Lista de medicamentos de Rx3

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Lista de medicamentos de Rx3

Nivel uno: incluye los medicamentos genéricos de bajo costo cubiertos.

Nivel dos: incluye los medicamentos de marca preferidos cubiertos.

Nivel tres: incluye los medicamentos genéricos y de marca de costo más alto cubiertos.

A continuación se enumeran por orden alfabético los medicamentos que se recetan con frecuencia para cada nivel. Esta no es una lista completa. Si hay un medicamento recetado que no figura en esta lista, visite Humana.com o llame al número de teléfono de Servicio al Cliente que se encuentra en la parte posterior de la tarjeta de identificación de afiliado de Humana para ver si el medicamento está cubierto y determinar el nivel al que pertenece.

* Especialidad: copagos o costos compartidos específicos del plan para los medicamentos de alto costo/alta tecnología que a menudo requieren condiciones especiales de despacho. La cobertura de medicamentos especializados varía según el plan. Visite Humana.com e inicie sesión en MyHumana para ver los beneficios específicos de medicamentos recetados, incluidos los copagos, los costos compartidos, las limitaciones y las exclusiones.

Nota: Los medicamentos genéricos se indican en LETRA MAYÚSCULA. Todos los demás son medicamentos de marca.

IR = liberación inmediata, SR = liberación sostenida, ER = liberación prolongada, QL = límite de cantidad, PA = autorización previa, ST = tratamiento por pasos

NOMBRE DEL MEDICAMENTO Nivel EspecialidadMedicamentos

de mantenimiento

Requisitos de administración

del usoABACAVIR 300 MG TABLET * Y QLAbilify 1 mg/mL oral solution 3 QL, PAAbilify 10 mg tablet 3 Y QL, PAAbilify 2 mg tablet 3 Y QL, PAAbilify 5 mg tablet 3 Y QL, PAAbilify Discmelt 10 mg disintegrating tablet 3 QL, PAAbsorica 10 mg capsule 3 QLAbsorica 20 mg capsule 3 QLAbsorica 30 mg capsule 3 QLAbsorica 40 mg capsule 3 QLAcanya 1.2 %-2.5 % topical gel 2Accu-Chek Active Glucose Cont combo pack 2Accu-Chek Active Test strips 2 QLAccu-Chek Aviva Control Soln solution 2Accu-Chek Aviva Plus Meter 2Accu-Chek Aviva Plus test strips 2 QLAccu-Chek Aviva strips 2 QL

Vigencia: 1o. de enero de 2014



de mantenimiento


del usoAccu-Chek Comfort Curve combo pack 2Accu-Chek Comfort Curve Linear combo pack 2Accu-Chek Comfort Curve solution 2Accu-Chek Comfort Curve Test strips 2 QLAccu-Chek Compact Blue Control, Mid-High solution 2Accu-Chek Compact Glucose Cont combo pack 2Accu-Chek Compact Plus Care kit 2Accu-Chek Compact Plus Control Solution 2Accu-Chek Compact Test strips 2 QLACCU-CHEK CONTROL SOLUTION 2Accu-Chek FastClix 2Accu-Chek FastClix kit 2Accu-Chek Multiclix Lancet 2Accu-Chek Multiclix Lancet kit 2Accu-Chek Nano 2Accu-Chek SmartView Control Solution 3Accu-Chek SmartView Test Strips 2 QLAccu-Chek Softclix Lancet Dev 2Accu-Chek Softclix Lancets 2Accu-Chek Softclix Lancing Device+Lancets kit 3Accu-Chek Voicemate kit 2Accupril 10 mg tablet 3 Y STAccupril 20 mg tablet 3 STAccupril 40 mg tablet 3 STAccupril 5 mg tablet 3 Y STAccuretic 10 mg-12.5 mg tablet 3 STAccuretic 20 mg-12.5 mg tablet 3 STAccuretic 20 mg-25 mg tablet 3 STAccutrend Glucose Control solution 3Accutrend Glucose strips 2 QLACETAMINOPHEN-COD #2 TABLET 1 QLACETAMINOPHEN-COD #3 TABLET 1 QLACETAMINOPHEN-CODEINE SOLUTION 1 QLACETAZOLAMIDE 125 MG TABLET 1 YACETAZOLAMIDE 250 MG TABLET 1 YACETIC ACID 0.25% IRRIG SOLN 1Aciphex 20 mg tablet,delayed release 3 QL, STActemra 162 mg/0.9 mL subcutaneous syringe * Y QL, PAActhar H.P. 80 unit/mL injection gel * Y PAActigall 300 mg capsule 3 Y STActive OB 20 mg iron-1 mg-320 mg capsule 3Actonel 150 mg tablet 3 Y QLActonel 30 mg tablet 3 QL



de mantenimiento


del usoActonel 35 mg tablet 3 Y QLActonel 5 mg tablet 3 Y QLActoplus MET 15 mg-500 mg tablet 3 QL, STActos 15 mg tablet 3 Y QL, STActos 30 mg tablet 3 QL, STActos 45 mg tablet 3 Y QL, STAcular LS 0.4 % eye drops 3 STACYCLOVIR 200 MG CAPSULE 1ACYCLOVIR 400 MG TABLET 1ACYCLOVIR 5% OINTMENT 1 PAACYCLOVIR 800 MG TABLET 1Aczone 5 % topical gel 3Adalat CC 30 mg tablet,extended release 3 QL, STAdalat CC 60 mg tablet,extended release 3 QL, STAdalat CC 90 mg tablet,extended release 3 QL, STADAPALENE 0.1% CREAM 1ADAPALENE 0.1% GEL 1Adcirca 20 mg tablet * Y QL, PAAdderall XR 20 mg capsule,extended release 1 QLAdderall XR 30 mg capsule,extended release 1 QLAdvair Diskus 100 mcg-50 mcg/dose powder for inhalation

2 QL

Advair Diskus 250 mcg-50 mcg/dose powder for inhalation

2 QL

Advair Diskus 500 mcg-50 mcg/dose powder for inhalation

2 QL

Advair HFA 115 mcg-21 mcg/actuation aerosol inhaler

2 QL


2 QL


2 QL

Aggrenox 200 mg-25 mg capsule, extended release 2 STAla-Scalp 2 % lotion 2ALBUTEROL 0.083% INHAL SOLN 1 YALBUTEROL SUL 0.63 MG/3 ML SOL 1 YALBUTEROL SUL 1.25 MG/3 ML SOL 1 YALBUTEROL SULFATE ER 4 MG TAB 1 YALBUTEROL SULFATE ER 8 MG TAB 1 YALENDRONATE SODIUM 70 MG TAB 1 Y QLAlinia 100 mg/5 mL oral suspension 3 QLALLOPURINOL 100 MG TABLET 1 YALLOPURINOL 300 MG TABLET 1 YAlphagan P 0.1 % eye drops 2



de mantenimiento


del usoAlphagan P 0.15 % eye drops 3ALPRAZOLAM 0.25 MG ODT 1ALPRAZOLAM 0.25 MG TABLET 1 QLALPRAZOLAM 0.5 MG TABLET 1 QLALPRAZOLAM 1 MG TABLET 1 QLALPRAZOLAM 2 MG TABLET 1 QLALPRAZOLAM ODT 0.25 MG TAB 1Altace 1.25 mg capsule 3 Y STAltace 10 mg capsule 3 Y STAltace 2.5 mg capsule 3 Y STAltace 5 mg capsule 3 STAltavera (28) 0.15 mg-30 mcg tablet 1Altoprev 20 mg tablet,extended release 3 QL, STAltoprev 40 mg tablet,extended release 3 QL, STAltoprev 60 mg tablet,extended release 3 QL, STAluvea 39 % topical cream 3 STAlvesco 160 mcg/actuation aerosol inhaler 3 QLAlvesco 80 mcg/actuation aerosol inhaler 3 QLAlyacen 1/35 (28) 1 mg-35 mcg tablet 1Amaryl 1 mg tablet 3 Y STAmaryl 2 mg tablet 3 STAmaryl 4 mg tablet 3 STAmbien 10 mg tablet 3 QL, STAmbien 5 mg tablet 3 QL, STAmethia 0.15 mg-30 mcg (84)/10 mcg(7) tablets,3 month dose pack

1 QL

AMIODARONE HCL 200 MG TABLET 1 YAmitiza 24 mcg capsule 2 QLAmitiza 8 mcg capsule 2 Y QLAMITRIPTYLINE HCL 10 MG TAB 1 YAMITRIPTYLINE HCL 25 MG TAB 1 YAMITRIPTYLINE HCL 50 MG TAB 1 YAMLODIPINE BESYLATE 10 MG TAB 1 Y QLAMLODIPINE BESYLATE 2.5 MG TAB 1 Y QLAMLODIPINE BESYLATE 5 MG TAB 1 Y QLAMLODIPINE-ATORVAST 10-10 MG 1 Y QLAMLODIPINE-ATORVAST 10-20 MG 1 Y QLAMLODIPINE-ATORVAST 10-40 MG 1 Y QLAMLODIPINE-ATORVAST 10-80 MG 1 Y QLAMLODIPINE-ATORVAST 2.5-10 MG 1 Y QLAMLODIPINE-ATORVAST 2.5-20 MG 1 Y QLAMLODIPINE-ATORVAST 2.5-40 MG 1 Y QLAMLODIPINE-ATORVAST 5-10 MG 1 Y QL



de mantenimiento


del usoAMLODIPINE-ATORVAST 5-20 MG 1 Y QLAMLODIPINE-ATORVAST 5-40 MG 1 Y QLAMLODIPINE-ATORVAST 5-80 MG 1 Y QLAMLODIPINE-BENAZEPRIL 10-20 MG 1 Y QLAMLODIPINE-BENAZEPRIL 10-40 MG 1 Y QLAMLODIPINE-BENAZEPRIL 5-10 MG 1 Y QLAMLODIPINE-BENAZEPRIL 5-20 MG 1 Y QLAmnesteem 10 mg capsule 1 QLAmnesteem 40 mg capsule 1 QLAMOX TR-K CLV 400-57/5 SUSP 1AMOX TR-K CLV 500-125 MG TAB 1AMOX TR-K CLV 600-42.9/5 SUSP 1AMOX TR-K CLV 875-125 MG TAB 1AMOXICILLIN 250 MG/5 ML SUSP 1AMOXICILLIN 400 MG/5 ML SUSP 1AMOXICILLIN 500 MG CAPSULE 1AMOXICILLIN 875 MG TABLET 1Amphetamine Salt Combo 10 mg tablet 1 QLAmphetamine Salt Combo 15 mg tablet 1 QLAmphetamine Salt Combo 20 mg tablet 1 QLAmphetamine Salt Combo 30 mg tablet 1 QLAmphetamine Salt Combo 5 mg tablet 1 QLAMPICILLIN 500 MG CAPSULE 1Amturnide 150 mg-5 mg-12.5 mg tablet 2 QLAmturnide 300 mg-10 mg-12.5 mg tablet 2 QLAmturnide 300 mg-10 mg-25 mg tablet 2 QLAmturnide 300 mg-5 mg-12.5 mg tablet 2 QLAmturnide 300 mg-5 mg-25 mg tablet 2 QLAnafranil 25 mg capsule 3 Y STAnafranil 50 mg capsule 3 Y STAnafranil 75 mg capsule 3 Y STAnalpram E 2.5 %-1 % (4 gram)-1 % kit,cream & towelette

3 ST

Analpram E 2.5 %-1 %-1 % kit,cream & towelette 3 STAnalpram-HC Singles 1 %-1 % (4g) rectal cream 3Analpram-HC Singles 2.5 %-1 % (4g) rectal cream 3 STANASTROZOLE 1 MG TABLET 1 QLAndroGel 1 % (25 mg/2.5 gram) transdermal gel packet

2 QL

AndroGel 1 % (50 mg/5 gram) transdermal gel packet

2 QL

AndroGel 1.25 gram/actuation (1%) transdermal gel pump

2 QL



de mantenimiento


del usoAndroGel 1.62 % (20.25 mg/1.25 gram) transdermal gel packet

2 QL

AndroGel 1.62 % (40.5 mg/2.5 gram) transdermal gel packet

2 QL

AndroGel 20.25 mg/1.25 gram (1.62 %) transdermal gel pump

2 QL

ANTARA 130 MG CAPSULE 3 Y QL, STANTARA 43 MG CAPSULE 3 Y QL, STANTIPYRINE-BENZOCAINE EAR DROP 1Anucort-HC 25 mg suppository 1APRACLONIDINE HCL 0.5% DROPS 1Apri 0.15 mg-30 mcg tablet 1Apriso 0.375 gram capsule,extended release 2 QLArcapta Neohaler 75 mcg capsule with inhalation device

3 QL

Armour Thyroid 120 mg tablet 2 YArmour Thyroid 15 mg tablet 2 YArmour Thyroid 30 mg tablet 2 YArmour Thyroid 60 mg tablet 2 YArmour Thyroid 90 mg tablet 2 YAsacol HD 800 mg tablet,delayed release 3 QL, STAsmanex Twisthaler 110 mcg (30 doses) breath activated

2 QL

Asmanex Twisthaler 110 mcg (7 doses) breath activated

2 QL


2 QL


2 QL


2 QL


2 QL

Assure Haemolance Plus 25 gauge 3ASTELIN 137 MCG NASAL SPRAY 3 Y QL, STAstepro 0.15 % (205.5 mcg) nasal spray 2 QLAtelvia 35 mg tablet,delayed release 3 QLATENOLOL 100 MG TABLET 1 YATENOLOL 25 MG TABLET 1ATENOLOL 50 MG TABLET 1 YATENOLOL-CHLORTHAL 50-25 TB 1 YATORVASTATIN 10 MG TABLET 1 Y QLATORVASTATIN 20 MG TABLET 1 Y QLATORVASTATIN 40 MG TABLET 1 Y QLATORVASTATIN 80 MG TABLET 1 Y QL



de mantenimiento


del usoATOVAQUONE-PROGUANIL 250-100 1 QLAtralin 0.05 % topical gel 3 STATRIPLA 600 mg-200 mg-300 mg tablet * Y QLAvalide 150 mg-12.5 mg tablet 3 QL, STAvalide 300 mg-12.5 mg tablet 3 QL, STAvapro 150 mg tablet 3 QL, STAvapro 300 mg tablet 3 QL, STAvelox 400 mg tablet 3Aviane 0.1 mg-20 mcg tablet 1Avinza 120 mg capsule, extended release 3 QL, STAvinza 30 mg capsule, extended release 3 QL, STAvinza 45 mg capsule, extended release 3 QL, STAvinza 60 mg capsule, extended release 3 QL, STAvinza 75 mg capsule, extended release 3 QL, STAvinza 90 mg capsule, extended release 3 QL, STAvita 0.025 % topical gel 3Avodart 0.5 mg capsule 2 QLAvonex 30 mcg intramuscular kit * Y QL, PAAvonex 30 mcg/0.5 mL intramuscular pen kit * Y QL, PAAvonex 30 mcg/0.5 mL intramuscular syringe * Y QL, PAAvonex Administration Pack 30 mcg/0.5 mL intramuscular kit

* Y QL, PA

AXID 15 MG/ML ORAL SOLUTION 3 Y STAygestin 5 mg tablet 3 Y STAzasite 1 % eye drops 2AZATHIOPRINE 50 MG TABLET 1 YAZELASTINE 137 MCG NASAL SPRAY 1 QLAZELASTINE HCL 0.1% NASAL SPRY 1 QLAzilect 0.5 mg tablet 2 YAzilect 1 mg tablet 2 YAZITHROMYCIN 100 MG/5 ML SUSP 1AZITHROMYCIN 200 MG/5 ML SUSP 1AZITHROMYCIN 250 MG TABLET 1AZITHROMYCIN 500 MG TABLET 1Azopt 1 % eye drops,suspension 3 STAzurette (28) 0.15 mg-0.02 mg(21)/0.01 mg(5) tablet

1

BACLOFEN 10 MG TABLET 1 YBalziva (28) 0.4 mg-35 mcg tablet 1Banzel 200 mg tablet 3 Y QL, PABanzel 40 mg/mL oral suspension 3 QL, PABanzel 400 mg tablet 3 Y QL, PABD Insulin Pen Needle UF Mini 31 x 3/16" 2BD Insulin Pen Needle UF Short 31 X 5/16" 2



de mantenimiento


del usoBD Lancet Device 3BD Ultra-Fine Nano Pen Needles 32 x 5/32" 2BENAZEPRIL HCL 10 MG TABLET 1BENAZEPRIL HCL 20 MG TABLET 1 YBENAZEPRIL HCL 40 MG TABLET 1BENAZEPRIL-HCTZ 10-12.5 MG TAB 1 YBENAZEPRIL-HCTZ 20-12.5 MG TAB 1 YBENAZEPRIL-HCTZ 20-25 MG TAB 1 YBenicar 20 mg tablet 3 Y QL, STBenicar 40 mg tablet 3 Y QL, STBenicar HCT 40 mg-25 mg tablet 3 QL, STBenzePrO 5.3 % topical foam 1BenzePrO 9.8 % topical foam 1BENZONATATE 100 MG CAPSULE 1BENZONATATE 200 MG CAPSULE 1Besivance 0.6 % eye drops,suspension 3 STBetagan 0.5 % eye drops 3 STBETAMETHASONE VALER 0.12% FOAM 1Betapace 120 mg tablet 3 Y STBetapace 160 mg tablet 3 Y STBetapace 240 mg tablet 3 Y STBetapace 80 mg tablet 3 Y STBetapace AF 120 mg tablet 3 STBetapace AF 160 mg tablet 3 STBetapace AF 80 mg tablet 3 STBetaseron 0.3 mg subcutaneous kit * Y QL, PABetaseron 0.3 mg subcutaneous solution * Y QL, PABeyaz 3 mg-0.02 mg-0.451 mg (24) tablet 2BISOPROLOL-HCTZ 10-6.25 MG TAB 1 YBISOPROLOL-HCTZ 5-6.25 MG TAB 1 YBlood Glucose Test strips 2 QLBoniva 150 mg tablet 3 Y QL, STBP Wash 10 % topical cleanser 1BP Wash 2.5 % topical cleanser 1BP Wash 5 % topical cleanser 1BP Wash 7 % topical cleanser 1BPO Creamy Wash Pack 4 %-5 % Topical 1Brilinta 90 mg tablet 2 Y QLBromfed DM 2 mg-30 mg-10 mg/5 mL syrup 1BUDESONIDE 0.25 MG/2 ML SUSP 1 YBUDESONIDE 0.5 MG/2 ML SUSP 1BUMETANIDE 1 MG TABLET 1 YBuphenyl 0.94 gram/gram oral powder * Y



de mantenimiento


del usoBuphenyl 500 mg tablet * YBUPROPION HCL 100 MG TABLET 1 Y QLBUPROPION HCL 75 MG TABLET 1 Y QLBUPROPION HCL SR 100 MG TABLET 1 Y QLBUPROPION HCL XL 150 MG TABLET 1 QLBUPROPION HCL XL 300 MG TABLET 1 QLBUPROPION SR 150 MG TABLET 1 Y QLBUSPIRONE HCL 10 MG TABLET 1 YBUSPIRONE HCL 15 MG TABLET 1 YBUTALB-ACETAMIN-CAFF 50-325-40 1 QLBUTALB-ACETAMIN-CAFF 50-500-40 1 QLBUTALB-CAFF-ACETAMINOPH-CODEIN 1 QLBUTALBITAL-ASA-CAFFEINE CAP 1 QLBydureon 2 mg subcutaneous extended release suspension

2 QL, ST

Byetta 10 mcg/0.04 mL per dose subcutaneous pen injector

2 QL, ST

Bystolic 10 mg tablet 3 QL, STBystolic 2.5 mg tablet 3 Y QL, STBystolic 20 mg tablet 3 Y QL, STBystolic 5 mg tablet 3 Y QL, STCABERGOLINE 0.5 MG TABLET 1 Y QLCALCITRIOL 1 MCG/ML SOLUTION 1 YCALCIUM ACETATE 667 MG CAPSULE 1CALCIUM ACETATE 667 MG GELCAP 1 YCambia 50 mg oral powder packet 3 QLCamila 0.35 mg tablet 1Camrese 0.15 mg-30 mcg (84)/10 mcg(7) tablets,3 month dose pack

1 QL

Canasa 1,000 mg rectal suppository 2 QLCAPTOPRIL-HCTZ 25-15 MG TABLET 1 YCAPTOPRIL-HCTZ 25-25 MG TABLET 1 YCAPTOPRIL-HCTZ 50-15 MG TABLET 1 YCAPTOPRIL-HCTZ 50-25 MG TABLET 1 YCarac 0.5 % topical cream 3Carafate 1 gram tablet 3 STCarafate 100 mg/mL oral suspension 3CARBAMAZEPINE 100 MG/5 ML SUSP 1 YCARBIDOPA-LEVO 25-100 MG ODT 1 YCARBIDOPA-LEVO ER 25-100 TAB 1CARBIDOPA-LEVO ER 50-200 TAB 1 YCARBINOXAMINE 4 MG/5 ML LIQUID 1Cardura 1 mg tablet 3 Y STCardura 2 mg tablet 3 Y ST



de mantenimiento


del usoCardura 4 mg tablet 3 Y STCardura 8 mg tablet 3 STCARISOPRODL-ASPIRIN 200-325 MG 1CARISOPRODOL 350 MG TABLET 1CARISOPRODOL COMPOUND TAB 1CARISOPRODOL CPD-CODEINE TAB 1 QLCARISOPRODOL-ASPIRIN-CODEIN TB 1 QLCartia XT 240 mg capsule,extended release 1 QLCARVEDILOL 12.5 MG TABLET 1CARVEDILOL 25 MG TABLET 1 YCARVEDILOL 3.125 MG TABLET 1 YCARVEDILOL 6.25 MG TABLET 1Cataflam 50 mg tablet 3 STCatapres 0.1 mg tablet 3 Y STCatapres 0.2 mg tablet 3 STCatapres 0.3 mg tablet 3 Y STCatapres-TTS-1 0.1 mg/24 hr transdermal patch 3 QL, STCatapres-TTS-2 0.2 mg/24 hr transdermal patch 3 QL, STCatapres-TTS-3 0.3 mg/24 hr transdermal patch 3 QL, STCedax 90 mg/5 mL oral suspension 3CEFACLOR 125 MG/5 ML SUSP 1CEFACLOR 250 MG/5 ML SUSP 1CEFACLOR 375 MG/5 ML SUSPEN 1CEFADROXIL 1 GM TABLET 1CEFADROXIL 250 MG/5 ML SUSP 1CEFADROXIL 500 MG CAPSULE 1CEFADROXIL 500 MG/5 ML SUSP 1CEFDINIR 125 MG/5 ML SUSP 1CEFDINIR 250 MG/5 ML SUSP 1CEFDINIR 300 MG CAPSULE 1CEFPROZIL 125 MG/5 ML SUSP 1CEFPROZIL 250 MG TABLET 1CEFPROZIL 250 MG/5 ML SUSP 1Ceftin 250 mg tablet 3 STCeftin 500 mg tablet 3 STCEFUROXIME AXETIL 250 MG TAB 1CEFUROXIME AXETIL 500 MG TAB 1Celebrex 100 mg capsule 3 Y QLCelebrex 200 mg capsule 3 Y QLCelebrex 400 mg capsule 3 Y QLCelebrex 50 mg capsule 3 Y QLCEPHALEXIN 250 MG CAPSULE 1CEPHALEXIN 250 MG/5 ML SUSP 1



de mantenimiento


del usoCEPHALEXIN 500 MG CAPSULE 1Cerefolin 6 mg-5 mg-50 mg-1 mg tablet 3 STCetacaine 2 %-2 %-14 % (200 mg/sec) topical spray 3CETIRIZINE HCL 1 MG/ML SOLN 1 QLCETIRIZINE HCL 1 MG/ML SYRUP 1 Y QLCetraxal 0.2 % ear drops in a dropperette 3 STCEVIMELINE HCL 30 MG CAPSULE 1CHLORHEXIDINE 0.12% RINSE 1CHLOROQUINE PH 250 MG TABLET 1 YCHLORPROMAZINE 10 MG TABLET 1 YCHLORTHALIDONE 25 MG TABLET 1 YCHLORZOXAZONE 500 MG TABLET 1CICLOPIROX 0.77% GEL 1Cipro 250 mg tablet 3 STCipro 500 mg tablet 3 STCiprodex 0.3 %-0.1 % ear drops,suspension 2CIPROFLOXACIN 0.3% EYE DROP 1CIPROFLOXACIN HCL 250 MG TAB 1CIPROFLOXACIN HCL 500 MG TAB 1CITALOPRAM HBR 10 MG TABLET 1 Y QLCITALOPRAM HBR 20 MG TABLET 1 Y QLCITALOPRAM HBR 40 MG TABLET 1 Y QLCITRANATAL HARMONY CAPSULE 3Claravis 30 mg capsule 1 QLClaravis 40 mg capsule 1 QLClarifoam EF 10 %-5 % topical 3 STCLARITHROMYCIN 125 MG/5 ML SUS 1CLARITHROMYCIN 250 MG TABLET 1CLARITHROMYCIN 250 MG/5 ML SUS 1CLARITHROMYCIN 500 MG TABLET 1CLARITHROMYCIN ER 500 MG TAB 1CLEMASTINE 0.5 MG/5 ML SYRUP 1CLEMASTINE FUM 2.68 MG TAB 1Cleocin 150 mg capsule 3 STCleocin 2 % vaginal cream 3 STCleocin 300 mg capsule 3 STCleocin 75 mg capsule 3 STCleocin 75 mg/5 mL oral solution 3 STCleocin T 1 % lotion 3 STCleocin T 1 % solution 3 STCleocin T 1 % topical gel 3 STCleocin T 1 % topical swab 3 ST



de mantenimiento


del usoClimara Pro 0.045 mg-0.015 mg/24 hr transdermal patch

3 QL

CLIND PH-BENZOYL PEROX 1.2-5% 1CLINDAMYCIN 2% VAGINAL CREAM 1CLINDAMYCIN HCL 150 MG CAPSULE 1CLINDAMYCIN HCL 300 MG CAPSULE 1CLINDAMYCIN PH 1% GEL 1CLINDAMYCIN PH 1% SOLUTION 1CLINDAMYCIN PHOS 1% PLEDGET 1CLINDAMYCIN PHOSP 1% LOTION 1CLINDAMYCIN-BENZOYL PEROX GEL 1CLOBETASOL 0.05% CREAM 1CLOBETASOL 0.05% OINTMENT 1CLOBETASOL 0.05% SHAMPOO 1CLOBETASOL 0.05% TOPICAL LOTN 1Clobex 0.05 % lotion 3 STClobex 0.05 % shampoo 3 STClobex 0.05 % topical spray 2 STCLOMIPRAMINE 25 MG CAPSULE 1CLONAZEPAM 0.25 MG ODT 1CLONAZEPAM 0.5 MG DIS TABLET 1 YCLONAZEPAM 0.5 MG TABLET 1 YCLONAZEPAM 1 MG TABLET 1 YCLONAZEPAM 2 MG TABLET 1 YCLONIDINE HCL 0.1 MG TABLET 1CLONIDINE HCL 0.2 MG TABLET 1 YCLOPIDOGREL 75 MG TABLET 1 Y QLCLOTRIMAZOLE-BETAMETHASONE CRM 1Clozaril 100 mg tablet 3 Y STClozaril 25 mg tablet 3 Y STCODEINE SULFATE 15 MG TABLET 1 QLCODEINE SULFATE 30 MG TABLET 1 QLCODEINE SULFATE 60 MG TABLET 1 QLColcrys 0.6 mg tablet 2 Y QLColestid 1 gram tablet 3 STColestid 5 gram oral granules 3 STColestid 5 gram oral packet 3 STColestid Flavored 5 gram oral granules 3 STColyte with Flavor Packs 227.1 gram-21.5 gram-6.36gram oral solution

2

Combigan 0.2 %-0.5 % eye drops 2CombiPatch 0.05 mg-0.14 mg/24 hr transdermal 3 QLCOMBIVENT INHALER 3 Y QLComfort EZ Pen Needles 31 X 1/4" 2



de mantenimiento


del usoComfort EZ Pen Needles 31 x 3/16" 2Comfort EZ Pen Needles 31 X 5/16" 2CompleteNate 29 mg-1 mg chewable tablet 1Concerta 18 mg tablet,extended release 3 QL, STCopaxone 20 mg/mL subcutaneous syringe kit * Y QL, PACopaxone 40 mg/mL subcutaneous syringe * Y QL, PACordarone 200 mg tablet 3Coreg 12.5 mg tablet 3 Y STCoreg 25 mg tablet 3 STCoreg 3.125 mg tablet 3 STCoreg 6.25 mg tablet 3 Y STCoreg CR 10 mg capsule, extended release 3 QLCoreg CR 20 mg capsule, extended release 3 QLCoreg CR 40 mg capsule, extended release 3 QLCoreg CR 80 mg capsule, extended release 3 QLCorgard 20 mg tablet 3 STCorgard 40 mg tablet 3 STCorgard 80 mg tablet 3 Y STCortane-B Aqueous 10 mg-10 mg-1 mg/mL ear drops

3

Cortef 10 mg tablet 3 Y STCortef 20 mg tablet 3 Y STCortef 5 mg tablet 3 Y STCortisporin 3.5 mg-10,000 unit/mL-1 % ear solution 3 STCorzide 40 mg-5 mg tablet 3 STCorzide 80 mg-5 mg tablet 3 STCreon 12,000-38,000-60,000 unit capsule,delayed release

2

Creon 24,000-76,000-120,000 unit capsule,delayed release

2


2


2


2

Crestor 10 mg tablet 2 Y QLCrestor 20 mg tablet 2 Y QLCrestor 40 mg tablet 2 Y QLCrestor 5 mg tablet 2 Y QLCrixivan 200 mg capsule * Y QLCrixivan 400 mg capsule * Y QLCryselle (28) 0.3 mg-30 mcg tablet 1CYANOCOBALAMIN 1,000 MCG/ML 1 QLCyclafem 1/35 (28) 1 mg-35 mcg tablet 1



de mantenimiento


del usoCYCLOBENZAPRINE 10 MG TABLET 1CYCLOBENZAPRINE 5 MG TABLET 1Cymbalta 20 mg capsule,delayed release 3 QL, PACymbalta 30 mg capsule,delayed release 3 QL, PACymbalta 60 mg capsule,delayed release 3 QL, PACYPROHEPTADINE 4 MG TABLET 1 YDANAZOL 50 MG CAPSULE 1DANTROLENE SODIUM 100 MG CAP 1 YDDAVP 0.1 mg tablet 3 Y QLDDAVP 0.2 mg tablet 3 Y QLDemadex 10 mg tablet 3 Y STDemadex 100 mg tablet 3 Y STDemadex 20 mg tablet 3 Y STDemadex 5 mg tablet 3 Y STDepen Titratabs 250 mg tablet 3DEPLIN 15 MG TABLET 3 STDEPLIN 7.5 MG TABLET 3 STDESIPRAMINE 10 MG TABLET 1 YDESIPRAMINE 25 MG TABLET 1DESLORATADINE 2.5 MG ODT 1 Y QL, STDESLORATADINE 5 MG ODT 1 Y QLDESLORATADINE 5 MG TABLET 1 Y QL, STDESONIDE 0.05% CREAM 1DESQUAM-X 10% WASH 3DESQUAM-X 5% WASH 1Detrol LA 4 mg capsule,extended release 3 QLDEXAMETHASONE 4 MG TABLET 1Dexilant 60 mg capsule, delayed release 3 QL, STDEXMETHYLPHENIDATE 10 MG TAB 1 QLDEXMETHYLPHENIDATE 5 MG TAB 1 QLDEXTROAMP-AMPHET ER 10 MG CAP 1 QLDEXTROAMP-AMPHET ER 15 MG CAP 1 QLDEXTROAMP-AMPHET ER 20 MG CAP 1 QLDEXTROAMP-AMPHET ER 25 MG CAP 1 QLDEXTROAMP-AMPHET ER 30 MG CAP 1 QLDiamox Sequels 500 mg capsule,extended release 3 STDIAZEPAM 10 MG RECTAL GEL SYST 1DIAZEPAM 10 MG TABLET 1 QLDIAZEPAM 2 MG TABLET 1 QLDIAZEPAM 2.5 MG RECTAL GEL SYS 1DIAZEPAM 20 MG RECTAL GEL SYST 1DIAZEPAM 5 MG TABLET 1 QLDICLOFENAC POT 50 MG TABLET 1



de mantenimiento


del usoDICLOFENAC SOD DR 50 MG TAB 1 YDICLOFENAC SOD DR 75 MG TAB 1 YDICLOFENAC SOD EC 50 MG TAB 1DICLOFENAC SOD EC 75 MG TAB 1DICLOFENAC-MISOPROST 50-0.2 TB 1 STDICLOFENAC-MISOPROST 50-200 TB 1 Y STDICLOFENAC-MISOPROST 75-0.2 TB 1 Y STDICLOFENAC-MISOPROST 75-200 TB 1 STDICYCLOMINE 10 MG CAPSULE 1DICYCLOMINE 20 MG TABLET 1DIDANOSINE DR 125 MG CAPSULE * Y QLDIDANOSINE DR 200 MG CAPSULE * Y QLDIDANOSINE DR 250 MG CAPSULE * Y QLDIDANOSINE DR 400 MG CAPSULE * Y QLDifferin 0.1 % lotion 2Differin 0.1 % topical cream 2Differin 0.1 % topical gel 2Differin 0.3 % topical gel 2Diflucan 10 mg/mL oral suspension 3 STDiflucan 100 mg tablet 3 STDiflucan 150 mg tablet 3 STDiflucan 200 mg tablet 3 STDiflucan 40 mg/mL oral suspension 3 STDiflucan 50 mg tablet 3 STDigox 125 mcg tablet 1 Y QLDigox 250 mcg tablet 1 YDIGOXIN 125 MCG TABLET 1 QLDIGOXIN 250 MCG TABLET 1DIGOXIN 50 MCG/ML SOLUTION 1 YDilantin Extended 100 mg capsule 3Dilantin Infatabs 50 mg chewable tablet 3DILTIAZEM 24HR CD 180 MG CAP 1 Y QLDILTIAZEM 24HR CD 240 MG CAP 1 QLDILTIAZEM 24HR ER 180 MG CAP 1 QLDILTIAZEM 24HR ER 240 MG CAP 1 QLDILTIAZEM ER 240 MG CAPSULE 1 Y QLDiovan 160 mg tablet 2 Y QLDiovan 320 mg tablet 2 Y QLDiovan 40 mg tablet 2 Y QLDiovan 80 mg tablet 2 Y QLDiovan HCT 160 mg-12.5 mg tablet 3 QL, STDiovan HCT 160 mg-25 mg tablet 3 QL, STDiovan HCT 320 mg-12.5 mg tablet 3 QL, ST



de mantenimiento


del usoDiovan HCT 320 mg-25 mg tablet 3 QL, STDiovan HCT 80 mg-12.5 mg tablet 3 QL, STDIPHENHYDRAMINE 50 MG CAPSULE 1DIPHENOXYLATE-ATROP 2.5-0.025 1DIPYRIDAMOLE 25 MG TABLET 1DIPYRIDAMOLE 75 MG TABLET 1 YDiskets 40 mg soluble tablet 2 QLDIVALPROEX SOD ER 500 MG TAB 1 YDonnatal 16.2 mg-0.1037 mg-0.0194 mg tablet 3 STDonnatal 16.2 mg-0.1037mg-0.0194mg/5mL oral elixir

3 ST

DORZOLAMIDE-TIMOLOL EYE DROPS 1 Y QLDOXAZOSIN MESYLATE 2 MG TAB 1DOXAZOSIN MESYLATE 4 MG TAB 1DOXAZOSIN MESYLATE 8 MG TAB 1 YDOXEPIN 10 MG CAPSULE 1 YDOXYCYCLINE HYCLATE 100 MG CAP 1DOXYCYCLINE HYCLATE 100 MG TAB 1DOXYCYCLINE HYCLATE 50 MG CAP 1DOXYCYCLINE MONO 100 MG CAP 1 QLDOXYCYCLINE MONO 150 MG CAP 1 QLDOXYCYCLINE MONO 75 MG CAPSULE 1 QLDRONABINOL 10 MG CAPSULE 1 QL, PADRONABINOL 2.5 MG CAPSULE 1 QL, PADRONABINOL 5 MG CAPSULE 1 QL, PADuac 1.2 %(1 % base)-5 % topical gel,extended release

3 ST

DUET DHA BALANCED COMBO PACK 3 STDUETACT 30 mg-2 mg tablet 3 QL, STDulera 100 mcg-5 mcg/actuation HFA aerosol inhaler

2 QL

Dulera 200 mcg-5 mcg/actuation HFA aerosol inhaler

2 QL

DULOXETINE HCL DR 20 MG CAP 1 QLDULOXETINE HCL DR 30 MG CAP 1 Y QLDULOXETINE HCL DR 60 MG CAP 1 Y QLDuoNeb 0.5 mg-3 mg(2.5 mg base)/3 mL solution for nebulization

3 ST

Durezol 0.05 % eye drops 3 STDyazide 37.5 mg-25 mg capsule 3 STDymista 137 mcg-50 mcg/spray nasal spray 2 QLE.E.S. 400 400 mg tablet 3EasiVent Holding Chamber 2EC-Naprosyn 375 mg tablet,delayed release 3



de mantenimiento


del usoEC-Naprosyn 500 mg tablet,delayed release 3Edarbi 40 mg tablet 3 Y QL, STEdarbi 80 mg tablet 3 Y QL, STEdarbyclor 40 mg-12.5 mg tablet 3 QL, STEdarbyclor 40 mg-25 mg tablet 3 QL, STEffer-K 25 mEq effervescent tablet 1Effient 10 mg tablet 2 Y QLEffient 5 mg tablet 2 Y QLEldepryl 5 mg capsule 3 YEliquis 2.5 mg tablet 2 Y QLEliquis 5 mg tablet 2 Y QLElmiron 100 mg capsule 3Elocon 0.1 % topical ointment 3 STEmend 125 mg (1)-80 mg (2) capsules in a dose pack

3 QL, PA

Emend 125 mg capsule 3 QL, PAEmend 40 mg capsule 3 QL, PAEmend 80 mg capsule 3 QL, PAEmoquette 0.15 mg-30 mcg tablet 1Emtriva 10 mg/mL oral solution * Y QLEmtriva 200 mg capsule * Y QLENALAPRIL MALEATE 10 MG TAB 1 YENALAPRIL MALEATE 20 MG TAB 1Enbrel 25 mg (1 mL) subcutaneous kit * Y QL, PAEnbrel 25 mg/0.5 mL (0.51 mL) subcutaneous syringe

* Y QL, PA

Enbrel 50 mg/mL (0.98 mL) subcutaneous syringe * Y QL, PAEnbrel SureClick 50 mg/mL (0.98 mL) subcutaneous pen injector

* Y QL, PA

Enpresse 50-30 (6)/75-40(5)/125-30(10) tablet 1Epiduo 0.1 %-2.5 % topical gel 2Epiduo 0.1 %-2.5 % topical gel with pump 2EpiPen 2-Pak 0.3 mg/0.3 mL (1:1,000) injection,auto-injector

2

EpiPen Jr 2-Pak 0.15 mg/0.3 mL (1:2,000) injection,auto-injector

2

ERGOCALCIFEROL 1.25 MG CAPSULE 1 YErrin 0.35 mg tablet 1EryPed 200 200 mg/5 mL oral suspension 3EryPed 400 400 mg/5 mL oral suspension 3ERYTHROMYCIN 0.5% EYE OINTMENT 1ERYTHROMYCIN 250 MG FILMTAB 1ERYTHROMYCIN DR 250 MG CAP 1ERYTHROMYCIN EC 250 MG CAP 1



de mantenimiento


del usoESCITALOPRAM 10 MG TABLET 1 QLESCITALOPRAM 20 MG TABLET 1 QLESCITALOPRAM OXALATE 5 MG/5 ML 1 Y QLESTAZOLAM 1 MG TABLET 1 QLESTAZOLAM 2 MG TABLET 1 QLEstrace 0.01% (0.1 mg/gram) vaginal cream 3Estrace 0.5 mg tablet 3 STEstrace 1 mg tablet 3 Y STEstrace 2 mg tablet 3 Y STESTRADIOL 0.5 MG TABLET 1 YESTRADIOL 1 MG TABLET 1ESTRADIOL 2 MG TABLET 1ESTRADIOL-NORETH 0.5-0.1 MG TB 1 YESTRADIOL-NORETH 1-0.5 MG TAB 1 YEstroGel 1.25 gram/actuation (0.06%) transdermal gel pump

3 QL

ESTROGEN-METHYLTESTOS F.S. TAB 1 YESTROGEN-METHYLTESTOS H.S. TAB 1 YESTROGEN-METHYLTESTOSTERONE TB 1ETHAMBUTOL HCL 100 MG TABLET 1 YETHAMBUTOL HCL 400 MG TABLET 1 YETHOSUXIMIDE 250 MG CAPSULE 1 YETHOSUXIMIDE 250 MG/5 ML SOLN 1 YETODOLAC 400 MG TABLET 1 YEvista 60 mg tablet 3 Y QLEvoclin 1 % topical foam 3 STEvoxac 30 mg capsule 3 Y STExelon 1.5 mg capsule 3 Y QLEXELON 2 MG/ML ORAL SOLUTION 3 Y QLExelon 3 mg capsule 3 Y QLExelon 4.5 mg capsule 3 Y QLExelon 6 mg capsule 3 Y QLExelon Patch 13.3 mg/24 hour transdermal 2 QLExelon Patch 4.6 mg/24 hr transdermal 2 QLExelon Patch 9.5 mg/24 hr transdermal 2 QLExforge 10 mg-160 mg tablet 2 QLExforge 10 mg-320 mg tablet 2 QLExforge 5 mg-160 mg tablet 2 QLExforge 5 mg-320 mg tablet 2 QLExforge HCT 10 mg-160 mg-12.5 mg tablet 2 QLExforge HCT 10 mg-160 mg-25 mg tablet 2 QLExforge HCT 10 mg-320 mg-25 mg tablet 2 QLExforge HCT 5 mg-160 mg-12.5 mg tablet 2 QL



de mantenimiento


del usoExforge HCT 5 mg-160 mg-25 mg tablet 2 QLFAMOTIDINE 20 MG TABLET 1 YFAMOTIDINE 40 MG TABLET 1Fanapt 10 mg tablet 3 Y QL, PAFanapt 12 mg tablet 3 Y QL, PAFanapt 2 mg tablet 3 Y QL, PAFanapt 4 mg tablet 3 Y QL, PAFelbatol 400 mg tablet 3 YFENOFIBRATE 134 MG CAPSULE 1 Y QLFENOFIBRATE 145 MG TABLET 1 Y QLFENOFIBRATE 160 MG TABLET 1 QLFENOFIBRATE 200 MG CAPSULE 1 QLFENOFIBRATE 48 MG TABLET 1 Y QLFerraPlus 90 90 mg-1 mg-12 mcg-120 mg-50mg tablet

1

Ferrocite Plus 106 mg iron-1 mg tablet 1FEXOFENADINE HCL 180 MG TABLET 1 Y QLFEXOFENADINE HCL 60 MG TABLET 1 Y QLFinacea 15 % topical gel 2FINACEA PLUS KIT 2FINASTERIDE 5 MG TABLET 1 Y QLFlagyl 250 mg tablet 3 STFlagyl 375 mg capsule 3 STFlagyl 500 mg tablet 3 STFlovent Diskus 100 mcg/actuation powder for inhalation

2 QL

Flovent Diskus 250 mcg/actuation powder for inhalation

2 QL

Flovent Diskus 50 mcg/actuation powder for inhalation

2 QL

Flovent HFA 110 mcg/actuation aerosol inhaler 2 QLFlovent HFA 220 mcg/actuation aerosol inhaler 2 QLFlovent HFA 44 mcg/actuation aerosol inhaler 2 QLFLUCONAZOLE 100 MG TABLET 1FLUCONAZOLE 150 MG TABLET 1FLUCONAZOLE 200 MG TABLET 1FLUOCINOLONE 0.01% CREAM 1FLUOCINOLONE 0.01% SOLUTION 1FLUOCINOLONE 0.025% CREAM 1FLUOCINOLONE 0.025% OINTMENT 1FLUOCINONIDE 0.05% CREAM 1FLUOCINONIDE 0.05% SOLUTION 1FLUOROMETHOLONE 0.1% DROPS 1Fluoroplex 1 % topical cream 3



de mantenimiento


del usoFLUOROURACIL 2% TOPICAL SOLN 1FLUOROURACIL 5% CREAM 1FLUOROURACIL 5% TOP SOLUTION 1FLUOXETINE HCL 10 MG CAPSULE 1 Y QLFLUOXETINE HCL 10 MG TABLET 1 Y QLFLUOXETINE HCL 20 MG CAPSULE 1 QLFLUOXETINE HCL 20 MG TABLET 1 Y QLFLUOXETINE HCL 40 MG CAPSULE 1 QLFLUOXETINE HCL 60 MG TABLET 1 Y QLFLURAZEPAM 15 MG CAPSULE 1 QLFLURAZEPAM 30 MG CAPSULE 1 QLFLURESS EYE DROPS 3FLUTICASONE PROP 0.005% OINT 1FLUTICASONE PROP 0.05% CREAM 1FLUTICASONE PROP 50 MCG SPRAY 1 Y QLFLUVASTATIN SODIUM 20 MG CAP 1 Y QLFLUVASTATIN SODIUM 40 MG CAP 1 Y QLFocalin XR 10 mg capsule,extended release 3 QL, STFocalin XR 15 mg capsule,extended release 3 QL, STFocalin XR 20 mg capsule,extended release 3 QL, STFocalin XR 25 mg capsule,extended release 3 QL, STFocalin XR 30 mg capsule,extended release 3 QL, STFocalin XR 35 mg capsule,extended release 3 QL, STFocalin XR 40 mg capsule,extended release 3 QL, STFocalin XR 5 mg capsule,extended release 3 QL, STFolbic 2.5 mg-25 mg-2 mg tablet 1Folgard RX 2.2 mg-25 mg-1 mg tablet 2FOLIC ACID 1 MG TABLET 1 YForadil Aerolizer 12 mcg capsule with inhalation device

2 QL

Fortamet 1,000 mg tablet,extended release 3 QL, STFragmin 10,000 unit/mL subcutaneous syringe 3 QLFragmin 12,500 unit/0.5 mL subcutaneous syringe 3 QLFragmin 15,000 unit/0.6 mL subcutaneous syringe 3 QLFragmin 18,000 unit/0.72 mL subcutaneous syringe 3 QLFragmin 2,500 unit/0.2 mL subcutaneous syringe 3 QLFragmin 25,000 unit/mL subcutaneous solution 3 QLFragmin 5,000 unit/0.2 mL subcutaneous syringe 3 QLFragmin 7,500 unit/0.3 mL subcutaneous syringe 3 QLFUROSEMIDE 20 MG TABLET 1 YFUROSEMIDE 40 MG TABLET 1 YGABAPENTIN 100 MG CAPSULE 1 Y QLGABAPENTIN 300 MG CAPSULE 1 Y QL



de mantenimiento


del usoGABAPENTIN 400 MG CAPSULE 1 Y QLGABAPENTIN 600 MG TABLET 1 Y QLGABAPENTIN 800 MG TABLET 1 Y QLGabitril 12 mg tablet 3 YGabitril 16 mg tablet 3 YGabitril 2 mg tablet 3 YGabitril 4 mg tablet 3 Y QLGaviLyte-N 420 gram oral solution 1Gelnique 10 % (100 mg/gram) transdermal gel packet

2 QL

Gelnique 28 mg/0.92 gram (3 %) transdermal gel pump

2 QL

GEMFIBROZIL 600 MG TABLET 1 Y QLGeneress Fe 0.8 mg-25 mcg (24)/75 mg (4) chewable tablet

3

Genotropin 12 mg/mL (36 unit/mL) subcutaneous cartridge

* Y QL, PA

Genotropin 5 mg/mL (15 unit/mL) subcutaneous cartridge

* Y QL, PA

Genotropin Miniquick 0.2 mg/0.25 mL subcutaneous syringe

* Y QL, PA


* Y QL, PA


* Y QL, PA


* Y QL, PA

Genotropin Miniquick 1 mg/0.25 mL subcutaneous syringe

* Y QL, PA


* Y QL, PA


* Y QL, PA


* Y QL, PA


* Y QL, PA

Genotropin Miniquick 2 mg/0.25 mL subcutaneous syringe

* Y QL, PA

GENTAMICIN 0.1% OINTMENT 1GENTAMICIN 0.3% EYE DROPS 1GENTAMICIN 0.3% EYE OINTMENT 1GENTAMICIN 3 MG/GM EYE OINT 1GENTAMICIN 3 MG/ML EYE DROPS 1Gentle Draw Lancing Device 3Gianvi (28) 3 mg-20 mcg tablet 1Gildess FE 1 mg-20 mcg tablet 1



de mantenimiento


del usoGildess FE 1.5 mg-30 mcg tablet 1Gilenya 0.5 mg capsule * Y QL, PAGLIMEPIRIDE 2 MG TABLET 1 YGLIMEPIRIDE 4 MG TABLET 1 YGLIPIZIDE 10 MG TABLET 1 YGLIPIZIDE 5 MG TABLET 1 YGLIPIZIDE ER 10 MG TABLET 1GLIPIZIDE ER 2.5 MG TABLET 1GLIPIZIDE ER 5 MG TABLET 1GLIPIZIDE XL 10 MG TABLET 1 YGLIPIZIDE XL 2.5 MG TABLET 1 YGLIPIZIDE XL 5 MG TABLET 1 YGlucaGen 1 mg solution for injection 3GlucaGen HypoKit 1 mg Injection 3Glucophage 1,000 mg tablet 3 Y STGlucophage 500 mg tablet 3 Y STGlucophage 850 mg tablet 3 Y STGlucotrol XL 10 mg tablet,extended release 3 STGlucotrol XL 2.5 mg tablet,extended release 3 STGlucotrol XL 5 mg tablet,extended release 3 STGlucovance 2.5 mg-500 mg tablet 3 STGlucovance 5 mg-500 mg tablet 3 STGlumetza 1,000 mg tablet,extended release 3 QL, STGlumetza 500 mg tablet,extended release 3 QL, STGLYBURIDE 5 MG TABLET 1 YGLYBURIDE-METFORMIN 5-500 MG 1Gmate Lancets 30 gauge 3Golytely 227.1 g-21.5 g-6.36 g-5.53 g oral powder packet

2

Golytely 236 g-22.74 g-6.74 g-5.86 g oral solution 2Grifulvin V 500 mg tablet 3GRISEOFULVIN MICRO 500 MG TAB 1GRISEOFULVIN ULTRA 125 MG TAB 1GRISEOFULVIN ULTRA 250 MG TAB 1GUANFACINE 1 MG TABLET 1 YHALFLYTELY-BISACODYL BOWEL KIT 3HALOPERIDOL LAC 2 MG/ML CONC 1 YHecoria 1 mg capsule 1 YHectorol 0.5 mcg capsule 3 YHectorol 1 mcg capsule 3 YHectorol 2.5 mcg capsule 3 YHematron-AF 150 mg-1 mg-50 mg tablet,extended release

2



de mantenimiento


del usoHorizant ER 600 mg tablet,extended release 3 QL, PAHumalog 100 unit/mL subcutaneous cartridge 2 QLHumalog 100 unit/mL subcutaneous solution 2 QLHumalog KwikPen 100 unit/mL subcutaneous 2Humalog Mix 50-50 100 unit/mL subcutaneous suspension

2

Humalog Mix 50-50 KwikPen 100 unit/mL subcutaneous pen

2

Humalog Mix 75-25 100 unit/mL subcutaneous suspension

2

Humalog Mix 75-25 KwikPen 100 unit/mL subcutaneous insulin pen

2

Humira 20 mg/0.4 mL subcutaneous kit * Y QL, PAHumira 40 mg/0.8 mL subcutaneous kit * Y QL, PAHumira Crohn's Disease Starter Pack 40 mg/0.8 mL subcutaneous pen kit

* Y QL, PA

Humira Pen 40 mg/0.8 mL subcutaneous * Y QL, PAHumira Psoriasis Starter Pack 40 mg/0.8 mL subcutaneous pen kit

* Y QL, PA

Humulin 70/30 100 unit/mL subcutaneous suspension

2

HUMULIN 70-30 PEN 2 YHumulin N 100 unit/mL subcutaneous suspension 2HUMULIN N 100 UNITS/ML PEN 2 YHumulin R 100 unit/mL injection solution 2Humulin R U-500 "Concentrated" Insulin 500 unit/mL subcutaneous soln

2

HYDROCHLOROTHIAZIDE 12.5 MG CP 1HYDROCHLOROTHIAZIDE 12.5 MG TB 1 YHYDROCHLOROTHIAZIDE 25 MG TAB 1 YHYDROCHLOROTHIAZIDE 50 MG TAB 1 YHYDROCODON-ACETAMIN 7.5-500/15 1 QLHYDROCODON-ACETAMINOPH 7.5-300 1 QLHYDROCODON-ACETAMINOPH 7.5-325 1 QLHYDROCODON-ACETAMINOPH 7.5-500 1 QLHYDROCODON-ACETAMINOPH 7.5-750 1 QLHYDROCODON-ACETAMINOPHEN 5-300 1 QLHYDROCODON-ACETAMINOPHEN 5-325 1 QLHYDROCODON-ACETAMINOPHEN 5-500 1 QLHYDROCODON-ACETAMINOPHN 10-325 1 QLHYDROCODON-ACETAMINOPHN 10-500 1 QLHYDROCODON-ACETAMINOPHN 10-650 1 QLHYDROCODONE-CHLORPHENIRAM SUSP 1HYDROCODONE-HOMATROPINE SYRUP 1HYDROCODONE-IBUPROFEN 7.5-200 1 QL



de mantenimiento


del usoHYDROCORTISON-ACETIC ACID SOLN 1HYDROCORTISONE 100 MG ENEMA 1HYDROCORTISONE 100 MG/60 ML 1HYDROCORTISONE 2.5% CREAM 1HYDROCORTISONE VAL 0.2% OINTMT 1Hydromet 5 mg-1.5 mg/5 mL syrup 1HYDROXYCHLOROQUINE 200 MG TAB 1 YHYDROXYZINE HCL 10 MG TABLET 1HYDROXYZINE HCL 25 MG TABLET 1HYDROXYZINE PAM 25 MG CAP 1Hyosyne 0.125 mg/5 mL oral elixir 1IBANDRONATE SODIUM 150 MG TAB 1 QLIBUPROFEN 600 MG TABLET 1 YIBUPROFEN 800 MG TABLET 1 YImdur 120 mg tablet,extended release 3 STImdur 30 mg tablet,extended release 3 STImdur 60 mg tablet,extended release 3 STIMIPRAMINE HCL 10 MG TABLET 1IMIPRAMINE HCL 25 MG TABLET 1IMIPRAMINE PAMOATE 100 MG CAP 1 Y STIMIPRAMINE PAMOATE 125 MG CAP 1 Y STIMIPRAMINE PAMOATE 150 MG CAP 1 Y STIMIPRAMINE PAMOATE 75 MG CAP 1 Y STIMIQUIMOD 5% CREAM PACKET 1 QLIncivek 375 mg tablet * Y QL, PAInderal LA 120 mg capsule,extended release 3 STInderal LA 160 mg capsule,extended release 3 STInderal LA 60 mg capsule,extended release 3 STInderal LA 80 mg capsule,extended release 3 STINDOMETHACIN 50 MG CAPSULE 1Infergen 15 mcg/0.5 mL subcutaneous solution * Y QL, PAInfergen 9 mcg/0.3 mL subcutaneous solution * Y QL, PAInlyta 1 mg tablet * Y QL, PAInlyta 5 mg tablet * Y QL, PAInspra 25 mg tablet 3 Y STInspra 50 mg tablet 3 Y STIntron A 10 million unit (1 mL) solution for injection * Y QL, PAIntron A 10 million unit/mL injection solution * Y QL, PAIntron A 18 million unit (1 mL) solution for injection * Y QL, PAIntron A 50 million unit (1 mL) solution for injection * Y QL, PAIntron A 6 million unit/mL injection solution * Y QL, PAIntuniv ER 2 mg tablet,extended release 3 QL, STIntuniv ER 3 mg tablet,extended release 3 QL, ST



de mantenimiento


del usoInvega 1.5 mg tablet,extended release 3 QL, PAInvega 3 mg tablet,extended release 3 QL, PAInvega 6 mg tablet,extended release 3 QL, PAInvega 9 mg tablet,extended release 3 QL, PAInvirase 200 mg capsule * Y QLInvirase 500 mg tablet * Y QLIPRATROPIUM 0.06% SPRAY 1 Y QLIRBESARTAN 150 MG TABLET 1 Y QLIRBESARTAN 300 MG TABLET 1 Y QLIsentress 400 mg tablet * Y QLISOMETHEPT-DICHLORALP-ACETAMIN 1 QLIsopto Carbachol 1.5 % eye drops 3ISOPTO CARBACHOL 3% DROPS 3 YIsopto Carpine 1 % eye drops 2Isopto Carpine 2 % eye drops 2Isopto Carpine 4 % eye drops 2ISOPTO HOMATROPINE 2% DROPS 3 YIsordil 40 mg tablet 3 YIsordil Titradose 5 mg tablet 2ISOSORBIDE DN 10 MG TABLET 1 YISOSORBIDE DN 20 MG TABLET 1 YISOSORBIDE DN 30 MG TABLET 1 YISOSORBIDE DN 5 MG TABLET 1ISOSORBIDE DN ER 40 MG TABLET 1 YISOSORBIDE MN 10 MG TABLET 1 YISOSORBIDE MN 20 MG TABLET 1 YISOSORBIDE MN ER 30 MG TABLET 1 YJalyn 0.5 mg-0.4 mg capsule, extended release 2 QLJanumet 50 mg-1,000 mg tablet 2 QL, STJanumet 50 mg-500 mg tablet 2 QL, STJanumet XR 100 mg-1,000 mg tablet,extended release

2 QL, ST

Janumet XR 50 mg-1,000 mg tablet,extended release

2 QL, ST

Janumet XR 50 mg-500 mg tablet,extended release 2 QL, STJanuvia 100 mg tablet 2 Y QL, STJanuvia 25 mg tablet 2 QL, STJanuvia 50 mg tablet 2 Y QL, STJentadueto 2.5 mg-1,000 mg tablet 3 QL, STJentadueto 2.5 mg-500 mg tablet 3 QL, STJentadueto 2.5 mg-850 mg tablet 3 QL, STJinteli 1 mg-5 mcg tablet 1 YJolivette 0.35 mg tablet 1Junel 1.5/30 (21) 1.5 mg-30 mcg tablet 1



de mantenimiento


del usoJunel 1/20 (21) 1 mg-20 mcg tablet 1Junel FE 1.5/30 (28) 1.5 mg-30 mcg tablet 1Junel FE 1/20 (28) 1 mg-20 mcg tablet 1JUVISYNC 100-20 MG TABLET 2 Y QL, STJUVISYNC 100-40 MG TABLET 2 Y QL, STKadian 10 mg capsule,extended release 3 QL, STKadian 100 mg capsule,extended release 3 QL, STKadian 130 mg capsule,extended release 3 QL, STKadian 150 mg capsule,extended release 3 QL, STKadian 20 mg capsule,extended release 3 QL, STKadian 200 mg capsule,extended release 3 QL, STKadian 30 mg capsule,extended release 3 QL, STKadian 40 mg capsule,extended release 3 QL, STKadian 50 mg capsule,extended release 3 QL, STKadian 60 mg capsule,extended release 3 QL, STKadian 70 mg capsule,extended release 3 QL, STKadian 80 mg capsule,extended release 3 QL, STKaletra 100 mg-25 mg tablet * Y QLKaletra 200 mg-50 mg tablet * Y QLKaletra 400 mg-100 mg/5 mL oral solution * YKariva (28) 0.15 mg-0.02 mg(21)/0.01 mg(5) tablet 1Kayexalate oral powder 3Ketek 300 mg tablet 3KETOCONAZOLE 2% SHAMPOO 1KETOCONAZOLE 200 MG TABLET 1KETOROLAC 10 MG TABLET 1 QLKlaron 10 % topical suspension 3 STKlor-Con 10 mEq tablet,extended release 2Klor-Con 20 mEq oral packet 1Klor-Con 25 mEq oral packet 2Klor-Con 8 mEq tablet,extended release 2Klor-Con M10 mEq tablet,extended release 1Klor-Con M20 mEq tablet,extended release 1Kombiglyze XR 2.5 mg-1,000 mg tablet,extended release

2 QL, ST

Kombiglyze XR 5 mg-1,000 mg tablet,extended release

2 QL, ST

Kombiglyze XR 5 mg-500 mg tablet,extended release

2 QL, ST

LABETALOL HCL 100 MG TABLET 1 YLABETALOL HCL 200 MG TABLET 1 YLamictal 100 mg tablet 3 YLamictal 150 mg tablet 3 YLamictal 200 mg tablet 3



de mantenimiento


del usoLamictal 25 mg chewable dispersible tablet 3 QLLamictal 25 mg tablet 3Lamictal 5 mg chewable dispersible tablet 3 QLLamictal ODT 100 mg disintegrating tablet 3Lamictal ODT 200 mg disintegrating tablet 3Lamictal ODT 25 mg disintegrating tablet 3Lamictal ODT 50 mg disintegrating tablet 3Lamictal ODT Starter (Blue) 25 mg (21)-50 mg (7) tablet,disintegrating

3

Lamictal ODT Starter (Green) 50 mg (42)-100 mg (14) tablet,disintegrat

3

Lamictal ODT Starter(Orange) 25 mg(14)-50 mg(14)-100 mg(7) tab,disint

3

Lamictal Starter (Green) Kit 25 mg (84)-100 mg (14) tablets, dose pack

3

Lamictal XR 100 mg tablet,extended release 3Lamictal XR 200 mg tablet,extended release 3Lamictal XR 25 mg tablet,extended release 3Lamictal XR 250 mg tablet,extended release 3Lamictal XR 300 mg tablet,extended release 3Lamictal XR 50 mg tablet,extended release 3Lamictal XR Starter (Green) 50 mg(14)-100 mg(14)-200 mg(7) tab,ext.rel

3

Lamictal XR Starter (Orange) 25 mg(14)-50 mg(14)-100 mg(7) tab,ext.rel

3

LAMIVUDINE 150 MG TABLET * Y QLLAMIVUDINE 300 MG TABLET * Y QLLAMIVUDINE-ZIDOVUDINE TABLET * Y QLLAMOTRIGINE 100 MG TABLET 1LAMOTRIGINE 150 MG TABLET 1LAMOTRIGINE 200 MG TABLET 1 YLAMOTRIGINE 25 MG DISPER TAB 1 Y QLLAMOTRIGINE 25 MG TABLET 1 YLAMOTRIGINE 5 MG DISPER TABLET 1 Y QLLAMOTRIGINE ER 100 MG TABLET 1LAMOTRIGINE ER 200 MG TABLET 1LAMOTRIGINE ER 25 MG TABLET 1 YLAMOTRIGINE ER 250 MG TABLET 1LAMOTRIGINE ER 300 MG TABLET 1LAMOTRIGINE ER 50 MG TABLET 1 Ylancing device with lancets 3LANSOPRAZOLE DR 30 MG CAPSULE 1 Y QLLantus 100 unit/mL subcutaneous solution 2Lantus Solostar 100 unit/mL (3 mL) subcutaneous insulin pen

2



de mantenimiento


del usoLastacaft 0.25 % eye drops 3LATANOPROST 0.005% EYE DROPS 1 Y QLLEFLUNOMIDE 20 MG TABLET 1 Y QLLescol XL 80 mg tablet,extended release 3 QL, STLetairis 10 mg tablet * Y QL, PALetairis 5 mg tablet * Y QL, PALETROZOLE 2.5 MG TABLET 1 Y QLLEUCOVORIN CALCIUM 15 MG TAB * YLEUCOVORIN CALCIUM 5 MG TAB * YLeukine 250 mcg solution for injection * Y QL, PALEUKINE 500 MCG/ML VIAL * Y QL, PALEVALBUTEROL CONC 1.25 MG/0.5 1 YLevemir 100 unit/mL subcutaneous solution 2Levemir Flexpen 100 unit/mL (3 mL) solution subcutaneous insulin pen

2

LEVETIRACETAM 100 MG/ML SOLN 1 Y QLLEVETIRACETAM 500 MG TABLET 1 YLEVOBUNOLOL 0.25% EYE DROPS 1 YLEVOCETIRIZINE 5 MG TABLET 1 QLLEVOFLOXACIN 500 MG TABLET 1LEVOFLOXACIN 750 MG TABLET 1Levomefolate DHA 27 mg-400 mcg-1.13 mg-250 mg capsule

1

Levora-28 0.15 mg-30 mcg tablet 1LEVORPHANOL 2 MG TABLET 1 QLLEVOTHYROXINE 100 MCG TABLET 1LEVOTHYROXINE 112 MCG TABLET 1 YLEVOTHYROXINE 125 MCG TABLET 1LEVOTHYROXINE 137 MCG TABLET 1LEVOTHYROXINE 150 MCG TABLET 1LEVOTHYROXINE 175 MCG TABLET 1LEVOTHYROXINE 200 MCG TABLET 1LEVOTHYROXINE 25 MCG TABLET 1 YLEVOTHYROXINE 50 MCG TABLET 1 YLEVOTHYROXINE 75 MCG TABLET 1 YLEVOTHYROXINE 88 MCG TABLET 1Levoxyl 125 mcg tablet 2Levulan 20 % topical solution 3Lexapro 10 mg tablet 3 Y QL, STLexapro 20 mg tablet 3 Y QL, STLialda 1.2 gram tablet,delayed release 2 QLLibrax (with clidinium) 5 mg-2.5 mg capsule 3 STLIDOCAINE 5% OINTMENT 1Lidocaine Viscous 2 % mucosal solution 1



de mantenimiento


del usoLidoderm 5 % (700 mg/patch) adhesive patch 3 QL, PALidoRx 3 % topical gel with pump 2Linzess 145 mcg capsule 2 Y QLLinzess 290 mcg capsule 2 Y QLLIOTHYRONINE SOD 5 MCG TAB 1 YLipitor 20 mg tablet 3 QL, STLipitor 40 mg tablet 3 QL, STLipochol Plus 0.5 mg tablet 2LISINOPRIL 10 MG TABLET 1 YLISINOPRIL 2.5 MG TABLET 1LISINOPRIL 20 MG TABLET 1 YLISINOPRIL 30 MG TABLET 1 YLISINOPRIL 40 MG TABLET 1LISINOPRIL 5 MG TABLET 1LISINOPRIL-HCTZ 10-12.5 MG TAB 1LISINOPRIL-HCTZ 20-12.5 MG TAB 1 YLISINOPRIL-HCTZ 20-25 MG TAB 1 YLite Touch Insulin Pen Needles 29 x 1/2" 2Lite Touch Insulin Pen Needles 31 x 3/16" 2Lite Touch Insulin Pen Needles 31 X 5/16" 2Lithobid 300 mg tablet,extended release 3 STLivalo 2 mg tablet 3 Y QL, STLo Loestrin Fe 1 mg-10 mcg (24)/10 mcg (2) tablet 3Locoid 0.1 % lotion 3Locoid 0.1 % topical cream 3 STLocoid 0.1 % topical ointment 3Locoid Lipocream 0.1 % topical 2LOESTRIN 24 FE TABLET 3 YLOPERAMIDE 2 MG CAPSULE 1 YLOPRESSOR 100 MG TABLET 3 STLOPRESSOR 50 MG TABLET 3 STLoprox 1 % shampoo 3 STLORAZEPAM 0.5 MG TABLET 1 QLLORAZEPAM 1 MG TABLET 1 QLLORAZEPAM 2 MG TABLET 1 QLLorazepam Intensol 2 mg/mL oral concentrate 1 QLLoryna (28) 3 mg-20 mcg tablet 1LOSARTAN POTASSIUM 100 MG TAB 1 QLLOSARTAN POTASSIUM 25 MG TAB 1 Y QLLOSARTAN POTASSIUM 50 MG TAB 1 Y QLLOSARTAN-HCTZ 100-12.5 MG TAB 1 Y QLLOSARTAN-HCTZ 100-25 MG TAB 1 Y QLLOSARTAN-HCTZ 50-12.5 MG TAB 1 Y QL



de mantenimiento


del usoLoSeasonique 0.10 mg-20 mcg (84)/10 mcg(7) tablets,3 month dose pack

3 QL

Lotemax 0.5 % eye drops,suspension 3LOTENSIN 10 MG TABLET 3 Y STLotensin 20 mg tablet 3 STLotensin 40 mg tablet 3 Y STLotrisone 1 %-0.05 % topical cream 3 STLOVASTATIN 20 MG TABLET 1 Y QLLOVASTATIN 40 MG TABLET 1 Y QLLovaza 1 gram capsule 2 QLLow-Ogestrel (28) 0.3 mg-30 mcg tablet 1Lumigan 0.01 % eye drops 2 QLLUMIGAN 0.03% EYE DROPS 2 Y QLLunesta 1 mg tablet 3 QL, STLunesta 2 mg tablet 3 QL, STLunesta 3 mg tablet 3 QL, STLutera (28) 0.1 mg-20 mcg tablet 1Luvox CR 100 mg capsule,extended release 3 QLLuvox CR 150 mg capsule,extended release 3 QLLuxiq 0.12 % topical foam 3 STLyrica 100 mg capsule 3 Y QL, PALyrica 150 mg capsule 3 Y QL, PALyrica 20 mg/mL oral solution 3 Y QL, PALyrica 200 mg capsule 3 Y QL, PALyrica 225 mg capsule 3 Y QL, PALyrica 25 mg capsule 3 Y QL, PALyrica 300 mg capsule 3 Y QL, PALyrica 50 mg capsule 3 Y QL, PALyrica 75 mg capsule 3 Y QL, PAMacrobid 100 mg capsule 3 STMagellan Syringe 1 mL 27 x 1/2" 2MAPROTILINE 25 MG TABLET 1 YMAPROTILINE 50 MG TABLET 1 YMAPROTILINE 75 MG TABLET 1 YMarinol 10 mg capsule 3 QL, PAMarinol 2.5 mg capsule 3 QL, PAMarinol 5 mg capsule 3 QL, PAMatzim LA 180 mg tablet,extended release 1 QLMatzim LA 240 mg tablet,extended release 1 QLMatzim LA 300 mg tablet,extended release 1 QLMatzim LA 360 mg tablet,extended release 1 QLMatzim LA 420 mg tablet,extended release 1 QLMavik 1 mg tablet 3 Y ST



de mantenimiento


del usoMavik 2 mg tablet 3 Y STMavik 4 mg tablet 3 Y STMAXAIR AUTOHALER 0.2 MG AERO 3 Y QL, STMaxalt 10 mg tablet 3 QL, STMaxalt 5 mg tablet 3 QL, STMaxalt-MLT 10 mg disintegrating tablet 3 QL, STMaxalt-MLT 5 mg disintegrating tablet 3 QL, STMAXIDONE 10-750 MG TABLET 3 QLMaxitrol 3.5 mg/mL-10,000 unit/mL-0.1% eye drops,suspension

3 ST

Maxzide 75 mg-50 mg tablet 3 STMaxzide-25mg 37.5 mg-25 mg tablet 3 STMECLIZINE 25 MG TABLET 1MEDROXYPROGESTERONE 10 MG TAB 1MEDROXYPROGESTERONE 150 MG/ML 1 QLMEDROXYPROGESTERONE 2.5 MG TAB 1 YMegace 400 mg/10 mL (40 mg/mL) oral suspension 3MELOXICAM 15 MG TABLET 1 Y QLMELOXICAM 7.5 MG TABLET 1 Y QLMELOXICAM 7.5 MG/5 ML SUSP 1 Y QLMeperitab 100 mg tablet 1 QLMestinon 60 mg tablet 3 Y STMestinon 60 mg/5 mL syrup 3 YMETAXALONE 800 MG TABLET 1 QLMETFORMIN HCL 1,000 MG TABLET 1METFORMIN HCL 500 MG TABLET 1METFORMIN HCL 850 MG TABLET 1METFORMIN HCL ER 1,000 MG TAB 1 QLMETFORMIN HCL ER 500 MG TABLET 1 Y QLMETFORMIN HCL ER 750 MG TABLET 1 Y QLMETHADONE HCL 10 MG TABLET 1 QLMethadose 10 mg/mL oral concentrate 3 QLMETHENAMINE MD 500 MG TABLET 1METHOCARBAMOL 500 MG TABLET 1METHOCARBAMOL 750 MG TABLET 1METHOTREXATE 2.5 MG TABLET 1 YMETHYCLOTHIAZIDE 5 MG TABLET 1 YMETHYLDOPA-HCTZ 250-15 MG TAB 1 YMETHYLDOPA-HCTZ 250-25 MG TAB 1 YMethylin 10 mg/5 mL oral solution 3 QLMethylin 5 mg/5 mL oral solution 3 QLMETHYLPHENIDATE 10 MG TABLET 1 QLMETHYLPHENIDATE 20 MG TABLET 1 QL



de mantenimiento


del usoMETHYLPHENIDATE CD 10 MG CAP 1 QLMETHYLPHENIDATE CD 20 MG CAP 1 QLMETHYLPHENIDATE CD 30 MG CAP 1 QLMETHYLPHENIDATE CD 40 MG CAP 1 QLMETHYLPHENIDATE CD 50 MG CAP 1 QLMETHYLPHENIDATE CD 60 MG CAP 1 QLMETHYLPHENIDATE ER 10 MG TAB 1 QLMETHYLPHENIDATE ER 18 MG TAB 1 QLMETHYLPHENIDATE ER 20 MG TAB 1 QLMETHYLPHENIDATE ER 27 MG TAB 1 QLMETHYLPHENIDATE ER 36 MG TAB 1 QLMETHYLPHENIDATE ER 54 MG TAB 1 QLMETHYLPHENIDATE SR 20 MG TAB 1 QLMETHYLPREDNISOLONE 4 MG DOSEPK 1METOCLOPRAMIDE 10 MG TABLET 1METOPROLOL SUCC ER 100 MG TAB 1 Y QLMETOPROLOL SUCC ER 200 MG TAB 1 Y QLMETOPROLOL SUCC ER 25 MG TAB 1 Y QLMETOPROLOL SUCC ER 50 MG TAB 1 Y QLMETOPROLOL TARTRATE 100 MG TAB 1 YMETOPROLOL TARTRATE 25 MG TAB 1 YMETOPROLOL TARTRATE 50 MG TAB 1 YMetrogel 1 % topical 2Metrogel 1 % topical gel with pump 2METROGEL 1% KIT 2 QLMETRONIDAZOLE 0.75% CREAM 1METRONIDAZOLE 0.75% LOTION 1METRONIDAZOLE 250 MG TABLET 1METRONIDAZOLE 375 MG CAPSULE 1METRONIDAZOLE 500 MG TABLET 1METRONIDAZOLE TOPICAL 0.75% GL 1METRONIDAZOLE VAGINAL 0.75% GL 1MEXILETINE 150 MG CAPSULE 1 YMEXILETINE 200 MG CAPSULE 1 YMEXILETINE 250 MG CAPSULE 1 YMicrogestin 1.5/30 (21) 1.5 mg-30 mcg tablet 1Microgestin 1/20 (21) 1 mg-20 mcg tablet 1Microgestin Fe 1.5/30 (28) 1.5 mg-30 mcg tablet 1Microgestin FE 1/20 (28) 1 mg-20 mcg tablet 1Microzide 12.5 mg capsule 3 YMIGERGOT SUPPOSITORY 1Mimvey 1 mg-0.5 mg tablet 1Minipress 1 mg capsule 3 Y ST



de mantenimiento


del usoMinipress 2 mg capsule 3 Y STMinipress 5 mg capsule 3 Y STMinitran 0.2 mg/hr transdermal 24 hour patch 1 QLMinitran 0.4 mg/hr transdermal 24 hour patch 1 QLMinocin 100 mg capsule 3 STMinocin 100 mg combo pack 3 QL, PAMinocin 50 mg capsule 3 STMinocin 50 mg combo pack 3 QL, PAMINOCYCLINE 100 MG CAPSULE 1MINOCYCLINE 50 MG CAPSULE 1MINOCYCLINE HCL 50 MG TABLET 1MINOXIDIL 2.5 MG TABLET 1 YMIRTAZAPINE 15 MG ODT 1 Y QLMIRTAZAPINE 15 MG TABLET 1 Y QLMIRTAZAPINE 30 MG ODT 1 Y QLMIRTAZAPINE 30 MG TABLET 1 Y QLMIRTAZAPINE 45 MG ODT 1 Y QLMISOPROSTOL 200 MCG TABLET 1 YMonodox 100 mg capsule 3 QL, PAMonodox 50 mg capsule 3 QL, PAMonodox 75 mg capsule 3 QL, PAMonoject Luer-Lock Tip 12 mL syringe 3Monoject Regular Luer 12 mL syringe 3Monoject Syringe 12 mL 3Monoject Syringe 3 mL 3Monoject Syringe 6 mL 3Monoject Syringe 6 mL 20 x 1 1/2" 3Monoject Syringe 6 mL 21 x 1 1/2" 3Monoject Syringe 6 mL 21 x 1" 3Monoject Syringe 6 mL 22 x 1 1/2" 3Mononessa (28) 0.25 mg-35 mcg tablet 1MONTELUKAST SOD 10 MG TABLET 1 QLMONTELUKAST SOD 4 MG GRANULES 1 QLMONTELUKAST SOD 4 MG TAB CHEW 1 Y QLMONTELUKAST SOD 5 MG TAB CHEW 1 Y QLMorgidox 100 mg capsule 3MORPHINE SULF ER 15 MG TABLET 1 QLMORPHINE SULF ER 30 MG TABLET 1 QLMoviPrep 100 g-7.5 g-2.691 g-4.7 g oral powder packet

3

Moxeza 0.5 % eye drops 2Multaq 400 mg tablet 2 Y QLMUPIROCIN 2% OINTMENT 1



de mantenimiento


del usoMyfortic 180 mg tablet,delayed release 3Myfortic 360 mg tablet,delayed release 3Myrbetriq 25 mg tablet,extended release 3 QLMyrbetriq 50 mg tablet,extended release 3 QLNABUMETONE 500 MG TABLET 1 YNABUMETONE 750 MG TABLET 1 YNADOLOL 20 MG TABLET 1 YNADOLOL 40 MG TABLET 1 YNamenda 10 mg tablet 2 Y QLNamenda 10 mg/5 mL oral solution 2 QLNamenda 5 mg tablet 2 Y QLNamenda Titration Pak 5 mg-10 mg tablets in a dose pack

2 QL

Namenda XR 14 mg capsule sprinkle,ER 24hr 2 QLNamenda XR 21 mg capsule sprinkle,ER 24hr 2 QLNamenda XR 28 mg capsule sprinkle,ER 24hr 2 QLNamenda XR 7 mg capsule sprinkle,ER 24hr 2 QLNamenda XR 7 mg-14 mg-21 mg-28 mg capsule,sprinkle,ER 24hr,dose pack

2 QL

Naprosyn 125 mg/5 mL oral suspension 3NAPROXEN 500 MG KIT 1NAPROXEN 500 MG TABLET 1 YNAPROXEN SODIUM 550 MG TAB 1 YNARATRIPTAN 1 MG TABLET 1 QLNARATRIPTAN 2.5 MG TABLET 1 QLNARATRIPTAN HCL 1 MG TABLET 1 QLNARATRIPTAN HCL 2.5 MG TABLET 1 QLNascobal 500 mcg nasal spray 2 YNasonex 50 mcg/actuation Spray 2 QLNatazia 3 mg/2 mg-2 mg/2 mg-3 mg/1 mg tablet 2NATEGLINIDE 120 MG TABLET 1 YNATEGLINIDE 60 MG TABLET 1Necon 1/35 (28) 1 mg-35 mcg tablet 1Necon 7/7/7 (28) 0.5 mg/0.75 mg/1 mg-35 mcg tablet

1

NEEVO DHA GELCAP 3NEOMYC-BACIT-POLYMIX EYE OINT 1NEOMYCIN-POLY-HC EYE DROPS 1NEOMYCIN-POLYMYXIN-HC EAR SOLN 1NEOMYCIN-POLYMYXIN-HC EAR SUSP 1NEOMYC-POLYM-DEXAMETH EYE DROP 1Neutrasal 538 mg mucosal powder in packet 3Nevanac 0.1 % eye drops,suspension 3 STNexa Plus 29 mg iron-1.25 mg-55 mg capsule 3



de mantenimiento


del usoNexium 20 mg capsule,delayed release 3 QLNexium 40 mg capsule,delayed release 3 QLNexium Packet 10 mg granules delayed release for susp

3 QL

Nexium Packet 2.5 mg granules delayed release for susp

3 QL

Nexium Packet 20 mg granules delayed release for susp

3 QL


3 QL


3 QL

Niacor 500 mg tablet 1 YNiaspan 1,000 mg tablet,extended release 3 PANiaspan 500 mg tablet,extended release 3 PANiaspan 750 mg tablet,extended release 3 PANifedical XL 30 mg tablet,extended release 1 QLNifedical XL 60 mg tablet,extended release 1 QLNitro-Bid 2 % transdermal ointment 2NITROFURANTOIN MONO-MCR 100 MG 1NITROGLYCERIN 0.4 MG/HR PATCH 1 QLNITROGLYCERIN ER 9 MG CAPSULE 1 YNitrolingual 400 mcg/spray 3Nitrostat 0.4 mg sublingual tablet 2Nitro-Time 2.5 mg capsule,extended release 1NIZATIDINE 150 MG CAPSULE 1 YNizoral 2 % shampoo 3 STNora-BE 0.35 mg tablet 1NORETHINDRONE 0.35 MG TABLET 1NORGESTIMATE-ETH ESTRADIOL TAB 1Norinyl 1+50 (28) 1 mg-50 mcg tablet 3Norpace 100 mg capsule 3 Y STNorpace 150 mg capsule 3 Y STNorpramin 10 mg tablet 3 STNorpramin 100 mg tablet 3 Y STNorpramin 150 mg tablet 3 Y STNorpramin 25 mg tablet 3 Y STNorpramin 50 mg tablet 3 Y STNorpramin 75 mg tablet 3 Y STNortrel 1/35 (28) 1 mg-35 mcg tablet 1Nortrel 7/7/7 (28) 0.5 mg/0.75 mg/1 mg-35 mcg tablet

1

NORTRIPTYLINE HCL 10 MG CAP 1 YNORTRIPTYLINE HCL 25 MG CAP 1 Y



de mantenimiento


del usoNorvir 100 mg tablet * Y QLNovoFine 30 30 x 1/3" needle 2Novofine 32 32 x 1/4" needle 2Novofine Autocover 30 x 1/3" needle 2Novolog 100 unit/mL subcutaneous solution 2Novolog Flexpen 100 unit/mL subcutaneous 2Novolog Mix 70-30 100 unit/mL subcutaneous solution

2

Novolog Mix 70-30 FlexPen 100 unit/mL subcutaneous pen

2

Novolog PenFill 100 unit/mL subcutaneous cartridge 2NovoTwist 30 x 1/3" needle 2NovoTwist 32 x 1/5" needle 2Nuedexta 20 mg-10 mg capsule 2 QLNuLYTELY with Flavor Packs 420 gram oral solution 2Nutropin 10 mg subcutaneous solution * Y QL, PANutropin AQ 10 mg/2 mL (5 mg/mL) subcutaneous cartridge

* Y QL, PA

Nutropin AQ 20 mg/2 mL (10 mg/mL) subcutaneous cartridge

* Y QL, PA

NUTROPIN AQ 5 MG/ML VIAL * Y QL, PANutropin AQ Nuspin 10 mg/2 mL (5 mg/mL) subcutaneous cartridge

* Y QL, PA

Nutropin AQ Nuspin 20 mg/2 mL (10 mg/mL) subcutaneous cartridge

* Y QL, PA

Nutropin AQ Nuspin 5 mg/2 mL (2.5 mg/mL) subcutaneous cartridge

* Y QL, PA

NuvaRing 0.12 mg -0.015 mg/24 hr vaginal 2 QLNuvigil 150 mg tablet 3 Y QL, PANuvigil 200 mg tablet 3 Y QL, PANuvigil 250 mg tablet 3 Y QL, PANuvigil 50 mg tablet 3 Y QL, PANYSTATIN 100,000 UNIT/GM CREAM 1NYSTATIN 100,000 UNITS/ML SUSP 1NYSTATIN 150,000,000 UNITS PWD 3NYSTATIN 50,000,000 UNITS PWD 1 QLNYSTATIN 500,000 UNITS/5 ML 1NYSTATIN 500,000,000 UNITS PWD 1 QLNYSTATIN-TRIAMCINOLONE CREAM 1NYSTATIN-TRIAMCINOLONE OINTM 1Obtrex DHA 29 mg iron-1 mg-50 mg tablet&capsule,delayed release

2

Ocella 3 mg-0.03 mg tablet 1Ocudox 50 mg kit 3Ocufen 0.03 % eye drops 3



de mantenimiento


del usoOFLOXACIN 0.3% EAR DROPS 1OFLOXACIN 0.3% EYE DROPS 1OFLOXACIN 200 MG TABLET 1OFLOXACIN 300 MG TABLET 1OFLOXACIN 400 MG TABLET 1OLANZAPINE ODT 10 MG TABLET 1 QLOLANZAPINE ODT 15 MG TABLET 1 Y QLOLANZAPINE ODT 20 MG TABLET 1 Y QLOLANZAPINE ODT 5 MG TABLET 1 Y QLOlux-E 0.05 % topical foam 3 STOMEPRAZOLE DR 20 MG CAPSULE 1 Y QLOMEPRAZOLE DR 40 MG CAPSULE 1 QLOmnaris 50 mcg nasal spray 3 Y QLONDANSETRON HCL 4 MG TABLET 1 QLONDANSETRON HCL 8 MG TABLET 1 QLONDANSETRON ODT 4 MG TABLET 1 QLONDANSETRON ODT 8 MG TABLET 1 QLOnglyza 2.5 mg tablet 2 Y QL, STOnglyza 5 mg tablet 2 Y QL, STOPANA ER 10 MG TABLET 3 QLOpana ER 10 mg tablet, crush resistant, extended release

2 QL

Opana ER 15 mg tablet, crush resistant, extended release

2 QL

OPANA ER 20 MG TABLET 3 QLOpana ER 20 mg tablet, crush resistant, extended release

2 QL


2 QL


2 QL


2 QL

Opana ER 7.5 mg tablet, crush resistant, extended release

2 QL

Oracea 40 mg capsule, extended release 3 QLOravig 50 mg buccal tablet 2 QLOrencia 125 mg/mL subcutaneous syringe * Y QL, PAORPHENADRINE ER 100 MG TABLET 1Orsythia 0.1 mg-20 mcg tablet 1Ortho Evra 150 mcg-35 mcg/24 hr transdermal patch

3 QL



de mantenimiento


del usoOrtho Tri-Cyclen (28) 0.18 mg(7)/0.215 mg(7)/0.25 mg(7)-35 mcg tablet

3

Ortho Tri-Cyclen Lo (28) 0.18 mg/0.215 mg/0.25 mg-25 mcg tablet

2

Oticin 0.1 %-1 % ear drops 1Otozin 5.4 %-1 %-2 %1 % ear drops 1OXAPROZIN 600 MG CAPLET 1OXAPROZIN 600 MG TABLET 1 YOXCARBAZEPINE 300 MG TABLET 1 YOXYBUTYNIN CL ER 10 MG TABLET 1 Y QLOXYCODON-ACETAMINOPHEN 7.5-325 1 QLOXYCODONE CONC 20 MG/ML SOLN 1 QLOXYCODONE HCL 10 MG TABLET 1 QLOXYCODONE HCL 100 MG/5 ML SOLN 1 QLOXYCODONE HCL 15 MG TABLET 1 QLOXYCODONE HCL 30 MG TABLET 1 QLOXYCODONE HCL 5 MG TABLET 1 QLOXYCODONE HCL 5 MG/5 ML SOL 1 QLOXYCODONE HCL 5 MG/5 ML SOLN 1 QLOXYCODONE-ACETAMINOPHEN 10-325 1 QLOXYCODONE-ACETAMINOPHEN 10-650 1 QLOXYCODONE-ACETAMINOPHEN 5-325 1 QLOxyContin 10 mg tablet,extended release 3 QL, PAOxyContin 15 mg tablet,extended release 3 QL, PAOxyContin 20 mg tablet,extended release 3 QL, PAOxyContin 30 mg tablet,extended release 3 QL, PAOxyContin 40 mg tablet,extended release 3 QL, PAOxyContin 60 mg tablet,extended release 3 QL, PAOxyContin 80 mg tablet,extended release 3 QL, PAOXYMORPHONE HCL ER 15 MG TAB 1 QLOXYMORPHONE HCL ER 7.5 MG TAB 1 QLPANTOPRAZOLE SOD DR 40 MG TAB 1 Y QLParafon Forte DSC 500 mg tablet 3PAREGORIC LIQUID 1Parlodel 2.5 mg tablet 3 Y STPAROXETINE CR 12.5 MG TABLET 1 Y QLPAROXETINE CR 25 MG TABLET 1 Y QLPAROXETINE CR 37.5 MG TABLET 1 QLPAROXETINE ER 37.5 MG TABLET 1 Y QLPAROXETINE HCL 10 MG TABLET 1 Y QLPAROXETINE HCL 20 MG TABLET 1 Y QLPAROXETINE HCL 40 MG TABLET 1 Y QLPataday 0.2 % eye drops 2Patanase 0.6 % nasal spray 3 QL, ST



de mantenimiento


del usoPatanol 0.1 % eye drops 3 STPCE 333 mg particles in tablet 2PEG-3350 with flavor packs 420 gram oral solution 1Pegasys 180 mcg/0.5 mL subcutaneous syringe * Y QL, PAPegasys 180 mcg/mL subcutaneous solution * Y QL, PAPegasys Convenience Pack 180 mcg/0.5 mL subcutaneous kit

* Y QL, PA

Pegasys ProClick 135 mcg/0.5 mL subcutaneous pen injector

* Y QL, PA

Pegasys ProClick 180 mcg/0.5 mL subcutaneous pen injector

* Y QL, PA

PegIntron 120 mcg/0.5 mL subcutaneous kit * Y QL, PAPegIntron 150 mcg/0.5 mL subcutaneous kit * Y QL, PAPegIntron 50 mcg/0.5 mL subcutaneous kit * Y QL, PAPegIntron 80 mcg/0.5 mL subcutaneous kit * Y QL, PAPegIntron Redipen 120 mcg/0.5 mL subcutaneous kit

* Y QL, PA

PegIntron Redipen 150 mcg/0.5 mL subcutaneous kit

* Y QL, PA

PegIntron Redipen 50 mcg/0.5 mL subcutaneous kit * Y QL, PAPegIntron Redipen 80 mcg/0.5 mL subcutaneous kit * Y QL, PAPENICILLIN VK 500 MG TABLET 1Pennsaid 1.5 % topical drops 3Pentasa 250 mg capsule,extended release 3 QLPentasa 500 mg capsule,extended release 3 QLPENTAZOCINE-NALOXONE TABLET 1 QLPepcid 20 mg tablet 3 STPepcid 40 mg tablet 3 Y STPepcid 40 mg/5 mL oral suspension 3 STPercocet 10 mg-325 mg tablet 3 QL, STPERCOCET 10-650 MG TABLET 3 QL, STPercocet 2.5 mg-325 mg tablet 3 QL, STPercocet 5 mg-325 mg tablet 3 QL, STPercocet 7.5 mg-325 mg tablet 3 QL, STPERCOCET 7.5-500 MG TABLET 3 QL, STPERMETHRIN 5% CREAM 1PERPHEN-AMITRIP 4 MG-10 MG TAB 1 YPersantine 25 mg tablet 3 YPersantine 50 mg tablet 3 YPersantine 75 mg tablet 3PHENAZOPYRIDINE 100 MG TAB 1PHENAZOPYRIDINE 200 MG TAB 1Phenytek 200 mg capsule 3 YPhenytek 300 mg capsule 3 Y



de mantenimiento


del usoPHENYTOIN SOD EXT 100 MG CAP 1PILOCARPINE HCL 7.5 MG TABLET 1 YPinnacaine 20 % ear drops 1PIOGLITAZONE HCL 15 MG TABLET 1 QLPIOGLITAZONE HCL 30 MG TABLET 1 Y QLPIOGLITAZONE HCL 45 MG TABLET 1 QLPIOGLITAZONE-METFORMIN 15-500 1 Y QLPIOGLITAZONE-METFORMIN 15-850 1 Y QLPlaquenil 200 mg tablet 3 STPNV-Select 27 mg-1 mg tablet 1POLYETHYLENE GLYCOL 3350 POWD 1 QLPOLYMYXIN B-TMP EYE DROPS 1Portia 0.15 mg-30 mcg tablet 1POTASSIUM CITRATE ER 10 MEQ TB 1 YPOTASSIUM CL ER 10 MEQ CAPSULE 1 YPOTASSIUM CL ER 10 MEQ TABLET 1 YPOTASSIUM CL ER 20 MEQ TABLET 1 YPOTASSIUM CL ER 8 MEQ CAPSULE 1 YPOTASSIUM CL ER 8 MEQ TABLET 1 YPradaxa 150 mg capsule 2 Y QLPradaxa 75 mg capsule 2 Y QLPramosone 1 %-1 % lotion 2Pramosone 1 %-1 % topical cream 2Pramosone 1 %-1 % topical ointment 3Pramosone 2.5 %- 1 % topical ointment 3Pramosone 2.5 %-1 % topical cream 2Pramosone 2.5%-1 % lotion 2Prandin 0.5 mg tablet 2 YPrandin 1 mg tablet 2 YPrandin 2 mg tablet 2 YPRAVASTATIN SODIUM 10 MG TAB 1 Y QLPRAVASTATIN SODIUM 20 MG TAB 1 Y QLPRAVASTATIN SODIUM 40 MG TAB 1 Y QLPRAVASTATIN SODIUM 80 MG TAB 1 Y QLPREDNISOLONE 15 MG/5 ML SOLN 1PREDNISOLONE 15 MG/5 ML SYRUP 1PREDNISOLONE AC 1% EYE DROP 1PREDNISONE 10 MG TAB DOSE PACK 1PREDNISONE 10 MG TABLET 1PREDNISONE 20 MG TABLET 1PREDNISONE 5 MG TABLET 1PREDNISONE 5 MG/5 ML SOLUTION 1PREDNISONE 50 MG TABLET 1



de mantenimiento


del usoPremarin 0.3 mg tablet 3 YPremarin 0.45 mg tablet 3 YPremarin 0.625 mg tablet 3 YPremarin 0.625 mg/gram vaginal cream 3Premarin 0.9 mg tablet 3 YPremarin 1.25 mg tablet 3 YPremphase 0.625 mg(14)/0.625 mg-5mg(14) tablet 3Prempro 0.3 mg-1.5 mg tablet 3 YPrempro 0.45 mg-1.5 mg tablet 3Prempro 0.625 mg-2.5 mg tablet 3Prempro 0.625 mg-5 mg tablet 3Prenaissance 90 DHA 90 mg iron-1 mg-50 mg-300 mg oral pack

1

Prenaissance DHA 27 mg-1 mg-50 mg-250 mg oral pack

1

Prenaissance Promise 35 mg-1 mg-50 mg-300 mg oral pack

1

Prenatal 19 (with docusate) 29 mg iron-1 mg-25 mg tablet

3

Prenatal Plus (calcium carbonate) 27 mg iron-1 mg tablet

1

Prenate AM 1 mg-500 mg tablet 3PRENEXA CAPSULE 3Prevacid SoluTab 15 mg delayed release,disintegrating tablet

3 QL, ST

Previfem 0.25 mg-35 mcg tablet 1Prezista 400 mg tablet * Y QLPrilosec 10 mg capsule,delayed release 3 QL, STPrilosec 40 mg capsule,delayed release 3 QL, STPrimlev 10 mg-300 mg tablet 1 QLPrimlev 5 mg-300 mg tablet 1 QLPrimlev 7.5 mg-300 mg tablet 1 QLPrinivil 10 mg tablet 3 STPrinivil 20 mg tablet 3 STPrinivil 5 mg tablet 3 Y STPristiq 100 mg tablet,extended release 3 QLPristiq 50 mg tablet,extended release 3 QLProAir HFA 90 mcg/actuation aerosol inhaler 2 QLProcardia XL 30 mg tablet,extended release 3 QL, STProcardia XL 60 mg tablet,extended release 3 QL, STProcardia XL 90 mg tablet,extended release 3 QL, STProcrit 10,000 unit/mL injection solution * Y QL, PAProcrit 2,000 unit/mL injection solution * Y QL, PAProcrit 20,000 unit/2 mL injection solution * Y QL, PA



de mantenimiento


del usoProcrit 20,000 unit/mL injection solution * Y QL, PAProcrit 3,000 unit/mL injection solution * Y QL, PAProcrit 4,000 unit/mL injection solution * Y QL, PAProcrit 40,000 unit/mL injection solution * Y QL, PAProctocort 1 % rectal cream 3 STProctocort 30 mg rectal suppository 3 STProctosol HC 2.5 % rectal cream 1Proctozone-HC 2.5 % rectal cream 1Prodigy Autocode Meter kit 3PRODIGY AUTOCODE PRO METER KIT 3PRODIGY AUTOCODE TEST STRIPS 2 QLProdigy Control Solution, Low 3Prodigy Control Solution,High 3Prodigy Lancing Device 3Prodigy No Coding strips 2 QLProdigy Pocket Meter kit 3PRODIGY POCKET PRO METER KIT 3Prodigy Twist Top Lancet 28 gauge 2Prodigy Voice Glucose Meter kit 3PRODIGY VOICE PRO METER KIT 3PROGESTERONE 100 MG CAPSULE 1 YPROGESTERONE 200 MG CAPSULE 1 YPromacta 12.5 mg tablet * Y QL, PAPROMETHAZINE 12.5 MG TABLET 1PROMETHAZINE 25 MG TABLET 1Promethazine VC-Codeine 6.25 mg-5 mg-10 mg/5 mL syrup

1

PROMETHAZINE-CODEINE SYRUP 1PROMETHAZINE-DM SYRUP 1Promethegan 12.5 mg rectal suppository 1Promethegan 25 mg rectal suppository 1Prometrium 100 mg capsule 3 STPrometrium 200 mg capsule 3 STPROPAFENONE HCL ER 225 MG CAP 1 YPROPAFENONE HCL SR 325 MG CAP 1 YPROPAFENONE HCL SR 425 MG CAP 1 YPROPRANOLOL 20 MG TABLET 1 YPROPRANOLOL ER 60 MG CAPSULE 1PROPRANOLOL ER 80 MG CAPSULE 1 YPROPRANOLOL-HCTZ 40-25 MG TAB 1 YProventil HFA 90 mcg/actuation aerosol inhaler 2 QLProvera 10 mg tablet 3 Y STProvera 2.5 mg tablet 3 ST



de mantenimiento


del usoProvera 5 mg tablet 3 Y STProzac 10 mg capsule 3 QL, STProzac 20 mg capsule 3 QL, STProzac 40 mg capsule 3 QL, STPrudoxin 5 % topical cream 3Pulmicort 0.25 mg/2 mL suspension for nebulization 3 STPulmicort 0.5 mg/2 mL suspension for nebulization 3 STPulmicort 1 mg/2 mL suspension for nebulization 3Pulmicort Flexhaler 180 mcg/actuation breath activated

3 QL

QNASL 80 mcg/actuation nasal aerosol spray 3 QLQuasense 0.15 mg-30 mcg tablets,3 month dose pack

1 QL

Questran Light 4 gram oral powder 3QUETIAPINE FUMARATE 100 MG TAB 1 QLQUETIAPINE FUMARATE 200 MG TAB 1 Y QLQUETIAPINE FUMARATE 25 MG TAB 1 QLQUETIAPINE FUMARATE 300 MG TAB 1 Y QLQUETIAPINE FUMARATE 400 MG TAB 1 Y QLQUETIAPINE FUMARATE 50 MG TAB 1 QLQUINAPRIL 20 MG TABLET 1 YQUINAPRIL 40 MG TABLET 1 YQUINIDINE SULFATE 300 MG TAB 1 YQUININE SULFATE 324 MG CAPSULE 1 QL, PAQvar 40 mcg/actuation Metered Aerosol oral inhaler 2 QLQvar 80 mcg/actuation Metered Aerosol oral inhaler 2 QLRABEPRAZOLE SOD DR 20 MG TAB 1 Y QL, STRAMIPRIL 10 MG CAPSULE 1RAMIPRIL 2.5 MG CAPSULE 1RAMIPRIL 5 MG CAPSULE 1 YRanexa 1,000 mg tablet,extended release 2 QL, STRanexa 500 mg tablet,extended release 2 QL, STRANITIDINE 15 MG/ML SYRUP 1 YRANITIDINE 150 MG CAPSULE 1 YRANITIDINE 150 MG TABLET 1RANITIDINE 150 MG/10 ML SYRUP 1RANITIDINE 300 MG CAPSULE 1 YRANITIDINE 300 MG TABLET 1Rapaflo 4 mg capsule 3 Y QLRapaflo 8 mg capsule 3 Y QLRebif (with albumin) 22 mcg/0.5 mL subcutaneous syringe

* Y QL, PA

Rebif (with albumin) 44 mcg/0.5 mL subcutaneous syringe

* Y QL, PA



de mantenimiento


del usoRebif Rebidose 22 mcg/0.5 mL subcutaneous pen injector

* Y QL, PA

Rebif Rebidose 44 mcg/0.5 mL subcutaneous pen injector

* Y QL, PA

Rebif Rebidose 8.8 mcg/0.2 mL-22 mcg/0.5 mL subcutaneous pen injector

* Y QL, PA

Rebif Titration Pack 8.8 mcg/0.2 mL-22 mcg/0.5 mL subcutaneous syringe

* Y QL, PA

Reclipsen (28) 0.15 mg-30 mcg tablet 1Relpax 40 mg tablet 3 QL, STRenagel 400 mg tablet 3 YRenvela 0.8 gram oral powder packet 3 QLRenvela 2.4 gram oral powder packet 3 QLRenvela 800 mg tablet 3 Y QLRequip XL 12 mg tablet,extended release 3 QL, STRequip XL 2 mg tablet,extended release 3 QL, STRequip XL 4 mg tablet,extended release 3 QL, STRequip XL 6 mg tablet,extended release 3 QL, STRequip XL 8 mg tablet,extended release 3 QL, STRescriptor 200 mg tablet * Y QLRescula 0.15 % eye drops 3 QL, STRestasis 0.05 % eye drops in a dropperette 2 QLRetin-A Micro 0.04 % topical gel 2Retin-A Micro 0.1 % topical gel 2Retin-A Micro Pump 0.04 % topical gel 2Retin-A Micro Pump 0.1 % topical gel 2Retrovir 10 mg/mL syrup * Y QLRETROVIR 300 MG TABLET * Y QLREYATAZ 100 MG CAPSULE * Y QLReyataz 150 mg capsule * Y QLReyataz 200 mg capsule * Y QLReyataz 300 mg capsule * Y QLRibaPak Dose Pack 200 mg (28)-400 mg (28) tablets * Y QLRibaPak Dose Pack 200 mg (7)-400 mg (7) tablets * Y QLRightSource Blood Glucose Meter 3Risperdal 1 mg/mL oral solution 3 STRISPERIDONE 0.25 MG ODT 1 QLRISPERIDONE 0.5 MG ODT 1 Y QLRISPERIDONE 1 MG ODT 1 Y QLRISPERIDONE 1 MG/ML SOLUTION 1RISPERIDONE 2 MG ODT 1 Y QLRISPERIDONE 3 MG ODT 1 QLRISPERIDONE 4 MG ODT 1 Y QLRIZATRIPTAN 10 MG ODT 1 QL



de mantenimiento


del usoRobaxin-750 750 mg tablet 3 STRobinul Forte 2 mg tablet 3 STRythmol 150 mg tablet 3 Y STRythmol 225 mg tablet 3 Y STSafyral 3 mg-0.03 mg-0.451 mg (21/7) tablet 3SANCTURA XR 60 MG CAPSULE 3 Y QL, STSancuso 3.1 mg/24 hour transdermal patch 3 QLSaphris (black cherry) 10 mg sublingual tablet 3 QL, PASaphris (black cherry) 5 mg sublingual tablet 3 QL, PASaphris 10 mg sublingual tablet 3 QL, PASaphris 5 mg sublingual tablet 3 QL, PASavella 100 mg tablet 2 Y QLSavella 12.5 mg (5)-25 mg(8)-50mg(42) tablets in a dose pack

2 QL

Savella 12.5 mg tablet 2 Y QLSavella 25 mg tablet 2 Y QLSavella 50 mg tablet 2 Y QLSeasonique 0.15 mg-30 mcg (84)/10 mcg(7) tablets,3 month dose pack

2 QL

Select-OB + DHA 29 mg iron-1 mg-250 mg oral pack 3Serevent Diskus 50 mcg/dose powder for inhalation 2 QLSeroquel 100 mg tablet 3 QL, STSeroquel 25 mg tablet 3 Y QL, STSeroquel 50 mg tablet 3 Y QL, STSeroquel XR 150 mg tablet,extended release 2 QLSeroquel XR 200 mg tablet,extended release 2 QLSeroquel XR 300 mg tablet,extended release 2 QLSeroquel XR 400 mg tablet,extended release 2 QLSeroquel XR 50 mg tablet,extended release 2 QLSERTRALINE HCL 100 MG TABLET 1 Y QLSERTRALINE HCL 25 MG TABLET 1 Y QLSERTRALINE HCL 50 MG TABLET 1 Y QLSidekick Blood Glucose System kit 3SILVER SULFADIAZINE 1% CREAM 1SIMVASTATIN 10 MG TABLET 1 Y QLSIMVASTATIN 20 MG TABLET 1 Y QLSIMVASTATIN 40 MG TABLET 1 Y QLSIMVASTATIN 80 MG TABLET 1 Y QLSinemet 10 mg-100 mg tablet 3 STSinemet 25 mg-100 mg tablet 3 STSinemet 25 mg-250 mg tablet 3 STSinemet CR 25 mg-100 mg tablet,extended release 3 STSinemet CR 50 mg-200 mg tablet,extended release 3 STSingulair 10 mg tablet 3 Y QL, ST



de mantenimiento


del usoSingulair 4 mg chewable tablet 3 QL, STSingulair 4 mg oral granules in packet 3 QL, STSingulair 5 mg chewable tablet 3 QL, STSOD SULFACETAMIDE-SULFUR GREEN 1SOD SULFACETAMIDE-SULFUR SUSP 1SODIUM CHLORIDE 0.9% INHAL VL 1SODIUM CHLORIDE 10% VIAL 1SODIUM POLYSTYRENE SULF POWDER 1sodium polystyrene sulfonate (sorbitol free) 15 gram/60 mL oral susp

1

Soft Touch Lancets 2Solaraze 3 % topical gel 3 PASolodyn 105 mg tablet,extended release 3 QLSolodyn 115 mg tablet,extended release 3 QLSolodyn 55 mg tablet,extended release 3 QLSolodyn 65 mg tablet,extended release 3 QLSolodyn 80 mg tablet,extended release 3 QLSOLODYN ER 135 MG TABLET 3 QL, STSOLODYN ER 45 MG TABLET 3 QL, STSOLODYN ER 90 MG TABLET 3 QL, STSoriatane 10 mg capsule 3 PASoriatane 17.5 mg capsule 3 PASoriatane 25 mg capsule 3 PASorilux 0.005 % topical foam 3 QLSovaldi 400 mg tablet * Y QL, PASPECTRACEF 200 MG DOSE PACK TB 3Spiriva with HandiHaler 18 mcg & inhalation capsules

2 QL

SPIRONOLACTONE 100 MG TABLET 1 YSPIRONOLACTONE 25 MG TABLET 1 YSPIRONOLACTONE 50 MG TABLET 1 YSprintec (28) 0.25 mg-35 mcg tablet 1Sprycel 100 mg tablet * Y QL, PASprycel 140 mg tablet * Y QL, PASprycel 20 mg tablet * Y QL, PASprycel 50 mg tablet * Y QL, PASprycel 70 mg tablet * Y QL, PASprycel 80 mg tablet * Y QL, PASPS 15 gram/60 mL oral suspension 2Sronyx 0.1 mg-20 mcg tablet 1Stalevo 100 25 mg-100 mg-200 mg tablet 3 STSTAVUDINE 1 MG/ML SOLUTION * Y QLSTAVUDINE 15 MG CAPSULE * Y QLSTAVUDINE 20 MG CAPSULE * Y QL



de mantenimiento


del usoSTAVUDINE 30 MG CAPSULE * Y QLSTAVUDINE 40 MG CAPSULE * Y QLStrattera 10 mg capsule 3 Y QL, PAStrattera 100 mg capsule 3 Y QL, PAStrattera 18 mg capsule 3 Y QL, PAStrattera 25 mg capsule 3 Y QL, PAStrattera 40 mg capsule 3 Y QL, PAStrattera 60 mg capsule 3 Y QL, PAStrattera 80 mg capsule 3 Y QL, PASuboxone 12 mg-3 mg sublingual film 3 QL, PASuboxone 2 mg-0.5 mg sublingual film 3 QL, PASUBOXONE 2 MG-0.5 MG TABLET SL 3 QL, PASuboxone 4 mg-1 mg sublingual film 3 QL, PASuboxone 8 mg-2 mg sublingual film 3 QL, PASUBOXONE 8 MG-2 MG TABLET SL 3 QL, PASUCRALFATE 1 GM TABLET 1 YSULFACETAMIDE-SULFUR 10-5% CRM 1SULFAMETHOXAZOLE-TMP DS TABLET 1SULFAMETHOXAZOLE-TMP SUSP 1SUMATRIPTAN 6 MG/0.5 ML INJECT 1 QLSUMATRIPTAN 6 MG/0.5 ML REFILL 1 QLSUMATRIPTAN SUCC 100 MG TABLET 1 QLSUMATRIPTAN SUCC 50 MG TABLET 1 QLSumavel DosePro 6 mg/0.5 mL subcutaneous needle-free injector

3 QL, ST

Sumaxin 10 %-4 % topical pads 3 STSumaxin 9 %-4 % topical cleanser 3 STSumaxin TS 8 %-4 % topical suspension 3 STSuprax 100 mg/5 mL oral suspension 2Suprax 200 mg/5 mL oral suspension 2SUPRAX 400 MG TABLET 2Suprep 17.5 gram-3.13 gram-1.6 gram oral solution 3Sustiva 200 mg capsule * Y QLSustiva 50 mg capsule * Y QLSutent 12.5 mg capsule * Y QL, PASutent 25 mg capsule * Y QL, PASutent 50 mg capsule * Y QL, PASyeda 3 mg-0.03 mg tablet 1Symbicort 160 mcg-4.5 mcg/actuation HFA aerosol inhaler

2 QL

Symbicort 80 mcg-4.5 mcg/actuation HFA aerosol inhaler

2 QL

Symbyax 12 mg-25 mg capsule 3 QL, STSymbyax 12 mg-50 mg capsule 3 QL, ST



de mantenimiento


del usoSymbyax 3 mg-25 mg capsule 3 QL, STSymbyax 6 mg-25 mg capsule 3 QL, STSymbyax 6 mg-50 mg capsule 3 QL, STSynalar 0.025 % topical cream 3 STSynthroid 100 mcg tablet 2 YSynthroid 112 mcg tablet 2Synthroid 125 mcg tablet 2 YSynthroid 137 mcg tablet 2 YSynthroid 150 mcg tablet 2 YSynthroid 175 mcg tablet 2 YSynthroid 200 mcg tablet 2 YSynthroid 25 mcg tablet 2Synthroid 300 mcg tablet 2 YSynthroid 50 mcg tablet 2Synthroid 75 mcg tablet 2Synthroid 88 mcg tablet 2 YTaclonex 0.005 %-0.064 % topical ointment 3 QLTaclonex 0.005 %-0.064 % topical suspension 3 QLTamiflu 6 mg/mL oral suspension 3 QLTamiflu 75 mg capsule 3 QLTAMOXIFEN 20 MG TABLET 1 YTAMSULOSIN HCL 0.4 MG CAPSULE 1 Y QLTasmar 100 mg tablet 3 Y QL, PATazorac 0.05 % topical cream 3 STTazorac 0.05 % topical gel 3 STTazorac 0.1 % topical cream 3 STTazorac 0.1 % topical gel 3 STTecfidera 240 mg capsule,delayed release * Y QL, PATekamlo 150 mg-10 mg tablet 2 Y QLTekamlo 150 mg-5 mg tablet 2 Y QLTekamlo 300 mg-10 mg tablet 2 Y QLTekamlo 300 mg-5 mg tablet 2 Y QLTekturna 150 mg tablet 2 Y QLTekturna 300 mg tablet 2 Y QLTekturna HCT 150 mg-12.5 mg tablet 2 QLTekturna HCT 150 mg-25 mg tablet 2 QLTekturna HCT 300 mg-12.5 mg tablet 2 QLTekturna HCT 300 mg-25 mg tablet 2 QLTEMAZEPAM 15 MG CAPSULE 1 QLTEMAZEPAM 30 MG CAPSULE 1 QLTenoretic 50 50 mg-25 mg tablet 3 STTenormin 100 mg tablet 3 STTenormin 25 mg tablet 3 Y ST



de mantenimiento


del usoTenormin 50 mg tablet 3 STTERBUTALINE SULFATE 5 MG TAB 1 YTestim 50 mg/5 gram (1 %) transdermal gel 2 QLTexacort 2.5 % topical solution 3THEOPHYLLINE ER 100 MG TABLET 1 YTHEOPHYLLINE ER 200 MG TABLET 1 YTHEOPHYLLINE ER 300 MG TAB 1 YThermazene 1 % topical cream 2TICLOPIDINE 250 MG TABLET 1 YTilia Fe 1-20 (5)/1-30(7)/1mg-35mcg(9) tablet 1TIMOLOL MALEATE 20 MG TABLET 1 YTimoptic-XE 0.25 % eye gel 3 STTimoptic-XE 0.5 % eye gel 3 STTIZANIDINE HCL 2 MG TABLET 1 YTIZANIDINE HCL 4 MG TABLET 1 YTL-Select 29 mg-1.25 mg-55 mg-325 mg capsule 1TobraDex 0.3 %-0.1 % eye drops,suspension 3 STTOBRAMYCIN 0.3% EYE DROPS 1TOBRAMYCIN-DEXAMETH OPHTH SUSP 1Tofranil 10 mg tablet 3 Y STTofranil 25 mg tablet 3 Y STTofranil 50 mg tablet 3 Y STTOLMETIN SODIUM 200 MG TAB 1 YTOLMETIN SODIUM 400 MG CAP 1 YTopamax 15 mg sprinkle capsule 3 QLTopamax 25 mg sprinkle capsule 3 QLTOPIRAMATE 100 MG TABLET 1 Y QLTOPIRAMATE 15 MG SPRINKLE CAP 1 Y QLTOPIRAMATE 25 MG SPRINKLE CAP 1 QLTOPIRAMATE 25 MG TABLET 1 Y QLTOPIRAMATE 50 MG TABLET 1 Y QLToviaz 4 mg tablet,extended release 2 QLToviaz 8 mg tablet,extended release 2 QLTracleer 125 mg tablet * Y QL, PATracleer 62.5 mg tablet * Y QL, PATradjenta 5 mg tablet 3 Y QL, STTRAMADOL HCL 50 MG TABLET 1 QLTRAMADOL-ACETAMINOPHN 37.5-325 1 QLTRANEXAMIC ACID 650 MG TABLET 1 Y QL, PATransderm-Scop 1.5 mg transdermal 72 hour patch 3 QLTravatan Z 0.004 % eye drops 2 QLTRAZODONE 100 MG TABLET 1 YTRAZODONE 150 MG TABLET 1 Y



de mantenimiento


del usoTRAZODONE 50 MG TABLET 1 YTRETINOIN 10 MG CAPSULE * Y QL, PATRETINOIN GEL MICRO 0.04% PUMP 1 PATRETINOIN GEL MICRO 0.04% TUBE 1 PATRETINOIN GEL MICRO 0.1% PUMP 1 PATRETINOIN GEL MICRO 0.1% TUBE 1 PATreximet 85 mg-500 mg tablet 3 QLTRIAMCINOLONE 0.1% CREAM 1TRIAMCINOLONE 0.1% OINTMENT 1TRIAMTERENE-HCTZ 37.5-25 MG CP 1 YTRIAMTERENE-HCTZ 37.5-25 MG TB 1TRIAMTERENE-HCTZ 75-50 MG TAB 1 YTRIAZOLAM 0.125 MG TABLET 1 QLTRIAZOLAM 0.25 MG TABLET 1 QLTriCare 27 mg iron-1 mg tablet 2Tricor 145 mg tablet 3 QL, STTricor 48 mg tablet 3 QL, STTRIFLUOPERAZINE 5 MG TABLET 1 YTrileptal 150 mg tablet 3 YTrileptal 300 mg tablet 3Trileptal 600 mg tablet 3 YTri-Linyah (28) 0.18 mg(7)/0.215 mg(7)/0.25 mg(7)-35 mcg tablet

1

Trilipix 135 mg capsule,delayed release 3 QLTrilipix 45 mg capsule,delayed release 3 QLTRIMIPRAMINE MALEATE 100 MG CP 1 YTRIMIPRAMINE MALEATE 25 MG CAP 1 YTRIMIPRAMINE MALEATE 50 MG CAP 1 YTriNessa (28) 0.18 mg(7)/0.215 mg(7)/0.25 mg(7)-35 mcg tablet

1

Tri-Previfem (28) 0.18 mg(7)/0.215 mg(7)/0.25 mg(7)-35 mcg tablet

1

Tri-Sprintec (28) 0.18 mg(7)/0.215 mg(7)/0.25 mg(7)-35 mcg tablet

1

Trivora (28) 50-30 (6)/75-40(5)/125-30(10) tablet 1True2Go Blood Glucose System kit 3TrueControl Level 0 solution 3TrueControl Level 1 solution 3TRUEplus Lancets 28 gauge 2TRUEplus Lancets 30 gauge 2Trueresult Blood Glucose Systm kit 3Truetest High Glucose Control solution 3Truetest Low Glucose Control solution 3Truetest Normal Glucose Control solution 3



de mantenimiento


del usoTruetest Test Strips 2 QLTRUETRACK GLUCOSE CONTROL 3TrueTrack Smart System kit 3Truetrack Test strips 2 QLTruvada 200 mg-300 mg tablet * Y QLTudorza Pressair 400 mcg/actuation breath activated

3 QL

Tussionex Pennkinetic ER 8 mg-10 mg/5 mL suspension,extended release

3 ST

Tyzine 0.05 % nasal drops 2Tyzine 0.1 % nasal drops 2Uloric 40 mg tablet 2 Y QL, STUloric 80 mg tablet 2 Y QL, STUlticare 1 mL 25 x 5/8" syringe 2Ulticare 1.5 mL 22 x 1 1/2" syringe 2Ulticare 29 x 1/2" needle 2Ulticare 31 X 1/4" needle 2Ulticare 31 X 5/16" needle 2Ulticare 32 x 5/32" needle 2ULTICARE THIN 28G LANCETS 2ULTICARE THIN 30G LANCETS 2Ultravate 0.05 % topical cream 3 STUltravate 0.05 % topical ointment 3 STUramaxin GT 45 % topical gel 3 STUREA 40% GEL 1Vagifem 10 mcg vaginal tablet 3VALACYCLOVIR HCL 1 GRAM TABLET 1 Y QLVALACYCLOVIR HCL 500 MG TABLET 1 Y QLVALSARTAN-HCTZ 160-12.5 MG TAB 1 QLVALSARTAN-HCTZ 160-25 MG TAB 1 Y QLVALSARTAN-HCTZ 320-12.5 MG TAB 1 QLVALSARTAN-HCTZ 320-25 MG TAB 1 QLVALSARTAN-HCTZ 80-12.5 MG TAB 1 QLVancocin 125 mg capsule 3 QL, STVancocin 250 mg capsule 3 QL, STVanos 0.1 % topical cream 3 STVasotec 10 mg tablet 3 STVasotec 2.5 mg tablet 3 Y STVasotec 20 mg tablet 3 Y STVasotec 5 mg tablet 3 Y STVeltin 1.2 %-0.025 % topical gel 3VENLAFAXINE HCL 75 MG TABLET 1 YVENLAFAXINE HCL ER 150 MG CAP 1 Y QLVENLAFAXINE HCL ER 150 MG TAB 3 Y QL



de mantenimiento


del usoVENLAFAXINE HCL ER 225 MG TAB 3 Y QLVENLAFAXINE HCL ER 37.5 MG CAP 1 Y QLVENLAFAXINE HCL ER 37.5 MG TAB 3 Y QLVENLAFAXINE HCL ER 75 MG CAP 1 Y QLVENLAFAXINE HCL ER 75 MG TAB 3 Y QLVentolin HFA 90 mcg/actuation aerosol inhaler 2 QLVeramyst 27.5 mcg/actuation nasal spray,suspension

2 QL

VERAPAMIL 360 MG CAP PELLET 1 Y QLVERAPAMIL ER 240 MG TABLET 1 Y QLVERAPAMIL ER PM 100 MG CAPSULE 1 Y QLVERAPAMIL ER PM 200 MG CAPSULE 1 Y QLVERAPAMIL ER PM 300 MG CAPSULE 1 Y QLVeregen 15 % topical ointment 2 QLVesicare 10 mg tablet 2 Y QLVesicare 5 mg tablet 2 Y QLVicodin 5 mg-300 mg tablet 1 QLVicodin ES 7.5 mg-300 mg tablet 1 QLVicodin HP 10 mg-300 mg tablet 1 QLVictoza 2-Pak 0.6 mg/0.1 mL (18 mg/3 mL) subcutaneous pen injector

2 QL, ST

Victoza 3-Pak 0.6 mg/0.1 mL (18 mg/3 mL) subcutaneous pen injector

2 QL, ST

Victrelis 200 mg capsule * Y QL, PAVidex 2 gram Pediatric 10 mg/mL (Final Conc.) oral solution

* Y QL

Videx EC 125 mg capsule,delayed release * Y QLVidex EC 200 mg capsule,delayed release * Y QLVidex EC 250 mg capsule,delayed release * Y QLVidex EC 400 mg capsule,delayed release * Y QLVigamox 0.5 % eye drops 2Viibryd 10 mg (7)-20 mg (7)-40 mg(16) tablets in a dose pack

3 QL, ST

Viibryd 10 mg tablet 3 Y QL, STViibryd 20 mg tablet 3 Y QL, STViibryd 40 mg tablet 3 Y QL, STVimpat 10 mg/mL oral solution 3 QLVimpat 100 mg tablet 3 YVimpat 150 mg tablet 3 YVimpat 200 mg tablet 3 YVimpat 50 mg tablet 3 YVinate Care 40 mg iron-1 mg chewable tablet 2Viorele (28) 0.15 mg-0.02 mg(21)/0.01 mg(5) tablet 1Viracept 250 mg tablet * Y QL



de mantenimiento


del usoViracept 625 mg tablet * Y QLViramune 50 mg/5 mL oral suspension * Y QLViramune XR 100 mg tablet,extended release 3 QLViramune XR 400 mg tablet,extended release * Y QLVirasal 27.5 % topical film-forming liquid 3 STViread 150 mg tablet * Y QLViread 200 mg tablet * Y QLViread 250 mg tablet * Y QLViread 300 mg tablet * Y QLViread 40 mg/scoop (40 mg/gram) oral powder * Y QLVirt-Bal DHA 26 mg iron-1 mg-374 mg tablet&capsule,delayed release

3

Virt-Bal DHA Plus 26 mg iron-1 mg-374 mg tablet&capsule,delay release

3

VIT D2 1.25 MG (50,000 UNIT) 1Vitafol-One 29 mg iron-1 mg-200 mg capsule 3VitaMed Md One Rx 30 mg iron-1 mg-200 mg capsule

2

VitaMed Md Plus Rx 30 mg iron-1 mg-300 mg oral pack

2

VitaMedMD RediChew Rx 1.4 mg chew tablet,immediate & delayed rel

3

VITAMEDMD REDICHEW RX TAB CHEW 2Vitamin D2 50,000 unit capsule 1Viva DHA 28 mg-1 mg-200 mg capsule 3Vivelle-Dot 0.0375 mg/24 hr transdermal patch 3 QLVivelle-Dot 0.05 mg/24 hr transdermal patch 3 QLVivelle-Dot 0.075 mg/24 hr transdermal patch 3 QLVivelle-Dot 0.1 mg/24 hr transdermal patch 3 QLVoltaren 1 % topical gel 3Vospire ER 4 mg tablet,extended release 3Vospire ER 8 mg tablet,extended release 3Vytorin 10 mg-20 mg tablet 3 QL, STVytorin 10 mg-40 mg tablet 3 QL, STVyvanse 20 mg capsule 2 QLVyvanse 30 mg capsule 2 QLVyvanse 40 mg capsule 2 QLVyvanse 50 mg capsule 2 QLVyvanse 60 mg capsule 2 QLVyvanse 70 mg capsule 2 QLWARFARIN SODIUM 1 MG TABLET 1 YWARFARIN SODIUM 5 MG TABLET 1 YWelChol 3.75 gram oral powder packet 2WelChol 625 mg tablet 2 Y



de mantenimiento


del usoWellbutrin XL 150 mg 24 hr tablet, extended release 3 QL, STWellbutrin XL 300 mg 24 hr tablet, extended release 3 QL, STWesthroid 195 mg tablet 3 YWymzya Fe 0.4 mg-35 mcg (21)/75 mg (7) chewable tablet

1

Xarelto 10 mg tablet 2 QLXarelto 15 mg tablet 2 Y QLXarelto 20 mg tablet 2 Y QLXopenex HFA 45 mcg/actuation aerosol inhaler 3 QLYAZ (28) 3 mg-20 mcg tablet 3ZALEPLON 10 MG CAPSULE 1 QLZANTAC 15 MG/ML SYRUP 3 STZantac 150 mg tablet 3 Y STZantac 300 mg tablet 3 Y STZarah 3 mg-0.03 mg tablet 1Zavesca 100 mg capsule * Y QL, PAZenChent (28) 0.4 mg-35 mcg tablet 1Zenpep 10,000-34,000-55,000 unit capsule,delayed release

2

Zenpep 15,000-51,000-82,000 unit capsule,delayed release

2


2


2


2


2

Zerit 20 mg capsule * Y QLZerit 30 mg capsule * Y QLZestoretic 10 mg-12.5 mg tablet 3 STZestoretic 20 mg-12.5 mg tablet 3 STZestoretic 20 mg-25 mg tablet 3 STZestril 10 mg tablet 3 STZestril 2.5 mg tablet 3 Y STZestril 20 mg tablet 3 STZestril 30 mg tablet 3 STZestril 40 mg tablet 3 Y STZestril 5 mg tablet 3 STZetia 10 mg tablet 2 Y QLZetonna 37 mcg/actuation nasal HFA inhaler 2 QLZiac 10 mg-6.25 mg tablet 3 STZiac 2.5 mg-6.25 mg tablet 3 ST



de mantenimiento


del usoZiac 5 mg-6.25 mg tablet 3 STZiagen 20 mg/mL oral solution * Y QLZiagen 300 mg tablet * Y QL, STZiana 1.2 %-0.025 % topical gel 3ZIDOVUDINE 100 MG CAPSULE * Y QLZIDOVUDINE 50 MG/5 ML SYRUP * Y QLZIPRASIDONE HCL 20 MG CAPSULE 1 Y QLZIPRASIDONE HCL 40 MG CAPSULE 1 Y QLZIPRASIDONE HCL 60 MG CAPSULE 1 Y QLZIPRASIDONE HCL 80 MG CAPSULE 1 Y QLZithromax 1 gram oral packet 3 STZithromax 100 mg/5 mL oral suspension 3 STZithromax 200 mg/5 mL oral suspension 3 STZithromax 250 mg tablet 3 STZithromax 500 mg tablet 3 STZithromax 600 mg tablet 3 QL, STZithromax TRI-PAK 500 mg tablet 3 STZithromax Z-Pak 250 mg tablet 3 STZOLPIDEM TART ER 12.5 MG TAB 1 QL, STZOLPIDEM TARTRATE 10 MG TABLET 1 QLZOLPIDEM TARTRATE 5 MG TABLET 1 QLZonalon 5 % topical cream 2Zonegran 100 mg capsule 3 YZonegran 25 mg capsule 3 YZONISAMIDE 100 MG CAPSULE 1Zortress 0.25 mg tablet 3 Y QL, PAZortress 0.5 mg tablet 3 Y QL, PAZortress 0.75 mg tablet 3 Y QL, PAZovia 1/35E (28) 1 mg-35 mcg tablet 1Zovirax 200 mg capsule 3 Y STZovirax 200 mg/5 mL oral suspension 3 STZovirax 400 mg tablet 3 Y STZovirax 5 % topical cream 3 PAZovirax 5 % topical ointment 3 PAZovirax 800 mg tablet 3 Y STZutripro 4 mg-60 mg-5 mg/5 mL oral solution 3Zyclara 2.5 % topical cream pump 3 QL, STZyclara 3.75 % topical cream packet 3 STZyclara 3.75 % topical cream pump 3 QL, STZymaxid 0.5 % eye drops 2 QLZytiga 250 mg tablet * Y QL, PA


Humana.com

Administrado por Humana Insurance Company

Para obtener más información sobre la empresa que presta sus beneficios, consulte su Documento de beneficios del plan (Certificado de cobertura/seguro o la Descripción resumida del plan).

Nuestros planes de beneficios de salud tienen limitaciones y exclusiones.

Tenga en cuenta que: Esta es una lista parcial.

Todas las listas están sujetas a cambio. Los beneficios varían según el plan. Esta Lista de medicamentos puede no corresponder a todos los planes. Consulte el Resumen de Beneficios o Humana.com para ver el beneficio específico de medicamentos recetados, incluidos los copagos, las limitaciones y las exclusiones. También puede llamar a un representante del Servicio al Cliente de Humana al número de teléfono que está al dorso de la tarjeta de identificación de afiliado de Humana.

Vaya a Humana.com para obtener una Lista de medicamentos vigente. Visite el sitio Web de Humana para obtener la Lista de medicamentos más actualizada. La lista en línea se actualiza regularmente. Además, puede obtener más información sobre el beneficio de medicamentos recetados y los copagos. Se aconseja a los afiliados que, antes de ir a la farmacia, vayan a Humana.com e inicien sesión en MyHumana o hagan clic en “Register Now” (Registrarse ahora) para obtener esta información y más.

Documents

Lista de medicamentos de Rx3