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2020 Formulary Reference Guide

MAIL ORDER AVAILABLE FOR CERTAIN PRESCRIPTIONS

2

Understanding your formulary

What is a formulary?A formulary is a list of prescribed medications or other pharmacy care products, services or supplies chosen for their safety, cost, and effectiveness. Medications are listed by categories or classes and are placed into cost levels known as tiers. It includes both brand and generic prescription medications.

To create the list, OptumRx® is guided by the Pharmacy and Therapeutics Committee. This group of doctors, nurses, and pharmacists reviews which medications will be covered, how well the drugs work, and overall value. They also make sure there are safe and covered options.

About this formulary Where differences between this formulary and your benefit plan exist, the benefit plan documents rule. This may not be a complete list of medications that are covered by your plan. Please review your benefit plan for full details.

How do I use my formulary?You and your doctor can use the formulary to help you choose the most cost-effective prescription medications. This guide tells you if a medication is generic or brand, and if special rules apply. Bring this list with you when you see your doctor. If your medication is not listed here, please visit your plan’s member website or call the number on your member ID card.

Some medications on your formulary have extra requirements before they can be covered. A few of the most common coverage programs are prior authorization (PA), step therapy (ST) and quantity limits (QL). We use programs like these to help make sure the medication you take is safe and effective. Check your plan documents for more information. Some Affordable Care Act (ACA) preventive medication may have coverage restrictions. If you want to learn more about these programs or to see if you take a medication in one of these programs, please visit your plan’s member website or call the number on your member ID card.

What are tiers?Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, set by your employer or plan sponsor. This is how much you will pay when you fill a prescription.

3

Understanding your formulary

When does the formulary change?• Medications may move to a lower tier at any time.

• Medications may move to a higher tier when a generic equal becomes available.

• Medications may move to a higher tier or be excluded from coverage on January 1 or July 1 ofeach year.

When a medication changes tiers, you may have to pay a different amount for that medication.

Why are some medications excluded from coverage?A medication may be excluded from coverage under your pharmacy benefit when it works the same as or similar to another prescription or over-the-counter (OTC) medication.

What if I don’t agree with a decision about an excluded medication?You or your authorized representative and your doctor can ask for a coverage request by calling the number on your member ID card.

4

Medication tips

What is the difference between brand-name and generic medications?Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications, but they often cost less. Once the patent for a brand-name medication ends, the FDA can approve a generic version with the same active ingredients.

What if my doctor writes a brand-name prescription?If your doctor gives you a prescription for a brand-name medication, ask if a generic or lower-cost option could be right for you. Generic medications are usually your lowest-cost option.

Over-the-counter medicationsAn over-the-counter (OTC) medication may be the right treatment for some conditions. Talk to your doctor about available OTC options. Even though OTC medications may not be covered by your pharmacy benefit, they may cost less than a prescription medication.

What if I am taking a specialty medication?Specialty medications are for rare or complex conditions and are usually higher-cost medications. Please note, not all specialty medications are listed in the formulary. BriovaRx®, the OptumRx specialty pharmacy, can provide most of your specialty medications along with helpful programs and services. Call BriovaRx at 1-855-4BRIOVA (1-855-427-4682) and have your prescriptions delivered right to your home or doctor’s office.

5

Reading your formulary

The formulary gives you choices so you and your doctor can decide your best course of treatment. In this formulary, brand-name medications are shown in UPPERCASE (for example, CLOBEX). Generic medications are shown in lowercase (for example, clobetasol).

Tier informationUsing lower tier or preferred medications can help you pay your lowest out-of-pocket cost. Your plan may have multiple or no tiers.

Drug Tier Includes Helpful Tips

Tier CM Oral Chemotherapy Oral chemotherapy drugs may have a designated copayment or coinsurance based on state laws or client preference.

Tier 1 $ Generic Use Tier 1 generic drugs instead of brand-name drugs to help reduce your out-of-pocket costs.

Tier 2 $$ Preferred Preferred brand-name drugs will generally have lower copayments than non-preferred brand-name drugs.

Tier 3 $$$ Non-Preferred Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4 $$$$ Specialty Tier 4 is generally highest in copayment and cost. These drugs are sometimes used for complex and chronic conditions and may require special monitoring and handling.

Drug list informationIn this drug list, some medications are noted with letters next to them to help you see which ones may have coverage requirements or limits. Your benefit plan decides how these medications may be covered.

M Authorized generic or cobranded product

PA Prior Authorization – Your doctor is required to give OptumRx more information to determine coverage.

PV Preventive drugs – May have coverage and no copayments when health care reform requirements are met.

PV* Preventive drugs – Available at $0 if prior authorization is approved.

QL Quantity Limit – Medication may be limited to a certain quantity.

ST Step Therapy – Must try lower-cost medication(s) before a higher-cost medication can be covered.

Table of Contents

Analgesics ....................................................................................................................................................... 11Anesthetics ...................................................................................................................................................... 13Anti-Addiction/Substance Abuse Treatment Agents ...................................................................................14Antibacterials ...................................................................................................................................................15Anticonvulsants .............................................................................................................................................. 18Antidementia Agents ...................................................................................................................................... 19Antidepressants .............................................................................................................................................. 19Antiemetics ...................................................................................................................................................... 20Antifungals .......................................................................................................................................................21Antigout Agents .............................................................................................................................................. 21Antimigraine Agents ....................................................................................................................................... 22Antimyasthenic Agents .................................................................................................................................. 22Antimycobacterials ......................................................................................................................................... 22Antineoplastics ................................................................................................................................................22Antiparasitics ...................................................................................................................................................26Antiparkinson Agents ..................................................................................................................................... 26Antipsychotics .................................................................................................................................................27Antispasticity Agents ......................................................................................................................................28Antivirals .......................................................................................................................................................... 28Anxiolytics ....................................................................................................................................................... 30Bipolar Agents .................................................................................................................................................30Blood Glucose Monitoring ............................................................................................................................. 30Blood Glucose Regulators ............................................................................................................................. 31Blood Products/Modifiers/Volume Expanders ............................................................................................. 32Cardiovascular Agents ................................................................................................................................... 34Central Nervous System Agents ....................................................................................................................38Dental and Oral Agents ...................................................................................................................................39Dermatological Agents ................................................................................................................................... 39Electrolytes/Minerals/Metals/Vitamins .......................................................................................................... 41Gastrointestinal Agents ..................................................................................................................................44Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment ............................................................ 46Genitourinary Agents ......................................................................................................................................46Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal) ................................................................47Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary) ...............................................................49Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins) ................................................... 49Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers) ................................... 49Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid) ................................................................ 53Hormonal Agents, Suppressant (Adrenal) ....................................................................................................54Hormonal Agents, Suppressant (pituitary) ................................................................................................... 54Hormonal Agents, Suppressant (Thyroid) .................................................................................................... 54Immunological Agents ....................................................................................................................................54Inflammatory Bowel Disease Agents ............................................................................................................ 57Metabolic Bone Disease Agents .................................................................................................................... 57Miscellaneous Therapeutic Agents ............................................................................................................... 57Ophthalmic Agents ......................................................................................................................................... 59Otic Agents ...................................................................................................................................................... 62Respiratory Tract/Pulmonary Agents ............................................................................................................62Skeletal Muscle Relaxants ..............................................................................................................................65Sleep Disorder Agents ....................................................................................................................................65

9

Drug Name Drug Tier Notes

Analgesics

butalbital-acetaminophen oral tablet

1

butalbital-apap 1

butalbital-apap-caffeine 1

butalbital-aspirin-caffeine

1

duraxin 1

phrenilin forte 1

tencon 1

Nonsteroidal Anti-inflammatory Drugs

aspirin adult 1 PV

aspirin adult low strength oral tablet delayed release

1 PV

aspirin childrens 1 PV

aspirin ec low dose 1 PV

aspirin ec low strength 1 PV

aspirin low dose 1 PV

aspirin oral tablet 1 PV

aspirin oral tablet delayed release 325 mg

1 PV

bayer aspirin 1 PV

bayer aspirin ec low dose

1 PV

celecoxib oral 1 QL

diclofenac potassium 1

diclofenac sodium er 1

diclofenac sodium oral 1

diclofenac sodium transdermal gel 1 %

1 QL

diclofenac sodium transdermal solution

1 PA

diclofenac-misoprostol 1

diflunisal oral 1


ec-naproxen 1

etodolac 1

etodolac er 1

fenoprofen calcium oral 3

fenortho 3

flurbiprofen oral 1

ibu 1

ibuprofen lysine 1

ibuprofen oral suspension

1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

1

indomethacin er 1

indomethacin oral 1

indomethacin sodium 1

ketoprofen er 1

ketoprofen oral 1

ketorolac tromethamine injection

1

ketorolac tromethamine intramuscular

1

ketorolac tromethamine oral

1 QL

meclofenamate sodium oral

1

medique aspirin 1 PV

meloxicam oral 1

nabumetone oral 1

naproxen dr 1

naproxen oral tablet 1

naproxen sodium oral tablet 275 mg, 550 mg

1

oxaprozin 1

piroxicam oral 1

qc aspirin low dose oral tablet delayed release

1 PV

For more information regarding the tiers and designations in this drug list, please see the Reading your formulary section of this booklet.

11


sulindac oral 1

tolmetin sodium 1

Opioid Analgesics, Long-acting

buprenorphine hcl injection

1

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

1 PA; QL

BUPRENORPHINE TRANSDERMAL PATCH WEEKLY 7.5 MCG/HR

3 PA; QL

BUTRANS TRANSDERMAL PATCH WEEKLY 7.5 MCG/HR

3 PA; QL

EMBEDA 2 PA; QL

fentanyl 1 PA; QL

hydromorphone hcl er 1 PA; QL

HYSINGLA ER 2 PA; QL

methadone hcl injection 1

methadone hcl intensol 1

methadone hcl oral concentrate

1

methadone hcl oral solution

1

methadone hcl oral tablet

1 PA

methadone hcl oral tablet soluble

1

methadose oral concentrate 10 mg/ml

1

methadose oral tablet soluble

1

methadose sugar-free 1

mitigo 1


morphine sulfate er 1 PA; QL

morphine sulfate er beads

1 PA; QL

morphine sulfate intramuscular

1

OXYCODONE HCL ER 3 PA; M; QL

OXYCONTIN 2 PA; QL

oxymorphone hcl er 1 PA; QL

tramadol hcl er (biphasic)

1 QL

tramadol hcl er oral capsule extended release 24 hour 150 mg

1 PA; QL

tramadol hcl er oral tablet extended release 24 hour

1 QL

Opioid Analgesics, Short-acting

acetaminophen-codeine #2

1 QL


1 QL


1 QL

acetaminophen-codeine oral solution

1 QL

acetaminophen-codeine oral tablet 300-15 mg, 300-60 mg

1 QL

alfentanil hcl 1

apap-caff-dihydrocodeine

1 PA; QL

ascomp-codeine 1

butalbital-apap-caff-cod 1

butalbital-asa-caff-codeine

1

butorphanol tartrate injection

1


12


butorphanol tartrate nasal

1 QL

codeine sulfate 1 QL

duramorph 1

endocet 1 QL

fentanyl citrate buccal lozenge on a handle

1 PA; QL

hydrocodone-acetaminophen

1 QL

hydrocodone-ibuprofen 1 QL

hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 mg/ml

1

hydromorphone hcl oral 1 QL

hydromorphone hcl pf 1

levorphanol tartrate oral tablet 2 mg

3 QL

lorcet 1 QL

lorcet hd 1 QL

lorcet plus 1 QL

meperidine hcl injection 1

meperidine hcl oral 1 QL

morphine sulfate (concentrate) oral solution 100 mg/5ml, 20 mg/ml

1 QL

morphine sulfate (pf) 1

morphine sulfate injection solution 10 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml

1

morphine sulfate intravenous solution 1 mg/ml, 150 mg/30ml

1

morphine sulfate oral 1 QL

nalbuphine hcl injection 1


oxycodone hcl oral capsule

1 QL

oxycodone hcl oral concentrate 100 mg/5ml

1 QL

oxycodone hcl oral solution

1 QL

oxycodone hcl oral tablet

1 QL

oxycodone-acetaminophen

1 QL

oxycodone-aspirin 1 QL

oxycodone-ibuprofen 1 QL

oxymorphone hcl 1 QL

pentazocine-naloxone hcl

1 QL

remifentanil hcl 1

tramadol hcl ir 1 QL

tramadol-acetaminophen

1 QL

vicodin 1 QL

vicodin es 1 QL

vicodin hp 1 QL

Anesthetics

Local Anesthetics

bd pudendal/local tray/1% lido

1

bupivacaine hcl (pf) 1

bupivacaine hcl injection solution 0.25 %, 0.5 %

1

bupivacaine in dextrose intrathecal

1

bupivacaine spinal 1

bupivacaine-epinephrine

1

bupivacaine-epinephrine (pf)

1


13


chloroprocaine hcl (pf) 1

ethyl chloride 1

glydo 1

lidocaine external ointment

1

lidocaine external patch 1

lidocaine hcl (pf) 1

lidocaine hcl external solution

1

lidocaine hcl injection solution

1

lidocaine hcl mouth/throat

1

lidocaine hcl urethral/mucosal

1

lidocaine viscous mouth/throat solution 2 %

1

lidocaine-epinephrine injection

1

lidocaine-prilocaine external cream

1

polocaine 1

polocaine-mpf 1

ropivacaine hcl injection solution 10 mg/ml, 2 mg/ml, 5 mg/ml, 7.5 mg/ml

1

sensorcaine 1

sensorcaine/epinephrine

1

sensorcaine-mpf 1

sensorcaine-mpf/epinephrine injection solution 0.25% -1:200000, 0.5% -1:200000

1

xylocaine dental 1


Anti-Addiction/Substance Abuse Treatment Agents

Alcohol Deterrents/Anti-craving

acamprosate calcium 1

disulfiram oral 1

VIVITROL 4

Opioid Dependence Treatments

buprenorphine hcl sublingual

1 QL

buprenorphine hcl-naloxone hcl

1 QL

naltrexone hcl oral 1

Opioid Reversal Agents

naloxone hcl injection 1

NARCAN 2

Smoking Cessation Agents

bupropion hcl er (smoking det)

1 PV; QL

CHANTIX 3 ST; PV; QL

CHANTIX CONTINUING MONTH PAK

3 ST; PV; QL

CHANTIX STARTING MONTH PAK

3 ST; PV; QL

nicotine polacrilex mouth/throat gum

1 PV; QL

nicotine polacrilex mouth/throat lozenge 2 mg

1 PV; QL

nicotine step 1 1 PV; QL




14


NICOTROL 3 ST; PV; QL

NICOTROL NS 3 ST; PV; QL

Antibacterials

Aminoglycosides

amikacin sulfate injection

1

gentamicin in saline 1

gentamicin sulfate external

1

gentamicin sulfate injection

1

neomycin sulfate oral 1

paromomycin sulfate oral

1

streptomycin sulfate intramuscular

1

tobramycin sulfate injection

1

Antibacterials, Other

ALTABAX 3

baciim 1

bacitracin intramuscular 1

chloramphenicol sod succinate

1

clindamycin hcl oral 1

clindamycin palmitate hcl

1

clindamycin phosphate in d5w

1

clindamycin phosphate injection

1

clindamycin phosphate intravenous

1

clindamycin phosphate vaginal

1

colistimethate sodium (cba)

1

CORTISPORIN 3


daptomycin 1

IMPAVIDO 3

iodine tincture external tincture 2 %

1

lincomycin hcl injection 1

linezolid in sodium chloride

1

linezolid intravenous 1

linezolid oral 1 QL

mafenide acetate external

1

methenamine hippurate 1

metronidazole in nacl intravenous solution 5-0.79 mg/ml-%, 500-0.79 mg/100ml-%

1

metronidazole oral 1

metronidazole vaginal 1

mupirocin external 1

NEO-SYNALAR EXTERNAL CREAM

3

nitrofurantoin 1

nitrofurantoin macrocrystal oral

1

nitrofurantoin monohydrate macrocrystals

1

polymyxin b sulfate injection

1

PRIMSOL 3

silver sulfadiazine external

1

ssd 1

SULFAMYLON EXTERNAL CREAM

3

trimethoprim oral 1


15


vancomycin hcl in dextrose intravenous solution 1-5 gm/200ml-%, 500-5 mg/100ml-%, 750-5 mg/150ml-%

1

vancomycin hcl in nacl intravenous solution 1-0.9 gm/200ml-%, 500-0.9 mg/100ml-%

1

VANCOMYCIN HCL IN NACL SOLUTION 750-0.9 MG/150ML-% INTRAVENOUS

3

vancomycin hcl in nacl solution 750-0.9 mg/150ml-% intravenous

1

vancomycin hcl intravenous solution 1000 mg/200ml, 1500 mg/300ml, 2000 mg/400ml

1

vancomycin hcl intravenous solution reconstituted 1 gm, 1.25 gm, 10 gm, 100 gm, 250 mg, 5 gm, 500 mg, 750 mg

1

vancomycin hcl oral capsule

1

vandazole 1

XIFAXAN 3 PA

ZYVOX INTRAVENOUS SOLUTION 200 MG/100ML

3

Beta-lactam, Cephalosporins

cefaclor 1

cefaclor er 1

cefadroxil 1


cefazolin sodium injection

1

cefazolin sodium intravenous solution reconstituted

1

cefazolin sodium-dextrose

1

cefdinir 1

cefditoren pivoxil 1

cefepime hcl 1

cefepime-dextrose 1

cefixime 1

cefotaxime sodium 1

cefotetan disodium 1

cefotetan disodium-dextrose

1

cefoxitin sodium 1

cefpodoxime proxetil 1

cefprozil 1

ceftazidime and dextrose

1

ceftazidime injection 1

ceftriaxone sodium in dextrose

1

ceftriaxone sodium injection

1

ceftriaxone sodium intravenous

1

ceftriaxone sodium-dextrose

1

cefuroxime axetil 1

cefuroxime sodium 1

cephalexin 1

MAXIPIME INTRAVENOUS SOLUTION RECONSTITUTED 2 GM

3


16


tazicef injection 1

tazicef intravenous solution reconstituted

1

Beta-lactam, Other

aztreonam 1

ertapenem sodium 1

imipenem-cilastatin 1

meropenem 1

Beta-lactam, Penicillins

amoxicillin 1

amoxicillin-potassium clavulanate er

1

amoxicillin-potassium clavulanate oral

1

ampicillin 1

ampicillin sodium 1

ampicillin-sulbactam sodium

1

AUGMENTIN ORAL SUSPENSION RECONSTITUTED 125-31.25 MG/5ML

3

BICILLIN L-A 3

dicloxacillin sodium 1

nafcillin sodium injection solution reconstituted 1 gm, 2 gm

1

nafcillin sodium intravenous

1

oxacillin sodium 1

penicillin g potassium 1

penicillin g procaine 1

penicillin g sodium 1

penicillin v potassium 1

piperacillin sod-tazobactam so

1


Macrolides

azithromycin intravenous

1

azithromycin oral 1

clarithromycin er 1

clarithromycin oral 1

DIFICID 3

erythromycin base 1

erythromycin ethylsuccinate oral

1

ZITHROMAX ORAL PACKET

3

Quinolones

AVELOX 3

BAXDELA ORAL 3

CIPRO ORAL SUSPENSION RECONSTITUTED 250 MG/5ML (5%)

3

ciprofloxacin hcl oral 1

ciprofloxacin in d5w 1

ciprofloxacin oral 1

levofloxacin in d5w 1

levofloxacin intravenous

1

levofloxacin oral 1

moxifloxacin hcl in nacl 1

moxifloxacin hcl oral 1

ofloxacin oral 1

Sulfonamides

sulfadiazine oral 1

sulfamethoxazole-trimethoprim

1

sulfatrim pediatric 1

Tetracyclines

avidoxy 1

demeclocycline hcl 1


17


doxy 100 1

doxycycline hyclate intravenous

1

doxycycline hyclate oral capsule

1

doxycycline hyclate oral tablet 100 mg, 20 mg

1

doxycycline monohydrate oral

1

MINOCIN INTRAVENOUS

3

minocycline hcl oral 1

mondoxyne nl 1

morgidox oral 1

okebo 1

tetracycline hcl oral 1

tigecycline 1

Anticonvulsants

Anticonvulsants, Other

BRIVIACT ORAL 3 ST

FYCOMPA 3

levetiracetam er 1

levetiracetam in nacl 1

levetiracetam intravenous

1

levetiracetam oral 1

roweepra 1

roweepra xr 1

Calcium Channel Modifying Agents

CELONTIN 3

ethosuximide oral 1

pregabalin oral 1 QL

zonisamide oral 1


Gamma-aminobutyric Acid (GABA) Augmenting Agents

clobazam 1 PA

clonazepam oral 1 QL

diazepam rectal 1 QL

divalproex sodium er 1

divalproex sodium oral 1

gabapentin oral 1

phenobarbital oral 1

primidone oral 1

tiagabine hcl 1

valproate sodium intravenous

1

valproic acid oral 1

vigabatrin 4 PA

vigadrone 4 PA

Glutamate Reducing Agents

felbamate 1

lamotrigine er 1

lamotrigine oral 1

lamotrigine starter kit-blue

1

lamotrigine starter kit-green

1

lamotrigine starter kit-orange

1

subvenite 1

subvenite starter kit-blue

1

subvenite starter kit-green

1

subvenite starter kit-orange

1

topiramate er 1

topiramate oral 1


18


Sodium Channel Agents

BANZEL 3 PA

carbamazepine er 1

carbamazepine oral 1

DILANTIN ORAL CAPSULE 30 MG

3

epitol 1

fosphenytoin sodium 1

oxcarbazepine 1

PEGANONE 3

phenytoin infatabs 1

phenytoin oral 1

phenytoin sodium extended

1

phenytoin sodium injection

1

VIMPAT ORAL 3

Antidementia Agents

Antidementia Agents, Other

ergoloid mesylates oral 1

Cholinesterase Inhibitors

donepezil hcl 1

galantamine hydrobromide

1

galantamine hydrobromide er

1

rivastigmine 1

rivastigmine tartrate 1

N-methyl-D-aspartate (NMDA) Receptor Antagonist

memantine hcl er 1 QL

memantine hcl oral solution 2 mg/ml

1


memantine hcl oral tablet

1

NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2 QL

Antidepressants

Antidepressants, Other

APLENZIN 3 ST; QL

bupropion hcl er (sr) 1 QL

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

1 QL

bupropion hcl oral 1

mirtazapine oral 1

Monoamine Oxidase Inhibitors

EMSAM 3 QL

MARPLAN 3

phenelzine sulfate oral 1

tranylcypromine sulfate 1

SSRI/SNRI (Selective Serotonin Reuptake Inhibitor/ Serotonin and Norepinephrine Reuptake Inhibitor)

citalopram hydrobromide

1

desvenlafaxine succinate er

1 QL

duloxetine hcl oral 1 QL

escitalopram oxalate 1

FETZIMA 3 ST; QL

FETZIMA TITRATION 3 ST; QL

fluoxetine hcl (pmdd) 1

fluoxetine hcl oral capsule

1


19


fluoxetine hcl oral capsule delayed release

1 QL

fluoxetine hcl oral solution

1

fluoxetine hcl oral tablet 1

fluvoxamine maleate 1

fluvoxamine maleate er 1 QL

maprotiline hcl 1

nefazodone hcl 1

olanzapine-fluoxetine hcl

1 QL

paroxetine hcl 1

paroxetine hcl er 1

paroxetine mesylate 1 QL

PAXIL ORAL SUSPENSION

2 ST

sertraline hcl oral 1

trazodone hcl oral 1

TRINTELLIX 3 ST; QL

venlafaxine hcl 1

venlafaxine hcl er oral capsule extended release 24 hour

1

venlafaxine hcl er oral tablet extended release 24 hour 225 mg

1

VIIBRYD 3 QL

VIIBRYD STARTER PACK

3 QL

Tricyclics

amitriptyline hcl oral 1

amoxapine 1

chlordiazepoxide-amitriptyline

1

clomipramine hcl oral 1

desipramine hcl oral 1

doxepin hcl oral 1


imipramine hcl oral 1

imipramine pamoate 1

nortriptyline hcl oral 1

perphenazine-amitriptyline

1

protriptyline hcl 1

trimipramine maleate oral

1

Antiemetics

Antiemetics, Other

AKYNZEO ORAL 3 QL

compro 1

dimenhydrinate injection

1

doxylamine-pyridoxine 1 PA; QL

droperidol injection 1

meclizine hcl oral tablet 1

phenadoz 1

prochlorperazine 1

prochlorperazine edisylate injection

1

prochlorperazine maleate oral

1

promethazine hcl injection

1

promethazine hcl oral syrup

1

promethazine hcl oral tablet

1

promethazine hcl rectal 1

promethegan 1

scopolamine 1

trimethobenzamide hcl oral

1

Emetogenic Therapy Adjuncts

ANZEMET 3 QL


20


aprepitant 1 QL

dronabinol 1 PA; QL

granisetron hcl intravenous

1

granisetron hcl oral 1 QL

ondansetron hcl injection

1

ondansetron hcl oral solution

1 QL

ondansetron hcl oral tablet 24 mg

1 QL

ondansetron hcl oral tablet 4 mg, 8 mg

1

ondansetron odt 1

palonosetron hcl 1

Antifungals

ABELCET 3

AMBISOME 3

amphotericin b intravenous

1

caspofungin acetate 1

ciclodan 1

ciclopirox 1

ciclopirox olamine external

1

clotrimazole external 1

clotrimazole mouth/throat

1

clotrimazole-betamethasone

1

CRESEMBA 3

econazole nitrate external

1

exoderm external lotion 1

fluconazole in sodium chloride

1

fluconazole oral 1

flucytosine oral 1


griseofulvin microsize oral

1

griseofulvin ultramicrosize

1

GYNAZOLE-1 3

itraconazole oral 1 PA

KERYDIN 3 PA

ketoconazole external cream

1

ketoconazole external shampoo

1

ketoconazole oral 1

miconazole 3 vaginal suppository

1

naftifine hcl 1

NOXAFIL ORAL TABLET DELAYED RELEASE

3

nyamyc 1

nystatin external 1

nystatin mouth/throat 1

nystatin oral 1

nystatin-triamcinolone 1

nystop 1

OXISTAT EXTERNAL LOTION

3

terbinafine hcl oral 1 QL

terconazole 1

voriconazole intravenous

1

voriconazole oral 1

Antigout Agents

allopurinol oral 1

allopurinol sodium 1

COLCHICINE ORAL TABLET

3 ST

colchicine-probenecid 1


21


COLCRYS 2

febuxostat 1 ST

probenecid 1

Antimigraine Agents

Ergot Alkaloids

dihydroergotamine mesylate injection

1

dihydroergotamine mesylate nasal

1 QL

ergotamine-caffeine 1

Serotonin (5-HT) 1b/1d Receptor Agonists

almotriptan malate 1 QL

eletriptan hydrobromide 1 QL

frovatriptan succinate 3 QL

naratriptan hcl 1 QL

rizatriptan benzoate 1 QL

sumatriptan nasal 1 QL

sumatriptan succinate oral

1 QL

sumatriptan succinate refill

1 QL

sumatriptan succinate subcutaneous

1 QL

zolmitriptan oral 1 QL

ZOMIG NASAL 3 ST; QL

Antimyasthenic Agents

Parasympathomimetics

GUANIDINE HCL 3

neostigmine methylsulfate intravenous solution 10 mg/10ml, 5 mg/10ml

1

pyridostigmine bromide er

1


pyridostigmine bromide oral solution

1

pyridostigmine bromide oral tablet

1

Antimycobacterials

Antimycobacterials, Other

dapsone oral 1

rifabutin 1

Antituberculars

CAPASTAT SULFATE 3

cycloserine oral 1

ethambutol hcl oral 1

isoniazid injection 1

isoniazid oral 1

PASER 3

PRIFTIN 3

pyrazinamide oral 1

rifampin intravenous 1

rifampin oral 1

RIFATER 3

SIRTURO 3

TRECATOR 3

Antineoplastics

Alkylating Agents

busulfan 4

carboplatin 4

carmustine 4

cisplatin intravenous solution

4

cyclophosphamide injection

4

cyclophosphamide oral CM

dacarbazine 4

GLEOSTINE CM

ifosfamide 4


22


LEUKERAN CM

MATULANE CM

melphalan CM

melphalan hcl 4

MYLERAN CM

oxaliplatin 4

TEMODAR INTRAVENOUS

4

temozolomide CM PA

thiotepa injection 4

TREANDA 4

VYXEOS 4 PA

ZANOSAR 4

Antiandrogens

abiraterone acetate CM PA

bicalutamide CM

flutamide CM

nilutamide CM

XTANDI CM PA

ZYTIGA ORAL TABLET 500 MG

CM PA

Antiangiogenic Agents

POMALYST CM PA

REVLIMID CM PA

THALOMID CM PA

Antiestrogens/Modifiers

EMCYT CM

fulvestrant 4

SOLTAMOX CM

tamoxifen citrate oral CM PV*

toremifene citrate CM

Antimetabolites

adrucil 4

ALIMTA 4


ARRANON 4

capecitabine CM PA

cladribine 4

clofarabine 4

cytarabine 4

cytarabine (pf) 4

decitabine 4 PA

DROXIA 3

ELITEK 4

floxuridine injection 4

fludarabine phosphate 4

fluorouracil intravenous 4

FOLOTYN 4 PA

gemcitabine hcl 4

hydroxyurea oral CM

LONSURF CM PA

mercaptopurine oral CM

NIPENT 4

TABLOID CM

Antineoplastics, Other

ABRAXANE 4

adriamycin 4

arsenic trioxide intravenous

4

azacitidine 4

BELEODAQ 4 PA

bleomycin sulfate 4

COTELLIC CM PA

dactinomycin 4

daunorubicin hcl 4

dexrazoxane hcl 4

dexrazoxane intravenous solution reconstituted 500 mg

4


23


diclofenac sodium transdermal gel 3 %

1 ST; QL

docetaxel 4

doxorubicin hcl 4

doxorubicin hcl liposomal

4

epirubicin hcl 4

ERWINAZE 4

ETHYOL 4

FARYDAK CM PA

FLUOROPLEX 3

FLUOROURACIL EXTERNAL CREAM 0.5 %

2

fluorouracil external cream 5 %

1

fluorouracil external solution

4

HALAVEN 4 PA

IBRANCE CM PA

idarubicin hcl 4

ISTODAX (OVERFILL) 4 PA

IXEMPRA KIT 4

JEVTANA 4 PA

KYPROLIS INTRAVENOUS SOLUTION RECONSTITUTED 10 MG

4 PA

leucovorin calcium injection

1

leucovorin calcium oral CM

levoleucovorin calcium 4

levoleucovorin calcium pf

4

LYNPARZA CM PA

MARQIBO 4

mesna 4


MESNEX ORAL CM

mitomycin intravenous 4

mitoxantrone hcl 4 PA

mutamycin 4

NINLARO CM PA

ONCASPAR 4

paclitaxel 4

PICATO 3 ST

PROLEUKIN 4

ROMIDEPSIN 4 PA

RUBRACA CM PA

SYLATRON 4 PA

SYNRIBO 4 PA

teniposide 4

TOTECT 4

TRISENOX 4

VELCADE 4 PA

vinblastine sulfate 4

vincristine sulfate 4

vinorelbine tartrate 4

ZALTRAP 4 PA

ZOLINZA CM PA

Aromatase Inhibitors, 3rd Generation

anastrozole oral CM

exemestane CM

letrozole oral CM

Enzyme Inhibitors

CAMPTOSAR INTRAVENOUS SOLUTION 300 MG/15ML

4

etoposide intravenous 4

etoposide oral CM

HYCAMTIN ORAL CM

irinotecan hcl 4


24


KYPROLIS INTRAVENOUS SOLUTION RECONSTITUTED 30 MG, 60 MG

4 PA

ONIVYDE 4

toposar 4

topotecan hcl 4

ZYDELIG CM PA

Molecular Target Inhibitors

AFINITOR CM PA; QL

AFINITOR DISPERZ CM PA

BOSULIF CM PA

CABOMETYX CM PA

CAPRELSA ORAL TABLET 100 MG

CM PA; QL

CAPRELSA ORAL TABLET 300 MG

CM PA

COMETRIQ (100 MG DAILY DOSE)

CM PA


CM PA


CM PA

ERIVEDGE CM PA

erlotinib hcl oral tablet 100 mg, 150 mg

CM PA

erlotinib hcl oral tablet 25 mg

CM PA; QL

GILOTRIF CM PA; QL

ICLUSIG ORAL TABLET 15 MG

CM PA; QL

ICLUSIG ORAL TABLET 45 MG

CM PA

imatinib mesylate CM PA

IMBRUVICA CM PA

INLYTA CM PA


JAKAFI ORAL TABLET 10 MG

CM PA; QL

JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

CM PA

LENVIMA (10 MG DAILY DOSE)

CM PA


CM PA


CM PA


CM PA


CM PA


CM PA


CM PA


CM PA

MEKINIST CM PA

NEXAVAR CM PA

RYDAPT CM PA

SPRYCEL CM PA

STIVARGA CM PA

SUTENT CM PA

TAFINLAR CM PA

TAGRISSO ORAL TABLET 40 MG

CM PA; QL

TAGRISSO ORAL TABLET 80 MG

CM PA

TASIGNA CM PA

temsirolimus 4

TYKERB CM PA

VENCLEXTA CM PA

VENCLEXTA STARTING PACK

CM PA


25


VOTRIENT CM PA

XALKORI CM PA

ZELBORAF CM PA

ZYKADIA CM PA

Monoclonal Antibody/Antibody-Drug Conjugate

ADCETRIS 4 PA

ARZERRA 4 PA

AVASTIN 4 PA

BAVENCIO 4 PA

BLINCYTO 4 PA

CYRAMZA 4 PA

DARZALEX 4 PA

EMPLICITI 4 PA

ERBITUX 4 PA

GAZYVA 4 PA

HERCEPTIN 4 PA

KADCYLA 4 PA

OPDIVO 4 PA

PERJETA 4 PA

RITUXAN 4 PA

TECENTRIQ 4 PA

UNITUXIN 4 PA

YERVOY 4 PA

Retinoids

bexarotene CM PA

PANRETIN 3

TARGRETIN EXTERNAL

4 PA

tretinoin oral CM

Antiparasitics

Anthelmintics

albendazole oral 1 PA

EMVERM 2

ivermectin oral 1


praziquantel oral 1

Antiprotozoals

ALINIA 2

atovaquone oral 1

atovaquone-proguanil hcl

1

BENZNIDAZOLE 3

chloroquine phosphate oral

1

COARTEM 3

DARAPRIM 4 PA

hydroxychloroquine sulfate oral

1

mefloquine hcl 1

NEBUPENT 2

pentamidine isethionate 1

primaquine phosphate 1

quinine sulfate oral 1 PA

tinidazole oral 1

Pediculicides/Scabicides

crotan 1

EURAX EXTERNAL CREAM

2

lindane 1

malathion 1

permethrin external 1

SKLICE 3

spinosad 1

sulfurated lime 1

ULESFIA 3

Antiparkinson Agents

Anticholinergics

benztropine mesylate 1

trihexyphenidyl hcl oral elixir

1


26


trihexyphenidyl hcl oral tablet

1

Antiparkinson Agents, Other

entacapone 1

tolcapone 1

Dopamine Agonists

APOKYN 4 PA; QL

bromocriptine mesylate oral

1

NEUPRO 3 ST

pramipexole dihydrochloride

1

pramipexole dihydrochloride er

1

ropinirole hcl 1

ropinirole hcl er 1

Dopamine Precursors/L- Amino Acid Decarboxylase Inhibitors

carbidopa oral 1

carbidopa-levodopa 1

carbidopa-levodopa er 1

carbidopa-levodopa-entacapone

1

Monoamine Oxidase B (MAO-B) Inhibitors

rasagiline mesylate oral 1

selegiline hcl oral 1

Antipsychotics

1st Generation/Typical

chlorpromazine hcl injection

1

chlorpromazine hcl oral 1

fluphenazine decanoate injection

1


fluphenazine hcl 1

haloperidol decanoate intramuscular

1

haloperidol lactate 1

haloperidol oral 1

loxapine succinate 1

molindone hcl 1

perphenazine oral 1

pimozide 1

thioridazine hcl oral 1

thiothixene 1

trifluoperazine hcl 1

2nd Generation/Atypical

ABILIFY MAINTENA 3

aripiprazole 1 QL

FANAPT 3 ST; QL

FANAPT TITRATION PACK

3 ST; QL

GEODON INTRAMUSCULAR

3

INVEGA SUSTENNA 3

INVEGA TRINZA 3

LATUDA 3 QL

olanzapine intramuscular

1

olanzapine oral 1 QL

paliperidone er 1 QL

quetiapine fumarate 1 QL

quetiapine fumarate er 1 QL

REXULTI 3 QL

RISPERDAL CONSTA 3

risperidone 1 QL

SAPHRIS 2 QL

ziprasidone hcl 1 QL

ZYPREXA RELPREVV 3


27


Treatment-Resistant

clozapine oral tablet 1 QL

clozapine oral tablet dispersible 100 mg, 150 mg, 200 mg, 25 mg

1 QL

clozapine oral tablet dispersible 12.5 mg

1 PA; QL

Antispasticity Agents

baclofen intrathecal 1

baclofen oral 1

BOTOX INJECTION SOLUTION RECONSTITUTED 200 UNIT

4PA; Non-Cosmetic

BOTOX SOLUTION RECONSTITUTED 100 UNIT INJECTION

4 PA

BOTOX SOLUTION RECONSTITUTED 100 UNIT INJECTION

4PA; Non-Cosmetic

dantrolene sodium oral 1

revonto 1

tizanidine hcl oral 1

Antivirals

Anti-cytomegalovirus (CMV) Agents

cidofovir intravenous 1

ganciclovir sodium 1

valganciclovir hcl 1

Anti-hepatitis B (HBV) Agents

adefovir dipivoxil 4

BARACLUDE ORAL SOLUTION

4 QL

entecavir 4 QL

EPIVIR HBV ORAL SOLUTION

4

INTRON A 4 PA


lamivudine oral tablet 100 mg

4

VEMLIDY 4

Anti-hepatitis C (HBV) Agents

EPCLUSA 4 PA; QL

HARVONI 4 PA; QL

MAVYRET 4 PA; QL

PEGASYS 4 PA

PEGASYS PROCLICK 4 PA

REBETOL ORAL SOLUTION 40 MG/ML

4

ribasphere 4

ribasphere ribapak oral tablet

4

RIBASPHERE RIBAPAK ORAL TABLET THERAPY PACK

4

ribavirin oral 4

ZEPATIER 4 PA; QL

Antiherpetic Agents

acyclovir external 1

acyclovir oral 1

acyclovir sodium 1

famciclovir 1

valacyclovir hcl oral 1 QL

Anti-HIV Agents, Integrase Inhibitors (INSTI)

BIKTARVY 3

GENVOYA 3

ISENTRESS 2

ISENTRESS HD 2

JULUCA 2

STRIBILD 3

TIVICAY 2


28


TRIUMEQ 2

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

ATRIPLA 3 ST

COMPLERA 2

EDURANT 2

efavirenz 1

INTELENCE 2

nevirapine 1

nevirapine er 1

ODEFSEY 3

RESCRIPTOR 2

SYMFI 2

SYMFI LO 2

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)

abacavir sulfate 1

abacavir sulfate-lamivudine

1

abacavir-lamivudine-zidovudine

1

CIMDUO 2

DESCOVY 3

didanosine 1

EMTRIVA 2

lamivudine oral solution 1

lamivudine oral tablet 150 mg, 300 mg

1

lamivudine-zidovudine 1

RETROVIR INTRAVENOUS

2

stavudine 1


tenofovir disoproxil fumarate

1

TRUVADA 2

VIDEX 2

VIDEX EC ORAL CAPSULE DELAYED RELEASE 125 MG

3

VIREAD ORAL POWDER

2

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG

2

zidovudine 1

Anti-HIV Agents, Other

FUZEON 2 QL

SELZENTRY 2 PA

TYBOST 2

Anti-HIV Agents, Protease Inhibitors

APTIVUS 2

atazanavir sulfate 1

CRIXIVAN 2

EVOTAZ 2

fosamprenavir calcium 1

INVIRASE 2

KALETRA ORAL TABLET

2

LEXIVA ORAL SUSPENSION

2

lopinavir-ritonavir 1

NORVIR ORAL PACKET

2

NORVIR ORAL SOLUTION

2

PREZCOBIX 2

PREZISTA 2


29


REYATAZ ORAL PACKET

2

ritonavir 1

VIRACEPT 2

Anti-influenza Agents

amantadine hcl oral 1

oseltamivir phosphate oral

1 QL

RELENZA DISKHALER 3 QL

rimantadine hcl 1

Anxiolytics

Anxiolytics, Other

buspirone hcl oral 1

meprobamate 1

Benzodiazepines

alprazolam er 1 QL

alprazolam oral tablet 1 QL

alprazolam xr 1 QL

chlordiazepoxide hcl 1 QL

clorazepate dipotassium

1 QL

diazepam injection 1

diazepam intensol 1

diazepam intramuscular

1

diazepam oral 1

estazolam 1 QL

lorazepam injection 1

lorazepam intensol 1 QL

lorazepam oral 1 QL

oxazepam 1 QL

quazepam 1 QL

temazepam 1 QL

triazolam 1 QL


Bipolar Agents

Mood Stabilizers

lithium 1

lithium carbonate er 1

lithium carbonate oral 1

Blood Glucose Monitoring

ACCU-CHEK FASTCLIX LANCET KIT

2

ACCU-CHEK FASTCLIX LANCETS

2

ACCU-CHEK MULTICLIX LANCET DEVICE KIT

2

ACCU-CHEK MULTICLIX LANCETS

2

ACCU-CHEK SOFT TOUCH LANCETS

2

ACCU-CHEK SOFTCLIX LANCET DEVICE KIT

2

ACCU-CHEK SOFTCLIX LANCETS

2

CHEMSTRIP UGK 3

INPEN 100-BLUE-LILLY

3

INPEN 100-BLUE-NOVO

3

INPEN 100-GRAY-LILLY

3

INPEN 100-GREY-NOVO

3

INPEN 100-PINK-LILLY

3

INPEN 100-PINK-NOVO

3

KETOCARE IN VITRO STRIP

3


30


KETOSTIX 3

LANCETS 2

NOVOPEN ECHO 3

ONETOUCH DELICA LANCING DEV

3

ONETOUCH DELICA PLUS LANCING

3

ONETOUCH ULTRA 2 2

ONETOUCH ULTRA BLUE TEST STRIPS

2 QL

ONETOUCH ULTRA MINI

2

ONE TOUCH VERIO KIT W/DEVICE

2

ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE

2

ONETOUCH VERIO IN VITRO SOLUTION HIGH

3

ONETOUCH VERIO TEST STRIPS

2 QL

ONETOUCH VERIO IQ SYSTEM

2

ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE

2

SURESTEP PRO HIGH GLUCOSE

3

SURESTEP PRO LOW GLUCOSE

3

SURESTEP PRO NORMAL GLUCOSE

3

Blood Glucose Regulators

Antidiabetic Agents

acarbose oral 1

BYDUREON 2 ST; QL


BYDUREON BCISE AUTOINJECTOR

2 ST; QL

BYETTA 10 MCG PEN 2 ST; QL

BYETTA 5 MCG PEN 2 ST; QL

CYCLOSET 3 ST

glimepiride 1

glipizide er 1

glipizide ir 1

glipizide xl 1

glipizide-metformin hcl 1

glyburide micronized 1

glyburide oral 1

glyburide-metformin 1

GLYXAMBI 2 ST

INVOKAMET 2 ST

INVOKAMET XR 2 ST

INVOKANA 2 ST

JANUMET 2 ST

JANUMET XR 2 ST

JANUVIA 2 ST

JARDIANCE 2 ST

JENTADUETO 2 ST

JENTADUETO XR 2 ST

metformin hcl er 1

metformin hcl oral tablet

1

miglitol 1

nateglinide 1

OZEMPIC 2 ST; QL

pioglitazone hcl 1

pioglitazone hcl-glimepiride

1

pioglitazone hcl-metformin hcl

1

repaglinide 1


31


repaglinide-metformin hcl

1

SYNJARDY 2 ST

SYNJARDY XR 2 ST

tolbutamide 1

TRADJENTA 2 ST

TRULICITY 2 ST; QL

VICTOZA 2 ST; QL

Glycemic Agents

GLUCAGEN HYPOKIT 2

GLUCAGON EMERGENCY

2

PROGLYCEM 2

Insulins

HUMALOG KWIKPEN 2

HUMALOG MIX 50/50 KWIKPEN

2

HUMALOG MIX 50/50 VIAL

2

HUMALOG MIX 75/25 KWIKPEN

2

HUMALOG MIX 75/25 VIAL

2

HUMALOG U-100 JUNIOR KWIKPEN

2

HUMALOG U-100 VIAL AND CARTRIDGE

2

HUMULIN 70/30 KWIKPEN

2

HUMULIN 70/30 VIAL 2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL 2

HUMULIN R U-500 KWIKPEN

2

HUMULIN R U-500 VIAL (CONCENTRATED)

2

HUMULIN R VIAL 2


LANTUS SOLOSTAR 2

LANTUS U-100 VIAL 2

LEVEMIR U-100 FLEXTOUCH

2

LEVEMIR U-100 VIAL 2

NOVOLIN 70/30 FLEXPEN

3

NOVOLIN 70/30 FLEXPEN RELION

3

NOVOLIN 70/30 RELION

3

NOVOLIN 70/30 VIAL 3

NOVOLIN N RELION 3

NOVOLIN N VIAL 3

NOVOLIN R RELION 3

NOVOLIN R VIAL 3

NOVOLOG FLEXPEN 3

NOVOLOG MIX 70/30 FLEXPEN

3

NOVOLOG MIX 70/30 VIAL

3

NOVOLOG PENFILL 3

NOVOLOG U-100 VIAL 3

TOUJEO MAX SOLOSTAR

2

TOUJEO SOLOSTAR 2

TRESIBA 3

TRESIBA FLEXTOUCH

3

Blood Products/Modifiers/Volume Expanders

SOLIRIS 4 PA

Anticoagulants

acd formula a 1

acd formula b in vitro solution 440-1.47-1.32

1

acd-a noclot-50 1


32


anticoagulant cit dext soln a

1

anticoagulant sodium citrate

1

argatroban 1

BEVYXXA 3 QL

bivalirudin trifluoroacetate

1

CEPROTIN 4

ELIQUIS 2 QL

ELIQUIS STARTER PACK

2 QL

enoxaparin sodium 1 QL

fondaparinux sodium 1 QL

heparin (porcine) in nacl injection

1

heparin (porcine) in nacl intravenous solution 1000-0.9 ut/500ml-%, 12500-0.45 ut/250ml-%, 2000-0.9 unit/l-%, 25000-0.45 ut/250ml-%, 25000-0.45 ut/500ml-%

1

heparin sod (porcine) in d5w

1

heparin sodium (porcine)

1

heparin sodium (porcine) pf

1

jantoven 1

PRADAXA 2 QL

SAVAYSA 3 QL

THROMBATE III 4

warfarin sodium oral 1

XARELTO 2 QL

XARELTO STARTER PACK

2 QL


Blood Formation Modifiers

anagrelide hcl 1

ARANESP (ALBUMIN FREE)

4 PA

MOZOBIL 4 PA; QL

NEULASTA 4 PA

NEULASTA ONPRO 4 PA

NIVESTYM 4 PA

NPLATE 4 PA

PROMACTA 4 PA

RETACRIT 4 PA

Hemostasis Agents

ADVATE 4

aminocaproic acid intravenous

1

aminocaproic acid oral 1

BENEFIX 4

COAGADEX 4

CORIFACT 4

ELOCTATE 4

FEIBA 4

FIBRYGA 4

HELIXATE FS 4

HEMLIBRA 4

hemofil m intravenous solution reconstituted 1000 unit, 250 unit, 500 unit

4

HEMOFIL M INTRAVENOUS SOLUTION RECONSTITUTED 1700 UNIT

4

HUMATE-P 4

KOATE 4


33


KOATE-DVI INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 500 UNIT

4

koate-dvi intravenous solution reconstituted 250 unit

4

KOGENATE FS 4

NOVOSEVEN RT 4

OBIZUR 4

PROFILNINE 4

PROFILNINE SD 4

protamine sulfate intravenous

1

RECOMBINATE 4

RIASTAP 4

RIXUBIS 4

tranexamic acid intravenous

1

tranexamic acid oral 1

VONVENDI 4

XYNTHA 4

XYNTHA SOLOFUSE 4

Platelet Modifying Agents

aspirin-dipyridamole er 1

BRILINTA 2

CABLIVI 4 PA; QL

cilostazol 1

clopidogrel bisulfate oral

1

dipyridamole oral 1

eptifibatide 1

prasugrel hcl 1

ZONTIVITY 3


Cardiovascular Agents

Alpha-adrenergic Agonists

clonidine 1

clonidine hcl oral 1

guanfacine hcl 1

methyldopa 1

methyldopa-hydrochlorothiazide

1

phenylephrine hcl injection solution 10 mg/ml

1

phenylephrine hcl intravenous solution

1

Alpha-adrenergic Blocking Agents

phenoxybenzamine hcl oral

1

phentolamine mesylate injection

1

prazosin hcl oral 1

Angiotensin II Receptor Antagonists

amlodipine besylate-valsartan

1

amlodipine-olmesartan 1

amlodipine-valsartan-hctz

1

candesartan cilexetil 1

candesartan cilexetil-hctz

1

eprosartan mesylate 1

irbesartan 1

irbesartan-hydrochlorothiazide

1

losartan potassium 1

losartan potassium-hctz 1


34


olmesartan medoxomil oral

1

olmesartan medoxomil-hctz

1

olmesartan-amlodipine-hctz

1

telmisartan 1

telmisartan-amlodipine 1

telmisartan-hctz 1

valsartan 1

valsartan-hydrochlorothiazide

1

Angiotensin-converting Enzyme (ACE) Inhibitors

amlodipine besylate-benazepril hcl

1

benazepril hcl oral 1

benazepril-hydrochlorothiazide

1

captopril oral 1

captopril-hydrochlorothiazide

1

enalapril maleate oral 1

enalaprilat 1

enalapril-hydrochlorothiazide

1

fosinopril sodium 1

fosinopril sodium-hctz 1

lisinopril oral 1

lisinopril-hydrochlorothiazide

1

moexipril hcl 1

perindopril erbumine 1

quinapril hcl 1

quinapril-hydrochlorothiazide

1

ramipril 1


trandolapril 1

trandolapril-verapamil hcl er

1

Antiarrhythmics

adenosine intravenous solution 12 mg/4ml, 6 mg/2ml

1

amiodarone hcl 1

disopyramide phosphate

1

dofetilide 1

flecainide acetate 1

ibutilide fumarate 1

lidocaine hcl (cardiac) 1

lidocaine hcl (cardiac) pf

1

lidocaine in d5w intravenous solution 4-5 mg/ml-%, 8-5 mg/ml-%

1

mexiletine hcl oral 1

pacerone oral tablet 200 mg

1

procainamide hcl injection

1

propafenone hcl 1

propafenone hcl er 1

quinidine gluconate er 1

quinidine sulfate 1

sorine 1

sotalol hcl (af) 1

sotalol hcl oral 1

Beta-adrenergic Blocking Agents

acebutolol hcl oral 1

atenolol oral 1

atenolol-chlorthalidone 1

betaxolol hcl oral 1


35


bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide

1

BYSTOLIC 2

carvedilol 1

carvedilol phosphate er 1

esmolol hcl intravenous solution 100 mg/10ml

1

esmolol hcl-sodium chloride

1

labetalol hcl intravenous solution

1

labetalol hcl oral 1

metoprolol succinate er 1

metoprolol tartrate intravenous

1

metoprolol tartrate oral 1

metoprolol-hydrochlorothiazide

1

pindolol 1

propranolol hcl er 1

propranolol hcl intravenous

1

propranolol hcl oral 1

propranolol-hctz 1

timolol maleate oral 1

Calcium Channel Blocking Agents

amlodipine besylate oral

1

amlodipine-atorvastatin 1

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR 120 MG

3

cartia xt 1

diltiazem hcl er beads 1


diltiazem hcl er coated beads

1

diltiazem hcl er oral capsule extended release 12 hour

1

diltiazem hcl er oral capsule extended release 24 hour 180 mg, 240 mg

1

diltiazem hcl intravenous

1

diltiazem hcl oral 1

dilt-xr 1

felodipine er 1

isradipine 1

matzim la 1

nicardipine hcl 1

nifedipine er 1

nifedipine er osmotic release

1

nifedipine oral 1

nimodipine oral 1

nisoldipine er 1

taztia xt 1

verapamil hcl er 1

verapamil hcl intravenous

1

verapamil hcl oral 1

Cardiovascular Agents, Other

aliskiren fumarate 1

DEMSER 3

digitek 1

digox 1

digoxin injection 1

digoxin oral 1

dobutamine hcl 1


36


dobutamine in d5w 1

dopamine hcl intravenous

1

dopamine in d5w 1

ENTRESTO 2 QL

ephedrine sulfate intravenous solution

1

epinephrine pf 1

GIAPREZA 3

mannitol intravenous 1

midodrine hcl 1

milrinone lactate 1

milrinone lactate in dextrose

1

norepinephrine bitartrate intravenous

1

osmitrol 1

pentoxifylline er 1

ranolazine er 1

VECAMYL 3

Diuretics, Loop

bumetanide 1

ethacrynate sodium 1

ethacrynic acid 1

furosemide injection 1

furosemide oral 1

torsemide 1

Diuretics, Potassium-sparing

amiloride hcl oral 1

amiloride-hydrochlorothiazide

1

DYRENIUM ORAL CAPSULE 100 MG

3

eplerenone 1

spironolactone oral 1

spironolactone-hctz 1


triamterene-hctz 1

Diuretics, Thiazide

chlorothiazide 1

chlorothiazide sodium 1

chlorthalidone 1

hydrochlorothiazide oral

1

indapamide 1

metolazone 1

Dyslipidemics, Fibric Acid Derivatives

choline fenofibrate 1

fenofibrate micronized 1

fenofibrate oral capsule 1

fenofibrate oral tablet 145 mg, 160 mg, 48 mg, 54 mg

1

fenofibric acid oral capsule delayed release

1

gemfibrozil oral 1

Dyslipidemics, HMG CoA Reductase Inhibitors

atorvastatin calcium oral tablet 10 mg, 20 mg

1 PV*

atorvastatin calcium oral tablet 40 mg, 80 mg

1

fluvastatin sodium 3

fluvastatin sodium er 3

LIVALO 3 ST

lovastatin 1 PV

PRALUENT 4 PA; QL

pravastatin sodium 1

REPATHA 4 PA; QL


37


REPATHA PUSHTRONEX SYSTEM

4 PA; QL

REPATHA SURECLICK

4 PA; QL

rosuvastatin calcium 1

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

1 PV*

simvastatin oral tablet 80 mg

1

Dyslipidemics, Other

cholestyramine light 1

cholestyramine oral 1

colesevelam hcl 1

colestipol hcl 1

ezetimibe 1

ezetimibe-simvastatin 1

niacin er (antihyperlipidemic)

1

omega-3-acid ethyl esters

1

prevalite 1

Vasodilators, Direct-acting Arterial

hydralazine hcl injection

1

hydralazine hcl oral 1

minoxidil oral 1

Vasodilators, Direct-acting Arterial/Venous

DILATRATE-SR 3

isosorbide dinitrate 1

isosorbide dinitrate er 1

isosorbide mononitrate 1

isosorbide mononitrate er

1


minitran 1

NITRO-BID 3

nitroglycerin 1

nitroglycerin in d5w 1

NITROMIST 3

nitroprusside sodium 1

Central Nervous System Agents

Attention Deficit Hyperactivity Disorder Agents, Amphetamines

amphetamine sulfate 1 PA; QL

amphetamine-dextroamphetamine

1 PA; QL

amphetamine-dextroamphetamine er

1 PA; QL

dextroamphetamine sulfate

1 PA; QL

dextroamphetamine sulfate er

1 PA; QL

methamphetamine hcl 3 PA; QL

VYVANSE 2 PA; QL

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines

atomoxetine hcl 1 QL

clonidine hcl er 1

DAYTRANA 3 ST; PA; QL

dexmethylphenidate hcl 1 PA; QL

dexmethylphenidate hcl er

1 PA; QL

guanfacine hcl er 1

metadate er 1 PA; QL

methylphenidate hcl er 1 PA; QL

methylphenidate hcl er (cd)

1 PA; QL


38


methylphenidate hcl er (la)

1 PA; QL

methylphenidate hcl oral

1 PA; QL

QUILLIVANT XR 3 ST; PA; QL

relexxii 1 PA; QL

Central Nervous System, Other

caffeine citrate 1

flumazenil intravenous 1

GRALISE 3 ST; QL

GRALISE STARTER 3 ST; QL

riluzole 4 PA; QL

TEGSEDI 4 PA

tetrabenazine 4 PA

Fibromyalgia Agents

SAVELLA 3 ST; QL

SAVELLA TITRATION PACK

3 ST; QL

Multiple Sclerosis Agents

AVONEX PEN 4 PA; QL

AVONEX PREFILLED 4 PA; QL

BETASERON 4 PA; QL

COPAXONE 4 PA; QL, STdalfampridine er 4 PA; QL

GILENYA 4 PA; QL

glatiramer acetate 4 PA; QL

glatopa 4 PA; QL

TECFIDERA 4 PA; QL

TYSABRI 4 PA; QL

Dental and Oral Agents

cavarest 1

cevimeline hcl 1

chlorhexidine gluconate mouth/throat

1


clinpro 5000 1

DEBACTEROL 3

denta 5000 plus 1

dentagel 1

easygel 1

fluoridex 1

fluoridex daily renewal 1

fluoridex enhanced whitening

1

fluoridex sensitivity relief

1

neutral sodium fluoride 1

oralone 1

paroex 1

periogard 1

pilocarpine hcl oral 1

prevident mouth/throat 1

sf 1

sf 5000 plus 1

sodium fluoride 5000 plus

1

sodium fluoride dental 1

triamcinolone acetonide mouth/throat

1

Dermatological Agents

acitretin 1

adapalene external cream

1 PA

adapalene external gel 1 PA

adapalene-benzoyl peroxide

1

ammonium lactate external

1

amnesteem 1 PA

avita 1 PA

azelaic acid external 1


39


AZELEX 3

benzoyl peroxide-erythromycin

1

calcipotriene 1

calcitriol external 1

claravis 1 PA

clindacin etz external swab

1

clindacin-p 1

clindamycin phosphate-benzoyl peroxide

1

clindamycin phosphate external

1

clindamycin-tretinoin 1

coal tar external 1

colocort 1

CONDYLOX 3

CORTIFOAM 3

COSENTYX (300 MG DOSE)

4 PA

COSENTYX 150 MG/ML

4 PA

COSENTYX SENSOREADY (300 MG)

4 PA

COSENTYX SENSOREADY PEN

4 PA

dapsone external 1

doxepin hcl external 3

doxycycline 1

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MG/2ML

4 PA; QL

EPIDUO FORTE 3

ery 1

erythromycin external 1


hydrocortisone ace-pramoxine rectal cream 1-1 %

1

hydrocortisone rectal 1

imiquimod external 1

isotretinoin oral 1 PA

lactic acid e 1

lactic acid external 1

methoxsalen oral 1

methoxsalen rapid 1

metronidazole external 1

MIRVASO 2

myorisan 1 PA

neuac external gel 1

pimecrolimus 1

podofilox external 1

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc 1

RECTIV 3

REGRANEX 3 PA

rosadan external cream 1

rosadan external gel 1

SANTYL 3

selenium sulfide external lotion

1

silver nitrate external ointment 10 %

1

STELARA SUBCUTANEOUS

4 PA

sulfacetamide sodium (acne)

1

TACLONEX EXTERNAL SUSPENSION

3 QL

tacrolimus external 1


40


tazarotene external 1

TAZORAC EXTERNAL CREAM 0.05 %

3

TAZORAC EXTERNAL GEL

3

TREMFYA 4 PA

tretinoin external 1 PA

tretinoin microsphere 1 PA

tretinoin microsphere pump

1 PA

zenatane 1 PA

Electrolytes/Minerals/Metals/Vitamins

Electrolyte/Mineral Replacement

calcium chloride 1

calcium gluconate intravenous solution

1

chromagen 1

chromic chloride intravenous

1

corvita 150 1

dehydrated alcohol 1

dextrose in lactated ringers

1

dextrose intravenous 1

dextrose-nacl 1

effer-k oral tablet effervescent 25 meq

1

ferocon 1

ferotrinsic 1

ferraplus 90 1

ferrocite plus 1

fluoritab 1 PV

foltrin 1

glucose intravenous 1


hematinic plus vit/minerals

1

hematinic/folic acid 1

hematogen 1

hematogen forte 1

hemocyte-f 1

hemocyte-plus 1

iferex 150 forte 1

iodine strong oral 1

kcl in d5w lactated ringers

1

kcl in dextrose-nacl 1

kcl-lactated ringers-d5w 1

klor-con 1

klor-con 10 1

klor-con m10 1

KLOR-CON M15 3

klor-con m20 1

klor-con sprinkle 1

klor-con/ef 1

k-prime 1

k-tan plus 1

lactated ringers intravenous

1

ludent 1 PV

magnesium chloride injection

1

magnesium sulfate in d5w intravenous solution 1-5 gm/100ml-%

1

magnesium sulfate injection

1


41


magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, 40 gm/1000ml

1

multigen 1

multigen folic 1

multigen plus 1

na ferric gluc cplx in sucrose

1

nafrinse 1 PV

nafrinse drops 1 PV

phosphorous 1

poly-iron 150 forte 1

polysaccharide iron forte

1

pot bicarb-pot chloride 1

potassium acetate intravenous

1

potassium chloride crys er

1

potassium chloride er 1

potassium chloride in dextrose

1

potassium chloride in nacl

1

potassium chloride intravenous solution

1

potassium chloride oral 1

potassium citrate er 1

purevit dualfe plus 1

ringers 1

se-tan plus 1

sod citrate-citric acid 1

sodium bicarbonate intravenous solution 4.2 %, 7.5 %

1


sodium chloride injection

1

sodium chloride intravenous

1

sodium fluoride oral 1 PV

sodium lactate intravenous

1

sodium phosphates intravenous solution 45 mmole/15ml

1

tl icon 1

tl-hem 150 1

tpn electrolytes 1

tricon 1

trigels-f forte 1

virt-phos 250 neutral 1

Electrolyte/Mineral/Metal Modifiers

CHEMET 3

deferasirox 1 PA

DEPEN TITRATABS 2

FERRIPROX ORAL TABLET 500 MG

4 PA

JADENU 3 PA

JADENU SPRINKLE 3 PA

kionex 1

penicillamine oral 4 PA

SAMSCA 4 QL

sodium polystyrene sulfonate

1

sps 1

trientine hcl 4 PA

VELTASSA 3

Vitamins

adc/f (0.5mg/ml) 1

airavite 1

b-6 folic acid 1


42


biocel 1

bp vit 3 1

b-plex 1

b-plex plus 1

cod liver oil oral oil 1

corvita 1

corvite free 1

cyanocobalamin injection solution 1000 mcg/ml

1

decara oral capsule 50000 unit

1

dexifol 1

dialyvite 1

ergocalciferol oral capsule

1

fabb 1

fa-vitamin b-6-vitamin b-12

1

folbee 1

folbee plus 1

folbee plus cz 1

folic acid injection 1

folic acid oral tablet 1 mg

1

folic acid oral tablet 400 mcg, 800 mcg

1 PV

folplex 2.2 1

gnp folic acid 1 PV

hydroxocobalamin acetate

1

infuvite adult 1

infuvite pediatric 1

lysiplex plus oral tablet 1

multi prenatal 1 PV

multi-vit/iron/fluoride 1

multi-vitamin/fluoride 1


multivitamin/fluoride oral solution

1

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg

1

multivitamin/fluoride/iron

1

multi-vitamin/fluoride/iron

1

multivitamins/fluoride 1

mvc-fluoride 1

mynephron 1

NASCOBAL 3

nephronex oral tablet 1

nufol 1

nutricap 1

nutrifac zx 1

ONE-A-DAY WOMENS PRENATAL 1

3 PV

phytonadione injection 1

phytonadione oral 1

pnv prenatal plus multivit+dha

1

prenatal multi +dha 1 PV

prenatal oral tablet 27-0.8 mg, 28-0.8 mg

1 PV

prenatal oral tablet 27-1 mg

1

prenatal plus iron 1

pyridoxine hcl injection 1

RAYALDEE 3

renal 1

siderol 1

sodium acetate intravenous

1

thiamine hcl injection 1

tl gard rx 1


43


trinate 1

triphrocaps 1

tri-vitamin/fluoride 1

tri-vite/fluoride 1

v-c forte 1

vic-forte 1

virt-caps 1

virt-gard 1

vita s forte 1

vitacel 1

vitamax pediatric 1

vita-min 1

vitamin b complex 100 1

vitamin d (ergocalciferol) oral capsule 50000 unit

1

vitamin k1 injection 1

vitamins acd-fluoride 1

vp-pnv-dha 1

vp-vite rx 1

Gastrointestinal Agents

Antispasmodics, Gastrointestinal

atropine sulfate injection solution 8 mg/20ml

1

atropine sulfate injection solution prefilled syringe

1

CUVPOSA 3

dicyclomine hcl intramuscular

1

dicyclomine hcl oral 1

ed-spaz 1

glycopyrrolate injection solution

1


glycopyrrolate oral tablet 1 mg, 2 mg

1

glycopyrrolate pf 1

hyoscyamine sulfate oral

1

hyoscyamine sulfate sl 1

hyoscyamine sulfate sublingual

1

methscopolamine bromide oral

1

nulev 1

oscimin 1

Gastrointestinal Agents, Other

amoxicill-clarithro-lansopraz

1

CHOLBAM 4 PA

cromolyn sodium oral 1

diphenoxylate-atropine 1

GATTEX 4 PA

loperamide hcl oral capsule

1

metoclopramide hcl injection

1

metoclopramide hcl oral

1

OMECLAMOX-PAK 2

PYLERA 2

sodium bicarbonate oral powder

1

SYMPROIC 2 ST; QL

ursodiol oral 1

Histamine2 (H2) receptor Antagonists

cimetidine hcl 1

cimetidine oral 1

famotidine intravenous 1


44


famotidine oral suspension reconstituted

1

famotidine oral tablet 20 mg, 40 mg

1

famotidine premixed 1

nizatidine 1

ranitidine hcl injection 1

ranitidine hcl oral capsule

1

ranitidine hcl oral syrup 1

ranitidine hcl oral tablet 150 mg, 300 mg

1

Irritable Bowel Syndrome Agents

alosetron hcl 1 PA

AMITIZA 3 ST; QL

LINZESS 2 ST; QL

Laxatives

bisacodyl ec 1 PV; QL

cascara sagrada oral fluid extract

1

clearlax 1 PV; QL

constulose 1

enulose 1

ex-lax ultra 1 PV; QL

gavilax oral powder 1 PV; QL

gavilyte-c 1 PV; QL

gavilyte-g 1 PV; QL

gavilyte-h 1

gavilyte-n with flavor pack

1 PV; QL

generlac 1

gentle laxative oral 1 PV; QL

glycolax 1 PV; QL

lactulose encephalopathy

1


lactulose oral solution 1

magnesium citrate oral solution

1 PV; QL

mineral oil heavy oral 1

MOVIPREP 3

peg 3350/electrolytes 1 PV; QL

peg 3350-kcl-na bicarb-nacl

1 PV; QL

peg-3350/electrolytes 1 PV; QL

peg-prep 1

PREPOPIK 3

SUPREP BOWEL PREP KIT

3

trilyte 1 PV; QL

Protectants

CARAFATE ORAL SUSPENSION

3

misoprostol oral 1

sucralfate oral tablet 1

Proton Pump Inhibitors

DEXILANT 2 QL,STesomeprazole sodium 1

lansoprazole oral capsule delayed release

1 QL

lansoprazole oral tablet dispersible 15 mg

1 QL

omeprazole oral capsule delayed release

1 QL

pantoprazole sodium intravenous

1 QL

pantoprazole sodium oral

1 QL

rabeprazole sodium oral tablet delayed release

1 QL


45


Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

ALDURAZYME 4 PA

CARBAGLU 4

CERDELGA 4 PA

CEREZYME 4 PA

CREON 2

CYSTADANE 4

CYSTAGON 4

ELAPRASE 4 PA

FABRAZYME 4 PA

KANUMA 4 PA

KUVAN 4 PA

LUMIZYME 4 PA

MEPSEVII 4 PA

miglustat 4 PA

MYALEPT 4 PA

NAGLAZYME 4 PA

ORFADIN 4 PA

RAVICTI 4 PA

REVCOVI 4 PA

sod benz-sod phenylacet

1

sodium phenylbutyrate oral

4

STRENSIQ 4 PA

SUCRAID 4

VIMIZIM 4 PA

XIAFLEX 4 PA

ZENPEP 2

Genitourinary Agents

Antispasmodics, Urinary

darifenacin hydrobromide er

1


flavoxate hcl 1

GELNIQUE 3 ST

GELNIQUE PUMP 3 ST

MYRBETRIQ 2

oxybutynin chloride er 1

oxybutynin chloride oral 1

solifenacin succinate 1

tolterodine tartrate 1

tolterodine tartrate er 1

TOVIAZ 3

trospium chloride 1

trospium chloride er 1

Benign Prostatic Hypertrophy Agents

alfuzosin hcl er 1

doxazosin mesylate oral

1

dutasteride oral 1

dutasteride-tamsulosin hcl

1

finasteride oral tablet 5 mg

1

silodosin 1

tadalafil oral tablet 2.5 mg, 5 mg

1 PA; QL

tamsulosin hcl 1

terazosin hcl 1

Genitourinary Agents, Other

acetic acid irrigation 1

aminoacetic acid 1

argyle sterile saline 1

bethanechol chloride oral

1

ELMIRON 2

glycine irrigation 1

glycine urologic 1


46


neomycin-polymyxin b gu

1

phenazo oral tablet 200 mg

1

phenazopyridine hcl oral tablet 100 mg, 200 mg

1

RENACIDIN 3

sodium chloride irrigation

1

sorbitol irrigation solution 3.3 %

1

sorbitol-mannitol 1

vcf vaginal contraceptive vaginal gel

1 PV; QL

Phosphate Binders

calcium acetate (phos binder)

1

FOSRENOL ORAL PACKET

3

lanthanum carbonate 1

PHOSLYRA 3

sevelamer carbonate 1

sevelamer hcl 1

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)

ala-cort 1

alclometasone dipropionate

1

amcinonide external lotion

1

amcinonide external ointment

1

beser external lotion 1

betamethasone dipropionate aug

1


betamethasone dipropionate external

1

betamethasone sod phos & acet injection suspension 6 (3-3) mg/ml

1

betamethasone valerate external

1

clobetasol prop emollient base

1

clobetasol propionate e 1

clobetasol propionate emulsion

1

clobetasol propionate external

1

clodan external shampoo

1

CORDRAN EXTERNAL TAPE

3

cortisone acetate oral 1

deltasone oral tablet 20 mg

1

DEPO-MEDROL INJECTION SUSPENSION 20 MG/ML

3

desonide external 1

desoximetasone external cream 0.25 %

1

desoximetasone external gel

1

desoximetasone external liquid

1

desoximetasone external ointment 0.25 %

1

DEXAMETHASONE INTENSOL

3

dexamethasone oral 1


47


dexamethasone sod phosphate pf

1

dexamethasone sodium phosphate injection

1

fludrocortisone acetate oral

1

fluocinolone acetonide body

1

fluocinolone acetonide external

1

fluocinolone acetonide scalp

1

fluocinonide emulsified base

1

fluocinonide external cream 0.05 %

1

fluocinonide external gel

1

fluocinonide external ointment

1

fluocinonide external solution

1

fluticasone propionate external

1

halobetasol propionate external cream

1

halobetasol propionate external ointment

1

hydrocortisone butyrate external cream

1

hydrocortisone butyrate external ointment

1

hydrocortisone butyrate external solution

1

hydrocortisone external cream 1 %, 2.5 %

1

hydrocortisone external lotion 2.5 %

1


hydrocortisone external ointment 1 %, 2.5 %

1

hydrocortisone oral 1

hydrocortisone valerate 1

INTRAROSA 3

methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml

1

methylprednisolone oral

1

methylprednisolone sodium succ

1

mometasone furoate external

1

prednicarbate 1

prednisolone oral solution

1

prednisolone sodium phosphate oral

1

PREDNISONE INTENSOL

2

prednisone oral 1

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED 1000 MG

3

TEXACORT 3

triamcinolone acetonide external cream

1

triamcinolone acetonide external lotion

1

triamcinolone acetonide external ointment

1

triamcinolone acetonide injection suspension 40 mg/ml

1

triderm 1


48


Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary)

ACTHAR 4 PA

cabergoline 1

chorionic gonadotropin intramuscular

4 PA

desmopressin ace spray refrig

1

desmopressin acetate injection

1

desmopressin acetate oral

1

desmopressin acetate spray

1

INCRELEX 4 PA

NORDITROPIN FLEXPRO

4 PA

NUTROPIN AQ NUSPIN 10

4 PA


4 PA


4 PA

oxytocin injection 1

pregnyl 4 PA

Hormonal Agents, Suppressant (Pituitary)

leuprolide acetate injection

4 PA

LUPRON DEPOT (1-MONTH)

4 PA

LUPRON DEPOT (3-MONTH)

4 PA

LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG

4 PA


LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG

4 PA

ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG

4 QL

Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins)

alprostadil injection 1

carboprost tromethamine

1

KORLYM 4 PA; QL

mifepristone 1

Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers)

Anabolic Steroids

ANADROL-50 3 PA

oxandrolone oral 1 PA; QL

Androgens

danazol oral 1

METHITEST 3 PA

methyltestosterone oral 1 PA

STRIANT 3 PA

testosterone cypionate intramuscular

1 PA

testosterone enanthate intramuscular

1 PA


49


testosterone transdermal gel 12.5 mg/act (1%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 25 mg/2.5gm (1%), 40.5 mg/2.5gm (1.62%), 50 mg/5gm (1%)

1 PA

testosterone transdermal solution

1 PA

Estrogens

afirmelle 1 PV

altavera 1 PV

alyacen 1/35 1 PV

alyacen 7/7/7 1 PV

amabelz 1

amethia 1 PV; QL

amethia lo 1 PV; QL

amethyst 1 PV

ANNOVERA 3 PV

apri 1 PV

aranelle 1 PV

ashlyna 1 PV; QL

aubra 1 PV

aubra eq 1 PV

aurovela 1.5/30 1 PV

aurovela 1/20 1 PV

aurovela 24 fe 1 PV

aurovela fe 1.5/30 1 PV

aurovela fe 1/20 1 PV

aviane 1 PV

ayuna 1 PV

azurette 1 PV

balziva 1 PV

bekyree 1 PV

blisovi 24 fe 1 PV


blisovi fe 1.5/30 1 PV

briellyn 1 PV

camrese 1 PV; QL

camrese lo 1 PV; QL

caziant 1 PV

chateal 1 PV

chateal eq 1 PV

COMBIPATCH 3

cryselle-28 1 PV

cyclafem 1/35 1 PV

cyclafem 7/7/7 1 PV

cyred 1 PV

cyred eq 1 PV

dasetta 1/35 1 PV

dasetta 7/7/7 1 PV

daysee 1 PV; QL

delyla 1 PV

desogestrel-ethinyl estradiol

1 PV

DIVIGEL 3

dotti 1

drospiren-eth estrad-levomefol

1 PV

drospirenone-ethinyl estradiol

1 PV

DUAVEE 2

elinest 1 PV

emoquette 1 PV

enpresse-28 1 PV

enskyce 1 PV

estarylla 1 PV

estradiol oral 1

estradiol transdermal 1

estradiol vaginal 1

estradiol valerate intramuscular

1


50


estradiol-norethindrone acet

1

ethynodiol diac-eth estradiol

1 PV

EVAMIST 3

falmina 1 PV

fayosim 1 PV; QL

femynor 1 PV

fyavolv 1

gianvi 1 PV

hailey 24 fe 1 PV

introvale 1 PV; QL

isibloom 1 PV

jasmiel 1 PV

jinteli 1

jolessa 1 PV; QL

juleber 1 PV

junel 1.5/30 1 PV

junel 1/20 1 PV

junel fe 1.5/30 1 PV

junel fe 1/20 1 PV

junel fe 24 1 PV

kaitlib fe 1 PV

kalliga 1 PV

kariva 1 PV

kelnor 1/35 1 PV

kelnor 1/50 1 PV

kurvelo 1 PV

larin 1.5/30 1 PV

larin 1/20 1 PV

larin 24 fe 1 PV

larin fe 1.5/30 1 PV

larin fe 1/20 1 PV

larissia 1 PV

layolis fe 1 PV


leena 1 PV

lessina 1 PV

levonest 1 PV

levonorgest-eth est & eth est

1 PV; QL

levonorgest-eth estrad 91-day

1 PV; QL

levonorgestrel-ethinyl estrad

1 PV

levonorg-eth estrad triphasic

1 PV

levora 0.15/30 (28) 1 PV

lillow 1 PV

LO LOESTRIN FE 3

lopreeza 1

loryna 1 PV

low-ogestrel 1 PV

lo-zumandimine 1 PV

lutera 1 PV

marlissa 1 PV

melodetta 24 fe 1 PV

MENEST 2

mibelas 24 fe 1 PV

microgestin 1.5/30 1 PV

microgestin 1/20 1 PV

microgestin fe 1.5/30 1 PV

microgestin fe 1/20 1 PV

mili 1 PV

mimvey 1

mimvey lo 1

mono-linyah 1 PV

NATAZIA 2 PV

necon 0.5/35 (28) 1 PV

nikki 1 PV

norethin ace-eth estrad-fe

1 PV


51


norethindrone acet-ethinyl est

1 PV

norethindrone-eth estradiol

1

norethin-eth estradiol-fe 1 PV

norgestimate-eth estradiol

1 PV

norgestimate-ethinyl estradiol triphasic

1 PV

nortrel 0.5/35 (28) 1 PV

nortrel 1/35 (21) 1 PV

nortrel 1/35 (28) 1 PV

nortrel 7/7/7 1 PV

NUVARING 2 PV

ocella 1 PV

ogestrel 1 PV

orsythia 1 PV

philith 1 PV

pimtrea 1 PV

pirmella 1/35 1 PV

pirmella 7/7/7 1 PV

portia-28 1 PV

PREMARIN ORAL 2

PREMPHASE 2

PREMPRO 2

previfem 1 PV

reclipsen 1 PV

rivelsa 1 PV; QL

setlakin 1 PV; QL

simliya 1 PV

simpesse 1 PV; QL

sprintec 28 1 PV

sronyx 1 PV

syeda 1 PV

tarina 24 fe 1 PV

tarina fe 1/20 1 PV


tarina fe 1/20 eq 1 PV

tilia fe 1 PV

tri femynor 1 PV

tri-estarylla 1 PV

tri-legest fe 1 PV

tri-linyah 1 PV

tri-lo-estarylla 1 PV

tri-lo-marzia 1 PV

tri-lo-mili 1 PV

tri-lo-sprintec 1 PV

tri-mili 1 PV

tri-previfem 1 PV

tri-sprintec 1 PV

trivora (28) 1 PV

tri-vylibra 1 PV

tri-vylibra lo 1 PV

tydemy 1 PV

velivet 1 PV

vienva 1 PV

viorele 1 PV

vyfemla 1 PV

vylibra 1 PV

wera 1 PV

wymzya fe 1 PV

xulane 1 PV

yuvafem 1

zarah 1 PV

zovia 1/35e (28) 1 PV

zumandimine 1 PV

Progesterone Agonists/Antagonists

ELLA 3 PV

Progestins

camila 1 PV

deblitane 1 PV


52


DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML

3

DEPO-SUBQ PROVERA 104

3 QL

errin 1 PV

heather 1 PV

hydroxyprogesterone caproate intramuscular oil

4 PA

incassia 1 PV

jencycla 1 PV

KYLEENA 4 PV

levonorgestrel 1 PV

LILETTA (52 MG) 4 PV

lyza 1 PV

MAKENA SUBCUTANEOUS

4 PA

medroxyprogesterone acetate intramuscular

1 PV; QL

medroxyprogesterone acetate oral

1

megestrol acetate oral suspension 40 mg/ml, 400 mg/10ml

CM

megestrol acetate oral suspension 625 mg/5ml

1

megestrol acetate oral tablet

CM

MIRENA (52 MG) 4 PV

NEXPLANON 3 PV

nora-be 1 PV

norethindrone acetate oral

1

norethindrone oral 1 PV

norlyda 1 PV

norlyroc 1 PV


preventeza 1 PV

progesterone intramuscular

1

progesterone micronized oral

1

sharobel 1 PV

SKYLA 4 PV

SLYND 3 PV

tulana 1 PV

Selective Estrogen Receptor Modifying Agents

OSPHENA 3

raloxifene hcl 1 PV*

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)

ARMOUR THYROID 3 ST

euthyrox 1

levo-t 1

levothyroxine sodium intravenous

1

levothyroxine sodium oral

1

levothyroxine-liothyronine oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

1

levoxyl 1

liothyronine sodium intravenous

1

liothyronine sodium oral 1

np thyroid 1

THYROLAR-1 ORAL TABLET 60 (12.5-50) MG (MCG)

3

THYROLAR-1/2 ORAL TABLET 30 (6.25-25) MG (MCG)

3


53


THYROLAR-1/4 ORAL TABLET 15 (3.1-12.5) MG (MCG)

3

THYROLAR-2 ORAL TABLET 120 (25-100) MG (MCG)

3

THYROLAR-3 ORAL TABLET 180 (37.5-150) MG (MCG)

3

unithroid 1

WP THYROID 3 ST

Hormonal Agents, Suppressant (Adrenal)

LYSODREN CM

Hormonal Agents, Suppressant (pituitary)

LUPANETA PACK 4 PA; QL

LUPRON DEPOT-PED (1-MONTH)

4 PA

LUPRON DEPOT-PED (3-MONTH)

4 PA

octreotide acetate 4 PA

SIGNIFOR 4 PA; QL

SOMATULINE DEPOT 4 PA

SOMAVERT 4 PA

SUPPRELIN LA 4 PA; QL

SYNAREL 2

Hormonal Agents, Suppressant (Thyroid)

Antithyroid Agents

methimazole oral 1

propylthiouracil oral 1

Immunological Agents

Angioedema Agents

BERINERT 4 PA


CINRYZE 4 PA

icatibant acetate 4 PA

Immune Suppressants

AZASAN 3

azathioprine oral 1

azathioprine sodium 1

CIMZIA 4 PA

CIMZIA PREFILLED KIT

4 PA

CIMZIA STARTER KIT 4 PA

cyclosporine intravenous

1

cyclosporine modified 1

cyclosporine oral 1

ENBREL 4 PA

ENBREL MINI 4 PA

ENBREL SURECLICK 4 PA

gengraf 1

HUMIRA 4 PA

HUMIRA PEDIATRIC CROHNS START

4 PA

HUMIRA PEN 4 PA

HUMIRA PEN-CD/UC/HS STARTER

4 PA

HUMIRA PEN-PS/UV/ADOL HS START

4 PA

INFLECTRA 4 PA

KINERET 4 PA

methotrexate (anti-rheumatic) oral tablet 2.5 mg

1

methotrexate oral CM

methotrexate sodium (pf)

1

methotrexate sodium injection

1


54


methotrexate sodium oral

CM

mycophenolate mofetil 1

mycophenolate mofetil hcl

1

mycophenolate sodium 1

ORENCIA 4 PA

ORENCIA CLICKJECT 4 PA

PROGRAF INTRAVENOUS

3

RENFLEXIS 4 PA

SANDIMMUNE ORAL SOLUTION

2

SIMPONI 4 PA

SIMPONI ARIA 4 PA

sirolimus oral 1

STELARA INTRAVENOUS

4 PA

tacrolimus oral 1

TREXALL CM

ZORTRESS 3 PA

Immunizing Agents, Passive

BIVIGAM 4 PA

CARIMUNE NF SOLUTION RECONSTITUTED 12 GM INTRAVENOUS

4 PA

carimune nf solution reconstituted 12 gm intravenous

4 PA

CARIMUNE NF SOLUTION RECONSTITUTED 6 GM INTRAVENOUS

4 PA

carimune nf solution reconstituted 6 gm intravenous

4 PA

CUVITRU 4 PA


CYTOGAM 4 PA

FLEBOGAMMA DIF 4 PA

GAMASTAN 4 PA

gamastan s/d injectable intramuscular

4 PA

GAMASTAN S/D INJECTABLE INTRAMUSCULAR

4 PA

GAMMAGARD 4 PA

GAMMAGARD S/D LESS IGA

4 PA

GAMMAKED 4 PA

GAMMAPLEX 4 PA

GAMUNEX-C 4 PA

HEPAGAM B 4

HIZENTRA 4 PA

HYPERHEP B S/D 4

HYPERRHO S/D 4

HYQVIA 4 PA

MICRHOGAM ULTRA-FILTERED PLUS

4

nabi-hb 4

OCTAGAM INTRAVENOUS SOLUTION 1 GM/20ML, 10 GM/100ML, 10 GM/200ML, 2 GM/20ML, 2.5 GM/50ML, 20 GM/200ML, 25 GM/500ML, 5 GM/100ML, 5 GM/50ML

4 PA

PRIVIGEN 4 PA

RHOGAM ULTRA-FILTERED PLUS

4

RHOPHYLAC 4

SYNAGIS 4 PA


55


THYMOGLOBULIN 3

WINRHO SDF 4

Immunomodulators

ACTEMRA 4 PA

ACTEMRA ACTPEN 4 PA

ACTIMMUNE 4 PA

ALFERON N 4

GAMIFANT 4 PA

ILARIS 4 PA; QL

leflunomide oral 1

OTEZLA 4 PA

XELJANZ 4 PA

XELJANZ XR 4 PA

Vaccines

ACTHIB 2 PV

ADACEL 2 PV

AFLURIA 2 PV

AFLURIA PRESERVATIVE FREE

2 PV

AFLURIA QUADRIVALENT

2 PV

BEXSERO 2 PV

BOOSTRIX 2 PV

DAPTACEL 2 PV

DIPHTHERIA-TETANUS TOXOIDS DT

2 PV

ENGERIX-B 2 PV

EZ FLU SHOT-FLUCELVAX QUAD

2 PV

FLUAD 2 PV

FLUARIX QUADRIVALENT

2 PV

FLUBLOK QUADRIVALENT

2 PV


FLUCELVAX QUADRIVALENT

2 PV

FLULAVAL QUADRIVALENT

2 PV

FLUMIST QUADRIVALENT

2 PV

FLUZONE HIGH-DOSE

2 PV

FLUZONE QUADRIVALENT

2 PV

GARDASIL 9 2 PV

HAVRIX 2 PV

HEPLISAV-B 2 PV

HIBERIX 2 PV

INFANRIX 2 PV

IPOL 2 PV

KINRIX 2 PV

MENACTRA 2 PV

MENVEO 2 PV

M-M-R II 2 PV

PEDIARIX 2 PV

PEDVAX HIB 2 PV

PENTACEL 2 PV

pneumovax 23 injectable 25 mcg/0.5ml injection

2 PV

PNEUMOVAX 23 INJECTABLE 25 MCG/0.5ML INJECTION

2 PV

PREVNAR 13 2 PV

PROQUAD 2 PV

QUADRACEL 2 PV

RECOMBIVAX HB 2 PV

ROTARIX 2 PV

ROTATEQ 2 PV

SHINGRIX 2 PV


56


TDVAX 2 PV

TENIVAC 2 PV

TRUMENBA 2 PV

TWINRIX 2 PV

VAQTA 2 PV

VARIVAX 2 PV

ZOSTAVAX 2 PV

Inflammatory Bowel Disease Agents

Aminosalicylates

APRISO 2

balsalazide disodium 1

DIPENTUM 3

mesalamine oral capsule delayed release

1

mesalamine oral tablet delayed release 1.2 gm

1

mesalamine rectal 1

mesalamine-cleanser 1

PENTASA 3

Glucocorticoids

budesonide er 1

budesonide oral 1

Sulfonamides

sulfasalazine oral 1

Metabolic Bone Disease Agents

alendronate sodium oral solution

1

alendronate sodium oral tablet 10 mg, 40 mg, 5 mg

1

alendronate sodium oral tablet 35 mg, 70 mg

1 QL

calcitonin (salmon) 1 QL


calcitriol intravenous 1

calcitriol oral 1

cinacalcet hcl 1 PA

doxercalciferol intravenous

1

etidronate disodium 1

FORTEO 4 PA

FOSAMAX PLUS D 3 QL

ibandronate sodium 1 QL

MIACALCIN INJECTION

3

pamidronate disodium 4

paricalcitol 1

PROLIA 4 PA; QL

risedronate sodium oral tablet 150 mg, 35 mg

1 QL

risedronate sodium oral tablet 30 mg, 5 mg

1

risedronate sodium oral tablet delayed release

1 QL

zoledronic acid 4

Miscellaneous Therapeutic Agents

albumin human 1

albumin-zlb 1

alburx 1

alcohol prep pads pad , 70 %

3

argyle sterile water 1

bal in oil 1

BD AUTOSHIELD DUO PEN NEEDLES

2

bd posiflush 1

BD ULTRA-FINE INSULIN SYRINGES

2

BD ULTRA-FINE PEN NEEDLES

2


57


benzalkonium chloride external solution

1

BREATHE EASE LARGE

2

BREATHE EASE MEDIUM

2

BREATHE EASE SMALL

2

BREATHERITE 2

CAYA 3 PV; QL

chlorhexidine gluconate solution 20 %

1

COMFORT EZ MICRO PEN NEEDLES

2

COMFORT EZ SHORT PEN NEEDLES

2

deferoxamine mesylate 1

DROPSAFE SAFETY PEN NEEDLES 31G X 8 MM

2

EASIVENT 2

EASY TOUCH SAFETY PEN NEEDLES

2

FEMCAP 3 PV; QL

FLEXICHAMBER ADULT MASK/SMALL

2

FLEXICHAMBER CHILD MASK/LARGE

2

FLEXICHAMBER CHILD MASK/SMALL

2

fomepizole 1

GOODSENSE CLICKFINE PEN NEEDLE

2

GOODSENSE PEN NEEDLE PENFINE

2

HEALTHWISE INSULIN SYR/NEEDLE

2


HEALTHWISE MICRON PEN NEEDLES

2

heparin lock flush 1

heparin sodium flush 1

heparin sodium lock flush

1

hepatamine 1

hetastarch-nacl 1

INSPIREASE RESERVOIR BAGS

2

INSULIN PEN NEEDLES

2

INSULIN SYRINGES 2

intralipid intravenous emulsion 20 %

1

J-TIP KIT W/VIALADAPTERS

3

kedbumin 1

KEVEYIS 4 PA; QL

lactated ringers irrigation

1

levocarnitine oral solution

1

levocarnitine oral tablet 1

lmd in d5w 1

MASK VORTEX 2

MAXICOMFORT II PEN NEEDLE

2

MAXI-COMFORT SAFETY PEN NEEDLE

2

MAXICOMFORT SYR 27G X 1/2"

2

methergine 1

methylergonovine maleate

1

monoject flush syringe 1


58


monoject sodium chloride flush

1

n-acetyl-l-cysteine oral 1

normal saline flush 1

NOVOFINE AUTOCOVER PEN NEEDLE

2

NOVOFINE PEN NEEDLE

2

NOVOFINE PLUS PEN NEEDLE

2

NOVOTWIST PEN NEEDLE

2

nutrilipid 1

PANDA MASK LARGE 2

PANDA MASK MEDIUM

2

PANDA MASK SMALL 2

PARAGARD INTRAUTERINE COPPER

3 PV

PEDIATRIC PANDA MASK

2

pocket spacer 1

pralidoxime chloride intramuscular

1

PREVENT SAFETY PEN NEEDLES

2

PRO COMFORT SPACER ADULT

2

PRO COMFORT SPACER CHILD

2

PROCARE SPACER/ADULT MASK

2

PROCARE SPACER/CHILD MASK

2

ringers irrigation 1

saline flush 1


saline flush zr 1

SAPS HEALTH CARE ALCOHOL PREP

3

sash kit 1

SECURESAFE INSULIN SYRINGE

2

sodium chloride flush 1

sodium nitrite intravenous

1

sodium thiosulfate intravenous

1

sterile water for irrigation

1

swabflush saline flush 1

tis-u-sol 1

TRUE COMFORT ALCOHOL PREP PADS

3

TRUEPLUS 5-BEVEL PEN NEEDLES

2

ULTRACARE PEN NEEDLES

2

VISTOGARD 3

WIDE-SEAL DIAPHRAGM 60

3 PV; QL

Ophthalmic Agents

Aminoglycosides

gentak 1

gentamicin sulfate ophthalmic

1

neomycin-polymyxin-gramicidin

1

TOBRADEX OPHTHALMIC OINTMENT

3

TOBRADEX ST 3

tobramycin ophthalmic 1

tobramycin-dexamethasone

1


59


TOBREX OPHTHALMIC OINTMENT

3

Antibacterials, Other

ak-poly-bac 1

bacitracin ophthalmic 1

bacitracin-polymyxin b ophthalmic

1

bacitra-neomycin-polymyxin-hc

1

neomycin-bacitracin zn-polymyx

1

neomycin-polymyxin-dexameth ophthalmic ointment

1

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

1

neomycin-polymyxin-hc ophthalmic

1

neo-polycin 1

neo-polycin hc 1

polycin 1

polymyxin b-trimethoprim

1

Anti-cytomegalovirus (CMV) Agents

ZIRGAN 3

Antifungals

NATACYN 2

Antiherpetic Agents

trifluridine 1

Macrolides

AZASITE 3

erythromycin ophthalmic

1


Ophthalmic Prostaglandin and Prostamide Analogs

bimatoprost ophthalmic 1 QL

latanoprost ophthalmic 1

LUMIGAN 2 QL

TRAVATAN Z 2 QL

Ophthalmic Agents, Other

altacaine 1

atropine sulfate ophthalmic ointment

1

atropine sulfate ophthalmic solution

1

cyclopentolate hcl ophthalmic

1

CYSTARAN 4 PA; QL

homatropaire 1

homatropine hbr 1

OMIDRIA 3

proparacaine hcl ophthalmic

1

RESTASIS 2 PA

RESTASIS MULTIDOSE OPHTHALMIC EMULSION 0.05 %

2 PA

tetcaine 1

tetracaine hcl ophthalmic

1

tropicamide ophthalmic solution 0.5 %

1

XIIDRA 2 PA

Ophthalmic Anti-allergy Agents

ALOCRIL 3

ALOMIDE 3

altafrin 1


60


azelastine hcl ophthalmic

1

BEPREVE 3 ST

cromolyn sodium ophthalmic

1

epinastine hcl 1

LASTACAFT 3 ST

olopatadine hcl ophthalmic

1

PAZEO 2

phenylephrine hcl ophthalmic

1

Ophthalmic Antiglaucoma Agents

acetazolamide er 1

acetazolamide oral 1

acetazolamide sodium 1

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %

2

apraclonidine hcl 1

AZOPT 2

betaxolol hcl ophthalmic

1

BETIMOL 3

brimonidine tartrate ophthalmic

1

carteolol hcl 1

COMBIGAN 2

dorzolamide hcl ophthalmic

1

dorzolamide hcl-timolol mal

1

dorzolamide hcl-timolol mal pf ophthalmic solution 22.3-6.8 mg/ml

1

IOPIDINE 3

levobunolol hcl 1


methazolamide oral 1

PHOSPHOLINE IODIDE

2

pilocarpine hcl ophthalmic

1

RHOPRESSA 2

SIMBRINZA 2

timolol maleate ophthalmic

1

Ophthalmic Anti-inflammatories

bromfenac sodium (once-daily)

1 QL

dexamethasone sodium phosphate ophthalmic

1

diclofenac sodium ophthalmic

1

DUREZOL 3

FLAREX 3

fluorometholone 1

flurbiprofen sodium 1

FML 2

ketorolac tromethamine ophthalmic

1

LOTEMAX SM 3

loteprednol etabonate 1

NEVANAC 3 ST; QL

PRED MILD 2

prednisolone acetate ophthalmic

1

prednisolone sodium phosphate ophthalmic

1

PROLENSA 2 QL

sulfacetamide-prednisolone ophthalmic solution

1


61


Quinolones

BESIVANCE 3

ciprofloxacin hcl ophthalmic

1

gatifloxacin ophthalmic 1

levofloxacin ophthalmic 1

MOXEZA 2

moxifloxacin hcl ophthalmic

1

ofloxacin ophthalmic 1

Sulfonamides

sulfacetamide sodium ophthalmic

1

Otic Agents

acetic acid otic 1

CIPRO HC 3

CIPRODEX 2

ciprofloxacin hcl otic 1

COLY-MYCIN S 3

flac 1

fluocinolone acetonide otic

1

hydrocortisone-acetic acid

1

neomycin-polymyxin-hc otic

1

ofloxacin otic 1

Respiratory Tract/Pulmonary Agents

Antihistamines

azelastine hcl nasal 1 QL

brompheniramine tannate

1

carbinoxamine maleate oral solution

1

carbinoxamine maleate oral tablet 4 mg

1


cetirizine hcl oral solution

1

clemastine fumarate oral tablet 2.68 mg

3

cyproheptadine hcl oral 1

desloratadine 1

dexchlorpheniramine maleate oral

3

diphenhydramine hcl injection

1

diphenhydramine hcl oral elixir

1

hydroxyzine hcl intramuscular

1

hydroxyzine hcl oral 1

hydroxyzine pamoate oral

1

levocetirizine dihydrochloride oral

1

olopatadine hcl nasal 1 QL

ryvent 1

TUZISTRA XR 3 PA; QL

Anti-inflammatories, Inhaled Corticosteroids

ADVAIR HFA 2 QL

ARNUITY ELLIPTA 2 QL

BECONASE AQ 3 QL

BREO ELLIPTA 2 QL

budesonide inhalation 1 QL

DYMISTA 2 QL

FLOVENT DISKUS 2 QL

FLOVENT HFA 2 QL

flunisolide nasal 1 QL

fluticasone propionate nasal

1


62


fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose

1 QL

FLUTICASONE-SALMETEROL INHALATION AEROSOL POWDER BREATH ACTIVATED 113-14 MCG/ACT, 232-14 MCG/ACT, 55-14MCG/ACT

1 QL

mometasone furoate nasal

1 QL

OMNARIS 3 QL

PULMICORT FLEXHALER

2 QL

SYMBICORT 2 QL

wixela inhub 1 QL

Antileukotrienes

montelukast sodium oral

1

zafirlukast 1

zileuton er 3 ST

Bronchodilators, Anticholinergic

ANORO ELLIPTA 2 QL

ATROVENT HFA 3 QL

COMBIVENT RESPIMAT

2 QL

INCRUSE ELLIPTA 2 QL

ipratropium bromide inhalation

1 QL

ipratropium bromide nasal

1

ipratropium-albuterol 1 QL


SPIRIVA HANDIHALER

2 QL

SPIRIVA RESPIMAT 2 QL

STIOLTO RESPIMAT 2 QL

Bronchodilators, Sympathomimetic

albuterol sulfate er 1

albuterol sulfate inhalation

1 QL

albuterol sulfate oral 1

AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.1 MG/0.1ML

3 QL

BROVANA 3 QL

EPINEPHRINE INJECTION SOLUTION 0.3 MG/0.3ML

1

EPINEPHRINE INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.15ML

1

EPINEPHRINE INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML

1 Made by Mylan

EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML INJECTION

1 Made by Mylan

epinephrine solution auto-injector 0.3 mg/0.3ml injection

1

isoproterenol hcl injection

1

levalbuterol hcl inhalation

1 QL


63


metaproterenol sulfate oral

1

PERFOROMIST 3 QL

PROAIR HFA 2 M; QL

PROAIR RESPICLICK 2 QL

SEREVENT DISKUS 2 QL

terbutaline sulfate injection

1

terbutaline sulfate oral 1

VENTOLIN HFA 2 M; QL

Cystic Fibrosis Agents

BETHKIS 4

CAYSTON 4 PA

KALYDECO 4 PA

ORKAMBI 4 PA; QL

PULMOZYME 4 PA

tobramycin inhalation 4 ST

Mast Cell Stabilizers

cromolyn sodium inhalation

1

Phosphodiesterase Inhibitors, Airways Disease

aminophylline intravenous

1

DALIRESP ORAL TABLET 500 MCG

3 PA

difil-g forte 1

ELIXOPHYLLIN 2

THEO-24 3

theochron 1

theophylline 1

theophylline er 1

theophylline in d5w 1


Pulmonary Antihypertensives

ADEMPAS 4 PA; QL

alyq 4 PA; QL

ambrisentan 4 PA; QL

bosentan 4 PA; QL

epoprostenol sodium 4 PA

OPSUMIT 4 PA; QL

ORENITRAM 4 PA

sildenafil citrate intravenous

4 PA

sildenafil citrate oral suspension reconstituted

4 PA; QL

sildenafil citrate oral tablet 20 mg

4 PA; QL

tadalafil (pah) 4 PA; QL

TRACLEER 32 MG 4 PA; QL

treprostinil 4 PA; QL

TYVASO 4 PA; QL

TYVASO REFILL 4 PA; QL

TYVASO STARTER 4 PA; QL

UPTRAVI 4 PA; QL

VELETRI 4 PA

VENTAVIS 4 PA; QL

Pulmonary Fibrosis Agents

ESBRIET 4 PA

OFEV 4 PA

Respiratory Tract Agents, Other

acetylcysteine inhalation

1

acetylcysteine intravenous

1

ARALAST NP 4 PA

benzonatate 1


64


DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/1.14ML

4 PA; QL

GLASSIA 4 PA

hydrocodone-homatropine

1 PA; QL

hydromet 1 PA; QL

nebusal inhalation nebulization solution 3 %

1

NUCALA SUBCUTANEOUS SOLUTION RECONSTITUTED

4 PA; QL

PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED

4 PA

pulmosal 1

sodium chloride inhalation

1

XOLAIR 4 PA

ZEMAIRA 4 PA

Skeletal Muscle Relaxants

atracurium besylate 1

carisoprodol oral 1

chlorzoxazone 1

cisatracurium besylate (pf)

1

cisatracurium besylate intravenous solution 20 mg/10ml

1

cyclobenzaprine hcl er oral capsule extended release 24 hour 15 mg

1

cyclobenzaprine hcl oral

1


metaxall oral tablet 800 mg

1

metaxalone 1

methocarbamol injection

1

methocarbamol oral 1

orphenadrine citrate er 1

orphenadrine citrate injection

1

pancuronium bromide 1

rocuronium bromide intravenous solution

1

succinylcholine chloride injection solution

1

vecuronium bromide intravenous solution reconstituted

1

Sleep Disorder Agents

GABA Receptor Modulators

eszopiclone 1 QL

flurazepam hcl 1 PA; QL

zaleplon 1 QL

zolpidem tartrate oral 1 QL

Sleep Disorders, Other

armodafinil 1 PA; QL

BELSOMRA 3 ST; QL

dexmedetomidine hcl in nacl

1

dexmedetomidine hcl intravenous solution 200 mcg/2ml

1

HETLIOZ 4 PA; QL

modafinil 1 PA; QL

pentobarbital sodium injection

1


65


ramelteon 1 QL

SILENOR 3 QL


66

Index of Drugs

abacavir sulfate.........................29abacavir sulfate-lamivudine...... 29abacavir-lamivudine-zidovudine.................................29ABELCET..................................21ABILIFY MAINTENA................. 27abiraterone acetate................... 23ABRAXANE.............................. 23acamprosate calcium................ 14acarbose................................... 31ACCU-CHEK FASTCLIX LANCET KIT............................. 30ACCU-CHEK FASTCLIX LANCETS................................. 30ACCU-CHEK MULTICLIX LANCET DEVICE KIT...............30ACCU-CHEK MULTICLIX LANCETS................................. 30ACCU-CHEK SOFT TOUCH LANCETS................................. 30ACCU-CHEK SOFTCLIX LANCET DEVICE KIT...............30ACCU-CHEK SOFTCLIX LANCETS................................. 30acd formula a............................ 32acd formula b............................ 32acd-a noclot-50......................... 32acebutolol hcl............................ 35acetaminophen-codeine............12acetaminophen-codeine #2.......12acetaminophen-codeine #3.......12acetaminophen-codeine #4.......12acetazolamide...........................61acetazolamide er.......................61acetazolamide sodium.............. 61acetic acid........................... 46, 62acetylcysteine........................... 64acitretin..................................... 39ACTEMRA................................ 56ACTEMRA ACTPEN.................56ACTHAR................................... 49ACTHIB.....................................56ACTIMMUNE............................ 56acyclovir.................................... 28acyclovir sodium....................... 28ADACEL....................................56adapalene................................. 39adapalene-benzoyl peroxide.....39adc/f (0.5mg/ml)........................ 42ADCETRIS................................26adefovir dipivoxil ....................... 28ADEMPAS................................ 64adenosine................................. 35

adriamycin.................................23adrucil ....................................... 23ADVAIR HFA............................ 62ADVATE....................................33AFINITOR................................. 25AFINITOR DISPERZ.................25afirmelle.................................... 50AFLURIA...................................56AFLURIA PRESERVATIVE FREE........................................ 56AFLURIA QUADRIVALENT......56airavite...................................... 42ak-poly-bac............................... 60AKYNZEO.................................20ala-cort...................................... 47albendazole...............................26albumin human......................... 57albumin-zlb................................57alburx........................................ 57albuterol sulfate.........................63albuterol sulfate er.................... 63alclometasone dipropionate...... 47alcohol prep pads......................57ALDURAZYME......................... 46alendronate sodium.................. 57alfentanil hcl.............................. 12ALFERON N............................. 56alfuzosin hcl er.......................... 46ALIMTA..................................... 23ALINIA.......................................26aliskiren fumarate......................36allopurinol..................................21allopurinol sodium..................... 21almotriptan malate.................... 22ALOCRIL...................................60ALOMIDE..................................60alosetron hcl..............................45ALPHAGAN P........................... 61alprazolam................................ 30alprazolam er............................ 30alprazolam xr............................ 30alprostadil ..................................49ALTABAX..................................15altacaine....................................60altafrin....................................... 60altavera..................................... 50alyacen 1/35..............................50alyacen 7/7/7.............................50alyq........................................... 64amabelz.................................... 50amantadine hcl..........................30AMBISOME...............................21ambrisentan.............................. 64

amcinonide................................47amethia..................................... 50amethia lo................................. 50amethyst................................... 50amikacin sulfate........................ 15amiloride hcl..............................37amiloride-hydrochlorothiazide... 37aminoacetic acid....................... 46aminocaproic acid..................... 33aminophylline............................ 64amiodarone hcl......................... 35AMITIZA....................................45amitriptyline hcl......................... 20amlodipine besylate.................. 36amlodipine besylate-benazepril hcl............................................. 35amlodipine besylate-valsartan.. 34amlodipine-atorvastatin.............36amlodipine-olmesartan..............34amlodipine-valsartan-hctz......... 34ammonium lactate.....................39amnesteem............................... 39amoxapine................................ 20amoxicill-clarithro-lansopraz..... 44amoxicillin................................. 17amoxicillin-potassium clavulanate................................17amoxicillin-potassium clavulanate er............................17amphetamine sulfate.................38amphetamine-dextroamphetamine.................. 38amphetamine-dextroamphetamine er.............. 38amphotericin b.......................... 21ampicillin................................... 17ampicillin sodium.......................17ampicillin-sulbactam sodium..... 17ANADROL-50........................... 49anagrelide hcl............................33anastrozole............................... 24ANNOVERA..............................50ANORO ELLIPTA..................... 63anticoagulant cit dext soln a......33anticoagulant sodium citrate..... 33ANZEMET.................................20apap-caff-dihydrocodeine......... 12APLENZIN................................ 19APOKYN................................... 27apraclonidine hcl....................... 61aprepitant.................................. 21apri............................................ 50APRISO.................................... 57

67

APTIVUS...................................29ARALAST NP............................64aranelle..................................... 50ARANESP (ALBUMIN FREE)...33argatroban.................................33argyle sterile saline................... 46argyle sterile water....................57aripiprazole............................... 27armodafinil ................................ 65ARMOUR THYROID.................53ARNUITY ELLIPTA...................62ARRANON................................ 23arsenic trioxide..........................23ARZERRA.................................26ascomp-codeine........................12ashlyna......................................50aspirin....................................... 11aspirin adult...............................11aspirin adult low strength.......... 11aspirin childrens........................ 11aspirin ec low dose................... 11aspirin ec low strength.............. 11aspirin low dose........................ 11aspirin-dipyridamole er..............34atazanavir sulfate......................29atenolol..................................... 35atenolol-chlorthalidone..............35atomoxetine hcl.........................38atorvastatin calcium.................. 37atovaquone............................... 26atovaquone-proguanil hcl..........26atracurium besylate...................65ATRIPLA................................... 29atropine sulfate................... 44, 60ATROVENT HFA...................... 63aubra.........................................50aubra eq....................................50AUGMENTIN............................ 17aurovela 1.5/30......................... 50aurovela 1/20............................ 50aurovela 24 fe........................... 50aurovela fe 1.5/30..................... 50aurovela fe 1/20........................ 50AUVI-Q......................................63AVASTIN...................................26AVELOX....................................17aviane....................................... 50avidoxy......................................17avita.......................................... 39AVONEX PEN...........................39AVONEX PREFILLED.............. 39ayuna........................................ 50azacitidine................................. 23

AZASAN....................................54AZASITE................................... 60azathioprine.............................. 54azathioprine sodium..................54azelaic acid............................... 39azelastine hcl...................... 61, 62AZELEX.................................... 40azithromycin..............................17AZOPT...................................... 61aztreonam................................. 17azurette..................................... 50b-6 folic acid..............................42baciim........................................15bacitracin.............................15, 60bacitracin-polymyxin b.............. 60bacitra-neomycin-polymyxin-hc 60baclofen.................................... 28bal in oil .....................................57balsalazide disodium.................57balziva.......................................50BANZEL.................................... 19BARACLUDE............................ 28BAVENCIO............................... 26BAXDELA................................. 17bayer aspirin............................. 11bayer aspirin ec low dose......... 11BD AUTOSHIELD DUO PEN NEEDLES................................. 57bd posiflush...............................57bd pudendal/local tray/1% lido.. 13BD ULTRA-FINE INSULIN SYRINGES............................... 57BD ULTRA-FINE PEN NEEDLES................................. 57BECONASE AQ........................62bekyree..................................... 50BELEODAQ.............................. 23BELSOMRA.............................. 65benazepril hcl............................35benazepril-hydrochlorothiazide. 35BENEFIX...................................33benzalkonium chloride.............. 58BENZNIDAZOLE...................... 26benzonatate.............................. 64benzoyl peroxide-erythromycin. 40benztropine mesylate................26BEPREVE................................. 61BERINERT................................54beser......................................... 47BESIVANCE............................. 62betamethasone dipropionate.... 47betamethasone dipropionate aug............................................ 47

betamethasone sod phos & acet........................................... 47betamethasone valerate........... 47BETASERON............................39betaxolol hcl........................ 35, 61bethanechol chloride.................46BETHKIS...................................64BETIMOL.................................. 61BEVYXXA................................. 33bexarotene................................ 26BEXSERO.................................56bicalutamide..............................23BICILLIN L-A.............................17BIKTARVY................................ 28bimatoprost............................... 60biocel.........................................43bisacodyl ec.............................. 45bisoprolol fumarate................... 36bisoprolol-hydrochlorothiazide.. 36bivalirudin trifluoroacetate......... 33BIVIGAM................................... 55bleomycin sulfate...................... 23BLINCYTO................................ 26blisovi 24 fe............................... 50blisovi fe 1.5/30......................... 50BOOSTRIX............................... 56bosentan................................... 64BOSULIF...................................25BOTOX..................................... 28bp vit 3...................................... 43b-plex........................................ 43b-plex plus.................................43BREATHE EASE LARGE......... 58BREATHE EASE MEDIUM.......58BREATHE EASE SMALL..........58BREATHERITE.........................58BREO ELLIPTA........................ 62briellyn.......................................50BRILINTA..................................34brimonidine tartrate................... 61BRIVIACT................................. 18bromfenac sodium (once-daily).61bromocriptine mesylate.............27brompheniramine tannate......... 62BROVANA................................ 63budesonide......................... 57, 62budesonide er........................... 57bumetanide............................... 37bupivacaine hcl......................... 13bupivacaine hcl (pf)...................13bupivacaine in dextrose............ 13bupivacaine spinal.................... 13bupivacaine-epinephrine...........13

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bupivacaine-epinephrine (pf).... 13buprenorphine...........................12BUPRENORPHINE...................12buprenorphine hcl............... 12, 14buprenorphine hcl-naloxone hcl............................................. 14bupropion hcl............................ 19bupropion hcl er (smoking det). 14bupropion hcl er (sr)..................19bupropion hcl er (xl).................. 19buspirone hcl.............................30busulfan.................................... 22butalbital-acetaminophen..........11butalbital-apap.......................... 11butalbital-apap-caff-cod............ 12butalbital-apap-caffeine.............11butalbital-asa-caff-codeine........12butalbital-aspirin-caffeine.......... 11butorphanol tartrate.............12, 13BUTRANS.................................12BYDUREON..............................31BYDUREON BCISE AUTOINJECTOR...................... 31BYETTA 10 MCG PEN............. 31BYETTA 5 MCG PEN............... 31BYSTOLIC................................ 36cabergoline............................... 49CABLIVI.................................... 34CABOMETYX........................... 25caffeine citrate...........................39calcipotriene..............................40calcitonin (salmon).................... 57calcitriol............................... 40, 57calcium acetate (phos binder)...47calcium chloride........................ 41calcium gluconate..................... 41camila........................................52CAMPTOSAR........................... 24camrese.................................... 50camrese lo................................ 50candesartan cilexetil ................. 34candesartan cilexetil-hctz..........34CAPASTAT SULFATE..............22capecitabine..............................23CAPRELSA...............................25captopril .................................... 35captopril-hydrochlorothiazide.... 35CARAFATE...............................45CARBAGLU.............................. 46carbamazepine......................... 19carbamazepine er..................... 19carbidopa.................................. 27carbidopa-levodopa.................. 27

carbidopa-levodopa er.............. 27carbidopa-levodopa-entacapone............................... 27carbinoxamine maleate.............62carboplatin................................ 22carboprost tromethamine.......... 49CARDIZEM LA..........................36CARIMUNE NF......................... 55carimune nf............................... 55carisoprodol.............................. 65carmustine................................ 22carteolol hcl...............................61cartia xt..................................... 36carvedilol...................................36carvedilol phosphate er.............36cascara sagrada....................... 45caspofungin acetate..................21cavarest.................................... 39CAYA........................................ 58CAYSTON.................................64caziant.......................................50cefaclor..................................... 16cefaclor er................................. 16cefadroxil ...................................16cefazolin sodium....................... 16cefazolin sodium-dextrose........ 16cefdinir...................................... 16cefditoren pivoxil ....................... 16cefepime hcl..............................16cefepime-dextrose.................... 16cefixime.....................................16cefotaxime sodium.................... 16cefotetan disodium....................16cefotetan disodium-dextrose.....16cefoxitin sodium........................ 16cefpodoxime proxetil ................. 16cefprozil .....................................16ceftazidime................................16ceftazidime and dextrose.......... 16ceftriaxone sodium....................16ceftriaxone sodium in dextrose. 16ceftriaxone sodium-dextrose.....16cefuroxime axetil ....................... 16cefuroxime sodium....................16celecoxib................................... 11CELONTIN................................18cephalexin.................................16CEPROTIN............................... 33CERDELGA.............................. 46CEREZYME.............................. 46cetirizine hcl.............................. 62cevimeline hcl........................... 39CHANTIX.................................. 14

CHANTIX CONTINUING MONTH PAK.............................14CHANTIX STARTING MONTH PAK...........................................14chateal...................................... 50chateal eq................................. 50CHEMET...................................42CHEMSTRIP UGK.................... 30chloramphenicol sod succinate.15chlordiazepoxide hcl................. 30chlordiazepoxide-amitriptyline...20chlorhexidine gluconate...... 39, 58chloroprocaine hcl (pf).............. 14chloroquine phosphate..............26chlorothiazide............................37chlorothiazide sodium............... 37chlorpromazine hcl....................27chlorthalidone............................37chlorzoxazone...........................65CHOLBAM................................ 44cholestyramine..........................38cholestyramine light.................. 38choline fenofibrate.....................37chorionic gonadotropin..............49chromagen................................ 41chromic chloride........................41ciclodan.....................................21ciclopirox................................... 21ciclopirox olamine..................... 21cidofovir.....................................28cilostazol................................... 34CIMDUO................................... 29cimetidine..................................44cimetidine hcl............................ 44CIMZIA......................................54CIMZIA PREFILLED KIT...........54CIMZIA STARTER KIT............. 54cinacalcet hcl............................ 57CINRYZE.................................. 54CIPRO.......................................17CIPRO HC................................ 62CIPRODEX............................... 62ciprofloxacin.............................. 17ciprofloxacin hcl.................. 17, 62ciprofloxacin in d5w...................17cisatracurium besylate.............. 65cisatracurium besylate (pf)........65cisplatin..................................... 22citalopram hydrobromide.......... 19cladribine...................................23claravis......................................40clarithromycin............................17clarithromycin er........................17

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clearlax......................................45clemastine fumarate..................62clindacin etz.............................. 40clindacin-p.................................40clindamycin hcl..........................15clindamycin palmitate hcl.......... 15clindamycin phosphate....... 15, 40clindamycin phosphate in d5w.. 15clindamycin phosphate-benzoyl peroxide.......................40clindamycin-tretinoin................. 40clinpro 5000.............................. 39clobazam...................................18clobetasol prop emollient base. 47clobetasol propionate................47clobetasol propionate e.............47clobetasol propionate emulsion 47clodan....................................... 47clofarabine................................ 23clomipramine hcl....................... 20clonazepam...............................18clonidine....................................34clonidine hcl.............................. 34clonidine hcl er.......................... 38clopidogrel bisulfate.................. 34clorazepate dipotassium........... 30clotrimazole...............................21clotrimazole-betamethasone.....21clozapine...................................28COAGADEX..............................33coal tar...................................... 40COARTEM................................ 26cod liver oil ................................ 43codeine sulfate..........................13COLCHICINE............................21colchicine-probenecid............... 21COLCRYS.................................22colesevelam hcl........................ 38colestipol hcl............................. 38colistimethate sodium (cba)...... 15colocort..................................... 40COLY-MYCIN S........................ 62COMBIGAN.............................. 61COMBIPATCH.......................... 50COMBIVENT RESPIMAT......... 63COMETRIQ (100 MG DAILY DOSE).......................................25COMETRIQ (140 MG DAILY DOSE).......................................25COMETRIQ (60 MG DAILY DOSE).......................................25COMFORT EZ MICRO PEN NEEDLES................................. 58

COMFORT EZ SHORT PEN NEEDLES................................. 58COMPLERA..............................29compro...................................... 20CONDYLOX..............................40constulose.................................45COPAXONE..............................39CORDRAN................................47CORIFACT................................33CORTIFOAM............................ 40cortisone acetate.......................47CORTISPORIN......................... 15corvita....................................... 43corvita 150................................ 41corvite free................................ 43COSENTYX (300 MG DOSE)...40COSENTYX 150 MG/ML.......... 40COSENTYX SENSOREADY (300 MG)...................................40COSENTYX SENSOREADY PEN...........................................40COTELLIC................................ 23CREON..................................... 46CRESEMBA..............................21CRIXIVAN................................. 29cromolyn sodium...........44, 61, 64crotan........................................ 26cryselle-28.................................50CUVITRU.................................. 55CUVPOSA................................ 44cyanocobalamin........................ 43cyclafem 1/35............................50cyclafem 7/7/7...........................50cyclobenzaprine hcl.................. 65cyclobenzaprine hcl er.............. 65cyclopentolate hcl..................... 60cyclophosphamide.................... 22cycloserine................................ 22CYCLOSET...............................31cyclosporine.............................. 54cyclosporine modified............... 54cyproheptadine hcl....................62CYRAMZA................................ 26cyred......................................... 50cyred eq.................................... 50CYSTADANE............................ 46CYSTAGON..............................46CYSTARAN.............................. 60cytarabine................................. 23cytarabine (pf)........................... 23CYTOGAM................................55dacarbazine.............................. 22dactinomycin............................. 23

dalfampridine er........................ 39DALIRESP................................ 64danazol..................................... 49dantrolene sodium.................... 28dapsone.............................. 22, 40DAPTACEL............................... 56daptomycin................................15DARAPRIM............................... 26darifenacin hydrobromide er..... 46DARZALEX............................... 26dasetta 1/35.............................. 50dasetta 7/7/7............................. 50daunorubicin hcl........................23daysee...................................... 50DAYTRANA.............................. 38DEBACTEROL..........................39deblitane................................... 52decara....................................... 43decitabine..................................23deferasirox................................ 42deferoxamine mesylate.............58dehydrated alcohol....................41deltasone.................................. 47delyla.........................................50demeclocycline hcl....................17DEMSER...................................36denta 5000 plus........................ 39dentagel.................................... 39DEPEN TITRATABS.................42DEPO-MEDROL....................... 47DEPO-PROVERA..................... 53DEPO-SUBQ PROVERA 104...53DESCOVY................................ 29desipramine hcl.........................20desloratadine............................ 62desmopressin ace spray refrig..49desmopressin acetate...............49desmopressin acetate spray..... 49desogestrel-ethinyl estradiol..... 50desonide................................... 47desoximetasone........................47desvenlafaxine succinate er......19dexamethasone........................ 47DEXAMETHASONE INTENSOL................................ 47dexamethasone sod phosphate pf............................. 48dexamethasone sodium phosphate........................... 48, 61dexchlorpheniramine maleate...62dexifol........................................43DEXILANT................................ 45dexmedetomidine hcl................ 65

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dexmedetomidine hcl in nacl.....65dexmethylphenidate hcl............ 38dexmethylphenidate hcl er........ 38dexrazoxane............................. 23dexrazoxane hcl........................23dextroamphetamine sulfate.......38dextroamphetamine sulfate er.. 38dextrose.................................... 41dextrose in lactated ringers.......41dextrose-nacl............................ 41dialyvite..................................... 43diazepam............................ 18, 30diazepam intensol..................... 30diclofenac potassium................ 11diclofenac sodium......... 11, 24, 61diclofenac sodium er................. 11diclofenac-misoprostol.............. 11dicloxacillin sodium................... 17dicyclomine hcl..........................44didanosine.................................29DIFICID..................................... 17difil-g forte................................. 64diflunisal.................................... 11digitek........................................36digox......................................... 36digoxin.......................................36dihydroergotamine mesylate.....22DILANTIN..................................19DILATRATE-SR........................ 38diltiazem hcl.............................. 36diltiazem hcl er.......................... 36diltiazem hcl er beads............... 36diltiazem hcl er coated beads... 36dilt-xr......................................... 36dimenhydrinate......................... 20DIPENTUM............................... 57diphenhydramine hcl.................62diphenoxylate-atropine..............44DIPHTHERIA-TETANUS TOXOIDS DT............................ 56dipyridamole..............................34disopyramide phosphate...........35disulfiram...................................14divalproex sodium..................... 18divalproex sodium er.................18DIVIGEL....................................50dobutamine hcl..........................36dobutamine in d5w....................37docetaxel...................................24dofetilide....................................35donepezil hcl............................. 19dopamine hcl.............................37dopamine in d5w.......................37

dorzolamide hcl.........................61dorzolamide hcl-timolol mal...... 61dorzolamide hcl-timolol mal pf.. 61dotti ........................................... 50doxazosin mesylate.................. 46doxepin hcl..........................20, 40doxercalciferol...........................57doxorubicin hcl.......................... 24doxorubicin hcl liposomal..........24doxy 100................................... 18doxycycline............................... 40doxycycline hyclate................... 18doxycycline monohydrate......... 18doxylamine-pyridoxine.............. 20dronabinol................................. 21droperidol.................................. 20DROPSAFE SAFETY PEN NEEDLES................................. 58drospiren-eth estrad-levomefol. 50drospirenone-ethinyl estradiol...50DROXIA.................................... 23DUAVEE................................... 50duloxetine hcl............................ 19DUPIXENT..........................40, 65duramorph.................................13duraxin...................................... 11DUREZOL.................................61dutasteride................................ 46dutasteride-tamsulosin hcl........ 46DYMISTA.................................. 62DYRENIUM...............................37EASIVENT................................ 58EASY TOUCH SAFETY PEN NEEDLES................................. 58easygel......................................39ec-naproxen.............................. 11econazole nitrate.......................21ed-spaz..................................... 44EDURANT.................................29efavirenz................................... 29effer-k........................................41ELAPRASE............................... 46eletriptan hydrobromide............ 22elinest........................................50ELIQUIS....................................33ELIQUIS STARTER PACK....... 33ELITEK......................................23ELIXOPHYLLIN........................ 64ELLA......................................... 52ELMIRON..................................46ELOCTATE............................... 33EMBEDA...................................12EMCYT..................................... 23

emoquette................................. 50EMPLICITI................................ 26EMSAM.....................................19EMTRIVA.................................. 29EMVERM.................................. 26enalapril maleate.......................35enalaprilat................................. 35enalapril-hydrochlorothiazide.... 35ENBREL....................................54ENBREL MINI........................... 54ENBREL SURECLICK.............. 54endocet..................................... 13ENGERIX-B.............................. 56enoxaparin sodium....................33enpresse-28.............................. 50enskyce.....................................50entacapone............................... 27entecavir................................... 28ENTRESTO.............................. 37enulose..................................... 45EPCLUSA................................. 28ephedrine sulfate...................... 37EPIDUO FORTE....................... 40epinastine hcl............................ 61EPINEPHRINE..........................63epinephrine............................... 63epinephrine pf........................... 37epirubicin hcl............................. 24epitol......................................... 19EPIVIR HBV..............................28eplerenone................................ 37epoprostenol sodium.................64eprosartan mesylate................. 34eptifibatide.................................34ERBITUX.................................. 26ergocalciferol.............................43ergoloid mesylates.................... 19ergotamine-caffeine.................. 22ERIVEDGE............................... 25erlotinib hcl................................25errin...........................................53ertapenem sodium.................... 17ERWINAZE............................... 24ery............................................. 40erythromycin....................... 40, 60erythromycin base.....................17erythromycin ethylsuccinate......17ESBRIET...................................64escitalopram oxalate................. 19esmolol hcl................................ 36esmolol hcl-sodium chloride......36esomeprazole sodium...............45estarylla.....................................50

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estazolam..................................30estradiol.................................... 50estradiol valerate.......................50estradiol-norethindrone acet..... 51eszopiclone............................... 65ethacrynate sodium...................37ethacrynic acid.......................... 37ethambutol hcl...........................22ethosuximide.............................18ethyl chloride.............................14ethynodiol diac-eth estradiol..... 51ETHYOL....................................24etidronate disodium...................57etodolac.................................... 11etodolac er................................ 11etoposide.................................. 24EURAX......................................26euthyrox.................................... 53EVAMIST.................................. 51EVOTAZ....................................29exemestane.............................. 24ex-lax ultra................................ 45exoderm.................................... 21EZ FLU SHOT-FLUCELVAX QUAD........................................56ezetimibe...................................38ezetimibe-simvastatin............... 38fabb........................................... 43FABRAZYME............................ 46falmina...................................... 51famciclovir................................. 28famotidine........................... 44, 45famotidine premixed..................45FANAPT....................................27FANAPT TITRATION PACK..... 27FARYDAK................................. 24fa-vitamin b-6-vitamin b-12....... 43fayosim......................................51febuxostat................................. 22FEIBA........................................33felbamate.................................. 18felodipine er.............................. 36FEMCAP................................... 58femynor..................................... 51fenofibrate................................. 37fenofibrate micronized...............37fenofibric acid............................37fenoprofen calcium....................11fenortho.....................................11fentanyl..................................... 12fentanyl citrate...........................13ferocon...................................... 41ferotrinsic.................................. 41

ferraplus 90............................... 41FERRIPROX............................. 42ferrocite plus............................. 41FETZIMA...................................19FETZIMA TITRATION...............19FIBRYGA.................................. 33finasteride................................. 46flac............................................ 62FLAREX.................................... 61flavoxate hcl.............................. 46FLEBOGAMMA DIF..................55flecainide acetate...................... 35FLEXICHAMBER ADULT MASK/SMALL........................... 58FLEXICHAMBER CHILD MASK/LARGE...........................58FLEXICHAMBER CHILD MASK/SMALL........................... 58FLOVENT DISKUS................... 62FLOVENT HFA......................... 62floxuridine..................................23FLUAD...................................... 56FLUARIX QUADRIVALENT......56FLUBLOK QUADRIVALENT.....56FLUCELVAX QUADRIVALENT...................... 56fluconazole................................21fluconazole in sodium chloride..21flucytosine................................. 21fludarabine phosphate.............. 23fludrocortisone acetate..............48FLULAVAL QUADRIVALENT... 56flumazenil ..................................39FLUMIST QUADRIVALENT......56flunisolide.................................. 62fluocinolone acetonide........ 48, 62fluocinolone acetonide body..... 48fluocinolone acetonide scalp.....48fluocinonide...............................48fluocinonide emulsified base.....48fluoridex.................................... 39fluoridex daily renewal.............. 39fluoridex enhanced whitening... 39fluoridex sensitivity relief........... 39fluoritab..................................... 41fluorometholone........................ 61FLUOROPLEX..........................24fluorouracil .......................... 23, 24FLUOROURACIL......................24fluoxetine hcl....................... 19, 20fluoxetine hcl (pmdd).................19fluphenazine decanoate............27fluphenazine hcl........................ 27

flurazepam hcl...........................65flurbiprofen................................ 11flurbiprofen sodium................... 61flutamide................................... 23fluticasone propionate.........48, 62fluticasone-salmeterol............... 63FLUTICASONE-SALMETEROL..........................63fluvastatin sodium..................... 37fluvastatin sodium er................. 37fluvoxamine maleate................. 20fluvoxamine maleate er.............20FLUZONE HIGH-DOSE............56FLUZONE QUADRIVALENT.... 56FML...........................................61folbee........................................ 43folbee plus.................................43folbee plus cz............................ 43folic acid.................................... 43FOLOTYN................................. 23folplex 2.2..................................43foltrin......................................... 41fomepizole.................................58fondaparinux sodium.................33FORTEO................................... 57FOSAMAX PLUS D.................. 57fosamprenavir calcium.............. 29fosinopril sodium....................... 35fosinopril sodium-hctz............... 35fosphenytoin sodium................. 19FOSRENOL.............................. 47frovatriptan succinate................22fulvestrant................................. 23furosemide................................ 37FUZEON................................... 29fyavolv.......................................51FYCOMPA................................ 18gabapentin................................ 18galantamine hydrobromide....... 19galantamine hydrobromide er... 19GAMASTAN..............................55gamastan s/d............................ 55GAMASTAN S/D.......................55GAMIFANT............................... 56GAMMAGARD.......................... 55GAMMAGARD S/D LESS IGA..55GAMMAKED............................. 55GAMMAPLEX........................... 55GAMUNEX-C............................ 55ganciclovir sodium.................... 28GARDASIL 9.............................56gatifloxacin................................ 62GATTEX....................................44

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gavilax.......................................45gavilyte-c...................................45gavilyte-g...................................45gavilyte-h...................................45gavilyte-n with flavor pack.........45GAZYVA................................... 26GELNIQUE............................... 46GELNIQUE PUMP.................... 46gemcitabine hcl......................... 23gemfibrozil .................................37generlac.................................... 45gengraf......................................54gentak....................................... 59gentamicin in saline.................. 15gentamicin sulfate............... 15, 59gentle laxative........................... 45GENVOYA................................ 28GEODON.................................. 27gianvi.........................................51GIAPREZA................................37GILENYA.................................. 39GILOTRIF................................. 25GLASSIA...................................65glatiramer acetate..................... 39glatopa...................................... 39GLEOSTINE............................. 22glimepiride.................................31glipizide er.................................31glipizide ir.................................. 31glipizide xl................................. 31glipizide-metformin hcl.............. 31GLUCAGEN HYPOKIT............. 32GLUCAGON EMERGENCY..... 32glucose......................................41glyburide................................... 31glyburide micronized................. 31glyburide-metformin.................. 31glycine.......................................46glycine urologic......................... 46glycolax..................................... 45glycopyrrolate............................44glycopyrrolate pf........................44glydo......................................... 14GLYXAMBI................................31gnp folic acid............................. 43GOODSENSE CLICKFINE PEN NEEDLE........................... 58GOODSENSE PEN NEEDLE PENFINE.................................. 58GRALISE.................................. 39GRALISE STARTER.................39granisetron hcl.......................... 21griseofulvin microsize................21

griseofulvin ultramicrosize.........21guanfacine hcl...........................34guanfacine hcl er.......................38GUANIDINE HCL......................22GYNAZOLE-1........................... 21hailey 24 fe................................51HALAVEN................................. 24halobetasol propionate..............48haloperidol................................ 27haloperidol decanoate...............27haloperidol lactate.....................27HARVONI..................................28HAVRIX.....................................56HEALTHWISE INSULIN SYR/NEEDLE........................... 58HEALTHWISE MICRON PEN NEEDLES................................. 58heather......................................53HELIXATE FS........................... 33hematinic plus vit/minerals........41hematinic/folic acid....................41hematogen................................ 41hematogen forte........................41HEMLIBRA................................33hemocyte-f................................ 41hemocyte-plus...........................41hemofil m.................................. 33HEMOFIL M.............................. 33HEPAGAM B.............................55heparin (porcine) in nacl........... 33heparin lock flush...................... 58heparin sod (porcine) in d5w.....33heparin sodium (porcine).......... 33heparin sodium (porcine) pf...... 33heparin sodium flush.................58heparin sodium lock flush......... 58hepatamine............................... 58HEPLISAV-B.............................56HERCEPTIN............................. 26hetastarch-nacl......................... 58HETLIOZ...................................65HIBERIX....................................56HIZENTRA................................ 55homatropaire.............................60homatropine hbr........................60HUMALOG KWIKPEN.............. 32HUMALOG MIX 50/50 KWIKPEN................................. 32HUMALOG MIX 50/50 VIAL......32HUMALOG MIX 75/25 KWIKPEN................................. 32HUMALOG MIX 75/25 VIAL......32

HUMALOG U-100 JUNIOR KWIKPEN................................. 32HUMALOG U-100 VIAL AND CARTRIDGE.............................32HUMATE-P............................... 33HUMIRA....................................54HUMIRA PEDIATRIC CROHNS START......................54HUMIRA PEN........................... 54HUMIRA PEN-CD/UC/HS STARTER................................. 54HUMIRA PEN-PS/UV/ADOL HS START................................ 54HUMULIN 70/30 KWIKPEN...... 32HUMULIN 70/30 VIAL...............32HUMULIN N KWIKPEN............ 32HUMULIN N VIAL..................... 32HUMULIN R U-500 KWIKPEN..32HUMULIN R U-500 VIAL (CONCENTRATED)..................32HUMULIN R VIAL..................... 32HYCAMTIN............................... 24hydralazine hcl.......................... 38hydrochlorothiazide...................37hydrocodone-acetaminophen... 13hydrocodone-homatropine........ 65hydrocodone-ibuprofen............. 13hydrocortisone.................... 40, 48hydrocortisone ace-pramoxine..40hydrocortisone butyrate............ 48hydrocortisone valerate.............48hydrocortisone-acetic acid........ 62hydromet................................... 65hydromorphone hcl................... 13hydromorphone hcl er............... 12hydromorphone hcl pf............... 13hydroxocobalamin acetate........ 43hydroxychloroquine sulfate....... 26hydroxyprogesterone caproate. 53hydroxyurea.............................. 23hydroxyzine hcl......................... 62hydroxyzine pamoate................62hyoscyamine sulfate................. 44hyoscyamine sulfate sl..............44HYPERHEP B S/D....................55HYPERRHO S/D.......................55HYQVIA.................................... 55HYSINGLA ER..........................12ibandronate sodium.................. 57IBRANCE.................................. 24ibu............................................. 11ibuprofen................................... 11ibuprofen lysine.........................11

73

ibutilide fumarate.......................35icatibant acetate........................54ICLUSIG....................................25idarubicin hcl............................. 24iferex 150 forte.......................... 41ifosfamide..................................22ILARIS.......................................56imatinib mesylate...................... 25IMBRUVICA.............................. 25imipenem-cilastatin................... 17imipramine hcl...........................20imipramine pamoate................. 20imiquimod..................................40IMPAVIDO................................ 15incassia..................................... 53INCRELEX................................ 49INCRUSE ELLIPTA.................. 63indapamide............................... 37indomethacin.............................11indomethacin er........................ 11indomethacin sodium................ 11INFANRIX................................. 56INFLECTRA.............................. 54infuvite adult..............................43infuvite pediatric........................ 43INLYTA..................................... 25INPEN 100-BLUE-LILLY...........30INPEN 100-BLUE-NOVO..........30INPEN 100-GRAY-LILLY.......... 30INPEN 100-GREY-NOVO.........30INPEN 100-PINK-LILLY............30INPEN 100-PINK-NOVO...........30INSPIREASE RESERVOIR BAGS........................................ 58INSULIN PEN NEEDLES..........58INSULIN SYRINGES................ 58INTELENCE..............................29intralipid.....................................58INTRAROSA............................. 48INTRON A.................................28introvale.................................... 51INVEGA SUSTENNA................27INVEGA TRINZA...................... 27INVIRASE................................. 29INVOKAMET.............................31INVOKAMET XR.......................31INVOKANA............................... 31iodine strong............................. 41iodine tincture............................15IOPIDINE.................................. 61IPOL..........................................56ipratropium bromide.................. 63ipratropium-albuterol................. 63

irbesartan.................................. 34irbesartan-hydrochlorothiazide..34irinotecan hcl.............................24ISENTRESS..............................28ISENTRESS HD....................... 28isibloom.....................................51isoniazid.................................... 22isoproterenol hcl........................63isosorbide dinitrate....................38isosorbide dinitrate er................38isosorbide mononitrate..............38isosorbide mononitrate er......... 38isotretinoin.................................40isradipine...................................36ISTODAX (OVERFILL)............. 24itraconazole...............................21ivermectin..................................26IXEMPRA KIT........................... 24JADENU....................................42JADENU SPRINKLE.................42JAKAFI......................................25jantoven.................................... 33JANUMET................................. 31JANUMET XR........................... 31JANUVIA...................................31JARDIANCE..............................31jasmiel.......................................51jencycla..................................... 53JENTADUETO.......................... 31JENTADUETO XR.................... 31JEVTANA..................................24jinteli ..........................................51jolessa.......................................51J-TIP KIT W/VIAL ADAPTERS. 58juleber....................................... 51JULUCA.................................... 28junel 1.5/30............................... 51junel 1/20.................................. 51junel fe 1.5/30........................... 51junel fe 1/20.............................. 51junel fe 24................................. 51KADCYLA................................. 26kaitlib fe.....................................51KALETRA..................................29kalliga........................................51KALYDECO.............................. 64KANUMA...................................46kariva........................................ 51kcl in d5w lactated ringers.........41kcl in dextrose-nacl................... 41kcl-lactated ringers-d5w............ 41kedbumin.................................. 58kelnor 1/35................................ 51

kelnor 1/50................................ 51KERYDIN.................................. 21KETOCARE.............................. 30ketoconazole.............................21ketoprofen................................. 11ketoprofen er.............................11ketorolac tromethamine...... 11, 61KETOSTIX................................ 31KEVEYIS...................................58KINERET.................................. 54KINRIX...................................... 56kionex........................................42klor-con..................................... 41klor-con 10................................ 41klor-con m10............................. 41KLOR-CON M15....................... 41klor-con m20............................. 41klor-con sprinkle........................41klor-con/ef................................. 41KOATE......................................33KOATE-DVI...............................34koate-dvi................................... 34KOGENATE FS........................ 34KORLYM...................................49k-prime...................................... 41k-tan plus.................................. 41kurvelo...................................... 51KUVAN......................................46KYLEENA................................. 53KYPROLIS.......................... 24, 25labetalol hcl............................... 36lactated ringers................... 41, 58lactic acid.................................. 40lactic acid e............................... 40lactulose....................................45lactulose encephalopathy......... 45lamivudine...........................28, 29lamivudine-zidovudine.............. 29lamotrigine................................ 18lamotrigine er............................ 18lamotrigine starter kit-blue.........18lamotrigine starter kit-green...... 18lamotrigine starter kit-orange.... 18LANCETS................................. 31lansoprazole..............................45lanthanum carbonate................ 47LANTUS SOLOSTAR............... 32LANTUS U-100 VIAL................ 32larin 1.5/30................................ 51larin 1/20................................... 51larin 24 fe.................................. 51larin fe 1.5/30............................ 51larin fe 1/20............................... 51

74

larissia.......................................51LASTACAFT............................. 61latanoprost................................ 60LATUDA....................................27layolis fe.................................... 51leena......................................... 51leflunomide................................56LENVIMA (10 MG DAILY DOSE).......................................25LENVIMA (12 MG DAILY DOSE).......................................25LENVIMA (14 MG DAILY DOSE).......................................25LENVIMA (18 MG DAILY DOSE).......................................25LENVIMA (20 MG DAILY DOSE).......................................25LENVIMA (24 MG DAILY DOSE).......................................25LENVIMA (4 MG DAILY DOSE).......................................25LENVIMA (8 MG DAILY DOSE).......................................25lessina.......................................51letrozole.................................... 24leucovorin calcium.................... 24LEUKERAN...............................23leuprolide acetate......................49levalbuterol hcl.......................... 63LEVEMIR U-100 FLEXTOUCH.32LEVEMIR U-100 VIAL...............32levetiracetam.............................18levetiracetam er........................ 18levetiracetam in nacl................. 18levobunolol hcl.......................... 61levocarnitine..............................58levocetirizine dihydrochloride....62levofloxacin......................... 17, 62levofloxacin in d5w....................17levoleucovorin calcium..............24levoleucovorin calcium pf..........24levonest.....................................51levonorgest-eth est & eth est.... 51levonorgest-eth estrad 91-day.. 51levonorgestrel........................... 53levonorgestrel-ethinyl estrad.....51levonorg-eth estrad triphasic.....51levora 0.15/30 (28)....................51levorphanol tartrate................... 13levo-t......................................... 53levothyroxine sodium................ 53levothyroxine-liothyronine......... 53levoxyl....................................... 53

LEXIVA..................................... 29lidocaine....................................14lidocaine hcl.............................. 14lidocaine hcl (cardiac)............... 35lidocaine hcl (cardiac) pf........... 35lidocaine hcl (pf)........................14lidocaine hcl urethral/mucosal...14lidocaine in d5w........................ 35lidocaine viscous.......................14lidocaine-epinephrine................14lidocaine-prilocaine................... 14LILETTA (52 MG)......................53lillow.......................................... 51lincomycin hcl............................15lindane...................................... 26linezolid..................................... 15linezolid in sodium chloride....... 15LINZESS................................... 45liothyronine sodium................... 53lisinopril ..................................... 35lisinopril-hydrochlorothiazide.....35lithium........................................30lithium carbonate.......................30lithium carbonate er.................. 30LIVALO..................................... 37lmd in d5w.................................58LO LOESTRIN FE.....................51LONSURF.................................23loperamide hcl...........................44lopinavir-ritonavir.......................29lopreeza.................................... 51lorazepam................................. 30lorazepam intensol....................30lorcet......................................... 13lorcet hd.................................... 13lorcet plus..................................13loryna........................................ 51losartan potassium....................34losartan potassium-hctz............ 34LOTEMAX SM.......................... 61loteprednol etabonate............... 61lovastatin...................................37low-ogestrel...............................51loxapine succinate.................... 27lo-zumandimine.........................51ludent........................................ 41LUMIGAN..................................60LUMIZYME............................... 46LUPANETA PACK.................... 54LUPRON DEPOT (1-MONTH)..49LUPRON DEPOT (3-MONTH)..49LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG..49

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG..49LUPRON DEPOT-PED (1-MONTH)....................................54LUPRON DEPOT-PED (3-MONTH)....................................54lutera......................................... 51LYNPARZA............................... 24lysiplex plus...............................43LYSODREN.............................. 54lyza............................................53mafenide acetate...................... 15magnesium chloride..................41magnesium citrate.....................45magnesium sulfate..............41, 42magnesium sulfate in d5w........ 41MAKENA...................................53malathion.................................. 26mannitol.................................... 37maprotiline hcl...........................20marlissa.....................................51MARPLAN.................................19MARQIBO................................. 24MASK VORTEX........................ 58MATULANE.............................. 23matzim la...................................36MAVYRET.................................28MAXICOMFORT II PEN NEEDLE....................................58MAXI-COMFORT SAFETY PEN NEEDLE........................... 58MAXICOMFORT SYR 27G X 1/2"............................................58MAXIPIME................................ 16meclizine hcl............................. 20meclofenamate sodium.............11medique aspirin.........................11medroxyprogesterone acetate.. 53mefloquine hcl...........................26megestrol acetate..................... 53MEKINIST................................. 25melodetta 24 fe......................... 51meloxicam.................................11melphalan................................. 23melphalan hcl............................23memantine hcl...........................19memantine hcl er...................... 19MENACTRA..............................56MENEST................................... 51MENVEO.................................. 56meperidine hcl...........................13meprobamate............................30MEPSEVII................................. 46

75

mercaptopurine......................... 23meropenem...............................17mesalamine...............................57mesalamine-cleanser................57mesna....................................... 24MESNEX...................................24metadate er...............................38metaproterenol sulfate.............. 64metaxall .....................................65metaxalone............................... 65metformin hcl er........................ 31metformin hcl ir ......................... 31methadone hcl.......................... 12methadone hcl intensol............. 12methadose................................ 12methadose sugar-free...............12methamphetamine hcl...............38methazolamide..........................61methenamine hippurate............ 15methergine................................ 58methimazole..............................54METHITEST..............................49methocarbamol......................... 65methotrexate............................. 54methotrexate (anti-rheumatic)...54methotrexate sodium.......... 54, 55methotrexate sodium (pf).......... 54methoxsalen..............................40methoxsalen rapid.....................40methscopolamine bromide........44methyldopa............................... 34methyldopa-hydrochlorothiazide...................34methylergonovine maleate........58methylphenidate hcl.................. 39methylphenidate hcl er..............38methylphenidate hcl er (cd).......38methylphenidate hcl er (la)........39methylprednisolone...................48methylprednisolone acetate...... 48methylprednisolone sodium succ...........................................48methyltestosterone....................49metoclopramide hcl...................44metolazone............................... 37metoprolol succinate er.............36metoprolol tartrate.....................36metoprolol-hydrochlorothiazide.36metronidazole..................... 15, 40metronidazole in nacl................ 15mexiletine hcl............................ 35MIACALCIN.............................. 57mibelas 24 fe.............................51

miconazole 3.............................21MICRHOGAM ULTRA-FILTERED PLUS...................... 55microgestin 1.5/30.....................51microgestin 1/20........................51microgestin fe 1.5/30.................51microgestin fe 1/20....................51midodrine hcl.............................37mifepristone.............................. 49miglitol.......................................31miglustat....................................46mili .............................................51milrinone lactate........................37milrinone lactate in dextrose..... 37mimvey......................................51mimvey lo..................................51mineral oil heavy....................... 45minitran..................................... 38MINOCIN.................................. 18minocycline hcl..........................18minoxidil .................................... 38MIRENA (52 MG)......................53mirtazapine............................... 19MIRVASO................................. 40misoprostol................................45mitigo........................................ 12mitomycin..................................24mitoxantrone hcl........................24M-M-R II.................................... 56modafinil ....................................65moexipril hcl.............................. 35molindone hcl............................27mometasone furoate........... 48, 63mondoxyne nl............................18monoject flush syringe.............. 58monoject sodium chloride flush.59mono-linyah.............................. 51montelukast sodium.................. 63morgidox................................... 18morphine sulfate................. 12, 13morphine sulfate (concentrate). 13morphine sulfate (pf)................. 13morphine sulfate er................... 12morphine sulfate er beads........ 12MOVIPREP............................... 45MOXEZA...................................62moxifloxacin hcl...................17, 62moxifloxacin hcl in nacl............. 17MOZOBIL..................................33multi prenatal............................ 43multigen.................................... 42multigen folic............................. 42multigen plus.............................42

multi-vit/iron/fluoride..................43multivitamin/fluoride.................. 43multi-vitamin/fluoride................. 43multivitamin/fluoride/iron........... 43multi-vitamin/fluoride/iron.......... 43multivitamins/fluoride................ 43mupirocin.................................. 15mutamycin.................................24mvc-fluoride.............................. 43MYALEPT................................. 46mycophenolate mofetil .............. 55mycophenolate mofetil hcl........ 55mycophenolate sodium............. 55MYLERAN.................................23mynephron................................ 43myorisan................................... 40MYRBETRIQ.............................46na ferric gluc cplx in sucrose.....42nabi-hb...................................... 55nabumetone.............................. 11n-acetyl-l-cysteine..................... 59nafcillin sodium......................... 17nafrinse..................................... 42nafrinse drops........................... 42naftifine hcl................................21NAGLAZYME............................46nalbuphine hcl...........................13naloxone hcl..............................14naltrexone hcl............................14NAMZARIC............................... 19naproxen................................... 11naproxen dr...............................11naproxen sodium...................... 11naratriptan hcl........................... 22NARCAN...................................14NASCOBAL.............................. 43NATACYN.................................60NATAZIA...................................51nateglinide.................................31NEBUPENT.............................. 26nebusal..................................... 65necon 0.5/35 (28)......................51nefazodone hcl..........................20neomycin sulfate....................... 15neomycin-bacitracin zn-polymyx.....................................60neomycin-polymyxin b gu......... 47neomycin-polymyxin-dexameth 60neomycin-polymyxin-gramicidin..................................59neomycin-polymyxin-hc...... 60, 62neo-polycin................................60neo-polycin hc...........................60

76

neostigmine methylsulfate........ 22NEO-SYNALAR........................ 15nephronex................................. 43neuac........................................ 40NEULASTA............................... 33NEULASTA ONPRO.................33NEUPRO...................................27neutral sodium fluoride..............39NEVANAC.................................61nevirapine................................. 29nevirapine er............................. 29NEXAVAR.................................25NEXPLANON............................53niacin er (antihyperlipidemic).... 38nicardipine hcl........................... 36nicotine polacrilex..................... 14nicotine step 1...........................14nicotine step 2...........................14nicotine step 3...........................14NICOTROL............................... 15NICOTROL NS......................... 15nifedipine...................................36nifedipine er.............................. 36nifedipine er osmotic release.... 36nikki...........................................51nilutamide..................................23nimodipine.................................36NINLARO.................................. 24NIPENT.....................................23nisoldipine er.............................36NITRO-BID................................38nitrofurantoin............................. 15nitrofurantoin macrocrystal........15nitrofurantoin monohydrate macrocrystals............................15nitroglycerin...............................38nitroglycerin in d5w................... 38NITROMIST.............................. 38nitroprusside sodium.................38NIVESTYM................................33nizatidine...................................45nora-be......................................53NORDITROPIN FLEXPRO....... 49norepinephrine bitartrate...........37norethin ace-eth estrad-fe.........51norethindrone............................53norethindrone acetate............... 53norethindrone acet-ethinyl est...52norethindrone-eth estradiol....... 52norethin-eth estradiol-fe............ 52norgestimate-eth estradiol........ 52norgestimate-ethinyl estradiol triphasic.....................................52

norlyda...................................... 53norlyroc..................................... 53normal saline flush.................... 59nortrel 0.5/35 (28)..................... 52nortrel 1/35 (21)........................ 52nortrel 1/35 (28)........................ 52nortrel 7/7/7...............................52nortriptyline hcl..........................20NORVIR.................................... 29NOVOFINE AUTOCOVER PEN NEEDLE........................... 59NOVOFINE PEN NEEDLE....... 59NOVOFINE PLUS PEN NEEDLE....................................59NOVOLIN 70/30 FLEXPEN...... 32NOVOLIN 70/30 FLEXPEN RELION.....................................32NOVOLIN 70/30 RELION......... 32NOVOLIN 70/30 VIAL............... 32NOVOLIN N RELION................32NOVOLIN N VIAL..................... 32NOVOLIN R RELION................32NOVOLIN R VIAL..................... 32NOVOLOG FLEXPEN.............. 32NOVOLOG MIX 70/30 FLEXPEN..................................32NOVOLOG MIX 70/30 VIAL......32NOVOLOG PENFILL................ 32NOVOLOG U-100 VIAL............ 32NOVOPEN ECHO.....................31NOVOSEVEN RT..................... 34NOVOTWIST PEN NEEDLE.... 59NOXAFIL...................................21np thyroid.................................. 53NPLATE.................................... 33NUCALA................................... 65nufol.......................................... 43nulev......................................... 44nutricap..................................... 43nutrifac zx..................................43nutrilipid.....................................59NUTROPIN AQ NUSPIN 10..... 49NUTROPIN AQ NUSPIN 20..... 49NUTROPIN AQ NUSPIN 5....... 49NUVARING............................... 52nyamyc......................................21nystatin......................................21nystatin-triamcinolone............... 21nystop....................................... 21OBIZUR.................................... 34ocella.........................................52OCTAGAM................................55octreotide acetate..................... 54

ODEFSEY.................................29OFEV........................................ 64ofloxacin..............................17, 62ogestrel..................................... 52okebo........................................ 18olanzapine.................................27olanzapine-fluoxetine hcl.......... 20olmesartan medoxomil..............35olmesartan medoxomil-hctz...... 35olmesartan-amlodipine-hctz......35olopatadine hcl....................61, 62OMECLAMOX-PAK.................. 44omega-3-acid ethyl esters.........38omeprazole............................... 45OMIDRIA...................................60OMNARIS................................. 63ONCASPAR..............................24ondansetron hcl........................ 21ondansetron odt........................ 21ONE TOUCH VERIO KIT W/DEVICE................................ 31ONE-A-DAY WOMENS PRENATAL 1............................ 43ONETOUCH DELICA LANCING DEV..........................31ONETOUCH DELICA PLUS LANCING.................................. 31ONETOUCH ULTRA 2..............31ONETOUCH ULTRA BLUE TEST STRIPS...........................31ONETOUCH ULTRA MINI........ 31ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE..........31ONETOUCH VERIO IQ SYSTEM................................... 31ONETOUCH VERIO SYNC SYSTEM KIT W/DEVICE..........31ONIVYDE..................................25OPDIVO.................................... 26OPSUMIT..................................64oralone...................................... 39ORENCIA..................................55ORENCIA CLICKJECT............. 55ORENITRAM............................ 64ORFADIN..................................46ORKAMBI................................. 64orphenadrine citrate.................. 65orphenadrine citrate er..............65orsythia..................................... 52oscimin......................................44oseltamivir phosphate............... 30osmitrol..................................... 37OSPHENA................................ 53

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OTEZLA.................................... 56oxacillin sodium.........................17oxaliplatin.................................. 23oxandrolone.............................. 49oxaprozin.................................. 11oxazepam................................. 30oxcarbazepine...........................19OXISTAT...................................21oxybutynin chloride................... 46oxybutynin chloride er............... 46oxycodone hcl........................... 13OXYCODONE HCL ER............ 12oxycodone-acetaminophen.......13oxycodone-aspirin.....................13oxycodone-ibuprofen................ 13OXYCONTIN.............................12oxymorphone hcl.......................13oxymorphone hcl er.................. 12oxytocin.....................................49OZEMPIC..................................31pacerone................................... 35paclitaxel................................... 24paliperidone er.......................... 27palonosetron hcl........................21pamidronate disodium...............57pancuronium bromide............... 65PANDA MASK LARGE............. 59PANDA MASK MEDIUM...........59PANDA MASK SMALL..............59PANRETIN................................26pantoprazole sodium.................45PARAGARD INTRAUTERINE COPPER...................................59paricalcitol................................. 57paroex....................................... 39paromomycin sulfate.................15paroxetine hcl............................20paroxetine hcl er....................... 20paroxetine mesylate..................20PASER......................................22PAXIL........................................20PAZEO......................................61PEDIARIX................................. 56PEDIATRIC PANDA MASK...... 59PEDVAX HIB............................ 56peg 3350/electrolytes................45peg 3350-kcl-na bicarb-nacl......45peg-3350/electrolytes................45PEGANONE..............................19PEGASYS.................................28PEGASYS PROCLICK............. 28peg-prep....................................45penicillamine............................. 42

penicillin g potassium................17penicillin g procaine.................. 17penicillin g sodium.....................17penicillin v potassium................ 17PENTACEL............................... 56pentamidine isethionate............ 26PENTASA................................. 57pentazocine-naloxone hcl......... 13pentobarbital sodium.................65pentoxifylline er......................... 37PERFOROMIST........................64perindopril erbumine................. 35periogard...................................39PERJETA..................................26permethrin.................................26perphenazine............................ 27perphenazine-amitriptyline........20phenadoz.................................. 20phenazo.................................... 47phenazopyridine hcl.................. 47phenelzine sulfate..................... 19phenobarbital............................ 18phenoxybenzamine hcl............. 34phentolamine mesylate............. 34phenylephrine hcl................34, 61phenytoin.................................. 19phenytoin infatabs.....................19phenytoin sodium......................19phenytoin sodium extended...... 19philith.........................................52PHOSLYRA.............................. 47PHOSPHOLINE IODIDE...........61phosphorous............................. 42phrenilin forte............................ 11phytonadione............................ 43PICATO.....................................24pilocarpine hcl..................... 39, 61pimecrolimus.............................40pimozide....................................27pimtrea...................................... 52pindolol......................................36pioglitazone hcl......................... 31pioglitazone hcl-glimepiride.......31pioglitazone hcl-metformin hcl.. 31piperacillin sod-tazobactam so..17pirmella 1/35............................. 52pirmella 7/7/7............................ 52piroxicam...................................11pneumovax 23.......................... 56PNEUMOVAX 23...................... 56pnv prenatal plus multivit+dha.. 43pocket spacer............................59podofilox....................................40

polocaine...................................14polocaine-mpf........................... 14polycin.......................................60poly-iron 150 forte..................... 42polymyxin b sulfate................... 15polymyxin b-trimethoprim..........60polysaccharide iron forte...........42POMALYST.............................. 23portia-28....................................52pot bicarb-pot chloride.............. 42potassium acetate.....................42potassium chloride.................... 42potassium chloride crys er........ 42potassium chloride er................42potassium chloride in dextrose. 42potassium chloride in nacl.........42potassium citrate er...................42PRADAXA.................................33pralidoxime chloride.................. 59PRALUENT...............................37pramipexole dihydrochloride..... 27pramipexole dihydrochloride er.27prasugrel hcl............................. 34pravastatin sodium....................37praziquantel.............................. 26prazosin hcl...............................34PRED MILD.............................. 61prednicarbate............................ 48prednisolone............................. 48prednisolone acetate.................61prednisolone sodium phosphate........................... 48, 61prednisone................................ 48PREDNISONE INTENSOL....... 48pregabalin................................. 18pregnyl...................................... 49PREMARIN............................... 52PREMPHASE........................... 52PREMPRO................................52prenatal..................................... 43prenatal multi +dha................... 43prenatal plus iron...................... 43PREPOPIK................................45prevalite.................................... 38PREVENT SAFETY PEN NEEDLES................................. 59preventeza................................ 53prevident................................... 39previfem.................................... 52PREVNAR 13............................56PREZCOBIX............................. 29PREZISTA................................ 29PRIFTIN.................................... 22

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primaquine phosphate.............. 26primidone.................................. 18PRIMSOL..................................15PRIVIGEN.................................55PRO COMFORT SPACER ADULT...................................... 59PRO COMFORT SPACER CHILD....................................... 59PROAIR HFA............................ 64PROAIR RESPICLICK..............64probenecid................................ 22procainamide hcl.......................35PROCARE SPACER/ADULT MASK........................................59PROCARE SPACER/CHILD MASK........................................59prochlorperazine....................... 20prochlorperazine edisylate........ 20prochlorperazine maleate......... 20procto-med hc........................... 40procto-pak................................. 40proctosol hc...............................40proctozone-hc........................... 40PROFILNINE............................ 34PROFILNINE SD...................... 34progesterone.............................53progesterone micronized.......... 53PROGLYCEM........................... 32PROGRAF................................ 55PROLASTIN-C..........................65PROLENSA.............................. 61PROLEUKIN............................. 24PROLIA.....................................57PROMACTA..............................33promethazine hcl.......................20promethegan.............................20propafenone hcl........................ 35propafenone hcl er.................... 35proparacaine hcl....................... 60propranolol hcl.......................... 36propranolol hcl er...................... 36propranolol-hctz........................ 36propylthiouracil ..........................54PROQUAD................................56protamine sulfate...................... 34protriptyline hcl..........................20PULMICORT FLEXHALER.......63pulmosal....................................65PULMOZYME........................... 64purevit dualfe plus.....................42PYLERA....................................44pyrazinamide.............................22pyridostigmine bromide.............22

pyridostigmine bromide er.........22pyridoxine hcl............................ 43qc aspirin low dose................... 11QUADRACEL............................56quazepam................................. 30quetiapine fumarate.................. 27quetiapine fumarate er.............. 27QUILLIVANT XR....................... 39quinapril hcl...............................35quinapril-hydrochlorothiazide.... 35quinidine gluconate er...............35quinidine sulfate........................ 35quinine sulfate...........................26rabeprazole sodium.................. 45raloxifene hcl.............................53ramelteon.................................. 66ramipril ...................................... 35ranitidine hcl..............................45ranolazine er............................. 37rasagiline mesylate................... 27RAVICTI....................................46RAYALDEE...............................43REBETOL................................. 28reclipsen....................................52RECOMBINATE........................34RECOMBIVAX HB.................... 56RECTIV.....................................40REGRANEX..............................40RELENZA DISKHALER............ 30relexxii .......................................39remifentanil hcl..........................13RENACIDIN.............................. 47renal.......................................... 43RENFLEXIS.............................. 55repaglinide................................ 31repaglinide-metformin hcl..........32REPATHA................................. 37REPATHA PUSHTRONEX SYSTEM................................... 38REPATHA SURECLICK........... 38RESCRIPTOR.......................... 29RESTASIS................................ 60RESTASIS MULTIDOSE.......... 60RETACRIT................................ 33RETROVIR............................... 29REVCOVI..................................46REVLIMID................................. 23revonto...................................... 28REXULTI...................................27REYATAZ................................. 30RHOGAM ULTRA-FILTERED PLUS.........................................55RHOPHYLAC............................55

RHOPRESSA........................... 61RIASTAP...................................34ribasphere................................. 28ribasphere ribapak.................... 28RIBASPHERE RIBAPAK.......... 28ribavirin..................................... 28rifabutin..................................... 22rifampin..................................... 22RIFATER...................................22riluzole.......................................39rimantadine hcl..........................30ringers....................................... 42ringers irrigation........................ 59risedronate sodium................... 57RISPERDAL CONSTA..............27risperidone................................ 27ritonavir..................................... 30RITUXAN.................................. 26rivastigmine...............................19rivastigmine tartrate.................. 19rivelsa........................................52RIXUBIS....................................34rizatriptan benzoate.................. 22rocuronium bromide.................. 65ROMIDEPSIN........................... 24ropinirole hcl..............................27ropinirole hcl er......................... 27ropivacaine hcl.......................... 14rosadan..................................... 40rosuvastatin calcium................. 38ROTARIX.................................. 56ROTATEQ.................................56roweepra................................... 18roweepra xr............................... 18RUBRACA................................ 24RYDAPT................................... 25ryvent........................................ 62saline flush................................ 59saline flush zr............................ 59SAMSCA...................................42SANDIMMUNE......................... 55SANTYL.................................... 40SAPHRIS.................................. 27SAPS HEALTH CARE ALCOHOL PREP...................... 59sash kit ......................................59SAVAYSA................................. 33SAVELLA.................................. 39SAVELLA TITRATION PACK... 39scopolamine..............................20SECURESAFE INSULIN SYRINGE..................................59selegiline hcl............................. 27

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selenium sulfide........................ 40SELZENTRY.............................29sensorcaine...............................14sensorcaine/epinephrine...........14sensorcaine-mpf....................... 14sensorcaine-mpf/epinephrine....14SEREVENT DISKUS................ 64sertraline hcl..............................20se-tan plus................................ 42setlakin......................................52sevelamer carbonate................ 47sevelamer hcl............................47sf............................................... 39sf 5000 plus...............................39sharobel.................................... 53SHINGRIX.................................56siderol....................................... 43SIGNIFOR.................................54sildenafil citrate......................... 64SILENOR.................................. 66silodosin.................................... 46silver nitrate...............................40silver sulfadiazine......................15SIMBRINZA.............................. 61simliya....................................... 52simpesse...................................52SIMPONI...................................55SIMPONI ARIA......................... 55simvastatin................................ 38sirolimus....................................55SIRTURO..................................22SKLICE..................................... 26SKYLA...................................... 53SLYND...................................... 53sod benz-sod phenylacet.......... 46sod citrate-citric acid................. 42sodium acetate..........................43sodium bicarbonate.............42, 44sodium chloride.............42, 47, 65sodium chloride flush................ 59sodium fluoride....................39, 42sodium fluoride 5000 plus......... 39sodium lactate...........................42sodium nitrite.............................59sodium phenylbutyrate..............46sodium phosphates...................42sodium polystyrene sulfonate... 42sodium thiosulfate..................... 59solifenacin succinate.................46SOLIRIS....................................32SOLTAMOX.............................. 23SOLU-CORTEF........................ 48SOMATULINE DEPOT............. 54

SOMAVERT..............................54sorbitol...................................... 47sorbitol-mannitol........................47sorine........................................ 35sotalol hcl.................................. 35sotalol hcl (af)............................35spinosad....................................26SPIRIVA HANDIHALER............63SPIRIVA RESPIMAT................ 63spironolactone...........................37spironolactone-hctz...................37sprintec 28................................ 52SPRYCEL................................. 25sps............................................ 42sronyx....................................... 52ssd............................................ 15stavudine...................................29STELARA............................40, 55sterile water for irrigation...........59STIOLTO RESPIMAT............... 63STIVARGA................................25STRENSIQ................................46streptomycin sulfate.................. 15STRIANT...................................49STRIBILD..................................28subvenite...................................18subvenite starter kit-blue...........18subvenite starter kit-green........ 18subvenite starter kit-orange...... 18succinylcholine chloride............ 65SUCRAID..................................46sucralfate.................................. 45sulfacetamide sodium............... 62sulfacetamide sodium (acne).... 40sulfacetamide-prednisolone...... 61sulfadiazine............................... 17sulfamethoxazole-trimethoprim.17SULFAMYLON..........................15sulfasalazine............................. 57sulfatrim pediatric......................17sulfurated lime...........................26sulindac.....................................12sumatriptan............................... 22sumatriptan succinate............... 22sumatriptan succinate refill ....... 22SUPPRELIN LA........................ 54SUPREP BOWEL PREP KIT....45SURESTEP PRO HIGH GLUCOSE................................ 31SURESTEP PRO LOW GLUCOSE................................ 31SURESTEP PRO NORMAL GLUCOSE................................ 31

SUTENT....................................25swabflush saline flush............... 59syeda........................................ 52SYLATRON...............................24SYMBICORT.............................63SYMFI....................................... 29SYMFI LO................................. 29SYMPROIC...............................44SYNAGIS.................................. 55SYNAREL................................. 54SYNJARDY...............................32SYNJARDY XR.........................32SYNRIBO..................................24TABLOID...................................23TACLONEX...............................40tacrolimus............................40, 55tadalafil ......................................46tadalafil (pah)............................ 64TAFINLAR.................................25TAGRISSO............................... 25tamoxifen citrate........................23tamsulosin hcl........................... 46TARGRETIN............................. 26tarina 24 fe................................ 52tarina fe 1/20............................. 52tarina fe 1/20 eq........................ 52TASIGNA.................................. 25tazarotene................................. 41tazicef........................................17TAZORAC.................................41taztia xt......................................36TDVAX...................................... 57TECENTRIQ............................. 26TECFIDERA..............................39TEGSEDI.................................. 39telmisartan................................ 35telmisartan-amlodipine..............35telmisartan-hctz.........................35temazepam............................... 30TEMODAR................................ 23temozolomide............................23temsirolimus..............................25tencon....................................... 11teniposide..................................24TENIVAC.................................. 57tenofovir disoproxil fumarate.....29terazosin hcl..............................46terbinafine hcl............................21terbutaline sulfate......................64terconazole............................... 21testosterone.............................. 50testosterone cypionate..............49testosterone enanthate............. 49

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tetcaine..................................... 60tetrabenazine............................ 39tetracaine hcl.............................60tetracycline hcl.......................... 18TEXACORT.............................. 48THALOMID............................... 23THEO-24...................................64theochron.................................. 64theophylline...............................64theophylline er...........................64theophylline in d5w................... 64thiamine hcl...............................43thioridazine hcl.......................... 27thiotepa..................................... 23thiothixene.................................27THROMBATE III ....................... 33THYMOGLOBULIN...................56THYROLAR-1........................... 53THYROLAR-1/2........................ 53THYROLAR-1/4........................ 54THYROLAR-2........................... 54THYROLAR-3........................... 54tiagabine hcl..............................18tigecycline................................. 18tilia fe.........................................52timolol maleate....................36, 61tinidazole...................................26tis-u-sol..................................... 59TIVICAY.................................... 28tizanidine hcl............................. 28tl gard rx.................................... 43tl icon.........................................42tl-hem 150................................. 42TOBRADEX.............................. 59TOBRADEX ST.........................59tobramycin.......................... 59, 64tobramycin sulfate.....................15tobramycin-dexamethasone......59TOBREX................................... 60tolbutamide............................... 32tolcapone.................................. 27tolmetin sodium.........................12tolterodine tartrate.....................46tolterodine tartrate er.................46topiramate................................. 18topiramate er.............................18toposar...................................... 25topotecan hcl.............................25toremifene citrate...................... 23torsemide.................................. 37TOTECT....................................24TOUJEO MAX SOLOSTAR...... 32TOUJEO SOLOSTAR...............32

TOVIAZ..................................... 46tpn electrolytes..........................42TRACLEER...............................64TRADJENTA.............................32tramadol hcl er.......................... 12tramadol hcl er (biphasic)..........12tramadol hcl ir ........................... 13tramadol-acetaminophen.......... 13trandolapril ................................ 35trandolapril-verapamil hcl er......35tranexamic acid.........................34tranylcypromine sulfate............. 19TRAVATAN Z............................60trazodone hcl............................ 20TREANDA.................................23TRECATOR.............................. 22TREMFYA.................................41treprostinil ................................. 64TRESIBA...................................32TRESIBA FLEXTOUCH............32tretinoin............................... 26, 41tretinoin microsphere................ 41tretinoin microsphere pump...... 41TREXALL.................................. 55tri femynor................................. 52triamcinolone acetonide...... 39, 48triamterene-hctz........................ 37triazolam................................... 30tricon......................................... 42triderm.......................................48trientine hcl................................42tri-estarylla................................ 52trifluoperazine hcl......................27trifluridine.................................. 60trigels-f forte.............................. 42trihexyphenidyl hcl.............. 26, 27tri-legest fe................................ 52tri-linyah.................................... 52tri-lo-estarylla............................ 52tri-lo-marzia............................... 52tri-lo-mili .................................... 52tri-lo-sprintec............................. 52trilyte......................................... 45trimethobenzamide hcl..............20trimethoprim.............................. 15tri-mili ........................................ 52trimipramine maleate................ 20trinate........................................ 44TRINTELLIX..............................20triphrocaps................................ 44tri-previfem................................ 52TRISENOX................................24tri-sprintec................................. 52

TRIUMEQ................................. 29tri-vitamin/fluoride......................44tri-vite/fluoride........................... 44trivora (28).................................52tri-vylibra................................... 52tri-vylibra lo................................52tropicamide............................... 60trospium chloride.......................46trospium chloride er.................. 46TRUE COMFORT ALCOHOL PREP PADS............................. 59TRUEPLUS 5-BEVEL PEN NEEDLES................................. 59TRULICITY............................... 32TRUMENBA..............................57TRUVADA.................................29tulana........................................ 53TUZISTRA XR.......................... 62TWINRIX...................................57TYBOST....................................29tydemy...................................... 52TYKERB....................................25TYSABRI...................................39TYVASO................................... 64TYVASO REFILL...................... 64TYVASO STARTER..................64ULESFIA................................... 26ULTRACARE PEN NEEDLES.. 59unithroid.................................... 54UNITUXIN................................. 26UPTRAVI.................................. 64ursodiol..................................... 44valacyclovir hcl..........................28valganciclovir hcl.......................28valproate sodium.......................18valproic acid.............................. 18valsartan................................... 35valsartan-hydrochlorothiazide... 35vancomycin hcl......................... 16vancomycin hcl in dextrose.......16vancomycin hcl in nacl.............. 16VANCOMYCIN HCL IN NACL.. 16vandazole..................................16VAQTA......................................57VARIVAX.................................. 57v-c forte..................................... 44vcf vaginal contraceptive...........47VECAMYL.................................37vecuronium bromide................. 65VELCADE................................. 24VELETRI................................... 64velivet........................................52VELTASSA............................... 42

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VEMLIDY.................................. 28VENCLEXTA.............................25VENCLEXTA STARTING PACK........................................ 25venlafaxine hcl.......................... 20venlafaxine hcl er...................... 20VENTAVIS................................ 64VENTOLIN HFA........................64verapamil hcl.............................36verapamil hcl er.........................36vic-forte..................................... 44vicodin.......................................13vicodin es.................................. 13vicodin hp..................................13VICTOZA.................................. 32VIDEX....................................... 29VIDEX EC................................. 29vienva........................................52vigabatrin.................................. 18vigadrone.................................. 18VIIBRYD....................................20VIIBRYD STARTER PACK....... 20VIMIZIM.................................... 46VIMPAT.....................................19vinblastine sulfate..................... 24vincristine sulfate...................... 24vinorelbine tartrate.................... 24viorele....................................... 52VIRACEPT................................ 30VIREAD.....................................29virt-caps.................................... 44virt-gard.....................................44virt-phos 250 neutral................. 42VISTOGARD.............................59vita s forte................................. 44vitacel........................................44vitamax pediatric....................... 44vita-min..................................... 44vitamin b complex 100.............. 44vitamin d (ergocalciferol)...........44vitamin k1..................................44vitamins acd-fluoride................. 44VIVITROL..................................14VONVENDI............................... 34voriconazole..............................21VOTRIENT................................26vp-pnv-dha................................ 44vp-vite rx................................... 44vyfemla......................................52vylibra........................................52VYVANSE................................. 38VYXEOS................................... 23warfarin sodium.........................33

wera.......................................... 52WIDE-SEAL DIAPHRAGM 60.. 59WINRHO SDF...........................56wixela inhub.............................. 63WP THYROID........................... 54wymzya fe................................. 52XALKORI.................................. 26XARELTO................................. 33XARELTO STARTER PACK.....33XELJANZ.................................. 56XELJANZ XR............................ 56XIAFLEX................................... 46XIFAXAN...................................16XIIDRA...................................... 60XOLAIR.....................................65XTANDI.....................................23xulane....................................... 52xylocaine dental........................ 14XYNTHA................................... 34XYNTHA SOLOFUSE...............34YERVOY................................... 26yuvafem.................................... 52zafirlukast..................................63zaleplon.....................................65ZALTRAP..................................24ZANOSAR.................................23zarah......................................... 52ZELBORAF............................... 26ZEMAIRA.................................. 65zenatane................................... 41ZENPEP....................................46ZEPATIER................................ 28zidovudine.................................29zileuton er................................. 63ziprasidone hcl.......................... 27ZIRGAN.................................... 60ZITHROMAX.............................17ZOLADEX................................. 49zoledronic acid.......................... 57ZOLINZA...................................24zolmitriptan................................22zolpidem tartrate....................... 65ZOMIG...................................... 22zonisamide................................18ZONTIVITY............................... 34ZORTRESS.............................. 55ZOSTAVAX...............................57zovia 1/35e (28)........................ 52zumandimine.............................52ZYDELIG...................................25ZYKADIA...................................26ZYPREXA RELPREVV............. 27ZYTIGA..................................... 23

ZYVOX......................................16

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Nondiscrimination notice and access to communication services

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ध्यान दें: यदि आप हिंदी (Hindi) बोलते है, आपको भाषा सहायता सेबाए,ं नि:शुल्क उपलब्ध हैं। कृपया अपने पहचान पत्र पर सूचीबद्ध टोल-फ्री फोन नंबर पर कॉल करें।

CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim qhia tus kheej.

ចំណាប់អារម្មណ៍ៈ បើសិនអ្នកនិយាយភាសាខ្មែរ(Khmer)សេវាជំនួយភាសាដោយឥតគិតថ្លៃ គឺមានសំរាប់អ្នក។សូមទូរស័ព្ទទៅលេខឥតគិតថ្លៃ ដែលមាននៅលើអត្ដសញ្ញាណប័ណ្ណរបស់អ្នក។

PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll-free a numero ti telepono nga nakalista ayan iti identi-fication card mo.

DÍÍ BAA’ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti’go, saad bee áka›anída›awo›ígíí, t’áá jíík’eh, bee ná’ahóót’i’. T’áá shǫǫdí ninaaltsoos nitł’izí bee nééhozinígíí bine’dę́ę́› t’áá jíík’ehgo béésh bee hane’í biká’ígíí bee hodíilnih.

OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga.

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