stress formula with iron ........ 67 stress formula with iron(sulf)67 STRIANT ............................. 39 STRIBILD .............................. 4 STRIVERDI RESPIMAT .... 62 strong iodine ......................... 64 SUBSYS ............................... 16 subvenite............................... 13 subvenite starter (blue) kit .... 13 subvenite starter (green) kit .. 13 subvenite starter (orange) kit 13 SUCRAID ............................ 44 sucralfate .............................. 46 sulfacetamide sodium ..... 28, 58 sulfacetamide sodium (acne) 32 sulfacetamide sodium-sulfur 31 sulfacetamide sod-sulfur-urea

.......................................... 31 sulfacetamide-prednisolone .. 58 sulfacetamide-sulfur-cleansr23

.......................................... 31 sulfacleanse 8-4 .................... 31 sulfact na-sul-avobnz-otn-ocsa

.......................................... 31 sulfadiazine............................. 6 sulfamethoxazole-trimethoprim

........................................ 6, 7 SULFAMYLON................... 32 sulfasalazine ......................... 44 sulfatrim ................................. 7 sulindac................................. 18 SUMADAN .......................... 31 SUMADAN XLT ................. 31

sumatriptan ........................... 14 sumatriptan succinate ........... 14 sumatriptan-naproxen ........... 14 SUMAXIN ........................... 31 SUMAXIN CP ..................... 31 SUMAXIN TS ...................... 31 super b complex-vitamin c ... 67 super b maxi complex........... 67 super b-50 complex plus....... 67 super quints........................... 67 super quints b-50 .................. 67 superplex-t ............................ 67 SUPPRELIN LA .................. 11 SUPRAX ................................ 5 SUPREP BOWEL PREP KIT

.......................................... 44 SURVANTA ........................ 35 SUTENT ............................... 11 syeda ..................................... 54 SYLATRON ......................... 47 SYLVANT ........................... 11 SYMAX DUOTAB .............. 42 symax fastabs ....................... 42 symax-sl................................ 42 symax-sr ............................... 42 SYMBICORT ....................... 62 SYMDEKO .......................... 62 SYMFI .................................... 4 SYMFI LO ............................. 4 SYMLINPEN 120 ................ 41 SYMLINPEN 60 .................. 41 SYMPAZAN ........................ 13 SYMPROIC.......................... 45 SYNAGIS ............................... 4 SYNALAR CREAM KIT .... 33 SYNALAR OINTMENT KIT

.......................................... 33 SYNALAR TS ..................... 33 SYNAREL............................ 39 SYNDROS ........................... 45 SYNERA .............................. 31 SYNJARDY ......................... 41 SYNRIBO ............................ 11 T TABLOID ............................ 11 TACLONEX ........................ 28 tacrolimus ....................... 11, 29 tadalafil ................................. 63 tadalafil (antihypertensive) ... 62 TAFINLAR .......................... 11

TAGRISSO ........................... 11 TAKHZYRO ........................ 62 TALTZ AUTOINJECTOR .. 28 TALTZ AUTOINJECTOR (2

PACK) .............................. 28 TALTZ AUTOINJECTOR (3

PACK) .............................. 28 TALTZ SYRINGE ............... 28 TALZENNA ......................... 11 tamoxifen .............................. 11 tamsulosin ............................. 63 TAPERDEX ......................... 36 TARCEVA ........................... 11 TARGADOX .......................... 7 TARGRETIN ....................... 11 tarina fe 1/20 (28) ................. 54 taron-c dha ............................ 67 taron-prex prenatal-dha ........ 67 TASIGNA ............................. 11 TAYTULLA ......................... 54 tazarotene .............................. 31 TAZORAC ........................... 31 taztia xt ................................. 24 TDVAX ................................ 49 TECENTRIQ ........................ 11 TECFIDERA ........................ 47 TECHNIVIE ........................... 4 TEGSEDI ............................. 15 TEKTURNA ......................... 24 TEKTURNA HCT ................ 24 telmisartan ............................ 24 telmisartan-amlodipine ......... 24 telmisartan-hydrochlorothiazid

.......................................... 24 temazepam ............................ 21 TEMODAR .......................... 11 temozolomide ....................... 11 temsirolimus ......................... 11 tencon ................................... 16 TENIPOSIDE ....................... 11 TENIVAC (PF) .................... 49 tenofovir disoproxil fumarate . 4 TEPADINA .......................... 11 terazosin ................................ 24 terbinafine hcl ......................... 3 terbutaline ............................. 62 terconazole ............................ 52 TERSI FOAM ...................... 28 TESTOPEL ........................... 40 testosterone ........................... 40

87

testosterone cypionate .......... 40 testosterone enanthate .......... 40 TETANUS,DIPHTHERIA

TOX PED(PF) .................. 49 tetcaine ................................. 57 tetrabenazine......................... 15 tetracaine hcl ........................ 57 TETRACAINE HCL (PF) .... 57 tetracycline ............................. 7 TETRAVISC ........................ 57 TETRAVISC FORTE .......... 57 TEXACORT......................... 33 THALOMID......................... 11 THEO-24 .............................. 62 theochron .............................. 62 theophylline .......................... 62 THIOLA ............................... 35 thioridazine ........................... 21 thiotepa ................................. 11 thiothixene ............................ 21 THRIVITE RX ..................... 67 THYMOGLOBULIN ........... 49 thyroid (pork) ....................... 41 THYROLAR-1 ..................... 41 THYROLAR-1/2 .................. 41 THYROLAR-1/4 .................. 41 THYROLAR-2 ..................... 41 THYROLAR-3 ..................... 41 tiagabine ............................... 13 TICE BCG ............................ 49 TIGLUTIK ........................... 35 tilia fe.................................... 54 timolol maleate ............... 24, 56 tinidazole ................................ 6 TIROSINT ............................ 41 tis-u-sol pentalyte ................. 34 TIVICAY ............................... 4 TIVORBEX .......................... 18 tizanidine .............................. 15 tl g-fol os .............................. 67 TOBI....................................... 6 TOBI PODHALER ................ 6 TOBRADEX ........................ 57 TOBRADEX ST .................. 57 tobramycin ............................ 55 tobramycin in 0.225 % nacl ... 6 TOBRAMYCIN WITH

NEBULIZER ...................... 6 tobramycin-dexamethasone .. 57 TOBREX .............................. 55

TODAY CONTRACEPTIVE SPONGE .......................... 52

TOLAK ................................ 29 tolazamide ............................ 41 tolbutamide ........................... 41 tolcapone .............................. 14 tolmetin ................................. 18 tolterodine ............................. 62 topiramate ............................. 13 TOPIRAMATE .................... 13 topotecan .............................. 11 toremifene ............................. 11 TORISEL.............................. 11 torsemide .............................. 24 total b/c ................................. 67 TOUJEO MAX U-300

SOLOSTAR ..................... 39 TOUJEO SOLOSTAR U-300

INSULIN .......................... 39 TOVIAZ ............................... 62 TRACLEER ......................... 62 TRADJENTA ....................... 41 tramadol ................................ 18 TRAMADOL ....................... 18 tramadol-acetaminophen ...... 18 trandolapril ........................... 24 trandolapril-verapamil .......... 25 tranexamic acid..................... 52 tranylcypromine.................... 21 TRAVATAN Z..................... 57 trazodone .............................. 21 TREANDA ........................... 11 TRECATOR ........................... 6 TRELSTAR .......................... 11 TREMFYA ........................... 28 TRESIBA FLEXTOUCH U-

100 .................................... 39 TRESIBA FLEXTOUCH U-

200 .................................... 39 tretinoin ................................ 31 tretinoin (chemotherapy) ...... 12 tretinoin microspheres .......... 31 TRETIN-X............................ 31 TRETIN-X CREAM KIT ..... 31 TRETTEN ............................ 26 TREXALL ............................ 12 TREZIX ................................ 16 tri femynor ............................ 54 TRIACETIN ......................... 32 triamcinolone acetonide . 33, 36

triamterene-hydrochlorothiazid .......................................... 25

trianex ................................... 33 triazolam ............................... 21 TRICARE ............................. 67 triderm .................................. 33 trientine ................................. 35 TRIESENCE (PF) ................ 36 tri-estarylla ............................ 54 trifluoperazine ....................... 21 trifluridine ............................. 55 TRIGLIDE ............................ 27 trihexyphenidyl ..................... 14 triklo ..................................... 27 tri-legest fe ............................ 54 tri-linyah ............................... 54 tri-lo-estarylla ....................... 54 tri-lo-marzia .......................... 54 tri-lo-sprintec ........................ 54 trilyte with flavor packets ..... 45 trimethobenzamide ............... 45 trimethoprim ........................... 7 tri-mili ................................... 54 trimipramine ......................... 21 TRIMO-SAN JELLY ........... 52 TRIMPEX ............................... 7 trinatal rx 1 ........................... 67 trinate .................................... 67 TRINTELLIX ....................... 21 TRIPLE DYE ....................... 32 tri-previfem (28) ................... 54 TRIPTODUR ........................ 12 TRISENOX .......................... 12 tri-sprintec (28) ..................... 54 TRISTART DHA ................. 67 TRIUMEQ .............................. 4 triveen-duo dha ..................... 67 tri-vitamin with fluoride ....... 67 trivora (28) ............................ 55 tri-vylibra .............................. 55 tri-vylibra lo .......................... 55 TROKENDI XR ................... 13 tropicamide ........................... 56 trospium ................................ 62 TRULICITY ......................... 41 TRUMENBA ........................ 49 trust natal dha ....................... 67 TRUVADA ............................. 4 TUDORZA PRESSAIR ....... 62 tulana .................................... 51

88

tusnel c.................................. 59 TUSNEL PEDIATRIC ......... 59 TUSSICAPS ......................... 59 TUZISTRA XR .................... 59 TWINRIX (PF) .................... 49 TYBOST ................................ 4 tydemy .................................. 55 TYKERB .............................. 12 TYMLOS ............................. 49 TYSABRI ............................. 15 TYVASO .............................. 62 TYVASO REFILL KIT ....... 62 TYVASO STARTER KIT ... 62 TYZINE ............................... 36 U UCERIS ................................ 45 ULESFIA ............................. 34 ULORIC ............................... 49 ultra b-100 complex ............. 67 ULTRASAL-ER................... 29 ULTRAVATE ...................... 33 ULTRAVATE X .................. 33 umecta .................................. 29 unithroid ............................... 41 UNITUXIN .......................... 12 UPTRAVI............................. 25 URAMAXIN ........................ 29 urea ....................................... 29 urea nail stick ....................... 29 URELLE............................... 63 uretron d-s ............................ 63 URIBEL ............................... 63 urimar-t ................................. 63 urin ds ................................... 63 uro-458 ................................. 63 urogesic-blue ........................ 63 uro-mp .................................. 63 UROQID-ACID NO.2 ......... 63 ursodiol ................................. 45 uryl ....................................... 63 ustell ..................................... 63 UTIBRON NEOHALER...... 62 utira-c ................................... 63 UTOPIC ............................... 29 V vaginal contraceptive foam .. 52 valacyclovir ............................ 4 VALCHLOR ........................ 29 valganciclovir ......................... 4 valproic acid ......................... 13

valproic acid (as sodium salt) .......................................... 13

valsartan................................ 25 valsartan-hydrochlorothiazide

.......................................... 25 VANATOL LQ .................... 16 VANATOL S ....................... 16 vancomycin ............................ 7 vandazole .............................. 52 VANOXIDE-HC .................. 31 VANTAS .............................. 12 VAQTA (PF) ........................ 49 VARIVAX (PF) ................... 49 VARIZIG.............................. 49 VARUBI ............................... 45 VASCEPA ............................ 27 VASHE WOUND THERAPY

.......................................... 34 VCF CONTRACEPTIVE

FILM ................................ 52 VCF CONTRACEPTIVE GEL

.......................................... 52 VECAMYL .......................... 27 VECTIBIX ........................... 12 VELCADE ........................... 12 veletri .................................... 25 velivet triphasic regimen (28)

.......................................... 55 VELPHORO ......................... 45 VELTASSA.......................... 45 VEMLIDY.............................. 4 VENCLEXTA ...................... 12 VENCLEXTA STARTING

PACK ............................... 12 venlafaxine ........................... 21 VENTAVIS .......................... 62 VENTOLIN HFA ................. 62 verapamil .............................. 25 verdrocet ............................... 17 VEREGEN ........................... 29 veripred 20 ............................ 36 VERSACLOZ ...................... 21 VERZENIO .......................... 12 VESICARE .......................... 63 V-GO 20 ............................... 38 V-GO 30 ............................... 38 V-GO 40 ............................... 38 VIBERZI .............................. 45 VIBRAMYCIN ...................... 7 vicodin .................................. 17

vicodin es .............................. 17 vicodin hp ............................. 17 VIDAZA ............................... 12 VIDEX 2 GRAM PEDIATRIC

............................................ 4 VIEKIRA PAK ....................... 4 vienva ................................... 55 vigabatrin .............................. 13 vigadrone .............................. 13 VIIBRYD ............................. 21 vilamit mb ............................. 63 vilevev mb ............................ 63 VIMIZIM .............................. 40 VIMOVO .............................. 18 VIMPAT ............................... 13 vinate care ............................. 67 VINATE DHA RF ................ 67 vinate ii ................................. 67 vinate m ................................ 67 vinate one .............................. 67 vinorelbine ............................ 12 VIOKACE ............................ 45 viorele (28) ........................... 55 VIRACEPT ............................. 4 VIRASAL ............................. 29 VIRAZOLE ............................ 4 VIREAD ................................. 4 virt-advance .......................... 67 virt-c dha ............................... 67 virt-nate dha .......................... 67 virt-pn ................................... 67 virt-pn dha ............................ 67 virt-pn plus ............................ 67 VIRTPREX ........................... 67 virt-select .............................. 67 virtussin ac ............................ 59 virtussin dac .......................... 59 virt-vite gt ............................. 67 VISUDYNE .......................... 57 VITAFOL NANO ................ 67 VITAFOL ULTRA ............... 67 VITAFOL-OB ...................... 68 VITAFOL-OB+DHA ........... 68 VITAFOL-ONE ................... 68 VITAMED MD ONE RX .... 68 vitamin b complex ................ 68 vitamin b complex-folic acid 68 vitamin d3 ............................. 68 vitamin k ............................... 26 vitamin k1 ............................. 26

89

vitamins a,c,d and fluoride ... 68 VITAPEARL ........................ 68 VIVLODEX ......................... 18 VIZIMPRO........................... 12 VOGELXO........................... 40 VORAXAZE .......................... 7 voriconazole ........................... 3 VORTEX HOLDING

CHAMBER ...................... 37 VOSEVI ................................. 4 VOTRIENT .......................... 12 vp-ch plus ............................. 68 vp-ch-pnv ............................. 68 VP-PNV-DHA ..................... 68 VPRIV .................................. 40 VRAYLAR........................... 21 VUSION ............................... 32 vyfemla (28) ......................... 55 vylibra................................... 55 VYTONE ............................. 32 VYVANSE ........................... 21 VYXEOS .............................. 12 VYZULTA ........................... 57 W warfarin ................................ 26 water for irrigation, sterile .... 35 wera (28) .............................. 55 westhroid .............................. 41 WIDE-SEAL DIAPHRAGM

.......................................... 50 WILATE............................... 26 wixela inhub ......................... 62 woman's laxative .................. 45 women's gentle laxative(bisac)

.......................................... 45 women's laxative (bisacodyl)45 WP THYROID ..................... 41 wymzya fe ............................ 55 X XALIX ................................. 29 XALKORI ............................ 12 XARELTO ........................... 26 XATMEP ............................. 12 XELJANZ ............................ 50 XELJANZ XR ...................... 50 XELODA ............................. 12 XENAZINE .......................... 15 XEOMIN .............................. 49 XERMELO........................... 12 XGEVA .................................. 7

XIFAXAN .............................. 6 XIGDUO XR ........................ 41 XIIDRA ................................ 57 XOFLUZA ............................. 4 XOLAIR ............................... 62 XOLEGEL............................ 32 XTANDI ............................... 12 xulane ................................... 52 XULTOPHY 100/3.6 ........... 39 xylon 10 ................................ 17 XYOSTED ........................... 40 XYREM................................ 21 Y YERVOY ............................. 12 YESCARTA ......................... 12 YONDELIS .......................... 12 YUPELRI ............................. 62 YUTIQ.................................. 58 yuvafem ................................ 51 Z zafirlukast ............................. 62 zaleplon ................................ 21 ZALTRAP ............................ 12 ZANOSAR ........................... 12 zarah ..................................... 55 ZARXIO ............................... 46 zatean-pn dha ........................ 68 zatean-pn plus ....................... 68 ZAVESCA............................ 40 zebutal .................................. 17 ZEJULA ............................... 12 ZELAPAR ............................ 14 ZELBORAF ......................... 12 ZEMAIRA ............................ 35 zenatane ................................ 31 zenchent (28) ........................ 55 ZENPEP ............................... 45 zenzedi .................................. 21 ZENZEDI ............................. 21 ZEPATIER ............................. 4 ZEVALIN (Y-90) ................. 12 zidovudine .............................. 4 zileuton ................................. 62 zingiber ................................. 68 ziprasidone hcl ...................... 21 ZIPSOR ................................ 18 ZIRGAN ............................... 55 ZITHRANOL ....................... 28 ZODRYL AC 25 .................. 59 ZODRYL AC 30 .................. 59

ZODRYL AC 35 .................. 59 ZODRYL AC 40 .................. 59 ZODRYL AC 50 .................. 59 ZODRYL AC 60 .................. 59 ZODRYL AC 80 .................. 59 ZODRYL DAC 25 ............... 59 ZODRYL DAC 30 ............... 59 ZODRYL DAC 35 ............... 59 ZODRYL DAC 40 ............... 59 ZODRYL DAC 50 ............... 59 ZODRYL DAC 60 ............... 59 ZODRYL DAC 80 ............... 59 ZODRYL DEC 25 ................ 59 ZODRYL DEC 30 ................ 59 ZODRYL DEC 35 ................ 59 ZODRYL DEC 40 ................ 59 ZODRYL DEC 50 ................ 59 ZODRYL DEC 60 ................ 60 ZODRYL DEC 80 ................ 60 ZOHYDRO ER .................... 17 ZOLADEX ........................... 12 zoledronic acid ...................... 40 zoledronic acid-mannitol-water

.................................... 35, 40 ZOLEDRONIC AC-

MANNITOL-0.9NACL .... 40 ZOLINZA ............................. 12 zolmitriptan ........................... 14 zolpidem ............................... 21 ZOLPIMIST ......................... 21 ZOMACTON ....................... 46 ZOMIG ................................. 14 ZONALON ........................... 29 zonisamide ............................ 13 ZONTIVITY ......................... 26 ZORBTIVE .......................... 46 ZORTRESS .......................... 12 ZORVOLEX ......................... 18 ZOSTAVAX (PF) ................ 49 zovia 1/35e (28) .................... 55 ZTLIDO ................................ 31 Z-TUSS AC .......................... 60 ZUBSOLV ............................ 18 ZUPLENZ ............................ 45 ZYDELIG ............................. 12 ZYFLO ................................. 62 ZYKADIA ............................ 12 ZYLET ................................. 57 ZYTIGA ............................... 12

2019 wps preferred drugs guide...list of abbreviations aca: affordable care act.la: limited...

Documents