Florida Blue January 2017 Rx Medication Guide

3022 © Prime Therapeutics LLC 01/18 Rev.10/2017

January 2018

Medication Guide

Please consider talking to your doctor about prescribing one of the formulary medications that are indicated as covered under your plan; which may help reduce your out-of-pocket costs. This list may help guide you and your doctor in selecting an appropriate medication for you.

The drug formulary is regularly updated. Please visit www.floridablue.com for the most up-to-date information.

Contents Introduction ................................................................I Medication list .............................................................II Changes to the formulary ...........................................II Your Share of Expenses ............................................III Pharmacy Benefits .....................................................III Medications that are not covered .............................III Condition Care Rx Program ..................................... IV Generic drugs ........................................................... IV Mail Order Pharmacy ................................................ IV Oral Chemotherapy Drugs ........................................ IV Over-the-counter (OTC) medications ........................ V Preventive Services ................................................... V Immunizations ............................................................ V Women’s preventive Services ................................... V Specialty Pharmacy medications ............................... V Participating Specialty Pharmacy Provider .............. VI Three-month supply .................................................. VI Pharmacy Options ................................................... VII Utilization Management Programs .......................... VII Obtaining Prior Authorization ................................... VII Responsible Quantity Program ............................... VIII Responsible Steps Program ................................... VIII Responsible Steps (Medical Pharmacy) Program ........... VIII U/M Exception Requests .......................................... IX Notice ........................................................................ IX Using the Medication Guide ..................................... IX Abbreviation/acronym key ......................................... X

Preferred Medication List Anti-Infective Drugs .................................................... 1 Immunizing Agents ................................................... 14 Cancer Drugs ........................................................... 17 Hormones, Diabetes and Related Drugs ................. 23 Heart and Circulatory Drugs ..................................... 43 Respiratory Drugs..................................................... 65 Gastrointestinal Drugs .............................................. 71 Genitourinary Drugs ................................................. 77 Central Nervous System Drugs ................................ 80 Pain Relief Drugs ...................................................... 98 Neuromuscular Drugs ............................................ 108 Supplements ........................................................... 118 Blood Modifying Drugs ........................................... 127 Topical Products ..................................................... 137 Miscellaneous Categories ...................................... 152 Index ...................................................................... 156

To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search.

http://www.floridablue.com/

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide I

Introduction

Florida Blue and Florida Blue HMO are pleased to present the Medication Guide. This is a general guide that includes an abbreviated listing of Brand and Generic medications that are covered under your plan. Since coverage for medication varies by the plan purchased by you or your employer, it’s important that you refer to your plan documents for complete coverage details. When we refer to “plan documents” we are referring to one or more of the following: Benefit Booklet, Certificate of Coverage, Contract, Member Handbook or prescription drug endorsement.

The Medication Guide provides helpful tips on how to make the most of your pharmacy benefits and details about the various coverage programs that are designed to provide safe and appropriate medication when you need it. Changes in the formulary can occur over time and the most up-to-date listing can always be found by viewing the Medication Guide online at www.floridablue.com or by calling the customer service number listed on your member ID card. For the hearing impaired, call Florida TTY Relay Service 711.

Si desea hablar sobre esta guía en español con uno de nuestros representantes, por favor llame al número de atención al cliente indicado en su tarjeta de asegurado y pida ser transferido a un representante bilingüe.

NOTE: The decision concerning whether a prescription medication should be prescribed must be made by you and your physician. Any and all decisions that require or pertain to independent professional medical judgments or training, or the need for, and dosage of, a prescription medication, must be made solely by you and your treating physician in accordance with the patient/physician relationship.

Key Tips and Coverage Guidelines

By following these simple guidelines, you will be assured that you are getting the maximum benefit from your plan.

• When you have your prescriptions filled, ask your pharmacist if a generic equivalent is available. Generic medications are usually less expensive and most generics are covered unless specifically excluded under your plan documents.

• Select Brand Name medications are included in the formulary and are therefore available to you through your plan. The List includes all covered brand name medications unless specifically excluded under your plan documents.

• Take this Guide with you when you visit your doctor or health care provider so that he or she is aware of the drugs listed and cost impacts when you discuss medication options.


Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide II

Medication List

The Medication Guide includes the Preferred Medication List and some commonly prescribed Non-Preferred prescription medications. The Preferred Medication List reflects the current recommendations of Florida Blue and is developed in conjunction with Prime Therapeutics’ National Pharmacy & Therapeutics Committee.

NOTE: This is not a complete listing of all covered prescriptions medications. Florida Blue reserves the right to modify (add, remove or change) the tier or apply limits of coverage to any prescription medication in this Medication Guide at any time.

For your out-of-pocket expenses to be as low as possible, please consider asking your doctor to prescribe generic medications, or if necessary, brand name medications that are included on the List. This will help ensure that your covered medications are allowed and reimbursed under your plan. In addition, consider using a participating pharmacy to obtain your covered medications because your out-of-pocket expenses should be lower than if you used a non-participating pharmacy.

To save the most money on medications, share this Medication Guide with your doctor or health care provider at each visit so he or she is aware of the drugs listed and cost impacts when you discuss medication options.

Changes to the formulary

The Formulary List is subject to change at any time. It is reviewed quarterly to examine new medications and new information about medications that are already on the market concerning safety, effectiveness and current use in therapy.

There are varying reasons changes are made to the medications listed in the Medication Guide:

• The tier level of a medication included on the medication list may increase (change to a higher tier or non-covered) when an FDA-approved bioequivalent generic medication becomes available.

• Newly marketed prescription medications may not be covered until the Pharmacy & Therapeutics Committee has had an opportunity to review the medication, to determine whether the medication will be covered and if so, which tier will apply based on safety, efficacy and the availability of other products within that class of medications. Go to New To Market Drug List for the most up-to-date information.

The most up to date information about modifications to the medications listed in this Medication Guide can be found by:

Going to www.floridablue.com.

• Click on the Members tab.

• Click on the Login Now button and either Login or Register.

• Once Logged in, click on My Plan, then select Pharmacy from the drop down menu.

• Under Medication Guide/Approved Drug Lists, click Medication Guide or Medication Guide Updates.

Medication Guides are posted every January and July, and Medication Guide Updates are posted January, April, July and October.

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_NewToMarket.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_NewToMarket.pdf

http://www.floridablue.com

http://www.floridablue.com./

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuideUpdate.pdf

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide III

Your Share of Expenses Your cost share will depend on which cost share tier the medication is assigned. You can determine your out-of-pocket amount for medication by reviewing your Schedule of Benefits. If your plan includes a Deductible, you may have to satisfy that amount before the costs of your medications are covered.

If you or your provider requests a covered brand name medication when there is a generic medication available; you will be responsible for:

• the difference in cost between the generic medication and the brand name medication; and

• the cost share applicable to brand name medication, as indicated on your Schedule of Benefits.

Pharmacy Benefits

The pharmacy benefit has three parts/components, called Tiers. This means that covered medications must be included in one of the following Tiers, unless specifically excluded by your plan:

Tier 1: Covered Generic Prescription Medications

Tier 2: Covered Preferred Brand Prescription Medications

Tier 3: Covered Non-Preferred Brand Prescription Medications or Medications not listed on the Preferred Medication List

Specialty Medications: Covered Specialty Medications as indicated in the Medication List Condition Care Rx* Value/HSA Preventive Prescription Medications

* Refer to the Condition Care Rx Program section of this Medication Guide for a description of the program

Medications that are not covered

Your pharmacy benefit may not cover select medications. Some of the reasons a medication may not be covered are:

• The medication has been shown to have excessive adverse effects and/or safer alternatives.

• The medication has a preferred formulary alternative or over-the-counter (OTC) alternative.

• The medication is no longer marketed.

• The medication has a widely available/distributed AB rated generic equivalent formulation.

• The medication has not been approved by the FDA.

• The medication has been repackaged — a pharmaceutical product that is removed from the original manufacturer container (Brand Originator) and repackaged by another manufacturer with a different NDC.

• The medication is not covered because of safety or effectiveness concerns.

A list of medications that are not covered may be found at Medications Not Covered List.

NOTE: To determine the medication exclusions that apply to your plan, check your plan documents. Coverage details are also available to you by logging into the member section of www.floridablue.com.

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_DrugsNotCovered.pdf

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide IV

Condition Care Rx Program

The Condition Care Rx Program is designed to help manage the cost of medications used to treat certain chronic conditions and encourage medication adherence. If members have the Condition Care Rx Program as part of their benefits, they can purchase medications from the Condition Care Rx Program Value/Health Savings Account Preventive List at a reduced cost.

A list of medications that are part of the Condition Care Rx Value Program may be found at: Condition Care Rx Program Value List.

A list of medications that are part of the Condition Care Rx Program for Health Savings Account (HSA) compatible plans may be found at: Condition Care Rx Program HSA Preventive List.

Note: Check your plan documents to determine if the Condition Care Rx Program applies to your plan and the applicable cost share. Coverage details may also be available to you by logging into the member section of www.floridablue.com or by calling the customer service number listed on your member ID card.

Generic drugs

Florida Blue encourages the use of generic medications as a way to provide high-quality medications at a reduced cost. Generic medications are as safe and effective as their brand name counterparts, and are usually considerably less expensive.

A Food and Drug Administration (FDA) approved generic medication may be substituted for its brand name counterpart because it:

• Contains the same active ingredient(s) as the brand name medication.

• Is identical in strength, dosage form, and route of administration.

• Is therapeutically equivalent and can be expected to have the same clinical effect and safety profile.

Check with your doctor or health care provider to determine if switching to a generic medication is appropriate for you.

Mail Order Pharmacy

Obtaining prescription medications through the mail order pharmacy may reduce the cost you pay for your prescription medications.

Check you plan documents to determine if you plan provides a mail order pharmacy benefit.

Members who have pharmacy benefits through Florida Blue can access and print out the Mail Order Pharmacy Form on our website, www.floridablue.com.

Note: If the original prescription was filled at a pharmacy other than the mail order pharmacy, you must submit a new original three-month supply prescription with a quantity of up to a three-month supply and not less than a two-month supply along with the Registration and Prescription Order Form. Prescriptions may not be transferred from a retail pharmacy to the Mail Order Pharmacy.

Oral Chemotherapy Drugs

Oral chemotherapy drugs are drugs prescribed by a physician to kill or slow the growth of cancerous cells in a manner consistent with the national accepted standards of practice. A list of these drugs can be found at: Oral Chemotherapy Drug List.

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_ConditionCare.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_ConditionCare.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_ConditionCareHSA.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_PrimeMailOrderForm.pdf


http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_ChemoParity.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_ChemoParity.pdf

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide V

Over-the-Counter (OTC) medications

An over-the-counter medication can be an appropriate treatment for some conditions and may offer a lower cost alternative to some commonly prescribed medications. Your pharmacy benefit may provide coverage for select OTC medications. Some groups may customize their pharmacy plan to exclude coverage for OTC medications, so it is important to check your plan documents to determine if OTC medications are covered under your plan. Only those OTC medications prescribed by your physician and designated on the formulary with “OTC” in parenthesis following the medication name are eligible for coverage.

NOTE: Check your plan documents to determine if this benefit applies to your plan. Coverage details are also available to you logging into the member section of www.floridablue.com.

Patient Protection Affordable Care Act (PPACA) Preventive Services

• Preventive medications - Certain preventive care services, medications, and immunizations are covered at no cost share when purchased at a participating pharmacy.

A list of medications covered under this benefit may be found at: Preventive Medications List. For HSA plans the list of medications may be found at: HSA Preventive List.

• Immunizations - Certain vaccines which are covered under your preventive benefit can be administered by pharmacists that are certified. Not all pharmacies provide services for vaccine administration. It is important to contact the pharmacy prior to your visit to ensure availability and administration of the vaccine.

A list of vaccines that are covered under your pharmacy benefits may be found at: Pharmacy Benefit Vaccines List.

• Women’s preventive services - Certain contraceptive medications or devices (e.g., oral contraceptives, emergency contraceptive, and diaphragms) are covered at no cost share when purchased at a participating pharmacy.

A list of medications and devices covered under this benefit may be found at: Women’s Preventive Services List.

Specialty Pharmacy medications

Specialty Pharmacy medications are high-cost injectable, infused, oral or inhaled medications that generally require close supervision and monitoring of the patient’s therapy.

NOTE: Check your plan documents for information on how Specialty Pharmacy medications are covered on your plan. Coverage details are also available by calling the customer service number listed on your member ID card.

Specialty Medications are divided into two categories:

• Self-Administered – Patients self-administer these Specialty Pharmacy medications themselves. Because these medications are intended to be self-administered, these medications may not be covered if administered in a physician’s office. If these medications are not obtained from a participating Specialty Pharmacy, out-of-network cost shares will apply (where out-of-network coverage is available). A current listing of Self-Administered Specialty Medications can be found here.

• Self-administered injectable medications are designated in the Medication List with “inj” following the medication name (e.g., enoxaparin inj). No other Self-administered injectables will be covered unless such injectable is identified as a Specialty Drug in this Medication Guide. Self-administered injectables will be subject to the Brand or Generic cost share, as described in your Schedule of Benefits. Florida Blue reserves the right to change the Self-administered injectables covered through your plan at any time and for any reason.

• Provider-Administered – These medications require the administration to be performed by a physician. The Specialty Pharmacy medications are ordered by a provider and administered in an office or outpatient setting. Provider-administered Specialty Pharmacy medications are covered under your medical benefit. A current listing of Provider-Administered Specialty Medications can be found here.


http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_PreventiveMedications.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_ConditionCareHSA.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_PharmacyBenefitVaccines.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_WomensPreventive.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_Specialty_Table_Self.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_Specialty_Table_Self.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_Specialty_Table_Prov.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_Specialty_Table_Prov.pdf

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide VI

Note: Medications listed in the Self-Administered Specialty Drug List are not available through mail order.

Participating Specialty Pharmacy Provider

If you are currently taking a Specialty Pharmacy medication, then your network for Specialty Pharmacies is limited to the following participating Specialty Pharmacy providers. Unless indicated below, any other pharmacy is considered a non-participating Specialty Pharmacy even if it participates in Florida Blue’s networks for non-Specialty Pharmacy medications.

Caremark Specialty Pharmacy Services All Products Phone: 1.866.278.5108 Fax: 1.800.323.2445

Caremark Specialty Pharmacy

Caremark Hemophilia Services Hemophilia Products Telephone: 1.866.792.2731 (Mon-Fri., 9:00 a.m. to 7:30 p.m. EST) Fax: 1.866.811.7450

Caremark Hemophilia

AllianceRx Walgreens Prime

Telephone: 877-627-MEDS (6337) Fax: 877-828-3939

TTY 711 AllianceRx Walgreens Prime

Note: Specialty Pharmacy medications are not covered when purchased through the Mail Order Pharmacy.

Self-administered specialty medications as classified by Florida Blue outside of the state of Florida may be obtained by a member with a written prescription through the preferred specialty pharmacy providers Prime Specialty Pharmacy or Caremark Specialty.

If a member resides or is traveling outsides the state of Florida and needs to receive a provider-administered specialty medication, the prescribing physician should coordinate with the participating specialty pharmacy provider for their area or contact the local BlueCross and BlueShield Plan. This coordination can help ensure members receive their medications at the in-network cost share.

Members that receive a written prescription directly from their provider for a provider-administered specialty medication should contact customer service for further assistance.

Three-month supply

Some plans allow you to purchase up to a three-month supply of medications. Check your Benefit Booklet, Certificate of Coverage, Contract, Member Handbook or prescription drug endorsement to determine if your plan includes this benefit. In addition to being able to obtain up to a three-month supply of medication through our mail order pharmacy, you may be able to receive up to a three-month supply of your medication through a participating retail pharmacy. Please refer to your Benefit Booklet, Certificate of Coverage, Contract, Member Handbook or prescription drug endorsement for complete coverage details.

http://www.cvscaremarkspecialtyrx.com/

https://www.cvscaremarkspecialtyrx.com/wps/portal/specialty/patients/drugs-conditions/conditions/hemophilia/!ut/p/c5/hY1djoIwFEbX4gJMrxaxPt5a4yAzZlD5kRdTC1MwYIlBCq5eNmDmO48nJx9JychddqWWbWnusiIJSd0LbqMwgPXSZcJfAG5ZSKm_oQAw-rN7gQ9D-KfekVRX5jr-xOJsemFQCxR_tuW

https://www.primetherapeutics.com/speciality

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue July 2017 Rx Medication Guide VII

Pharmacy Options

There are two different types of pharmacies for you to be aware of as you decide where to get your prescriptions filled – retail pharmacies and specialty pharmacies. To save the most money, before you get a prescription filled, you should confirm which pharmacy is considered ‘in-network’ for that particular medication.

• Participating Pharmacy

o Retail Pharmacy Network – Non-Specialty ‘Generic’ medications and ‘Brand Name’ medications listed in the Medication Guide can be filled at these pharmacies at a lower cost to you than other pharmacies in your area. If you go to a non-participating pharmacy, your prescription will cost you more.

o Specialty Pharmacy Network – We have identified certain drugs as specialty drugs due to requirements such as special handling, storage, training, distribution, and management of the therapy. These drugs are listed as a ‘Specialty Drug’ in this Medication Guide. To be covered under your pharmacy program at the in-network cost share, they must be purchased at a preferred Specialty Pharmacy. These pharmacies are different than the retail pharmacies and are identified in both the Provider Directory and this Medication Guide. Using an in-network Specialty Pharmacy to provide these Specialty Drugs lowers the amount you pay for these medications.

• Non-Participating Pharmacy

o If your plan offers out-of-network pharmacy coverage, choosing a non-participating pharmacy will cost you more money. You may have to pay the full cost of the medication and then file a claim to be reimbursed. Our payment will be based on our Non-Participating Pharmacy Allowance minus your cost share. You will be responsible for your cost share and the difference between our Allowance and the cost of the medication.

Utilization Management Programs The Prior Authorization Program encourages the appropriate, safe and cost-effective use of medication. If you are currently taking or are prescribed a medication that is included in the Prior Authorization Program, your physician will need to submit a request form in order for your prescription to be considered for coverage. If you do not request and/or receive prior approval, the medication will not be covered. A current listing of drugs requiring prior authorization are indicated in the prior authorization column following the product name in the medication list.

Florida Blue reserves the right to change the medications that require Prior Authorization at any time and for any reason.

NOTE: Some groups may customize their pharmacy plan to exclude prior authorization requirements, so it is important to check your plan documents to determine if prior authorization requirements apply to your plan. Coverage details are also available to you by logging into the member section of www.floridablue.com.

Obtaining Prior Authorization

Information about Prior Authorization and forms for how to obtain a prior authorization approval can be found here:

Prior Authorization Program Information and Forms

NOTE: Your provider is required to complete and submit the Prior Authorization form in order for a coverage determination to be made.


http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_PriorAuthorization.pdf

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide VIII

Once a decision is made, you and/or your doctor will be informed of the decision. If the decision is made to authorize coverage, the medication(s) and/or supplies may be obtained from a participating pharmacy or at the appropriate location if the medication(s) will be administered by a health professional. Prior authorization approval does not waive your cost share. If a decision is made to deny authorization, you are free to purchase the prescription medication, supplies or over-the-counter (OTC) medication, but you will have to pay the full cost of the medication and will not be entitled to reimbursement under your plan.

NOTE: You have the right to request an appeal if coverage authorization is denied. Please refer to the “How to Appeal an Adverse Benefit Determination” subsection of the Claims Processing or Appeal and Grievance Process section in your current plan documents for information on how to file an appeal.

Responsible Quantity Program

The Responsible Quantity Program encourages the appropriate, safe and cost-effective use of medication by setting a maximum quantity per month for a medication or supply. The quantity limitations are based on the Food and Drug Administration guidelines and the manufacturer’s dosing recommendations. Medications that are subject to this program are indicated in the quantity limits column following the product name in the medication list.

Florida Blue reserves the right to change the Drugs and the quantity limits subject to the Responsible Quantity Program at any time and for any reason. In cases where a larger quantity of a Responsible Quantity Drug is medically required, your doctor or health care provider can request an override.

Information about the Responsible Quantity Program and steps for how to obtain an exception can be found here: Responsible Quantity Program Information

Responsible Steps Program

The Responsible Steps Program promotes the appropriate, safe, and effective use of medications and helps you save on prescriptions. Responsible Steps is based on nationally recognized therapeutic guidelines, clinical evidence, and research. For certain prescription medications, you are required to try designated or prerequisite medication(s) prior to trying a medication subject to the Responsible Steps Program.

A list of current drugs included in the Responsible Steps Program may be found here: Responsible Steps Program Information

Responsible Steps (Medical Pharmacy) Program

Certain physician-administered prescription drugs which are rendered in a physician’s office may be included in the Responsible Steps for Medical Pharmacy Program. If you are taking a medication in the Responsible Steps Program, please contact your physician/provider to discuss what medication options are best for you.

If, due to medical reasons, you cannot use the prerequisite drug and require the Responsible Steps Medication, your doctor or health care provider may request prior authorization for an override. If the override request is approved, coverage will be provided for the Responsible Steps Medication. Florida Blue reserves the right to change the drugs subject to the Responsible Steps Program at any time and for any reason.

A list of current drugs included in the Responsible Steps Program may be found here: Responsible Steps for Medical Pharmacy Program Information

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_ResponsibleQuantity.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_ResponsibleSteps.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_MedicalResponsibleStepsTable.pdf

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue July 2017 Rx Medication Guide IX

U/M Exception Requests

If, for medical reasons, you require a quantity of medication outside the Responsible Quantity Program limits or you cannot use one of the alternative medications and require the medication listed in the Responsible Steps or Responsible Steps for Medical Pharmacy Programs, or you require a tier exception for an oral contraceptive drug, your physician may submit an exception request by completing one of the forms below:

Prior Authorization Forms Responsible Quantity Authorization Form Responsible Steps Program Information and Authorization Forms Responsible Steps for Medical Pharmacy Information and Authorization Forms Oral Contraceptives Tier Exception Request Form

Notice This Medication Guide shall not extend, vary, alter, replace, or waive any of the provisions, benefits, exclusions, limitations, or conditions contained in your plan documents. In the event of any inconsistencies between the Medication Guide and the provisions contained in your plan documents, the provisions contained in your plan documents shall control to the extent necessary to effectuate the intent of Blue Cross and Blue Shield of Florida and Health Options, Inc.

Using the Medication Guide

The Medication List is organized into broad categories (e.g., Antibacterials). Below are descriptions of the columns included the medication list.

Column 1. Drug Name: lists the medication name. Generic medications are listed in lowercase boldface (e.g., demeclocycline) followed by a reference to the brand prescription drug (in parentheses) to assist in product recognition. Example: azithromycin (Zinthromax). The brand name reference does not indicate the brand prescription drug is covered. Covered Brand name medications are listed in UPPERCASE letters (e.g., ZITHROMAX packets). Separate medication entries are shown for each dosage form and strength. Note: Self-administered injectable medications are designated in the medication list with “inj” following the medication name (e.g., enoxaparin inj).

Column 2. Drug Tier: indicates the tier level and whether the medication is on the preventive list: 1 (Lowest Cost): Covered Generic Prescription Medications 2 (Higher Cost): Covered Preferred Brand Prescription Medications 3 (Highest Cost): Covered Non-Preferred Brand Prescription Medications or Medications not listed on the

Preferred Medication List

Column 3. Specialty: indicates if the medication is a Self-Administered Specialty medication. *If your Pharmacy plan has a separate cost share for Specialty medications, then all Specialty medications will apply that cost share regardless of the Tier level displayed in the Medication List. Check your plan documents to determine how coverage of Self-Administered Specialty medications applies to your plan.

Column 4. Prior Authorization: indicates if the prior authorization requirement applies to the medication. If an indicator is present in the column, then the prior authorization requirement applies.

Column 5. Quantity Limit: indicates if quantity limits apply to the medication. If an indicator is present in the column, then quantity limits apply.

Column 6. Responsible Steps: indicates if responsible steps apply to the medication. If an indicator is present in the column then the Responsible Steps Program applies.

An asterisk (*) next to a drug name signifies that this drug may not be covered. Please refer to your plan documents.

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_PriorAuthorization.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/RxF_QuantityLimit.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_ResponsibleSteps.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_MedicalResponsibleStepsTable.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_OC_TierException.pdf

http://www.bcbsfl.com/DocumentLibrary/Providers/Content/Rx_OC_TierException.pdf

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. Florida Blue HMO is a trade name of Health Options, Inc., an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue January 2018 Rx Medication Guide X

Abbreviation/acronym key

cap .........................................................capsules chew tabs ................................. chewable tablets conc .................................................. concentrate crm ............................................................. cream ext-release............................... extended-release inhal ..................................................... inhalation inj ............................................................injection lotn .............................................................. lotion NP .................................................. non-preferred ODT ........................... orally disintegrating tablets oint ......................................................... ointment OSM ........................................... osmotic-release

OTC .................................................................. over-the-counter PA .................................. Prior Coverage Authorization required QL ......... Responsible Quantity Program —quantity limit applies RS .. Responsible Steps Program —Pre-requisite drug required SI ....................................................Self-Administered Injectable SL ............................................................................... sublingual SP ................................................................ Specialty Pharmacy soln ................................................................................ solution supp ...................................................................... suppositories susp ......................................................................... suspension tabs .................................................................................. tablets

To determine if your drug is covered and/or find drug pricing, please login to Your Account on the Florida Blue website at www.floridablue.com. In Your Account choose Tools, and then Compare Drug Prices.


2018

TierKEY 1 = Covered Generic Drugs 2 = Preferred Brand Drugs * = May not be covered – see endorsement

3 = Non-preferred Brand Drugs • = Responsible Rx Program X = Tier 4: Separate Specialty costsharemay apply – see endorsement

Florida Blue January 2018 Rx Medication Guide 1

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ANTI-INFECTIVE DRUGSPENICILLINSAMOXICILLIN – amoxicillin

(trihydrate) chew tab 125 mg3

AMOXICILLIN – amoxicillin(trihydrate) chew tab 250 mg

2

amoxicillin (trihydrate) cap250 mg

1

amoxicillin (trihydrate) cap500 mg

1

amoxicillin (trihydrate) for susp125 mg/5ml

1


1


1


1

amoxicillin (trihydrate) tab500 mg

1

amoxicillin (trihydrate) tab875 mg

1

amoxicillin & k clavulanate forsusp 200-28.5 mg/5ml

1

amoxicillin & k clavulanatefor susp 250-62.5 mg/5ml(Augmentin)

1

amoxicillin & k clavulanate forsusp 400-57 mg/5ml

1

amoxicillin & k clavulanatefor susp 600-42.9 mg/5ml(Augmentin es-600)

1

amoxicillin & k clavulanate tab er12hr 1000-62.5 mg (Augmentinxr)

1

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amoxicillin & k clavulanate tab250-125 mg

1

amoxicillin & k clavulanate tab500-125 mg (Augmentin)

1

amoxicillin & k clavulanate tab875-125 mg (Augmentin)

1

AMOXICILLIN/CLAVULANATE P –amoxicillin & k clavulanate chewtab 200-28.5 mg

3

AMOXICILLIN/CLAVULANATE P –amoxicillin & k clavulanate chewtab 400-57 mg

3

AMPICILLIN – ampicillin cap 500mg

2

AUGMENTIN – amoxicillin & kclavulanate tab 500-125 mg

3

AUGMENTIN – amoxicillin & kclavulanate tab 875-125 mg

3

AUGMENTIN – amoxicillin & kclavulanate for susp 125-31.25mg/5ml

2

AUGMENTIN – amoxicillin & kclavulanate for susp 250-62.5mg/5ml

3

AUGMENTIN ES-600 – amoxicillin& k clavulanate for susp 600-42.9mg/5ml

3

AUGMENTIN XR – amoxicillin& k clavulanate tab er 12hr1000-62.5 mg

3

dicloxacillin sodium cap 250 mg 1

dicloxacillin sodium cap 500 mg 1

MOXATAG – amoxicillin (trihydrate)tab er 24hr 775 mg

3

PENICILLIN V POTASSIUM –penicillin v potassium for soln125 mg/5ml

2

2018




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PENICILLIN V POTASSIUM –penicillin v potassium for soln250 mg/5ml

2

penicillin v potassium tab250 mg

1

penicillin v potassium tab500 mg

1

CEPHALOSPORINSCEDAX – ceftibuten cap 400 mg 3

CEDAX – ceftibuten for susp 180mg/5ml

3

CEFACLOR – cefaclor for susp125 mg/5ml

3


3


3

cefaclor cap 250 mg 1

cefaclor cap 500 mg 1

cefadroxil cap 500 mg 1

cefadroxil for susp 250 mg/5ml 1

cefadroxil for susp 500 mg/5ml 1

cefadroxil tab 1 gm 1

cefdinir cap 300 mg 1

cefdinir for susp 125 mg/5ml 1

cefdinir for susp 250 mg/5ml 1

CEFDITOREN PIVOXIL –cefditoren pivoxil tab 200 mg(base equivalent)

3

CEFDITOREN PIVOXIL –cefditoren pivoxil tab 400 mg(base equivalent)

3

cefixime for susp 100 mg/5ml(Suprax)

1

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cefixime for susp 200 mg/5ml(Suprax)

1

cefpodoxime proxetil for susp50 mg/5ml

1

cefpodoxime proxetil for susp100 mg/5ml

1

cefpodoxime proxetil tab 100 mg 1

cefpodoxime proxetil tab 200 mg 1

cefprozil for susp 125 mg/5ml 1

cefprozil for susp 250 mg/5ml 1

cefprozil tab 250 mg 1

cefprozil tab 500 mg 1

CEFTIBUTEN – ceftibuten cap 400mg

3

CEFTIBUTEN – ceftibuten for susp180 mg/5ml

3

CEFTIN – cefuroxime axetil forsusp 125 mg/5ml

3

CEFTIN – cefuroxime axetil forsusp 250 mg/5ml

3

cefuroxime axetil tab 250 mg 1

cefuroxime axetil tab 500 mg(Ceftin)

1

cephalexin cap 250 mg (Keflex) 1



cephalexin for susp 125 mg/5ml 1

cephalexin for susp 250 mg/5ml 1

KEFLEX – cephalexin cap 250 mg 3



SPECTRACEF – cefditoren pivoxiltab 400 mg (base equivalent)

3

SUPRAX – cefixime cap 400 mg 2

2018




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SUPRAX – cefixime chew tab 100mg

2

SUPRAX – cefixime chew tab 200mg

2

SUPRAX – cefixime for susp 100mg/5ml

3


3


2

MACROLIDESAZITHROMYCIN – azithromycin

powd pack for susp 1 gm3

azithromycin for susp100 mg/5ml (Zithromax)

1

azithromycin for susp200 mg/5ml (Zithromax)

1

azithromycin tab 250 mg(Zithromax)

1


1


1

CLARITHROMYCIN –clarithromycin for susp 125mg/5ml

3

CLARITHROMYCIN –clarithromycin for susp 250mg/5ml

3

clarithromycin tab er 24hr500 mg

1

clarithromycin tab 250 mg(Biaxin)

1

clarithromycin tab 500 mg(Biaxin)

1

DIFICID – fidaxomicin tab 200 mg 3 •

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E.E.S. GRANULES – erythromycinethylsuccinate for susp 200mg/5ml

3

E.E.S. 400 – erythromycinethylsuccinate tab 400 mg

3

ERY-TAB – erythromycin tabdelayed release 250 mg

3


3


3

ERYPED 200 – erythromycinethylsuccinate for susp 200mg/5ml

3

ERYPED 400 – erythromycinethylsuccinate for susp 400mg/5ml

3

ERYTHROCIN STEARATE –erythromycin stearate tab 250mg

3

ERYTHROMYCIN BASE –erythromycin tab 250 mg

3

ERYTHROMYCIN BASE –erythromycin tab 500 mg

3

ERYTHROMYCINETHYLSUCCINA – erythromycinethylsuccinate tab 400 mg

3

erythromycin ethylsuccinatefor susp 200 mg/5ml (E.e.s.granules)

1

erythromycin w/ delayed releaseparticles cap 250 mg

1

PCE – erythromycin w/ entericcoated particles tab 333 mg

3

PCE – erythromycin w/ entericcoated particles tab 500 mg

3

2018




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ZITHROMAX – azithromycin tab250 mg

3


3


3

ZITHROMAX – azithromycin forsusp 100 mg/5ml

3

ZITHROMAX – azithromycin forsusp 200 mg/5ml

3

ZITHROMAX – azithromycin powdpack for susp 1 gm

2

ZITHROMAX TRI-PAK –azithromycin tab 500 mg

3

ZITHROMAX Z-PAK –azithromycin tab 250 mg

3

ZMAX – azithromycin extendedrelease for oral susp 2 gm

3

TETRACYCLINESdemeclocycline hcl tab 150 mg 1

demeclocycline hcl tab 300 mg 1

doxycycline hyclate cap 50 mg 1

doxycycline hyclate cap 100 mg(Vibramycin)

1

doxycycline hyclate tab delayedrelease 75 mg

1

doxycycline hyclate tab 20 mg 1

doxycycline hyclate tab 75 mg(Acticlate)

1

doxycycline hyclate tab 100 mg 1

doxycycline hyclate tab 150 mg(Acticlate)

1

doxycycline monohydrate cap50 mg

1

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doxycycline monohydrate cap100 mg (Monodox)

1

doxycycline monohydrate forsusp 25 mg/5ml (Vibramycin)

1

doxycycline monohydrate tab50 mg (Adoxa)

1

doxycycline monohydrate tab75 mg (Adoxa)

1

doxycycline monohydrate tab100 mg (Adoxa pak 1/100)

1

doxycycline monohydrate tab150 mg (Adoxa pak 1/150)

1

minocycline hcl cap 50 mg(Minocin)

1


1


1

minocycline hcl tab 50 mg 1



TETRACYCLINE HCL –tetracycline hcl cap 250 mg

3

TETRACYCLINE HCL –tetracycline hcl cap 500 mg

3

tetracycline hcl cap 250 mg(Tetracycline hcl)

1

tetracycline hcl cap 500 mg(Tetracycline hcl)

1

VIBRAMYCIN – doxycyclinecalcium syrup 50 mg/5ml

3 •

FLUOROQUINOLONESAVELOX – moxifloxacin hcl tab 400

mg (base equiv)3

CIPRO – ciprofloxacin for oral susp250 mg/5ml (5%) (5 gm/100ml)

3

2018




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CIPRO – ciprofloxacin for oralsusp 500 mg/5ml (10%) (10gm/100ml)

3

CIPRO – ciprofloxacin hcl tab 250mg (base equiv)

3

CIPRO – ciprofloxacin hcl tab 500mg (base equiv)

3

CIPRO XR – ciprofloxacin-ciprofloxacin hcl tab er 24hr 500mg (base eq)

3

CIPRO XR – ciprofloxacin-ciprofloxacin hcl tab er 24hr 1000mg(base eq)

3

ciprofloxacin for oral susp250 mg/5ml (5%) (5 gm/100ml)(Cipro)

1

ciprofloxacin for oralsusp 500 mg/5ml (10%)(10 gm/100ml) (Cipro)

1

CIPROFLOXACIN HCL –ciprofloxacin hcl tab 100 mg(base equiv)

3

ciprofloxacin hcl tab 250 mg(base equiv) (Cipro)

1

ciprofloxacin hcl tab 500 mg(base equiv) (Cipro)

1

ciprofloxacin hcl tab 750 mg(base equiv)

1

ciprofloxacin-ciprofloxacin hcltab er 24hr 500 mg (base eq)(Cipro xr)

1

ciprofloxacin-ciprofloxacin hcltab er 24hr 1000 mg(base eq)(Cipro xr)

1

FACTIVE – gemifloxacin mesylatetab 320 mg (base equiv)

3

LEVAQUIN – levofloxacin tab 250mg

3

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3


3

LEVOFLOXACIN – levofloxacinoral soln 25 mg/ml

3

levofloxacin tab 250 mg(Levaquin)

1


1


1

moxifloxacin hcl tab 400 mg(base equiv) (Avelox)

1

OFLOXACIN – ofloxacin tab 300mg

3

ofloxacin tab 400 mg 1

SULFONAMIDESSULFADIAZINE – sulfadiazine tab

500 mg2

AMINOGLYCOSIDESBETHKIS – tobramycin nebu soln

300 mg/4ml2 X

KITABIS PAK – tobramycin nebusoln 300 mg/5ml

3 X

neomycin sulfate tab 500 mg 1

paromomycin sulfate cap250 mg

1

TOBI PODHALER – tobramycininhal cap 28 mg

2 X

TOBRAMYCIN – tobramycin nebusoln 300 mg/5ml

3 X

tobramycin nebu soln300 mg/5ml (Tobi)

1 X

TUBERCULOSIS

2018




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CYCLOSERINE – cycloserine cap250 mg

3

ethambutol hcl tab 100 mg(Myambutol)

1

ethambutol hcl tab 400 mg(Myambutol)

1

ISONIAZID – isoniazid syrup 50mg/5ml

2

isoniazid tab 100 mg 1

isoniazid tab 300 mg 1

MYAMBUTOL – ethambutol hcl tab100 mg

3

MYAMBUTOL – ethambutol hcl tab400 mg

3

MYCOBUTIN – rifabutin cap 150mg

3

PASER – aminosalicylic acid ergranules packet 4 gm

3

PRIFTIN – rifapentine tab 150 mg 2

pyrazinamide tab 500 mg 1

rifabutin cap 150 mg (Mycobutin) 1

RIFADIN – rifampin cap 150 mg 3

RIFAMATE – isoniazid & rifampincap 150-300 mg

3

rifampin cap 150 mg (Rifadin) 1

rifampin cap 300 mg (Rifadin) 1

RIFATER – isoniazid-rifampin w/pyrazinamide tab 50-120-300 mg

3

SIRTURO – bedaquiline fumaratetab 100 mg (base equiv)

3

TRECATOR – ethionamide tab 250mg

3

FUNGAL INFECTIONSANCOBON – flucytosine cap 250

mg3

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ANCOBON – flucytosine cap 500mg

3

BIO-STATIN – nystatin cap 500000unit

3

BIO-STATIN – nystatin cap1000000 unit

3

CRESEMBA – isavuconazoniumsulfate cap 186 mg

3 •

DIFLUCAN – fluconazole tab 50mg

3


3


3


3

DIFLUCAN – fluconazole for susp10 mg/ml

3

DIFLUCAN – fluconazole for susp40 mg/ml

3

fluconazole for susp 10 mg/ml(Diflucan)

1

fluconazole for susp 40 mg/ml(Diflucan)

1

fluconazole tab 50 mg (Diflucan) 1




flucytosine cap 250 mg(Ancobon)

1

flucytosine cap 500 mg(Ancobon)

1

GRIS-PEG – griseofulvinultramicrosize tab 125 mg

3

GRIS-PEG – griseofulvinultramicrosize tab 250 mg

3

2018




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griseofulvin microsize susp125 mg/5ml

1

griseofulvin microsize tab500 mg

1

griseofulvin ultramicrosize tab125 mg (Gris-peg)

1

griseofulvin ultramicrosize tab250 mg (Gris-peg)

1

itraconazole cap 100 mg(Sporanox)

1 •

ketoconazole tab 200 mg 1

LAMISIL – terbinafine hcl tab 250mg

3

NOXAFIL – posaconazole tabdelayed release 100 mg

3 •

NOXAFIL – posaconazole susp 40mg/ml

2 •

nystatin tab 500000 unit 1

SPORANOX – itraconazole oralsoln 10 mg/ml

2 •

SPORANOX – itraconazole cap100 mg

3 •

SPORANOX PULSEPAK –itraconazole cap 100 mg

3 •

terbinafine hcl tab 250 mg(Lamisil)

1

VFEND – voriconazole for susp 40mg/ml

3 •

VFEND – voriconazole tab 50 mg 3 •VFEND – voriconazole tab 200 mg 3 •voriconazole for susp 40 mg/ml

(Vfend)1 •

voriconazole tab 50 mg (Vfend) 1 •voriconazole tab 200 mg (Vfend) 1 •VIRAL INFECTIONS

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CytomegalovirusVALCYTE – valganciclovir hcl for

soln 50 mg/ml (base equiv)3

valganciclovir hcl for soln50 mg/ml (base equiv) (Valcyte)

1

valganciclovir hcl tab 450 mg(base equivalent) (Valcyte)

1

Hepatitisadefovir dipivoxil tab 10 mg

(Hepsera)1

BARACLUDE – entecavir oral soln0.05 mg/ml

2

BARACLUDE – entecavir tab 0.5mg

3

BARACLUDE – entecavir tab 1 mg 3

COPEGUS – ribavirin tab 200 mg 3 X •DAKLINZA – daclatasvir

dihydrochloride tab 30 mg (baseequivalent)

3 X • •

DAKLINZA – daclatasvirdihydrochloride tab 60 mg (baseequivalent)

3 X • •

DAKLINZA – daclatasvirdihydrochloride tab 90 mg (baseequivalent)

3 X • •

entecavir tab 0.5 mg (Baraclude) 1

entecavir tab 1 mg (Baraclude) 1

EPCLUSA – sofosbuvir-velpatasvirtab 400-100 mg

2 X • •

EPIVIR HBV – lamivudine tab 100mg (hbv)

2

EPIVIR HBV – lamivudine oral soln5 mg/ml (hbv)

2

HARVONI – ledipasvir-sofosbuvirtab 90-400 mg

2 X • •

2018




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HEPSERA – adefovir dipivoxil tab10 mg

3

INTRON A – interferon alfa-2b inj6000000 unit/ml

2 X •


2 X •

INTRON A – interferon alfa-2b forinj 10000000 unit

2 X •


2 X •


2 X •

INTRON A W/DILUENT –interferon alfa-2b for inj10000000 unit

2 X •


2 X •


2 X •

lamivudine tab 100 mg (hbv)(Epivir hbv)

1

MAVYRET – glecaprevir-pibrentasvir tab 100-40 mg

2 X • •

MODERIBA – ribavirin tab 200 mg& ribavirin 400 mg tab therapypack

3 X •

MODERIBA – ribavirin tab 400 mg& ribavirin 600 mg tab therapypack

3 X •

MODERIBA 1200 DOSE PACK –ribavirin tab 600 mg

3 X •

MODERIBA 800 DOSE PACK –ribavirin tab 400 mg

3 X •

OLYSIO – simeprevir sodium cap150 mg (base equivalent)

3 X • •

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PEGASYS – peginterferon alfa-2ainj 180 mcg/ml

3 X •

PEGASYS – peginterferon alfa-2ainj 180 mcg/0.5ml

3 X •

PEGASYS PROCLICK –peginterferon alfa-2a inj 135mcg/0.5ml

3 X •

PEGASYS PROCLICK –peginterferon alfa-2a inj 180mcg/0.5ml

3 X •

PEGINTRON – peginterferonalfa-2b for inj kit 50 mcg/0.5ml

3 X •


3 X •


3 X •


3 X •

REBETOL – ribavirin cap 200 mg 3 X •REBETOL – ribavirin soln 40 mg/

ml3 X •

RIBASPHERE – ribavirin tab 400mg

3 X •

RIBASPHERE – ribavirin tab 600mg

3 X •

RIBASPHERE RIBAPAK – ribavirintab 200 mg & ribavirin 400 mgtab therapy pack

3 X •

RIBASPHERE RIBAPAK – ribavirintab 400 mg & ribavirin 600 mgtab therapy pack

3 X •

RIBASPHERE RIBAPAK – ribavirintab 400 mg

3 X •

RIBASPHERE RIBAPAK – ribavirintab 600 mg

3 X •

ribavirin cap 200 mg (Rebetol) 1 X •ribavirin tab 200 mg (Copegus) 1 X •

2018




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SOVALDI – sofosbuvir tab 400 mg 2 X • •TECHNIVIE – ombitasvir-

paritaprevir-ritonavir tab12.5-75-50 mg

3 X • •

VEMLIDY – tenofovir alafenamidefumarate tab 25 mg

3

VIEKIRA PAK – ombitas-paritapre-riton & dasab tab pak 12.5-75-50& 250 mg

3 X • •

VIEKIRA XR – dasab-ombit-paritap-riton tab er 24hr200-8.33-50-33.33 mg

3 X • •

VOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab 400-100-100 mg

2 X • •

ZEPATIER – elbasvir-grazoprevirtab 50-100 mg

3 X • •

Herpesacyclovir cap 200 mg (Zovirax) 1

acyclovir susp 200 mg/5ml(Zovirax)

1

acyclovir tab 400 mg (Zovirax) 1

acyclovir tab 800 mg (Zovirax) 1

famciclovir tab 125 mg (Famvir) 1



valacyclovir hcl tab 500 mg(Valtrex)

1

valacyclovir hcl tab 1 gm(Valtrex)

1

ZOVIRAX – acyclovir cap 200 mg 3

ZOVIRAX – acyclovir susp 200mg/5ml

3

ZOVIRAX – acyclovir tab 400 mg 3

ZOVIRAX – acyclovir tab 800 mg 3

HIV/AIDS

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ible

Ste

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abacavir sulfate soln 20 mg/ml(base equiv) (Ziagen)

1 •

abacavir sulfate tab 300 mg(base equiv) (Ziagen)

1 •

abacavir sulfate-lamivudine tab600-300 mg (Epzicom)

1 •

abacavir sulfate-lamivudine-zidovudine tab 300-150-300 mg(Trizivir)

1 •

APTIVUS – tipranavir cap 250 mg 2 •APTIVUS – tipranavir oral soln 100

mg/ml2 •

ATRIPLA – efavirenz-emtricitabine-tenofovir df tab 600-200-300 mg

2 •

COMBIVIR – lamivudine-zidovudine tab 150-300 mg

3 •

COMPLERA – emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg

2 •

CRIXIVAN – indinavir sulfate cap200 mg

2 •

CRIXIVAN – indinavir sulfate cap400 mg

2 •

DESCOVY – emtricitabine-tenofovir alafenamide fumaratetab 200-25 mg

2 •

didanosine delayed releasecapsule 125 mg (Videx ec)

1 •


1 •


1 •


1 •

EDURANT – rilpivirine hcl tab 25mg (base equivalent)

2 •

2018




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EMTRIVA – emtricitabine caps 200mg

2 •

EMTRIVA – emtricitabine soln 10mg/ml

2 •

EPIVIR – lamivudine oral soln 10mg/ml

2 •

EPIVIR – lamivudine tab 150 mg 2 •EPIVIR – lamivudine tab 300 mg 2 •EPZICOM – abacavir sulfate-

lamivudine tab 600-300 mg2 •

EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg (baseequiv)

2 •

fosamprenavir calcium tab700 mg (base equiv) (Lexiva)

1 •

FUZEON – enfuvirtide for inj 90 mg 2 X •GENVOYA – elvitegrav-cobic-

emtricitab-tenofov af tab150-150-200-10 mg

2 •

INTELENCE – etravirine tab 25 mg 2 •INTELENCE – etravirine tab 100

mg2 •

INTELENCE – etravirine tab 200mg

2 •

INVIRASE – saquinavir mesylatecap 200 mg

2 •

INVIRASE – saquinavir mesylatetab 500 mg

2 •

ISENTRESS – raltegravirpotassium packet for susp 100mg (base equiv)

2 •

ISENTRESS – raltegravirpotassium tab 400 mg (baseequiv)

2 •

ISENTRESS – raltegravirpotassium chew tab 25 mg (baseequiv)

2 •

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ible

Ste

ps

ISENTRESS – raltegravirpotassium chew tab 100 mg(base equiv)

2 •

ISENTRESS HD – raltegravirpotassium tab 600 mg (baseequiv)

2 •

KALETRA – lopinavir-ritonavir soln400-100 mg/5ml (80-20 mg/ml)

2 •

KALETRA – lopinavir-ritonavir tab100-25 mg

2 •

KALETRA – lopinavir-ritonavir tab200-50 mg

2 •

lamivudine oral soln 10 mg/ml(Epivir)

1 •

lamivudine tab 150 mg (Epivir) 1 •lamivudine tab 300 mg (Epivir) 1 •lamivudine-zidovudine tab

150-300 mg (Combivir)1 •

LEXIVA – fosamprenavir calciumtab 700 mg (base equiv)

2 •

LEXIVA – fosamprenavir calciumsusp 50 mg/ml (base equiv)

2 •

lopinavir-ritonavir soln400-100 mg/5ml (80-20 mg/ml)(Kaletra)

1 •

nevirapine tab er 24hr 100 mg(Viramune xr)

1 •

nevirapine tab er 24hr 400 mg(Viramune xr)

1 •

nevirapine tab 200 mg (Viramune) 1 •NORVIR – ritonavir cap 100 mg 2 •NORVIR – ritonavir tab 100 mg 2 •NORVIR – ritonavir oral soln 80

mg/ml2 •

2018




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ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab200-25-25 mg

2 •

PREZCOBIX – darunavir-cobicistattab 800-150 mg

2 •

PREZISTA – darunavir ethanolatesusp 100 mg/ml (base equiv)

2 •

PREZISTA – darunavir ethanolatetab 75 mg (base equiv)

2 •


2 •


2 •


2 •

RESCRIPTOR – delavirdinemesylate tab 100 mg

2 •

RESCRIPTOR – delavirdinemesylate tab 200 mg

2 •

RETROVIR – zidovudine cap 100mg

3 •

RETROVIR – zidovudine syrup 10mg/ml

3 •

REYATAZ – atazanavir sulfateoral powder packet 50 mg (baseequiv)

2 •

REYATAZ – atazanavir sulfate cap150 mg (base equiv)

2 •


2 •


2 •

SELZENTRY – maraviroc oral soln20 mg/ml

2 •

SELZENTRY – maraviroc tab 25mg

2 •

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2 •


2 •


2 •

stavudine cap 15 mg (Zerit) 1 •stavudine cap 20 mg (Zerit) 1 •stavudine cap 30 mg (Zerit) 1 •stavudine cap 40 mg (Zerit) 1 •STRIBILD – elvitegrav-cobic-

emtricitab-tenofovdf tab150-150-200-300 mg

2 •

SUSTIVA – efavirenz tab 600 mg 2 •SUSTIVA – efavirenz cap 50 mg 2 •SUSTIVA – efavirenz cap 200 mg 2 •TIVICAY – dolutegravir sodium tab

10 mg (base equiv)2 •

TIVICAY – dolutegravir sodium tab25 mg (base equiv)

2 •

TIVICAY – dolutegravir sodium tab50 mg (base equiv)

2 •

TRIUMEQ – abacavir-dolutegravir-lamivudine tab 600-50-300 mg

2 •

TRIZIVIR – abacavir sulfate-lamivudine-zidovudine tab300-150-300 mg

2 •

TRUVADA – emtricitabine-tenofovirdisoproxil fumarate tab 100-150mg

2 •


2 •


2 •

2018




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2 •

TYBOST – cobicistat tab 150 mg 2 •VIDEX – didanosine for soln 2 gm 2 •VIDEX – didanosine for soln 4 gm 2 •VIDEX EC – didanosine delayed

release capsule 125 mg3 •

VIDEX EC – didanosine delayedrelease capsule 200 mg

3 •


3 •


3 •

VIRACEPT – nelfinavir mesylatetab 250 mg

2 • •

VIRACEPT – nelfinavir mesylatetab 625 mg

2 •

VIRAMUNE – nevirapine tab 200mg

3 •

VIRAMUNE – nevirapine susp 50mg/5ml

2 •

VIRAMUNE XR – nevirapine tab er24hr 100 mg

2 •

VIRAMUNE XR – nevirapine tab er24hr 400 mg

2 •

VIREAD – tenofovir disoproxilfumarate oral powder 40 mg/gm

2 •

VIREAD – tenofovir disoproxilfumarate tab 150 mg

2 •


2 •


2 •


2 •

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ZERIT – stavudine for oral soln 1mg/ml

2 •

ZERIT – stavudine cap 15 mg 3 •ZERIT – stavudine cap 20 mg 3 •ZERIT – stavudine cap 30 mg 3 •ZERIT – stavudine cap 40 mg 3 •ZIAGEN – abacavir sulfate tab 300

mg (base equiv)3 •

ZIAGEN – abacavir sulfate soln 20mg/ml (base equiv)

2 •

zidovudine cap 100 mg (Retrovir) 1 •zidovudine syrup 10 mg/ml

(Retrovir)1 •

zidovudine tab 300 mg 1 •InfluenzaFLUMADINE – rimantadine

hydrochloride tab 100 mg3

oseltamivir phosphate cap30 mg (base equiv) (Tamiflu)

1 •


1 •


1 •

oseltamivir phosphate for susp6 mg/ml (base equiv) (Tamiflu)

1 •

RELENZA DISKHALER –zanamivir aero powder breathactivated 5 mg/blister

3 •

rimantadine hydrochloride tab100 mg (Flumadine)

1

TAMIFLU – oseltamivir phosphatefor susp 6 mg/ml (base equiv)

2 •

TAMIFLU – oseltamivir phosphatecap 30 mg (base equiv)

3 •

2018




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3 •


3 •

MALARIAatovaquone-proguanil hcl tab

62.5-25 mg (Malarone)1

atovaquone-proguanil hcl tab250-100 mg (Malarone)

1

CHLOROQUINE PHOSPHATE –chloroquine phosphate tab 250mg

3

chloroquine phosphate tab500 mg (Aralen)

1

COARTEM – artemether-lumefantrine tab 20-120 mg

2

DARAPRIM – pyrimethamine tab25 mg

2 X • •

hydroxychloroquine sulfate tab200 mg (Plaquenil)

1

MALARONE – atovaquone-proguanil hcl tab 62.5-25 mg

3

MALARONE – atovaquone-proguanil hcl tab 250-100 mg

3

mefloquine hcl tab 250 mg 1

PLAQUENIL – hydroxychloroquinesulfate tab 200 mg

3

PRIMAQUINE PHOSPHATE –primaquine phosphate tab 26.3mg (15 mg base)

2

QUALAQUIN – quinine sulfate cap324 mg

3 •

quinine sulfate cap 324 mg(Qualaquin)

1 •

WORM INFECTIONS

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ALBENZA – albendazole tab 200mg

2

BILTRICIDE – praziquantel tab 600mg

2

EMVERM – mebendazole chewtab 100 mg

3

ivermectin tab 3 mg (Stromectol) 1

STROMECTOL – ivermectin tab 3mg

3

OTHER ANTI-INFECTIVESALINIA – nitazoxanide tab 500 mg 2

ALINIA – nitazoxanide for susp 100mg/5ml

2

atovaquone susp 750 mg/5ml(Mepron)

1

BACTRIM – sulfamethoxazole-trimethoprim tab 400-80 mg

3

BACTRIM DS – sulfamethoxazole-trimethoprim tab 800-160 mg

3

CAYSTON – aztreonam lysinefor inhal soln 75 mg (baseequivalent)

2

CLEOCIN – clindamycin hcl cap 75mg

3

CLEOCIN – clindamycin hcl cap150 mg

3

CLEOCIN – clindamycin hcl cap300 mg

3

CLEOCIN PEDIATRIC GRANULE– clindamycin palmitate hcl forsoln 75 mg/5ml (base equiv)

3

clindamycin hcl cap 75 mg(Cleocin)

1


1

2018




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1

clindamycin palmitate hcl forsoln 75 mg/5ml (base equiv)(Cleocin pediatric gr)

1

colistimethate sodium for inj150 mg (Coly-mycin m)

1

COLY-MYCIN M – colistimethatesodium for inj 150 mg

3

dapsone tab 25 mg 1

dapsone tab 100 mg 1

FLAGYL – metronidazole cap 375mg

3

FLAGYL – metronidazole tab 250mg

3

FLAGYL – metronidazole tab 500mg

3

IMPAVIDO – miltefosine cap 50 mg 2

linezolid for susp 100 mg/5ml(Zyvox)

1 •

linezolid tab 600 mg (Zyvox) 1 •MEPRON – atovaquone susp 750

mg/5ml3

metronidazole cap 375 mg(Flagyl)

1

metronidazole tab 250 mg(Flagyl)

1

metronidazole tab 500 mg(Flagyl)

1

NEBUPENT – pentamidineisethionate for nebulization soln300 mg

2

PRIMSOL – trimethoprim hcl oralsoln 50 mg/5ml (base equiv)

2

ribavirin for inhal soln 6 gm(Virazole)

1

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SIVEXTRO – tedizolid phosphatetab 200 mg

2 • •

sulfamethoxazole-trimethoprimsusp 200-40 mg/5ml

1

sulfamethoxazole-trimethoprimtab 400-80 mg (Bactrim)

1

sulfamethoxazole-trimethoprimtab 800-160 mg (Bactrim ds)

1

TINDAMAX – tinidazole tab 500mg

3

tinidazole tab 250 mg (Tindamax) 1

tinidazole tab 500 mg (Tindamax) 1

trimethoprim tab 100 mg 1

TRIMPEX – trimethoprim hcl oralsoln 50 mg/5ml (base equiv)

3

VANCOCIN HCL – vancomycin hclcap 125 mg

3

VANCOCIN HCL – vancomycin hclcap 250 mg

3

vancomycin hcl cap 125 mg(Vancocin hcl)

1

vancomycin hcl cap 250 mg(Vancocin hcl)

1

VIRAZOLE – ribavirin for inhal soln6 gm

3

XIFAXAN – rifaximin tab 200 mg 3 • •XIFAXAN – rifaximin tab 550 mg 2 • •ZYVOX – linezolid tab 600 mg 3 •ZYVOX – linezolid for susp 100

mg/5ml3 •

IMMUNIZING AGENTSACTHIB – haemophilus b

polysaccharide conjugatevaccine for inj

3

2018




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ADACEL – tet tox-diph-acellpertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml

3

BEXSERO – meningococcal vac b(recomb omv adjuv) inj prefilledsyringe

3

BOOSTRIX – tet tox-diph-acellpertuss ad inj 5-2.5-18.5 lf-lf-mcg/0.5ml

3

CUVITRU – immune globulin(human) subcutaneous inj 1gm/5ml

3 X •


3 X •


3 X •


3 X •

DAPTACEL – diph, acellular pert &tet tox inj 15 lf-23 mcg-5 lf/0.5ml

3

DIPHTHERIA/TETANUS TOXOID– diphtheria-tetanus toxadsorbed (dt) im inj 25-5unit/0.5ml

3

ENGERIX-B – hepatitis b vaccine(recombinant) susp 10 mcg/0.5ml

3

ENGERIX-B – hepatitis b vaccine(recombinant) susp 20 mcg/ml

3

ENGERIX-B – hepatitis b vaccine(recombinant) 10 mcg/0.5ml

3

ENGERIX-B – hepatitis b vaccine(recombinant) 20 mcg/ml

3

FLU VACCINES 3 •

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GAMMAGARD LIQUID –immune globulin (human) iv orsubcutaneous soln 1 gm/10ml

2 X •

GAMMAGARD LIQUID –immune globulin (human) iv orsubcutaneous soln 2.5 gm/25ml

2 X •


2 X •


2 X •


2 X •


2 X •

GAMMAKED – immune globulin(human) iv or subcutaneous soln1 gm/10ml

2 X •

GAMMAKED – immune globulin(human) iv or subcutaneous soln2.5 gm/25ml

2 X •


2 X •


2 X •


2 X •

GAMUNEX-C – immune globulin(human) iv or subcutaneous soln1 gm/10ml

2 X •

2018




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GAMUNEX-C – immune globulin(human) iv or subcutaneous soln2.5 gm/25ml

2 X •


2 X •


2 X •


2 X •


2 X •

GARDASIL 9 – humanpapillomavirus (hpv) 9-valentrecomb vac susp pref syr

3

GARDASIL 9 – humanpapillomavirus (hpv) 9-valentrecomb vac im susp

3

HAVRIX – hepatitis a vaccine injsusp 720 el unit/0.5ml

3

HAVRIX – hepatitis a vaccine injsusp 1440 el unit/ml

3

HIBERIX – haemophilus bpolysaccharide conjugate vac forinj 10 mcg

3

HIZENTRA – immune globulin(human) subcutaneous inj 1gm/5ml

3 X •


3 X •


3 X •

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3 X •

HYQVIA – immun glob inj 2.5gm/25ml-hyaluron inj 200unt/1.25 ml kit

3 X •

HYQVIA – immun glob inj 5gm/50ml-hyaluron inj 400 unt/2.5ml kit

3 X •

HYQVIA – immun glob inj 10gm/100ml-hyaluron inj 800 unt/5ml kit

3 X •

HYQVIA – immun glob inj 20gm/200ml-hyaluron inj 1600unt/10 ml kit

3 X •

HYQVIA – immun glob inj 30gm/300ml-hyaluron inj 2400unt/15 ml kit

3 X •

INFANRIX – diph, acellular pert &tet tox inj 25 lf-58 mcg-10 lf/0.5ml

3

KINRIX – diph-tetanus tox ad-acellpert & polio virus, ipv vac inj

3

M-M-R II – measles, mumps &rubella virus vaccines for inj

3

MENACTRA – meningococcal(a, c, y, and w-135) conjugatevaccine inj

3

MENVEO – meningococcal (a, c, y,and w-135) oligo conj vac for inj

3

PEDIARIX – diph-tetanus tox-acellpert-hepatitis b-polio ipv vac inj

3

PEDVAX HIB – haemophilus bpolysaccharide conj vac im susp7.5 mcg/0.5 ml

3

PENTACEL – diph-ac per-tet toxad-poliov-haemoph b poly vac forim susp

3

2018




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PNEUMOVAX 23 – pneumococcalvaccine polyvalent inj 25mcg/0.5ml

3

PNEUMOVAX 23/1 DOSE– pneumococcal vaccinepolyvalent inj 25 mcg/0.5ml

3

PREVNAR 13 – pneumococcal 13-valent conjugate vaccine inj

3

PROQUAD – measles-mumps-rubella-varicella virus vaccinesfor inj

3

QUADRACEL – diph-tetanus toxad-acell pert & polio virus, ipvvac inj

3

RECOMBIVAX HB – hepatitis bvaccine (recombinant) susp 5mcg/0.5ml

3

RECOMBIVAX HB – hepatitis bvaccine (recombinant) susp 10mcg/ml

3

RECOMBIVAX HB – hepatitis bvaccine (recombinant) susp 40mcg/ml

3

SHINGRIX – zoster vaccinerecombinant adjuvanted for im inj50 mcg

3

TENIVAC – tetanus-diphtheriatoxoids (td) inj 5-2 lfu

3

TETANUS/DIPHTHERIA TOXOID– tetanus-diphtheria toxoids (td)inj 2-2 lf/0.5ml

3

TRUMENBA – meningococcalgroup b vac (recomb) im suspprefilled syr

3

TWINRIX – hepatitis a (inact)-hepb (recomb) vac inj 720-20 elu-mcg/ml

3

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VAQTA – hepatitis a vaccine injsusp 25 unit/0.5ml

3

VAQTA – hepatitis a vaccine injsusp 50 unit/ml

3

VARIVAX – varicella virus vaclive for subcutaneous inj 1350pfu/0.5ml

3

VAXCHORA – cholera vaccine liveattenuated for oral susp

3

VIVOTIF – typhoid vaccine capdelayed release

3

ZOSTAVAX – zoster vaccine livefor subcutaneous susp 19400unit/0.65ml

3 •

CANCER DRUGSACTIMMUNE – interferon

gamma-1b inj 100 mcg/0.5ml(2000000 unit/0.5ml)

2 X •

AFINITOR – everolimus tab 2.5 mg 2 X • •AFINITOR – everolimus tab 5 mg 2 X • •AFINITOR – everolimus tab 7.5 mg 2 X • •AFINITOR – everolimus tab 10 mg 2 X • •AFINITOR DISPERZ – everolimus

tab for oral susp 2 mg2 X • •

AFINITOR DISPERZ – everolimustab for oral susp 3 mg

2 X • •

AFINITOR DISPERZ – everolimustab for oral susp 5 mg

2 X • •

ALECENSA – alectinib hcl cap 150mg (base equivalent)

2 X • •

ALKERAN – melphalan tab 2 mg 3

ALUNBRIG – brigatinib tab 30 mg 2 X • •anastrozole tab 1 mg (Arimidex) 1

ARIMIDEX – anastrozole tab 1 mg 3

2018




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AROMASIN – exemestane tab 25mg

3

bexarotene cap 75 mg (Targretin) 1 X •bicalutamide tab 50 mg

(Casodex)1

BOSULIF – bosutinib tab 100 mg 2 X • •BOSULIF – bosutinib tab 500 mg 2 X • •CABOMETYX – cabozantinib

s-malate tab 20 mg (baseequivalent)

2 X • •

CABOMETYX – cabozantinibs-malate tab 40 mg (baseequivalent)

2 X • •

CABOMETYX – cabozantinibs-malate tab 60 mg (baseequivalent)

2 X • •

CALQUENCE – acalabrutinib cap100 mg

2

capecitabine tab 150 mg (Xeloda) 1 X • •capecitabine tab 500 mg (Xeloda) 1 X • •CAPRELSA – vandetanib tab 100

mg2 X • •

CAPRELSA – vandetanib tab 300mg

2 X • •

CASODEX – bicalutamide tab 50mg

3

COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60 mgdose) kit

2 X • •

COMETRIQ – cabozantinib s-malcap 1 x 80 mg & 1 x 20 mg (100dose) kit

2 X • •

COMETRIQ – cabozantinib s-malcap 1 x 80 mg & 3 x 20 mg (140dose) kit

2 X • •

COTELLIC – cobimetinib fumaratetab 20 mg (base equivalent)

2 X • •

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CYCLOPHOSPHAMIDE –cyclophosphamide cap 25 mg

2

CYCLOPHOSPHAMIDE –cyclophosphamide cap 50 mg

2

EMCYT – estramustine phosphatesodium cap 140 mg

2

ERIVEDGE – vismodegib cap 150mg

2 X • •

ETOPOSIDE – etoposide cap 50mg

2

exemestane tab 25 mg(Aromasin)

1

FARESTON – toremifene citratetab 60 mg (base equivalent)

2

FARYDAK – panobinostat lactatecap 10 mg (base equivalent)

2 X • •


2 X • •


2 X • •

flutamide cap 125 mg 1

GILOTRIF – afatinib dimaleate tab20 mg (base equivalent)

2 X • •


2 X • •


2 X • •

GLEOSTINE – lomustine cap 5 mg 2 XGLEOSTINE – lomustine cap 10

mg2 X

GLEOSTINE – lomustine cap 40mg

2 X

GLEOSTINE – lomustine cap 100mg

2 X

HEXALEN – altretamine cap 50 mg 2 X

2018




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HYCAMTIN – topotecan hcl cap0.25 mg (base equiv)

2 X •

HYCAMTIN – topotecan hcl cap 1mg (base equiv)

2 X •

HYDREA – hydroxyurea cap 500mg

3

hydroxyurea cap 500 mg(Hydrea)

1

IBRANCE – palbociclib cap 75 mg 2 X • •IBRANCE – palbociclib cap 100 mg 2 X • •IBRANCE – palbociclib cap 125 mg 2 X • •ICLUSIG – ponatinib hcl tab 15 mg

(base equiv)2 X • •

ICLUSIG – ponatinib hcl tab 45 mg(base equiv)

2 X • •

IDHIFA – enasidenib mesylate tab50 mg (base equivalent)

2 X • •

IDHIFA – enasidenib mesylate tab100 mg (base equivalent)

2 X • •

imatinib mesylate tab 100 mg(base equivalent) (Gleevec)

1 X • •

imatinib mesylate tab 400 mg(base equivalent) (Gleevec)

1 X • •

IMBRUVICA – ibrutinib cap 140 mg 2 X • •INLYTA – axitinib tab 1 mg 2 X • •INLYTA – axitinib tab 5 mg 2 X • •INTRON A – interferon alfa-2b inj

6000000 unit/ml2 X •


2 X •


2 X •


2 X •

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2 X •


2 X •


2 X •


2 X •

IRESSA – gefitinib tab 250 mg 2 X • •JAKAFI – ruxolitinib phosphate tab

5 mg (base equivalent)2 X • •

JAKAFI – ruxolitinib phosphate tab10 mg (base equivalent)

2 X • •


2 X • •


2 X • •


2 X • •

KISQALI – ribociclib succinate tab200 mg (base equiv)

2 X • •

KISQALI FEMARA 200 DOSE –ribociclib tab 200 mg & letrozoletab 2.5 mg therapy pack

2 • •


2 • •


2 • •

LENVIMA 10 MG DAILY DOSE –lenvatinib cap therapy pack 10mg (10 mg daily dose)

2 X • •

2018




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LENVIMA 14 MG DAILY DOSE –lenvatinib cap therapy pack 10 &4 mg (14 mg daily dose)

2 X • •

LENVIMA 18 MG DAILY DOSE –lenvatinib cap therapy pack 10 &4 (2) mg (18 mg daily dose)

2 X • •

LENVIMA 20 MG DAILY DOSE –lenvatinib cap therapy pack 10(2) mg (20 mg daily dose)

2 X • •

LENVIMA 24 MG DAILY DOSE –lenvatinib cap therapy pack 10(2) & 4 mg (24 mg daily dose)

2 X • •

LENVIMA 8 MG DAILY DOSE –lenvatinib cap therapy pack 4 (2)mg (8 mg daily dose)

2 X • •

letrozole tab 2.5 mg (Femara) 1

LEUCOVORIN CALCIUM –leucovorin calcium tab 10 mg

2

LEUCOVORIN CALCIUM –leucovorin calcium tab 15 mg

2

leucovorin calcium tab 5 mg 1

leucovorin calcium tab 25 mg 1

LEUKERAN – chlorambucil tab 2mg

2

leuprolide acetate inj kit 5 mg/ml 1 X • •LONSURF – trifluridine-tipiracil tab

15-6.14 mg2 X • •

LONSURF – trifluridine-tipiracil tab20-8.19 mg

2 X • •

LYNPARZA – olaparib cap 50 mg 2 X • •LYNPARZA – olaparib tab 100 mg 2 X • •LYNPARZA – olaparib tab 150 mg 2 X • •LYSODREN – mitotane tab 500 mg 2 XMATULANE – procarbazine hcl cap

50 mg2 X

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megestrol acetate susp 40 mg/ml(Megace oral)

1

megestrol acetate tab 20 mg 1

megestrol acetate tab 40 mg 1

MEKINIST – trametinib dimethylsulfoxide tab 0.5 mg (baseequivalent)

2 X • •

MEKINIST – trametinib dimethylsulfoxide tab 2 mg (baseequivalent)

2 X • •

melphalan tab 2 mg (Alkeran) 1

mercaptopurine tab 50 mg 1

MESNEX – mesna tab 400 mg 2

METHOTREXATE SODIUM –methotrexate sodium inj 250mg/10ml (25 mg/ml)

3

methotrexate sodium for inj1 gm

1

methotrexate sodium inj pf50 mg/2ml (25 mg/ml)

1


1


1


1


1

methotrexate sodium inj50 mg/2ml (25 mg/ml)

1

methotrexate sodium tab 2.5 mg(base equiv)

1

MYLERAN – busulfan tab 2 mg 2

NERLYNX – neratinib maleate tab40 mg (base equivalent)

2 X • •

2018




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NEXAVAR – sorafenib tosylate tab200 mg (base equivalent)

2 X • •

NILANDRON – nilutamide tab 150mg

3

nilutamide tab 150 mg (Nilandron) 1

NINLARO – ixazomib citrate cap2.3 mg (base equivalent)

2 X • •

NINLARO – ixazomib citrate cap 3mg (base equivalent)

2 X • •

NINLARO – ixazomib citrate cap 4mg (base equivalent)

2 X • •

ODOMZO – sonidegib phosphatecap 200 mg (base equivalent)

2 X • •

POMALYST – pomalidomide cap 1mg

2 X • •


2 X • •


2 X • •


2 X • •

PURIXAN – mercaptopurine susp2000 mg/100ml (20 mg/ml)

2 X

RUBRACA – rucaparib camsylatetab 200 mg (base equivalent)

3 X • •


3 X • •


3 X • •

RYDAPT – midostaurin cap 25 mg 2 X • •SOLTAMOX – tamoxifen citrate

oral soln 10 mg/5ml (baseequivalent)

3

SPRYCEL – dasatinib tab 20 mg 2 X • •SPRYCEL – dasatinib tab 50 mg 2 X • •SPRYCEL – dasatinib tab 70 mg 2 X • •

Drug Name Dru

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ible

Ste

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SPRYCEL – dasatinib tab 80 mg 2 X • •SPRYCEL – dasatinib tab 100 mg 2 X • •SPRYCEL – dasatinib tab 140 mg 2 X • •STIVARGA – regorafenib tab 40

mg2 X • •

SUTENT – sunitinib malate cap12.5 mg (base equivalent)

2 X • •

SUTENT – sunitinib malate cap 25mg (base equivalent)

2 X • •

SUTENT – sunitinib malate cap37.5 mg (base equivalent)

2 X • •

SUTENT – sunitinib malate cap 50mg (base equivalent)

2 X • •

SYLATRON – peginterferon alfa-2bfor inj kit 200 mcg

2 X


2 X


2 X

SYNRIBO – omacetaxinemepesuccinate for inj 3.5 mg

3 X •

TABLOID – thioguanine tab 40 mg 2

TAFINLAR – dabrafenib mesylatecap 50 mg (base equivalent)

2 X • •

TAFINLAR – dabrafenib mesylatecap 75 mg (base equivalent)

2 X • •

TAGRISSO – osimertinib mesylatetab 40 mg (base equivalent)

2 X • •

TAGRISSO – osimertinib mesylatetab 80 mg (base equivalent)

2 X • •

tamoxifen citrate tab 10 mg(base equivalent)

1

tamoxifen citrate tab 20 mg(base equivalent)

1

TARCEVA – erlotinib hcl tab 25 mg(base equivalent)

2 X • •

2018




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TARCEVA – erlotinib hcl tab 100mg (base equivalent)

2 X • •

TARCEVA – erlotinib hcl tab 150mg (base equivalent)

2 X • •

TARGRETIN – bexarotene cap 75mg

3 X •

TASIGNA – nilotinib hcl cap 150mg (base equivalent)

2 X • •

TASIGNA – nilotinib hcl cap 200mg (base equivalent)

2 X • •

TEMODAR – temozolomide cap 5mg

3 X •

TEMODAR – temozolomide cap 20mg

3 X •

TEMODAR – temozolomide cap100 mg

3 X •


3 X •


3 X •


3 X •

temozolomide cap 5 mg(Temodar)

1 X •


1 X •


1 X •


1 X •


1 X •


1 X •

tretinoin cap 10 mg 1 X •

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ible

Ste

ps

TREXALL – methotrexate sodiumtab 5 mg (base equiv)

3

TREXALL – methotrexate sodiumtab 7.5 mg (base equiv)

3


3


3

TYKERB – lapatinib ditosylate tab250 mg (base equiv)

2 X • •

VENCLEXTA – venetoclax tab 10mg

2 X • •


2 X • •


2 X • •

VENCLEXTA STARTING PACK –venetoclax tab therapy starterpack 10 & 50 & 100 mg

2 X • •

VERZENIO – abemaciclib tab 50mg

2


2


2


2

VOTRIENT – pazopanib hcl tab200 mg (base equiv)

2 X • •

XALKORI – crizotinib cap 200 mg 2 X • •XALKORI – crizotinib cap 250 mg 2 X • •XELODA – capecitabine tab 150

mg3 X • •

XELODA – capecitabine tab 500mg

3 X • •

XTANDI – enzalutamide cap 40 mg 2 X • •

2018




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Ste

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ZEJULA – niraparib tosylate cap100 mg (base equivalent)

2 X • •

ZELBORAF – vemurafenib tab 240mg

2 X • •

ZOLINZA – vorinostat cap 100 mg 2 X • •ZYDELIG – idelalisib tab 100 mg 2 X • •ZYDELIG – idelalisib tab 150 mg 2 X • •ZYKADIA – ceritinib cap 150 mg 2 X • •ZYTIGA – abiraterone acetate tab

250 mg2 X • •

ZYTIGA – abiraterone acetate tab500 mg

2 X • •

HORMONES, DIABETES AND RELATED DRUGSCORTICOSTEROIDSbudesonide delayed release

particles cap 3 mg (Entocort ec)1

CORTEF – hydrocortisone tab 5mg

3


3


3

CORTISONE ACETATE –cortisone acetate tab 25 mg

3

DEXAMETHASONE –dexamethasone soln 0.5 mg/5ml

2

DEXAMETHASONE –dexamethasone tab 1 mg

2

DEXAMETHASONE –dexamethasone tab 2 mg

2

dexamethasone elixir 0.5 mg/5ml 1

DEXAMETHASONE INTENSOL –dexamethasone conc 1 mg/ml

3

dexamethasone tab 0.5 mg 1


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dexamethasone tab 4 mg 1

dexamethasone tab 6 mg 1

DEXPAK 10 DAY –dexamethasone tab therapy pack1.5 mg (35)

3

DEXPAK 13 DAY –dexamethasone tab therapy pack1.5 mg (51)

3

DEXPAK 6 DAY – dexamethasonetab therapy pack 1.5 mg (21)

3

EMFLAZA – deflazacort susp22.75 mg/ml

3 X •

EMFLAZA – deflazacort tab 6 mg 3 X • •EMFLAZA – deflazacort tab 18 mg 3 X • •EMFLAZA – deflazacort tab 30 mg 3 X •EMFLAZA – deflazacort tab 36 mg 3 X •ENTOCORT EC – budesonide

delayed release particles cap 3mg

3

fludrocortisone acetate tab0.1 mg

1

hydrocortisone tab 5 mg (Cortef) 1

hydrocortisone tab 10 mg(Cortef)

1

hydrocortisone tab 20 mg(Cortef)

1

MEDROL – methylprednisolone tab2 mg

3


3


3


3

2018




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3

MEDROL DOSEPAK –methylprednisolone tab therapypack 4 mg (21)

3

methylprednisolone tab therapypack 4 mg (21) (Medroldosepak)

1

methylprednisolone tab 4 mg(Medrol)

1


1


1


1

ORAPRED ODT – prednisolonesod phos orally disintegr tab 10mg (base eq)

3


3


3

PEDIAPRED – prednisolone sodphosph oral soln 6.7 mg/5ml (5mg/5ml base)

3

prednisolone sod phos orallydisintegr tab 10 mg (base eq)(Orapred odt)

1


1


1

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Ste

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prednisolone sod phosph oralsoln 6.7 mg/5ml (5 mg/5mlbase) (Pediapred)

1

prednisolone sod phosphateoral soln 15 mg/5ml (baseequiv)

1

prednisolone sod phosphateoral soln 10 mg/5ml (baseequiv) (Millipred)

1

prednisolone sod phosphateoral soln 20 mg/5ml (baseequiv) (Veripred 20)

1

PREDNISOLONE SODIUMPHOSP – prednisolone sodiumphosphate oral soln 25 mg/5ml(base eq)

3

prednisolone syrup 15 mg/5ml(usp solution equivalent)

1

PREDNISONE – prednisone tab 50mg

2

PREDNISONE – prednisone oralsoln 5 mg/5ml

2

PREDNISONE – prednisone tabtherapy pack 5 mg (21)

3


3


3


3

PREDNISONE INTENSOL –prednisone conc 5 mg/ml

3

prednisone tab 1 mg 1

prednisone tab 2.5 mg 1




2018




Drug Name Dru

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Ste

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VERIPRED 20 – prednisolone sodphosphate oral soln 20 mg/5ml(base equiv)

3

MALE HORMONESANADROL-50 – oxymetholone tab

50 mg3 •

ANDROGEL – testosterone td gel25 mg/2.5gm (1%)

3 • •

ANDROGEL – testosterone td gel50 mg/5gm (1%)

3 • •

ANDROGEL – testosterone td gel20.25 mg/1.25gm (1.62%)

2 • •

ANDROGEL – testosterone td gel40.5 mg/2.5gm (1.62%)

2 • •

ANDROGEL PUMP – testosteronetd gel 20.25 mg/act (1.62%)

2 • •

danazol cap 50 mg 1 •danazol cap 100 mg 1 •danazol cap 200 mg 1 •DEPO-TESTOSTERONE –

testosterone cypionate im inj inoil 100 mg/ml

3 •

DEPO-TESTOSTERONE –testosterone cypionate im inj inoil 200 mg/ml

3 •

METHITEST – methyltestosteroneoral tab 10 mg

3 •

methyltestosterone cap 10 mg(Testred)

1 •

OXANDRIN – oxandrolone tab 2.5mg

3 •

OXANDRIN – oxandrolone tab 10mg

3 •

oxandrolone tab 2.5 mg(Oxandrin)

1 •

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ible

Ste

ps

oxandrolone tab 10 mg(Oxandrin)

1 •

testosterone cypionate iminj in oil 100 mg/ml (Depo-testosterone)

1 •

testosterone cypionate iminj in oil 200 mg/ml (Depo-testosterone)

1 •

testosterone enanthate im inj inoil 200 mg/ml

1 • •

testosterone td gel 25 mg/2.5gm(1%) (Androgel)

1 • •

testosterone td gel 50 mg/5gm(1%) (Androgel)

1 • •

testosterone td gel 12.5 mg/act(1%) (Androgel pump)

1 • •

testosterone td soln 30 mg/act 1 • •ESTROGENSACTIVELLA – estradiol &

norethindrone acetate tab 0.5-0.1mg

3

ACTIVELLA – estradiol &norethindrone acetate tab 1-0.5mg

3

ALORA – estradiol td patch twiceweekly 0.025 mg/24hr

3 •


3 •


3 •


3 •

ANGELIQ – drospirenone-estradioltab 0.25-0.5 mg

3

ANGELIQ – drospirenone-estradioltab 0.5-1 mg

3

2018




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CLIMARA – estradiol td patchweekly 0.025 mg/24hr

3 •

CLIMARA – estradiol td patchweekly 0.0375 mg/24hr (37.5mcg/24hr)

3 •


3 •


3 •


3 •


3 •

CLIMARA PRO – estradiol-levonorgestrel td patch weekly0.045-0.015 mg/day

2 •

COMBIPATCH – estradiol-norethindrone ace td pttw0.05-0.14 mg/day

3

COMBIPATCH – estradiol-norethindrone ace td pttw0.05-0.25 mg/day

3

DIVIGEL – estradiol td gel 0.25mg/0.25gm (0.1%)

2 •

DIVIGEL – estradiol td gel 0.5mg/0.5gm (0.1%)

2 •

DIVIGEL – estradiol td gel 1 mg/gm(0.1%)

2 •

DUAVEE – conjugated estrogens-bazedoxifene tab 0.45-20 mg

3

ELESTRIN – estradiol gel 0.06%(0.52 mg/0.87 gm metered-dosepump)

3 •

esterified estrogens &methyltestosterone tab0.625-1.25 mg

1

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esterified estrogens &methyltestosterone tab1.25-2.5 mg

1

ESTRACE – estradiol tab 0.5 mg 3

ESTRACE – estradiol tab 1 mg 3

ESTRACE – estradiol tab 2 mg 3

estradiol & norethindroneacetate tab 0.5-0.1 mg(Activella)

1

estradiol & norethindroneacetate tab 1-0.5 mg (Activella)

1

estradiol tab 0.5 mg (Estrace) 1

estradiol tab 1 mg (Estrace) 1

estradiol tab 2 mg (Estrace) 1

estradiol td patch twice weekly0.025 mg/24hr (Vivelle-dot)

1 •


1 •


1 •


1 •


1 •

estradiol td patch weekly0.025 mg/24hr (Climara)

1 •

estradiol td patch weekly0.0375 mg/24hr (37.5 mcg/24hr)(Climara)

1 •


1 •


1 •


1 •

2018




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1 •

ESTROGEL – estradiol gel 0.06%(0.75 mg/1.25 gm metered-dosepump)

2 •

ESTROPIPATE – estropipate tab0.75 mg

3

ESTROPIPATE – estropipate tab1.5 mg

3

ESTROPIPATE – estropipate tab 3mg

3

EVAMIST – estradiol transdermalspray 1.53 mg/spray

3 •

FEMHRT LOW DOSE –norethindrone acetate-ethinylestradiol tab 0.5 mg-2.5 mcg

3

MENEST – esterified estrogens tab0.3 mg

2


2


2

MENOSTAR – estradiol td patchweekly 14 mcg/24hr

3 •

MINIVELLE – estradiol td patchtwice weekly 0.025 mg/24hr

3 •


3 •


3 •


3 •


3 •

norethindrone acetate-ethinylestradiol tab 0.5 mg-2.5 mcg(Femhrt low dose)

1

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ible

Ste

ps

norethindrone acetate-ethinylestradiol tab 1 mg-5 mcg

1

PREFEST – estradiol tab 1mg(15)/estrad-norgestimate tab1-0.09mg(15)

3

PREMARIN – estrogens,conjugated tab 0.3 mg

2


2


2


2


2

PREMPHASE – conj est 0.625(14)/conj est-medroxypro ac tab0.625-5mg(14)

2

PREMPRO – conjugated estrogen-medroxyprogest acetate tab0.3-1.5 mg

2


2


2

PREMPRO – conjugated estrogen-medroxyprogest acetate tab0.625-5 mg

2

VIVELLE-DOT – estradiol td patchtwice weekly 0.025 mg/24hr

3 •


3 •


3 •

2018




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3 •


3 •

PROGESTINSAYGESTIN – norethindrone

acetate tab 5 mg3

medroxyprogesterone acetatetab 2.5 mg (Provera)

1

medroxyprogesterone acetatetab 5 mg (Provera)

1

medroxyprogesterone acetatetab 10 mg (Provera)

1

MEGACE ES – megestrol acetatesusp 625 mg/5ml

3

megestrol acetate susp625 mg/5ml (Megace es)

1

norethindrone acetate tab 5 mg(Aygestin)

1

progesterone micronized cap100 mg (Prometrium)

1

progesterone micronized cap200 mg (Prometrium)

1

PROMETRIUM – progesteronemicronized cap 100 mg

3

PROMETRIUM – progesteronemicronized cap 200 mg

3

PROVERA – medroxyprogesteroneacetate tab 2.5 mg

3

PROVERA – medroxyprogesteroneacetate tab 5 mg

3

PROVERA – medroxyprogesteroneacetate tab 10 mg

3

BIRTH CONTROL

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BEYAZ – drospirenone-ethinylestrad-levomefolate tab3-0.02-0.451 mg

3

BREVICON-28 – norethindrone &ethinyl estradiol tab 0.5 mg-35mcg

3

CAYA – diaphragm arc-spring 3

CYCLESSA – desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg

3

DESOGEN – desogestrel & ethinylestradiol tab 0.15 mg-30 mcg

3

ELLA – ulipristal acetate tab 30 mg 2

ENCARE – nonoxynol-9 vaginalsuppos 100 mg

3

ESTROSTEP FE – norethindroneac-ethinyl estrad-fe tab1-20/1-30/1-35 mg-mcg

3

FEMCAP – cervical cap 22 mm 3



GENERESS FE – norethindrone &ethinyl estradiol-fe chew tab 0.8mg-25 mcg

3

LEVONORGESTREL ANDETHINY – levonorgestrel-ethinylestradiol (continuous) tab 90-20mcg

3

levonorgestrel tab 1.5 mg 1

LO LOESTRIN FE – norethin-ethestradiol-fe tab 1 mg-10 mcg(24)/10 mcg (2)

3

LOESTRIN FE 1.5/30 –norethindrone ace & ethinylestradiol-fe tab 1.5 mg-30 mcg

3

2018




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LOESTRIN FE 1/20 –norethindrone ace & ethinylestradiol-fe tab 1 mg-20 mcg

3

LOSEASONIQUE – levonorg-ethest tab 0.1-0.02mg(84) & eth esttab 0.01mg(7)

3

MINASTRIN 24 FE – norethindroneace-eth estradiol-fe chew tab 1mg-20 mcg (24)

3

NATAZIA – estradiol valerate-dienogest tab 3 mg /2-2 mg/2-3mg/1 mg

3

NECON 1/50-28 – norethindrone &mestranol tab 1 mg-50 mcg

3

nonoxynol-9 gel 4% 1

NUVARING – etonogestrel-ethinylestradiol va ring 0.120-0.015mg/24hr

2

OGESTREL – norgestrel & ethinylestradiol tab 0.5 mg-50 mcg

3

OMNIFLEX DIAPHRAGM –diaphragms

3

OPTIONS CONCEPTROL VAGINA– nonoxynol-9 gel 4%

3

OPTIONS GYNOL II VAGINAL –nonoxynol-9 gel 3%

3

oral contraceptives –all generics

1

ORTHO MICRONOR –norethindrone tab 0.35 mg

3

ORTHO TRI-CYCLEN –norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg

3

ORTHO TRI-CYCLEN LO –norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25 mg-mcg

3

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ORTHO-CYCLEN – norgestimate& ethinyl estradiol tab 0.25mg-35 mcg

3

ORTHO-NOVUM 1/35 –norethindrone & ethinyl estradioltab 1 mg-35 mcg

3

ORTHO-NOVUM 7/7/7 –norethindrone-eth estradiol tab0.5-35/0.75-35/1-35 mg-mcg

3

PLAN B ONE-STEP –levonorgestrel tab 1.5 mg

3

QUARTETTE – levonor-eth est tab0.15-0.02/0.025/0.03 mg &eth est0.01 mg

3

SAFYRAL – drospirenone-ethinyl estrad-levomefolate tab3-0.03-0.451 mg

3

SEASONIQUE – levonorg-eth esttab 0.15-0.03mg(84) & eth esttab 0.01mg(7)

3

SHUR-SEAL – nonoxynol-9 gel 2% 3

TAYTULLA – norethindrone ace-ethinyl estradiol-fe cap 1 mg-20mcg (24)

3

TODAY SPONGE – nonoxynol-9vaginal sponge 1000 mg

3

TRI-NORINYL 28 –norethindrone-eth estradiol tab0.5-35/1-35/0.5-35 mg-mcg

3

VCF VAGINAL CONTRACEPTIVE– nonoxynol-9 foam 12.5%

3

VCF VAGINAL CONTRACEPTIVE– nonoxynol-9 film 28%

3

WIDE-SEAL SILICONE DIAPHR –diaphragm wide seal 60 mm

3


3

2018




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ible

Ste

ps


3


3


3


3


3


3

XULANE – norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr

3

YASMIN 28 – drospirenone-ethinylestradiol tab 3-0.03 mg

3

YAZ – drospirenone-ethinylestradiol tab 3-0.02 mg

3

INFERTILITYBRAVELLE – urofollitropin purified

for inj 75 unit2

OVIDREL – choriogonadotropinalfa inj 250 mcg/0.5ml

2

DIABETESacarbose tab 25 mg (Precose) 1

acarbose tab 50 mg (Precose) 1

acarbose tab 100 mg (Precose) 1

ACTOPLUS MET XR –pioglitazone hcl-metformin hcltab er 24hr 15-1000 mg

3

ACTOPLUS MET XR –pioglitazone hcl-metformin hcltab er 24hr 30-1000 mg

3

ALOGLIPTIN – alogliptin benzoatetab 6.25 mg (base equiv)

3 • •

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ible

Ste

ps

ALOGLIPTIN – alogliptin benzoatetab 12.5 mg (base equiv)

3 • •

ALOGLIPTIN – alogliptin benzoatetab 25 mg (base equiv)

3 • •

ALOGLIPTIN/METFORMIN HCL– alogliptin-metformin hcl tab12.5-500 mg

3 • •

ALOGLIPTIN/METFORMIN HCL– alogliptin-metformin hcl tab12.5-1000 mg

3 • •

ALOGLIPTIN/PIOGLITAZONE– alogliptin-pioglitazone tab12.5-15 mg

3 • •


3 • •


3 • •

ALOGLIPTIN/PIOGLITAZONE –alogliptin-pioglitazone tab 25-15mg

3 • •


3 • •


3 • •

AMARYL – glimepiride tab 1 mg 3



AVANDIA – rosiglitazone maleatetab 2 mg (base equiv)

3

AVANDIA – rosiglitazone maleatetab 4 mg (base equiv)

3

BYDUREON – exenatide for injextended release susp 2 mg

2 • •

2018




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Ste

ps

BYDUREON BCISE – exenatideextended release susp auto-injector 2 mg/0.85ml

2 • •

BYDUREON PEN – exenatideextended release for susp pen-injector 2 mg

2 • •

BYETTA – exenatide soln pen-injector 5 mcg/0.02ml

2 • •

BYETTA – exenatide soln pen-injector 10 mcg/0.04ml

2 • •

CHLORPROPAMIDE –chlorpropamide tab 100 mg

3

CHLORPROPAMIDE –chlorpropamide tab 250 mg

3

CYCLOSET – bromocriptinemesylate tab 0.8 mg (baseequivalent)

3

FARXIGA – dapagliflozinpropanediol tab 5 mg (baseequivalent)

3 • •

FARXIGA – dapagliflozinpropanediol tab 10 mg (baseequivalent)

3 • •

glimepiride tab 1 mg (Amaryl) 1



glipizide tab er 24hr 2.5 mg(Glucotrol xl)

1

glipizide tab er 24hr 5 mg(Glucotrol xl)

1

glipizide tab er 24hr 10 mg(Glucotrol xl)

1

glipizide tab 5 mg (Glucotrol) 1

glipizide tab 10 mg (Glucotrol) 1

glipizide-metformin hcl tab2.5-250 mg

1

Drug Name Dru

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ier 4

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Res

pons

ible

Ste

ps

glipizide-metformin hcl tab2.5-500 mg

1

glipizide-metformin hcl tab5-500 mg

1

GLUCAGEN HYPOKIT – glucagonhcl (rdna) for inj 1 mg (baseequiv)

3

GLUCAGON EMERGENCY KIT –glucagon (rdna) for inj kit 1 mg

2

GLUCOPHAGE – metformin hcltab 500 mg

3


3


3

GLUCOPHAGE XR – metforminhcl tab er 24hr 500 mg

3

GLUCOPHAGE XR – metforminhcl tab er 24hr 750 mg

3

GLUCOTROL – glipizide tab 5 mg 3

GLUCOTROL – glipizide tab 10 mg 3

GLUCOTROL XL – glipizide tab er24hr 2.5 mg

3

GLUCOTROL XL – glipizide tab er24hr 5 mg

3

GLUCOTROL XL – glipizide tab er24hr 10 mg

3

GLUCOVANCE – glyburide-metformin tab 2.5-500 mg

3

GLUCOVANCE – glyburide-metformin tab 5-500 mg

3

glyburide micronized tab 1.5 mg(Glynase)

1

glyburide micronized tab 3 mg(Glynase)

1

2018




Drug Name Dru

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ty/T

ier 4

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n

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its

Res

pons

ible

Ste

ps

glyburide micronized tab 6 mg(Glynase)

1

glyburide tab 1.25 mg 1

glyburide tab 2.5 mg 1

glyburide tab 5 mg 1

glyburide-metformin tab1.25-250 mg (Glucovance)

1

glyburide-metformin tab2.5-500 mg (Glucovance)

1

glyburide-metformin tab5-500 mg (Glucovance)

1

GLYNASE – glyburide micronizedtab 1.5 mg

3

GLYNASE – glyburide micronizedtab 3 mg

3

GLYNASE – glyburide micronizedtab 6 mg

3

GLYSET – miglitol tab 25 mg 3



GLYXAMBI – empagliflozin-linagliptin tab 10-5 mg

3 • •

GLYXAMBI – empagliflozin-linagliptin tab 25-5 mg

3 • •

INVOKAMET – canagliflozin-metformin hcl tab 50-500 mg

2 • •


2 • •


2 • •


2 • •

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr 50-500mg

2 • •

Drug Name Dru

g Ti

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cial

ty/T

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its

Res

pons

ible

Ste

ps

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr50-1000 mg

2 • •


2 • •


2 • •

INVOKANA – canagliflozin tab 100mg

2 • •

INVOKANA – canagliflozin tab 300mg

2 • •

JANUMET – sitagliptin-metforminhcl tab 50-500 mg

2 • •

JANUMET – sitagliptin-metforminhcl tab 50-1000 mg

2 • •

JANUMET XR – sitagliptin-metformin hcl tab er 24hr 50-500mg

2 • •

JANUMET XR – sitagliptin-metformin hcl tab er 24hr50-1000 mg

2 • •

JANUMET XR – sitagliptin-metformin hcl tab er 24hr100-1000 mg

2 • •

JANUVIA – sitagliptin phosphatetab 25 mg (base equiv)

2 • •


2 • •


2 • •

JARDIANCE – empagliflozin tab 10mg

2 • •

JARDIANCE – empagliflozin tab 25mg

2 • •

2018




Drug Name Dru

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ty/T

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its

Res

pons

ible

Ste

ps

JENTADUETO – linagliptin-metformin hcl tab 2.5-500 mg

3 • •


3 • •


3 • •

JENTADUETO XR – linagliptin-metformin hcl tab er 24hr2.5-1000 mg

3 • •

JENTADUETO XR – linagliptin-metformin hcl tab er 24hr 5-1000mg

3 • •

KAZANO – alogliptin-metformin hcltab 12.5-500 mg

3 • •

KAZANO – alogliptin-metformin hcltab 12.5-1000 mg

3 • •

KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr2.5-1000 mg

2 • •

KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr 5-500mg

2 • •

KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr 5-1000mg

2 • •

KORLYM – mifepristone tab 300mg

3 X • •

metformin hcl tab er 24hr 500 mg(Glucophage xr)

1

metformin hcl tab er 24hr 750 mg(Glucophage xr)

1

metformin hcl tab 500 mg(Glucophage)

1


1


1

Drug Name Dru

g Ti

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Spe

cial

ty/T

ier 4

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its

Res

pons

ible

Ste

ps

miglitol tab 25 mg (Glyset) 1



nateglinide tab 60 mg (Starlix) 1

nateglinide tab 120 mg (Starlix) 1

NESINA – alogliptin benzoate tab6.25 mg (base equiv)

3 • •

NESINA – alogliptin benzoate tab12.5 mg (base equiv)

3 • •

NESINA – alogliptin benzoate tab25 mg (base equiv)

3 • •

ONGLYZA – saxagliptin hcl tab 2.5mg (base equiv)

2 • •

ONGLYZA – saxagliptin hcl tab 5mg (base equiv)

2 • •

OSENI – alogliptin-pioglitazone tab12.5-15 mg

3 • •


3 • •


3 • •

OSENI – alogliptin-pioglitazone tab25-15 mg

3 • •


3 • •


3 • •

pioglitazone hcl tab 15 mg (baseequiv) (Actos)

1


1


1

pioglitazone hcl-metformin hcltab 15-500 mg (Actoplus met)

1

2018




Drug Name Dru

g Ti

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ty/T

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n

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Lim

its

Res

pons

ible

Ste

ps

pioglitazone hcl-metformin hcltab 15-850 mg (Actoplus met)

1

PRECOSE – acarbose tab 25 mg 3



PROGLYCEM – diazoxide susp 50mg/ml

2

repaglinide tab 0.5 mg (Prandin) 1

repaglinide tab 1 mg (Prandin) 1

repaglinide tab 2 mg (Prandin) 1

REPAGLINIDE/METFORMIN HYD– repaglinide-metformin hcl tab1-500 mg

3

REPAGLINIDE/METFORMIN HYD– repaglinide-metformin hcl tab2-500 mg

3

RIOMET – metformin hcl oral soln500 mg/5ml

3

SOLIQUA 100/33 – insulinglargine-lixisenatide sol pen-inj100-33 unit-mcg/ml

2 • •

STARLIX – nateglinide tab 60 mg 3

STARLIX – nateglinide tab 120 mg 3

SYMLINPEN 120 – pramlintideacetate pen-inj 2700 mcg/2.7ml(1000 mcg/ml)

2

SYMLINPEN 60 – pramlintideacetate pen-inj 1500 mcg/1.5ml(1000 mcg/ml)

2

SYNJARDY – empagliflozin-metformin hcl tab 5-500 mg

2 • •

SYNJARDY – empagliflozin-metformin hcl tab 5-1000 mg

2 • •

SYNJARDY – empagliflozin-metformin hcl tab 12.5-500 mg

2 • •

Drug Name Dru

g Ti

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Spe

cial

ty/T

ier 4

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n

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ntity

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its

Res

pons

ible

Ste

ps

SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000 mg

2 • •

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr 5-1000mg

2 • •

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr10-1000 mg

2 • •

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr12.5-1000 mg

2 • •

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr25-1000 mg

2 • •

TANZEUM – albiglutide for solnpen-injector 30 mg

3 • •

TANZEUM – albiglutide for solnpen-injector 50 mg

3 • •

TOLAZAMIDE – tolazamide tab250 mg

3

TOLAZAMIDE – tolazamide tab500 mg

3

TOLBUTAMIDE – tolbutamide tab500 mg

3

TRADJENTA – linagliptin tab 5 mg 3 • •TRULICITY – dulaglutide soln pen-

injector 0.75 mg/0.5ml3 • •

TRULICITY – dulaglutide soln pen-injector 1.5 mg/0.5ml

3 • •

VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)

2 • •

XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr 5-500mg

3 • •


3 • •

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps


3 • •

XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr10-1000 mg

3 • •

XULTOPHY 100/3.6 – insulindegludec-liraglutide sol pen-inj100-3.6 unit-mg/ml

2 • •

InsulinsRapid-Acting InsulinsAPIDRA – insulin glulisine inj 100

unit/ml3 •

APIDRA SOLOSTAR – insulinglulisine soln pen-injector inj 100unit/ml

3 •

NOVOLOG – insulin aspart inj 100unit/ml

2

NOVOLOG FLEXPEN – insulinaspart soln pen-injector 100 unit/ml

2

NOVOLOG PENFILL – insulinaspart soln cartridge 100 unit/ml

2

Short-Acting InsulinsAFREZZA – insulin regular

(human) inhalation powder 4 unit/cartridge

3 • •

AFREZZA – insulin regular(human) inhalation powder 8 unit/cartridge

3 • •

AFREZZA – insulin regular(human) inhalation powder 12unit/cartridge

3 • •

AFREZZA – insulin regular(human) inhal powd 4 (30) & 8(60) unit/cart

3 • •

Drug Name Dru

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Res

pons

ible

Ste

ps


3 • •


3 • •

AFREZZA – insulin regular(human) inh powd 8 (60) & 12(30) unit/cart

3 • •

AFREZZA – insulin regular(human) inh powd 4 & 8 & 12unit/cart (60)

3 • •

HUMULIN R U-500 (CONCENTR– insulin regular (human) inj 500unit/ml

2

HUMULIN R U-500 KWIKPEN –insulin regular (human) soln pen-injector 500 unit/ml

2

NOVOLIN R – insulin regular(human) inj 100 unit/ml

2

NOVOLIN R RELION – insulinregular (human) inj 100 unit/ml

2

RELION R – insulin regular(human) inj 100 unit/ml

2

Intermediate-Acting InsulinsHUMALOG MIX 50/50 – insulin

lispro protamine & lispro inj 100unit/ml (50-50)

3 •

HUMALOG MIX 50/50 KWIKPEN– insulin lispro prot & lispro suspen-inj 100 unit/ml (50-50)

3 •

HUMALOG MIX 75/25 – insulinlispro prot & lispro inj 100 unit/ml(75-25)

3 •

HUMALOG MIX 75/25 KWIKPEN– insulin lispro prot & lispro suspen-inj 100 unit/ml (75-25)

3 •

2018




Drug Name Dru

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pons

ible

Ste

ps

NOVOLIN N – insulin nph (human)(isophane) inj 100 unit/ml

2

NOVOLIN N RELION – insulin nph(human) (isophane) inj 100 unit/ml

2

NOVOLIN 70/30 – insulin nphisophane & regular human inj100 unit/ml (70-30)

2

NOVOLIN 70/30 RELION – insulinnph isophane & regular humaninj 100 unit/ml (70-30)

2

NOVOLOG MIX 70/30 – insulinaspart prot & aspart (human) inj100 unit/ml (70-30)

2

NOVOLOG MIX 70/30 PREFILL –insulin aspart prot & aspart suspen-inj 100 unit/ml (70-30)

2

Basal InsulinsBASAGLAR KWIKPEN – insulin

glargine soln pen-injector 100unit/ml

3

LANTUS – insulin glargine inj 100unit/ml

2

LANTUS SOLOSTAR – insulinglargine soln pen-injector 100unit/ml

2

LEVEMIR – insulin detemir inj 100unit/ml

2

LEVEMIR FLEXTOUCH – insulindetemir soln pen-injector 100unit/ml

2

TOUJEO SOLOSTAR – insulinglargine soln pen-injector 300unit/ml

2

TRESIBA FLEXTOUCH – insulindegludec soln pen-injector 100unit/ml

2

Drug Name Dru

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its

Res

pons

ible

Ste

ps

TRESIBA FLEXTOUCH – insulindegludec soln pen-injector 200unit/ml

2

THYROID REGULATIONARMOUR THYROID – thyroid tab

15 mg (1/4 grain)3

ARMOUR THYROID – thyroid tab30 mg (1/2 grain)

3

ARMOUR THYROID – thyroid tab60 mg (1 grain)

3

ARMOUR THYROID – thyroid tab90 mg (1 1/2 grain)

3


3


3


3


3

CYTOMEL – liothyronine sodiumtab 5 mcg

3


3


3

levothyroxine sodium tab25 mcg (Synthroid)

1


1


1


1


1

2018




Drug Name Dru

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Res

pons

ible

Ste

ps


1


1


1


1


1


1


1

liothyronine sodium tab 5 mcg(Cytomel)

1


1


1

methimazole tab 5 mg (Tapazole) 1

methimazole tab 10 mg(Tapazole)

1

NATURE-THROID – thyroid tab16.25 mg

3


3

NATURE-THROID – thyroid tab48.75 mg (3/4 grain)

3

NATURE-THROID – thyroid tab 65mg

3


3


3

Drug Name Dru

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pons

ible

Ste

ps


3

NATURE-THROID – thyroid tab130 mg

3


3


3

NATURE-THROID – thyroid tab325 mg (5 grain)

3


3

NATURE-THROID NT-2.5 – thyroidtab 162.5 mg (2 1/2 grain)

3

propylthiouracil tab 50 mg 1

SYNTHROID – levothyroxinesodium tab 25 mcg

3


3


3


3


3


3


3


3


3


3

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps


3


3

TAPAZOLE – methimazole tab 5mg

3

TAPAZOLE – methimazole tab 10mg

3

thyroid tab 15 mg (1/4 grain)(Armour thyroid)

1

thyroid tab 30 mg (1/2 grain)(Armour thyroid)

1

thyroid tab 60 mg (1 grain)(Armour thyroid)

1

thyroid tab 90 mg (1 1/2 grain)(Armour thyroid)

1

thyroid tab 120 mg (2 grain)(Armour thyroid)

1

THYROLAR-1 – liotrix (t3-t4) tab60 mg (12.5-50 mcg)

2

THYROLAR-1/2 – liotrix (t3-t4) tab30 mg (6.25-25 mcg)

2

THYROLAR-1/4 – liotrix (t3-t4) tab15 mg (3.1-12.5 mcg)

2

THYROLAR-2 – liotrix (t3-t4) tab120 mg (25-100 mcg)

2

THYROLAR-3 – liotrix (t3-t4) tab180 mg (37.5-150 mcg)

2

TIROSINT – levothyroxine sodiumcap 13 mcg

3


3


3


3

Drug Name Dru

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Res

pons

ible

Ste

ps


3


3


3


3


3


3

WESTHROID – thyroid tab 32.5mg

3

WESTHROID – thyroid tab 65 mg 3

WESTHROID – thyroid tab 97.5mg

3



WP THYROID – thyroid tab 16.25mg

3


3

WP THYROID – thyroid tab 48.75mg (3/4 grain)

3

WP THYROID – thyroid tab 65 mg 3


3


3


3

WP THYROID – thyroid tab 130mg

3

GROWTH HORMONE

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps

EGRIFTA – tesamorelin acetate forinj 1 mg (base equiv)

3 X •

GENOTROPIN – somatropin forsubcutaneous inj 5 mg

3 X •

GENOTROPIN – somatropin for inj12 mg (13.8 mg overfill)

3 X •

GENOTROPIN MINIQUICK –somatropin for inj 0.2 mg

3 X •


3 X •


3 X •


3 X •

GENOTROPIN MINIQUICK –somatropin for inj 1 mg

3 X •


3 X •


3 X •


3 X •


3 X •

GENOTROPIN MINIQUICK –somatropin for inj 2 mg

3 X •

HUMATROPE – somatropin for inj6 mg (18 unit)

3 X •

HUMATROPE – somatropin for inj12 mg (36 unit)

3 X •

HUMATROPE – somatropin for inj24 mg

3 X •

HUMATROPE COMBO PACK –somatropin for inj 5 mg

3 X •

INCRELEX – mecasermin inj 40mg/4ml (10 mg/ml)

2 X •

Drug Name Dru

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its

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pons

ible

Ste

ps

NORDITROPIN FLEXPRO –somatropin inj 5 mg/1.5ml

2 X •


2 X •


2 X •

NORDITROPIN FLEXPRO –somatropin inj 30 mg/3ml

2 X •

NUTROPIN AQ NUSPIN 10 –somatropin inj 10 mg/2ml

3 X •


3 X •


3 X •

OMNITROPE – somatropin inj 5mg/1.5ml

3 X •

OMNITROPE – somatropin inj 10mg/1.5ml

3 X •

OMNITROPE – somatropin for inj5.8 mg

3 X •

SAIZEN – somatropin (non-refrigerated) for inj 5 mg

3 X •

SAIZEN – somatropin (non-refrigerated) for inj 8.8 mg

3 X •

SAIZEN CLICK.EASY –somatropin (non-refrigerated) forinj 8.8 mg

3 X •

SAIZENPREP RECONSTITUTION– somatropin (non-refrigerated)for inj 8.8 mg

3 X •

SEROSTIM – somatropin (non-refrigerated) for subcutaneous inj4 mg

3 X •


3 X •

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps


3 X •

ZOMACTON – somatropin forsubcutaneous inj 5 mg

3 X •

ZOMACTON – somatropin for inj10 mg

3 X •

ZORBTIVE – somatropin (non-refrigerated) for subcutaneous inj8.8 mg

3 X •

OTHER HORMONES AND RELATED DRUGSACTONEL – risedronate sodium

tab 5 mg3

ACTONEL – risedronate sodiumtab 30 mg

3


3


3

ALENDRONATE SODIUM –alendronate sodium oral soln 70mg/75ml

3

ALENDRONATE SODIUM –alendronate sodium tab 40 mg

3

alendronate sodium tab 5 mg 1



alendronate sodium tab 70 mg(Fosamax)

1

ATELVIA – risedronate sodium tabdelayed release 35 mg

3

BINOSTO – alendronate sodiumeffervescent tab 70 mg

3

BONIVA – ibandronate sodium tab150 mg (base equivalent)

3

Drug Name Dru

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Res

pons

ible

Ste

ps

BUPHENYL – sodiumphenylbutyrate tab 500 mg

3 X • •

BUPHENYL – sodiumphenylbutyrate oral powder 3 gm/teaspoonful

3 X • •

cabergoline tab 0.5 mg 1

calcitonin (salmon) nasal soln200 unit/act (Miacalcin)

1

calcitriol cap 0.25 mcg (Rocaltrol) 1

calcitriol cap 0.5 mcg (Rocaltrol) 1

calcitriol oral soln 1 mcg/ml(Rocaltrol)

1

CARBAGLU – carglumic acid tab200 mg

3 X

CARNITOR – levocarnitine tab 330mg

3

CARNITOR – levocarnitine oralsoln 1 gm/10ml (10%)

3

CARNITOR SF – levocarnitine oralsoln 1 gm/10ml (10%)

3

CYSTADANE – betaine powder fororal solution

3 X •

DDAVP – desmopressin acetatenasal soln 0.01% (refrigerated)

3

DDAVP – desmopressin acetatetab 0.1 mg

3

DDAVP – desmopressin acetatetab 0.2 mg

3

DDAVP – desmopressin acetate inj4 mcg/ml

3

desmopressin acetate inj 4 mcg/ml (Ddavp)

1

desmopressin acetate nasal soln0.01% (refrigerated) (Ddavp)

1

desmopressin acetate nasalspray soln 0.01% (Ddavp)

1

2018




Drug Name Dru

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ty/T

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n

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its

Res

pons

ible

Ste

ps

desmopressin acetate nasalspray soln 0.01% (refrigerated)

1

desmopressin acetate tab 0.1 mg(Ddavp)

1

desmopressin acetate tab 0.2 mg(Ddavp)

1

doxercalciferol cap 0.5 mcg(Hectorol)

1

doxercalciferol cap 1 mcg(Hectorol)

1

doxercalciferol cap 2.5 mcg(Hectorol)

1

ETIDRONATE DISODIUM –etidronate disodium tab 200 mg

3

ETIDRONATE DISODIUM –etidronate disodium tab 400 mg

3

EVISTA – raloxifene hcl tab 60 mg 3

FORTEO – teriparatide(recombinant) inj 600 mcg/2.4ml

3 X •

FOSAMAX – alendronate sodiumtab 70 mg

3

FOSAMAX PLUS D – alendronatesodium-cholecalciferol tab70-2800 mg-unit

3

FOSAMAX PLUS D – alendronatesodium-cholecalciferol tab70-5600 mg-unit

3

H.P. ACTHAR – corticotropin inj gel80 unit/ml

3 X • •

HECTOROL – doxercalciferol cap0.5 mcg

3

HECTOROL – doxercalciferol cap1 mcg

3

HECTOROL – doxercalciferol cap2.5 mcg

3

ibandronate sodium tab 150 mg(base equivalent) (Boniva)

1

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

KUVAN – sapropterindihydrochloride soluble tab 100mg

2 X •

KUVAN – sapropterindihydrochloride powder packet100 mg

3 X •

KUVAN – sapropterindihydrochloride powder packet500 mg

3 X •

levocarnitine oral soln1 gm/10ml (10%) (Carnitor)

1

levocarnitine tab 330 mg(Carnitor)

1

METHERGINE – methylergonovinemaleate tab 0.2 mg

3

MIACALCIN – calcitonin (salmon)inj 200 unit/ml

3

MYALEPT – metreleptin forsubcutaneous inj 11.3 mg

3 X • •

NATPARA – parathyroid hormone(recombinant) for inj cartridge 25mcg

3 X •


3 X •


3 X •

NATPARA – parathyroid hormone(recombinant) for inj cartridge100 mcg

3 X •

NITYR – nitisinone tab 2 mg 2 X •NITYR – nitisinone tab 5 mg 2 X •NITYR – nitisinone tab 10 mg 2 X •octreotide acetate inj 50 mcg/ml

(0.05 mg/ml) (Sandostatin)1 X

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

octreotide acetate inj 100 mcg/ml(0.1 mg/ml) (Sandostatin)

1 X


1 X


1 X

octreotide acetate inj 1000 mcg/ml (1 mg/ml) (Sandostatin)

1 X

ORFADIN – nitisinone susp 4 mg/ml

2 •

ORFADIN – nitisinone cap 2 mg 2 X •ORFADIN – nitisinone cap 5 mg 2 X •ORFADIN – nitisinone cap 10 mg 2 X •ORFADIN – nitisinone cap 20 mg 2 X •OSPHENA – ospemifene tab 60

mg3

paricalcitol cap 1 mcg (Zemplar) 1

paricalcitol cap 2 mcg (Zemplar) 1

paricalcitol cap 4 mcg 1

raloxifene hcl tab 60 mg (Evista) 1

RAVICTI – glycerol phenylbutyrateliquid 1.1 gm/ml

3 X • •

risedronate sodium tab delayedrelease 35 mg (Atelvia)

1

risedronate sodium tab 5 mg(Actonel)

1


1


1


1

ROCALTROL – calcitriol oral soln 1mcg/ml

3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

ROCALTROL – calcitriol cap 0.25mcg

3

ROCALTROL – calcitriol cap 0.5mcg

3

SAMSCA – tolvaptan tab 15 mg 3 X •SAMSCA – tolvaptan tab 30 mg 3 X •SANDOSTATIN – octreotide

acetate inj 50 mcg/ml (0.05 mg/ml)

3 X

SANDOSTATIN – octreotideacetate inj 100 mcg/ml (0.1 mg/ml)

3 X


3 X


3 X

SANDOSTATIN – octreotideacetate inj 1000 mcg/ml (1 mg/ml)

3 X

SENSIPAR – cinacalcet hcl tab 30mg (base equiv)

2 •


2 •


2 •

SIGNIFOR – pasireotidediaspartate inj 0.3 mg/ml (baseequiv)

3 X • •


3 X • •


3 X • •

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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r Aut

horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps

sodium phenylbutyrate oralpowder 3 gm/teaspoonful(Buphenyl)

1 X • •

sodium phenylbutyrate tab500 mg (Buphenyl)

1 X • •

SOMAVERT – pegvisomant for inj10 mg (as protein)

2 X


2 X


2 X


2 X


2 X

STIMATE – desmopressin acetatenasal soln 1.5 mg/ml

2

STRENSIQ – asfotase alfasubcutaneous inj 18 mg/0.45ml

2 X •


2 X •

STRENSIQ – asfotase alfasubcutaneous inj 40 mg/ml

2 X •


2 X •

SYNAREL – nafarelin acetatenasal soln 2 mg/ml (200 mcg/act)(base eq)

2 X

TYMLOS – abaloparatidesubcutaneous soln pen-injector3120 mcg/1.56ml

2 X •

XURIDEN – uridine triacetate oralgranules packet 2 gm

3 X •

ZEMPLAR – paricalcitol cap 1 mcg 3

ZEMPLAR – paricalcitol cap 2 mcg 3

HEART AND CIRCULATORY DRUGS

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

ANGIOTENSIN CONVERTING ENZYME (ACE)INHIBITORS AND COMBINATIONSACCUPRIL – quinapril hcl tab 5 mg 3

ACCUPRIL – quinapril hcl tab 10mg

3


3


3

ACCURETIC – quinapril-hydrochlorothiazide tab 10-12.5mg

3

ACCURETIC – quinapril-hydrochlorothiazide tab 20-12.5mg

3

ACCURETIC – quinapril-hydrochlorothiazide tab 20-25 mg

3

ACEON – perindopril erbumine tab4 mg

3

ACEON – perindopril erbumine tab8 mg

3

ALTACE – ramipril cap 1.25 mg 3

ALTACE – ramipril cap 2.5 mg 3

ALTACE – ramipril cap 5 mg 3

ALTACE – ramipril cap 10 mg 3

benazepril &hydrochlorothiazide tab5-6.25 mg

1

benazepril &hydrochlorothiazide tab10-12.5 mg (Lotensin hct)

1

benazepril &hydrochlorothiazide tab20-12.5 mg (Lotensin hct)

1

benazepril &hydrochlorothiazide tab20-25 mg (Lotensin hct)

1

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

benazepril hcl tab 5 mg 1

benazepril hcl tab 10 mg(Lotensin)

1


1


1

captopril tab 12.5 mg 1

captopril tab 25 mg 1



CAPTOPRIL/HYDROCHLOROTHIA –captopril & hydrochlorothiazidetab 25-15 mg

2


3


2


3

enalapril maleate &hydrochlorothiazide tab5-12.5 mg

1

enalapril maleate &hydrochlorothiazide tab10-25 mg (Vaseretic)

1

enalapril maleate tab 2.5 mg(Vasotec)

1

enalapril maleate tab 5 mg(Vasotec)

1

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


1


1

fosinopril sodium &hydrochlorothiazide tab10-12.5 mg

1

fosinopril sodium &hydrochlorothiazide tab20-12.5 mg

1

fosinopril sodium tab 10 mg 1



lisinopril & hydrochlorothiazidetab 10-12.5 mg (Zestoretic)

1

lisinopril & hydrochlorothiazidetab 20-12.5 mg (Zestoretic)

1

lisinopril & hydrochlorothiazidetab 20-25 mg (Zestoretic)

1

lisinopril tab 2.5 mg (Zestril) 1

lisinopril tab 5 mg (Prinivil) 1



lisinopril tab 30 mg (Zestril) 1

lisinopril tab 40 mg (Zestril) 1

LOTENSIN – benazepril hcl tab 20mg

3

LOTENSIN – benazepril hcl tab 40mg

3

LOTENSIN HCT – benazepril &hydrochlorothiazide tab 10-12.5mg

3

LOTENSIN HCT – benazepril &hydrochlorothiazide tab 20-12.5mg

3

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

LOTENSIN HCT – benazepril &hydrochlorothiazide tab 20-25 mg

3

moexipril hcl tab 7.5 mg 1

moexipril hcl tab 15 mg 1

moexipril-hydrochlorothiazidetab 7.5-12.5 mg

1

moexipril-hydrochlorothiazidetab 15-12.5 mg

1

moexipril-hydrochlorothiazidetab 15-25 mg

1

perindopril erbumine tab 2 mg 1

perindopril erbumine tab 4 mg(Aceon)

1

perindopril erbumine tab 8 mg(Aceon)

1

quinapril hcl tab 5 mg (Accupril) 1




quinapril-hydrochlorothiazidetab 10-12.5 mg (Accuretic)

1

quinapril-hydrochlorothiazidetab 20-12.5 mg (Accuretic)

1

quinapril-hydrochlorothiazidetab 20-25 mg (Accuretic)

1

ramipril cap 1.25 mg (Altace) 1

ramipril cap 2.5 mg (Altace) 1

ramipril cap 5 mg (Altace) 1

ramipril cap 10 mg (Altace) 1

trandolapril tab 1 mg (Mavik) 1

trandolapril tab 2 mg (Mavik) 1

trandolapril tab 4 mg 1

ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBS)AND COMBINATIONS

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)

1 •

amlodipine-valsartan-hydrochlorothiazide tab5-160-25 mg (Exforge hct)

1 •

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct)

1 •


1 •


1 •

ATACAND – candesartan cilexetiltab 4 mg

3 • •


3 • •


3 • •


3 • •

ATACAND HCT – candesartancilexetil-hydrochlorothiazide tab16-12.5 mg

3 • •

ATACAND HCT – candesartancilexetil-hydrochlorothiazide tab32-12.5 mg

3 • •

ATACAND HCT – candesartancilexetil-hydrochlorothiazide tab32-25 mg

3 • •

AVALIDE – irbesartan-hydrochlorothiazide tab 150-12.5mg

3 • •

AVALIDE – irbesartan-hydrochlorothiazide tab 300-12.5mg

3 • •

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps

AVAPRO – irbesartan tab 75 mg 3 • •AVAPRO – irbesartan tab 150 mg 3 • •AVAPRO – irbesartan tab 300 mg 3 • •candesartan cilexetil tab 4 mg

(Atacand)1 •

candesartan cilexetil tab 8 mg(Atacand)

1 •


1 •


1 •

candesartan cilexetil-hydrochlorothiazide tab16-12.5 mg (Atacand hct)

1 •

candesartan cilexetil-hydrochlorothiazide tab32-12.5 mg (Atacand hct)

1 •

candesartan cilexetil-hydrochlorothiazide tab32-25 mg (Atacand hct)

1 •

COZAAR – losartan potassium tab25 mg

3 • •


3 • •


3 • •

DIOVAN – valsartan tab 40 mg 3 • •DIOVAN – valsartan tab 80 mg 3 • •DIOVAN – valsartan tab 160 mg 3 • •DIOVAN – valsartan tab 320 mg 3 • •DIOVAN HCT – valsartan-

hydrochlorothiazide tab 80-12.5mg

3 • •

DIOVAN HCT – valsartan-hydrochlorothiazide tab 160-12.5mg

3 • •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

DIOVAN HCT – valsartan-hydrochlorothiazide tab 160-25mg

3 • •

DIOVAN HCT – valsartan-hydrochlorothiazide tab 320-12.5mg

3 • •

DIOVAN HCT – valsartan-hydrochlorothiazide tab 320-25mg

3 • •

EDARBI – azilsartan medoxomiltab 40 mg

3 • •

EDARBI – azilsartan medoxomiltab 80 mg

3 • •

EDARBYCLOR – azilsartanmedoxomil-chlorthalidone tab40-12.5 mg

3 • •

EDARBYCLOR – azilsartanmedoxomil-chlorthalidone tab40-25 mg

3 • •

EPROSARTAN MESYLATE –eprosartan mesylate tab 600 mg

3 • •

EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg

3 • •

EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab5-160-25 mg

3 • •

EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg

3 • •


3 • •


3 • •

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

HYZAAR – losartan potassium &hydrochlorothiazide tab 50-12.5mg

3 • •

HYZAAR – losartan potassium &hydrochlorothiazide tab 100-12.5mg

3 • •

HYZAAR – losartan potassium &hydrochlorothiazide tab 100-25mg

3 • •

irbesartan tab 75 mg (Avapro) 1 •irbesartan tab 150 mg (Avapro) 1 •irbesartan tab 300 mg (Avapro) 1 •irbesartan-hydrochlorothiazide

tab 150-12.5 mg (Avalide)1 •

irbesartan-hydrochlorothiazidetab 300-12.5 mg (Avalide)

1 •

losartan potassium &hydrochlorothiazide tab50-12.5 mg (Hyzaar)

1 •

losartan potassium &hydrochlorothiazide tab100-12.5 mg (Hyzaar)

1 •

losartan potassium &hydrochlorothiazide tab100-25 mg (Hyzaar)

1 •

losartan potassium tab 25 mg(Cozaar)

1 •


1 •


1 •

MICARDIS – telmisartan tab 20 mg 3 • •MICARDIS – telmisartan tab 40 mg 3 • •MICARDIS – telmisartan tab 80 mg 3 • •MICARDIS HCT – telmisartan-

hydrochlorothiazide tab 40-12.5mg

3 • •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps

MICARDIS HCT – telmisartan-hydrochlorothiazide tab 80-12.5mg

3 • •

MICARDIS HCT – telmisartan-hydrochlorothiazide tab 80-25 mg

3 • •

olmesartan medoxomil tab 5 mg(Benicar)

1 •

olmesartan medoxomil tab20 mg (Benicar)

1 •

olmesartan medoxomil tab40 mg (Benicar)

1 •

olmesartan medoxomil-hydrochlorothiazide tab20-12.5 mg (Benicar hct)

1 •

olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg (Benicar hct)

1 • •

olmesartan medoxomil-hydrochlorothiazide tab40-25 mg (Benicar hct)

1 •

olmesartan-amlodipine-hydrochlorothiazide tab20-5-12.5 mg (Tribenzor)

1 •


1 •

olmesartan-amlodipine-hydrochlorothiazide tab40-5-25 mg (Tribenzor)

1 •


1 •

olmesartan-amlodipine-hydrochlorothiazide tab40-10-25 mg (Tribenzor)

1 •

telmisartan tab 20 mg (Micardis) 1 •telmisartan tab 40 mg (Micardis) 1 •

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

telmisartan tab 80 mg (Micardis) 1 •telmisartan-hydrochlorothiazide

tab 40-12.5 mg (Micardis hct)1 •

telmisartan-hydrochlorothiazidetab 80-12.5 mg (Micardis hct)

1 •

telmisartan-hydrochlorothiazidetab 80-25 mg (Micardis hct)

1 •

TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazidetab 20-5-12.5 mg

3 • •


3 • •

TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazidetab 40-5-25 mg

3 • •


3 • •

TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazidetab 40-10-25 mg

3 • •

valsartan tab 40 mg (Diovan) 1 •valsartan tab 80 mg (Diovan) 1 •valsartan tab 160 mg (Diovan) 1 •valsartan tab 320 mg (Diovan) 1 •valsartan-hydrochlorothiazide

tab 80-12.5 mg (Diovan hct)1 •

valsartan-hydrochlorothiazidetab 160-12.5 mg (Diovan hct)

1 •

valsartan-hydrochlorothiazidetab 160-25 mg (Diovan hct)

1 •

valsartan-hydrochlorothiazidetab 320-12.5 mg (Diovan hct)

1 •

valsartan-hydrochlorothiazidetab 320-25 mg (Diovan hct)

1 •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

BETA BLOCKERS AND COMBINATIONSacebutolol hcl cap 200 mg

(Sectral)1

acebutolol hcl cap 400 mg(Sectral)

1

atenolol & chlorthalidone tab50-25 mg (Tenoretic 50)

1

atenolol & chlorthalidone tab100-25 mg (Tenoretic 100)

1

atenolol tab 25 mg (Tenormin) 1



betaxolol hcl tab 10 mg (Kerlone) 1

betaxolol hcl tab 20 mg (Kerlone) 1

bisoprolol & hydrochlorothiazidetab 2.5-6.25 mg (Ziac)

1

bisoprolol & hydrochlorothiazidetab 5-6.25 mg (Ziac)

1

bisoprolol & hydrochlorothiazidetab 10-6.25 mg (Ziac)

1

bisoprolol fumarate tab 5 mg(Zebeta)

1

bisoprolol fumarate tab 10 mg(Zebeta)

1

BYSTOLIC – nebivolol hcl tab 2.5mg (base equivalent)

3

BYSTOLIC – nebivolol hcl tab 5 mg(base equivalent)

3

BYSTOLIC – nebivolol hcl tab 10mg (base equivalent)

3

BYSTOLIC – nebivolol hcl tab 20mg (base equivalent)

3

BYVALSON – nebivolol-valsartantab 5-80 mg

3 • •

2018




Drug Name Dru

g Ti

er

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cial

ty/T

ier 4

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r Aut

horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps

carvedilol phosphate cap er 24hr10 mg (Coreg cr)

1


1


1


1

carvedilol tab 3.125 mg (Coreg) 1



carvedilol tab 25 mg (Coreg) 1

COREG – carvedilol tab 3.125 mg 3



COREG – carvedilol tab 25 mg 3

COREG CR – carvedilol phosphatecap er 24hr 10 mg

3


3


3


3

CORGARD – nadolol tab 20 mg 3



CORZIDE – nadolol &bendroflumethiazide tab 40-5 mg

3

CORZIDE – nadolol &bendroflumethiazide tab 80-5 mg

3

DUTOPROL – metoprolol &hydrochlorothiazide tab er 24hr25-12.5 mg

3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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Lim

its

Res

pons

ible

Ste

ps


3


3

HEMANGEOL – propranolol hcloral soln 4.28 mg/ml (3.75 mg/mlbase equiv)

3

INDERAL LA – propranolol hcl caper 24hr 60 mg

3


3


3


3

INDERAL XL – propranolol hclsustained-release beads cap er24hr 80 mg

3

INDERAL XL – propranolol hclsustained-release beads cap er24hr 120 mg

3

INNOPRAN XL – propranolol hclsustained-release beads cap er24hr 80 mg

2

INNOPRAN XL – propranolol hclsustained-release beads cap er24hr 120 mg

2

labetalol hcl tab 100 mg 1



LOPRESSOR – metoprolol tartratetab 50 mg

3

LOPRESSOR – metoprolol tartratetab 100 mg

3

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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horiz

atio

n

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Lim

its

Res

pons

ible

Ste

ps

LOPRESSOR HCT – metoprolol &hydrochlorothiazide tab 50-25 mg

3

metoprolol &hydrochlorothiazide tab50-25 mg (Lopressor hct)

1

metoprolol &hydrochlorothiazide tab100-25 mg (Lopressor hct)

1

metoprolol succinate tab er 24hr25 mg (tartrate equiv) (Toprol xl)

1

metoprolol succinate tab er 24hr50 mg (tartrate equiv) (Toprol xl)

1

metoprolol succinate tab er 24hr100 mg (tartrate equiv) (Toprolxl)

1

metoprolol succinate tab er 24hr200 mg (tartrate equiv) (Toprolxl)

1

METOPROLOL TARTRATE –metoprolol tartrate tab 37.5 mg

3

METOPROLOL TARTRATE –metoprolol tartrate tab 75 mg

3

metoprolol tartrate tab 25 mg 1

metoprolol tartrate tab 50 mg(Lopressor)

1

metoprolol tartrate tab 100 mg(Lopressor)

1

METOPROLOL/HYDROCHLOROTHI –metoprolol & hydrochlorothiazidetab 100-50 mg

3

nadolol & bendroflumethiazidetab 40-5 mg (Corzide)

1

nadolol & bendroflumethiazidetab 80-5 mg (Corzide)

1

nadolol tab 20 mg (Corgard) 1


Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps


pindolol tab 5 mg 1

pindolol tab 10 mg 1

PROPRANOLOL HCL –propranolol hcl oral soln 20mg/5ml

2

PROPRANOLOL HCL –propranolol hcl oral soln 40mg/5ml

2

propranolol hcl cap er 24hr60 mg (Inderal la)

1


1


1


1

propranolol hcl tab 10 mg 1





PROPRANOLOL/HYDROCHLOROTH– propranolol &hydrochlorothiazide tab 40-25 mg

2

PROPRANOLOL/HYDROCHLOROTH– propranolol &hydrochlorothiazide tab 80-25 mg

2

TENORETIC 100 – atenolol &chlorthalidone tab 100-25 mg

3

TENORETIC 50 – atenolol &chlorthalidone tab 50-25 mg

3

TIMOLOL MALEATE – timololmaleate tab 5 mg

2

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


2


2

TOPROL XL – metoprololsuccinate tab er 24hr 25 mg(tartrate equiv)

3


3


3


3

ZIAC – bisoprolol &hydrochlorothiazide tab 2.5-6.25mg

3

ZIAC – bisoprolol &hydrochlorothiazide tab 5-6.25mg

3

ZIAC – bisoprolol &hydrochlorothiazide tab 10-6.25mg

3

CALCIUM CHANNEL BLOCKERS ANDCOMBINATIONSADALAT CC – nifedipine tab er

24hr 30 mg3

ADALAT CC – nifedipine tab er24hr 60 mg

3

ADALAT CC – nifedipine tab er24hr 90 mg

3

amlodipine besylate tab 2.5 mg(Norvasc)

1

amlodipine besylate tab 5 mg(Norvasc)

1

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

amlodipine besylate tab 10 mg(Norvasc)

1

amlodipine besylate-benazeprilhcl cap 2.5-10 mg

1

amlodipine besylate-benazeprilhcl cap 5-10 mg (Lotrel)

1


1

amlodipine besylate-benazeprilhcl cap 5-40 mg

1


1


1

amlodipine besylate-olmesartanmedoxomil tab 5-20 mg (Azor)

1 •


1 •


1 •


1 •

amlodipine besylate-valsartantab 5-160 mg (Exforge)

1 •


1 •


1 •


1 •

AZOR – amlodipine besylate-olmesartan medoxomil tab 5-20mg

3 • •


3 • •

2018




Drug Name Dru

g Ti

er

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cial

ty/T

ier 4

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horiz

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n

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Lim

its

Res

pons

ible

Ste

ps


3 • •


3 • •

CALAN – verapamil hcl tab 80 mg 3

CALAN – verapamil hcl tab 120 mg 3

CALAN SR – verapamil hcl tab er120 mg

3


3


3

CARDIZEM LA – diltiazem hclcoated beads tab er 24hr 120 mg

3

diltiazem hcl cap er 12hr 60 mg 1






diltiazem hcl coated beads caper 24hr 120 mg (Cardizem cd)

1


1


1

diltiazem hcl coated beads caper 24hr 300 mg

1


1

diltiazem hcl coated beads tab er24hr 180 mg (Cardizem la)

1

Drug Name Dru

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ible

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ps


1


1


1


1

diltiazem hcl extended releasebeads cap er 24hr 120 mg(Tiazac)

1


1


1


1


1


1

diltiazem hcl tab 30 mg(Cardizem)

1


1

diltiazem hcl tab 90 mg 1


1

EXFORGE – amlodipine besylate-valsartan tab 5-160 mg

3 • •


3 • •

2018




Drug Name Dru

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pons

ible

Ste

ps


3 • •


3 • •

felodipine tab er 24hr 2.5 mg 1

felodipine tab er 24hr 5 mg 1

felodipine tab er 24hr 10 mg 1

isradipine cap 2.5 mg 1

isradipine cap 5 mg 1

LOTREL – amlodipine besylate-benazepril hcl cap 5-10 mg

3


3


3


3

nicardipine hcl cap 20 mg 1

nicardipine hcl cap 30 mg 1

nifedipine cap 10 mg (Procardia) 1

nifedipine cap 20 mg 1

nifedipine tab er 24hr 30 mg(Adalat cc)

1


1


1

nifedipine tab er 24hr osmoticrelease 30 mg (Procardia xl)

1


1


1

nimodipine cap 30 mg 1

Drug Name Dru

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ier 4

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pons

ible

Ste

ps

NISOLDIPINE ER – nisoldipine taber 24hr 20 mg

2

NISOLDIPINE ER – nisoldipine taber 24hr 25.5 mg

2


2


2

nisoldipine tab er 24hr 8.5 mg(Sular)

1

nisoldipine tab er 24hr 17 mg(Sular)

1

nisoldipine tab er 24hr 34 mg(Sular)

1

NORVASC – amlodipine besylatetab 2.5 mg

3

NORVASC – amlodipine besylatetab 5 mg

3

NORVASC – amlodipine besylatetab 10 mg

3

NYMALIZE – nimodipine oral soln60 mg/20ml

3

PROCARDIA – nifedipine cap 10mg

3

PROCARDIA XL – nifedipine tab er24hr osmotic release 30 mg

3


3


3

SULAR – nisoldipine tab er 24hr8.5 mg

3

SULAR – nisoldipine tab er 24hr 17mg

3

SULAR – nisoldipine tab er 24hr 34mg

3

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps

TARKA – trandolapril-verapamil hcltab er 1-240 mg

3


3


3


3

telmisartan-amlodipine tab40-5 mg (Twynsta)

1 •


1 •


1 •


1 •

trandolapril-verapamil hcl tab er1-240 mg (Tarka)

1


1


1


1

TWYNSTA – telmisartan-amlodipine tab 40-5 mg

3 • •


3 • •


3 • •


3 • •

verapamil hcl cap er 24hr 100 mg(Verelan pm)

1

verapamil hcl cap er 24hr 120 mg(Verelan)

1

Drug Name Dru

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pons

ible

Ste

ps


1


1


1


1


1

verapamil hcl tab er 120 mg(Calan sr)

1


1


1

verapamil hcl tab 40 mg 1

verapamil hcl tab 80 mg (Calan) 1

verapamil hcl tab 120 mg (Calan) 1

VERELAN – verapamil hcl cap er24hr 120 mg

3


3


3


3

VERELAN PM – verapamil hcl caper 24hr 100 mg

3


3


3

CHEST PAINDILATRATE SR – isosorbide

dinitrate cap er 40 mg3

2018




Drug Name Dru

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ible

Ste

ps

ISOSORBIDE DINITRATE ER –isosorbide dinitrate tab er 40 mg

3

isosorbide dinitrate tab 5 mg(Isordil titradose)

1

isosorbide dinitrate tab 10 mg 1



isosorbide mononitrate tab er24hr 30 mg

1


1


1

isosorbide mononitrate tab10 mg

1

isosorbide mononitrate tab20 mg

1

NITRO-BID – nitroglycerin oint 2% 2

NITRO-DUR – nitroglycerin tdpatch 24hr 0.1 mg/hr

3


3


2


3


3


2

nitroglycerin cap er 2.5 mg 1

nitroglycerin cap er 6.5 mg 1

nitroglycerin cap er 9 mg 1

Drug Name Dru

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ible

Ste

ps

NITROGLYCERIN LINGUAL –nitroglycerin lingual aerosol 400mcg/spray

3

nitroglycerin sl tab 0.3 mg(Nitrostat)

1


1


1

nitroglycerin td patch 24hr0.1 mg/hr (Nitro-dur)

1


1


1


1

nitroglycerin tl soln 0.4 mg/spray(400 mcg/spray) (Nitrolingualpumpspr)

1

NITROLINGUAL PUMPSPRAY –nitroglycerin tl soln 0.4 mg/spray(400 mcg/spray)

3

NITROMIST – nitroglycerin lingualaerosol 400 mcg/spray

3

NITROSTAT – nitroglycerin sl tab0.3 mg

3


3


3

RANEXA – ranolazine tab er 12hr500 mg

3

RANEXA – ranolazine tab er 12hr1000 mg

3

CHOLESTEROL LOWERING

2018




Drug Name Dru

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ible

Ste

ps

ALTOPREV – lovastatin tab er 24hr20 mg

3 • •


3 • •


3 • •

atorvastatin calcium tab 10 mg(base equivalent) (Lipitor)

1 •


1 •


1 •


1 •

cholestyramine light powderpackets 4 gm

1

cholestyramine light powder4 gm/dose (Questran light)

1

cholestyramine powder packets4 gm (Questran)

1

cholestyramine powder 4 gm/dose (Questran)

1

choline fenofibrate cap dr 45 mg(fenofibric acid equiv) (Trilipix)

1 •

choline fenofibrate cap dr135 mg (fenofibric acid equiv)(Trilipix)

1 •

COLESTID – colestipol hcl tab 1gm

3

COLESTID – colestipol hclgranules 5 gm

3

COLESTID – colestipol hcl granulepackets 5 gm

3

COLESTID FLAVORED –colestipol hcl granules 5 gm

3

Drug Name Dru

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pons

ible

Ste

ps

COLESTID FLAVORED –colestipol hcl granule packets 5gm

3

colestipol hcl granule packets5 gm (Colestid flavored)

1

colestipol hcl granules 5 gm(Colestid flavored)

1

colestipol hcl tab 1 gm (Colestid) 1

ezetimibe tab 10 mg (Zetia) 1

ezetimibe-simvastatin tab10-10 mg (Vytorin)

1 •


1 •


1 •


1 •

FENOFIBRATE – fenofibrate cap50 mg

3 • •

FENOFIBRATE – fenofibrate cap150 mg

3 • •

fenofibrate micronized cap43 mg

1 •

fenofibrate micronized cap67 mg (Lofibra)

1 •

fenofibrate micronized cap130 mg

1 •


1 •


1 •

fenofibrate tab 48 mg (Tricor) 1 •fenofibrate tab 54 mg (Lofibra) 1 •fenofibrate tab 145 mg (Tricor) 1 •fenofibrate tab 160 mg (Lofibra) 1 •

2018




Drug Name Dru

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its

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pons

ible

Ste

ps

FENOFIBRIC ACID – fenofibricacid tab 35 mg

3 • •

FENOFIBRIC ACID – fenofibricacid tab 105 mg

3 • •

FIBRICOR – fenofibric acid tab 35mg

3 • •

FIBRICOR – fenofibric acid tab 105mg

3 • •

fluvastatin sodium cap 20 mg 1 •fluvastatin sodium cap 40 mg 1 •fluvastatin sodium tab er 24 hr

80 mg (Lescol xl)1 •

gemfibrozil tab 600 mg (Lopid) 1 •JUXTAPID – lomitapide mesylate

cap 5 mg (base equiv)3 X • •

JUXTAPID – lomitapide mesylatecap 10 mg (base equiv)

3 X • •


3 X • •


3 X • •


3 X • •


3 X • •

KYNAMRO – mipomersen sodiumsoln prefilled syringe 200 mg/ml

3 X • •

LESCOL XL – fluvastatin sodiumtab er 24 hr 80 mg

3 • •

LIPOFEN – fenofibrate cap 50 mg 3 • •LIPOFEN – fenofibrate cap 150 mg 3 • •LIVALO – pitavastatin calcium tab

1 mg (base equiv)3 • •

LIVALO – pitavastatin calcium tab2 mg (base equiv)

3 • •

Drug Name Dru

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pons

ible

Ste

ps

LIVALO – pitavastatin calcium tab4 mg (base equiv)

3 • •

LOFIBRA – fenofibrate tab 54 mg 3 • •LOFIBRA – fenofibrate micronized

cap 67 mg3 • •

LOFIBRA – fenofibrate micronizedcap 134 mg

3 • •

LOPID – gemfibrozil tab 600 mg 3 • •lovastatin tab 10 mg 1 •lovastatin tab 20 mg 1 •lovastatin tab 40 mg (Mevacor) 1 •LOVAZA – omega-3-acid ethyl

esters cap 1 gm3 • •

niacin tab er 500 mg(antihyperlipidemic) (Niaspan)

1


1


1

NIACOR – niacin(antihyperlipidemic) tab 500 mg

3

omega-3-acid ethyl esters cap1 gm (Lovaza)

1 • •

PRALUENT – alirocumabsubcutaneous soln pen-injector75 mg/ml

3 X • •

PRALUENT – alirocumabsubcutaneous soln pen-injector150 mg/ml

3 X • •

PRAVACHOL – pravastatin sodiumtab 20 mg

3 • •


3 • •


3 • •

pravastatin sodium tab 10 mg 1 •

2018




Drug Name Dru

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ty/T

ier 4

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its

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pons

ible

Ste

ps

pravastatin sodium tab 20 mg(Pravachol)

1 •


1 •


1 •

QUESTRAN – cholestyraminepowder 4 gm/dose

3

QUESTRAN – cholestyraminepowder packets 4 gm

3

QUESTRAN LIGHT –cholestyramine light powder 4gm/dose

3

REPATHA – evolocumabsubcutaneous soln prefilledsyringe 140 mg/ml

3 X • •

REPATHA PUSHTRONEXSYSTEM – evolocumabsubcutaneous soln cartridge/infusor 420 mg/3.5ml

3 X • •

REPATHA SURECLICK –evolocumab subcutaneous solnauto-injector 140 mg/ml

3 X • •

rosuvastatin calcium tab 5 mg(Crestor)

1 •


1 •


1 •


1 •

simvastatin tab 5 mg (Zocor) 1 •simvastatin tab 10 mg (Zocor) 1 •simvastatin tab 20 mg (Zocor) 1 •simvastatin tab 40 mg (Zocor) 1 •simvastatin tab 80 mg (Zocor) 1 •

Drug Name Dru

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ible

Ste

ps

TRICOR – fenofibrate tab 48 mg 3 • •TRICOR – fenofibrate tab 145 mg 3 • •TRIGLIDE – fenofibrate tab 160 mg 3 • •TRILIPIX – choline fenofibrate cap

dr 45 mg (fenofibric acid equiv)3 • •

TRILIPIX – choline fenofibrate capdr 135 mg (fenofibric acid equiv)

3 • •

VASCEPA – icosapent ethyl cap0.5 gm

3 • •

VASCEPA – icosapent ethyl cap 1gm

3 • •

VYTORIN – ezetimibe-simvastatintab 10-10 mg

3 • •


3 • •


3 • •


3 • •

WELCHOL – colesevelam hcl tab625 mg

2

WELCHOL – colesevelam hclpacket for susp 3.75 gm

2

ZOCOR – simvastatin tab 5 mg 3 • •ZOCOR – simvastatin tab 10 mg 3 • •ZOCOR – simvastatin tab 20 mg 3 • •ZOCOR – simvastatin tab 40 mg 3 • •ZOCOR – simvastatin tab 80 mg 3 • •FLUID RETENTIONacetazolamide cap er 12hr

500 mg (Diamox)1

acetazolamide tab 125 mg 1

acetazolamide tab 250 mg 1

ALDACTAZIDE – spironolactone &hydrochlorothiazide tab 25-25 mg

3

2018




Drug Name Dru

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ty/T

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its

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pons

ible

Ste

ps

ALDACTAZIDE – spironolactone &hydrochlorothiazide tab 50-50 mg

3

ALDACTONE – spironolactone tab25 mg

3


3


3

amiloride & hydrochlorothiazidetab 5-50 mg

1

amiloride hcl tab 5 mg 1

bumetanide tab 0.5 mg (Bumex) 1

bumetanide tab 1 mg (Bumex) 1

bumetanide tab 2 mg (Bumex) 1

BUMEX – bumetanide tab 0.5 mg 3

BUMEX – bumetanide tab 1 mg 3

BUMEX – bumetanide tab 2 mg 3

CHLOROTHIAZIDE –chlorothiazide tab 250 mg

3

chlorothiazide tab 500 mg 1

chlorthalidone tab 25 mg 1

chlorthalidone tab 50 mg 1

DEMADEX – torsemide tab 10 mg 3

DEMADEX – torsemide tab 20 mg 3

DIAMOX – acetazolamide cap er12hr 500 mg

3

DIURIL – chlorothiazide susp 250mg/5ml

3

DYAZIDE – triamterene &hydrochlorothiazide cap 37.5-25mg

3

DYRENIUM – triamterene cap 50mg

3

DYRENIUM – triamterene cap 100mg

3

Drug Name Dru

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pons

ible

Ste

ps

EDECRIN – ethacrynic acid tab 25mg

3

ethacrynic acid tab 25 mg(Edecrin)

1

FUROSEMIDE – furosemide oralsoln 8 mg/ml

3

furosemide oral soln 10 mg/ml 1

furosemide tab 20 mg (Lasix) 1



hydrochlorothiazide cap 12.5 mg(Microzide)

1

hydrochlorothiazide tab 12.5 mg 1

hydrochlorothiazide tab 25 mg 1

hydrochlorothiazide tab 50 mg 1

indapamide tab 1.25 mg 1

indapamide tab 2.5 mg 1

KEVEYIS – dichlorphenamide tab50 mg

3 X • •

LASIX – furosemide tab 20 mg 3



MAXZIDE – triamterene &hydrochlorothiazide tab 75-50 mg

3

MAXZIDE-25 – triamterene &hydrochlorothiazide tab 37.5-25mg

3

methazolamide tab 25 mg(Neptazane)

1

methazolamide tab 50 mg(Neptazane)

1

METHYCLOTHIAZIDE –methyclothiazide tab 5 mg

3

metolazone tab 2.5 mg 1

2018




Drug Name Dru

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pons

ible

Ste

ps

metolazone tab 5 mg 1

metolazone tab 10 mg 1

MICROZIDE – hydrochlorothiazidecap 12.5 mg

3

NEPTAZANE – methazolamide tab25 mg

3

NEPTAZANE – methazolamide tab50 mg

3

spironolactone &hydrochlorothiazide tab25-25 mg (Aldactazide)

1

spironolactone tab 25 mg(Aldactone)

1


1


1

torsemide tab 5 mg (Demadex) 1



torsemide tab 100 mg 1

triamterene &hydrochlorothiazide cap37.5-25 mg (Dyazide)

1

triamterene &hydrochlorothiazide tab37.5-25 mg (Maxzide-25)

1

triamterene &hydrochlorothiazide tab75-50 mg (Maxzide)

1

TRIAMTERENE/HYDROCHLOROTH– triamterene &hydrochlorothiazide cap 50-25mg

3

HEART RHYTHM

Drug Name Dru

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pons

ible

Ste

ps

amiodarone hcl tab 100 mg 1

amiodarone hcl tab 200 mg(Cordarone)

1

amiodarone hcl tab 400 mg 1

BETAPACE AF – sotalol hcl (afib/afl) tab 80 mg

3


3


3

disopyramide phosphate cap100 mg (Norpace)

1

disopyramide phosphate cap150 mg (Norpace)

1

dofetilide cap 125 mcg(0.125 mg) (Tikosyn)

1

dofetilide cap 250 mcg (0.25 mg)(Tikosyn)

1

dofetilide cap 500 mcg (0.5 mg)(Tikosyn)

1

flecainide acetate tab 50 mg 1



mexiletine hcl cap 150 mg 1



MULTAQ – dronedarone hcl tab400 mg (base equivalent)

2

NORPACE – disopyramidephosphate cap 100 mg

3

NORPACE – disopyramidephosphate cap 150 mg

3

NORPACE CR – disopyramidephosphate cap er 12hr 100 mg

3

2018




Drug Name Dru

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pons

ible

Ste

ps

NORPACE CR – disopyramidephosphate cap er 12hr 150 mg

3

propafenone hcl cap er 12hr225 mg (Rythmol sr)

1


1


1

propafenone hcl tab 150 mg 1

propafenone hcl tab 225 mg(Rythmol)

1

propafenone hcl tab 300 mg 1

quinidine gluconate tab er324 mg

1

QUINIDINE SULFATE – quinidinesulfate tab 200 mg

2

QUINIDINE SULFATE – quinidinesulfate tab 300 mg

3

RYTHMOL SR – propafenone hclcap er 12hr 225 mg

3


3


3

sotalol hcl (afib/afl) tab 80 mg(Betapace af)

1


1


1

sotalol hcl tab 80 mg (Betapace) 1



sotalol hcl tab 240 mg 1

Drug Name Dru

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pons

ible

Ste

ps

TIKOSYN – dofetilide cap 125 mcg(0.125 mg)

3


3


3

OTHER HEART RELATED DRUGSADCIRCA – tadalafil tab 20 mg

(pah)2 X • •

ADEMPAS – riociguat tab 0.5 mg 3 X • •ADEMPAS – riociguat tab 1 mg 3 X • •ADEMPAS – riociguat tab 1.5 mg 3 X • •ADEMPAS – riociguat tab 2 mg 3 X • •ADEMPAS – riociguat tab 2.5 mg 3 X • •amlodipine besylate-atorvastatin

calcium tab 2.5-10 mg (Caduet)1

amlodipine besylate-atorvastatincalcium tab 2.5-20 mg (Caduet)

1

amlodipine besylate-atorvastatincalcium tab 2.5-40 mg (Caduet)

1

amlodipine besylate-atorvastatincalcium tab 5-10 mg (Caduet)

1


1


1


1


1


1


1

2018




Drug Name Dru

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its

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pons

ible

Ste

ps


1

BIDIL – isosorbide dinitrate-hydralazine hcl tab 20-37.5 mg

3

CADUET – amlodipine besylate-atorvastatin calcium tab 5-10 mg

3


3


3


3

CADUET – amlodipine besylate-atorvastatin calcium tab 10-10mg

3


3


3


3

CARDURA – doxazosin mesylatetab 1 mg

3


3


3


3

CATAPRES – clonidine hcl tab 0.1mg

3


3

Drug Name Dru

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ible

Ste

ps


3

CATAPRES-TTS-1 – clonidine hcltd patch weekly 0.1 mg/24hr

3


3


3

clonidine hcl tab 0.1 mg(Catapres)

1


1


1

clonidine hcl td patch weekly0.1 mg/24hr (Catapres-tts-1)

1


1


1

CLORPRES – clonidine &chlorthalidone tab 0.1-15 mg

3


3


3

CORLANOR – ivabradine hcl tab 5mg (base equiv)

3

CORLANOR – ivabradine hcl tab7.5 mg (base equiv)

3

DIBENZYLINE –phenoxybenzamine hcl cap 10mg

3

DIGOXIN – digoxin oral soln 0.05mg/ml

2

digoxin tab 125 mcg (0.125 mg)(Lanoxin)

1

2018




Drug Name Dru

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Res

pons

ible

Ste

ps

digoxin tab 250 mcg (0.25 mg)(Lanoxin)

1

doxazosin mesylate tab 1 mg(Cardura)

1


1


1


1

ENTRESTO – sacubitril-valsartantab 24-26 mg

2 • •


2 • •


2 • •

EPINEPHRINE HCL – epinephrineinj 30 mg/30ml

3

epinephrine pf inj 1 mg/ml 1

epinephrine pf soln prefilledsyringe 1 mg/10ml (0.1 mg/ml)

1

eplerenone tab 25 mg (Inspra) 1

eplerenone tab 50 mg (Inspra) 1

guanfacine hcl tab 1 mg (Tenex) 1

guanfacine hcl tab 2 mg (Tenex) 1

hydralazine hcl tab 10 mg 1




INSPRA – eplerenone tab 25 mg 3

INSPRA – eplerenone tab 50 mg 3

ISOXSUPRINE HCL – isoxsuprinehcl tab 20 mg

3

isoxsuprine hcl tab 10 mg 1

Drug Name Dru

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ty/T

ier 4

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its

Res

pons

ible

Ste

ps

LANOXIN – digoxin tab 62.5 mcg(0.0625 mg)

3

LANOXIN – digoxin tab 125 mcg(0.125 mg)

3

LANOXIN – digoxin tab 187.5 mcg(0.1875 mg)

3

LANOXIN – digoxin tab 250 mcg(0.25 mg)

3

LETAIRIS – ambrisentan tab 5 mg 2 X • •LETAIRIS – ambrisentan tab 10 mg 2 X • •methyldopa tab 250 mg 1

methyldopa tab 500 mg 1

METHYLDOPA/HYDROCHLOROTHI– methyldopa &hydrochlorothiazide tab 250-15mg

3

METHYLDOPA/HYDROCHLOROTHI– methyldopa &hydrochlorothiazide tab 250-25mg

3

midodrine hcl tab 2.5 mg 1

midodrine hcl tab 5 mg 1

midodrine hcl tab 10 mg 1

MINIPRESS – prazosin hcl cap 1mg

3


3


3

minoxidil tab 2.5 mg 1

minoxidil tab 10 mg 1

OPSUMIT – macitentan tab 10 mg 2 X • •

2018




Drug Name Dru

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pons

ible

Ste

ps

ORENITRAM – treprostinildiolamine tab er 0.125 mg (baseequiv)

3 X •


3 X •

ORENITRAM – treprostinildiolamine tab er 1 mg (baseequiv)

3 X •


3 X •

ORENITRAM – treprostinildiolamine tab er 5 mg (baseequiv)

3 X •

phenoxybenzamine hcl cap10 mg (Dibenzyline)

1

prazosin hcl cap 1 mg (Minipress) 1



REMODULIN – treprostinil sodiuminj 1 mg/ml (base equiv)

3 X •

REMODULIN – treprostinil sodiuminj 2.5 mg/ml (base equiv)

3 X •


3 X •


3 X •

REVATIO – sildenafil citrate forsuspension 10 mg/ml

3 X • •

sildenafil citrate tab 20 mg(Revatio)

1 X • •

TEKTURNA – aliskiren fumaratetab 150 mg (base equivalent)

3 • •

TEKTURNA – aliskiren fumaratetab 300 mg (base equivalent)

3 • •

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TEKTURNA HCT – aliskiren-hydrochlorothiazide tab 150-12.5mg

3 • •

TEKTURNA HCT – aliskiren-hydrochlorothiazide tab 150-25mg

3 • •

TEKTURNA HCT – aliskiren-hydrochlorothiazide tab 300-12.5mg

3 • •

TEKTURNA HCT – aliskiren-hydrochlorothiazide tab 300-25mg

3 • •

terazosin hcl cap 1 mg 1




TRACLEER – bosentan tab for oralsusp 32 mg

2 X • •

TRACLEER – bosentan tab 62.5mg

2 X • •

TRACLEER – bosentan tab 125mg

2 X • •

TYVASO – treprostinil inhalationsolution 0.6 mg/ml

3 X • •

TYVASO REFILL – treprostinilinhalation solution 0.6 mg/ml

3 X • •

TYVASO STARTER – treprostinilinhalation solution 0.6 mg/ml

3 X • •

UPTRAVI – selexipag tab therapypack 200 mcg (140) & 800 mcg(60)

2 X • •

UPTRAVI – selexipag tab 200 mcg 2 X • •UPTRAVI – selexipag tab 400 mcg 2 X • •UPTRAVI – selexipag tab 600 mcg 2 X • •UPTRAVI – selexipag tab 800 mcg 2 X • •

2018




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UPTRAVI – selexipag tab 1000mcg

2 X • •


2 X • •


2 X • •


2 X • •

VECAMYL – mecamylamine hcltab 2.5 mg

3

VENTAVIS – iloprost inhalationsolution 10 mcg/ml

2 X • •

VENTAVIS – iloprost inhalationsolution 20 mcg/ml

2 X • •

ERECTILE DYSFUNCTIONCIALIS – tadalafil tab 2.5 mg 3 • •CIALIS – tadalafil tab 5 mg 3 • •LEVITRA* – vardenafil hcl tab 2.5

mg2

LEVITRA* – vardenafil hcl tab 5 mg 2

LEVITRA* – vardenafil hcl tab 10mg

2

LEVITRA* – vardenafil hcl tab 20mg

2

ALLERGIC REACTION KITSEPINEPHRINE (Mylan Products) –

epinephrine solution auto-injector0.15 mg/0.3ml (1:2000)

2

EPINEPHRINE (Mylan Products) –epinephrine solution auto-injector0.3 mg/0.3ml (1:1000)

2

EPINEPHRINE – epinephrinesolution auto-injector 0.15mg/0.15ml (1:1000)

3

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EPINEPHRINE – epinephrinesolution auto-injector 0.3mg/0.3ml (1:1000)

3

EPIPEN 2-PAK – epinephrinesolution auto-injector 0.3mg/0.3ml (1:1000)

2

EPIPEN-JR 2-PAK – epinephrinesolution auto-injector 0.15mg/0.3ml (1:2000)

2

RESPIRATORY DRUGSANTIHISTAMINEScarbinoxamine maleate soln

4 mg/5ml1

carbinoxamine maleate tab 4 mg 1

CLEMASTINE FUMARATE –clemastine fumarate tab 2.68 mg

3

cyproheptadine hcl syrup2 mg/5ml

1

cyproheptadine hcl tab 4 mg 1

desloratadine tab 5 mg (Clarinex) 1

diphenhydramine hcl cap 50 mg 1

levocetirizine dihydrochloridetab 5 mg (Xyzal)

1

loratadine rapidly-disintegratingtab 10 mg (Claritin)

1

loratadine syrup 5 mg/5ml 1

loratadine tab 10 mg 1

promethazine hcl suppos12.5 mg

1

promethazine hcl suppos 25 mg 1

2018




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promethazine hcl suppos 50 mg 1

promethazine hcl syrup6.25 mg/5ml

1

promethazine hcl tab 12.5 mg 1

promethazine hcl tab 25 mg 1

promethazine hcl tab 50 mg 1

NASAL PRODUCTSASTEPRO – azelastine hcl nasal

spray 0.15% (205.5 mcg/spray)3 •

azelastine hcl nasal spray 0.1%(137 mcg/spray)

1 •

azelastine hcl nasal spray 0.15%(205.5 mcg/spray) (Astepro)

1 •

BACTROBAN NASAL – mupirocincalcium nasal oint 2%

3

FLUNISOLIDE – flunisolide nasalsoln 25 mcg/act (0.025%)

3 • •

fluticasone propionate nasalsusp 50 mcg/act

1 •

ipratropium bromide nasal soln0.03% (21 mcg/spray) (Atrovent)

1 •

ipratropium bromide nasal soln0.06% (42 mcg/spray) (Atrovent)

1 •

olopatadine hcl nasal soln 0.6%(Patanase)

1 •

triamcinolone acetonide nasalaerosol suspension 55 mcg/act

1 •

COUGH/COLD/ALLERGYacetylcysteine inhal soln 10% 1

acetylcysteine inhal soln 20% 1

benzonatate cap 100 mg(Tessalon perles)

1

benzonatate cap 150 mg 1

benzonatate cap 200 mg 1

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CODAR AR – chlorpheniramine w/codeine liquid 2-8 mg/5ml

3

hydrocod polst-chlorphen polster susp 10-8 mg/5ml (Tussionexpennkineti)

1

hydrocodone w/ homatropinesyrup 5-1.5 mg/5ml

1

hydrocodone w/ homatropinetab 5-1.5 mg

1

HYPER-SAL – sodium chloridesoln nebu 7%

3

HYPERSAL – sodium chloride solnnebu 3.5%

3

HYPERSAL – sodium chloride solnnebu 7%

3

loratadine & pseudoephedrinetab er 12hr 5-120 mg

1

loratadine & pseudoephedrinetab er 24hr 10-240 mg

1

NEBUSAL – sodium chloride solnnebu 6%

3

promethazine & phenylephrinesyrup 6.25-5 mg/5ml

1

promethazine w/ codeine syrup6.25-10 mg/5ml

1

promethazine-dm syrup6.25-15 mg/5ml

1

promethazine-phenylephrine-codeine syrup6.25-5-10 mg/5ml

1

pseudoeph-chlorphenw/ hydrocodone soln60-4-5 mg/5ml (Zutripro)

1

pseudoephed-bromphen-dmsyrup 30-2-10 mg/5ml

1

sodium chloride soln nebu 0.9% 1

sodium chloride soln nebu 3% 1

2018




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sodium chloride soln nebu 7%(Hyper-sal)

1

sodium chloride soln nebu 10% 1

SSKI – potassium iodide soln 1gm/ml

3

TESSALON PERLES –benzonatate cap 100 mg

3

TUSSIONEX PENNKINETIC EXT– hydrocod polst-chlorphen polster susp 10-8 mg/5ml

3

ZUTRIPRO – pseudoeph-chlorphen w/ hydrocodone soln60-4-5 mg/5ml

3

ASTHMA/COPDACCOLATE – zafirlukast tab 10 mg 3

ACCOLATE – zafirlukast tab 20 mg 3

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba 100-50mcg/dose

2 •


2 •


2 •

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21mcg/act

2 •


2 •


2 •

AEROSPAN – flunisolide hfa inhalaerosol 80 mcg/act

3 •

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albuterol sulfate soln nebu0.083% (2.5 mg/3ml)

1

albuterol sulfate soln nebu 0.5%(5 mg/ml)

1

albuterol sulfate soln nebu0.63 mg/3ml (base equiv)

1

albuterol sulfate soln nebu1.25 mg/3ml (base equiv)

1

albuterol sulfate syrup 2 mg/5ml 1

albuterol sulfate tab er 12hr 4 mg(Vospire er)

1

albuterol sulfate tab er 12hr 8 mg(Vospire er)

1

albuterol sulfate tab 2 mg 1

albuterol sulfate tab 4 mg 1

ALVESCO – ciclesonide inhalaerosol 80 mcg/act

3 •

ALVESCO – ciclesonide inhalaerosol 160 mcg/act

3 •

ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba 62.5-25mcg/inh

2 •

ARCAPTA NEOHALER –indacaterol maleate inhal powdercap 75 mcg (base equiv)

3 •

ARNUITY ELLIPTA – fluticasonefuroate aerosol powder breathactiv 100 mcg/act

2 •

ARNUITY ELLIPTA – fluticasonefuroate aerosol powder breathactiv 200 mcg/act

2 •

ASMANEX HFA – mometasonefuroate inhal aerosol suspension100 mcg/act

2 •

ASMANEX HFA – mometasonefuroate inhal aerosol suspension200 mcg/act

2 •

2018




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ASMANEX TWISTHALER 120ME – mometasone furoateinhal powd 220 mcg/inh (breathactivated)

2 •

ASMANEX TWISTHALER 14MET – mometasone furoateinhal powd 220 mcg/inh (breathactivated)

2 •


2 •


2 •


2 •

ATROVENT HFA – ipratropiumbromide hfa inhal aerosol 17mcg/act

2 •

BREO ELLIPTA – fluticasonefuroate-vilanterol aero powd ba100-25 mcg/inh

2 •

BREO ELLIPTA – fluticasonefuroate-vilanterol aero powd ba200-25 mcg/inh

2 •

BROVANA – arformoterol tartratesoln nebu 15 mcg/2ml (baseequiv)

3

budesonide inhalation susp0.25 mg/2ml (Pulmicort)

1

budesonide inhalation susp0.5 mg/2ml (Pulmicort)

1

budesonide inhalation susp1 mg/2ml (Pulmicort)

1

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COMBIVENT RESPIMAT –ipratropium-albuterol inhalaerosol soln 20-100 mcg/act

3 •

cromolyn sodium soln nebu20 mg/2ml

1

DALIRESP – roflumilast tab 500mcg

3

DULERA – mometasone furoate-formoterol fumarate aerosol100-5 mcg/act

2 •

DULERA – mometasone furoate-formoterol fumarate aerosol200-5 mcg/act

2 •

dyphylline-guaifenesin liqd100-100 mg/5ml

1

ELIXOPHYLLIN – theophyllineelixir 80 mg/15ml

3

FLOVENT DISKUS – fluticasonepropionate aer pow ba 50 mcg/blister

2 •


2 •


2 •

FLOVENT HFA – fluticasonepropionate hfa inhal aero 44mcg/act (50/valve)

2 •

FLOVENT HFA – fluticasonepropionate hfa inhal aer 110 mcg/act (125/valve)

2 •

FLOVENT HFA – fluticasonepropionate hfa inhal aer 220mcg/act (250/valve)

2 •

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aerpowder ba 55-14 mcg/act

2 •

2018




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2 •


2 •

INCRUSE ELLIPTA – umeclidiniumbr aero powd breath act 62.5mcg/inh (base eq)

2 •

ipratropium bromide inhal soln0.02%

1

ipratropium-albuterol nebu soln0.5-2.5(3) mg/3ml

1

levalbuterol hcl soln nebu conc1.25 mg/0.5ml (base equiv)(Xopenex concentrate)

1

levalbuterol hcl soln nebu0.31 mg/3ml (base equiv)(Xopenex)

1


1


1

METAPROTERENOL SULFATE –metaproterenol sulfate syrup 10mg/5ml

3

METAPROTERENOL SULFATE –metaproterenol sulfate tab 10 mg

3

METAPROTERENOL SULFATE –metaproterenol sulfate tab 20 mg

3

montelukast sodium chew tab4 mg (base equiv) (Singulair)

1

montelukast sodium chew tab5 mg (base equiv) (Singulair)

1

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montelukast sodiumoral granules packet 4 mg(base equiv) (Singulair)

1

montelukast sodium tab 10 mg(base equiv) (Singulair)

1

PROAIR HFA – albuterol sulfateinhal aero 108 mcg/act (90mcgbase equiv)

2 •

PROAIR RESPICLICK – albuterolsulfate aer pow ba 108 mcg/act(90 mcg base equiv)

2 •

PULMICORT – budesonideinhalation susp 0.25 mg/2ml

3

PULMICORT – budesonideinhalation susp 0.5 mg/2ml

3

PULMICORT – budesonideinhalation susp 1 mg/2ml

3

PULMICORT FLEXHALER –budesonide inhal aero powd 90mcg/act (breath activated)

3 •

PULMICORT FLEXHALER –budesonide inhal aero powd 180mcg/act (breath activated)

3 •

QVAR – beclomethasone dipropinhal aero soln 40 mcg/act (50/valve)

2 •

QVAR – beclomethasone dipropinhal aero soln 80 mcg/act (100/valve)

2 •

SEREVENT DISKUS – salmeterolxinafoate aer pow ba 50 mcg/dose (base equiv)

3 •

SINGULAIR – montelukast sodiumoral granules packet 4 mg (baseequiv)

3

SPIRIVA HANDIHALER –tiotropium bromide monohydrateinhal cap 18 mcg (base equiv)

2 •

2018




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SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhalaerosol 1.25 mcg/act

2 •

SPIRIVA RESPIMAT – tiotropiumbromide monohydrate inhalaerosol 2.5 mcg/act

2 •

STIOLTO RESPIMAT – tiotropiumbr-olodaterol inhal aero soln2.5-2.5 mcg/act

2 •

STRIVERDI RESPIMAT –olodaterol hcl inhal aerosol soln2.5 mcg/act (base equiv)

2 •

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 80-4.5 mcg/act

2 •

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 160-4.5 mcg/act

2 •

terbutaline sulfate tab 2.5 mg 1

terbutaline sulfate tab 5 mg 1

THEO-24 – theophylline cap er24hr 100 mg

3


3


3


3

theophylline soln 80 mg/15ml 1

theophylline tab er 12hr 100 mg 1






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TUDORZA PRESSAIR – aclidiniumbromide aerosol powd breathactivated 400 mcg/act

3 •

UTIBRON NEOHALER –indacaterol-glycopyrrolate inhalcap 27.5-15.6 mcg

3 •

VENTOLIN HFA – albuterol sulfateinhal aero 108 mcg/act (90mcgbase equiv)

2 •

VOSPIRE ER – albuterol sulfatetab er 12hr 4 mg

3

VOSPIRE ER – albuterol sulfatetab er 12hr 8 mg

3

zafirlukast tab 10 mg (Accolate) 1

zafirlukast tab 20 mg (Accolate) 1

zileuton tab er 12hr 600 mg (Zyflocr)

1

ZYFLO CR – zileuton tab er 12hr600 mg

3

OTHER RESPIRATORY DRUGSESBRIET – pirfenidone cap 267

mg3 X • •

ESBRIET – pirfenidone tab 267 mg 3 X • •ESBRIET – pirfenidone tab 801 mg 3 X • •KALYDECO – ivacaftor tab 150 mg 2 X • •KALYDECO – ivacaftor packet 50

mg2 X • •

KALYDECO – ivacaftor packet 75mg

2 X • •

OFEV – nintedanib esylate cap 100mg (base equivalent)

3 X • •

OFEV – nintedanib esylate cap 150mg (base equivalent)

3 X • •

ORKAMBI – lumacaftor-ivacaftortab 100-125 mg

3 X • •

2018




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ORKAMBI – lumacaftor-ivacaftortab 200-125 mg

3 X • •

PULMOZYME – dornase alfa inhalsoln 1 mg/ml

2 X

GASTROINTESTINAL DRUGSLAXATIVESbisacodyl tab & peg 3350-kcl-

sod bicarb-nacl for soln kit1

COLYTE-FLAVOR PACKS – peg3350-kcl-na bicarb-nacl-nasulfate for soln 240 gm

3

GOLYTELY – peg 3350-kcl-nabicarb-nacl-na sulfate packet227.1 gm

3

GOLYTELY – peg 3350-kcl-nabicarb-nacl-na sulfate for soln236 gm

3

lactulose solution 10 gm/15ml 1

MOVIPREP – peg 3350-kcl-nacl-na sulfate-na ascorbate-c for soln100 gm

3

NULYTELY/FLAVOR PACKS – peg3350-kcl-sod bicarb-nacl for soln420 gm

3

OSMOPREP – sod phos mono-sod phos di tabs 1.102-0.398gm(1.5gm na phos)

3

peg 3350-kcl-sod bicarb-naclfor soln 420 gm (Nulytely/flavorpack)

1

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm(Golytely)

1

peg 3350-kcl-na bicarb-nacl-nasulfate for soln 240 gm (Colyte-flavor packs)

1

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polyethylene glycol 3350 oralpacket

1

polyethylene glycol 3350 oralpowder

1

PREPOPIK – sod picosulfate-mgoxide-citric acid pack 10 mg-3.5gm-12 gm

3

SUPREP BOWEL PREP KIT – sodsulfate-pot sulf-mg sulf oral sol17.5-3.13-1.6 gm/180ml

3

ANTIDIARRHEALSdiphenoxylate w/ atropine tab

2.5-0.025 mg (Lomotil)1

DIPHENOXYLATE/ATROPINE– diphenoxylate w/ atropine liq2.5-0.025 mg/5ml

3

LOMOTIL – diphenoxylate w/atropine tab 2.5-0.025 mg

3

loperamide hcl cap 2 mg 1

MYTESI – crofelemer tab delayedrelease 125 mg

3

PAREGORIC – paregoric tincture 2mg/5ml (morphine equivalent)

3

ULCER/GERDamoxicillin cap-clarithro tab-

lansopraz cap dr therapy pack(Prevpac)

1

ANASPAZ – hyoscyamine sulfatetab disint 0.125 mg

3

BENTYL – dicyclomine hcl cap 10mg

3

CARAFATE – sucralfate tab 1 gm 3

CARAFATE – sucralfate susp 1gm/10ml

2

chlordiazepoxide hcl-clidiniumbromide cap 5-2.5 mg (Librax)

1

2018




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cimetidine hcl soln 300 mg/5ml 1

cimetidine tab 200 mg 1




CUVPOSA – glycopyrrolate oralsoln 1 mg/5ml

3

CYTOTEC – misoprostol tab 100mcg

3

CYTOTEC – misoprostol tab 200mcg

3

dicyclomine hcl cap 10 mg(Bentyl)

1

dicyclomine hcl oral soln10 mg/5ml

1

dicyclomine hcl tab 20 mg(Bentyl)

1

esomeprazole magnesium capdelayed release 20 mg (baseeq) (Nexium)

1 •

esomeprazole magnesium capdelayed release 40 mg (baseeq) (Nexium)

1 •

famotidine for susp 40 mg/5ml(Pepcid)

1

famotidine tab 20 mg (Pepcid) 1

famotidine tab 40 mg (Pepcid) 1

glycopyrrolate tab 1 mg 1

glycopyrrolate tab 2 mg 1

hyoscyamine sulfate elixir0.125 mg/5ml

1

hyoscyamine sulfate soln0.125 mg/ml

1

hyoscyamine sulfate tab disint0.125 mg (Anaspaz)

1

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hyoscyamine sulfate tab er 12hr0.375 mg (Levbid)

1

hyoscyamine sulfate tab sl0.125 mg (Levsin/sl)

1

hyoscyamine sulfate tab0.125 mg (Levsin)

1

lansoprazole cap delayedrelease 15 mg (Prevacid)

1 •

lansoprazole cap delayedrelease 30 mg (Prevacid)

1 •

LEVBID – hyoscyamine sulfate taber 12hr 0.375 mg

3

LEVSIN – hyoscyamine sulfate tab0.125 mg

3

LEVSIN/SL – hyoscyamine sulfatetab sl 0.125 mg

3

methscopolamine bromide tab2.5 mg (Pamine)

1

methscopolamine bromide tab5 mg (Pamine forte)

1

misoprostol tab 100 mcg(Cytotec)

1

misoprostol tab 200 mcg(Cytotec)

1

NEXIUM – esomeprazolemagnesium for delayed releasesusp pack 2.5 mg

2 •

NEXIUM – esomeprazolemagnesium for delayed releasesusp packet 5 mg

2 •


2 •


2 •

2018




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2 •

NIZATIDINE – nizatidine oral soln15 mg/ml

3

nizatidine cap 150 mg 1

nizatidine cap 300 mg 1

OMECLAMOX-PAK – amoxicillincap-clarithro tab w/ omepraz capdr therapy pack

3

omeprazole cap delayed release10 mg (Prilosec)

1 •


1 •


1 •

PAMINE – methscopolaminebromide tab 2.5 mg

3

PAMINE FORTE –methscopolamine bromide tab 5mg

3

pantoprazole sodium ec tab20 mg (base equiv) (Protonix)

1 •

pantoprazole sodium ec tab40 mg (base equiv) (Protonix)

1 •

PREVPAC – amoxicillin cap-clarithro tab-lansopraz cap drtherapy pack

3

PRILOSEC OTC – omeprazolemagnesium delayed release tab20 mg (base equiv)

2

PROPANTHELINE BROMIDE –propantheline bromide tab 15 mg

2

PYLERA – bismuth subcit-metronidazole-tetracycline cap140-125-125 mg

3

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rabeprazole sodium ec tab20 mg (Aciphex)

1 •

ranitidine hcl cap 150 mg 1

ranitidine hcl cap 300 mg 1

ranitidine hcl syrup 15 mg/ml(75 mg/5ml)

1

ranitidine hcl tab 150 mg (Zantac) 1

ranitidine hcl tab 300 mg (Zantac) 1

ROBINUL – glycopyrrolate tab 1mg

3

ROBINUL FORTE – glycopyrrolatetab 2 mg

3

sucralfate tab 1 gm (Carafate) 1

SYMAX DUOTAB – hyoscyaminesulfate tab er 0.375 mg (0.125mg ir/0.25 mg er)

2

NAUSEA AND VOMITINGAKYNZEO – netupitant-

palonosetron cap 300-0.5 mg3 • •

ANZEMET – dolasetron mesylatetab 50 mg

3 •

ANZEMET – dolasetron mesylatetab 100 mg

3 •

aprepitant capsule therapy pack80 & 125 mg (Emend)

1 •

aprepitant capsule 40 mg(Emend)

1


1 •


1 •

CESAMET – nabilone cap 1 mg 3 •DICLEGIS – doxylamine-pyridoxine

tab delayed release 10-10 mg3 • •

dronabinol cap 2.5 mg (Marinol) 1

2018




Drug Name Dru

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pons

ible

Ste

ps

dronabinol cap 5 mg (Marinol) 1

dronabinol cap 10 mg (Marinol) 1

EMEND – aprepitant for oral susp125 mg (125 mg/5ml)

2 •

EMEND – aprepitant capsule 40mg

3


3 •


3 •

EMEND TRIPACK – aprepitantcapsule therapy pack 80 & 125mg

3 •

granisetron hcl tab 1 mg 1 •MARINOL – dronabinol cap 2.5 mg 3

MARINOL – dronabinol cap 5 mg 3

MARINOL – dronabinol cap 10 mg 3

meclizine hcl tab 12.5 mg 1

meclizine hcl tab 25 mg 1

ondansetron hcl oral soln4 mg/5ml (Zofran)

1

ondansetron hcl tab 4 mg(Zofran)

1 •

ondansetron hcl tab 8 mg(Zofran)

1 •

ondansetron hcl tab 24 mg 1 •ondansetron orally

disintegrating tab 4 mg (Zofranodt)

1 •

ondansetron orallydisintegrating tab 8 mg (Zofranodt)

1 •

SANCUSO – granisetron td patch3.1 mg/24hr (contains 34.3 mg)

3 • •

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ible

Ste

ps

scopolamine td patch 72hr1 mg/3days (Transderm-scop)

1

TIGAN – trimethobenzamide hclcap 300 mg

3

TRANSDERM-SCOP –scopolamine td patch 72hr 1mg/3days

3

trimethobenzamide hcl cap300 mg (Tigan)

1

VARUBI – rolapitant hcl tab 90 mg(base equiv)

2 •

ZOFRAN – ondansetron hcl oralsoln 4 mg/5ml

3

ZOFRAN – ondansetron hcl tab 4mg

3 •

ZOFRAN – ondansetron hcl tab 8mg

3 •

ZOFRAN ODT – ondansetronorally disintegrating tab 4 mg

3 •

ZOFRAN ODT – ondansetronorally disintegrating tab 8 mg

3 •

DIGESTIVE ENZYMES– Pancreatic enzyme products:CREON – pancrelipase (lip-prot-

amyl) dr cap 3000-9500-15000unit

2

CREON – pancrelipase (lip-prot-amyl) dr cap 6000-19000-30000unit

2

CREON – pancrelipase (lip-prot-amyl) dr cap 12000-38000-60000unit

2

CREON – pancrelipase(lip-prot-amyl) dr cap24000-76000-120000 unit

2

2018




Drug Name Dru

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pons

ible

Ste

ps

CREON – pancrelipase(lip-prot-amyl) dr cap36000-114000-180000 unit

2

SUCRAID – sacrosidase soln 8500unit/ml

3 X • •

ZENPEP – pancrelipase (lip-prot-amyl) dr cap 3000-10000-16000unit

2


2


2


2


2

ZENPEP – pancrelipase(lip-prot-amyl) dr cap20000-68000-109000 unit

2


2


2

OTHER GASTROINTESTINAL DRUGSACTIGALL – ursodiol cap 300 mg 3

alosetron hcl tab 0.5 mg (baseequiv) (Lotronex)

1 • •

alosetron hcl tab 1 mg (baseequiv) (Lotronex)

1 • •

AMITIZA – lubiprostone cap 8 mcg 3 •

Drug Name Dru

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ible

Ste

ps

AMITIZA – lubiprostone cap 24mcg

3 •

ASACOL HD – mesalamine tabdelayed release 800 mg

2

AZULFIDINE – sulfasalazine tab500 mg

3

AZULFIDINE EN-TABS –sulfasalazine tab delayed release500 mg

3

balsalazide disodium cap750 mg (Colazal)

1

calcium acetate (phosphatebinder) cap 667 mg (169 mgca) (Phoslo)

1

calcium acetate (phosphatebinder) tab 667 mg (Eliphos)

1

CANASA – mesalamine suppos1000 mg

2

CHENODAL – chenodiol tab 250mg

2

CHOLBAM – cholic acid cap 50 mg 3 X •CHOLBAM – cholic acid cap 250

mg3 X •

CIMZIA – certolizumab pegol for injkit 2 x 200 mg

3 X • •

CIMZIA – certolizumab pegol inj kit2 x 200 mg/ml

3 X • •

CIMZIA STARTER KIT –certolizumab pegol inj kit 6 x 200mg/ml

3 X • •

COLAZAL – balsalazide disodiumcap 750 mg

3

cromolyn sodium oral conc100 mg/5ml (Gastrocrom)

1

DELZICOL – mesalamine cap dr400 mg

2

2018




Drug Name Dru

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Res

pons

ible

Ste

ps

FOSRENOL – lanthanumcarbonate chew tab 500 mg(elemental)

3 •


3 •


3 •

FOSRENOL – lanthanumcarbonate oral powder pack 750mg (elemental)

3 •

FOSRENOL – lanthanumcarbonate oral powder pack 1000mg (elemental)

3 •

GASTROCROM – cromolynsodium oral conc 100 mg/5ml

3

GATTEX – teduglutide (rdna) for injkit 5 mg

3 X • •

lactulose (encephalopathy)solution 10 gm/15ml

1

lanthanum carbonate chew tab500 mg (elemental) (Fosrenol)

1 •


1 •


1 •

LIALDA – mesalamine tab delayedrelease 1.2 gm

3

LINZESS – linaclotide cap 72 mcg 3 •LINZESS – linaclotide cap 145 mcg 3 •LINZESS – linaclotide cap 290 mcg 3 •LOTRONEX – alosetron hcl tab 0.5

mg (base equiv)3 • •

LOTRONEX – alosetron hcl tab 1mg (base equiv)

3 • •

Drug Name Dru

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ible

Ste

ps

MESALAMINE DR – mesalaminetab delayed release 800 mg

3

mesalamine enema 4 gm 1

mesalamine tab delayed release1.2 gm (Lialda)

1

metoclopramide hcl soln5 mg/5ml (10 mg/10ml)

1

metoclopramide hcl tab 5 mg(Reglan)

1

metoclopramide hcl tab 10 mg(Reglan)

1

MOVANTIK – naloxegol oxalate tab12.5 mg (base equivalent)

3 •

MOVANTIK – naloxegol oxalate tab25 mg (base equivalent)

3 •

OCALIVA – obeticholic acid tab 5mg

3 X • •

OCALIVA – obeticholic acid tab 10mg

3 X • •

PENTASA – mesalamine cap er250 mg

2

PENTASA – mesalamine cap er500 mg

2

PHOSLYRA – calcium acetate(phosphate binder) oral soln 667mg/5ml

3

REGLAN – metoclopramide hcl tab5 mg

3

REGLAN – metoclopramide hcl tab10 mg

3

RELISTOR – methylnaltrexonebromide tab 150 mg

3 •

RELISTOR – methylnaltrexonebromide inj 8 mg/0.4ml (20 mg/ml)

3 •

2018




Drug Name Dru

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pons

ible

Ste

ps

RELISTOR – methylnaltrexonebromide inj 12 mg/0.6ml (20 mg/ml)

3 •

RENAGEL – sevelamer hcl tab 400mg

3 •

RENAGEL – sevelamer hcl tab 800mg

3 •

RENVELA – sevelamer carbonatetab 800 mg

3 •

RENVELA – sevelamer carbonatepacket 0.8 gm

3 •

RENVELA – sevelamer carbonatepacket 2.4 gm

3 •

sevelamer carbonate packet0.8 gm (Renvela)

1 •

sevelamer carbonate packet2.4 gm (Renvela)

1 •

sevelamer carbonate tab 800 mg(Renvela)

1 •

SFROWASA – mesalamine sulfite-free (sf) enema 4 gm/60ml

3

sulfasalazine tab delayed release500 mg (Azulfidine en-tabs)

1

sulfasalazine tab 500 mg(Azulfidine)

1

TRULANCE – plecanatide tab 3mg

3 •

URSO FORTE – ursodiol tab 500mg

3

URSO 250 – ursodiol tab 250 mg 3

ursodiol cap 300 mg (Actigall) 1

ursodiol tab 250 mg (Urso 250) 1

ursodiol tab 500 mg (Urso forte) 1

VELPHORO – sucroferricoxyhydroxide chew tab 500 mg

2 •

VIBERZI – eluxadoline tab 75 mg 2 • •

Drug Name Dru

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ible

Ste

ps

VIBERZI – eluxadoline tab 100 mg 2 • •XERMELO – telotristat etiprate tab

250 mg (telotristat ethyl equiv)3 X •

GENITOURINARY DRUGSURINARY TRACT INFECTIONSFURADANTIN – nitrofurantoin

susp 25 mg/5ml3

HIPREX – methenamine hippuratetab 1 gm

3

MACROBID – nitrofurantoinmonohydrate macrocrystallinecap 100 mg

3

MACRODANTIN – nitrofurantoinmacrocrystalline cap 25 mg

3


3


3

methenamine hippurate tab 1 gm(Hiprex)

1

MONUROL – fosfomycintromethamine powd pack 3 gm(base equivalent)

3

nitrofurantoin macrocrystallinecap 25 mg (Macrodantin)

1


1


1

nitrofurantoin monohydratemacrocrystalline cap 100 mg(Macrobid)

1

nitrofurantoin susp 25 mg/5ml 1

URINARY TRACT SPASMSbethanechol chloride tab 5 mg

(Urecholine)1

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps

bethanechol chloride tab 10 mg(Urecholine)

1


1


1

darifenacin hydrobromide taber 24hr 7.5 mg (base equiv)(Enablex)

1 •

darifenacin hydrobromide taber 24hr 15 mg (base equiv)(Enablex)

1 •

ENABLEX – darifenacinhydrobromide tab er 24hr 7.5 mg(base equiv)

3 •

ENABLEX – darifenacinhydrobromide tab er 24hr 15 mg(base equiv)

3 •

flavoxate hcl tab 100 mg 1

MYRBETRIQ – mirabegron tab er24 hr 25 mg

2 •

MYRBETRIQ – mirabegron tab er24 hr 50 mg

2 •

oxybutynin chloride syrup5 mg/5ml

1 •

oxybutynin chloride tab er 24hr5 mg (Ditropan xl)

1 •


1 •


1 •

oxybutynin chloride tab 5 mg 1 •tolterodine tartrate cap er 24hr

2 mg (Detrol la)1 •

tolterodine tartrate cap er 24hr4 mg (Detrol la)

1 •

Drug Name Dru

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ty/T

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its

Res

pons

ible

Ste

ps

tolterodine tartrate tab 1 mg(Detrol)

1 •

tolterodine tartrate tab 2 mg(Detrol)

1 •

TOVIAZ – fesoterodine fumaratetab er 24hr 4 mg

3 •

TOVIAZ – fesoterodine fumaratetab er 24hr 8 mg

3 •

trospium chloride cap er 24hr60 mg

1 •

trospium chloride tab 20 mg 1 •URECHOLINE – bethanechol

chloride tab 5 mg3

URECHOLINE – bethanecholchloride tab 10 mg

3


3


3

VESICARE – solifenacin succinatetab 5 mg

2 •

VESICARE – solifenacin succinatetab 10 mg

2 •

VAGINAL PRODUCTSAVC – sulfanilamide vaginal cream

15%2

CLEOCIN – clindamycin phosphatevaginal cream 2%

3

CLEOCIN – clindamycin phosphatevaginal suppos 100 mg

2

clindamycin phosphate vaginalcream 2% (Cleocin)

1

CLINDESSE – clindamycinphosphate (one dose) vaginalcream 2%

3

2018




Drug Name Dru

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ible

Ste

ps

CRINONE – progesterone vaginalgel 4%

3

ESTRACE – estradiol vaginalcream 0.1 mg/gm

3

estradiol vaginal tab 10 mcg(Vagifem)

1 •

ESTRING – estradiol vaginal ring 2mg (7.5 mcg/24hrs)

3 •

FEM PH – acetic acid-oxyquinolinevaginal gel 0.9-0.025%

3

FEMRING – estradiol acetatevaginal ring 0.05 mg/24hr

3 •

FEMRING – estradiol acetatevaginal ring 0.1 mg/24hr

3 •

GYNAZOLE-1 – butoconazolenitrate (one dose) vaginal cream2%

3

INTRAROSA – prasterone vaginalinsert 6.5 mg

3

METROGEL-VAGINAL –metronidazole vaginal gel 0.75%

3

metronidazole vaginal gel 0.75%(Metrogel-vaginal)

1

MICONAZOLE 3 – miconazolenitrate vaginal suppos 200 mg

3

PREMARIN – estrogens,conjugated vaginal cream 0.625mg/gm

2

RELAGARD – acetic acid-oxyquinoline vaginal gel0.9-0.025%

3

TERAZOL 7 – terconazole vaginalcream 0.4%

3

terconazole vaginal cream 0.4%(Terazol 7)

1

terconazole vaginal cream 0.8%(Terazol 3)

1

Drug Name Dru

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ible

Ste

ps

terconazole vaginal suppos80 mg

1

VAGIFEM – estradiol vaginal tab10 mcg

2

OTHER GENITOURINARY DRUGSacetic acid irrigation soln 0.25% 1

alfuzosin hcl tab er 24hr 10 mg(Uroxatral)

1

AVODART – dutasteride cap 0.5mg

3

CARDURA XL – doxazosinmesylate tab er 24 hr 4 mg (baseequiv)

3

CARDURA XL – doxazosinmesylate tab er 24 hr 8 mg (baseequiv)

3

CYSTAGON – cysteaminebitartrate cap 50 mg

2

CYSTAGON – cysteaminebitartrate cap 150 mg

2

dutasteride cap 0.5 mg (Avodart) 1

dutasteride-tamsulosin hcl cap0.5-0.4 mg (Jalyn)

1

ELMIRON – pentosan polysulfatesodium caps 100 mg

3 •

finasteride tab 5 mg (Proscar) 1

FLOMAX – tamsulosin hcl cap 0.4mg

3

JALYN – dutasteride-tamsulosinhcl cap 0.5-0.4 mg

3

K-PHOS NO 2 – potassium &sodium acid phosphates tab305-700 mg

2

LITHOSTAT – acetohydroxamicacid tab 250 mg

3

2018




Drug Name Dru

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ible

Ste

ps

ORACIT – sodium citrate & citricacid soln 490-640 mg/5ml

3

phenazopyridine hcl tab 100 mg(Pyridium)

1

phenazopyridine hcl tab 200 mg(Pyridium)

1

pot & sod citrates w/ cit ac soln550-500-334 mg/5ml

1

potassium citrate & citric acidpowder pack 3300-1002 mg

1

potassium citrate tab er 5 meq(540 mg) (Urocit-k 5)

1


1


1

PROCYSBI – cysteamine bitartratecap delayed release 25 mg (baseequiv)

3 X •

PROCYSBI – cysteamine bitartratecap delayed release 75 mg (baseequiv)

3 X •

PROSCAR – finasteride tab 5 mg 3

PYRIDIUM – phenazopyridine hcltab 100 mg

3

PYRIDIUM – phenazopyridine hcltab 200 mg

3

RAPAFLO – silodosin cap 4 mg 3

RAPAFLO – silodosin cap 8 mg 3

SHOHLS SOLUTION MODIFIED– sodium citrate & citric acid soln500-334 mg/5ml

3

sodium chloride irrigation soln0.9%

1

sodium citrate & citric acid soln500-334 mg/5ml (Shohls solutionmodi)

1

Drug Name Dru

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Res

pons

ible

Ste

ps

tamsulosin hcl cap 0.4 mg(Flomax)

1

THIOLA – tiopronin tab 100 mg 3 X • •UROCIT-K 10 – potassium citrate

tab er 10 meq (1080 mg)3

UROCIT-K 15 – potassium citratetab er 15 meq (1620 mg)

3

UROCIT-K 5 – potassium citratetab er 5 meq (540 mg)

3

CENTRAL NERVOUS SYSTEM DRUGSANXIETYALPRAZOLAM INTENSOL –

alprazolam conc 1 mg/ml3

alprazolam orally disintegratingtab 0.25 mg (Niravam)

1

alprazolam orally disintegratingtab 0.5 mg

1

alprazolam orally disintegratingtab 1 mg

1

alprazolam orally disintegratingtab 2 mg

1

alprazolam tab er 24hr 0.5 mg(Xanax xr)

1

alprazolam tab er 24hr 1 mg(Xanax xr)

1


1


1

alprazolam tab 0.25 mg (Xanax) 1

alprazolam tab 0.5 mg (Xanax) 1

alprazolam tab 1 mg (Xanax) 1

alprazolam tab 2 mg (Xanax) 1

buspirone hcl tab 5 mg 1

buspirone hcl tab 7.5 mg 1

2018




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ible

Ste

ps




chlordiazepoxide hcl cap 5 mg 1



clorazepate dipotassium tab3.75 mg (Tranxene t)

1

clorazepate dipotassium tab7.5 mg (Tranxene t)

1

clorazepate dipotassium tab15 mg (Tranxene t)

1

DIAZEPAM – diazepam oral soln 1mg/ml

2

diazepam conc 5 mg/ml 1

diazepam tab 2 mg (Valium) 1



hydroxyzine hcl syrup 10 mg/5ml 1

hydroxyzine hcl tab 10 mg 1



HYDROXYZINE PAMOATE –hydroxyzine pamoate cap 100mg

3

hydroxyzine pamoate cap 25 mg(Vistaril)

1

hydroxyzine pamoate cap 50 mg(Vistaril)

1

lorazepam conc 2 mg/ml 1

lorazepam tab 0.5 mg (Ativan) 1

lorazepam tab 1 mg (Ativan) 1

lorazepam tab 2 mg (Ativan) 1

meprobamate tab 200 mg 1

Drug Name Dru

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ible

Ste

ps

meprobamate tab 400 mg 1

oxazepam cap 10 mg 1



VISTARIL – hydroxyzine pamoatecap 25 mg

3

VISTARIL – hydroxyzine pamoatecap 50 mg

3

DEPRESSIONamitriptyline hcl tab 10 mg 1

amitriptyline hcl tab 25 mg(Elavil)

1

amitriptyline hcl tab 50 mg 1




AMOXAPINE – amoxapine tab 25mg

3


3


3


3

bupropion hcl tab er 12hr100 mg (Wellbutrin sr)

1


1


1

bupropion hcl tab er 24hr150 mg (Wellbutrin xl)

1

bupropion hcl tab er 24hr300 mg (Wellbutrin xl)

1

bupropion hcl tab 75 mg 1

2018




Drug Name Dru

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ible

Ste

ps

bupropion hcl tab 100 mg 1

citalopram hydrobromide oralsoln 10 mg/5ml

1

citalopram hydrobromide tab10 mg (base equiv) (Celexa)

1


1


1

clomipramine hcl cap 25 mg(Anafranil)

1


1


1

desipramine hcl tab 10 mg(Norpramin)

1

desipramine hcl tab 25 mg(Norpramin)

1

desipramine hcl tab 50 mg 1




DESVENLAFAXINE ER –desvenlafaxine tab er 24hr 50 mg

3 • •

DESVENLAFAXINE ER –desvenlafaxine tab er 24hr 100mg

3 • •

desvenlafaxine succinate taber 24hr 25 mg (base equiv)(Pristiq)

1 •


1 •

Drug Name Dru

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ible

Ste

ps


1 •

doxepin hcl cap 10 mg 1






doxepin hcl conc 10 mg/ml 1

duloxetine hcl enteric coatedpellets cap 20 mg (base eq)(Cymbalta)

1


1


1

EMSAM – selegiline td patch 24hr6 mg/24hr

3


3


3

escitalopram oxalate soln5 mg/5ml (base equiv)(Lexapro)

1

escitalopram oxalate tab 5 mg(base equiv) (Lexapro)

1


1


1

2018




Drug Name Dru

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Res

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ible

Ste

ps

FETZIMA – levomilnacipranhcl cap er 24hr 20 mg (baseequivalent)

3 • •


3 • •


3 • •


3 • •

FETZIMA TITRATION PACK –levomilnacipran hcl cap er 24hr20 & 40 mg therapy pack

3 • •

FLUOXETINE DR – fluoxetine hclcap delayed release 90 mg

3 •

fluoxetine hcl cap 10 mg (Prozac) 1



fluoxetine hcl solution20 mg/5ml

1

fluoxetine hcl tab 10 mg 1

fluoxetine hcl tab 20 mg 1

fluoxetine hcl tab 60 mg(Fluoxetine hcl)

1

fluvoxamine maleate tab 25 mg 1 •fluvoxamine maleate tab 50 mg 1 •fluvoxamine maleate tab 100 mg 1 •imipramine hcl tab 10 mg

(Tofranil)1

imipramine hcl tab 25 mg(Tofranil)

1

imipramine hcl tab 50 mg(Tofranil)

1

imipramine pamoate cap 75 mg 1

Drug Name Dru

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Res

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ible

Ste

ps




MAPROTILINE HCL – maprotilinehcl tab 25 mg

3 • •


3 • •


3 • •

MARPLAN – isocarboxazid tab 10mg

3

mirtazapine orally disintegratingtab 15 mg (Remeron soltab)

1 •


1 •


1 •

mirtazapine tab 7.5 mg 1 •mirtazapine tab 15 mg (Remeron) 1 •mirtazapine tab 30 mg (Remeron) 1 •mirtazapine tab 45 mg (Remeron) 1 •NARDIL – phenelzine sulfate tab

15 mg3

NEFAZODONE HCL – nefazodonehcl tab 100 mg

3


3


3

nefazodone hcl tab 50 mg 1

nefazodone hcl tab 250 mg 1

NORPRAMIN – desipramine hcltab 10 mg

3

NORPRAMIN – desipramine hcltab 25 mg

3

2018




Drug Name Dru

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Res

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ible

Ste

ps

NORTRIPTYLINE HCL –nortriptyline hcl soln 10 mg/5ml

3

nortriptyline hcl cap 10 mg(Pamelor)

1


1


1


1

PAMELOR – nortriptyline hcl cap10 mg

3


3


3


3

PARNATE – tranylcyprominesulfate tab 10 mg

3

paroxetine hcl tab 10 mg (Paxil) 1




PAXIL – paroxetine hcl oral susp10 mg/5ml (base equiv)

3 •

phenelzine sulfate tab 15 mg(Nardil)

1

PRISTIQ – desvenlafaxinesuccinate tab er 24hr 25 mg(base equiv)

3 • •


3 • •

Drug Name Dru

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cial

ty/T

ier 4

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r Aut

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atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


3 • •

protriptyline hcl tab 5 mg 1

protriptyline hcl tab 10 mg 1

sertraline hcl oral conc 20 mg/ml(Zoloft)

1

sertraline hcl tab 25 mg (Zoloft) 1



SURMONTIL – trimipraminemaleate cap 25 mg

3


3


3

tranylcypromine sulfate tab10 mg (Parnate)

1

trazodone hcl tab 50 mg 1




trimipramine maleate cap 25 mg(Surmontil)

1

trimipramine maleate cap 50 mg(Surmontil)

1

trimipramine maleate cap100 mg (Surmontil)

1

TRINTELLIX – vortioxetine hbr tab5 mg (base equiv)

3 • •


3 • •


3 • •

2018




Drug Name Dru

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n

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its

Res

pons

ible

Ste

ps

venlafaxine hcl cap er 24hr37.5 mg (base equivalent)(Effexor xr)

1

venlafaxine hcl cap er 24hr75 mg (base equivalent)(Effexor xr)

1

venlafaxine hcl cap er 24hr150 mg (base equivalent)(Effexor xr)

1

VENLAFAXINE HCL ER –venlafaxine hcl tab er 24hr 37.5mg (base equivalent)

3 •

VENLAFAXINE HCL ER –venlafaxine hcl tab er 24hr 75 mg(base equivalent)

3 •

VENLAFAXINE HCL ER –venlafaxine hcl tab er 24hr 150mg (base equivalent)

3 •

venlafaxine hcl tab er 24hr37.5 mg (base equivalent)(Venlafaxine hcl er)

1

venlafaxine hcl tab er 24hr 75 mg(base equivalent) (Venlafaxinehcl er)

1

venlafaxine hcl tab er 24hr150 mg (base equivalent)(Venlafaxine hcl er)

1

venlafaxine hcl tab er 24hr225 mg (base equivalent)

1 •

venlafaxine hcl tab 25 mg 1

venlafaxine hcl tab 37.5 mg 1




VIIBRYD – vilazodone hcl tab 10mg

3 • •

Drug Name Dru

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its

Res

pons

ible

Ste

ps


3 • •


3 • •

VIIBRYD STARTER PACK –vilazodone hcl tab starter kit 10(7) & 20 (23) mg

3 • •

ZOLOFT – sertraline hcl oral conc20 mg/ml

3 •

PSYCHOTIC AND BIPOLAR DISORDERSaripiprazole oral solution 1 mg/

ml1 •

aripiprazole orally disintegratingtab 10 mg

1 •

aripiprazole orally disintegratingtab 15 mg

1 •

aripiprazole tab 2 mg (Abilify) 1 •aripiprazole tab 5 mg (Abilify) 1 •aripiprazole tab 10 mg (Abilify) 1 •aripiprazole tab 15 mg (Abilify) 1 •aripiprazole tab 20 mg (Abilify) 1 •aripiprazole tab 30 mg (Abilify) 1 •chlorpromazine hcl tab 10 mg 1

chlorpromazine hcl tab 25 mg 1




CLOZAPINE ODT – clozapineorally disintegrating tab 12.5 mg

3

CLOZAPINE ODT – clozapineorally disintegrating tab 150 mg

3

CLOZAPINE ODT – clozapineorally disintegrating tab 200 mg

3

clozapine orally disintegratingtab 25 mg (Fazaclo)

1

2018




Drug Name Dru

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ty/T

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

clozapine orally disintegratingtab 100 mg (Fazaclo)

1

clozapine tab 25 mg (Clozaril) 1

clozapine tab 50 mg 1

clozapine tab 100 mg (Clozaril) 1

clozapine tab 200 mg 1

CLOZARIL – clozapine tab 25 mg 3

CLOZARIL – clozapine tab 100 mg 3

EQUETRO – carbamazepine(antipsychotic) cap er 12hr 100mg

3


3


3

FANAPT – iloperidone tab 1 mg 3 • •FANAPT – iloperidone tab 2 mg 3 • •FANAPT – iloperidone tab 4 mg 3 • •FANAPT – iloperidone tab 6 mg 3 • •FANAPT – iloperidone tab 8 mg 3 • •FANAPT – iloperidone tab 10 mg 3 • •FANAPT – iloperidone tab 12 mg 3 • •FANAPT TITRATION PACK –

iloperidone tab 1 mg & 2 mg & 4mg & 6 mg titration pak

3 • •

FAZACLO – clozapine orallydisintegrating tab 12.5 mg

3

FAZACLO – clozapine orallydisintegrating tab 25 mg

3


3


3

Drug Name Dru

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its

Res

pons

ible

Ste

ps


3

FLUPHENAZINE HCL –fluphenazine hcl elixir 2.5 mg/5ml

2

FLUPHENAZINE HCL –fluphenazine hcl oral conc 5 mg/ml

2

fluphenazine hcl tab 1 mg 1

fluphenazine hcl tab 2.5 mg 1



haloperidol lactate oral conc2 mg/ml

1

haloperidol tab 0.5 mg 1

haloperidol tab 1 mg 1





INVEGA – paliperidone tab er 24hr1.5 mg

3 • •

INVEGA – paliperidone tab er 24hr3 mg

3 • •


3 • •


3 • •

LATUDA – lurasidone hcl tab 20mg

3 • •


3 • •


3 • •


3 • •

2018




Drug Name Dru

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Lim

its

Res

pons

ible

Ste

ps


3 • •

LITHIUM – lithium oral solution 8meq/5ml

2

LITHIUM CARBONATE – lithiumcarbonate cap 150 mg

3

LITHIUM CARBONATE – lithiumcarbonate cap 600 mg

3

lithium carbonate cap 150 mg(Lithium carbonate)

1

lithium carbonate cap 300 mg 1

lithium carbonate cap 600 mg(Lithium carbonate)

1

lithium carbonate tab er 300 mg(Lithobid)

1

lithium carbonate tab er 450 mg 1

lithium carbonate tab 300 mg 1

LITHOBID – lithium carbonate taber 300 mg

3

loxapine succinate cap 5 mg 1




NUPLAZID – pimavanserin tartratetab 17 mg (base equivalent)

3 X • •

olanzapine orally disintegratingtab 5 mg (Zyprexa zydis)

1 •


1 •


1 •


1 •

olanzapine tab 2.5 mg (Zyprexa) 1 •olanzapine tab 5 mg (Zyprexa) 1 •

Drug Name Dru

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ty/T

ier 4

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

olanzapine tab 7.5 mg (Zyprexa) 1 •olanzapine tab 10 mg (Zyprexa) 1 •olanzapine tab 15 mg (Zyprexa) 1 •olanzapine tab 20 mg (Zyprexa) 1 •paliperidone tab er 24hr 1.5 mg

(Invega)1 •

paliperidone tab er 24hr 3 mg(Invega)

1 •


1 •


1 •

perphenazine tab 2 mg 1




prochlorperazine maleatetab 5 mg (base equivalent)(Compazine)

1

prochlorperazine maleate tab10 mg (base equivalent)(Compazine)

1

prochlorperazine suppos 25 mg 1

quetiapine fumarate tab er 24hr50 mg (Seroquel xr)

1 •


1 •


1 •


1 •


1 •

quetiapine fumarate tab 25 mg(Seroquel)

1 •

2018




Drug Name Dru

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Lim

its

Res

pons

ible

Ste

ps


1 •


1 •


1 •


1 •


1 •

REXULTI – brexpiprazole tab 0.25mg

3 • •

REXULTI – brexpiprazole tab 0.5mg

3 • •

REXULTI – brexpiprazole tab 1 mg 3 • •REXULTI – brexpiprazole tab 2 mg 3 • •REXULTI – brexpiprazole tab 3 mg 3 • •REXULTI – brexpiprazole tab 4 mg 3 • •risperidone orally disintegrating

tab 0.25 mg1 •

risperidone orally disintegratingtab 0.5 mg (Risperdal m-tab)

1 •

risperidone orally disintegratingtab 1 mg (Risperdal m-tab)

1 •


1 •


1 •


1 •

risperidone soln 1 mg/ml(Risperdal)

1 •

risperidone tab 0.25 mg(Risperdal)

1 •

risperidone tab 0.5 mg(Risperdal)

1 •

Drug Name Dru

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cial

ty/T

ier 4

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atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

risperidone tab 1 mg (Risperdal) 1 •risperidone tab 2 mg (Risperdal) 1 •risperidone tab 3 mg (Risperdal) 1 •risperidone tab 4 mg (Risperdal) 1 •SAPHRIS – asenapine maleate sl

tab 2.5 mg (base equiv)3 • •

SAPHRIS – asenapine maleate sltab 5 mg (base equiv)

3 • •

SAPHRIS – asenapine maleate sltab 10 mg (base equiv)

3 • •

thioridazine hcl tab 10 mg 1




thiothixene cap 1 mg 1




trifluoperazine hcl tab 1 mg(base equivalent)

1


1


1


1

VERSACLOZ – clozapine susp 50mg/ml

3 • •

VRAYLAR – cariprazine hcl captherapy pack 1.5 mg (1) & 3 mg(6)

3 • •

VRAYLAR – cariprazine hcl cap 1.5mg (base equivalent)

3 • •

VRAYLAR – cariprazine hcl cap 3mg (base equivalent)

3 • •

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps

VRAYLAR – cariprazine hcl cap 4.5mg (base equivalent)

3 • •

VRAYLAR – cariprazine hcl cap 6mg (base equivalent)

3 • •

ziprasidone hcl cap 20 mg(Geodon)

1 •


1 •


1 •


1 •

SLEEP AIDSBUTISOL SODIUM – butabarbital

sodium tab 30 mg3

estazolam tab 1 mg 1

estazolam tab 2 mg 1

eszopiclone tab 1 mg (Lunesta) 1 •eszopiclone tab 2 mg (Lunesta) 1 •eszopiclone tab 3 mg (Lunesta) 1 •FLURAZEPAM HCL – flurazepam

hcl cap 15 mg3

FLURAZEPAM HCL – flurazepamhcl cap 30 mg

3

HALCION – triazolam tab 0.25 mg 3

HETLIOZ – tasimelteon capsule 20mg

3 X • •

PHENOBARBITAL – phenobarbitaltab 15 mg

2


2


2


2

Drug Name Dru

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Lim

its

Res

pons

ible

Ste

ps

phenobarbital elixir 20 mg/5ml 1

phenobarbital tab 16.2 mg 1




ROZEREM – ramelteon tab 8 mg 3 • •SECONAL SODIUM – secobarbital

sodium cap 100 mg3

SONATA – zaleplon cap 5 mg 3 • •SONATA – zaleplon cap 10 mg 3 • •temazepam cap 7.5 mg (Restoril) 1

temazepam cap 15 mg (Restoril) 1

temazepam cap 22.5 mg(Restoril)

1

temazepam cap 30 mg (Restoril) 1

TRIAZOLAM – triazolam tab 0.125mg

3

triazolam tab 0.25 mg (Halcion) 1

zaleplon cap 5 mg (Sonata) 1 •zaleplon cap 10 mg (Sonata) 1 •zolpidem tartrate tab er 6.25 mg

(Ambien cr)1 •

zolpidem tartrate tab er 12.5 mg(Ambien cr)

1 •

zolpidem tartrate tab 5 mg(Ambien)

1 •

zolpidem tartrate tab 10 mg(Ambien)

1 •

HYPERACTIVITY/NARCOLEPSYADDERALL – amphetamine-

dextroamphetamine tab 5 mg3 • •

ADDERALL – amphetamine-dextroamphetamine tab 7.5 mg

3 • •

2018




Drug Name Dru

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its

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pons

ible

Ste

ps

ADDERALL – amphetamine-dextroamphetamine tab 10 mg

3 • •

ADDERALL – amphetamine-dextroamphetamine tab 12.5 mg

3 • •


3 • •


3 • •


3 • •

ADDERALL XR – amphetamine-dextroamphetamine cap er 24hr5 mg

3 • •


3 • •


3 • •


3 • •


3 • •


3 • •

amphetamine-dextroamphetamine cap er24hr 5 mg (Adderall xr)

1 •


1 •


1 •

Drug Name Dru

g Ti

er

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cial

ty/T

ier 4

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


1 •


1 •


1 •

amphetamine-dextroamphetamine tab 5 mg(Adderall)

1 •

amphetamine-dextroamphetamine tab 7.5 mg(Adderall)

1 •


1 •

amphetamine-dextroamphetamine tab12.5 mg (Adderall)

1 •


1 •


1 •


1 •

APTENSIO XR – methylphenidatehcl cap er 24hr 10 mg (xr)

3 • •


3 • •


3 • •


3 • •

2018




Drug Name Dru

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cial

ty/T

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horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


3 • •


3 • •


3 • •

armodafinil tab 50 mg (Nuvigil) 1 •armodafinil tab 150 mg (Nuvigil) 1 •armodafinil tab 200 mg (Nuvigil) 1 •armodafinil tab 250 mg (Nuvigil) 1 •atomoxetine hcl cap 10 mg (base

equiv) (Strattera)1 •

atomoxetine hcl cap 18 mg (baseequiv) (Strattera)

1 •


1 •


1 •


1 •


1 •

atomoxetine hcl cap 100 mg(base equiv) (Strattera)

1 •

caffeine citrate oral soln60 mg/3ml (10 mg/ml baseequiv)

1

clonidine hcl tab er 12hr 0.1 mg(Kapvay)

1 •

CONCERTA – methylphenidate hcltab er osmotic release (osm) 18mg

3 • •


3 • •

Drug Name Dru

g Ti

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cial

ty/T

ier 4

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n

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ntity

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its

Res

pons

ible

Ste

ps


3 • •


3 • •

DAYTRANA – methylphenidate tdpatch 10 mg/9hr

3 • •


3 • •


3 • •


3 • •

DESOXYN – methamphetaminehcl tab 5 mg

3 • •

DEXEDRINE –dextroamphetamine sulfate caper 24hr 5 mg

3 • •


3 • •


3 • •

dexmethylphenidate hcl cap er24 hr 5 mg (Focalin xr)

1 •


1 •


1 •


1 •


1 •


1 •

2018




Drug Name Dru

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ty/T

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n

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its

Res

pons

ible

Ste

ps


1 •


1 •

dexmethylphenidate hcl tab2.5 mg (Focalin)

1 •

dexmethylphenidate hcl tab5 mg (Focalin)

1 •

dexmethylphenidate hcl tab10 mg (Focalin)

1 •

dextroamphetamine sulfate caper 24hr 5 mg (Dexedrine)

1 •


1 •


1 •

dextroamphetamine sulfate oralsolution 5 mg/5ml (Procentra)

1 •

dextroamphetamine sulfate tab5 mg

1 •

dextroamphetamine sulfate tab10 mg

1 •

DYANAVEL XR – amphetamineextended release susp 2.5 mg/ml

3 • •

EVEKEO – amphetamine sulfatetab 5 mg

3 • •

EVEKEO – amphetamine sulfatetab 10 mg

3 • •

FOCALIN – dexmethylphenidatehcl tab 2.5 mg

3 • •

FOCALIN – dexmethylphenidatehcl tab 5 mg

3 • •

FOCALIN – dexmethylphenidatehcl tab 10 mg

3 • •

guanfacine hcl tab er 24hr 1 mg(base equiv) (Intuniv)

1 •

Drug Name Dru

g Ti

er

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ty/T

ier 4

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


1 •


1 •


1 •

KAPVAY – clonidine hcl tab er 12hr0.1 mg

3 • •

methamphetamine hcl tab 5 mg(Desoxyn)

1 •

METHYLIN – methylphenidate hclsoln 5 mg/5ml

3 • •

METHYLIN – methylphenidate hclsoln 10 mg/5ml

3 • •

METHYLPHENIDATE HCL –methylphenidate hcl chew tab 2.5mg

3 • •

METHYLPHENIDATE HCL –methylphenidate hcl chew tab 5mg

3 • •

METHYLPHENIDATE HCL –methylphenidate hcl chew tab 10mg

3 • •

methylphenidate hcl cap er10 mg (cd)

1 •


1 •


1 •


1 •


1 •


1 •

methylphenidate hcl cap er 24hr20 mg (la) (Ritalin la)

1 •

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps


1 •


1 •

METHYLPHENIDATE HCL ER –methylphenidate hcl tab er 24hr18 mg

3 • •

methylphenidate hcl soln5 mg/5ml (Methylin)

1 •

methylphenidate hcl soln10 mg/5ml (Methylin)

1 •

methylphenidate hcl tab erosmotic release (osm) 18 mg(Concerta)

1 •


1 •


1 •


1 •

methylphenidate hcl tab er10 mg

1 •

methylphenidate hcl tab er20 mg

1 •

methylphenidate hcl tab 5 mg(Ritalin)

1 •


1 •


1 •

modafinil tab 100 mg (Provigil) 1 •modafinil tab 200 mg (Provigil) 1 •phendimetrazine tartrate tab

35 mg1

Drug Name Dru

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n

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Lim

its

Res

pons

ible

Ste

ps

phentermine hcl cap 15 mg 1

PROCENTRA –dextroamphetamine sulfate oralsolution 5 mg/5ml

3 • •

QUILLICHEW ER –methylphenidate hcl chew tabextended release 20 mg

3 • •


3 • •


3 • •

QUILLIVANT XR –methylphenidate hcl for er susp25 mg/5ml (5 mg/ml)

3 • •

RITALIN – methylphenidate hcl tab5 mg

3 • •


3 • •


3 • •

STRATTERA – atomoxetine hclcap 10 mg (base equiv)

3 • •


3 • •


3 • •


3 • •


3 • •


3 • •


3 • •

2018




Drug Name Dru

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ier 4

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n

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Lim

its

Res

pons

ible

Ste

ps

VYVANSE – lisdexamfetaminedimesylate cap 10 mg

3 • •


3 • •


3 • •


3 • •


3 • •


3 • •


3 • •

VYVANSE – lisdexamfetaminedimesylate chew tab 10 mg

3 • •


3 • •


3 • •


3 • •


3 • •


3 • •

ZENZEDI – dextroamphetaminesulfate tab 2.5 mg

3 • •

ZENZEDI – dextroamphetaminesulfate tab 7.5 mg

3 • •

ZENZEDI – dextroamphetaminesulfate tab 15 mg

3 • •


3 • •


3 • •

Drug Name Dru

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its

Res

pons

ible

Ste

ps

MULTIPLE SCLEROSISAMPYRA – dalfampridine tab er

12hr 10 mg3 X • •

AUBAGIO – teriflunomide tab 7 mg 2 X • •AUBAGIO – teriflunomide tab 14

mg2 X • •

AVONEX – interferon beta-1a imprefilled syringe kit 30 mcg/0.5ml

2 X • •

AVONEX – interferon beta-1a forim inj kit 30mcg (33mcg(6.6 mu)/vial)

2 X • •

AVONEX PEN – interferon beta-1aim auto-injector kit 30 mcg/0.5ml

2 X • •

BETASERON – interferon beta-1bfor inj kit 0.3 mg

2 X • •

COPAXONE – glatiramer acetatesoln prefilled syringe 20 mg/ml

2 X • •

COPAXONE – glatiramer acetatesoln prefilled syringe 40 mg/ml

2 X • •

EXTAVIA – interferon beta-1b forinj kit 0.3 mg

3 X • •

GILENYA – fingolimod hcl cap 0.5mg (base equiv)

2 X • •

glatiramer acetate soln prefilledsyringe 20 mg/ml (Copaxone)

1 X • •

glatiramer acetate soln prefilledsyringe 40 mg/ml (Copaxone)

1 X • •

PLEGRIDY – peginterferon beta-1asoln pen-injector 125 mcg/0.5ml

2 X • •

PLEGRIDY – peginterferonbeta-1a soln prefilled syringe 125mcg/0.5ml

2 X • •

PLEGRIDY STARTER PACK –peginterferon beta-1a soln pen-inj 63 & 94 mcg/0.5ml pack

2 X • •

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps

PLEGRIDY STARTER PACK –peginterferon beta-1a soln prefsyr 63 & 94 mcg/0.5ml pack

2 X • •

REBIF – interferon beta-1a solnpref syr 22 mcg/0.5ml (12mu/ml)

2 X • •

REBIF – interferon beta-1a solnpref syr 44 mcg/0.5ml (24mu/ml)

2 X • •

REBIF REBIDOSE – interferonbeta-1a soln auto-inj 22mcg/0.5ml (12mu/ml)

2 X • •

REBIF REBIDOSE – interferonbeta-1a soln auto-inj 44mcg/0.5ml (24mu/ml)

2 X • •

REBIF REBIDOSE TITRATION –interferon beta-1a auto-inj 6x8.8mcg/0.2ml & 6x22 mcg/0.5ml

2 X • •

REBIF TITRATION PACK –interferon beta-1a pref syr 6x8.8mcg/0.2ml & 6x22 mcg/0.5ml

2 X • •

TECFIDERA – dimethyl fumaratecapsule delayed release 120 mg

2 X • •

TECFIDERA – dimethyl fumaratecapsule delayed release 240 mg

2 X • •

TECFIDERA STARTER PACK –dimethyl fumarate capsule drstarter pack 120 mg & 240 mg

2 X • •

ZINBRYTA – daclizumab solnprefilled syringe 150 mg/ml

3 X • •

OTHER CENTRAL NERVOUS SYSTEM DRUGSacamprosate calcium tab

delayed release 333 mg1

ANTABUSE – disulfiram tab 250mg

3

ANTABUSE – disulfiram tab 500mg

3

ARICEPT – donepezilhydrochloride tab 5 mg

3

Drug Name Dru

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its

Res

pons

ible

Ste

ps


3


3

AUSTEDO – deutetrabenazine tab6 mg

3 X • •


3 X • •


3 X • •

CHLORDIAZEPOXIDE/AMITRIPT– chlordiazepoxide-amitriptylinetab 5-12.5 mg

3

CHLORDIAZEPOXIDE/AMITRIPT– chlordiazepoxide-amitriptylinetab 10-25 mg

3

disulfiram tab 250 mg (Antabuse) 1

disulfiram tab 500 mg (Antabuse) 1

donepezil hydrochloride orallydisintegrating tab 5 mg

1

donepezil hydrochloride orallydisintegrating tab 10 mg

1

donepezil hydrochloride tab5 mg (Aricept)

1


1


1

ERGOLOID MESYLATES –ergoloid mesylates tab 1 mg

3

EXELON – rivastigmine td patch24hr 4.6 mg/24hr

3


3


3

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps

FLUOXETINE – fluoxetine hcl(pmdd) cap 10 mg

3

FLUOXETINE – fluoxetine hcl(pmdd) cap 20 mg

3

GALANTAMINE HYDROBROMIDE– galantamine hydrobromide oralsoln 4 mg/ml

3

galantamine hydrobromide caper 24hr 8 mg (Razadyne er)

1


1


1

galantamine hydrobromide tab4 mg (Razadyne)

1


1


1

INGREZZA – valbenazine tosylatecap 40 mg (base equiv)

3 X • •

INGREZZA – valbenazine tosylatecap 80 mg (base equiv)

3 X • •

memantine hcl oral solution2 mg/ml (Namenda)

1

memantine hcl tab 5 mg(Namenda)

1

memantine hcl tab 10 mg(Namenda)

1

memantine hcl tab 5 mg (28)& 10 mg (21) titration pak(Namenda titration pa)

1

naltrexone hcl tab 50 mg 1

NAMENDA – memantine hcl tab 5mg

3

NAMENDA – memantine hcl tab 10mg

3

Drug Name Dru

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cial

ty/T

ier 4

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ntity

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its

Res

pons

ible

Ste

ps

NAMENDA TITRATION PAK –memantine hcl tab 5 mg (28) &10 mg (21) titration pak

3

NAMENDA XR – memantine hclcap er 24hr 7 mg

2


2


2


2

NAMENDA XR TITRATION PACK– memantine hcl cap er 24hr 7mg & 14 mg & 21 mg & 28 mgpack

2

NAMZARIC – memantine-donepezil cap er 24hr 7 & 14 &21 & 28-10 mg pack

3

NAMZARIC – memantine hcl-donepezil hcl cap er 24hr 7-10mg

3


3


3


3

NUEDEXTA – dextromethorphanhbr-quinidine sulfate cap 20-10mg

3

olanzapine-fluoxetine hcl cap3-25 mg (Symbyax)

1 •


1 •

2018




Drug Name Dru

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its

Res

pons

ible

Ste

ps


1 •


1 •


1 •

ORAP – pimozide tab 1 mg 3

ORAP – pimozide tab 2 mg 3

paroxetine mesylate cap 7.5 mg(base equiv) (Brisdelle)

1

PERPHENAZINE/AMITRIPTYLIN– perphenazine-amitriptyline tab2-10 mg

3


3


3


3


3

pimozide tab 1 mg (Orap) 1

pimozide tab 2 mg (Orap) 1

RAZADYNE – galantaminehydrobromide tab 4 mg

3


3


3

RAZADYNE ER – galantaminehydrobromide cap er 24hr 8 mg

3


3

Drug Name Dru

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cial

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ier 4

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its

Res

pons

ible

Ste

ps


3

rivastigmine tartrate cap 1.5 mg(Exelon)

1

rivastigmine tartrate cap 3 mg(Exelon)

1

rivastigmine tartrate cap 4.5 mg(Exelon)

1

rivastigmine tartrate cap 6 mg(Exelon)

1

rivastigmine td patch 24hr4.6 mg/24hr (Exelon)

1


1


1

SAVELLA – milnacipran hcl tab12.5 mg

3 • •

SAVELLA – milnacipran hcl tab 25mg

3 • •

SAVELLA – milnacipran hcl tab 50mg

3 • •

SAVELLA – milnacipran hcl tab100 mg

3 • •

SAVELLA TITRATION PACK –milnacipran hcl tab 12.5 mg (5) &25 mg (8) & 50 mg (42) pak

3 • •

SYMBYAX – olanzapine-fluoxetinehcl cap 3-25 mg

3 • •


3 • •


3 • •


3 • •


3 • •

2018




Drug Name Dru

g Ti

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cial

ty/T

ier 4

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horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

tetrabenazine tab 12.5 mg(Xenazine)

1 X • •

tetrabenazine tab 25 mg(Xenazine)

1 X • •

XYREM – sodium oxybate oralsolution 500 mg/ml

3 X • •

TOBACCO CESSATIONbupropion hcl (smoking

deterrent) tab er 12hr 150 mg(Zyban)

1

CHANTIX – varenicline tartrate tab0.5 mg (base equiv)

2

CHANTIX – varenicline tartrate tab1 mg (base equiv)

2

CHANTIX CONTINUING MONTH– varenicline tartrate tab 1 mg(base equiv)

2

CHANTIX STARTING MONTH PA– varenicline tartrate tab 0.5 mg x11 & tab 1 mg x 42 pack

2

nicotine polacrilex gum 2 mg 1

nicotine polacrilex gum 4 mg 1

nicotine polacrilex lozenge 2 mg 1

nicotine polacrilex lozenge 4 mg 1

nicotine td patch 24hr 7 mg/24hr 1

nicotine td patch 24hr14 mg/24hr

1

nicotine td patch 24hr21 mg/24hr

1

NICOTROL INHALER* – nicotineinhaler system 10 mg (4 mgdelivered)

2

NICOTROL NS* – nicotine nasalspray 10 mg/ml (0.5 mg/spray)

2

PAIN RELIEF DRUGSNON-NARCOTIC DRUGS

Drug Name Dru

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its

Res

pons

ible

Ste

ps

aspirin chew tab 81 mg 1

aspirin tab delayed release81 mg

1

butalbital-acetaminophen tab50-325 mg

1 •

butalbital-acetaminophen-caffeine cap 50-300-40 mg(Fioricet)

1 •

butalbital-acetaminophen-caffeine cap 50-325-40 mg

1 •

butalbital-acetaminophen-caffeine tab 50-325-40 mg(Esgic)

1 •

butalbital-aspirin-caffeine cap50-325-40 mg (Fiorinal)

1 •

BUTALBITAL/ASPIRIN/CAFFEI– butalbital-aspirin-caffeine tab50-325-40 mg

3 • •

diflunisal tab 500 mg 1

salsalate tab 500 mg (Disalcid) 1

salsalate tab 750 mg (Disalcid) 1

TENCON – butalbital-acetaminophen tab 50-325 mg

3 •

NARCOTIC DRUGSacetaminophen w/ codeine soln

120-12 mg/5ml1 •

acetaminophen w/ codeine tab300-15 mg (Tylenol/codeine)

1 •

acetaminophen w/ codeine tab300-30 mg (Tylenol/codeine #3)

1 •

acetaminophen w/ codeine tab300-60 mg (Tylenol/codeine #4)

1 •

ACETAMINOPHEN/CAFFEINE/DI – acetaminophen-caffeine-dihydrocodeine cap 320.5-30-16mg

3 • •

2018




Drug Name Dru

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ty/T

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

ACTIQ – fentanyl citrate lozengeon a handle 200 mcg

3 • •


3 • •


3 • •


3 • •


3 • •


3 • •

BUPRENORPHINE –buprenorphine td patch weekly 5mcg/hr

3 • •

BUPRENORPHINE –buprenorphine td patch weekly7.5 mcg/hr

3 • •

BUPRENORPHINE –buprenorphine td patch weekly10 mcg/hr

3 • •


3 • •


3 • •

buprenorphine hcl sl tab 2 mg(base equiv)

1 • •

buprenorphine hcl sl tab 8 mg(base equiv)

1 • •

butalbital-acetaminophen-caff w/cod cap 50-325-40-30 mg

1 •

butalbital-aspirin-caff w/ codeinecap 50-325-40-30 mg (Fiorinal/codeine #3)

1 •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

butorphanol tartrate nasal soln10 mg/ml

1 • •

BUTRANS – buprenorphine tdpatch weekly 5 mcg/hr

3 • •

BUTRANS – buprenorphine tdpatch weekly 7.5 mcg/hr

3 • •


3 • •


3 • •


3 • •

CODEINE SULFATE – codeinesulfate tab 15 mg

3 •


3 •


3 •

codeine sulfate tab 15 mg(Codeine sulfate)

1 •


1 •


1 •

DILAUDID – hydromorphone hclliqd 1 mg/ml

3 •

DOLOPHINE – methadone hcl tab5 mg

3 •

DOLOPHINE – methadone hcl tab10 mg

3 •

EMBEDA – morphine-naltrexonecap er 20-0.8 mg

3 • •


3 • •

EMBEDA – morphine-naltrexonecap er 50-2 mg

3 • •

2018




Drug Name Dru

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ty/T

ier 4

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


3 • •


3 • •

EMBEDA – morphine-naltrexonecap er 100-4 mg

3 • •

fentanyl citrate lozenge on ahandle 200 mcg (Actiq)

1 • •


1 • •


1 • •


1 • •


1 • •


1 • •

fentanyl td patch 72hr 12 mcg/hr(Duragesic)

1 • •


1 • •


1 • •


1 • •

fentanyl td patch 72hr 100 mcg/hr (Duragesic)

1 • •

FIORINAL/CODEINE #3 –butalbital-aspirin-caff w/ codeinecap 50-325-40-30 mg

3 •

hydrocodone-acetaminophensoln 7.5-325 mg/15ml (Hycet)

1 •

hydrocodone-acetaminophentab 2.5-325 mg

1 •

hydrocodone-acetaminophentab 10-325 mg (Norco)

1 •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

hydrocodone-acetaminophentab 5-300 mg (Xodol)

1 •

hydrocodone-acetaminophentab 7.5-300 mg (Xodol)

1 •

hydrocodone-acetaminophentab 5-325 mg (Norco)

1 •

hydrocodone-acetaminophentab 7.5-325 mg (Norco)

1 •

hydrocodone-acetaminophentab 10-300 mg (Xodol)

1 •

hydrocodone-ibuprofen tab5-200 mg (Reprexain)

1 •

hydrocodone-ibuprofen tab7.5-200 mg (Vicoprofen)

1 •

hydrocodone-ibuprofen tab10-200 mg (Ibudone)

1 •

HYDROMORPHONE HCL –hydromorphone hcl suppos 3 mg

3 • •

hydromorphone hcl liqd 1 mg/ml(Dilaudid)

1 •

hydromorphone hcl tab er 24hrdeter 8 mg (Exalgo)

1 • •


1 • •


1 • •


1 • •

hydromorphone hcl tab 2 mg(Dilaudid)

1 •


1 •


1 •

MEPERIDINE HCL – meperidinehcl oral soln 50 mg/5ml

3 •

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

meperidine hcl tab 50 mg 1 •meperidine hcl tab 100 mg 1 •MEPERIDINE HCL/PROMETHAZI

– meperidine w/ promethazinecap 50-25 mg

3 • •

METHADONE HCL – methadonehcl soln 5 mg/5ml

3 •

METHADONE HCL – methadonehcl soln 10 mg/5ml

3 •

methadone hcl conc 10 mg/ml(Methadose)

1 •

methadone hcl soln 5 mg/5ml(Methadone hcl)

1 •

methadone hcl soln 10 mg/5ml(Methadone hcl)

1 •

methadone hcl tab for oral susp40 mg

1 •

methadone hcl tab 5 mg(Dolophine)

1 •

methadone hcl tab 10 mg(Dolophine)

1 •

METHADOSE – methadone hclconc 10 mg/ml

3 •

METHADOSE SUGAR-FREE –methadone hcl conc 10 mg/ml

3 •

MORPHINE SULFATE – morphinesulfate tab 15 mg

2 •

MORPHINE SULFATE – morphinesulfate tab 30 mg

2 •

MORPHINE SULFATE – morphinesulfate suppos 5 mg

3 • •


3 • •


3 • •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


2 • •

morphine sulfate cap er 24hr10 mg (Kadian)

1 • •


1 • •


1 • •


1 • •


1 • •


1 • •


1 • •

MORPHINE SULFATE ER –morphine sulfate beads cap er24hr 30 mg

3 • •


3 • •


3 • •


3 • •


3 • •


3 • •

morphine sulfate oral soln10 mg/5ml

1 •

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

morphine sulfate oral soln20 mg/5ml

1 •

morphine sulfate oral soln100 mg/5ml (20 mg/ml)

1 •

morphine sulfate tab er 15 mg(Ms contin)

1 • •


1 • •


1 • •


1 • •


1 • •

NUCYNTA ER – tapentadol hcl taber 12hr 50 mg

3 • •


3 • •


3 • •


3 • •


3 • •

OPANA – oxymorphone hcl tab 5mg

3 •

OPANA – oxymorphone hcl tab 10mg

3 •

OPANA ER (CRUSH RESISTANT– oxymorphone hcl tab er 12hrdeter 5 mg

3 • •

OPANA ER (CRUSH RESISTANT– oxymorphone hcl tab er 12hrdeter 7.5 mg

3 • •


3 • •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


3 • •


3 • •


3 • •


3 • •

oxycodone hcl cap 5 mg 1 •oxycodone hcl conc 100 mg/5ml

(20 mg/ml)1 •

oxycodone hcl soln 5 mg/5ml 1 •oxycodone hcl tab 5 mg

(Roxicodone)1 •

oxycodone hcl tab 10 mg 1 •oxycodone hcl tab 15 mg

(Roxicodone)1 •

oxycodone hcl tab 20 mg 1 •oxycodone hcl tab 30 mg

(Roxicodone)1 •

oxycodone w/ acetaminophentab 2.5-325 mg (Percocet)

1 •

oxycodone w/ acetaminophentab 5-325 mg (Percocet)

1 •

oxycodone w/ acetaminophentab 7.5-325 mg (Percocet)

1 •

oxycodone w/ acetaminophentab 10-325 mg (Percocet)

1 •

oxycodone-aspirin tab4.8355-325 mg (Percodan)

1 • •

OXYCODONE/ACETAMINOPHEN– oxycodone w/ acetaminophensoln 5-325 mg/5ml

3 •

2018




Drug Name Dru

g Ti

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cial

ty/T

ier 4

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

OXYCODONE/IBUPROFEN –oxycodone-ibuprofen tab 5-400mg

3 •

oxymorphone hcl tab 5 mg(Opana)

1 •

oxymorphone hcl tab 10 mg(Opana)

1 •

OXYMORPHONEHYDROCHLORIDE –oxymorphone hcl tab er 12hr 5mg

3 • •

OXYMORPHONEHYDROCHLORIDE –oxymorphone hcl tab er 12hr 7.5mg

3 • •


3 • •


3 • •


3 • •


3 • •


3 • •

pentazocine w/ naloxone tab50-0.5 mg

1 • •

tramadol hcl tab er 24hr 100 mg 1 • •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

tramadol hcl tab er 24hr 200 mg 1 • •tramadol hcl tab er 24hr 300 mg 1 • •tramadol hcl tab er 24hr biphasic

release 100 mg1 • •

tramadol hcl tab er 24hr biphasicrelease 200 mg

1 • •

tramadol hcl tab er 24hr biphasicrelease 300 mg

1 • •

tramadol hcl tab 50 mg (Ultram) 1 •tramadol-acetaminophen tab

37.5-325 mg (Ultracet)1 •

TREZIX – acetaminophen-caffeine-dihydrocodeine cap 320.5-30-16mg

3 •

TYLENOL/CODEINE –acetaminophen w/ codeine tab300-15 mg

3 •

TYLENOL/CODEINE #3 –acetaminophen w/ codeine tab300-30 mg

3 •

TYLENOL/CODEINE #4 –acetaminophen w/ codeine tab300-60 mg

3 •

XTAMPZA ER – oxycodone cap er12hr abuse-deterrent 9 mg

2 •

XTAMPZA ER – oxycodone cap er12hr abuse-deterrent 13.5 mg

2 •


2 •


2 •


2 •

RHEUMATOID AND OSTEOARTHRITISACTEMRA – tocilizumab

subcutaneous soln prefilledsyringe 162 mg/0.9ml

3 X • •

2018




Drug Name Dru

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Spe

cial

ty/T

ier 4

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n

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ntity

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its

Res

pons

ible

Ste

ps

ANAPROX DS – naproxen sodiumtab 550 mg

3

ARAVA – leflunomide tab 10 mg 3

ARAVA – leflunomide tab 20 mg 3

ARCALYST – rilonacept for inj 220mg

2 X • •

ARTHROTEC 50 – diclofenac w/misoprostol tab delayed release50-0.2 mg

3

ARTHROTEC 75 – diclofenac w/misoprostol tab delayed release75-0.2 mg

3

celecoxib cap 50 mg (Celebrex) 1




DAYPRO – oxaprozin tab 600 mg 3

diclofenac potassium tab 50 mg 1

diclofenac sodium tab delayedrelease 25 mg

1


1


1

diclofenac sodium tab er 24hr100 mg

1

diclofenac w/ misoprostol tabdelayed release 50-0.2 mg(Arthrotec 50)

1

diclofenac w/ misoprostol tabdelayed release 75-0.2 mg(Arthrotec 75)

1

EC-NAPROSYN – naproxen tab ec375 mg

3

EC-NAPROSYN – naproxen tab ec500 mg

3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps

ENBREL – etanercept forsubcutaneous inj 25 mg

2 X • •

ENBREL – etanerceptsubcutaneous soln prefilledsyringe 25 mg/0.5ml

2 X • •

ENBREL – etanerceptsubcutaneous soln prefilledsyringe 50 mg/ml

2 X • •

ENBREL MINI – etanerceptsubcutaneous solution cartridge50 mg/ml

2 X • •

ENBREL SURECLICK –etanercept subcutaneoussolution auto-injector 50 mg/ml

2 X • •

etodolac cap 200 mg 1

etodolac cap 300 mg 1

etodolac tab er 24hr 400 mg 1



etodolac tab 400 mg 1

etodolac tab 500 mg 1

FELDENE – piroxicam cap 10 mg 3

FELDENE – piroxicam cap 20 mg 3

FENOPROFEN CALCIUM –fenoprofen calcium cap 200 mg

3

FENOPROFEN CALCIUM –fenoprofen calcium cap 400 mg

3

fenoprofen calcium tab 600 mg 1

flurbiprofen tab 50 mg 1

flurbiprofen tab 100 mg 1

HUMIRA – adalimumab prefilledsyringe kit 10 mg/0.2ml

2 X • •


2 X • •

2018




Drug Name Dru

g Ti

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cial

ty/T

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


2 X • •

HUMIRA PEDIATRIC CROHNS D– adalimumab prefilled syringe kit40 mg/0.8ml

2 X • •

HUMIRA PEN – adalimumab pen-injector kit 40 mg/0.8ml

2 X • •

HUMIRA PEN-CROHNS DISEASE– adalimumab pen-injector kit 40mg/0.8ml

2 X • •

HUMIRA PEN-PSORIASIS STAR– adalimumab pen-injector kit 40mg/0.8ml

2 X • •

ibuprofen susp 100 mg/5ml 1

ibuprofen tab 400 mg 1



INDOCIN – indomethacin susp 25mg/5ml

3

INDOCIN – indomethacin suppos50 mg

3

indomethacin cap er 75 mg 1

indomethacin cap 25 mg 1

indomethacin cap 50 mg 1

ketoprofen cap 50 mg 1

ketoprofen cap 75 mg 1

KETOPROFEN ER – ketoprofencap er 24hr 200 mg

3

ketorolac tromethamine tab10 mg

1 •

KINERET – anakinrasubcutaneous soln prefilledsyringe 100 mg/0.67ml

3 X • •

leflunomide tab 10 mg (Arava) 1

leflunomide tab 20 mg (Arava) 1

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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Lim

its

Res

pons

ible

Ste

ps

LODINE – etodolac tab 400 mg 3

MECLOFENAMATE SODIUM –meclofenamate sodium cap 50mg

3

MECLOFENAMATE SODIUM –meclofenamate sodium cap 100mg

3

mefenamic acid cap 250 mg(Ponstel)

1

meloxicam tab 7.5 mg (Mobic) 1

meloxicam tab 15 mg (Mobic) 1

nabumetone tab 500 mg 1

nabumetone tab 750 mg 1

NAPROSYN – naproxen tab 500mg

3

naproxen sodium tab 275 mg 1

naproxen sodium tab 550 mg(Anaprox ds)

1

naproxen susp 125 mg/5ml(Naprosyn)

1

naproxen tab ec 375 mg (Ec-naprosyn)

1

naproxen tab ec 500 mg (Ec-naprosyn)

1

naproxen tab 250 mg 1

naproxen tab 375 mg 1

naproxen tab 500 mg (Naprosyn) 1

ORENCIA – abataceptsubcutaneous soln prefilledsyringe 125 mg/ml

3 X • •

ORENCIA CLICKJECT –abatacept subcutaneous solnauto-injector 125 mg/ml

3 X • •

OTEZLA – apremilast tab startertherapy pack 10 mg & 20 mg &30 mg

2 X • •

2018




Drug Name Dru

g Ti

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Spe

cial

ty/T

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horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

OTEZLA – apremilast tab 30 mg 2 X • •OTREXUP – methotrexate soln pf

auto-injector 10 mg/0.4ml3

OTREXUP – methotrexate soln pfauto-injector 12.5 mg/0.4ml

3

OTREXUP – methotrexate soln pfauto-injector 15 mg/0.4ml

3


3


3


3


3

oxaprozin tab 600 mg (Daypro) 1

piroxicam cap 10 mg (Feldene) 1

piroxicam cap 20 mg (Feldene) 1

RASUVO – methotrexate soln pfauto-injector 7.5 mg/0.15ml

3

RASUVO – methotrexate soln pfauto-injector 10 mg/0.2ml

3


3


3


3


3


3


3


3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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horiz

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n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

RIDAURA – auranofin cap 3 mg 2

SIMPONI – golimumabsubcutaneous soln auto-injector50 mg/0.5ml

2 X • •

SIMPONI – golimumabsubcutaneous soln auto-injector100 mg/ml

2 X • •

SIMPONI – golimumabsubcutaneous soln prefilledsyringe 50 mg/0.5ml

2 X • •

SIMPONI – golimumabsubcutaneous soln prefilledsyringe 100 mg/ml

2 X • •

sulindac tab 150 mg 1

sulindac tab 200 mg 1

TOLMETIN SODIUM – tolmetinsodium cap 400 mg

3

TOLMETIN SODIUM – tolmetinsodium tab 200 mg

3

TOLMETIN SODIUM – tolmetinsodium tab 600 mg

3

XELJANZ – tofacitinib citrate tab 5mg (base equivalent)

3 X • •

XELJANZ XR – tofacitinib citratetab er 24hr 11 mg (baseequivalent)

3 X • •

MIGRAINE HEADACHESalmotriptan malate tab 6.25 mg

(Axert)1 •

almotriptan malate tab 12.5 mg(Axert)

1 •

AXERT – almotriptan malate tab6.25 mg

3 •

AXERT – almotriptan malate tab12.5 mg

3 •

CAFERGOT – ergotamine w/caffeine tab 1-100 mg

3

2018




Drug Name Dru

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ty/T

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps

D.H.E. 45 – dihydroergotaminemesylate inj 1 mg/ml

3 •

dihydroergotamine mesylate inj1 mg/ml (D.h.e. 45)

1 •

eletriptan hydrobromide tab20 mg (base equivalent)(Relpax)

1 •

eletriptan hydrobromide tab40 mg (base equivalent)(Relpax)

1 •

ergotamine w/ caffeine tab1-100 mg (Cafergot)

1

frovatriptan succinate tab 2.5 mg(base equivalent) (Frova)

1 •

isometheptene-caffeine-acetaminophen tab65-20-325 mg (Prodrin)

1

isometheptene-dichloral-acetaminophen cap65-100-325 mg

1

MIGERGOT – ergotamine w/caffeine suppos 2-100 mg

3

MIGRANAL – dihydroergotaminemesylate nasal spray 4 mg/ml

2 •

naratriptan hcl tab 1 mg (baseequiv) (Amerge)

1 •

naratriptan hcl tab 2.5 mg (baseequiv) (Amerge)

1 •

RELPAX – eletriptan hydrobromidetab 20 mg (base equivalent)

3 •

RELPAX – eletriptan hydrobromidetab 40 mg (base equivalent)

3 •

rizatriptan benzoate oraldisintegrating tab 5 mg (baseeq) (Maxalt-mlt)

1 •

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

rizatriptan benzoate oraldisintegrating tab 10 mg (baseeq) (Maxalt-mlt)

1 •

rizatriptan benzoate tab 5 mg(base equivalent) (Maxalt)

1 •

rizatriptan benzoate tab 10 mg(base equivalent) (Maxalt)

1 •

sumatriptan nasal spray 5 mg/act (Imitrex)

1 •

sumatriptan nasal spray 20 mg/act (Imitrex)

1 •

sumatriptan succinate inj6 mg/0.5ml (Imitrex)

1 •

sumatriptan succinate solutionauto-injector 4 mg/0.5ml(Imitrex statdose sys)

1 •

sumatriptan succinate solutionauto-injector 6 mg/0.5ml(Imitrex statdose sys)

1 •

sumatriptan succinate solutioncartridge 4 mg/0.5ml (Imitrexstatdose ref)

1 •

sumatriptan succinate solutioncartridge 6 mg/0.5ml (Imitrexstatdose ref)

1 •

sumatriptan succinate tab 25 mg(Imitrex)

1 •

sumatriptan succinate tab 50 mg(Imitrex)

1 •

sumatriptan succinate tab100 mg (Imitrex)

1 •

zolmitriptan orally disintegratingtab 2.5 mg (Zomig zmt)

1 •

zolmitriptan orally disintegratingtab 5 mg (Zomig zmt)

1 •

zolmitriptan tab 2.5 mg (Zomig) 1 •zolmitriptan tab 5 mg (Zomig) 1 •

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

ZOMIG – zolmitriptan nasal spray2.5 mg/spray unit

3 •

ZOMIG – zolmitriptan nasal spray 5mg/spray unit

3 •

GOUTallopurinol tab 100 mg (Zyloprim) 1

allopurinol tab 300 mg (Zyloprim) 1

COLCHICINE – colchicine cap 0.6mg

3

COLCHICINE – colchicine tab 0.6mg

3

colchicine w/ probenecid tab0.5-500 mg

1

COLCRYS – colchicine tab 0.6 mg 2

DUZALLO – lesinurad-allopurinoltab 200-200 mg

3 • •

DUZALLO – lesinurad-allopurinoltab 200-300 mg

3 • •

MITIGARE – colchicine cap 0.6 mg 3

probenecid tab 500 mg 1

ULORIC – febuxostat tab 40 mg 3 •ULORIC – febuxostat tab 80 mg 3 •ZURAMPIC – lesinurad tab 200 mg 3 • •ZYLOPRIM – allopurinol tab 100

mg3

ZYLOPRIM – allopurinol tab 300mg

3

NEUROMUSCULAR DRUGSSEIZURESAPTIOM – eslicarbazepine acetate

tab 200 mg3

APTIOM – eslicarbazepine acetatetab 400 mg

3


3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


3

BANZEL – rufinamide susp 40 mg/ml

3

BANZEL – rufinamide tab 200 mg 3

BANZEL – rufinamide tab 400 mg 3

BRIVIACT – brivaracetam tab 10mg

3


3


3


3


3

BRIVIACT – brivaracetam oral soln10 mg/ml

3

BRIVIACT – brivaracetam iv soln50 mg/5ml

3

carbamazepine cap er 12hr100 mg (Carbatrol)

1


1


1

carbamazepine chew tab 100 mg 1

carbamazepine susp 100 mg/5ml(Tegretol)

1

carbamazepine tab er 12hr100 mg (Tegretol-xr)

1


1


1

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

carbamazepine tab 200 mg(Tegretol)

1

CARBATROL – carbamazepinecap er 12hr 100 mg

3


3


3

CELONTIN – methsuximide cap300 mg

2

clonazepam orally disintegratingtab 0.125 mg

1


1


1

clonazepam orally disintegratingtab 1 mg

1

clonazepam orally disintegratingtab 2 mg

1

clonazepam tab 0.5 mg(Klonopin)

1

clonazepam tab 1 mg (Klonopin) 1

clonazepam tab 2 mg (Klonopin) 1

DEPAKENE – valproate sodiumoral soln 250 mg/5ml (baseequiv)

3

DEPAKENE – valproic acid cap250 mg

3

DEPAKOTE – divalproex sodiumtab delayed release 125 mg

3


3


3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

DEPAKOTE ER – divalproexsodium tab er 24 hr 250 mg

3

DEPAKOTE ER – divalproexsodium tab er 24 hr 500 mg

3

DEPAKOTE SPRINKLES –divalproex sodium cap delayedrelease sprinkle 125 mg

3

DIASTAT ACUDIAL – diazepamrectal gel delivery system 10 mg

2

DIASTAT ACUDIAL – diazepamrectal gel delivery system 20 mg

2

DIASTAT PEDIATRIC – diazepamrectal gel delivery system 2.5 mg

2

DIAZEPAM RECTAL GEL –diazepam rectal gel deliverysystem 2.5 mg

3

DIAZEPAM RECTAL GEL –diazepam rectal gel deliverysystem 10 mg

3

DIAZEPAM RECTAL GEL –diazepam rectal gel deliverysystem 20 mg

3

DILANTIN – phenytoin sodiumextended cap 30 mg

2

DILANTIN – phenytoin sodiumextended cap 100 mg

3

DILANTIN INFATABS – phenytoinchew tab 50 mg

3

DILANTIN-125 – phenytoin susp125 mg/5ml

3

divalproex sodium cap delayedrelease sprinkle 125 mg(Depakote sprinkles)

1

divalproex sodium tab delayedrelease 125 mg (Depakote)

1


1

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


1

divalproex sodium tab er 24 hr250 mg (Depakote er)

1

divalproex sodium tab er 24 hr500 mg (Depakote er)

1

ethosuximide cap 250 mg(Zarontin)

1

ethosuximide soln 250 mg/5ml(Zarontin)

1

felbamate susp 600 mg/5ml(Felbatol)

1

felbamate tab 400 mg (Felbatol) 1

felbamate tab 600 mg (Felbatol) 1

FELBATOL – felbamate susp 600mg/5ml

3

FELBATOL – felbamate tab 400mg

3

FELBATOL – felbamate tab 600mg

3

FYCOMPA – perampanel susp 0.5mg/ml

3

FYCOMPA – perampanel tab 2 mg 3




FYCOMPA – perampanel tab 10mg

3

FYCOMPA – perampanel tab 12mg

3

gabapentin cap 100 mg(Neurontin)

1


1

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


1

gabapentin oral soln 250 mg/5ml(Neurontin)

1

gabapentin tab 600 mg(Neurontin)

1

gabapentin tab 800 mg(Neurontin)

1

GABITRIL – tiagabine hcl tab 2 mg 3

GABITRIL – tiagabine hcl tab 4 mg 3

GABITRIL – tiagabine hcl tab 12mg

2

GABITRIL – tiagabine hcl tab 16mg

2

KEPPRA – levetiracetam oral soln100 mg/ml

3

KEPPRA – levetiracetam tab 250mg

3


3


3


3

KEPPRA XR – levetiracetam tab er24hr 500 mg

3

KEPPRA XR – levetiracetam tab er24hr 750 mg

3

LAMICTAL – lamotrigine tab 25 mg 3

LAMICTAL – lamotrigine tab 100mg

3


3


3

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps

LAMICTAL CHEWABLE DISPERS– lamotrigine tab chewabledispersible 5 mg

3

LAMICTAL CHEWABLE DISPERS– lamotrigine tab chewabledispersible 25 mg

3

LAMICTAL ODT – lamotrigine tabdisint 25 mg (21) & 50 mg (7)titration kit

3

LAMICTAL ODT – lamotrigine tabdisint 50 mg (42)- 100 mg(14)titration kit

3

LAMICTAL ODT – lamotrigine tabdisint 25 (14) & 50 mg (14) & 100mg (7) kit

3

LAMICTAL ODT – lamotrigineorally disintegrating tab 25 mg

3


3


3


3

LAMICTAL STARTER/NOT TAKI –lamotrigine tab 25 mg (42) & 100mg (7) starter kit

3

LAMICTAL STARTER/TAKING C –lamotrigine tab 25 mg (84) & 100mg (14) starter kit

3

LAMICTAL STARTER/TAKING V –lamotrigine tab 25 mg (35) starterkit

3

LAMICTAL XR – lamotrigine taber 24hr 25 mg (21) & 50 mg (7)titration kit

3

LAMICTAL XR – lamotrigine tab er24hr 25 (14) & 50 mg (14) & 100mg(7) kit

3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

LAMICTAL XR – lamotrigine tab er24hr 50 (14) & 100 mg(14) & 200mg(7) kit

3

LAMICTAL XR – lamotrigine tab er24hr 25 mg

3


3


3


3


3


3

lamotrigine orally disintegratingtab 25 mg (Lamictal odt)

1


1


1


1

lamotrigine tab chewabledispersible 5 mg (Lamictalchewable di)

1

lamotrigine tab chewabledispersible 25 mg (Lamictalchewable di)

1

lamotrigine tab disint 25 mg(21) & 50 mg (7) titration kit(Lamictal odt)

1

lamotrigine tab disint 50 mg(42)- 100 mg(14) titration kit(Lamictal odt)

1

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

lamotrigine tab disint 25 (14)& 50 mg (14) & 100 mg (7) kit(Lamictal odt)

1

lamotrigine tab er 24hr 25 mg(Lamictal xr)

1


1


1


1


1


1

lamotrigine tab 25 mg (Lamictal) 1




lamotrigine tab 25 mg (35)starter kit (Lamictal starter/tak)

1

lamotrigine tab 25 mg (42) &100 mg (7) starter kit (Lamictalstarter/not)

1

lamotrigine tab 25 mg (84) &100 mg (14) starter kit (Lamictalstarter/tak)

1

levetiracetam oral soln 100 mg/ml (Keppra)

1

levetiracetam tab er 24hr 500 mg(Keppra xr)

1

levetiracetam tab er 24hr 750 mg(Keppra xr)

1

levetiracetam tab 250 mg(Keppra)

1

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


1


1


1

LYRICA – pregabalin soln 20 mg/ml

3 • •

LYRICA – pregabalin cap 25 mg 3 • •LYRICA – pregabalin cap 50 mg 3 • •LYRICA – pregabalin cap 75 mg 3 • •LYRICA – pregabalin cap 100 mg 3 • •LYRICA – pregabalin cap 150 mg 3 • •LYRICA – pregabalin cap 200 mg 3 • •LYRICA – pregabalin cap 225 mg 3 • •LYRICA – pregabalin cap 300 mg 3 • •NEURONTIN – gabapentin oral

soln 250 mg/5ml3

NEURONTIN – gabapentin cap100 mg

3


3


3

NEURONTIN – gabapentin tab 600mg

3

NEURONTIN – gabapentin tab 800mg

3

ONFI – clobazam suspension 2.5mg/ml

3

ONFI – clobazam tab 10 mg 3

ONFI – clobazam tab 20 mg 3

oxcarbazepine susp 300 mg/5ml(60 mg/ml) (Trileptal)

1

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

oxcarbazepine tab 150 mg(Trileptal)

1


1


1

OXTELLAR XR – oxcarbazepinetab er 24hr 150 mg

3


3


3

PEGANONE – ethotoin tab 250 mg 2

PHENYTEK – phenytoin sodiumextended cap 200 mg

3

PHENYTEK – phenytoin sodiumextended cap 300 mg

3

phenytoin chew tab 50 mg(Dilantin infatabs)

1

phenytoin sodium extended cap100 mg (Dilantin)

1

phenytoin sodium extended cap200 mg (Phenytek)

1

phenytoin sodium extended cap300 mg (Phenytek)

1

phenytoin susp 125 mg/5ml(Dilantin-125)

1

primidone tab 50 mg (Mysoline) 1

primidone tab 250 mg (Mysoline) 1

QUDEXY XR – topiramate cap er24hr sprinkle 25 mg

3


3


3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


3


3

SABRIL – vigabatrin tab 500 mg 3

SABRIL – vigabatrin powd pack500 mg

3

TEGRETOL – carbamazepine tab200 mg

3

TEGRETOL – carbamazepine susp100 mg/5ml

3

TEGRETOL-XR – carbamazepinetab er 12hr 100 mg

3


3


3

tiagabine hcl tab 2 mg (Gabitril) 1

tiagabine hcl tab 4 mg (Gabitril) 1

TOPAMAX – topiramate tab 25 mg 3

TOPAMAX – topiramate tab 50 mg 3

TOPAMAX – topiramate tab 100mg

3

TOPAMAX – topiramate tab 200mg

3

TOPAMAX SPRINKLE –topiramate sprinkle cap 15 mg

3

TOPAMAX SPRINKLE –topiramate sprinkle cap 25 mg

3

TOPIRAMATE ER – topiramatecap er 24hr sprinkle 25 mg

3


3


3

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


3


3

topiramate sprinkle cap 15 mg(Topamax sprinkle)

1

topiramate sprinkle cap 25 mg(Topamax sprinkle)

1

topiramate tab 25 mg (Topamax) 1




TRILEPTAL – oxcarbazepine susp300 mg/5ml (60 mg/ml)

3

TRILEPTAL – oxcarbazepine tab150 mg

3


3


3

TROKENDI XR – topiramate cap er24hr 25 mg

3


3


3


3

valproate sodium oral soln250 mg/5ml (base equiv)(Depakene)

1

valproic acid cap 250 mg(Depakene)

1

vigabatrin powd pack 500 mg(Sabril)

1

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

VIMPAT – lacosamide oral solution10 mg/ml

3

VIMPAT – lacosamide tab 50 mg 3




ZARONTIN – ethosuximide cap250 mg

3

ZARONTIN – ethosuximide soln250 mg/5ml

3

ZONEGRAN – zonisamide cap 25mg

3

ZONEGRAN – zonisamide cap 100mg

3

zonisamide cap 25 mg(Zonegran)

1

zonisamide cap 50 mg 1

zonisamide cap 100 mg(Zonegran)

1

PARKINSON'S DISEASEamantadine hcl cap 100 mg 1

amantadine hcl syrup 50 mg/5ml 1

amantadine hcl tab 100 mg 1

APOKYN – apomorphine hcl solncartridge 30 mg/3ml

3 X •

AZILECT – rasagiline mesylate tab0.5 mg (base equiv)

3

AZILECT – rasagiline mesylate tab1 mg (base equiv)

3

benztropine mesylate tab 0.5 mg 1

benztropine mesylate tab 1 mg 1

benztropine mesylate tab 2 mg 1

bromocriptine mesylate cap5 mg (base equivalent)

1

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

bromocriptine mesylate tab2.5 mg (base equivalent)(Parlodel)

1

carbidopa & levodopa orallydisintegrating tab 10-100 mg

1


1


1

carbidopa & levodopa tab er25-100 mg (Sinemet cr)

1

carbidopa & levodopa tab er50-200 mg (Sinemet cr)

1

carbidopa & levodopa tab10-100 mg (Sinemet)

1


1


1

carbidopa tab 25 mg (Lodosyn) 1

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 12.5-50-200 mg

3

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 18.75-75-200mg

3

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 25-100-200 mg

3


3


3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 50-200-200 mg

3

COMTAN – entacapone tab 200mg

3

ELDEPRYL – selegiline hcl cap 5mg

3

entacapone tab 200 mg (Comtan) 1

LODOSYN – carbidopa tab 25 mg 3

MIRAPEX – pramipexoledihydrochloride tab 0.125 mg

3


3


3


3

MIRAPEX – pramipexoledihydrochloride tab 1 mg

3


3

NEUPRO – rotigotine td patch 24hr1 mg/24hr

3


3


3


3


3


3

PARLODEL – bromocriptinemesylate cap 5 mg (baseequivalent)

3

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

PARLODEL – bromocriptinemesylate tab 2.5 mg (baseequivalent)

3

pramipexole dihydrochloride taber 24hr 0.375 mg (Mirapex er)

1


1


1


1

pramipexole dihydrochloride taber 24hr 3 mg (Mirapex er)

1


1


1

pramipexole dihydrochloride tab0.125 mg (Mirapex)

1


1


1


1

pramipexole dihydrochloride tab1 mg (Mirapex)

1


1

rasagiline mesylate tab 0.5 mg(base equiv) (Azilect)

1

rasagiline mesylate tab 1 mg(base equiv) (Azilect)

1

REQUIP – ropinirole hydrochloridetab 0.25 mg

3

REQUIP – ropinirole hydrochloridetab 0.5 mg

3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

REQUIP – ropinirole hydrochloridetab 1 mg

3


3


3


3


3

REQUIP XL – ropinirolehydrochloride tab er 24hr 2 mg(base equivalent)

3


3


3


3


3

ropinirole hydrochloride tab er24hr 2 mg (base equivalent)(Requip xl)

1


1


1


1

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps


1

ropinirole hydrochloride tab0.25 mg (Requip)

1

ropinirole hydrochloride tab0.5 mg (Requip)

1

ropinirole hydrochloride tab1 mg (Requip)

1


1


1


1


1

selegiline hcl cap 5 mg (Eldepryl) 1

selegiline hcl tab 5 mg 1

SINEMET – carbidopa & levodopatab 10-100 mg

3


3


3

SINEMET CR – carbidopa &levodopa tab er 25-100 mg

3

SINEMET CR – carbidopa &levodopa tab er 50-200 mg

3

STALEVO 100 – carbidopa-levodopa-entacapone tabs25-100-200 mg

3

STALEVO 125 – carbidopa-levodopa-entacapone tabs31.25-125-200 mg

3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

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n

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ntity

Lim

its

Res

pons

ible

Ste

ps


3

STALEVO 200 – carbidopa-levodopa-entacapone tabs50-200-200 mg

3


3


3

TASMAR – tolcapone tab 100 mg 3

tolcapone tab 100 mg (Tasmar) 1

trihexyphenidyl hcl elixir 0.4 mg/ml

1

trihexyphenidyl hcl tab 2 mg 1

trihexyphenidyl hcl tab 5 mg 1

XADAGO – safinamide mesylatetab 50 mg (base equiv)

3

XADAGO – safinamide mesylatetab 100 mg (base equiv)

3

MUSCLE RELAXANTSbaclofen tab 10 mg 1

baclofen tab 20 mg 1

carisoprodol tab 350 mg (Soma) 1

CHLORZOXAZONE –chlorzoxazone tab 250 mg

3

chlorzoxazone tab 500 mg(Parafon forte dsc)

1

cyclobenzaprine hcl tab 5 mg 1

cyclobenzaprine hcl tab 7.5 mg 1

cyclobenzaprine hcl tab 10 mg 1

DANTRIUM – dantrolene sodiumcap 25 mg

3

2018




Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

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r Aut

horiz

atio

n

Qua

ntity

Lim

its

Res

pons

ible

Ste

ps

DANTRIUM – dantrolene sodiumcap 50 mg

3

dantrolene sodium cap 25 mg(Dantrium)

1

dantrolene sodium cap 50 mg(Dantrium)

1

dantrolene sodium cap 100 mg 1

METAXALONE – metaxalone tab400 mg

3

metaxalone tab 800 mg (Skelaxin) 1

methocarbamol tab 500 mg(Robaxin)

1

methocarbamol tab 750 mg(Robaxin-750)

1

orphenadrine citrate tab er 12hr100 mg

1

ROBAXIN – methocarbamol tab500 mg

3

ROBAXIN-750 – methocarbamoltab 750 mg

3

SKELAXIN – metaxalone tab 800mg

3

tizanidine hcl cap 2 mg (baseequivalent) (Zanaflex)

1


1


1

tizanidine hcl tab 2 mg (baseequivalent)

1

tizanidine hcl tab 4 mg (baseequivalent) (Zanaflex)

1

ZANAFLEX – tizanidine hcl tab 4mg (base equivalent)

3

ZANAFLEX – tizanidine hcl cap 2mg (base equivalent)

3

Drug Name Dru

g Ti

er

Spe

cial

ty/T

ier 4

Prio

r Aut

horiz

atio

n

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ntity

Lim

its

Res

pons

ible

Ste

ps


3


3

OTHER NEUROMUSCULAR DRUGSGUANIDINE HCL – guanidine hcl

tab 125 mg3

MESTINON – pyridostigminebromide syrup 60 mg/5ml

2

MESTINON TIMESPAN –pyridostigmine bromide tab er180 mg

3

pyridostigmine bromide tab er180 mg (Mestinon timespan)

1

pyridostigmine bromide tab60 mg (Mestinon)

1

RILUTEK – riluzole tab 50 mg 3

riluzole tab 50 mg (Rilutek) 1

SUPPLEMENTSVITAMINSAMINOBENZOATE POTASSIUM

– potassium aminobenzoatepacket 2 gm

3

cholecalciferol cap 1000 unit 1

cholecalciferol cap 50000 unit 1

cholecalciferol chew tab 400 unit 1

cholecalciferol chew tab 1000unit

1

cholecalciferol drops 5000 unit/ml (1000 unit/0.2ml)

1

cholecalciferol drops 400unit/0.03ml (per drop)

1

cholecalciferol oral liquid 400unit/ml

1

cholecalciferol tab 400 unit 1

2018




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cholecalciferol tab 1000 unit 1

ergocalciferol cap 50000 unit 1

MEPHYTON – phytonadione tab 5mg

2 •

MULTIVITAMINSACTIVE OB – prenatal w/o a w/fe

cbn-fa-dha cap 20-1-320 mg3

BAL-CARE DHA – prenat w/fepoly-na fered-fa tab 27-1 &omega cap dr 430mg

3

BP FOLINATAL PLUS B – prenatalw/ calcium carbonate-b6-b12-fatab 1 mg

3

BP MULTINATAL PLUS – prenatalw/o a vit w/ fe fumarate-fa tab30-1 mg

3

BP MULTINATAL PLUS – prenatalw/o a vit w/ fe fum-fa tab chew40-1 mg

3

C-NATE DHA – prenatal vit w/ fefum-fa-omega 3 cap 28-1-200mg

3

CALCIUM PNV – prenatal w/ovit a w/ fe fum-fa-omega 3 cap28-1-250 mg

3

CITRANATAL ASSURE – prenat w/o a w/fecbn-fegl-dss-fa tab & dhacap 300 mg pack

3

CITRANATAL B-CALM – prenat w/o a w/fecbn-feglu-fa tab 20-1 mg& vit b6 tab pak

3

CITRANATAL BLOOM – prenatalvit w/ dss-fe cbn-fe gluc-fa tab90-1 mg

3

CITRANATAL DHA – prenat w/oa w/fecbn-fegl-dss-fa tab & dhacap 250 mg pack

3

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CITRANATAL HARMONY – prenatw/o a w/fe fum-fe cbn-dss-fa-dhacap 27-1-260 mg

3

CITRANATAL RX – prenatal w/o aw/ fe carbonyl-fe gluc-dss-fa tab27-1mg

3

CITRANATAL 90 DHA – prenat w/o a w/fecbn-fegl-dss-fa tab 90&dha cap 300mg pak

3

CO-NATAL FA – prenatal vit w/ fefumarate-fa tab 29-1 mg

3

COMPLETE NATAL DHA – prenat-fe bis-fe prot succ-fa-ca tab &omega 3 cap 250 pk

3

COMPLETENATE – prenatal vit w/fe fumarate-fa chew tab 29-1 mg

3

CONCEPT DHA – prenatal w/fefum-fe poly -fa-omega 3 cap53.5-38-1 mg

3

CONCEPT OB – prenatal w/o a w/fe fum-fe poly-fa cap 130-92.4-1mg

3

DOTHELLE DHA – prenatal w/fe fum-fe poly -fa-omega 3 cap53.5-38-1 mg

3

DUET DHA BALANCED – prenatw/fe poly-na fered-fa tab 25-1 &omega cap 267 mg

3

DUET DHA 400 – prenat w/fe poly-na fered-fa tab 25-1 & omegacap 400 mg

3

ELITE-OB – prenatal vit w/ ironcarbonyl-fa tab 50-1.25 mg

3

ENBRACE HR – prenatal vit w/ fegly cys-fa-omega 3 fatty acidscap

3

2018




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FOLCAL DHA – prenatal w/ovit a w/ fe fum-dss-fa-dha cap27-1.25-300 mg

3

FOLCAPS OMEGA 3 – prenatal vitw/ fe cbn-fe asp glyc-fa-omega 3cap 27-1mg

3

FOLET DHA – prenat w/fecbn-bisg-methylf-dss tab dr & dhacap pak

3

FOLET ONE – prenat w/o a w/fecbn-bisg-methylf-dss-dha cap38-1-225 mg

3

FOLIVANE-OB – prenatal w/o a w/fe fum-fe poly-fa cap 130-92.4-1mg

3

HEMENATAL OB – prenat vit-fepoly cmplx-fe heme poly-fa tab28-6-1 mg

3

HEMENATAL OB + DHA – prenat-fe poly cmplx-fe heme poly-fa tab& omega 3 cap pck

3

INATAL ADVANCE – prenatal vit w/dss-iron carbonyl-fa tab 90-1 mg

3

INATAL GT – prenatal vit w/ dss-iron carbonyl-fa tab 90-1 mg

3

INATAL ULTRA – prenatal vit w/dss-iron carbonyl-fa tab 90-1 mg

3

INFANATE BALANCE – prenatalw/o a w/fe cbn-dss-fa-dha cap29-1-265 mg

3

KOSHER PRENATAL PLUS IRON– prenatal vit w/ iron carbonyl-fatab 30-1 mg

3

LEVOMEFOLATE DHA – prenat w/fe fum-l methylfolate-fa-dha cap27-1.13-0.4 mg

3

M-VIT – prenatal vit w/ fe fumarate-fa tab 27-1 mg

3

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MARNATAL-F – prenatal w/o vit aw/ fe polysac cmplx-fa cap 60-1mg

3

MYNATAL – prenatal multivitamins& minerals w/ iron & fa cap 1 mg

3

MYNATAL ADVANCE – prenatal vitw/ dss-iron carbonyl-fa tab 90-1mg

3

MYNATAL PLUS – prenatal vit w/fe fumarate-fa tab 65-1 mg

3

MYNATAL ULTRACAPLET –prenatal vit w/ dss-iron carbonyl-fa tab 90-1 mg

3

MYNATAL-Z – prenatal vit w/ fefumarate-fa tab 65-1 mg

3

MYNATE 90 PLUS – prenatal vitw/ dss-fe fumarate-fa tab er 90-1mg

3

NATACHEW – prenatal vit w/ fefum-fe bisglycin-fa chew tab 28-1mg

3

NATALVIT – prenatal vit w/ fefumarate-fa tab 75-1 mg

3

NATELLE ONE – prenatal w/ovit a w/ fe fum-fa-omega 3 cap28-1-250 mg

3

NEEVO DHA – prenat w/o a w/fefum-methylfol-omegas cap27-1.13 mg

3

NESTABS – prenatal vit w/o vit aw/ fe bisglycinate-fa tab 32-1 mg

3

NESTABS ABC – prenatal w/o vit aw/fe polysac-fa-ca tab & omega 3cap

3

NESTABS DHA – prenat w/o aw/ fe bisglyc-fa tab 32-1 mg &omega cap pack

3

2018




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NESTABS ONE – prenat w/o aw/fecbn-bisg-methylf-dha cap38-1-225 mg

3

NEWGEN – prenatal vit w/o vit a w/fe bisglycinate-fa tab 32-1 mg

3

NEXA PLUS – prenatal w/o vita w/ fe fum-doc-fa-dha cap29-1.25-350 mg

3

NIVA-PLUS – prenatal vit w/ fefumarate-fa tab 27-1 mg

3

O-CAL FA – prenatal vit w/ fefumarate-fa tab 27-1 mg

3

O-CAL PRENATAL – prenatal vitw/ fe fumarate-fa tab 15-1 mg

3

OB COMPLETE – prenatal vit w/iron carbonyl-fa tab 50-1.25 mg

3

OB COMPLETE GOLD – prenat w/o a w/fecbn-methfol-fa-dha cap27.5-1-200 mg

3

OB COMPLETE ONE – prenatalw/o a w/fecbn-fe asp glyc-fa-fishcap 50-1-476 mg

3

OB COMPLETE PETITE – prenatw/o a w/fecbn-feaspglyc-fa-omega cap 35-5-1-200 mg

3

OB COMPLETE PREMIER –prenatal vit w/ fe cbn-fe asp glyc-fa tab 30-20-1 mg

3

OB COMPLETE/DHA – prenat w/iron cbn-fe asp glyc-fa-omegacap 30-10-1-200 mg

3

OBSTETRIX DHA – prenat w/fecbn-fa-dss tab 29-1 mg &omega 3 cap 387 mg pak

3

OBSTETRIX EC – prenatal vit w/dss-iron carbonyl-fa tab 29-1 mg

3

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OBSTETRIX ONE – prenat w/o aw/fecbn-bisg-methylf-dss-dhacap 38-1-225 mg

3

PNV FOLIC ACID + IRON MUL –prenatal vit w/ fe fumarate-fa tab27-1 mg

3

PNV OB+DHA – prenat w/o a w/fecbn-fegl-dss-fa tab & dha cap250 mg pack

3

PNV PRENATAL PLUS MULTIVI –prenat w/ fe fum-fa tab 27-1 mg& omega 3 cap 312 mg pak

3

PNV PRENATAL PLUS MULTIVI –prenatal vit w/ fe fumarate-fa tab27-1 mg

3

PNV TABS 29-1 – prenatal vit w/iron carbonyl-fa tab 29-1 mg

3

PNV-DHA – prenat w/o a w/fefum-methfol-fa-dha cap27-0.6-0.4-300 mg

3

PNV-DHA+DOCUSATE – prenatalw/o vit a w/ fe fum-dss-fa-dhacap 27-1.25-300 mg

3

PNV-OMEGA – prenat w/o a w/ fefumerate-methylfolate-fa-omega3 cap

3

PNV-SELECT – prenatal vitw/ fe fum-methylfolate-fa tab27-0.6-0.4 mg

3

PNV-TOTAL – prenat w/ fe cbn-febisglyc-fa-fish oil cap 35-5-1.2mg

3

PNV-VP-U – prenatal w/o a vit w/fe fumarate-fa cap 106.5-1 mg

3

PR NATAL 400 – prenat-fe bis-feprot succ-fa-ca tab & omega 3cap 400 pk

3

2018




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PR NATAL 400 EC – prenat-fe bis-fe prot succ-fa-ca tab & omegacap dr 400 pk

3

PR NATAL 430 – prenat-fe bis-feprot succ-fa-ca tab & omega 3cap 430 pk

3

PR NATAL 430 EC – prenat-fe bis-fe prot succ-fa-ca tab & omegacap dr 430 pk

3

PREFERA OB – prenat vit-fe polycmplx-fe heme poly-fa tab 34-1mg

3

PREFERAOB +DHA – prenat-fepoly cmplx 28mg-fe heme poly-fatab&dha cap pack

3

PREFERAOB ONE – prenat-fepoly cmplx-fe heme poly-fa-dhacap 22-6-1-200 mg

3

PRENA 1 TRUE – prenat w/o a w/fe chel-fa tab 30-1.4 mg & dhacap 300mg pk

3

PRENAISSANCE – prenatal w/ovit a w/ fe fum-dss-fa-dha cap29-1.25-325 mg

3

PRENAISSANCE BALANCE –prenatal w/o vit a w/ fe cbn-dss-fa-dha cap 30-1-260 mg

3

PRENAISSANCE HARMONY DHA– prenat w/fe poly-na fered-fa tab27-1 & omega cap dr 380mg

3

PRENAISSANCE NEXT – prenatalw/ calcium-vit b6-fa-ginger tab1.2 mg

3

PRENAISSANCE NEXT-B –prenatal w/ calcium-vit b6-fa-ginger tab 1.22 mg

3

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PRENAISSANCE PLUS – prenatalw/o a w/fe cbn-dss-fa-dha cap28-1-250 mg

3

PRENATA – prenatal w/o a vit w/ fefum-fa tab chew 29-1 mg

3

PRENATABS RX – prenatal vit w/iron carbonyl-fa tab 29-1 mg

3

PRENATAL – prenatal vit w/ fefumarate-fa tab 27-1 mg

3

PRENATAL PLUS – prenatal vit w/fe fumarate-fa tab 27-1 mg

3

PRENATAL PLUS IRON – prenatalvit w/ iron carbonyl-fa tab 29-1mg

3

PRENATAL VITAMINS PLUS LO –prenatal vit w/ fe fumarate-fa tab27-1 mg

3

PRENATAL 19 – prenatal vit w/ fefumarate-fa chew tab 29-1 mg

3

PRENATAL 19 – prenatal vit w/dss-fe fumarate-fa tab 29-1 mg

3

PRENATAL-U – prenatal w/o a vitw/ fe fumarate-fa cap 106.5-1 mg

3

PRENATE – prenat mv & min w/ l-methylfolate-fa chew tab 0.6-0.4mg

3

PRENATE AM – prenatal w/calcium-vit b6-vit b12-fa-gingertab 1 mg

3

PRENATE DHA – prenat w/o aw/fefum-methfol-fa-dha cap28-0.6-0.4-300 mg

3

PRENATE DHA – prenat w/o aw/feaspg-methfol-fa-dha cap18-0.6-0.4-300 mg

3

PRENATE ELITE – prenatal w/fe asp gly-l methylfol-fa tab20-0.6-0.4 mg

3

2018




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PRENATE ELITE – prenatal vitw/ fe fum-methylfolate-fa tab26-0.6-0.4 mg

3

PRENATE ENHANCE – prenat w/o a w/fefum-methfol-fa-dha cap28-0.6-0.4-400 mg

3

PRENATE ESSENTIAL – prenat w/o a w/feasp-methylf-fa-omeg cap29-0.6-0.4-340 mg

3

PRENATE ESSENTIAL – prenat w/o a w/feaspg-methfol-fa-dha cap18-0.6-0.4-300 mg

3

PRENATE MINI – prenat w/oaw/fecb-feasp-meth-fa-dha cap18-0.6-0.4-350 mg

3

PRENATE MINI – prenat w/o aw/fecbn-methylf-fa-dha cap29-0.6-0.4-350 mg

3

PRENATE PIXIE – prenat w/o aw/feaspg-methfol-fa-dha cap10-0.6-0.4-200 mg

3

PRENATE RESTORE – prenat w/o a w/fefum-methfol-fa-dha cap27-0.6-0.4-400 mg

3

PRENA1 CHEW – prenat w/ b2-b6-b12-d3-folic acid chew tab 1.4mg

3

PRENA1 PEARL – prenat w/oaw/fefum-na fered-fa-dha cap er30-1.4-200 mg

3

PREPLUS – prenatal vit w/ fefumarate-fa tab 27-1 mg

3

PRETAB – prenatal vit w/ fefumarate-fa tab 29-1 mg

3

PRIMACARE – prenat w/o aw/feasp-methlf-fa-omeg cap30-0.75-0.25-470mg

3

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PROVIDA DHA – prenat w/o aw/fe fum-fe poly-fa-dha cap16-16-1.25-110 mg

3

PROVIDA OB – prenatal w/o a w/fefum-fe poly-fa cap 20-20-1.25 mg

3

PUREFE OB PLUS – prenatalw/o a w/fe fum-fe poly-fa cap162.115.2-1 mg

3

R-NATAL OB – prenatal w/o a w/fecbn-fa-dha cap 20-1-320 mg

3

RELNATE DHA – prenatal vit w/fe fum-fa-omega 3 cap 28-1-200mg

3

SE-NATAL 19 – prenatal vit w/ fefumarate-fa chew tab 29-1 mg

3

SE-NATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab 29-1 mg

3

SELECT-OB – prenatal vit w/ fepolysac cmplx-fa chew tab 29-1mg

3

SELECT-OB – prenat w/fepolycmplx-methylfol-fa chewtab 29-0.6-0.4 mg

3

SELECT-OB+DHA – prenatal mvw/fe poly-fa chw 29-1 mg & dhacap 250 mg pak

3

TARON-BC – prenat w/o a w/ fecbnyl-fa tab 20-1 mg & vit b6 tabpak

3

TARON-C DHA – prenatal w/fefum-fe poly -fa-omega 3 cap53.5-38-1 mg

3

TARON-PREX – prenatal w/ovit a w/ fe fum-dss-fa-dha cap30-1.2-265 mg

3

THRIVITE RX – prenatal vit w/ ironcarbonyl-fa tab 29-1 mg

3

2018




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THRIVITE 19 – prenatal vit w/ dss-fe fumarate-fa tab 29-1 mg

3

TL FOLATE – prenatal vit w/fe fum-methylfolate-fa tab27-0.5-0.5 mg

3

TL-CARE DHA – prenatal w/fefumarate-fa-dss-fish oil cap27-1-500 mg

3

TL-SELECT – prenatal w/o vita w/ fe fum-dss-fa-dha cap29-1.25-325 mg

3

TRI-TABS DHA – prenat w/o aw/ fe bisglyc-fa tab 32-1 mg &omega cap pack

3

TRICARE – prenatal vit w/ fefumarate-fa tab 27-1 mg

3

TRICARE PRENATAL – prenat w/ovit a w/ fe pyrophos-methylf chewtab 4.5-1 mg

3

TRICARE PRENATAL COMPLEAT– prenat w/o a fefum-fa tab 27-1mg & fish oil chew cap pak

3

TRICARE PRENATAL DHA ONE– prenatal w/fe fumarate-fa-dss-fish oil cap 27-1-500 mg

3

TRICARE PRENATAL DHA ONE/ –prenatal multivitamins & mineralsw/iron & fa cap 0.8 mg

3

TRINATAL RX 1 – prenatal vit w/ fefumarate-fa tab 60-1 mg

3

TRINATE – prenatal vit w/ fefumarate-fa tab 28-1 mg

3

TRISTART DHA – prenat w/oa w/fecbn-methylf-fa-dha cap31-0.6-0.4-200 mg

3

TRISTART ONE – prenat w/oa w/fecbn-methylf-fa-dha cap35-1-215 mg

3

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TRIVEEN-DUO DHA – prenat-fe bis-fe prot succ-fa-ca tab &omega 3 cap 400 pk

3

ULTIMATECARE ONE – prenatalvit w/ fe cbn-fe asp glyc-fa-omega 3 cap 27-1mg

3

VEMAVITE-PRX 2 – prenatal w/o vit a w/ fe fum-dss-fa-dha cap27-1.25-300 mg

3

VENA-BAL DHA – prenat w/fepoly-na fered-fa tab 27-1 &omega cap dr 430mg

3

VINATE DHA RF – prenat w/o aw/fefum-methylfol-omegas cap27-1.13 mg

3

VINATE II – prenatal vit w/ febisglycinate chelate-fa tab 29-1mg

3

VINATE M – prenatal vit w/ sel-fefumarate-fa tab 27-1 mg

3

VINATE ONE – prenatal vit w/ fefumarate-fa tab 60-1 mg

3

VIRT NATE – prenatal vit w/ fefumarate-fa tab 28-1 mg

3

VIRT-ADVANCE – prenatal vit w/dss-iron carbonyl-fa tab 90-1 mg

3

VIRT-C DHA – prenatal w/fe fum-fepoly -fa-omega 3 cap 53.5-38-1mg

3

VIRT-NATE DHA – prenatal vit w/fe fum-fa-omega 3 cap 28-1-200mg

3

VIRT-PN – prenatal vit w/ fe fum-methylfolate-fa tab 27-0.6-0.4 mg

3

VIRT-PN DHA – prenat w/o aw/fefum-methfol-fa-dha cap27-0.6-0.4-300 mg

3

2018




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VIRT-PN PLUS – prenat w/o aw/ fe fumerate-methylfolate-fa-omega 3 cap

3

VIRT-SELECT – prenatal w/ovit a w/ fe fum-dss-fa-dha cap29-1.25-325 mg

3

VIRT-VITE GT – prenatal vit w/dss-iron carbonyl-fa tab 90-1 mg

3

VIRTPREX – prenatal w/o vit a w/fe fum-dss-fa-dha cap 26-1.2-300mg

3

VITA-PREN – prenatal vit w/docusate-iron-fa tab 65-1 mg

3

VITAFOL FE+ – prenat-fepoly-methol-fa-dha cap 90-1-200 mg& dss 50mg cap

3

VITAFOL GUMMIES – prenat vitw/ fe phos-fa-omega chew tab3.33-0.333-34.8 mg

3

VITAFOL ULTRA – prenat w/fe poly-methylfol-fa-dha cap29-0.6-0.4-200 mg

3

VITAFOL-NANO – prenatal w/o a w/ fefum-l methylfol-fa tab18-0.6-0.4 mg

3

VITAFOL-OB – prenatal vit w/ fefumarate-fa tab 65-1 mg

3

VITAFOL-OB+DHA – prenatal mvw/fe fum-fa tab 65-1 mg & dhacap 250 mg pack

3

VITAFOL-ONE – prenatal mv w/fe polysac cmplx-fa-dha cap29-1-200 mg

3

VITAMEDMD ONE RX/QUATREFO – prenat w/o aw/fefum-methfol-fa-dha cap30-0.6-0.4-200 mg

3

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VITAMEDMD REDICHEW RX –prenat w/ b2-b6-b12-d3-folic acidchew tab 1.4 mg

3

VITAPEARL – prenat w/oa w/fefum-na fered-fa-dha cap er30-1.4-200 mg

3

VITATRUE – prenat w/o a w/fechel-fa tab 30-1.4 mg & dha cap300mg pk

3

VIVA DHA – prenatal vit w/ fe fum-fa-omega 3 cap 28-1-200 mg

3

VOL-NATE – prenatal vit w/ fefumarate-fa tab 28-1 mg

3

VOL-PLUS – prenatal vit w/ fefumarate-fa tab 27-1 mg

3

VOL-TAB RX – prenatal vit w/ ironcarbonyl-fa tab 29-1 mg

3

VP-CH-PNV – prenatal w/o vit a w/fe cbn-dss-fa-dha cap 30-1-260mg

3

VP-GGR-B6 PRENATAL – prenatalw/ calcium-vit b6-fa-ginger tab1.2 mg

3

VP-HEME OB – prenat vit-fe polycmplx-fe heme poly-fa tab 28-6-1mg

3

VP-HEME OB + DHA – prenat-fepoly cmplx-fe heme poly-fa tab &omega 3 cap pck

3

VP-HEME ONE – prenat-fe polycmplx-fe heme poly-fa-dha cap22-6-1-200 mg

3

VP-PNV-DHA – prenatal vit w/ fefum-fa-omega 3 cap 28-1-215.8mg

3

ZATEAN-PN DHA – prenat w/oa w/fefum-methfol-fa-dha cap27-0.6-0.4-300 mg

3

2018




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ZATEAN-PN PLUS – prenat w/o aw/ fe fumerate-methylfolate-fa-omega 3 cap

3

MINERALS AND ELECTROLYTESEFFER-K – potassium

bicarbonate-citric acid effer tab10 meq

3

EFFER-K – potassiumbicarbonate-citric acid effer tab20 meq

3

FLORIVA – sodium fluoride-vitamind liqd drops 0.25 mg/ml-400 unit/ml

3

FLUOR-A-DAY – sodium fluoride-xylitol chew tab 0.55 (0.25 mgf)-236.79 mg

3

FLUOR-A-DAY – sodium fluoride-xylitol chew tab 2.2 (1 mgf)-236.79 mg

3

FLUORABON – sodium fluoridesoln 0.25 mg/0.6ml (from 0.55mg/0.6ml naf)

3

FLURA-DROPS – sodium fluoridesoln 0.25 mg/drop f (from 0.55mg/drop naf)

3

GALZIN – zinc acetate cap 25 mg(elemental zinc)

3

GALZIN – zinc acetate cap 50 mg(elemental zinc)

3

K-PHOS – potassium phosphatemonobasic tab 500 mg

3

K-PHOS NEUTRAL – pot phosmonobasic w/sod phos di &monobas tab 155-852-130mg

3

K-TAB – potassium chloride tab er8 meq (600 mg)

3

K-TAB – potassium chloride tab er10 meq

3

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K-TAB – potassium chloride tab er20 meq (1500 mg)

3

KLOR-CON M15 – potassiumchloride microencapsulated cryser tab 15 meq

3

MICRO-K – potassium chloride caper 8 meq

3

MICRO-K – potassium chloride caper 10 meq

3

pot bicarbonate & chloride effertab 25 meq

1

pot phos monobasic w/sodphos di & monobas tab155-852-130mg (K-phos neutral)

1

potassium bicarbonate effer tab25 meq

1

POTASSIUM CHLORIDE –potassium chloride oral soln 20%(40 meq/15ml)

3

potassium chloride cap er 8 meq(Micro-k)

1

potassium chloride cap er 10meq (Micro-k)

1

POTASSIUM CHLORIDE ER –potassium chloride tab er 8 meq(600 mg)

3

POTASSIUM CHLORIDE ER –potassium chloride tab er 20 meq(1500 mg)

3

potassium chloridemicroencapsulated crys er tab10 meq

1

potassium chloridemicroencapsulated crys er tab20 meq

1

potassium chloride oral soln10% (20 meq/15ml)

1

2018




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potassium chloride powderpacket 20 meq

1

potassium chloride tab er 8 meq(600 mg)

1

potassium chloride tab er 10meq (K-tab)

1

SODIUM FLUORIDE – sodiumfluoride tab 0.5 mg f (from 1.1 mgnaf)

2

SODIUM FLUORIDE – sodiumfluoride tab 1 mg f (from 2.2 mgnaf)

2

sodium fluoride chew tab0.25 mg f (from 0.55 mg naf)(Luride)

1

sodium fluoride chew tab 0.5 mgf (from 1.1 mg naf) (Luride)

1

sodium fluoride chew tab 1 mg f(from 2.2 mg naf) (Luride)

1

sodium fluoride soln 0.125 mg/drop f (0.275 mg/drop naf)

1

sodium fluoride soln 0.5 mg/ml f(from 1.1 mg/ml naf) (Luride)

1

OTHER SUPPLEMENTSacetylcysteine cap 600 mg 1

LECITHIN – lecithin granules 3

NUTRESTORE – glutamine powdpack 5 gm

3

BLOOD MODIFYING DRUGSAGGRENOX – aspirin-

dipyridamole cap er 12hr 25-200mg

3

AGRYLIN – anagrelide hcl cap 0.5mg

3

AMICAR – aminocaproic acid oralsoln 0.25 gm/ml

3

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AMICAR – aminocaproic acid tab500 mg

3

AMICAR – aminocaproic acid tab1000 mg

3

anagrelide hcl cap 0.5 mg(Agrylin)

1

anagrelide hcl cap 1 mg 1

ARANESP ALBUMIN FREE –darbepoetin alfa soln prefilledsyringe 10 mcg/0.4ml

2 X •


2 X •


2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

ARANESP ALBUMIN FREE –darbepoetin alfa soln prefilledsyringe 500 mcg/ml

2 X •

ARANESP ALBUMIN FREE –darbepoetin alfa soln inj 25 mcg/ml

2 X •

2018




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2 X •


2 X •

ARANESP ALBUMIN FREE –darbepoetin alfa soln inj 100mcg/ml

2 X •


2 X •


2 X •

ARIXTRA – fondaparinux sodiumsubcutaneous inj 2.5 mg/0.5ml

3 •

ARIXTRA – fondaparinux sodiumsubcutaneous inj 5 mg/0.4ml

3 •

ARIXTRA – fondaparinux sodiumsubcutaneous inj 7.5 mg/0.6ml

3 •

ARIXTRA – fondaparinux sodiumsubcutaneous inj 10 mg/0.8ml

3 •

aspirin-dipyridamole cap er 12hr25-200 mg (Aggrenox)

1

BERINERT – c1 esterase inhibitor(human) for iv inj kit 500 unit

3 X • •

BRILINTA – ticagrelor tab 60 mg 2

BRILINTA – ticagrelor tab 90 mg 2

carbonyl iron susp 15 mg/1.25ml(elemental iron)

1

CERDELGA – eliglustat tartratecap 84 mg (base equivalent)

3 X • •

cilostazol tab 50 mg 1

cilostazol tab 100 mg 1

CINRYZE – c1 esterase inhibitor(human) for iv inj 500 unit

2 X • •

Drug Name Dru

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Ste

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clopidogrel bisulfate tab 75 mg(base equiv) (Plavix)

1

clopidogrel bisulfate tab 300 mg(base equiv) (Plavix)

1

COUMADIN – warfarin sodium tab1 mg

3


3

COUMADIN – warfarin sodium tab2.5 mg

3


3


3


3


3

COUMADIN – warfarin sodium tab7.5 mg

3


3

cyanocobalamin inj 1000 mcg/ml 1

dipyridamole tab 25 mg(Persantine)

1


1


1

DROXIA – hydroxyurea cap 200mg

2


2


2

ELIQUIS – apixaban tab 2.5 mg 2 •

2018




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ELIQUIS – apixaban tab 5 mg 2 •enoxaparin sodium inj

30 mg/0.3ml (Lovenox)1 •

enoxaparin sodium inj40 mg/0.4ml (Lovenox)

1 •


1 •


1 •

enoxaparin sodium inj 100 mg/ml (Lovenox)

1 •


1 •

enoxaparin sodium inj 150 mg/ml (Lovenox)

1 •

enoxaparin sodium inj300 mg/3ml (Lovenox)

1 •

EPOGEN – epoetin alfa inj 2000unit/ml

3 X •


3 X •


3 X •


3 X •


3 X •

FERROUS SULFATE – ferroussulfate liquid 220 mg/5ml (44mg/5ml elemental fe)

3

ferrous sulfate elixir 220 mg/5ml(44 mg/5ml elemental fe)

1

ferrous sulfate soln 75 mg/ml(15 mg/ml elemental fe)

1

FIRAZYR – icatibant acetate inj 30mg/3ml (base equivalent)

2 X • •

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folic acid tab 400 mcg 1

folic acid tab 800 mcg 1

folic acid tab 1 mg 1

FOLIVANE-F – fe fum-fe poly-fa-c-b3 cap 62.5-62.5-1-40-3mg(125mg fe)

3

fondaparinux sodiumsubcutaneous inj 2.5 mg/0.5ml(Arixtra)

1 •

fondaparinux sodiumsubcutaneous inj 5 mg/0.4ml(Arixtra)

1 •

fondaparinux sodiumsubcutaneous inj 7.5 mg/0.6ml(Arixtra)

1 •

fondaparinux sodiumsubcutaneous inj 10 mg/0.8ml(Arixtra)

1 •

FRAGMIN – dalteparin sodium inj10000 unit/ml

3 •

FRAGMIN – dalteparin sodium inj2500 unit/0.2ml

3 •


3 •


3 •


3 •


3 •


3 •


3 •

GRANIX – tbo-filgrastim solnprefilled syringe 300 mcg/0.5ml

3 X •

2018




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GRANIX – tbo-filgrastim solnprefilled syringe 480 mcg/0.8ml

3 X •

HAEGARDA – c1 esterase inhibitor(human) for subcutaneous inj2000 unit

2 X • •

HAEGARDA – c1 esterase inhibitor(human) for subcutaneous inj3000 unit

2 X • •

heparin sodium (porcine) inj5000 unit/ml

1

INTEGRA F – fe fum-fe poly-fa-c-b3 cap 62.5-62.5-1-40-3mg(125mg fe)

3

LEUKINE – sargramostimlyophilized for inj 250 mcg

3 X •

LOVENOX – enoxaparin sodium inj30 mg/0.3ml

3 •


3 •


3 •


3 •

LOVENOX – enoxaparin sodium inj100 mg/ml

3 •


3 •

LOVENOX – enoxaparin sodium inj150 mg/ml

3 •

LOVENOX – enoxaparin sodium inj300 mg/3ml

3 •

LYSTEDA – tranexamic acid tab650 mg

3

MIRCERA – methoxy peg-epoetin beta soln prefilled syr 30mcg/0.3ml

3 X •

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3 X •


3 X •

MIRCERA – methoxy peg-epoetinbeta soln prefilled syr 100mcg/0.3ml

3 X •


3 X •


3 X •

NASCOBAL – cyanocobalaminnasal spray 500 mcg/0.1ml

3 • •

NEULASTA – pegfilgrastim solnprefilled syringe 6 mg/0.6ml

2 X • •

NEUPOGEN – filgrastim solnprefilled syringe 300 mcg/0.5ml

2 X •

NEUPOGEN – filgrastim solnprefilled syringe 480 mcg/0.8ml(600 mcg/ml)

2 X •

NEUPOGEN – filgrastim inj 300mcg/ml

2 X •

NEUPOGEN – filgrastim inj 480mcg/1.6ml (300 mcg/ml)

2 X •

pentoxifylline tab er 400 mg 1

PRADAXA – dabigatran etexilatemesylate cap 75 mg (etexilatebase eq)

2 •


2 •


2 •

2018




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Ste

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prasugrel hcl tab 5 mg (baseequiv) (Effient)

1

prasugrel hcl tab 10 mg (baseequiv) (Effient)

1

PROCRIT – epoetin alfa inj 2000unit/ml

2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

PROMACTA – eltrombopagolamine tab 12.5 mg (base equiv)

3 X • •

PROMACTA – eltrombopagolamine tab 25 mg (base equiv)

3 X • •


3 X • •


3 X • •

RAPLIXA – fibrinogen-thrombinpowder 79-699 mg-unit/gm

3

RUCONEST – c1 esterase inhibitor(recombinant) for iv inj 2100 unit

3 X • •

SAVAYSA – edoxaban tosylate tab15 mg (base equivalent)

3 •


3 •


3 •

tranexamic acid tab 650 mg(Lysteda)

1

Drug Name Dru

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warfarin sodium tab 1 mg(Coumadin)

1


1

warfarin sodium tab 2.5 mg(Coumadin)

1


1


1


1


1

warfarin sodium tab 7.5 mg(Coumadin)

1


1

XARELTO – rivaroxaban tab 10 mg 2 •XARELTO – rivaroxaban tab 15 mg 2 •XARELTO – rivaroxaban tab 20 mg 2 •XARELTO STARTER PACK –

rivaroxaban tab starter therapypack 15 mg & 20 mg

2 •

ZARXIO – filgrastim-sndz solnprefilled syringe 300 mcg/0.5ml

3 X •

ZARXIO – filgrastim-sndz solnprefilled syringe 480 mcg/0.8ml

3 X •

ZAVESCA – miglustat cap 100 mg 3 X • •ZONTIVITY – vorapaxar sulfate tab

2.08 mg (base equivalent)3

COAGULATION FACTORSADVATE – antihemophilic factor

rahf-pfm for inj 250 unit2 X •

ADVATE – antihemophilic factorrahf-pfm for inj 500 unit

2 X •

2018




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2 X •


2 X •


2 X •


2 X •


2 X •

ADYNOVATE – antihemophilicfactor recomb pegylated for inj250 unit

2 X •


2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

AFSTYLA – antihemophilic factrcmb single chain for inj kit 250unit

2 X •


2 X •

Drug Name Dru

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Ste

ps


2 X •


2 X •


2 X •


2 X •


2 X •

ALPHANATE/VON WILLEBRAND– antihemophilic factor/vwf(human) for inj 250 unit

2 X •


2 X •


2 X •


2 X •


2 X •

ALPHANINE SD – coagulationfactor ix for inj 500 unit

2 X •


2 X •


2 X •

ALPROLIX – coagulation factor ix(recomb) (rfixfc) for inj 250 unit

2 X •

2018




Drug Name Dru

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2 X •


2 X •


2 X •


2 X •


2 X •

BEBULIN – factor ix complex for inj200-1200 unit

2 X •

BENEFIX – coagulation factor ix(recombinant) for inj kit 250 unit

2 X •


2 X •


2 X •


2 X •


2 X •

COAGADEX – coagulation factor x(human) for inj 250 unit

2 X •

COAGADEX – coagulation factor x(human) for inj 500 unit

2 X •

CORIFACT – factor xiii concentrate(human) for inj kit 1000-1600 unit

2 X •

ELOCTATE – antihemophilic factor(recomb) rfviiifc for inj 250 unit

2 X •


2 X •


2 X •


2 X •

Drug Name Dru

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Ste

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2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

FEIBA – antiinhibitor coagulantcomplex for inj

2 X •

HELIXATE FS – antihemophilicfactor (recombinant) for inj kit250 unit

2 X •


2 X •


2 X •


2 X •


2 X •

HEMOFIL M – antihemophilicfactor (human) for inj 250 unit

2 X •


2 X •


2 X •


2 X •

2018




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HUMATE-P – antihemophilic factor/vwf (human) for inj 250-600 unit

2 X •

HUMATE-P – antihemophilic factor/vwf (human) for inj 500-1200 unit

2 X •

HUMATE-P – antihemophilic factor/vwf (human) for inj 1000-2400unit

2 X •

IDELVION – coagulation factor ix(recomb) (rix-fp) for inj 250 unit

2 X •


2 X •


2 X •


2 X •

IXINITY – coagulation factor ix(recombinant) for inj 250 unit

2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

KOATE – antihemophilic factor(human) for inj 250 unit

2 X •


2 X •


2 X •

KOATE-DVI – antihemophilic factor(human) for inj 250 unit

2 X •


2 X •

Drug Name Dru

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Ste

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2 X •

KOGENATE FS – antihemophilicfactor (recombinant) for inj kit250 unit

2 X •


2 X •


2 X •


2 X •


2 X •

KOGENATE FS BIO-SET– antihemophilic factor(recombinant) for inj kit 250 unit

2 X •


2 X •


2 X •


2 X •


2 X •

KOVALTRY – antihemophilic factor(recombinant) for inj 250 unit

2 X •


2 X •


2 X •

2018




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2 X •


2 X •

MONOCLATE-P – antihemophilicfactor (human) for inj kit 1000unit

2 X •

MONOCLATE-P – antihemophilicfactor (human) for inj kit 1500unit

2 X •

MONONINE – coagulation factor ixfor inj 1000 unit

2 X •

NOVOEIGHT – antihemophilicfactor (recombinant) for inj 250unit

2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

NOVOSEVEN RT – coagulationfactor viia (recomb) for inj 1 mg(1000 mcg)

2 X •


2 X •

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2 X •


2 X •

NUWIQ – antihemophilic factor(bdd-rfviii) for inj 250 unit

2 X •


2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

NUWIQ – antihemophilic factor(bdd-rfviii) for inj kit 250 unit

2 X •


2 X •


2 X •


2 X •


2 X •


2 X •


2 X •

OBIZUR – antihemophilic factor(recomb porc) rpfviii for inj 500unit

2 X •

2018




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PROFILNINE – factor ix complexfor inj 500 unit

2 X •


2 X •


2 X •

PROFILNINE SD – factor ixcomplex for inj 500 unit

2 X •


2 X •


2 X •

RECOMBINATE – antihemophilicfactor (recombinant) for inj220-400 unit

2 X •


2 X •


2 X •


2 X •


2 X •

RIXUBIS – coagulation factor ix(recombinant) for inj 250 unit

2 X •


2 X •


2 X •


2 X •


2 X •

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Ste

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TRETTEN – coagulation factor xiiia-subunit for inj 2000-3125 unit

2 X •

VONVENDI – von willebrand factor(recombinant) for inj 650 unit

2 X •

VONVENDI – von willebrand factor(recombinant) for inj 1300 unit

2 X •

WILATE – antihemophilic factor/vwf(human) for inj 500-500 unit kit

2 X •

WILATE – antihemophilic factor/vwf(human) for inj 1000-1000 unit kit

2 X •

XYNTHA – antihemophilic factorrecombinant paf for inj kit 250unit

2 X •


2 X •


2 X •


2 X •

XYNTHA SOLOFUSE –antihemophilic factorrecombinant paf for inj kit 250unit

2 X •


2 X •


2 X •


2 X •

2018




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2 X •

TOPICAL PRODUCTSEYEAnti-infectivesBACITRACIN – bacitracin ophth

oint 500 unit/gm2

bacitracin-polymyxin b ophthoint

1

BESIVANCE – besifloxacin hclophth susp 0.6% (base equiv)

3

BETADINE OPHTHALMIC PREP –povidone-iodine ophth soln 5%

3

BLEPH-10 – sulfacetamide sodiumophth soln 10%

3

CILOXAN – ciprofloxacin hcl ophthsoln 0.3%

3

CILOXAN – ciprofloxacin hcl ophthoint 0.3%

3

ciprofloxacin hcl ophth soln0.3% (Ciloxan)

1

erythromycin ophth oint 5 mg/gm

1

gatifloxacin ophth soln 0.5%(Zymaxid)

1

GENTAK – gentamicin sulfateophth oint 0.3%

3

gentamicin sulfate ophth soln0.3%

1

levofloxacin ophth soln 0.5% 1

MOXEZA – moxifloxacin hcl ophthsoln 0.5% (base eq) (2 timesdaily)

3

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moxifloxacin hcl ophth soln0.5% (base equiv) (Vigamox)

1

NATACYN – natamycin ophth susp5%

2

neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt opoin

1

neomycin-polymy-gramicid opsol 1.75-10000-0.025mg-unt-mg/ml (Neosporin)

1

NEOSPORIN – neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml

3

OCUFLOX – ofloxacin ophth soln0.3%

3

ofloxacin ophth soln 0.3%(Ocuflox)

1

polymyxin b-trimethoprimophth soln 10000 unit/ml-0.1%(Polytrim)

1

POLYTRIM – polymyxin b-trimethoprim ophth soln 10000unit/ml-0.1%

3

SULFACETAMIDE SODIUM –sulfacetamide sodium ophth oint10%

3

sulfacetamide sodium ophthsoln 10% (Bleph-10)

1

tobramycin ophth soln 0.3%(Tobrex)

1

TOBREX – tobramycin ophth soln0.3%

3

TOBREX – tobramycin ophth oint0.3%

3

trifluridine ophth soln 1%(Viroptic)

1

2018




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VIGAMOX – moxifloxacin hcl ophthsoln 0.5% (base equiv)

3

VIROPTIC – trifluridine ophth soln1%

3

ZIRGAN – ganciclovir ophth gel0.15%

3

ZYMAXID – gatifloxacin ophth soln0.5%

3

Steroids and Combination ProductsALREX – loteprednol etabonate

ophth susp 0.2%3

bacitracin-polymyxin-neomycin-hc ophth oint 1%

1

BLEPHAMIDE – sulfacetamidesodium-prednisolone ophth susp10-0.2%

2

BLEPHAMIDE S.O.P. –sulfacetamide sodium-prednisolone ophth oint 10-0.2%

2

DEXAMETHASONE SODIUMPHOS – dexamethasone sodiumphosphate ophth soln 0.1%

3

DUREZOL – difluprednate ophthemulsion 0.05%

3

FLAREX – fluorometholone acetateophth susp 0.1%

3

fluorometholone ophth susp0.1% (Fml liquifilm)

1

FML – fluorometholone ophth oint0.1%

3

FML FORTE – fluorometholoneophth susp 0.25%

3

FML LIQUIFILM – fluorometholoneophth susp 0.1%

3

LOTEMAX – loteprednol etabonateophth gel 0.5%

2

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LOTEMAX – loteprednol etabonateophth oint 0.5%

2

LOTEMAX – loteprednol etabonateophth susp 0.5%

2

MAXIDEX – dexamethasone ophthsusp 0.1%

3

MAXITROL – neomycin-polymyxin-dexamethasone ophth susp 0.1%

3

MAXITROL – neomycin-polymyxin-dexamethasone ophth oint 0.1%

3

neomycin-polymyxin-dexamethasone ophth oint0.1% (Maxitrol)

1

neomycin-polymyxin-dexamethasone ophth susp0.1% (Maxitrol)

1

NEOMYCIN/POLYMYXIN/HYDROC – neomycin-polymyxin-hc ophth susp

3

OMNIPRED – prednisoloneacetate ophth susp 1%

3

PRED FORTE – prednisoloneacetate ophth susp 1%

3

PRED MILD – prednisoloneacetate ophth susp 0.12%

3

PRED-G – gentamicin-prednisolone ace ophth susp0.3-1%

3

PRED-G S.O.P. – gentamicin-prednisolone ace ophth oint0.3-0.6%

3

prednisolone acetate ophth susp1% (Pred forte)

1

PREDNISOLONE SODIUMPHOSP – prednisolone sodiumphosphate ophth soln 1%

3

2018




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sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%

1

TOBRADEX – tobramycin-dexamethasone ophth oint0.3-0.1%

2

TOBRADEX – tobramycin-dexamethasone ophth susp0.3-0.1%

3

TOBRADEX ST – tobramycin-dexamethasone ophth susp0.3-0.05%

3

tobramycin-dexamethasoneophth susp 0.3-0.1% (Tobradex)

1

GlaucomaALPHAGAN P – brimonidine

tartrate ophth soln 0.1%2

ALPHAGAN P – brimonidinetartrate ophth soln 0.15%

3

apraclonidine hcl ophth soln0.5% (base equivalent)(Iopidine)

1

AZOPT – brinzolamide ophth susp1%

3

BETAGAN – levobunolol hcl ophthsoln 0.5%

3

betaxolol hcl ophth soln 0.5% 1

BETIMOL – timolol ophth soln0.25%

3

BETIMOL – timolol ophth soln0.5%

3

BIMATOPROST – bimatoprostophth soln 0.03%

3 •

brimonidine tartrate ophth soln0.15% (Alphagan p)

1

brimonidine tartrate ophth soln0.2%

1

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carteolol hcl ophth soln 1% 1

COMBIGAN – brimonidine tartrate-timolol maleate ophth soln0.2-0.5%

3

COSOPT – dorzolamide hcl-timololmaleate ophth soln 22.3-6.8 mg/ml

3

COSOPT PF – dorzolamidehcl-timolol maleate ophth sol22.3-6.8 mg/ml pf

3

dorzolamide hcl ophth soln 2%(Trusopt)

1

dorzolamide hcl-timolol maleateophth soln 22.3-6.8 mg/ml(Cosopt)

1

IOPIDINE – apraclonidinehcl ophth soln 0.5% (baseequivalent)

3

IOPIDINE – apraclonidine hclophth soln 1% (base equivalent)

3

ISOPTO CARPINE – pilocarpinehcl ophth soln 1%

3


3


3

latanoprost ophth soln 0.005%(Xalatan)

1 •

levobunolol hcl ophth soln 0.5%(Betagan)

1

LUMIGAN – bimatoprost ophthsoln 0.01%

2 •

METIPRANOLOL – metipranololophth soln 0.3%

3

PHOSPHOLINE IODIDE –echothiophate iodide ophth forsoln 0.125%

3

2018




Drug Name Dru

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pilocarpine hcl ophth soln 1%(Isopto carpine)

1


1


1

RESCULA – unoprostone isopropylophth soln 0.15%

3 •

SIMBRINZA – brinzolamide-brimonidine tartrate ophth susp1-0.2%

3

timolol maleate ophth gelforming soln 0.25% (Timoptic-xe)

1

timolol maleate ophth gelforming soln 0.5% (Timoptic-xe)

1

timolol maleate ophth soln0.25% (Timoptic)

1

timolol maleate ophth soln 0.5%(Timoptic)

1

TIMOPTIC – timolol maleate ophthsoln 0.25%

3

TIMOPTIC – timolol maleate ophthsoln 0.5%

3

TIMOPTIC OCUDOSE – timololmaleate preservative free ophthsoln 0.25%

3

TIMOPTIC OCUDOSE – timololmaleate preservative free ophthsoln 0.5%

3

TIMOPTIC-XE – timolol maleateophth gel forming soln 0.25%

3

TIMOPTIC-XE – timolol maleateophth gel forming soln 0.5%

3

TRAVATAN Z – travoprost ophthsoln 0.004% (benzalkonium free)(bak free)

2 •

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TRUSOPT – dorzolamide hcl ophthsoln 2%

3

XALATAN – latanoprost ophth soln0.005%

3 •

ZIOPTAN – tafluprost ophth soln0.0015%

3 •

Other Eye ProductsACULAR – ketorolac tromethamine

ophth soln 0.5%3

ACULAR LS – ketorolactromethamine ophth soln 0.4%

3

AKTEN – lidocaine hcl ophth gel3.5%

3

ALOCRIL – nedocromil sodiumophth soln 2%

3

ALOMIDE – lodoxamidetromethamine ophth soln 0.1%

3

ATROPINE SULFATE – atropinesulfate ophth soln 1%

3

ATROPINE SULFATE – atropinesulfate ophth oint 1%

2

azelastine hcl ophth soln 0.05% 1

BEPREVE – bepotastine besilateophth soln 1.5%

3

BROMFENAC – bromfenac sodiumophth soln 0.09% (base equiv)(once-daily)

3

cromolyn sodium ophth soln 4% 1

CYCLOGYL – cyclopentolate hclophth soln 0.5%

3

CYCLOGYL – cyclopentolate hclophth soln 1%

3

CYCLOGYL – cyclopentolate hclophth soln 2%

3

2018




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CYCLOMYDRIL – cyclopentolatew/ phenylephrine ophth soln0.2-1%

3

cyclopentolate hcl ophth soln0.5% (Cyclogyl)

1

cyclopentolate hcl ophth soln1% (Cyclogyl)

1

cyclopentolate hcl ophth soln2% (Cyclogyl)

1

CYSTARAN – cysteaminehcl ophth soln 0.44% (baseequivalent)

3 X •

diclofenac sodium ophth soln0.1%

1

ELESTAT – epinastine hcl ophthsoln 0.05%

3

EMADINE – emedastinedifumarate ophth soln 0.05%(base equiv)

3

epinastine hcl ophth soln 0.05%(Elestat)

1

FLURBIPROFEN SODIUM –flurbiprofen sodium ophth soln0.03%

3

homatropine hbr ophth soln 5%(Isopto homatropine)

1

ILEVRO – nepafenac ophth susp0.3%

2

ketorolac tromethamine ophthsoln 0.4% (Acular ls)

1

ketorolac tromethamine ophthsoln 0.5% (Acular)

1

LACRISERT – artificial tear ophthinsert

3

LASTACAFT – alcaftadine ophthsoln 0.25%

3

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MYDRIACYL – tropicamide ophthsoln 1%

3

olopatadine hcl ophth soln 0.1%(base equivalent) (Patanol)

1

olopatadine hcl ophth soln 0.2%(base equivalent) (Pataday)

1

PATADAY – olopatadine hcl ophthsoln 0.2% (base equivalent)

3

PAZEO – olopatadine hcl ophthsoln 0.7% (base equivalent)

2

phenylephrine hcl ophth soln2.5%

1

phenylephrine hcl ophth soln10%

1

PHOTREXA VISCOUS – riboflavin5-phos sod-dextran ophth solnpref syr 0.146-20%

3

PHOTREXA/PHOTREXAVISCOUS – riboflav 0.146% &riboflav-dextran 0.146-20% opsol pref syr

3

PROLENSA – bromfenac sodiumophth soln 0.07% (baseequivalent)

3

proparacaine hcl ophth soln0.5% (Alcaine)

1

RESTASIS – cyclosporine (ophth)emulsion 0.05%

3 • •

RESTASIS MULTIDOSE –cyclosporine (ophth) emulsion0.05%

3 • •

tetracaine hcl ophth soln 0.5% 1

tropicamide ophth soln 0.5% 1

tropicamide ophth soln 1%(Mydriacyl)

1

XIIDRA – lifitegrast ophth soln 5% 3 • •EAR

2018




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Ste

ps

acetic acid otic soln 2% 1

CETRAXAL – ciprofloxacin hcl oticsoln 0.2% (base equivalent)

3

CIPRO HC – ciprofloxacin-hydrocortisone otic susp 0.2-1%

3

CIPRODEX – ciprofloxacin-dexamethasone otic susp0.3-0.1%

2

CIPROFLOXACIN – ciprofloxacinhcl otic soln 0.2% (baseequivalent)

3

COLY-MYCIN S – neomycin-colistin-hc-thonzonium otic susp3.3-3-10-0.5 mg/ml

3

DERMOTIC – fluocinoloneacetonide (otic) oil 0.01%

3

FLOXIN OTIC – ofloxacin otic soln0.3%

3

fluocinolone acetonide (otic) oil0.01% (Dermotic)

1

hydrocortisone w/ acetic acidotic soln 1-2%

1

neomycin-polymyxin-hc oticsoln 1%

1

neomycin-polymyxin-hc oticsusp 3.5 mg/ml-10000 unit/ml-1%

1

ofloxacin otic soln 0.3% 1

OTOVEL – ciprofloxacin-fluocinolone aceton (pf) otic soln0.3-0.025%

3

MOUTH AND THROAT (LOCAL)benzocaine mouth/throat aerosol

20%1

cevimeline hcl cap 30 mg(Evoxac)

1

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chlorhexidine gluconate soln0.12% (Peridex)

1

clotrimazole troche 10 mg 1

EVOXAC – cevimeline hcl cap 30mg

3

LIDOCAINE HCL – lidocaine hcllaryngotracheal soln 4%

3

lidocaine hcl viscous soln 2% 1

nystatin susp 100000 unit/ml 1

ORAVIG – miconazole buccal tab50 mg (mouth-throat)

3

PERIDEX – chlorhexidinegluconate soln 0.12%

3

pilocarpine hcl tab 5 mg(Salagen)

1

pilocarpine hcl tab 7.5 mg(Salagen)

1

SALAGEN – pilocarpine hcl tab 5mg

3

SALAGEN – pilocarpine hcl tab 7.5mg

3

sodium fluoride cream 1.1%(Prevident 5000 plus)

1

sodium fluoride gel 1.1% (0.5% f)(Prevident fluoride)

1

sodium fluoride paste 1.1%(Prevident 5000 boost)

1

sodium fluoride rinse 0.2% 1

sodium fluoride-potassiumnitrate paste 1.1-5% (Prevident5000 sensi)

1

stannous fluoride gel 0.4% 1

triamcinolone acetonide dentalpaste 0.1%

1

ANORECTAL AGENTS

2018




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ANALPRAM HC – hydrocortisoneacetate w/ pramoxine rectalcream 2.5-1%

3

ANALPRAM HC SINGLES –hydrocortisone acetate w/pramoxine rectal cream 2.5-1%

3

ANALPRAM-HC – hydrocortisoneacetate w/ pramoxine rectal lotn2.5-1%

3

ANALPRAM-HC – hydrocortisoneacetate w/ pramoxine rectalcream 1-1%

3

ANUSOL-HC – hydrocortisonerectal cream 2.5%

3

CORTENEMA – hydrocortisoneenema 100 mg/60ml

3

CORTIFOAM – hydrocortisoneacetate rectal foam 10% (90 mg/dose)

2

hydrocortisone acetate suppos25 mg

1

hydrocortisone acetate w/pramoxine rectal cream 1-1%(Analpram-hc singles)

1

hydrocortisone acetate w/pramoxine rectal cream 2.5-1%(Analpram-hc singles)

1

hydrocortisone enema100 mg/60ml (Cortenema)

1

hydrocortisone rectal cream 1%(Proctocort)

1

hydrocortisone rectal cream2.5% (Anusol-hc)

1

LIDOCAINE HCL-HYDROCORTIS– lidocaine-hydrocortisoneacetate rectal gel 2.8-0.55%

3

PROCTOCORT – hydrocortisonerectal cream 1%

3

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PROCTOFOAM HC –hydrocortisone acetate w/pramoxine rectal foam 1-1%

2

RECTIV – nitroglycerin oint 0.4% 3

UCERIS – budesonide rectal foam2 mg/act

3

SKIN CONDITIONS/PRODUCTSAcneACANYA – clindamycin phosphate-

benzoyl peroxide gel 1.2-2.5%3

adapalene cream 0.1%* (Differin) 1

adapalene gel 0.1%* (Differin) 1

adapalene gel 0.3%* (Differin) 1

adapalene-benzoyl peroxide gel0.1-2.5%* (Epiduo)

1

AVAR – sulfacetamide sodium w/sulfur foam 9.5-5%

3

AVAR LS – sulfacetamide sodiumw/ sulfur foam 10-2%

3

AZELEX – azelaic acid cream 20% 3

BENZAC AC WASH – benzoylperoxide liq 5%

3

BENZAMYCIN – benzoyl peroxide-erythromycin gel 5-3%

3

BENZIQ – benzoyl peroxide gel5.25 %

3

BENZIQ LS – benzoyl peroxide gel2.75%

3

BENZIQ WASH – benzoyl peroxideliq 5.25%

3

BENZOLYL PEROXIDE FORTE- –benzoyl peroxide-hydrocortisonelotion 7.5-1%

3

BENZOYL PEROXIDE – benzoylperoxide gel 6.5%

3

2018




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benzoyl peroxide liq 10% 1

benzoyl peroxide lotion 6% 1

benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)

1

BP CLEANSING WASH –sulfacetamide sodium-sulfur inurea emulsion 10-4%

3

CLEOCIN-T – clindamycinphosphate soln 1%

3

CLEOCIN-T – clindamycinphosphate lotion 1%

3

CLEOCIN-T – clindamycinphosphate swab 1%

3

clindamycin phosph-benzoylperoxide (refrig) gel 1.2 (1)-5%(Duac)

1

clindamycin phosphate gel 1%(Cleocin-t)

1

clindamycin phosphate lotion1% (Cleocin-t)

1

clindamycin phosphate soln 1%(Cleocin-t)

1

clindamycin phosphate swab 1%(Cleocin-t)

1

clindamycin phosphate-benzoylperoxide gel 1-5% (Benzaclin)

1

dapsone gel 5% (Aczone) 1

DUAC – clindamycin phosph-benzoyl peroxide (refrig) gel 1.2(1)-5%

3

EPIDUO FORTE* – adapalene-benzoyl peroxide gel 0.3-2.5%

3

EPIDUO* – adapalene-benzoylperoxide gel 0.1-2.5%

3

ERYGEL – erythromycin gel 2% 3

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erythromycin gel 2% (Erygel) 1

erythromycin pads 2% 1

erythromycin soln 2% 1

FINACEA – azelaic acid foam 15% 2

FINACEA – azelaic acid gel 15% 2

isotretinoin cap 10 mg –amnesteem, claravis,myorisan, zenatane

1


1

isotretinoin cap 30 mg – claravis,myorisan, zenatane

1


1

KLARON – sulfacetamide sodiumlotion 10% (acne)

3

METROCREAM – metronidazolecream 0.75%

3

METROGEL – metronidazole gel1%

3

METROLOTION – metronidazolelotion 0.75%

3

metronidazole cream 0.75%(Metrocream)

1

metronidazole gel 0.75% 1

metronidazole gel 1% (Metrogel) 1

metronidazole lotion 0.75%(Metrolotion)

1

RETIN-A* – tretinoin cream0.025%

3

RETIN-A* – tretinoin cream 0.05% 3

RETIN-A* – tretinoin cream 0.1% 3

RETIN-A* – tretinoin gel 0.01% 3

2018




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RETIN-A* – tretinoin gel 0.025% 3

SOOLANTRA – ivermectin cream1%

2

sulfacetamide sodium lotion10% (acne) (Klaron)

1

tazarotene cream 0.1%* (Tazorac) 1 •TAZORAC* – tazarotene cream

0.05%2 •

TAZORAC* – tazarotene cream0.1%

3 •

TAZORAC* – tazarotene gel 0.05% 2 •TAZORAC* – tazarotene gel 0.1% 2 •tretinoin cream 0.025%* (Retin-a) 1

tretinoin cream 0.05%* (Retin-a) 1

tretinoin cream 0.1%* (Retin-a) 1

tretinoin gel 0.01%* (Retin-a) 1

tretinoin gel 0.025%* (Retin-a) 1

tretinoin gel 0.05%* (Atralin) 1

ZACLIR CLEANSING – benzoylperoxide lotion 8%

3

Anti-infectivesacyclovir oint 5% (Zovirax) 1

ALTABAX – retapamulin oint 1% 3

BACTROBAN – mupirocin calciumcream 2%

3

CENTANY – mupirocin oint 2% 3

ciclopirox gel 0.77% 1

ciclopirox olamine cream 0.77%(base equiv)

1

ciclopirox olamine susp 0.77%(base equiv)

1

ciclopirox shampoo 1% (Loproxshampoo)

1

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ciclopirox solution 8% (Penlacnail lacquer)

1

clotrimazole cream 1% 1

clotrimazole soln 1% 1

clotrimazole w/ betamethasonecream 1-0.05% (Lotrisone)

1

clotrimazole w/ betamethasonelotion 1-0.05%

1

CORTISPORIN – neomycin-polymyxin-hc crm 3.5 mg/gm-10000 unt/gm-0.5%

3

CORTISPORIN – bacitracin-polymyxin-neomycin hc oint 1%

3

DENAVIR – penciclovir cream 1% 3

diclofenac sodium gel 1%(Voltaren)

1 •

diclofenac sodium soln 1.5% 1 • •econazole nitrate cream 1% 1

ERTACZO – sertaconazole nitratecream 2%

3

EXELDERM – sulconazole nitratesolution 1%

3

EXELDERM – sulconazole nitratecream 1%

3

GENTAMICIN SULFATE –gentamicin sulfate oint 0.1%

3

gentamicin sulfate cream 0.1% 1

GORDOFILM – salicylic & lacticacids soln 16.7-16.7%

3

HALOTIN – haloprogin cream 1% 3

iodoquinol-hc cream 1% 1

KERALYT – salicylic acid gel 6% 3

ketoconazole cream 2% 1

ketoconazole shampoo 2%(Nizoral)

1

2018




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ps

LOPROX – ciclopirox olamine susp0.77% (base equiv)

3

LOPROX – ciclopirox olaminecream 0.77% (base equiv)

3

LOTRISONE – clotrimazole w/betamethasone cream 1-0.05%

3

mafenide acetate packet fortopical soln 5% (50 gm)(Sulfamylon)

1

MENTAX – butenafine hcl cream1%

3

mupirocin calcium cream 2%(Bactroban)

1

mupirocin oint 2% 1

NEO-SYNALAR – neomycinsulfate-fluocinolone acetonidecream 0.5-0.025%

3

NIZORAL – ketoconazole shampoo2%

3

nystatin cream 100000 unit/gm 1

nystatin oint 100000 unit/gm 1

nystatin topical powder 100000unit/gm

1

oxiconazole nitrate cream 1%(Oxistat)

1

OXISTAT – oxiconazole nitratecream 1%

3

OXISTAT – oxiconazole nitratelotion 1%

3

PYROGALLIC ACID – pyrogallol-chlorobutanol oint 25-2%

3

SALEX – salicylic acid shampoo6%

3

salicylic acid cream 6% 1

salicylic acid gel 6% (Keralyt) 1

salicylic acid lotion 6% 1

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salicylic acid shampoo 6%(Salex)

1

salicylic acid soln 26% 1

SALIMEZ FORTE – salicylic acidcream 10%

3

SILVADENE – silver sulfadiazinecream 1%

3

silver sulfadiazine cream 1%(Silvadene)

1

SULFAMYLON – mafenide acetatepacket for topical soln 5% (50gm)

3

SULFAMYLON – mafenide acetatecream 85 mg/gm

3

VOLTAREN – diclofenac sodiumgel 1%

3 •

XALIX – salicylic acid er film-forming soln 28%

3

CorticosteroidsALA SCALP – hydrocortisone

lotion 2%3

alclometasone dipropionatecream 0.05% (Aclovate)

1

alclometasone dipropionate oint0.05%

1

AMCINONIDE – amcinonide cream0.1%

3

AMCINONIDE – amcinonide lotion0.1%

3

AMCINONIDE – amcinonide oint0.1%

3

betamethasone dipropionateaugmented cream 0.05%(Diprolene af)

1

betamethasone dipropionateaugmented gel 0.05%

1

2018




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pons

ible

Ste

ps

betamethasone dipropionateaugmented lotion 0.05%(Diprolene)

1

betamethasone dipropionateaugmented oint 0.05%(Diprolene)

1

betamethasone dipropionatecream 0.05%

1

betamethasone dipropionatelotion 0.05%

1

betamethasone dipropionateoint 0.05%

1

betamethasone valerate aerosolfoam 0.12% (Luxiq)

1

betamethasone valerate cream0.1% (base equivalent)

1

betamethasone valerate lotion0.1% (base equivalent)

1

betamethasone valerate oint0.1% (base equivalent)

1

calcipotriene-betamethasonedipropionate oint 0.005-0.064%(Taclonex)

1 •

CAPEX – fluocinolone acetonideshampoo 0.01%

2

clobetasol propionate cream0.05% (Temovate)

1

clobetasol propionate emollientbase cream 0.05% (Temovate e)

1

clobetasol propionate emulsionfoam 0.05% (Olux-e)

1

clobetasol propionate foam0.05% (Olux)

1

clobetasol propionate gel 0.05%(Temovate)

1

clobetasol propionate lotion0.05% (Clobex)

1

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ible

Ste

ps

clobetasol propionate oint 0.05%(Temovate)

1

clobetasol propionate shampoo0.05% (Clobex)

1

clobetasol propionate soln0.05% (Temovate)

1

clobetasol propionate spray0.05% (Clobex)

1

CLOBEX – clobetasol propionatelotion 0.05%

3

CLOBEX – clobetasol propionateshampoo 0.05%

3

CLOCORTOLONE PIVALATE –clocortolone pivalate cream 0.1%

3 •

CLOCORTOLONE PIVALATEPUM – clocortolone pivalatecream 0.1%

3 •

CLODERM – clocortolone pivalatecream 0.1%

3 •

CLODERM PUMP – clocortolonepivalate cream 0.1%

3 •

CORDRAN – flurandrenolide tape4 mcg/sqcm

3 •

CORTANE-B – hydrocortisone-pramoxine-chloroxylenol lot10-10-1mg/ml

3

DERMA-SMOOTHE/FS BODY –fluocinolone acetonide oil 0.01%(body oil)

3

DERMA-SMOOTHE/FS SCALP –fluocinolone acetonide oil 0.01%(scalp oil)

3

DERMATOP – prednicarbatecream 0.1%

3

DERMATOP – prednicarbate oint0.1%

3

2018




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desonide cream 0.05%(Desowen)

1

desonide lotion 0.05% (Desowen) 1

desonide oint 0.05% 1

DESOWEN – desonide lotion0.05%

3 •

DESOWEN – desonide cream0.05%

3 •

desoximetasone cream 0.05%(Topicort)

1

desoximetasone cream 0.25%(Topicort)

1

desoximetasone gel 0.05%(Topicort)

1

desoximetasone oint 0.05%(Topicort)

1

desoximetasone oint 0.25%(Topicort)

1

DIFLORASONE DIACETATE –diflorasone diacetate oint 0.05%

3

DIFLORASONE DIACETATE –diflorasone diacetate cream0.05%

3

DIPROLENE – betamethasonedipropionate augmented lotion0.05%

3

DIPROLENE – betamethasonedipropionate augmented oint0.05%

3

DIPROLENE AF – betamethasonedipropionate augmented cream0.05%

3

ELOCON – mometasone furoatecream 0.1%

3

ELOCON – mometasone furoateoint 0.1%

3

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EPIFOAM – pramoxine-hc aerosolfoam 1-1%

3

fluocinolone acetonide cream0.01%

1

fluocinolone acetonide cream0.025% (Synalar)

1

fluocinolone acetonide oil 0.01%(body oil) (Derma-smoothe/fsbod)

1

fluocinolone acetonide oil 0.01%(scalp oil) (Derma-smoothe/fssca)

1

fluocinolone acetonide oint0.025% (Synalar)

1

fluocinolone acetonide soln0.01% (Synalar)

1

fluocinonide cream 0.05% 1

fluocinonide emulsified basecream 0.05%

1

fluocinonide gel 0.05% 1

fluocinonide oint 0.05% 1

fluocinonide soln 0.05% 1

fluticasone propionate cream0.05% (Cutivate)

1

fluticasone propionate oint0.005%

1

halobetasol propionate cream0.05% (Ultravate)

1

halobetasol propionate oint0.05% (Ultravate)

1

HALOG – halcinonide oint 0.1% 3 •hydrocortisone butyrate cream

0.1% (Locoid)1

hydrocortisone butyrate oint0.1% (Locoid)

1

2018




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hydrocortisone butyrate soln0.1% (Locoid)

1

hydrocortisone cream 1% 1

hydrocortisone cream 2.5% 1

hydrocortisone lotion 2% (Alascalp)

1

hydrocortisone lotion 2.5% 1

hydrocortisone oint 1% 1

hydrocortisone oint 2.5% 1

hydrocortisone valerate cream0.2%

1

hydrocortisone valerate oint0.2% (Westcort)

1

LOCOID – hydrocortisone butyratesoln 0.1%

3 •

LOCOID – hydrocortisone butyrateoint 0.1%

3 •

LUXIQ – betamethasone valerateaerosol foam 0.12%

3 •

mometasone furoate cream 0.1%(Elocon)

1

mometasone furoate oint 0.1%(Elocon)

1

mometasone furoate solution0.1% (lotion) (Elocon)

1

NUCORT – hydrocortisone acetatelotion 2%

3

nystatin-triamcinolone cream100000-0.1 unit/gm-%

1

nystatin-triamcinolone oint100000-0.1 unit/gm-%

1

PRAMOSONE – pramoxine-hc oint1-2.5%

3

prednicarbate cream 0.1%(Dermatop)

1

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prednicarbate oint 0.1%(Dermatop)

1

PSORCON – diflorasone diacetatecream 0.05%

3

SYNALAR – fluocinolone acetonidesoln 0.01%

3

SYNALAR – fluocinolone acetonidecream 0.025%

3

SYNALAR – fluocinolone acetonideoint 0.025%

3

TEMOVATE – clobetasolpropionate soln 0.05%

3

TEMOVATE – clobetasolpropionate cream 0.05%

3

TEMOVATE – clobetasolpropionate gel 0.05%

3

TEMOVATE – clobetasolpropionate oint 0.05%

3

TOPICORT – desoximetasonecream 0.25%

3

TOPICORT – desoximetasone gel0.05%

3

TOPICORT – desoximetasone oint0.25%

3

triamcinolone acetonide aerosolsoln 0.147 mg/gm (Kenalog)

1

triamcinolone acetonide cream0.025%

1


1


1

triamcinolone acetonide lotion0.025%

1

triamcinolone acetonide lotion0.1%

1

2018




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triamcinolone acetonide oint0.025%

1


1


1

TRIDESILON – desonide cream0.05%

3 •

ULTRAVATE – halobetasolpropionate cream 0.05%

3

ULTRAVATE – halobetasolpropionate oint 0.05%

3

WESTCORT – hydrocortisonevalerate oint 0.2%

3

Other Skin Productsacitretin cap 10 mg (Soriatane) 1

acitretin cap 17.5 mg (Soriatane) 1

acitretin cap 25 mg (Soriatane) 1

ARZOL SILVER NITRATE APP –silver nitrate-potassium nitrateapplicator 75-25%

3

calcipotriene cream 0.005%(Dovonex)

1 •

calcipotriene oint 0.005% 1 •calcipotriene soln 0.005%

(50 mcg/ml)1 •

CALCITRIOL – calcitriol oint 3mcg/gm

3 •

CARAC – fluorouracil cream 0.5% 2

CONDYLOX – podofilox gel 0.5% 2

COSENTYX – secukinumabsubcutaneous soln prefilledsyringe 150 mg/ml

2 X • •

COSENTYX SENSOREADY PEN– secukinumab subcutaneoussoln auto-injector 150 mg/ml

2 X • •

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DOVONEX – calcipotriene cream0.005%

3 •

DOXEPIN HYDROCHLORIDE –doxepin hcl cream 5%

3 • •

DUPIXENT – dupilumabsubcutaneous soln prefilledsyringe 300 mg/2ml

3 X • •

EFUDEX – fluorouracil cream 5% 3

ELIDEL – pimecrolimus cream 1% 3 •ELIMITE – permethrin cream 5% 3

ESSENTRA WIPES 9X9" CLEAN– isopropyl alcohol wipes 70%

3

EUCRISA – crisaborole oint 2% 3 •EURAX – crotamiton cream 10% 3

EURAX – crotamiton lotion 10% 3

FLUOROPLEX – fluorouracilcream 1%

3

FLUOROURACIL – fluorouracilsoln 2%

3

FLUOROURACIL – fluorouracilsoln 5%

3

fluorouracil cream 5% (Efudex) 1

imiquimod cream 5% (Aldara) 1

LAC-HYDRIN – lactic acid(ammonium lactate) cream 12%

3

LAC-HYDRIN – lactic acid(ammonium lactate) lotion 12%

3

lactic acid (ammonium lactate)cream 12% (Lac-hydrin)

1

lactic acid (ammonium lactate)lotion 12% (Lac-hydrin)

1

LEVULAN KERASTICK –aminolevulinic acid hcl for soln20% (stick applicator)

3

lidocaine hcl gel 2% 1

2018




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lidocaine hcl soln 4% (Xylocaine) 1

lidocaine patch 5% (Lidoderm) 1 • •lidocaine-prilocaine cream

2.5-2.5%1

LIDODERM – lidocaine patch 5% 3 • •LINDANE – lindane shampoo 1% 3

malathion lotion 0.5% (Ovide) 1

methoxsalen rapid cap 10 mg(Oxsoralen ultra)

1

NATROBA – spinosad susp 0.9% 3

OVIDE – malathion lotion 0.5% 3

OXSORALEN ULTRA –methoxsalen rapid cap 10 mg

3

PANRETIN – alitretinoin gel 0.1% 3

permethrin cream 5% (Elimite) 1

PICATO – ingenol mebutate gel0.015%

2 •

PICATO – ingenol mebutate gel0.05%

2 •

podofilox soln 0.5% (Condylox) 1

PROTOPIC – tacrolimus oint0.03%

3 •

PROTOPIC – tacrolimus oint 0.1% 3 •PRUDOXIN – doxepin hcl cream

5%3 • •

REGENECARE – lidocaine hcl-collagen-aloe vera gel 2%

3

REGRANEX – becaplermin gel0.01%

3

SANTYL – collagenase oint 250unit/gm

2

selenium sulfide lotion 2.5% 1

selenium sulfide-pyrithione zincin urea shampoo 2.25%

1

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SILVER NITRATE – silver nitrateoint 10%

3

SILVER NITRATE – silver nitratesoln 0.5%

3

SILVER NITRATE – silver nitratesoln 10%

3


3


3

SKLICE – ivermectin lotion 0.5% 3

SODIUM SULFACETAMIDEWASH – sulfacetamide sodium inbakuchiol vehicle wash 10%

3

SORIATANE – acitretin cap 10 mg 3

SORIATANE – acitretin cap 17.5mg

3

SORIATANE – acitretin cap 25 mg 3

SPINOSAD – spinosad susp 0.9% 3

STELARA – ustekinumab inj 45mg/0.5ml

2 X • •

STELARA – ustekinumab solnprefilled syringe 45 mg/0.5ml

2 X • •

STELARA – ustekinumab solnprefilled syringe 90 mg/ml

2 X • •

SYNERA – lidocaine-tetracainetopical patch 70-70 mg

3 • •

tacrolimus oint 0.03% (Protopic) 1 •tacrolimus oint 0.1% (Protopic) 1 •TALTZ – ixekizumab subcutaneous

soln auto-injector 80 mg/ml3 X • •

TALTZ – ixekizumab subcutaneoussoln prefilled syringe 80 mg/ml

3 X • •

TARGRETIN – bexarotene gel 1% 3 X •TOLAK – fluorouracil cream 4% 3

2018




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ULESFIA – benzyl alcohol lotion5%

3

URAMAXIN – urea in ammoniumlactate vehicle foam 20%

3

VALCHLOR – mechlorethamine hclgel 0.016% (base equivalent)

2 X

VECTICAL – calcitriol oint 3 mcg/gm

3 •

XYLOCAINE – lidocaine hcl soln4%

3

ZONALON – doxepin hcl cream5%

3 • •

MISCELLANEOUS CATEGORIESDIABETIC SUPPLIESBAYER BREEZE 2 BLOOD GLUC

– blood glucose monitoring kit w/device

2

BAYER BREEZE 2 TEST DISC –glucose blood test disk

2 •

BAYER CONTOUR BLOODGLUCO – glucose blood teststrip

2 •

BAYER CONTOUR BLOODGLUCO – blood glucosemonitoring devices

2

BAYER CONTOUR BLOODGLUCO – blood glucosemonitoring kit w/ device

2

BAYER CONTOUR LINK BLOOD– blood glucose monitoring kit w/device

2

BAYER CONTOUR NEXT BLOOD– glucose blood test strip

2 •

BAYER CONTOUR NEXT BLOOD– blood glucose monitoring kit w/device

2

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BAYER CONTOUR NEXT EZ BLO– blood glucose monitoring kit w/device

2

BAYER CONTOUR NEXT LINK B– blood glucose monitoring kit w/device

2

BAYER CONTOUR NEXT LINK W– blood glucose monitoring kit w/device

2

BLOOD GLUCOSE MONITORINGDEVICES – VARIOUSMANUFACTURERS

3

BLOOD GLUCOSE MONITORINGKIT W/ DEVICE – VARIOUSMANUFACTURERS

3

CONTOUR NEXT ONE BLOODGL – blood glucose monitoring kit

2

GLUCAGEN DIAGNOSTIC –glucagon hcl (rdna) diagnostic forinj 1 mg (base equiv)

3

INSULIN PEN NEEDLES –NOVOFINE, NOVOTWIST,OTHER VARIOUSMANUFACTURERS

2

LANCET DEVICES – VARIOUSMANUFACTURERS

2

LANCETS – VARIOUSMANUFACTURERS

2

SYRINGES/NEEDLES – VARIOUSMANUFACTURERS – for self-injectable drug administration

2

TEST DISCS – VARIOUSMANUFACTURERS

3 • •

TEST STRIPS – VARIOUSMANUFACTURERS

3 • •

MISCELLANEOUS DRUGSASTAGRAF XL – tacrolimus cap er

24hr 0.5 mg3

2018




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ASTAGRAF XL – tacrolimus cap er24hr 1 mg

3

ASTAGRAF XL – tacrolimus cap er24hr 5 mg

3

AZASAN – azathioprine tab 75 mg 3

AZASAN – azathioprine tab 100mg

3

azathioprine tab 50 mg (Imuran) 1

BENLYSTA – belimumabsubcutaneous solution auto-injector 200 mg/ml

3 X • •

BENLYSTA – belimumabsubcutaneous solution prefilledsyringe 200 mg/ml

3 X • •

buprenorphine hcl-naloxone hclsl tab 2-0.5 mg (base equiv)

1 • •

buprenorphine hcl-naloxone hclsl tab 8-2 mg (base equiv)

1 • •

CELLCEPT – mycophenolatemofetil cap 250 mg

3

CELLCEPT – mycophenolatemofetil tab 500 mg

3

CELLCEPT – mycophenolatemofetil for oral susp 200 mg/ml

3

CHEMET – succimer cap 100 mg 2 X •cyclosporine cap 25 mg

(Sandimmune)1

cyclosporine cap 100 mg(Sandimmune)

1

CYCLOSPORINE MODIFIED –cyclosporine modified cap 50 mg

3

cyclosporine modified cap25 mg (Neoral)

1

cyclosporine modified cap50 mg (Cyclosporine modifie)

1

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cyclosporine modified cap100 mg (Neoral)

1

cyclosporine modified oral soln100 mg/ml (Neoral)

1

DEPEN TITRATABS –penicillamine tab 250 mg

2 X •

ENVARSUS XR – tacrolimus tab er24hr 0.75 mg

3

ENVARSUS XR – tacrolimus tab er24hr 1 mg

3

ENVARSUS XR – tacrolimus tab er24hr 4 mg

3

EVZIO – naloxone hcl solutionauto-injector 0.4 mg/0.4ml

3 • •

EVZIO – naloxone hcl solutionauto-injector 2 mg/0.4ml

3 • •

EXJADE – deferasirox tab for oralsusp 125 mg

2 X


2 X


2 X

FERRIPROX – deferiprone tab 500mg

3 X

FERRIPROX – deferiprone oralsoln 100 mg/ml

3 X

IMURAN – azathioprine tab 50 mg 3

irrigation solution, physiological 1

JADENU – deferasirox tab 90 mg 3 XJADENU – deferasirox tab 180 mg 3 XJADENU – deferasirox tab 360 mg 3 XJADENU SPRINKLE – deferasirox

granules packet 90 mg3 X

JADENU SPRINKLE – deferasiroxgranules packet 180 mg

3 X

2018




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JADENU SPRINKLE – deferasiroxgranules packet 360 mg

3 X

lactated ringer's for irrigation 1

mycophenolate mofetil cap250 mg (Cellcept)

1

mycophenolate mofetil for oralsusp 200 mg/ml (Cellcept)

1

mycophenolate mofetil tab500 mg (Cellcept)

1

mycophenolate sodium tab dr180 mg (mycophenolic acidequiv) (Myfortic)

1

mycophenolate sodium tab dr360 mg (mycophenolic acidequiv) (Myfortic)

1

MYFORTIC – mycophenolatesodium tab dr 180 mg(mycophenolic acid equiv)

3

MYFORTIC – mycophenolatesodium tab dr 360 mg(mycophenolic acid equiv)

3

NALOXONE HCL – naloxone hclsoln cartridge 0.4 mg/ml

3 •

NALOXONE HCL – naloxone hclsoln prefilled syringe 2 mg/2ml

3 •

naloxone hcl inj 0.4 mg/ml 1 •naloxone hcl inj 4 mg/10ml 1 •NARCAN – naloxone hcl nasal

spray 4 mg/0.1ml2 •

NEORAL – cyclosporine modifiedoral soln 100 mg/ml

3

NEORAL – cyclosporine modifiedcap 25 mg

3

NEORAL – cyclosporine modifiedcap 100 mg

3

PROGRAF – tacrolimus cap 0.5mg

3

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PROGRAF – tacrolimus cap 1 mg 3

PROGRAF – tacrolimus cap 5 mg 3

RADIOGARDASE – prussian blueinsoluble cap 0.5 gm

3

RAPAMUNE – sirolimus oral soln 1mg/ml

2

RAPAMUNE – sirolimus tab 0.5 mg 3

RAPAMUNE – sirolimus tab 1 mg 3

RAPAMUNE – sirolimus tab 2 mg 3

REVLIMID – lenalidomide caps 2.5mg

2 X • •

REVLIMID – lenalidomide cap 5mg

2 X • •


2 X • •


2 X • •


2 X • •


2 X • •

ringer's solution for irrigation 1

SANDIMMUNE – cyclosporine oralsoln 100 mg/ml

3

SANDIMMUNE – cyclosporine cap25 mg

3

SANDIMMUNE – cyclosporine cap100 mg

3

sirolimus tab 0.5 mg (Rapamune) 1

sirolimus tab 1 mg (Rapamune) 1

sirolimus tab 2 mg (Rapamune) 1

sodium polystyrene sulfonateoral susp 15 gm/60ml

1

sodium polystyrene sulfonatepowder (Kayexalate)

1

2018




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sodium polystyrene sulfonaterectal susp 30 gm/120ml

1

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 2-0.5 mg(base equiv)

2 • •

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 4-1 mg (baseequiv)

2 • •

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 8-2 mg (baseequiv)

2 • •

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 12-3 mg(base equiv)

2 • •

SYPRINE – trientine hcl cap 250mg

2 X •

tacrolimus cap 0.5 mg (Prograf) 1

tacrolimus cap 1 mg (Prograf) 1

tacrolimus cap 5 mg (Prograf) 1

THALOMID – thalidomide cap 50mg

2 X • •


2 X • •


2 X • •


2 X • •

VELTASSA – patiromer sorbitexcalcium for susp packet 8.4 gm(base eq)

3 •


3 •


3 •

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VISTOGARD – uridine triacetateoral granules packet 10 gm

3 X •

water for irrigation, sterileirrigation soln

1

ZORTRESS – everolimus tab 0.25mg

2


2


2

2018


INDEX

Aabacavir sulfate-lamivudine tab 600-300 mg(Epzicom)............................................................................9

abacavir sulfate-lamivudine-zidovudine tab300-150-300 mg (Trizivir).................................................. 9

abacavir sulfate soln 20 mg/ml (base equiv)(Ziagen)............................................................................... 9

abacavir sulfate tab 300 mg (base equiv) (Ziagen).........9acamprosate calcium tab delayed release 333 mg.......95ACANYA – clindamycin phosphate-benzoyl peroxide gel1.2-2.5%...........................................................................143

acarbose tab 25 mg (Precose)........................................ 30acarbose tab 50 mg (Precose)........................................ 30acarbose tab 100 mg (Precose)...................................... 30ACCOLATE – zafirlukast tab 10 mg...................................67ACCOLATE – zafirlukast tab 20 mg...................................67ACCUPRIL – quinapril hcl tab 5 mg.................................. 43ACCUPRIL – quinapril hcl tab 10 mg................................ 43ACCUPRIL – quinapril hcl tab 20 mg................................ 43ACCUPRIL – quinapril hcl tab 40 mg................................ 43ACCURETIC – quinapril-hydrochlorothiazide tab 10-12.5mg...................................................................................... 43

ACCURETIC – quinapril-hydrochlorothiazide tab 20-12.5mg...................................................................................... 43

ACCURETIC – quinapril-hydrochlorothiazide tab 20-25mg...................................................................................... 43

acebutolol hcl cap 200 mg (Sectral)...............................48acebutolol hcl cap 400 mg (Sectral)...............................48ACEON – perindopril erbumine tab 4 mg.......................... 43ACEON – perindopril erbumine tab 8 mg.......................... 43ACETAMINOPHEN/CAFFEINE/DI – acetaminophen-caffeine-dihydrocodeine cap 320.5-30-16 mg..................98

acetaminophen w/ codeine soln 120-12 mg/5ml........... 98acetaminophen w/ codeine tab 300-15 mg (Tylenol/codeine)............................................................................ 98

acetaminophen w/ codeine tab 300-30 mg (Tylenol/codeine #3).......................................................................98

acetaminophen w/ codeine tab 300-60 mg (Tylenol/codeine #4).......................................................................98

acetazolamide cap er 12hr 500 mg (Diamox)................ 58acetazolamide tab 125 mg............................................... 58acetazolamide tab 250 mg............................................... 58acetic acid irrigation soln 0.25%.....................................79acetic acid otic soln 2%.................................................142acetylcysteine cap 600 mg............................................ 127acetylcysteine inhal soln 10%.........................................66acetylcysteine inhal soln 20%.........................................66acitretin cap 10 mg (Soriatane).....................................150acitretin cap 17.5 mg (Soriatane)..................................150acitretin cap 25 mg (Soriatane).....................................150ACTEMRA – tocilizumab subcutaneous soln prefilledsyringe 162 mg/0.9ml......................................................103

ACTHIB – haemophilus b polysaccharide conjugatevaccine for inj.................................................................... 14

ACTIGALL – ursodiol cap 300 mg..................................... 75ACTIMMUNE – interferon gamma-1b inj 100 mcg/0.5ml(2000000 unit/0.5ml)......................................................... 17

ACTIQ – fentanyl citrate lozenge on a handle 200mcg.....................................................................................99






ACTIVELLA – estradiol & norethindrone acetate tab0.5-0.1 mg..........................................................................25

ACTIVELLA – estradiol & norethindrone acetate tab 1-0.5mg...................................................................................... 25

ACTIVE OB – prenatal w/o a w/fe cbn-fa-dha cap20-1-320 mg.................................................................... 119

ACTONEL – risedronate sodium tab 5 mg........................ 40ACTONEL – risedronate sodium tab 30 mg...................... 40ACTONEL – risedronate sodium tab 35 mg...................... 40ACTONEL – risedronate sodium tab 150 mg.................... 40ACTOPLUS MET XR – pioglitazone hcl-metformin hcl taber 24hr 15-1000 mg.......................................................... 30

ACTOPLUS MET XR – pioglitazone hcl-metformin hcl taber 24hr 30-1000 mg.......................................................... 30

ACULAR – ketorolac tromethamine ophth soln 0.5%......140ACULAR LS – ketorolac tromethamine ophth soln0.4%................................................................................. 140

acyclovir cap 200 mg (Zovirax).........................................9acyclovir oint 5% (Zovirax)............................................145acyclovir susp 200 mg/5ml (Zovirax)............................... 9acyclovir tab 400 mg (Zovirax)..........................................9acyclovir tab 800 mg (Zovirax)..........................................9ADACEL – tet tox-diph-acell pertuss ad inj 5-2-15.5 lf-lf-mcg/0.5ml...........................................................................15

ADALAT CC – nifedipine tab er 24hr 30 mg......................51ADALAT CC – nifedipine tab er 24hr 60 mg......................51ADALAT CC – nifedipine tab er 24hr 90 mg......................51adapalene-benzoyl peroxide gel 0.1-2.5%(Epiduo)...........................................................................143

adapalene cream 0.1% (Differin)...................................143adapalene gel 0.1% (Differin)........................................ 143adapalene gel 0.3% (Differin)........................................ 143ADCIRCA – tadalafil tab 20 mg (pah)................................61ADDERALL – amphetamine-dextroamphetamine tab 5mg...................................................................................... 89

ADDERALL – amphetamine-dextroamphetamine tab 7.5mg...................................................................................... 89

ADDERALL – amphetamine-dextroamphetamine tab 10mg...................................................................................... 90

2018


ADDERALL – amphetamine-dextroamphetamine tab 12.5mg...................................................................................... 90




ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 5 mg..................................................................... 90

ADDERALL XR – amphetamine-dextroamphetamine caper 24hr 10 mg................................................................... 90





adefovir dipivoxil tab 10 mg (Hepsera)............................7ADEMPAS – riociguat tab 0.5 mg...................................... 61ADEMPAS – riociguat tab 1 mg......................................... 61ADEMPAS – riociguat tab 1.5 mg...................................... 61ADEMPAS – riociguat tab 2 mg......................................... 61ADEMPAS – riociguat tab 2.5 mg...................................... 61ADVAIR DISKUS – fluticasone-salmeterol aer powder ba100-50 mcg/dose...............................................................67

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba250-50 mcg/dose...............................................................67

ADVAIR DISKUS – fluticasone-salmeterol aer powder ba500-50 mcg/dose...............................................................67

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 45-21mcg/act...............................................................................67

ADVAIR HFA – fluticasone-salmeterol inhal aerosol 115-21mcg/act...............................................................................67

ADVAIR HFA – fluticasone-salmeterol inhal aerosol230-21 mcg/act..................................................................67

ADVATE – antihemophilic factor rahf-pfm for inj 250unit....................................................................................131







ADYNOVATE – antihemophilic factor recomb pegylated forinj 250 unit.......................................................................132



ADYNOVATE – antihemophilic factor recomb pegylated forinj 1000 unit.....................................................................132




AEROSPAN – flunisolide hfa inhal aerosol 80 mcg/act..... 67AFINITOR DISPERZ – everolimus tab for oral susp 2mg...................................................................................... 17

AFINITOR DISPERZ – everolimus tab for oral susp 3mg...................................................................................... 17

AFINITOR DISPERZ – everolimus tab for oral susp 5mg...................................................................................... 17

AFINITOR – everolimus tab 2.5 mg...................................17AFINITOR – everolimus tab 5 mg......................................17AFINITOR – everolimus tab 7.5 mg...................................17AFINITOR – everolimus tab 10 mg....................................17AFREZZA – insulin regular (human) inhalation powder 4unit/cartridge...................................................................... 35

AFREZZA – insulin regular (human) inhalation powder 8unit/cartridge...................................................................... 35

AFREZZA – insulin regular (human) inhalation powder 12unit/cartridge...................................................................... 35

AFREZZA – insulin regular (human) inhal powd 4 (30) & 8(60) unit/cart...................................................................... 35



AFREZZA – insulin regular (human) inh powd 4 & 8 & 12unit/cart (60)...................................................................... 35

AFREZZA – insulin regular (human) inh powd 8 (60) & 12(30) unit/cart...................................................................... 35

AFSTYLA – antihemophilic fact rcmb single chain for inj kit250 unit............................................................................132

AFSTYLA – antihemophilic fact rcmb single chain for inj kit500 unit............................................................................132

AFSTYLA – antihemophilic fact rcmb single chain for inj kit1000 unit..........................................................................132





AGGRENOX – aspirin-dipyridamole cap er 12hr 25-200mg.................................................................................... 127

AGRYLIN – anagrelide hcl cap 0.5 mg............................127AKTEN – lidocaine hcl ophth gel 3.5%............................ 140AKYNZEO – netupitant-palonosetron cap 300-0.5 mg......73

2018


ALA SCALP – hydrocortisone lotion 2%..........................146ALBENZA – albendazole tab 200 mg................................ 13albuterol sulfate soln nebu 0.083% (2.5 mg/3ml)..........67albuterol sulfate soln nebu 0.5% (5 mg/ml)...................67albuterol sulfate soln nebu 0.63 mg/3ml (baseequiv).................................................................................67

albuterol sulfate soln nebu 1.25 mg/3ml (baseequiv).................................................................................67

albuterol sulfate syrup 2 mg/5ml....................................67albuterol sulfate tab er 12hr 4 mg (Vospire er)..............67albuterol sulfate tab er 12hr 8 mg (Vospire er)..............67albuterol sulfate tab 2 mg................................................67albuterol sulfate tab 4 mg................................................67alclometasone dipropionate cream 0.05%(Aclovate)........................................................................146

alclometasone dipropionate oint 0.05%.......................146ALDACTAZIDE – spironolactone & hydrochlorothiazide tab25-25 mg............................................................................58

ALDACTAZIDE – spironolactone & hydrochlorothiazide tab50-50 mg............................................................................59

ALDACTONE – spironolactone tab 25 mg.........................59ALDACTONE – spironolactone tab 50 mg.........................59ALDACTONE – spironolactone tab 100 mg.......................59ALECENSA – alectinib hcl cap 150 mg (baseequivalent)......................................................................... 17

ALENDRONATE SODIUM – alendronate sodium oral soln70 mg/75ml........................................................................40

ALENDRONATE SODIUM – alendronate sodium tab 40mg...................................................................................... 40

alendronate sodium tab 5 mg......................................... 40alendronate sodium tab 10 mg....................................... 40alendronate sodium tab 35 mg....................................... 40alendronate sodium tab 70 mg (Fosamax).................... 40alfuzosin hcl tab er 24hr 10 mg (Uroxatral)................... 79ALINIA – nitazoxanide for susp 100 mg/5ml......................13ALINIA – nitazoxanide tab 500 mg.................................... 13ALKERAN – melphalan tab 2 mg.......................................17allopurinol tab 100 mg (Zyloprim)................................ 108allopurinol tab 300 mg (Zyloprim)................................ 108almotriptan malate tab 6.25 mg (Axert)........................106almotriptan malate tab 12.5 mg (Axert)........................106ALOCRIL – nedocromil sodium ophth soln 2%................140ALOGLIPTIN/METFORMIN HCL – alogliptin-metformin hcltab 12.5-500 mg................................................................30

ALOGLIPTIN/METFORMIN HCL – alogliptin-metformin hcltab 12.5-1000 mg..............................................................30

ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone tab12.5-15 mg........................................................................ 30



ALOGLIPTIN/PIOGLITAZONE – alogliptin-pioglitazone tab25-15 mg............................................................................30



ALOGLIPTIN – alogliptin benzoate tab 6.25 mg (baseequiv)................................................................................. 30

ALOGLIPTIN – alogliptin benzoate tab 12.5 mg (baseequiv)................................................................................. 30

ALOGLIPTIN – alogliptin benzoate tab 25 mg (baseequiv)................................................................................. 30

ALOMIDE – lodoxamide tromethamine ophth soln0.1%................................................................................. 140

ALORA – estradiol td patch twice weekly 0.025mg/24hr..............................................................................25



ALORA – estradiol td patch twice weekly 0.1 mg/24hr......25alosetron hcl tab 0.5 mg (base equiv) (Lotronex).........75alosetron hcl tab 1 mg (base equiv) (Lotronex)............75ALPHAGAN P – brimonidine tartrate ophth soln0.1%................................................................................. 139

ALPHAGAN P – brimonidine tartrate ophth soln0.15%............................................................................... 139

ALPHANATE/VON WILLEBRAND – antihemophilic factor/vwf (human) for inj 250 unit............................................132

ALPHANATE/VON WILLEBRAND – antihemophilic factor/vwf (human) for inj 500 unit............................................132

ALPHANATE/VON WILLEBRAND – antihemophilic factor/vwf (human) for inj 1000 unit..........................................132



ALPHANINE SD – coagulation factor ix for inj 500unit....................................................................................132



ALPRAZOLAM INTENSOL – alprazolam conc 1 mg/ml........................................................................................80

alprazolam orally disintegrating tab 0.5 mg.................. 80alprazolam orally disintegrating tab 1 mg..................... 80alprazolam orally disintegrating tab 2 mg..................... 80alprazolam orally disintegrating tab 0.25 mg(Niravam)...........................................................................80

alprazolam tab er 24hr 0.5 mg (Xanax xr)......................80alprazolam tab er 24hr 1 mg (Xanax xr).........................80alprazolam tab er 24hr 2 mg (Xanax xr).........................80alprazolam tab er 24hr 3 mg (Xanax xr).........................80alprazolam tab 0.25 mg (Xanax)......................................80alprazolam tab 0.5 mg (Xanax)........................................80alprazolam tab 1 mg (Xanax)...........................................80alprazolam tab 2 mg (Xanax)...........................................80ALPROLIX – coagulation factor ix (recomb) (rfixfc) for inj250 unit............................................................................132

2018


ALPROLIX – coagulation factor ix (recomb) (rfixfc) for inj500 unit............................................................................133

ALPROLIX – coagulation factor ix (recomb) (rfixfc) for inj1000 unit..........................................................................133




ALREX – loteprednol etabonate ophth susp 0.2%...........138ALTABAX – retapamulin oint 1%......................................145ALTACE – ramipril cap 1.25 mg.........................................43ALTACE – ramipril cap 2.5 mg...........................................43ALTACE – ramipril cap 5 mg..............................................43ALTACE – ramipril cap 10 mg............................................43ALTOPREV – lovastatin tab er 24hr 20 mg....................... 56ALTOPREV – lovastatin tab er 24hr 40 mg....................... 56ALTOPREV – lovastatin tab er 24hr 60 mg....................... 56ALUNBRIG – brigatinib tab 30 mg.....................................17ALVESCO – ciclesonide inhal aerosol 80 mcg/act............ 67ALVESCO – ciclesonide inhal aerosol 160 mcg/act.......... 67amantadine hcl cap 100 mg.......................................... 114amantadine hcl syrup 50 mg/5ml..................................114amantadine hcl tab 100 mg........................................... 114AMARYL – glimepiride tab 1 mg........................................30AMARYL – glimepiride tab 2 mg........................................30AMARYL – glimepiride tab 4 mg........................................30AMCINONIDE – amcinonide cream 0.1%....................... 146AMCINONIDE – amcinonide lotion 0.1%.........................146AMCINONIDE – amcinonide oint 0.1%............................146AMICAR – aminocaproic acid oral soln 0.25 gm/ml.........127AMICAR – aminocaproic acid tab 500 mg.......................127AMICAR – aminocaproic acid tab 1000 mg.....................127amiloride & hydrochlorothiazide tab 5-50 mg............... 59amiloride hcl tab 5 mg..................................................... 59AMINOBENZOATE POTASSIUM – potassiumaminobenzoate packet 2 gm.......................................... 118

amiodarone hcl tab 100 mg.............................................60amiodarone hcl tab 400 mg.............................................60amiodarone hcl tab 200 mg (Cordarone)....................... 60AMITIZA – lubiprostone cap 8 mcg....................................75AMITIZA – lubiprostone cap 24 mcg..................................75amitriptyline hcl tab 10 mg..............................................81amitriptyline hcl tab 50 mg..............................................81amitriptyline hcl tab 75 mg..............................................81amitriptyline hcl tab 100 mg............................................81amitriptyline hcl tab 150 mg............................................81amitriptyline hcl tab 25 mg (Elavil).................................81amlodipine besylate-atorvastatin calcium tab 2.5-10mg (Caduet)......................................................................61

amlodipine besylate-atorvastatin calcium tab 2.5-20mg (Caduet)......................................................................61

amlodipine besylate-atorvastatin calcium tab 2.5-40mg (Caduet)......................................................................61

amlodipine besylate-atorvastatin calcium tab 5-10 mg(Caduet).............................................................................61








amlodipine besylate-benazepril hcl cap 2.5-10 mg.......51amlodipine besylate-benazepril hcl cap 5-40 mg..........51amlodipine besylate-benazepril hcl cap 5-10 mg(Lotrel)...............................................................................51

amlodipine besylate-benazepril hcl cap 5-20 mg(Lotrel)...............................................................................51



amlodipine besylate-olmesartan medoxomil tab 5-20mg (Azor)..........................................................................51




amlodipine besylate tab 2.5 mg (Norvasc).................... 51amlodipine besylate tab 5 mg (Norvasc)....................... 51amlodipine besylate tab 10 mg (Norvasc)..................... 51amlodipine besylate-valsartan tab 5-160 mg(Exforge)........................................................................... 51

amlodipine besylate-valsartan tab 5-320 mg(Exforge)........................................................................... 51



amlodipine-valsartan-hydrochlorothiazide tab5-160-12.5 mg (Exforge hct)...........................................45

amlodipine-valsartan-hydrochlorothiazide tab 5-160-25mg (Exforge hct)..............................................................45

amlodipine-valsartan-hydrochlorothiazide tab10-160-12.5 mg (Exforge hct).........................................45

amlodipine-valsartan-hydrochlorothiazide tab10-160-25 mg (Exforge hct)............................................45

amlodipine-valsartan-hydrochlorothiazide tab10-320-25 mg (Exforge hct)............................................45

AMOXAPINE – amoxapine tab 25 mg...............................81

2018


AMOXAPINE – amoxapine tab 50 mg...............................81AMOXAPINE – amoxapine tab 100 mg.............................81AMOXAPINE – amoxapine tab 150 mg.............................81AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 200-28.5 mg.....................................1

AMOXICILLIN/CLAVULANATE P – amoxicillin & kclavulanate chew tab 400-57 mg........................................1

amoxicillin & k clavulanate for susp 200-28.5mg/5ml.................................................................................1

amoxicillin & k clavulanate for susp 400-57 mg/5ml...... 1amoxicillin & k clavulanate for susp 250-62.5 mg/5ml(Augmentin)........................................................................1

amoxicillin & k clavulanate for susp 600-42.9 mg/5ml(Augmentin es-600)...........................................................1

amoxicillin & k clavulanate tab er 12hr 1000-62.5 mg(Augmentin xr)...................................................................1

amoxicillin & k clavulanate tab 250-125 mg.................... 1amoxicillin & k clavulanate tab 500-125 mg(Augmentin)........................................................................1

amoxicillin & k clavulanate tab 875-125 mg(Augmentin)........................................................................1

AMOXICILLIN – amoxicillin (trihydrate) chew tab 125mg........................................................................................ 1

AMOXICILLIN – amoxicillin (trihydrate) chew tab 250mg........................................................................................ 1

amoxicillin cap-clarithro tab-lansopraz cap dr therapypack (Prevpac).................................................................71

amoxicillin (trihydrate) cap 250 mg..................................1amoxicillin (trihydrate) cap 500 mg..................................1amoxicillin (trihydrate) for susp 125 mg/5ml...................1amoxicillin (trihydrate) for susp 200 mg/5ml...................1amoxicillin (trihydrate) for susp 250 mg/5ml...................1amoxicillin (trihydrate) for susp 400 mg/5ml...................1amoxicillin (trihydrate) tab 500 mg...................................1amoxicillin (trihydrate) tab 875 mg...................................1amphetamine-dextroamphetamine cap er 24hr 5 mg(Adderall xr)..................................................................... 90

amphetamine-dextroamphetamine cap er 24hr 10 mg(Adderall xr)..................................................................... 90





amphetamine-dextroamphetamine tab 5 mg(Adderall).......................................................................... 90

amphetamine-dextroamphetamine tab 7.5 mg(Adderall).......................................................................... 90


amphetamine-dextroamphetamine tab 12.5 mg(Adderall).......................................................................... 90




AMPICILLIN – ampicillin cap 500 mg.................................. 1AMPYRA – dalfampridine tab er 12hr 10 mg.....................94ANADROL-50 – oxymetholone tab 50 mg.........................25anagrelide hcl cap 1 mg................................................ 127anagrelide hcl cap 0.5 mg (Agrylin)............................. 127ANALPRAM-HC – hydrocortisone acetate w/ pramoxinerectal cream 1-1%...........................................................143

ANALPRAM HC – hydrocortisone acetate w/ pramoxinerectal cream 2.5-1%........................................................143

ANALPRAM-HC – hydrocortisone acetate w/ pramoxinerectal lotn 2.5-1%............................................................ 143

ANALPRAM HC SINGLES – hydrocortisone acetate w/pramoxine rectal cream 2.5-1%......................................143

ANAPROX DS – naproxen sodium tab 550 mg...............104ANASPAZ – hyoscyamine sulfate tab disint 0.125 mg...... 71anastrozole tab 1 mg (Arimidex).....................................17ANCOBON – flucytosine cap 250 mg..................................6ANCOBON – flucytosine cap 500 mg..................................6ANDROGEL PUMP – testosterone td gel 20.25 mg/act(1.62%)...............................................................................25

ANDROGEL – testosterone td gel 25 mg/2.5gm (1%).......25ANDROGEL – testosterone td gel 50 mg/5gm (1%)..........25ANDROGEL – testosterone td gel 20.25 mg/1.25gm(1.62%)...............................................................................25

ANDROGEL – testosterone td gel 40.5 mg/2.5gm(1.62%)...............................................................................25

ANGELIQ – drospirenone-estradiol tab 0.25-0.5 mg.........25ANGELIQ – drospirenone-estradiol tab 0.5-1 mg..............25ANORO ELLIPTA – umeclidinium-vilanterol aero powd ba62.5-25 mcg/inh.................................................................67

ANTABUSE – disulfiram tab 250 mg................................. 95ANTABUSE – disulfiram tab 500 mg................................. 95ANUSOL-HC – hydrocortisone rectal cream 2.5%.......... 143ANZEMET – dolasetron mesylate tab 50 mg.................... 73ANZEMET – dolasetron mesylate tab 100 mg...................73APIDRA – insulin glulisine inj 100 unit/ml.......................... 35APIDRA SOLOSTAR – insulin glulisine soln pen-injectorinj 100 unit/ml.................................................................... 35

APOKYN – apomorphine hcl soln cartridge 30mg/3ml............................................................................. 114

apraclonidine hcl ophth soln 0.5% (base equivalent)(Iopidine).........................................................................139

aprepitant capsule 40 mg (Emend).................................73aprepitant capsule 80 mg (Emend).................................73aprepitant capsule 125 mg (Emend)...............................73aprepitant capsule therapy pack 80 & 125 mg(Emend).............................................................................73

APTENSIO XR – methylphenidate hcl cap er 24hr 10 mg(xr)...................................................................................... 90

2018








APTIOM – eslicarbazepine acetate tab 200 mg.............. 108APTIOM – eslicarbazepine acetate tab 400 mg.............. 108APTIOM – eslicarbazepine acetate tab 600 mg.............. 108APTIOM – eslicarbazepine acetate tab 800 mg.............. 108APTIVUS – tipranavir cap 250 mg.......................................9APTIVUS – tipranavir oral soln 100 mg/ml.......................... 9ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 25mcg/ml..............................................................................127

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 40mcg/ml..............................................................................128

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj 60mcg/ml..............................................................................128

ARANESP ALBUMIN FREE – darbepoetin alfa soln inj100 mcg/ml...................................................................... 128



ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 10 mcg/0.4ml........................................127

ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 25 mcg/0.42ml......................................127







ARANESP ALBUMIN FREE – darbepoetin alfa solnprefilled syringe 500 mcg/ml...........................................127

ARAVA – leflunomide tab 10 mg......................................104ARAVA – leflunomide tab 20 mg......................................104ARCALYST – rilonacept for inj 220 mg............................104ARCAPTA NEOHALER – indacaterol maleate inhalpowder cap 75 mcg (base equiv).....................................67

ARICEPT – donepezil hydrochloride tab 5 mg.................. 95ARICEPT – donepezil hydrochloride tab 10 mg................ 95ARICEPT – donepezil hydrochloride tab 23 mg................ 95

ARIMIDEX – anastrozole tab 1 mg....................................17aripiprazole orally disintegrating tab 10 mg..................85aripiprazole orally disintegrating tab 15 mg..................85aripiprazole oral solution 1 mg/ml..................................85aripiprazole tab 2 mg (Abilify).........................................85aripiprazole tab 5 mg (Abilify).........................................85aripiprazole tab 10 mg (Abilify).......................................85aripiprazole tab 15 mg (Abilify).......................................85aripiprazole tab 20 mg (Abilify).......................................85aripiprazole tab 30 mg (Abilify).......................................85ARIXTRA – fondaparinux sodium subcutaneous inj 2.5mg/0.5ml.......................................................................... 128

ARIXTRA – fondaparinux sodium subcutaneous inj 5mg/0.4ml.......................................................................... 128

ARIXTRA – fondaparinux sodium subcutaneous inj 7.5mg/0.6ml.......................................................................... 128

ARIXTRA – fondaparinux sodium subcutaneous inj 10mg/0.8ml.......................................................................... 128

armodafinil tab 50 mg (Nuvigil).......................................91armodafinil tab 150 mg (Nuvigil).....................................91armodafinil tab 200 mg (Nuvigil).....................................91armodafinil tab 250 mg (Nuvigil).....................................91ARMOUR THYROID – thyroid tab 15 mg (1/4 grain).........36ARMOUR THYROID – thyroid tab 30 mg (1/2 grain).........36ARMOUR THYROID – thyroid tab 90 mg (1 1/2 grain)......36ARMOUR THYROID – thyroid tab 60 mg (1 grain)........... 36ARMOUR THYROID – thyroid tab 120 mg (2 grain)..........36ARMOUR THYROID – thyroid tab 180 mg (3 grain)..........36ARMOUR THYROID – thyroid tab 240 mg (4 grain)..........36ARMOUR THYROID – thyroid tab 300 mg (5 grain)..........36ARNUITY ELLIPTA – fluticasone furoate aerosol powderbreath activ 100 mcg/act.................................................. 67

ARNUITY ELLIPTA – fluticasone furoate aerosol powderbreath activ 200 mcg/act.................................................. 67

AROMASIN – exemestane tab 25 mg............................... 18ARTHROTEC 50 – diclofenac w/ misoprostol tab delayedrelease 50-0.2 mg........................................................... 104

ARTHROTEC 75 – diclofenac w/ misoprostol tab delayedrelease 75-0.2 mg........................................................... 104

ARZOL SILVER NITRATE APP – silver nitrate-potassiumnitrate applicator 75-25%................................................150

ASACOL HD – mesalamine tab delayed release 800mg...................................................................................... 75

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 100 mcg/act................................................... 67

ASMANEX HFA – mometasone furoate inhal aerosolsuspension 200 mcg/act................................................... 67

ASMANEX TWISTHALER 120 ME – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 68

ASMANEX TWISTHALER 14 MET – mometasone furoateinhal powd 220 mcg/inh (breath activated)...................... 68

ASMANEX TWISTHALER 30 MET – mometasone furoateinhal powd 110 mcg/inh (breath activated).......................68


2018



aspirin chew tab 81 mg....................................................98aspirin-dipyridamole cap er 12hr 25-200 mg(Aggrenox)......................................................................128

aspirin tab delayed release 81 mg..................................98ASTAGRAF XL – tacrolimus cap er 24hr 0.5 mg.............152ASTAGRAF XL – tacrolimus cap er 24hr 1 mg................153ASTAGRAF XL – tacrolimus cap er 24hr 5 mg................153ASTEPRO – azelastine hcl nasal spray 0.15% (205.5 mcg/spray)................................................................................. 66

ATACAND – candesartan cilexetil tab 4 mg.......................45ATACAND – candesartan cilexetil tab 8 mg.......................45ATACAND – candesartan cilexetil tab 16 mg.....................45ATACAND – candesartan cilexetil tab 32 mg.....................45ATACAND HCT – candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg................................. 45

ATACAND HCT – candesartan cilexetil-hydrochlorothiazide tab 32-12.5 mg................................. 45

ATACAND HCT – candesartan cilexetil-hydrochlorothiazide tab 32-25 mg.................................... 45

ATELVIA – risedronate sodium tab delayed release 35mg...................................................................................... 40

atenolol & chlorthalidone tab 50-25 mg (Tenoretic50)...................................................................................... 48

atenolol & chlorthalidone tab 100-25 mg (Tenoretic100).................................................................................... 48

atenolol tab 25 mg (Tenormin)........................................ 48atenolol tab 50 mg (Tenormin)........................................ 48atenolol tab 100 mg (Tenormin)...................................... 48atomoxetine hcl cap 10 mg (base equiv) (Strattera).....91atomoxetine hcl cap 18 mg (base equiv) (Strattera).....91atomoxetine hcl cap 25 mg (base equiv) (Strattera).....91atomoxetine hcl cap 40 mg (base equiv) (Strattera).....91atomoxetine hcl cap 60 mg (base equiv) (Strattera).....91atomoxetine hcl cap 80 mg (base equiv) (Strattera).....91atomoxetine hcl cap 100 mg (base equiv)(Strattera)..........................................................................91

atorvastatin calcium tab 10 mg (base equivalent)(Lipitor)..............................................................................56




atovaquone-proguanil hcl tab 62.5-25 mg(Malarone).........................................................................13

atovaquone-proguanil hcl tab 250-100 mg(Malarone).........................................................................13

atovaquone susp 750 mg/5ml (Mepron).........................13ATRIPLA – efavirenz-emtricitabine-tenofovir df tab600-200-300 mg.................................................................. 9

ATROPINE SULFATE – atropine sulfate ophth oint1%.................................................................................... 140

ATROPINE SULFATE – atropine sulfate ophth soln1%.................................................................................... 140

ATROVENT HFA – ipratropium bromide hfa inhal aerosol17 mcg/act......................................................................... 68

AUBAGIO – teriflunomide tab 7 mg...................................94AUBAGIO – teriflunomide tab 14 mg.................................94AUGMENTIN – amoxicillin & k clavulanate for susp125-31.25 mg/5ml............................................................... 1

AUGMENTIN – amoxicillin & k clavulanate for susp250-62.5 mg/5ml..................................................................1

AUGMENTIN – amoxicillin & k clavulanate tab 500-125mg........................................................................................ 1

AUGMENTIN – amoxicillin & k clavulanate tab 875-125mg........................................................................................ 1

AUGMENTIN ES-600 – amoxicillin & k clavulanate forsusp 600-42.9 mg/5ml........................................................ 1

AUGMENTIN XR – amoxicillin & k clavulanate tab er 12hr1000-62.5 mg...................................................................... 1

AUSTEDO – deutetrabenazine tab 6 mg...........................95AUSTEDO – deutetrabenazine tab 9 mg...........................95AUSTEDO – deutetrabenazine tab 12 mg.........................95AVALIDE – irbesartan-hydrochlorothiazide tab 150-12.5mg...................................................................................... 45

AVALIDE – irbesartan-hydrochlorothiazide tab 300-12.5mg...................................................................................... 45

AVANDIA – rosiglitazone maleate tab 2 mg (baseequiv)................................................................................. 30

AVANDIA – rosiglitazone maleate tab 4 mg (baseequiv)................................................................................. 30

AVAPRO – irbesartan tab 75 mg....................................... 46AVAPRO – irbesartan tab 150 mg..................................... 46AVAPRO – irbesartan tab 300 mg..................................... 46AVAR LS – sulfacetamide sodium w/ sulfur foam10-2%...............................................................................143

AVAR – sulfacetamide sodium w/ sulfur foam 9.5-5%..... 143AVC – sulfanilamide vaginal cream 15%........................... 78AVELOX – moxifloxacin hcl tab 400 mg (base equiv)..........4AVODART – dutasteride cap 0.5 mg................................. 79AVONEX – interferon beta-1a for im inj kit 30mcg(33mcg(6.6 mu)/vial)......................................................... 94

AVONEX – interferon beta-1a im prefilled syringe kit 30mcg/0.5ml...........................................................................94

AVONEX PEN – interferon beta-1a im auto-injector kit 30mcg/0.5ml...........................................................................94

AXERT – almotriptan malate tab 6.25 mg....................... 106AXERT – almotriptan malate tab 12.5 mg....................... 106AYGESTIN – norethindrone acetate tab 5 mg...................28AZASAN – azathioprine tab 75 mg..................................153AZASAN – azathioprine tab 100 mg................................153azathioprine tab 50 mg (Imuran)...................................153azelastine hcl nasal spray 0.1% (137 mcg/spray)......... 66azelastine hcl nasal spray 0.15% (205.5 mcg/spray)(Astepro)........................................................................... 66

azelastine hcl ophth soln 0.05%................................... 140AZELEX – azelaic acid cream 20%................................. 143

2018


AZILECT – rasagiline mesylate tab 0.5 mg (baseequiv)............................................................................... 114

AZILECT – rasagiline mesylate tab 1 mg (baseequiv)............................................................................... 114

AZITHROMYCIN – azithromycin powd pack for susp 1gm........................................................................................ 3

azithromycin for susp 100 mg/5ml (Zithromax).............. 3azithromycin for susp 200 mg/5ml (Zithromax).............. 3azithromycin tab 250 mg (Zithromax).............................. 3azithromycin tab 500 mg (Zithromax).............................. 3azithromycin tab 600 mg (Zithromax).............................. 3AZOPT – brinzolamide ophth susp 1%............................139AZOR – amlodipine besylate-olmesartan medoxomil tab5-20 mg..............................................................................51

AZOR – amlodipine besylate-olmesartan medoxomil tab5-40 mg..............................................................................51

AZOR – amlodipine besylate-olmesartan medoxomil tab10-20 mg............................................................................52

AZOR – amlodipine besylate-olmesartan medoxomil tab10-40 mg............................................................................52

AZULFIDINE EN-TABS – sulfasalazine tab delayedrelease 500 mg................................................................. 75

AZULFIDINE – sulfasalazine tab 500 mg.......................... 75

BBACITRACIN – bacitracin ophth oint 500 unit/gm........... 137bacitracin-polymyxin b ophth oint................................137bacitracin-polymyxin-neomycin-hc ophth oint 1%.....138baclofen tab 10 mg.........................................................117baclofen tab 20 mg.........................................................117BACTRIM DS – sulfamethoxazole-trimethoprim tab800-160 mg....................................................................... 13

BACTRIM – sulfamethoxazole-trimethoprim tab 400-80mg...................................................................................... 13

BACTROBAN – mupirocin calcium cream 2%.................145BACTROBAN NASAL – mupirocin calcium nasal oint2%...................................................................................... 66

BAL-CARE DHA – prenat w/fe poly-na fered-fa tab 27-1 &omega cap dr 430mg......................................................119

balsalazide disodium cap 750 mg (Colazal).................. 75BANZEL – rufinamide susp 40 mg/ml..............................108BANZEL – rufinamide tab 200 mg................................... 108BANZEL – rufinamide tab 400 mg................................... 108BARACLUDE – entecavir oral soln 0.05 mg/ml...................7BARACLUDE – entecavir tab 0.5 mg.................................. 7BARACLUDE – entecavir tab 1 mg..................................... 7BASAGLAR KWIKPEN – insulin glargine soln pen-injector100 unit/ml......................................................................... 36

BAYER BREEZE 2 BLOOD GLUC – blood glucosemonitoring kit w/ device.................................................. 152

BAYER BREEZE 2 TEST DISC – glucose blood testdisk...................................................................................152

BAYER CONTOUR BLOOD GLUCO – blood glucosemonitoring devices.......................................................... 152

BAYER CONTOUR BLOOD GLUCO – blood glucosemonitoring kit w/ device.................................................. 152

BAYER CONTOUR BLOOD GLUCO – glucose blood teststrip...................................................................................152

BAYER CONTOUR LINK BLOOD – blood glucosemonitoring kit w/ device.................................................. 152

BAYER CONTOUR NEXT BLOOD – blood glucosemonitoring kit w/ device.................................................. 152

BAYER CONTOUR NEXT BLOOD – glucose blood teststrip...................................................................................152

BAYER CONTOUR NEXT EZ BLO – blood glucosemonitoring kit w/ device.................................................. 152

BAYER CONTOUR NEXT LINK B – blood glucosemonitoring kit w/ device.................................................. 152

BAYER CONTOUR NEXT LINK W – blood glucosemonitoring kit w/ device.................................................. 152

BEBULIN – factor ix complex for inj 200-1200 unit..........133benazepril & hydrochlorothiazide tab 5-6.25 mg.......... 43benazepril & hydrochlorothiazide tab 10-12.5 mg(Lotensin hct)...................................................................43

benazepril & hydrochlorothiazide tab 20-12.5 mg(Lotensin hct)...................................................................43

benazepril & hydrochlorothiazide tab 20-25 mg(Lotensin hct)...................................................................43

benazepril hcl tab 5 mg................................................... 44benazepril hcl tab 10 mg (Lotensin)...............................44benazepril hcl tab 20 mg (Lotensin)...............................44benazepril hcl tab 40 mg (Lotensin)...............................44BENEFIX – coagulation factor ix (recombinant) for inj kit250 unit............................................................................133

BENEFIX – coagulation factor ix (recombinant) for inj kit500 unit............................................................................133

BENEFIX – coagulation factor ix (recombinant) for inj kit1000 unit..........................................................................133



BENLYSTA – belimumab subcutaneous solution auto-injector 200 mg/ml...........................................................153

BENLYSTA – belimumab subcutaneous solution prefilledsyringe 200 mg/ml...........................................................153

BENTYL – dicyclomine hcl cap 10 mg...............................71BENZAC AC WASH – benzoyl peroxide liq 5%...............143BENZAMYCIN – benzoyl peroxide-erythromycin gel5-3%.................................................................................143

BENZIQ – benzoyl peroxide gel 5.25 %.......................... 143BENZIQ LS – benzoyl peroxide gel 2.75%......................143BENZIQ WASH – benzoyl peroxide liq 5.25%.................143benzocaine mouth/throat aerosol 20%........................ 142BENZOLYL PEROXIDE FORTE- – benzoyl peroxide-hydrocortisone lotion 7.5-1%.......................................... 143

benzonatate cap 150 mg..................................................66benzonatate cap 200 mg..................................................66benzonatate cap 100 mg (Tessalon perles)................... 66BENZOYL PEROXIDE – benzoyl peroxide gel 6.5%...... 143benzoyl peroxide-erythromycin gel 5-3%(Benzamycin)................................................................. 144

2018


benzoyl peroxide liq 10%...............................................144benzoyl peroxide lotion 6%........................................... 144benztropine mesylate tab 0.5 mg..................................114benztropine mesylate tab 1 mg.....................................114benztropine mesylate tab 2 mg.....................................114BEPREVE – bepotastine besilate ophth soln 1.5%......... 140BERINERT – c1 esterase inhibitor (human) for iv inj kit500 unit............................................................................128

BESIVANCE – besifloxacin hcl ophth susp 0.6% (baseequiv)............................................................................... 137

BETADINE OPHTHALMIC PREP – povidone-iodine ophthsoln 5%............................................................................137

BETAGAN – levobunolol hcl ophth soln 0.5%................. 139betamethasone dipropionate augmented cream 0.05%(Diprolene af)................................................................. 146

betamethasone dipropionate augmented gel0.05%............................................................................... 146

betamethasone dipropionate augmented lotion 0.05%(Diprolene)......................................................................147

betamethasone dipropionate augmented oint 0.05%(Diprolene)......................................................................147

betamethasone dipropionate cream 0.05%................. 147betamethasone dipropionate lotion 0.05%..................147betamethasone dipropionate oint 0.05%..................... 147betamethasone valerate aerosol foam 0.12%(Luxiq)............................................................................. 147

betamethasone valerate cream 0.1% (baseequivalent)......................................................................147

betamethasone valerate lotion 0.1% (baseequivalent)......................................................................147

betamethasone valerate oint 0.1% (baseequivalent)......................................................................147

BETAPACE AF – sotalol hcl (afib/afl) tab 80 mg................60BETAPACE AF – sotalol hcl (afib/afl) tab 120 mg..............60BETAPACE AF – sotalol hcl (afib/afl) tab 160 mg..............60BETASERON – interferon beta-1b for inj kit 0.3 mg.......... 94betaxolol hcl ophth soln 0.5%.......................................139betaxolol hcl tab 10 mg (Kerlone).................................. 48betaxolol hcl tab 20 mg (Kerlone).................................. 48bethanechol chloride tab 5 mg (Urecholine)................. 77bethanechol chloride tab 10 mg (Urecholine)............... 78bethanechol chloride tab 25 mg (Urecholine)............... 78bethanechol chloride tab 50 mg (Urecholine)............... 78BETHKIS – tobramycin nebu soln 300 mg/4ml....................5BETIMOL – timolol ophth soln 0.25%..............................139BETIMOL – timolol ophth soln 0.5%................................139bexarotene cap 75 mg (Targretin)...................................18BEXSERO – meningococcal vac b (recomb omv adjuv) injprefilled syringe................................................................. 15

BEYAZ – drospirenone-ethinyl estrad-levomefolate tab3-0.02-0.451 mg................................................................ 28

bicalutamide tab 50 mg (Casodex).................................18BIDIL – isosorbide dinitrate-hydralazine hcl tab 20-37.5mg...................................................................................... 62

BILTRICIDE – praziquantel tab 600 mg.............................13BIMATOPROST – bimatoprost ophth soln 0.03%............139

BINOSTO – alendronate sodium effervescent tab 70mg...................................................................................... 40

BIO-STATIN – nystatin cap 500000 unit.............................. 6BIO-STATIN – nystatin cap 1000000 unit............................ 6bisacodyl tab & peg 3350-kcl-sod bicarb-nacl for solnkit....................................................................................... 71

bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg(Ziac)..................................................................................48

bisoprolol & hydrochlorothiazide tab 5-6.25 mg(Ziac)..................................................................................48

bisoprolol & hydrochlorothiazide tab 10-6.25 mg(Ziac)..................................................................................48

bisoprolol fumarate tab 5 mg (Zebeta)...........................48bisoprolol fumarate tab 10 mg (Zebeta).........................48BLEPHAMIDE S.O.P. – sulfacetamide sodium-prednisolone ophth oint 10-0.2%....................................138

BLEPHAMIDE – sulfacetamide sodium-prednisoloneophth susp 10-0.2%........................................................ 138

BLEPH-10 – sulfacetamide sodium ophth soln 10%....... 137BLOOD GLUCOSE MONITORING DEVICES – VARIOUSMANUFACTURERS........................................................ 152

BLOOD GLUCOSE MONITORING KIT W/ DEVICE –VARIOUS MANUFACTURERS.......................................152

BONIVA – ibandronate sodium tab 150 mg (baseequivalent)......................................................................... 40

BOOSTRIX – tet tox-diph-acell pertuss ad inj 5-2.5-18.5 lf-lf-mcg/0.5ml....................................................................... 15

BOSULIF – bosutinib tab 100 mg...................................... 18BOSULIF – bosutinib tab 500 mg...................................... 18BP CLEANSING WASH – sulfacetamide sodium-sulfur inurea emulsion 10-4%......................................................144

BP FOLINATAL PLUS B – prenatal w/ calcium carbonate-b6-b12-fa tab 1 mg......................................................... 119

BP MULTINATAL PLUS – prenatal w/o a vit w/ fefumarate-fa tab 30-1 mg................................................. 119

BP MULTINATAL PLUS – prenatal w/o a vit w/ fe fum-fatab chew 40-1 mg........................................................... 119

BRAVELLE – urofollitropin purified for inj 75 unit...............30BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 100-25 mcg/inh............................................................ 68

BREO ELLIPTA – fluticasone furoate-vilanterol aero powdba 200-25 mcg/inh............................................................ 68

BREVICON-28 – norethindrone & ethinyl estradiol tab 0.5mg-35 mcg.........................................................................28

BRILINTA – ticagrelor tab 60 mg..................................... 128BRILINTA – ticagrelor tab 90 mg..................................... 128brimonidine tartrate ophth soln 0.2%...........................139brimonidine tartrate ophth soln 0.15% (Alphaganp)...................................................................................... 139

BRIVIACT – brivaracetam iv soln 50 mg/5ml...................108BRIVIACT – brivaracetam oral soln 10 mg/ml................. 108BRIVIACT – brivaracetam tab 10 mg...............................108BRIVIACT – brivaracetam tab 25 mg...............................108BRIVIACT – brivaracetam tab 50 mg...............................108BRIVIACT – brivaracetam tab 75 mg...............................108BRIVIACT – brivaracetam tab 100 mg.............................108

2018


BROMFENAC – bromfenac sodium ophth soln 0.09%(base equiv) (once-daily)................................................ 140

bromocriptine mesylate cap 5 mg (baseequivalent)......................................................................114

bromocriptine mesylate tab 2.5 mg (base equivalent)(Parlodel)........................................................................ 115

BROVANA – arformoterol tartrate soln nebu 15 mcg/2ml(base equiv).......................................................................68

budesonide delayed release particles cap 3 mg(Entocort ec).................................................................... 23

budesonide inhalation susp 0.25 mg/2ml(Pulmicort)........................................................................ 68

budesonide inhalation susp 0.5 mg/2ml(Pulmicort)........................................................................ 68

budesonide inhalation susp 1 mg/2ml (Pulmicort).......68bumetanide tab 0.5 mg (Bumex).....................................59bumetanide tab 1 mg (Bumex)........................................59bumetanide tab 2 mg (Bumex)........................................59BUMEX – bumetanide tab 0.5 mg..................................... 59BUMEX – bumetanide tab 1 mg........................................ 59BUMEX – bumetanide tab 2 mg........................................ 59BUPHENYL – sodium phenylbutyrate oral powder 3 gm/teaspoonful........................................................................ 40

BUPHENYL – sodium phenylbutyrate tab 500 mg............ 40BUPRENORPHINE – buprenorphine td patch weekly 5mcg/hr................................................................................ 99

BUPRENORPHINE – buprenorphine td patch weekly 7.5mcg/hr................................................................................ 99

BUPRENORPHINE – buprenorphine td patch weekly 10mcg/hr................................................................................ 99



buprenorphine hcl-naloxone hcl sl tab 2-0.5 mg (baseequiv)...............................................................................153

buprenorphine hcl-naloxone hcl sl tab 8-2 mg (baseequiv)...............................................................................153

buprenorphine hcl sl tab 2 mg (base equiv)................. 99buprenorphine hcl sl tab 8 mg (base equiv)................. 99bupropion hcl (smoking deterrent) tab er 12hr 150 mg(Zyban).............................................................................. 98

bupropion hcl tab er 12hr 100 mg (Wellbutrin sr).........81bupropion hcl tab er 12hr 150 mg (Wellbutrin sr).........81bupropion hcl tab er 12hr 200 mg (Wellbutrin sr).........81bupropion hcl tab er 24hr 150 mg (Wellbutrin xl)......... 81bupropion hcl tab er 24hr 300 mg (Wellbutrin xl)......... 81bupropion hcl tab 75 mg................................................. 81bupropion hcl tab 100 mg............................................... 82buspirone hcl tab 5 mg....................................................80buspirone hcl tab 7.5 mg.................................................80buspirone hcl tab 10 mg..................................................81buspirone hcl tab 15 mg..................................................81buspirone hcl tab 30 mg..................................................81BUTALBITAL/ASPIRIN/CAFFEI – butalbital-aspirin-caffeine tab 50-325-40 mg................................................98

butalbital-acetaminophen-caffeine cap 50-325-40mg...................................................................................... 98

butalbital-acetaminophen-caffeine cap 50-300-40 mg(Fioricet)............................................................................98

butalbital-acetaminophen-caffeine tab 50-325-40 mg(Esgic)............................................................................... 98

butalbital-acetaminophen-caff w/ cod cap 50-325-40-30mg...................................................................................... 99

butalbital-acetaminophen tab 50-325 mg.......................98butalbital-aspirin-caffeine cap 50-325-40 mg(Fiorinal)............................................................................98

butalbital-aspirin-caff w/ codeine cap 50-325-40-30 mg(Fiorinal/codeine #3)....................................................... 99

BUTISOL SODIUM – butabarbital sodium tab 30 mg........89butorphanol tartrate nasal soln 10 mg/ml..................... 99BUTRANS – buprenorphine td patch weekly 5 mcg/hr......99BUTRANS – buprenorphine td patch weekly 7.5 mcg/hr........................................................................................ 99

BUTRANS – buprenorphine td patch weekly 10 mcg/hr........................................................................................ 99



BYDUREON BCISE – exenatide extended release suspauto-injector 2 mg/0.85ml................................................. 31

BYDUREON – exenatide for inj extended release susp 2mg...................................................................................... 30

BYDUREON PEN – exenatide extended release for susppen-injector 2 mg.............................................................. 31

BYETTA – exenatide soln pen-injector 5 mcg/0.02ml........31BYETTA – exenatide soln pen-injector 10 mcg/0.04ml......31BYSTOLIC – nebivolol hcl tab 2.5 mg (baseequivalent)......................................................................... 48

BYSTOLIC – nebivolol hcl tab 5 mg (base equivalent)......48BYSTOLIC – nebivolol hcl tab 10 mg (baseequivalent)......................................................................... 48

BYSTOLIC – nebivolol hcl tab 20 mg (baseequivalent)......................................................................... 48

BYVALSON – nebivolol-valsartan tab 5-80 mg..................48

Ccabergoline tab 0.5 mg.................................................... 40CABOMETYX – cabozantinib s-malate tab 20 mg (baseequivalent)......................................................................... 18

CABOMETYX – cabozantinib s-malate tab 40 mg (baseequivalent)......................................................................... 18

CABOMETYX – cabozantinib s-malate tab 60 mg (baseequivalent)......................................................................... 18

CADUET – amlodipine besylate-atorvastatin calcium tab5-10 mg..............................................................................62



2018



CADUET – amlodipine besylate-atorvastatin calcium tab10-10 mg............................................................................62




CAFERGOT – ergotamine w/ caffeine tab 1-100 mg.......106caffeine citrate oral soln 60 mg/3ml (10 mg/ml baseequiv).................................................................................91

CALAN SR – verapamil hcl tab er 120 mg........................ 52CALAN SR – verapamil hcl tab er 180 mg........................ 52CALAN SR – verapamil hcl tab er 240 mg........................ 52CALAN – verapamil hcl tab 80 mg.....................................52CALAN – verapamil hcl tab 120 mg...................................52calcipotriene-betamethasone dipropionate oint0.005-0.064% (Taclonex)...............................................147

calcipotriene cream 0.005% (Dovonex)........................150calcipotriene oint 0.005%...............................................150calcipotriene soln 0.005% (50 mcg/ml)........................ 150calcitonin (salmon) nasal soln 200 unit/act(Miacalcin)........................................................................ 40

CALCITRIOL – calcitriol oint 3 mcg/gm........................... 150calcitriol cap 0.25 mcg (Rocaltrol)..................................40calcitriol cap 0.5 mcg (Rocaltrol)....................................40calcitriol oral soln 1 mcg/ml (Rocaltrol).........................40calcium acetate (phosphate binder) cap 667 mg (169mg ca) (Phoslo)............................................................... 75

calcium acetate (phosphate binder) tab 667 mg(Eliphos)............................................................................75

CALCIUM PNV – prenatal w/o vit a w/ fe fum-fa-omega 3cap 28-1-250 mg.............................................................119

CALQUENCE – acalabrutinib cap 100 mg........................ 18CANASA – mesalamine suppos 1000 mg......................... 75candesartan cilexetil-hydrochlorothiazide tab 16-12.5mg (Atacand hct).............................................................46

candesartan cilexetil-hydrochlorothiazide tab 32-12.5mg (Atacand hct).............................................................46

candesartan cilexetil-hydrochlorothiazide tab 32-25mg (Atacand hct).............................................................46

candesartan cilexetil tab 4 mg (Atacand)...................... 46candesartan cilexetil tab 8 mg (Atacand)...................... 46candesartan cilexetil tab 16 mg (Atacand).................... 46candesartan cilexetil tab 32 mg (Atacand).................... 46capecitabine tab 150 mg (Xeloda).................................. 18capecitabine tab 500 mg (Xeloda).................................. 18CAPEX – fluocinolone acetonide shampoo 0.01%..........147CAPRELSA – vandetanib tab 100 mg............................... 18CAPRELSA – vandetanib tab 300 mg............................... 18CAPTOPRIL/HYDROCHLOROTHIA – captopril &hydrochlorothiazide tab 25-15 mg.................................... 44

CAPTOPRIL/HYDROCHLOROTHIA – captopril &hydrochlorothiazide tab 25-25 mg.................................... 44



captopril tab 12.5 mg........................................................44captopril tab 25 mg...........................................................44captopril tab 50 mg...........................................................44captopril tab 100 mg.........................................................44CARAC – fluorouracil cream 0.5%...................................150CARAFATE – sucralfate susp 1 gm/10ml.......................... 71CARAFATE – sucralfate tab 1 gm......................................71CARBAGLU – carglumic acid tab 200 mg......................... 40carbamazepine cap er 12hr 100 mg (Carbatrol)..........108carbamazepine cap er 12hr 200 mg (Carbatrol)..........108carbamazepine cap er 12hr 300 mg (Carbatrol)..........108carbamazepine chew tab 100 mg................................. 108carbamazepine susp 100 mg/5ml (Tegretol)................108carbamazepine tab er 12hr 100 mg (Tegretol-xr)........ 108carbamazepine tab er 12hr 200 mg (Tegretol-xr)........ 108carbamazepine tab er 12hr 400 mg (Tegretol-xr)........ 108carbamazepine tab 200 mg (Tegretol)..........................109CARBATROL – carbamazepine cap er 12hr 100 mg...... 109CARBATROL – carbamazepine cap er 12hr 200 mg...... 109CARBATROL – carbamazepine cap er 12hr 300 mg...... 109CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 12.5-50-200 mg...................................115

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 18.75-75-200 mg................................ 115

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 25-100-200 mg....................................115

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 31.25-125-200 mg.............................. 115

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 37.5-150-200 mg................................ 115

CARBIDOPA/LEVODOPA/ENTACA – carbidopa-levodopa-entacapone tabs 50-200-200 mg....................................115

carbidopa & levodopa orally disintegrating tab 10-100mg....................................................................................115



carbidopa & levodopa tab er 25-100 mg (Sinemetcr).....................................................................................115

carbidopa & levodopa tab er 50-200 mg (Sinemetcr).....................................................................................115

carbidopa & levodopa tab 10-100 mg (Sinemet).........115carbidopa & levodopa tab 25-100 mg (Sinemet).........115carbidopa & levodopa tab 25-250 mg (Sinemet).........115carbidopa tab 25 mg (Lodosyn)....................................115carbinoxamine maleate soln 4 mg/5ml.......................... 65carbinoxamine maleate tab 4 mg....................................65carbonyl iron susp 15 mg/1.25ml (elemental iron)..... 128CARDIZEM LA – diltiazem hcl coated beads tab er 24hr120 mg...............................................................................52

CARDURA – doxazosin mesylate tab 1 mg...................... 62

2018


CARDURA – doxazosin mesylate tab 2 mg...................... 62CARDURA – doxazosin mesylate tab 4 mg...................... 62CARDURA – doxazosin mesylate tab 8 mg...................... 62CARDURA XL – doxazosin mesylate tab er 24 hr 4 mg(base equiv).......................................................................79

CARDURA XL – doxazosin mesylate tab er 24 hr 8 mg(base equiv).......................................................................79

carisoprodol tab 350 mg (Soma).................................. 117CARNITOR – levocarnitine oral soln 1 gm/10ml (10%)..... 40CARNITOR – levocarnitine tab 330 mg............................. 40CARNITOR SF – levocarnitine oral soln 1 gm/10ml(10%)..................................................................................40

carteolol hcl ophth soln 1%.......................................... 139carvedilol phosphate cap er 24hr 10 mg (Coreg cr)..... 49carvedilol phosphate cap er 24hr 20 mg (Coreg cr)..... 49carvedilol phosphate cap er 24hr 40 mg (Coreg cr)..... 49carvedilol phosphate cap er 24hr 80 mg (Coreg cr)..... 49carvedilol tab 3.125 mg (Coreg)......................................49carvedilol tab 6.25 mg (Coreg)........................................49carvedilol tab 12.5 mg (Coreg)........................................49carvedilol tab 25 mg (Coreg)...........................................49CASODEX – bicalutamide tab 50 mg................................ 18CATAPRES – clonidine hcl tab 0.1 mg.............................. 62CATAPRES – clonidine hcl tab 0.2 mg.............................. 62CATAPRES – clonidine hcl tab 0.3 mg.............................. 62CATAPRES-TTS-1 – clonidine hcl td patch weekly 0.1mg/24hr..............................................................................62

CATAPRES-TTS-2 – clonidine hcl td patch weekly 0.2mg/24hr..............................................................................62

CATAPRES-TTS-3 – clonidine hcl td patch weekly 0.3mg/24hr..............................................................................62

CAYA – diaphragm arc-spring............................................ 28CAYSTON – aztreonam lysine for inhal soln 75 mg (baseequivalent)......................................................................... 13

CEDAX – ceftibuten cap 400 mg......................................... 2CEDAX – ceftibuten for susp 180 mg/5ml........................... 2cefaclor cap 250 mg........................................................... 2cefaclor cap 500 mg........................................................... 2CEFACLOR – cefaclor for susp 125 mg/5ml....................... 2CEFACLOR – cefaclor for susp 250 mg/5ml....................... 2CEFACLOR – cefaclor for susp 375 mg/5ml....................... 2cefadroxil cap 500 mg........................................................2cefadroxil for susp 250 mg/5ml........................................ 2cefadroxil for susp 500 mg/5ml........................................ 2cefadroxil tab 1 gm.............................................................2cefdinir cap 300 mg............................................................2cefdinir for susp 125 mg/5ml............................................ 2cefdinir for susp 250 mg/5ml............................................ 2CEFDITOREN PIVOXIL – cefditoren pivoxil tab 200 mg(base equivalent).................................................................2

CEFDITOREN PIVOXIL – cefditoren pivoxil tab 400 mg(base equivalent).................................................................2

cefixime for susp 100 mg/5ml (Suprax)........................... 2cefixime for susp 200 mg/5ml (Suprax)........................... 2cefpodoxime proxetil for susp 50 mg/5ml....................... 2cefpodoxime proxetil for susp 100 mg/5ml..................... 2

cefpodoxime proxetil tab 100 mg..................................... 2cefpodoxime proxetil tab 200 mg..................................... 2cefprozil for susp 125 mg/5ml...........................................2cefprozil for susp 250 mg/5ml...........................................2cefprozil tab 250 mg...........................................................2cefprozil tab 500 mg...........................................................2CEFTIBUTEN – ceftibuten cap 400 mg...............................2CEFTIBUTEN – ceftibuten for susp 180 mg/5ml................. 2CEFTIN – cefuroxime axetil for susp 125 mg/5ml............... 2CEFTIN – cefuroxime axetil for susp 250 mg/5ml............... 2cefuroxime axetil tab 250 mg............................................2cefuroxime axetil tab 500 mg (Ceftin).............................. 2celecoxib cap 50 mg (Celebrex)....................................104celecoxib cap 100 mg (Celebrex)..................................104celecoxib cap 200 mg (Celebrex)..................................104celecoxib cap 400 mg (Celebrex)..................................104CELLCEPT – mycophenolate mofetil cap 250 mg...........153CELLCEPT – mycophenolate mofetil for oral susp 200 mg/ml......................................................................................153

CELLCEPT – mycophenolate mofetil tab 500 mg........... 153CELONTIN – methsuximide cap 300 mg.........................109CENTANY – mupirocin oint 2%........................................145cephalexin cap 250 mg (Keflex)........................................2cephalexin cap 500 mg (Keflex)........................................2cephalexin cap 750 mg (Keflex)........................................2cephalexin for susp 125 mg/5ml.......................................2cephalexin for susp 250 mg/5ml.......................................2CERDELGA – eliglustat tartrate cap 84 mg (baseequivalent)....................................................................... 128

CESAMET – nabilone cap 1 mg........................................ 73CETRAXAL – ciprofloxacin hcl otic soln 0.2% (baseequivalent)....................................................................... 142

cevimeline hcl cap 30 mg (Evoxac)..............................142CHANTIX CONTINUING MONTH – varenicline tartrate tab1 mg (base equiv).............................................................98

CHANTIX STARTING MONTH PA – varenicline tartratetab 0.5 mg x 11 & tab 1 mg x 42 pack............................. 98

CHANTIX – varenicline tartrate tab 0.5 mg (baseequiv)................................................................................. 98

CHANTIX – varenicline tartrate tab 1 mg (base equiv)......98CHEMET – succimer cap 100 mg....................................153CHENODAL – chenodiol tab 250 mg.................................75CHLORDIAZEPOXIDE/AMITRIPT – chlordiazepoxide-amitriptyline tab 5-12.5 mg............................................... 95

CHLORDIAZEPOXIDE/AMITRIPT – chlordiazepoxide-amitriptyline tab 10-25 mg................................................ 95

chlordiazepoxide hcl cap 5 mg.......................................81chlordiazepoxide hcl cap 10 mg.....................................81chlordiazepoxide hcl cap 25 mg.....................................81chlordiazepoxide hcl-clidinium bromide cap 5-2.5 mg(Librax).............................................................................. 71

chlorhexidine gluconate soln 0.12% (Peridex)............142CHLOROQUINE PHOSPHATE – chloroquine phosphatetab 250 mg........................................................................ 13

chloroquine phosphate tab 500 mg (Aralen).................13CHLOROTHIAZIDE – chlorothiazide tab 250 mg..............59

2018


chlorothiazide tab 500 mg............................................... 59chlorpromazine hcl tab 10 mg........................................ 85chlorpromazine hcl tab 25 mg........................................ 85chlorpromazine hcl tab 50 mg........................................ 85chlorpromazine hcl tab 100 mg...................................... 85chlorpromazine hcl tab 200 mg...................................... 85CHLORPROPAMIDE – chlorpropamide tab 100 mg......... 31CHLORPROPAMIDE – chlorpropamide tab 250 mg......... 31chlorthalidone tab 25 mg.................................................59chlorthalidone tab 50 mg.................................................59CHLORZOXAZONE – chlorzoxazone tab 250 mg.......... 117chlorzoxazone tab 500 mg (Parafon forte dsc)........... 117CHOLBAM – cholic acid cap 50 mg.................................. 75CHOLBAM – cholic acid cap 250 mg................................ 75cholecalciferol cap 1000 unit........................................ 118cholecalciferol cap 50000 unit...................................... 118cholecalciferol chew tab 400 unit.................................118cholecalciferol chew tab 1000 unit...............................118cholecalciferol drops 400 unit/0.03ml (per drop)........ 118cholecalciferol drops 5000 unit/ml (1000unit/0.2ml)....................................................................... 118

cholecalciferol oral liquid 400 unit/ml..........................118cholecalciferol tab 400 unit........................................... 118cholecalciferol tab 1000 unit......................................... 119cholestyramine light powder 4 gm/dose (Questranlight)...................................................................................56

cholestyramine light powder packets 4 gm.................. 56cholestyramine powder 4 gm/dose (Questran).............56cholestyramine powder packets 4 gm (Questran)........56choline fenofibrate cap dr 45 mg (fenofibric acidequiv) (Trilipix).................................................................56

choline fenofibrate cap dr 135 mg (fenofibric acidequiv) (Trilipix).................................................................56

CIALIS – tadalafil tab 2.5 mg............................................. 65CIALIS – tadalafil tab 5 mg................................................ 65ciclopirox gel 0.77%....................................................... 145ciclopirox olamine cream 0.77% (base equiv).............145ciclopirox olamine susp 0.77% (base equiv)...............145ciclopirox shampoo 1% (Loprox shampoo)................ 145ciclopirox solution 8% (Penlac nail lacquer)...............145cilostazol tab 50 mg....................................................... 128cilostazol tab 100 mg..................................................... 128CILOXAN – ciprofloxacin hcl ophth oint 0.3%..................137CILOXAN – ciprofloxacin hcl ophth soln 0.3%.................137cimetidine hcl soln 300 mg/5ml...................................... 72cimetidine tab 200 mg......................................................72cimetidine tab 300 mg......................................................72cimetidine tab 400 mg......................................................72cimetidine tab 800 mg......................................................72CIMZIA – certolizumab pegol for inj kit 2 x 200 mg........... 75CIMZIA – certolizumab pegol inj kit 2 x 200 mg/ml............75CIMZIA STARTER KIT – certolizumab pegol inj kit 6 x 200mg/ml..................................................................................75

CINRYZE – c1 esterase inhibitor (human) for iv inj 500unit....................................................................................128

CIPRO – ciprofloxacin for oral susp 250 mg/5ml (5%) (5gm/100ml)............................................................................ 4

CIPRO – ciprofloxacin for oral susp 500 mg/5ml (10%) (10gm/100ml)............................................................................ 5

CIPRO – ciprofloxacin hcl tab 250 mg (base equiv)............ 5CIPRO – ciprofloxacin hcl tab 500 mg (base equiv)............ 5CIPRODEX – ciprofloxacin-dexamethasone otic susp0.3-0.1%...........................................................................142

CIPROFLOXACIN – ciprofloxacin hcl otic soln 0.2% (baseequivalent)....................................................................... 142

ciprofloxacin-ciprofloxacin hcl tab er 24hr 1000mg(base eq) (Cipro xr)..................................................... 5

ciprofloxacin-ciprofloxacin hcl tab er 24hr 500 mg(base eq) (Cipro xr)...........................................................5

ciprofloxacin for oral susp 250 mg/5ml (5%) (5gm/100ml) (Cipro)..............................................................5

ciprofloxacin for oral susp 500 mg/5ml (10%) (10gm/100ml) (Cipro)..............................................................5

CIPROFLOXACIN HCL – ciprofloxacin hcl tab 100 mg(base equiv).........................................................................5

ciprofloxacin hcl ophth soln 0.3% (Ciloxan)............... 137ciprofloxacin hcl tab 750 mg (base equiv).......................5ciprofloxacin hcl tab 250 mg (base equiv) (Cipro)..........5ciprofloxacin hcl tab 500 mg (base equiv) (Cipro)..........5CIPRO HC – ciprofloxacin-hydrocortisone otic susp0.2-1%..............................................................................142

CIPRO XR – ciprofloxacin-ciprofloxacin hcl tab er 24hr1000 mg(base eq)...............................................................5

CIPRO XR – ciprofloxacin-ciprofloxacin hcl tab er 24hr 500mg (base eq)....................................................................... 5

citalopram hydrobromide oral soln 10 mg/5ml............. 82citalopram hydrobromide tab 10 mg (base equiv)(Celexa)............................................................................. 82

citalopram hydrobromide tab 20 mg (base equiv)(Celexa)............................................................................. 82

citalopram hydrobromide tab 40 mg (base equiv)(Celexa)............................................................................. 82

CITRANATAL ASSURE – prenat w/o a w/fecbn-fegl-dss-fatab & dha cap 300 mg pack........................................... 119

CITRANATAL B-CALM – prenat w/o a w/fecbn-feglu-fa tab20-1 mg & vit b6 tab pak................................................119

CITRANATAL BLOOM – prenatal vit w/ dss-fe cbn-fe gluc-fa tab 90-1 mg.................................................................119

CITRANATAL DHA – prenat w/o a w/fecbn-fegl-dss-fa tab& dha cap 250 mg pack................................................. 119

CITRANATAL 90 DHA – prenat w/o a w/fecbn-fegl-dss-fatab 90 &dha cap 300mg pak.......................................... 119

CITRANATAL HARMONY – prenat w/o a w/fe fum-fe cbn-dss-fa-dha cap 27-1-260 mg.......................................... 119

CITRANATAL RX – prenatal w/o a w/ fe carbonyl-fe gluc-dss-fa tab 27-1mg........................................................... 119

CLARITHROMYCIN – clarithromycin for susp 125mg/5ml..................................................................................3

CLARITHROMYCIN – clarithromycin for susp 250mg/5ml..................................................................................3

clarithromycin tab er 24hr 500 mg................................... 3

2018


clarithromycin tab 250 mg (Biaxin).................................. 3clarithromycin tab 500 mg (Biaxin).................................. 3CLEMASTINE FUMARATE – clemastine fumarate tab2.68 mg..............................................................................65

CLEOCIN – clindamycin hcl cap 75 mg.............................13CLEOCIN – clindamycin hcl cap 150 mg...........................13CLEOCIN – clindamycin hcl cap 300 mg...........................13CLEOCIN – clindamycin phosphate vaginal cream 2%.....78CLEOCIN – clindamycin phosphate vaginal suppos 100mg...................................................................................... 78

CLEOCIN PEDIATRIC GRANULE – clindamycin palmitatehcl for soln 75 mg/5ml (base equiv)................................. 13

CLEOCIN-T – clindamycin phosphate lotion 1%............. 144CLEOCIN-T – clindamycin phosphate soln 1%............... 144CLEOCIN-T – clindamycin phosphate swab 1%............. 144CLIMARA – estradiol td patch weekly 0.025 mg/24hr....... 26CLIMARA – estradiol td patch weekly 0.05 mg/24hr......... 26CLIMARA – estradiol td patch weekly 0.06 mg/24hr......... 26CLIMARA – estradiol td patch weekly 0.075 mg/24hr....... 26CLIMARA – estradiol td patch weekly 0.1 mg/24hr........... 26CLIMARA – estradiol td patch weekly 0.0375 mg/24hr(37.5 mcg/24hr)................................................................. 26

CLIMARA PRO – estradiol-levonorgestrel td patch weekly0.045-0.015 mg/day.......................................................... 26

clindamycin hcl cap 75 mg (Cleocin).............................13clindamycin hcl cap 150 mg (Cleocin)...........................13clindamycin hcl cap 300 mg (Cleocin)...........................14clindamycin palmitate hcl for soln 75 mg/5ml (baseequiv) (Cleocin pediatric gr).......................................... 14

clindamycin phosphate-benzoyl peroxide gel 1-5%(Benzaclin)......................................................................144

clindamycin phosphate gel 1% (Cleocin-t)..................144clindamycin phosphate lotion 1% (Cleocin-t)............. 144clindamycin phosphate soln 1% (Cleocin-t)................144clindamycin phosphate swab 1% (Cleocin-t).............. 144clindamycin phosphate vaginal cream 2%(Cleocin)............................................................................78

clindamycin phosph-benzoyl peroxide (refrig) gel 1.2(1)-5% (Duac)..................................................................144

CLINDESSE – clindamycin phosphate (one dose) vaginalcream 2%...........................................................................78

clobetasol propionate cream 0.05% (Temovate).........147clobetasol propionate emollient base cream 0.05%(Temovate e)...................................................................147

clobetasol propionate emulsion foam 0.05% (Olux-e)...................................................................................... 147

clobetasol propionate foam 0.05% (Olux)................... 147clobetasol propionate gel 0.05% (Temovate).............. 147clobetasol propionate lotion 0.05% (Clobex).............. 147clobetasol propionate oint 0.05% (Temovate).............147clobetasol propionate shampoo 0.05% (Clobex)........ 147clobetasol propionate soln 0.05% (Temovate)............ 147clobetasol propionate spray 0.05% (Clobex).............. 147CLOBEX – clobetasol propionate lotion 0.05%............... 147CLOBEX – clobetasol propionate shampoo 0.05%......... 147

CLOCORTOLONE PIVALATE – clocortolone pivalatecream 0.1%..................................................................... 147

CLOCORTOLONE PIVALATE PUM – clocortolone pivalatecream 0.1%..................................................................... 147

CLODERM – clocortolone pivalate cream 0.1%..............147CLODERM PUMP – clocortolone pivalate cream0.1%................................................................................. 147

clomipramine hcl cap 25 mg (Anafranil)........................82clomipramine hcl cap 50 mg (Anafranil)........................82clomipramine hcl cap 75 mg (Anafranil)........................82clonazepam orally disintegrating tab 0.125 mg.......... 109clonazepam orally disintegrating tab 0.25 mg............ 109clonazepam orally disintegrating tab 0.5 mg.............. 109clonazepam orally disintegrating tab 1 mg................. 109clonazepam orally disintegrating tab 2 mg................. 109clonazepam tab 0.5 mg (Klonopin)...............................109clonazepam tab 1 mg (Klonopin)..................................109clonazepam tab 2 mg (Klonopin)..................................109clonidine hcl tab er 12hr 0.1 mg (Kapvay).....................91clonidine hcl tab 0.1 mg (Catapres)............................... 62clonidine hcl tab 0.2 mg (Catapres)............................... 62clonidine hcl tab 0.3 mg (Catapres)............................... 62clonidine hcl td patch weekly 0.1 mg/24hr (Catapres-tts-1)...................................................................................62

clonidine hcl td patch weekly 0.2 mg/24hr (Catapres-tts-2)...................................................................................62

clonidine hcl td patch weekly 0.3 mg/24hr (Catapres-tts-3)...................................................................................62

clopidogrel bisulfate tab 75 mg (base equiv)(Plavix)............................................................................ 128

clopidogrel bisulfate tab 300 mg (base equiv)(Plavix)............................................................................ 128

clorazepate dipotassium tab 3.75 mg (Tranxene t).......81clorazepate dipotassium tab 7.5 mg (Tranxene t).........81clorazepate dipotassium tab 15 mg (Tranxene t)..........81CLORPRES – clonidine & chlorthalidone tab 0.1-15mg...................................................................................... 62

CLORPRES – clonidine & chlorthalidone tab 0.2-15mg...................................................................................... 62

CLORPRES – clonidine & chlorthalidone tab 0.3-15mg...................................................................................... 62

clotrimazole cream 1%...................................................145clotrimazole soln 1%...................................................... 145clotrimazole troche 10 mg............................................. 142clotrimazole w/ betamethasone cream 1-0.05%(Lotrisone)...................................................................... 145

clotrimazole w/ betamethasone lotion 1-0.05%...........145CLOZAPINE ODT – clozapine orally disintegrating tab12.5 mg..............................................................................85

CLOZAPINE ODT – clozapine orally disintegrating tab 150mg...................................................................................... 85

CLOZAPINE ODT – clozapine orally disintegrating tab 200mg...................................................................................... 85

clozapine orally disintegrating tab 25 mg (Fazaclo).....85clozapine orally disintegrating tab 100 mg(Fazaclo)............................................................................86

2018


clozapine tab 50 mg......................................................... 86clozapine tab 200 mg....................................................... 86clozapine tab 25 mg (Clozaril).........................................86clozapine tab 100 mg (Clozaril).......................................86CLOZARIL – clozapine tab 25 mg..................................... 86CLOZARIL – clozapine tab 100 mg................................... 86C-NATE DHA – prenatal vit w/ fe fum-fa-omega 3 cap28-1-200 mg.................................................................... 119

COAGADEX – coagulation factor x (human) for inj 250unit....................................................................................133

COAGADEX – coagulation factor x (human) for inj 500unit....................................................................................133

COARTEM – artemether-lumefantrine tab 20-120 mg...... 13CODAR AR – chlorpheniramine w/ codeine liquid 2-8mg/5ml............................................................................... 66

CODEINE SULFATE – codeine sulfate tab 15 mg.............99CODEINE SULFATE – codeine sulfate tab 30 mg.............99CODEINE SULFATE – codeine sulfate tab 60 mg.............99codeine sulfate tab 15 mg (Codeine sulfate).................99codeine sulfate tab 30 mg (Codeine sulfate).................99codeine sulfate tab 60 mg (Codeine sulfate).................99COLAZAL – balsalazide disodium cap 750 mg................. 75COLCHICINE – colchicine cap 0.6 mg............................ 108COLCHICINE – colchicine tab 0.6 mg.............................108colchicine w/ probenecid tab 0.5-500 mg.................... 108COLCRYS – colchicine tab 0.6 mg..................................108COLESTID – colestipol hcl granule packets 5 gm.............56COLESTID – colestipol hcl granules 5 gm........................ 56COLESTID – colestipol hcl tab 1 gm................................. 56COLESTID FLAVORED – colestipol hcl granule packets 5gm...................................................................................... 56

COLESTID FLAVORED – colestipol hcl granules 5gm...................................................................................... 56

colestipol hcl granule packets 5 gm (Colestidflavored)............................................................................56

colestipol hcl granules 5 gm (Colestid flavored).......... 56colestipol hcl tab 1 gm (Colestid)...................................56colistimethate sodium for inj 150 mg (Coly-mycinm)....................................................................................... 14

COLY-MYCIN M – colistimethate sodium for inj 150mg...................................................................................... 14

COLY-MYCIN S – neomycin-colistin-hc-thonzonium oticsusp 3.3-3-10-0.5 mg/ml.................................................142

COLYTE-FLAVOR PACKS – peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm................................................71

COMBIGAN – brimonidine tartrate-timolol maleate ophthsoln 0.2-0.5%...................................................................139

COMBIPATCH – estradiol-norethindrone ace td pttw0.05-0.14 mg/day.............................................................. 26

COMBIPATCH – estradiol-norethindrone ace td pttw0.05-0.25 mg/day.............................................................. 26

COMBIVENT RESPIMAT – ipratropium-albuterol inhalaerosol soln 20-100 mcg/act............................................ 68

COMBIVIR – lamivudine-zidovudine tab 150-300 mg......... 9COMETRIQ – cabozantinib s-malate cap 3 x 20 mg (60mg dose) kit.......................................................................18

COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 1 x 20mg (100 dose) kit.............................................................. 18

COMETRIQ – cabozantinib s-mal cap 1 x 80 mg & 3 x 20mg (140 dose) kit.............................................................. 18

COMPLERA – emtricitabine-rilpivirine-tenofovir df tab200-25-300 mg.................................................................... 9

COMPLETE NATAL DHA – prenat-fe bis-fe prot succ-fa-catab & omega 3 cap 250 pk.............................................119

COMPLETENATE – prenatal vit w/ fe fumarate-fa chewtab 29-1 mg..................................................................... 119

COMTAN – entacapone tab 200 mg................................115CO-NATAL FA – prenatal vit w/ fe fumarate-fa tab 29-1mg.................................................................................... 119

CONCEPT DHA – prenatal w/fe fum-fe poly -fa-omega 3cap 53.5-38-1 mg............................................................119

CONCEPT OB – prenatal w/o a w/fe fum-fe poly-fa cap130-92.4-1 mg................................................................. 119

CONCERTA – methylphenidate hcl tab er osmotic release(osm) 18 mg...................................................................... 91




CONDYLOX – podofilox gel 0.5%....................................150CONTOUR NEXT ONE BLOOD GL – blood glucosemonitoring kit................................................................... 152

COPAXONE – glatiramer acetate soln prefilled syringe 20mg/ml..................................................................................94

COPAXONE – glatiramer acetate soln prefilled syringe 40mg/ml..................................................................................94

COPEGUS – ribavirin tab 200 mg....................................... 7CORDRAN – flurandrenolide tape 4 mcg/sqcm...............147COREG – carvedilol tab 3.125 mg.....................................49COREG – carvedilol tab 6.25 mg.......................................49COREG – carvedilol tab 12.5 mg.......................................49COREG – carvedilol tab 25 mg..........................................49COREG CR – carvedilol phosphate cap er 24hr 10mg...................................................................................... 49

COREG CR – carvedilol phosphate cap er 24hr 20mg...................................................................................... 49



CORGARD – nadolol tab 20 mg........................................49CORGARD – nadolol tab 40 mg........................................49CORGARD – nadolol tab 80 mg........................................49CORIFACT – factor xiii concentrate (human) for inj kit1000-1600 unit................................................................ 133

CORLANOR – ivabradine hcl tab 5 mg (base equiv).........62CORLANOR – ivabradine hcl tab 7.5 mg (base equiv)......62CORTANE-B – hydrocortisone-pramoxine-chloroxylenol lot10-10-1mg/ml...................................................................147

CORTEF – hydrocortisone tab 5 mg..................................23

2018


CORTEF – hydrocortisone tab 10 mg................................23CORTEF – hydrocortisone tab 20 mg................................23CORTENEMA – hydrocortisone enema 100 mg/60ml.....143CORTIFOAM – hydrocortisone acetate rectal foam 10%(90 mg/dose)................................................................... 143

CORTISONE ACETATE – cortisone acetate tab 25mg...................................................................................... 23

CORTISPORIN – bacitracin-polymyxin-neomycin hc oint1%.................................................................................... 145

CORTISPORIN – neomycin-polymyxin-hc crm 3.5 mg/gm-10000 unt/gm-0.5%...................................................145

CORZIDE – nadolol & bendroflumethiazide tab 40-5mg...................................................................................... 49

CORZIDE – nadolol & bendroflumethiazide tab 80-5mg...................................................................................... 49

COSENTYX – secukinumab subcutaneous soln prefilledsyringe 150 mg/ml...........................................................150

COSENTYX SENSOREADY PEN – secukinumabsubcutaneous soln auto-injector 150 mg/ml...................150

COSOPT – dorzolamide hcl-timolol maleate ophth soln22.3-6.8 mg/ml.................................................................139

COSOPT PF – dorzolamide hcl-timolol maleate ophth sol22.3-6.8 mg/ml pf............................................................ 139

COTELLIC – cobimetinib fumarate tab 20 mg (baseequivalent)......................................................................... 18

COUMADIN – warfarin sodium tab 1 mg.........................128COUMADIN – warfarin sodium tab 2 mg.........................128COUMADIN – warfarin sodium tab 2.5 mg......................128COUMADIN – warfarin sodium tab 3 mg.........................128COUMADIN – warfarin sodium tab 4 mg.........................128COUMADIN – warfarin sodium tab 5 mg.........................128COUMADIN – warfarin sodium tab 6 mg.........................128COUMADIN – warfarin sodium tab 7.5 mg......................128COUMADIN – warfarin sodium tab 10 mg.......................128COZAAR – losartan potassium tab 25 mg.........................46COZAAR – losartan potassium tab 50 mg.........................46COZAAR – losartan potassium tab 100 mg.......................46CREON – pancrelipase (lip-prot-amyl) dr cap3000-9500-15000 unit....................................................... 74

CREON – pancrelipase (lip-prot-amyl) dr cap6000-19000-30000 unit..................................................... 74

CREON – pancrelipase (lip-prot-amyl) dr cap12000-38000-60000 unit...................................................74

CREON – pancrelipase (lip-prot-amyl) dr cap24000-76000-120000 unit.................................................74

CREON – pancrelipase (lip-prot-amyl) dr cap36000-114000-180000 unit............................................... 75

CRESEMBA – isavuconazonium sulfate cap 186 mg..........6CRINONE – progesterone vaginal gel 4%.........................79CRIXIVAN – indinavir sulfate cap 200 mg........................... 9CRIXIVAN – indinavir sulfate cap 400 mg........................... 9cromolyn sodium ophth soln 4%..................................140cromolyn sodium oral conc 100 mg/5ml(Gastrocrom).................................................................... 75

cromolyn sodium soln nebu 20 mg/2ml........................ 68

CUVITRU – immune globulin (human) subcutaneous inj 1gm/5ml............................................................................... 15

CUVITRU – immune globulin (human) subcutaneous inj 2gm/10ml............................................................................. 15



CUVPOSA – glycopyrrolate oral soln 1 mg/5ml.................72cyanocobalamin inj 1000 mcg/ml................................. 128CYCLESSA – desogest-ethin est tab0.1-0.025/0.125-0.025/0.15-0.025mg-mg.........................28

cyclobenzaprine hcl tab 5 mg.......................................117cyclobenzaprine hcl tab 7.5 mg....................................117cyclobenzaprine hcl tab 10 mg.....................................117CYCLOGYL – cyclopentolate hcl ophth soln 0.5%..........140CYCLOGYL – cyclopentolate hcl ophth soln 1%.............140CYCLOGYL – cyclopentolate hcl ophth soln 2%.............140CYCLOMYDRIL – cyclopentolate w/ phenylephrine ophthsoln 0.2-1%......................................................................141

cyclopentolate hcl ophth soln 0.5% (Cyclogyl)...........141cyclopentolate hcl ophth soln 1% (Cyclogyl)..............141cyclopentolate hcl ophth soln 2% (Cyclogyl)..............141CYCLOPHOSPHAMIDE – cyclophosphamide cap 25mg...................................................................................... 18

CYCLOPHOSPHAMIDE – cyclophosphamide cap 50mg...................................................................................... 18

CYCLOSERINE – cycloserine cap 250 mg......................... 6CYCLOSET – bromocriptine mesylate tab 0.8 mg (baseequivalent)......................................................................... 31

cyclosporine cap 25 mg (Sandimmune)...................... 153cyclosporine cap 100 mg (Sandimmune).................... 153cyclosporine modified cap 50 mg (Cyclosporinemodifie)........................................................................... 153

cyclosporine modified cap 25 mg (Neoral)..................153cyclosporine modified cap 100 mg (Neoral)................153CYCLOSPORINE MODIFIED – cyclosporine modified cap50 mg...............................................................................153

cyclosporine modified oral soln 100 mg/ml(Neoral)............................................................................153

cyproheptadine hcl syrup 2 mg/5ml...............................65cyproheptadine hcl tab 4 mg.......................................... 65CYSTADANE – betaine powder for oral solution...............40CYSTAGON – cysteamine bitartrate cap 50 mg................79CYSTAGON – cysteamine bitartrate cap 150 mg..............79CYSTARAN – cysteamine hcl ophth soln 0.44% (baseequivalent)....................................................................... 141

CYTOMEL – liothyronine sodium tab 5 mcg......................36CYTOMEL – liothyronine sodium tab 25 mcg....................36CYTOMEL – liothyronine sodium tab 50 mcg....................36CYTOTEC – misoprostol tab 100 mcg...............................72CYTOTEC – misoprostol tab 200 mcg...............................72

DDAKLINZA – daclatasvir dihydrochloride tab 30 mg (baseequivalent)............................................................................7

2018


DAKLINZA – daclatasvir dihydrochloride tab 60 mg (baseequivalent)............................................................................7

DAKLINZA – daclatasvir dihydrochloride tab 90 mg (baseequivalent)............................................................................7

DALIRESP – roflumilast tab 500 mcg................................68danazol cap 50 mg............................................................25danazol cap 100 mg..........................................................25danazol cap 200 mg..........................................................25DANTRIUM – dantrolene sodium cap 25 mg.................. 117DANTRIUM – dantrolene sodium cap 50 mg.................. 118dantrolene sodium cap 100 mg.................................... 118dantrolene sodium cap 25 mg (Dantrium)................... 118dantrolene sodium cap 50 mg (Dantrium)................... 118dapsone gel 5% (Aczone).............................................. 144dapsone tab 25 mg...........................................................14dapsone tab 100 mg.........................................................14DAPTACEL – diph, acellular pert & tet tox inj 15 lf-23mcg-5 lf/0.5ml....................................................................15

DARAPRIM – pyrimethamine tab 25 mg........................... 13darifenacin hydrobromide tab er 24hr 7.5 mg (baseequiv) (Enablex)...............................................................78

darifenacin hydrobromide tab er 24hr 15 mg (baseequiv) (Enablex)...............................................................78

DAYPRO – oxaprozin tab 600 mg................................... 104DAYTRANA – methylphenidate td patch 10 mg/9hr.......... 91DAYTRANA – methylphenidate td patch 15 mg/9hr.......... 91DAYTRANA – methylphenidate td patch 20 mg/9hr.......... 91DAYTRANA – methylphenidate td patch 30 mg/9hr.......... 91DDAVP – desmopressin acetate inj 4 mcg/ml................... 40DDAVP – desmopressin acetate nasal soln 0.01%(refrigerated)...................................................................... 40

DDAVP – desmopressin acetate tab 0.1 mg......................40DDAVP – desmopressin acetate tab 0.2 mg......................40DELZICOL – mesalamine cap dr 400 mg..........................75DEMADEX – torsemide tab 10 mg.................................... 59DEMADEX – torsemide tab 20 mg.................................... 59demeclocycline hcl tab 150 mg........................................ 4demeclocycline hcl tab 300 mg........................................ 4DENAVIR – penciclovir cream 1%................................... 145DEPAKENE – valproate sodium oral soln 250 mg/5ml(base equiv).....................................................................109

DEPAKENE – valproic acid cap 250 mg..........................109DEPAKOTE – divalproex sodium tab delayed release 125mg.................................................................................... 109

DEPAKOTE – divalproex sodium tab delayed release 250mg.................................................................................... 109

DEPAKOTE – divalproex sodium tab delayed release 500mg.................................................................................... 109

DEPAKOTE ER – divalproex sodium tab er 24 hr 250mg.................................................................................... 109

DEPAKOTE ER – divalproex sodium tab er 24 hr 500mg.................................................................................... 109

DEPAKOTE SPRINKLES – divalproex sodium capdelayed release sprinkle 125 mg....................................109

DEPEN TITRATABS – penicillamine tab 250 mg............ 153

DEPO-TESTOSTERONE – testosterone cypionate im injin oil 100 mg/ml.................................................................25

DEPO-TESTOSTERONE – testosterone cypionate im injin oil 200 mg/ml.................................................................25

DERMA-SMOOTHE/FS BODY – fluocinolone acetonide oil0.01% (body oil).............................................................. 147

DERMA-SMOOTHE/FS SCALP – fluocinolone acetonideoil 0.01% (scalp oil).........................................................147

DERMATOP – prednicarbate cream 0.1%.......................147DERMATOP – prednicarbate oint 0.1%........................... 147DERMOTIC – fluocinolone acetonide (otic) oil 0.01%..... 142DESCOVY – emtricitabine-tenofovir alafenamide fumaratetab 200-25 mg..................................................................... 9

desipramine hcl tab 50 mg..............................................82desipramine hcl tab 75 mg..............................................82desipramine hcl tab 100 mg............................................82desipramine hcl tab 150 mg............................................82desipramine hcl tab 10 mg (Norpramin)........................ 82desipramine hcl tab 25 mg (Norpramin)........................ 82desloratadine tab 5 mg (Clarinex).................................. 65desmopressin acetate inj 4 mcg/ml (Ddavp).................40desmopressin acetate nasal soln 0.01% (refrigerated)(Ddavp)..............................................................................40

desmopressin acetate nasal spray soln 0.01%(Ddavp)..............................................................................40

desmopressin acetate nasal spray soln 0.01%(refrigerated).....................................................................41

desmopressin acetate tab 0.1 mg (Ddavp)....................41desmopressin acetate tab 0.2 mg (Ddavp)....................41DESOGEN – desogestrel & ethinyl estradiol tab 0.15mg-30 mcg.........................................................................28

desonide cream 0.05% (Desowen)............................... 148desonide lotion 0.05% (Desowen)................................ 148desonide oint 0.05%....................................................... 148DESOWEN – desonide cream 0.05%..............................148DESOWEN – desonide lotion 0.05%............................... 148desoximetasone cream 0.05% (Topicort).....................148desoximetasone cream 0.25% (Topicort).....................148desoximetasone gel 0.05% (Topicort).......................... 148desoximetasone oint 0.05% (Topicort).........................148desoximetasone oint 0.25% (Topicort).........................148DESOXYN – methamphetamine hcl tab 5 mg...................91DESVENLAFAXINE ER – desvenlafaxine tab er 24hr 50mg...................................................................................... 82

DESVENLAFAXINE ER – desvenlafaxine tab er 24hr 100mg...................................................................................... 82

desvenlafaxine succinate tab er 24hr 25 mg (baseequiv) (Pristiq)................................................................. 82



DEXAMETHASONE – dexamethasone soln 0.5mg/5ml............................................................................... 23

DEXAMETHASONE – dexamethasone tab 1 mg..............23DEXAMETHASONE – dexamethasone tab 2 mg..............23

2018


dexamethasone elixir 0.5 mg/5ml................................... 23DEXAMETHASONE INTENSOL – dexamethasone conc 1mg/ml..................................................................................23

DEXAMETHASONE SODIUM PHOS – dexamethasonesodium phosphate ophth soln 0.1%............................... 138

dexamethasone tab 0.5 mg............................................. 23dexamethasone tab 0.75 mg........................................... 23dexamethasone tab 1.5 mg............................................. 23dexamethasone tab 4 mg................................................ 23dexamethasone tab 6 mg................................................ 23DEXEDRINE – dextroamphetamine sulfate cap er 24hr 5mg...................................................................................... 91

DEXEDRINE – dextroamphetamine sulfate cap er 24hr 10mg...................................................................................... 91

DEXEDRINE – dextroamphetamine sulfate cap er 24hr 15mg...................................................................................... 91

dexmethylphenidate hcl cap er 24 hr 5 mg (Focalinxr).......................................................................................91








dexmethylphenidate hcl tab 2.5 mg (Focalin)............... 92dexmethylphenidate hcl tab 5 mg (Focalin).................. 92dexmethylphenidate hcl tab 10 mg (Focalin)................ 92DEXPAK 10 DAY – dexamethasone tab therapy pack 1.5mg (35).............................................................................. 23

DEXPAK 13 DAY – dexamethasone tab therapy pack 1.5mg (51).............................................................................. 23

DEXPAK 6 DAY – dexamethasone tab therapy pack 1.5mg (21).............................................................................. 23

dextroamphetamine sulfate cap er 24hr 5 mg(Dexedrine)....................................................................... 92



dextroamphetamine sulfate oral solution 5 mg/5ml(Procentra)........................................................................92

dextroamphetamine sulfate tab 5 mg.............................92dextroamphetamine sulfate tab 10 mg...........................92D.H.E. 45 – dihydroergotamine mesylate inj 1 mg/ml......107DIAMOX – acetazolamide cap er 12hr 500 mg................. 59DIASTAT ACUDIAL – diazepam rectal gel delivery system10 mg...............................................................................109

DIASTAT ACUDIAL – diazepam rectal gel delivery system20 mg...............................................................................109

DIASTAT PEDIATRIC – diazepam rectal gel deliverysystem 2.5 mg.................................................................109

diazepam conc 5 mg/ml................................................... 81DIAZEPAM – diazepam oral soln 1 mg/ml.........................81DIAZEPAM RECTAL GEL – diazepam rectal gel deliverysystem 2.5 mg.................................................................109

DIAZEPAM RECTAL GEL – diazepam rectal gel deliverysystem 10 mg..................................................................109

DIAZEPAM RECTAL GEL – diazepam rectal gel deliverysystem 20 mg..................................................................109

diazepam tab 2 mg (Valium)............................................81diazepam tab 5 mg (Valium)............................................81diazepam tab 10 mg (Valium)..........................................81DIBENZYLINE – phenoxybenzamine hcl cap 10 mg.........62DICLEGIS – doxylamine-pyridoxine tab delayed release10-10 mg............................................................................73

diclofenac potassium tab 50 mg...................................104diclofenac sodium gel 1% (Voltaren)............................145diclofenac sodium ophth soln 0.1%.............................141diclofenac sodium soln 1.5%........................................ 145diclofenac sodium tab delayed release 25 mg............104diclofenac sodium tab delayed release 50 mg............104diclofenac sodium tab delayed release 75 mg............104diclofenac sodium tab er 24hr 100 mg........................ 104diclofenac w/ misoprostol tab delayed release 50-0.2mg (Arthrotec 50).......................................................... 104

diclofenac w/ misoprostol tab delayed release 75-0.2mg (Arthrotec 75).......................................................... 104

dicloxacillin sodium cap 250 mg...................................... 1dicloxacillin sodium cap 500 mg...................................... 1dicyclomine hcl cap 10 mg (Bentyl)...............................72dicyclomine hcl oral soln 10 mg/5ml............................. 72dicyclomine hcl tab 20 mg (Bentyl)................................72didanosine delayed release capsule 125 mg (Videxec)........................................................................................ 9

didanosine delayed release capsule 200 mg (Videxec)........................................................................................ 9



DIFICID – fidaxomicin tab 200 mg.......................................3DIFLORASONE DIACETATE – diflorasone diacetatecream 0.05%................................................................... 148

DIFLORASONE DIACETATE – diflorasone diacetate oint0.05%............................................................................... 148

DIFLUCAN – fluconazole for susp 10 mg/ml....................... 6DIFLUCAN – fluconazole for susp 40 mg/ml....................... 6DIFLUCAN – fluconazole tab 50 mg....................................6DIFLUCAN – fluconazole tab 100 mg..................................6DIFLUCAN – fluconazole tab 150 mg..................................6DIFLUCAN – fluconazole tab 200 mg..................................6diflunisal tab 500 mg........................................................98DIGOXIN – digoxin oral soln 0.05 mg/ml...........................62

2018


digoxin tab 125 mcg (0.125 mg) (Lanoxin).................... 62digoxin tab 250 mcg (0.25 mg) (Lanoxin)...................... 63dihydroergotamine mesylate inj 1 mg/ml (D.h.e.45).................................................................................... 107

DILANTIN INFATABS – phenytoin chew tab 50 mg.........109DILANTIN – phenytoin sodium extended cap 30 mg.......109DILANTIN – phenytoin sodium extended cap 100 mg.....109DILANTIN-125 – phenytoin susp 125 mg/5ml................. 109DILATRATE SR – isosorbide dinitrate cap er 40 mg......... 54DILAUDID – hydromorphone hcl liqd 1 mg/ml...................99diltiazem hcl cap er 12hr 60 mg......................................52diltiazem hcl cap er 12hr 90 mg......................................52diltiazem hcl cap er 12hr 120 mg....................................52diltiazem hcl cap er 24hr 120 mg....................................52diltiazem hcl cap er 24hr 180 mg....................................52diltiazem hcl cap er 24hr 240 mg....................................52diltiazem hcl coated beads cap er 24hr 300 mg............52diltiazem hcl coated beads cap er 24hr 120 mg(Cardizem cd)...................................................................52

diltiazem hcl coated beads cap er 24hr 180 mg(Cardizem cd)...................................................................52



diltiazem hcl coated beads tab er 24hr 180 mg(Cardizem la)....................................................................52





diltiazem hcl extended release beads cap er 24hr 120mg (Tiazac).......................................................................52






diltiazem hcl tab 90 mg....................................................52diltiazem hcl tab 30 mg (Cardizem)................................52diltiazem hcl tab 60 mg (Cardizem)................................52diltiazem hcl tab 120 mg (Cardizem)..............................52DIOVAN HCT – valsartan-hydrochlorothiazide tab 80-12.5mg...................................................................................... 46

DIOVAN HCT – valsartan-hydrochlorothiazide tab160-12.5 mg...................................................................... 46

DIOVAN HCT – valsartan-hydrochlorothiazide tab 160-25mg...................................................................................... 46

DIOVAN HCT – valsartan-hydrochlorothiazide tab320-12.5 mg...................................................................... 46

DIOVAN HCT – valsartan-hydrochlorothiazide tab 320-25mg...................................................................................... 46

DIOVAN – valsartan tab 40 mg..........................................46DIOVAN – valsartan tab 80 mg..........................................46DIOVAN – valsartan tab 160 mg........................................46DIOVAN – valsartan tab 320 mg........................................46diphenhydramine hcl cap 50 mg.................................... 65DIPHENOXYLATE/ATROPINE – diphenoxylate w/atropine liq 2.5-0.025 mg/5ml........................................... 71

diphenoxylate w/ atropine tab 2.5-0.025 mg(Lomotil)............................................................................71

DIPHTHERIA/TETANUS TOXOID – diphtheria-tetanus toxadsorbed (dt) im inj 25-5 unit/0.5ml..................................15

DIPROLENE AF – betamethasone dipropionateaugmented cream 0.05%................................................148

DIPROLENE – betamethasone dipropionate augmentedlotion 0.05%.....................................................................148

DIPROLENE – betamethasone dipropionate augmentedoint 0.05%........................................................................148

dipyridamole tab 25 mg (Persantine)........................... 128dipyridamole tab 50 mg (Persantine)........................... 128dipyridamole tab 75 mg (Persantine)........................... 128disopyramide phosphate cap 100 mg (Norpace).......... 60disopyramide phosphate cap 150 mg (Norpace).......... 60disulfiram tab 250 mg (Antabuse).................................. 95disulfiram tab 500 mg (Antabuse).................................. 95DIURIL – chlorothiazide susp 250 mg/5ml.........................59divalproex sodium cap delayed release sprinkle 125mg (Depakote sprinkles).............................................. 109

divalproex sodium tab delayed release 125 mg(Depakote)...................................................................... 109



divalproex sodium tab er 24 hr 250 mg (Depakoteer).....................................................................................110

divalproex sodium tab er 24 hr 500 mg (Depakoteer).....................................................................................110

DIVIGEL – estradiol td gel 0.25 mg/0.25gm (0.1%)...........26DIVIGEL – estradiol td gel 0.5 mg/0.5gm (0.1%)...............26DIVIGEL – estradiol td gel 1 mg/gm (0.1%).......................26dofetilide cap 125 mcg (0.125 mg) (Tikosyn).................60dofetilide cap 250 mcg (0.25 mg) (Tikosyn)...................60dofetilide cap 500 mcg (0.5 mg) (Tikosyn).....................60DOLOPHINE – methadone hcl tab 5 mg........................... 99DOLOPHINE – methadone hcl tab 10 mg......................... 99donepezil hydrochloride orally disintegrating tab 5mg...................................................................................... 95

donepezil hydrochloride orally disintegrating tab 10mg...................................................................................... 95

2018


donepezil hydrochloride tab 5 mg (Aricept)..................95donepezil hydrochloride tab 10 mg (Aricept)................95donepezil hydrochloride tab 23 mg (Aricept)................95dorzolamide hcl ophth soln 2% (Trusopt)................... 139dorzolamide hcl-timolol maleate ophth soln 22.3-6.8mg/ml (Cosopt).............................................................. 139

DOTHELLE DHA – prenatal w/fe fum-fe poly -fa-omega 3cap 53.5-38-1 mg............................................................119

DOVONEX – calcipotriene cream 0.005%.......................150doxazosin mesylate tab 1 mg (Cardura)........................63doxazosin mesylate tab 2 mg (Cardura)........................63doxazosin mesylate tab 4 mg (Cardura)........................63doxazosin mesylate tab 8 mg (Cardura)........................63doxepin hcl cap 10 mg.....................................................82doxepin hcl cap 25 mg.....................................................82doxepin hcl cap 50 mg.....................................................82doxepin hcl cap 75 mg.....................................................82doxepin hcl cap 100 mg...................................................82doxepin hcl cap 150 mg...................................................82doxepin hcl conc 10 mg/ml............................................. 82DOXEPIN HYDROCHLORIDE – doxepin hcl cream5%.................................................................................... 150

doxercalciferol cap 0.5 mcg (Hectorol)..........................41doxercalciferol cap 1 mcg (Hectorol).............................41doxercalciferol cap 2.5 mcg (Hectorol)..........................41doxycycline hyclate cap 50 mg.........................................4doxycycline hyclate cap 100 mg (Vibramycin)................4doxycycline hyclate tab delayed release 75 mg............. 4doxycycline hyclate tab 20 mg......................................... 4doxycycline hyclate tab 100 mg....................................... 4doxycycline hyclate tab 75 mg (Acticlate).......................4doxycycline hyclate tab 150 mg (Acticlate).....................4doxycycline monohydrate cap 50 mg.............................. 4doxycycline monohydrate cap 100 mg (Monodox).........4doxycycline monohydrate for susp 25 mg/5ml(Vibramycin)....................................................................... 4

doxycycline monohydrate tab 50 mg (Adoxa)................ 4doxycycline monohydrate tab 75 mg (Adoxa)................ 4doxycycline monohydrate tab 100 mg (Adoxa pak1/100)................................................................................... 4

doxycycline monohydrate tab 150 mg (Adoxa pak1/150)................................................................................... 4

dronabinol cap 2.5 mg (Marinol).....................................73dronabinol cap 5 mg (Marinol)........................................74dronabinol cap 10 mg (Marinol)......................................74DROXIA – hydroxyurea cap 200 mg................................128DROXIA – hydroxyurea cap 300 mg................................128DROXIA – hydroxyurea cap 400 mg................................128DUAC – clindamycin phosph-benzoyl peroxide (refrig) gel1.2 (1)-5%........................................................................144

DUAVEE – conjugated estrogens-bazedoxifene tab0.45-20 mg........................................................................ 26

DUET DHA BALANCED – prenat w/fe poly-na fered-fa tab25-1 & omega cap 267 mg.............................................119

DUET DHA 400 – prenat w/fe poly-na fered-fa tab 25-1 &omega cap 400 mg.........................................................119

DULERA – mometasone furoate-formoterol fumarateaerosol 100-5 mcg/act...................................................... 68

DULERA – mometasone furoate-formoterol fumarateaerosol 200-5 mcg/act...................................................... 68

duloxetine hcl enteric coated pellets cap 20 mg (baseeq) (Cymbalta)..................................................................82



DUPIXENT – dupilumab subcutaneous soln prefilledsyringe 300 mg/2ml.........................................................150

DUREZOL – difluprednate ophth emulsion 0.05%.......... 138dutasteride cap 0.5 mg (Avodart)................................... 79dutasteride-tamsulosin hcl cap 0.5-0.4 mg (Jalyn).......79DUTOPROL – metoprolol & hydrochlorothiazide tab er24hr 25-12.5 mg................................................................49

DUTOPROL – metoprolol & hydrochlorothiazide tab er24hr 50-12.5 mg................................................................49

DUTOPROL – metoprolol & hydrochlorothiazide tab er24hr 100-12.5 mg..............................................................49

DUZALLO – lesinurad-allopurinol tab 200-200 mg..........108DUZALLO – lesinurad-allopurinol tab 200-300 mg..........108DYANAVEL XR – amphetamine extended release susp2.5 mg/ml...........................................................................92

DYAZIDE – triamterene & hydrochlorothiazide cap 37.5-25mg...................................................................................... 59

dyphylline-guaifenesin liqd 100-100 mg/5ml.................68DYRENIUM – triamterene cap 50 mg................................59DYRENIUM – triamterene cap 100 mg..............................59

EEC-NAPROSYN – naproxen tab ec 375 mg....................104EC-NAPROSYN – naproxen tab ec 500 mg....................104econazole nitrate cream 1%.......................................... 145EDARBI – azilsartan medoxomil tab 40 mg.......................46EDARBI – azilsartan medoxomil tab 80 mg.......................46EDARBYCLOR – azilsartan medoxomil-chlorthalidone tab40-12.5 mg........................................................................ 46

EDARBYCLOR – azilsartan medoxomil-chlorthalidone tab40-25 mg............................................................................46

EDECRIN – ethacrynic acid tab 25 mg..............................59EDURANT – rilpivirine hcl tab 25 mg (base equivalent)...... 9E.E.S. 400 – erythromycin ethylsuccinate tab 400 mg........ 3E.E.S. GRANULES – erythromycin ethylsuccinate for susp200 mg/5ml..........................................................................3

EFFER-K – potassium bicarbonate-citric acid effer tab 10meq.................................................................................. 126

EFFER-K – potassium bicarbonate-citric acid effer tab 20meq.................................................................................. 126

EFUDEX – fluorouracil cream 5%....................................150EGRIFTA – tesamorelin acetate for inj 1 mg (baseequiv)................................................................................. 39

ELDEPRYL – selegiline hcl cap 5 mg..............................115ELESTAT – epinastine hcl ophth soln 0.05%...................141

2018


ELESTRIN – estradiol gel 0.06% (0.52 mg/0.87 gmmetered-dose pump).........................................................26

eletriptan hydrobromide tab 20 mg (base equivalent)(Relpax)...........................................................................107

eletriptan hydrobromide tab 40 mg (base equivalent)(Relpax)...........................................................................107

ELIDEL – pimecrolimus cream 1%.................................. 150ELIMITE – permethrin cream 5%.....................................150ELIQUIS – apixaban tab 2.5 mg...................................... 128ELIQUIS – apixaban tab 5 mg......................................... 129ELITE-OB – prenatal vit w/ iron carbonyl-fa tab 50-1.25mg.................................................................................... 119

ELIXOPHYLLIN – theophylline elixir 80 mg/15ml..............68ELLA – ulipristal acetate tab 30 mg...................................28ELMIRON – pentosan polysulfate sodium caps 100mg...................................................................................... 79

ELOCON – mometasone furoate cream 0.1%.................148ELOCON – mometasone furoate oint 0.1%.....................148ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj250 unit............................................................................133

ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj500 unit............................................................................133

ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj750 unit............................................................................133

ELOCTATE – antihemophilic factor (recomb) rfviiifc for inj1000 unit..........................................................................133







EMADINE – emedastine difumarate ophth soln 0.05%(base equiv).....................................................................141

EMBEDA – morphine-naltrexone cap er 20-0.8 mg...........99EMBEDA – morphine-naltrexone cap er 30-1.2 mg...........99EMBEDA – morphine-naltrexone cap er 50-2 mg..............99EMBEDA – morphine-naltrexone cap er 60-2.4 mg.........100EMBEDA – morphine-naltrexone cap er 80-3.2 mg.........100EMBEDA – morphine-naltrexone cap er 100-4 mg..........100EMCYT – estramustine phosphate sodium cap 140mg...................................................................................... 18

EMEND – aprepitant capsule 40 mg..................................74EMEND – aprepitant capsule 80 mg..................................74EMEND – aprepitant capsule 125 mg................................74EMEND – aprepitant for oral susp 125 mg (125mg/5ml).............................................................................. 74

EMEND TRIPACK – aprepitant capsule therapy pack 80 &125 mg...............................................................................74

EMFLAZA – deflazacort susp 22.75 mg/ml....................... 23

EMFLAZA – deflazacort tab 6 mg......................................23EMFLAZA – deflazacort tab 18 mg....................................23EMFLAZA – deflazacort tab 30 mg....................................23EMFLAZA – deflazacort tab 36 mg....................................23EMSAM – selegiline td patch 24hr 6 mg/24hr................... 82EMSAM – selegiline td patch 24hr 9 mg/24hr................... 82EMSAM – selegiline td patch 24hr 12 mg/24hr................. 82EMTRIVA – emtricitabine caps 200 mg............................. 10EMTRIVA – emtricitabine soln 10 mg/ml........................... 10EMVERM – mebendazole chew tab 100 mg..................... 13ENABLEX – darifenacin hydrobromide tab er 24hr 7.5 mg(base equiv).......................................................................78

ENABLEX – darifenacin hydrobromide tab er 24hr 15 mg(base equiv).......................................................................78

enalapril maleate & hydrochlorothiazide tab 5-12.5mg...................................................................................... 44

enalapril maleate & hydrochlorothiazide tab 10-25 mg(Vaseretic).........................................................................44

enalapril maleate tab 2.5 mg (Vasotec)..........................44enalapril maleate tab 5 mg (Vasotec).............................44enalapril maleate tab 10 mg (Vasotec)...........................44enalapril maleate tab 20 mg (Vasotec)...........................44ENBRACE HR – prenatal vit w/ fe gly cys-fa-omega 3 fattyacids cap......................................................................... 119

ENBREL – etanercept for subcutaneous inj 25 mg......... 104ENBREL – etanercept subcutaneous soln prefilled syringe25 mg/0.5ml.....................................................................104

ENBREL – etanercept subcutaneous soln prefilled syringe50 mg/ml..........................................................................104

ENBREL MINI – etanercept subcutaneous solutioncartridge 50 mg/ml.......................................................... 104

ENBREL SURECLICK – etanercept subcutaneoussolution auto-injector 50 mg/ml.......................................104

ENCARE – nonoxynol-9 vaginal suppos 100 mg.............. 28ENGERIX-B – hepatitis b vaccine (recombinant) 10mcg/0.5ml...........................................................................15

ENGERIX-B – hepatitis b vaccine (recombinant) 20 mcg/ml........................................................................................15

ENGERIX-B – hepatitis b vaccine (recombinant) susp 10mcg/0.5ml...........................................................................15

ENGERIX-B – hepatitis b vaccine (recombinant) susp 20mcg/ml................................................................................15

enoxaparin sodium inj 30 mg/0.3ml (Lovenox)........... 129enoxaparin sodium inj 40 mg/0.4ml (Lovenox)........... 129enoxaparin sodium inj 60 mg/0.6ml (Lovenox)........... 129enoxaparin sodium inj 80 mg/0.8ml (Lovenox)........... 129enoxaparin sodium inj 100 mg/ml (Lovenox).............. 129enoxaparin sodium inj 120 mg/0.8ml (Lovenox)......... 129enoxaparin sodium inj 150 mg/ml (Lovenox).............. 129enoxaparin sodium inj 300 mg/3ml (Lovenox)............ 129entacapone tab 200 mg (Comtan).................................115entecavir tab 0.5 mg (Baraclude)......................................7entecavir tab 1 mg (Baraclude).........................................7ENTOCORT EC – budesonide delayed release particlescap 3 mg............................................................................23

ENTRESTO – sacubitril-valsartan tab 24-26 mg............... 63

2018


ENTRESTO – sacubitril-valsartan tab 49-51 mg............... 63ENTRESTO – sacubitril-valsartan tab 97-103 mg............. 63ENVARSUS XR – tacrolimus tab er 24hr 0.75 mg...........153ENVARSUS XR – tacrolimus tab er 24hr 1 mg............... 153ENVARSUS XR – tacrolimus tab er 24hr 4 mg............... 153EPCLUSA – sofosbuvir-velpatasvir tab 400-100 mg........... 7EPIDUO – adapalene-benzoyl peroxide gel 0.1-2.5%.....144EPIDUO FORTE – adapalene-benzoyl peroxide gel0.3-2.5%...........................................................................144

EPIFOAM – pramoxine-hc aerosol foam 1-1%................148epinastine hcl ophth soln 0.05% (Elestat)................... 141EPINEPHRINE – epinephrine solution auto-injector 0.15mg/0.15ml (1:1000)........................................................... 65

EPINEPHRINE – epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)............................................................. 65

EPINEPHRINE HCL – epinephrine inj 30 mg/30ml........... 63EPINEPHRINE (Mylan Products) – epinephrine solutionauto-injector 0.15 mg/0.3ml (1:2000)................................65

EPINEPHRINE (Mylan Products) – epinephrine solutionauto-injector 0.3 mg/0.3ml (1:1000)..................................65

epinephrine pf inj 1 mg/ml...............................................63epinephrine pf soln prefilled syringe 1 mg/10ml (0.1mg/ml)............................................................................... 63

EPIPEN-JR 2-PAK – epinephrine solution auto-injector0.15 mg/0.3ml (1:2000).....................................................65

EPIPEN 2-PAK – epinephrine solution auto-injector 0.3mg/0.3ml (1:1000)............................................................. 65

EPIVIR HBV – lamivudine oral soln 5 mg/ml (hbv)..............7EPIVIR HBV – lamivudine tab 100 mg (hbv)....................... 7EPIVIR – lamivudine oral soln 10 mg/ml........................... 10EPIVIR – lamivudine tab 150 mg.......................................10EPIVIR – lamivudine tab 300 mg.......................................10eplerenone tab 25 mg (Inspra)........................................63eplerenone tab 50 mg (Inspra)........................................63EPOGEN – epoetin alfa inj 2000 unit/ml..........................129EPOGEN – epoetin alfa inj 3000 unit/ml..........................129EPOGEN – epoetin alfa inj 4000 unit/ml..........................129EPOGEN – epoetin alfa inj 10000 unit/ml........................129EPOGEN – epoetin alfa inj 20000 unit/ml........................129EPROSARTAN MESYLATE – eprosartan mesylate tab600 mg...............................................................................46

EPZICOM – abacavir sulfate-lamivudine tab 600-300mg...................................................................................... 10

EQUETRO – carbamazepine (antipsychotic) cap er 12hr100 mg...............................................................................86



ergocalciferol cap 50000 unit........................................119ERGOLOID MESYLATES – ergoloid mesylates tab 1mg...................................................................................... 95

ergotamine w/ caffeine tab 1-100 mg (Cafergot).........107ERIVEDGE – vismodegib cap 150 mg.............................. 18ERTACZO – sertaconazole nitrate cream 2%..................145ERYGEL – erythromycin gel 2%...................................... 144

ERYPED 200 – erythromycin ethylsuccinate for susp 200mg/5ml..................................................................................3

ERYPED 400 – erythromycin ethylsuccinate for susp 400mg/5ml..................................................................................3

ERY-TAB – erythromycin tab delayed release 250 mg........3ERY-TAB – erythromycin tab delayed release 333 mg........3ERY-TAB – erythromycin tab delayed release 500 mg........3ERYTHROCIN STEARATE – erythromycin stearate tab250 mg.................................................................................3

ERYTHROMYCIN BASE – erythromycin tab 250 mg..........3ERYTHROMYCIN BASE – erythromycin tab 500 mg..........3ERYTHROMYCIN ETHYLSUCCINA – erythromycinethylsuccinate tab 400 mg..................................................3

erythromycin ethylsuccinate for susp 200 mg/5ml(E.e.s. granules).................................................................3

erythromycin gel 2% (Erygel)........................................144erythromycin ophth oint 5 mg/gm................................137erythromycin pads 2%................................................... 144erythromycin soln 2%.................................................... 144erythromycin w/ delayed release particles cap 250mg........................................................................................ 3

ESBRIET – pirfenidone cap 267 mg..................................70ESBRIET – pirfenidone tab 267 mg...................................70ESBRIET – pirfenidone tab 801 mg...................................70escitalopram oxalate soln 5 mg/5ml (base equiv)(Lexapro)...........................................................................82

escitalopram oxalate tab 5 mg (base equiv)(Lexapro)...........................................................................82



esomeprazole magnesium cap delayed release 20 mg(base eq) (Nexium)..........................................................72

esomeprazole magnesium cap delayed release 40 mg(base eq) (Nexium)..........................................................72

ESSENTRA WIPES 9X9" CLEAN – isopropyl alcoholwipes 70%....................................................................... 150

estazolam tab 1 mg.......................................................... 89estazolam tab 2 mg.......................................................... 89esterified estrogens & methyltestosterone tab0.625-1.25 mg...................................................................26

esterified estrogens & methyltestosterone tab 1.25-2.5mg...................................................................................... 26

ESTRACE – estradiol tab 0.5 mg...................................... 26ESTRACE – estradiol tab 1 mg......................................... 26ESTRACE – estradiol tab 2 mg......................................... 26ESTRACE – estradiol vaginal cream 0.1 mg/gm...............79estradiol & norethindrone acetate tab 0.5-0.1 mg(Activella)..........................................................................26

estradiol & norethindrone acetate tab 1-0.5 mg(Activella)..........................................................................26

estradiol tab 0.5 mg (Estrace).........................................26estradiol tab 1 mg (Estrace)............................................26estradiol tab 2 mg (Estrace)............................................26

2018


estradiol td patch twice weekly 0.025 mg/24hr (Vivelle-dot).....................................................................................26

estradiol td patch twice weekly 0.0375 mg/24hr(Vivelle-dot)...................................................................... 26




estradiol td patch weekly 0.025 mg/24hr (Climara).......26estradiol td patch weekly 0.05 mg/24hr (Climara).........26estradiol td patch weekly 0.06 mg/24hr (Climara).........26estradiol td patch weekly 0.075 mg/24hr (Climara).......26estradiol td patch weekly 0.1 mg/24hr (Climara)...........27estradiol td patch weekly 0.0375 mg/24hr (37.5mcg/24hr) (Climara).........................................................26

estradiol vaginal tab 10 mcg (Vagifem)..........................79ESTRING – estradiol vaginal ring 2 mg (7.5mcg/24hrs)......................................................................... 79

ESTROGEL – estradiol gel 0.06% (0.75 mg/1.25 gmmetered-dose pump).........................................................27

ESTROPIPATE – estropipate tab 0.75 mg.........................27ESTROPIPATE – estropipate tab 1.5 mg...........................27ESTROPIPATE – estropipate tab 3 mg..............................27ESTROSTEP FE – norethindrone ac-ethinyl estrad-fe tab1-20/1-30/1-35 mg-mcg.....................................................28

eszopiclone tab 1 mg (Lunesta)......................................89eszopiclone tab 2 mg (Lunesta)......................................89eszopiclone tab 3 mg (Lunesta)......................................89ethacrynic acid tab 25 mg (Edecrin).............................. 59ethambutol hcl tab 100 mg (Myambutol)......................... 6ethambutol hcl tab 400 mg (Myambutol)......................... 6ethosuximide cap 250 mg (Zarontin)............................110ethosuximide soln 250 mg/5ml (Zarontin)................... 110ETIDRONATE DISODIUM – etidronate disodium tab 200mg...................................................................................... 41

ETIDRONATE DISODIUM – etidronate disodium tab 400mg...................................................................................... 41

etodolac cap 200 mg...................................................... 104etodolac cap 300 mg...................................................... 104etodolac tab er 24hr 400 mg......................................... 104etodolac tab er 24hr 500 mg......................................... 104etodolac tab er 24hr 600 mg......................................... 104etodolac tab 400 mg.......................................................104etodolac tab 500 mg.......................................................104ETOPOSIDE – etoposide cap 50 mg.................................18EUCRISA – crisaborole oint 2%.......................................150EURAX – crotamiton cream 10%.....................................150EURAX – crotamiton lotion 10%...................................... 150EVAMIST – estradiol transdermal spray 1.53 mg/spray...................................................................................27

EVEKEO – amphetamine sulfate tab 5 mg........................92EVEKEO – amphetamine sulfate tab 10 mg......................92EVISTA – raloxifene hcl tab 60 mg.................................... 41

EVOTAZ – atazanavir sulfate-cobicistat tab 300-150 mg(base equiv).......................................................................10

EVOXAC – cevimeline hcl cap 30 mg............................. 142EVZIO – naloxone hcl solution auto-injector 0.4mg/0.4ml.......................................................................... 153

EVZIO – naloxone hcl solution auto-injector 2mg/0.4ml.......................................................................... 153

EXELDERM – sulconazole nitrate cream 1%..................145EXELDERM – sulconazole nitrate solution 1%................145EXELON – rivastigmine td patch 24hr 4.6 mg/24hr...........95EXELON – rivastigmine td patch 24hr 9.5 mg/24hr...........95EXELON – rivastigmine td patch 24hr 13.3 mg/24hr.........95exemestane tab 25 mg (Aromasin).................................18EXFORGE – amlodipine besylate-valsartan tab 5-160mg...................................................................................... 52

EXFORGE – amlodipine besylate-valsartan tab 5-320mg...................................................................................... 52



EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab 5-160-12.5 mg............................46

EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab 5-160-25 mg...............................46

EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab 10-160-12.5 mg..........................46

EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab 10-160-25 mg.............................46

EXFORGE HCT – amlodipine-valsartan-hydrochlorothiazide tab 10-320-25 mg.............................46

EXJADE – deferasirox tab for oral susp 125 mg............. 153EXJADE – deferasirox tab for oral susp 250 mg............. 153EXJADE – deferasirox tab for oral susp 500 mg............. 153EXTAVIA – interferon beta-1b for inj kit 0.3 mg................. 94ezetimibe-simvastatin tab 10-10 mg (Vytorin)...............56ezetimibe-simvastatin tab 10-20 mg (Vytorin)...............56ezetimibe-simvastatin tab 10-40 mg (Vytorin)...............56ezetimibe-simvastatin tab 10-80 mg (Vytorin)...............56ezetimibe tab 10 mg (Zetia)............................................. 56F

FACTIVE – gemifloxacin mesylate tab 320 mg (baseequiv)....................................................................................5

famciclovir tab 125 mg (Famvir)....................................... 9famciclovir tab 250 mg (Famvir)....................................... 9famciclovir tab 500 mg (Famvir)....................................... 9famotidine for susp 40 mg/5ml (Pepcid)........................72famotidine tab 20 mg (Pepcid)........................................72famotidine tab 40 mg (Pepcid)........................................72FANAPT – iloperidone tab 1 mg........................................ 86FANAPT – iloperidone tab 2 mg........................................ 86FANAPT – iloperidone tab 4 mg........................................ 86FANAPT – iloperidone tab 6 mg........................................ 86FANAPT – iloperidone tab 8 mg........................................ 86FANAPT – iloperidone tab 10 mg...................................... 86

2018


FANAPT – iloperidone tab 12 mg...................................... 86FANAPT TITRATION PACK – iloperidone tab 1 mg & 2 mg& 4 mg & 6 mg titration pak............................................. 86

FARESTON – toremifene citrate tab 60 mg (baseequivalent)......................................................................... 18

FARXIGA – dapagliflozin propanediol tab 5 mg (baseequivalent)......................................................................... 31

FARXIGA – dapagliflozin propanediol tab 10 mg (baseequivalent)......................................................................... 31

FARYDAK – panobinostat lactate cap 10 mg (baseequivalent)......................................................................... 18



FAZACLO – clozapine orally disintegrating tab 12.5mg...................................................................................... 86

FAZACLO – clozapine orally disintegrating tab 25 mg...... 86FAZACLO – clozapine orally disintegrating tab 100mg...................................................................................... 86

FAZACLO – clozapine orally disintegrating tab 150mg...................................................................................... 86

FAZACLO – clozapine orally disintegrating tab 200mg...................................................................................... 86

FEIBA – antiinhibitor coagulant complex for inj............... 133felbamate susp 600 mg/5ml (Felbatol)......................... 110felbamate tab 400 mg (Felbatol)................................... 110felbamate tab 600 mg (Felbatol)................................... 110FELBATOL – felbamate susp 600 mg/5ml.......................110FELBATOL – felbamate tab 400 mg................................ 110FELBATOL – felbamate tab 600 mg................................ 110FELDENE – piroxicam cap 10 mg................................... 104FELDENE – piroxicam cap 20 mg................................... 104felodipine tab er 24hr 2.5 mg.......................................... 53felodipine tab er 24hr 5 mg............................................. 53felodipine tab er 24hr 10 mg........................................... 53FEMCAP – cervical cap 22 mm.........................................28FEMCAP – cervical cap 26 mm.........................................28FEMCAP – cervical cap 30 mm.........................................28FEMHRT LOW DOSE – norethindrone acetate-ethinylestradiol tab 0.5 mg-2.5 mcg............................................27

FEM PH – acetic acid-oxyquinoline vaginal gel0.9-0.025%.........................................................................79

FEMRING – estradiol acetate vaginal ring 0.05mg/24hr..............................................................................79

FEMRING – estradiol acetate vaginal ring 0.1mg/24hr..............................................................................79

FENOFIBRATE – fenofibrate cap 50 mg........................... 56FENOFIBRATE – fenofibrate cap 150 mg......................... 56fenofibrate micronized cap 43 mg..................................56fenofibrate micronized cap 130 mg................................56fenofibrate micronized cap 67 mg (Lofibra).................. 56fenofibrate micronized cap 134 mg (Lofibra)................ 56fenofibrate micronized cap 200 mg (Lofibra)................ 56fenofibrate tab 54 mg (Lofibra)....................................... 56fenofibrate tab 160 mg (Lofibra)..................................... 56

fenofibrate tab 48 mg (Tricor)......................................... 56fenofibrate tab 145 mg (Tricor)....................................... 56FENOFIBRIC ACID – fenofibric acid tab 35 mg................ 57FENOFIBRIC ACID – fenofibric acid tab 105 mg.............. 57FENOPROFEN CALCIUM – fenoprofen calcium cap 200mg.................................................................................... 104

FENOPROFEN CALCIUM – fenoprofen calcium cap 400mg.................................................................................... 104

fenoprofen calcium tab 600 mg.................................... 104fentanyl citrate lozenge on a handle 200 mcg(Actiq)..............................................................................100

fentanyl citrate lozenge on a handle 400 mcg(Actiq)..............................................................................100





fentanyl td patch 72hr 12 mcg/hr (Duragesic).............100fentanyl td patch 72hr 25 mcg/hr (Duragesic).............100fentanyl td patch 72hr 50 mcg/hr (Duragesic).............100fentanyl td patch 72hr 75 mcg/hr (Duragesic).............100fentanyl td patch 72hr 100 mcg/hr (Duragesic)...........100FERRIPROX – deferiprone oral soln 100 mg/ml............. 153FERRIPROX – deferiprone tab 500 mg...........................153ferrous sulfate elixir 220 mg/5ml (44 mg/5ml elementalfe).....................................................................................129

FERROUS SULFATE – ferrous sulfate liquid 220 mg/5ml(44 mg/5ml elemental fe)................................................129

ferrous sulfate soln 75 mg/ml (15 mg/ml elementalfe).....................................................................................129

FETZIMA – levomilnacipran hcl cap er 24hr 20 mg (baseequivalent)......................................................................... 83




FETZIMA TITRATION PACK – levomilnacipran hcl cap er24hr 20 & 40 mg therapy pack.........................................83

FIBRICOR – fenofibric acid tab 35 mg.............................. 57FIBRICOR – fenofibric acid tab 105 mg............................ 57FINACEA – azelaic acid foam 15%................................. 144FINACEA – azelaic acid gel 15%.....................................144finasteride tab 5 mg (Proscar)........................................ 79FIORINAL/CODEINE #3 – butalbital-aspirin-caff w/codeine cap 50-325-40-30 mg........................................100

FIRAZYR – icatibant acetate inj 30 mg/3ml (baseequivalent)....................................................................... 129

FLAGYL – metronidazole cap 375 mg...............................14FLAGYL – metronidazole tab 250 mg................................14FLAGYL – metronidazole tab 500 mg................................14

2018


FLAREX – fluorometholone acetate ophth susp0.1%................................................................................. 138

flavoxate hcl tab 100 mg..................................................78flecainide acetate tab 50 mg........................................... 60flecainide acetate tab 100 mg......................................... 60flecainide acetate tab 150 mg......................................... 60FLOMAX – tamsulosin hcl cap 0.4 mg.............................. 79FLORIVA – sodium fluoride-vitamin d liqd drops 0.25 mg/ml-400 unit/ml..................................................................126

FLOVENT DISKUS – fluticasone propionate aer pow ba50 mcg/blister.................................................................... 68

FLOVENT DISKUS – fluticasone propionate aer pow ba100 mcg/blister.................................................................. 68

FLOVENT DISKUS – fluticasone propionate aer pow ba250 mcg/blister.................................................................. 68

FLOVENT HFA – fluticasone propionate hfa inhal aer 110mcg/act (125/valve)...........................................................68

FLOVENT HFA – fluticasone propionate hfa inhal aer 220mcg/act (250/valve)...........................................................68

FLOVENT HFA – fluticasone propionate hfa inhal aero 44mcg/act (50/valve)............................................................. 68

FLOXIN OTIC – ofloxacin otic soln 0.3%.........................142fluconazole for susp 10 mg/ml (Diflucan)........................6fluconazole for susp 40 mg/ml (Diflucan)........................6fluconazole tab 50 mg (Diflucan)......................................6fluconazole tab 100 mg (Diflucan)....................................6fluconazole tab 150 mg (Diflucan)....................................6fluconazole tab 200 mg (Diflucan)....................................6flucytosine cap 250 mg (Ancobon)...................................6flucytosine cap 500 mg (Ancobon)...................................6fludrocortisone acetate tab 0.1 mg.................................23FLUMADINE – rimantadine hydrochloride tab 100 mg......12FLUNISOLIDE – flunisolide nasal soln 25 mcg/act(0.025%).............................................................................66

fluocinolone acetonide cream 0.01%........................... 148fluocinolone acetonide cream 0.025% (Synalar).........148fluocinolone acetonide oil 0.01% (body oil) (Derma-smoothe/fs bod)............................................................ 148

fluocinolone acetonide oil 0.01% (scalp oil) (Derma-smoothe/fs sca)............................................................. 148

fluocinolone acetonide oint 0.025% (Synalar).............148fluocinolone acetonide (otic) oil 0.01% (Dermotic).....142fluocinolone acetonide soln 0.01% (Synalar)..............148fluocinonide cream 0.05%............................................. 148fluocinonide emulsified base cream 0.05%.................148fluocinonide gel 0.05%...................................................148fluocinonide oint 0.05%..................................................148fluocinonide soln 0.05%.................................................148FLUORABON – sodium fluoride soln 0.25 mg/0.6ml (from0.55 mg/0.6ml naf).......................................................... 126

FLUOR-A-DAY – sodium fluoride-xylitol chew tab 0.55(0.25 mg f)-236.79 mg.................................................... 126

FLUOR-A-DAY – sodium fluoride-xylitol chew tab 2.2 (1mg f)-236.79 mg..............................................................126

fluorometholone ophth susp 0.1% (Fml liquifilm)...... 138FLUOROPLEX – fluorouracil cream 1%.......................... 150

fluorouracil cream 5% (Efudex).................................... 150FLUOROURACIL – fluorouracil soln 2%......................... 150FLUOROURACIL – fluorouracil soln 5%......................... 150FLUOXETINE DR – fluoxetine hcl cap delayed release 90mg...................................................................................... 83

FLUOXETINE – fluoxetine hcl (pmdd) cap 10 mg............. 96FLUOXETINE – fluoxetine hcl (pmdd) cap 20 mg............. 96fluoxetine hcl cap 10 mg (Prozac)..................................83fluoxetine hcl cap 20 mg (Prozac)..................................83fluoxetine hcl cap 40 mg (Prozac)..................................83fluoxetine hcl solution 20 mg/5ml.................................. 83fluoxetine hcl tab 10 mg.................................................. 83fluoxetine hcl tab 20 mg.................................................. 83fluoxetine hcl tab 60 mg (Fluoxetine hcl)...................... 83FLUPHENAZINE HCL – fluphenazine hcl elixir 2.5mg/5ml............................................................................... 86

FLUPHENAZINE HCL – fluphenazine hcl oral conc 5 mg/ml........................................................................................86

fluphenazine hcl tab 1 mg............................................... 86fluphenazine hcl tab 2.5 mg............................................ 86fluphenazine hcl tab 5 mg............................................... 86fluphenazine hcl tab 10 mg............................................. 86FLURA-DROPS – sodium fluoride soln 0.25 mg/drop f(from 0.55 mg/drop naf)..................................................126

FLURAZEPAM HCL – flurazepam hcl cap 15 mg..............89FLURAZEPAM HCL – flurazepam hcl cap 30 mg..............89FLURBIPROFEN SODIUM – flurbiprofen sodium ophthsoln 0.03%.......................................................................141

flurbiprofen tab 50 mg................................................... 104flurbiprofen tab 100 mg................................................. 104flutamide cap 125 mg.......................................................18FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aer powder ba 55-14 mcg/act.........................68

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aer powder ba 113-14 mcg/act....................... 69

FLUTICASONE PROPIONATE/SA – fluticasone-salmeterol aer powder ba 232-14 mcg/act.......................69

fluticasone propionate cream 0.05% (Cutivate).......... 148fluticasone propionate nasal susp 50 mcg/act............. 66fluticasone propionate oint 0.005%..............................148FLU VACCINES.................................................................. 15fluvastatin sodium cap 20 mg.........................................57fluvastatin sodium cap 40 mg.........................................57fluvastatin sodium tab er 24 hr 80 mg (Lescol xl).........57fluvoxamine maleate tab 25 mg......................................83fluvoxamine maleate tab 50 mg......................................83fluvoxamine maleate tab 100 mg....................................83FML – fluorometholone ophth oint 0.1%..........................138FML FORTE – fluorometholone ophth susp 0.25%......... 138FML LIQUIFILM – fluorometholone ophth susp 0.1%......138FOCALIN – dexmethylphenidate hcl tab 2.5 mg................92FOCALIN – dexmethylphenidate hcl tab 5 mg.................. 92FOCALIN – dexmethylphenidate hcl tab 10 mg.................92FOLCAL DHA – prenatal w/o vit a w/ fe fum-dss-fa-dhacap 27-1.25-300 mg........................................................120

2018


FOLCAPS OMEGA 3 – prenatal vit w/ fe cbn-fe asp glyc-fa-omega 3 cap 27-1mg................................................. 120

FOLET DHA – prenat w/fecbn-bisg-methylf-dss tab dr &dha cap pak.....................................................................120

FOLET ONE – prenat w/o a w/fecbn-bisg-methylf-dss-dhacap 38-1-225 mg.............................................................120

folic acid tab 400 mcg....................................................129folic acid tab 800 mcg....................................................129folic acid tab 1 mg..........................................................129FOLIVANE-F – fe fum-fe poly-fa-c-b3 cap62.5-62.5-1-40-3mg(125 mg fe)......................................129

FOLIVANE-OB – prenatal w/o a w/fe fum-fe poly-fa cap130-92.4-1 mg................................................................. 120

fondaparinux sodium subcutaneous inj 2.5 mg/0.5ml(Arixtra)........................................................................... 129

fondaparinux sodium subcutaneous inj 5 mg/0.4ml(Arixtra)........................................................................... 129

fondaparinux sodium subcutaneous inj 7.5 mg/0.6ml(Arixtra)........................................................................... 129

fondaparinux sodium subcutaneous inj 10 mg/0.8ml(Arixtra)........................................................................... 129

FORTEO – teriparatide (recombinant) inj 600mcg/2.4ml...........................................................................41

FOSAMAX – alendronate sodium tab 70 mg.....................41FOSAMAX PLUS D – alendronate sodium-cholecalciferoltab 70-2800 mg-unit..........................................................41

FOSAMAX PLUS D – alendronate sodium-cholecalciferoltab 70-5600 mg-unit..........................................................41

fosamprenavir calcium tab 700 mg (base equiv)(Lexiva)..............................................................................10

fosinopril sodium & hydrochlorothiazide tab 10-12.5mg...................................................................................... 44

fosinopril sodium & hydrochlorothiazide tab 20-12.5mg...................................................................................... 44

fosinopril sodium tab 10 mg........................................... 44fosinopril sodium tab 20 mg........................................... 44fosinopril sodium tab 40 mg........................................... 44FOSRENOL – lanthanum carbonate chew tab 500 mg(elemental)......................................................................... 76

FOSRENOL – lanthanum carbonate chew tab 750 mg(elemental)......................................................................... 76

FOSRENOL – lanthanum carbonate chew tab 1000 mg(elemental)......................................................................... 76

FOSRENOL – lanthanum carbonate oral powder pack 750mg (elemental)...................................................................76

FOSRENOL – lanthanum carbonate oral powder pack1000 mg (elemental)......................................................... 76

FRAGMIN – dalteparin sodium inj 10000 unit/ml.............129FRAGMIN – dalteparin sodium inj 2500 unit/0.2ml..........129FRAGMIN – dalteparin sodium inj 5000 unit/0.2ml..........129FRAGMIN – dalteparin sodium inj 7500 unit/0.3ml..........129FRAGMIN – dalteparin sodium inj 12500 unit/0.5ml........129FRAGMIN – dalteparin sodium inj 15000 unit/0.6ml........129FRAGMIN – dalteparin sodium inj 18000 unit/0.72ml......129FRAGMIN – dalteparin sodium inj 95000 unit/3.8ml........129

frovatriptan succinate tab 2.5 mg (base equivalent)(Frova).............................................................................107

FURADANTIN – nitrofurantoin susp 25 mg/5ml................ 77FUROSEMIDE – furosemide oral soln 8 mg/ml.................59furosemide oral soln 10 mg/ml....................................... 59furosemide tab 20 mg (Lasix)......................................... 59furosemide tab 40 mg (Lasix)......................................... 59furosemide tab 80 mg (Lasix)......................................... 59FUZEON – enfuvirtide for inj 90 mg...................................10FYCOMPA – perampanel susp 0.5 mg/ml....................... 110FYCOMPA – perampanel tab 2 mg................................. 110FYCOMPA – perampanel tab 4 mg................................. 110FYCOMPA – perampanel tab 6 mg................................. 110FYCOMPA – perampanel tab 8 mg................................. 110FYCOMPA – perampanel tab 10 mg............................... 110FYCOMPA – perampanel tab 12 mg............................... 110

Ggabapentin cap 100 mg (Neurontin).............................110gabapentin cap 300 mg (Neurontin).............................110gabapentin cap 400 mg (Neurontin).............................110gabapentin oral soln 250 mg/5ml (Neurontin).............110gabapentin tab 600 mg (Neurontin)..............................110gabapentin tab 800 mg (Neurontin)..............................110GABITRIL – tiagabine hcl tab 2 mg................................. 110GABITRIL – tiagabine hcl tab 4 mg................................. 110GABITRIL – tiagabine hcl tab 12 mg............................... 110GABITRIL – tiagabine hcl tab 16 mg............................... 110galantamine hydrobromide cap er 24hr 8 mg(Razadyne er)...................................................................96

galantamine hydrobromide cap er 24hr 16 mg(Razadyne er)...................................................................96

galantamine hydrobromide cap er 24hr 24 mg(Razadyne er)...................................................................96

GALANTAMINE HYDROBROMIDE – galantaminehydrobromide oral soln 4 mg/ml.......................................96

galantamine hydrobromide tab 4 mg (Razadyne).........96galantamine hydrobromide tab 8 mg (Razadyne).........96galantamine hydrobromide tab 12 mg (Razadyne).......96GALZIN – zinc acetate cap 25 mg (elemental zinc).........126GALZIN – zinc acetate cap 50 mg (elemental zinc).........126GAMMAGARD LIQUID – immune globulin (human) iv orsubcutaneous soln 1 gm/10ml..........................................15

GAMMAGARD LIQUID – immune globulin (human) iv orsubcutaneous soln 2.5 gm/25ml.......................................15

GAMMAGARD LIQUID – immune globulin (human) iv orsubcutaneous soln 5 gm/50ml..........................................15

GAMMAGARD LIQUID – immune globulin (human) iv orsubcutaneous soln 10 gm/100ml......................................15



GAMMAKED – immune globulin (human) iv orsubcutaneous soln 1 gm/10ml..........................................15

2018


GAMMAKED – immune globulin (human) iv orsubcutaneous soln 2.5 gm/25ml.......................................15

GAMMAKED – immune globulin (human) iv orsubcutaneous soln 5 gm/50ml..........................................15

GAMMAKED – immune globulin (human) iv orsubcutaneous soln 10 gm/100ml......................................15

GAMMAKED – immune globulin (human) iv orsubcutaneous soln 20 gm/200ml......................................15

GAMUNEX-C – immune globulin (human) iv orsubcutaneous soln 1 gm/10ml..........................................15

GAMUNEX-C – immune globulin (human) iv orsubcutaneous soln 2.5 gm/25ml.......................................16

GAMUNEX-C – immune globulin (human) iv orsubcutaneous soln 5 gm/50ml..........................................16

GAMUNEX-C – immune globulin (human) iv orsubcutaneous soln 10 gm/100ml......................................16



GARDASIL 9 – human papillomavirus (hpv) 9-valentrecomb vac im susp..........................................................16

GARDASIL 9 – human papillomavirus (hpv) 9-valentrecomb vac susp pref syr................................................. 16

GASTROCROM – cromolyn sodium oral conc 100mg/5ml............................................................................... 76

gatifloxacin ophth soln 0.5% (Zymaxid).......................137GATTEX – teduglutide (rdna) for inj kit 5 mg.....................76gemfibrozil tab 600 mg (Lopid).......................................57GENERESS FE – norethindrone & ethinyl estradiol-fechew tab 0.8 mg-25 mcg.................................................. 28

GENOTROPIN MINIQUICK – somatropin for inj 0.2mg...................................................................................... 39




GENOTROPIN MINIQUICK – somatropin for inj 1 mg...... 39GENOTROPIN MINIQUICK – somatropin for inj 1.2mg...................................................................................... 39




GENOTROPIN MINIQUICK – somatropin for inj 2 mg...... 39GENOTROPIN – somatropin for inj 12 mg (13.8 mgoverfill)................................................................................39

GENOTROPIN – somatropin for subcutaneous inj 5mg...................................................................................... 39

GENTAK – gentamicin sulfate ophth oint 0.3%............... 137gentamicin sulfate cream 0.1%.....................................145

GENTAMICIN SULFATE – gentamicin sulfate oint0.1%................................................................................. 145

gentamicin sulfate ophth soln 0.3%.............................137GENVOYA – elvitegrav-cobic-emtricitab-tenofov af tab150-150-200-10 mg...........................................................10

GILENYA – fingolimod hcl cap 0.5 mg (base equiv)..........94GILOTRIF – afatinib dimaleate tab 20 mg (baseequivalent)......................................................................... 18

GILOTRIF – afatinib dimaleate tab 30 mg (baseequivalent)......................................................................... 18

GILOTRIF – afatinib dimaleate tab 40 mg (baseequivalent)......................................................................... 18

glatiramer acetate soln prefilled syringe 20 mg/ml(Copaxone)....................................................................... 94

glatiramer acetate soln prefilled syringe 40 mg/ml(Copaxone)....................................................................... 94

GLEOSTINE – lomustine cap 5 mg................................... 18GLEOSTINE – lomustine cap 10 mg................................. 18GLEOSTINE – lomustine cap 40 mg................................. 18GLEOSTINE – lomustine cap 100 mg............................... 18glimepiride tab 1 mg (Amaryl).........................................31glimepiride tab 2 mg (Amaryl).........................................31glimepiride tab 4 mg (Amaryl).........................................31glipizide-metformin hcl tab 2.5-250 mg..........................31glipizide-metformin hcl tab 2.5-500 mg..........................31glipizide-metformin hcl tab 5-500 mg.............................31glipizide tab er 24hr 2.5 mg (Glucotrol xl)..................... 31glipizide tab er 24hr 5 mg (Glucotrol xl)........................ 31glipizide tab er 24hr 10 mg (Glucotrol xl)...................... 31glipizide tab 5 mg (Glucotrol)..........................................31glipizide tab 10 mg (Glucotrol)........................................31GLUCAGEN DIAGNOSTIC – glucagon hcl (rdna)diagnostic for inj 1 mg (base equiv)............................... 152

GLUCAGEN HYPOKIT – glucagon hcl (rdna) for inj 1 mg(base equiv).......................................................................31

GLUCAGON EMERGENCY KIT – glucagon (rdna) for injkit 1 mg..............................................................................31

GLUCOPHAGE – metformin hcl tab 500 mg.....................31GLUCOPHAGE – metformin hcl tab 850 mg.....................31GLUCOPHAGE – metformin hcl tab 1000 mg...................31GLUCOPHAGE XR – metformin hcl tab er 24hr 500mg...................................................................................... 31

GLUCOPHAGE XR – metformin hcl tab er 24hr 750mg...................................................................................... 31

GLUCOTROL – glipizide tab 5 mg.....................................31GLUCOTROL – glipizide tab 10 mg...................................31GLUCOTROL XL – glipizide tab er 24hr 2.5 mg................31GLUCOTROL XL – glipizide tab er 24hr 5 mg...................31GLUCOTROL XL – glipizide tab er 24hr 10 mg.................31GLUCOVANCE – glyburide-metformin tab 2.5-500 mg..... 31GLUCOVANCE – glyburide-metformin tab 5-500 mg........ 31glyburide-metformin tab 1.25-250 mg(Glucovance).................................................................... 32

glyburide-metformin tab 2.5-500 mg (Glucovance)...... 32glyburide-metformin tab 5-500 mg (Glucovance)......... 32glyburide micronized tab 1.5 mg (Glynase)...................31

2018


glyburide micronized tab 3 mg (Glynase)......................31glyburide micronized tab 6 mg (Glynase)......................32glyburide tab 1.25 mg.......................................................32glyburide tab 2.5 mg.........................................................32glyburide tab 5 mg............................................................32glycopyrrolate tab 1 mg...................................................72glycopyrrolate tab 2 mg...................................................72GLYNASE – glyburide micronized tab 1.5 mg................... 32GLYNASE – glyburide micronized tab 3 mg...................... 32GLYNASE – glyburide micronized tab 6 mg...................... 32GLYSET – miglitol tab 25 mg.............................................32GLYSET – miglitol tab 50 mg.............................................32GLYSET – miglitol tab 100 mg...........................................32GLYXAMBI – empagliflozin-linagliptin tab 10-5 mg........... 32GLYXAMBI – empagliflozin-linagliptin tab 25-5 mg........... 32GOLYTELY – peg 3350-kcl-na bicarb-nacl-na sulfate forsoln 236 gm.......................................................................71

GOLYTELY – peg 3350-kcl-na bicarb-nacl-na sulfatepacket 227.1 gm................................................................71

GORDOFILM – salicylic & lactic acids soln16.7-16.7%.......................................................................145

granisetron hcl tab 1 mg................................................. 74GRANIX – tbo-filgrastim soln prefilled syringe 300mcg/0.5ml........................................................................ 129

GRANIX – tbo-filgrastim soln prefilled syringe 480mcg/0.8ml........................................................................ 130

griseofulvin microsize susp 125 mg/5ml......................... 7griseofulvin microsize tab 500 mg................................... 7griseofulvin ultramicrosize tab 125 mg (Gris-peg)......... 7griseofulvin ultramicrosize tab 250 mg (Gris-peg)......... 7GRIS-PEG – griseofulvin ultramicrosize tab 125 mg...........6GRIS-PEG – griseofulvin ultramicrosize tab 250 mg...........6guanfacine hcl tab er 24hr 1 mg (base equiv)(Intuniv).............................................................................92

guanfacine hcl tab er 24hr 2 mg (base equiv)(Intuniv).............................................................................92



guanfacine hcl tab 1 mg (Tenex).................................... 63guanfacine hcl tab 2 mg (Tenex).................................... 63GUANIDINE HCL – guanidine hcl tab 125 mg................ 118GYNAZOLE-1 – butoconazole nitrate (one dose) vaginalcream 2%...........................................................................79

HHAEGARDA – c1 esterase inhibitor (human) forsubcutaneous inj 2000 unit.............................................130

HAEGARDA – c1 esterase inhibitor (human) forsubcutaneous inj 3000 unit.............................................130

HALCION – triazolam tab 0.25 mg.................................... 89halobetasol propionate cream 0.05% (Ultravate)........148halobetasol propionate oint 0.05% (Ultravate)............148HALOG – halcinonide oint 0.1%...................................... 148haloperidol lactate oral conc 2 mg/ml............................86

haloperidol tab 0.5 mg..................................................... 86haloperidol tab 1 mg........................................................ 86haloperidol tab 2 mg........................................................ 86haloperidol tab 5 mg........................................................ 86haloperidol tab 10 mg...................................................... 86haloperidol tab 20 mg...................................................... 86HALOTIN – haloprogin cream 1%....................................145HARVONI – ledipasvir-sofosbuvir tab 90-400 mg................7HAVRIX – hepatitis a vaccine inj susp 720 elunit/0.5ml............................................................................16

HAVRIX – hepatitis a vaccine inj susp 1440 el unit/ml.......16HECTOROL – doxercalciferol cap 0.5 mcg....................... 41HECTOROL – doxercalciferol cap 1 mcg.......................... 41HECTOROL – doxercalciferol cap 2.5 mcg....................... 41HELIXATE FS – antihemophilic factor (recombinant) for injkit 250 unit.......................................................................133

HELIXATE FS – antihemophilic factor (recombinant) for injkit 500 unit.......................................................................133

HELIXATE FS – antihemophilic factor (recombinant) for injkit 1000 unit.....................................................................133



HEMANGEOL – propranolol hcl oral soln 4.28 mg/ml (3.75mg/ml base equiv).............................................................49

HEMENATAL OB + DHA – prenat-fe poly cmplx-fe hemepoly-fa tab & omega 3 cap pck...................................... 120

HEMENATAL OB – prenat vit-fe poly cmplx-fe heme poly-fa tab 28-6-1 mg............................................................. 120

HEMOFIL M – antihemophilic factor (human) for inj 250unit....................................................................................133




heparin sodium (porcine) inj 5000 unit/ml...................130HEPSERA – adefovir dipivoxil tab 10 mg............................ 8HETLIOZ – tasimelteon capsule 20 mg.............................89HEXALEN – altretamine cap 50 mg...................................18HIBERIX – haemophilus b polysaccharide conjugate vacfor inj 10 mcg.................................................................... 16

HIPREX – methenamine hippurate tab 1 gm.....................77HIZENTRA – immune globulin (human) subcutaneous inj1 gm/5ml............................................................................16

HIZENTRA – immune globulin (human) subcutaneous inj2 gm/10ml..........................................................................16

HIZENTRA – immune globulin (human) subcutaneous inj4 gm/20ml..........................................................................16

HIZENTRA – immune globulin (human) subcutaneous inj10 gm/50ml........................................................................16

homatropine hbr ophth soln 5% (Isoptohomatropine)..................................................................141

H.P. ACTHAR – corticotropin inj gel 80 unit/ml..................41

2018


HUMALOG MIX 75/25 – insulin lispro prot & lispro inj 100unit/ml (75-25)................................................................... 35

HUMALOG MIX 50/50 – insulin lispro protamine & lisproinj 100 unit/ml (50-50).......................................................35

HUMALOG MIX 50/50 KWIKPEN – insulin lispro prot &lispro sus pen-inj 100 unit/ml (50-50)...............................35

HUMALOG MIX 75/25 KWIKPEN – insulin lispro prot &lispro sus pen-inj 100 unit/ml (75-25)...............................35

HUMATE-P – antihemophilic factor/vwf (human) for inj250-600 unit.....................................................................134

HUMATE-P – antihemophilic factor/vwf (human) for inj500-1200 unit...................................................................134

HUMATE-P – antihemophilic factor/vwf (human) for inj1000-2400 unit................................................................ 134

HUMATROPE COMBO PACK – somatropin for inj 5mg...................................................................................... 39

HUMATROPE – somatropin for inj 24 mg..........................39HUMATROPE – somatropin for inj 6 mg (18 unit)............. 39HUMATROPE – somatropin for inj 12 mg (36 unit)........... 39HUMIRA – adalimumab prefilled syringe kit 10mg/0.2ml.......................................................................... 104

HUMIRA – adalimumab prefilled syringe kit 20mg/0.4ml.......................................................................... 104

HUMIRA – adalimumab prefilled syringe kit 40mg/0.8ml.......................................................................... 105

HUMIRA PEDIATRIC CROHNS D – adalimumab prefilledsyringe kit 40 mg/0.8ml...................................................105

HUMIRA PEN – adalimumab pen-injector kit 40mg/0.8ml.......................................................................... 105

HUMIRA PEN-CROHNS DISEASE – adalimumab pen-injector kit 40 mg/0.8ml...................................................105

HUMIRA PEN-PSORIASIS STAR – adalimumab pen-injector kit 40 mg/0.8ml...................................................105

HUMULIN R U-500 (CONCENTR – insulin regular(human) inj 500 unit/ml..................................................... 35

HUMULIN R U-500 KWIKPEN – insulin regular (human)soln pen-injector 500 unit/ml.............................................35

HYCAMTIN – topotecan hcl cap 0.25 mg (base equiv)..... 19HYCAMTIN – topotecan hcl cap 1 mg (base equiv).......... 19hydralazine hcl tab 10 mg............................................... 63hydralazine hcl tab 25 mg............................................... 63hydralazine hcl tab 50 mg............................................... 63hydralazine hcl tab 100 mg............................................. 63HYDREA – hydroxyurea cap 500 mg................................ 19hydrochlorothiazide cap 12.5 mg (Microzide)............... 59hydrochlorothiazide tab 12.5 mg.................................... 59hydrochlorothiazide tab 25 mg....................................... 59hydrochlorothiazide tab 50 mg....................................... 59hydrocodone-acetaminophen soln 7.5-325 mg/15ml(Hycet).............................................................................100

hydrocodone-acetaminophen tab 2.5-325 mg.............100hydrocodone-acetaminophen tab 7.5-325 mg(Norco)............................................................................ 100

hydrocodone-acetaminophen tab 5-325 mg(Norco)............................................................................ 100

hydrocodone-acetaminophen tab 10-325 mg(Norco)............................................................................ 100

hydrocodone-acetaminophen tab 7.5-300 mg(Xodol).............................................................................100

hydrocodone-acetaminophen tab 5-300 mg(Xodol).............................................................................100

hydrocodone-acetaminophen tab 10-300 mg(Xodol).............................................................................100

hydrocodone-ibuprofen tab 10-200 mg (Ibudone)...... 100hydrocodone-ibuprofen tab 5-200 mg (Reprexain).....100hydrocodone-ibuprofen tab 7.5-200 mg(Vicoprofen)....................................................................100

hydrocodone w/ homatropine syrup 5-1.5 mg/5ml....... 66hydrocodone w/ homatropine tab 5-1.5 mg...................66hydrocod polst-chlorphen polst er susp 10-8 mg/5ml(Tussionex pennkineti)................................................... 66

hydrocortisone acetate suppos 25 mg........................ 143hydrocortisone acetate w/ pramoxine rectal cream1-1% (Analpram-hc singles).........................................143

hydrocortisone acetate w/ pramoxine rectal cream2.5-1% (Analpram-hc singles)......................................143

hydrocortisone butyrate cream 0.1% (Locoid)............148hydrocortisone butyrate oint 0.1% (Locoid)................148hydrocortisone butyrate soln 0.1% (Locoid)...............149hydrocortisone cream 1%..............................................149hydrocortisone cream 2.5%...........................................149hydrocortisone enema 100 mg/60ml (Cortenema)......143hydrocortisone lotion 2.5%........................................... 149hydrocortisone lotion 2% (Ala scalp)...........................149hydrocortisone oint 1%..................................................149hydrocortisone oint 2.5%...............................................149hydrocortisone rectal cream 2.5% (Anusol-hc).......... 143hydrocortisone rectal cream 1% (Proctocort).............143hydrocortisone tab 5 mg (Cortef)................................... 23hydrocortisone tab 10 mg (Cortef)................................. 23hydrocortisone tab 20 mg (Cortef)................................. 23hydrocortisone valerate cream 0.2%............................149hydrocortisone valerate oint 0.2% (Westcort).............149hydrocortisone w/ acetic acid otic soln 1-2%............. 142HYDROMORPHONE HCL – hydromorphone hcl suppos 3mg.................................................................................... 100

hydromorphone hcl liqd 1 mg/ml (Dilaudid)................100hydromorphone hcl tab er 24hr deter 8 mg(Exalgo)...........................................................................100

hydromorphone hcl tab er 24hr deter 12 mg(Exalgo)...........................................................................100



hydromorphone hcl tab 2 mg (Dilaudid)......................100hydromorphone hcl tab 4 mg (Dilaudid)......................100hydromorphone hcl tab 8 mg (Dilaudid)......................100hydroxychloroquine sulfate tab 200 mg (Plaquenil).....13hydroxyurea cap 500 mg (Hydrea)................................. 19hydroxyzine hcl syrup 10 mg/5ml...................................81

2018


hydroxyzine hcl tab 10 mg.............................................. 81hydroxyzine hcl tab 25 mg.............................................. 81hydroxyzine hcl tab 50 mg.............................................. 81hydroxyzine pamoate cap 25 mg (Vistaril).................... 81hydroxyzine pamoate cap 50 mg (Vistaril).................... 81HYDROXYZINE PAMOATE – hydroxyzine pamoate cap100 mg...............................................................................81

hyoscyamine sulfate elixir 0.125 mg/5ml.......................72hyoscyamine sulfate soln 0.125 mg/ml..........................72hyoscyamine sulfate tab disint 0.125 mg(Anaspaz)..........................................................................72

hyoscyamine sulfate tab er 12hr 0.375 mg (Levbid).....72hyoscyamine sulfate tab 0.125 mg (Levsin)..................72hyoscyamine sulfate tab sl 0.125 mg (Levsin/sl)..........72HYPER-SAL – sodium chloride soln nebu 7%.................. 66HYPERSAL – sodium chloride soln nebu 3.5%.................66HYPERSAL – sodium chloride soln nebu 7%....................66HYQVIA – immun glob inj 2.5 gm/25ml-hyaluron inj 200unt/1.25 ml kit....................................................................16

HYQVIA – immun glob inj 5 gm/50ml-hyaluron inj 400unt/2.5 ml kit......................................................................16

HYQVIA – immun glob inj 10 gm/100ml-hyaluron inj 800unt/5 ml kit.........................................................................16

HYQVIA – immun glob inj 20 gm/200ml-hyaluron inj 1600unt/10 ml kit.......................................................................16

HYQVIA – immun glob inj 30 gm/300ml-hyaluron inj 2400unt/15 ml kit.......................................................................16

HYZAAR – losartan potassium & hydrochlorothiazide tab50-12.5 mg........................................................................ 47

HYZAAR – losartan potassium & hydrochlorothiazide tab100-12.5 mg...................................................................... 47

HYZAAR – losartan potassium & hydrochlorothiazide tab100-25 mg......................................................................... 47

Iibandronate sodium tab 150 mg (base equivalent)(Boniva).............................................................................41

IBRANCE – palbociclib cap 75 mg.................................... 19IBRANCE – palbociclib cap 100 mg.................................. 19IBRANCE – palbociclib cap 125 mg.................................. 19ibuprofen susp 100 mg/5ml...........................................105ibuprofen tab 400 mg..................................................... 105ibuprofen tab 600 mg..................................................... 105ibuprofen tab 800 mg..................................................... 105ICLUSIG – ponatinib hcl tab 15 mg (base equiv).............. 19ICLUSIG – ponatinib hcl tab 45 mg (base equiv).............. 19IDELVION – coagulation factor ix (recomb) (rix-fp) for inj250 unit............................................................................134

IDELVION – coagulation factor ix (recomb) (rix-fp) for inj500 unit............................................................................134

IDELVION – coagulation factor ix (recomb) (rix-fp) for inj1000 unit..........................................................................134

IDELVION – coagulation factor ix (recomb) (rix-fp) for inj2000 unit..........................................................................134

IDHIFA – enasidenib mesylate tab 50 mg (baseequivalent)......................................................................... 19

IDHIFA – enasidenib mesylate tab 100 mg (baseequivalent)......................................................................... 19

ILEVRO – nepafenac ophth susp 0.3%........................... 141imatinib mesylate tab 100 mg (base equivalent)(Gleevec)...........................................................................19

imatinib mesylate tab 400 mg (base equivalent)(Gleevec)...........................................................................19

IMBRUVICA – ibrutinib cap 140 mg...................................19imipramine hcl tab 10 mg (Tofranil)............................... 83imipramine hcl tab 25 mg (Tofranil)............................... 83imipramine hcl tab 50 mg (Tofranil)............................... 83imipramine pamoate cap 75 mg......................................83imipramine pamoate cap 100 mg....................................83imipramine pamoate cap 125 mg....................................83imipramine pamoate cap 150 mg....................................83imiquimod cream 5% (Aldara).......................................150IMPAVIDO – miltefosine cap 50 mg...................................14IMURAN – azathioprine tab 50 mg.................................. 153INATAL ADVANCE – prenatal vit w/ dss-iron carbonyl-fatab 90-1 mg..................................................................... 120

INATAL GT – prenatal vit w/ dss-iron carbonyl-fa tab 90-1mg.................................................................................... 120

INATAL ULTRA – prenatal vit w/ dss-iron carbonyl-fa tab90-1 mg............................................................................120

INCRELEX – mecasermin inj 40 mg/4ml (10 mg/ml).........39INCRUSE ELLIPTA – umeclidinium br aero powd breathact 62.5 mcg/inh (base eq)...............................................69

indapamide tab 1.25 mg...................................................59indapamide tab 2.5 mg.....................................................59INDERAL LA – propranolol hcl cap er 24hr 60 mg............ 49INDERAL LA – propranolol hcl cap er 24hr 80 mg............ 49INDERAL LA – propranolol hcl cap er 24hr 120 mg.......... 49INDERAL LA – propranolol hcl cap er 24hr 160 mg.......... 49INDERAL XL – propranolol hcl sustained-release beadscap er 24hr 80 mg............................................................ 49

INDERAL XL – propranolol hcl sustained-release beadscap er 24hr 120 mg.......................................................... 49

INDOCIN – indomethacin suppos 50 mg.........................105INDOCIN – indomethacin susp 25 mg/5ml......................105indomethacin cap er 75 mg...........................................105indomethacin cap 25 mg............................................... 105indomethacin cap 50 mg............................................... 105INFANATE BALANCE – prenatal w/o a w/fe cbn-dss-fa-dha cap 29-1-265 mg......................................................120

INFANRIX – diph, acellular pert & tet tox inj 25 lf-58mcg-10 lf/0.5ml..................................................................16

INGREZZA – valbenazine tosylate cap 40 mg (baseequiv)................................................................................. 96

INGREZZA – valbenazine tosylate cap 80 mg (baseequiv)................................................................................. 96

INLYTA – axitinib tab 1 mg.................................................19INLYTA – axitinib tab 5 mg.................................................19INNOPRAN XL – propranolol hcl sustained-release beadscap er 24hr 80 mg............................................................ 49

INNOPRAN XL – propranolol hcl sustained-release beadscap er 24hr 120 mg.......................................................... 49

2018


INSPRA – eplerenone tab 25 mg.......................................63INSPRA – eplerenone tab 50 mg.......................................63INSULIN PEN NEEDLES – NOVOFINE, NOVOTWIST,OTHER VARIOUS MANUFACTURERS.........................152

INTEGRA F – fe fum-fe poly-fa-c-b3 cap62.5-62.5-1-40-3mg(125 mg fe)......................................130

INTELENCE – etravirine tab 25 mg...................................10INTELENCE – etravirine tab 100 mg.................................10INTELENCE – etravirine tab 200 mg.................................10INTRAROSA – prasterone vaginal insert 6.5 mg...............79INTRON A – interferon alfa-2b for inj 10000000 unit......8,19INTRON A – interferon alfa-2b for inj 18000000 unit......8,19INTRON A – interferon alfa-2b for inj 50000000 unit......8,19INTRON A – interferon alfa-2b inj 6000000 unit/ml........ 8,19INTRON A – interferon alfa-2b inj 10000000 unit/ml...... 8,19INTRON A W/DILUENT – interferon alfa-2b for inj10000000 unit.................................................................8,19

INTRON A W/DILUENT – interferon alfa-2b for inj18000000 unit.................................................................8,19

INTRON A W/DILUENT – interferon alfa-2b for inj50000000 unit.................................................................8,19

INVEGA – paliperidone tab er 24hr 1.5 mg....................... 86INVEGA – paliperidone tab er 24hr 3 mg.......................... 86INVEGA – paliperidone tab er 24hr 6 mg.......................... 86INVEGA – paliperidone tab er 24hr 9 mg.......................... 86INVIRASE – saquinavir mesylate cap 200 mg...................10INVIRASE – saquinavir mesylate tab 500 mg................... 10INVOKAMET – canagliflozin-metformin hcl tab 50-500mg...................................................................................... 32

INVOKAMET – canagliflozin-metformin hcl tab 50-1000mg...................................................................................... 32



INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr50-500 mg......................................................................... 32

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr50-1000 mg....................................................................... 32

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr150-500 mg....................................................................... 32

INVOKAMET XR – canagliflozin-metformin hcl tab er 24hr150-1000 mg..................................................................... 32

INVOKANA – canagliflozin tab 100 mg..............................32INVOKANA – canagliflozin tab 300 mg..............................32iodoquinol-hc cream 1%................................................ 145IOPIDINE – apraclonidine hcl ophth soln 0.5% (baseequivalent)....................................................................... 139

IOPIDINE – apraclonidine hcl ophth soln 1% (baseequivalent)....................................................................... 139

ipratropium-albuterol nebu soln 0.5-2.5(3) mg/3ml...... 69ipratropium bromide inhal soln 0.02%...........................69ipratropium bromide nasal soln 0.03% (21 mcg/spray)(Atrovent)..........................................................................66

ipratropium bromide nasal soln 0.06% (42 mcg/spray)(Atrovent)..........................................................................66

irbesartan-hydrochlorothiazide tab 150-12.5 mg(Avalide)............................................................................ 47

irbesartan-hydrochlorothiazide tab 300-12.5 mg(Avalide)............................................................................ 47

irbesartan tab 75 mg (Avapro)........................................ 47irbesartan tab 150 mg (Avapro)...................................... 47irbesartan tab 300 mg (Avapro)...................................... 47IRESSA – gefitinib tab 250 mg.......................................... 19irrigation solution, physiological..................................153ISENTRESS HD – raltegravir potassium tab 600 mg (baseequiv)................................................................................. 10

ISENTRESS – raltegravir potassium chew tab 25 mg(base equiv).......................................................................10

ISENTRESS – raltegravir potassium chew tab 100 mg(base equiv).......................................................................10

ISENTRESS – raltegravir potassium packet for susp 100mg (base equiv)................................................................ 10

ISENTRESS – raltegravir potassium tab 400 mg (baseequiv)................................................................................. 10

isometheptene-caffeine-acetaminophen tab 65-20-325mg (Prodrin)...................................................................107

isometheptene-dichloral-acetaminophen cap65-100-325 mg................................................................107

ISONIAZID – isoniazid syrup 50 mg/5ml............................. 6isoniazid tab 100 mg.......................................................... 6isoniazid tab 300 mg.......................................................... 6ISOPTO CARPINE – pilocarpine hcl ophth soln 1%........139ISOPTO CARPINE – pilocarpine hcl ophth soln 2%........139ISOPTO CARPINE – pilocarpine hcl ophth soln 4%........139ISOSORBIDE DINITRATE ER – isosorbide dinitrate tab er40 mg.................................................................................55

isosorbide dinitrate tab 10 mg........................................55isosorbide dinitrate tab 20 mg........................................55isosorbide dinitrate tab 30 mg........................................55isosorbide dinitrate tab 5 mg (Isordil titradose)........... 55isosorbide mononitrate tab er 24hr 30 mg.................... 55isosorbide mononitrate tab er 24hr 60 mg.................... 55isosorbide mononitrate tab er 24hr 120 mg.................. 55isosorbide mononitrate tab 10 mg................................. 55isosorbide mononitrate tab 20 mg................................. 55isotretinoin cap 10 mg – amnesteem, claravis,myorisan, zenatane.......................................................144

isotretinoin cap 20 mg – amnesteem, claravis,myorisan, zenatane.......................................................144

isotretinoin cap 40 mg – amnesteem, claravis,myorisan, zenatane.......................................................144

isotretinoin cap 30 mg – claravis, myorisan,zenatane..........................................................................144

ISOXSUPRINE HCL – isoxsuprine hcl tab 20 mg............. 63isoxsuprine hcl tab 10 mg............................................... 63isradipine cap 2.5 mg.......................................................53isradipine cap 5 mg..........................................................53itraconazole cap 100 mg (Sporanox)................................7ivermectin tab 3 mg (Stromectol)................................... 13IXINITY – coagulation factor ix (recombinant) for inj 250unit....................................................................................134

2018


IXINITY – coagulation factor ix (recombinant) for inj 500unit....................................................................................134





JJADENU – deferasirox tab 90 mg....................................153JADENU – deferasirox tab 180 mg..................................153JADENU – deferasirox tab 360 mg..................................153JADENU SPRINKLE – deferasirox granules packet 90mg.................................................................................... 153

JADENU SPRINKLE – deferasirox granules packet 180mg.................................................................................... 153

JADENU SPRINKLE – deferasirox granules packet 360mg.................................................................................... 154

JAKAFI – ruxolitinib phosphate tab 5 mg (baseequivalent)......................................................................... 19





JALYN – dutasteride-tamsulosin hcl cap 0.5-0.4 mg......... 79JANUMET – sitagliptin-metformin hcl tab 50-500 mg........32JANUMET – sitagliptin-metformin hcl tab 50-1000 mg......32JANUMET XR – sitagliptin-metformin hcl tab er 24hr50-500 mg......................................................................... 32

JANUMET XR – sitagliptin-metformin hcl tab er 24hr50-1000 mg....................................................................... 32

JANUMET XR – sitagliptin-metformin hcl tab er 24hr100-1000 mg..................................................................... 32

JANUVIA – sitagliptin phosphate tab 25 mg (baseequiv)................................................................................. 32



JARDIANCE – empagliflozin tab 10 mg.............................32JARDIANCE – empagliflozin tab 25 mg.............................32JENTADUETO – linagliptin-metformin hcl tab 2.5-500mg...................................................................................... 33

JENTADUETO – linagliptin-metformin hcl tab 2.5-850mg...................................................................................... 33

JENTADUETO – linagliptin-metformin hcl tab 2.5-1000mg...................................................................................... 33

JENTADUETO XR – linagliptin-metformin hcl tab er 24hr2.5-1000 mg...................................................................... 33

JENTADUETO XR – linagliptin-metformin hcl tab er 24hr5-1000 mg......................................................................... 33

JUXTAPID – lomitapide mesylate cap 5 mg (baseequiv)................................................................................. 57






KKALETRA – lopinavir-ritonavir soln 400-100 mg/5ml(80-20 mg/ml).................................................................... 10

KALETRA – lopinavir-ritonavir tab 100-25 mg...................10KALETRA – lopinavir-ritonavir tab 200-50 mg...................10KALYDECO – ivacaftor packet 50 mg............................... 70KALYDECO – ivacaftor packet 75 mg............................... 70KALYDECO – ivacaftor tab 150 mg................................... 70KAPVAY – clonidine hcl tab er 12hr 0.1 mg.......................92KAZANO – alogliptin-metformin hcl tab 12.5-500 mg........33KAZANO – alogliptin-metformin hcl tab 12.5-1000 mg......33KEFLEX – cephalexin cap 250 mg...................................... 2KEFLEX – cephalexin cap 500 mg...................................... 2KEFLEX – cephalexin cap 750 mg...................................... 2KEPPRA – levetiracetam oral soln 100 mg/ml.................110KEPPRA – levetiracetam tab 250 mg..............................110KEPPRA – levetiracetam tab 500 mg..............................110KEPPRA – levetiracetam tab 750 mg..............................110KEPPRA – levetiracetam tab 1000 mg............................110KEPPRA XR – levetiracetam tab er 24hr 500 mg........... 110KEPPRA XR – levetiracetam tab er 24hr 750 mg........... 110KERALYT – salicylic acid gel 6%.....................................145ketoconazole cream 2%................................................. 145ketoconazole shampoo 2% (Nizoral)............................145ketoconazole tab 200 mg...................................................7ketoprofen cap 50 mg.................................................... 105ketoprofen cap 75 mg.................................................... 105KETOPROFEN ER – ketoprofen cap er 24hr 200 mg..... 105ketorolac tromethamine ophth soln 0.5% (Acular)..... 141ketorolac tromethamine ophth soln 0.4% (Acularls)..................................................................................... 141

ketorolac tromethamine tab 10 mg...............................105KEVEYIS – dichlorphenamide tab 50 mg.......................... 59KINERET – anakinra subcutaneous soln prefilled syringe100 mg/0.67ml.................................................................105

KINRIX – diph-tetanus tox ad-acell pert & polio virus, ipvvac inj.................................................................................16

KISQALI FEMARA 200 DOSE – ribociclib tab 200 mg &letrozole tab 2.5 mg therapy pack....................................19


2018



KISQALI – ribociclib succinate tab 200 mg (baseequiv)................................................................................. 19

KITABIS PAK – tobramycin nebu soln 300 mg/5ml............. 5KLARON – sulfacetamide sodium lotion 10% (acne)...... 144KLOR-CON M15 – potassium chloride microencapsulatedcrys er tab 15 meq..........................................................126

KOATE – antihemophilic factor (human) for inj 250unit....................................................................................134



KOATE-DVI – antihemophilic factor (human) for inj 250unit....................................................................................134



KOGENATE FS – antihemophilic factor (recombinant) forinj kit 250 unit..................................................................134

KOGENATE FS – antihemophilic factor (recombinant) forinj kit 500 unit..................................................................134

KOGENATE FS – antihemophilic factor (recombinant) forinj kit 1000 unit................................................................134



KOGENATE FS BIO-SET – antihemophilic factor(recombinant) for inj kit 250 unit.....................................134

KOGENATE FS BIO-SET – antihemophilic factor(recombinant) for inj kit 500 unit.....................................134

KOGENATE FS BIO-SET – antihemophilic factor(recombinant) for inj kit 1000 unit...................................134



KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr2.5-1000 mg...................................................................... 33

KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr5-500 mg............................................................................33

KOMBIGLYZE XR – saxagliptin-metformin hcl tab er 24hr5-1000 mg......................................................................... 33

KORLYM – mifepristone tab 300 mg................................. 33KOSHER PRENATAL PLUS IRON – prenatal vit w/ ironcarbonyl-fa tab 30-1 mg..................................................120

KOVALTRY – antihemophilic factor (recombinant) for inj250 unit............................................................................134

KOVALTRY – antihemophilic factor (recombinant) for inj500 unit............................................................................134

KOVALTRY – antihemophilic factor (recombinant) for inj1000 unit..........................................................................134



K-PHOS NEUTRAL – pot phos monobasic w/sod phos di& monobas tab 155-852-130mg.....................................126

K-PHOS NO 2 – potassium & sodium acid phosphates tab305-700 mg....................................................................... 79

K-PHOS – potassium phosphate monobasic tab 500mg.................................................................................... 126

K-TAB – potassium chloride tab er 10 meq..................... 126K-TAB – potassium chloride tab er 8 meq (600 mg)........126K-TAB – potassium chloride tab er 20 meq (1500mg)................................................................................... 126

KUVAN – sapropterin dihydrochloride powder packet 100mg...................................................................................... 41

KUVAN – sapropterin dihydrochloride powder packet 500mg...................................................................................... 41

KUVAN – sapropterin dihydrochloride soluble tab 100mg...................................................................................... 41

KYNAMRO – mipomersen sodium soln prefilled syringe200 mg/ml..........................................................................57

Llabetalol hcl tab 100 mg...................................................49labetalol hcl tab 200 mg...................................................49labetalol hcl tab 300 mg...................................................49LAC-HYDRIN – lactic acid (ammonium lactate) cream12%.................................................................................. 150

LAC-HYDRIN – lactic acid (ammonium lactate) lotion12%.................................................................................. 150

LACRISERT – artificial tear ophth insert..........................141lactated ringer's for irrigation....................................... 154lactic acid (ammonium lactate) cream 12% (Lac-hydrin).............................................................................150

lactic acid (ammonium lactate) lotion 12% (Lac-hydrin).............................................................................150

lactulose (encephalopathy) solution 10 gm/15ml......... 76lactulose solution 10 gm/15ml........................................ 71LAMICTAL CHEWABLE DISPERS – lamotrigine tabchewable dispersible 5 mg............................................. 111

LAMICTAL CHEWABLE DISPERS – lamotrigine tabchewable dispersible 25 mg........................................... 111

LAMICTAL – lamotrigine tab 25 mg................................. 110LAMICTAL – lamotrigine tab 100 mg............................... 110LAMICTAL – lamotrigine tab 150 mg............................... 110LAMICTAL – lamotrigine tab 200 mg............................... 110LAMICTAL ODT – lamotrigine orally disintegrating tab 25mg.................................................................................... 111

LAMICTAL ODT – lamotrigine orally disintegrating tab 50mg.................................................................................... 111



2018


LAMICTAL ODT – lamotrigine tab disint 25 (14) & 50 mg(14) & 100 mg (7) kit...................................................... 111

LAMICTAL ODT – lamotrigine tab disint 25 mg (21) & 50mg (7) titration kit............................................................111

LAMICTAL ODT – lamotrigine tab disint 50 mg (42)- 100mg(14) titration kit........................................................... 111

LAMICTAL STARTER/NOT TAKI – lamotrigine tab 25 mg(42) & 100 mg (7) starter kit...........................................111

LAMICTAL STARTER/TAKING C – lamotrigine tab 25 mg(84) & 100 mg (14) starter kit.........................................111

LAMICTAL STARTER/TAKING V – lamotrigine tab 25 mg(35) starter kit.................................................................. 111

LAMICTAL XR – lamotrigine tab er 24hr 25 (14) & 50 mg(14) & 100 mg(7) kit........................................................111

LAMICTAL XR – lamotrigine tab er 24hr 50 (14) & 100mg(14) & 200 mg(7) kit...................................................111

LAMICTAL XR – lamotrigine tab er 24hr 25 mg.............. 111LAMICTAL XR – lamotrigine tab er 24hr 50 mg.............. 111LAMICTAL XR – lamotrigine tab er 24hr 100 mg.............111LAMICTAL XR – lamotrigine tab er 24hr 200 mg.............111LAMICTAL XR – lamotrigine tab er 24hr 250 mg.............111LAMICTAL XR – lamotrigine tab er 24hr 300 mg.............111LAMICTAL XR – lamotrigine tab er 24hr 25 mg (21) & 50mg (7) titration kit............................................................111

LAMISIL – terbinafine hcl tab 250 mg..................................7lamivudine oral soln 10 mg/ml (Epivir).......................... 10lamivudine tab 150 mg (Epivir)....................................... 10lamivudine tab 300 mg (Epivir)....................................... 10lamivudine tab 100 mg (hbv) (Epivir hbv)........................8lamivudine-zidovudine tab 150-300 mg (Combivir)...... 10lamotrigine orally disintegrating tab 25 mg (Lamictalodt)...................................................................................111

lamotrigine orally disintegrating tab 50 mg (Lamictalodt)...................................................................................111



lamotrigine tab chewable dispersible 5 mg (Lamictalchewable di)...................................................................111

lamotrigine tab chewable dispersible 25 mg (Lamictalchewable di)...................................................................111

lamotrigine tab disint 25 (14) & 50 mg (14) & 100 mg (7)kit (Lamictal odt)........................................................... 112

lamotrigine tab disint 25 mg (21) & 50 mg (7) titrationkit (Lamictal odt)........................................................... 111

lamotrigine tab disint 50 mg (42)- 100 mg(14) titrationkit (Lamictal odt)........................................................... 111

lamotrigine tab er 24hr 25 mg (Lamictal xr)................ 112lamotrigine tab er 24hr 50 mg (Lamictal xr)................ 112lamotrigine tab er 24hr 100 mg (Lamictal xr).............. 112lamotrigine tab er 24hr 200 mg (Lamictal xr).............. 112lamotrigine tab er 24hr 250 mg (Lamictal xr).............. 112lamotrigine tab er 24hr 300 mg (Lamictal xr).............. 112lamotrigine tab 25 mg (42) & 100 mg (7) starter kit(Lamictal starter/not).................................................... 112

lamotrigine tab 25 mg (84) & 100 mg (14) starter kit(Lamictal starter/tak).....................................................112

lamotrigine tab 25 mg (Lamictal)..................................112lamotrigine tab 100 mg (Lamictal)................................112lamotrigine tab 150 mg (Lamictal)................................112lamotrigine tab 200 mg (Lamictal)................................112lamotrigine tab 25 mg (35) starter kit (Lamictal starter/tak)...................................................................................112

LANCET DEVICES – VARIOUS MANUFACTURERS.....152LANCETS – VARIOUS MANUFACTURERS................... 152LANOXIN – digoxin tab 62.5 mcg (0.0625 mg)................. 63LANOXIN – digoxin tab 125 mcg (0.125 mg).................... 63LANOXIN – digoxin tab 187.5 mcg (0.1875 mg)............... 63LANOXIN – digoxin tab 250 mcg (0.25 mg)...................... 63lansoprazole cap delayed release 15 mg(Prevacid)..........................................................................72

lansoprazole cap delayed release 30 mg(Prevacid)..........................................................................72

lanthanum carbonate chew tab 500 mg (elemental)(Fosrenol)..........................................................................76



LANTUS – insulin glargine inj 100 unit/ml......................... 36LANTUS SOLOSTAR – insulin glargine soln pen-injector100 unit/ml......................................................................... 36

LASIX – furosemide tab 20 mg..........................................59LASIX – furosemide tab 40 mg..........................................59LASIX – furosemide tab 80 mg..........................................59LASTACAFT – alcaftadine ophth soln 0.25%.................. 141latanoprost ophth soln 0.005% (Xalatan).....................139LATUDA – lurasidone hcl tab 20 mg..................................86LATUDA – lurasidone hcl tab 40 mg..................................86LATUDA – lurasidone hcl tab 60 mg..................................86LATUDA – lurasidone hcl tab 80 mg..................................86LATUDA – lurasidone hcl tab 120 mg................................87LECITHIN – lecithin granules...........................................127leflunomide tab 10 mg (Arava)......................................105leflunomide tab 20 mg (Arava)......................................105LENVIMA 14 MG DAILY DOSE – lenvatinib cap therapypack 10 & 4 mg (14 mg daily dose)................................. 20

LENVIMA 18 MG DAILY DOSE – lenvatinib cap therapypack 10 & 4 (2) mg (18 mg daily dose)............................20

LENVIMA 24 MG DAILY DOSE – lenvatinib cap therapypack 10 (2) & 4 mg (24 mg daily dose)............................20

LENVIMA 10 MG DAILY DOSE – lenvatinib cap therapypack 10 mg (10 mg daily dose)........................................19

LENVIMA 20 MG DAILY DOSE – lenvatinib cap therapypack 10 (2) mg (20 mg daily dose).................................. 20

LENVIMA 8 MG DAILY DOSE – lenvatinib cap therapypack 4 (2) mg (8 mg daily dose)...................................... 20

LESCOL XL – fluvastatin sodium tab er 24 hr 80 mg........ 57LETAIRIS – ambrisentan tab 5 mg.................................... 63LETAIRIS – ambrisentan tab 10 mg.................................. 63letrozole tab 2.5 mg (Femara)......................................... 20

2018


LEUCOVORIN CALCIUM – leucovorin calcium tab 10mg...................................................................................... 20

LEUCOVORIN CALCIUM – leucovorin calcium tab 15mg...................................................................................... 20

leucovorin calcium tab 5 mg...........................................20leucovorin calcium tab 25 mg.........................................20LEUKERAN – chlorambucil tab 2 mg................................ 20LEUKINE – sargramostim lyophilized for inj 250 mcg..... 130leuprolide acetate inj kit 5 mg/ml................................... 20levalbuterol hcl soln nebu conc 1.25 mg/0.5ml (baseequiv) (Xopenex concentrate)....................................... 69

levalbuterol hcl soln nebu 0.31 mg/3ml (base equiv)(Xopenex)..........................................................................69



LEVAQUIN – levofloxacin tab 250 mg................................. 5LEVAQUIN – levofloxacin tab 500 mg................................. 5LEVAQUIN – levofloxacin tab 750 mg................................. 5LEVBID – hyoscyamine sulfate tab er 12hr 0.375 mg....... 72LEVEMIR FLEXTOUCH – insulin detemir soln pen-injector100 unit/ml......................................................................... 36

LEVEMIR – insulin detemir inj 100 unit/ml.........................36levetiracetam oral soln 100 mg/ml (Keppra)................112levetiracetam tab er 24hr 500 mg (Keppra xr).............112levetiracetam tab er 24hr 750 mg (Keppra xr).............112levetiracetam tab 250 mg (Keppra)...............................112levetiracetam tab 500 mg (Keppra)...............................112levetiracetam tab 750 mg (Keppra)...............................112levetiracetam tab 1000 mg (Keppra).............................112LEVITRA – vardenafil hcl tab 2.5 mg.................................65LEVITRA – vardenafil hcl tab 5 mg....................................65LEVITRA – vardenafil hcl tab 10 mg..................................65LEVITRA – vardenafil hcl tab 20 mg..................................65levobunolol hcl ophth soln 0.5% (Betagan)................ 139levocarnitine oral soln 1 gm/10ml (10%) (Carnitor)...... 41levocarnitine tab 330 mg (Carnitor)................................41

levocetirizine dihydrochloride tab 5 mg (Xyzal)............65LEVOFLOXACIN – levofloxacin oral soln 25 mg/ml............ 5levofloxacin ophth soln 0.5%........................................137levofloxacin tab 250 mg (Levaquin)................................. 5levofloxacin tab 500 mg (Levaquin)................................. 5levofloxacin tab 750 mg (Levaquin)................................. 5LEVOMEFOLATE DHA – prenat w/fe fum-l methylfolate-fa-dha cap 27-1.13-0.4 mg............................................. 120

LEVONORGESTREL AND ETHINY – levonorgestrel-ethinyl estradiol (continuous) tab 90-20 mcg................... 28

levonorgestrel tab 1.5 mg................................................28levothyroxine sodium tab 25 mcg (Synthroid)..............36levothyroxine sodium tab 50 mcg (Synthroid)..............36levothyroxine sodium tab 75 mcg (Synthroid)..............36levothyroxine sodium tab 88 mcg (Synthroid)..............36levothyroxine sodium tab 100 mcg (Synthroid)............36

levothyroxine sodium tab 112 mcg (Synthroid)............ 37levothyroxine sodium tab 125 mcg (Synthroid)............37levothyroxine sodium tab 137 mcg (Synthroid)............37levothyroxine sodium tab 150 mcg (Synthroid)............37levothyroxine sodium tab 175 mcg (Synthroid)............37levothyroxine sodium tab 200 mcg (Synthroid)............37levothyroxine sodium tab 300 mcg (Synthroid)............37LEVSIN/SL – hyoscyamine sulfate tab sl 0.125 mg...........72LEVSIN – hyoscyamine sulfate tab 0.125 mg................... 72LEVULAN KERASTICK – aminolevulinic acid hcl for soln20% (stick applicator)......................................................150

LEXIVA – fosamprenavir calcium susp 50 mg/ml (baseequiv)................................................................................. 10

LEXIVA – fosamprenavir calcium tab 700 mg (baseequiv)................................................................................. 10

LIALDA – mesalamine tab delayed release 1.2 gm...........76lidocaine hcl gel 2%....................................................... 150LIDOCAINE HCL-HYDROCORTIS – lidocaine-hydrocortisone acetate rectal gel 2.8-0.55%..................143

LIDOCAINE HCL – lidocaine hcl laryngotracheal soln4%.................................................................................... 142

lidocaine hcl soln 4% (Xylocaine).................................151lidocaine hcl viscous soln 2%...................................... 142lidocaine patch 5% (Lidoderm)..................................... 151lidocaine-prilocaine cream 2.5-2.5%.............................151LIDODERM – lidocaine patch 5%....................................151LINDANE – lindane shampoo 1%....................................151linezolid for susp 100 mg/5ml (Zyvox)...........................14linezolid tab 600 mg (Zyvox)........................................... 14LINZESS – linaclotide cap 72 mcg.................................... 76LINZESS – linaclotide cap 145 mcg.................................. 76LINZESS – linaclotide cap 290 mcg.................................. 76liothyronine sodium tab 5 mcg (Cytomel)..................... 37liothyronine sodium tab 25 mcg (Cytomel)................... 37liothyronine sodium tab 50 mcg (Cytomel)................... 37LIPOFEN – fenofibrate cap 50 mg.....................................57LIPOFEN – fenofibrate cap 150 mg...................................57lisinopril & hydrochlorothiazide tab 10-12.5 mg(Zestoretic)....................................................................... 44

lisinopril & hydrochlorothiazide tab 20-12.5 mg(Zestoretic)....................................................................... 44

lisinopril & hydrochlorothiazide tab 20-25 mg(Zestoretic)....................................................................... 44

lisinopril tab 5 mg (Prinivil)............................................. 44lisinopril tab 10 mg (Prinivil)........................................... 44lisinopril tab 20 mg (Prinivil)........................................... 44lisinopril tab 2.5 mg (Zestril)........................................... 44lisinopril tab 30 mg (Zestril)............................................ 44lisinopril tab 40 mg (Zestril)............................................ 44lithium carbonate cap 300 mg.........................................87lithium carbonate cap 150 mg (Lithium carbonate)......87lithium carbonate cap 600 mg (Lithium carbonate)......87LITHIUM CARBONATE – lithium carbonate cap 150mg...................................................................................... 87

LITHIUM CARBONATE – lithium carbonate cap 600mg...................................................................................... 87

2018


lithium carbonate tab er 450 mg.....................................87lithium carbonate tab er 300 mg (Lithobid)................... 87lithium carbonate tab 300 mg......................................... 87LITHIUM – lithium oral solution 8 meq/5ml........................87LITHOBID – lithium carbonate tab er 300 mg....................87LITHOSTAT – acetohydroxamic acid tab 250 mg..............79LIVALO – pitavastatin calcium tab 1 mg (base equiv)....... 57LIVALO – pitavastatin calcium tab 2 mg (base equiv)....... 57LIVALO – pitavastatin calcium tab 4 mg (base equiv)....... 57LOCOID – hydrocortisone butyrate oint 0.1%..................149LOCOID – hydrocortisone butyrate soln 0.1%.................149LODINE – etodolac tab 400 mg.......................................105LODOSYN – carbidopa tab 25 mg...................................115LOESTRIN FE 1.5/30 – norethindrone ace & ethinylestradiol-fe tab 1.5 mg-30 mcg.........................................28

LOESTRIN FE 1/20 – norethindrone ace & ethinylestradiol-fe tab 1 mg-20 mcg............................................29

LOFIBRA – fenofibrate micronized cap 67 mg.................. 57LOFIBRA – fenofibrate micronized cap 134 mg................ 57LOFIBRA – fenofibrate tab 54 mg......................................57LO LOESTRIN FE – norethin-eth estradiol-fe tab 1 mg-10mcg (24)/10 mcg (2)......................................................... 28

LOMOTIL – diphenoxylate w/ atropine tab 2.5-0.025mg...................................................................................... 71

LONSURF – trifluridine-tipiracil tab 15-6.14 mg.................20LONSURF – trifluridine-tipiracil tab 20-8.19 mg.................20loperamide hcl cap 2 mg................................................. 71LOPID – gemfibrozil tab 600 mg........................................57lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml)(Kaletra).............................................................................10

LOPRESSOR HCT – metoprolol & hydrochlorothiazide tab50-25 mg............................................................................50

LOPRESSOR – metoprolol tartrate tab 50 mg.................. 49LOPRESSOR – metoprolol tartrate tab 100 mg................ 49LOPROX – ciclopirox olamine cream 0.77% (baseequiv)............................................................................... 146

LOPROX – ciclopirox olamine susp 0.77% (baseequiv)............................................................................... 146

loratadine & pseudoephedrine tab er 12hr 5-120mg...................................................................................... 66

loratadine & pseudoephedrine tab er 24hr 10-240mg...................................................................................... 66

loratadine rapidly-disintegrating tab 10 mg(Claritin)............................................................................ 65

loratadine syrup 5 mg/5ml...............................................65loratadine tab 10 mg.........................................................65lorazepam conc 2 mg/ml..................................................81lorazepam tab 0.5 mg (Ativan)........................................ 81lorazepam tab 1 mg (Ativan)........................................... 81lorazepam tab 2 mg (Ativan)........................................... 81losartan potassium & hydrochlorothiazide tab 50-12.5mg (Hyzaar)...................................................................... 47

losartan potassium & hydrochlorothiazide tab 100-12.5mg (Hyzaar)...................................................................... 47

losartan potassium & hydrochlorothiazide tab 100-25mg (Hyzaar)...................................................................... 47

losartan potassium tab 25 mg (Cozaar).........................47losartan potassium tab 50 mg (Cozaar).........................47losartan potassium tab 100 mg (Cozaar).......................47LOSEASONIQUE – levonorg-eth est tab 0.1-0.02mg(84) &eth est tab 0.01mg(7)........................................................29

LOTEMAX – loteprednol etabonate ophth gel 0.5%........138LOTEMAX – loteprednol etabonate ophth oint 0.5%.......138LOTEMAX – loteprednol etabonate ophth susp 0.5%..... 138LOTENSIN – benazepril hcl tab 20 mg..............................44LOTENSIN – benazepril hcl tab 40 mg..............................44LOTENSIN HCT – benazepril & hydrochlorothiazide tab10-12.5 mg........................................................................ 44

LOTENSIN HCT – benazepril & hydrochlorothiazide tab20-12.5 mg........................................................................ 44

LOTENSIN HCT – benazepril & hydrochlorothiazide tab20-25 mg............................................................................45

LOTREL – amlodipine besylate-benazepril hcl cap 5-10mg...................................................................................... 53




LOTRISONE – clotrimazole w/ betamethasone cream1-0.05%............................................................................146

LOTRONEX – alosetron hcl tab 0.5 mg (base equiv)........76LOTRONEX – alosetron hcl tab 1 mg (base equiv)...........76lovastatin tab 10 mg.........................................................57lovastatin tab 20 mg.........................................................57lovastatin tab 40 mg (Mevacor).......................................57LOVAZA – omega-3-acid ethyl esters cap 1 gm................57LOVENOX – enoxaparin sodium inj 30 mg/0.3ml............130LOVENOX – enoxaparin sodium inj 40 mg/0.4ml............130LOVENOX – enoxaparin sodium inj 60 mg/0.6ml............130LOVENOX – enoxaparin sodium inj 80 mg/0.8ml............130LOVENOX – enoxaparin sodium inj 100 mg/ml...............130LOVENOX – enoxaparin sodium inj 120 mg/0.8ml..........130LOVENOX – enoxaparin sodium inj 150 mg/ml...............130LOVENOX – enoxaparin sodium inj 300 mg/3ml.............130loxapine succinate cap 5 mg.......................................... 87loxapine succinate cap 10 mg........................................ 87loxapine succinate cap 25 mg........................................ 87loxapine succinate cap 50 mg........................................ 87LUMIGAN – bimatoprost ophth soln 0.01%.....................139LUXIQ – betamethasone valerate aerosol foam0.12%............................................................................... 149

LYNPARZA – olaparib cap 50 mg......................................20LYNPARZA – olaparib tab 100 mg.....................................20LYNPARZA – olaparib tab 150 mg.....................................20LYRICA – pregabalin cap 25 mg......................................112LYRICA – pregabalin cap 50 mg......................................112LYRICA – pregabalin cap 75 mg......................................112LYRICA – pregabalin cap 100 mg....................................112LYRICA – pregabalin cap 150 mg....................................112LYRICA – pregabalin cap 200 mg....................................112

2018


LYRICA – pregabalin cap 225 mg....................................112LYRICA – pregabalin cap 300 mg....................................112LYRICA – pregabalin soln 20 mg/ml................................ 112LYSODREN – mitotane tab 500 mg...................................20LYSTEDA – tranexamic acid tab 650 mg.........................130

MMACROBID – nitrofurantoin monohydrate macrocrystallinecap 100 mg....................................................................... 77

MACRODANTIN – nitrofurantoin macrocrystalline cap 25mg...................................................................................... 77



mafenide acetate packet for topical soln 5% (50 gm)(Sulfamylon)................................................................... 146

MALARONE – atovaquone-proguanil hcl tab 62.5-25mg...................................................................................... 13

MALARONE – atovaquone-proguanil hcl tab 250-100mg...................................................................................... 13

malathion lotion 0.5% (Ovide).......................................151MAPROTILINE HCL – maprotiline hcl tab 25 mg.............. 83MAPROTILINE HCL – maprotiline hcl tab 50 mg.............. 83MAPROTILINE HCL – maprotiline hcl tab 75 mg.............. 83MARINOL – dronabinol cap 2.5 mg...................................74MARINOL – dronabinol cap 5 mg......................................74MARINOL – dronabinol cap 10 mg....................................74MARNATAL-F – prenatal w/o vit a w/ fe polysac cmplx-facap 60-1 mg.................................................................... 120

MARPLAN – isocarboxazid tab 10 mg...............................83MATULANE – procarbazine hcl cap 50 mg....................... 20MAVYRET – glecaprevir-pibrentasvir tab 100-40 mg.......... 8MAXIDEX – dexamethasone ophth susp 0.1%............... 138MAXITROL – neomycin-polymyxin-dexamethasone ophthoint 0.1%..........................................................................138

MAXITROL – neomycin-polymyxin-dexamethasone ophthsusp 0.1%........................................................................138

MAXZIDE – triamterene & hydrochlorothiazide tab 75-50mg...................................................................................... 59

MAXZIDE-25 – triamterene & hydrochlorothiazide tab37.5-25 mg........................................................................ 59

meclizine hcl tab 12.5 mg................................................ 74meclizine hcl tab 25 mg................................................... 74MECLOFENAMATE SODIUM – meclofenamate sodiumcap 50 mg....................................................................... 105

MECLOFENAMATE SODIUM – meclofenamate sodiumcap 100 mg..................................................................... 105

MEDROL DOSEPAK – methylprednisolone tab therapypack 4 mg (21)..................................................................24

MEDROL – methylprednisolone tab 2 mg......................... 23MEDROL – methylprednisolone tab 4 mg......................... 23MEDROL – methylprednisolone tab 8 mg......................... 23MEDROL – methylprednisolone tab 16 mg....................... 23MEDROL – methylprednisolone tab 32 mg....................... 24

medroxyprogesterone acetate tab 2.5 mg(Provera)........................................................................... 28

medroxyprogesterone acetate tab 5 mg (Provera).......28medroxyprogesterone acetate tab 10 mg (Provera).....28mefenamic acid cap 250 mg (Ponstel).........................105mefloquine hcl tab 250 mg.............................................. 13MEGACE ES – megestrol acetate susp 625 mg/5ml.........28megestrol acetate susp 625 mg/5ml (Megace es).........28megestrol acetate susp 40 mg/ml (Megace oral).......... 20megestrol acetate tab 20 mg...........................................20megestrol acetate tab 40 mg...........................................20MEKINIST – trametinib dimethyl sulfoxide tab 0.5 mg(base equivalent)...............................................................20

MEKINIST – trametinib dimethyl sulfoxide tab 2 mg (baseequivalent)......................................................................... 20

meloxicam tab 7.5 mg (Mobic)......................................105meloxicam tab 15 mg (Mobic).......................................105melphalan tab 2 mg (Alkeran).........................................20memantine hcl oral solution 2 mg/ml (Namenda)......... 96memantine hcl tab 5 mg (28) & 10 mg (21) titration pak(Namenda titration pa)....................................................96

memantine hcl tab 5 mg (Namenda).............................. 96memantine hcl tab 10 mg (Namenda)............................ 96MENACTRA – meningococcal (a, c, y, and w-135)conjugate vaccine inj.........................................................16

MENEST – esterified estrogens tab 0.3 mg...................... 27MENEST – esterified estrogens tab 0.625 mg...................27MENEST – esterified estrogens tab 1.25 mg.................... 27MENOSTAR – estradiol td patch weekly 14 mcg/24hr...... 27MENTAX – butenafine hcl cream 1%...............................146MENVEO – meningococcal (a, c, y, and w-135) oligo conjvac for inj...........................................................................16

MEPERIDINE HCL/PROMETHAZI – meperidine w/promethazine cap 50-25 mg...........................................101

MEPERIDINE HCL – meperidine hcl oral soln 50mg/5ml............................................................................. 100

meperidine hcl tab 50 mg..............................................101meperidine hcl tab 100 mg............................................101MEPHYTON – phytonadione tab 5 mg............................ 119meprobamate tab 200 mg................................................ 81meprobamate tab 400 mg................................................ 81MEPRON – atovaquone susp 750 mg/5ml........................14mercaptopurine tab 50 mg.............................................. 20MESALAMINE DR – mesalamine tab delayed release 800mg...................................................................................... 76

mesalamine enema 4 gm................................................. 76mesalamine tab delayed release 1.2 gm (Lialda)..........76MESNEX – mesna tab 400 mg..........................................20MESTINON – pyridostigmine bromide syrup 60mg/5ml............................................................................. 118

MESTINON TIMESPAN – pyridostigmine bromide tab er180 mg.............................................................................118

METAPROTERENOL SULFATE – metaproterenol sulfatesyrup 10 mg/5ml................................................................69

METAPROTERENOL SULFATE – metaproterenol sulfatetab 10 mg.......................................................................... 69

2018


METAPROTERENOL SULFATE – metaproterenol sulfatetab 20 mg.......................................................................... 69

METAXALONE – metaxalone tab 400 mg....................... 118metaxalone tab 800 mg (Skelaxin)................................118metformin hcl tab er 24hr 500 mg (Glucophage xr)......33metformin hcl tab er 24hr 750 mg (Glucophage xr)......33metformin hcl tab 500 mg (Glucophage)....................... 33metformin hcl tab 850 mg (Glucophage)....................... 33metformin hcl tab 1000 mg (Glucophage)..................... 33methadone hcl conc 10 mg/ml (Methadose)............... 101METHADONE HCL – methadone hcl soln 5 mg/5ml.......101METHADONE HCL – methadone hcl soln 10 mg/5ml.....101methadone hcl soln 5 mg/5ml (Methadone hcl).......... 101methadone hcl soln 10 mg/5ml (Methadone hcl)........ 101methadone hcl tab for oral susp 40 mg.......................101methadone hcl tab 5 mg (Dolophine)...........................101methadone hcl tab 10 mg (Dolophine).........................101METHADOSE – methadone hcl conc 10 mg/ml.............. 101METHADOSE SUGAR-FREE – methadone hcl conc 10mg/ml............................................................................... 101

methamphetamine hcl tab 5 mg (Desoxyn)...................92methazolamide tab 25 mg (Neptazane)..........................59methazolamide tab 50 mg (Neptazane)..........................59methenamine hippurate tab 1 gm (Hiprex).................... 77METHERGINE – methylergonovine maleate tab 0.2mg...................................................................................... 41

methimazole tab 5 mg (Tapazole)................................... 37methimazole tab 10 mg (Tapazole)................................. 37METHITEST – methyltestosterone oral tab 10 mg............ 25methocarbamol tab 750 mg (Robaxin-750)..................118methocarbamol tab 500 mg (Robaxin).........................118methotrexate sodium for inj 1 gm.................................. 20methotrexate sodium inj 50 mg/2ml (25 mg/ml)............20methotrexate sodium inj pf 50 mg/2ml (25 mg/ml)....... 20methotrexate sodium inj pf 100 mg/4ml (25 mg/ml)..... 20methotrexate sodium inj pf 200 mg/8ml (25 mg/ml)..... 20methotrexate sodium inj pf 250 mg/10ml (25 mg/ml)...................................................................................... 20

methotrexate sodium inj pf 1000 mg/40ml (25 mg/ml)...................................................................................... 20

METHOTREXATE SODIUM – methotrexate sodium inj250 mg/10ml (25 mg/ml)...................................................20

methotrexate sodium tab 2.5 mg (base equiv)..............20methoxsalen rapid cap 10 mg (Oxsoralen ultra).........151methscopolamine bromide tab 2.5 mg (Pamine).......... 72methscopolamine bromide tab 5 mg (Pamineforte).................................................................................. 72

METHYCLOTHIAZIDE – methyclothiazide tab 5 mg.........59METHYLDOPA/HYDROCHLOROTHI – methyldopa &hydrochlorothiazide tab 250-15 mg.................................. 63

METHYLDOPA/HYDROCHLOROTHI – methyldopa &hydrochlorothiazide tab 250-25 mg.................................. 63

methyldopa tab 250 mg................................................... 63methyldopa tab 500 mg................................................... 63METHYLIN – methylphenidate hcl soln 5 mg/5ml............. 92METHYLIN – methylphenidate hcl soln 10 mg/5ml........... 92

methylphenidate hcl cap er 24hr 20 mg (la) (Ritalinla)....................................................................................... 92



methylphenidate hcl cap er 10 mg (cd)......................... 92methylphenidate hcl cap er 20 mg (cd)......................... 92methylphenidate hcl cap er 30 mg (cd)......................... 92methylphenidate hcl cap er 40 mg (cd)......................... 92methylphenidate hcl cap er 50 mg (cd)......................... 92methylphenidate hcl cap er 60 mg (cd)......................... 92METHYLPHENIDATE HCL ER – methylphenidate hcl taber 24hr 18 mg................................................................... 93

METHYLPHENIDATE HCL – methylphenidate hcl chewtab 2.5 mg......................................................................... 92

METHYLPHENIDATE HCL – methylphenidate hcl chewtab 5 mg............................................................................ 92

METHYLPHENIDATE HCL – methylphenidate hcl chewtab 10 mg.......................................................................... 92

methylphenidate hcl soln 5 mg/5ml (Methylin)............. 93methylphenidate hcl soln 10 mg/5ml (Methylin)........... 93methylphenidate hcl tab er 10 mg..................................93methylphenidate hcl tab er 20 mg..................................93methylphenidate hcl tab er osmotic release (osm) 18mg (Concerta).................................................................. 93

methylphenidate hcl tab er osmotic release (osm) 27mg (Concerta).................................................................. 93



methylphenidate hcl tab 5 mg (Ritalin).......................... 93methylphenidate hcl tab 10 mg (Ritalin)........................ 93methylphenidate hcl tab 20 mg (Ritalin)........................ 93methylprednisolone tab 4 mg (Medrol)..........................24methylprednisolone tab 8 mg (Medrol)..........................24methylprednisolone tab 16 mg (Medrol)........................24methylprednisolone tab 32 mg (Medrol)........................24methylprednisolone tab therapy pack 4 mg (21)(Medrol dosepak).............................................................24

methyltestosterone cap 10 mg (Testred)....................... 25METIPRANOLOL – metipranolol ophth soln 0.3%.......... 139metoclopramide hcl soln 5 mg/5ml (10 mg/10ml).........76metoclopramide hcl tab 5 mg (Reglan)..........................76metoclopramide hcl tab 10 mg (Reglan)........................76metolazone tab 2.5 mg.....................................................59metolazone tab 5 mg........................................................60metolazone tab 10 mg......................................................60METOPROLOL/HYDROCHLOROTHI – metoprolol &hydrochlorothiazide tab 100-50 mg.................................. 50

metoprolol & hydrochlorothiazide tab 50-25 mg(Lopressor hct)................................................................ 50

metoprolol & hydrochlorothiazide tab 100-25 mg(Lopressor hct)................................................................ 50

2018


metoprolol succinate tab er 24hr 25 mg (tartrate equiv)(Toprol xl)......................................................................... 50

metoprolol succinate tab er 24hr 50 mg (tartrate equiv)(Toprol xl)......................................................................... 50

metoprolol succinate tab er 24hr 100 mg (tartrateequiv) (Toprol xl)............................................................. 50

metoprolol succinate tab er 24hr 200 mg (tartrateequiv) (Toprol xl)............................................................. 50

METOPROLOL TARTRATE – metoprolol tartrate tab 37.5mg...................................................................................... 50

METOPROLOL TARTRATE – metoprolol tartrate tab 75mg...................................................................................... 50

metoprolol tartrate tab 25 mg......................................... 50metoprolol tartrate tab 50 mg (Lopressor).................... 50metoprolol tartrate tab 100 mg (Lopressor).................. 50METROCREAM – metronidazole cream 0.75%.............. 144METROGEL – metronidazole gel 1%.............................. 144METROGEL-VAGINAL – metronidazole vaginal gel0.75%................................................................................. 79

METROLOTION – metronidazole lotion 0.75%............... 144metronidazole cap 375 mg (Flagyl)................................ 14metronidazole cream 0.75% (Metrocream).................. 144metronidazole gel 0.75%................................................144metronidazole gel 1% (Metrogel).................................. 144metronidazole lotion 0.75% (Metrolotion)....................144metronidazole tab 250 mg (Flagyl)................................. 14metronidazole tab 500 mg (Flagyl)................................. 14metronidazole vaginal gel 0.75% (Metrogel-vaginal)..............................................................................79

mexiletine hcl cap 150 mg...............................................60mexiletine hcl cap 200 mg...............................................60mexiletine hcl cap 250 mg...............................................60MIACALCIN – calcitonin (salmon) inj 200 unit/ml.............. 41MICARDIS HCT – telmisartan-hydrochlorothiazide tab40-12.5 mg........................................................................ 47

MICARDIS HCT – telmisartan-hydrochlorothiazide tab80-12.5 mg........................................................................ 47

MICARDIS HCT – telmisartan-hydrochlorothiazide tab80-25 mg............................................................................47

MICARDIS – telmisartan tab 20 mg...................................47MICARDIS – telmisartan tab 40 mg...................................47MICARDIS – telmisartan tab 80 mg...................................47MICONAZOLE 3 – miconazole nitrate vaginal suppos 200mg...................................................................................... 79

MICRO-K – potassium chloride cap er 8 meq................. 126MICRO-K – potassium chloride cap er 10 meq............... 126MICROZIDE – hydrochlorothiazide cap 12.5 mg...............60midodrine hcl tab 2.5 mg.................................................63midodrine hcl tab 5 mg....................................................63midodrine hcl tab 10 mg..................................................63MIGERGOT – ergotamine w/ caffeine suppos 2-100mg.................................................................................... 107

miglitol tab 25 mg (Glyset).............................................. 33miglitol tab 50 mg (Glyset).............................................. 33miglitol tab 100 mg (Glyset)............................................ 33

MIGRANAL – dihydroergotamine mesylate nasal spray 4mg/ml............................................................................... 107

MINASTRIN 24 FE – norethindrone ace-eth estradiol-fechew tab 1 mg-20 mcg (24)............................................. 29

MINIPRESS – prazosin hcl cap 1 mg................................ 63MINIPRESS – prazosin hcl cap 2 mg................................ 63MINIPRESS – prazosin hcl cap 5 mg................................ 63MINIVELLE – estradiol td patch twice weekly 0.025mg/24hr..............................................................................27

MINIVELLE – estradiol td patch twice weekly 0.0375mg/24hr..............................................................................27




minocycline hcl cap 50 mg (Minocin).............................. 4minocycline hcl cap 75 mg (Minocin).............................. 4minocycline hcl cap 100 mg (Minocin)............................ 4minocycline hcl tab 50 mg................................................ 4minocycline hcl tab 75 mg................................................ 4minocycline hcl tab 100 mg.............................................. 4minoxidil tab 2.5 mg.........................................................63minoxidil tab 10 mg..........................................................63MIRAPEX – pramipexole dihydrochloride tab 0.125mg.................................................................................... 115

MIRAPEX – pramipexole dihydrochloride tab 0.25mg.................................................................................... 115

MIRAPEX – pramipexole dihydrochloride tab 0.5 mg......115MIRAPEX – pramipexole dihydrochloride tab 0.75mg.................................................................................... 115

MIRAPEX – pramipexole dihydrochloride tab 1 mg.........115MIRAPEX – pramipexole dihydrochloride tab 1.5 mg......115MIRCERA – methoxy peg-epoetin beta soln prefilled syr30 mcg/0.3ml...................................................................130

MIRCERA – methoxy peg-epoetin beta soln prefilled syr50 mcg/0.3ml...................................................................130

MIRCERA – methoxy peg-epoetin beta soln prefilled syr75 mcg/0.3ml...................................................................130

MIRCERA – methoxy peg-epoetin beta soln prefilled syr100 mcg/0.3ml.................................................................130



mirtazapine orally disintegrating tab 15 mg (Remeronsoltab)............................................................................... 83



mirtazapine tab 7.5 mg.....................................................83mirtazapine tab 15 mg (Remeron).................................. 83mirtazapine tab 30 mg (Remeron).................................. 83mirtazapine tab 45 mg (Remeron).................................. 83

2018


misoprostol tab 100 mcg (Cytotec)................................ 72misoprostol tab 200 mcg (Cytotec)................................ 72MITIGARE – colchicine cap 0.6 mg.................................108M-M-R II – measles, mumps & rubella virus vaccines forinj........................................................................................16

modafinil tab 100 mg (Provigil).......................................93modafinil tab 200 mg (Provigil).......................................93MODERIBA 1200 DOSE PACK – ribavirin tab 600 mg....... 8MODERIBA 800 DOSE PACK – ribavirin tab 400 mg......... 8MODERIBA – ribavirin tab 200 mg & ribavirin 400 mg tabtherapy pack........................................................................ 8

MODERIBA – ribavirin tab 400 mg & ribavirin 600 mg tabtherapy pack........................................................................ 8

moexipril hcl tab 7.5 mg.................................................. 45moexipril hcl tab 15 mg................................................... 45moexipril-hydrochlorothiazide tab 7.5-12.5 mg.............45moexipril-hydrochlorothiazide tab 15-12.5 mg..............45moexipril-hydrochlorothiazide tab 15-25 mg.................45mometasone furoate cream 0.1% (Elocon)................. 149mometasone furoate oint 0.1% (Elocon)......................149mometasone furoate solution 0.1% (lotion)(Elocon)...........................................................................149

MONOCLATE-P – antihemophilic factor (human) for inj kit1000 unit..........................................................................135

MONOCLATE-P – antihemophilic factor (human) for inj kit1500 unit..........................................................................135

MONONINE – coagulation factor ix for inj 1000 unit........135montelukast sodium chew tab 4 mg (base equiv)(Singulair)......................................................................... 69

montelukast sodium chew tab 5 mg (base equiv)(Singulair)......................................................................... 69

montelukast sodium oral granules packet 4 mg (baseequiv) (Singulair)............................................................. 69

montelukast sodium tab 10 mg (base equiv)(Singulair)......................................................................... 69

MONUROL – fosfomycin tromethamine powd pack 3 gm(base equivalent)...............................................................77

morphine sulfate cap er 24hr 10 mg (Kadian).............101morphine sulfate cap er 24hr 20 mg (Kadian).............101morphine sulfate cap er 24hr 30 mg (Kadian).............101morphine sulfate cap er 24hr 50 mg (Kadian).............101morphine sulfate cap er 24hr 60 mg (Kadian).............101morphine sulfate cap er 24hr 80 mg (Kadian).............101morphine sulfate cap er 24hr 100 mg (Kadian)...........101MORPHINE SULFATE ER – morphine sulfate beads caper 24hr 30 mg................................................................. 101

MORPHINE SULFATE ER – morphine sulfate beads caper 24hr 45 mg................................................................. 101




MORPHINE SULFATE ER – morphine sulfate beads caper 24hr 120 mg............................................................... 101

MORPHINE SULFATE – morphine sulfate suppos 5mg.................................................................................... 101




MORPHINE SULFATE – morphine sulfate tab 15 mg..... 101MORPHINE SULFATE – morphine sulfate tab 30 mg..... 101morphine sulfate oral soln 10 mg/5ml......................... 101morphine sulfate oral soln 20 mg/5ml......................... 102morphine sulfate oral soln 100 mg/5ml (20 mg/ml)....................................................................................102

morphine sulfate tab er 15 mg (Ms contin)................. 102morphine sulfate tab er 30 mg (Ms contin)................. 102morphine sulfate tab er 60 mg (Ms contin)................. 102morphine sulfate tab er 100 mg (Ms contin)............... 102morphine sulfate tab er 200 mg (Ms contin)............... 102MOVANTIK – naloxegol oxalate tab 12.5 mg (baseequivalent)......................................................................... 76

MOVANTIK – naloxegol oxalate tab 25 mg (baseequivalent)......................................................................... 76

MOVIPREP – peg 3350-kcl-nacl-na sulfate-na ascorbate-cfor soln 100 gm................................................................. 71

MOXATAG – amoxicillin (trihydrate) tab er 24hr 775 mg..... 1MOXEZA – moxifloxacin hcl ophth soln 0.5% (base eq) (2times daily)...................................................................... 137

moxifloxacin hcl ophth soln 0.5% (base equiv)(Vigamox)........................................................................137

moxifloxacin hcl tab 400 mg (base equiv) (Avelox)........5MULTAQ – dronedarone hcl tab 400 mg (baseequivalent)......................................................................... 60

mupirocin calcium cream 2% (Bactroban).................. 146mupirocin oint 2%...........................................................146M-VIT – prenatal vit w/ fe fumarate-fa tab 27-1 mg......... 120MYALEPT – metreleptin for subcutaneous inj 11.3 mg......41MYAMBUTOL – ethambutol hcl tab 100 mg........................6MYAMBUTOL – ethambutol hcl tab 400 mg........................6MYCOBUTIN – rifabutin cap 150 mg...................................6mycophenolate mofetil cap 250 mg (Cellcept)............154mycophenolate mofetil for oral susp 200 mg/ml(Cellcept).........................................................................154

mycophenolate mofetil tab 500 mg (Cellcept).............154mycophenolate sodium tab dr 180 mg (mycophenolicacid equiv) (Myfortic)....................................................154

mycophenolate sodium tab dr 360 mg (mycophenolicacid equiv) (Myfortic)....................................................154

MYDRIACYL – tropicamide ophth soln 1%......................141MYFORTIC – mycophenolate sodium tab dr 180 mg(mycophenolic acid equiv).............................................. 154

MYFORTIC – mycophenolate sodium tab dr 360 mg(mycophenolic acid equiv).............................................. 154

MYLERAN – busulfan tab 2 mg.........................................20MYNATAL ADVANCE – prenatal vit w/ dss-iron carbonyl-fatab 90-1 mg..................................................................... 120

2018


MYNATAL PLUS – prenatal vit w/ fe fumarate-fa tab 65-1mg.................................................................................... 120

MYNATAL – prenatal multivitamins & minerals w/ iron & facap 1 mg..........................................................................120

MYNATAL ULTRACAPLET – prenatal vit w/ dss-ironcarbonyl-fa tab 90-1 mg..................................................120

MYNATAL-Z – prenatal vit w/ fe fumarate-fa tab 65-1mg.................................................................................... 120

MYNATE 90 PLUS – prenatal vit w/ dss-fe fumarate-fa taber 90-1 mg.......................................................................120

MYRBETRIQ – mirabegron tab er 24 hr 25 mg.................78MYRBETRIQ – mirabegron tab er 24 hr 50 mg.................78MYTESI – crofelemer tab delayed release 125 mg........... 71

Nnabumetone tab 500 mg................................................ 105nabumetone tab 750 mg................................................ 105nadolol & bendroflumethiazide tab 40-5 mg(Corzide)............................................................................50

nadolol & bendroflumethiazide tab 80-5 mg(Corzide)............................................................................50

nadolol tab 20 mg (Corgard)........................................... 50nadolol tab 40 mg (Corgard)........................................... 50nadolol tab 80 mg (Corgard)........................................... 50naloxone hcl inj 0.4 mg/ml............................................ 154naloxone hcl inj 4 mg/10ml........................................... 154NALOXONE HCL – naloxone hcl soln cartridge 0.4 mg/ml......................................................................................154

NALOXONE HCL – naloxone hcl soln prefilled syringe 2mg/2ml............................................................................. 154

naltrexone hcl tab 50 mg................................................. 96NAMENDA – memantine hcl tab 5 mg.............................. 96NAMENDA – memantine hcl tab 10 mg............................ 96NAMENDA TITRATION PAK – memantine hcl tab 5 mg(28) & 10 mg (21) titration pak......................................... 96

NAMENDA XR – memantine hcl cap er 24hr 7 mg........... 96NAMENDA XR – memantine hcl cap er 24hr 14 mg......... 96NAMENDA XR – memantine hcl cap er 24hr 21 mg......... 96NAMENDA XR – memantine hcl cap er 24hr 28 mg......... 96NAMENDA XR TITRATION PACK – memantine hcl cap er24hr 7 mg & 14 mg & 21 mg & 28 mg pack.....................96

NAMZARIC – memantine-donepezil cap er 24hr 7 & 14 &21 & 28-10 mg pack......................................................... 96

NAMZARIC – memantine hcl-donepezil hcl cap er 24hr7-10 mg..............................................................................96

NAMZARIC – memantine hcl-donepezil hcl cap er 24hr14-10 mg............................................................................96



NAPROSYN – naproxen tab 500 mg...............................105naproxen sodium tab 275 mg....................................... 105naproxen sodium tab 550 mg (Anaprox ds)................105naproxen susp 125 mg/5ml (Naprosyn).......................105naproxen tab ec 375 mg (Ec-naprosyn).......................105

naproxen tab ec 500 mg (Ec-naprosyn).......................105naproxen tab 250 mg..................................................... 105naproxen tab 375 mg..................................................... 105naproxen tab 500 mg (Naprosyn)................................. 105naratriptan hcl tab 1 mg (base equiv) (Amerge)......... 107naratriptan hcl tab 2.5 mg (base equiv) (Amerge)...... 107NARCAN – naloxone hcl nasal spray 4 mg/0.1ml........... 154NARDIL – phenelzine sulfate tab 15 mg............................83NASCOBAL – cyanocobalamin nasal spray 500mcg/0.1ml........................................................................ 130

NATACHEW – prenatal vit w/ fe fum-fe bisglycin-fa chewtab 28-1 mg..................................................................... 120

NATACYN – natamycin ophth susp 5%........................... 137NATALVIT – prenatal vit w/ fe fumarate-fa tab 75-1mg.................................................................................... 120

NATAZIA – estradiol valerate-dienogest tab 3 mg /2-2mg/2-3 mg/1 mg................................................................29

nateglinide tab 60 mg (Starlix)........................................33nateglinide tab 120 mg (Starlix)......................................33NATELLE ONE – prenatal w/o vit a w/ fe fum-fa-omega 3cap 28-1-250 mg.............................................................120

NATPARA – parathyroid hormone (recombinant) for injcartridge 25 mcg............................................................... 41



NATPARA – parathyroid hormone (recombinant) for injcartridge 100 mcg............................................................. 41

NATROBA – spinosad susp 0.9%....................................151NATURE-THROID NT-2.5 – thyroid tab 162.5 mg (2 1/2grain).................................................................................. 37

NATURE-THROID – thyroid tab 16.25 mg.........................37NATURE-THROID – thyroid tab 32.5 mg...........................37NATURE-THROID – thyroid tab 65 mg..............................37NATURE-THROID – thyroid tab 81.25 mg.........................37NATURE-THROID – thyroid tab 97.5 mg...........................37NATURE-THROID – thyroid tab 113.75 mg.......................37NATURE-THROID – thyroid tab 130 mg............................37NATURE-THROID – thyroid tab 195 mg............................37NATURE-THROID – thyroid tab 260 mg............................37NATURE-THROID – thyroid tab 146.25 mg.......................37NATURE-THROID – thyroid tab 48.75 mg (3/4 grain)....... 37NATURE-THROID – thyroid tab 325 mg (5 grain)............. 37NEBUPENT – pentamidine isethionate for nebulizationsoln 300 mg.......................................................................14

NEBUSAL – sodium chloride soln nebu 6%...................... 66NECON 1/50-28 – norethindrone & mestranol tab 1 mg-50mcg.....................................................................................29

NEEVO DHA – prenat w/o a w/fefum-methylfol-omegascap 27-1.13 mg............................................................... 120

NEFAZODONE HCL – nefazodone hcl tab 100 mg...........83NEFAZODONE HCL – nefazodone hcl tab 150 mg...........83NEFAZODONE HCL – nefazodone hcl tab 200 mg...........83nefazodone hcl tab 50 mg............................................... 83nefazodone hcl tab 250 mg............................................. 83

2018


NEOMYCIN/POLYMYXIN/HYDROC – neomycin-polymyxin-hc ophth susp................................................ 138

neomycin-bacitrac zn-polymyx5(3.5)mg-400unt-10000unt op oin............................... 137

neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml (Neosporin)..............137

neomycin-polymyxin-dexamethasone ophth oint 0.1%(Maxitrol).........................................................................138

neomycin-polymyxin-dexamethasone ophth susp0.1% (Maxitrol)............................................................... 138

neomycin-polymyxin-hc otic soln 1%.......................... 142neomycin-polymyxin-hc otic susp 3.5 mg/ml-10000unit/ml-1%.......................................................................142

neomycin sulfate tab 500 mg............................................5NEORAL – cyclosporine modified cap 25 mg..................154NEORAL – cyclosporine modified cap 100 mg................154NEORAL – cyclosporine modified oral soln 100 mg/ml......................................................................................154

NEOSPORIN – neomycin-polymy-gramicid op sol1.75-10000-0.025mg-unt-mg/ml......................................137

NEO-SYNALAR – neomycin sulfate-fluocinoloneacetonide cream 0.5-0.025%..........................................146

NEPTAZANE – methazolamide tab 25 mg........................ 60NEPTAZANE – methazolamide tab 50 mg........................ 60NERLYNX – neratinib maleate tab 40 mg (baseequivalent)......................................................................... 20

NESINA – alogliptin benzoate tab 6.25 mg (baseequiv)................................................................................. 33

NESINA – alogliptin benzoate tab 12.5 mg (baseequiv)................................................................................. 33

NESINA – alogliptin benzoate tab 25 mg (base equiv)......33NESTABS ABC – prenatal w/o vit a w/fe polysac-fa-ca tab& omega 3 cap................................................................120

NESTABS DHA – prenat w/o a w/ fe bisglyc-fa tab 32-1mg & omega cap pack....................................................120

NESTABS ONE – prenat w/o a w/fecbn-bisg-methylf-dhacap 38-1-225 mg.............................................................121

NESTABS – prenatal vit w/o vit a w/ fe bisglycinate-fa tab32-1 mg............................................................................120

NEULASTA – pegfilgrastim soln prefilled syringe 6mg/0.6ml.......................................................................... 130

NEUPOGEN – filgrastim inj 300 mcg/ml..........................130NEUPOGEN – filgrastim inj 480 mcg/1.6ml (300 mcg/ml).................................................................................... 130

NEUPOGEN – filgrastim soln prefilled syringe 300mcg/0.5ml........................................................................ 130

NEUPOGEN – filgrastim soln prefilled syringe 480mcg/0.8ml (600 mcg/ml)................................................. 130

NEUPRO – rotigotine td patch 24hr 1 mg/24hr............... 115NEUPRO – rotigotine td patch 24hr 2 mg/24hr............... 115NEUPRO – rotigotine td patch 24hr 3 mg/24hr............... 115NEUPRO – rotigotine td patch 24hr 4 mg/24hr............... 115NEUPRO – rotigotine td patch 24hr 6 mg/24hr............... 115NEUPRO – rotigotine td patch 24hr 8 mg/24hr............... 115NEURONTIN – gabapentin cap 100 mg..........................112NEURONTIN – gabapentin cap 300 mg..........................112

NEURONTIN – gabapentin cap 400 mg..........................112NEURONTIN – gabapentin oral soln 250 mg/5ml........... 112NEURONTIN – gabapentin tab 600 mg...........................112NEURONTIN – gabapentin tab 800 mg...........................112nevirapine tab er 24hr 100 mg (Viramune xr)................10nevirapine tab er 24hr 400 mg (Viramune xr)................10nevirapine tab 200 mg (Viramune)..................................10NEWGEN – prenatal vit w/o vit a w/ fe bisglycinate-fa tab32-1 mg............................................................................121

NEXA PLUS – prenatal w/o vit a w/ fe fum-doc-fa-dha cap29-1.25-350 mg............................................................... 121

NEXAVAR – sorafenib tosylate tab 200 mg (baseequivalent)......................................................................... 21

NEXIUM – esomeprazole magnesium for delayed releasesusp packet 5 mg..............................................................72

NEXIUM – esomeprazole magnesium for delayed releasesusp packet 10 mg............................................................72



NEXIUM – esomeprazole magnesium for delayed releasesusp pack 2.5 mg..............................................................72

niacin tab er 500 mg (antihyperlipidemic)(Niaspan)...........................................................................57



NIACOR – niacin (antihyperlipidemic) tab 500 mg............ 57nicardipine hcl cap 20 mg............................................... 53nicardipine hcl cap 30 mg............................................... 53nicotine polacrilex gum 2 mg..........................................98nicotine polacrilex gum 4 mg..........................................98nicotine polacrilex lozenge 2 mg....................................98nicotine polacrilex lozenge 4 mg....................................98nicotine td patch 24hr 7 mg/24hr....................................98nicotine td patch 24hr 14 mg/24hr..................................98nicotine td patch 24hr 21 mg/24hr..................................98NICOTROL INHALER – nicotine inhaler system 10 mg (4mg delivered).....................................................................98

NICOTROL NS – nicotine nasal spray 10 mg/ml (0.5 mg/spray)................................................................................. 98

nifedipine cap 20 mg........................................................53nifedipine cap 10 mg (Procardia)....................................53nifedipine tab er 24hr 30 mg (Adalat cc)........................53nifedipine tab er 24hr 60 mg (Adalat cc)........................53nifedipine tab er 24hr 90 mg (Adalat cc)........................53nifedipine tab er 24hr osmotic release 30 mg(Procardia xl)....................................................................53

nifedipine tab er 24hr osmotic release 60 mg(Procardia xl)....................................................................53

nifedipine tab er 24hr osmotic release 90 mg(Procardia xl)....................................................................53

NILANDRON – nilutamide tab 150 mg.............................. 21nilutamide tab 150 mg (Nilandron)................................. 21

2018


nimodipine cap 30 mg......................................................53NINLARO – ixazomib citrate cap 2.3 mg (baseequivalent)......................................................................... 21

NINLARO – ixazomib citrate cap 3 mg (baseequivalent)......................................................................... 21

NINLARO – ixazomib citrate cap 4 mg (baseequivalent)......................................................................... 21

NISOLDIPINE ER – nisoldipine tab er 24hr 20 mg............53NISOLDIPINE ER – nisoldipine tab er 24hr 25.5 mg.........53NISOLDIPINE ER – nisoldipine tab er 24hr 30 mg............53NISOLDIPINE ER – nisoldipine tab er 24hr 40 mg............53nisoldipine tab er 24hr 8.5 mg (Sular)............................53nisoldipine tab er 24hr 17 mg (Sular).............................53nisoldipine tab er 24hr 34 mg (Sular).............................53NITRO-BID – nitroglycerin oint 2%.................................... 55NITRO-DUR – nitroglycerin td patch 24hr 0.1 mg/hr......... 55NITRO-DUR – nitroglycerin td patch 24hr 0.2 mg/hr......... 55NITRO-DUR – nitroglycerin td patch 24hr 0.3 mg/hr......... 55NITRO-DUR – nitroglycerin td patch 24hr 0.4 mg/hr......... 55NITRO-DUR – nitroglycerin td patch 24hr 0.6 mg/hr......... 55NITRO-DUR – nitroglycerin td patch 24hr 0.8 mg/hr......... 55nitrofurantoin macrocrystalline cap 25 mg(Macrodantin)................................................................... 77

nitrofurantoin macrocrystalline cap 50 mg(Macrodantin)................................................................... 77

nitrofurantoin macrocrystalline cap 100 mg(Macrodantin)................................................................... 77

nitrofurantoin monohydrate macrocrystalline cap 100mg (Macrobid)..................................................................77

nitrofurantoin susp 25 mg/5ml........................................77nitroglycerin cap er 2.5 mg............................................. 55nitroglycerin cap er 6.5 mg............................................. 55nitroglycerin cap er 9 mg................................................ 55NITROGLYCERIN LINGUAL – nitroglycerin lingual aerosol400 mcg/spray...................................................................55

nitroglycerin sl tab 0.3 mg (Nitrostat)............................ 55nitroglycerin sl tab 0.4 mg (Nitrostat)............................ 55nitroglycerin sl tab 0.6 mg (Nitrostat)............................ 55nitroglycerin td patch 24hr 0.1 mg/hr (Nitro-dur)..........55nitroglycerin td patch 24hr 0.2 mg/hr (Nitro-dur)..........55nitroglycerin td patch 24hr 0.4 mg/hr (Nitro-dur)..........55nitroglycerin td patch 24hr 0.6 mg/hr (Nitro-dur)..........55nitroglycerin tl soln 0.4 mg/spray (400 mcg/spray)(Nitrolingual pumpspr)................................................... 55

NITROLINGUAL PUMPSPRAY – nitroglycerin tl soln 0.4mg/spray (400 mcg/spray)................................................ 55

NITROMIST – nitroglycerin lingual aerosol 400 mcg/spray...................................................................................55

NITROSTAT – nitroglycerin sl tab 0.3 mg.......................... 55NITROSTAT – nitroglycerin sl tab 0.4 mg.......................... 55NITROSTAT – nitroglycerin sl tab 0.6 mg.......................... 55NITYR – nitisinone tab 2 mg..............................................41NITYR – nitisinone tab 5 mg..............................................41NITYR – nitisinone tab 10 mg............................................41NIVA-PLUS – prenatal vit w/ fe fumarate-fa tab 27-1mg.................................................................................... 121

nizatidine cap 150 mg...................................................... 73nizatidine cap 300 mg...................................................... 73NIZATIDINE – nizatidine oral soln 15 mg/ml......................73NIZORAL – ketoconazole shampoo 2%.......................... 146nonoxynol-9 gel 4%.......................................................... 29NORDITROPIN FLEXPRO – somatropin inj 5mg/1.5ml............................................................................ 39

NORDITROPIN FLEXPRO – somatropin inj 10mg/1.5ml............................................................................ 39

NORDITROPIN FLEXPRO – somatropin inj 15mg/1.5ml............................................................................ 39

NORDITROPIN FLEXPRO – somatropin inj 30mg/3ml............................................................................... 39

norethindrone acetate-ethinyl estradiol tab 1 mg-5mcg....................................................................................27

norethindrone acetate-ethinyl estradiol tab 0.5 mg-2.5mcg (Femhrt low dose).................................................. 27

norethindrone acetate tab 5 mg (Aygestin)...................28NORPACE CR – disopyramide phosphate cap er 12hr 100mg...................................................................................... 60

NORPACE CR – disopyramide phosphate cap er 12hr 150mg...................................................................................... 61

NORPACE – disopyramide phosphate cap 100 mg.......... 60NORPACE – disopyramide phosphate cap 150 mg.......... 60NORPRAMIN – desipramine hcl tab 10 mg.......................83NORPRAMIN – desipramine hcl tab 25 mg.......................83nortriptyline hcl cap 10 mg (Pamelor)............................84nortriptyline hcl cap 25 mg (Pamelor)............................84nortriptyline hcl cap 50 mg (Pamelor)............................84nortriptyline hcl cap 75 mg (Pamelor)............................84NORTRIPTYLINE HCL – nortriptyline hcl soln 10mg/5ml............................................................................... 84

NORVASC – amlodipine besylate tab 2.5 mg....................53NORVASC – amlodipine besylate tab 5 mg.......................53NORVASC – amlodipine besylate tab 10 mg.....................53NORVIR – ritonavir cap 100 mg........................................ 10NORVIR – ritonavir oral soln 80 mg/ml..............................10NORVIR – ritonavir tab 100 mg......................................... 10NOVOEIGHT – antihemophilic factor (recombinant) for inj250 unit............................................................................135

NOVOEIGHT – antihemophilic factor (recombinant) for inj500 unit............................................................................135

NOVOEIGHT – antihemophilic factor (recombinant) for inj1000 unit..........................................................................135




NOVOLIN 70/30 – insulin nph isophane & regular humaninj 100 unit/ml (70-30).......................................................36

NOVOLIN 70/30 RELION – insulin nph isophane & regularhuman inj 100 unit/ml (70-30)...........................................36

NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/ml........................................................................................36

2018


NOVOLIN N RELION – insulin nph (human) (isophane) inj100 unit/ml......................................................................... 36

NOVOLIN R – insulin regular (human) inj 100 unit/ml....... 35NOVOLIN R RELION – insulin regular (human) inj 100unit/ml.................................................................................35

NOVOLOG FLEXPEN – insulin aspart soln pen-injector100 unit/ml......................................................................... 35

NOVOLOG – insulin aspart inj 100 unit/ml........................ 35NOVOLOG MIX 70/30 – insulin aspart prot & aspart(human) inj 100 unit/ml (70-30)........................................ 36

NOVOLOG MIX 70/30 PREFILL – insulin aspart prot &aspart sus pen-inj 100 unit/ml (70-30)..............................36

NOVOLOG PENFILL – insulin aspart soln cartridge 100unit/ml.................................................................................35

NOVOSEVEN RT – coagulation factor viia (recomb) for inj1 mg (1000 mcg).............................................................135




NOXAFIL – posaconazole susp 40 mg/ml...........................7NOXAFIL – posaconazole tab delayed release 100 mg......7NUCORT – hydrocortisone acetate lotion 2%................. 149NUCYNTA ER – tapentadol hcl tab er 12hr 50 mg..........102NUCYNTA ER – tapentadol hcl tab er 12hr 100 mg........102NUCYNTA ER – tapentadol hcl tab er 12hr 150 mg........102NUCYNTA ER – tapentadol hcl tab er 12hr 200 mg........102NUCYNTA ER – tapentadol hcl tab er 12hr 250 mg........102NUEDEXTA – dextromethorphan hbr-quinidine sulfate cap20-10 mg............................................................................96

NULYTELY/FLAVOR PACKS – peg 3350-kcl-sod bicarb-nacl for soln 420 gm......................................................... 71

NUPLAZID – pimavanserin tartrate tab 17 mg (baseequivalent)......................................................................... 87

NUTRESTORE – glutamine powd pack 5 gm................. 127NUTROPIN AQ NUSPIN 10 – somatropin inj 10mg/2ml............................................................................... 39

NUTROPIN AQ NUSPIN 20 – somatropin inj 20mg/2ml............................................................................... 39

NUTROPIN AQ NUSPIN 5 – somatropin inj 5 mg/2ml...... 39NUVARING – etonogestrel-ethinyl estradiol va ring0.120-0.015 mg/24hr.........................................................29

NUWIQ – antihemophilic factor (bdd-rfviii) for inj kit 250unit....................................................................................135







NUWIQ – antihemophilic factor (bdd-rfviii) for inj 250unit....................................................................................135







NYMALIZE – nimodipine oral soln 60 mg/20ml................. 53nystatin cream 100000 unit/gm.....................................146nystatin oint 100000 unit/gm.........................................146nystatin susp 100000 unit/ml........................................ 142nystatin tab 500000 unit.....................................................7nystatin topical powder 100000 unit/gm......................146nystatin-triamcinolone cream 100000-0.1 unit/gm-%...................................................................................... 149

nystatin-triamcinolone oint 100000-0.1 unit/gm-%..... 149O

OB COMPLETE/DHA – prenat w/ iron cbn-fe asp glyc-fa-omega cap 30-10-1-200 mg........................................... 121

OB COMPLETE GOLD – prenat w/o a w/fecbn-methfol-fa-dha cap 27.5-1-200 mg.................................................. 121

OB COMPLETE ONE – prenatal w/o a w/fecbn-fe aspglyc-fa-fish cap 50-1-476 mg..........................................121

OB COMPLETE PETITE – prenat w/o a w/fecbn-feaspglyc-fa-omega cap 35-5-1-200 mg........................ 121

OB COMPLETE PREMIER – prenatal vit w/ fe cbn-fe aspglyc-fa tab 30-20-1 mg....................................................121

OB COMPLETE – prenatal vit w/ iron carbonyl-fa tab50-1.25 mg...................................................................... 121

OBIZUR – antihemophilic factor (recomb porc) rpfviii for inj500 unit............................................................................135

OBSTETRIX DHA – prenat w/fecbn-fa-dss tab 29-1 mg &omega 3 cap 387 mg pak...............................................121

OBSTETRIX EC – prenatal vit w/ dss-iron carbonyl-fa tab29-1 mg............................................................................121

OBSTETRIX ONE – prenat w/o a w/fecbn-bisg-methylf-dss-dha cap 38-1-225 mg...............................................121

O-CAL FA – prenatal vit w/ fe fumarate-fa tab 27-1mg.................................................................................... 121

OCALIVA – obeticholic acid tab 5 mg................................76OCALIVA – obeticholic acid tab 10 mg..............................76O-CAL PRENATAL – prenatal vit w/ fe fumarate-fa tab15-1 mg............................................................................121

octreotide acetate inj 50 mcg/ml (0.05 mg/ml)(Sandostatin)....................................................................41

2018





octreotide acetate inj 1000 mcg/ml (1 mg/ml)(Sandostatin)....................................................................42

OCUFLOX – ofloxacin ophth soln 0.3%...........................137ODEFSEY – emtricitabine-rilpivirine-tenofovir af tab200-25-25 mg.................................................................... 11

ODOMZO – sonidegib phosphate cap 200 mg (baseequivalent)......................................................................... 21

OFEV – nintedanib esylate cap 100 mg (baseequivalent)......................................................................... 70

OFEV – nintedanib esylate cap 150 mg (baseequivalent)......................................................................... 70

OFLOXACIN – ofloxacin tab 300 mg...................................5ofloxacin ophth soln 0.3% (Ocuflox)............................137ofloxacin otic soln 0.3%.................................................142ofloxacin tab 400 mg..........................................................5OGESTREL – norgestrel & ethinyl estradiol tab 0.5 mg-50mcg.....................................................................................29

olanzapine-fluoxetine hcl cap 3-25 mg (Symbyax)....... 96olanzapine-fluoxetine hcl cap 6-25 mg (Symbyax)....... 96olanzapine-fluoxetine hcl cap 6-50 mg (Symbyax)....... 97olanzapine-fluoxetine hcl cap 12-25 mg (Symbyax)..... 97olanzapine-fluoxetine hcl cap 12-50 mg (Symbyax)..... 97olanzapine orally disintegrating tab 5 mg (Zyprexazydis)................................................................................. 87

olanzapine orally disintegrating tab 10 mg (Zyprexazydis)................................................................................. 87



olanzapine tab 2.5 mg (Zyprexa).....................................87olanzapine tab 5 mg (Zyprexa)........................................87olanzapine tab 7.5 mg (Zyprexa).....................................87olanzapine tab 10 mg (Zyprexa)......................................87olanzapine tab 15 mg (Zyprexa)......................................87olanzapine tab 20 mg (Zyprexa)......................................87olmesartan-amlodipine-hydrochlorothiazide tab20-5-12.5 mg (Tribenzor).................................................47

olmesartan-amlodipine-hydrochlorothiazide tab40-5-12.5 mg (Tribenzor).................................................47

olmesartan-amlodipine-hydrochlorothiazide tab40-5-25 mg (Tribenzor)....................................................47

olmesartan-amlodipine-hydrochlorothiazide tab40-10-12.5 mg (Tribenzor)...............................................47

olmesartan-amlodipine-hydrochlorothiazide tab40-10-25 mg (Tribenzor)..................................................47

olmesartan medoxomil-hydrochlorothiazide tab20-12.5 mg (Benicar hct)................................................ 47

olmesartan medoxomil-hydrochlorothiazide tab40-12.5 mg (Benicar hct)................................................ 47

olmesartan medoxomil-hydrochlorothiazide tab 40-25mg (Benicar hct)..............................................................47

olmesartan medoxomil tab 5 mg (Benicar)................... 47olmesartan medoxomil tab 20 mg (Benicar)................. 47olmesartan medoxomil tab 40 mg (Benicar)................. 47olopatadine hcl nasal soln 0.6% (Patanase)..................66olopatadine hcl ophth soln 0.2% (base equivalent)(Pataday).........................................................................141

olopatadine hcl ophth soln 0.1% (base equivalent)(Patanol)..........................................................................141

OLYSIO – simeprevir sodium cap 150 mg (baseequivalent)............................................................................8

OMECLAMOX-PAK – amoxicillin cap-clarithro tab w/omepraz cap dr therapy pack...........................................73

omega-3-acid ethyl esters cap 1 gm (Lovaza)...............57omeprazole cap delayed release 10 mg (Prilosec)....... 73omeprazole cap delayed release 20 mg (Prilosec)....... 73omeprazole cap delayed release 40 mg (Prilosec)....... 73OMNIFLEX DIAPHRAGM – diaphragms........................... 29OMNIPRED – prednisolone acetate ophth susp 1%....... 138OMNITROPE – somatropin for inj 5.8 mg......................... 39OMNITROPE – somatropin inj 5 mg/1.5ml........................39OMNITROPE – somatropin inj 10 mg/1.5ml......................39ondansetron hcl oral soln 4 mg/5ml (Zofran)................74ondansetron hcl tab 24 mg............................................. 74ondansetron hcl tab 4 mg (Zofran).................................74ondansetron hcl tab 8 mg (Zofran).................................74ondansetron orally disintegrating tab 4 mg (Zofranodt).....................................................................................74

ondansetron orally disintegrating tab 8 mg (Zofranodt).....................................................................................74

ONFI – clobazam suspension 2.5 mg/ml.........................112ONFI – clobazam tab 10 mg............................................112ONFI – clobazam tab 20 mg............................................112ONGLYZA – saxagliptin hcl tab 2.5 mg (base equiv).........33ONGLYZA – saxagliptin hcl tab 5 mg (base equiv)............33OPANA ER (CRUSH RESISTANT – oxymorphone hcl taber 12hr deter 5 mg..........................................................102

OPANA ER (CRUSH RESISTANT – oxymorphone hcl taber 12hr deter 7.5 mg.......................................................102

OPANA ER (CRUSH RESISTANT – oxymorphone hcl taber 12hr deter 10 mg........................................................102





OPANA – oxymorphone hcl tab 5 mg.............................. 102OPANA – oxymorphone hcl tab 10 mg............................ 102OPSUMIT – macitentan tab 10 mg....................................63OPTIONS CONCEPTROL VAGINA – nonoxynol-9 gel4%...................................................................................... 29

OPTIONS GYNOL II VAGINAL – nonoxynol-9 gel 3%...... 29

2018


ORACIT – sodium citrate & citric acid soln 490-640mg/5ml............................................................................... 80

oral contraceptives – all generics.................................. 29ORAP – pimozide tab 1 mg............................................... 97ORAP – pimozide tab 2 mg............................................... 97ORAPRED ODT – prednisolone sod phos orally disintegrtab 10 mg (base eq)......................................................... 24

ORAPRED ODT – prednisolone sod phos orally disintegrtab 15 mg (base eq)......................................................... 24

ORAPRED ODT – prednisolone sod phos orally disintegrtab 30 mg (base eq)......................................................... 24

ORAVIG – miconazole buccal tab 50 mg (mouth-throat)...............................................................................142

ORENCIA – abatacept subcutaneous soln prefilled syringe125 mg/ml........................................................................105

ORENCIA CLICKJECT – abatacept subcutaneous solnauto-injector 125 mg/ml.................................................. 105

ORENITRAM – treprostinil diolamine tab er 0.125 mg(base equiv).......................................................................64

ORENITRAM – treprostinil diolamine tab er 0.25 mg (baseequiv)................................................................................. 64

ORENITRAM – treprostinil diolamine tab er 1 mg (baseequiv)................................................................................. 64

ORENITRAM – treprostinil diolamine tab er 2.5 mg (baseequiv)................................................................................. 64

ORENITRAM – treprostinil diolamine tab er 5 mg (baseequiv)................................................................................. 64

ORFADIN – nitisinone cap 2 mg........................................42ORFADIN – nitisinone cap 5 mg........................................42ORFADIN – nitisinone cap 10 mg......................................42ORFADIN – nitisinone cap 20 mg......................................42ORFADIN – nitisinone susp 4 mg/ml................................. 42ORKAMBI – lumacaftor-ivacaftor tab 100-125 mg.............70ORKAMBI – lumacaftor-ivacaftor tab 200-125 mg.............71orphenadrine citrate tab er 12hr 100 mg..................... 118ORTHO-CYCLEN – norgestimate & ethinyl estradiol tab0.25 mg-35 mcg................................................................ 29

ORTHO MICRONOR – norethindrone tab 0.35 mg...........29ORTHO-NOVUM 7/7/7 – norethindrone-eth estradiol tab0.5-35/0.75-35/1-35 mg-mcg............................................ 29

ORTHO-NOVUM 1/35 – norethindrone & ethinyl estradioltab 1 mg-35 mcg...............................................................29

ORTHO TRI-CYCLEN LO – norgestimate-eth estrad tab0.18-25/0.215-25/0.25-25 mg-mcg................................... 29

ORTHO TRI-CYCLEN – norgestimate-eth estrad tab0.18-35/0.215-35/0.25-35 mg-mcg................................... 29

oseltamivir phosphate cap 30 mg (base equiv)(Tamiflu)............................................................................ 12



oseltamivir phosphate for susp 6 mg/ml (base equiv)(Tamiflu)............................................................................ 12

OSENI – alogliptin-pioglitazone tab 12.5-15 mg................33OSENI – alogliptin-pioglitazone tab 12.5-30 mg................33

OSENI – alogliptin-pioglitazone tab 12.5-45 mg................33OSENI – alogliptin-pioglitazone tab 25-15 mg...................33OSENI – alogliptin-pioglitazone tab 25-30 mg...................33OSENI – alogliptin-pioglitazone tab 25-45 mg...................33OSMOPREP – sod phos mono-sod phos di tabs1.102-0.398 gm(1.5gm na phos)...................................... 71

OSPHENA – ospemifene tab 60 mg..................................42OTEZLA – apremilast tab 30 mg..................................... 106OTEZLA – apremilast tab starter therapy pack 10 mg & 20mg & 30 mg.................................................................... 105

OTOVEL – ciprofloxacin-fluocinolone aceton (pf) otic soln0.3-0.025%.......................................................................142

OTREXUP – methotrexate soln pf auto-injector 10mg/0.4ml.......................................................................... 106

OTREXUP – methotrexate soln pf auto-injector 12.5mg/0.4ml.......................................................................... 106






OVIDE – malathion lotion 0.5%........................................151OVIDREL – choriogonadotropin alfa inj 250mcg/0.5ml...........................................................................30

OXANDRIN – oxandrolone tab 2.5 mg.............................. 25OXANDRIN – oxandrolone tab 10 mg............................... 25oxandrolone tab 2.5 mg (Oxandrin)................................25oxandrolone tab 10 mg (Oxandrin).................................25oxaprozin tab 600 mg (Daypro).....................................106oxazepam cap 10 mg........................................................81oxazepam cap 15 mg........................................................81oxazepam cap 30 mg........................................................81oxcarbazepine susp 300 mg/5ml (60 mg/ml)(Trileptal).........................................................................112

oxcarbazepine tab 150 mg (Trileptal)........................... 113oxcarbazepine tab 300 mg (Trileptal)........................... 113oxcarbazepine tab 600 mg (Trileptal)........................... 113oxiconazole nitrate cream 1% (Oxistat)....................... 146OXISTAT – oxiconazole nitrate cream 1%.......................146OXISTAT – oxiconazole nitrate lotion 1%........................ 146OXSORALEN ULTRA – methoxsalen rapid cap 10mg.................................................................................... 151

OXTELLAR XR – oxcarbazepine tab er 24hr 150 mg..... 113OXTELLAR XR – oxcarbazepine tab er 24hr 300 mg..... 113OXTELLAR XR – oxcarbazepine tab er 24hr 600 mg..... 113oxybutynin chloride syrup 5 mg/5ml..............................78oxybutynin chloride tab er 24hr 5 mg (Ditropan xl)......78oxybutynin chloride tab er 24hr 10 mg (Ditropanxl)....................................................................................... 78

oxybutynin chloride tab er 24hr 15 mg (Ditropanxl)....................................................................................... 78

2018


oxybutynin chloride tab 5 mg......................................... 78OXYCODONE/ACETAMINOPHEN – oxycodone w/acetaminophen soln 5-325 mg/5ml................................ 102

OXYCODONE/IBUPROFEN – oxycodone-ibuprofen tab5-400 mg......................................................................... 103

oxycodone-aspirin tab 4.8355-325 mg (Percodan)..... 102oxycodone hcl cap 5 mg............................................... 102oxycodone hcl conc 100 mg/5ml (20 mg/ml)...............102oxycodone hcl soln 5 mg/5ml.......................................102oxycodone hcl tab 10 mg.............................................. 102oxycodone hcl tab 20 mg.............................................. 102oxycodone hcl tab 5 mg (Roxicodone)........................ 102oxycodone hcl tab 15 mg (Roxicodone)...................... 102oxycodone hcl tab 30 mg (Roxicodone)...................... 102oxycodone w/ acetaminophen tab 2.5-325 mg(Percocet)....................................................................... 102

oxycodone w/ acetaminophen tab 5-325 mg(Percocet)....................................................................... 102

oxycodone w/ acetaminophen tab 7.5-325 mg(Percocet)....................................................................... 102

oxycodone w/ acetaminophen tab 10-325 mg(Percocet)....................................................................... 102

oxymorphone hcl tab 5 mg (Opana).............................103oxymorphone hcl tab 10 mg (Opana)...........................103OXYMORPHONE HYDROCHLORIDE – oxymorphone hcltab er 12hr 5 mg............................................................. 103

OXYMORPHONE HYDROCHLORIDE – oxymorphone hcltab er 12hr 7.5 mg.......................................................... 103

OXYMORPHONE HYDROCHLORIDE – oxymorphone hcltab er 12hr 10 mg........................................................... 103





Ppaliperidone tab er 24hr 1.5 mg (Invega).......................87paliperidone tab er 24hr 3 mg (Invega)..........................87paliperidone tab er 24hr 6 mg (Invega)..........................87paliperidone tab er 24hr 9 mg (Invega)..........................87PAMELOR – nortriptyline hcl cap 10 mg............................84PAMELOR – nortriptyline hcl cap 25 mg............................84PAMELOR – nortriptyline hcl cap 50 mg............................84PAMELOR – nortriptyline hcl cap 75 mg............................84PAMINE FORTE – methscopolamine bromide tab 5mg...................................................................................... 73

PAMINE – methscopolamine bromide tab 2.5 mg............. 73PANRETIN – alitretinoin gel 0.1%....................................151pantoprazole sodium ec tab 20 mg (base equiv)(Protonix).......................................................................... 73

pantoprazole sodium ec tab 40 mg (base equiv)(Protonix).......................................................................... 73

PAREGORIC – paregoric tincture 2 mg/5ml (morphineequivalent)......................................................................... 71

paricalcitol cap 4 mcg......................................................42paricalcitol cap 1 mcg (Zemplar).................................... 42paricalcitol cap 2 mcg (Zemplar).................................... 42PARLODEL – bromocriptine mesylate cap 5 mg (baseequivalent)....................................................................... 115

PARLODEL – bromocriptine mesylate tab 2.5 mg (baseequivalent)....................................................................... 116

PARNATE – tranylcypromine sulfate tab 10 mg................ 84paromomycin sulfate cap 250 mg.................................... 5paroxetine hcl tab 10 mg (Paxil).....................................84paroxetine hcl tab 20 mg (Paxil).....................................84paroxetine hcl tab 30 mg (Paxil).....................................84paroxetine hcl tab 40 mg (Paxil).....................................84paroxetine mesylate cap 7.5 mg (base equiv)(Brisdelle)......................................................................... 97

PASER – aminosalicylic acid er granules packet 4 gm........6PATADAY – olopatadine hcl ophth soln 0.2% (baseequivalent)....................................................................... 141

PAXIL – paroxetine hcl oral susp 10 mg/5ml (baseequiv)................................................................................. 84

PAZEO – olopatadine hcl ophth soln 0.7% (baseequivalent)....................................................................... 141

PCE – erythromycin w/ enteric coated particles tab 333mg........................................................................................ 3

PCE – erythromycin w/ enteric coated particles tab 500mg........................................................................................ 3

PEDIAPRED – prednisolone sod phosph oral soln 6.7mg/5ml (5 mg/5ml base)...................................................24

PEDIARIX – diph-tetanus tox-acell pert-hepatitis b-polioipv vac inj...........................................................................16

PEDVAX HIB – haemophilus b polysaccharide conj vac imsusp 7.5 mcg/0.5 ml..........................................................16

PEGANONE – ethotoin tab 250 mg.................................113PEGASYS – peginterferon alfa-2a inj 180 mcg/ml.............. 8PEGASYS – peginterferon alfa-2a inj 180 mcg/0.5ml......... 8PEGASYS PROCLICK – peginterferon alfa-2a inj 135mcg/0.5ml.............................................................................8

PEGASYS PROCLICK – peginterferon alfa-2a inj 180mcg/0.5ml.............................................................................8

PEGINTRON – peginterferon alfa-2b for inj kit 50mcg/0.5ml.............................................................................8




peg 3350-kcl-na bicarb-nacl-na sulfate for soln 240 gm(Colyte-flavor packs).......................................................71

peg 3350-kcl-na bicarb-nacl-na sulfate for soln 236 gm(Golytely)...........................................................................71

peg 3350-kcl-sod bicarb-nacl for soln 420 gm(Nulytely/flavor pack)......................................................71

2018


PENICILLIN V POTASSIUM – penicillin v potassium forsoln 125 mg/5ml..................................................................1

PENICILLIN V POTASSIUM – penicillin v potassium forsoln 250 mg/5ml..................................................................2

penicillin v potassium tab 250 mg....................................2penicillin v potassium tab 500 mg....................................2PENTACEL – diph-ac per-tet tox ad-poliov-haemoph bpoly vac for im susp..........................................................16

PENTASA – mesalamine cap er 250 mg...........................76PENTASA – mesalamine cap er 500 mg...........................76pentazocine w/ naloxone tab 50-0.5 mg.......................103pentoxifylline tab er 400 mg..........................................130PERIDEX – chlorhexidine gluconate soln 0.12%.............142perindopril erbumine tab 2 mg....................................... 45perindopril erbumine tab 4 mg (Aceon).........................45perindopril erbumine tab 8 mg (Aceon).........................45permethrin cream 5% (Elimite)......................................151PERPHENAZINE/AMITRIPTYLIN – perphenazine-amitriptyline tab 2-10 mg.................................................. 97

PERPHENAZINE/AMITRIPTYLIN – perphenazine-amitriptyline tab 2-25 mg.................................................. 97




perphenazine tab 2 mg.................................................... 87perphenazine tab 4 mg.................................................... 87perphenazine tab 8 mg.................................................... 87perphenazine tab 16 mg.................................................. 87phenazopyridine hcl tab 100 mg (Pyridium)..................80phenazopyridine hcl tab 200 mg (Pyridium)..................80phendimetrazine tartrate tab 35 mg............................... 93phenelzine sulfate tab 15 mg (Nardil)............................ 84phenobarbital elixir 20 mg/5ml........................................89PHENOBARBITAL – phenobarbital tab 15 mg.................. 89PHENOBARBITAL – phenobarbital tab 30 mg.................. 89PHENOBARBITAL – phenobarbital tab 60 mg.................. 89PHENOBARBITAL – phenobarbital tab 100 mg................ 89phenobarbital tab 16.2 mg...............................................89phenobarbital tab 32.4 mg...............................................89phenobarbital tab 64.8 mg...............................................89phenobarbital tab 97.2 mg...............................................89phenoxybenzamine hcl cap 10 mg (Dibenzyline)......... 64phentermine hcl cap 15 mg.............................................93phenylephrine hcl ophth soln 2.5%..............................141phenylephrine hcl ophth soln 10%...............................141PHENYTEK – phenytoin sodium extended cap 200mg.................................................................................... 113

PHENYTEK – phenytoin sodium extended cap 300mg.................................................................................... 113

phenytoin chew tab 50 mg (Dilantin infatabs).............113phenytoin sodium extended cap 100 mg(Dilantin)..........................................................................113

phenytoin sodium extended cap 200 mg(Phenytek).......................................................................113

phenytoin sodium extended cap 300 mg(Phenytek).......................................................................113

phenytoin susp 125 mg/5ml (Dilantin-125).................. 113PHOSLYRA – calcium acetate (phosphate binder) oralsoln 667 mg/5ml................................................................76

PHOSPHOLINE IODIDE – echothiophate iodide ophth forsoln 0.125%.....................................................................139

PHOTREXA/PHOTREXA VISCOUS – riboflav 0.146% &riboflav-dextran 0.146-20% op sol pref syr.................... 141

PHOTREXA VISCOUS – riboflavin 5-phos sod-dextranophth soln pref syr 0.146-20%....................................... 141

PICATO – ingenol mebutate gel 0.015%......................... 151PICATO – ingenol mebutate gel 0.05%........................... 151pilocarpine hcl ophth soln 1% (Isopto carpine).......... 140pilocarpine hcl ophth soln 2% (Isopto carpine).......... 140pilocarpine hcl ophth soln 4% (Isopto carpine).......... 140pilocarpine hcl tab 5 mg (Salagen)...............................142pilocarpine hcl tab 7.5 mg (Salagen)............................142pimozide tab 1 mg (Orap)................................................ 97pimozide tab 2 mg (Orap)................................................ 97pindolol tab 5 mg..............................................................50pindolol tab 10 mg............................................................50pioglitazone hcl-metformin hcl tab 15-500 mg(Actoplus met)................................................................. 33

pioglitazone hcl-metformin hcl tab 15-850 mg(Actoplus met)................................................................. 34

pioglitazone hcl tab 15 mg (base equiv) (Actos)...........33pioglitazone hcl tab 30 mg (base equiv) (Actos)...........33pioglitazone hcl tab 45 mg (base equiv) (Actos)...........33piroxicam cap 10 mg (Feldene).....................................106piroxicam cap 20 mg (Feldene).....................................106PLAN B ONE-STEP – levonorgestrel tab 1.5 mg.............. 29PLAQUENIL – hydroxychloroquine sulfate tab 200 mg.....13PLEGRIDY – peginterferon beta-1a soln pen-injector 125mcg/0.5ml...........................................................................94

PLEGRIDY – peginterferon beta-1a soln prefilled syringe125 mcg/0.5ml...................................................................94

PLEGRIDY STARTER PACK – peginterferon beta-1a solnpen-inj 63 & 94 mcg/0.5ml pack.......................................94

PLEGRIDY STARTER PACK – peginterferon beta-1a solnpref syr 63 & 94 mcg/0.5ml pack..................................... 95

PNEUMOVAX 23/1 DOSE – pneumococcal vaccinepolyvalent inj 25 mcg/0.5ml.............................................. 17

PNEUMOVAX 23 – pneumococcal vaccine polyvalent inj25 mcg/0.5ml.....................................................................17

PNV-DHA+DOCUSATE – prenatal w/o vit a w/ fe fum-dss-fa-dha cap 27-1.25-300 mg............................................ 121

PNV-DHA – prenat w/o a w/fefum-methfol-fa-dha cap27-0.6-0.4-300 mg...........................................................121

PNV FOLIC ACID + IRON MUL – prenatal vit w/ fefumarate-fa tab 27-1 mg................................................. 121

PNV OB+DHA – prenat w/o a w/fecbn-fegl-dss-fa tab &dha cap 250 mg pack..................................................... 121

2018


PNV-OMEGA – prenat w/o a w/ fe fumerate-methylfolate-fa-omega 3 cap............................................................... 121

PNV PRENATAL PLUS MULTIVI – prenatal vit w/ fefumarate-fa tab 27-1 mg................................................. 121

PNV PRENATAL PLUS MULTIVI – prenat w/ fe fum-fa tab27-1 mg & omega 3 cap 312 mg pak.............................121

PNV-SELECT – prenatal vit w/ fe fum-methylfolate-fa tab27-0.6-0.4 mg.................................................................. 121

PNV TABS 29-1 – prenatal vit w/ iron carbonyl-fa tab 29-1mg.................................................................................... 121

PNV-TOTAL – prenat w/ fe cbn-fe bisglyc-fa-fish oil cap35-5-1.2 mg..................................................................... 121

PNV-VP-U – prenatal w/o a vit w/ fe fumarate-fa cap106.5-1 mg...................................................................... 121

podofilox soln 0.5% (Condylox)....................................151polyethylene glycol 3350 oral packet.............................71polyethylene glycol 3350 oral powder........................... 71polymyxin b-trimethoprim ophth soln 10000 unit/ml-0.1% (Polytrim).........................................................137

POLYTRIM – polymyxin b-trimethoprim ophth soln 10000unit/ml-0.1%.....................................................................137

POMALYST – pomalidomide cap 1 mg............................. 21POMALYST – pomalidomide cap 2 mg............................. 21POMALYST – pomalidomide cap 3 mg............................. 21POMALYST – pomalidomide cap 4 mg............................. 21pot & sod citrates w/ cit ac soln 550-500-334mg/5ml...............................................................................80

potassium bicarbonate effer tab 25 meq.....................126potassium chloride cap er 8 meq (Micro-k).................126potassium chloride cap er 10 meq (Micro-k)...............126POTASSIUM CHLORIDE ER – potassium chloride tab er8 meq (600 mg).............................................................. 126

POTASSIUM CHLORIDE ER – potassium chloride tab er20 meq (1500 mg).......................................................... 126

potassium chloride microencapsulated crys er tab 10meq..................................................................................126

potassium chloride microencapsulated crys er tab 20meq..................................................................................126

potassium chloride oral soln 10% (20 meq/15ml).......126POTASSIUM CHLORIDE – potassium chloride oral soln20% (40 meq/15ml).........................................................126

potassium chloride powder packet 20 meq................ 127potassium chloride tab er 10 meq (K-tab)................... 127potassium chloride tab er 8 meq (600 mg)..................127potassium citrate & citric acid powder pack 3300-1002mg...................................................................................... 80

potassium citrate tab er 5 meq (540 mg) (Urocit-k5)........................................................................................ 80

potassium citrate tab er 10 meq (1080 mg) (Urocit-k10)...................................................................................... 80

potassium citrate tab er 15 meq (1620 mg) (Urocit-k15)...................................................................................... 80

pot bicarbonate & chloride effer tab 25 meq...............126pot phos monobasic w/sod phos di & monobas tab155-852-130mg (K-phos neutral)................................. 126

PRADAXA – dabigatran etexilate mesylate cap 75 mg(etexilate base eq).......................................................... 130



PRALUENT – alirocumab subcutaneous soln pen-injector75 mg/ml............................................................................57

PRALUENT – alirocumab subcutaneous soln pen-injector150 mg/ml..........................................................................57

pramipexole dihydrochloride tab er 24hr 0.375 mg(Mirapex er).................................................................... 116




pramipexole dihydrochloride tab er 24hr 3 mg(Mirapex er).................................................................... 116



pramipexole dihydrochloride tab 0.125 mg(Mirapex)......................................................................... 116




pramipexole dihydrochloride tab 1 mg (Mirapex).......116pramipexole dihydrochloride tab 1.5 mg(Mirapex)......................................................................... 116

PRAMOSONE – pramoxine-hc oint 1-2.5%.....................149prasugrel hcl tab 5 mg (base equiv) (Effient)..............131prasugrel hcl tab 10 mg (base equiv) (Effient)............131PRAVACHOL – pravastatin sodium tab 20 mg.................. 57PRAVACHOL – pravastatin sodium tab 40 mg.................. 57PRAVACHOL – pravastatin sodium tab 80 mg.................. 57pravastatin sodium tab 10 mg........................................ 57pravastatin sodium tab 20 mg (Pravachol)....................58pravastatin sodium tab 40 mg (Pravachol)....................58pravastatin sodium tab 80 mg (Pravachol)....................58prazosin hcl cap 1 mg (Minipress)................................. 64prazosin hcl cap 2 mg (Minipress)................................. 64prazosin hcl cap 5 mg (Minipress)................................. 64PRECOSE – acarbose tab 25 mg......................................34PRECOSE – acarbose tab 50 mg......................................34PRECOSE – acarbose tab 100 mg....................................34PRED FORTE – prednisolone acetate ophth susp1%.................................................................................... 138

PRED-G – gentamicin-prednisolone ace ophth susp0.3-1%..............................................................................138

2018


PRED-G S.O.P. – gentamicin-prednisolone ace ophth oint0.3-0.6%...........................................................................138

PRED MILD – prednisolone acetate ophth susp0.12%............................................................................... 138

prednicarbate cream 0.1% (Dermatop)........................ 149prednicarbate oint 0.1% (Dermatop)............................ 149prednisolone acetate ophth susp 1% (Pred forte)...... 138PREDNISOLONE SODIUM PHOSP – prednisolonesodium phosphate ophth soln 1%.................................. 138

PREDNISOLONE SODIUM PHOSP – prednisolonesodium phosphate oral soln 25 mg/5ml (base eq)........... 24

prednisolone sod phos orally disintegr tab 10 mg(base eq) (Orapred odt)..................................................24



prednisolone sod phosphate oral soln 15 mg/5ml(base equiv)......................................................................24

prednisolone sod phosphate oral soln 10 mg/5ml(base equiv) (Millipred)...................................................24

prednisolone sod phosphate oral soln 20 mg/5ml(base equiv) (Veripred 20)..............................................24

prednisolone sod phosph oral soln 6.7 mg/5ml (5mg/5ml base) (Pediapred).............................................. 24

prednisolone syrup 15 mg/5ml (usp solutionequivalent)........................................................................ 24

PREDNISONE INTENSOL – prednisone conc 5 mg/ml........................................................................................24

PREDNISONE – prednisone oral soln 5 mg/5ml...............24PREDNISONE – prednisone tab 50 mg............................ 24PREDNISONE – prednisone tab therapy pack 5 mg(21).....................................................................................24

PREDNISONE – prednisone tab therapy pack 5 mg(48).....................................................................................24



prednisone tab 1 mg........................................................ 24prednisone tab 2.5 mg..................................................... 24prednisone tab 5 mg........................................................ 24prednisone tab 10 mg...................................................... 24prednisone tab 20 mg...................................................... 24PREFERAOB +DHA – prenat-fe poly cmplx 28mg-fe hemepoly-fa tab&dha cap pack............................................... 122

PREFERAOB ONE – prenat-fe poly cmplx-fe heme poly-fa-dha cap 22-6-1-200 mg.............................................. 122

PREFERA OB – prenat vit-fe poly cmplx-fe heme poly-fatab 34-1 mg..................................................................... 122

PREFEST – estradiol tab 1 mg(15)/estrad-norgestimatetab 1-0.09mg(15)...............................................................27

PREMARIN – estrogens, conjugated tab 0.3 mg...............27PREMARIN – estrogens, conjugated tab 0.45 mg.............27PREMARIN – estrogens, conjugated tab 0.625 mg...........27PREMARIN – estrogens, conjugated tab 0.9 mg...............27

PREMARIN – estrogens, conjugated tab 1.25 mg.............27PREMARIN – estrogens, conjugated vaginal cream 0.625mg/gm................................................................................ 79

PREMPHASE – conj est 0.625(14)/conj est-medroxyproac tab 0.625-5mg(14)........................................................27

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.3-1.5 mg......................................................27

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.45-1.5 mg....................................................27

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-2.5 mg..................................................27

PREMPRO – conjugated estrogen-medroxyprogestacetate tab 0.625-5 mg.....................................................27

PRENA1 CHEW – prenat w/ b2-b6-b12-d3-folic acid chewtab 1.4 mg....................................................................... 123

PRENAISSANCE BALANCE – prenatal w/o vit a w/ fecbn-dss-fa-dha cap 30-1-260 mg................................... 122

PRENAISSANCE HARMONY DHA – prenat w/fe poly-nafered-fa tab 27-1 & omega cap dr 380mg...................... 122

PRENAISSANCE NEXT-B – prenatal w/ calcium-vit b6-fa-ginger tab 1.22 mg..........................................................122

PRENAISSANCE NEXT – prenatal w/ calcium-vit b6-fa-ginger tab 1.2 mg............................................................122

PRENAISSANCE PLUS – prenatal w/o a w/fe cbn-dss-fa-dha cap 28-1-250 mg......................................................122

PRENAISSANCE – prenatal w/o vit a w/ fe fum-dss-fa-dhacap 29-1.25-325 mg........................................................122

PRENA1 PEARL – prenat w/oa w/fefum-na fered-fa-dhacap er 30-1.4-200 mg..................................................... 123

PRENATABS RX – prenatal vit w/ iron carbonyl-fa tab 29-1mg.................................................................................... 122

PRENATAL PLUS IRON – prenatal vit w/ iron carbonyl-fatab 29-1 mg..................................................................... 122

PRENATAL PLUS – prenatal vit w/ fe fumarate-fa tab 27-1mg.................................................................................... 122

PRENATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab29-1 mg............................................................................122

PRENATAL 19 – prenatal vit w/ fe fumarate-fa chew tab29-1 mg............................................................................122

PRENATAL – prenatal vit w/ fe fumarate-fa tab 27-1mg.................................................................................... 122

PRENATAL-U – prenatal w/o a vit w/ fe fumarate-fa cap106.5-1 mg...................................................................... 122

PRENATAL VITAMINS PLUS LO – prenatal vit w/ fefumarate-fa tab 27-1 mg................................................. 122

PRENATA – prenatal w/o a vit w/ fe fum-fa tab chew 29-1mg.................................................................................... 122

PRENATE AM – prenatal w/ calcium-vit b6-vit b12-fa-ginger tab 1 mg...............................................................122

PRENATE DHA – prenat w/o a w/feaspg-methfol-fa-dhacap 18-0.6-0.4-300 mg....................................................122

PRENATE DHA – prenat w/o a w/fefum-methfol-fa-dhacap 28-0.6-0.4-300 mg....................................................122

PRENATE ELITE – prenatal vit w/ fe fum-methylfolate-fatab 26-0.6-0.4 mg............................................................123

2018


PRENATE ELITE – prenatal w/ fe asp gly-l methylfol-fa tab20-0.6-0.4 mg.................................................................. 122

PRENATE ENHANCE – prenat w/o a w/fefum-methfol-fa-dha cap 28-0.6-0.4-400 mg............................................ 123

PRENATE ESSENTIAL – prenat w/o a w/feaspg-methfol-fa-dha cap 18-0.6-0.4-300 mg........................................123

PRENATE ESSENTIAL – prenat w/o a w/feasp-methylf-fa-omeg cap 29-0.6-0.4-340 mg......................................... 123

PRENATE MINI – prenat w/oa w/fecb-feasp-meth-fa-dhacap 18-0.6-0.4-350 mg....................................................123

PRENATE MINI – prenat w/o a w/fecbn-methylf-fa-dha cap29-0.6-0.4-350 mg...........................................................123

PRENATE PIXIE – prenat w/o a w/feaspg-methfol-fa-dhacap 10-0.6-0.4-200 mg....................................................123

PRENATE – prenat mv & min w/ l-methylfolate-fa chew tab0.6-0.4 mg....................................................................... 122

PRENATE RESTORE – prenat w/o a w/fefum-methfol-fa-dha cap 27-0.6-0.4-400 mg............................................ 123

PRENA 1 TRUE – prenat w/o a w/fe chel-fa tab 30-1.4 mg& dha cap 300mg pk...................................................... 122

PREPLUS – prenatal vit w/ fe fumarate-fa tab 27-1mg.................................................................................... 123

PREPOPIK – sod picosulfate-mg oxide-citric acid pack 10mg-3.5 gm-12 gm..............................................................71

PRETAB – prenatal vit w/ fe fumarate-fa tab 29-1 mg..... 123PREVNAR 13 – pneumococcal 13-valent conjugatevaccine inj..........................................................................17

PREVPAC – amoxicillin cap-clarithro tab-lansopraz cap drtherapy pack...................................................................... 73

PREZCOBIX – darunavir-cobicistat tab 800-150 mg.........11PREZISTA – darunavir ethanolate susp 100 mg/ml (baseequiv)................................................................................. 11

PREZISTA – darunavir ethanolate tab 75 mg (baseequiv)................................................................................. 11




PRIFTIN – rifapentine tab 150 mg....................................... 6PRILOSEC OTC – omeprazole magnesium delayedrelease tab 20 mg (base equiv)........................................73

PRIMACARE – prenat w/o a w/feasp-methlf-fa-omeg cap30-0.75-0.25-470mg........................................................123

PRIMAQUINE PHOSPHATE – primaquine phosphate tab26.3 mg (15 mg base)...................................................... 13

primidone tab 50 mg (Mysoline)................................... 113primidone tab 250 mg (Mysoline)................................. 113PRIMSOL – trimethoprim hcl oral soln 50 mg/5ml (baseequiv)................................................................................. 14

PRISTIQ – desvenlafaxine succinate tab er 24hr 25 mg(base equiv).......................................................................84



PR NATAL 400 EC – prenat-fe bis-fe prot succ-fa-ca tab &omega cap dr 400 pk......................................................122

PR NATAL 430 EC – prenat-fe bis-fe prot succ-fa-ca tab &omega cap dr 430 pk......................................................122

PR NATAL 400 – prenat-fe bis-fe prot succ-fa-ca tab &omega 3 cap 400 pk.......................................................121

PR NATAL 430 – prenat-fe bis-fe prot succ-fa-ca tab &omega 3 cap 430 pk.......................................................122

PROAIR HFA – albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv).......................................................... 69

PROAIR RESPICLICK – albuterol sulfate aer pow ba 108mcg/act (90 mcg base equiv)........................................... 69

probenecid tab 500 mg.................................................. 108PROCARDIA – nifedipine cap 10 mg................................ 53PROCARDIA XL – nifedipine tab er 24hr osmotic release30 mg.................................................................................53

PROCARDIA XL – nifedipine tab er 24hr osmotic release60 mg.................................................................................53

PROCARDIA XL – nifedipine tab er 24hr osmotic release90 mg.................................................................................53

PROCENTRA – dextroamphetamine sulfate oral solution 5mg/5ml............................................................................... 93

prochlorperazine maleate tab 5 mg (base equivalent)(Compazine)..................................................................... 87

prochlorperazine maleate tab 10 mg (base equivalent)(Compazine)..................................................................... 87

prochlorperazine suppos 25 mg.....................................87PROCRIT – epoetin alfa inj 2000 unit/ml.........................131PROCRIT – epoetin alfa inj 3000 unit/ml.........................131PROCRIT – epoetin alfa inj 4000 unit/ml.........................131PROCRIT – epoetin alfa inj 10000 unit/ml.......................131PROCRIT – epoetin alfa inj 20000 unit/ml.......................131PROCRIT – epoetin alfa inj 40000 unit/ml.......................131PROCTOCORT – hydrocortisone rectal cream 1%.........143PROCTOFOAM HC – hydrocortisone acetate w/pramoxine rectal foam 1-1%...........................................143

PROCYSBI – cysteamine bitartrate cap delayed release25 mg (base equiv)...........................................................80

PROCYSBI – cysteamine bitartrate cap delayed release75 mg (base equiv)...........................................................80

PROFILNINE – factor ix complex for inj 500 unit.............136PROFILNINE – factor ix complex for inj 1000 unit...........136PROFILNINE – factor ix complex for inj 1500 unit...........136PROFILNINE SD – factor ix complex for inj 500 unit.......136PROFILNINE SD – factor ix complex for inj 1000 unit.....136PROFILNINE SD – factor ix complex for inj 1500 unit.....136progesterone micronized cap 100 mg(Prometrium).................................................................... 28

progesterone micronized cap 200 mg(Prometrium).................................................................... 28

PROGLYCEM – diazoxide susp 50 mg/ml.........................34PROGRAF – tacrolimus cap 0.5 mg................................154PROGRAF – tacrolimus cap 1 mg...................................154PROGRAF – tacrolimus cap 5 mg...................................154

2018


PROLENSA – bromfenac sodium ophth soln 0.07% (baseequivalent)....................................................................... 141

PROMACTA – eltrombopag olamine tab 12.5 mg (baseequiv)............................................................................... 131

PROMACTA – eltrombopag olamine tab 25 mg (baseequiv)............................................................................... 131



promethazine & phenylephrine syrup 6.25-5mg/5ml...............................................................................66

promethazine-dm syrup 6.25-15 mg/5ml........................66promethazine hcl suppos 12.5 mg................................. 65promethazine hcl suppos 25 mg.................................... 65promethazine hcl suppos 50 mg.................................... 66promethazine hcl syrup 6.25 mg/5ml............................. 66promethazine hcl tab 12.5 mg.........................................66promethazine hcl tab 25 mg............................................66promethazine hcl tab 50 mg............................................66promethazine-phenylephrine-codeine syrup 6.25-5-10mg/5ml...............................................................................66

promethazine w/ codeine syrup 6.25-10 mg/5ml...........66PROMETRIUM – progesterone micronized cap 100mg...................................................................................... 28

PROMETRIUM – progesterone micronized cap 200mg...................................................................................... 28

propafenone hcl cap er 12hr 225 mg (Rythmol sr)....... 61propafenone hcl cap er 12hr 325 mg (Rythmol sr)....... 61propafenone hcl cap er 12hr 425 mg (Rythmol sr)....... 61propafenone hcl tab 150 mg........................................... 61propafenone hcl tab 300 mg........................................... 61propafenone hcl tab 225 mg (Rythmol)......................... 61PROPANTHELINE BROMIDE – propantheline bromidetab 15 mg.......................................................................... 73

proparacaine hcl ophth soln 0.5% (Alcaine)............... 141PROPRANOLOL/HYDROCHLOROTH – propranolol &hydrochlorothiazide tab 40-25 mg.................................... 50

PROPRANOLOL/HYDROCHLOROTH – propranolol &hydrochlorothiazide tab 80-25 mg.................................... 50

propranolol hcl cap er 24hr 60 mg (Inderal la)..............50propranolol hcl cap er 24hr 80 mg (Inderal la)..............50propranolol hcl cap er 24hr 120 mg (Inderal la)............50propranolol hcl cap er 24hr 160 mg (Inderal la)............50PROPRANOLOL HCL – propranolol hcl oral soln 20mg/5ml............................................................................... 50

PROPRANOLOL HCL – propranolol hcl oral soln 40mg/5ml............................................................................... 50

propranolol hcl tab 10 mg............................................... 50propranolol hcl tab 20 mg............................................... 50propranolol hcl tab 40 mg............................................... 50propranolol hcl tab 60 mg............................................... 50propranolol hcl tab 80 mg............................................... 50propylthiouracil tab 50 mg.............................................. 37PROQUAD – measles-mumps-rubella-varicella virusvaccines for inj.................................................................. 17

PROSCAR – finasteride tab 5 mg......................................80PROTOPIC – tacrolimus oint 0.03%................................151PROTOPIC – tacrolimus oint 0.1%.................................. 151protriptyline hcl tab 5 mg................................................ 84protriptyline hcl tab 10 mg.............................................. 84PROVERA – medroxyprogesterone acetate tab 2.5mg...................................................................................... 28

PROVERA – medroxyprogesterone acetate tab 5 mg.......28PROVERA – medroxyprogesterone acetate tab 10mg...................................................................................... 28

PROVIDA DHA – prenat w/o a w/fe fum-fe poly-fa-dha cap16-16-1.25-110 mg.......................................................... 123

PROVIDA OB – prenatal w/o a w/fe fum-fe poly-fa cap20-20-1.25 mg................................................................. 123

PRUDOXIN – doxepin hcl cream 5%...............................151pseudoeph-chlorphen w/ hydrocodone soln 60-4-5mg/5ml (Zutripro).............................................................66

pseudoephed-bromphen-dm syrup 30-2-10mg/5ml...............................................................................66

PSORCON – diflorasone diacetate cream 0.05%........... 149PULMICORT – budesonide inhalation susp 0.25mg/2ml............................................................................... 69

PULMICORT – budesonide inhalation susp 0.5mg/2ml............................................................................... 69

PULMICORT – budesonide inhalation susp 1 mg/2ml...... 69PULMICORT FLEXHALER – budesonide inhal aero powd90 mcg/act (breath activated)........................................... 69

PULMICORT FLEXHALER – budesonide inhal aero powd180 mcg/act (breath activated).........................................69

PULMOZYME – dornase alfa inhal soln 1 mg/ml.............. 71PUREFE OB PLUS – prenatal w/o a w/fe fum-fe poly-facap 162.115.2-1 mg........................................................ 123

PURIXAN – mercaptopurine susp 2000 mg/100ml (20 mg/ml)...................................................................................... 21

PYLERA – bismuth subcit-metronidazole-tetracycline cap140-125-125 mg................................................................ 73

pyrazinamide tab 500 mg...................................................6PYRIDIUM – phenazopyridine hcl tab 100 mg.................. 80PYRIDIUM – phenazopyridine hcl tab 200 mg.................. 80pyridostigmine bromide tab er 180 mg (Mestinontimespan)........................................................................ 118

pyridostigmine bromide tab 60 mg (Mestinon)........... 118PYROGALLIC ACID – pyrogallol-chlorobutanol oint25-2%...............................................................................146

QQUADRACEL – diph-tetanus tox ad-acell pert & poliovirus, ipv vac inj................................................................ 17

QUALAQUIN – quinine sulfate cap 324 mg.......................13QUARTETTE – levonor-eth est tab 0.15-0.02/0.025/0.03mg &eth est 0.01 mg........................................................ 29

QUDEXY XR – topiramate cap er 24hr sprinkle 25mg.................................................................................... 113


2018





QUESTRAN – cholestyramine powder 4 gm/dose............ 58QUESTRAN – cholestyramine powder packets 4 gm........58QUESTRAN LIGHT – cholestyramine light powder 4 gm/dose....................................................................................58

quetiapine fumarate tab er 24hr 50 mg (Seroquelxr).......................................................................................87





quetiapine fumarate tab 25 mg (Seroquel).................... 87quetiapine fumarate tab 50 mg (Seroquel).................... 88quetiapine fumarate tab 100 mg (Seroquel).................. 88quetiapine fumarate tab 200 mg (Seroquel).................. 88quetiapine fumarate tab 300 mg (Seroquel).................. 88quetiapine fumarate tab 400 mg (Seroquel).................. 88QUILLICHEW ER – methylphenidate hcl chew tabextended release 20 mg................................................... 93

QUILLICHEW ER – methylphenidate hcl chew tabextended release 30 mg................................................... 93

QUILLICHEW ER – methylphenidate hcl chew tabextended release 40 mg................................................... 93

QUILLIVANT XR – methylphenidate hcl for er susp 25mg/5ml (5 mg/ml).............................................................. 93

quinapril hcl tab 5 mg (Accupril).................................... 45quinapril hcl tab 10 mg (Accupril).................................. 45quinapril hcl tab 20 mg (Accupril).................................. 45quinapril hcl tab 40 mg (Accupril).................................. 45quinapril-hydrochlorothiazide tab 10-12.5 mg(Accuretic)........................................................................ 45

quinapril-hydrochlorothiazide tab 20-12.5 mg(Accuretic)........................................................................ 45

quinapril-hydrochlorothiazide tab 20-25 mg(Accuretic)........................................................................ 45

quinidine gluconate tab er 324 mg.................................61QUINIDINE SULFATE – quinidine sulfate tab 200 mg.......61QUINIDINE SULFATE – quinidine sulfate tab 300 mg.......61quinine sulfate cap 324 mg (Qualaquin)........................ 13QVAR – beclomethasone diprop inhal aero soln 40 mcg/act (50/valve).....................................................................69

QVAR – beclomethasone diprop inhal aero soln 80 mcg/act (100/valve)...................................................................69

Rrabeprazole sodium ec tab 20 mg (Aciphex).................73

RADIOGARDASE – prussian blue insoluble cap 0.5gm.................................................................................... 154

raloxifene hcl tab 60 mg (Evista)....................................42ramipril cap 1.25 mg (Altace).......................................... 45ramipril cap 2.5 mg (Altace)............................................ 45ramipril cap 5 mg (Altace)............................................... 45ramipril cap 10 mg (Altace)............................................. 45RANEXA – ranolazine tab er 12hr 500 mg........................55RANEXA – ranolazine tab er 12hr 1000 mg......................55ranitidine hcl cap 150 mg................................................ 73ranitidine hcl cap 300 mg................................................ 73ranitidine hcl syrup 15 mg/ml (75 mg/5ml).................... 73ranitidine hcl tab 150 mg (Zantac)..................................73ranitidine hcl tab 300 mg (Zantac)..................................73RAPAFLO – silodosin cap 4 mg.........................................80RAPAFLO – silodosin cap 8 mg.........................................80RAPAMUNE – sirolimus oral soln 1 mg/ml...................... 154RAPAMUNE – sirolimus tab 0.5 mg.................................154RAPAMUNE – sirolimus tab 1 mg....................................154RAPAMUNE – sirolimus tab 2 mg....................................154RAPLIXA – fibrinogen-thrombin powder 79-699 mg-unit/gm.................................................................................... 131

rasagiline mesylate tab 0.5 mg (base equiv)(Azilect)........................................................................... 116

rasagiline mesylate tab 1 mg (base equiv)(Azilect)........................................................................... 116

RASUVO – methotrexate soln pf auto-injector 7.5mg/0.15ml........................................................................ 106

RASUVO – methotrexate soln pf auto-injector 10mg/0.2ml.......................................................................... 106








RAVICTI – glycerol phenylbutyrate liquid 1.1 gm/ml..........42RAZADYNE ER – galantamine hydrobromide cap er 24hr8 mg...................................................................................97

RAZADYNE ER – galantamine hydrobromide cap er 24hr16 mg.................................................................................97

RAZADYNE ER – galantamine hydrobromide cap er 24hr24 mg.................................................................................97

RAZADYNE – galantamine hydrobromide tab 4 mg..........97RAZADYNE – galantamine hydrobromide tab 8 mg..........97RAZADYNE – galantamine hydrobromide tab 12 mg........97REBETOL – ribavirin cap 200 mg........................................8REBETOL – ribavirin soln 40 mg/ml.................................... 8

2018


REBIF – interferon beta-1a soln pref syr 22 mcg/0.5ml(12mu/ml)...........................................................................95

REBIF – interferon beta-1a soln pref syr 44 mcg/0.5ml(24mu/ml)...........................................................................95

REBIF REBIDOSE – interferon beta-1a soln auto-inj 22mcg/0.5ml (12mu/ml).........................................................95

REBIF REBIDOSE – interferon beta-1a soln auto-inj 44mcg/0.5ml (24mu/ml).........................................................95

REBIF REBIDOSE TITRATION – interferon beta-1a auto-inj 6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml............................ 95

REBIF TITRATION PACK – interferon beta-1a pref syr6x8.8 mcg/0.2ml & 6x22 mcg/0.5ml................................. 95

RECOMBINATE – antihemophilic factor (recombinant) forinj 220-400 unit................................................................136

RECOMBINATE – antihemophilic factor (recombinant) forinj 401-800 unit................................................................136

RECOMBINATE – antihemophilic factor (recombinant) forinj 801-1240 unit..............................................................136

RECOMBINATE – antihemophilic factor (recombinant) forinj 1241-1800 unit........................................................... 136

RECOMBINATE – antihemophilic factor (recombinant) forinj 1801-2400 unit........................................................... 136

RECOMBIVAX HB – hepatitis b vaccine (recombinant)susp 5 mcg/0.5ml..............................................................17

RECOMBIVAX HB – hepatitis b vaccine (recombinant)susp 10 mcg/ml.................................................................17

RECOMBIVAX HB – hepatitis b vaccine (recombinant)susp 40 mcg/ml.................................................................17

RECTIV – nitroglycerin oint 0.4%.....................................143REGENECARE – lidocaine hcl-collagen-aloe vera gel2%.................................................................................... 151

REGLAN – metoclopramide hcl tab 5 mg..........................76REGLAN – metoclopramide hcl tab 10 mg........................76REGRANEX – becaplermin gel 0.01%............................ 151RELAGARD – acetic acid-oxyquinoline vaginal gel0.9-0.025%.........................................................................79

RELENZA DISKHALER – zanamivir aero powder breathactivated 5 mg/blister........................................................ 12

RELION R – insulin regular (human) inj 100 unit/ml..........35RELISTOR – methylnaltrexone bromide inj 8 mg/0.4ml (20mg/ml)................................................................................ 76

RELISTOR – methylnaltrexone bromide inj 12 mg/0.6ml(20 mg/ml)..........................................................................77

RELISTOR – methylnaltrexone bromide tab 150 mg.........76RELNATE DHA – prenatal vit w/ fe fum-fa-omega 3 cap28-1-200 mg.................................................................... 123

RELPAX – eletriptan hydrobromide tab 20 mg (baseequivalent)....................................................................... 107

RELPAX – eletriptan hydrobromide tab 40 mg (baseequivalent)....................................................................... 107

REMODULIN – treprostinil sodium inj 1 mg/ml (baseequiv)................................................................................. 64

REMODULIN – treprostinil sodium inj 2.5 mg/ml (baseequiv)................................................................................. 64



RENAGEL – sevelamer hcl tab 400 mg............................ 77RENAGEL – sevelamer hcl tab 800 mg............................ 77RENVELA – sevelamer carbonate packet 0.8 gm.............77RENVELA – sevelamer carbonate packet 2.4 gm.............77RENVELA – sevelamer carbonate tab 800 mg..................77REPAGLINIDE/METFORMIN HYD – repaglinide-metformin hcl tab 1-500 mg..............................................34

REPAGLINIDE/METFORMIN HYD – repaglinide-metformin hcl tab 2-500 mg..............................................34

repaglinide tab 0.5 mg (Prandin).................................... 34repaglinide tab 1 mg (Prandin)....................................... 34repaglinide tab 2 mg (Prandin)....................................... 34REPATHA – evolocumab subcutaneous soln prefilledsyringe 140 mg/ml.............................................................58

REPATHA PUSHTRONEX SYSTEM – evolocumabsubcutaneous soln cartridge/infusor 420 mg/3.5ml..........58

REPATHA SURECLICK – evolocumab subcutaneous solnauto-injector 140 mg/ml.................................................... 58

REQUIP – ropinirole hydrochloride tab 0.25 mg..............116REQUIP – ropinirole hydrochloride tab 0.5 mg................116REQUIP – ropinirole hydrochloride tab 1 mg...................116REQUIP – ropinirole hydrochloride tab 2 mg...................116REQUIP – ropinirole hydrochloride tab 3 mg...................116REQUIP – ropinirole hydrochloride tab 4 mg...................116REQUIP – ropinirole hydrochloride tab 5 mg...................116REQUIP XL – ropinirole hydrochloride tab er 24hr 2 mg(base equivalent).............................................................116

REQUIP XL – ropinirole hydrochloride tab er 24hr 4 mg(base equivalent).............................................................116




RESCRIPTOR – delavirdine mesylate tab 100 mg............11RESCRIPTOR – delavirdine mesylate tab 200 mg............11RESCULA – unoprostone isopropyl ophth soln0.15%............................................................................... 140

RESTASIS – cyclosporine (ophth) emulsion 0.05%........ 141RESTASIS MULTIDOSE – cyclosporine (ophth) emulsion0.05%............................................................................... 141

RETIN-A – tretinoin cream 0.025%..................................144RETIN-A – tretinoin cream 0.05%....................................144RETIN-A – tretinoin cream 0.1%......................................144RETIN-A – tretinoin gel 0.01%.........................................144RETIN-A – tretinoin gel 0.025%.......................................145RETROVIR – zidovudine cap 100 mg............................... 11RETROVIR – zidovudine syrup 10 mg/ml..........................11REVATIO – sildenafil citrate for suspension 10 mg/ml.......64REVLIMID – lenalidomide cap 5 mg................................154REVLIMID – lenalidomide cap 10 mg..............................154REVLIMID – lenalidomide cap 15 mg..............................154REVLIMID – lenalidomide cap 20 mg..............................154

2018


REVLIMID – lenalidomide cap 25 mg..............................154REVLIMID – lenalidomide caps 2.5 mg........................... 154REXULTI – brexpiprazole tab 0.25 mg.............................. 88REXULTI – brexpiprazole tab 0.5 mg................................ 88REXULTI – brexpiprazole tab 1 mg................................... 88REXULTI – brexpiprazole tab 2 mg................................... 88REXULTI – brexpiprazole tab 3 mg................................... 88REXULTI – brexpiprazole tab 4 mg................................... 88REYATAZ – atazanavir sulfate cap 150 mg (baseequiv)................................................................................. 11

REYATAZ – atazanavir sulfate cap 200 mg (baseequiv)................................................................................. 11

REYATAZ – atazanavir sulfate cap 300 mg (baseequiv)................................................................................. 11

REYATAZ – atazanavir sulfate oral powder packet 50 mg(base equiv).......................................................................11

RIBASPHERE RIBAPAK – ribavirin tab 400 mg..................8RIBASPHERE RIBAPAK – ribavirin tab 600 mg..................8RIBASPHERE RIBAPAK – ribavirin tab 200 mg & ribavirin400 mg tab therapy pack....................................................8

RIBASPHERE RIBAPAK – ribavirin tab 400 mg & ribavirin600 mg tab therapy pack....................................................8

RIBASPHERE – ribavirin tab 400 mg.................................. 8RIBASPHERE – ribavirin tab 600 mg.................................. 8ribavirin cap 200 mg (Rebetol)..........................................8ribavirin for inhal soln 6 gm (Virazole)...........................14ribavirin tab 200 mg (Copegus)........................................ 8RIDAURA – auranofin cap 3 mg......................................106rifabutin cap 150 mg (Mycobutin).....................................6RIFADIN – rifampin cap 150 mg.......................................... 6RIFAMATE – isoniazid & rifampin cap 150-300 mg.............6rifampin cap 150 mg (Rifadin)...........................................6rifampin cap 300 mg (Rifadin)...........................................6RIFATER – isoniazid-rifampin w/ pyrazinamide tab50-120-300 mg.................................................................... 6

RILUTEK – riluzole tab 50 mg......................................... 118riluzole tab 50 mg (Rilutek)........................................... 118rimantadine hydrochloride tab 100 mg(Flumadine).......................................................................12

ringer's solution for irrigation.......................................154RIOMET – metformin hcl oral soln 500 mg/5ml.................34risedronate sodium tab delayed release 35 mg(Atelvia).............................................................................42

risedronate sodium tab 5 mg (Actonel)......................... 42risedronate sodium tab 30 mg (Actonel)....................... 42risedronate sodium tab 35 mg (Actonel)....................... 42risedronate sodium tab 150 mg (Actonel)..................... 42risperidone orally disintegrating tab 0.25 mg............... 88risperidone orally disintegrating tab 0.5 mg (Risperdalm-tab)................................................................................ 88

risperidone orally disintegrating tab 1 mg (Risperdalm-tab)................................................................................ 88




risperidone soln 1 mg/ml (Risperdal).............................88risperidone tab 0.25 mg (Risperdal)...............................88risperidone tab 0.5 mg (Risperdal).................................88risperidone tab 1 mg (Risperdal)....................................88risperidone tab 2 mg (Risperdal)....................................88risperidone tab 3 mg (Risperdal)....................................88risperidone tab 4 mg (Risperdal)....................................88RITALIN – methylphenidate hcl tab 5 mg.......................... 93RITALIN – methylphenidate hcl tab 10 mg........................ 93RITALIN – methylphenidate hcl tab 20 mg........................ 93rivastigmine tartrate cap 1.5 mg (Exelon)......................97rivastigmine tartrate cap 3 mg (Exelon).........................97rivastigmine tartrate cap 4.5 mg (Exelon)......................97rivastigmine tartrate cap 6 mg (Exelon).........................97rivastigmine td patch 24hr 4.6 mg/24hr (Exelon)..........97rivastigmine td patch 24hr 9.5 mg/24hr (Exelon)..........97rivastigmine td patch 24hr 13.3 mg/24hr (Exelon)........ 97RIXUBIS – coagulation factor ix (recombinant) for inj 250unit....................................................................................136

RIXUBIS – coagulation factor ix (recombinant) for inj 500unit....................................................................................136




rizatriptan benzoate oral disintegrating tab 5 mg (baseeq) (Maxalt-mlt)..............................................................107

rizatriptan benzoate oral disintegrating tab 10 mg(base eq) (Maxalt-mlt)...................................................107

rizatriptan benzoate tab 5 mg (base equivalent)(Maxalt)............................................................................107

rizatriptan benzoate tab 10 mg (base equivalent)(Maxalt)............................................................................107

R-NATAL OB – prenatal w/o a w/fe cbn-fa-dha cap20-1-320 mg.................................................................... 123

ROBAXIN – methocarbamol tab 500 mg.........................118ROBAXIN-750 – methocarbamol tab 750 mg..................118ROBINUL FORTE – glycopyrrolate tab 2 mg.................... 73ROBINUL – glycopyrrolate tab 1 mg..................................73ROCALTROL – calcitriol cap 0.25 mcg..............................42ROCALTROL – calcitriol cap 0.5 mcg................................42ROCALTROL – calcitriol oral soln 1 mcg/ml......................42ropinirole hydrochloride tab er 24hr 2 mg (baseequivalent) (Requip xl)................................................. 116

ropinirole hydrochloride tab er 24hr 4 mg (baseequivalent) (Requip xl)................................................. 116




2018


ropinirole hydrochloride tab 0.25 mg (Requip)........... 117ropinirole hydrochloride tab 0.5 mg (Requip)............. 117ropinirole hydrochloride tab 1 mg (Requip)................ 117ropinirole hydrochloride tab 2 mg (Requip)................ 117ropinirole hydrochloride tab 3 mg (Requip)................ 117ropinirole hydrochloride tab 4 mg (Requip)................ 117ropinirole hydrochloride tab 5 mg (Requip)................ 117rosuvastatin calcium tab 5 mg (Crestor)....................... 58rosuvastatin calcium tab 10 mg (Crestor)..................... 58rosuvastatin calcium tab 20 mg (Crestor)..................... 58rosuvastatin calcium tab 40 mg (Crestor)..................... 58ROZEREM – ramelteon tab 8 mg......................................89RUBRACA – rucaparib camsylate tab 200 mg (baseequivalent)......................................................................... 21

RUBRACA – rucaparib camsylate tab 250 mg (baseequivalent)......................................................................... 21

RUBRACA – rucaparib camsylate tab 300 mg (baseequivalent)......................................................................... 21

RUCONEST – c1 esterase inhibitor (recombinant) for iv inj2100 unit..........................................................................131

RYDAPT – midostaurin cap 25 mg.................................... 21RYTHMOL SR – propafenone hcl cap er 12hr 225 mg..... 61RYTHMOL SR – propafenone hcl cap er 12hr 325 mg..... 61RYTHMOL SR – propafenone hcl cap er 12hr 425 mg..... 61

SSABRIL – vigabatrin powd pack 500 mg......................... 113SABRIL – vigabatrin tab 500 mg......................................113SAFYRAL – drospirenone-ethinyl estrad-levomefolate tab3-0.03-0.451 mg................................................................ 29

SAIZEN CLICK.EASY – somatropin (non-refrigerated) forinj 8.8 mg...........................................................................39

SAIZENPREP RECONSTITUTION – somatropin (non-refrigerated) for inj 8.8 mg................................................ 39

SAIZEN – somatropin (non-refrigerated) for inj 5 mg........ 39SAIZEN – somatropin (non-refrigerated) for inj 8.8 mg..... 39SALAGEN – pilocarpine hcl tab 5 mg..............................142SALAGEN – pilocarpine hcl tab 7.5 mg...........................142SALEX – salicylic acid shampoo 6%............................... 146salicylic acid cream 6%................................................. 146salicylic acid gel 6% (Keralyt).......................................146salicylic acid lotion 6%.................................................. 146salicylic acid shampoo 6% (Salex)...............................146salicylic acid soln 26%...................................................146SALIMEZ FORTE – salicylic acid cream 10%................. 146salsalate tab 500 mg (Disalcid).......................................98salsalate tab 750 mg (Disalcid).......................................98SAMSCA – tolvaptan tab 15 mg........................................ 42SAMSCA – tolvaptan tab 30 mg........................................ 42SANCUSO – granisetron td patch 3.1 mg/24hr (contains34.3 mg).............................................................................74

SANDIMMUNE – cyclosporine cap 25 mg.......................154SANDIMMUNE – cyclosporine cap 100 mg.....................154SANDIMMUNE – cyclosporine oral soln 100 mg/ml........154SANDOSTATIN – octreotide acetate inj 50 mcg/ml (0.05mg/ml)................................................................................ 42

SANDOSTATIN – octreotide acetate inj 100 mcg/ml (0.1mg/ml)................................................................................ 42



SANDOSTATIN – octreotide acetate inj 1000 mcg/ml (1mg/ml)................................................................................ 42

SANTYL – collagenase oint 250 unit/gm......................... 151SAPHRIS – asenapine maleate sl tab 2.5 mg (baseequiv)................................................................................. 88

SAPHRIS – asenapine maleate sl tab 5 mg (baseequiv)................................................................................. 88

SAPHRIS – asenapine maleate sl tab 10 mg (baseequiv)................................................................................. 88

SAVAYSA – edoxaban tosylate tab 15 mg (baseequivalent)....................................................................... 131



SAVELLA – milnacipran hcl tab 12.5 mg........................... 97SAVELLA – milnacipran hcl tab 25 mg.............................. 97SAVELLA – milnacipran hcl tab 50 mg.............................. 97SAVELLA – milnacipran hcl tab 100 mg............................ 97SAVELLA TITRATION PACK – milnacipran hcl tab 12.5mg (5) & 25 mg (8) & 50 mg (42) pak..............................97

scopolamine td patch 72hr 1 mg/3days (Transderm-scop)..................................................................................74

SEASONIQUE – levonorg-eth est tab 0.15-0.03mg(84) &eth est tab 0.01mg(7)........................................................29

SECONAL SODIUM – secobarbital sodium cap 100mg...................................................................................... 89

SELECT-OB+DHA – prenatal mv w/fe poly-fa chw 29-1mg & dha cap 250 mg pak.............................................123

SELECT-OB – prenatal vit w/ fe polysac cmplx-fa chewtab 29-1 mg..................................................................... 123

SELECT-OB – prenat w/ fepolycmplx-methylfol-fa chewtab 29-0.6-0.4 mg............................................................123

selegiline hcl cap 5 mg (Eldepryl)................................ 117selegiline hcl tab 5 mg...................................................117selenium sulfide lotion 2.5%......................................... 151selenium sulfide-pyrithione zinc in urea shampoo2.25%............................................................................... 151

SELZENTRY – maraviroc oral soln 20 mg/ml....................11SELZENTRY – maraviroc tab 25 mg................................. 11SELZENTRY – maraviroc tab 75 mg................................. 11SELZENTRY – maraviroc tab 150 mg............................... 11SELZENTRY – maraviroc tab 300 mg............................... 11SE-NATAL 19 – prenatal vit w/ dss-fe fumarate-fa tab 29-1mg.................................................................................... 123

SE-NATAL 19 – prenatal vit w/ fe fumarate-fa chew tab29-1 mg............................................................................123

SENSIPAR – cinacalcet hcl tab 30 mg (base equiv)..........42SENSIPAR – cinacalcet hcl tab 60 mg (base equiv)..........42SENSIPAR – cinacalcet hcl tab 90 mg (base equiv)..........42

2018


SEREVENT DISKUS – salmeterol xinafoate aer pow ba50 mcg/dose (base equiv)................................................ 69

SEROSTIM – somatropin (non-refrigerated) forsubcutaneous inj 4 mg......................................................39



sertraline hcl oral conc 20 mg/ml (Zoloft)......................84sertraline hcl tab 25 mg (Zoloft)..................................... 84sertraline hcl tab 50 mg (Zoloft)..................................... 84sertraline hcl tab 100 mg (Zoloft)................................... 84sevelamer carbonate packet 0.8 gm (Renvela)............. 77sevelamer carbonate packet 2.4 gm (Renvela)............. 77sevelamer carbonate tab 800 mg (Renvela).................. 77SFROWASA – mesalamine sulfite-free (sf) enema 4gm/60ml............................................................................. 77

SHINGRIX – zoster vaccine recombinant adjuvanted forim inj 50 mcg.....................................................................17

SHOHLS SOLUTION MODIFIED – sodium citrate & citricacid soln 500-334 mg/5ml................................................ 80

SHUR-SEAL – nonoxynol-9 gel 2%...................................29SIGNIFOR – pasireotide diaspartate inj 0.3 mg/ml (baseequiv)................................................................................. 42

SIGNIFOR – pasireotide diaspartate inj 0.6 mg/ml (baseequiv)................................................................................. 42

SIGNIFOR – pasireotide diaspartate inj 0.9 mg/ml (baseequiv)................................................................................. 42

sildenafil citrate tab 20 mg (Revatio)............................. 64SILVADENE – silver sulfadiazine cream 1%....................146SILVER NITRATE – silver nitrate oint 10%......................151SILVER NITRATE – silver nitrate soln 0.5%.................... 151SILVER NITRATE – silver nitrate soln 10%..................... 151SILVER NITRATE – silver nitrate soln 25%..................... 151SILVER NITRATE – silver nitrate soln 50%..................... 151silver sulfadiazine cream 1% (Silvadene).................... 146SIMBRINZA – brinzolamide-brimonidine tartrate ophthsusp 1-0.2%.....................................................................140

SIMPONI – golimumab subcutaneous soln auto-injector50 mg/0.5ml.....................................................................106

SIMPONI – golimumab subcutaneous soln auto-injector100 mg/ml........................................................................106

SIMPONI – golimumab subcutaneous soln prefilledsyringe 50 mg/0.5ml........................................................106

SIMPONI – golimumab subcutaneous soln prefilledsyringe 100 mg/ml...........................................................106

simvastatin tab 5 mg (Zocor).......................................... 58simvastatin tab 10 mg (Zocor)........................................ 58simvastatin tab 20 mg (Zocor)........................................ 58simvastatin tab 40 mg (Zocor)........................................ 58simvastatin tab 80 mg (Zocor)........................................ 58SINEMET – carbidopa & levodopa tab 10-100 mg..........117SINEMET – carbidopa & levodopa tab 25-100 mg..........117SINEMET – carbidopa & levodopa tab 25-250 mg..........117SINEMET CR – carbidopa & levodopa tab er 25-100mg.................................................................................... 117

SINEMET CR – carbidopa & levodopa tab er 50-200mg.................................................................................... 117

SINGULAIR – montelukast sodium oral granules packet 4mg (base equiv)................................................................ 69

sirolimus tab 0.5 mg (Rapamune).................................154sirolimus tab 1 mg (Rapamune)....................................154sirolimus tab 2 mg (Rapamune)....................................154SIRTURO – bedaquiline fumarate tab 100 mg (baseequiv)....................................................................................6

SIVEXTRO – tedizolid phosphate tab 200 mg...................14SKELAXIN – metaxalone tab 800 mg..............................118SKLICE – ivermectin lotion 0.5%..................................... 151sodium chloride irrigation soln 0.9%............................. 80sodium chloride soln nebu 0.9%.................................... 66sodium chloride soln nebu 3%....................................... 66sodium chloride soln nebu 10%..................................... 67sodium chloride soln nebu 7% (Hyper-sal)................... 67sodium citrate & citric acid soln 500-334 mg/5ml(Shohls solution modi)................................................... 80

sodium fluoride chew tab 0.25 mg f (from 0.55 mg naf)(Luride)............................................................................127

sodium fluoride chew tab 0.5 mg f (from 1.1 mg naf)(Luride)............................................................................127

sodium fluoride chew tab 1 mg f (from 2.2 mg naf)(Luride)............................................................................127

sodium fluoride cream 1.1% (Prevident 5000plus).................................................................................142

sodium fluoride gel 1.1% (0.5% f) (Previdentfluoride)...........................................................................142

sodium fluoride paste 1.1% (Prevident 5000boost).............................................................................. 142

sodium fluoride-potassium nitrate paste 1.1-5%(Prevident 5000 sensi)..................................................142

sodium fluoride rinse 0.2%............................................142SODIUM FLUORIDE – sodium fluoride tab 0.5 mg f (from1.1 mg naf)...................................................................... 127

SODIUM FLUORIDE – sodium fluoride tab 1 mg f (from2.2 mg naf)...................................................................... 127

sodium fluoride soln 0.125 mg/drop f (0.275 mg/dropnaf)...................................................................................127

sodium fluoride soln 0.5 mg/ml f (from 1.1 mg/ml naf)(Luride)............................................................................127

sodium phenylbutyrate oral powder 3 gm/teaspoonful(Buphenyl)........................................................................ 43

sodium phenylbutyrate tab 500 mg (Buphenyl)............43sodium polystyrene sulfonate oral susp 15gm/60ml...........................................................................154

sodium polystyrene sulfonate powder(Kayexalate)....................................................................154

sodium polystyrene sulfonate rectal susp 30gm/120ml........................................................................ 155

SODIUM SULFACETAMIDE WASH – sulfacetamidesodium in bakuchiol vehicle wash 10%..........................151

SOLIQUA 100/33 – insulin glargine-lixisenatide sol pen-inj100-33 unit-mcg/ml............................................................34

2018


SOLTAMOX – tamoxifen citrate oral soln 10 mg/5ml (baseequivalent)......................................................................... 21

SOMAVERT – pegvisomant for inj 10 mg (as protein).......43SOMAVERT – pegvisomant for inj 15 mg (as protein).......43SOMAVERT – pegvisomant for inj 20 mg (as protein).......43SOMAVERT – pegvisomant for inj 25 mg (as protein).......43SOMAVERT – pegvisomant for inj 30 mg (as protein).......43SONATA – zaleplon cap 5 mg........................................... 89SONATA – zaleplon cap 10 mg......................................... 89SOOLANTRA – ivermectin cream 1%............................. 145SORIATANE – acitretin cap 10 mg.................................. 151SORIATANE – acitretin cap 17.5 mg............................... 151SORIATANE – acitretin cap 25 mg.................................. 151sotalol hcl (afib/afl) tab 80 mg (Betapace af).................61sotalol hcl (afib/afl) tab 120 mg (Betapace af)...............61sotalol hcl (afib/afl) tab 160 mg (Betapace af)...............61sotalol hcl tab 240 mg......................................................61sotalol hcl tab 80 mg (Betapace)....................................61sotalol hcl tab 120 mg (Betapace)..................................61sotalol hcl tab 160 mg (Betapace)..................................61SOVALDI – sofosbuvir tab 400 mg...................................... 9SPECTRACEF – cefditoren pivoxil tab 400 mg (baseequivalent)............................................................................2

SPINOSAD – spinosad susp 0.9%.................................. 151SPIRIVA HANDIHALER – tiotropium bromidemonohydrate inhal cap 18 mcg (base equiv)................... 69

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 1.25 mcg/act................................................70

SPIRIVA RESPIMAT – tiotropium bromide monohydrateinhal aerosol 2.5 mcg/act..................................................70

spironolactone & hydrochlorothiazide tab 25-25 mg(Aldactazide).....................................................................60

spironolactone tab 25 mg (Aldactone)...........................60spironolactone tab 50 mg (Aldactone)...........................60spironolactone tab 100 mg (Aldactone).........................60SPORANOX – itraconazole cap 100 mg............................. 7SPORANOX – itraconazole oral soln 10 mg/ml...................7SPORANOX PULSEPAK – itraconazole cap 100 mg..........7SPRYCEL – dasatinib tab 20 mg.......................................21SPRYCEL – dasatinib tab 50 mg.......................................21SPRYCEL – dasatinib tab 70 mg.......................................21SPRYCEL – dasatinib tab 80 mg.......................................21SPRYCEL – dasatinib tab 100 mg.....................................21SPRYCEL – dasatinib tab 140 mg.....................................21SSKI – potassium iodide soln 1 gm/ml.............................. 67STALEVO 100 – carbidopa-levodopa-entacapone tabs25-100-200 mg................................................................ 117

STALEVO 125 – carbidopa-levodopa-entacapone tabs31.25-125-200 mg...........................................................117

STALEVO 150 – carbidopa-levodopa-entacapone tabs37.5-150-200 mg............................................................. 117

STALEVO 200 – carbidopa-levodopa-entacapone tabs50-200-200 mg................................................................ 117

STALEVO 50 – carbidopa-levodopa-entacapone tabs12.5-50-200 mg............................................................... 117

STALEVO 75 – carbidopa-levodopa-entacapone tabs18.75-75-200 mg............................................................. 117

stannous fluoride gel 0.4%............................................142STARLIX – nateglinide tab 60 mg......................................34STARLIX – nateglinide tab 120 mg....................................34stavudine cap 15 mg (Zerit).............................................11stavudine cap 20 mg (Zerit).............................................11stavudine cap 30 mg (Zerit).............................................11stavudine cap 40 mg (Zerit).............................................11STELARA – ustekinumab inj 45 mg/0.5ml.......................151STELARA – ustekinumab soln prefilled syringe 45mg/0.5ml.......................................................................... 151

STELARA – ustekinumab soln prefilled syringe 90 mg/ml......................................................................................151

STIMATE – desmopressin acetate nasal soln 1.5 mg/ml........................................................................................43

STIOLTO RESPIMAT – tiotropium br-olodaterol inhal aerosoln 2.5-2.5 mcg/act..........................................................70

STIVARGA – regorafenib tab 40 mg..................................21STRATTERA – atomoxetine hcl cap 10 mg (baseequiv)................................................................................. 93

STRATTERA – atomoxetine hcl cap 18 mg (baseequiv)................................................................................. 93






STRENSIQ – asfotase alfa subcutaneous inj 18mg/0.45ml.......................................................................... 43

STRENSIQ – asfotase alfa subcutaneous inj 28mg/0.7ml............................................................................ 43

STRENSIQ – asfotase alfa subcutaneous inj 40 mg/ml........................................................................................43

STRENSIQ – asfotase alfa subcutaneous inj 80mg/0.8ml............................................................................ 43

STRIBILD – elvitegrav-cobic-emtricitab-tenofovdf tab150-150-200-300 mg.........................................................11

STRIVERDI RESPIMAT – olodaterol hcl inhal aerosol soln2.5 mcg/act (base equiv).................................................. 70

STROMECTOL – ivermectin tab 3 mg...............................13SUBOXONE – buprenorphine hcl-naloxone hcl sl film2-0.5 mg (base equiv).....................................................155

SUBOXONE – buprenorphine hcl-naloxone hcl sl film 4-1mg (base equiv).............................................................. 155



SUCRAID – sacrosidase soln 8500 unit/ml....................... 75sucralfate tab 1 gm (Carafate).........................................73

2018


SULAR – nisoldipine tab er 24hr 8.5 mg........................... 53SULAR – nisoldipine tab er 24hr 17 mg............................ 53SULAR – nisoldipine tab er 24hr 34 mg............................ 53sulfacetamide sodium lotion 10% (acne) (Klaron)......145sulfacetamide sodium ophth soln 10% (Bleph-10)..... 137sulfacetamide sodium-prednisolone ophth soln10-0.23(0.25)%................................................................ 139

SULFACETAMIDE SODIUM – sulfacetamide sodiumophth oint 10%................................................................ 137

SULFADIAZINE – sulfadiazine tab 500 mg......................... 5sulfamethoxazole-trimethoprim susp 200-40mg/5ml...............................................................................14

sulfamethoxazole-trimethoprim tab 400-80 mg(Bactrim)........................................................................... 14

sulfamethoxazole-trimethoprim tab 800-160 mg(Bactrim ds)......................................................................14

SULFAMYLON – mafenide acetate cream 85 mg/gm..... 146SULFAMYLON – mafenide acetate packet for topical soln5% (50 gm)......................................................................146

sulfasalazine tab delayed release 500 mg (Azulfidineen-tabs)............................................................................. 77

sulfasalazine tab 500 mg (Azulfidine)............................ 77sulindac tab 150 mg....................................................... 106sulindac tab 200 mg....................................................... 106sumatriptan nasal spray 5 mg/act (Imitrex).................107sumatriptan nasal spray 20 mg/act (Imitrex)...............107sumatriptan succinate inj 6 mg/0.5ml (Imitrex)...........107sumatriptan succinate solution auto-injector 4mg/0.5ml (Imitrex statdose sys)..................................107

sumatriptan succinate solution auto-injector 6mg/0.5ml (Imitrex statdose sys)..................................107

sumatriptan succinate solution cartridge 4 mg/0.5ml(Imitrex statdose ref).................................................... 107

sumatriptan succinate solution cartridge 6 mg/0.5ml(Imitrex statdose ref).................................................... 107

sumatriptan succinate tab 25 mg (Imitrex)..................107sumatriptan succinate tab 50 mg (Imitrex)..................107sumatriptan succinate tab 100 mg (Imitrex)................107SUPRAX – cefixime cap 400 mg......................................... 2SUPRAX – cefixime chew tab 100 mg................................ 3SUPRAX – cefixime chew tab 200 mg................................ 3SUPRAX – cefixime for susp 100 mg/5ml........................... 3SUPRAX – cefixime for susp 200 mg/5ml........................... 3SUPRAX – cefixime for susp 500 mg/5ml........................... 3SUPREP BOWEL PREP KIT – sod sulfate-pot sulf-mg sulforal sol 17.5-3.13-1.6 gm/180ml.......................................71

SURMONTIL – trimipramine maleate cap 25 mg.............. 84SURMONTIL – trimipramine maleate cap 50 mg.............. 84SURMONTIL – trimipramine maleate cap 100 mg............ 84SUSTIVA – efavirenz cap 50 mg....................................... 11SUSTIVA – efavirenz cap 200 mg..................................... 11SUSTIVA – efavirenz tab 600 mg...................................... 11SUTENT – sunitinib malate cap 12.5 mg (baseequivalent)......................................................................... 21

SUTENT – sunitinib malate cap 25 mg (baseequivalent)......................................................................... 21

SUTENT – sunitinib malate cap 37.5 mg (baseequivalent)......................................................................... 21

SUTENT – sunitinib malate cap 50 mg (baseequivalent)......................................................................... 21

SYLATRON – peginterferon alfa-2b for inj kit 200 mcg..... 21SYLATRON – peginterferon alfa-2b for inj kit 300 mcg..... 21SYLATRON – peginterferon alfa-2b for inj kit 600 mcg..... 21SYMAX DUOTAB – hyoscyamine sulfate tab er 0.375 mg(0.125 mg ir/0.25 mg er)...................................................73

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 80-4.5 mcg/act..................................................... 70

SYMBICORT – budesonide-formoterol fumarate dihydaerosol 160-4.5 mcg/act................................................... 70

SYMBYAX – olanzapine-fluoxetine hcl cap 3-25 mg......... 97SYMBYAX – olanzapine-fluoxetine hcl cap 6-25 mg......... 97SYMBYAX – olanzapine-fluoxetine hcl cap 6-50 mg......... 97SYMBYAX – olanzapine-fluoxetine hcl cap 12-25 mg....... 97SYMBYAX – olanzapine-fluoxetine hcl cap 12-50 mg....... 97SYMLINPEN 120 – pramlintide acetate pen-inj 2700mcg/2.7ml (1000 mcg/ml)................................................. 34

SYMLINPEN 60 – pramlintide acetate pen-inj 1500mcg/1.5ml (1000 mcg/ml)................................................. 34

SYNALAR – fluocinolone acetonide cream 0.025%........ 149SYNALAR – fluocinolone acetonide oint 0.025%............ 149SYNALAR – fluocinolone acetonide soln 0.01%..............149SYNAREL – nafarelin acetate nasal soln 2 mg/ml (200mcg/act) (base eq)............................................................ 43

SYNERA – lidocaine-tetracaine topical patch 70-70mg.................................................................................... 151

SYNJARDY – empagliflozin-metformin hcl tab 5-500mg...................................................................................... 34

SYNJARDY – empagliflozin-metformin hcl tab 5-1000mg...................................................................................... 34

SYNJARDY – empagliflozin-metformin hcl tab 12.5-500mg...................................................................................... 34

SYNJARDY – empagliflozin-metformin hcl tab 12.5-1000mg...................................................................................... 34

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr5-1000 mg......................................................................... 34

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr10-1000 mg....................................................................... 34

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr12.5-1000 mg.................................................................... 34

SYNJARDY XR – empagliflozin-metformin hcl tab er 24hr25-1000 mg....................................................................... 34

SYNRIBO – omacetaxine mepesuccinate for inj 3.5mg...................................................................................... 21

SYNTHROID – levothyroxine sodium tab 25 mcg............. 37SYNTHROID – levothyroxine sodium tab 50 mcg............. 37SYNTHROID – levothyroxine sodium tab 75 mcg............. 37SYNTHROID – levothyroxine sodium tab 88 mcg............. 37SYNTHROID – levothyroxine sodium tab 100 mcg........... 37SYNTHROID – levothyroxine sodium tab 112 mcg........... 37SYNTHROID – levothyroxine sodium tab 125 mcg........... 37SYNTHROID – levothyroxine sodium tab 137 mcg........... 37SYNTHROID – levothyroxine sodium tab 150 mcg........... 37

2018


SYNTHROID – levothyroxine sodium tab 175 mcg........... 37SYNTHROID – levothyroxine sodium tab 200 mcg........... 38SYNTHROID – levothyroxine sodium tab 300 mcg........... 38SYPRINE – trientine hcl cap 250 mg...............................155SYRINGES/NEEDLES – VARIOUS MANUFACTURERS –for self-injectable drug administration.............................152

TTABLOID – thioguanine tab 40 mg.................................... 21tacrolimus cap 0.5 mg (Prograf)................................... 155tacrolimus cap 1 mg (Prograf)...................................... 155tacrolimus cap 5 mg (Prograf)...................................... 155tacrolimus oint 0.03% (Protopic).................................. 151tacrolimus oint 0.1% (Protopic).................................... 151TAFINLAR – dabrafenib mesylate cap 50 mg (baseequivalent)......................................................................... 21

TAFINLAR – dabrafenib mesylate cap 75 mg (baseequivalent)......................................................................... 21

TAGRISSO – osimertinib mesylate tab 40 mg (baseequivalent)......................................................................... 21

TAGRISSO – osimertinib mesylate tab 80 mg (baseequivalent)......................................................................... 21

TALTZ – ixekizumab subcutaneous soln auto-injector 80mg/ml............................................................................... 151

TALTZ – ixekizumab subcutaneous soln prefilled syringe80 mg/ml..........................................................................151

TAMIFLU – oseltamivir phosphate cap 30 mg (baseequiv)................................................................................. 12



TAMIFLU – oseltamivir phosphate for susp 6 mg/ml (baseequiv)................................................................................. 12

tamoxifen citrate tab 10 mg (base equivalent)..............21tamoxifen citrate tab 20 mg (base equivalent)..............21tamsulosin hcl cap 0.4 mg (Flomax).............................. 80TANZEUM – albiglutide for soln pen-injector 30 mg..........34TANZEUM – albiglutide for soln pen-injector 50 mg..........34TAPAZOLE – methimazole tab 5 mg................................. 38TAPAZOLE – methimazole tab 10 mg............................... 38TARCEVA – erlotinib hcl tab 25 mg (base equivalent).......21TARCEVA – erlotinib hcl tab 100 mg (base equivalent).....22TARCEVA – erlotinib hcl tab 150 mg (base equivalent).....22TARGRETIN – bexarotene cap 75 mg...............................22TARGRETIN – bexarotene gel 1%...................................151TARKA – trandolapril-verapamil hcl tab er 1-240 mg.........54TARKA – trandolapril-verapamil hcl tab er 2-180 mg.........54TARKA – trandolapril-verapamil hcl tab er 2-240 mg.........54TARKA – trandolapril-verapamil hcl tab er 4-240 mg.........54TARON-BC – prenat w/o a w/ fe cbnyl-fa tab 20-1 mg & vitb6 tab pak....................................................................... 123

TARON-C DHA – prenatal w/fe fum-fe poly -fa-omega 3cap 53.5-38-1 mg............................................................123

TARON-PREX – prenatal w/o vit a w/ fe fum-dss-fa-dhacap 30-1.2-265 mg..........................................................123

TASIGNA – nilotinib hcl cap 150 mg (base equivalent)..... 22TASIGNA – nilotinib hcl cap 200 mg (base equivalent)..... 22TASMAR – tolcapone tab 100 mg....................................117TAYTULLA – norethindrone ace-ethinyl estradiol-fe cap 1mg-20 mcg (24).................................................................29

tazarotene cream 0.1% (Tazorac)..................................145TAZORAC – tazarotene cream 0.05%.............................145TAZORAC – tazarotene cream 0.1%...............................145TAZORAC – tazarotene gel 0.05%.................................. 145TAZORAC – tazarotene gel 0.1%.................................... 145TECFIDERA – dimethyl fumarate capsule delayed release120 mg...............................................................................95

TECFIDERA – dimethyl fumarate capsule delayed release240 mg...............................................................................95

TECFIDERA STARTER PACK – dimethyl fumaratecapsule dr starter pack 120 mg & 240 mg....................... 95

TECHNIVIE – ombitasvir-paritaprevir-ritonavir tab12.5-75-50 mg..................................................................... 9

TEGRETOL – carbamazepine susp 100 mg/5ml.............113TEGRETOL – carbamazepine tab 200 mg...................... 113TEGRETOL-XR – carbamazepine tab er 12hr 100mg.................................................................................... 113

TEGRETOL-XR – carbamazepine tab er 12hr 200mg.................................................................................... 113

TEGRETOL-XR – carbamazepine tab er 12hr 400mg.................................................................................... 113

TEKTURNA – aliskiren fumarate tab 150 mg (baseequivalent)......................................................................... 64

TEKTURNA – aliskiren fumarate tab 300 mg (baseequivalent)......................................................................... 64

TEKTURNA HCT – aliskiren-hydrochlorothiazide tab150-12.5 mg...................................................................... 64

TEKTURNA HCT – aliskiren-hydrochlorothiazide tab150-25 mg......................................................................... 64

TEKTURNA HCT – aliskiren-hydrochlorothiazide tab300-12.5 mg...................................................................... 64

TEKTURNA HCT – aliskiren-hydrochlorothiazide tab300-25 mg......................................................................... 64

telmisartan-amlodipine tab 40-5 mg (Twynsta)............. 54telmisartan-amlodipine tab 80-5 mg (Twynsta)............. 54telmisartan-amlodipine tab 40-10 mg (Twynsta)........... 54telmisartan-amlodipine tab 80-10 mg (Twynsta)........... 54telmisartan-hydrochlorothiazide tab 40-12.5 mg(Micardis hct)................................................................... 48

telmisartan-hydrochlorothiazide tab 80-12.5 mg(Micardis hct)................................................................... 48

telmisartan-hydrochlorothiazide tab 80-25 mg(Micardis hct)................................................................... 48

telmisartan tab 20 mg (Micardis).................................... 47telmisartan tab 40 mg (Micardis).................................... 47telmisartan tab 80 mg (Micardis).................................... 48temazepam cap 7.5 mg (Restoril)................................... 89temazepam cap 15 mg (Restoril).................................... 89temazepam cap 22.5 mg (Restoril)................................. 89temazepam cap 30 mg (Restoril).................................... 89TEMODAR – temozolomide cap 5 mg...............................22

2018


TEMODAR – temozolomide cap 20 mg.............................22TEMODAR – temozolomide cap 100 mg...........................22TEMODAR – temozolomide cap 140 mg...........................22TEMODAR – temozolomide cap 180 mg...........................22TEMODAR – temozolomide cap 250 mg...........................22TEMOVATE – clobetasol propionate cream 0.05%......... 149TEMOVATE – clobetasol propionate gel 0.05%...............149TEMOVATE – clobetasol propionate oint 0.05%..............149TEMOVATE – clobetasol propionate soln 0.05%.............149temozolomide cap 5 mg (Temodar)................................ 22temozolomide cap 20 mg (Temodar)..............................22temozolomide cap 100 mg (Temodar)............................22temozolomide cap 140 mg (Temodar)............................22temozolomide cap 180 mg (Temodar)............................22temozolomide cap 250 mg (Temodar)............................22TENCON – butalbital-acetaminophen tab 50-325 mg....... 98TENIVAC – tetanus-diphtheria toxoids (td) inj 5-2 lfu........ 17TENORETIC 100 – atenolol & chlorthalidone tab 100-25mg...................................................................................... 50

TENORETIC 50 – atenolol & chlorthalidone tab 50-25mg...................................................................................... 50

TERAZOL 7 – terconazole vaginal cream 0.4%................ 79terazosin hcl cap 1 mg.....................................................64terazosin hcl cap 2 mg.....................................................64terazosin hcl cap 5 mg.....................................................64terazosin hcl cap 10 mg...................................................64terbinafine hcl tab 250 mg (Lamisil).................................7terbutaline sulfate tab 2.5 mg......................................... 70terbutaline sulfate tab 5 mg............................................ 70terconazole vaginal cream 0.4% (Terazol 7).................. 79terconazole vaginal cream 0.8% (Terazol 3).................. 79terconazole vaginal suppos 80 mg.................................79TESSALON PERLES – benzonatate cap 100 mg.............67TEST DISCS – VARIOUS MANUFACTURERS...............152testosterone cypionate im inj in oil 100 mg/ml (Depo-testosterone).................................................................... 25

testosterone cypionate im inj in oil 200 mg/ml (Depo-testosterone).................................................................... 25

testosterone enanthate im inj in oil 200 mg/ml.............25testosterone td gel 12.5 mg/act (1%) (Androgelpump)................................................................................ 25

testosterone td gel 25 mg/2.5gm (1%) (Androgel)........ 25testosterone td gel 50 mg/5gm (1%) (Androgel)........... 25testosterone td soln 30 mg/act....................................... 25TEST STRIPS – VARIOUS MANUFACTURERS.............152TETANUS/DIPHTHERIA TOXOID – tetanus-diphtheriatoxoids (td) inj 2-2 lf/0.5ml................................................ 17

tetrabenazine tab 12.5 mg (Xenazine)............................ 98tetrabenazine tab 25 mg (Xenazine)............................... 98tetracaine hcl ophth soln 0.5%..................................... 141tetracycline hcl cap 250 mg (Tetracycline hcl)................4tetracycline hcl cap 500 mg (Tetracycline hcl)................4TETRACYCLINE HCL – tetracycline hcl cap 250 mg..........4TETRACYCLINE HCL – tetracycline hcl cap 500 mg..........4THALOMID – thalidomide cap 50 mg.............................. 155THALOMID – thalidomide cap 100 mg............................ 155

THALOMID – thalidomide cap 150 mg............................ 155THALOMID – thalidomide cap 200 mg............................ 155theophylline soln 80 mg/15ml......................................... 70theophylline tab er 12hr 100 mg.....................................70theophylline tab er 12hr 200 mg.....................................70theophylline tab er 12hr 300 mg.....................................70theophylline tab er 12hr 450 mg.....................................70theophylline tab er 24hr 400 mg.....................................70theophylline tab er 24hr 600 mg.....................................70THEO-24 – theophylline cap er 24hr 100 mg.................... 70THEO-24 – theophylline cap er 24hr 200 mg.................... 70THEO-24 – theophylline cap er 24hr 300 mg.................... 70THEO-24 – theophylline cap er 24hr 400 mg.................... 70THIOLA – tiopronin tab 100 mg......................................... 80thioridazine hcl tab 10 mg............................................... 88thioridazine hcl tab 25 mg............................................... 88thioridazine hcl tab 50 mg............................................... 88thioridazine hcl tab 100 mg............................................. 88thiothixene cap 1 mg........................................................88thiothixene cap 2 mg........................................................88thiothixene cap 5 mg........................................................88thiothixene cap 10 mg......................................................88THRIVITE 19 – prenatal vit w/ dss-fe fumarate-fa tab 29-1mg.................................................................................... 124

THRIVITE RX – prenatal vit w/ iron carbonyl-fa tab 29-1mg.................................................................................... 123

thyroid tab 15 mg (1/4 grain) (Armour thyroid)............. 38thyroid tab 30 mg (1/2 grain) (Armour thyroid)............. 38thyroid tab 90 mg (1 1/2 grain) (Armour thyroid).......... 38thyroid tab 60 mg (1 grain) (Armour thyroid)................ 38thyroid tab 120 mg (2 grain) (Armour thyroid).............. 38THYROLAR-1/2 – liotrix (t3-t4) tab 30 mg (6.25-25mcg)................................................................................... 38

THYROLAR-1/4 – liotrix (t3-t4) tab 15 mg (3.1-12.5mcg)................................................................................... 38

THYROLAR-1 – liotrix (t3-t4) tab 60 mg (12.5-50 mcg).....38THYROLAR-2 – liotrix (t3-t4) tab 120 mg (25-100mcg)................................................................................... 38

THYROLAR-3 – liotrix (t3-t4) tab 180 mg (37.5-150mcg)................................................................................... 38

tiagabine hcl tab 2 mg (Gabitril)................................... 113tiagabine hcl tab 4 mg (Gabitril)................................... 113TIGAN – trimethobenzamide hcl cap 300 mg....................74TIKOSYN – dofetilide cap 125 mcg (0.125 mg).................61TIKOSYN – dofetilide cap 250 mcg (0.25 mg)...................61TIKOSYN – dofetilide cap 500 mcg (0.5 mg).....................61timolol maleate ophth gel forming soln 0.25%(Timoptic-xe).................................................................. 140

timolol maleate ophth gel forming soln 0.5%(Timoptic-xe).................................................................. 140

timolol maleate ophth soln 0.25% (Timoptic)..............140timolol maleate ophth soln 0.5% (Timoptic)................140TIMOLOL MALEATE – timolol maleate tab 5 mg.............. 50TIMOLOL MALEATE – timolol maleate tab 10 mg............ 51TIMOLOL MALEATE – timolol maleate tab 20 mg............ 51

2018


TIMOPTIC OCUDOSE – timolol maleate preservative freeophth soln 0.25%............................................................ 140

TIMOPTIC OCUDOSE – timolol maleate preservative freeophth soln 0.5%.............................................................. 140

TIMOPTIC – timolol maleate ophth soln 0.25%...............140TIMOPTIC – timolol maleate ophth soln 0.5%.................140TIMOPTIC-XE – timolol maleate ophth gel forming soln0.25%............................................................................... 140

TIMOPTIC-XE – timolol maleate ophth gel forming soln0.5%................................................................................. 140

TINDAMAX – tinidazole tab 500 mg.................................. 14tinidazole tab 250 mg (Tindamax)...................................14tinidazole tab 500 mg (Tindamax)...................................14TIROSINT – levothyroxine sodium cap 13 mcg.................38TIROSINT – levothyroxine sodium cap 25 mcg.................38TIROSINT – levothyroxine sodium cap 50 mcg.................38TIROSINT – levothyroxine sodium cap 75 mcg.................38TIROSINT – levothyroxine sodium cap 88 mcg.................38TIROSINT – levothyroxine sodium cap 100 mcg...............38TIROSINT – levothyroxine sodium cap 112 mcg...............38TIROSINT – levothyroxine sodium cap 125 mcg...............38TIROSINT – levothyroxine sodium cap 137 mcg...............38TIROSINT – levothyroxine sodium cap 150 mcg...............38TIVICAY – dolutegravir sodium tab 10 mg (baseequiv)................................................................................. 11

TIVICAY – dolutegravir sodium tab 25 mg (baseequiv)................................................................................. 11

TIVICAY – dolutegravir sodium tab 50 mg (baseequiv)................................................................................. 11

tizanidine hcl cap 2 mg (base equivalent)(Zanaflex)........................................................................ 118



tizanidine hcl tab 2 mg (base equivalent)....................118tizanidine hcl tab 4 mg (base equivalent)(Zanaflex)........................................................................ 118

TL-CARE DHA – prenatal w/fe fumarate-fa-dss-fish oil cap27-1-500 mg.................................................................... 124

TL FOLATE – prenatal vit w/ fe fum-methylfolate-fa tab27-0.5-0.5 mg.................................................................. 124

TL-SELECT – prenatal w/o vit a w/ fe fum-dss-fa-dha cap29-1.25-325 mg............................................................... 124

TOBI PODHALER – tobramycin inhal cap 28 mg................5TOBRADEX ST – tobramycin-dexamethasone ophth susp0.3-0.05%.........................................................................139

TOBRADEX – tobramycin-dexamethasone ophth oint0.3-0.1%...........................................................................139

TOBRADEX – tobramycin-dexamethasone ophth susp0.3-0.1%...........................................................................139

tobramycin-dexamethasone ophth susp 0.3-0.1%(Tobradex).......................................................................139

tobramycin nebu soln 300 mg/5ml (Tobi)........................ 5tobramycin ophth soln 0.3% (Tobrex)..........................137TOBRAMYCIN – tobramycin nebu soln 300 mg/5ml........... 5

TOBREX – tobramycin ophth oint 0.3%...........................137TOBREX – tobramycin ophth soln 0.3%..........................137TODAY SPONGE – nonoxynol-9 vaginal sponge 1000mg...................................................................................... 29

TOLAK – fluorouracil cream 4%.......................................151TOLAZAMIDE – tolazamide tab 250 mg............................34TOLAZAMIDE – tolazamide tab 500 mg............................34TOLBUTAMIDE – tolbutamide tab 500 mg........................ 34tolcapone tab 100 mg (Tasmar).................................... 117TOLMETIN SODIUM – tolmetin sodium cap 400 mg...... 106TOLMETIN SODIUM – tolmetin sodium tab 200 mg....... 106TOLMETIN SODIUM – tolmetin sodium tab 600 mg....... 106tolterodine tartrate cap er 24hr 2 mg (Detrol la)............78tolterodine tartrate cap er 24hr 4 mg (Detrol la)............78tolterodine tartrate tab 1 mg (Detrol)............................. 78tolterodine tartrate tab 2 mg (Detrol)............................. 78TOPAMAX SPRINKLE – topiramate sprinkle cap 15mg.................................................................................... 113

TOPAMAX SPRINKLE – topiramate sprinkle cap 25mg.................................................................................... 113

TOPAMAX – topiramate tab 25 mg..................................113TOPAMAX – topiramate tab 50 mg..................................113TOPAMAX – topiramate tab 100 mg................................113TOPAMAX – topiramate tab 200 mg................................113TOPICORT – desoximetasone cream 0.25%.................. 149TOPICORT – desoximetasone gel 0.05%....................... 149TOPICORT – desoximetasone oint 0.25%...................... 149TOPIRAMATE ER – topiramate cap er 24hr sprinkle 25mg.................................................................................... 113

TOPIRAMATE ER – topiramate cap er 24hr sprinkle 50mg.................................................................................... 113




topiramate sprinkle cap 15 mg (Topamaxsprinkle).......................................................................... 114

topiramate sprinkle cap 25 mg (Topamaxsprinkle).......................................................................... 114

topiramate tab 25 mg (Topamax).................................. 114topiramate tab 50 mg (Topamax).................................. 114topiramate tab 100 mg (Topamax)................................114topiramate tab 200 mg (Topamax)................................114TOPROL XL – metoprolol succinate tab er 24hr 25 mg(tartrate equiv)................................................................... 51

TOPROL XL – metoprolol succinate tab er 24hr 50 mg(tartrate equiv)................................................................... 51



torsemide tab 100 mg.......................................................60torsemide tab 5 mg (Demadex).......................................60torsemide tab 10 mg (Demadex).....................................60

2018


torsemide tab 20 mg (Demadex).....................................60TOUJEO SOLOSTAR – insulin glargine soln pen-injector300 unit/ml......................................................................... 36

TOVIAZ – fesoterodine fumarate tab er 24hr 4 mg............78TOVIAZ – fesoterodine fumarate tab er 24hr 8 mg............78TRACLEER – bosentan tab for oral susp 32 mg............... 64TRACLEER – bosentan tab 62.5 mg.................................64TRACLEER – bosentan tab 125 mg..................................64TRADJENTA – linagliptin tab 5 mg.................................... 34tramadol-acetaminophen tab 37.5-325 mg(Ultracet)......................................................................... 103

tramadol hcl tab er 24hr biphasic release 100 mg......103tramadol hcl tab er 24hr biphasic release 200 mg......103tramadol hcl tab er 24hr biphasic release 300 mg......103tramadol hcl tab er 24hr 100 mg...................................103tramadol hcl tab er 24hr 200 mg...................................103tramadol hcl tab er 24hr 300 mg...................................103tramadol hcl tab 50 mg (Ultram)...................................103trandolapril tab 4 mg........................................................45trandolapril tab 1 mg (Mavik).......................................... 45trandolapril tab 2 mg (Mavik).......................................... 45trandolapril-verapamil hcl tab er 1-240 mg (Tarka).......54trandolapril-verapamil hcl tab er 2-180 mg (Tarka).......54trandolapril-verapamil hcl tab er 2-240 mg (Tarka).......54trandolapril-verapamil hcl tab er 4-240 mg (Tarka).......54tranexamic acid tab 650 mg (Lysteda)......................... 131TRANSDERM-SCOP – scopolamine td patch 72hr 1mg/3days............................................................................74

tranylcypromine sulfate tab 10 mg (Parnate)................84TRAVATAN Z – travoprost ophth soln 0.004%(benzalkonium free) (bak free)....................................... 140

trazodone hcl tab 50 mg.................................................. 84trazodone hcl tab 100 mg................................................ 84trazodone hcl tab 150 mg................................................ 84trazodone hcl tab 300 mg................................................ 84TRECATOR – ethionamide tab 250 mg...............................6TRESIBA FLEXTOUCH – insulin degludec soln pen-injector 100 unit/ml............................................................36

TRESIBA FLEXTOUCH – insulin degludec soln pen-injector 200 unit/ml............................................................36

tretinoin cap 10 mg...........................................................22tretinoin cream 0.025% (Retin-a)...................................145tretinoin cream 0.05% (Retin-a).....................................145tretinoin cream 0.1% (Retin-a).......................................145tretinoin gel 0.05% (Atralin)...........................................145tretinoin gel 0.01% (Retin-a)..........................................145tretinoin gel 0.025% (Retin-a)........................................145TRETTEN – coagulation factor xiii a-subunit for inj2000-3125 unit................................................................ 136

TREXALL – methotrexate sodium tab 5 mg (baseequiv)................................................................................. 22

TREXALL – methotrexate sodium tab 7.5 mg (baseequiv)................................................................................. 22



TREZIX – acetaminophen-caffeine-dihydrocodeine cap320.5-30-16 mg............................................................... 103

triamcinolone acetonide aerosol soln 0.147 mg/gm(Kenalog)........................................................................ 149

triamcinolone acetonide cream 0.025%.......................149triamcinolone acetonide cream 0.1%........................... 149triamcinolone acetonide cream 0.5%........................... 149triamcinolone acetonide dental paste 0.1%................ 142triamcinolone acetonide lotion 0.025%........................149triamcinolone acetonide lotion 0.1%............................149triamcinolone acetonide nasal aerosol suspension 55mcg/act..............................................................................66

triamcinolone acetonide oint 0.025%........................... 150triamcinolone acetonide oint 0.1%............................... 150triamcinolone acetonide oint 0.5%............................... 150TRIAMTERENE/HYDROCHLOROTH – triamterene &hydrochlorothiazide cap 50-25 mg................................... 60

triamterene & hydrochlorothiazide cap 37.5-25 mg(Dyazide)........................................................................... 60

triamterene & hydrochlorothiazide tab 37.5-25 mg(Maxzide-25)..................................................................... 60

triamterene & hydrochlorothiazide tab 75-50 mg(Maxzide)...........................................................................60

triazolam tab 0.25 mg (Halcion)...................................... 89TRIAZOLAM – triazolam tab 0.125 mg..............................89TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazide tab 20-5-12.5 mg..............................48

TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazide tab 40-5-12.5 mg..............................48

TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazide tab 40-5-25 mg.................................48

TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazide tab 40-10-12.5 mg............................48

TRIBENZOR – olmesartan-amlodipine-hydrochlorothiazide tab 40-10-25 mg...............................48

TRICARE PRENATAL COMPLEAT – prenat w/o a fefum-fa tab 27-1 mg & fish oil chew cap pak..........................124

TRICARE PRENATAL DHA ONE/ – prenatal multivitamins& minerals w/iron & fa cap 0.8 mg................................. 124

TRICARE PRENATAL DHA ONE – prenatal w/fefumarate-fa-dss-fish oil cap 27-1-500 mg.......................124

TRICARE PRENATAL – prenat w/o vit a w/ fe pyrophos-methylf chew tab 4.5-1 mg............................................. 124

TRICARE – prenatal vit w/ fe fumarate-fa tab 27-1mg.................................................................................... 124

TRICOR – fenofibrate tab 48 mg....................................... 58TRICOR – fenofibrate tab 145 mg..................................... 58TRIDESILON – desonide cream 0.05%...........................150trifluoperazine hcl tab 1 mg (base equivalent)..............88trifluoperazine hcl tab 2 mg (base equivalent)..............88trifluoperazine hcl tab 5 mg (base equivalent)..............88trifluoperazine hcl tab 10 mg (base equivalent)............88trifluridine ophth soln 1% (Viroptic)............................. 137TRIGLIDE – fenofibrate tab 160 mg.................................. 58

2018


trihexyphenidyl hcl elixir 0.4 mg/ml............................. 117trihexyphenidyl hcl tab 2 mg.........................................117trihexyphenidyl hcl tab 5 mg.........................................117TRILEPTAL – oxcarbazepine susp 300 mg/5ml (60 mg/ml).................................................................................... 114

TRILEPTAL – oxcarbazepine tab 150 mg........................114TRILEPTAL – oxcarbazepine tab 300 mg........................114TRILEPTAL – oxcarbazepine tab 600 mg........................114TRILIPIX – choline fenofibrate cap dr 45 mg (fenofibricacid equiv)......................................................................... 58

TRILIPIX – choline fenofibrate cap dr 135 mg (fenofibricacid equiv)......................................................................... 58

trimethobenzamide hcl cap 300 mg (Tigan).................. 74trimethoprim tab 100 mg................................................. 14trimipramine maleate cap 25 mg (Surmontil)................ 84trimipramine maleate cap 50 mg (Surmontil)................ 84trimipramine maleate cap 100 mg (Surmontil).............. 84TRIMPEX – trimethoprim hcl oral soln 50 mg/5ml (baseequiv)................................................................................. 14

TRINATAL RX 1 – prenatal vit w/ fe fumarate-fa tab 60-1mg.................................................................................... 124

TRINATE – prenatal vit w/ fe fumarate-fa tab 28-1mg.................................................................................... 124

TRI-NORINYL 28 – norethindrone-eth estradiol tab0.5-35/1-35/0.5-35 mg-mcg...............................................29

TRINTELLIX – vortioxetine hbr tab 5 mg (base equiv)...... 84TRINTELLIX – vortioxetine hbr tab 10 mg (baseequiv)................................................................................. 84

TRINTELLIX – vortioxetine hbr tab 20 mg (baseequiv)................................................................................. 84

TRISTART DHA – prenat w/o a w/fecbn-methylf-fa-dhacap 31-0.6-0.4-200 mg....................................................124

TRISTART ONE – prenat w/o a w/fecbn-methylf-fa-dhacap 35-1-215 mg.............................................................124

TRI-TABS DHA – prenat w/o a w/ fe bisglyc-fa tab 32-1 mg& omega cap pack..........................................................124

TRIUMEQ – abacavir-dolutegravir-lamivudine tab600-50-300 mg.................................................................. 11

TRIVEEN-DUO DHA – prenat-fe bis-fe prot succ-fa-ca tab& omega 3 cap 400 pk................................................... 124

TRIZIVIR – abacavir sulfate-lamivudine-zidovudine tab300-150-300 mg................................................................ 11

TROKENDI XR – topiramate cap er 24hr 25 mg............. 114TROKENDI XR – topiramate cap er 24hr 50 mg............. 114TROKENDI XR – topiramate cap er 24hr 100 mg........... 114TROKENDI XR – topiramate cap er 24hr 200 mg........... 114tropicamide ophth soln 0.5%........................................ 141tropicamide ophth soln 1% (Mydriacyl)....................... 141trospium chloride cap er 24hr 60 mg.............................78trospium chloride tab 20 mg...........................................78TRULANCE – plecanatide tab 3 mg.................................. 77TRULICITY – dulaglutide soln pen-injector 0.75mg/0.5ml............................................................................ 34

TRULICITY – dulaglutide soln pen-injector 1.5mg/0.5ml............................................................................ 34

TRUMENBA – meningococcal group b vac (recomb) imsusp prefilled syr............................................................... 17

TRUSOPT – dorzolamide hcl ophth soln 2%...................140TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 100-150 mg.................................................................11

TRUVADA – emtricitabine-tenofovir disoproxil fumaratetab 133-200 mg.................................................................11



TUDORZA PRESSAIR – aclidinium bromide aerosol powdbreath activated 400 mcg/act........................................... 70

TUSSIONEX PENNKINETIC EXT – hydrocod polst-chlorphen polst er susp 10-8 mg/5ml...............................67

TWINRIX – hepatitis a (inact)-hep b (recomb) vac inj720-20 elu-mcg/ml.............................................................17

TWYNSTA – telmisartan-amlodipine tab 40-5 mg............. 54TWYNSTA – telmisartan-amlodipine tab 40-10 mg........... 54TWYNSTA – telmisartan-amlodipine tab 80-5 mg............. 54TWYNSTA – telmisartan-amlodipine tab 80-10 mg........... 54TYBOST – cobicistat tab 150 mg.......................................12TYKERB – lapatinib ditosylate tab 250 mg (baseequiv)................................................................................. 22

TYLENOL/CODEINE #3 – acetaminophen w/ codeine tab300-30 mg....................................................................... 103

TYLENOL/CODEINE #4 – acetaminophen w/ codeine tab300-60 mg....................................................................... 103

TYLENOL/CODEINE – acetaminophen w/ codeine tab300-15 mg....................................................................... 103

TYMLOS – abaloparatide subcutaneous soln pen-injector3120 mcg/1.56ml...............................................................43

TYVASO REFILL – treprostinil inhalation solution 0.6 mg/ml........................................................................................64

TYVASO STARTER – treprostinil inhalation solution 0.6mg/ml..................................................................................64

TYVASO – treprostinil inhalation solution 0.6 mg/ml......... 64

UUCERIS – budesonide rectal foam 2 mg/act................... 143ULESFIA – benzyl alcohol lotion 5%............................... 152ULORIC – febuxostat tab 40 mg......................................108ULORIC – febuxostat tab 80 mg......................................108ULTIMATECARE ONE – prenatal vit w/ fe cbn-fe asp glyc-fa-omega 3 cap 27-1mg................................................. 124

ULTRAVATE – halobetasol propionate cream 0.05%...... 150ULTRAVATE – halobetasol propionate oint 0.05%.......... 150UPTRAVI – selexipag tab 200 mcg....................................64UPTRAVI – selexipag tab 400 mcg....................................64UPTRAVI – selexipag tab 600 mcg....................................64UPTRAVI – selexipag tab 800 mcg....................................64UPTRAVI – selexipag tab 1000 mcg..................................65UPTRAVI – selexipag tab 1200 mcg..................................65UPTRAVI – selexipag tab 1400 mcg..................................65UPTRAVI – selexipag tab 1600 mcg..................................65

2018


UPTRAVI – selexipag tab therapy pack 200 mcg (140) &800 mcg (60)..................................................................... 64

URAMAXIN – urea in ammonium lactate vehicle foam20%.................................................................................. 152

URECHOLINE – bethanechol chloride tab 5 mg............... 78URECHOLINE – bethanechol chloride tab 10 mg............. 78URECHOLINE – bethanechol chloride tab 25 mg............. 78URECHOLINE – bethanechol chloride tab 50 mg............. 78UROCIT-K 10 – potassium citrate tab er 10 meq (1080mg)..................................................................................... 80

UROCIT-K 15 – potassium citrate tab er 15 meq (1620mg)..................................................................................... 80

UROCIT-K 5 – potassium citrate tab er 5 meq (540mg)..................................................................................... 80

ursodiol cap 300 mg (Actigall)........................................77ursodiol tab 250 mg (Urso 250)...................................... 77ursodiol tab 500 mg (Urso forte).................................... 77URSO FORTE – ursodiol tab 500 mg................................77URSO 250 – ursodiol tab 250 mg......................................77UTIBRON NEOHALER – indacaterol-glycopyrrolate inhalcap 27.5-15.6 mcg............................................................ 70

VVAGIFEM – estradiol vaginal tab 10 mcg.......................... 79valacyclovir hcl tab 1 gm (Valtrex)................................... 9valacyclovir hcl tab 500 mg (Valtrex)............................... 9VALCHLOR – mechlorethamine hcl gel 0.016% (baseequivalent)....................................................................... 152

VALCYTE – valganciclovir hcl for soln 50 mg/ml (baseequiv)....................................................................................7

valganciclovir hcl for soln 50 mg/ml (base equiv)(Valcyte).............................................................................. 7

valganciclovir hcl tab 450 mg (base equivalent)(Valcyte).............................................................................. 7

valproate sodium oral soln 250 mg/5ml (base equiv)(Depakene)......................................................................114

valproic acid cap 250 mg (Depakene)..........................114valsartan-hydrochlorothiazide tab 80-12.5 mg (Diovanhct).....................................................................................48

valsartan-hydrochlorothiazide tab 160-12.5 mg (Diovanhct).....................................................................................48

valsartan-hydrochlorothiazide tab 160-25 mg (Diovanhct).....................................................................................48

valsartan-hydrochlorothiazide tab 320-12.5 mg (Diovanhct).....................................................................................48

valsartan-hydrochlorothiazide tab 320-25 mg (Diovanhct).....................................................................................48

valsartan tab 40 mg (Diovan).......................................... 48valsartan tab 80 mg (Diovan).......................................... 48valsartan tab 160 mg (Diovan)........................................ 48valsartan tab 320 mg (Diovan)........................................ 48VANCOCIN HCL – vancomycin hcl cap 125 mg................14VANCOCIN HCL – vancomycin hcl cap 250 mg................14vancomycin hcl cap 125 mg (Vancocin hcl)..................14vancomycin hcl cap 250 mg (Vancocin hcl)..................14VAQTA – hepatitis a vaccine inj susp 25 unit/0.5ml...........17

VAQTA – hepatitis a vaccine inj susp 50 unit/ml................17VARIVAX – varicella virus vac live for subcutaneous inj1350 pfu/0.5ml...................................................................17

VARUBI – rolapitant hcl tab 90 mg (base equiv)............... 74VASCEPA – icosapent ethyl cap 0.5 gm............................58VASCEPA – icosapent ethyl cap 1 gm...............................58VAXCHORA – cholera vaccine live attenuated for oralsusp....................................................................................17

VCF VAGINAL CONTRACEPTIVE – nonoxynol-9 film28%.................................................................................... 29

VCF VAGINAL CONTRACEPTIVE – nonoxynol-9 foam12.5%................................................................................. 29

VECAMYL – mecamylamine hcl tab 2.5 mg......................65VECTICAL – calcitriol oint 3 mcg/gm...............................152VELPHORO – sucroferric oxyhydroxide chew tab 500mg...................................................................................... 77

VELTASSA – patiromer sorbitex calcium for susp packet8.4 gm (base eq).............................................................155

VELTASSA – patiromer sorbitex calcium for susp packet16.8 gm (base eq)...........................................................155

VELTASSA – patiromer sorbitex calcium for susp packet25.2 gm (base eq)...........................................................155

VEMAVITE-PRX 2 – prenatal w/o vit a w/ fe fum-dss-fa-dha cap 27-1.25-300 mg................................................ 124

VEMLIDY – tenofovir alafenamide fumarate tab 25 mg.......9VENA-BAL DHA – prenat w/fe poly-na fered-fa tab 27-1 &omega cap dr 430mg......................................................124

VENCLEXTA STARTING PACK – venetoclax tab therapystarter pack 10 & 50 & 100 mg........................................ 22

VENCLEXTA – venetoclax tab 10 mg................................22VENCLEXTA – venetoclax tab 50 mg................................22VENCLEXTA – venetoclax tab 100 mg..............................22venlafaxine hcl cap er 24hr 37.5 mg (base equivalent)(Effexor xr)....................................................................... 85

venlafaxine hcl cap er 24hr 75 mg (base equivalent)(Effexor xr)....................................................................... 85

venlafaxine hcl cap er 24hr 150 mg (base equivalent)(Effexor xr)....................................................................... 85

VENLAFAXINE HCL ER – venlafaxine hcl tab er 24hr 37.5mg (base equivalent)........................................................ 85

VENLAFAXINE HCL ER – venlafaxine hcl tab er 24hr 75mg (base equivalent)........................................................ 85

VENLAFAXINE HCL ER – venlafaxine hcl tab er 24hr 150mg (base equivalent)........................................................ 85

venlafaxine hcl tab er 24hr 225 mg (baseequivalent)........................................................................ 85

venlafaxine hcl tab er 24hr 37.5 mg (base equivalent)(Venlafaxine hcl er)......................................................... 85

venlafaxine hcl tab er 24hr 75 mg (base equivalent)(Venlafaxine hcl er)......................................................... 85

venlafaxine hcl tab er 24hr 150 mg (base equivalent)(Venlafaxine hcl er)......................................................... 85

venlafaxine hcl tab 25 mg................................................85venlafaxine hcl tab 37.5 mg.............................................85venlafaxine hcl tab 50 mg................................................85venlafaxine hcl tab 75 mg................................................85

2018


venlafaxine hcl tab 100 mg..............................................85VENTAVIS – iloprost inhalation solution 10 mcg/ml...........65VENTAVIS – iloprost inhalation solution 20 mcg/ml...........65VENTOLIN HFA – albuterol sulfate inhal aero 108 mcg/act(90mcg base equiv).......................................................... 70

verapamil hcl cap er 24hr 120 mg (Verelan).................. 54verapamil hcl cap er 24hr 180 mg (Verelan).................. 54verapamil hcl cap er 24hr 240 mg (Verelan).................. 54verapamil hcl cap er 24hr 360 mg (Verelan).................. 54verapamil hcl cap er 24hr 100 mg (Verelan pm)............54verapamil hcl cap er 24hr 200 mg (Verelan pm)............54verapamil hcl cap er 24hr 300 mg (Verelan pm)............54verapamil hcl tab er 120 mg (Calan sr)..........................54verapamil hcl tab er 180 mg (Calan sr)..........................54verapamil hcl tab er 240 mg (Calan sr)..........................54verapamil hcl tab 40 mg.................................................. 54verapamil hcl tab 80 mg (Calan).....................................54verapamil hcl tab 120 mg (Calan)...................................54VERELAN PM – verapamil hcl cap er 24hr 100 mg.......... 54VERELAN PM – verapamil hcl cap er 24hr 200 mg.......... 54VERELAN PM – verapamil hcl cap er 24hr 300 mg.......... 54VERELAN – verapamil hcl cap er 24hr 120 mg.................54VERELAN – verapamil hcl cap er 24hr 180 mg.................54VERELAN – verapamil hcl cap er 24hr 240 mg.................54VERELAN – verapamil hcl cap er 24hr 360 mg.................54VERIPRED 20 – prednisolone sod phosphate oral soln 20mg/5ml (base equiv)......................................................... 25

VERSACLOZ – clozapine susp 50 mg/ml..........................88VERZENIO – abemaciclib tab 50 mg.................................22VERZENIO – abemaciclib tab 100 mg...............................22VERZENIO – abemaciclib tab 150 mg...............................22VERZENIO – abemaciclib tab 200 mg...............................22VESICARE – solifenacin succinate tab 5 mg.................... 78VESICARE – solifenacin succinate tab 10 mg...................78VFEND – voriconazole for susp 40 mg/ml...........................7VFEND – voriconazole tab 50 mg........................................7VFEND – voriconazole tab 200 mg......................................7VIBERZI – eluxadoline tab 75 mg......................................77VIBERZI – eluxadoline tab 100 mg....................................77VIBRAMYCIN – doxycycline calcium syrup 50 mg/5ml....... 4VICTOZA – liraglutide soln pen-injector 18 mg/3ml (6 mg/ml)...................................................................................... 34

VIDEX – didanosine for soln 2 gm.....................................12VIDEX – didanosine for soln 4 gm.....................................12VIDEX EC – didanosine delayed release capsule 125mg...................................................................................... 12

VIDEX EC – didanosine delayed release capsule 200mg...................................................................................... 12



VIEKIRA PAK – ombitas-paritapre-riton & dasab tab pak12.5-75-50 & 250 mg..........................................................9

VIEKIRA XR – dasab-ombit-paritap-riton tab er 24hr200-8.33-50-33.33 mg.........................................................9

vigabatrin powd pack 500 mg (Sabril)......................... 114VIGAMOX – moxifloxacin hcl ophth soln 0.5% (baseequiv)............................................................................... 138

VIIBRYD STARTER PACK – vilazodone hcl tab starter kit10 (7) & 20 (23) mg..........................................................85

VIIBRYD – vilazodone hcl tab 10 mg.................................85VIIBRYD – vilazodone hcl tab 20 mg.................................85VIIBRYD – vilazodone hcl tab 40 mg.................................85VIMPAT – lacosamide oral solution 10 mg/ml..................114VIMPAT – lacosamide tab 50 mg.....................................114VIMPAT – lacosamide tab 100 mg...................................114VIMPAT – lacosamide tab 150 mg...................................114VIMPAT – lacosamide tab 200 mg...................................114VINATE DHA RF – prenat w/o a w/fefum-methylfol-omegas cap 27-1.13 mg.................................................124

VINATE II – prenatal vit w/ fe bisglycinate chelate-fa tab29-1 mg............................................................................124

VINATE M – prenatal vit w/ sel-fe fumarate-fa tab 27-1mg.................................................................................... 124

VINATE ONE – prenatal vit w/ fe fumarate-fa tab 60-1mg.................................................................................... 124

VIRACEPT – nelfinavir mesylate tab 250 mg.................... 12VIRACEPT – nelfinavir mesylate tab 625 mg.................... 12VIRAMUNE – nevirapine susp 50 mg/5ml.........................12VIRAMUNE – nevirapine tab 200 mg................................ 12VIRAMUNE XR – nevirapine tab er 24hr 100 mg..............12VIRAMUNE XR – nevirapine tab er 24hr 400 mg..............12VIRAZOLE – ribavirin for inhal soln 6 gm..........................14VIREAD – tenofovir disoproxil fumarate oral powder 40mg/gm................................................................................ 12

VIREAD – tenofovir disoproxil fumarate tab 150 mg......... 12VIREAD – tenofovir disoproxil fumarate tab 200 mg......... 12VIREAD – tenofovir disoproxil fumarate tab 250 mg......... 12VIREAD – tenofovir disoproxil fumarate tab 300 mg......... 12VIROPTIC – trifluridine ophth soln 1%.............................138VIRT-ADVANCE – prenatal vit w/ dss-iron carbonyl-fa tab90-1 mg............................................................................124

VIRT-C DHA – prenatal w/fe fum-fe poly -fa-omega 3 cap53.5-38-1 mg................................................................... 124

VIRT-NATE DHA – prenatal vit w/ fe fum-fa-omega 3 cap28-1-200 mg.................................................................... 124

VIRT NATE – prenatal vit w/ fe fumarate-fa tab 28-1mg.................................................................................... 124

VIRT-PN DHA – prenat w/o a w/fefum-methfol-fa-dha cap27-0.6-0.4-300 mg...........................................................124

VIRT-PN PLUS – prenat w/o a w/ fe fumerate-methylfolate-fa-omega 3 cap.......................................... 125

VIRT-PN – prenatal vit w/ fe fum-methylfolate-fa tab27-0.6-0.4 mg.................................................................. 124

VIRTPREX – prenatal w/o vit a w/ fe fum-dss-fa-dha cap26-1.2-300 mg................................................................. 125

VIRT-SELECT – prenatal w/o vit a w/ fe fum-dss-fa-dhacap 29-1.25-325 mg........................................................125

VIRT-VITE GT – prenatal vit w/ dss-iron carbonyl-fa tab90-1 mg............................................................................125

VISTARIL – hydroxyzine pamoate cap 25 mg................... 81

2018


VISTARIL – hydroxyzine pamoate cap 50 mg................... 81VISTOGARD – uridine triacetate oral granules packet 10gm.................................................................................... 155

VITAFOL FE+ – prenat-fepoly-methol-fa-dha cap 90-1-200mg & dss 50mg cap........................................................125

VITAFOL GUMMIES – prenat vit w/ fe phos-fa-omegachew tab 3.33-0.333-34.8 mg.........................................125

VITAFOL-NANO – prenatal w/o a w/ fefum-l methylfol-fatab 18-0.6-0.4 mg............................................................125

VITAFOL-OB+DHA – prenatal mv w/fe fum-fa tab 65-1 mg& dha cap 250 mg pack................................................. 125

VITAFOL-OB – prenatal vit w/ fe fumarate-fa tab 65-1mg.................................................................................... 125

VITAFOL-ONE – prenatal mv w/ fe polysac cmplx-fa-dhacap 29-1-200 mg.............................................................125

VITAFOL ULTRA – prenat w/fe poly-methylfol-fa-dha cap29-0.6-0.4-200 mg...........................................................125

VITAMEDMD ONE RX/QUATREFO – prenat w/o a w/fefum-methfol-fa-dha cap 30-0.6-0.4-200 mg.................125

VITAMEDMD REDICHEW RX – prenat w/ b2-b6-b12-d3-folic acid chew tab 1.4 mg..............................................125

VITAPEARL – prenat w/oa w/fefum-na fered-fa-dha cap er30-1.4-200 mg................................................................. 125

VITA-PREN – prenatal vit w/ docusate-iron-fa tab 65-1mg.................................................................................... 125

VITATRUE – prenat w/o a w/fe chel-fa tab 30-1.4 mg &dha cap 300mg pk.......................................................... 125

VIVA DHA – prenatal vit w/ fe fum-fa-omega 3 cap28-1-200 mg.................................................................... 125

VIVELLE-DOT – estradiol td patch twice weekly 0.025mg/24hr..............................................................................27





VIVOTIF – typhoid vaccine cap delayed release...............17VOL-NATE – prenatal vit w/ fe fumarate-fa tab 28-1mg.................................................................................... 125

VOL-PLUS – prenatal vit w/ fe fumarate-fa tab 27-1mg.................................................................................... 125

VOL-TAB RX – prenatal vit w/ iron carbonyl-fa tab 29-1mg.................................................................................... 125

VOLTAREN – diclofenac sodium gel 1%......................... 146VONVENDI – von willebrand factor (recombinant) for inj650 unit............................................................................136

VONVENDI – von willebrand factor (recombinant) for inj1300 unit..........................................................................136

voriconazole for susp 40 mg/ml (Vfend)..........................7voriconazole tab 50 mg (Vfend)........................................7voriconazole tab 200 mg (Vfend)......................................7VOSEVI – sofosbuvir-velpatasvir-voxilaprevir tab400-100-100 mg.................................................................. 9

VOSPIRE ER – albuterol sulfate tab er 12hr 4 mg............ 70VOSPIRE ER – albuterol sulfate tab er 12hr 8 mg............ 70VOTRIENT – pazopanib hcl tab 200 mg (base equiv).......22VP-CH-PNV – prenatal w/o vit a w/ fe cbn-dss-fa-dha cap30-1-260 mg.................................................................... 125

VP-GGR-B6 PRENATAL – prenatal w/ calcium-vit b6-fa-ginger tab 1.2 mg............................................................125

VP-HEME OB + DHA – prenat-fe poly cmplx-fe hemepoly-fa tab & omega 3 cap pck...................................... 125

VP-HEME OB – prenat vit-fe poly cmplx-fe heme poly-fatab 28-6-1 mg..................................................................125

VP-HEME ONE – prenat-fe poly cmplx-fe heme poly-fa-dha cap 22-6-1-200 mg.................................................. 125

VP-PNV-DHA – prenatal vit w/ fe fum-fa-omega 3 cap28-1-215.8 mg................................................................. 125

VRAYLAR – cariprazine hcl cap 1.5 mg (baseequivalent)......................................................................... 88

VRAYLAR – cariprazine hcl cap 3 mg (baseequivalent)......................................................................... 88

VRAYLAR – cariprazine hcl cap 4.5 mg (baseequivalent)......................................................................... 89

VRAYLAR – cariprazine hcl cap 6 mg (baseequivalent)......................................................................... 89

VRAYLAR – cariprazine hcl cap therapy pack 1.5 mg (1) &3 mg (6).............................................................................88

VYTORIN – ezetimibe-simvastatin tab 10-10 mg.............. 58VYTORIN – ezetimibe-simvastatin tab 10-20 mg.............. 58VYTORIN – ezetimibe-simvastatin tab 10-40 mg.............. 58VYTORIN – ezetimibe-simvastatin tab 10-80 mg.............. 58VYVANSE – lisdexamfetamine dimesylate cap 10 mg...... 94VYVANSE – lisdexamfetamine dimesylate cap 20 mg...... 94VYVANSE – lisdexamfetamine dimesylate cap 30 mg...... 94VYVANSE – lisdexamfetamine dimesylate cap 40 mg...... 94VYVANSE – lisdexamfetamine dimesylate cap 50 mg...... 94VYVANSE – lisdexamfetamine dimesylate cap 60 mg...... 94VYVANSE – lisdexamfetamine dimesylate cap 70 mg...... 94VYVANSE – lisdexamfetamine dimesylate chew tab 10mg...................................................................................... 94

VYVANSE – lisdexamfetamine dimesylate chew tab 20mg...................................................................................... 94





Wwarfarin sodium tab 1 mg (Coumadin)........................ 131warfarin sodium tab 2 mg (Coumadin)........................ 131warfarin sodium tab 2.5 mg (Coumadin)..................... 131warfarin sodium tab 3 mg (Coumadin)........................ 131warfarin sodium tab 4 mg (Coumadin)........................ 131warfarin sodium tab 5 mg (Coumadin)........................ 131

2018


warfarin sodium tab 6 mg (Coumadin)........................ 131warfarin sodium tab 7.5 mg (Coumadin)..................... 131warfarin sodium tab 10 mg (Coumadin)...................... 131water for irrigation, sterile irrigation soln....................155WELCHOL – colesevelam hcl packet for susp 3.75gm...................................................................................... 58

WELCHOL – colesevelam hcl tab 625 mg........................ 58WESTCORT – hydrocortisone valerate oint 0.2%........... 150WESTHROID – thyroid tab 32.5 mg.................................. 38WESTHROID – thyroid tab 65 mg..................................... 38WESTHROID – thyroid tab 97.5 mg.................................. 38WESTHROID – thyroid tab 130 mg................................... 38WESTHROID – thyroid tab 195 mg................................... 38WIDE-SEAL SILICONE DIAPHR – diaphragm wide seal60 mm................................................................................29

WIDE-SEAL SILICONE DIAPHR – diaphragm wide seal65 mm................................................................................29







WILATE – antihemophilic factor/vwf (human) for inj500-500 unit kit................................................................136

WILATE – antihemophilic factor/vwf (human) for inj1000-1000 unit kit........................................................... 136

WP THYROID – thyroid tab 16.25 mg............................... 38WP THYROID – thyroid tab 32.5 mg................................. 38WP THYROID – thyroid tab 65 mg....................................38WP THYROID – thyroid tab 81.25 mg............................... 38WP THYROID – thyroid tab 97.5 mg................................. 38WP THYROID – thyroid tab 113.75 mg............................. 38WP THYROID – thyroid tab 130 mg.................................. 38WP THYROID – thyroid tab 48.75 mg (3/4 grain)..............38

XXADAGO – safinamide mesylate tab 50 mg (baseequiv)............................................................................... 117

XADAGO – safinamide mesylate tab 100 mg (baseequiv)............................................................................... 117

XALATAN – latanoprost ophth soln 0.005%.....................140XALIX – salicylic acid er film-forming soln 28%...............146XALKORI – crizotinib cap 200 mg..................................... 22XALKORI – crizotinib cap 250 mg..................................... 22XARELTO – rivaroxaban tab 10 mg.................................131XARELTO – rivaroxaban tab 15 mg.................................131XARELTO – rivaroxaban tab 20 mg.................................131XARELTO STARTER PACK – rivaroxaban tab startertherapy pack 15 mg & 20 mg.........................................131

XELJANZ – tofacitinib citrate tab 5 mg (baseequivalent)....................................................................... 106

XELJANZ XR – tofacitinib citrate tab er 24hr 11 mg (baseequivalent)....................................................................... 106

XELODA – capecitabine tab 150 mg................................. 22XELODA – capecitabine tab 500 mg................................. 22XERMELO – telotristat etiprate tab 250 mg (telotristat ethylequiv)................................................................................. 77

XIFAXAN – rifaximin tab 200 mg....................................... 14XIFAXAN – rifaximin tab 550 mg....................................... 14XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr5-500 mg............................................................................34

XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr5-1000 mg......................................................................... 34

XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr10-500 mg......................................................................... 35

XIGDUO XR – dapagliflozin-metformin hcl tab er 24hr10-1000 mg....................................................................... 35

XIIDRA – lifitegrast ophth soln 5%...................................141XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent 9mg.................................................................................... 103

XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent13.5 mg............................................................................103

XTAMPZA ER – oxycodone cap er 12hr abuse-deterrent18 mg...............................................................................103



XTANDI – enzalutamide cap 40 mg...................................22XULANE – norelgestromin-ethinyl estradiol td ptwk 150-35mcg/24hr............................................................................ 30

XULTOPHY 100/3.6 – insulin degludec-liraglutide sol pen-inj 100-3.6 unit-mg/ml....................................................... 35

XURIDEN – uridine triacetate oral granules packet 2gm...................................................................................... 43

XYLOCAINE – lidocaine hcl soln 4%...............................152XYNTHA – antihemophilic factor recombinant paf for inj kit250 unit............................................................................136

XYNTHA – antihemophilic factor recombinant paf for inj kit500 unit............................................................................136

XYNTHA – antihemophilic factor recombinant paf for inj kit1000 unit..........................................................................136

XYNTHA – antihemophilic factor recombinant paf for inj kit2000 unit..........................................................................136

XYNTHA SOLOFUSE – antihemophilic factor recombinantpaf for inj kit 250 unit......................................................136

XYNTHA SOLOFUSE – antihemophilic factor recombinantpaf for inj kit 500 unit......................................................136

XYNTHA SOLOFUSE – antihemophilic factor recombinantpaf for inj kit 1000 unit....................................................136



XYREM – sodium oxybate oral solution 500 mg/ml...........98

2018


YYASMIN 28 – drospirenone-ethinyl estradiol tab 3-0.03mg...................................................................................... 30

YAZ – drospirenone-ethinyl estradiol tab 3-0.02 mg..........30

ZZACLIR CLEANSING – benzoyl peroxide lotion 8%....... 145zafirlukast tab 10 mg (Accolate)..................................... 70zafirlukast tab 20 mg (Accolate)..................................... 70zaleplon cap 5 mg (Sonata).............................................89zaleplon cap 10 mg (Sonata)...........................................89ZANAFLEX – tizanidine hcl cap 2 mg (baseequivalent)....................................................................... 118

ZANAFLEX – tizanidine hcl cap 4 mg (baseequivalent)....................................................................... 118

ZANAFLEX – tizanidine hcl cap 6 mg (baseequivalent)....................................................................... 118

ZANAFLEX – tizanidine hcl tab 4 mg (baseequivalent)....................................................................... 118

ZARONTIN – ethosuximide cap 250 mg..........................114ZARONTIN – ethosuximide soln 250 mg/5ml..................114ZARXIO – filgrastim-sndz soln prefilled syringe 300mcg/0.5ml........................................................................ 131

ZARXIO – filgrastim-sndz soln prefilled syringe 480mcg/0.8ml........................................................................ 131

ZATEAN-PN DHA – prenat w/o a w/fefum-methfol-fa-dhacap 27-0.6-0.4-300 mg....................................................125

ZATEAN-PN PLUS – prenat w/o a w/ fe fumerate-methylfolate-fa-omega 3 cap.......................................... 126

ZAVESCA – miglustat cap 100 mg.................................. 131ZEJULA – niraparib tosylate cap 100 mg (baseequivalent)......................................................................... 23

ZELBORAF – vemurafenib tab 240 mg............................. 23ZEMPLAR – paricalcitol cap 1 mcg................................... 43ZEMPLAR – paricalcitol cap 2 mcg................................... 43ZENPEP – pancrelipase (lip-prot-amyl) dr cap3000-10000-16000 unit..................................................... 75

ZENPEP – pancrelipase (lip-prot-amyl) dr cap5000-17000-27000 unit..................................................... 75

ZENPEP – pancrelipase (lip-prot-amyl) dr cap10000-34000-55000 unit...................................................75



ZENPEP – pancrelipase (lip-prot-amyl) dr cap20000-68000-109000 unit.................................................75

ZENPEP – pancrelipase (lip-prot-amyl) dr cap25000-85000-136000 unit.................................................75

ZENPEP – pancrelipase (lip-prot-amyl) dr cap40000-136000-218000 unit...............................................75

ZENZEDI – dextroamphetamine sulfate tab 2.5 mg.......... 94ZENZEDI – dextroamphetamine sulfate tab 7.5 mg.......... 94ZENZEDI – dextroamphetamine sulfate tab 15 mg........... 94ZENZEDI – dextroamphetamine sulfate tab 20 mg........... 94

ZENZEDI – dextroamphetamine sulfate tab 30 mg........... 94ZEPATIER – elbasvir-grazoprevir tab 50-100 mg................ 9ZERIT – stavudine cap 15 mg........................................... 12ZERIT – stavudine cap 20 mg........................................... 12ZERIT – stavudine cap 30 mg........................................... 12ZERIT – stavudine cap 40 mg........................................... 12ZERIT – stavudine for oral soln 1 mg/ml........................... 12ZIAC – bisoprolol & hydrochlorothiazide tab 2.5-6.25mg...................................................................................... 51

ZIAC – bisoprolol & hydrochlorothiazide tab 5-6.25mg...................................................................................... 51

ZIAC – bisoprolol & hydrochlorothiazide tab 10-6.25mg...................................................................................... 51

ZIAGEN – abacavir sulfate soln 20 mg/ml (baseequiv)................................................................................. 12

ZIAGEN – abacavir sulfate tab 300 mg (base equiv).........12zidovudine cap 100 mg (Retrovir)...................................12zidovudine syrup 10 mg/ml (Retrovir)............................12zidovudine tab 300 mg.....................................................12zileuton tab er 12hr 600 mg (Zyflo cr)............................70ZINBRYTA – daclizumab soln prefilled syringe 150 mg/ml........................................................................................95

ZIOPTAN – tafluprost ophth soln 0.0015%...................... 140ziprasidone hcl cap 20 mg (Geodon)............................. 89ziprasidone hcl cap 40 mg (Geodon)............................. 89ziprasidone hcl cap 60 mg (Geodon)............................. 89ziprasidone hcl cap 80 mg (Geodon)............................. 89ZIRGAN – ganciclovir ophth gel 0.15%........................... 138ZITHROMAX – azithromycin for susp 100 mg/5ml..............4ZITHROMAX – azithromycin for susp 200 mg/5ml..............4ZITHROMAX – azithromycin powd pack for susp 1 gm.......4ZITHROMAX – azithromycin tab 250 mg.............................4ZITHROMAX – azithromycin tab 500 mg.............................4ZITHROMAX – azithromycin tab 600 mg.............................4ZITHROMAX TRI-PAK – azithromycin tab 500 mg..............4ZITHROMAX Z-PAK – azithromycin tab 250 mg................. 4ZMAX – azithromycin extended release for oral susp 2gm........................................................................................ 4

ZOCOR – simvastatin tab 5 mg.........................................58ZOCOR – simvastatin tab 10 mg.......................................58ZOCOR – simvastatin tab 20 mg.......................................58ZOCOR – simvastatin tab 40 mg.......................................58ZOCOR – simvastatin tab 80 mg.......................................58ZOFRAN ODT – ondansetron orally disintegrating tab 4mg...................................................................................... 74

ZOFRAN ODT – ondansetron orally disintegrating tab 8mg...................................................................................... 74

ZOFRAN – ondansetron hcl oral soln 4 mg/5ml................ 74ZOFRAN – ondansetron hcl tab 4 mg............................... 74ZOFRAN – ondansetron hcl tab 8 mg............................... 74ZOLINZA – vorinostat cap 100 mg.................................... 23zolmitriptan orally disintegrating tab 2.5 mg (Zomigzmt)..................................................................................107

zolmitriptan orally disintegrating tab 5 mg (Zomigzmt)..................................................................................107

zolmitriptan tab 2.5 mg (Zomig)....................................107

2018


zolmitriptan tab 5 mg (Zomig).......................................107ZOLOFT – sertraline hcl oral conc 20 mg/ml.....................85zolpidem tartrate tab er 6.25 mg (Ambien cr)................89zolpidem tartrate tab er 12.5 mg (Ambien cr)................89zolpidem tartrate tab 5 mg (Ambien)..............................89zolpidem tartrate tab 10 mg (Ambien)............................89ZOMACTON – somatropin for inj 10 mg............................40ZOMACTON – somatropin for subcutaneous inj 5 mg...... 40ZOMIG – zolmitriptan nasal spray 2.5 mg/spray unit.......108ZOMIG – zolmitriptan nasal spray 5 mg/spray unit..........108ZONALON – doxepin hcl cream 5%................................ 152ZONEGRAN – zonisamide cap 25 mg.............................114ZONEGRAN – zonisamide cap 100 mg...........................114zonisamide cap 50 mg................................................... 114zonisamide cap 25 mg (Zonegran)............................... 114zonisamide cap 100 mg (Zonegran)............................. 114ZONTIVITY – vorapaxar sulfate tab 2.08 mg (baseequivalent)....................................................................... 131

ZORBTIVE – somatropin (non-refrigerated) forsubcutaneous inj 8.8 mg...................................................40

ZORTRESS – everolimus tab 0.25 mg............................ 155ZORTRESS – everolimus tab 0.5 mg.............................. 155ZORTRESS – everolimus tab 0.75 mg............................ 155ZOSTAVAX – zoster vaccine live for subcutaneous susp19400 unit/0.65ml..............................................................17

ZOVIRAX – acyclovir cap 200 mg....................................... 9ZOVIRAX – acyclovir susp 200 mg/5ml...............................9ZOVIRAX – acyclovir tab 400 mg........................................ 9ZOVIRAX – acyclovir tab 800 mg........................................ 9ZURAMPIC – lesinurad tab 200 mg.................................108ZUTRIPRO – pseudoeph-chlorphen w/ hydrocodone soln60-4-5 mg/5ml................................................................... 67

ZYDELIG – idelalisib tab 100 mg.......................................23ZYDELIG – idelalisib tab 150 mg.......................................23ZYFLO CR – zileuton tab er 12hr 600 mg......................... 70ZYKADIA – ceritinib cap 150 mg....................................... 23ZYLOPRIM – allopurinol tab 100 mg............................... 108ZYLOPRIM – allopurinol tab 300 mg............................... 108ZYMAXID – gatifloxacin ophth soln 0.5%........................ 138ZYTIGA – abiraterone acetate tab 250 mg........................23ZYTIGA – abiraterone acetate tab 500 mg........................23ZYVOX – linezolid for susp 100 mg/5ml............................ 14ZYVOX – linezolid tab 600 mg...........................................14

Documents

Florida Blue January 2017 Rx Medication Guide