table of contents anti - infectives 32 . list of abbreviations. aca: affordable care act. la:...

1

Table of Contents

ANTI - INFECTIVES ............................................................................................................................... 3

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS................................................................... 8

AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCH .................................................................. 11

CARDIOVASCULAR, HYPERTENSION & LIPIDS ........................................................................... 23

DERMATOLOGICALS/TOPICAL THERAPY .................................................................................... 31

DIAGNOSTICS & MISCELLANEOUS AGENTS ................................................................................ 39

EAR, NOSE & THROAT MEDICATIONS ........................................................................................... 41

ENDOCRINE/DIABETES ...................................................................................................................... 42

GASTROENTEROLOGY ...................................................................................................................... 54

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY ........................................................................ 60

MUSCULOSKELETAL & RHEUMATOLOGY ................................................................................... 63

OBSTETRICS & GYNECOLOGY ........................................................................................................ 64

OPHTHALMOLOGY............................................................................................................................. 66

RESPIRATORY, ALLERGY, COUGH & COLD ................................................................................. 69

UROLOGICALS..................................................................................................................................... 73

VITAMINS, HEMATINICS & ELECTROLYTES................................................................................ 74

Index........................................................................................................................................................ 84

2

List of Abbreviations

ACA: Affordable Care Act.

LA: Limited Availability. This prescription may be available only at certain pharmacies. For more information, please call Customer Service.

OTC: Over the Counter. An OTC drug is a non-prescription drug.

PA : Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we may not cover the drug.

QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover.

ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table.

3

Drug Name Drug Tier

Requirements / Limits

ANTI - INFECTIVES

ANTIFUNGAL AGENTS

ANCOBON 3

clotrimazole 1

CRESEMBA 2

DIFLUCAN ORAL SUSPENSION FOR RECONSTITUTION

3

DIFLUCAN ORAL TABLET 100 MG, 200 MG, 50 MG

3

DIFLUCAN ORAL TABLET 150 MG

3 QL

fluconazole oral suspension for reconstitution

1

fluconazole oral tablet 100 mg, 200 mg, 50 mg

1

fluconazole oral tablet 150 mg

1 QL

flucytosine 1

griseofulvin microsize

1

griseofulvin ultramicrosize

1

GRIS-PEG (ULTRAMICROSIZE)

3

itraconazole 1 QL

ketoconazole 1

LAMISIL 3

NOXAFIL 2

nystatin 1

Drug Name Drug Tier


ONMEL 3 QL

ORAVIG 3

SPORANOX 2

SPORANOX PULSEPAK

3 QL

terbinafine hcl 1

VFEND 3

voriconazole 1

ANTIVIRALS

abacavir 1

abacavir-lamivudine 1

abacavir-lamivudine-zidovudine

1

acyclovir 1

adefovir 1

amantadine hcl 1

APTIVUS 2

ATRIPLA 2

BARACLUDE ORAL SOLUTION

2

BARACLUDE ORAL TABLET

3

COMBIVIR 3

COMPLERA 2

CRIXIVAN 2

DESCOVY 2

didanosine 1

EDURANT 2

EMTRIVA 2

entecavir 1

EPCLUSA 4 ST; QL


4

Drug Name Drug Tier


EPIVIR 3

EPIVIR HBV ORAL SOLUTION

2

EPIVIR HBV ORAL TABLET

3

EPZICOM 3

EVOTAZ 3

famciclovir 1 QL

FLUMADINE 3

FUZEON 4

GENVOYA 2

HARVONI 4 PA; ST; QL

HEPSERA 3

INTELENCE 2

INVIRASE 2

ISENTRESS 2

ISENTRESS HD 2

KALETRA ORAL SOLUTION

3

KALETRA ORAL TABLET

2

lamivudine 1

lamivudine-zidovudine

1

LEXIVA 2

lopinavir-ritonavir 1

MAVYRET 4

nevirapine 1

NORVIR 2

ODEFSEY 2

OLYSIO 4 PA; ST; QL

oseltamivir 1 QL

PREZCOBIX 3

Drug Name Drug Tier


PREZISTA 2

RELENZA DISKHALER

2 QL

RESCRIPTOR 2

RETROVIR 3

REYATAZ 2

ribavirin 1

rimantadine 1

SELZENTRY 2 PA

SITAVIG 3 ST; QL

SOVALDI 4 PA; ST; QL

stavudine 1

STRIBILD 2

SUSTIVA 2

TAMIFLU ORAL CAPSULE

3 QL

TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION

2 QL

TECHNIVIE 4 ST; QL

TIVICAY 2

TRIUMEQ 2

TRIZIVIR 3

TRUVADA 2

TYBOST 3

valacyclovir 1 QL

VALCYTE 3

valganciclovir 1

VEMLIDY 2

VIDEX 2 GRAM PEDIATRIC

2

VIDEX EC 3


5

Drug Name Drug Tier


VIEKIRA PAK 4 PA; ST; QL

VIEKIRA XR 4 ST; QL

VIRACEPT 2

VIRAMUNE 3

VIRAMUNE XR 3

VIRAZOLE 3

VIREAD 2

VOSEVI 4

ZERIT 3

ZIAGEN ORAL SOLUTION

2

ZIAGEN ORAL TABLET

3

zidovudine 1

ZOVIRAX 3

CEPHALOSPORINS

CEDAX 3

cefaclor 1

cefadroxil 1

cefdinir 1

cefditoren pivoxil 1

cefixime 1

cefpodoxime 1

cefprozil 1

ceftibuten 1

CEFTIN 3

cefuroxime axetil 1

cephalexin 1

DAXBIA 3

KEFLEX 3

SPECTRACEF 3

SUPRAX 3

Drug Name Drug Tier


ERYTHROMYCINS & OTHER MACROLIDES

azithromycin 1

clarithromycin 1

DIFICID 3

e.e.s. 400 1

E.E.S. GRANULES 3

ERYPED 200 3

ERYPED 400 3

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

1

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

3

erythrocin (as stearate)

1

erythromycin 1

erythromycin ethylsuccinate

1

PCE 3

ZITHROMAX 3

ZITHROMAX TRI-PAK

3

ZITHROMAX Z-PAK

3

ZMAX 3

MISCELLANEOUS ANTIINFECTIVES

ALBENZA 2 QL

ALINIA 2 QL

atovaquone 1


6

Drug Name Drug Tier


atovaquone-proguanil

1

BETHKIS 4 LA; QL

BILTRICIDE 2

CAYSTON 4 LA; QL

chloroquine phosphate

1

CLEOCIN HCL 3

CLEOCIN PEDIATRIC

3

clindamycin hcl 1

clindamycin palmitate hcl

1

clindamycin pediatric

1

COARTEM 2

CYCLOSERINE 3

dapsone 1

DARAPRIM 2 LA

EMVERM 2 QL

ethambutol 1

FLAGYL 3

hydroxychloroquine 1

IMPAVIDO 2

isoniazid 1

ivermectin 1 QL

KITABIS PAK 4 LA; QL

linezolid 1 PA

MALARONE 3

MALARONE PEDIATRIC

3

mefloquine 1

MEPRON 3

Drug Name Drug Tier


metronidazole 1

MYAMBUTOL 3

MYCOBUTIN 3

NEBUPENT 2 QL

neomycin 1

paromomycin 1

PASER 3

PRIFTIN 2

PRIMAQUINE 2

pyrazinamide 1

QUALAQUIN 3

quinine sulfate 1

rifabutin 1

RIFADIN 3

RIFAMATE 3

rifampin 1

RIFATER 3

SIRTURO 2 LA

SIVEXTRO 3 PA

STROMECTOL 3 QL

TINDAMAX 3 QL

tinidazole oral tablet 250 mg

1

tinidazole oral tablet 500 mg

1 QL

TOBI PODHALER 4 LA; QL

tobramycin in 0.225 % nacl

4 QL

TOBRAMYCIN WITH NEBULIZER

4 QL

TRECATOR 3

XIFAXAN 2 QL

ZYVOX 3 PA


7

Drug Name Drug Tier


PENICILLINS

amoxicillin 1

amoxicillin-pot clavulanate

1

ampicillin 1

AUGMENTIN ES-600

3

AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 125-31.25 MG/5 ML

2

AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTION 250-62.5 MG/5 ML

3

AUGMENTIN ORAL TABLET

3

AUGMENTIN XR 3

dicloxacillin 1

MOXATAG 3

penicillin v potassium

1

QUINOLONES

AVELOX 3

CIPRO 3

CIPRO XR 3

ciprofloxacin 1

ciprofloxacin (mixture)

1

ciprofloxacin hcl 1

FACTIVE 3

LEVAQUIN 3

Drug Name Drug Tier


levofloxacin 1

moxifloxacin 1

ofloxacin 1

SULFA'S & RELATED AGENTS

BACTRIM 3

BACTRIM DS 3

sulfadiazine 1

sulfamethoxazole-trimethoprim

1

sulfatrim 1

TETRACYCLINES

ACTICLATE 3 ST

avidoxy 1

AVIDOXY DK 3 ST

demeclocycline 1

DORYX 3 ST

DORYX MPC 3 ST

doxycycline hyclate 1

doxycycline monohydrate

1

MINOCIN 3 ST

minocycline 1

mondoxyne nl 1

MONODOX 3 ST

morgidox 1

MORGIDOX 1X 50 3 ST

MORGIDOX 2X100 3 ST

ORACEA 2 ST

SOLODYN 2 ST

TARGADOX 3 ST

tetracycline 1


8

Drug Name Drug Tier


VIBRAMYCIN ORAL CAPSULE

3 ST

VIBRAMYCIN ORAL SUSPENSION FOR RECONSTITUTION

3

VIBRAMYCIN ORAL SYRUP

3

URINARY TRACT AGENTS

FURADANTIN 3

HIPREX 3

MACROBID 3

MACRODANTIN 3

methenamine hippurate

1

methenamine mandelate

1

MONUROL 3

nitrofurantoin 1

nitrofurantoin macrocrystal

1

nitrofurantoin monohyd/m-cryst

1

PRIMSOL 3

trimethoprim 1

VANCOMYCIN

VANCOCIN 3

vancomycin 1

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS

ADJUNCTIVE AGENTS

leucovorin calcium 1

Drug Name Drug Tier


MESNEX 2

VISTOGARD 2 LA

XGEVA 4

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS

AFINITOR 4 PA; QL

AFINITOR DISPERZ

4 PA

ALECENSA 4 PA; LA; QL

ALKERAN 3

ALUNBRIG 4 PA; LA; QL

anastrozole 1

ARIMIDEX 3

AROMASIN 3

ASTAGRAF XL 3 ST

AZASAN 3

azathioprine 1

bexarotene 1

bicalutamide 1

BOSULIF 4 PA; LA; QL

CABOMETYX ORAL TABLET 20 MG

4 PA; LA; QL

CABOMETYX ORAL TABLET 40 MG, 60 MG

4 PA; LA

capecitabine 4

CAPRELSA 2 PA; LA; QL

CASODEX 3

CELLCEPT 3

COMETRIQ 3 PA; LA

COTELLIC 4 PA; LA; QL


9

Drug Name Drug Tier


CYCLOPHOSPHAMIDE

2

cyclosporine 1

cyclosporine modified

1

DROXIA 2

ELIGARD 4 PA

ELIGARD (3 MONTH)

4 PA

ELIGARD (4 MONTH)

4 PA

ELIGARD (6 MONTH)

4 PA

EMCYT 2

ENVARSUS XR 3 ST

ERIVEDGE 4 PA; LA; QL

etoposide 1

exemestane 1

FARESTON 2

FARYDAK 4 PA; LA; QL

FEMARA 3

flutamide 1

gengraf 1

GILOTRIF 4 PA; LA; QL

GLEEVEC 4 PA; QL

GLEOSTINE 2

GLIADEL WAFER 3

HEXALEN 2

HYCAMTIN 4 LA

HYDREA 3

hydroxyurea 1

IBRANCE 4 PA; LA; QL

ICLUSIG 2 PA; LA; QL

Drug Name Drug Tier


IDHIFA 4

imatinib 4 PA; QL

IMBRUVICA 2 PA; LA; QL

IMURAN 3

INLYTA 4 PA; LA; QL

IRESSA 4 PA; LA; QL

JAKAFI 4 PA; LA; QL

KISQALI 4 PA; QL

KISQALI FEMARA CO-PACK

4 PA; QL

LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1/DAY), 14 MG/DAY(10 MG X 1-4 MG X 1), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1)

4 PA; LA

LENVIMA ORAL CAPSULE 18 MG/DAY (10 MG X 1-4 MG X2), 8 MG/DAY (4 MG X 2)

4 PA

letrozole 1

LEUKERAN 2

leuprolide 4

LONSURF 4 PA; LA

LUPRON DEPOT 4 PA

LUPRON DEPOT (3 MONTH)

4 PA


4 PA


4 PA


10

Drug Name Drug Tier


LUPRON DEPOT-PED

4 PA

LUPRON DEPOT-PED (3 MONTH)

4 PA

LYNPARZA ORAL CAPSULE

4 PA; LA

LYNPARZA ORAL TABLET

4 PA

LYSODREN 2

MATULANE 2 LA

MEGACE ES 3

megestrol 1

MEKINIST ORAL TABLET 0.5 MG

4 PA; QL

MEKINIST ORAL TABLET 2 MG

4 PA; LA; QL

melphalan 1

mercaptopurine 1

methotrexate sodium 1

methotrexate sodium (pf)

1

mycophenolate mofetil

1

mycophenolate sodium

1

MYFORTIC 3

MYLERAN 2

NEORAL 3

NERLYNX 4

NEXAVAR 4 PA; LA; QL

NILANDRON 3

nilutamide 1

NINLARO 4 PA; LA; QL

octreotide acetate 4

Drug Name Drug Tier


ODOMZO 4 PA; LA; QL

PROGRAF 3

PURIXAN 2 LA

RAPAMUNE ORAL SOLUTION

2

RAPAMUNE ORAL TABLET

3

RUBRACA ORAL TABLET 200 MG, 300 MG

2 PA; LA; QL

RUBRACA ORAL TABLET 250 MG

2 PA

RYDAPT 4 PA

SANDIMMUNE ORAL CAPSULE

3

SANDIMMUNE ORAL SOLUTION

2

SIGNIFOR 4 PA; LA

sirolimus 1

SOLTAMOX 3 ACA; LA

SOMATULINE DEPOT

4 LA

SPRYCEL 4 PA; QL

STIVARGA 4 PA; LA; QL

SUPPRELIN LA 4 LA

SUTENT 4 PA; LA; QL

SYNRIBO 2 LA

TABLOID 2

tacrolimus 1

TAFINLAR 4 PA; QL

TAGRISSO 4 PA; LA; QL

tamoxifen 1 ACA

TARCEVA 4 PA; LA; QL


11

Drug Name Drug Tier


TARGRETIN ORAL

3

TARGRETIN TOPICAL

2

TASIGNA 4 PA; QL

TEMODAR 4 PA

temozolomide 4 PA

THALOMID 4 PA; LA

tretinoin (chemotherapy)

1

TREXALL 3

TYKERB 4 PA; LA; QL

VANTAS 4 LA

VENCLEXTA 2 PA; LA

VENCLEXTA STARTING PACK

2 PA; LA; QL

VOTRIENT 4 PA; LA; QL

XALKORI 4 PA; LA; QL

XATMEP 3

XELODA 4

XERMELO 2 PA; QL

XTANDI 4 PA; LA; QL

ZEJULA 2 PA; LA; QL

ZELBORAF 4 PA; LA; QL

ZOLINZA 4 LA

ZORTRESS 2

ZYDELIG 2 PA; LA; QL

ZYKADIA 4 PA; LA; QL

ZYTIGA ORAL TABLET 250 MG

4 PA; LA; QL

ZYTIGA ORAL TABLET 500 MG

4 PA; QL

Drug Name Drug Tier


AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCH

ANTICONVULSANTS

APTIOM 3

BANZEL 2

BRIVIACT 3 ST

carbamazepine 1

CARBATROL 3

CELONTIN 2

clonazepam 1

DEPAKENE 3 ST

DEPAKOTE 3 ST

DEPAKOTE ER 3 ST

DEPAKOTE SPRINKLES

3 ST

DIASTAT 3

DIASTAT ACUDIAL

3

diazepam 1

DILANTIN 2

DILANTIN EXTENDED

3

DILANTIN INFATABS

3

DILANTIN-125 3

divalproex 1

epitol 1

EQUETRO 3

ethosuximide 1

felbamate 1

FELBATOL 3

FYCOMPA 2


12

Drug Name Drug Tier


gabapentin 1

GABITRIL ORAL TABLET 12 MG, 16 MG

2

GABITRIL ORAL TABLET 2 MG, 4 MG

3

GRALISE 2 ST

GRALISE 30-DAY STARTER PACK

2 ST

KEPPRA 3 ST

KEPPRA XR 3 ST

KLONOPIN 3

LAMICTAL 3 ST

LAMICTAL ODT 3 ST

LAMICTAL ODT STARTER (BLUE)

3 ST

LAMICTAL ODT STARTER (GREEN)

3 ST

LAMICTAL ODT STARTER (ORANGE)

3 ST

LAMICTAL STARTER (BLUE) KIT

3 ST

LAMICTAL STARTER (GREEN) KIT

3 ST

LAMICTAL STARTER (ORANGE) KIT

3 ST

LAMICTAL XR 3 ST

LAMICTAL XR STARTER (BLUE)

3 ST

Drug Name Drug Tier


LAMICTAL XR STARTER (GREEN)

3 ST

LAMICTAL XR STARTER (ORANGE)

3 ST

lamotrigine 1

levetiracetam 1

LYRICA 2 ST

MYSOLINE 3

NEURONTIN 3 ST

ONFI 2

oxcarbazepine 1

OXTELLAR XR 3 ST

PEGANONE 2

phenobarbital 1

PHENYTEK 3

phenytoin 1

phenytoin sodium extended

1

primidone 1

QUDEXY XR 2 ST

roweepra 1

SABRIL 4 LA

TEGRETOL 3

TEGRETOL XR 3

tiagabine 1

TOPAMAX 3 ST

topiramate oral capsule, sprinkle

1

TOPIRAMATE ORAL CAPSULE,SPRINKLE,ER 24HR

3 ST


13

Drug Name Drug Tier


topiramate oral tablet

1

TRILEPTAL 3 ST

TROKENDI XR 3 ST

valproic acid 1

valproic acid (as sodium salt)

1

vigabatrin 1

VIMPAT 2

ZARONTIN 3

ZONEGRAN 3

zonisamide 1

ANTIPARKINSONISM AGENTS

APOKYN 4 LA

AZILECT 3

benztropine 1

bromocriptine 1

carbidopa 1

carbidopa-levodopa 1

carbidopa-levodopa-entacapone

1

COMTAN 3

DUOPA 4 LA

ELDEPRYL 3

entacapone 1

LODOSYN 3

MIRAPEX 3

MIRAPEX ER 3

NEUPRO 3

PARLODEL 3

pramipexole 1

rasagiline 1

Drug Name Drug Tier


REQUIP 3

REQUIP XL 3

ropinirole 1

RYTARY 3

selegiline hcl 1

SINEMET 3

SINEMET CR 3

STALEVO 100 3

STALEVO 125 3

STALEVO 150 3

STALEVO 200 3

STALEVO 50 3

STALEVO 75 3

TASMAR 3

tolcapone 1

trihexyphenidyl 1

XADAGO 3

ZELAPAR 3

MIGRAINE & CLUSTER HEADACHE THERAPY

almotriptan malate 1 QL

ALSUMA 3 ST; QL

AMERGE 3 ST; QL

AXERT 3 ST; QL

CAFERGOT 3

D.H.E.45 3

dihydroergotamine injection

1

dihydroergotamine nasal

1 QL

eletriptan hbr 1 QL

ERGOMAR 3


14

Drug Name Drug Tier


ergotamine-caffeine 1

frovatriptan 1 QL

isometh-dichloral-acetaminophn

1

isomethepten-caf-acetaminophen

1

MAXALT 3 ST; QL

MAXALT-MLT 3 ST; QL

migergot 1

MIGRANAL 3 QL

naratriptan 1 QL

nodolor 1

ONZETRA XSAIL 3 ST; QL

PRODRIN 3

RELPAX 3 ST; QL

rizatriptan 1 QL

sumatriptan 1 QL

sumatriptan succinate

1 QL

TREXIMET 3 ST; QL

ZEMBRACE SYMTOUCH

3 ST; QL

zolmitriptan 1 QL

ZOMIG NASAL 2 ST; QL

ZOMIG ORAL 3 ST; QL

ZOMIG ZMT 3 ST; QL

MISCELLANEOUS NEUROLOGICAL THERAPY

AMPYRA 4 PA; LA

ARICEPT 3 ST

AUSTEDO 3 PA; LA; QL

donepezil oral tablet 10 mg, 5 mg

1

Drug Name Drug Tier


donepezil oral tablet 23 mg

1 ST

donepezil oral tablet,disintegrating

1

EXELON 3 ST

galantamine 1

HORIZANT 3 ST

INGREZZA 3 PA; LA; QL

KEVEYIS 3 PA; LA

memantine oral solution

1

memantine oral tablet

1

MEMANTINE ORAL TABLETS,DOSE PACK

3

NAMENDA 3 ST

NAMENDA TITRATION PAK

3

NAMENDA XR ORAL CAP,SPRINKLE,ER 24HR DOSE PACK

2

NAMENDA XR ORAL CAPSULE,SPRINKLE,ER 24HR

2 ST

NAMZARIC 2 ST

NUEDEXTA 2 PA

RAZADYNE 3 ST

RAZADYNE ER 3 ST

rivastigmine 1

rivastigmine tartrate 1

tetrabenazine 4 PA; ST; QL

XENAZINE 4 PA; LA; QL


15

Drug Name Drug Tier


MUSCLE RELAXANTS & ANTISPASMODIC THERAPY

AMRIX 3 ST

baclofen 1

carisoprodol 1

carisoprodol-asa-codeine

1

carisoprodol-aspirin 1

chlorzoxazone 1

cyclobenzaprine 1

DANTRIUM 3

dantrolene 1

FEXMID 3 ST

LORZONE 3 ST

meprobamate 1

MESTINON ORAL SYRUP

2

MESTINON ORAL TABLET

3

MESTINON TIMESPAN

3

metaxall 1

metaxalone 1

methocarbamol 1

orphenadrine citrate 1

PARAFON FORTE DSC

3

pyridostigmine bromide

1

ROBAXIN 3

ROBAXIN-750 3

SKELAXIN 3

SOMA 3

Drug Name Drug Tier


tizanidine 1

ZANAFLEX 3

NARCOTIC ANALGESICS

acetaminophen-caff-dihydrocod oral capsule

1

ACETAMINOPHEN-CAFF-DIHYDROCOD ORAL TABLET

3

acetaminophen-codeine

1

ACTIQ 3 PA; QL

ALLZITAL 3 ST

ARYMO ER 3 ST; QL

ascomp with codeine 1

aspirin-caffeine-dihydrocodein

1

BELBUCA 3 PA; QL

buprenorphine hcl 1

butalbital compound w/codeine

1

butalbital-acetaminop-caf-cod

1

butalbital-acetaminophen

1

butalbital-acetaminophen-caff

1

butalbital-aspirin-caffeine

1

capacet 1

CAPITAL WITH CODEINE

3

codeine sulfate 1

codeine-butalbital-asa-caff

1


16

Drug Name Drug Tier


DEMEROL 3

DILAUDID 3

diskets 1 PA

DOLOPHINE 3 PA

DURAGESIC 3 PA

EMBEDA 3 ST; QL

endocet 1

ESGIC 3 ST

EXALGO ER 3 ST; QL

fentanyl citrate 1 PA; QL

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

1 PA

FENTANYL TRANSDERMAL PATCH 72 HOUR 37.5 MCG/HOUR, 62.5 MCG/HOUR, 87.5 MCG/HOUR

3 PA

FIORICET 3 ST

FIORINAL 3 ST

FIORINAL-CODEINE #3

3 ST

hydrocodone-acetaminophen

1

hydrocodone-ibuprofen

1

hydromorphone oral liquid

1

hydromorphone oral tablet

1

hydromorphone oral tablet extended release 24 hr

1 PA; QL

Drug Name Drug Tier


hydromorphone rectal

1

HYSINGLA ER 2 ST; QL

IBUDONE 3

ibuprofen-oxycodone 1

IONSYS 3

KADIAN 3 ST; QL

levorphanol tartrate 1

lorcet (hydrocodone) 1

lorcet hd 1

lorcet plus 1

LORTAB ELIXIR 3

marten-tab 1

meperidine 1

methadone 1 PA

methadose 1 PA

MORPHABOND ER

3 PA; QL

morphine concentrate

1

morphine oral capsule, er multiphase 24 hr

1 PA; QL

morphine oral capsule,extend.release pellets

1 PA; QL

morphine oral solution

1

morphine oral tablet 1

morphine oral tablet extended release

1 PA; QL

morphine rectal 1

MS CONTIN 3 PA; QL

NORCO 3


17

Drug Name Drug Tier


OPANA 3

OXAYDO 3

oxycodone 1

oxycodone-acetaminophen

1

oxycodone-aspirin 1

OXYCONTIN 2 ST; QL

oxymorphone oral tablet

1

oxymorphone oral tablet extended release 12 hr

1 PA; QL

PERCOCET 3

PRIMLEV 3

ROXICODONE 3

SYNALGOS-DC 3

tencon 1

TREZIX 3

TYLENOL-CODEINE #3

3

TYLENOL-CODEINE #4

3

VANATOL LQ 3 ST

verdrocet 1

vicodin 1

vicodin es 1

vicodin hp 1

XODOL 10/300 3

XODOL 5/300 3

XODOL 7.5/300 3

XTAMPZA ER 3 ST; QL

xylon 10 1

zamicet 1

Drug Name Drug Tier


zebutal 1

ZOHYDRO ER 3 ST; QL

NON-NARCOTIC ANALGESICS

ANAPROX DS 3 ST

ARTHROTEC 50 3 ST

ARTHROTEC 75 3 ST

aspir-81 1 ACA; OTC

aspirin 1 ACA; OTC

aspirin low dose 1 ACA; OTC

aspir-low 1 ACA; OTC

aspir-trin 1 ACA; OTC

bayer aspirin 1 ACA; OTC

butorphanol tartrate injection

1

butorphanol tartrate nasal

1 QL

CAMBIA 3 ST; QL

CELEBREX 3 ST

celecoxib 1 ST

children's aspirin 1 ACA; OTC

choline,magnesium salicylate

1

CONZIP 3 ST; QL

DAYPRO 3 ST

diclofenac potassium 1

diclofenac sodium oral

1

diclofenac sodium topical drops

1 QL

diclofenac sodium topical gel

1 ST; QL

diclofenac-misoprostol

1


18

Drug Name Drug Tier


diflunisal 1

DISALCID 3

DUEXIS 3 ST

e.c. prin 1 ACA; OTC

EC-NAPROSYN 3 ST

ecotrin 1 ACA; OTC

ecotrin low strength 1 ACA; OTC

etodolac 1

FELDENE 3 ST

FENOPROFEN ORAL CAPSULE

3 ST

fenoprofen oral tablet

1

FENORTHO 3 ST

FLECTOR 2 ST; QL

flurbiprofen 1

ibuprofen 1

INDOCIN ORAL 3 ST

INDOCIN RECTAL 3

indomethacin 1

ketoprofen 1

ketorolac 1 QL

lite coat aspirin 1 ACA; OTC

LODINE 3 ST

meclofenamate 1

mefenamic acid 1

meloxicam oral suspension

1

meloxicam oral tablet 15 mg

1

meloxicam oral tablet 7.5 mg

1 QL

Drug Name Drug Tier


MOBIC ORAL TABLET 15 MG

3 ST

MOBIC ORAL TABLET 7.5 MG

3 ST; QL

nabumetone 1

NALFON 3 ST

naloxone 1

naltrexone 1

NAPRELAN CR 3 ST

NAPROSYN 3 ST

naproxen 1

naproxen sodium 1

NARCAN 2 QL

NUCYNTA 2 QL

NUCYNTA ER 2 ST; QL

oxaprozin 1

PENNSAID 3 ST; QL

pentazocine-naloxone

1

piroxicam 1

PONSTEL 3 ST

salsalate 1

SPRIX 3 ST; LA; QL

sulindac 1

TIVORBEX ORAL CAPSULE 20 MG

3 ST; QL

TIVORBEX ORAL CAPSULE 40 MG

3 ST

tolmetin 1

TRAMADOL ORAL CAPSULE,ER BIPHASE 24 HR 17-83

3 ST; QL


19

Drug Name Drug Tier


TRAMADOL ORAL CAPSULE,ER BIPHASE 24 HR 25-75

3 ST; QL

tramadol oral tablet 1 QL

tramadol oral tablet extended release 24 hr

1 PA; QL

tramadol oral tablet, er multiphase 24 hr

1 PA

tramadol-acetaminophen

1 QL

ULTRACET 3 ST; QL

ULTRAM 3 ST; QL

ULTRAM ER 3 ST; QL

VIMOVO 3 ST

VIVLODEX ORAL CAPSULE 10 MG

3 ST

VIVLODEX ORAL CAPSULE 5 MG

3 ST; QL

VOLTAREN 3 ST; QL

VOLTAREN-XR 3 ST

ZIPSOR 3 ST

ZORVOLEX ORAL CAPSULE 18 MG

3 ST; QL

ZORVOLEX ORAL CAPSULE 35 MG

3 ST

PSYCHOTHERAPEUTIC DRUGS

ABILIFY 3 QL

ADASUVE 3

ADDERALL 3 PA

ADDYI 3 PA

ADZENYS XR-ODT

3 ST

Drug Name Drug Tier


alprazolam 1

alprazolam intensol 1

AMBIEN 3 ST; QL

AMBIEN CR 3 ST; QL

amitriptyline 1

amitriptyline-chlordiazepoxide

1

amoxapine 1

ANAFRANIL 3

APLENZIN 3 ST; QL

APTENSIO XR 3 PA; ST

aripiprazole oral solution

1

aripiprazole oral tablet

1 QL

aripiprazole oral tablet,disintegrating

1 QL

armodafinil 1 PA

ATIVAN 3

atomoxetine 1 PA

BELSOMRA 3 ST; QL

BRISDELLE 2 ST; QL

bupropion hcl oral tablet

1

bupropion hcl oral tablet extended release 12 hr

1 QL

bupropion hcl oral tablet extended release 24 hr

1 QL

buspirone 1

BUTISOL 3

CELEXA 3 ST; QL

chlordiazepoxide hcl 1


20

Drug Name Drug Tier


chlorpromazine 1

citalopram oral solution

1

citalopram oral tablet

1 QL

clomipramine 1

clonidine hcl 1 PA

clorazepate dipotassium

1

clozapine oral tablet 1

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

1

CLOZAPINE ORAL TABLET,DISINTEGRATING 150 MG, 200 MG

3

CLOZARIL 3

CONCERTA 3 PA; ST

COTEMPLA XR-ODT

3 ST

DAYTRANA 2 PA; ST

desipramine 1

DESOXYN 3 ST

DESVENLAFAXINE

3 ST; QL

DESVENLAFAXINE FUMARATE

3 ST

desvenlafaxine succinate

1 QL

Drug Name Drug Tier


DEXEDRINE SPANSULE ORAL CAPSULE, EXTENDED RELEASE 10 MG, 5 MG

3 ST

DEXEDRINE SPANSULE ORAL CAPSULE, EXTENDED RELEASE 15 MG

3 PA; ST

dexmethylphenidate 1 PA

dextroamphetamine 1 PA

dextroamphetamine-amphetamine

1 PA

diazepam 1

diazepam intensol 1

DORAL 3

doxepin 1

duloxetine 1 QL

DYANAVEL XR 3 ST

EDLUAR 3 ST; QL

EMSAM 3

ergoloid 1

escitalopram oxalate oral solution

1

escitalopram oxalate oral tablet

1 QL

estazolam 1

eszopiclone 1 QL

EVEKEO 2 PA

FANAPT 3 QL

FAZACLO 3

FETZIMA 2 ST; QL


21

Drug Name Drug Tier


fluoxetine oral capsule 10 mg, 40 mg

1 QL

fluoxetine oral capsule 20 mg

1

fluoxetine oral capsule,delayed release(dr/ec)

1 QL

fluoxetine oral solution

1

fluoxetine oral tablet 10 mg

1 QL

fluoxetine oral tablet 20 mg

1

FLUOXETINE ORAL TABLET 60 MG

3 ST

fluphenazine hcl 1

flurazepam 1

fluvoxamine 1 QL

FOCALIN 3 PA

FOCALIN XR 3 PA; ST

FORFIVO XL 3 ST; QL

GEODON 3 QL

guanfacine 1 PA

guanidine 1

HALCION 3

haloperidol 1

haloperidol lactate 1

HETLIOZ 4 PA; LA; QL

imipramine hcl 1

imipramine pamoate 1

INTERMEZZO 3 ST; QL

INVEGA 3 QL

Drug Name Drug Tier


IRENKA 3 ST; QL

KAPVAY 3 PA

KHEDEZLA 3 ST; QL

LATUDA 2 QL

lithium carbonate 1

lithium citrate 1

LITHOBID 3

lorazepam 1

lorazepam intensol 1

loxapine succinate 1

LUNESTA 3 ST; QL

maprotiline 1

MARPLAN 3

metadate er 1 PA

methamphetamine 1 PA

METHYLIN 3 PA

methylphenidate hcl 1 PA

midazolam 1

mirtazapine 1

modafinil 1 PA

MYDAYIS 2 ST

NARDIL 3

nefazodone 1

NORPRAMIN 3

nortriptyline 1

NUPLAZID 4 LA

NUVIGIL 3 PA

olanzapine 1 QL

olanzapine-fluoxetine

1

ORAP 3

oxazepam 1


22

Drug Name Drug Tier


paliperidone 1 QL

PAMELOR 3

PARNATE 3

paroxetine hcl 1 QL

PAXIL CR 3 ST; QL

PAXIL ORAL SUSPENSION

3 ST

PAXIL ORAL TABLET

3 ST; QL

perphenazine 1

perphenazine-amitriptyline

1

PEXEVA 3 ST; QL

phenelzine 1

pimozide 1

procentra 1 PA

protriptyline 1

PROVIGIL 3 PA

quazepam 1

quetiapine 1 QL

QUILLICHEW ER 2 ST

QUILLIVANT XR 2 PA; ST

REMERON 3

REMERON SOLTAB

3

RESTORIL 3

REXULTI 3 QL

RISPERDAL M-TAB

3 QL

RISPERDAL ORAL SOLUTION

3

RISPERDAL ORAL TABLET

3 QL

Drug Name Drug Tier


risperidone oral solution

1

risperidone oral tablet

1 QL

risperidone oral tablet,disintegrating

1 QL

RITALIN 3 PA

RITALIN LA 3 PA; ST

ROZEREM 2 ST; QL

SAPHRIS (BLACK CHERRY)

3 QL

SARAFEM ORAL TABLET 10 MG

3 ST; QL

SARAFEM ORAL TABLET 20 MG

3 ST

seconal sodium 1 QL

sertraline oral concentrate

1

sertraline oral tablet 1 QL

SILENOR 3 ST; QL

SONATA 3 ST; QL

SURMONTIL 3

SYMBYAX 3

temazepam 1

thioridazine 1

thiothixene 1

TOFRANIL 3

TRANXENE T-TAB

3

tranylcypromine 1

trazodone 1

triazolam 1

trifluoperazine 1

trimipramine 1


23

Drug Name Drug Tier


TRINTELLIX 3 ST; QL

venlafaxine 1 QL

VERSACLOZ 3

VIIBRYD 2 ST; QL

VRAYLAR 3 QL

VYVANSE ORAL CAPSULE

2 PA; ST

VYVANSE ORAL TABLET,CHEWABLE

2 ST

WELLBUTRIN XL 3 ST; QL

XYREM 2 LA

zaleplon 1 QL

zenzedi oral tablet 10 mg, 5 mg

1 PA

ZENZEDI ORAL TABLET 15 MG, 2.5 MG, 20 MG, 30 MG, 7.5 MG

3 PA

ziprasidone hcl 1 QL

zolpidem 1 QL

ZOLPIMIST 3 ST; QL

ZYPREXA 3 QL

ZYPREXA ZYDIS 3 QL

CARDIOVASCULAR, HYPERTENSION & LIPIDS

ANTIARRHYTHMIC AGENTS

amiodarone 1

BETAPACE 3 ST

BETAPACE AF 3 ST

disopyramide phosphate

1

dofetilide 1

flecainide 1

Drug Name Drug Tier


mexiletine 1

MULTAQ 3

NORPACE 3

NORPACE CR 3

pacerone 1

propafenone 1

quinidine gluconate 1

quinidine sulfate 1

RYTHMOL SR 3

sotalol 1

sotalol af 1

SOTYLIZE 2

ANTIHYPERTENSIVE THERAPY

ACCUPRIL 3

ACCURETIC 3

acebutolol 1

ADALAT CC 3 ST

afeditab cr 1

ALDACTAZIDE 3

ALDACTONE 3

ALTACE 3

amiloride 1

amiloride-hydrochlorothiazide

1

amlodipine 1

amlodipine-benazepril

1

amlodipine-olmesartan

1

amlodipine-valsartan

1

amlodipine-valsartan-hcthiazid

1


24

Drug Name Drug Tier


atenolol 1

atenolol-chlorthalidone

1

AVALIDE 3 ST

AVAPRO 3 ST

AZOR 3 ST

benazepril 1

benazepril-hydrochlorothiazide

1

BENICAR 3 ST

BENICAR HCT 3 ST

betaxolol 1

BIDIL 3

bisoprolol fumarate 1

bisoprolol-hydrochlorothiazide

1

bumetanide 1

BYSTOLIC 2 ST

BYVALSON 2 ST

CALAN 3

CALAN SR 3

candesartan 1

candesartan-hydrochlorothiazid

1

captopril 1

captopril-hydrochlorothiazide

1

CARDIZEM 3

CARDIZEM CD 3

CARDIZEM LA 3

CARDURA 3 ST; QL

CARDURA XL 3 ST; QL

cartia xt 1

Drug Name Drug Tier


carvedilol 1

CATAPRES 3

CATAPRES-TTS-1 3 QL

CATAPRES-TTS-2 3 QL

CATAPRES-TTS-3 3 QL

chlorothiazide 1

chlorthalidone 1

clonidine 1 QL

clonidine hcl 1

clorpres oral tablet 0.1-15 mg, 0.2-15 mg

1

CLORPRES ORAL TABLET 0.3-15 MG

3

COREG 3 ST

COREG CR 2 ST

CORGARD 3 ST

CORZIDE 3 ST

COZAAR 3 ST

DEMADEX 3

DEMSER 2

DIBENZYLINE 3

diltiazem 1

dilt-xr 1

DIOVAN 3 ST

DIOVAN HCT 3 ST

DIURIL 3

doxazosin 1 QL

DUTOPROL 3 ST

DYAZIDE 3

DYRENIUM 3

EDARBI 2 ST


25

Drug Name Drug Tier


EDARBYCLOR 2 ST

EDECRIN 3

enalapril maleate 1

enalapril-hydrochlorothiazide

1

EPANED 3

eplerenone 1

eprosartan 1

ethacrynic acid 1

EXFORGE 3 ST

EXFORGE HCT 3 ST

felodipine 1

fosinopril 1

fosinopril-hydrochlorothiazide

1

furosemide 1

guanfacine 1

HEMANGEOL 3 LA

hydralazine 1

hydrochlorothiazide 1

HYZAAR 3 ST

indapamide 1

INDERAL XL 3 ST

INNOPRAN XL 3 ST

INSPRA 3

irbesartan 1

irbesartan-hydrochlorothiazide

1

isradipine 1

labetalol 1

LASIX 3

LEVATOL 3 ST

Drug Name Drug Tier


lisinopril 1

lisinopril-hydrochlorothiazide

1

LOPRESSOR 3 ST

LOPRESSOR HCT 3 ST

losartan 1

losartan-hydrochlorothiazide

1

LOTENSIN 3

LOTENSIN HCT 3

LOTREL 3

matzim la 1

MAXZIDE 3

MAXZIDE-25MG 3

methyclothiazide 1

methyldopa 1

methyldopa-hydrochlorothiazide

1

metolazone 1

metoprolol succinate 1

METOPROLOL SU-HYDROCHLOROTHIAZ

3 ST

metoprolol ta-hydrochlorothiaz

1

metoprolol tartrate 1

MICARDIS 3 ST

MICARDIS HCT 3 ST

MICROZIDE 3

MINIPRESS 3

minoxidil 1

moexipril 1


26

Drug Name Drug Tier


moexipril-hydrochlorothiazide

1

nadolol 1

nadolol-bendroflumethiazide

1

nicardipine 1

nifedipine 1

nimodipine 1

nisoldipine 1

NORVASC 3 ST

NYMALIZE 3

olmesartan 1

olmesartan-amlodipin-hcthiazid

1

olmesartan-hydrochlorothiazide

1

ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG, 0.25 MG, 1 MG, 2.5 MG

4 PA; LA

ORENITRAM ORAL TABLET EXTENDED RELEASE 5 MG

4 PA

perindopril erbumine

1

phenoxybenzamine 1

pindolol 1

prazosin 1

PRESTALIA 3 ST

PRINIVIL 3

PROCARDIA 3 ST

PROCARDIA XL 3 ST

Drug Name Drug Tier


propranolol 1

propranolol-hydrochlorothiazid

1

QBRELIS 3

quinapril 1

quinapril-hydrochlorothiazide

1

ramipril 1

spironolactone 1

spironolacton-hydrochlorothiaz

1

SULAR 3 ST

TARKA 3

taztia xt 1

TEKTURNA 2

TEKTURNA HCT 2

telmisartan 1

telmisartan-amlodipine

1

telmisartan-hydrochlorothiazid

1

TENORETIC 100 3 ST

TENORETIC 50 3 ST

TENORMIN 3 ST

terazosin 1 QL

TIAZAC 3

timolol maleate 1

TOPROL XL 3 ST

torsemide 1

trandolapril 1

trandolapril-verapamil

1


27

Drug Name Drug Tier


triamterene-hydrochlorothiazid

1

TRIBENZOR 3 ST

TWYNSTA 3 ST

UPTRAVI 4 PA; LA

valsartan 1

valsartan-hydrochlorothiazide

1

VASERETIC 3

VASOTEC 3

verapamil 1

VERELAN 3

VERELAN PM 3

ZESTORETIC 3

ZESTRIL 3

ZIAC 3 ST

CARDIAC GLYCOSIDES

digitek 1

digox 1

digoxin 1

LANOXIN 3

COAGULATION THERAPY

ADVATE 4 LA

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

4 LA

Drug Name Drug Tier


ADYNOVATE INTRAVENOUS SOLUTION 1,500 (+/-) UNIT, 3,000 (+/-) UNIT, 750 (+/-) UNIT

4

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

4 LA

AFSTYLA INTRAVENOUS RECON SOLN 1,500 (+/-) UNIT RANGE, 2,500 (+/-) UNIT RANGE

4

AGGRENOX 3

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

4 LA

ALPROLIX INTRAVENOUS RECON SOLN 4,000 UNIT

4

AMICAR 2

ARIXTRA 4

aspirin-dipyridamole 1

BENEFIX 4 LA

BRILINTA 2


28

Drug Name Drug Tier


CEPROTIN (BLUE BAR)

2 LA

CEPROTIN (GREEN BAR)

2 LA

cilostazol 1

clopidogrel 1

COAGADEX 2 LA

COUMADIN 3

dipyridamole 1

DURLAZA 3 ST

EFFIENT 3

ELIQUIS 2 PA

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

4 LA

ELOCTATE INTRAVENOUS RECON SOLN 4,000 UNIT, 5,000 UNIT, 6,000 UNIT

4

enoxaparin 4

fondaparinux 4

FRAGMIN 4

HELIXATE FS 4 LA

hep flush-10 (pf) 1

heparin (porcine) 1

HEPARIN (PORCINE) IN 0.9% NACL

3

heparin (porcine) in 5 % dex

1

Drug Name Drug Tier


heparin (porcine) in nacl (pf)

1

heparin flush(porcine)-0.9nacl

1

heparin lock flush 1

heparin lock flush (porcine)

1

heparin lockflush(porcine)(pf)

1

HEPARIN(PORCINE) IN 0.45% NACL INTRAVENOUS PARENTERAL SOLUTION 12,500 UNIT/250 ML

3

heparin(porcine) in 0.45% nacl intravenous parenteral solution 25,000 unit/250 ml, 25,000 unit/500 ml

1

heparin, porcine (pf) 1

IDELVION 4 LA

IPRIVASK 4

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

4 LA

IXINITY INTRAVENOUS RECON SOLN 2,000 UNIT, 250 UNIT, 3,000 UNIT

4

jantoven 1

KOGENATE FS 4 LA

KOVALTRY 4 LA


29

Drug Name Drug Tier


MEPHYTON 2

NOVOEIGHT 4 LA

NOVOSEVEN RT 4 LA

NUWIQ 4 LA

pentoxifylline 1

PHYTONADIONE (VITAMIN K1)

2

PLAVIX 3

PRADAXA 3 PA

prasugrel 1

PROMACTA 4 PA; LA

RECOMBINATE 4 LA

RIXUBIS 4 LA

SAVAYSA 3 PA

ticlopidine 1

vitamin k 1

vitamin k1 1

warfarin 1

WILATE 4 LA

XARELTO 2 PA

XYNTHA 4 LA

XYNTHA SOLOFUSE INTRAVENOUS SYRINGE 1,000 (+/-) UNIT, 2,000 (+/-) UNIT, 250 (+/-) UNIT, 500 (+/-) UNIT

4

XYNTHA SOLOFUSE INTRAVENOUS SYRINGE 3,000 (+/-) UNIT

4 LA

YOSPRALA 3 ST

Drug Name Drug Tier


ZONTIVITY 2 PA

LIPID/CHOLESTEROL LOWERING AGENTS

ALTOPREV 3 ST; QL

amlodipine-atorvastatin

1 QL

ANTARA 3 ST

atorvastatin 1 QL

CADUET 3 ST; QL

cholestyramine (with sugar)

1

cholestyramine light 1

COLESTID FLAVORED

3 ST

COLESTID ORAL GRANULES

3 PA; ST

COLESTID ORAL PACKET

3 PA

COLESTID ORAL TABLET

3 ST

colestipol 1

CRESTOR 3 ST; QL

ezetimibe 1 ST

ezetimibe-simvastatin

1 QL

fenofibrate micronized

1

fenofibrate nanocrystallized

1

FENOFIBRATE ORAL CAPSULE

3 ST

fenofibrate oral tablet

1

fenofibric acid 1


30

Drug Name Drug Tier


fenofibric acid (choline)

1

FENOGLIDE 3 ST

FIBRICOR 3 ST

FLOLIPID 3 ST

fluvastatin 1 QL

gemfibrozil 1

JUXTAPID 2 PA; LA

KYNAMRO 4 PA; LA

LESCOL 3 ST; QL

LESCOL XL 3 ST; QL

LIPITOR 3 ST; QL

LIPOFEN 2 ST

LIVALO 2 ST; QL

LOPID 3

lovastatin 1 QL

LOVAZA 3 PA

niacin 1

NIACOR 3

NIASPAN EXTENDED-RELEASE

3

omega-3 acid ethyl esters

1 PA

PRALUENT PEN 4 PA; LA; QL

PRAVACHOL 3 ST; QL

pravastatin 1 QL

prevalite 1

QUESTRAN 3 ST

QUESTRAN LIGHT

3 ST

REPATHA PUSHTRONEX

4 PA; QL

Drug Name Drug Tier


REPATHA SURECLICK

4 PA; QL

REPATHA SYRINGE

4 PA; QL

rosuvastatin 1 QL

simvastatin 1 QL

TRICOR 3 ST

TRIGLIDE 3 ST

triklo 1 PA

TRILIPIX 3 ST

VASCEPA 2 PA

VYTORIN 10-10 3 ST; QL




WELCHOL 2 ST

ZETIA 3 ST

ZOCOR 3 ST; QL

MISCELLANEOUS CARDIOVASCULAR AGENTS

CORLANOR 2 PA

ENTRESTO 2 PA; QL

RANEXA 2

VECAMYL 3 LA

NITRATES

DILATRATE-SR 2

GONITRO 3

ISOCHRON 3

ISORDIL 3

ISORDIL TITRADOSE

3

isosorbide dinitrate 1


31

Drug Name Drug Tier


isosorbide mononitrate

1

MINITRAN 3

nitro-bid 1

NITRO-DUR 3

nitroglycerin 1

NITROLINGUAL 3

NITROMIST 3

NITROSTAT 3

nitro-time 1

DERMATOLOGICALS/TOPICAL THERAPY

ANTIPSORIATIC / ANTISEBORRHEIC

acitretin 1

ANALPRAM-HC 3 ST

calcipotriene 1

calcipotriene-betamethasone

1

calcitrene 1

calcitriol 1

COAL TAR 2

COSENTYX 4 PA; ST

COSENTYX (2 SYRINGES)

4 PA; ST

COSENTYX PEN 4 PA; ST

COSENTYX PEN (2 PENS)

4 PA; ST

DOVONEX 3

drithocreme hp 1

ENSTILAR 2

EPIFOAM 3 ST

Drug Name Drug Tier


hydrocortisone-pramoxine

1

OVACE 3

OVACE PLUS SHAMPOO

3

OVACE PLUS TOPICAL CLEANSER,EXTENDED RELEASE

3

OVACE PLUS TOPICAL CREAM

3 ST

OVACE PLUS TOPICAL FOAM

3

OVACE PLUS TOPICAL LOTION

3 ST

OVACE PLUS WASH

3

PRAMOSONE 3 ST

PRAMOSONE E 3 ST

PROMISEB COMPLETE

3

seb-prev 1

selenium sulfide 1

SELRX 3

SORIATANE 3

SORILUX 3

STELARA SUBCUTANEOUS SOLUTION

4 ST

STELARA SUBCUTANEOUS SYRINGE

4 PA; ST

sulfacetamide sodium

1

TACLONEX TOPICAL OINTMENT

3


32

Drug Name Drug Tier


TACLONEX TOPICAL SUSPENSION

2

TERSI FOAM 3

VECTICAL 3

ZITHRANOL 3

BURN THERAPY

SILVADENE 3

silver sulfadiazine 1

ssd 1

thermazene 1

KERATOLYTICS

BENSAL HP 3

INOVA 4-1 3 ST

INOVA 8-2 3 ST

KERALYT RX 3

KERALYT SCALP COMPLETE

3

PODOCON 3

POTASSIUM HYDROXIDE

3

SALEX 3

salicylic acid 1

salicylic acid er-ceramides

1

SALKERA 3

salvax 1

SALVAX DUO PLUS

3

ULTRASAL-ER 3

VIRASAL 3

MISCELLANEOUS DERMATOLOGICALS

Drug Name Drug Tier


ALEVICYN ANTIPRURITIC

3

ALEVICYN ANTIPRURITIC SG

3

AMELUZ 3

ammonium lactate 1

ATOPICLAIR 3

ATRAPRO CP 3

ATRAPRO HYDROGEL

3

avo cream 1

BIAFINE EMULSION

3

bp-50% urea 1

CARAC 2

celacyn 1

cem-urea 1

CERACADE 3

CERAMAX 3

CONDYLOX 3

CORTANE-B 3

DEXERYL 3

diclofenac sodium 1 PA; QL

doxepin 1 QL

DUPIXENT 4 PA; QL

EFUDEX 3

eletone 1

ELIDEL 2 ST; QL

emulsion sb 1

ENTTY 3

EPICERAM 3

EUCRISA 3 ST; QL

FLUOROPLEX 3


33

Drug Name Drug Tier


fluorouracil 1

GORDONS UREA 3

hpr 1

hpr plus 1

hpr plus hydrogel 1

HPR PLUS-MB HYDROGEL

3

HYDRO 35 3

HYDRO 40 3

HYLATOPIC 3

HYLATOPICPLUS 3

IODOFLEX 3

IODOSORB 3

KERAFOAM 3

KERALAC 3

LEVULAN 3

LOUTREX 3

luxamend 1

mb hydrogel 1

mb hydrogel (cyclomethicone)

1

methoxsalen 1

NEOSALUS 3

nivatopic plus 1

OXSORALEN ULTRA

3

PANRETIN 3

PHLAG SPRAY 3

PICATO 2

podofilox 1

PRESERA 3

PROMISEB 3

Drug Name Drug Tier


PROTOPIC 3 ST; QL

pruclair 1

prudoxin 1 QL

prumyx 1

prutect 1

QUTENZA 3 LA

rea lo 39 1

rea lo 40 1

REGRANEX 2 QL

RESTIZAN 3

SEBUDERM 3

silver nitrate 1

silver nitrate applicators

1

SOLARAZE 3 PA; QL

sonafine 1

sp antipruritic 1

sp scar management 1

SYNERDERM 3

tacrolimus 1 ST; QL

TOLAK 3

umecta 1

URAMAXIN 3

urea 1

urea nail stick 1

UTOPIC 3

VALCHLOR 4 LA

VEREGEN 3

XCLAIR 3

ZONALON 3 QL

THERAPY FOR ACNE

ABSORICA 2


34

Drug Name Drug Tier


ACANYA 2 ST

ACZONE 3 ST

adapalene topical cream

1

adapalene topical gel

1

adapalene topical gel with pump

1

ADAPALENE TOPICAL LOTION

3 ST

adapalene-benzoyl peroxide

1

amnesteem 1

ATRALIN 3 PA

AVAR LS 3 ST

avar topical cleanser 1

AVAR TOPICAL FOAM

3 ST

AVAR TOPICAL PADS, MEDICATED

3 ST

AVAR-E GREEN 3 ST

AVAR-E LS 3 ST

avita topical cream 1 PA

AVITA TOPICAL GEL

3 PA

AZELEX 3 ST

BENZACLIN 3 ST

BENZACLIN PUMP

3 ST

BENZAMYCIN 3 ST

BENZEFOAM 3 ST

BENZEFOAM ULTRA

3 ST

benzepro 1

Drug Name Drug Tier


BENZEPRO (MICROSPHERES)

3 ST

benzoyl peroxide 1

bp 10-1 1

bpo 1

claravis 1

cleansing wash 1

CLEOCIN T 3 ST

CLINDACIN ETZ 3 ST

clindacin p 1

CLINDACIN PAC 3 ST

CLINDAGEL 3 ST

clindamycin phosphate

1

clindamycin-benzoyl peroxide

1

clindamycin-tretinoin

1 PA

DIFFERIN 3 ST

DUAC 3 ST

EPIDUO 2 ST

EPIDUO FORTE 2 ST

ery pads 1

erygel 1

erythromycin with ethanol

1

erythromycin-benzoyl peroxide

1

EVOCLIN 3 ST

FABIOR 3 PA

FINACEA 2 ST

INOVA 3 ST

METROCREAM 3 ST


35

Drug Name Drug Tier


METROGEL 3 ST

METROLOTION 3 ST

metronidazole 1

MIRVASO 2 PA

neuac 1

NEUAC KIT 3 ST

NORITATE 3 ST

NUOX 3 ST

ONEXTON 2 ST

PACNEX 3 ST

PLEXION 3 ST

PLEXION CLEANSING CLOTHS

3 ST

PR BENZOYL PEROXIDE

3 ST

RETIN-A 3 PA

RETIN-A MICRO 3 PA

RETIN-A MICRO PUMP

3 PA

RHOFADE 3 PA

rosadan topical cream

1

rosadan topical gel 1

ROSADAN TOPICAL KIT, CLEANSER AND GEL

3 ST

ROSADAN TOPICAL KIT,CLEANSER AND CREAM

3 ST

ROSANIL 3 ST

ROSULA 3 ST

Drug Name Drug Tier


rosula cleansing cloths

1

SOOLANTRA 2 ST

sss 10-5 1

sulfacetamide sodium-sulfur

1

sulfacetamide sod-sulfur-urea

1

sulfacetamide-sulfur-cleansr23

1

sulfacleanse 8-4 1

sulfact na-sul-avobnz-otn-ocsa

1

SUMADAN 3 ST

SUMADAN XLT 3 ST

SUMAXIN 3 ST

SUMAXIN CP 3 ST

SUMAXIN TS 3 ST

tazarotene 1 PA

TAZORAC TOPICAL CREAM 0.05 %

2 PA

TAZORAC TOPICAL CREAM 0.1 %

3 PA

TAZORAC TOPICAL GEL

2 PA

tretinoin 1 PA

tretinoin microspheres

1 PA

TRETIN-X 3 PA

TRETIN-X CREAM KIT

3 PA

VANOXIDE-HC 3 ST

zenatane 1


36

Drug Name Drug Tier


ZIANA 3 PA; ST

TOPICAL ANESTHETICS

BUCALSEP 3

ethyl chloride 1

glydo 1 QL

lidocaine hcl laryngotracheal

1

lidocaine hcl mucous membrane jelly

1 QL

lidocaine hcl mucous membrane jelly in applicator

1 QL

lidocaine hcl mucous membrane solution

1

lidocaine hcl-hydrocortison ac

1

lidocaine topical adhesive patch,medicated

1 ST

lidocaine topical ointment

1 QL

lidocaine viscous 1

lidocaine-prilocaine topical cream

1 QL

lidocaine-prilocaine topical kit

1

LIDOCAINE-TETRACAINE

3 ST

lta pre-attached 1

PLIAGLIS 3

SYNERA 3

TOPICAL ANTIBACTERIALS

ALCORTIN A 3 ST

ALOQUIN 3 ST

ALTABAX 3

Drug Name Drug Tier


BACTROBAN 3

CENTANY 3

CENTANY AT 3

CORTISPORIN 3

DERMASORB AF COMPLETE KIT

3

gentamicin 1

hydrocortisone-iodoquinol-aloe

1

iodoquinol-hc 1

KLARON 3 ST

lugols 1

mupirocin 1

mupirocin calcium 1

NEO-SYNALAR 3

NEO-SYNALAR KIT

3

SILVRSTAT 3

sulfacetamide sodium (acne)

1

SULFAMYLON 2

VYTONE 3

TOPICAL ANTIFUNGALS

ALA-QUIN 3

CICLODAN KIT TOPICAL COMBO PACK

3

CICLODAN KIT TOPICAL SOLUTION

3 ST

ciclodan topical cream

1 QL

ciclodan topical solution

1


37

Drug Name Drug Tier


ciclopirox topical cream

1 QL

ciclopirox topical gel

1 QL

ciclopirox topical shampoo

1 QL

ciclopirox topical solution

1

ciclopirox topical suspension

1 QL

ciclopirox-ure-camph-menth-euc

1

clotrimazole 1 QL

clotrimazole-betamethasone

1 QL

econazole 1 QL

ECOZA 3 QL

ERTACZO 3 QL

EXELDERM 3 QL

EXODERM 3

EXTINA 3 QL

JUBLIA 3 ST

KERYDIN 3 ST

ketoconazole 1 QL

LOPROX 3 QL

LOPROX (AS OLAMINE)

3 QL

LOPROX KIT 3

LOTRISONE 3 QL

LUZU 3 QL

MENTAX 3 QL

naftifine 1 QL

NAFTIN 3 QL

NIZORAL 3 QL

Drug Name Drug Tier


nyamyc 1

nyata 1

nystatin topical cream

1 QL

nystatin topical ointment

1 QL

nystatin topical powder

1

nystatin-triamcinolone

1 QL

nystop 1

oxiconazole 1 QL

OXISTAT 3 QL

PENLAC 3 ST

TRIACETIN 2

TRIPLE DYE 3

VUSION 3 QL

XOLEGEL 3 QL

TOPICAL ANTIVIRALS

acyclovir 1 PA; QL

DENAVIR 3

XERESE 3

ZOVIRAX TOPICAL CREAM

2 PA; QL

ZOVIRAX TOPICAL OINTMENT

3 PA; QL

TOPICAL CORTICOSTEROIDS

ala-cort 1

ALA-SCALP 3 ST

alclometasone 1

amcinonide 1

apexicon e 1


38

Drug Name Drug Tier


AQUA GLYCOLIC HC

3 ST

betamethasone dipropionate

1

betamethasone valerate

1

betamethasone, augmented

1

CAPEX 3 ST

clobetasol 1 QL

clobetasol-emollient 1 QL

CLOBEX 3 ST; QL

CLOCORTOLONE PIVALATE

3 ST

clodan 1 QL

CLODAN KIT 3 ST

CLODERM 3 ST

CORDRAN 3 ST

CORDRAN TAPE LARGE ROLL

3 ST

cormax 1 QL

CUTIVATE 3 ST

DERMA-SMOOTHE/FS BODY OIL

3 ST

DERMA-SMOOTHE/FS SCALP OIL

3 ST

DERMASORB HC COMPLETE KIT

3 ST

DERMASORB TA COMPLETE KIT

3 ST

DERMATOP 3 ST

DESONATE 3 ST

desonide 1

Drug Name Drug Tier


DESOWEN 3 ST

desoximetasone 1

diflorasone 1

DIPROLENE 3 ST

ELOCON 3 ST

fluocinolone 1

fluocinolone and shower cap

1

fluocinonide 1 QL

fluocinonide-e 1 QL

fluocinonide-emollient

1 QL

flurandrenolide 1

fluticasone 1

halobetasol propionate

1

HALOG 3 ST

hydrocortisone 1

hydrocortisone butyrate

1

hydrocortisone butyr-emollient

1

hydrocortisone valerate

1

hydrocortisone-min oil-wht pet

1

KENALOG 3 ST

LOCOID 3 ST

LOCOID LIPOCREAM

3 ST

LUXIQ 3 ST

mometasone 1

nolix 1

NUCORT 3 ST


39

Drug Name Drug Tier


OLUX 3 ST; QL

OLUX-E 3 ST; QL

PANDEL 3 ST

prednicarbate 1

PROCTOCORT 3 ST

PSORCON 3 ST

scalacort 1

SCALACORT DK 3 ST

SERNIVO 3 ST

SYNALAR 3 ST

SYNALAR CREAM KIT

3 ST

SYNALAR OINTMENT KIT

3 ST

SYNALAR TS 3 ST

TEMOVATE 3 ST; QL

TEXACORT 3 ST

TOPICORT 3 ST

triamcinolone acetonide

1

trianex 1

triderm 1

TRIDESILON 3 ST

ULTRAVATE 3 ST

ULTRAVATE X 3 ST

VANOS 3 ST; QL

VERDESO 3 ST

TOPICAL ENZYMES

SANTYL 2

TOPICAL SCABICIDES / PEDICULICIDES

ELIMITE 3

Drug Name Drug Tier


EURAX 3

lindane 1

malathion 1

NATROBA 3

OVIDE 3

permethrin 1

SKLICE 3

spinosad 1

ULESFIA 3

DIAGNOSTICS & MISCELLANEOUS AGENTS

IRRIGATING SOLUTIONS

lactated ringers 1

neomycin-polymyxin b gu

1

NEOSPORIN GU IRRIGANT

3

PHYSIOLYTE 3

PHYSIOSOL IRRIGATION

3

ringer's 1

SORBITOL 3

SORBITOL-MANNITOL

3

tis-u-sol pentalyte 1

VASHE WOUND THERAPY

3

MISCELLANEOUS AGENTS

acamprosate 1

acetic acid 1

ACTONEL 3 ST; QL

AGRYLIN 3

alendronate 1 QL


40

Drug Name Drug Tier


anagrelide 1

BUPHENYL ORAL POWDER

3

BUPHENYL ORAL TABLET

2

caffeine citrate 1

CARBAGLU 4 LA

CARNITOR 3

CARNITOR (SUGAR-FREE)

3

cevimeline 1

CHEMET 2 PA

disulfiram 1

etidronate disodium 1

EVOXAC 3

EXJADE 4 PA; LA

FERRIPROX 2 PA; LA

GLASSIA 4 PA; LA

INCRELEX 4 PA; LA

INFASURF 3

JADENU 4 PA; LA

JADENU SPRINKLE

4 PA

levocarnitine 1

levocarnitine (with sugar)

1

LIPOCHOL PLUS 3

LITHOSTAT 3

METOPIRONE 3 LA

midodrine 1

NITYR 3

NORTHERA 4 PA; LA

NUTRESTORE 3

Drug Name Drug Tier


ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG

2 LA

ORFADIN ORAL CAPSULE 20 MG

2

ORFADIN ORAL SUSPENSION

2 LA

pilocarpine hcl 1

RADIOGARDASE 3

RAVICTI 4 LA

RILUTEK 3

riluzole 1

risedronate 1 QL

SALAGEN (PILOCARPINE)

3

sodium chloride 1

sodium chloride 0.9 %

1

sodium phenylbutyrate

1

SURVANTA 3

SYPRINE 3 PA

THIOLA 3 LA

water for irrigation, sterile

1

XURIDEN 2 LA

SMOKING DETERRENTS

bupropion hcl (smoking deter)

1 ACA

CHANTIX 2 ACA

CHANTIX CONTINUING MONTH BOX

2 ACA


41

Drug Name Drug Tier


CHANTIX STARTING MONTH BOX

2 ACA

nicorelief 1 ACA; OTC

nicorette 1 ACA; OTC

nicotine 1 ACA; OTC

nicotine (polacrilex) 1 ACA; OTC

NICOTROL 3 ACA

NICOTROL NS 3 ACA

nts step 1 1 ACA; OTC

quit 2 1 ACA; OTC

quit 4 1 ACA; OTC

stop smoking aid 1 ACA; OTC

EAR, NOSE & THROAT MEDICATIONS

MISCELLANEOUS AGENTS

ALZAIR 3

ARESTIN 3 LA

ASTEPRO 3

azelastine nasal aerosol,spray

1 QL

azelastine nasal spray,non-aerosol

1

BACTROBAN NASAL

3

chlorhexidine gluconate

1

CLINPRO 5000 3

DEBACTEROL 3

denta 5000 plus 1

dentagel 1

EPISIL 3

fluoride (sodium) 1

Drug Name Drug Tier


FLUORIDEX DAILY DEFENSE

3

GELCLAIR 3

GELX 3

ipratropium bromide 1 QL

MUGARD 3

olopatadine 1 QL

oralone 1

ORAMAGICRX 3

paroex oral rinse 1

PATANASE 3 QL

PERIDEX 3

periogard 1

pilocarpine hcl 1

PREVIDENT 3

PREVIDENT 5000 BOOSTER PLUS

3

PREVIDENT 5000 DRY MOUTH

3

PREVIDENT 5000 ENAMEL PROTECT

3

PREVIDENT 5000 PLUS

3

PREVIDENT 5000 SENSITIVE

3

SALAGEN (PILOCARPINE)

3

sf 1

sf 5000 plus 1

triamcinolone acetonide

1

TYZINE 3


42

Drug Name Drug Tier


MISCELLANEOUS OTIC PREPARATIONS

acetic acid 1

ciprofloxacin hcl 1

DERMOTIC OIL 3

floxin 1

fluocinolone acetonide oil

1

hydrocortisone-acetic acid

1

ofloxacin 1

OTIPRIO 3

OTIC STEROID / ANTIBIOTIC

CIPRO HC 3

CIPRODEX 2

COLY-MYCIN S 3

neomycin-polymyxin-hc

1

OTOVEL 2

ENDOCRINE/DIABETES

ADRENAL HORMONES

ACTHAR H.P. 4 PA; LA

CORTEF 3

cortisone 1

deltasone 1

dexamethasone 1

dexamethasone intensol

1

DEXPAK 10 DAY 3 ST

DEXPAK 13 DAY 3 ST

DEXPAK 6 DAY 3 ST

fludrocortisone 1

Drug Name Drug Tier


hydrocortisone 1

LOCORT 3 ST

MEDROL 3

MEDROL (PAK) 3

methylprednisolone 1

millipred dp 1

MILLIPRED ORAL SOLUTION

3

millipred oral tablet 1

ORAPRED ODT 3

PEDIAPRED 3

prednisolone 1

prednisolone sodium phosphate

1

prednisone 1

prednisone intensol 1

RAYOS 3 ST

TRIESENCE (PF) 3

veripred 20 1

ZONACORT 3 ST

ANTITHYROID AGENTS

methimazole 1

propylthiouracil 1

SSKI 3

TAPAZOLE 3

BLOOD GLUCOSE MONITORING DEVICES & SUPPLIES

ADVANCED GLUC METER TEST STRIP

3 OTC

AGAMATRIX AMP TEST STRIPS

3 OTC

ASSURE 4 STRIPS 3 OTC


43

Drug Name Drug Tier


ASSURE PLATINUM

3 OTC

ASSURE PRISM MULTI STRIP

3 OTC

BIONIME RIGHTEST TEST STRIPS

3 OTC

BLOOD GLUCOSE TEST

3 OTC

CARESENS N TEST STRIPS

3 OTC

CLEVER CHOICE MICRO TEST STRIP

3 OTC

CLEVER CHOICE PRO

3 OTC

CLEVER CHOICE TEST STRIPS

3 OTC

CLEVER CHOICE VOICE+ TEST

3 OTC

COOL GLUCOSE TEST STRIP

3 OTC

DIATRUE PLUS TEST STRIP

3 OTC

EASY PLUS II TEST

3 OTC

EASY STEP 3 OTC

EASY TALK GLUCOSE TEST

3 OTC

EASY TOUCH TEST STRIP

3 OTC

EASY TRAK GLUCOSE TEST

3 OTC

EASYGLUCO PLUS

3 OTC

EASYGLUCO TEST

3 OTC

Drug Name Drug Tier


EASYMAX 3 OTC

ELEMENT COMPACT TEST STRIPS

3 OTC

ELEMENT TEST STRIPS

3 OTC

EVENCARE G2 3 OTC

EVENCARE G3 TEST

3 OTC

EVENCARE MINI GLUCOSE TEST STR

3 OTC

EVOLUTION TEST STRIPS

3 OTC

EZ SMART PLUS TEST

3 OTC

EZ SMART TEST 3 OTC

FIFTY50 TEST STRIP

3 OTC

FORA D15G 3 OTC

FORA D20 3 OTC

FORA D40-G31 TEST STRIPS

3 OTC

FORA G20 3 OTC

FORA G30A 3 OTC

FORA GD50 TEST STRIPS

3 OTC

FORA TEST STRIP 3 OTC

FORA TN'G VOICE TEST STRIPS

3 OTC

FORA V10 3 OTC

FORA V10-V12-D10-D20 STRIPS

3 OTC

FORA V12 GLUCOSE

3 OTC

FORA V20 3 OTC


44

Drug Name Drug Tier


FORACARE GD20 3 OTC

FORACARE GD40 3 OTC

FORTISCARE GLUCOSE TEST STRIPS

3 OTC

GE100 BLOOD GLUCOSE TEST STRIP

3 OTC

GENSTRIP TEST STRIP

3 OTC

GLUCO NAVII TEST STRIP

3 OTC

GLUCOCARD 01 SENSOR PLUS

3 OTC

GLUCOCARD EXPRESSION

3 OTC

GLUCOCARD SHINE TEST STRIPS

3 OTC

GLUCOCARD VITAL SENSOR

3 OTC

GLUCOCARD VITAL TEST STRIPS

3 OTC

GLUCOCOM GLUCOSE

3 OTC

GM100 3 OTC

HEALTHPRO TEST STRIPS

3 OTC

INFINITY TEST STRIPS

3 OTC

MICRO BLOOD GLUCOSE

3 OTC

MICRODOT BLOOD GLUCOSE SYSTEM

3 OTC

MYGLUCOHEALTH

3 OTC

Drug Name Drug Tier


NEUTEK 2TEK TEST STRIPS

3 OTC

NOVA MAX GLUCOSE TEST

3 OTC

ON CALL EXPRESS TEST STRIP

3 OTC

ON CALL PLUS TEST STRIP

3 OTC

ON CALL VIVID TEST STRIP

3 OTC

ONETOUCH ULTRA TEST

2 OTC

ONETOUCH VERIO

2 OTC

OPTUMRX 3 OTC

PHARMACIST CHOICE

3 OTC

PREMIUM V10 3 OTC

PRODIGY NO CODING

3 OTC

QUINTET AC 3 OTC

REFUAH PLUS 3 OTC

RELION CONFIRM-MICRO

3 OTC

RELION PRIME TEST STRIPS

3 OTC

REVEAL TEST STRIP

3 OTC

RIGHTEST GS550 TEST STRIPS

3 OTC

SMART SENSE TEST STRIPS

3 OTC

SMARTEST TEST 3 OTC

SOLUS V2 TEST STRIPS

3 OTC


45

Drug Name Drug Tier


SURE-TEST EASYPLUS MINI

3 OTC

TELCARE TEST STRIPS

3 OTC

TEST N'GO TEST 3 OTC

ULTRATRAK 3 OTC

ULTRATRAK ULTIMATE

3 OTC

WAVESENSE JAZZ

3 OTC

WAVESENSE PRESTO

3 OTC

DIABETES, SUPPLIES, & DURABLE MEDICAL EQUIPMENT

GLUCAGEN DIAGNOSTIC KIT

2

GLUCAGON HCL 3

INSULIN SYRINGE-NEEDLE U-100

2

GLUCOSE ELEVATING AGENTS

GLUCAGEN HYPOKIT

2

GLUCAGON EMERGENCY KIT (HUMAN)

2

PROGLYCEM 2

INSULIN SYRINGES/MISCELLANEOUS DURABLE MEDICAL EQU

2TEK GLUCOSE/BLOOD PRESSURE

3 OTC

ACCU-CHEK COMPACT PLUS CONTROL

3 OTC

Drug Name Drug Tier


ACCU-CHEK GUIDE L1-L2 CTRL SOL

3 OTC

ACCU-CHEK SMARTVIEW CONTRL SOL

3 OTC

ACCUTREND GLUCOSE CONTROL

3 OTC

ADVANCED GLUCOSE METER

3 OTC

ADVOCATE LOW CONTROL

3 OTC

ADVOCATE REDI-CODE+ CTRL LOW

3 OTC

AGAMATRIX AMP GLUC MONITOR SYS

3 OTC

AGAMATRIX CONTROL HIGH

3 OTC

ASSURE 4 CONTROL SOLUTION

3 OTC

ASSURE DOSE NORMAL CONTROL

3 OTC

ASSURE PLATINUM

3 OTC

ASSURE PRISM CONTROL 1-2 SOLN

3 OTC

ASSURE PRISM MULTI METER

3 OTC

AT HOME A1C 3 OTC

AUTOJECT 2 INJECTION DEVICE

2 OTC


46

Drug Name Drug Tier


AUTOPEN 1 TO 21 UNITS

2 OTC

BIONIME RIGHTEST GM300 SYSTEM

3 OTC

BLOOD GLUCOSE CONTROL, NORMAL

3 OTC

BLOOD-GLUCOSE METER

3 OTC

BREEZE 2 CONTROL SOLUTION,HIGH

3 OTC

CARESENS CONTROL A NORMAL

3 OTC

CARESENS N 3 OTC

CARESENS N VOICE

3 OTC

CARTRIDGE STAMPED IR 1200

2 OTC

CLEO 90 INFUSION SET 24"

2

CLEVER CHEK BLOOD GLUCOSE

3 OTC

CLEVER CHOICE GLUCOSE MONITOR

3 OTC

CLEVER CHOICE LEVEL 2 CONTROL

3 OTC

CLEVER CHOICE MICRO

3 OTC

CLEVER CHOICE PRO

3 OTC

COMFORT INFUSION SET 43"

2

Drug Name Drug Tier


COMFORT SHORT INSULIN PUMP 23"

2

CONTACT DETACH INFUS SET 23"

2

CONTOUR CONTROL SOLUTION, NML

3 OTC

CONTOUR NEXT LEV 2 CONTROL SOL

3 OTC

CONTOUR NEXT LINK

3 OTC

CONTROL AST MONITORING SYSTEM

3 OTC

COOL BLOOD GLUCOSE METER

3 OTC

COOL CONTROL A SOLUTION

3 OTC

DEXCOM G4 RECEIVER

2

DEXCOM G5 RECEIVER

2

DIATRUE CONTROL SOLN NORMAL

3 OTC

DIATRUE PLUS BLOOD GLUCOSE MET

3 OTC

EASY PLUS II BLOOD GLUCOSE MET

3 OTC

EASY STEP BLOOD GLUCOSE METER

3 OTC


47

Drug Name Drug Tier


EASY TALK BLOOD GLUCOSE METER

3 OTC

EASY TOUCH GLUCOSE MONITOR

3 OTC

EASY TRAK LOW CONTROL

3 OTC

EASYGLUCO MONITORING SYSTEM

3 OTC

EASYGLUCO PLUS

3 OTC

EASYGLUCO PLUS NORMAL CONTROL

3 OTC

EASYMAX L BLOOD GLUCOSE METER

3 OTC

EASYMAX LOW CONTROL

3 OTC

EASYMAX NG 3 OTC

EASYMAX NORMAL CONTROL

3 OTC

EASYMAX V SPEAKING GLUCOSE SYS

3 OTC

EASYMAX V2 BLOOD GLUCOSE METER

3 OTC

ELEMENT COMPACT GLUCOSE METER

3 OTC

ELEMENT COMPACT NORMAL CONTROL

3 OTC

Drug Name Drug Tier


ELEMENT COMPACT V GLUCOSE MTR

3 OTC

ELEMENT NORMAL CONTROL

3 OTC

ELEMENT PLUS BLOOD GLUCOSE KIT

3 OTC

EMBRACE EVO LEVEL 1

3 OTC

EMBRACE GLUCOSE CONTROL LOW

3 OTC

ENLITE SYSTEM 3

EVENCARE G2 3 OTC

EVENCARE G3 GLUCOSE METER

3 OTC

EVENCARE MINI MONITOR SYSTEM

3 OTC

EVOLUTION BLOOD GLUCOSE METER

3 OTC

EVOLUTION NORMAL CONTROL

3 OTC

EZ SMART PLUS SYSTEM

3 OTC

EZ SMART SYSTEM

3 OTC

FORA D10 3 OTC

FORA D15 3 OTC

FORA D20 3 OTC

FORA D40 3 OTC

FORA G20 3 OTC

FORA G30A 3 OTC


48

Drug Name Drug Tier


FORA GD50 BLOOD GLUCOSE SYSTEM

3 OTC

FORA NORMAL CONTROL

3 OTC

FORA PREMIUM V10 GLUCOSE METER

3 OTC

FORA TEST N'GO VOICE METER

3 OTC

FORA TN'G VOICE METER

3 OTC

FORA V10 3 OTC

FORA V12 BLOOD GLUCOSE SYSTEM

3 OTC

FORA V20 3 OTC

FORA V30A 3 OTC

FORACARE GD20 GLUCOSE METER

3 OTC

FORACARE GD40A GLUCOSE METER

3 OTC

FORACARE GD40B GLUCOSE METER

3 OTC

FORACARE GDH LOW CONTROL

3 OTC

FORTISCARE BLOOD GLUCOSE SYST

3 OTC

FORTISCARE NORMAL

3 OTC

FREESTYLE CONTROL

3 OTC

GE100 BLOOD GLUCOSE SYSTEM

3 OTC

Drug Name Drug Tier


GE100 CONTROL SOLUTION NORMAL

3 OTC

GLUCO NAVII GLUCOSE MONITOR

3 OTC

GLUCOCARD 01 METER

3 OTC

GLUCOCARD 01 NORMAL CONTROL

3 OTC

GLUCOCARD EXPRESSION

3 OTC

GLUCOCARD SHINE METER

3 OTC

GLUCOCARD VITAL

3 OTC

GLUCOCOM BLOOD GLUCOSE

3 OTC

GLUCOCOM CONTROL NORMAL

3 OTC

GLUCOSE CONTROL

3 OTC

GM100 3 OTC

GUARDIAN REAL-TIME GLU MONITOR

3

HEALTHPRO GLUCOSE MONITOR

3 OTC

HEALTHPRO HIGH-LOW CONTROL

3 OTC

HUMAPEN LUXURA HD

2

INFINITY CONTROL SOLUTION NORM

3 OTC


49

Drug Name Drug Tier


INFINITY STARTER KIT

3 OTC

INSET 30 INFUSION SET 23"

2

INSET INFUSION SET 23"

2

JAZZ WIRELESS 2 METER KIT

3 OTC

LANCETS 2 OTC

LANCING DEVICE 2 OTC

MEDISENSE 3 OTC

MEDISENSE GLUCOSE KETONE

3 OTC

MICRODOT BLOOD GLUCOSE SYSTEM

3 OTC

MINIMED INFUSION SET-MMT 390

2

MIO INFUSION SET

2

MYGLUCOHEALTH

3 OTC

MYGLUCOHEALTH CONTROL SOLUTION

3 OTC

NOVA MAX BLOOD GLUCOSE METER

3 OTC

NOVA MAX GLUCOSE CONTROL

3 OTC

NOVAMAX PLUS GLU-KET

3 OTC

NOVOPEN ECHO 3

OMNIPOD INSULIN REFILL

2

Drug Name Drug Tier


ON CALL EXPRESS CONTROL

3 OTC

ON CALL EXPRESS METER

3 OTC

ON CALL PLUS CONTROL

3 OTC

ON CALL PLUS METER

3 OTC

ON CALL VIVID CONTROL

3 OTC

ON CALL VIVID METER

3 OTC

ON CALL VIVID PAL METER

3 OTC

ONETOUCH ULTRA CONTROL

2 OTC

ONETOUCH ULTRA2

2 OTC

ONETOUCH ULTRAMINI

2 OTC

ONETOUCH VERIO FLEX

2 OTC

ONETOUCH VERIO IQ METER

2 OTC

ONETOUCH VERIO SYNC

2 OTC

ONETOUCH VERIO SYSTEM

2 OTC

OPTUMRX 3 OTC

PARADIGM REAL-TIME TRANSMIT-SN

3

PEN NEEDLE 2 OTC

PHARMACIST CHOICE GLUCOSE SYS

3 OTC


50

Drug Name Drug Tier


PRECISION XTRA MONITOR

2 OTC

PREMIUM BLOOD GLUCOSE MONITOR

3 OTC

PREMIUM V10 3 OTC

PRESTO PRO BLOOD GLUCOSE METER

3 OTC

PRODIGY AUTOCODE METER

3 OTC

PRODIGY AUTOCODE MONITOR SYST

3 OTC

PRODIGY CONTROL SOLUTION, LOW

3 OTC

PRODIGY CONTROL SOLUTION,HIGH

3 OTC

PRODIGY POCKET METER

3 OTC

PRODIGY VOICE GLUCOSE METER

3 OTC

QUICK-SET PARADIGM

2

QUINTET BLOOD GLUCOSE METER

3 OTC

REFUAH PLUS GLUCOSE CONTROL

3 OTC

REFUAH PLUS GLUCOSE MONITOR

3 OTC

RELION ALL-IN-ONE METER

3 OTC

RELION CONFIRM 3 OTC

Drug Name Drug Tier


RELION MICRO GLUCOSE MONITOR

3 OTC

RELION PRIME METER

3 OTC

REVEAL BLOOD GLUCOSE METER

3 OTC

RIGHTEST CONTROL SOLUTION HIGH

3 OTC

RIGHTEST GM550 SYSTEM

3 OTC

SAFE-CLIP BY MAIL

2 OTC

SIDEKICK BLOOD GLUCOSE SYSTEM

3 OTC

SMART SENSE MONITORING SYSTEM

3 OTC

SMARTEST CONTROL

3 OTC

SMARTEST EJECT 3 OTC

SMARTEST PERSONA STARTER

3 OTC

SMARTEST PRONTO STARTER

3 OTC

SMARTEST PROTEGE

3 OTC

SNAP INSULIN PUMP-INFUSION SET

2

SOLUS V2 AUDIBLE METER

3 OTC

SOLUS V2 CONTROL SOLUTION,HIGH

3 OTC


51

Drug Name Drug Tier


SURE-T PARADIGM

2

SURE-TEST EASYPLUS MINI METER

3 OTC

T:30 INFUSION SET

2

T:90 INFUSION SET 23"

2

T:SLIM 2

T:SLIM G4 2

TELCARE BGM 3 OTC

TELCARE BLOOD GLUCOSE KIT

3 OTC

TELCARE CONTROL

3 OTC

TEST N'GO BLOOD GLUCOSE SYSTEM

3 OTC

TRUE METRIX LEVEL 1

3 OTC

TRUECONTROL LEVEL 0

3 OTC

TRUETRACK BLOOD GLUCOSE SYSTEM

3 OTC

ULTIMA MONITOR

3 OTC

ULTRATRAK GLUCOSE METER

3 OTC

ULTRATRAK ULTIMATE

3 OTC

UNISTRIP LOW CONTROL

3 OTC

VGO 20 2

VGO 30 2

VGO 40 2

Drug Name Drug Tier


WAVESENSE AMP 3 OTC

WAVESENSE CONTROL SOLUTION

3 OTC

WAVESENSE PRESTO

3 OTC

INSULIN THERAPY

AFREZZA 3

APIDRA 3

APIDRA SOLOSTAR

3

BASAGLAR KWIKPEN

3

HUMALOG 2

HUMALOG JUNIOR KWIKPEN

3

HUMALOG KWIKPEN

2

HUMALOG MIX 50-50

2

HUMALOG MIX 50-50 KWIKPEN

2

HUMALOG MIX 75-25

2

HUMALOG MIX 75-25 KWIKPEN

2

HUMULIN 70/30 2

HUMULIN 70/30 KWIKPEN

2

HUMULIN N 2

HUMULIN N KWIKPEN

2

HUMULIN R U-100 2

HUMULIN R U-500 (CONC) KWIKPEN

2


52

Drug Name Drug Tier


HUMULIN R U-500 (CONCENTRATED)

2

LANTUS 2

LANTUS SOLOSTAR

2

LEVEMIR 2

LEVEMIR FLEXTOUCH

2

NOVOLOG 3

NOVOLOG FLEXPEN

3

NOVOLOG MIX 70-30

3

NOVOLOG MIX 70-30 FLEXPEN

3

NOVOLOG PENFILL

3

RELION NOVOLIN 70/30

3

RELION NOVOLIN N

3

RELION NOVOLIN R

3

SOLIQUA 100/33 2 QL

TOUJEO SOLOSTAR

2

TRESIBA FLEXTOUCH U-100

2

TRESIBA FLEXTOUCH U-200

2

XULTOPHY 100/3.6

2 QL

MISCELLANEOUS HORMONES

ANADROL-50 3

Drug Name Drug Tier


ANDRODERM 2 PA

ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP

2 PA

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

3 PA; ST

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

2 PA

ANDROID 3 ST

AXIRON 3 PA

cabergoline 1 QL

calcitonin (salmon) 1

calcitriol 1

CERDELGA 4

danazol 1

DDAVP 3

DEPO-TESTOSTERONE

3 PA

desmopressin 1

doxercalciferol 1

HECTOROL 3

KORLYM 3 PA; LA

KUVAN 4 PA; LA

METHITEST 2

methyltestosterone 1


53

Drug Name Drug Tier


MIACALCIN 2

MYALEPT 4 PA; LA

NATPARA 4 PA; LA

OXANDRIN 3

oxandrolone 1

paricalcitol 1

RAYALDEE 3

ROCALTROL 3

SAMSCA 4 PA; LA; QL

SENSIPAR 2 PA

SOMAVERT 4 LA

STIMATE 4

STRENSIQ 2 LA

STRIANT 3 PA; ST

SYNAREL 2

TESTOPEL 3 PA; LA

testosterone 1 PA

testosterone cypionate

1 PA

testosterone enanthate

1 PA

TESTRED 3 ST

ZAVESCA 4 LA

ZEMPLAR 3

NON-INSULIN HYPOGLYCEMIC AGENTS

acarbose 1

ACTOPLUS MET 3 ST; QL

ACTOPLUS MET XR

3 ST; QL

ACTOS 3 ST; QL

ALOGLIPTIN-PIOGLITAZONE

3 QL

Drug Name Drug Tier


AMARYL 3

AVANDIA 3 ST; LA; QL

BYDUREON 2 PA; QL

BYETTA 2 PA; QL

chlorpropamide 1

CYCLOSET 3

DUETACT 3 ST; QL

FARXIGA 2 ST; QL

FORTAMET 3 ST

glimepiride 1

glipizide 1

glipizide-metformin 1

GLUCOPHAGE 3 ST

GLUCOPHAGE XR 3 ST

GLUCOTROL 3

GLUCOTROL XL 3

GLUCOVANCE 3

glyburide 1

glyburide micronized

1

glyburide-metformin 1

GLYNASE 3

GLYSET 3

GLYXAMBI 2 ST; QL

INVOKAMET 2 ST; QL

INVOKAMET XR 2 ST; QL

INVOKANA 2 ST; QL

JANUMET 2 QL

JANUMET XR 2 QL

JANUVIA 2 QL

JARDIANCE 2 ST; QL

JENTADUETO 2 QL


54

Drug Name Drug Tier


JENTADUETO XR 2 QL

metformin oral tablet

1

metformin oral tablet extended release 24 hr

1

metformin oral tablet extended release 24hr

1 ST

metformin oral tablet,er gast.retention 24 hr

1 ST

miglitol 1

nateglinide 1

NESINA 3 ST; QL

ONGLYZA 3 ST; QL

OSENI 3 QL

pioglitazone 1 QL

pioglitazone-glimepiride

1 QL

pioglitazone-metformin

1 QL

PRANDIN 3

PRECOSE 3

repaglinide 1

repaglinide-metformin

1 QL

RIOMET 3 ST

STARLIX 3

SYMLINPEN 120 2 PA; QL

SYMLINPEN 60 2 PA; QL

SYNJARDY 2 ST; QL

SYNJARDY XR 2 ST; QL

TANZEUM 3 PA; QL

Drug Name Drug Tier


tolazamide 1

tolbutamide 1

TRADJENTA 2 QL

TRULICITY 2 PA; QL

XIGDUO XR 2 ST; QL

THYROID HORMONES

ARMOUR THYROID

2

CYTOMEL 3

LEVO-T 3

levothyroxine 1

levoxyl 1

liothyronine 1

nature-throid 1

np thyroid 1

SYNTHROID 3

THYROLAR-1 3

THYROLAR-1/2 3

THYROLAR-1/4 3

THYROLAR-2 3

THYROLAR-3 3

TIROSINT 3

unithroid 1

westhroid 1

WP THYROID 3

GASTROENTEROLOGY

ANTIDIARRHEALS & ANTISPASMODICS

anaspaz 1

belladonna alkaloids-opium

1

belladonna-opium 1


55

Drug Name Drug Tier


BENTYL 3

chlordiazepoxide-clidinium

1

CUVPOSA 3

dicyclomine 1

diphenoxylate-atropine

1

DONNATAL 3

ed-spaz 1

glycopyrrolate 1

hyoscyamine sulfate 1

hyosyne 1

LEVBID 3

LEVSIN 3

LEVSIN/SL 3

LOMOTIL 3

loperamide 1

methscopolamine 1

MOTOFEN 3

MYTESI 3

NULEV 3

opium tincture 1

oscimin 1

oscimin sl 1

oscimin sr 1

paregoric 1

phenobarb-hyoscy-atropine-scop

1

phenohytro 1

propantheline 1

ROBINUL 3

ROBINUL FORTE 3

Drug Name Drug Tier


SYMAX DUOTAB 3

symax fastabs 1

symax-sl 1

symax-sr 1

MISCELLANEOUS GASTROINTESTINAL AGENTS

ACTIGALL 3

AKYNZEO 2 QL

alophen 1 ACA; OTC

alosetron 1

AMITIZA 2

ANA-LEX KIT 3

ANALPRAM-HC 3

ANALPRAM-HC SINGLES

3

anucort-hc 1

ANUSOL-HC 3 ST

ANZEMET 3 QL

aprepitant 1 QL

APRISO 2

AURYXIA 3

AZULFIDINE 3

AZULFIDINE EN-TABS

3

balsalazide 1

bisacodyl 1 ACA; OTC

bisa-lax 1 ACA; OTC

budesonide 1

calcium acetate 1

CANASA 2

CESAMET 3 QL

CHENODAL 2 PA; LA


56

Drug Name Drug Tier


CHOLBAM ORAL CAPSULE 250 MG

2 PA; LA

CHOLBAM ORAL CAPSULE 50 MG

2 PA; LA; QL

CIMZIA 4 PA; ST; LA

CIMZIA POWDER FOR RECONST

4 PA; ST; LA

citrate of magnesia 1 ACA; OTC

citroma 1 ACA; OTC

clearlax 1 ACA; OTC

COLAZAL 3

colocort 1

COLYTE WITH FLAVOR PACKS

3

COMPAZINE 3

compro 1

constulose 1

CORTENEMA 3

CORTIFOAM 2

CREON 2

cromolyn 1

CYSTADANE 2 LA

DICLEGIS 3 PA

DIPENTUM 3

dronabinol 1

ducodyl 1 ACA; OTC

eliphos 1

EMEND ORAL CAPSULE 125 MG, 40 MG

2 QL

EMEND ORAL CAPSULE 80 MG

3 QL

Drug Name Drug Tier


EMEND ORAL CAPSULE,DOSE PACK

3 QL

EMEND ORAL SUSPENSION FOR RECONSTITUTION

2 QL

ENTEREG 3

ENTOCORT EC 3

enulose 1

fleet laxative 1 ACA; OTC

FOSRENOL 3

GASTROCROM 3

GATTEX 30-VIAL 4 LA

gavilax 1 ACA; OTC

gavilyte-c 1 ACA

gavilyte-g 1 ACA

gavilyte-n 1 ACA

generlac 1

gentle laxative 1 ACA; OTC

gentlelax 1 ACA; OTC

GIALAX 3

GIAZO 3

glycolax 1 ACA; OTC

GOLYTELY 3

granisetron hcl 1 QL

healthylax 1 ACA; OTC

hemmorex-hc 1

hydrocortisone 1

hydrocortisone acetate

1

hydrocortisone-pramoxine

1


57

Drug Name Drug Tier


kionex 1

kionex (with sorbitol)

1

KRISTALOSE 3

lactulose 1

laxaclear 1 ACA; OTC

laxative (bisacodyl) 1 ACA; OTC

laxative feminine 1 ACA; OTC

laxative peg 3350 1 ACA; OTC

LIALDA 3

LIDOCAINE HCL-HYDROCORTISON AC RECTAL CREAM 3 %-1 % (7 GRAM)

3

lidocaine hcl-hydrocortison ac rectal cream 3-0.5 %

1

LIDOCAINE HCL-HYDROCORTISON AC RECTAL GEL

3

lidocaine hcl-hydrocortison ac rectal kit

1

lidocaine-hydrocortisone-aloe

1

LINZESS 2

LOTRONEX 3

MAGNEBIND 400 3

magnesium citrate 1 ACA; OTC

MARINOL 3

meclizine 1

mesalamine 1

mesalamine with cleansing wipe

1

Drug Name Drug Tier


metoclopramide hcl 1

MICORT-HC 3 ST

milk of magnesia 1 ACA; OTC

milk of magnesia concentrated

1 ACA; OTC

miralax 1 ACA; OTC

MOVANTIK 2

MOVIPREP 3

natura-lax 1 ACA; OTC

NULYTELY WITH FLAVOR PACKS

3

OCALIVA 4 PA; LA; QL

ondansetron 1 QL

ondansetron hcl 1 QL

oral saline laxative 1 ACA; OTC

OSMOPREP 3

peg 3350-electrolytes

1 ACA

peg3350 1 ACA; OTC

peg-electrolyte soln 1 ACA

peg-prep 1 ACA

PENTASA 2

PHOSLYRA 2

phosphate laxative 1 ACA; OTC

polyethylene glycol 3350

1 ACA

powderlax 1 ACA; OTC

pramcort 1

PREPOPIK 2

prochlorperazine 1

prochlorperazine maleate

1

PROCORT 3


58

Drug Name Drug Tier


PROCTOCORT 3 ST

PROCTOFOAM HC 3

procto-med hc 1

procto-pak 1

proctosol hc 1

proctozone-hc 1

purelax 1 ACA; OTC

RECTIV 2

REGLAN 3

RELISTOR ORAL 3 ST

RELISTOR SUBCUTANEOUS

2 ST

RENVELA ORAL POWDER IN PACKET

3

RENVELA ORAL TABLET

2

ROWASA 3

SANCUSO 2 QL

scopolamine base 1

sevelamer carbonate 1

SFROWASA 3

smoothlax 1 ACA; OTC

sodium polystyrene sulfonate oral

1

sodium polystyrene sulfonate rectal enema 30 gram/120 ml

1

SODIUM POLYSTYRENE SULFONATE RECTAL ENEMA 50 GRAM/200 ML

3

SOLESTA 3

Drug Name Drug Tier


sps (with sorbitol) 1

SUCRAID 2 LA

sulfasalazine 1

SUPREP BOWEL PREP KIT

2

SYNDROS 3

TIGAN 3

TRANSDERM-SCOP

3

trilyte with flavor packets

1 ACA

trimethobenzamide 1

UCERIS ORAL 2

UCERIS RECTAL 3

URSO 250 3

URSO FORTE 3

ursodiol 1

VARUBI 2 QL

VELPHORO 2

VELTASSA 2 LA

VIBERZI 2

VIOKACE 2

woman's laxative 1 ACA; OTC

women's gentle laxative(bisac)

1 ACA; OTC

women's laxative (bisacodyl)

1 ACA; OTC

ZENPEP 2

ZOFRAN (AS HYDROCHLORIDE)

3 QL

ZOFRAN ODT 3 QL

ZUPLENZ 3 QL


59

Drug Name Drug Tier


ULCER THERAPY

amoxicil-clarithromy-lansopraz

1 QL

CARAFATE ORAL SUSPENSION

2

CARAFATE ORAL TABLET

3

cimetidine 1

cimetidine hcl 1

CYTOTEC 3

DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 30 MG

3 ST; QL

DEXILANT ORAL CAPSULE,BIPHASE DELAYED RELEAS 60 MG

3 ST

esomeprazole magnesium oral capsule,delayed release(dr/ec) 20 mg

1 QL

esomeprazole magnesium oral capsule,delayed release(dr/ec) 40 mg

1

ESOMEPRAZOLE STRONTIUM ORAL CAPSULE,DELAYED RELEASE(DR/EC) 24.65 MG

3 ST; QL

Drug Name Drug Tier


ESOMEPRAZOLE STRONTIUM ORAL CAPSULE,DELAYED RELEASE(DR/EC) 49.3 MG

3 ST

famotidine 1

lansoprazole oral capsule,delayed release(dr/ec) 15 mg

1 QL

lansoprazole oral capsule,delayed release(dr/ec) 30 mg

1

misoprostol 1

NEXIUM ORAL CAPSULE,DELAYED RELEASE(DR/EC) 20 MG

3 ST; QL

NEXIUM ORAL CAPSULE,DELAYED RELEASE(DR/EC) 40 MG

3 ST

NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 10 MG, 2.5 MG, 20 MG, 5 MG

2 ST; QL

NEXIUM PACKET ORAL GRANULES DR FOR SUSP IN PACKET 40 MG

2 ST

nizatidine 1

OMECLAMOX-PAK

3 QL

omeppi oral capsule 20-1.1 mg-gram

1 ST; QL


60

Drug Name Drug Tier


omeppi oral capsule 40-1.1 mg-gram

1 ST

omeprazole oral capsule,delayed release(dr/ec) 10 mg

1 QL

omeprazole oral capsule,delayed release(dr/ec) 20 mg, 40 mg

1

omeprazole-sodium bicarbonate oral capsule 20-1.1 mg-gram

1 ST; QL

omeprazole-sodium bicarbonate oral capsule 40-1.1 mg-gram

1 ST

omeprazole-sodium bicarbonate oral packet 20-1,680 mg

1 ST; QL

omeprazole-sodium bicarbonate oral packet 40-1,680 mg

1 ST

pantoprazole oral tablet,delayed release (dr/ec) 20 mg

1 QL

pantoprazole oral tablet,delayed release (dr/ec) 40 mg

1

PEPCID 3

PREVACID 3 ST; QL

PREVPAC 3 QL

PYLERA 2

rabeprazole 1

ranitidine hcl 1

sucralfate 1

Drug Name Drug Tier


ZANTAC 3

ZEGERID ORAL CAPSULE 20-1.1 MG-GRAM

3 ST; QL

ZEGERID ORAL CAPSULE 40-1.1 MG-GRAM

3 ST

ZEGERID ORAL PACKET 20-1,680 MG

3 ST; QL

ZEGERID ORAL PACKET 40-1,680 MG

3 ST

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY

BIOTECHNOLOGY DRUGS

ARANESP (IN POLYSORBATE)

4 PA

GRANIX 4 ST

LEUKINE 4

MOZOBIL 4 LA

NEULASTA 4 PA; QL

PROCRIT 4 PA

ZARXIO 4 ST

GROWTH HORMONES

EGRIFTA 4 PA; LA

GENOTROPIN 4 PA

GENOTROPIN MINIQUICK

4 PA

HUMATROPE 4 PA

NORDITROPIN FLEXPRO

4 PA

SEROSTIM 4 PA

ZORBTIVE 4 PA; LA

INTERFERONS


61

Drug Name Drug Tier


AUBAGIO 4 PA; LA

AVONEX 4 PA; QL

AVONEX (WITH ALBUMIN)

4 PA; QL

BETASERON 4 PA; ST; QL

COPAXONE 4 PA; ST; QL

COPEGUS 4 PA

EXTAVIA 4 PA; QL

GILENYA 4 PA

glatopa 4 PA; QL

moderiba 4 PA

moderiba dose pack 4 PA

PEGASYS 4 PA; QL

PEGASYS PROCLICK

4 PA; QL

PEGINTRON 4 PA; QL

PLEGRIDY 4 PA; ST; QL

POMALYST 4 LA

REBETOL 4 PA

REBIF (WITH ALBUMIN)

4 PA; QL

REBIF REBIDOSE 4 PA; QL

REBIF TITRATION PACK

4 PA; QL

REVLIMID 4 PA; LA

ribasphere 4 PA

ribavirin 4 PA

SYLATRON SUBCUTANEOUS KIT 200 MCG, 600 MCG

4

SYLATRON SUBCUTANEOUS KIT 300 MCG

4 LA

Drug Name Drug Tier


TECFIDERA 4 PA; LA

ZINBRYTA 4 PA; ST; LA; QL

INTERLEUKINS

ACTIMMUNE 4 LA

ALDARA 3

ALFERON N 2

ARCALYST 4 PA; LA

imiquimod 1

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

4 LA

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

4

INTRON A INJECTION SOLUTION

4 LA

KINERET 3 PA; ST; LA

PROLEUKIN 4

VACCINES & MISCELLANEOUS IMMUNOLOGICALS

ACTHIB (PF) 2 ACA

ADACEL(TDAP ADOLESN/ADULT)(PF)

2 ACA

AFLURIA 2017-2018

2 ACA

AFLURIA 2017-2018 (PF)

2 ACA

AFLURIA QUAD 2017-2018

2 ACA


62

Drug Name Drug Tier


AFLURIA QUAD 2017-2018 (PF)

2 ACA

BCG VACCINE, LIVE (PF)

2 ACA

BEXSERO 2 ACA

BIOTHRAX 2 ACA

BOOSTRIX TDAP 2 ACA

BOTOX 2 PA

DAPTACEL (DTAP PEDIATRIC) (PF)

2 ACA

ENGERIX-B (PF) 2 ACA

ENGERIX-B PEDIATRIC (PF)

2 ACA

FLUAD 2017-2018 (65 YR UP)(PF)

2 ACA

FLUARIX QUAD 2017-2018 (PF)

2 ACA

FLUBLOK 2017-2018 (PF)

2 ACA

FLUBLOK QUAD 2017-2018 (PF)

2 ACA

FLUCELVAX QUAD 2017-2018

2 ACA

FLUCELVAX QUAD 2017-2018 (PF)

2 ACA

FLULAVAL QUAD 2017-2018

2 ACA

FLULAVAL QUAD 2017-2018 (PF)

2 ACA

FLUVIRIN 2017-2018

2 ACA

FLUVIRIN 2017-2018 (PF)

2 ACA

FLUZONE HIGH-DOSE 2017-18 (PF)

2 ACA

Drug Name Drug Tier


FLUZONE INTRADERM QUAD 2017-18

2 ACA

FLUZONE QUAD 2017-2018

2 ACA

FLUZONE QUAD 2017-2018 (PF)

2 ACA

FLUZONE QUAD PEDI 2017-18 (PF)

2 ACA

GARDASIL 9 (PF) 2 ACA

HAVRIX (PF) 2 ACA

HIBERIX (PF) 2 ACA

IMOVAX RABIES VACCINE (PF)

2 ACA

INFANRIX (DTAP) (PF)

2 ACA

IPOL 2 ACA

IXIARO (PF) 2 ACA

KINRIX (PF) 3 ACA

MENACTRA (PF) 2 ACA

MENHIBRIX (PF) 3 ACA

MENOMUNE - A/C/Y/W-135

2 ACA

MENOMUNE - A/C/Y/W-135 (PF)

2 ACA

MENVEO A-C-Y-W-135-DIP (PF)

3 ACA

M-M-R II (PF) 2 ACA

PEDIARIX (PF) 2 ACA

PEDVAX HIB (PF) 2 ACA

PENTACEL (PF) 2 ACA

PENTACEL ACTHIB COMPONENT (PF)

2 ACA

PNEUMOVAX 23 2 ACA


63

Drug Name Drug Tier


PREVNAR 13 (PF) 2 ACA

PROQUAD (PF) 2 ACA

QUADRACEL (PF) 2 ACA

RABAVERT (PF) 2 ACA

RECOMBIVAX HB (PF)

2 ACA

ROTARIX 3 ACA

ROTATEQ VACCINE

2 ACA

STAMARIL (PF) 2 ACA

TENIVAC (PF) 3 ACA

TETANUS,DIPHTHERIA TOX PED(PF)

2 ACA

TETANUS-DIPHTHERIA TOXOIDS-TD

2 ACA

TRUMENBA 2 ACA

TWINRIX (PF) 2 ACA

TYPHIM VI 2 ACA

VAQTA (PF) INTRAMUSCULAR SUSPENSION

2 ACA

VAQTA (PF) INTRAMUSCULAR SYRINGE

3 ACA

VARIVAX (PF) 2 ACA

VARIZIG 2 ACA

VAXCHORA VACCINE

2 ACA

VIVOTIF 2 ACA

VIVOTIF BERNA VACCINE

2 ACA

YF-VAX (PF) 2 ACA

ZOSTAVAX (PF) 2 ACA

Drug Name Drug Tier


MUSCULOSKELETAL & RHEUMATOLOGY

GOUT THERAPY

allopurinol 1

COLCRYS 2 ST

MITIGARE 2

probenecid 1

probenecid-colchicine

1

ULORIC 2 ST

ZURAMPIC 3 ST

ZYLOPRIM 3

OSTEOPOROSIS THERAPY

ACTONEL 3 ST; QL

alendronate 1 QL

ATELVIA 3 ST; QL

BINOSTO 3 ST; QL

BONIVA 3 ST; QL

EVISTA 3

FOSAMAX 3 ST; QL

FOSAMAX PLUS D

3 ST; QL

ibandronate 1 QL

raloxifene 1 ACA

risedronate 1 QL

TYMLOS 4 PA; QL

OTHER RHEUMATOLOGICALS

ACTEMRA 4 PA; ST; LA

ARAVA 3 QL

BENLYSTA 4

CUPRIMINE 3


64

Drug Name Drug Tier


DEPEN TITRATABS

2

ENBREL 4 ST; QL

ENBREL SURECLICK

4 ST; QL

HUMIRA 4 ST; LA; QL

HUMIRA PEDIATRIC CROHN'S START

4 ST; LA; QL

HUMIRA PEN CROHN'S-UC-HS START

4 ST; LA; QL

HUMIRA PEN PSORIASIS-UVEITIS

4 ST; LA; QL

KEVZARA 4 ST; QL

leflunomide 1 QL

ORENCIA CLICKJECT

4 ST

ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML

4 PA; ST

ORENCIA SUBCUTANEOUS SYRINGE 50 MG/0.4 ML, 87.5 MG/0.7 ML

4 ST

OTEZLA 4 PA; ST; LA

OTEZLA STARTER

4 PA; ST; LA

OTREXUP (PF) 2 ST

RASUVO (PF) 2 ST

RIDAURA 2

SAVELLA 2 ST; QL

SIMPONI 4 PA; ST

SIMPONI ARIA 4 PA; ST

Drug Name Drug Tier


XELJANZ 4 ST

XELJANZ XR 4 ST

OBSTETRICS & GYNECOLOGY

ESTROGENS & PROGESTINS

ACTIVELLA 3

ALORA 3 QL

amabelz 1

ANGELIQ 3

AYGESTIN 3

CLIMARA 3 QL

CLIMARA PRO 3 QL

COMBIPATCH 2

covaryx 1

covaryx h.s. 1

CRINONE 2

DELESTROGEN 3

DEPO-ESTRADIOL 2

DIVIGEL 2 QL

DUAVEE 2

eemt 1

eemt hs 1

ELESTRIN 3 QL

ESTRACE ORAL 3

ESTRACE VAGINAL

2

estradiol oral 1

estradiol transdermal

1 QL

estradiol vaginal 1

estradiol valerate 1


65

Drug Name Drug Tier


estradiol-norethindrone acet

1

ESTRING 2

estrogens-methyltestosterone

1

estropipate 1

EVAMIST 3 QL

FEMHRT LOW DOSE

3

fyavolv 1

jevantique lo 1

jinteli 1

lopreeza 1

medroxyprogesterone

1

MENEST 3

MENOSTAR 3 QL

mimvey 1

mimvey lo 1

MINIVELLE 2 QL

norethindrone acetate

1

norethindrone ac-eth estradiol

1

PREFEST 3

PREMARIN 2

PREMPHASE 2

PREMPRO 2

progesterone 1

progesterone micronized

1

PROMETRIUM 3

PROVERA 3

Drug Name Drug Tier


VAGIFEM 3

VIVELLE-DOT 3 QL

yuvafem 1

MISCELLANEOUS OB/GYN

AVC VAGINAL 3

CERVIDIL 3

CLEOCIN 3

clindamycin phosphate

1

CLINDESSE 3

fem ph 1

GYNAZOLE-1 3

INTRAROSA 3

isoxsuprine 1

LUPANETA PACK (1 MONTH)

4 PA

LUPANETA PACK (3 MONTH)

4 PA

LYSTEDA 3

METROGEL VAGINAL

3

metronidazole 1

miconazole-3 1

NUVESSA 3

OSPHENA 3

PREPIDIL 3

PROSTIN E2 3

RELAGARD 3

TERAZOL 7 3

terconazole 1

tranexamic acid 1

vandazole 1


66

Drug Name Drug Tier


OXYTOCICS

methergine 1

OPHTHALMOLOGY

ANTIBIOTICS

AZASITE 2

bacitracin 1

bacitracin-polymyxin b

1

BESIVANCE 3

BETADINE OPHTHALMIC PREP

3

CEFUROXIME SODIUM-0.9%NACL(PF)

3

CILOXAN 3

ciprofloxacin hcl 1

erythromycin 1

gatifloxacin 1

gentak 1

gentamicin 1

levofloxacin 1

MOXEZA 2

moxifloxacin 1

MOXIFLOXACIN (PF)-BSS NO.2

3

NATACYN 2

neomycin-bacitracin-polymyxin

1

neomycin-polymyxin-gramicidin

1

neo-polycin 1

Drug Name Drug Tier


OCUFLOX 3

ofloxacin 1

polycin 1

polymyxin b sulf-trimethoprim

1

POLYTRIM 3

tobramycin 1

TOBREX 3

VIGAMOX 3

ZYMAXID 3

ANTIVIRALS

trifluridine 1

VIROPTIC 3

ZIRGAN 3

BETA-BLOCKERS

BETAGAN 3

betaxolol 1

BETIMOL 3

BETOPTIC S 3

carteolol 1

levobunolol 1

metipranolol 1

timolol maleate 1

TIMOPTIC 3

TIMOPTIC-XE 3

CHOLINESTERASE INHIBITOR MIOTICS

PHOSPHOLINE IODIDE

2

CYCLOPLEGIC MYDRIATICS

atropine 1

CYCLOGYL 3


67

Drug Name Drug Tier


cyclopentolate 1

homatropaire 1

homatropine hbr 1

MYDRIACYL 3

PAREMYD 3

tropicamide 1

DIRECT ACTING MIOTICS

ISOPTO CARPINE 3

MIOCHOL-E 3

pilocarpine hcl 1

MISCELLANEOUS OPHTHALMOLOGICS

acuicyn 1

AKTEN (PF) 3

ALOCRIL 3 ST

ALOMIDE 3 ST

altacaine 1

altafluor 1

AVENOVA 3

azelastine 1

BEPREVE 2 ST

cromolyn 1

CYSTARAN 2 LA

ELESTAT 3 ST

EMADINE 3 ST

epinastine 1

EYLEA 4 PA; LA

flucaine 1

fluorescein-proparacaine

1

flurox 1

JETREA (PF) 2 LA

Drug Name Drug Tier


LACRISERT 3

LASTACAFT 3 ST

LUCENTIS 4 PA

MACUGEN 4 PA; LA

olopatadine 1

OMIDRIA 3

PATADAY 3 ST

PATANOL 3 ST

PAZEO 2 ST

proparacaine 1

RESTASIS 2 PA; QL

RESTASIS MULTIDOSE

2 PA; QL

tetcaine 1

tetracaine hcl 1

tetracaine hcl (pf) 1

TETRAVISC 3

TETRAVISC FORTE

3

XIIDRA 2 PA; QL

NON-STEROIDAL ANTI-INFLAMMATORY AGENTS

ACULAR 3

ACULAR LS 3

bromfenac 1

BROMSITE 3

diclofenac sodium 1

flurbiprofen sodium 1

ILEVRO 2

ketorolac 1

OCUFEN 3

PROLENSA 2


68

Drug Name Drug Tier


ORAL DRUGS FOR GLAUCOMA

acetazolamide 1

DIAMOX SEQUELS

3

methazolamide 1

NEPTAZANE 3

OTHER GLAUCOMA DRUGS

AZOPT 3

bimatoprost 1 PA

COMBIGAN 2

COSOPT 3

COSOPT (PF) 3

dorzolamide 1

dorzolamide-timolol 1

latanoprost 1 PA

LUMIGAN 2 PA; ST

miostat 1

MITOSOL 3

SIMBRINZA 3

TRAVATAN Z 2 PA; ST

TRUSOPT 3

XALATAN 3 PA; ST

STEROID-ANTIBIOTIC COMBINATIONS

MAXITROL 3

neomycin-bacitracin-poly-hc

1

neomycin-polymyxin b-dexameth

1

neomycin-polymyxin-hc

1

neo-polycin hc 1

PRED-G 3

Drug Name Drug Tier


PRED-G S.O.P. 3

TOBRADEX OPHTHALMIC (EYE) DROPS,SUSPENSION

3

TOBRADEX OPHTHALMIC (EYE) OINTMENT

2

TOBRADEX ST 2

tobramycin-dexamethasone

1

ZYLET 2

STEROIDS

ALREX 2 ST

dexamethasone sodium phosphate

1

DUREZOL 3

FLAREX 3

fluorometholone 1

FML FORTE 3

FML LIQUIFILM 3

FML S.O.P. 3

ILUVIEN 4 LA

LOTEMAX 2

MAXIDEX 3

OMNIPRED 3

OZURDEX 4

PRED FORTE 3

PRED MILD 3

prednisolone acetate 1

prednisolone sodium phosphate

1

RETISERT 4


69

Drug Name Drug Tier


STEROID-SULFONAMIDE COMBINATIONS

BLEPHAMIDE 3

BLEPHAMIDE S.O.P.

3

sulfacetamide-prednisolone

1

SULFONAMIDES

BLEPH-10 3

sulfacetamide sodium

1

SYMPATHOMIMETICS

ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.1 %

2

ALPHAGAN P OPHTHALMIC (EYE) DROPS 0.15 %

3

apraclonidine 1

brimonidine 1

IOPIDINE 3

VASOCONSTRICTOR DECONGESTANTS

CYCLOMYDRIL 3

phenylephrine hcl 1

RESPIRATORY, ALLERGY, COUGH & COLD

ANTIHISTAMINE & ANTIALLERGENIC AGENTS

carbinoxamine maleate

1

cetirizine 1

Drug Name Drug Tier


CLARINEX ORAL SYRUP

3

CLARINEX ORAL TABLET

3 QL

clemastine 1

cyproheptadine 1

desloratadine 1 QL

diphenhydramine hcl 1

EPINEPHRINE INJECTION AUTO-INJECTOR 0.15 MG/0.15 ML

3 QL

EPINEPHRINE INJECTION AUTO-INJECTOR 0.15 MG/0.3 ML, 0.3 MG/0.3 ML

2 QL

EPIPEN 2-PAK 2 QL

EPIPEN JR 2-PAK 2 QL

hydroxyzine hcl 1

hydroxyzine pamoate

1

KARBINAL ER 3

levocetirizine oral solution

1

levocetirizine oral tablet

1 QL

phenadoz 1

phenergan 1

promethazine 1

promethegan 1

RYVENT 3

VISTARIL 3

XYZAL ORAL SOLUTION

3


70

Drug Name Drug Tier


XYZAL ORAL TABLET

3 QL

COUGH & COLD THERAPY

benzonatate 1

BROMFED DM 3

brompheniramine-pseudoeph-dm

1

CAPCOF 3

centergy 1

cheratussin ac 1

CLARINEX-D 12 HOUR

3 QL

codeine-guaifenesin 1

CODITUSSIN AC 3

CODITUSSIN DAC 3

FLOWTUSS 3 ST

g tussin ac 1

guaiatussin ac 1

guaifenesin ac 1

guaifenesin dac 1

HISTEX-AC 3

HYCOFENIX 3 ST

hydrocodone-chlorpheniramine

1

hydrocodone-cpm-pseudoephed

1

hydrocodone-homatropine

1

hydromet 1

lortuss ex 1

MAR-COF BP 3

MAR-COF CG 3

m-clear wc 1

Drug Name Drug Tier


M-END PE 3

NINJACOF-XG 3

OBREDON 3 ST

POLY-TUSSIN AC 3

promethazine vc-codeine

1

promethazine-codeine

1

promethazine-dm 1

promethazine-phenyleph-codeine

1

promethazine-phenylephrine

1

PRO-RED AC (W/ DEXCHLORPHENIR)

3

relcof c 1

RESPA-AR 3

REZIRA 3

rydex 1

SEMPREX-D 3

TESSALON PERLES

3

tusnel c 1

TUSNEL PEDIATRIC

3

TUSSICAPS 3 ST

tussigon 1

TUSSIONEX PENNKINETIC ER

3

TUZISTRA XR 3 ST

virtussin ac 1

virtussin dac 1

VITUZ 3 ST


71

Drug Name Drug Tier


ZODRYL AC 25 3

ZODRYL AC 30 3

ZODRYL AC 35 3

ZODRYL AC 40 3

ZODRYL AC 50 3

ZODRYL AC 60 3

ZODRYL AC 80 3

ZODRYL DAC 25 3

ZODRYL DAC 30 3

ZODRYL DAC 35 3

ZODRYL DAC 40 3

ZODRYL DAC 50 3

ZODRYL DAC 60 3

ZODRYL DAC 80 3

ZODRYL DEC 25 3

ZODRYL DEC 30 3

ZODRYL DEC 35 3

ZODRYL DEC 40 3

ZODRYL DEC 50 3

ZODRYL DEC 60 3

ZODRYL DEC 80 3

Z-TUSS AC 3

ZUTRIPRO 3

PULMONARY AGENTS

ACCOLATE 3

acetylcysteine 1

ADCIRCA 4 PA; ST; QL

ADEMPAS 4 PA; LA

ADRENALIN 3

ADVAIR DISKUS 2 PA; QL

ADVAIR HFA 2 PA; QL

Drug Name Drug Tier


AEROSPAN 3 ST; QL

AIRDUO RESPICLICK

3 PA; QL

albuterol sulfate 1

ANORO ELLIPTA 2 QL

ARCAPTA NEOHALER

2 QL

ARMONAIR RESPICLICK

2

ARNUITY ELLIPTA

2 ST; QL

ASMANEX HFA 2 QL

ASMANEX TWISTHALER

2 QL

ATROVENT HFA 2 QL

BEVESPI AEROSPHERE

2 QL

BREO ELLIPTA 2 PA; QL

BROVANA 3 QL

budesonide 1 QL

COMBIVENT RESPIMAT

2 QL

cromolyn 1

CUROSURF 3

DALIRESP 2 PA

DULERA 2 PA; QL

DYMISTA 2 ST; QL

ELIXOPHYLLIN 3

ESBRIET ORAL CAPSULE

4 PA; LA; QL

ESBRIET ORAL TABLET

4 PA

FIRAZYR 4 PA; LA

FLOVENT DISKUS 2 ST; QL


72

Drug Name Drug Tier


FLOVENT HFA 2 ST; QL

flunisolide 1 QL

fluticasone 1 QL

FLUTICASONE-SALMETEROL

2 PA; QL

HAEGARDA 4 PA

HYPER-SAL 3

INCRUSE ELLIPTA

2 QL

ipratropium bromide 1

ipratropium-albuterol

1 QL

KALYDECO 4 PA; LA; QL

LETAIRIS 4 PA; ST; LA

levalbuterol hcl 1

metaproterenol 1

mometasone 1 QL

montelukast 1

nebusal inhalation solution for nebulization 3 %

1

NEBUSAL INHALATION SOLUTION FOR NEBULIZATION 6 %

3

OFEV 4 PA; LA; QL

OPSUMIT 4 PA; ST; LA

ORKAMBI ORAL TABLET 100-125 MG

4 PA; QL

ORKAMBI ORAL TABLET 200-125 MG

4 PA; LA; QL

PERFOROMIST 2 QL

Drug Name Drug Tier


PROAIR HFA 2 QL

PROAIR RESPICLICK

2 QL

PULMICORT FLEXHALER

2 QL

pulmosal 1

PULMOZYME 4

QNASL 2 QL

QVAR 2 QL

REVATIO 4 PA; ST; QL

RUCONEST 4 PA; LA

SEEBRI NEOHALER

3 QL

SEREVENT DISKUS

2 QL

sildenafil 4 PA; QL

sodium chloride 1

SPIRIVA RESPIMAT

2 QL

SPIRIVA WITH HANDIHALER

2 QL

STIOLTO RESPIMAT

2 QL

STRIVERDI RESPIMAT

2 QL

SURFAXIN 3

SYMBICORT 2 PA; QL

terbutaline 1

THEO-24 3

theochron 1

theophylline 1

TRACLEER 4 PA; LA

TUDORZA PRESSAIR

2 QL


73

Drug Name Drug Tier


TYVASO 4 PA; LA

TYVASO REFILL KIT

4 PA; LA

TYVASO STARTER KIT

4 PA; LA

UTIBRON NEOHALER

3 QL

VENTAVIS 4 PA; ST; LA

VENTOLIN HFA 2 QL

XOLAIR 4 PA; LA; QL

XOPENEX 3

XOPENEX CONCENTRATE

3

zafirlukast 1

ZETONNA 3 ST; QL

zileuton 1

ZYFLO 3 ST

UROLOGICALS

ANTICHOLINERGICS & ANTISPASMODICS

darifenacin 1

DETROL 3 ST

DETROL LA 3 ST

DITROPAN XL 3 ST

ENABLEX 3 ST

flavoxate 1

GELNIQUE 2 QL

MYRBETRIQ 2

oxybutynin chloride 1

OXYTROL 3 ST; QL

tolterodine 1

TOVIAZ 2

trospium 1

Drug Name Drug Tier


VESICARE 2

BENIGN PROSTATIC HYPERPLASIA (BPH) THERAPY

alfuzosin 1

AVODART 3 ST

CIALIS 2 PA; QL

dutasteride 1 ST

dutasteride-tamsulosin

1 ST

finasteride 1

FLOMAX 3 ST

JALYN 3 ST

PROSCAR 3 ST

RAPAFLO 2 ST

tamsulosin 1

UROXATRAL 3 ST

CHOLINERGIC STIMULANTS

bethanechol chloride 1

URECHOLINE 3

MISCELLANEOUS UROLOGICALS

azuphen mb 1

CAVERJECT 2 PA; QL

CAVERJECT IMPULSE

2 PA; QL

CIALIS 2 PA; QL

CYSTAGON 2 LA

cytra k crystals 1

cytra-2 1

cytra-3 1

cytra-k 1

EDEX 3 PA; QL

ELMIRON 2


74

Drug Name Drug Tier


hyolev mb 1

hyophen 1

INDIOMIN MB 3

K-PHOS NO 2 3

K-PHOS ORIGINAL

2

methen-sod phos-meth blue-hyos

1

ORACIT 3

PAPAVERINE-ALPROSTADIL-WATER

3

PAPAV-PHENTOLAM-ALPROST-WATER

3

PAPAV-PHENTOLAMINE IN WATER

3

PHENTOLAM-ALPROSTADIL IN WATER

3

phosphasal 1

pot,sodium citrate-citric acid

1

potassium citrate 1

potassium citrate-citric acid

1

PROCYSBI 4 ST; LA

RENACIDIN 2

SHOHL'S MODIFIED

3

sodium citrate-citric acid

1

tricitrates 1

ur n-c 1

uramit mb 1

Drug Name Drug Tier


URELLE 3

uretron d-s 1

URIBEL 3

urimar-t 1

urin ds 1

uro-458 1

UROCIT-K 10 3

UROCIT-K 15 3

UROCIT-K 5 3

urogesic-blue 1

uro-mp 1

urophen mb 1

UROQID-ACID NO.2

3

uryl 1

ustell 1

UTA 3

utira-c 1

VIAGRA 2 PA; QL

virtrate-2 1

virtrate-3 1

virtrate-k 1

URINARY ANESTHETICS

phenazopyridine 1

PYRIDIUM 3

VITAMINS, HEMATINICS & ELECTROLYTES

ELECTROLYTES

calcium 500 + d 1 ACA; OTC

calcium 500 with d 1 ACA; OTC

calcium 600 + d(3) 1 ACA; OTC


75

Drug Name Drug Tier


calcium 600 with vitamin d3

1 ACA; OTC

calcium carb and citrate-vitd3

1 ACA; OTC

calcium carbonate-vitamin d3

1 ACA; OTC

calcium citrate + d 1 ACA; OTC

calcium citrate-vitamin d2

1 ACA; OTC

calcium citrate-vitamin d3

1 ACA; OTC

citrus calcium 1 ACA; OTC

EFFER-K ORAL TABLET, EFFERVESCENT 10 MEQ, 20 MEQ

3

effer-k oral tablet, effervescent 25 meq

1

GALZIN 3

hi-cal plus vit d 1 ACA; OTC

k-effervescent 1

klor-con 1

klor-con 10 1

klor-con 8 1

klor-con m10 1

klor-con m15 1

klor-con m20 1

klor-con sprinkle 1

KLOR-CON/25 3

klor-con/ef 1

k-phos-neutral 1

Drug Name Drug Tier


K-TAB ORAL TABLET EXTENDED RELEASE 10 MEQ, 20 MEQ

3

k-tab oral tablet extended release 8 meq

1

lugols 1

oysco 500/d 1 ACA; OTC

oyster shell + d3 1 ACA; OTC

oyster shell calcium-vit d3

1 ACA; OTC

oystercal-d 1 ACA; OTC

phospha 250 neutral 1

POTABA 3

potassium bicarb and chloride

1

potassium bicarb-citric acid

1

potassium chloride 1

strong iodine 1

virt-phos 250 neutral 1

MISCELLANEOUS VITAMINS, HEMATINICS, & ELECTROLYTES

FORTAVIT 3

VITAMINS & HEMATINICS

ACTIVE FE 3

ANIMI-3 WITH VITAMIN D

3

ATABEX EC 3

b complex-vitamin b12

1 ACA; OTC

b complex-vitamin c-folic acid

1 ACA; OTC


76

Drug Name Drug Tier


BACMIN 3

balanced b-100 1 ACA; OTC

balanced b-100 complex

1 ACA; OTC

balanced b-50 1 ACA; OTC

bal-care dha 1

BAL-CARE DHA ESSENTIAL

3

b-complex with vitamin c

1 ACA; OTC

BIFERA RX 3

CADEAU DHA 3

calcium pnv 1

calcium-folic acid-vitamin d

1

CARDIOTEK-RX (BIOPERINE)

3

centratex 1

cholecalciferol (vitamin d3)

1 ACA; OTC

CITRANATAL (DUAL-IRON)

3

CITRANATAL 90 DHA (ALGAL OIL)

3

CITRANATAL ASSURE

3

CITRANATAL B-CALM (FE GLUC)

3

CITRANATAL DHA (ALGAL OIL)

3

CITRANATAL HARMONY (IRON FUM)

3

classic prenatal 1 ACA; OTC

c-nate dha 1

Drug Name Drug Tier


complete natal dha 1

completenate 1

complex b-100 1 ACA; OTC

CONCEPT DHA 3

CONCEPT OB 3

corvita 1

corvita 150 1

CORVITE 3

CORVITE 150 3

CORVITE FE 3

CORVITE FREE 3

cyanocobalamin (vitamin b-12)

1

delta d3 1 ACA; OTC

dialyvite 1

DIALYVITE 3000 3

DIALYVITE 5000 3

dialyvite 800 1 ACA; OTC

DIALYVITE 800 WITH IRON

3

DIALYVITE SUPREME D

3

dothelle dha 1

DUET DHA BALANCED

3

DUET DHA WITH OMEGA-3

3

d-vi-sol 1 ACA; OTC

elite-ob 1

ENBRACE HR 3

ENLYTE (FERROUS GLYCINE)

3


77

Drug Name Drug Tier


ergocalciferol (vitamin d2) oral capsule

1

ergocalciferol (vitamin d2) oral tablet

1 ACA; OTC

ESCAVITE 3

ESCAVITE D 3

ESCAVITE LQ 3

EXTRA-VIRT PLUS DHA

3

FERIVA 21-7 TABLET

3

FERIVA FA (SUMALATE)

3

ferocon 1

FERRALET 90 DUAL-IRON DELIVERY

3

ferraplus 90 1

ferrex 150 forte 1

ferrex 150 forte plus 1

ferrex 28 1

ferrocite plus 1

FLORIVA 3

FLORIVA (FLUORIDE-VITAMIN D3)

3

FLORIVA PLUS 3

FLUORABON 3

FLUOR-A-DAY 3

fluor-a-day (with xylitol) oral tablet,chewable 0.25 mg f (0.55 mg)-236.79mg

1 ACA

Drug Name Drug Tier


fluor-a-day (with xylitol) oral tablet,chewable 1 mg f (2.2 mg)-236.79 mg

1

fluoride (sodium) oral drops

1 ACA

fluoride (sodium) oral tablet,chewable 0.25 mg(0.55 mg sod. fluoride), 0.5 mg (1.1 mg sodium fluorid)

1 ACA

fluoride (sodium) oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

1

fluoritab oral tablet,chewable 0.5 mg (1.1 mg sodium fluorid)

1 ACA

fluoritab oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

1

FLURA-DROPS 3

focalgin 90 dha 1

focalgin ca 1

focalgin dss 1

folbee 1

folbee ar 1

folbee plus 1

folbic 1

FOLET ONE 3

FOLGARD OS 3

FOLGARD RX 3

folic acid oral tablet 1 mg

1


78

Drug Name Drug Tier


folic acid oral tablet 400 mcg, 800 mcg

1 ACA; OTC

folic acid-vit b6-vit b12

1

folivane-f 1

folivane-ob 1

folivane-plus 1

folplex 2.2 1

foltabs 800 1 ACA; OTC

FOLTRATE 3

full spectrum b-vitamin c

1 ACA; OTC

FUSION PLUS 3

FUSION SPRINKLES

3

hematinic plus vit/minerals

1

hematinic/folic acid 1

hematogen 1

hematogen fa 1

hematogen forte 1

HEMATRON-AF 3

hemenatal ob 1

hemenatal ob + dha 1

hemetab 1

HEMOCYTE-F 3

HEMOCYTE-PLUS 3

hydroxocobalamin 1

ICAR-C PLUS 3

iferex 150 forte 1

INTEGRA F 3

INTEGRA PLUS 3

IROSPAN 24/6 3

Drug Name Drug Tier


kobee 1 ACA; OTC

KOSHER PRENATAL PLUS IRON

3

kpn 1 ACA; OTC

levomefolate dha 1

ludent fluoride oral tablet,chewable 0.25 mg(0.55 mg sod. fluoride), 0.5 mg (1.1 mg sodium fluorid)

1 ACA

ludent fluoride oral tablet,chewable 1 mg (2.2 mg sod. fluoride)

1

MARNATAL-F 3

MAXFE (FOLATE-DOCUSATE)

3

MEBOLIC 3

METHAVER 3

multigen folic 1

multigen plus 1

multi-vit with fluoride-iron

1

multi-vitamin with fluoride oral drops

1 ACA

multi-vitamin with fluoride oral tablet,chewable 0.25 mg, 0.5 mg

1 ACA

multi-vitamin with fluoride oral tablet,chewable 1 mg

1


79

Drug Name Drug Tier


multivitamins with fluoride oral tablet,chewable 0.25 mg, 0.5 mg

1 ACA

multivitamins with fluoride oral tablet,chewable 1 mg

1

mvc-fluoride oral tablet,chewable 0.25 mg, 0.5 mg

1 ACA

mvc-fluoride oral tablet,chewable 1 mg

1

myferon 150 forte 1

mynatal 1

mynatal advance 1

mynatal plus 1

mynatal-z 1

mynate 90 plus 1

mynephrocaps 1

mynephron 1

NASCOBAL 2

NATACHEW (FE BIS-GLYCINATE)

3

NATELLE ONE 3

natural b-100 complex

1 ACA; OTC

NEEVODHA (WITH ALGAL OIL)

3

nephplex rx 1

NEPHROCAPS 3

NEPHROCAPS QT 3

NEPHRON FA 3

nephro-vite rx 1

Drug Name Drug Tier


NESTABS 3

NESTABS ABC 3

NESTABS DHA 3

NEURIN-SL 3

newgen 1

NEXA PLUS 3

NICOMIDE 3

NICOMIDE (SELENIUM-CHROMIUM)

3

NIVA-FOL 3

NIVA-PLUS 3

NUFERA 3

NUTRICAP 3

OB COMPLETE 3

OB COMPLETE GOLD

3

OB COMPLETE ONE

3

OB COMPLETE PETITE

3

OB COMPLETE PREMIER

3

OB COMPLETE WITH DHA

3

obstetrix dha 1

OBSTETRIX EC 3

OBSTETRIX ONE 3

OBTREX DHA 3

O-CAL FA 3

O-CAL PRENATAL

3

one daily prenatal 1 ACA; OTC


80

Drug Name Drug Tier


oyster shell calcium-vit d2

1 ACA; OTC

perry prenatal 1 ACA; OTC

pnv 29-1 1

pnv ob+dha 1

pnv-dha 1

pnv-dha + docusate 1

pnv-ferrous fumarate-docu-fa

1

pnv-omega 1

pnv-select 1

pnv-vp-u 1

poly-iron 150 forte 1

POLY-VI-FLOR 3

POLY-VI-FLOR WITH IRON

3

pr natal 400 1

pr natal 400 ec 1

pr natal 430 1

pr natal 430 ec 1

PREFERA-OB 3

PREFERA-OB ONE 3

PREFERA-OB PLUS DHA

3

prena1 chew 1

prena1 pearl 1

prena1 true 1

prenaissance 1

prenaissance plus 1

PRENATA 3

prenatabs fa 1

prenatabs rx 1

prenatal 1 ACA; OTC

Drug Name Drug Tier


prenatal complete 1 ACA; OTC

prenatal formula 1 ACA; OTC

prenatal multi-dha (algal oil)

1 ACA; OTC

prenatal one daily 1 ACA; OTC

prenatal plus 1

prenatal plus (calcium carb)

1

PRENATAL PLUS DHA

3

prenatal vitamin 1 ACA; OTC

prenatal vitamin plus low iron

1

prenatal vitamin with minerals

1 ACA; OTC

prenatal vits96-iron fum-folic

1 ACA; OTC

prenatal-u 1

PRENATE AM 3

PRENATE CHEWABLE

3

PRENATE DHA (FERR ASP GLYCIN)

3

PRENATE ELITE (IRON ASP GLYC)

3

PRENATE ENHANCE

3

PRENATE ESSENTIAL(IRON-ASP-GL)

3

PRENATE MINI (FERR ASP GLYCIN)

3

PRENATE PIXIE 3


81

Drug Name Drug Tier


PRENATE RESTORE

3

PRENATE STAR 3

preplus 1

pretab 1

PRIMACARE 3

PROFERRIN-FORTE

3

PROTECT IRON 3

PROVIDA DHA 3

PROVIDA OB 3

PURALOR CI 3

PUREFE OB PLUS 3

PUREFE PLUS 3

purevit dualfe plus 1

QUFLORA FE 3

QUFLORA FE (FERROUS SULFATE)

3

QUFLORA PEDIATRIC

3

QUFLORA PEDIATRIC DROPS

3

relnate dha 1

renal caps 1

rena-vite 1 ACA; OTC

rena-vite rx 1

reno caps 1

risacal-d 1 ACA; OTC

R-NATAL OB 3

SELECT-OB 3

SELECT-OB (FOLIC ACID)

3

Drug Name Drug Tier


SELECT-OB + DHA

3

se-natal 19 1

se-natal 19 (with docusate)

1

se-tan plus 1

stress formula 1 ACA; OTC

stress formula with iron

1 ACA; OTC

stress formula with iron(sulf)

1 ACA; OTC

STROVITE FORTE 3

STROVITE ONE 3

super b complex-vitamin c

1 ACA; OTC

super b maxi complex

1 ACA; OTC

super b-50 complex plus

1 ACA; OTC

super quints 1 ACA; OTC

super quints b-50 1 ACA; OTC

superplex-t 1 ACA; OTC

SUPERVITE 3

TANDEM PLUS 3

taron forte 1

taron-c dha 1

taron-prex prenatal-dha

1

TEXAVITE LQ 3

THRIVITE RX 3

thrivite-19 1

tl gard rx 1

tl g-fol os 1

tl icon 1


82

Drug Name Drug Tier


tl-hem 150 1

total b/c 1 ACA; OTC

TRICARE 3

TRICARE PRENATAL

3

TRICARE PRENATAL DHA ONE

3

tricon 1

TRIFERIC 3

trigels-f forte 1

trinatal gt 1

trinatal rx 1 1

trinate 1

triphrocaps 1

TRISTART DHA 3

tri-tabs dha 1

triveen-duo dha 1

TRI-VI-FLOR 3

tri-vit with fluoride and iron

1 ACA

tri-vitamin with fluoride

1 ACA

trust natal dha 1

UDAMIN SP 3

ultimatecare one 1

ultimatecare one nf 1

ultra b-100 complex 1 ACA; OTC

v-c forte 1

vemavite-prx-2 1

vic-forte 1

vinate care 1

VINATE DHA RF 3

Drug Name Drug Tier


vinate ii 1

vinate m 1

vinate one 1

vinate ultra 1

virt-advance 1

virt-c dha 1

VIRT-CAPS 3

virt-gard 1

virt-nate 1

virt-nate dha 1

virt-pn 1

virt-pn dha 1

virt-pn plus 1

VIRTPREX 3

virt-select 1

virt-vite 1

virt-vite forte 1

virt-vite gt 1

VIRT-VITE PLUS 3

vit 3 1

vit b complex-folic acid

1 ACA; OTC

VITAFOL 3

VITAFOL FE+ (WITH DOCUSATE)

3

VITAFOL GUMMIES

3

VITAFOL NANO 3

VITAFOL ULTRA 3

VITAFOL-OB 3

VITAFOL-OB+DHA

3


83

Drug Name Drug Tier


VITAFOL-ONE 3

vitajoy daily d 1 ACA; OTC

VITAL-D RX 3

VITAMED MD ONE RX

3

VITAMEDMD REDICHEW RX

3

vitamin b complex 1 ACA; OTC

vitamin d3 1 ACA; OTC

vitamins a,c,d and fluoride

1 ACA

VITAPEARL 3

VITA-RESPA 3

VITATRUE 3

vol-care rx 1

vol-nate 1

Drug Name Drug Tier


vol-plus 1

vol-tab rx 1

vp-ch plus 1

vp-ch-pnv 1

vp-ggr-b6 1

vp-heme ob 1

vp-heme one 1

VP-PNV-DHA 3

vp-vite rx 1

XYZBAC 3

zatean-ch 1

zatean-pn dha 1

zatean-pn plus 1

zingiber 1

84

Index 2 2TEK GLUCOSE/BLOOD

PRESSURE..................... 45 A abacavir ................................ 3 abacavir-lamivudine .............. 3 abacavir-lamivudine-

zidovudine ........................ 3 ABILIFY ............................ 19 ABSORICA ........................ 34 acamprosate ........................ 40 ACANYA ........................... 34 acarbose .............................. 53 ACCOLATE ....................... 72 ACCU-CHEK COMPACT

PLUS CONTROL ........... 45 ACCU-CHEK GUIDE L1-L2

CTRL SOL...................... 45 ACCU-CHEK SMARTVIEW

CONTRL SOL ................ 45 ACCUPRIL ........................ 23 ACCURETIC...................... 23 ACCUTREND GLUCOSE

CONTROL ..................... 46 acebutolol ........................... 23 acetaminophen-caff-

dihydrocod ...................... 15 ACETAMINOPHEN-CAFF-

DIHYDROCOD .............. 15 acetaminophen-codeine ....... 15 acetazolamide ..................... 68 acetic acid ......................40, 42 acetylcysteine...................... 72 acitretin............................... 31 ACTEMRA......................... 64 ACTHAR H.P. .................... 42 ACTHIB (PF) ..................... 62 ACTICLATE ........................ 7 ACTIGALL ........................ 56 ACTIMMUNE .................... 62 ACTIQ ............................... 15 ACTIVE FE ........................ 76 ACTIVELLA ...................... 65 ACTONEL ....................40, 64 ACTOPLUS MET............... 54 ACTOPLUS MET XR ........ 54 ACTOS............................... 54 acuicyn ............................... 68

ACULAR ........................... 68 ACULAR LS ...................... 68 acyclovir ..........................3, 38 ACZONE............................ 34 ADACEL(TDAP

ADOLESN/ADULT)(PF) 62 ADALAT CC...................... 23 adapalene ............................ 34 ADAPALENE .................... 34 adapalene-benzoyl peroxide. 34 ADASUVE ......................... 19 ADCIRCA .......................... 72 ADDERALL....................... 19 ADDYI ............................... 19 adefovir ................................ 3 ADEMPAS ......................... 72 ADRENALIN ..................... 72 ADVAIR DISKUS .............. 72 ADVAIR HFA .................... 72 ADVANCED GLUC METER

TEST STRIP ................... 43 ADVANCED GLUCOSE

METER .......................... 46 ADVATE ........................... 27 ADVOCATE LOW

CONTROL ..................... 46 ADVOCATE REDI-CODE+

CTRL LOW .................... 46 ADYNOVATE ................... 27 ADZENYS XR-ODT .......... 19 AEROSPAN ....................... 72 afeditab cr ........................... 23 AFINITOR ........................... 8 AFINITOR DISPERZ ........... 8 AFLURIA 2017-2018 ......... 62 AFLURIA 2017-2018 (PF) .. 62 AFLURIA QUAD 2017-2018

....................................... 62 AFLURIA QUAD 2017-2018

(PF) ................................ 62 AFREZZA .......................... 52 AFSTYLA .......................... 27 AGAMATRIX AMP GLUC

MONITOR SYS .............. 46 AGAMATRIX AMP TEST

STRIPS ........................... 43 AGAMATRIX CONTROL

HIGH .............................. 46

AGGRENOX ...................... 27 AGRYLIN .......................... 40 AIRDUO RESPICLICK ...... 72 AKTEN (PF)....................... 68 AKYNZEO ......................... 56 ala-cort ............................... 38 ALA-QUIN......................... 37 ALA-SCALP ...................... 38 ALBENZA ........................... 5 albuterol sulfate................... 72 alclometasone ..................... 38 ALCORTIN A .................... 36 ALDACTAZIDE ................ 23 ALDACTONE .................... 23 ALDARA ........................... 62 ALECENSA ......................... 8 alendronate ....................40, 64 ALEVICYN ANTIPRURITIC

....................................... 32 ALEVICYN ANTIPRURITIC

SG .................................. 32 ALFERON N ...................... 62 alfuzosin ............................. 74 ALINIA ................................ 6 ALKERAN ........................... 8 allopurinol .......................... 64 ALLZITAL ......................... 15 almotriptan malate............... 13 ALOCRIL........................... 68 ALOGLIPTIN-

PIOGLITAZONE ............ 54 ALOMIDE.......................... 68 alophen ............................... 56 ALOQUIN .......................... 36 ALORA .............................. 65 alosetron ............................. 56 ALPHAGAN P ................... 70 alprazolam .......................... 19 alprazolam intensol ............. 19 ALPROLIX ...................27, 28 ALREX .............................. 69 ALSUMA ........................... 13 ALTABAX ......................... 36 altacaine.............................. 68 ALTACE ............................ 23 altafluor .............................. 68 ALTOPREV ....................... 29 ALUNBRIG.......................... 8

85

ALZAIR ............................. 41 amabelz .............................. 65 amantadine hcl ...................... 3 AMARYL........................... 54 AMBIEN ............................ 19 AMBIEN CR ...................... 19 amcinonide ......................... 38 AMELUZ ........................... 32 AMERGE ........................... 13 AMICAR ............................ 28 amiloride............................. 23 amiloride-hydrochlorothiazide

....................................... 24 amiodarone ......................... 23 AMITIZA ........................... 56 amitriptyline........................ 19 amitriptyline-chlordiazepoxide

....................................... 19 amlodipine .......................... 24 amlodipine-atorvastatin ....... 29 amlodipine-benazepril ......... 24 amlodipine-olmesartan ........ 24 amlodipine-valsartan ........... 24 amlodipine-valsartan-hcthiazid

....................................... 24 ammonium lactate ............... 32 amnesteem .......................... 34 amoxapine .......................... 19 amoxicil-clarithromy-lansopraz

....................................... 59 amoxicillin ............................ 7 amoxicillin-pot clavulanate.... 7 ampicillin.............................. 7 AMPYRA ........................... 14 AMRIX .............................. 15 ANADROL-50.................... 53 ANAFRANIL ..................... 19 anagrelide ........................... 40 ANA-LEX KIT ................... 56 ANALPRAM-HC ..........31, 56 ANALPRAM-HC SINGLES 56 ANAPROX DS ................... 17 anaspaz ............................... 55 anastrozole ............................ 8 ANCOBON .......................... 3 ANDRODERM................... 53 ANDROGEL ...................... 53 ANDROID.......................... 53 ANGELIQ .......................... 65

ANIMI-3 WITH VITAMIN D ....................................... 76

ANORO ELLIPTA ............. 72 ANTARA ........................... 29 anucort-hc ........................... 56 ANUSOL-HC ..................... 56 ANZEMET ......................... 56 apexicon e........................... 38 APIDRA ............................. 52 APIDRA SOLOSTAR......... 52 APLENZIN......................... 19 APOKYN ........................... 13 apraclonidine ...................... 70 aprepitant ............................ 56 APRISO.............................. 56 APTENSIO XR................... 19 APTIOM ............................ 11 APTIVUS ............................. 3 AQUA GLYCOLIC HC ...... 38 ARANESP (IN

POLYSORBATE) ........... 61 ARAVA.............................. 64 ARCALYST ....................... 62 ARCAPTA NEOHALER .... 72 ARESTIN ........................... 41 ARICEPT ........................... 14 ARIMIDEX .......................... 8 aripiprazole ......................... 19 ARIXTRA .......................... 28 armodafinil ......................... 19 ARMONAIR RESPICLICK 72 ARMOUR THYROID......... 55 ARNUITY ELLIPTA .......... 72 AROMASIN ......................... 8 ARTHROTEC 50................ 17 ARTHROTEC 75................ 17 ARYMO ER ....................... 15 ascomp with codeine ........... 15 ASMANEX HFA ................ 72 ASMANEX TWISTHALER 72 aspir-81............................... 17 aspirin................................. 17 aspirin low dose .................. 17 aspirin-caffeine-dihydrocodein

....................................... 15 aspirin-dipyridamole ........... 28 aspir-low............................. 17 aspir-trin ............................. 17

ASSURE 4 CONTROL SOLUTION .................... 46

ASSURE 4 STRIPS ............ 43 ASSURE DOSE NORMAL

CONTROL ..................... 46 ASSURE PLATINUM ...43, 46 ASSURE PRISM CONTROL

1-2 SOLN ....................... 46 ASSURE PRISM MULTI

METER .......................... 46 ASSURE PRISM MULTI

STRIP ............................. 43 ASTAGRAF XL ................... 8 ASTEPRO .......................... 41 AT HOME A1C .................. 46 ATABEX EC ...................... 76 ATELVIA........................... 64 atenolol ............................... 24 atenolol-chlorthalidone ........ 24 ATIVAN............................. 19 atomoxetine ........................ 19 ATOPICLAIR..................... 32 atorvastatin ......................... 29 atovaquone............................ 6 atovaquone-proguanil ............ 6 ATRALIN .......................... 34 ATRAPRO CP .................... 32 ATRAPRO HYDROGEL .... 32 ATRIPLA ............................. 3 atropine............................... 67 ATROVENT HFA .............. 72 AUBAGIO.......................... 61 AUGMENTIN ...................... 7 AUGMENTIN ES-600 .......... 7 AUGMENTIN XR ................ 7 AURYXIA.......................... 56 AUSTEDO ......................... 14 AUTOJECT 2 INJECTION

DEVICE ......................... 46 AUTOPEN 1 TO 21 UNITS 46 AVALIDE .......................... 24 AVANDIA ......................... 54 AVAPRO ........................... 24 avar .................................... 34 AVAR ................................ 34 AVAR LS ........................... 34 AVAR-E GREEN ............... 34 AVAR-E LS ....................... 34 AVC VAGINAL ................. 66

86

AVELOX ............................. 7 AVENOVA ........................ 68 avidoxy ................................. 7 AVIDOXY DK ..................... 7 avita.................................... 34 AVITA ............................... 34 avo cream ........................... 32 AVODART......................... 74 AVONEX ........................... 61 AVONEX (WITH ALBUMIN)

....................................... 61 AXERT .............................. 13 AXIRON ............................ 53 AYGESTIN ........................ 65 AZASAN.............................. 8 AZASITE ........................... 66 azathioprine .......................... 8 azelastine .......................41, 68 AZELEX ............................ 34 AZILECT ........................... 13 azithromycin ......................... 5 AZOPT ............................... 69 AZOR................................. 24 AZULFIDINE..................... 56 AZULFIDINE EN-TABS .... 56 azuphen mb......................... 74 B b complex-vitamin b12 ........ 76 b complex-vitamin c-folic acid

....................................... 76 bacitracin ............................ 66 bacitracin-polymyxin b ........ 66 baclofen .............................. 15 BACMIN ............................ 77 BACTRIM ............................ 7 BACTRIM DS ...................... 7 BACTROBAN.................... 36 BACTROBAN NASAL ...... 41 balanced b-100 .................... 77 balanced b-100 complex ...... 77 balanced b-50...................... 77 bal-care dha ........................ 77 BAL-CARE DHA

ESSENTIAL ................... 77 balsalazide .......................... 56 BANZEL ............................ 11 BARACLUDE ...................... 3 BASAGLAR KWIKPEN .... 52 bayer aspirin ....................... 17

BCG VACCINE, LIVE (PF) 62 b-complex with vitamin c .... 77 BELBUCA ......................... 15 belladonna alkaloids-opium . 55 belladonna-opium................ 55 BELSOMRA ...................... 19 benazepril ........................... 24 benazepril-hydrochlorothiazide

....................................... 24 BENEFIX ........................... 28 BENICAR .......................... 24 BENICAR HCT .................. 24 BENLYSTA ....................... 64 BENSAL HP....................... 32 BENTYL ............................ 55 BENZACLIN...................... 34 BENZACLIN PUMP .......... 34 BENZAMYCIN .................. 34 BENZEFOAM .................... 34 BENZEFOAM ULTRA....... 34 benzepro ............................. 34 BENZEPRO

(MICROSPHERES) ........ 34 benzonatate ......................... 70 benzoyl peroxide ................. 34 benztropine ......................... 13 BEPREVE .......................... 68 BESIVANCE ...................... 66 BETADINE OPHTHALMIC

PREP .............................. 67 BETAGAN ......................... 67 betamethasone dipropionate. 38 betamethasone valerate ........ 38 betamethasone, augmented .. 38 BETAPACE ....................... 23 BETAPACE AF .................. 23 BETASERON ..................... 61 betaxolol ........................24, 67 bethanechol chloride............ 74 BETHKIS ............................. 6 BETIMOL .......................... 67 BETOPTIC S ...................... 67 BEVESPI AEROSPHERE... 72 bexarotene ............................ 8 BEXSERO .......................... 62 BIAFINE EMULSION ........ 32 bicalutamide.......................... 8 BIDIL ................................. 24 BIFERA RX ....................... 77

BILTRICIDE ........................ 6 bimatoprost ......................... 69 BINOSTO........................... 64 BIONIME RIGHTEST

GM300 SYSTEM............ 46 BIONIME RIGHTEST TEST

STRIPS ........................... 43 BIOTHRAX........................ 62 bisacodyl............................. 56 bisa-lax ............................... 56 bisoprolol fumarate ............. 24 bisoprolol-hydrochlorothiazide

....................................... 24 BLEPH-10 .......................... 70 BLEPHAMIDE................... 69 BLEPHAMIDE S.O.P. ........ 69 BLOOD GLUCOSE

CONTROL, NORMAL ... 46 BLOOD GLUCOSE TEST .. 43 BLOOD-GLUCOSE METER

....................................... 46 BONIVA ............................ 64 BOOSTRIX TDAP ............. 62 BOSULIF ............................. 8 BOTOX .............................. 62 bp 10-1 ............................... 34 bp-50% urea........................ 32 bpo ..................................... 34 BREEZE 2 CONTROL

SOLUTION,HIGH .......... 46 BREO ELLIPTA................. 72 BRILINTA ......................... 28 brimonidine......................... 70 BRISDELLE....................... 19 BRIVIACT ......................... 11 BROMFED DM .................. 70 bromfenac ........................... 68 bromocriptine...................... 13 brompheniramine-pseudoeph-

dm .................................. 71 BROMSITE ........................ 68 BROVANA ........................ 72 BUCALSEP........................ 36 budesonide .....................56, 72 bumetanide ......................... 24 BUPHENYL ....................... 40 buprenorphine hcl ............... 15 bupropion hcl .................19, 20

87

bupropion hcl (smoking deter) ....................................... 41

buspirone ............................ 20 butalbital compound w/codeine

....................................... 15 butalbital-acetaminop-caf-cod

....................................... 15 butalbital-acetaminophen ..... 15 butalbital-acetaminophen-caff

....................................... 15 butalbital-aspirin-caffeine .... 15 BUTISOL ........................... 20 butorphanol tartrate ............. 17 BYDUREON ...................... 54 BYETTA ............................ 54 BYSTOLIC......................... 24 BYVALSON ...................... 24 C cabergoline ......................... 53 CABOMETYX ..................... 8 CADEAU DHA .................. 77 CADUET............................ 29 CAFERGOT ....................... 13 caffeine citrate .................... 40 CALAN .............................. 24 CALAN SR ........................ 24 calcipotriene........................ 31 calcipotriene-betamethasone 31 calcitonin (salmon) .............. 53 calcitrene ............................ 31 calcitriol.........................31, 53 calcium 500 + d................... 75 calcium 500 with d .............. 75 calcium 600 + d(3) .............. 75 calcium 600 with vitamin d3 76 calcium acetate.................... 56 calcium carb and citrate-vitd3

....................................... 76 calcium carbonate-vitamin d3

....................................... 76 calcium citrate + d ............... 76 calcium citrate-vitamin d2 ... 76 calcium citrate-vitamin d3 ... 76 calcium pnv ........................ 77 calcium-folic acid-vitamin d 77 CAMBIA ............................ 17 CANASA ........................... 56 candesartan ......................... 24

candesartan-hydrochlorothiazid ....................................... 24

capacet................................ 15 CAPCOF ............................ 71 capecitabine .......................... 8 CAPEX............................... 38 CAPITAL WITH CODEINE

....................................... 16 CAPRELSA.......................... 8 captopril.............................. 24 captopril-hydrochlorothiazide

....................................... 24 CARAC .............................. 32 CARAFATE ....................... 59 CARBAGLU ...................... 40 carbamazepine .................... 11 CARBATROL .................... 11 carbidopa ............................ 13 carbidopa-levodopa ............. 13 carbidopa-levodopa-

entacapone ...................... 13 carbinoxamine maleate ........ 70 CARDIOTEK-RX

(BIOPERINE) ................. 77 CARDIZEM ....................... 24 CARDIZEM CD ................. 24 CARDIZEM LA ................. 24 CARDURA......................... 24 CARDURA XL................... 24 CARESENS CONTROL A

NORMAL ....................... 46 CARESENS N .................... 46 CARESENS N TEST STRIPS

....................................... 43 CARESENS N VOICE........ 46 carisoprodol ........................ 15 carisoprodol-asa-codeine ..... 15 carisoprodol-aspirin............. 15 CARNITOR........................ 40 CARNITOR (SUGAR-FREE)

....................................... 40 carteolol .............................. 67 cartia xt............................... 24 CARTRIDGE STAMPED IR

1200................................ 46 carvedilol ............................ 24 CASODEX ........................... 9 CATAPRES........................ 24 CATAPRES-TTS-1............. 24

CATAPRES-TTS-2............. 24 CATAPRES-TTS-3............. 24 CAVERJECT...................... 74 CAVERJECT IMPULSE..... 74 CAYSTON ........................... 6 CEDAX ................................ 5 cefaclor ................................. 5 cefadroxil.............................. 5 cefdinir ................................. 5 cefditoren pivoxil .................. 5 cefixime ................................ 5 cefpodoxime ......................... 5 cefprozil................................ 5 ceftibuten .............................. 5 CEFTIN................................ 5 cefuroxime axetil................... 5 CEFUROXIME SODIUM-

0.9%NACL(PF) .............. 67 celacyn ............................... 32 CELEBREX........................ 17 celecoxib............................. 17 CELEXA ............................ 20 CELLCEPT .......................... 9 CELONTIN ........................ 11 cem-urea ............................. 32 CENTANY ......................... 36 CENTANY AT ................... 36 centergy .............................. 71 centratex ............................. 77 cephalexin............................. 5 CEPROTIN (BLUE BAR)... 28 CEPROTIN (GREEN BAR) 28 CERACADE....................... 33 CERAMAX ........................ 33 CERDELGA ....................... 53 CERVIDIL ......................... 66 CESAMET ......................... 56 cetirizine ............................. 70 cevimeline .......................... 40 CHANTIX .......................... 41 CHANTIX CONTINUING

MONTH BOX................. 41 CHANTIX STARTING

MONTH BOX................. 41 CHEMET ........................... 40 CHENODAL ...................... 56 cheratussin ac...................... 71 children's aspirin ................. 17 chlordiazepoxide hcl............ 20

88

chlordiazepoxide-clidinium . 55 chlorhexidine gluconate....... 41 chloroquine phosphate ........... 6 chlorothiazide ..................... 24 chlorpromazine ................... 20 chlorpropamide ................... 54 chlorthalidone ..................... 24 chlorzoxazone ..................... 15 CHOLBAM ........................ 56 cholecalciferol (vitamin d3) . 77 cholestyramine (with sugar) . 29 cholestyramine light ............ 29 choline,magnesium salicylate

....................................... 17 CIALIS ............................... 74 ciclodan .............................. 37 CICLODAN KIT ................ 37 ciclopirox............................ 37 ciclopirox-ure-camph-menth-

euc .................................. 37 cilostazol............................. 28 CILOXAN .......................... 67 cimetidine ........................... 59 cimetidine hcl...................... 59 CIMZIA.............................. 56 CIMZIA POWDER FOR

RECONST ...................... 56 CIPRO .................................. 7 CIPRO HC.......................... 42 CIPRO XR............................ 7 CIPRODEX ........................ 42 ciprofloxacin ......................... 7 ciprofloxacin (mixture) .......... 7 ciprofloxacin hcl ........ 7, 42, 67 citalopram ........................... 20 CITRANATAL (DUAL-

IRON)............................. 77 CITRANATAL 90 DHA

(ALGAL OIL)................. 77 CITRANATAL ASSURE.... 77 CITRANATAL B-CALM (FE

GLUC)............................ 77 CITRANATAL DHA

(ALGAL OIL)................. 77 CITRANATAL HARMONY

(IRON FUM) .................. 77 citrate of magnesia .............. 56 citroma ............................... 56 citrus calcium...................... 76

claravis ............................... 34 CLARINEX ........................ 70 CLARINEX-D 12 HOUR.... 71 clarithromycin ....................... 5 classic prenatal .................... 77 cleansing wash .................... 34 clearlax ............................... 56 clemastine ........................... 70 CLEO 90 INFUSION SET 24

....................................... 46 CLEOCIN........................... 66 CLEOCIN HCL .................... 6 CLEOCIN PEDIATRIC ........ 6 CLEOCIN T ....................... 34 CLEVER CHEK BLOOD

GLUCOSE ...................... 46 CLEVER CHOICE

GLUCOSE MONITOR ... 46 CLEVER CHOICE LEVEL 2

CONTROL ..................... 46 CLEVER CHOICE MICRO 46 CLEVER CHOICE MICRO

TEST STRIP ................... 43 CLEVER CHOICE PRO 43, 46 CLEVER CHOICE TEST

STRIPS ........................... 43 CLEVER CHOICE VOICE+

TEST .............................. 43 CLIMARA.......................... 65 CLIMARA PRO ................. 65 CLINDACIN ETZ .............. 34 clindacin p .......................... 34 CLINDACIN PAC .............. 34 CLINDAGEL ..................... 34 clindamycin hcl ..................... 6 clindamycin palmitate hcl ...... 6 clindamycin pediatric ............ 6 clindamycin phosphate ...35, 66 clindamycin-benzoyl peroxide

....................................... 35 clindamycin-tretinoin .......... 35 CLINDESSE....................... 66 CLINPRO 5000 .................. 41 clobetasol............................ 38 clobetasol-emollient ............ 38 CLOBEX ............................ 38 CLOCORTOLONE

PIVALATE ..................... 38 clodan ................................. 38

CLODAN KIT .................... 38 CLODERM......................... 38 clomipramine ...................... 20 clonazepam ......................... 11 clonidine ............................. 24 clonidine hcl ..................20, 24 clopidogrel .......................... 28 clorazepate dipotassium....... 20 clorpres ............................... 24 CLORPRES ........................ 24 clotrimazole .....................3, 37 clotrimazole-betamethasone. 37 clozapine............................. 20 CLOZAPINE ...................... 20 CLOZARIL ........................ 20 c-nate dha ........................... 77 COAGADEX ...................... 28 COAL TAR ........................ 31 COARTEM........................... 6 codeine sulfate .................... 16 codeine-butalbital-asa-caff... 16 codeine-guaifenesin............. 71 CODITUSSIN AC .............. 71 CODITUSSIN DAC............ 71 COLAZAL ......................... 56 COLCRYS.......................... 64 COLESTID ......................... 29 COLESTID FLAVORED .... 29 colestipol ............................ 29 colocort............................... 56 COLY-MYCIN S ................ 42 COLYTE WITH FLAVOR

PACKS ........................... 56 COMBIGAN ...................... 69 COMBIPATCH .................. 65 COMBIVENT RESPIMAT . 72 COMBIVIR .......................... 3 COMETRIQ ......................... 9 COMFORT INFUSION SET

43 ................................... 46 COMFORT SHORT INSULIN

PUMP 23 ........................ 46 COMPAZINE ..................... 56 COMPLERA ........................ 3 complete natal dha............... 77 completenate ....................... 77 complex b-100 .................... 77 compro ............................... 56 COMTAN........................... 13

89

CONCEPT DHA................. 77 CONCEPT OB.................... 77 CONCERTA....................... 20 CONDYLOX ...................... 33 constulose ........................... 56 CONTACT DETACH INFUS

SET 23 ............................ 46 CONTOUR CONTROL

SOLUTION, NML .......... 47 CONTOUR NEXT LEV 2

CONTROL SOL ............. 47 CONTOUR NEXT LINK .... 47 CONTROL AST

MONITORING SYSTEM 47 CONZIP ............................. 17 COOL BLOOD GLUCOSE

METER .......................... 47 COOL CONTROL A

SOLUTION .................... 47 COOL GLUCOSE TEST

STRIP ............................. 43 COPAXONE ...................... 61 COPEGUS .......................... 61 CORDRAN......................... 38 CORDRAN TAPE LARGE

ROLL ............................. 38 COREG .............................. 24 COREG CR ........................ 24 CORGARD......................... 24 CORLANOR ...................... 31 cormax................................ 38 CORTANE-B ..................... 33 CORTEF ............................ 42 CORTENEMA.................... 56 CORTIFOAM ..................... 56 cortisone ............................. 42 CORTISPORIN .................. 36 corvita ................................ 77 corvita 150 .......................... 77 CORVITE........................... 77 CORVITE 150 .................... 77 CORVITE FE ..................... 77 CORVITE FREE................. 77 CORZIDE........................... 24 COSENTYX ....................... 31 COSENTYX (2 SYRINGES)

....................................... 31 COSENTYX PEN ............... 31 COSENTYX PEN (2 PENS) 31

COSOPT ............................ 69 COSOPT (PF) ..................... 69 COTELLIC ........................... 9 COTEMPLA XR-ODT........ 20 COUMADIN ...................... 28 covaryx ............................... 65 covaryx h.s.......................... 65 COZAAR ........................... 24 CREON .............................. 56 CRESEMBA......................... 3 CRESTOR .......................... 29 CRINONE .......................... 65 CRIXIVAN........................... 3 cromolyn.................. 56, 68, 72 CUPRIMINE ...................... 64 CUROSURF ....................... 72 CUTIVATE ........................ 38 CUVPOSA ......................... 55 cyanocobalamin (vitamin b-12)

....................................... 77 cyclobenzaprine .................. 15 CYCLOGYL ...................... 67 CYCLOMYDRIL ............... 70 cyclopentolate ..................... 67 CYCLOPHOSPHAMIDE ..... 9 CYCLOSERINE ................... 6 CYCLOSET ....................... 54 cyclosporine.......................... 9 cyclosporine modified ........... 9 cyproheptadine .................... 70 CYSTADANE .................... 56 CYSTAGON ...................... 74 CYSTARAN....................... 68 CYTOMEL ......................... 55 CYTOTEC.......................... 59 cytra k crystals .................... 74 cytra-2 ................................ 74 cytra-3 ................................ 74 cytra-k ................................ 74 D D.H.E.45............................. 13 DALIRESP ......................... 72 danazol ............................... 53 DANTRIUM....................... 15 dantrolene ........................... 15 dapsone................................. 6 DAPTACEL (DTAP

PEDIATRIC) (PF)........... 62 DARAPRIM ......................... 6

darifenacin .......................... 74 DAXBIA .............................. 5 DAYPRO ........................... 17 DAYTRANA ...................... 20 DDAVP .............................. 53 DEBACTEROL .................. 41 DELESTROGEN ................ 65 delta d3 ............................... 77 deltasone............................. 42 DEMADEX ........................ 24 demeclocycline ..................... 7 DEMEROL ......................... 16 DEMSER............................ 24 DENAVIR .......................... 38 denta 5000 plus ................... 41 dentagel .............................. 41 DEPAKENE ....................... 11 DEPAKOTE ....................... 11 DEPAKOTE ER ................. 11 DEPAKOTE SPRINKLES .. 11 DEPEN TITRATABS ......... 64 DEPO-ESTRADIOL ........... 65 DEPO-TESTOSTERONE ... 53 DERMA-SMOOTHE/FS

BODY OIL ..................... 38 DERMA-SMOOTHE/FS

SCALP OIL .................... 38 DERMASORB AF

COMPLETE KIT ............ 36 DERMASORB HC

COMPLETE KIT ............ 38 DERMASORB TA

COMPLETE KIT ............ 38 DERMATOP ...................... 38 DERMOTIC OIL ................ 42 DESCOVY ........................... 3 desipramine......................... 20 desloratadine ....................... 70 desmopressin ...................... 53 DESONATE ....................... 38 desonide.............................. 38 DESOWEN......................... 38 desoximetasone ................... 38 DESOXYN ......................... 20 DESVENLAFAXINE ......... 20 DESVENLAFAXINE

FUMARATE .................. 20 desvenlafaxine succinate ..... 20 DETROL ............................ 74

90

DETROL LA ...................... 74 dexamethasone .................... 42 dexamethasone intensol ....... 42 dexamethasone sodium

phosphate ........................ 69 DEXCOM G4 RECEIVER .. 47 DEXCOM G5 RECEIVER .. 47 DEXEDRINE SPANSULE.. 20 DEXERYL ......................... 33 DEXILANT ........................ 59 dexmethylphenidate ............ 20 DEXPAK 10 DAY .............. 42 DEXPAK 13 DAY .............. 42 DEXPAK 6 DAY ................ 42 dextroamphetamine ............. 20 dextroamphetamine-

amphetamine ................... 20 dialyvite .............................. 77 DIALYVITE 3000 .............. 77 DIALYVITE 5000 .............. 77 dialyvite 800 ....................... 77 DIALYVITE 800 WITH IRON

....................................... 77 DIALYVITE SUPREME D . 77 DIAMOX SEQUELS .......... 68 DIASTAT ........................... 11 DIASTAT ACUDIAL ......... 11 DIATRUE CONTROL SOLN

NORMAL ....................... 47 DIATRUE PLUS BLOOD

GLUCOSE MET ............. 47 DIATRUE PLUS TEST STRIP

....................................... 43 diazepam........................11, 20 diazepam intensol................ 20 DIBENZYLINE .................. 25 DICLEGIS .......................... 56 diclofenac potassium ........... 17 diclofenac sodium ... 17, 18, 33,

68 diclofenac-misoprostol ........ 18 dicloxacillin .......................... 7 dicyclomine ........................ 55 didanosine............................. 3 DIFFERIN .......................... 35 DIFICID ............................... 5 diflorasone .......................... 38 DIFLUCAN .......................... 3 diflunisal............................. 18

digitek ................................ 27 digox .................................. 27 digoxin ............................... 27 dihydroergotamine .........13, 14 DILANTIN ......................... 11 DILANTIN EXTENDED .... 11 DILANTIN INFATABS...... 11 DILANTIN-125 .................. 11 DILATRATE-SR ................ 31 DILAUDID......................... 16 diltiazem ............................. 25 dilt-xr.................................. 25 DIOVAN ............................ 25 DIOVAN HCT.................... 25 DIPENTUM........................ 56 diphenhydramine hcl ........... 70 diphenoxylate-atropine ........ 55 DIPROLENE ...................... 38 dipyridamole ....................... 28 DISALCID ......................... 18 diskets ................................ 16 disopyramide phosphate ...... 23 disulfiram ........................... 40 DITROPAN XL .................. 74 DIURIL .............................. 25 divalproex ........................... 11 DIVIGEL............................ 65 dofetilide............................. 23 DOLOPHINE ..................... 16 donepezil ............................ 14 DONNATAL ...................... 55 DORAL .............................. 20 DORYX................................ 7 DORYX MPC....................... 7 dorzolamide ........................ 69 dorzolamide-timolol ............ 69 dothelle dha ........................ 77 DOVONEX ........................ 31 doxazosin............................ 25 doxepin ..........................20, 33 doxercalciferol .................... 53 doxycycline hyclate ............... 7 doxycycline monohydrate ...... 7 drithocreme hp .................... 31 dronabinol........................... 56 DROXIA .............................. 9 DUAC ................................ 35 DUAVEE ........................... 65 ducodyl ............................... 57

DUET DHA BALANCED .. 77 DUET DHA WITH OMEGA-3

....................................... 77 DUETACT ......................... 54 DUEXIS ............................. 18 DULERA............................ 72 duloxetine ........................... 20 DUOPA .............................. 13 DUPIXENT ........................ 33 DURAGESIC ..................... 16 DUREZOL ......................... 69 DURLAZA ......................... 28 dutasteride .......................... 74 dutasteride-tamsulosin ......... 74 DUTOPROL ....................... 25 d-vi-sol ............................... 77 DYANAVEL XR ................ 20 DYAZIDE .......................... 25 DYMISTA .......................... 72 DYRENIUM....................... 25 E e.c. prin............................... 18 e.e.s. 400............................... 5 E.E.S. GRANULES .............. 5 EASY PLUS II BLOOD

GLUCOSE MET ............. 47 EASY PLUS II TEST.......... 43 EASY STEP ....................... 43 EASY STEP BLOOD

GLUCOSE METER ........ 47 EASY TALK BLOOD

GLUCOSE METER ........ 47 EASY TALK GLUCOSE

TEST .............................. 43 EASY TOUCH GLUCOSE

MONITOR...................... 47 EASY TOUCH TEST STRIP

....................................... 43 EASY TRAK GLUCOSE

TEST .............................. 43 EASY TRAK LOW

CONTROL ..................... 47 EASYGLUCO

MONITORING SYSTEM 47 EASYGLUCO PLUS .....43, 47 EASYGLUCO PLUS

NORMAL CONTROL .... 47 EASYGLUCO TEST .......... 43 EASYMAX ........................ 43

91

EASYMAX L BLOOD GLUCOSE METER ........ 47

EASYMAX LOW CONTROL ....................................... 47

EASYMAX NG .................. 47 EASYMAX NORMAL

CONTROL ..................... 47 EASYMAX V SPEAKING

GLUCOSE SYS .............. 47 EASYMAX V2 BLOOD

GLUCOSE METER ........ 47 EC-NAPROSYN................. 18 econazole ............................ 37 ecotrin ................................ 18 ecotrin low strength ............. 18 ECOZA .............................. 37 EDARBI ............................. 25 EDARBYCLOR ................. 25 EDECRIN........................... 25 EDEX ................................. 74 EDLUAR............................ 20 ed-spaz ............................... 55 EDURANT ........................... 3 eemt.................................... 65 eemt hs ............................... 65 effer-k................................. 76 EFFER-K............................ 76 EFFIENT ............................ 28 EFUDEX ............................ 33 EGRIFTA ........................... 61 ELDEPRYL........................ 13 ELEMENT COMPACT

GLUCOSE METER ........ 47 ELEMENT COMPACT

NORMAL CONTROL .... 47 ELEMENT COMPACT TEST

STRIPS ........................... 43 ELEMENT COMPACT V

GLUCOSE MTR ............. 47 ELEMENT NORMAL

CONTROL ..................... 47 ELEMENT PLUS BLOOD

GLUCOSE KIT............... 48 ELEMENT TEST STRIPS .. 43 ELESTAT........................... 68 ELESTRIN ......................... 65 eletone ................................ 33 eletriptan hbr ....................... 14 ELIDEL .............................. 33

ELIGARD ............................ 9 ELIGARD (3 MONTH) ........ 9 ELIGARD (4 MONTH) ........ 9 ELIGARD (6 MONTH) ........ 9 ELIMITE ............................ 39 eliphos ................................ 57 ELIQUIS ............................ 28 elite-ob ............................... 77 ELIXOPHYLLIN................ 72 ELMIRON .......................... 74 ELOCON............................ 38 ELOCTATE........................ 28 EMADINE.......................... 68 EMBEDA ........................... 16 EMBRACE EVO LEVEL 1 48 EMBRACE GLUCOSE

CONTROL LOW ............ 48 EMCYT................................ 9 EMEND.............................. 57 EMSAM ............................. 20 EMTRIVA ............................ 3 emulsion sb ......................... 33 EMVERM ............................ 6 ENABLEX ......................... 74 enalapril maleate ................. 25 enalapril-hydrochlorothiazide

....................................... 25 ENBRACE HR ................... 77 ENBREL ............................ 64 ENBREL SURECLICK....... 64 endocet ............................... 16 ENGERIX-B (PF) ............... 62 ENGERIX-B PEDIATRIC

(PF) ................................ 62 ENLITE SYSTEM .............. 48 ENLYTE (FERROUS

GLYCINE) ..................... 77 enoxaparin .......................... 28 ENSTILAR ......................... 31 entacapone .......................... 13 entecavir ............................... 3 ENTEREG .......................... 57 ENTOCORT EC ................. 57 ENTRESTO........................ 31 ENTTY............................... 33 enulose ............................... 57 ENVARSUS XR ................... 9 EPANED ............................ 25 EPCLUSA ............................ 3

EPICERAM ........................ 33 EPIDUO ............................. 35 EPIDUO FORTE ................ 35 EPIFOAM .......................... 31 epinastine............................ 68 EPINEPHRINE................... 70 EPIPEN 2-PAK................... 70 EPIPEN JR 2-PAK.............. 70 EPISIL................................ 41 epitol .................................. 11 EPIVIR ................................. 4 EPIVIR HBV ........................ 4 eplerenone .......................... 25 eprosartan ........................... 25 EPZICOM ............................ 4 EQUETRO ......................... 11 ergocalciferol (vitamin d2) .. 78 ergoloid .............................. 20 ERGOMAR ........................ 14 ergotamine-caffeine............. 14 ERIVEDGE .......................... 9 ERTACZO.......................... 37 ery pads .............................. 35 erygel.................................. 35 ERYPED 200........................ 5 ERYPED 400........................ 5 ery-tab .................................. 5 ERY-TAB............................. 5 erythrocin (as stearate)........... 5 erythromycin....................5, 67 erythromycin ethylsuccinate .. 5 erythromycin with ethanol ... 35 erythromycin-benzoyl peroxide

....................................... 35 ESBRIET............................ 72 ESCAVITE ......................... 78 ESCAVITE D ..................... 78 ESCAVITE LQ ................... 78 escitalopram oxalate ............ 20 ESGIC ................................ 16 esomeprazole magnesium ....59,

60 ESOMEPRAZOLE

STRONTIUM ................. 60 estazolam ............................ 20 ESTRACE .......................... 65 estradiol .............................. 65 estradiol valerate ................. 65 estradiol-norethindrone acet. 65

92

ESTRING ........................... 65 estrogens-methyltestosterone 65 estropipate .......................... 65 eszopiclone ......................... 20 ethacrynic acid .................... 25 ethambutol ............................ 6 ethosuximide....................... 12 ethyl chloride ...................... 36 etidronate disodium ............. 40 etodolac .............................. 18 etoposide............................... 9 EUCRISA ........................... 33 EURAX .............................. 39 EVAMIST .......................... 65 EVEKEO ............................ 21 EVENCARE G2 ............43, 48 EVENCARE G3 GLUCOSE

METER .......................... 48 EVENCARE G3 TEST ....... 43 EVENCARE MINI

GLUCOSE TEST STR .... 44 EVENCARE MINI

MONITOR SYSTEM ...... 48 EVISTA.............................. 64 EVOCLIN .......................... 35 EVOLUTION BLOOD

GLUCOSE METER ........ 48 EVOLUTION NORMAL

CONTROL ..................... 48 EVOLUTION TEST STRIPS

....................................... 44 EVOTAZ .............................. 4 EVOXAC ........................... 40 EXALGO ER...................... 16 EXELDERM ...................... 37 EXELON ............................ 14 exemestane ........................... 9 EXFORGE.......................... 25 EXFORGE HCT ................. 25 EXJADE............................. 40 EXODERM ........................ 37 EXTAVIA .......................... 61 EXTINA ............................. 37 EXTRA-VIRT PLUS DHA . 78 EYLEA............................... 68 EZ SMART PLUS SYSTEM

....................................... 48 EZ SMART PLUS TEST .... 44 EZ SMART SYSTEM......... 48

EZ SMART TEST............... 44 ezetimibe ............................ 30 ezetimibe-simvastatin .......... 30 F FABIOR ............................. 35 FACTIVE ............................. 7 famciclovir............................ 4 famotidine........................... 60 FANAPT ............................ 21 FARESTON ......................... 9 FARXIGA .......................... 54 FARYDAK........................... 9 FAZACLO.......................... 21 felbamate ............................ 12 FELBATOL........................ 12 FELDENE .......................... 18 felodipine............................ 25 fem ph ................................ 66 FEMARA ............................. 9 FEMHRT LOW DOSE ....... 65 fenofibrate .......................... 30 FENOFIBRATE ................. 30 fenofibrate micronized......... 30 fenofibrate nanocrystallized . 30 fenofibric acid ..................... 30 fenofibric acid (choline) ...... 30 FENOGLIDE ...................... 30 fenoprofen .......................... 18 FENOPROFEN................... 18 FENORTHO ....................... 18 fentanyl............................... 16 FENTANYL ....................... 16 fentanyl citrate .................... 16 FERIVA 21-7 TABLET ...... 78 FERIVA FA (SUMALATE) 78 ferocon ............................... 78 FERRALET 90 DUAL-IRON

DELIVERY .................... 78 ferraplus 90 ......................... 78 ferrex 150 forte ................... 78 ferrex 150 forte plus ............ 78 ferrex 28 ............................. 78 FERRIPROX ...................... 40 ferrocite plus ....................... 78 FETZIMA........................... 21 FEXMID ............................ 15 FIBRICOR.......................... 30 FIFTY50 TEST STRIP........ 44 FINACEA........................... 35

finasteride ........................... 74 FIORICET .......................... 16 FIORINAL ......................... 16 FIORINAL-CODEINE #3 ... 16 FIRAZYR ........................... 72 FLAGYL .............................. 6 FLAREX ............................ 69 flavoxate ............................. 74 flecainide ............................ 23 FLECTOR .......................... 18 fleet laxative ....................... 57 FLOLIPID .......................... 30 FLOMAX ........................... 74 FLORIVA........................... 78 FLORIVA (FLUORIDE-

VITAMIN D3) ................ 78 FLORIVA PLUS................. 78 FLOVENT DISKUS ........... 72 FLOVENT HFA ................. 72 FLOWTUSS ....................... 71 floxin .................................. 42 FLUAD 2017-2018 (65 YR

UP)(PF) .......................... 63 FLUARIX QUAD 2017-2018

(PF) ................................ 63 FLUBLOK 2017-2018 (PF) . 63 FLUBLOK QUAD 2017-2018

(PF) ................................ 63 flucaine ............................... 68 FLUCELVAX QUAD 2017-

2018................................ 63 FLUCELVAX QUAD 2017-

2018 (PF) ........................ 63 fluconazole ........................... 3 flucytosine ............................ 3 fludrocortisone .................... 42 FLULAVAL QUAD 2017-

2018................................ 63 FLULAVAL QUAD 2017-

2018 (PF) ........................ 63 FLUMADINE ....................... 4 flunisolide ........................... 72 fluocinolone ........................ 38 fluocinolone acetonide oil.... 42 fluocinolone and shower cap 38 fluocinonide ........................ 38 fluocinonide-e ..................... 38 fluocinonide-emollient......... 39 FLUORABON .................... 78

93

FLUOR-A-DAY ................. 78 fluor-a-day (with xylitol) ..... 78 fluorescein-proparacaine...... 68 fluoride (sodium)............41, 78 FLUORIDEX DAILY

DEFENSE....................... 41 fluoritab .............................. 78 fluorometholone .................. 69 FLUOROPLEX .................. 33 fluorouracil ......................... 33 fluoxetine............................ 21 FLUOXETINE.................... 21 fluphenazine hcl .................. 21 FLURA-DROPS ................. 78 flurandrenolide .................... 39 flurazepam .......................... 21 flurbiprofen ......................... 18 flurbiprofen sodium ............. 68 flurox.................................. 68 flutamide............................... 9 fluticasone .....................39, 72 FLUTICASONE-

SALMETEROL .............. 73 fluvastatin ........................... 30 FLUVIRIN 2017-2018 ........ 63 FLUVIRIN 2017-2018 (PF). 63 fluvoxamine ........................ 21 FLUZONE HIGH-DOSE

2017-18 (PF) ................... 63 FLUZONE INTRADERM

QUAD 2017-18 ............... 63 FLUZONE QUAD 2017-2018

....................................... 63 FLUZONE QUAD 2017-2018

(PF) ................................ 63 FLUZONE QUAD PEDI

2017-18 (PF) ................... 63 FML FORTE ...................... 69 FML LIQUIFILM ............... 69 FML S.O.P.......................... 69 focalgin 90 dha.................... 78 focalgin ca .......................... 78 focalgin dss ......................... 78 FOCALIN........................... 21 FOCALIN XR .................... 21 folbee.................................. 78 folbee ar.............................. 78 folbee plus .......................... 78 folbic .................................. 78

FOLET ONE....................... 78 FOLGARD OS ................... 78 FOLGARD RX ................... 78 folic acid ............................. 79 folic acid-vit b6-vit b12 ....... 79 folivane-f ............................ 79 folivane-ob.......................... 79 folivane-plus ....................... 79 folplex 2.2........................... 79 foltabs 800 .......................... 79 FOLTRATE........................ 79 fondaparinux ....................... 28 FORA D10 ......................... 48 FORA D15 ......................... 48 FORA D15G ....................... 44 FORA D20 ....................44, 48 FORA D40 ......................... 48 FORA D40-G31 TEST

STRIPS ........................... 44 FORA G20 ....................44, 48 FORA G30A ..................44, 48 FORA GD50 BLOOD

GLUCOSE SYSTEM ...... 48 FORA GD50 TEST STRIPS 44 FORA NORMAL CONTROL

....................................... 48 FORA PREMIUM V10

GLUCOSE METER ........ 48 FORA TEST N'GO VOICE

METER .......................... 48 FORA TEST STRIP ............ 44 FORA TN'G VOICE METER

....................................... 48 FORA TN'G VOICE TEST

STRIPS ........................... 44 FORA V10 ....................44, 48 FORA V10-V12-D10-D20

STRIPS ........................... 44 FORA V12 BLOOD

GLUCOSE SYSTEM ...... 48 FORA V12 GLUCOSE ....... 44 FORA V20 ....................44, 48 FORA V30A ....................... 48 FORACARE GD20 ............. 44 FORACARE GD20

GLUCOSE METER ........ 48 FORACARE GD40 ............. 44 FORACARE GD40A

GLUCOSE METER ........ 48

FORACARE GD40B GLUCOSE METER ........ 48

FORACARE GDH LOW CONTROL ..................... 48

FORFIVO XL ..................... 21 FORTAMET....................... 54 FORTAVIT ........................ 76 FORTISCARE BLOOD

GLUCOSE SYST............ 48 FORTISCARE GLUCOSE

TEST STRIPS ................. 44 FORTISCARE NORMAL ... 48 FOSAMAX......................... 64 FOSAMAX PLUS D ........... 64 fosinopril ............................ 25 fosinopril-hydrochlorothiazide

....................................... 25 FOSRENOL ....................... 57 FRAGMIN.......................... 28 FREESTYLE CONTROL ... 48 frovatriptan ......................... 14 full spectrum b-vitamin c ..... 79 FURADANTIN .................... 8 furosemide .......................... 25 FUSION PLUS ................... 79 FUSION SPRINKLES ........ 79 FUZEON .............................. 4 fyavolv ............................... 65 FYCOMPA......................... 12 G g tussin ac ........................... 71 gabapentin .......................... 12 GABITRIL ......................... 12 galantamine......................... 14 GALZIN ............................. 76 GARDASIL 9 (PF) ............. 63 GASTROCROM ................. 57 gatifloxacin ......................... 67 GATTEX 30-VIAL ............. 57 gavilax ................................ 57 gavilyte-c ............................ 57 gavilyte-g............................ 57 gavilyte-n............................ 57 GE100 BLOOD GLUCOSE

SYSTEM ........................ 48 GE100 BLOOD GLUCOSE

TEST STRIP ................... 44 GE100 CONTROL

SOLUTION NORMAL ... 48

94

GELCLAIR ........................ 41 GELNIQUE ........................ 74 GELX ................................. 41 gemfibrozil ......................... 30 generlac .............................. 57 gengraf ................................. 9 GENOTROPIN ................... 61 GENOTROPIN MINIQUICK

....................................... 61 GENSTRIP TEST STRIP .... 44 gentak ................................. 67 gentamicin .....................36, 67 gentle laxative ..................... 57 gentlelax ............................. 57 GENVOYA .......................... 4 GEODON ........................... 21 GIALAX............................. 57 GIAZO ............................... 57 GILENYA .......................... 61 GILOTRIF ............................ 9 GLASSIA ........................... 40 glatopa ................................ 61 GLEEVEC ............................ 9 GLEOSTINE ........................ 9 GLIADEL WAFER............... 9 glimepiride.......................... 54 glipizide .............................. 54 glipizide-metformin............. 54 GLUCAGEN DIAGNOSTIC

KIT ................................. 45 GLUCAGEN HYPOKIT ..... 45 GLUCAGON EMERGENCY

KIT (HUMAN) ............... 45 GLUCAGON HCL ............. 45 GLUCO NAVII GLUCOSE

MONITOR...................... 49 GLUCO NAVII TEST STRIP

....................................... 44 GLUCOCARD 01 METER . 49 GLUCOCARD 01 NORMAL

CONTROL ..................... 49 GLUCOCARD 01 SENSOR

PLUS .............................. 44 GLUCOCARD EXPRESSION

..................................44, 49 GLUCOCARD SHINE

METER .......................... 49 GLUCOCARD SHINE TEST

STRIPS ........................... 44

GLUCOCARD VITAL ....... 49 GLUCOCARD VITAL

SENSOR......................... 44 GLUCOCARD VITAL TEST

STRIPS ........................... 44 GLUCOCOM BLOOD

GLUCOSE ...................... 49 GLUCOCOM CONTROL

NORMAL ....................... 49 GLUCOCOM GLUCOSE ... 44 GLUCOPHAGE ................. 54 GLUCOPHAGE XR ........... 54 GLUCOSE CONTROL ....... 49 GLUCOTROL .................... 54 GLUCOTROL XL .............. 54 GLUCOVANCE ................. 54 glyburide............................. 54 glyburide micronized........... 54 glyburide-metformin ........... 54 glycolax .............................. 57 glycopyrrolate ..................... 55 glydo .................................. 36 GLYNASE ......................... 54 GLYSET............................. 54 GLYXAMBI....................... 54 GM100 ..........................44, 49 GOLYTELY ....................... 57 GONITRO .......................... 31 GORDONS UREA.............. 33 GRALISE ........................... 12 GRALISE 30-DAY STARTER

PACK ............................. 12 granisetron hcl .................... 57 GRANIX ............................ 61 griseofulvin microsize ........... 3 griseofulvin ultramicrosize .... 3 GRIS-PEG

(ULTRAMICROSIZE) ...... 3 guaiatussin ac...................... 71 guaifenesin ac ..................... 71 guaifenesin dac ................... 71 guanfacine .....................21, 25 guanidine ............................ 21 GUARDIAN REAL-TIME

GLU MONITOR ............. 49 GYNAZOLE-1 ................... 66 H HAEGARDA ...................... 73 HALCION .......................... 21

halobetasol propionate ......... 39 HALOG .............................. 39 haloperidol .......................... 21 haloperidol lactate ............... 21 HARVONI............................ 4 HAVRIX (PF)..................... 63 HEALTHPRO GLUCOSE

MONITOR...................... 49 HEALTHPRO HIGH-LOW

CONTROL ..................... 49 HEALTHPRO TEST STRIPS

....................................... 44 healthylax ........................... 57 HECTOROL ....................... 53 HELIXATE FS ................... 28 HEMANGEOL ................... 25 hematinic plus vit/minerals .. 79 hematinic/folic acid ............. 79 hematogen .......................... 79 hematogen fa....................... 79 hematogen forte .................. 79 HEMATRON-AF................ 79 hemenatal ob ....................... 79 hemenatal ob + dha ............. 79 hemetab .............................. 79 hemmorex-hc ...................... 57 HEMOCYTE-F................... 79 HEMOCYTE-PLUS............ 79 hep flush-10 (pf) ................. 28 heparin (porcine) ................. 28 HEPARIN (PORCINE) IN

0.9% NACL .................... 28 heparin (porcine) in 5 % dex 28 heparin (porcine) in nacl (pf) 28 heparin flush(porcine)-0.9nacl

....................................... 28 heparin lock flush ................ 28 heparin lock flush (porcine) . 28 heparin lockflush(porcine)(pf)

....................................... 28 heparin(porcine) in 0.45% nacl

....................................... 28 HEPARIN(PORCINE) IN

0.45% NACL .................. 28 heparin, porcine (pf) ............ 28 HEPSERA ............................ 4 HETLIOZ ........................... 21 HEXALEN ........................... 9 HIBERIX (PF) .................... 63

95

hi-cal plus vit d ................... 76 HIPREX ............................... 8 HISTEX-AC ....................... 71 homatropaire ....................... 67 homatropine hbr .................. 67 HORIZANT........................ 14 hpr ...................................... 33 hpr plus............................... 33 hpr plus hydrogel ................ 33 HPR PLUS-MB HYDROGEL

....................................... 33 HUMALOG........................ 52 HUMALOG JUNIOR

KWIKPEN ...................... 52 HUMALOG KWIKPEN ..... 52 HUMALOG MIX 50-50 ...... 52 HUMALOG MIX 50-50

KWIKPEN ...................... 52 HUMALOG MIX 75-25 ...... 52 HUMALOG MIX 75-25

KWIKPEN ...................... 52 HUMAPEN LUXURA HD . 49 HUMATROPE.................... 61 HUMIRA............................ 64 HUMIRA PEDIATRIC

CROHN'S START .......... 64 HUMIRA PEN CROHN'S-

UC-HS START ............... 64 HUMIRA PEN PSORIASIS-

UVEITIS......................... 65 HUMULIN 70/30................ 52 HUMULIN 70/30 KWIKPEN

....................................... 52 HUMULIN N...................... 52 HUMULIN N KWIKPEN ... 52 HUMULIN R U-100 ........... 52 HUMULIN R U-500 (CONC)

KWIKPEN ...................... 52 HUMULIN R U-500

(CONCENTRATED) ...... 52 HYCAMTIN......................... 9 HYCOFENIX ..................... 71 hydralazine ......................... 25 HYDREA ............................. 9 HYDRO 35 ......................... 33 HYDRO 40 ......................... 33 hydrochlorothiazide............. 25 hydrocodone-acetaminophen 16

hydrocodone-chlorpheniramine ....................................... 71

hydrocodone-cpm-pseudoephed.................... 71

hydrocodone-homatropine ... 71 hydrocodone-ibuprofen ....... 16 hydrocortisone ......... 39, 42, 57 hydrocortisone acetate ......... 57 hydrocortisone butyrate ....... 39 hydrocortisone butyr-emollient

....................................... 39 hydrocortisone valerate........ 39 hydrocortisone-acetic acid ... 42 hydrocortisone-iodoquinol-aloe

....................................... 36 hydrocortisone-min oil-wht pet

....................................... 39 hydrocortisone-pramoxine ...31,

57 hydromet............................. 71 hydromorphone ................... 16 hydroxocobalamin ............... 79 hydroxychloroquine .............. 6 hydroxyurea .......................... 9 hydroxyzine hcl................... 70 hydroxyzine pamoate .......... 70 HYLATOPIC...................... 33 HYLATOPICPLUS ............ 33 hyolev mb ........................... 74 hyophen .............................. 75 hyoscyamine sulfate ............ 55 hyosyne .............................. 55 HYPER-SAL ...................... 73 HYSINGLA ER .................. 16 HYZAAR ........................... 25 I ibandronate ......................... 64 IBRANCE ............................ 9 IBUDONE .......................... 16 ibuprofen ............................ 18 ibuprofen-oxycodone........... 16 ICAR-C PLUS .................... 79 ICLUSIG .............................. 9 IDELVION ......................... 28 IDHIFA ................................ 9 iferex 150 forte.................... 79 ILEVRO ............................. 68 ILUVIEN............................ 69 imatinib ................................ 9

IMBRUVICA ....................... 9 imipramine hcl .................... 21 imipramine pamoate ............ 21 imiquimod .......................... 62 IMOVAX RABIES VACCINE

(PF) ................................ 63 IMPAVIDO .......................... 6 IMURAN.............................. 9 INCRELEX ........................ 40 INCRUSE ELLIPTA........... 73 indapamide ......................... 25 INDERAL XL .................... 25 INDIOMIN MB .................. 75 INDOCIN ........................... 18 indomethacin ...................... 18 INFANRIX (DTAP) (PF) .... 63 INFASURF......................... 40 INFINITY CONTROL

SOLUTION NORM ........ 49 INFINITY STARTER KIT .. 49 INFINITY TEST STRIPS ... 44 INGREZZA ........................ 14 INLYTA ............................... 9 INNOPRAN XL.................. 25 INOVA ............................... 35 INOVA 4-1 ......................... 32 INOVA 8-2 ......................... 32 INSET 30 INFUSION SET 23

....................................... 49 INSET INFUSION SET 23.. 49 INSPRA.............................. 25 INSULIN SYRINGE-

NEEDLE U-100 .............. 45 INTEGRA F ....................... 79 INTEGRA PLUS ................ 79 INTELENCE ........................ 4 INTERMEZZO ................... 21 INTRAROSA ..................... 66 INTRON A ......................... 62 INVEGA............................. 21 INVIRASE ........................... 4 INVOKAMET .................... 54 INVOKAMET XR .............. 54 INVOKANA....................... 54 IODOFLEX ........................ 33 iodoquinol-hc ...................... 36 IODOSORB........................ 33 IONSYS ............................. 16 IOPIDINE........................... 70

96

IPOL................................... 63 ipratropium bromide.......41, 73 ipratropium-albuterol........... 73 IPRIVASK.......................... 28 irbesartan ............................ 25 irbesartan-hydrochlorothiazide

....................................... 25 IRENKA............................. 21 IRESSA ................................ 9 IROSPAN 24/6 ................... 79 ISENTRESS ......................... 4 ISENTRESS HD ................... 4 ISOCHRON........................ 31 isometh-dichloral-

acetaminophn .................. 14 isomethepten-caf-

acetaminophen ................ 14 isoniazid ............................... 6 ISOPTO CARPINE ............. 67 ISORDIL ............................ 31 ISORDIL TITRADOSE ...... 31 isosorbide dinitrate .............. 31 isosorbide mononitrate ........ 31 isoxsuprine.......................... 66 isradipine ............................ 25 itraconazole........................... 3 ivermectin ............................. 6 IXIARO (PF) ...................... 63 IXINITY............................. 29 J JADENU ............................ 40 JADENU SPRINKLE ......... 40 JAKAFI ................................ 9 JALYN ............................... 74 jantoven .............................. 29 JANUMET ......................... 54 JANUMET XR ................... 54 JANUVIA........................... 54 JARDIANCE ...................... 54 JAZZ WIRELESS 2 METER

KIT ................................. 49 JENTADUETO................... 54 JENTADUETO XR............. 54 JETREA (PF)...................... 68 jevantique lo ....................... 66 jinteli .................................. 66 JUBLIA .............................. 37 JUXTAPID ......................... 30

K KADIAN ............................ 16 KALETRA ........................... 4 KALYDECO ...................... 73 KAPVAY ........................... 21 KARBINAL ER .................. 70 k-effervescent ..................... 76 KEFLEX............................... 5 KENALOG ......................... 39 KEPPRA ............................ 12 KEPPRA XR ...................... 12 KERAFOAM ...................... 33 KERALAC ......................... 33 KERALYT RX ................... 32 KERALYT SCALP

COMPLETE ................... 32 KERYDIN .......................... 37 ketoconazole ....................3, 37 ketoprofen........................... 18 ketorolac ........................18, 68 KEVEYIS ........................... 14 KEVZARA ......................... 65 KHEDEZLA ....................... 21 KINERET ........................... 62 KINRIX (PF) ...................... 63 kionex................................. 57 kionex (with sorbitol) .......... 57 KISQALI .............................. 9 KISQALI FEMARA CO-

PACK ............................... 9 KITABIS PAK...................... 6 KLARON ........................... 36 KLONOPIN........................ 12 klor-con .............................. 76 klor-con 10 ......................... 76 klor-con 8 ........................... 76 klor-con m10....................... 76 klor-con m15....................... 76 klor-con m20....................... 76 klor-con sprinkle ................. 76 KLOR-CON/25................... 76 klor-con/ef .......................... 76 kobee .................................. 79 KOGENATE FS ................. 29 KORLYM........................... 53 KOSHER PRENATAL PLUS

IRON .............................. 79 KOVALTRY ...................... 29 K-PHOS NO 2 .................... 75

K-PHOS ORIGINAL .......... 75 k-phos-neutral ..................... 76 kpn ..................................... 79 KRISTALOSE .................... 57 k-tab ................................... 76 K-TAB ............................... 76 KUVAN ............................. 53 KYNAMRO ....................... 30 L labetalol .............................. 25 LACRISERT ...................... 68 lactated ringers .................... 40 lactulose.............................. 57 LAMICTAL........................ 12 LAMICTAL ODT ............... 12 LAMICTAL ODT STARTER

(BLUE) ........................... 12 LAMICTAL ODT STARTER

(GREEN) ........................ 12 LAMICTAL ODT STARTER

(ORANGE) ..................... 12 LAMICTAL STARTER

(BLUE) KIT.................... 12 LAMICTAL STARTER

(GREEN) KIT ................. 12 LAMICTAL STARTER

(ORANGE) KIT .............. 12 LAMICTAL XR ................. 12 LAMICTAL XR STARTER

(BLUE) ........................... 12 LAMICTAL XR STARTER

(GREEN) ........................ 12 LAMICTAL XR STARTER

(ORANGE) ..................... 12 LAMISIL.............................. 3 lamivudine ............................ 4 lamivudine-zidovudine .......... 4 lamotrigine.......................... 12 LANCETS .......................... 49 LANCING DEVICE ........... 49 LANOXIN .......................... 27 lansoprazole ........................ 60 LANTUS ............................ 52 LANTUS SOLOSTAR ........ 52 LASIX ................................ 25 LASTACAFT ..................... 68 latanoprost .......................... 69 LATUDA ........................... 21 laxaclear ............................. 57

97

laxative (bisacodyl) ............. 57 laxative feminine................. 57 laxative peg 3350 ................ 57 leflunomide ......................... 65 LENVIMA............................ 9 LESCOL............................. 30 LESCOL XL ....................... 30 LETAIRIS .......................... 73 letrozole ................................ 9 leucovorin calcium ................ 8 LEUKERAN......................... 9 LEUKINE........................... 61 leuprolide.............................. 9 levalbuterol hcl ................... 73 LEVAQUIN.......................... 7 LEVATOL.......................... 25 LEVBID ............................. 55 LEVEMIR .......................... 52 LEVEMIR FLEXTOUCH ... 52 levetiracetam....................... 12 levobunolol ......................... 67 levocarnitine ....................... 40 levocarnitine (with sugar) .... 40 levocetirizine ...................... 70 levofloxacin .....................7, 67 levomefolate dha ................. 79 levorphanol tartrate ............. 16 LEVO-T ............................. 55 levothyroxine ...................... 55 levoxyl................................ 55 LEVSIN.............................. 55 LEVSIN/SL ........................ 55 LEVULAN ......................... 33 LEXIVA ............................... 4 LIALDA ............................. 57 lidocaine ............................. 36 lidocaine hcl........................ 36 lidocaine hcl-hydrocortison ac

..................................36, 57 LIDOCAINE HCL-

HYDROCORTISON AC . 57 lidocaine viscous ................. 36 lidocaine-hydrocortisone-aloe

....................................... 57 lidocaine-prilocaine ............. 36 LIDOCAINE-TETRACAINE

....................................... 36 lindane ................................ 39 linezolid ................................ 6

LINZESS ............................ 57 liothyronine......................... 55 LIPITOR............................. 30 LIPOCHOL PLUS .............. 40 LIPOFEN ........................... 30 lisinopril ............................. 25 lisinopril-hydrochlorothiazide

....................................... 25 lite coat aspirin .................... 18 lithium carbonate................. 21 lithium citrate...................... 21 LITHOBID ......................... 21 LITHOSTAT ...................... 40 LIVALO ............................. 30 LOCOID............................. 39 LOCOID LIPOCREAM ...... 39 LOCORT ............................ 42 LODINE ............................. 18 LODOSYN ......................... 13 LOMOTIL .......................... 55 LONSURF ............................ 9 loperamide .......................... 55 LOPID ................................ 30 lopinavir-ritonavir ................. 4 lopreeza .............................. 66 LOPRESSOR...................... 25 LOPRESSOR HCT ............. 25 LOPROX ............................ 37 LOPROX (AS OLAMINE) . 37 LOPROX KIT..................... 37 lorazepam ........................... 21 lorazepam intensol .............. 21 lorcet (hydrocodone) ........... 16 lorcet hd.............................. 16 lorcet plus ........................... 16 LORTAB ELIXIR............... 16 lortuss ex ............................ 71 LORZONE ......................... 15 losartan ............................... 25 losartan-hydrochlorothiazide 25 LOTEMAX......................... 69 LOTENSIN......................... 25 LOTENSIN HCT ................ 25 LOTREL............................. 25 LOTRISONE ...................... 37 LOTRONEX....................... 57 LOUTREX ......................... 33 lovastatin ............................ 30 LOVAZA ........................... 30

loxapine succinate ............... 21 lta pre-attached.................... 36 LUCENTIS ......................... 68 ludent fluoride..................... 79 lugols.............................37, 76 LUMIGAN ......................... 69 LUNESTA .......................... 21 LUPANETA PACK (1

MONTH) ........................ 66 LUPANETA PACK (3

MONTH) ........................ 66 LUPRON DEPOT ................. 9 LUPRON DEPOT (3

MONTH) ........................ 10 LUPRON DEPOT (4

MONTH) ........................ 10 LUPRON DEPOT (6

MONTH) ........................ 10 LUPRON DEPOT-PED....... 10 LUPRON DEPOT-PED (3

MONTH) ........................ 10 luxamend ............................ 33 LUXIQ ............................... 39 LUZU ................................. 37 LYNPARZA ....................... 10 LYRICA ............................. 12 LYSODREN ....................... 10 LYSTEDA .......................... 66 M MACROBID......................... 8 MACRODANTIN................. 8 MACUGEN ........................ 68 MAGNEBIND 400 ............. 58 magnesium citrate ............... 58 MALARONE........................ 6 MALARONE PEDIATRIC ... 6 malathion ............................ 39 maprotiline.......................... 21 MAR-COF BP .................... 71 MAR-COF CG.................... 71 MARINOL ......................... 58 MARNATAL-F .................. 79 MARPLAN......................... 21 marten-tab........................... 16 MATULANE ...................... 10 matzim la ............................ 25 MAVYRET .......................... 4 MAXALT ........................... 14 MAXALT-MLT.................. 14

98

MAXFE (FOLATE-DOCUSATE) .................. 79

MAXIDEX ......................... 69 MAXITROL ....................... 69 MAXZIDE.......................... 25 MAXZIDE-25MG............... 25 mb hydrogel ........................ 33 mb hydrogel (cyclomethicone)

....................................... 33 m-clear wc .......................... 71 MEBOLIC .......................... 79 meclizine ............................ 58 meclofenamate .................... 18 MEDISENSE ...................... 49 MEDISENSE GLUCOSE

KETONE ........................ 49 MEDROL ........................... 42 MEDROL (PAK) ................ 42 medroxyprogesterone .......... 66 mefenamic acid ................... 18 mefloquine ............................ 6 MEGACE ES...................... 10 megestrol ............................ 10 MEKINIST ......................... 10 meloxicam .......................... 18 melphalan ........................... 10 memantine .......................... 14 MEMANTINE .................... 14 MENACTRA (PF) .............. 63 M-END PE ......................... 71 MENEST ............................ 66 MENHIBRIX (PF) .............. 63 MENOMUNE - A/C/Y/W-135

....................................... 63 MENOMUNE - A/C/Y/W-135

(PF) ................................ 63 MENOSTAR ...................... 66 MENTAX ........................... 37 MENVEO A-C-Y-W-135-DIP

(PF) ................................ 63 meperidine .......................... 16 MEPHYTON ...................... 29 meprobamate ...................... 15 MEPRON ............................. 6 mercaptopurine ................... 10 mesalamine ......................... 58 mesalamine with cleansing

wipe ................................ 58 MESNEX ............................. 8

MESTINON........................ 15 MESTINON TIMESPAN .... 15 metadate er ......................... 21 metaproterenol .................... 73 metaxall .............................. 15 metaxalone.......................... 15 metformin ........................... 54 methadone .......................... 16 methadose ........................... 16 methamphetamine ............... 21 METHAVER ...................... 79 methazolamide .................... 68 methenamine hippurate.......... 8 methenamine mandelate ........ 8 methen-sod phos-meth blue-

hyos ................................ 75 methergine .......................... 66 methimazole........................ 43 METHITEST ...................... 53 methocarbamol.................... 15 methotrexate sodium ........... 10 methotrexate sodium (pf) ..... 10 methoxsalen ........................ 33 methscopolamine ................ 55 methyclothiazide ................. 25 methyldopa ......................... 25 methyldopa-

hydrochlorothiazide ......... 25 METHYLIN ....................... 21 methylphenidate hcl ............ 21 methylprednisolone ............. 42 methyltestosterone............... 53 metipranolol........................ 67 metoclopramide hcl ............. 58 metolazone.......................... 25 METOPIRONE................... 40 metoprolol succinate............ 25 METOPROLOL SU-

HYDROCHLOROTHIAZ 26 metoprolol ta-hydrochlorothiaz

....................................... 26 metoprolol tartrate ............... 26 METROCREAM ................ 35 METROGEL ...................... 35 METROGEL VAGINAL .... 66 METROLOTION ................ 35 metronidazole ............ 6, 35, 66 mexiletine ........................... 23 MIACALCIN...................... 53

MICARDIS......................... 26 MICARDIS HCT ................ 26 miconazole-3 ...................... 66 MICORT-HC ...................... 58 MICRO BLOOD GLUCOSE

....................................... 44 MICRODOT BLOOD

GLUCOSE SYSTEM .44, 49 MICROZIDE ...................... 26 midazolam .......................... 21 midodrine ........................... 40 migergot ............................. 14 miglitol ............................... 54 MIGRANAL....................... 14 milk of magnesia ................. 58 milk of magnesia concentrated

....................................... 58 millipred ............................. 43 MILLIPRED ....................... 42 millipred dp ........................ 42 mimvey............................... 66 mimvey lo........................... 66 MINIMED INFUSION SET-

MMT 390........................ 49 MINIPRESS ....................... 26 MINITRAN ........................ 31 MINIVELLE ...................... 66 MINOCIN ............................ 7 minocycline .......................... 7 minoxidil ............................ 26 MIO INFUSION SET.......... 49 MIOCHOL-E ...................... 68 miostat ................................ 69 miralax ............................... 58 MIRAPEX .......................... 13 MIRAPEX ER .................... 13 mirtazapine ......................... 21 MIRVASO.......................... 35 misoprostol ......................... 60 MITIGARE......................... 64 MITOSOL .......................... 69 M-M-R II (PF) .................... 63 MOBIC............................... 18 modafinil ............................ 21 moderiba............................. 61 moderiba dose pack ............. 61 moexipril ............................ 26 moexipril-hydrochlorothiazide

....................................... 26

99

mometasone ...................39, 73 mondoxyne nl ....................... 7 MONODOX ......................... 7 montelukast......................... 73 MONUROL .......................... 8 morgidox .............................. 7 MORGIDOX 1X 50 .............. 7 MORGIDOX 2X100 ............. 7 MORPHABOND ER .......... 16 morphine........................16, 17 morphine concentrate .......... 16 MOTOFEN......................... 55 MOVANTIK ...................... 58 MOVIPREP ........................ 58 MOXATAG.......................... 7 MOXEZA ........................... 67 moxifloxacin ....................7, 67 MOXIFLOXACIN (PF)-BSS

NO.2 ............................... 67 MOZOBIL .......................... 61 MS CONTIN ...................... 17 MUGARD .......................... 41 MULTAQ ........................... 23 multigen folic...................... 79 multigen plus ...................... 79 multi-vit with fluoride-iron .. 79 multi-vitamin with fluoride .. 79 multivitamins with fluoride.. 80 mupirocin ........................... 37 mupirocin calcium............... 37 mvc-fluoride ....................... 80 MYALEPT ......................... 53 MYAMBUTOL .................... 6 MYCOBUTIN ...................... 6 mycophenolate mofetil ........ 10 mycophenolate sodium ........ 10 MYDAYIS ......................... 21 MYDRIACYL .................... 67 myferon 150 forte................ 80 MYFORTIC ....................... 10 MYGLUCOHEALTH ....44, 49 MYGLUCOHEALTH

CONTROL SOLUTION.. 49 MYLERAN ........................ 10 mynatal ............................... 80 mynatal advance.................. 80 mynatal plus........................ 80 mynatal-z ............................ 80 mynate 90 plus .................... 80

mynephrocaps ..................... 80 mynephron .......................... 80 MYRBETRIQ ..................... 74 MYSOLINE........................ 12 MYTESI ............................. 55 N nabumetone......................... 18 nadolol................................ 26 nadolol-bendroflumethiazide 26 naftifine .............................. 37 NAFTIN ............................. 37 NALFON............................ 18 naloxone ............................. 18 naltrexone ........................... 18 NAMENDA........................ 14 NAMENDA TITRATION

PAK................................ 14 NAMENDA XR.................. 14 NAMZARIC ....................... 14 NAPRELAN CR ................. 18 NAPROSYN....................... 18 naproxen ............................. 18 naproxen sodium ................. 18 naratriptan........................... 14 NARCAN ........................... 18 NARDIL............................. 21 NASCOBAL....................... 80 NATACHEW (FE BIS-

GLYCINATE) ................ 80 NATACYN......................... 67 nateglinide .......................... 54 NATELLE ONE ................. 80 NATPARA ......................... 53 NATROBA......................... 39 natural b-100 complex ......... 80 natura-lax............................ 58 nature-throid ....................... 55 NEBUPENT ......................... 6 nebusal ............................... 73 NEBUSAL.......................... 73 NEEVODHA (WITH ALGAL

OIL)................................ 80 nefazodone.......................... 21 neomycin .............................. 6 neomycin-bacitracin-poly-hc 69 neomycin-bacitracin-

polymyxin ....................... 67 neomycin-polymyxin b gu ... 40

neomycin-polymyxin b-dexameth......................... 69

neomycin-polymyxin-gramicidin ....................... 67

neomycin-polymyxin-hc .42, 69 neo-polycin ......................... 67 neo-polycin hc .................... 69 NEORAL............................ 10 NEOSALUS ....................... 33 NEOSPORIN GU IRRIGANT

....................................... 40 NEO-SYNALAR ................ 37 NEO-SYNALAR KIT ......... 37 nephplex rx ......................... 80 NEPHROCAPS .................. 80 NEPHROCAPS QT............. 80 NEPHRON FA ................... 80 nephro-vite rx...................... 80 NEPTAZANE ..................... 68 NERLYNX ......................... 10 NESINA ............................. 54 NESTABS .......................... 80 NESTABS ABC.................. 80 NESTABS DHA ................. 80 neuac .................................. 35 NEUAC KIT ....................... 35 NEULASTA ....................... 61 NEUPRO ............................ 13 NEURIN-SL ....................... 80 NEURONTIN ..................... 12 NEUTEK 2TEK TEST

STRIPS ........................... 44 nevirapine ............................. 4 newgen ............................... 80 NEXA PLUS ...................... 80 NEXAVAR......................... 10 NEXIUM ............................ 60 NEXIUM PACKET ............ 60 niacin.................................. 30 NIACOR ............................ 30 NIASPAN EXTENDED-

RELEASE....................... 30 nicardipine .......................... 26 NICOMIDE ........................ 80 NICOMIDE (SELENIUM-

CHROMIUM) ................. 80 nicorelief............................. 41 nicorette .............................. 41 nicotine ............................... 41

100

nicotine (polacrilex) ............ 41 NICOTROL ........................ 41 NICOTROL NS .................. 41 nifedipine............................ 26 NILANDRON..................... 10 nilutamide ........................... 10 nimodipine .......................... 26 NINJACOF-XG .................. 71 NINLARO .......................... 10 nisoldipine .......................... 26 nitro-bid .............................. 31 NITRO-DUR ...................... 31 nitrofurantoin ........................ 8 nitrofurantoin macrocrystal.... 8 nitrofurantoin monohyd/m-

cryst .................................. 8 nitroglycerin........................ 31 NITROLINGUAL ............... 31 NITROMIST ...................... 31 NITROSTAT ...................... 31 nitro-time ............................ 31 NITYR ............................... 40 NIVA-FOL ......................... 80 NIVA-PLUS ....................... 80 nivatopic plus...................... 33 nizatidine ............................ 60 NIZORAL .......................... 37 nodolor ............................... 14 nolix ................................... 39 NORCO.............................. 17 NORDITROPIN FLEXPRO 61 norethindrone acetate .......... 66 norethindrone ac-eth estradiol

....................................... 66 NORITATE ........................ 35 NORPACE ......................... 23 NORPACE CR ................... 23 NORPRAMIN .................... 21 NORTHERA ...................... 40 nortriptyline ........................ 21 NORVASC ......................... 26 NORVIR .............................. 4 NOVA MAX BLOOD

GLUCOSE METER ........ 49 NOVA MAX GLUCOSE

CONTROL ..................... 49 NOVA MAX GLUCOSE

TEST .............................. 44

NOVAMAX PLUS GLU-KET ....................................... 49

NOVOEIGHT ..................... 29 NOVOLOG ........................ 52 NOVOLOG FLEXPEN ....... 52 NOVOLOG MIX 70-30 ...... 52 NOVOLOG MIX 70-30

FLEXPEN....................... 52 NOVOLOG PENFILL ........ 52 NOVOPEN ECHO .............. 49 NOVOSEVEN RT .............. 29 NOXAFIL ............................ 3 np thyroid ........................... 55 nts step 1............................. 41 NUCORT ........................... 39 NUCYNTA......................... 18 NUCYNTA ER ................... 18 NUEDEXTA ...................... 14 NUFERA ............................ 80 NULEV .............................. 55 NULYTELY WITH FLAVOR

PACKS ........................... 58 NUOX ................................ 35 NUPLAZID ........................ 21 NUTRESTORE .................. 40 NUTRICAP ........................ 80 NUVESSA.......................... 66 NUVIGIL ........................... 21 NUWIQ .............................. 29 nyamyc ............................... 37 nyata ................................... 37 NYMALIZE ....................... 26 nystatin ............................3, 37 nystatin-triamcinolone ......... 37 nystop ................................. 37 O OB COMPLETE ................. 80 OB COMPLETE GOLD...... 80 OB COMPLETE ONE ........ 80 OB COMPLETE PETITE.... 80 OB COMPLETE PREMIER 80 OB COMPLETE WITH DHA

....................................... 80 OBREDON......................... 71 obstetrix dha ....................... 80 OBSTETRIX EC................. 80 OBSTETRIX ONE.............. 80 OBTREX DHA ................... 80 O-CAL FA.......................... 80

O-CAL PRENATAL ........... 80 OCALIVA .......................... 58 octreotide acetate................. 10 OCUFEN ............................ 68 OCUFLOX ......................... 67 ODEFSEY ............................ 4 ODOMZO .......................... 10 OFEV ................................. 73 ofloxacin.................... 7, 42, 67 olanzapine........................... 22 olanzapine-fluoxetine .......... 22 olmesartan .......................... 26 olmesartan-amlodipin-

hcthiazid ......................... 26 olmesartan-

hydrochlorothiazide ......... 26 olopatadine ....................41, 68 OLUX ................................ 39 OLUX-E ............................. 39 OLYSIO ............................... 4 OMECLAMOX-PAK.......... 60 omega-3 acid ethyl esters..... 30 omeppi................................ 60 omeprazole ......................... 60 omeprazole-sodium

bicarbonate...................... 60 OMIDRIA .......................... 68 OMNIPOD INSULIN REFILL

....................................... 49 OMNIPRED ....................... 69 ON CALL EXPRESS

CONTROL ..................... 50 ON CALL EXPRESS METER

....................................... 50 ON CALL EXPRESS TEST

STRIP ............................. 44 ON CALL PLUS CONTROL

....................................... 50 ON CALL PLUS METER ... 50 ON CALL PLUS TEST STRIP

....................................... 45 ON CALL VIVID CONTROL

....................................... 50 ON CALL VIVID METER.. 50 ON CALL VIVID PAL

METER .......................... 50 ON CALL VIVID TEST

STRIP ............................. 45 ondansetron......................... 58

101

ondansetron hcl ................... 58 one daily prenatal ................ 81 ONETOUCH ULTRA

CONTROL ..................... 50 ONETOUCH ULTRA TEST

....................................... 45 ONETOUCH ULTRA2 ....... 50 ONETOUCH ULTRAMINI 50 ONETOUCH VERIO .......... 45 ONETOUCH VERIO FLEX 50 ONETOUCH VERIO IQ

METER .......................... 50 ONETOUCH VERIO SYNC

....................................... 50 ONETOUCH VERIO

SYSTEM ........................ 50 ONEXTON ......................... 35 ONFI .................................. 12 ONGLYZA ......................... 54 ONMEL................................ 3 ONZETRA XSAIL ............. 14 OPANA .............................. 17 opium tincture ..................... 55 OPSUMIT .......................... 73 OPTUMRX....................45, 50 ORACEA ............................. 8 ORACIT ............................. 75 oral saline laxative............... 58 oralone................................ 41 ORAMAGICRX ................. 42 ORAP ................................. 22 ORAPRED ODT................. 43 ORAVIG .............................. 3 ORENCIA .......................... 65 ORENCIA CLICKJECT ..... 65 ORENITRAM..................... 26 ORFADIN .......................... 40 ORKAMBI ......................... 73 orphenadrine citrate ............. 15 oscimin ............................... 55 oscimin sl............................ 55 oscimin sr ........................... 55 oseltamivir ............................ 4 OSENI ................................ 54 OSMOPREP ....................... 58 OSPHENA.......................... 66 OTEZLA ............................ 65 OTEZLA STARTER........... 65 OTIPRIO ............................ 42

OTOVEL ............................ 42 OTREXUP (PF) .................. 65 OVACE .............................. 31 OVACE PLUS .................... 31 OVACE PLUS SHAMPOO. 31 OVACE PLUS WASH ........ 31 OVIDE ............................... 39 OXANDRIN ....................... 53 oxandrolone ........................ 53 oxaprozin ............................ 18 OXAYDO........................... 17 oxazepam............................ 22 oxcarbazepine ..................... 12 oxiconazole ......................... 38 OXISTAT ........................... 38 OXSORALEN ULTRA....... 33 OXTELLAR XR ................. 12 oxybutynin chloride............. 74 oxycodone .......................... 17 oxycodone-acetaminophen .. 17 oxycodone-aspirin ............... 17 OXYCONTIN..................... 17 oxymorphone ...................... 17 OXYTROL ......................... 74 oysco 500/d......................... 76 oyster shell + d3 .................. 76 oyster shell calcium-vit d2 ... 81 oyster shell calcium-vit d3 ... 76 oystercal-d .......................... 76 OZURDEX ......................... 69 P pacerone ............................. 23 PACNEX ............................ 35 paliperidone ........................ 22 PAMELOR ......................... 22 PANDEL ............................ 39 PANRETIN ........................ 33 pantoprazole........................ 61 PAPAVERINE-

ALPROSTADIL-WATER ....................................... 75

PAPAV-PHENTOLAM-ALPROST-WATER ........ 75

PAPAV-PHENTOLAMINE IN WATER ..................... 75

PARADIGM REAL-TIME TRANSMIT-SN .............. 50

PARAFON FORTE DSC .... 15 paregoric............................. 56

PAREMYD......................... 67 paricalcitol .......................... 53 PARLODEL ....................... 13 PARNATE.......................... 22 paroex oral rinse.................. 42 paromomycin ........................ 6 paroxetine hcl...................... 22 PASER ................................. 6 PATADAY ......................... 68 PATANASE ....................... 42 PATANOL ......................... 68 PAXIL ................................ 22 PAXIL CR .......................... 22 PAZEO ............................... 68 PCE ...................................... 5 PEDIAPRED ...................... 43 PEDIARIX (PF) .................. 63 PEDVAX HIB (PF)............. 63 peg 3350-electrolytes .......... 58 peg3350 .............................. 58 PEGANONE....................... 12 PEGASYS .......................... 61 PEGASYS PROCLICK....... 61 peg-electrolyte soln ............. 58 PEGINTRON...................... 61 peg-prep.............................. 58 PEN NEEDLE .................... 50 penicillin v potassium ............ 7 PENLAC ............................ 38 PENNSAID ........................ 18 PENTACEL (PF) ................ 63 PENTACEL ACTHIB

COMPONENT (PF) ........ 63 PENTASA .......................... 58 pentazocine-naloxone .......... 18 pentoxifylline ...................... 29 PEPCID .............................. 61 PERCOCET........................ 17 PERFOROMIST ................. 73 PERIDEX ........................... 42 perindopril erbumine ........... 26 periogard............................. 42 permethrin .......................... 39 perphenazine ....................... 22 perphenazine-amitriptyline .. 22 perry prenatal ...................... 81 PEXEVA ............................ 22 PHARMACIST CHOICE .... 45

102

PHARMACIST CHOICE GLUCOSE SYS .............. 50

phenadoz............................. 70 phenazopyridine .................. 75 phenelzine........................... 22 phenergan ........................... 70 phenobarb-hyoscy-atropine-

scop ................................ 56 phenobarbital ...................... 12 phenohytro .......................... 56 phenoxybenzamine.............. 26 PHENTOLAM-

ALPROSTADIL IN WATER .......................... 75

phenylephrine hcl ................ 70 PHENYTEK ....................... 12 phenytoin ............................ 12 phenytoin sodium extended . 12 PHLAG SPRAY ................. 33 PHOSLYRA ....................... 58 phospha 250 neutral ............ 76 phosphasal .......................... 75 phosphate laxative ............... 58 PHOSPHOLINE IODIDE ... 67 PHYSIOLYTE .................... 40 PHYSIOSOL IRRIGATION 40 PHYTONADIONE

(VITAMIN K1) ............... 29 PICATO ............................. 33 pilocarpine hcl ......... 40, 42, 68 pimozide ............................. 22 pindolol .............................. 26 pioglitazone ........................ 54 pioglitazone-glimepiride ...... 54 pioglitazone-metformin ....... 54 piroxicam............................ 18 PLAVIX ............................. 29 PLEGRIDY ........................ 61 PLEXION ........................... 35 PLEXION CLEANSING

CLOTHS......................... 35 PLIAGLIS .......................... 36 PNEUMOVAX 23 .............. 63 pnv 29-1 ............................. 81 pnv ob+dha ......................... 81 pnv-dha............................... 81 pnv-dha + docusate ............. 81 pnv-ferrous fumarate-docu-fa

....................................... 81

pnv-omega .......................... 81 pnv-select ........................... 81 pnv-vp-u ............................. 81 PODOCON......................... 32 podofilox ............................ 33 polycin................................ 67 polyethylene glycol 3350 ..... 58 poly-iron 150 forte .............. 81 polymyxin b sulf-trimethoprim

....................................... 67 POLYTRIM........................ 67 POLY-TUSSIN AC............. 71 POLY-VI-FLOR ................. 81 POLY-VI-FLOR WITH IRON

....................................... 81 POMALYST....................... 62 PONSTEL .......................... 18 pot,sodium citrate-citric acid 75 POTABA ............................ 76 potassium bicarb and chloride

....................................... 76 potassium bicarb-citric acid . 76 potassium chloride .............. 76 potassium citrate ................. 75 potassium citrate-citric acid . 75 POTASSIUM HYDROXIDE

....................................... 32 powderlax ........................... 58 PR BENZOYL PEROXIDE 35 pr natal 400 ......................... 81 pr natal 400 ec..................... 81 pr natal 430 ......................... 81 pr natal 430 ec..................... 81 PRADAXA......................... 29 PRALUENT PEN ............... 30 pramcort ............................. 58 pramipexole ........................ 13 PRAMOSONE.................... 31 PRAMOSONE E................. 31 PRANDIN .......................... 54 prasugrel ............................. 29 PRAVACHOL .................... 30 pravastatin .......................... 30 prazosin .............................. 26 PRECISION XTRA

MONITOR...................... 50 PRECOSE .......................... 54 PRED FORTE .................... 69 PRED MILD ....................... 69

PRED-G ............................. 69 PRED-G S.O.P.................... 69 prednicarbate ...................... 39 prednisolone........................ 43 prednisolone acetate ............ 69 prednisolone sodium phosphate

..................................43, 69 prednisone .......................... 43 prednisone intensol.............. 43 PREFERA-OB .................... 81 PREFERA-OB ONE ........... 81 PREFERA-OB PLUS DHA . 81 PREFEST ........................... 66 PREMARIN ....................... 66 PREMIUM BLOOD

GLUCOSE MONITOR ... 50 PREMIUM V10 .............45, 50 PREMPHASE ..................... 66 PREMPRO ......................... 66 prena1 chew ........................ 81 prena1 pearl ........................ 81 prena1 true .......................... 81 prenaissance........................ 81 prenaissance plus................. 81 PRENATA.......................... 81 prenatabs fa......................... 81 prenatabs rx ........................ 81 prenatal ............................... 81 prenatal complete ................ 81 prenatal formula .................. 81 prenatal multi-dha (algal oil) 81 prenatal one daily ................ 81 prenatal plus........................ 81 prenatal plus (calcium carb) . 81 PRENATAL PLUS DHA .... 81 prenatal vitamin .................. 81 prenatal vitamin plus low iron

....................................... 81 prenatal vitamin with minerals

....................................... 81 prenatal vits96-iron fum-folic

....................................... 81 prenatal-u............................ 81 PRENATE AM ................... 81 PRENATE CHEWABLE .... 81 PRENATE DHA (FERR ASP

GLYCIN)........................ 81 PRENATE ELITE (IRON ASP

GLYC)............................ 81

103

PRENATE ENHANCE ....... 81 PRENATE

ESSENTIAL(IRON-ASP-GL) ................................. 81

PRENATE MINI (FERR ASP GLYCIN)........................ 81

PRENATE PIXIE ............... 82 PRENATE RESTORE ........ 82 PRENATE STAR ............... 82 PREPIDIL .......................... 66 preplus ................................ 82 PREPOPIK ......................... 58 PRESERA .......................... 33 PRESTALIA....................... 26 PRESTO PRO BLOOD

GLUCOSE METER ........ 50 pretab.................................. 82 PREVACID ........................ 61 prevalite .............................. 30 PREVIDENT ...................... 42 PREVIDENT 5000 BOOSTER

PLUS .............................. 42 PREVIDENT 5000 DRY

MOUTH ......................... 42 PREVIDENT 5000 ENAMEL

PROTECT ...................... 42 PREVIDENT 5000 PLUS ... 42 PREVIDENT 5000

SENSITIVE .................... 42 PREVNAR 13 (PF) ............. 63 PREVPAC .......................... 61 PREZCOBIX ........................ 4 PREZISTA ........................... 4 PRIFTIN............................... 6 PRIMACARE ..................... 82 PRIMAQUINE ..................... 6 primidone ........................... 12 PRIMLEV .......................... 17 PRIMSOL............................. 8 PRINIVIL ........................... 26 PROAIR HFA..................... 73 PROAIR RESPICLICK....... 73 probenecid .......................... 64 probenecid-colchicine.......... 64 PROCARDIA ..................... 26 PROCARDIA XL ............... 26 procentra............................. 22 prochlorperazine ................. 58 prochlorperazine maleate ..... 58

PROCORT.......................... 58 PROCRIT ........................... 61 PROCTOCORT .............39, 58 PROCTOFOAM HC ........... 58 procto-med hc ..................... 58 procto-pak........................... 58 proctosol hc ........................ 58 proctozone-hc ..................... 58 PROCYSBI......................... 75 PRODIGY AUTOCODE

METER .......................... 50 PRODIGY AUTOCODE

MONITOR SYST............ 50 PRODIGY CONTROL

SOLUTION, LOW .......... 50 PRODIGY CONTROL

SOLUTION,HIGH .......... 50 PRODIGY NO CODING .... 45 PRODIGY POCKET METER

....................................... 50 PRODIGY VOICE GLUCOSE

METER .......................... 50 PRODRIN .......................... 14 PROFERRIN-FORTE ......... 82 progesterone........................ 66 progesterone micronized...... 66 PROGLYCEM.................... 45 PROGRAF.......................... 10 PROLENSA ....................... 68 PROLEUKIN...................... 62 PROMACTA ...................... 29 promethazine ...................... 70 promethazine vc-codeine ..... 71 promethazine-codeine.......... 71 promethazine-dm ................ 71 promethazine-phenyleph-

codeine ........................... 71 promethazine-phenylephrine 71 promethegan ....................... 70 PROMETRIUM .................. 66 PROMISEB ........................ 33 PROMISEB COMPLETE ... 32 propafenone ........................ 23 propantheline ...................... 56 proparacaine........................ 68 propranolol ......................... 26 propranolol-hydrochlorothiazid

....................................... 26 propylthiouracil................... 43

PROQUAD (PF) ................. 63 PRO-RED AC (W/

DEXCHLORPHENIR) .... 71 PROSCAR .......................... 74 PROSTIN E2 ...................... 66 PROTECT IRON ................ 82 PROTOPIC......................... 33 protriptyline ........................ 22 PROVERA ......................... 66 PROVIDA DHA ................. 82 PROVIDA OB .................... 82 PROVIGIL ......................... 22 pruclair ............................... 33 prudoxin ............................. 33 prumyx ............................... 33 prutect ................................ 33 PSORCON.......................... 39 PULMICORT FLEXHALER

....................................... 73 pulmosal ............................. 73 PULMOZYME ................... 73 PURALOR CI..................... 82 PUREFE OB PLUS............. 82 PUREFE PLUS ................... 82 purelax................................ 58 purevit dualfe plus ............... 82 PURIXAN .......................... 10 PYLERA ............................ 61 pyrazinamide ........................ 6 PYRIDIUM ........................ 75 pyridostigmine bromide....... 15 Q QBRELIS ........................... 26 QNASL .............................. 73 QUADRACEL (PF) ............ 63 QUALAQUIN ...................... 6 quazepam............................ 22 QUDEXY XR ..................... 12 QUESTRAN ....................... 30 QUESTRAN LIGHT........... 30 quetiapine ........................... 22 QUFLORA FE .................... 82 QUFLORA FE (FERROUS

SULFATE) ..................... 82 QUFLORA PEDIATRIC..... 82 QUFLORA PEDIATRIC

DROPS ........................... 82 QUICK-SET PARADIGM .. 50 QUILLICHEW ER.............. 22

104

QUILLIVANT XR .............. 22 quinapril ............................. 26 quinapril-hydrochlorothiazide

....................................... 26 quinidine gluconate ............. 23 quinidine sulfate .................. 23 quinine sulfate....................... 6 QUINTET AC .................... 45 QUINTET BLOOD

GLUCOSE METER ........ 50 quit 2 .................................. 41 quit 4 .................................. 41 QUTENZA ......................... 33 QVAR ................................ 73 R RABAVERT (PF) ............... 63 rabeprazole ......................... 61 RADIOGARDASE ............. 41 raloxifene............................ 64 ramipril ............................... 26 RANEXA ........................... 31 ranitidine hcl ....................... 61 RAPAFLO .......................... 74 RAPAMUNE ...................... 10 rasagiline ............................ 13 RASUVO (PF) .................... 65 RAVICTI............................ 41 RAYALDEE....................... 53 RAYOS .............................. 43 RAZADYNE ...................... 14 RAZADYNE ER................. 14 rea lo 39 .............................. 33 rea lo 40 .............................. 33 REBETOL .......................... 62 REBIF (WITH ALBUMIN). 62 REBIF REBIDOSE ............. 62 REBIF TITRATION PACK 62 RECOMBINATE ................ 29 RECOMBIVAX HB (PF) .... 63 RECTIV ............................. 58 REFUAH PLUS .................. 45 REFUAH PLUS GLUCOSE

CONTROL ..................... 50 REFUAH PLUS GLUCOSE

MONITOR...................... 50 REGLAN............................ 58 REGRANEX ...................... 33 RELAGARD ...................... 66 relcof c................................ 71

RELENZA DISKHALER...... 4 RELION ALL-IN-ONE

METER .......................... 50 RELION CONFIRM ........... 50 RELION CONFIRM-MICRO

....................................... 45 RELION MICRO GLUCOSE

MONITOR...................... 51 RELION NOVOLIN 70/30.. 52 RELION NOVOLIN N ....... 52 RELION NOVOLIN R........ 52 RELION PRIME METER ... 51 RELION PRIME TEST

STRIPS ........................... 45 RELISTOR ......................... 58 relnate dha .......................... 82 RELPAX ............................ 14 REMERON......................... 22 REMERON SOLTAB ......... 22 RENACIDIN ...................... 75 renal caps ............................ 82 rena-vite.............................. 82 rena-vite rx ......................... 82 reno caps............................. 82 RENVELA ......................... 58 repaglinide .......................... 54 repaglinide-metformin ......... 54 REPATHA PUSHTRONEX 30 REPATHA SURECLICK .... 30 REPATHA SYRINGE ........ 30 REQUIP ............................. 13 REQUIP XL ....................... 13 RESCRIPTOR ...................... 4 RESPA-AR......................... 71 RESTASIS.......................... 68 RESTASIS MULTIDOSE ... 68 RESTIZAN ......................... 33 RESTORIL ......................... 22 RETIN-A ............................ 35 RETIN-A MICRO............... 35 RETIN-A MICRO PUMP ... 35 RETISERT ......................... 69 RETROVIR .......................... 4 REVATIO .......................... 73 REVEAL BLOOD GLUCOSE

METER .......................... 51 REVEAL TEST STRIP ....... 45 REVLIMID......................... 62 REXULTI ........................... 22

REYATAZ ........................... 4 REZIRA ............................. 71 RHOFADE ......................... 35 ribasphere ........................... 62 ribavirin ...........................4, 62 RIDAURA .......................... 65 rifabutin ................................ 6 RIFADIN.............................. 6 RIFAMATE.......................... 6 rifampin ................................ 6 RIFATER ............................. 6 RIGHTEST CONTROL

SOLUTION HIGH .......... 51 RIGHTEST GM550 SYSTEM

....................................... 51 RIGHTEST GS550 TEST

STRIPS ........................... 45 RILUTEK ........................... 41 riluzole ............................... 41 rimantadine ........................... 4 ringer's ................................ 40 RIOMET............................. 54 risacal-d .............................. 82 risedronate .....................41, 64 RISPERDAL ...................... 22 RISPERDAL M-TAB ......... 22 risperidone .......................... 22 RITALIN ............................ 22 RITALIN LA ...................... 22 rivastigmine ........................ 15 rivastigmine tartrate............. 15 RIXUBIS ............................ 29 rizatriptan ........................... 14 R-NATAL OB .................... 82 ROBAXIN .......................... 15 ROBAXIN-750 ................... 15 ROBINUL .......................... 56 ROBINUL FORTE ............. 56 ROCALTROL .................... 53 ropinirole ............................ 13 rosadan ............................... 35 ROSADAN......................... 35 ROSANIL........................... 35 ROSULA ............................ 35 rosula cleansing cloths......... 35 rosuvastatin ......................... 30 ROTARIX .......................... 63 ROTATEQ VACCINE ........ 63 ROWASA........................... 58

105

roweepra ............................. 12 ROXICODONE .................. 17 ROZEREM ......................... 22 RUBRACA......................... 10 RUCONEST ....................... 73 RYDAPT ............................ 10 rydex .................................. 71 RYTARY ........................... 13 RYTHMOL SR ................... 23 RYVENT............................ 70 S SABRIL.............................. 12 SAFE-CLIP BY MAIL........ 51 SALAGEN (PILOCARPINE)

..................................41, 42 SALEX ............................... 32 salicylic acid ....................... 32 salicylic acid er-ceramides ... 32 SALKERA.......................... 32 salsalate .............................. 18 salvax ................................. 32 SALVAX DUO PLUS ........ 32 SAMSCA ........................... 53 SANCUSO ......................... 58 SANDIMMUNE ................. 10 SANTYL ............................ 39 SAPHRIS (BLACK

CHERRY)....................... 22 SARAFEM ......................... 22 SAVAYSA ......................... 29 SAVELLA .......................... 65 scalacort.............................. 39 SCALACORT DK .............. 39 scopolamine base ................ 58 seb-prev .............................. 32 SEBUDERM ...................... 33 seconal sodium.................... 22 SEEBRI NEOHALER ......... 73 SELECT-OB....................... 82 SELECT-OB (FOLIC ACID)

....................................... 82 SELECT-OB + DHA........... 82 selegiline hcl ....................... 13 selenium sulfide .................. 32 SELRX ............................... 32 SELZENTRY ....................... 4 SEMPREX-D...................... 71 se-natal 19........................... 82 se-natal 19 (with docusate) .. 82

SENSIPAR ......................... 53 SEREVENT DISKUS ......... 73 SERNIVO........................... 39 SEROSTIM ........................ 61 sertraline ............................. 22 se-tan plus........................... 82 sevelamer carbonate ............ 58 sf 42 sf 5000 plus......................... 42 SFROWASA ...................... 58 SHOHL'S MODIFIED ........ 75 SIDEKICK BLOOD

GLUCOSE SYSTEM ...... 51 SIGNIFOR.......................... 10 sildenafil ............................. 73 SILENOR ........................... 22 SILVADENE ...................... 32 silver nitrate ........................ 33 silver nitrate applicators....... 33 silver sulfadiazine ............... 32 SILVRSTAT....................... 37 SIMBRINZA ...................... 69 SIMPONI ........................... 65 SIMPONI ARIA ................. 65 simvastatin .......................... 30 SINEMET........................... 13 SINEMET CR..................... 13 sirolimus ............................. 10 SIRTURO ............................. 6 SITAVIG .............................. 4 SIVEXTRO .......................... 6 SKELAXIN ........................ 15 SKLICE.............................. 39 SMART SENSE

MONITORING SYSTEM 51 SMART SENSE TEST

STRIPS ........................... 45 SMARTEST CONTROL..... 51 SMARTEST EJECT............ 51 SMARTEST PERSONA

STARTER ...................... 51 SMARTEST PRONTO

STARTER ...................... 51 SMARTEST PROTEGE ..... 51 SMARTEST TEST ............. 45 smoothlax ........................... 58 SNAP INSULIN PUMP-

INFUSION SET .............. 51 sodium chloride..............41, 73

sodium chloride 0.9 % ......... 41 sodium citrate-citric acid ..... 75 sodium phenylbutyrate ........ 41 sodium polystyrene sulfonate

....................................... 59 SODIUM POLYSTYRENE

SULFONATE ................. 59 SOLARAZE ....................... 33 SOLESTA .......................... 59 SOLIQUA 100/33 ............... 52 SOLODYN ........................... 8 SOLTAMOX ...................... 10 SOLUS V2 AUDIBLE

METER .......................... 51 SOLUS V2 CONTROL

SOLUTION,HIGH .......... 51 SOLUS V2 TEST STRIPS .. 45 SOMA ................................ 15 SOMATULINE DEPOT ..... 10 SOMAVERT ...................... 53 sonafine .............................. 34 SONATA............................ 22 SOOLANTRA .................... 35 SORBITOL......................... 40 SORBITOL-MANNITOL ... 40 SORIATANE...................... 32 SORILUX........................... 32 sotalol ................................. 23 sotalol af ............................. 23 SOTYLIZE ......................... 23 SOVALDI ............................ 4 sp antipruritic ...................... 34 sp scar management ............ 34 SPECTRACEF...................... 5 spinosad.............................. 39 SPIRIVA RESPIMAT ......... 73 SPIRIVA WITH

HANDIHALER............... 73 spironolactone ..................... 26 spironolacton-hydrochlorothiaz

....................................... 26 SPORANOX......................... 3 SPORANOX PULSEPAK ..... 3 SPRIX ................................ 18 SPRYCEL .......................... 10 sps (with sorbitol)................ 59 ssd ...................................... 32 SSKI................................... 43 sss 10-5............................... 35

106

STALEVO 100 ................... 13 STALEVO 125 ................... 13 STALEVO 150 ................... 13 STALEVO 200 ................... 13 STALEVO 50 ..................... 13 STALEVO 75 ..................... 13 STAMARIL (PF) ................ 63 STARLIX ........................... 55 stavudine............................... 4 STELARA .......................... 32 STIMATE........................... 53 STIOLTO RESPIMAT ........ 73 STIVARGA ........................ 10 stop smoking aid ................. 41 STRENSIQ ......................... 53 stress formula...................... 82 stress formula with iron ....... 82 stress formula with iron(sulf) 82 STRIANT ........................... 53 STRIBILD ............................ 4 STRIVERDI RESPIMAT .... 73 STROMECTOL .................... 6 strong iodine ....................... 76 STROVITE FORTE ............ 82 STROVITE ONE ................ 82 SUCRAID .......................... 59 sucralfate ............................ 61 SULAR............................... 26 sulfacetamide sodium .....32, 70 sulfacetamide sodium (acne) 37 sulfacetamide sodium-sulfur 35 sulfacetamide sod-sulfur-urea

....................................... 35 sulfacetamide-prednisolone . 70 sulfacetamide-sulfur-cleansr23

....................................... 35 sulfacleanse 8-4................... 35 sulfact na-sul-avobnz-otn-ocsa

....................................... 35 sulfadiazine ........................... 7 sulfamethoxazole-trimethoprim

......................................... 7 SULFAMYLON ................. 37 sulfasalazine........................ 59 sulfatrim ............................... 7 sulindac .............................. 18 SUMADAN ........................ 36 SUMADAN XLT................ 36 sumatriptan ......................... 14

sumatriptan succinate .......... 14 SUMAXIN ......................... 36 SUMAXIN CP .................... 36 SUMAXIN TS .................... 36 super b complex-vitamin c ... 82 super b maxi complex.......... 82 super b-50 complex plus ...... 82 super quints......................... 82 super quints b-50 ................. 82 superplex-t .......................... 82 SUPERVITE....................... 82 SUPPRELIN LA ................. 10 SUPRAX .............................. 5 SUPREP BOWEL PREP KIT

....................................... 59 SURE-T PARADIGM ......... 51 SURE-TEST EASYPLUS

MINI............................... 45 SURE-TEST EASYPLUS

MINI METER ................. 51 SURFAXIN ........................ 73 SURMONTIL ..................... 22 SURVANTA ...................... 41 SUSTIVA ............................. 4 SUTENT............................. 10 SYLATRON ....................... 62 SYMAX DUOTAB ............. 56 symax fastabs...................... 56 symax-sl ............................. 56 symax-sr ............................. 56 SYMBICORT ..................... 73 SYMBYAX ........................ 22 SYMLINPEN 120 ............... 55 SYMLINPEN 60................. 55 SYNALAR ......................... 39 SYNALAR CREAM KIT.... 39 SYNALAR OINTMENT KIT

....................................... 39 SYNALAR TS .................... 39 SYNALGOS-DC ................ 17 SYNAREL.......................... 53 SYNDROS ......................... 59 SYNERA ............................ 36 SYNERDERM.................... 34 SYNJARDY ....................... 55 SYNJARDY XR ................. 55 SYNRIBO .......................... 10 SYNTHROID ..................... 55 SYPRINE ........................... 41

T T

30 INFUSION SET ......... 51 90 INFUSION SET 23..... 51 SLIM .............................. 51 SLIM G4......................... 51

TABLOID .......................... 10 TACLONEX....................... 32 tacrolimus ......................11, 34 TAFINLAR ........................ 11 TAGRISSO......................... 11 TAMIFLU ............................ 4 tamoxifen............................ 11 tamsulosin........................... 74 TANDEM PLUS................. 82 TANZEUM......................... 55 TAPAZOLE........................ 43 TARCEVA ......................... 11 TARGADOX ........................ 8 TARGRETIN...................... 11 TARKA .............................. 26 taron forte ........................... 82 taron-c dha .......................... 82 taron-prex prenatal-dha........ 82 TASIGNA .......................... 11 TASMAR ........................... 13 tazarotene ........................... 36 TAZORAC ......................... 36 taztia xt ............................... 26 TECFIDERA ...................... 62 TECHNIVIE ......................... 4 TEGRETOL........................ 12 TEGRETOL XR ................. 12 TEKTURNA....................... 26 TEKTURNA HCT .............. 26 TELCARE BGM................. 51 TELCARE BLOOD

GLUCOSE KIT............... 51 TELCARE CONTROL ....... 51 TELCARE TEST STRIPS ... 45 telmisartan .......................... 26 telmisartan-amlodipine ........ 26 telmisartan-hydrochlorothiazid

....................................... 26 temazepam .......................... 22 TEMODAR ........................ 11 TEMOVATE ...................... 39 temozolomide ..................... 11 tencon ................................. 17

107

TENIVAC (PF) ................... 63 TENORETIC 100 ............... 27 TENORETIC 50 ................. 27 TENORMIN ....................... 27 TERAZOL 7 ....................... 66 terazosin ............................. 27 terbinafine hcl ....................... 3 terbutaline ........................... 73 terconazole.......................... 66 TERSI FOAM..................... 32 TESSALON PERLES ......... 71 TEST N'GO BLOOD

GLUCOSE SYSTEM ...... 51 TEST N'GO TEST .............. 45 TESTOPEL......................... 53 testosterone ......................... 53 testosterone cypionate ......... 53 testosterone enanthate.......... 53 TESTRED .......................... 53 TETANUS,DIPHTHERIA

TOX PED(PF)................. 64 TETANUS-DIPHTHERIA

TOXOIDS-TD ................ 64 tetcaine ............................... 68 tetrabenazine ....................... 15 tetracaine hcl ....................... 68 tetracaine hcl (pf) ................ 68 tetracycline ........................... 8 TETRAVISC ...................... 68 TETRAVISC FORTE ......... 68 TEXACORT ....................... 39 TEXAVITE LQ .................. 82 THALOMID ....................... 11 THEO-24 ............................ 73 theochron ............................ 73 theophylline ........................ 73 thermazene.......................... 32 THIOLA ............................. 41 thioridazine ......................... 22 thiothixene .......................... 22 THRIVITE RX ................... 82 thrivite-19 ........................... 82 THYROLAR-1 ................... 55 THYROLAR-1/2 ................ 55 THYROLAR-1/4 ................ 55 THYROLAR-2 ................... 55 THYROLAR-3 ................... 55 tiagabine ............................. 12 TIAZAC ............................. 27

ticlopidine ........................... 29 TIGAN ............................... 59 timolol maleate ..............27, 67 TIMOPTIC ......................... 67 TIMOPTIC-XE ................... 67 TINDAMAX ........................ 6 tinidazole .............................. 6 TIROSINT .......................... 55 tis-u-sol pentalyte ................ 40 TIVICAY ............................. 4 TIVORBEX ...................18, 19 tizanidine ............................ 15 tl gard rx ............................. 82 tl g-fol os ............................ 83 tl icon ................................. 83 tl-hem 150........................... 83 TOBI PODHALER ............... 6 TOBRADEX ...................... 69 TOBRADEX ST ................. 69 tobramycin .......................... 67 tobramycin in 0.225 % nacl ... 6 TOBRAMYCIN WITH

NEBULIZER .................... 6 tobramycin-dexamethasone . 69 TOBREX ............................ 67 TOFRANIL ........................ 22 TOLAK .............................. 34 tolazamide .......................... 55 tolbutamide ......................... 55 tolcapone ............................ 13 tolmetin .............................. 19 tolterodine........................... 74 TOPAMAX ........................ 12 TOPICORT......................... 39 topiramate ......................12, 13 TOPIRAMATE................... 13 TOPROL XL ...................... 27 torsemide ............................ 27 total b/c............................... 83 TOUJEO SOLOSTAR ........ 52 TOVIAZ ............................. 74 TRACLEER........................ 73 TRADJENTA ..................... 55 tramadol.............................. 19 TRAMADOL...................... 19 tramadol-acetaminophen...... 19 trandolapril ......................... 27 trandolapril-verapamil ......... 27 tranexamic acid ................... 66

TRANSDERM-SCOP ......... 59 TRANXENE T-TAB........... 23 tranylcypromine .................. 23 TRAVATAN Z ................... 69 trazodone ............................ 23 TRECATOR ......................... 7 TRESIBA FLEXTOUCH U-

100 ................................. 52 TRESIBA FLEXTOUCH U-

200 ................................. 52 tretinoin .............................. 36 tretinoin (chemotherapy) ..... 11 tretinoin microspheres ......... 36 TRETIN-X.......................... 36 TRETIN-X CREAM KIT .... 36 TREXALL .......................... 11 TREXIMET ........................ 14 TREZIX.............................. 17 TRIACETIN ....................... 38 triamcinolone acetonide..39, 42 triamterene-hydrochlorothiazid

....................................... 27 trianex ................................ 39 triazolam............................. 23 TRIBENZOR ...................... 27 TRICARE ........................... 83 TRICARE PRENATAL ...... 83 TRICARE PRENATAL DHA

ONE ............................... 83 tricitrates............................. 75 tricon .................................. 83 TRICOR ............................. 30 triderm ................................ 39 TRIDESILON ..................... 39 TRIESENCE (PF) ............... 43 TRIFERIC .......................... 83 trifluoperazine ..................... 23 trifluridine........................... 67 trigels-f forte ....................... 83 TRIGLIDE.......................... 30 trihexyphenidyl ................... 13 triklo ................................... 30 TRILEPTAL ....................... 13 TRILIPIX ........................... 30 trilyte with flavor packets .... 59 trimethobenzamide .............. 59 trimethoprim ......................... 8 trimipramine ....................... 23 trinatal gt ............................ 83

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trinatal rx 1 ......................... 83 trinate ................................. 83 TRINTELLIX ..................... 23 triphrocaps .......................... 83 TRIPLE DYE...................... 38 TRISTART DHA ................ 83 tri-tabs dha .......................... 83 TRIUMEQ ............................ 4 triveen-duo dha ................... 83 TRI-VI-FLOR ..................... 83 tri-vit with fluoride and iron. 83 tri-vitamin with fluoride ...... 83 TRIZIVIR ............................. 4 TROKENDI XR.................. 13 tropicamide ......................... 67 trospium.............................. 74 TRUE METRIX LEVEL 1 .. 51 TRUECONTROL LEVEL 0 51 TRUETRACK BLOOD

GLUCOSE SYSTEM ...... 51 TRULICITY ....................... 55 TRUMENBA ...................... 64 TRUSOPT .......................... 69 trust natal dha...................... 83 TRUVADA........................... 4 TUDORZA PRESSAIR....... 73 tusnel c ............................... 71 TUSNEL PEDIATRIC ........ 71 TUSSICAPS ....................... 71 tussigon .............................. 71 TUSSIONEX PENNKINETIC

ER .................................. 71 TUZISTRA XR................... 71 TWINRIX (PF) ................... 64 TWYNSTA......................... 27 TYBOST .............................. 4 TYKERB ............................ 11 TYLENOL-CODEINE #3 ... 17 TYLENOL-CODEINE #4 ... 17 TYMLOS ........................... 64 TYPHIM VI........................ 64 TYVASO............................ 73 TYVASO REFILL KIT ....... 73 TYVASO STARTER KIT ... 74 TYZINE ............................. 42 U UCERIS.............................. 59 UDAMIN SP ...................... 83 ULESFIA ........................... 39

ULORIC ............................. 64 ULTIMA MONITOR .......... 51 ultimatecare one .................. 83 ultimatecare one nf .............. 83 ultra b-100 complex ............ 83 ULTRACET ....................... 19 ULTRAM ........................... 19 ULTRAM ER ..................... 19 ULTRASAL-ER ................. 32 ULTRATRAK .................... 45 ULTRATRAK GLUCOSE

METER .......................... 51 ULTRATRAK ULTIMATE 45,

51 ULTRAVATE .................... 39 ULTRAVATE X................. 39 umecta ................................ 34 UNISTRIP LOW CONTROL

....................................... 51 unithroid ............................. 55 UPTRAVI........................... 27 ur n-c .................................. 75 URAMAXIN ...................... 34 uramit mb ........................... 75 urea .................................... 34 urea nail stick ...................... 34 URECHOLINE ................... 74 URELLE............................. 75 uretron d-s........................... 75 URIBEL ............................. 75 urimar-t............................... 75 urin ds................................. 75 uro-458 ............................... 75 UROCIT-K 10 .................... 75 UROCIT-K 15 .................... 75 UROCIT-K 5 ...................... 75 urogesic-blue ...................... 75 uro-mp ................................ 75 urophen mb ......................... 75 UROQID-ACID NO.2......... 75 UROXATRAL .................... 74 URSO 250 .......................... 59 URSO FORTE .................... 59 ursodiol............................... 59 uryl ..................................... 75 ustell ................................... 75 UTA ................................... 75 UTIBRON NEOHALER ..... 74 utira-c ................................. 75

UTOPIC ............................. 34 V VAGIFEM .......................... 66 valacyclovir .......................... 4 VALCHLOR ...................... 34 VALCYTE ........................... 4 valganciclovir ....................... 4 valproic acid ....................... 13 valproic acid (as sodium salt)

....................................... 13 valsartan ............................. 27 valsartan-hydrochlorothiazide

....................................... 27 VANATOL LQ ................... 17 VANCOCIN ......................... 8 vancomycin........................... 8 vandazole............................ 66 VANOS .............................. 39 VANOXIDE-HC................. 36 VANTAS............................ 11 VAQTA (PF) ...................... 64 VARIVAX (PF) .................. 64 VARIZIG ........................... 64 VARUBI ............................ 59 VASCEPA .......................... 30 VASERETIC ...................... 27 VASHE WOUND THERAPY

....................................... 40 VASOTEC.......................... 27 VAXCHORA VACCINE .... 64 v-c forte .............................. 83 VECAMYL ........................ 31 VECTICAL ........................ 32 VELPHORO ....................... 59 VELTASSA........................ 59 vemavite-prx-2 .................... 83 VEMLIDY............................ 4 VENCLEXTA .................... 11 VENCLEXTA STARTING

PACK ............................. 11 venlafaxine ......................... 23 VENTAVIS ........................ 74 VENTOLIN HFA ............... 74 verapamil ............................ 27 VERDESO.......................... 39 verdrocet............................. 17 VEREGEN ......................... 34 VERELAN ......................... 27 VERELAN PM ................... 27

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veripred 20.......................... 43 VERSACLOZ ..................... 23 VESICARE......................... 74 VFEND ................................ 3 VGO 20 .............................. 52 VGO 30 .............................. 52 VGO 40 .............................. 52 VIAGRA ............................ 75 VIBERZI ............................ 59 VIBRAMYCIN..................... 8 vic-forte .............................. 83 vicodin................................ 17 vicodin es............................ 17 vicodin hp ........................... 17 VIDEX 2 GRAM PEDIATRIC

......................................... 4 VIDEX EC ........................... 5 VIEKIRA PAK ..................... 5 VIEKIRA XR ....................... 5 vigabatrin............................ 13 VIGAMOX ......................... 67 VIIBRYD ........................... 23 VIMOVO ........................... 19 VIMPAT ............................ 13 vinate care........................... 83 VINATE DHA RF .............. 83 vinate ii............................... 83 vinate m .............................. 83 vinate one ........................... 83 vinate ultra .......................... 83 VIOKACE .......................... 59 VIRACEPT........................... 5 VIRAMUNE......................... 5 VIRAMUNE XR................... 5 VIRASAL........................... 32 VIRAZOLE .......................... 5 VIREAD............................... 5 VIROPTIC.......................... 67 virt-advance ........................ 83 virt-c dha ............................ 83 VIRT-CAPS ....................... 83 virt-gard .............................. 83 virt-nate .............................. 83 virt-nate dha ........................ 83 virt-phos 250 neutral ........... 76 virt-pn................................. 83 virt-pn dha .......................... 83 virt-pn plus ......................... 83 VIRTPREX......................... 83

virtrate-2 ............................. 75 virtrate-3 ............................. 75 virtrate-k ............................. 75 virt-select ............................ 83 virtussin ac.......................... 71 virtussin dac ........................ 71 virt-vite ............................... 83 virt-vite forte ....................... 83 virt-vite gt ........................... 83 VIRT-VITE PLUS .............. 83 VISTARIL .......................... 70 VISTOGARD ....................... 8 vit 3 .................................... 83 vit b complex-folic acid ....... 83 VITAFOL ........................... 83 VITAFOL FE+ (WITH

DOCUSATE) .................. 83 VITAFOL GUMMIES ........ 83 VITAFOL NANO ............... 83 VITAFOL ULTRA ............. 84 VITAFOL-OB .................... 84 VITAFOL-OB+DHA .......... 84 VITAFOL-ONE .................. 84 vitajoy daily d ..................... 84 VITAL-D RX...................... 84 VITAMED MD ONE RX .... 84 VITAMEDMD REDICHEW

RX .................................. 84 vitamin b complex ............... 84 vitamin d3........................... 84 vitamin k............................. 29 vitamin k1........................... 29 vitamins a,c,d and fluoride ... 84 VITAPEARL ...................... 84 VITA-RESPA ..................... 84 VITATRUE ........................ 84 VITUZ................................ 71 VIVELLE-DOT .................. 66 VIVLODEX........................ 19 VIVOTIF ............................ 64 VIVOTIF BERNA VACCINE

....................................... 64 vol-care rx........................... 84 vol-nate............................... 84 vol-plus............................... 84 vol-tab rx ............................ 84 VOLTAREN....................... 19 VOLTAREN-XR ................ 19 voriconazole.......................... 3

VOSEVI ............................... 5 VOTRIENT ........................ 11 vp-ch plus ........................... 84 vp-ch-pnv ........................... 84 vp-ggr-b6 ............................ 84 vp-heme ob ......................... 84 vp-heme one ....................... 84 VP-PNV-DHA .................... 84 vp-vite rx ............................ 84 VRAYLAR......................... 23 VUSION............................. 38 VYTONE ........................... 37 VYTORIN 10-10 ................ 30 VYTORIN 10-20 ................ 30 VYTORIN 10-40 ................ 30 VYTORIN 10-80 ................ 30 VYVANSE ......................... 23 W warfarin .............................. 29 water for irrigation, sterile ... 41 WAVESENSE AMP ........... 52 WAVESENSE CONTROL

SOLUTION .................... 52 WAVESENSE JAZZ .......... 45 WAVESENSE PRESTO 45, 52 WELCHOL......................... 30 WELLBUTRIN XL............. 23 westhroid ............................ 55 WILATE............................. 29 woman's laxative ................. 59 women's gentle laxative(bisac)

....................................... 59 women's laxative (bisacodyl) 59 WP THYROID ................... 55 X XADAGO........................... 13 XALATAN ......................... 69 XALKORI .......................... 11 XARELTO ......................... 29 XATMEP ........................... 11 XCLAIR ............................. 34 XELJANZ .......................... 65 XELJANZ XR .................... 65 XELODA ........................... 11 XENAZINE ........................ 15 XERESE............................. 38 XERMELO ......................... 11 XGEVA ................................ 8 XIFAXAN ............................ 7

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XIGDUO XR ...................... 55 XIIDRA .............................. 68 XODOL 10/300 .................. 17 XODOL 5/300 .................... 17 XODOL 7.5/300 ................. 17 XOLAIR............................. 74 XOLEGEL.......................... 38 XOPENEX ......................... 74 XOPENEX CONCENTRATE

....................................... 74 XTAMPZA ER ................... 17 XTANDI............................. 11 XULTOPHY 100/3.6 .......... 53 XURIDEN .......................... 41 xylon 10.............................. 17 XYNTHA ........................... 29 XYNTHA SOLOFUSE ....... 29 XYREM ............................. 23 XYZAL .............................. 70 XYZBAC ........................... 84 Y YF-VAX (PF) ..................... 64 YOSPRALA ....................... 29 yuvafem .............................. 66 Z zafirlukast ........................... 74 zaleplon .............................. 23 zamicet ............................... 17 ZANAFLEX ....................... 15 ZANTAC............................ 61 ZARONTIN........................ 13 ZARXIO............................. 61 zatean-ch............................. 84 zatean-pn dha ...................... 84 zatean-pn plus ..................... 84 ZAVESCA.......................... 53 zebutal ................................ 17 ZEGERID ........................... 61 ZEJULA ............................. 11 ZELAPAR .......................... 13 ZELBORAF ....................... 11

ZEMBRACE SYMTOUCH 14 ZEMPLAR ......................... 53 zenatane .............................. 36 ZENPEP ............................. 59 zenzedi ............................... 23 ZENZEDI ........................... 23 ZERIT .................................. 5 ZESTORETIC .................... 27 ZESTRIL ............................ 27 ZETIA ................................ 30 ZETONNA ......................... 74 ZIAC .................................. 27 ZIAGEN ............................... 5 ZIANA ............................... 36 zidovudine ............................ 5 zileuton ............................... 74 ZINBRYTA ........................ 62 zingiber............................... 84 ziprasidone hcl .................... 23 ZIPSOR .............................. 19 ZIRGAN............................. 67 ZITHRANOL ..................... 32 ZITHROMAX ...................... 5 ZITHROMAX TRI-PAK....... 5 ZITHROMAX Z-PAK .......... 5 ZMAX .................................. 5 ZOCOR .............................. 30 ZODRYL AC 25 ................. 71 ZODRYL AC 30 ................. 71 ZODRYL AC 35 ................. 71 ZODRYL AC 40 ................. 71 ZODRYL AC 50 ................. 72 ZODRYL AC 60 ................. 72 ZODRYL AC 80 ................. 72 ZODRYL DAC 25 .............. 72 ZODRYL DAC 30 .............. 72 ZODRYL DAC 35 .............. 72 ZODRYL DAC 40 .............. 72 ZODRYL DAC 50 .............. 72 ZODRYL DAC 60 .............. 72 ZODRYL DAC 80 .............. 72

ZODRYL DEC 25............... 72 ZODRYL DEC 30............... 72 ZODRYL DEC 35............... 72 ZODRYL DEC 40............... 72 ZODRYL DEC 50............... 72 ZODRYL DEC 60............... 72 ZODRYL DEC 80............... 72 ZOFRAN (AS

HYDROCHLORIDE)...... 59 ZOFRAN ODT ................... 59 ZOHYDRO ER ................... 17 ZOLINZA........................... 11 zolmitriptan......................... 14 zolpidem ............................. 23 ZOLPIMIST ....................... 23 ZOMIG............................... 14 ZOMIG ZMT...................... 14 ZONACORT ...................... 43 ZONALON ......................... 34 ZONEGRAN ...................... 13 zonisamide .......................... 13 ZONTIVITY....................... 29 ZORBTIVE ........................ 61 ZORTRESS ........................ 11 ZORVOLEX....................... 19 ZOSTAVAX (PF) ............... 64 ZOVIRAX .......................5, 38 Z-TUSS AC ........................ 72 ZUPLENZ .......................... 59 ZURAMPIC ....................... 64 ZUTRIPRO......................... 72 ZYDELIG........................... 11 ZYFLO ............................... 74 ZYKADIA .......................... 11 ZYLET ............................... 69 ZYLOPRIM........................ 64 ZYMAXID ......................... 67 ZYPREXA.......................... 23 ZYPREXA ZYDIS.............. 23 ZYTIGA ............................. 11 ZYVOX ................................ 7

table of contents anti - infectives 32 . list of abbreviations. aca: affordable care act. la:...

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