drug formulary update, january 2022 commercial programs

Formulary Abbreviations: F = Formulary, NF = Non-Formulary, PA = Prior Authorization, ST = Step Therapy, NC = Not Covered, SP = Specialty Drug, QL = Quantity Limit. MED = covered as a medical claim. A current formulary status is not shown for new medications. PRx = PreferredRx Drug Formulary, GA = GenericsAdvantageRx Drug Formulary.

Drug Formulary Update, January 2022

Commercial Programs

Updates to the HealthPartners Commercial Formularies (PreferredRx and GenericsAdvantageRx) are listed below. Please see www.healthpartners.com/formularies for details. Updates are effective by January 1, 2022. Updates include

Drug name Current

Status New Status Notes

Canagliflozin (Invokana)

F-QL NF-PA-QL Empagliflozin (Jardiance) remains on-formulary as the preferred alternative.

This update also applies to canagliflozin/ metformin (Invokamet and Invokamet XR).

Emtricitabine/ tenofovir (Descovy)

F F-PA Generic Truvada is preferred. Descovy is reserved for patients with: 1. decreased bone mineral density due to

osteopenia or osteoporosis, OR 2. decreased renal function (defined as creatinine

clearance <60 mL/ min, or documentation of a significant decline), OR

3. 65 years of age and older

Continuous glucose monitoring systems (Dexcom and Freestyle Libre)

COV-PA-QL COV-ST-QL Coverage criteria have been updated, including a step-therapy from insulin.

If you've used insulin within the previous 6 months, these will be covered.

These are also available for patients with type 2 diabetes and one of the following:

1. documented hypoglycemia, or 2. documentation of considerable variability in

glucose levels or inability to reach A1c goals despite frequent medication dose adjustments for 2 of more glucose lowering agents; or

3. documentation of barriers to glucose testing with glucose test strips (such as visual impairment, cognitive issues, and care giver assisting with care)

http://www.healthpartners.com/formularies

Formulary Update, page 2 of 22


Drug name Current

Status New Status Notes

True Metrix glucose test strips

COV-QL NC-QL Accu-Chek remains as the preferred alternative.

Interferon beta (Rebif)

F-SP-QL F-SP-PA-QL Reserved for patients with an inadequate response or a medical contraindication to Avonex AND Plegridy

Weight loss medications, Saxenda and Wegovy

NF-PA NF-PA PA update. Phentermine/ topiramate (Qsymia) and naltrexone/ bupropion (Contrave) are preferred.

Mometasone/ formoterol (Dulera)

F-PA NF-PA Preferred alternatives include budesonide/ formoterol (Symbicort generic).

Salmeterol (Serevent)

F F-PA Olodaterol (Striverdi) remains on-formulary as the preferred alternative.

Ustekinumab (Stelara)

MED-PA F-PA-SP Ustekinumab (Stelara) is being added to HealthPartners’ self-administered drug list.

Medications on the self-administered drug list are processed through the pharmacy benefit.

All updates

GENERIC NAME Label Name PRx

Current GA Current New Status

ABIRATERONE ACETATE ABIRATERONE ACETATE 250 MG TAB

F PA F PA QL F PA QL

ACETAMINOPHEN/ CAFFEINE/ DIHYDROCODEINE BITARTRATE

ACETAMIN-CAF-DIHYDROCODEIN 325

NF PA NF PA F-PA

ACETAMINOPHEN/ CAFFEINE/ DIHYDROCODEINE BITARTRATE

ACETAMN-CAF-DIHYDRCODEIN 320.5

NF NF F-PA

ACYCLOVIR ACYCLOVIR 5% CREAM NF PA QL NF PA QL F-PA-QL

ACYCLOVIR ACYCLOVIR 5% OINTMENT NF QL NF QL F-PA-QL

ALCAFTADINE LASTACAFT 0.25% EYE DROPS NF NF F-PA

ALIROCUMAB PRALUENT 150 MG/ML PEN NF PA QL NF PA NF PA QL

ALIROCUMAB PRALUENT 75 MG/ML PEN NF PA QL NF PA NF PA QL

ALITRETINOIN PANRETIN 0.1% GEL NF NF NF PA





ALMOTRIPTAN MALATE ALMOTRIPTAN MALATE 12.5 MG TAB

NF QL NF QL F-PA-QL

ALMOTRIPTAN MALATE ALMOTRIPTAN MALATE 6.25 MG TAB

NF QL NF QL F-PA-QL

ALPROSTADIL CAVERJECT 20 MCG VIAL NF EXCL NF

ALPROSTADIL CAVERJECT 40 MCG VIAL NF EXCL NF

ALPROSTADIL CAVERJECT IMPULSE 10 MCG KIT NF EXCL NF

ALPROSTADIL CAVERJECT IMPULSE 10 MCG SYRNG

NF EXCL NF

ALPROSTADIL CAVERJECT IMPULSE 20 MCG KIT NF EXCL NF

ALPROSTADIL CAVERJECT IMPULSE 20 MCG SYRNG

NF EXCL NF

ALPROSTADIL EDEX 10 MCG CARTRIDGE 2-PK KIT NF EXCL NF






ALPROSTADIL MUSE 1,000 MCG URETHRAL SUPP NF EXCL NF

ALPROSTADIL MUSE 125 MCG URETHRAL SUPPOS NF EXCL NF



ALPROSTADIL IN BACTERIOSTATIC SODIUM CHLORIDE

IFE-PG20 100 MCG/5 ML VIAL NF EXCL NC

AMITRIPTYLINE HCL/ CHLORDIAZEPOXIDE

CHLORDIAZEPO-AMITRIPTYL 5-12.5 NF NF F-PA

AMITRIPTYLINE HCL/ CHLORDIAZEPOXIDE

CHLORDIAZEPOX-AMITRIPTYL 10-25

NF NF F-PA

AMOXAPINE AMOXAPINE 100 MG TABLET NF NF F-PA




AMPHETAMINE SULFATE AMPHETAMINE SULFATE 10 MG TAB

NF QL NF QL F-PA-QL

AMPHETAMINE SULFATE AMPHETAMINE SULFATE 5 MG TAB NF QL NF QL F-PA-QL

ANASTROZOLE ARIMIDEX 1 MG TABLET NF NF NF PA

ANTHRALIN DRITHOCREME HP 1% CREAM F NF NF

APOMORPHINE HCL KYNMOBI 10 MG SL FILM S NF PA S NF PA S F PA









APOMORPHINE HCL KYNMOBI TITRATION KIT S NF PA S NF PA S F PA

APRACLONIDINE HCL APRACLONIDINE HCL 0.5% DROPS NF NF F-PA

APREMILAST OTEZLA 30 MG TABLET S F PA QL S F PA S F PA QL

ARFORMOTEROL TARTRATE ARFORMOTEROL 15 MCG/2 ML SOLN

NF PA NF PA maintain

ARFORMOTEROL TARTRATE BROVANA 15 MCG/2 ML SOLUTION NF PA NF PA F-PA

ASPIRIN/ OMEPRAZOLE ASPIRIN-OMEPRAZOL DR 325-40 MG

NF NF F-PA

ASPIRIN/ OMEPRAZOLE ASPIRIN-OMEPRAZOLE DR 81-40 MG

NF NF F-PA

AVANAFIL STENDRA 100 MG TABLET NF EXCL NF



AZACITIDINE ONUREG 200 MG TABLET F PA F PA QL F PA QL

AZACITIDINE ONUREG 300 MG TABLET F PA F PA QL F PA QL

AZITHROMYCIN AZASITE 1% EYE DROPS NF NF F-PA

BENZHYDROCODONE HCL/ ACETAMINOPHEN

BENZHYDROCOD-ACETAMIN 4.08-325

NF NF F-PA

BENZHYDROCODONE HCL/ ACETAMINOPHEN

BENZHYDROCOD-ACETAMIN 8.16-325

NF NF F-PA

BENZYL ALCOHOL ULESFIA 5% LOTION NF NF F-PA

BEXAROTENE BEXAROTENE 75 MG CAPSULE NF PA QL NF PA QL F-PA-QL

BICALUTAMIDE CASODEX 50 MG TABLET NF NF NF PA

BRIMONIDINE TARTRATE ALPHAGAN P 0.1% DROPS F NF F

BRIMONIDINE TARTRATE/ TIMOLOL MALEATE

COMBIGAN 0.2%-0.5% EYE DROPS F NF F

BRINZOLAMIDE BRINZOLAMIDE 1% EYE DROPS F NF F

BRINZOLAMIDE/ BRIMONIDINE TARTRATE

SIMBRINZA 1%-0.2% EYE DROPS F NF F

BUPRENORPHINE HCL BUPRENORPHINE 2 MG TABLET SL NF QL NF QL F-PA-QL

BUPRENORPHINE HCL BUPRENORPHINE 8 MG TABLET SL NF QL NF QL F-PA-QL

BUTALBITAL/ ACETAMINOPHEN/ CAFFEINE/ CODEINE PHOSPHATE

BUTALB-ACETAMIN-CAF-COD 50-300

NF QL NF QL F-PA-QL





BUTALBITAL/ ACETAMINOPHEN/ CAFFEINE/ CODEINE PHOSPHATE

BUTALB-ACETAMIN-CAF-COD 50-325

NF NF F-PA

CALCITRIOL CALCITRIOL 3 MCG/G OINTMENT F PA NF PA F PA

CANNABIDIOL (CBD) EPIDIOLEX 100 MG/ML SOLUTION S F PA QL S F QL S F PA QL

CARBINOXAMINE MALEATE CARBINOXAMINE MALEATE 4 MG TAB

NF NF F-PA

CARISOPRODOL CARISOPRODOL 250 MG TABLET NF QL NF QL F-PA-QL

CARISOPRODOL CARISOPRODOL 350 MG TABLET NF QL NF QL F-PA-QL

CARISOPRODOL/ ASPIRIN/ CODEINE PHOSPHATE

CARISOPRODOL-ASPIRIN-CODEIN TB

NF QL NF QL F-PA-QL

CEFACLOR CEFACLOR 500 MG CAPSULE NF NF F-PA

CETIRIZINE HCL ZERVIATE 0.24% EYE DROP NF PA NF PA F-PA

CETRORELIX ACETATE CETROTIDE 0.25 MG KIT F EXCL F

CHLOROTHIAZIDE DIURIL 250 MG/5 ML ORAL SUSP F NF F

CHLORPROMAZINE HCL CHLORPROMAZINE 10 MG TABLET NF F PA F PA





CHORIOGONADOTROPIN ALFA

OVIDREL 250 MCG/0.5 ML SYRG F EXCL F

CHORIONIC GONADOTROPIN, HUMAN

CHORIONIC GONAD 1 MILLION UNIT

NF EXCL NF


CHORIONIC GONAD 10,000 UNIT VL F EXCL F





NF EXCL NF



NF EXCL NF


CHORIONIC GONAD 50,000 UNIT VL NF EXCL NF




CHORIONIC GONADOTROPIN POWDER

NF EXCL NF


NOVAREL 10,000 UNITS VIAL F EXCL F






NOVAREL 5,000 UNIT VIAL F EXCL F


PREGNYL 10,000 UNITS VIAL F EXCL F

CIPROFLOXACIN HCL CIPROFLOXACIN 0.2% OTIC SOLN NF NF F-PA

CIPROFLOXACIN HCL/ FLUOCINOLONE ACETONIDE

CIPROFLOX-FLUOCINLN 0.3-0.025% NF NF F-PA

CLINDAMYCIN PHOSPHATE CLEOCIN T 1% SOLUTION F QL NF QL NF QL

CLOMIPHENE CITRATE CLOMIPHENE CITRATE 50 MG TAB F EXCL F

CLOMIPHENE CITRATE SEROPHENE 50 MG TABLET F EXCL F

CLONIDINE HCL CLONIDINE HCL ER 0.1 MG TABLET F PA QL NF QL F PA QL

CLORAZEPATE DIPOTASSIUM CLORAZEPATE 15 MG TABLET NF QL NF QL F-PA-QL

CLORAZEPATE DIPOTASSIUM CLORAZEPATE 3.75 MG TABLET NF QL NF QL F-PA-QL

CLORAZEPATE DIPOTASSIUM CLORAZEPATE 7.5 MG TABLET NF QL NF QL F-PA-QL

CORTICOTROPIN ACTHAR GEL 400 UNIT/5 ML VIAL NF PA S F PA S F PA

CORTISONE ACETATE CORTISONE 25 MG TABLET NF NF F-PA

CROMOLYN SODIUM CROMOLYN 20 MG/2 ML NEB SOLN NF F PA F PA

CROTAMITON EURAX 10% CREAM F NF F-PA

CYCLOPENTOLATE HCL CYCLOPENTOLATE HCL 2% DROPS F NF NF

DAPSONE ACZONE 5% GEL NF PA NF NF PA

DAPSONE DAPSONE 5% GEL F PA NF F PA

DARIFENACIN HYDROBROMIDE

DARIFENACIN ER 15 MG TABLET NF NF F-PA


DARIFENACIN ER 7.5 MG TABLET NF NF F-PA


ENABLEX 15 MG TABLET NF NF F-PA


ENABLEX 7.5 MG TABLET NF NF F-PA

DEFERASIROX DEFERASIROX 360 MG TABLET S F PA S NF PA S F PA

DELAFLOXACIN MEGLUMINE BAXDELA 450 MG TABLET NF PA NF PA F-PA

DESLORATADINE DESLORATADINE 5 MG TABLET NF NF F-PA

DICLOFENAC SODIUM/ MISOPROSTOL

DICLOFENAC-MISOPROST 50-0.2 MG

NF NF F-PA

DICLOFENAC SODIUM/ MISOPROSTOL

DICLOFENAC-MISOPROST 75-0.2 MG

NF NF F-PA

DIFLUNISAL DIFLUNISAL 500 MG TABLET NF NF F-PA

DIFLUPREDNATE DUREZOL 0.05% EYE DROPS NF NF F-PA

DIHYDROERGOTAMINE MESYLATE

DIHYDROERGOTAMINE 1 MG/ML AMP

NF PA QL NF PA QL F-PA-QL





DIHYDROERGOTAMINE MESYLATE

DIHYDROERGOTAMINE 4 MG/ML SPRY


DIMETHYL FUMARATE DIMETHYL FUMARATE 30D START PK

S F QL S F S F QL

DIMETHYL FUMARATE DIMETHYL FUMARATE DR 120 MG CP

S F QL S F S F QL

DIMETHYL FUMARATE DIMETHYL FUMARATE DR 240 MG CP

S F QL S F S F QL

DOXEPIN HCL DOXEPIN HCL 3 MG TABLET NF PA NF PA F-PA

DOXEPIN HCL DOXEPIN HCL 6 MG TABLET NF PA NF PA F-PA

DOXORUBICIN HCL ADRIAMYCIN 200 MG/100 ML VIAL MED NF MED

DOXYCYCLINE MONOHYDRATE

MONDOXYNE NL 100 MG CAPSULE NF PA F NF PA

DOXYCYCLINE MONOHYDRATE

MONDOXYNE NL 75 MG CAPSULE NF PA NF NF PA

DUPILUMAB DUPIXENT 300 MG/2 ML PEN S F PA QL S F PA S F PA QL

DUTASTERIDE/ TAMSULOSIN HCL

DUTASTERIDE-TAMSULOSIN 0.5-0.4 F NF F-PA

ECHOTHIOPHATE IODIDE PHOSPHOLINE IODIDE 0.125% F NF F

ELAGOLIX SODIUM ORILISSA 150 MG TABLET S-F PA QL S-F PA QL S-F PA QL

ELAGOLIX SODIUM ORILISSA 200 MG TABLET S-F PA QL S-F PA QL S-F PA QL

ELAGOLIX SODIUM/ ESTRADIOL/ NORETHINDRONE ACETATE

ORIAHNN 300-1-0.5MG/300MG CAPS

F PA QL S F PA QL S F PA QL

ELETRIPTAN HYDROBROMIDE ELETRIPTAN HBR 20 MG TABLET NF QL F PA QL F PA QL

ELETRIPTAN HYDROBROMIDE ELETRIPTAN HBR 40 MG TABLET NF QL F PA QL F PA QL

EMOL53/ E.WATER/ NAMGFS/ NAPHOS/ NACL/ HYPOCHLOROUS ACID/ NAHYPOCL

MB HYDROGEL KIT NF PA EXCL PA NF PA

ERGOLOID MESYLATES ERGOLOID MESYLATES 1 MG TAB NF F PA F PA

ERGOTAMINE TARTRATE ERGOMAR 2 MG TABLET SL F QL NF QL NF QL

ERGOTAMINE TARTRATE/ CAFFEINE

ERGOTAMINE-CAFFEINE 1-100MG TB

NF QL NF QL F-PA-QL

ERYTHROMYCIN BASE ERYTHROMYCIN 500 MG FILMTAB NF NF F-PA

ESTAZOLAM ESTAZOLAM 1 MG TABLET NF QL NF QL F-PA-QL

ESTAZOLAM ESTAZOLAM 2 MG TABLET NF QL NF QL F-PA-QL

ESTRADIOL ESTRING 2 MG VAGINAL RING F NF F

ESTRADIOL IMVEXXY 10 MCG MAINTENANCE PAK

NF QL EXCL NF QL

ESTRADIOL IMVEXXY 10 MCG STARTER PACK NF QL EXCL NF QL





ESTRADIOL IMVEXXY 4 MCG MAINTENANCE PACK

NF QL EXCL NF QL

ESTRADIOL IMVEXXY 4 MCG STARTER PACK NF QL EXCL NF QL

ESTRADIOL/ LEVONORGESTREL

CLIMARA PRO PATCH F NF F

ESTRADIOL/ NORETHINDRONE ACETATE

COMBIPATCH 0.05-0.14 MG PTCH F NF F

ESTRADIOL/ NORETHINDRONE ACETATE

COMBIPATCH 0.05-0.25 MG PTCH F NF F

ESTROGENS, CONJUGATED PREMARIN 0.3 MG TABLET F NF F





ESTROGENS, CONJUGATED/ MEDROXYPROGESTERONE ACETATE

PREMPHASE 0.625-5 MG TABLET F NF F

ETHACRYNIC ACID ETHACRYNIC ACID 25 MG TABLET NF PA NF PA F-PA

EVEROLIMUS EVEROLIMUS 0.25 MG TABLET NF NF F-PA



EVEROLIMUS EVEROLIMUS 2.5 MG TABLET F PA QL F PA F PA QL

EVEROLIMUS ZORTRESS 1 MG TABLET NF NF F-PA

EXEMESTANE AROMASIN 25 MG TABLET NF NF NF PA

EZETIMIBE/ SIMVASTATIN EZETIMIBE-SIMVASTATIN 10-10 MG NF NF F-PA




FENOPROFEN CALCIUM FENOPROFEN 200 MG CAPSULE NF NF F-PA

FENOPROFEN CALCIUM FENOPROFEN 400 MG CAPSULE NF NF F-PA

FENOPROFEN CALCIUM FENOPROFEN 600 MG TABLET NF NF F-PA

FENTANYL CITRATE FENTANYL CIT 100 MCG BUCCAL TB NF PA NF NF PA



FENTANYL CITRATE FENTORA 100 MCG BUCCAL TABLET

NF PA NF NF PA


NF PA NF NF PA


NF PA NF NF PA





FLAVOXATE HCL FLAVOXATE HCL 100 MG TABLET NF NF F-PA

FLIBANSERIN ADDYI 100 MG TABLET NF PA EXCL NF PA

FLUCYTOSINE FLUCYTOSINE 250 MG CAPSULE NF PA NF PA F-PA

FLUCYTOSINE FLUCYTOSINE 500 MG CAPSULE NF PA NF PA F-PA

FLUOROURACIL FLUOROPLEX 1% CREAM F NF NF

FLURANDRENOLIDE CORDRAN 4 MCG/SQ CM TAPE LARGE

F PA NF PA F PA

FLURAZEPAM HCL FLURAZEPAM 15 MG CAPSULE NF QL NF QL F-PA-QL

FLURAZEPAM HCL FLURAZEPAM 30 MG CAPSULE NF QL NF QL F-PA-QL

FLUVASTATIN SODIUM FLUVASTATIN ER 80 MG TABLET NF NF F-PA

FLUVASTATIN SODIUM FLUVASTATIN SODIUM 20 MG CAP NF NF F-PA

FLUVASTATIN SODIUM FLUVASTATIN SODIUM 40 MG CAP NF NF F-PA

FOLLITROPIN ALFA, RECOMBINANT

GONAL-F 1,050 UNITS VIAL NF EXCL NF


GONAL-F 450 UNITS VIAL NF EXCL NF


GONAL-F RFF 75 UNITS VIAL NF EXCL NF


GONAL-F RFF REDI-JECT 300 UNIT NF EXCL NF





FOLLITROPIN BETA,RECOMBINANT

FOLLISTIM AQ 300 UNIT CARTRIDG F EXCL F





FORMOTEROL FUMARATE FORMOTEROL 20 MCG/2 ML NEB VL

NF PA NF PA maintain

FORMOTEROL FUMARATE PERFOROMIST 20 MCG/2 ML SOLN NF PA NF PA F-PA

FROVATRIPTAN SUCCINATE FROVATRIPTAN SUCC 2.5 MG TAB NF QL NF QL F-PA-QL

GABAPENTIN/ LIDOCAINE/ PRILOCAINE/ TRANSPARENT DRESSING

LIPRITIN II KIT NF NF PA NC

GANIRELIX ACETATE GANIRELIX ACET 250 MCG/0.5 ML F EXCL F

GATIFLOXACIN GATIFLOXACIN 0.5% EYE DROPS F NF F

GEMIFLOXACIN MESYLATE FACTIVE 320 MG TABLET NF NF F-PA

GENTAMICIN SULFATE GENTAK 0.3 % EYE OINTMENT NF NF F-PA





GENTAMICIN SULFATE GENTAMICIN 0.3% EYE DROP NF NF F-PA

GENTAMICIN SULFATE/ PREDNISOLONE ACETATE

PRED-G 1% EYE DROPS NF NF F-PA

GENTAMICIN SULFATE/ PREDNISOLONE ACETATE

PRED-G S.O.P. EYE OINTMENT NF NF F-PA

GRANISETRON SANCUSO 3.1 MG/24 HR PATCH NF NF NF PA

GRANISETRON HCL GRANISETRON HCL 1 MG TABLET NF NF F PA

GUANIDINE HCL GUANIDINE HCL 125 MG TABLET NF NF F-PA

HALOBETASOL PROPIONATE HALOBETASOL PROP 0.05% FOAM NF NF F-PA

HYALURONATE SODIUM TRIVISC 25 MG/2.5 ML SYR MED PA MED PA MED

HYALURONATE SODIUM, MODIFIED, NON-CROSSLINKED

HYMOVIS 24 MG/3 ML SYRINGE MED PA MED PA MED

HYALURONATE SODIUM, STABILIZED

DUROLANE 60 MG/3 ML SYRINGE MED PA MED PA MED

HYDROCODONE BITARTRATE HYDROCODONE ER 10 MG CAPSULE

NF PA NF PA F-PA


NF PA NF PA F-PA


NF PA NF PA F-PA


NF PA NF PA F-PA


NF PA NF PA F-PA


NF PA NF PA F-PA

HYDROCODONE POLISTIREX/ CHLORPHENIRAMINE POLISTIREX

HYDROCODONE-CHLORPHEN ER SUSP

NF NF F-PA

HYDROCORTISONE ACETATE/ PRAMOXINE HCL

PROCTOFOAM-HC 1%-1% FOAM F NF NF

HYDROCORTISONE SOD SUCCINATE

SOLU-CORTEF 100 MG VIAL MED MED F

HYDROCORTISONE SODIUM SUCCINATE/ PF

SOLU-CORTEF 250 MG ACT-O-VIAL MED MED F

HYDROCORTISONE SODIUM SUCCINATE/ PF

SOLU-CORTEF 500 MG ACT-O-VIAL MED MED F

HYDROCORTISONE/ ACETIC ACID

HYDROCORTISON-ACETIC ACID SOLN

NF NF F-PA

HYDROMORPHONE HCL HYDROMORPHONE HCL ER 12 MG TAB

NF PA NF PA F-PA






NF PA NF PA F-PA


NF PA NF PA F-PA


NF PA NF PA F-PA

HYDROXYPROGESTERONE CAPROATE

HYDROXYPROGESTERONE CAPROATE MULTIDOSE 1.25 G/5ML VIAL

MED MED NC

HYDROXYPROGESTERONE CAPROATE

MAKENA 1,250 MG/5 ML VIAL MED MED NC

HYDROXYPROGESTERONE CAPROATE/ PF

MAKENA 250 MG/ML VIAL S-F QL S-F QL NC

HYDROXYPROGESTERONE CAPROATE/ PF

MAKENA 275 MG/1.1 ML AUTOINJCT

S-F QL S-F QL NC

HYDROXYPROPYL CELLULOSE LACRISERT 5 MG EYE INSERT F PA NF PA NF PA

HYDROXYUREA HYDREA 500 MG CAPSULE NF NF NF PA

IBUPROFEN/ FAMOTIDINE DUEXIS 800-26.6 MG TABLET NF PA NF PA F-PA

INDOMETHACIN, SUBMICRONIZED

INDOMETHACIN 20 MG CAPSULE EXCL EXCL PA EXCL/ NF-PA

INSULIN ASPART INSULIN ASPART 100 UNIT/ML CRT NF PA NF PA F-PA

INSULIN ASPART INSULIN ASPART 100 UNIT/ML PEN NF PA NF PA F-PA

INSULIN ASPART INSULIN ASPART 100 UNIT/ML VL NF PA NF PA F-PA

INTERFERON BETA-1A/ ALBUMIN HUMAN

REBIF 22 MCG/0.5 ML SYRINGE S-F QL S-F QL S-F PA QL


REBIF 44 MCG/0.5 ML SYRINGE S-F QL S-F QL S-F PA QL


REBIF REBIDOSE 22 MCG/0.5 ML S-F QL S-F QL S-F PA QL


REBIF REBIDOSE 44 MCG/0.5 ML S-F QL S-F QL S-F PA QL


REBIF REBIDOSE TITRATION PACK S-F QL S-F QL S-F PA QL


REBIF TITRATION PACK S-F QL S-F QL S-F PA QL

IVERMECTIN IVERMECTIN 0.5% LOTION NF PA NF PA F-PA

KETAMINE HCL IN 0.9 % SODIUM CHLORIDE

KETAMINE 100 MG/100ML-0.9%NACL

MED PA MED MED PA

KETOPROFEN KETOPROFEN 25 MG CAPSULE NF NF F-PA







KETOROLAC TROMETHAMINE/ PF

ACUVAIL 0.45% OPHTH SOLUTION F PA NF NF

LANSOPRAZOLE/ AMOXICILLIN TRIHYDRATE/ CLARITHROMYCIN

LANSOPRAZOL-AMOXICIL-CLARITHRO

NF NF F-PA

LANTHANUM CARBONATE LANTHANUM CARB 1,000 MG TB CHW

NF NF F-PA

LANTHANUM CARBONATE LANTHANUM CARB 500 MG TAB CHEW

NF NF F-PA

LANTHANUM CARBONATE LANTHANUM CARB 750 MG TAB CHEW

NF NF F-PA

LETROZOLE FEMARA 2.5 MG TABLET NF NF NF PA

LEUPROLIDE ACETATE LEUPROLIDE 2WK 1 MG/0.2 ML KIT F EXCL F

LEUPROLIDE ACETATE LEUPROLIDE 2WK 14 MG/2.8 ML KT F EXCL F

LEVOCETIRIZINE DIHYDROCHLORIDE

LEVOCETIRIZINE 5 MG TABLET NF NF F-PA

LEVOFLOXACIN LEVOFLOXACIN 0.5% EYE DROPS NF NF F-PA

LEVONORGESTREL/ ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL

LEVONORG 0.15MG-EE 20-25-30MCG

F NF F

LEVORPHANOL TARTRATE LEVORPHANOL 2 MG TABLET NF PA NF PA F-PA

LEVORPHANOL TARTRATE LEVORPHANOL 3 MG TABLET NF PA NF PA F-PA

LIDOCAINE LIDOCAINE 5% PATCH F PA QL NF QL F PA QL

LIDOCAINE LIDODERM 5% PATCH NF PA QL NF QL NF PA QL

LIDOCAINE/ TETRACAINE LIDOCAINE-TETRACAINE 7%-7% CRM

NF NF F-PA

LINDANE LINDANE 1% SHAMPOO NF NF F-PA

LIOTRIX THYROLAR-1 STRENGTH TABLET NF NF F-PA

LIOTRIX THYROLAR-1/2 STRENGTH TAB NF NF F-PA

LIOTRIX THYROLAR-1/4 STRENGTH TAB NF NF F-PA



LIRAGLUTIDE SAXENDA 18 MG/3 ML PEN NF PA NF PA #REF!

LODOXAMIDE TROMETHAMINE

ALOMIDE 0.1% EYE DROPS NF NF F-PA

LOTEPREDNOL ETABONATE ALREX 0.2% EYE DROPS NF NF F-PA

LOTEPREDNOL ETABONATE LOTEMAX 0.5% EYE OINTMENT F NF F

LOTEPREDNOL ETABONATE LOTEMAX SM 0.38% OPHTH GEL F NF F

LOTEPREDNOL ETABONATE LOTEPREDNOL 0.5% OPHTHALMC GEL

F NF F





LOTEPREDNOL ETABONATE LOTEPREDNOL ETABONATE 0.5% DRP

F NF F

LULICONAZOLE LULICONAZOLE 1% CREAM NF PA NF PA F-PA

MAFENIDE ACETATE MAFENIDE ACETATE 50 GM POWD PK

NF NF F-PA

MAPROTILINE HCL MAPROTILINE 25 MG TABLET NF NF F-PA



MECLIZINE HCL MECLIZINE 25 MG TABLET NF NF F-PA

MECLOFENAMATE SODIUM MECLOFENAMATE 100 MG CAPSULE

NF NF F-PA

MECLOFENAMATE SODIUM MECLOFENAMATE 50 MG CAPSULE NF NF F-PA

MEFENAMIC ACID MEFENAMIC ACID 250 MG CAPSULE

NF NF F-PA

MELPHALAN ALKERAN 2 MG TABLET NF NF NF PA

MENOTROPINS MENOPUR 75 UNIT VIAL F EXCL F

MEPROBAMATE MEPROBAMATE 200 MG TABLET NF QL NF QL F-PA-QL

MEPROBAMATE MEPROBAMATE 400 MG TABLET NF QL NF QL F-PA-QL

METAXALONE METAXALONE 800 MG TABLET NF NF F-PA

METHENAMINE HIPPURATE METHENAMINE HIPP 1 GM TABLET NF NF F-PA

METHOTREXATE SODIUM TREXALL 10 MG TABLET NF NF NF PA



METHOTREXATE SODIUM TREXALL 7.5 MG TABLET NF NF NF PA

METHSCOPOLAMINE BROMIDE

METHSCOPOLAMINE BROM 2.5 MG TB

NF NF F-PA

METHSCOPOLAMINE BROMIDE

METHSCOPOLAMINE BROM 5 MG TAB

NF NF F-PA

METHSUXIMIDE CELONTIN 300 MG KAPSEAL NF NF F-PA

METHYLTESTOSTERONE METHYLTESTOSTERONE 10 MG CAP NF PA QL F PA QL F PA QL

METIPRANOLOL METIPRANOLOL 0.3% EYE DROPS NF NF F-PA

METRONIDAZOLE METRONIDAZOLE TOPICAL 1% GEL F NF F

METRONIDAZOLE NORITATE 1% CREAM NF PA NF PA maintain

MILNACIPRAN HCL SAVELLA 100 MG TABLET F PA QL NF PA QL F PA QL

MILNACIPRAN HCL SAVELLA 12.5 MG TABLET F PA QL NF PA QL F PA QL



MILNACIPRAN HCL SAVELLA TITRATION PACK F PA QL NF PA QL F PA QL

MITOTANE LYSODREN 500 MG TABLET NF PA F PA F-PA





MONOMETHYL FUMARATE BAFIERTAM DR 95 MG CAPSULE S-F PA QL S-F QL S-F PA QL

NABUMETONE RELAFEN DS 1,000 MG TABLET EXCL NF PA EXCL/ NF-PA

NAFTIFINE HCL NAFTIFINE HCL 1% CREAM NF NF F-PA

NAFTIFINE HCL NAFTIFINE HCL 1% GEL NF PA NF PA F-PA

NAFTIFINE HCL NAFTIFINE HCL 2% CREAM NF QL NF QL F-PA-QL

NALTREXONE HCL/ BUPROPION HCL

CONTRAVE ER 8-90 MG TABLET NF NF F-PA

NAPROXEN/ ESOMEPRAZOLE MAGNESIUM

NAPROXEN-ESOMEPRAZ DR 375-20MG

NF PA NF PA F-PA

NAPROXEN/ ESOMEPRAZOLE MAGNESIUM

NAPROXEN-ESOMEPRAZ DR 500-20MG

NF PA NF PA F-PA

NATAMYCIN NATACYN EYE DROPS NF NF F-PA

NEDOCROMIL SODIUM ALOCRIL 2% EYE DROPS NF NF F-PA

NEOMYCIN/ POLYMYXIN B SULFATE/ DEXAMETHASONE

NEOMYC-POLYM-DEXAMETH EYE DROP

F NF NF

NEPAFENAC ILEVRO 0.3% OPHTH DROPS NF NF F-PA

NILUTAMIDE NILANDRON 150 MG TABLET NF NF NF PA

NILUTAMIDE NILUTAMIDE 150 MG TABLET NF NF F PA

NINTEDANIB ESYLATE OFEV 100 MG CAPSULE S-F PA S-F PA S-NF PA

NINTEDANIB ESYLATE OFEV 150 MG CAPSULE S-F PA S-F PA S-NF PA

NIVOLUMAB OPDIVO 100 MG/10 ML VIAL MED PA MED PA MED PA



NIZATIDINE NIZATIDINE 15 MG/ML SOLUTION NF NF F-PA

NIZATIDINE NIZATIDINE 150 MG CAPSULE NF NF F-PA

NIZATIDINE NIZATIDINE 300 MG CAPSULE NF NF F-PA

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL

NORETHIND-ETH ESTRAD 0.5-2.5 F NF F

NYSTATIN NYSTATIN 100,000 UNIT/ML SUSP F QL F F QL

NYSTATIN/ TRIAMCINOLONE ACETONIDE

NYSTATIN-TRIAMCINOLONE CREAM

NF NF F-PA

NYSTATIN/ TRIAMCINOLONE ACETONIDE

NYSTATIN-TRIAMCINOLONE OINTM NF NF F-PA

OLOPATADINE HCL OLOPATADINE 665 MCG NASAL SPRY

NF NF F-PA

OLSALAZINE SODIUM DIPENTUM 250 MG CAPSULE NF PA NF PA F-PA

ONDANSETRON HCL ZOFRAN 4 MG TABLET NF NF NF PA

ONDANSETRON HCL ZOFRAN 8 MG TABLET NF NF NF PA





OPIUM/ BELLADONNA ALKALOIDS

BELLADONNA-OPIUM 16.2-30 SUPP NF NF QL NF QL

ORLISTAT ALLI 60 MG CAPSULE F PA F PA #REF!

ORLISTAT XENICAL 120 MG CAPSULE F PA F PA #REF!

OSPEMIFENE OSPHENA 60 MG TABLET NF EXCL NF

OXANDROLONE OXANDRIN 10 MG TABLET NF QL NF PA QL NF PA QL

OXANDROLONE OXANDRIN 2.5 MG TABLET NF QL NF PA QL NF PA QL

OXANDROLONE OXANDROLONE 10 MG TABLET NF QL F PA QL F PA QL

OXANDROLONE OXANDROLONE 2.5 MG TABLET NF QL F PA QL F PA QL

OXAPROZIN OXAPROZIN 600 MG TABLET NF NF F-PA

OXAZEPAM OXAZEPAM 10 MG CAPSULE NF QL NF QL F-PA-QL



OXICONAZOLE NITRATE OXICONAZOLE NITRATE 1% CREAM NF QL NF QL F-PA-QL

OXICONAZOLE NITRATE OXISTAT 1% LOTION NF PA NF PA F-PA

OXYMETHOLONE ANADROL-50 TABLET NF PA NF PA F-PA

OXYMORPHONE HCL OXYMORPHONE HCL 10 MG TABLET

NF QL NF QL F-PA-QL

OXYMORPHONE HCL OXYMORPHONE HCL 5 MG TABLET NF QL NF QL F-PA-QL

OXYMORPHONE HCL OXYMORPHONE HCL ER 10 MG TAB NF PA NF PA F-PA





OXYMORPHONE HCL OXYMORPHONE HCL ER 5 MG TABLET

NF PA NF PA F-PA

OXYMORPHONE HCL OXYMORPHONE HCL ER 7.5 MG TAB

NF PA NF PA F-PA

OZANIMOD HYDROCHLORIDE ZEPOSIA 0.23-0.46 MG START PCK S-F QL S-F QL S-F PA QL

OZANIMOD HYDROCHLORIDE ZEPOSIA 0.23-0.46-0.92 MG KIT S-F QL S-F QL S-F PA QL

OZANIMOD HYDROCHLORIDE ZEPOSIA 0.92 MG CAPSULE S-F QL S-F QL S-F PA QL

PALM OIL/ BENZOYL PEROXIDE

KIVIK SKIN EMULSION EXCL NF NC

PAPAVERINE HCL/ PHENTOLAMINE MESYLATE IN WATER

IFE-BIMIX 30/1 150-5 MG/5 ML NF EXCL NC

PAPAVERINE HCL/ PHENTOLAMINE MESYLATE/ ALPROSTADIL IN WATER

PPVRN 12MG-PHNT 1MG-ALPR 10MCG

NF EXCL NC





PAPAVERINE HCL/ PHENTOLAMINE MESYLATE/ ALPROSTADIL IN WATER

PPVRN 30MG-PHNT 1MG-ALPR 20MCG

NF EXCL NC

PEG 3350/ SOD SULF/ SOD BICARB/ SOD CHLORIDE/ POTASSIUM CHLORIDE

COLYTE WITH FLAVOR PACKETS NF NF NF


GOLYTELY SOLUTION NF NF NF


PEG 3350 ELECTROLYTE SOLN NF NF F


PEG-3350 AND ELECTROLYTES SOLN

NF NF F

PEGFILGRASTIM NEULASTA 6 MG/0.6 ML SYRINGE S-NF PA S-NF PA NF-PA-SP

PEGFILGRASTIM NEULASTA ONPRO 6 MG/0.6 ML KIT

S-NF PA S-NF PA NF-PA-SP

PEGFILGRASTIM-APGF NYVEPRIA 6 MG/0.6 ML SYRINGE F F F-PA

PEGFILGRASTIM-BMEZ ZIEXTENZO 6 MG/0.6 ML SYRINGE F F F-PA

PEGFILGRASTIM-CBQV UDENYCA 6 MG/0.6 ML SYRINGE F F F-PA

PEGFILGRASTIM-JMDB FULPHILA 6 MG/0.6 ML SYRINGE F F F-PA

PEMBROLIZUMAB KEYTRUDA 100 MG/4 ML VIAL MED PA MED PA MED PA

PEMIGATINIB PEMAZYRE 4.5 MG TABLET F QL F PA QL F PA QL

PENCICLOVIR DENAVIR 1% CREAM NF NF F-PA

PENTAZOCINE HCL/ NALOXONE HCL

PENTAZOCINE-NALOXONE TABLET NF QL NF QL F-PA-QL

PERPHENAZINE/ AMITRIPTYLINE HCL

PERPHEN-AMITRIP 2 MG-10 MG TAB

NF AGE NF AGE F-PA-Age













PHENTERMINE HCL/ TOPIRAMATE

QSYMIA 11.25 MG-69 MG CAPSULE NF QL NF QL #REF!


QSYMIA 15 MG-92 MG CAPSULE NF QL NF QL #REF!









PIMOZIDE PIMOZIDE 1 MG TABLET NF AGE NF AGE F PA Age

PIMOZIDE PIMOZIDE 2 MG TABLET NF AGE NF AGE F PA Age

PIRFENIDONE ESBRIET 267 MG CAPSULE S-F PA S-F PA S-NF PA

PIRFENIDONE ESBRIET 267 MG TABLET S-F PA S-F PA S-NF PA

PIRFENIDONE ESBRIET 801 MG TABLET S-F PA S-F PA S-NF PA

PRAMIPEXOLE DI-HCL MIRAPEX ER 0.375 MG TABLET NF PA NF NF PA




PRAMIPEXOLE DI-HCL MIRAPEX ER 3 MG TABLET NF PA NF NF PA



PRAMIPEXOLE DI-HCL PRAMIPEXOLE ER 0.375 MG TABLET F PA NF NF




PRAMIPEXOLE DI-HCL PRAMIPEXOLE ER 3 MG TABLET F PA NF NF



PRASTERONE (DHEA) INTRAROSA 6.5 MG VAG INSERT NF EXCL NF

PRENATAL VITAMIN NO.59/ IRON CARB,FUM/ FOLIC ACID/ DOCUSATE/ DHA

CITRANATAL HARMONY CAPSULE NF PA NF NC

PRENATAL VITAMINS NO.147/ FERROUS GLUCONATE/ FOLIC ACID

AZESCO TABLET NF PA NF NC

PRENATAL VITS NO.114/ FERROUS ASPART GLYCINATE/ FOLATE NO.1

PRENATE ELITE TABLET F PA NF PA NC

PROGESTERONE, MICRONIZED

CRINONE 8% GEL NF EXCL NF

PROGESTERONE, MICRONIZED

ENDOMETRIN 100 MG VAG INSERT NF EXCL NF

PROTRIPTYLINE HCL PROTRIPTYLINE HCL 10 MG TABLET NF NF F-PA

PROTRIPTYLINE HCL PROTRIPTYLINE HCL 5 MG TABLET NF NF F-PA

QUAZEPAM QUAZEPAM 15 MG TABLET NF QL NF QL F-PA-QL





QUININE SULFATE QUININE SULFATE 324 MG CAPSULE

NF NF F-PA

RETAPAMULIN ALTABAX 1% OINTMENT F STEP NF F STEP

RIBOCICLIB SUCCINATE KISQALI 200 MG DAILY DOSE F PA QL F PA F PA QL



RISEDRONATE SODIUM RISEDRONATE SODIUM 150 MG TAB

F NF F

RISEDRONATE SODIUM RISEDRONATE SODIUM 30 MG TAB F NF F

RISEDRONATE SODIUM RISEDRONATE SODIUM 35 MG TAB F NF F

RISEDRONATE SODIUM RISEDRONATE SODIUM 5 MG TABLET

F NF F

RIVASTIGMINE RIVASTIGMINE 13.3 MG/24HR PTCH

F NF F

RIVASTIGMINE RIVASTIGMINE 4.6 MG/24HR PATCH

F NF F

RIVASTIGMINE RIVASTIGMINE 9.5 MG/24HR PATCH

F NF F

ROPINIROLE HCL REQUIP XL 12 MG TABLET NF PA NF NF PA




ROPINIROLE HCL ROPINIROLE HCL ER 12 MG TABLET F PA NF F PA





SELEGILINE EMSAM 12 MG/24 HOURS PATCH F PA NF PA F PA



SELUMETINIB SULFATE/ VITAMIN E TPGS

KOSELUGO 10 MG CAPSULE F PA QL F PA F PA QL

SELUMETINIB SULFATE/ VITAMIN E TPGS

KOSELUGO 25 MG CAPSULE F PA QL F PA F PA QL

SEMAGLUTIDE WEGOVY 0.25 MG/0.5 ML PEN NF PA NF PA #REF!


SEMAGLUTIDE WEGOVY 1 MG/0.5 ML PEN NF PA NF PA #REF!



SILDENAFIL CITRATE REVATIO 10 MG/12.5 ML VIAL MED PA MED MED PA





SILDENAFIL CITRATE SILDENAFIL 100 MG TABLET F EXCL F



SILDENAFIL CITRATE VIAGRA 100 MG TABLET NF PA EXCL NF PA



SILODOSIN SILODOSIN 4 MG CAPSULE NF NF F-PA

SILODOSIN SILODOSIN 8 MG CAPSULE NF NF F-PA

SODIUM CHLORIDE/ SODIUM BICARBONATE/ POTASSIUM CHLORIDE/ PEG

TRILYTE WITH FLAVOR PACKETS F F NF

SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE

FERRLECIT 62.5 MG/5 ML VIAL NF MED MED

SODIUM ZIRCONIUM CYCLOSILICATE

LOKELMA 10 GRAM POWDER PACKET

NF NF F

SODIUM ZIRCONIUM CYCLOSILICATE

LOKELMA 5 GRAM POWDER PACKET

NF NF F

SPINOSAD SPINOSAD 0.9% TOPICAL SUSP NF NF F-PA

SPIRONOLACTONE/ HYDROCHLOROTHIAZIDE

ALDACTAZIDE 50-50 TABLET F NF NF

STIRIPENTOL DIACOMIT 500 MG CAPSULE S F PA S F PA QL S F PA QL

SUCRALFATE CARAFATE 1 GM/10 ML SUSP NF NF PA NF PA

SUCRALFATE SUCRALFATE 1 GM/10 ML SUSP NF F PA F PA

SULCONAZOLE NITRATE SULCONAZOLE NITRATE 1% CREAM NF PA NF PA F-PA

SULCONAZOLE NITRATE SULCONAZOLE NITRATE 1% SOLN NF PA NF PA F-PA

SULFACETAMIDE SODIUM/ SULFUR

PLEXION 9.8-4.8% CLEANSER NF NF NC


PLEXION 9.8-4.8% CLNSING CLOTH NF NF NC


PLEXION 9.8-4.8% CREAM NF NF NC


PLEXION 9.8-4.8% LOTION NF NF NC

SULFADIAZINE SULFADIAZINE 500 MG TABLET NF NF F-PA

SUMATRIPTAN SUCCINATE ONZETRA XSAIL 11 MG/NOSEPIECE NF PA QL NF QL NF PA QL

SUMATRIPTAN SUCCINATE/ NAPROXEN SODIUM

SUMATRIPTAN-NAPROXEN 85-500 MG


TADALAFIL CIALIS 10 MG TABLET NF PA EXCL NF PA

TADALAFIL CIALIS 20 MG TABLET NF PA EXCL NF PA

TADALAFIL TADALAFIL 10 MG TABLET F EXCL F





TADALAFIL TADALAFIL 2.5 MG TABLET F QL F PA QL F QL

TADALAFIL TADALAFIL 20 MG TABLET F EXCL F

TADALAFIL TADALAFIL 5 MG TABLET F QL F PA QL F QL

TAPENTADOL HCL NUCYNTA 100 MG TABLET NF QL NF QL F-PA-QL



TAZAROTENE TAZORAC 0.05% CREAM F PA QL NF PA QL F PA QL

TAZAROTENE TAZORAC 0.05% GEL F PA QL NF PA QL F PA QL

TAZAROTENE TAZORAC 0.1% GEL F PA QL NF PA QL F PA QL

TERBUTALINE SULFATE TERBUTALINE SULFATE 2.5 MG TAB NF NF F-PA

TERBUTALINE SULFATE TERBUTALINE SULFATE 5 MG TAB NF NF F-PA

TETRACYCLINE HCL TETRACYCLINE 250 MG CAPSULE NF NF F-PA

TETRACYCLINE HCL TETRACYCLINE 500 MG CAPSULE NF NF F-PA

TINIDAZOLE TINIDAZOLE 250 MG TABLET NF NF F-PA

TINIDAZOLE TINIDAZOLE 500 MG TABLET NF NF F-PA

TOBRAMYCIN TOBRAMYCIN 300 MG/4 ML AMPULE

S NF PA NF PA S NF PA

TOBRAMYCIN/ LOTEPREDNOL ETABONATE

ZYLET EYE DROPS NF NF F-PA

TOCILIZUMAB ACTEMRA 162 MG/0.9 ML SYRINGE S F PA QL S F PA S F PA QL

TOLMETIN SODIUM TOLMETIN SODIUM 200 MG TAB NF F PA F PA

TOLMETIN SODIUM TOLMETIN SODIUM 400 MG CAP NF F PA F PA

TOLMETIN SODIUM TOLMETIN SODIUM 600 MG TAB NF F PA F PA

TOLVAPTAN JYNARQUE 15 MG TABLET S-NF PA S-NF PA S-NF PA

TOLVAPTAN JYNARQUE 15 MG-15 MG TABLET S-NF PA S-NF PA S-NF PA

TOLVAPTAN JYNARQUE 30 MG TABLET S-NF PA S-NF PA S-NF PA





TOLVAPTAN TOLVAPTAN 15 MG TABLET S NF PA S NF S NF PA

TOREMIFENE CITRATE FARESTON 60 MG TABLET NF NF NF PA

TOREMIFENE CITRATE TOREMIFENE CITRATE 60 MG TAB NF NF F PA

TRAMADOL HCL TRAMADOL ER 100 MG TABLET NF PA QL AGE

NF PA QL AGE

F-PA-QL-Age


NF PA QL AGE

F-PA-QL-Age


NF PA QL AGE

F-PA-QL-Age





TRAMADOL HCL TRAMADOL HCL ER 100 MG CAPSULE

NF PA NF PA F-PA

TRAMADOL HCL TRAMADOL HCL ER 100 MG TABLET NF PA NF PA F-PA


NF PA NF PA F-PA


NF PA NF PA F-PA



NF PA NF PA F-PA


TRASTUZUMAB HERCEPTIN 150 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-ANNS KANJINTI 150 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-ANNS KANJINTI 420 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-DKST OGIVRI 150 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-DKST OGIVRI 420 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-DTTB ONTRUZANT 150 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-DTTB ONTRUZANT 420 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-HYALURONIDASE-OYSK

HERCEPTIN HYLECTA 600MG-10,000

MED PA MED PA MED PA

TRASTUZUMAB-PKRB HERZUMA 150 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-PKRB HERZUMA 420 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-QYYP TRAZIMERA 150 MG VIAL MED PA MED PA MED PA

TRASTUZUMAB-QYYP TRAZIMERA 420 MG VIAL MED PA MED PA MED PA

TRIAZOLAM TRIAZOLAM 0.125 MG TABLET NF QL NF QL F-PA-QL

TRIAZOLAM TRIAZOLAM 0.25 MG TABLET NF QL NF QL F-PA-QL

TRIMIPRAMINE MALEATE TRIMIPRAMINE MALEATE 100 MG CP

NF NF F-PA

TRIMIPRAMINE MALEATE TRIMIPRAMINE MALEATE 25 MG CAP

NF NF F-PA

TRIMIPRAMINE MALEATE TRIMIPRAMINE MALEATE 50 MG CAP

NF NF F-PA

VARDENAFIL HCL LEVITRA 10 MG TABLET NF PA EXCL NF PA

VARDENAFIL HCL LEVITRA 20 MG TABLET NF PA EXCL NF PA

VARDENAFIL HCL STAXYN 10 MG ODT NF EXCL NF

VARDENAFIL HCL VARDENAFIL HCL 10 MG ODT NF EXCL NF

VARDENAFIL HCL VARDENAFIL HCL 10 MG TABLET NF PA EXCL NF PA

VARDENAFIL HCL VARDENAFIL HCL 2.5 MG TABLET NF PA EXCL NF PA







VIGABATRIN SABRIL 500 MG TABLET S NF S NF PA S NF PA

ZAFIRLUKAST ZAFIRLUKAST 10 MG TABLET NF NF F-PA

ZAFIRLUKAST ZAFIRLUKAST 20 MG TABLET NF NF F-PA

ZILEUTON ZILEUTON ER 600 MG TABLET NF PA QL NF PA QL F-PA-QL

ZOLPIDEM TARTRATE ZOLPIDEM TART ER 12.5 MG TAB F STEP NF F STEP

ZOLPIDEM TARTRATE ZOLPIDEM TART ER 6.25 MG TAB F STEP NF F STEP

drug formulary update, january 2022 commercial programs

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