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Molina Healthcare of Ohio Preferred Drug List (Formulary)
(10/01/2019)
INTRODUCTION .......................................................................................................................................................................................................................................... 4 PREFACE ..................................................................................................................................................................................................................................................... 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE .......................................................................................................................................................................... 4 DRUG LIST PRODUCT DESCRIPTIONS ................................................................................................................................................................................................... 4 GENERIC SUBSTITUTION .......................................................................................................................................................................................................................... 4 PLAN DESIGN ............................................................................................................................................................................................................................................. 5 NON-COVERED MEDICATIONS ................................................................................................................................................................................................................ 5 STEP THERAPY (ST) .................................................................................................................................................................................................................................. 5 LEGEND ....................................................................................................................................................................................................................................................... 5 NOTICE ........................................................................................................................................................................................................................................................ 5 ANALGESICS .............................................................................................................................................................................................................................................. 6
ANALGESICS, OTHER ..................................................................................................................................................................................................................... 6 NSAIDs .............................................................................................................................................................................................................................................. 6 NSAIDs, TOPICAL ............................................................................................................................................................................................................................. 6 COX-2 INHIBITORS........................................................................................................................................................................................................................... 6 GOUT ................................................................................................................................................................................................................................................. 6 OPIOID ANALGESICS ...................................................................................................................................................................................................................... 6 NON-OPIOID ANALGESICS ............................................................................................................................................................................................................. 7 VISCOSUPPLEMENTS ..................................................................................................................................................................................................................... 7
ANTI-INFECTIVES ....................................................................................................................................................................................................................................... 7 ANTIBACTERIALS............................................................................................................................................................................................................................. 7 ANTIFUNGALS .................................................................................................................................................................................................................................. 8 ANTIMALARIALS ............................................................................................................................................................................................................................... 8 ANTIRETROVIRAL AGENTS ............................................................................................................................................................................................................ 8 ANTITUBERCULAR AGENTS ........................................................................................................................................................................................................... 9 ANTIVIRALS .................................................................................................................................................................................................................................... 10 MISCELLANEOUS........................................................................................................................................................................................................................... 10
ANTINEOPLASTIC AGENTS .................................................................................................................................................................................................................... 11 ALKYLATING AGENTS ................................................................................................................................................................................................................... 11 ANTIMETABOLITES ........................................................................................................................................................................................................................ 11 CYTOPROTECTIVE AGENTS ........................................................................................................................................................................................................ 11 HORMONAL ANTINEOPLASTIC AGENTS .................................................................................................................................................................................... 11 IMMUNOMODULATORS ................................................................................................................................................................................................................. 11 KINASE INHIBITORS ...................................................................................................................................................................................................................... 11 TOPOISOMERASE INHIBITORS .................................................................................................................................................................................................... 12 MISCELLANEOUS........................................................................................................................................................................................................................... 12
CARDIOVASCULAR.................................................................................................................................................................................................................................. 12 ACE INHIBITORS ............................................................................................................................................................................................................................ 12 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ............................................................................................................................................ 12 ACE INHIBITOR/DIURETIC COMBINATIONS................................................................................................................................................................................ 12 ADRENOLYTICS, CENTRAL .......................................................................................................................................................................................................... 12 ALDOSTERONE RECEPTOR ANTAGONISTS .............................................................................................................................................................................. 13 ALPHA BLOCKERS ......................................................................................................................................................................................................................... 13 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS .............................................................................................................................. 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ............................................................................................. 13 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ........................................................................... 13 ANTIARRHYTHMICS....................................................................................................................................................................................................................... 13 ANTILIPEMICS ................................................................................................................................................................................................................................ 13 BETA-BLOCKERS ........................................................................................................................................................................................................................... 14 BETA-BLOCKER/DIURETIC COMBINATIONS .............................................................................................................................................................................. 14 CALCIUM CHANNEL BLOCKERS .................................................................................................................................................................................................. 14 DIGITALIS GLYCOSIDES ............................................................................................................................................................................................................... 15 DIURETICS ...................................................................................................................................................................................................................................... 15 HEART FAILURE ............................................................................................................................................................................................................................. 15 NITRATES ....................................................................................................................................................................................................................................... 15 PULMONARY ARTERIAL HYPERTENSION .................................................................................................................................................................................. 16 MISCELLANEOUS........................................................................................................................................................................................................................... 16
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CENTRAL NERVOUS SYSTEM ................................................................................................................................................................................................................ 16 AMYOTROPHIC LATERAL SCLEROSIS ........................................................................................................................................................................................ 16 ANTIANXIETY .................................................................................................................................................................................................................................. 16 ANTICONVULSANTS ...................................................................................................................................................................................................................... 16 ANTIDEMENTIA .............................................................................................................................................................................................................................. 17 ANTIDEPRESSANTS ...................................................................................................................................................................................................................... 17 ANTIPARKINSONIAN AGENTS ...................................................................................................................................................................................................... 18 ANTIPSYCHOTICS.......................................................................................................................................................................................................................... 18 ATTENTION DEFICIT HYPERACTIVITY DISORDER .................................................................................................................................................................... 19 HUNTINGTON'S DISEASE AGENTS ............................................................................................................................................................................................. 19 HYPNOTICS .................................................................................................................................................................................................................................... 19 MIGRAINE ....................................................................................................................................................................................................................................... 19 MOOD STABILIZERS ...................................................................................................................................................................................................................... 20 MULTIPLE SCLEROSIS AGENTS .................................................................................................................................................................................................. 20 MUSCULOSKELETAL THERAPY AGENTS ................................................................................................................................................................................... 20 MYASTHENIA GRAVIS ................................................................................................................................................................................................................... 20 NARCOLEPSY/CATAPLEXY .......................................................................................................................................................................................................... 20 PSYCHOTHERAPEUTIC-MISCELLANEOUS ................................................................................................................................................................................. 20 MISCELLANEOUS........................................................................................................................................................................................................................... 21
ENDOCRINE AND METABOLIC ............................................................................................................................................................................................................... 21 ACROMEGALY ................................................................................................................................................................................................................................ 21 ANDROGENS .................................................................................................................................................................................................................................. 21 ANTIDIABETICS .............................................................................................................................................................................................................................. 21 CALCIUM RECEPTOR ANTAGONISTS ......................................................................................................................................................................................... 23 CALCIUM REGULATORS ............................................................................................................................................................................................................... 23 CARNITINE DEFICIENCY AGENTS ............................................................................................................................................................................................... 23 CONTRACEPTIVES ........................................................................................................................................................................................................................ 23 ENDOMETRIOSIS ........................................................................................................................................................................................................................... 24 ESTROGENS ................................................................................................................................................................................................................................... 24 ESTROGEN/PROGESTINS ............................................................................................................................................................................................................ 25 ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS ................................................................................................................. 25 GAUCHER DISEASE....................................................................................................................................................................................................................... 25 GLUCOCORTICOIDS ...................................................................................................................................................................................................................... 25 GLUCOSE ELEVATING AGENTS .................................................................................................................................................................................................. 25 HEREDITARY TYROSINEMIA TYPE 1 AGENTS ........................................................................................................................................................................... 25 HUMAN GROWTH HORMONES .................................................................................................................................................................................................... 25 HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS ..................................................................................................................................................... 25 INSULIN-LIKE GROWTH FACTOR ................................................................................................................................................................................................. 25 PHOSPHATE BINDER AGENTS .................................................................................................................................................................................................... 25 POTASSIUM-REMOVING AGENTS ............................................................................................................................................................................................... 26 PROGESTINS .................................................................................................................................................................................................................................. 26 SELECTIVE ESTROGEN RECEPTOR MODULATORS ................................................................................................................................................................ 26 THYROID AGENTS ......................................................................................................................................................................................................................... 26 UREA CYCLE DISORDERS ............................................................................................................................................................................................................ 26 VASOPRESSIN RECEPTOR ANTAGONISTS ............................................................................................................................................................................... 26 VASOPRESSINS ............................................................................................................................................................................................................................. 26 MISCELLANEOUS........................................................................................................................................................................................................................... 26
GASTROINTESTINAL ............................................................................................................................................................................................................................... 26 ANTACIDS ....................................................................................................................................................................................................................................... 26 ANTIDIARRHEALS .......................................................................................................................................................................................................................... 26 ANTIEMETICS ................................................................................................................................................................................................................................. 27 ANTISPASMODICS ......................................................................................................................................................................................................................... 27 CHOLELITHOLYTICS ..................................................................................................................................................................................................................... 27 H2 RECEPTOR ANTAGONISTS ...................................................................................................................................................................................................... 27 INFLAMMATORY BOWEL DISEASE .............................................................................................................................................................................................. 27 IRRITABLE BOWEL SYNDROME ................................................................................................................................................................................................... 28 LAXATIVES/STOOL SOFTENERS ................................................................................................................................................................................................. 28 PANCREATIC ENZYMES ............................................................................................................................................................................................................... 28 PROSTAGLANDINS ........................................................................................................................................................................................................................ 28 PROTON PUMP INHIBITORS ......................................................................................................................................................................................................... 28 SALIVA STIMULANTS ..................................................................................................................................................................................................................... 29 STEROIDS, RECTAL ...................................................................................................................................................................................................................... 29 ULCER THERAPY COMBINATIONS .............................................................................................................................................................................................. 29 MISCELLANEOUS........................................................................................................................................................................................................................... 29
GENITOURINARY...................................................................................................................................................................................................................................... 29
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BENIGN PROSTATIC HYPERPLASIA ............................................................................................................................................................................................ 29 URINARY ANTISPASMODICS ........................................................................................................................................................................................................ 29 VAGINAL ANTI-INFECTIVES .......................................................................................................................................................................................................... 29 MISCELLANEOUS........................................................................................................................................................................................................................... 30
HEMATOLOGIC ......................................................................................................................................................................................................................................... 30 ANTICOAGULANTS ........................................................................................................................................................................................................................ 30 HEMATOPOIETIC GROWTH FACTORS ........................................................................................................................................................................................ 30 HEMOPHILIA A AGENTS ................................................................................................................................................................................................................ 30 HEMOPHILIA B AGENTS ................................................................................................................................................................................................................ 30 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS ............................................................................................................................................ 30 PLATELET AGGREGATION INHIBITORS...................................................................................................................................................................................... 30 PLATELET SYNTHESIS INHIBITORS ............................................................................................................................................................................................ 31 THROMBOCYTOPENIA AGENTS .................................................................................................................................................................................................. 31 MISCELLANEOUS........................................................................................................................................................................................................................... 31
IMMUNOLOGIC AGENTS ......................................................................................................................................................................................................................... 31 ALLERGENIC EXTRACTS .............................................................................................................................................................................................................. 31 AUTOIMMUNE AGENTS ................................................................................................................................................................................................................. 31 DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs) ..................................................................................................................................................... 31 IMMUNE GLOBULINS ..................................................................................................................................................................................................................... 31 IMMUNOMODULATORS ................................................................................................................................................................................................................. 31 IMMUNOSUPPRESSANTS ............................................................................................................................................................................................................. 32 VACCINES ....................................................................................................................................................................................................................................... 32
NUTRITIONAL/SUPPLEMENTS ............................................................................................................................................................................................................... 32 ELECTROLYTES ............................................................................................................................................................................................................................. 32 VITAMINS AND MINERALS ............................................................................................................................................................................................................ 32
RESPIRATORY .......................................................................................................................................................................................................................................... 34 ANAPHYLAXIS TREATMENT AGENTS ......................................................................................................................................................................................... 34 ANTICHOLINERGICS...................................................................................................................................................................................................................... 34 ANTICHOLINERGIC/BETA AGONIST COMBINATIONS ............................................................................................................................................................... 34 ANTIHISTAMINES, LOW SEDATING ............................................................................................................................................................................................. 34 ANTIHISTAMINES, NONSEDATING .............................................................................................................................................................................................. 34 ANTIHISTAMINES, SEDATING ...................................................................................................................................................................................................... 34 ANTIHISTAMINE/DECONGESTANT COMBINATIONS ................................................................................................................................................................. 35 ANTITUSSIVES ............................................................................................................................................................................................................................... 35 ANTITUSSIVE COMBINATIONS ..................................................................................................................................................................................................... 35 BETA AGONISTS ............................................................................................................................................................................................................................ 35 CYSTIC FIBROSIS .......................................................................................................................................................................................................................... 35 DECONGESTANTS ......................................................................................................................................................................................................................... 36 DECONGESTANT/EXPECTORANT COMBINATIONS .................................................................................................................................................................. 36 EXPECTORANTS ............................................................................................................................................................................................................................ 36 LEUKOTRIENE MODULATORS ..................................................................................................................................................................................................... 36 MAST CELL STABILIZERS ............................................................................................................................................................................................................. 36 MEDICAL SUPPLIES....................................................................................................................................................................................................................... 36 NASAL ANTIHISTAMINES .............................................................................................................................................................................................................. 36 NASAL DECONGESTANTS ............................................................................................................................................................................................................ 36 NASAL STEROIDS .......................................................................................................................................................................................................................... 36 PHOSPHODIESTERASE-4 INHIBITORS ....................................................................................................................................................................................... 36 RESPIRATORY SYNCYTIAL VIRUS .............................................................................................................................................................................................. 36 SEVERE ASTHMA AGENTS ........................................................................................................................................................................................................... 37 STEROID/BETA AGONIST COMBINATIONS................................................................................................................................................................................. 37 STEROID INHALANTS .................................................................................................................................................................................................................... 37 XANTHINES ..................................................................................................................................................................................................................................... 37 XANTHINE COMBINATIONS .......................................................................................................................................................................................................... 37 MISCELLANEOUS........................................................................................................................................................................................................................... 37
TOPICAL .................................................................................................................................................................................................................................................... 37 DERMATOLOGY ............................................................................................................................................................................................................................. 37 MOUTH/THROAT/DENTAL AGENTS ............................................................................................................................................................................................. 40 OPHTHALMIC .................................................................................................................................................................................................................................. 40 OTIC ................................................................................................................................................................................................................................................. 42 VAGINAL .......................................................................................................................................................................................................................................... 43
NON-DISCRIMINATION STATEMENT ..................................................................................................................................................................................................... 44 INDEX ......................................................................................................................................................................................................................................................... 46
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INTRODUCTION
We are pleased to provide the 2019 Molina Healthcare of Ohio Preferred Drug List (Formulary) as a useful reference and informational tool. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. The drugs represented have been reviewed by a Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. The document is reflective of current medical practice as of the date of review. The information contained in this document and its appendices is provided solely for the convenience of medical providers and is not intended to be comprehensive in nature. All the information in the document is provided as a reference for drug therapy selection. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. We assume no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer's product literature or standard references for more detailed information.
PREFACE
The document is organized by sections. Each section is divided by therapeutic drug class primarily defined by mechanism of action. Products are listed by generic name with brand name for reference only. Unless the cited drug is available as an injectable or an exception is specifically noted, generally, all applicable dosage forms and strengths of the drug cited are included in the document.
PHARMACY AND THERAPEUTICS (P&T) COMMITTEE
The services of a Pharmacy and Therapeutics Committee ("P&T Committee") are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an advisory body of clinical professionals. The P&T Committee's voting members include physicians and pharmacists, all of whom have a broad background of clinical and academic expertise regarding prescription drugs. Voting members of the P&T Committee must disclose any financial relationship or conflicts of interest with any pharmaceutical manufacturers.
DRUG LIST PRODUCT DESCRIPTIONS
To assist in understanding which specific strengths and dosage forms on the document are covered, general principles are noted below.
• Listed products on the document generally include all strengths and dosage forms of the cited brand-name product.
• When a strength or dosage form is specified, only the specified strength and dosage form is on the document. Other strengths/dosage forms, including injectable dosage forms of the reference product are not.
• If the OTC and Prescription versions of the product are covered, then both are listed.
• Extended-release and delayed-release products require their own entry.
• Dosage forms on the document will be consistent with the category and use where listed.
GENERIC SUBSTITUTION
Generic substitution is a pharmacy action whereby a generic version is dispensed rather than a prescribed brand-name product. Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. In most instances, a brand-name drug for which a generic product becomes available will become non-formulary, with the generic product covered in its place, upon release of the generic product to the market. However, the document is subject to state specific regulations and rules regarding generic substitution and mandatory generic rules apply where appropriate. Generic drugs are usually priced lower than their brand-name equivalents. Prescription generic drugs are:
• Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards that apply to brand-name drugs.
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• Tested in humans to assure the generic is absorbed into the bloodstream in a similar rate and extent compared to the brand-name drug (bioequivalence). Generics may be different from the brand in size, color and inactive ingredients, but this does not alter their effectiveness or ability to be absorbed just like the brand-name drug.
• Manufactured in the same strength and dosage form as the brand-name drugs.
When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and safety profile as the brand-name drug (therapeutic equivalence).
PLAN DESIGN
The document represents a closed formulary plan design. The medications listed on the document are covered by the plan as represented. Certain medications on the list are covered if utilization management criteria are met (i.e., Step Therapy, Prior Authorization, Quantity Limits, etc.); requests for use of such medications outside of their listed criteria will be reviewed for medical necessity. If a medication is not listed on the document, a formulary exception may be requested for coverage. Medical necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non-formulary prescription request criteria. Log in to www.molinahealthcare.com to check coverage.
NON-COVERED MEDICATIONS
Please note that certain medications are not covered. This includes, but is not limited to:
• Fertility enhancing drugs
• Weight loss drugs
• Drugs and other agents used for cosmetic purposes or for hair growth
• Sexual dysfunction drugs
• Pharmaceuticals determined by the Federal Drug Administration (FDA) to be less than effective and identical, related or similar drugs (frequently referred to as “DESI 5 and 6” drugs)
STEP THERAPY (ST)
Step therapy (ST) drugs are covered after an adequate trial of a first-line drug has been tried and failed. Step therapy (ST) drugs may also be requested through the prior authorization process. Step therapy drug requests are reviewed based on medical necessity which takes into account the needs of different patient populations.
LEGEND
AL Age Limit
HRM High Risk Medications require PA for members age 65 and older
OTC Over the counter
PA Prior Authorization
PA, QL Quantity Limit is applied after Prior Authorization approval
QL Quantity Limit
SP Specialty Drug; these drugs must be obtained through a specialty pharmacy
ST Step Therapy
† Specific NDCs may not be reimbursable under the Molina Pharmacy Program
boldface
Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name
delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification
ext-rel Extended-release (also known as sustained-release), refer to the reference brand listed for clarification
NOTICE
The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. ©2019. All rights reserved. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers.
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ANALGESICS
ANALGESICS, OTHER
acetaminophen OTC, QL TYLENOL NSAIDs
ibuprofen OTC ADVIL naproxen sodium OTC ALEVE
diclofenac potassium diclofenac sodium delayed-rel diclofenac sodium delayed-rel/misoprostol PA ARTHROTEC
diclofenac sodium ext-rel diflunisal
etodolac etodolac ext-rel
fenoprofen 600 mg flurbiprofen ibuprofen
ketoprofen ketoprofen ext-rel
ketorolac QL meclofenamate meloxicam MOBIC
nabumetone naproxen NAPROSYN
oxaprozin DAYPRO piroxicam FELDENE sulindac
tolmetin 200 mg, 400 mg NSAIDs, TOPICAL
diclofenac sodium gel 1% QL VOLTAREN GEL COX-2 INHIBITORS
celecoxib PA CELEBREX GOUT
allopurinol ZYLOPRIM colchicine tabs QL COLCRYS
colchicine/probenecid febuxostat PA ULORIC
probenecid OPIOID ANALGESICS All Opioid Analgesics are subject to Ohio Department of Medicaid Opioid Policy:
butalbital/acetaminophen/caffeine/codeine 50/325/40/30 mg QL, *
butorphanol nasal spray QL, * codeine sulfate QL, * codeine/acetaminophen QL, * TYLENOL w/CODEINE
fentanyl citrate buccal PA, QL, * FENTORA fentanyl lozenge PA, QL, * ACTIQ
fentanyl sublingual PA, QL, * ABSTRAL fentanyl transdermal PA, QL DURAGESIC
hydrocodone/acetaminophen QL, * NORCO hydrocodone/acetaminophen soln 7.5-325 mg/15 mL PA, QL, * hydromorphone oral soln 1 mg/mL QL, * DILAUDID-5
hydromorphone tabs QL, * DILAUDID
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morphine QL, *
morphine ext-rel PA, QL KADIAN morphine ext-rel PA, QL MS CONTIN morphine supp QL, *
oxycodone QL, * oxycodone QL, * ROXICODONE
oxycodone ext-rel PA, QL OXYCONTIN oxycodone/acetaminophen QL, * oxycodone/aspirin QL, * PERCODAN
oxymorphone QL, * OPANA pentazocine/naloxone PA, QL, *
QL* all immediate-release opioid analgesics = Max quantity limit of 7 days supply per fill; Max quantity limit of 14
days supply per 45 days; Prior authorization required for existing utilizers dose > 60 mg morphine equivalent; new utilizers dose ≥ 30 mg morphine equivalent.
NON-OPIOID ANALGESICS
butalbital/acetaminophen 50/325 mg butalbital/acetaminophen/caffeine 50/325/40 mg QL ESGIC butalbital/aspirin/caffeine QL FIORINAL
tramadol ext-rel tabs PA tramadol immediate-release QL ULTRAM
tramadol/acetaminophen QL ULTRACET VISCOSUPPLEMENTS
hylan G-F 20 PA, SP SYNVISC-ONE
ANTI-INFECTIVES
ANTIBACTERIALS Aminoglycosides
neomycin
Cephalosporins First Generation
cefadroxil QL cephalexin caps 250 mg, 500 mg KEFLEX cephalexin caps 750 mg PA KEFLEX
cephalexin susp KEFLEX Second Generation
cefaclor QL cefaclor ext-rel CEFACLOR ER
cefprozil cefuroxime axetil
Third Generation
cefdinir QL
cefpodoxime Erythromycins/Macrolides
azithromycin ZITHROMAX clarithromycin
clarithromycin ext-rel erythromycin delayed-rel ERY-TAB erythromycin ethylsuccinate E.E.S.
erythromycin ethylsuccinate 200 mg/5 mL ERYPED erythromycin stearate ERYTHROCIN
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Fluoroquinolones
ciprofloxacin QL CIPRO levofloxacin QL LEVAQUIN moxifloxacin PA AVELOX
Penicillins
amoxicillin QL amoxicillin/clavulanate 200 mg/5 mL, 400 mg/5 mL AUGMENTIN amoxicillin/clavulanate chew tabs, tabs AUGMENTIN
ampicillin dicloxacillin
penicillin VK Sulfonamides
sulfadiazine sulfamethoxazole/trimethoprim sulfamethoxazole/trimethoprim DS
Tetracyclines
doxycycline calcium syrup VIBRAMYCIN SYRUP doxycycline hyclate caps 50 mg, 100 mg VIBRAMYCIN doxycycline hyclate tabs 20 mg, 100 mg
doxycycline monohydrate minocycline MINOCIN
tetracycline ANTIFUNGALS
clotrimazole troches fluconazole QL DIFLUCAN griseofulvin microsize
griseofulvin ultramicrosize itraconazole SPORANOX
itraconazole oral soln PA SPORANOX ORAL SOLUTION ketoconazole
nystatin terbinafine tabs QL
ANTIMALARIALS
artemether/lumefantrine COARTEM atovaquone/proguanil MALARONE
chloroquine mefloquine
primaquine PRIMAQUINE ANTIRETROVIRAL AGENTS Antiretroviral Adjuvants
cobicistat TYBOST Antiretroviral Combinations
abacavir/dolutegravir/lamivudine TRIUMEQ abacavir/lamivudine EPZICOM
abacavir/lamivudine/zidovudine TRIZIVIR atazanavir/cobicistat EVOTAZ
bictegravir/emtricitabine/tenofovir alafenamide QL BIKTARVY darunavir/cobicistat PREZCOBIX dolutegravir/rilpivirine QL JULUCA
efavirenz/lamivudine/tenofovir disoproxil fumarate QL SYMFI, SYMFI LO
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elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide GENVOYA
elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate STRIBILD emtricitabine/rilpivirine/tenofovir alafenamide ODEFSEY emtricitabine/rilpivirine/tenofovir disoproxil fumarate COMPLERA
emtricitabine/tenofovir alafenamide DESCOVY emtricitabine/tenofovir disoproxil fumarate TRUVADA
lamivudine/tenofovir disoproxil fumarate QL CIMDUO lamivudine/zidovudine COMBIVIR
Chemokine Receptor Antagonists
maraviroc SELZENTRY
Fusion Inhibitors
enfuvirtide PA, SP FUZEON
Integrase Inhibitors
dolutegravir TIVICAY
raltegravir ISENTRESS raltegravir ISENTRESS HD
Non-nucleoside Reverse Transcriptase Inhibitors
efavirenz SUSTIVA
etravirine INTELENCE nevirapine VIRAMUNE nevirapine ext-rel 100 mg PA VIRAMUNE XR
nevirapine ext-rel 400 mg VIRAMUNE XR rilpivirine EDURANT
Nucleoside Reverse Transcriptase Inhibitors
abacavir ZIAGEN
didanosine delayed-rel VIDEX EC didanosine soln VIDEX emtricitabine EMTRIVA
lamivudine EPIVIR stavudine
zidovudine RETROVIR Nucleotide Reverse Transcriptase Inhibitors
tenofovir disoproxil fumarate powder VIREAD tenofovir disoproxil fumarate tabs VIREAD
Protease Inhibitors
atazanavir caps REYATAZ
atazanavir powder REYATAZ darunavir PREZISTA fosamprenavir susp LEXIVA
fosamprenavir tabs LEXIVA indinavir CRIXIVAN
lopinavir/ritonavir soln KALETRA lopinavir/ritonavir tabs KALETRA
nelfinavir VIRACEPT ritonavir caps, soln NORVIR ritonavir tabs NORVIR
saquinavir mesylate INVIRASE tipranavir APTIVUS
ANTITUBERCULAR AGENTS
bedaquiline PA SIRTURO
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cycloserine PA
ethambutol MYAMBUTOL ethionamide TRECATOR isoniazid syrup QL
isoniazid tabs pyrazinamide
rifampin RIFADIN rifapentine PRIFTIN
ANTIVIRALS Cytomegalovirus Agents
valganciclovir PA VALCYTE
Hepatitis Agents Hepatitis B
adefovir dipivoxil HEPSERA entecavir soln BARACLUDE entecavir tabs BARACLUDE
lamivudine soln EPIVIR-HBV lamivudine tabs EPIVIR-HBV
Hepatitis C
ledipasvir/sofosbuvir PA, SP, * HARVONI
ribavirin caps 200 mg PA, SP REBETOL ribavirin oral soln 40 mg/mL PA, SP REBETOL
ribavirin tabs 200 mg PA, SP sofosbuvir/velpatasvir PA, SP, * EPCLUSA sofosbuvir/velpatasvir/voxilaprevir PA, SP VOSEVI
* ledipasvir/sofosbuvir and sofosbuvir/velpatasvir are the preferred agents Herpes Agents
acyclovir caps, susp, tabs ZOVIRAX famciclovir
valacyclovir VALTREX Influenza Agents
oseltamivir QL TAMIFLU rimantadine FLUMADINE
zanamivir QL RELENZA MISCELLANEOUS
pyrantel OTC REESES PINWORM MEDICINE albendazole PA ALBENZA
atovaquone MEPRON clindamycin CLEOCIN dapsone
ivermectin PA STROMECTOL linezolid PA ZYVOX
metronidazole FLAGYL nitazoxanide susp PA ALINIA nitazoxanide tabs ALINIA
nitrofurantoin ext-rel HRM MACROBID nitrofurantoin macrocrystals HRM MACRODANTIN
nitrofurantoin susp HRM FURADANTIN paromomycin praziquantel PA BILTRICIDE
rifabutin MYCOBUTIN
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rifaximin PA XIFAXAN
trimethoprim vancomycin oral soln FIRVANQ
ANTINEOPLASTIC AGENTS
ALKYLATING AGENTS busulfan MYLERAN
chlorambucil LEUKERAN cyclophosphamide caps PA
estramustine PA EMCYT lomustine GLEOSTINE mechlorethamine gel PA VALCHLOR
melphalan ALKERAN temozolomide PA, SP TEMODAR
ANTIMETABOLITES
capecitabine PA, SP XELODA
mercaptopurine methotrexate TREXALL
methotrexate inj thioguanine TABLOID
CYTOPROTECTIVE AGENTS
leucovorin calcium LEUCOVORIN HORMONAL ANTINEOPLASTIC AGENTS Antiandrogens
bicalutamide CASODEX
flutamide nilutamide NILANDRON
Antiestrogens
tamoxifen QL
toremifene FARESTON Aromatase Inhibitors
anastrozole ARIMIDEX exemestane AROMASIN
letrozole FEMARA Progestins
megestrol acetate susp 40 mg/mL, tabs IMMUNOMODULATORS
lenalidomide PA, SP REVLIMID pomalidomide PA, SP POMALYST thalidomide PA, SP THALOMID
KINASE INHIBITORS
afatinib PA, SP GILOTRIF axitinib PA, SP INLYTA bosutinib PA, SP BOSULIF
cabozantinib PA, SP COMETRIQ dabrafenib PA, SP TAFINLAR
dasatinib PA, SP SPRYCEL erlotinib PA, SP TARCEVA everolimus PA, SP AFINITOR
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everolimus tablets for oral suspension PA, SP AFINITOR DISPERZ
ibrutinib PA, SP IMBRUVICA idelalisib PA, SP ZYDELIG imatinib mesylate PA, SP GLEEVEC
lapatinib PA, SP TYKERB nilotinib PA, SP TASIGNA
pazopanib PA, SP VOTRIENT regorafenib PA, SP STIVARGA ruxolitinib PA, SP JAKAFI
sorafenib PA, SP NEXAVAR sunitinib PA, SP SUTENT
trametinib PA, SP MEKINIST vandetanib PA, SP CAPRELSA
TOPOISOMERASE INHIBITORS
topotecan PA, SP HYCAMTIN
MISCELLANEOUS
aldesleukin PA, SP PROLEUKIN
bexarotene caps TARGRETIN caps etoposide hydroxyurea DROXIA
hydroxyurea HYDREA mitotane LYSODREN
procarbazine MATULANE tretinoin caps vorinostat PA, SP ZOLINZA
CARDIOVASCULAR
ACE INHIBITORS benazepril LOTENSIN captopril
enalapril VASOTEC fosinopril
lisinopril ZESTRIL moexipril perindopril
quinapril ACCUPRIL ramipril ALTACE
trandolapril ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS
amlodipine/benazepril QL LOTREL trandolapril/verapamil ext-rel TARKA
ACE INHIBITOR/DIURETIC COMBINATIONS
benazepril/hydrochlorothiazide LOTENSIN HCT
captopril/hydrochlorothiazide enalapril/hydrochlorothiazide VASERETIC fosinopril/hydrochlorothiazide
lisinopril/hydrochlorothiazide ZESTORETIC quinapril/hydrochlorothiazide ACCURETIC
ADRENOLYTICS, CENTRAL
clonidine CATAPRES
clonidine transdermal PA CATAPRES TTS guanfacine
13
ALDOSTERONE RECEPTOR ANTAGONISTS
eplerenone PA INSPRA spironolactone ALDACTONE
ALPHA BLOCKERS
doxazosin CARDURA
prazosin MINIPRESS terazosin
ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS
candesartan PA ATACAND candesartan/hydrochlorothiazide PA ATACAND HCT
eprosartan PA irbesartan AVAPRO
irbesartan/hydrochlorothiazide AVALIDE losartan COZAAR losartan/hydrochlorothiazide HYZAAR
olmesartan PA BENICAR olmesartan/hydrochlorothiazide PA BENICAR HCT
telmisartan PA MICARDIS telmisartan/hydrochlorothiazide PA MICARDIS HCT
valsartan DIOVAN valsartan/hydrochlorothiazide QL DIOVAN HCT
ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS
amlodipine/olmesartan PA AZOR amlodipine/valsartan PA EXFORGE
amlodipine/valsartan/hydrochlorothiazide PA EXFORGE HCT ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS
olmesartan/amlodipine/hydrochlorothiazide PA TRIBENZOR ANTIARRHYTHMICS
amiodarone disopyramide NORPACE
disopyramide ext-rel NORPACE CR dofetilide SP TIKOSYN
dronedarone MULTAQ flecainide propafenone
propafenone ext-rel RYTHMOL SR sotalol BETAPACE
sotalol BETAPACE AF ANTILIPEMICS Bile Acid Resins
cholestyramine QUESTRAN/QUESTRAN LIGHT colestipol packets, tabs COLESTID
Cholesterol Absorption Inhibitors
ezetimibe ST * ZETIA
ST * Requires prior use of a HMG-CoA Reductase Inhibitor Fibrates
choline fenofibrate delayed-rel 45 mg TRILIPIX fenofibrate caps 150 mg LIPOFEN
14
fenofibrate tabs 48 mg PA TRICOR
fenofibrate tabs 54 mg, 160 mg fenofibrate tabs 145 mg TRICOR gemfibrozil LOPID
HMG-CoA Reductase Inhibitors
atorvastatin 10 mg, 20 mg, 40 mg LIPITOR
atorvastatin 80 mg QL LIPITOR lovastatin
pravastatin PRAVACHOL rosuvastatin QL CRESTOR
simvastatin ZOCOR Microsomal Triglyceride Transfer Protein Inhibitors
lomitapide PA JUXTAPID Niacins
niacin ext-rel PA NIASPAN Omega-3 Fatty Acids
omega-3 acid ethyl esters PA LOVAZA PCSK9 Inhibitors
evolocumab PA, SP, QL REPATHA evolocumab PA, SP, QL REPATHA PUSHTRONEX
Miscellaneous
mipomersen PA KYNAMRO
BETA-BLOCKERS
acebutolol
atenolol betaxolol
bisoprolol carvedilol COREG labetalol TRANDATE
metoprolol succinate ext-rel TOPROL-XL metoprolol tartrate 25 mg, 50 mg LOPRESSOR
nadolol CORGARD pindolol propranolol
propranolol ext-rel INDERAL LA timolol
BETA-BLOCKER/DIURETIC COMBINATIONS
atenolol/chlorthalidone
bisoprolol/hydrochlorothiazide ZIAC metoprolol/hydrochlorothiazide LOPRESSOR HCT
CALCIUM CHANNEL BLOCKERS Dihydropyridines
amlodipine NORVASC
felodipine ext-rel nicardipine
nifedipine PROCARDIA nifedipine ext-rel ADALAT CC nifedipine ext-rel PROCARDIA XL
nimodipine NIMOTOP
15
nisoldipine ext-rel SULAR
Nondihydropyridines
diltiazem CARDIZEM
diltiazem ext-rel diltiazem ext-rel CARDIZEM CD diltiazem ext-rel TIAZAC
diltiazem ext-rel, except 120 mg CARDIZEM LA verapamil ext-rel tabs CALAN SR
DIGITALIS GLYCOSIDES
digoxin LANOXIN
digoxin ped elixir AL DIURETICS Carbonic Anhydrase Inhibitors
acetazolamide acetazolamide ext-rel
methazolamide Loop Diuretics
bumetanide furosemide LASIX
torsemide DEMADEX Potassium-sparing Diuretics
amiloride Thiazides and Thiazide-like Diuretics
chlorthalidone hydrochlorothiazide
indapamide metolazone
chlorothiazide Diuretic Combinations
amiloride/hydrochlorothiazide spironolactone/hydrochlorothiazide ALDACTAZIDE triamterene/hydrochlorothiazide DYAZIDE
triamterene/hydrochlorothiazide MAXZIDE HEART FAILURE
isosorbide dinitrate/hydralazine BIDIL NITRATES Oral
isosorbide dinitrate ext-rel tabs
isosorbide dinitrate oral ISORDIL isosorbide mononitrate isosorbide mononitrate ext-rel
Sublingual
nitroglycerin sublingual NITROSTAT
Transdermal
nitroglycerin transdermal QL nitroglycerin transdermal QL NITRO-DUR
16
PULMONARY ARTERIAL HYPERTENSION Endothelin Receptor Antagonists
ambrisentan PA, SP, QL LETAIRIS bosentan PA, SP TRACLEER macitentan PA, SP, QL OPSUMIT
Phosphodiesterase Inhibitors
sildenafil PA, SP REVATIO Prostacyclin Receptor Agonists
selexipag PA, SP, QL UPTRAVI Prostaglandin Vasodilators
epoprostenol PA, SP VELETRI epoprostenol sodium PA, SP FLOLAN iloprost PA, SP VENTAVIS
treprostinil PA, SP REMODULIN treprostinil PA, SP TYVASO
Soluble Guanylate Cyclase Stimulators
riociguat PA, SP ADEMPAS
MISCELLANEOUS
hydralazine
methyldopa methyldopa/hydrochlorothiazide
metyrosine PA DEMSER midodrine minoxidil tabs
phentolamine inj ranolazine ext-rel RANEXA
CENTRAL NERVOUS SYSTEM
AMYOTROPHIC LATERAL SCLEROSIS
riluzole PA RILUTEK ANTIANXIETY Benzodiazepines
alprazolam XANAX alprazolam ext-rel PA XANAX XR
chlordiazepoxide clonazepam tabs KLONOPIN
clorazepate diazepam VALIUM
lorazepam ATIVAN oxazepam
Miscellaneous
buspirone QL clomipramine ANAFRANIL
fluvoxamine meprobamate
ANTICONVULSANTS
carbamazepine TEGRETOL
carbamazepine ext-rel CARBATROL carbamazepine ext-rel TEGRETOL-XR
17
clobazam PA ONFI
diazepam rectal gel DIASTAT divalproex sodium delayed-rel DEPAKOTE divalproex sodium ext-rel DEPAKOTE ER
ethosuximide ZARONTIN ethotoin PEGANONE
felbamate FELBATOL gabapentin QL NEURONTIN lacosamide PA VIMPAT
lamotrigine QL LAMICTAL levetiracetam KEPPRA
levetiracetam ext-rel KEPPRA XR methsuximide CELONTIN oxcarbazepine QL TRILEPTAL
perampanel PA FYCOMPA phenobarbital QL
phenytoin DILANTIN INFATABS phenytoin sodium extended DILANTIN
pregabalin PA, QL LYRICA primidone MYSOLINE rufinamide PA BANZEL
tiagabine GABITRIL topiramate sprinkle caps, tabs QL TOPAMAX
valproic acid DEPAKENE zonisamide ZONEGRAN
ANTIDEMENTIA
donepezil ARICEPT galantamine RAZADYNE
galantamine ext-rel RAZADYNE ER memantine NAMENDA
rivastigmine ANTIDEPRESSANTS Although these agents are primarily indicated for depression, some of these are also approved for other indications, including bipolar disorder, obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder. Monoamine Oxidase Inhibitors (MAOIs)
isocarboxazid MARPLAN phenelzine NARDIL
tranylcypromine PARNATE Selective Serotonin Reuptake Inhibitors (SSRIs)
citalopram CELEXA escitalopram soln LEXAPRO escitalopram tabs LEXAPRO
fluoxetine caps 10 mg, 20 mg, 40 mg PROZAC paroxetine HCl susp PAXIL
paroxetine HCl tabs PAXIL sertraline ZOLOFT
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
duloxetine delayed-rel 20 mg, 30 mg, 60 mg CYMBALTA
venlafaxine ext-rel EFFEXOR XR venlafaxine tabs
Tricyclic Antidepressants (TCAs)
amitriptyline QL
18
amoxapine QL
desipramine NORPRAMIN doxepin imipramine HCl TOFRANIL
imipramine pamoate nortriptyline PAMELOR
protriptyline trimipramine SURMONTIL
Miscellaneous Agents
bupropion
bupropion ext-rel PA APLENZIN bupropion ext-rel QL WELLBUTRIN SR bupropion ext-rel QL WELLBUTRIN XL
chlordiazepoxide/amitriptyline loxapine
maprotiline mirtazapine REMERON thioridazine
trazodone 50 mg, 100 mg, 150 mg ANTIPARKINSONIAN AGENTS
amantadine QL benztropine QL
bromocriptine PARLODEL carbidopa/levodopa SINEMET carbidopa/levodopa ext-rel SINEMET CR
carbidopa/levodopa/entacapone ST * STALEVO entacapone ST * COMTAN
pramipexole MIRAPEX ropinirole
selegiline selegiline orally disintegrating tablets ZELAPAR trihexyphenidyl QL
ST * Requires prior use of carbidopa/levodopa ANTIPSYCHOTICS Atypicals
aripiprazole QL ABILIFY
aripiprazole ext-rel inj ABILIFY MAINTENA aripiprazole lauroxil ext-rel inj ARISTADA aripiprazole lauroxil ext-rel inj ARISTADA INITIO
asenapine PA, * SAPHRIS clozapine CLOZARIL
iloperidone PA, * FANAPT lurasidone PA, * LATUDA olanzapine ZYPREXA
olanzapine pamoate ext-rel inj ZYPREXA RELPREVV paliperidone ext-rel PA, * INVEGA
paliperidone palmitate ext-rel inj INVEGA SUSTENNA paliperidone palmitate ext-rel inj PA, * INVEGA TRINZA quetiapine SEROQUEL
quetiapine ext-rel PA, * SEROQUEL XR risperidone RISPERDAL
risperidone long-acting inj RISPERDAL CONSTA ziprasidone QL GEODON
19
* Psychiatrists exempt from PA Miscellaneous
chlorpromazine fluphenazine
haloperidol perphenazine
perphenazine/amitriptyline pimozide thiothixene
trifluoperazine ATTENTION DEFICIT HYPERACTIVITY DISORDER
amphetamine/dextroamphetamine mixed salts AL, QL ADDERALL amphetamine/dextroamphetamine mixed salts ext-rel AL, QL ADDERALL XR
atomoxetine AL, ST * STRATTERA clonidine ext-rel AL, PA KAPVAY dexmethylphenidate AL FOCALIN
dexmethylphenidate ext-rel AL, PA FOCALIN XR dextroamphetamine 5 mg, 10 mg AL, QL
dextroamphetamine ext-rel AL, QL DEXEDRINE SPANSULE guanfacine ext-rel AL, PA INTUNIV
lisdexamfetamine AL, PA, QL VYVANSE methylphenidate AL METHYLIN methylphenidate AL RITALIN
methylphenidate ext-rel AL, QL CONCERTA methylphenidate ext-rel AL, QL METADATE CD
methylphenidate ext-rel 10 mg AL, QL methylphenidate ext-rel 10 mg, 60 mg AL, PA, QL RITALIN LA methylphenidate ext-rel 20 mg AL, QL METADATE ER
methylphenidate ext-rel 20 mg, 30 mg, 40 mg AL, QL RITALIN LA ST * Requires prior use of methylphenidate or an amphetamine HUNTINGTON'S DISEASE AGENTS
tetrabenazine PA XENAZINE
HYPNOTICS Benzodiazepines
estazolam temazepam QL RESTORIL triazolam QL
Nonbenzodiazepines
zolpidem QL AMBIEN MIGRAINE Ergotamine Derivatives
dihydroergotamine spray QL MIGRANAL ergotamine/caffeine CAFERGOT
Selective Serotonin Agonists
almotriptan PA, QL
naratriptan QL AMERGE rizatriptan QL MAXALT
rizatriptan orally disintegrating tabs QL MAXALT-MLT sumatriptan QL IMITREX sumatriptan inj QL IMITREX
20
sumatriptan nasal spray QL IMITREX
MOOD STABILIZERS
carbamazepine ext-rel EQUETRO
lithium carbonate lithium carbonate ext-rel tabs 300 mg LITHOBID lithium carbonate ext-rel tabs 450 mg
MULTIPLE SCLEROSIS AGENTS
dalfampridine ext-rel PA, SP AMPYRA dimethyl fumarate delayed-rel PA, SP TECFIDERA fingolimod PA, SP GILENYA
glatiramer 20 mg/mL PA, SP COPAXONE interferon beta-1a PA, SP AVONEX
interferon beta-1b PA, SP EXTAVIA teriflunomide PA, SP AUBAGIO
MUSCULOSKELETAL THERAPY AGENTS
baclofen 10 mg, 20 mg carisoprodol/aspirin QL
carisoprodol/aspirin/codeine PA chlorzoxazone 500 mg
cyclobenzaprine 5 mg, 10 mg QL dantrolene DANTRIUM
methocarbamol ROBAXIN orphenadrine ext-rel orphenadrine/aspirin/caffeine PA
tizanidine tabs ZANAFLEX MYASTHENIA GRAVIS
pyridostigmine MESTINON NARCOLEPSY/CATAPLEXY
armodafinil PA NUVIGIL modafinil PA, QL PROVIGIL
sodium oxybate PA XYREM PSYCHOTHERAPEUTIC-MISCELLANEOUS Alcohol Deterrents
acamprosate calcium disulfiram ANTABUSE
Opioid Antagonists
naloxone inj
naloxone nasal spray NARCAN naltrexone
Partial Opioid Agonists
buprenorphine ext-rel inj PA SUBLOCADE
buprenorphine sublingual Partial Opioid Agonist/Opioid Antagonist Combinations
buprenorphine/naloxone buccal film BUNAVAIL buprenorphine/naloxone sublingual film SUBOXONE
buprenorphine/naloxone sublingual tabs buprenorphine/naloxone sublingual tabs ZUBSOLV
21
Pseudobulbar Affect dextromethorphan/quinidine PA NUEDEXTA
Smoking Deterrents
nicotine polacrilex gum OTC, QL NICORETTE
nicotine polacrilex lozenge OTC NICORETTE nicotine transdermal OTC, QL
bupropion ext-rel ZYBAN varenicline ST * CHANTIX
ST * Requires prior use of nicotine or bupropion ext-rel MISCELLANEOUS
guanidine PA
ENDOCRINE AND METABOLIC
ACROMEGALY octreotide acetate SANDOSTATIN
pegvisomant PA, SP SOMAVERT ANDROGENS
oxandrolone PA oxymetholone PA ANADROL-50 testosterone cypionate PA DEPO-TESTOSTERONE
testosterone enanthate PA DELATESTRYL testosterone gel PA ANDROGEL
testosterone gel PA FORTESTA ANTIDIABETICS Alpha-glucosidase Inhibitors
acarbose PRECOSE miglitol GLYSET
Amylin Analogs
pramlintide ST * SYMLINPEN
ST * Requires prior use of insulin therapy Biguanides
metformin GLUCOPHAGE metformin ext-rel GLUCOPHAGE XR
Biguanide/Sulfonylurea Combinations
glipizide/metformin
glyburide/metformin HRM Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
alogliptin ST * NESINA ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Biguanide Combinations
alogliptin/metformin ST * KAZANO
ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination Dipeptidyl Peptidase-4 (DPP-4) Inhibitor/Insulin Sensitizer Combinations
alogliptin/pioglitazone ST * OSENI
22
ST * Requires trial of metformin, metformin-containing product, Sulfonylurea or Sulfonylurea Combination Incretin Mimetic Agents
liraglutide ST * VICTOZA
semaglutide PA OZEMPIC ST * Requires prior use of metformin AND an oral hypoglycemic agent Insulins
insulin human OTC, QL HUMULIN R
insulin human OTC, QL NOVOLIN R insulin isophane human OTC HUMULIN N insulin isophane human OTC NOVOLIN N
insulin isophane human 70%/regular 30% OTC HUMULIN 70/30 insulin isophane human 70%/regular 30% OTC NOVOLIN 70/30
insulin aspart protamine 70%/insulin aspart 30% NOVOLOG MIX 70/30 insulin glargine BASAGLAR insulin glargine PA, QL TOUJEO SOLOSTAR
insulin human inhalation powder PA AFREZZA insulin human vial PA, QL HUMULIN R U-500 VIAL
insulin lispro QL ADMELOG insulin lispro QL ADMELOG SOLOSTAR insulin lispro protamine/insulin lispro HUMALOG MIX
Insulin Sensitizers
pioglitazone ACTOS
Insulin Sensitizer/Biguanide Combinations
pioglitazone/metformin ACTOPLUS MET pioglitazone/metformin ext-rel PA ACTOPLUS MET XR
Insulin Sensitizer/Sulfonylurea Combinations
pioglitazone/glimepiride PA DUETACT Meglitinides
nateglinide STARLIX
repaglinide PRANDIN Meglitinide/Biguanide Combinations
repaglinide/metformin PA Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors
ertugliflozin ST * STEGLATRO ST * Requires trial of DDP-4 Inhibitor or DPP-4 Inhibitor/Biguanide Combination Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitor/Biguanide Combinations
ertugliflozin/metformin ST * SEGLUROMET
ST * Requires trial of DDP-4 Inhibitor or DPP-4 Inhibitor/Biguanide Combination Sulfonylureas
glimepiride AMARYL glipizide GLUCOTROL
glipizide ext-rel GLUCOTROL XL glyburide HRM glyburide micronized HRM GLYNASE
23
tolbutamide
Supplies
alcohol swabs OTC, QL
blood glucose monitoring kits OTC TRUE METRIX AIR kits blood glucose monitoring kits OTC TRUE METRIX kits blood glucose test strips OTC TRUE METRIX test strips
insulin syringes, needles OTC lancets OTC
insulin infusion disposable pump PA OMNIPOD INSULIN INFUSION PUMP CALCIUM RECEPTOR ANTAGONISTS
cinacalcet PA SENSIPAR CALCIUM REGULATORS Bisphosphonates
alendronate tabs FOSAMAX alendronate soln
ibandronate PA BONIVA Calcitonins
calcitonin-salmon spray MIACALCIN Parathyroid Hormones
abaloparatide PA, SP TYMLOS Miscellaneous
denosumab PA, SP PROLIA CARNITINE DEFICIENCY AGENTS
levocarnitine oral soln, tabs CARNITOR
CONTRACEPTIVES EE = ethinyl estradiol Monophasic 20 mcg Estrogen
levonorgestrel/EE 0.1/20
norethindrone acetate/EE 1/20 LOESTRIN 1/20 norethindrone acetate/EE 1/20 and iron LOESTRIN FE 1/20
30 mcg Estrogen
desogestrel/EE 0.15/30 APRI drospirenone/EE 3/30 YASMIN
levonorgestrel/EE 0.15/30 norethindrone acetate/EE 1.5/30 LOESTRIN 1.5/30
norethindrone acetate/EE 1.5/30 and iron LOESTRIN FE 1.5/30 norgestrel/EE 0.3/30
35 mcg Estrogen
ethynodiol diacetate/EE 1/35
norethindrone/EE 0.5/35 norethindrone/EE 1/35 ORTHO-NOVUM 1/35 norgestimate/EE 0.25/35
50 mcg Estrogen
ethynodiol diacetate/EE 1/50 KELNOR 1/50
norgestrel/EE 0.5/50 OGESTREL
24
Biphasic
desogestrel/EE MIRCETTE Triphasic
desogestrel/EE CAZIANT, VELIVET levonorgestrel/EE
norethindrone/EE QL ORTHO-NOVUM 7/7/7 norethindrone/EE 0.5-35/1-35/0.5-35 mg-mcg norgestimate/EE ORTHO TRI-CYCLEN LO
norgestimate/EE 0.18-35/0.215-35/0.25-35 mg-mcg Extended Cycle
levonorgestrel/EE 0.1/20 and EE 10 QL AMETHIA LO, CAMRESE LO levonorgestrel/EE 0.15/30 QL INTROVALE, JOLESSA, SETLAKIN
Continuous
levonorgestrel/EE 0.09/20
Progestin Only
norethindrone
norethindrone ORTHO MICRONOR Emergency Contraception
levonorgestrel OTC, QL PLAN B ONE-STEP ulipristal QL ELLA
Implant
etonogestrel implant SP NEXPLANON
Injectable
medroxyprogesterone acetate vial 150 mg/mL DEPO-PROVERA
Progestin Intrauterine Device
levonorgestrel-releasing IUD SP, QL KYLEENA
levonorgestrel-releasing IUD SP, QL LILETTA levonorgestrel-releasing IUD SP, QL MIRENA
levonorgestrel-releasing IUD SP, QL SKYLA Transdermal
norelgestromin/EE QL XULANE Vaginal
etonogestrel/EE ring NUVARING Miscellaneous
condoms, male OTC, QL nonoxynol-9 OTC GYNOL II
ENDOMETRIOSIS
danazol
nafarelin PA SYNAREL ESTROGENS Oral
estradiol HRM ESTRACE estrogens, esterified PA MENEST
25
Transdermal estradiol PA ALORA
estradiol HRM CLIMARA Vaginal
estradiol vaginal crm ESTRACE CREAM estradiol vaginal tabs PA VAGIFEM
ESTROGEN/PROGESTINS Oral
EE/norethindrone acetate JINTELI EE/norethindrone acetate 0.5 mg/2.5 mcg FEMHRT estradiol/norethindrone acetate PA ACTIVELLA
estradiol/norgestimate PREFEST ESTROGEN/SELECTIVE ESTROGEN RECEPTOR MODULATOR COMBINATIONS
conjugated estrogens/bazedoxifene PA DUAVEE GAUCHER DISEASE
miglustat PA ZAVESCA GLUCOCORTICOIDS
cortisone acetate dexamethasone
dexamethasone concentrate 1 mg/mL DEXAMETHASONE INTENSOL fludrocortisone
hydrocortisone CORTEF methylprednisolone MEDROL methylprednisolone 2 mg MEDROL
prednisolone sodium phosphate soln 5 mg/5 mL, 15 mg/5 mL, 25 mg/5 mL prednisolone syrup
prednisone prednisone concentrate 5 mg/mL PREDNISONE INTENSOL
GLUCOSE ELEVATING AGENTS
glucose tablets OTC
diazoxide PROGLYCEM glucagon, human recombinant QL GLUCAGEN HYPOKIT glucagon, human recombinant QL GLUCAGON EMERGENCY KIT
HEREDITARY TYROSINEMIA TYPE 1 AGENTS
nitisinone PA ORFADIN
HUMAN GROWTH HORMONES
somatropin PA, SP OMNITROPE HYPERPARATHYROID TREATMENT, VITAMIN D ANALOGS
calcitriol (1,25-D3) QL ROCALTROL doxercalciferol HECTOROL paricalcitol ZEMPLAR
INSULIN-LIKE GROWTH FACTOR
mecasermin PA, SP INCRELEX
PHOSPHATE BINDER AGENTS
calcium acetate lanthanum chew tabs PA FOSRENOL lanthanum powder PA FOSRENOL
26
POTASSIUM-REMOVING AGENTS
sodium polystyrene sulfonate SPS PROGESTINS Oral
medroxyprogesterone acetate PROVERA norethindrone acetate AYGESTIN
progesterone, micronized PROMETRIUM Vaginal
progesterone gel PA CRINONE progesterone supp FIRST-PROGESTERONE VGS
progesterone vaginal inserts ENDOMETRIN SELECTIVE ESTROGEN RECEPTOR MODULATORS
raloxifene EVISTA THYROID AGENTS Antithyroid Agents
methimazole TAPAZOLE propylthiouracil
Thyroid Supplements
levothyroxine levothyroxine LEVOXYL levothyroxine SYNTHROID
liothyronine CYTOMEL liotrix THYROLAR
thyroid ARMOUR THYROID UREA CYCLE DISORDERS
sodium phenylbutyrate BUPHENYL VASOPRESSIN RECEPTOR ANTAGONISTS
tolvaptan PA, SP SAMSCA VASOPRESSINS
desmopressin spray PA STIMATE desmopressin spray, tabs DDAVP
MISCELLANEOUS
cabergoline
methylergonovine METHERGINE
GASTROINTESTINAL
ANTACIDS alumina/magnesia OTC MAALOX alumina/magnesia/simethicone OTC MAALOX
alumina/magnesia/simethicone OTC MYLANTA aluminum hydroxide OTC
calcium carbonate OTC sodium bicarbonate OTC
ANTIDIARRHEALS
bismuth subsalicylate OTC PEPTO-BISMOL
loperamide OTC diphenoxylate/atropine LOMOTIL
27
loperamide
ANTIEMETICS
dextrose/fructose/phosphoric acid OTC EMETROL
dimenhydrinate OTC DRAMAMINE meclizine OTC aprepitant caps PA EMEND
aprepitant susp PA EMEND dronabinol PA MARINOL
granisetron tabs ST*, QL meclizine
metoclopramide REGLAN metoclopramide orally-disintegrating tabs PA ondansetron QL ZOFRAN
prochlorperazine promethazine HRM
promethazine supp 12.5 mg, 25 mg HRM scopolamine transdermal TRANSDERM SCOP trimethobenzamide caps TIGAN
ST * Requires prior use of ondansetron ANTISPASMODICS
dicyclomine BENTYL glycopyrrolate tabs 1 mg, 2 mg
hyoscyamine sulfate ext-rel caps hyoscyamine sulfate ext-rel tabs LEVBID
hyoscyamine sulfate oral soln, elixir hyoscyamine sulfate orally disintegrating tabs ANASPAZ hyoscyamine sulfate orally disintegrating tabs LEVSIN
methscopolamine bromide propantheline
CHOLELITHOLYTICS
ursodiol ACTIGALL
ursodiol URSO H2 RECEPTOR ANTAGONISTS
cimetidine OTC TAGAMET HB famotidine OTC PEPCID
ranitidine OTC ZANTAC cimetidine famotidine PEPCID
nizatidine ranitidine ZANTAC
INFLAMMATORY BOWEL DISEASE Oral Agents
balsalazide budesonide delayed-rel caps ENTOCORT EC mesalamine delayed-rel PA DELZICOL
mesalamine delayed-rel tabs ASACOL HD mesalamine delayed-rel tabs PA LIALDA
mesalamine ext-rel caps APRISO olsalazine DIPENTUM sulfasalazine AZULFIDINE
sulfasalazine delayed-rel AZULFIDINE EN-TABS
28
Rectal Agents hydrocortisone acetate foam CORTIFOAM
hydrocortisone enema mesalamine rectal susp ROWASA
mesalamine supp CANASA IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome with Constipation
lubiprostone PA AMITIZA Irritable Bowel Syndrome with Diarrhea
alosetron ST * LOTRONEX ST * Requires prior use of Metamucil, psyllium and dicyclomine LAXATIVES/STOOL SOFTENERS
bisacodyl OTC DULCOLAX bisacodyl enema OTC FLEET docusate calcium OTC
docusate sodium OTC COLACE karaya gum OTC KARAYA GUM
magnesium citrate OTC magnesium hydroxide OTC MILK OF MAGNESIA methylcellulose OTC CITRUCEL
mineral oil OTC FLEET MINERAL OIL ENEMA polyethylene glycol 3350 powder OTC MIRALAX
psyllium powder OTC KONSYL senna OTC sennosides OTC SENOKOT
sennosides/docusate sodium OTC SENNA PLUS sodium phosphates OTC
lactulose packets KRISTALOSE lactulose soln
peg 3350/electrolytes COLYTE peg 3350/electrolytes COLYTE FLAVORED peg 3350/electrolytes GOLYTELY
peg 3350/electrolytes NULYTELY PANCREATIC ENZYMES
pancrelipase delayed-rel CREON pancrelipase delayed-rel PANCREAZE
pancrelipase delayed-rel ZENPEP PROSTAGLANDINS
misoprostol CYTOTEC PROTON PUMP INHIBITORS
esomeprazole magnesium delayed-rel OTC, QL NEXIUM 24HR lansoprazole delayed-rel OTC, QL PREVACID 24HR
omeprazole magnesium delayed-rel OTC, QL PRILOSEC OTC omeprazole/sodium bicarbonate OTC, QL, PA ZEGERID OTC lansoprazole delayed-rel QL PREVACID
lansoprazole delayed-rel orally-disintegrating tabs QL, PA PREVACID omeprazole delayed-rel QL
omeprazole powder for suspension QL PRILOSEC pantoprazole delayed-rel packets for suspension QL, PA PROTONIX pantoprazole delayed-rel tabs QL PROTONIX
29
SALIVA STIMULANTS cevimeline EVOXAC
pilocarpine tabs SALAGEN STEROIDS, RECTAL
petrolatum/mineral oil/shark liver oil/phenylephrine oint OTC PREPARATION H pramoxine/phenylephrine/glycerin/petrolatum OTC PREPARATION H
hydrocortisone crm ANUSOL-HC 2.5% hydrocortisone crm PROCTOCORT 1%
ULCER THERAPY COMBINATIONS
lansoprazole + amoxicillin + clarithromycin
MISCELLANEOUS
loperamide/simethicone OTC IMODIUM
simethicone OTC cholic acid PA CHOLBAM cromolyn sodium GASTROCROM
glycopyrrolate PA CUVPOSA sucralfate susp CARAFATE
sucralfate tabs CARAFATE
GENITOURINARY
BENIGN PROSTATIC HYPERPLASIA alfuzosin ext-rel PA UROXATRAL
doxazosin CARDURA doxazosin ext-rel PA CARDURA XL dutasteride PA AVODART
dutasteride/tamsulosin PA JALYN finasteride 5 mg PROSCAR
silodosin PA RAPAFLO tamsulosin FLOMAX terazosin
URINARY ANTISPASMODICS
oxybutynin transdermal OTC, PA OXYTROL FOR WOMEN
oxybutynin oxybutynin ext-rel DITROPAN XL
tolterodine PA DETROL tolterodine ext-rel PA DETROL LA
trospium trospium ext-rel PA
VAGINAL ANTI-INFECTIVES
clotrimazole OTC GYNE-LOTRIMIN miconazole OTC
tioconazole OTC VAGISTAT-1 clindamycin CLINDESSE
clindamycin crm CLEOCIN clindamycin vaginal supp CLEOCIN clotrimazole
metronidazole METROGEL-VAGINAL miconazole
nystatin vaginal tab terconazole crm, supp
30
MISCELLANEOUS acetohydroxamic acid PA LITHOSTAT
bethanechol URECHOLINE methenamine mandelate
pentosan polysulfate sodium ELMIRON potassium citrate UROCIT-K potassium citrate/citric acid CYTRA-K
potassium citrate/sodium citrate/citric acid CYTRA-3 potassium/sodium acid phosphates PA K-PHOS
sodium citrate/citric acid CYTRA-2
HEMATOLOGIC
ANTICOAGULANTS Injectable
dalteparin QL*, PA FRAGMIN
enoxaparin QL*, PA LOVENOX QL* Ten days supply allowed unless a PA is initiated Oral
apixaban PA ELIQUIS
rivaroxaban PA XARELTO warfarin COUMADIN
Synthetic Heparinoid-like Agents
fondaparinux QL*, PA ARIXTRA
QL* Ten days supply allowed unless a PA is initiated HEMATOPOIETIC GROWTH FACTORS
darbepoetin alfa PA, SP ARANESP epoetin alfa PA, SP EPOGEN
epoetin alfa PA, SP PROCRIT filgrastim PA, SP NEUPOGEN filgrastim-sndz PA, SP ZARXIO
pegfilgrastim PA, SP NEULASTA sargramostim PA, SP LEUKINE
HEMOPHILIA A AGENTS
antihemophilic factor, recombinant PA, SP ADVATE
antihemophilic factor, recombinant PA, SP HELIXATE FS antihemophilic factor, recombinant PA, SP KOGENATE FS
antihemophilic factor/von Willebrand factor complex (human) PA, SP HUMATE-P HEMOPHILIA B AGENTS
factor IX concentrate PA, SP BENEFIX PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH) AGENTS
eculizumab PA, SP SOLIRIS PLATELET AGGREGATION INHIBITORS
aspirin OTC clopidogrel PLAVIX
dipyridamole ext-rel/aspirin AGGRENOX dipyridamole tabs prasugrel PA EFFIENT
31
PLATELET SYNTHESIS INHIBITORS anagrelide AGRYLIN
THROMBOCYTOPENIA AGENTS
eltrombopag PA, SP PROMACTA
MISCELLANEOUS
aminocaproic acid soln AMICAR aminocaproic acid tabs AMICAR cilostazol
deferasirox PA, SP EXJADE pentoxifylline ext-rel
succimer CHEMET
IMMUNOLOGIC AGENTS
ALLERGENIC EXTRACTS ragweed pollen allergen extract PA RAGWITEK timothy grass pollen allergen extract PA GRASTEK
AUTOIMMUNE AGENTS
adalimumab PA, SP HUMIRA
apremilast PA, SP OTEZLA etanercept PA, SP ENBREL
sarilumab PA, SP KEVZARA DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)
auranofin RIDAURA hydroxychloroquine PLAQUENIL
leflunomide ARAVA methotrexate penicillamine CUPRIMINE
penicillamine PA DEPEN TITRA IMMUNE GLOBULINS
cytomegalovirus immune globulin PA, SP CYTOGAM hepatitis B immune globulin PA, SP HEPAGAM B
immune globulin PA, SP CARIMUNE immune globulin PA, SP FLEBOGAMMA
immune globulin PA, SP GAMMAGARD immune globulin PA, SP GAMUNEX-C immune globulin PA, SP HIZENTRA
immune globulin PA, SP PRIVIGEN immune globulin PA, SP WINRHO SDF
immune globulin, gamma (IGG) PA, SP GAMASTAN S/D lymphocyte immune globulin anti-thymocyte G PA ATGAM rabies immune globulin PA, SP HYPERRAB S/D
rho D immune globulin PA, SP HYPERRHO rho D immune globulin RHOGAM
rho D immune globulin PA, SP RHOPHYLAC IMMUNOMODULATORS Interferons
interferon alfa-2b PA, SP INTRON A interferon gamma-1b PA, SP ACTIMMUNE
peginterferon alfa-2a PA, SP PEGASYS
32
Miscellaneous canakinumab PA, SP ILARIS
rilonacept PA, SP ARCALYST IMMUNOSUPPRESSANTS Antimetabolites
azathioprine AZASAN
azathioprine IMURAN mycophenolate mofetil CELLCEPT
Calcineurin Inhibitors
cyclosporine QL SANDIMMUNE cyclosporine, modified NEORAL
tacrolimus QL PROGRAF Rapamycin Derivatives
mycophenolate sodium delayed-rel MYFORTIC sirolimus QL RAPAMUNE
VACCINES
pneumococcal vaccine QL PNEUMOVAX 23
pneumococcal vaccine QL PREVNAR 13 zoster vaccine AL* ZOSTAVAX
zoster vaccine recombinant AL**, QL SHINGRIX AL* Covered for ages 60 years and older AL** Covered for ages 50 years and older
NUTRITIONAL/SUPPLEMENTS
ELECTROLYTES Potassium
potassium chloride ext-rel potassium chloride liquid
VITAMINS AND MINERALS Folic Acid
folic acid Prenatal Vitamins and Supplements
docosahexaenoic acid OTC PRENATAL DHA prenatal vitamins fast dissolving tabs OTC CALNA
prenatal vitamins without A/ferrous fumarate/folic acid 9-0.267 mg OTC PRENATAL FORMULA A-FREE prenatal vitamins without A/iron polysaccharide complex/folic acid 155-1 mg OTC EZFE FORTE prenatal vitamins/carbonyl iron/folic acid tabs PRENATABS RX
prenatal vitamins/carbonyl iron/folic acid tabs PRENATAL PLUS IRON prenatal vitamins/docusate/ferrous fumarate/folic acid 29-1 mg † PRENATAL 19
prenatal vitamins/docusate/ferrous fumarate/folic acid ext-rel 90-1 mg MYNATE 90 PLUS prenatal vitamins/docusate/iron carbonyl/folic acid 90-1 mg † MYNATAL, MYNATAL ADVANCE prenatal vitamins/ferrous bisglycinate chelate/folic acid ATABEX OB, VINATE II
prenatal vitamins/ferrous bisglycinate/folic acid + omega-3 delayed-rel OTC BE WELL ROUNDED PAK prenatal vitamins/ferrous fumarate/folic acid 6.75-0.2 mg OTC PRENATAL TAB
prenatal vitamins/ferrous fumarate/folic acid 13.5-0.4 mg OTC PERRY PRENATAL prenatal vitamins/ferrous fumarate/folic acid 15-1 mg O-CAL PRENATAL
prenatal vitamins/ferrous fumarate/folic acid 27-0.8 mg + DHA 200 mg OTC CENTRUM SPECIALIST PRENATAL PAK, SIMILAC PRENATAL EARLY SHIELD
prenatal vitamins/ferrous fumarate/folic acid 27-1 mg + DHA 300 mg OTC THERANATAL COMPLETE
33
prenatal vitamins/ferrous fumarate/folic acid 27-1 mg † M-VIT, NIVA-PLUS, PRENATAL TAB 27-1 MG, PNV FOLIC ACID + IRON, O-CAL FA, PRENATAL VITAMIN TAB LOW IRON, PNV PRENATAL PLUS
prenatal vitamins/ferrous fumarate/folic acid 27-1 mg OTC, † THERANATAL
prenatal vitamins/ferrous fumarate/folic acid 28-0.975 mg + DHA 200 mg OTC COMPLETE PRENATAL + DHA, PRENATAL + DHA, PRENATAL + DHA WOMENS
prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 223 mg OTC ONE-A-DAY PRENATAL PAK prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 440 mg OTC ONE-A-DAY PRENATAL PAK, GNP
DAILY PRENATAL, RA ONE DAILY PRENATAL, SM ONE DAILY PRENATAL, HM ONE DAILY PRENATAL
prenatal vitamins/ferrous fumarate/folic acid 29-1 mg † CO-NATAL FA
prenatal vitamins/ferrous fumarate/folic acid 60-1 mg VINATE ONE, TRINATAL RX1 prenatal vitamins/ferrous fumarate/folic acid 65-1 mg VITAFOL-OB, MYNATAL-Z, MYNATAL
PLUS
prenatal vitamins/ferrous fumarate/folic acid 75-1 mg NATALVIT prenatal vitamins/ferrous fumarate/folic acid chew tabs 29-1 mg COMPLETENATE, SE-NATAL 19,
PRENATAL 19 prenatal vitamins/ferrous fumarate/folic acid/fish oil OTC PRENATAL OMEGA-3, YOUR LIFE
PRENATAL
prenatal vitamins/ferrous fumarate/folic acid/omega-3 27-0.8-228 mg OTC PRENATAL MULTI + DHA prenatal vitamins/ferrous fumarate/folic acid/omega-3 28-0.8-235 mg OTC PRENATAL FORMULA prenatal vitamins/ferrous fumarate/l-methylfolate/folic acid 27-0.5-0.5 mg † TL FOLATE
prenatal vitamins/ferrous succinate/folic acid OTC NUTRIENTS PRENATAL prenatal vitamins/iron carbonyl/folic acid 29-1 mg † PRENATAL + FE
prenatal vitamins/iron carbonyl/folic acid + DHA OTC BRAINSTRONG PRENATAL prenatal vitamins/l-methylfolate + fish oil/choline OTC PRENATAL DHA PAK MULTI prenatal vitamins/minerals/ferrous fumarate/folic acid/DHA OTC PRENATAL MULTI + DHA
prenatal vitamins/minerals/folic acid/fish oil chew tabs OTC CVS PRENATAL CHEW GUMMY prenatal vitamins/minerals/iron/folic acid 0.1 mg OTC KPN PRENATAL
prenatal vitamins/minerals/iron/folic acid 1 mg MYNATAL prenatal vitamins/selenium/ferrous fumarate/folic acid 9-0.5 mg OTC PRENATAL FORMULA
prenatal vitamins/selenium/ferrous fumarate/folic acid 27-1 mg VINATE M Miscellaneous
acidophilus/pectin OTC arginine OTC ascorbic acid OTC VITAMIN C
b-complex/vitamin c/folic acid caps OTC calcium OTC
calcium/vitamin D OTC cholecalciferol (D3) OTC VITAMIN D coenzyme Q10-vitamin E OTC LIQ-10
electrolyte soln, oral OTC PEDIALYTE ferrous fumarate OTC
ferrous gluconate OTC FERGON ferrous sulfate OTC, QL FEOSOL
inositol niacinate OTC NIACIN FLUSH FREE magnesium chloride ex-rel OTC SLOW-MAG magnesium oxide OTC MAG-OX 400
niacin OTC niacin ext-rel OTC
omega-3 fatty acids OTC FISH OIL omega-3 fatty acids OTC SEA-OMEGA pediatric multivitamin liquid OTC MULTI-DELYN, PEDIAVIT
34
polysaccharide iron complex caps, drops OTC NOVAFERRUM
polysaccharide iron complex/cholecalciferol liq OTC NOVAFERRUM pyridoxine 25 mg, 50 mg OTC VITAMIN B-6 riboflavin tabs 100 mg OTC VITAMIN B-2
tocopherols-tocotrienols OTC AQUA-E ubidecarenone OTC COENZYME Q10
ubiquinol liposomal OTC CYTO-Q vitamin E OTC VITAMIN E zinc OTC
cyanocobalamin inj ergocalciferol (D2)
ferrous fumarate/vitamin C/vitamin B12/folic acid FERROGELS FORTE ferrous fumarate/vitamin C/vitamin B12/folic acid FERROGELS FORTE SOFTGEL fluoride drops, tabs
multivitamins/fluoride drops, tabs multivitamins/fluoride/iron drops, tabs
phytonadione MEPHYTON polysaccharide iron forte
vitamin ADC/fluoride drops vitamin ADC/fluoride/iron drops vitamin B complex/vitamin C/folic acid NEPHROCAPS
zinc sulfate
RESPIRATORY
ANAPHYLAXIS TREATMENT AGENTS epinephrine QL EPIPEN
epinephrine QL EPIPEN JR. ANTICHOLINERGICS
ipratropium soln QL ipratropium, CFC-free aerosol QL ATROVENT HFA
umeclidinium QL INCRUSE ELLIPTA ANTICHOLINERGIC/BETA AGONIST COMBINATIONS Short Acting
ipratropium/albuterol soln QL ipratropium/albuterol, CFC-free aerosol QL COMBIVENT RESPIMAT
Long Acting
tiotropium/olodaterol PA STIOLTO RESPIMAT
umeclidinium/vilanterol QL ANORO ELLIPTA ANTIHISTAMINES, LOW SEDATING
cetirizine OTC ZYRTEC cetirizine
levocetirizine PA ANTIHISTAMINES, NONSEDATING
fexofenadine tabs 180 mg OTC ALLEGRA loratadine caps OTC, PA CLARITIN loratadine tabs OTC CLARITIN
ANTIHISTAMINES, SEDATING
chlorpheniramine OTC clemastine OTC diphenhydramine OTC BENADRYL
carbinoxamine PA
35
clemastine
cyproheptadine diphenhydramine hydroxyzine HCl
hydroxyzine pamoate VISTARIL ANTIHISTAMINE/DECONGESTANT COMBINATIONS
cetirizine/pseudoephedrine ext-rel OTC ZYRTEC-D 12 Hour fexofenadine/pseudoephedrine ext-rel OTC, PA ALLEGRA-D
loratadine/pseudoephedrine ext-rel OTC CLARITIN-D triprolidine/pseudoephedrine liq, syp OTC
acrivastine/pseudoephedrine SEMPREX-D chlorpheniramine/phenylephrine susp promethazine/phenylephrine
ANTITUSSIVES
dextromethorphan syrup 15 mg/5 mL OTC
benzonatate 100 mg. 200 mg QL TESSALON ANTITUSSIVE COMBINATIONS Opioid
codeine/guaifenesin liquid OTC
codeine/guaifenesin/pseudoephedrine OTC codeine/chlorpheniramine/phenylephrine PA CAPCOF codeine/promethazine
codeine/promethazine/phenylephrine hydrocodone/homatropine
Non-opioid
dextromethorphan/guaifenesin ext-rel OTC MUCINEX DM
dextromethorphan/guaifenesin liq, soln, syp OTC dextromethorphan/guaifenesin/pseudoephedrine liq 10 mg/100 mg/30 mg/5 mL OTC dextromethorphan/phenylephrine/chlorpheniramine/acetaminophen OTC ROBITUSSIN COLD/FLU
dextromethorphan/promethazine dextromethorphan/pyrilamine OTC CAPRON DM
BETA AGONISTS Inhalants Short Acting
albuterol soln QL albuterol sulfate, CFC-free aerosol QL, * PROAIR HFA
albuterol sulfate, CFC-free aerosol QL, * VENTOLIN HFA * Both brand and generic VENTOLIN HFA and PROAIR HFA are covered Long Acting Hand-held Active Inhalation
salmeterol xinafoate QL SEREVENT
Oral Agents
albuterol albuterol ext-rel metaproterenol
terbutaline CYSTIC FIBROSIS
aztreonam lysine inhalation soln PA CAYSTON dornase alfa PA, SP PULMOZYME
36
tobramycin inhalation powder PA, SP TOBI PODHALER
tobramycin inhalation soln PA, SP BETHKIS tobramycin inhalation soln PA, SP TOBI
DECONGESTANTS
phenylephrine OTC SUDAFED PE pseudoephedrine OTC SUDAFED
pseudoephedrine ext-rel OTC SUDAFED DECONGESTANT/EXPECTORANT COMBINATIONS
pseudoephedrine/guaifenesin ext-rel OTC MUCINEX D EXPECTORANTS
guaifenesin ext-rel OTC MUCINEX guaifenesin liq OTC DIABETIC TUSSIN
guaifenesin liq, syp, tabs OTC ROBITUSSIN LEUKOTRIENE MODULATORS
montelukast SINGULAIR montelukast granules ST * SINGULAIR
zafirlukast ACCOLATE zileuton ST * ZYFLO
zileuton ext-rel ST * ST * Requires prior use of inhaled corticosteroid therapy MAST CELL STABILIZERS
cromolyn sodium nasal spray OTC NASALCROM cromolyn soln for inhalation QL
MEDICAL SUPPLIES
mask OTC, QL MASK spacer OTC, QL AEROCHAMBER vaporizer OTC, QL VAPORIZER
peak flow meter TRUZONE peak flow meter sodium chloride for inhalation
NASAL ANTIHISTAMINES
azelastine spray QL
NASAL DECONGESTANTS
oxymetazoline spray OTC AFRIN
phenylephrine spray OTC NEO-SYNEPHRINE epinephrine nasal soln 0.1% ADRENALIN 1:1000
NASAL STEROIDS
fluticasone spray OTC FLONASE ALLERGY RELIEF
triamcinolone acetonide spray OTC, PA flunisolide spray QL fluticasone spray QL
PHOSPHODIESTERASE-4 INHIBITORS
roflumilast PA DALIRESP
RESPIRATORY SYNCYTIAL VIRUS
palivizumab PA, SP SYNAGIS
37
SEVERE ASTHMA AGENTS omalizumab PA, SP XOLAIR
STEROID/BETA AGONIST COMBINATIONS
budesonide/formoterol AL*, QL SYMBICORT
fluticasone/salmeterol QL AIRDUO RESPICLICK fluticasone/salmeterol QL WIXELA INHUB
* Covered for ages under 12 years old STEROID INHALANTS
beclomethasone breath-activated aerosol QL QVAR REDIHALER budesonide inhalation susp AL PULMICORT RESPULES
fluticasone furoate QL ARNUITY ELLIPTA fluticasone propionate, CFC-free aerosol 44 mcg, 110 mcg AL*, QL FLOVENT HFA mometasone QL ASMANEX TWISTHALER
mometasone, CFC-free aerosol QL ASMANEX HFA AL* Covered for ages 11 years old and under XANTHINES
aminophylline
theophylline elixir ELIXOPHYLLIN theophylline ext-rel caps THEO-24
theophylline ext-rel tabs theophylline liquid
XANTHINE COMBINATIONS
dyphylline/guaifenesin PA
MISCELLANEOUS
sodium chloride soln OTC OCEAN
acetylcysteine caffeine citrate soln AL*, QL ephedrine HCl OTC EPHEDRINE HCL
ipratropium nasal spray AL* Covered for ages 1 year old and under
TOPICAL
DERMATOLOGY Acne Oral
isotretinoin PA
Topical
adapalene gel 0.1% OTC, AL, QL DIFFERIN OTC
benzoyl peroxide OTC, AL adapalene AL, PA DIFFERIN
benzoyl peroxide AL clindamycin gel, lotion AL, QL, ST* CLEOCIN T clindamycin soln AL
clindamycin/benzoyl peroxide BENZACLIN erythromycin soln AL
sulfacetamide lotion 10% KLARON sulfacetamide/sulfur crm, gel, lotion, pads tretinoin crm 0.025%, 0.05%, 0.1% AL, ST** RETIN-A
tretinoin gel 0.01%, 0.025% AL, ST** RETIN-A
38
ST * Requires prior use of clindamycin soln or erythromycin soln ST ** Requires prior use of DIFFERIN OTC Actinic Keratosis
fluorouracil EFUDEX
fluorouracil soln Antibiotics
bacitracin/polymyxin B OTC POLYSPORIN neomycin/bacitracin/polymyxin B OTC NEOSPORIN
neomycin/bacitracin/polymyxin/pramoxine OTC NEOSPORIN+PN gentamicin mupirocin
polymyxin B/bacitracin POLYSPORIN silver sulfadiazine SILVADENE
Antifungals
clotrimazole 1% OTC
clotrimazole oint OTC, PA ALEVAZOL miconazole OTC FUNGOID TINCTURE
miconazole OTC MICATIN terbinafine OTC LAMISIL AT tolnaftate OTC TINACTIN
ciclopirox LOPROX ciclopirox topical soln 8% PENLAC
clotrimazole econazole ketoconazole crm, shampoo 2%
nystatin Anti-infective/Anti-inflammatory Combinations
neomycin/polymyxin B/bacitracin/hydrocortisone oint CORTISPORIN OINTMENT Antipsoriatics Topical
calcipotriene crm, oint, soln 0.005% DOVONEX
tazarotene crm 0.05%, gel 0.05%, 0.1% TAZORAC tazarotene crm 0.1% TAZORAC
Antiseborrheics
coal tar shampoo OTC NEUTROGENA
salicylic acid/sulfur shampoo OTC SEBULEX selenium sulfide shampoo 1% OTC SELSUN BLUE ketoconazole shampoo 2% NIZORAL SHAMPOO
sulfacetamide sodium Atopic Dermatitis Topical
pimecrolimus PA ELIDEL
tacrolimus PA PROTOPIC Corticosteroids Low Potency
hydrocortisone crm, gel, lotion, oint, soln 1% OTC CORTIZONE-10 hydrocortisone oint 0.5% OTC
hydrocortisone/aloe vera crm 0.5%, 1% OTC alclometasone crm, oint 0.05% QL
39
desonide crm, oint 0.05% QL DESOWEN
desonide lotion 0.05% PA, QL DESOWEN fluocinolone acetonide soln 0.01% hydrocortisone crm, lotion, oint 2.5%
Medium Potency
betamethasone valerate crm, lotion, oint 0.1%
desoximetasone crm 0.05% TOPICORT LP fluocinolone acetonide crm, oint 0.025%
fluocinolone acetonide oil 0.01% DERMA-SMOOTHE-FS flurandrenolide tape CORDRAN
fluticasone propionate crm 0.05%, oint 0.005% CUTIVATE hydrocortisone butyrate crm, oint, soln 0.1% LOCOID hydrocortisone valerate crm, oint 0.2%
mometasone crm, oint 0.1% QL ELOCON mometasone lotion 0.1% ELOCON
prednicarbate crm, oint 0.1% PA triamcinolone acetonide crm, lotion, oint 0.025% triamcinolone acetonide crm, lotion, oint 0.1%
High Potency
amcinonide crm, lotion, oint 0.1%
betamethasone dipropionate augmented crm 0.05% DIPROLENE AF betamethasone dipropionate augmented lotion 0.05% QL DIPROLENE
betamethasone dipropionate crm, lotion, oint 0.05% QL desoximetasone crm 0.25% TOPICORT diflorasone diacetate crm 0.05%
diflorasone diacetate emollient crm 0.05% fluocinonide crm 0.05% QL
fluocinonide gel, oint 0.05% fluocinonide soln 0.05% QL
triamcinolone acetonide crm, oint 0.5% Very High Potency
betamethasone dipropionate augmented gel, oint 0.05% QL DIPROLENE clobetasol propionate crm, gel, oint, soln 0.05% TEMOVATE clobetasol propionate foam 0.05% OLUX
clobetasol propionate shampoo 0.05% CLOBEX diflorasone diacetate oint 0.05%
Emollients
emollient lotion OTC DML
mineral oil-hydrophilic petrolatum OTC PETROLATUM ammonium lactate 12% LAC-HYDRIN
Local Analgesics
lidocaine patch 4% OTC, QL LIDOCARE
lidocaine patch 5% PA LIDODERM Local Anesthetics
lidocaine crm 4% OTC LMX 4 lidocaine 5% crm lidocaine/prilocaine
Rosacea
metronidazole crm 0.75% METROCREAM metronidazole gel 0.75% metronidazole gel 1% METROGEL
40
metronidazole lotion 0.75% METROLOTION
sulfacetamide/sulfur Scabicides and Pediculicides
permethrin OTC pyrethrins/piperonyl butoxide OTC RID SHAMPOO crotamiton crm EURAX
crotamiton lotion EURAX malathion OVIDE
permethrin spinosad NATROBA
Wound Care Agents
becaplermin PA REGRANEX
Miscellaneous Skin and Mucous Membrane
aluminum hydroxide OTC DERMAGRAN
calamine lotion OTC capsaicin OTC ZOSTRIX capsaicin/menthol/methyl salicylate OTC ZIKS
dimethicone 1% crm OTC 4-N-1 CREAM diphenhydramine/zinc acetate OTC BENADRYL
docosanol OTC ABREVA lidocaine OTC BACTINE
nail scrub OTC NAIL SCRUB LIQ W/BRUSH povidone-iodine OTC BETADINE salicylic acid OTC
sodium chloride soln OTC zinc acetate OTC DERMAFIX
acyclovir crm, oint 5% PA ZOVIRAX bexarotene gel TARGRETIN collagen/lidocaine/aloe vera/vit E REGENECARE
collagenase PA, QL SANTYL imiquimod PA ALDARA
mafenide SULFAMYLON podofilox soln CONDYLOX trypsin/balsam/castor oil
MOUTH/THROAT/DENTAL AGENTS Anesthetics - Topical Oral
lidocaine viscous Steroids - Mouth/Throat
triamcinolone paste Miscellaneous
chlorhexidine PERIDEX sodium fluoride PREVIDENT 5000
OPHTHALMIC Antiallergics
ketotifen OTC, QL azelastine PA cromolyn sodium
phenylephrine Antifungals
natamycin NATACYN
41
Anti-infectives
bacitracin ciprofloxacin ophth oint CILOXAN ciprofloxacin ophth soln CILOXAN
erythromycin gentamicin
levofloxacin 0.5% moxifloxacin PA VIGAMOX
neomycin/polymyxin B/gramicidin ofloxacin OCUFLOX polymyxin B/bacitracin
polymyxin B/trimethoprim POLYTRIM sulfacetamide soln 10% BLEPH-10
tobramycin TOBREX tobramycin oint TOBREX tobramycin soln TOBREX
Anti-infective/Anti-inflammatory Combinations
gentamicin/prednisolone acetate PRED-G
neomycin/polymyxin B/bacitracin/hydrocortisone oint neomycin/polymyxin B/dexamethasone MAXITROL
neomycin/polymyxin B/hydrocortisone susp sulfacetamide/prednisolone phosphate 10%/0.25%
tobramycin/dexamethasone oint 0.3%/0.1% TOBRADEX tobramycin/dexamethasone susp 0.3%/0.05% TOBRADEX ST tobramycin/dexamethasone susp 0.3%/0.1% TOBRADEX
Anti-inflammatories Nonsteroidal
bromfenac sodium PA diclofenac sodium flurbiprofen
ketorolac 0.4% ACULAR LS ketorolac 0.5% ACULAR
Steroidal
dexamethasone MAXIDEX
dexamethasone sodium phosphate fluorometholone 0.1% susp FML LIQUIFILM
fluorometholone 0.25% FML FORTE prednisolone acetate 0.12% PRED MILD prednisolone acetate 1% PRED FORTE
prednisolone phosphate 1% Antivirals
ganciclovir PA ZIRGAN trifluridine
Beta-blockers Nonselective
carteolol levobunolol timolol hemihydrate BETIMOL
timolol maleate TIMOPTIC timolol maleate gel TIMOPTIC-XE
42
Selective betaxolol 0.25% BETOPTIC S
betaxolol 0.5% Carbonic Anhydrase Inhibitors Topical
brinzolamide AZOPT
dorzolamide TRUSOPT Carbonic Anhydrase Inhibitor/Beta-blocker Combinations
dorzolamide/timolol maleate COSOPT Dry Eye Disease
lifitegrast ST* XIIDRA ST * Requires prior use of OTC lubricant and ointment Immunomodulators
cyclosporine RESTASIS
Mydriatics
atropine
cyclopentolate CYCLOGYL cyclopentolate/phenylephrine CYCLOMYDRIL
homatropine tropicamide
Parasympathomimetics
pilocarpine ISOPTO CARPINE Prostaglandins
latanoprost XALATAN Sympathomimetics
brimonidine 0.15% ALPHAGAN P
Sympathomimetic/Beta-blocker Combinations
brimonidine/timolol COMBIGAN
Miscellaneous
artificial tears OTC ARTIFICIAL TEARS
carboxymethylcellulose sodium OTC REFRESH sodium chloride OTC MURO-128 echothiophate iodide PHOSPHOLINE IODIDE
naphazoline 0.1% proparacaine 0.5%
tetracaine 0.5% OTIC Anti-infectives
acetic acid ciprofloxacin otic CETRAXAL
ofloxacin otic Anti-infective/Anti-inflammatory Combinations
acetic acid/hydrocortisone neomycin/polymyxin B/hydrocortisone CORTISPORIN OTIC
43
Miscellaneous carbamide peroxide 6.5% OTC DEBROX
fluocinolone acetonide DERMOTIC VAGINAL
acetic acid soln OTC
44
NON-DISCRIMINATION STATEMENT
45
46
INDEX
4 4-N-1 CREAM, 40
A abacavir, 9 abacavir/dolutegravir/lamivudine, 8 abacavir/lamivudine, 8 abacavir/lamivudine/zidovudine, 8 abaloparatide, 23 ABILIFY, 18 ABILIFY MAINTENA, 18 ABREVA, 40 ABSTRAL, 6 acamprosate calcium, 20 acarbose, 21 ACCOLATE, 36 ACCUPRIL, 12 ACCURETIC, 12 acebutolol, 14 acetaminophen, 6 acetazolamide, 15 acetazolamide ext-rel, 15 acetic acid, 42 acetic acid soln, 43 acetic acid/hydrocortisone, 42 acetohydroxamic acid, 30 acetylcysteine, 37 acidophilus/pectin, 33 acrivastine/pseudoephedrine, 35 ACTIGALL, 27 ACTIMMUNE, 31 ACTIQ, 6 ACTIVELLA, 25 ACTOPLUS MET, 22 ACTOPLUS MET XR, 22 ACTOS, 22 ACULAR, 41 ACULAR LS, 41 acyclovir caps, susp, tabs, 10 acyclovir crm, oint 5%, 40 ADALAT CC, 14 adalimumab, 31 adapalene, 37 adapalene gel 0.1%, 37 ADDERALL, 19 ADDERALL XR, 19 adefovir dipivoxil, 10 ADEMPAS, 16 ADMELOG, 22 ADMELOG SOLOSTAR, 22 ADRENALIN 1
1000, 36 ADVATE, 30 ADVIL, 6 AEROCHAMBER, 36 afatinib, 11 AFINITOR, 11 AFINITOR DISPERZ, 12 AFREZZA, 22 AFRIN, 36 AGGRENOX, 30 AGRYLIN, 31
AIRDUO RESPICLICK, 37 albendazole, 10 ALBENZA, 10 albuterol, 35 albuterol ext-rel, 35 albuterol soln, 35 albuterol sulfate, CFC-free aerosol, 35 alclometasone crm, oint 0.05%, 38 alcohol swabs, 23 ALDACTAZIDE, 15 ALDACTONE, 13 ALDARA, 40 aldesleukin, 12 alendronate soln, 23 alendronate tabs, 23 ALEVAZOL, 38 ALEVE, 6 alfuzosin ext-rel, 29 ALINIA, 10 ALKERAN, 11 ALLEGRA, 34 ALLEGRA-D, 35 allopurinol, 6 almotriptan, 19 alogliptin, 21 alogliptin/metformin, 21 alogliptin/pioglitazone, 21 ALORA, 25 alosetron, 28 ALPHAGAN P, 42 alprazolam, 16 alprazolam ext-rel, 16 ALTACE, 12 alumina/magnesia, 26 alumina/magnesia/simethicone, 26 aluminum hydroxide, 26, 40 amantadine, 18 AMARYL, 22 AMBIEN, 19 ambrisentan, 16 amcinonide crm, lotion, oint 0.1%, 39 AMERGE, 19 AMETHIA LO, 24 AMICAR, 31 amiloride, 15 amiloride/hydrochlorothiazide, 15 aminocaproic acid soln, 31 aminocaproic acid tabs, 31 aminophylline, 37 amiodarone, 13 AMITIZA, 28 amitriptyline, 17 amlodipine, 14 amlodipine/benazepril, 12 amlodipine/olmesartan, 13 amlodipine/valsartan, 13 amlodipine/valsartan/hydrochlorothiazide, 13 ammonium lactate 12%, 39 amoxapine, 18 amoxicillin, 8 amoxicillin/clavulanate 200 mg/5 mL, 400 mg/5 mL, 8 amoxicillin/clavulanate chew tabs, tabs, 8 amphetamine/dextroamphetamine mixed salts, 19
47
amphetamine/dextroamphetamine mixed salts ext-rel, 19 ampicillin, 8 AMPYRA, 20 ANADROL-50, 21 ANAFRANIL, 16 anagrelide, 31 ANASPAZ, 27 anastrozole, 11 ANDROGEL, 21 ANORO ELLIPTA, 34 ANTABUSE, 20 antihemophilic factor, recombinant, 30 antihemophilic factor/von Willebrand factor complex (human), 30 ANUSOL-HC 2.5%, 29 apixaban, 30 APLENZIN, 18 apremilast, 31 aprepitant caps, 27 aprepitant susp, 27 APRI, 23 APRISO, 27 APTIVUS, 9 AQUA-E, 34 ARANESP, 30 ARAVA, 31 ARCALYST, 32 arginine, 33 ARICEPT, 17 ARIMIDEX, 11 aripiprazole, 18 aripiprazole ext-rel inj, 18 aripiprazole lauroxil ext-rel inj, 18 ARISTADA, 18 ARISTADA INITIO, 18 ARIXTRA, 30 armodafinil, 20 ARMOUR THYROID, 26 ARNUITY ELLIPTA, 37 AROMASIN, 11 artemether/lumefantrine, 8 ARTHROTEC, 6 artificial tears, 42 ARTIFICIAL TEARS, 42 ASACOL HD, 27 ascorbic acid, 33 asenapine, 18 ASMANEX HFA, 37 ASMANEX TWISTHALER, 37 aspirin, 30 ATABEX OB, 32 ATACAND, 13 ATACAND HCT, 13 atazanavir caps, 9 atazanavir powder, 9 atazanavir/cobicistat, 8 atenolol, 14 atenolol/chlorthalidone, 14 ATGAM, 31 ATIVAN, 16 atomoxetine, 19 atorvastatin 10 mg, 20 mg, 40 mg, 14 atorvastatin 80 mg, 14 atovaquone, 10 atovaquone/proguanil, 8 atropine, 42 ATROVENT HFA, 34
AUBAGIO, 20 AUGMENTIN, 8 auranofin, 31 AVALIDE, 13 AVAPRO, 13 AVELOX, 8 AVODART, 29 AVONEX, 20 axitinib, 11 AYGESTIN, 26 AZASAN, 32 azathioprine, 32 azelastine, 40 azelastine spray, 36 azithromycin, 7 AZOPT, 42 AZOR, 13 aztreonam lysine inhalation soln, 35 AZULFIDINE, 27 AZULFIDINE EN-TABS, 27
B bacitracin, 41 bacitracin/polymyxin B, 38 baclofen 10 mg, 20 mg, 20 BACTINE, 40 balsalazide, 27 BANZEL, 17 BARACLUDE, 10 BASAGLAR, 22 b-complex/vitamin c/folic acid caps, 33 BE WELL ROUNDED PAK, 32 becaplermin, 40 beclomethasone breath-activated aerosol, 37 bedaquiline, 9 BENADRYL, 34, 40 benazepril, 12 benazepril/hydrochlorothiazide, 12 BENEFIX, 30 BENICAR, 13 BENICAR HCT, 13 BENTYL, 27 BENZACLIN, 37 benzonatate 100 mg. 200 mg, 35 benzoyl peroxide, 37 benztropine, 18 BETADINE, 40 betamethasone dipropionate augmented crm 0.05%, 39 betamethasone dipropionate augmented gel, oint 0.05%, 39 betamethasone dipropionate augmented lotion 0.05%, 39 betamethasone dipropionate crm, lotion, oint 0.05%, 39 betamethasone valerate crm, lotion, oint 0.1%, 39 BETAPACE, 13 BETAPACE AF, 13 betaxolol, 14 betaxolol 0.25%, 41 betaxolol 0.5%, 42 bethanechol, 30 BETHKIS, 36 BETIMOL, 41 BETOPTIC S, 41 bexarotene caps, 12 bexarotene gel, 40 bicalutamide, 11 bictegravir/emtricitabine/tenofovir alafenamide, 8 BIDIL, 15
48
BIKTARVY, 8 BILTRICIDE, 10 bisacodyl, 28 bisacodyl enema, 28 bismuth subsalicylate, 26 bisoprolol, 14 bisoprolol/hydrochlorothiazide, 14 BLEPH-10, 41 blood glucose monitoring kits, 23 blood glucose test strips, 23 BONIVA, 23 bosentan, 16 BOSULIF, 11 bosutinib, 11 BRAINSTRONG PRENATAL, 33 brimonidine 0.15%, 42 brimonidine/timolol, 42 brinzolamide, 42 bromfenac sodium, 41 bromocriptine, 18 budesonide delayed-rel caps, 27 budesonide inhalation susp, 37 budesonide/formoterol, 37 bumetanide, 15 BUNAVAIL, 20 BUPHENYL, 26 buprenorphine ext-rel inj, 20 buprenorphine sublingual, 20 buprenorphine/naloxone buccal film, 20 buprenorphine/naloxone sublingual film, 20 buprenorphine/naloxone sublingual tabs, 20 bupropion, 18 bupropion ext-rel, 18, 21 buspirone, 16 busulfan, 11 butalbital/acetaminophen 50/325 mg, 7 butalbital/acetaminophen/caffeine 50/325/40 mg, 7 butalbital/acetaminophen/caffeine/codeine 50/325/40/30 mg, 6 butalbital/aspirin/caffeine, 7 butorphanol nasal spray, 6
C cabergoline, 26 cabozantinib, 11 CAFERGOT, 19 caffeine citrate soln, 37 calamine lotion, 40 CALAN SR, 15 calcipotriene crm, oint, soln 0.005%, 38 calcitonin-salmon spray, 23 calcitriol (1,25-D3), 25 calcium, 33 calcium acetate, 25 calcium carbonate, 26 calcium/vitamin D, 33 CALNA, 32 CAMRESE LO, 24 canakinumab, 32 CANASA, 28 candesartan, 13 candesartan/hydrochlorothiazide, 13 CAPCOF, 35 capecitabine, 11 CAPRELSA, 12 CAPRON DM, 35 capsaicin, 40
capsaicin/menthol/methyl salicylate, 40 captopril, 12 captopril/hydrochlorothiazide, 12 CARAFATE, 29 carbamazepine, 16 carbamazepine ext-rel, 16, 20 carbamide peroxide 6.5%, 42 CARBATROL, 16 carbidopa/levodopa, 18 carbidopa/levodopa ext-rel, 18 carbidopa/levodopa/entacapone, 18 carbinoxamine, 34 carboxymethylcellulose sodium, 42 CARDIZEM, 15 CARDIZEM CD, 15 CARDIZEM LA, 15 CARDURA, 13, 29 CARDURA XL, 29 CARIMUNE, 31 carisoprodol/aspirin, 20 carisoprodol/aspirin/codeine, 20 CARNITOR, 23 carteolol, 41 carvedilol, 14 CASODEX, 11 CATAPRES, 12 CATAPRES TTS, 12 CAYSTON, 35 CAZIANT, 24 cefaclor, 7 CEFACLOR ER, 7 cefaclor ext-rel, 7 cefadroxil, 7 cefdinir, 7 cefpodoxime, 7 cefprozil, 7 cefuroxime axetil, 7 CELEBREX, 6 celecoxib, 6 CELEXA, 17 CELLCEPT, 32 CELONTIN, 17 CENTRUM SPECIALIST PRENATAL PAK, 32 cephalexin caps 250 mg, 500 mg, 7 cephalexin caps 750 mg, 7 cephalexin susp, 7 cetirizine, 34 cetirizine/pseudoephedrine ext-rel, 35 CETRAXAL, 42 cevimeline, 29 CHANTIX, 21 CHEMET, 31 chlorambucil, 11 chlordiazepoxide, 16 chlordiazepoxide/amitriptyline, 18 chlorhexidine, 40 chloroquine, 8 chlorothiazide, 15 chlorpheniramine, 34 chlorpheniramine/phenylephrine susp, 35 chlorpromazine, 19 chlorthalidone, 15 chlorzoxazone 500 mg, 20 CHOLBAM, 29 cholecalciferol (D3), 33 cholestyramine, 13
49
cholic acid, 29 choline fenofibrate delayed-rel 45 mg, 13 ciclopirox, 38 ciclopirox topical soln 8%, 38 cilostazol, 31 CILOXAN, 41 CIMDUO, 9 cimetidine, 27 cinacalcet, 23 CIPRO, 8 ciprofloxacin, 8 ciprofloxacin ophth oint, 41 ciprofloxacin ophth soln, 41 ciprofloxacin otic, 42 citalopram, 17 CITRUCEL, 28 clarithromycin, 7 clarithromycin ext-rel, 7 CLARITIN, 34 CLARITIN-D, 35 clemastine, 34 CLEOCIN, 10, 29 CLEOCIN T, 37 CLIMARA, 25 clindamycin, 10, 29 clindamycin crm, 29 clindamycin gel, lotion, 37 clindamycin soln, 37 clindamycin vaginal supp, 29 clindamycin/benzoyl peroxide, 37 CLINDESSE, 29 clobazam, 17 clobetasol propionate crm, gel, oint, soln 0.05%, 39 clobetasol propionate foam 0.05%, 39 clobetasol propionate shampoo 0.05%, 39 CLOBEX, 39 clomipramine, 16 clonazepam tabs, 16 clonidine, 12 clonidine ext-rel, 19 clonidine transdermal, 12 clopidogrel, 30 clorazepate, 16 clotrimazole, 29, 38 clotrimazole 1%, 38 clotrimazole oint, 38 clotrimazole troches, 8 clozapine, 18 CLOZARIL, 18 coal tar shampoo, 38 COARTEM, 8 cobicistat, 8 codeine sulfate, 6 codeine/acetaminophen, 6 codeine/chlorpheniramine/phenylephrine, 35 codeine/guaifenesin liquid, 35 codeine/guaifenesin/pseudoephedrine, 35 codeine/promethazine, 35 codeine/promethazine/phenylephrine, 35 COENZYME Q10, 34 coenzyme Q10-vitamin E, 33 COLACE, 28 colchicine tabs, 6 colchicine/probenecid, 6 COLCRYS, 6 COLESTID, 13
colestipol packets, tabs, 13 collagen/lidocaine/aloe vera/vit E, 40 collagenase, 40 COLYTE, 28 COLYTE FLAVORED, 28 COMBIGAN, 42 COMBIVENT RESPIMAT, 34 COMBIVIR, 9 COMETRIQ, 11 COMPLERA, 9 COMPLETE PRENATAL + DHA, 33 COMPLETENATE, 33 COMTAN, 18 CO-NATAL FA, 33 CONCERTA, 19 condoms, male, 24 CONDYLOX, 40 conjugated estrogens/bazedoxifene, 25 COPAXONE, 20 CORDRAN, 39 COREG, 14 CORGARD, 14 CORTEF, 25 CORTIFOAM, 28 cortisone acetate, 25 CORTISPORIN OINTMENT, 38 CORTISPORIN OTIC, 42 CORTIZONE-10, 38 COSOPT, 42 COUMADIN, 30 COZAAR, 13 CREON, 28 CRESTOR, 14 CRINONE, 26 CRIXIVAN, 9 cromolyn sodium, 29, 40 cromolyn sodium nasal spray, 36 cromolyn soln for inhalation, 36 crotamiton crm, 40 crotamiton lotion, 40 CUPRIMINE, 31 CUTIVATE, 39 CUVPOSA, 29 CVS PRENATAL CHEW GUMMY, 33 cyanocobalamin inj, 34 cyclobenzaprine 5 mg, 10 mg, 20 CYCLOGYL, 42 CYCLOMYDRIL, 42 cyclopentolate, 42 cyclopentolate/phenylephrine, 42 cyclophosphamide caps, 11 cycloserine, 10 cyclosporine, 32, 42 cyclosporine, modified, 32 CYMBALTA, 17 cyproheptadine, 35 CYTOGAM, 31 cytomegalovirus immune globulin, 31 CYTOMEL, 26 CYTO-Q, 34 CYTOTEC, 28 CYTRA-2, 30 CYTRA-3, 30 CYTRA-K, 30
50
D dabrafenib, 11 dalfampridine ext-rel, 20 DALIRESP, 36 dalteparin, 30 danazol, 24 DANTRIUM, 20 dantrolene, 20 dapsone, 10 darbepoetin alfa, 30 darunavir, 9 darunavir/cobicistat, 8 dasatinib, 11 DAYPRO, 6 DDAVP, 26 DEBROX, 42 deferasirox, 31 DELATESTRYL, 21 DELZICOL, 27 DEMADEX, 15 DEMSER, 16 denosumab, 23 DEPAKENE, 17 DEPAKOTE, 17 DEPAKOTE ER, 17 DEPEN TITRA, 31 DEPO-PROVERA, 24 DEPO-TESTOSTERONE, 21 DERMAFIX, 40 DERMAGRAN, 40 DERMA-SMOOTHE-FS, 39 DERMOTIC, 43 DESCOVY, 9 desipramine, 18 desmopressin spray, 26 desmopressin spray, tabs, 26 desogestrel/EE, 24 desogestrel/EE 0.15/30, 23 desonide crm, oint 0.05%, 38 desonide lotion 0.05%, 38 DESOWEN, 38 desoximetasone crm 0.05%, 39 desoximetasone crm 0.25%, 39 DETROL, 29 DETROL LA, 29 dexamethasone, 25, 41 dexamethasone concentrate 1 mg/mL, 25 DEXAMETHASONE INTENSOL, 25 dexamethasone sodium phosphate, 41 DEXEDRINE SPANSULE, 19 dexmethylphenidate, 19 dexmethylphenidate ext-rel, 19 dextroamphetamine 5 mg, 10 mg, 19 dextroamphetamine ext-rel, 19 dextromethorphan syrup 15 mg/5 mL, 35 dextromethorphan/guaifenesin ext-rel, 35 dextromethorphan/guaifenesin liq, soln, syp, 35 dextromethorphan/guaifenesin/pseudoephedrine liq 10 mg/100 mg/30
mg/5 mL, 35 dextromethorphan/phenylephrine/chlorpheniramine/acetaminophen, 35 dextromethorphan/promethazine, 35 dextromethorphan/pyrilamine, 35 dextromethorphan/quinidine, 21 dextrose/fructose/phosphoric acid, 27 DIABETIC TUSSIN, 36 DIASTAT, 17
diazepam, 16 diazepam rectal gel, 17 diazoxide, 25 diclofenac potassium, 6 diclofenac sodium, 41 diclofenac sodium delayed-rel, 6 diclofenac sodium delayed-rel/misoprostol, 6 diclofenac sodium ext-rel, 6 diclofenac sodium gel 1%, 6 dicloxacillin, 8 dicyclomine, 27 didanosine delayed-rel, 9 didanosine soln, 9 DIFFERIN, 37 DIFFERIN OTC, 37 diflorasone diacetate crm 0.05%, 39 diflorasone diacetate emollient crm 0.05%, 39 diflorasone diacetate oint 0.05%, 39 DIFLUCAN, 8 diflunisal, 6 digoxin, 15 digoxin ped elixir, 15 dihydroergotamine spray, 19 DILANTIN, 17 DILANTIN INFATABS, 17 DILAUDID, 6 DILAUDID-5, 6 diltiazem, 15 diltiazem ext-rel, 15 diltiazem ext-rel, except 120 mg, 15 dimenhydrinate, 27 dimethicone 1% crm, 40 dimethyl fumarate delayed-rel, 20 DIOVAN, 13 DIOVAN HCT, 13 DIPENTUM, 27 diphenhydramine, 34, 35 diphenhydramine/zinc acetate, 40 diphenoxylate/atropine, 26 DIPROLENE, 39 DIPROLENE AF, 39 dipyridamole ext-rel/aspirin, 30 dipyridamole tabs, 30 disopyramide, 13 disopyramide ext-rel, 13 disulfiram, 20 DITROPAN XL, 29 divalproex sodium delayed-rel, 17 divalproex sodium ext-rel, 17 DML, 39 docosahexaenoic acid, 32 docosanol, 40 docusate calcium, 28 docusate sodium, 28 dofetilide, 13 dolutegravir, 9 dolutegravir/rilpivirine, 8 donepezil, 17 dornase alfa, 35 dorzolamide, 42 dorzolamide/timolol maleate, 42 DOVONEX, 38 doxazosin, 13, 29 doxazosin ext-rel, 29 doxepin, 18 doxercalciferol, 25
51
doxycycline calcium syrup, 8 doxycycline hyclate caps 50 mg, 100 mg, 8 doxycycline hyclate tabs 20 mg, 100 mg, 8 doxycycline monohydrate, 8 DRAMAMINE, 27 dronabinol, 27 dronedarone, 13 drospirenone/EE 3/30, 23 DROXIA, 12 DUAVEE, 25 DUETACT, 22 DULCOLAX, 28 duloxetine delayed-rel 20 mg, 30 mg, 60 mg, 17 DURAGESIC, 6 dutasteride, 29 dutasteride/tamsulosin, 29 DYAZIDE, 15 dyphylline/guaifenesin, 37
E E.E.S., 7 echothiophate iodide, 42 econazole, 38 eculizumab, 30 EDURANT, 9 EE/norethindrone acetate, 25 EE/norethindrone acetate 0.5 mg/2.5 mcg, 25 efavirenz, 9 efavirenz/lamivudine/tenofovir disoproxil fumarate, 8 EFFEXOR XR, 17 EFFIENT, 30 EFUDEX, 38 electrolyte soln, oral, 33 ELIDEL, 38 ELIQUIS, 30 ELIXOPHYLLIN, 37 ELLA, 24 ELMIRON, 30 ELOCON, 39 eltrombopag, 31 elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide, 9 elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate, 9 EMCYT, 11 EMEND, 27 EMETROL, 27 emollient lotion, 39 emtricitabine, 9 emtricitabine/rilpivirine/tenofovir alafenamide, 9 emtricitabine/rilpivirine/tenofovir disoproxil fumarate, 9 emtricitabine/tenofovir alafenamide, 9 emtricitabine/tenofovir disoproxil fumarate, 9 EMTRIVA, 9 enalapril, 12 enalapril/hydrochlorothiazide, 12 ENBREL, 31 ENDOMETRIN, 26 enfuvirtide, 9 enoxaparin, 30 entacapone, 18 entecavir soln, 10 entecavir tabs, 10 ENTOCORT EC, 27 EPCLUSA, 10 ephedrine HCl, 37 EPHEDRINE HCL, 37 epinephrine, 34
epinephrine nasal soln 0.1%, 36 EPIPEN, 34 EPIPEN JR., 34 EPIVIR, 9 EPIVIR-HBV, 10 eplerenone, 13 epoetin alfa, 30 EPOGEN, 30 epoprostenol, 16 epoprostenol sodium, 16 eprosartan, 13 EPZICOM, 8 EQUETRO, 20 ergocalciferol (D2), 34 ergotamine/caffeine, 19 erlotinib, 11 ertugliflozin, 22 ertugliflozin/metformin, 22 ERYPED, 7 ERY-TAB, 7 ERYTHROCIN, 7 erythromycin, 41 erythromycin delayed-rel, 7 erythromycin ethylsuccinate, 7 erythromycin ethylsuccinate 200 mg/5 mL, 7 erythromycin soln, 37 erythromycin stearate, 7 escitalopram soln, 17 escitalopram tabs, 17 ESGIC, 7 esomeprazole magnesium delayed-rel, 28 estazolam, 19 ESTRACE, 24 ESTRACE CREAM, 25 estradiol, 24, 25 estradiol vaginal crm, 25 estradiol vaginal tabs, 25 estradiol/norethindrone acetate, 25 estradiol/norgestimate, 25 estramustine, 11 estrogens, esterified, 24 etanercept, 31 ethambutol, 10 ethionamide, 10 ethosuximide, 17 ethotoin, 17 ethynodiol diacetate/EE 1/35, 23 ethynodiol diacetate/EE 1/50, 23 etodolac, 6 etodolac ext-rel, 6 etonogestrel implant, 24 etonogestrel/EE ring, 24 etoposide, 12 etravirine, 9 EURAX, 40 everolimus, 11 everolimus tablets for oral suspension, 12 EVISTA, 26 evolocumab, 14 EVOTAZ, 8 EVOXAC, 29 exemestane, 11 EXFORGE, 13 EXFORGE HCT, 13 EXJADE, 31 EXTAVIA, 20
52
ezetimibe, 13 EZFE FORTE, 32
F factor IX concentrate, 30 famciclovir, 10 famotidine, 27 FANAPT, 18 FARESTON, 11 febuxostat, 6 felbamate, 17 FELBATOL, 17 FELDENE, 6 felodipine ext-rel, 14 FEMARA, 11 FEMHRT, 25 fenofibrate caps 150 mg, 13 fenofibrate tabs 145 mg, 14 fenofibrate tabs 48 mg, 14 fenofibrate tabs 54 mg, 160 mg, 14 fenoprofen 600 mg, 6 fentanyl citrate buccal, 6 fentanyl lozenge, 6 fentanyl sublingual, 6 fentanyl transdermal, 6 FENTORA, 6 FEOSOL, 33 FERGON, 33 FERROGELS FORTE, 34 FERROGELS FORTE SOFTGEL, 34 ferrous fumarate, 33 ferrous fumarate/vitamin C/vitamin B12/folic acid, 34 ferrous gluconate, 33 ferrous sulfate, 33 fexofenadine tabs 180 mg, 34 fexofenadine/pseudoephedrine ext-rel, 35 filgrastim, 30 filgrastim-sndz, 30 finasteride 5 mg, 29 fingolimod, 20 FIORINAL, 7 FIRST-PROGESTERONE VGS, 26 FIRVANQ, 11 FISH OIL, 33 FLAGYL, 10 FLEBOGAMMA, 31 flecainide, 13 FLEET, 28 FLEET MINERAL OIL ENEMA, 28 FLOLAN, 16 FLOMAX, 29 FLONASE ALLERGY RELIEF, 36 FLOVENT HFA, 37 fluconazole, 8 fludrocortisone, 25 FLUMADINE, 10 flunisolide spray, 36 fluocinolone acetonide, 43 fluocinolone acetonide crm, oint 0.025%, 39 fluocinolone acetonide oil 0.01%, 39 fluocinolone acetonide soln 0.01%, 39 fluocinonide crm 0.05%, 39 fluocinonide gel, oint 0.05%, 39 fluocinonide soln 0.05%, 39 fluoride drops, tabs, 34 fluorometholone 0.1% susp, 41
fluorometholone 0.25%, 41 fluorouracil, 38 fluorouracil soln, 38 fluoxetine caps 10 mg, 20 mg, 40 mg, 17 fluphenazine, 19 flurandrenolide tape, 39 flurbiprofen, 6, 41 flutamide, 11 fluticasone furoate, 37 fluticasone propionate crm 0.05%, oint 0.005%, 39 fluticasone propionate, CFC-free aerosol 44 mcg, 110 mcg, 37 fluticasone spray, 36 fluticasone/salmeterol, 37 fluvoxamine, 16 FML FORTE, 41 FML LIQUIFILM, 41 FOCALIN, 19 FOCALIN XR, 19 folic acid, 32 fondaparinux, 30 FORTESTA, 21 FOSAMAX, 23 fosamprenavir susp, 9 fosamprenavir tabs, 9 fosinopril, 12 fosinopril/hydrochlorothiazide, 12 FOSRENOL, 25 FRAGMIN, 30 FUNGOID TINCTURE, 38 FURADANTIN, 10 furosemide, 15 FUZEON, 9 FYCOMPA, 17
G gabapentin, 17 GABITRIL, 17 galantamine, 17 galantamine ext-rel, 17 GAMASTAN S/D, 31 GAMMAGARD, 31 GAMUNEX-C, 31 ganciclovir, 41 GASTROCROM, 29 gemfibrozil, 14 gentamicin, 38, 41 gentamicin/prednisolone acetate, 41 GENVOYA, 9 GEODON, 18 GILENYA, 20 GILOTRIF, 11 glatiramer 20 mg/mL, 20 GLEEVEC, 12 GLEOSTINE, 11 glimepiride, 22 glipizide, 22 glipizide ext-rel, 22 glipizide/metformin, 21 GLUCAGEN HYPOKIT, 25 GLUCAGON EMERGENCY KIT, 25 glucagon, human recombinant, 25 GLUCOPHAGE, 21 GLUCOPHAGE XR, 21 glucose tablets, 25 GLUCOTROL, 22 GLUCOTROL XL, 22
53
glyburide, 22 glyburide micronized, 22 glyburide/metformin, 21 glycopyrrolate, 29 glycopyrrolate tabs 1 mg, 2 mg, 27 GLYNASE, 22 GLYSET, 21 GNP DAILY PRENATAL, 33 GOLYTELY, 28 granisetron tabs, 27 GRASTEK, 31 griseofulvin microsize, 8 griseofulvin ultramicrosize, 8 guaifenesin ext-rel, 36 guaifenesin liq, 36 guaifenesin liq, syp, tabs, 36 guanfacine, 12 guanfacine ext-rel, 19 guanidine, 21 GYNE-LOTRIMIN, 29 GYNOL II, 24
H haloperidol, 19 HARVONI, 10 HECTOROL, 25 HELIXATE FS, 30 HEPAGAM B, 31 hepatitis B immune globulin, 31 HEPSERA, 10 HIZENTRA, 31 HM ONE DAILY PRENATAL, 33 homatropine, 42 HUMALOG MIX, 22 HUMATE-P, 30 HUMIRA, 31 HUMULIN 70/30, 22 HUMULIN N, 22 HUMULIN R, 22 HUMULIN R U-500 VIAL, 22 HYCAMTIN, 12 hydralazine, 16 HYDREA, 12 hydrochlorothiazide, 15 hydrocodone/acetaminophen, 6 hydrocodone/acetaminophen soln 7.5-325 mg/15 mL, 6 hydrocodone/homatropine, 35 hydrocortisone, 25 hydrocortisone acetate foam, 28 hydrocortisone butyrate crm, oint, soln 0.1%, 39 hydrocortisone crm, 29 hydrocortisone crm, gel, lotion, oint, soln 1%, 38 hydrocortisone crm, lotion, oint 2.5%, 39 hydrocortisone enema, 28 hydrocortisone oint 0.5%, 38 hydrocortisone valerate crm, oint 0.2%, 39 hydrocortisone/aloe vera crm 0.5%, 1%, 38 hydromorphone oral soln 1 mg/mL, 6 hydromorphone tabs, 6 hydroxychloroquine, 31 hydroxyurea, 12 hydroxyzine HCl, 35 hydroxyzine pamoate, 35 hylan G-F 20, 7 hyoscyamine sulfate ext-rel caps, 27 hyoscyamine sulfate ext-rel tabs, 27
hyoscyamine sulfate oral soln, elixir, 27 hyoscyamine sulfate orally disintegrating tabs, 27 HYPERRAB S/D, 31 HYPERRHO, 31 HYZAAR, 13
I ibandronate, 23 ibrutinib, 12 ibuprofen, 6 idelalisib, 12 ILARIS, 32 iloperidone, 18 iloprost, 16 imatinib mesylate, 12 IMBRUVICA, 12 imipramine HCl, 18 imipramine pamoate, 18 imiquimod, 40 IMITREX, 19, 20 immune globulin, 31 immune globulin, gamma (IGG), 31 IMODIUM, 29 IMURAN, 32 INCRELEX, 25 INCRUSE ELLIPTA, 34 indapamide, 15 INDERAL LA, 14 indinavir, 9 INLYTA, 11 inositol niacinate, 33 INSPRA, 13 insulin aspart protamine 70%/insulin aspart 30%, 22 insulin glargine, 22 insulin human, 22 insulin human inhalation powder, 22 insulin human vial, 22 insulin infusion disposable pump, 23 insulin isophane human, 22 insulin isophane human 70%/regular 30%, 22 insulin lispro, 22 insulin lispro protamine/insulin lispro, 22 insulin syringes, needles, 23 INTELENCE, 9 interferon alfa-2b, 31 interferon beta-1a, 20 interferon beta-1b, 20 interferon gamma-1b, 31 INTRON A, 31 INTROVALE, 24 INTUNIV, 19 INVEGA, 18 INVEGA SUSTENNA, 18 INVEGA TRINZA, 18 INVIRASE, 9 ipratropium nasal spray, 37 ipratropium soln, 34 ipratropium, CFC-free aerosol, 34 ipratropium/albuterol soln, 34 ipratropium/albuterol, CFC-free aerosol, 34 irbesartan, 13 irbesartan/hydrochlorothiazide, 13 ISENTRESS, 9 ISENTRESS HD, 9 isocarboxazid, 17 isoniazid syrup, 10
54
isoniazid tabs, 10 ISOPTO CARPINE, 42 ISORDIL, 15 isosorbide dinitrate ext-rel tabs, 15 isosorbide dinitrate oral, 15 isosorbide dinitrate/hydralazine, 15 isosorbide mononitrate, 15 isosorbide mononitrate ext-rel, 15 isotretinoin, 37 itraconazole, 8 itraconazole oral soln, 8 ivermectin, 10
J JAKAFI, 12 JALYN, 29 JINTELI, 25 JOLESSA, 24 JULUCA, 8 JUXTAPID, 14
K KADIAN, 7 KALETRA, 9 KAPVAY, 19 karaya gum, 28 KARAYA GUM, 28 KAZANO, 21 KEFLEX, 7 KELNOR 1/50, 23 KEPPRA, 17 KEPPRA XR, 17 ketoconazole, 8 ketoconazole crm, shampoo 2%, 38 ketoconazole shampoo 2%, 38 ketoprofen, 6 ketoprofen ext-rel, 6 ketorolac, 6 ketorolac 0.4%, 41 ketorolac 0.5%, 41 ketotifen, 40 KEVZARA, 31 KLARON, 37 KLONOPIN, 16 KOGENATE FS, 30 KONSYL, 28 K-PHOS, 30 KPN PRENATAL, 33 KRISTALOSE, 28 KYLEENA, 24 KYNAMRO, 14
L labetalol, 14 LAC-HYDRIN, 39 lacosamide, 17 lactulose packets, 28 lactulose soln, 28 LAMICTAL, 17 LAMISIL AT, 38 lamivudine, 9 lamivudine soln, 10 lamivudine tabs, 10 lamivudine/tenofovir disoproxil fumarate, 9 lamivudine/zidovudine, 9 lamotrigine, 17 lancets, 23
LANOXIN, 15 lansoprazole + amoxicillin + clarithromycin, 29 lansoprazole delayed-rel, 28 lansoprazole delayed-rel orally-disintegrating tabs, 28 lanthanum chew tabs, 25 lanthanum powder, 25 lapatinib, 12 LASIX, 15 latanoprost, 42 LATUDA, 18 ledipasvir/sofosbuvir, 10 leflunomide, 31 lenalidomide, 11 LETAIRIS, 16 letrozole, 11 LEUCOVORIN, 11 leucovorin calcium, 11 LEUKERAN, 11 LEUKINE, 30 LEVAQUIN, 8 LEVBID, 27 levetiracetam, 17 levetiracetam ext-rel, 17 levobunolol, 41 levocarnitine oral soln, tabs, 23 levocetirizine, 34 levofloxacin, 8 levofloxacin 0.5%, 41 levonorgestrel, 24 levonorgestrel/EE, 24 levonorgestrel/EE 0.09/20, 24 levonorgestrel/EE 0.1/20, 23 levonorgestrel/EE 0.1/20 and EE 10, 24 levonorgestrel/EE 0.15/30, 23, 24 levonorgestrel-releasing IUD, 24 levothyroxine, 26 LEVOXYL, 26 LEVSIN, 27 LEXAPRO, 17 LEXIVA, 9 LIALDA, 27 lidocaine, 40 lidocaine 5% crm, 39 lidocaine crm 4%, 39 lidocaine patch 4%, 39 lidocaine patch 5%, 39 lidocaine viscous, 40 lidocaine/prilocaine, 39 LIDOCARE, 39 LIDODERM, 39 lifitegrast, 42 LILETTA, 24 linezolid, 10 liothyronine, 26 liotrix, 26 LIPITOR, 14 LIPOFEN, 13 LIQ-10, 33 liraglutide, 22 lisdexamfetamine, 19 lisinopril, 12 lisinopril/hydrochlorothiazide, 12 lithium carbonate, 20 lithium carbonate ext-rel tabs 300 mg, 20 lithium carbonate ext-rel tabs 450 mg, 20 LITHOBID, 20
55
LITHOSTAT, 30 LMX 4, 39 LOCOID, 39 LOESTRIN 1.5/30, 23 LOESTRIN 1/20, 23 LOESTRIN FE 1.5/30, 23 LOESTRIN FE 1/20, 23 lomitapide, 14 LOMOTIL, 26 lomustine, 11 loperamide, 26, 27 loperamide/simethicone, 29 LOPID, 14 lopinavir/ritonavir soln, 9 lopinavir/ritonavir tabs, 9 LOPRESSOR, 14 LOPRESSOR HCT, 14 LOPROX, 38 loratadine caps, 34 loratadine tabs, 34 loratadine/pseudoephedrine ext-rel, 35 lorazepam, 16 losartan, 13 losartan/hydrochlorothiazide, 13 LOTENSIN, 12 LOTENSIN HCT, 12 LOTREL, 12 LOTRONEX, 28 lovastatin, 14 LOVAZA, 14 LOVENOX, 30 loxapine, 18 lubiprostone, 28 lurasidone, 18 lymphocyte immune globulin anti-thymocyte G, 31 LYRICA, 17 LYSODREN, 12
M MAALOX, 26 macitentan, 16 MACROBID, 10 MACRODANTIN, 10 mafenide, 40 magnesium chloride ex-rel, 33 magnesium citrate, 28 magnesium hydroxide, 28 magnesium oxide, 33 MAG-OX 400, 33 MALARONE, 8 malathion, 40 maprotiline, 18 maraviroc, 9 MARINOL, 27 MARPLAN, 17 mask, 36 MASK, 36 MATULANE, 12 MAXALT, 19 MAXALT-MLT, 19 MAXIDEX, 41 MAXITROL, 41 MAXZIDE, 15 mecasermin, 25 mechlorethamine gel, 11 meclizine, 27
meclofenamate, 6 MEDROL, 25 medroxyprogesterone acetate, 26 medroxyprogesterone acetate vial 150 mg/mL, 24 mefloquine, 8 megestrol acetate susp 40 mg/mL, tabs, 11 MEKINIST, 12 meloxicam, 6 melphalan, 11 memantine, 17 MENEST, 24 MEPHYTON, 34 meprobamate, 16 MEPRON, 10 mercaptopurine, 11 mesalamine delayed-rel, 27 mesalamine delayed-rel tabs, 27 mesalamine ext-rel caps, 27 mesalamine rectal susp, 28 mesalamine supp, 28 MESTINON, 20 METADATE CD, 19 METADATE ER, 19 metaproterenol, 35 metformin, 21 metformin ext-rel, 21 methazolamide, 15 methenamine mandelate, 30 METHERGINE, 26 methimazole, 26 methocarbamol, 20 methotrexate, 11, 31 methotrexate inj, 11 methscopolamine bromide, 27 methsuximide, 17 methylcellulose, 28 methyldopa, 16 methyldopa/hydrochlorothiazide, 16 methylergonovine, 26 METHYLIN, 19 methylphenidate, 19 methylphenidate ext-rel, 19 methylphenidate ext-rel 10 mg, 19 methylphenidate ext-rel 10 mg, 60 mg, 19 methylphenidate ext-rel 20 mg, 19 methylphenidate ext-rel 20 mg, 30 mg, 40 mg, 19 methylprednisolone, 25 methylprednisolone 2 mg, 25 metoclopramide, 27 metoclopramide orally-disintegrating tabs, 27 metolazone, 15 metoprolol succinate ext-rel, 14 metoprolol tartrate 25 mg, 50 mg, 14 metoprolol/hydrochlorothiazide, 14 METROCREAM, 39 METROGEL, 39 METROGEL-VAGINAL, 29 METROLOTION, 39 metronidazole, 10, 29 metronidazole crm 0.75%, 39 metronidazole gel 0.75%, 39 metronidazole gel 1%, 39 metronidazole lotion 0.75%, 39 metyrosine, 16 MIACALCIN, 23 MICARDIS, 13
56
MICARDIS HCT, 13 MICATIN, 38 miconazole, 29, 38 midodrine, 16 miglitol, 21 miglustat, 25 MIGRANAL, 19 MILK OF MAGNESIA, 28 mineral oil, 28 mineral oil-hydrophilic petrolatum, 39 MINIPRESS, 13 MINOCIN, 8 minocycline, 8 minoxidil tabs, 16 mipomersen, 14 MIRALAX, 28 MIRAPEX, 18 MIRCETTE, 24 MIRENA, 24 mirtazapine, 18 misoprostol, 28 mitotane, 12 MOBIC, 6 modafinil, 20 moexipril, 12 mometasone, 37 mometasone crm, oint 0.1%, 39 mometasone lotion 0.1%, 39 mometasone, CFC-free aerosol, 37 montelukast, 36 montelukast granules, 36 morphine, 7 morphine ext-rel, 7 morphine supp, 7 moxifloxacin, 8, 41 MS CONTIN, 7 MUCINEX, 36 MUCINEX D, 36 MUCINEX DM, 35 MULTAQ, 13 MULTI-DELYN, 33 multivitamins/fluoride drops, tabs, 34 multivitamins/fluoride/iron drops, tabs, 34 mupirocin, 38 MURO-128, 42 M-VIT, 32 MYAMBUTOL, 10 MYCOBUTIN, 10 mycophenolate mofetil, 32 mycophenolate sodium delayed-rel, 32 MYFORTIC, 32 MYLANTA, 26 MYLERAN, 11 MYNATAL, 32, 33 MYNATAL ADVANCE, 32 MYNATAL PLUS, 33 MYNATAL-Z, 33 MYNATE 90 PLUS, 32 MYSOLINE, 17
N nabumetone, 6 nadolol, 14 nafarelin, 24 nail scrub, 40 NAIL SCRUB LIQ W/BRUSH, 40
naloxone inj, 20 naloxone nasal spray, 20 naltrexone, 20 NAMENDA, 17 naphazoline 0.1%, 42 NAPROSYN, 6 naproxen, 6 naproxen sodium, 6 naratriptan, 19 NARCAN, 20 NARDIL, 17 NASALCROM, 36 NATACYN, 40 NATALVIT, 33 natamycin, 40 nateglinide, 22 NATROBA, 40 nelfinavir, 9 neomycin, 7 neomycin/bacitracin/polymyxin B, 38 neomycin/bacitracin/polymyxin/pramoxine, 38 neomycin/polymyxin B/bacitracin/hydrocortisone oint, 38, 41 neomycin/polymyxin B/dexamethasone, 41 neomycin/polymyxin B/gramicidin, 41 neomycin/polymyxin B/hydrocortisone, 42 neomycin/polymyxin B/hydrocortisone susp, 41 NEORAL, 32 NEOSPORIN, 38 NEOSPORIN+PN, 38 NEO-SYNEPHRINE, 36 NEPHROCAPS, 34 NESINA, 21 NEULASTA, 30 NEUPOGEN, 30 NEURONTIN, 17 NEUTROGENA, 38 nevirapine, 9 nevirapine ext-rel 100 mg, 9 nevirapine ext-rel 400 mg, 9 NEXAVAR, 12 NEXIUM 24HR, 28 NEXPLANON, 24 niacin, 33 niacin ext-rel, 14, 33 NIACIN FLUSH FREE, 33 NIASPAN, 14 nicardipine, 14 NICORETTE, 21 nicotine polacrilex gum, 21 nicotine polacrilex lozenge, 21 nicotine transdermal, 21 nifedipine, 14 nifedipine ext-rel, 14 NILANDRON, 11 nilotinib, 12 nilutamide, 11 nimodipine, 14 NIMOTOP, 14 nisoldipine ext-rel, 15 nitazoxanide susp, 10 nitazoxanide tabs, 10 nitisinone, 25 NITRO-DUR, 15 nitrofurantoin ext-rel, 10 nitrofurantoin macrocrystals, 10 nitrofurantoin susp, 10
57
nitroglycerin sublingual, 15 nitroglycerin transdermal, 15 NITROSTAT, 15 NIVA-PLUS, 32 nizatidine, 27 NIZORAL SHAMPOO, 38 nonoxynol-9, 24 NORCO, 6 norelgestromin/EE, 24 norethindrone, 24 norethindrone acetate, 26 norethindrone acetate/EE 1.5/30, 23 norethindrone acetate/EE 1.5/30 and iron, 23 norethindrone acetate/EE 1/20, 23 norethindrone acetate/EE 1/20 and iron, 23 norethindrone/EE, 24 norethindrone/EE 0.5-35/1-35/0.5-35 mg-mcg, 24 norethindrone/EE 0.5/35, 23 norethindrone/EE 1/35, 23 norgestimate/EE, 24 norgestimate/EE 0.18-35/0.215-35/0.25-35 mg-mcg, 24 norgestimate/EE 0.25/35, 23 norgestrel/EE 0.3/30, 23 norgestrel/EE 0.5/50, 23 NORPACE, 13 NORPACE CR, 13 NORPRAMIN, 18 nortriptyline, 18 NORVASC, 14 NORVIR, 9 NOVAFERRUM, 33, 34 NOVOLIN 70/30, 22 NOVOLIN N, 22 NOVOLIN R, 22 NOVOLOG MIX 70/30, 22 NUEDEXTA, 21 NULYTELY, 28 NUTRIENTS PRENATAL, 33 NUVARING, 24 NUVIGIL, 20 nystatin, 8, 38 nystatin vaginal tab, 29
O O-CAL FA, 33 O-CAL PRENATAL, 32 OCEAN, 37 octreotide acetate, 21 OCUFLOX, 41 ODEFSEY, 9 ofloxacin, 41 ofloxacin otic, 42 OGESTREL, 23 olanzapine, 18 olanzapine pamoate ext-rel inj, 18 olmesartan, 13 olmesartan/amlodipine/hydrochlorothiazide, 13 olmesartan/hydrochlorothiazide, 13 olsalazine, 27 OLUX, 39 omalizumab, 36 omega-3 acid ethyl esters, 14 omega-3 fatty acids, 33 omeprazole delayed-rel, 28 omeprazole magnesium delayed-rel, 28 omeprazole powder for suspension, 28
omeprazole/sodium bicarbonate, 28 OMNIPOD INSULIN INFUSION PUMP, 23 OMNITROPE, 25 ondansetron, 27 ONE-A-DAY PRENATAL PAK, 33 ONFI, 17 OPANA, 7 OPSUMIT, 16 ORFADIN, 25 orphenadrine ext-rel, 20 orphenadrine/aspirin/caffeine, 20 ORTHO MICRONOR, 24 ORTHO TRI-CYCLEN LO, 24 ORTHO-NOVUM 1/35, 23 ORTHO-NOVUM 7/7/7, 24 oseltamivir, 10 OSENI, 21 OTEZLA, 31 OVIDE, 40 oxandrolone, 21 oxaprozin, 6 oxazepam, 16 oxcarbazepine, 17 oxybutynin, 29 oxybutynin ext-rel, 29 oxybutynin transdermal, 29 oxycodone, 7 oxycodone ext-rel, 7 oxycodone/acetaminophen, 7 oxycodone/aspirin, 7 OXYCONTIN, 7 oxymetazoline spray, 36 oxymetholone, 21 oxymorphone, 7 OXYTROL FOR WOMEN, 29 OZEMPIC, 22
P paliperidone ext-rel, 18 paliperidone palmitate ext-rel inj, 18 palivizumab, 36 PAMELOR, 18 PANCREAZE, 28 pancrelipase delayed-rel, 28 pantoprazole delayed-rel packets for suspension, 28 pantoprazole delayed-rel tabs, 28 paricalcitol, 25 PARLODEL, 18 PARNATE, 17 paromomycin, 10 paroxetine HCl susp, 17 paroxetine HCl tabs, 17 PAXIL, 17 pazopanib, 12 peak flow meter, 36 PEDIALYTE, 33 pediatric multivitamin liquid, 33 PEDIAVIT, 33 peg 3350/electrolytes, 28 PEGANONE, 17 PEGASYS, 31 pegfilgrastim, 30 peginterferon alfa-2a, 31 pegvisomant, 21 penicillamine, 31 penicillin VK, 8
58
PENLAC, 38 pentazocine/naloxone, 7 pentosan polysulfate sodium, 30 pentoxifylline ext-rel, 31 PEPCID, 27 PEPTO-BISMOL, 26 perampanel, 17 PERCODAN, 7 PERIDEX, 40 perindopril, 12 permethrin, 40 perphenazine, 19 perphenazine/amitriptyline, 19 PERRY PRENATAL, 32 PETROLATUM, 39 petrolatum/mineral oil/shark liver oil/phenylephrine oint, 29 phenelzine, 17 phenobarbital, 17 phentolamine inj, 16 phenylephrine, 36, 40 phenylephrine spray, 36 phenytoin, 17 phenytoin sodium extended, 17 PHOSPHOLINE IODIDE, 42 phytonadione, 34 pilocarpine, 42 pilocarpine tabs, 29 pimecrolimus, 38 pimozide, 19 pindolol, 14 pioglitazone, 22 pioglitazone/glimepiride, 22 pioglitazone/metformin, 22 pioglitazone/metformin ext-rel, 22 piroxicam, 6 PLAN B ONE-STEP, 24 PLAQUENIL, 31 PLAVIX, 30 pneumococcal vaccine, 32 PNEUMOVAX 23, 32 PNV FOLIC ACID + IRON, 33 PNV PRENATAL PLUS, 33 podofilox soln, 40 polyethylene glycol 3350 powder, 28 polymyxin B/bacitracin, 38, 41 polymyxin B/trimethoprim, 41 polysaccharide iron complex caps, drops, 33 polysaccharide iron complex/cholecalciferol liq, 34 polysaccharide iron forte, 34 POLYSPORIN, 38 POLYTRIM, 41 pomalidomide, 11 POMALYST, 11 potassium chloride ext-rel, 32 potassium chloride liquid, 32 potassium citrate, 30 potassium citrate/citric acid, 30 potassium citrate/sodium citrate/citric acid, 30 potassium/sodium acid phosphates, 30 povidone-iodine, 40 pramipexole, 18 pramlintide, 21 pramoxine/phenylephrine/glycerin/petrolatum, 29 PRANDIN, 22 prasugrel, 30 PRAVACHOL, 14
pravastatin, 14 praziquantel, 10 prazosin, 13 PRECOSE, 21 PRED FORTE, 41 PRED MILD, 41 PRED-G, 41 prednicarbate crm, oint 0.1%, 39 prednisolone acetate 0.12%, 41 prednisolone acetate 1%, 41 prednisolone phosphate 1%, 41 prednisolone sodium phosphate soln 5 mg/5 mL, 15 mg/5 mL, 25 mg/5
mL, 25 prednisolone syrup, 25 prednisone, 25 prednisone concentrate 5 mg/mL, 25 PREDNISONE INTENSOL, 25 PREFEST, 25 pregabalin, 17 PRENATABS RX, 32 PRENATAL + DHA, 33 PRENATAL + DHA WOMENS, 33 PRENATAL + FE, 33 PRENATAL 19, 32, 33 PRENATAL DHA, 32 PRENATAL DHA PAK MULTI, 33 PRENATAL FORMULA, 33 PRENATAL FORMULA A-FREE, 32 PRENATAL MULTI + DHA, 33 PRENATAL OMEGA-3, 33 PRENATAL PLUS IRON, 32 PRENATAL TAB, 32 PRENATAL TAB 27-1 MG, 33 PRENATAL VITAMIN TAB LOW IRON, 33 prenatal vitamins fast dissolving tabs, 32 prenatal vitamins without A/ferrous fumarate/folic acid 9-0.267 mg, 32 prenatal vitamins without A/iron polysaccharide complex/folic acid 155-1 mg,
32 prenatal vitamins/carbonyl iron/folic acid tabs, 32 prenatal vitamins/docusate/ferrous fumarate/folic acid 29-1 mg, 32 prenatal vitamins/docusate/ferrous fumarate/folic acid ext-rel 90-1 mg, 32 prenatal vitamins/docusate/iron carbonyl/folic acid 90-1 mg, 32 prenatal vitamins/ferrous bisglycinate chelate/folic acid, 32 prenatal vitamins/ferrous bisglycinate/folic acid + omega-3 delayed-rel, 32 prenatal vitamins/ferrous fumarate/folic acid 13.5-0.4 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 15-1 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 27-0.8 mg + DHA 200 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 27-1 mg, 32, 33 prenatal vitamins/ferrous fumarate/folic acid 27-1 mg + DHA 300 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 223 mg,
33 prenatal vitamins/ferrous fumarate/folic acid 28-0.8 mg + omega-3 440 mg,
33 prenatal vitamins/ferrous fumarate/folic acid 28-0.975 mg + DHA 200 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 29-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 6.75-0.2 mg, 32 prenatal vitamins/ferrous fumarate/folic acid 60-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 65-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid 75-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid chew tabs 29-1 mg, 33 prenatal vitamins/ferrous fumarate/folic acid/fish oil, 33 prenatal vitamins/ferrous fumarate/folic acid/omega-3 27-0.8-228 mg, 33 prenatal vitamins/ferrous fumarate/folic acid/omega-3 28-0.8-235 mg, 33 prenatal vitamins/ferrous fumarate/l-methylfolate/folic acid 27-0.5-0.5 mg, 33 prenatal vitamins/ferrous succinate/folic acid, 33 prenatal vitamins/iron carbonyl/folic acid + DHA, 33
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prenatal vitamins/iron carbonyl/folic acid 29-1 mg, 33 prenatal vitamins/l-methylfolate + fish oil/choline, 33 prenatal vitamins/minerals/ferrous fumarate/folic acid/DHA, 33 prenatal vitamins/minerals/folic acid/fish oil chew tabs, 33 prenatal vitamins/minerals/iron/folic acid 0.1 mg, 33 prenatal vitamins/minerals/iron/folic acid 1 mg, 33 prenatal vitamins/selenium/ferrous fumarate/folic acid 27-1 mg, 33 prenatal vitamins/selenium/ferrous fumarate/folic acid 9-0.5 mg, 33 PREPARATION H, 29 PREVACID, 28 PREVACID 24HR, 28 PREVIDENT 5000, 40 PREVNAR 13, 32 PREZCOBIX, 8 PREZISTA, 9 PRIFTIN, 10 PRILOSEC, 28 PRILOSEC OTC, 28 primaquine, 8 PRIMAQUINE, 8 primidone, 17 PRIVIGEN, 31 PROAIR HFA, 35 probenecid, 6 procarbazine, 12 PROCARDIA, 14 PROCARDIA XL, 14 prochlorperazine, 27 PROCRIT, 30 PROCTOCORT 1%, 29 progesterone gel, 26 progesterone supp, 26 progesterone vaginal inserts, 26 progesterone, micronized, 26 PROGLYCEM, 25 PROGRAF, 32 PROLEUKIN, 12 PROLIA, 23 PROMACTA, 31 promethazine, 27 promethazine supp 12.5 mg, 25 mg, 27 promethazine/phenylephrine, 35 PROMETRIUM, 26 propafenone, 13 propafenone ext-rel, 13 propantheline, 27 proparacaine 0.5%, 42 propranolol, 14 propranolol ext-rel, 14 propylthiouracil, 26 PROSCAR, 29 PROTONIX, 28 PROTOPIC, 38 protriptyline, 18 PROVERA, 26 PROVIGIL, 20 PROZAC, 17 pseudoephedrine, 36 pseudoephedrine ext-rel, 36 pseudoephedrine/guaifenesin ext-rel, 36 psyllium powder, 28 PULMICORT RESPULES, 37 PULMOZYME, 35 pyrantel, 10 pyrazinamide, 10 pyrethrins/piperonyl butoxide, 40
pyridostigmine, 20 pyridoxine 25 mg, 50 mg, 34
Q QUESTRAN/QUESTRAN LIGHT, 13 quetiapine, 18 quetiapine ext-rel, 18 quinapril, 12 quinapril/hydrochlorothiazide, 12 QVAR REDIHALER, 37
R RA ONE DAILY PRENATAL, 33 rabies immune globulin, 31 ragweed pollen allergen extract, 31 RAGWITEK, 31 raloxifene, 26 raltegravir, 9 ramipril, 12 RANEXA, 16 ranitidine, 27 ranolazine ext-rel, 16 RAPAFLO, 29 RAPAMUNE, 32 RAZADYNE, 17 RAZADYNE ER, 17 REBETOL, 10 REESES PINWORM MEDICINE, 10 REFRESH, 42 REGENECARE, 40 REGLAN, 27 regorafenib, 12 REGRANEX, 40 RELENZA, 10 REMERON, 18 REMODULIN, 16 repaglinide, 22 repaglinide/metformin, 22 REPATHA, 14 REPATHA PUSHTRONEX, 14 RESTASIS, 42 RESTORIL, 19 RETIN-A, 37 RETROVIR, 9 REVATIO, 16 REVLIMID, 11 REYATAZ, 9 rho D immune globulin, 31 RHOGAM, 31 RHOPHYLAC, 31 ribavirin caps 200 mg, 10 ribavirin oral soln 40 mg/mL, 10 ribavirin tabs 200 mg, 10 riboflavin tabs 100 mg, 34 RID SHAMPOO, 40 RIDAURA, 31 rifabutin, 10 RIFADIN, 10 rifampin, 10 rifapentine, 10 rifaximin, 11 rilonacept, 32 rilpivirine, 9 RILUTEK, 16 riluzole, 16 rimantadine, 10 riociguat, 16
60
RISPERDAL, 18 RISPERDAL CONSTA, 18 risperidone, 18 risperidone long-acting inj, 18 RITALIN, 19 RITALIN LA, 19 ritonavir caps, soln, 9 ritonavir tabs, 9 rivaroxaban, 30 rivastigmine, 17 rizatriptan, 19 rizatriptan orally disintegrating tabs, 19 ROBAXIN, 20 ROBITUSSIN, 36 ROBITUSSIN COLD/FLU, 35 ROCALTROL, 25 roflumilast, 36 ropinirole, 18 rosuvastatin, 14 ROWASA, 28 ROXICODONE, 7 rufinamide, 17 ruxolitinib, 12 RYTHMOL SR, 13
S SALAGEN, 29 salicylic acid, 40 salicylic acid/sulfur shampoo, 38 salmeterol xinafoate, 35 SAMSCA, 26 SANDIMMUNE, 32 SANDOSTATIN, 21 SANTYL, 40 SAPHRIS, 18 saquinavir mesylate, 9 sargramostim, 30 sarilumab, 31 scopolamine transdermal, 27 SEA-OMEGA, 33 SEBULEX, 38 SEGLUROMET, 22 selegiline, 18 selegiline orally disintegrating tablets, 18 selenium sulfide shampoo 1%, 38 selexipag, 16 SELSUN BLUE, 38 SELZENTRY, 9 semaglutide, 22 SEMPREX-D, 35 SE-NATAL 19, 33 senna, 28 SENNA PLUS, 28 sennosides, 28 sennosides/docusate sodium, 28 SENOKOT, 28 SENSIPAR, 23 SEREVENT, 35 SEROQUEL, 18 SEROQUEL XR, 18 sertraline, 17 SETLAKIN, 24 SHINGRIX, 32 sildenafil, 16 silodosin, 29 SILVADENE, 38
silver sulfadiazine, 38 simethicone, 29 SIMILAC PRENATAL EARLY SHIELD, 32 simvastatin, 14 SINEMET, 18 SINEMET CR, 18 SINGULAIR, 36 sirolimus, 32 SIRTURO, 9 SKYLA, 24 SLOW-MAG, 33 SM ONE DAILY PRENATAL, 33 sodium bicarbonate, 26 sodium chloride, 42 sodium chloride for inhalation, 36 sodium chloride soln, 37, 40 sodium citrate/citric acid, 30 sodium fluoride, 40 sodium oxybate, 20 sodium phenylbutyrate, 26 sodium phosphates, 28 sodium polystyrene sulfonate, 26 sofosbuvir/velpatasvir, 10 sofosbuvir/velpatasvir/voxilaprevir, 10 SOLIRIS, 30 somatropin, 25 SOMAVERT, 21 sorafenib, 12 sotalol, 13 spacer, 36 spinosad, 40 spironolactone, 13 spironolactone/hydrochlorothiazide, 15 SPORANOX, 8 SPORANOX ORAL SOLUTION, 8 SPRYCEL, 11 SPS, 26 STALEVO, 18 STARLIX, 22 stavudine, 9 STEGLATRO, 22 STIMATE, 26 STIOLTO RESPIMAT, 34 STIVARGA, 12 STRATTERA, 19 STRIBILD, 9 STROMECTOL, 10 SUBLOCADE, 20 SUBOXONE, 20 succimer, 31 sucralfate susp, 29 sucralfate tabs, 29 SUDAFED, 36 SUDAFED PE, 36 SULAR, 15 sulfacetamide lotion 10%, 37 sulfacetamide sodium, 38 sulfacetamide soln 10%, 41 sulfacetamide/prednisolone phosphate 10%/0.25%, 41 sulfacetamide/sulfur, 39 sulfacetamide/sulfur crm, gel, lotion, pads, 37 sulfadiazine, 8 sulfamethoxazole/trimethoprim, 8 sulfamethoxazole/trimethoprim DS, 8 SULFAMYLON, 40 sulfasalazine, 27
61
sulfasalazine delayed-rel, 27 sulindac, 6 sumatriptan, 19 sumatriptan inj, 19 sumatriptan nasal spray, 20 sunitinib, 12 SURMONTIL, 18 SUSTIVA, 9 SUTENT, 12 SYMBICORT, 37 SYMFI, 8 SYMFI LO, 8 SYMLINPEN, 21 SYNAGIS, 36 SYNAREL, 24 SYNTHROID, 26 SYNVISC-ONE, 7
T TABLOID, 11 tacrolimus, 32, 38 TAFINLAR, 11 TAGAMET HB, 27 TAMIFLU, 10 tamoxifen, 11 tamsulosin, 29 TAPAZOLE, 26 TARCEVA, 11 TARGRETIN, 40 TARGRETIN caps, 12 TARKA, 12 TASIGNA, 12 tazarotene crm 0.05%, gel 0.05%, 0.1%, 38 tazarotene crm 0.1%, 38 TAZORAC, 38 TECFIDERA, 20 TEGRETOL, 16 TEGRETOL-XR, 16 telmisartan, 13 telmisartan/hydrochlorothiazide, 13 temazepam, 19 TEMODAR, 11 TEMOVATE, 39 temozolomide, 11 tenofovir disoproxil fumarate powder, 9 tenofovir disoproxil fumarate tabs, 9 terazosin, 13, 29 terbinafine, 38 terbinafine tabs, 8 terbutaline, 35 terconazole crm, supp, 29 teriflunomide, 20 TESSALON, 35 testosterone cypionate, 21 testosterone enanthate, 21 testosterone gel, 21 tetrabenazine, 19 tetracaine 0.5%, 42 tetracycline, 8 thalidomide, 11 THALOMID, 11 THEO-24, 37 theophylline elixir, 37 theophylline ext-rel caps, 37 theophylline ext-rel tabs, 37 theophylline liquid, 37
THERANATAL, 33 THERANATAL COMPLETE, 32 thioguanine, 11 thioridazine, 18 thiothixene, 19 thyroid, 26 THYROLAR, 26 tiagabine, 17 TIAZAC, 15 TIGAN, 27 TIKOSYN, 13 timolol, 14 timolol hemihydrate, 41 timolol maleate, 41 timolol maleate gel, 41 TIMOPTIC, 41 TIMOPTIC-XE, 41 timothy grass pollen allergen extract, 31 TINACTIN, 38 tioconazole, 29 tiotropium/olodaterol, 34 tipranavir, 9 TIVICAY, 9 tizanidine tabs, 20 TL FOLATE, 33 TOBI, 36 TOBI PODHALER, 35 TOBRADEX, 41 TOBRADEX ST, 41 tobramycin, 41 tobramycin inhalation powder, 35 tobramycin inhalation soln, 36 tobramycin oint, 41 tobramycin soln, 41 tobramycin/dexamethasone oint 0.3%/0.1%, 41 tobramycin/dexamethasone susp 0.3%/0.05%, 41 tobramycin/dexamethasone susp 0.3%/0.1%, 41 TOBREX, 41 tocopherols-tocotrienols, 34 TOFRANIL, 18 tolbutamide, 23 tolmetin 200 mg, 400 mg, 6 tolnaftate, 38 tolterodine, 29 tolterodine ext-rel, 29 tolvaptan, 26 TOPAMAX, 17 TOPICORT, 39 TOPICORT LP, 39 topiramate sprinkle caps, tabs, 17 topotecan, 12 TOPROL-XL, 14 toremifene, 11 torsemide, 15 TOUJEO SOLOSTAR, 22 TRACLEER, 16 tramadol ext-rel tabs, 7 tramadol immediate-release, 7 tramadol/acetaminophen, 7 trametinib, 12 TRANDATE, 14 trandolapril, 12 trandolapril/verapamil ext-rel, 12 TRANSDERM SCOP, 27 tranylcypromine, 17 trazodone 50 mg, 100 mg, 150 mg, 18
62
TRECATOR, 10 treprostinil, 16 tretinoin caps, 12 tretinoin crm 0.025%, 0.05%, 0.1%, 37 tretinoin gel 0.01%, 0.025%, 37 TREXALL, 11 triamcinolone acetonide crm, lotion, oint 0.025%, 39 triamcinolone acetonide crm, lotion, oint 0.1%, 39 triamcinolone acetonide crm, oint 0.5%, 39 triamcinolone acetonide spray, 36 triamcinolone paste, 40 triamterene/hydrochlorothiazide, 15 triazolam, 19 TRIBENZOR, 13 TRICOR, 14 trifluoperazine, 19 trifluridine, 41 trihexyphenidyl, 18 TRILEPTAL, 17 TRILIPIX, 13 trimethobenzamide caps, 27 trimethoprim, 11 trimipramine, 18 TRINATAL RX1, 33 triprolidine/pseudoephedrine liq, syp, 35 TRIUMEQ, 8 TRIZIVIR, 8 tropicamide, 42 trospium, 29 trospium ext-rel, 29 TRUE METRIX AIR kits, 23 TRUE METRIX kits, 23 TRUE METRIX test strips, 23 TRUSOPT, 42 TRUVADA, 9 TRUZONE peak flow meter, 36 trypsin/balsam/castor oil, 40 TYBOST, 8 TYKERB, 12 TYLENOL, 6 TYLENOL w/CODEINE, 6 TYMLOS, 23 TYVASO, 16
U ubidecarenone, 34 ubiquinol liposomal, 34 ulipristal, 24 ULORIC, 6 ULTRACET, 7 ULTRAM, 7 umeclidinium, 34 umeclidinium/vilanterol, 34 UPTRAVI, 16 URECHOLINE, 30 UROCIT-K, 30 UROXATRAL, 29 URSO, 27 ursodiol, 27
V VAGIFEM, 25 VAGISTAT-1, 29 valacyclovir, 10 VALCHLOR, 11 VALCYTE, 10 valganciclovir, 10
VALIUM, 16 valproic acid, 17 valsartan, 13 valsartan/hydrochlorothiazide, 13 VALTREX, 10 vancomycin oral soln, 11 vandetanib, 12 vaporizer, 36 VAPORIZER, 36 varenicline, 21 VASERETIC, 12 VASOTEC, 12 VELETRI, 16 VELIVET, 24 venlafaxine ext-rel, 17 venlafaxine tabs, 17 VENTAVIS, 16 VENTOLIN HFA, 35 verapamil ext-rel tabs, 15 VIBRAMYCIN, 8 VIBRAMYCIN SYRUP, 8 VICTOZA, 22 VIDEX, 9 VIDEX EC, 9 VIGAMOX, 41 VIMPAT, 17 VINATE II, 32 VINATE M, 33 VINATE ONE, 33 VIRACEPT, 9 VIRAMUNE, 9 VIRAMUNE XR, 9 VIREAD, 9 VISTARIL, 35 VITAFOL-OB, 33 vitamin ADC/fluoride drops, 34 vitamin ADC/fluoride/iron drops, 34 vitamin B complex/vitamin C/folic acid, 34 VITAMIN B-2, 34 VITAMIN B-6, 34 VITAMIN C, 33 VITAMIN D, 33 vitamin E, 34 VITAMIN E, 34 VOLTAREN GEL, 6 vorinostat, 12 VOSEVI, 10 VOTRIENT, 12 VYVANSE, 19
W warfarin, 30 WELLBUTRIN SR, 18 WELLBUTRIN XL, 18 WINRHO SDF, 31 WIXELA INHUB, 37
X XALATAN, 42 XANAX, 16 XANAX XR, 16 XARELTO, 30 XELODA, 11 XENAZINE, 19 XIFAXAN, 11 XIIDRA, 42 XOLAIR, 36
63
XULANE, 24 XYREM, 20
Y YASMIN, 23 YOUR LIFE PRENATAL, 33
Z zafirlukast, 36 ZANAFLEX, 20 zanamivir, 10 ZANTAC, 27 ZARONTIN, 17 ZARXIO, 30 ZAVESCA, 25 ZEGERID OTC, 28 ZELAPAR, 18 ZEMPLAR, 25 ZENPEP, 28 ZESTORETIC, 12 ZESTRIL, 12 ZETIA, 13 ZIAC, 14 ZIAGEN, 9 zidovudine, 9 ZIKS, 40 zileuton, 36 zileuton ext-rel, 36 zinc, 34
zinc acetate, 40 zinc sulfate, 34 ziprasidone, 18 ZIRGAN, 41 ZITHROMAX, 7 ZOCOR, 14 ZOFRAN, 27 ZOLINZA, 12 ZOLOFT, 17 zolpidem, 19 ZONEGRAN, 17 zonisamide, 17 ZOSTAVAX, 32 zoster vaccine, 32 zoster vaccine recombinant, 32 ZOSTRIX, 40 ZOVIRAX, 10, 40 ZUBSOLV, 20 ZYBAN, 21 ZYDELIG, 12 ZYFLO, 36 ZYLOPRIM, 6 ZYPREXA, 18 ZYPREXA RELPREVV, 18 ZYRTEC, 34 ZYRTEC-D 12 Hour, 35 ZYVOX, 10
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