ESSENTIAL FORMULARY

2017 Comprehensive Medication List

Effective Date: April 1, 2017

This document has information about the drugs covered in your plan.

Please read carefully.

1610 CR 007_02

QualChoice uses a Pharmacy and Therapeutics Committee made up of practicing doctors,

pharmacists, and nurses to make sure our drug list is clinically sound and gives the best value to

our members. This committee reviews FDA-approved drugs that are newly approved and those

thatare currently on the market. Drugs are chosen based on safety, effectiveness, and cost in

comparison to other drugs in their class.

Our Essential formulary includes generic drugs, preferred and non-preferred drugs, specialty

drugs and ACA (Affordable Care Act) preventive drugs. Our Essential formulary is a closed

formulary. This means that coverage is limited to those products listed in the different tiers.

There are 4 tiers on the formulary, along with the preventive drugs.

Tier 1 – This tier has the lowest member cost share. Most, but not all, generic medications are in

Tier 1.

Tier 2 – This tier contains some higher cost generic drugs and preferred brand-name drugs.

Preferred brand-name drugs generally have lower co-payments than non-preferredbrand-name

drugs.

Tier 3 – This tier may contain some higher cost generic drugs but is mostly non-preferred brand

drugs. Non-preferred drugs generally have higher co-payments than preferred brand-name

drugs.

Tier 5 – This tier contains specialty drugs and has the highest co-payment and cost. These drugs

are used to treat complex or rare health problems.

ACA Preventive Drugs – Drugs listed as ‘Preventive’ may have coverage and no co-payment

when health care reform requirements are met for age, gender, and/or risk factors.

We use reasonable medical and utilization management to determine whether a medication is

medically necessary. These may include prior authorization, quantity limits, and step therapy as

described below. Those drugs are listed as:

PA — Prior Authorization QL — Quantity Limits ST — Step Therapy

Table of Contents

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

PROGESTERONE ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

GENERAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

erythromycin ethylsuccinate

Azithromycin

E.e.s. 400

Erythromycin Base

April 2017

Erythromycin Ethylsuccinate

TIER 03 DificidPA

ANTI-INFECTIVES

E.e.s. Granules

Ery-TAB

PENICILLINS

Eryped 200

TIER 01 amoxicillin

Eryped 400

amoxicillin/clavulanate potassium

Erythrocin Stearate

amoxicillin/clavulanate potassium ER

Erythromycin

ampicillin

PCE

ampicillin sodium

Zmax

ampicillin-sulbactam

dicloxacillin sodium

TETRACYCLINES

nafcillin sodium

TIER 01 avidoxy

oxacillin sodium

demeclocycline HCL

penicillin v potassium

doxycycline

Amoxicillin

doxycycline hyclate

Amoxicillin/Clavulanate Potassium

doxycycline monohydrate

Ampicillin

minocycline HCL

TIER 03 Amoxicillin Trihydrate

mondoxyne nl

Augmentin

morgidox 1X100MG

Moxatag

morgidox 1X50MG

Penicillin G Procaine

morgidox 2X100MG

TIER 03 Demeclocycline HCL

CEPHALOSPORIN

Doxycycline Hyclate

FIRST GENERATION

Minocycline HCL

TIER 01 cefadroxil

Oxytetracycline HCL

cefazolin sodium

Vibramycin

cephalexin

Cefazolin Sodium

QUINOLONES

Cephalexin

TIER 01 ciprofloxacin

SECOND GENERATION

ciprofloxacin ER

TIER 01 cefaclor

ciprofloxacin HCL

cefotetan

levofloxacin

cefoxitin sodium

moxifloxacin HCL

cefprozil

ofloxacin

cefuroxime axetil

Ciprofloxacin HCL

cefuroxime sodium

Factive

Cefaclor

Cefaclor ER

AMINOGLYCOSIDES

Cefuroxime Sodium

TIER 01 amikacin sulfate

TIER 03 Ceftin

gentamicin sulfate

THIRD GENERATION

gentamicin sulfate pediatric

TIER 01 cefdinir

neomycin sulfate

cefixime

paromomycin sulfate

cefotaxime sodium

tobramycin sulfate

cefpodoxime proxetil

Amikacin Sulfate

ceftazidime

TIER 03 Streptomycin Sulfate

ceftriaxone sodium

Tobramycin Sulfate

tazicef

TIER 05 tobramycin

Cefotaxime Sodium

Tobramycin

TIER 03 Cedax

Cefditoren Pivoxil

SULFONAMIDES

Ceftibuten

Spectracef

TIER 01 Sulfadiazine

Suprax

TIER 03 Sulfadiazine Sodium

FOURTH GENERATION

Sulfamethoxazole

TIER 01 cefepime

Sulfamethoxazole Micro

Sulfapyridine

MACROLIDES

Sulfisoxizole

TIER 01 azithromycin

ANTIMYCOBACTERIAL AGENTS

clarithromycin

clarithromycin ER

TIER 01 ethambutol HCL

erythromycin

isoniazid

pyrazinamide

rifabutin

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 1

rifampin

Lexiva

Isoniazid

Odefsey

TIER 03 Aminosalicylic Acid

Prezcobix

Cycloserine

Relenza Diskhaler

Ethambutol HCL

Rescriptor

Myambutol

Selzentry

Mycobutin

Stribild

Paser

Sustiva

Priftin

Tamiflu

Rifamate

Tivicay

Rifampin

Triumeq

Rifater

Valcyte

Trecator

Videx Pediatric

Viracept

ANTIFUNGALS

Virazole

Vitekta

TIER 01 bio-statin

Ziagen

fluconazole

TIER 05 adefovir dipivoxil

flucytosine

entecavir

griseofulvin microsize

moderiba

griseofulvin ultramicrosize

ribasphere

itraconazole

ribavirin

ketoconazolePA

Baraclude

nystatin

EpclusaPA

terbinafine HCL

Fuzeon

voriconazole

Moderiba

TIER 03 Bio-statin

Moderiba 1200 Dose Pack

CresembaPA

Moderiba 800 Dose Pack

Noxafil

Peg-intron RedipenPA

Peg-intron Redipen PAK 4PA

ANTIVIRALS

PegasysPA

TIER 01 abacavir

Pegasys ProclickPA

abacavir sulfate/lamivudine/zidovudine

PegintronPA

abacavir/lamivudine

Rebetol

acyclovir

Ribasphere

didanosine

Ribasphere Ribapak

famciclovir

ZepatierPA

lamivudine

lamivudine/zidovudine

ANTIMALARIALS

nevirapine

TIER 01 atovaquone/proguanil HCL

nevirapine ERST

chloroquine phosphate

oseltamivir phosphate

hydroxychloroquine sulfate

rimantadine HCL

mefloquine HCL

stavudine

quinine sulfate

valacyclovir HCL

Primaquine Phosphate

valganciclovir

TIER 03 Chloroquine Phosphate

valganciclovir hydrochlorde

Coartem

zidovudine

Daraprim

Nevirapine

Quinacrine HCL

TIER 02 Atripla

Quinine Sulfate

Intelence

Quinine Sulfate Dihydrate

Invirase

Kaletra

AMEBICIDES

Norvir

Prezista

TIER 03 Iodoquinol

Reyataz

Truvada

ANTHELMINTICS

Viramune

TIER 01 ivermectin

Viread

TIER 03 Albenza

TIER 03 Aptivus

Biltricide

Complera

Emverm

Crixivan

Mebendazole

Descovy

Piperazine Citrate

Edurant

Thiabendazole

Emtriva

Epzicom

MISC. ANTI-INFECTIVES

Evotaz

TIER 01 atovaquone

Genvoya

aztreonam

Isentress

baciim

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 2

bacitracin

EligardPA

clindamycin palmitate HCL

Firmagon

clindamycin HCL

Hydroxyprogesterone Caproate

dapsone

Lupron DepotPA

lincomycin HCL

TrelstarPA

linezolid

VantasPA

metronidazole

XtandiPA

polymyxin b sulfate

ZoladexPA

sulfamethoxazole/trimethoprim

ZytigaPA

sulfamethoxazole/trimethoprim DS

sulfatrim pediatric

IMMUNOMODULATORS

tinidazole

TIER 01 azathioprine

trimethoprim

cyclosporine

vancomycin HCL

cyclosporine modified

TIER 03 Alinia

gengraf

Chloramphenicol

mycophenolate mofetil

Nebupent

mycophenolic acid DR

Polymyxin B Sulfate

sirolimus

Primsol

tacrolimus

Sivextro

Cyclosporine Modified

Trimethoprim

TIER 03 Astagraf XLPA

Vancomycin HCL

Azasan

Xifaxan

Azathioprine

TIER 05 colistimethate sodium

Envarsus XR

Cayston

Levamisole HCL

Rapamune

ANTINEOPLASTICS, ETC

Zortress

TIER 05 Pomalyst

ALKYLATING AGENTS

Revlimid

TIER 01 Thiotepa

Thalomid

TIER 03 Alkeran

Gleostine

MITOTIC INHIBITORS

Hexalen

TIER 05 Etoposide

Leukeran

Mustargen

ENZYME INHIBITORS

Myleran

TIER 05 temozolomide

TIER 03 Iressa

Cyclophosphamide

Lenvima 10 MG Daily DosePA

EvomelaPA

Lenvima 14 MG Daily DosePA

Lenvima 20 MG Daily DosePA

ANTIMETABOLITES

Velcade

Votrient

TIER 01 azacitidine

TIER 05 imatinib mesylatePA

mercaptopurine

AfinitorPA

methotrexate

Afinitor Disperz

methotrexate sodium

AlecensaPA

TIER 03 Methotrexate

BosulifPA

Tabloid

CaprelsaPA

Trexall

CometriqPA

TIER 05 capecitabinePA

CotellicPA

FarydakPA

ANTIBODIES

GilotrifPA

TIER 05 RituxanPA

IbrancePA

TecentriqPA

IclusigPA

ImbruvicaPA

HORMONAL AGENTS

InlytaPA

TIER 01 anastrozole

JakafiPA

bicalutamide

Lenvima 18 MG Daily DosePA

exemestane

Lenvima 24 MG Daily DosePA

flutamide

Lenvima 8 MG Daily DosePA

letrozole

LynparzaPA

megestrol acetate

MekinistPA

tamoxifen citrate

NexavarPA

TIER 03 Emcyt

NinlaroPA

Fareston

SprycelPA

Lysodren

StivargaPA

Megestrol Acetate

SutentPA

Soltamox

TafinlarPA

Trelstar Mixject

TagrissoPA

TIER 05 leuprolide acetatePA

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 3

TarcevaPA

carvedilol

TasignaPA

labetalol HCL

ToriselPA

metoprolol succinate ER

TykerbPA

metoprolol tartrate

XalkoriPA

nadolol

ZelborafPA

pindolol

ZolinzaPA

propranolol HCL

ZydeligPA

propranolol HCL ER

ZykadiaPA

sorine

sotalol HCL

TOPOISOMERASE I INHIBITOR

sotalol HCL (AF)

Propranolol HCL

TIER 03 Hycamtin

Timolol Maleate

TIER 03 Acebutolol HCL

ANTINEOPLASTICS MISC.

Atenolol

TIER 01 hydroxyurea

Bystolic

tretinoin

Coreg CR

TIER 03 Matulane

Innopran XL

TIER 05 bexarotenePA

Metoprolol Tartrate

ActimmunePA

Nadolol

Alferon NPA

Intron APA

CALCIUM CHANNEL BLOCKERS

Intron A W/DiluentPA

TIER 01 afeditab CR

ProleukinPA

amlodipine besylate

SylatronPA

cartia XT

Theracys

dilt-XR

Tice Bcg

diltiazem CD

diltiazem HCL

CHEMOTHERAPY RESCUE

diltiazem HCL CD

TIER 01 leucovorin calcium

diltiazem HCL ER

Leucovorin Calcium

felodipine ER

TIER 03 Mesnex

isradipine

matzim LA

ANTINEOPLASTIC COMBO

nicardipine HCL

TIER 05 LonsurfPA

nifedipine

nifedipine ER

CARDIOVASCULAR DRUGS

nimodipine

CARDIAC GLYCOSIDES

nisoldipine

TIER 01 digitek

taztia XT

digox

verapamil HCL

digoxin

verapamil HCL ER

Digoxin

verapamil HCL SR

TIER 03 Lanoxin

Nisoldipine

Nisoldipine ER

ANTIANGINAL AGENTS

TIER 03 Nymalize

TIER 01 isosorbide dinitrate

isosorbide mononitrate

ANTIARRHYTHMICS

isosorbide mononitrate ER

TIER 01 amiodarone HCL

minitran

disopyramide phosphate

nitro-time

dofetilide

nitroglycerin

flecainide acetate

nitroglycerin lingual

mexiletine HCL

nitroglycerin transdermal

pacerone

nitroglycerin ER

propafenone HCL

Nitroglycerin Lingual

propafenone HCL ER

TIER 02 Ranexa

quinidine gluconate CR

TIER 03 Dilatrate SR

quinidine gluconate ER

Isordil Titradose

Quinidine Sulfate

Nitro-bid

TIER 02 Norpace CR

Nitro-dur

TIER 03 Multaq

Nitromist

Procainamide HCL

Nitrostat

Tikosyn

BETA BLOCKERS

ACE INHIBITORS

TIER 01 acebutolol HCL

TIER 01 benazepril HCL

atenolol

captopril

betaxolol HCL

enalapril maleate

bisoprolol fumarate

fosinopril sodium

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 4

lisinopril

Azor

moexipril HCL

Benicar HCTQL,PA

perindopril erbumine

Clorpres

quinapril HCL

Dutoprol

ramipril

EdarbyclorPA

trandolapril

Metoprolol Succinate ER/Hydrochlorothiazide

Tekturna HCTQL

ANGIOTENSIN RCPTR BLOCKER

Tribenzor

TIER 01 irbesartan

DIURETICS

losartan potassium

olmesartan medoxomilQL,PA

TIER 01 acetazolamide

valsartanPA

acetazolamide sodium

Eprosartan Mesylate

acetazolamide ER

TIER 02 candesartan cilexetil

amiloride HCL

telmisartanQL

amiloride/hydrochlorothiazide

TIER 03 BenicarQL,PA

bumetanide

EdarbiQL,PA

chlorothiazide

chlorthalidone

DIRECT RENIN INHIBITORS

furosemide

hydrochlorothiazide

TIER 03 TekturnaQL

indapamide

methazolamide

ANTIHYPERTENSIVES MISC.

metolazone

TIER 01 clonidine HCL

spironolactone

doxazosin

spironolactone/hydrochlorothiazide

doxazosin mesylate

torsemide

eplerenone

triamterene/hydrochlorothiazide

guanfacine HCL

Acetazolamide

hydralazine HCL

Chlorothiazide

methyldopa

Chlorthalidone

minoxidil

Furosemide

phenoxybenzamine hydrochloride

Methyclothiazide

prazosin HCL

TIER 03 Aldactazide

terazosin HCL

Amiloride HCL

TIER 03 Demser

Diuril

Diazoxide

Dyazide

Phentolamine Mesylate

Dyrenium

Prazosin Hydrochloride

Hydrochlorothiazide

Prazosin HCL

Maxzide

Maxzide-25

ANTIHYPERTENSIVE COMBO

Methazolamide

TIER 01 amlodipine besylate/benazepril hydrochloride

Triamterene

amlodipine besylate/benazepril HCL

amlodipine besylate/valsartan

VASOPRESSORS

amlodipine/olmesartan medoxomil

TIER 01 ephedrine sulfate

amlodipine/valsartan/hctz

midodrine HCL

atenolol/chlorthalidone

norepinephrine bitartrate

benazepril HCL/hydrochlorothiazide

phenylephrine HCL

bisoprolol fumarate/hydrochlorothiazide

Phenylephrine HCL

candesartan cilexetil/hydrochlorothiazide

TIER 02 Adrenaclick

enalapril maleate/hydrochlorothiazide

EpinephrineQL

fosinopril sodium/hydrochlorothiazide

irbesartan/hydrochlorothiazide

ANTIHYPERLIPIDEMICS

lisinopril/hydrochlorothiazide

TIER 01 atorvastatin calcium

losartan potassium/hydrochlorothiazide

cholestyramine

metoprolol/hydrochlorothiazide

cholestyramine light

moexipril/hydrochlorothiazide

colestipol HCL

nadolol/bendroflumethiazide

ezetimibe

olmesartan medoxomil/amlodipine/hydrochlorothiazide

fenofibrate

olmesartan medoxomil/hydrochlorothiazideQL,PA

fenofibrate micronized

quinapril/hydrochlorothiazide

fluvastatin

telmisartan/amlodipine

gemfibrozil

trandolapril/verapamil HCL

lovastatin

trandolapril/verapamil HCL ER

niacin ER

valsartan/hydrochlorothiazide

pravastatin sodium

Captopril/Hydrochlorothiazide

prevalite

Methyldopa/Hydrochlorothiazide

simvastatin

Propranolol/Hydrochlorothiazide

Fenofibrate

TIER 02 telmisartan/hydrochlorothiazideQL

TIER 02

TIER 03

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 5

fenofibric acid DR

oscion cleanser

rosuvastatin calcium

pr benzoyl peroxide wash

TIER 03 Gemfibrozil

rosanil cleanser

Niacor

sodium sulfacetamide

VytorinPA

sodium sulfacetamide/sulfur

Welchol

sodium sulfacetamide/sulfur cleanser

Zetia

sodium sulfacetamide/sulfur green

TIER 05 RepathaPA

sodium sulfacetamide/sulfur wash

Repatha Pushtronex SystemPA

ss 10-2

Repatha SureclickPA

sss 10%-5%

sulfacetamide sodium

CARDIOVASCULAR - MISC.

sulfacetamide sodium/sulfur

sulfacetamide sodium/sulfur cleanser

TIER 01 amlodipine besylate/atorvastatin calcium

tretinoin

isoxsuprine HCL

tretinoin microsphere

papaverine HCL

tretinoin microsphere P.M.PA

TIER 03 BidilQL

zenatane

CaverjectQL,PA

zencia

CialisQL,PA

Sodium Sulfacetamide/Sulfur

EdexQL,PA

TIER 02 Veltin

Entresto

TIER 03 Aczone

LevitraQL,PA

Azelex

MuseQL,PA

Benziq

Nylidrin Hydrochloride

Benziq LS

StaxynQL,PA

Benzoyl Peroxide

StendraQL,PA

Benzoyl Peroxide Hydrous

ViagraQL,PA

Clindagel

TIER 05 sildenafilPA

Epiduo

AdcircaPA

FabiorPA

AdempasPA

Sodium Sulfacetamide/Sulfur Cleanser IN Urea

LetairisPA

Sodium Sulfacetamide/Sulfur IN Urea

OpsumitPA

Sulfoam

RevatioPA

Sumaxin CP Kit

TracleerPA

Vanoxide-HC

TyvasoPA

Zaclir Cleansing

Tyvaso RefillPA

Tyvaso StarterPA

ROSACEA AGENTS

UptraviQL,PA

VentavisPA

TIER 01 metronidazole

rosadan

DERMATOLOGICALS

TIER 03 Finacea

Noritate

ACNE PRODUCTS

Rosadan Kit

TIER 01 adapalene

adapalene P.M.

ANTIBIOTICS - TOPICAL

avar cleanser

TIER 01 gentamicin sulfate

avar-e emollient

mupirocin

avar-e green

TIER 03 Altabax

avita

Bacitracin

benzepro

Bacitracin Zinc

benzepro creamy wash

Cortisporin

benzepro SHORT contact

Gentamicin Sulfate

benzoyl peroxide

Gentamicin Sulfate Micronized

benzoyl peroxide SHORT contact

Neo-synalar

bp foam

Neomycin Sulfate

bp wash

bp 10-1

ANTIFUNGALS - TOPICAL

cerisa wash

TIER 01 ciclodan

claravis

ciclopirox

clearplex x

ciclopirox nail lacquer

clindacin etz pledgets

ciclopirox olamine

clindacin-p

ciclopirox treatment

clindamax

clotrimazole

clindamycin phosphate

clotrimazole/betamethasone dipropionate

clindamycin/benzoyl peroxide

dermazene

ery

econazole nitrate

erythromycin

hydrocortisone/iodoquinol

erythromycin/benzoyl peroxide

ketoconazole

myorisan

ketodan

neuac

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 6

nyamyc

betamethasone dipropionate

nyata

betamethasone valerate

nystatin

calcipotriene/betamethasone dipropionate

nystatin/triamcinolone

clobetasol propionate

nystop

clobetasol propionate e

oxiconazole nitrate

clobetasol propionate emollient

TIER 03 Ala-quin

clodan

Aloquin

cormax scalp application

Ertaczo

desonide

Exelderm

desoximetasone

Gentian Violet

fluocinolone acetonide

Halotin

fluocinolone acetonide body

Mentax

fluocinolone acetonide scalp

Naftin

fluocinonide

Oxistat

fluocinonide-e

Vusion

flurandrenolide

Xolegel

fluticasone propionate

halobetasol propionate

ANTIVIRALS - TOPICAL

hydrocortisone

hydrocortisone acetate/pramoxine

TIER 01 acyclovir

hydrocortisone butyrate

TIER 02 Denavir

hydrocortisone butyrate (lipid)

TIER 03 Xerese

hydrocortisone butyrate (lipophilic)

Zovirax

hydrocortisone valerate

hydrocortisone IN absorbase

ANTI-INFLAMMATORY AGENTS

hydrocortisone 1% IN absobase

TIER 01 diclofenac sodium

lokara

TIER 03 FlectorPA

mometasone furoate

prednicarbate

ANTIPRURITICS

scalacort

TIER 01 Doxepin Hydrochloride

triamcinolone acetonide

TIER 03 Camphor

triderm

Prudoxin

Amcinonide

Zonalon

Apexicon E

Desoximetasone

ANTIPSORIATICS

Diflorasone Diacetate

TIER 01 acitretin

Psorcon

calcipotriene

Trianex

calcitrene

TIER 03 Capex

methoxsalen

Clocortolone Pivalate

Calcitriol

Clocortolone Pivalate P.M.

TIER 03 Anthralin

Cloderm

Dritho-creme HP

Cloderm P.M.

Tazorac

Cordran

Vectical

Cortane-b

Zithranol-rr

Desonate

TIER 05 CosentyxPA

Desonide

Cosentyx Sensoready PenPA

Enstilar

StelaraPA

Epifoam

TaltzPA

Fluocinolone Acetonide

Fluocinonide

ANTISEBORRHEIC AGENTS

Halog

TIER 01 seb-prev wash

Hydrocortisone

selenium sulfide

Hydrocortisone Acetate

sodium sulfacetamide

Hydrocortisone Acetate Micronized

sodium sulfacetamide wash

Hydrocortisone Micronized

TIER 03 Glycolic Acid

Locoid

Glycolic Acid 70% High Purity

Nucort

Loutrex

Pandel

Ovace Plus

Taclonex

Promiseb

Texacort

Sulfacetamide Sodium

Topicort

Tersi Foam

Verdeso

CORTICOSTEROIDS - TOPICAL

IMMUNOMODULATING AGENTS

TIER 01 ala-cort

TIER 01 imiquimod

alclometasone dipropionate

tacrolimus

alphatrex

TIER 02 Elidel

augmented betamethasone dipropionate

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 7

DERMATOLOGICALS - MISC.

Capsaicin

Ceracade

TIER 01 agoneaze

Coal TAR

ammonium lactate

Cocaine HCL

cidaleaze

Condylox

dermacinrx empricaine

Emulsion SB

dermacinrx prizopak

Entty Spray Emulsion

episone CRE

Epiceram

glydo

Eurax

lactic acid

Gebauers Pain Ease

lactic acid e

Gebauers Spray And Stretch

lactic acid w/vitamin e

Genadur

latrix

Gordofilm

lidocaine

Gordons Urea

lidocaine HCL

Hylatopic Plus

lidocaine HCL jelly

Hylira

lidocaine PAK

HPR

lidocaine/prilocaine

HPR Plus

lidopin

Ichthammol

lidopril

Keralyt Scalp

lidopril XR

Latrix XM

liprozonepak

Lido-k

livixil PAK

Lidocaine HCL

malathion

Lidocaine HCL Monohydrate

medolor PAK

Natroba

permethrin

Neosalus

podofilox

Nuvail

pramox gel

Phlag Spray

premium lidocaine

Podophyllum Resin

prilolid

Pramoxine HCL

rea LO 40

Presera

relador PAK

Pyrogallic Acid

relador PAK plus

Salicylic Acid

remeven

Sebuderm

salacyn

Sulfurated Lime

salicylic acid

Synera

salicylic acid cream

Synerderm

salicylic acid lotion

Tannic Acid

salisol forte

Ulesfia

sodium hyaluronate

Umecta

ure-k

Uramaxin

urea

Uramaxin GT Kit

urea hydrating

Urea Nail

urea topical

Veregen

urea IN zinc undecylenate/lactic acid vehicle

urea 40% nail film

ENDOCRINE AND METABOLIC

Cem-urea

Ethyl Chloride

CORTICOSTEROIDS

Ethyl Chloride/Fine Pinpoint

TIER 01 betamethasone sodium phosphate/betamethasone acetate

Ethyl Chloride/Fine Stream

Ethyl Chloride/Medium Jet Stream

budesonide

Ethyl Chloride/Medium Stream

deltasone

Ethyl Chloride/Mist

dexamethasone

Lindane

dexamethasone sodium phosphate

LP lite PAK

fludrocortisone acetate

Podocon 25 IN Benzoin Tincture

hydrocortisone

TIER 03 Alevicyn Antipruritic SG

methylprednisolone

Aluminum Chloride Anhydrous

methylprednisolone acetate

Aluminum Chloride Hexahydrate

methylprednisolone dose pack

Anacaine

methylprednisolone sodiumsuccinate

Arnica Flower

prednisolone

Avage

prednisolone sodium phosphate

Bensal HP

prednisolone sodium phosphate odt

Benzocaine

prednisone

Benzoin Compound Tincture

Dexamethasone

Benzoin Tincture

Dexamethasone Intensol

Boric Acid

Dexamethasone Sodium Phosphate

Calamine

Prednisolone Sodium Phosphate

Cantharidin

Prednisone

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 8

Prednisone Intensol

Ethinyl Estradiol

TIER 03 Cortisone Acetate

Evamist

Dexpak 10 Day

Menest

Dexpak 13 Day

Menostar

Dexpak 6 Day

Vivelle-dot

Fludrocortisone Acetate

Medrol

CONTRACEPTIVES

Methylprednisolone

TIER 01 aftera

Methylprednisolone Acetate

altavera

Millipred

alyacen 1/35

Millipred DP

alyacen 7/7/7

Prednisolone

amethia

Prednisolone Acetate

amethia LO

Prednisolone Anhydrous

amethyst

Prednisolone Sodium Phosphate, Usp

apri

Prednisolone Usp, Micronized Anhydrous

aranelle

Veripred 20

ashlyna

aubra

ANDROGENS-ANABOLIC

aviane

TIER 01 danazol

azurette

methyltestosterone

balziva

oxandrolone

bekyree

testosterone cypionatePA

blisovi FE 1.5/30

TIER 02 AndrogelPA

blisovi FE 1/20

Androgel P.M.PA

blisovi 24 FE

Methitest

briellyn

TIER 03 Anadrol-50

camila

Androxy

camrese

Danazol

camrese LO

MethyltestosteronePA

caziant

chateal

ESTROGENS

cryselle-28

cyclafem 1/35

TIER 01 amabelz

cyclafem 7/7/7

covaryx

cyred

covaryx HS

dasetta 1/35

eemt

dasetta 7/7/7

eemt HS

daysee

esterified estrogens/methltestosterone

deblitane

esterified estrogens/methyltestosterone

delyla

esterified estrogens/methyltestosterone DS

desogestrel/ethinyl estradiol

esterified estrogens/methyltestosterone HS

drospirenone/ethinyl estradiol

estradiol

drospirenone/ethinyl estradiol/levomefolate calcium

estradiol valerate

econtra EZ

estradiol/norethindrone acetate

elinest

fyavolv

emoquette

jevantique LO

enpresse-28

jinteli

enskyce

mimvey

errin

mimvey LO

estarylla

norethindrone acetate/ethinyl estradiol

fallback solo

Estropipate

falmina

TIER 02 Alora

femynor

Combipatch

gianvi

Minivelle

gildagia

Premarin

heather

Premphase

introvale

Prempro

jencycla

TIER 03 Depo-estradiol

jolessa

Divigel

jolivette

DuaveePA

juleber

Elestrin

junel FE 1.5/30

Estradiol

junel FE 1/20

Estradiol Micronized

junel FE 24

Estriol

junel 1.5/30

Estriol Micronized

junel 1/20

Estriol Ultra Micronized

kaitlib FE

Estrogel

kariva

Estrone

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 9

kelnor 1/35

tilia FE

kimidess

tri-estarylla

kurvelo

tri-legest FE

larin FE 1.5/30

tri-linyah

larin FE 1/20

tri-previfem

larin 1.5/30

tri-sprintec

larin 1/20

tri-LO-estarylla

larin 24 FE

tri-LO-marzia

larissia

tri-LO-sprintec

layolis FE

trinessa

leena

trinessa LO

lessina

trivora-28

levonest

velivet

levonorgestrel

vestura

levonorgestrel and ethinyl estradiol

vienva

levonorgestrel/ethinyl estradiol

viorele

levora 0.15/30-28

vyfemla

lomedia 24 FE

wera

loryna

wymzya FE

low-ogestrel

zarah

lutera

zenchent

lyza

zenchent FE

marlissa

zovia 1/35e

medroxyprogesterone acetateQL

Necon 10/11-28

microgestin FE

Ogestrel

microgestin FE 1.5/30

Xulane

microgestin 1.5/30

TIER 02 Depo-subq Provera 104QL

microgestin 1/20

Falessa

microgestin 24 FE

Minastrin 24 FE

mono-linyah

Natazia

mononessa

Nuvaring

my way

TIER 03 Beyaz

myzilra

Ella

necon 0.5/35-28

LO Loestrin FE

necon 1/35

Ortho Micronor

necon 7/7/7

Safyral

next choice one dose

nikki

PROGESTINS

nora-be

TIER 01 medroxyprogesterone acetate

norethindrone

megestrol acetate

norethindrone & ethinyl estradiol ferrous fumarate

norethindrone acetate

norethindrone acetate/ethinyl estradiol

progesterone

norethindrone acetate/ethinyl estradiol/ferrous fumarate

TIER 03 Norethindrone Acetate

norethindrone/ethinyl estradiol/ferrous fumarate

Progesterone

norgestimate/ethinyl estradiol

Progesterone Micronized

norlyroc

Progesterone Micronized (soy)

nortrel 0.5/35 (28)

Progesterone Micronized (yam)

nortrel 1/35

Progesterone Micronized Premium

nortrel 7/7/7

Progesterone Milled

ocella

Progesterone Ultra Micronized

opcicon one-step

Progesterone Wettable

option 2

Progesterone Wettable (yam)

orsythia

TIER 05 MakenaPA

philith

pimtrea

ANTIDIABETIC AGENTS

pirmella 1/35

INSULIN

pirmella 7/7/7

TIER 02 Basaglar Kwikpen

portia-28

Lantus

previfem

Lantus Solostar

quasense

Levemir

rajani

Levemir Flextouch

react

Novolin N

reclipsen

Novolin N Relion

setlakin

Novolin R

sharobel

Novolin R Relion

sprintec 28

Novolin 70/30

sronyx

Novolin 70/30 Relion

syeda

Novolog

take action

Novolog Flexpen

tarina FE 1/20

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 10

Novolog Mix 70/30

CALCITONINS

Novolog Mix 70/30 Prefilled Flexpen

TIER 01 calcitonin salmon

Novolog Penfill

calcitonin-salmon

Toujeo Solostar

TIER 03 Humalog Kwikpen

PARATHYROID HORMONE

Humulin R U-500 (concentrated)

TIER 05 ForteoPA

AMYLIN ANALOGS

NatparaPA

TIER 03 Symlinpen 120

Symlinpen 60

RANK LIGAND INHIBITORS

INCRETIN MIMETIC AGENTS

TIER 05 ProliaPA

TIER 03 BydureonPA

Bydureon PenPA

HORMONE RECEPTOR MDLTR

ByettaPA

TIER 01 raloxifene hydrochloride

VictozaPA

TIER 03 OsphenaPA

SULFONYLUREAS

TIER 01 glimepiride

FERTILITY REGULATORS

glipizide

TIER 05 chorionic gonadotropinPA

glipizide ER

novarelPA

glipizide XL

pregnyl w/diluent benzyl alcohol/NACLPA

glyburide

BravellePA

glyburide micronized

Follistim AQPA

Chlorpropamide

Gonal-fPA

Tolazamide

Gonal-f RFFPA

Tolbutamide

Gonal-f RFF RedijectPA

TIER 03 Glipizide

MenopurPA

Glyburide

OvidrelPA

BIGUANIDES

TIER 01 metformin HCL

LHRH/GNRH AGONIST

metformin HCL ER

TIER 05 Lupaneta Pack

metformin HCL ER (osmotic)

Lupron Depot-PEDPA

TIER 03 Riomet

Supprelin LAPA

MEGLITINIDE ANALOGUES

SynarelPA

TIER 01 nateglinide

repaglinide

GNRH/LHRH ANTAGONISTS

DIABETIC OTHER

TIER 05 CetrotidePA

TIER 02 InvokanaPA

Ganirelix AcetatePA

JardiancePA

TIER 03 Glucagen Hypokit

GROWTH HORMONES

Glucagon Emergency Kit

TIER 05 Norditropin CartridgePA

Proglycem

Norditropin FlexproPA

TIER 05 KorlymPA

ALPHA-GLUCOSIDASE INHIBIT

GHRH

TIER 01 acarbose

TIER 05 EgriftaPA

miglitol

DPP-4 INHIBITORS

SOMATOMEDINS

TIER 02 JanuviaPA

OnglyzaPA

TIER 05 IncrelexPA

INSULIN SENSITIZING AGENT

TIER 01 pioglitazone HCL

SOMATOSTATIC AGENTS

ANTIDIABETIC COMBINATIONS

TIER 05 octreotide acetatePA

TIER 01 glipizide/metformin HCL

Sandostatin Lar Depot

glyburide/metformin HCL

Signifor

pioglitazone HCL-glimepiride

Somatuline Depot

pioglitazone HCL/metformin HCL

Repaglinide/Metformin Hydrochloride

GH RECEPTOR ANTAGONISTS

TIER 02 Invokamet

TIER 05 Somavert

Janumet

Kombiglyze XR

POSTERIOR PITUITARY

Synjardy

TIER 01 desmopressin acetate

TIER 03 Actoplus Met XR

TIER 03 Stimate

BISPHOSPHONATES

PROLACTIN INHIBITORS

TIER 01 alendronate sodium

TIER 01 cabergoline

risedronate sodium

risedronate sodium DR

VASOPRESSIN ANTAGONISTS

Alendronate Sodium

TIER 03 Samsca

Etidronate Disodium

TIER 03 ibandronate sodiumST

PROGESTERONE ANTAGONISTS

TIER 03

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 11

Mifeprex

Golytely

Kristalose

METABOLIC MODIFIERS

Magnesium Sulfate

Magnesium Sulfate Heptahydrate

TIER 01 calcitriol

Mineral Oil

doxercalciferol

Mineral Oil Heavy

levocarnitine

Mineral Oil Light

paricalcitol

Moviprep

sodium phenylbutyrate

Muri-lube

TIER 03 Buphenyl

Nulytely/Flavor Packs

Cystadane

Osmoprep

TIER 05 CarbagluPA

Prepopik

KuvanPA

Suprep Bowel Prep

OrfadinPA

Sensipar

ANTIDIARRHEALS

THYROID AGENTS

TIER 01 diphenoxylate/atropine

lofene

TIER 01 levo-t

loperamide HCL

levothyroxine sodium

opium

levoxyl

opium tincture

liothyronine sodium

Diphenoxylate/Atropine

methimazole

TIER 03 Bismuth Subgallate

propylthiouracil

Kaolin

unithroid

Paregoric

unithroid direct

Pectin

NP thyroid 15

NP thyroid 60

ANTACIDS

NP thyroid 90

TIER 02 Nature-throid

TIER 03 Magnesium Oxide Heavy

Nature-throid Nt-2.5

Magnesium Oxide Light

NP thyroid 30

Magnesium Trisilicate

Thyrolar-1

Magnesium Trisilicate Anhydrous

Thyrolar-1/2

Magnesium Trisilicate Hydrate

Thyrolar-1/4

Sodium Bicarbonate

Thyrolar-2

Thyrolar-3

ULCER DRUGS

Westhroid

TIER 01 atropine sulfate

Wp Thyroid

chlordiazepoxide HCL/clidinium bromide

TIER 03 Armour Thyroid

dicyclomine HCL

Cytomel

ed-spaz

Liothyronine Sodium

glycopyrrolate

Methimazole

hyoscyamine sulfate

PCCA T3 Sodium Dilution

hyoscyamine sulfate odt

Synthroid

hyoscyamine sulfate ER

Thyroid

hyoscyamine sulfate SR

Thyroid Porcine

hyosyne

Tirosint

lansoprazole/amoxicillin/clarithromycin

Triiodo-l-thyronine Sodium

methscopolamine bromide

misoprostol

GASTROINTESTINAL

nulev

omeprazole

LAXATIVES

oscimin

TIER 01 constulose

oscimin SR

gavilyte-c

pantoprazole sodium

gavilyte-h

phenohytro

gavilyte-n/flavor pack

sucralfate

gavilyte-G

symax-SL

lactulose

symax-SR

peg 3350/electrolytes

Belladonna & Opium

peg-prep

Belladonna Alkaloids & Opium

peg-3350/electrolytes

Propantheline Bromide

peg-3350/NACL/NA bicarbonate/KCL

TIER 02 lansoprazole

pegylax

rabeprazole sodium

polyethylene glycol 3350

TIER 03 Atropine Sulfate

trilyte

Atropine Sulfate Monohydrate

TIER 03 Bisacodyl

Carafate

Cascara Sagrada

Cuvposa

Colyte-flavor Packs

Donnatal

Docusate Sodium

Hyoscyamine Sulfate

Gialax

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 12

Isopropamide Iodide

Amitiza

Levsin

Analpram-HC

Pylera

AprisoST

Scopolamine HBR

Asacol HDST

Sucralfate

Auryxia

Symax DuotabQL

Azulfidine

Azulfidine EN-TABS

ANTIEMETICS

Chenodal

DelzicolST

TIER 01 aprepitantQL

Dipentum

dronabinol

Entereg

granisetron HCLQL

Fosrenol

meclizine HCL

Mesalamine

ondansetron odt

Metoclopramide HCL

ondansetron HCLQL

Metoclopramide HCL Monohydrate

trimethobenzamide HCL

Movantik

TIER 03 AnzemetQL

Phoslyra

Cesamet

Procort

EmendQL

Renagel

Meclizine HCL

Renvela

Meclizine HCL Monohydrate

Simethicone

SancusoQL

Sulfasalazine

Transderm-scop

5-aminosalicylic Acid

VarubiQL

TIER 05 CholbamPA

CimziaPA

DIGESTIVE AIDS

Cimzia Starter KitPA

TIER 02 Creon

RelistorQL,PA

Zenpep

TIER 03 L-glutamic Acid HCL

GENITOURINARY

Pepsin

Sucraid

URINARY ANTI-INFECTIVES

TIER 01 azuphen mb

GASTROINTESTINAL - MISC.

hyolev mb

TIER 01 alosetron hydrochloride

hyophen

ana-lex

me/naphos/mb/hyo 1

anucort-HC

methenamine hippurate

anusol-HC

methenamine mandelate

balsalazide disodium

nitrofurantoin

calcium acetate

nitrofurantoin macrocrystals

colocort

nitrofurantoin monohydrate

cromolyn sodium

nitrofurantoin monohydrate/macrocrystals

enulose

phosphasal

generlac

ur n-c

hemmorex-HC

uramit mb

hydrocort ene 100MG

urelle

hydrocortisone

uretron d/s

hydrocortisone acetate

uribel

hydrocortisone acetate/pramoxine

urin d/s

lactulose

uro-mp

lidazone HC

uro-458

lidocaine HCL/hydrocortisone acetate

uroav-b

mesalamine

uroav-81

metoclopramide HCL

urolet mb

pramcort

urophen mb

procto-MED HC

uryl

procto-PAK

ustell

proctosol HC

uticap

proctozone-HC

utira-c

sulfasalazine

utrona-c

ursodiol

Methenamine Mandelate

Lidocaine HCL-hydrocortisone Acetate With Aloe

TIER 03 Monurol

Mesalamine DRST

Nalidixic Acid

TIER 02 Canasa

Nitrofurantoin Macrocrystal

Cortifoam

Lialda

URINARY ANTISPASMODICS

Linzess

TIER 01 bethanechol chloride

Pentasa

darifenacin hydrobromide ERPA

Proctofoam HC

flavoxate HCL

Sfrowasa

oxybutynin chloride

TIER 03

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 13

oxybutynin chloride ER

Elmiron

tolterodine tartrate

TIER 03 Cardura XL

tolterodine tartrate ER

Cystagon

trospium chloride

Glycine

trospium chloride ER

Glycine (l)

TIER 03 Bethanechol Chloride

K-phos NO 2

MyrbetriqPA

Lithostat

Oxybutinin Chloride

Oracit

OxytrolPA

Phenazopyridine HCL

ToviazPA

Potassium Citrate

VesicarePA

Potassium Citrate Monohydrate

RapafloPA

VAGINAL PRODUCTS

Renacidin

Sodium Citrate

TIER 01 clindamycin phosphate

Sodium Citrate Anhydrous

metronidazole vaginal

Sorbitol

terconazole

Sorbitol-mannitol

vandazole

Thiola

vcf vaginal contraceptivegel

yuvafem

HEMATOLOGICAL

zazole

Miconazole 3

HEMATOPOIETIC AGENTS

TIER 02 Clindesse

TIER 01 bprotected pedia iron

Encare

cyanocobalamin

Estrace

fa-8

Options Gynol II Vaginal Contraceptive

fer-iron

Premarin

ferosul

Shur-seal

ferrous drops

Today Sponge

ferrous sulfate

Vcf Vaginal Contraceptive Film

folic acid

Vcf Vaginal Contraceptive Foam

gnp folic acid

TIER 03 Avc

iron supplement childrens

Cleocin

kp folic acid

Crinone

px folic acid

Endometrin

ra folic acid

Estring

sm folic acid

Fem PH

wee care

Femring

yl folic acid

Gynazole-1

CVS folic acid

Relagard

HM folic acid

Vagifem

TIER 02 Ferretts IPS

Ferrous Sulfate

GENITOURINARY - MISC.

Iron Chews Pediatric

TIER 01 acetic acid 0.25%

Iron Up

alfuzosin HCL ER

Nascobal

aminoacetic acid

Novaferrum Pediatric Drops

argyle sterile saline 100ML

TIER 03 Cyanocobalamin

citric acid/sodium citrate

Droxia

curity sterile saline

Ferrous Sulfate Anhydrous

cytra k crystals

Ferrous Sulfate Heptahydrate

dutasteridePA

Folic Acid

dutasteride/tamsulosin hydrochloridePA

Hydroxocobalamin

dutasteride/tamsulosin HCLPA

TIER 05 Aranesp Albumin Free

finasteride

CerdelgaPA

glycine

ElelysoPA

neomycin/polymyxin b sulfates

EpogenPA

phenazo

GranixPA

phenazopyridine HCL

LeukinePA

potassium citrate ER

Mircera

potassium citrate-citric acid crystals

Mozobil

potassium citrate/citric acid

Neulasta

sodium chloride

Neulasta Onpro Kit

sodium chloride 0.9%

Neupogen

tamsulosin HCL

Nplate

taron-crystals

ProcritPA

tricitrates

Promacta

virtrate-k

Zarxio

virtrate-2

Zavesca

virtrate-3

TIER 02

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 14

ANTICOAGULANTS

RecombinatePA

Riastap

TIER 01 heparin sodium

RixubisPA

heparin sodium dcu

Thrombate Iii

heparin sodium/sodium chloride 0.9% premix

Thrombate Iii W/10 ML Sterile Water

heparin sodium/NACL 0.9%

Thrombate Iii W/20 ML Sterile Water

jantoven

XynthaPA

warfarin sodium

Xyntha SolofusePA

TIER 02 Eliquis

Pradaxa

MOUTH/THROAT/DENTAL AGENT

Xarelto

Xarelto Starter Pack

TIER 03 Acd-a Noclot-50

TIER 01 cavarest

Anticoagulant Citrate Dextrose Solution A

cevimeline HCL

Anticoagulant Citrate Phosphate Dextrose Solution

chlorhexidine gluconate

Anticoagulant Sodium Citrate

chlorhexidine gluconate oral rinse

Coumadin

clinpro 5000

Tricitrasol

clotrimazole

Warfarin Sodium Clathrateform

denta 5000 plus

TIER 05 enoxaparin sodium

dentagel

fondaparinux sodium

easygel

Fragmin

fluoridex daily defense

fluoridex daily defense enhanced whitening

HEMOSTATICS

fluoridex daily defense sensitivity relief

TIER 01 tranexamic acidQL

karigel

TIER 03 Amicar

karigel-n

Astringyn

lidocaine viscous

Evicel

lidocaine HCL viscous

Thrombin-jmi Diluent

neutragard advanced

Thrombin-jmi Syringe Spray Kit

neutral sodium fluoride

Thrombin-jmi W/Dil Spray P.M. Actuator

nystatin

Thrombogen

oralone

paroex

HEMATOLOGICAL - MISC.

periogard

phos-flur

TIER 01 anagrelide hydrochloride

pilocarpine hydrochloride

aspirin/dipyridamole

pilocarpine HCL

cilostazol

prevident rinse

clopidogrel

topex topical anesthetic

dipyridamole

triamcinolone acetonide

pentoxifylline ER

triamcinolone IN orabase

TIER 03 Aggrenox

Lidocaine HCL

Brilinta

SF

Effient

SF 5000 plus

TIER 05 AdvatePA

TIER 03 Amphotericin B

AdynovatePA

Debacterol

AfstylaPA

Fluoridex Daily Defense Sensitivity Relief

Alphanate/Von Willebrand Factor Complex/HumanPA

Gel-kam Oral Care Rinse

Alphanine SDPA

Gelclair

AlprolixPA

Mucotrol

BebulinPA

Nafrinse Daily/Acidulated

BenefixPA

Nafrinse Daily/Neutral

CoagadexPA

Nafrinse Weekly

CorifactPA

Neutrasal

FeibaPA

Oramagicrx

Helixate FSPA

OravigST

Hemofil MPA

Prevident Fluoride

Humate-pPA

Prevident 5000 Booster

IdelvionPA

Prevident 5000 Booster Plus

IxinityPA

Prevident 5000 Dry Mouth

Koate-dviPA

Prevident 5000 Enamel Protect

Kogenate FSPA

Prevident 5000 Plus

Kogenate FS Bio-setPA

Prevident 5000 Sensitive

Monoclate-pPA

Salicept

MononinePA

Salivamax

NovosevenPA

Salivate RX

Novoseven RtPA

Thera-flur-n

NuwiqPA

Zinc Acetate

ProfilninePA

Profilnine SDPA

NEUROLOGY, CNS, PSYCH

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 15

ANTIANXIETY AGENTS

Trazodone HCL

Trimipramine Maleate

TIER 01 alprazolam

alprazolam odt

ANTIPSYCHOTICS

alprazolam ER

alprazolam XR

TIER 01 aripiprazoleQL

buspirone HCL

chlorpromazine HCL

chlordiazepoxide HCL

clozapineQL

clorazepate dipotassium

clozapine odtQL

diazepam

compro

diazepam intensol

fluphenazine decanoate

droperidol

fluphenazine HCL

gene-xene TAB 15MG

haloperidol

gene-xene TAB 3.75MG

haloperidol decanoate

gene-xene TAB 7.5MG

haloperidol lactate

hydroxyzine pamoate

lithium carbonate

hydroxyzine HCL

lithium carbonate ER

lorazepam

loxapine

lorazepam intensol

loxapine succinate

meprobamate

olanzapineQL

oxazepam

olanzapine odtQL

Alprazolam Intensol

paliperidone ERQL

Diazepam

perphenazine

Hydroxyzine Pamoate

prochlorperazine

TIER 03 Droperidol

prochlorperazine maleate

quetiapine fumarateQL

ANTIDEPRESSANTS

quetiapine fumarate ERQL

risperidoneQL

TIER 01 amitriptyline HCL

risperidone odtQL

bupropion HCL

risperidone M-TABQL

bupropion HCL ER

thioridazine HCL

bupropion HCL SR

thiothixene

bupropion HCL XL

trifluoperazine HCL

citalopram hydrobromide

ziprasidone HCLQL

clomipramine HCL

Clozapine OdtQL

desipramine HCL

Fluphenazine HCL

doxepin HCL

Lithium

escitalopram oxalate

Lithium Carbonate

fluoxetine DR

Quetiapine Fumarate ERQL

fluoxetine HCL

TIER 03 Abilify Maintena

fluvoxamine maleate

Aristada

fluvoxamine maleate ER

Chlorpromazine HCL

imipramine pamoate

EquetroQL

imipramine HCL

FanaptQL

mirtazapine

Fanapt Titration PackQL

mirtazapine odt

FazacloQL

nefazodone HCL

Haloperidol

nortriptyline HCL

Invega Sustenna

paroxetine HCL

Invega Trinza

paroxetine HCL ER

LatudaQL

phenelzine sulfate

NuplazidPA

protriptyline HCL

Prochlorperazine Maleate

sertraline HCL

RexultiPA

tranylcypromine sulfate

SaphrisQL,PA

trazodone HCL

Seroquel XRQL

trimipramine maleate

VraylarPA

venlafaxine HCLQL

Zyprexa Relprevv

venlafaxine HCL ER

TIER 05 Risperdal Consta

Amoxapine

Doxepin HCL

HYPNOTICS

Maprotiline HCL

Nefazodone HCL

TIER 01 estazolam

Nortriptyline HCL

phenobarbital

TIER 02 duloxetine HCLQL

temazepam

Desvenlafaxine ER

triazolam

Khedezla

zaleplonQL

TIER 03 Desipramine HCL

zolpidem tartrateQL

EmsamQL

Flurazepam HCL

Marplan

Phenobarbital

PristiqPA

Phenobarbital Sodium

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 16

Quazepam

topiramate

Triazolam

valproic acid

TIER 02 eszopicloneQL

zonisamide

zolpidem tartrate ERQL

Diazepam

TIER 03 Amytal Sodium

TIER 03 Banzel

Butisol Sodium

BriviactPA

Chloral Hydrate

Carbatrol

Doral

Celontin

Pentobarbital Sodium

Depakene

RozeremQL

Depakote

Seconal Sodium

Depakote ER

SilenorQL,ST

Depakote Sprinkles

Dilantin

ADHD, NARCOLEPSY, ETC.

Dilantin Infatabs

Dilantin-125

TIER 01 armodafinilQL,PA

FycompaPA

caffeine citrate

Gabitril

dexedrineQL

Keppra

enidate HCL

Keppra XR

dextroamphetamine sulfateQL

Lamictal

guanfacine ERPA

Lamictal Chewable Dispersible

methamphetamine HCLQL

Lamictal Odt

methylphenidate hydrochloride

Lamictal XR

methylphenidate HCLQL

LyricaPA

modafinilQL,PA

Mysoline

zenzediQL

Neurontin

TIER 02 amphetamine/dextroamphetamineQL

OnfiPA

dexmethylphenidate HCL ERQL

Oxtellar XR

dextroamphetamine sulfate ERQL

Peganone

metadate ERQL

Phenytek

methylphenidate HCL CDQL

Phenytoin Sodium

methylphenidate HCL ERQL

Sabril

methylphenidate HCL SRQL

Tegretol

Methylphenidate HCL ERQL

Tegretol-XR

StratteraQL,PA

Topamax

TIER 03 Caffeine Anhydrous

Topamax Sprinkle

Caffeine Citrated

Trileptal

DaytranaQL,PA

Trokendi XRPA

Focalin XRQL

Vimpat

NuvigilQL,PA

Zarontin

Quillivant XRQL

Zonegran

VyvanseQL

ANTIPARKINSON AGENTS

ANTICONVULSANTS

TIER 01 amantadine HCL

TIER 01 carbamazepine

benztropine mesylate

carbamazepine ER

bromocriptine mesylate

clonazepam

carbidopa

clonazepam odt

carbidopa/levodopa

divalproex sodium

carbidopa/levodopa odt

divalproex sodium DR

carbidopa/levodopa ER

divalproex sodium ER

entacapone

epitol

pramipexole dihydrochloride

ethosuximide

pramipexole dihydrochloride ER

felbamate

rasagiline mesylatePA

fosphenytoin sodium

ropinirole ER

gabapentin

ropinirole HCL

lamotrigine

selegiline HCL

lamotrigine odt

tolcapone

lamotrigine titration

trihexyphenidyl HCL

lamotrigine ER

Carbidopa/Levodopa/Entacapone

levetiracetam

TIER 03 AzilectPA

levetiracetam ER

Benztropine Mesylate

oxcarbazepine

Bromocriptine Mesylate

phenytoin

Levodopa

phenytoin infatabs

NeuproPA

phenytoin sodium extended

Selegiline HCL

primidone

Stalevo 100

roweepra

Stalevo 125

tiagabine hydrochloride

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 17

Stalevo 150

methocarbamol

Stalevo 200

orphenadrine citrate

Stalevo 50

orphenadrine citrate ER

Stalevo 75

tizanidine HCL

Zelapar

TIER 02 metaxallST

metaxaloneST

NEUROLOGY, PSYCH - MISC.

TIER 03 Carisoprodol

TIER 05 EuflexxaPA

TIER 01 acamprosate calcium DR

Gel-onePA

bupropion HCL SR

Genvisc 850PA

disulfiram

HyalganPA

fluoxetine HCL

OrthoviscPA

galantamine hydrobromide

SupartzPA

galantamine hydrobromide ER

Supartz FxPA

olanzapine/fluoxetineQL

SynviscPA

pimozide

Synvisc OnePA

rivastigmine tartrate

rivastigmine transdermal system

ANTIMYASTHENIC AGENTS

Chlordiazepoxide/Amitriptyline

Ergoloid Mesylates

TIER 01 pyridostigmine bromide

Fluoxetine

pyridostigmine bromide ER

Galantamine Hydrobromide

Guanidine HCL

Perphenazine/Amitriptyline

TIER 03 Mestinon

TIER 02 donepezil HCLST

TIER 03 ChantixPA

OPHTHALMOLOGY AND OTIC

Chantix Continuing Month PAKPA

ANTI-INFECTIVES

Chantix Starting Month PAKPA

TIER 01 bacitracin/polymyxin b

Namenda XR

ciprofloxacin HCL

Namenda XR Titration Pack

erythromycin

NuedextaPA

gatifloxacin

Sarafem

gentak

Savella

gentamicin sulfate

Savella Titration Pack

ilotycin

TIER 05 glatopa

levofloxacin

tetrabenazinePA

neo-polycin

AmpyraPA

neomycin/bacitracin/polymyxin

AubagioPA

neomycin/polymyxin/gramicidin

Avonex

ofloxacin

Avonex Pen

polycin

Betaseron

polymyxin b sulfate/trimethoprim sulfate

Copaxone

sodium sulfacetamide

Extavia

sulfacetamide sodium

GilenyaPA

tobramycin sulfate

Plegridy

trifluridine

Plegridy Starter Pack

trimethoprim sulfate/polymyxin b sulfate

RebifPA

Bacitracin

Rebif RebidosePA

TIER 02 Vigamox

Rebif Rebidose Titration PackPA

TIER 03 Azasite

Rebif Titration PackPA

Besivance

TecfideraPA

Betadine Ophthalmic Prep

Tecfidera Starter PackPA

Ciloxan

XyremPA

Moxeza

ZinbrytaPA

Natacyn

Sulfacetamide Sodium

NEUROMUSCULAR AGENTS

Tobrex

TIER 03 Xeomin

Zirgan

TIER 05 riluzole

BotoxPA

ARTIFICIAL TEAR/LUBRICANT

DysportPA

TIER 03 Lacrisert

MyoblocPA

BETA-BLOCKERS

MUSCULOSKELETAL AGENTS

TIER 01 betaxolol HCL

TIER 01 baclofen

carteolol HCL

carisoprodol

dorzolamide HCL/timolol maleate

carisoprodol/aspirin

levobunolol HCL

carisoprodol/aspirin/codeine

timolol maleate

chlorzoxazone

timolol maleate ophthalmic gel forming

cyclobenzaprine HCL

Metipranolol

dantrolene sodium

TIER 03 Betimol

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 18

Betoptic-s

proparacaine HCL

Combigan

tetcaine

Istalol

tetracaine HCL

Timoptic Ocudose

tetravisc

tetravisc forte

OPHTHALMIC STEROIDS

TIER 03 Akten

TIER 01 fluorometholone

OPHTHALMICS - MISC.

neo-polycin HC

neomycin/polymyxin/bacitracin/hydrocortisone

TIER 01 azelastine HCL

neomycin/polymyxin/dexamethasone

bromfenac

prednisolone acetate

cromolyn sodium

sulfacetamide sodium/prednisolone sodium phosphate

diclofenac sodium

tobramycin/dexamethasone

dorzolamide HCL

Dexamethasone Sodium Phosphate

epinastine HCL

Neomycin/Polymyxin/Hydrocortisone

flurbiprofen sodium

Prednisolone Sodium Phosphate

ketorolac tromethamine

TIER 02 Lotemax

olopatadine HCL

TIER 03 Alrex

Bromfenac

Blephamide

TIER 02 Pataday

Blephamide S.o.p.

Pazeo

Durezol

TIER 03 Alocril

Flarex

Alomide

FML

Azopt

FML Forte

Bepreve

Maxidex

Emadine

Pred Mild

Ilevro

Pred-G

Lastacaft

Pred-G S.o.p.

Nevanac

Tobradex

Tobradex ST

OTIC AGENTS

Zylet

TIER 01 acetasol HC

acetic acid

PROSTAGLANDINS

cortic-nd

TIER 01 latanoprost

cyotic

Bimatoprost

exotic-HC

TIER 02 Travatan Z

fluocinolone acetonide

fluocinolone acetonide ear drops

CYCLOPLEGIC MYDRIATICS

hydrocortisone/acetic acid

neomycin/polymyxin/hydrocortisone

TIER 01 cyclopentolate hydrochloride

neomycin/polymyxin/HC

cyclopentolate HCL

ofloxacin

homatropaire

otomax-HC

homatropine HBR

Acetic Acid/Aluminum Acetate

tropicamide

TIER 02 Ciprodex

Atropine Sulfate

TIER 03 Cetraxal

TIER 03 Cyclomydril

Cipro HC

Tropicamide

Ciprofloxacin

Coly-mycin S

DECONGESTANTS

Cortane-b Aqueous

TIER 01 altafrin

phenylephrine HCL

OXYTOCICS

MIOTICS

TIER 01 methergine

TIER 01 pilocarpine HCL

methylergonovine maleate

TIER 03 Phospholine Iodide

oxytocin

ADRENERGIC AGENTS

PAIN MANAGEMENT

TIER 01 apraclonidine

brimonidine tartrate

ANALGESICS - NONNARCOTIC

TIER 03 Alphagan P

TIER 01 adult aspirin EC low strength

Iopidine

aspir-low

Simbrinza

aspir-81

aspirin

IMMUNOMODULATORS

aspirin adult low dose

TIER 02 Restasis

aspirin adult low strength

Restasis Multidose

aspirin childrens

aspirin enteric coated adult low strength

LOCAL ANESTHETICS

aspirin low dose

aspirin low strength

TIER 01 altacaine

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 19

aspirin EC

tgt childrens aspirin

aspirin EC low dose

tgt enteric-coated aspirin

aspirin 81

CVS aspirin

aspirin 81 low dose

CVS aspirin adult low dose

aspirtab

CVS aspirin adult low strength

bayer advanced aspirin regular strength

CVS aspirin low dose

bayer aspirin

CVS aspirin EC

bayer aspirin regimen

CVS childrens aspirin

bayer aspirin EC low dose

CVS enteric aspirin

bayer chewable low dose

EC-81 aspirin

bayer low dose

HM aspirin

butalbital/acetaminophen

HM aspirin EC

butalbital/acetaminophen/caffeine

HM aspirin EC low dose

butalbital/aspirin/caffeine

MM aspirin

childrens aspirin

SB aspirin

childrens aspirin low strength

SB aspirin adult low strength

choline magnesium trisalicylate

SB aspirin EC

coated aspirin

SB childrens aspirin

diflunisal

SB low dose asa EC

duraxin

Tencon

ecotrin

TIER 03 Acetyl Salicylic Acid

ecotrin low strength

Aspirin

ecpirin

Levacet

ed-flex

Sodium Salicylate

enteric coated aspirin

Vanatol LQ

eq adult aspirin low strength

TIER 05 Prialt

eq aspirin

eq aspirin adult low dose

ANALGESICS - OPIOID

eq aspirin low dose

TIER 01 acetaminophen/codeineQL

eq aspirin EC

acetaminophen/codeine phosphateQL

eq childrens aspirin

alfentanil

eql aspirin

ascomp/codeine

eql aspirin low dose

buprenorphine HCL

eql aspirin EC

buprenorphine HCL/naloxone HCLPA

gnp adult aspirin low strength

butalbital/acetaminophen/caffeine/codeine

gnp aspirin

butalbital/aspirin/caffeine/codeine

gnp aspirin low dose

butorphanol tartrateQL

goodsense aspirin low dose

codeine sulfate

h-e-b aspirin

duramorph

kls aspirin low dose

endocetQL

kls aspirin EC

fentanyl

kp aspirin

fentanyl citrate oral transmucosalQL,PA

marten-TAB

hydrocodone bitartrate/acetaminophenQL

meijer aspirin EC

hydrocodone/acetaminophenQL

miniprin low dose

hydrocodone/ibuprofen

norwich aspirin

hydromorphone HCL

px aspirin

hydromorphone HCL dosette

px enteric aspirin

ibudone

qc aspirin

lorcetQL

qc aspirin low dose

lorcet plusQL

qc chewable aspirin low dose

lorcet HDQL

qc childrens aspirin

lortabQL

qc enteric aspirin

meperidine HCL

ra aspirin

methadone HCL

ra aspirin adult low dose

methadone HCL intensol

ra aspirin adult low strength

methadose

ra aspirin childrens

morphine sulfate

ra aspirin EC

morphine sulfate ER

ra aspirin EC adult low strength

nalbuphine HCL

ra childrens aspirin

oxycodone HCL

salsalate

oxycodone/acetaminophenQL

sm aspirin

oxycodone/aspirin

sm aspirin adult low strength

oxymorphone hydrochloride

sm aspirin enteric coated

pentazocine/naloxone HCL

sm aspirin EC low strength

reprexain

sm childrens aspirin

tramadol hydrochloride/acetaminophenQL

st joseph aspirin

tramadol HCL

st joseph low dose aspirin

tramadol HCL ER

tgt aspirin

tgt aspirin low dose

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 20

verdrocet

HumiraPA

vicodinQL

Humira Pediatric Crohns Disease Starter PackPA

vicodin ESQL

Humira PenPA

vicodin HPQL

Humira Pen-crohns DiseasestarterPA

xylon

Humira Pen-psoriasis StarterPA

Aspirin-caffeine-dihydrocodeine

KineretPA

Capital/CodeineQL

OrenciaPA

Codeine Sulfate

Orencia ClickjectPA

Hydromorphone HCL

OtezlaPA

Levorphanol Tartrate

SimponiPA

Meperidine HCL

XeljanzPA

Methadone HCL

Xeljanz XRPA

Morphine Sulfate

Morphine Sulfate ER

MIGRAINE PRODUCTS

Oxycodone HCL ER

TIER 01 dihydroergotamine mesylate

Oxycodone/Ibuprofen

ergotamine tartrate/caffeine

Oxymorphone Hydrochloride ER

frovatriptan succinateQL,PA

TIER 02 Oxycontin

isometheptene/dichloralphenazone/acetaminophen

SuboxonePA

naratriptan HCLQL

TIER 03 BunavailPA

nodolor

Codeine Phosphate

rizatriptan benzoateQL

Kadian

rizatriptan benzoate odtQL

Lortab

sumatriptanQL

Meperidine HCL/Promethazine HCL

sumatriptan succinateQL

Nucynta

sumatriptan succinate refillQL

Nucynta ER

Sumatriptan SuccinateQL

Opana ER (crush Resistant)

TIER 02 almotriptanQL,PA

Oxycodone/AcetaminophenQL

almotriptan malateQL,PA

PrimlevQL

zolmitriptanQL

Synalgos-dc

zolmitriptan odtQL

TIER 03 Cafergot

ANTI-INFLAMMATORY

Dihydroergotamine Mesylate

TIER 01 diclofenac potassium

Ergomar

diclofenac sodium DR

Ergotamine Tartrate

diclofenac sodium ER

Migergot

diclofenac sodium/misoprostol

MigranalQL

flurbiprofen

RelpaxQL,PA

ibuprofen

ZomigQL,ST

indomethacin

Zomig Nasal SprayQL,ST

indomethacin ER

ketoprofen

GOUT AGENTS

ketorolac tromethamine

TIER 01 allopurinol

leflunomide

probenecid

mefenamic acid

probenecid/colchicine

meloxicam

TIER 03 Colchicine

nabumetone

Colcrys

naproxen

Mitigare

naproxen sodium

Uloric

naproxen DR

ZurampicPA

oxaprozin

sulindac

LOCAL ANESTHETICS-INJ

Fenoprofen Calcium

TIER 01 bupivacaine HCL

Ketoprofen ER

bupivacaine/epinephrine

Ketorolac Tromethamine

lidocaine HCL

Meclofenamate Sodium

lidocaine/epinephrine

Tolmetin Sodium

polocaine

TIER 02 celecoxibPA

polocaine-mpf

etodolac

ropivacaine

etodolac ER

ropivacaine HCL

piroxicam

sensorcaine

TIER 03 Arcalyst

sensorcaine-mpf

Indocin

sensorcaine-mpf/epinephrine

Phenylbutazone

sensorcaine/epinephrine

Ridaura

xylocaine dental

Sulindac

Tetracaine HCL

TIER 05 ActemraPA

TIER 03 Mepivacaine HCL

EnbrelPA

Procaine HCL

Enbrel SureclickPA

Sensorcaine-mpf/Epinephrine

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 21

GENERAL ANESTHETICS

Bromhexine HCL

Carbaphen 12

TIER 01 isoflurane

Carbaphen 12 PED

ketamine HCL

Decon-a

sevoflurane

Decon-G

sojourn

Gilphex TR

terrell

Giltuss TR

Hypersal

RESPIRATORY, ALLERGY, ETC

N-acetyl-l-cysteine

ANTIHISTAMINES

Neotuss Plus

TIER 01 arbinoxa

Nortuss-EX

carbinoxamine maleate

Panatuss Dxp

cyproheptadine HCL

Relhist

diphenhydramine HCL

Rezira

pharbedryl

Semprex-d

phenadoz

Terpin Hydrate

phenergan

Terpin Hydrate Monohydrate

promethazine HCL

Tgq 15DM/5PEH/2CPM

promethazine HCL plain

Tgq 30PSE/150GFN/15DM

promethegan

Tgq 30PSE/3BRM/15DM

TIER 03 Brompheniramine Maleate

Tusnel

Brompheniramine Tannate

Tussicaps

Chlorpheniramine Maleate

Clemastine Fumarate

ANTIASTHMATIC/COPD AGENTS

Diphenhydramine HCL

TIER 01 albuterol

Doxylamine Succinate

albuterol sulfate

Pyrilamine Maleate

albuterol sulfate ER

Tripelennamine HCL

albuterol TAB 4MG

budesonide

NASAL AGENTS

difil-G forte

TIER 01 azelastine HCL

epinephrine HCL

budesonide

ipratropium bromide

flunisolide

ipratropium bromide/albuterol sulfate

fluticasone propionate

levalbuterol

ipratropium bromide

levalbuterol HCL

olopatadine HCL

montelukast sodium

triamcinolone acetonide

terbutaline sulfate

TIER 03 Adrenalin

theochron

Phenylephrine HCL

theophylline CR

Phenylpropanolamine Hydrochloride Usp

theophylline ER

Pseudoephedrine HCL

zafirlukast

Tyzine Pediatric Nasal Drops

Cromolyn Sodium

Elixophyllin

COUGH/COLD/ALLERGY

Levalbuterol Tartrate HFA

TIER 01 acetylcysteine

TIER 02 Advair DiskusPA

benzonatate

Advair HFAPA

biotuss

Anoro Ellipta

biotuss pediatric

Arnuity Ellipta

bromfed DM

Breo ElliptaPA

bromphen/pseudoephedrine HCL/dextromethorphan HBR

Flovent Diskus

giltuss pediatric

Flovent HFA

hydrocodone bitartrate/homatropine methylbromide

Incruse Ellipta

hydrocodone polistirex/chlorpheniramine polistirex

Proair HFA

hydrocodone/homatropine

Proair Respiclick

hydromet

Pulmicort Flexhaler

nebusal

Serevent Diskus

nortuss-DE

Spiriva Handihaler

promethazine VC plain

Spiriva Respimat

promethazine VC/codeine

SymbicortPA

promethazine-DM

Theo-24

promethazine/codeine

Ventolin HFA

promethazine/dextromethorphan

TIER 03 Aerospan

promethazine/phenylephrine

Albuterol Sulfate

promethazine/phenylephrine/codeine

Aminophylline Anhydrous

pulmosal

Arcapta Neohaler

sodium chloride

Atrovent HFA

tussigon

Bevespi

Benzonatate

Brovana

TIER 03 Acetylcysteine

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 22

Combivent Respimat

Menactra

DalirespPA

Menhibrix

Ephedrine HCL

Menomune-a/C/Y/W-135

Ephedrine Sulfate

Menveo

Flunisolide

Pedvax HIB

Flunisolide Anhydrous

Pneumovax 23

Ipratropium Bromide

Pneumovax 23/1 Dose

Ipratropium Bromide Monohydrate

Prevnar 13

Metaproterenol Sulfate

Proquad

Perforomist

Recombivax HB

Stiolto Respimat

Rotarix

Striverdi Respimat

Rotateq

Terbutaline Sulfate

Trumenba

Xopenex HFA

Twinrix

TIER 05 NucalaPA

Vaqta

XolairPA

Varivax

ZostavaxQL

RESPIRATORY AGENTS - MISC

VITAMINS

TIER 03 Curosurf

Survanta Intratracheal

VITAMINS

TIER 05 EsbrietPA

TIER 01 aqueous vitamin d infants

KalydecoPA

ascorbic acid

OfevPA

bio-d-mulsion

OrkambiPA

bio-d-mulsion forte

Pulmozyme

bprotected pedia d-vite

d 1000

TOXOIDS

d 10000

d 2000

TIER 03 Adacel

d 400

Boostrix

d 5000

Daptacel

d-vita

Diphtheria/Tetanus Toxoids Adsorbed Pediatric

d-1000

Infanrix

d-1000 extra strength

Kinrix

d-2000 maximum strength

Pediarix

d-3-5

Pentacel

d-400

Quadracel

d-5000

Tenivac

decara

Tetanus/Diphtheria Toxoids-adsorbed

delta d3

dialyvite vitamin d 5000

VACCINES

dialyvite vitamin d3 max

d2000 ultra strength

d3

TIER 03 Acthib

d3 adult

Afluria PF 2015-2016

d3 adult gummy

Afluria PF 2016-2017

d3 high potency

Afluria Quadrivalent 2016-2017

d3 kids

Afluria 2015-2016QL

d3 maximum strength

Afluria 2016-2017QL

d3 super strength

Bexsero

d3 ultra strength

Engerix-b

d3 2000

Fluad 2016-2017

d3-1000

Fluarix Quadrivalent 2016-2017

d3-50

Flublok 2015-2016

eql vitamin d3

Flublok 2016-2017

eql vitamin d3 gummies

Flucelvax Quadrivalent 2016-2017

gnp d 2000

Flucelvax 2015-2016

gnp vitamin d

Flulaval Quadrivalent 2016-2017

gnp vitamin d maximum strength

Fluvirin 2015-2016QL

gnp vitamin d super strength

Fluvirin 2016-2017QL

gnp vitamin d3 extra strength

Fluzone High-dose PF 2016-2017

healthy kids vitamin d3

Fluzone Intradermal Quadrivalent 2016-2017

just d

Fluzone Quadrivalent 2016-2017

kp vitamin d

Gardasil

maximum d3

Gardasil 9

mega-c/a plus

Havrix

nat-rul vitamin d

Hiberix

natural vitamin d-3

Ipol Inactivated IPV

optimal-d

M-m-r II

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 23

optimal-d pack

Bp Folinatal Plus B

opurity vitamin d

Bp Multinatal Plus

ortho-CS 250

Classic Prenatal

pronutrients vitamin d3

Complete Natal DHA

ra vitamin d-3

Completenate

sm vitamin d

CO-natal Fa

sm vitamin d3

CVS Prenatal

thera-d rapid repletion

Elite-OB

thera-d 2000

Eql Prenatal Formula

thiamine HCL

Inatal Advance

vitajoy daily d gummies

Inatal GT

vitamin c 222MG

Inatal Ultra

vitamin d

M-vit

vitamin d high potency

Macnatal CN DHA

vitamin d 400

Mission Prenatal HP

vitamin d-1000

Multi Prenatal

vitamin d-1000 maximum strength

Mynatal Advance

vitamin d-3

Mynatal Plus

vitamin d-400

Mynatal Ultracaplet

vitamin d3

Mynatal-z

vitamin d3 adult gummies

Mynate 90 Plus

vitamin d3 gummies

Obstetrix EC

vitamin d3 high potency

Perry Prenatal

vitamin d3 maximum strength

Pr Natal 400

vitamin d3 super strength

Pr Natal 400 EC

vitamin d3 400

Pr Natal 430

Aminobenzoate Potassium

Pr Natal 430 EC

CVS d3

Pre-natal Formula

CVS vitamin d childrens gummies

Prenaissance Plus

CVS vitamin d3

Prenatabs RX

HM vitamin d

Prenatal

HM vitamin d3

Prenatal And Iron

PA vitamin d-3

Prenatal Forte

PA vitamin d-3 gummy

Prenatal Low Iron

TIER 02 Baby Super Daily D3

Prenatal Vitamins

Baby Vitamin D3 Drops

Prenatal-u

CVS Vitamin D3 Drops/Infants

Px Prenatal Multivitamins

Ddrops

PNV-DHA

D3 Dots

Ra Prenatal

HM Vitamin D3

Se-natal 19

Replesta

Sm Prenatal Vitamins

Replesta Childrens

Taron-prex

Replesta Nx

Triadvance

Sm Vitamin D3 Maximum Strength

Tricare

Super Daily D3

Trinatal RX 1

Thera-d 4000

Trinate

Vitamelts Vitamin D

Ultimatecare One

Vitamin D3

Ultimatecare One NF

Wellesse Vitamin D3

Vinate II

TIER 03 Aminobenzoic Acid

Vinate M

Calcium Ascorbate Dihydrate

Vinate One

Calcium Pantothenate

Vitafol-OB

Decara

TIER 02 Active OB

Ergocalciferol

Atabex EC

Niacin

Atabex Prenatal

Para-aminobenzoic Acid

Bal-care DHA

Potaba

C-nate DHA

Potassium P-aminobenzoate

Calcium PNV

Pyridoxine HCL

Citranatal Assure

Sodium Ascorbate

Citranatal B-calm

Thiamine Hydrochloride

Citranatal DHA

Thiamine HCL

Citranatal Harmony

Wheat Germ

Citranatal RX

4-aminobenzoic Acid Potassium Salt

Citranatal 90 DHA

Clinical Nutrients Prenatal Formula

MULTIVITAMINS

Concept DHA

Concept OB

TIER 01 corvita

Dothelle DHA

sm prenatal vitamins

Duet DHA Balanced

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 24

Duet DHA 400

Prenate Enhance

Extra-virt Plus DHA

Prenate Essential

Ezfe Forte

Prenate Mini

Focalgin CA

Prenate Pixie

Focalgin 90 DHA

Prenate Restore

Folcal DHA

Prena1 Chew

Folcaps Omega 3

Prena1 Pearl

Folet One

Preplus

Folivane-OB

Preque 10

Gnp Daily Prenatal

Pretab

Gnp Prenatal

Profe Forte

Goodsense Prenatal Vitamins

Provida OB

Hemenatal OB

Purefe OB Plus

Hemenatal OB + DHA

PA Prenatal Formula

HM One Daily Prenatal Combo

PNV Ferrous Fumarate/Docusate/Folic Acid

HM Prenatal

PNV Folic Acid + Iron Multivitamin

Infanate Balance

PNV Ob+dha

Kosher Prenatal Plus Iron

PNV Prenatal Plus Multivitamin

Kp Prenatal Multivitamins

PNV TABS 29-1

Kpn Prenatal

PNV-dha+docusate

Levomefolate DHA

PNV-omega

Marnatal-f

PNV-select

Mission Prenatal

PNV-total

Mynatal

PNV-vp-u

Nat-rul Prenatal Vitamins

Qc Prenatal

Natachew

R-natal OB

Natalvit

Ra One Daily

Natelle One

Ra Prenatal Formula/Folicacid

Neevo DHA

Relnate DHA

Nestabs

Right Step Prenatal

Nestabs Abc

Rulavite DHA

Nestabs DHA

Select-ob+dha

Newgen

Select-OB

Nexa Plus

Sm One Daily Prenatal

Niva-plus

Taron-bc

Nutricion Porvida

Taron-c DHA

O-CAL Fa

Theranatal Core Nutrition

O-CAL Prenatal

Thrivite RX

Obstetrix DHA

Thrivite 19

Obstetrix One

Tri-TABS DHA

One-a-day Womens Prenatal

Tricare Prenatal

OB Complete

Tricare Prenatal Compleat

OB Complete Gold

Tricare Prenatal DHA One

OB Complete One

Trinatal GT

OB Complete Petite

Triveen-duo DHA

OB Complete Premier

Triveen-prx RNF

OB Complete/DHA

TL Folate

Preferaob +dha

TL-care DHA

Preferaob One

TL-select

Prenaissance

Vemavite-prx 2

Prenaissance Balance

Vena-bal DHA

Prenaissance Harmony DHA

Vinate DHA RF

Prenaissance Next

Virt Nate

Prenaissance Next-b

Virt-advance

Prenata

Virt-c DHA

Prenatabs Fa

Virt-care One

Prenatal Complete

Virt-nate DHA

Prenatal Formula A-free

Virt-pn

Prenatal Multi +dha

Virt-pn DHA

Prenatal One Daily

Virt-pn Plus

Prenatal Plus

Virt-select

Prenatal Plus Iron

Virt-vite GT

Prenatal Vitamin

Virtprex

Prenatal Vitamin/Iron

Vita-pren

Prenatal Vitamins Plus Low Iron

Vitafol Fe+

Prenatal 19

Vitafol Gummies

Prenate

Vitafol Ultra

Prenate AM

Vitafol-nano

Prenate DHA

Vitafol-ob+dha

Prenate Elite

Vitafol-one

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 25

Vitamedmd One RX/Quatrefolic

Advocate Insulin Syringe/U-100/1ML/29GX1/2"

Vitamedmd Redichew RX

Advocate Insulin Syringe/U-100/1ML/30GX5/16"

Vitapearl

Advocate Insulin Syringe/U-100/1ML/31GX5/16"

Viva DHA

Advocate Lancets

Vol-nate

Advocate Lancets 30G

Vol-plus

Advocate Lancing Device

Vol-TAB RX

Advocate Rapid-safe Lancing Device

Vp-ggr-b6 Prenatal

Advocate Safety Lancets

Vp-heme One

Advocate Safety Lancets 26G

Vp-heme OB

Agamatrix Ultra-thin Lancets 33G

Vp-heme OB + DHA

Alternate Site Lancing Device

Vp-CH Plus

Anti-stick Insulin Syringe/U-100/0.5ML/28G X 1/2"

Vp-CH-PNV

Anti-stick Insulin Syringe/U-100/0.5ML/29G X 1/2"

Vp-PNV-DHA

Anti-stick Insulin Syringe/U-100/1ML/29G X 1/2"

Zatean-pn DHA

Aqua Lance Adjustable Lancing Device

Zatean-pn Plus

Assure Comfort Lancets Ultra Thin 28G

Zatean-CH

Assure Comfort Lancets Ultra Thin 30G

TIER 03 Nicomide

Assure Haemolance Plus High Flow 18G

Prefera OB

Assure Haemolance Plus Low Flow 25G

Prenate Star

Assure Haemolance Plus Micro Flow 28G

Provida DHA

Assure Haemolance Plus Normal Flow 21G

Tristart DHA

Assure Haemolance Plus Pediatric Blade

Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X 1/2"

MEDICAL DEVICES

Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2"

Assure Lance Lancets

DIABETIC SUPPLIES

Assure Lance Lancets 21G

TIER 02 Accu-chek Aviva

Assure Lance Plus Safety Lancets 25G

Accu-chek Aviva Plus

Assure Lance Plus Safety Lancets 30G

Accu-chek Compact Plus

Assure Lancets

Accu-chek Compact Test Drum

Aurora Lancet Super Thin 30G

Accu-chek Fastclix Lancetdevice Kit

Aurora Lancet Thin 23G

Accu-chek Fastclix Lancets

Aurora Pen Needles 29GX12MM

Accu-chek Multiclix Lanc Et Device Kit

Aurora Pen Needles 31G X 6MM

Accu-chek Multiclix Lancets

Aurora Pen Needles 31G X 8MM

Accu-chek Safe-t-pro Lancets

Aurora Unifine Pentips/Mini/31GX3/16"

Accu-chek Safe-t-pro Pluslancets

Aurora Unifine Pentips/32GX5/32"

Accu-chek Smartview Strips

Auto-lancet

Accu-chek Soft Touch Lancets

Auto-lancet Mini

Accu-chek Softclix Lancetdevice Kit

Autolet Impression

Accu-chek Softclix Lancets

Autolet Impression Lancing Device

Accutrend Glucose

Autolet II Clinisafe

Onetouch Club Lancets Fine Point

Autolet Lite Clinisafe

Onetouch Combo Pack

Autolet Lite Starter Pack

Onetouch Delica Lancets Fine 30G

Autolet Mini

Onetouch Delica Lancing Device

Autolet Platforms

Onetouch Finepoint Lancets

Autolet Plus

Onetouch Lancets

AF Lancets Super Thin

Onetouch Suresoft Lancing Device/18G

AT Last Lancets

Onetouch Suresoft Lancing Device/21G

B-d Insulin Syringe Ultrafine II/0.3ML/31G X 5/16"

Onetouch Suresoft Lancing Device/28G

B-d Insulin Syringe Ultrafine II/0.5ML/31G X 5/16"

Onetouch Ultra Blue

B-d Insulin Syringe Ultrafine II/1ML/31G X 5/16"

Onetouch Ultrasoft Lancets

B-d Insulin Syringe Ultrafine/0.3ML/30G X 1/2"

Onetouch Verio Test Strips

B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2"

TIER 03 Acti-lance Lancets 28G

B-d Insulin Syringe Ultrafine/1ML/30G X 1/2"

Acti-lance Lite Safety Lancets 28G

Bayer Microlet Lancets

Acti-lance Special Safety Lancets 17G

Bayer Microlet 2 Lancing Device

Acti-lance Special Safetylancets 17G

Bullseye Mini Safety Lancets

Acti-lance Universal Safety Lancets 23G

Bullseye Safety Lancets

Active 1ST Blood Lancets 30G/Easy Twist CAP

BD Autoshield Duo 30G X 3/16"

Adjustable Lancing Device

BD Autoshield 29G X 3/16"

Advocate Insulin Pen Needles 29GX12.7MM

BD Autoshield 29G X 5/16"

Advocate Insulin Pen Needles 31GX5MM

BD Insulin Syringe LUER-LOK/U-100/1ML

Advocate Insulin Pen Needles 31GX8MM

BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2"

Advocate Insulin Syringe/U-100/0.3ML/29GX1/2"

BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"

Advocate Insulin Syringe/U-100/0.3ML/30GX5/16"

BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"

Advocate Insulin Syringe/U-100/0.3ML/31GX5/16"

BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"

Advocate Insulin Syringe/U-100/0.5ML/29GX1/2"

BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"

Advocate Insulin Syringe/U-100/0.5ML/30GX5/16"

BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"

Advocate Insulin Syringe/U-100/0.5ML/31GX5/16"

BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 15/64"

BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16"

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 26

BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2"

Careone Unifine Pentips Plus Pen Needles 29GX12MM

BD Insulin Syringe Safetyglide/1ML/29G X 1/2"

Careone Unifine Pentips Plus Pen Needles 31GX5MM

BD Insulin Syringe Slip Tip/U-100/1ML

Careone Unifine Pentips Plus Pen Needles 31GX6MM

BD Insulin Syringe U-40/1ML/25G X 5/8"

Careone Unifine Pentips Plus Pen Needles 31GX8MM

BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"

Careone Unifine Pentips Plus Pen Needles 32GX4MM

BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16"

Careone Unifine Pentips 29GX12MM

BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"

Careone Unifine Pentips 31GX5MM

BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"

Careone Unifine Pentips 31GX6MM

BD Insulin Syringe Ultrafine/U-100/0.3ML/30G X 1/2"

Careone Unifine Pentips 31GX8MM

BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64"

Cleanlet Lancets 28G

BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 5/16"

Clever Chek Lancets Ultrathin

BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"

Clever Chek Lancets Ultrathin 30G

BD Insulin Syringe Ultrafine/U-100/0.5ML/30G X 1/2"

Clever Choice Comfort EZ Insulin Pen Needles 31GX8MM

BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64"

Clever Choice Comfort EZ Insulin Pen Needles 33GX4MM

BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 5/16"

Clever Choice Comfort EZ Insulin Syringe/U-100/1ML/31GX5/16"

BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"

Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X 1/2"

BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2"

BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64"

Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 1/2"

BD Insulin Syringe Ultrafine/U-100/1ML/31G X 5/16"

BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"

Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16"

BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"

BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2"

Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X 5/16"

BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16"

BD Insulin Syringe Ultrafine/1ML/30G X 1/2"

Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2"

BD Insulin Syringe Ultrafine/1ML/31G X 5/16"

Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X 1/2"

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1"

Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 1/2"

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/8"

Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16"

BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2"

Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X 5/16"

BD Insulin Syringe/U-100/0.5ML/30G X 1/2"

BD Insulin Syringe/U-100/1ML/27G X 1/2"

Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X 1/2"

BD Insulin Syringe/U-100/2ML/27.5G X 5/8"

BD Integra Insulin Syringe/U-100/1ML/29G X 1/2"

Clever Choice Comfort EZ Insulin Syringe/1ML/29G X 1/2"

BD Integra Syringe/Retracting Needle/1ML/25G X 1"

Clever Choice Comfort EZ Insulin Syringe/1ML/30G X 5/16"

BD Lancet Device

BD Lancet Ultrafine 30G

Clever Choice Comfort EZ Pen Needles 29GX12MM

BD Lancet Ultrafine 33G

Clever Choice Comfort EZ Pen Needles 31GX5MM

BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2"

Clever Choice Comfort EZ Pen Needles 31GX6MM

Clever Choice Comfort EZ Pen Needles 31GX8MM

BD Microtainer Lancets

Clever Choice Comfort EZ Pen Needles 32GX4MM

BD Pen Needle/Mini/Ultrafine/31G X 3/16"

Clever Choice Comfort EZ Pen Needles 32GX5MM

BD Pen Needle/Nano/Ultra Fine/32G X 4MM

Clever Choice Comfort EZ Pen Needles 32GX6MM

BD Pen Needle/SHORT/Ultrafine/31G X 5/16"

Clever Choice Comfort EZ Pen Needles 32GX8MM

BD Pen Needle/Ultrafine/29G X 12.7MM

Clever Choice Comfort EZ Pen Needles 33GX4MM

BD Pen Needle/Ultrafine/29GX1/2" 12.7MM

Clever Choice Comfort EZ Pen Needles 33GX5MM

BD Pen Needles SHORT/Ultrafine/31G X 5/16"

Clever Choice Comfort EZ Pen Needles 33GX6MM

BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2"

Clever Choice Comfort EZ Pen Needles 33GX8MM

BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2"

Clickfine Pen Needle Universal/31GX1/4"

Clickfine Pen Needle Universal/31GX5/16"

BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16"

Clickfine Pen Needle 32GX5/32"

BD-insul SYR Mis LO Dose

Clickfine Pen Needles/31GX1/4"

Cardiocom Lancing Device

Clickfine Pen Needles/31GX5/16"

Carefine Pen Needle 32GX4MM

Clickfine Universal Pen Needles 31GX5/16"

Carefine Pen Needles 29GX1/2"

Closercare

Carefine Pen Needles 30GX5/16"

Coaguchek Lancets

Carefine Pen Needles 31GX6MM

Comfort Assist Insulin Syringe 0.3ML/29G X 1/2"

Carefine Pen Needles 31GX8MM

Comfort Assist Insulin Syringe/0.3ML/30G X 5/16"

Carefine Pen Needles 32GX5MM

Comfort Assist Insulin Syringe/0.3ML/31G X 5/16"

Carefine Pen Needles 32GX6MM

Comfort Assist Insulin Syringe/0.5ML/29G X 1/2"

Careone Advanced Lancing Device

Comfort Assist Insulin Syringe/0.5ML/30G X 5/16"

Careone Insulin Syringes/0.3ML/30G X 1/2"

Comfort Assist Insulin Syringe/0.5ML/31G X 5/16"

Careone Insulin Syringes/0.3ML/31G X 5/16"

Comfort Assist Insulin Syringe/1ML/29G X 1/2"

Careone Insulin Syringes/0.5ML/30G X 1/2"

Comfort Assist Insulin Syringe/1ML/30G X 5/16"

Careone Insulin Syringes/0.5ML/31G X 5/16"

Comfort Assist Insulin Syringe/1ML/31G X 5/16"

Careone Insulin Syringes/1ML/30G X 1/2"

Comfort Assured Lancets Micro Thin 33G

Careone Insulin Syringes/1ML/31GX5/16"

Comfort Assured Lancets Super Thin 28G

Careone Lancet Thin

Comfort Lancets

Careone Lancet Ultra Thin

CVS Lancets Micro Thin 33G

Careone Unifine Pentips Pen Needles 32GX4MM

CVS Lancets Micro-thin 33G

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 27

CVS Lancets Original

Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X 1/2"

CVS Lancets Thin 26G

Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2"

CVS Lancets Ultra Thin 30G

Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2"

CVS Lancets Ultra-thin 30G

Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2"

CVS Lancets 21G

Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2"

CVS Lancing Device

Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16"

CVS Ultra Thin Lancets

Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2"

Diastar Easy Test II Lancets 30G

Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2"

Diastar Easy Test Lancets30G

Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2"

Droplet Lancets Ultra Thin 30G

Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16"

Droplet Lancing Device

Easy Touch Insulin Syringe/0.3ML/30G X 5/16"

Droplet Pen Needles 29GX12MM

Easy Touch Insulin Syringe/0.3ML/31G X 5/16"

Droplet Pen Needles 31GX5MM

Easy Touch Insulin Syringe/0.5ML/29G X 1/2"

Droplet Pen Needles 31GX6MM

Easy Touch Insulin Syringe/0.5ML/30G X 5/16"

Droplet Pen Needles 31GX8MM

Easy Touch Insulin Syringe/1ML/30G X 5/16"

Droplet Pen Needles 32GX4MM

Easy Touch Lancets 21G/Pressure Activated

Droplet Pen Needles 32GX5MM

Easy Touch Lancets 23G/Pressure Activated

Droplet Pen Needles 32GX6MM

Easy Touch Lancets 26G/Pressure Activated

Droplet Pen Needles 32GX8MM

Easy Touch Lancets 26G/Pull-top

Drug Mart Adjustable Lancing Device

Easy Touch Lancets 26G/Twist

Drug Mart Lancets Thin

Easy Touch Lancets 28G/Pressure Activated

Drug Mart Lancets Ultra Thin

Easy Touch Lancets 28G/Pull-top

Drug Mart On-the-go Lancets Gentle 30G

Easy Touch Lancets 28G/Twist

Drug Mart Unifine Pentips 31GX5MM

Easy Touch Lancets 30G/Button-activated

Drug Mart Unifine Pentipsplus 32GX4MM

Easy Touch Lancets 30G/Pressure Activated

Drug Mart Unifine Pentips29G X 12MM

Easy Touch Lancets 30G/Pull-top

Drug Mart Unifine Pentips31GX6MM

Easy Touch Lancets 30G/Twist

Drug Mart Unifine Pentips31GX8MM

Easy Touch Lancets 32G/Pressure Activated

Drug Mart Unifine Pentips32GX4MM

Easy Touch Lancets 32G/Pull-top

Drug Mart Unilet Lancets Super Thin 30G

Easy Touch Lancets 32G/Twist

Drug Mart Unilet Lancets Ultra Thin 28G

Easy Touch Lancets 33G/Twist

Duane Reade Lancet Alternate Site 26G

Easy Touch Lancing Device/Ejector

Duane Reade Lancet Super Thin 30G

Easy Touch Pen Needles 29GX1/2"

Duane Reade Lancet Ultra Thin 28G

Easy Touch Pen Needles 31GX1/4"

Duane Reade Unifine Pentips 29G X 12MM

Easy Touch Pen Needles 31GX5/16"

Duane Reade Unifine Pentips 31G X 6MM Ultra SHORT

Easy Touch Pen Needles 32GX1/4"

Duane Reade Unifine Pentips 31G X 8MM SHORT

Easy Touch Pen Needles 32GX3/16"

E-z Ject Lancets

Easy Touch Pen Needles 32GX5/32"

E-z Ject Lancets Color

Easy Touch Pen Needles/31G X 3/16"

E-z Ject Lancets Super Thin

Easy Touch Safety Lancets21G/Pressure Activated

E-z Ject Lancets Super Thin 30G

Easy Touch Safety Lancets23G/Pressure Activated

E-z Ject Lancets Thin 26G

Easy Touch Safety Lancets26G/Button Activated

E-z Ject Lancets 21G

Easy Touch Safety Lancets26G/Pressure Activated

E-ZJECT Lancets Micro-thin 33G

Easy Touch Safety Lancets28G/Button Activated

Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"

Easy Touch Safety Lancets28G/Pressure Activated

Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2"

Easy Touch Sheathlock Safety Insulin Syringe 1ML/29GX1/2"

Easy Comfort Insulin Syringe/0.3ML/30G X 5/16"

Easy Touch Sheathlock Safety Insulin Syringe 1ML/30GX5/16"

Easy Comfort Insulin Syringe/0.5ML/30G X 5/16"

Easy Comfort Insulin Syringe/0.5ML/31G X 5/16"

Easy Touch Sheathlock Safety Insulin Syringe 1ML/31GX5/16"

Easy Comfort Insulin Syringe/1ML/30G X 5/16"

Easy Comfort Insulin Syringe/1ML/31G X 5/16"

Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2"

Easy Comfort Lancets

Easy Touch 32GX5MM

Easy Comfort Lancets 30G/Pull Top

Easy Touch 32GX6MM

Easy Comfort Lancets 30G/Thin Top

Easy Twist & CAP Lancets

Easy Comfort Pen Needles 31GX1/4"

Easytest II Lancets

Easy Comfort Pen Needles 31GX3/16"

Easytest Lancets

Easy Comfort Pen Needles 31GX5/16"

Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2"

Easy Comfort Pen Needles 32GX5/32"

Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16"

Easy Mini Eject Lancing Device

Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16"

Easy Mini Lancing Device

Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16"

Easy Touch Fliplock Safety Insulin Syringe 1ML/29GX1/2"

Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16"

Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX1/2"

Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2"

Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX5/16"

Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16"

Elite-thin Insulin Syringe/0.3ML/31G X 5/16"

Easy Touch Fliplock Safety Insulin Syringe 1ML/31GX5/16"

Elite-thin Insulin Syringe/0.5ML/29G X 1/2"

Elite-thin Insulin Syringe/0.5ML/30G X 5/16"

Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X 1/2"

Elite-thin Insulin Syringe/1ML/29G X 5/16"

Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X 5/16"

Elite-thin Insulin Syringe/1ML/30G X 5/16"

Embrace Lancets Ultra Thin 30G

Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X 1/2"

Eql Color Lancets Micro Thin 33G

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 28

Eql Color Lancets 21G

Gentle-let Platforms 2.4MM

Eql Insulin Syringe/0.3ML/29G X 1/2"

Gentle-let Platforms 3.0MM

Eql Insulin Syringe/0.3ML/30G X 5/16"

Global Ease Inject Pen Needles 29GX12MM

Eql Insulin Syringe/0.3ML/31G X 5/16"

Global Ease Inject Pen Needles 31GX8MM

Eql Insulin Syringe/0.5ML/29G X 1/2"

Global Ease Inject Pen Needles 32GX4MM

Eql Insulin Syringe/0.5ML/30G X 5/16"

Global Ease Inject Pen Neeedles 31GX5MM

Eql Insulin Syringe/0.5ML/31G X 5/16"

Global Easy Glide Pen Needles 32GX4MM

Eql Insulin Syringe/1ML/29G X 1/2"

Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X 1/2"

Eql Insulin Syringe/1ML/30G X 5/16"

Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 1/2"

Eql Insulin Syringe/1ML/31G X 5/16"

Eql Super Thin Lancets 30G

Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 5/16"

Eql SHORT Pen Needles 31G X 8MM

Eql Thin Lancets 26G

Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X 5/16"

Eql Ultra SHORT Pen Needles 31G X 6MM

Excel Comfort Point Insulin Pen Needles 31G X 4MM

Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X 1/2"

Exel Comfort Point Insulin Pen Needles 29G X 12MM

Exel Comfort Point Insulin Pen Needles 31G X 6MM

Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X 1/2"

Exel Comfort Point Insulin Pen Needles 31G X 8MM

Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 1/2"

Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2"

Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16"

Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 5/16"

Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2"

Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2"

Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X 5/16"

Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16"

Exel Comfort Point Insulin Syringe/1ML/29G X 1/2"

Global Inject Ease Insulin Syringe/U-100/1ML/29G X 1/2"

Exel Comfort Point Insulin Syringe/1ML/30G X 5/16"

Global Inject Ease Insulin Syringe/U-100/1ML/30G X 1/2"

EZ Smart Blood Glucose Lancets

Global Inject Ease Insulin Syringe/U-100/1ML/30G X 5/16"

EZ-lets Lancets 21G

Global Inject Ease Insulin Syringe/U-100/1ML/31G X 5/16"

EZ-lets Lancets 23G

Global Inject Ease Lancets 28G

EZ-lets Lancets 26G Super-soft

Global Inject Ease Lancets 30G

EZ-lets Lancets 28G Ultra-soft

Global Lancing Device

EZ-lets Lancets 30G

Glucocom Lancets 28G

Fifty50 Lancing Device

Glucocom Lancets 30G

Fifty50 Pen Needles 31G X3/16" (5MM)

Glucocom Lancets 33G

Fifty50 Pen Needles 31G X5/16" (8MM)

Glucolet 2 Automatic Lancing Device

Fifty50 Pen Needles 31GX5MM

Glucopro Insulin Syringe/U-100/0.3ML/30G X 1/2"

Fifty50 Pen Needles/31GX8MM

Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16"

Fifty50 Pen Needles/32GX4MM

Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16"

Fifty50 Pen Needles/32GX6MM

Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2"

Fifty50 Safety Seal Lancets 30G

Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16"

Fifty50 Safety Seal Lancets 32G

Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16"

Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X 5/16"

Glucopro Insulin Syringe/U-100/1ML/30G X 1/2"

Glucopro Insulin Syringe/U-100/1ML/30G X 5/16"

Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X 5/16"

Glucopro Insulin Syringe/U-100/1ML/31G X 5/16"

Glucosource Lancet Device

Fifty50 Superior Comfort Insulin Syringe/1ML/31G X 5/16"

Glucosource Lancets

Fifty50 Unilet Lancets 33G

Gmate Lancets 30G

Fine 30

Gmate Lancing Device

Fingerstix Lancets

Gnp Clickfine Pen Needle Universal/31GX5/16"

Fora Lancets

Gnp Clickfine Universal Pen Needles 31GX1/4"

Fora Lancing Device

Gnp Clickfine Universal Pen Needles 31GX5/16"

Fora Lancing Device/Clearcap

Gnp Insulin Syringe/0.3ML/29G X 1/2"

Freds Pharmacy Autolet Lancing Device

Gnp Insulin Syringe/0.3ML/30G X 5/16"

Freds Pharmacy Unifine Pentips Pen Needles 32GX4MM

Gnp Insulin Syringe/0.3ML/31G X 5/16"

Freds Pharmacy Unifine Pentips Plus 31GX5MM

Gnp Insulin Syringe/0.5ML/28G X 1/2"

Freds Pharmacy Unifine Pentips Plus 31GX8MM

Gnp Insulin Syringe/0.5ML/29G X 1/2"

Freds Pharmacy Unilet Lancets Super Thin 30G

Gnp Insulin Syringe/0.5ML/30G X 5/16"

Freds Pharmacy Unilet Lancets Ultra Thin 28G

Gnp Insulin Syringe/0.5ML/31G X 5/16"

Freestyle Lancets

Gnp Insulin Syringe/1ML/29G X 1/2"

Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X 5/16"

Gnp Insulin Syringe/1ML/30G X 5/16"

Gnp Insulin Syringe/1ML/31G X 5/16"

Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X 5/16"

Gnp Lancets

Freestyle Precision Insulin Syringe/U-100/1ML/31G X 5/16"

Gnp Lancets Micro Thin 33G

Gnp Lancets Super Thin 30G

Freestyle Precision Insulin Syringes/U-100/1ML/30G X 5/16"

Gnp Lancets Thin

Gnp Lancets Thin 26G

Freestyle Unistick II Lancets

Gnp Lancets 21G

Gentle-let GP Lancets

Gnp Micro Thin Lancets 33G

Gentle-let Lancets General Purpose Style/Fine Point

Gnp Super Thin Lancets/30G

Gentle-let Lancets General Purpose Style/Medium Point

Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"

Gentle-let Lancets Safety Style/Fine Point

Gentle-let Lancets Safety Style/Medium Point

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 29

Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" SHORT

Insupen Ultrafin 31GX6MM

Insupen Ultrafin 31GX8MM

Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" SHORT

Insupen 33GX4MM

IN Touch Lancing Device

Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"

IN Touch Sterile Lancets 30G

Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"

Kinney Lancets

Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" SHORT

Kinney Thin Lancets

Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16"

Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORT

Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16"

Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16"

Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2"

Kinray Insulin Syringe/0.5ML/29G X 1/2"

Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16" SHORT

Kmart Valu Plus Insulin Syringe/0.3ML/30G

Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16" SHORT

Kmart Valu Plus Insulin Syringe/0.5ML/29G

Kmart Valu Plus Insulin Syringe/0.5ML/30G

H-e-b Incontrol Advanced Lancing Device

Kmart Valu Plus Insulin Syringe/1ML/29G

H-e-b Incontrol Lancets Micro Thin 33G

Kmart Valu Plus Insulin Syringe/1ML/30G

H-e-b Incontrol Lancets Super Thin 30G

Kroger Insulin Syringe/0.3ML/29G X 1/2"

H-e-b Incontrol Lancets Ultra Thin 28G

Kroger Insulin Syringe/0.3ML/30G X 5/16"

H-e-b Incontrol Pen Needles 29GX12MM

Kroger Insulin Syringe/0.3ML/31G X 5/16"

H-e-b IN Control Pen Needles 31GX5MM

Kroger Insulin Syringe/0.5ML/29G X 1/2"

H-e-b IN Control Pen Needles 31GX6MM

Kroger Insulin Syringe/0.5ML/30G X 5/16"

H-e-b IN Control Pen Needles 31GX8MM

Kroger Insulin Syringe/0.5ML/31G X 5/16"

H-e-b IN Control Pen Needles/Nano/32GX4MM

Kroger Insulin Syringe/1ML/29G X 1/2"

H-e-b IN Control Unifine Pentips Plus 31GX5MM

Kroger Insulin Syringe/1ML/30G X 5/16"

H-e-b IN Control Unifine Pentips Plus 32GX4MM

Kroger Insulin Syringe/1ML/31G X 5/16"

Haemolance

Kroger Lancets

Haemolance Low Flow Lancets

Kroger Lancets Micro Thin33G

Haemolance Plus

Kroger Lancets Super Thin

Haemolance Plus High Flow

Kroger Lancets Thin

Haemolance Plus Low Flow

Kroger Lancets Thin 26G

Haemolance Plus Max Flow

Kroger Lancets Ultrathin 30G

Haemolance Plus Pediatric Flow

Kroger Lancets 21G

Health Care Lancing Device

Kroger Lancing Device

Healthwise Lancets 30G

Kroger Pen Needles 29G X 12MM

Healthwise Lancing Pen

Kroger Pen Needles 31G X 8MM

Healthwise Mini Pen Needles 31GX6MM

Kroger Pen Needles 31GX1/4"

Healthwise Pen Needles 29GX12MM

Lancet Device Adjustable

Healthwise SHORT Pen Needles 31GX8MM

Lancet Device With Ejector

Healthwise Unifine Pentips Pen Needles 32GX4MM

Lancet Transporter Case

Healthy Accents Autolet Impression Lancing Device

Lancets

Healthy Accents Unifine Pentips Pen Needles 29GX12MM

Lancets Bullseye Safety

Healthy Accents Unifine Pentips Pen Needles 31GX5MM

Lancets Micro Thin 33G

Healthy Accents Unifine Pentips Pen Needles 31GX6MM

Lancets Safety Seal 21G

Healthy Accents Unifine Pentips Pen Needles 31GX8MM

Lancets Safety Seal 26G

Healthy Accents Unifine Pentips Pen Needles 32GX4MM

Lancets Safety Seal 28G

Healthy Accents Unilet Lancets Super Thin 30G

Lancets Safety Seal 30G

Hy-vee Lancets

Lancets Super Thin 28G

Hy-vee Thin Lancets

Lancets Thin

Hypolance AST Lancing Kit

Lancets Twist Top

Insulin Syringe/U-100/0.3ML/29G X 1/2"

Lancets Ultra Fine

Insulin Syringe/U-100/0.5ML/28G X 1/2"

Lancets Ultra Thin

Insulin Syringe/U-100/0.5ML/29G X 1/2"

Lancets Ultra Thin 30G

Insulin Syringe/U-100/1ML/29G X 1/2"

Lancets 26G Twist Top

Insulin Syringe/U-100/1ML/30G X 5/16"

Lancets 28G

Insulin Syringe/U-100/1ML/31G X 5/16"

Lancets 30G

Insulin Syringe/0.3ML/29G X 1/2"

Lancets 30G Twist Top

Insulin Syringe/0.3ML/29G X 1"

Lancets 30G/Twist Top

Insulin Syringe/0.3ML/30G X 5/16"

Lancets 31G Twist Top

Insulin Syringe/0.3ML/31G X 5/16"

Lancets 33G Universal Design

Insulin Syringe/0.5ML/27G X 1/2"

Lancing Device

Insulin Syringe/0.5ML/28G X 1/2"

Lancing Device Adjustable

Insulin Syringe/0.5ML/30G X 1/2"

Lanzo

Insulin Syringe/0.5ML/30G X 5/16"

Leader Advanced Lancing Device

Insulin Syringe/0.5ML/31G X 5/16"

Leader Insulin Syringe/0.3ML/29G X 1/2"

Insulin Syringe/1ML/29G X 1/2"

Leader Insulin Syringe/0.3ML/30G X 5/16"

Insulin Syringe/1ML/30G X 5/16"

Leader Insulin Syringe/0.3ML/31G X 5/16"

Insupen Pen Needles 32G X4MM

Leader Insulin Syringe/0.5ML/28G X 1/2"

Insupen Sensitive 32GX6MM

Leader Insulin Syringe/0.5ML/29G X 1/2"

Insupen Sensitive 32GX8MM

Leader Insulin Syringe/0.5ML/30G X 5/16"

Insupen Ultrafin 29GX12MM

Leader Insulin Syringe/0.5ML/31G X 5/16"

Insupen Ultrafin 30GX8MM

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 30

Leader Insulin Syringe/1ML/29G X 1/2"

Medlance Plus Superlite 30G/Comfort Max

Leader Insulin Syringe/1ML/30G X 5/16"

Medlance Plus Universal Lancets 21G

Leader Insulin Syringe/1ML/31G X 5/16"

Medlance Plus/Lite 25G

Leader Lancets Colored

Medlance/Extra

Leader Super Thin Lancet

Medlance/Lite

Leader Thin Lancets

Medlance/Universal

Leader Unifine Pentips Plus/Mini/31GX3/16"

Meijer Color Lancets Universal 33G

Leader Unifine Pentips Plus/SHORT/31GX5/16"

Meijer Lancets

Leader Unifine Pentips/Mini/31GX3/16"

Meijer Lancets Thin

Leader Unifine Pentips/Nano/32GX5/32"

Meijer Lancets Universal 21G

Leader Unifine Pentips/Plus/32GX5/32"

Meijer Lancets Universal 30G

Liberty Medical Lancets 30G

Meijer Lancets Universal 33G

Liberty Mini Lancing Device

Meijer Pen Needles 29G X 12MM

Lifescan Unistik II Lancets

Meijer Pen Needles 31G X 6MM

Lifescan Unistik 2 Deep Penetration

Meijer Pen Needles 31G X 8MM

Lite Touch Lancets

Meijer Super Thin Lancets

Lite Touch Lancing Device

Microlet Lancets

Lite Touch Lancing Pen

Microtainer Safety Flow Lancet/Sterile/Single-use

Lite Touch Pen Needles/31G X 3/16"

Mini Lancing Device

Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2"

Monoject Insulin Syringe Regular LUER Tip/Softpack/1ML

Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2"

Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8"

Litetouch Insulin Syringe/U-100/1ML/29G X 1/2"

Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2"

Litetouch Insulin Syringe/U-100/1ML/31G X 5/16"

Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X 1/2"

Litetouch Insulin Syringe/0.3ML/29G X 1/2"

Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X 1/2"

Litetouch Insulin Syringe/0.3ML/30G X 5/16"

Litetouch Insulin Syringe/0.3ML/31G X 5/16"

Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29GX1/2"

Litetouch Insulin Syringe/0.5ML/30G X 5/16"

Litetouch Insulin Syringe/0.5ML/31G X 5/16"

Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X 1/2"

Litetouch Insulin Syringe/1ML/30G X 5/16"

Litetouch Lancets Micro Thin 33G

Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X 1/2"

Litetouch Pen Needles 29GX12.7MM

Litetouch Pen Needles 31G X 6MM

Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X 1/2"

Litetouch Pen Needles 31GX8MM SHORT

Monoject Insulin Syringe/Softpack/1ML/27G X 1/2"

Live Better Advanced Lancing Device

Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16"

Live Better Lancet Super Thin 30G

Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"

Live Better Lancet Ultra Thin 28G

Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16"

Live Better Pen Needles 29G X 12MM

Monoject Insulin Syringe/U-100/1ML/28G X 1/2"

Live Better Pen Needles 31G X 12MM

Monoject Insulin Syringe/U-100/1ML/30G X 5/16"

Live Better Pen Needles 31G X 6MM

Monoject Insulin Syringe/1ML

Longs Insulin Syringe/0.5ML/31G X 5/16"

Monoject Insulin Syringe/1ML/31G X 5/16"

Longs Lancets Standard

Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2"

Longs Lancets Thin

Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"

Longs Lancets Ultra Thin

Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"

Magellan Insulin Safety Syringe/U-100/0.3ML/29G X 1/2"

Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2"

Magellan Insulin Safety Syringe/U-100/0.3ML/30G X 5/16"

Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2"

Magellan Insulin Safety Syringe/U-100/0.5ML/29G X 1/2"

Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"

Magellan Insulin Safety Syringe/U-100/0.5ML/30G X 5/16"

Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"

Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2"

Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2"

Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16"

Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2"

Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2"

Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16"

Medic Insulin Syringe/0.3ML/30G X 5/16"

Monojector End CAPS

Medic Insulin Syringe/0.5ML/30G X 5/16"

Monojector Opd End CAPS

Medichoice Pre-set Safety Lancet Dual Use

Monolet Lancets

Medichoice Pre-set Safety Lancet Low Flow

Monolet Opd Lancets

Medichoice Pre-set Safety Lancet Medium Flow

Monolettor Safety Lancets

Medichoice Pre-set Safety Lancet Moderate Flow

Moore MED Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"

Medichoice Safety Lancet Extra

Medichoice Safety Lancet Normal

Moore MED Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"

Medicine Shoppe Lancets

Medicine Shoppe Lancets Thin

Moore MED Monoject Insulin Syringe/U-100/1ML/29G X 1/2"

Medicine Shoppe Pen Needles 29G X 12MM

Medicine Shoppe Pen Needles 31G X 6MM

Multi-lancet Device

Medicine Shoppe Pen Needles 31G X 8MM

Multi-lancet Device 2

Medisense Thin Lancets

Myglucohealth Mgh Softlance Lancets 30G

Medlance Plus Extra Lancets 21G

MS Insulin Syringe/0.3ML/29G X 1/2"

Medlance Plus Lancets

MS Insulin Syringe/0.3ML/30G X 5/16"

Medlance Plus Lancets Lite 25G

MS Insulin Syringe/0.3ML/31G X 5/16"

Medlance Plus Lite Lancets 25G

MS Insulin Syringe/0.5ML/29G X 1/2"

Medlance Plus Special Lancets 0.8MM

MS Insulin Syringe/0.5ML/30G X 5/16"

Medlance Plus Superlite 30G

MS Insulin Syringe/0.5ML/31G X 5/16"

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 31

MS Insulin Syringe/1ML/29G X 1/2"

Pressure Activated Safetylancet 21G

MS Insulin Syringe/1ML/30G X 5/16"

Pro Comfort Lancets 30G

MS Insulin Syringe/1ML/31G X 5/16"

Pro Comfort Lancets 31G

Netgroup Lancets

Pro Comfort Pen Needles/ 32G X 5MM

Nova Safety Lancets 23G

Pro Comfort Pen Needles/ 32G X 6MM

Nova Safety Lancets 28G

Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16"

Nova Sureflex Lancets

Prodigy Insulin Syringe/1/2ML/31G X 5/16"

Nova Sureflex Lancing Device

Prodigy Lancing Device

Novofine Autocover 30GX8MM

Prodigy Pressure Activated Safety Lancets

Novofine Plus 32GX4MM

Prodigy Safety Lancets

Novofine 30GX8MM

Prodigy Twist Top Lancets

Novofine 32GX6MM

Pss Select GP Lancets

Novotwist 32GX5MM

Pss Select Platforms

On Call Lancets

Pss Select Safety Lancets

On Call Lancing Device

Push Button Safety Lancets 21G

On Call Plus Lancets

Push Button Safety Lancets 28G

On Call Plus Lancing Device

Px Advanced Lancing Device

Onetouch Delica Lancets Extra Fine 33G

Px Extra SHORT Pen Needles 31GX6MM

Pen Needles 29G X 12MM

Px Insulin Syringe/U-100/0.3ML/30G X 1/2"

Pen Needles 29GX1/2"

Px Insulin Syringe/U-100/0.3ML/31G X 5/16"

Pen Needles 30GX5/16"

Px Insulin Syringe/U-100/0.5ML/30G X 1/2"

Pen Needles 31G X 1/4" SHORT

Px Insulin Syringe/U-100/0.5ML/31G X 5/16"

Pen Needles 31G X 3/16"

Px Insulin Syringe/U-100/1ML/30G X 1/2"

Pen Needles 31G X 5MM

Px Insulin Syringe/U-100/1ML/31G X 5/16"

Pen Needles 31GX5/16"

Px Lancet Auto Injector

Pen Needles 31GX6MM (1/4")

Px Lancets Ultra Thin

Pen Needles 31GX8MM

Px Mini Pen Needles 31GX5MM

Pen Needles 31GX8MM (5/16")

Px Pen Needle 29GX12MM

Pen Needles 32GX4MM

Px Pen Needle 31GX8MM

Penlet II Automatic Bloodsampler

Px Shortlength Pen Needles/31GX8MM

Penlet II Replacement CAPS

PC Lancets Super Thin 30G

Penlet II Replacement CAPS-deep

PC Unifine Pentips 29G X 1/2"

Penlet II Replacement CAPS-regular

PC Unifine Pentips 31G X 5MM Mini

Pentips 29GX12MM

PC Unifine Pentips 31G X 6MM Ultra SHORT

Pentips 31GX5MM

PC Unifine Pentips 31G X 8MM SHORT

Pentips 31GX6MM

Qc Advanced Lancing Device

Pentips 31GX8MM

Qc Insulin Syringe/0.3ML/29G X 1/2"

Pentips 32GX4MM

Qc Insulin Syringe/0.5ML/29G X 1/2"

Perfect Lancets 30G

Qc Insulin Syringe/0.5ML/31G X 5/16"

Perfect Pressure Activated Safety Lancets 28G

Qc Insulin Syringe/1ML/29G X 1/2"

Pharmacist Choice Ultra Thin Lancets

Qc Insulin Syringe/1ML/31G X 5/16"

Pharmacist Choice Ultra Thin Lancets 28G

Qc Lancets

Pharmacist Choice Ultra Thin Lancets 30G

Qc Lancets Super Thin

Pharmacist Choice Ultra Thin Lancets 31G

Qc Lancets Thin

Pharmacist Choice Ultra Thin Lancets 33G

Qc Lancets Ultra Thin

Pharmacy Counter Lancets

Qc Pen Needles 29G X 12MM

Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16"

Qc Pen Needles 31G X 6MM

Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2"

Qc Pen Needles 31G X 8MM

Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2"

Qc Unifine Pentips 32GX4MM

Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8"

Qc Unilet Lancets 28G/Ultra Thin

Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X 1/2"

Qc Unilet Lancets 33G/Micro Thin

Ra E-ZJECT Color Lancets Micro-thin 33G

Precision Sure-dose Plus Insulin Syringe/1ML/29G X 1/2"

Ra E-ZJECT Lancets Thin 26G

Precision Thin Lancets

Ra E-ZJECT Lancets Thin 28G

Precision Thins GP Lancet

Ra E-ZJECT Lancets Ultra Thin 30G

Precision Ultra Lancet

Ra E-ZJECT Lancets 28G

Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2"

Ra Insulin Syringe/U-100/0.5ML/30G X 5/16"

Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16"

Ra Insulin Syringe/U-100/1 ML/30G X 5/16"

Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2"

Ra Insulin Syringe/0.5ML/29G X 1/2"

Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2"

Ra Insulin Syringe/1ML/29G X 1/2"

Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16"

Ra Lancing Device

Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2"

Ra Pen Needles 31G X 5MM 3/16"

Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16"

Ra Pen Needles 31G X 8MM 5/16"

Preferred Plus Lancets Colored 21G

Reality Insulin Syringe/U-100/0.5ML/28G X 1/2"

Preferred Plus Lancets Super Thin 30G

Reality Insulin Syringe/U-100/0.5ML/29G X 1/2"

Preferred Plus Lancets Thin 26G

Reality Insulin Syringe/U-100/1ML/29G X 1/2"

Preferred Plus Unifine Pentips 29G X 12MM

Reality Lancets

Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORT

Reality Trigger Lancets

Preferred Plus Unifine Pentips 31G X 8MM SHORT

Relion Insulin Syringe/U -100/0.5ML/29G

Preferred Plus Unifine Pentips 32GX4MM

Relion Insulin Syringe/U-00/1ML/29G X 1/2"

Preferred Plus Unifine Pentips/Mini/31GX5MM

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 32

Relion Insulin Syringe/U-100/0.3ML/29G

Shopko Unifine Pentips Plus Pen Needles/SHORT/Removr/31GX8MM

Relion Insulin Syringe/U-100/0.3ML/29G X 1/2"

Shopko Unilet Lancets Super Thin 30G

Relion Insulin Syringe/U-100/0.3ML/30G

Shopko Unilet Lancets Ultra Thin 28G

Relion Insulin Syringe/U-100/0.3ML/30G X 5/16"

Side Button Safety Lancet21G

Relion Insulin Syringe/U-100/0.3ML/31G X 5/16"

Simple Diagnostics Lancing Device

Relion Insulin Syringe/U-100/0.5ML/29G X 1/2"

Single-let

Relion Insulin Syringe/U-100/0.5ML/30G

Sm Insulin Syringe/1ML/31G X 5/16"

Relion Insulin Syringe/U-100/0.5ML/30G X 5/16"

Sm Lancets 21G

Relion Insulin Syringe/U-100/0.5ML/31G X 5/16"

Sm Micro Thin Lancets 33G

Relion Insulin Syringe/U-100/1ML/30G

Sm Super Thin Lancets

Relion Insulin Syringe/U-100/1ML/30G X 5/16"

Sm Super Thin Lancets 30G

Relion Insulin Syringe/U-100/1ML/31G X 5/16"

Sm Thin Lancets 26G

Relion Lancets Micro-thin33G

Smart Diabetes Vantage Lancing Device

Relion Lancets Standard 21G

Smart Sense Color Lancets Universal 33G

Relion Lancets Thin 26G

Smart Sense Standard Lancets Universal 21G

Relion Lancets Ultra-thin30G

Smart Sense Super Thin Lancets Universal 30G

Relion Lancing Device

Smart Sense Thin Lancets Universal 26G

Relion Mini Pen Needles 31GX6MM

Smartest Lancets 28G

Relion Pen Needles 29GX12MM

Solus V2 Lancing Device

Relion Pen Needles 31GX6MM

Solus V2 Pressure Activated Safety Lancets 28G

Relion Pen Needles 31GX8MM

Solus V2 Twist Lancets 30G

Relion Pen Needles 32GX4MM

Sterilance PA

Relion SHORT Pen Needles 31GX8MM

Sterilance TL

Relion Thin Lancets

Super Thin Lancets

Relion Ultra Thin Lancets

Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"

Relion Ultra Thin Lancets30G

Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2"

Relion Ultra Thin Plus Lancets 32G

Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"

Relion Ultra Thin Plus Lancets 33G

Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16

Relion 2-IN-1 Lancing Device 25G

Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"

Relion 2-IN-1 Lancing Device 30G

Sure Comfort Insulin Syringe/U-100/0.3ML/31GX1/4"

Rexall Lancets Ultra Thin

Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"

Rightest Gl300 Lancets

Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"

Rightest GD-L500 Alternate Site Adapter

Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2"

Rightest GD500 Lancing Device

Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"

Safe-t-lance Low Flow 25G

Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16

Safe-t-lance Normal Flow 21G

Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2"

Safe-t-lance Plus Safety Lancet High Flow

Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2"

Safe-t-lance Plus Safety Lancet Low Flow

Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16"

Safe-t-lance Plus Safety Lancet Normal Flow

Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16"

Safesnap Insulin Syringe/0.3ML/30G X 5/16"

Sure Comfort Lancets 28G

Safesnap Insulin Syringe/0.5ML/29G X 1/2"

Sure Comfort Lancets 30G

Safesnap Insulin Syringe/0.5ML/30G X 5/16"

Sure Comfort Lancing Pen

Safesnap Insulin Syringe/1ML/29G X 1/2"

Sure Comfort Pen Needles 29GX1/2" 12.7MM

Safety Lancet 21G/Pressure Activated

Sure Comfort Pen Needles 30GX5/16" SHORT

Safety Lancet 28G/Pressure Activated

Sure Comfort Pen Needles 31GX3/16" (5MM)

Safety Lancets

Sure Comfort Pen Needles 31GX5/16" (8MM)

Safety Lancets 21G

Sure Comfort Pen Needles 32GX5/32"

Safety Lancets 28G

Sure Comfort Pen Needles 32GX6MM

Safety Let Lancets

Sure-fine Pen Needles 29GX1/2" 12.7MM

Safety Seal Lancets 28G

Sure-fine Pen Needles 31GX3/16" 5MM

Safety Seal Lancets 30G

Sure-fine Pen Needles 31GX5/16" 8MM

Safety-glide Insulin Syringe/0.3ML/29G X 1/2"

Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2"

Sapscare Twist Top Lancets 30G

Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16"

Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X 1/2"

Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16"

Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X 5/16"

Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2"

Select-lite Device/Lancets

Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2"

Select-lite Lancing Device

Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16"

Shopko Autolet Lancing Device

Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16"

Shopko On-the-go Comfort Lancets 30G

Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2"

Shopko Unifine Pentips Pen Needles/Micro/32GX4MM

Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16"

Shopko Unifine Pentips Pen Needles/Mini/31GX5MM

Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16"

Shopko Unifine Pentips Pen Needles/Original/29GX12MM

Sure-lance Flat Lancets

Shopko Unifine Pentips Pen Needles/SHORT/31GX8MM

Sure-lance Lancets 26G

Shopko Unifine Pentips Plus Pen Needles/Micro/Removr/32GX4MM

Sure-lance Thin Lancets 28G

Sure-lance Ultra Thin Lancets

Shopko Unifine Pentips Plus Pen Needles/Mini/Remover/31GX5MM

Sure-pen

Sure-touch Lancets Universal

Shopko Unifine Pentips Plus Pen Needles/Remover/29GX12MM

Surelite Lancets

SB Insulin Syringe/U-100/0.5ML/29G X 1/2"

SB Insulin Syringe/U-100/0.5ML/30G X 5/16"

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 33

SB Insulin Syringe/U-100/1ML/29G X 1/2"

Trueplus Pen Needles 31GX8MM

SB Insulin Syringe/U-100/1ML/30G X 5/16"

Trueplus Pen Needles 32GX4MM

SB Insulin Syringe/U-100/1ML/31G X 5/16"

Trueplus Safety Lancets 28G

SB Lancets Thin

Ulti-lance Automatic/ Clear Tip

SB Lancets Ultra Thin

Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2"

Techlite AST Lancets

Ulticare Insulin Safety Syringe/1ML/29G X 1/2"

Techlite Lancets

Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X 5/16"

Techlite Lancets 30G

Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X 5/16"

Techlite Pen Needles/31G X 5MM

Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16"

Techlite Pen Needles/31G X 6 MM

Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16"

Techlite Pen Needles/31G X 8MM

Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16"

Techlite Pen Needles/32G X 4MM

Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16"

Techlite Pen Needles/32G X 6MM

Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16"

Techlite Pen Needles/32G X 8MM

Ulticare Insulin Syringe/SHORT/1ML/30G X 5/16"

Tgt Advanced Lancing Device

Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16"

Tgt Lancet Alternate Site

Ulticare Insulin Syringe/U-100/0.3ML/29G X 1/2"

Tgt Lancet Micro Thin 33G

Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2"

Tgt Lancet Super Thin 30G

Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16"

Tgt Lancet Thin 23G

Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16"

Tgt Lancet Thin 26G

Ulticare Insulin Syringe/U-100/0.5ML/29G X 1/2"

Tgt Lancet Ultra Thin 28G

Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2"

Tgt Lancet Ultra Thin 30G

Ulticare Insulin Syringe/U-100/0.5ML/30G X 5/16"

Tgt Lancing Device

Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16"

Thinlets GP Lancets

Ulticare Insulin Syringe/U-100/1ML/29G X 1/2"

Thinlets Lancet

Ulticare Insulin Syringe/U-100/1ML/30G X 1/2"

Todays Health Advanced Lancing Device

Ulticare Insulin Syringe/U-100/1ML/30G X 5/16"

Todays Health Mini Pen Needles 31G X 1/4"

Ulticare Insulin Syringe/U-100/1ML/31G X 5/16"

Todays Health Original Pen Needles 29G X 1/2"

Ulticare Insulin Syringe/0.3ML/29G X 1/2"

Todays Health Super Thin Lancets 30G

Ulticare Insulin Syringe/0.3ML/30G X 1/2"

Todays Health SHORT Pen Needles 31G X 5/16"

Ulticare Insulin Syringe/0.3ML/30G X 5/16"

Todays Health Ultra Thin Lancets 28G

Ulticare Insulin Syringe/0.5ML/28G X 1/2"

Topcare Clickfine Universal Pen Eedles 31GX1/4"

Ulticare Insulin Syringe/0.5ML/29G X 1/2"

Topcare Clickfine Universal Pen Eedles 31GX5/16"

Ulticare Insulin Syringe/0.5ML/30G X 1/2"

Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"

Ulticare Insulin Syringe/0.5ML/30G X 5/16"

Ulticare Insulin Syringe/1ML/29G X 1/2"

Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"

Ulticare Insulin Syringe/1ML/30G X 1/2"

Ulticare Insulin Syringe/1ML/30G X 5/16"

Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X 1/2"

Ulticare Micro Pen Needles 31G X 8MM

Ulticare Micro Pen Needles 32G X 4MM

Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16"

Ulticare Micro Pen Needles/32G X 4MM

Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16"

Ulticare Mini Pen Needles Ulti-fine IV

Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16"

Ulticare Mini Pen Needles 31GX6MM

Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16"

Ulticare Mini Pen Needles/31G X 6MM

Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16"

Ulticare Mini Pen Needles31GX6MM

Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16"

Ulticare Original Pen Needles Ulti-fine

Topco Insulin Syringe/U-100/0.3ML/29G X 1/2"

Ulticare Pen Needles/29G X 12.7MM

Topco Insulin Syringe/U-100/0.5ML/28G X 1/2"

Ulticare SHORT Pen Needles Ulti-fine IV

Topco Insulin Syringe/U-100/0.5ML/29G X 1/2"

Ulticare SHORT Pen Needles 31GX8MM

Topco Insulin Syringe/U-100/1ML/29G X 1/2"

Ulticare SHORT Pen Needles/31G X 8MM

Travel Lancets 30G

Ulticare Thin Lancets 30G

Truedraw Lancing Device

Ulticare U-100 Insulin Syringes/0.3ML/31G X 1/4"

Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2"

Ulticare U-100 Insulin Syringes/0.3ML/31G X1/4"

Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16"

Ulticare U-100 Insulin Syringes/0.5ML/31G X 1/4"

Trueplus Insulin Syringe/U-100/0.3ML/31G X 5/16"

Ulticare U-100 Insulin Syringes/1ML/31G X 1/4"

Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2"

Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16"

Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2"

Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16"

Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16"

Ultilet Classic Lancets

Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16"

Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16"

Trueplus Insulin Syringe/U-100/1ML/29G X 1/2"

Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16"

Trueplus Insulin Syringe/U-100/1ML/30G X 5/16"

Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16"

Trueplus Insulin Syringe/U-100/1ML/31G X 5/16"

Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16"

Trueplus Lancets 26G

Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16"

Trueplus Lancets 28G

Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16"

Trueplus Lancets 28G Super Thin

Ultilet Lancets

Trueplus Lancets 30G

Ultilet Lancets 33G

Trueplus Lancets 30G Ultra Thin

Ultilet Pen Needle 32GX4MM/SHORT

Trueplus Lancets 33G

Ultilet Safety Lancets 23G

Trueplus Lancets 33G Micro Thin

Ultilet SHORT Pen Needles 31GX5/16"

Trueplus Pen Needles 29GX12MM

Ultilet SHORT Pen Needles31GX3/16"

Trueplus Pen Needles 31GX5MM

Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"

Trueplus Pen Needles 31GX6MM

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 34

Ultra Thin Lancets 28G

Unistik 3

Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2"

Unistik 3 Comfort

Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16"

Unistik 3 Extra

Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16"

Unistik 3 Extra Single Use Safety Lancets/21G

Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2"

Unistik 3 Gentle

Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2"

Unistik 3 Neonatal

Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16"

Unistik 3 Normal

Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16"

Universal 1 Lancets Thin 26G

Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2"

Universal 1 Lancets Ultra Thin 30G

Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16"

Universal 1 Lancets/33G/Micro-thin

Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16"

V-r Monoject Insulin Syringe/U-100/0.3ML/29G X 1/2"

Ultra-thin II Auto Lancet

V-r Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2"

Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/30GX5/16"

V-r Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2"

V-r Monoject Insulin Syringe/U-100/1ML/29G X 1/2"

Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/31GX5/16"

Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2"

Value Health Insulin Syringe/U-100/1ML/29G X 1/2"

Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/30GX5/16"

Value Plus Lancets Standard 21G

Value Plus Lancets Super Thin 30G

Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/31GX5/16"

Value Plus Lancets Thin 26G

Value Plus Lancing Device

Ultra-thin II Insulin Syringe SHORT/U-100/1ML/30GX5/16"

Valumark Lancet Super Thin 30G

Ultra-thin II Insulin Syringe SHORT/U-100/1ML/31GX5/16"

Valumark Lancet Ultra Thin 28G

Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2"

Valumark Pen Needles 29GX12MM

Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2"

Valumark Pen Needles 31G X 6MM

Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2"

Valumark Pen Needles 31G X 8MM

Ultra-thin II Lancets 28G

Vanishpoint Insulin Syringe/0.5ML/30G X 1/2"

Ultra-thin II Lancets 30G

Vanishpoint Insulin Syringe/0.5ML/30G X 5/16"

Ultra-thin II Mini Pen Neeedles/31GX3/16"

Vanishpoint Insulin Syringe/1ML/29G X 1/2"

Ultra-thin II Pen Needles 29GX1/2"

Vanishpoint Insulin Syringe/1ML/29G X 5/16"

Ultra-thin II Pen Needles/SHORT/31GX5/16"

Vanishpoint Insulin Syringe/1ML/30G X 5/16"

Ultra-thin II Safety Autolancets 26G

Vida Mia Autolet Lancing Device

Ultralance

Vida Mia Unifine Pentips Mini 31GX6MM

Unifine Pentips Plus 29GX12MM

Vida Mia Unifine Pentips Original 29GX12MM

Unifine Pentips Plus 31GX5MM

Vida Mia Unifine Pentips 32GX4MM

Unifine Pentips Plus 31GX6MM

Vida Mia Unilet Lancets Super Thin 30G

Unifine Pentips Plus 31GX8MM

Vida Mia Unilet Lancets Ultra Thin 28G

Unifine Pentips Plus 32GX4MM

Vida Mia Unipfine Pentipsshort 31GX8MM

Unifine Pentips 29GX12MM

Vitalet Pro Lancets

Unifine Pentips 31G X 3/16"

Vitalet Pro Plus Lancets

Unifine Pentips 31G X 6MM

Vp Insulin Syringe/U-100/0.3ML/29G X 1/2"

Unifine Pentips 31G X 8MM

W&f Lancets Colored 21G

Unifine Pentips 31GX5MM

W&f Lancets 26G

Unifine Pentips 31GX6MM

Walgreens Advanced Travellancets 28G

Unifine Pentips 31GX8MM

Walgreens Comfort Assuredlancets Micro Thin/33G

Unifine Pentips 32GX4MM

Walgreens Comfort Assuredlancets Super Thin/28G

Unilet Comfortouch Lancet

Walgreens Lancets

Unilet Excelite

Walgreens Thin Lancets

Unilet Excelite II

Walgreens Ultra Thin Lancets

Unilet G.p. Lancet

Wegmans Unifine Pentips Plus 32GX4MM

Unilet G.p. Superlite Lancet

Wegmans Unifine Pentips Plus/Mini/31GX5MM

Unilet GP 28 Ultra Thin

Wegmans Unifine Pentips Plus/SHORT/31GX8MM

Unilet Lancet

Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MM

Unilet Lancets Micro-thin33G

1ST Choice Lancets Super Thin

Unilet Lancets Super-thin30G

1ST Choice Lancets Thin

Unilet Lancets Ultra-thin 28G

1ST Choice Lancets Ultra Thin

Unilet Superlite Lancet

1ST Tier Unifine Pentips /Mini/31GX5MM

Unistik CZT Comfort

1ST Tier Unifine Pentips Plus 31GX8MM

Unistik CZT Normal

1ST Tier Unifine Pentips Plus 32GX4MM

Unistik Safety Lancets 28G

1ST Tier Unifine Pentips Plus/Mini/31GX5MM

Unistik Safety Lancets 30G

1ST Tier Unifine Pentips Plus/Original/29GX12MM

Unistik Touch Safety Lancets 21G

1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MM

Unistik Touch Safety Lancets 23G

1ST Tier Unifine Pentips 29GX12MM

Unistik Touch Safety Lancets 28G

1ST Tier Unifine Pentips 31GX6MM

Unistik Touch Safety Lancets 30G

1ST Tier Unifine Pentips 31GX8MM

Unistik 1

1ST Tier Unifine Pentips 32GX4MM

Unistik 2

1ST Tier Unilet Comfortouch Lancets 28G

Unistik 2 Comfort

1ST Tier Unilet Comfortouch Lancets 30G

Unistik 2 Extra

Unistik 2 Neonatal

Unistik 2 Normal

Unistik 2 Super

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 35

MEDICAL DEVICES - MISC

Valved Holding Chamber

Vortex Valved Holding Chamber

TIER 03 Aerochamber Mini Aerosol Chamber

Watchhaler

Aerochamber MV

Aerochamber Plus Flow VU

MISCELLANEOUS

Aerochamber Plus Flow-VU

Aerochamber Plus Flow-VU/Large Mask

Aerochamber Plus Flow-VU/Mask

TIER 03 Chemet

Aerochamber Plus Flow-VU/Medium Mask

Pentetate Calcium Trisodium

Aerochamber Plus Flow-VU/Small Mask

Pentetate Zinc Trisodium

Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VU

TIER 05 ExjadePA

FerriproxPA

Aerochamber Z-stat Plus/Flowsignal

JadenuPA

Aerochamber Z-stat Plus/Large Mask

Aerochamber Z-stat Plus/Medium Mask

Aerochamber Z-stat Plus/Small Mask

Aerochamber/Flowsignal

Aerovent Plus Holding Chamber/Collapsible

Breatherite

Breatherite Collapsible Adult Spacer W/Mask

Breatherite Collapsible Child Spacer W/Mask

Breatherite Collapsible Infant Spacer W/Mask

Breatherite Collapsible Small Child Spacer W/Mask

Breatherite Collapsible Spacer W/ Neonate Mask

Breatherite Rigid Spacer W/Mask

Breatherite W/Large Mask

Breatherite W/Medium Mask

Breatherite W/Small Mask

Clever Choice Anti-staticvalved Holding Chamber/Adult Large

Clever Choice Anti-staticvalved Holding Chamber/Medium

Clever Choice Anti-staticvalved Holding Chamber/Small

Compact Space Chamber/Anti-static

Compact Space Chamber/Anti-static/Large Mask

Compact Space Chamber/Anti-static/Medium Mask

Compact Space Chamber/Anti-static/Small Mask

E-z Spacer

E-z Spacer The Body Guards Pack

Easivent

Easivent/Mask-large

Easivent/Mask-medium

Easivent/Mask-small

Flexichamber

Flexichamber Adult Mask/Small

Flexichamber Child Mask/Large

Flexichamber Child Mask/Small

Inspirachamber/Anti-static Valved/Mouthpiece

Inspirachamber/Large

Inspirachamber/Soothermask/Inspiramask/Medium

Inspirachamber/Soothermask/Inspiramask/Small

Inspirease Bags

Inspirease Drug Delivery System

Inspirease Mouthpiece

Inspirease Reservoir Bags

Liteaire

Microchamber

Microspacer

Optichamber Advantage

Optichamber Advantage/Large Mask

Optichamber Advantage/Medium Face Mask

Optichamber Advantage/Small Face Mask

Optichamber Diamond

Optichamber Diamond/Largeface Mask

Optichamber Diamond/Medium Face Mask

Optichamber Diamond/Smallface Mask

Optihaler

Optihaler MDI Drug Delivery System

Pocket Chamber

Pocket Spacer

Riteflo

Effective April 1, 2017

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 36

Index

A

adult aspirin EC low strength, 19

Afluria Quadrivalent 2016-2017, 23

Advair Diskus, 22

Afstyla, 15

abacavir, 2

Advair HFA, 22

aftera, 9

abacavir sulfate/lamivudine/zidovudine, 2

Advate, 15

Agamatrix Ultra-thin Lancets 33G, 26

abacavir/lamivudine, 2

Advocate Insulin Pen Needles 29GX12.7MM, 26

Aggrenox, 15

Abilify Maintena, 16

agoneaze, 8

acamprosate calcium DR, 18

Advocate Insulin Pen Needles 31GX5MM, 26

Akten, 19

acarbose, 11

ala-cort, 7

Accu-chek Aviva, 26

Advocate Insulin Pen Needles 31GX8MM, 26

Ala-quin, 7

Accu-chek Aviva Plus, 26

Albenza, 2

Accu-chek Compact Plus, 26

Advocate Insulin Syringe/U-100/0.3ML/29GX1/2", 26

albuterol, 22

Accu-chek Compact Test Drum, 26

albuterol sulfate, 22

Accu-chek Fastclix Lancetdevice Kit, 26

Advocate Insulin Syringe/U-100/0.3ML/30GX5/16", 26

Albuterol Sulfate, 22

Accu-chek Fastclix Lancets, 26

albuterol sulfate ER, 22

Accu-chek Multiclix Lanc Et Device Kit, 26

Advocate Insulin Syringe/U-100/0.3ML/31GX5/16", 26

albuterol TAB 4MG, 22

alclometasone dipropionate, 7

Accu-chek Multiclix Lancets, 26

Advocate Insulin Syringe/U-100/0.5ML/29GX1/2", 26

Aldactazide, 5

Accu-chek Safe-t-pro Lancets, 26

Alecensa, 3

Accu-chek Safe-t-pro Pluslancets, 26

Advocate Insulin Syringe/U-100/0.5ML/30GX5/16", 26

alendronate sodium, 11

Accu-chek Smartview Strips, 26

Alendronate Sodium, 11

Accu-chek Soft Touch Lancets, 26

Advocate Insulin Syringe/U-100/0.5ML/31GX5/16", 26

Alevicyn Antipruritic SG, 8

Accu-chek Softclix Lancetdevice Kit, 26

alfentanil, 20

Accu-chek Softclix Lancets, 26

Advocate Insulin Syringe/U-100/1ML/29GX1/2", 26

Alferon N, 4

Accutrend Glucose, 26

alfuzosin HCL ER, 14

Acd-a Noclot-50, 15

Advocate Insulin Syringe/U-100/1ML/30GX5/16", 26

Alinia, 3

acebutolol HCL, 4

Alkeran, 3

Acebutolol HCL, 4

Advocate Insulin Syringe/U-100/1ML/31GX5/16", 26

allopurinol, 21

acetaminophen/codeine, 20

almotriptan, 21

acetaminophen/codeine phosphate, 20

Advocate Lancets, 26

almotriptan malate, 21

acetasol HC, 19

Advocate Lancets 30G, 26

Alocril, 19

acetazolamide, 5

Advocate Lancing Device, 26

Alomide, 19

Acetazolamide, 5

Advocate Rapid-safe Lancing Device, 26

Aloquin, 7

acetazolamide ER, 5

Advocate Safety Lancets, 26

Alora, 9

acetazolamide sodium, 5

Advocate Safety Lancets 26G, 26

alosetron hydrochloride, 13

acetic acid, 19

Adynovate, 15

Alphagan P, 19

acetic acid 0.25%, 14

Aerochamber Mini Aerosol Chamber, 36

Alphanate/Von Willebrand Factor Complex/Human, 15

Acetic Acid/Aluminum Acetate, 19

Aerochamber MV, 36

Acetyl Salicylic Acid, 20

Aerochamber Plus Flow VU, 36

Alphanine SD, 15

acetylcysteine, 22

Aerochamber Plus Flow-VU, 36

alphatrex, 7

Acetylcysteine, 22

Aerochamber Plus Flow-VU/Large Mask, 36

alprazolam, 16

acitretin, 7

alprazolam ER, 16

Actemra, 21

Aerochamber Plus Flow-VU/Mask, 36

Alprazolam Intensol, 16

Acthib, 23

Aerochamber Plus Flow-VU/Medium Mask, 36

alprazolam odt, 16

Acti-lance Lancets 28G, 26

alprazolam XR, 16

Acti-lance Lite Safety Lancets 28G, 26

Aerochamber Plus Flow-VU/Small Mask, 36

Alprolix, 15

Acti-lance Special Safety Lancets 17G, 26

Alrex, 19

Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VU, 36

Altabax, 6

Acti-lance Special Safetylancets 17G, 26

altacaine, 19

Acti-lance Universal Safety Lancets 23G, 26

Aerochamber Z-stat Plus/Flowsignal, 36

altafrin, 19

Aerochamber Z-stat Plus/Large Mask, 36

altavera, 9

Actimmune, 4

Aerochamber Z-stat Plus/Medium Mask, 36

Alternate Site Lancing Device, 26

Active 1ST Blood Lancets 30G/Easy Twist CAP, 26

Aluminum Chloride Anhydrous, 8

Aerochamber Z-stat Plus/Small Mask, 36

Aluminum Chloride Hexahydrate, 8

Active OB, 24

Aerochamber/Flowsignal, 36

alyacen 1/35, 9

Actoplus Met XR, 11

Aerospan, 22

alyacen 7/7/7, 9

acyclovir, 2, 7

Aerovent Plus Holding Chamber/Collapsible, 36

amabelz, 9

Aczone, 6

amantadine HCL, 17

Adacel, 23

AF Lancets Super Thin, 26

Amcinonide, 7

adapalene, 6

afeditab CR, 4

amethia, 9

adapalene P.M., 6

Afinitor, 3

amethia LO, 9

Adcirca, 6

Afinitor Disperz, 3

amethyst, 9

adefovir dipivoxil, 2

Afluria 2015-2016, 23

Amicar, 15

Adempas, 6

Afluria 2016-2017, 23

amikacin sulfate, 1

Adjustable Lancing Device, 26

Afluria PF 2015-2016, 23

Amikacin Sulfate, 1

Adrenaclick, 5

Afluria PF 2016-2017, 23

amiloride HCL, 5

Adrenalin, 22

Amiloride HCL, 5

aqueous vitamin d infants, 23

atorvastatin calcium, 5

amiloride/hydrochlorothiazide, 5

aranelle, 9

atovaquone, 2

aminoacetic acid, 14

Aranesp Albumin Free, 14

atovaquone/proguanil HCL, 2

Aminobenzoate Potassium, 24

arbinoxa, 22

Atripla, 2

Aminobenzoic Acid, 24

Arcalyst, 21

atropine sulfate, 12

Aminophylline Anhydrous, 22

Arcapta Neohaler, 22

Atropine Sulfate, 12, 19

Aminosalicylic Acid, 2

argyle sterile saline 100ML, 14

Atropine Sulfate Monohydrate, 12

amiodarone HCL, 4

aripiprazole, 16

Atrovent HFA, 22

Amitiza, 13

Aristada, 16

Aubagio, 18

amitriptyline HCL, 16

armodafinil, 17

aubra, 9

amlodipine besylate, 4

Armour Thyroid, 12

augmented betamethasone dipropionate, 7

amlodipine besylate/atorvastatin calcium, 6

Arnica Flower, 8

Arnuity Ellipta, 22

Augmentin, 1

amlodipine besylate/benazepril HCL, 5

Asacol HD, 13

Aurora Lancet Super Thin 30G, 26

amlodipine besylate/benazepril hydrochloride, 5

ascomp/codeine, 20

Aurora Lancet Thin 23G, 26

ascorbic acid, 23

Aurora Pen Needles 29GX12MM, 26

amlodipine besylate/valsartan, 5

ashlyna, 9

Aurora Pen Needles 31G X 6MM, 26

amlodipine/olmesartan medoxomil, 5

aspir-81, 19

Aurora Pen Needles 31G X 8MM, 26

amlodipine/valsartan/hctz, 5

aspir-low, 19

Aurora Unifine Pentips/32GX5/32", 26

ammonium lactate, 8

aspirin, 19

Aurora Unifine Pentips/Mini/31GX3/16", 26

Amoxapine, 16

Aspirin, 20

amoxicillin, 1

aspirin 81, 20

Auryxia, 13

Amoxicillin, 1

aspirin 81 low dose, 20

Auto-lancet, 26

Amoxicillin Trihydrate, 1

aspirin adult low dose, 19

Auto-lancet Mini, 26

amoxicillin/clavulanate potassium, 1

aspirin adult low strength, 19

Autolet II Clinisafe, 26

Amoxicillin/Clavulanate Potassium, 1

aspirin childrens, 19

Autolet Impression, 26

amoxicillin/clavulanate potassium ER, 1

aspirin EC, 20

Autolet Impression Lancing Device, 26

amphetamine/dextroamphetamine, 17

aspirin EC low dose, 20

Autolet Lite Clinisafe, 26

Amphotericin B, 15

aspirin enteric coated adult low strength, 19

Autolet Lite Starter Pack, 26

ampicillin, 1

Autolet Mini, 26

Ampicillin, 1

aspirin low dose, 19

Autolet Platforms, 26

ampicillin sodium, 1

aspirin low strength, 19

Autolet Plus, 26

ampicillin-sulbactam, 1

Aspirin-caffeine-dihydrocodeine, 21

Avage, 8

Ampyra, 18

aspirin/dipyridamole, 15

avar cleanser, 6

Amytal Sodium, 17

aspirtab, 20

avar-e emollient, 6

ana-lex, 13

Assure Comfort Lancets Ultra Thin 28G, 26

avar-e green, 6

Anacaine, 8

Avc, 14

Anadrol-50, 9

Assure Comfort Lancets Ultra Thin 30G, 26

aviane, 9

anagrelide hydrochloride, 15

avidoxy, 1

Analpram-HC, 13

Assure Haemolance Plus High Flow 18G, 26

avita, 6

anastrozole, 3

Avonex, 18

Androgel, 9

Assure Haemolance Plus Low Flow 25G, 26

Avonex Pen, 18

Androgel P.M., 9

azacitidine, 3

Androxy, 9

Assure Haemolance Plus Micro Flow 28G, 26

Azasan, 3

Anoro Ellipta, 22

Azasite, 18

Anthralin, 7

Assure Haemolance Plus Normal Flow 21G, 26

azathioprine, 3

Anti-stick Insulin Syringe/U-100/0.5ML/28G X 1/2", 26

Azathioprine, 3

Assure Haemolance Plus Pediatric Blade, 26

azelastine HCL, 19, 22

Anti-stick Insulin Syringe/U-100/0.5ML/29G X 1/2", 26

Azelex, 6

Assure ID Insulin Safety Syringe/U-100/0.5ML/29G X 1/2", 26

Azilect, 17

Anti-stick Insulin Syringe/U-100/1ML/29G X 1/2", 26

azithromycin, 1

Assure ID Insulin Safety Syringe/U-100/1ML/29G X 1/2", 26

Azithromycin, 1

Anticoagulant Citrate Dextrose Solution A, 15

Azopt, 19

Assure Lance Lancets, 26

Azor, 5

Anticoagulant Citrate Phosphate Dextrose Solution, 15

Assure Lance Lancets 21G, 26

aztreonam, 2

Assure Lance Plus Safety Lancets 25G, 26

Azulfidine, 13

Anticoagulant Sodium Citrate, 15

Azulfidine EN-TABS, 13

anucort-HC, 13

Assure Lance Plus Safety Lancets 30G, 26

azuphen mb, 13

anusol-HC, 13

azurette, 9

Anzemet, 13

Assure Lancets, 26

B

Apexicon E, 7

Astagraf XL, 3

B-d Insulin Syringe Ultrafine II/0.3ML/31G X 5/16", 26

apraclonidine, 19

Astringyn, 15

aprepitant, 13

AT Last Lancets, 26

B-d Insulin Syringe Ultrafine II/0.5ML/31G X 5/16", 26

apri, 9

Atabex EC, 24

Apriso, 13

Atabex Prenatal, 24

B-d Insulin Syringe Ultrafine II/1ML/31G X 5/16", 26

Aptivus, 2

atenolol, 4

Aqua Lance Adjustable Lancing Device, 26

Atenolol, 4

B-d Insulin Syringe Ultrafine/0.3ML/30G X 1/2", 26

atenolol/chlorthalidone, 5

B-d Insulin Syringe Ultrafine/0.5ML/30G X 1/2", 26

BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16", 27

BD Safetyglide Insulin Sysyringe/0.5ML/30G X 5/16", 27

B-d Insulin Syringe Ultrafine/1ML/30G X 1/2", 26

BD Insulin Syringe Ultrafine/1ML/30G X 1/2", 27

BD-insul SYR Mis LO Dose, 27

Bebulin, 15

Baby Super Daily D3, 24

BD Insulin Syringe Ultrafine/1ML/31G X 5/16", 27

bekyree, 9

Baby Vitamin D3 Drops, 24

Belladonna & Opium, 12

baciim, 2

BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2", 27

Belladonna Alkaloids & Opium, 12

bacitracin, 3

benazepril HCL, 4

Bacitracin, 6, 18

BD Insulin Syringe Ultrafine/U-100/0.3ML/30G X 1/2", 27

benazepril HCL/hydrochlorothiazide, 5

Bacitracin Zinc, 6

Benefix, 15

bacitracin/polymyxin b, 18

BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 15/64", 27

Benicar, 5

baclofen, 18

Benicar HCT, 5

Bal-care DHA, 24

BD Insulin Syringe Ultrafine/U-100/0.3ML/31G X 5/16", 27

Bensal HP, 8

balsalazide disodium, 13

benzepro, 6

balziva, 9

BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2", 27

benzepro creamy wash, 6

Banzel, 17

benzepro SHORT contact, 6

Baraclude, 2

BD Insulin Syringe Ultrafine/U-100/0.5ML/30G X 1/2", 27

Benziq, 6

Basaglar Kwikpen, 10

Benziq LS, 6

bayer advanced aspirin regular strength, 20

BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 15/64", 27

Benzocaine, 8

Benzoin Compound Tincture, 8

bayer aspirin, 20

BD Insulin Syringe Ultrafine/U-100/0.5ML/31G X 5/16", 27

Benzoin Tincture, 8

bayer aspirin EC low dose, 20

benzonatate, 22

bayer aspirin regimen, 20

BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2", 27

Benzonatate, 22

bayer chewable low dose, 20

benzoyl peroxide, 6

bayer low dose, 20

BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2", 27

Benzoyl Peroxide, 6

Bayer Microlet 2 Lancing Device, 26

Benzoyl Peroxide Hydrous, 6

Bayer Microlet Lancets, 26

BD Insulin Syringe Ultrafine/U-100/1ML/31G X 15/64", 27

benzoyl peroxide SHORT contact, 6

BD Autoshield 29G X 3/16", 26

benztropine mesylate, 17

BD Autoshield 29G X 5/16", 26

BD Insulin Syringe Ultrafine/U-100/1ML/31G X 5/16", 27

Benztropine Mesylate, 17

BD Autoshield Duo 30G X 3/16", 26

Bepreve, 19

BD Insulin Syringe LUER-LOK/U-100/1ML, 26

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1", 27

Besivance, 18

Betadine Ophthalmic Prep, 18

BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2", 26

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/8", 27

betamethasone dipropionate, 7

betamethasone sodium phosphate/betamethasone acetate, 8

BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2", 26

BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2", 27

betamethasone valerate, 7

BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8", 26

BD Insulin Syringe/U-100/0.5ML/30G X 1/2", 27

Betaseron, 18

betaxolol HCL, 4, 18

BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2", 26

BD Insulin Syringe/U-100/1ML/27G X 1/2", 27

bethanechol chloride, 13

Bethanechol Chloride, 14

BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2", 26

BD Insulin Syringe/U-100/2ML/27.5G X 5/8", 27

Betimol, 18

Betoptic-s, 19

BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8", 26

BD Integra Insulin Syringe/U-100/1ML/29G X 1/2", 27

Bevespi, 22

bexarotene, 4

BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2", 27

BD Integra Syringe/Retracting Needle/1ML/25G X 1", 27

Bexsero, 23

Beyaz, 10

BD Insulin Syringe Safetyglide/1ML/29G X 1/2", 27

BD Lancet Device, 27

bicalutamide, 3

BD Lancet Ultrafine 30G, 27

Bidil, 6

BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 15/64", 26

BD Lancet Ultrafine 33G, 27

Biltricide, 2

BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2", 27

Bimatoprost, 19

BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16", 26

bio-d-mulsion, 23

BD Microtainer Lancets, 27

bio-d-mulsion forte, 23

BD Insulin Syringe Slip Tip/U-100/1ML, 27

BD Pen Needle/Mini/Ultrafine/31G X 3/16", 27

bio-statin, 2

Bio-statin, 2

BD Insulin Syringe U-40/1ML/25G X 5/8", 27

BD Pen Needle/Nano/Ultra Fine/32G X 4MM, 27

biotuss, 22

biotuss pediatric, 22

BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16", 27

BD Pen Needle/SHORT/Ultrafine/31G X 5/16", 27

Bisacodyl, 12

Bismuth Subgallate, 12

BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16", 27

BD Pen Needle/Ultrafine/29G X 12.7MM, 27

bisoprolol fumarate, 4

bisoprolol fumarate/hydrochlorothiazide, 5

BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16", 27

BD Pen Needle/Ultrafine/29GX1/2" 12.7MM, 27

Blephamide, 19

BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2", 27

BD Pen Needles SHORT/Ultrafine/31G X 5/16", 27

Blephamide S.o.p., 19

blisovi 24 FE, 9

BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16", 27

BD Safety-glide Insulin Syringe/0.5ML/29G X 1/2", 27

blisovi FE 1.5/30, 9

blisovi FE 1/20, 9

BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2", 27

BD Safety-lok Insulin Syringe/Perm Needle/UF/1ML/29G X 1/2", 27

Boostrix, 23

Boric Acid, 8

Bosulif, 3

C

1/2", 27

Botox, 18

Careone Insulin Syringes/1ML/31GX5/16", 27

C-nate DHA, 24

bp 10-1, 6

cabergoline, 11

bp foam, 6

Careone Lancet Thin, 27

Cafergot, 21

Bp Folinatal Plus B, 24

Careone Lancet Ultra Thin, 27

Caffeine Anhydrous, 17

Bp Multinatal Plus, 24

Careone Unifine Pentips 29GX12MM, 27

caffeine citrate, 17

bp wash, 6

Careone Unifine Pentips 31GX5MM, 27

Caffeine Citrated, 17

bprotected pedia d-vite, 23

Careone Unifine Pentips 31GX6MM, 27

Calamine, 8

bprotected pedia iron, 14

Careone Unifine Pentips 31GX8MM, 27

calcipotriene, 7

Bravelle, 11

Careone Unifine Pentips Pen Needles 32GX4MM, 27

calcipotriene/betamethasone dipropionate, 7

Breatherite, 36

Breatherite Collapsible Adult Spacer W/Mask, 36

Careone Unifine Pentips Plus Pen Needles 29GX12MM, 27

calcitonin salmon, 11

calcitonin-salmon, 11

Breatherite Collapsible Child Spacer W/Mask, 36

Careone Unifine Pentips Plus Pen Needles 31GX5MM, 27

calcitrene, 7

Calcitriol, 7

Breatherite Collapsible Infant Spacer W/Mask, 36

Careone Unifine Pentips Plus Pen Needles 31GX6MM, 27

calcitriol, 12

calcium acetate, 13

Breatherite Collapsible Small Child Spacer W/Mask, 36

Careone Unifine Pentips Plus Pen Needles 31GX8MM, 27

Calcium Ascorbate Dihydrate, 24

Calcium Pantothenate, 24

Breatherite Collapsible Spacer W/ Neonate Mask, 36

Careone Unifine Pentips Plus Pen Needles 32GX4MM, 27

Calcium PNV, 24

camila, 9

Breatherite Rigid Spacer W/Mask, 36

carisoprodol, 18

Camphor, 7

Breatherite W/Large Mask, 36

Carisoprodol, 18

camrese, 9

Breatherite W/Medium Mask, 36

carisoprodol/aspirin, 18

camrese LO, 9

Breatherite W/Small Mask, 36

carisoprodol/aspirin/codeine, 18

Canasa, 13

Breo Ellipta, 22

carteolol HCL, 18

candesartan cilexetil, 5

briellyn, 9

cartia XT, 4

candesartan cilexetil/hydrochlorothiazide, 5

Brilinta, 15

carvedilol, 4

brimonidine tartrate, 19

Cascara Sagrada, 12

Cantharidin, 8

Briviact, 17

cavarest, 15

capecitabine, 3

bromfed DM, 22

Caverject, 6

Capex, 7

bromfenac, 19

Cayston, 3

Capital/Codeine, 21

Bromfenac, 19

caziant, 9

Caprelsa, 3

Bromhexine HCL, 22

Cedax, 1

Capsaicin, 8

bromocriptine mesylate, 17

cefaclor, 1

captopril, 4

Bromocriptine Mesylate, 17

Cefaclor, 1

Captopril/Hydrochlorothiazide, 5

bromphen/pseudoephedrine HCL/dextromethorphan HBR, 22

Cefaclor ER, 1

Carafate, 12

cefadroxil, 1

Carbaglu, 12

Brompheniramine Maleate, 22

cefazolin sodium, 1

carbamazepine, 17

Brompheniramine Tannate, 22

Cefazolin Sodium, 1

carbamazepine ER, 17

Brovana, 22

cefdinir, 1

Carbaphen 12, 22

budesonide, 8, 22(2)

Cefditoren Pivoxil, 1

Carbaphen 12 PED, 22

Bullseye Mini Safety Lancets, 26

cefepime, 1

Carbatrol, 17

Bullseye Safety Lancets, 26

cefixime, 1

carbidopa, 17

bumetanide, 5

cefotaxime sodium, 1

carbidopa/levodopa, 17

Bunavail, 21

Cefotaxime Sodium, 1

carbidopa/levodopa ER, 17

Buphenyl, 12

cefotetan, 1

carbidopa/levodopa odt, 17

bupivacaine HCL, 21

cefoxitin sodium, 1

Carbidopa/Levodopa/Entacapone, 17

bupivacaine/epinephrine, 21

cefpodoxime proxetil, 1

carbinoxamine maleate, 22

buprenorphine HCL, 20

cefprozil, 1

Cardiocom Lancing Device, 27

buprenorphine HCL/naloxone HCL, 20

ceftazidime, 1

Cardura XL, 14

bupropion HCL, 16

Ceftibuten, 1

Carefine Pen Needle 32GX4MM, 27

bupropion HCL ER, 16

Ceftin, 1

Carefine Pen Needles 29GX1/2", 27

bupropion HCL SR, 16, 18

ceftriaxone sodium, 1

Carefine Pen Needles 30GX5/16", 27

bupropion HCL XL, 16

cefuroxime axetil, 1

Carefine Pen Needles 31GX6MM, 27

buspirone HCL, 16

cefuroxime sodium, 1

Carefine Pen Needles 31GX8MM, 27

butalbital/acetaminophen, 20

Cefuroxime Sodium, 1

Carefine Pen Needles 32GX5MM, 27

butalbital/acetaminophen/caffeine, 20

celecoxib, 21

Carefine Pen Needles 32GX6MM, 27

butalbital/acetaminophen/caffeine/codeine, 20

Celontin, 17

Careone Advanced Lancing Device, 27

Cem-urea, 8

Careone Insulin Syringes/0.3ML/30G X 1/2", 27

butalbital/aspirin/caffeine, 20

cephalexin, 1

butalbital/aspirin/caffeine/codeine, 20

Cephalexin, 1

Careone Insulin Syringes/0.3ML/31G X 5/16", 27

Butisol Sodium, 17

Ceracade, 8

butorphanol tartrate, 20

Cerdelga, 14

Careone Insulin Syringes/0.5ML/30G X 1/2", 27

Bydureon, 11

cerisa wash, 6

Bydureon Pen, 11

Cesamet, 13

Careone Insulin Syringes/0.5ML/31G X 5/16", 27

Byetta, 11

Cetraxal, 19

Bystolic, 4

Cetrotide, 11

Careone Insulin Syringes/1ML/30G X

cevimeline HCL, 15

Clever Chek Lancets Ultrathin 30G, 27

Clickfine Universal Pen Needles 31GX5/16", 27

Chantix, 18

Clever Choice Anti-staticvalved Holding Chamber/Adult Large, 36

Chantix Continuing Month PAK, 18

clindacin etz pledgets, 6

Chantix Starting Month PAK, 18

Clever Choice Anti-staticvalved Holding Chamber/Medium, 36

clindacin-p, 6

chateal, 9

Clindagel, 6

Chemet, 36

Clever Choice Anti-staticvalved Holding Chamber/Small, 36

clindamax, 6

Chenodal, 13

clindamycin HCL, 3

childrens aspirin, 20

Clever Choice Comfort EZ Insulin Pen Needles 31GX8MM, 27

clindamycin palmitate HCL, 3

childrens aspirin low strength, 20

clindamycin phosphate, 6, 14

Chloral Hydrate, 17

Clever Choice Comfort EZ Insulin Pen Needles 33GX4MM, 27

clindamycin/benzoyl peroxide, 6

Chloramphenicol, 3

Clindesse, 14

chlordiazepoxide HCL, 16

Clever Choice Comfort EZ Insulin Syringe/0.3ML/29G X 1/2", 27

Clinical Nutrients Prenatal Formula, 24

chlordiazepoxide HCL/clidinium bromide, 12

clinpro 5000, 15

Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 1/2", 27

clobetasol propionate, 7

Chlordiazepoxide/Amitriptyline, 18

clobetasol propionate e, 7

chlorhexidine gluconate, 15

Clever Choice Comfort EZ Insulin Syringe/0.3ML/30G X 5/16", 27

clobetasol propionate emollient, 7

chlorhexidine gluconate oral rinse, 15

Clocortolone Pivalate, 7

chloroquine phosphate, 2

Clever Choice Comfort EZ Insulin Syringe/0.3ML/31G X 5/16", 27

Clocortolone Pivalate P.M., 7

Chloroquine Phosphate, 2

clodan, 7

chlorothiazide, 5

Clever Choice Comfort EZ Insulin Syringe/0.5ML/28G X 1/2", 27

Cloderm, 7

Chlorothiazide, 5

Cloderm P.M., 7

Chlorpheniramine Maleate, 22

Clever Choice Comfort EZ Insulin Syringe/0.5ML/29G X 1/2", 27

clomipramine HCL, 16

chlorpromazine HCL, 16

clonazepam, 17

Chlorpromazine HCL, 16

Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 1/2", 27

clonazepam odt, 17

Chlorpropamide, 11

clonidine HCL, 5

chlorthalidone, 5

Clever Choice Comfort EZ Insulin Syringe/0.5ML/30G X 5/16", 27

clopidogrel, 15

Chlorthalidone, 5

clorazepate dipotassium, 16

chlorzoxazone, 18

Clever Choice Comfort EZ Insulin Syringe/0.5ML/31G X 5/16", 27

Clorpres, 5

Cholbam, 13

Closercare, 27

cholestyramine, 5

Clever Choice Comfort EZ Insulin Syringe/1.0ML/30G X 1/2", 27

clotrimazole, 6, 15

cholestyramine light, 5

clotrimazole/betamethasone dipropionate, 6

choline magnesium trisalicylate, 20

Clever Choice Comfort EZ Insulin Syringe/1ML/29G X 1/2", 27

chorionic gonadotropin, 11

clozapine, 16

Cialis, 6

Clever Choice Comfort EZ Insulin Syringe/1ML/30G X 5/16", 27

clozapine odt, 16

ciclodan, 6

Clozapine Odt, 16

ciclopirox, 6

Clever Choice Comfort EZ Insulin Syringe/U-100/1ML/31GX5/16", 27

CO-natal Fa, 24

ciclopirox nail lacquer, 6

Coagadex, 15

ciclopirox olamine, 6

Clever Choice Comfort EZ Pen Needles 29GX12MM, 27

Coaguchek Lancets, 27

ciclopirox treatment, 6

Coal TAR, 8

cidaleaze, 8

Clever Choice Comfort EZ Pen Needles 31GX5MM, 27

Coartem, 2

cilostazol, 15

coated aspirin, 20

Ciloxan, 18

Clever Choice Comfort EZ Pen Needles 31GX6MM, 27

Cocaine HCL, 8

Cimzia, 13

Codeine Phosphate, 21

Cimzia Starter Kit, 13

Clever Choice Comfort EZ Pen Needles 31GX8MM, 27

codeine sulfate, 20

Cipro HC, 19

Codeine Sulfate, 21

Ciprodex, 19

Clever Choice Comfort EZ Pen Needles 32GX4MM, 27

Colchicine, 21

ciprofloxacin, 1

Colcrys, 21

Ciprofloxacin, 19

Clever Choice Comfort EZ Pen Needles 32GX5MM, 27

colestipol HCL, 5

ciprofloxacin ER, 1

colistimethate sodium, 3

ciprofloxacin HCL, 1, 18

Clever Choice Comfort EZ Pen Needles 32GX6MM, 27

colocort, 13

Ciprofloxacin HCL, 1

Coly-mycin S, 19

citalopram hydrobromide, 16

Clever Choice Comfort EZ Pen Needles 32GX8MM, 27

Colyte-flavor Packs, 12

Citranatal 90 DHA, 24

Combigan, 19

Citranatal Assure, 24

Clever Choice Comfort EZ Pen Needles 33GX4MM, 27

Combipatch, 9

Citranatal B-calm, 24

Combivent Respimat, 23

Citranatal DHA, 24

Clever Choice Comfort EZ Pen Needles 33GX5MM, 27

Cometriq, 3

Citranatal Harmony, 24

Comfort Assist Insulin Syringe 0.3ML/29G X 1/2", 27

Citranatal RX, 24

Clever Choice Comfort EZ Pen Needles 33GX6MM, 27

citric acid/sodium citrate, 14

Comfort Assist Insulin Syringe/0.3ML/30G X 5/16", 27

claravis, 6

Clever Choice Comfort EZ Pen Needles 33GX8MM, 27

clarithromycin, 1

Comfort Assist Insulin Syringe/0.3ML/31G X 5/16", 27

clarithromycin ER, 1

Clickfine Pen Needle 32GX5/32", 27

Classic Prenatal, 24

Clickfine Pen Needle Universal/31GX1/4", 27

Comfort Assist Insulin Syringe/0.5ML/29G X 1/2", 27

Cleanlet Lancets 28G, 27

clearplex x, 6

Clickfine Pen Needle Universal/31GX5/16", 27

Comfort Assist Insulin Syringe/0.5ML/30G X 5/16", 27

Clemastine Fumarate, 22

Cleocin, 14

Clickfine Pen Needles/31GX1/4", 27

Comfort Assist Insulin Syringe/0.5ML/31G X 5/16", 27

Clever Chek Lancets Ultrathin, 27

Clickfine Pen Needles/31GX5/16", 27

Comfort Assist Insulin Syringe/1ML/29G X 1/2", 27

CVS Lancets Ultra Thin 30G, 28

deblitane, 9

CVS Lancets Ultra-thin 30G, 28

decara, 23

Comfort Assist Insulin Syringe/1ML/30G X 5/16", 27

CVS Lancing Device, 28

Decara, 24

CVS Prenatal, 24

Decon-a, 22

Comfort Assist Insulin Syringe/1ML/31G X 5/16", 27

CVS Ultra Thin Lancets, 28

Decon-G, 22

CVS vitamin d childrens gummies, 24

delta d3, 23

Comfort Assured Lancets Micro Thin 33G, 27

CVS vitamin d3, 24

deltasone, 8

CVS Vitamin D3 Drops/Infants, 24

delyla, 9

Comfort Assured Lancets Super Thin 28G, 27

cyanocobalamin, 14

Delzicol, 13

Cyanocobalamin, 14

demeclocycline HCL, 1

Comfort Lancets, 27

cyclafem 1/35, 9

Demeclocycline HCL, 1

Compact Space Chamber/Anti-static, 36

cyclafem 7/7/7, 9

Demser, 5

Compact Space Chamber/Anti-static/Large Mask, 36

cyclobenzaprine HCL, 18

Denavir, 7

Cyclomydril, 19

denta 5000 plus, 15

Compact Space Chamber/Anti-static/Medium Mask, 36

cyclopentolate HCL, 19

dentagel, 15

cyclopentolate hydrochloride, 19

Depakene, 17

Compact Space Chamber/Anti-static/Small Mask, 36

Cyclophosphamide, 3

Depakote, 17

Cycloserine, 2

Depakote ER, 17

Complera, 2

cyclosporine, 3

Depakote Sprinkles, 17

Complete Natal DHA, 24

cyclosporine modified, 3

Depo-estradiol, 9

Completenate, 24

Cyclosporine Modified, 3

Depo-subq Provera 104, 10

compro, 16

cyotic, 19

dermacinrx empricaine, 8

Concept DHA, 24

cyproheptadine HCL, 22

dermacinrx prizopak, 8

Concept OB, 24

cyred, 9

dermazene, 6

Condylox, 8

Cystadane, 12

Descovy, 2

constulose, 12

Cystagon, 14

desipramine HCL, 16

Copaxone, 18

Cytomel, 12

Desipramine HCL, 16

Cordran, 7

cytra k crystals, 14

desmopressin acetate, 11

Coreg CR, 4

D

desogestrel/ethinyl estradiol, 9

Corifact, 15

Desonate, 7

d 1000, 23

cormax scalp application, 7

desonide, 7

d 10000, 23

Cortane-b, 7

Desonide, 7

d 2000, 23

Cortane-b Aqueous, 19

desoximetasone, 7

d 400, 23

cortic-nd, 19

Desoximetasone, 7

d 5000, 23

Cortifoam, 13

Desvenlafaxine ER, 16

d-1000, 23

Cortisone Acetate, 9

dexamethasone, 8

d-1000 extra strength, 23

Cortisporin, 6

Dexamethasone, 8

d-2000 maximum strength, 23

corvita, 24

Dexamethasone Intensol, 8

d-3-5, 23

Cosentyx, 7

dexamethasone sodium phosphate, 8

d-400, 23

Cosentyx Sensoready Pen, 7

Dexamethasone Sodium Phosphate, 8, 19

d-5000, 23

Cotellic, 3

d-vita, 23

Coumadin, 15

dexedrine, 17

d2000 ultra strength, 23

covaryx, 9

dexmethylphenidate HCL, 17

d3, 23

covaryx HS, 9

dexmethylphenidate HCL ER, 17

d3 2000, 23

Creon, 13

Dexpak 10 Day, 9

d3 adult, 23

Cresemba, 2

Dexpak 13 Day, 9

d3 adult gummy, 23

Crinone, 14

Dexpak 6 Day, 9

D3 Dots, 24

Crixivan, 2

dextroamphetamine sulfate, 17

d3 high potency, 23

cromolyn sodium, 13, 19

dextroamphetamine sulfate ER, 17

d3 kids, 23

Cromolyn Sodium, 22

dialyvite vitamin d 5000, 23

d3 maximum strength, 23

cryselle-28, 9

dialyvite vitamin d3 max, 23

d3 super strength, 23

curity sterile saline, 14

Diastar Easy Test II Lancets 30G, 28

d3 ultra strength, 23

Curosurf, 23

Diastar Easy Test Lancets30G, 28

d3-1000, 23

Cuvposa, 12

diazepam, 16

d3-50, 23

CVS aspirin, 20

Diazepam, 16, 17

Daliresp, 23

CVS aspirin adult low dose, 20

diazepam intensol, 16

danazol, 9

CVS aspirin adult low strength, 20

Diazoxide, 5

Danazol, 9

CVS aspirin EC, 20

diclofenac potassium, 21

dantrolene sodium, 18

CVS aspirin low dose, 20

diclofenac sodium, 7, 19

dapsone, 3

CVS childrens aspirin, 20

diclofenac sodium DR, 21

Daptacel, 23

CVS d3, 24

diclofenac sodium ER, 21

Daraprim, 2

CVS enteric aspirin, 20

diclofenac sodium/misoprostol, 21

darifenacin hydrobromide ER, 13

CVS folic acid, 14

dicloxacillin sodium, 1

dasetta 1/35, 9

CVS Lancets 21G, 28

dicyclomine HCL, 12

dasetta 7/7/7, 9

CVS Lancets Micro Thin 33G, 27

didanosine, 2

daysee, 9

CVS Lancets Micro-thin 33G, 27

Dificid, 1

Daytrana, 17

CVS Lancets Original, 28

difil-G forte, 22

Ddrops, 24

CVS Lancets Thin 26G, 28

Diflorasone Diacetate, 7

Debacterol, 15

diflunisal, 20

Drug Mart Adjustable Lancing Device, 28

Easy Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2", 28

digitek, 4

Drug Mart Lancets Thin, 28

digox, 4

Drug Mart Lancets Ultra Thin, 28

Easy Comfort Insulin Syringe/U-100/1ML/30G X 1/2", 28

digoxin, 4

Drug Mart On-the-go Lancets Gentle 30G, 28

Digoxin, 4

Easy Comfort Lancets, 28

dihydroergotamine mesylate, 21

Drug Mart Unifine Pentips 31GX5MM, 28

Easy Comfort Lancets 30G/Pull Top, 28

Dihydroergotamine Mesylate, 21

Drug Mart Unifine Pentips29G X 12MM, 28

Easy Comfort Lancets 30G/Thin Top, 28

Dilantin, 17

Easy Comfort Pen Needles 31GX1/4", 28

Dilantin Infatabs, 17

Drug Mart Unifine Pentips31GX6MM, 28

Easy Comfort Pen Needles 31GX3/16", 28

Dilantin-125, 17

Drug Mart Unifine Pentips31GX8MM, 28

Dilatrate SR, 4

Drug Mart Unifine Pentips32GX4MM, 28

Easy Comfort Pen Needles 31GX5/16", 28

dilt-XR, 4

Drug Mart Unifine Pentipsplus 32GX4MM, 28

diltiazem CD, 4

Easy Comfort Pen Needles 32GX5/32", 28

diltiazem HCL, 4

Drug Mart Unilet Lancets Super Thin 30G, 28

diltiazem HCL CD, 4

Easy Mini Eject Lancing Device, 28

diltiazem HCL ER, 4

Drug Mart Unilet Lancets Ultra Thin 28G, 28

Easy Mini Lancing Device, 28

Dipentum, 13

Easy Touch 32GX5MM, 28

diphenhydramine HCL, 22

Duane Reade Lancet Alternate Site 26G, 28

Easy Touch 32GX6MM, 28

Diphenhydramine HCL, 22

Easy Touch Fliplock Safety Insulin Syringe 1ML/29GX1/2", 28

diphenoxylate/atropine, 12

Duane Reade Lancet Super Thin 30G, 28

Diphenoxylate/Atropine, 12

Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX1/2", 28

Diphtheria/Tetanus Toxoids Adsorbed Pediatric, 23

Duane Reade Lancet Ultra Thin 28G, 28

Duane Reade Unifine Pentips 29G X 12MM, 28

Easy Touch Fliplock Safety Insulin Syringe 1ML/30GX5/16", 28

dipyridamole, 15

disopyramide phosphate, 4

Duane Reade Unifine Pentips 31G X 6MM Ultra SHORT, 28

Easy Touch Fliplock Safety Insulin Syringe 1ML/31GX5/16", 28

disulfiram, 18

Diuril, 5

Duane Reade Unifine Pentips 31G X 8MM SHORT, 28

Easy Touch Insulin Syringe/0.3ML/30G X 5/16", 28

divalproex sodium, 17

divalproex sodium DR, 17

Duavee, 9

Easy Touch Insulin Syringe/0.3ML/31G X 5/16", 28

divalproex sodium ER, 17

Duet DHA 400, 25

Divigel, 9

Duet DHA Balanced, 24

Easy Touch Insulin Syringe/0.5ML/29G X 1/2", 28

Docusate Sodium, 12

duloxetine HCL, 16

dofetilide, 4

duramorph, 20

Easy Touch Insulin Syringe/0.5ML/30G X 5/16", 28

donepezil HCL, 18

duraxin, 20

Donnatal, 12

Durezol, 19

Easy Touch Insulin Syringe/1ML/30G X 5/16", 28

Doral, 17

dutasteride, 14

dorzolamide HCL, 19

dutasteride/tamsulosin HCL, 14

Easy Touch Insulin Syringe/Safety/U-100/0.5ML/29G X 1/2", 28

dorzolamide HCL/timolol maleate, 18

dutasteride/tamsulosin hydrochloride, 14

Dothelle DHA, 24

Dutoprol, 5

Easy Touch Insulin Syringe/Safety/U-100/0.5ML/30G X 5/16", 28

doxazosin, 5

Dyazide, 5

doxazosin mesylate, 5

Dyrenium, 5

Easy Touch Insulin Syringe/Safety/U-100/1ML/29G X 1/2", 28

doxepin HCL, 16

Dysport, 18

Doxepin HCL, 16

E

Easy Touch Insulin Syringe/Safety/U-100/1ML/30G X 1/2", 28

Doxepin Hydrochloride, 7

E-z Ject Lancets, 28

doxercalciferol, 12

Easy Touch Insulin Syringe/U-100/0.3ML/30G X 1/2", 28

E-z Ject Lancets 21G, 28

doxycycline, 1

E-z Ject Lancets Color, 28

doxycycline hyclate, 1

Easy Touch Insulin Syringe/U-100/0.5ML/27G X 1/2", 28

E-z Ject Lancets Super Thin, 28

Doxycycline Hyclate, 1

E-z Ject Lancets Super Thin 30G, 28

doxycycline monohydrate, 1

Easy Touch Insulin Syringe/U-100/0.5ML/28G X 1/2", 28

E-z Ject Lancets Thin 26G, 28

Doxylamine Succinate, 22

E-z Spacer, 36

Dritho-creme HP, 7

Easy Touch Insulin Syringe/U-100/0.5ML/30G X 1/2", 28

E-z Spacer The Body Guards Pack, 36

dronabinol, 13

E-ZJECT Lancets Micro-thin 33G, 28

droperidol, 16

Easy Touch Insulin Syringe/U-100/0.5ML/31G X 5/16", 28

E.e.s. 400, 1

Droperidol, 16

E.e.s. Granules, 1

Droplet Lancets Ultra Thin 30G, 28

Easy Touch Insulin Syringe/U-100/1ML/27G X 1/2", 28

Easivent, 36

Droplet Lancing Device, 28

Easivent/Mask-large, 36

Droplet Pen Needles 29GX12MM, 28

Easy Touch Insulin Syringe/U-100/1ML/29G X 1/2", 28

Easivent/Mask-medium, 36

Droplet Pen Needles 31GX5MM, 28

Easivent/Mask-small, 36

Droplet Pen Needles 31GX6MM, 28

Easy Touch Insulin Syringe/U-100/1ML/30G X 1/2", 28

Easy Comfort Insulin Syringe/0.3ML/30G X 5/16", 28

Droplet Pen Needles 31GX8MM, 28

Droplet Pen Needles 32GX4MM, 28

Easy Touch Insulin Syringe/U-100/1ML/31G X 5/16", 28

Easy Comfort Insulin Syringe/0.5ML/30G X 5/16", 28

Droplet Pen Needles 32GX5MM, 28

Droplet Pen Needles 32GX6MM, 28

Easy Touch Lancets 21G/Pressure Activated, 28

Easy Comfort Insulin Syringe/0.5ML/31G X 5/16", 28

Droplet Pen Needles 32GX8MM, 28

drospirenone/ethinyl estradiol, 9

Easy Touch Lancets 23G/Pressure Activated, 28

Easy Comfort Insulin Syringe/1ML/30G X 5/16", 28

drospirenone/ethinyl estradiol/levomefolate calcium, 9

Easy Touch Lancets 26G/Pressure Activated, 28

Easy Comfort Insulin Syringe/1ML/31G X 5/16", 28

Droxia, 14

Easy Touch Lancets 26G/Pull-top, 28

Elidel, 7

epinastine HCL, 19

Easy Touch Lancets 26G/Twist, 28

Eligard, 3

Epinephrine, 5

Easy Touch Lancets 28G/Pressure Activated, 28

elinest, 9

epinephrine HCL, 22

Eliquis, 15

episone CRE, 8

Easy Touch Lancets 28G/Pull-top, 28

Elite-OB, 24

epitol, 17

Easy Touch Lancets 28G/Twist, 28

Elite-thin Insulin Syringe/0.3ML/31G X 5/16", 28

eplerenone, 5

Easy Touch Lancets 30G/Button-activated, 28

Epogen, 14

Elite-thin Insulin Syringe/0.5ML/29G X 1/2", 28

Eprosartan Mesylate, 5

Easy Touch Lancets 30G/Pressure Activated, 28

Epzicom, 2

Elite-thin Insulin Syringe/0.5ML/30G X 5/16", 28

eq adult aspirin low strength, 20

Easy Touch Lancets 30G/Pull-top, 28

eq aspirin, 20

Easy Touch Lancets 30G/Twist, 28

Elite-thin Insulin Syringe/1ML/29G X 5/16", 28

eq aspirin adult low dose, 20

Easy Touch Lancets 32G/Pressure Activated, 28

eq aspirin EC, 20

Elite-thin Insulin Syringe/1ML/30G X 5/16", 28

eq aspirin low dose, 20

Easy Touch Lancets 32G/Pull-top, 28

eq childrens aspirin, 20

Easy Touch Lancets 32G/Twist, 28

Elite-thin Insulin Syringe/U-100/0.5ML/28G X 1/2", 28

eql aspirin, 20

Easy Touch Lancets 33G/Twist, 28

eql aspirin EC, 20

Easy Touch Lancing Device/Ejector, 28

Elite-thin Insulin Syringe/U-100/0.5ML/28G X 5/16", 28

eql aspirin low dose, 20

Easy Touch Pen Needles 29GX1/2", 28

Eql Color Lancets 21G, 29

Easy Touch Pen Needles 31GX1/4", 28

Elite-thin Insulin Syringe/U-100/0.5ML/29G X 5/16", 28

Eql Color Lancets Micro Thin 33G, 28

Easy Touch Pen Needles 31GX5/16", 28

Eql Insulin Syringe/0.3ML/29G X 1/2", 29

Easy Touch Pen Needles 32GX1/4", 28

Elite-thin Insulin Syringe/U-100/0.5ML/31G X 5/16", 28

Eql Insulin Syringe/0.3ML/30G X 5/16", 29

Easy Touch Pen Needles 32GX3/16", 28

Easy Touch Pen Needles 32GX5/32", 28

Elite-thin Insulin Syringe/U-100/1ML/28G X 5/16", 28

Eql Insulin Syringe/0.3ML/31G X 5/16", 29

Easy Touch Pen Needles/31G X 3/16", 28

Elite-thin Insulin Syringe/U-100/1ML/29G X 1/2", 28

Eql Insulin Syringe/0.5ML/29G X 1/2", 29

Easy Touch Safety Lancets21G/Pressure Activated, 28

Eql Insulin Syringe/0.5ML/30G X 5/16", 29

Elite-thin Insulin Syringe/U-100/1ML/31G X 5/16", 28

Easy Touch Safety Lancets23G/Pressure Activated, 28

Eql Insulin Syringe/0.5ML/31G X 5/16", 29

Elixophyllin, 22

Easy Touch Safety Lancets26G/Button Activated, 28

Ella, 10

Eql Insulin Syringe/1ML/29G X 1/2", 29

Elmiron, 14

Eql Insulin Syringe/1ML/30G X 5/16", 29

Easy Touch Safety Lancets26G/Pressure Activated, 28

Emadine, 19

Eql Insulin Syringe/1ML/31G X 5/16", 29

Embrace Lancets Ultra Thin 30G, 28

Eql Prenatal Formula, 24

Easy Touch Safety Lancets28G/Button Activated, 28

Emcyt, 3

Eql SHORT Pen Needles 31G X 8MM, 29

Emend, 13

Easy Touch Safety Lancets28G/Pressure Activated, 28

emoquette, 9

Eql Super Thin Lancets 30G, 29

Emsam, 16

Eql Thin Lancets 26G, 29

Easy Touch Sheathlock Safety Insulin Syringe 1ML/29GX1/2", 28

Emtriva, 2

Eql Ultra SHORT Pen Needles 31G X 6MM, 29

Emulsion SB, 8

Easy Touch Sheathlock Safety Insulin Syringe 1ML/30GX5/16", 28

Emverm, 2

eql vitamin d3, 23

enalapril maleate, 4

eql vitamin d3 gummies, 23

Easy Touch Sheathlock Safety Insulin Syringe 1ML/31GX5/16", 28

enalapril maleate/hydrochlorothiazide, 5

Equetro, 16

Enbrel, 21

Ergocalciferol, 24

Easy Touch Sheathlock Safety Syringe 1ML/30GX1/2", 28

Enbrel Sureclick, 21

Ergoloid Mesylates, 18

Encare, 14

Ergomar, 21

Easy Twist & CAP Lancets, 28

endocet, 20

Ergotamine Tartrate, 21

easygel, 15

Endometrin, 14

ergotamine tartrate/caffeine, 21

Easytest II Lancets, 28

Engerix-b, 23

errin, 9

Easytest Lancets, 28

enoxaparin sodium, 15

Ertaczo, 7

EC-81 aspirin, 20

enpresse-28, 9

ery, 6

econazole nitrate, 6

enskyce, 9

Ery-TAB, 1

econtra EZ, 9

Enstilar, 7

Eryped 200, 1

ecotrin, 20

entacapone, 17

Eryped 400, 1

ecotrin low strength, 20

entecavir, 2

Erythrocin Stearate, 1

ecpirin, 20

Entereg, 13

erythromycin, 1, 6, 18

ed-flex, 20

enteric coated aspirin, 20

Erythromycin, 1

ed-spaz, 12

Entresto, 6

Erythromycin Base, 1

Edarbi, 5

Entty Spray Emulsion, 8

erythromycin ethylsuccinate, 1

Edarbyclor, 5

enulose, 13

Erythromycin Ethylsuccinate, 1

Edex, 6

Envarsus XR, 3

erythromycin/benzoyl peroxide, 6

Edurant, 2

Epclusa, 2

Esbriet, 23

eemt, 9

Ephedrine HCL, 23

escitalopram oxalate, 16

eemt HS, 9

ephedrine sulfate, 5

estarylla, 9

Effient, 15

Ephedrine Sulfate, 23

estazolam, 16

Egrifta, 11

Epiceram, 8

esterified estrogens/methltestosterone, 9

Elelyso, 14

Epiduo, 6

esterified estrogens/methyltestosterone, 9

Elestrin, 9

Epifoam, 7

esterified estrogens/methyltestosterone DS, 9

EZ-lets Lancets 23G, 29

Flexichamber, 36

EZ-lets Lancets 26G Super-soft, 29

Flexichamber Adult Mask/Small, 36

esterified estrogens/methyltestosterone HS, 9

EZ-lets Lancets 28G Ultra-soft, 29

Flexichamber Child Mask/Large, 36

EZ-lets Lancets 30G, 29

Flexichamber Child Mask/Small, 36

Estrace, 14

ezetimibe, 5

Flovent Diskus, 22

estradiol, 9

Ezfe Forte, 25

Flovent HFA, 22

Estradiol, 9

F

Fluad 2016-2017, 23

Estradiol Micronized, 9

Fluarix Quadrivalent 2016-2017, 23

fa-8, 14

estradiol valerate, 9

Flublok 2015-2016, 23

Fabior, 6

estradiol/norethindrone acetate, 9

Flublok 2016-2017, 23

Factive, 1

Estring, 14

Flucelvax 2015-2016, 23

Falessa, 10

Estriol, 9

Flucelvax Quadrivalent 2016-2017, 23

fallback solo, 9

Estriol Micronized, 9

fluconazole, 2

falmina, 9

Estriol Ultra Micronized, 9

flucytosine, 2

famciclovir, 2

Estrogel, 9

fludrocortisone acetate, 8

Fanapt, 16

Estrone, 9

Fludrocortisone Acetate, 9

Fanapt Titration Pack, 16

Estropipate, 9

Flulaval Quadrivalent 2016-2017, 23

Fareston, 3

eszopiclone, 17

flunisolide, 22

Farydak, 3

ethambutol HCL, 1

Flunisolide, 23

Fazaclo, 16

Ethambutol HCL, 2

Flunisolide Anhydrous, 23

Feiba, 15

Ethinyl Estradiol, 9

fluocinolone acetonide, 7, 19

felbamate, 17

ethosuximide, 17

Fluocinolone Acetonide, 7

felodipine ER, 4

Ethyl Chloride, 8

fluocinolone acetonide body, 7

Fem PH, 14

Ethyl Chloride/Fine Pinpoint, 8

fluocinolone acetonide ear drops, 19

Femring, 14

Ethyl Chloride/Fine Stream, 8

fluocinolone acetonide scalp, 7

femynor, 9

Ethyl Chloride/Medium Jet Stream, 8

fluocinonide, 7

fenofibrate, 5

Ethyl Chloride/Medium Stream, 8

Fluocinonide, 7

Fenofibrate, 5

Ethyl Chloride/Mist, 8

fluocinonide-e, 7

fenofibrate micronized, 5

Etidronate Disodium, 11

fluoridex daily defense, 15

fenofibric acid DR, 6

etodolac, 21

fluoridex daily defense enhanced whitening, 15

Fenoprofen Calcium, 21

etodolac ER, 21

fentanyl, 20

Etoposide, 3

fluoridex daily defense sensitivity relief, 15

fentanyl citrate oral transmucosal, 20

Euflexxa, 18

fer-iron, 14

Eurax, 8

Fluoridex Daily Defense Sensitivity Relief, 15

ferosul, 14

Evamist, 9

Ferretts IPS, 14

Evicel, 15

fluorometholone, 19

Ferriprox, 36

Evomela, 3

Fluoxetine, 18

ferrous drops, 14

Evotaz, 2

fluoxetine DR, 16

ferrous sulfate, 14

Excel Comfort Point Insulin Pen Needles 31G X 4MM, 29

fluoxetine HCL, 16, 18

Ferrous Sulfate, 14

fluphenazine decanoate, 16

Ferrous Sulfate Anhydrous, 14

Exel Comfort Point Insulin Pen Needles 29G X 12MM, 29

fluphenazine HCL, 16

Ferrous Sulfate Heptahydrate, 14

Fluphenazine HCL, 16

Fifty50 Lancing Device, 29

Exel Comfort Point Insulin Pen Needles 31G X 6MM, 29

flurandrenolide, 7

Fifty50 Pen Needles 31G X3/16" (5MM), 29

Flurazepam HCL, 16

Exel Comfort Point Insulin Pen Needles 31G X 8MM, 29

flurbiprofen, 21

Fifty50 Pen Needles 31G X5/16" (8MM), 29

flurbiprofen sodium, 19

Exel Comfort Point Insulin Syringe/0.3ML/29G X 1/2", 29

flutamide, 3

Fifty50 Pen Needles 31GX5MM, 29

fluticasone propionate, 7, 22

Fifty50 Pen Needles/31GX8MM, 29

Exel Comfort Point Insulin Syringe/0.3ML/30G X 5/16", 29

fluvastatin, 5

Fifty50 Pen Needles/32GX4MM, 29

Fluvirin 2015-2016, 23

Fifty50 Pen Needles/32GX6MM, 29

Exel Comfort Point Insulin Syringe/0.5ML/28G X 1/2", 29

Fluvirin 2016-2017, 23

Fifty50 Safety Seal Lancets 30G, 29

fluvoxamine maleate, 16

Fifty50 Safety Seal Lancets 32G, 29

Exel Comfort Point Insulin Syringe/0.5ML/29G X 1/2", 29

fluvoxamine maleate ER, 16

Fifty50 Superior Comfort Insulin Syringe/0.3ML/31G X 5/16", 29

Fluzone High-dose PF 2016-2017, 23

Exel Comfort Point Insulin Syringe/0.5ML/30G X 5/16", 29

Fluzone Intradermal Quadrivalent 2016-2017, 23

Fifty50 Superior Comfort Insulin Syringe/0.5ML/31G X 5/16", 29

Exel Comfort Point Insulin Syringe/1ML/29G X 1/2", 29

Fluzone Quadrivalent 2016-2017, 23

Fifty50 Superior Comfort Insulin Syringe/1ML/31G X 5/16", 29

FML, 19

Exel Comfort Point Insulin Syringe/1ML/30G X 5/16", 29

FML Forte, 19

Fifty50 Unilet Lancets 33G, 29

Focalgin 90 DHA, 25

Finacea, 6

Exelderm, 7

Focalgin CA, 25

finasteride, 14

exemestane, 3

Focalin XR, 17

Fine 30, 29

Exjade, 36

Folcal DHA, 25

Fingerstix Lancets, 29

exotic-HC, 19

Folcaps Omega 3, 25

Firmagon, 3

Extavia, 18

Folet One, 25

Flarex, 19

Extra-virt Plus DHA, 25

folic acid, 14

flavoxate HCL, 13

EZ Smart Blood Glucose Lancets, 29

Folic Acid, 14

flecainide acetate, 4

EZ-lets Lancets 21G, 29

Folivane-OB, 25

Flector, 7

Follistim AQ, 11

Gentamicin Sulfate, 6

100/1ML/31G X 5/16", 29

fondaparinux sodium, 15

Gentamicin Sulfate Micronized, 6

Global Inject Ease Lancets 28G, 29

Fora Lancets, 29

gentamicin sulfate pediatric, 1

Global Inject Ease Lancets 30G, 29

Fora Lancing Device, 29

Gentian Violet, 7

Global Lancing Device, 29

Fora Lancing Device/Clearcap, 29

Gentle-let GP Lancets, 29

Glucagen Hypokit, 11

Forteo, 11

Gentle-let Lancets General Purpose Style/Fine Point, 29

Glucagon Emergency Kit, 11

fosinopril sodium, 4

Glucocom Lancets 28G, 29

fosinopril sodium/hydrochlorothiazide, 5

Gentle-let Lancets General Purpose Style/Medium Point, 29

Glucocom Lancets 30G, 29

fosphenytoin sodium, 17

Glucocom Lancets 33G, 29

Fosrenol, 13

Gentle-let Lancets Safety Style/Fine Point, 29

Glucolet 2 Automatic Lancing Device, 29

Fragmin, 15

Glucopro Insulin Syringe/U-100/0.3ML/30G X 1/2", 29

Freds Pharmacy Autolet Lancing Device, 29

Gentle-let Lancets Safety Style/Medium Point, 29

Glucopro Insulin Syringe/U-100/0.3ML/30G X 5/16", 29

Freds Pharmacy Unifine Pentips Pen Needles 32GX4MM, 29

Gentle-let Platforms 2.4MM, 29

Gentle-let Platforms 3.0MM, 29

Glucopro Insulin Syringe/U-100/0.3ML/31G X 5/16", 29

Freds Pharmacy Unifine Pentips Plus 31GX5MM, 29

Genvisc 850, 18

Genvoya, 2

Glucopro Insulin Syringe/U-100/0.5ML/30G X 1/2", 29

Freds Pharmacy Unifine Pentips Plus 31GX8MM, 29

Gialax, 12

gianvi, 9

Glucopro Insulin Syringe/U-100/0.5ML/30G X 5/16", 29

Freds Pharmacy Unilet Lancets Super Thin 30G, 29

gildagia, 9

Gilenya, 18

Glucopro Insulin Syringe/U-100/0.5ML/31G X 5/16", 29

Freds Pharmacy Unilet Lancets Ultra Thin 28G, 29

Gilotrif, 3

Gilphex TR, 22

Glucopro Insulin Syringe/U-100/1ML/30G X 1/2", 29

Freestyle Lancets, 29

giltuss pediatric, 22

Freestyle Precision Insulin Syringe/U-100/0.5ML/30G X 5/16", 29

Giltuss TR, 22

Glucopro Insulin Syringe/U-100/1ML/30G X 5/16", 29

glatopa, 18

Freestyle Precision Insulin Syringe/U-100/0.5ML/31G X 5/16", 29

Gleostine, 3

Glucopro Insulin Syringe/U-100/1ML/31G X 5/16", 29

glimepiride, 11

Freestyle Precision Insulin Syringe/U-100/1ML/31G X 5/16", 29

glipizide, 11

Glucosource Lancet Device, 29

Glipizide, 11

Glucosource Lancets, 29

Freestyle Precision Insulin Syringes/U-100/1ML/30G X 5/16", 29

glipizide ER, 11

glyburide, 11

glipizide XL, 11

Glyburide, 11

Freestyle Unistick II Lancets, 29

glipizide/metformin HCL, 11

glyburide micronized, 11

frovatriptan succinate, 21

Global Ease Inject Pen Needles 29GX12MM, 29

glyburide/metformin HCL, 11

furosemide, 5

glycine, 14

Furosemide, 5

Global Ease Inject Pen Needles 31GX8MM, 29

Glycine, 14

Fuzeon, 2

Glycine (l), 14

fyavolv, 9

Global Ease Inject Pen Needles 32GX4MM, 29

Glycolic Acid, 7

Fycompa, 17

Glycolic Acid 70% High Purity, 7

G

Global Ease Inject Pen Neeedles 31GX5MM, 29

glycopyrrolate, 12

glydo, 8

gabapentin, 17

Global Easy Glide Pen Needles 32GX4MM, 29

Gmate Lancets 30G, 29

Gabitril, 17

Gmate Lancing Device, 29

galantamine hydrobromide, 18

Global Inject Ease Insulin Syringe/U-100/0.3ML/29G X 1/2", 29

gnp adult aspirin low strength, 20

Galantamine Hydrobromide, 18

gnp aspirin, 20

galantamine hydrobromide ER, 18

Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 1/2", 29

gnp aspirin low dose, 20

Ganirelix Acetate, 11

Gnp Clickfine Pen Needle Universal/31GX5/16", 29

Gardasil, 23

Global Inject Ease Insulin Syringe/U-100/0.3ML/30G X 5/16", 29

Gardasil 9, 23

Gnp Clickfine Universal Pen Needles 31GX1/4", 29

gatifloxacin, 18

Global Inject Ease Insulin Syringe/U-100/0.3ML/31G X 5/16", 29

gavilyte-c, 12

Gnp Clickfine Universal Pen Needles 31GX5/16", 29

gavilyte-G, 12

Global Inject Ease Insulin Syringe/U-100/0.5ML/28G X 1/2", 29

gavilyte-h, 12

gnp d 2000, 23

gavilyte-n/flavor pack, 12

Global Inject Ease Insulin Syringe/U-100/0.5ML/29G X 1/2", 29

Gnp Daily Prenatal, 25

Gebauers Pain Ease, 8

gnp folic acid, 14

Gebauers Spray And Stretch, 8

Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 1/2", 29

Gnp Insulin Syringe/0.3ML/29G X 1/2", 29

Gel-kam Oral Care Rinse, 15

Gel-one, 18

Global Inject Ease Insulin Syringe/U-100/0.5ML/30G X 5/16", 29

Gnp Insulin Syringe/0.3ML/30G X 5/16", 29

Gelclair, 15

gemfibrozil, 5

Global Inject Ease Insulin Syringe/U-100/0.5ML/31G X 5/16", 29

Gnp Insulin Syringe/0.3ML/31G X 5/16", 29

Gemfibrozil, 6

Genadur, 8

Global Inject Ease Insulin Syringe/U-100/1ML/29G X 1/2", 29

Gnp Insulin Syringe/0.5ML/28G X 1/2", 29

gene-xene TAB 15MG, 16

gene-xene TAB 3.75MG, 16

Global Inject Ease Insulin Syringe/U-100/1ML/30G X 1/2", 29

Gnp Insulin Syringe/0.5ML/29G X 1/2", 29

gene-xene TAB 7.5MG, 16

generlac, 13

Global Inject Ease Insulin Syringe/U-100/1ML/30G X 5/16", 29

Gnp Insulin Syringe/0.5ML/30G X 5/16", 29

gengraf, 3

gentak, 18

Global Inject Ease Insulin Syringe/U-

Gnp Insulin Syringe/0.5ML/31G X 5/16",

gentamicin sulfate, 1, 6, 18

29

Device, 30

HM vitamin d, 24

Gnp Insulin Syringe/1ML/29G X 1/2", 29

H-e-b Incontrol Lancets Micro Thin 33G, 30

HM vitamin d3, 24

Gnp Insulin Syringe/1ML/30G X 5/16", 29

HM Vitamin D3, 24

Gnp Insulin Syringe/1ML/31G X 5/16", 29

H-e-b Incontrol Lancets Super Thin 30G, 30

homatropaire, 19

Gnp Lancets, 29

homatropine HBR, 19

Gnp Lancets 21G, 29

H-e-b Incontrol Lancets Ultra Thin 28G, 30

HPR, 8

Gnp Lancets Micro Thin 33G, 29

HPR Plus, 8

Gnp Lancets Super Thin 30G, 29

H-e-b Incontrol Pen Needles 29GX12MM, 30

Humalog Kwikpen, 11

Gnp Lancets Thin, 29

Humate-p, 15

Gnp Lancets Thin 26G, 29

Haemolance, 30

Humira, 21

Gnp Micro Thin Lancets 33G, 29

Haemolance Low Flow Lancets, 30

Humira Pediatric Crohns Disease Starter Pack, 21

Gnp Prenatal, 25

Haemolance Plus, 30

Gnp Super Thin Lancets/30G, 29

Haemolance Plus High Flow, 30

Humira Pen, 21

Gnp Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2", 29

Haemolance Plus Low Flow, 30

Humira Pen-crohns Diseasestarter, 21

Haemolance Plus Max Flow, 30

Humira Pen-psoriasis Starter, 21

Gnp Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16" SHORT, 29

Haemolance Plus Pediatric Flow, 30

Humulin R U-500 (concentrated), 11

halobetasol propionate, 7

Hy-vee Lancets, 30

Gnp Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16" SHORT, 30

Halog, 7

Hy-vee Thin Lancets, 30

haloperidol, 16

Hyalgan, 18

Gnp Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2", 30

Haloperidol, 16

Hycamtin, 4

haloperidol decanoate, 16

hydralazine HCL, 5

Gnp Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2", 30

haloperidol lactate, 16

hydrochlorothiazide, 5

Halotin, 7

Hydrochlorothiazide, 5

Gnp Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16" SHORT, 30

Havrix, 23

hydrocodone bitartrate/acetaminophen, 20

Health Care Lancing Device, 30

Gnp Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16" SHORT, 30

Healthwise Lancets 30G, 30

hydrocodone bitartrate/homatropine methylbromide, 22

Healthwise Lancing Pen, 30

Gnp Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 30

Healthwise Mini Pen Needles 31GX6MM, 30

hydrocodone polistirex/chlorpheniramine polistirex, 22

Gnp Ultra Comfort Insulin Syringe/1ML/30G X 5/16" SHORT, 30

Healthwise Pen Needles 29GX12MM, 30

hydrocodone/acetaminophen, 20

Healthwise SHORT Pen Needles 31GX8MM, 30

hydrocodone/homatropine, 22

Gnp Ultra Comfort Insulin Syringe/1ML/31G X 5/16" SHORT, 30

hydrocodone/ibuprofen, 20

Healthwise Unifine Pentips Pen Needles 32GX4MM, 30

hydrocort ene 100MG, 13

gnp vitamin d, 23

hydrocortisone, 7, 8, 13

gnp vitamin d maximum strength, 23

Healthy Accents Autolet Impression Lancing Device, 30

Hydrocortisone, 7

gnp vitamin d super strength, 23

hydrocortisone 1% IN absobase, 7

gnp vitamin d3 extra strength, 23

Healthy Accents Unifine Pentips Pen Needles 29GX12MM, 30

Hydrocortisone Acetate, 7

Golytely, 12

hydrocortisone acetate, 13

Gonal-f, 11

Healthy Accents Unifine Pentips Pen Needles 31GX5MM, 30

Hydrocortisone Acetate Micronized, 7

Gonal-f RFF, 11

hydrocortisone acetate/pramoxine, 7, 13

Gonal-f RFF Rediject, 11

Healthy Accents Unifine Pentips Pen Needles 31GX6MM, 30

hydrocortisone butyrate, 7

goodsense aspirin low dose, 20

hydrocortisone butyrate (lipid), 7

Goodsense Prenatal Vitamins, 25

Healthy Accents Unifine Pentips Pen Needles 31GX8MM, 30

hydrocortisone butyrate (lipophilic), 7

Gordofilm, 8

hydrocortisone IN absorbase, 7

Gordons Urea, 8

Healthy Accents Unifine Pentips Pen Needles 32GX4MM, 30

Hydrocortisone Micronized, 7

granisetron HCL, 13

hydrocortisone valerate, 7

Granix, 14

Healthy Accents Unilet Lancets Super Thin 30G, 30

hydrocortisone/acetic acid, 19

griseofulvin microsize, 2

hydrocortisone/iodoquinol, 6

griseofulvin ultramicrosize, 2

healthy kids vitamin d3, 23

hydromet, 22

guanfacine ER, 17

heather, 9

hydromorphone HCL, 20

guanfacine HCL, 5

Helixate FS, 15

Hydromorphone HCL, 21

Guanidine HCL, 18

Hemenatal OB, 25

hydromorphone HCL dosette, 20

Gynazole-1, 14

Hemenatal OB + DHA, 25

Hydroxocobalamin, 14

H

hemmorex-HC, 13

hydroxychloroquine sulfate, 2

Hemofil M, 15

Hydroxyprogesterone Caproate, 3

h-e-b aspirin, 20

heparin sodium, 15

hydroxyurea, 4

H-e-b IN Control Pen Needles 31GX5MM, 30

heparin sodium dcu, 15

hydroxyzine HCL, 16

heparin sodium/NACL 0.9%, 15

hydroxyzine pamoate, 16

H-e-b IN Control Pen Needles 31GX6MM, 30

heparin sodium/sodium chloride 0.9% premix, 15

Hydroxyzine Pamoate, 16

Hylatopic Plus, 8

H-e-b IN Control Pen Needles 31GX8MM, 30

Hexalen, 3

Hylira, 8

Hiberix, 23

hyolev mb, 13

H-e-b IN Control Pen Needles/Nano/32GX4MM, 30

HM aspirin, 20

hyophen, 13

HM aspirin EC, 20

hyoscyamine sulfate, 12

H-e-b IN Control Unifine Pentips Plus 31GX5MM, 30

HM aspirin EC low dose, 20

Hyoscyamine Sulfate, 12

HM folic acid, 14

hyoscyamine sulfate ER, 12

H-e-b IN Control Unifine Pentips Plus 32GX4MM, 30

HM One Daily Prenatal Combo, 25

hyoscyamine sulfate odt, 12

HM Prenatal, 25

hyoscyamine sulfate SR, 12

H-e-b Incontrol Advanced Lancing

hyosyne, 12

Insupen Pen Needles 32G X4MM, 30

Kadian, 21

Hypersal, 22

Insupen Sensitive 32GX6MM, 30

kaitlib FE, 9

Hypolance AST Lancing Kit, 30

Insupen Sensitive 32GX8MM, 30

Kaletra, 2

I

Insupen Ultrafin 29GX12MM, 30

Kalydeco, 23

Insupen Ultrafin 30GX8MM, 30

Kaolin, 12

ibandronate sodium, 11

Insupen Ultrafin 31GX6MM, 30

karigel, 15

Ibrance, 3

Insupen Ultrafin 31GX8MM, 30

karigel-n, 15

ibudone, 20

Intelence, 2

kariva, 9

ibuprofen, 21

Intron A, 4

kelnor 1/35, 10

Ichthammol, 8

Intron A W/Diluent, 4

Keppra, 17

Iclusig, 3

introvale, 9

Keppra XR, 17

Idelvion, 15

Invega Sustenna, 16

Keralyt Scalp, 8

Ilevro, 19

Invega Trinza, 16

ketamine HCL, 22

ilotycin, 18

Invirase, 2

ketoconazole, 2, 6

imatinib mesylate, 3

Invokamet, 11

ketodan, 6

Imbruvica, 3

Invokana, 11

ketoprofen, 21

imipramine HCL, 16

Iodoquinol, 2

Ketoprofen ER, 21

imipramine pamoate, 16

Iopidine, 19

ketorolac tromethamine, 19, 21

imiquimod, 7

Ipol Inactivated IPV, 23

Ketorolac Tromethamine, 21

IN Touch Lancing Device, 30

ipratropium bromide, 22(2)

Khedezla, 16

IN Touch Sterile Lancets 30G, 30

Ipratropium Bromide, 23

kimidess, 10

Inatal Advance, 24

Ipratropium Bromide Monohydrate, 23

Kineret, 21

Inatal GT, 24

ipratropium bromide/albuterol sulfate, 22

Kinney Lancets, 30

Inatal Ultra, 24

irbesartan, 5

Kinney Thin Lancets, 30

Increlex, 11

irbesartan/hydrochlorothiazide, 5

Kinray Insulin Syringe Preferred Plus/0.3ML/31G X 5/16", 30

Incruse Ellipta, 22

Iressa, 3

indapamide, 5

Iron Chews Pediatric, 14

Kinray Insulin Syringe Preferred Plus/0.5ML/31G X 5/16", 30

Indocin, 21

iron supplement childrens, 14

indomethacin, 21

Iron Up, 14

Kinray Insulin Syringe Preferred Plus/1ML/31G X 5/16", 30

indomethacin ER, 21

Isentress, 2

Infanate Balance, 25

isoflurane, 22

Kinray Insulin Syringe/0.5ML/29G X 1/2", 30

Infanrix, 23

isometheptene/dichloralphenazone/acetaminophen, 21

Inlyta, 3

Kinrix, 23

Innopran XL, 4

isoniazid, 1

kls aspirin EC, 20

Inspirachamber/Anti-static Valved/Mouthpiece, 36

Isoniazid, 2

kls aspirin low dose, 20

Isopropamide Iodide, 13

Kmart Valu Plus Insulin Syringe/0.3ML/30G, 30

Inspirachamber/Large, 36

Isordil Titradose, 4

Inspirachamber/Soothermask/Inspiramask/Medium, 36

isosorbide dinitrate, 4

Kmart Valu Plus Insulin Syringe/0.5ML/29G, 30

isosorbide mononitrate, 4

Inspirachamber/Soothermask/Inspiramask/Small, 36

isosorbide mononitrate ER, 4

Kmart Valu Plus Insulin Syringe/0.5ML/30G, 30

isoxsuprine HCL, 6

Inspirease Bags, 36

isradipine, 4

Kmart Valu Plus Insulin Syringe/1ML/29G, 30

Inspirease Drug Delivery System, 36

Istalol, 19

Inspirease Mouthpiece, 36

itraconazole, 2

Kmart Valu Plus Insulin Syringe/1ML/30G, 30

Inspirease Reservoir Bags, 36

ivermectin, 2

Insulin Syringe/0.3ML/29G X 1", 30

Ixinity, 15

Koate-dvi, 15

Insulin Syringe/0.3ML/29G X 1/2", 30

J

Kogenate FS, 15

Insulin Syringe/0.3ML/30G X 5/16", 30

Kogenate FS Bio-set, 15

Insulin Syringe/0.3ML/31G X 5/16", 30

Jadenu, 36

Kombiglyze XR, 11

Insulin Syringe/0.5ML/27G X 1/2", 30

Jakafi, 3

Korlym, 11

Insulin Syringe/0.5ML/28G X 1/2", 30

jantoven, 15

Kosher Prenatal Plus Iron, 25

Insulin Syringe/0.5ML/30G X 1/2", 30

Janumet, 11

kp aspirin, 20

Insulin Syringe/0.5ML/30G X 5/16", 30

Januvia, 11

kp folic acid, 14

Insulin Syringe/0.5ML/31G X 5/16", 30

Jardiance, 11

Kp Prenatal Multivitamins, 25

Insulin Syringe/1ML/29G X 1/2", 30

jencycla, 9

kp vitamin d, 23

Insulin Syringe/1ML/30G X 5/16", 30

jevantique LO, 9

Kpn Prenatal, 25

Insulin Syringe/U-100/0.3ML/29G X 1/2", 30

jinteli, 9

Kristalose, 12

jolessa, 9

Kroger Insulin Syringe/0.3ML/29G X 1/2", 30

Insulin Syringe/U-100/0.5ML/28G X 1/2", 30

jolivette, 9

juleber, 9

Kroger Insulin Syringe/0.3ML/30G X 5/16", 30

Insulin Syringe/U-100/0.5ML/29G X 1/2", 30

junel 1.5/30, 9

junel 1/20, 9

Kroger Insulin Syringe/0.3ML/31G X 5/16", 30

Insulin Syringe/U-100/1ML/29G X 1/2", 30

junel FE 1.5/30, 9

junel FE 1/20, 9

Kroger Insulin Syringe/0.5ML/29G X 1/2", 30

Insulin Syringe/U-100/1ML/30G X 5/16", 30

junel FE 24, 9

just d, 23

Kroger Insulin Syringe/0.5ML/30G X 5/16", 30

Insulin Syringe/U-100/1ML/31G X 5/16", 30

K

Kroger Insulin Syringe/0.5ML/31G X

K-phos NO 2, 14

Insupen 33GX4MM, 30

5/16", 30

Lantus Solostar, 10

Levamisole HCL, 3

Kroger Insulin Syringe/1ML/29G X 1/2", 30

Lanzo, 30

Levemir, 10

larin 1.5/30, 10

Levemir Flextouch, 10

Kroger Insulin Syringe/1ML/30G X 5/16", 30

larin 1/20, 10

levetiracetam, 17

larin 24 FE, 10

levetiracetam ER, 17

Kroger Insulin Syringe/1ML/31G X 5/16", 30

larin FE 1.5/30, 10

Levitra, 6

larin FE 1/20, 10

levo-t, 12

Kroger Lancets, 30

larissia, 10

levobunolol HCL, 18

Kroger Lancets 21G, 30

Lastacaft, 19

levocarnitine, 12

Kroger Lancets Micro Thin33G, 30

latanoprost, 19

Levodopa, 17

Kroger Lancets Super Thin, 30

latrix, 8

levofloxacin, 1, 18

Kroger Lancets Thin, 30

Latrix XM, 8

Levomefolate DHA, 25

Kroger Lancets Thin 26G, 30

Latuda, 16

levonest, 10

Kroger Lancets Ultrathin 30G, 30

layolis FE, 10

levonorgestrel, 10

Kroger Lancing Device, 30

Leader Advanced Lancing Device, 30

levonorgestrel and ethinyl estradiol, 10

Kroger Pen Needles 29G X 12MM, 30

Leader Insulin Syringe/0.3ML/29G X 1/2", 30

levonorgestrel/ethinyl estradiol, 10

Kroger Pen Needles 31G X 8MM, 30

levora 0.15/30-28, 10

Kroger Pen Needles 31GX1/4", 30

Leader Insulin Syringe/0.3ML/30G X 5/16", 30

Levorphanol Tartrate, 21

kurvelo, 10

levothyroxine sodium, 12

Kuvan, 12

Leader Insulin Syringe/0.3ML/31G X 5/16", 30

levoxyl, 12

L

Levsin, 13

Leader Insulin Syringe/0.5ML/28G X 1/2", 30

Lexiva, 2

L-glutamic Acid HCL, 13

Lialda, 13

labetalol HCL, 4

Leader Insulin Syringe/0.5ML/29G X 1/2", 30

Liberty Medical Lancets 30G, 31

Lacrisert, 18

Liberty Mini Lancing Device, 31

lactic acid, 8

Leader Insulin Syringe/0.5ML/30G X 5/16", 30

lidazone HC, 13

lactic acid e, 8

Lido-k, 8

lactic acid w/vitamin e, 8

Leader Insulin Syringe/0.5ML/31G X 5/16", 30

lidocaine, 8

lactulose, 12, 13

lidocaine HCL, 8, 21

Lamictal, 17

Leader Insulin Syringe/1ML/29G X 1/2", 31

Lidocaine HCL, 8, 15

Lamictal Chewable Dispersible, 17

lidocaine HCL jelly, 8

Lamictal Odt, 17

Leader Insulin Syringe/1ML/30G X 5/16", 31

Lidocaine HCL Monohydrate, 8

Lamictal XR, 17

lidocaine HCL viscous, 15

lamivudine, 2

Leader Insulin Syringe/1ML/31G X 5/16", 31

Lidocaine HCL-hydrocortisone Acetate With Aloe, 13

lamivudine/zidovudine, 2

lamotrigine, 17

Leader Lancets Colored, 31

lidocaine HCL/hydrocortisone acetate, 13

lamotrigine ER, 17

Leader Super Thin Lancet, 31

lidocaine PAK, 8

lamotrigine odt, 17

Leader Thin Lancets, 31

lidocaine viscous, 15

lamotrigine titration, 17

Leader Unifine Pentips Plus/Mini/31GX3/16", 31

lidocaine/epinephrine, 21

Lancet Device Adjustable, 30

lidocaine/prilocaine, 8

Lancet Device With Ejector, 30

Leader Unifine Pentips Plus/SHORT/31GX5/16", 31

lidopin, 8

Lancet Transporter Case, 30

lidopril, 8

Lancets, 30

Leader Unifine Pentips/Mini/31GX3/16", 31

lidopril XR, 8

Lancets 26G Twist Top, 30

Lifescan Unistik 2 Deep Penetration, 31

Lancets 28G, 30

Leader Unifine Pentips/Nano/32GX5/32", 31

Lifescan Unistik II Lancets, 31

Lancets 30G, 30

lincomycin HCL, 3

Lancets 30G Twist Top, 30

Leader Unifine Pentips/Plus/32GX5/32", 31

Lindane, 8

Lancets 30G/Twist Top, 30

linezolid, 3

Lancets 31G Twist Top, 30

leena, 10

Linzess, 13

Lancets 33G Universal Design, 30

leflunomide, 21

liothyronine sodium, 12

Lancets Bullseye Safety, 30

Lenvima 10 MG Daily Dose, 3

Liothyronine Sodium, 12

Lancets Micro Thin 33G, 30

Lenvima 14 MG Daily Dose, 3

liprozonepak, 8

Lancets Safety Seal 21G, 30

Lenvima 18 MG Daily Dose, 3

lisinopril, 5

Lancets Safety Seal 26G, 30

Lenvima 20 MG Daily Dose, 3

lisinopril/hydrochlorothiazide, 5

Lancets Safety Seal 28G, 30

Lenvima 24 MG Daily Dose, 3

Lite Touch Lancets, 31

Lancets Safety Seal 30G, 30

Lenvima 8 MG Daily Dose, 3

Lite Touch Lancing Device, 31

Lancets Super Thin 28G, 30

lessina, 10

Lite Touch Lancing Pen, 31

Lancets Thin, 30

Letairis, 6

Lite Touch Pen Needles/31G X 3/16", 31

Lancets Twist Top, 30

letrozole, 3

Liteaire, 36

Lancets Ultra Fine, 30

leucovorin calcium, 4

Litetouch Insulin Syringe/0.3ML/29G X 1/2", 31

Lancets Ultra Thin, 30

Leucovorin Calcium, 4

Lancets Ultra Thin 30G, 30

Leukeran, 3

Litetouch Insulin Syringe/0.3ML/30G X 5/16", 31

Lancing Device, 30

Leukine, 14

Lancing Device Adjustable, 30

leuprolide acetate, 3

Litetouch Insulin Syringe/0.3ML/31G X 5/16", 31

Lanoxin, 4

Levacet, 20

lansoprazole, 12

levalbuterol, 22

Litetouch Insulin Syringe/0.5ML/30G X 5/16", 31

lansoprazole/amoxicillin/clarithromycin, 12

levalbuterol HCL, 22

Levalbuterol Tartrate HFA, 22

Litetouch Insulin Syringe/0.5ML/31G X

Lantus, 10

5/16", 31

M

Medlance Plus Lancets, 31

Litetouch Insulin Syringe/1ML/30G X 5/16", 31

Medlance Plus Lancets Lite 25G, 31

M-m-r II, 23

Medlance Plus Lite Lancets 25G, 31

M-vit, 24

Litetouch Insulin Syringe/U-100/0.5ML/28G X 1/2", 31

Medlance Plus Special Lancets 0.8MM, 31

Macnatal CN DHA, 24

Magellan Insulin Safety Syringe/U-100/0.3ML/29G X 1/2", 31

Litetouch Insulin Syringe/U-100/0.5ML/29G X 1/2", 31

Medlance Plus Superlite 30G, 31

Medlance Plus Superlite 30G/Comfort Max, 31

Magellan Insulin Safety Syringe/U-100/0.3ML/30G X 5/16", 31

Litetouch Insulin Syringe/U-100/1ML/29G X 1/2", 31

Medlance Plus Universal Lancets 21G, 31

Magellan Insulin Safety Syringe/U-100/0.5ML/29G X 1/2", 31

Litetouch Insulin Syringe/U-100/1ML/31G X 5/16", 31

Medlance Plus/Lite 25G, 31

Magellan Insulin Safety Syringe/U-100/0.5ML/30G X 5/16", 31

Litetouch Lancets Micro Thin 33G, 31

Medlance/Extra, 31

Litetouch Pen Needles 29GX12.7MM, 31

Medlance/Lite, 31

Magellan Insulin Safety Syringe/U-100/1ML/29G X 1/2", 31

Litetouch Pen Needles 31G X 6MM, 31

Medlance/Universal, 31

Litetouch Pen Needles 31GX8MM SHORT, 31

medolor PAK, 8

Magellan Insulin Safety Syringe/U-100/1ML/30G X 5/16", 31

Medrol, 9

Lithium, 16

medroxyprogesterone acetate, 10(2)

Magnesium Oxide Heavy, 12

lithium carbonate, 16

mefenamic acid, 21

Magnesium Oxide Light, 12

Lithium Carbonate, 16

mefloquine HCL, 2

Magnesium Sulfate, 12

lithium carbonate ER, 16

mega-c/a plus, 23

Magnesium Sulfate Heptahydrate, 12

Lithostat, 14

megestrol acetate, 3, 10

Magnesium Trisilicate, 12

Live Better Advanced Lancing Device, 31

Megestrol Acetate, 3

Magnesium Trisilicate Anhydrous, 12

Live Better Lancet Super Thin 30G, 31

meijer aspirin EC, 20

Magnesium Trisilicate Hydrate, 12

Live Better Lancet Ultra Thin 28G, 31

Meijer Color Lancets Universal 33G, 31

Makena, 10

Live Better Pen Needles 29G X 12MM, 31

Meijer Lancets, 31

malathion, 8

Meijer Lancets Thin, 31

Maprotiline HCL, 16

Live Better Pen Needles 31G X 12MM, 31

Meijer Lancets Universal 21G, 31

marlissa, 10

Meijer Lancets Universal 30G, 31

Marnatal-f, 25

Live Better Pen Needles 31G X 6MM, 31

Meijer Lancets Universal 33G, 31

Marplan, 16

livixil PAK, 8

Meijer Pen Needles 29G X 12MM, 31

marten-TAB, 20

LO Loestrin FE, 10

Meijer Pen Needles 31G X 6MM, 31

Matulane, 4

Locoid, 7

Meijer Pen Needles 31G X 8MM, 31

matzim LA, 4

lofene, 12

Meijer Super Thin Lancets, 31

Maxi-comfort Insulin Syringe/U-100/0.5ML/28GX1/2", 31

lokara, 7

Mekinist, 3

lomedia 24 FE, 10

meloxicam, 21

Maxidex, 19

Longs Insulin Syringe/0.5ML/31G X 5/16", 31

Menactra, 23

maximum d3, 23

Menest, 9

Maxzide, 5

Longs Lancets Standard, 31

Menhibrix, 23

Maxzide-25, 5

Longs Lancets Thin, 31

Menomune-a/C/Y/W-135, 23

me/naphos/mb/hyo 1, 13

Longs Lancets Ultra Thin, 31

Menopur, 11

Mebendazole, 2

Lonsurf, 4

Menostar, 9

meclizine HCL, 13

loperamide HCL, 12

Mentax, 7

Meclizine HCL, 13

lorazepam, 16

Menveo, 23

Meclizine HCL Monohydrate, 13

lorazepam intensol, 16

meperidine HCL, 20

Meclofenamate Sodium, 21

lorcet, 20

Meperidine HCL, 21

Medic Insulin Syringe/0.3ML/30G X 5/16", 31

lorcet HD, 20

Meperidine HCL/Promethazine HCL, 21

lorcet plus, 20

Mepivacaine HCL, 21

Medic Insulin Syringe/0.5ML/30G X 5/16", 31

lortab, 20

meprobamate, 16

Lortab, 21

mercaptopurine, 3

Medichoice Pre-set Safety Lancet Dual Use, 31

loryna, 10

mesalamine, 13

losartan potassium, 5

Mesalamine, 13

Medichoice Pre-set Safety Lancet Low Flow, 31

losartan potassium/hydrochlorothiazide, 5

Mesalamine DR, 13

Mesnex, 4

Medichoice Pre-set Safety Lancet Medium Flow, 31

Lotemax, 19

Mestinon, 18

Loutrex, 7

metadate ER, 17

Medichoice Pre-set Safety Lancet Moderate Flow, 31

lovastatin, 5

Metaproterenol Sulfate, 23

low-ogestrel, 10

metaxall, 18

Medichoice Safety Lancet Extra, 31

loxapine, 16

metaxalone, 18

Medichoice Safety Lancet Normal, 31

loxapine succinate, 16

metformin HCL, 11

Medicine Shoppe Lancets, 31

LP lite PAK, 8

metformin HCL ER, 11

Medicine Shoppe Lancets Thin, 31

Lupaneta Pack, 11

metformin HCL ER (osmotic), 11

Medicine Shoppe Pen Needles 29G X 12MM, 31

Lupron Depot, 3

methadone HCL, 20

Lupron Depot-PED, 11

Methadone HCL, 21

Medicine Shoppe Pen Needles 31G X 6MM, 31

lutera, 10

methadone HCL intensol, 20

Lynparza, 3

methadose, 20

Medicine Shoppe Pen Needles 31G X 8MM, 31

Lyrica, 17

methamphetamine HCL, 17

Lysodren, 3

methazolamide, 5

Medisense Thin Lancets, 31

lyza, 10

Methazolamide, 5

Medlance Plus Extra Lancets 21G, 31

methenamine hippurate, 13

Mineral Oil Light, 12

Monoject Ultra Comfort Insulin Syringe/0.5ML/29G X 1/2", 31

methenamine mandelate, 13

Mini Lancing Device, 31

Methenamine Mandelate, 13

miniprin low dose, 20

Monoject Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 31

methergine, 19

minitran, 4

methimazole, 12

Minivelle, 9

Monoject Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 31

Methimazole, 12

minocycline HCL, 1

Methitest, 9

Minocycline HCL, 1

Monoject Ultra Comfort Insulin Syringe/1ML/28G X 1/2", 31

methocarbamol, 18

minoxidil, 5

methotrexate, 3

Mircera, 14

Monoject Ultra Comfort Insulin Syringe/1ML/29G X 1/2", 31

Methotrexate, 3

mirtazapine, 16

methotrexate sodium, 3

mirtazapine odt, 16

Monoject Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 31

methoxsalen, 7

misoprostol, 12

methscopolamine bromide, 12

Mission Prenatal, 25

Monojector End CAPS, 31

Methyclothiazide, 5

Mission Prenatal HP, 24

Monojector Opd End CAPS, 31

methyldopa, 5

Mitigare, 21

Monolet Lancets, 31

Methyldopa/Hydrochlorothiazide, 5

MM aspirin, 20

Monolet Opd Lancets, 31

methylergonovine maleate, 19

modafinil, 17

Monolettor Safety Lancets, 31

methylphenidate HCL, 17

moderiba, 2

mononessa, 10

methylphenidate HCL CD, 17

Moderiba, 2

Mononine, 15

methylphenidate HCL ER, 17

Moderiba 1200 Dose Pack, 2

montelukast sodium, 22

Methylphenidate HCL ER, 17

Moderiba 800 Dose Pack, 2

Monurol, 13

methylphenidate HCL SR, 17

moexipril HCL, 5

Moore MED Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2", 31

methylphenidate hydrochloride, 17

moexipril/hydrochlorothiazide, 5

methylprednisolone, 8

mometasone furoate, 7

Moore MED Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2", 31

Methylprednisolone, 9

mondoxyne nl, 1

methylprednisolone acetate, 8

mono-linyah, 10

Moore MED Monoject Insulin Syringe/U-100/1ML/29G X 1/2", 31

Methylprednisolone Acetate, 9

Monoclate-p, 15

methylprednisolone dose pack, 8

Monoject Insulin Syringe Regular LUER Tip/Softpack/1ML, 31

morgidox 1X100MG, 1

methylprednisolone sodiumsuccinate, 8

morgidox 1X50MG, 1

methyltestosterone, 9

Monoject Insulin Syringe/1ML, 31

morgidox 2X100MG, 1

Methyltestosterone, 9

Monoject Insulin Syringe/1ML/31G X 5/16", 31

morphine sulfate, 20

Metipranolol, 18

Morphine Sulfate, 21

metoclopramide HCL, 13

Monoject Insulin Syringe/Detach Needle/1ML/25G X 5/8", 31

morphine sulfate ER, 20

Metoclopramide HCL, 13

Morphine Sulfate ER, 21

Metoclopramide HCL Monohydrate, 13

Monoject Insulin Syringe/Detach Needle/1ML/27G X 1/2", 31

Movantik, 13

metolazone, 5

Moviprep, 12

metoprolol succinate ER, 4

Monoject Insulin Syringe/Perm Needle/U-100/0.5ML/28G X 1/2", 31

Moxatag, 1

Metoprolol Succinate ER/Hydrochlorothiazide, 5

Moxeza, 18

Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29G X 1/2", 31

moxifloxacin HCL, 1

metoprolol tartrate, 4

Mozobil, 14

Metoprolol Tartrate, 4

Monoject Insulin Syringe/Safety/Perm Needle/0.3ML/29GX1/2", 31

MS Insulin Syringe/0.3ML/29G X 1/2", 31

metoprolol/hydrochlorothiazide, 5

MS Insulin Syringe/0.3ML/30G X 5/16", 31

metronidazole, 3, 6

Monoject Insulin Syringe/Safety/Perm Needle/0.5ML/29G X 1/2", 31

metronidazole vaginal, 14

MS Insulin Syringe/0.3ML/31G X 5/16", 31

mexiletine HCL, 4

Monoject Insulin Syringe/Safety/Perm Needle/1ML/29G X 1/2", 31

Miconazole 3, 14

MS Insulin Syringe/0.5ML/29G X 1/2", 31

Microchamber, 36

Monoject Insulin Syringe/Softpack/1ML/27G X 1/2", 31

MS Insulin Syringe/0.5ML/30G X 5/16", 31

microgestin 1.5/30, 10

microgestin 1/20, 10

Monoject Insulin Syringe/Softpack/U-100/0.5ML/28G X 1/2", 31

MS Insulin Syringe/0.5ML/31G X 5/16", 31

microgestin 24 FE, 10

microgestin FE, 10

Monoject Insulin Syringe/U-100/0.3ML/30G X 5/16", 31

MS Insulin Syringe/1ML/29G X 1/2", 32

microgestin FE 1.5/30, 10

MS Insulin Syringe/1ML/30G X 5/16", 32

Microlet Lancets, 31

Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2", 31

MS Insulin Syringe/1ML/31G X 5/16", 32

Microspacer, 36

Mucotrol, 15

Microtainer Safety Flow Lancet/Sterile/Single-use, 31

Monoject Insulin Syringe/U-100/0.5ML/30G X 5/16", 31

Multaq, 4

Multi Prenatal, 24

midodrine HCL, 5

Monoject Insulin Syringe/U-100/1ML/28G X 1/2", 31

Multi-lancet Device, 31

Mifeprex, 12

Multi-lancet Device 2, 31

Migergot, 21

Monoject Insulin Syringe/U-100/1ML/30G X 5/16", 31

mupirocin, 6

miglitol, 11

Muri-lube, 12

Migranal, 21

Monoject Ultra Comfort Insulin Syringe/0.3ML/29G X 1/2", 31

Muse, 6

Millipred, 9

Mustargen, 3

Millipred DP, 9

Monoject Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16", 31

my way, 10

mimvey, 9

Myambutol, 2

mimvey LO, 9

Monoject Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16", 31

Mycobutin, 2

Minastrin 24 FE, 10

mycophenolate mofetil, 3

Mineral Oil, 12

Monoject Ultra Comfort Insulin Syringe/0.5ML/28G X 1/2", 31

mycophenolic acid DR, 3

Mineral Oil Heavy, 12

Myglucohealth Mgh Softlance Lancets

30G, 31

neomycin/polymyxin/hydrocortisone, 19

norethindrone/ethinyl estradiol/ferrous fumarate, 10

Myleran, 3

Neosalus, 8

Mynatal, 25

Neotuss Plus, 22

norgestimate/ethinyl estradiol, 10

Mynatal Advance, 24

Nestabs, 25

Noritate, 6

Mynatal Plus, 24

Nestabs Abc, 25

norlyroc, 10

Mynatal Ultracaplet, 24

Nestabs DHA, 25

Norpace CR, 4

Mynatal-z, 24

Netgroup Lancets, 32

nortrel 0.5/35 (28), 10

Mynate 90 Plus, 24

neuac, 6

nortrel 1/35, 10

Myobloc, 18

Neulasta, 14

nortrel 7/7/7, 10

myorisan, 6

Neulasta Onpro Kit, 14

nortriptyline HCL, 16

Myrbetriq, 14

Neupogen, 14

Nortriptyline HCL, 16

Mysoline, 17

Neupro, 17

nortuss-DE, 22

myzilra, 10

Neurontin, 17

Nortuss-EX, 22

N

neutragard advanced, 15

Norvir, 2

neutral sodium fluoride, 15

norwich aspirin, 20

N-acetyl-l-cysteine, 22

Neutrasal, 15

Nova Safety Lancets 23G, 32

nabumetone, 21

Nevanac, 19

Nova Safety Lancets 28G, 32

nadolol, 4

nevirapine, 2

Nova Sureflex Lancets, 32

Nadolol, 4

Nevirapine, 2

Nova Sureflex Lancing Device, 32

nadolol/bendroflumethiazide, 5

nevirapine ER, 2

Novaferrum Pediatric Drops, 14

nafcillin sodium, 1

Newgen, 25

novarel, 11

Nafrinse Daily/Acidulated, 15

Nexa Plus, 25

Novofine 30GX8MM, 32

Nafrinse Daily/Neutral, 15

Nexavar, 3

Novofine 32GX6MM, 32

Nafrinse Weekly, 15

next choice one dose, 10

Novofine Autocover 30GX8MM, 32

Naftin, 7

Niacin, 24

Novofine Plus 32GX4MM, 32

nalbuphine HCL, 20

niacin ER, 5

Novolin 70/30, 10

Nalidixic Acid, 13

Niacor, 6

Novolin 70/30 Relion, 10

Namenda XR, 18

nicardipine HCL, 4

Novolin N, 10

Namenda XR Titration Pack, 18

Nicomide, 26

Novolin N Relion, 10

naproxen, 21

nifedipine, 4

Novolin R, 10

naproxen DR, 21

nifedipine ER, 4

Novolin R Relion, 10

naproxen sodium, 21

nikki, 10

Novolog, 10

naratriptan HCL, 21

nimodipine, 4

Novolog Flexpen, 10

Nascobal, 14

Ninlaro, 3

Novolog Mix 70/30, 11

Nat-rul Prenatal Vitamins, 25

nisoldipine, 4

Novolog Mix 70/30 Prefilled Flexpen, 11

nat-rul vitamin d, 23

Nisoldipine, 4

Novolog Penfill, 11

Natachew, 25

Nisoldipine ER, 4

Novoseven, 15

Natacyn, 18

Nitro-bid, 4

Novoseven Rt, 15

Natalvit, 25

Nitro-dur, 4

Novotwist 32GX5MM, 32

Natazia, 10

nitro-time, 4

Noxafil, 2

nateglinide, 11

nitrofurantoin, 13

NP thyroid 15, 12

Natelle One, 25

Nitrofurantoin Macrocrystal, 13

NP thyroid 30, 12

Natpara, 11

nitrofurantoin macrocrystals, 13

NP thyroid 60, 12

Natroba, 8

nitrofurantoin monohydrate, 13

NP thyroid 90, 12

natural vitamin d-3, 23

nitrofurantoin monohydrate/macrocrystals, 13

Nplate, 14

Nature-throid, 12

Nucala, 23

Nature-throid Nt-2.5, 12

nitroglycerin, 4

Nucort, 7

Nebupent, 3

nitroglycerin ER, 4

Nucynta, 21

nebusal, 22

nitroglycerin lingual, 4

Nucynta ER, 21

necon 0.5/35-28, 10

Nitroglycerin Lingual, 4

Nuedexta, 18

necon 1/35, 10

nitroglycerin transdermal, 4

nulev, 12

Necon 10/11-28, 10

Nitromist, 4

Nulytely/Flavor Packs, 12

necon 7/7/7, 10

Nitrostat, 4

Nuplazid, 16

Neevo DHA, 25

Niva-plus, 25

Nutricion Porvida, 25

nefazodone HCL, 16

nodolor, 21

Nuvail, 8

Nefazodone HCL, 16

nora-be, 10

Nuvaring, 10

neo-polycin, 18

Norditropin Cartridge, 11

Nuvigil, 17

neo-polycin HC, 19

Norditropin Flexpro, 11

Nuwiq, 15

Neo-synalar, 6

norepinephrine bitartrate, 5

nyamyc, 7

neomycin sulfate, 1

norethindrone, 10

nyata, 7

Neomycin Sulfate, 6

norethindrone & ethinyl estradiol ferrous fumarate, 10

Nylidrin Hydrochloride, 6

neomycin/bacitracin/polymyxin, 18

Nymalize, 4

neomycin/polymyxin b sulfates, 14

norethindrone acetate, 10

nystatin, 2, 7, 15

neomycin/polymyxin/bacitracin/hydrocortisone, 19

Norethindrone Acetate, 10

nystatin/triamcinolone, 7

norethindrone acetate/ethinyl estradiol, 9, 10

nystop, 7

neomycin/polymyxin/dexamethasone, 19

O

neomycin/polymyxin/gramicidin, 18

norethindrone acetate/ethinyl estradiol/ferrous fumarate, 10

neomycin/polymyxin/HC, 19

O-CAL Fa, 25

Neomycin/Polymyxin/Hydrocortisone, 19

O-CAL Prenatal, 25

OB Complete, 25

Optichamber Diamond/Smallface Mask, 36

Paregoric, 12

OB Complete Gold, 25

paricalcitol, 12

OB Complete One, 25

Optihaler, 36

paroex, 15

OB Complete Petite, 25

Optihaler MDI Drug Delivery System, 36

paromomycin sulfate, 1

OB Complete Premier, 25

optimal-d, 23

paroxetine HCL, 16

OB Complete/DHA, 25

optimal-d pack, 24

paroxetine HCL ER, 16

Obstetrix DHA, 25

option 2, 10

Paser, 2

Obstetrix EC, 24

Options Gynol II Vaginal Contraceptive, 14

Pataday, 19

Obstetrix One, 25

Pazeo, 19

ocella, 10

opurity vitamin d, 24

PC Lancets Super Thin 30G, 32

octreotide acetate, 11

Oracit, 14

PC Unifine Pentips 29G X 1/2", 32

Odefsey, 2

oralone, 15

PC Unifine Pentips 31G X 5MM Mini, 32

Ofev, 23

Oramagicrx, 15

PC Unifine Pentips 31G X 6MM Ultra SHORT, 32

ofloxacin, 1, 18, 19

Oravig, 15

Ogestrel, 10

Orencia, 21

PC Unifine Pentips 31G X 8MM SHORT, 32

olanzapine, 16

Orencia Clickject, 21

olanzapine odt, 16

Orfadin, 12

PCCA T3 Sodium Dilution, 12

olanzapine/fluoxetine, 18

Orkambi, 23

PCE, 1

olmesartan medoxomil, 5

orphenadrine citrate, 18

Pectin, 12

olmesartan medoxomil/amlodipine/hydrochlorothiazide, 5

orphenadrine citrate ER, 18

Pediarix, 23

orsythia, 10

Pedvax HIB, 23

Ortho Micronor, 10

peg 3350/electrolytes, 12

ortho-CS 250, 24

peg-3350/electrolytes, 12

olmesartan medoxomil/hydrochlorothiazide, 5

Orthovisc, 18

peg-3350/NACL/NA bicarbonate/KCL, 12

oscimin, 12

Peg-intron Redipen, 2

olopatadine HCL, 19, 22

oscimin SR, 12

Peg-intron Redipen PAK 4, 2

omeprazole, 12

oscion cleanser, 6

peg-prep, 12

On Call Lancets, 32

oseltamivir phosphate, 2

Peganone, 17

On Call Lancing Device, 32

Osmoprep, 12

Pegasys, 2

On Call Plus Lancets, 32

Osphena, 11

Pegasys Proclick, 2

On Call Plus Lancing Device, 32

Otezla, 21

Pegintron, 2

ondansetron HCL, 13

otomax-HC, 19

pegylax, 12

ondansetron odt, 13

Ovace Plus, 7

Pen Needles 29G X 12MM, 32

One-a-day Womens Prenatal, 25

Ovidrel, 11

Pen Needles 29GX1/2", 32

Onetouch Club Lancets Fine Point, 26

oxacillin sodium, 1

Pen Needles 30GX5/16", 32

Onetouch Combo Pack, 26

oxandrolone, 9

Pen Needles 31G X 1/4" SHORT, 32

Onetouch Delica Lancets Extra Fine 33G, 32

oxaprozin, 21

Pen Needles 31G X 3/16", 32

oxazepam, 16

Pen Needles 31G X 5MM, 32

Onetouch Delica Lancets Fine 30G, 26

oxcarbazepine, 17

Pen Needles 31GX5/16", 32

Onetouch Delica Lancing Device, 26

oxiconazole nitrate, 7

Pen Needles 31GX6MM (1/4"), 32

Onetouch Finepoint Lancets, 26

Oxistat, 7

Pen Needles 31GX8MM, 32

Onetouch Lancets, 26

Oxtellar XR, 17

Pen Needles 31GX8MM (5/16"), 32

Onetouch Suresoft Lancing Device/18G, 26

Oxybutinin Chloride, 14

Pen Needles 32GX4MM, 32

oxybutynin chloride, 13

Penicillin G Procaine, 1

Onetouch Suresoft Lancing Device/21G, 26

oxybutynin chloride ER, 14

penicillin v potassium, 1

oxycodone HCL, 20

Penlet II Automatic Bloodsampler, 32

Onetouch Suresoft Lancing Device/28G, 26

Oxycodone HCL ER, 21

Penlet II Replacement CAPS, 32

oxycodone/acetaminophen, 20

Penlet II Replacement CAPS-deep, 32

Onetouch Ultra Blue, 26

Oxycodone/Acetaminophen, 21

Penlet II Replacement CAPS-regular, 32

Onetouch Ultrasoft Lancets, 26

oxycodone/aspirin, 20

Pentacel, 23

Onetouch Verio Test Strips, 26

Oxycodone/Ibuprofen, 21

Pentasa, 13

Onfi, 17

Oxycontin, 21

pentazocine/naloxone HCL, 20

Onglyza, 11

oxymorphone hydrochloride, 20

Pentetate Calcium Trisodium, 36

Opana ER (crush Resistant), 21

Oxymorphone Hydrochloride ER, 21

Pentetate Zinc Trisodium, 36

opcicon one-step, 10

Oxytetracycline HCL, 1

Pentips 29GX12MM, 32

opium, 12

oxytocin, 19

Pentips 31GX5MM, 32

opium tincture, 12

Oxytrol, 14

Pentips 31GX6MM, 32

Opsumit, 6

P

Pentips 31GX8MM, 32

Optichamber Advantage, 36

Pentips 32GX4MM, 32

Optichamber Advantage/Large Mask, 36

PA Prenatal Formula, 25

Pentobarbital Sodium, 17

Optichamber Advantage/Medium Face Mask, 36

PA vitamin d-3, 24

pentoxifylline ER, 15

PA vitamin d-3 gummy, 24

Pepsin, 13

Optichamber Advantage/Small Face Mask, 36

pacerone, 4

Perfect Lancets 30G, 32

paliperidone ER, 16

Perfect Pressure Activated Safety Lancets 28G, 32

Optichamber Diamond, 36

Panatuss Dxp, 22

Optichamber Diamond/Largeface Mask, 36

Pandel, 7

Perforomist, 23

pantoprazole sodium, 12

perindopril erbumine, 5

Optichamber Diamond/Medium Face Mask, 36

papaverine HCL, 6

periogard, 15

Para-aminobenzoic Acid, 24

permethrin, 8

PNV-omega, 25

prednisolone sodium phosphate odt, 8

perphenazine, 16

PNV-select, 25

Prednisolone Sodium Phosphate, Usp, 9

Perphenazine/Amitriptyline, 18

PNV-total, 25

Prednisolone Usp, Micronized Anhydrous, 9

Perry Prenatal, 24

PNV-vp-u, 25

pharbedryl, 22

Pocket Chamber, 36

prednisone, 8

Pharmacist Choice Ultra Thin Lancets, 32

Pocket Spacer, 36

Prednisone, 8

Podocon 25 IN Benzoin Tincture, 8

Prednisone Intensol, 9

Pharmacist Choice Ultra Thin Lancets 28G, 32

podofilox, 8

Prefera OB, 26

Podophyllum Resin, 8

Preferaob +dha, 25

Pharmacist Choice Ultra Thin Lancets 30G, 32

polocaine, 21

Preferaob One, 25

polocaine-mpf, 21

Preferred Plus Insulin Syringe/U-100/0.3ML/29G X 1/2", 32

Pharmacist Choice Ultra Thin Lancets 31G, 32

polycin, 18

polyethylene glycol 3350, 12

Preferred Plus Insulin Syringe/U-100/0.3ML/30G X 5/16", 32

Pharmacist Choice Ultra Thin Lancets 33G, 32

polymyxin b sulfate, 3

Polymyxin B Sulfate, 3

Preferred Plus Insulin Syringe/U-100/0.5ML/28G X 1/2", 32

Pharmacy Counter Lancets, 32

polymyxin b sulfate/trimethoprim sulfate, 18

phenadoz, 22

Preferred Plus Insulin Syringe/U-100/0.5ML/29G X 1/2", 32

phenazo, 14

Pomalyst, 3

phenazopyridine HCL, 14

portia-28, 10

Preferred Plus Insulin Syringe/U-100/0.5ML/30G X 5/16", 32

Phenazopyridine HCL, 14

Potaba, 24

phenelzine sulfate, 16

Potassium Citrate, 14

Preferred Plus Insulin Syringe/U-100/1ML/29G X 1/2", 32

phenergan, 22

potassium citrate ER, 14

phenobarbital, 16

Potassium Citrate Monohydrate, 14

Preferred Plus Insulin Syringe/U-100/1ML/30G X 5/16", 32

Phenobarbital, 16

potassium citrate-citric acid crystals, 14

Phenobarbital Sodium, 16

potassium citrate/citric acid, 14

Preferred Plus Lancets Colored 21G, 32

phenohytro, 12

Potassium P-aminobenzoate, 24

Preferred Plus Lancets Super Thin 30G, 32

phenoxybenzamine hydrochloride, 5

pr benzoyl peroxide wash, 6

Phentolamine Mesylate, 5

Pr Natal 400, 24

Preferred Plus Lancets Thin 26G, 32

Phenylbutazone, 21

Pr Natal 400 EC, 24

Preferred Plus Unifine Pentips 29G X 12MM, 32

phenylephrine HCL, 5, 19

Pr Natal 430, 24

Phenylephrine HCL, 5, 22

Pr Natal 430 EC, 24

Preferred Plus Unifine Pentips 31G X 6MM Ultra SHORT, 32

Phenylpropanolamine Hydrochloride Usp, 22

Pradaxa, 15

pramcort, 13

Preferred Plus Unifine Pentips 31G X 8MM SHORT, 32

Phenytek, 17

pramipexole dihydrochloride, 17

phenytoin, 17

pramipexole dihydrochloride ER, 17

Preferred Plus Unifine Pentips 32GX4MM, 32

phenytoin infatabs, 17

pramox gel, 8

Phenytoin Sodium, 17

Pramoxine HCL, 8

Preferred Plus Unifine Pentips/Mini/31GX5MM, 32

phenytoin sodium extended, 17

pravastatin sodium, 5

philith, 10

prazosin HCL, 5

pregnyl w/diluent benzyl alcohol/NACL, 11

Phlag Spray, 8

Prazosin HCL, 5

phos-flur, 15

Prazosin Hydrochloride, 5

Premarin, 9, 14

Phoslyra, 13

Pre-natal Formula, 24

premium lidocaine, 8

phosphasal, 13

Precision Sure-dose Insulin Syringe/0.3ML/30G X 5/16", 32

Premphase, 9

Phospholine Iodide, 19

Prempro, 9

pilocarpine HCL, 15, 19

Precision Sure-dose Insulin Syringe/0.5ML/28G X 1/2", 32

Prena1 Chew, 25

pilocarpine hydrochloride, 15

Prena1 Pearl, 25

pimozide, 18

Precision Sure-dose Insulin Syringe/0.5ML/29G X 1/2", 32

Prenaissance, 25

pimtrea, 10

Prenaissance Balance, 25

pindolol, 4

Precision Sure-dose Insulin Syringe/0.5ML/30G X 3/8", 32

Prenaissance Harmony DHA, 25

pioglitazone HCL, 11

Prenaissance Next, 25

pioglitazone HCL-glimepiride, 11

Precision Sure-dose Plus Insulin Syringe/0.3ML/29G X 1/2", 32

Prenaissance Next-b, 25

pioglitazone HCL/metformin HCL, 11

Prenaissance Plus, 24

Piperazine Citrate, 2

Precision Sure-dose Plus Insulin Syringe/1ML/29G X 1/2", 32

Prenata, 25

pirmella 1/35, 10

Prenatabs Fa, 25

pirmella 7/7/7, 10

Precision Thin Lancets, 32

Prenatabs RX, 24

piroxicam, 21

Precision Thins GP Lancet, 32

Prenatal, 24

Plegridy, 18

Precision Ultra Lancet, 32

Prenatal 19, 25

Plegridy Starter Pack, 18

Pred Mild, 19

Prenatal And Iron, 24

Pneumovax 23, 23

Pred-G, 19

Prenatal Complete, 25

Pneumovax 23/1 Dose, 23

Pred-G S.o.p., 19

Prenatal Formula A-free, 25

PNV Ferrous Fumarate/Docusate/Folic Acid, 25

prednicarbate, 7

Prenatal Forte, 24

prednisolone, 8

Prenatal Low Iron, 24

PNV Folic Acid + Iron Multivitamin, 25

Prednisolone, 9

Prenatal Multi +dha, 25

PNV Ob+dha, 25

Prednisolone Acetate, 9

Prenatal One Daily, 25

PNV Prenatal Plus Multivitamin, 25

prednisolone acetate, 19

Prenatal Plus, 25

PNV TABS 29-1, 25

Prednisolone Anhydrous, 9

Prenatal Plus Iron, 25

PNV-DHA, 24

prednisolone sodium phosphate, 8

Prenatal Vitamin, 25

PNV-dha+docusate, 25

Prednisolone Sodium Phosphate, 8, 19

Prenatal Vitamin/Iron, 25

Prenatal Vitamins, 24

Lancets, 32

1/2", 32

Prenatal Vitamins Plus Low Iron, 25

Prodigy Safety Lancets, 32

Px Insulin Syringe/U-100/0.5ML/31G X 5/16", 32

Prenatal-u, 24

Prodigy Twist Top Lancets, 32

Prenate, 25

Profe Forte, 25

Px Insulin Syringe/U-100/1ML/30G X 1/2", 32

Prenate AM, 25

Profilnine, 15

Prenate DHA, 25

Profilnine SD, 15

Px Insulin Syringe/U-100/1ML/31G X 5/16", 32

Prenate Elite, 25

progesterone, 10

Prenate Enhance, 25

Progesterone, 10

Px Lancet Auto Injector, 32

Prenate Essential, 25

Progesterone Micronized, 10

Px Lancets Ultra Thin, 32

Prenate Mini, 25

Progesterone Micronized (soy), 10

Px Mini Pen Needles 31GX5MM, 32

Prenate Pixie, 25

Progesterone Micronized (yam), 10

Px Pen Needle 29GX12MM, 32

Prenate Restore, 25

Progesterone Micronized Premium, 10

Px Pen Needle 31GX8MM, 32

Prenate Star, 26

Progesterone Milled, 10

Px Prenatal Multivitamins, 24

Preplus, 25

Progesterone Ultra Micronized, 10

Px Shortlength Pen Needles/31GX8MM, 32

Prepopik, 12

Progesterone Wettable, 10

Preque 10, 25

Progesterone Wettable (yam), 10

Pylera, 13

Presera, 8

Proglycem, 11

pyrazinamide, 1

Pressure Activated Safetylancet 21G, 32

Proleukin, 4

pyridostigmine bromide, 18

Pretab, 25

Prolia, 11

pyridostigmine bromide ER, 18

prevalite, 5

Promacta, 14

Pyridoxine HCL, 24

Prevident 5000 Booster, 15

promethazine HCL, 22

Pyrilamine Maleate, 22

Prevident 5000 Booster Plus, 15

promethazine HCL plain, 22

Pyrogallic Acid, 8

Prevident 5000 Dry Mouth, 15

promethazine VC plain, 22

Q

Prevident 5000 Enamel Protect, 15

promethazine VC/codeine, 22

Qc Advanced Lancing Device, 32

Prevident 5000 Plus, 15

promethazine-DM, 22

qc aspirin, 20

Prevident 5000 Sensitive, 15

promethazine/codeine, 22

qc aspirin low dose, 20

Prevident Fluoride, 15

promethazine/dextromethorphan, 22

qc chewable aspirin low dose, 20

prevident rinse, 15

promethazine/phenylephrine, 22

qc childrens aspirin, 20

previfem, 10

promethazine/phenylephrine/codeine, 22

qc enteric aspirin, 20

Prevnar 13, 23

promethegan, 22

Qc Insulin Syringe/0.3ML/29G X 1/2", 32

Prezcobix, 2

Promiseb, 7

Qc Insulin Syringe/0.5ML/29G X 1/2", 32

Prezista, 2

pronutrients vitamin d3, 24

Qc Insulin Syringe/0.5ML/31G X 5/16", 32

Prialt, 20

propafenone HCL, 4

Priftin, 2

propafenone HCL ER, 4

Qc Insulin Syringe/1ML/29G X 1/2", 32

prilolid, 8

Propantheline Bromide, 12

Qc Insulin Syringe/1ML/31G X 5/16", 32

Primaquine Phosphate, 2

proparacaine HCL, 19

Qc Lancets, 32

primidone, 17

propranolol HCL, 4

Qc Lancets Super Thin, 32

Primlev, 21

Propranolol HCL, 4

Qc Lancets Thin, 32

Primsol, 3

propranolol HCL ER, 4

Qc Lancets Ultra Thin, 32

Pristiq, 16

Propranolol/Hydrochlorothiazide, 5

Qc Pen Needles 29G X 12MM, 32

Pro Comfort Lancets 30G, 32

propylthiouracil, 12

Qc Pen Needles 31G X 6MM, 32

Pro Comfort Lancets 31G, 32

Proquad, 23

Qc Pen Needles 31G X 8MM, 32

Pro Comfort Pen Needles/ 32G X 5MM, 32

protriptyline HCL, 16

Qc Prenatal, 25

Provida DHA, 26

Qc Unifine Pentips 32GX4MM, 32

Pro Comfort Pen Needles/ 32G X 6MM, 32

Provida OB, 25

Qc Unilet Lancets 28G/Ultra Thin, 32

Prudoxin, 7

Qc Unilet Lancets 33G/Micro Thin, 32

Proair HFA, 22

Pseudoephedrine HCL, 22

Quadracel, 23

Proair Respiclick, 22

Psorcon, 7

quasense, 10

probenecid, 21

Pss Select GP Lancets, 32

Quazepam, 17

probenecid/colchicine, 21

Pss Select Platforms, 32

quetiapine fumarate, 16

Procainamide HCL, 4

Pss Select Safety Lancets, 32

quetiapine fumarate ER, 16

Procaine HCL, 21

Pulmicort Flexhaler, 22

Quetiapine Fumarate ER, 16

prochlorperazine, 16

pulmosal, 22

Quillivant XR, 17

prochlorperazine maleate, 16

Pulmozyme, 23

Quinacrine HCL, 2

Prochlorperazine Maleate, 16

Purefe OB Plus, 25

quinapril HCL, 5

Procort, 13

Push Button Safety Lancets 21G, 32

quinapril/hydrochlorothiazide, 5

Procrit, 14

Push Button Safety Lancets 28G, 32

quinidine gluconate CR, 4

procto-MED HC, 13

Px Advanced Lancing Device, 32

quinidine gluconate ER, 4

procto-PAK, 13

px aspirin, 20

Quinidine Sulfate, 4

Proctofoam HC, 13

px enteric aspirin, 20

quinine sulfate, 2

proctosol HC, 13

Px Extra SHORT Pen Needles 31GX6MM, 32

Quinine Sulfate, 2

proctozone-HC, 13

Quinine Sulfate Dihydrate, 2

Prodigy Insulin Syring/U-100/0.3ML/31G X 5/16", 32

px folic acid, 14

R

Px Insulin Syringe/U-100/0.3ML/30G X 1/2", 32

Prodigy Insulin Syringe/1/2ML/31G X 5/16", 32

R-natal OB, 25

Px Insulin Syringe/U-100/0.3ML/31G X 5/16", 32

ra aspirin, 20

Prodigy Lancing Device, 32

ra aspirin adult low dose, 20

Prodigy Pressure Activated Safety

Px Insulin Syringe/U-100/0.5ML/30G X

ra aspirin adult low strength, 20

ra aspirin childrens, 20

X 5/16", 33

Rifampin, 2

ra aspirin EC, 20

Relion Insulin Syringe/U-100/0.3ML/31G X 5/16", 33

Rifater, 2

ra aspirin EC adult low strength, 20

Right Step Prenatal, 25

ra childrens aspirin, 20

Relion Insulin Syringe/U-100/0.5ML/29G X 1/2", 33

Rightest GD-L500 Alternate Site Adapter, 33

Ra E-ZJECT Color Lancets Micro-thin 33G, 32

Relion Insulin Syringe/U-100/0.5ML/30G, 33

Rightest GD500 Lancing Device, 33

Ra E-ZJECT Lancets 28G, 32

Rightest Gl300 Lancets, 33

Ra E-ZJECT Lancets Thin 26G, 32

Relion Insulin Syringe/U-100/0.5ML/30G X 5/16", 33

riluzole, 18

Ra E-ZJECT Lancets Thin 28G, 32

rimantadine HCL, 2

Ra E-ZJECT Lancets Ultra Thin 30G, 32

Relion Insulin Syringe/U-100/0.5ML/31G X 5/16", 33

Riomet, 11

ra folic acid, 14

risedronate sodium, 11

Ra Insulin Syringe/0.5ML/29G X 1/2", 32

Relion Insulin Syringe/U-100/1ML/30G, 33

risedronate sodium DR, 11

Ra Insulin Syringe/1ML/29G X 1/2", 32

Risperdal Consta, 16

Ra Insulin Syringe/U-100/0.5ML/30G X 5/16", 32

Relion Insulin Syringe/U-100/1ML/30G X 5/16", 33

risperidone, 16

risperidone M-TAB, 16

Ra Insulin Syringe/U-100/1 ML/30G X 5/16", 32

Relion Insulin Syringe/U-100/1ML/31G X 5/16", 33

risperidone odt, 16

Riteflo, 36

Ra Lancing Device, 32

Relion Lancets Micro-thin33G, 33

Rituxan, 3

Ra One Daily, 25

Relion Lancets Standard 21G, 33

rivastigmine tartrate, 18

Ra Pen Needles 31G X 5MM 3/16", 32

Relion Lancets Thin 26G, 33

rivastigmine transdermal system, 18

Ra Pen Needles 31G X 8MM 5/16", 32

Relion Lancets Ultra-thin30G, 33

Rixubis, 15

Ra Prenatal, 24

Relion Lancing Device, 33

rizatriptan benzoate, 21

Ra Prenatal Formula/Folicacid, 25

Relion Mini Pen Needles 31GX6MM, 33

rizatriptan benzoate odt, 21

ra vitamin d-3, 24

Relion Pen Needles 29GX12MM, 33

ropinirole ER, 17

rabeprazole sodium, 12

Relion Pen Needles 31GX6MM, 33

ropinirole HCL, 17

rajani, 10

Relion Pen Needles 31GX8MM, 33

ropivacaine, 21

raloxifene hydrochloride, 11

Relion Pen Needles 32GX4MM, 33

ropivacaine HCL, 21

ramipril, 5

Relion SHORT Pen Needles 31GX8MM, 33

rosadan, 6

Ranexa, 4

Rosadan Kit, 6

Rapaflo, 14

Relion Thin Lancets, 33

rosanil cleanser, 6

Rapamune, 3

Relion Ultra Thin Lancets, 33

rosuvastatin calcium, 6

rasagiline mesylate, 17

Relion Ultra Thin Lancets30G, 33

Rotarix, 23

rea LO 40, 8

Relion Ultra Thin Plus Lancets 32G, 33

Rotateq, 23

react, 10

Relion Ultra Thin Plus Lancets 33G, 33

roweepra, 17

Reality Insulin Syringe/U-100/0.5ML/28G X 1/2", 32

Relistor, 13

Rozerem, 17

Relnate DHA, 25

Rulavite DHA, 25

Reality Insulin Syringe/U-100/0.5ML/29G X 1/2", 32

Relpax, 21

S

remeven, 8

Sabril, 17

Reality Insulin Syringe/U-100/1ML/29G X 1/2", 32

Renacidin, 14

Safe-t-lance Low Flow 25G, 33

Renagel, 13

Safe-t-lance Normal Flow 21G, 33

Reality Lancets, 32

Renvela, 13

Safe-t-lance Plus Safety Lancet High Flow, 33

Reality Trigger Lancets, 32

repaglinide, 11

Rebetol, 2

Repaglinide/Metformin Hydrochloride, 11

Safe-t-lance Plus Safety Lancet Low Flow, 33

Rebif, 18

Repatha, 6

Rebif Rebidose, 18

Repatha Pushtronex System, 6

Safe-t-lance Plus Safety Lancet Normal Flow, 33

Rebif Rebidose Titration Pack, 18

Repatha Sureclick, 6

Rebif Titration Pack, 18

Replesta, 24

Safesnap Insulin Syringe/0.3ML/30G X 5/16", 33

reclipsen, 10

Replesta Childrens, 24

Recombinate, 15

Replesta Nx, 24

Safesnap Insulin Syringe/0.5ML/29G X 1/2", 33

Recombivax HB, 23

reprexain, 20

relador PAK, 8

Rescriptor, 2

Safesnap Insulin Syringe/0.5ML/30G X 5/16", 33

relador PAK plus, 8

Restasis, 19

Relagard, 14

Restasis Multidose, 19

Safesnap Insulin Syringe/1ML/29G X 1/2", 33

Relenza Diskhaler, 2

Revatio, 6

Relhist, 22

Revlimid, 3

Safety Lancet 21G/Pressure Activated, 33

Relion 2-IN-1 Lancing Device 25G, 33

Rexall Lancets Ultra Thin, 33

Relion 2-IN-1 Lancing Device 30G, 33

Rexulti, 16

Safety Lancet 28G/Pressure Activated, 33

Relion Insulin Syringe/U -100/0.5ML/29G, 32

Reyataz, 2

Rezira, 22

Safety Lancets, 33

Relion Insulin Syringe/U-00/1ML/29G X 1/2", 32

Riastap, 15

Safety Lancets 21G, 33

ribasphere, 2

Safety Lancets 28G, 33

Relion Insulin Syringe/U-100/0.3ML/29G, 33

Ribasphere, 2

Safety Let Lancets, 33

Ribasphere Ribapak, 2

Safety Seal Lancets 28G, 33

Relion Insulin Syringe/U-100/0.3ML/29G X 1/2", 33

ribavirin, 2

Safety Seal Lancets 30G, 33

Ridaura, 21

Safety-glide Insulin Syringe/0.3ML/29G X 1/2", 33

Relion Insulin Syringe/U-100/0.3ML/30G, 33

rifabutin, 1

Rifamate, 2

Safyral, 10

Relion Insulin Syringe/U-100/0.3ML/30G

rifampin, 2

salacyn, 8

Salicept, 15

Shopko Autolet Lancing Device, 33

sodium chloride 0.9%, 14

salicylic acid, 8

Shopko On-the-go Comfort Lancets 30G, 33

Sodium Citrate, 14

Salicylic Acid, 8

Sodium Citrate Anhydrous, 14

salicylic acid cream, 8

Shopko Unifine Pentips Pen Needles/Micro/32GX4MM, 33

sodium hyaluronate, 8

salicylic acid lotion, 8

sodium phenylbutyrate, 12

salisol forte, 8

Shopko Unifine Pentips Pen Needles/Mini/31GX5MM, 33

Sodium Salicylate, 20

Salivamax, 15

sodium sulfacetamide, 6, 7, 18

Salivate RX, 15

Shopko Unifine Pentips Pen Needles/Original/29GX12MM, 33

sodium sulfacetamide wash, 7

salsalate, 20

sodium sulfacetamide/sulfur, 6

Samsca, 11

Shopko Unifine Pentips Pen Needles/SHORT/31GX8MM, 33

Sodium Sulfacetamide/Sulfur, 6

Sancuso, 13

sodium sulfacetamide/sulfur cleanser, 6

Sandostatin Lar Depot, 11

Shopko Unifine Pentips Plus Pen Needles/Micro/Removr/32GX4MM, 33

Sodium Sulfacetamide/Sulfur Cleanser IN Urea, 6

Saphris, 16

Sapscare Twist Top Lancets 30G, 33

Shopko Unifine Pentips Plus Pen Needles/Mini/Remover/31GX5MM, 33

sodium sulfacetamide/sulfur green, 6

Sarafem, 18

Sodium Sulfacetamide/Sulfur IN Urea, 6

Savella, 18

Shopko Unifine Pentips Plus Pen Needles/Remover/29GX12MM, 33

sodium sulfacetamide/sulfur wash, 6

Savella Titration Pack, 18

sojourn, 22

SB aspirin, 20

Shopko Unifine Pentips Plus Pen Needles/SHORT/Removr/31GX8MM, 33

Soltamox, 3

SB aspirin adult low strength, 20

Solus V2 Lancing Device, 33

SB aspirin EC, 20

Shopko Unilet Lancets Super Thin 30G, 33

Solus V2 Pressure Activated Safety Lancets 28G, 33

SB childrens aspirin, 20

SB Insulin Syringe/U-100/0.5ML/29G X 1/2", 33

Shopko Unilet Lancets Ultra Thin 28G, 33

Solus V2 Twist Lancets 30G, 33

Somatuline Depot, 11

SB Insulin Syringe/U-100/0.5ML/30G X 5/16", 33

Shur-seal, 14

Somavert, 11

Side Button Safety Lancet21G, 33

Sorbitol, 14

SB Insulin Syringe/U-100/1ML/29G X 1/2", 34

Signifor, 11

Sorbitol-mannitol, 14

sildenafil, 6

sorine, 4

SB Insulin Syringe/U-100/1ML/30G X 5/16", 34

Silenor, 17

sotalol HCL, 4

Simbrinza, 19

sotalol HCL (AF), 4

SB Insulin Syringe/U-100/1ML/31G X 5/16", 34

Simethicone, 13

Spectracef, 1

Simple Diagnostics Lancing Device, 33

Spiriva Handihaler, 22

SB Lancets Thin, 34

Simponi, 21

Spiriva Respimat, 22

SB Lancets Ultra Thin, 34

simvastatin, 5

spironolactone, 5

SB low dose asa EC, 20

Single-let, 33

spironolactone/hydrochlorothiazide, 5

scalacort, 7

sirolimus, 3

sprintec 28, 10

Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/29G X 1/2", 33

Sivextro, 3

Sprycel, 3

sm aspirin, 20

sronyx, 10

Schnucks Insulin Syringe Ulti-fine/U-100/0.5ML/30G X 5/16", 33

sm aspirin adult low strength, 20

ss 10-2, 6

sm aspirin EC low strength, 20

sss 10%-5%, 6

Scopolamine HBR, 13

sm aspirin enteric coated, 20

st joseph aspirin, 20

Se-natal 19, 24

sm childrens aspirin, 20

st joseph low dose aspirin, 20

seb-prev wash, 7

sm folic acid, 14

Stalevo 100, 17

Sebuderm, 8

Sm Insulin Syringe/1ML/31G X 5/16", 33

Stalevo 125, 17

Seconal Sodium, 17

Sm Lancets 21G, 33

Stalevo 150, 18

Select-lite Device/Lancets, 33

Sm Micro Thin Lancets 33G, 33

Stalevo 200, 18

Select-lite Lancing Device, 33

Sm One Daily Prenatal, 25

Stalevo 50, 18

Select-OB, 25

sm prenatal vitamins, 24

Stalevo 75, 18

Select-ob+dha, 25

Sm Prenatal Vitamins, 24

stavudine, 2

selegiline HCL, 17

Sm Super Thin Lancets, 33

Staxyn, 6

Selegiline HCL, 17

Sm Super Thin Lancets 30G, 33

Stelara, 7

selenium sulfide, 7

Sm Thin Lancets 26G, 33

Stendra, 6

Selzentry, 2

sm vitamin d, 24

Sterilance PA, 33

Semprex-d, 22

sm vitamin d3, 24

Sterilance TL, 33

Sensipar, 12

Sm Vitamin D3 Maximum Strength, 24

Stimate, 11

sensorcaine, 21

Smart Diabetes Vantage Lancing Device, 33

Stiolto Respimat, 23

sensorcaine-mpf, 21

Stivarga, 3

sensorcaine-mpf/epinephrine, 21

Smart Sense Color Lancets Universal 33G, 33

Strattera, 17

Sensorcaine-mpf/Epinephrine, 21

Streptomycin Sulfate, 1

sensorcaine/epinephrine, 21

Smart Sense Standard Lancets Universal 21G, 33

Stribild, 2

Serevent Diskus, 22

Striverdi Respimat, 23

Seroquel XR, 16

Smart Sense Super Thin Lancets Universal 30G, 33

Suboxone, 21

sertraline HCL, 16

Sucraid, 13

setlakin, 10

Smart Sense Thin Lancets Universal 26G, 33

sucralfate, 12

sevoflurane, 22

Sucralfate, 13

SF, 15

Smartest Lancets 28G, 33

sulfacetamide sodium, 6, 18

SF 5000 plus, 15

Sodium Ascorbate, 24

Sulfacetamide Sodium, 7, 18

Sfrowasa, 13

Sodium Bicarbonate, 12

sulfacetamide sodium/prednisolone sodium phosphate, 19

sharobel, 10

sodium chloride, 14, 22

sulfacetamide sodium/sulfur, 6

Sure Comfort Pen Needles 31GX5/16" (8MM), 33

tamsulosin HCL, 14

sulfacetamide sodium/sulfur cleanser, 6

Tannic Acid, 8

Sulfadiazine, 1

Sure Comfort Pen Needles 32GX5/32", 33

Tarceva, 4

Sulfadiazine Sodium, 1

tarina FE 1/20, 10

Sulfamethoxazole, 1

Sure Comfort Pen Needles 32GX6MM, 33

Taron-bc, 25

Sulfamethoxazole Micro, 1

Taron-c DHA, 25

sulfamethoxazole/trimethoprim, 3

Sure-fine Pen Needles 29GX1/2" 12.7MM, 33

taron-crystals, 14

sulfamethoxazole/trimethoprim DS, 3

Taron-prex, 24

Sulfapyridine, 1

Sure-fine Pen Needles 31GX3/16" 5MM, 33

Tasigna, 4

sulfasalazine, 13

tazicef, 1

Sulfasalazine, 13

Sure-fine Pen Needles 31GX5/16" 8MM, 33

Tazorac, 7

sulfatrim pediatric, 3

taztia XT, 4

Sulfisoxizole, 1

Sure-ject Insulin Syringe/U-100/0.3ML/29G X 1/2", 33

Tecentriq, 3

Sulfoam, 6

Tecfidera, 18

Sulfurated Lime, 8

Sure-ject Insulin Syringe/U-100/0.3ML/30G X 5/16", 33

Tecfidera Starter Pack, 18

sulindac, 21

Techlite AST Lancets, 34

Sulindac, 21

Sure-ject Insulin Syringe/U-100/0.3ML/31G X 5/16", 33

Techlite Lancets, 34

sumatriptan, 21

Techlite Lancets 30G, 34

sumatriptan succinate, 21

Sure-ject Insulin Syringe/U-100/0.5ML/28G X 1/2", 33

Techlite Pen Needles/31G X 5MM, 34

Sumatriptan Succinate, 21

Techlite Pen Needles/31G X 6 MM, 34

sumatriptan succinate refill, 21

Sure-ject Insulin Syringe/U-100/0.5ML/29G X 1/2", 33

Techlite Pen Needles/31G X 8MM, 34

Sumaxin CP Kit, 6

Techlite Pen Needles/32G X 4MM, 34

Supartz, 18

Sure-ject Insulin Syringe/U-100/0.5ML/30G X 5/16", 33

Techlite Pen Needles/32G X 6MM, 34

Supartz Fx, 18

Techlite Pen Needles/32G X 8MM, 34

Super Daily D3, 24

Sure-ject Insulin Syringe/U-100/0.5ML/31G X 5/16", 33

Tegretol, 17

Super Thin Lancets, 33

Tegretol-XR, 17

Supprelin LA, 11

Sure-ject Insulin Syringe/U-100/1ML/29G X 1/2", 33

Tekturna, 5

Suprax, 1

Tekturna HCT, 5

Suprep Bowel Prep, 12

Sure-ject Insulin Syringe/U-100/1ML/30G X 5/16", 33

telmisartan, 5

Sure Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2", 33

telmisartan/amlodipine, 5

Sure-ject Insulin Syringe/U-100/1ML/31G X 5/16", 33

telmisartan/hydrochlorothiazide, 5

Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 1/2", 33

temazepam, 16

Sure-lance Flat Lancets, 33

temozolomide, 3

Sure Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16", 33

Sure-lance Lancets 26G, 33

Tencon, 20

Sure-lance Thin Lancets 28G, 33

Tenivac, 23

Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16, 33

Sure-lance Ultra Thin Lancets, 33

terazosin HCL, 5

Sure-pen, 33

terbinafine HCL, 2

Sure Comfort Insulin Syringe/U-100/0.3ML/31G X 5/16", 33

Sure-touch Lancets Universal, 33

terbutaline sulfate, 22

Surelite Lancets, 33

Terbutaline Sulfate, 23

Sure Comfort Insulin Syringe/U-100/0.3ML/31GX1/4", 33

Survanta Intratracheal, 23

terconazole, 14

Sustiva, 2

Terpin Hydrate, 22

Sure Comfort Insulin Syringe/U-100/0.5ML/28G X 1/2", 33

Sutent, 3

Terpin Hydrate Monohydrate, 22

syeda, 10

terrell, 22

Sure Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2", 33

Sylatron, 4

Tersi Foam, 7

Symax Duotab, 13

testosterone cypionate, 9

Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 1/2", 33

symax-SL, 12

Tetanus/Diphtheria Toxoids-adsorbed, 23

symax-SR, 12

Sure Comfort Insulin Syringe/U-100/0.5ML/30G X 5/16", 33

Symbicort, 22

tetcaine, 19

Symlinpen 120, 11

tetrabenazine, 18

Sure Comfort Insulin Syringe/U-100/0.5ML/31G X 5/16, 33

Symlinpen 60, 11

tetracaine HCL, 19

Synalgos-dc, 21

Tetracaine HCL, 21

Sure Comfort Insulin Syringe/U-100/1ML/29G X 1/2", 33

Synarel, 11

tetravisc, 19

Synera, 8

tetravisc forte, 19

Sure Comfort Insulin Syringe/U-100/1ML/30G X 1/2", 33

Synerderm, 8

Texacort, 7

Synjardy, 11

Tgq 15DM/5PEH/2CPM, 22

Sure Comfort Insulin Syringe/U-100/1ML/30G X 5/16", 33

Synthroid, 12

Tgq 30PSE/150GFN/15DM, 22

Synvisc, 18

Tgq 30PSE/3BRM/15DM, 22

Sure Comfort Insulin Syringe/U-100/1ML/31G X 5/16", 33

Synvisc One, 18

Tgt Advanced Lancing Device, 34

T

tgt aspirin, 20

Sure Comfort Lancets 28G, 33

tgt aspirin low dose, 20

Tabloid, 3

Sure Comfort Lancets 30G, 33

tgt childrens aspirin, 20

Taclonex, 7

Sure Comfort Lancing Pen, 33

tgt enteric-coated aspirin, 20

tacrolimus, 3, 7

Sure Comfort Pen Needles 29GX1/2" 12.7MM, 33

Tgt Lancet Alternate Site, 34

Tafinlar, 3

Tgt Lancet Micro Thin 33G, 34

Tagrisso, 3

Sure Comfort Pen Needles 30GX5/16" SHORT, 33

Tgt Lancet Super Thin 30G, 34

take action, 10

Tgt Lancet Thin 23G, 34

Taltz, 7

Sure Comfort Pen Needles 31GX3/16" (5MM), 33

Tgt Lancet Thin 26G, 34

Tamiflu, 2

Tgt Lancet Ultra Thin 28G, 34

tamoxifen citrate, 3

Tgt Lancet Ultra Thin 30G, 34

1/4", 34

Trazodone HCL, 16

Tgt Lancing Device, 34

Todays Health Original Pen Needles 29G X 1/2", 34

Trecator, 2

Thalomid, 3

Trelstar, 3

Theo-24, 22

Todays Health SHORT Pen Needles 31G X 5/16", 34

Trelstar Mixject, 3

theochron, 22

tretinoin, 4, 6

theophylline CR, 22

Todays Health Super Thin Lancets 30G, 34

tretinoin microsphere, 6

theophylline ER, 22

tretinoin microsphere P.M., 6

thera-d 2000, 24

Todays Health Ultra Thin Lancets 28G, 34

Trexall, 3

Thera-d 4000, 24

tri-estarylla, 10

thera-d rapid repletion, 24

Tolazamide, 11

tri-legest FE, 10

Thera-flur-n, 15

Tolbutamide, 11

tri-linyah, 10

Theracys, 4

tolcapone, 17

tri-LO-estarylla, 10

Theranatal Core Nutrition, 25

Tolmetin Sodium, 21

tri-LO-marzia, 10

Thiabendazole, 2

tolterodine tartrate, 14

tri-LO-sprintec, 10

thiamine HCL, 24

tolterodine tartrate ER, 14

tri-previfem, 10

Thiamine HCL, 24

Topamax, 17

tri-sprintec, 10

Thiamine Hydrochloride, 24

Topamax Sprinkle, 17

Tri-TABS DHA, 25

Thinlets GP Lancets, 34

Topcare Clickfine Universal Pen Eedles 31GX1/4", 34

Triadvance, 24

Thinlets Lancet, 34

triamcinolone acetonide, 7, 15, 22

Thiola, 14

Topcare Clickfine Universal Pen Eedles 31GX5/16", 34

triamcinolone IN orabase, 15

thioridazine HCL, 16

Triamterene, 5

Thiotepa, 3

Topcare Ultra Comfort Insulin Syringe/0.3ML/30G X 5/16", 34

triamterene/hydrochlorothiazide, 5

thiothixene, 16

Trianex, 7

Thrivite 19, 25

Topcare Ultra Comfort Insulin Syringe/0.3ML/31G X 5/16", 34

triazolam, 16

Thrivite RX, 25

Triazolam, 17

Thrombate Iii, 15

Topcare Ultra Comfort Insulin Syringe/0.5ML/30G X 5/16", 34

Tribenzor, 5

Thrombate Iii W/10 ML Sterile Water, 15

Tricare, 24

Thrombate Iii W/20 ML Sterile Water, 15

Topcare Ultra Comfort Insulin Syringe/0.5ML/31G X 5/16", 34

Tricare Prenatal, 25

Thrombin-jmi Diluent, 15

Tricare Prenatal Compleat, 25

Thrombin-jmi Syringe Spray Kit, 15

Topcare Ultra Comfort Insulin Syringe/1ML/30G X 5/16", 34

Tricare Prenatal DHA One, 25

Thrombin-jmi W/Dil Spray P.M. Actuator, 15

Tricitrasol, 15

Topcare Ultra Comfort Insulin Syringe/1ML/31G X 5/16", 34

tricitrates, 14

Thrombogen, 15

triderm, 7

Thyroid, 12

Topcare Ultra Comfort Insulin Syringe/U-100/0.3ML/29G X 1/2", 34

trifluoperazine HCL, 16

Thyroid Porcine, 12

trifluridine, 18

Thyrolar-1, 12

Topcare Ultra Comfort Insulin Syringe/U-100/0.5ML/29G X 1/2", 34

trihexyphenidyl HCL, 17

Thyrolar-1/2, 12

Triiodo-l-thyronine Sodium, 12

Thyrolar-1/4, 12

Topcare Ultra Comfort Insulin Syringe/U-100/1ML/29G X 1/2", 34

Trileptal, 17

Thyrolar-2, 12

trilyte, 12

Thyrolar-3, 12

Topco Insulin Syringe/U-100/0.3ML/29G X 1/2", 34

trimethobenzamide HCL, 13

tiagabine hydrochloride, 17

trimethoprim, 3

Tice Bcg, 4

Topco Insulin Syringe/U-100/0.5ML/28G X 1/2", 34

Trimethoprim, 3

Tikosyn, 4

trimethoprim sulfate/polymyxin b sulfate, 18

tilia FE, 10

Topco Insulin Syringe/U-100/0.5ML/29G X 1/2", 34

Timolol Maleate, 4

trimipramine maleate, 16

timolol maleate, 18

Topco Insulin Syringe/U-100/1ML/29G X 1/2", 34

Trimipramine Maleate, 16

timolol maleate ophthalmic gel forming, 18

Trinatal GT, 25

topex topical anesthetic, 15

Trinatal RX 1, 24

Timoptic Ocudose, 19

Topicort, 7

Trinate, 24

tinidazole, 3

topiramate, 17

trinessa, 10

Tirosint, 12

Torisel, 4

trinessa LO, 10

Tivicay, 2

torsemide, 5

Tripelennamine HCL, 22

tizanidine HCL, 18

Toujeo Solostar, 11

Tristart DHA, 26

TL Folate, 25

Toviaz, 14

Triumeq, 2

TL-care DHA, 25

Tracleer, 6

Triveen-duo DHA, 25

TL-select, 25

tramadol HCL, 20

Triveen-prx RNF, 25

Tobradex, 19

tramadol HCL ER, 20

trivora-28, 10

Tobradex ST, 19

tramadol hydrochloride/acetaminophen, 20

Trokendi XR, 17

tobramycin, 1

tropicamide, 19

Tobramycin, 1

trandolapril, 5

Tropicamide, 19

tobramycin sulfate, 1, 18

trandolapril/verapamil HCL, 5

trospium chloride, 14

Tobramycin Sulfate, 1

trandolapril/verapamil HCL ER, 5

trospium chloride ER, 14

tobramycin/dexamethasone, 19

tranexamic acid, 15

Truedraw Lancing Device, 34

Tobrex, 18

Transderm-scop, 13

Trueplus Insulin Syringe/U-100/0.3ML/29G X 1/2", 34

Today Sponge, 14

tranylcypromine sulfate, 16

Todays Health Advanced Lancing Device, 34

Travatan Z, 19

Trueplus Insulin Syringe/U-100/0.3ML/30G X 5/16", 34

Travel Lancets 30G, 34

Todays Health Mini Pen Needles 31G X

trazodone HCL, 16

Trueplus Insulin Syringe/U-100/0.

3ML/31G X 5/16", 34

34

Ulticare U-100 Insulin Syringes/1ML/31G X 1/4", 34

Trueplus Insulin Syringe/U-100/0.5ML/28G X 1/2", 34

Ulticare Insulin Syringe/1ML/30G X 1/2", 34

Ultiguard Insulin Syringe/U-100/0.5ML/30G X 5/16", 34

Trueplus Insulin Syringe/U-100/0.5ML/29G X 1/2", 34

Ulticare Insulin Syringe/1ML/30G X 5/16", 34

Ultiguard Insulin Syringe/U-100/1ML/30G X 5/16", 34

Trueplus Insulin Syringe/U-100/0.5ML/30G X 5/16", 34

Ulticare Insulin Syringe/SHORT/0.3ML/30G X 5/16", 34

Ultilet Classic Lancets, 34

Trueplus Insulin Syringe/U-100/0.5ML/31G X 5/16", 34

Ulticare Insulin Syringe/SHORT/0.3ML/31G X 5/16", 34

Ultilet Insulin Syringe/SHORT/0.3ML/30G X 5/16", 34

Trueplus Insulin Syringe/U-100/1ML/29G X 1/2", 34

Ulticare Insulin Syringe/SHORT/0.5ML/30G X 5/16", 34

Ultilet Insulin Syringe/SHORT/0.3ML/31G X 5/16", 34

Trueplus Insulin Syringe/U-100/1ML/30G X 5/16", 34

Ulticare Insulin Syringe/SHORT/0.5ML/31G X 5/16", 34

Ultilet Insulin Syringe/SHORT/0.5ML/30G X 5/16", 34

Trueplus Insulin Syringe/U-100/1ML/31G X 5/16", 34

Ulticare Insulin Syringe/SHORT/1ML/30G X 5/16", 34

Ultilet Insulin Syringe/SHORT/0.5ML/31G X 5/16", 34

Trueplus Lancets 26G, 34

Ulticare Insulin Syringe/SHORT/1ML/31G X 5/16", 34

Ultilet Insulin Syringe/SHORT/1ML/30G X 5/16", 34

Trueplus Lancets 28G, 34

Trueplus Lancets 28G Super Thin, 34

Ulticare Insulin Syringe/U-100/0.3ML/29G X 1/2", 34

Ultilet Insulin Syringe/SHORT/1ML/31G X 5/16", 34

Trueplus Lancets 30G, 34

Trueplus Lancets 30G Ultra Thin, 34

Ulticare Insulin Syringe/U-100/0.3ML/30G X 1/2", 34

Ultilet Lancets, 34

Trueplus Lancets 33G, 34

Ultilet Lancets 33G, 34

Trueplus Lancets 33G Micro Thin, 34

Ulticare Insulin Syringe/U-100/0.3ML/30G X 5/16", 34

Ultilet Pen Needle 32GX4MM/SHORT, 34

Trueplus Pen Needles 29GX12MM, 34

Trueplus Pen Needles 31GX5MM, 34

Ulticare Insulin Syringe/U-100/0.3ML/31G X 5/16", 34

Ultilet Safety Lancets 23G, 34

Trueplus Pen Needles 31GX6MM, 34

Ultilet SHORT Pen Needles 31GX5/16", 34

Trueplus Pen Needles 31GX8MM, 34

Ulticare Insulin Syringe/U-100/0.5ML/29G X 1/2", 34

Trueplus Pen Needles 32GX4MM, 34

Ultilet SHORT Pen Needles31GX3/16", 34

Trueplus Safety Lancets 28G, 34

Ulticare Insulin Syringe/U-100/0.5ML/30G X 1/2", 34

Trumenba, 23

Ultimatecare One, 24

Truvada, 2

Ulticare Insulin Syringe/U-100/0.5ML/30G X 5/16", 34

Ultimatecare One NF, 24

Tusnel, 22

Ultra Comfort Insulin Syringe/U-100/0.3ML/30G X 5/16", 34

Tussicaps, 22

Ulticare Insulin Syringe/U-100/0.5ML/31G X 5/16", 34

tussigon, 22

Ultra Thin Lancets 28G, 35

Twinrix, 23

Ulticare Insulin Syringe/U-100/1ML/29G X 1/2", 34

Ultra-comfort Insulin Syringe/U-100/0.3ML/29G X 1/2", 35

Tykerb, 4

Tyvaso, 6

Ulticare Insulin Syringe/U-100/1ML/30G X 1/2", 34

Ultra-comfort Insulin Syringe/U-100/0.3ML/30G X 5/16", 35

Tyvaso Refill, 6

Tyvaso Starter, 6

Ulticare Insulin Syringe/U-100/1ML/30G X 5/16", 34

Ultra-comfort Insulin Syringe/U-100/0.3ML/31G X 5/16", 35

Tyzine Pediatric Nasal Drops, 22

U

Ulticare Insulin Syringe/U-100/1ML/31G X 5/16", 34

Ultra-comfort Insulin Syringe/U-100/0.5ML/28G X 1/2", 35

Ulesfia, 8

Ulticare Micro Pen Needles 31G X 8MM, 34

Ultra-comfort Insulin Syringe/U-100/0.5ML/29G X 1/2", 35

Uloric, 21

Ulti-lance Automatic/ Clear Tip, 34

Ulticare Micro Pen Needles 32G X 4MM, 34

Ultra-comfort Insulin Syringe/U-100/0.5ML/30G X 5/16", 35

Ulticare Insulin Safety Syringe/0.5ML/29G X 1/2", 34

Ulticare Micro Pen Needles/32G X 4MM, 34

Ultra-comfort Insulin Syringe/U-100/0.5ML/31G X 5/16", 35

Ulticare Insulin Safety Syringe/1ML/29G X 1/2", 34

Ulticare Mini Pen Needles 31GX6MM, 34

Ultra-comfort Insulin Syringe/U-100/1ML/29G X 1/2", 35

Ulticare Insulin Syringe Ultrafine U-100/0.3ML/31G X 5/16", 34

Ulticare Mini Pen Needles Ulti-fine IV, 34

Ulticare Mini Pen Needles/31G X 6MM, 34

Ultra-comfort Insulin Syringe/U-100/1ML/30G X 5/16", 35

Ulticare Insulin Syringe Ultrafine U-100/0.5ML/31G X 5/16", 34

Ulticare Mini Pen Needles31GX6MM, 34

Ultra-comfort Insulin Syringe/U-100/1ML/31G X 5/16", 35

Ulticare Insulin Syringe Ultrafine U-100/1ML/31G X 5/16", 34

Ulticare Original Pen Needles Ulti-fine, 34

Ultra-thin II Auto Lancet, 35

Ulticare Insulin Syringe/0.3ML/29G X 1/2", 34

Ulticare Pen Needles/29G X 12.7MM, 34

Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/30GX5/16", 35

Ulticare SHORT Pen Needles 31GX8MM, 34

Ulticare Insulin Syringe/0.3ML/30G X 1/2", 34

Ultra-thin II Insulin Syringe SHORT/U-100/0.3ML/31GX5/16", 35

Ulticare SHORT Pen Needles Ulti-fine IV, 34

Ulticare Insulin Syringe/0.3ML/30G X 5/16", 34

Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/30GX5/16", 35

Ulticare SHORT Pen Needles/31G X 8MM, 34

Ulticare Insulin Syringe/0.5ML/28G X 1/2", 34

Ultra-thin II Insulin Syringe SHORT/U-100/0.5ML/31GX5/16", 35

Ulticare Thin Lancets 30G, 34

Ulticare Insulin Syringe/0.5ML/29G X 1/2", 34

Ulticare U-100 Insulin Syringes/0.3ML/31G X 1/4", 34

Ultra-thin II Insulin Syringe SHORT/U-100/1ML/30GX5/16", 35

Ulticare Insulin Syringe/0.5ML/30G X 1/2", 34

Ulticare U-100 Insulin Syringes/0.3ML/31G X1/4", 34

Ultra-thin II Insulin Syringe SHORT/U-100/1ML/31GX5/16", 35

Ulticare Insulin Syringe/0.5ML/30G X 5/16", 34

Ulticare U-100 Insulin Syringes/0.5ML/31G X 1/4", 34

Ultra-thin II Insulin Syringe/U-100/0.3ML/29GX1/2", 35

Ulticare Insulin Syringe/1ML/29G X 1/2",

Ultra-thin II Insulin Syringe/U-100/0.5ML/29GX1/2", 35

Uramaxin, 8

Vanishpoint Insulin Syringe/1ML/29G X 5/16", 35

Uramaxin GT Kit, 8

Ultra-thin II Insulin Syringe/U-100/1ML/29GX1/2", 35

uramit mb, 13

Vanishpoint Insulin Syringe/1ML/30G X 5/16", 35

ure-k, 8

Ultra-thin II Lancets 28G, 35

urea, 8

Vanoxide-HC, 6

Ultra-thin II Lancets 30G, 35

urea 40% nail film, 8

Vantas, 3

Ultra-thin II Mini Pen Neeedles/31GX3/16", 35

urea hydrating, 8

Vaqta, 23

urea IN zinc undecylenate/lactic acid vehicle, 8

Varivax, 23

Ultra-thin II Pen Needles 29GX1/2", 35

Varubi, 13

Ultra-thin II Pen Needles/SHORT/31GX5/16", 35

Urea Nail, 8

Vcf Vaginal Contraceptive Film, 14

urea topical, 8

Vcf Vaginal Contraceptive Foam, 14

Ultra-thin II Safety Autolancets 26G, 35

urelle, 13

vcf vaginal contraceptivegel, 14

Ultralance, 35

uretron d/s, 13

Vectical, 7

Umecta, 8

uribel, 13

Velcade, 3

Unifine Pentips 29GX12MM, 35

urin d/s, 13

velivet, 10

Unifine Pentips 31G X 3/16", 35

uro-458, 13

Veltin, 6

Unifine Pentips 31G X 6MM, 35

uro-mp, 13

Vemavite-prx 2, 25

Unifine Pentips 31G X 8MM, 35

uroav-81, 13

Vena-bal DHA, 25

Unifine Pentips 31GX5MM, 35

uroav-b, 13

venlafaxine HCL, 16

Unifine Pentips 31GX6MM, 35

urolet mb, 13

venlafaxine HCL ER, 16

Unifine Pentips 31GX8MM, 35

urophen mb, 13

Ventavis, 6

Unifine Pentips 32GX4MM, 35

ursodiol, 13

Ventolin HFA, 22

Unifine Pentips Plus 29GX12MM, 35

uryl, 13

verapamil HCL, 4

Unifine Pentips Plus 31GX5MM, 35

ustell, 13

verapamil HCL ER, 4

Unifine Pentips Plus 31GX6MM, 35

uticap, 13

verapamil HCL SR, 4

Unifine Pentips Plus 31GX8MM, 35

utira-c, 13

Verdeso, 7

Unifine Pentips Plus 32GX4MM, 35

utrona-c, 13

verdrocet, 21

Unilet Comfortouch Lancet, 35

V

Veregen, 8

Unilet Excelite, 35

Veripred 20, 9

V-r Monoject Insulin Syringe/U-100/0.3ML/29G X 1/2", 35

Unilet Excelite II, 35

Vesicare, 14

Unilet G.p. Lancet, 35

vestura, 10

V-r Monoject Insulin Syringe/U-100/0.5ML/28G X 1/2", 35

Unilet G.p. Superlite Lancet, 35

Viagra, 6

Unilet GP 28 Ultra Thin, 35

Vibramycin, 1

V-r Monoject Insulin Syringe/U-100/0.5ML/29G X 1/2", 35

Unilet Lancet, 35

vicodin, 21

Unilet Lancets Micro-thin33G, 35

vicodin ES, 21

V-r Monoject Insulin Syringe/U-100/1ML/29G X 1/2", 35

Unilet Lancets Super-thin30G, 35

vicodin HP, 21

Unilet Lancets Ultra-thin 28G, 35

Victoza, 11

Vagifem, 14

Unilet Superlite Lancet, 35

Vida Mia Autolet Lancing Device, 35

valacyclovir HCL, 2

Unistik 1, 35

Vida Mia Unifine Pentips 32GX4MM, 35

Valcyte, 2

Unistik 2, 35

Vida Mia Unifine Pentips Mini 31GX6MM, 35

valganciclovir, 2

Unistik 2 Comfort, 35

valganciclovir hydrochlorde, 2

Unistik 2 Extra, 35

Vida Mia Unifine Pentips Original 29GX12MM, 35

valproic acid, 17

Unistik 2 Neonatal, 35

valsartan, 5

Unistik 2 Normal, 35

Vida Mia Unilet Lancets Super Thin 30G, 35

valsartan/hydrochlorothiazide, 5

Unistik 2 Super, 35

Value Health Insulin Syringe/U-100/0.5ML/29G X 1/2", 35

Unistik 3, 35

Vida Mia Unilet Lancets Ultra Thin 28G, 35

Unistik 3 Comfort, 35

Value Health Insulin Syringe/U-100/1ML/29G X 1/2", 35

Unistik 3 Extra, 35

Vida Mia Unipfine Pentipsshort 31GX8MM, 35

Unistik 3 Extra Single Use Safety Lancets/21G, 35

Value Plus Lancets Standard 21G, 35

Videx Pediatric, 2

Value Plus Lancets Super Thin 30G, 35

Unistik 3 Gentle, 35

vienva, 10

Value Plus Lancets Thin 26G, 35

Unistik 3 Neonatal, 35

Vigamox, 18

Value Plus Lancing Device, 35

Unistik 3 Normal, 35

Vimpat, 17

Valumark Lancet Super Thin 30G, 35

Unistik CZT Comfort, 35

Vinate DHA RF, 25

Valumark Lancet Ultra Thin 28G, 35

Unistik CZT Normal, 35

Vinate II, 24

Valumark Pen Needles 29GX12MM, 35

Unistik Safety Lancets 28G, 35

Vinate M, 24

Valumark Pen Needles 31G X 6MM, 35

Unistik Safety Lancets 30G, 35

Vinate One, 24

Valumark Pen Needles 31G X 8MM, 35

Unistik Touch Safety Lancets 21G, 35

viorele, 10

Valved Holding Chamber, 36

Unistik Touch Safety Lancets 23G, 35

Viracept, 2

Vanatol LQ, 20

Unistik Touch Safety Lancets 28G, 35

Viramune, 2

vancomycin HCL, 3

Unistik Touch Safety Lancets 30G, 35

Virazole, 2

Vancomycin HCL, 3

unithroid, 12

Viread, 2

vandazole, 14

unithroid direct, 12

Virt Nate, 25

Vanishpoint Insulin Syringe/0.5ML/30G X 1/2", 35

Universal 1 Lancets Thin 26G, 35

Virt-advance, 25

Universal 1 Lancets Ultra Thin 30G, 35

Virt-c DHA, 25

Vanishpoint Insulin Syringe/0.5ML/30G X 5/16", 35

Universal 1 Lancets/33G/Micro-thin, 35

Virt-care One, 25

Uptravi, 6

Virt-nate DHA, 25

Vanishpoint Insulin Syringe/1ML/29G X 1/2", 35

ur n-c, 13

Virt-pn, 25

Virt-pn DHA, 25

Thin/33G, 35

Zepatier, 2

Virt-pn Plus, 25

Walgreens Comfort Assuredlancets Super Thin/28G, 35

Zetia, 6

Virt-select, 25

Ziagen, 2

Virt-vite GT, 25

Walgreens Lancets, 35

zidovudine, 2

Virtprex, 25

Walgreens Thin Lancets, 35

Zinbryta, 18

virtrate-2, 14

Walgreens Ultra Thin Lancets, 35

Zinc Acetate, 15

virtrate-3, 14

warfarin sodium, 15

ziprasidone HCL, 16

virtrate-k, 14

Warfarin Sodium Clathrateform, 15

Zirgan, 18

Vita-pren, 25

Watchhaler, 36

Zithranol-rr, 7

Vitafol Fe+, 25

wee care, 14

Zmax, 1

Vitafol Gummies, 25

Wegmans Unifine Pentips Plus 32GX4MM, 35

Zoladex, 3

Vitafol Ultra, 25

Zolinza, 4

Vitafol-nano, 25

Wegmans Unifine Pentips Plus/Mini/31GX5MM, 35

zolmitriptan, 21

Vitafol-OB, 24

zolmitriptan odt, 21

Vitafol-ob+dha, 25

Wegmans Unifine Pentips Plus/SHORT/31GX8MM, 35

zolpidem tartrate, 16

Vitafol-one, 25

zolpidem tartrate ER, 17

vitajoy daily d gummies, 24

Wegmans Unifine Pentips Plus/Ultra SHORT/31GX6MM, 35

Zomig, 21

Vitalet Pro Lancets, 35

Zomig Nasal Spray, 21

Vitalet Pro Plus Lancets, 35

Welchol, 6

Zonalon, 7

Vitamedmd One RX/Quatrefolic, 26

Wellesse Vitamin D3, 24

Zonegran, 17

Vitamedmd Redichew RX, 26

wera, 10

zonisamide, 17

Vitamelts Vitamin D, 24

Westhroid, 12

Zortress, 3

vitamin c 222MG, 24

Wheat Germ, 24

Zostavax, 23

vitamin d, 24

Wp Thyroid, 12

zovia 1/35e, 10

vitamin d 400, 24

wymzya FE, 10

Zovirax, 7

vitamin d high potency, 24

X

Zurampic, 21

vitamin d-1000, 24

Zydelig, 4

Xalkori, 4

vitamin d-1000 maximum strength, 24

Zykadia, 4

Xarelto, 15

vitamin d-3, 24

Zylet, 19

Xarelto Starter Pack, 15

vitamin d-400, 24

Zyprexa Relprevv, 16

Xeljanz, 21

vitamin d3, 24

Zytiga, 3

Xeljanz XR, 21

Vitamin D3, 24

1

Xeomin, 18

vitamin d3 400, 24

Xerese, 7

1ST Choice Lancets Super Thin, 35

vitamin d3 adult gummies, 24

Xifaxan, 3

1ST Choice Lancets Thin, 35

vitamin d3 gummies, 24

Xolair, 23

1ST Choice Lancets Ultra Thin, 35

vitamin d3 high potency, 24

Xolegel, 7

1ST Tier Unifine Pentips /Mini/31GX5MM, 35

vitamin d3 maximum strength, 24

Xopenex HFA, 23

vitamin d3 super strength, 24

Xtandi, 3

1ST Tier Unifine Pentips 29GX12MM, 35

Vitapearl, 26

Xulane, 10

1ST Tier Unifine Pentips 31GX6MM, 35

Vitekta, 2

xylocaine dental, 21

1ST Tier Unifine Pentips 31GX8MM, 35

Viva DHA, 26

xylon, 21

1ST Tier Unifine Pentips 32GX4MM, 35

Vivelle-dot, 9

Xyntha, 15

1ST Tier Unifine Pentips Plus 31GX8MM, 35

Vol-nate, 26

Xyntha Solofuse, 15

Vol-plus, 26

Xyrem, 18

1ST Tier Unifine Pentips Plus 32GX4MM, 35

Vol-TAB RX, 26

Y

voriconazole, 2

1ST Tier Unifine Pentips Plus/Mini/31GX5MM, 35

Vortex Valved Holding Chamber, 36

yl folic acid, 14

Votrient, 3

yuvafem, 14

1ST Tier Unifine Pentips Plus/Original/29GX12MM, 35

Vp Insulin Syringe/U-100/0.3ML/29G X 1/2", 35

Z

1ST Tier Unifine Pentips Plus/Ultra SHORT/31GX6MM, 35

Zaclir Cleansing, 6

Vp-CH Plus, 26

zafirlukast, 22

Vp-CH-PNV, 26

1ST Tier Unilet Comfortouch Lancets 28G, 35

zaleplon, 16

Vp-ggr-b6 Prenatal, 26

zarah, 10

Vp-heme OB, 26

1ST Tier Unilet Comfortouch Lancets 30G, 35

Zarontin, 17

Vp-heme OB + DHA, 26

Zarxio, 14

Vp-heme One, 26

4

Zatean-CH, 26

Vp-PNV-DHA, 26

Zatean-pn DHA, 26

Vraylar, 16

4-aminobenzoic Acid Potassium Salt, 24

Zatean-pn Plus, 26

Vusion, 7

5

Zavesca, 14

vyfemla, 10

zazole, 14

Vytorin, 6

5-aminosalicylic Acid, 13

Zelapar, 18

Vyvanse, 17

Zelboraf, 4

W

zenatane, 6

W&f Lancets 26G, 35

zenchent, 10

W&f Lancets Colored 21G, 35

zenchent FE, 10

Walgreens Advanced Travellancets 28G, 35

zencia, 6

Zenpep, 13

Walgreens Comfort Assuredlancets Micro

zenzedi, 17

1610 CR 007_02

53379208.1

Non-Discrimination and Accessibility Notice

QualChoice complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. QualChoice does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

QualChoice:

Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages

If you need these services, contact Customer Service at (501) 228-7111. If you believe that QualChoice has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

QualChoice Civil Rights Coordinator QualChoice P.O. Box 25610 Little Rock, AR 72221-5610 (501) 228-7111 Fax #: 501-707-6729 QCA_COE@qualchoice.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the QualChoice Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Notice of Discrimination Grievance Procedures

It is the policy of QualChoice not to discriminate on the basis of race, color, national origin, sex, age or disability. QualChoice has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. 18116) and its implementing regulations at 45 CFR part 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the QualChoice Civil Rights Coordinator, who has been designated to coordinate the efforts of QualChoice to comply with Section 1557 (the “Section 1557 Coordinator”):

QualChoice Civil Rights Coordinator QualChoice P.O. Box 25610 Little Rock, AR 72221-5610 (501) 228-7111 Fax #: 501-707-6729 QCA_COE@qualchoice.com

Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for QualChoice to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.

Procedure:

Grievances must be submitted to the Section 1557 Coordinator within sixty (60) days of the date the person filing the grievance becomes aware of the alleged discriminatory action.

A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.

The Section 1557 Coordinator (or her/his designee) shall conduct an investigation of the complaint. This investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Section 1557 Coordinator will maintain the files and records of QualChoice relating to such grievances. To the extent possible, and in accordance with applicable law, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know.

The Section 1557 Coordinator will issue a written decision on the grievance, based on a preponderance of the evidence, no later than thirty (30) days after its filing, including a notice to the complainant of their right to pursue further administrative or legal remedies.

The person filing the grievance may appeal the decision of the Section 1557 Coordinator by writing to the Vice President Corporate Responsibility within fifteen (15) days of receiving the Section 1557 Coordinator’s decision. The Vice President Corporate Responsibility shall issue a written decision in response to the appeal no later than thirty (30) days after its filing.

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The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the U.S. Department of Health and Human Services, Office for Civil Rights. A person can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201.

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. QualChoice will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements. QualChoice offers help for members with limited English proficiency (LEP). The following statement is printed in the top languages used in

Arkansas, as required by the Federal government:

ATTENTION: Language assistance services, free of charge, are available to you. Call 1-800-235-7111 (TTY: 711).

Spanish ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-235-7111 (TTY: 711). Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-235-7111 (TTY: 711). Marshallese LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 1-800-235-7111 (TTY: 711). Chinese 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-235-7111 (TTY: 711).

Lao

ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້ າພາສາ ລາວ, ການບໍ ລິ ການຊ່ວຍເຫ ຼື ອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-235-7111 (TTY: 711). Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-235-7111 (TTY: 711). Arabic

.(117)رقمهاتف الصم والبكم: 7111-235-800-1ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-235-7111 (TTY: 711). French ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-235-7111 (ATS: 711). Hmong LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-800-235-7111 (TTY: 711). Korean

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-235-7111 (TTY: 711) 번으로 전화해 주십시오. Portuguese ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-235-7111 (TTY: 711). Japanese 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-235-7111 (TTY: 711)s まで、お電話にてご連絡ください。

Hindi

ध्यान दें: यदद आप द िंदी बोलते ैं तो आपके ललए मुफ्त में भाषा स ायता सेवाएिं उपलब्ध ैं। 1-800-235-7111 (TTY: 711) पर कॉल करें। Gujarati

સચુના: જો તમે ગજુરાતી બોલતા હો, તો નન:શલુ્ક ભાષા સહાય સવેાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-800-235-7111 (TTY: 711).

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