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HealthPartners® GenericsAdvantageRx

2016 Formulary

(List of covered drugs)

For current information on the GenericsAdvantageRx Drug List, visit healthpartners.com/pharmacy.

Effective: October 1, 2016

©2015 HealthPartners

What’s the GenericsAdvantageRx drug list?

This is the list of medicines (sometimes called a formulary) covered by your health plan. The drug list is reviewed by a

team of experts every three months for new medicines, safety alerts and other updates.

Who decides what’s on the drug list?

The HealthPartners Pharmacy and Therapeutics Committee manages the list. This team of experts is focused on safety,

effectiveness and affordability. Visit healthpartners.com/pharmacy for more information.

How do you use the drug list?

The medicines on the drug list are listed in alphabetical order by type of medicine starting on page 3.

Generic medicines are in lowercase italics (e.g., cephalexin) and are just as safe and effective as brand medicines but cost you

less. Some generic medicines are very low-cost.

Brand medicines are in ALL CAPS (e.g., KEFLEX) and are more costly than generic medicines.

The Status can be used to determine how much a medicine will cost you. For exact cost information,

Find the status for your medicine.

Review your Summary of Plan Benefits or contract for the copay or coinsurance for that Status. Or,

Log on to your myHealthPartners account to check your pharmacy benefits.

F $ – Formulary Low Cost Generics

F $$ – Formulary High Cost Generics

F $$$ – Formulary Brands

What’s a Specialty Medicine?

Specialty medicines are usually prescribed by doctors whose focus is on the treatment of chronic and complex diseases.

These medicines usually require more management, have a high price and aren’t always stocked at retail pharmacies.

Prescriptions for these medicines must be filled at a specialty pharmacy and are often covered at a different benefit than

non-specialty medicines. Log on to your myHealthPartners account and click on My plan benefits on the Medical Plan

tab to check your benefits for specialty medicines.

What do the abbreviations in the More details column mean?

This column gives special information about the medicine you’re searching for. The abbreviations let you know there might be a

special program or rule for the medicine. Use this key to help you navigate the drug list:

Prior Authorization Required PA

Step Therapy Required ST

Age Edit AE

Gender Edit Female GE Female

Gender Edit Male GE Male

Quantity Limit QL

Smoking Cessation Benefit SC

Trial Drug Program TD

Weight Loss Benefit WL

Oncology Benefit ONC

Why do you need prior authorization (PA) for some medicines? Even though some medicines are on the drug list, they

need to meet the HealthPartners prior authorization

criteria in order for the medicine to be covered by your

pharmacy benefits.

What’s Step Therapy (ST)? Some medicines are on the drug list, but you need to try

one or more other medicines first. HealthPartners

covers a medicine with step therapy, if you've already

tried the other medicine(s). If you haven't, you or your

doctor will need to get approval from HealthPartners

before the medicine will be covered by your lowest

brand, generic or specialty copay or coinsurance.

What’s an Age Edit (AE)? An age edit means some medicines are only covered if

you’re within a specific age range. If you're not in the

approved age range, you or your doctor will need to

request approval from HealthPartners for your

medicine to be covered.

What’s a Gender Edit (GE)? A gender edit means some medicines are covered for

males or females only. If you're not in the approved

gender group, you or your doctor will need to request

approval from HealthPartners for your medicine to be

covered.

What’s a Quantity Limit (QL)? This means HealthPartners limits the amount of the

medicine you'll get each time you fill your prescription.

The quantity limit may be less than the days supply

listed in your contract or Summary Plan Description.

What’s the Trial Drug Program (TD)? The trial drug program is for new prescriptions for

certain medicines that may not be well tolerated due

to:

Side effects

High cost

High potential for waste

Your first 6 fills of a trial drug may be limited to less

than a month supply. If the medicine works well, you’ll

get the rest of your month supply. If a copay applies to

the medicine, you’ll pay no more than one copay for

each one month supply.

What’s the Weight Loss Benefit (WL)? This type of medicine may have limits on the amount

you get or may not be covered under all plans. Log on to

your myHealthPartners account and click on My plan

benefits on the Medical Plan tab to check your benefits

for weight loss. Weight Loss medicines are listed on the

drug list under the Weight Loss medicine category.

What’s the Oncology Benefit (ONC)? These are oncology (cancer) medicines that must be filled at a specialty pharmacy, but you’re only responsible for your regular generic or brand pharmacy copay or coinsurance.

The HealthPartners family of health plans is underwritten and/or administered by HealthPartners, Inc., Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc. Fully insured Wisconsin plans are underwritten by HealthPartners Insurance Company. (9/15) ©2015 HealthPartners

List of Covered Drugs

Table of Contents

Table of Contents

Alcohol Dependency ............................................................................................................................................................................................................................................................................................... 3Allergy ............................................................................................................................................................................................................................................................................................................................................ 3Alpha‐1 Antitrypsin Deficiency ............................................................................................................................................................................................................................................................... 4Anti‐Addiction/Substance Abuse Treatment Agents ........................................................................................................................................................................................... 4Anti‐Infective ...................................................................................................................................................................................................................................................................................................................... 4Arthritis .................................................................................................................................................................................................................................................................................................................................... 12Asthma & Copd ............................................................................................................................................................................................................................................................................................................ 13Behavioral Health .................................................................................................................................................................................................................................................................................................... 15Birth Control ..................................................................................................................................................................................................................................................................................................................... 19Bleeding Disorders ................................................................................................................................................................................................................................................................................................. 24Blood Modifier .............................................................................................................................................................................................................................................................................................................. 24Blood Thinner ................................................................................................................................................................................................................................................................................................................. 27Bone Health ....................................................................................................................................................................................................................................................................................................................... 28Cancer ......................................................................................................................................................................................................................................................................................................................................... 28Corticosteroids ............................................................................................................................................................................................................................................................................................................. 31Cough & Cold ................................................................................................................................................................................................................................................................................................................... 32Cystic Fibrosis ................................................................................................................................................................................................................................................................................................................. 32Dementia ............................................................................................................................................................................................................................................................................................................................... 32Diabetes .................................................................................................................................................................................................................................................................................................................................. 33Ear Conditions ............................................................................................................................................................................................................................................................................................................... 36Enzyme Replacement ......................................................................................................................................................................................................................................................................................... 36Eye Conditions .............................................................................................................................................................................................................................................................................................................. 37Gout ............................................................................................................................................................................................................................................................................................................................................... 39Heart Health ..................................................................................................................................................................................................................................................................................................................... 39Hereditary Angioedema ................................................................................................................................................................................................................................................................................ 46Idiopathic Pulmonary Fibrosis ............................................................................................................................................................................................................................................................. 46Immune Deficiency ................................................................................................................................................................................................................................................................................................ 46Immune Suppressant ......................................................................................................................................................................................................................................................................................... 47Kidney Failure ................................................................................................................................................................................................................................................................................................................ 48Men's Health ................................................................................................................................................................................................................................................................................................................... 48Migraine .................................................................................................................................................................................................................................................................................................................................. 49Mouth & Throat .......................................................................................................................................................................................................................................................................................................... 50Multiple Sclerosis ..................................................................................................................................................................................................................................................................................................... 50Muscle Relaxant ......................................................................................................................................................................................................................................................................................................... 51Other Conditions ....................................................................................................................................................................................................................................................................................................... 51Pain ................................................................................................................................................................................................................................................................................................................................................. 53Parkinson's ......................................................................................................................................................................................................................................................................................................................... 56Pulmonary Hypertension ............................................................................................................................................................................................................................................................................. 57Seizures / Epilepsy .................................................................................................................................................................................................................................................................................................. 57Skin Conditions ............................................................................................................................................................................................................................................................................................................ 60Sleep Disorders ............................................................................................................................................................................................................................................................................................................ 64Smoking Cessation ................................................................................................................................................................................................................................................................................................. 64Stomach / Gastrointestinal ....................................................................................................................................................................................................................................................................... 65Thyroid ...................................................................................................................................................................................................................................................................................................................................... 68Urinary & Bladder Health ............................................................................................................................................................................................................................................................................ 68Vaccines ................................................................................................................................................................................................................................................................................................................................... 69

1

Table of Contents

Vitamins And Minerals .................................................................................................................................................................................................................................................................................... 73Weight Loss ........................................................................................................................................................................................................................................................................................................................ 75Women's Health ........................................................................................................................................................................................................................................................................................................ 75

2

List of Covered Drugs

Drug Status More Details

Alcohol Dependency

Alcohol Dependency

acamprosate oral tablet,delayed release (dr/ec)333 mg

F $$

disulfiram oral tablet 250 mg, 500 mg F $$

naltrexone oral tablet 50 mg F $$

Allergy

Allergy, Eye

azelastine ophthalmic drops 0.05 % F $$

cromolyn ophthalmic drops 4 % F $$

epinastine ophthalmic drops 0.05 % F $$

olopatadine ophthalmic drops 0.1 % F $$

Allergy, Injection

AUVI‐Q INJECTION AUTO‐INJECTOR 0.15 MG/0.15 ML

F $$$

AUVI‐Q INJECTION AUTO‐INJECTOR 0.3 MG/0.3 ML

F $$$

epinephrine injection auto‐injector 0.15 mg/0.15 ml, 0.3 mg/0.3 ml

F $$

EPIPEN INJECTION AUTO‐INJECTOR 0.3 MG/0.3 ML

F $$$

EPIPEN JR 2‐PAK INJECTION AUTO‐INJECTOR0.15 MG/0.3 ML

F $$$

Allergy, Other Nasal

azelastine nasal aerosol,spray 137 mcg (0.1 %) F $$

ipratropium bromide nasal spray,non‐aerosol0.03 %, 0.06 %

F $$

Allergy, Other Oral

GRASTEK SUBLINGUAL TABLET 2,800 BAU F $$$ PA

GenericsAdvantageRx October 1, 20163


RAGWITEK SUBLINGUAL TABLET 12 AMB A 1 UNIT

F $$$ PA

Antihistamines, Oral

clemastine oral syrup 0.67 mg/5 ml F $$

cyproheptadine oral syrup 2 mg/5 ml F $$

cyproheptadine oral tablet 4 mg F $$

hydroxyzine hcl oral solution 10 mg/5 ml F $ QL; AE

hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg F $ QL; AE

hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg

F $ QL; AE

promethazine oral syrup 6.25 mg/5 ml F $ QL; AE

promethazine oral tablet 12.5 mg, 25 mg, 50 mg F $$ QL; AE

Corticosteroids, Nasal

flunisolide nasal spray,non‐aerosol 25 mcg (0.025 %)

F $$

fluticasone nasal spray,suspension 50 mcg/actuation

F $$

Alpha‐1 Antitrypsin Deficiency

Alpha‐1 Antitrypsin Deficiency

ARALAST NP INTRAVENOUS RECON SOLN 1,000 MG, 500 MG

F $$$ PA; Specialty

GLASSIA INTRAVENOUS SOLUTION 1 GRAM/50 ML (2 %)

F $$$ PA; Specialty

PROLASTIN INTRAVENOUS RECON SOLN 500 MG F $$$ PA; Specialty

PROLASTIN‐C INTRAVENOUS RECON SOLN 1,000 MG

F $$$ PA; Specialty

ZEMAIRA INTRAVENOUS RECON SOLN 1,000 MG F $$$ PA; Specialty

Anti‐Addiction/Substance Abuse Treatment Agents

Anti‐Addiction/Substance Abuse Treatment Agents

naloxone injection syringe 1 mg/ml F $$

NARCAN NASAL SPRAY,NON‐AEROSOL 4 MG/ACTUATION

F $$$

Anti‐Infective

Antibiotics, Cephalosporins

cefadroxil oral capsule 500 mg F $$



cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 mg/5 ml

F $$

cefadroxil oral tablet 1 gram F $$

cefdinir oral capsule 300 mg F $$

cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

F $$

cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

F $$

cefprozil oral tablet 250 mg, 500 mg F $$

CEFTIN ORAL SUSPENSION FOR RECONSTITUTION 125 MG/5 ML, 250 MG/5 ML

F $$$

cefuroxime axetil oral tablet 250 mg, 500 mg F $$

cephalexin oral capsule 250 mg, 500 mg F $

cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

F $

SUPRAX ORAL CAPSULE 400 MG F $$$ QL

Antibiotics, Macrolides

azithromycin oral suspension for reconstitution100 mg/5 ml, 200 mg/5 ml

F $$

azithromycin oral tablet 250 mg, 500 mg, 600 mg F $$

clarithromycin oral suspension for reconstitution125 mg/5 ml, 250 mg/5 ml

F $$

clarithromycin oral tablet 250 mg, 500 mg F $$

DIFICID ORAL TABLET 200 MG F $$$ PA

e.e.s. 200 oral suspension for reconstitution 200 mg/5 ml

F $$

e.e.s. 400 oral tablet 400 mg F $$

ERYPED 400 ORAL SUSPENSION FOR RECONSTITUTION 400 MG/5 ML

F $$$

ery‐tab oral tablet,delayed release (dr/ec) 250 mg, 500 mg

F $$

ERY‐TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 333 MG

F $$$

erythrocin (as stearate) oral tablet 250 mg F $$

erythromycin ethylsuccinate oral suspension for reconstitution 200 mg/5 ml

F $$

erythromycin ethylsuccinate oral tablet 400 mg F $$

erythromycin oral capsule,delayed release(dr/ec)250 mg

F $$



erythromycin oral tablet 250 mg, 500 mg F $$

Antibiotics, Other

clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg

F $$

clindamycin palmitate hcl oral recon soln 75 mg/5 ml

F $$

linezolid oral suspension for reconstitution 100 mg/5 ml

F $$ PA

linezolid oral tablet 600 mg F $$ PA

neomycin oral tablet 500 mg F $

sulfamethoxazole‐trimethoprim oral suspension200‐40 mg/5 ml

F $

sulfamethoxazole‐trimethoprim oral tablet400‐80 mg, 800‐160 mg

F $

trimethoprim oral tablet 100 mg F $$

vancomycin intravenous recon soln 1,000 mg, 10 gram, 5 gram, 500 mg

F $$

vancomycin oral capsule 125 mg, 250 mg F $$

XIFAXAN ORAL TABLET 200 MG, 550 MG F $$$ PA

Antibiotics, Penicillins

amoxicillin oral capsule 250 mg, 500 mg F $

amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml

F $

amoxicillin oral tablet 500 mg, 875 mg F $

amoxicillin oral tablet,chewable 125 mg, 250 mg F $

amoxicillin‐pot clavulanate oral suspension for reconstitution 200‐28.5 mg/5 ml, 250‐62.5 mg/5 ml, 400‐57 mg/5 ml, 600‐42.9 mg/5 ml

F $$

amoxicillin‐pot clavulanate oral tablet 250‐125 mg, 500‐125 mg, 875‐125 mg

F $$

amoxicillin‐pot clavulanate oral tablet,chewable200‐28.5 mg, 400‐57 mg

F $$

ampicillin oral capsule 250 mg, 500 mg F $

ampicillin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml

F $

dicloxacillin oral capsule 250 mg, 500 mg F $$

penicillin v potassium oral recon soln 125 mg/5 ml, 250 mg/5 ml

F $



penicillin v potassium oral tablet 250 mg, 500 mg F $

Antibiotics, Quinolones

ciprofloxacin hcl oral tablet 100 mg, 250 mg, 500 mg, 750 mg

F $

ciprofloxacin oral suspension,microcapsule recon250 mg/5 ml, 500 mg/5 ml

F $$

levofloxacin oral solution 250 mg/10 ml F $

levofloxacin oral tablet 250 mg, 500 mg, 750 mg F $

moxifloxacin oral tablet 400 mg F $$

Antibiotics, Tetracyclines

demeclocycline oral tablet 150 mg, 300 mg F $$

doxycycline hyclate oral tablet 20 mg F $$

doxycycline monohydrate oral capsule 100 mg, 50 mg

F $$

minocycline oral capsule 100 mg, 50 mg, 75 mg F $$

tetracycline oral capsule 250 mg, 500 mg F $

Antifungals

clotrimazole mucous membrane troche 10 mg F $$

CRESEMBA ORAL CAPSULE 186 MG F $$$ PA

fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml

F $

fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg

F $

griseofulvin microsize oral suspension 125 mg/5 ml

F $$

griseofulvin microsize oral tablet 500 mg F $$

griseofulvin ultramicrosize oral tablet 125 mg, 250 mg

F $$

itraconazole oral capsule 100 mg F $$ PA

ketoconazole oral tablet 200 mg F $$

NOXAFIL ORAL SUSPENSION 200 MG/5 ML (40 MG/ML)

F $$$ PA

NOXAFIL ORAL TABLET,DELAYED RELEASE (DR/EC) 100 MG

F $$$ PA

nystatin oral suspension 100,000 unit/ml F $$

nystatin oral tablet 500,000 unit F $$

terbinafine hcl oral tablet 250 mg F $$



voriconazole oral suspension for reconstitution200 mg/5 ml (40 mg/ml)

F $$ PA

voriconazole oral tablet 200 mg, 50 mg F $$ PA

Anti‐Infective, Other

ALBENZA ORAL TABLET 200 MG F $$$ PA

atovaquone oral suspension 750 mg/5 ml F $$

BILTRICIDE ORAL TABLET 600 MG F $$$

dapsone oral tablet 100 mg, 25 mg F $$

ivermectin oral tablet 3 mg F $$

rifabutin oral capsule 150 mg F $$

SIVEXTRO ORAL TABLET 200 MG F $$$ PA

Antiprotozoals

ALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML

F $$$ ST

ALINIA ORAL TABLET 500 MG F $$$ ST

atovaquone‐proguanil oral tablet 250‐100 mg, 62.5‐25 mg

F $$

chloroquine phosphate oral tablet 250 mg, 500 mg

F $$

hydroxychloroquine oral tablet 200 mg F $$

mefloquine oral tablet 250 mg F $$

metronidazole oral tablet 250 mg, 500 mg F $$

YODOXIN ORAL TABLET 210 MG, 650 MG F $$$

Antiviral, Hepatitis B

adefovir oral tablet 10 mg F $$

BARACLUDE ORAL SOLUTION 0.05 MG/ML F $$$

entecavir oral tablet 0.5 mg, 1 mg F $$

EPIVIR HBV ORAL SOLUTION 25 MG/5 ML (5 MG/ML)

F $$$

lamivudine oral tablet 100 mg F $$

TYZEKA ORAL TABLET 600 MG F $$$

Antiviral, Hepatitis C

EPCLUSA ORAL TABLET 400‐100 MG F $$$ PA; Specialty

HARVONI ORAL TABLET 90‐400 MG F $$$ PA; Specialty

INTRON A INJECTION RECON SOLN 10 MILLION UNIT (1 ML), 18 MILLION UNIT (1 ML), 50 MILLION UNIT (1 ML)

F $$$ Specialty



INTRON A INJECTION SOLUTION 10 MILLION UNIT/ML, 6 MILLION UNIT/ML

F $$$ Specialty

OLYSIO ORAL CAPSULE 150 MG F $$$ PA; Specialty

PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 135 MCG/0.5 ML, 180 MCG/0.5 ML

F $$$ PA; Specialty

PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML

F $$$ PA; Specialty

PEGASYS SUBCUTANEOUS SYRINGE 180 MCG/0.5 ML

F $$$ PA; Specialty

PEGINTRON REDIPEN SUBCUTANEOUS PEN INJECTOR KIT 120 MCG/0.5 ML, 150 MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5 ML

F $$$ PA; Specialty

PEGINTRON SUBCUTANEOUS KIT 120 MCG/0.5 ML, 150 MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5 ML

F $$$ PA; Specialty

REBETOL ORAL SOLUTION 40 MG/ML F $$$ Specialty

ribavirin oral capsule 200 mg F $$ Specialty

ribavirin oral tablet 200 mg F $$ Specialty

SOVALDI ORAL TABLET 400 MG F $$$ PA; Specialty

ZEPATIER ORAL TABLET 50‐100 MG F $$$ PA; Specialty

Antiviral, Hiv

abacavir oral tablet 300 mg F $$

abacavir‐lamivudine‐zidovudine oral tablet300‐150‐300 mg

F $$

APTIVUS ORAL CAPSULE 250 MG F $$$

APTIVUS ORAL SOLUTION 100 MG/ML F $$$

ATRIPLA ORAL TABLET 600‐200‐300 MG F $$$

COMPLERA ORAL TABLET 200‐25‐300 MG F $$$

CRIXIVAN ORAL CAPSULE 200 MG, 400 MG F $$$

DESCOVY ORAL TABLET 200‐25 MG F $$$

didanosine oral capsule,delayed release(dr/ec)125 mg, 200 mg, 250 mg, 400 mg

F $$

EDURANT ORAL TABLET 25 MG F $$$

EMTRIVA ORAL CAPSULE 200 MG F $$$

EMTRIVA ORAL SOLUTION 10 MG/ML F $$$

EPZICOM ORAL TABLET 600‐300 MG F $$$

EVOTAZ ORAL TABLET 300‐150 MG F $$$

FUZEON SUBCUTANEOUS RECON SOLN 90 MG F $$$ Specialty



GENVOYA ORAL TABLET 150‐150‐200‐10 MG F $$$

INTELENCE ORAL TABLET 100 MG, 200 MG, 25 MG

F $$$

INVIRASE ORAL CAPSULE 200 MG F $$$

INVIRASE ORAL TABLET 500 MG F $$$

ISENTRESS ORAL POWDER IN PACKET 100 MG F $$$

ISENTRESS ORAL TABLET 400 MG F $$$

ISENTRESS ORAL TABLET,CHEWABLE 100 MG, 25 MG

F $$$

KALETRA ORAL SOLUTION 400‐100 MG/5 ML F $$$

KALETRA ORAL TABLET 100‐25 MG, 200‐50 MG F $$$

lamivudine oral solution 10 mg/ml F $$

lamivudine oral tablet 150 mg, 300 mg F $$

lamivudine‐zidovudine oral tablet 150‐300 mg F $$

LEXIVA ORAL SUSPENSION 50 MG/ML F $$$

LEXIVA ORAL TABLET 700 MG F $$$

nevirapine oral suspension 50 mg/5 ml F $$

nevirapine oral tablet 200 mg F $$

nevirapine oral tablet extended release 24 hr 100 mg, 400 mg

F $$

NORVIR ORAL SOLUTION 80 MG/ML F $$$

NORVIR ORAL TABLET 100 MG F $$$

ODEFSEY ORAL TABLET 200‐25‐25 MG F $$$

PREZCOBIX ORAL TABLET 800‐150 MG‐MG F $$$

PREZISTA ORAL SUSPENSION 100 MG/ML F $$$

PREZISTA ORAL TABLET 150 MG, 400 MG, 600 MG, 75 MG, 800 MG

F $$$

RESCRIPTOR ORAL TABLET 200 MG F $$$

RESCRIPTOR ORAL TABLET, DISPERSIBLE 100 MG F $$$

REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG

F $$$

REYATAZ ORAL POWDER IN PACKET 50 MG F $$$

SELZENTRY ORAL TABLET 150 MG, 300 MG F $$$

stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg

F $$

stavudine oral recon soln 1 mg/ml F $$

STRIBILD ORAL TABLET 150‐150‐200‐300 MG F $$$



SUSTIVA ORAL CAPSULE 200 MG, 50 MG F $$$

SUSTIVA ORAL TABLET 600 MG F $$$

TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG F $$$

TRIUMEQ ORAL TABLET 600‐50‐300 MG F $$$

TRUVADA ORAL TABLET 100‐150 MG, 133‐200 MG, 167‐250 MG, 200‐300 MG

F $$$

TYBOST ORAL TABLET 150 MG F $$$

VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN 10 MG/ML (FINAL)

F $$$

VIDEX 4 GRAM PEDIATRIC ORAL RECON SOLN 10 MG/ML (FINAL)

F $$$

VIRACEPT ORAL TABLET 250 MG, 625 MG F $$$

VIREAD ORAL POWDER 40 MG/SCOOP (40 MG/GRAM)

F $$$

VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG, 300 MG

F $$$

VITEKTA ORAL TABLET 150 MG, 85 MG F $$$

ZIAGEN ORAL SOLUTION 20 MG/ML F $$$

zidovudine oral capsule 100 mg F $$

zidovudine oral syrup 10 mg/ml F $$

zidovudine oral tablet 300 mg F $$

Antiviral, Other

acyclovir oral capsule 200 mg F $$

acyclovir oral suspension 200 mg/5 ml F $$

acyclovir oral tablet 400 mg, 800 mg F $$

amantadine hcl oral capsule 100 mg F $$

amantadine hcl oral solution 50 mg/5 ml F $$

famciclovir oral tablet 125 mg, 250 mg, 500 mg F $$

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MG/ACTUATION

F $$$ QL

rimantadine oral tablet 100 mg F $$

TAMIFLU ORAL CAPSULE 30 MG, 45 MG, 75 MG F $$$ QL

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION 6 MG/ML

F $$$ QL

valacyclovir oral tablet 1 gram, 500 mg F $$

valganciclovir oral recon soln 50 mg/ml F $$

valganciclovir oral tablet 450 mg F $$



Tuberculosis

cycloserine oral capsule 250 mg F $$ PA

ethambutol oral tablet 100 mg, 400 mg F $$

isoniazid oral solution 50 mg/5 ml F $

isoniazid oral tablet 100 mg, 300 mg F $

PRIFTIN ORAL TABLET 150 MG F $$$ PA

pyrazinamide oral tablet 500 mg F $$

rifampin oral capsule 150 mg, 300 mg F $$

SIRTURO ORAL TABLET 100 MG F $$$ PA

TRECATOR ORAL TABLET 250 MG F $$$ PA

Urinary Anti‐Infectives

MONUROL ORAL PACKET 3 GRAM F $$$

nitrofurantoin macrocrystal oral capsule 100 mg, 50 mg

F $$ QL; AE

nitrofurantoin monohyd/m‐cryst oral capsule 100 mg

F $$ QL; AE

nitrofurantoin oral suspension 25 mg/5 ml F $$ QL; AE

Arthritis

Arthritis, Other

DEPEN TITRATABS ORAL TABLET 250 MG F $$$

Disease Modifying Agents

ENBREL SUBCUTANEOUS RECON SOLN 25 MG (1 ML)

F $$$ PA; Specialty

ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML)

F $$$ PA; Specialty

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR 50 MG/ML (0.98 ML)

F $$$ PA; Specialty

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML

F $$$ PA; Specialty

HUMIRA SUBCUTANEOUS SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML

F $$$ PA; Specialty

KINERET SUBCUTANEOUS SYRINGE 100 MG/0.67 ML

F $$$ PA; Specialty

leflunomide oral tablet 10 mg, 20 mg F $$

methotrexate sodium (pf) injection solution 25 mg/ml

F $$

methotrexate sodium injection solution 25 mg/ml F $$



methotrexate sodium oral tablet 2.5 mg F $$

RASUVO (PF) SUBCUTANEOUS AUTO‐INJECTOR10 MG/0.2 ML, 12.5 MG/0.25 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20 MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 27.5 MG/0.55 ML, 30 MG/0.6 ML, 7.5 MG/0.15 ML

F $$$ PA

RIDAURA ORAL CAPSULE 3 MG F $$$

Asthma & Copd

Asthma & Copd, Other

ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCG/ACTUATION

F $$$

cromolyn inhalation solution for nebulization 20 mg/2 ml

F $$

DALIRESP ORAL TABLET 500 MCG F $$$ PA

ipratropium bromide inhalation solution 0.02 % F $$

montelukast oral granules in packet 4 mg F $$

montelukast oral tablet 10 mg F $$

montelukast oral tablet,chewable 4 mg, 5 mg F $$

SPIRIVA RESPIMAT INHALATION MIST 1.25 MCG/ACTUATION, 2.5 MCG/ACTUATION

F $$$

SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE 18 MCG

F $$$

Bronchodilators, Inhaled

albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 5 mg/ml

F $$

FORADIL AEROLIZER INHALATION CAPSULE, W/INHALATION DEVICE 12 MCG

F $$$

SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCG/DOSE

F $$$

STRIVERDI RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION

F $$$

VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION

F $$$

Bronchodilators, Oral

albuterol sulfate oral syrup 2 mg/5 ml F $$

albuterol sulfate oral tablet 2 mg, 4 mg F $$

albuterol sulfate oral tablet extended release 12 hr 4 mg, 8 mg

F $$



LUFYLLIN ORAL TABLET 200 MG, 400 MG F $$$

terbutaline oral tablet 2.5 mg, 5 mg F $$

theophylline oral tablet extended release 12 hr100 mg, 200 mg, 300 mg, 450 mg

F $$

theophylline oral tablet extended release 400 mg, 600 mg

F $$

Combination Agents, Inhaled

ADVAIR DISKUS INHALATION BLISTER WITH DEVICE 100‐50 MCG/DOSE, 250‐50 MCG/DOSE, 500‐50 MCG/DOSE

F $$$

ADVAIR HFA INHALATION HFA AEROSOL INHALER 115‐21 MCG/ACTUATION, 230‐21 MCG/ACTUATION, 45‐21 MCG/ACTUATION

F $$$

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE 62.5‐25 MCG/ACTUATION

F $$$ PA

BREO ELLIPTA INHALATION BLISTER WITH DEVICE 100‐25 MCG/DOSE, 200‐25 MCG/DOSE

F $$$

COMBIVENT RESPIMAT INHALATION MIST20‐100 MCG/ACTUATION

F $$$

DULERA INHALATION HFA AEROSOL INHALER100‐5 MCG/ACTUATION, 200‐5 MCG/ACTUATION

F $$$ PA

ipratropium‐albuterol inhalation solution for nebulization 0.5 mg‐3 mg(2.5 mg base)/3 ml

F $$

Corticosteroids, Inhaled

ARNUITY ELLIPTA INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 200 MCG/ACTUATION

F $$$

ASMANEX HFA INHALATION HFA AEROSOL INHALER 100 MCG/ACTUATION, 200 MCG/ACTUATION

F $$$

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

F $$$

budesonide inhalation suspension for nebulization 0.25 mg/2 ml, 0.5 mg/2 ml, 1 mg/2 ml

F $$ AE

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 250 MCG/ACTUATION, 50 MCG/ACTUATION

F $$$



FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION, 220 MCG/ACTUATION, 44 MCG/ACTUATION

F $$$

PULMICORT FLEXHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 180 MCG/ACTUATION, 90 MCG/ACTUATION

F $$$

QVAR INHALATION AEROSOL 40 MCG/ACTUATION, 80 MCG/ACTUATION

F $$$

STIOLTO RESPIMAT INHALATION MIST 2.5‐2.5 MCG/ACTUATION

F $$$

Behavioral Health

Antipsychotic

aripiprazole oral solution 1 mg/ml F $$ AE

aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg

F $$ AE

aripiprazole oral tablet,disintegrating 10 mg, 15 mg

F $$ PA; AE

chlorpromazine oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg

F $$ AE

clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg

F $$ AE

clozapine oral tablet,disintegrating 100 mg, 12.5 mg, 150 mg, 200 mg, 25 mg

F $$ PA; AE

fluphenazine hcl oral concentrate 5 mg/ml F $ AE

fluphenazine hcl oral elixir 2.5 mg/5 ml F $ AE

fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg

F $ AE

haloperidol lactate oral concentrate 2 mg/ml F $ AE

haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg

F $ AE

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg

F $$ AE

NUPLAZID ORAL TABLET 17 MG F $$$ PA; Specialty

olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg

F $$ AE

olanzapine oral tablet,disintegrating 10 mg, 15 mg, 20 mg, 5 mg

F $$ PA; AE

perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg

F $$ AE



quetiapine oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg

F $$ AE

risperidone oral solution 1 mg/ml F $$ AE

risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

F $$ AE

risperidone oral tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

F $$ PA; AE

SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 150 MG, 200 MG, 300 MG, 400 MG, 50 MG

F $$$ PA; AE

thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg

F $$ AE

thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg F $$ AE

trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5 mg

F $$ AE

VERSACLOZ ORAL SUSPENSION 50 MG/ML F $$$ PA; AE

ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg

F $$ AE

Anxiety

alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg

F $ QL

alprazolam oral tablet extended release 24 hr 0.5 mg, 1 mg, 2 mg, 3 mg

F $$ QL

buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg

F $$

chlordiazepoxide hcl oral capsule 10 mg, 25 mg, 5 mg

F $ QL

clonazepam oral tablet 0.5 mg, 1 mg, 2 mg F $ QL

diazepam intensol oral concentrate 5 mg/ml F $ QL

diazepam oral solution 5 mg/5 ml (1 mg/ml) F $ QL

diazepam oral tablet 10 mg, 2 mg, 5 mg F $ QL

diazepam rectal kit 12.5‐15‐17.5‐20 mg, 2.5 mg, 5‐7.5‐10 mg

F $$ QL

lorazepam oral concentrate 2 mg/ml F $ QL

lorazepam oral tablet 0.5 mg, 1 mg, 2 mg F $ QL

Attention Deficit/Hyperactivity Disorder (Adhd)

adderall xr oral capsule,extended release 24hr 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 5 mg

F $$ QL



dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5 mg

F $$ QL

dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg

F $$ QL

dextroamphetamine oral tablet 10 mg, 5 mg F $$ QL

dextroamphetamine‐amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

F $$ QL

guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg

F $$ QL

methylphenidate oral capsule, er biphasic 30‐7010 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

F $$ QL

methylphenidate oral capsule,er biphasic 50‐5020 mg, 30 mg, 40 mg

F $$ QL

methylphenidate oral tablet 10 mg, 20 mg, 5 mg F $$ QL

methylphenidate oral tablet extended release 10 mg, 20 mg

F $$ QL

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

F $$ QL

QUILLIVANT XR ORAL SUSPENSION,EXT REL 24HR,RECON 5 MG/ML (25 MG/5 ML)

F $$$

STRATTERA ORAL CAPSULE 10 MG, 100 MG, 18 MG, 25 MG, 40 MG, 60 MG, 80 MG

F $$$ QL

VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG

F $$$ QL

Bipolar Disorder

divalproex oral capsule, sprinkle 125 mg F $$

divalproex oral tablet extended release 24 hr 250 mg, 500 mg

F $$

divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 mg

F $$

lithium carbonate oral capsule 150 mg, 300 mg, 600 mg

F $$

lithium carbonate oral tablet 300 mg F $$

lithium carbonate oral tablet extended release300 mg, 450 mg

F $$

lithium citrate oral solution 8 meq/5 ml F $$

Depression, Atypical Antidepressants

budeprion sr oral tablet extended release 150 mg F $$

bupropion hcl oral tablet 100 mg, 75 mg F $$



bupropion hcl oral tablet extended release 100 mg, 150 mg, 200 mg

F $$

bupropion hcl oral tablet extended release 24 hr150 mg, 300 mg

F $$

mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg

F $

Depression, Maois

phenelzine oral tablet 15 mg F $$

tranylcypromine oral tablet 10 mg F $$

Depression, Serotonin Modulators

nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg

F $$

trazodone oral tablet 100 mg, 150 mg, 300 mg, 50 mg

F $

Depression, Snris

duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg

F $$

venlafaxine oral capsule,extended release 24hr150 mg, 37.5 mg, 75 mg

F $$

venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

F $$

Depression, Ssris

citalopram oral solution 10 mg/5 ml F $

citalopram oral tablet 10 mg, 20 mg, 40 mg F $

escitalopram oxalate oral solution 5 mg/5 ml F $$

escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg

F $$

fluoxetine oral capsule 10 mg, 20 mg, 40 mg F $

fluoxetine oral solution 20 mg/5 ml (4 mg/ml) F $

fluvoxamine oral tablet 100 mg, 25 mg, 50 mg F $$

paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg

F $$

PAXIL ORAL SUSPENSION 10 MG/5 ML F $$$

sertraline oral concentrate 20 mg/ml F $

sertraline oral tablet 100 mg, 25 mg, 50 mg F $



Depression, Tricyclic & Tetracyclic Antidepressants

amitriptyline oral tablet 10 mg, 100 mg, 25 mg, 50 mg, 75 mg

F $$ AE

amitriptyline oral tablet 150 mg F $ AE

clomipramine oral capsule 25 mg, 50 mg, 75 mg F $$ AE

desipramine oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

F $$

doxepin oral capsule 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

F $$ AE

doxepin oral concentrate 10 mg/ml F $$ AE

imipramine hcl oral tablet 10 mg, 25 mg, 50 mg F $$ AE

nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg

F $$

nortriptyline oral solution 10 mg/5 ml F $$

Birth Control

Contraceptives, Other

NUVARING VAGINAL RING 0.12‐0.015 MG/24 HR

F $$$

xulane transdermal patch weekly 150‐35 mcg/24 hr

F $$

Emergency Contraception

ELLA ORAL TABLET 30 MG F $$$

levonorgestrel oral tablet 0.75 mg, 1.5 mg F $$

my way oral tablet 1.5 mg F $$

next choice one dose oral tablet 1.5 mg F $$

Oral Contraceptives

altavera (28) oral tablet 0.15‐0.03 mg F $$

alyacen 1/35 (28) oral tablet 1‐35 mg‐mcg F $$

alyacen 7/7/7 (28) oral tablet 0.5/0.75/1 mg‐ 35 mcg

F $$

apri oral tablet 0.15‐0.03 mg F $$

aranelle (28) oral tablet 0.5/1/0.5‐35 mg‐mcg F $$

aubra oral tablet 0.1‐20 mg‐mcg F $$

aviane oral tablet 0.1‐20 mg‐mcg F $$

azurette (28) oral tablet 0.15‐0.02 mgx21 /0.01 mg x 5

F $$



balziva (28) oral tablet 0.4‐35 mg‐mcg F $$

blisovi fe 1.5/30 (28) oral tablet 1.5 mg‐30 mcg (21)/75 mg (7)

F $$

blisovi fe 1/20 (28) oral tablet 1 mg‐20 mcg (21)/75 mg (7)

F $$

brevicon (28) oral tablet 0.5‐35 mg‐mcg F $$

briellyn oral tablet 0.4‐35 mg‐mcg F $$

camila oral tablet 0.35 mg F $$

caziant (28) oral tablet 0.1/.125/.15‐25 mg‐mcg F $$

cesia (28) oral tablet 0.1/.125/.15‐25 mg‐mcg F $$

chateal oral tablet 0.15‐0.03 mg F $$

cryselle (28) oral tablet 0.3‐30 mg‐mcg F $$

cyclafem 1/35 (28) oral tablet 1‐35 mg‐mcg F $$

cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg‐ 35 mcg

F $$

dasetta 1/35 (28) oral tablet 1‐35 mg‐mcg F $$

dasetta 7/7/7 (28) oral tablet 0.5/0.75/1 mg‐ 35 mcg

F $$

desogestrel‐ethinyl estradiol oral tablet 0.15‐0.03 mg

F $$

drospirenone‐ethinyl estradiol oral tablet 3‐0.03 mg

F $$

elinest oral tablet 0.3‐30 mg‐mcg F $$

emoquette oral tablet 0.15‐0.03 mg F $$

enpresse oral tablet 50‐30 (6)/75‐40 (5)/125‐30(10)

F $$

enskyce oral tablet 0.15‐0.03 mg F $$

errin oral tablet 0.35 mg F $$

estarylla oral tablet 0.25‐35 mg‐mcg F $$

falmina (28) oral tablet 0.1‐20 mg‐mcg F $$

gianvi (28) oral tablet 3‐0.02 mg F $$

gildagia oral tablet 0.4‐35 mg‐mcg F $$

gildess 1.5/30 (21) oral tablet 1.5‐30 mg‐mcg F $$

gildess 1/20 (21) oral tablet 1‐20 mg‐mcg F $$

gildess fe 1.5/30 (28) oral tablet 1.5 mg‐30 mcg (21)/75 mg (7)

F $$

gildess fe 1/20 (28) oral tablet 1 mg‐20 mcg (21)/75 mg (7)

F $$



heather oral tablet 0.35 mg F $$

introvale oral tablets,dose pack,3 month 0.15 mg‐30 mcg

F $$

jencycla oral tablet 0.35 mg F $$

jolessa oral tablets,dose pack,3 month 0.15 mg‐30 mcg

F $$

jolivette oral tablet 0.35 mg F $$

junel 1.5/30 (21) oral tablet 1.5‐30 mg‐mcg F $$

junel 1/20 (21) oral tablet 1‐20 mg‐mcg F $$

junel fe 1.5/30 (28) oral tablet 1.5 mg‐30 mcg (21)/75 mg (7)

F $$

junel fe 1/20 (28) oral tablet 1 mg‐20 mcg (21)/75 mg (7)

F $$

kariva (28) oral tablet 0.15‐0.02 mgx21 /0.01 mg x 5

F $$

kelnor 1/35 (28) oral tablet 1‐35 mg‐mcg F $$

kurvelo oral tablet 0.15‐0.03 mg F $$

larin 1/20 (21) oral tablet 1‐20 mg‐mcg F $$

larin fe 1.5/30 (28) oral tablet 1.5 mg‐30 mcg (21)/75 mg (7)

F $$

larin fe 1/20 (28) oral tablet 1 mg‐20 mcg (21)/75 mg (7)

F $$

leena 28 oral tablet 0.5/1/0.5‐35 mg‐mcg F $$

lessina oral tablet 0.1‐20 mg‐mcg F $$

levlen (28) oral tablet 0.15‐0.03 mg F $$

levonest (28) oral tablet 50‐30 (6)/75‐40 (5)/125‐30(10)

F $$

levonorgestrel‐ethinyl estrad oral tablet 0.1‐20 mg‐mcg, 0.15‐0.03 mg

F $$

levonorgestrel‐ethinyl estrad oral tablets,dose pack,3 month 0.15 mg‐30 mcg

F $$

levora‐28 oral tablet 0.15‐0.03 mg F $$

loryna (28) oral tablet 3‐0.02 mg F $$

low‐ogestrel (28) oral tablet 0.3‐30 mg‐mcg F $$

lutera (28) oral tablet 0.1‐20 mg‐mcg F $$

lyza oral tablet 0.35 mg F $$

marlissa oral tablet 0.15‐0.03 mg F $$



microgestin 1.5/30 (21) oral tablet 1.5‐30 mg‐mcg

F $$

microgestin 1/20 (21) oral tablet 1‐20 mg‐mcg F $$

microgestin fe 1.5/30 (28) oral tablet 1.5 mg‐30 mcg (21)/75 mg (7)

F $$

microgestin fe 1/20 (28) oral tablet 1 mg‐20 mcg (21)/75 mg (7)

F $$

mono‐linyah oral tablet 0.25‐35 mg‐mcg F $$

mononessa (28) oral tablet 0.25‐35 mg‐mcg F $$

myzilra oral tablet 50‐30 (6)/75‐40 (5)/125‐30(10)

F $$

necon 0.5/35 (28) oral tablet 0.5‐35 mg‐mcg F $$

necon 1/35 (28) oral tablet 1‐35 mg‐mcg F $$

necon 1/50 (28) oral tablet 1‐50 mg‐mcg F $$

necon 10/11 (28) oral tablet 0.5‐35/1‐35 mg‐mcg/mg‐mcg

F $$

necon 7/7/7 (28) oral tablet 0.5/0.75/1 mg‐ 35 mcg

F $$

nora‐be oral tablet 0.35 mg F $$

norethindrone (contraceptive) oral tablet 0.35 mg F $$

norgestimate‐ethinyl estradiol oral tablet0.18/0.215/0.25 mg‐25 mcg, 0.18/0.215/0.25 mg‐35 mcg (28), 0.25‐35 mg‐mcg

F $$

norinyl 1+35 (28) oral tablet 1‐35 mg‐mcg F $$

nortrel 0.5/35 (28) oral tablet 0.5‐35 mg‐mcg F $$

nortrel 1/35 (21) oral tablet 1‐35 mg‐mcg F $$

nortrel 1/35 (28) oral tablet 1‐35 mg‐mcg F $$

nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg‐ 35 mcg

F $$

ocella oral tablet 3‐0.03 mg F $$

ogestrel (28) oral tablet 0.5‐50 mg‐mcg F $$

orsythia oral tablet 0.1‐20 mg‐mcg F $$

philith oral tablet 0.4‐35 mg‐mcg F $$

pimtrea (28) oral tablet 0.15‐0.02 mgx21 /0.01 mg x 5

F $$

pirmella oral tablet 0.5/0.75/1 mg‐ 35 mcg, 1‐35 mg‐mcg

F $$

portia oral tablet 0.15‐0.03 mg F $$



previfem oral tablet 0.25‐35 mg‐mcg F $$

quasense oral tablets,dose pack,3 month 0.15 mg‐30 mcg

F $$

reclipsen (28) oral tablet 0.15‐0.03 mg F $$

sprintec (28) oral tablet 0.25‐35 mg‐mcg F $$

sronyx oral tablet 0.1‐20 mg‐mcg F $$

syeda oral tablet 3‐0.03 mg F $$

tilia fe oral tablet 1‐20(5)/1‐30(7) /1mg‐35mcg (9)

F $$

tri‐estarylla oral tablet 0.18/0.215/0.25 mg‐35 mcg (28)

F $$

tri‐legest fe oral tablet 1‐20(5)/1‐30(7) /1mg‐35mcg (9)

F $$

tri‐linyah oral tablet 0.18/0.215/0.25 mg‐35 mcg (28)

F $$

tri‐lo‐estarylla oral tablet 0.18/0.215/0.25 mg‐25 mcg

F $$

tri‐lo‐sprintec oral tablet 0.18/0.215/0.25 mg‐25 mcg

F $$

trinessa (28) oral tablet 0.18/0.215/0.25 mg‐35 mcg (28)

F $$

trinessa lo oral tablet 0.18/0.215/0.25 mg‐25 mcg

F $$

tri‐previfem (28) oral tablet 0.18/0.215/0.25 mg‐35 mcg (28)

F $$

tri‐sprintec (28) oral tablet 0.18/0.215/0.25 mg‐35 mcg (28)

F $$

trivora (28) oral tablet 50‐30 (6)/75‐40 (5)/125‐30(10)

F $$

velivet triphasic regimen (28) oral tablet0.1/.125/.15‐25 mg‐mcg

F $$

vestura (28) oral tablet 3‐0.02 mg F $$

viorele (28) oral tablet 0.15‐0.02 mgx21 /0.01 mg x 5

F $$

vyfemla (28) oral tablet 0.4‐35 mg‐mcg F $$

wera (28) oral tablet 0.5‐35 mg‐mcg F $$

zarah oral tablet 3‐0.03 mg F $$

zenchent (28) oral tablet 0.4‐35 mg‐mcg F $$

zovia 1/35e (28) oral tablet 1‐35 mg‐mcg F $$



zovia 1/50e (28) oral tablet 1‐50 mg‐mcg F $$

Bleeding Disorders

Bleeding Disorders, Hemophilia

STIMATE NASAL SPRAY,NON‐AEROSOL 150 MCG/SPRAY (0.1 ML)

F $$$ PA

Bleeding Disorders, Other

AMICAR ORAL TABLET 500 MG F $$$

aminocaproic acid oral solution 250 mg/ml (25 %) F $$

aminocaproic acid oral tablet 500 mg F $$

Blood Modifier

Blood Modifiers

ARANESP (IN POLYSORBATE) INJECTION SOLUTION 100 MCG/ML, 150 MCG/0.75 ML, 200 MCG/ML, 25 MCG/ML, 300 MCG/ML, 40 MCG/ML, 60 MCG/ML

F $$$ Specialty

ARANESP (IN POLYSORBATE) INJECTION SYRINGE 10 MCG/0.4 ML, 100 MCG/0.5 ML, 150 MCG/0.3 ML, 200 MCG/0.4 ML, 25 MCG/0.42 ML, 300 MCG/0.6 ML, 40 MCG/0.4 ML, 500 MCG/ML, 60 MCG/0.3 ML

F $$$ Specialty

GRANIX SUBCUTANEOUS SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML

F $$$ Specialty; ONC

LEUKINE INJECTION RECON SOLN 250 MCG F $$$ Specialty

NEULASTA SUBCUTANEOUS SYRINGE 6 MG/0.6ML

F $$$ Specialty

NEULASTA SUBCUTANEOUS SYRINGE, W/ WEARABLE INJECTOR 6 MG/0.6 ML

F $$$ Specialty

NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6 ML

F $$$ Specialty

NEUPOGEN INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML

F $$$ Specialty

PROCRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML

F $$$ Specialty

PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG

F $$$ PA; Specialty

ZARXIO INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML

F $$$ Specialty



Clotting Disorders

ADVATE INTRAVENOUS RECON SOLN 1,000 (+/‐) UNIT, 1,500 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 3,000 (+/‐) UNIT, 4,000 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

ADYNOVATE INTRAVENOUS SOLUTION 1,000 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

AFSTYLA INTRAVENOUS RECON SOLN 1,000 (+/‐) UNIT RANGE, 2,000 (+/‐) UNIT RANGE, 250 (+/‐) UNIT RANGE, 3,000 (+/‐) UNIT RANGE, 500 (+/‐) UNIT RANGE

F $$$ Specialty

ALPHANATE INTRAVENOUS RECON SOLN 1,000 (400 VWF) UNIT/10 ML, 1,500 (600 VWF) UNIT/10 ML, 2,000 (800 VWF) UNIT/10 ML, 250 (100 VWF) UNIT/5 ML, 500 (200 VWF) UNIT/5 ML

F $$$ Specialty

ALPHANINE SD INTRAVENOUS RECON SOLN1,000 (+/‐) UNIT, 1,500 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

ALPROLIX INTRAVENOUS RECON SOLN 1,000 UNIT, 2,000 UNIT, 250 UNIT, 3,000 UNIT, 500 UNIT

F $$$ Specialty

BEBULIN INTRAVENOUS RECON SOLN 700 (+/‐) UNIT

F $$$ Specialty

BENEFIX INTRAVENOUS KIT 1,000 UNIT, 2,000 UNIT, 250 UNIT, 3,000 UNIT, 500 UNIT

F $$$ Specialty

COAGADEX INTRAVENOUS RECON SOLN 250 (+/‐) UNIT RANGE, 500 (+/‐) UNIT RANGE

F $$$ Specialty

CORIFACT INTRAVENOUS KIT 1,000‐1,600 UNIT F $$$ Specialty

ELOCTATE INTRAVENOUS RECON SOLN 1,000 UNIT, 1,500 UNIT, 2,000 UNIT, 250 UNIT, 3,000 UNIT, 500 UNIT, 750 UNIT

F $$$ Specialty

FEIBA NF INTRAVENOUS RECON SOLN1,750‐3,250 UNIT, 400‐650 UNIT, 651‐1,200 UNIT

F $$$ Specialty

HELIXATE FS INTRAVENOUS RECON SOLN 1,000 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 3,000 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

HEMOFIL M HIGH INTRAVENOUS RECON SOLN801‐1,500 UNIT

F $$$ Specialty



HEMOFIL M LOW INTRAVENOUS RECON SOLN220‐400 UNIT

F $$$ Specialty

HEMOFIL M MID INTRAVENOUS RECON SOLN401‐800 UNIT

F $$$ Specialty

HEMOFIL M SUPER HIGH INTRAVENOUS RECON SOLN 1,501‐2,000 UNIT

F $$$ Specialty

HUMATE‐P INTRAVENOUS KIT 1,000‐2,400 UNIT, 250‐600 UNIT, 500‐1,200 UNIT

F $$$ Specialty

IDELVION INTRAVENOUS RECON SOLN 1,000 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

IXINITY INTRAVENOUS RECON SOLN 1,000 UNIT, 1,500 UNIT, 500 UNIT

F $$$ Specialty

KOATE‐DVI INTRAVENOUS RECON SOLN 1,000 (+/‐) UNIT, 250 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

KOGENATE FS INTRAVENOUS RECON SOLN1,000 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 3,000 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

MONOCLATE‐P INTRAVENOUS RECON SOLN1,000 (+/‐) UNIT, 1,500 (+/‐) UNIT

F $$$ Specialty

MONONINE INTRAVENOUS KIT 1,000 (+/‐) UNIT F $$$ Specialty

NOVOEIGHT INTRAVENOUS RECON SOLN 1,000 (+/‐) UNIT, 1,500 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 3,000 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

NOVOSEVEN RT INTRAVENOUS RECON SOLN 1 MG (1,000 MCG), 2 MG (2,000 MCG), 5 MG (5,000 MCG), 8 MG (8,000 MCG)

F $$$ Specialty

NUWIQ INTRAVENOUS RECON SOLN 1000 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

OBIZUR INTRAVENOUS RECON SOLN 500 (+/‐) UNIT RANGE

F $$$ Specialty

PLASMANATE INTRAVENOUS PARENTERAL SOLUTION 5 %

F $$$ Specialty

PROFILNINE INTRAVENOUS RECON SOLN 1,000 (+/‐) UNIT, 1,500 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

RECOMBINATE INTRAVENOUS RECON SOLN1,000 (+/‐) UNIT, 1,500 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty



RIXUBIS INTRAVENOUS RECON SOLN 1,000 UNIT, 2,000 UNIT, 250 UNIT, 3,000 UNIT, 500 UNIT

F $$$ Specialty

THROMBATE III INTRAVENOUS RECON SOLN 500 (+/‐) UNIT

F $$$ Specialty

TRETTEN INTRAVENOUS RECON SOLN 2,500 UNIT

F $$$ Specialty

VONVENDI INTRAVENOUS RECON SOLN 1,300 (+/‐) UNIT RANGE, 650 (+/‐) UNIT RANGE

F $$$ Specialty

WILATE INTRAVENOUS KIT 1,000‐1,000 UNIT, 450‐450 UNIT, 500‐500 UNIT, 900‐900 UNIT

F $$$ Specialty

WILATE INTRAVENOUS RECON SOLN1,000‐1,000 UNIT, 500‐500 UNIT

F $$$ Specialty

XYNTHA INTRAVENOUS SOLUTION 1,000 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

XYNTHA SOLOFUSE INTRAVENOUS SYRINGE1,000 (+/‐) UNIT, 2,000 (+/‐) UNIT, 250 (+/‐) UNIT, 3,000 (+/‐) UNIT, 500 (+/‐) UNIT

F $$$ Specialty

Blood Thinner

Anticoagulants

ELIQUIS ORAL TABLET 2.5 MG, 5 MG F $$$

enoxaparin subcutaneous solution 300 mg/3 ml F $$ QL

enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml

F $$ QL

fondaparinux subcutaneous syringe 10 mg/0.8 ml, 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml

F $$ PA

heparin (porcine) injection cartridge 5,000 unit/ml (1 ml)

F $$

heparin (porcine) injection solution 1,000 unit/ml, 10,000 unit/ml, 20,000 unit/ml, 5,000 unit/ml

F $$

heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml

F $$

jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

F $$

PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG

F $$$

warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

F $$



XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG F $$$

XARELTO ORAL TABLETS,DOSE PACK 15 MG (42)‐ 20 MG (9)

F $$$

Platelet Inhibitors

anagrelide oral capsule 0.5 mg, 1 mg F $$

aspirin‐dipyridamole oral capsule, er multiphase 12 hr 25‐200 mg

F $$

BRILINTA ORAL TABLET 60 MG, 90 MG F $$$

cilostazol oral tablet 100 mg, 50 mg F $$

clopidogrel oral tablet 75 mg F $$

dipyridamole oral tablet 25 mg, 50 mg, 75 mg F $$

EFFIENT ORAL TABLET 10 MG, 5 MG F $$$

pentoxifylline oral tablet extended release 400 mg

F $$

ZONTIVITY ORAL TABLET 2.08 MG F $$$ PA

Bone Health

Bone Health, Other

etidronate disodium oral tablet 200 mg, 400 mg F $$

Osteoporosis

alendronate oral solution 70 mg/75 ml F $

alendronate oral tablet 10 mg, 35 mg, 40 mg, 5 mg, 70 mg

F $

calcitonin (salmon) nasal spray,non‐aerosol 200 unit/actuation

F $$

FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE ‐ 600 MCG/2.4 ML

F $$$ PA; Specialty

FORTICAL NASAL SPRAY,NON‐AEROSOL 200 UNIT/ACTUATION

F $$$

ibandronate oral tablet 150 mg F $$

raloxifene oral tablet 60 mg F $$

Cancer

Cancer, Alkylating Agents

ALKERAN ORAL TABLET 2 MG F $$$

EMCYT ORAL CAPSULE 140 MG F $$$

GLEOSTINE ORAL CAPSULE 10 MG, 40 MG F $$$

HEXALEN ORAL CAPSULE 50 MG F $$$ Specialty; ONC

LEUKERAN ORAL TABLET 2 MG F $$$



lomustine oral capsule 10 mg, 100 mg, 40 mg F $$

MATULANE ORAL CAPSULE 50 MG F $$$ PA; Specialty; ONC

MYLERAN ORAL TABLET 2 MG F $$$

temozolomide oral capsule 100 mg, 140 mg, 180 mg, 20 mg, 250 mg, 5 mg

F $$ Specialty; ONC

VALCHLOR TOPICAL GEL 0.016 % F $$$ PA; Specialty; ONC; QL

Cancer, Antiandrogens

bicalutamide oral tablet 50 mg F $$

flutamide oral capsule 125 mg F $$

XTANDI ORAL CAPSULE 40 MG F $$$ PA; Specialty; TD; ONC

ZYTIGA ORAL TABLET 250 MG F $$$ PA; Specialty; TD; ONC

Cancer, Antimetabolites

capecitabine oral tablet 150 mg, 500 mg F $$ Specialty; ONC

hydroxyurea oral capsule 500 mg F $$

LONSURF ORAL TABLET 15‐6.14 MG, 20‐8.19 MG F $$$ PA; Specialty; ONC

mercaptopurine oral tablet 50 mg F $$

TABLOID ORAL TABLET 40 MG F $$$

Cancer, Aromatase Inhibitors

anastrozole oral tablet 1 mg F $$

exemestane oral tablet 25 mg F $$

letrozole oral tablet 2.5 mg F $$

Cancer, Hdac Inhibitors

ZOLINZA ORAL CAPSULE 100 MG F $$$ PA; Specialty; TD; ONC

Cancer, Immunosuppressives

AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG, 3 MG, 5 MG

F $$$ Specialty; TD; ONC

AFINITOR ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG


CYCLOPHOSPHAMIDE ORAL CAPSULE 25 MG, 50 MG

F $$$


F $$



POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG

F $$$ PA; Specialty; ONC



REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG


THALOMID ORAL CAPSULE 100 MG, 150 MG, 200 MG, 50 MG


Cancer, Interferons

SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG


Cancer, Natural And Semi‐Synthetic

etoposide oral capsule 50 mg F $$

HYCAMTIN INTRAVENOUS RECON SOLN 4 MG F $$$ Specialty; ONC

HYCAMTIN ORAL CAPSULE 0.25 MG, 1 MG F $$$ Specialty; ONC

Cancer, Other Agents

megestrol oral tablet 20 mg, 40 mg F $$

ODOMZO ORAL CAPSULE 200 MG F $$$ PA; Specialty; ONC

Cancer, Retinoids

tretinoin (chemotherapy) oral capsule 10 mg F $$ Specialty; ONC

Cancer, Serms

SOLTAMOX ORAL SOLUTION 10 MG/5 ML F $$$

tamoxifen oral tablet 10 mg, 20 mg F $$

Cancer, Signal Transduction Inhibitors

BOSULIF ORAL TABLET 100 MG, 500 MG F $$$ PA; Specialty; TD; ONC

CABOMETYX ORAL TABLET 20 MG, 40 MG, 60 MG


CAPRELSA ORAL TABLET 100 MG, 300 MG F $$$ Specialty; ONC

COMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG X1‐20 MG X1), 140 MG/DAY(80 MG X1‐20 MG X3), 60 MG/DAY (20 MG X 3/DAY)


COTELLIC ORAL TABLET 20 MG F $$$ PA; Specialty; ONC

ERIVEDGE ORAL CAPSULE 150 MG F $$$ PA; Specialty; TD; ONC

GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG F $$$ PA; Specialty; ONC

ICLUSIG ORAL TABLET 15 MG, 45 MG F $$$ PA; Specialty; ONC

imatinib oral tablet 100 mg, 400 mg F $$ Specialty; TD; ONC

IMBRUVICA ORAL CAPSULE 140 MG F $$$ PA; Specialty; ONC

INLYTA ORAL TABLET 1 MG, 5 MG F $$$ PA; Specialty; TD; ONC

IRESSA ORAL TABLET 250 MG F $$$ PA; Specialty; ONC

JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG

F $$$ PA; Specialty; TD; ONC



MEKINIST ORAL TABLET 0.5 MG, 2 MG F $$$ PA; Specialty; ONC

NEXAVAR ORAL TABLET 200 MG F $$$ Specialty; TD; ONC

NINLARO ORAL CAPSULE 2.3 MG, 3 MG, 4 MG F $$$ PA; Specialty; ONC

SPRYCEL ORAL TABLET 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG


STIVARGA ORAL TABLET 40 MG F $$$ PA; Specialty; ONC

SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG


TAFINLAR ORAL CAPSULE 50 MG, 75 MG F $$$ PA; Specialty; ONC

TARCEVA ORAL TABLET 100 MG, 150 MG, 25 MG F $$$ Specialty; TD; ONC

TASIGNA ORAL CAPSULE 150 MG, 200 MG F $$$ Specialty; TD; ONC

TYKERB ORAL TABLET 250 MG F $$$ Specialty; ONC

VOTRIENT ORAL TABLET 200 MG F $$$ Specialty; TD; ONC

XALKORI ORAL CAPSULE 200 MG, 250 MG F $$$ PA; Specialty; TD; ONC

ZELBORAF ORAL TABLET 240 MG F $$$ PA; Specialty; ONC

Corticosteroids

Corticosteroids, Oral

DEXAMETHASONE INTENSOL ORAL DROPS 1 MG/ML

F $$$

dexamethasone oral elixir 0.5 mg/5 ml F $

dexamethasone oral solution 0.5 mg/5 ml F $

dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg

F $

fludrocortisone oral tablet 0.1 mg F $$

hydrocortisone oral tablet 10 mg, 20 mg, 5 mg F $$

MEDROL ORAL TABLET 2 MG F $$$

methylprednisolone oral tablet 16 mg, 32 mg, 4 mg, 8 mg

F $$

methylprednisolone oral tablets,dose pack 4 mg F $$

MILLIPRED ORAL TABLET 5 MG F $$$

prednisolone oral solution 15 mg/5 ml F $$

prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml)

F $$

PREDNISONE INTENSOL ORAL CONCENTRATE 5 MG/ML

F $$$

prednisone oral solution 5 mg/5 ml F $



prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg

F $

prednisone oral tablets,dose pack 10 mg, 5 mg F $

Cough & Cold

Cough & Cold

benzonatate oral capsule 100 mg, 200 mg F $

codeine‐guaifenesin oral liquid 10‐100 mg/5 ml F $ QL; AE

guaiatussin ac oral liquid 10‐100 mg/5 ml F $ QL; AE

promethazine vc oral syrup 6.25‐5 mg/5 ml F $

promethazine‐dm oral syrup 6.25‐15 mg/5 ml F $

Cystic Fibrosis

Cystic Fibrosis

acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %)

F $$

CAYSTON INHALATION SOLUTION FOR NEBULIZATION 75 MG/ML

F $$$ PA; Specialty

KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG

F $$$ PA; Specialty

KALYDECO ORAL TABLET 150 MG F $$$ PA; Specialty

ORKAMBI ORAL TABLET 200‐125 MG F $$$ PA; Specialty

PULMOZYME INHALATION SOLUTION 1 MG/ML F $$$ PA; Specialty; QL

tobramycin in 0.225 % nacl inhalation solution for nebulization 300 mg/5 ml

F $$ PA; Specialty

Dementia

Dementia

donepezil oral tablet 10 mg, 5 mg F $$

donepezil oral tablet,disintegrating 10 mg, 5 mg F $$

galantamine oral capsule,ext rel. pellets 24 hr 16 mg, 24 mg, 8 mg

F $$

galantamine oral solution 4 mg/ml F $$

galantamine oral tablet 12 mg, 4 mg, 8 mg F $$

memantine oral solution 2 mg/ml F $$

memantine oral tablet 10 mg, 5 mg F $$

memantine oral tablets,dose pack 5‐10 mg F $$

rivastigmine tartrate oral capsule 1.5 mg, 3 mg, 4.5 mg, 6 mg

F $$



Diabetes

Diabetes, Alpha‐Glucosidase Inhibitors

acarbose oral tablet 100 mg, 25 mg, 50 mg F $$

miglitol oral tablet 100 mg, 25 mg, 50 mg F $$

Diabetes, Biguanides

metformin oral tablet 1,000 mg, 500 mg, 850 mg F $

metformin oral tablet extended release 24 hr 500 mg, 750 mg

F $

Diabetes, Dpp‐4 Inhibitor / Biguanide Combinations

JENTADUETO ORAL TABLET 2.5‐1,000 MG, 2.5‐500 MG, 2.5‐850 MG

F $$$

JENTADUETO XR ORAL TABLET, IR ‐ ER, BIPHASIC 24HR 2.5‐1,000 MG, 5‐1,000 MG

F $$$

Diabetes, Dpp‐4 Inhibitors

TRADJENTA ORAL TABLET 5 MG F $$$

Diabetes, Glp‐1 Agonists

BYDUREON SUBCUTANEOUS PEN INJECTOR 2 MG/0.65 ML

F $$$ QL

BYDUREON SUBCUTANEOUS SUSPENSION,EXTENDED REL RECON 2 MG

F $$$ QL

BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML, 5 MCG/DOSE (250 MCG/ML) 1.2 ML

F $$$ QL

TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML, 1.5 MG/0.5 ML

F $$$ PA; QL

VICTOZA 2‐PAK SUBCUTANEOUS PEN INJECTOR0.6 MG/0.1 ML (18 MG/3 ML)

F $$$ QL

VICTOZA 3‐PAK SUBCUTANEOUS PEN INJECTOR0.6 MG/0.1 ML (18 MG/3 ML)

F $$$ QL

Diabetes, Intermediate‐Acting Insulins

HUMULIN N KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

F $$$

HUMULIN N PEN SUBCUTANEOUS INSULIN PEN100 UNIT/ML (3 ML)

F $$$

HUMULIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML

F $$$



Diabetes, Long‐Acting Insulins

LANTUS SOLOSTAR SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

F $$$

LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML

F $$$

LEVEMIR FLEXTOUCH SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML)

F $$$ ST

LEVEMIR SUBCUTANEOUS SOLUTION 100 UNIT/ML

F $$$ ST

TOUJEO SOLOSTAR SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (1.5 ML)

F $$$

Diabetes, Meglitinides

nateglinide oral tablet 120 mg, 60 mg F $$

repaglinide oral tablet 0.5 mg, 1 mg, 2 mg F $$

Diabetes, Other Oral Agents

CYCLOSET ORAL TABLET 0.8 MG F $$$ PA

Diabetes, Pre‐Mixed Insulins

HUMALOG MIX 50‐50 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (50‐50)

F $$$

HUMALOG MIX 50‐50 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (50‐50)

F $$$

HUMALOG MIX 75‐25 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (75‐25)

F $$$

HUMALOG MIX 75‐25 SUBCUTANEOUS SUSPENSION 100 UNIT/ML (75‐25)

F $$$

HUMULIN 70/30 KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70‐30)

F $$$

HUMULIN 70/30 PEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70‐30)

F $$$

HUMULIN 70/30 SUBCUTANEOUS SUSPENSION100 UNIT/ML (70‐30)

F $$$

Diabetes, Rapid‐Acting Insulins

HUMALOG KWIKPEN SUBCUTANEOUS INSULIN PEN 100 UNIT/ML, 200 UNIT/ML (3 ML)

F $$$

HUMALOG SUBCUTANEOUS CARTRIDGE 100 UNIT/ML

F $$$



HUMALOG SUBCUTANEOUS SOLUTION 100 UNIT/ML

F $$$

Diabetes, Rescue Agents

GLUCAGEN HYPOKIT INJECTION RECON SOLN 1 MG

F $$$

GLUCAGEN INJECTION RECON SOLN 1 MG F $$$

GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT 1 MG

F $$$

Diabetes, Sglt2 Inhibitor / Biguanide Combinations

INVOKAMET ORAL TABLET 150‐1,000 MG, 150‐500 MG, 50‐1,000 MG, 50‐500 MG

F $$$ ST

SYNJARDY ORAL TABLET 12.5‐1,000 MG, 12.5‐500 MG, 5‐1,000 MG, 5‐500 MG

F $$$ ST

Diabetes, Sglt2 Inhibitors

INVOKANA ORAL TABLET 100 MG, 300 MG F $$$ ST

JARDIANCE ORAL TABLET 10 MG, 25 MG F $$$ ST

Diabetes, Short‐Acting Insulins

HUMULIN R INJECTION SOLUTION 100 UNIT/ML F $$$

HUMULIN R U‐500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML (3 ML)

F $$$

HUMULIN R U‐500 (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML

F $$$

Diabetes, Sulfonylurea / Biguanide Combination

glipizide‐metformin oral tablet 2.5‐250 mg, 2.5‐500 mg, 5‐500 mg

F $$

Diabetes, Sulfonylureas

glimepiride oral tablet 1 mg, 2 mg, 4 mg F $

glipizide oral tablet 10 mg, 5 mg F $$

glipizide oral tablet extended release 24hr 10 mg, 2.5 mg, 5 mg

F $$

glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg

F $$ GE Female; AE

glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg F $$ GE Female; AE



Diabetes, Thiazolidinedione / Biguanide Combinations

pioglitazone‐metformin oral tablet 15‐500 mg, 15‐850 mg

F $$

Diabetes, Thiazolidinedione / Sulfonylurea Combinations

pioglitazone‐glimepiride oral tablet 30‐2 mg, 30‐4 mg

F $$

Diabetes, Thiazolidinediones

pioglitazone oral tablet 15 mg, 30 mg, 45 mg F $$

Ear Conditions

Anti‐Infectives, Ear

acetic acid otic solution 2 % F $$

CIPRO HC OTIC DROPS,SUSPENSION 0.2‐1 % F $$$

CIPRODEX OTIC DROPS,SUSPENSION 0.3‐0.1 % F $$$

neomycin‐polymyxin‐hc otic drops,suspension3.5‐10,000‐1 mg/ml‐unit/ml‐%

F $$

neomycin‐polymyxin‐hc otic solution 3.5‐10,000‐1 mg/ml‐unit/ml‐%

F $$

ofloxacin otic drops 0.3 % F $$

Ear Conditions, Other

antipyrine‐benzocaine otic drops 5.4‐1.4 % F $$

fluocinolone acetonide oil otic drops 0.01 % F $$

Enzyme Replacement

Enzyme Replacement

CERDELGA ORAL CAPSULE 84 MG F $$$ PA; Specialty

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000‐38,000 ‐60,000 UNIT, 24,000‐76,000 ‐120,000 UNIT, 3,000‐9,500‐ 15,000 UNIT, 36,000‐114,000‐ 180,000 UNIT, 6,000‐19,000 ‐30,000 UNIT

F $$$

STRENSIQ SUBCUTANEOUS SOLUTION 100 MG/ML, 40 MG/ML

F $$$ PA; Specialty

SUCRAID ORAL SOLUTION 8,500 UNIT/ML F $$$ PA; Specialty

ZAVESCA ORAL CAPSULE 100 MG F $$$ PA; Specialty



Eye Conditions

Anti‐Infectives, Eye

bacitracin ophthalmic ointment 500 unit/gram F $$

bacitracin‐polymyxin b ophthalmic ointment500‐10,000 unit/gram

F $$

BESIVANCE OPHTHALMIC DROPS,SUSPENSION0.6 %

F $$$ PA

BLEPHAMIDE S.O.P. OPHTHALMIC OINTMENT10‐0.2 %

F $$$

CILOXAN OPHTHALMIC OINTMENT 0.3 % F $$$

ciprofloxacin hcl ophthalmic drops 0.3 % F $

erythromycin ophthalmic ointment 5 mg/gram (0.5 %)

F $$

gentamicin ophthalmic ointment 0.3 % (3 mg/gram)

F $$

neomycin‐bacitracin‐polymyxin ophthalmic ointment 3.5‐400‐10,000 mg‐unit‐unit/g

F $$

neomycin‐polymyxin‐gramicidin ophthalmic drops 1.75 mg‐10,000 unit‐0.025mg/ml

F $$

ofloxacin ophthalmic drops 0.3 % F $$

polymyxin b sulf‐trimethoprim ophthalmic drops10,000 unit‐ 1 mg/ml

F $$

sulfacetamide sodium ophthalmic drops 10 % F $$

sulfacetamide sodium ophthalmic ointment 10 % F $$

sulfacetamide‐prednisolone ophthalmic drops 10 %‐0.23 % (0.25 %)

F $$

TOBRADEX OPHTHALMIC OINTMENT 0.3‐0.1 % F $$$

tobramycin ophthalmic drops 0.3 % F $$

tobramycin‐dexamethasone ophthalmic drops,suspension 0.3‐0.1 %

F $$

TOBREX OPHTHALMIC OINTMENT 0.3 % F $$$

trifluridine ophthalmic drops 1 % F $$

ZIRGAN OPHTHALMIC GEL 0.15 % F $$$

Anti‐Inflammatories, Eye

bromfenac ophthalmic drops 0.09 % F $$

dexamethasone sodium phosphate ophthalmic drops 0.1 %

F $

diclofenac sodium ophthalmic drops 0.1 % F $$



fluorometholone ophthalmic drops,suspension0.1 %

F $

flurbiprofen sodium ophthalmic drops 0.03 % F $

FML S.O.P. OPHTHALMIC OINTMENT 0.1 % F $$$

ketorolac ophthalmic drops 0.4 %, 0.5 % F $

PRED FORTE OPHTHALMIC DROPS,SUSPENSION1 %

F $$$

PRED MILD OPHTHALMIC DROPS,SUSPENSION0.12 %

F $$$

prednisolone acetate ophthalmic drops,suspension 1 %

F $$

prednisolone sodium phosphate ophthalmic drops 1 %

F $$

Eye Conditions, Other

atropine ophthalmic drops 1 % F $

atropine ophthalmic ointment 1 % F $

cyclopentolate ophthalmic drops 1 % F $$

CYSTARAN OPHTHALMIC DROPS 0.44 % F $$$ PA; Specialty

homatropaire ophthalmic drops 5 % F $$

phenylephrine hcl ophthalmic drops 10 %, 2.5 % F $$

RESTASIS OPHTHALMIC DROPPERETTE 0.05 % F $$$

Glaucoma

acetazolamide oral capsule, extended release 500 mg

F $$

acetazolamide oral tablet 125 mg, 250 mg F $$

betaxolol ophthalmic drops 0.5 % F $$

bimatoprost ophthalmic drops 0.03 % F $$

brimonidine ophthalmic drops 0.15 %, 0.2 % F $$

carteolol ophthalmic drops 1 % F $$

COSOPT (PF) OPHTHALMIC DROPPERETTE 2‐0.5 %

F $$$ PA

dorzolamide ophthalmic drops 2 % F $$

dorzolamide‐timolol ophthalmic drops 22.3‐6.8 mg/ml

F $$

latanoprost ophthalmic drops 0.005 % F $$

levobunolol ophthalmic drops 0.5 % F $$

LUMIGAN OPHTHALMIC DROPS 0.01 % F $$$



methazolamide oral tablet 25 mg, 50 mg F $$

pilocarpine hcl ophthalmic drops 1 %, 2 %, 4 % F $$

timolol maleate ophthalmic drops 0.25 %, 0.5 % F $

timolol maleate ophthalmic gel forming solution0.25 %, 0.5 %

F $

TRAVATAN Z OPHTHALMIC DROPS 0.004 % F $$$

travoprost (benzalkonium) ophthalmic drops0.004 %

F $$

ZIOPTAN (PF) OPHTHALMIC DROPPERETTE0.0015 %

F $$$ PA

Gout

Gout

allopurinol oral tablet 100 mg, 300 mg F $$

colchicine oral capsule 0.6 mg F $$

colchicine oral tablet 0.6 mg F $$

colchicine‐probenecid oral tablet 0.5‐500 mg F $$

probenecid oral tablet 500 mg F $$

ULORIC ORAL TABLET 40 MG, 80 MG F $$$ ST

Heart Health

Angina

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg

F $$

isosorbide dinitrate oral tablet extended release40 mg

F $$

isosorbide mononitrate oral tablet 10 mg, 20 mg F $$

isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 mg, 60 mg

F $$

NITRO‐BID TRANSDERMAL OINTMENT 2 % F $$$

nitroglycerin sublingual tablet 0.3 mg, 0.4 mg, 0.6 mg

F $$

nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

F $$

Antiarrhythmics

amiodarone oral tablet 100 mg, 200 mg, 400 mg F $$

disopyramide phosphate oral capsule 100 mg, 150 mg

F $$



dofetilide oral capsule 125 mcg, 250 mcg, 500 mcg

F $$

flecainide oral tablet 100 mg, 150 mg, 50 mg F $$

mexiletine oral capsule 150 mg, 200 mg, 250 mg F $$

MULTAQ ORAL TABLET 400 MG F $$$ PA

NORPACE CR ORAL CAPSULE, EXTENDED RELEASE 100 MG, 150 MG

F $$$

propafenone oral tablet 150 mg, 225 mg, 300 mg F $$

quinidine gluconate oral tablet extended release324 mg

F $$

quinidine sulfate oral tablet 200 mg, 300 mg F $$

quinidine sulfate oral tablet extended release 300 mg

F $$

sotalol af oral tablet 120 mg, 160 mg, 80 mg F $$

sotalol oral tablet 120 mg, 160 mg, 240 mg, 80 mg

F $$

Blood Pressure, Acei & Arb

amlodipine‐benazepril oral capsule 10‐20 mg, 10‐40 mg, 2.5‐10 mg, 5‐10 mg, 5‐20 mg, 5‐40 mg

F $$

amlodipine‐valsartan oral tablet 10‐160 mg, 10‐320 mg, 5‐160 mg, 5‐320 mg

F $$ ST

amlodipine‐valsartan‐hcthiazid oral tablet10‐160‐12.5 mg, 10‐160‐25 mg, 10‐320‐25 mg, 5‐160‐12.5 mg, 5‐160‐25 mg

F $$ ST

benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg F $

benazepril‐hydrochlorothiazide oral tablet10‐12.5 mg, 20‐12.5 mg, 20‐25 mg, 5‐6.25 mg

F $$

captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg

F $

captopril‐hydrochlorothiazide oral tablet 25‐15 mg, 25‐25 mg, 50‐15 mg, 50‐25 mg

F $$

enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg

F $$

enalapril‐hydrochlorothiazide oral tablet 10‐25 mg, 5‐12.5 mg

F $

fosinopril oral tablet 10 mg, 20 mg, 40 mg F $$

fosinopril‐hydrochlorothiazide oral tablet 10‐12.5 mg, 20‐12.5 mg

F $$

irbesartan oral tablet 150 mg, 300 mg, 75 mg F $$



irbesartan‐hydrochlorothiazide oral tablet150‐12.5 mg, 300‐12.5 mg

F $$

lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg

F $

lisinopril‐hydrochlorothiazide oral tablet 10‐12.5 mg, 20‐12.5 mg, 20‐25 mg

F $

losartan oral tablet 100 mg, 25 mg, 50 mg F $

losartan‐hydrochlorothiazide oral tablet 100‐12.5 mg, 100‐25 mg, 50‐12.5 mg

F $

moexipril oral tablet 15 mg, 7.5 mg F $$

moexipril‐hydrochlorothiazide oral tablet 15‐12.5 mg, 15‐25 mg, 7.5‐12.5 mg

F $$

perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg

F $$

quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg F $

quinapril‐hydrochlorothiazide oral tablet 10‐12.5 mg, 20‐12.5 mg, 20‐25 mg

F $$

ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg

F $

trandolapril oral tablet 1 mg, 2 mg, 4 mg F $$

valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg

F $$

valsartan‐hydrochlorothiazide oral tablet160‐12.5 mg, 160‐25 mg, 320‐12.5 mg, 320‐25 mg, 80‐12.5 mg

F $$

Blood Pressure, Beta Blockers

atenolol oral tablet 100 mg, 25 mg, 50 mg F $

atenolol‐chlorthalidone oral tablet 100‐25 mg, 50‐25 mg

F $$

bisoprolol fumarate oral tablet 10 mg, 5 mg F $$

bisoprolol‐hydrochlorothiazide oral tablet 10‐6.25 mg, 2.5‐6.25 mg, 5‐6.25 mg

F $

carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg

F $

COREG CR ORAL CAPSULE, ER MULTIPHASE 24 HR 10 MG, 20 MG, 40 MG, 80 MG

F $$$ ST

labetalol oral tablet 100 mg, 200 mg, 300 mg F $$

metoprolol succinate oral tablet extended release 24 hr 100 mg, 200 mg, 25 mg, 50 mg

F $$



metoprolol ta‐hydrochlorothiaz oral tablet100‐25 mg, 100‐50 mg, 50‐25 mg

F $$

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

F $$

nadolol oral tablet 20 mg, 40 mg, 80 mg F $$

propranolol oral capsule,extended release 24 hr120 mg, 160 mg, 60 mg, 80 mg

F $$

propranolol oral solution 20 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml)

F $$

propranolol oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

F $$

propranolol‐hydrochlorothiazid oral tablet 40‐25 mg, 80‐25 mg

F $$

Blood Pressure, Calcium Channel Blockers

amlodipine oral tablet 10 mg, 2.5 mg, 5 mg F $

amlodipine‐benazepril oral capsule 10‐20 mg, 10‐40 mg, 2.5‐10 mg, 5‐10 mg, 5‐20 mg, 5‐40 mg

F $$

amlodipine‐valsartan oral tablet 10‐160 mg, 10‐320 mg, 5‐160 mg, 5‐320 mg

F $$ ST

amlodipine‐valsartan‐hcthiazid oral tablet10‐160‐12.5 mg, 10‐160‐25 mg, 10‐320‐25 mg, 5‐160‐12.5 mg, 5‐160‐25 mg

F $$ ST

cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 mg, 300 mg

F $$

diltia xt oral capsule,ext release degradable 120 mg, 240 mg

F $$

diltiazem hcl oral capsule, extended release 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

F $$

diltiazem hcl oral capsule,ext release degradable120 mg, 180 mg, 240 mg

F $$

diltiazem hcl oral capsule,extended release 12 hr120 mg, 60 mg, 90 mg

F $$

diltiazem hcl oral capsule,extended release 24hr120 mg, 180 mg, 240 mg, 300 mg, 360 mg

F $$

diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg

F $$

dilt‐xr oral capsule,ext release degradable 120 mg, 180 mg

F $$



nifedipine oral tablet extended release 24hr 30 mg, 60 mg, 90 mg

F $$

nifedipine oral tablet extended release 30 mg, 60 mg, 90 mg

F $$

nimodipine oral capsule 30 mg F $$

taztia xt oral capsule, extended release 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

F $$

verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg, 360 mg

F $$

verapamil oral tablet 120 mg, 40 mg, 80 mg F $$

verapamil oral tablet extended release 120 mg, 180 mg, 240 mg

F $$

Blood Pressure, Other

clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg F $$

clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr, 0.3 mg/24 hr

F $$

doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg F $

guanfacine oral tablet 1 mg, 2 mg F $

hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg

F $$

methyldopa oral tablet 250 mg, 500 mg F $$

midodrine oral tablet 10 mg, 2.5 mg, 5 mg F $$

minoxidil oral tablet 10 mg, 2.5 mg F $$

phenoxybenzamine oral capsule 10 mg F $$ PA

prazosin oral capsule 1 mg, 2 mg, 5 mg F $$

reserpine oral tablet 0.1 mg, 0.25 mg F $$

terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg F $

Cholesterol Lowering, Bile Acid Resins

cholestyramine (with sugar) oral powder 4 gram F $$

cholestyramine (with sugar) oral powder in packet 4 gram

F $$

cholestyramine light oral powder 4 gram F $$

cholestyramine light oral powder in packet 4 gram

F $$

colestipol oral tablet 1 gram F $$

prevalite oral powder 4 gram F $$

prevalite oral powder in packet 4 gram F $$



Cholesterol Lowering, Other

JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 5 MG, 60 MG

F $$$ PA; Specialty

KYNAMRO SUBCUTANEOUS SYRINGE 200 MG/ML

F $$$ PA; Specialty

REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR 420 MG/3.5 ML

F $$$ PA; Specialty

REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR 140 MG/ML

F $$$ PA; Specialty

REPATHA SYRINGE SUBCUTANEOUS SYRINGE140 MG/ML

F $$$ PA; Specialty

ZETIA ORAL TABLET 10 MG F $$$

Cholesterol Lowering, Statins

atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg

F $$

lovastatin oral tablet 10 mg, 20 mg, 40 mg F $

pravastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg

F $

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

F $$

simvastatin oral tablet 10 mg, 20 mg, 5 mg F $

simvastatin oral tablet 40 mg F $ QL

simvastatin oral tablet 80 mg F $ PA

Diuretics


F $$


amiloride oral tablet 5 mg F $$

amiloride‐hydrochlorothiazide oral tablet 5‐50 mg

F $$

bumetanide oral tablet 0.5 mg, 1 mg, 2 mg F $

chlorothiazide oral tablet 250 mg, 500 mg F $$

chlorthalidone oral tablet 25 mg, 50 mg F $$

eplerenone oral tablet 25 mg, 50 mg F $$ PA

furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml)

F $

furosemide oral tablet 20 mg, 40 mg, 80 mg F $

hydrochlorothiazide oral capsule 12.5 mg F $



hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg

F $

indapamide oral tablet 1.25 mg, 2.5 mg F $

metolazone oral tablet 10 mg, 2.5 mg, 5 mg F $$

spironolactone oral tablet 100 mg, 25 mg, 50 mg F $$

spironolacton‐hydrochlorothiaz oral tablet 25‐25 mg

F $$

torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg

F $$

triamterene‐hydrochlorothiazid oral capsule37.5‐25 mg, 50‐25 mg

F $

triamterene‐hydrochlorothiazid oral tablet37.5‐25 mg, 75‐50 mg

F $

Heart Health, Other

DIGOXIN ORAL SOLUTION 50 MCG/ML F $$$

digoxin oral tablet 125 mcg F $

digoxin oral tablet 250 mcg F $ AE

ENTRESTO ORAL TABLET 24‐26 MG, 49‐51 MG, 97‐103 MG

F $$$

klor‐con m10 oral tablet,er particles/crystals 10 meq

F $$

klor‐con m15 oral tablet,er particles/crystals 15 meq

F $$

KLOR‐CON/25 ORAL PACKET 25 MEQ F $$$

potassium chloride oral capsule, extended release10 meq, 8 meq

F $$

potassium chloride oral liquid 20 meq/15 ml, 40 meq/15 ml

F $$

potassium chloride oral packet 20 meq F $$

potassium chloride oral tablet extended release10 meq, 8 meq

F $$

potassium chloride oral tablet,er particles/crystals 10 meq, 20 meq

F $$

potassium cl er 20 meq tablet 20 meq F $$

Triglyceride Lowering

fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg

F $$

fenofibrate nanocrystallized oral tablet 145 mg, 48 mg

F $$



fenofibrate oral tablet 160 mg, 54 mg F $$

gemfibrozil oral tablet 600 mg F $$

omega‐3 acid ethyl esters oral capsule 1 gram F $$ ST

VASCEPA ORAL CAPSULE 1 GRAM F $$$ ST

Hereditary Angioedema

Hereditary Angioedema

BERINERT INTRAVENOUS KIT 500 UNIT (10 ML) F $$$ PA; Specialty

BERINERT INTRAVENOUS RECON SOLN 500 UNIT (10 ML)

F $$$ PA; Specialty

CINRYZE INTRAVENOUS RECON SOLN 500 UNIT (5 ML)

F $$$ PA; Specialty

FIRAZYR SUBCUTANEOUS SYRINGE 30 MG/3 ML F $$$ PA; Specialty; QL

KALBITOR SUBCUTANEOUS SOLUTION 10 MG/ML (1 ML)

F $$$ PA; Specialty

RUCONEST INTRAVENOUS RECON SOLN 2,100 UNIT

F $$$ PA; Specialty

Idiopathic Pulmonary Fibrosis

Idiopathic Pulmonary Fibrosis

ESBRIET ORAL CAPSULE 267 MG F $$$ PA; Specialty

OFEV ORAL CAPSULE 100 MG, 150 MG F $$$ PA; Specialty

Immune Deficiency

Immune Deficiency

BIVIGAM INTRAVENOUS SOLUTION 10 % F $$$ PA; Specialty

CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN 12 GRAM, 6 GRAM

F $$$ PA; Specialty

FLEBOGAMMA DIF INTRAVENOUS SOLUTION 10 %, 5 %

F $$$ PA; Specialty

GAMASTAN S/D INTRAMUSCULAR SOLUTION15‐18 % RANGE

F $$$ PA; Specialty

GAMMAGARD LIQUID INJECTION SOLUTION 10 %

F $$$ PA; Specialty

GAMMAGARD S/D INTRAVENOUS RECON SOLN10 GRAM, 5 GRAM

F $$$ PA; Specialty

GAMMAGARD S‐D (IGA < 1 MCG/ML) INTRAVENOUS RECON SOLN 10 GRAM, 5 GRAM

F $$$ PA; Specialty



GAMMAKED INJECTION SOLUTION 1 GRAM/10 ML (10 %), 10 GRAM/100 ML (10 %), 2.5 GRAM/25 ML (10 %), 20 GRAM/200 ML (10 %), 5 GRAM/50 ML (10 %)

F $$$ PA; Specialty

GAMMAPLEX INTRAVENOUS SOLUTION 5 % F $$$ PA; Specialty

GAMUNEX‐C INJECTION SOLUTION 1 GRAM/10 ML (10 %), 10 GRAM/100 ML (10 %), 2.5 GRAM/25 ML (10 %), 20 GRAM/200 ML (10 %), 40 GRAM/400 ML (10 %), 5 GRAM/50 ML (10 %)

F $$$ PA; Specialty

HIZENTRA SUBCUTANEOUS SOLUTION 1 GRAM/5 ML (20 %), 10 GRAM/50 ML (20 %), 2 GRAM/10 ML (20 %), 4 GRAM/20 ML (20 %)

F $$$ PA; Specialty

HYQVIA HY COMPONENT SUBCUTANEOUS SOLUTION 1,600 UNIT/10 ML, 2,400 UNIT/15 ML, 200 UNIT/1.25 ML, 400 UNIT/2.5 ML, 800 UNIT/5 ML

F $$$ PA; Specialty

HYQVIA IG COMPONENT SUBCUTANEOUS SOLUTION 10 GRAM/100 ML (10 %), 2.5 GRAM/25 ML (10 %), 20 GRAM/200 ML (10 %), 30 GRAM/300 ML (10 %), 5 GRAM/50 ML (10 %)

F $$$ PA; Specialty

HYQVIA SUBCUTANEOUS SOLUTION 10 GRAM /100 ML (10 %), 2.5 GRAM /25 ML (10 %), 20 GRAM /200 ML (10 %), 30 GRAM /300 ML (10 %), 5 GRAM /50 ML (10 %)

F $$$ PA; Specialty

OCTAGAM INTRAVENOUS SOLUTION 5 % F $$$ PA; Specialty

PRIVIGEN INTRAVENOUS SOLUTION 10 % F $$$ PA; Specialty

Immune Suppressant

Immune Suppressant

azathioprine oral tablet 50 mg F $$

CYCLOPHOSPHAMIDE ORAL CAPSULE 25 MG, 50 MG

F $$$

cyclosporine modified oral capsule 100 mg, 25 mg, 50 mg

F $$

cyclosporine modified oral solution 100 mg/ml F $$

cyclosporine oral capsule 100 mg, 25 mg F $$

gengraf oral capsule 100 mg, 25 mg F $$

gengraf oral solution 100 mg/ml F $$

mercaptopurine oral tablet 50 mg F $$


F $$





mycophenolate mofetil oral capsule 250 mg F $$

mycophenolate mofetil oral suspension for reconstitution 200 mg/ml

F $$

mycophenolate mofetil oral tablet 500 mg F $$

RAPAMUNE ORAL SOLUTION 1 MG/ML F $$$

sirolimus oral tablet 0.5 mg, 1 mg, 2 mg F $$

tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg F $$

Kidney Failure

Kidney Failure

calcium acetate oral capsule 667 mg F $$

PHOSLYRA ORAL SOLUTION 667 MG (169 MG CALCIUM)/5 ML

F $$$

RENVELA ORAL POWDER IN PACKET 0.8 GRAM, 2.4 GRAM

F $$$

RENVELA ORAL TABLET 800 MG F $$$

SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG F $$$

sevelamer carbonate oral tablet 800 mg F $$

Men's Health

Benign Prostatic Hypertrophy

alfuzosin oral tablet extended release 24 hr 10 mg

F $$

doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg F $

finasteride oral tablet 5 mg F $$

prazosin oral capsule 1 mg, 2 mg, 5 mg F $$

tamsulosin oral capsule,extended release 24hr0.4 mg

F $$

terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg F $

Testosterone Deficiency

ANDRODERM TRANSDERMAL PATCH 24 HOUR 2 MG/24 HOUR, 4 MG/24 HR

F $$$ PA; GE Male

ANDROGEL TRANSDERMAL GEL IN METERED‐DOSE PUMP 20.25 MG/1.25 GRAM (1.62 %)

F $$$ PA; GE Male



ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (20.25 MG/1.25 GRAM), 1.62 % (40.5 MG/2.5 GRAM)

F $$$ PA; GE Male

androxy oral tablet 10 mg F $$ QL

DEPO‐TESTOSTERONE INTRAMUSCULAR OIL 200 MG/ML

F $$$ PA; GE Male

testosterone cypionate intramuscular oil 100 mg/ml, 200 mg/ml

F $$ PA; GE Male

testosterone enanthate intramuscular oil 200 mg/ml

F $$ PA; GE Male

testosterone transdermal gel 50 mg/5 gram (1 %) F $$ PA; GE Male

testosterone transdermal gel in metered‐dose pump 1.25 gram/ actuation (1 %), 10 mg/0.5 gram /actuation

F $$ PA; GE Male

testosterone transdermal gel in packet 1 % (25 mg/2.5gram), 1 % (50 mg/5 gram)

F $$ PA; GE Male

Migraine

Migraine, Other

cafergot oral tablet 1‐100 mg F $$ QL

dihydroergotamine injection solution 1 mg/ml F $$ PA

isometh‐dichloral‐acetaminophn oral capsule65‐100‐325 mg

F $$ QL

migergot rectal suppository 2‐100 mg F $$ QL

migragesic ida oral capsule 65‐100‐325 mg F $$ QL

nodolor oral capsule 65‐100‐325 mg F $$ QL

prodrin oral tablet 65‐20‐325 mg F $$

Migraine, Preventives



F $$


F $$

propranolol oral capsule,extended release 24 hr120 mg, 160 mg, 60 mg, 80 mg

F $$

propranolol oral solution 20 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml)

F $$

propranolol oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

F $$



Migraine, Triptans

naratriptan oral tablet 1 mg, 2.5 mg F $$ QL

RELPAX ORAL TABLET 20 MG, 40 MG F $$$ PA; QL

rizatriptan oral tablet 10 mg, 5 mg F $$ QL

rizatriptan oral tablet,disintegrating 10 mg, 5 mg F $$ QL

sumatriptan nasal spray,non‐aerosol 20 mg/actuation, 5 mg/actuation

F $$ QL

sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg

F $$ QL

sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml, 6 mg/0.5 ml

F $$ QL

sumatriptan succinate subcutaneous pen injector4 mg/0.5 ml, 6 mg/0.5 ml

F $$ QL

sumatriptan succinate subcutaneous solution 6 mg/0.5 ml

F $$ QL

Mouth & Throat

Dental Health

chlorhexidine gluconate mucous membrane mouthwash 0.12 %

F $

periogard mucous membrane mouthwash 0.12 % F $$

triamcinolone acetonide dental paste 0.1 % F $$

Dry Mouth

cevimeline oral capsule 30 mg F $$

pilocarpine hcl oral tablet 5 mg, 7.5 mg F $$

Pain

lidocaine hcl mucous membrane gel 2 % F $$

lidocaine hcl mucous membrane jelly in applicator 2 %

F $$

lidocaine hcl mucous membrane solution 2 %, 4 % (40 mg/ml)

F $$

lidocaine viscous mucous membrane solution 2 % F $$

Multiple Sclerosis

Multiple Sclerosis, Injection

AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT30 MCG

F $$$ ST; Specialty

AVONEX INTRAMUSCULAR PEN INJECTOR 30 MCG/0.5 ML

F $$$ ST; Specialty



AVONEX INTRAMUSCULAR PEN INJECTOR KIT 30 MCG/0.5 ML

F $$$ ST; Specialty

AVONEX INTRAMUSCULAR SYRINGE 30 MCG/0.5 ML

F $$$ ST; Specialty

AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG/0.5 ML

F $$$ ST; Specialty

COPAXONE SUBCUTANEOUS SYRINGE 40 MG/ML

F $$$ Specialty

EXTAVIA SUBCUTANEOUS KIT 0.3 MG F $$$ ST; Specialty

glatopa subcutaneous syringe 20 mg/ml F $$ Specialty

REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE 22 MCG/0.5 ML, 44 MCG/0.5 ML

F $$$ Specialty

REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR22 MCG/0.5 ML, 44 MCG/0.5 ML, 8.8MCG/0.2ML‐22 MCG/0.5ML (6)

F $$$ Specialty

REBIF TITRATION PACK SUBCUTANEOUS SYRINGE 8.8MCG/0.2ML‐22 MCG/0.5ML (6)

F $$$ Specialty

Multiple Sclerosis, Oral

AMPYRA ORAL TABLET EXTENDED RELEASE 12 HR 10 MG

F $$$ PA; Specialty

GILENYA ORAL CAPSULE 0.5 MG F $$$ PA; Specialty

TECFIDERA ORAL CAPSULE,DELAYED RELEASE(DR/EC) 120 MG, 120 MG (14)‐ 240 MG (46), 240 MG

F $$$ Specialty

Muscle Relaxant

Muscle Relaxants

baclofen oral tablet 10 mg, 20 mg F $$

chlorzoxazone oral tablet 500 mg F $$ AE

cyclobenzaprine oral tablet 10 mg, 5 mg, 7.5 mg F $ AE

dantrolene oral capsule 100 mg, 25 mg, 50 mg F $$

methocarbamol oral tablet 500 mg, 750 mg F $$ AE

tizanidine oral tablet 2 mg, 4 mg F $$

Other Conditions

Other Agents

ACTHAR H.P. INJECTION GEL 80 UNIT/ML F $$$ PA; Specialty

ALFERON N INJECTION SOLUTION 5 MILLION UNIT/ML

F $$$ Specialty



ARCALYST SUBCUTANEOUS RECON SOLN 220 MG

F $$$ PA; Specialty

CHEMET ORAL CAPSULE 100 MG F $$$

CYSTAGON ORAL CAPSULE 150 MG, 50 MG F $$$

desmopressin nasal aerosol,spray 10 mcg/spray (0.1 ml)

F $$ PA

desmopressin nasal solution 0.1 mg/ml (refrigerate)

F $$ PA

desmopressin nasal spray,non‐aerosol 10 mcg/spray (0.1 ml)

F $$ PA

desmopressin oral tablet 0.1 mg, 0.2 mg F $$ AE

ergoloid oral tablet 1 mg F $$ PA

EXJADE ORAL TABLET, DISPERSIBLE 125 MG, 250 MG, 500 MG

F $$$ PA; Specialty

FERRIPROX ORAL SOLUTION 100 MG/ML F $$$ PA; Specialty

FERRIPROX ORAL TABLET 500 MG F $$$ PA; Specialty

ILARIS (PF) SUBCUTANEOUS RECON SOLN 180 MG/1.2 ML (150 MG/ML)

F $$$ PA; Specialty

JADENU ORAL TABLET 180 MG, 360 MG, 90 MG F $$$ PA; Specialty

kionex oral powder F $$

KUVAN ORAL POWDER IN PACKET 100 MG, 500 MG

F $$$ PA; Specialty

KUVAN ORAL TABLET,SOLUBLE 100 MG F $$$ PA; Specialty

leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg

F $$

levocarnitine (with sugar) oral solution 100 mg/ml

F $$

levocarnitine oral tablet 330 mg F $$

megestrol oral suspension 400 mg/10 ml (40 mg/ml)

F $$

nifedipine oral capsule 10 mg, 20 mg F $$ GE Female; AE

octreotide acetate injection solution 1,000 mcg/ml, 100 mcg/ml, 200 mcg/ml, 50 mcg/ml, 500 mcg/ml

F $$ Specialty

octreotide acetate injection syringe 100 mcg/ml (1 ml), 50 mcg/ml (1 ml), 500 mcg/ml (1 ml)

F $$ Specialty

oxandrolone oral tablet 10 mg, 2.5 mg F $$ PA; QL

pyridostigmine bromide oral tablet 60 mg F $$



pyridostigmine bromide oral tablet extended release 180 mg

F $$

riluzole oral tablet 50 mg F $$

SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 10 MG, 20 MG, 30 MG

F $$$ Specialty

SIGNIFOR SUBCUTANEOUS SOLUTION 0.3 MG/ML (1 ML), 0.6 MG/ML (1 ML), 0.9 MG/ML (1 ML)

F $$$ PA; Specialty

sodium phenylbutyrate oral powder 0.94 gram/gram

F $$ PA

sodium polystyrene (sorb free) oral suspension 15 gram/60 ml

F $$

sodium polystyrene sulfonate oral powder F $$

sodium polystyrene sulfonate oral suspension 15 gram/60 ml

F $$

tetrabenazine oral tablet 12.5 mg, 25 mg F $$ PA; Specialty

VISTOGARD ORAL GRANULES IN PACKET 10 GRAM

F $$$ PA; Specialty

Pain

Fibromyalgia / Neuropathic Pain

gabapentin oral capsule 100 mg, 300 mg, 400 mg F $$

gabapentin oral solution 250 mg/5 ml, 250 mg/5 ml (5 ml), 300 mg/6 ml (6 ml)

F $$

gabapentin oral tablet 600 mg, 800 mg F $$

Non‐Steroidal Anti‐Inflammatories

celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg

F $$

diclofenac potassium oral tablet 50 mg F $$

diclofenac sodium oral tablet extended release 24 hr 100 mg

F $$

diclofenac sodium oral tablet,delayed release (dr/ec) 25 mg, 50 mg, 75 mg

F $$

etodolac oral capsule 200 mg, 300 mg F $$

etodolac oral tablet 400 mg, 500 mg F $$

etodolac oral tablet extended release 24 hr 400 mg, 500 mg, 600 mg

F $$

flurbiprofen oral tablet 100 mg, 50 mg F $

ibuprofen oral tablet 400 mg, 600 mg, 800 mg F $



indomethacin oral capsule 25 mg, 50 mg F $$ QL; AE

ketorolac oral tablet 10 mg F $ QL

meloxicam oral suspension 7.5 mg/5 ml F $

meloxicam oral tablet 15 mg, 7.5 mg F $

nabumetone oral tablet 500 mg, 750 mg F $$

naproxen oral suspension 125 mg/5 ml F $

naproxen oral tablet 250 mg, 375 mg, 500 mg F $

naproxen oral tablet,delayed release (dr/ec) 375 mg, 500 mg

F $

naproxen sodium oral tablet 275 mg, 550 mg F $

piroxicam oral capsule 10 mg, 20 mg F $$

salsalate oral tablet 500 mg, 750 mg F $$

sulindac oral tablet 150 mg, 200 mg F $$

tolmetin oral capsule 400 mg F $$

tolmetin oral tablet 200 mg, 600 mg F $$

Pain, Opioids

acetaminophen‐codeine oral solution 120‐12 mg/5 ml, 300 mg‐30 mg /12.5 ml

F $ QL; AE

acetaminophen‐codeine oral tablet 300‐15 mg, 300‐30 mg, 300‐60 mg

F $ QL; AE

buprenorphine‐naloxone sublingual tablet 2‐0.5 mg, 8‐2 mg

F $$ QL

codeine sulfate oral tablet 15 mg, 30 mg, 60 mg F $$ QL; AE

endocet oral tablet 10‐325 mg, 2.5‐325 mg, 5‐325 mg, 7.5‐325 mg

F $$ QL

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hour, 50 mcg/hr, 62.5 mcg/hour, 75 mcg/hr, 87.5 mcg/hour

F $$ QL

hydrocodone‐acetaminophen oral solution7.5‐325 mg/15 ml

F $$ QL

hydrocodone‐acetaminophen oral tablet 10‐325 mg, 5‐325 mg, 7.5‐325 mg

F $$ QL

hydrocodone‐ibuprofen oral tablet 7.5‐200 mg F $$ QL

hydromorphone oral tablet 2 mg, 4 mg, 8 mg F $$ QL

hydromorphone rectal suppository 3 mg F $$ QL

methadone oral concentrate 10 mg/ml F $$ QL

methadone oral solution 10 mg/5 ml, 5 mg/5 ml F $$ QL



methadone oral tablet 10 mg, 5 mg F $$ QL

methadone oral tablet,soluble 40 mg F $$ PA; QL

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

F $$ QL

morphine oral solution 10 mg/5 ml, 20 mg/5 ml (4 mg/ml)

F $$ QL

MORPHINE ORAL TABLET 15 MG, 30 MG F $$$ QL

morphine oral tablet extended release 100 mg, 200 mg

F $$ PA

morphine oral tablet extended release 15 mg, 30 mg, 60 mg

F $$ QL

morphine rectal suppository 10 mg, 20 mg, 30 mg, 5 mg

F $$ QL

oxycodone oral capsule 5 mg F $$ QL

oxycodone oral concentrate 20 mg/ml F $$ QL

oxycodone oral solution 5 mg/5 ml F $$ QL

oxycodone oral tablet 10 mg, 15 mg, 20 mg, 5 mg F $$ QL

oxycodone oral tablet 30 mg F $$ PA

oxycodone oral tablet,oral only,ext.rel.12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg

F $$ QL

oxycodone oral tablet,oral only,ext.rel.12 hr 60 mg, 80 mg

F $$ PA

oxycodone‐acetaminophen oral tablet 10‐325 mg, 5‐325 mg, 7.5‐325 mg

F $$ QL

oxycodone‐aspirin oral tablet 4.8355‐325 mg F $$ QL

OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG

F $$$ QL

OXYCONTIN ORAL TABLET,ORAL ONLY,EXT.REL.12 HR 60 MG, 80 MG

F $$$ PA

roxicet oral solution 5‐325 mg/5 ml F $$ QL

SUBOXONE SUBLINGUAL FILM 12‐3 MG, 2‐0.5 MG, 4‐1 MG, 8‐2 MG

F $$$ QL

Pain, Other

butalbital‐acetaminophen oral tablet 50‐325 mg F $$ QL

butalbital‐acetaminophen‐caff oral capsule50‐325‐40 mg

F $ QL

butalbital‐acetaminophen‐caff oral tablet50‐325‐40 mg

F $ QL



butalbital‐aspirin‐caffeine oral capsule 50‐325‐40 mg

F $$ QL

tramadol oral tablet 50 mg F $ QL

Pain, Topical

diclofenac sodium topical gel 1 % F $$

lidocaine topical ointment 5 % F $$

lidocaine‐prilocaine topical cream 2.5‐2.5 % F $$ QL

Parkinson's

Parkinson's

amantadine hcl oral capsule 100 mg F $$

amantadine hcl oral solution 50 mg/5 ml F $$

benztropine oral tablet 0.5 mg, 1 mg, 2 mg F $

bromocriptine oral capsule 5 mg F $$

bromocriptine oral tablet 2.5 mg F $$

carbidopa oral tablet 25 mg F $$

carbidopa‐levodopa oral tablet 10‐100 mg, 25‐100 mg, 25‐250 mg

F $$

carbidopa‐levodopa oral tablet extended release25‐100 mg, 50‐200 mg

F $$

carbidopa‐levodopa‐entacapone oral tablet12.5‐50‐200 mg, 18.75‐75‐200 mg, 25‐100‐200 mg, 31.25‐125‐200 mg, 37.5‐150‐200 mg, 50‐200‐200 mg

F $$

entacapone oral tablet 200 mg F $$

NEUPRO TRANSDERMAL PATCH 24 HOUR 1 MG/24 HOUR, 2 MG/24 HOUR, 3 MG/24 HOUR, 4 MG/24 HOUR, 6 MG/24 HOUR, 8 MG/24 HOUR

F $$$ PA

pramipexole oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

F $$

ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

F $$

RYTARY ORAL CAPSULE, EXTENDED RELEASE23.75‐95 MG, 36.25‐145 MG, 48.75‐195 MG, 61.25‐245 MG

F $$$ PA

selegiline hcl oral capsule 5 mg F $$

selegiline hcl oral tablet 5 mg F $$

trihexyphenidyl oral elixir 0.4 mg/ml F $



trihexyphenidyl oral tablet 2 mg, 5 mg F $$

Pulmonary Hypertension

Pulmonary Hypertension

ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG

F $$$ PA; Specialty

EPOPROSTENOL (GLYCINE) INTRAVENOUS RECON SOLN 1.5 MG

F $$$ PA; Specialty

FLOLAN INTRAVENOUS RECON SOLN 1.5 MG F $$$ PA; Specialty

LETAIRIS ORAL TABLET 10 MG, 5 MG F $$$ PA; Specialty

OPSUMIT ORAL TABLET 10 MG F $$$ PA; Specialty

REMODULIN INJECTION SOLUTION 1 MG/ML, 10 MG/ML, 2.5 MG/ML, 5 MG/ML

F $$$ PA; Specialty

REVATIO ORAL SUSPENSION FOR RECONSTITUTION 10 MG/ML

F $$$ PA; Specialty

sildenafil oral tablet 20 mg F $$ PA; QL

TRACLEER ORAL TABLET 125 MG, 62.5 MG F $$$ PA; Specialty

TYVASO INHALATION SOLUTION FOR NEBULIZATION 1.74 MG/2.9 ML (0.6 MG/ML)

F $$$ PA; Specialty

TYVASO REFILL KIT INHALATION SOLUTION FOR NEBULIZATION 1.74 MG/2.9 ML (0.6 MG/ML)

F $$$ PA; Specialty

TYVASO STARTER KIT INHALATION SOLUTION FOR NEBULIZATION 1.74 MG/2.9 ML

F $$$ PA; Specialty

UPTRAVI ORAL TABLET 1,000 MCG, 1,200 MCG, 1,400 MCG, 1,600 MCG, 200 MCG, 400 MCG, 600 MCG, 800 MCG

F $$$ PA; Specialty

UPTRAVI ORAL TABLETS,DOSE PACK 200 MCG (140)‐ 800 MCG (60)

F $$$ PA; Specialty

VELETRI INTRAVENOUS RECON SOLN 0.5 MG, 1.5 MG

F $$$ PA; Specialty

VENTAVIS INHALATION SOLUTION FOR NEBULIZATION 10 MCG/ML, 20 MCG/ML

F $$$ PA; Specialty

Seizures / Epilepsy

Seizures / Epilepsy


F $$


APTIOM ORAL TABLET 200 MG, 400 MG, 600 MG, 800 MG

F $$$ PA

BANZEL ORAL SUSPENSION 40 MG/ML F $$$



BANZEL ORAL TABLET 200 MG, 400 MG F $$$

BRIVIACT ORAL SOLUTION 10 MG/ML F $$$ PA

BRIVIACT ORAL TABLET 10 MG, 100 MG, 25 MG, 50 MG, 75 MG

F $$$ PA

carbamazepine oral capsule, er multiphase 12 hr100 mg, 200 mg, 300 mg

F $$

carbamazepine oral suspension 100 mg/5 ml, 100 mg/5 ml (5 ml)

F $$

carbamazepine oral tablet 200 mg F $

carbamazepine oral tablet extended release 12 hr100 mg, 200 mg, 400 mg

F $$

carbamazepine oral tablet,chewable 100 mg F $$

clonazepam oral tablet 0.5 mg, 1 mg, 2 mg F $ QL

diazepam intensol oral concentrate 5 mg/ml F $ QL

diazepam oral solution 5 mg/5 ml (1 mg/ml) F $ QL

diazepam oral tablet 10 mg, 2 mg, 5 mg F $ QL

diazepam rectal kit 12.5‐15‐17.5‐20 mg, 2.5 mg, 5‐7.5‐10 mg

F $$ QL

DILANTIN KAPSEAL ORAL CAPSULE 30 MG F $$$

DILANTIN ORAL CAPSULE 30 MG F $$$



F $$


F $$

ethosuximide oral capsule 250 mg F $$

ethosuximide oral solution 250 mg/5 ml F $$

felbamate oral suspension 600 mg/5 ml F $$

felbamate oral tablet 400 mg, 600 mg F $$

FYCOMPA ORAL SUSPENSION 0.5 MG/ML F $$$ PA

FYCOMPA ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG

F $$$ PA

gabapentin oral capsule 100 mg, 300 mg, 400 mg F $$

gabapentin oral solution 250 mg/5 ml, 250 mg/5 ml (5 ml), 300 mg/6 ml (6 ml)

F $$

gabapentin oral tablet 600 mg, 800 mg F $$

GABITRIL ORAL TABLET 12 MG, 16 MG F $$$



LAMICTAL ORAL TABLET, CHEWABLE DISPERSIBLE 2 MG

F $$$

lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg

F $$

lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg

F $$

lamotrigine oral tablets,dose pack 25 mg (35) F $$

levetiracetam oral solution 100 mg/ml F $$

levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg

F $$

ONFI ORAL SUSPENSION 2.5 MG/ML F $$$ PA; QL

ONFI ORAL TABLET 10 MG, 20 MG F $$$ PA; QL

oxcarbazepine oral suspension 300 mg/5 ml F $$

oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg

F $$

phenobarbital oral elixir 20 mg/5 ml (4 mg/ml) F $$

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 60 mg

F $$

phenytoin oral suspension 125 mg/5 ml F $$

phenytoin oral tablet,chewable 50 mg F $$

phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg

F $$

POTIGA ORAL TABLET 200 MG, 300 MG, 400 MG, 50 MG

F $$$ QL

primidone oral tablet 250 mg, 50 mg F $$

SABRIL ORAL POWDER IN PACKET 500 MG F $$$ PA; Specialty

SABRIL ORAL TABLET 500 MG F $$$ PA; Specialty

tiagabine oral tablet 2 mg, 4 mg F $$

topiramate oral capsule, sprinkle 15 mg, 25 mg F $$

topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg

F $$

valproic acid (as sodium salt) oral solution 250 mg/5 ml, 500 mg/10 ml (10 ml)

F $$

valproic acid oral capsule 250 mg F $$

VIMPAT ORAL SOLUTION 10 MG/ML F $$$ QL

VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG

F $$$ QL

zonisamide oral capsule 100 mg, 25 mg, 50 mg F $$



Skin Conditions

Acne, Oral

amnesteem oral capsule 10 mg, 20 mg, 40 mg F $$

claravis oral capsule 10 mg, 20 mg, 30 mg, 40 mg F $$

myorisan oral capsule 10 mg, 20 mg, 40 mg F $$

sotret oral capsule 20 mg, 40 mg F $$

zenatane oral capsule 10 mg, 20 mg, 40 mg F $$

Acne, Topical

adapalene topical cream 0.1 % F $$

adapalene topical gel 0.1 %, 0.3 % F $$

adapalene topical gel with pump 0.3 % F $$

avita topical cream 0.025 % F $$

avita topical gel 0.025 % F $$

bp 10‐1 topical cleanser 10‐1 % F $$

clindamycin phosphate topical gel 1 % F $$

clindamycin phosphate topical lotion 1 % F $$

clindamycin phosphate topical solution 1 % F $$

clindamycin phosphate topical swab 1 % F $$

erythromycin with ethanol topical gel 2 % F $$

erythromycin with ethanol topical solution 2 % F $$

sulfacetamide sodium (acne) topical suspension10 %

F $$

sulfacetamide sodium‐sulfur topical cleanser 10‐5 % (w/w)

F $$

sulfacetamide sodium‐sulfur topical cream 10‐5 % (w/w)

F $$

sulfacetamide sodium‐sulfur topical lotion 10‐5 % (w/v), 10‐5 % (w/w)

F $$

sulfacetamide sod‐sulfur‐urea topical cleanser10‐5‐10 %

F $$

tretinoin topical cream 0.025 %, 0.05 %, 0.1 % F $$

tretinoin topical gel 0.01 %, 0.025 % F $$

Antifungals, Topical

ciclopirox topical cream 0.77 % F $$

ciclopirox topical gel 0.77 % F $$

ciclopirox topical solution 8 % F $$



ciclopirox topical suspension 0.77 % F $$

econazole topical cream 1 % F $$

ketoconazole topical cream 2 % F $$

ketoconazole topical shampoo 2 % F $$

nystatin topical cream 100,000 unit/gram F $$

nystatin topical ointment 100,000 unit/gram F $$

nystatin topical powder 100,000 unit/gram F $$

Anti‐Infectives, Topical

gentamicin topical cream 0.1 % F $$

gentamicin topical ointment 0.1 % F $$

mupirocin topical ointment 2 % F $$

silver sulfadiazine topical cream 1 % F $$

Corticosteroids, Topical

APEXICON E TOPICAL CREAM 0.05 % F $$$

betamethasone dipropionate topical cream 0.05 %

F $$

betamethasone dipropionate topical lotion 0.05 %

F $$

betamethasone dipropionate topical ointment0.05 %

F $$

betamethasone valerate topical cream 0.1 % F $$

betamethasone valerate topical lotion 0.1 % F $$

betamethasone valerate topical ointment 0.1 % F $$

betamethasone, augmented topical cream 0.05 %

F $$

betamethasone, augmented topical gel 0.05 % F $$

betamethasone, augmented topical lotion 0.05 % F $$

betamethasone, augmented topical ointment0.05 %

F $$

clobetasol scalp solution 0.05 % F $$

clobetasol topical cream 0.05 % F $$

clobetasol topical gel 0.05 % F $$

clobetasol topical ointment 0.05 % F $$

clobetasol‐emollient topical cream 0.05 % F $$

desonide topical cream 0.05 % F $$

desonide topical lotion 0.05 % F $$

desonide topical ointment 0.05 % F $$



desoximetasone topical cream 0.05 %, 0.25 % F $$

desoximetasone topical gel 0.05 % F $$

desoximetasone topical ointment 0.25 % F $$

fluocinolone and shower cap scalp oil 0.01 % F $$

fluocinolone topical cream 0.01 %, 0.025 % F $$

fluocinolone topical oil 0.01 % F $$

fluocinolone topical ointment 0.025 % F $$

fluocinonide topical cream 0.05 % F $$

fluocinonide topical gel 0.05 % F $$

fluocinonide topical ointment 0.05 % F $$

fluocinonide topical solution 0.05 % F $$

fluocinonide‐e topical cream 0.05 % F $$

fluticasone topical cream 0.05 % F $$

fluticasone topical ointment 0.005 % F $$

hydrocortisone topical cream 2.5 % F $$

hydrocortisone topical lotion 2.5 % F $$

hydrocortisone topical ointment 2.5 % F $$

hydrocortisone valerate topical cream 0.2 % F $$

hydrocortisone valerate topical ointment 0.2 % F $$

hydrocortisone‐pramoxine topical cream 2.5‐1 % F $$

iodoquinol‐hc topical cream 1‐1 % F $$

lokara topical lotion 0.05 % F $$

mometasone topical cream 0.1 % F $$

mometasone topical ointment 0.1 % F $$

mometasone topical solution 0.1 % F $$

triamcinolone acetonide topical cream 0.025 %, 0.1 %, 0.5 %

F $$

triamcinolone acetonide topical lotion 0.025 %, 0.1 %

F $$

triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 %

F $$

trianex topical ointment 0.05 % F $$

triderm topical cream 0.1 % F $$

Lice / Scabies, Topical

malathion topical lotion 0.5 % F $$

permethrin topical cream 5 % F $$



Psoriasis, Other

acitretin oral capsule 10 mg, 17.5 mg, 25 mg F $$

ENBREL SUBCUTANEOUS RECON SOLN 25 MG (1 ML)

F $$$ PA; Specialty

ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.51)

F $$$ PA; Specialty

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR 50 MG/ML (0.98 ML)

F $$$ PA; Specialty


F $$$ PA; Specialty


F $$$ PA; Specialty


F $$



Psoriasis, Topical

calcipotriene scalp solution 0.005 % F $$

calcipotriene topical ointment 0.005 % F $$

Rosacea

metronidazole topical cream 0.75 % F $$

metronidazole topical gel 0.75 % F $$

metronidazole topical lotion 0.75 % F $$

sulfacetamide sodium‐sulfur topical cleanser 10‐5 % (w/w)

F $$

sulfacetamide sodium‐sulfur topical cream 10‐5 % (w/w)

F $$

sulfacetamide sodium‐sulfur topical lotion 10‐5 % (w/v), 10‐5 % (w/w)

F $$

sulfacetamide sod‐sulfur‐urea topical cleanser10‐5‐10 %

F $$

Skin Conditions, Other

ammonium lactate topical cream 12 % F $$

ammonium lactate topical lotion 12 % F $$

DRYSOL DAB‐O‐MATIC TOPICAL SOLUTION 20 % F $$$

DRYSOL TOPICAL SOLUTION 20 % F $$$

ELIDEL TOPICAL CREAM 1 % F $$$

fluorouracil topical cream 5 % F $$



fluorouracil topical solution 2 %, 5 % F $$

granulex topical aerosol,spray 0.12‐87 mg/gram F $$

imiquimod topical cream in packet 5 % F $$

PICATO TOPICAL GEL 0.015 %, 0.05 % F $$$ PA

podofilox topical solution 0.5 % F $$

selenium sulfide topical lotion 2.5 % F $$

tacrolimus topical ointment 0.03 %, 0.1 % F $$

urea topical cream 40 % F $$

urea topical gel 40 % F $$

urea topical lotion 40 % F $$

urea topical nail film suspension 40 % F $$

Sleep Disorders

Insomnia

eszopiclone oral tablet 1 mg, 2 mg, 3 mg F $$ QL; AE

temazepam oral capsule 15 mg, 30 mg F $ QL

zaleplon oral capsule 10 mg, 5 mg F $$ QL; AE

zolpidem oral tablet 10 mg, 5 mg F $$ QL; AE

Narcolepsy / Excessive Sleepiness

armodafinil oral tablet 150 mg, 200 mg, 250 mg, 50 mg

F $$ PA; QL

modafinil oral tablet 100 mg, 200 mg F $$ PA; QL

XYREM ORAL SOLUTION 500 MG/ML F $$$ PA; Specialty; QL

Smoking Cessation

Nicotine Replacement

nicotine (polacrilex) buccal gum 2 mg, 4 mg F $$ SC

nicotine (polacrilex) buccal lozenge 2 mg, 4 mg F $$ SC

nicotine transdermal patch 24 hour 14 mg/24 hr, 21 mg/24 hr, 22 mg/24 hr, 7 mg/24 hr

F $$ SC

NICOTROL INHALATION CARTRIDGE 10 MG F $$$ SC

NICOTROL NS NASAL SPRAY,NON‐AEROSOL 10 MG/ML

F $$$ SC

Smoking Cessation, Other

buproban oral tablet extended release 150 mg F $$ SC

CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG

F $$$ SC; QL



CHANTIX CONTINUING MONTH PAK ORAL TABLET 1 MG

F $$$ SC; QL

CHANTIX ORAL TABLET 0.5 MG, 1 MG F $$$ SC; QL

CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK 0.5 MG (11)‐ 1 MG (42)

F $$$ SC; QL

CHANTIX STARTING MONTH PAK ORAL TABLETS,DOSE PACK 0.5 MG (11)‐ 1 MG (42)

F $$$ SC; QL

Stomach / Gastrointestinal

Bowel Prep

gavilyte‐c oral recon soln 240‐22.72‐6.72 ‐5.84 gram

F $$

gavilyte‐g oral recon soln 236‐22.74‐6.74 ‐5.86 gram

F $$

gavilyte‐n oral recon soln 420 gram F $$

Constipation

AMITIZA ORAL CAPSULE 24 MCG, 8 MCG F $$$

enulose oral solution 10 gram/15 ml F $$

lactulose oral solution 10 gram/15 ml F $

LINZESS ORAL CAPSULE 145 MCG, 290 MCG F $$$

polyethylene glycol 3350 oral powder 17 gram/dose

F $$

Crohn's Disease / Ulcerative Colitis

balsalazide oral capsule 750 mg F $$

budesonide oral capsule,delayed,extend.release 3 mg

F $$

CANASA RECTAL SUPPOSITORY 1,000 MG F $$$

DELZICOL ORAL CAPSULE (WITH DEL REL TABLETS) 400 MG

F $$$

DELZICOL ORAL CAPSULE,DELAYED RELEASE(DR/EC) 400 MG

F $$$

ENBREL SUBCUTANEOUS SYRINGE 50 MG/ML (0.98 ML)

F $$$ PA; Specialty


F $$$ PA; Specialty


F $$$ PA; Specialty

LIALDA ORAL TABLET,DELAYED RELEASE (DR/EC)1.2 GRAM

F $$$



mesalamine oral tablet,delayed release (dr/ec)800 mg

F $$

mesalamine rectal enema 4 gram/60 ml F $$

PENTASA ORAL CAPSULE, EXTENDED RELEASE250 MG, 500 MG

F $$$

sulfasalazine oral tablet 500 mg F $$

sulfasalazine oral tablet,delayed release (dr/ec)500 mg

F $$

Nausea / Vomiting

dronabinol oral capsule 10 mg, 2.5 mg, 5 mg F $$ QL

EMEND ORAL CAPSULE 125 MG, 40 MG, 80 MG F $$$

EMEND ORAL CAPSULE,DOSE PACK 125 MG (1)‐ 80 MG (2)

F $$$

EMEND ORAL SUSPENSION FOR RECONSTITUTION 125 MG (25 MG/ ML FINAL CONC.)

F $$$

metoclopramide hcl oral solution 5 mg/5 ml F $

metoclopramide hcl oral tablet 10 mg, 5 mg F $

ondansetron hcl oral solution 4 mg/5 ml F $$

ondansetron hcl oral tablet 24 mg, 4 mg, 8 mg F $$

ondansetron oral tablet,disintegrating 4 mg, 8 mg

F $$

prochlorperazine maleate oral tablet 10 mg, 5 mg F $

prochlorperazine rectal suppository 25 mg F $

promethazine oral syrup 6.25 mg/5 ml F $ QL; AE

promethazine oral tablet 12.5 mg, 25 mg, 50 mg F $$ QL; AE

promethazine rectal suppository 12.5 mg, 25 mg, 50 mg

F $$

trimethobenzamide oral capsule 300 mg F $$

Stomach / Gastrointestinal, Other

alosetron oral tablet 0.5 mg, 1 mg F $$ PA

CARBAGLU ORAL TABLET, DISPERSIBLE 200 MG F $$$ PA; Specialty

CHOLBAM ORAL CAPSULE 250 MG, 50 MG F $$$ PA; Specialty

CUVPOSA ORAL SOLUTION 1 MG/5 ML (0.2 MG/ML)

F $$$ PA

dicyclomine oral capsule 10 mg F $

dicyclomine oral solution 10 mg/5 ml F $

dicyclomine oral tablet 20 mg F $



diphenoxylate‐atropine oral liquid 2.5‐0.025 mg/5 ml

F $ QL

diphenoxylate‐atropine oral tablet 2.5‐0.025 mg F $$ QL

FULYZAQ ORAL TABLET,DELAYED RELEASE (DR/EC) 125 MG

F $$$ PA

glycopyrrolate oral tablet 1 mg, 2 mg F $$

hyoscyamine sulfate oral drops 0.125 mg/ml F $$

hyoscyamine sulfate oral elixir 0.125 mg/5 ml F $$

hyoscyamine sulfate oral tablet 0.125 mg F $$

hyoscyamine sulfate oral tablet extended release 12 hr 0.375 mg

F $$

hyoscyamine sulfate oral tablet,disintegrating0.125 mg

F $$

hyoscyamine sulfate sublingual tablet 0.125 mg F $$

MOVANTIK ORAL TABLET 12.5 MG, 25 MG F $$$ PA; QL

paregoric oral liquid 2 mg/5 ml F $$ QL

propantheline oral tablet 15 mg F $$

ursodiol oral capsule 300 mg F $$

ursodiol oral tablet 250 mg, 500 mg F $$

Stomach / Gastrointestinal, Rectal

hydrocortisone acetate rectal suppository 25 mg F $$

hydrocortisone rectal enema 100 mg/60 ml F $$

hydrocortisone‐pramoxine rectal cream 1‐1 %, 2.5‐1 %

F $$

proctosol hc rectal cream 2.5 % F $$

Ulcers / Heartburn / Gerd

CARAFATE ORAL SUSPENSION 100 MG/ML F $$$

famotidine oral tablet 20 mg, 40 mg F $

lansoprazole oral capsule,delayed release(dr/ec)15 mg, 30 mg

F $$

misoprostol oral tablet 100 mcg, 200 mcg F $$

omeprazole oral capsule,delayed release(dr/ec)10 mg, 20 mg, 40 mg

F $$

pantoprazole oral tablet,delayed release (dr/ec)20 mg, 40 mg

F $$

ranitidine hcl oral syrup 15 mg/ml F $ AE

ranitidine hcl oral tablet 150 mg, 300 mg F $



sucralfate oral suspension 100 mg/ml F $$

sucralfate oral tablet 1 gram F $$

Thyroid

Antithyroid Agents

methimazole oral tablet 10 mg, 5 mg F $$

propylthiouracil oral tablet 50 mg F $$

Thyroid Agents

levothyroxine oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg

F $$

liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg F $$

SYNTHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

F $$$

Urinary & Bladder Health

Overactive Bladder

MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG, 50 MG

F $$$

oxybutynin chloride oral syrup 5 mg/5 ml F $$

oxybutynin chloride oral tablet 5 mg F $$

oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 mg, 5 mg

F $$

tolterodine oral capsule,extended release 24hr 2 mg, 4 mg

F $$

tolterodine oral tablet 1 mg, 2 mg F $$

trospium oral tablet 20 mg F $$

VESICARE ORAL TABLET 10 MG, 5 MG F $$$

Urinary & Bladder Health, Other

bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg

F $$

ELMIRON ORAL CAPSULE 100 MG F $$$

phenazopyridine oral tablet 100 mg, 200 mg F $

phospha 250 neutral oral tablet 250 mg F $$

potassium citrate oral tablet extended release 10 meq (1,080 mg), 15 meq, 5 meq (540 mg)

F $$

virt‐phos 250 neutral oral tablet 250 mg F $$



Vaccines

Vaccines

ACTHIB (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML

F $$$

ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SUSPENSION 2 LF‐(2.5‐5‐3‐5 MCG)‐5LF/0.5 ML

F $$$

ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SYRINGE 2 LF‐(2.5‐5‐3‐5 MCG)‐5LF/0.5 ML

F $$$

ADENOVIRUS VAC LIVE TYPE‐4, 7 ORAL TABLET,DELAYED RELEASE (DR/EC)

F $$$

ADENOVIRUS VACCINE LIVE TYPE‐4 ORAL TABLET,DELAYED RELEASE (DR/EC)

F $$$

ADENOVIRUS VACCINE LIVE TYPE‐7 ORAL TABLET,DELAYED RELEASE (DR/EC)

F $$$

AFLURIA 2016‐2017 (PF) INTRAMUSCULAR SYRINGE 45 MCG (15 MCG X 3)/0.5 ML

F $$$

AFLURIA QUAD 2016‐2017 (PF) INTRAMUSCULAR SYRINGE 60 MCG/0.5 ML

F $$$

AFLURIA QUAD 2016‐2017 INTRAMUSCULAR SUSPENSION 60 MCG/0.5 ML

F $$$

BEXSERO (PF) INTRAMUSCULAR SYRINGE50‐50‐50‐25 MCG/0.5 ML

F $$$

BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION2.5‐8‐5 LF‐MCG‐LF/0.5ML

F $$$

BOOSTRIX TDAP INTRAMUSCULAR SYRINGE2.5‐8‐5 LF‐MCG‐LF/0.5ML

F $$$

CERVARIX VACCINE (PF) INTRAMUSCULAR SYRINGE 20‐20 MCG/0.5 ML

F $$$

COMVAX (PF) INTRAMUSCULAR SUSPENSION5‐7.5‐125 MCG/0.5 ML

F $$$

DAPTACEL (DTAP PEDIATRIC) (PF) INTRAMUSCULAR SUSPENSION 15‐10‐5 LF‐MCG‐LF/0.5ML

F $$$

ENGERIX‐B (PF) INTRAMUSCULAR SUSPENSION20 MCG/ML

F $$$

ENGERIX‐B (PF) INTRAMUSCULAR SYRINGE 20 MCG/ML

F $$$



ENGERIX‐B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION 10 MCG/0.5 ML

F $$$

ENGERIX‐B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 10 MCG/0.5 ML

F $$$

EZ FLU 2016‐17 (AFLURIA) (PF) INTRAMUSCULAR SYRINGE KIT 45 MCG (15 MCG X 3)/0.5 ML

F $$$

EZ FLU 2016‐17 (FLUVIRIN) (PF) INTRAMUSCULAR SYRINGE KIT 45 MCG (15 MCG X 3)/0.5 ML

F $$$

EZ FLU16‐17(FLUZON QD PED)(PF) INTRAMUSCULAR SYRINGE KIT 30 MCG (7.5MCG X4)/0.25 ML

F $$$

FLUAD 2016‐2017 (65 YR UP)(PF) INTRAMUSCULAR SYRINGE 45 MCG (15 MCG X 3)/0.5 ML

F $$$

FLUARIX QUAD 2016‐2017 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

F $$$

FLUBLOK 2016‐2017 (PF) INTRAMUSCULAR SOLUTION 135 MCG (45 MCG X 3)/0.5 ML

F $$$

FLUCELVAX QUAD 2016‐2017 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

F $$$

FLULAVAL QUAD 2016‐2017 (PF) INTRAMUSCULAR SYRINGE 60 MCG (15 MCG X 4)/0.5 ML

F $$$

FLULAVAL QUAD 2016‐2017 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

F $$$

FLUMIST QUAD 2016‐2017 NASAL NASAL SPRAY SYRINGE 10EXP6.5‐7.5 FF UNIT/0.2 ML

F $$$

FLUVIRIN 2016‐2017 (PF) INTRAMUSCULAR SYRINGE 45 MCG (15 MCG X 3)/0.5 ML

F $$$

FLUZONE HIGH‐DOSE 2016‐17 (PF) INTRAMUSCULAR SYRINGE 180 MCG/0.5 ML

F $$$

FLUZONE INTRADERM QUAD 2016‐17 INTRADERMAL SYRINGE 36 MCG/0.1 ML

F $$$

FLUZONE QUAD 2016‐2017 (PF) INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

F $$$

FLUZONE QUAD 2016‐2017 INTRAMUSCULAR SUSPENSION 60 MCG (15 MCG X 4)/0.5 ML

F $$$



FLUZONE QUAD PEDI 2016‐17 (PF) INTRAMUSCULAR SYRINGE 30 MCG (7.5 MCG X 4)/0.25 ML

F $$$

GARDASIL (PF) INTRAMUSCULAR SUSPENSION20‐40‐40‐20 MCG/0.5 ML

F $$$

GARDASIL (PF) INTRAMUSCULAR SYRINGE20‐40‐40‐20 MCG/0.5 ML

F $$$

GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION0.5 ML

F $$$

GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE 0.5 ML

F $$$

HAVRIX (PF) INTRAMUSCULAR SUSPENSION1,440 ELISA UNIT/ML, 720 ELISA UNIT/0.5 ML

F $$$

HAVRIX (PF) INTRAMUSCULAR SYRINGE 1,440 ELISA UNIT/ML, 720 ELISA UNIT/0.5 ML

F $$$

HIBERIX (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML

F $$$

INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION 25‐58‐10 LF‐MCG‐LF/0.5ML

F $$$

INFANRIX (DTAP) (PF) INTRAMUSCULAR SYRINGE 25‐58‐10 LF‐MCG‐LF/0.5ML

F $$$

KINRIX (PF) INTRAMUSCULAR SUSPENSION 25 LF‐58 MCG‐10 LF/0.5 ML

F $$$

KINRIX (PF) INTRAMUSCULAR SYRINGE 25 LF‐58 MCG‐10 LF/0.5 ML

F $$$

MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG/0.5 ML

F $$$

MENHIBRIX (PF) INTRAMUSCULAR RECON SOLN5‐2.5 MCG/0.5 ML

F $$$

MENOMUNE ‐ A/C/Y/W‐135 SUBCUTANEOUS RECON SOLN 50 MCG

F $$$

MENVEO A‐C‐Y‐W‐135‐DIP (PF) INTRAMUSCULAR KIT 10‐5 MCG/0.5 ML

F $$$

PEDIARIX (PF) INTRAMUSCULAR SYRINGE 10 MCG‐25LF‐25 MCG‐10LF/0.5 ML

F $$$

PEDVAX HIB (PF) INTRAMUSCULAR SOLUTION7.5 MCG/0.5 ML

F $$$

PENTACEL (PF) INTRAMUSCULAR KIT 15 LF UNIT‐20 MCG‐5 LF/0.5 ML

F $$$



PENTACEL DTAP‐IPV COMPNT (PF) INTRAMUSCULAR SUSPENSION 15 LF‐48 MCG‐ 5 LF UNIT/0.5ML

F $$$

PNEUMOVAX 23 INJECTION SOLUTION 25 MCG/0.5 ML

F $$$

PNEUMOVAX 23 INJECTION SYRINGE 25 MCG/0.5 ML

F $$$

PREVNAR 13 (PF) INTRAMUSCULAR SYRINGE 0.5 ML

F $$$

PROQUAD (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10EXP3‐4.3‐3‐ 3.99 TCID50/0.5

F $$$

RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 40 MCG/ML

F $$$

RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCG/ML, 5 MCG/0.5 ML

F $$$

TENIVAC (PF) INTRAMUSCULAR SYRINGE 5‐2 LF UNIT/0.5 ML

F $$$

TETANUS,DIPHTHERIA TOX PED(PF) INTRAMUSCULAR SUSPENSION 5‐25 LF UNIT/0.5 ML

F $$$

TETANUS‐DIPHTHERIA TOXOIDS‐TD INTRAMUSCULAR SUSPENSION 2‐2 LF UNIT/0.5 ML

F $$$

TRUMENBA INTRAMUSCULAR SYRINGE 120 MCG/0.5 ML

F $$$

TWINRIX (PF) INTRAMUSCULAR SUSPENSION720 ELISA UNIT ‐20 MCG/ML

F $$$

TWINRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT ‐20 MCG/ML

F $$$

VAQTA (PF) INTRAMUSCULAR SUSPENSION 50 UNIT/ML

F $$$

VAQTA (PF) INTRAMUSCULAR SYRINGE 25 UNIT/0.5 ML, 50 UNIT/ML

F $$$

VARIVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 1,350 UNIT/0.5 ML

F $$$

VAXCHORA BUFFER COMPONENT ORAL SUSPENSION FOR RECONSTITUTION

F $$$

VAXCHORA VACCINE ORAL SUSPENSION FOR RECONSTITUTION 4X10EXP8 TO 2X 10EXP9 CF UNIT

F $$$



VIVOTIF BERNA VACCINE ORAL CAPSULE,DELAYED RELEASE(DR/EC) 2 BILLION UNIT

F $$$

ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 19,400 UNIT/0.65 ML

F $$$

Vitamins And Minerals

Vitamins And Minerals

calcitriol oral capsule 0.25 mcg, 0.5 mcg F $$

calcitriol oral solution 1 mcg/ml F $$

completenate oral tablet,chewable 29‐1 mg F $$

cyanocobalamin (vitamin b‐12) injection solution1,000 mcg/ml

F $

denta 5000 plus dental cream 1.1 % F $

dentagel dental gel 1.1 % F $

ergocalciferol (vitamin d2) oral capsule 50,000 unit

F $

fabb oral tablet 2.2‐25‐1 mg F $$

fluoridex daily defense dental gel 1.1 % F $

folbee plus oral tablet 5 mg F $$

folic acid oral tablet 1 mg F $

inatal advance oral tablet 90‐1‐50 mg F $

inatal ultra oral tablet 90‐1‐50 mg F $

ludent fluoride oral tablet,chewable 0.25 mg fluorid (0.55 mg), 0.5 mg fluoride (1.1 mg), 1 mg fluoride (2.2 mg)

F $

MEPHYTON ORAL TABLET 5 MG F $$$ QL

multi‐vitamin with fluoride oral drops 0.25 mg/ml, 0.5 mg/ml

F $

multi‐vitamin with fluoride oral tablet,chewable0.25 mg, 0.5 mg, 1 mg

F $

multivitamins with fluoride oral tablet,chewable0.25 mg, 0.5 mg, 1 mg

F $

mynatal advance oral tablet 90‐1‐50 mg F $

mynatal oral tablet 90‐1‐50 mg F $

mynatal plus oral tablet 65‐1 mg F $

mynatal‐z oral tablet 65‐1 mg F $

mynate 90 plus oral tablet extended release 90 mg iron‐1 mg

F $



mynephrocaps oral capsule 1 mg F $$

natal‐v rx oral tablet 29 mg iron‐ 1 mg F $

o‐cal prenatal oral tablet 15 mg iron‐ 1,000 mcg F $

prenaplus oral tablet 27‐1 mg F $

prenatabs fa oral tablet 29‐1 mg F $

prenatabs rx oral tablet 29 mg iron‐ 1 mg F $

prenatal ad oral tablet 90‐1‐50 mg F $

prenatal low iron oral tablet 27‐1 mg F $

prenatal plus (calcium carb) oral tablet 27 mg iron‐ 1 mg

F $

prenatal plus oral tablet 29 mg iron‐ 1 mg F $

prenatal plus with iron (ca) oral tablet 29 mg iron‐ 1 mg

F $

purefe ob plus oral capsule 106 mg iron‐ 1 mg F $

purefe plus oral capsule 106 mg iron‐ 1 mg F $

QUFLORA PEDIATRIC DROPS ORAL DROPS0.25MG FLUORIDE (0.55 MG)/ML, 0.5 MG FLUORIDE (1.1 MG)/ML

F $$$

renal caps oral capsule 1 mg F $$

reno caps oral capsule 1 mg F $$

se‐natal 19 (with docusate) oral tablet 29 mg iron‐ 1 mg‐25 mg

F $

se‐natal 19 oral tablet,chewable 29 mg iron‐ 1 mg

F $

sf 5000 plus dental cream 1.1 % F $

sf dental gel 1.1 % F $

sodium fluoride dental solution 0.2 % F $

sodium fluoride oral drops 0.5 mg fluoride (1.1 mg)/ml

F $

sodium fluoride oral tablet,chewable 0.25 mg fluorid (0.55 mg), 0.5 mg fluoride (1.1 mg), 1 mg fluoride (2.2 mg)

F $

tl gard rx oral tablet 2.2‐25‐1 mg F $$

triadvance oral tablet 90‐1‐50 mg F $

trinatal gt oral tablet 90‐1‐50 mg F $

trinatal ultra oral tablet 90‐1‐50 mg F $

trinate oral tablet 28‐1 mg F $

triphrocaps oral capsule 1 mg F $$



triple vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

F $

tri‐vitamin with fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml, 0.5 mg fluoride (1.1 mg)/ml

F $

vinate care oral tablet,chewable 40 mg iron‐ 1 mg

F $

vinate gt oral tablet 90‐1‐50 mg F $

vinate m oral tablet 27‐1 mg F $

vinate one oral tablet 60 mg iron‐1 mg F $

vinate ultra oral tablet 90‐1‐50 mg F $

virt‐caps oral capsule 1 mg F $$

vitamin b‐12 injection solution 1,000 mcg/ml F $

vitamin d2 oral capsule 50,000 unit F $

vitamins a,c,d and fluoride oral drops 0.25 mg fluor. (0.55 mg)/ml

F $

vol‐tab rx oral tablet 29 mg iron‐ 1 mg F $

Weight Loss

Weight Loss

ALLI ORAL CAPSULE 60 MG F $$$ PA; WL

LOMAIRA ORAL TABLET 8 MG F $$$ WL; QL

phentermine oral capsule 15 mg, 30 mg, 37.5 mg F $$ WL; QL

phentermine oral tablet 37.5 mg F $$ WL; QL

XENICAL ORAL CAPSULE 120 MG F $$$ PA; WL

Women's Health

Anti‐Infectives, Vaginal

CLEOCIN VAGINAL SUPPOSITORY 100 MG F $$$

clindamycin phosphate vaginal cream 2 % F $$

metronidazole vaginal gel 0.75 % F $$

terconazole vaginal cream 0.4 %, 0.8 % F $$

terconazole vaginal suppository 80 mg F $$

Estrogens, Vaginal

ESTRACE VAGINAL CREAM 0.01 % (0.1 MG/GRAM)

F $$$

PREMARIN VAGINAL CREAM 0.625 MG/GRAM F $$$

VAGIFEM VAGINAL TABLET 10 MCG F $$$



Hormone Replacement

estradiol oral tablet 0.5 mg, 1 mg, 2 mg F $$

estradiol transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

F $$

estradiol transdermal patch weekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr

F $$

estropipate oral tablet 0.75 mg F $$

estropipate oral tablet 1.5 mg, 3 mg F $

medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5 mg

F $

norethindrone acetate oral tablet 5 mg F $$

progesterone micronized oral capsule 100 mg, 200 mg

F $$

Women's Health, Other

cabergoline oral tablet 0.5 mg F $$

danazol oral capsule 100 mg, 200 mg, 50 mg F $$

methylergonovine oral tablet 0.2 mg F $$

nifedipine oral capsule 10 mg, 20 mg F $$ GE Female; AE

raloxifene oral tablet 60 mg F $$

tranexamic acid oral tablet 650 mg F $$ QL


Index

Index

abacavir .............................................................................. 9abacavir‐lamivudine‐zidovudine ... 9acamprosate ............................................................... 3acarbose ........................................................................ 33acetaminophen‐codeine ........................ 54acetazolamide ............................... 38, 44, 57acetic acid .................................................................... 36acetylcysteine ........................................................ 32acitretin ........................................................................... 63ACTHAR H.P. ........................................................... 51ACTHIB (PF) ............................................................... 69acyclovir ......................................................................... 11ADACEL(TDAP ADOLESN/ADULT)(PF) ............................. 69adapalene .................................................................... 60adderall xr ................................................................... 16adefovir ............................................................................... 8ADEMPAS .................................................................... 57ADENOVIRUS VAC LIVE TYPE‐4, 7....................................................................................................... 69ADENOVIRUS VACCINE LIVE TYPE‐4 ............................................................................... 69ADENOVIRUS VACCINE LIVE TYPE‐7 ............................................................................... 69ADVAIR DISKUS .................................................. 14ADVAIR HFA ............................................................ 14ADVATE ........................................................................... 25ADYNOVATE ............................................................ 25AFINITOR ...................................................................... 29AFINITOR DISPERZ ......................................... 29AFLURIA 2016‐2017 (PF) ...................... 69AFLURIA QUAD 2016‐2017 ............... 69AFLURIA QUAD 2016‐2017 (PF)....................................................................................................... 69AFSTYLA ......................................................................... 25ALBENZA ........................................................................... 8albuterol sulfate ................................................. 13alendronate .............................................................. 28ALFERON N ................................................................ 51alfuzosin ......................................................................... 48ALINIA ................................................................................... 8ALKERAN ....................................................................... 28ALLI ........................................................................................ 75allopurinol ................................................................... 39alosetron ....................................................................... 66ALPHANATE .............................................................. 25ALPHANINE SD .................................................... 25alprazolam ................................................................. 16ALPROLIX ...................................................................... 25altavera (28) ............................................................ 19alyacen 1/35 (28) ............................................. 19alyacen 7/7/7 (28) .......................................... 19amantadine hcl ........................................ 11, 56

Index

AMICAR .......................................................................... 24amiloride ....................................................................... 44amiloride‐hydrochlorothiazide ..... 44aminocaproic acid ........................................... 24amiodarone ............................................................... 39AMITIZA ......................................................................... 65amitriptyline ............................................................ 19amlodipine .................................................................. 42amlodipine‐benazepril .................. 40, 42amlodipine‐valsartan ..................... 40, 42amlodipine‐valsartan‐hcthiazid........................................................................................... 40, 42ammonium lactate ........................................ 63amnesteem ................................................................ 60amoxicillin ....................................................................... 6amoxicillin‐pot clavulanate ................... 6ampicillin ........................................................................... 6AMPYRA ........................................................................ 51anagrelide ................................................................... 28anastrozole ................................................................ 29ANDRODERM ........................................................ 48ANDROGEL ..................................................... 48, 49androxy ............................................................................ 49ANORO ELLIPTA ................................................. 14antipyrine‐benzocaine .............................. 36APEXICON E .............................................................. 61apri ......................................................................................... 19APTIOM .......................................................................... 57APTIVUS ............................................................................. 9ARALAST NP ................................................................ 4aranelle (28) ............................................................. 19ARANESP (IN POLYSORBATE) ....... 24ARCALYST .................................................................... 52aripiprazole ............................................................... 15armodafinil ................................................................ 64ARNUITY ELLIPTA ............................................ 14ASMANEX HFA ..................................................... 14ASMANEX TWISTHALER ........................ 14aspirin‐dipyridamole ................................... 28atenolol ........................................................................... 41atenolol‐chlorthalidone .......................... 41atorvastatin .............................................................. 44atovaquone ................................................................... 8atovaquone‐proguanil .................................. 8ATRIPLA .............................................................................. 9atropine .......................................................................... 38ATROVENT HFA .................................................. 13aubra ................................................................................... 19AUVI‐Q ................................................................................. 3aviane ................................................................................ 19avita ..................................................................................... 60AVONEX ............................................................. 50, 51AVONEX (WITH ALBUMIN) .............. 50

Index

azathioprine ............................................................. 47azelastine ......................................................................... 3azithromycin ................................................................ 5azurette (28) ............................................................ 19bacitracin ...................................................................... 37bacitracin‐polymyxin b ............................. 37baclofen .......................................................................... 51balsalazide .................................................................. 65balziva (28) ................................................................ 20BANZEL ................................................................ 57, 58BARACLUDE .................................................................. 8BEBULIN ......................................................................... 25benazepril .................................................................... 40benazepril‐hydrochlorothiazide....................................................................................................... 40BENEFIX .......................................................................... 25benzonatate ............................................................. 32benztropine ............................................................... 56BERINERT ..................................................................... 46BESIVANCE ................................................................. 37betamethasone dipropionate ........ 61betamethasone valerate ....................... 61betamethasone, augmented .......... 61betaxolol ........................................................................ 38bethanechol chloride .................................. 68BEXSERO (PF) ......................................................... 69bicalutamide ............................................................ 29BILTRICIDE ...................................................................... 8bimatoprost .............................................................. 38bisoprolol fumarate ...................................... 41bisoprolol‐hydrochlorothiazide .... 41BIVIGAM ....................................................................... 46BLEPHAMIDE S.O.P. .................................... 37blisovi fe 1.5/30 (28) .................................... 20blisovi fe 1/20 (28) .......................................... 20BOOSTRIX TDAP ................................................ 69BOSULIF .......................................................................... 30bp 10‐1 ............................................................................. 60BREO ELLIPTA ........................................................ 14brevicon (28) ............................................................ 20briellyn .............................................................................. 20BRILINTA ....................................................................... 28brimonidine ............................................................... 38BRIVIACT ....................................................................... 58bromfenac ................................................................... 37bromocriptine ........................................................ 56budeprion sr ............................................................. 17budesonide ..................................................... 14, 65bumetanide ............................................................... 44buprenorphine‐naloxone ...................... 54buproban ...................................................................... 64bupropion hcl .............................................. 17, 18buspirone ...................................................................... 16


Index

butalbital‐acetaminophen .................. 55butalbital‐acetaminophen‐caff ... 55butalbital‐aspirin‐caffeine .................. 56BYDUREON ................................................................ 33BYETTA ............................................................................. 33cabergoline ................................................................ 76CABOMETYX ............................................................ 30cafergot ........................................................................... 49calcipotriene ............................................................ 63calcitonin (salmon) ......................................... 28calcitriol .......................................................................... 73calcium acetate ................................................... 48camila ................................................................................ 20CANASA .......................................................................... 65capecitabine ............................................................. 29CAPRELSA .................................................................... 30captopril ......................................................................... 40captopril‐hydrochlorothiazide ....... 40CARAFATE ................................................................... 67CARBAGLU ................................................................. 66carbamazepine .................................................... 58carbidopa ..................................................................... 56carbidopa‐levodopa ..................................... 56carbidopa‐levodopa‐entacapone....................................................................................................... 56CARIMUNE NF NANOFILTERED....................................................................................................... 46carteolol ......................................................................... 38cartia xt ........................................................................... 42carvedilol ....................................................................... 41CAYSTON ...................................................................... 32caziant (28) ................................................................ 20cefadroxil .................................................................. 4, 5cefdinir .................................................................................. 5cefprozil ............................................................................... 5CEFTIN ................................................................................... 5cefuroxime axetil ................................................... 5celecoxib ........................................................................ 53cephalexin ....................................................................... 5CERDELGA ................................................................... 36CERVARIX VACCINE (PF) ....................... 69cesia (28) ....................................................................... 20cevimeline .................................................................... 50CHANTIX ........................................................................ 65CHANTIX CONTINUING MONTH BOX ....................................................................................... 64CHANTIX CONTINUING MONTH PAK ........................................................................................ 65CHANTIX STARTING MONTH BOX....................................................................................................... 65CHANTIX STARTING MONTH PAK....................................................................................................... 65chateal .............................................................................. 20CHEMET .......................................................................... 52chlordiazepoxide hcl .................................... 16

Index

chlorhexidine gluconate ......................... 50chloroquine phosphate ................................ 8chlorothiazide ........................................................ 44chlorpromazine .................................................... 15chlorthalidone ....................................................... 44chlorzoxazone ........................................................ 51CHOLBAM .................................................................... 66cholestyramine (with sugar) ............ 43cholestyramine light .................................... 43ciclopirox ........................................................... 60, 61cilostazol ........................................................................ 28CILOXAN ........................................................................ 37CINRYZE .......................................................................... 46CIPRO HC ...................................................................... 36CIPRODEX .................................................................... 36ciprofloxacin ................................................................. 7ciprofloxacin hcl .......................................... 7, 37citalopram ................................................................... 18claravis ............................................................................. 60clarithromycin ........................................................... 5clemastine ....................................................................... 4CLEOCIN ......................................................................... 75clindamycin hcl ........................................................ 6clindamycin palmitate hcl ....................... 6clindamycin phosphate ................ 60, 75clobetasol ..................................................................... 61clobetasol‐emollient .................................... 61clomipramine .......................................................... 19clonazepam ................................................... 16, 58clonidine ......................................................................... 43clonidine hcl .............................................................. 43clopidogrel .................................................................. 28clotrimazole .................................................................. 7clozapine ....................................................................... 15COAGADEX ................................................................ 25codeine sulfate ..................................................... 54codeine‐guaifenesin ..................................... 32colchicine ...................................................................... 39colchicine‐probenecid ................................ 39colestipol ....................................................................... 43COMBIVENT RESPIMAT ......................... 14COMETRIQ ................................................................. 30COMPLERA .................................................................... 9completenate ......................................................... 73COMVAX (PF) ......................................................... 69COPAXONE ................................................................ 51COREG CR .................................................................... 41CORIFACT ..................................................................... 25COSOPT (PF) ............................................................ 38COTELLIC ....................................................................... 30CREON ............................................................................... 36CRESEMBA ..................................................................... 7CRIXIVAN .......................................................................... 9cromolyn ................................................................ 3, 13cryselle (28) ............................................................... 20

Index

CUVPOSA ..................................................................... 66cyanocobalamin (vitamin b‐12)....................................................................................................... 73cyclafem 1/35 (28) .......................................... 20cyclafem 7/7/7 (28) ...................................... 20cyclobenzaprine .................................................. 51cyclopentolate ....................................................... 38CYCLOPHOSPHAMIDE .................. 29, 47cycloserine .................................................................. 12CYCLOSET ..................................................................... 34cyclosporine .............................................................. 47cyclosporine modified ................................ 47cyproheptadine ....................................................... 4CYSTAGON ................................................................. 52CYSTARAN .................................................................. 38DALIRESP ...................................................................... 13danazol ............................................................................ 76dantrolene .................................................................. 51dapsone .............................................................................. 8DAPTACEL (DTAP PEDIATRIC) (PF)....................................................................................................... 69dasetta 1/35 (28) .............................................. 20dasetta 7/7/7 (28) ........................................... 20DELZICOL ....................................................................... 65demeclocycline ......................................................... 7denta 5000 plus .................................................. 73dentagel ......................................................................... 73DEPEN TITRATABS ......................................... 12DEPO‐TESTOSTERONE ............................. 49DESCOVY ........................................................................... 9desipramine .............................................................. 19desmopressin .......................................................... 52desogestrel‐ethinyl estradiol ........... 20desonide ......................................................................... 61desoximetasone .................................................. 62dexamethasone .................................................. 31DEXAMETHASONE INTENSOL ...... 31dexamethasone sodium phosphate....................................................................................................... 37dexmethylphenidate .................................... 17dextroamphetamine .................................... 17dextroamphetamine‐amphetamine .................................................................................................. 17diazepam .......................................................... 16, 58diazepam intensol ............................... 16, 58diclofenac potassium .................................. 53diclofenac sodium .................... 37, 53, 56dicloxacillin .................................................................... 6dicyclomine ................................................................ 66didanosine ....................................................................... 9DIFICID ................................................................................. 5DIGOXIN ........................................................................ 45digoxin .............................................................................. 45dihydroergotamine ........................................ 49DILANTIN ...................................................................... 58


Index

DILANTIN KAPSEAL ....................................... 58diltia xt ............................................................................. 42diltiazem hcl ............................................................. 42dilt‐xr ................................................................................... 42diphenoxylate‐atropine ........................... 67dipyridamole ........................................................... 28disopyramide phosphate ...................... 39disulfiram ......................................................................... 3divalproex ............................................. 17, 49, 58dofetilide ....................................................................... 40donepezil ....................................................................... 32dorzolamide .............................................................. 38dorzolamide‐timolol ..................................... 38doxazosin .......................................................... 43, 48doxepin ............................................................................ 19doxycycline hyclate ............................................ 7doxycycline monohydrate ........................ 7dronabinol ................................................................... 66drospirenone‐ethinyl estradiol ..... 20DRYSOL ............................................................................ 63DRYSOL DAB‐O‐MATIC ........................... 63DULERA ........................................................................... 14duloxetine .................................................................... 18e.e.s. 200 ........................................................................... 5e.e.s. 400 ........................................................................... 5econazole ..................................................................... 61EDURANT ......................................................................... 9EFFIENT ........................................................................... 28ELIDEL ................................................................................ 63elinest ................................................................................. 20ELIQUIS ............................................................................ 27ELLA ...................................................................................... 19ELMIRON ...................................................................... 68ELOCTATE .................................................................... 25EMCYT ............................................................................... 28EMEND ............................................................................. 66emoquette .................................................................. 20EMTRIVA ........................................................................... 9enalapril maleate ............................................. 40enalapril‐hydrochlorothiazide ....... 40ENBREL ..................................................... 12, 63, 65ENBREL SURECLICK ........................... 12, 63endocet ............................................................................ 54ENGERIX‐B (PF) ................................................... 69ENGERIX‐B PEDIATRIC (PF) ............... 70enoxaparin ................................................................. 27enpresse ......................................................................... 20enskyce ............................................................................ 20entacapone ................................................................ 56entecavir ............................................................................ 8ENTRESTO ................................................................... 45enulose ............................................................................. 65EPCLUSA ............................................................................ 8epinastine ........................................................................ 3epinephrine .................................................................... 3

Index

EPIPEN .................................................................................. 3EPIPEN JR 2‐PAK .................................................... 3EPIVIR HBV .................................................................... 8eplerenone .................................................................. 44EPOPROSTENOL (GLYCINE) .............. 57EPZICOM ........................................................................... 9ergocalciferol (vitamin d2) ................. 73ergoloid ........................................................................... 52ERIVEDGE ..................................................................... 30errin ....................................................................................... 20ERYPED 400 .................................................................. 5ery‐tab .................................................................................. 5ERY‐TAB .............................................................................. 5erythrocin (as stearate) .............................. 5erythromycin ........................................... 5, 6, 37erythromycin ethylsuccinate ............... 5erythromycin with ethanol ................. 60ESBRIET ........................................................................... 46escitalopram oxalate .................................. 18estarylla .......................................................................... 20ESTRACE ......................................................................... 75estradiol .......................................................................... 76estropipate ................................................................. 76eszopiclone ................................................................. 64ethambutol ................................................................ 12ethosuximide ........................................................... 58etidronate disodium ..................................... 28etodolac .......................................................................... 53etoposide ...................................................................... 30EVOTAZ ............................................................................... 9exemestane ............................................................... 29EXJADE ............................................................................. 52EXTAVIA ......................................................................... 51EZ FLU 2016‐17 (AFLURIA) (PF)....................................................................................................... 70EZ FLU 2016‐17 (FLUVIRIN) (PF)....................................................................................................... 70EZ FLU16‐17(FLUZON QD PED)(PF)....................................................................................................... 70fabb ....................................................................................... 73falmina (28) .............................................................. 20famciclovir .................................................................. 11famotidine ................................................................... 67FEIBA NF ........................................................................ 25felbamate ..................................................................... 58fenofibrate .................................................................. 46fenofibrate micronized ............................. 45fenofibrate nanocrystallized ............ 45fentanyl ........................................................................... 54FERRIPROX ................................................................. 52finasteride ................................................................... 48FIRAZYR .......................................................................... 46FLEBOGAMMA DIF ........................................ 46flecainide ....................................................................... 40FLOLAN ............................................................................ 57

Index

FLOVENT DISKUS .............................................. 14FLOVENT HFA ........................................................ 15FLUAD 2016‐2017 (65 YR UP)(PF)....................................................................................................... 70FLUARIX QUAD 2016‐2017 (PF)....................................................................................................... 70FLUBLOK 2016‐2017 (PF) ..................... 70FLUCELVAX QUAD 2016‐2017 (PF)....................................................................................................... 70fluconazole ..................................................................... 7fludrocortisone ..................................................... 31FLULAVAL QUAD 2016‐2017 .......... 70FLULAVAL QUAD 2016‐2017 (PF)....................................................................................................... 70FLUMIST QUAD 2016‐2017 .............. 70flunisolide ......................................................................... 4fluocinolone .............................................................. 62fluocinolone acetonide oil ................... 36fluocinolone and shower cap .......... 62fluocinonide .............................................................. 62fluocinonide‐e ........................................................ 62fluoridex daily defense ............................. 73fluorometholone ................................................ 38fluorouracil ..................................................... 63, 64fluoxetine ...................................................................... 18fluphenazine hcl ................................................. 15flurbiprofen ................................................................ 53flurbiprofen sodium ...................................... 38flutamide ....................................................................... 29fluticasone ........................................................... 4, 62FLUVIRIN 2016‐2017 (PF) .................... 70fluvoxamine .............................................................. 18FLUZONE HIGH‐DOSE 2016‐17 (PF)....................................................................................................... 70FLUZONE INTRADERM QUAD 2016‐17 ........................................................................... 70FLUZONE QUAD 2016‐2017 ............. 70FLUZONE QUAD 2016‐2017 (PF)....................................................................................................... 70FLUZONE QUAD PEDI 2016‐17 (PF)....................................................................................................... 71FML S.O.P. .................................................................. 38folbee plus ................................................................... 73folic acid ......................................................................... 73fondaparinux ........................................................... 27FORADIL AEROLIZER ................................... 13FORTEO ........................................................................... 28FORTICAL ...................................................................... 28fosinopril ........................................................................ 40fosinopril‐hydrochlorothiazide ..... 40FULYZAQ ....................................................................... 67furosemide ................................................................. 44FUZEON ............................................................................... 9FYCOMPA .................................................................... 58gabapentin ..................................................... 53, 58


Index

GABITRIL ....................................................................... 58galantamine ............................................................. 32GAMASTAN S/D ................................................ 46GAMMAGARD LIQUID ............................. 46GAMMAGARD S/D ........................................ 46GAMMAGARD S‐D (IGA < 1 MCG/ML) ..................................................................... 46GAMMAKED ............................................................ 47GAMMAPLEX ......................................................... 47GAMUNEX‐C ............................................................ 47GARDASIL (PF) ...................................................... 71GARDASIL 9 (PF) ................................................ 71gavilyte‐c ....................................................................... 65gavilyte‐g ...................................................................... 65gavilyte‐n ...................................................................... 65gemfibrozil .................................................................. 46gengraf ............................................................................ 47gentamicin ...................................................... 37, 61GENVOYA .................................................................... 10gianvi (28) .................................................................... 20gildagia ............................................................................ 20gildess 1.5/30 (21) .......................................... 20gildess 1/20 (21) ................................................ 20gildess fe 1.5/30 (28) .................................. 20gildess fe 1/20 (28) ........................................ 20GILENYA ......................................................................... 51GILOTRIF ........................................................................ 30GLASSIA .............................................................................. 4glatopa ............................................................................. 51GLEOSTINE ................................................................. 28glimepiride .................................................................. 35glipizide ........................................................................... 35glipizide‐metformin ....................................... 35GLUCAGEN ................................................................. 35GLUCAGEN HYPOKIT .................................. 35GLUCAGON EMERGENCY KIT (HUMAN) ...................................................................... 35glyburide ........................................................................ 35glyburide micronized ................................... 35glycopyrrolate ....................................................... 67GRANIX ............................................................................ 24granulex .......................................................................... 64GRASTEK ........................................................................... 3griseofulvin microsize ..................................... 7griseofulvin ultramicrosize ..................... 7guaiatussin ac ........................................................ 32guanfacine ...................................................... 17, 43haloperidol ................................................................. 15haloperidol lactate ......................................... 15HARVONI .......................................................................... 8HAVRIX (PF) .............................................................. 71heather ............................................................................ 21HELIXATE FS ............................................................. 25HEMOFIL M HIGH ............................................ 25HEMOFIL M LOW ............................................. 26

Index

HEMOFIL M MID ............................................... 26HEMOFIL M SUPER HIGH .................... 26heparin (porcine) ............................................... 27heparin, porcine (pf) .................................... 27HEXALEN ....................................................................... 28HIBERIX (PF) ............................................................. 71HIZENTRA .................................................................... 47homatropaire ......................................................... 38HUMALOG ...................................................... 34, 35HUMALOG KWIKPEN ................................. 34HUMALOG MIX 50‐50 .............................. 34HUMALOG MIX 50‐50 KWIKPEN....................................................................................................... 34HUMALOG MIX 75‐25 .............................. 34HUMALOG MIX 75‐25 KWIKPEN....................................................................................................... 34HUMATE‐P ................................................................. 26HUMIRA ................................................. 12, 63, 65HUMIRA PEN .................................. 12, 63, 65HUMULIN 70/30 ............................................... 34HUMULIN 70/30 KWIKPEN .............. 34HUMULIN 70/30 PEN ................................ 34HUMULIN N .............................................................. 33HUMULIN N KWIKPEN ............................ 33HUMULIN N PEN .............................................. 33HUMULIN R .............................................................. 35HUMULIN R U‐500 (CONC) KWIKPEN ...................................................................... 35HUMULIN R U‐500 (CONCENTRATED) ........................................... 35HYCAMTIN ................................................................. 30hydralazine ................................................................ 43hydrochlorothiazide .......................... 44, 45hydrocodone‐acetaminophen ....... 54hydrocodone‐ibuprofen .......................... 54hydrocortisone .............................. 31, 62, 67hydrocortisone acetate ........................... 67hydrocortisone valerate ......................... 62hydrocortisone‐pramoxine ..... 62, 67hydromorphone .................................................. 54hydroxychloroquine .......................................... 8hydroxyurea ............................................................. 29hydroxyzine hcl ........................................................ 4hydroxyzine pamoate ..................................... 4hyoscyamine sulfate .................................... 67HYQVIA ........................................................................... 47HYQVIA HY COMPONENT .................. 47HYQVIA IG COMPONENT .................... 47ibandronate .............................................................. 28ibuprofen ...................................................................... 53ICLUSIG ............................................................................ 30IDELVION ...................................................................... 26ILARIS (PF) .................................................................. 52imatinib ........................................................................... 30IMBRUVICA ............................................................... 30

Index

imipramine hcl ...................................................... 19imiquimod ................................................................... 64inatal advance ...................................................... 73inatal ultra .................................................................. 73indapamide ............................................................... 45indomethacin .......................................................... 54INFANRIX (DTAP) (PF) .............................. 71INLYTA .............................................................................. 30INTELENCE .................................................................. 10INTRON A ................................................................. 8, 9introvale ......................................................................... 21INVIRASE ....................................................................... 10INVOKAMET ............................................................ 35INVOKANA ................................................................. 35iodoquinol‐hc .......................................................... 62ipratropium bromide ........................... 3, 13ipratropium‐albuterol ................................ 14irbesartan ..................................................................... 40irbesartan‐hydrochlorothiazide....................................................................................................... 41IRESSA ............................................................................... 30ISENTRESS ................................................................... 10isometh‐dichloral‐acetaminophn....................................................................................................... 49isoniazid .......................................................................... 12isosorbide dinitrate ........................................ 39isosorbide mononitrate ........................... 39itraconazole .................................................................. 7ivermectin ........................................................................ 8IXINITY .............................................................................. 26JADENU ........................................................................... 52JAKAFI ............................................................................... 30jantoven ......................................................................... 27JARDIANCE ................................................................. 35jencycla ............................................................................ 21JENTADUETO .......................................................... 33JENTADUETO XR ............................................... 33jolessa ................................................................................ 21jolivette ............................................................................ 21junel 1.5/30 (21) ................................................ 21junel 1/20 (21) ...................................................... 21junel fe 1.5/30 (28) ........................................ 21junel fe 1/20 (28) .............................................. 21JUXTAPID ..................................................................... 44KALBITOR ..................................................................... 46KALETRA ........................................................................ 10KALYDECO ................................................................... 32kariva (28) ................................................................... 21kelnor 1/35 (28) .................................................. 21ketoconazole ................................................... 7, 61ketorolac ............................................................ 38, 54KINERET .......................................................................... 12KINRIX (PF) ................................................................ 71kionex ................................................................................. 52klor‐con m10 ........................................................... 45


Index

klor‐con m15 ........................................................... 45KLOR‐CON/25 ....................................................... 45KOATE‐DVI ................................................................. 26KOGENATE FS ........................................................ 26kurvelo .............................................................................. 21KUVAN ............................................................................. 52KYNAMRO .................................................................. 44labetalol ......................................................................... 41lactulose ......................................................................... 65LAMICTAL .................................................................... 59lamivudine .......................................................... 8, 10lamivudine‐zidovudine ............................. 10lamotrigine ................................................................ 59lansoprazole ............................................................. 67LANTUS ........................................................................... 34LANTUS SOLOSTAR ....................................... 34larin 1/20 (21) ........................................................ 21larin fe 1.5/30 (28) ......................................... 21larin fe 1/20 (28) ................................................ 21latanoprost ................................................................ 38leena 28 .......................................................................... 21leflunomide ................................................................ 12lessina ................................................................................ 21LETAIRIS ......................................................................... 57letrozole .......................................................................... 29leucovorin calcium .......................................... 52LEUKERAN ................................................................... 28LEUKINE .......................................................................... 24LEVEMIR ........................................................................ 34LEVEMIR FLEXTOUCH ................................ 34levetiracetam ......................................................... 59levlen (28) .................................................................... 21levobunolol ................................................................ 38levocarnitine ............................................................ 52levocarnitine (with sugar) ................... 52levofloxacin ................................................................... 7levonest (28) ............................................................ 21levonorgestrel ........................................................ 19levonorgestrel‐ethinyl estrad ......... 21levora‐28 ....................................................................... 21levothyroxine .......................................................... 68LEXIVA .............................................................................. 10LIALDA .............................................................................. 65lidocaine ......................................................................... 56lidocaine hcl .............................................................. 50lidocaine viscous ................................................ 50lidocaine‐prilocaine ....................................... 56linezolid ............................................................................... 6LINZESS ............................................................................ 65liothyronine ............................................................... 68lisinopril ........................................................................... 41lisinopril‐hydrochlorothiazide ........ 41lithium carbonate ............................................ 17lithium citrate ........................................................ 17lokara ................................................................................. 62

Index

LOMAIRA ...................................................................... 75lomustine ...................................................................... 29LONSURF ....................................................................... 29lorazepam .................................................................... 16loryna (28) ................................................................... 21losartan ........................................................................... 41losartan‐hydrochlorothiazide ......... 41lovastatin ...................................................................... 44low‐ogestrel (28) ............................................... 21loxapine succinate .......................................... 15ludent fluoride ....................................................... 73LUFYLLIN ....................................................................... 14LUMIGAN ..................................................................... 38lutera (28) .................................................................... 21lyza ......................................................................................... 21malathion ..................................................................... 62marlissa ........................................................................... 21MATULANE ................................................................ 29MEDROL ......................................................................... 31medroxyprogesterone ............................... 76mefloquine ..................................................................... 8megestrol .......................................................... 30, 52MEKINIST ..................................................................... 31meloxicam ................................................................... 54memantine ................................................................. 32MENACTRA (PF) ................................................. 71MENHIBRIX (PF) ................................................ 71MENOMUNE ‐ A/C/Y/W‐135 ........ 71MENVEO A‐C‐Y‐W‐135‐DIP (PF)....................................................................................................... 71MEPHYTON ............................................................... 73mercaptopurine ...................................... 29, 47mesalamine ............................................................... 66metformin .................................................................... 33methadone ..................................................... 54, 55methazolamide .................................................... 39methimazole ............................................................ 68methocarbamol .................................................. 51methotrexate sodium....................................................... 12, 13, 29, 48, 63methotrexate sodium (pf)................................................................... 12, 29, 47, 63methyldopa ............................................................... 43methylergonovine ........................................... 76methylphenidate ............................................... 17methylprednisolone ...................................... 31metoclopramide hcl ...................................... 66metolazone ................................................................ 45metoprolol succinate .................................. 41metoprolol ta‐hydrochlorothiaz....................................................................................................... 42metoprolol tartrate ....................................... 42metronidazole .................................... 8, 63, 75mexiletine .................................................................... 40microgestin 1.5/30 (21) .......................... 22

Index

microgestin 1/20 (21) ................................ 22microgestin fe 1.5/30 (28) .................. 22microgestin fe 1/20 (28) ........................ 22midodrine ..................................................................... 43migergot ........................................................................ 49miglitol ............................................................................. 33migragesic ida ....................................................... 49MILLIPRED .................................................................. 31minocycline .................................................................... 7minoxidil ........................................................................ 43mirtazapine ............................................................... 18misoprostol ................................................................ 67modafinil ....................................................................... 64moexipril ........................................................................ 41moexipril‐hydrochlorothiazide ..... 41mometasone ........................................................... 62MONOCLATE‐P .................................................... 26mono‐linyah ............................................................. 22mononessa (28) .................................................. 22MONONINE .............................................................. 26montelukast ............................................................. 13MONUROL .................................................................. 12morphine ....................................................................... 55MORPHINE ................................................................ 55morphine concentrate .............................. 55MOVANTIK ................................................................ 67moxifloxacin ................................................................. 7MULTAQ ........................................................................ 40multi‐vitamin with fluoride ................ 73multivitamins with fluoride ............... 73mupirocin ..................................................................... 61my way ............................................................................. 19mycophenolate mofetil ........................... 48MYLERAN ..................................................................... 29mynatal ........................................................................... 73mynatal advance .............................................. 73mynatal plus ............................................................ 73mynatal‐z ...................................................................... 73mynate 90 plus ..................................................... 73mynephrocaps ...................................................... 74myorisan ........................................................................ 60MYRBETRIQ .............................................................. 68myzilra .............................................................................. 22nabumetone ............................................................. 54nadolol .............................................................................. 42naloxone ............................................................................ 4naltrexone ....................................................................... 3naproxen ....................................................................... 54naproxen sodium .............................................. 54naratriptan ................................................................. 50NARCAN ............................................................................. 4natal‐v rx ....................................................................... 74nateglinide .................................................................. 34necon 0.5/35 (28) ............................................. 22necon 1/35 (28) ................................................... 22


Index

necon 1/50 (28) ................................................... 22necon 10/11 (28) ............................................... 22necon 7/7/7 (28) ................................................ 22nefazodone ................................................................ 18neomycin ........................................................................... 6neomycin‐bacitracin‐polymyxin....................................................................................................... 37neomycin‐polymyxin‐gramicidin....................................................................................................... 37neomycin‐polymyxin‐hc .......................... 36NEULASTA ................................................................... 24NEUPOGEN ................................................................ 24NEUPRO ......................................................................... 56nevirapine .................................................................... 10NEXAVAR ..................................................................... 31next choice one dose ................................... 19nicotine ............................................................................ 64nicotine (polacrilex) ...................................... 64NICOTROL .................................................................... 64NICOTROL NS ......................................................... 64nifedipine .............................................. 43, 52, 76nimodipine .................................................................. 43NINLARO ....................................................................... 31NITRO‐BID ................................................................... 39nitrofurantoin ........................................................ 12nitrofurantoin macrocrystal ............. 12nitrofurantoin monohyd/m‐cryst....................................................................................................... 12nitroglycerin ............................................................. 39nodolor ............................................................................. 49nora‐be ............................................................................ 22norethindrone (contraceptive) ..... 22norethindrone acetate ............................. 76norgestimate‐ethinyl estradiol .... 22norinyl 1+35 (28) ............................................... 22NORPACE CR ........................................................... 40nortrel 0.5/35 (28) .......................................... 22nortrel 1/35 (21) ................................................ 22nortrel 1/35 (28) ................................................ 22nortrel 7/7/7 (28) ............................................. 22nortriptyline .............................................................. 19NORVIR ........................................................................... 10NOVOEIGHT ............................................................. 26NOVOSEVEN RT ................................................. 26NOXAFIL ............................................................................. 7NUPLAZID .................................................................... 15NUVARING ................................................................. 19NUWIQ ............................................................................ 26nystatin .................................................................... 7, 61OBIZUR ............................................................................ 26o‐cal prenatal ......................................................... 74ocella ................................................................................... 22OCTAGAM ................................................................... 47octreotide acetate ........................................... 52ODEFSEY ........................................................................ 10

Index

ODOMZO ...................................................................... 30OFEV .................................................................................... 46ofloxacin ............................................................. 36, 37ogestrel (28) ............................................................. 22olanzapine ................................................................... 15olopatadine ................................................................... 3OLYSIO .................................................................................. 9omega‐3 acid ethyl esters ................... 46omeprazole ................................................................ 67ondansetron ............................................................. 66ondansetron hcl .................................................. 66ONFI ..................................................................................... 59OPSUMIT ...................................................................... 57ORKAMBI ..................................................................... 32orsythia ............................................................................ 22oxandrolone ............................................................. 52oxcarbazepine ....................................................... 59oxybutynin chloride ....................................... 68oxycodone ................................................................... 55oxycodone‐acetaminophen ............... 55oxycodone‐aspirin ........................................... 55OXYCONTIN .............................................................. 55pantoprazole ........................................................... 67paregoric ....................................................................... 67paroxetine hcl ........................................................ 18PAXIL ................................................................................... 18PEDIARIX (PF) ........................................................ 71PEDVAX HIB (PF) ............................................... 71PEGASYS ............................................................................ 9PEGASYS PROCLICK .......................................... 9PEGINTRON .................................................................. 9PEGINTRON REDIPEN .................................... 9penicillin v potassium ............................. 6, 7PENTACEL (PF) ...................................................... 71PENTACEL DTAP‐IPV COMPNT (PF) ......................................................................................... 72PENTASA ....................................................................... 66pentoxifylline .......................................................... 28perindopril erbumine .................................. 41periogard ...................................................................... 50permethrin .................................................................. 62perphenazine .......................................................... 15phenazopyridine ................................................ 68phenelzine ................................................................... 18phenobarbital ........................................................ 59phenoxybenzamine ....................................... 43phentermine ............................................................ 75phenylephrine hcl ............................................. 38phenytoin ..................................................................... 59phenytoin sodium extended ............. 59philith ................................................................................. 22PHOSLYRA ................................................................... 48phospha 250 neutral ................................... 68PICATO ............................................................................. 64pilocarpine hcl ........................................... 39, 50

Index

pimtrea (28) .............................................................. 22pioglitazone .............................................................. 36pioglitazone‐glimepiride ........................ 36pioglitazone‐metformin .......................... 36pirmella ........................................................................... 22piroxicam ...................................................................... 54PLASMANATE ........................................................ 26PNEUMOVAX 23 ............................................... 72podofilox ........................................................................ 64polyethylene glycol 3350 ...................... 65polymyxin b sulf‐trimethoprim .... 37POMALYST ................................................................. 29portia .................................................................................. 22potassium chloride ......................................... 45potassium citrate .............................................. 68POTIGA ............................................................................ 59PRADAXA ..................................................................... 27pramipexole .............................................................. 56pravastatin ................................................................. 44prazosin ............................................................... 43, 48PRED FORTE ............................................................. 38PRED MILD ................................................................. 38prednisolone ............................................................ 31prednisolone acetate .................................. 38prednisolone sodium phosphate........................................................................................... 31, 38prednisone ...................................................... 31, 32PREDNISONE INTENSOL ........................ 31PREMARIN .................................................................. 75prenaplus ...................................................................... 74prenatabs fa ............................................................. 74prenatabs rx ............................................................. 74prenatal ad ................................................................ 74prenatal low iron .............................................. 74prenatal plus ........................................................... 74prenatal plus (calcium carb) ............ 74prenatal plus with iron (ca) ............... 74prevalite ......................................................................... 43previfem ......................................................................... 23PREVNAR 13 (PF) ............................................. 72PREZCOBIX ................................................................. 10PREZISTA ....................................................................... 10PRIFTIN ............................................................................ 12primidone ..................................................................... 59PRIVIGEN ...................................................................... 47probenecid .................................................................. 39prochlorperazine ............................................... 66prochlorperazine maleate ................... 66PROCRIT ......................................................................... 24proctosol hc ............................................................... 67prodrin .............................................................................. 49PROFILNINE .............................................................. 26progesterone micronized ...................... 76PROLASTIN .................................................................... 4PROLASTIN‐C .............................................................. 4


Index

PROMACTA ............................................................... 24promethazine ................................................. 4, 66promethazine vc ................................................ 32promethazine‐dm ............................................ 32propafenone ............................................................ 40propantheline ........................................................ 67propranolol .................................................... 42, 49propranolol‐hydrochlorothiazid....................................................................................................... 42propylthiouracil ................................................... 68PROQUAD (PF) ..................................................... 72PULMICORT FLEXHALER ....................... 15PULMOZYME .......................................................... 32purefe ob plus ........................................................ 74purefe plus .................................................................. 74pyrazinamide .......................................................... 12pyridostigmine bromide ............. 52, 53quasense ........................................................................ 23quetiapine ................................................................... 16QUFLORA PEDIATRIC DROPS ........ 74QUILLIVANT XR ................................................... 17quinapril ......................................................................... 41quinapril‐hydrochlorothiazide ....... 41quinidine gluconate ...................................... 40quinidine sulfate ................................................ 40QVAR .................................................................................. 15RAGWITEK ...................................................................... 4raloxifene .......................................................... 28, 76ramipril ............................................................................ 41ranitidine hcl ............................................................ 67RAPAMUNE .............................................................. 48RASUVO (PF) ........................................................... 13REBETOL ............................................................................ 9REBIF (WITH ALBUMIN) ........................ 51REBIF REBIDOSE ................................................ 51REBIF TITRATION PACK .......................... 51reclipsen (28) .......................................................... 23RECOMBINATE .................................................... 26RECOMBIVAX HB (PF) .............................. 72RELENZA DISKHALER .................................. 11RELPAX ............................................................................. 50REMODULIN ............................................................ 57renal caps ..................................................................... 74reno caps ....................................................................... 74RENVELA ....................................................................... 48repaglinide ................................................................. 34REPATHA PUSHTRONEX ....................... 44REPATHA SURECLICK ................................. 44REPATHA SYRINGE ........................................ 44RESCRIPTOR ............................................................. 10reserpine ........................................................................ 43RESTASIS ....................................................................... 38REVATIO ........................................................................ 57REVLIMID ..................................................................... 30REYATAZ ........................................................................ 10

Index

ribavirin ............................................................................... 9RIDAURA ....................................................................... 13rifabutin .............................................................................. 8rifampin .......................................................................... 12riluzole .............................................................................. 53rimantadine .............................................................. 11risperidone .................................................................. 16rivastigmine tartrate ................................... 32RIXUBIS ........................................................................... 27rizatriptan .................................................................... 50ropinirole ....................................................................... 56rosuvastatin .............................................................. 44roxicet ................................................................................ 55RUCONEST .................................................................. 46RYTARY ............................................................................ 56SABRIL ............................................................................... 59salsalate ......................................................................... 54SANDOSTATIN LAR DEPOT ............... 53selegiline hcl ............................................................. 56selenium sulfide .................................................. 64SELZENTRY ................................................................. 10se‐natal 19 .................................................................. 74se‐natal 19 (with docusate) .............. 74SENSIPAR ..................................................................... 48SEREVENT DISKUS .......................................... 13SEROQUEL XR ........................................................ 16sertraline ....................................................................... 18sevelamer carbonate .................................. 48sf ................................................................................................ 74sf 5000 plus ............................................................... 74SIGNIFOR ...................................................................... 53sildenafil ......................................................................... 57silver sulfadiazine ............................................. 61simvastatin ................................................................ 44sirolimus ......................................................................... 48SIRTURO ........................................................................ 12SIVEXTRO ......................................................................... 8sodium fluoride .................................................... 74sodium phenylbutyrate ........................... 53sodium polystyrene (sorb free) .... 53sodium polystyrene sulfonate ....... 53SOLTAMOX ................................................................ 30sotalol ................................................................................ 40sotalol af ........................................................................ 40sotret ................................................................................... 60SOVALDI ............................................................................. 9SPIRIVA RESPIMAT ........................................ 13SPIRIVA WITH HANDIHALER .......... 13spironolactone ...................................................... 45spironolacton‐hydrochlorothiaz....................................................................................................... 45sprintec (28) ............................................................. 23SPRYCEL .......................................................................... 31sronyx ................................................................................. 23stavudine ...................................................................... 10

Index

STIMATE ........................................................................ 24STIOLTO RESPIMAT ...................................... 15STIVARGA .................................................................... 31STRATTERA ................................................................ 17STRENSIQ ..................................................................... 36STRIBILD ........................................................................ 10STRIVERDI RESPIMAT ............................... 13SUBOXONE ................................................................ 55SUCRAID ........................................................................ 36sucralfate ...................................................................... 68sulfacetamide sodium ............................... 37sulfacetamide sodium (acne) ......... 60sulfacetamide sodium‐sulfur........................................................................................... 60, 63sulfacetamide sod‐sulfur‐urea........................................................................................... 60, 63sulfacetamide‐prednisolone ............ 37sulfamethoxazole‐trimethoprim .... 6sulfasalazine ............................................................ 66sulindac ........................................................................... 54sumatriptan .............................................................. 50sumatriptan succinate .............................. 50SUPRAX ............................................................................... 5SUSTIVA ......................................................................... 11SUTENT ............................................................................ 31syeda ................................................................................... 23SYLATRON ................................................................... 30SYNJARDY ................................................................... 35SYNTHROID ............................................................... 68TABLOID ......................................................................... 29tacrolimus ........................................................ 48, 64TAFINLAR ..................................................................... 31TAMIFLU ........................................................................ 11tamoxifen ..................................................................... 30tamsulosin ................................................................... 48TARCEVA ....................................................................... 31TASIGNA ........................................................................ 31taztia xt ........................................................................... 43TECFIDERA .................................................................. 51temazepam ............................................................... 64temozolomide ........................................................ 29TENIVAC (PF) .......................................................... 72terazosin ............................................................ 43, 48terbinafine hcl ........................................................... 7terbutaline .................................................................. 14terconazole ................................................................ 75testosterone ............................................................. 49testosterone cypionate ............................ 49testosterone enanthate .......................... 49TETANUS,DIPHTHERIA TOX PED(PF) ............................................................................ 72TETANUS‐DIPHTHERIA TOXOIDS‐TD ............................................................ 72tetrabenazine ......................................................... 53tetracycline .................................................................... 7


Index

THALOMID ................................................................. 30theophylline .............................................................. 14thioridazine ............................................................... 16thiothixene ................................................................. 16THROMBATE III ................................................... 27tiagabine ....................................................................... 59tilia fe ................................................................................. 23timolol maleate ................................................... 39TIVICAY ............................................................................ 11tizanidine ...................................................................... 51tl gard rx ........................................................................ 74TOBRADEX ................................................................. 37tobramycin ................................................................. 37tobramycin in 0.225 % nacl ............... 32tobramycin‐dexamethasone ........... 37TOBREX ........................................................................... 37tolmetin .......................................................................... 54tolterodine .................................................................. 68topiramate ................................................................. 59torsemide ..................................................................... 45TOUJEO SOLOSTAR ....................................... 34TRACLEER ..................................................................... 57TRADJENTA ............................................................... 33tramadol ........................................................................ 56trandolapril ................................................................ 41tranexamic acid .................................................. 76tranylcypromine ................................................. 18TRAVATAN Z ........................................................... 39travoprost (benzalkonium) ................ 39trazodone ..................................................................... 18TRECATOR ................................................................... 12tretinoin .......................................................................... 60tretinoin (chemotherapy) ..................... 30TRETTEN ........................................................................ 27triadvance ................................................................... 74triamcinolone acetonide ............ 50, 62triamterene‐hydrochlorothiazid....................................................................................................... 45trianex ............................................................................... 62triderm .............................................................................. 62tri‐estarylla ................................................................ 23trifluoperazine ....................................................... 16trifluridine .................................................................... 37trihexyphenidyl ........................................ 56, 57tri‐legest fe ................................................................. 23tri‐linyah ......................................................................... 23tri‐lo‐estarylla ........................................................ 23tri‐lo‐sprintec .......................................................... 23trimethobenzamide ...................................... 66trimethoprim ............................................................... 6trinatal gt ..................................................................... 74trinatal ultra ............................................................. 74trinate ................................................................................ 74trinessa (28) .............................................................. 23trinessa lo ..................................................................... 23

Index

triphrocaps ................................................................. 74triple vitamin with fluoride ................ 75tri‐previfem (28) ................................................. 23tri‐sprintec (28) .................................................... 23TRIUMEQ ...................................................................... 11tri‐vitamin with fluoride ......................... 75trivora (28) ................................................................. 23trospium ......................................................................... 68TRULICITY .................................................................... 33TRUMENBA ............................................................... 72TRUVADA ..................................................................... 11TWINRIX (PF) .......................................................... 72TYBOST ............................................................................ 11TYKERB ............................................................................ 31TYVASO ........................................................................... 57TYVASO REFILL KIT ........................................ 57TYVASO STARTER KIT ................................ 57TYZEKA ................................................................................. 8ULORIC ............................................................................. 39UPTRAVI ........................................................................ 57urea ....................................................................................... 64ursodiol ............................................................................ 67VAGIFEM ....................................................................... 75valacyclovir ................................................................ 11VALCHLOR .................................................................. 29valganciclovir .......................................................... 11valproic acid ............................................................. 59valproic acid (as sodium salt) ......... 59valsartan ....................................................................... 41valsartan‐hydrochlorothiazide ..... 41vancomycin .................................................................... 6VAQTA (PF) ............................................................... 72VARIVAX (PF) ......................................................... 72VASCEPA ....................................................................... 46VAXCHORA BUFFER COMPONENT....................................................................................................... 72VAXCHORA VACCINE ................................. 72VELETRI ........................................................................... 57velivet triphasic regimen (28) ........ 23venlafaxine ................................................................. 18VENTAVIS ..................................................................... 57VENTOLIN HFA ..................................................... 13verapamil ..................................................................... 43VERSACLOZ ............................................................... 16VESICARE ...................................................................... 68vestura (28) ............................................................... 23VICTOZA 2‐PAK ................................................... 33VICTOZA 3‐PAK ................................................... 33VIDEX 2 GRAM PEDIATRIC ................ 11VIDEX 4 GRAM PEDIATRIC ................ 11VIMPAT ........................................................................... 59vinate care .................................................................. 75vinate gt ......................................................................... 75vinate m .......................................................................... 75vinate one .................................................................... 75

Index

vinate ultra ................................................................. 75viorele (28) ................................................................. 23VIRACEPT ..................................................................... 11VIREAD ............................................................................. 11virt‐caps .......................................................................... 75virt‐phos 250 neutral .................................. 68VISTOGARD .............................................................. 53vitamin b‐12 ............................................................. 75vitamin d2 ................................................................... 75vitamins a,c,d and fluoride ................ 75VITEKTA .......................................................................... 11VIVOTIF BERNA VACCINE .................... 73vol‐tab rx ....................................................................... 75VONVENDI ................................................................. 27voriconazole ................................................................. 8VOTRIENT .................................................................... 31vyfemla (28) .............................................................. 23VYVANSE ...................................................................... 17warfarin .......................................................................... 27wera (28) ....................................................................... 23WILATE ............................................................................ 27XALKORI ......................................................................... 31XARELTO ....................................................................... 28XENICAL .......................................................................... 75XIFAXAN ............................................................................ 6XTANDI ............................................................................ 29xulane ................................................................................ 19XYNTHA .......................................................................... 27XYNTHA SOLOFUSE ...................................... 27XYREM .............................................................................. 64YODOXIN .......................................................................... 8zaleplon ........................................................................... 64zarah .................................................................................... 23ZARXIO ............................................................................. 24ZAVESCA ........................................................................ 36ZELBORAF .................................................................... 31ZEMAIRA ........................................................................... 4zenatane ........................................................................ 60zenchent (28) .......................................................... 23ZEPATIER ........................................................................... 9ZETIA ................................................................................... 44ZIAGEN ............................................................................. 11zidovudine ................................................................... 11ZIOPTAN (PF) .......................................................... 39ziprasidone hcl ...................................................... 16ZIRGAN ............................................................................ 37ZOLINZA ......................................................................... 29zolpidem ......................................................................... 64zonisamide ................................................................. 59ZONTIVITY .................................................................. 28ZOSTAVAX (PF) .................................................... 73zovia 1/35e (28) .................................................. 23zovia 1/50e (28) .................................................. 24ZYTIGA .............................................................................. 29


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