medicaid-approved preferred drug list · va anthem common core formulary medicaid-approved...

VA Anthem Common Core Formulary

Medicaid-Approved

Preferred Drug List

Effective January 1, 2019

Legend

In each class, drugs are listed alphabetically by either brand name or generic name.

Brand name drug: Uppercase in bold type

Generic drug: Lowercase in plain type

AL: Age Limit Restrictions

DO: Dose Optimization Program

GR: Gender Restriction

OTC: Over the counter medication available with a prescription. (Prescribers please indicate OTC on the prescription)

PA: Prior authorization is required. Prior authorization is the process of obtaining approval of benefits before certain prescriptions are filled.

QL: Quantity limits; certain prescription medications have specific quantity limits per prescription or per month.

SP: Specialty Pharmacy

ST: Step therapy is required. You may need to use one medication before benefits for the use of another medication can be authorized.

Drug Name Reference Notes

ALTERNATIVE THERAPY

ALTERNATIVE THERAPY

e-400 c-500 and beta carotene oral tablet OTC

glucosamine su 2kcl-chondroit oral tabletGlucosamine-Chondroitin DS

OTC

glucosamine-chondroitin complx oral capsule

OTC

kelp-lecithin-b6 oral tablet OTC

lecithin-kelp-b6 (100-8.3) oral tablet OTC

lecithin-kelp-b6 (400-20) oral tablet OTC

lecithin-kelp-b6 oral capsule OTC

super antioxidant oral capsule OTC

ANALGESIC, ANTI-INFLAMMATORY OR ANTIPYRETIC

ANALGESIC/ANTIPYRETICS, SALICYLATES

adult low dose aspirin oral tablet,delayed release (dr/ec)

OTC

antacid and pain relief oral tablet, effervescent

OTC

back and body pain reliever oral tablet OTC

butalbital-aspirin-caffeine oral capsule Fiorinal QL

choline,magnesium salicylate oral liquid

enteric coated aspirin oral tablet,delayed release (dr/ec)

OTC

lo-dose aspirin oral tablet,delayed release (dr/ec)

OTC

salsalate oral tablet Disalcid

ANALGESICS, NARCOTICS

acetaminophen-codeine oral solution 120 mg-12 mg /5 ml (5 ml), 120-12 mg/5 ml, 300 mg-30 mg /12.5 ml

QL

acetaminophen-codeine oral solution 240 mg-24 mg /10 ml (10 ml)

acetaminophen-codeine oral tablet QL

butalbital-acetaminop-caf-cod oral capsule QL

BUTRANS TRANSDERMAL PATCH WEEKLY

PA

endocet oral tablet QL

2


fentanyl transdermal patch 72 hour Duragesic QL

hydrocodone-acetaminophen oral solution Hycet QL

hydrocodone-acetaminophen oral tablet Lorcet (hydrocodone) QL

hydrocodone-ibuprofen oral tablet QL

hydromorphone oral tablet Dilaudid QL

lorcet (hydrocodone) oral tablet QL

lorcet hd oral tablet QL

lorcet plus oral tablet QL

morphine concentrate oral solution QL

morphine oral solution QL

morphine oral tablet QL

morphine oral tablet extended release MS Contin QL

oxycodone oral capsule QL

oxycodone oral solution QL

oxycodone oral tablet Roxicodone QL

oxycodone-acetaminophen oral tablet Endocet QL

tramadol oral tablet Ultram QL

verdrocet oral tablet QL

vicodin es oral tablet QL

vicodin hp oral tablet QL

vicodin oral tablet QL

xylon 10 oral tablet QL

ANALGESICS, NON-NARCOTIC

acetaminophen oral liquid OTC

acetaminophen oral tablet,disintegrating Children's Pain-Fever Relief OTC

BUTALBITAL-ACETAMINOPHEN ORAL CAPSULE

QL

butalbital-acetaminophen oral tablet Tencon QL

butalbital-acetaminophen-caff oral capsule Capacet QL

butalbital-acetaminophen-caff oral tablet Esgic QL

capacet oral capsule QL

children's acetaminophen oral suspension OTC

children's acetaminophen oral syringe OTC

feverall rectal suppository OTC

infant's non-aspirin oral drops OTC

infant's non-aspirin oral drops,suspension OTC

pre-menstrual relief oral tablet OTC

3


premsyn pms oral tablet OTC

tencon oral tablet QL

ANTI-ARTHRITIC, FOLATE ANTAGONIST AGENTS

methotrexate sodium oral tablet

ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR

ENBREL MINI SUBCUTANEOUS CARTRIDGE

ENBREL SUBCUTANEOUS RECON SOLN

AL

ENBREL SUBCUTANEOUS SYRINGE AL

ENBREL SURECLICK SUBCUTANEOUS PEN INJECTOR

AL

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT

AL

HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT

AL

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT

AL

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

AL

HUMIRA SUBCUTANEOUS SYRINGE KIT

AL

ANTI-INFLAMMATORY, PYRIMIDINE SYNTHESIS INHIBITOR

leflunomide oral tablet Arava

RIDAURA ORAL CAPSULE

DISEASE MODIFYING ANTI-RHEUMATOID DRUGS (DMARD)

DEPEN TITRATABS ORAL TABLET PA

hydroxychloroquine oral tablet Plaquenil

minocycline oral capsule

minocycline oral tablet

sulfasalazine oral tablet Azulfidine

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs

IMMUNOSUPRESSANTS

azathioprine oral tablet Imuran

cyclosporine modified oral capsule Gengraf

4


cyclosporine modified oral solution Gengraf

cyclosporine oral capsule Sandimmune

gengraf oral capsule

gengraf oral solution

mycophenolate mofetil oral capsule CellCept

mycophenolate mofetil oral suspension for reconstitution

CellCept

mycophenolate mofetil oral tablet CellCept

SANDIMMUNE ORAL SOLUTION

NSAIDS

ALEVE ORAL CAPSULE OTC

CHILDREN'S MOTRIN ORAL SUSPENSION

OTC

ibu oral tablet

ibuprofen oral tablet IBU

ibuprofen pm oral tablet OTC

meloxicam oral tablet Mobic

MIDOL (NAPROXEN) ORAL TABLET OTC

MOTRIN IB ORAL TABLET OTC

motrin pm oral tablet OTC

naproxen oral tablet

naproxen oral tablet,delayed release (dr/ec)

EC-Naprosyn

sulindac oral tablet

ANESTHETICS

LOCAL ANESTHETICS

lidocaine hcl laryngotracheal solution LTA Pre-Attached QL

lidocaine topical ointment QL

ANORECTAL PREPARATIONS

ANORECTAL AGENTS

ANUSOL-HC TOPICAL CREAM WITH PERINEAL APPLICATOR

hydrocortisone topical cream with perineal applicator

Anusol-HC

PROCTOCORT TOPICAL CREAM

procto-med hc topical cream with perineal applicator

5


proctosol hc topical cream with perineal applicator

proctozone-hc topical cream with perineal applicator

HEMORRHOIDAL PREPARATIONS

hemorrhoid rectal ointment OTC

hemorrhoidal (phenyleph-cocoa) rectal suppository

OTC

hemorrhoidal rectal suppository OTC

lidocaine hcl-hydrocortison ac rectal cream

ANTIDOTES AND OTHER REVERSAL AGENTS

ANTIDOTES

acetylcysteine solution

CHELATING AGENTS

deferoxamine injection recon soln Desferal

DEPEN TITRATABS ORAL TABLET PA

trientine oral capsule Syprine PA; QL

MU-OPIOID RECEPTOR ANTAGONISTS, PERIPHERALLY-ACTING

MOVANTIK ORAL TABLET AL

NARCOTIC ANTAGONISTS

naloxone injection solution

naloxone injection syringe

naltrexone oral tablet

NARCAN NASAL SPRAY,NON-AEROSOL

REVIA ORAL TABLET

ANTI-INFECTIVE AGENTS

ABSORBABLE SULFONAMIDES

sulfamethoxazole-trimethoprim oral suspension

Sulfatrim

sulfamethoxazole-trimethoprim oral tablet Bactrim

sulfatrim oral suspension

trimethoprim oral tablet

6


AMINOPENICILLINS

amoxicillin oral capsule

amoxicillin oral suspension for reconstitution

QL

amoxicillin oral tablet

amoxicillin oral tablet,chewable

amoxicillin-pot clavulanate oral suspension for reconstitution

Augmentin ES-600

amoxicillin-pot clavulanate oral tablet 250-125 mg


Augmentin


Augmentin QL

amoxicillin-pot clavulanate oral tablet extended release 12 hr

Augmentin XR QL

amoxicillin-pot clavulanate oral tablet,chewable

QL

ampicillin oral capsule

ANTHELMINTIC AGENTS - MACROCYCLIC LACTONES

ivermectin oral tablet Stromectol

ANTHELMINTICS

ivermectin oral tablet Stromectol

praziquantel oral tablet Biltricide

reese's pinworm medicine oral suspension OTC

ANTIBACTERIAL AGENTS, OTHER

nitrofurantoin macrocrystal oral capsule Macrodantin

nitrofurantoin monohyd/m-cryst oral capsule

Macrobid

ANTIFUNGAL ANTIBIOTICS

fluconazole oral suspension for reconstitution

Diflucan

fluconazole oral tablet Diflucan

griseofulvin microsize oral suspension

nystatin oral powder

nystatin oral tablet

terbinafine hcl oral tablet

voriconazole intravenous solution Vfend IV PA

7


ANTI-INFECTIVE AGENTS, OTHER

methenamine hippurate oral tablet Hiprex

methenamine mandelate oral tablet

ANTILEPROTIC - SULFONE AGENTS

dapsone oral tablet

ANTIMYCOBACTERIUM AGENTS

ethambutol oral tablet Myambutol

isoniazid oral solution

isoniazid oral tablet

PRIFTIN ORAL TABLET

pyrazinamide oral tablet

rifabutin oral capsule Mycobutin

rifampin oral capsule Rifadin

RIFATER ORAL TABLET

ANTIPROTOZOAL ANTIBACTERIAL AGENTS

metronidazole oral tablet Flagyl

ANTIVIRALS, GENERAL

acyclovir oral capsule Zovirax

acyclovir oral suspension 200 mg/5 ml Zovirax

acyclovir oral suspension 200 mg/5 ml (5 ml)

acyclovir oral tablet Zovirax

famciclovir oral tablet

oseltamivir oral suspension for reconstitution

Tamiflu

RELENZA DISKHALER INHALATION BLISTER WITH DEVICE

rimantadine oral tablet Flumadine

TAMIFLU ORAL CAPSULE

valacyclovir oral tablet Valtrex

valganciclovir oral recon soln Valcyte

valganciclovir oral tablet Valcyte

ANTIVIRALS, HIV SPECIFIC

abacavir oral solution Ziagen

abacavir oral tablet Ziagen

abacavir-lamivudine oral tablet Epzicom

8


abacavir-lamivudine-zidovudine oral tablet Trizivir

APTIVUS ORAL CAPSULE

APTIVUS ORAL SOLUTION

atazanavir oral capsule Reyataz

BIKTARVY ORAL TABLET

CIMDUO ORAL TABLET

CRIXIVAN ORAL CAPSULE

DESCOVY ORAL TABLET

didanosine oral capsule,delayed release(dr/ec)

Videx EC

EDURANT ORAL TABLET

EMTRIVA ORAL CAPSULE

EMTRIVA ORAL SOLUTION

EVOTAZ ORAL TABLET

FUZEON SUBCUTANEOUS RECON SOLN

PA

GENVOYA ORAL TABLET

INTELENCE ORAL TABLET

ISENTRESS HD ORAL TABLET

ISENTRESS ORAL POWDER IN PACKET

ISENTRESS ORAL TABLET

ISENTRESS ORAL TABLET,CHEWABLE

JULUCA ORAL TABLET

KALETRA ORAL TABLET

lamivudine oral solution Epivir

lamivudine oral tablet Epivir

lamivudine-zidovudine oral tablet Combivir

lopinavir-ritonavir oral solution Kaletra

nevirapine oral suspension Viramune

nevirapine oral tablet Viramune

nevirapine oral tablet extended release 24 hr

Viramune XR

NORVIR ORAL CAPSULE

NORVIR ORAL SOLUTION

PREZCOBIX ORAL TABLET

PREZISTA ORAL SUSPENSION

9


PREZISTA ORAL TABLET

RESCRIPTOR ORAL TABLET

RESCRIPTOR ORAL TABLET, DISPERSIBLE

RETROVIR INTRAVENOUS SOLUTION

REYATAZ ORAL POWDER IN PACKET

ritonavir oral tablet Norvir

SELZENTRY ORAL SOLUTION

SELZENTRY ORAL TABLET

stavudine oral capsule Zerit

STRIBILD ORAL TABLET

tenofovir disoproxil fumarate oral tablet Viread PA; QL

TIVICAY ORAL TABLET

TRIUMEQ ORAL TABLET

TROGARZO INTRAVENOUS SOLUTION

TRUVADA ORAL TABLET

VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN

VIDEX 4 GRAM PEDIATRIC ORAL RECON SOLN

VIRACEPT ORAL TABLET

VIREAD ORAL POWDER PA; QL

VIREAD ORAL TABLET PA; QL

zidovudine oral capsule Retrovir

zidovudine oral syrup Retrovir

zidovudine oral tablet

CEPHALOSPORIN ANTIBIOTICS

cefaclor oral capsule

cefadroxil oral capsule

cefadroxil oral suspension for reconstitution

cefadroxil oral tablet

cefdinir oral capsule

cefdinir oral suspension for reconstitution

cefixime oral suspension for reconstitution Suprax

cefprozil oral suspension for reconstitution

cefprozil oral tablet

10


ceftriaxone injection recon soln 1 gram, 2 gram, 250 mg, 500 mg

QL

ceftriaxone injection recon soln 10 gram

cefuroxime axetil oral suspension for reconstitution

cefuroxime axetil oral tablet

cephalexin oral capsule Keflex

cephalexin oral suspension for reconstitution

cephalexin oral tablet

HEPATITIS B TREATMENT AGENTS

adefovir oral tablet Hepsera PA

BARACLUDE ORAL SOLUTION PA

entecavir oral tablet Baraclude PA

EPIVIR HBV ORAL SOLUTION PA; QL

lamivudine oral tablet Epivir HBV PA; QL

HEPATITIS C TREATMENT AGENTS

MAVYRET ORAL TABLET PA

PEGINTRON SUBCUTANEOUS KIT

ribavirin oral capsule Ribasphere

ribavirin oral tablet Moderiba

LINCOSAMIDES

clindamycin hcl oral capsule Cleocin HCl

clindamycin palmitate hcl oral recon soln Cleocin Pediatric

clindamycin pediatric oral recon soln

MACROLIDES

azithromycin oral packet Zithromax

azithromycin oral suspension for reconstitution

Zithromax

azithromycin oral tablet Zithromax

clarithromycin oral suspension for reconstitution

clarithromycin oral tablet

e.e.s. 400 oral tablet

ERYPED 200 ORAL SUSPENSION FOR RECONSTITUTION

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

11


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

erythrocin (as stearate) oral tablet

erythromycin oral capsule,delayed release(dr/ec)

erythromycin stearate oral tablet Erythrocin (as stearate)

PENICILLINS

dicloxacillin oral capsule

penicillin v potassium oral recon soln

penicillin v potassium oral tablet

PLASMOCIDES COMBINATION

atovaquone-proguanil oral tablet Malarone Pediatric

PLASMOCIDES

chloroquine phosphate oral tablet

hydroxychloroquine oral tablet Plaquenil

mefloquine oral tablet QL

PRIMAQUINE ORAL TABLET

QUINOLONES

ciprofloxacin hcl oral tablet

ciprofloxacin oral suspension,microcapsule recon

Cipro

levofloxacin oral tablet

SULFONAMIDE ANTIBIOTIC

sulfadiazine oral tablet

TETRACYCLINES

demeclocycline oral tablet

doxycycline monohydrate oral capsule Mondoxyne NL

doxycycline monohydrate oral suspension for reconstitution

Vibramycin

minocycline oral capsule

minocycline oral tablet

tetracycline oral capsule

VANCOMYCIN AND DERIVATIVES

linezolid oral suspension for reconstitution Zyvox PA; QL

linezolid oral tablet Zyvox PA; QL

vancomycin oral capsule Vancocin

12


ANTINEOPLASTICS

ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS

anastrozole oral tablet Arimidex QL

bicalutamide oral tablet Casodex

DEPO-PROVERA INTRAMUSCULAR SUSPENSION

EMCYT ORAL CAPSULE PA

exemestane oral tablet Aromasin QL

flutamide oral capsule

hydroxyurea oral capsule Hydrea

imatinib oral tablet Gleevec PA; QL

IRESSA ORAL TABLET PA; QL

letrozole oral tablet Femara QL

leucovorin calcium oral tablet

megestrol oral tablet

melphalan oral tablet Alkeran

MESNEX ORAL TABLET PA

methotrexate sodium (pf) injection recon soln

methotrexate sodium (pf) injection solution

methotrexate sodium injection solution

methotrexate sodium oral tablet

MYLERAN ORAL TABLET

tamoxifen oral tablet

tretinoin (chemotherapy) oral capsule

ANTISEPTICS AND DISINFECTANTS

ANTISEPTICS, GENERAL

alcohol pads topical pads, medicated OTC

alcohol swabs topical pads, medicated Alcohol Pads OTC

alcohol wipes topical pads, medicated OTC

antiseptic skin clnsr(chlorhe) topical liquid OTC

betasept surgical scrub topical liquid OTC

chlorhexidine gluconate topical liquid Dyna-Hex OTC

curity alcohol swabs topical pads, medicated

OTC

easy touch alcohol prep pads topical pads, medicated

OTC

13


hibiclens topical liquid OTC

hydrogen peroxide solution OTC

sure comfort alcohol prep pads topical pads, medicated

OTC

webcol topical pads, medicated OTC

DISINFECTANTS - OTHER

alcoh-wipe towelette OTC

BIOLOGICALS

IMMUNE GLOBULINS

GAMUNEX-C INJECTION SOLUTION PA

OCTAGAM INTRAVENOUS SOLUTION PA

IMMUNOLOGICALS VACCINES

AFLURIA 2018-2019 (PF) INTRAMUSCULAR SYRINGE

QL

AFLURIA 2018-2019 INTRAMUSCULAR SUSPENSION

QL

AFLURIA QUAD 2018-2019 (PF) INTRAMUSCULAR SYRINGE

QL

AFLURIA QUAD 2018-2019 INTRAMUSCULAR SUSPENSION

QL

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

QL

FLUARIX QUAD 2018-2019 (PF) INTRAMUSCULAR SYRINGE

QL

FLUBLOK QUAD 2018-2019 (PF) INTRAMUSCULAR SYRINGE

QL

FLUCELVAX QUAD 2018-2019 (PF) INTRAMUSCULAR SYRINGE

FLUCELVAX QUAD 2018-2019 INTRAMUSCULAR SUSPENSION

FLULAVAL QUAD 2018-2019 (PF) INTRAMUSCULAR SYRINGE

QL

FLULAVAL QUAD 2018-2019 INTRAMUSCULAR SUSPENSION

QL

FLUMIST QUAD 2018-2019 NASAL NASAL SPRAY SYRINGE

FLUZONE HIGH-DOSE 2018-19 (PF) INTRAMUSCULAR SYRINGE

QL

FLUZONE QUAD 2018-2019 (PF) INTRAMUSCULAR SUSPENSION

QL

14


FLUZONE QUAD 2018-2019 (PF) INTRAMUSCULAR SYRINGE

QL

FLUZONE QUAD 2018-2019 INTRAMUSCULAR SUSPENSION

QL

FLUZONE QUAD PEDI 2018-19 (PF) INTRAMUSCULAR SYRINGE

QL

GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION

GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE

SHINGRIX (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION

AL; QL

SYNAGIS INTRAMUSCULAR SOLUTION

PA

TWINRIX (PF) INTRAMUSCULAR SYRINGE

ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION

AL; QL

CARDIOVASCULAR THERAPY AGENTS

ACE INHIBITOR/CALCIUM CHANNEL BLOCK COMBINATION

amlodipine-benazepril oral capsule

ADRENERGIC VASOPRESSOR

midodrine oral tablet

ALDOSTERONE RECEPTOR ANTAGONISTS

spironolactone oral tablet Aldactone

ALPHA/BETA-ADRENERGIC BLOCKING AGENTS

carvedilol oral tablet Coreg

labetalol oral tablet

ALPHA-ADRENERGIC BLOCKING AGENTS

doxazosin oral tablet Cardura QL

prazosin oral capsule Minipress

terazosin oral capsule QL

ANAPHYLAXIS THERAPY AGENTS

epinephrine injection auto-injector EpiPen Jr

epinephrine injection solution Adrenalin

15


ANTIARRHYTHMICS

amiodarone oral tablet 200 mg Pacerone QL

amiodarone oral tablet 400 mg Pacerone

disopyramide phosphate oral capsule Norpace

flecainide oral tablet QL

mexiletine oral capsule

pacerone oral tablet 200 mg QL

pacerone oral tablet 400 mg

propafenone oral capsule,extended release 12 hr

Rythmol SR

propafenone oral tablet

quinidine gluconate oral tablet extended release

quinidine sulfate oral tablet

sorine oral tablet

sotalol af oral tablet

sotalol oral tablet Betapace

verapamil oral tablet

BETA-ADRENERGIC BLOCKING AGENTS

atenolol oral tablet Tenormin

bisoprolol fumarate oral tablet

metoprolol succinate oral tablet extended release 24 hr

Toprol XL

metoprolol tartrate oral tablet Lopressor

propranolol oral capsule,extended release 24 hr

Inderal LA

propranolol oral solution

propranolol oral tablet

sorine oral tablet

sotalol af oral tablet

sotalol oral tablet Betapace

CALCIUM CHANNEL BLOCKING AGENTS

afeditab cr oral tablet extended release

amlodipine oral tablet Norvasc

cartia xt oral capsule,extended release 24hr

16


diltiazem hcl oral capsule,ext.rel 24h degradable

DILT-XR

diltiazem hcl oral capsule,extended release 12 hr

diltiazem hcl oral capsule,extended release 24 hr

Taztia XT

diltiazem hcl oral capsule,extended release 24hr

Cardizem CD

diltiazem hcl oral tablet Cardizem

diltiazem hcl oral tablet extended release 24 hr

Cardizem LA

dilt-xr oral capsule,ext.rel 24h degradable

nifedipine oral capsule

nifedipine oral tablet extended release Adalat CC

nifedipine oral tablet extended release 24hr

Procardia XL

taztia xt oral capsule,extended release 24 hr

verapamil oral tablet

verapamil oral tablet extended release Calan SR

DIGITALIS GLYCOSIDES

digitek oral tablet

digox oral tablet

digoxin oral solution

digoxin oral tablet Digitek

DIURETIC AGENTS, OTHER

acetazolamide oral capsule, extended release

acetazolamide oral tablet

methazolamide oral tablet

spironolactone oral tablet Aldactone

HYPOTENSIVES, ACE INHIBITORS, COMBINATIONS

benazepril oral tablet

benazepril-hydrochlorothiazide oral tablet

enalapril maleate oral tablet Vasotec

enalapril-hydrochlorothiazide oral tablet

lisinopril oral tablet Prinivil

lisinopril-hydrochlorothiazide oral tablet Zestoretic

17


ramipril oral capsule Altace

HYPOTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST

amlodipine-valsartan oral tablet Exforge

ENTRESTO ORAL TABLET PA; AL

losartan oral tablet Cozaar

losartan-hydrochlorothiazide oral tablet Hyzaar

valsartan oral tablet Diovan

valsartan-hydrochlorothiazide oral tablet Diovan HCT

HYPOTENSIVES, MISCELLANEOUS

atenolol-chlorthalidone oral tablet Tenoretic 100

bisoprolol-hydrochlorothiazide oral tablet Ziac

CATAPRES-TTS-1 TRANSDERMAL PATCH WEEKLY



clonidine hcl oral tablet Catapres

guanfacine oral tablet

methyldopa oral tablet

methyldopate intravenous solution

HYPOTENSIVES, VASODILATORS

hydralazine oral tablet

minoxidil oral tablet

LIPOTROPICS

atorvastatin oral tablet Lipitor

cholestyramine (with sugar) oral powder Questran

cholestyramine (with sugar) oral powder in packet

Questran

cholestyramine light oral powder

cholestyramine light oral powder in packet

colestipol oral tablet Colestid

ezetimibe oral tablet Zetia

fenofibrate nanocrystallized oral tablet Tricor

fish oil concentrate oral capsule OTC

fish oil oral capsule OTC

gemfibrozil oral tablet Lopid

18


GRAM-O-LECI ORAL TABLET,CHEWABLE

OTC

inositol oral tablet OTC

lecithin oral capsule 1,200 mg OTC

LECITHIN ORAL CAPSULE 518 MG OTC

lovastatin oral tablet

maxepa oral capsule OTC

niacin oral tablet extended release 24 hr Niaspan Extended-Release

omega-3 fatty acids oral capsule Fish Oil Concentrate OTC

pravastatin oral tablet Pravachol

prenatal dha oral capsule OTC

prevalite oral powder

prevalite oral powder in packet

rosuvastatin oral tablet Crestor

simvastatin oral tablet Zocor

super omega-3 oral capsule OTC

super twin epa-dha oral capsule OTC

vitamin e oral capsule OTC

WELCHOL ORAL TABLET

LOOP DIURETICS

bumetanide oral tablet

furosemide oral solution

furosemide oral tablet Lasix

torsemide oral tablet Demadex

PLASMA KALLIKREIN INHIBITOR AGENTS, RECOMBINANT PROTEIN

KALBITOR SUBCUTANEOUS SOLUTION

PLASMA KALLIKREIN INHIBITOR AGENTS

KALBITOR SUBCUTANEOUS SOLUTION

POTASSIUM SPARING DIURETICS

amiloride oral tablet

amiloride-hydrochlorothiazide oral tablet

spironolacton-hydrochlorothiaz oral tablet Aldactazide

triamterene-hydrochlorothiazid oral capsule

19


triamterene-hydrochlorothiazid oral tablet Maxzide-25mg

PULMONARY ANTIHYPERTENSIVE AGENTS

VENTAVIS INHALATION SOLUTION FOR NEBULIZATION

PULMONARY ARTERIAL HYPERTENSION

ADCIRCA ORAL TABLET PA

LETAIRIS ORAL TABLET PA; AL

sildenafil (antihypertensive) oral tablet Revatio PA; AL

TRACLEER ORAL TABLET PA; AL

THIAZIDE AND RELATED DIURETICS

chlorothiazide oral tablet

chlorthalidone oral tablet

hydrochlorothiazide oral capsule Microzide QL

hydrochlorothiazide oral tablet 12.5 mg QL

hydrochlorothiazide oral tablet 25 mg, 50 mg

indapamide oral tablet

metolazone oral tablet

VASODILATORS, CORONARY

isosorbide dinitrate oral tablet

isosorbide dinitrate oral tablet extended release

ISOCHRON

isosorbide mononitrate oral tablet

isosorbide mononitrate oral tablet extended release 24 hr

nitro-bid transdermal ointment

NITRO-DUR TRANSDERMAL PATCH 24 HOUR

nitroglycerin oral capsule, extended release

Nitro-Time

nitroglycerin sublingual tablet Nitrostat

nitroglycerin transdermal patch 24 hour Minitran

nitro-time oral capsule, extended release

20


CENTRAL NERVOUS SYSTEM AGENTS

ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS

mirtazapine oral tablet Remeron

mirtazapine oral tablet,disintegrating Remeron SolTab

ANTI-ANXIETY DRUGS

alprazolam intensol oral concentrate

alprazolam oral tablet Xanax

alprazolam oral tablet,disintegrating

buspirone oral tablet

chlordiazepoxide hcl oral capsule

clonazepam oral tablet Klonopin

clorazepate dipotassium oral tablet

diazepam intensol oral concentrate

diazepam oral concentrate Diazepam Intensol

diazepam oral solution

diazepam oral tablet Valium

hydroxyzine hcl oral solution

hydroxyzine pamoate oral capsule

lorazepam oral tablet Ativan

oxazepam oral capsule

ANTICONVULSANTS

carbamazepine oral capsule, er multiphase 12 hr

Carbatrol

carbamazepine oral suspension Tegretol

carbamazepine oral tablet Epitol

carbamazepine oral tablet extended release 12 hr

Tegretol XR

carbamazepine oral tablet,chewable


DIASTAT RECTAL KIT

diazepam rectal kit Diastat AcuDial

DILANTIN EXTENDED ORAL CAPSULE

DILANTIN ORAL CAPSULE

divalproex oral capsule, delayed rel sprinkle

Depakote Sprinkles

21


divalproex oral tablet extended release 24 hr

Depakote ER

divalproex oral tablet,delayed release (dr/ec)

Depakote

epitol oral tablet

ethosuximide oral capsule Zarontin

ethosuximide oral solution Zarontin

felbamate oral suspension Felbatol

felbamate oral tablet Felbatol

gabapentin oral capsule Neurontin

gabapentin oral solution Neurontin

gabapentin oral tablet Neurontin

GABITRIL ORAL TABLET

lamotrigine oral tablet Lamictal

lamotrigine oral tablet extended release 24hr

Lamictal XR

lamotrigine oral tablet, chewable dispersible

Lamictal

levetiracetam oral solution Keppra

levetiracetam oral tablet Keppra

levetiracetam oral tablet extended release 24 hr

Keppra XR

LYRICA ORAL CAPSULE PA

oxcarbazepine oral suspension Trileptal

oxcarbazepine oral tablet Trileptal

phenobarbital oral elixir

phenobarbital oral tablet

phenytoin oral suspension Dilantin-125

phenytoin oral tablet,chewable Dilantin Infatabs

phenytoin sodium extended oral capsule Phenytek

primidone oral tablet Mysoline

ROWEEPRA ORAL TABLET

TEGRETOL XR ORAL TABLET EXTENDED RELEASE 12 HR

topiramate oral capsule, sprinkle Topamax

topiramate oral tablet Topamax

valproic acid (as sodium salt) oral solution Depakene

valproic acid oral capsule Depakene

22


VIMPAT ORAL SOLUTION

VIMPAT ORAL TABLET

VIMPAT ORAL TABLETS,DOSE PACK

zonisamide oral capsule Zonegran

ANTIDEPRESSANTS, OTHER

perphenazine-amitriptyline oral tablet

ANTIMANIA DRUGS

lithium carbonate oral capsule

lithium carbonate oral tablet

lithium carbonate oral tablet extended release

Lithobid

lithium citrate oral solution

ANTIMIGRAINE PREPARATIONS

divalproex oral tablet extended release 24 hr

Depakote ER

ergotamine-caffeine oral tablet Cafergot

isometh-dichloral-acetaminophn oral capsule

migergot rectal suppository

RELPAX ORAL TABLET

rizatriptan oral tablet Maxalt

rizatriptan oral tablet,disintegrating Maxalt-MLT

sumatriptan nasal spray,non-aerosol Imitrex

sumatriptan succinate oral tablet Imitrex

sumatriptan succinate subcutaneous cartridge

Imitrex STATdose Refill

sumatriptan succinate subcutaneous pen injector

Imitrex STATdose Pen

sumatriptan succinate subcutaneous solution

Imitrex

sumatriptan succinate subcutaneous syringe

ANTIPARKINSONISM DRUGS, ANTICHOLINERGIC

benztropine oral tablet

trihexyphenidyl oral elixir

trihexyphenidyl oral tablet

23


ANTIPARKINSONISM DRUGS, OTHER

amantadine hcl oral solution

amantadine hcl oral tablet

bromocriptine oral capsule Parlodel

bromocriptine oral tablet Parlodel

carbidopa-levodopa oral tablet Sinemet

carbidopa-levodopa oral tablet extended release

Sinemet CR

carbidopa-levodopa oral tablet,disintegrating

carbidopa-levodopa-entacapone oral tablet

Stalevo 50

entacapone oral tablet Comtan

pramipexole oral tablet Mirapex

ropinirole oral tablet Requip

selegiline hcl oral capsule

selegiline hcl oral tablet

ANTIPSYCHOTICS, ATYPICAL DOPAMINE AND SEROTONIN ANTAGONISTS

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

AL

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

AL

aripiprazole oral tablet Abilify

ARISTADA INITIO INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

AL

ARISTADA INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING

AL

clozapine oral tablet Clozaril

INVEGA SUSTENNA INTRAMUSCULAR SYRINGE

AL

INVEGA TRINZA INTRAMUSCULAR SYRINGE

AL

LATUDA ORAL TABLET

olanzapine intramuscular recon soln Zyprexa AL

olanzapine oral tablet Zyprexa AL

olanzapine oral tablet,disintegrating Zyprexa Zydis

quetiapine oral tablet Seroquel AL

24


quetiapine oral tablet extended release 24 hr

Seroquel XR

RISPERDAL CONSTA INTRAMUSCULAR SYRINGE

AL

risperidone oral solution Risperdal AL

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

Risperdal

risperidone oral tablet 1 mg Risperdal AL

risperidone oral tablet,disintegrating

ziprasidone hcl oral capsule Geodon AL

ANTIPSYCHOTICS, TYPICAL

ADASUVE INHALATION AEROSOL POWDR BREATH ACTIVATED

chlorpromazine oral tablet

fluphenazine decanoate injection solution AL

fluphenazine hcl injection solution

fluphenazine hcl oral concentrate

fluphenazine hcl oral elixir

fluphenazine hcl oral tablet

haloperidol decanoate intramuscular solution

Haldol Decanoate

haloperidol lactate injection solution Haldol

haloperidol lactate intramuscular syringe

haloperidol lactate oral concentrate

haloperidol oral tablet

loxapine succinate oral capsule

perphenazine oral tablet

prochlorperazine maleate oral tablet Compazine

thioridazine oral tablet

thiothixene oral capsule

trifluoperazine oral tablet

ATTENTION DEFICIT - HYPERACTIVITY (ADHD)/NARCOLEPSY

ADDERALL XR ORAL CAPSULE,EXTENDED RELEASE 24HR

PA; AL

atomoxetine oral capsule Strattera AL

CONCERTA ORAL TABLET EXTENDED RELEASE 24HR

AL

25


DAYTRANA TRANSDERMAL PATCH 24 HOUR

AL

dextroamphetamine oral tablet Zenzedi AL

dextroamphetamine-amphetamine oral tablet

Adderall AL

FOCALIN ORAL TABLET AL

FOCALIN XR ORAL CAPSULE,ER BIPHASIC 50-50

AL

guanfacine oral tablet extended release 24 hr

Intuniv ER

KAPVAY ORAL TABLET EXTENDED RELEASE 12 HR

AL

methylphenidate hcl oral tablet Ritalin AL

QUILLICHEW ER ORAL TABLET,CHEW,IR-ER.BIPHASIC24HR

AL

QUILLIVANT XR ORAL SUSPENSION,EXT REL 24HR,RECON

AL

VYVANSE ORAL CAPSULE AL

VYVANSE ORAL TABLET,CHEWABLE AL

ATTENTION DEFICIT-HYPERACTIVITY (ADHD)/NARCOLEPSY

caffeine citrate intravenous solution Cafcit

caffeine citrate oral solution

BENZODIAZEPINES

alprazolam intensol oral concentrate

alprazolam oral tablet Xanax

alprazolam oral tablet,disintegrating

amitriptyline-chlordiazepoxide oral tablet

chlordiazepoxide hcl oral capsule


clorazepate dipotassium oral tablet

DIASTAT RECTAL KIT

diazepam intensol oral concentrate

diazepam oral concentrate Diazepam Intensol

diazepam oral solution

diazepam oral tablet Valium

diazepam rectal kit Diastat AcuDial

lorazepam oral tablet Ativan

26


oxazepam oral capsule

temazepam oral capsule Restoril

CANNABIS AND CANNABINOID RECEPTOR AGONISTS

dronabinol oral capsule Marinol

CNS STIMULANTS

ADDERALL XR ORAL CAPSULE,EXTENDED RELEASE 24HR

PA; AL

dextroamphetamine oral tablet Zenzedi AL

dextroamphetamine-amphetamine oral tablet

Adderall AL

FIBROMYALGIA AGENTS

duloxetine oral capsule,delayed release(dr/ec)

Cymbalta

LYRICA ORAL CAPSULE PA

NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIBITORS (NDRIS)

bupropion hcl oral tablet

bupropion hcl oral tablet extended release 24 hr

Wellbutrin XL

bupropion hcl oral tablet sustained-release 12 hr

Wellbutrin SR

SEDATIVE-HYPNOTICS, BARBITURATES

phenobarbital oral elixir

phenobarbital oral tablet

SEDATIVE-HYPNOTICS, NON-BARBITURATES

diphenhydramine hcl oral capsule Banophen OTC

restfully sleep oral tablet OTC

sleep aid (doxylamine) oral tablet OTC

temazepam oral capsule Restoril

zolpidem oral tablet Ambien

SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS)

citalopram oral solution

citalopram oral tablet Celexa

escitalopram oxalate oral tablet Lexapro

fluoxetine oral capsule Prozac

27


fluoxetine oral solution

fluvoxamine oral tablet

paroxetine hcl oral tablet Paxil

sertraline oral tablet Zoloft

SEROTONIN-2 ANTAGONIST REUPTAKE INHIBITORS (SARIS)

trazodone oral tablet

SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)

desvenlafaxine succinate oral tablet extended release 24 hr

Pristiq

duloxetine oral capsule,delayed release(dr/ec)

Cymbalta

venlafaxine oral capsule,extended release 24hr

Effexor XR

venlafaxine oral tablet

TRICYCLIC ANTIDEPRESSANT/BENZODIAZEPINE COMBINATIONS

amitriptyline-chlordiazepoxide oral tablet

TRICYCLIC ANTIDEPRESSANTS AND RELATED NON-SELECT REUPTAKE INHIBITORS

amitriptyline oral tablet

amoxapine oral tablet

clomipramine oral capsule Anafranil

desipramine oral tablet Norpramin

doxepin oral capsule

doxepin oral concentrate

imipramine hcl oral tablet Tofranil

imipramine pamoate oral capsule

maprotiline oral tablet

nortriptyline oral capsule Pamelor

nortriptyline oral solution

protriptyline oral tablet

trimipramine oral capsule Surmontil

28


CHEMICAL DEPENDENCY, AGENTS TO TREAT

ALCOHOL ANTAGONIST

acamprosate oral tablet,delayed release (dr/ec)

QL

disulfiram oral tablet Antabuse

VIVITROL INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON

NARCOTIC ANTAGONISTS

buprenorphine hcl sublingual tablet PA; AL

SUBOXONE SUBLINGUAL FILM AL; QL

SMOKING DETERRENT AGENTS

bupropion hcl (smoking deter) oral tablet extended release 12 hr

Zyban

bupropion hcl oral tablet sustained-release 12 hr

Wellbutrin SR

CHANTIX CONTINUING MONTH BOX ORAL TABLET

CHANTIX ORAL TABLET

CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK

CHEMICALS-PHARMACEUTICAL ADJUVANTS

CHEMICALS - SOLVENTS

alcohol, rubbing solution OTC

PHARMACEUTICAL ADJUVANT

nebusal inhalation solution for nebulization

petrolatum topical ointment OTC

pulmosal inhalation solution for nebulization

sodium chloride inhalation solution for nebulization

NebuSal

COGNITIVE DISORDER THERAPY

CHOLINESTERASE INHIBITORS

donepezil oral tablet Aricept

donepezil oral tablet,disintegrating

EXELON TRANSDERMAL PATCH 24 HOUR

29


memantine oral tablet Namenda

CONTRACEPTIVES

CONTRACEPTIVES

altavera (28) oral tablet AL

alyacen 1/35 (28) oral tablet AL

alyacen 7/7/7 (28) oral tablet AL

amethia lo oral tablets,dose pack,3 month AL

amethia oral tablets,dose pack,3 month AL

amethyst oral tablet AL

apri oral tablet AL

aranelle (28) oral tablet AL

ashlyna oral tablets,dose pack,3 month AL

aubra oral tablet AL

aviane oral tablet AL

azurette (28) oral tablet AL

balziva (28) oral tablet AL

bekyree (28) oral tablet AL

blisovi 24 fe oral tablet AL

blisovi fe 1.5/30 (28) oral tablet AL

blisovi fe 1/20 (28) oral tablet AL

briellyn oral tablet AL

camila oral tablet AL

camrese lo oral tablets,dose pack,3 month AL

camrese oral tablets,dose pack,3 month AL

caziant (28) oral tablet AL

chateal oral tablet AL

cryselle (28) oral tablet AL

cyclafem 1/35 (28) oral tablet AL

cyclafem 7/7/7 (28) oral tablet AL

cyred oral tablet AL

dasetta 1/35 (28) oral tablet AL

dasetta 7/7/7 (28) oral tablet AL

daysee oral tablets,dose pack,3 month AL

deblitane oral tablet AL

delyla (28) oral tablet AL

DEPO-PROVERA INTRAMUSCULAR SUSPENSION

AL

30


desog-e.estradiol/e.estradiol oral tablet Azurette (28) AL

desogestrel-ethinyl estradiol oral tablet Apri AL

drospirenone-e.estradiol-lm.fa oral tablet Beyaz AL

drospirenone-ethinyl estradiol oral tablet Ocella AL

elinest oral tablet AL

emoquette oral tablet AL

enpresse oral tablet AL

enskyce oral tablet AL

errin oral tablet AL

estarylla oral tablet AL

ethynodiol diac-eth estradiol oral tablet Kelnor 1-50 AL

falmina (28) oral tablet AL

fayosim oral tablets,dose pack,3 month AL

femynor oral tablet AL

gianvi (28) oral tablet AL

heather oral tablet AL

introvale oral tablets,dose pack,3 month AL

isibloom oral tablet AL

jencycla oral tablet AL

jolessa oral tablets,dose pack,3 month AL

jolivette oral tablet AL

juleber oral tablet AL

junel 1.5/30 (21) oral tablet AL

junel 1/20 (21) oral tablet AL

junel fe 1.5/30 (28) oral tablet AL

junel fe 1/20 (28) oral tablet AL

junel fe 24 oral tablet AL

kaitlib fe oral tablet,chewable AL

kariva (28) oral tablet AL

kelnor 1/35 (28) oral tablet AL

kelnor 1-50 oral tablet AL

kurvelo oral tablet AL

KYLEENA INTRAUTERINE INTRAUTERINE DEVICE

l norgest/e.estradiol-e.estrad oral tablets,dose pack,3 month

Amethia AL

larin 1.5/30 (21) oral tablet AL

31


larin 1/20 (21) oral tablet AL

larin 24 fe oral tablet AL

larin fe 1.5/30 (28) oral tablet AL

larin fe 1/20 (28) oral tablet AL

larissia oral tablet AL

layolis fe oral tablet,chewable AL

leena 28 oral tablet AL

lessina oral tablet AL

levonest (28) oral tablet AL

levonorgestrel-ethinyl estrad oral tablet Aubra AL

levonorgestrel-ethinyl estrad oral tablets,dose pack,3 month

Introvale AL

levonorg-eth estrad triphasic oral tablet Enpresse AL

levora 0.15/30 (28) oral tablet AL

levora-28 oral tablet AL

LILETTA INTRAUTERINE INTRAUTERINE DEVICE

lillow oral tablet AL

loryna (28) oral tablet AL

low-ogestrel (28) oral tablet AL

lutera (28) oral tablet AL

lyza oral tablet AL

marlissa oral tablet AL

medroxyprogesterone intramuscular suspension

Depo-Provera AL

medroxyprogesterone intramuscular syringe

Depo-Provera AL

melodetta 24 fe oral tablet,chewable AL

mibelas 24 fe oral tablet,chewable AL

microgestin 1.5/30 (21) oral tablet AL

microgestin 1/20 (21) oral tablet AL

microgestin fe 1.5/30 (28) oral tablet AL

microgestin fe 1/20 (28) oral tablet AL

MIRENA INTRAUTERINE INTRAUTERINE DEVICE

mono-linyah oral tablet AL

mononessa (28) oral tablet AL

myzilra oral tablet AL

32


necon 0.5/35 (28) oral tablet AL

NEXPLANON SUBDERMAL IMPLANT

nikki (28) oral tablet AL

nora-be oral tablet AL

noreth-ethinyl estradiol-iron oral tablet,chewable

Wymzya Fe AL

norethindrone (contraceptive) oral tablet Camila AL

norethindrone ac-eth estradiol oral tablet Junel 1/20 (21) AL

norethindrone-e.estradiol-iron oral tablet Blisovi Fe 1/20 (28) AL

norethindrone-e.estradiol-iron oral tablet,chewable

Melodetta 24 Fe AL

norgestimate-ethinyl estradiol oral tablet Estarylla AL

norgestrel-ethinyl estradiol oral tablet Ogestrel (28) AL

norlyda oral tablet AL

norlyroc oral tablet AL

nortrel 0.5/35 (28) oral tablet AL

nortrel 1/35 (21) oral tablet AL

nortrel 1/35 (28) oral tablet AL

nortrel 7/7/7 (28) oral tablet AL

NUVARING VAGINAL RING AL

ocella oral tablet AL

ogestrel (28) oral tablet AL

orsythia oral tablet AL

PARAGARD T 380A INTRAUTERINE INTRAUTERINE DEVICE

philith oral tablet AL

pimtrea (28) oral tablet AL

pirmella oral tablet AL

portia oral tablet AL

previfem oral tablet AL

quasense oral tablets,dose pack,3 month AL

rajani oral tablet AL

reclipsen (28) oral tablet AL

RIVELSA ORAL TABLETS,DOSE PACK,3 MONTH

AL

setlakin oral tablets,dose pack,3 month AL

sharobel oral tablet AL

33


SKYLA INTRAUTERINE INTRAUTERINE DEVICE

sprintec (28) oral tablet AL

sronyx oral tablet AL

syeda oral tablet AL

tarina fe 1/20 (28) oral tablet AL

tarina fe 1-20 eq (28) oral tablet

tilia fe oral tablet AL

TODAY CONTRACEPTIVE SPONGE VAGINAL CONTRACEPTIVE SPONGE

OTC

tri femynor oral tablet AL

tri-estarylla oral tablet AL

tri-legest fe oral tablet AL

tri-linyah oral tablet AL

tri-lo-estarylla oral tablet AL

tri-lo-marzia oral tablet AL

tri-lo-sprintec oral tablet AL

tri-previfem (28) oral tablet AL

tri-sprintec (28) oral tablet AL

trivora (28) oral tablet AL

tri-vylibra oral tablet AL

tydemy oral tablet AL

VAGINAL CONTRACEPTIVE FILM VAGINAL FILM

OTC

vaginal contraceptive foam vaginal foam OTC

VCF CONTRACEPTIVE FILM VAGINAL FILM

OTC

velivet triphasic regimen (28) oral tablet AL

vienva oral tablet AL

viorele (28) oral tablet AL

vyfemla (28) oral tablet AL

vylibra oral tablet AL

wera (28) oral tablet AL

wymzya fe oral tablet,chewable AL

xulane transdermal patch weekly AL; QL

zarah oral tablet AL

zenchent (28) oral tablet AL

zovia 1/35e (28) oral tablet AL

34


EMERGENCY CONTRACEPTIVES

ELLA ORAL TABLET QL

DENTAL AIDS AND PREPARATIONS

ANTISEPTICS, GENERAL

chlorhexidine gluconate mucous membrane mouthwash

Paroex Oral Rinse QL

paroex oral rinse mucous membrane mouthwash

QL

periogard mucous membrane mouthwash QL

sore throat (hexylresorcinol) mucous membrane lozenge

OTC

FLUORIDE PREPARATIONS

denta 5000 plus dental cream QL

dentagel dental gel

fluoride (sodium) oral drops OTC; QL

fluoride (sodium) oral tablet,chewable Fluoritab OTC

fluoritab oral tablet,chewable OTC

flura-drops oral drops OTC

ludent fluoride oral tablet,chewable OTC

perio med dental solution OTC

sf 5000 plus dental cream QL

sf dental gel

MOUTH AND THROAT AGENTS

cherry cough drops mucous membrane lozenge

OTC

cherry menthol mucous membrane lozenge

OTC

cough drops (with eucalyptus) mucous membrane lozenge

OTC

honey lemon mucous membrane lozenge OTC

lidocaine hcl mucous membrane jelly

lidocaine hcl mucous membrane solution QL

lidocaine viscous mucous membrane solution

QL

medikoff drops mucous membrane lozenge

OTC

menthol drops mucous membrane lozenge

OTC

35


nystatin oral suspension

oralone dental paste

pilocarpine hcl oral tablet Salagen (pilocarpine) QL

sore throat relief (pectin) mucous membrane lozenge on a handle

OTC

throat drops mucous membrane lozenge OTC

throat lozenges mucous membrane lozenge

OTC

triamcinolone acetonide dental paste Oralone

zinc with vitamins a and c oral lozenge OTC

DERMATOLOGICAL

ACNE AGENTS, SYSTEMIC

amnesteem oral capsule PA

claravis oral capsule PA

isotretinoin oral capsule Absorica PA

MYORISAN ORAL CAPSULE 10 MG, 30 MG

PA

myorisan oral capsule 20 mg, 40 mg PA

zenatane oral capsule PA

ACNE AGENTS, TOPICAL

acne medication topical lotion AL; OTC

advanced acne wash topical cleanser,extended release

OTC

bp gel topical gel OTC

bp wash topical cleanser OTC

CLEAR PORE CLEANSER-MASK TOPICAL CLEANSER

OTC

clindamycin phosphate topical solution Cleocin T AL

clindamycin phosphate topical swab Cleocin T PA; AL

clindamycin-benzoyl peroxide topical gel Duac PA; AL

erythromycin with ethanol topical solution AL

METROCREAM TOPICAL CREAM

METROLOTION TOPICAL LOTION

NEUTROGENA ON THE SPOT TOPICAL CREAM

OTC

OC8 TOPICAL GEL OTC

ANTIPSORIATIC AGENTS

calcipotriene scalp solution

36


calcipotriene topical cream Dovonex

calcipotriene topical ointment Calcitrene

HAIR GROWTH AGENTS

finasteride oral tablet Propecia

ROSACEA AGENTS, TOPICAL

METROGEL TOPICAL GEL

METROGEL TOPICAL GEL WITH PUMP

SCABICIDE AND PEDICULICIDES

complete lice treatment topical kit OTC; QL

lice complete kit 1-2-3 topical kit OTC; QL

lice solution topical kit OTC; QL

permethrin topical cream Elimite QL

rid complete lice elim kit topical kit OTC; QL

spinosad topical suspension Natroba

TOPICAL AGENTS, MISCELLANEOUS

alphabath topical oil OTC

ameriphor topical ointment OTC

ammonium lactate topical cream Geri-Hydrolac OTC

ammonium lactate topical lotion AmLactin OTC

aqua glycolic face topical cream OTC

aqua glycolic topical shampoo OTC

aqua lube topical lubricant OTC

arthricream rub topical cream OTC

bath oil topical oil OTC

beta care topical cream OTC

beta care topical lotion OTC

calamine topical lotion OTC

calamine-zinc oxide-phenol topical suspension

OTC

cam topical lotion OTC

capsaicin topical liquid Capzasin OTC

CAPZASIN TOPICAL LIQUID OTC

CAPZASIN-P TOPICAL CREAM OTC

CERAVE PM TOPICAL LOTION,EXTENDED RELEASE

OTC

CERAVE SUNSCREEN TOPICAL LOTION

OTC

37


CERAVE TOPICAL CLEANSER OTC

CERAVE TOPICAL CREAM OTC

CUTTER BACKWOODS TOPICAL AEROSOL,SPRAY

OTC; QL

CUTTER SKINSATIONS TOPICAL SPRAY,NON-AEROSOL

OTC; QL

daily moisturizing lotion topical lotion OTC

dermabase topical cream OTC

dermaphor topical ointment OTC

dermavantage topical lotion OTC

diaper rash topical ointment OTC

dry skin care topical lotion OTC

dry skin therapy moisturizing topical lotion OTC

dry skin therapy topical cream OTC

emollient topical cream Aqua Glycolic Face OTC

eucerin original topical lotion OTC

excel-gel topical gel OTC

finger cream topical cream OTC

glycerin topical liquid OTC

high potency capsaicin topical cream OTC

hydrocerin topical lotion OTC

HYPERCARE TOPICAL LIQUID OTC

insect repellent (picaridin) topical spray with pump

OTC; QL

lan-o-soothe topical cream OTC

lidocaine hcl mucous membrane jelly

lidocaine hcl topical cream Lidopin

lidocaine hcl topical lotion Lido-K

lidocaine topical adhesive patch,medicated

Lidoderm

lidocaine topical ointment QL

lubriderm daily moisture (pet) topical lotion OTC

lubriderm skin nourishing topical lotion OTC

lubrisilk topical lotion OTC

lubrisoft topical lotion OTC

mapo bath topical oil OTC

medicated heat patch topical adhesive patch,medicated

OTC

38


mineral freez topical gel OTC

mineral oil light topical oil OTC

mineral oil topical oil Lobana Bath OTC

minerin topical lotion OTC

NATRAPEL TOPICAL AEROSOL,SPRAY

OTC; QL

natural oatmeal bath treatment topical packet

OTC

nivatopic plus topical cream

oatmeal bath regular topical packet OTC

OFF ACTIVE TOPICAL AEROSOL,SPRAY

OTC; QL

OFF DEEP WOODS DRY TOPICAL AEROSOL POWDER

OTC; QL

OFF DEEP WOODS TOPICAL AEROSOL,SPRAY

OTC; QL

OFF FAMILYCARE (WITH DEET) TOPICAL AEROSOL POWDER

OTC; QL

pediatric oint (cod liver oil) topical ointment

OTC

petrolatum topical ointment OTC

podofilox topical solution

prumyx topical cream

REPEL SPORTSMEN DRY TOPICAL AEROSOL,SPRAY

OTC; QL

REPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY

OTC; QL

REPEL SPORTSMEN TOPICAL AEROSOL,SPRAY

OTC; QL

salactic film topical liquid OTC

salicylic acid er-ceramides topical kit,cleanser and cream er

Salex

salicylic acid topical cream Salimez

salicylic acid topical cream,extended release

salicylic acid topical film forming liquid w/appl

Virasal

salicylic acid topical foam Salvax

salicylic acid topical gel Keralyt Rx

salicylic acid topical liquid

39


salicylic acid topical lotion

salicylic acid topical lotion,extended release

salicylic acid topical shampoo Salex

SALONPAS-HOT TOPICAL ADHESIVE PATCH,MEDICATED

OTC

salvax topical foam

scar topical gel OTC

selenium sulfide topical lotion

selenium sulfide topical shampoo

silver sulfadiazine topical cream Silvadene

sorbidon hydrate topical cream OTC

special care lotion topical lotion OTC

ssd topical cream

sween cream topical cream OTC

sween topical cream OTC

thera bath topical oil OTC

thera-derm topical lotion OTC

unscented cold cream topical cream OTC

urea topical cream

urea topical gel CEM-Urea

urea topical lotion Uramaxin

vanicream topical cream OTC

vitamin a and d topical ointment OTC

vitamin e plus topical cream OTC

vitamin e-vitamins a and d topical cream OTC

VOLTAREN TOPICAL GEL

x-seb t pearl topical shampoo OTC

zinc oxide diaper cream topical cream OTC

TOPICAL ANESTHETICS

hydrocortisone-pramoxine topical cream Pramosone

lidocaine hcl-hydrocortison ac topical cream

lidocaine-prilocaine topical cream QL

TOPICAL ANTIBIOTICS

double antibiotic (b.tracn zn) topical ointment

OTC

gentamicin topical cream

40


gentamicin topical ointment

mupirocin topical ointment Centany

wal-sporin topical ointment OTC

TOPICAL ANTIFUNGALS

antifungal topical liquid OTC

ATHLETE'S FOOT (TERBINAFINE) TOPICAL CREAM

OTC

baza cream hospital care pack topical combo pack

OTC

CICLODAN TOPICAL SOLUTION

ciclopirox topical solution Ciclodan

clotrimazole topical cream Antifungal (clotrimazole) OTC

ELON DUAL DEFENSE TOPICAL SOLUTION

OTC

EQ TERBINAFINE 1% CREAM Antifungal (terbinafine) OTC

GORDOCHOM TOPICAL SOLUTION OTC

HONGO CURA SPRAY TOPICAL AEROSOL,SPRAY

OTC

JOCK ITCH (TERBINAFINE) TOPICAL CREAM

OTC

ketoconazole topical cream

ketoconazole topical shampoo Nizoral

lotrimin af topical aerosol,spray OTC

MYCO NAIL A TOPICAL SOLUTION OTC

MYCO NAIL TOPICAL LIQUID OTC

nyamyc topical powder

nystatin topical cream

nystatin topical ointment

nystatin topical powder Nyamyc

nystop topical powder

terbinafine 1% cream Antifungal (terbinafine) OTC

TERBINAFINE 1% CREAM Antifungal (terbinafine) OTC

tinactin topical cream OTC

UNDELENIC TOPICAL TINCTURE OTC

TOPICAL ANTI-INFLAMMATORY STEROIDAL AGENTS

ala-cort topical cream 1 %

ala-cort topical cream 2.5 % QL

41


alclometasone topical cream

alclometasone topical ointment

ANUSOL-HC TOPICAL CREAM WITH PERINEAL APPLICATOR

betamethasone valerate topical cream

betamethasone valerate topical lotion

betamethasone valerate topical ointment

clobetasol scalp solution Cormax

clobetasol topical cream Temovate

clobetasol topical gel

clobetasol topical ointment Temovate

clobetasol-emollient topical cream

cormax scalp solution

cortisone with aloe topical cream OTC

fluocinonide topical solution

fluticasone topical cream Cutivate

fluticasone topical ointment

halobetasol propionate topical cream Ultravate

halobetasol propionate topical ointment Ultravate

hydrocortisone 1% ointment (rx) Anti-Itch (HC) OTC

hydrocortisone 1% ointment (rx) Anti-Itch (HC) OTC

hydrocortisone acetate topical cream OTC

hydrocortisone acetate topical ointment OTC

hydrocortisone butyrate topical lotion Locoid

hydrocortisone butyr-emollient topical cream

Locoid Lipocream

hydrocortisone topical cream 1 % Ala-Cort OTC; QL

hydrocortisone topical cream 2.5 % Ala-Cort

hydrocortisone topical cream with perineal applicator

Anusol-HC

hydrocortisone topical lotion

hydrocortisone topical ointment 2.5 %

hydrocortisone-aloe vera topical cream Cortisone with Aloe OTC

hydrocortisone-pramoxine topical cream Pramosone

mometasone topical cream Elocon

mometasone topical ointment Elocon

mometasone topical solution

PROCTOCORT TOPICAL CREAM

42


procto-med hc topical cream with perineal applicator

proctosol hc topical cream with perineal applicator

proctozone-hc topical cream with perineal applicator

scalacort topical lotion

triamcinolone acetonide topical cream Triderm

triamcinolone acetonide topical lotion

triamcinolone acetonide topical ointment

triderm topical cream

TOPICAL ANTINEOPLASTIC AND PREMALIGNANT

fluorouracil topical cream Efudex QL

fluorouracil topical solution QL

TOPICAL ANTIPARASITICS

CUTTER BACKWOODS TOPICAL AEROSOL,SPRAY

OTC; QL

CUTTER SKINSATIONS TOPICAL SPRAY,NON-AEROSOL

OTC; QL

insect repellent (picaridin) topical spray with pump

OTC; QL

NATRAPEL TOPICAL AEROSOL,SPRAY

OTC; QL

OFF ACTIVE TOPICAL AEROSOL,SPRAY

OTC; QL

OFF DEEP WOODS DRY TOPICAL AEROSOL POWDER

OTC; QL

OFF DEEP WOODS TOPICAL AEROSOL,SPRAY

OTC; QL

OFF FAMILYCARE (WITH DEET) TOPICAL AEROSOL POWDER

OTC; QL

REPEL SPORTSMEN DRY TOPICAL AEROSOL,SPRAY

OTC; QL

REPEL SPORTSMEN MAX TOPICAL AEROSOL,SPRAY

OTC; QL

REPEL SPORTSMEN TOPICAL AEROSOL,SPRAY

OTC; QL

TOPICAL ANTIVIRALS

ABREVA TOPICAL CREAM OTC

43


ZOVIRAX TOPICAL CREAM

TOPICAL IMMUNOMODULATORS

ELIDEL TOPICAL CREAM AL

imiquimod topical cream in packet Aldara PA; QL

VITAMIN A DERIVATIVES

RETIN-A TOPICAL CREAM AL

RETIN-A TOPICAL GEL AL

DIAGNOSTIC AGENTS

DIAGNOSTIC - MULTIPLE URINE TESTS

AZO TEST STRIPS STRIP OTC

URINARY TRACT INF.TEST (WBCS) STRIP

OTC

DIAGNOSTIC DRUGS - GASTROINTESTINAL RADIOLOGICAL ADJUNCT

GLUCAGEN DIAGNOSTIC KIT INJECTION RECON SOLN

QL

DIAGNOSTIC DRUGS

dipyridamole intravenous solution

DRUGS TO TREAT MULTIPLE SCLEROSIS

DRUGS TO TREAT MULTIPLE SCLEROSIS

AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT

AVONEX INTRAMUSCULAR PEN INJECTOR KIT

AVONEX INTRAMUSCULAR SYRINGE KIT

BETASERON SUBCUTANEOUS KIT

COPAXONE SUBCUTANEOUS SYRINGE

GILENYA ORAL CAPSULE

REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE

REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR

44


REBIF TITRATION PACK SUBCUTANEOUS SYRINGE

EATING DISORDER THERAPY

ANTI-OBESITY AGENTS

ALLI ORAL CAPSULE PA; OTC; QL

APPETITE STIMULANT AGENTS


megestrol oral suspension

ELECTROLYTE BALANCE-NUTRITIONAL PRODUCTS

AMINO ACIDS

levocarnitine oral tablet Carnitor OTC

BIOFLAVONOID COMBINATIONS

ear care oral tablet OTC

ear health formula oral tablet OTC

CALCIUM REPLACEMENT

bone meal-vitamin d2 oral tablet OTC

ca-d3-mag ox-zinc-cop-mang-bor oral tablet

Calcium 600-D3 Plus OTC

ca-d3-mag ox-zinc-cop-mang-bor oral tablet,chewable

OTC

CA-D3-MAG-ZINC-COP-MANG-BOR ORAL TABLET

OTC

calcium 500 oral tablet OTC

calcium 600 + minerals oral tablet OTC

calcium carb and citrate-vitd3 oral tablet extended release

Citracal + D Slow Release OTC

calcium carbonate oral tablet OTC

calcium carbonate-vit d3-min oral tablet Calcium 600 + Minerals OTC

CALCIUM CARBONATE-VITAMIN D3 ORAL TABLET,CHEWABLE

OTC

calcium citrate-vitamin d2 oral tablet OTC

calcium for women oral tablet,chewable OTC

calcium gluconate oral tablet OTC

calcium lactate oral tablet OTC

calcium magnesium oral tablet OTC

calcium soft chew oral tablet,chewable OTC

calcium-folic acid-vitamin d oral wafer OTC

45


calcium-magnesium-zinc oral tablet OTC

calcium-vitamin d3-vitamin k oral tablet,chewable

Calcium Soft Chew OTC

oyst-cal-500 oral tablet OTC

oyster shell calcium-vit d2 oral tablet OTC

risacal-d oral tablet OTC

tl g-fol os oral tablet

DIETARY PRODUCTS

hair, skin and nails advanced oral tablet OTC

FOLIC ACID PREPARATIONS

elfolate oral tablet OTC

fabb oral tablet OTC

folbee oral tablet OTC

folbic oral tablet OTC

folic acid injection solution

folic acid oral tablet OTC

folic acid-vit b6-vit b12 oral tablet Folplex 2.2 OTC

folplex 2.2 oral tablet OTC

levomefolate calcium oral tablet Elfolate OTC

l-methylfolate oral tablet OTC

tl gard rx oral tablet OTC

virt-gard oral tablet OTC

virt-vite oral tablet OTC

IRON REPLACEMENT

centratex oral capsule OTC

chewable iron oral tablet,chewable OTC

corvita 150 oral tablet OTC

duofer oral tablet OTC

fe c plus oral tablet OTC; QL

ferocon oral capsule OTC

ferraplus 90 oral tablet OTC

ferrex 150 forte oral capsule OTC

ferrex 150 forte plus oral capsule OTC

ferrex 150 plus oral capsule OTC

ferrex 28 oral tablet OTC

ferrocite plus oral tablet OTC

ferrous sulfate oral syringe OTC

46


folivane-f oral capsule OTC

folivane-plus oral capsule OTC

hematinic plus vit/minerals oral tablet OTC

hematinic/folic acid oral tablet OTC

hematogen fa oral capsule OTC

hematogen forte oral capsule OTC

hematogen oral capsule OTC

hemetab oral tablet OTC; QL

iferex 150 forte oral capsule OTC

infed injection solution

iron chews oral tablet,chewable OTC

iron, carbonyl oral tablet Feosol OTC

multigen folic oral tablet OTC

multigen oral tablet OTC

multigen plus oral tablet OTC

myferon 150 forte oral capsule OTC

poly-iron 150 forte oral capsule OTC

sodium ferric gluconat-sucrose intravenous solution

Ferrlecit

taron forte oral capsule OTC

tl icon oral capsule OTC

tricon oral capsule OTC

trigels-f forte oral capsule OTC

wee care oral suspension OTC

IRRIGATION SOLUTIONS

sodium chloride irrigation solution Aqua Care Sodium Chloride

sterile saline irrigation solution OTC

MINERALS AND ELECTROLYTES AGENTS

av-phos 250 neutral oral tablet OTC

calcium-magnesium-copper-zinc oral tablet

OTC

k-phos-neutral oral tablet OTC

mag-g oral tablet OTC

magnesium gluconate oral tablet Mag-G OTC

phospha 250 neutral oral tablet OTC

phospho-trin 250 neutral oral tablet OTC

virt-phos 250 neutral oral tablet OTC

47


MULTIVITAMINS

a thru z high potency oral tablet OTC

a thru z select oral tablet OTC

a thru z select women's oral tablet OTC

actical oral capsule OTC

apatate forte oral liquid OTC

bee-zee oral tablet OTC

biocel (with lutein) oral tablet OTC

biosupp oral liquid OTC

biotect plus oral liquid OTC

biovol oral syrup OTC

calcium citrate plus (vit b6) oral tablet OTC

central-vite cardio oral tablet OTC

centravites oral tablet OTC

century cardio oral tablet OTC

century mature oral tablet OTC

century ultimate women's oral tablet OTC

cerovite senior oral tablet OTC

certa plus oral tablet OTC

certavite-antioxid (iron gluc) oral liquid OTC

complete multivitamin oral tablet OTC

complete premium vitamin oral tablet OTC

corvita oral tablet OTC

daily multiple for men oral tablet OTC

daily multivitamin-minerals oral tablet OTC

daily vitamin formula-minerals oral tablet OTC

e-400 c-500 and beta carotene oral tablet OTC

eldertonic oral elixir OTC

essential daily oral tablet OTC

fosfree oral tablet OTC

hair,skin and nails oral tablet OTC

ICAPS PLUS ORAL TABLET OTC

m.v.i. adult intravenous solution

macuvite eye care oral tablet OTC

maximum daily multivitamin oral tablet OTC

mega multi for women oral tablet OTC

mega multiple/chelated mineral oral tablet OTC

48


mega multivitamin for men oral tablet OTC

mega multivitamin with mineral oral tablet OTC

men's daily multivit-mineral oral tablet OTC

men's one daily oral tablet OTC

milltrium senior oral tablet OTC

multi for her oral tablet OTC

multi-delyn with iron oral liquid OTC

multilex-t and m oral tablet OTC

multiple vitamin, womens oral tablet OTC

multiple vitamin-minerals oral tablet OTC

multivitamin 50 plus oral tablet OTC

multivitamin with minerals oral tablet Bee-Zee OTC

multi-vite (with folic acid) oral tablet OTC

multivit-min-iron fum-folic ac oral tablet OTC

my-vitalife oral capsule OTC

ocutabs oral tablet OTC

omnicap oral tablet OTC

one daily calcium/iron oral tablet OTC

one daily complete oral tablet OTC

one daily energy oral tablet OTC

one daily essential oral tablet OTC

one daily for men oral tablet OTC

one daily for women oral tablet OTC

one daily maximum oral tablet OTC

one daily oral tablet OTC

one daily plus minerals oral tablet OTC

one daily women 50 plus oral tablet OTC

one daily womens 50 plus oral tablet OTC

one daily women's oral tablet OTC

ONE-A-DAY MAXIMUM FORMULA ORAL TABLET

OTC

one-tablet-daily oral tablet OTC

purevit dualfe plus oral capsule OTC

quintabs-m iron free oral tablet OTC

se-tan plus oral capsule OTC

spectravite men's oral tablet OTC

spectravite ultra women's sr oral tablet OTC

49


sunvite oral tablet OTC

super antioxidant oral capsule OTC

support oral liquid OTC

theralogix companion oral tablet OTC

thera-m oral tablet OTC

therapeutic-m vitamin/minerals oral tablet OTC

theratrum complete 50 plus/lut oral tablet OTC

theratrum complete with lutein oral tablet OTC

therems-m oral tablet OTC

totalday multiple oral tablet extended release

OTC

tyr cooler oral liquid OTC

ultimate women's complete 50+ oral tablet OTC

urosex oral tablet OTC

v-c forte oral capsule OTC

vic-forte oral capsule OTC

vit 3 oral capsule OTC

vitalee oral tablet OTC

vitamins a and d oral capsule OTC

vitrum senior oral tablet OTC

women's daily formula oral tablet OTC

women's daily multivitamin oral tablet OTC

NUTRITIONAL PRODUCTS

GERBER GOOD START GLUCOSE ORAL SOLUTION

OTC

MSUD EXPRESS15 ORAL POWDER IN PACKET

OTC

PEDIATRIC VITAMIN PREPARATIONS

children's chewable multivitmn oral tablet,chewable

OTC

children's chewable oral tablet,chewable OTC

children's chewables extra c oral tablet,chewable

OTC

children's chewables oral tablet,chewable OTC

children's chewables with iron oral tablet,chewable

OTC

FLINTSTONES MULTI-VIT GUMMIES ORAL TABLET,CHEWABLE

OTC

50


FLINTSTONES TAB CHEW ORAL TABLET,CHEWABLE

OTC

gummy dinos oral tablet,chewable OTC

multi-vit with fluoride-iron oral drops OTC

multi-vitamin with fluoride oral drops OTC

multivitamin with fluoride oral tablet,chewable

OTC

multi-vitamin with fluoride oral tablet,chewable

OTC

multivitamins with fluoride oral tablet,chewable

OTC

multi-vitamins with iron oral tablet,chewable

OTC

mvc-fluoride oral tablet,chewable OTC

PEDIA POLY-VITE ORAL DROPS OTC

POLY-VI-SOL ORAL DROPS OTC

POLY-VI-SOL WITH IRON ORAL DROPS

OTC

triple vitamin with fluoride oral drops OTC

tri-vitamin with fluoride oral drops OTC

tri-vite with fluoride oral drops OTC

vitalets oral tablet,chewable OTC

vitamins a,c,d and fluoride oral drops OTC

zoo friends original oral tablet,chewable OTC

POTASSIUM REMOVING RESINS

sodium polystyrene (sorb free) oral suspension

sodium polystyrene sulfonate oral suspension

sodium polystyrene (sorb free)

sodium polystyrene sulfonate rectal enema

sps (with sorbitol) oral suspension

sps (with sorbitol) rectal enema

POTASSIUM REPLACEMENT

effer-k oral tablet, effervescent

k-effervescent oral tablet, effervescent

klor-con 10 oral tablet extended release

klor-con 8 oral tablet extended release

51


klor-con m10 oral tablet,er particles/crystals



klor-con oral packet

klor-con/ef oral tablet, effervescent

k-tab oral tablet extended release

potassium bicarb and chloride oral tablet, effervescent

potassium bicarb-citric acid oral tablet, effervescent

Effer-K

potassium chloride oral capsule, extended release

potassium chloride oral liquid

potassium chloride oral packet Klor-Con

potassium chloride oral tablet extended release

K-Tab

potassium chloride oral tablet,er particles/crystals

Klor-Con M20

potassium gluconate oral tablet OTC

PRENATAL VITAMIN PREPARATIONS

daily prenatal oral combo pack OTC; QL

kpn oral tablet OTC; QL

one daily prenatal oral combo pack OTC; QL

perry prenatal oral capsule OTC; QL

prenatal + dha oral combo pack OTC; QL

prenatal 19 (with docusate) oral tablet OTC; QL

prenatal 19 oral tablet,chewable OTC; QL

prenatal complete oral tablet OTC; QL

prenatal multi-dha (algal oil) oral capsule OTC; QL

PRENATAL MULTIVITAMINS ORAL TABLET

OTC; QL

prenatal one daily oral tablet OTC; QL

prenatal tablet oral tablet OTC; QL

prenatal vitamin oral tablet OTC; QL

prenatal vitamin with minerals oral tablet OTC; QL

52


prenatal vit-iron fum-folic ac oral tablet Prenatal Tablet OTC; QL

VITAMIN B PREPARATIONS

apetigen plus oral liquid OTC

b complex 100 injection solution

b complex 100 oral tablet OTC

b-100 complex oral tablet extended release

OTC

balanced b-100 complex oral tablet extended release

OTC

balanced b-100 oral tablet OTC

b-complex with vitamin c oral tablet OTC

cyanocobalamin (vitamin b-12) injection solution

dialyvite oral tablet OTC

fabb oral tablet OTC

folbee oral tablet OTC

folbee plus oral tablet OTC

folbic oral tablet OTC

folic acid-vit b6-vit b12 oral tablet Folplex 2.2 OTC

folplex 2.2 oral tablet OTC

foltabs 800 oral tablet OTC

hydroxocobalamin intramuscular solution

kobee oral tablet OTC

mynephrocaps oral capsule OTC

mynephron oral capsule OTC

natural b-100 complex oral tablet OTC

nephplex rx oral tablet OTC

nephronex oral liquid OTC

nephronex-sl oral tablet,disintegrating OTC

nephro-vite rx oral tablet OTC

niacin (inositol niacinate) oral capsule Niacin Flush Free OTC

niacin flush free oral capsule OTC

pantothenic acid (vit b5) oral tablet OTC

pyridoxine (vitamin b6) injection solution

renal caps oral capsule OTC

rena-vite rx oral tablet OTC

reno caps oral capsule OTC

riboflavin (vitamin b2) oral tablet Vitamin B-2 OTC

53


stress b plus zinc oral tablet OTC

stress formula plus iron oral tablet OTC

stress formula with iron(sulf) oral tablet OTC

super b maxi complex oral tablet OTC

super quints oral tablet OTC

thiamine hcl (vitamin b1) injection solution

thiamine mononitrate (vit b1) oral tablet Vitamin B-1 (mononitrate) OTC

tl gard rx oral tablet OTC

triphrocaps oral capsule OTC

virt-gard oral tablet OTC

virt-vite oral tablet OTC

vitamin b complex-folic acid oral tablet B Complex 100 OTC

vitamin b-1 (mononitrate) oral tablet OTC

vitamin b-2 oral tablet OTC

vp-vite rx oral tablet OTC

VITAMIN C PREPARATIONS

acerola c-500 oral wafer OTC

ascorbate calcium oral tablet OTC

ascorbic acid (vitamin c) injection solution

zinc and c oral lozenge OTC

VITAMIN D PREPARATIONS

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

CHOLECALCIFEROL (VITAMIN D3) ORAL CAPSULE

Decara OTC

ergocalciferol (vitamin d2) oral capsule Drisdol

vitamin d2 oral capsule

VITAMIN E PREPARATIONS

vitamin e acetate oral capsule OTC

vitamin e mixed oral capsule OTC

vitamin e oral capsule OTC

wheat germ oil oral capsule OTC

VITAMIN K PREPARATIONS

phytonadione (vitamin k1) oral tablet 100 mcg

OTC

phytonadione (vitamin k1) oral tablet 5 mg Mephyton

vitamin k injection solution

54


vitamin k1 injection solution

ZINC REPLACEMENT

chelated zinc oral tablet OTC

zinc oral tablet Chelated Zinc OTC

zinc-vit c-pyridoxine (vit b6) oral lozenge OTC

ENDOCRINE

ANDROGENIC AGENTS

ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP

PA; AL

ANDROGEL TRANSDERMAL GEL IN PACKET 1 % (25 MG/2.5GRAM), 1 % (50 MG/5 GRAM)

PA

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

PA; AL

testosterone cypionate intramuscular oil Depo-Testosterone PA

testosterone enanthate intramuscular oil PA

ANTIDIURETIC AND VASOPRESSOR HORMONES

desmopressin nasal spray with pump DDAVP

desmopressin nasal spray,non-aerosol

desmopressin oral tablet DDAVP QL

ANTIHYPERGLYCEMIC, INCRETIN MIMETIC (GLP-1 RECEPTOR AGONIST)

BYDUREON SUBCUTANEOUS PEN INJECTOR

BYDUREON SUBCUTANEOUS SUSPENSION,EXTENDED REL RECON

BYETTA SUBCUTANEOUS PEN INJECTOR

VICTOZA 2-PAK SUBCUTANEOUS PEN INJECTOR

VICTOZA 3-PAK SUBCUTANEOUS PEN INJECTOR

ANTITHYROID PREPARATIONS

methimazole oral tablet Tapazole

propylthiouracil oral tablet

55


BONE RESORPTION INHIBITORS

alendronate oral tablet

CALCITONINS

calcitonin (salmon) nasal spray,non-aerosol

DIPEPTIDYL PEPTIDASE - IV INHIBITOR & COMBINATIONS

GLYXAMBI ORAL TABLET

JANUMET ORAL TABLET

JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR

JANUVIA ORAL TABLET

JENTADUETO ORAL TABLET

TRADJENTA ORAL TABLET

ESTROGENIC AGENTS

amabelz oral tablet

estradiol oral tablet Estrace

estradiol transdermal patch weekly Climara QL

estradiol-norethindrone acet oral tablet Activella

estropipate oral tablet

fyavolv oral tablet

jevantique lo oral tablet

jinteli oral tablet

lopreeza oral tablet

mimvey lo oral tablet

mimvey oral tablet

norethindrone ac-eth estradiol oral tablet Fyavolv

PREMPHASE ORAL TABLET

PREMPRO ORAL TABLET

raloxifene oral tablet Evista

FERTILITY ENHANCER

MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR

QL

GLUCOCORTICOIDS

a-hydrocort injection recon soln

dexamethasone oral solution

dexamethasone oral tablet Decadron

56


dexamethasone sodium phosphate injection solution

hydrocortisone oral tablet Cortef

methylprednisolone acetate injection suspension

Depo-Medrol

methylprednisolone oral tablet Medrol

methylprednisolone oral tablets,dose pack Medrol (Pak)

prednisolone oral solution

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)

prednisolone sodium phosphate oral solution 15 mg/5 ml (5 ml)

prednisone oral solution

prednisone oral tablet

prednisone oral tablets,dose pack

GROWTH HORMONES

GENOTROPIN MINIQUICK SUBCUTANEOUS SYRINGE

PA; AL

GENOTROPIN SUBCUTANEOUS CARTRIDGE

PA; AL

NUTROPIN AQ NUSPIN SUBCUTANEOUS PEN INJECTOR

PA; AL

HYPERGLYCEMICS

dex4 glucose bits oral tablet,chewable OTC

dex4 glucose oral tablet,chewable OTC

dex4 glucose pouch pack oral tablet,chewable

OTC

dex4 glucose quick dissolve oral tablet,chewable

OTC

dextrose oral gel Dex4 Glucose OTC

GLUCAGEN HYPOKIT INJECTION RECON SOLN

GLUCAGON EMERGENCY KIT (HUMAN) INJECTION RECON SOLN

gluco burst oral gel OTC

glucose bits oral tablet,chewable OTC

glucose gel oral gel OTC

glucose oral tablet,chewable Dex4 Glucose OTC

57


HYPOGLYCEMICS, ALPHA GLUCOSIDASE INHIBITOR TYPE

acarbose oral tablet Precose

HYPOGLYCEMICS, BIGUANIDINE TYPE

metformin oral tablet Glucophage

metformin oral tablet extended release 24 hr

Glucophage XR

metformin oral tablet,er gast.retention 24 hr

Glumetza PA

HYPOGLYCEMICS, INSULIN - RELEASE STIMULANT TYPE

glimepiride oral tablet Amaryl

glipizide oral tablet Glucotrol

glipizide oral tablet extended release 24hr Glucotrol XL

glyburide micronized oral tablet Glynase

glyburide oral tablet

glyburide-metformin oral tablet

nateglinide oral tablet Starlix

repaglinide oral tablet Prandin

HYPOGLYCEMICS, INSULIN - RESPONSE ENHANCER

pioglitazone oral tablet Actos

INSULINS

HUMALOG MIX 50-50 INSULN U-100 SUBCUTANEOUS SUSPENSION

HUMALOG MIX 75-25(U-100)INSULN SUBCUTANEOUS SUSPENSION

HUMALOG U-100 INSULIN SUBCUTANEOUS SOLUTION

HUMULIN 70/30 U-100 INSULIN SUBCUTANEOUS SUSPENSION

OTC

HUMULIN N NPH U-100 INSULIN SUBCUTANEOUS SUSPENSION

OTC

HUMULIN R REGULAR U-100 INSULN INJECTION SOLUTION

OTC

HUMULIN R U-500 (CONC) INSULIN SUBCUTANEOUS SOLUTION

HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN

58


LANTUS SOLOSTAR U-100 INSULIN SUBCUTANEOUS INSULIN PEN

LANTUS U-100 INSULIN SUBCUTANEOUS SOLUTION

LEVEMIR FLEXTOUCH U-100 INSULN SUBCUTANEOUS INSULIN PEN

LEVEMIR U-100 INSULIN SUBCUTANEOUS SOLUTION

NOVOLOG FLEXPEN U-100 INSULIN SUBCUTANEOUS INSULIN PEN

NOVOLOG MIX 70-30 U-100 INSULN SUBCUTANEOUS SOLUTION

NOVOLOG MIX 70-30FLEXPEN U-100 SUBCUTANEOUS INSULIN PEN

NOVOLOG PENFILL U-100 INSULIN SUBCUTANEOUS CARTRIDGE

NOVOLOG U-100 INSULIN ASPART SUBCUTANEOUS SOLUTION

MINERALOCORTICOIDES

fludrocortisone oral tablet

OXYTOCICS

METHYLERGONOVINE INJECTION SOLUTION

methylergonovine oral tablet Methergine

PITUITARY SUPPRESSIVE AGENTS

cabergoline oral tablet QL

PROGESTATIONAL AGENTS

MAKENA (PF) SUBCUTANEOUS AUTO-INJECTOR

QL

medroxyprogesterone oral tablet Provera

norethindrone acetate oral tablet Aygestin

progesterone in oil intramuscular oil

progesterone intramuscular oil Progesterone in Oil

progesterone micronized oral capsule Prometrium

SODIUM GLUCOSE (SGLT2) INHIBITORS

FARXIGA ORAL TABLET PA; AL

INVOKANA ORAL TABLET AL

JARDIANCE ORAL TABLET AL

59


SYNJARDY ORAL TABLET AL

THYROID HORMONES

levothyroxine oral tablet Levo-T

levoxyl oral tablet

liothyronine oral tablet Cytomel

nature-throid oral tablet

np thyroid oral tablet

thyroid (pork) oral tablet Armour Thyroid

unithroid oral tablet

westhroid oral tablet

GASTROINTESTINAL THERAPY AGENTS

ANTACIDS

alum-mag hydroxide-simeth oral suspension

Advanced Antacid-Antigas OTC

antacid (calcium carb-mag hyd) oral tablet,chewable

OTC

ANTACID (CALCIUM CARBONATE) ORAL TABLET,CHEWABLE

OTC

antacid supreme oral suspension OTC

liquid antacid oral suspension OTC

mi-acid oral tablet,chewable OTC

ri-mag oral suspension OTC

ri-mag plus oral suspension OTC

ANTIDIARRHEALS

bismuth subsalicylate oral suspension Anti-Diarrheal OTC; QL

diphenoxylate-atropine oral liquid

diphenoxylate-atropine oral tablet Lomotil

loperamide oral capsule Anti-Diarrheal (loperamide) OTC; QL

ANTIEMETIC/ANTIVERTIGO AGENTS

anti-nausea oral solution OTC


formula em oral solution OTC

meclizine oral tablet OTC

nausea control oral solution OTC

nausea relief oral solution OTC

ondansetron hcl oral tablet 24 mg QL

60


ondansetron hcl oral tablet 4 mg, 8 mg Zofran

ondansetron oral tablet,disintegrating

phenadoz rectal suppository 12.5 mg

phenadoz rectal suppository 25 mg AL

phenergan rectal suppository AL

prochlorperazine edisylate injection solution

prochlorperazine maleate oral tablet Compazine

prochlorperazine rectal suppository Compazine

promethazine oral syrup

promethazine oral tablet

promethazine rectal suppository 12.5 mg Phenadoz AL

promethazine rectal suppository 25 mg Phenadoz

promethegan rectal suppository

ANTIFLATULENTS

GAS RELIEF ORAL CAPSULE OTC

SIMETHICONE ORAL CAPSULE Anti-Gas Ultra Strength OTC

ANTISPASMODICS

dicyclomine oral capsule

dicyclomine oral solution

dicyclomine oral tablet

glycopyrrolate oral tablet

hyoscyamine sulfate oral drops Hyosyne

hyoscyamine sulfate oral elixir Hyosyne

hyoscyamine sulfate oral tablet Levsin

hyoscyamine sulfate oral tablet extended release 12 hr

Levbid

hyoscyamine sulfate oral tablet,disintegrating

Anaspaz

hyoscyamine sulfate sublingual tablet Levsin/SL

hyosyne oral drops

hyosyne oral elixir

oscimin oral tablet

oscimin oral tablet,disintegrating

oscimin sl sublingual tablet

oscimin sr oral tablet extended release 12 hr

propantheline oral tablet

61


symax fastabs oral tablet,disintegrating

symax-sr oral tablet extended release 12 hr

BILE SALTS

ursodiol oral tablet URSO 250

CHRONIC IIDOPATHIC CONST. AGENTS - GUANYLATE CYCLASE-C (GC-C) AGONISTS

LINZESS ORAL CAPSULE PA; AL

CHRONIC INFLAMMATION, COLON DISEASE, 5-AMINOSALICYLATES

APRISO ORAL CAPSULE,EXTENDED RELEASE 24HR

CANASA RECTAL SUPPOSITORY

LIALDA ORAL TABLET,DELAYED RELEASE (DR/EC)

mesalamine rectal enema Rowasa

PENTASA ORAL CAPSULE, EXTENDED RELEASE

sulfasalazine oral tablet Azulfidine

sulfasalazine oral tablet,delayed release (dr/ec)

Azulfidine EN-tabs

GASTRIC ACID SECRETION REDUCERS

CARAFATE ORAL SUSPENSION

famotidine (pf) intravenous solution

famotidine oral tablet 20 mg Acid Controller OTC

famotidine oral tablet 40 mg Pepcid

misoprostol oral tablet Cytotec

omeprazole oral capsule,delayed release(dr/ec)

pantoprazole oral tablet,delayed release (dr/ec)

Protonix

PRILOSEC OTC ORAL TABLET,DELAYED RELEASE (DR/EC)

OTC

ranitidine hcl oral syrup

ranitidine hcl oral tablet 150 mg Acid Control (ranitidine) OTC

ranitidine hcl oral tablet 300 mg Zantac

sucralfate oral suspension Carafate

62


sucralfate oral tablet Carafate

INFLAMMATORY BOWEL AGENTS

budesonide oral capsule,delayed,extend.release

Entocort EC

budesonide oral tablet,delayed and ext.release

Uceris PA

colocort rectal enema

HUMIRA PEDIATRIC CROHN'S START SUBCUTANEOUS SYRINGE KIT

AL

HUMIRA PEN CROHN'S-UC-HS START SUBCUTANEOUS PEN INJECTOR KIT

AL

HUMIRA PEN PSORIASIS-UVEITIS SUBCUTANEOUS PEN INJECTOR KIT

AL

HUMIRA PEN SUBCUTANEOUS PEN INJECTOR KIT

AL

HUMIRA SUBCUTANEOUS SYRINGE KIT

AL

hydrocortisone rectal enema Colocort

INTESTINAL MOTILITY STIMULANTS

metoclopramide hcl oral solution

metoclopramide hcl oral tablet Reglan

IRRITABLE BOWEL SYNDROME (IBS) AGENTS

AMITIZA ORAL CAPSULE PA; AL

LINZESS ORAL CAPSULE PA; AL

LAXATIVES AND CATHARTICS

constulose oral solution QL

easy fiber oral powder OTC

enulose oral solution

epsom salt oral granules OTC

fiber (dextrin) oral powder OTC

FIBER (PSYLLIUM HUSK/SUGAR) ORAL POWDER

OTC

fiber supplement (inulin) oral tablet,chewable

OTC

gavilax oral powder in packet OTC; QL

gavilyte-c oral recon soln QL

gavilyte-g oral recon soln QL

63


gavilyte-n oral recon soln QL

generlac oral solution

KONSYL FORMULA-D ORAL POWDER OTC

lactulose oral solution 10 gram/15 ml Constulose QL

lactulose oral solution 10 gram/15 ml (15 ml)

QL

lactulose oral solution 20 gram/30 ml

mineral oil extra heavy oral oil OTC

mineral oil laxative oral oil OTC

NATURAL FIBER LAXATIVE (SUGAR) ORAL POWDER

OTC

natural fiber laxative(aspart) oral powder OTC

peg 3350-electrolytes oral recon soln GaviLyte-G QL

peg-3350 with flavor packs oral recon soln QL

peg-electrolyte soln oral recon soln GaviLyte-N QL

polyethylene glycol 3350 oral powder ClearLax OTC

polyethylene glycol 3350 oral powder in packet

ClearLax OTC; QL

reguloid (dextrose) oral powder OTC

senna concentrate oral tablet OTC

senna-gen oral tablet OTC

sennosides oral tablet Evac-U-Gen (sennosides) OTC

stool softener oral capsule OTC

trilyte with flavor packets oral recon soln QL

PANCREATIC ENZYMES

CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC)

PA

dairy aid oral tablet,chewable OTC

dairy digestive oral tablet OTC

dairy digestive supplement oral tablet OTC

dairy relief oral tablet OTC

dairy relief oral tablet,chewable OTC

lac-dose oral tablet OTC

lactase fast acting oral tablet OTC

lactase fast acting oral tablet,chewable OTC

lactase oral tablet Dairy Relief OTC

ultra dairy digestive oral tablet OTC

64


ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC)

PA

PEPTIC ULCER TREATMENT AGENTS

PYLERA ORAL CAPSULE

GENITOURINARY THERAPY

BENIGN PROSTATIC HYPERTROPHY/MICTURITION AGENTS

alfuzosin oral tablet extended release 24 hr

Uroxatral

dutasteride oral capsule Avodart

finasteride oral tablet Proscar

tamsulosin oral capsule Flomax

BLOOD DETOXICANTS

calcium acetate oral capsule

RENAGEL ORAL TABLET

RENVELA ORAL TABLET

PARASYMPATHETIC AGENTS

bethanechol chloride oral tablet Urecholine

URINARY ACIDIFIER

av-phos 250 neutral oral tablet OTC

k-phos-neutral oral tablet OTC

phospha 250 neutral oral tablet OTC

phospho-trin 250 neutral oral tablet OTC

virt-phos 250 neutral oral tablet OTC

URINARY ANTIBACTERIAL AGENTS

methenamine hippurate oral tablet Hiprex

methenamine mandelate oral tablet

nitrofurantoin macrocrystal oral capsule Macrodantin

nitrofurantoin monohyd/m-cryst oral capsule

Macrobid

URINARY PH MODIFIERS

cytra k crystals oral packet

cytra-2 oral solution OTC

cytra-3 oral solution OTC

cytra-k oral solution OTC

65


potassium citrate oral tablet extended release

Urocit-K 10

potassium citrate-citric acid oral solution Cytra-K OTC

sodium citrate-citric acid oral solution Cytra-2 OTC

tricitrates oral solution OTC

virtrate-k oral solution OTC

URINARY TRACT ANESTHETIC/ANALGESIC AGENT

phenazopyridine oral tablet Pyridium

urinary pain relief oral tablet OTC

urinary tract oral tablet OTC

URINARY TRACT ANTISPASMODIC/ANTI-INCONTINENCE AGENT

oxybutynin chloride oral syrup

oxybutynin chloride oral tablet

oxybutynin chloride oral tablet extended release 24hr

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HR

VESICARE ORAL TABLET

GOUT AND HYPERURICEMIA THERAPY

COLCHICINE COMBINATION

probenecid-colchicine oral tablet

COLCHICINES

COLCHICINE ORAL CAPSULE Mitigare

HYPERURICEMIA TREATMENT - PURINE INHIBITORS

allopurinol oral tablet Zyloprim

URICOSURIC AGENTS

probenecid oral tablet

HEMATOLOGICAL AGENTS

ANTIFIBRINOLYTIC AGENTS

tranexamic acid oral tablet Lysteda QL

C1 ESTERASE INHIBITOR AGENTS

BERINERT INTRAVENOUS KIT

66


CINRYZE INTRAVENOUS RECON SOLN

HEMATINICS, OTHER

ARANESP (IN POLYSORBATE) INJECTION SOLUTION

ARANESP (IN POLYSORBATE) INJECTION SYRINGE

PROCRIT INJECTION SOLUTION

HEMORRHEOLOGIC AGENTS

pentoxifylline oral tablet extended release

HEPARIN AND RELATED PREPARATIONS

enoxaparin subcutaneous solution Lovenox

enoxaparin subcutaneous syringe Lovenox

heparin (porcine) injection cartridge

heparin (porcine) injection solution

heparin (porcine) injection syringe

heparin, porcine (pf) injection solution

heparin, porcine (pf) injection syringe

ORAL ANTICOAGULANTS

ELIQUIS ORAL TABLET

ELIQUIS ORAL TABLETS,DOSE PACK

jantoven oral tablet

warfarin oral tablet Coumadin

XARELTO ORAL TABLET

PLATELET AGGREGATION INHIBITORS

adult low dose aspirin oral tablet,delayed release (dr/ec)

OTC

anagrelide oral capsule Agrylin

BRILINTA ORAL TABLET

cilostazol oral tablet

clopidogrel oral tablet Plavix

dipyridamole intravenous solution

dipyridamole oral tablet

enteric coated aspirin oral tablet,delayed release (dr/ec)

OTC

67


lo-dose aspirin oral tablet,delayed release (dr/ec)

OTC

prasugrel oral tablet Effient

SICKLE CELL ANEMIA AGENTS

DROXIA ORAL CAPSULE

THROMBIN INHIBITORS

PRADAXA ORAL CAPSULE

IMMUNOSUPPRESSIVE AGENTS

IMMUNOSUPRESSANTS

azathioprine oral tablet Imuran

cyclosporine modified oral capsule Gengraf

cyclosporine modified oral solution Gengraf

cyclosporine oral capsule Sandimmune

gengraf oral capsule

gengraf oral solution

mycophenolate mofetil oral capsule CellCept

mycophenolate mofetil oral suspension for reconstitution

CellCept

mycophenolate mofetil oral tablet CellCept

mycophenolate sodium oral tablet,delayed release (dr/ec)

Myfortic

RAPAMUNE ORAL SOLUTION

SANDIMMUNE ORAL SOLUTION

sirolimus oral tablet Rapamune

tacrolimus oral capsule Prograf

IMPOTENCE AGENTS

IMPOTENCE AGENTS

sildenafil oral tablet Viagra

LOCOMOTOR SYSTEM

MUSCULOSKELETAL THERAPY AGENTS

EUFLEXXA INTRA-ARTICULAR SYRINGE

PA; QL

GELSYN-3 INTRA-ARTICULAR SYRINGE

PA; QL

SUPARTZ FX INTRA-ARTICULAR SYRINGE

PA; QL

68


OTHER CNS/AUTONOMIC DRUGS

MESTINON ORAL SYRUP

pyridostigmine bromide oral tablet Mestinon

pyridostigmine bromide oral tablet extended release

Mestinon Timespan

SKELETAL MUSCLE RELAXANTS

baclofen oral tablet 10 mg, 20 mg

BACLOFEN ORAL TABLET 5 MG

chlorzoxazone oral tablet

cyclobenzaprine oral tablet

dantrolene oral capsule Dantrium

methocarbamol oral tablet Robaxin

riluzole oral tablet Rilutek PA

tizanidine oral tablet

MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT (DME)

ANTISEPTICS - OTHER

alcoh-wipe towelette OTC

BLOOD SUGAR DIAGNOSTICS

TRUE METRIX GLUCOSE TEST STRIP STRIP

OTC; QL

CONDOMS

AIMSCO LATEX CONDOM DEVICE OTC; QL

CONDOMS-PREM LUBRICATED DEVICE

OTC

FANTASY CONDOM DEVICE OTC; QL

FC2 FEMALE CONDOM OTC

KIMONO CONDOMS(NON-LUBRICATED) DEVICE

OTC

KIMONO MAXX CONDOMS DEVICE OTC

KIMONO MICROTHIN AQUA LUBE CON DEVICE

OTC

KIMONO MICROTHIN CONDOMS DEVICE

OTC

KIMONO MICROTHIN LARGE CONDOMS DEVICE

OTC

KIMONO TEXTURED CONDOMS DEVICE

OTC

69


TRUSTEX LATEX CONDOM DEVICE OTC

TRUSTEX LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX NON-LUB CONDOMS DEVICE

OTC

TRUSTEX-RIA LUB/SPERMICIDE DEVICE

OTC

TRUSTEX-RIA LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX-RIA NON-LUB CONDOMS DEVICE

OTC

DIAPHRAGMS/CERVICAL CAP

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM


QL


QL


QL


QL


QL



MEDICAL SUPPLIES AND DME - GLUCOSE MONITORING TEST SUPPLIES

1ST TIER UNILET COMFORTOUCH OTC; QL

ACCU-CHEK SOFTCLIX LANCET DEV OTC

ADJUSTABLE LANCING DEVICE OTC

ADVANCED TRAVEL LANCETS OTC; QL

ADVOCATE LANCING DEVICE OTC

ADVOCATE RAPID-SAFE LANCING OTC

ALTERNATE SITE LANCET OTC; QL

ALTERNATE SITE LANCING DEVICE OTC

AQUA LANCE LANCING DEVICE OTC

70


ASSURE HAEMOLANCE PLUS OTC; QL

ASSURE LANCE OTC; QL

ASSURE LANCE PLUS OTC; QL

AUTO-LANCET MINI OTC

AUTOLET IMPRESSION LANC DEV KIT OTC

AUTOLET LANCING DEVICE OTC

AUTOLET PLUS LANCING DEVICE OTC

CAREONE LANCING DEVICE OTC

CAREONE THIN LANCET OTC; QL

CAREONE ULTRA THIN LANCET OTC; QL

CARETOUCH LANCING DEVICE OTC

CARETOUCH TWIST LANCET OTC; QL

COLOR LANCETS OTC; QL

COMFORT LANCETS OTC; QL

DROPLET LANCING DEVICE OTC

EASY MINI EJECT LANCING DEVICE OTC

EASY TOUCH LANCETS OTC; QL

EASY TOUCH LANCING DEVICE OTC

EASY TOUCH SAFETY LANCETS OTC; QL

EASY TOUCH TWIST LANCETS OTC; QL

E-Z JECT LANCETS OTC; QL

E-Z JECT THIN LANCETS OTC; QL

EZ SMART LANCETS OTC; QL

FINE 30 UNIVERSAL LANCETS OTC; QL

FORA LANCING DEVICE OTC

FORACARE LANCETS OTC; QL

GLUCOCOM LANCETS OTC; QL

HEALTHY ACCENTS AUTOLET OTC

HEALTHY ACCENTS UNILET LANCET OTC; QL

HYPOLANCE AST LANCING KIT OTC

INCONTROL LANCING DEVICE OTC

INCONTROL SUPER THIN LANCETS OTC; QL

INCONTROL ULTRA THIN LANCETS OTC; QL

INVACARE LANCETS OTC; QL

LANZO LANCING DEVICE KIT OTC

LITE TOUCH LANCING DEVICE OTC

MICRO THIN LANCETS OTC; QL

71


MICROLET NEXT LANCING DEVICE KIT

OTC

MINI LANCING DEVICE OTC

MONOLET LANCETS OTC; QL

MONOLET THIN LANCETS OTC; QL

MULTI-LANCET DEVICE 2 KIT OTC

MYGLUCOHEALTH LANCETS OTC; QL

ON CALL LANCING DEVICE OTC

ON CALL PLUS LANCING DEVICE OTC

ON-THE-GO LANCETS OTC; QL

PRODIGY LANCING DEVICE OTC

RELIAMED MINI LANCING DEVICE OTC

RELION THIN LANCETS OTC; QL

RELION ULTRA THIN PLUS LANCETS OTC; QL

RIGHTEST GD500 LANCING DEVICE OTC

RIGHTEST GL300 LANCETS OTC; QL

SMART SENSE LANCETS OTC; QL

SMARTDIABETES VANTAGE OTC

STERILANCE TL OTC; QL

SUPER THIN LANCETS OTC; QL

SURE COMFORT LANCING PEN OTC

SUREFLEX LANCING DEVICE OTC

SURE-PEN LANCING DEVICE OTC

TECHLITE LANCETS OTC; QL

THIN LANCETS OTC; QL

TOPCARE UNIVERSAL1 LANCET OTC; QL

TRUE METRIX LEVEL 1 SOLUTION OTC



TRUEDRAW LANCING DEVICE OTC

TRUEPLUS LANCETS OTC; QL

TWIST LANCETS OTC; QL

ULTI-LANCE OTC

ULTRA THIN LANCETS OTC; QL

ULTRA THIN PLUS LANCETS OTC; QL

ULTRA-CARE LANCETS OTC; QL

UNILET COMFORTOUCH LANCET OTC; QL

72


UNILET EXCELITE II LANCET OTC; QL

UNILET EXCELITE LANCET OTC; QL

UNILET GP LANCET OTC; QL

UNILET LANCET OTC; QL

UNILET LANCETS OTC; QL

UNILET SUPER THIN LANCETS OTC; QL

UNISTIK 2 DEVICE KIT OTC

UNISTIK 3 COMFORT DEVICE KIT OTC

UNISTIK 3 COMFORT LANCET OTC; QL

UNISTIK 3 EXTRA LANCET OTC; QL

UNISTIK 3 GENTLE OTC; QL

UNISTIK 3 KIT OTC

UNISTIK 3 LANCETS OTC; QL

UNISTIK 3 NEONATAL DEVICE KIT OTC

UNISTIK 3 NEONATAL KIT OTC

UNISTIK 3 NORMAL LANCET OTC; QL

UNISTIK CZT LANCET OTC; QL

UNISTIK PRO LANCET OTC; QL

UNISTIK SAFETY OTC; QL

UNISTIK TOUCH LANCETS OTC; QL

UNIVERSAL 1 LANCETS OTC; QL

MEDICAL SUPPLIES AND DME - PEAK FLOW METERS

AIRZONE PEAK FLOW METER DEVICE OTC; QL

ASTHMA CHECK METER DEVICE OTC; QL

IN-CHECK NASAL WITH MASK DEVICE OTC

IN-CHECK ORAL FLOW METER DEVICE

OTC

MICROLIFE PEAK FLOW METER DEVICE

OTC; QL

MINI WRIGHT PEAK FLOW METER DEVICE

QL

PEAK AIR PEAK FLOW METER DEVICE

OTC; QL

PERSONAL BEST FULL RANGE DEVICE

OTC; QL

PERSONAL BEST LOW RANGE DEVICE

OTC; QL

PIKO 1 DEVICE OTC; QL

73


POCKET PEAK FLOW METER DEVICE OTC; QL

TRUZONE PEAK FLOW METER DEVICE

QL

NEEDLES/NEEDLELESS DEVICES, SYRINGES AND ACCESSORIES

BD AUTOSHIELD DUO PEN NEEDLE NEEDLE

OTC

BD ECLIPSE LUER-LOK SYRINGE OTC

BD INSULIN SYRINGE HALF UNIT SYRINGE

OTC

BD INSULIN SYRINGE MICRO-FINE SYRINGE

OTC

BD INSULIN SYRINGE SAFETY-LOK SYRINGE

OTC

BD INSULIN SYRINGE SLIP TIP SYRINGE

OTC

BD INSULIN SYRINGE SYRINGE OTC

BD INSULIN SYRINGE U-500 SYRINGE

BD INSULIN SYRINGE ULTRA-FINE SYRINGE

OTC

BD LO-DOSE MICRO-FINE IV SYRINGE OTC

BD LO-DOSE ULTRA-FINE SYRINGE OTC

BD LUER-LOK SYRINGE SYRINGE OTC

BD SAFETYGLIDE INSULIN SYRINGE SYRINGE

OTC

BD ULTRA-FINE MICRO PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE MINI PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE NANO PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE ORIG PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE SHORT PEN NEEDLE NEEDLE

OTC

BD VEO INSULIN SYR HALF UNIT SYRINGE

OTC

BD VEO INSULIN SYRINGE UF SYRINGE

OTC

insulin syringe microfine syringe OTC

insulin syringe needleless syringe BD Insulin Syringe Slip Tip OTC

74


INSULIN SYRINGE SYRINGE OTC

insulin syringe-needle u-100 syringe BD Insulin Syringe OTC

RESPIRATORY AIDS, SPACERS, DEVICES AND EQUIPMENT

ACE AEROSOL CLOUD ENHANCER SPACER

QL

AEROTRACH PLUS SPACER QL

AEROVENT PLUS SPACER QL

BREATHERITE MDI SPACER SPACER QL

BREATHERITE SPACER-MASK, NEO. SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

COMPACT SPACE CHAMBER SPACER QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

LITEAIRE MDI CHAMBER SPACER QL

MICROCHAMBER SPACER QL

MICROSPACER SPACER QL

OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

75


OPTICHAMBER DIAMOND-SML MASK SPACER

QL

PANDA MASK DEVICE OTC; QL

PEDIATRIC MEDIUM MASK DEVICE OTC; QL

PEDIATRIC PANDA MASK DEVICE OTC; QL

PEDIATRIC SMALL MASK DEVICE OTC; QL

POCKET CHAMBER SPACER QL

PRIMEAIRE SPACER QL

PROCHAMBER SPACER QL

RITEFLO AEROCHAMBER SPACER QL

SIDESTREAM PEDIATRIC FACE MASK DEVICE

OTC; QL

VORTEX HOLDING CHAMBER CHILD SPACER

QL

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

VORTEX VHC FROG MASK-CHILD SPACER

QL

VORTEX VHC LADYBUG MASK-TODDLR SPACER

QL

URINE KETONE TEST AIDS

KETONE CARE STRIP OTC; QL

KETONE URINE TEST STRIP OTC; QL

KETOSTIX STRIP OTC; QL

TRUEPLUS KETONE STRIP OTC; QL

METABOLIC MODIFIERS

METABOLIC DEFICIENCY AGENTS

calcitriol oral capsule Rocaltrol PA

calcitriol oral solution Rocaltrol PA

levocarnitine oral tablet Carnitor OTC

sodium phenylbutyrate oral powder Buphenyl PA; QL

sodium phenylbutyrate oral tablet Buphenyl QL

PHARMACOENHANCER - CYTOCHROME P450 INHIBITORS

TYBOST ORAL TABLET

76


OPHTHALMIC AGENTS

ARTIFICIAL TEARS

advanced eye relief ophthalmic (eye) drops

OTC

artificial tears(glycerin-peg) ophthalmic (eye) drops

OTC

artificial tears(pg-hypm-glyc) ophthalmic (eye) drops

OTC

dry eye relief ophthalmic (eye) drops OTC

eye drop tears ophthalmic (eye) drops OTC

eye drops (with povidone) ophthalmic (eye) drops

OTC

eye drops advanced relief ophthalmic (eye) drops

OTC

lubricant (p-glycol-glycerin) ophthalmic (eye) drops

OTC

moisture drops ophthalmic (eye) drops OTC

tearfair ophthalmic (eye) drops OTC

MIOTICS/OTHER INTRAOCULAR PRESSURE REDUCERS

ALPHAGAN P OPHTHALMIC (EYE) DROPS

AZOPT OPHTHALMIC (EYE) DROPS,SUSPENSION

brimonidine ophthalmic (eye) drops

carteolol ophthalmic (eye) drops

dorzolamide ophthalmic (eye) drops Trusopt

latanoprost ophthalmic (eye) drops Xalatan

levobunolol ophthalmic (eye) drops

metipranolol ophthalmic (eye) drops

timolol maleate ophthalmic (eye) drops Timoptic

timolol maleate ophthalmic (eye) drops, once daily

Istalol

timolol maleate ophthalmic (eye) gel forming solution

Timoptic-XE

TRAVATAN Z OPHTHALMIC (EYE) DROPS

MYDRIATICS

atropine ophthalmic (eye) drops Isopto Atropine QL

atropine ophthalmic (eye) ointment QL

77


OPHTHALMIC ANTIBIOTIC - CORTICOID COMBINATIONS

neomycin-polymyxin b-dexameth ophthalmic (eye) drops,suspension

Maxitrol

neomycin-polymyxin b-dexameth ophthalmic (eye) ointment

Maxitrol

TOBRADEX OPHTHALMIC (EYE) DROPS,SUSPENSION

TOBRADEX OPHTHALMIC (EYE) OINTMENT

OPHTHALMIC ANTIBIOTICS

ciprofloxacin hcl ophthalmic (eye) drops Ciloxan

erythromycin ophthalmic (eye) ointment

gentak ophthalmic (eye) ointment

gentamicin ophthalmic (eye) drops

gentamicin ophthalmic (eye) ointment Gentak

MOXEZA OPHTHALMIC (EYE) DROPS, VISCOUS

ofloxacin ophthalmic (eye) drops Ocuflox

polymyxin b sulf-trimethoprim ophthalmic (eye) drops

Polytrim

tobramycin ophthalmic (eye) drops Tobrex

VIGAMOX OPHTHALMIC (EYE) DROPS

OPHTHALMIC ANTIHISTAMINES

PAZEO OPHTHALMIC (EYE) DROPS

redness reliever lubricant ophthalmic (eye) drops

OTC

ZADITOR OPHTHALMIC (EYE) DROPS OTC

OPHTHALMIC ANTI-INFLAMMATORY AGENTS

diclofenac sodium ophthalmic (eye) drops

DUREZOL OPHTHALMIC (EYE) DROPS

fluorometholone ophthalmic (eye) drops,suspension

FML Liquifilm

flurbiprofen sodium ophthalmic (eye) drops

ketorolac ophthalmic (eye) drops Acular

PREDNISOLONE ACETATE (PF) OPHTHALMIC (EYE) DROPS,SUSPENSION

78


prednisolone acetate ophthalmic (eye) drops,suspension

Omnipred

XIIDRA OPHTHALMIC (EYE) DROPPERETTE

PA; QL

OPHTHALMIC ANTIVIRALS

trifluridine ophthalmic (eye) drops Viroptic QL

OPHTHALMIC BETA BLOCKERS

COMBIGAN OPHTHALMIC (EYE) DROPS

DORZOLAMIDE-TIMOLOL (PF) OPHTHALMIC (EYE) DROPS

dorzolamide-timolol ophthalmic (eye) drops

Cosopt

OPHTHALMIC DECONGESTANT

eye drops allergy relief ophthalmic (eye) drops

OTC; QL

phenylephrine hcl ophthalmic (eye) drops

redness reliever lubricant ophthalmic (eye) drops

OTC

tetrahydrozoline ophthalmic (eye) drops Altazine OTC; QL

OPHTHALMIC MAST CELL STABILIZERS

cromolyn ophthalmic (eye) drops

OPHTHALMIC, OTHER

SIMBRINZA OPHTHALMIC (EYE) DROPS,SUSPENSION

OTIC

OTIC PREPARATIONS, MISCELLANEOUS ANTI-INFECTIVES

acetic acid otic (ear) solution

carbamide peroxide otic (ear) drops Carbamoxide Ear Drops OTC

CIPRODEX OTIC (EAR) DROPS,SUSPENSION

ear wax drops otic (ear) drops OTC

79




1ST TIER UNILET COMFORTOUCH OTC; QL

ACCU-CHEK SOFTCLIX LANCET DEV OTC

ACE AEROSOL CLOUD ENHANCER SPACER

QL

ADJUSTABLE LANCING DEVICE OTC

ADVANCED TRAVEL LANCETS OTC; QL

ADVOCATE LANCING DEVICE OTC

ADVOCATE RAPID-SAFE LANCING OTC

AEROTRACH PLUS SPACER QL

AEROVENT PLUS SPACER QL

AIMSCO LATEX CONDOM DEVICE OTC; QL

AIRZONE PEAK FLOW METER DEVICE OTC; QL

ALTERNATE SITE LANCET OTC; QL

ALTERNATE SITE LANCING DEVICE OTC

AQUA LANCE LANCING DEVICE OTC

ASSURE HAEMOLANCE PLUS OTC; QL

ASSURE LANCE OTC; QL

ASSURE LANCE PLUS OTC; QL

ASTHMA CHECK METER DEVICE OTC; QL

AUTO-LANCET MINI OTC

AUTOLET IMPRESSION LANC DEV KIT OTC

AUTOLET LANCING DEVICE OTC

AUTOLET PLUS LANCING DEVICE OTC

AZO TEST STRIPS STRIP OTC

BD AUTOSHIELD DUO PEN NEEDLE NEEDLE

OTC

BD ECLIPSE LUER-LOK SYRINGE OTC

BD INSULIN SYRINGE HALF UNIT SYRINGE

OTC

BD INSULIN SYRINGE MICRO-FINE SYRINGE

OTC

BD INSULIN SYRINGE SAFETY-LOK SYRINGE

OTC

BD INSULIN SYRINGE SLIP TIP SYRINGE

OTC

80


BD INSULIN SYRINGE SYRINGE OTC

BD INSULIN SYRINGE U-500 SYRINGE

BD INSULIN SYRINGE ULTRA-FINE SYRINGE

OTC

BD LO-DOSE MICRO-FINE IV SYRINGE OTC

BD LO-DOSE ULTRA-FINE SYRINGE OTC

BD LUER-LOK SYRINGE SYRINGE OTC

BD SAFETYGLIDE INSULIN SYRINGE SYRINGE

OTC

BD ULTRA-FINE MICRO PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE MINI PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE NANO PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE ORIG PEN NEEDLE NEEDLE

OTC

BD ULTRA-FINE SHORT PEN NEEDLE NEEDLE

OTC

BD VEO INSULIN SYR HALF UNIT SYRINGE

OTC

BD VEO INSULIN SYRINGE UF SYRINGE

OTC

BREATHERITE MDI SPACER SPACER QL

BREATHERITE SPACER-MASK, NEO. SPACER

QL

BREATHERITE SPACER-MASK,ADULT SPACER

QL

BREATHERITE SPACER-MASK,CHILD SPACER

QL

BREATHERITE SPACER-MASK,INFANT SPACER

QL

BREATHERITE SPACER-MASK,S.CHLD SPACER

QL

BREATHERITE VALVED MDI CHAMBER SPACER

QL

BREATHERITE VALVED MDI SPACER SPACER

QL

CAREONE LANCING DEVICE OTC

CAREONE THIN LANCET OTC; QL

CAREONE ULTRA THIN LANCET OTC; QL

81


CARETOUCH LANCING DEVICE OTC

CARETOUCH TWIST LANCET OTC; QL

COLOR LANCETS OTC; QL

COMFORT LANCETS OTC; QL

COMPACT SPACE CHAMBER SPACER QL

COMPACT SPACE CHAMBER-LRG MASK SPACER

QL

COMPACT SPACE CHAMBER-MED MASK SPACER

QL

COMPACT SPACE CHAMBER-SM MASK SPACER

QL

CONDOMS-PREM LUBRICATED DEVICE

OTC

DROPLET LANCING DEVICE OTC

EASY MINI EJECT LANCING DEVICE OTC

EASY TOUCH LANCETS 26 GAUGE, 30 GAUGE, 32 GAUGE

OTC; QL

EASY TOUCH LANCETS 28 GAUGE OTC

EASY TOUCH LANCING DEVICE OTC

EASY TOUCH SAFETY LANCETS OTC; QL

EASY TOUCH TWIST LANCETS OTC; QL

E-Z JECT LANCETS OTC; QL

E-Z JECT THIN LANCETS OTC; QL

EZ SMART LANCETS OTC; QL

FANTASY CONDOM DEVICE OTC; QL

FC2 FEMALE CONDOM OTC

FINE 30 UNIVERSAL LANCETS OTC; QL

FORA LANCING DEVICE OTC

FORACARE LANCETS OTC

GLUCOCOM LANCETS OTC; QL

HEALTHY ACCENTS AUTOLET OTC

HEALTHY ACCENTS UNILET LANCET OTC; QL

HYPOLANCE AST LANCING KIT OTC

IN-CHECK NASAL WITH MASK DEVICE OTC

IN-CHECK ORAL FLOW METER DEVICE

OTC

INCONTROL LANCING DEVICE OTC

INCONTROL SUPER THIN LANCETS OTC; QL

82


INCONTROL ULTRA THIN LANCETS OTC; QL

insulin syringe microfine syringe OTC

insulin syringe needleless syringe BD Insulin Syringe Slip Tip OTC

INSULIN SYRINGE SYRINGE OTC

insulin syringe-needle u-100 syringe BD Insulin Syringe OTC

INVACARE LANCETS OTC; QL

KETONE CARE STRIP OTC; QL

KETONE URINE TEST STRIP OTC; QL

KETOSTIX STRIP OTC; QL

KIMONO CONDOMS(NON-LUBRICATED) DEVICE

OTC

KIMONO MAXX CONDOMS DEVICE OTC

KIMONO MICROTHIN AQUA LUBE CON DEVICE

OTC

KIMONO MICROTHIN CONDOMS DEVICE

OTC

KIMONO MICROTHIN LARGE CONDOMS DEVICE

OTC

KIMONO TEXTURED CONDOMS DEVICE

OTC

LANZO LANCING DEVICE KIT OTC

LITE TOUCH LANCING DEVICE OTC

LITEAIRE MDI CHAMBER SPACER QL

MICRO THIN LANCETS OTC; QL

MICROCHAMBER SPACER QL

MICROLET NEXT LANCING DEVICE KIT

OTC

MICROLIFE PEAK FLOW METER DEVICE

OTC; QL

MICROSPACER SPACER QL

MINI LANCING DEVICE OTC

MINI WRIGHT PEAK FLOW METER DEVICE

QL

MONOLET LANCETS OTC; QL

MONOLET THIN LANCETS OTC; QL

MULTI-LANCET DEVICE 2 KIT OTC

MYGLUCOHEALTH LANCETS OTC; QL

ON CALL LANCING DEVICE OTC

ON CALL PLUS LANCING DEVICE OTC

83


ON-THE-GO LANCETS OTC; QL

OPTICHAMBER ADULT MASK-LARGE DEVICE

QL

OPTICHAMBER DIAMOND LG MASK SPACER

QL

OPTICHAMBER DIAMOND VHC SPACER

QL

OPTICHAMBER DIAMOND-MED MSK SPACER

QL

OPTICHAMBER DIAMOND-SML MASK SPACER

QL

PANDA MASK DEVICE OTC; QL

PEAK AIR PEAK FLOW METER DEVICE

OTC; QL

PEDIATRIC MEDIUM MASK DEVICE OTC; QL

PEDIATRIC PANDA MASK DEVICE OTC; QL

PEDIATRIC SMALL MASK DEVICE OTC; QL

PERSONAL BEST FULL RANGE DEVICE

OTC; QL

PERSONAL BEST LOW RANGE DEVICE

OTC; QL

PIKO 1 DEVICE OTC; QL

POCKET CHAMBER SPACER QL

POCKET PEAK FLOW METER DEVICE OTC; QL

PRIMEAIRE SPACER QL

PROCHAMBER SPACER QL

PRODIGY LANCING DEVICE OTC

RELIAMED MINI LANCING DEVICE OTC

RELION THIN LANCETS OTC; QL

RELION ULTRA THIN PLUS LANCETS OTC; QL

RIGHTEST GD500 LANCING DEVICE OTC

RIGHTEST GL300 LANCETS OTC; QL

RITEFLO AEROCHAMBER SPACER QL

SIDESTREAM PEDIATRIC FACE MASK DEVICE

OTC; QL

SMART SENSE LANCETS OTC; QL

SMARTDIABETES VANTAGE OTC

STERILANCE TL OTC; QL

SUPER THIN LANCETS OTC; QL

84


SURE COMFORT LANCING PEN OTC

SUREFLEX LANCING DEVICE OTC

SURE-PEN LANCING DEVICE OTC

TECHLITE LANCETS OTC; QL

THIN LANCETS OTC; QL

TOPCARE UNIVERSAL1 LANCET OTC; QL

TRUE METRIX GLUCOSE TEST STRIP STRIP

OTC; QL




TRUEDRAW LANCING DEVICE OTC

TRUEPLUS KETONE STRIP OTC; QL

TRUEPLUS LANCETS OTC; QL

TRUSTEX LATEX CONDOM DEVICE OTC

TRUSTEX LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX NON-LUB CONDOMS DEVICE

OTC

TRUSTEX-RIA LUB/SPERMICIDE DEVICE

OTC

TRUSTEX-RIA LUBRICATED CONDOMS DEVICE

OTC

TRUSTEX-RIA NON-LUB CONDOMS DEVICE

OTC

TRUZONE PEAK FLOW METER DEVICE

QL

TWIST LANCETS OTC; QL

ULTI-LANCE OTC

ULTRA THIN LANCETS OTC; QL

ULTRA THIN PLUS LANCETS OTC; QL

ULTRA-CARE LANCETS OTC; QL

UNILET COMFORTOUCH LANCET OTC; QL

UNILET EXCELITE II LANCET OTC; QL

UNILET EXCELITE LANCET OTC; QL

UNILET GP LANCET OTC; QL

UNILET LANCET OTC; QL

UNILET LANCETS OTC; QL

UNILET SUPER THIN LANCETS OTC; QL

85


UNISTIK 2 DEVICE KIT OTC

UNISTIK 3 COMFORT DEVICE KIT OTC

UNISTIK 3 COMFORT LANCET OTC; QL

UNISTIK 3 EXTRA LANCET OTC; QL

UNISTIK 3 GENTLE OTC; QL

UNISTIK 3 KIT OTC

UNISTIK 3 LANCETS OTC; QL

UNISTIK 3 NEONATAL DEVICE KIT OTC

UNISTIK 3 NEONATAL KIT OTC

UNISTIK 3 NORMAL LANCET OTC; QL

UNISTIK CZT LANCET OTC; QL

UNISTIK PRO LANCET OTC; QL

UNISTIK SAFETY OTC; QL

UNISTIK TOUCH LANCETS OTC; QL

UNIVERSAL 1 LANCETS OTC; QL

URINARY TRACT INF.TEST (WBCS) STRIP

OTC

VORTEX HOLDING CHAMBER CHILD SPACER

QL

VORTEX HOLDING CHAMBER SPACER

QL

VORTEX HOLDING CHAMBER TODDLER SPACER

QL

VORTEX VHC FROG MASK-CHILD SPACER

QL

VORTEX VHC LADYBUG MASK-TODDLR SPACER

QL



QL


QL


QL


QL


QL

86




RESPIRATORY THERAPY AGENTS

ALPHA/BETA ADRENERGIC AGENTS

epinephrine injection solution Adrenalin

epinephrine injection syringe

ANALGESIC/ANTIPYRETICS, NON-SALICYLATE

headache relief pm oral tablet OTC

menstrual relief oral tablet OTC

midol pm oral tablet OTC

ANTIHISTAMINE AND DECONGESTANT COMBINATIONS

allergy and sinus relief oral tablet AL; OTC

hist-pse oral liquid AL; OTC

lohist - d oral liquid AL; OTC

loratadine-pseudoephedrine oral tablet extended release 24 hr

AllerClear D-24hr AL; OTC

promethazine vc oral syrup AL

promethazine-phenylephrine oral syrup Promethazine VC AL

rynex pse oral liquid AL; OTC

ANTIHISTAMINES

24hr allergy relief oral tablet OTC

allergy relief (clemastine) oral tablet OTC

ALLERGY RELIEF(CHLORPHENIRAMN) ORAL TABLET EXTENDED RELEASE

OTC

carbinoxamine maleate oral liquid AL

carbinoxamine maleate oral tablet AL

CHILDREN'S ZYRTEC ALLERGY ORAL SOLUTION

OTC

clemastine oral tablet 1.34 mg Allergy Relief (clemastine)

clemastine oral tablet 2.68 mg

cyproheptadine oral syrup

cyproheptadine oral tablet

dayhist allergy oral tablet OTC

87


diphenhydramine hcl oral capsule Banophen OTC

diphenhydramine hcl oral elixirChildren's Allergy (diphenhyd)

OTC

levocetirizine oral tablet 24HR Allergy Relief OTC

phenadoz rectal suppository 12.5 mg

phenadoz rectal suppository 25 mg AL

phenergan rectal suppository AL

promethazine oral syrup

promethazine oral tablet

promethazine rectal suppository 12.5 mg Phenadoz AL

promethazine rectal suppository 25 mg Phenadoz

promethegan rectal suppository

restfully sleep oral tablet OTC

ASTHMA THERAPY AGENTS

ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED

cromolyn inhalation solution for nebulization

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE

FLOVENT HFA INHALATION HFA AEROSOL INHALER

montelukast oral tablet Singulair

montelukast oral tablet,chewable Singulair

PULMICORT FLEXHALER INHALATION AEROSOL POWDR BREATH ACTIVATED

PULMICORT INHALATION SUSPENSION FOR NEBULIZATION

BETA-ADRENERGIC AGENTS

albuterol sulfate inhalation solution for nebulization

albuterol sulfate oral syrup

albuterol sulfate oral tablet

albuterol sulfate oral tablet extended release 12 hr

metaproterenol oral syrup

metaproterenol oral tablet

88


PROAIR HFA INHALATION HFA AEROSOL INHALER

PROVENTIL HFA INHALATION HFA AEROSOL INHALER

SEREVENT DISKUS INHALATION BLISTER WITH DEVICE

AL

terbutaline oral tablet

BETA-ADRENERGIC COMBINATION AGENTS

ANORO ELLIPTA INHALATION BLISTER WITH DEVICE

AL

BEVESPI AEROSPHERE INHALATION HFA AEROSOL INHALER

COMBIVENT RESPIMAT INHALATION MIST

ipratropium-albuterol inhalation solution for nebulization

STIOLTO RESPIMAT INHALATION MIST

AL

BETA-ADRENERGICS AND GLUCOCORTICOIDS COMBINATIONS

ADVAIR DISKUS INHALATION BLISTER WITH DEVICE

AL

DULERA INHALATION HFA AEROSOL INHALER

AL

SYMBICORT INHALATION HFA AEROSOL INHALER

AL

CYSTIC FIBROSIS THERAPY AGENTS

BETHKIS INHALATION SOLUTION FOR NEBULIZATION

AL; QL

KITABIS PAK INHALATION SOLUTION FOR NEBULIZATION

AL; QL

TOBI PODHALER INHALATION CAPSULE

TOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE

DECONGESTANT COMBINATIONS

ibuprofen cold oral suspension AL; OTC

pain reliever pm oral tablet OTC

89


GENERAL BRONCHODILATOR AGENTS

ATROVENT HFA INHALATION HFA AEROSOL INHALER

ipratropium bromide inhalation solution

SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE

IMMUNOGLOBULIN ANTIBODIES

XOLAIR SUBCUTANEOUS RECON SOLN

PA

MUCOLYTICS

acetylcysteine solution

PULMOZYME INHALATION SOLUTION PA; QL

NARCOTIC ANTITUSSIVE COMBINATIONS

codeine-guaifenesin oral liquid Cheratussin AC AL; OTC

hydrocodone compound oral syrup

hydrocodone-homatropine oral syrup 5-1.5 mg/5 ml

Hydrocodone Compound AL

HYDROCODONE-HOMATROPINE ORAL SYRUP 5-1.5 MG/5 ML (5 ML)

AL

hydromet oral syrup AL

promethazine-codeine oral syrup

NASAL ANTIBIOTICS

BACTROBAN NASAL NASAL OINTMENT

NASAL ANTICHOLINERGICS

ipratropium bromide nasal spray,non-aerosol

NASAL ANTIHISTAMINES

azelastine nasal aerosol,spray

azelastine nasal spray,non-aerosol Astepro

NASAL, OTHER

nasal mist nasal aerosol,spray OTC

sodium chloride nasal aerosol,spray Altamist OTC

sterile saline nasal aerosol,spray OTC

90


NON-NARCOTIC ANTITUSSIVE COMBINATIONS

30pse-150gfn-15dm oral liquid AL; OTC

benzonatate oral capsule AL

BROMPHENEX DM ORAL SYRUP AL; OTC

COUGH DM ER ORAL SUSPENSION,EXTENDED REL 12 HR

OTC

GUIATUSS DM ORAL SYRUP OTC

head congestion cold relief oral tablets, sequential

AL; OTC

night time cold-flu oral liquid AL; OTC

nite time cold-flu formula oral capsule AL; OTC

nite-time cold-flu oral capsule AL; OTC

nite-time oral liquid AL; OTC

non-aspirin flu oral tablet OTC

promethazine-dm oral syrup AL

tussin cf oral syrup AL; OTC

XANTHINES

theochron oral tablet extended release 12 hr

theophylline oral elixir Elixophyllin

theophylline oral solution

theophylline oral tablet extended release 12 hr

Theochron

theophylline oral tablet extended release 24 hr

VAGINAL PRODUCTS

VAGINAL AGENTS

CRINONE VAGINAL GEL

VAGINAL ANTIBIOTICS

CLEOCIN VAGINAL SUPPOSITORY

CLINDESSE VAGINAL CREAM,EXTENDED RELEASE

metronidazole vaginal gel Metrogel Vaginal

vandazole vaginal gel

VAGINAL ANTIFUNGALS

MICONAZOLE NITRATE VAGINAL KIT Monistat 1 Combo Pack OTC

91


MICONAZOLE-3 PREFIL,CREAM,WIPE VAGINAL KIT

OTC

miconazole-3 vaginal suppository PA

miconazole-skin clnsr17 vaginal kitMiconazole-3 prefil,cream,wipe

OTC

terconazole vaginal cream

terconazole vaginal suppository

tioconazole vaginal ointment 1-Day OTC

tioconazole-1 vaginal ointment OTC

VAGINAL ESTROGEN PREPARATIONS

estradiol vaginal tablet Vagifem

PREMARIN VAGINAL CREAM

VAGIFEM VAGINAL TABLET

92

medicaid-approved preferred drug list · va anthem common core formulary medicaid-approved...

Documents