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Marketplace Exchange Standard FormularyL.A. Care Covered
Administered by MedImpactEffective May 2014
ForewordThis document represents the efforts of L.A. Care HealthPlan and the MedImpact Healthcare Systems Pharmacyand Therapeutics (P & T) and Formulary Committees toprovide physicians and pharmacists with a method toevaluate the safety, efficacy and cost-effectiveness ofcommercially available drug products. A structuredapproach to the drug selection process is essential inensuring continuing patient access to rational drugtherapies. This is accomplished through the auspices of theMedImpact P & T and Formulary Committees. Thesecommittees meet quarterly and more often as warrantedto ensure clinical relevancy of the Formulary. Toaccommodate changes to this document, updates aremade accessible as necessary. Access to the most current version of the L.A. CareCovered Formulary can be obtained by visitinghttp://www.lacarecovered.org/for-members/pharmacy-center. The MedImpact P & T and Formulary Committees use thefollowing criteria in the evaluation of drug selection for theMarketplace Exchange Standard Formulary:• Drug safety profile• Drug efficacy• Comparison of relevant therapeutic benefits to currentformulary agents of similar use, and to minimizetherapeutic duplication where possible• Cost-effectiveness relative to comparable therapies
How to Use the FormularyThe Formulary is a list of medications available to L.A.Care Covered members under their pharmacy benefit. Alldrugs are listed by their generic names and most commonproprietary (branded) name. The Formulary may beaccessed by using the index, either by generic orproprietary name and by therapeutic drug category. Insituations where an FDA approved generic equivalent isavailable, brand names are listed for reference purposes
only, and do not denote coverage for the brand, unlessspecifically noted. All drugs are listed in each category in alphabetical orderby generic name. Where an FDA approved generic isavailable for the listed generic name, the generic name isbolded. For certain agents within the Formulary, a recommendedprescribing guideline may apply. These are denotedthroughout the document using the following symbols: Symbol Guideline Description
AGE Age Edit Coverage may depend onpatient age
G Gender Edit Coverage may depend onpatient gender
PA PriorAuthorization
Requires specific physicianrequest process
QL QuantityLimit
Coverage may be limited tospecific quantities perprescription and/or time period
ST StepTherapy
Coverage may depend onprevious use of another drug
Please refer to the prescribing guideline appendix withinthis document for details regarding specific agents.
Benefit Coverage and LimitationsThis printed Formulary does not provide informationregarding the specific coverage and limitations anindividual member may be subject to. Many membershave specific benefit inclusions, exclusions, copays, or alack of coverage, which are not reflected in the Formulary. The Formulary applies only to outpatient drugs providedto members, and does not apply to medications used ininpatient settings. If a member has any specific questionsregarding their coverage, they should contact L.A. Care
L.A. Care Page 1 of 96
Health Plan at (855) 270-2327 or MedImpact at (800)788-2949.
Depending upon a member’s specificbenefit parameters, the followingtopics may apply:1.Generic SubstitutionWhen available, FDA approved generic drugs are tobe used in all situations, regardless of the brand nameindicated. The generic names are bolded in theformulary listing wherever an FDA approved genericdrug product is available. Greater economy is realizedthrough the use of generic equivalents. This policy isnot meant to preclude or supplant any state statutesthat may exist. All drugs that are or become availablegenerically are subject to review by MedImpact’sPharmacy and Therapeutics Committee. MedImpactapproves such multi-source drugs for addition to theMAC list based on the following criteria:• A multi-source drug product manufactured by atleast one (1) nationally marketed company.• At least one (1) of the generic manufacturer’sproducts must have an “A” rating or the genericproduct has been determined to be unassociatedwith efficacy, safety or bioequivalency concerns bythe MedImpact P & T Committee.• Drug product will be approved for genericsubstitution by the MedImpact P & T Committee.
This list is reviewed and updated periodically basedon the clinical literature and pharmacokineticcharacteristics of currently available versions of thesedrug products. If a member or physician requests a brand nameproduct in lieu of an approved generic, the member,based upon their coverage, will typically be requiredto pay the difference in cost between the brand andthe generic. If a physician determines that there is adocumented medical need for the brand equivalent, arequest for coverage may be made using themedication request process.
2.Tier Benefit DesignThe Formulary may be applied to a tier benefit design,where the member shares the cost of prescriptiondrug therapy based on the drug’s tier and copaymentor coinsurance. In most instances, genericallyavailable drugs will be covered in a separate lower tier
(low copay), preferred branded drugs listed on theFormulary will be covered under a higher tier, andbranded drugs not on the Formulary will be coveredunder a separate non-preferred branded drug copaytier. Specialty drugs will be covered under the highesttier (highest copay). Essential healthbenefit/preventative medications, if available on theformulary (applies to new and non-grandfatheredplans), will be covered without cost sharing (zerocopay). Tier Definitions
Tier 1: Preferred generic medications(formulary agents)
Tier 2: Preferred brand medications (formularyagents)
Tier 3: Non-preferred medications (non-formulary agents)
Tier 4: Specialty medicationsTier 5: EHB Zero Copay/Preventative
medications
3.Medication Request ProcessDepending upon plan benefit design, a medicationrequest process may apply as follows:
Drugs that are listed in the Formulary withassociated Prior Authorization (PA) requireevaluation, per MedImpact P & T CommitteePrior Authorization guidelines prior to dispensingat a pharmacy. Each request will be reviewed onan individual patient need basis. If the requestdoes not meet the guidelines established by theP & T Committee, the request will not beapproved and alternative therapy may berecommended. If the request does not meet the guidelinesestablished by the P & T Committee, the requestwill not be approved and alternative therapy maybe recommended. Obtaining CoverageCoverage, questions or information regarding themedication request or formulary process may beobtained by:1. Faxing a completed Medication RequestForm to MedImpact at (800) 681-7651.
2. Contacting MedImpact at (855) 270-2327 andproviding all necessary information requested.
L.A. Care Page 2 of 96
MedImpact will provide an authorization number,specific for the medical need, for all approvedrequests. Non-approved requests may beappealed. The prescriber must provideinformation to support the appeal on the basis ofmedical necessity. Prior Authorization is generallynot available for drugs that are specificallyexcluded by benefit design.
4.General Exclusions
A. Over the Counter (OTC) medications or theirequivalents, unless the individual’s pharmacybenefit offers coverage of OTC medications.
B. Drugs specifically listed as not covered.C.Any drug products used for cosmetic purposes.D.Experimental drug products or any drug productused in an experimental manner.
E. Replacement of lost or stolen medication.F. Non self-administered injectable drug productsunless otherwise specified in the Formularylisting.
G.Foreign sourced drugs or drugs not approved bythe United States Food & Drug Administration,except in certain cases of drug shortage, whenallowed under the individual's pharmacy benefit.
The P & T and Formulary Committees recognizethat not all medical needs can be met with thisdocument and encourage inquiries about alternativetherapies.
5.Pharmacist and Physician CommunicationThe Formulary is a tool to promote cost-effectiveprescription drug use. The P & T and FormularyCommittees have made every attempt to create adocument that meets all therapeutic needs; however,the art of medicine makes this a formidable task.MedImpact welcomes the participation of physicians,pharmacists, and ancillary medical providers, in thisdynamic process. Physicians and pharmacists arehighly encouraged to direct any suggestions,comments or formulary additions to MedImpact at thefollowing address: Chairperson, Pharmacy & Therapeutics CommitteeMedImpact Healthcare Systems, Inc.10181 Scripps Gateway CourtSan Diego, CA 92131
L.A. Care Page 3 of 96
ALLERGY2nd Gen Antihistamine & Decongestant
CombinationsT3 desloratadine/pseudoe
phedrineCLARINEX-D 12HOUR
QL, ST
T3 desloratadine/pseudoephedrine
CLARINEX-D 24HOUR
QL, ST
T1 fexofenadine/pseudoephedrine
FEXOFENADINE/PSEUDOEPHEDRINE
T3 pseudoephedrinehcl/acrivas
SEMPREX-D
Allergenic Extracts, TherapeuticsT3 gr pol-orc/sw
ver/rye/kent/timORALAIR PA
T3 grass pollen-timothy,std
GRASTEK PA
T3 weed pollen-shortragweed
RAGWITEK PA
AntihistaminesT1 tripelennamine hcl TRIPELENNAMINE
HCL
Antihistamines - 1st GenerationT1 carbinoxamine
maleateCARBINOXAMINEMALEATE
AGE
T1 carbinoxaminemaleate
PALGIC AGE
T1 chlorpheniraminemaleate
CHLORPHENIRAMINE MALEATE
T3 chlorpheniraminetannate
RICOBID-H
T1 clemastine fumarate CLEMASTINEFUMARATE
T1 cyproheptadine hcl CYPROHEPTADINEHCL
T1 dexchlorpheniraminemaleate
DEXCHLORPHENIRAMINE MALEATE
T3 diphenhydramine hcl DICOPANOLT1 diphenhydramine hcl DIPHENHYDRAMINE
HCLT1 hydroxyzine hcl HYDROXYZINE HCLT1 hydroxyzine pamoateHYDROXYZINE
PAMOATET1 hydroxyzine pamoateVISTARILT1 promethazine hcl PHENERGANT1 promethazine hcl PROMETHAZINE HCL
Antihistamines - 2nd GenerationT1 cetirizine hcl CETIRIZINE HCLT3 desloratadine CLARINEX(SYRUP) QL, STT1 desloratadine CLARINEX(TAB) QLT1 desloratadine DESLORATADINE QL, STT1 fexofenadine hcl FEXOFENADINE HCLT1 levocetirizine
dihydrochlorideXYZAL(SOLUTION) QL, ST
T1 levocetirizinedihydrochloride
XYZAL(TAB)
Nasal AntihistamineT1 azelastine hcl ASTELIN QLT3 olopatadine hcl PATANASE QL, ST
Nasal Antihistamine & Anti-inflam. Steroid
Comb.T3 azelastine/fluticasone DYMISTA QL, ST
Nasal Anti-inflammatory SteroidsT3 beclomethasone
dipropionateBECONASE AQ QL, ST
T2 beclomethasonedipropionate
QNASL QL, ST
T3 ciclesonide OMNARIS QL, STT3 ciclesonide ZETONNA QL, STT1 flunisolide FLUNISOLIDE QLT3 fluticasone furoate VERAMYST QL, STT1 fluticasone
propionateFLONASE QL
T2 mometasone furoate NASONEX QLT1 triamcinolone
acetonideNASACORT AQ QL
ANTIEMESIS/ANTIVERTIGOAntiemetic/antivertigo AgentsT2 aprepitant EMEND(CAP DS PK) QLT2 aprepitant EMEND(CAP)(125
MG)QL
T2 aprepitant EMEND(CAP)(40 MG) QLT2 aprepitant EMEND(CAP)(80 MG) QLT3 dolasetron mesylate ANZEMET(TAB)(100
MG)QL, ST
T3 dolasetron mesylate ANZEMET(TAB)(50MG)
QL, ST
T3 doxylamine/pyridoxinehcl
DICLEGIS QL
T1 dronabinol MARINOL QL, STT3 granisetron SANCUSO QL, STT1 granisetron hcl GRANISETRON HCL QL, STT1 meclizine hcl ANTIVERTT3 nabilone CESAMET QL, STT1 ondansetron ZOFRAN ODTT3 ondansetron ZUPLENZ(FILM)(4
MG)QL, ST
T3 ondansetron ZUPLENZ(FILM)(8MG)
QL, ST
T1 ondansetron hcl ONDANSETRON HCLT1 ondansetron hcl ZOFRAN(SOLUTION) QLT1 ondansetron hcl ZOFRAN(TAB)T2 prochlorperazine
edisylateCOMPAZINE
T1 prochlorperazinemaleate
PROCHLORPERAZINE MALEATE
T1 promethazine hcl PROMETHEGANT3 scopolamine TRANSDERM-SCOPT1 trimethobenzamide
hclTIGAN
T1 trimethobenzamidehcl/b-caine
TRIMETHOBENZAMIDE HCL
Commercial Formulary
L.A. Care Page 4 of 96
ASTHMA5-lipoxygenase InhibitorsT3 zileuton ZYFLOT3 zileuton ZYFLO CR
Adrenergic Agents,catecholaminesT1 epinephrine EPINEPHRINET1 isoetharine hcl ISOETHARINE HCL
Beta-adrenergic AgentsT1 albuterol sulfate ALBUTEROL
SULFATET3 albuterol sulfate PROAIR HFAT3 albuterol sulfate PROVENTIL HFAT2 albuterol sulfate VENTOLIN HFAT1 albuterol sulfate VOSPIRE ERT3 arformoterol tartrate BROVANA QLT3 formoterol fumarate FORADIL QL, STT2 formoterol fumarate PERFOROMIST QLT3 indacaterol maleate ARCAPTA
NEOHALERQL, ST
T1 levalbuterol hcl XOPENEXT3 levalbuterol tartrate XOPENEX HFAT1 metaproterenol
sulfateMETAPROTERENOLSULFATE
T3 pirbuterol acetate MAXAIR AUTOHALERT2 salmeterol xinafoate SEREVENT DISKUS QLT1 terbutaline sulfate TERBUTALINE
SULFATE
Beta-adrenergic And Anticholinergic
CombinationsT2 ipratropium/albuterol
sulfateCOMBIVENT
T2 ipratropium/albuterolsulfate
COMBIVENTRESPIMAT
T1 ipratropium/albuterolsulfate
DUONEB
T3 umeclidiniumbrm/vilanterol tr
ANORO ELLIPTA QL
Beta-adrenergic And Glucocorticoid
CombinationsT3 budesonide/formoterol
fumarateSYMBICORT QL, ST
T3 fluticasone/salmeterol ADVAIR DISKUS QLT3 fluticasone/salmeterol ADVAIR HFA QLT3 fluticasone/vilanterol BREO ELLIPTA QLT2 mometasone/formoter
olDULERA QL
General Bronchodilator AgentsT3 aclidinium bromide TUDORZA PRESSAIRQL, STT1 guaifenesin/dyphyllin
eDIFIL-G 400
T1 guaifenesin/theophylline
BRONCOMAR GG
T3 guaifenesin/theophylline
QUIBRON
T2 ipratropium bromide ATROVENT HFA QLT1 ipratropium bromide IPRATROPIUM
BROMIDET2 tiotropium bromide SPIRIVA QL
Glucocorticoids, Orally InhaledT2 beclomethasone
dipropionateQVAR QL
T3 budesonide PULMICORTFLEXHALER
QL, ST
T1 budesonide PULMICORT(AMPUL-NEB)(0.25MG/2ML)
QL
T1 budesonide PULMICORT(AMPUL-NEB)(0.5 MG/2ML)
QL
T2 budesonide PULMICORT(AMPUL-NEB)(1 MG/2 ML)
QL
T3 ciclesonide ALVESCO QL, STT3 flunisolide AEROSPAN QL, STT2 fluticasone propionate FLOVENT
DISKUS(BLSTW/DEV)(100 MCG)
QL
T2 fluticasone propionate FLOVENTDISKUS(BLSTW/DEV)(250 MCG)
QL
T2 fluticasone propionate FLOVENTDISKUS(BLSTW/DEV)(50 MCG)
QL
T2 fluticasone propionate FLOVENT HFA(AERW/ADAP)(110 MCG)
QL
T2 fluticasone propionate FLOVENT HFA(AERW/ADAP)(220 MCG)
QL
T2 fluticasone propionate FLOVENT HFA(AERW/ADAP)(44 MCG)
QL
T3 mometasone furoate ASMANEX QL, ST
Leukotriene Receptor AntagonistsT1 montelukast sodium SINGULAIRT1 zafirlukast ACCOLATE
Mast Cell StabilizersT1 cromolyn sodium CROMOLYN SODIUMT1 cromolyn sodium GASTROCROM
Monoclonal Antibodies To Immunoglobulin
ET4 omalizumab XOLAIR PA, QL
Phosphodiesterase-4 (pde4) InhibitorsT2 roflumilast DALIRESP QL, ST
Respiratory Aids,devices,equipmentT3 compressor, for
nebulizerDEVILBISS PULMO-AIDE
T3 inhaler, assist devices ACE AEROSOLCLOUD ENHANCER
T3 inhaler, assist devices AEROCHAMBER MINIT3 inhaler, assist devices AEROCHAMBER MVT3 inhaler, assist devices AEROCHAMBER
PLUS
Commercial Formulary
L.A. Care Page 5 of 96
T3 inhaler, assist devices AEROCHAMBERPLUS FLOW-VU
T3 inhaler, assist devices AEROCHAMBERPLUS Z STAT
T3 inhaler, assist devices AEROCHAMBERWITH FLOWSIGNAL
T3 inhaler, assist devices AEROCHAMBER Z-STAT PLUS
T3 inhaler, assist devices AEROTRACH PLUST3 inhaler, assist devices AEROVENT IIT3 inhaler, assist devices BREATHERITET3 inhaler, assist devices BREATHRITET3 inhaler, assist devices EASIVENTT3 inhaler, assist devices E-Z SPACERT3 inhaler, assist devices LITEAIRET3 inhaler, assist devices MICROCHAMBERT3 inhaler, assist devices MICROSPACERT3 inhaler, assist devices MONAGHAN Z STATT3 inhaler, assist devices POCKET CHAMBERT3 inhaler, assist devices PRIMEAIRET3 inhaler, assist devices PROCHAMBERT3 inhaler, assist devices RITEFLOT3 inhaler, assist devices VORTEXT3 inhaler, assist devices VORTEX VHC FROG
MASKT3 inhaler, assist devices VORTEX VHC
LADYBUG MASKT3 inhaler, assist devices WATCHHALERT3 inhaler,assist
device,accesoryEASIVENT
T3 inhaler,assistdevice,accesory
LITETOUCH
T3 inhaler,assistdevice,accesory
OPTICHAMBER
T3 inhaler,assistdevice,accesory
OPTICHAMBERDIAMOND
T3 inhaler,assistdevice,accesory
SILICONE MASK
T3 nebulizer AEROECLIPSET3 nebulizer AEROECLIPSE IIT3 nebulizer ALTERA NEBULIZERT3 nebulizer BABY NEBULIZERT3 nebulizer ERAPID NEBULIZERT3 nebulizer INSPIRATIONT3 nebulizer LC D NEBULIZER
SETT3 nebulizer LC PLUST3 nebulizer LC SPRINT
NEBULIZERT3 nebulizer LC START3 nebulizer MICRO PLUST3 nebulizer MINI PLUS
NEBULIZERT3 nebulizer MISTERNEB
NEBULIZERT3 nebulizer NASONEB NASAL
NEBULIZERT3 nebulizer PARI LC SPRINT
SINUST3 nebulizer PRODIGY MINI-MISTT3 nebulizer SIDESTREAM
T3 nebulizer SIDESTREAMNEBULIZER
T3 nebulizer SIDESTREAM PLUST3 nebulizer SINUSTART3 nebulizer/compressor COMP-AIR ELITE
COMPRESSOR SYSTT3 nebulizer/compressor COMP-AIR
NEBULIZERCOMPRESSOR
T3 nebulizer/compressor DEVILBISSTRAVELER
T3 nebulizer/compressor INNOSPIREELEGANCE
T3 nebulizer/compressor INNOSPIREESSENCE
T3 nebulizer/compressor INSPIRATION ELITET3 nebulizer/compressor MICRO ELITET3 nebulizer/compressor MINIELITET3 nebulizer/compressor NASONEB NASAL
NEBULIZERT3 nebulizer/compressor PARI SINUS
AEROSOL SYSTEMT3 nebulizer/compressor PRONEB ULTRAT3 nebulizer/compressor PRONEB ULTRA IIT3 nebulizer/compressor SAMI THE SEALT3 nebulizer/compressor SINUSTART3 nebulizer/compressor TREK S COMBO
PACKT3 nebulizer/compressor TREK S COMPACT
COMPRESSORT3 nebulizer/compressor VIOS AEROSOL
DELIVERY SYSTEMT3 peak flow meter MINI-WRIGHT PEAK
FLOW METERT3 peak flow meter TRUZONE PEAK
FLOW METERT3 peak flow meter/inh
asst devAEROGEAR ASTHMAACTION KIT
T3 peak flow meter/inhasst dev
ASTHMAPACKCHILDREN'S
T3 spirometers andaccessories
PFLEX TRAINER
T3 spirometers andaccessories
THRESHOLD IMT
T3 spirometers andaccessories
THRESHOLD PEP
XanthinesT1 aminophylline AMINOPHYLLINET1 caffeine citrated CAFCITT3 dyphylline LUFYLLINT3 dyphylline LUFYLLIN-400T1 theophyll/ephed
hcl/phenobarbTHEOTAL
T2 theophylline anhydrousTHEO-24T1 theophylline
anhydrousTHEOPHYLLINEANHYDROUS
Commercial Formulary
L.A. Care Page 6 of 96
AUTONOMIC NERVOUS SYSTEM
DISORDERSAlzheimer's Therapy, Nmda Receptor
AntagonistsT2 memantine hcl NAMENDA XR(CAP
24 DSPK)QL
T2 memantine hcl NAMENDA XR(CAPSPR 24)
QL
T2 memantine hcl NAMENDA(SOLUTION)
QL
T2 memantine hcl NAMENDA(TAB DSPK)
QL
T2 memantine hcl NAMENDA(TAB) QL
Cholinesterase InhibitorsT1 donepezil hcl ARICEPTT1 galantamine hbr RAZADYNE QLT1 galantamine hbr RAZADYNE ER QLT2 neostigmine bromide PROSTIGMINT2 pyridostigmine
bromideMESTINON(SYRUP)
T2 pyridostigminebromide
MESTINON(TAB ER)
T1 pyridostigminebromide
MESTINON(TAB)
T2 rivastigmine EXELON QLT1 rivastigmine tartrate EXELON(CAP)T2 rivastigmine tartrate EXELON(SOLUTION)
BEHAVIORAL HEALTH -
ANTIDEPRESSANTSAlpha-2 Receptor Antagonist
AntidepressantsT1 mirtazapine MIRTAZAPINET1 mirtazapine REMERON
Maois - Non-selective & IrreversibleT3 isocarboxazid MARPLANT1 phenelzine sulfate NARDILT1 tranylcypromine
sulfatePARNATE
Norepinephrine And Dopamine Reuptake
InhibT3 bupropion hbr APLENZIN QL, STT3 bupropion hcl FORFIVO XL QL, STT1 bupropion hcl WELLBUTRIN XL
Selective Serotonin Reuptake InhibitorT1 citalopram
hydrobromideCELEXA
T1 citalopramhydrobromide
CITALOPRAM HBR
T1 escitalopram oxalate LEXAPROT1 fluoxetine hcl FLUOXETINE HCLT1 fluoxetine hcl PROZACT3 fluoxetine hcl SARAFEMT1 fluvoxamine maleate FLUVOXAMINE
MALEATET1 fluvoxamine maleate LUVOX CR QL, STT1 paroxetine hcl PAROXETINE HCLT1 paroxetine hcl PAXIL CRT2 paroxetine hcl PAXIL(ORAL SUSP)T1 paroxetine hcl PAXIL(TAB)T3 paroxetine mesylate BRISDELLE QL, STT3 paroxetine mesylate PEXEVA QL, STT1 sertraline hcl ZOLOFT
Serotonin-2 Antagonist/reuptake InhibitorsT1 nefazodone hcl NEFAZODONE HCLT3 trazodone hcl OLEPTRO ER QL, STT1 trazodone hcl TRAZODONE HCL
Serotonin-norepinephrine Reuptake-inhibT1 desvenlafaxine KHEDEZLA QL, STT3 desvenlafaxine
fumarateDESVENLAFAXINEFUMARATE ER
T2 desvenlafaxinesuccinate
PRISTIQ ER QL, ST
T1 duloxetine hcl DULOXETINE HCL QLT3 levomilnacipran
hydrochlorideFETZIMA QL, ST
T3 venlafaxine hcl VENLAFAXINE HCLER
Ssri & 5ht1a Partial Agonist AntidepressantT3 vilazodone
hydrochlorideVIIBRYD(TAB DS PK) ST
T3 vilazodonehydrochloride
VIIBRYD(TAB) QL, ST
Ssri & Serotonin Receptor Modulator
AntidepressantT3 vortioxetine
hydrobromideBRINTELLIX QL, ST
Tricyclic Antidepressant/benzodiazepine
CombinatnsT1 amitrip
hcl/chlordiazepoxideCHLORDIAZEPOXIDE-AMITRIPTYLINE
Tricyclic Antidepressant/phenothiazine
CombinatnsT1 perphenazine/amitrip
tyline hclPERPHENAZINE-AMITRIPTYLINE
Tricyclic Antidepressants & Rel. Non-sel. Ru-
inhibT1 amitriptyline hcl AMITRIPTYLINE HCLT1 amoxapine AMOXAPINET1 clomipramine hcl ANAFRANIL
Commercial Formulary
L.A. Care Page 7 of 96
T1 desipramine hcl NORPRAMINT1 doxepin hcl DOXEPIN HCLT1 imipramine hcl TOFRANILT1 imipramine pamoate TOFRANIL-PMT1 maprotiline hcl MAPROTILINE HCLT1 nortriptyline hcl NORTRIPTYLINE HCLT1 nortriptyline hcl PAMELORT1 protriptyline hcl VIVACTILT3 trimipramine maleate SURMONTIL
BEHAVIORAL HEALTH - OTHERAdrenergics, Aromatic, Non-catecholamineT1 dextroamphetamine
sulfateDEXEDRINE(CAPER)(10 MG)
QL
T1 dextroamphetaminesulfate
DEXEDRINE(CAPER)(15 MG)
QL
T1 dextroamphetaminesulfate
DEXEDRINE(CAPER)(5 MG)
QL
T1 dextroamphetaminesulfate
DEXTROAMPHETAMINE SULFATE(TAB)(10MG)
QL
T1 dextroamphetaminesulfate
DEXTROAMPHETAMINE SULFATE(TAB)(5MG)
QL
T1 dextroamphetaminesulfate
PROCENTRA QL
T2 dextroamphetaminesulfate
ZENZEDI QL, ST
T1 dextroamphetamine/amphetamine
ADDERALL QL
T2 lisdexamfetaminedimesylate
VYVANSE QL, ST
T1 methamphetaminehcl
DESOXYN QL
Anti-alcoholic PreparationsT1 disulfiram ANTABUSET4 naltrexone
microspheresVIVITROL
Anti-anxiety DrugsT1 alprazolam ALPRAZOLAMT2 alprazolam ALPRAZOLAM
INTENSOLT1 alprazolam XANAXT1 buspirone hcl BUSPIRONE HCLT3 chlordiazepoxide LIBRITABST1 chlordiazepoxide hcl CHLORDIAZEPOXIDE
HCLT1 clorazepate
dipotassiumTRANXENE T-TAB
T1 diazepam DIAZEPAMT1 diazepam VALIUMT1 lorazepam ATIVANT1 lorazepam LORAZEPAMT1 meprobamate MEPROBAMATET1 meprobamate MILTOWNT1 oxazepam OXAZEPAM
Anti-mania DrugsT3 carbamazepine EQUETRO
T1 lithium carbonate ESKALITHT1 lithium carbonate LITHIUM
CARBONATET1 lithium carbonate LITHOBIDT1 lithium citrate LITHIUM
Anti-narcolepsy & Anti-cataplexy,sedative-
type AgtT3 sodium oxybate XYREM PA
Antipsych,dopamine
Antag.,diphenylbutylpiperidinesT3 pimozide ORAP
Antipsychotics, Atyp, D2 Partial Agonist/5ht
MixedT2 aripiprazole ABILIFY
DISCMELT(TAB RDPDIS)(10 MG)
QL, ST
T2 aripiprazole ABILIFYDISCMELT(TAB RDPDIS)(15 MG)
QL, ST
T4 aripiprazole ABILIFY MAINTENAT2 aripiprazole ABILIFY(SOLUTION) QL, STT2 aripiprazole ABILIFY(TAB) QL, ST
Antipsychotics, Dopamine & Serotonin
AntagonistsT4 loxapine ADASUVET1 loxapine succinate LOXAPINET1 loxapine succinate LOXITANE
Antipsychotics,atypical,dopamine,&
Serotonin AntagT3 asenapine maleate SAPHRIS QL, STT4 clozapine CLOZAPINE QLT4 clozapine CLOZARIL QLT4 clozapine FAZACLO QL, STT4 clozapine VERSACLOZ QL, STT3 iloperidone FANAPT(TAB DS PK) QL, STT3 iloperidone FANAPT(TAB) QL, STT3 lurasidone hcl LATUDA(TAB)(120
MG)QL, ST
T3 lurasidone hcl LATUDA(TAB)(20 MG) QL, STT3 lurasidone hcl LATUDA(TAB)(40 MG) QL, STT3 lurasidone hcl LATUDA(TAB)(60 MG) QL, STT3 lurasidone hcl LATUDA(TAB)(80 MG) QL, STT1 olanzapine ZYPREXA QLT4 olanzapine pamoate ZYPREXA RELPREVVT3 paliperidone INVEGA(TAB ER
24H)(1.5 MG)QL, ST
T3 paliperidone INVEGA(TAB ER24H)(3 MG)
QL, ST
T3 paliperidone INVEGA(TAB ER24H)(6 MG)
QL, ST
T3 paliperidone INVEGA(TAB ER24H)(9 MG)
QL, ST
Commercial Formulary
L.A. Care Page 8 of 96
T4 paliperidone palmitate INVEGA SUSTENNAT1 quetiapine fumarate SEROQUEL QLT2 quetiapine fumarate SEROQUEL XR QL, STT1 risperidone RISPERDAL(SOLUTI
ON)QL
T1 risperidone RISPERDAL(TAB) QLT1 risperidone RISPERIDONE QLT4 risperidone
microspheresRISPERDAL CONSTA
T1 ziprasidone hcl GEODON QL
Antipsychotics,dopamine Antagonists,
ThioxanthenesT1 thiothixene THIOTHIXENE
Antipsychotics,dopamine
Antagonists,butyrophenonesT1 haloperidol HALOPERIDOLT1 haloperidol lactate HALOPERIDOL
LACTATE
Anti-psychotics,phenothiazinesT1 chlorpromazine hcl CHLORPROMAZINE
HCLT1 fluphenazine hcl FLUPHENAZINE HCLT1 perphenazine PERPHENAZINET1 thioridazine hcl THIORIDAZINE HCLT1 trifluoperazine hcl TRIFLUOPERAZINE
HCL
BarbituratesT3 butabarbital sodium BUTISOL SODIUMT1 phenobarbital PHENOBARBITALT3 secobarbital sodium SECONAL SODIUM
Hypnotics, Melatonin Mt1/mt2 Receptor
AgonistsT3 ramelteon ROZEREM QL, STT4 tasimelteon HETLIOZ PA
Monoamine Oxidase(mao) InhibitorsT3 selegiline EMSAM QL
Narcolepsy And Sleep Disorder Therapy
AgentsT3 armodafinil NUVIGIL PAT1 modafinil PROVIGIL PA
Narcotic AntagonistsT1 naltrexone hcl REVIA
Sedative-hypnotics,non-barbiturateT3 doxepin hcl SILENOR QL, STT1 estazolam ESTAZOLAMT1 eszopiclone LUNESTA QL, STT3 ethchlorvynol PLACIDYLT1 flurazepam hcl FLURAZEPAM HCLT1 glutethimide GLUTETHIMIDE
T1 midazolam hcl MIDAZOLAM HCLT1 quazepam DORALT1 temazepam RESTORILT1 temazepam TEMAZEPAMT1 triazolam HALCIONT1 triazolam TRIAZOLAMT1 zaleplon SONATA QLT1 zolpidem tartrate AMBIEN QLT3 zolpidem tartrate EDLUAR QL, STT3 zolpidem tartrate INTERMEZZO QL, STT1 zolpidem tartrate ZOLPIDEM
TARTRATEQL
T3 zolpidem tartrate ZOLPIMIST QL, ST
Ssri &antipsych,atyp,dopamine&serotonin
Antag CombT1 olanzapine/fluoxetine
hclSYMBYAX QL
Tx For Adhd - Selective Alpha-2a Receptor
AgonistT1 clonidine hcl KAPVAY QLT3 guanfacine hcl INTUNIV QL
Tx For Attention Deficit-
hyperact(adhd)/narcolepsyT1 dexmethylphenidate
hclFOCALIN QL
T2 dexmethylphenidatehcl
FOCALIN XR QL
T3 methylphenidate DAYTRANA QL, STT1 methylphenidate hcl CONCERTA(TAB ER
24H)(18 MG)QL
T1 methylphenidate hcl CONCERTA(TAB ER24H)(27 MG)
QL
T1 methylphenidate hcl CONCERTA(TAB ER24H)(36 MG)
QL
T1 methylphenidate hcl CONCERTA(TAB ER24H)(54 MG)
QL
T2 methylphenidate hcl METHYLIN QLT1 methylphenidate hcl METHYLPHENIDATE
ER(CPBP 50-50)(20MG)
QL
T1 methylphenidate hcl METHYLPHENIDATEER(CPBP 50-50)(30MG)
QL
T1 methylphenidate hcl METHYLPHENIDATEER(CPBP 50-50)(40MG)
T1 methylphenidate hcl METHYLPHENIDATEER(TAB ER)(10 MG)
T1 methylphenidate hcl METHYLPHENIDATEER(TAB ER)(20 MG)
QL
T3 methylphenidate hcl QUILLIVANT XR QL, STT2 methylphenidate hcl RITALIN LA QL
Commercial Formulary
L.A. Care Page 9 of 96
Tx For Attention Deficit-hyperact.(adhd), Nri-
typeT2 atomoxetine hcl STRATTERA(CAP)(10
MG)QL
T2 atomoxetine hcl STRATTERA(CAP)(100 MG)
QL
T2 atomoxetine hcl STRATTERA(CAP)(18MG)
QL
T2 atomoxetine hcl STRATTERA(CAP)(25MG)
QL
T2 atomoxetine hcl STRATTERA(CAP)(40MG)
QL
T2 atomoxetine hcl STRATTERA(CAP)(60MG)
QL
T2 atomoxetine hcl STRATTERA(CAP)(80MG)
QL
CARDIOVASCULAR DISEASE -
ARRHYTHMIAAntiarrhythmicsT1 amiodarone hcl AMIODARONE HCLT1 disopyramide
phosphateNORPACE
T2 disopyramidephosphate
NORPACE CR
T2 dofetilide TIKOSYNT2 dronedarone hcl MULTAQT1 flecainide acetate FLECAINIDE
ACETATET1 mexiletine hcl MEXILETINE HCLT1 procainamide hcl PROCAINAMIDE HCLT2 procainamide hcl PRONESTYLT1 propafenone hcl PROPAFENONE HCLT1 propafenone hcl RYTHMOLT1 propafenone hcl RYTHMOL SRT1 quinidine gluconate QUINIDINE
GLUCONATET1 quinidine sulfate QUINIDINE SULFATE
CARDIOVASCULAR DISEASE -
CARDIAC STIMULANTDigitalis GlycosidesT1 digoxin DIGOXT2 digoxin DIGOXINT3 digoxin LANOXIN
CARDIOVASCULAR DISEASE -
HYPERTENSIONAce Inhibitor/calcium Channel Blocker
CombinationT1 amlodipine
besylate/benazeprilLOTREL
T3 trandolapril/verapamilhcl
TARKA
Ace Inhibitor/thiazide & Thiazide-like DiureticT1 benazepril/hydrochlo
rothiazideBENAZEPRIL-HYDROCHLOROTHIAZIDE
T1 benazepril/hydrochlorothiazide
LOTENSIN HCT
T1 captopril/hydrochlorothiazide
CAPTOPRIL-HYDROCHLOROTHIAZIDE
T1 enalapril/hydrochlorothiazide
ENALAPRIL-HYDROCHLOROTHIAZIDE
T1 enalapril/hydrochlorothiazide
VASERETIC
T1 fosinopril/hydrochlorothiazide
FOSINOPRIL-HYDROCHLOROTHIAZIDE
T1 lisinopril/hydrochlorothiazide
ZESTORETIC
T1 moexipril/hydrochlorothiazide
UNIRETIC
T1 quinapril/hydrochlorothiazide
ACCURETIC
Alpha/beta-adrenergic Blocking AgentsT1 carvedilol COREGT2 carvedilol phosphate COREG CRT1 labetalol hcl LABETALOL HCLT1 labetalol hcl TRANDATE
Alpha-adrenergic Blocking AgentsT1 doxazosin mesylate CARDURAT3 doxazosin mesylate CARDURA XLT2 phenoxybenzamine hclDIBENZYLINET1 prazosin hcl MINIPRESST1 terazosin hcl TERAZOSIN HCL
Angioten.receptr Antag./cal.chanl
Blkr/thiazide CbT2 amlodipine/valsartan/h
cthiazidEXFORGE HCT ST
T3 olmesartan/amlodipin/hcthiazid
TRIBENZOR ST
Commercial Formulary
L.A. Care Page 10 of 96
Angiotensin Receptor Antag./thiazide
Diuretic CombT3 azilsartan
med/chlorthalidoneEDARBYCLOR ST
T1 candesartan/hydrochlorothiazid
ATACAND HCT ST
T3 eprosartan/hydrochlorothiazide
TEVETEN HCT ST
T1 irbesartan/hydrochlorothiazide
AVALIDE
T1 losartan/hydrochlorothiazide
HYZAAR
T2 olmesartan/hydrochlorothiazide
BENICAR HCT ST
T1 telmisartan/hydrochlorothiazid
TELMISARTAN-HYDROCHLOROTHIAZID
ST
T1 valsartan/hydrochlorothiazide
DIOVAN HCT
Angiotensin Receptor Antgnst &
Calc.channel BlockrT3 amlodipine
bes/olmesartan medAZOR ST
T2 amlodipine/valsartan EXFORGE STT1 telmisartan/amlodipi
neTELMISARTAN-AMLODIPINE
ST
Antihypertensives, Ace InhibitorsT1 benazepril hcl BENAZEPRIL HCLT1 benazepril hcl LOTENSINT1 captopril CAPTOPRILT1 enalapril maleate ENALAPRIL
MALEATET3 enalapril maleate EPANED QL, STT1 enalapril maleate VASOTECT1 fosinopril sodium FOSINOPRIL
SODIUMT1 lisinopril ZESTRILT1 moexipril hcl UNIVASCT1 perindopril erbumine ACEONT1 perindopril erbumine PERINDOPRIL
ERBUMINET1 quinapril hcl ACCUPRILT1 ramipril ALTACET1 trandolapril MAVIK
Antihypertensives, Angiotensin Receptor
AntagonistT3 azilsartan medoxomil EDARBI STT1 candesartan cilexetil ATACAND STT1 eprosartan mesylate TEVETEN STT1 irbesartan AVAPROT1 losartan potassium COZAART2 olmesartan medoxomil BENICAR STT1 telmisartan TELMISARTAN STT2 valsartan DIOVAN ST
Antihypertensives, Ganglionic BlockersT3 mecamylamine hcl VECAMYL PA
Antihypertensives, MiscellaneousT3 metyrosine DEMSER
Antihypertensives, SympatholyticT1 clonidine CATAPRES-TTS 1T1 clonidine CATAPRES-TTS 2T1 clonidine CATAPRES-TTS 3T1 clonidine hcl CATAPREST1 clonidine
hcl/chlorthalidoneCLORPRES
T1 guanfacine hcl TENEXT2 methyldopa ALDOMETT1 methyldopa METHYLDOPAT3 methyldopa/hydrochlor
othiazideALDORIL-D50
T1 methyldopa/hydrochlorothiazide
METHYLDOPA-HYDROCHLOROTHIAZIDE
T1 reserpine RESERPINET1 reserpine/hydrochlor
othiazideHYDROCHLOROTHIAZIDE/RESERPINE
Antihypertensives, VasodilatorsT1 hydralazine hcl HYDRALAZINE HCLT1 hydralazine/hydrochl
orothiazidHYDRALAZINEW/HCTZ
T1 hydralazine/reserpin/hctz
HCTZ/RESERPINE/HYDRALAZINE
T1 minoxidil MINOXIDIL
Beta-adrenergic Blocking AgentsT1 acebutolol hcl SECTRALT1 atenolol TENORMINT1 betaxolol hcl BETAXOLOL HCLT1 bisoprolol fumarate ZEBETAT1 metoprolol succinate TOPROL XLT1 metoprolol tartrate METOPROLOL
TARTRATET1 nadolol CORGARDT2 nebivolol hcl BYSTOLICT3 penbutolol sulfate LEVATOLT1 pindolol PINDOLOLT1 propranolol hcl INDERAL LAT2 propranolol hcl INDERAL XLT2 propranolol hcl INNOPRAN XLT1 propranolol hcl PROPRANOLOL HCLT1 sotalol hcl BETAPACET1 sotalol hcl SOTALOLT1 timolol maleate TIMOLOL MALEATE
Beta-adrenergic Blocking Agents/thiazide &
RelatedT1 atenolol/chlorthalido
neTENORETIC 100
T1 atenolol/chlorthalidone
TENORETIC 50
Commercial Formulary
L.A. Care Page 11 of 96
T1 bisoprololfumarate/hctz
ZIAC
T3 metoprololsuccinate/hctz
DUTOPROL
T1 metoprolol/hydrochlorothiazide
LOPRESSOR HCT
T1 metoprolol/hydrochlorothiazide
METOPROLOL-HYDROCHLOROTHIAZIDE
T1 nadolol/bendroflumethiazide
CORZIDE
T1 propranolol/hydrochlorothiazid
PROPRANOLOL-HYDROCHLOROTHIAZID
Calcium Channel Blocking AgentsT1 amlodipine besylate NORVASCT1 diltiazem hcl CARDIZEM CDT3 diltiazem hcl CARDIZEM LAT1 diltiazem hcl DILTIAZEM 24HR ERT1 felodipine FELODIPINE ERT1 isradipine ISRADIPINET3 nicardipine hcl CARDENE SRT1 nicardipine hcl NICARDIPINE HCLT1 nifedipine ADALAT CCT1 nifedipine PROCARDIA XLT1 nimodipine NIMOTOPT4 nimodipine NYMALIZE PAT1 nisoldipine NISOLDIPINET1 nisoldipine SULART1 verapamil hcl CALAN SRT1 verapamil hcl VERELAN
Loop DiureticsT1 bumetanide BUMETANIDET3 ethacrynic acid EDECRINT1 furosemide FUROSEMIDET1 furosemide LASIXT1 torsemide DEMADEX
Osmotic DiureticsT3 mannitol RESECTISOL
Potassium Sparing DiureticsT1 amiloride hcl AMILORIDE HCLT1 eplerenone EPLERENONET1 eplerenone INSPRAT1 spironolactone ALDACTONET3 triamterene DYRENIUM
Potassium Sparing Diuretics In CombinationT1 amiloride/hydrochlor
othiazideAMILORIDE-HYDROCHLOROTHIAZIDE
T1 spironolact/hydrochlorothiazid
ALDACTAZIDE(TAB)(25 MG-25MG)
T3 spironolact/hydrochlorothiazid
ALDACTAZIDE(TAB)(50 MG-50MG)
T1 triamterene/hydrochlorothiazid
DYAZIDE
T1 triamterene/hydrochlorothiazid
MAXZIDE-25 MG
T1 triamterene/hydrochlorothiazid
TRIAMTERENE-HCTZ
Pulm Anti-htn,soluble Guanylate Cyclase
StimulatorT4 riociguat ADEMPAS PA
Pulm.anti-htn,sel.c-gmp Phosphodiesterase
T5 InhibT1 sildenafil citrate REVATIO QLT4 tadalafil ADCIRCA PA, ST
Pulmonary Anti-htn, Endothelin Receptor
AntagonistT4 ambrisentan LETAIRIS PAT4 bosentan TRACLEER PAT4 macitentan OPSUMIT PA
Pulmonary Antihypertensives, Prostacyclin-
typeT4 epoprostenol sodium
(arginine)VELETRI PA
T4 epoprostenol sodium(glycine)
FLOLAN PA
T4 iloprost tromethamine VENTAVIS PAT4 treprostinil TYVASO PAT4 treprostinil diolamine ORENITRAM ER PAT4 treprostinil sodium REMODULIN PAT4 treprostinil/neb
accessoriesTYVASO PA
T4 treprostinil/nebulizer/accesor
TYVASO PA
Renin Inhib, Direct/calc. Channel
Blkr/thiazide CbT3 aliskiren/amlodipin/hct
hiazideAMTURNIDE PA
Renin Inhibitor, DirectT3 aliskiren hemifumarate TEKTURNA PA
Renin Inhibitor, Direct & Calcium Channel
BlockerT3 aliskiren/amlodipine
besylateTEKAMLO PA
Renin Inhibitor, Direct/thiazide Diuretic
CombT3 aliskiren/hydrochlorothi
azideTEKTURNA HCT PA
Thiazide And Related DiureticsT3 bendroflumethiazide NATURETIN-5T1 chlorothiazide CHLOROTHIAZIDET3 chlorothiazide DIURIL
Commercial Formulary
L.A. Care Page 12 of 96
T1 chlorthalidone CHLORTHALIDONET1 hydrochlorothiazide HYDROCHLOROTHIA
ZIDET1 hydrochlorothiazide MICROZIDET3 hydroflumethiazide SALURONT1 indapamide INDAPAMIDET1 methyclothiazide METHYCLOTHIAZIDET1 metolazone METOLAZONET1 metolazone ZAROXOLYN
Vasodilators, CombinationT3 isosorb
dinit/hydralazine hclBIDIL
CARDIOVASCULAR DISEASE - LIPID
IRREGULARITYAntihyperlip.hmg Coa Reduct
Inhib&cholest.ab.inhibT3 ezetimibe/atorvastatin
calciumLIPTRUZET(TAB)(10MG-10MG)
QL, ST
T3 ezetimibe/atorvastatincalcium
LIPTRUZET(TAB)(10MG-20MG)
QL, ST
T3 ezetimibe/atorvastatincalcium
LIPTRUZET(TAB)(10MG-40MG)
QL, ST
T3 ezetimibe/atorvastatincalcium
LIPTRUZET(TAB)(10MG-80MG)
QL, ST
T3 ezetimibe/simvastatin VYTORIN(TAB)(10MG-10MG)
QL, ST
T3 ezetimibe/simvastatin VYTORIN(TAB)(10MG-20MG)
QL, ST
T3 ezetimibe/simvastatin VYTORIN(TAB)(10MG-40MG)
QL, ST
T3 ezetimibe/simvastatin VYTORIN(TAB)(10MG-80MG)
QL
Antihyperlipidemic - Apo B-100 Synthesis
InhibitorT4 mipomersen sodium KYNAMRO PA
Antihyperlipidemic - Hmg Coa Reductase
InhibitorsT1 atorvastatin calcium LIPITORT1 fluvastatin sodium LESCOL QL, STT3 fluvastatin sodium LESCOL XL QL, STT3 lovastatin ALTOPREV QL, STT1 lovastatin LOVASTATINT1 lovastatin MEVACORT3 pitavastatin calcium LIVALO QL, STT1 pravastatin sodium PRAVACHOLT1 pravastatin sodium PRAVASTATIN
SODIUMT2 rosuvastatin calcium CRESTOR(TAB)(10
MG)QL, ST
T2 rosuvastatin calcium CRESTOR(TAB)(20MG)
QL, ST
T2 rosuvastatin calcium CRESTOR(TAB)(40MG)
QL, ST
T2 rosuvastatin calcium CRESTOR(TAB)(5MG)
QL, ST
T1 simvastatin ZOCOR
Antihyperlipidemic - Mtp InhibitorT4 lomitapide mesylate JUXTAPID PA
Antihyperlipidemic-hmg Coa Reductase
Inhib.&niacinT3 niacin/lovastatin ADVICOR(TBMP
24HR)(1000-20MG)QL, ST
T3 niacin/lovastatin ADVICOR(TBMP24HR)(1000-40 MG)
QL, ST
T3 niacin/lovastatin ADVICOR(TBMP24HR)(500MG-20MG)
QL, ST
T3 niacin/lovastatin ADVICOR(TBMP24HR)(750MG-20MG)
QL, ST
T2 niacin/simvastatin SIMCOR(TBMP24HR)(1000-20MG)
QL, ST
T2 niacin/simvastatin SIMCOR(TBMP24HR)(1000-40 MG)
QL, ST
T2 niacin/simvastatin SIMCOR(TBMP24HR)(500MG-20MG)
QL, ST
T2 niacin/simvastatin SIMCOR(TBMP24HR)(500MG-40MG)
QL, ST
T2 niacin/simvastatin SIMCOR(TBMP24HR)(750MG-20MG)
QL, ST
Bile Salt SequestrantsT1 cholestyramine (with
sugar)QUESTRAN
T1 cholestyramine/aspartame
CHOLESTYRAMINELIGHT
T2 colesevelam hcl WELCHOLT1 colestipol hcl COLESTID(GRANULE
S)T1 colestipol hcl COLESTID(PACKET)
(5 G)T3 colestipol hcl COLESTID(PACKET)
(7.5G)T1 colestipol hcl COLESTID(TAB)
LipotropicsT2 ezetimibe ZETIA QLT2 fenofibrate FENOGLIDE STT1 fenofibrate LOFIBRAT1 fenofibrate
nanocrystallizedTRICOR
T1 fenofibrate,micronized
ANTARA(CAP)(130MG)
T3 fenofibrate,micronized ANTARA(CAP)(30MG)
ST
T1 fenofibrate,micronized
ANTARA(CAP)(43MG)
T3 fenofibrate,micronized ANTARA(CAP)(90MG)
ST
T1 fenofibrate,micronized
LOFIBRA
T1 fenofibric acid FIBRICORT1 fenofibric acid
(choline)TRILIPIX
Commercial Formulary
L.A. Care Page 13 of 96
T1 gemfibrozil LOPIDT2 icosapent ethyl VASCEPA QLT3 methionine/inositol/cho
line/faLIPOCHOL PLUS
T1 niacin NIASPAN STT1 omega-3 acid ethyl
estersLOVAZA QL
Niacin PreparationsT1 niacin NIACIN SR 250MG
CARDIOVASCULAR DISEASE -
MISCELLANEOUS AGENTSAdrenergic Vasopressor AgentsT1 midodrine hcl MIDODRINE HCL
Antianginal & Anti-ischemic Agents,non-
hemodynamicT2 ranolazine RANEXA(TAB ER
12H)(1000 MG)QL
T2 ranolazine RANEXA(TAB ER12H)(500 MG)
QL
Antihyperlip - Hmg-coa&calcium Channel
Blocker CbT1 amlodipine/atorvasta
tinCADUET QL
CARDIOVASCULAR DISEASE -
VASODILATIONVasodilators,coronaryT3 isosorbide dinitrate DILATRATE-SRT1 isosorbide dinitrate ISOCHRONT2 isosorbide dinitrate ISORDILT1 isosorbide dinitrate ISORDIL TITRADOSET1 isosorbide dinitrate ISOSORBIDE
DINITRATET1 isosorbide
mononitrateIMDUR
T2 nitroglycerin NITRO-BIDT1 nitroglycerin NITRO-DUR(PATCH
TD24)(0.1MG/HR)T1 nitroglycerin NITRO-DUR(PATCH
TD24)(0.2MG/HR)T2 nitroglycerin NITRO-DUR(PATCH
TD24)(0.3 MG/HR)T1 nitroglycerin NITRO-DUR(PATCH
TD24)(0.4MG/HR)T1 nitroglycerin NITRO-DUR(PATCH
TD24)(0.6MG/HR)T2 nitroglycerin NITRO-DUR(PATCH
TD24)(0.8MG/HR)T2 nitroglycerin NITROSTAT
Vasodilators,peripheralT1 ergoloid mesylates ERGOLOID
MESYLATEST3 ethaverine hcl ISOVEXT1 isoxsuprine hcl ISOXSUPRINE HCLT1 nylidrin hcl NYLIDRIN HCLT1 papaverine hcl PAPAVERINE HCL
CONTRACEPTION/OXYTOCICSContraceptives, Intravaginal, SystemicT3 etonogestrel/ethinyl
estradiolNUVARING QL, ST
Contraceptives,injectableT1 medroxyprogesteron
e acetateDEPO-PROVERA QL
T3 medroxyprogesteroneacetate
DEPO-SUBQPROVERA 104
QL
Contraceptives,intravaginalT5 nonoxynol 9 CONCEPTROL(OTC) GT5 nonoxynol 9 GYNOL II(OTC) GT5 nonoxynol 9 TODAY
CONTRACEPTIVESPONGE(OTC)
G
T5 nonoxynol 9 VCF(OTC) G
Contraceptives,oralT5 desog-
e.estradiol/e.estradiolVIORELE G
T5 desogestrel-ethinylestradiol
APRI G
T3 drospir/ethestra/levomefol ca
BEYAZ ST
T3 drospir/ethestra/levomefol ca
SAFYRAL ST
T3 estradiolvalerate/dienogest
NATAZIA ST
T5 ethinylestradiol/drospirenone
OCELLA G, ST
T5 ethynodiol d-ethinylestradiol
ZOVIA 1-35E G
T5 levonorgestrel PLAN B ONE-STEP AGE,G
T3 levonorgestrel-ethestradiol
AMETHYST ST
T5 levonorgestrel-ethestradiol
LEVORA-28 G
T5 l-norgest-ethestr/ethin estra
CAMRESE G, QL
T3 l-norgest-eth estr/ethinestra
QUARTETTE
T2 noreth a-et estra/fefumarate
LO LOESTRIN FE ST
T5 noreth a-et estra/fefumarate
MICROGESTIN FE G
T3 noreth a-et estra/fefumarate
MINASTRIN 24 FE
Commercial Formulary
L.A. Care Page 14 of 96
T5 noreth-ethinylestradiol/iron
FEMCON FE G
T3 noreth-ethinylestradiol/iron
GENERESS FE
T5 norethindrone NOR-Q-D GT5 norethindrone a-e
estradiolMICROGESTIN G
T5 norethindrone-ethinyl estrad
NECON G
T5 norethindrone-ethinyl estrad
ORTHO-NOVUM G
T5 norethindrone-mestranol
NORINYL 1+50 G
T2 norgestimate-ethinylestradiol
ORTHO TRI-CYCLENLO
ST
T5 norgestimate-ethinylestradiol
SPRINTEC G
T5 norgestrel-ethinylestradiol
CRYSELLE G
T3 ulipristal acetate ELLA
Diaphragms/cervical CapT5 cervical cap FEMCAP GT5 diaphragm fitting
set,arcsprngORTHO ALL-FLEX G
T5 diaphragms, arc-springORTHO ALL-FLEX GT5 diaphragms, wide seal WIDE SEAL
DIAPHRAGMG
OxytocicsT3 dinoprostone CERVIDILT3 dinoprostone PREPIDILT3 dinoprostone PROSTIN E2
VAGINALSUPPOSITORY
T1 methylergonovinemaleate
METHYLERGONOVINE MALEATE
COUGH AND COLD1st Gen Antihistamine & Decongestant
CombinationsT1 phenylephrine
hcl/prometh hclPROMETHAZINE VC
Analgesic, Non-sal.- 1st Generation
AntihistamineT1 acetaminophen/phen
yltolx citRELAGESIC
T3 acetaminophen/phenyltolx cit
ZGESIC
Antitussives,non-narcoticT1 benzonatate BENZONATATET1 benzonatate TESSALON PERLET3 benzonatate ZONATUSS
Narcotic Antituss-1st Gen. Antihistamine-
decongestT1 bromphenira/pseudo
ephed/codeinMESEHIST WC
T1 bromphenrm/pseudoeph/dihydrocd
J-COF DHC
T1 promethazine/phenyleph/codeine
PROMETHAZINE VC-CODEINE
Narcotic Antitussive-1st Generation
AntihistamineT1 chlorpheniramine/co
deine phosENDACOF-C
T3 hydrocodone/chlorphen polis
TUSSICAPS
T1 hydrocodone/chlorphen polis
TUSSIONEX
T3 hydrocodone/chlorpheniramine
VITUZ
T1 promethazinehcl/codeine
PROMETHAZINE-CODEINE
Narcotic Antitussive-anticholinergic Comb.T1 hydrocodone
bit/homatrop me-brHYDROCODONE-HOMATROPINE MBR
Narcotic Antitussive-expectorant
CombinationT1 dihydrocodeine/guaif
enesinJ-MAX DHC
T3 guaifenesin/codeinephosphate
ALLFEN CDX
T1 guaifenesin/codeinephosphate
CODAR GF
Non-narc Antituss-1st Gen. Antihistamine-
decongestT1 brompheniram/pheny
lephrine/dmLOHIST-DM
T1 dm/phenyleph/chlorpheniramine
CENTERGY DM
T1 d-methorphan hb/p-epd hcl/bpm
BROMFED DM
Non-narc Antitussive-1st Gen Antihistamine
Comb.T1 d-methorphan
hb/prometh hclPROMETHAZINE-DM
Nose Preparations, VasoconstrictorsT3 epinephrine hcl ADRENALIN
CHLORIDET3 tetrahydrozoline hcl TYZINE
Commercial Formulary
L.A. Care Page 15 of 96
DERMATOLOGY - ACNEAcne Agents,systemicT2 isotretinoin ABSORICAT1 isotretinoin CLARAVIS
Acne Agents,topicalT3 adapalene/benzoyl
peroxideEPIDUO
T3 azelaic acid AZELEXT3 clindamycin
phos/benzoyl peroxACANYA
T3 clindamycinphos/benzoyl perox
BENZACLIN(GELW/PUMP)
T1 clindamycinphos/benzoyl perox
BENZACLIN(GEL)
T3 clindamycin/tretinoin VELTINT3 clindamycin/tretinoin ZIANAT3 dapsone ACZONET1 sulfacetamide
sodiumKLARON
Anticorrosive AgentsT3 butylated
hydroxytolueneBUTYLATEDHYDROXYTOLUENE(BHT)
Keratolytic-glucocorticoid CombinationsT2 benzoyl
peroxide/hydrocortisonVANOXIDE-HC
Rosacea Agents, TopicalT3 azelaic acid FINACEAT3 brimonidine tartrate MIRVASO QLT1 metronidazole METROGELT1 metronidazole METROLOTIONT1 metronidazole METRONIDAZOLET3 metronidazole NORITATET1 metronidazole ROSADANT3 metronidazole/skin
cleansr #23ROSADAN
Topical Preparations,antibacterialsT3 cadexomer iodine IODOFLEXT3 cadexomer iodine IODOSORBT3 clioquinol/hc/emollient
cmb#88DERMASORB AF
T3 clioquinol/hydrocortisone
ALA-QUIN
T1 clioquinol/hydrocortisone/pram
1 + 1-F
T3 hydrocortisone/iodoquin/aloe#2
ALCORTIN A
T1 hydrocortisone/iodoquinol
HYDROCORTISONE-IODOQUINOL
T1 iodine/potassiumiodide
LUGOL'S
T3 iodoquinol/aloepolysacchar #1
ALOQUIN
T3 nitrofurazone FURACINT3 silver SILVRSTAT
T3 silver carbonate NORMLGEL AGT1 silver nitrate SILVER NITRATE
Vitamin A DerivativesT1 adapalene DIFFERIN(CREAM) AGET1 adapalene DIFFERIN(GEL
W/PUMP)AGE
T1 adapalene DIFFERIN(GEL) AGET2 adapalene DIFFERIN(LOTION) AGET2 adapalene DIFFERIN(MED
SWAB)AGE
T3 tretinoin ATRALIN AGET1 tretinoin RETIN-A AGET3 tretinoin TRETIN-X AGET1 tretinoin
microspheresRETIN-A MICRO AGE
T1 tretinoinmicrospheres
RETIN-A MICROPUMP
AGE
T3 tretinoin/emolcmb9/skin cln1
TRETIN-X AGE
Vitamin A Derivatives, Topical Acne AgentsT2 tazarotene FABIOR AGE
Vitamin A Derivatives, Topical Cosmetic
AgentsT3 tazarotene AVAGET1 tretinoin/emollient
baseREFISSA
T3 tretinoin/emollient baseRENOVAT3 tretinoin/emollient baseRENOVA PUMP
DERMATOLOGY - ANTIINFECTIVEAntiparasiticsT3 nitazoxanide ALINIAT3 sulfur SULFUR
Topical AntibioticsT3 clindamycin phos/skin
clnsr 19CLINDACIN ETZ
T3 clindamycin phos/skinclnsr 19
CLINDACIN PAC
T1 clindamycinphosphate
CLEOCIN T
T1 clindamycinphosphate
CLINDACIN P
T3 clindamycin phosphateCLINDAGELT1 clindamycin
phosphateEVOCLIN
T3 erythromycin base AKNE-MYCINT1 erythromycin
base/ethanolERYGEL
T1 erythromycinbase/ethanol
ERYTHROMYCIN
T1 erythromycin/benzoyl peroxide
BENZAMYCIN
T2 erythromycin/benzoylperoxide
BENZAMYCINPAK
T1 gentamicin sulfate GENTAMICINSULFATE
Commercial Formulary
L.A. Care Page 16 of 96
T1 mupirocin BACTROBANT3 mupirocin CENTANY ATT1 mupirocin calcium BACTROBAN
Topical Antifungal/antiinflammatory,steriod
AgentT1 clotrimazole/betamet
hasone dipCLOTRIMAZOLE-BETAMETHASONE
T1 clotrimazole/betamethasone dip
LOTRISONE
Topical AntifungalsT3 benzoic acid/salicylic
acidBENSAL HP
T3 butenafine hcl MENTAXT1 ciclopirox LOPROXT1 ciclopirox PENLACT1 ciclopirox olamine CICLODANT1 ciclopirox olamine CICLOPIROXT3 ciclopirox/nail lacq/ft
deod#4PEDIPIROX-4
T3 ciclopirox/skin cleanserno.28
CICLODAN
T1 ciclopirox/ure/camph/menth/euc
CICLODAN
T1 clotrimazole CLOTRIMAZOLET1 econazole nitrate ECONAZOLE
NITRATET3 econazole nitrate ECOZAT1 gentian viol/brlnt
grn/proflavTRIPLE DYE(MEDSWAB)(2.29-2.29)
T3 gentian viol/brlntgrn/proflav
TRIPLE DYE(MEDSWAB)(2.29-2.29)
T1 ketoconazole KETOCONAZOLET1 ketoconazole NIZORALT3 ketoconazole XOLEGELT3 ketoconazole/skin
cleanser #28KETODAN
T3 luliconazole LUZUT3 miconazole nitrate/hc FUNGOID & HCT3 miconazole nitrate/zinc
ox/petVUSION
T2 naftifine hcl NAFTIN(CREAM)T2 naftifine hcl NAFTIN(GEL)(1 %)T3 naftifine hcl NAFTIN(GEL)(2 %)T1 nystatin NYSTATINT3 nystatin/emollient
combo no.54PEDIADERM AF
T1 nystatin/triamcin NYSTATIN-TRIAMCINOLONE
T3 oxiconazole nitrate OXISTATT3 sertaconazole nitrate ERTACZOT1 sodium
thiosulfate/sal acidEXODERM
T2 sulconazole nitrate EXELDERM
Topical AntiparasiticsT3 benzyl alcohol ULESFIAT3 citric/citronellyl/hydrox/
methLYCELLE
T2 crotamiton EURAX
T3 ivermectin SKLICET1 lindane LINDANET1 malathion OVIDET1 permethrin ELIMITET1 spinosad NATROBA
Topical Antiviral & Local Anesthetic
CombinationsT3 acyclovir/lidocaine hcl LIDOVIR
Topical AntiviralsT2 acyclovir ZOVIRAX(CREAM)T1 acyclovir ZOVIRAX(OINT)T3 penciclovir DENAVIR
Topical Antivirals/antiinflammatory, Steroid
AgentT3 acyclovir/hydrocortison
eXERESE
Topical Genital Wart-hpv Treatment AgentsT3 sinecatechins VEREGEN
Topical Pleuromutilin DerivativesT3 retapamulin ALTABAX
Topical SulfonamidesT3 mafenide acetate SULFAMYLON(CREA
M)T1 mafenide acetate SULFAMYLON(PACK
ET)T1 silver sulfadiazine SILVER
SULFADIAZINET1 sulfacet
sod/sulfur/witch hazSE 10-5 SS
T1 sulfacetamidesod/sulfur/urea
SODIUMSULFACETAMIDE-SULFUR
T3 sulfacetamidesodium/sulfur
AVAR LS
T1 sulfacetamidesodium/sulfur
AVAR(CLEANSER)
T3 sulfacetamidesodium/sulfur
AVAR(MED PAD)
T3 sulfacetamidesodium/sulfur
PLEXION
T3 sulfacetamidesodium/sulfur
ROSANIL
T1 sulfacetamidesodium/sulfur
SODIUMSULFACETAMIDE-SULFUR
T1 sulfacetamidesodium/sulfur
SUMADAN
T1 sulfacetamidesodium/sulfur
SUMAXIN
T1 sulfacetamidesodium/sulfur
ZENCIA
T1 sulfacetamide/sulfur/cleansr23
SODIUMSULFACETAMIDE-SULFUR
Commercial Formulary
L.A. Care Page 17 of 96
T3 sulfacetamide/sulfur/cleansr23
SUMADAN
T3 sulfacetamide/sulfur/cleansr23
SUMAXIN CP
DERMATOLOGY -
ANTIINFLAMMATORYTopical
Antibiotics/antiinflammatory,steroidalT2 neomycin/bacitra/poly
myxin/hcCORTISPORIN
T2 neomycin/polymyxin bsulf/hc
CORTISPORIN
Topical Anti-inflammatory SteroidalT1 alclometasone
dipropionateACLOVATE
T1 alclometasonedipropionate
ALCLOMETASONEDIPROPIONATE
T1 amcinonide AMCINONIDET1 betamethasone
dipropionateBETAMETHASONEDIPROPIONATE
T1 betamethasonedipropionate
DEL-BETA
T1 betamethasonevalerate
BETAMETHASONEVALERATE
T1 betamethasonevalerate
LUXIQ
T1 betamethasone/propylene glyc
DIPROLENE
T1 betamethasone/propylene glyc
DIPROLENE AF
T1 clobetasolpropionate
CLOBETASOLPROPIONATE
T1 clobetasolpropionate
CLOBEX(LOTION)
T1 clobetasolpropionate
CLOBEX(SHAMPOO)
T2 clobetasol propionate CLOBEX(SPRAY)T1 clobetasol
propionateOLUX
T1 clobetasolpropionate
TEMOVATE
T1 clobetasolpropionate/emoll
CLOBETASOLEMOLLIENT
T1 clobetasolpropionate/emoll
TEMOVATEEMOLLIENT
T1 clocortolone pivalate CLODERMT3 desonide DESONATET1 desonide DESONIDET1 desonide TRIDESILONT3 desonide VERDESOT1 desoximetasone TOPICORT(CREAM)T1 desoximetasone TOPICORT(GEL)T1 desoximetasone TOPICORT(OINT)T3 desoximetasone TOPICORT(SPRAY) STT1 diflorasone diacetate DIFLORASONE
DIACETATE
T2 diflorasonediacetate/emoll
APEXICON E
T3 fluocinolone acetonide CAPEX SHAMPOOT1 fluocinolone
acetonideDERMA-SMOOTHE-FS
T1 fluocinoloneacetonide
FLUOCINOLONEACETONIDE
T1 fluocinoloneacetonide
SYNALAR
T3 fluocinolone/emolcmb#65
SYNALAR
T1 fluocinolone/showercap
DERMA-SMOOTHE-FS
T3 fluocinolone/skinclnsr28
SYNALAR TS
T1 fluocinonide FLUOCINONIDET1 fluocinonide/emollien
t baseFLUOCINONIDE-E
T2 flurandrenolide CORDRANT1 fluticasone
propionateCUTIVATE
T1 fluticasonepropionate
FLUTICASONEPROPIONATE
T3 halcinonide HALOGT1 halobetasol
propionateULTRAVATE
T3 halobetasol/ammonium lactate
HALONATE
T3 halobetasol/lactic acid ULTRAVATE XT1 hc/mineral
oil/petrolat,whtHYDROCORTISONE
T2 hydrocort/salacid/sulf/shmp#1
SCALACORT DK
T2 hydrocortisone FIRST-HYDROCORTISONE
T1 hydrocortisone HYDROCORTISONET1 hydrocortisone LACTICARE-HCT2 hydrocortisone TEXACORTT1 hydrocortisone
acetate/aloe vHYDROCORTISONEACETATE
T3 hydrocortisoneacetate/aloe v
NUCORT
T1 hydrocortisoneacetate/urea
U-CORT
T1 hydrocortisonebutyrate
HYDROCORTISONEBUTYRATE
T2 hydrocortisonebutyrate
LOCOID(CREAM)
T3 hydrocortisonebutyrate
LOCOID(LOTION)
T1 hydrocortisonebutyrate
LOCOID(OINT)
T1 hydrocortisonebutyrate
LOCOID(SOLUTION)
T1 hydrocortisonebutyrate/emoll
HYDROCORTISONEBUTYRATE
T2 hydrocortisonebutyrate/emoll
LOCOID LIPOCREAM
T2 hydrocortisoneprobutate
PANDEL
T1 hydrocortisonevalerate
HYDROCORTISONEVALERATE
Commercial Formulary
L.A. Care Page 18 of 96
T1 hydrocortisonevalerate
WESTCORT
T3 hydrocortisone/emolno.45
PEDIADERM HC
T3 hydrocortisone/skinclnsr #25
AQUA GLYCOLIC HC
T3 hydrocortisone/skinclnsr #35
DERMASORB HC
T3 mometasonefuroat/ammonium lac
MOMEXIN
T1 mometasone furoate ELOCONT1 prednicarbate DERMATOPT3 triamcin/hydrophilic
ointmentAQUAPHILICW/TRIAMCINOLONE
T3 triamcin/urea/hydrooint
AQUAPHILIC W/TAC+ CARBAMIDE
T2 triamcinoloneacetonide
KENALOG(AEROSOL)
T1 triamcinoloneacetonide
KENALOG(LOTION)
T1 triamcinoloneacetonide
TRIAMCINOLONEACETONIDE
T1 triamcinoloneacetonide
TRIDERM
T3 triamcinolone/emollientcmb#45
PEDIADERM TA
T3 triamcinolone/emollientcmb#86
DERMASORB TA
Topical Anti-inflammatory, NsaidsT3 diclofenac epolamine FLECTORT3 diclofenac sodium PENNSAID STT2 diclofenac sodium VOLTAREN
DERMATOLOGY - ANTIPRURITIC
DRUGSAntipruritics,topicalT3 doxepin hcl PRUDOXINT3 doxepin hcl ZONALON
DERMATOLOGY - MISCELLANEOUSAntiperspirantsT1 aluminum chloride DRYSOLT3 aluminum chloride XERAC AC
Antiseborrheic AgentsT3 emollient #43/skin
cleanser#27PROMISEBCOMPLETE
T3 emollient combinationno.43
PROMISEB
T1 emollientcombination no.43
TL TRISEB
T1 emollientcombination no.85
LOUTREX
T1 selenium sulfide SELENIUM SULFIDET3 selenium sulfide TERSI FOAMT1 sulfacetamide
sodiumOVACE
T3 sulfacetamide sodium OVACEPLUS(CLEANSR ER)
T3 sulfacetamide sodium OVACEPLUS(CREAM)
T2 sulfacetamide sodium OVACEPLUS(SHAMPOO)
T1 sulfacetamidesodium/urea
SODIUMSULFACETAMIDE
Antiseptics,miscellaneousT3 guaiacol GUAIACOLT1 phenol PHENOL
EmollientsT3 alc/isopropanol/prop
gly/waterVEHICLE-N
T3 alc/isopropanol/propgly/water
VEHICLE-N MILD
T1 ammonium lactate LAC-HYDRINT3 em#53/namgf/cyc/pho
s/nahc/naclAURSTAT
T1 emol53/namgfs/ha/nahypochlorit
MB HYDROGEL
T1 emollientcombination no.10
PRUTECT
T3 emollient combinationno.10
SONAFINE
T1 emollientcombination no.32
EMULSION SB
T1 emollientcombination no.35
PRUMYX
T3 emollient combinationno.38
NEOSALUS
T3 emollient combinationno.44
HPR
T3 emollient combinationno.44
HYLATOPIC
T3 emollient combinationno.47
NEOSALUS
T3 emollient combinationno.47
NEOSALUS CP
T3 emollient combinationno.48
TROPAZONE
T3 emollient combinationno.53
HPR PLUS
T3 emollient combinationno.53
HYLATOPIC PLUS
T3 emollient combinationno.57
TROPAZONE
T3 emollient combinationno.60
ATRAPROHYDROGEL
T3 emollient combinationno.80
PRESERA
T3 emollient combo no.47& no.60
ATRAPRO CP
T3 hyaluro/dl-eac/e12/allan/shea
XCLAIR
T1 lactic acid LACTIC ACIDT3 namgflu/cyclo/phos/na
hco3/naclAURSTAT
T3 petrolatum,white VASELINE WHITEPETROLEUM
Commercial Formulary
L.A. Care Page 19 of 96
T1 viteac/grape/hyaluronicacid
PRUCLAIR
IrrigantsT1 acetic acid ACETIC ACIDT1 mannitol/sorbitol
solutionSORBITOL-MANNITOL
T1 neomysulf/polymyxin bsulfate
NEOSPORIN G.U.IRRIGANT
T1 ringers solution RINGERSIRRIGATION
T3 ringerssolution,lactated
LACTATED RINGERS
T1 sodium chloride irrigsolution
SODIUM CHLORIDE
T1 sorbitol solution SORBITOLT1 water for
irrigation,sterileWATER
Irritants/counter-irritantsT3 capsaicin/skin cleanserQUTENZA PAT3 menthol/bandages,
tubularICY HOT(OTC)
T3 oxalic acid OXALIS
KeratolyticsT2 benzoyl peroxide BP WASHT1 benzoyl peroxide BP WASH ACNE
TREATMENTT1 benzoyl peroxide BPOT3 benzoyl peroxide PACNEX HPT3 benzoyl peroxide PACNEX LPT3 benzoyl peroxide RIAXT1 benzoyl peroxide
microspheresSE BPO
T3 benzoyl peroxide/sulfurNUOXT3 benzoyl peroxide/vit e
mixINOVA
T3 dichloroacetic acid BICHLORACETICACID
T2 podofilox CONDYLOX(GEL)T1 podofilox CONDYLOX(SOLUTI
ON)T1 podophyllum resin PODOCON-25T1 potassium hydroxide POTASSIUM
HYDROXIDET3 salicylic ac/benzoyl
per/vit eINOVA 4-1
T3 salicylic ac/benzoylper/vit e
INOVA 8-2
T1 salicylic acid KERALYTT3 salicylic acid KERALYT SCALPT1 salicylic acid SALACYNT1 salicylic acid SALEXT1 salicylic acid SALICYLIC ACIDT3 salicylic acid ULTRASAL-ERT1 salicylic acid VIRASALT1 salicylic acid/ammon
lact/aloeSALICYLIC ACID
T3 salicylicacid/ammoniated hg
EMERSAL
T1 salicylicacid/ceramide cmb#1
SALEX
T3 salicylic acid/urea SALVAX DUO PLUST1 silver nitrate SILVER NITRATET1 silver nitrate
applicatorSILVER NITRATEAPPLICATOR
T1 urea ALUVEAT3 urea GORDO-UREAT3 urea HYDRO 35T3 urea KERAFOAMT3 urea KERALACT3 urea UMECTA PDT3 urea UMECTA(EMULSN)T1 urea UMECTA(NL FM
SUSP)T1 urea URAMAXIN(CREAM)T3 urea URAMAXIN(FOAM)T1 urea URAMAXIN(GEL)T1 urea URAMAXIN(LOTION)T1 urea UREAT1 urea X-VIATET3 urea/emollient cmb
no.18DERMASORB XM
T3 urea/emollientcombination #65
URAMAXIN GT
T1 urea/hyaluronatesodium
UREA
T1 urea/lactic ac/znundecylenate
BP-50% UREA
T1 urea/lacticacid/salicyl acid
UREA
Oxidizing AgentsT3 elect wtr/sod ch/sod
hy/hyp acATRAPRO DERMALSPRAY
ProtectivesT3 carbit/equis
xt/ethan/chit/msmGENADUR
T3 hyaluronsod/allantoin/aloe xt
RADIAPLEXRX
T3 hyaluronate sodium BIONECTT3 poly-ureaurethane NUVAILT1 protect
cmb2/ceramide 1,3,6-11
PR CREAM
Topical AntifungalsT3 salicylic acid BENSAL HP
Topical Anti-inflammatory Steroid-local
AnestheticT1 hydrocortisone
ac/lidocaineLIDOCAINE-HYDROCORTISONE
T3 hydrocortisone/pramoxine
EPIFOAM
T1 hydrocortisone/pramoxine
PRAMOSONE(CREAM)
Commercial Formulary
L.A. Care Page 20 of 96
T2 hydrocortisone/pramoxine
PRAMOSONE(LOTION)
T2 hydrocortisone/pramoxine
PRAMOSONE(OINT)
T3 hydrocortisone/pramoxine/aloe
NOVACORT
T2 hydrocortisone/pramoxine/emoll
PRAMOSONE E
Topical Antineoplastic & Premalignant
Lesion AgntsT4 alitretinoin PANRETINT4 bexarotene TARGRETIN PAT1 diclofenac sodium DICLOFENAC
SODIUMPA, QL
T3 fluorouracil CARACT1 fluorouracil EFUDEXT3 fluorouracil FLUOROPLEXT1 fluorouracil FLUOROURACILT2 ingenol mebutate PICATO(GEL)(0.015
%)QL
T2 ingenol mebutate PICATO(GEL)(0.05 %) QLT4 mechlorethamine hcl VALCHLOR PA
Topical Local AnestheticsT3 benzocaine ANACAINET1 cocaine hcl COCAINE HCLT3 dichlorotetrafluoroetha
neGEBAUER'S 114
T1 ethyl chloride ETHYL CHLORIDET1 lidocaine LIDOCAINET1 lidocaine LIDODERMT1 lidocaine hcl LIDOCAINE HCLT3 lidocaine hcl LIDORXT3 lidocaine hcl/collagen REGENECARET1 lidocaine/prilocaine EMLAT1 lidocaine/prilocaine LIDOCAINE-
PRILOCAINET3 lidocaine/tetracaine PLIAGLIST3 lidocaine/tetracaine SYNERAT3 norflurane/hfc 245fa PAIN EASET3 norflurane/hfc 245fa SPRAY AND
STRETCHT3 tetracaine hcl PONTOCAINET3 tetracaine/benzocaine/
butambenCETACAINE
T3 tetracaine/benzocaine/butamben
CETACAINEANESTHETIC
T3 vit e/lidocain/alover/colagn
REGENECARE
Topical Preparations,miscellaneousT3 honey MEDIHONEY
Topical/mucous Membr./subcut. EnzymesT3 collagenase
clostridium hist.SANTYL
T1 trypsin/balsamperu/castor oil
VASOLEX
DERMATOLOGY - PIGMENTATION
DISORDERSHypopigmentation AgentsT3 dioxybenzone/hydroqui
noneNUQUIN HP
T1 dioxybenzone/pdo/hydroquinone
NUQUIN HP
T3 fluocinolone/tretinoin/h-quin
TRI-LUMA
T1 hydroquinone HYDROQUINONET1 hydroquinone
microspheresHYDROQUINONE
T3 hydroquinone/ascorbicacid
C-CLARIFYINGSERUM
T3 hydroquinone/avobenz/octinox
ACLARO
T3 hydroquinone/avobenz/octinox
ACLARO PD
T1 hydroquinone/ferricoxide
MELPAQUE HP
T3 hydroquinone/vit c/vit eacet
C-THERAPY NIGHTCREAM
T1 oxybenzone/octinox/h-quinone
ALPHAQUIN HP
T3 oxybenzone/octinox/h-quinone
NU-DERMSUNFADER
Topical Hyperpigmentation AgentsT2 methoxsalen OXSORALEN
DERMATOLOGY -
PSORIASIS/ECZEMAAntipsoriatic Agents,systemicT4 acitretin SORIATANET2 methoxsalen 8-MOPT2 methoxsalen, rapid OXSORALEN-ULTRA
Antipsoriatics AgentsT2 anthralin DRITHOCREME HP STT3 anthralin ZITHRANOL-RR STT3 anthralin micronized ZITHRANOL STT1 calcipotriene CALCIPOTRIENE STT1 calcipotriene DOVONEX STT3 calcipotriene SORILUX STT1 calcitriol VECTICAL STT2 tazarotene TAZORAC
Hair Growth Reduction AgentsT3 eflornithine hcl VANIQA
Topical Agents,miscellaneousT3 pyrogallol PYROGALLIC ACIDT3 urea GORDO-UREA
Commercial Formulary
L.A. Care Page 21 of 96
Topical Immunosuppressive AgentsT3 pimecrolimus ELIDEL AGE,
STT2 tacrolimus PROTOPIC AGE,
ST
Topical Vit D Analog/antiinflammatory,
SteroidalT1 calcipotriene/betamet
hasoneTACLONEX(OINT) ST
T3 calcipotriene/betamethasone
TACLONEX(SUSPENSION)
ST
DIABETESAntihypergly, (dpp-4) Inhibitor & Biguanide
Comb.T3 alogliptin
benz/metformin hclKAZANO ST
T2 linagliptin/metforminhcl
JENTADUETO
T3 saxagliptinhcl/metformin hcl
KOMBIGLYZE XR ST
T2 sitagliptinphos/metformin hcl
JANUMET
T2 sitagliptinphos/metformin hcl
JANUMET XR
Antihypergly,dpp-4 Enzyme Inhib
&thiazolidinedioneT3 alogliptin
benz/pioglitzoneOSENI ST
Antihypergly,incretin MimeticT2 exenatide BYETTA(PEN
INJCTR)(10MCG/0.04)QL
T2 exenatide BYETTA(PENINJCTR)(5MCG/0.02)
QL
T2 exenatidemicrospheres
BYDUREON QL
T3 liraglutide VICTOZA 2-PAK QL, STT3 liraglutide VICTOZA 3-PAK QL, ST
Antihyperglycemc-sod/gluc
Cotransport2(sglt2)inhibT2 canagliflozin INVOKANA QL, STT3 dapagliflozin
propanediolFARXIGA QL, ST
Antihyperglycemic - Dopamine Receptor
AgonistsT3 bromocriptine
mesylateCYCLOSET ST
Antihyperglycemic, Alpha-glucosidase InhibT1 acarbose PRECOSE
T3 miglitol GLYSET
Antihyperglycemic, Amylin Analog-typeT2 pramlintide acetate SYMLINPEN 120T2 pramlintide acetate SYMLINPEN 60
Antihyperglycemic, Dpp-4 InhibitorsT3 alogliptin benzoate NESINA STT2 linagliptin TRADJENTAT3 saxagliptin hcl ONGLYZA STT2 sitagliptin phosphate JANUVIA
Antihyperglycemic, Insulin-release Stimulant
TypeT1 chlorpropamide CHLORPROPAMIDET1 glimepiride AMARYLT1 glipizide GLUCOTROLT2 glyburide DIABETAT1 glyburide GLYBURIDET1 glyburide,micronized GLYNASET1 nateglinide STARLIXT1 repaglinide PRANDINT1 tolazamide TOLAZAMIDET1 tolbutamide TOLBUTAMIDE
Antihyperglycemic, Insulin-response
EnhancerT1 pioglitazone hcl ACTOST3 rosiglitazone maleate AVANDIA
Antihyperglycemic,biguanide TypeT1 metformin hcl GLUCOPHAGET3 metformin hcl GLUMETZA STT2 metformin hcl RIOMET
Antihyperglycemic,insulin-rel Stim.&
Biguanide CmbT1 glipizide/metformin
hclGLIPIZIDE-METFORMIN
T1 glyburide/metforminhcl
GLUCOVANCE
T1 glyburide/metforminhcl
GLYBURIDE-METFORMIN HCL
T2 repaglinide/metforminhcl
PRANDIMET
Antihyperglycemic,insulin-response &
Release Comb.T1 pioglitazone
hcl/glimepirideDUETACT ST
T3 rosiglitazone/glimepiride
AVANDARYL
Antihyperglycemic-glucocorticoid Receptor
BlockerT4 mifepristone KORLYM PA
Commercial Formulary
L.A. Care Page 22 of 96
Antihyperglycm,insul-resp.enhancer &
Biguanide CmbT1 pioglitazone
hcl/metformin hclACTOPLUS MET ST
T2 pioglitazonehcl/metformin hcl
ACTOPLUS MET XR ST
T3 rosiglitazone/metformin hcl
AVANDAMET
Blood Sugar DiagnosticsT3 blood sugar diagnostic ACCU-CHEK
ACTIVE(OTC)T3 blood sugar diagnostic ACCU-CHEK AVIVA
PLUS(OTC)T3 blood sugar diagnostic ACCU-CHEK
AVIVA(OTC)T3 blood sugar diagnostic ACCU-CHEK
COMFORTCURVE(OTC)
T3 blood sugar diagnostic ACCU-CHEKSIMPLICITY(OTC)
T3 blood sugar diagnostic ACCU-CHEKSMARTVIEW(OTC)
T3 blood sugar diagnostic ACCU-CHEK(OTC)T3 blood sugar diagnostic ACCUTREND
GLUCOSE(OTC)T3 blood sugar diagnostic ACURA TEST
STRIPS(OTC)T3 blood sugar diagnostic ADVANCE TEST
STRIPS(OTC)T3 blood sugar diagnostic ADVOCATE REDI-
CODE(OTC)T3 blood sugar diagnostic ADVOCATE REDI-
CODE+(OTC)T3 blood sugar diagnostic ADVOCATE TEST
STRIP(OTC)T3 blood sugar diagnostic AGAMATRIX
AMP(OTC)T3 blood sugar diagnostic ASSURE 4(OTC)T3 blood sugar diagnostic ASSURE
PLATINUM(OTC)T3 blood sugar diagnostic ASSURE PRO(OTC)T3 blood sugar diagnostic AT-LAST TEST
STRIPS(OTC)T3 blood sugar diagnostic BG-STAR(OTC)T3 blood sugar diagnostic BLOOD GLUCOSE
TEST STRIP(OTC)T3 blood sugar diagnostic BLOOD GLUCOSE
TEST(OTC)T3 blood sugar diagnostic BLOOD GLUOCSE
TEST(OTC)T3 blood sugar diagnostic CARESENS N(OTC)T3 blood sugar diagnostic CHEMSTRIP
BG(OTC)T3 blood sugar diagnostic CHOICEDM CLARUS
TEST STRIPS(OTC)T3 blood sugar diagnostic CHOICEDM
G20(OTC)
T3 blood sugar diagnostic CLEVER CHOICEMICRO TESTSTRIP(OTC)
T3 blood sugar diagnostic CLEVER CHOICEPRO(OTC)
T3 blood sugar diagnostic CLEVER CHOICETALK(OTC)
T3 blood sugar diagnostic CLEVER CHOICETEST STRIPS(OTC)
T3 blood sugar diagnostic CLEVER CHOICEVOICE+(OTC)
T2 blood sugar diagnostic CONTOURNEXT(OTC)
T3 blood sugar diagnostic CONTOUR TS(OTC)T2 blood sugar diagnostic CONTOUR(OTC)T3 blood sugar diagnostic CONTROL G3(OTC)T3 blood sugar diagnostic CONTROL(OTC)T3 blood sugar diagnostic DIATRUE PLUS(OTC)T3 blood sugar diagnostic EASY CHECK TEST
STRIP(OTC)T3 blood sugar diagnostic EASY GLUCO
G2(OTC)T3 blood sugar diagnostic EASY PLUS II(OTC)T3 blood sugar diagnostic EASY PLUS(OTC)T3 blood sugar diagnostic EASY STEP(OTC)T3 blood sugar diagnostic EASY TALK(OTC)T3 blood sugar diagnostic EASY TOUCH(OTC)T3 blood sugar diagnostic EASY TRAK(OTC)T3 blood sugar diagnostic EASYGLUCO
PLUS(OTC)T3 blood sugar diagnostic EASYGLUCO(OTC)T3 blood sugar diagnostic EASYMAX 15(OTC)T3 blood sugar diagnostic EASYMAX(OTC)T3 blood sugar diagnostic ELEMENT
COMPACT(OTC)T3 blood sugar diagnostic ELEMENT TEST
STRIPS(OTC)T3 blood sugar diagnostic EMBRACE EVO(OTC)T3 blood sugar diagnostic EMBRACE PRO(OTC)T3 blood sugar diagnostic EMBRACE(OTC)T3 blood sugar diagnostic EVENCARE G2(OTC)T3 blood sugar diagnostic EVENCARE G3(OTC)T3 blood sugar diagnostic EVENCARE(OTC)T3 blood sugar diagnostic EVOLUTION TEST
STRIPS(OTC)T3 blood sugar diagnostic EZ SMART
PLUS(OTC)T3 blood sugar diagnostic EZ SMART(OTC)T3 blood sugar diagnostic FIFTY50 TEST
STRIP(OTC)T3 blood sugar diagnostic FORA D10(OTC)T3 blood sugar diagnostic FORA D15C(OTC)T3 blood sugar diagnostic FORA D15G(OTC)T3 blood sugar diagnostic FORA D15Z(OTC)T3 blood sugar diagnostic FORA D20(OTC)T3 blood sugar diagnostic FORA G20(OTC)T3 blood sugar diagnostic FORA G30A(OTC)T3 blood sugar diagnostic FORA G71A(OTC)T3 blood sugar diagnostic FORA G90(OTC)T3 blood sugar diagnostic FORA V10(OTC)T3 blood sugar diagnostic FORA V12(OTC)T3 blood sugar diagnostic FORA V20(OTC)
Commercial Formulary
L.A. Care Page 23 of 96
T3 blood sugar diagnostic FORA V22(OTC)T3 blood sugar diagnostic FORA V30A(OTC)T3 blood sugar diagnostic FORA(OTC)T3 blood sugar diagnostic FORACARE
GD20(OTC)T3 blood sugar diagnostic FORACARE
GD40(OTC)T2 blood sugar diagnostic FREESTYLE
INSULINX(OTC)T2 blood sugar diagnostic FREESTYLE
LITE(OTC)T2 blood sugar diagnostic FREESTYLE(OTC)T3 blood sugar diagnostic G-4(OTC)T3 blood sugar diagnostic GE100 BLOOD
GLUCOSE TESTSTRIP(OTC)
T3 blood sugar diagnostic GENSTRIP(OTC)T3 blood sugar diagnostic GLUCO NAVII(OTC)T3 blood sugar diagnostic GLUCOCARD 01
SENSOR(OTC)T3 blood sugar diagnostic GLUCOCARD
EXPRESSION(OTC)T3 blood sugar diagnostic GLUCOCARD VITAL
SENSOR(OTC)T3 blood sugar diagnostic GLUCOCOM
GLUCOSE(OTC)T3 blood sugar diagnostic GLUCOFILM(OTC)T3 blood sugar diagnostic GLUCOSE TEST
STRIP(OTC)T3 blood sugar diagnostic GLUCOSTIX
REAGENT(OTC)T3 blood sugar diagnostic GMATE TEST
STRIPS(OTC)T3 blood sugar diagnostic HEALTHPRO TEST
STRIPS(OTC)T3 blood sugar diagnostic INFINITY TEST
STRIPS(OTC)T3 blood sugar diagnostic LIBERTY TEST
STRIPS(OTC)T3 blood sugar diagnostic MAXIMA(OTC)T3 blood sugar diagnostic MICRO(OTC)T3 blood sugar diagnostic MICRODOT
XTRA(OTC)T3 blood sugar diagnostic MICRODOT(OTC)T3 blood sugar diagnostic MYGLUCOHEALTH(O
TC)T3 blood sugar diagnostic NEUTEK 2TEK TEST
STRIPS(OTC)T3 blood sugar diagnostic NOVA MAX(OTC)T3 blood sugar diagnostic ON CALL EXPRESS
TEST STRIP(OTC)T3 blood sugar diagnostic ON CALL PLUS TEST
STRIP(OTC)T3 blood sugar diagnostic ON CALL VIVID TEST
STRIP(OTC)T3 blood sugar diagnostic ONE TOUCH
ULTRA(OTC)T3 blood sugar diagnostic ONE TOUCH
VERIO(OTC)T3 blood sugar diagnostic OPTUMRX(OTC)T3 blood sugar diagnostic PHARMACIST
CHOICE(OTC)
T2 blood sugar diagnostic PRECISIONXTRA(OTC)
T3 blood sugar diagnostic PREMIUM BLOODGLUCOSETEST(OTC)
T3 blood sugar diagnostic PREMIUM V10(OTC)T3 blood sugar diagnostic PRODIGY NO
CODING(OTC)T3 blood sugar diagnostic QUINTET AC(OTC)T3 blood sugar diagnostic QUINTET(OTC)T3 blood sugar diagnostic REAGENT
STRIPS(OTC)T3 blood sugar diagnostic REFUAH PLUS(OTC)T3 blood sugar diagnostic RELION CONFIRM-
MICRO(OTC)T3 blood sugar diagnostic RELION PRIME(OTC)T3 blood sugar diagnostic REVEAL TEST
STRIP(OTC)T3 blood sugar diagnostic RIGHTEST GS100
TEST STRIPS(OTC)T3 blood sugar diagnostic RIGHTEST GS250S
TEST STRIPS(OTC)T3 blood sugar diagnostic RIGHTEST GS260
TEST STRIPS(OTC)T3 blood sugar diagnostic RIGHTEST GS300
TEST STRIPS(OTC)T3 blood sugar diagnostic RIGHTEST GS550
TEST STRIPS(OTC)T3 blood sugar diagnostic SMART CARESENS
N(OTC)T3 blood sugar diagnostic SMART SENSE TEST
STRIPS(OTC)T3 blood sugar diagnostic SMARTDIABETES
XPRES(OTC)T3 blood sugar diagnostic SMARTEST
TEST(OTC)T3 blood sugar diagnostic SOLUS V2(OTC)T3 blood sugar diagnostic SURE EDGE TEST
STRIPS(OTC)T3 blood sugar diagnostic SURECHEK TEST
STRIPS(OTC)T3 blood sugar diagnostic SURESTEP
PRO(OTC)T3 blood sugar diagnostic SURE-TEST
EASYPLUSMINI(OTC)
T3 blood sugar diagnostic TD GOLD TESTSTRIP(OTC)
T3 blood sugar diagnostic TELCARE(OTC)T3 blood sugar diagnostic TEST N'GO(OTC)T3 blood sugar diagnostic TEST STRIPS(OTC)T3 blood sugar diagnostic TRACER BG(OTC)T3 blood sugar diagnostic TRUETEST TEST
STRIPS(OTC)T3 blood sugar diagnostic TRUETRACK SMART
SYSTEM(OTC)T3 blood sugar diagnostic TRUETRACK TEST
STRIP(OTC)T3 blood sugar diagnostic ULTIMA(OTC)T3 blood sugar diagnostic ULTRATRAK
ULTIMATE(OTC)T3 blood sugar diagnostic ULTRATRAK(OTC)
Commercial Formulary
L.A. Care Page 24 of 96
T3 blood sugar diagnostic UNISTRIP1(OTC)T3 blood sugar diagnostic VICTORY(OTC)T3 blood sugar diagnostic VOCAL POINT(OTC)T3 blood sugar diagnostic WAVESENSE
JAZZ(OTC)T3 blood sugar diagnostic WAVESENSE
PRESTO(OTC)T2 blood sugar diagnostic,
discBREEZE 2(OTC)
T3 blood sugar diagnostic,drum
ACCU-CHEKCOMPACTPLUS(OTC)
T3 blood sugar diagnostic,drum
ACCU-CHEKCOMPACT(OTC)
Diabetic SuppliesT2 blood glucose ctl
high,nml&lowMYGLUCOHEALTHCONTROLSOLUTION(OTC)
T3 blood glucose strips-dispmeter
SIDEKICK(OTC)
T3 blood-gl & bpmeter,adult cuff
FORA D15(OTC)
T3 blood-glumeter,cont/transmit
GUARDIAN REAL-TIME
T3 blood-gluc.meter&wrist bp mon
2TEK(OTC)
T3 blood-gluc.meter&wrist bp mon
ADVOCATEDUO(OTC)
T3 blood-gluc.meter&wrist bp mon
FORA D10(OTC)
T3 blood-glucose meter ACURA METERKIT(OTC)
T3 blood-glucose meter ACURA PLUS(OTC)T3 blood-glucose meter ACURA STARTER
KIT(OTC)T3 blood-glucose meter ADVOCATE BLOOD
GLUCOSEMONITOR(OTC)
T3 blood-glucose meter ADVOCATE REDI-CODE(OTC)
T3 blood-glucose meter ADVOCATE REDI-CODE+(OTC)
T3 blood-glucose meter AGAMATRIXAMP(OTC)
T3 blood-glucose meter ASSURE 4(OTC)T3 blood-glucose meter ASSURE
PLATINUM(OTC)T3 blood-glucose meter ASSURE PRO(OTC)T3 blood-glucose meter AT-LAST(OTC)T3 blood-glucose meter BLOOD GLUCOSE
METER(OTC)T3 blood-glucose meter BLOOD GLUCOSE
MONITOR(OTC)T3 blood-glucose meter BLOOD GLUCOSE
MONITORING(OTC)T3 blood-glucose meter BLOOD-GLUCOSE
METER(OTC)T3 blood-glucose meter CARESENS N
VOICE(OTC)T3 blood-glucose meter CARESENS N(OTC)
T3 blood-glucose meter CHOICEDMCLARUS(OTC)
T3 blood-glucose meter CHOICEDMG20(OTC)
T3 blood-glucose meter CLEVER CHEKBLOOD GLUCOSESYST(OTC)
T3 blood-glucose meter CLEVER CHOICEBLOOD GLUCSYS(OTC)
T3 blood-glucose meter CLEVER CHOICE HDGLUCOSESYST(OTC)
T3 blood-glucose meter CLEVER CHOICEMICRO(OTC)
T3 blood-glucose meter CLEVER CHOICEPRO(OTC)
T3 blood-glucose meter CLEVER CHOICETALK(OTC)
T3 blood-glucose meter CLEVERCHOICE(OTC)
T3 blood-glucose meter CONTROL(OTC)T3 blood-glucose meter DIATRUE PLUS(OTC)T3 blood-glucose meter EASY CHECK(OTC)T3 blood-glucose meter EASY PLUS II(OTC)T3 blood-glucose meter EASY PLUS(OTC)T3 blood-glucose meter EASY STEP(OTC)T3 blood-glucose meter EASY TALK(OTC)T3 blood-glucose meter EASY TOUCH
GLUCOSEMONITOR(OTC)
T3 blood-glucose meter EASY TRAK(OTC)T3 blood-glucose meter EASYGLUCO
PLUS(OTC)T3 blood-glucose meter EASYGLUCO(OTC)T3 blood-glucose meter EASYMAX L(OTC)T3 blood-glucose meter EASYMAX N(OTC)T3 blood-glucose meter EASYMAX NG(OTC)T3 blood-glucose meter EASYMAX V
SPEAKING(OTC)T3 blood-glucose meter EASYMAX V(OTC)T3 blood-glucose meter EASYMAX V2(OTC)T3 blood-glucose meter ELEMENT BLOOD
GLUCOSEMETER(OTC)
T3 blood-glucose meter ELEMENTCOMPACT(OTC)
T3 blood-glucose meter ELEMENTPLUS(OTC)
T3 blood-glucose meter EMBRACE(OTC)T3 blood-glucose meter EVENCARE G2(OTC)T3 blood-glucose meter EVENCARE G3(OTC)T3 blood-glucose meter EVENCARE(OTC)T3 blood-glucose meter EVOLUTION BLOOD
GLUCOSEMETER(OTC)
T3 blood-glucose meter EZ SMARTPLUS(OTC)
T3 blood-glucose meter EZ SMART(OTC)T3 blood-glucose meter FORA D20(OTC)T3 blood-glucose meter FORA G20(OTC)T3 blood-glucose meter FORA G30A(OTC)
Commercial Formulary
L.A. Care Page 25 of 96
T3 blood-glucose meter FORA G71A(OTC)T3 blood-glucose meter FORA G90(OTC)T3 blood-glucose meter FORA V10(OTC)T3 blood-glucose meter FORA V12(OTC)T3 blood-glucose meter FORA V20(OTC)T3 blood-glucose meter FORA V22(OTC)T3 blood-glucose meter FORA V30A(OTC)T3 blood-glucose meter FORACARE
GD20(OTC)T3 blood-glucose meter FORACARE
GD40A(OTC)T3 blood-glucose meter FORACARE
GD40B(OTC)T3 blood-glucose meter G-4(OTC)T3 blood-glucose meter GDRIVE(OTC)T3 blood-glucose meter GE100 BLOOD
GLUCOSESYSTEM(OTC)
T3 blood-glucose meter GLUCO NAVII(OTC)T3 blood-glucose meter GLUCOCARD
01(OTC)T3 blood-glucose meter GLUCOCARD 01-
MINI(OTC)T3 blood-glucose meter GLUCOCARD
EXPRESSION(OTC)T3 blood-glucose meter GLUCOCARD
VITAL(OTC)T3 blood-glucose meter GLUCOCOM BLOOD
GLUCOSE(OTC)T3 blood-glucose meter GMATE VOICE
METER(OTC)T3 blood-glucose meter GMATE VOICE
STARTER(OTC)T3 blood-glucose meter IBG-STAR(OTC)T3 blood-glucose meter INFINITY(OTC)T3 blood-glucose meter LIBERTY
MONITOR(OTC)T3 blood-glucose meter MICRO(OTC)T3 blood-glucose meter MICRODOT(OTC)T3 blood-glucose meter MYGLUCOHEALTH(O
TC)T3 blood-glucose meter NEWTEK(OTC)T3 blood-glucose meter NOVA MAX BLOOD
GLUCOSEMETER(OTC)
T3 blood-glucose meter ON CALL PLUSMETER(OTC)
T3 blood-glucose meter ON CALL VIVIDMETER(OTC)
T3 blood-glucose meter ON CALL VIVIDPAL(OTC)
T3 blood-glucose meter OPTUMRX(OTC)T3 blood-glucose meter PHARMACIST
CHOICE(OTC)T3 blood-glucose meter PREMIUM BLOOD
GLUCOSE(OTC)T3 blood-glucose meter PREMIUM V10(OTC)T3 blood-glucose meter PRESTO PRO(OTC)T3 blood-glucose meter PRODIGY
POCKET(OTC)T3 blood-glucose meter PRODIGY
VOICE(OTC)
T3 blood-glucose meter PRODIGY(OTC)T3 blood-glucose meter QUINTET AC(OTC)T3 blood-glucose meter QUINTET(OTC)T3 blood-glucose meter REFUAH PLUS(OTC)T3 blood-glucose meter RELION
CONFIRM(OTC)T3 blood-glucose meter RELION MICRO(OTC)T3 blood-glucose meter RELION PRIME(OTC)T3 blood-glucose meter REVEAL BLOOD
GLUCOSEMETER(OTC)
T3 blood-glucose meter RIGHTEST GM100SYSTEM(OTC)
T3 blood-glucose meter RIGHTEST GM250SMETER(OTC)
T3 blood-glucose meter RIGHTEST GM260METER(OTC)
T3 blood-glucose meter RIGHTEST GM300SYSTEM(OTC)
T3 blood-glucose meter RIGHTEST GM550SYSTEM(OTC)
T3 blood-glucose meter RIGHTSOURCE(OTC)T3 blood-glucose meter SMART CARESENS
N(OTC)T3 blood-glucose meter SMART SENSE
MONITORINGSYSTEM(OTC)
T3 blood-glucose meter SMARTDIABETESXPRES(OTC)
T3 blood-glucose meter SMARTESTEJECT(OTC)
T3 blood-glucose meter SMARTESTPERSONA(OTC)
T3 blood-glucose meter SMARTESTPRONTO(OTC)
T3 blood-glucose meter SMARTESTPROTEGE(OTC)
T3 blood-glucose meter SMARTEST SMARTCODE(OTC)
T3 blood-glucose meter SMARTESTTALKING(OTC)
T3 blood-glucose meter SOLUS V2(OTC)T3 blood-glucose meter STARTER KIT(OTC)T3 blood-glucose meter SURE EDGE BLOOD
GLUCOSEMETER(OTC)
T3 blood-glucose meter SURE-TESTEASYPLUSMINI(OTC)
T3 blood-glucose meter TD GOLD BLOODGLUCOSEMONITOR(OTC)
T3 blood-glucose meter TD GOLD VOICEGLUCOSEMONITOR(OTC)
T3 blood-glucose meter TELCARE(OTC)T3 blood-glucose meter TEST N'GO(OTC)T3 blood-glucose meter TRUE2GO BLOOD
GLUCOSESYSTEM(OTC)
Commercial Formulary
L.A. Care Page 26 of 96
T3 blood-glucose meter TRUERESULTBLOOD GLUCOSESYSTM(OTC)
T3 blood-glucose meter TRUETRACK BLOODGLUCOSESYSTEM(OTC)
T3 blood-glucose meter TRUETRACKMETER(OTC)
T3 blood-glucose meter TRUETRACK SMARTSYSTEM(OTC)
T3 blood-glucose meter ULTIMA(OTC)T3 blood-glucose meter ULTRATRAK
PRO(OTC)T3 blood-glucose meter ULTRATRAK
ULTIMATE(OTC)T3 blood-glucose meter ULTRATRAK(OTC)T3 blood-glucose meter VICTORY(OTC)T3 blood-glucose meter WAVESENSE
AMP(OTC)T3 blood-glucose meter WAVESENSE
JAZZ(OTC)T3 blood-glucose meter WAVESENSE
PRESTO(OTC)T3 blood-glucose
meter,continuousDEXCOM G4
T2 lancing device ADJUSTABLELANCINGDEVICE(OTC)
T2 lancing device ADVOCATE LANCINGDEVICE(OTC)
T3 lancing device ADVOCATE RAPID-SAFE(OTC)
T2 lancing device ALTERNATE SITELANCINGDEVICE(OTC)
T2 lancing device AQUA LANCELANCINGDEVICE(OTC)
T2 lancing device AUTO-LANCETMINI(OTC)
T2 lancing device AUTOLET LANCINGDEVICE(OTC)
T2 lancing device CAREONE(OTC)T2 lancing device DROPLET LANCING
DEVICE(OTC)T2 lancing device EASY CLICK(OTC)T2 lancing device EASY TOUCH
LANCINGDEVICE(OTC)
T2 lancing device FORA LANCINGDEVICE(OTC)
T2 lancing device GENTLE DRAW(OTC)T2 lancing device GLUCOLET 2(OTC)T2 lancing device GLUCOSOURCE(OT
C)T2 lancing device HEALTHY ACCENTS
AUTOLET(OTC)T2 lancing device INCONTROL
LANCINGDEVICE(OTC)
T2 lancing device LANCETDEVICE(OTC)
T2 lancing device LANCINGDEVICE(OTC)
T2 lancing device LANCINGSYSTEM(OTC)
T2 lancing device LITE TOUCH(OTC)T2 lancing device MINI LANCING
DEVICE(OTC)T2 lancing device MULTI-LANCET
DEVICE(OTC)T2 lancing device ON CALL LANCING
DEVICE(OTC)T2 lancing device ON CALL PLUS
LANCINGDEVICE(OTC)
T2 lancing device PRODIGY LANCINGDEVICE(OTC)
T2 lancing device RELIAMED MINILANCINGDEVICE(OTC)
T2 lancing device RIGHTESTGD500(OTC)
T2 lancing device SELECT-LITE(OTC)T2 lancing device SMARTDIABETES
VANTAGE(OTC)T2 lancing device SOFT TOUCH(OTC)T2 lancing device SOFTCLIX(OTC)T2 lancing device SURE COMFORT
LANCING PEN(OTC)T2 lancing device SUREFLEX(OTC)T2 lancing device SURE-PEN(OTC)T2 lancing device ULTI-LANCE(OTC)T2 lancing device/lancets ACCU-CHEK
FASTCLIX(OTC)T2 lancing device/lancets ACCU-CHEK
SOFTCLIX(OTC)T2 lancing device/lancets ACCU-CHEK(OTC)T2 lancing device/lancets ADVANCED LANCING
DEVICE(OTC)T2 lancing device/lancets AUTOLET
IMPRESSION(OTC)T2 lancing device/lancets GLUCOLET 2(OTC)T2 lancing device/lancets HYPOLANCE(OTC)T2 lancing device/lancets LANCING
DEVICE(OTC)T2 lancing device/lancets MICROLET 2(OTC)T2 lancing device/lancets ONE TOUCH
DELICA(OTC)T2 lancing device/lancets ONE TOUCH
SURESOFT(OTC)T2 lancing device/lancets PENLET PLUS
BLOODSAMPLER(OTC)
T2 lancing device/lancets SOLUS V2 LANCINGDEVICE(OTC)
T2 lancing device/lancets SUREFLEX(OTC)T2 lancing device/lancets ULTI-LANCE(OTC)T2 lancing device/lancets UNISTIK 2
EXTRA(OTC)T2 lancing device/lancets UNISTIK 2 NORMALT2 lancing device/lancets UNISTIK 2
NORMAL(OTC)T2 lancing device/lancets UNISTIK 2(OTC)
Commercial Formulary
L.A. Care Page 27 of 96
T2 lancing device/lancets UNISTIK 3COMFORT(OTC)
T2 lancing device/lancets UNISTIK 3NEONATAL(OTC)
T2 lancing device/lancets UNISTIK 3(OTC)
Diabetic Ulcer Preparations,topicalT2 becaplermin REGRANEX
HyperglycemicsT3 diazoxide PROGLYCEMT2 glucagon,human
recombinantGLUCAGEN
T2 glucagon,humanrecombinant
GLUCAGONEMERGENCY KIT
InsulinsT2 hum insulin nph/reg
insulin hmHUMULIN 70/30KWIKPEN(OTC)
T2 hum insulin nph/reginsulin hm
HUMULIN 70-30(OTC)
T2 hum insulin nph/reginsulin hm
NOVOLIN 70-30(OTC)
T2 insulin aspart NOVOLOGT2 insulin aspart NOVOLOG FLEXPENT3 insulin detemir LEVEMIR STT3 insulin detemir LEVEMIR FLEXPEN STT2 insulin
glargine,hum.rec.anlogLANTUS
T2 insulinglargine,hum.rec.anlog
LANTUS SOLOSTAR
T3 insulin glulisine APIDRAT3 insulin glulisine APIDRA SOLOSTART2 insulin lispro HUMALOGT2 insulin npl/insulin lisproHUMALOG MIX 50-50T2 insulin npl/insulin lisproHUMALOG MIX 75-25T2 insulin regular, human HUMULIN RT2 insulin regular, human HUMULIN R(OTC)T2 insulin regular, human NOVOLIN R(OTC)T2 insuln asp prt/insulin
aspartNOVOLOG MIX 70-30
T2 insuln asp prt/insulinaspart
NOVOLOG MIX 70-30FLEXPEN
T2 nph, human insulinisophane
HUMULIN N(OTC)
T2 nph, human insulinisophane
NOVOLIN NINNOLET(OTC)
T2 nph, human insulinisophane
NOVOLIN N(OTC)
Urine Glucose Test AidsT3 urine glucose test,strip CHEMSTRIP
UG(OTC)T3 urine glucose test,strip DIASCREEN 1G
REAGENT(OTC)T3 urine glucose test,strip DIASTIX
REAGENT(OTC)T2 urine glucose
test,tabletCLINITESTREAGENT(OTC)
Urine Glucose/acetone Test Aids,stripsT3 urine gluc-acet
comb.tst,stripCHEMSTRIPUGK(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN 10(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN 2GKREAGENT(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN 3REAGENT(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN4OBL(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN 5(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN 7(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN 8(OTC)
T3 urine gluc-acetcomb.tst,strip
DIASCREEN 9(OTC)
T3 urine gluc-acetcomb.tst,strip
KETO-DIASTIXREAGENT(OTC)
EAR - GENERAL DISORDERSEar Preparations Anti-inflammatoryT1 fluocinolone
acetonide oilDERMOTIC
Ear Preparations, Misc. Anti-infectivesT1 acetic acid ACETIC ACIDT1 acetic acid/aluminum
acetateDOMEBORO
T1 aceticacid/hydrocortisone
HYDROCORTISONE-ACETIC ACID
T1 cresyl ace/benalc/butanol/ipa
CRESYLATE
T1 hc/pramox hcl/cl-xylenol/water
CORTANE-B
T3 hc/pramoxinehcl/chloroxylenol
CORTANE-B
T1 hc/pramoxinehcl/chloroxylenol
PRAMOXINE-HC
Ear Preparations,antibioticsT1 ciprofloxacin hcl CETRAXALT3 neomy sulf/colist
sul/hc/thonzCOLY-MYCIN S
T3 neomy sulf/colistsul/hc/thonz
CORTISPORIN-TC
T1 neomycin/polymyxinb sulf/hc
NEOMYCIN-POLYMYXIN-HC
T3 ofloxacin FLOXINT1 ofloxacin OFLOXACIN
Ear Preparations,local AnestheticsT1 aa/antipyrn/bcaine/po
lico#1/alTREAGAN OTIC
T3 antipyrine/benzocain/gly/zinc
OTOZIN
T1 antipyrine/benzocaine
ANTIPYRINE-BENZOCAINE
Commercial Formulary
L.A. Care Page 28 of 96
T1 antipyrine/benzocaine/glycerin
ANTIPYRINE-BENZOCAINE
T3 antipyrine/benzocaine/glycerin
OTIC CARE
T1 benzocaine PINNACAINE
Otic Preparations,anti-inflammatory-
antibioticsT2 ciprofloxacin
hcl/dexamethCIPRODEX
T3 ciprofloxacin/hydrocortisone
CIPRO HC
Otic,antiinfective-local Anesthetic
CombinationsT3 chloroxylenol/pramoxin
e hclOTICIN
ELECTROLYTE REGULATIONArginine Vasopressin (avp) Receptor
AntagonistsT3 tolvaptan SAMSCA(TAB)(15
MG)QL
T3 tolvaptan SAMSCA(TAB)(30MG)
QL
Electrolyte DepletersT1 calcium acetate CALCIUM ACETATET1 calcium acetate PHOSLOT3 calcium acetate PHOSLYRAT1 calcium
carbonate/magcarb/fa
MAGNEBIND 400 RX
T3 lanthanum carbonate FOSRENOLT2 sevelamer carbonate RENVELA(POWD
PACK)T1 sevelamer carbonate RENVELA(TAB)T2 sevelamer hcl RENAGELT1 sodium polystyrene
sulfonateSPS
T3 sucroferricoxyhydroxide
VELPHORO
Potassium ReplacementT1 pot chloride/pot
bicarb/cit acPOTASSIUMCHLORIDE
T3 potassium bicarbonate QUIC-KT3 potassium
bicarbonate/cit acEFFER-K
T1 potassiumbicarbonate/cit ac
KLOR-CON-EF
T1 potassium chloride KAOCHLORT1 potassium chloride K-TAB ERT1 potassium chloride POTASSIUM
CHLORIDET3 potassium chloride/pot
bicarbKAOCHLOR-EFF
T1 potassium gluconate POTASSIUMGLUCONATE
Sodium/saline PreparationsT1 0.5 normal saline SODIUM CHLORIDET1 0.9 % sodium
chlorideNORMAL SALINEFLUSH
T1 normal saline SODIUM CHLORIDET1 sodium chloride 0.45
%SODIUM CHLORIDE
ENDOCRINE DISORDER - FERTILITYDrugs To Treat ImpotencyT3 alprostadil CAVERJECT QLT3 alprostadil EDEX QLT3 alprostadil MUSE QLT3 avanafil STENDRA G, QLT2 sildenafil citrate VIAGRA G, QLT2 tadalafil CIALIS(TAB)(10 MG) G, QLT2 tadalafil CIALIS(TAB)(2.5 MG) G, QLT2 tadalafil CIALIS(TAB)(20 MG) G, QLT2 tadalafil CIALIS(TAB)(5 MG) G, QLT3 vardenafil hcl LEVITRA G, QLT2 vardenafil hcl STAXYN G, QLT1 yohimbine hcl YOHIMEXT1 yohimbine hcl/zinc
sulfateYOHIMAR
Fertility Stimulating Preparations,non-fshT1 clomiphene citrate SEROPHENE
Follicle Stim./luteinizing HormonesT4 menotropins MENOPURT4 menotropins REPRONEX
Follicle-stimulating HormoneT4 follitropin alfa, recomb GONAL-FT4 follitropin alfa, recomb GONAL-F RFFT4 follitropin alfa, recomb GONAL-F RFF REDI-
JECTT4 follitropin beta,recomb FOLLISTIM AQT4 urofollitropin BRAVELLE
Human Chorionic GonadotropinT2 choriogonadotropin
alfaOVIDREL
T2 chorionicgonadotropin, human
CHORIONICGONADOTROPIN
T2 chorionicgonadotropin, human
NOVAREL
T2 chorionicgonadotropin, human
PREGNYL
Pregnancy Facilitating/maintaining
Agent,hormonalT3 progesterone FIRST-
PROGESTERONEVGS 100
Commercial Formulary
L.A. Care Page 29 of 96
T3 progesterone FIRST-PROGESTERONEVGS 200
T3 progesterone FIRST-PROGESTERONEVGS 25
T3 progesterone FIRST-PROGESTERONEVGS 400
T3 progesterone FIRST-PROGESTERONEVGS 50
T2 progesterone,micronized
CRINONE
T2 progesterone,micronized
ENDOMETRIN
ENDOCRINE DISORDER - OTHERAdrenocorticotrophic HormonesT4 corticotropin H.P. ACTHAR PA
Antidiuretic And Vasopressor HormonesT1 desmopressin
(nonrefrigerated)DDAVP
T3 desmopressin acetate DDAVP(AMPUL)(15MCG/ML)
T1 desmopressinacetate
DDAVP(AMPUL)(4MCG/ML)
T2 desmopressin acetate DDAVP(SOLUTION)T1 desmopressin
acetateDDAVP(TAB)
T1 desmopressinacetate
DDAVP(VIAL)
T1 desmopressinacetate
DESMOPRESSINACETATE
T3 desmopressin acetate STIMATE
Antineoplastic Lhrh(gnrh) Agonist,pituitary
Suppr.T4 goserelin acetate ZOLADEX PAT4 leuprolide acetate ELIGARD PAT4 leuprolide acetate LEUPROLIDE
ACETATET4 leuprolide acetate LUPRON DEPOTT4 triptorelin pamoate TRELSTART4 triptorelin pamoate TRELSTAR DEPOTT4 triptorelin pamoate TRELSTAR LA
Bone Formation Stim. Agents - Parathyroid
HormoneT4 teriparatide FORTEO QL
Bone Resorption Inhibitor & Vitamin D
CombinationsT2 alendronate
sodium/vitamin d3FOSAMAX PLUS D
Bone Resorption InhibitorsT1 alendronate sodium ALENDRONATE
SODIUM(SOLUTION)QL
T1 alendronate sodium ALENDRONATESODIUM(TAB)
T3 alendronate sodium BINOSTO QL, STT1 alendronate sodium FOSAMAXT3 calcitonin,salmon,synt
heticFORTICAL
T1 calcitonin,salmon,synthetic
MIACALCIN(SPRAY/PUMP)
T3 calcitonin,salmon,synthetic
MIACALCIN(VIAL)
T4 denosumab PROLIAT4 denosumab XGEVA PAT1 etidronate disodium ETIDRONATE
DISODIUMT1 ibandronate sodium BONIVAT1 raloxifene hcl EVISTA QLT3 risedronate sodium ACTONEL(TAB)(150
MG)QL, ST
T3 risedronate sodium ACTONEL(TAB)(30MG)
QL, ST
T3 risedronate sodium ACTONEL(TAB)(35MG)
QL, ST
T3 risedronate sodium ACTONEL(TAB)(5MG)
QL, ST
T3 risedronate sodium ATELVIA QL, STT4 zoledronic acid ZOLEDRONIC ACIDT4 zoledronic acid ZOMETAT4 zoledronic
acid/mannitol&waterRECLAST
T4 zoledronicacid/mannitol&water
ZOLEDRONIC ACID
T4 zoledronicacid/mannitol&water
ZOMETA
Calcimimetic,parathyroid Calcium EnhancerT4 cinacalcet hcl SENSIPAR
Growth Hormone Receptor AntagonistsT4 pegvisomant SOMAVERT
Growth Hormone Releasing Hormone (ghrh)
& AnalogsT4 tesamorelin acetate EGRIFTA PA
Growth HormonesT4 somatropin GENOTROPIN PAT4 somatropin HUMATROPE PAT4 somatropin NORDITROPIN
FLEXPROPA
T4 somatropin NORDITROPINNORDIFLEX
PA
T4 somatropin NUTROPIN PAT4 somatropin NUTROPIN AQ PAT4 somatropin NUTROPIN AQ
NUSPINPA
T4 somatropin OMNITROPE PAT4 somatropin SAIZEN PA
Commercial Formulary
L.A. Care Page 30 of 96
T4 somatropin SEROSTIM PAT4 somatropin TEV-TROPIN PAT4 somatropin ZORBTIVE PA
Hyperparathyroid Tx Agents - Vitamin D
Analog-typeT1 doxercalciferol HECTOROLT1 paricalcitol ZEMPLAR
Insulin-like Growth Factor-1 (igf-1)
HormonesT4 mecasermin INCRELEX PA
Leptin Hormone AnalogsT4 metreleptin MYALEPT
Lhrh(gnrh) Agonist Analog Pituitary
SuppressantsT3 histrelin ac SUPPRELINT4 histrelin ac VANTAST4 nafarelin acetate SYNAREL
Lhrh(gnrh) Antagonist,pituitary Suppressant
AgentsT4 cetrorelix acetate CETROTIDET4 ganirelix acetate GANIRELIX ACETATE
Lhrh(gnrh)agnst Pit.sup-central Precocious
PubertyT4 histrelin ac SUPPRELIN LAT4 leuprolide acetate LUPRON DEPOT-PED
Luteinizing Hormone Releasing Hormone
-lhrhT2 gonadorelin acetate LUTREPULSE
Menopausal Sympt Supp-sel Estrogen
Recep ModulatorT3 ospemifene OSPHENA QL
Pituitary Suppressive AgentsT1 cabergoline CABERGOLINET1 danazol DANAZOL
ENDOCRINE DISORDER - THYROIDAntithyroid PreparationsT1 methimazole METHIMAZOLET1 methimazole TAPAZOLET1 propylthiouracil PROPYLTHIOURACIL
Iodine Containing AgentsT1 potassium iodide SSKIT1 potassium
iodide/iodineSTRONG IODINE
Thyroid HormonesT1 levothyroxine
sodiumLEVOTHYROXINESODIUM
T2 levothyroxine sodium LEVOXYLT2 levothyroxine sodium SYNTHROIDT3 levothyroxine sodium TIROSINTT2 levothyroxine sodium UNITHROIDT1 liothyronine sodium CYTOMELT3 liotrix THYROLAR-1T3 liotrix THYROLAR-1/2T3 liotrix THYROLAR-1/4T3 liotrix THYROLAR-2T3 liotrix THYROLAR-3T2 thyroid,pork ARMOUR THYROIDT1 thyroid,pork NATURE-THROID
EYE - GENERAL DISORDERSEye Antibiotic-corticoid CombinationsT3 gentamicin/prednisol
acPRED-G
T1 neo/polymyx bsulf/dexameth
MAXITROL
T1 neomy sulf/bacitraczn/poly/hc
NEOMYCIN-BACITRACIN-POLY-HC
T1 neomycin sulfate/dexna ph
NEOMYCINW/DEXAMETHASONE
T3 tobramycin/dexamethasone
TOBRADEX ST
T1 tobramycin/dexamethasone
TOBRADEX(DROPSSUSP)
T2 tobramycin/dexamethasone
TOBRADEX(OINT)
T2 tobramycin/lotepredetab
ZYLET
Eye AntihistaminesT3 alcaftadine LASTACAFTT1 azelastine hcl OPTIVART3 bepotastine besilate BEPREVET3 emedastine difumarateEMADINET1 epinastine hcl ELESTATT2 olopatadine hcl PATADAYT2 olopatadine hcl PATANOL
Eye Anti-infectivesT3 povidone-iodine BETADINE
Eye Antiinflammatory AgentsT1 bromfenac sodium BROMFENAC
SODIUMT3 bromfenac sodium PROLENSAT3 dexamethasone MAXIDEXT3 dexamethasone sod
phosphateDECADRON
T1 dexamethasone sodphosphate
DEXAMETHASONESODIUMPHOSPHATE
T1 diclofenac sodium DICLOFENACSODIUM
Commercial Formulary
L.A. Care Page 31 of 96
T2 difluprednate DUREZOLT1 fluorometholone FLUOROMETHOLON
ET2 fluorometholone FML FORTET2 fluorometholone FML S.O.P.T2 fluorometholone
acetateFLAREX
T1 flurbiprofen sodium OCUFENT1 ketorolac
tromethamineACULAR
T1 ketorolactromethamine
ACULAR LS
T3 ketorolactromethamine/pf
ACUVAIL
T2 loteprednol etabonate ALREXT2 loteprednol etabonate LOTEMAXT2 nepafenac ILEVROT2 nepafenac NEVANACT1 prednisolone acetate OMNIPREDT2 prednisolone acetate PRED MILDT1 prednisolone sod
phosphatePREDNISOLONESODIUMPHOSPHATE
T3 rimexolone VEXOL
Eye AntiviralsT2 ganciclovir ZIRGANT1 trifluridine VIROPTIC
Eye Local AnestheticsT1 benoxinate
hcl/fluorescein naFLURESS
T3 lidocaine hcl/pf AKTENT1 proparac
hcl/fluorescein naFLUCAINE
T1 proparacaine hcl PROPARACAINE HCLT1 proparacaine/fluores
cein sodFLUORESCEIN-PROPARACAINE
T1 tetracaine hcl TETCAINET3 tetracaine hcl TETRAVISCT3 tetracaine hcl TETRAVISC FORTET1 tetracaine hcl/pf TETRACAINE HCL
Eye SulfonamidesT3 na sulfacetm/prednis
spOPTIMYD
T1 na sulfacetm/prednissp
SULFALONE
T1 sulfacetamidesodium
SULFACETAMIDESODIUM
T1 sulfacetamide/prednisolone sp
SULFACETAMIDE-PREDNISOLONE
T2 sulfacetm na/prednisolac
BLEPHAMIDE
T2 sulfacetm na/prednisolac
BLEPHAMIDE S.O.P.
Eye VasoconstrictorsT1 naphazoline hcl NAPHAZOLINE HCLT1 naphazoline
hcl/antazolineNAPHAZOLINE HCLW/ANTAZOLINE
T1 phenylephrine hcl MYDFRIN
T1 phenylephrine hcl PHENYLEPHRINEHCL
Ophthalmic AntibioticsT3 azithromycin AZASITET1 bacitracin BACITRACINT1 bacitracin/polymyxin
b sulfateBACITRACIN-POLYMYXIN
T2 besifloxacin hcl BESIVANCET1 ciprofloxacin hcl CILOXAN(DROPS)T2 ciprofloxacin hcl CILOXAN(OINT)T1 erythromycin base ILOTYCINT1 gatifloxacin ZYMAXIDT1 gentamicin sulfate GARAMYCINT1 levofloxacin LEVOFLOXACINT2 moxifloxacin hcl MOXEZAT2 moxifloxacin hcl VIGAMOXT3 natamycin NATACYNT1 neomy
sulf/bacitra/polymyxin b
NEO-POLYCIN
T1 neomycin/polymyxnb/gramicidin
NEOSPORIN
T1 ofloxacin OCUFLOXT3 oxy-tcn hcl/polymyx b
sulfTERAK
T3 oxytetracycline/polymyx b sulf
TERRAMYCIN WITHPOLYMYXIN
T1 polymyxin bsulf/trimethoprim
POLYTRIM
T1 tobramycin TOBREX(DROPS)T2 tobramycin TOBREX(OINT)
Ophthalmic Anti-inflammatory
Immunomodulator-typeT2 cyclosporine RESTASIS QL
Ophthalmic Mast Cell StabilizersT1 cromolyn sodium CROMOLYN SODIUMT2 lodoxamide
tromethamineALOMIDE
T2 nedocromil sodium ALOCRIL
Ophthalmic Preparations, MiscellaneousT3 doxycycline/eyelid clns
no.2&3ALODOX
EYE - GLAUCOMACarbonic Anhydrase InhibitorsT1 acetazolamide ACETAZOLAMIDET1 acetazolamide DIAMOX SEQUELST1 methazolamide NEPTAZANE
Miotics/other Intraoc. Pressure ReducersT3 apraclonidine hcl IOPIDINE(DROPERET
TE)T1 apraclonidine hcl IOPIDINE(DROPS)T1 betaxolol hcl BETAXOLOL HCLT2 betaxolol hcl BETOPTIC ST2 bimatoprost LUMIGAN QL
Commercial Formulary
L.A. Care Page 32 of 96
T2 brimonidine tartrate ALPHAGANP(DROPS)(0.1 %)
T1 brimonidine tartrate ALPHAGANP(DROPS)(0.15 %)
T1 brimonidine tartrate BRIMONIDINETARTRATE
T2 brimonidinetartrate/timolol
COMBIGAN
T2 brinzolamide AZOPTT2 brinzolamide/brimonid
tartSIMBRINZA
T2 carbachol ISOPTO CARBACHOLT1 carteolol hcl CARTEOLOL HCLT3 demecarium bromide HUMORSOLT1 dorzolamide hcl TRUSOPTT1 dorzolamide
hcl/timolol maleatCOSOPT
T3 dorzolamide/timolol/pf COSOPT PF QL, STT3 echothiophate iodide PHOSPHOLINE
IODIDET1 latanoprost XALATANT1 levobunolol hcl BETAGANT1 levobunolol hcl LEVOBUNOLOL HCLT1 metipranolol METIPRANOLOLT1 pilocarpine hcl ISOPTO
CARPINE(DROPS)(1%)
T1 pilocarpine hcl ISOPTOCARPINE(DROPS)(2%)
T1 pilocarpine hcl ISOPTOCARPINE(DROPS)(4%)
T3 pilocarpine hcl ISOPTOCARPINE(DROPS)(8%)
T1 pilocarpine hcl PILOCARPINE HCLT3 tafluprost/pf ZIOPTAN QL, STT2 timolol BETIMOLT3 timolol maleate ISTALOLT1 timolol maleate TIMOPTICT1 timolol maleate TIMOPTIC-XET3 timolol maleate/pf TIMOPTIC OCUDOSEQL, STT2 travoprost TRAVATAN Z QLT1 travoprost
(benzalkonium)TRAVOPROST QL
T3 unoprostone isopropyl RESCULA QL, ST
MydriaticsT1 atropine sulfate ATROPINE SULFATET1 atropine sulfate ISOPTO ATROPINET2 cyclopentolate hcl CYCLOGYL(DROPS)
(0.5 %)T1 cyclopentolate hcl CYCLOGYL(DROPS)
(1 %)T1 cyclopentolate hcl CYCLOGYL(DROPS)
(2 %)T3 cyclopentolate/phenyle
phrineCYCLOMYDRIL
T1 homatropine hbr HOMATROPAIRET3 hydroxyamphetamine/t
ropicamidePAREMYD
T3 scopolaminehydrobromide
ISOPTO HYOSCINE
T1 tropicamide MYDRIACYLT1 tropicamide TROPICAMIDE
Ophthalmic Antifibrotic AgentsT3 mitomycin MITOSOL
EYE - MISCELLANEOUSArtificial TearsT3 hydroxypropyl
celluloseLACRISERT
Eye Diagnostic AgentsT1 fluorescein sodium BIOGLOT3 fluorescein sodium FLUORETST3 fluorescein sodium FLUOR-I-STRIP ATT3 fluorescein sodium FUL-GLOT1 lissamine green GREEN GLOT3 oftascein
disod/benoxinate hclFLURA-SAFE
T1 rose bengal sodium ROSE GLO
Eye Preparations, MiscellaneousT3 gelatin GELFILM
Ophth Vasc. Endothelial Growth Factor
AntagonistsT4 aflibercept EYLEAT4 pegaptanib sodium MACUGEN
Ophth. Vegf-a Receptor Antag. Rcmb Mc
AntibodyT4 ranibizumab LUCENTIS
Ophthalmic Cystine Depleting AgentsT4 cysteamine hcl CYSTARAN PA
Topical Hypertrichotic Agents, EyelashesT3 bimatoprost LATISSE
GOUT AND RELATED DISEASESColchicineT2 colchicine COLCRYST1 colchicine/probeneci
dPROBENECID-COLCHICINE
Hyperuricemia Tx - Purine InhibitorsT1 allopurinol ZYLOPRIMT2 febuxostat ULORIC QL, ST
Uricosuric AgentsT1 probenecid PROBENECID
Commercial Formulary
L.A. Care Page 33 of 96
HEMATOLOGICAL DISORDERSAnticoagulants,coumarin TypeT2 warfarin sodium COUMADINT1 warfarin sodium WARFARIN SODIUM
Antifibrinolytic AgentsT1 aminocaproic acid AMINOCAPROIC
ACIDT1 tranexamic acid LYSTEDA
Antihemophilic FactorsT4 antihemoph.fviii
plas/alb freeADVATE
T4 antihemoph.fviiiplas/alb free
ADVATE H
T4 antihemoph.fviiiplas/alb free
ADVATE L
T4 antihemoph.fviiiplas/alb free
ADVATE M
T4 antihemoph.fviiiplas/alb free
ADVATE SH
T4 antihemoph.fviiiplas/alb free
ADVATE UH
T4 antihemoph.fviiiplas/alb free
XYNTHA
T4 antihemoph.fviiiplas/alb free
XYNTHA SOLOFUSE
T4 antihemophilic factor,hum rec
BIOCLATE
T4 antihemophilic factor,hum rec
HELIXATE FS
T4 antihemophilic factor,hum rec
KOGENATE FS
T4 antihemophilic factor,hum rec
RECOMBINATE
T4 antihemophilic factor,human
HEMOFIL M
T4 antihemophilic factor,human
KOATE-DVI
T4 antihemophilic factor,human
MONOCLATE-P
T4 antihemophilicfactor/vwf
ALPHANATE
T4 antihemophilicfactor/vwf
HUMATE-P
T4 antihemophilicfactor/vwf
WILATE
T4 anti-inhibitor coagulantcomp.
FEIBA NF
T4 anti-inhibitor coagulantcomp.
FEIBA VH IMMUNO
T4 coagulation factorviia,recomb
NOVOSEVEN
T4 coagulation factorviia,recomb
NOVOSEVEN RT
Antiporphyria FactorsT4 hemin PANHEMATIN
Blood Factors,miscellaneousT4 factor xiii CORIFACT
Citrates As AnticoagulantsT1 citrate phosphate
dextros solnCITRATEPHOSPHATEDEXTROSE
T3 dextrose/sodcitrate/citric ac
ACD
T1 sodium citrate SODIUM CITRATE
Direct Factor Xa InhibitorsT2 apixaban ELIQUIS QLT2 rivaroxaban XARELTO(TAB)(10
MG)QL
T2 rivaroxaban XARELTO(TAB)(15MG)
QL
T2 rivaroxaban XARELTO(TAB)(20MG)
QL
Factor Ix PreparationsT4 factor ix ALPHANINE SDT4 factor ix MONONINET4 factor ix complex
humanBEBULIN
T4 factor ix complexhuman
PROFILNINE SD
T4 factor ix humanrecombinant
BENEFIX
T4 factor ix humanrecombinant
RIXUBIS
T4 factor ix rec, fc fusionprotn
ALPROLIX
Factor Xiii PreparationsT4 factor xiii a-
subunit,recombTRETTEN
Hematinics,otherT4 darbepoetin alfa in
polysorbatARANESP PA
T4 epoetin alfa EPOGEN PAT4 epoetin alfa PROCRIT PA
Hemorrheologic AgentsT1 pentoxifylline PENTOXIFYLLINE
Heparin And Related PreparationsT4 dalteparin
sodium,porcineFRAGMIN(SYRINGE)(10000/ML)
QL
T4 dalteparinsodium,porcine
FRAGMIN(SYRINGE)(12500/0.5)
QL
T4 dalteparinsodium,porcine
FRAGMIN(SYRINGE)(15000/0.6)
QL
T4 dalteparinsodium,porcine
FRAGMIN(SYRINGE)(18000/0.72)
QL
T4 dalteparinsodium,porcine
FRAGMIN(SYRINGE)(2500/0.2ML)
QL
T4 dalteparinsodium,porcine
FRAGMIN(SYRINGE)(5000/0.2ML)
QL
Commercial Formulary
L.A. Care Page 34 of 96
T4 dalteparinsodium,porcine
FRAGMIN(SYRINGE)(7500/0.3ML)
QL
T4 dalteparinsodium,porcine
FRAGMIN(VIAL) QL
T4 enoxaparin sodium LOVENOX(SYRINGE)(100 MG/ML)
QL
T4 enoxaparin sodium LOVENOX(SYRINGE)(120MG/.8ML)
QL
T4 enoxaparin sodium LOVENOX(SYRINGE)(150 MG/ML)
QL
T4 enoxaparin sodium LOVENOX(SYRINGE)(30MG/0.3ML)
QL
T4 enoxaparin sodium LOVENOX(SYRINGE)(40MG/0.4ML)
QL
T4 enoxaparin sodium LOVENOX(SYRINGE)(60MG/0.6ML)
QL
T4 enoxaparin sodium LOVENOX(SYRINGE)(80MG/0.8ML)
QL
T4 enoxaparin sodium LOVENOX(VIAL) QLT4 fondaparinux sodiumARIXTRA(SYRINGE)
(10MG/0.8ML)QL
T4 fondaparinux sodiumARIXTRA(SYRINGE)(2.5 MG/0.5)
QL
T4 fondaparinux sodiumARIXTRA(SYRINGE)(5MG/0.4ML)
QL
T4 fondaparinux sodiumARIXTRA(SYRINGE)(7.5MG/0.6)
QL
T1 heparin sod,porcine-0.9 % nacl
HEPARIN FLUSH
T1 heparin sod,pork in0.45% nacl
HEPARIN SODIUM IN0.45% NACL
T1 heparinsodium,porcine
HEPARIN SODIUM
T1 heparinsodium,porcine/d5w
HEPARIN SODIUM-D5W
T1 heparinsodium,porcine/ns
HEP-PAK CVC
T1 heparinsodium,porcine/ns/pf
HEPARIN SODIUM-NS
T1 heparinsodium,porcine/pf
HEPARIN FLUSH
T1 heparinsodium,porcine/pf
MONOJECT PREFILLADVANCED
Human Monoclonal Antibody
Complement(c5) InhibitorT4 eculizumab SOLIRIS PA
Leukocyte (wbc) StimulantsT4 filgrastim NEUPOGEN PAT4 pegfilgrastim NEULASTA PAT4 sargramostim LEUKINE PAT4 tbo-filgrastim GRANIX PA
Platelet Aggregation InhibitorsT4 abciximab REOPROT3 aspirin/dipyridamole AGGRENOXT1 cilostazol PLETALT1 clopidogrel bisulfate PLAVIXT1 dipyridamole DIPYRIDAMOLET1 dipyridamole PERSANTINE
T4 eptifibatide INTEGRILINT2 prasugrel hcl EFFIENT QLT2 ticagrelor BRILINTA QLT1 ticlopidine hcl TICLOPIDINE HCLT4 tirofiban-0.9% sodium
chlorideAGGRASTAT
Platelet Proliferation StimulantsT4 oprelvekin NEUMEGA
Platelet Reducing AgentsT1 anagrelide hcl AGRYLINT1 anagrelide hcl ANAGRELIDE HCL
Protein C PreparationsT4 protein c concentrate,
humanCEPROTIN
Sickle Cell Anemia AgentsT3 hydroxyurea DROXIA
Thrombin Inhibitors,sel.,direct,&rev.-hirudin
TypeT4 bivalirudin ANGIOMAXT4 desirudin IPRIVASK PA, QLT4 lepirudin,recombinant REFLUDAN
Thrombin Inhibitors,selective,direct, &
ReversibleT4 argatroban ARGATROBANT4 argatroban in 0.9 %
sod chlorARGATROBAN-SODIUM CHLORIDE
T4 argatroban in nacl,iso-osmotic
ARGATROBAN-SODIUM CHLORIDE
T3 dabigatran etexilatemesylate
PRADAXA PA, QL
Thrombopoietin Receptor AgonistsT4 eltrombopag olamine PROMACTA PAT4 romiplostim NPLATE
Topical HemostaticsT3 cellulose,oxidized OXYCELT3 ferric subsulfate ASTRINGYNT3 fibrinogen/thrombin
(hum plas)TACHOSIL
T3 gelatinsponge,absorbable
GELFOAM
T3 gelatinsponge,absorbable
GELFOAM PACKS
T3 microfibrillar collagen AVITENET3 microfibrillar collagen ENDO-AVITENET3 microfibrillar collagen SYRINGE AVITENET3 microfibrillar collagen ULTRAFOAMT1 thrombin (bovine) THROMBIN-JMIT3 thrombin
(recombinant)RECOTHROM
T3 thrombin(humplas)/fib/apro/ca
TISSEEL VHSD
Commercial Formulary
L.A. Care Page 35 of 96
T1 thrombin/fibrinogen/apro/cal
HEMASEELAPR(KIT)(1 ML)
T3 thrombin/fibrinogen/apro/cal
HEMASEELAPR(KIT)(2 ML)
T1 thrombin/fibrinogen/apro/cal
HEMASEELAPR(KIT)(5ML)
Vitamin K PreparationsT1 phytonadione AQUA-MEPHYTONT2 phytonadione MEPHYTON
HORMONAL DEFICIENCYAndrogenic AgentsT1 fluoxymesterone ANDROXY QLT2 methyltestosterone ANDROIDT2 methyltestosterone METHITESTT2 methyltestosterone TESTREDT1 oxandrolone OXANDRINT3 oxymetholone ANADROL-50T3 testosterone ANDRODERMT2 testosterone ANDROGEL PAT2 testosterone AXIRON PAT3 testosterone FORTESTA PAT3 testosterone STRIANT PAT3 testosterone TESTIM PAT2 testosterone cypionate DEPO-
TESTOSTERONE(VIAL)(100 MG/ML)
PA
T1 testosteronecypionate
DEPO-TESTOSTERONE(VIAL)(200 MG/ML)
PA
T1 testosteronecypionate
TESTOSTERONECYPIONATE
PA
T2 testosterone enanthateDELATESTRYL(SYRINGE)
PA
T1 testosteroneenanthate
DELATESTRYL(VIAL) PA
T3 testosteronepropionate
FIRST-TESTOSTERONE
T3 testosteronepropionate
FIRST-TESTOSTERONE MC
Estrogen & Progestin With
Antimineralocorticoid CbT3 drospirenone/estradiol ANGELIQ
Estrogen & Selective Estrogen Recept
Mod(serm)combT2 estrogens,conj/bazedo
xifeneDUAVEE
Estrogen/androgen CombinationsT1 estrogen,ester/me-
testosteroneESTROGEN &METHYLTESTOSTERONE
Estrogenic AgentsT2 estradiol ALORA QLT1 estradiol CLIMARA QL
T3 estradiol DIVIGELT3 estradiol ELESTRINT1 estradiol ESTRACET3 estradiol ESTRASORBT3 estradiol ESTROGELT3 estradiol EVAMISTT3 estradiol MENOSTAR QLT2 estradiol MINIVELLE QLT2 estradiol VIVELLE-DOT QLT3 estradiol/levonorgestre
lCLIMARA PRO QL
T1 estradiol/norethindrone acet
ACTIVELLA
T2 estradiol/norethindroneacet
COMBIPATCH QL
T1 estradiol/norethindrone acet
ESTRADIOL-NORETHINDRONEACETAT
T3 estradiol/norgestimate PREFESTT2 estrogen,con/m-
progest acetPREMPHASE
T2 estrogen,con/m-progest acet
PREMPRO
T2 estrogens, conjugated PREMARINT3 estrogens,conj.,synthet
ic aCENESTIN
T3 estrogens,conj.,synthetic b
ENJUVIA
T2 estrogens,esterified MENESTT1 estropipate OGENT2 norethind ac/ethinyl
estradiolFEMHRT
T1 norethind ac/ethinylestradiol
JINTELI
Progestational AgentsT4 hydroxyprogesterone
caproateMAKENA
T1 medroxyprogesterone acet
MEDROXYPROGESTERONE ACETATE
T1 medroxyprogesterone acetate
PROVERA
T1 norethindroneacetate
AYGESTIN
T1 progesterone PROGESTERONET3 progesterone,microniz
edCRINONE
T1 progesterone,micronized
PROMETRIUM
IMMUNIZATIONAntiseraT4 immune glob,gam
caprylate(igg)GAMMAKED PA
T4 immune glob,gamcaprylate(igg)
GAMUNEX
T4 immune glob,gamcaprylate(igg)
GAMUNEX-C PA
T4 immuneglobulin,g(igg)/maltose
OCTAGAM
Commercial Formulary
L.A. Care Page 36 of 96
T4 immuneglobulin,gamma(igg)
BIVIGAM
T4 immuneglobulin,gamma(igg)
CARIMUNE NFNANOFILTERED
T4 immuneglobulin,gamma(igg)
FLEBOGAMMA
T4 immuneglobulin,gamma(igg)
FLEBOGAMMA DIF
T4 immuneglobulin,gamma(igg)
GAMASTAN S-D
T4 immuneglobulin,gamma(igg)
GAMMAGARD LIQUIDPA
T4 immuneglobulin,gamma(igg)
GAMMAGARD S-D
T4 immuneglobulin,gamma(igg)
GAMMAPLEX
T4 immuneglobulin,gamma(igg)
HIZENTRA PA
T4 immuneglobulin,gamma(igg)
PRIVIGEN
T4 lymphocyte immuglob.,rabbit
THYMOGLOBULIN
T4 lymphocyte immuneglobulin
ATGAM
Enteric Virus VaccinesT3 rotavirus vac,live att,
89-12ROTARIX
T3 rotavirus vaccine,liveoral pv
ROTATEQ
Gram (-) Bacilli (non-enteric) VaccinesT3 typhoid
vacc,live,attenuatedVIVOTIF BERNA
Influenza Virus VaccinesT3 flu vacc ts 2013 (18-
64yrs)/pfFLUZONEINTRADERMAL 2013-2014
T3 flu vaccine qval2013(2-49yrs)
FLUMIST
IMMUNOSUPPRESSION/MODULATIONImmunomodulatorsT4 aldesleukin PROLEUKINT1 imiquimod ALDARA PA, QLT3 imiquimod ZYCLARA(CREAM
PACK)PA, QL
T3 imiquimod ZYCLARA(CRM MDPMP)(2.5 %)
PA, QL
T3 imiquimod ZYCLARA(CRM MDPMP)(3.75 %)
PA, QL
T4 interferon alfa-2b,recomb.
INTRON A PA
T4 interferon alfa-n3 ALFERON NT4 interferon gamma-
1b,recomb.ACTIMMUNE
Immunosupp - Monoclonal Ab Inhibiting T
Lymph FxnT4 basiliximab SIMULECT
ImmunosuppressivesT3 azathioprine AZASANT1 azathioprine IMURANT4 belatacept NULOJIXT4 cyclosporine CYCLOSPORINET4 cyclosporine SANDIMMUNET4 cyclosporine,
modifiedCYCLOSPORINEMODIFIED
T4 cyclosporine, modified NEORALT4 everolimus ZORTRESST1 mycophenolate
mofetilCELLCEPT(CAP)
T2 mycophenolate mofetil CELLCEPT(SUSPRECON)
T1 mycophenolatemofetil
CELLCEPT(TAB)
T4 mycophenolate mofetilhcl
CELLCEPT
T1 mycophenolatesodium
MYCOPHENOLICACID
T4 sirolimus RAPAMUNET4 tacrolimus ASTAGRAF XLT4 tacrolimus HECORIAT4 tacrolimus PROGRAF
INFECTIOUS DISEASE - BACTERIALAbsorbable SulfonamidesT1 sulfamethoxazole/tri
methoprimBACTRIM
T1 sulfamethoxazole/trimethoprim
SULFAMETHOXAZOLE-TRIMETHOPRIM
BetalactamsT4 aztreonam lysine CAYSTON PA
CephalosporinsT1 cephalexin
monohydrateCEPHALEXIN
Cephalosporins - 1st GenerationT1 cefadroxil hydrate CEFADROXILT1 cephalexin CEPHALEXINT1 cephalexin KEFLEX
Cephalosporins - 2nd GenerationT1 cefaclor CEFACLORT1 cefprozil CEFPROZILT2 cefuroxime axetil CEFTIN(SUSP
RECON)T1 cefuroxime axetil CEFTIN(TAB)
Cephalosporins - 3rd GenerationT1 cefdinir CEFDINIRT2 cefixime SUPRAX
Commercial Formulary
L.A. Care Page 37 of 96
T1 cefpodoxime proxetil CEFPODOXIMEPROXETIL
T1 ceftibuten dihydrate CEDAX(CAP)T1 ceftibuten dihydrate CEDAX(SUSP
RECON)(180MG/5ML)
T3 ceftibuten dihydrate CEDAX(SUSPRECON)(90 MG/5 ML)
Chemotherapeutics, Antibacterial, Misc.T3 fosfomycin
tromethamineMONUROL
T3 methen/m-blue/sal/naphos/hyos
URELLE
T1 methen/m-blue/sal/naphos/hyos
UTA
T1 methen/sodphos/meth blue/hyos
URYL
T1 methenam/meblue/ba/salicy/hyo
HYOPHEN
T2 methenam/meblue/ba/salicy/hyo
PROSED-DS
T1 methenaminehippurate
HIPREX
T1 methenaminemandelate
METHENAMINEMANDELATE
T2 mth/me blue/sodphos/phen/hyos
PHOSPHASAL
T1 mth/me blue/sodphos/phen/hyos
UR N-C
T2 mth/me blue/sodphos/phen/hyos
URETRON D-S
T3 mth/me blue/sodphos/phen/hyos
URIBEL
T2 mth/me blue/sodphos/phen/hyos
URIN D.S.
T2 trimethoprim PRIMSOLT1 trimethoprim TRIMETHOPRIM
KetolidesT2 telithromycin KETEK
MacrolidesT1 azithromycin ZITHROMAXT1 azithromycin ZITHROMAX TRI-PAKT2 azithromycin ZMAXT1 clarithromycin BIAXINT1 clarithromycin CLARITHROMYCINT1 ery e-
succ/sulfisoxazoleERYTHROMYCIN-SULFISOXAZOLE
T2 erythromycin base ERY-TABT1 erythromycin base ERYTHROMYCINT2 erythromycin base PCET2 erythromycin
ethylsuccinateE.E.S. 200
T2 erythromycinethylsuccinate
ERYPED 200
T2 erythromycinethylsuccinate
ERYPED 400
T1 erythromycinethylsuccinate
ERYTHROMYCINETHYLSUCCINATE
T1 erythromycinstearate
ERYTHROCINSTEARATE
T2 fidaxomicin DIFICID QL, ST
Nitrofuran DerivativesT1 nitrofurantoin FURADANTINT1 nitrofurantoin
macrocrystalMACRODANTIN(CAP)(100 MG)
T2 nitrofurantoinmacrocrystal
MACRODANTIN(CAP)(25 MG)
T1 nitrofurantoinmacrocrystal
MACRODANTIN(CAP)(50 MG)
T1 nitrofurantoinmonohyd/m-cryst
MACROBID
OxazolidinonesT2 linezolid ZYVOX PA
PenicillinsT1 amoxicillin AMOXICILLINT1 amoxicillin AMOXILT3 amoxicillin MOXATAGT1 amoxicillin trihydrate AMOXICILLINT1 amoxicillin/potassiu
m clavAMOX TR-POTASSIUMCLAVULANATE
T1 amoxicillin/potassium clav
AUGMENTIN ES-600
T2 amoxicillin/potassiumclav
AUGMENTIN(SUSPRECON)(125-31.25/)
T1 amoxicillin/potassium clav
AUGMENTIN(SUSPRECON)(250-62.5/5)
T1 amoxicillin/potassium clav
AUGMENTIN(TAB)
T1 ampicillin trihydrate AMPICILLINTRIHYDRATE
T1 dicloxacillin sodium DICLOXACILLINSODIUM
T3 oxacillin sodium BACTOCILLT1 penicillin v
potassiumPENICILLIN VPOTASSIUM
QuinolonesT2 ciprofloxacin CIPROT1 ciprofloxacin hcl CIPROT1 ciprofloxacin hcl CIPROFLOXACIN
HCLT1 ciprofloxacin/ciproflo
xa hclCIPRO XR
T3 gemifloxacin mesylate FACTIVET1 levofloxacin LEVAQUINT1 levofloxacin LEVOFLOXACINT3 lomefloxacin hcl MAXAQUINT1 moxifloxacin hcl AVELOXT1 nalidixic acid NALIDIXIC ACIDT3 nalidixic acid NEGGRAMT3 norfloxacin NOROXINT1 ofloxacin OFLOXACIN
TetracyclinesT1 demeclocycline hcl DEMECLOCYCLINE
HCL
Commercial Formulary
L.A. Care Page 38 of 96
T2 doxycycline calcium VIBRAMYCINT1 doxycycline hyclate DORYX(TAB DR)(150
MG)T3 doxycycline hyclate DORYX(TAB DR)(200
MG)QL, ST
T1 doxycycline hyclate DOXYCYCLINEHYCLATE
T1 doxycycline hyclate MORGIDOXT1 doxycycline hyclate VIBRAMYCINT3 doxycycline
monohy/skin clnsr9ADOXA CK
T3 doxycyclinemonohy/skin clnsr9
ADOXA TT
T1 doxycyclinemonohydrate
ADOXA
T1 doxycyclinemonohydrate
ADOXA PAK QL, ST
T1 doxycyclinemonohydrate
AVIDOXY
T1 doxycyclinemonohydrate
MONODOX
T3 doxycyclinemonohydrate
ORACEA AGE,QL, ST
T1 doxycyclinemonohydrate
VIBRAMYCIN
T3 doxycycline/salicy/oct/zinc ox
AVIDOXY DK
T3 doxycycline/skincleanser #19
MORGIDOX
T1 minocycline hcl DYNACINT1 minocycline hcl MINOCINT1 minocycline hcl MINOCYCLINE
HCL(TAB ER 24H)AGE,QL
T1 minocycline hcl MINOCYCLINEHCL(TAB)
T3 minocycline hcl SOLODYN AGE,QL, ST
T3 minocycline hcl/skin clno.4
MINOCIN
T1 tetracycline hcl ALA-TETT1 tetracycline hcl TETRACYCLINE HCL
INFECTIOUS DISEASE - FUNGALAntifungal AgentsT1 clotrimazole CLOTRIMAZOLET1 fluconazole DIFLUCANT1 flucytosine ANCOBONT3 itraconazole ONMELT1 itraconazole SPORANOX(CAP)T2 itraconazole SPORANOX(SOLUTI
ON)T1 ketoconazole KETOCONAZOLET3 miconazole ORAVIGT3 posaconazole NOXAFILT2 terbinafine hcl LAMISIL(GRAN
PACK)T1 terbinafine hcl LAMISIL(TAB)T3 terbinafine/hydroxy
chitosanTERBINEX
T1 triacetin TRIACETINT1 voriconazole VFEND
Antifungal AntibioticsT1 griseofulvin
ultramicrosizeGRIS-PEG
T3 griseofulvin, microsize FULVICIN U/FT1 griseofulvin,
microsizeGRIFULVIN V
T1 griseofulvin,microsize
GRISEOFULVIN
T1 nystatin NYSTATIN
Antifungal-antibiotic-steroid-antihistamine
CombT3 nystatin/tcn/hc/diphenh
ydraminFIRST-MARY'S
Antifungal-anti-inflammatory Steroid-
antihistamineT3 nystatin/hydrocortisone
/diphenFIRST-DUKE'S
Antifungal-local Anesthetic-antihistamine
CombT3 nystatin/lidocaine/diph
enhydFIRST-BXN
INFECTIOUS DISEASE -
MISCELLANEOUSAminoglycosidesT1 neomycin sulfate NEOMYCIN SULFATET4 tobramycin BETHKIS PAT4 tobramycin TOBI PODHALER PAT4 tobramycin in 0.225%
naclTOBI PA
Antibacterial Agents,miscellaneousT1 glycine GLYCINET3 urologic solution-g IRRIGATING
SOLUTION GT1 urologic solution-g UROLOGIC
SOLUTION G(IRRIGSOLN)(3.24G-380)
T3 urologic solution-g UROLOGICSOLUTION G(IRRIGSOLN)(3.24G-380)
AntileproticsT1 dapsone DAPSONET4 thalidomide THALOMID PA, QL
Anti-mycobacterium AgentsT3 aminosalicylic acid PASERT1 ethambutol hcl ETHAMBUTOL HCLT1 ethambutol hcl MYAMBUTOLT3 ethionamide TRECATORT1 isoniazid ISONIAZIDT1 pyrazinamide PYRAZINAMIDE
Commercial Formulary
L.A. Care Page 39 of 96
T1 rifabutin MYCOBUTIN
Antitubercular AntibioticsT4 bedaquiline fumarate SIRTURO PAT1 cycloserine CYCLOSERINET3 rifamp/isoniazid/pyrazi
namideRIFATER
T1 rifampin RIFADINT2 rifampin/isoniazid RIFAMATET3 rifapentine PRIFTIN
LincosamidesT1 clindamycin hcl CLEOCIN HCLT1 clindamycin
palmitate hclCLINDAMYCINPALMITATE HCL
Rifamycins And Related Derivative
AntibioticsT3 rifaximin XIFAXAN(TAB)(200
MG)T2 rifaximin XIFAXAN(TAB)(550
MG)QL, ST
Vancomycin And DerivativesT1 vancomycin hcl VANCOCIN HCL QL
INFECTIOUS DISEASE - PARASITIC2nd Gen. Anaerobic Antiprotozoal-
antibacterialT1 tinidazole TINDAMAX
AmebacidesT2 iodoquinol YODOXINT1 paromomycin sulfate PAROMOMYCIN
SULFATE
Anaerobic Antiprotozoal-antibacterial
AgentsT2 metronidazole FLAGYL ERT1 metronidazole METRONIDAZOLE
AnthelminticsT3 albendazole ALBENZAT3 ivermectin STROMECTOLT2 praziquantel BILTRICIDE
Antimalarial DrugsT3 artemether/lumefantrin
eCOARTEM
T1 atovaquone/proguanil hcl
MALARONE
T1 chloroquinephosphate
ARALENPHOSPHATE
T1 chloroquinephosphate
CHLOROQUINEPHOSPHATE
T3 halofantrine hcl HALFANT1 hydroxychloroquine
sulfatePLAQUENIL
T1 mefloquine hcl MEFLOQUINE HCLT2 primaquine phosphate PRIMAQUINET2 pyrimethamine DARAPRIMT1 quinine sulfate QUALAQUINT1 quinine sulfate QUININE SULFATE
Antiprotozoal Drugs,miscellaneousT1 atovaquone ATOVAQUONET2 pentamidine
isethionateNEBUPENT
INFECTIOUS DISEASE - VIRALAntiviral Monoclonal AntibodiesT4 palivizumab SYNAGIS PA
Antivirals, GeneralT1 acyclovir ZOVIRAXT1 famciclovir FAMVIRT2 oseltamivir phosphate TAMIFLU(CAP)(30
MG)QL
T2 oseltamivir phosphate TAMIFLU(CAP)(45MG)
QL
T2 oseltamivir phosphate TAMIFLU(CAP)(75MG)
QL
T2 oseltamivir phosphate TAMIFLU(SUSPRECON)
QL
T2 ribavirin VIRAZOLET1 rimantadine hcl FLUMADINET1 valacyclovir hcl VALTREXT3 valganciclovir hcl VALCYTET3 zanamivir RELENZA QL
Antivirals, Hiv-spec, Non-peptidic Protease
InhibT4 darunavir ethanolate PREZISTA(ORAL
SUSP)QL
T4 darunavir ethanolate PREZISTA(TAB)(150MG)
QL
T4 darunavir ethanolate PREZISTA(TAB)(400MG)
QL
T4 darunavir ethanolate PREZISTA(TAB)(600MG)
QL
T4 darunavir ethanolate PREZISTA(TAB)(75MG)
QL
T4 darunavir ethanolate PREZISTA(TAB)(800MG)
QL
T4 tipranavir APTIVUS PAT4 tipranavir/vitamin e
tpgsAPTIVUS PA
Antivirals, Hiv-spec, Nucleoside-nucleotide
AnalogT4 emtricitabine/tenofovir TRUVADA QL
Antivirals, Hiv-spec., Nucleoside Analog, Rti
CombT4 abacavir
sulfate/lamivudineEPZICOM QL
Commercial Formulary
L.A. Care Page 40 of 96
T4 abacavir/lamivudine/zidovudine
TRIZIVIR PA
T4 lamivudine/zidovudine
COMBIVIR QL
Antivirals, Hiv-specific, Ccr5 Co-receptor
Antag.T4 maraviroc SELZENTRY PA
Antivirals, Hiv-specific, Fusion InhibitorsT4 enfuvirtide FUZEON QL, ST
Antivirals, Hiv-specific, Non-nucleoside, RtiT2 delavirdine mesylate RESCRIPTORT4 efavirenz SUSTIVAT4 etravirine INTELENCE PAT2 nevirapine VIRAMUNE XRT1 nevirapine VIRAMUNE(ORAL
SUSP)QL
T1 nevirapine VIRAMUNE(TAB) QLT4 rilpivirine hcl EDURANT PA
Antivirals, Hiv-specific, Nucleoside Analog,
RtiT4 abacavir sulfate ZIAGEN(SOLUTION) QLT4 abacavir sulfate ZIAGEN(TAB) QLT2 didanosine VIDEX QLT1 didanosine VIDEX EC(CAP
DR)(125 MG)QL
T1 didanosine VIDEX EC(CAPDR)(200 MG)
QL
T1 didanosine VIDEX EC(CAPDR)(250 MG)
T1 didanosine VIDEX EC(CAPDR)(400 MG)
T2 emtricitabine EMTRIVA(CAP) QLT2 emtricitabine EMTRIVA(SOLUTION)QLT2 lamivudine EPIVIR(SOLUTION) QLT1 lamivudine EPIVIR(TAB)(150 MG) QLT1 lamivudine EPIVIR(TAB)(300 MG) QLT1 stavudine ZERIT(CAP) QLT1 stavudine ZERIT(SOLN RECON)QLT1 zidovudine RETROVIR(CAP) QLT1 zidovudine RETROVIR(SYRUP) QLT1 zidovudine ZIDOVUDINE QL
Antivirals, Hiv-specific, Nucleotide Analog,
RtiT4 tenofovir disoproxil
fumarateVIREAD(POWDER) QL
T4 tenofovir disoproxilfumarate
VIREAD(TAB) QL
Antivirals, Hiv-specific, Protease Inhibitor
CombT4 lopinavir/ritonavir KALETRA(SOLUTIO
N)QL
T4 lopinavir/ritonavir KALETRA(TAB)(100MG-25MG)
QL
T4 lopinavir/ritonavir KALETRA(TAB)(200MG-50MG)
QL
Antivirals, Hiv-specific, Protease InhibitorsT4 atazanavir sulfate REYATAZT4 fosamprenavir calcium LEXIVA PAT2 indinavir sulfate CRIXIVANT4 nelfinavir mesylate VIRACEPTT4 ritonavir NORVIR QLT4 saquinavir mesylate INVIRASE(CAP) QL, STT4 saquinavir mesylate INVIRASE(TAB) QL, ST
Antivirals,hiv-1 Integrase Strand Transfer
InhibtrT4 dolutegravir sodium TIVICAY PAT4 raltegravir potassium ISENTRESS
Artv Cmb Nucleoside,nucleotide,&non-
nucleoside RtiT4 efavirenz/emtricitab/te
nofovirATRIPLA QL
T4 emtricitab/rilpivirine/tenofov
COMPLERA PA
Arv Cmb-nrti,n(t)rti, Integrase InhibitorT4 elvitegr/cobicist/emtric/
tenofSTRIBILD QL
Hep C Virus,nucleotide Analog Ns5b
Polymerase InhT4 sofosbuvir SOVALDI PA
Hepatitis B Treatment AgentsT4 adefovir dipivoxil HEPSERAT4 entecavir BARACLUDET2 lamivudine EPIVIR HBVT1 lamivudine LAMIVUDINE HBVT4 telbivudine TYZEKA
Hepatitis C Treatment AgentsT4 interferon alfacon-1 INFERGENT4 peginterferon alfa-2a PEGASYS PAT4 peginterferon alfa-2a PEGASYS PROCLICKPAT4 peginterferon alfa-2b PEGINTRON PAT4 peginterferon alfa-2b PEGINTRON
REDIPENPA
T1 ribavirin COPEGUST1 ribavirin REBETOL(CAP)T2 ribavirin REBETOL(SOLUTIO
N)
Hepatitis C Virus Ns3/4a Serine Protease
Inhib.T4 boceprevir VICTRELIS PAT4 simeprevir sodium OLYSIO PAT4 telaprevir INCIVEK PA
Commercial Formulary
L.A. Care Page 41 of 96
INFLAMMATORY DISEASEAnti-arthritic And Chelating AgentsT2 penicillamine CUPRIMINET2 penicillamine DEPEN
Anti-arthritic, Folate Antagonist AgentsT1 methotrexate sodiumMETHOTREXATET4 methotrexate/pf OTREXUP QL, ST
Anti-flam. Interleukin-1 Receptor AntagonistT4 anakinra KINERET PAT4 rilonacept ARCALYST
Anti-inflammatory Tumor Necrosis Factor
InhibitorT4 adalimumab HUMIRA PAT4 etanercept ENBREL PAT4 golimumab SIMPONI PAT4 golimumab SIMPONI ARIA PA
Anti-inflammatory, Interleukin-1 Beta
BlockersT4 canakinumab/pf ILARIS
Anti-inflammatory, Pyrimidine Synthesis
InhibitorT1 leflunomide ARAVA
Anti-inflammatory,phosphodiesterase-
4(pde4) Inhib.T4 apremilast OTEZLA PA
Antinflammatory, Sel.costim.mod.,t-cell
InhibitorT4 abatacept ORENCIA PAT4 abatacept/maltose ORENCIA
Bradykinin B2 Receptor AntagonistsT4 icatibant acetate FIRAZYR PA
C1 Esterase InhibitorsT4 c1 esterase inhibitor BERINERT PAT4 c1 esterase inhibitor CINRYZE PA
GlucocorticoidsT1 budesonide ENTOCORT ECT3 budesonide UCERIS STT1 cortisone acetate CORTISONE
ACETATET1 dexamethasone DEXAMETHASONET3 dexamethasone DEXAMETHASONE
INTENSOLT3 dexamethasone DEXPAKT1 hydrocortisone CORTEFT1 methylprednisolone MEDROL(TAB DS PK)
T1 methylprednisolone MEDROL(TAB)(16MG)
T2 methylprednisolone MEDROL(TAB)(2 MG)T1 methylprednisolone MEDROL(TAB)(32
MG)T1 methylprednisolone MEDROL(TAB)(4 MG)T1 methylprednisolone MEDROL(TAB)(8 MG)T1 methylprednisolone METHYLPREDNISOL
ONET2 prednisolone MILLIPREDT2 prednisolone MILLIPRED DPT1 prednisolone PREDNISOLONET3 prednisolone acetate FLO-PREDT3 prednisolone sod
phosphateMILLIPRED
T1 prednisolone sodphosphate
ORAPRED
T3 prednisolone sodphosphate
ORAPRED ODT
T1 prednisolone sodphosphate
PEDIAPRED
T1 prednisolone sodphosphate
PREDNISOLONESODIUMPHOSPHATE
T3 prednisolone sodphosphate
VERIPRED 20
T1 prednisone PREDNISONET2 prednisone PREDNISONE
INTENSOLT3 prednisone RAYOS STT3 triamcinolone diacetateARISTOCORT
Gold SaltsT3 auranofin RIDAURA
Interleukin-6 (il-6) Receptor InhibitorsT4 tocilizumab ACTEMRA PA
Janus Kinase (jak) InhibitorsT4 tofacitinib citrate XELJANZ PA
MineralocorticoidsT1 fludrocortisone
acetateFLUDROCORTISONEACETATE
Monoclonal Antibody-human Interleukin
12/23 InhibT4 ustekinumab STELARA PA
Nasal Nsaids, Cox Non-selective,systemic
AnalgesicT3 ketorolac
tromethamineSPRIX QL
Nsaid & Histamine H2 Receptor Antagonist
Comb.T3 ibuprofen/famotidine DUEXIS QL, ST
Commercial Formulary
L.A. Care Page 42 of 96
Nsaid, Cox Inhibitor-type & Proton Pump
Inhib CombT2 naproxen/esomeprazol
e magVIMOVO ST
Nsaids (cox Non-specific Inhib)&
Prostaglandin CmbT1 diclofenac
sodium/misoprostolARTHROTEC 50
T1 diclofenacsodium/misoprostol
ARTHROTEC 75
Nsaids, Cyclooxygenase 2 Inhibitor - TypeT2 celecoxib CELEBREX AGE,
ST
Nsaids, Cyclooxygenase Inhibitor-typeT1 diclofenac potassiumCATAFLAMT3 diclofenac potassium ZIPSORT1 diclofenac sodium DICLOFENAC
SODIUMT1 diclofenac sodium VOLTAREN-XRT3 diclofenac
submicronizedZORVOLEX QL, ST
T1 etodolac ETODOLACT1 fenoprofen calcium FENOPROFEN
CALCIUMT2 fenoprofen calcium NALFONT1 flurbiprofen ANSAIDT1 flurbiprofen FLURBIPROFENT1 ibuprofen IBUPROFENT2 indomethacin INDOCINT1 indomethacin INDOMETHACINT1 ketoprofen KETOPROFENT1 ketorolac
tromethamineKETOROLACTROMETHAMINE
T1 ketorolactromethamine
TORADOL(CARTRIDGE)(15 MG/ML)
T3 ketorolactromethamine
TORADOL(CARTRIDGE)(15 MG/ML)
T3 ketorolactromethamine
TORADOL(CARTRIDGE)(30 MG/ML)
T1 meclofenamatesodium
MECLOFENAMATESODIUM
T1 mefenamic acid PONSTELT1 meloxicam MOBICT1 nabumetone NABUMETONET1 naproxen EC-NAPROSYNT1 naproxen NAPROSYNT1 naproxen NAPROXENT1 naproxen sodium ANAPROXT1 naproxen sodium ANAPROX DST3 naproxen sodium NAPRELANT1 oxaprozin DAYPROT1 phenylbutazone PHENYLBUTAZONET1 piroxicam FELDENET1 piroxicam PIROXICAMT1 sulindac SULINDACT1 tolmetin sodium TOLMETIN SODIUM
Plasma Kallikrein InhibitorsT4 ecallantide KALBITOR PA
UnknownT3 ibuprofen/irr cnt-irrit
cmb #2COMFORT PAC-IBUPROFEN
T3 meloxicam/irr cntr-irrcmb #2
COMFORT PAC-MELOXICAM
T3 naproxen/irr cntr-irritcmb #2
COMFORT PAC-NAPROXEN
LOCAL ANESTHESIALocal AnestheticsT3 b-caine/zinc
cl/pine/cpyrdBUCALSEP
T1 lidocaine hcl LIDOCAINE HCLVISCOUS
LOWER GASTROINTESTINAL
DISORDERS - BOWEL INFLAMMATBowel Antiinflamatory AgentsT1 sulfadiazine SULFADIAZINET1 sulfamethoxazole/tri
methoprimSULFATRIM
T1 sulfasalazine SULFASALAZINE
Chronic Inflam. Colon Dx, 5-a-salicylat,rectal
TxT2 mesalamine CANASAT1 mesalamine SFROWASAT1 mesalamine
w/cleansing wipesROWASA
Drug Tx-chronic Inflam. Colon Dx,5-
aminosalicylatT1 balsalazide disodium COLAZALT3 balsalazide disodium GIAZO STT2 mesalamine APRISOT3 mesalamine ASACOL HD STT3 mesalamine DELZICOL STT3 mesalamine LIALDA STT3 mesalamine PENTASA STT3 olsalazine sodium DIPENTUM ST
Drugs To Tx Chronic Inflamm. Disease Of
ColonT4 certolizumab pegol CIMZIA PAT4 infliximab REMICADE PA
Hemorrhoidal Prep, Anti-infam Steroid/local
AnesthT1 hydrocort/pramoxin/e
mol/pram#1ANALPRAM E
Commercial Formulary
L.A. Care Page 43 of 96
T1 hydrocortisoneac/lidocaine
LIDOCAINE-HYDROCORTISONE
T1 hydrocortisone/lidocaine/aloe
LIDOCAINE-HYDROCORTISONE
T2 hydrocortisone/pramoxine
ANALPRAM HC
T1 hydrocortisone/pramoxine
HYDROCORTISONE-PRAMOXINE
T1 hydrocortisone/pramoxine
PRAMCORT
T3 hydrocortisone/pramoxine
PROCORT
T2 hydrocortisone/pramoxine
PROCTOFOAM-HC
Irritable Bowel Agents,guanylate Cylase-c
AgonistT2 linaclotide LINZESS QL
Local Anorectal Nitrate PreparationsT3 nitroglycerin RECTIV
Rectal PreparationsT1 hydrocortisone PROCTOZONE-HCT1 hydrocortisone
acetateHYDROCORTISONEACETATE
T1 hydrocortisoneacetate
PROCTOCORT
Rectal/lower Bowel Prep.,glucocort.T1 hydrocortisone CORTENEMAT3 hydrocortisone acetate CORTIFOAM
LOWER GASTROINTESTINAL
DISORDERS - OTHERAmmonia InhibitorsT3 acetohydroxamic acid LITHOSTATT4 carglumic acid CARBAGLUT4 glycerol phenylbutyrateRAVICTI PAT1 lactulose GENERLACT3 sodium benzoate/na
ph-acetateUCEPHAN
T4 sodium phenylbutyrate BUPHENYL
Antidiarrheal - G.i. Chloride Channel
InhibitorsT3 crofelemer FULYZAQ QL, ST
AntidiarrhealsT3 difenoxin hcl/atropine
sulfateMOTOFEN
T1 diphenoxylatehcl/atropine
DIPHENOXYLATE-ATROPINE
T1 diphenoxylatehcl/atropine
LOMOTIL
T1 loperamide hcl LOPERAMIDET1 opium tincture OPIUM TINCTURET1 paregoric PAREGORIC
Bile SaltsT3 chenodiol CHENODALT1 ursodiol ACTIGALLT1 ursodiol URSOT1 ursodiol URSO FORTE
Irritable Bowel Synd. Agent,5ht-3
Antagonist-typeT3 alosetron hcl LOTRONEX
Laxatives And CatharticsT2 lactulose KRISTALOSET1 lactulose LACTULOSET2 lubiprostone AMITIZA QLT3 naphos m-b m-h/na
phos,di-baOSMOPREP
T3 peg 3350/nasulf,bicarb,cl/kcl
COLYTE WITHFLAVOR PACKS
T1 peg 3350/nasulf,bicarb,cl/kcl
GAVILYTE-C
T2 peg 3350/nasulf,bicarb,cl/kcl
GOLYTELY
T3 peg 3350-bowel 2,twopart prep
SUCLEAR
T3 peg3350/sodsul/nacl/asb/c/kcl
MOVIPREP
T1 polyethylene glycol3350
POLYETHYLENEGLYCOL 3350
T3 sod picosulf/magox/citric ac
PREPOPIK
T1 sodiumchloride/nahco3/kcl/peg
GAVILYTE-N
T3 sodium,potassium,&mag sulfates
SUPREP
Narcotic Antagonists, Peripherally-actingT3 alvimopan ENTEREGT2 methylnaltrexone
bromideRELISTOR PA
Sbs - Glucagon-like Peptide-2 (glp-2)
AnalogsT4 teduglutide GATTEX PA
MISCELLANEOUS AGENTSAnaphylaxis Therapy AgentsT1 epinephrine ADRENACLICKT3 epinephrine AUVI-Q STT2 epinephrine EPIPEN 2-PAKT2 epinephrine EPIPEN JR 2-PAK
Miscellaneous AgentsT3 liver extract (non-vit) NEXAVIR
Parasympathetic AgentsT1 bethanechol chloride URECHOLINET1 cevimeline hcl EVOXAC
Commercial Formulary
L.A. Care Page 44 of 96
T1 guanidine hcl GUANIDINE HCLT1 pilocarpine hcl SALAGEN
Systemic Enzyme InhibitorsT4 alpha-1-proteinase
inhibitorARALAST NP
T4 alpha-1-proteinaseinhibitor
GLASSIA
T4 alpha-1-proteinaseinhibitor
PROLASTIN C
T4 alpha-1-proteinaseinhibitor
ZEMAIRA
NEOPLASTIC DISEASEAlkylating AgentsT4 altretamine HEXALENT4 bendamustine hcl TREANDAT4 busulfan BUSULFEXT4 busulfan MYLERANT4 carboplatin CARBOPLATINT4 carmustine BICNUT4 carmustine in
polifeprosan 20GLIADEL
T4 chlorambucil LEUKERANT4 cisplatin CISPLATINT4 cyclophosphamide CYCLOPHOSPHAMID
ET1 hydroxyurea HYDREAT4 ifosfamide IFEXT4 ifosfamide IFOSFAMIDET4 ifosfamide/mesna IFOSFAMIDE-MESNAT4 lomustine LOMUSTINET4 mechlorethamine hcl MUSTARGENT2 melphalan ALKERANT4 melphalan hcl ALKERANT4 oxaliplatin ELOXATINT4 oxaliplatin OXALIPLATINT4 temozolomide TEMODAR PAT4 thiotepa THIOTEPA
Antiandrogenic AgentsT4 abiraterone acetate ZYTIGA PA, QLT1 bicalutamide BICALUTAMIDET1 bicalutamide CASODEXT4 enzalutamide XTANDI PA, QLT1 flutamide FLUTAMIDET4 nilutamide NILANDRON QL
Antibiotic AntineoplasticsT4 bleomycin sulfate BLEOMYCIN
SULFATET4 dactinomycin COSMEGENT4 daunorubicin citrate
liposomalDAUNOXOME
T4 daunorubicin hcl CERUBIDINET4 daunorubicin hcl DAUNORUBICIN HCLT4 doxorubicin hcl peg-
liposomalDOXORUBICIN HCLLIPOSOME
T4 epirubicin hcl ELLENCET4 epirubicin hcl EPIRUBICIN HCLT4 idarubicin hcl IDAMYCIN PFS
T4 mitomycin MITOMYCINT4 plicamycin MITHRACINT4 streptozocin ZANOSART4 valrubicin VALSTAR
Anti-cd20 (b Lymphocyte) Monoclonal
AntibodyT4 obinutuzumab GAZYVA PAT4 ofatumumab ARZERRA PAT4 rituximab RITUXAN PA
AntimetabolitesT4 azacitidine VIDAZAT4 capecitabine XELODA(TAB)(150
MG)PA, QL
T4 capecitabine XELODA(TAB)(500MG)
PA, QL
T4 cladribine CLADRIBINET4 clofarabine CLOLART4 cytarabine CYTARABINET4 cytarabine liposome/pf DEPOCYTT4 cytarabine/pf CYTARABINET4 decitabine DACOGENT4 floxuridine FUDRT4 fludarabine
phosphateFLUDARABINEPHOSPHATE
T4 gemcitabine hcl GEMCITABINE HCLT4 gemcitabine hcl GEMZART1 mercaptopurine PURINETHOLT1 methotrexate sodiumMETHOTREXATET2 methotrexate sodium TREXALLT1 methotrexate
sodium/pfMETHOTREXATESODIUM
T4 nelarabine ARRANONT4 pemetrexed disodium ALIMTA PAT4 pentostatin NIPENTT4 pralatrexate FOLOTYNT4 thioguanine TABLOID
Antineoplast Egf Receptor Blocker Rcmb Mc
AntibodyT4 cetuximab ERBITUX PAT4 panitumumab VECTIBIX PAT4 pertuzumab PERJETA PAT4 trastuzumab HERCEPTIN PA
Antineoplast Hum Vegf Inhibitor Recomb Mc
AntibodyT4 bevacizumab AVASTIN PA
Antineoplastic Aromatase InhibitorsT1 anastrozole ARIMIDEXT1 exemestane AROMASIN PAT1 letrozole FEMARA
Antineoplastic - Epothilones And AnalogsT4 ixabepilone IXEMPRA PA
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Antineoplastic - Halichondrin B AnalogsT4 eribulin mesylate HALAVEN PA
Antineoplastic - Hedgehog Pathway InhibitorT4 vismodegib ERIVEDGE PA, QL
Antineoplastic - Immunotherapy,
Therapeutic VacT4 sipuleucel-t/lactated
ringersPROVENGE
Antineoplastic - Janus Kinase (jak) InhibitorsT4 ruxolitinib phosphate JAKAFI PA, QL
Antineoplastic - Mtor Kinase InhibitorsT4 everolimus AFINITOR DISPERZ PAT4 everolimus AFINITOR(TAB)(10
MG)PA, QL
T4 everolimus AFINITOR(TAB)(2.5MG)
PA, QL
T4 everolimus AFINITOR(TAB)(5 MG)PA, QLT4 everolimus AFINITOR(TAB)(7.5
MG)PA
T4 temsirolimus TORISEL PA
Antineoplastic - Topoisomerase I InhibitorsT4 irinotecan hcl CAMPTOSART4 irinotecan hcl IRINOTECAN HCLT4 topotecan hcl HYCAMTINT4 topotecan hcl TOPOTECAN HCL
Antineoplastic - Vegf-a,b & P1gf InhibitorT4 ziv-aflibercept ZALTRAP PA
Antineoplastic - Vegfr AntagonistT4 ramucirumab CYRAMZA PA
Antineoplastic Antibody/radioactive-drug
ComplexesT4 tositumomab iodine-
131/maltoseBEXXAR
Antineoplastic Immunomodulator AgentsT4 lenalidomide REVLIMID PA, QLT4 peginterferon alfa-2b SYLATRON PA, QLT4 peginterferon alfa-2b SYLATRON 4-PACK PA, QLT4 pomalidomide POMALYST PA
Antineoplastic Lhrh(gnrh)
Antagonist,pituit.supprsT4 degarelix acetate FIRMAGON(VIAL)(120
MG)QL
T4 degarelix acetate FIRMAGON(VIAL)(80MG)
QL
Antineoplastic Systemic Enzyme InhibitorsT4 afatinib dimaleate GILOTRIF PAT4 axitinib INLYTA(TAB)(1 MG) PA, QL
T4 axitinib INLYTA(TAB)(5 MG) PA, QLT4 bortezomib VELCADE PAT4 bosutinib BOSULIF(TAB)(100
MG)PA, QL
T4 bosutinib BOSULIF(TAB)(500MG)
PA, QL
T4 cabozantinib s-malate COMETRIQ PA, QLT4 carfilzomib KYPROLIS PAT4 ceritinib ZYKADIA PAT4 crizotinib XALKORI PA, QLT4 dabrafenib mesylate TAFINLAR PAT4 dasatinib SPRYCEL(TAB)(100
MG)PA, QL
T4 dasatinib SPRYCEL(TAB)(140MG)
PA, QL
T4 dasatinib SPRYCEL(TAB)(20MG)
PA, QL
T4 dasatinib SPRYCEL(TAB)(50MG)
PA, QL
T4 dasatinib SPRYCEL(TAB)(70MG)
PA, QL
T4 dasatinib SPRYCEL(TAB)(80MG)
PA, QL
T4 erlotinib hcl TARCEVA PA, QLT4 ibrutinib IMBRUVICA PAT4 imatinib mesylate GLEEVEC PA, QLT4 lapatinib ditosylate TYKERB PAT4 nilotinib hcl TASIGNA PA, QLT4 pazopanib hcl VOTRIENT PA, QLT4 ponatinib hcl ICLUSIG(TAB)(15 MG)PA, QLT4 ponatinib hcl ICLUSIG(TAB)(45 MG)PA, QLT4 regorafenib STIVARGA PA, QLT4 sorafenib tosylate NEXAVAR PA, QLT4 sunitinib malate SUTENT PA, QLT4 trametinib dimethyl
sulfoxideMEKINIST PA
T4 vandetanib CAPRELSA(TAB)(100MG)
PA, QL
T4 vandetanib CAPRELSA(TAB)(300MG)
PA, QL
T4 vemurafenib ZELBORAF PA, QL
Antineoplastic,histone Deacetylase
Inhibitors,hdisT4 romidepsin ISTODAX PAT4 vorinostat ZOLINZA
Antineoplastics Antibody/antibody-drug
ComplexesT4 ado-trastuzumab
emtansineKADCYLA PA
T4 brentuximab vedotin ADCETRIS PAT4 kit for y-
90/ibritumomab/albumZEVALIN
T4 tositumomab (withmaltose)
BEXXAR
Antineoplastics,miscellaneousT4 arsenic trioxide TRISENOXT4 asparaginase ELSPAR PA
Commercial Formulary
L.A. Care Page 46 of 96
T4 asparaginase (erwiniachrysan)
ERWINAZE PA
T4 cabazitaxel JEVTANAT4 docetaxel DOCEFREZT4 docetaxel DOCETAXELT4 docetaxel TAXOTERET1 etoposide ETOPOSIDET4 mitotane LYSODRENT4 mitoxantrone hcl MITOXANTRONE
HCLPA
T4 omacetaxinemepesuccinate
SYNRIBO PA
T4 paclitaxel PACLITAXELT4 paclitaxel protein-
boundABRAXANE PA
T4 pegaspargase ONCASPAR PAT4 procarbazine hcl MATULANET4 teniposide TENIPOSIDET4 tretinoin TRETINOIN
Chemotherapy Rescue/antidote AgentsT4 glucarpidase VORAXAZET1 leucovorin calcium LEUCOVORIN
CALCIUMT3 mesna MESNEX
Cytotoxic T-lymphocyte Antigen(ctla-4)rmc
AntibodyT4 ipilimumab YERVOY PA
Intrapleural Sclerosing Agents, Antineoplast.
Adj.T3 talc SCLEROSOLT1 talc STERILE TALC
Photoactivated, Antineoplastic AgentsT4 porfimer sodium PHOTOFRIN PA
Photoactivated, Antineopls. & Premalignant
LesionsT3 aminolevulinic acid hcl LEVULAN
Selective Estrogen Receptor ModulatorsT4 fulvestrant FASLODEX PAT2 tamoxifen citrate SOLTAMOXT1 tamoxifen citrate TAMOXIFEN CITRATET4 toremifene citrate FARESTON PA
Selective Retinoid X Receptor AgonistsT4 bexarotene TARGRETIN PA
Steroid AntineoplasticsT4 estramustine
phosphate sodiumEMCYT
T1 megestrol acetate MEGESTROLACETATE
Vinca AlkaloidsT4 vinblastine sulfate VINBLASTINE
SULFATET4 vincristine sulfate
liposomalMARQIBO PA
T4 vinorelbine tartrate NAVELBINE
NEUROLOGICAL DISEASE -
MISCELLANEOUSAgents To Treat Multiple SclerosisT4 dimethyl fumarate TECFIDERA PAT4 fingolimod hcl GILENYA PAT4 glatiramer acetate COPAXONE PAT4 interferon beta-1a AVONEX PAT4 interferon beta-1a AVONEX PEN PAT4 interferon beta-
1a/albuminAVONEXADMINISTRATIONPACK
PA
T4 interferon beta-1a/albumin
REBIF PA
T4 interferon beta-1a/albumin
REBIF REBIDOSE PA
T4 interferon beta-1b BETASERON PAT4 interferon beta-1b EXTAVIA PAT4 teriflunomide AUBAGIO PA
Agts Tx Neuromusc Transmission Dis,pot-
chan BlkrT4 dalfampridine AMPYRA PA
Amyotrophic Lateral Sclerosis AgentsT4 riluzole RILUTEK
Fibromyalgia Agents,serotonin-norepineph
Ru InhibT2 milnacipran hcl SAVELLA
Leukocyte Adhesion Inhib,alpha4-mediat
Igg4k Mc AbT4 natalizumab TYSABRI PA
Movement DisordersT3 gabapentin enacarbil HORIZANT(TAB
ER)(300 MG)QL, ST
T3 gabapentin enacarbil HORIZANT(TABER)(600 MG)
QL, ST
T4 tetrabenazine XENAZINE
Postherpetic Neuralgia AgentsT3 gabapentin GRALISE(TAB ER
24H)(300 MG)QL, ST
T3 gabapentin GRALISE(TAB ER24H)(300-600 MG)
QL, ST
T3 gabapentin GRALISE(TAB ER24H)(600 MG)
QL, ST
Commercial Formulary
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Pseudobulbar Affect (pba) Agents, Nmda
AntagonistsT3 dextromethorphan
hbr/quinidineNUEDEXTA PA
ORAL/PHARYNGEAL DISORDERSDental Aids And PreparationsT1 chlorhexidine
gluconateCHLORHEXIDINEGLUCONATE
T1 triamcinoloneacetonide
TRIAMCINOLONEACETONIDE
T3 zinc cl/b-caine/cetylpyrd cl
BUCALCIDE
Keratinocyte Growth FactorT4 palifermin KEPIVANCE
Nose Preparations AntibioticsT2 mupirocin calcium BACTROBAN NASAL
Nose Preparations, MiscellaneousT1 ipratropium bromide ATROVENT
Periodontal Tetracycline Antiinfective, LocalT3 minocycline hcl
microspheresARESTIN
OTHER RESPIRATORY DISORDERSCystic Fib.transmemb
Conduct.reg.(cftr)potentiatorT4 ivacaftor KALYDECO PA
Lung SurfactantsT3 beractant SURVANTAT3 calfactant INFASURFT3 lucinactant SURFAXINT3 poractant alfa CUROSURF
MucolyticsT1 acetylcysteine ACETYLCYSTEINET4 dornase alfa PULMOZYME PA
PAIN MANAGEMENT - ANALGESICSAnalgesic, Non-salicylate & Barbiturate
Comb.T1 butalbital/acetaminop
henACETAMINOPHEN-BUTALBITAL
T3 butalbital/acetaminophen
BUPAP
T2 butalbital/acetaminophen
PHRENILIN FORTE
Analgesic, Salicylate, Barbiturate,& Xanthine
CmbT1 butalbital/aspirin/caff
eineBUTALBITAL-ASPIRIN-CAFFEINE
T1 butalbital/aspirin/caffeine
FIORINAL
Analgesic,non-
salicylate,barbiturate,&xanthine CmbT1 acetaminophen/caffei
ne/butalbAMERICET
T1 butalb/acetaminophen/caffeine
BUTALBITAL-ACETAMINOPHEN-CAFFE
T3 butalb/acetaminophen/caffeine
DOLGIC PLUS
T3 butalb/acetaminophen/caffeine
ESGIC-PLUS(CAP)
T1 butalb/acetaminophen/caffeine
ESGIC-PLUS(TAB)
T1 butalb/acetaminophen/caffeine
FIORICET
Analgesic/antipyretics, SalicylatesT3 asa/salicylam/acetami
noph/caffLEVACET
T1 aspirin ASPIRIN ECT5 aspirin ASPIRIN EC(OTC) AGET1 choline sal/mag
salicylateCHOLINE MAGTRISALICYLATE
T1 diflunisal DIFLUNISALT3 magnesium salicylate MAGANT1 sal-
amide/acetaminophn/p-tlox
ASP
T1 sal-amide/acetaminophn/p-tlox
DOLOREX
T1 salsalate SALSALATE
Analgesics, Narcotic Agonist And Nsaid
CombinationT1 hydrocodone/ibuprof
enVICOPROFEN
T1 ibuprofen/oxycodonehcl
OXYCODONE HCL-IBUPROFEN
Analgesics, Non-narcoticsT1 clonidine hcl/pf CLONIDINE HCL
Analgesics,narcoticsT2 buprenorphine BUTRANS QLT1 butorphanol tartrate BUTORPHANOL
TARTRATET1 codeine sulfate CODEINE SULFATET1 codeine/carisoprodol
/aspirinCARISOPRODOL-ASPIRIN-CODEINE
Commercial Formulary
L.A. Care Page 48 of 96
T1 dhcodeinebt/acetaminophn/caff
TREZIX
T1 dihydrocodeine/aspirin/caffein
SYNALGOS-DC
T1 fentanyl DURAGESIC QLT3 fentanyl SUBSYS PAT3 fentanyl citrate ABSTRAL PAT1 fentanyl citrate ACTIQ PAT3 fentanyl citrate FENTORA PAT3 fentanyl citrate LAZANDA PAT3 fentanyl citrate ONSOLIS PAT3 hydrocodone bitartrate ZOHYDRO ERT1 hydrocodone/acetam
inophenHYCET QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(SOLUTION)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10-660MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-300MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-325MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-325MG)
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-500 MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-300MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-325MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-300MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-325MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-750MG)
QL
T1 hydrocodone/acetaminophen
LORCET 10-650 QL
T1 hydrocodone/acetaminophen
LORCET PLUS QL
T1 hydrocodone/acetaminophen
LORTAB QL
T1 hydrocodone/acetaminophen
MAXIDONE QL
T2 hydrocodone/acetaminophen
STAGESIC-10 QL
T3 hydrocodone/acetaminophen
ZAMICET QL
T2 hydrocodone/acetaminophen
ZYDONE QL
T1 hydromorphone hcl DILAUDID
T3 hydromorphone hcl EXALGOT1 hydromorphone hcl HYDROMORPHONE
HCLT1 hydromorphone
hcl/pfDILAUDID
T1 hydromorphonehcl/pf
DILAUDID-HP(AMPUL)
T3 hydromorphone hcl/pf DILAUDID-HP(VIAL)T1 hydromorphone
hcl/pfHYDROMORPHONEHCL
T1 levorphanol tartrate LEVORPHANOLTARTRATE
T1 meperidine hcl MEPERIDINE HCLT3 meperidine hcl/pf DEMEROLT1 meperidine hcl/pf MEPERIDINE HCLT1 methadone hcl DOLOPHINE HCLT1 methadone hcl METHADONE HCLT1 morphine sulfate AVINZAT3 morphine sulfate KADIAN(CAP ER
PEL)(10 MG)T1 morphine sulfate KADIAN(CAP ER
PEL)(100 MG)T3 morphine sulfate KADIAN(CAP ER
PEL)(130 MG)T3 morphine sulfate KADIAN(CAP ER
PEL)(150 MG)T1 morphine sulfate KADIAN(CAP ER
PEL)(20 MG)T3 morphine sulfate KADIAN(CAP ER
PEL)(200 MG)T1 morphine sulfate KADIAN(CAP ER
PEL)(30 MG)T3 morphine sulfate KADIAN(CAP ER
PEL)(40 MG)T1 morphine sulfate KADIAN(CAP ER
PEL)(50 MG)T1 morphine sulfate KADIAN(CAP ER
PEL)(60 MG)T3 morphine sulfate KADIAN(CAP ER
PEL)(70 MG)T1 morphine sulfate KADIAN(CAP ER
PEL)(80 MG)T3 morphine sulfate MORPHINE SULFATET1 morphine sulfate MS CONTINT3 morphine sulfate
liposomal/pfDEPODUR
T1 morphine sulfate/pf MORPHINE SULFATET1 nalbuphine hcl NALBUPHINE HCLT1 opium/belladonna
alkaloidsBELLADONNA-OPIUM
T3 oxycodone hcl OXECTAT1 oxycodone hcl OXYCODONE HCLT2 oxycodone hcl OXYCONTINT1 oxycodone hcl ROXICODONET3 oxycodone
hcl/acetaminophenMAGNACET QL
T1 oxycodonehcl/acetaminophen
OXYCODONE-ACETAMINOPHEN
QL
T1 oxycodonehcl/acetaminophen
PERCOCET QL
T3 oxycodonehcl/acetaminophen
PRIMLEV QL
Commercial Formulary
L.A. Care Page 49 of 96
T3 oxycodonehcl/acetaminophen
XARTEMIS XR
T1 oxycodonehcl/aspirin
PERCODAN
T3 oxymorphone hcl NUMORPHANT3 oxymorphone hcl OPANA ERT3 oxymorphone hcl OPANA(AMPUL)T1 oxymorphone hcl OPANA(TAB)T1 pentazocine
hcl/acetaminophenPENTAZOCINE-ACETAMINOPHEN
T1 pentazocinehcl/naloxone hcl
PENTAZOCINE-NALOXONE HCL
T3 pentazocine lactate TALWINT2 tapentadol hcl NUCYNTA QLT2 tapentadol hcl NUCYNTA ER QLT3 tramadol hcl CONZIP QL, STT1 tramadol hcl ULTRAMT1 tramadol
hcl/acetaminophenULTRACET
Antimigraine PreparationsT3 almotriptan malate AXERT QL, STT3 diclofenac potassium CAMBIA QLT1 dihydroergotamine
mesylateD.H.E.45 QL
T1 dihydroergotaminemesylate
DIHYDROERGOTAMINE MESYLATE
T1 dihydroergotaminemesylate
MIGRANAL QL
T3 eletriptan hbr RELPAX QL, STT3 ergotamine tartrate ERGOMAR QLT2 ergotamine
tartrate/caffeineCAFERGOT QL
T1 ergotaminetartrate/caffeine
MIGERGOT QL
T3 frovatriptan succinate FROVA QL, STT1 isomethept/dichlphn/
acetaminopISOMETHEPT-DICHLORALP-ACETAMIN
T1 isomethepten/caf/acetaminophen
PRODRIN
T1 naratriptan hcl AMERGE QLT1 rizatriptan benzoate MAXALT QLT1 rizatriptan benzoate MAXALT MLT QLT1 sumatriptan IMITREX QLT3 sumatriptan
succ/naproxen sodTREXIMET QL, ST
T3 sumatriptan succinate ALSUMA QLT1 sumatriptan
succinateIMITREX(CARTRIDGE)
QL
T1 sumatriptansuccinate
IMITREX(PENINJCTR)
QL
T1 sumatriptansuccinate
IMITREX(TAB) QL
T1 sumatriptansuccinate
IMITREX(VIAL) QL
T1 sumatriptansuccinate
SUMATRIPTANSUCCINATE
QL
T3 sumatriptan succinate SUMAVEL DOSEPRO QL, STT2 zolmitriptan ZOMIG(SPRAY)(2.5
MG)QL, ST
T2 zolmitriptan ZOMIG(SPRAY)(5MG)
QL, ST
T1 zolmitriptan ZOMIG(TAB) QL, ST
Narc.& Non-sal.analgesic,barbiturate
&xanthine CmbT1 butalbit/acetamin/caff
/codeineFIORICET WITHCODEINE
Narcotic & Salicylate Analgesics, Barb.&
XanthineT1 codeine/butalbital/as
a/caffeinFIORINAL WITHCODEINE #3
Narcotic Analgesic & Non-salicylate
Analgesic CombT1 acetaminophen with
codeineACETAMINOPHEN-CODEINE
T2 acetaminophen withcodeine
CAPITAL W-CODEINE
T1 acetaminophen withcodeine
TYLENOL-CODEINENO.3
T1 acetaminophen withcodeine
TYLENOL-CODEINENO.4
T1 codeinephos/acetaminophen
ACETAMINOPHENW/CODEINE
Narcotic Withdrawal Therapy AgentsT3 buprenorphine hcl BUPRENEXT1 buprenorphine hcl BUPRENORPHINE
HCLT1 buprenorphine
hcl/naloxone hclBUPRENORPHINE-NALOXONE
PA
T3 buprenorphinehcl/naloxone hcl
SUBOXONE PA
T2 buprenorphinehcl/naloxone hcl
ZUBSOLV PA
PARKINSONS DISEASEAntiparkinsonism Drugs,anticholinergicT1 benztropine mesylateBENZTROPINE
MESYLATET1 trihexyphenidyl hcl TRIHEXYPHENIDYL
HCL
Antiparkinsonism Drugs,otherT1 amantadine hcl AMANTADINET4 apomorphine hcl APOKYN PA, QLT1 bromocriptine
mesylatePARLODEL
T1 carbidopa/levodopa PARCOPAT1 carbidopa/levodopa SINEMET 10-100T1 carbidopa/levodopa SINEMET 25-100T1 carbidopa/levodopa SINEMET 25-250T1 carbidopa/levodopa/e
ntacaponeSTALEVO 100
T1 carbidopa/levodopa/entacapone
STALEVO 125
Commercial Formulary
L.A. Care Page 50 of 96
T1 carbidopa/levodopa/entacapone
STALEVO 150
T1 carbidopa/levodopa/entacapone
STALEVO 200
T1 carbidopa/levodopa/entacapone
STALEVO 50
T1 carbidopa/levodopa/entacapone
STALEVO 75
T1 entacapone COMTANT1 pramipexole di-hcl MIRAPEXT3 pramipexole di-hcl MIRAPEX ER QL, STT2 rasagiline mesylate AZILECT QLT1 ropinirole hcl REQUIPT1 ropinirole hcl REQUIP XL QL, STT2 rotigotine NEUPRO QL, STT1 selegiline hcl ELDEPRYLT1 selegiline hcl SELEGILINE HCLT3 selegiline hcl ZELAPAR QLT3 tolcapone TASMAR QL, ST
Decarboxylase InhibitorsT1 carbidopa CARBIDOPA
SEIZURE DISORDERAnticonvulsantsT1 carbamazepine CARBAMAZEPINET1 carbamazepine CARBATROLT1 carbamazepine TEGRETOLT2 carbamazepine TEGRETOL XRT3 clobazam ONFI(ORAL SUSP) QL, STT3 clobazam ONFI(TAB) QL, STT1 clonazepam CLONAZEPAMT1 clonazepam KLONOPINT1 diazepam DIASTAT QLT2 diazepam DIASTAT
ACUDIAL(KIT)(12.5-15-20)
QL
T1 diazepam DIASTATACUDIAL(KIT)(5-7.5-10MG)
QL
T1 diazepam DIAZEPAMT1 divalproex sodium DEPAKOTE ERT3 eslicarbazepine
acetateAPTIOM
T1 ethosuximide ZARONTINT3 ethotoin PEGANONET3 ezogabine POTIGA(TAB)(200
MG)QL, ST
T3 ezogabine POTIGA(TAB)(300MG)
QL, ST
T3 ezogabine POTIGA(TAB)(400MG)
QL, ST
T3 ezogabine POTIGA(TAB)(50 MG) QL, STT1 felbamate FELBATOL(ORAL
SUSP)QL, ST
T1 felbamate FELBATOL(TAB)(400MG)
QL, ST
T1 felbamate FELBATOL(TAB)(600MG)
QL, ST
T3 gabapentin FANATREXT1 gabapentin GABAPENTIN
T1 gabapentin NEURONTINT3 lacosamide VIMPAT(SOLUTION)T3 lacosamide VIMPAT(TAB) QL, STT1 lamotrigine LAMICTALT1 lamotrigine LAMICTAL (BLUE)T2 lamotrigine LAMICTAL (GREEN)T2 lamotrigine LAMICTAL (ORANGE)T3 lamotrigine LAMICTAL ODT
(BLUE)ST
T3 lamotrigine LAMICTAL ODT(GREEN)
ST
T3 lamotrigine LAMICTAL ODT(ORANGE)
ST
T3 lamotrigine LAMICTAL ODT(TABRDP DIS)(100 MG)
QL, ST
T3 lamotrigine LAMICTAL ODT(TABRDP DIS)(200 MG)
QL, ST
T3 lamotrigine LAMICTAL ODT(TABRDP DIS)(25 MG)
QL, ST
T3 lamotrigine LAMICTAL ODT(TABRDP DIS)(50 MG)
QL, ST
T3 lamotrigine LAMICTAL XR (BLUE) STT3 lamotrigine LAMICTAL XR
(GREEN)ST
T3 lamotrigine LAMICTAL XR(ORANGE)
ST
T1 levetiracetam KEPPRAT1 levetiracetam LEVETIRACETAMT3 methsuximide CELONTINT1 oxcarbazepine OXCARBAZEPINET3 oxcarbazepine OXTELLAR XR(TAB
ER 24H)(150 MG)QL, ST
T3 oxcarbazepine OXTELLAR XR(TABER 24H)(300 MG)
QL, ST
T3 oxcarbazepine OXTELLAR XR(TABER 24H)(600 MG)
QL, ST
T2 oxcarbazepine TRILEPTAL(ORALSUSP)
T1 oxcarbazepine TRILEPTAL(TAB)T3 perampanel FYCOMPA(TAB)(10
MG)QL, ST
T3 perampanel FYCOMPA(TAB)(12MG)
QL, ST
T3 perampanel FYCOMPA(TAB)(2MG)
QL, ST
T3 perampanel FYCOMPA(TAB)(4MG)
QL, ST
T3 perampanel FYCOMPA(TAB)(6MG)
QL, ST
T3 perampanel FYCOMPA(TAB)(8MG)
QL, ST
T1 phenytoin DILANTINT2 phenytoin DILANTIN-125T1 phenytoin PHENYTOINT2 phenytoin sodium
extendedDILANTIN
T2 phenytoin sodiumextended
PHENYTEK
T1 phenytoin sodiumextended
PHENYTOIN SODIUMEXTENDED
T2 pregabalin LYRICAT1 primidone MYSOLINE
Commercial Formulary
L.A. Care Page 51 of 96
T3 rufinamide BANZEL(ORAL SUSP)QL, STT3 rufinamide BANZEL(TAB)(200
MG)QL, ST
T3 rufinamide BANZEL(TAB)(400MG)
QL, ST
T3 tiagabine hcl GABITRIL(TAB)(12MG)
QL, ST
T3 tiagabine hcl GABITRIL(TAB)(16MG)
QL, ST
T1 tiagabine hcl GABITRIL(TAB)(2 MG)QL, STT1 tiagabine hcl GABITRIL(TAB)(4 MG)QL, STT1 topiramate TOPAMAXT3 topiramate TROKENDI XR(CAP
ER 24H)(100 MG)QL, ST
T3 topiramate TROKENDI XR(CAPER 24H)(200 MG)
QL, ST
T3 topiramate TROKENDI XR(CAPER 24H)(25 MG)
QL, ST
T3 topiramate TROKENDI XR(CAPER 24H)(50 MG)
QL, ST
T1 valproic acid DEPAKENET3 valproic acid STAVZOR STT1 valproic acid VALPROIC ACIDT1 valproic acid (as
sodium salt)DEPAKENE
T3 vigabatrin SABRIL QLT1 zonisamide ZONEGRANT1 zonisamide ZONISAMIDE
SKELETAL MUSCLE DISORDERSkeletal Muscle RelaxantsT1 baclofen BACLOFENT1 carisoprodol SOMAT1 carisoprodol/aspirin CARISOPRODOL-
ASPIRINT3 chlorzoxazone LORZONET1 chlorzoxazone PARAFON FORTE
DSCT1 chlorzoxazone/aceta
minophenCHLORZOXAZONEW/ACETAMINOPHEN
T3 cyclobenzaprine hcl AMRIXT1 cyclobenzaprine hcl CYCLOBENZAPRINE
HCLT1 cyclobenzaprine hcl FEXMIDT1 dantrolene sodium DANTRIUMT1 metaxalone SKELAXINT1 methocarbamol ROBAXINT1 methocarbamol ROBAXIN-750T1 orphenadrine citrate ORPHENADRINE
CITRATET1 orphenadrine/aspirin/
caffeineORPHENADRINECOMPOUND FORTE
T1 tizanidine hcl TIZANIDINE HCLT1 tizanidine hcl ZANAFLEX
UnknownT3 cyclobenz hcl/irr cntr-
irr cb2COMFORT PAC-CYCLOBENZAPRINE
T3 tizanidine/irr cntr-irrcmb #2
COMFORT PAC-TIZANIDINE
SMOKING CESSATIONSmoking Deterrent AgentsT3 nicotine NICOTROL QLT3 nicotine NICOTROL NS QL
Smoking Deterrent-nicotinic Recept.partial
AgonistT3 varenicline tartrate CHANTIX QL
Smoking Deterrents, OtherT1 bupropion hcl BUPROBAN
UPPER GASTROINTESTINAL
DISORDERS - DIGESTIVEGastric EnzymesT4 sacrosidase SUCRAID PA
Pancreatic EnzymesT2 lipase/protease/amylas
eCREON
T3 lipase/protease/amylase
PANCREAZE
T3 lipase/protease/amylase
PERTZYE
T2 lipase/protease/amylase
ULTRASE
T2 lipase/protease/amylase
ULTRASE MT 12
T2 lipase/protease/amylase
ULTRASE MT 18
T2 lipase/protease/amylase
ULTRASE MT 20
T3 lipase/protease/amylase
ULTRESA
T3 lipase/protease/amylase
VIOKACE
T2 lipase/protease/amylase
ZENPEP(CAP DR)(10-34-55K)
T2 lipase/protease/amylase
ZENPEP(CAP DR)(15-51-82K)
T2 lipase/protease/amylase
ZENPEP(CAP DR)(20-68-109K)
T2 lipase/protease/amylase
ZENPEP(CAP DR)(25-85-136K)
T2 lipase/protease/amylase
ZENPEP(CAPDR)(3K-10K-16K)
T1 lipase/protease/amylase
ZENPEP(CAPDR)(5K-17K-27K)
UPPER GASTROINTESTINAL
DISORDERS - SPASTIC DISEASEAnticholinergics/antispasmodicsT1 dicyclomine hcl BENTYLT1 dicyclomine hcl DICYCLOMINE HCL
Commercial Formulary
L.A. Care Page 52 of 96
Anticholinergics/microorganisms
CombinationsT3 methscp
br/la/s.thm/l.para/bifPAMINE FQ
Belladonna AlkaloidsT3 belladonna
alkaloids/phenobarbBARBIDONNA
T1 belladonnaalkaloids/phenobarb
SPASMOLIN
T1 hyoscyamine HYOSCYAMINET2 hyoscyamine sulfate CYSTOSPAZ-MT1 hyoscyamine sulfate HYOSCYAMINE
SULFATET3 hyoscyamine sulfate SYMAX DUOTABT1 hyoscyamine sulfate SYMAX-SLT1 hyoscyamine sulfate SYMAX-SRT1 methscopolamine
bromidePAMINE
T1 methscopolaminebromide
PAMINE FORTE
T1 phenobarb/hyoscy/atropine/scop
ANTISPASMODIC
T2 phenobarb/hyoscy/atropine/scop
DONNATAL
UPPER GASTROINTESTINAL
DISORDERS - ULCER DISEASEAnticholinergics,quaternary AmmoniumT1 chlordiazepoxide/clid
inium brLIBRAX
T3 glycopyrrolate CUVPOSAT1 glycopyrrolate ROBINULT1 glycopyrrolate ROBINUL FORTET1 isopropamide/prochl
orperazinePROCHLORPERAZINE/ISOPROPAMIDE
T3 mepenzolate bromide CANTILT3 propantheline bromide PRO-BANTHINET1 propantheline
bromidePROPANTHELINEBROMIDE
T1 propantheline/phenobarbital
PROBANTHELINEW/PHENOBARBITAL
Anti-ulcer PreparationsT1 misoprostol CYTOTECT2 sucralfate CARAFATE(ORAL
SUSP)T1 sucralfate CARAFATE(TAB)T1 sucralfate SUCRALFATE
Anti-ulcer-h.pylori AgentsT3 bismuth
sal/metronid/tetracycHELIDAC
T3 bismuth/metronid/tetracycline
PYLERA
T1 lansoprazole/amoxiciln/clarith
PREVPAC QL
T3 omeprazole/clarith/amoxicillin
OMECLAMOX-PAK
Histamine H2-receptor InhibitorsT1 cimetidine CIMETIDINET1 cimetidine TAGAMETT1 cimetidine hcl CIMETIDINET1 famotidine PEPCIDT2 famotidine PEPCID RPDT1 nizatidine AXIDT1 nizatidine NIZATIDINET1 ranitidine RANITIDINE 150MGT3 ranitidine hcl DEPRIZINET1 ranitidine hcl RANITIDINE HCLT1 ranitidine hcl ZANTAC
Intestinal Motility StimulantsT1 metoclopramide hcl METOCLOPRAMIDE
HCLT2 metoclopramide hcl METOCLOPRAMIDE
HCL INTENSOLT3 metoclopramide hcl METOZOLV ODTT1 metoclopramide hcl REGLAN
Proton-pump InhibitorsT2 dexlansoprazole DEXILANT QL, STT3 esomeprazole
magnesiumNEXIUM QL
T3 esomeprazolestrontium
ESOMEPRAZOLESTRONTIUM
QL, ST
T3 lansoprazole FIRST-LANSOPRAZOLE
T1 lansoprazole PREVACID(CAP DR)T2 lansoprazole PREVACID(TAB RAP
DR)ST
T3 omeprazole FIRST-OMEPRAZOLET1 omeprazole OMEPRAZOLET1 omeprazole PRILOSECT3 omeprazole
magnesiumPRILOSEC
T1 omeprazole/sodiumbicarbonate
ZEGERID(CAP) QL, ST
T3 omeprazole/sodiumbicarbonate
ZEGERID(PACKET) QL, ST
T3 pantoprazole sodium PROTONIX(GRANPKT DR)
ST
T1 pantoprazole sodium PROTONIX(TAB DR)T3 rabeprazole sodium ACIPHEX SPRINKLE QL, STT1 rabeprazole sodium RABEPRAZOLE
SODIUMQL
URINARY TRACT - FUNCTIONAL
DISORDERSBenign Prostatic Hypertrophy/micturition
AgentsT1 alfuzosin hcl UROXATRALT2 dutasteride AVODART G, STT1 finasteride PROSCAR GT3 silodosin RAPAFLO G, ST
Commercial Formulary
L.A. Care Page 53 of 96
T1 tamsulosin hcl FLOMAX
Bph Agents,5-alpha-red Inh & Alpha-1-adr
Antg CmbT2 dutasteride/tamsulosin
hclJALYN G, ST
Kidney Stone AgentsT3 cysteamine bitartrate CYSTAGONT4 cysteamine bitartrate PROCYSBI PAT3 tiopronin THIOLA
Overactive Bladder Agents, Beta-3
Adrenergic RecepT3 mirabegron MYRBETRIQ QL, ST
Urinary Ph ModifiersT3 citric acid/g-
lactone/mag carbRENACIDIN
T1 citric acid/sodiumcitrate
CYTRA-2
T3 citric acid/sodiumcitrate
ORACIT
T3 citric acid/sodiumcitrate
SHOHL'S MODIFIED
T3 methen mand/naphosm-b m-h
UROQID-ACID NO.2
T3 na phos,m-b/kphos,monob
K-PHOS NO.2
T1 phosphorus #1 K-PHOS NEUTRALT1 potassium citrate UROCIT-KT1 potassium
citrate/citric acidCYTRA-K
T3 potassiumphosphate,monobasic
K-PHOS ORIGINAL
T1 sod/pot/k cit/sodcit/cit acid
CYTRA-3
Urinary Tract Analgesic AgentsT2 pentosan polysulfate
sodiumELMIRON
Urinary Tract Anesthetic/analgesic AgntT1 phenazopyridine hcl PHENAZOPYRIDINE
HCLT1 phenazopyridine hcl PYRIDIUM
Urinary Tract Antispasmodic, M(3) Selective
Antag.T3 darifenacin
hydrobromideENABLEX ST
T2 solifenacin succinate VESICARE ST
Urinary Tract
Antispasmodic/antiincontinence AgentT2 fesoterodine fumarate TOVIAZ STT1 flavoxate hcl FLAVOXATE HCLT3 oxybutynin GELNIQUE ST
T3 oxybutynin OXYTROL STT3 oxybutynin chloride GELNIQUE STT1 oxybutynin chloride OXYBUTYNIN
CHLORIDET1 tolterodine tartrate DETROL STT1 trospium chloride SANCTURA ST
VAGINAL DISORDERSVaginal AntibioticsT1 clindamycin
phosphateCLEOCIN(CREAM/APPL)
T3 clindamycin phosphateCLEOCIN(SUPP VAG)T3 clindamycin phosphateCLINDESSET1 metronidazole METROGEL-VAGINALT2 metronidazole VANDAZOLE
Vaginal AntifungalsT1 miconazole nitrate MICONAZOLE 3T1 terconazole TERAZOL 3T1 terconazole TERCONAZOLE
Vaginal Estrogen PreparationsT2 estradiol ESTRACET3 estradiol ESTRING QLT2 estradiol VAGIFEMT3 estradiol acetate FEMRING QLT2 estrogens, conjugated PREMARIN
Vaginal SulfonamidesT2 sulfanilamide AVC
Vaginal/cervical Care And Treatment AgentsT1 sod
propion/inositol/aa14/urea
AMINO ACIDCERVICAL
VITAMIN AND/OR MINERAL
DEFICIENCYAntioxidant Multivitamin CombinationsT1 vit
a,c,e/zinc/copper/lut/zeax
MACUTEK
Calcium ReplacementT1 cal
carb/mgox/d3/b12/fa/b6/bor
FOLGARD OS
Fluoride PreparationsT3 sodium fluoride CLINPRO 5000T3 sodium fluoride FLUORABONT3 sodium fluoride FLUOR-A-DAYT5 sodium fluoride FLUORIDET2 sodium fluoride FLUORITABT2 sodium fluoride FLURA-DROPST3 sodium fluoride PREVIDENTT3 sodium fluoride PREVIDENT 5000
Commercial Formulary
L.A. Care Page 54 of 96
T1 sodium fluoride/potnitrate
FLUORIDEXSENSITIVITY RELIEF
T3 sodium fluoride/potnitrate
PREVIDENT 5000ENAMEL PROTECT
T3 sodium fluoride/potnitrate
PREVIDENT 5000SENSITIVE
T3 sodium fluoride/xylitol FLUOR-A-DAYT1 stannous fluoride STANNOUS
FLUORIDE
Folic Acid PreparationsT1 folic acid FOLIC ACIDT5 folic acid FOLIC ACID(OTC) G
Geriatric Vitamin PreparationsT3 mv, min
cmb#16/fa/lutein/lycopREQ49+
Iron ReplacementT1 fe
fumarate/cal/e/fa/multivit
VITAFOL
T1 fefumarate/doss/fa/bcomp&c
NEPHRON FA
T1 fe fumarate/vitc/b12/stomc
HEMATOGEN
T1 fe fumarate/vit c/b12-if/fa
FEROCON
T3 fe hemepolypeptide/folic acid
PROFERRIN-FORTE
T3 ferricamcit/cyanocobalamin/fa
HEMATRON
T3 ferric amcit/lys/vit bcomp/fa
HEMATRON
T4 ferric carboxymaltose INJECTAFERT1 ferrous fumarate/folic
acidHEMOCYTE-F
T3 ferrous fumarate/vitc/fa
CEVI-FER
T5 ferrous sulfate CHILDREN'SFERROUSSULFATE(OTC)
T1 ferrous sulfate/vitc/fa
TL-FOL 500
T3 ferumoxytol FERAHEMET3 iron &iron asp
gly/fa/mv,min27CORVITE FE
T1 iron ag&fum/c/fa/mvcmb11/ca-t
FERREX 28
T1 ironag/c/b12/ca/suc.acid/stom
MULTIGEN
T1 ironaspgly&ps/c/b12/fa/ca/suc
FERREX 150 FORTEPLUS
T1 ironaspgly/c/b12/fa/ca-th/suc
MULTIGEN FOLIC
T1 iron bg&ps/vitc/b12/fa/ca thr
TARON FORTE
T3 iron bisgly &ps/fa/b&c#12/suc
IROSPAN
T1 iron fum &ag/c/b12/fa/ca/succ
MULTIGEN PLUS
T1 iron fum & p/fa/vit b& c no.9
INTEGRA PLUS
T1 iron fum & pscmp/fa/vit c/b3
INTEGRA F
T1 ironfum&polysac#1/fa/mvno.18
TANDEM PLUS
T1 iron fumarate/vit c/vitb12/fa
TRIGELS-F FORTE
T3 iron gly&fum/c/b12/me-thfolate
MAXARON FORTE
T3 iron ps cmplx/folicacid/vit c
NOVAFERRUM
T3 iron ps cmplx/vit b12/faHEMOCYTE-FT1 iron ps cmplx/vit
b12/faPOLY-IRON 150FORTE
T1 iron ps/iron hempoly/fa/b12
BIFERA RX
T1 iron, carb &gluc/fa/b12/c/dss
FERRALET 90
T1 iron, carbonyl/fa/c/b-6/b12/zn
CORVITE 150
T1 iron,carb/dss/b12if/fa/mv-mn
HEMATRON-AF
T3 iron,carb/fa#6/mv, minno.40
CORVITE FE
T2 iron,carb/fa#6/mv, minno.41
CORVITE 150
T3 iron,carbonyl/fa/multivits-min
ACTIVE FE
T3 iron,fum&ps/fa/vitb&c#18/l.ca
FUSION PLUS
T1 iron/fa/b12/c/docusate sodium
FERRAPLUS 90
T1 iron/fa/vitamin bcomp w-c/min
HEMATINIC PLUS
T3 iron/folicacid/c/b12/biotin
FERIVA
T1 iron/liver ext/vitbcomp&c/min
SIDEROL
Multivitamin PreparationsT1 b complex with
vitamin cSUPPORT-500
T3 b complex with vitaminc
VI-CERT C1000 WITHB12
T3 fa/mu-vits-minth/lycopene/lut
CORVITA
T3 fa/mu-vits-minth/lycopene/lut
CORVITE
T1 fe fumarate/fa/vitbcomp&c
DIALYVITE 800 WITHIRON
T1 folic acid/mu-vits-minth
VITE CON FORTE
T3 folic acid/mv,fe,othermin
NUTRICAP
Commercial Formulary
L.A. Care Page 55 of 96
T3 m-tetrahyrofolate/niacin/cu/zn
NICOMIDE
T3 multivit, iron, min #4, faMULTICHEWT1 multivit, iron, min #5,
faSTROVITE FORTE
T1 multivit, iron, min #6,fa
STROVITE PLUS
T1 multivit, mincmb#20/iron/fa
BACMIN
T3 multivit, min no.21/folicacid
SUPERVITE EC
T3 multivit, min no.23/folicacid
PROTECT BONE
T1 multivitamin no.44/vitd3/k
MULTIVITAMINS-A,B,D,E,K,ZN
T3 multivitamin w/iron,minerals
HEMOCYTE
T1 multivitamins withmin no.7/fa
V-C FORTE
T1 multivits,therap w-fe,hematin
B-PLEX PLUS
T3 mv, min cmb#6/fa/lut/lyco/q10
CORVITE FREE
T3 mv, min cmb#24/ironps cmp/fa
PROTECT IRON
T3 mv, min cmb#9/fa/sawpalmet xt
UDAMIN SP
T1 mv,min #10/fa/d3/alipacid/lut
STROVITE ONE
T3 mv/dietary 4/dna/rna FORTAVITT1 om-3/ca
carb/d3/fa/mv cmb 13ADVANCED AM/PM
T1 om-3/dha/epa/b12/fa/b6/phytost
VIT 3
T3 om-3/dha/epa/d3/b12/fa/b-6/phy
ANIMI-3
T3 om-3/dha/epa/d3/b12/fa/b-6/phy
ANIMI-3 WITHVITAMIN D
T1 vitamin b comp andvit c no.6
STROVITE
Pediatric Vitamin PreparationsT1 fluoride
ion/multivitaminsMULTIVITAMINSW/FLUORIDE
T1 fluoride/iron/vit a,c&dTRI-VIT WITHFLUORIDE-IRON
T3 iron/fluoride/vits a, c, &d3
MYKIDZ IRON FL
T1 multivitamins withfluoride
MULTIVITAMINSWITH FLUORIDE
T1 multivits with iron &fluoride
MULTIVITAMINS W-FLUORIDE-IRON
T1 ped mv a,c,d3 #21 w-fluoride
TRI-VITAMIN WITHFLUORIDE
T1 ped mv a,c,d3 #38 w-fluoride
TRI-VI-FLOR
T1 pedi m.vit no.17 withfluoride
MULTIVITAMIN WITHFLUORIDE
T3 pedi multivit #37 w-fluoride
POLY-VI-FLOR
T1 pedi multivit #65/vitd3/vit k
MULTIVITAMINS-A,B,D,E,K,ZN
T1 pedi multivit no.2 w-fluoride
MULTI-VITAMIN W-FLUORIDE
T3 pedi mv #37 w-fluoride& iron
POLY-VI-FLOR WITHIRON
T1 pedi mv#45/fluoride/iron
MULTI-VITAMIN-FLUOR-IRON
T1 pedi mvino.12/sodiumfluoride
MVC-FLUORIDE
T1 pedi mvi no.16 withfluoride
MULTIVITAMINSWITH FLUORIDE
T3 pedi mvi no.33 withfluoride
POLY-VI-FLOR
T3 pediatric mv #33 w-fluoride&fe
POLY-VI-FLOR WITHIRON
T3 pediatric mv #47 w-fe&fluoride
ESCAVITE
T1 pediatric mv #47 w-fe&fluoride
TL-FLUORIVITE
Prenatal Vitamin PreparationsT1 iron,carbonyl/vit c/vit
b12/faFE C
T3 pn vit.w-o ca #7,iron,fa,dha
ELITE OB DHA
T3 pn vits.w-o ca #8,iron,fa
VP-ERA OB PLUS
T1 pn w-ca64/ironcb&gl/fa/dss/dh
NATALVIRT 90 DHA
T3 pn85/iron cb&aspg/fa/dha/fish
OB COMPLETE ONE
T1 pnv #14/ferrousfum/folic acid
COMPLETENATE
T3 pnv #30/ironcarb&aspg/fa/om3
OB COMPLETE WITHDHA
T3 pnv #35/iron/fa #6/dha PRENATEESSENTIAL
T3 pnv #38/ironfum/folate/dha
PRENATE DHA
T3 pnv #56/ironcarb&aspg/fa/dha
OB COMPLETEPETITE
T1 pnv #8/iron pscmp&aspg/fa/dha
PAIRE OB PLUS DHA
T3 pnv #86/ironpoly/fa/dha/epa
NESTABS ABC
T1 pnv #87/ironbisgly/fa/dha
NESTABS DHA
T1 pnv 11-iron fum-folicacid-om3
RELNATE DHA
T3 pnv18/fe,carb/fa/dss/ubi/dha
PREQUE 10
T3 pnv comb no.3/ironfum&gluc/fa
MAXINATE
T1 pnvcomb.no.44/iron/folicacid
VITASPIRE
Commercial Formulary
L.A. Care Page 56 of 96
T3 pnvcomb.no43/iron,carb/fa/dss
ATABEX EC
T3 pnv combo #19/iron/folac/dha
PREFERA-OB ONE
T1 pnv combo#19/iron/fol ac/dha
VP-HEME ONE
T1 pnv combo#22/iron/fa/om3/dha
HEMENATAL OB +DHA
T1 pnvcombo#47/iron/fa#1/dha
ZATEAN-PN DHA
T1 pnv no.115/ironfumarate/fa
PRENATAL 19
T1 pnv no.118/ironfumarate/fa
SE-NATAL 19
T1 pnv no.15/iron fum &ps cmp/fa
CONCEPT OB
T1 pnv no.22/ironcbn&gluc/fa/dss
CITRANATAL RX
T3 pnv no.27/iron carb &fum/fa
NATAFORT
T1 pnvno.66/iron,carbonyl/fa/dha
R-NATAL OB
T1 pnv no10/ironfum&p/fa/omega-3
SE-TAN DHA
T1 pnvno12/iron,carb/fa/dss/om-3
OBTREX DHA
T1 pnv w-ca #40/ironfum/fa cmb#1
PNV-SELECT
T1 pnv w-cano.37/iron/fa/omega-3
ULTIMATECARE ONE
T1 pnv w-ca8/iron/fa/lmefolateca
PNV-IRON
T1 pnv with ca#68/iron/fa#1/dha
ZATEAN-PN PLUS
T3 pnv with cacombo.11/iron/fa
VITAFOL-PN
T1 pnv with cano.65/iron poly/fa
MARNATAL-F
T3 pnv withca,no.60/iron/fa/dha
GESTICARE DHA
T1 pnv withca,no.62/iron/fa/dha
TRIVEEN-ONE
T3 pnv withca,no.70/iron/fa/dha
NATELLE ONE
T1 pnv withca,no.71/iron/fa
PRENAPLUS
T1 pnv withca,no.72/iron,carb/fa
PRENATAL PLUS
T1 pnv withca,no.72/iron/fa
PRENATAL PLUS
T1 pnv withca,no.74/iron/fa
PRENATAL LOWIRON
T1 pnv withca,no63/iron/fa/b6
TARON-BC
T1 pnv w-o ca no5/fefumarate/fa
PRENATAL-U
T1 pnv#16/iron fum &ps/fa/om-3
CONCEPT DHA
T1 pnv#20/iron/fa/ds/fish/dha/epa
TRICARE PRENATALDHA ONE
T1 pnv#26/ironpoly/fa/dha
VITAFOL-ONE
T1 pnv#64/iron/lmfolate/algal/soy
VINATE DHA RF
T3 pnv#67/iron ps/facmb#1/dha
VITAFOL ULTRA
T1 pnv,ca,no.35/iron/fa/ds/omeg-3
ULTIMATECARE ONENF
T1 pnv,ca42/iron/fa/lmefol ca/dha
PNV-DHA PLUS
T1 pnv/ferrousfumarate/doss/fa
MYNATE 90 PLUS
T1 pnv/ferrousfumarate/fa/se
VINATE-M
T1 pnv/iron,carbonyl/docusate/fa
MYNATAL
T1 pnv100/ironedta&ps/fa/omega3
BAL-CARE DHAESSENTIAL
T3 pnv103/fe/fa/dha/epa/other om3
TRICARE PRENATALCOMPLEAT
T1 pnv105/iron/fa/omega3/dha/epa
PRENAISSANCE DHAHARMONY
T3 pnv106/iron/fa/om3/dha/epa
DUET DHA
T3 pnv106/iron/fa/om3/dha/epa
DUET DHA 400
T3 pnv107/iron/fa/om3/dha/epa
DUET DHA EC
T3 pnv110/iron/fa/omega3/dha/epa
DUET DHABALANCED
T1 pnv115/ironfumarate/fa/dss
PRENATAL 19
T1 pnv119/ironfumarate/fa/dss
SE-NATAL 19
T1 pnv17/iron/fa/fishoil/dha/om
ELITE-OB 400
T1 pnv19/iron bghc&succ-p/fa/om3
PR NATAL 400 EC
T3 pnv2/iron b-g suc-p/fa/omega-3
COMPLETE NATALDHA
T3 pnv2/iron b-g suc-p/fa/omega-3
TRUST NATAL DHA
T3 pnv22/ironcbn&gluc/fa/dss/dha
CITRANATAL DHA
T1 pnv22/ironcbn&gluc/fa/dss/dha
PNV OB+DHA
T3 pnv29/ironcb&aspg/fa/dha/fish
OB COMPLETE 400
T1 pnv34/iron,carb&fum/fa/dss/dha
VP CH ULTRA
T1 pnv34/iron,carbonyl/fa/dss/dha
VP-CH-PNV
T1 pnv38/ironcbn&gluc/fa/dss/dha
NATALVIRT CA
T1 pnv39/ironfumarate/fa/dss/dha
TARON-PREXPRENATAL
T1 pnv48/iron naferedetat/fa/om3
CAVAN-EC SOD DHA
Commercial Formulary
L.A. Care Page 57 of 96
T1 pnv53/iron b-g hcl-p/fa/omega3
PR NATAL 400
T3 pnv53/ironfum/fa/docusate/dha
NEXA PLUS
T1 pnv54/iron b-g hcl-p/fa/omega3
PR NATAL 430
T1 pnv55/iron bghc&succ#2/fa/om3
SETONET-EC
T1 pnv55/iron bghc&succ-p/fa/om3
PR NATAL 430 EC
T3 pnv55/iron fum &bisgly/fa
NATACHEW
T3 pnv59/iron,carb&fum/fa/dss/dha
CITRANATALHARMONY
T1 pnv59/iron,carbonyl/fa/dss/dha
CITRANATALHARMONY
T1 pnv66/ironfumarate/fa/dss/dha
TRIVEEN-PRX RNF
T1 pnv69/iron,carbonyl/fa/dss/dha
PRENAISSANCEPLUS
T1 pnv7/fe aspgly/docusate/fa
VINATE PN CARE
T3 pnv72/iron,carb&glu/fa/dss/dha
CITRANATAL 90 DHA
T1 pnv77/sod iron edta&ps/fa/om3
VENATAL COMPLETEDHA
T1 pnv80/ironfumarate/fa/dss/dha
PRENAISSANCE
T1 pnv81/sod iron edta&ps/fa/om3
VENA-BAL DHA
T3 pnv82/feps/fa/om3/dha/epa/fish
PROTECT NATAL
T3 pnv83/iron,carb/ironasp gl/fa
OB COMPLETEPREMIER
T3 pnv84/iron,carbonyl/fa/dha
OB COMPLETE
T1 pnv94/sod iron edta&ps/fa/om3
PRENAISSANCEHARMONY DHA
T1 prenat vitcomb.10/iron/fa/dha
VITAFOL-OB+DHA
T3 prenatal #103/ironfumarate/fa
TRICARE
T1 prenatal#57/iron/fa/dss/dha
TL-SELECT DHA
T1 prenatal no.25/iron/fa#6/dha
VITAMEDMD ONE RX
T1 prenatal no.39/iron/fa#6/dha
VITAMEDMD PLUSRX
T1 prenatalno.52/iron/fa/dha
VP-PNV-DHA
T1 prenatal vit #60/ironfum/fa
PNV FOLIC ACID +IRON
T3 prenatal vit#68/iron/fa#6/dha
PRENATE ENHANCE
T3 prenatal vit#69/iron/fa#6/dha
PRENATE RESTORE
T1 prenatal vit#76/iron,carb/fa
VOL-TAB RX
T1 prenatal vit 15/ironcb/fa/dss
PRENATAL AD
T1 prenatal vit 16/ironcb/fa/dss
VINATE GT
T1 prenatal vit 18/ironcb/fa/dss
VINATE ULTRA
T3 prenatal vitcomb.10/iron/fa
VITAFOL-OB
T1 prenatal vitno.109/iron/fa
VINATE CARE
T3 prenatal vit no.112/folicacid
PRENATECHEWABLE
T3 prenatal vitno.114/fa/ginger
PRENATE AM
T3 prenatal vitno.44/iron/fa/dha
PRENATE MINI
T1 prenatal vitno.73/iron/fa
TRINATE
T1 prenatal vitno.78/iron/fa
PRENATABS FA
T3 prenatal vit#36/iron/facmb#6
PRENATE ELITE
T1 prenatal vit#4/ironfum &ps/fa
PUREFE OB PLUS
T1 prenatal vit#42/facmb#6
VITAMEDMDREDICHEW RX
T3 prenatal vit#65/ironfum&ps/fa
PROVIDA OB
T1 prenatal vit/fe carb-feso4/fa
PRENAFORT
T1 prenatal vit/ironbisglycin/fa
VINATE II
T3 prenatal vit/ironfumarate/fa
NATALVIT
T1 prenatal vit/ironfumarate/fa
O-CAL FA
T1 prenatalvit27&calcium/iron/fa
TRINATAL RX 1
T3 prenatal vit37/iron/folicacid
PRENATA
T1 prenatal vitamins#45/iron/fa
VIVA CT
T1 prenatal vitamins#21,iron, fa
HEMENATAL OB
T1 prenatal vits#33/iron/fa/dha
CHOICE-OB + DHA
T3 prenatal vits#33/iron/fa/dha
SELECT-OB + DHA
T1 prenatal vits w-ca,fe,fa(1mg)
PRENATAL Z
T1 prenatal vits#4/ironfum/fa
PUREFE PLUS
T1 pv w-o cal/fe pscmplx/fa
SELECT-OB
T3 pv w-ocal/fe,carbonyl/doss/fa
OBSTETRIX EC
T3 pv w-ocal/fe,carbonyl/doss/fa
OBTREX
T3 pv w-o cal/ferrousfumarate/fa
M-VIT
Prenatal Vitamins Without IronT1 pnv w-o
iron/fa/calcium/b6/b12
FOLBECAL
Commercial Formulary
L.A. Care Page 58 of 96
T1 pnv/fa/b6/calciumcarb/ginger
PRENAISSANCENEXT-B
T1 pnv/fa/b6/calciumphos/ginger
PRENAISSANCENEXT
Vitamin B PreparationsT1 b cmplx 4/vit
d3/c/fa/zinc oxVITAL-D RX
T1 b complex & cno.20/folic acid
VIRT-CAPS
T1 cyanocobalamin/fa/pyridoxine
FOLBEE
T3 cyanocobalamin/fa/pyridoxine
MYO VYT
T3 cyanocobalamin/fa/pyridoxine
VITA-RESPA
T1 fa/vitbcomp&c/se/minaa/zn
DIALYVITE 3000
T1 folic acid/b complex& c no.17
VIRT-VITE PLUS
T1 folic acid/vitbcomp&c/cu/znox
FOLBEE PLUS CZ
T1 folic acid/vitamin bcomp w-c
RENAL CAPS
T3 lysine hcl/vit bcomp/fa/zinc
SUPERVITE
T3 lysine/vitamin bcomplex/fa/zn
LYSIPLEX
T3 multivit,mincmb#11/folic acid
DIALYVITE 5000
T3 multivitamin, mincmb#25/fa/d3
DIALYVITE SUPREMED
T3 mv, mincmb#26/fa/ala/lutein
SYNAGEX
T1 potassiumaminobenzoate
AMINOBENZOATEPOTASSIUM
T3 potassiumaminobenzoate
POTABA
T1 vit b cmplx 3/fa/vitc/biotin
RENA-VITE RX
T1 vit b cmplxno3/fa/c/biot/zinc
NEPHPLEX RX
T3 vit b complex & cno.13/fa/d3
NEPHROCAPS QT
T1 vit b cplx#11/fa/c/biot/zn ox
DIALYVITE ZINC
T1 vitamin b complex B COMPLEX 100T1 vitamins
b1,b2,b3,b5,& b6B-COMPLEX
Vitamin B1 PreparationsT1 thiamine hcl THIAMINE HCL
Vitamin B12 PreparationsT1 cyanocobalamin VITMAIN B-12T1 cyanocobalamin
(vitamin b-12)CYANOCOBALAMININJECTION
T3 cyanocobalamin(vitamin b-12)
NASCOBAL
T1 cyanocobalamin/mecobalamin
NEURIN-SL
T3 cyanocobalamin/vitbcomp&c
VITAJECT
T1 hydroxocobalamin HYDROXOCOBALAMIN
Vitamin B6 PreparationsT1 pyridoxine hcl PYRIDOXINE HCL
Vitamin C PreparationsT1 ascorbic acid ASCORBIC ACIDT1 ascorbic acid VI-CERT C500
Vitamin D PreparationsT1 calcitriol ROCALTROLT5 cholecalciferol
(vitamin d3)VITAMIN D3(OTC) AGE
T2 dihydrotachysterol DHTT1 ergocalciferol
(vitamin d2)DRISDOL
Zinc ReplacementT1 zinc sulfate ZINC SULFATE
WEIGHT REDUCTIONAnorexic AgentsT1 benzphetamine hcl DIDREXT3 benzphetamine hcl REGIMEXT1 diethylpropion hcl DIETHYLPROPION
HCLT1 phendimetrazine
tartrateBONTRIL PDM
T1 phendimetrazinetartrate
PHENDIMETRAZINETARTRATE
T1 phentermine hcl ADIPEX-PT1 phentermine hcl PHENTERMINE HCLT3 phentermine hcl SUPRENZA ODT QL, STT3 phentermine resin IONAMINT3 phentermine/topiramat
eQSYMIA PA
Fat Absorption Decreasing AgentsT3 orlistat XENICAL
Serotonin 2c Receptor AgonistsT3 lorcaserin hcl BELVIQ PA
Commercial Formulary
L.A. Care Page 59 of 96
AGE RESTRICTIONS - FORMULARY • ASPIRIN EC(OTC) >= 45 years• ATRALIN <= 25 years• CARBINOXAMINE MALEATE >= 2 years• CELEBREX >= 60 years• DIFFERIN(CREAM) <= 25 years• DIFFERIN(GEL W/PUMP) <= 25 years• DIFFERIN(GEL) <= 25 years• DIFFERIN(LOTION) <= 25 years• DIFFERIN(MED SWAB) <= 25 years• ELIDEL >= 2 years• FABIOR >= 12 years• MINOCYCLINE HCL(TAB ER24H) >= 12 years• ORACEA >= 18 years• PALGIC >= 2 years• PLAN B ONE-STEP < 15 years• PROTOPIC >= 2 years• RETIN-A <= 25 years• RETIN-A MICRO <= 25 years• RETIN-A MICRO PUMP <= 25 years• SOLODYN >= 12 years• TRETIN-X <= 25 years• VITAMIN D3(OTC) >= 65 years
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 60 of 96
QUANTITY RESTRICTIONS - FORMULARY • ABILIFY DISCMELT(TAB RDPDIS)(10 MG) 3 units per 1 days• ABILIFY DISCMELT(TAB RDPDIS)(15 MG) 2 units per 1 days• ABILIFY(SOLUTION) 30 ml per 1 days• ABILIFY(TAB) 1 units per 1 days• ACIPHEX SPRINKLE 1 units per 1 days• ACTONEL(TAB)(150 MG) 1 units per 30 days• ACTONEL(TAB)(30 MG) 1 units per 1 days• ACTONEL(TAB)(35 MG) 1 units per 7 days• ACTONEL(TAB)(5 MG) 1 units per 1 days• ADDERALL 2 units per 1 days• ADOXA PAK 2 units per 1 days• ADVAIR DISKUS 2 units per 1 days;60
units per 30 days• ADVAIR HFA 12 gm per 30 days• ADVICOR(TBMP 24HR)(1000-20MG) 2 units per 1 days• ADVICOR(TBMP 24HR)(1000-40MG) 1 units per 1 days• ADVICOR(TBMP 24HR)(500MG-20MG) 1 units per 1 days• ADVICOR(TBMP 24HR)(750MG-20MG) 2 units per 1 days• AEROSPAN 17.8 gm per 30 days• AFINITOR(TAB)(10 MG) 1 units per 1 days• AFINITOR(TAB)(2.5 MG) 1 units per 1 days• AFINITOR(TAB)(5 MG) 1 units per 1 days• ALDARA 24 units per 30 days• ALENDRONATESODIUM(SOLUTION) 75 ml per 7 days• ALORA 2 units per 7 days• ALSUMA 1 ml per 14 days• ALTOPREV 1 units per 1 days• ALVESCO 12.2 gm per 25 days• AMBIEN 1 units per 1 days• AMERGE 3 units per 5 days• AMITIZA 2 units per 1 days• ANDROXY 120 units per 30 days• ANORO ELLIPTA 60 units per 30 days• ANZEMET(TAB)(100 MG) 4 units per fill• ANZEMET(TAB)(50 MG) 8 units per fill• APLENZIN 1 units per 1 days• APOKYN 2 ml per 1 days• ARCAPTA NEOHALER 1 units per 1 days• ARIXTRA(SYRINGE)(10MG/0.8ML) 8 ml per 30 days• ARIXTRA(SYRINGE)(2.5 MG/0.5)5 ml per 30 days• ARIXTRA(SYRINGE)(5MG/0.4ML) 4 ml per 30 days• ARIXTRA(SYRINGE)(7.5MG/0.6) 6 ml per 30 days• ASMANEX 1 units per 30 days• ASTELIN 60 ml per 30 days• ATELVIA 1 units per 7 days• ATRIPLA 30 units per 30 days• ATROVENT HFA 25.8 gm per 28 days• AXERT 2 units per 5 days• AZILECT 1 units per 1 days• BANZEL(ORAL SUSP) 80 ml per 1 days• BANZEL(TAB)(200 MG) 16 units per 1 days• BANZEL(TAB)(400 MG) 8 units per 1 days• BECONASE AQ 25 gm per 30 days
• BINOSTO 1 units per 7 days• BOSULIF(TAB)(100 MG) 4 units per 1 days• BOSULIF(TAB)(500 MG) 1 units per 1 days• BREO ELLIPTA 60 units per 30 days• BRILINTA 2 units per 1 days• BRINTELLIX 1 units per 1 days• BRISDELLE 1 units per 1 days• BROVANA 60 ml per 15 days• BUTRANS 1 units per 7 days• BYDUREON 1 units per 7 days• BYETTA(PENINJCTR)(10MCG/0.04) 2.4 ml per 30 days• BYETTA(PENINJCTR)(5MCG/0.02) 1.2 ml per 30 days• CADUET 1 units per 1 days• CAFERGOT 10 units per 7 days• CAMBIA 3 units per 10 days• CAMRESE 91 units per 84 days• CAPRELSA(TAB)(100 MG) 2 units per 1 days• CAPRELSA(TAB)(300 MG) 1 units per 1 days• CAVERJECT 1 ml per 5 days• CESAMET 6 units per 1 days• CHANTIX 2 units per 1 days• CIALIS(TAB)(10 MG) 1 units per 5 days• CIALIS(TAB)(2.5 MG) 1 units per 1 days• CIALIS(TAB)(20 MG) 1 units per 5 days• CIALIS(TAB)(5 MG) 1 units per 1 days• CLARINEX(SYRUP) 10 ml per 1 days• CLARINEX(TAB) 1 units per 1 days• CLARINEX-D 12 HOUR 2 units per 1 days• CLARINEX-D 24 HOUR 1 units per 1 days• CLIMARA 1 units per 7 days• CLIMARA PRO 1 units per 7 days• CLOZAPINE 3 units per 1 days• CLOZARIL 3 units per 1 days• COMBIPATCH 2 units per 7 days• COMBIVIR 60 units per 30 days• COMETRIQ 4 units per 1 days• CONCERTA(TAB ER 24H)(18 MG)1 units per 1 days• CONCERTA(TAB ER 24H)(27 MG)1 units per 1 days• CONCERTA(TAB ER 24H)(36 MG)2 units per 1 days• CONCERTA(TAB ER 24H)(54 MG)1 units per 1 days• CONZIP 1 units per 1 days• COSOPT PF 2 units per 1 days• CRESTOR(TAB)(10 MG) 1 units per 1 days• CRESTOR(TAB)(20 MG) 1 units per 1 days• CRESTOR(TAB)(40 MG) 1 units per 1 days• CRESTOR(TAB)(5 MG) 1 units per 1 days• D.H.E.45 15 ml per 14 days• DALIRESP 1 units per 1 days• DAYTRANA 1 units per 1 days;30
units per 30 days• DEPO-PROVERA 1 ml per 84 days• DEPO-SUBQ PROVERA 104 .65 ml per 84 days• DESLORATADINE 1 units per 1 days• DESOXYN 150 units per 30 days• DEXEDRINE(CAP ER)(10 MG) 60 units per 30 days• DEXEDRINE(CAP ER)(15 MG) 120 units per 30 days• DEXEDRINE(CAP ER)(5 MG) 60 units per 30 days• DEXILANT 1 units per 1 days• DEXTROAMPHETAMINESULFATE(TAB)(10 MG) 180 units per 30 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 61 of 96
• DEXTROAMPHETAMINESULFATE(TAB)(5 MG) 90 units per 30 days• DIASTAT 1 units per fill• DIASTAT ACUDIAL(KIT)(12.5-15-20) 1 units per fill• DIASTAT ACUDIAL(KIT)(5-7.5-10MG) 1 units per fill• DICLEGIS 4 units per 1 days• DICLOFENAC SODIUM 100 gm per fill• DIFICID 20 units per 30 days• DORYX(TAB DR)(200 MG) 1 units per 1 days• DUEXIS 3 units per 1 days• DULERA 13 gm per 30 days• DULOXETINE HCL 2 units per 1 days• DURAGESIC 1 units per 3 days• DYMISTA 23 gm per 30 days• EDEX 1 units per 5 days• EDLUAR 1 units per 1 days• EFFIENT 1 units per 1 days• ELIQUIS 2 units per 1 days• EMEND(CAP DS PK) 3 units per fill• EMEND(CAP)(125 MG) 1 units per fill• EMEND(CAP)(40 MG) 4 units per fill• EMEND(CAP)(80 MG) 2 units per fill• EMSAM 1 units per 1 days• EMTRIVA(CAP) 30 units per 30 days• EMTRIVA(SOLUTION) 720 ml per 30 days• EPANED 1200 ml per 30 days• EPIVIR(SOLUTION) 900 ml per 30 days• EPIVIR(TAB)(150 MG) 60 units per 30 days• EPIVIR(TAB)(300 MG) 30 units per 30 days• EPZICOM 30 units per 30 days• ERGOMAR 10 units per 7 days• ERIVEDGE 1 units per 1 days• ESOMEPRAZOLE STRONTIUM 4 units per 1 days• ESTRING 1 units per 90 days• EVISTA 1 units per 1 days• EXELON 30 units per 30 days• FANAPT(TAB DS PK) 2 units per 1 days;8 units
per 28 days• FANAPT(TAB) 2 units per 1 days• FARXIGA 1 units per 1 days• FAZACLO 3 units per 1 days• FELBATOL(ORAL SUSP) 30 ml per 1 days• FELBATOL(TAB)(400 MG) 9 units per 1 days• FELBATOL(TAB)(600 MG) 6 units per 1 days• FEMRING 1 units per 84 days• FETZIMA 1 units per 1 days• FIRMAGON(VIAL)(120 MG) 2 units per 365 days• FIRMAGON(VIAL)(80 MG) 1 units per 30 days• FLONASE 16 gm per 30 days• FLOVENT DISKUS(BLSTW/DEV)(100 MCG) 2 units per 1 days• FLOVENT DISKUS(BLSTW/DEV)(250 MCG) 4 units per 1 days• FLOVENT DISKUS(BLSTW/DEV)(50 MCG) 2 units per 1 days• FLOVENT HFA(AERW/ADAP)(110 MCG) 12 gm per 30 days• FLOVENT HFA(AERW/ADAP)(220 MCG) 24 gm per 30 days• FLOVENT HFA(AER W/ADAP)(44MCG) 21.2 gm per 30 days• FLUNISOLIDE 25 ml per 30 days• FOCALIN 2 units per 1 days
• FOCALIN XR 1 units per 1 days• FORADIL 60 units per 30 days• FORFIVO XL 1 units per 1 days• FORTEO 2.4 ml per 28 days• FRAGMIN(SYRINGE)(10000/ML) 10 ml per 30 days• FRAGMIN(SYRINGE)(12500/0.5) 5 ml per 30 days• FRAGMIN(SYRINGE)(15000/0.6) 6 ml per 30 days• FRAGMIN(SYRINGE)(18000/0.72)7.2 ml per 30 days• FRAGMIN(SYRINGE)(2500/0.2ML) 2 ml per 30 days• FRAGMIN(SYRINGE)(5000/0.2ML) 2 ml per 30 days• FRAGMIN(SYRINGE)(7500/0.3ML) 3 ml per 30 days• FRAGMIN(VIAL) 38 ml per 30 days• FROVA 3 units per 5 days• FULYZAQ 2 units per 1 days• FUZEON 60 units per 30 days• FYCOMPA(TAB)(10 MG) 30 units per 30 days• FYCOMPA(TAB)(12 MG) 30 units per 30 days• FYCOMPA(TAB)(2 MG) 120 units per 30 days• FYCOMPA(TAB)(4 MG) 60 units per 30 days• FYCOMPA(TAB)(6 MG) 60 units per 30 days• FYCOMPA(TAB)(8 MG) 30 units per 30 days• GABITRIL(TAB)(12 MG) 4 units per 1 days• GABITRIL(TAB)(16 MG) 3 units per 1 days• GABITRIL(TAB)(2 MG) 4 units per 1 days• GABITRIL(TAB)(4 MG) 4 units per 1 days• GEODON 2 units per 1 days• GLEEVEC 2 units per 1 days• GRALISE(TAB ER 24H)(300 MG) 3 units per 1 days• GRALISE(TAB ER 24H)(300-600MG) 39 units per 15 days• GRALISE(TAB ER 24H)(600 MG) 3 units per 1 days• GRANISETRON HCL 8 units per 30 days• HORIZANT(TAB ER)(300 MG) 30 units per 30 days• HORIZANT(TAB ER)(600 MG) 2 units per 1 days• HYCET 184 ml per 1 days• HYDROCODONE-ACETAMINOPHEN(SOLUTION) 120 ml per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10-660MG) 6 units per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-300MG) 13 units per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-325MG) 12 units per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-500MG) 8 units per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-300MG) 13 units per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-325MG) 12 units per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-300MG) 13 units per 1 days• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-325MG) 12 units per 1 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 62 of 96
• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-750MG) 5 units per 1 days• ICLUSIG(TAB)(15 MG) 2 units per 1 days• ICLUSIG(TAB)(45 MG) 1 units per 1 days• IMITREX 6 units per 15 days• IMITREX(CARTRIDGE) 1 ml per 14 days• IMITREX(PEN INJCTR) 1 ml per 14 days• IMITREX(TAB) 3 units per 5 days• IMITREX(VIAL) 1 ml per 14 days• INLYTA(TAB)(1 MG) 6 units per 1 days• INLYTA(TAB)(5 MG) 2 units per 1 days• INTERMEZZO 1 units per 1 days• INTUNIV 1 units per 1 days• INVEGA(TAB ER 24H)(1.5 MG) 1 units per 1 days• INVEGA(TAB ER 24H)(3 MG) 1 units per 1 days• INVEGA(TAB ER 24H)(6 MG) 1 units per 1 days;2 units
per 1 days• INVEGA(TAB ER 24H)(9 MG) 1 units per 1 days• INVIRASE(CAP) 300 units per 30 days• INVIRASE(TAB) 120 units per 30 days• INVOKANA 30 units per 30 days• IPRIVASK 6 units per 30 days• JAKAFI 2 units per 1 days• KALETRA(SOLUTION) 390 ml per 30 days• KALETRA(TAB)(100MG-25MG) 300 units per 30 days• KALETRA(TAB)(200MG-50MG) 120 units per 30 days• KAPVAY 120 units per 30 days• KHEDEZLA 1 units per 1 days• LAMICTAL ODT(TAB RDPDIS)(100 MG) 3 units per 1 days• LAMICTAL ODT(TAB RDPDIS)(200 MG) 2 units per 1 days• LAMICTAL ODT(TAB RDPDIS)(25 MG) 6 units per 1 days• LAMICTAL ODT(TAB RDPDIS)(50 MG) 6 units per 1 days• LATUDA(TAB)(120 MG) 30 units per 30 days• LATUDA(TAB)(20 MG) 30 units per 30 days• LATUDA(TAB)(40 MG) 30 units per 30 days• LATUDA(TAB)(60 MG) 30 units per 30 days• LATUDA(TAB)(80 MG) 60 units per 30 days• LESCOL 2 units per 1 days• LESCOL XL 1 units per 1 days• LEVITRA 1 units per 5 days• LINZESS 1 units per 1 days• LIPTRUZET(TAB)(10 MG-10MG) 30 units per 30 days• LIPTRUZET(TAB)(10 MG-20MG) 30 units per 30 days• LIPTRUZET(TAB)(10 MG-40MG) 30 units per 30 days• LIPTRUZET(TAB)(10 MG-80MG) 30 units per 30 days• LIVALO 1 units per 1 days• LORCET 10-650 6 units per 1 days• LORCET PLUS 6 units per 1 days• LORTAB 8 units per 1 days• LOVAZA 4 units per 1 days• LOVENOX(SYRINGE)(100MG/ML) 20 ml per 30 days• LOVENOX(SYRINGE)(120MG/.8ML) 16 ml per 30 days• LOVENOX(SYRINGE)(150MG/ML) 20 ml per 30 days• LOVENOX(SYRINGE)(30MG/0.3ML) 6 ml per 30 days
• LOVENOX(SYRINGE)(40MG/0.4ML) 8 ml per 30 days• LOVENOX(SYRINGE)(60MG/0.6ML) 12 ml per 30 days• LOVENOX(SYRINGE)(80MG/0.8ML) 16 ml per 30 days• LOVENOX(VIAL) 60 ml per 30 days• LUMIGAN 1 ml per 12 days• LUNESTA 1 units per 1 days• LUVOX CR 2 units per 1 days• MAGNACET 10 units per 1 days• MARINOL 2 units per 1 days• MAXALT 3 units per 5 days• MAXALT MLT 3 units per 5 days• MAXIDONE 5 units per 1 days• MENOSTAR 1 units per 7 days• METHYLIN 90 units per 30 days• METHYLPHENIDATE ER(CPBP50-50)(20 MG) 1 units per 1 days• METHYLPHENIDATE ER(CPBP50-50)(30 MG) 2 units per 1 days• METHYLPHENIDATE ER(TABER)(20 MG) 90 units per 30 days• MIGERGOT 5 units per 7 days• MIGRANAL 8 ml per 7 days• MINIVELLE 2 units per 7 days• MINOCYCLINE HCL(TAB ER24H) 1 units per 1 days• MIRAPEX ER 1 units per 1 days• MIRVASO 30 gm per 30 days• MUSE 1 units per 5 days• MYRBETRIQ 30 units per 30 days• NAMENDA XR(CAP 24 DSPK) 28 units per 28 days• NAMENDA XR(CAP SPR 24) 30 units per 30 days• NAMENDA(SOLUTION) 300 ml per 30 days• NAMENDA(TAB DS PK) 49 units per 28 days• NAMENDA(TAB) 60 units per 30 days• NASACORT AQ 11 gm per 20 days• NASONEX 17 gm per 30 days• NEUPRO 1 units per 1 days• NEXAVAR 4 units per 1 days• NEXIUM 1 units per 1 days• NICOTROL 2016 units per 365 days• NICOTROL NS 480 ml per 365 days• NILANDRON 150 units after 30 days• NORVIR 360 units per 30 days• NUCYNTA 6 units per 1 days• NUCYNTA ER 2 units per 1 days• NUVARING 1 units per 28 days• OLEPTRO ER 3 units per 2 days• OMNARIS 5 gm per 12 days• ONFI(ORAL SUSP) 480 ml per 30 days• ONFI(TAB) 2 units per 1 days• ORACEA 1 units per 1 days• OSPHENA 1 units per 1 days• OTREXUP 1.6 ml per 28 days• OXTELLAR XR(TAB ER 24H)(150MG) 1 units per 1 days• OXTELLAR XR(TAB ER 24H)(300MG) 1 units per 1 days• OXTELLAR XR(TAB ER 24H)(600MG) 4 units per 1 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 63 of 96
• OXYCODONE-ACETAMINOPHEN 8 units per 1 days• PATANASE 30.5 gm per 30 days• PERCOCET 12 units per 1 days• PERFOROMIST 120 ml per 30 days• PEXEVA 1 units per 1 days• PICATO(GEL)(0.015 %) 3 units per 28 days• PICATO(GEL)(0.05 %) 2 units per 28 days• POTIGA(TAB)(200 MG) 3 units per 1 days• POTIGA(TAB)(300 MG) 3 units per 1 days• POTIGA(TAB)(400 MG) 3 units per 1 days• POTIGA(TAB)(50 MG) 9 units per 1 days• PRADAXA 2 units per 1 days• PREVPAC 112 units per 10 days• PREZISTA(ORAL SUSP) 240 ml per 30 days• PREZISTA(TAB)(150 MG) 240 units per 30 days• PREZISTA(TAB)(400 MG) 60 units per 30 days• PREZISTA(TAB)(600 MG) 60 units per 30 days• PREZISTA(TAB)(75 MG) 480 units per 30 days• PREZISTA(TAB)(800 MG) 30 units per 30 days• PRIMLEV 13 units per 1 days• PRISTIQ ER 1 units per 1 days• PROCENTRA 1800 ml per 30 days• PULMICORT FLEXHALER 1 units per 30 days• PULMICORT(AMPUL-NEB)(0.25MG/2ML) 60 ml per 15 days• PULMICORT(AMPUL-NEB)(0.5MG/2ML) 60 ml per 15 days• PULMICORT(AMPUL-NEB)(1MG/2 ML) 60 ml per 15 days• QNASL 8.7 gm per 30 days• QUILLIVANT XR 2 ml per 1 days• QVAR 174 gm per 300 days• RABEPRAZOLE SODIUM 1 units per 1 days• RANEXA(TAB ER 12H)(1000 MG)60 units per 30 days• RANEXA(TAB ER 12H)(500 MG) 120 units per 30 days• RAZADYNE 60 units per 30 days• RAZADYNE ER 30 units per 30 days• RELENZA 40 units per 183 days• RELPAX 2 units per 5 days• REQUIP XL 1 units per 1 days• RESCULA 1 ml per 3 days• RESTASIS 64 units per 30 days• RETROVIR(CAP) 180 units per 30 days• RETROVIR(SYRUP) 1800 ml per 30 days• REVATIO 3 units per 1 days• REVLIMID 1 units per 1 days• RISPERDAL(SOLUTION) 2 ml per 1 days;8 ml per
1 days• RISPERDAL(TAB) 2 units per 1 days• RISPERIDONE 2 units per 1 days• RITALIN LA 1 units per 1 days• ROZEREM 1 units per 1 days• SABRIL 6 units per 1 days• SAMSCA(TAB)(15 MG) 30 units per 365 days• SAMSCA(TAB)(30 MG) 60 units per 365 days• SANCUSO 1 units per 7 days• SAPHRIS 2 units per 1 days• SEREVENT DISKUS 60 units per 30 days• SEROQUEL 3 units per 1 days• SEROQUEL XR 1 units per 1 days• SILENOR 1 units per 1 days• SIMCOR(TBMP 24HR)(1000-20MG) 2 units per 1 days
• SIMCOR(TBMP 24HR)(1000-40MG) 1 units per 1 days• SIMCOR(TBMP 24HR)(500MG-20MG) 1 units per 1 days• SIMCOR(TBMP 24HR)(500MG-40MG) 1 units per 1 days• SIMCOR(TBMP 24HR)(750MG-20MG) 2 units per 1 days• SOLODYN 1 units per 1 days• SONATA 1 units per 1 days• SPIRIVA 1 units per 1 days• SPRIX 1 units per 6 days• SPRYCEL(TAB)(100 MG) 1 units per 1 days• SPRYCEL(TAB)(140 MG) 1 units per 1 days• SPRYCEL(TAB)(20 MG) 2 units per 1 days• SPRYCEL(TAB)(50 MG) 1 units per 1 days• SPRYCEL(TAB)(70 MG) 1 units per 1 days• SPRYCEL(TAB)(80 MG) 1 units per 1 days• STAGESIC-10 16 units per 1 days• STAXYN 1 units per 5 days• STENDRA 1 units per 5 days• STIVARGA 3 units per 1 days• STRATTERA(CAP)(10 MG) 60 units per 30 days• STRATTERA(CAP)(100 MG) 30 units per 30 days• STRATTERA(CAP)(18 MG) 60 units per 30 days• STRATTERA(CAP)(25 MG) 60 units per 30 days• STRATTERA(CAP)(40 MG) 60 units per 30 days• STRATTERA(CAP)(60 MG) 30 units per 30 days• STRATTERA(CAP)(80 MG) 30 units per 30 days• STRIBILD 30 units per 30 days• SUMATRIPTAN SUCCINATE 1 ml per 14 days• SUMAVEL DOSEPRO 1 ml per 14 days• SUPRENZA ODT 1 units per 1 days• SUTENT 1 units per 1 days• SYLATRON 1 units per 28 days;1
units per 7 days• SYLATRON 4-PACK 1 units per 28 days• SYMBICORT 10.2 gm per 30 days• SYMBYAX 1 units per 1 days• TAMIFLU(CAP)(30 MG) 40 units per 183 days• TAMIFLU(CAP)(45 MG) 20 units per 183 days• TAMIFLU(CAP)(75 MG) 20 units per 183 days• TAMIFLU(SUSP RECON) 360 ml per 183 days• TARCEVA 1 units per 1 days• TASIGNA 4 units per 1 days• TASMAR 3 units per 1 days• THALOMID 2 units per 1 days• TIMOPTIC OCUDOSE 2 units per 1 days• TRAVATAN Z 1 ml per 12 days• TRAVOPROST 1 ml per 12 days• TREXIMET 1 units per 3 days• TROKENDI XR(CAP ER 24H)(100MG) 1 units per 1 days• TROKENDI XR(CAP ER 24H)(200MG) 2 units per 1 days• TROKENDI XR(CAP ER 24H)(25MG) 1 units per 1 days• TROKENDI XR(CAP ER 24H)(50MG) 1 units per 1 days• TRUVADA 30 units per 30 days• TUDORZA PRESSAIR 1 units per 30 days• ULORIC 30 units per 30 days• VANCOCIN HCL 40 units per 30 days• VASCEPA 4 units per 1 days• VERAMYST 10 gm per 30 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 64 of 96
• VERSACLOZ 18 ml per 1 days;3 ml per1 days
• VIAGRA 1 units per 5 days• VICTOZA 2-PAK 9 ml per 30 days• VICTOZA 3-PAK 9 ml per 30 days• VIDEX 1200 ml per 30 days• VIDEX EC(CAP DR)(125 MG) 60 units per 30 days• VIDEX EC(CAP DR)(200 MG) 60 units per 30 days• VIIBRYD(TAB) 1 units per 1 days• VIMPAT(TAB) 2 units per 1 days• VIRAMUNE(ORAL SUSP) 1200 ml per 30 days• VIRAMUNE(TAB) 60 units per 30 days• VIREAD(POWDER) 225 gm per 30 days• VIREAD(TAB) 30 units per 30 days• VIVELLE-DOT 2 units per 7 days• VOTRIENT 4 units per 1 days• VYTORIN(TAB)(10 MG-10MG) 1 units per 1 days• VYTORIN(TAB)(10 MG-20MG) 1 units per 1 days• VYTORIN(TAB)(10 MG-40MG) 1 units per 1 days• VYTORIN(TAB)(10 MG-80MG) 1 units per 1 days• VYVANSE 1 units per 1 days• XALKORI 2 units per 1 days• XARELTO(TAB)(10 MG) 1 units per 1 days• XARELTO(TAB)(15 MG) 15 units after 21 days;2
units per 1 days• XARELTO(TAB)(20 MG) 1 units per 1 days• XELODA(TAB)(150 MG) 28 units per 21 days• XELODA(TAB)(500 MG) 112 units per 21 days• XIFAXAN(TAB)(550 MG) 2 units per 1 days• XOLAIR 1 units per 5 days• XTANDI 4 units per 1 days• XYZAL(SOLUTION) 10 ml per 1 days• ZAMICET 184 ml per 1 days• ZEGERID(CAP) 1 units per 1 days• ZEGERID(PACKET) 1 units per 1 days• ZELAPAR 2 units per 1 days• ZELBORAF 8 units per 1 days• ZENZEDI 90 units per 30 days• ZERIT(CAP) 60 units per 30 days• ZERIT(SOLN RECON) 2400 ml per 30 days• ZETIA 1 units per 1 days• ZETONNA 6.1 gm per 30 days• ZIAGEN(SOLUTION) 900 ml per 30 days• ZIAGEN(TAB) 60 units per 30 days• ZIDOVUDINE 60 units per 30 days• ZIOPTAN 1 units per 1 days• ZOFRAN(SOLUTION) 50 ml per 15 days• ZOLPIDEM TARTRATE 1 units per 1 days• ZOLPIMIST 77 ml per 300 days• ZOMIG(SPRAY)(2.5 MG) 12 units per 30 days• ZOMIG(SPRAY)(5 MG) 6 units per 15 days• ZOMIG(TAB) 2 units per 5 days• ZORVOLEX 3 units per 1 days• ZUPLENZ(FILM)(4 MG) 2 units per 3 days• ZUPLENZ(FILM)(8 MG) 1 units per 3 days• ZYCLARA(CREAM PACK) 1 units per 1 days• ZYCLARA(CRM MD PMP)(2.5 %)7.5 gm per 1 days• ZYCLARA(CRM MD PMP)(3.75%) 7.5 gm per 28 days• ZYDONE 10 units per 1 days• ZYPREXA 1 units per 1 days• ZYTIGA 4 units per 1 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 65 of 96
STEP THERAPY EDITS - FORMULARY • ABILIFY DISCMELT(TAB RDP DIS)(10MG)
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ABILIFY DISCMELT(TAB RDP DIS)(15MG)
Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ABILIFY(SOLUTION) Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ABILIFY(TAB) Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• ACIPHEX SPRINKLE Atleast 2 of Prior prescription for Prevacid Iv in 365 days or Protonix Iv in 365 daysor Zantac-ppi in 365 days
• ACTONEL(TAB)(150 MG) Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in365 days
• ACTONEL(TAB)(30 MG) Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in365 days
• ACTONEL(TAB)(35 MG) Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in365 days
• ACTONEL(TAB)(5 MG) Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in365 days
• ACTOPLUS MET Prior prescription for Avandamet in 120 days or Avandaryl in 120 days or Avandia in120 days or Chlorpropamide in 120 days or Glimepiride in 120 days or Glucotrol Xlin 120 days or Glyburide-metformin Hcl in 120 days or Metaglip in 120 days orMicronase in 120 days or Riomet in 120 days or Tolazamide in 120 days orTolbutamide in 120 days
• ACTOPLUS MET XR Prior prescription for Avandamet in 120 days or Avandaryl in 120 days or Avandia in120 days or Chlorpropamide in 120 days or Glimepiride in 120 days or Glucotrol Xlin 120 days or Glyburide-metformin Hcl in 120 days or Metaglip in 120 days orMicronase in 120 days or Riomet in 120 days or Tolazamide in 120 days orTolbutamide in 120 days
• ADCIRCA Prior prescription for Revatio in 120 days or Sildenafil in 120 days• ADOXA PAK Prior prescription for Vibramycin in 120 days• ADVICOR(TBMP 24HR)(1000-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• ADVICOR(TBMP 24HR)(1000-40 MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• ADVICOR(TBMP 24HR)(500MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• ADVICOR(TBMP 24HR)(750MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• AEROSPAN Atleast 2 of Prior prescription for Fluticasone Propionate in 365 days or Qvar in 365
days• ALTOPREV Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• ALVESCO Atleast 2 of Prior prescription for Flovent Diskus in 365 days or Qvar in 365 days• AMETHYST Prior prescription for Norgestimate-ethinyl Estradiol in 120 days• ANTARA(CAP)(30 MG) Prior prescription for Fenofibrate in 120 days or Lofibra in 120 days or Lopid in 120
days or Tricor in 120 days or Triglide in 120 days• ANTARA(CAP)(90 MG) Prior prescription for Fenofibrate in 120 days or Lofibra in 120 days or Lopid in 120
days or Tricor in 120 days or Triglide in 120 days• ANZEMET(TAB)(100 MG) Prior prescription for Anzemet in 120 days or Ondansetron Hcl in 120 days or Zofran
Odt in 120 days or Zofran in 120 days• ANZEMET(TAB)(50 MG) Prior prescription for Anzemet in 120 days or Ondansetron Hcl in 120 days or Zofran
Odt in 120 days or Zofran in 120 days• APLENZIN Prior prescription for Zyban in 120 days• ARCAPTA NEOHALER Prior prescription for Serevent Diskus in 120 days• ASACOL HD Prior prescription for Apriso in 120 days or Colazal in 120 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 66 of 96
• ASMANEX Atleast 2 of Prior prescription for Flovent Diskus in 365 days or Qvar in 365 days• ATACAND Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• ATACAND HCT Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• ATELVIA Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in
365 days• AUVI-Q Prior prescription for Auvi-q in 120 days or Twinject in 120 days• AVODART Prior prescription for Doxazosin Mesylate in 120 days or Prazosin Hcl in 120 days or
Proscar in 120 days or Rapaflo in 120 days or Tamsulosin Hcl in 120 days orTerazosin Hcl in 120 days or Uroxatral in 120 days
• AXERT Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days• AZOR Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• BANZEL(ORAL SUSP) Prior prescription for Divalproex Sodium Er in 120 days or Lamotrigine Er in 120
days or Trokendi Xr in 120 days or Valproic Acid in 120 days• BANZEL(TAB)(200 MG) Prior prescription for Divalproex Sodium Er in 120 days or Lamotrigine Er in 120
days or Trokendi Xr in 120 days or Valproic Acid in 120 days• BANZEL(TAB)(400 MG) Prior prescription for Divalproex Sodium Er in 120 days or Lamotrigine Er in 120
days or Trokendi Xr in 120 days or Valproic Acid in 120 days• BECONASE AQ Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days• BENICAR Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• BENICAR HCT Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• BEYAZ Atleast 2 of Prior prescription for in 365 days or Generess Fe in 365 days or Lo
Loestrin Fe in 365 days or Lomedia 24 Fe in 365 days or Loseasonique in 365 daysor Microgestin Fe in 365 days or Microgestin in 365 days or Necon in 365 days orOrtho Micronor in 365 days or Ortho-novum in 365 days or Ovcon-50 in 365 days orOvral-28 in 365 days or Pirmella in 365 days or Portia in 365 days or Seasonale in365 days or Seasonique in 365 days or Sprintec in 365 days or Sronyx in 365 days orTri-legest Fe in 365 days or Tri-lo-sprintec in 365 days or Tri-norinyl in 365 days orTrinessa in 365 days or Trivora-28 in 365 days or Viorele in 365 days or Wera in 365days or Zenchent in 365 days or Zeosa in 365 days or Zovia 1-50e in 365 days
• BINOSTO Atleast 2 of Prior prescription for Fosamax in 365 days or Ibandronate Sodium in365 days
• BRINTELLIX Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365days or Paxil Cr in 365 days or Remeron in 365 days or Selfemra in 365 days orVenlafaxine Hcl Er in 365 days or Zoloft in 365 days or Zyban in 365 days
• BRISDELLE Prior prescription for Paxil Cr in 120 days or Paxil in 120 days or Venlafaxine Hcl Erin 120 days
• CALCIPOTRIENE Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• CELEBREX Atleast 2 of Prior prescription for in 120 days or Actron in 120 days or Diclofenac
Sodium in 120 days or Diclofenac Sodium-misoprostol in 120 days or Etodolac Er in120 days or Fenoprofen Calcium in 120 days or Flurbiprofen in 120 days orIbuprofen in 120 days or Ibuprohm in 120 days or Indocin in 120 days orIndomethacin in 120 days or Infants' Motrin in 120 days or Ketoprofen in 120 daysor Ketorolac Tromethamine in 120 days or Meclofenamate Sodium in 120 days orMobic in 120 days or Motrin in 120 days or Nalfon in 120 days or Naprelan in 120days or Naproxen Sodium in 120 days or Naproxen in 120 days or Oxaprozin in 120days or Phenylbutazone in 120 days or Piroxicam in 120 days or Ponstel in 120 daysor Relafen in 120 days or Sulindac in 120 days or Tolmetin Sodium in 120 days orToradol in 120 days or Voltaren in 120 days or Voltaren-xr in 120 days or Wal-profenin 120 days or Wal-proxen in 120 days or Zipsor in 120 days
• CESAMET Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days orZofran in 120 days
• CLARINEX(SYRUP) Prior prescription for Desloratadine in 120 days or Xyzal in 120 days• CLARINEX-D 12 HOUR Prior prescription for Wal-itin D 12 Hour in 180 days or Wal-vert in 180 days or
Xyzal in 180 days or Zyrtec in 180 days or Zyrtec-d in 180 days• CLARINEX-D 24 HOUR Prior prescription for Wal-itin D 12 Hour in 180 days or Wal-vert in 180 days or
Xyzal in 180 days or Zyrtec in 180 days or Zyrtec-d in 180 days• CONZIP Prior prescription for Conzip in 120 days or Tramadol Hcl Er in 120 days or Ultram
Er in 120 days• COSOPT PF Prior prescription for Dorzolamide-timolol in 120 days• CRESTOR(TAB)(10 MG) Prior prescription for Lipitor in 120 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 67 of 96
• CRESTOR(TAB)(20 MG) Prior prescription for Lipitor in 120 days• CRESTOR(TAB)(40 MG) Prior prescription for Lipitor in 120 days• CRESTOR(TAB)(5 MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• CYCLOSET Prior prescription for Glyburide-metformin Hcl in 180 days or Metaglip in 180 days
or Riomet in 180 days• DALIRESP Prior prescription for Arcapta Neohaler in 120 days or Atrovent Hfa in 120 days or
Combivent in 120 days or Foradil in 120 days or Serevent Diskus in 120 days orSpiriva in 120 days
• DAYTRANA Prior prescription for in 120 days or Methylphenidate Hcl Cd in 120 days orMethylphenidate Hcl in 120 days or Quillivant Xr in 120 days or Ritalin La in 120days or Ritalin-sr in 120 days
• DELZICOL Prior prescription for Apriso in 120 days or Colazal in 120 days• DESLORATADINE Prior prescription for Desloratadine in 120 days or Xyzal in 120 days• DETROL Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days• DEXILANT Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days or
Prevacid in 120 days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonixin 120 days or Zantac-ppi in 120 days
• DIFICID Prior prescription for Vancomycin Hcl in 120 days• DIOVAN Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• DIPENTUM Prior prescription for Apriso in 120 days or Colazal in 120 days• DORYX(TAB DR)(200 MG) Prior prescription for Vibramycin in 120 days• DOVONEX Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• DRITHOCREME HP Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• DUETACT Prior prescription for Avandamet in 120 days or Avandaryl in 120 days or Avandia in
120 days or Chlorpropamide in 120 days or Glimepiride in 120 days or Glucotrol Xlin 120 days or Glyburide-metformin Hcl in 120 days or Metaglip in 120 days orMicronase in 120 days or Riomet in 120 days or Tolazamide in 120 days orTolbutamide in 120 days
• DUEXIS Prior prescription for Etodolac Er in 120 days or Flurbiprofen in 120 days orIndomethacin in 120 days or Ketoprofen in 120 days or Meclofenamate Sodium in120 days or Mobic in 120 days or Nalfon in 120 days or Oxaprozin in 120 days orPiroxicam in 120 days or Relafen in 120 days or Sulindac in 120 days or TolmetinSodium in 120 days or Toradol in 120 days or Voltaren-xr in 120 days or Wal-profenin 120 days or Wal-proxen in 120 days
• DYMISTA Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days• EDARBI Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• EDARBYCLOR Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• EDLUAR Prior prescription for Edluar in 180 days or Zolpidem Tartrate Er in 180 days or
Zolpidem Tartrate in 180 days• ELIDEL Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• ENABLEX Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days• EPANED Prior prescription for Vasotec in 120 days• ESOMEPRAZOLE STRONTIUM Prior prescription for Prevacid Iv in 120 days or Protonix Iv in 120 days or Zantac-
ppi in 120 days• EXFORGE Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• EXFORGE HCT Prior prescription for Captopril-hydrochlorothiazide in 120 days or Exforge in 120
days or Losartan Potassium in 120 days• FANAPT(TAB DS PK) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• FANAPT(TAB) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• FARXIGA Prior prescription for Chlorpropamide in 120 days or Glimepiride in 120 days or
Glyburide-metformin Hcl in 120 days or Glynase in 120 days or Metaglip in 120days or Pioglitazone Hcl in 120 days or Pioglitazone-glimepiride in 120 days orPioglitazone-metformin in 120 days or Riomet in 120 days or Tolazamide in 120days or Tolbutamide in 120 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 68 of 96
• FAZACLO Atleast 2 of Prior prescription for Fazaclo in 365 days or Risperidone Odt in 365days or Seroquel Xr in 365 days or Ziprasidone Hcl in 365 days or Zyprexa Zydis in365 days
• FELBATOL(ORAL SUSP) Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days• FELBATOL(TAB)(400 MG) Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days• FELBATOL(TAB)(600 MG) Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days• FENOGLIDE Prior prescription for Lofibra in 120 days or Lopid in 120 days or Tricor in 120 days• FETZIMA Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365
days or Paxil Cr in 365 days or Remeron in 365 days or Selfemra in 365 days orVenlafaxine Hcl Er in 365 days or Zoloft in 365 days or Zyban in 365 days
• FORADIL Prior prescription for Serevent Diskus in 120 days• FORFIVO XL Prior prescription for Wellbutrin Sr in 120 days or Wellbutrin Xl in 120 days or
Wellbutrin in 120 days or Zyban in 120 days• FROVA Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days• FULYZAQ Prior prescription for Antiretrovirals in 120 days• FUZEON Prior prescription for Antiretrovirals in 120 days• FYCOMPA(TAB)(10 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in
365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days orNeurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days orTrokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
• FYCOMPA(TAB)(12 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days orNeurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days orTrokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
• FYCOMPA(TAB)(2 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days orNeurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days orTrokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
• FYCOMPA(TAB)(4 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days orNeurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days orTrokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
• FYCOMPA(TAB)(6 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days orNeurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days orTrokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
• FYCOMPA(TAB)(8 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or Fycompa in365 days or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days orNeurontin in 365 days or Tegretol Xr in 365 days or Trileptal in 365 days orTrokendi Xr in 365 days or Valproic Acid in 365 days or Zonisamide in 365 days
• GABITRIL(TAB)(12 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 daysor Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• GABITRIL(TAB)(16 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 daysor Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• GABITRIL(TAB)(2 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 daysor Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• GABITRIL(TAB)(4 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 daysor Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• GELNIQUE Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in120 days
• GIAZO Prior prescription for Apriso in 120 days or Colazal in 120 days• GLUMETZA Prior prescription for Metformin Hcl Er in 120 days• GRALISE(TAB ER 24H)(300 MG) Prior prescription for in 120 days or Gralise in 120 days or Neurontin in 120 days• GRALISE(TAB ER 24H)(300-600 MG) Prior prescription for in 120 days or Gralise in 120 days or Neurontin in 120 days• GRALISE(TAB ER 24H)(600 MG) Prior prescription for in 120 days or Gralise in 120 days or Neurontin in 120 days• GRANISETRON HCL Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 69 of 96
• HORIZANT(TAB ER)(300 MG) Prior prescription for Neurontin in 120 days or Pramipexole Dihydrochloride in 120days or Ropinirole Hcl in 120 days
• HORIZANT(TAB ER)(600 MG) Prior prescription for Neurontin in 120 days or Pramipexole Dihydrochloride in 120days or Ropinirole Hcl in 120 days
• INTERMEZZO Prior prescription for Intermezzo in 120 days or Zolpidem Tartrate in 120 days• INVEGA(TAB ER 24H)(1.5 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• INVEGA(TAB ER 24H)(3 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• INVEGA(TAB ER 24H)(6 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• INVEGA(TAB ER 24H)(9 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• INVIRASE(CAP) Prior prescription for Atripla in 120 days or Isentress in 120 days or Prezista in 120
days or Reyataz in 120 days or Sustiva in 120 days• INVIRASE(TAB) Prior prescription for Atripla in 120 days or Isentress in 120 days or Prezista in 120
days or Reyataz in 120 days or Sustiva in 120 days• INVOKANA Prior prescription for Chlorpropamide in 120 days or Glimepiride in 120 days or
Glucotrol Xl in 120 days or Glyburide-metformin Hcl in 120 days or Glynase in 120days or Metaglip in 120 days or Micronase in 120 days or Pioglitazone Hcl in 120days or Pioglitazone-glimepiride in 120 days or Pioglitazone-metformin in 120 daysor Riomet in 120 days or Tolazamide in 120 days or Tolbutamide in 120 days
• JALYN Prior prescription for in 120 days or Doxazosin Mesylate in 120 days or Prazosin Hclin 120 days or Proscar in 120 days or Rapaflo in 120 days or Tamsulosin Hcl in 120days or Terazosin Hcl in 120 days or Uroxatral in 120 days
• KAZANO Prior prescription for Janumet Xr in 120 days or Jentadueto in 120 days or Juvisyncin 120 days or Tradjenta in 120 days
• KHEDEZLA Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Desvenlafaxine Erin 365 days or Khedezla in 365 days or Lexapro in 365 days or Paxil Cr in 365 daysor Remeron in 365 days or Selfemra in 365 days or Venlafaxine Hcl Er in 365 daysor Zoloft in 365 days or Zyban in 365 days
• KOMBIGLYZE XR Prior prescription for Januvia in 120 days or Jentadueto in 120 days• LAMICTAL ODT (BLUE) Prior prescription for Lamotrigine in 120 days• LAMICTAL ODT (GREEN) Prior prescription for Lamotrigine in 120 days• LAMICTAL ODT (ORANGE) Prior prescription for Lamotrigine in 120 days• LAMICTAL ODT(TAB RDP DIS)(100MG) Prior prescription for Lamotrigine in 120 days• LAMICTAL ODT(TAB RDP DIS)(200MG) Prior prescription for Lamotrigine in 120 days• LAMICTAL ODT(TAB RDP DIS)(25 MG) Prior prescription for Lamotrigine in 120 days• LAMICTAL ODT(TAB RDP DIS)(50 MG) Prior prescription for Lamotrigine in 120 days• LAMICTAL XR (BLUE) Prior prescription for Lamotrigine in 120 days• LAMICTAL XR (GREEN) Prior prescription for Lamotrigine in 120 days• LAMICTAL XR (ORANGE) Prior prescription for Lamotrigine in 120 days• LATUDA(TAB)(120 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• LATUDA(TAB)(20 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• LATUDA(TAB)(40 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• LATUDA(TAB)(60 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• LATUDA(TAB)(80 MG) Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365
days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days• LESCOL Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• LESCOL XL Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• LEVEMIR Prior prescription for Lantus Solostar in 120 days• LEVEMIR FLEXPEN Prior prescription for Lantus Solostar in 120 days• LIALDA Prior prescription for Apriso in 120 days or Colazal in 120 days• LIPTRUZET(TAB)(10 MG-10MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• LIPTRUZET(TAB)(10 MG-20MG) Prior prescription for Lipitor in 365 days• LIPTRUZET(TAB)(10 MG-40MG) Prior prescription for Lipitor in 365 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 70 of 96
• LIPTRUZET(TAB)(10 MG-80MG) Prior prescription for Lipitor in 365 days• LIVALO Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days or
Pravastatin Sodium in 365 days or Zocor in 365 days• LO LOESTRIN FE Atleast 2 of Prior prescription for Desog-e.estradiol/e.estradiol in 365 days or
Desogestrel-ethinyl Estradiol in 365 days or Ethinyl Estradiol/drospirenone in 365days or Ethynodiol D-ethinyl Estradiol in 365 days or Etonogestrel/ethinyl Estradiolin 365 days or L-norgest-eth Estr/ethin Estra in 365 days or Levonorgestrel in 365days or Levonorgestrel-eth Estradiol in 365 days or Norelgestromin/ethin.estradiol in365 days or Noreth A-et Estra/fe Fumarate in 365 days or Noreth-ethinylEstradiol/iron in 365 days or Norethindrone A-e Estradiol in 365 days orNorethindrone in 365 days or Norethindrone-ethinyl Estrad in 365 days orNorethindrone-mestranol in 365 days or Norgestimate-ethinyl Estradiol in 365 daysor Norgestrel-ethinyl Estradiol in 365 days
• LUNESTA Prior prescription for Zolpidem Tartrate in 180 days• LUVOX CR Prior prescription for Citalopram Hbr in 120 days or Fluvoxamine Maleate in 120
days or Lexapro in 120 days or Paxil Cr in 120 days or Selfemra in 120 days orZoloft in 120 days
• MARINOL Atleast 3 of Prior prescription for Emend in 365 days or Methylprednisolone in 365days or Zofran in 365 days
• MIRAPEX ER Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in120 days
• MYRBETRIQ Atleast 2 of Prior prescription for Enablex in 365 days or Gelnique in 365 days orOxybutynin Chloride in 365 days or Oxytrol in 365 days or Tolterodine Tartrate Er in365 days or Toviaz in 365 days or Trospium Chloride Er in 365 days or Vesicare in365 days
• NATAZIA Atleast 2 of Prior prescription for in 120 days or Desog-e.estradiol/e.estradiol in 365days or Desogestrel-ethinyl Estradiol in 365 days or Ethinyl Estradiol/drospirenonein 365 days or Ethynodiol D-ethinyl Estradiol in 365 days or Etonogestrel/ethinylEstradiol in 365 days or L-norgest-eth Estr/ethin Estra in 365 days or Levonorgestrelin 365 days or Levonorgestrel-eth Estradiol in 365 days or Microgestin in 120 daysor Norelgestromin/ethin.estradiol in 365 days or Noreth A-et Estra/fe Fumarate in365 days or Noreth-ethinyl Estradiol/iron in 365 days or Norethindrone A-e Estradiolin 365 days or Norethindrone in 365 days or Norethindrone-ethinyl Estrad in 365days or Norethindrone-mestranol in 365 days or Norgestimate-ethinyl Estradiol in365 days or Norgestrel-ethinyl Estradiol in 365 days or Ortho Micronor in 120 daysor Ortho-novum in 120 days or Ovral-28 in 120 days or Seasonique in 120 days orSkyla in 120 days or Tri-legest Fe in 120 days or Trinessa in 120 days or Trivora-28in 120 days or Velivet in 120 days or Viorele in 120 days or Zarah in 120 days orZenchent in 120 days or Zeosa in 120 days or Zovia 1-50e in 120 days
• NESINA Prior prescription for Janumet Xr in 120 days or Jentadueto in 120 days or Juvisyncin 120 days or Tradjenta in 120 days
• NEUPRO Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in120 days
• NIASPAN Prior prescription for Lipitor in 365 days or Lofibra in 365 days or Lopid in 365 daysor Mevacor in 365 days or Pravastatin Sodium in 365 days or Tricor in 365 days orTriglide in 365 days or Zocor in 365 days
• NUVARING Prior prescription for Norgestimate-ethinyl Estradiol in 120 days• OCELLA Atleast 2 of Prior prescription for Generess Fe in 365 days or Lo Loestrin Fe in 365
days or Lomedia 24 Fe in 365 days or Loseasonique in 365 days or Lybrel in 365days or Microgestin Fe in 365 days or Microgestin in 365 days or Necon in 365 daysor Ortho Micronor in 365 days or Ortho-novum in 365 days or Ovcon-50 in 365 daysor Ovral-28 in 365 days or Pirmella in 365 days or Portia in 365 days or Seasonale in365 days or Seasonique in 365 days or Sprintec in 365 days or Sronyx in 365 days orTri-legest Fe in 365 days or Tri-lo-sprintec in 365 days or Tri-norinyl in 365 days orTrinessa in 365 days or Trivora-28 in 365 days or Velivet in 365 days or Viorele in365 days or Wera in 365 days or Zenchent in 365 days or Zeosa in 365 days or Zovia1-50e in 365 days
• OLEPTRO ER Prior prescription for Oleptro Er in 120 days or Trazodone Hcl in 120 days• OMNARIS Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days• ONFI(ORAL SUSP) Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days• ONFI(TAB) Prior prescription for Lamotrigine Er in 120 days or Trokendi Xr in 120 days• ONGLYZA Prior prescription for Januvia in 120 days or Jentadueto in 120 days• ORACEA Prior prescription for Vibramycin in 120 days• ORTHO TRI-CYCLEN LO Atleast 2 of Prior prescription for Desog-e.estradiol/e.estradiol in 365 days or
Desogestrel-ethinyl Estradiol in 365 days or Ethinyl Estradiol/drospirenone in 365
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 71 of 96
days or Ethynodiol D-ethinyl Estradiol in 365 days or Etonogestrel/ethinyl Estradiolin 365 days or L-norgest-eth Estr/ethin Estra in 365 days or Levonorgestrel in 365days or Levonorgestrel-eth Estradiol in 365 days or Norelgestromin/ethin.estradiol in365 days or Noreth A-et Estra/fe Fumarate in 365 days or Noreth-ethinylEstradiol/iron in 365 days or Norethindrone A-e Estradiol in 365 days orNorethindrone in 365 days or Norethindrone-ethinyl Estrad in 365 days orNorethindrone-mestranol in 365 days or Norgestimate-ethinyl Estradiol in 365 daysor Norgestrel-ethinyl Estradiol in 365 days
• OSENI Prior prescription for Janumet Xr in 120 days or Jentadueto in 120 days or Juvisyncin 120 days or Tradjenta in 120 days
• OTREXUP Prior prescription for Methotrexate Sodium in 120 days or Methotrexate in 120 daysor Rheumatrex in 120 days or Trexall in 120 days
• OXTELLAR XR(TAB ER 24H)(150 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or LamotrigineEr in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or TegretolXr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acidin 365 days or Zonisamide in 365 days
• OXTELLAR XR(TAB ER 24H)(300 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or LamotrigineEr in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or TegretolXr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acidin 365 days or Zonisamide in 365 days
• OXTELLAR XR(TAB ER 24H)(600 MG) Atleast 2 of Prior prescription for Divalproex Sodium Er in 365 days or LamotrigineEr in 365 days or Levetiracetam Er in 365 days or Neurontin in 365 days or TegretolXr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 days or Valproic Acidin 365 days or Zonisamide in 365 days
• OXYTROL Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in120 days
• PATANASE Prior prescription for Azelastine Hcl in 120 days• PENNSAID Prior prescription for Voltaren in 120 days• PENTASA Prior prescription for Apriso in 120 days or Colazal in 120 days or Pentasa in 120
days• PEXEVA Prior prescription for Paxil in 120 days• POTIGA(TAB)(200 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• POTIGA(TAB)(300 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 daysor Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• POTIGA(TAB)(400 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 daysor Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• POTIGA(TAB)(50 MG) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 daysor Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• PREVACID(TAB RAP DR) Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days orPrevacid in 120 days or Prilosec in 120 days or Protonix in 120 days or Zantac-ppi in120 days
• PRISTIQ ER Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365days or Paxil Cr in 365 days or Remeron in 365 days or Selfemra in 365 days orVenlafaxine Hcl Er in 365 days or Zoloft in 365 days or Zyban in 365 days
• PROTONIX(GRANPKT DR) Prior prescription for Omeprazole Magnesium in 120 days or Omeprazole in 120days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonix in 120 days orZantac-ppi in 120 days
• PROTOPIC Prior prescription for Protopic in 120 days or Topical Anti-inflammatory Steroidal in120 days
• PULMICORT FLEXHALER Atleast 2 of Prior prescription for Flovent Diskus in 365 days or Qvar in 365 days• QNASL Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days• QUILLIVANT XR Prior prescription for Methylphenidate Hcl Cd in 120 days or Ritalin La in 120 days• RAPAFLO Prior prescription for Doxazosin Mesylate in 120 days or Prazosin Hcl in 120 days or
Proscar in 120 days or Rapaflo in 120 days or Tamsulosin Hcl in 120 days orTerazosin Hcl in 120 days or Uroxatral in 120 days
• RAYOS Prior prescription for Prednisone in 120 days or Rayos in 120 days
Preferred Drug List Medication Prescribing Limitations
L.A. Care Page 72 of 96
• RELPAX Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days• REQUIP XL Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in
120 days• RESCULA Atleast 2 of Prior prescription for Travatan Z in 365 days or Xalatan in 365 days• ROZEREM Prior prescription for Zaleplon in 120 days or Zolpidem Tartrate in 120 days• SAFYRAL Atleast 2 of Prior prescription for in 365 days or Beyaz in 365 days or Generess Fe in
365 days or Lo Loestrin Fe in 365 days or Lomedia 24 Fe in 365 days orLoseasonique in 365 days or Microgestin Fe in 365 days or Microgestin in 365 daysor Necon in 365 days or Ortho Micronor in 365 days or Ortho-novum in 365 days orOvcon-50 in 365 days or Ovral-28 in 365 days or Pirmella in 365 days or Portia in365 days or Seasonale in 365 days or Seasonique in 365 days or Sprintec in 365 daysor Sronyx in 365 days or Tri-legest Fe in 365 days or Tri-lo-sprintec in 365 days orTri-norinyl in 365 days or Trinessa in 365 days or Trivora-28 in 365 days or Viorelein 365 days or Wera in 365 days or Zenchent in 365 days or Zeosa in 365 days orZovia 1-50e in 365 days
• SANCTURA Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in120 days
• SANCUSO Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days orZofran in 120 days
• SAPHRIS Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Risperidone in 365days or Seroquel in 365 days or Ziprasidone Hcl in 365 days or Zyprexa in 365 days
• SEROQUEL XR Atleast 2 of Prior prescription for Citalopram Hbr in 365 days or Lexapro in 365days or Paxil Cr in 365 days or Risperidone Odt in 365 days or Risperidone in 365days or Selfemra in 365 days or Seroquel in 365 days or Venlafaxine Hcl Er in 365days or Ziprasidone Hcl in 365 days or Zoloft in 365 days or Zyprexa in 365 days
• SILENOR Prior prescription for Silenor in 120 days or Zaleplon in 120 days or Zolpimist in 120days
• SIMCOR(TBMP 24HR)(1000-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days orPravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(1000-40 MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days orPravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(500MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days orPravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(500MG-40MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days orPravastatin Sodium in 365 days or Zocor in 365 days
• SIMCOR(TBMP 24HR)(750MG-20MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days orPravastatin Sodium in 365 days or Zocor in 365 days
• SOLODYN Prior prescription for Minocycline Hcl in 120 days• SORILUX Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• STAVZOR Prior prescription for in 120 days or Valproic Acid in 120 days• SUMAVEL DOSEPRO Prior prescription for Sumatriptan Succinate in 180 days or Sumatriptan in 180 days• SUPRENZA ODT Prior prescription for Phentermine Hcl in 120 days or Suprenza Odt in 120 days• SYMBICORT Prior prescription for Dulera in 120 days• TACLONEX(OINT) Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• TACLONEX(SUSPENSION) Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• TASMAR Prior prescription for Entacapone in 120 days• TELMISARTAN Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• TELMISARTAN-AMLODIPINE Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days• TELMISARTAN-HYDROCHLOROTHIAZID
Prior prescription for Captopril-hydrochlorothiazide in 120 days or LosartanPotassium in 120 days
• TEVETEN Prior prescription for Captopril-hydrochlorothiazide in 120 days or LosartanPotassium in 120 days
• TEVETEN HCT Prior prescription for Captopril-hydrochlorothiazide in 120 days or LosartanPotassium in 120 days
• TIMOPTIC OCUDOSE Prior prescription for Timoptic Ocudose in 120 days or Timoptic in 120 days• TOPICORT(SPRAY) Prior prescription for Diprosone in 120 days or Fluocinonide in 120 days or
Mometasone Furoate in 120 days or Topicort in 120 days• TOVIAZ Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days• TREXIMET Prior prescription for Sumatriptan in 180 days or Sumavel Dosepro in 180 days or
Zomig Zmt in 180 days• TRIBENZOR Prior prescription for Captopril-hydrochlorothiazide in 120 days or Losartan
Potassium in 120 days
Preferred Drug List Medication Prescribing Limitations
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• TROKENDI XR(CAP ER 24H)(100 MG) Prior prescription for Topiramate in 120 days• TROKENDI XR(CAP ER 24H)(200 MG) Prior prescription for Topiramate in 120 days• TROKENDI XR(CAP ER 24H)(25 MG) Prior prescription for Topiramate in 120 days• TROKENDI XR(CAP ER 24H)(50 MG) Prior prescription for Topiramate in 120 days• TUDORZA PRESSAIR Prior prescription for Spiriva in 120 days• UCERIS Prior prescription for Colazal in 120 days• ULORIC Prior prescription for Uloric in 120 days or Zyloprim in 120 days• VECTICAL Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• VERAMYST Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days• VERSACLOZ Atleast 2 of Prior prescription for Risperidone Odt in 365 days or Seroquel Xr in 365
days or Ziprasidone Hcl in 365 days or Zyprexa Zydis in 365 days• VESICARE Prior prescription for Oxybutynin Chloride Er in 120 days or Oxybutynin Chloride in
120 days• VICTOZA 2-PAK Prior prescription for Tolbutamide in 365 days• VICTOZA 3-PAK Prior prescription for Tolbutamide in 365 days• VIIBRYD(TAB DS PK) Atleast 2 of Prior prescription for Citalopram Hbr in 120 days or Lexapro in 120
days or Paxil Cr in 365 days or Remeron in 120 days or Selfemra in 120 days orVenlafaxine Hcl Er in 120 days or Zoloft in 120 days or Zyban in 120 days
• VIIBRYD(TAB) Atleast 2 of Prior prescription for Citalopram Hbr in 120 days or Lexapro in 120days or Paxil Cr in 365 days or Remeron in 120 days or Selfemra in 120 days orVenlafaxine Hcl Er in 120 days or Zoloft in 120 days or Zyban in 120 days
• VIMOVO Prior prescription for Naproxen in 120 days or Wal-proxen in 120 days• VIMPAT(TAB) Atleast 2 of Prior prescription for in 365 days or Divalproex Sodium Er in 365 days
or Lamotrigine Er in 365 days or Levetiracetam Er in 365 days or Neurontin in 365days or Tegretol Xr in 365 days or Trileptal in 365 days or Trokendi Xr in 365 daysor Valproic Acid in 365 days
• VYTORIN(TAB)(10 MG-10MG) Atleast 2 of Prior prescription for Lipitor in 365 days or Mevacor in 365 days orPravastatin Sodium in 365 days or Zocor in 365 days
• VYTORIN(TAB)(10 MG-20MG) Prior prescription for Lipitor in 120 days• VYTORIN(TAB)(10 MG-40MG) Prior prescription for Lipitor in 120 days• VYVANSE Prior prescription for Amphetamine Salt Combo in 120 days or Ritalin in 120 days• XIFAXAN(TAB)(550 MG) Prior prescription for Lactulose in 120 days• XYZAL(SOLUTION) Prior prescription for Desloratadine in 120 days or Xyzal in 120 days• ZEGERID(CAP) Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days or
Prevacid in 120 days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonixin 120 days or Zantac-ppi in 120 days
• ZEGERID(PACKET) Prior prescription for Omeprazole in 120 days or Prevacid 24hr in 120 days orPrevacid in 120 days or Prilosec Otc in 120 days or Prilosec in 120 days or Protonixin 120 days or Zantac-ppi in 120 days
• ZENZEDI Prior prescription for Procentra in 120 days or Zenzedi in 120 days• ZETONNA Prior prescription for Flunisolide in 365 days or Fluticasone Propionate in 365 days• ZIOPTAN Atleast 2 of Prior prescription for Travatan Z in 365 days or Xalatan in 365 days• ZITHRANOL Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• ZITHRANOL-RR Prior prescription for Topical Anti-inflammatory Steroidal in 120 days• ZOLPIMIST Prior prescription for Zolpidem Tartrate in 120 days• ZOMIG(SPRAY)(2.5 MG) Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days• ZOMIG(SPRAY)(5 MG) Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days• ZOMIG(TAB) Prior prescription for Rizatriptan in 180 days or Sumatriptan Succinate in 180 days• ZORVOLEX Prior prescription for Voltaren-xr in 120 days• ZUPLENZ(FILM)(4 MG) Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days or Zuplenz in 120 days• ZUPLENZ(FILM)(8 MG) Prior prescription for Ondansetron Hcl in 120 days or Zofran Odt in 120 days or
Zofran in 120 days or Zuplenz in 120 days
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PRIOR AUTHORIZATION RESRICTION - FORMULARY • ABRAXANE• ABSTRAL• ACTEMRA• ACTIQ• ADCETRIS• ADCIRCA• ADEMPAS• AFINITOR DISPERZ• AFINITOR(TAB)(10 MG)• AFINITOR(TAB)(2.5 MG)• AFINITOR(TAB)(5 MG)• AFINITOR(TAB)(7.5 MG)• ALDARA• ALIMTA• AMPYRA• AMTURNIDE• ANDROGEL• APOKYN• APTIVUS• ARANESP• AROMASIN• ARZERRA• AUBAGIO• AVASTIN• AVONEX• AVONEX ADMINISTRATION PACK• AVONEX PEN• AXIRON• BELVIQ• BERINERT• BETASERON• BETHKIS• BOSULIF(TAB)(100 MG)• BOSULIF(TAB)(500 MG)• BUPRENORPHINE-NALOXONE• CAPRELSA(TAB)(100 MG)• CAPRELSA(TAB)(300 MG)• CAYSTON• CIMZIA• CINRYZE• COMETRIQ• COMPLERA• COPAXONE• CYRAMZA• CYSTARAN• DELATESTRYL(SYRINGE)• DELATESTRYL(VIAL)• DEPO-TESTOSTERONE(VIAL)(100 MG/ML)• DEPO-TESTOSTERONE(VIAL)(200 MG/ML)• DICLOFENAC SODIUM• EDURANT• EGRIFTA• ELIGARD• ELSPAR• ENBREL• EPOGEN• ERBITUX• ERIVEDGE• ERWINAZE• EXTAVIA• FARESTON• FASLODEX• FENTORA
• FIRAZYR• FLOLAN• FORTESTA• GAMMAGARD LIQUID• GAMMAKED• GAMUNEX-C• GATTEX• GAZYVA• GENOTROPIN• GILENYA• GILOTRIF• GLEEVEC• GRANIX• GRASTEK• H.P. ACTHAR• HALAVEN• HERCEPTIN• HETLIOZ• HIZENTRA• HUMATROPE• HUMIRA• ICLUSIG(TAB)(15 MG)• ICLUSIG(TAB)(45 MG)• IMBRUVICA• INCIVEK• INCRELEX• INLYTA(TAB)(1 MG)• INLYTA(TAB)(5 MG)• INTELENCE• INTRON A• IPRIVASK• ISTODAX• IXEMPRA• JAKAFI• JUXTAPID• KADCYLA• KALBITOR• KALYDECO• KINERET• KORLYM• KYNAMRO• KYPROLIS• LAZANDA• LETAIRIS• LEUKINE• LEXIVA• MARQIBO• MEKINIST• MITOXANTRONE HCL• NEULASTA• NEUPOGEN• NEXAVAR• NORDITROPIN FLEXPRO• NORDITROPIN NORDIFLEX• NUEDEXTA• NUTROPIN• NUTROPIN AQ• NUTROPIN AQ NUSPIN• NUVIGIL• NYMALIZE• OLYSIO• OMNITROPE• ONCASPAR
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• ONSOLIS• OPSUMIT• ORALAIR• ORENCIA• ORENITRAM ER• OTEZLA• PEGASYS• PEGASYS PROCLICK• PEGINTRON• PEGINTRON REDIPEN• PERJETA• PHOTOFRIN• POMALYST• PRADAXA• PROCRIT• PROCYSBI• PROMACTA• PROVIGIL• PULMOZYME• QSYMIA• QUTENZA• RAGWITEK• RAVICTI• REBIF• REBIF REBIDOSE• RELISTOR• REMICADE• REMODULIN• REVLIMID• RITUXAN• SAIZEN• SELZENTRY• SEROSTIM• SIMPONI• SIMPONI ARIA• SIRTURO• SOLIRIS• SOVALDI• SPRYCEL(TAB)(100 MG)• SPRYCEL(TAB)(140 MG)• SPRYCEL(TAB)(20 MG)• SPRYCEL(TAB)(50 MG)• SPRYCEL(TAB)(70 MG)• SPRYCEL(TAB)(80 MG)• STELARA• STIVARGA• STRIANT• SUBOXONE• SUBSYS• SUCRAID• SUTENT• SYLATRON• SYLATRON 4-PACK• SYNAGIS• SYNRIBO• TAFINLAR• TARCEVA• TARGRETIN• TASIGNA• TECFIDERA• TEKAMLO• TEKTURNA• TEKTURNA HCT• TEMODAR• TESTIM
• TESTOSTERONE CYPIONATE• TEV-TROPIN• THALOMID• TIVICAY• TOBI• TOBI PODHALER• TORISEL• TRACLEER• TRIZIVIR• TYKERB• TYSABRI• TYVASO• VALCHLOR• VECAMYL• VECTIBIX• VELCADE• VELETRI• VENTAVIS• VICTRELIS• VOTRIENT• XALKORI• XELJANZ• XELODA(TAB)(150 MG)• XELODA(TAB)(500 MG)• XGEVA• XOLAIR• XTANDI• XYREM• YERVOY• ZALTRAP• ZELBORAF• ZOLADEX• ZORBTIVE• ZUBSOLV• ZYCLARA(CREAM PACK)• ZYCLARA(CRM MD PMP)(2.5 %)• ZYCLARA(CRM MD PMP)(3.75 %)• ZYKADIA• ZYTIGA• ZYVOX
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GENDER LIMITS - FORMULARY • APRI Female Only• AVODART Male Only• CAMRESE Female Only• CIALIS(TAB)(10 MG) Male Only• CIALIS(TAB)(2.5 MG) Male Only• CIALIS(TAB)(20 MG) Male Only• CIALIS(TAB)(5 MG) Male Only• CONCEPTROL(OTC) Female Only• CRYSELLE Female Only• FEMCAP Female Only• FEMCON FE Female Only• FOLIC ACID(OTC) Female Only• GYNOL II(OTC) Female Only• JALYN Male Only• LEVITRA Male Only• LEVORA-28 Female Only• MICROGESTIN Female Only• MICROGESTIN FE Female Only• NECON Female Only• NORINYL 1+50 Female Only• NOR-Q-D Female Only• OCELLA Female Only• ORTHO ALL-FLEX Female Only• ORTHO-NOVUM Female Only• PLAN B ONE-STEP Female Only• PROSCAR Male Only• RAPAFLO Male Only• SPRINTEC Female Only• STAXYN Male Only• STENDRA Male Only• TODAY CONTRACEPTIVESPONGE(OTC) Female Only• VCF(OTC) Female Only• VIAGRA Male Only• VIORELE Female Only• WIDE SEAL DIAPHRAGM Female Only• ZOVIA 1-35E Female Only
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- # -0.5 NORMAL SALINE.............................................. 290.9 % SODIUM CHLORIDE......................................291 + 1-F...................................................................... 162TEK(OTC)...............................................................258-MOP...................................................................... 21- A -AA/ANTIPYRN/BCAINE/POLICO#1/AL................... 28ABACAVIR SULFATE............................................... 41ABACAVIR SULFATE/LAMIVUDINE........................ 40ABACAVIR/LAMIVUDINE/ZIDOVUDINE..................41ABATACEPT.............................................................42ABATACEPT/MALTOSE........................................... 42ABCIXIMAB.............................................................. 35ABILIFY DISCMELT(TAB RDP DIS)(10 MG)......8, 61,6 6ABILIFY DISCMELT(TAB RDP DIS)(15 MG)......8, 61,6 6ABILIFY MAINTENA...................................................8ABILIFY(SOLUTION)..................................... 8, 61, 66ABILIFY(TAB)................................................. 8, 61, 66ABIRATERONE ACETATE....................................... 45ABRAXANE........................................................ 47, 75ABSORICA............................................................... 16ABSTRAL........................................................... 49, 75ACANYA................................................................... 16ACARBOSE..............................................................22ACCOLATE.................................................................5ACCU-CHEK ACTIVE(OTC).................................... 23ACCU-CHEK AVIVA PLUS(OTC).............................23ACCU-CHEK AVIVA(OTC)....................................... 23ACCU-CHEK COMFORT CURVE(OTC)..................23ACCU-CHEK COMPACT PLUS(OTC)..................... 25ACCU-CHEK COMPACT(OTC)................................25ACCU-CHEK FASTCLIX(OTC)................................ 27ACCU-CHEK SIMPLICITY(OTC)............................. 23ACCU-CHEK SMARTVIEW(OTC)............................23ACCU-CHEK SOFTCLIX(OTC)................................27ACCU-CHEK(OTC)............................................ 23, 27ACCUPRIL................................................................11ACCURETIC.............................................................10ACCUTREND GLUCOSE(OTC)...............................23ACD.......................................................................... 34ACE AEROSOL CLOUD ENHANCER....................... 5ACEBUTOLOL HCL..................................................11ACEON..................................................................... 11ACETAMINOPHEN W/CODEINE.............................50ACETAMINOPHEN WITH CODEINE....................... 50ACETAMINOPHEN/CAFFEINE/BUTALB................. 48ACETAMINOPHEN/PHENYLTOLX CIT................... 15ACETAMINOPHEN-BUTALBITAL............................ 48ACETAMINOPHEN-CODEINE................................. 50ACETAZOLAMIDE....................................................32ACETIC ACID.....................................................20, 28ACETIC ACID/ALUMINUM ACETATE......................28ACETIC ACID/HYDROCORTISONE........................28ACETOHYDROXAMIC ACID................................... 44ACETYLCYSTEINE..................................................48ACIPHEX SPRINKLE................................... 53, 61, 66ACITRETIN...............................................................21ACLARO...................................................................21ACLARO PD.............................................................21ACLIDINIUM BROMIDE............................................. 5ACLOVATE............................................................... 18ACTEMRA.......................................................... 42, 75ACTIGALL................................................................ 44ACTIMMUNE............................................................37ACTIQ.................................................................49, 75ACTIVE FE............................................................... 55ACTIVELLA.............................................................. 36ACTONEL(TAB)(150 MG)............................ 30, 61, 66ACTONEL(TAB)(30 MG).............................. 30, 61, 66ACTONEL(TAB)(35 MG).............................. 30, 61, 66ACTONEL(TAB)(5 MG)................................ 30, 61, 66ACTOPLUS MET................................................23, 66ACTOPLUS MET XR..........................................23, 66ACTOS..................................................................... 22ACULAR................................................................... 32ACULAR LS..............................................................32ACURA METER KIT(OTC).......................................25ACURA PLUS(OTC).................................................25ACURA STARTER KIT(OTC)................................... 25ACURA TEST STRIPS(OTC)...................................23ACUVAIL...................................................................32ACYCLOVIR.......................................................17, 40ACYCLOVIR/HYDROCORTISONE..........................17ACYCLOVIR/LIDOCAINE HCL................................ 17ACZONE...................................................................16ADALAT CC..............................................................12
ADALIMUMAB..........................................................42ADAPALENE............................................................ 16ADAPALENE/BENZOYL PEROXIDE....................... 16ADASUVE...................................................................8ADCETRIS......................................................... 46, 75ADCIRCA..................................................... 12, 66, 75ADDERALL...........................................................8, 61ADEFOVIR DIPIVOXIL.............................................41ADEMPAS.......................................................... 12, 75ADIPEX-P.................................................................59ADJUSTABLE LANCING DEVICE(OTC)................. 27ADO-TRASTUZUMAB EMTANSINE........................ 46ADOXA..................................................................... 39ADOXA CK............................................................... 39ADOXA PAK................................................. 39, 61, 66ADOXA TT................................................................39ADRENACLICK........................................................ 44ADRENALIN CHLORIDE..........................................15ADVAIR DISKUS.................................................. 5, 61ADVAIR HFA.........................................................5, 61ADVANCE TEST STRIPS(OTC).............................. 23ADVANCED AM/PM................................................. 56ADVANCED LANCING DEVICE(OTC).....................27ADVATE....................................................................34ADVATE H................................................................ 34ADVATE L.................................................................34ADVATE M................................................................34ADVATE SH..............................................................34ADVATE UH..............................................................34ADVICOR(TBMP 24HR)(1000-20MG)......... 13, 61, 66ADVICOR(TBMP 24HR)(1000-40 MG)........ 13, 61, 66ADVICOR(TBMP 24HR)(500MG-20MG)......13, 61,6 6ADVICOR(TBMP 24HR)(750MG-20MG)......13, 61,6 6ADVOCATE BLOOD GLUCOSE MONITOR(OTC)......2 5ADVOCATE DUO(OTC)........................................... 25ADVOCATE LANCING DEVICE(OTC).....................27ADVOCATE RAPID-SAFE(OTC)..............................27ADVOCATE REDI-CODE(OTC)......................... 23, 25ADVOCATE REDI-CODE+(OTC).......................23, 25ADVOCATE TEST STRIP(OTC).............................. 23AEROCHAMBER MINI...............................................5AEROCHAMBER MV................................................. 5AEROCHAMBER PLUS............................................. 5AEROCHAMBER PLUS FLOW-VU............................6AEROCHAMBER PLUS Z STAT................................ 6AEROCHAMBER WITH FLOWSIGNAL.....................6AEROCHAMBER Z-STAT PLUS................................ 6AEROECLIPSE.......................................................... 6AEROECLIPSE II....................................................... 6AEROGEAR ASTHMA ACTION KIT.......................... 6AEROSPAN.................................................... 5, 61, 66AEROTRACH PLUS...................................................6AEROVENT II.............................................................6AFATINIB DIMALEATE.............................................46AFINITOR DISPERZ.......................................... 46, 75AFINITOR(TAB)(10 MG)...............................46, 61, 75AFINITOR(TAB)(2.5 MG)..............................46, 61, 75AFINITOR(TAB)(5 MG).................................46, 61, 75AFINITOR(TAB)(7.5 MG)....................................46, 75AFLIBERCEPT......................................................... 33AGAMATRIX AMP(OTC).................................... 23, 25AGGRASTAT............................................................ 35AGGRENOX.............................................................35AGRYLIN.................................................................. 35AKNE-MYCIN........................................................... 16AKTEN......................................................................32ALA-QUIN.................................................................16ALA-TET...................................................................39ALBENDAZOLE....................................................... 40ALBENZA................................................................. 40ALBUTEROL SULFATE..............................................5ALC/ISOPROPANOL/PROP GLY/WATER............... 19ALCAFTADINE......................................................... 31ALCLOMETASONE DIPROPIONATE...................... 18ALCORTIN A............................................................ 16ALDACTAZIDE(TAB)(25 MG-25MG)........................12ALDACTAZIDE(TAB)(50 MG-50MG)........................12ALDACTONE............................................................12ALDARA....................................................... 37, 61, 75ALDESLEUKIN.........................................................37ALDOMET.................................................................11ALDORIL-D50...........................................................11ALENDRONATE SODIUM........................................30ALENDRONATE SODIUM(SOLUTION).............30, 61ALENDRONATE SODIUM(TAB).............................. 30ALENDRONATE SODIUM/VITAMIN D3...................30
ALFERON N............................................................. 37ALFUZOSIN HCL..................................................... 53ALIMTA............................................................... 45, 75ALINIA...................................................................... 16ALISKIREN HEMIFUMARATE................................. 12ALISKIREN/AMLODIPIN/HCTHIAZIDE....................12ALISKIREN/AMLODIPINE BESYLATE.................... 12ALISKIREN/HYDROCHLOROTHIAZIDE................. 12ALITRETINOIN.........................................................21ALKERAN.................................................................45ALLFEN CDX........................................................... 15ALLOPURINOL........................................................ 33ALMOTRIPTAN MALATE......................................... 50ALOCRIL.................................................................. 32ALODOX...................................................................32ALOGLIPTIN BENZ/METFORMIN HCL...................22ALOGLIPTIN BENZ/PIOGLITZONE.........................22ALOGLIPTIN BENZOATE........................................ 22ALOMIDE..................................................................32ALOQUIN..................................................................16ALORA............................................................... 36, 61ALOSETRON HCL................................................... 44ALPHA-1-PROTEINASE INHIBITOR....................... 45ALPHAGAN P(DROPS)(0.1 %)................................33ALPHAGAN P(DROPS)(0.15 %)..............................33ALPHANATE.............................................................34ALPHANINE SD....................................................... 34ALPHAQUIN HP.......................................................21ALPRAZOLAM............................................................8ALPRAZOLAM INTENSOL.........................................8ALPROLIX................................................................ 34ALPROSTADIL......................................................... 29ALREX......................................................................32ALSUMA.............................................................50, 61ALTABAX.................................................................. 17ALTACE.....................................................................11ALTERA NEBULIZER.................................................6ALTERNATE SITE LANCING DEVICE(OTC)...........27ALTOPREV...................................................13, 61, 66ALTRETAMINE......................................................... 45ALUMINUM CHLORIDE...........................................19ALUVEA................................................................... 20ALVESCO....................................................... 5, 61, 66ALVIMOPAN............................................................. 44AMANTADINE.......................................................... 50AMANTADINE HCL.................................................. 50AMARYL................................................................... 22AMBIEN................................................................9, 61AMBRISENTAN........................................................ 12AMCINONIDE...........................................................18AMERGE............................................................ 50, 61AMERICET............................................................... 48AMETHYST........................................................ 14, 66AMILORIDE HCL......................................................12AMILORIDE/HYDROCHLOROTHIAZIDE................ 12AMILORIDE-HYDROCHLOROTHIAZIDE................12AMINO ACID CERVICAL......................................... 54AMINOBENZOATE POTASSIUM.............................59AMINOCAPROIC ACID............................................34AMINOLEVULINIC ACID HCL..................................47AMINOPHYLLINE.......................................................6AMINOSALICYLIC ACID..........................................39AMIODARONE HCL.................................................10AMITIZA..............................................................44, 61AMITRIP HCL/CHLORDIAZEPOXIDE....................... 7AMITRIPTYLINE HCL................................................ 7AMLODIPINE BES/OLMESARTAN MED................. 11AMLODIPINE BESYLATE........................................ 12AMLODIPINE BESYLATE/BENAZEPRIL.................10AMLODIPINE/ATORVASTATIN................................ 14AMLODIPINE/VALSARTAN...................................... 11AMLODIPINE/VALSARTAN/HCTHIAZID..................10AMMONIUM LACTATE.............................................19AMOX TR-POTASSIUM CLAVULANATE.................38AMOXAPINE.............................................................. 7AMOXICILLIN...........................................................38AMOXICILLIN TRIHYDRATE................................... 38AMOXICILLIN/POTASSIUM CLAV...........................38AMOXIL.................................................................... 38AMPICILLIN TRIHYDRATE...................................... 38AMPYRA............................................................ 47, 75AMRIX...................................................................... 52AMTURNIDE...................................................... 12, 75ANACAINE............................................................... 21ANADROL-50........................................................... 36ANAFRANIL................................................................7ANAGRELIDE HCL.................................................. 35ANAKINRA............................................................... 42ANALPRAM E.......................................................... 43
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Index
ANALPRAM HC........................................................44ANAPROX................................................................ 43ANAPROX DS.......................................................... 43ANASTROZOLE.......................................................45ANCOBON................................................................39ANDRODERM.......................................................... 36ANDROGEL....................................................... 36, 75ANDROID................................................................. 36ANDROXY..........................................................36, 61ANGELIQ..................................................................36ANGIOMAX.............................................................. 35ANIMI-3.....................................................................56ANIMI-3 WITH VITAMIN D....................................... 56ANORO ELLIPTA................................................. 5, 61ANSAID.................................................................... 43ANTABUSE.................................................................8ANTARA(CAP)(130 MG).......................................... 13ANTARA(CAP)(30 MG)...................................... 13, 66ANTARA(CAP)(43 MG)............................................ 13ANTARA(CAP)(90 MG)...................................... 13, 66ANTHRALIN............................................................. 21ANTHRALIN MICRONIZED......................................21ANTIHEMOPH.FVIII PLAS/ALB FREE.................... 34ANTIHEMOPHILIC FACTOR, HUM REC.................34ANTIHEMOPHILIC FACTOR, HUMAN.................... 34ANTIHEMOPHILIC FACTOR/VWF...........................34ANTI-INHIBITOR COAGULANT COMP................... 34ANTIPYRINE/BENZOCAIN/GLY/ZINC.....................28ANTIPYRINE/BENZOCAINE....................................28ANTIPYRINE/BENZOCAINE/GLYCERIN.................29ANTIPYRINE-BENZOCAINE..............................28, 29ANTISPASMODIC.................................................... 53ANTIVERT.................................................................. 4ANZEMET(TAB)(100 MG).............................. 4, 61, 66ANZEMET(TAB)(50 MG)................................ 4, 61, 66APEXICON E............................................................18APIDRA.................................................................... 28APIDRA SOLOSTAR................................................ 28APIXABAN................................................................34APLENZIN...................................................... 7, 61, 66APOKYN.......................................................50, 61, 75APOMORPHINE HCL...............................................50APRACLONIDINE HCL............................................ 32APREMILAST...........................................................42APREPITANT............................................................. 4APRI................................................................... 14, 77APRISO.................................................................... 43APTIOM....................................................................51APTIVUS............................................................ 40, 75AQUA GLYCOLIC HC.............................................. 19AQUA LANCE LANCING DEVICE(OTC)................. 27AQUA-MEPHYTON.................................................. 36AQUAPHILIC W/TAC + CARBAMIDE...................... 19AQUAPHILIC W/TRIAMCINOLONE.........................19ARALAST NP........................................................... 45ARALEN PHOSPHATE............................................ 40ARANESP.......................................................... 34, 75ARAVA...................................................................... 42ARCALYST............................................................... 42ARCAPTA NEOHALER.................................. 5, 61, 66ARESTIN.................................................................. 48ARFORMOTEROL TARTRATE..................................5ARGATROBAN.........................................................35ARGATROBAN IN 0.9 % SOD CHLOR....................35ARGATROBAN IN NACL,ISO-OSMOTIC................ 35ARGATROBAN-SODIUM CHLORIDE......................35ARICEPT.................................................................... 7ARIMIDEX................................................................ 45ARIPIPRAZOLE..........................................................8ARISTOCORT.......................................................... 42ARIXTRA(SYRINGE)(10MG/0.8ML).................. 35, 61ARIXTRA(SYRINGE)(2.5 MG/0.5)..................... 35, 61ARIXTRA(SYRINGE)(5MG/0.4ML).................... 35, 61ARIXTRA(SYRINGE)(7.5MG/0.6)...................... 35, 61ARMODAFINIL........................................................... 9ARMOUR THYROID.................................................31AROMASIN........................................................ 45, 75ARRANON................................................................45ARSENIC TRIOXIDE................................................46ARTEMETHER/LUMEFANTRINE............................ 40ARTHROTEC 50...................................................... 43ARTHROTEC 75...................................................... 43ARZERRA.......................................................... 45, 75ASA/SALICYLAM/ACETAMINOPH/CAFF................48ASACOL HD.......................................................43, 66ASCORBIC ACID..................................................... 59ASENAPINE MALEATE..............................................8ASMANEX...................................................... 5, 61, 67ASP.......................................................................... 48
ASPARAGINASE......................................................46ASPARAGINASE (ERWINIA CHRYSAN).................47ASPIRIN................................................................... 48ASPIRIN EC............................................................. 48ASPIRIN EC(OTC)............................................. 48, 60ASPIRIN/DIPYRIDAMOLE....................................... 35ASSURE 4(OTC)................................................23, 25ASSURE PLATINUM(OTC)................................ 23, 25ASSURE PRO(OTC).......................................... 23, 25ASTAGRAF XL......................................................... 37ASTELIN...............................................................4, 61ASTHMAPACK CHILDREN'S.....................................6ASTRINGYN.............................................................35ATABEX EC.............................................................. 57ATACAND........................................................... 11, 67ATACAND HCT...................................................11, 67ATAZANAVIR SULFATE........................................... 41ATELVIA....................................................... 30, 61, 67ATENOLOL............................................................... 11ATENOLOL/CHLORTHALIDONE.............................11ATGAM..................................................................... 37ATIVAN....................................................................... 8AT-LAST TEST STRIPS(OTC)................................. 23AT-LAST(OTC)......................................................... 25ATOMOXETINE HCL................................................10ATORVASTATIN CALCIUM...................................... 13ATOVAQUONE.........................................................40ATOVAQUONE/PROGUANIL HCL...........................40ATRALIN.............................................................16, 60ATRAPRO CP...........................................................19ATRAPRO DERMAL SPRAY....................................20ATRAPRO HYDROGEL........................................... 19ATRIPLA............................................................. 41, 61ATROPINE SULFATE...............................................33ATROVENT.............................................................. 48ATROVENT HFA.................................................. 5, 61AUBAGIO........................................................... 47, 75AUGMENTIN ES-600............................................... 38AUGMENTIN(SUSP RECON)(125-31.25/).............. 38AUGMENTIN(SUSP RECON)(250-62.5/5).............. 38AUGMENTIN(TAB)................................................... 38AURANOFIN.............................................................42AURSTAT................................................................. 19AUTO-LANCET MINI(OTC)......................................27AUTOLET IMPRESSION(OTC)................................27AUTOLET LANCING DEVICE(OTC)........................27AUVI-Q............................................................... 44, 67AVAGE......................................................................16AVALIDE................................................................... 11AVANAFIL.................................................................29AVANDAMET............................................................23AVANDARYL............................................................ 22AVANDIA.................................................................. 22AVAPRO....................................................................11AVAR LS................................................................... 17AVAR(CLEANSER)...................................................17AVAR(MED PAD)......................................................17AVASTIN.............................................................45, 75AVC...........................................................................54AVELOX....................................................................38AVIDOXY.................................................................. 39AVIDOXY DK............................................................ 39AVINZA..................................................................... 49AVITENE...................................................................35AVODART.....................................................53, 67, 77AVONEX............................................................. 47, 75AVONEX ADMINISTRATION PACK...................47, 75AVONEX PEN.....................................................47, 75AXERT..........................................................50, 61, 67AXID......................................................................... 53AXIRON..............................................................36, 75AXITINIB...................................................................46AYGESTIN................................................................36AZACITIDINE........................................................... 45AZASAN................................................................... 37AZASITE...................................................................32AZATHIOPRINE....................................................... 37AZELAIC ACID......................................................... 16AZELASTINE HCL............................................... 4, 31AZELASTINE/FLUTICASONE....................................4AZELEX....................................................................16AZILECT.............................................................51, 61AZILSARTAN MED/CHLORTHALIDONE................. 11AZILSARTAN MEDOXOMIL..................................... 11AZITHROMYCIN................................................ 32, 38AZOPT......................................................................33AZOR.................................................................. 11, 67AZTREONAM LYSINE..............................................37- B -
B CMPLX 4/VIT D3/C/FA/ZINC OX.......................... 59B COMPLEX & C NO.20/FOLIC ACID..................... 59B COMPLEX 100......................................................59B COMPLEX WITH VITAMIN C................................55BABY NEBULIZER.....................................................6BACITRACIN............................................................32BACITRACIN/POLYMYXIN B SULFATE.................. 32BACITRACIN-POLYMYXIN...................................... 32BACLOFEN.............................................................. 52BACMIN....................................................................56BACTOCILL..............................................................38BACTRIM..................................................................37BACTROBAN........................................................... 17BACTROBAN NASAL.............................................. 48BAL-CARE DHA ESSENTIAL.................................. 57BALSALAZIDE DISODIUM...................................... 43BANZEL(ORAL SUSP).................................52, 61, 67BANZEL(TAB)(200 MG)............................... 52, 61, 67BANZEL(TAB)(400 MG)............................... 52, 61, 67BARACLUDE............................................................41BARBIDONNA..........................................................53BASILIXIMAB........................................................... 37B-CAINE/ZINC CL/PINE/CPYRD............................. 43B-COMPLEX.............................................................59BEBULIN.................................................................. 34BECAPLERMIN........................................................28BECLOMETHASONE DIPROPIONATE.................4, 5BECONASE AQ............................................. 4, 61, 67BEDAQUILINE FUMARATE..................................... 40BELATACEPT...........................................................37BELLADONNA ALKALOIDS/PHENOBARB.............53BELLADONNA-OPIUM.............................................49BELVIQ............................................................... 59, 75BENAZEPRIL HCL................................................... 11BENAZEPRIL/HYDROCHLOROTHIAZIDE..............10BENAZEPRIL-HYDROCHLOROTHIAZIDE............. 10BENDAMUSTINE HCL.............................................45BENDROFLUMETHIAZIDE......................................12BENEFIX.................................................................. 34BENICAR............................................................ 11, 67BENICAR HCT....................................................11, 67BENOXINATE HCL/FLUORESCEIN NA.................. 32BENSAL HP....................................................... 17, 20BENTYL....................................................................52BENZACLIN(GEL W/PUMP).................................... 16BENZACLIN(GEL)....................................................16BENZAMYCIN.......................................................... 16BENZAMYCINPAK................................................... 16BENZOCAINE.................................................... 21, 29BENZOIC ACID/SALICYLIC ACID........................... 17BENZONATATE........................................................15BENZOYL PEROXIDE............................................. 20BENZOYL PEROXIDE MICROSPHERES............... 20BENZOYL PEROXIDE/HYDROCORTISON............ 16BENZOYL PEROXIDE/SULFUR..............................20BENZOYL PEROXIDE/VIT E MIX............................20BENZPHETAMINE HCL........................................... 59BENZTROPINE MESYLATE.................................... 50BENZYL ALCOHOL................................................. 17BEPOTASTINE BESILATE.......................................31BEPREVE.................................................................31BERACTANT............................................................ 48BERINERT..........................................................42, 75BESIFLOXACIN HCL............................................... 32BESIVANCE............................................................. 32BETADINE................................................................ 31BETAGAN.................................................................33BETAMETHASONE DIPROPIONATE......................18BETAMETHASONE VALERATE...............................18BETAMETHASONE/PROPYLENE GLYC................ 18BETAPACE............................................................... 11BETASERON......................................................47, 75BETAXOLOL HCL...............................................11, 32BETHANECHOL CHLORIDE................................... 44BETHKIS............................................................ 39, 75BETIMOL..................................................................33BETOPTIC S............................................................ 32BEVACIZUMAB........................................................ 45BEXAROTENE................................................... 21, 47BEXXAR................................................................... 46BEYAZ................................................................ 14, 67BG-STAR(OTC)........................................................ 23BIAXIN......................................................................38BICALUTAMIDE....................................................... 45BICHLORACETIC ACID...........................................20BICNU.......................................................................45BIDIL.........................................................................13BIFERA RX...............................................................55BILTRICIDE.............................................................. 40
L.A. Care Page 79 of 96
Index
BIMATOPROST..................................................32, 33BINOSTO......................................................30, 61, 67BIOCLATE................................................................ 34BIOGLO....................................................................33BIONECT..................................................................20BISMUTH SAL/METRONID/TETRACYC................. 53BISMUTH/METRONID/TETRACYCLINE.................53BISOPROLOL FUMARATE...................................... 11BISOPROLOL FUMARATE/HCTZ........................... 12BIVALIRUDIN........................................................... 35BIVIGAM...................................................................37BLEOMYCIN SULFATE............................................45BLEPHAMIDE.......................................................... 32BLEPHAMIDE S.O.P................................................ 32BLOOD GLUCOSE CTL HIGH,NML&LOW..............25BLOOD GLUCOSE METER(OTC)...........................25BLOOD GLUCOSE MONITOR(OTC).......................25BLOOD GLUCOSE MONITORING(OTC)................ 25BLOOD GLUCOSE STRIPS-DISPMETER.............. 25BLOOD GLUCOSE TEST STRIP(OTC)...................23BLOOD GLUCOSE TEST(OTC).............................. 23BLOOD GLUOCSE TEST(OTC).............................. 23BLOOD SUGAR DIAGNOSTIC...........................23-25BLOOD SUGAR DIAGNOSTIC, DISC..................... 25BLOOD SUGAR DIAGNOSTIC, DRUM................... 25BLOOD-GL & BP METER,ADULT CUFF................. 25BLOOD-GLU METER,CONT/TRANSMIT................ 25BLOOD-GLUC.METER& WRIST BP MON.............. 25BLOOD-GLUCOSE METER................................25-27BLOOD-GLUCOSE METER(OTC)...........................25BLOOD-GLUCOSE METER,CONTINUOUS............27BOCEPREVIR.......................................................... 41BONIVA.................................................................... 30BONTRIL PDM......................................................... 59BORTEZOMIB.......................................................... 46BOSENTAN.............................................................. 12BOSULIF(TAB)(100 MG).............................. 46, 61, 75BOSULIF(TAB)(500 MG).............................. 46, 61, 75BOSUTINIB.............................................................. 46BP WASH................................................................. 20BP WASH ACNE TREATMENT................................20BP-50% UREA......................................................... 20B-PLEX PLUS.......................................................... 56BPO.......................................................................... 20BRAVELLE............................................................... 29BREATHERITE...........................................................6BREATHRITE............................................................. 6BREEZE 2(OTC)...................................................... 25BRENTUXIMAB VEDOTIN.......................................46BREO ELLIPTA.................................................... 5, 61BRILINTA............................................................35, 61BRIMONIDINE TARTRATE................................ 16, 33BRIMONIDINE TARTRATE/TIMOLOL......................33BRINTELLIX................................................... 7, 61, 67BRINZOLAMIDE.......................................................33BRINZOLAMIDE/BRIMONID TART..........................33BRISDELLE....................................................7, 61, 67BROMFED DM......................................................... 15BROMFENAC SODIUM........................................... 31BROMOCRIPTINE MESYLATE......................... 22, 50BROMPHENIRA/PSEUDOEPHED/CODEIN........... 15BROMPHENIRAM/PHENYLEPHRINE/DM..............15BROMPHENRM/PSEUDOEPH/DIHYDROCD.........15BRONCOMAR GG..................................................... 5BROVANA............................................................ 5, 61BUCALCIDE............................................................. 48BUCALSEP.............................................................. 43BUDESONIDE......................................................5, 42BUDESONIDE/FORMOTEROL FUMARATE............. 5BUMETANIDE.......................................................... 12BUPAP......................................................................48BUPHENYL.............................................................. 44BUPRENEX..............................................................50BUPRENORPHINE.................................................. 48BUPRENORPHINE HCL.......................................... 50BUPRENORPHINE HCL/NALOXONE HCL.............50BUPRENORPHINE-NALOXONE....................... 50, 75BUPROBAN..............................................................52BUPROPION HBR......................................................7BUPROPION HCL................................................7, 52BUSPIRONE HCL...................................................... 8BUSULFAN...............................................................45BUSULFEX...............................................................45BUTABARBITAL SODIUM..........................................9BUTALB/ACETAMINOPHEN/CAFFEINE................. 48BUTALBIT/ACETAMIN/CAFF/CODEINE..................50BUTALBITAL/ACETAMINOPHEN.............................48BUTALBITAL/ASPIRIN/CAFFEINE.......................... 48BUTALBITAL-ACETAMINOPHEN-CAFFE............... 48
BUTALBITAL-ASPIRIN-CAFFEINE.......................... 48BUTENAFINE HCL...................................................17BUTISOL SODIUM.....................................................9BUTORPHANOL TARTRATE................................... 48BUTRANS.......................................................... 48, 61BUTYLATED HYDROXYTOLUENE......................... 16BUTYLATED HYDROXYTOLUENE(BHT)............... 16BYDUREON....................................................... 22, 61BYETTA(PEN INJCTR)(10MCG/0.04)................22, 61BYETTA(PEN INJCTR)(5MCG/0.02)..................22, 61BYSTOLIC................................................................ 11- C -C1 ESTERASE INHIBITOR......................................42CABAZITAXEL..........................................................47CABERGOLINE........................................................31CABOZANTINIB S-MALATE.................................... 46CADEXOMER IODINE............................................. 16CADUET.............................................................14, 61CAFCIT.......................................................................6CAFERGOT........................................................50, 61CAFFEINE CITRATED............................................... 6CAL CARB/MGOX/D3/B12/FA/B6/BOR................... 54CALAN SR................................................................12CALCIPOTRIENE...............................................21, 67CALCIPOTRIENE/BETAMETHASONE....................22CALCITONIN,SALMON,SYNTHETIC...................... 30CALCITRIOL...................................................... 21, 59CALCIUM ACETATE................................................ 29CALCIUM CARBONATE/MAG CARB/FA.................29CALFACTANT...........................................................48CAMBIA..............................................................50, 61CAMPTOSAR........................................................... 46CAMRESE....................................................14, 61, 77CANAGLIFLOZIN..................................................... 22CANAKINUMAB/PF..................................................42CANASA...................................................................43CANDESARTAN CILEXETIL.................................... 11CANDESARTAN/HYDROCHLOROTHIAZID............11CANTIL.....................................................................53CAPECITABINE........................................................45CAPEX SHAMPOO.................................................. 18CAPITAL W-CODEINE............................................. 50CAPRELSA(TAB)(100 MG).......................... 46, 61, 75CAPRELSA(TAB)(300 MG).......................... 46, 61, 75CAPSAICIN/SKIN CLEANSER................................ 20CAPTOPRIL..............................................................11CAPTOPRIL/HYDROCHLOROTHIAZIDE................10CAPTOPRIL-HYDROCHLOROTHIAZIDE............... 10CARAC..................................................................... 21CARAFATE(ORAL SUSP)........................................ 53CARAFATE(TAB)......................................................53CARBACHOL........................................................... 33CARBAGLU..............................................................44CARBAMAZEPINE...............................................8, 51CARBATROL............................................................ 51CARBIDOPA.............................................................51CARBIDOPA/LEVODOPA........................................ 50CARBIDOPA/LEVODOPA/ENTACAPONE.........50, 51CARBINOXAMINE MALEATE.............................. 4, 60CARBIT/EQUIS XT/ETHAN/CHIT/MSM...................20CARBOPLATIN.........................................................45CARDENE SR.......................................................... 12CARDIZEM CD.........................................................12CARDIZEM LA..........................................................12CARDURA................................................................10CARDURA XL...........................................................10CAREONE(OTC)......................................................27CARESENS N VOICE(OTC).................................... 25CARESENS N(OTC).......................................... 23, 25CARFILZOMIB..........................................................46CARGLUMIC ACID...................................................44CARIMUNE NF NANOFILTERED............................ 37CARISOPRODOL.....................................................52CARISOPRODOL/ASPIRIN..................................... 52CARISOPRODOL-ASPIRIN..................................... 52CARISOPRODOL-ASPIRIN-CODEINE....................48CARMUSTINE..........................................................45CARMUSTINE IN POLIFEPROSAN 20................... 45CARTEOLOL HCL....................................................33CARVEDILOL........................................................... 10CARVEDILOL PHOSPHATE.................................... 10CASODEX................................................................ 45CATAFLAM............................................................... 43CATAPRES............................................................... 11CATAPRES-TTS 1.................................................... 11CATAPRES-TTS 2.................................................... 11CATAPRES-TTS 3.................................................... 11CAVAN-EC SOD DHA.............................................. 57CAVERJECT.......................................................29, 61
CAYSTON...........................................................37, 75C-CLARIFYING SERUM.......................................... 21CEDAX(CAP)............................................................38CEDAX(SUSP RECON)(180 MG/5ML)....................38CEDAX(SUSP RECON)(90 MG/5 ML).....................38CEFACLOR.............................................................. 37CEFADROXIL...........................................................37CEFADROXIL HYDRATE......................................... 37CEFDINIR.................................................................37CEFIXIME.................................................................37CEFPODOXIME PROXETIL.................................... 38CEFPROZIL..............................................................37CEFTIBUTEN DIHYDRATE......................................38CEFTIN(SUSP RECON)...........................................37CEFTIN(TAB)............................................................37CEFUROXIME AXETIL............................................ 37CELEBREX.................................................. 43, 60, 67CELECOXIB............................................................. 43CELEXA..................................................................... 7CELLCEPT............................................................... 37CELLCEPT(CAP)..................................................... 37CELLCEPT(SUSP RECON).....................................37CELLCEPT(TAB)...................................................... 37CELLULOSE,OXIDIZED.......................................... 35CELONTIN................................................................51CENESTIN................................................................36CENTANY AT........................................................... 17CENTERGY DM....................................................... 15CEPHALEXIN...........................................................37CEPHALEXIN MONOHYDRATE..............................37CEPROTIN............................................................... 35CERITINIB................................................................46CERTOLIZUMAB PEGOL........................................ 43CERUBIDINE............................................................45CERVICAL CAP....................................................... 15CERVIDIL................................................................. 15CESAMET...................................................... 4, 61, 67CETACAINE............................................................. 21CETACAINE ANESTHETIC......................................21CETIRIZINE HCL........................................................4CETRAXAL...............................................................28CETRORELIX ACETATE..........................................31CETROTIDE.............................................................31CETUXIMAB.............................................................45CEVI-FER.................................................................55CEVIMELINE HCL....................................................44CHANTIX............................................................52, 61CHEMSTRIP BG(OTC)............................................ 23CHEMSTRIP UG(OTC)............................................ 28CHEMSTRIP UGK(OTC)..........................................28CHENODAL..............................................................44CHENODIOL............................................................ 44CHILDREN'S FERROUS SULFATE(OTC)...............55CHLORAMBUCIL..................................................... 45CHLORDIAZEPOXIDE...............................................8CHLORDIAZEPOXIDE HCL.......................................8CHLORDIAZEPOXIDE/CLIDINIUM BR....................53CHLORDIAZEPOXIDE-AMITRIPTYLINE...................7CHLORHEXIDINE GLUCONATE............................. 48CHLOROQUINE PHOSPHATE................................ 40CHLOROTHIAZIDE..................................................12CHLOROXYLENOL/PRAMOXINE HCL...................29CHLORPHENIRAMINE MALEATE.............................4CHLORPHENIRAMINE TANNATE.............................4CHLORPHENIRAMINE/CODEINE PHOS................15CHLORPROMAZINE HCL..........................................9CHLORPROPAMIDE................................................22CHLORTHALIDONE.................................................13CHLORZOXAZONE................................................. 52CHLORZOXAZONE W/ACETAMINOPHEN.............52CHLORZOXAZONE/ACETAMINOPHEN................. 52CHOICEDM CLARUS TEST STRIPS(OTC)............ 23CHOICEDM CLARUS(OTC).....................................25CHOICEDM G20(OTC)...................................... 23, 25CHOICE-OB + DHA..................................................58CHOLECALCIFEROL (VITAMIN D3)....................... 59CHOLESTYRAMINE (WITH SUGAR)......................13CHOLESTYRAMINE LIGHT.....................................13CHOLESTYRAMINE/ASPARTAME..........................13CHOLINE MAG TRISALICYLATE............................ 48CHOLINE SAL/MAG SALICYLATE.......................... 48CHORIOGONADOTROPIN ALFA............................29CHORIONIC GONADOTROPIN...............................29CHORIONIC GONADOTROPIN, HUMAN............... 29CIALIS(TAB)(10 MG).................................... 29, 61, 77CIALIS(TAB)(2.5 MG)................................... 29, 61, 77CIALIS(TAB)(20 MG).................................... 29, 61, 77CIALIS(TAB)(5 MG)...................................... 29, 61, 77CICLESONIDE....................................................... 4, 5
L.A. Care Page 80 of 96
Index
CICLODAN............................................................... 17CICLOPIROX............................................................17CICLOPIROX OLAMINE.......................................... 17CICLOPIROX/NAIL LACQ/FT DEOD#4...................17CICLOPIROX/SKIN CLEANSER NO.28.................. 17CICLOPIROX/URE/CAMPH/MENTH/EUC...............17CILOSTAZOL............................................................35CILOXAN(DROPS)...................................................32CILOXAN(OINT).......................................................32CIMETIDINE.............................................................53CIMETIDINE HCL.....................................................53CIMZIA................................................................43, 75CINACALCET HCL...................................................30CINRYZE............................................................ 42, 75CIPRO...................................................................... 38CIPRO HC................................................................ 29CIPRO XR................................................................ 38CIPRODEX...............................................................29CIPROFLOXACIN.................................................... 38CIPROFLOXACIN HCL................................ 28, 32, 38CIPROFLOXACIN HCL/DEXAMETH....................... 29CIPROFLOXACIN/CIPROFLOXA HCL....................38CIPROFLOXACIN/HYDROCORTISONE................. 29CISPLATIN............................................................... 45CITALOPRAM HBR.................................................... 7CITALOPRAM HYDROBROMIDE..............................7CITRANATAL 90 DHA.............................................. 58CITRANATAL DHA................................................... 57CITRANATAL HARMONY........................................ 58CITRANATAL RX......................................................57CITRATE PHOSPHATE DEXTROS SOLN.............. 34CITRATE PHOSPHATE DEXTROSE.......................34CITRIC ACID/G-LACTONE/MAG CARB.................. 54CITRIC ACID/SODIUM CITRATE.............................54CITRIC/CITRONELLYL/HYDROX/METH.................17CLADRIBINE............................................................ 45CLARAVIS................................................................ 16CLARINEX(SYRUP).......................................4, 61, 67CLARINEX(TAB)...................................................4, 61CLARINEX-D 12 HOUR................................. 4, 61, 67CLARINEX-D 24 HOUR................................. 4, 61, 67CLARITHROMYCIN................................................. 38CLEMASTINE FUMARATE........................................ 4CLEOCIN HCL..........................................................40CLEOCIN T...............................................................16CLEOCIN(CREAM/APPL)........................................ 54CLEOCIN(SUPP VAG)............................................. 54CLEVER CHEK BLOOD GLUCOSE SYST(OTC)......2 5CLEVER CHOICE BLOOD GLUC SYS(OTC)..........25CLEVER CHOICE HD GLUCOSE SYST(OTC)....... 25CLEVER CHOICE MICRO TEST STRIP(OTC)........23CLEVER CHOICE MICRO(OTC)............................. 25CLEVER CHOICE PRO(OTC)............................23, 25CLEVER CHOICE TALK(OTC)...........................23, 25CLEVER CHOICE TEST STRIPS(OTC).................. 23CLEVER CHOICE VOICE+(OTC)............................ 23CLEVER CHOICE(OTC).......................................... 25CLIMARA............................................................36, 61CLIMARA PRO...................................................36, 61CLINDACIN ETZ.......................................................16CLINDACIN P...........................................................16CLINDACIN PAC...................................................... 16CLINDAGEL............................................................. 16CLINDAMYCIN HCL.................................................40CLINDAMYCIN PALMITATE HCL.............................40CLINDAMYCIN PHOS/BENZOYL PEROX.............. 16CLINDAMYCIN PHOS/SKIN CLNSR 19.................. 16CLINDAMYCIN PHOSPHATE............................ 16, 54CLINDAMYCIN/TRETINOIN.....................................16CLINDESSE............................................................. 54CLINITEST REAGENT(OTC)...................................28CLINPRO 5000.........................................................54CLIOQUINOL/HC/EMOLLIENT CMB#88.................16CLIOQUINOL/HYDROCORTISONE........................ 16CLIOQUINOL/HYDROCORTISONE/PRAM.............16CLOBAZAM..............................................................51CLOBETASOL EMOLLIENT.....................................18CLOBETASOL PROPIONATE..................................18CLOBETASOL PROPIONATE/EMOLL.................... 18CLOBEX(LOTION)................................................... 18CLOBEX(SHAMPOO).............................................. 18CLOBEX(SPRAY).....................................................18CLOCORTOLONE PIVALATE.................................. 18CLODERM................................................................18CLOFARABINE........................................................ 45CLOLAR................................................................... 45CLOMIPHENE CITRATE..........................................29CLOMIPRAMINE HCL................................................7
CLONAZEPAM......................................................... 51CLONIDINE.............................................................. 11CLONIDINE HCL............................................ 9, 11, 48CLONIDINE HCL/CHLORTHALIDONE.................... 11CLONIDINE HCL/PF................................................ 48CLOPIDOGREL BISULFATE....................................35CLORAZEPATE DIPOTASSIUM................................ 8CLORPRES.............................................................. 11CLOTRIMAZOLE................................................17, 39CLOTRIMAZOLE/BETAMETHASONE DIP..............17CLOTRIMAZOLE-BETAMETHASONE.....................17CLOZAPINE......................................................... 8, 61CLOZARIL............................................................ 8, 61COAGULATION FACTOR VIIA,RECOMB................34COARTEM................................................................40COCAINE HCL......................................................... 21CODAR GF...............................................................15CODEINE PHOS/ACETAMINOPHEN...................... 50CODEINE SULFATE.................................................48CODEINE/BUTALBITAL/ASA/CAFFEIN...................50CODEINE/CARISOPRODOL/ASPIRIN....................48COLAZAL................................................................. 43COLCHICINE............................................................33COLCHICINE/PROBENECID...................................33COLCRYS................................................................ 33COLESEVELAM HCL...............................................13COLESTID(GRANULES)..........................................13COLESTID(PACKET)(5 G)....................................... 13COLESTID(PACKET)(7.5G)..................................... 13COLESTID(TAB).......................................................13COLESTIPOL HCL...................................................13COLLAGENASE CLOSTRIDIUM HIST.................... 21COLY-MYCIN S........................................................ 28COLYTE WITH FLAVOR PACKS............................. 44COMBIGAN.............................................................. 33COMBIPATCH.................................................... 36, 61COMBIVENT.............................................................. 5COMBIVENT RESPIMAT........................................... 5COMBIVIR..........................................................41, 61COMETRIQ.................................................. 46, 61, 75COMFORT PAC-CYCLOBENZAPRINE...................52COMFORT PAC-IBUPROFEN................................. 43COMFORT PAC-MELOXICAM.................................43COMFORT PAC-NAPROXEN.................................. 43COMFORT PAC-TIZANIDINE.................................. 52COMP-AIR ELITE COMPRESSOR SYST................. 6COMP-AIR NEBULIZER COMPRESSOR..................6COMPAZINE...............................................................4COMPLERA....................................................... 41, 75COMPLETE NATAL DHA......................................... 57COMPLETENATE.....................................................56COMPRESSOR, FOR NEBULIZER...........................5COMTAN.................................................................. 51CONCEPT DHA........................................................57CONCEPT OB..........................................................57CONCEPTROL(OTC).........................................14, 77CONCERTA(TAB ER 24H)(18 MG)......................9, 61CONCERTA(TAB ER 24H)(27 MG)......................9, 61CONCERTA(TAB ER 24H)(36 MG)......................9, 61CONCERTA(TAB ER 24H)(54 MG)......................9, 61CONDYLOX(GEL)....................................................20CONDYLOX(SOLUTION).........................................20CONTOUR NEXT(OTC)........................................... 23CONTOUR TS(OTC)................................................ 23CONTOUR(OTC)......................................................23CONTROL G3(OTC)................................................ 23CONTROL(OTC)................................................ 23, 25CONZIP........................................................ 50, 61, 67COPAXONE........................................................47, 75COPEGUS................................................................41CORDRAN................................................................18COREG.....................................................................10COREG CR.............................................................. 10CORGARD................................................................11CORIFACT................................................................34CORTANE-B.............................................................28CORTEF................................................................... 42CORTENEMA...........................................................44CORTICOTROPIN....................................................30CORTIFOAM............................................................ 44CORTISONE ACETATE........................................... 42CORTISPORIN.........................................................18CORTISPORIN-TC...................................................28CORVITA.................................................................. 55CORVITE..................................................................55CORVITE 150...........................................................55CORVITE FE............................................................ 55CORVITE FREE....................................................... 56CORZIDE..................................................................12
COSMEGEN.............................................................45COSOPT...................................................................33COSOPT PF.................................................33, 61, 67COUMADIN.............................................................. 34COZAAR................................................................... 11CREON.....................................................................52CRESTOR(TAB)(10 MG)..............................13, 61, 67CRESTOR(TAB)(20 MG)..............................13, 61, 68CRESTOR(TAB)(40 MG)..............................13, 61, 68CRESTOR(TAB)(5 MG)................................13, 61, 68CRESYL ACE/BEN ALC/BUTANOL/IPA.................. 28CRESYLATE.............................................................28CRINONE........................................................... 30, 36CRIXIVAN................................................................. 41CRIZOTINIB............................................................. 46CROFELEMER.........................................................44CROMOLYN SODIUM..........................................5, 32CROTAMITON..........................................................17CRYSELLE......................................................... 15, 77C-THERAPY NIGHT CREAM...................................21CUPRIMINE..............................................................42CUROSURF............................................................. 48CUTIVATE................................................................ 18CUVPOSA................................................................ 53CYANOCOBALAMIN................................................ 59CYANOCOBALAMIN (VITAMIN B-12)......................59CYANOCOBALAMIN INJECTION............................ 59CYANOCOBALAMIN/FA/PYRIDOXINE................... 59CYANOCOBALAMIN/MECOBALAMIN.................... 59CYANOCOBALAMIN/VIT BCOMP&C...................... 59CYCLOBENZ HCL/IRR CNTR-IRR CB2..................52CYCLOBENZAPRINE HCL...................................... 52CYCLOGYL(DROPS)(0.5 %)................................... 33CYCLOGYL(DROPS)(1 %)...................................... 33CYCLOGYL(DROPS)(2 %)...................................... 33CYCLOMYDRIL........................................................33CYCLOPENTOLATE HCL........................................ 33CYCLOPENTOLATE/PHENYLEPHRINE.................33CYCLOPHOSPHAMIDE...........................................45CYCLOSERINE........................................................40CYCLOSET........................................................ 22, 68CYCLOSPORINE............................................... 32, 37CYCLOSPORINE MODIFIED...................................37CYCLOSPORINE, MODIFIED..................................37CYPROHEPTADINE HCL.......................................... 4CYRAMZA.......................................................... 46, 75CYSTAGON..............................................................54CYSTARAN........................................................ 33, 75CYSTEAMINE BITARTRATE....................................54CYSTEAMINE HCL.................................................. 33CYSTOSPAZ-M........................................................ 53CYTARABINE........................................................... 45CYTARABINE LIPOSOME/PF..................................45CYTARABINE/PF..................................................... 45CYTOMEL................................................................ 31CYTOTEC.................................................................53CYTRA-2.................................................................. 54CYTRA-3.................................................................. 54CYTRA-K..................................................................54- D -D.H.E.45............................................................. 50, 61DABIGATRAN ETEXILATE MESYLATE.................. 35DABRAFENIB MESYLATE.......................................46DACOGEN................................................................45DACTINOMYCIN......................................................45DALFAMPRIDINE.....................................................47DALIRESP......................................................5, 61, 68DALTEPARIN SODIUM,PORCINE.....................34, 35DANAZOL.................................................................31DANTRIUM...............................................................52DANTROLENE SODIUM..........................................52DAPAGLIFLOZIN PROPANEDIOL...........................22DAPSONE.......................................................... 16, 39DARAPRIM...............................................................40DARBEPOETIN ALFA IN POLYSORBAT.................34DARIFENACIN HYDROBROMIDE...........................54DARUNAVIR ETHANOLATE.................................... 40DASATINIB............................................................... 46DAUNORUBICIN CITRATE LIPOSOMAL................ 45DAUNORUBICIN HCL..............................................45DAUNOXOME.......................................................... 45DAYPRO...................................................................43DAYTRANA.................................................... 9, 61, 68DDAVP......................................................................30DDAVP(AMPUL)(15 MCG/ML)................................. 30DDAVP(AMPUL)(4MCG/ML).................................... 30DDAVP(SOLUTION).................................................30DDAVP(TAB)............................................................ 30DDAVP(VIAL)........................................................... 30
L.A. Care Page 81 of 96
Index
DECADRON............................................................. 31DECITABINE............................................................ 45DEGARELIX ACETATE............................................ 46DELATESTRYL(SYRINGE)................................36, 75DELATESTRYL(VIAL)........................................ 36, 75DELAVIRDINE MESYLATE...................................... 41DEL-BETA................................................................ 18DELZICOL.......................................................... 43, 68DEMADEX................................................................12DEMECARIUM BROMIDE....................................... 33DEMECLOCYCLINE HCL........................................ 38DEMEROL................................................................49DEMSER...................................................................11DENAVIR.................................................................. 17DENOSUMAB...........................................................30DEPAKENE.............................................................. 52DEPAKOTE ER........................................................ 51DEPEN..................................................................... 42DEPOCYT................................................................ 45DEPODUR................................................................49DEPO-PROVERA...............................................14, 61DEPO-SUBQ PROVERA 104............................ 14, 61DEPO-TESTOSTERONE(VIAL)(100 MG/ML)......36,7 5DEPO-TESTOSTERONE(VIAL)(200 MG/ML)......36,7 5DEPRIZINE...............................................................53DERMA-SMOOTHE-FS............................................18DERMASORB AF.....................................................16DERMASORB HC.................................................... 19DERMASORB TA..................................................... 19DERMASORB XM.................................................... 20DERMATOP..............................................................19DERMOTIC...............................................................28DESIPRAMINE HCL...................................................8DESIRUDIN..............................................................35DESLORATADINE..........................................4, 61, 68DESLORATADINE/PSEUDOEPHEDRINE.................4DESMOPRESSIN (NONREFRIGERATED)............. 30DESMOPRESSIN ACETATE....................................30DESOG-E.ESTRADIOL/E.ESTRADIOL...................14DESOGESTREL-ETHINYL ESTRADIOL.................14DESONATE.............................................................. 18DESONIDE...............................................................18DESOXIMETASONE................................................ 18DESOXYN............................................................ 8, 61DESVENLAFAXINE....................................................7DESVENLAFAXINE FUMARATE............................... 7DESVENLAFAXINE FUMARATE ER......................... 7DESVENLAFAXINE SUCCINATE.............................. 7DETROL............................................................. 54, 68DEVILBISS PULMO-AIDE..........................................5DEVILBISS TRAVELER............................................. 6DEXAMETHASONE........................................... 31, 42DEXAMETHASONE INTENSOL.............................. 42DEXAMETHASONE SOD PHOSPHATE................. 31DEXAMETHASONE SODIUM PHOSPHATE...........31DEXCHLORPHENIRAMINE MALEATE..................... 4DEXCOM G4............................................................ 27DEXEDRINE(CAP ER)(10 MG)............................8, 61DEXEDRINE(CAP ER)(15 MG)............................8, 61DEXEDRINE(CAP ER)(5 MG)..............................8, 61DEXILANT.................................................... 53, 61, 68DEXLANSOPRAZOLE............................................. 53DEXMETHYLPHENIDATE HCL................................. 9DEXPAK................................................................... 42DEXTROAMPHETAMINE SULFATE..........................8DEXTROAMPHETAMINE SULFATE(TAB)(10 MG)..............................................................................8, 61DEXTROAMPHETAMINE SULFATE(TAB)(5 MG)......8, 62DEXTROAMPHETAMINE/AMPHETAMINE............... 8DEXTROMETHORPHAN HBR/QUINIDINE.............48DEXTROSE/SOD CITRATE/CITRIC AC.................. 34DHCODEINE BT/ACETAMINOPHN/CAFF.............. 49DHT.......................................................................... 59DIABETA...................................................................22DIALYVITE 3000.......................................................59DIALYVITE 5000.......................................................59DIALYVITE 800 WITH IRON.................................... 55DIALYVITE SUPREME D......................................... 59DIALYVITE ZINC...................................................... 59DIAMOX SEQUELS................................................. 32DIAPHRAGM FITTING SET,ARCSPRNG................15DIAPHRAGMS, ARC-SPRING.................................15DIAPHRAGMS, WIDE SEAL....................................15DIASCREEN 10(OTC)..............................................28DIASCREEN 1G REAGENT(OTC)...........................28DIASCREEN 2GK REAGENT(OTC)........................ 28
DIASCREEN 3 REAGENT(OTC)............................. 28DIASCREEN 4OBL(OTC).........................................28DIASCREEN 5(OTC)................................................28DIASCREEN 7(OTC)................................................28DIASCREEN 8(OTC)................................................28DIASCREEN 9(OTC)................................................28DIASTAT............................................................. 51, 62DIASTAT ACUDIAL(KIT)(12.5-15-20).................51, 62DIASTAT ACUDIAL(KIT)(5-7.5-10MG)...............51, 62DIASTIX REAGENT(OTC)....................................... 28DIATRUE PLUS(OTC)........................................23, 25DIAZEPAM............................................................8, 51DIAZOXIDE.............................................................. 28DIBENZYLINE.......................................................... 10DICHLOROACETIC ACID........................................20DICHLOROTETRAFLUOROETHANE..................... 21DICLEGIS.............................................................4, 62DICLOFENAC EPOLAMINE.....................................19DICLOFENAC POTASSIUM...............................43, 50DICLOFENAC SODIUM............. 19, 21, 31, 43, 62, 75DICLOFENAC SODIUM/MISOPROSTOL................43DICLOFENAC SUBMICRONIZED........................... 43DICLOXACILLIN SODIUM....................................... 38DICOPANOL...............................................................4DICYCLOMINE HCL.................................................52DIDANOSINE........................................................... 41DIDREX.................................................................... 59DIETHYLPROPION HCL..........................................59DIFENOXIN HCL/ATROPINE SULFATE.................. 44DIFFERIN(CREAM)............................................16, 60DIFFERIN(GEL W/PUMP)..................................16, 60DIFFERIN(GEL)..................................................16, 60DIFFERIN(LOTION)........................................... 16, 60DIFFERIN(MED SWAB)..................................... 16, 60DIFICID.........................................................38, 62, 68DIFIL-G 400................................................................5DIFLORASONE DIACETATE................................... 18DIFLORASONE DIACETATE/EMOLL...................... 18DIFLUCAN................................................................39DIFLUNISAL.............................................................48DIFLUPREDNATE.................................................... 32DIGOX...................................................................... 10DIGOXIN...................................................................10DIHYDROCODEINE/ASPIRIN/CAFFEIN.................49DIHYDROCODEINE/GUAIFENESIN....................... 15DIHYDROERGOTAMINE MESYLATE..................... 50DIHYDROTACHYSTEROL.......................................59DILANTIN................................................................. 51DILANTIN-125.......................................................... 51DILATRATE-SR........................................................ 14DILAUDID.................................................................49DILAUDID-HP(AMPUL)............................................49DILAUDID-HP(VIAL).................................................49DILTIAZEM 24HR ER............................................... 12DILTIAZEM HCL....................................................... 12DIMETHYL FUMARATE........................................... 47DINOPROSTONE.....................................................15DIOVAN.............................................................. 11, 68DIOVAN HCT............................................................ 11DIOXYBENZONE/HYDROQUINONE...................... 21DIOXYBENZONE/PDO/HYDROQUINONE..............21DIPENTUM.........................................................43, 68DIPHENHYDRAMINE HCL........................................ 4DIPHENOXYLATE HCL/ATROPINE........................ 44DIPHENOXYLATE-ATROPINE................................ 44DIPROLENE.............................................................18DIPROLENE AF....................................................... 18DIPYRIDAMOLE.......................................................35DISOPYRAMIDE PHOSPHATE............................... 10DISULFIRAM..............................................................8DIURIL......................................................................12DIVALPROEX SODIUM............................................51DIVIGEL................................................................... 36DM/PHENYLEPH/CHLORPHENIRAMINE...............15D-METHORPHAN HB/P-EPD HCL/BPM................. 15D-METHORPHAN HB/PROMETH HCL................... 15DOCEFREZ..............................................................47DOCETAXEL............................................................ 47DOFETILIDE.............................................................10DOLASETRON MESYLATE....................................... 4DOLGIC PLUS......................................................... 48DOLOPHINE HCL.................................................... 49DOLOREX................................................................ 48DOLUTEGRAVIR SODIUM...................................... 41DOMEBORO............................................................ 28DONEPEZIL HCL....................................................... 7DONNATAL...............................................................53DORAL....................................................................... 9DORNASE ALFA...................................................... 48
DORYX(TAB DR)(150 MG)...................................... 39DORYX(TAB DR)(200 MG).......................... 39, 62, 68DORZOLAMIDE HCL............................................... 33DORZOLAMIDE HCL/TIMOLOL MALEAT............... 33DORZOLAMIDE/TIMOLOL/PF.................................33DOVONEX..........................................................21, 68DOXAZOSIN MESYLATE.........................................10DOXEPIN HCL................................................. 8, 9, 19DOXERCALCIFEROL.............................................. 31DOXORUBICIN HCL LIPOSOME............................ 45DOXORUBICIN HCL PEG-LIPOSOMAL..................45DOXYCYCLINE CALCIUM.......................................39DOXYCYCLINE HYCLATE.......................................39DOXYCYCLINE MONOHY/SKIN CLNSR9.............. 39DOXYCYCLINE MONOHYDRATE...........................39DOXYCYCLINE/EYELID CLNS NO.2&3..................32DOXYCYCLINE/SALICY/OCT/ZINC OX..................39DOXYCYCLINE/SKIN CLEANSER #19................... 39DOXYLAMINE/PYRIDOXINE HCL.............................4DRISDOL..................................................................59DRITHOCREME HP...........................................21, 68DRONABINOL............................................................4DRONEDARONE HCL............................................. 10DROPLET LANCING DEVICE(OTC)....................... 27DROSPIR/ETH ESTRA/LEVOMEFOL CA............... 14DROSPIRENONE/ESTRADIOL............................... 36DROXIA....................................................................35DRYSOL................................................................... 19DUAVEE................................................................... 36DUET DHA............................................................... 57DUET DHA 400........................................................ 57DUET DHA BALANCED...........................................57DUET DHA EC......................................................... 57DUETACT........................................................... 22, 68DUEXIS........................................................ 42, 62, 68DULERA............................................................... 5, 62DULOXETINE HCL.............................................. 7, 62DUONEB.................................................................... 5DURAGESIC...................................................... 49, 62DUREZOL.................................................................32DUTASTERIDE.........................................................53DUTASTERIDE/TAMSULOSIN HCL........................ 54DUTOPROL..............................................................12DYAZIDE.................................................................. 12DYMISTA........................................................ 4, 62, 68DYNACIN..................................................................39DYPHYLLINE............................................................. 6DYRENIUM...............................................................12- E -E.E.S. 200................................................................ 38EASIVENT..................................................................6EASY CHECK TEST STRIP(OTC)...........................23EASY CHECK(OTC).................................................25EASY CLICK(OTC)...................................................27EASY GLUCO G2(OTC)...........................................23EASY PLUS II(OTC)...........................................23, 25EASY PLUS(OTC)..............................................23, 25EASY STEP(OTC)..............................................23, 25EASY TALK(OTC).............................................. 23, 25EASY TOUCH GLUCOSE MONITOR(OTC)............25EASY TOUCH LANCING DEVICE(OTC)................. 27EASY TOUCH(OTC)................................................ 23EASY TRAK(OTC)..............................................23, 25EASYGLUCO PLUS(OTC).................................23, 25EASYGLUCO(OTC)........................................... 23, 25EASYMAX 15(OTC)................................................. 23EASYMAX L(OTC)................................................... 25EASYMAX N(OTC)...................................................25EASYMAX NG(OTC)................................................25EASYMAX V SPEAKING(OTC)................................25EASYMAX V(OTC)...................................................25EASYMAX V2(OTC).................................................25EASYMAX(OTC)...................................................... 23ECALLANTIDE......................................................... 43ECHOTHIOPHATE IODIDE......................................33EC-NAPROSYN....................................................... 43ECONAZOLE NITRATE........................................... 17ECOZA..................................................................... 17ECULIZUMAB...........................................................35EDARBI...............................................................11, 68EDARBYCLOR................................................... 11, 68EDECRIN..................................................................12EDEX..................................................................29, 62EDLUAR......................................................... 9, 62, 68EDURANT.......................................................... 41, 75EFAVIRENZ.............................................................. 41EFAVIRENZ/EMTRICITAB/TENOFOVIR................. 41EFFER-K.................................................................. 29EFFIENT.............................................................35, 62
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Index
EFLORNITHINE HCL............................................... 21EFUDEX................................................................... 21EGRIFTA............................................................ 30, 75ELDEPRYL............................................................... 51ELECT WTR/SOD CH/SOD HY/HYP AC.................20ELEMENT BLOOD GLUCOSE METER(OTC).........25ELEMENT COMPACT(OTC).............................. 23, 25ELEMENT PLUS(OTC)............................................ 25ELEMENT TEST STRIPS(OTC)...............................23ELESTAT.................................................................. 31ELESTRIN................................................................ 36ELETRIPTAN HBR................................................... 50ELIDEL......................................................... 22, 60, 68ELIGARD............................................................30, 75ELIMITE....................................................................17ELIQUIS............................................................. 34, 62ELITE OB DHA.........................................................56ELITE-OB 400.......................................................... 57ELLA.........................................................................15ELLENCE................................................................. 45ELMIRON................................................................. 54ELOCON...................................................................19ELOXATIN................................................................ 45ELSPAR..............................................................46, 75ELTROMBOPAG OLAMINE..................................... 35ELVITEGR/COBICIST/EMTRIC/TENOF.................. 41EM#53/NAMGF/CYC/PHOS/NAHC/NACL...............19EMADINE................................................................. 31EMBRACE EVO(OTC)............................................. 23EMBRACE PRO(OTC)............................................. 23EMBRACE(OTC)................................................23, 25EMCYT..................................................................... 47EMEDASTINE DIFUMARATE.................................. 31EMEND(CAP DS PK)........................................... 4, 62EMEND(CAP)(125 MG)........................................4, 62EMEND(CAP)(40 MG)..........................................4, 62EMEND(CAP)(80 MG)..........................................4, 62EMERSAL................................................................ 20EMLA........................................................................21EMOL53/NAMGFS/HA/NAHYPOCHLORIT............. 19EMOLLIENT #43/SKIN CLEANSER#27.................. 19EMOLLIENT COMBINATION NO.10........................19EMOLLIENT COMBINATION NO.32........................19EMOLLIENT COMBINATION NO.35........................19EMOLLIENT COMBINATION NO.38........................19EMOLLIENT COMBINATION NO.43........................19EMOLLIENT COMBINATION NO.44........................19EMOLLIENT COMBINATION NO.47........................19EMOLLIENT COMBINATION NO.48........................19EMOLLIENT COMBINATION NO.53........................19EMOLLIENT COMBINATION NO.57........................19EMOLLIENT COMBINATION NO.60........................19EMOLLIENT COMBINATION NO.80........................19EMOLLIENT COMBINATION NO.85........................19EMOLLIENT COMBO NO.47 & NO.60.................... 19EMSAM.................................................................9, 62EMTRICITAB/RILPIVIRINE/TENOFOV....................41EMTRICITABINE...................................................... 41EMTRICITABINE/TENOFOVIR................................ 40EMTRIVA(CAP).................................................. 41, 62EMTRIVA(SOLUTION)....................................... 41, 62EMULSION SB......................................................... 19ENABLEX........................................................... 54, 68ENALAPRIL MALEATE.............................................11ENALAPRIL/HYDROCHLOROTHIAZIDE................ 10ENALAPRIL-HYDROCHLOROTHIAZIDE................10ENBREL............................................................. 42, 75ENDACOF-C............................................................ 15ENDO-AVITENE....................................................... 35ENDOMETRIN..........................................................30ENFUVIRTIDE..........................................................41ENJUVIA...................................................................36ENOXAPARIN SODIUM........................................... 35ENTACAPONE......................................................... 51ENTECAVIR............................................................. 41ENTEREG................................................................ 44ENTOCORT EC........................................................42ENZALUTAMIDE...................................................... 45EPANED....................................................... 11, 62, 68EPIDUO....................................................................16EPIFOAM..................................................................20EPINASTINE HCL.................................................... 31EPINEPHRINE..................................................... 5, 44EPINEPHRINE HCL................................................. 15EPIPEN 2-PAK......................................................... 44EPIPEN JR 2-PAK.................................................... 44EPIRUBICIN HCL.....................................................45EPIVIR HBV............................................................. 41EPIVIR(SOLUTION)........................................... 41, 62
EPIVIR(TAB)(150 MG)........................................41, 62EPIVIR(TAB)(300 MG)........................................41, 62EPLERENONE......................................................... 12EPOETIN ALFA........................................................ 34EPOGEN............................................................ 34, 75EPOPROSTENOL SODIUM (ARGININE)................12EPOPROSTENOL SODIUM (GLYCINE)..................12EPROSARTAN MESYLATE......................................11EPROSARTAN/HYDROCHLOROTHIAZIDE............11EPTIFIBATIDE..........................................................35EPZICOM........................................................... 40, 62EQUETRO..................................................................8ERAPID NEBULIZER................................................. 6ERBITUX............................................................ 45, 75ERGOCALCIFEROL (VITAMIN D2)......................... 59ERGOLOID MESYLATES........................................ 14ERGOMAR......................................................... 50, 62ERGOTAMINE TARTRATE...................................... 50ERGOTAMINE TARTRATE/CAFFEINE....................50ERIBULIN MESYLATE............................................. 46ERIVEDGE................................................... 46, 62, 75ERLOTINIB HCL.......................................................46ERTACZO.................................................................17ERWINAZE.........................................................47, 75ERY E-SUCC/SULFISOXAZOLE............................. 38ERYGEL................................................................... 16ERYPED 200............................................................ 38ERYPED 400............................................................ 38ERY-TAB...................................................................38ERYTHROCIN STEARATE...................................... 38ERYTHROMYCIN...............................................16, 38ERYTHROMYCIN BASE.............................. 16, 32, 38ERYTHROMYCIN BASE/ETHANOL........................ 16ERYTHROMYCIN ETHYLSUCCINATE................... 38ERYTHROMYCIN STEARATE.................................38ERYTHROMYCIN/BENZOYL PEROXIDE............... 16ERYTHROMYCIN-SULFISOXAZOLE......................38ESCAVITE................................................................ 56ESCITALOPRAM OXALATE...................................... 7ESGIC-PLUS(CAP).................................................. 48ESGIC-PLUS(TAB)...................................................48ESKALITH.................................................................. 8ESLICARBAZEPINE ACETATE............................... 51ESOMEPRAZOLE MAGNESIUM.............................53ESOMEPRAZOLE STRONTIUM................. 53, 62, 68ESTAZOLAM.............................................................. 9ESTRACE...........................................................36, 54ESTRADIOL....................................................... 36, 54ESTRADIOL ACETATE............................................ 54ESTRADIOL VALERATE/DIENOGEST....................14ESTRADIOL/LEVONORGESTREL..........................36ESTRADIOL/NORETHINDRONE ACET..................36ESTRADIOL/NORGESTIMATE................................36ESTRADIOL-NORETHINDRONE ACETAT..............36ESTRAMUSTINE PHOSPHATE SODIUM............... 47ESTRASORB............................................................36ESTRING............................................................54, 62ESTROGEL.............................................................. 36ESTROGEN & METHYLTESTOSTERONE............. 36ESTROGEN,CON/M-PROGEST ACET................... 36ESTROGEN,ESTER/ME-TESTOSTERONE............36ESTROGENS, CONJUGATED...........................36, 54ESTROGENS,CONJ.,SYNTHETIC A.......................36ESTROGENS,CONJ.,SYNTHETIC B.......................36ESTROGENS,CONJ/BAZEDOXIFENE....................36ESTROGENS,ESTERIFIED.....................................36ESTROPIPATE......................................................... 36ESZOPICLONE.......................................................... 9ETANERCEPT..........................................................42ETHACRYNIC ACID.................................................12ETHAMBUTOL HCL................................................. 39ETHAVERINE HCL...................................................14ETHCHLORVYNOL....................................................9ETHINYL ESTRADIOL/DROSPIRENONE...............14ETHIONAMIDE.........................................................39ETHOSUXIMIDE...................................................... 51ETHOTOIN............................................................... 51ETHYL CHLORIDE...................................................21ETHYNODIOL D-ETHINYL ESTRADIOL.................14ETIDRONATE DISODIUM........................................30ETODOLAC.............................................................. 43ETONOGESTREL/ETHINYL ESTRADIOL...............14ETOPOSIDE.............................................................47ETRAVIRINE............................................................ 41EURAX..................................................................... 17EVAMIST.................................................................. 36EVENCARE G2(OTC)........................................ 23, 25EVENCARE G3(OTC)........................................ 23, 25EVENCARE(OTC)..............................................23, 25
EVEROLIMUS.................................................... 37, 46EVISTA............................................................... 30, 62EVOCLIN..................................................................16EVOLUTION BLOOD GLUCOSE METER(OTC)......2 5EVOLUTION TEST STRIPS(OTC)...........................23EVOXAC...................................................................44EXALGO...................................................................49EXELDERM..............................................................17EXELON............................................................... 7, 62EXELON(CAP)........................................................... 7EXELON(SOLUTION)................................................ 7EXEMESTANE......................................................... 45EXENATIDE..............................................................22EXENATIDE MICROSPHERES............................... 22EXFORGE.......................................................... 11, 68EXFORGE HCT..................................................10, 68EXODERM................................................................17EXTAVIA............................................................. 47, 75EYLEA...................................................................... 33EZ SMART PLUS(OTC)..................................... 23, 25EZ SMART(OTC)................................................23, 25E-Z SPACER.............................................................. 6EZETIMIBE...............................................................13EZETIMIBE/ATORVASTATIN CALCIUM.................. 13EZETIMIBE/SIMVASTATIN.......................................13EZOGABINE.............................................................51- F -FA/MU-VITS-MIN TH/LYCOPENE/LUT....................55FA/VIT BCOMP&C/SE/MIN AA/ZN...........................59FABIOR.............................................................. 16, 60FACTIVE...................................................................38FACTOR IX...............................................................34FACTOR IX COMPLEX HUMAN.............................. 34FACTOR IX HUMAN RECOMBINANT..................... 34FACTOR IX REC, FC FUSION PROTN................... 34FACTOR XIII.............................................................34FACTOR XIII A-SUBUNIT,RECOMB........................ 34FAMCICLOVIR......................................................... 40FAMOTIDINE............................................................53FAMVIR.................................................................... 40FANAPT(TAB DS PK).....................................8, 62, 68FANAPT(TAB).................................................8, 62, 68FANATREX............................................................... 51FARESTON........................................................ 47, 75FARXIGA...................................................... 22, 62, 68FASLODEX.........................................................47, 75FAZACLO....................................................... 8, 62, 69FE C..........................................................................56FE FUMARATE/CAL/E/FA/MULTIVIT.......................55FE FUMARATE/DOSS/FA/BCOMP&C.....................55FE FUMARATE/FA/VIT BCOMP&C......................... 55FE FUMARATE/VIT C/B12/STOMC......................... 55FE FUMARATE/VIT C/B12-IF/FA............................. 55FE HEME POLYPEPTIDE/FOLIC ACID...................55FEBUXOSTAT.......................................................... 33FEIBA NF..................................................................34FEIBA VH IMMUNO................................................. 34FELBAMATE.............................................................51FELBATOL(ORAL SUSP).............................51, 62, 69FELBATOL(TAB)(400 MG)........................... 51, 62, 69FELBATOL(TAB)(600 MG)........................... 51, 62, 69FELDENE................................................................. 43FELODIPINE............................................................ 12FELODIPINE ER...................................................... 12FEMARA...................................................................45FEMCAP.............................................................15, 77FEMCON FE.......................................................15, 77FEMHRT...................................................................36FEMRING........................................................... 54, 62FENOFIBRATE.........................................................13FENOFIBRATE NANOCRYSTALLIZED...................13FENOFIBRATE,MICRONIZED................................. 13FENOFIBRIC ACID.................................................. 13FENOFIBRIC ACID (CHOLINE)...............................13FENOGLIDE.......................................................13, 69FENOPROFEN CALCIUM........................................43FENTANYL............................................................... 49FENTANYL CITRATE............................................... 49FENTORA...........................................................49, 75FERAHEME..............................................................55FERIVA..................................................................... 55FEROCON................................................................55FERRALET 90..........................................................55FERRAPLUS 90....................................................... 55FERREX 150 FORTE PLUS.....................................55FERREX 28.............................................................. 55FERRIC AMCIT/CYANOCOBALAMIN/FA................ 55FERRIC AMCIT/LYS/VIT B COMP/FA..................... 55
L.A. Care Page 83 of 96
Index
FERRIC CARBOXYMALTOSE.................................55FERRIC SUBSULFATE............................................ 35FERROUS FUMARATE/FOLIC ACID...................... 55FERROUS FUMARATE/VIT C/FA............................ 55FERROUS SULFATE............................................... 55FERROUS SULFATE/VIT C/FA................................55FERUMOXYTOL...................................................... 55FESOTERODINE FUMARATE.................................54FETZIMA........................................................ 7, 62, 69FEXMID.................................................................... 52FEXOFENADINE HCL................................................4FEXOFENADINE/PSEUDOEPHEDRINE...................4FIBRICOR.................................................................13FIBRINOGEN/THROMBIN (HUM PLAS)................. 35FIDAXOMICIN.......................................................... 38FIFTY50 TEST STRIP(OTC)....................................23FILGRASTIM............................................................ 35FINACEA.................................................................. 16FINASTERIDE..........................................................53FINGOLIMOD HCL...................................................47FIORICET.................................................................48FIORICET WITH CODEINE..................................... 50FIORINAL................................................................. 48FIORINAL WITH CODEINE #3.................................50FIRAZYR............................................................ 42, 75FIRMAGON(VIAL)(120 MG)...............................46, 62FIRMAGON(VIAL)(80 MG).................................46, 62FIRST-BXN...............................................................39FIRST-DUKE'S......................................................... 39FIRST-HYDROCORTISONE.................................... 18FIRST-LANSOPRAZOLE......................................... 53FIRST-MARY'S.........................................................39FIRST-OMEPRAZOLE............................................. 53FIRST-PROGESTERONE VGS 100........................ 29FIRST-PROGESTERONE VGS 200........................ 30FIRST-PROGESTERONE VGS 25.......................... 30FIRST-PROGESTERONE VGS 400........................ 30FIRST-PROGESTERONE VGS 50.......................... 30FIRST-TESTOSTERONE......................................... 36FIRST-TESTOSTERONE MC.................................. 36FLAGYL ER..............................................................40FLAREX....................................................................32FLAVOXATE HCL.....................................................54FLEBOGAMMA........................................................ 37FLEBOGAMMA DIF..................................................37FLECAINIDE ACETATE........................................... 10FLECTOR................................................................. 19FLOLAN..............................................................12, 75FLOMAX...................................................................54FLONASE.............................................................4, 62FLO-PRED................................................................42FLOVENT DISKUS(BLST W/DEV)(100 MCG)......5,6 2FLOVENT DISKUS(BLST W/DEV)(250 MCG)......5,6 2FLOVENT DISKUS(BLST W/DEV)(50 MCG).......5, 62FLOVENT HFA(AER W/ADAP)(110 MCG)...........5, 62FLOVENT HFA(AER W/ADAP)(220 MCG).......... 5, 62FLOVENT HFA(AER W/ADAP)(44 MCG)............ 5, 62FLOXIN.....................................................................28FLOXURIDINE..........................................................45FLU VACC TS 2013 (18-64YRS)/PF........................ 37FLU VACCINE QVAL 2013(2-49YRS)......................37FLUCAINE................................................................32FLUCONAZOLE....................................................... 39FLUCYTOSINE.........................................................39FLUDARABINE PHOSPHATE..................................45FLUDROCORTISONE ACETATE.............................42FLUMADINE.............................................................40FLUMIST.................................................................. 37FLUNISOLIDE.................................................. 4, 5, 62FLUOCINOLONE ACETONIDE............................... 18FLUOCINOLONE ACETONIDE OIL.........................28FLUOCINOLONE/EMOL CMB#65........................... 18FLUOCINOLONE/SHOWER CAP............................18FLUOCINOLONE/SKIN CLNSR28...........................18FLUOCINOLONE/TRETINOIN/H-QUIN................... 21FLUOCINONIDE.......................................................18FLUOCINONIDE/EMOLLIENT BASE.......................18FLUOCINONIDE-E...................................................18FLUORABON........................................................... 54FLUOR-A-DAY....................................................54, 55FLUORESCEIN SODIUM.........................................33FLUORESCEIN-PROPARACAINE...........................32FLUORETS...............................................................33FLUORIDE................................................................54FLUORIDE ION/MULTIVITAMINS............................56FLUORIDE/IRON/VIT A,C&D...................................56FLUORIDEX SENSITIVITY RELIEF.........................55
FLUOR-I-STRIP AT.................................................. 33FLUORITAB..............................................................54FLUOROMETHOLONE............................................32FLUOROMETHOLONE ACETATE...........................32FLUOROPLEX......................................................... 21FLUOROURACIL......................................................21FLUOXETINE HCL.....................................................7FLUOXYMESTERONE.............................................36FLUPHENAZINE HCL................................................ 9FLURA-DROPS........................................................54FLURANDRENOLIDE.............................................. 18FLURA-SAFE........................................................... 33FLURAZEPAM HCL....................................................9FLURBIPROFEN......................................................43FLURBIPROFEN SODIUM.......................................32FLURESS................................................................. 32FLUTAMIDE..............................................................45FLUTICASONE FUROATE.........................................4FLUTICASONE PROPIONATE........................ 4, 5, 18FLUTICASONE/SALMETEROL................................. 5FLUTICASONE/VILANTEROL................................... 5FLUVASTATIN SODIUM...........................................13FLUVOXAMINE MALEATE........................................ 7FLUZONE INTRADERMAL 2013-2014....................37FML FORTE............................................................. 32FML S.O.P................................................................ 32FOCALIN.............................................................. 9, 62FOCALIN XR........................................................ 9, 62FOLBECAL...............................................................58FOLBEE................................................................... 59FOLBEE PLUS CZ................................................... 59FOLGARD OS.......................................................... 54FOLIC ACID..............................................................55FOLIC ACID(OTC)..............................................55, 77FOLIC ACID/B COMPLEX & C NO.17..................... 59FOLIC ACID/MU-VITS-MIN TH................................ 55FOLIC ACID/MV,FE,OTHER MIN.............................55FOLIC ACID/VIT BCOMP&C/CU/ZNOX...................59FOLIC ACID/VITAMIN B COMP W-C.......................59FOLLISTIM AQ.........................................................29FOLLITROPIN ALFA, RECOMB...............................29FOLLITROPIN BETA,RECOMB............................... 29FOLOTYN.................................................................45FONDAPARINUX SODIUM...................................... 35FORA D10(OTC)................................................ 23, 25FORA D15(OTC)...................................................... 25FORA D15C(OTC)....................................................23FORA D15G(OTC)................................................... 23FORA D15Z(OTC)....................................................23FORA D20(OTC)................................................ 23, 25FORA G20(OTC)................................................23, 25FORA G30A(OTC)..............................................23, 25FORA G71A(OTC)..............................................23, 26FORA G90(OTC)................................................23, 26FORA LANCING DEVICE(OTC).............................. 27FORA V10(OTC)................................................ 23, 26FORA V12(OTC)................................................ 23, 26FORA V20(OTC)................................................ 23, 26FORA V22(OTC)................................................ 24, 26FORA V30A(OTC)..............................................24, 26FORA(OTC)..............................................................24FORACARE GD20(OTC)................................... 24, 26FORACARE GD40(OTC)......................................... 24FORACARE GD40A(OTC).......................................26FORACARE GD40B(OTC).......................................26FORADIL........................................................ 5, 62, 69FORFIVO XL.................................................. 7, 62, 69FORMOTEROL FUMARATE......................................5FORTAVIT.................................................................56FORTEO.............................................................30, 62FORTESTA.........................................................36, 75FORTICAL................................................................ 30FOSAMAX................................................................ 30FOSAMAX PLUS D.................................................. 30FOSAMPRENAVIR CALCIUM..................................41FOSFOMYCIN TROMETHAMINE............................38FOSINOPRIL SODIUM.............................................11FOSINOPRIL/HYDROCHLOROTHIAZIDE.............. 10FOSINOPRIL-HYDROCHLOROTHIAZIDE..............10FOSRENOL..............................................................29FRAGMIN(SYRINGE)(10000/ML)...................... 34, 62FRAGMIN(SYRINGE)(12500/0.5)...................... 34, 62FRAGMIN(SYRINGE)(15000/0.6)...................... 34, 62FRAGMIN(SYRINGE)(18000/0.72).................... 34, 62FRAGMIN(SYRINGE)(2500/0.2ML)................... 34, 62FRAGMIN(SYRINGE)(5000/0.2ML)................... 34, 62FRAGMIN(SYRINGE)(7500/0.3ML)................... 35, 62FRAGMIN(VIAL).................................................35, 62FREESTYLE INSULINX(OTC)................................. 24
FREESTYLE LITE(OTC).......................................... 24FREESTYLE(OTC)...................................................24FROVA..........................................................50, 62, 69FROVATRIPTAN SUCCINATE................................. 50FUDR........................................................................45FUL-GLO.................................................................. 33FULVESTRANT........................................................ 47FULVICIN U/F...........................................................39FULYZAQ..................................................... 44, 62, 69FUNGOID & HC........................................................17FURACIN..................................................................16FURADANTIN...........................................................38FUROSEMIDE..........................................................12FUSION PLUS..........................................................55FUZEON.......................................................41, 62, 69FYCOMPA(TAB)(10 MG)..............................51, 62, 69FYCOMPA(TAB)(12 MG)..............................51, 62, 69FYCOMPA(TAB)(2 MG)................................51, 62, 69FYCOMPA(TAB)(4 MG)................................51, 62, 69FYCOMPA(TAB)(6 MG)................................51, 62, 69FYCOMPA(TAB)(8 MG)................................51, 62, 69- G -G-4(OTC)............................................................24, 26GABAPENTIN.................................................... 47, 51GABAPENTIN ENACARBIL..................................... 47GABITRIL(TAB)(12 MG)............................... 52, 62, 69GABITRIL(TAB)(16 MG)............................... 52, 62, 69GABITRIL(TAB)(2 MG)................................. 52, 62, 69GABITRIL(TAB)(4 MG)................................. 52, 62, 69GALANTAMINE HBR..................................................7GAMASTAN S-D.......................................................37GAMMAGARD LIQUID.......................................37, 75GAMMAGARD S-D...................................................37GAMMAKED.......................................................36, 75GAMMAPLEX...........................................................37GAMUNEX................................................................36GAMUNEX-C......................................................36, 75GANCICLOVIR.........................................................32GANIRELIX ACETATE............................................. 31GARAMYCIN............................................................32GASTROCROM..........................................................5GATIFLOXACIN........................................................32GATTEX..............................................................44, 75GAVILYTE-C.............................................................44GAVILYTE-N.............................................................44GAZYVA............................................................. 45, 75GDRIVE(OTC)..........................................................26GE100 BLOOD GLUCOSE SYSTEM(OTC)............ 26GE100 BLOOD GLUCOSE TEST STRIP(OTC).......24GEBAUER'S 114...................................................... 21GELATIN...................................................................33GELATIN SPONGE,ABSORBABLE......................... 35GELFILM.................................................................. 33GELFOAM................................................................ 35GELFOAM PACKS................................................... 35GELNIQUE......................................................... 54, 69GEMCITABINE HCL................................................. 45GEMFIBROZIL......................................................... 14GEMIFLOXACIN MESYLATE...................................38GEMZAR.................................................................. 45GENADUR................................................................20GENERESS FE........................................................ 15GENERLAC..............................................................44GENOTROPIN....................................................30, 75GENSTRIP(OTC)..................................................... 24GENTAMICIN SULFATE.....................................16, 32GENTAMICIN/PREDNISOL AC................................31GENTIAN VIOL/BRLNT GRN/PROFLAV................. 17GENTLE DRAW(OTC)............................................. 27GEODON..............................................................9, 62GESTICARE DHA.................................................... 57GIAZO................................................................ 43, 69GILENYA............................................................ 47, 75GILOTRIF........................................................... 46, 75GLASSIA.................................................................. 45GLATIRAMER ACETATE..........................................47GLEEVEC.....................................................46, 62, 75GLIADEL.................................................................. 45GLIMEPIRIDE...........................................................22GLIPIZIDE................................................................ 22GLIPIZIDE/METFORMIN HCL................................. 22GLIPIZIDE-METFORMIN......................................... 22GLUCAGEN..............................................................28GLUCAGON EMERGENCY KIT.............................. 28GLUCAGON,HUMAN RECOMBINANT................... 28GLUCARPIDASE..................................................... 47GLUCO NAVII(OTC)...........................................24, 26GLUCOCARD 01 SENSOR(OTC)............................24GLUCOCARD 01(OTC)............................................26
L.A. Care Page 84 of 96
Index
GLUCOCARD 01-MINI(OTC)...................................26GLUCOCARD EXPRESSION(OTC).................. 24, 26GLUCOCARD VITAL SENSOR(OTC)......................24GLUCOCARD VITAL(OTC)...................................... 26GLUCOCOM BLOOD GLUCOSE(OTC).................. 26GLUCOCOM GLUCOSE(OTC)................................24GLUCOFILM(OTC)...................................................24GLUCOLET 2(OTC)................................................. 27GLUCOPHAGE........................................................ 22GLUCOSE TEST STRIP(OTC)................................ 24GLUCOSOURCE(OTC)............................................27GLUCOSTIX REAGENT(OTC).................................24GLUCOTROL........................................................... 22GLUCOVANCE.........................................................22GLUMETZA........................................................ 22, 69GLUTETHIMIDE.........................................................9GLYBURIDE............................................................. 22GLYBURIDE,MICRONIZED..................................... 22GLYBURIDE/METFORMIN HCL.............................. 22GLYBURIDE-METFORMIN HCL.............................. 22GLYCEROL PHENYLBUTYRATE............................ 44GLYCINE.................................................................. 39GLYCOPYRROLATE................................................53GLYNASE................................................................. 22GLYSET....................................................................22GMATE TEST STRIPS(OTC)................................... 24GMATE VOICE METER(OTC)................................. 26GMATE VOICE STARTER(OTC)..............................26GOLIMUMAB............................................................42GOLYTELY............................................................... 44GONADORELIN ACETATE...................................... 31GONAL-F..................................................................29GONAL-F RFF..........................................................29GONAL-F RFF REDI-JECT......................................29GORDO-UREA...................................................20, 21GOSERELIN ACETATE............................................30GR POL-ORC/SW VER/RYE/KENT/TIM....................4GRALISE(TAB ER 24H)(300 MG)................ 47, 62, 69GRALISE(TAB ER 24H)(300-600 MG)......... 47, 62, 69GRALISE(TAB ER 24H)(600 MG)................ 47, 62, 69GRANISETRON......................................................... 4GRANISETRON HCL..................................... 4, 62, 69GRANIX..............................................................35, 75GRASS POLLEN-TIMOTHY, STD..............................4GRASTEK............................................................ 4, 75GREEN GLO............................................................ 33GRIFULVIN V........................................................... 39GRISEOFULVIN....................................................... 39GRISEOFULVIN ULTRAMICROSIZE.......................39GRISEOFULVIN, MICROSIZE................................. 39GRIS-PEG................................................................ 39GUAIACOL............................................................... 19GUAIFENESIN/CODEINE PHOSPHATE................. 15GUAIFENESIN/DYPHYLLINE....................................5GUAIFENESIN/THEOPHYLLINE...............................5GUANFACINE HCL.............................................. 9, 11GUANIDINE HCL......................................................45GUARDIAN REAL-TIME...........................................25GYNOL II(OTC).................................................. 14, 77- H -H.P. ACTHAR..................................................... 30, 75HALAVEN........................................................... 46, 75HALCINONIDE......................................................... 18HALCION....................................................................9HALFAN....................................................................40HALOBETASOL PROPIONATE............................... 18HALOBETASOL/AMMONIUM LACTATE..................18HALOBETASOL/LACTIC ACID................................ 18HALOFANTRINE HCL..............................................40HALOG..................................................................... 18HALONATE...............................................................18HALOPERIDOL.......................................................... 9HALOPERIDOL LACTATE......................................... 9HC/MINERAL OIL/PETROLAT,WHT........................ 18HC/PRAMOX HCL/CL-XYLENOL/WATER...............28HC/PRAMOXINE HCL/CHLOROXYLENOL.............28HCTZ/RESERPINE/HYDRALAZINE........................ 11HEALTHPRO TEST STRIPS(OTC)..........................24HEALTHY ACCENTS AUTOLET(OTC)....................27HECORIA................................................................. 37HECTOROL..............................................................31HELIDAC.................................................................. 53HELIXATE FS........................................................... 34HEMASEEL APR(KIT)(1 ML)................................... 36HEMASEEL APR(KIT)(2 ML)................................... 36HEMASEEL APR(KIT)(5ML).................................... 36HEMATINIC PLUS....................................................55HEMATOGEN...........................................................55HEMATRON............................................................. 55
HEMATRON-AF........................................................55HEMENATAL OB...................................................... 58HEMENATAL OB + DHA.......................................... 57HEMIN...................................................................... 34HEMOCYTE............................................................. 56HEMOCYTE-F..........................................................55HEMOFIL M..............................................................34HEPARIN FLUSH..................................................... 35HEPARIN SOD,PORCINE-0.9 % NACL...................35HEPARIN SOD,PORK IN 0.45% NACL....................35HEPARIN SODIUM...................................................35HEPARIN SODIUM IN 0.45% NACL........................ 35HEPARIN SODIUM,PORCINE................................. 35HEPARIN SODIUM,PORCINE/D5W........................ 35HEPARIN SODIUM,PORCINE/NS........................... 35HEPARIN SODIUM,PORCINE/NS/PF......................35HEPARIN SODIUM,PORCINE/PF............................35HEPARIN SODIUM-D5W......................................... 35HEPARIN SODIUM-NS............................................ 35HEP-PAK CVC..........................................................35HEPSERA................................................................ 41HERCEPTIN.......................................................45, 75HETLIOZ...............................................................9, 75HEXALEN.................................................................45HIPREX.................................................................... 38HISTRELIN AC.........................................................31HIZENTRA..........................................................37, 75HOMATROPAIRE..................................................... 33HOMATROPINE HBR...............................................33HONEY.....................................................................21HORIZANT(TAB ER)(300 MG)..................... 47, 62, 70HORIZANT(TAB ER)(600 MG)..................... 47, 62, 70HPR.......................................................................... 19HPR PLUS................................................................19HUM INSULIN NPH/REG INSULIN HM................... 28HUMALOG................................................................28HUMALOG MIX 50-50..............................................28HUMALOG MIX 75-25..............................................28HUMATE-P............................................................... 34HUMATROPE..................................................... 30, 75HUMIRA..............................................................42, 75HUMORSOL.............................................................33HUMULIN 70/30 KWIKPEN(OTC)............................28HUMULIN 70-30(OTC)............................................. 28HUMULIN N(OTC)....................................................28HUMULIN R..............................................................28HUMULIN R(OTC)....................................................28HYALURO/DL-E AC/E12/ALLAN/SHEA...................19HYALURON SOD/ALLANTOIN/ALOE XT................ 20HYALURONATE SODIUM........................................20HYCAMTIN...............................................................46HYCET............................................................... 49, 62HYDRALAZINE HCL.................................................11HYDRALAZINE W/HCTZ..........................................11HYDRALAZINE/HYDROCHLOROTHIAZID............. 11HYDRALAZINE/RESERPIN/HCTZ...........................11HYDREA...................................................................45HYDRO 35................................................................20HYDROCHLOROTHIAZIDE.....................................13HYDROCHLOROTHIAZIDE/RESERPINE............... 11HYDROCODONE BIT/HOMATROP ME-BR............ 15HYDROCODONE BITARTRATE.............................. 49HYDROCODONE/ACETAMINOPHEN.....................49HYDROCODONE/CHLORPHEN POLIS..................15HYDROCODONE/CHLORPHENIRAMINE.............. 15HYDROCODONE/IBUPROFEN...............................48HYDROCODONE-ACETAMINOPHEN(SOLUTION)............................................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(10-660MG)...............................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-300MG)...............................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-325MG)...............................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-325MG).....................................................................49HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-500MG).....................................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-300MG)...............................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-325MG)...............................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-300MG)...............................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-325MG)...............................................................49, 62HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-750MG)...............................................................49, 63HYDROCODONE-HOMATROPINE MBR................ 15
HYDROCORT/PRAMOXIN/EMOL/PRAM#1............43HYDROCORT/SAL ACID/SULF/SHMP#1................18HYDROCORTISONE................................... 18, 42, 44HYDROCORTISONE AC/LIDOCAINE............... 20, 44HYDROCORTISONE ACETATE........................ 18, 44HYDROCORTISONE ACETATE/ALOE V................ 18HYDROCORTISONE ACETATE/UREA................... 18HYDROCORTISONE BUTYRATE........................... 18HYDROCORTISONE BUTYRATE/EMOLL.............. 18HYDROCORTISONE PROBUTATE.........................18HYDROCORTISONE VALERATE...................... 18, 19HYDROCORTISONE/EMOL NO.45.........................19HYDROCORTISONE/IODOQUIN/ALOE#2..............16HYDROCORTISONE/IODOQUINOL....................... 16HYDROCORTISONE/LIDOCAINE/ALOE................ 44HYDROCORTISONE/PRAMOXINE.............20, 21, 44HYDROCORTISONE/PRAMOXINE/ALOE.............. 21HYDROCORTISONE/PRAMOXINE/EMOLL............21HYDROCORTISONE/SKIN CLNSR #25..................19HYDROCORTISONE/SKIN CLNSR #35..................19HYDROCORTISONE-ACETIC ACID....................... 28HYDROCORTISONE-IODOQUINOL....................... 16HYDROCORTISONE-PRAMOXINE.........................44HYDROFLUMETHIAZIDE........................................ 13HYDROMORPHONE HCL....................................... 49HYDROMORPHONE HCL/PF..................................49HYDROQUINONE....................................................21HYDROQUINONE MICROSPHERES......................21HYDROQUINONE/ASCORBIC ACID.......................21HYDROQUINONE/AVOBENZ/OCTINOX.................21HYDROQUINONE/FERRIC OXIDE......................... 21HYDROQUINONE/VIT C/VIT E ACET..................... 21HYDROXOCOBALAMIN.......................................... 59HYDROXYAMPHETAMINE/TROPICAMIDE............ 33HYDROXYCHLOROQUINE SULFATE.................... 40HYDROXYPROGESTERONE CAPROATE............. 36HYDROXYPROPYL CELLULOSE........................... 33HYDROXYUREA................................................35, 45HYDROXYZINE HCL..................................................4HYDROXYZINE PAMOATE........................................4HYLATOPIC..............................................................19HYLATOPIC PLUS................................................... 19HYOPHEN................................................................38HYOSCYAMINE....................................................... 53HYOSCYAMINE SULFATE.......................................53HYPOLANCE(OTC)..................................................27HYZAAR................................................................... 11- I -IBANDRONATE SODIUM.........................................30IBG-STAR(OTC)....................................................... 26IBRUTINIB................................................................46IBUPROFEN.............................................................43IBUPROFEN/FAMOTIDINE......................................42IBUPROFEN/IRR CNT-IRRIT CMB #2.....................43IBUPROFEN/OXYCODONE HCL............................ 48ICATIBANT ACETATE.............................................. 42ICLUSIG(TAB)(15 MG)................................. 46, 63, 75ICLUSIG(TAB)(45 MG)................................. 46, 63, 75ICOSAPENT ETHYL................................................ 14ICY HOT(OTC)......................................................... 20IDAMYCIN PFS........................................................ 45IDARUBICIN HCL.....................................................45IFEX..........................................................................45IFOSFAMIDE............................................................45IFOSFAMIDE/MESNA.............................................. 45IFOSFAMIDE-MESNA..............................................45ILARIS...................................................................... 42ILEVRO.................................................................... 32ILOPERIDONE........................................................... 8ILOPROST TROMETHAMINE................................. 12ILOTYCIN................................................................. 32IMATINIB MESYLATE.............................................. 46IMBRUVICA........................................................46, 75IMDUR......................................................................14IMIPRAMINE HCL...................................................... 8IMIPRAMINE PAMOATE............................................ 8IMIQUIMOD..............................................................37IMITREX............................................................. 50, 63IMITREX(CARTRIDGE)......................................50, 63IMITREX(PEN INJCTR)......................................50, 63IMITREX(TAB).................................................... 50, 63IMITREX(VIAL)...................................................50, 63IMMUNE GLOB,GAM CAPRYLATE(IGG)................36IMMUNE GLOBULIN,G(IGG)/MALTOSE................. 36IMMUNE GLOBULIN,GAMMA(IGG)........................ 37IMURAN....................................................................37INCIVEK............................................................. 41, 75INCONTROL LANCING DEVICE(OTC)................... 27INCRELEX..........................................................31, 75
L.A. Care Page 85 of 96
Index
INDACATEROL MALEATE.........................................5INDAPAMIDE............................................................13INDERAL LA............................................................. 11INDERAL XL............................................................. 11INDINAVIR SULFATE............................................... 41INDOCIN...................................................................43INDOMETHACIN......................................................43INFASURF................................................................48INFERGEN............................................................... 41INFINITY TEST STRIPS(OTC).................................24INFINITY(OTC).........................................................26INFLIXIMAB..............................................................43INGENOL MEBUTATE............................................. 21INHALER, ASSIST DEVICES................................ 5, 6INHALER,ASSIST DEVICE,ACCESORY...................6INJECTAFER............................................................55INLYTA(TAB)(1 MG)..................................... 46, 63, 75INLYTA(TAB)(5 MG)..................................... 46, 63, 75INNOPRAN XL..........................................................11INNOSPIRE ELEGANCE........................................... 6INNOSPIRE ESSENCE..............................................6INOVA.......................................................................20INOVA 4-1.................................................................20INOVA 8-2.................................................................20INSPIRATION............................................................. 6INSPIRATION ELITE.................................................. 6INSPRA.................................................................... 12INSULIN ASPART.................................................... 28INSULIN DETEMIR.................................................. 28INSULIN GLARGINE,HUM.REC.ANLOG.................28INSULIN GLULISINE................................................28INSULIN LISPRO..................................................... 28INSULIN NPL/INSULIN LISPRO.............................. 28INSULIN REGULAR, HUMAN..................................28INSULN ASP PRT/INSULIN ASPART......................28INTEGRA F...............................................................55INTEGRA PLUS....................................................... 55INTEGRILIN..............................................................35INTELENCE....................................................... 41, 75INTERFERON ALFA-2B,RECOMB.......................... 37INTERFERON ALFACON-1..................................... 41INTERFERON ALFA-N3...........................................37INTERFERON BETA-1A...........................................47INTERFERON BETA-1A/ALBUMIN..........................47INTERFERON BETA-1B...........................................47INTERFERON GAMMA-1B,RECOMB..................... 37INTERMEZZO................................................ 9, 63, 70INTRON A...........................................................37, 75INTUNIV............................................................... 9, 63INVEGA SUSTENNA..................................................9INVEGA(TAB ER 24H)(1.5 MG)..................... 8, 63, 70INVEGA(TAB ER 24H)(3 MG)........................ 8, 63, 70INVEGA(TAB ER 24H)(6 MG)........................ 8, 63, 70INVEGA(TAB ER 24H)(9 MG)........................ 8, 63, 70INVIRASE(CAP)........................................... 41, 63, 70INVIRASE(TAB)............................................41, 63, 70INVOKANA................................................... 22, 63, 70IODINE/POTASSIUM IODIDE.................................. 16IODOFLEX................................................................16IODOQUINOL...........................................................40IODOQUINOL/ALOE POLYSACCHAR #1............... 16IODOSORB.............................................................. 16IONAMIN.................................................................. 59IOPIDINE(DROPERETTE).......................................32IOPIDINE(DROPS)...................................................32IPILIMUMAB.............................................................47IPRATROPIUM BROMIDE................................... 5, 48IPRATROPIUM/ALBUTEROL SULFATE....................5IPRIVASK..................................................... 35, 63, 75IRBESARTAN........................................................... 11IRBESARTAN/HYDROCHLOROTHIAZIDE..............11IRINOTECAN HCL................................................... 46IRON &IRON ASP GLY/FA/MV,MIN27..................... 55IRON AG&FUM/C/FA/MV CMB11/CA-T...................55IRON AG/C/B12/CA/SUC.ACID/STOM.................... 55IRON ASPGLY&PS/C/B12/FA/CA/SUC................... 55IRON ASPGLY/C/B12/FA/CA-TH/SUC.....................55IRON BG&PS/VIT C/B12/FA/CA THR......................55IRON BISGLY & PS/FA/B&C#12/SUC..................... 55IRON FUM & AG/C/B12/FA/CA/SUCC.....................55IRON FUM & P/FA/VIT B & C NO.9......................... 55IRON FUM & PS CMP/FA/VIT C/B3.........................55IRON FUM&POLYSAC#1/FA/MV NO.18..................55IRON FUMARATE/VIT C/VIT B12/FA.......................55IRON GLY&FUM/C/B12/ME-THFOLATE................. 55IRON PS CMPLX/FOLIC ACID/VIT C...................... 55IRON PS CMPLX/VIT B12/FA.................................. 55IRON PS/IRON HEM POLY/FA/B12.........................55IRON, CARB & GLUC/FA/B12/C/DSS..................... 55
IRON, CARBONYL/FA/C/B-6/B12/ZN...................... 55IRON,CARB/DSS/B12IF/FA/MV-MN........................ 55IRON,CARB/FA#6/MV, MIN NO.40.......................... 55IRON,CARB/FA#6/MV, MIN NO.41.......................... 55IRON,CARBONYL/FA/MULTIVITS-MIN................... 55IRON,CARBONYL/VIT C/VIT B12/FA...................... 56IRON,FUM&PS/FA/VIT B&C#18/L.CA..................... 55IRON/FA/B12/C/DOCUSATE SODIUM.................... 55IRON/FA/VITAMIN B COMP W-C/MIN..................... 55IRON/FLUORIDE/VITS A, C, & D3...........................56IRON/FOLIC ACID/C/B12/BIOTIN............................55IRON/LIVER EXT/VIT BCOMP&C/MIN....................55IROSPAN..................................................................55IRRIGATING SOLUTION G......................................39ISENTRESS............................................................. 41ISOCARBOXAZID...................................................... 7ISOCHRON.............................................................. 14ISOETHARINE HCL................................................... 5ISOMETHEPT/DICHLPHN/ACETAMINOP.............. 50ISOMETHEPT-DICHLORALP-ACETAMIN...............50ISOMETHEPTEN/CAF/ACETAMINOPHEN............. 50ISONIAZID................................................................39ISOPROPAMIDE/PROCHLORPERAZINE...............53ISOPTO ATROPINE................................................. 33ISOPTO CARBACHOL.............................................33ISOPTO CARPINE(DROPS)(1 %)........................... 33ISOPTO CARPINE(DROPS)(2 %)........................... 33ISOPTO CARPINE(DROPS)(4 %)........................... 33ISOPTO CARPINE(DROPS)(8 %)........................... 33ISOPTO HYOSCINE................................................ 33ISORDIL................................................................... 14ISORDIL TITRADOSE..............................................14ISOSORB DINIT/HYDRALAZINE HCL.....................13ISOSORBIDE DINITRATE........................................14ISOSORBIDE MONONITRATE................................ 14ISOTRETINOIN........................................................ 16ISOVEX.................................................................... 14ISOXSUPRINE HCL.................................................14ISRADIPINE............................................................. 12ISTALOL................................................................... 33ISTODAX............................................................ 46, 75ITRACONAZOLE......................................................39IVACAFTOR............................................................. 48IVERMECTIN......................................................17, 40IXABEPILONE..........................................................45IXEMPRA........................................................... 45, 75- J -JAKAFI......................................................... 46, 63, 75JALYN...........................................................54, 70, 77JANUMET.................................................................22JANUMET XR...........................................................22JANUVIA...................................................................22J-COF DHC.............................................................. 15JENTADUETO.......................................................... 22JEVTANA..................................................................47JINTELI.....................................................................36J-MAX DHC.............................................................. 15JUXTAPID...........................................................13, 75- K -KADCYLA...........................................................46, 75KADIAN(CAP ER PEL)(10 MG)................................49KADIAN(CAP ER PEL)(100 MG)............................. 49KADIAN(CAP ER PEL)(130 MG)............................. 49KADIAN(CAP ER PEL)(150 MG)............................. 49KADIAN(CAP ER PEL)(20 MG)................................49KADIAN(CAP ER PEL)(200 MG)............................. 49KADIAN(CAP ER PEL)(30 MG)................................49KADIAN(CAP ER PEL)(40 MG)................................49KADIAN(CAP ER PEL)(50 MG)................................49KADIAN(CAP ER PEL)(60 MG)................................49KADIAN(CAP ER PEL)(70 MG)................................49KADIAN(CAP ER PEL)(80 MG)................................49KALBITOR.......................................................... 43, 75KALETRA(SOLUTION)...................................... 41, 63KALETRA(TAB)(100MG-25MG)......................... 41, 63KALETRA(TAB)(200MG-50MG)......................... 41, 63KALYDECO........................................................ 48, 75KAOCHLOR..............................................................29KAOCHLOR-EFF......................................................29KAPVAY................................................................9, 63KAZANO.............................................................22, 70KEFLEX....................................................................37KENALOG(AEROSOL)............................................ 19KENALOG(LOTION).................................................19KEPIVANCE............................................................. 48KEPPRA................................................................... 51KERAFOAM..............................................................20KERALAC.................................................................20KERALYT..................................................................20
KERALYT SCALP.....................................................20KETEK......................................................................38KETOCONAZOLE.............................................. 17, 39KETOCONAZOLE/SKIN CLEANSER #28............... 17KETODAN................................................................ 17KETO-DIASTIX REAGENT(OTC)............................ 28KETOPROFEN......................................................... 43KETOROLAC TROMETHAMINE................. 32, 42, 43KETOROLAC TROMETHAMINE/PF........................32KHEDEZLA.....................................................7, 63, 70KINERET............................................................ 42, 75KIT FOR Y-90/IBRITUMOMAB/ALBUM................... 46KLARON...................................................................16KLONOPIN............................................................... 51KLOR-CON-EF.........................................................29KOATE-DVI...............................................................34KOGENATE FS........................................................ 34KOMBIGLYZE XR...............................................22, 70KORLYM.............................................................22, 75K-PHOS NEUTRAL.................................................. 54K-PHOS NO.2...........................................................54K-PHOS ORIGINAL..................................................54KRISTALOSE........................................................... 44K-TAB ER................................................................. 29KYNAMRO......................................................... 13, 75KYPROLIS..........................................................46, 75- L -LABETALOL HCL..................................................... 10LAC-HYDRIN............................................................19LACOSAMIDE.......................................................... 51LACRISERT..............................................................33LACTATED RINGERS.............................................. 20LACTIC ACID........................................................... 19LACTICARE-HC....................................................... 18LACTULOSE............................................................ 44LAMICTAL................................................................ 51LAMICTAL (BLUE)....................................................51LAMICTAL (GREEN)................................................ 51LAMICTAL (ORANGE)............................................. 51LAMICTAL ODT (BLUE)..................................... 51, 70LAMICTAL ODT (GREEN)..................................51, 70LAMICTAL ODT (ORANGE)...............................51, 70LAMICTAL ODT(TAB RDP DIS)(100 MG)......51, 63,7 0LAMICTAL ODT(TAB RDP DIS)(200 MG)......51, 63,7 0LAMICTAL ODT(TAB RDP DIS)(25 MG)......51, 63, 70LAMICTAL ODT(TAB RDP DIS)(50 MG)......51, 63, 70LAMICTAL XR (BLUE)........................................51, 70LAMICTAL XR (GREEN).................................... 51, 70LAMICTAL XR (ORANGE)................................. 51, 70LAMISIL(GRAN PACK).............................................39LAMISIL(TAB)...........................................................39LAMIVUDINE............................................................41LAMIVUDINE HBV................................................... 41LAMIVUDINE/ZIDOVUDINE.....................................41LAMOTRIGINE.........................................................51LANCET DEVICE(OTC)........................................... 27LANCING DEVICE................................................... 27LANCING DEVICE(OTC)......................................... 27LANCING DEVICE/LANCETS............................27, 28LANCING SYSTEM(OTC)........................................27LANOXIN..................................................................10LANSOPRAZOLE.....................................................53LANSOPRAZOLE/AMOXICILN/CLARITH............... 53LANTHANUM CARBONATE.................................... 29LANTUS....................................................................28LANTUS SOLOSTAR............................................... 28LAPATINIB DITOSYLATE.........................................46LASIX....................................................................... 12LASTACAFT............................................................. 31LATANOPROST....................................................... 33LATISSE................................................................... 33LATUDA(TAB)(120 MG)................................. 8, 63, 70LATUDA(TAB)(20 MG)................................... 8, 63, 70LATUDA(TAB)(40 MG)................................... 8, 63, 70LATUDA(TAB)(60 MG)................................... 8, 63, 70LATUDA(TAB)(80 MG)................................... 8, 63, 70LAZANDA........................................................... 49, 75LC D NEBULIZER SET.............................................. 6LC PLUS.....................................................................6LC SPRINT NEBULIZER............................................6LC STAR.....................................................................6LEFLUNOMIDE........................................................ 42LENALIDOMIDE.......................................................46LEPIRUDIN,RECOMBINANT...................................35LESCOL....................................................... 13, 63, 70LESCOL XL.................................................. 13, 63, 70LETAIRIS............................................................ 12, 75
L.A. Care Page 86 of 96
Index
LETROZOLE............................................................ 45LEUCOVORIN CALCIUM.........................................47LEUKERAN.............................................................. 45LEUKINE............................................................ 35, 75LEUPROLIDE ACETATE....................................30, 31LEVACET..................................................................48LEVALBUTEROL HCL................................................5LEVALBUTEROL TARTRATE.................................... 5LEVAQUIN................................................................38LEVATOL.................................................................. 11LEVEMIR............................................................28, 70LEVEMIR FLEXPEN.......................................... 28, 70LEVETIRACETAM.................................................... 51LEVITRA.......................................................29, 63, 77LEVOBUNOLOL HCL...............................................33LEVOCETIRIZINE DIHYDROCHLORIDE..................4LEVOFLOXACIN................................................ 32, 38LEVOMILNACIPRAN HYDROCHLORIDE.................7LEVONORGESTREL............................................... 14LEVONORGESTREL-ETH ESTRADIOL..................14LEVORA-28........................................................14, 77LEVORPHANOL TARTRATE................................... 49LEVOTHYROXINE SODIUM....................................31LEVOXYL................................................................. 31LEVULAN................................................................. 47LEXAPRO...................................................................7LEXIVA............................................................... 41, 75LIALDA............................................................... 43, 70LIBERTY MONITOR(OTC).......................................26LIBERTY TEST STRIPS(OTC).................................24LIBRAX.....................................................................53LIBRITABS..................................................................8LIDOCAINE.............................................................. 21LIDOCAINE HCL................................................ 21, 43LIDOCAINE HCL VISCOUS.....................................43LIDOCAINE HCL/COLLAGEN................................. 21LIDOCAINE HCL/PF.................................................32LIDOCAINE/PRILOCAINE....................................... 21LIDOCAINE/TETRACAINE.......................................21LIDOCAINE-HYDROCORTISONE.....................20, 44LIDOCAINE-PRILOCAINE....................................... 21LIDODERM...............................................................21LIDORX.................................................................... 21LIDOVIR................................................................... 17LINACLOTIDE.......................................................... 44LINAGLIPTIN............................................................22LINAGLIPTIN/METFORMIN HCL.............................22LINDANE.................................................................. 17LINEZOLID............................................................... 38LINZESS.............................................................44, 63LIOTHYRONINE SODIUM....................................... 31LIOTRIX....................................................................31LIPASE/PROTEASE/AMYLASE...............................52LIPITOR....................................................................13LIPOCHOL PLUS..................................................... 14LIPTRUZET(TAB)(10 MG-10MG).................13, 63, 70LIPTRUZET(TAB)(10 MG-20MG).................13, 63, 70LIPTRUZET(TAB)(10 MG-40MG).................13, 63, 70LIPTRUZET(TAB)(10 MG-80MG).................13, 63, 71LIRAGLUTIDE.......................................................... 22LISDEXAMFETAMINE DIMESYLATE........................ 8LISINOPRIL.............................................................. 11LISINOPRIL/HYDROCHLOROTHIAZIDE................ 10LISSAMINE GREEN.................................................33LITE TOUCH(OTC).................................................. 27LITEAIRE....................................................................6LITETOUCH............................................................... 6LITHIUM..................................................................... 8LITHIUM CARBONATE.............................................. 8LITHIUM CITRATE..................................................... 8LITHOBID................................................................... 8LITHOSTAT.............................................................. 44LIVALO......................................................... 13, 63, 71LIVER EXTRACT (NON-VIT)................................... 44L-NORGEST-ETH ESTR/ETHIN ESTRA................. 14LO LOESTRIN FE.............................................. 14, 71LOCOID LIPOCREAM..............................................18LOCOID(CREAM).....................................................18LOCOID(LOTION).................................................... 18LOCOID(OINT).........................................................18LOCOID(SOLUTION)............................................... 18LODOXAMIDE TROMETHAMINE............................32LOFIBRA.................................................................. 13LOHIST-DM.............................................................. 15LOMEFLOXACIN HCL............................................. 38LOMITAPIDE MESYLATE........................................ 13LOMOTIL..................................................................44LOMUSTINE.............................................................45LOPERAMIDE.......................................................... 44
LOPERAMIDE HCL..................................................44LOPID.......................................................................14LOPINAVIR/RITONAVIR...........................................41LOPRESSOR HCT...................................................12LOPROX...................................................................17LORAZEPAM..............................................................8LORCASERIN HCL.................................................. 59LORCET 10-650.................................................49, 63LORCET PLUS...................................................49, 63LORTAB..............................................................49, 63LORZONE................................................................ 52LOSARTAN POTASSIUM......................................... 11LOSARTAN/HYDROCHLOROTHIAZIDE................. 11LOTEMAX.................................................................32LOTENSIN................................................................ 11LOTENSIN HCT....................................................... 10LOTEPREDNOL ETABONATE.................................32LOTREL....................................................................10LOTRISONE.............................................................17LOTRONEX..............................................................44LOUTREX.................................................................19LOVASTATIN............................................................ 13LOVAZA..............................................................14, 63LOVENOX(SYRINGE)(100 MG/ML).................. 35, 63LOVENOX(SYRINGE)(120MG/.8ML)................ 35, 63LOVENOX(SYRINGE)(150 MG/ML).................. 35, 63LOVENOX(SYRINGE)(30MG/0.3ML)................ 35, 63LOVENOX(SYRINGE)(40MG/0.4ML)................ 35, 63LOVENOX(SYRINGE)(60MG/0.6ML)................ 35, 63LOVENOX(SYRINGE)(80MG/0.8ML)................ 35, 63LOVENOX(VIAL)................................................ 35, 63LOXAPINE..................................................................8LOXAPINE SUCCINATE............................................ 8LOXITANE.................................................................. 8LUBIPROSTONE......................................................44LUCENTIS................................................................33LUCINACTANT.........................................................48LUFYLLIN...................................................................6LUFYLLIN-400............................................................6LUGOL'S.................................................................. 16LULICONAZOLE...................................................... 17LUMIGAN........................................................... 32, 63LUNESTA....................................................... 9, 63, 71LUPRON DEPOT..................................................... 30LUPRON DEPOT-PED.............................................31LURASIDONE HCL.................................................... 8LUTREPULSE.......................................................... 31LUVOX CR..................................................... 7, 63, 71LUXIQ.......................................................................18LUZU........................................................................ 17LYCELLE.................................................................. 17LYMPHOCYTE IMMU GLOB.,RABBIT.....................37LYMPHOCYTE IMMUNE GLOBULIN...................... 37LYRICA..................................................................... 51LYSINE HCL/VIT B COMP/FA/ZINC........................ 59LYSINE/VITAMIN B COMPLEX/FA/ZN.....................59LYSIPLEX................................................................. 59LYSODREN.............................................................. 47LYSTEDA..................................................................34- M -MACITENTAN...........................................................12MACROBID.............................................................. 38MACRODANTIN(CAP)(100 MG)..............................38MACRODANTIN(CAP)(25 MG)................................38MACRODANTIN(CAP)(50 MG)................................38MACUGEN............................................................... 33MACUTEK................................................................ 54MAFENIDE ACETATE.............................................. 17MAGAN.....................................................................48MAGNACET....................................................... 49, 63MAGNEBIND 400 RX...............................................29MAGNESIUM SALICYLATE..................................... 48MAKENA...................................................................36MALARONE..............................................................40MALATHION............................................................. 17MANNITOL............................................................... 12MANNITOL/SORBITOL SOLUTION.........................20MAPROTILINE HCL................................................... 8MARAVIROC............................................................ 41MARINOL....................................................... 4, 63, 71MARNATAL-F........................................................... 57MARPLAN.................................................................. 7MARQIBO...........................................................47, 75MATULANE.............................................................. 47MAVIK....................................................................... 11MAXAIR AUTOHALER............................................... 5MAXALT..............................................................50, 63MAXALT MLT......................................................50, 63MAXAQUIN...............................................................38
MAXARON FORTE.................................................. 55MAXIDEX..................................................................31MAXIDONE........................................................ 49, 63MAXIMA(OTC)..........................................................24MAXINATE................................................................56MAXITROL............................................................... 31MAXZIDE-25 MG......................................................12MB HYDROGEL....................................................... 19MECAMYLAMINE HCL.............................................11MECASERMIN......................................................... 31MECHLORETHAMINE HCL...............................21, 45MECLIZINE HCL........................................................ 4MECLOFENAMATE SODIUM.................................. 43MEDIHONEY............................................................21MEDROL(TAB DS PK)............................................. 42MEDROL(TAB)(16 MG)............................................ 42MEDROL(TAB)(2 MG).............................................. 42MEDROL(TAB)(32 MG)............................................ 42MEDROL(TAB)(4 MG).............................................. 42MEDROL(TAB)(8 MG).............................................. 42MEDROXYPROGESTERONE ACET.......................36MEDROXYPROGESTERONE ACETATE.......... 14, 36MEFENAMIC ACID...................................................43MEFLOQUINE HCL..................................................40MEGESTROL ACETATE.......................................... 47MEKINIST...........................................................46, 75MELOXICAM............................................................ 43MELOXICAM/IRR CNTR-IRR CMB #2.....................43MELPAQUE HP........................................................ 21MELPHALAN............................................................45MELPHALAN HCL....................................................45MEMANTINE HCL......................................................7MENEST...................................................................36MENOPUR............................................................... 29MENOSTAR........................................................36, 63MENOTROPINS.......................................................29MENTAX................................................................... 17MENTHOL/BANDAGES, TUBULAR........................ 20MEPENZOLATE BROMIDE..................................... 53MEPERIDINE HCL................................................... 49MEPERIDINE HCL/PF..............................................49MEPHYTON............................................................. 36MEPROBAMATE........................................................ 8MERCAPTOPURINE................................................45MESALAMINE.......................................................... 43MESALAMINE W/CLEANSING WIPES................... 43MESEHIST WC........................................................ 15MESNA.....................................................................47MESNEX...................................................................47MESTINON(SYRUP)..................................................7MESTINON(TAB ER)..................................................7MESTINON(TAB)........................................................7METAPROTERENOL SULFATE................................ 5METAXALONE......................................................... 52METFORMIN HCL....................................................22METHADONE HCL...................................................49METHAMPHETAMINE HCL....................................... 8METHAZOLAMIDE...................................................32METHEN MAND/NAPHOS M-B M-H....................... 54METHEN/M-BLUE/SAL/NA PHOS/HYOS................38METHEN/SOD PHOS/METH BLUE/HYOS..............38METHENAM/ME BLUE/BA/SALICY/HYO................38METHENAMINE HIPPURATE..................................38METHENAMINE MANDELATE................................ 38METHIMAZOLE........................................................31METHIONINE/INOSITOL/CHOLINE/FA................... 14METHITEST............................................................. 36METHOCARBAMOL.................................................52METHOTREXATE.............................................. 42, 45METHOTREXATE SODIUM............................... 42, 45METHOTREXATE SODIUM/PF............................... 45METHOTREXATE/PF...............................................42METHOXSALEN.......................................................21METHOXSALEN, RAPID..........................................21METHSCOPOLAMINE BROMIDE........................... 53METHSCP BR/LA/S.THM/L.PARA/BIF.................... 53METHSUXIMIDE...................................................... 51METHYCLOTHIAZIDE............................................. 13METHYLDOPA......................................................... 11METHYLDOPA/HYDROCHLOROTHIAZIDE............11METHYLDOPA-HYDROCHLOROTHIAZIDE........... 11METHYLERGONOVINE MALEATE......................... 15METHYLIN............................................................9, 63METHYLNALTREXONE BROMIDE......................... 44METHYLPHENIDATE.................................................9METHYLPHENIDATE ER(CPBP 50-50)(20 MG)......9,6 3METHYLPHENIDATE ER(CPBP 50-50)(30 MG)......9,6 3
L.A. Care Page 87 of 96
Index
METHYLPHENIDATE ER(CPBP 50-50)(40 MG)....... 9METHYLPHENIDATE ER(TAB ER)(10 MG).............. 9METHYLPHENIDATE ER(TAB ER)(20 MG)........ 9, 63METHYLPHENIDATE HCL.........................................9METHYLPREDNISOLONE.......................................42METHYLTESTOSTERONE...................................... 36METIPRANOLOL......................................................33METOCLOPRAMIDE HCL....................................... 53METOCLOPRAMIDE HCL INTENSOL.................... 53METOLAZONE......................................................... 13METOPROLOL SUCCINATE....................................11METOPROLOL SUCCINATE/HCTZ.........................12METOPROLOL TARTRATE......................................11METOPROLOL/HYDROCHLOROTHIAZIDE........... 12METOPROLOL-HYDROCHLOROTHIAZIDE...........12METOZOLV ODT......................................................53METRELEPTIN.........................................................31METROGEL..............................................................16METROGEL-VAGINAL............................................. 54METROLOTION....................................................... 16METRONIDAZOLE.......................................16, 40, 54METRONIDAZOLE/SKIN CLEANSR #23................ 16METYROSINE.......................................................... 11MEVACOR................................................................13MEXILETINE HCL.................................................... 10MIACALCIN(SPRAY/PUMP).................................... 30MIACALCIN(VIAL)....................................................30MICONAZOLE..........................................................39MICONAZOLE 3.......................................................54MICONAZOLE NITRATE..........................................54MICONAZOLE NITRATE/HC....................................17MICONAZOLE NITRATE/ZINC OX/PET.................. 17MICRO ELITE.............................................................6MICRO PLUS............................................................. 6MICRO(OTC)......................................................24, 26MICROCHAMBER......................................................6MICRODOT XTRA(OTC)..........................................24MICRODOT(OTC).............................................. 24, 26MICROFIBRILLAR COLLAGEN...............................35MICROGESTIN.................................................. 15, 77MICROGESTIN FE.............................................14, 77MICROLET 2(OTC).................................................. 27MICROSPACER......................................................... 6MICROZIDE..............................................................13MIDAZOLAM HCL...................................................... 9MIDODRINE HCL.....................................................14MIFEPRISTONE.......................................................22MIGERGOT........................................................ 50, 63MIGLITOL................................................................. 22MIGRANAL.........................................................50, 63MILLIPRED...............................................................42MILLIPRED DP.........................................................42MILNACIPRAN HCL.................................................47MILTOWN................................................................... 8MINASTRIN 24 FE................................................... 14MINI LANCING DEVICE(OTC).................................27MINI PLUS NEBULIZER.............................................6MINIELITE.................................................................. 6MINIPRESS..............................................................10MINIVELLE.........................................................36, 63MINI-WRIGHT PEAK FLOW METER.........................6MINOCIN.................................................................. 39MINOCYCLINE HCL.................................................39MINOCYCLINE HCL MICROSPHERES.................. 48MINOCYCLINE HCL(TAB ER 24H)..............39, 60, 63MINOCYCLINE HCL(TAB)....................................... 39MINOCYCLINE HCL/SKIN CL NO.4........................ 39MINOXIDIL................................................................11MIPOMERSEN SODIUM..........................................13MIRABEGRON......................................................... 54MIRAPEX..................................................................51MIRAPEX ER............................................... 51, 63, 71MIRTAZAPINE............................................................7MIRVASO........................................................... 16, 63MISOPROSTOL....................................................... 53MISTERNEB NEBULIZER..........................................6MITHRACIN..............................................................45MITOMYCIN....................................................... 33, 45MITOSOL..................................................................33MITOTANE............................................................... 47MITOXANTRONE HCL.......................................47, 75MOBIC......................................................................43MODAFINIL................................................................ 9MOEXIPRIL HCL...................................................... 11MOEXIPRIL/HYDROCHLOROTHIAZIDE................ 10MOMETASONE FUROAT/AMMONIUM LAC........... 19MOMETASONE FUROATE.............................. 4, 5, 19MOMETASONE/FORMOTEROL................................5MOMEXIN.................................................................19
MONAGHAN Z STAT..................................................6MONOCLATE-P........................................................34MONODOX...............................................................39MONOJECT PREFILL ADVANCED......................... 35MONONINE..............................................................34MONTELUKAST SODIUM......................................... 5MONUROL............................................................... 38MORGIDOX..............................................................39MORPHINE SULFATE..............................................49MORPHINE SULFATE LIPOSOMAL/PF.................. 49MORPHINE SULFATE/PF........................................ 49MOTOFEN................................................................44MOVIPREP...............................................................44MOXATAG................................................................ 38MOXEZA...................................................................32MOXIFLOXACIN HCL........................................ 32, 38MS CONTIN..............................................................49M-TETRAHYROFOLATE/NIACIN/CU/ZN................ 56MTH/ME BLUE/SOD PHOS/PHEN/HYOS...............38MULTAQ................................................................... 10MULTICHEW............................................................ 56MULTIGEN............................................................... 55MULTIGEN FOLIC....................................................55MULTIGEN PLUS..................................................... 55MULTI-LANCET DEVICE(OTC)............................... 27MULTIVIT, IRON, MIN #4, FA................................... 56MULTIVIT, IRON, MIN #5, FA................................... 56MULTIVIT, IRON, MIN #6, FA................................... 56MULTIVIT, MIN CMB#20/IRON/FA........................... 56MULTIVIT, MIN NO.21/FOLIC ACID.........................56MULTIVIT, MIN NO.23/FOLIC ACID.........................56MULTIVIT, MINCMB#11/FOLIC ACID...................... 59MULTIVITAMIN NO.44/VIT D3/K..............................56MULTIVITAMIN W/IRON, MINERALS...................... 56MULTI-VITAMIN W-FLUORIDE................................56MULTIVITAMIN WITH FLUORIDE........................... 56MULTIVITAMIN, MIN CMB#25/FA/D3...................... 59MULTI-VITAMIN-FLUOR-IRON................................ 56MULTIVITAMINS W/FLUORIDE...............................56MULTIVITAMINS W-FLUORIDE-IRON.....................56MULTIVITAMINS WITH FLUORIDE......................... 56MULTIVITAMINS WITH MIN NO.7/FA......................56MULTIVITAMINS-A,B,D,E,K,ZN............................... 56MULTIVITS WITH IRON & FLUORIDE.................... 56MULTIVITS,THERAP W-FE,HEMATIN.....................56MUPIROCIN............................................................. 17MUPIROCIN CALCIUM......................................17, 48MUSE................................................................. 29, 63MUSTARGEN........................................................... 45MV, MIN CMB #6/FA/LUT/LYCO/Q10...................... 56MV, MIN CMB#16/FA/LUTEIN/LYCOP.....................55MV, MIN CMB#24/IRON PS CMP/FA.......................56MV, MIN CMB#26/FA/ALA/LUTEIN.......................... 59MV, MIN CMB#9/FA/SAW PALMET XT....................56MV,MIN #10/FA/D3/ALIP ACID/LUT.........................56MV/DIETARY 4/DNA/RNA........................................56MVC-FLUORIDE...................................................... 56M-VIT........................................................................58MYALEPT................................................................. 31MYAMBUTOL........................................................... 39MYCOBUTIN............................................................ 40MYCOPHENOLATE MOFETIL.................................37MYCOPHENOLATE MOFETIL HCL.........................37MYCOPHENOLATE SODIUM.................................. 37MYCOPHENOLIC ACID...........................................37MYDFRIN................................................................. 32MYDRIACYL.............................................................33MYGLUCOHEALTH CONTROL SOLUTION(OTC)..................................................................................25MYGLUCOHEALTH(OTC)..................................24, 26MYKIDZ IRON FL.....................................................56MYLERAN................................................................ 45MYNATAL................................................................. 57MYNATE 90 PLUS....................................................57MYO VYT..................................................................59MYRBETRIQ................................................ 54, 63, 71MYSOLINE............................................................... 51- N -NA PHOS,M-B/K PHOS,MONOB.............................54NA SULFACETM/PREDNIS SP............................... 32NABILONE..................................................................4NABUMETONE........................................................ 43NADOLOL.................................................................11NADOLOL/BENDROFLUMETHIAZIDE....................12NAFARELIN ACETATE.............................................31NAFTIFINE HCL.......................................................17NAFTIN(CREAM)..................................................... 17NAFTIN(GEL)(1 %)...................................................17NAFTIN(GEL)(2 %)...................................................17
NALBUPHINE HCL.................................................. 49NALFON................................................................... 43NALIDIXIC ACID.......................................................38NALTREXONE HCL................................................... 9NALTREXONE MICROSPHERES............................. 8NAMENDA XR(CAP 24 DSPK)............................ 7, 63NAMENDA XR(CAP SPR 24).............................. 7, 63NAMENDA(SOLUTION).......................................7, 63NAMENDA(TAB DS PK).......................................7, 63NAMENDA(TAB)...................................................7, 63NAMGFLU/CYCLO/PHOS/NAHCO3/NACL.............19NAPHAZOLINE HCL................................................ 32NAPHAZOLINE HCL W/ANTAZOLINE.................... 32NAPHAZOLINE HCL/ANTAZOLINE.........................32NAPHOS M-B M-H/NA PHOS,DI-BA....................... 44NAPRELAN.............................................................. 43NAPROSYN..............................................................43NAPROXEN..............................................................43NAPROXEN SODIUM.............................................. 43NAPROXEN/ESOMEPRAZOLE MAG......................43NAPROXEN/IRR CNTR-IRRIT CMB #2...................43NARATRIPTAN HCL.................................................50NARDIL.......................................................................7NASACORT AQ....................................................4, 63NASCOBAL.............................................................. 59NASONEB NASAL NEBULIZER................................ 6NASONEX............................................................ 4, 63NATACHEW..............................................................58NATACYN................................................................. 32NATAFORT...............................................................57NATALIZUMAB......................................................... 47NATALVIRT 90 DHA................................................. 56NATALVIRT CA.........................................................57NATALVIT................................................................. 58NATAMYCIN............................................................. 32NATAZIA............................................................. 14, 71NATEGLINIDE.......................................................... 22NATELLE ONE......................................................... 57NATROBA.................................................................17NATURE-THROID.................................................... 31NATURETIN-5.......................................................... 12NAVELBINE..............................................................47NEBIVOLOL HCL..................................................... 11NEBULIZER................................................................6NEBULIZER/COMPRESSOR.....................................6NEBUPENT.............................................................. 40NECON...............................................................15, 77NEDOCROMIL SODIUM..........................................32NEFAZODONE HCL...................................................7NEGGRAM............................................................... 38NELARABINE...........................................................45NELFINAVIR MESYLATE.........................................41NEO/POLYMYX B SULF/DEXAMETH..................... 31NEOMY SULF/BACITRA/POLYMYXIN B.................32NEOMY SULF/BACITRAC ZN/POLY/HC.................31NEOMY SULF/COLIST SUL/HC/THONZ.................28NEOMY SULF/POLYMYXIN B SULFATE................ 20NEOMYCIN SULFATE..............................................39NEOMYCIN SULFATE/DEX NA PH......................... 31NEOMYCIN W/DEXAMETHASONE........................ 31NEOMYCIN/BACITRA/POLYMYXIN/HC..................18NEOMYCIN/POLYMYXIN B SULF/HC...............18, 28NEOMYCIN/POLYMYXN B/GRAMICIDIN................32NEOMYCIN-BACITRACIN-POLY-HC.......................31NEOMYCIN-POLYMYXIN-HC.................................. 28NEO-POLYCIN......................................................... 32NEORAL...................................................................37NEOSALUS.............................................................. 19NEOSALUS CP........................................................ 19NEOSPORIN............................................................ 32NEOSPORIN G.U. IRRIGANT..................................20NEOSTIGMINE BROMIDE.........................................7NEPAFENAC............................................................ 32NEPHPLEX RX........................................................ 59NEPHROCAPS QT...................................................59NEPHRON FA.......................................................... 55NEPTAZANE............................................................ 32NESINA.............................................................. 22, 71NESTABS ABC.........................................................56NESTABS DHA.........................................................56NEULASTA......................................................... 35, 75NEUMEGA................................................................35NEUPOGEN....................................................... 35, 75NEUPRO...................................................... 51, 63, 71NEURIN-SL.............................................................. 59NEURONTIN............................................................ 51NEUTEK 2TEK TEST STRIPS(OTC).......................24NEVANAC.................................................................32NEVIRAPINE............................................................41
L.A. Care Page 88 of 96
Index
NEWTEK(OTC)........................................................ 26NEXA PLUS............................................................. 58NEXAVAR..................................................... 46, 63, 75NEXAVIR.................................................................. 44NEXIUM..............................................................53, 63NIACIN......................................................................14NIACIN SR 250MG...................................................14NIACIN/LOVASTATIN...............................................13NIACIN/SIMVASTATIN............................................. 13NIASPAN............................................................ 14, 71NICARDIPINE HCL.................................................. 12NICOMIDE................................................................56NICOTINE.................................................................52NICOTROL......................................................... 52, 63NICOTROL NS................................................... 52, 63NIFEDIPINE..............................................................12NILANDRON...................................................... 45, 63NILOTINIB HCL........................................................46NILUTAMIDE............................................................ 45NIMODIPINE............................................................ 12NIMOTOP................................................................. 12NIPENT.....................................................................45NISOLDIPINE...........................................................12NITAZOXANIDE....................................................... 16NITRO-BID............................................................... 14NITRO-DUR(PATCH TD24)(0.1MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.2MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.3 MG/HR)................. 14NITRO-DUR(PATCH TD24)(0.4MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.6MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.8MG/HR).................. 14NITROFURANTOIN..................................................38NITROFURANTOIN MACROCRYSTAL...................38NITROFURANTOIN MONOHYD/M-CRYST............ 38NITROFURAZONE...................................................16NITROGLYCERIN.............................................. 14, 44NITROSTAT..............................................................14NIZATIDINE.............................................................. 53NIZORAL.................................................................. 17NONOXYNOL 9........................................................14NORDITROPIN FLEXPRO.................................30, 75NORDITROPIN NORDIFLEX.............................30, 75NORETH A-ET ESTRA/FE FUMARATE.................. 14NORETH-ETHINYL ESTRADIOL/IRON...................15NORETHIND AC/ETHINYL ESTRADIOL.................36NORETHINDRONE..................................................15NORETHINDRONE ACETATE.................................36NORETHINDRONE A-E ESTRADIOL......................15NORETHINDRONE-ETHINYL ESTRAD..................15NORETHINDRONE-MESTRANOL.......................... 15NORFLOXACIN........................................................38NORFLURANE/HFC 245FA..................................... 21NORGESTIMATE-ETHINYL ESTRADIOL............... 15NORGESTREL-ETHINYL ESTRADIOL................... 15NORINYL 1+50...................................................15, 77NORITATE................................................................ 16NORMAL SALINE.................................................... 29NORMAL SALINE FLUSH........................................29NORMLGEL AG....................................................... 16NOROXIN.................................................................38NORPACE................................................................ 10NORPACE CR.......................................................... 10NORPRAMIN..............................................................8NOR-Q-D............................................................15, 77NORTRIPTYLINE HCL...............................................8NORVASC................................................................ 12NORVIR..............................................................41, 63NOVA MAX BLOOD GLUCOSE METER(OTC)....... 26NOVA MAX(OTC)..................................................... 24NOVACORT..............................................................21NOVAFERRUM........................................................ 55NOVAREL.................................................................29NOVOLIN 70-30(OTC)............................................. 28NOVOLIN N INNOLET(OTC)................................... 28NOVOLIN N(OTC)....................................................28NOVOLIN R(OTC)....................................................28NOVOLOG................................................................28NOVOLOG FLEXPEN.............................................. 28NOVOLOG MIX 70-30..............................................28NOVOLOG MIX 70-30 FLEXPEN............................ 28NOVOSEVEN...........................................................34NOVOSEVEN RT..................................................... 34NOXAFIL.................................................................. 39NPH, HUMAN INSULIN ISOPHANE........................ 28NPLATE.................................................................... 35NUCORT.................................................................. 18NUCYNTA...........................................................50, 63NUCYNTA ER.....................................................50, 63NU-DERM SUNFADER............................................ 21
NUEDEXTA........................................................ 48, 75NULOJIX...................................................................37NUMORPHAN.......................................................... 50NUOX....................................................................... 20NUQUIN HP..............................................................21NUTRICAP............................................................... 55NUTROPIN.........................................................30, 75NUTROPIN AQ...................................................30, 75NUTROPIN AQ NUSPIN.................................... 30, 75NUVAIL..................................................................... 20NUVARING................................................... 14, 63, 71NUVIGIL............................................................... 9, 75NYLIDRIN HCL.........................................................14NYMALIZE..........................................................12, 75NYSTATIN.......................................................... 17, 39NYSTATIN/EMOLLIENT COMBO NO.54................. 17NYSTATIN/HYDROCORTISONE/DIPHEN...............39NYSTATIN/LIDOCAINE/DIPHENHYD......................39NYSTATIN/TCN/HC/DIPHENHYDRAMIN................ 39NYSTATIN/TRIAMCIN.............................................. 17NYSTATIN-TRIAMCINOLONE................................. 17- O -OB COMPLETE........................................................58OB COMPLETE 400.................................................57OB COMPLETE ONE...............................................56OB COMPLETE PETITE.......................................... 56OB COMPLETE PREMIER...................................... 58OB COMPLETE WITH DHA.....................................56OBINUTUZUMAB.....................................................45OBSTETRIX EC....................................................... 58OBTREX...................................................................58OBTREX DHA.......................................................... 57O-CAL FA................................................................. 58OCELLA....................................................... 14, 71, 77OCTAGAM................................................................36OCUFEN...................................................................32OCUFLOX................................................................ 32OFATUMUMAB.........................................................45OFLOXACIN.................................................28, 32, 38OFTASCEIN DISOD/BENOXINATE HCL.................33OGEN....................................................................... 36OLANZAPINE.............................................................8OLANZAPINE PAMOATE...........................................8OLANZAPINE/FLUOXETINE HCL............................. 9OLEPTRO ER................................................ 7, 63, 71OLMESARTAN MEDOXOMIL...................................11OLMESARTAN/AMLODIPIN/HCTHIAZID................ 10OLMESARTAN/HYDROCHLOROTHIAZIDE............11OLOPATADINE HCL.............................................4, 31OLSALAZINE SODIUM............................................ 43OLUX........................................................................18OLYSIO...............................................................41, 75OM-3/CA CARB/D3/FA/MV CMB 13........................ 56OM-3/DHA/EPA/B12/FA/B6/PHYTOST.................... 56OM-3/DHA/EPA/D3/B12/FA/B-6/PHY.......................56OMACETAXINE MEPESUCCINATE........................ 47OMALIZUMAB............................................................5OMECLAMOX-PAK.................................................. 53OMEGA-3 ACID ETHYL ESTERS............................14OMEPRAZOLE.........................................................53OMEPRAZOLE MAGNESIUM..................................53OMEPRAZOLE/CLARITH/AMOXICILLIN.................53OMEPRAZOLE/SODIUM BICARBONATE...............53OMNARIS.......................................................4, 63, 71OMNIPRED.............................................................. 32OMNITROPE......................................................30, 75ON CALL EXPRESS TEST STRIP(OTC).................24ON CALL LANCING DEVICE(OTC).........................27ON CALL PLUS LANCING DEVICE(OTC)...............27ON CALL PLUS METER(OTC)................................ 26ON CALL PLUS TEST STRIP(OTC)........................ 24ON CALL VIVID METER(OTC)................................ 26ON CALL VIVID PAL(OTC)...................................... 26ON CALL VIVID TEST STRIP(OTC)........................ 24ONCASPAR........................................................47, 75ONDANSETRON........................................................4ONDANSETRON HCL................................................4ONE TOUCH DELICA(OTC).................................... 27ONE TOUCH SURESOFT(OTC)..............................27ONE TOUCH ULTRA(OTC)......................................24ONE TOUCH VERIO(OTC)...................................... 24ONFI(ORAL SUSP)...................................... 51, 63, 71ONFI(TAB).................................................... 51, 63, 71ONGLYZA...........................................................22, 71ONMEL.....................................................................39ONSOLIS............................................................49, 76OPANA ER............................................................... 50OPANA(AMPUL).......................................................50OPANA(TAB)............................................................ 50
OPIUM TINCTURE...................................................44OPIUM/BELLADONNA ALKALOIDS........................49OPRELVEKIN........................................................... 35OPSUMIT........................................................... 12, 76OPTICHAMBER......................................................... 6OPTICHAMBER DIAMOND....................................... 6OPTIMYD................................................................. 32OPTIVAR.................................................................. 31OPTUMRX(OTC)................................................24, 26ORACEA................................................ 39, 60, 63, 71ORACIT.................................................................... 54ORALAIR..............................................................4, 76ORAP..........................................................................8ORAPRED................................................................42ORAPRED ODT....................................................... 42ORAVIG.................................................................... 39ORENCIA........................................................... 42, 76ORENITRAM ER................................................ 12, 76ORLISTAT.................................................................59ORPHENADRINE CITRATE.....................................52ORPHENADRINE COMPOUND FORTE................. 52ORPHENADRINE/ASPIRIN/CAFFEINE...................52ORTHO ALL-FLEX............................................. 15, 77ORTHO TRI-CYCLEN LO.................................. 15, 71ORTHO-NOVUM................................................ 15, 77OSELTAMIVIR PHOSPHATE................................... 40OSENI................................................................ 22, 72OSMOPREP.............................................................44OSPEMIFENE.......................................................... 31OSPHENA.......................................................... 31, 63OTEZLA..............................................................42, 76OTIC CARE.............................................................. 29OTICIN......................................................................29OTOZIN.................................................................... 28OTREXUP.................................................... 42, 63, 72OVACE..................................................................... 19OVACE PLUS(CLEANSR ER)..................................19OVACE PLUS(CREAM)............................................19OVACE PLUS(SHAMPOO)...................................... 19OVIDE.......................................................................17OVIDREL..................................................................29OXACILLIN SODIUM................................................38OXALIC ACID...........................................................20OXALIPLATIN...........................................................45OXALIS.....................................................................20OXANDRIN...............................................................36OXANDROLONE......................................................36OXAPROZIN.............................................................43OXAZEPAM................................................................ 8OXCARBAZEPINE................................................... 51OXECTA................................................................... 49OXICONAZOLE NITRATE........................................17OXISTAT...................................................................17OXSORALEN........................................................... 21OXSORALEN-ULTRA...............................................21OXTELLAR XR(TAB ER 24H)(150 MG)....... 51, 63, 72OXTELLAR XR(TAB ER 24H)(300 MG)....... 51, 63, 72OXTELLAR XR(TAB ER 24H)(600 MG)....... 51, 63, 72OXYBENZONE/OCTINOX/H-QUINONE..................21OXYBUTYNIN.......................................................... 54OXYBUTYNIN CHLORIDE.......................................54OXYCEL................................................................... 35OXYCODONE HCL.................................................. 49OXYCODONE HCL/ACETAMINOPHEN............ 49, 50OXYCODONE HCL/ASPIRIN...................................50OXYCODONE HCL-IBUPROFEN............................48OXYCODONE-ACETAMINOPHEN.................... 49, 64OXYCONTIN............................................................ 49OXYMETHOLONE................................................... 36OXYMORPHONE HCL.............................................50OXY-TCN HCL/POLYMYX B SULF..........................32OXYTETRACYCLINE/POLYMYX B SULF............... 32OXYTROL.......................................................... 54, 72- P -PACLITAXEL............................................................ 47PACLITAXEL PROTEIN-BOUND............................. 47PACNEX HP............................................................. 20PACNEX LP..............................................................20PAIN EASE............................................................... 21PAIRE OB PLUS DHA.............................................. 56PALGIC.................................................................4, 60PALIFERMIN............................................................ 48PALIPERIDONE......................................................... 8PALIPERIDONE PALMITATE..................................... 9PALIVIZUMAB.......................................................... 40PAMELOR.................................................................. 8PAMINE.................................................................... 53PAMINE FORTE....................................................... 53PAMINE FQ.............................................................. 53
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Index
PANCREAZE............................................................ 52PANDEL....................................................................18PANHEMATIN...........................................................34PANITUMUMAB....................................................... 45PANRETIN................................................................21PANTOPRAZOLE SODIUM..................................... 53PAPAVERINE HCL................................................... 14PARAFON FORTE DSC...........................................52PARCOPA.................................................................50PAREGORIC............................................................ 44PAREMYD................................................................ 33PARI LC SPRINT SINUS............................................6PARI SINUS AEROSOL SYSTEM............................. 6PARICALCITOL........................................................ 31PARLODEL...............................................................50PARNATE................................................................... 7PAROMOMYCIN SULFATE......................................40PAROXETINE HCL.....................................................7PAROXETINE MESYLATE.........................................7PASER......................................................................39PATADAY.................................................................. 31PATANASE..................................................... 4, 64, 72PATANOL..................................................................31PAXIL CR....................................................................7PAXIL(ORAL SUSP)...................................................7PAXIL(TAB).................................................................7PAZOPANIB HCL..................................................... 46PCE.......................................................................... 38PEAK FLOW METER................................................. 6PEAK FLOW METER/INH ASST DEV....................... 6PED MV A,C,D3 #21 W-FLUORIDE.........................56PED MV A,C,D3 #38 W-FLUORIDE.........................56PEDI M.VIT NO.17 WITH FLUORIDE......................56PEDI MULTIVIT #37 W-FLUORIDE......................... 56PEDI MULTIVIT #65/VIT D3/VIT K........................... 56PEDI MULTIVIT NO.2 W-FLUORIDE....................... 56PEDI MV #37 W-FLUORIDE & IRON.......................56PEDI MV #45/FLUORIDE/IRON...............................56PEDI MVI NO.12/SODIUM FLUORIDE....................56PEDI MVI NO.16 WITH FLUORIDE......................... 56PEDI MVI NO.33 WITH FLUORIDE......................... 56PEDIADERM AF.......................................................17PEDIADERM HC...................................................... 19PEDIADERM TA....................................................... 19PEDIAPRED.............................................................42PEDIATRIC MV #33 W-FLUORIDE&FE...................56PEDIATRIC MV #47 W-FE&FLUORIDE...................56PEDIPIROX-4...........................................................17PEG 3350/NA SULF,BICARB,CL/KCL..................... 44PEG 3350-BOWEL 2,TWO PART PREP................. 44PEG3350/SOD SUL/NACL/ASB/C/KCL...................44PEGANONE............................................................. 51PEGAPTANIB SODIUM............................................33PEGASPARGASE.................................................... 47PEGASYS.......................................................... 41, 76PEGASYS PROCLICK....................................... 41, 76PEGFILGRASTIM.....................................................35PEGINTERFERON ALFA-2A................................... 41PEGINTERFERON ALFA-2B............................. 41, 46PEGINTRON...................................................... 41, 76PEGINTRON REDIPEN..................................... 41, 76PEGVISOMANT....................................................... 30PEMETREXED DISODIUM......................................45PENBUTOLOL SULFATE......................................... 11PENCICLOVIR......................................................... 17PENICILLAMINE...................................................... 42PENICILLIN V POTASSIUM.....................................38PENLAC................................................................... 17PENLET PLUS BLOOD SAMPLER(OTC)............... 27PENNSAID......................................................... 19, 72PENTAMIDINE ISETHIONATE.................................40PENTASA........................................................... 43, 72PENTAZOCINE HCL/ACETAMINOPHEN................ 50PENTAZOCINE HCL/NALOXONE HCL................... 50PENTAZOCINE LACTATE........................................50PENTAZOCINE-ACETAMINOPHEN........................ 50PENTAZOCINE-NALOXONE HCL........................... 50PENTOSAN POLYSULFATE SODIUM.................... 54PENTOSTATIN......................................................... 45PENTOXIFYLLINE................................................... 34PEPCID.................................................................... 53PEPCID RPD............................................................53PERAMPANEL......................................................... 51PERCOCET........................................................49, 64PERCODAN............................................................. 50PERFOROMIST................................................... 5, 64PERINDOPRIL ERBUMINE......................................11PERJETA............................................................45, 76PERMETHRIN..........................................................17
PERPHENAZINE........................................................9PERPHENAZINE/AMITRIPTYLINE HCL................... 7PERPHENAZINE-AMITRIPTYLINE........................... 7PERSANTINE...........................................................35PERTUZUMAB......................................................... 45PERTZYE................................................................. 52PETROLATUM,WHITE.............................................19PEXEVA..........................................................7, 64, 72PFLEX TRAINER........................................................6PHARMACIST CHOICE(OTC)........................... 24, 26PHENAZOPYRIDINE HCL....................................... 54PHENDIMETRAZINE TARTRATE............................59PHENELZINE SULFATE............................................ 7PHENERGAN.............................................................4PHENOBARB/HYOSCY/ATROPINE/SCOP.............53PHENOBARBITAL......................................................9PHENOL...................................................................19PHENOXYBENZAMINE HCL...................................10PHENTERMINE HCL............................................... 59PHENTERMINE RESIN............................................59PHENTERMINE/TOPIRAMATE............................... 59PHENYLBUTAZONE................................................ 43PHENYLEPHRINE HCL........................................... 32PHENYLEPHRINE HCL/PROMETH HCL................15PHENYTEK.............................................................. 51PHENYTOIN.............................................................51PHENYTOIN SODIUM EXTENDED.........................51PHOSLO...................................................................29PHOSLYRA.............................................................. 29PHOSPHASAL......................................................... 38PHOSPHOLINE IODIDE.......................................... 33PHOSPHORUS #1................................................... 54PHOTOFRIN.......................................................47, 76PHRENILIN FORTE................................................. 48PHYTONADIONE..................................................... 36PICATO(GEL)(0.015 %)..................................... 21, 64PICATO(GEL)(0.05 %)....................................... 21, 64PILOCARPINE HCL........................................... 33, 45PIMECROLIMUS......................................................22PIMOZIDE.................................................................. 8PINDOLOL................................................................11PINNACAINE............................................................29PIOGLITAZONE HCL............................................... 22PIOGLITAZONE HCL/GLIMEPIRIDE....................... 22PIOGLITAZONE HCL/METFORMIN HCL................ 23PIRBUTEROL ACETATE............................................5PIROXICAM..............................................................43PITAVASTATIN CALCIUM........................................ 13PLACIDYL.................................................................. 9PLAN B ONE-STEP..................................... 14, 60, 77PLAQUENIL............................................................. 40PLAVIX..................................................................... 35PLETAL.....................................................................35PLEXION.................................................................. 17PLIAGLIS..................................................................21PLICAMYCIN............................................................45PN VIT.W-O CA #7, IRON,FA,DHA.......................... 56PN VITS.W-O CA #8, IRON,FA................................ 56PN W-CA64/IRON CB&GL/FA/DSS/DH................... 56PN85/IRON CB&ASP G/FA/DHA/FISH.................... 56PNV #14/FERROUS FUM/FOLIC ACID...................56PNV #30/IRON CARB&ASPG/FA/OM3....................56PNV #35/IRON/FA #6/DHA...................................... 56PNV #38/IRON FUM/FOLATE/DHA......................... 56PNV #56/IRON CARB&ASPG/FA/DHA....................56PNV #8/IRON PS CMP&ASPG/FA/DHA.................. 56PNV #86/IRON POLY/FA/DHA/EPA......................... 56PNV #87/IRON BISGLY/FA/DHA..............................56PNV 11-IRON FUM-FOLIC ACID-OM3.................... 56PNV 18/FE,CARB/FA/DSS/UBI/DHA....................... 56PNV COMB NO.3/IRON FUM&GLUC/FA.................56PNV COMB.NO.44/IRON/FOLIC ACID....................56PNV COMB.NO43/IRON,CARB/FA/DSS................. 57PNV COMBO #19/IRON/FOL AC/DHA.................... 57PNV COMBO #22/IRON/FA/OM3/DHA....................57PNV COMBO#47/IRON/FA #1/DHA.........................57PNV FOLIC ACID + IRON........................................ 58PNV NO.115/IRON FUMARATE/FA......................... 57PNV NO.118/IRON FUMARATE/FA......................... 57PNV NO.15/IRON FUM & PS CMP/FA.....................57PNV NO.22/IRON CBN&GLUC/FA/DSS.................. 57PNV NO.27/IRON CARB & FUM/FA........................ 57PNV NO.66/IRON,CARBONYL/FA/DHA.................. 57PNV NO10/IRON FUM&P/FA/OMEGA-3................. 57PNV NO12/IRON,CARB/FA/DSS/OM-3................... 57PNV OB+DHA.......................................................... 57PNV W-CA #40/IRON FUM/FA CMB#1....................57PNV W-CA NO.37/IRON/FA/OMEGA-3................... 57PNV W-CA8/IRON/FA/LMEFOLATE CA.................. 57
PNV WITH CA #68/IRON/FA#1/DHA....................... 57PNV WITH CA COMBO.11/IRON/FA....................... 57PNV WITH CA NO.65/IRON POLY/FA..................... 57PNV WITH CA,NO.60/IRON/FA/DHA.......................57PNV WITH CA,NO.62/IRON/FA/DHA.......................57PNV WITH CA,NO.70/IRON/FA/DHA.......................57PNV WITH CA,NO.71/IRON/FA............................... 57PNV WITH CA,NO.72/IRON,CARB/FA.................... 57PNV WITH CA,NO.72/IRON/FA............................... 57PNV WITH CA,NO.74/IRON/FA............................... 57PNV WITH CA,NO63/IRON/FA/B6...........................57PNV W-O CA NO5/FE FUMARATE/FA.................... 57PNV W-O IRON/FA/CALCIUM/B6/B12.....................58PNV#16/IRON FUM & PS/FA/OM-3.........................57PNV#20/IRON/FA/DS/FISH/DHA/EPA..................... 57PNV#26/IRON POLY/FA/DHA.................................. 57PNV#64/IRON/LMFOLATE/ALGAL/SOY................. 57PNV#67/IRON PS/FA CMB#1/DHA......................... 57PNV,CA,NO.35/IRON/FA/DS/OMEG-3.....................57PNV,CA42/IRON/FA/LMEFOL CA/DHA................... 57PNV/FA/B6/CALCIUM CARB/GINGER.................... 59PNV/FA/B6/CALCIUM PHOS/GINGER....................59PNV/FERROUS FUMARATE/DOSS/FA...................57PNV/FERROUS FUMARATE/FA/SE........................ 57PNV/IRON,CARBONYL/DOCUSATE/FA................. 57PNV100/IRON EDTA&PS/FA/OMEGA3................... 57PNV103/FE/FA/DHA/EPA/OTHER OM3.................. 57PNV105/IRON/FA/OMEGA 3/DHA/EPA................... 57PNV106/IRON/FA/OM3/DHA/EPA............................57PNV107/IRON/FA/OM3/DHA/EPA............................57PNV110/IRON/FA/OMEGA 3/DHA/EPA................... 57PNV115/IRON FUMARATE/FA/DSS........................ 57PNV119/IRON FUMARATE/FA/DSS........................ 57PNV17/IRON/FA/FISH OIL/DHA/OM........................57PNV19/IRON BG HC&SUCC-P/FA/OM3..................57PNV2/IRON B-G SUC-P/FA/OMEGA-3....................57PNV22/IRON CBN&GLUC/FA/DSS/DHA.................57PNV29/IRON CB&ASPG/FA/DHA/FISH...................57PNV34/IRON,CARB&FUM/FA/DSS/DHA.................57PNV34/IRON,CARBONYL/FA/DSS/DHA................. 57PNV38/IRON CBN&GLUC/FA/DSS/DHA.................57PNV39/IRON FUMARATE/FA/DSS/DHA................. 57PNV48/IRON NA FEREDETAT/FA/OM3.................. 57PNV53/IRON B-G HCL-P/FA/OMEGA3................... 58PNV53/IRON FUM/FA/DOCUSATE/DHA.................58PNV54/IRON B-G HCL-P/FA/OMEGA3................... 58PNV55/IRON BG HC&SUCC#2/FA/OM3................. 58PNV55/IRON BG HC&SUCC-P/FA/OM3..................58PNV55/IRON FUM & BISGLY/FA............................. 58PNV59/IRON,CARB&FUM/FA/DSS/DHA.................58PNV59/IRON,CARBONYL/FA/DSS/DHA................. 58PNV66/IRON FUMARATE/FA/DSS/DHA................. 58PNV69/IRON,CARBONYL/FA/DSS/DHA................. 58PNV7/FE ASP GLY/DOCUSATE/FA........................ 58PNV72/IRON,CARB&GLU/FA/DSS/DHA................. 58PNV77/SOD IRON EDTA& PS/FA/OM3...................58PNV80/IRON FUMARATE/FA/DSS/DHA................. 58PNV81/SOD IRON EDTA& PS/FA/OM3...................58PNV82/FEPS/FA/OM3/DHA/EPA/FISH.................... 58PNV83/IRON,CARB/IRON ASP GL/FA....................58PNV84/IRON,CARBONYL/FA/DHA......................... 58PNV94/SOD IRON EDTA& PS/FA/OM3...................58PNV-DHA PLUS....................................................... 57PNV-IRON................................................................ 57PNV-SELECT........................................................... 57POCKET CHAMBER..................................................6PODOCON-25..........................................................20PODOFILOX.............................................................20PODOPHYLLUM RESIN.......................................... 20POLYETHYLENE GLYCOL 3350............................. 44POLY-IRON 150 FORTE.......................................... 55POLYMYXIN B SULF/TRIMETHOPRIM...................32POLYTRIM................................................................32POLY-UREAURETHANE..........................................20POLY-VI-FLOR......................................................... 56POLY-VI-FLOR WITH IRON..................................... 56POMALIDOMIDE......................................................46POMALYST........................................................ 46, 76PONATINIB HCL...................................................... 46PONSTEL.................................................................43PONTOCAINE.......................................................... 21PORACTANT ALFA.................................................. 48PORFIMER SODIUM............................................... 47POSACONAZOLE....................................................39POT CHLORIDE/POT BICARB/CIT AC................... 29POTABA................................................................... 59POTASSIUM AMINOBENZOATE.............................59POTASSIUM BICARBONATE.................................. 29POTASSIUM BICARBONATE/CIT AC..................... 29
L.A. Care Page 90 of 96
Index
POTASSIUM CHLORIDE......................................... 29POTASSIUM CHLORIDE/POT BICARB.................. 29POTASSIUM CITRATE.............................................54POTASSIUM CITRATE/CITRIC ACID...................... 54POTASSIUM GLUCONATE......................................29POTASSIUM HYDROXIDE...................................... 20POTASSIUM IODIDE............................................... 31POTASSIUM IODIDE/IODINE.................................. 31POTASSIUM PHOSPHATE,MONOBASIC...............54POTIGA(TAB)(200 MG)................................51, 64, 72POTIGA(TAB)(300 MG)................................51, 64, 72POTIGA(TAB)(400 MG)................................51, 64, 72POTIGA(TAB)(50 MG)..................................51, 64, 72POVIDONE-IODINE................................................. 31PR CREAM...............................................................20PR NATAL 400..........................................................58PR NATAL 400 EC....................................................57PR NATAL 430..........................................................58PR NATAL 430 EC....................................................58PRADAXA.................................................... 35, 64, 76PRALATREXATE......................................................45PRAMCORT............................................................. 44PRAMIPEXOLE DI-HCL...........................................51PRAMLINTIDE ACETATE........................................ 22PRAMOSONE E.......................................................21PRAMOSONE(CREAM)...........................................20PRAMOSONE(LOTION)...........................................21PRAMOSONE(OINT)............................................... 21PRAMOXINE-HC......................................................28PRANDIMET.............................................................22PRANDIN..................................................................22PRASUGREL HCL................................................... 35PRAVACHOL............................................................ 13PRAVASTATIN SODIUM.......................................... 13PRAZIQUANTEL...................................................... 40PRAZOSIN HCL....................................................... 10PRECISION XTRA(OTC)......................................... 24PRECOSE................................................................ 22PRED MILD.............................................................. 32PRED-G....................................................................31PREDNICARBATE................................................... 19PREDNISOLONE..................................................... 42PREDNISOLONE ACETATE.............................. 32, 42PREDNISOLONE SOD PHOSPHATE............... 32, 42PREDNISOLONE SODIUM PHOSPHATE.........32, 42PREDNISONE..........................................................42PREDNISONE INTENSOL.......................................42PREFERA-OB ONE..................................................57PREFEST................................................................. 36PREGABALIN...........................................................51PREGNYL................................................................ 29PREMARIN.........................................................36, 54PREMIUM BLOOD GLUCOSE TEST(OTC)............ 24PREMIUM BLOOD GLUCOSE(OTC).......................26PREMIUM V10(OTC)......................................... 24, 26PREMPHASE........................................................... 36PREMPRO................................................................36PRENAFORT............................................................58PRENAISSANCE..................................................... 58PRENAISSANCE DHA HARMONY..........................57PRENAISSANCE HARMONY DHA..........................58PRENAISSANCE NEXT...........................................59PRENAISSANCE NEXT-B....................................... 59PRENAISSANCE PLUS........................................... 58PRENAPLUS............................................................57PRENAT VIT COMB.10/IRON/FA/DHA.................... 58PRENATA................................................................. 58PRENATABS FA....................................................... 58PRENATAL #103/IRON FUMARATE/FA.................. 58PRENATAL #57/IRON/FA/DSS/DHA........................58PRENATAL 19.......................................................... 57PRENATAL AD......................................................... 58PRENATAL LOW IRON............................................ 57PRENATAL NO.25/IRON/FA #6/DHA.......................58PRENATAL NO.39/IRON/FA #6/DHA.......................58PRENATAL NO.52/IRON/FA/DHA............................58PRENATAL PLUS.....................................................57PRENATAL VIT #60/IRON FUM/FA......................... 58PRENATAL VIT #68/IRON/FA#6/DHA......................58PRENATAL VIT #69/IRON/FA#6/DHA......................58PRENATAL VIT #76/IRON,CARB/FA....................... 58PRENATAL VIT 15/IRON CB/FA/DSS......................58PRENATAL VIT 16/IRON CB/FA/DSS......................58PRENATAL VIT 18/IRON CB/FA/DSS......................58PRENATAL VIT COMB.10/IRON/FA........................ 58PRENATAL VIT NO.109/IRON/FA............................58PRENATAL VIT NO.112/FOLIC ACID...................... 58PRENATAL VIT NO.114/FA/GINGER.......................58PRENATAL VIT NO.44/IRON/FA/DHA..................... 58
PRENATAL VIT NO.73/IRON/FA..............................58PRENATAL VIT NO.78/IRON/FA..............................58PRENATAL VIT#36/IRON/FA CMB#6...................... 58PRENATAL VIT#4/IRON FUM &PS/FA.................... 58PRENATAL VIT#42/FA CMB#6................................ 58PRENATAL VIT#65/IRON FUM&PS/FA................... 58PRENATAL VIT/FE CARB-FESO4/FA......................58PRENATAL VIT/IRON BISGLYCIN/FA..................... 58PRENATAL VIT/IRON FUMARATE/FA.....................58PRENATAL VIT27&CALCIUM/IRON/FA...................58PRENATAL VIT37/IRON/FOLIC ACID..................... 58PRENATAL VITAMINS #45/IRON/FA....................... 58PRENATAL VITAMINS#21, IRON, FA...................... 58PRENATAL VITS #33/IRON/FA/DHA....................... 58PRENATAL VITS W-CA,FE,FA(1MG).......................58PRENATAL VITS#4/IRON FUM/FA.......................... 58PRENATAL Z............................................................ 58PRENATAL-U........................................................... 57PRENATE AM...........................................................58PRENATE CHEWABLE............................................58PRENATE DHA........................................................ 56PRENATE ELITE...................................................... 58PRENATE ENHANCE.............................................. 58PRENATE ESSENTIAL............................................ 56PRENATE MINI........................................................ 58PRENATE RESTORE...............................................58PREPIDIL................................................................. 15PREPOPIK............................................................... 44PREQUE 10............................................................. 56PRESERA................................................................ 19PRESTO PRO(OTC)................................................ 26PREVACID(CAP DR)................................................53PREVACID(TAB RAP DR)..................................53, 72PREVIDENT............................................................. 54PREVIDENT 5000.................................................... 54PREVIDENT 5000 ENAMEL PROTECT.................. 55PREVIDENT 5000 SENSITIVE................................ 55PREVPAC...........................................................53, 64PREZISTA(ORAL SUSP)................................... 40, 64PREZISTA(TAB)(150 MG).................................. 40, 64PREZISTA(TAB)(400 MG).................................. 40, 64PREZISTA(TAB)(600 MG).................................. 40, 64PREZISTA(TAB)(75 MG).................................... 40, 64PREZISTA(TAB)(800 MG).................................. 40, 64PRIFTIN....................................................................40PRILOSEC............................................................... 53PRIMAQUINE...........................................................40PRIMAQUINE PHOSPHATE.................................... 40PRIMEAIRE................................................................6PRIMIDONE............................................................. 51PRIMLEV............................................................49, 64PRIMSOL..................................................................38PRISTIQ ER................................................... 7, 64, 72PRIVIGEN.................................................................37PROAIR HFA..............................................................5PROBANTHELINE W/PHENOBARBITAL................ 53PRO-BANTHINE.......................................................53PROBENECID..........................................................33PROBENECID-COLCHICINE...................................33PROCAINAMIDE HCL..............................................10PROCARBAZINE HCL............................................. 47PROCARDIA XL.......................................................12PROCENTRA....................................................... 8, 64PROCHAMBER..........................................................6PROCHLORPERAZINE EDISYLATE.........................4PROCHLORPERAZINE MALEATE............................4PROCHLORPERAZINE/ISOPROPAMIDE...............53PROCORT................................................................44PROCRIT............................................................34, 76PROCTOCORT........................................................ 44PROCTOFOAM-HC..................................................44PROCTOZONE-HC.................................................. 44PROCYSBI......................................................... 54, 76PRODIGY LANCING DEVICE(OTC)........................27PRODIGY MINI-MIST.................................................6PRODIGY NO CODING(OTC)................................. 24PRODIGY POCKET(OTC)....................................... 26PRODIGY VOICE(OTC)...........................................26PRODIGY(OTC)....................................................... 26PRODRIN................................................................. 50PROFERRIN-FORTE............................................... 55PROFILNINE SD...................................................... 34PROGESTERONE....................................... 29, 30, 36PROGESTERONE,MICRONIZED......................30, 36PROGLYCEM........................................................... 28PROGRAF................................................................37PROLASTIN C..........................................................45PROLENSA.............................................................. 31PROLEUKIN.............................................................37
PROLIA.................................................................... 30PROMACTA........................................................35, 76PROMETHAZINE HCL...............................................4PROMETHAZINE HCL/CODEINE............................15PROMETHAZINE VC............................................... 15PROMETHAZINE VC-CODEINE..............................15PROMETHAZINE/PHENYLEPH/CODEINE.............15PROMETHAZINE-CODEINE....................................15PROMETHAZINE-DM.............................................. 15PROMETHEGAN........................................................4PROMETRIUM......................................................... 36PROMISEB...............................................................19PROMISEB COMPLETE..........................................19PRONEB ULTRA........................................................ 6PRONEB ULTRA II..................................................... 6PRONESTYL............................................................10PROPAFENONE HCL.............................................. 10PROPANTHELINE BROMIDE..................................53PROPANTHELINE/PHENOBARBITAL.....................53PROPARAC HCL/FLUORESCEIN NA..................... 32PROPARACAINE HCL............................................. 32PROPARACAINE/FLUORESCEIN SOD.................. 32PROPRANOLOL HCL.............................................. 11PROPRANOLOL/HYDROCHLOROTHIAZID...........12PROPRANOLOL-HYDROCHLOROTHIAZID...........12PROPYLTHIOURACIL..............................................31PROSCAR..........................................................53, 77PROSED-DS............................................................ 38PROSTIGMIN.............................................................7PROSTIN E2 VAGINAL SUPPOSITORY................. 15PROTECT BONE..................................................... 56PROTECT CMB2/CERAMIDE 1,3,6-11....................20PROTECT IRON.......................................................56PROTECT NATAL.................................................... 58PROTEIN C CONCENTRATE, HUMAN...................35PROTONIX(GRANPKT DR)............................... 53, 72PROTONIX(TAB DR)................................................53PROTOPIC................................................... 22, 60, 72PROTRIPTYLINE HCL...............................................8PROVENGE............................................................. 46PROVENTIL HFA....................................................... 5PROVERA................................................................ 36PROVIDA OB........................................................... 58PROVIGIL.............................................................9, 76PROZAC.....................................................................7PRUCLAIR................................................................20PRUDOXIN...............................................................19PRUMYX.................................................................. 19PRUTECT.................................................................19PSEUDOEPHEDRINE HCL/ACRIVAS.......................4PULMICORT FLEXHALER.............................5, 64, 72PULMICORT(AMPUL-NEB)(0.25MG/2ML).......... 5, 64PULMICORT(AMPUL-NEB)(0.5 MG/2ML)........... 5, 64PULMICORT(AMPUL-NEB)(1 MG/2 ML)............. 5, 64PULMOZYME.....................................................48, 76PUREFE OB PLUS.................................................. 58PUREFE PLUS.........................................................58PURINETHOL...........................................................45PV W-O CAL/FE PS CMPLX/FA.............................. 58PV W-O CAL/FE,CARBONYL/DOSS/FA..................58PV W-O CAL/FERROUS FUMARATE/FA................ 58PYLERA................................................................... 53PYRAZINAMIDE.......................................................39PYRIDIUM................................................................ 54PYRIDOSTIGMINE BROMIDE...................................7PYRIDOXINE HCL................................................... 59PYRIMETHAMINE....................................................40PYROGALLIC ACID................................................. 21PYROGALLOL......................................................... 21- Q -QNASL........................................................... 4, 64, 72QSYMIA..............................................................59, 76QUALAQUIN.............................................................40QUARTETTE............................................................ 14QUAZEPAM................................................................9QUESTRAN..............................................................13QUETIAPINE FUMARATE......................................... 9QUIBRON...................................................................5QUIC-K..................................................................... 29QUILLIVANT XR............................................. 9, 64, 72QUINAPRIL HCL...................................................... 11QUINAPRIL/HYDROCHLOROTHIAZIDE.................10QUINIDINE GLUCONATE........................................ 10QUINIDINE SULFATE.............................................. 10QUININE SULFATE.................................................. 40QUINTET AC(OTC)............................................24, 26QUINTET(OTC)..................................................24, 26QUTENZA...........................................................20, 76QVAR....................................................................5, 64
L.A. Care Page 91 of 96
Index
- R -RABEPRAZOLE SODIUM..................................53, 64RADIAPLEXRX........................................................ 20RAGWITEK...........................................................4, 76RALOXIFENE HCL...................................................30RALTEGRAVIR POTASSIUM...................................41RAMELTEON..............................................................9RAMIPRIL................................................................. 11RAMUCIRUMAB.......................................................46RANEXA(TAB ER 12H)(1000 MG)..................... 14, 64RANEXA(TAB ER 12H)(500 MG)....................... 14, 64RANIBIZUMAB......................................................... 33RANITIDINE............................................................. 53RANITIDINE 150MG.................................................53RANITIDINE HCL..................................................... 53RANOLAZINE...........................................................14RAPAFLO..................................................... 53, 72, 77RAPAMUNE..............................................................37RASAGILINE MESYLATE........................................ 51RAVICTI..............................................................44, 76RAYOS............................................................... 42, 72RAZADYNE.......................................................... 7, 64RAZADYNE ER.................................................... 7, 64REAGENT STRIPS(OTC)........................................ 24REBETOL(CAP)....................................................... 41REBETOL(SOLUTION)............................................ 41REBIF................................................................. 47, 76REBIF REBIDOSE............................................. 47, 76RECLAST................................................................. 30RECOMBINATE........................................................34RECOTHROM.......................................................... 35RECTIV.....................................................................44REFISSA.................................................................. 16REFLUDAN.............................................................. 35REFUAH PLUS(OTC).........................................24, 26REGENECARE.........................................................21REGIMEX................................................................. 59REGLAN...................................................................53REGORAFENIB........................................................46REGRANEX..............................................................28RELAGESIC............................................................. 15RELENZA........................................................... 40, 64RELIAMED MINI LANCING DEVICE(OTC)............. 27RELION CONFIRM(OTC).........................................26RELION CONFIRM-MICRO(OTC)........................... 24RELION MICRO(OTC)............................................. 26RELION PRIME(OTC)........................................24, 26RELISTOR..........................................................44, 76RELNATE DHA.........................................................56RELPAX........................................................50, 64, 73REMERON................................................................. 7REMICADE.........................................................43, 76REMODULIN...................................................... 12, 76RENACIDIN..............................................................54RENAGEL................................................................ 29RENAL CAPS...........................................................59RENA-VITE RX.........................................................59RENOVA...................................................................16RENOVA PUMP....................................................... 16RENVELA(POWD PACK).........................................29RENVELA(TAB)........................................................29REOPRO.................................................................. 35REPAGLINIDE..........................................................22REPAGLINIDE/METFORMIN HCL...........................22REPRONEX..............................................................29REQ49+....................................................................55REQUIP....................................................................51REQUIP XL.................................................. 51, 64, 73RESCRIPTOR.......................................................... 41RESCULA.....................................................33, 64, 73RESECTISOL...........................................................12RESERPINE............................................................. 11RESERPINE/HYDROCHLOROTHIAZIDE............... 11RESTASIS.......................................................... 32, 64RESTORIL..................................................................9RETAPAMULIN.........................................................17RETIN-A............................................................. 16, 60RETIN-A MICRO................................................ 16, 60RETIN-A MICRO PUMP.....................................16, 60RETROVIR(CAP)............................................... 41, 64RETROVIR(SYRUP).......................................... 41, 64REVATIO............................................................ 12, 64REVEAL BLOOD GLUCOSE METER(OTC)............26REVEAL TEST STRIP(OTC)....................................24REVIA.........................................................................9REVLIMID.....................................................46, 64, 76REYATAZ..................................................................41RIAX......................................................................... 20RIBAVIRIN.......................................................... 40, 41
RICOBID-H.................................................................4RIDAURA..................................................................42RIFABUTIN...............................................................40RIFADIN....................................................................40RIFAMATE................................................................ 40RIFAMP/ISONIAZID/PYRAZINAMIDE..................... 40RIFAMPIN.................................................................40RIFAMPIN/ISONIAZID..............................................40RIFAPENTINE.......................................................... 40RIFATER...................................................................40RIFAXIMIN................................................................40RIGHTEST GD500(OTC)......................................... 27RIGHTEST GM100 SYSTEM(OTC).........................26RIGHTEST GM250S METER(OTC).........................26RIGHTEST GM260 METER(OTC)........................... 26RIGHTEST GM300 SYSTEM(OTC).........................26RIGHTEST GM550 SYSTEM(OTC).........................26RIGHTEST GS100 TEST STRIPS(OTC)................. 24RIGHTEST GS250S TEST STRIPS(OTC)...............24RIGHTEST GS260 TEST STRIPS(OTC)................. 24RIGHTEST GS300 TEST STRIPS(OTC)................. 24RIGHTEST GS550 TEST STRIPS(OTC)................. 24RIGHTSOURCE(OTC)............................................. 26RILONACEPT...........................................................42RILPIVIRINE HCL.................................................... 41RILUTEK...................................................................47RILUZOLE................................................................ 47RIMANTADINE HCL................................................. 40RIMEXOLONE..........................................................32RINGERS IRRIGATION............................................20RINGERS SOLUTION..............................................20RINGERS SOLUTION,LACTATED...........................20RIOCIGUAT.............................................................. 12RIOMET....................................................................22RISEDRONATE SODIUM.........................................30RISPERDAL CONSTA................................................9RISPERDAL(SOLUTION).....................................9, 64RISPERDAL(TAB)................................................ 9, 64RISPERIDONE.....................................................9, 64RISPERIDONE MICROSPHERES.............................9RITALIN LA...........................................................9, 64RITEFLO.....................................................................6RITONAVIR.............................................................. 41RITUXAN............................................................45, 76RITUXIMAB.............................................................. 45RIVAROXABAN........................................................ 34RIVASTIGMINE.......................................................... 7RIVASTIGMINE TARTRATE.......................................7RIXUBIS................................................................... 34RIZATRIPTAN BENZOATE.......................................50R-NATAL OB.............................................................57ROBAXIN..................................................................52ROBAXIN-750.......................................................... 52ROBINUL..................................................................53ROBINUL FORTE.....................................................53ROCALTROL............................................................ 59ROFLUMILAST...........................................................5ROMIDEPSIN...........................................................46ROMIPLOSTIM.........................................................35ROPINIROLE HCL................................................... 51ROSADAN................................................................16ROSANIL..................................................................17ROSE BENGAL SODIUM.........................................33ROSE GLO...............................................................33ROSIGLITAZONE MALEATE................................... 22ROSIGLITAZONE/GLIMEPIRIDE.............................22ROSIGLITAZONE/METFORMIN HCL......................23ROSUVASTATIN CALCIUM..................................... 13ROTARIX.................................................................. 37ROTATEQ.................................................................37ROTAVIRUS VAC,LIVE ATT, 89-12.......................... 37ROTAVIRUS VACCINE,LIVE ORAL PV................... 37ROTIGOTINE........................................................... 51ROWASA..................................................................43ROXICODONE......................................................... 49ROZEREM......................................................9, 64, 73RUFINAMIDE........................................................... 52RUXOLITINIB PHOSPHATE.................................... 46RYTHMOL................................................................ 10RYTHMOL SR.......................................................... 10- S -SABRIL...............................................................52, 64SACROSIDASE........................................................52SAFYRAL........................................................... 14, 73SAIZEN...............................................................30, 76SALACYN.................................................................20SALAGEN.................................................................45SAL-AMIDE/ACETAMINOPHN/P-TLOX...................48SALEX...................................................................... 20
SALICYLIC AC/BENZOYL PER/VIT E..................... 20SALICYLIC ACID......................................................20SALICYLIC ACID/AMMON LACT/ALOE.................. 20SALICYLIC ACID/AMMONIATED HG...................... 20SALICYLIC ACID/CERAMIDE CMB #1....................20SALICYLIC ACID/UREA...........................................20SALMETEROL XINAFOATE...................................... 5SALSALATE............................................................. 48SALURON................................................................ 13SALVAX DUO PLUS.................................................20SAMI THE SEAL.........................................................6SAMSCA(TAB)(15 MG)...................................... 29, 64SAMSCA(TAB)(30 MG)...................................... 29, 64SANCTURA........................................................54, 73SANCUSO......................................................4, 64, 73SANDIMMUNE......................................................... 37SANTYL....................................................................21SAPHRIS........................................................8, 64, 73SAQUINAVIR MESYLATE........................................41SARAFEM.................................................................. 7SARGRAMOSTIM.................................................... 35SAVELLA.................................................................. 47SAXAGLIPTIN HCL..................................................22SAXAGLIPTIN HCL/METFORMIN HCL...................22SCALACORT DK......................................................18SCLEROSOL............................................................47SCOPOLAMINE......................................................... 4SCOPOLAMINE HYDROBROMIDE.........................33SE 10-5 SS...............................................................17SE BPO.................................................................... 20SECOBARBITAL SODIUM......................................... 9SECONAL SODIUM................................................... 9SECTRAL................................................................. 11SELECT-LITE(OTC)................................................. 27SELECT-OB............................................................. 58SELECT-OB + DHA..................................................58SELEGILINE...............................................................9SELEGILINE HCL.................................................... 51SELENIUM SULFIDE............................................... 19SELZENTRY.......................................................41, 76SEMPREX-D.............................................................. 4SE-NATAL 19............................................................57SENSIPAR................................................................30SEREVENT DISKUS............................................5, 64SEROPHENE........................................................... 29SEROQUEL..........................................................9, 64SEROQUEL XR..............................................9, 64, 73SEROSTIM.........................................................31, 76SERTACONAZOLE NITRATE.................................. 17SERTRALINE HCL..................................................... 7SE-TAN DHA............................................................ 57SETONET-EC...........................................................58SEVELAMER CARBONATE.....................................29SEVELAMER HCL................................................... 29SFROWASA............................................................. 43SHOHL'S MODIFIED................................................54SIDEKICK(OTC).......................................................25SIDEROL..................................................................55SIDESTREAM............................................................ 6SIDESTREAM NEBULIZER....................................... 6SIDESTREAM PLUS..................................................6SILDENAFIL CITRATE....................................... 12, 29SILENOR........................................................9, 64, 73SILICONE MASK........................................................6SILODOSIN.............................................................. 53SILVER..................................................................... 16SILVER CARBONATE.............................................. 16SILVER NITRATE............................................... 16, 20SILVER NITRATE APPLICATOR..............................20SILVER SULFADIAZINE...........................................17SILVRSTAT...............................................................16SIMBRINZA.............................................................. 33SIMCOR(TBMP 24HR)(1000-20MG)........... 13, 64, 73SIMCOR(TBMP 24HR)(1000-40 MG).......... 13, 64, 73SIMCOR(TBMP 24HR)(500MG-20MG)....... 13, 64, 73SIMCOR(TBMP 24HR)(500MG-40MG)....... 13, 64, 73SIMCOR(TBMP 24HR)(750MG-20MG)....... 13, 64, 73SIMEPREVIR SODIUM............................................ 41SIMPONI............................................................ 42, 76SIMPONI ARIA................................................... 42, 76SIMULECT................................................................37SIMVASTATIN...........................................................13SINECATECHINS.....................................................17SINEMET 10-100..................................................... 50SINEMET 25-100..................................................... 50SINEMET 25-250..................................................... 50SINGULAIR................................................................ 5SINUSTAR..................................................................6SIPULEUCEL-T/LACTATED RINGERS................... 46
L.A. Care Page 92 of 96
Index
SIROLIMUS..............................................................37SIRTURO............................................................40, 76SITAGLIPTIN PHOS/METFORMIN HCL..................22SITAGLIPTIN PHOSPHATE..................................... 22SKELAXIN................................................................ 52SKLICE.....................................................................17SMART CARESENS N(OTC).............................24, 26SMART SENSE MONITORING SYSTEM(OTC)......26SMART SENSE TEST STRIPS(OTC)......................24SMARTDIABETES VANTAGE(OTC)........................27SMARTDIABETES XPRES(OTC)...................... 24, 26SMARTEST EJECT(OTC)........................................26SMARTEST PERSONA(OTC)..................................26SMARTEST PRONTO(OTC)....................................26SMARTEST PROTEGE(OTC)..................................26SMARTEST SMART CODE(OTC)........................... 26SMARTEST TALKING(OTC).................................... 26SMARTEST TEST(OTC).......................................... 24SOD PICOSULF/MAG OX/CITRIC AC.....................44SOD PROPION/INOSITOL/AA14/UREA..................54SOD/POT/K CIT/SOD CIT/CIT ACID....................... 54SODIUM BENZOATE/NA PH-ACETATE..................44SODIUM CHLORIDE..........................................20, 29SODIUM CHLORIDE 0.45 %................................... 29SODIUM CHLORIDE IRRIG SOLUTION................. 20SODIUM CHLORIDE/NAHCO3/KCL/PEG............... 44SODIUM CITRATE................................................... 34SODIUM FLUORIDE................................................ 54SODIUM FLUORIDE/POT NITRATE........................55SODIUM FLUORIDE/XYLITOL................................ 55SODIUM OXYBATE....................................................8SODIUM PHENYLBUTYRATE................................. 44SODIUM POLYSTYRENE SULFONATE..................29SODIUM SULFACETAMIDE.....................................19SODIUM SULFACETAMIDE-SULFUR..................... 17SODIUM THIOSULFATE/SAL ACID.........................17SODIUM,POTASSIUM,&MAG SULFATES...............44SOFOSBUVIR.......................................................... 41SOFT TOUCH(OTC)................................................ 27SOFTCLIX(OTC)...................................................... 27SOLIFENACIN SUCCINATE.................................... 54SOLIRIS............................................................. 35, 76SOLODYN.............................................. 39, 60, 64, 73SOLTAMOX.............................................................. 47SOLUS V2 LANCING DEVICE(OTC).......................27SOLUS V2(OTC)................................................ 24, 26SOMA....................................................................... 52SOMATROPIN....................................................30, 31SOMAVERT..............................................................30SONAFINE............................................................... 19SONATA............................................................... 9, 64SORAFENIB TOSYLATE......................................... 46SORBITOL................................................................20SORBITOL SOLUTION............................................ 20SORBITOL-MANNITOL............................................20SORIATANE............................................................. 21SORILUX............................................................21, 73SOTALOL..................................................................11SOTALOL HCL......................................................... 11SOVALDI............................................................ 41, 76SPASMOLIN............................................................. 53SPINOSAD............................................................... 17SPIRIVA................................................................5, 64SPIROMETERS AND ACCESSORIES......................6SPIRONOLACT/HYDROCHLOROTHIAZID.............12SPIRONOLACTONE................................................ 12SPORANOX(CAP)....................................................39SPORANOX(SOLUTION).........................................39SPRAY AND STRETCH........................................... 21SPRINTEC......................................................... 15, 77SPRIX.................................................................42, 64SPRYCEL(TAB)(100 MG).............................46, 64, 76SPRYCEL(TAB)(140 MG).............................46, 64, 76SPRYCEL(TAB)(20 MG)...............................46, 64, 76SPRYCEL(TAB)(50 MG)...............................46, 64, 76SPRYCEL(TAB)(70 MG)...............................46, 64, 76SPRYCEL(TAB)(80 MG)...............................46, 64, 76SPS.......................................................................... 29SSKI......................................................................... 31STAGESIC-10.....................................................49, 64STALEVO 100.......................................................... 50STALEVO 125.......................................................... 50STALEVO 150.......................................................... 51STALEVO 200.......................................................... 51STALEVO 50............................................................ 51STALEVO 75............................................................ 51STANNOUS FLUORIDE...........................................55STARLIX................................................................... 22STARTER KIT(OTC).................................................26
STAVUDINE..............................................................41STAVZOR........................................................... 52, 73STAXYN........................................................29, 64, 77STELARA........................................................... 42, 76STENDRA.................................................... 29, 64, 77STERILE TALC.........................................................47STIMATE.................................................................. 30STIVARGA....................................................46, 64, 76STRATTERA(CAP)(10 MG)................................10, 64STRATTERA(CAP)(100 MG)..............................10, 64STRATTERA(CAP)(18 MG)................................10, 64STRATTERA(CAP)(25 MG)................................10, 64STRATTERA(CAP)(40 MG)................................10, 64STRATTERA(CAP)(60 MG)................................10, 64STRATTERA(CAP)(80 MG)................................10, 64STREPTOZOCIN......................................................45STRIANT............................................................ 36, 76STRIBILD........................................................... 41, 64STROMECTOL.........................................................40STRONG IODINE.....................................................31STROVITE................................................................56STROVITE FORTE...................................................56STROVITE ONE.......................................................56STROVITE PLUS..................................................... 56SUBOXONE....................................................... 50, 76SUBSYS............................................................. 49, 76SUCLEAR.................................................................44SUCRAID........................................................... 52, 76SUCRALFATE.......................................................... 53SUCROFERRIC OXYHYDROXIDE......................... 29SULAR......................................................................12SULCONAZOLE NITRATE.......................................17SULFACET SOD/SULFUR/WITCH HAZ..................17SULFACETAMIDE SOD/SULFUR/UREA.................17SULFACETAMIDE SODIUM.........................16, 19, 32SULFACETAMIDE SODIUM/SULFUR..................... 17SULFACETAMIDE SODIUM/UREA..........................19SULFACETAMIDE/PREDNISOLONE SP.................32SULFACETAMIDE/SULFUR/CLEANSR23.........17, 18SULFACETAMIDE-PREDNISOLONE...................... 32SULFACETM NA/PREDNISOL AC.......................... 32SULFADIAZINE........................................................ 43SULFALONE............................................................ 32SULFAMETHOXAZOLE/TRIMETHOPRIM........ 37, 43SULFAMETHOXAZOLE-TRIMETHOPRIM.............. 37SULFAMYLON(CREAM).......................................... 17SULFAMYLON(PACKET)......................................... 17SULFANILAMIDE..................................................... 54SULFASALAZINE.....................................................43SULFATRIM..............................................................43SULFUR................................................................... 16SULINDAC................................................................43SUMADAN..........................................................17, 18SUMATRIPTAN........................................................ 50SUMATRIPTAN SUCC/NAPROXEN SOD............... 50SUMATRIPTAN SUCCINATE.............................50, 64SUMAVEL DOSEPRO..................................50, 64, 73SUMAXIN................................................................. 17SUMAXIN CP........................................................... 18SUNITINIB MALATE.................................................46SUPERVITE............................................................. 59SUPERVITE EC....................................................... 56SUPPORT-500......................................................... 55SUPPRELIN............................................................. 31SUPPRELIN LA........................................................31SUPRAX...................................................................37SUPRENZA ODT......................................... 59, 64, 73SUPREP...................................................................44SURE COMFORT LANCING PEN(OTC)................. 27SURE EDGE BLOOD GLUCOSE METER(OTC)......2 6SURE EDGE TEST STRIPS(OTC).......................... 24SURECHEK TEST STRIPS(OTC)............................24SUREFLEX(OTC).....................................................27SURE-PEN(OTC)..................................................... 27SURESTEP PRO(OTC)............................................24SURE-TEST EASYPLUS MINI(OTC).................24, 26SURFAXIN................................................................48SURMONTIL...............................................................8SURVANTA...............................................................48SUSTIVA...................................................................41SUTENT....................................................... 46, 64, 76SYLATRON...................................................46, 64, 76SYLATRON 4-PACK.....................................46, 64, 76SYMAX DUOTAB..................................................... 53SYMAX-SL............................................................... 53SYMAX-SR...............................................................53SYMBICORT.................................................. 5, 64, 73SYMBYAX.............................................................9, 64
SYMLINPEN 120......................................................22SYMLINPEN 60........................................................22SYNAGEX................................................................ 59SYNAGIS............................................................40, 76SYNALAR.................................................................18SYNALAR TS........................................................... 18SYNALGOS-DC........................................................49SYNAREL.................................................................31SYNERA...................................................................21SYNRIBO........................................................... 47, 76SYNTHROID.............................................................31SYRINGE AVITENE................................................. 35- T -TABLOID...................................................................45TACHOSIL................................................................ 35TACLONEX(OINT)..............................................22, 73TACLONEX(SUSPENSION)...............................22, 73TACROLIMUS.................................................... 22, 37TADALAFIL.........................................................12, 29TAFINLAR...........................................................46, 76TAFLUPROST/PF.....................................................33TAGAMET.................................................................53TALC.........................................................................47TALWIN.....................................................................50TAMIFLU(CAP)(30 MG)......................................40, 64TAMIFLU(CAP)(45 MG)......................................40, 64TAMIFLU(CAP)(75 MG)......................................40, 64TAMIFLU(SUSP RECON).................................. 40, 64TAMOXIFEN CITRATE.............................................47TAMSULOSIN HCL.................................................. 54TANDEM PLUS........................................................ 55TAPAZOLE............................................................... 31TAPENTADOL HCL.................................................. 50TARCEVA..................................................... 46, 64, 76TARGRETIN................................................. 21, 47, 76TARKA...................................................................... 10TARON FORTE........................................................ 55TARON-BC............................................................... 57TARON-PREX PRENATAL.......................................57TASIGNA...................................................... 46, 64, 76TASIMELTEON...........................................................9TASMAR....................................................... 51, 64, 73TAXOTERE...............................................................47TAZAROTENE....................................................16, 21TAZORAC.................................................................21TBO-FILGRASTIM....................................................35TD GOLD BLOOD GLUCOSE MONITOR(OTC)......2 6TD GOLD TEST STRIP(OTC)..................................24TD GOLD VOICE GLUCOSE MONITOR(OTC)....... 26TECFIDERA....................................................... 47, 76TEDUGLUTIDE........................................................ 44TEGRETOL.............................................................. 51TEGRETOL XR........................................................ 51TEKAMLO.......................................................... 12, 76TEKTURNA........................................................ 12, 76TEKTURNA HCT................................................12, 76TELAPREVIR........................................................... 41TELBIVUDINE.......................................................... 41TELCARE(OTC)................................................. 24, 26TELITHROMYCIN.................................................... 38TELMISARTAN................................................... 11, 73TELMISARTAN/AMLODIPINE..................................11TELMISARTAN/HYDROCHLOROTHIAZID..............11TELMISARTAN-AMLODIPINE............................11, 73TELMISARTAN-HYDROCHLOROTHIAZID........11, 73TEMAZEPAM..............................................................9TEMODAR..........................................................45, 76TEMOVATE.............................................................. 18TEMOVATE EMOLLIENT......................................... 18TEMOZOLOMIDE.....................................................45TEMSIROLIMUS...................................................... 46TENEX...................................................................... 11TENIPOSIDE............................................................47TENOFOVIR DISOPROXIL FUMARATE................. 41TENORETIC 100...................................................... 11TENORETIC 50........................................................ 11TENORMIN...............................................................11TERAK......................................................................32TERAZOL 3.............................................................. 54TERAZOSIN HCL.....................................................10TERBINAFINE HCL..................................................39TERBINAFINE/HYDROXY CHITOSAN....................39TERBINEX................................................................39TERBUTALINE SULFATE.......................................... 5TERCONAZOLE.......................................................54TERIFLUNOMIDE.................................................... 47TERIPARATIDE........................................................ 30TERRAMYCIN WITH POLYMYXIN.......................... 32
L.A. Care Page 93 of 96
Index
TERSI FOAM............................................................19TESAMORELIN ACETATE.......................................30TESSALON PERLE..................................................15TEST N'GO(OTC)...............................................24, 26TEST STRIPS(OTC).................................................24TESTIM...............................................................36, 76TESTOSTERONE.................................................... 36TESTOSTERONE CYPIONATE.........................36, 76TESTOSTERONE ENANTHATE..............................36TESTOSTERONE PROPIONATE............................ 36TESTRED.................................................................36TETCAINE................................................................32TETRABENAZINE....................................................47TETRACAINE HCL.............................................21, 32TETRACAINE HCL/PF............................................. 32TETRACAINE/BENZOCAINE/BUTAMBEN..............21TETRACYCLINE HCL.............................................. 39TETRAHYDROZOLINE HCL....................................15TETRAVISC..............................................................32TETRAVISC FORTE.................................................32TEVETEN........................................................... 11, 73TEVETEN HCT................................................... 11, 73TEV-TROPIN...................................................... 31, 76TEXACORT.............................................................. 18THALIDOMIDE......................................................... 39THALOMID................................................... 39, 64, 76THEO-24.....................................................................6THEOPHYLL/EPHED HCL/PHENOBARB................. 6THEOPHYLLINE ANHYDROUS................................ 6THEOTAL................................................................... 6THIAMINE HCL........................................................ 59THIOGUANINE.........................................................45THIOLA.....................................................................54THIORIDAZINE HCL.................................................. 9THIOTEPA................................................................ 45THIOTHIXENE............................................................9THRESHOLD IMT...................................................... 6THRESHOLD PEP..................................................... 6THROMBIN (BOVINE)..............................................35THROMBIN (RECOMBINANT).................................35THROMBIN(HUM PLAS)/FIB/APRO/CA..................35THROMBIN/FIBRINOGEN/APRO/CAL....................36THROMBIN-JMI........................................................35THYMOGLOBULIN...................................................37THYROID,PORK...................................................... 31THYROLAR-1...........................................................31THYROLAR-1/2........................................................31THYROLAR-1/4........................................................31THYROLAR-2...........................................................31THYROLAR-3...........................................................31TIAGABINE HCL...................................................... 52TICAGRELOR.......................................................... 35TICLOPIDINE HCL...................................................35TIGAN.........................................................................4TIKOSYN..................................................................10TIMOLOL..................................................................33TIMOLOL MALEATE...........................................11, 33TIMOLOL MALEATE/PF...........................................33TIMOPTIC.................................................................33TIMOPTIC OCUDOSE................................. 33, 64, 73TIMOPTIC-XE...........................................................33TINDAMAX............................................................... 40TINIDAZOLE.............................................................40TIOPRONIN..............................................................54TIOTROPIUM BROMIDE........................................... 5TIPRANAVIR............................................................ 40TIPRANAVIR/VITAMIN E TPGS...............................40TIROFIBAN-0.9% SODIUM CHLORIDE.................. 35TIROSINT.................................................................31TISSEEL VHSD........................................................35TIVICAY.............................................................. 41, 76TIZANIDINE HCL......................................................52TIZANIDINE/IRR CNTR-IRR CMB #2...................... 52TL TRISEB................................................................19TL-FLUORIVITE....................................................... 56TL-FOL 500.............................................................. 55TL-SELECT DHA......................................................58TOBI................................................................... 39, 76TOBI PODHALER...............................................39, 76TOBRADEX ST........................................................ 31TOBRADEX(DROPS SUSP).................................... 31TOBRADEX(OINT)................................................... 31TOBRAMYCIN....................................................32, 39TOBRAMYCIN IN 0.225% NACL............................. 39TOBRAMYCIN/DEXAMETHASONE........................ 31TOBRAMYCIN/LOTEPRED ETAB........................... 31TOBREX(DROPS)....................................................32TOBREX(OINT)........................................................ 32TOCILIZUMAB..........................................................42
TODAY CONTRACEPTIVE SPONGE(OTC)......14,7 7TOFACITINIB CITRATE........................................... 42TOFRANIL.................................................................. 8TOFRANIL-PM........................................................... 8TOLAZAMIDE...........................................................22TOLBUTAMIDE........................................................ 22TOLCAPONE............................................................51TOLMETIN SODIUM................................................ 43TOLTERODINE TARTRATE..................................... 54TOLVAPTAN............................................................. 29TOPAMAX................................................................ 52TOPICORT(CREAM)................................................18TOPICORT(GEL)......................................................18TOPICORT(OINT).................................................... 18TOPICORT(SPRAY)...........................................18, 73TOPIRAMATE...........................................................52TOPOTECAN HCL................................................... 46TOPROL XL..............................................................11TORADOL(CARTRIDGE)(15 MG/ML)......................43TORADOL(CARTRIDGE)(30 MG/ML)......................43TOREMIFENE CITRATE.......................................... 47TORISEL............................................................ 46, 76TORSEMIDE............................................................ 12TOSITUMOMAB (WITH MALTOSE).........................46TOSITUMOMAB IODINE-131/MALTOSE.................46TOVIAZ...............................................................54, 73TRACER BG(OTC)...................................................24TRACLEER........................................................ 12, 76TRADJENTA.............................................................22TRAMADOL HCL......................................................50TRAMADOL HCL/ACETAMINOPHEN..................... 50TRAMETINIB DIMETHYL SULFOXIDE................... 46TRANDATE...............................................................10TRANDOLAPRIL...................................................... 11TRANDOLAPRIL/VERAPAMIL HCL.........................10TRANEXAMIC ACID.................................................34TRANSDERM-SCOP..................................................4TRANXENE T-TAB..................................................... 8TRANYLCYPROMINE SULFATE............................... 7TRASTUZUMAB.......................................................45TRAVATAN Z...................................................... 33, 64TRAVOPROST................................................... 33, 64TRAVOPROST (BENZALKONIUM)......................... 33TRAZODONE HCL.....................................................7TREAGAN OTIC.......................................................28TREANDA.................................................................45TRECATOR.............................................................. 39TREK S COMBO PACK..............................................6TREK S COMPACT COMPRESSOR......................... 6TRELSTAR............................................................... 30TRELSTAR DEPOT..................................................30TRELSTAR LA..........................................................30TREPROSTINIL........................................................12TREPROSTINIL DIOLAMINE...................................12TREPROSTINIL SODIUM........................................ 12TREPROSTINIL/NEB ACCESSORIES.................... 12TREPROSTINIL/NEBULIZER/ACCESOR................12TRETINOIN........................................................ 16, 47TRETINOIN MICROSPHERES................................ 16TRETINOIN/EMOL CMB9/SKIN CLN1.....................16TRETINOIN/EMOLLIENT BASE.............................. 16TRETIN-X........................................................... 16, 60TRETTEN................................................................. 34TREXALL..................................................................45TREXIMET................................................... 50, 64, 73TREZIX.....................................................................49TRIACETIN...............................................................39TRIAMCIN/HYDROPHILIC OINTMENT...................19TRIAMCIN/UREA/HYDRO OINT..............................19TRIAMCINOLONE ACETONIDE....................4, 19, 48TRIAMCINOLONE DIACETATE............................... 42TRIAMCINOLONE/EMOLLIENT CMB#45............... 19TRIAMCINOLONE/EMOLLIENT CMB#86............... 19TRIAMTERENE........................................................12TRIAMTERENE/HYDROCHLOROTHIAZID.............12TRIAMTERENE-HCTZ............................................. 12TRIAZOLAM............................................................... 9TRIBENZOR.......................................................10, 73TRICARE..................................................................58TRICARE PRENATAL COMPLEAT..........................57TRICARE PRENATAL DHA ONE............................. 57TRICOR....................................................................13TRIDERM................................................................. 19TRIDESILON............................................................ 18TRIFLUOPERAZINE HCL.......................................... 9TRIFLURIDINE.........................................................32TRIGELS-F FORTE..................................................55TRIHEXYPHENIDYL HCL........................................50
TRILEPTAL(ORAL SUSP)........................................51TRILEPTAL(TAB)......................................................51TRILIPIX................................................................... 13TRI-LUMA.................................................................21TRIMETHOBENZAMIDE HCL....................................4TRIMETHOBENZAMIDE HCL/B-CAINE.................... 4TRIMETHOPRIM......................................................38TRIMIPRAMINE MALEATE........................................ 8TRINATAL RX 1........................................................58TRINATE...................................................................58TRIPELENNAMINE HCL............................................4TRIPLE DYE(MED SWAB)(2.29-2.29)..................... 17TRIPTORELIN PAMOATE........................................30TRISENOX............................................................... 46TRIVEEN-ONE......................................................... 57TRIVEEN-PRX RNF................................................. 58TRI-VI-FLOR.............................................................56TRI-VIT WITH FLUORIDE-IRON..............................56TRI-VITAMIN WITH FLUORIDE............................... 56TRIZIVIR.............................................................41, 76TROKENDI XR(CAP ER 24H)(100 MG)...... 52, 64, 74TROKENDI XR(CAP ER 24H)(200 MG)...... 52, 64, 74TROKENDI XR(CAP ER 24H)(25 MG)........ 52, 64, 74TROKENDI XR(CAP ER 24H)(50 MG)........ 52, 64, 74TROPAZONE............................................................19TROPICAMIDE.........................................................33TROSPIUM CHLORIDE........................................... 54TRUE2GO BLOOD GLUCOSE SYSTEM(OTC)...... 26TRUERESULT BLOOD GLUCOSE SYSTM(OTC)......2 7TRUETEST TEST STRIPS(OTC).............................24TRUETRACK BLOOD GLUCOSE SYSTEM(OTC)......2 7TRUETRACK METER(OTC).................................... 27TRUETRACK SMART SYSTEM(OTC).............. 24, 27TRUETRACK TEST STRIP(OTC)............................24TRUSOPT.................................................................33TRUST NATAL DHA................................................. 57TRUVADA...........................................................40, 64TRUZONE PEAK FLOW METER...............................6TRYPSIN/BALSAM PERU/CASTOR OIL.................21TUDORZA PRESSAIR................................... 5, 64, 74TUSSICAPS............................................................. 15TUSSIONEX.............................................................15TYKERB............................................................. 46, 76TYLENOL-CODEINE NO.3...................................... 50TYLENOL-CODEINE NO.4...................................... 50TYPHOID VACC,LIVE,ATTENUATED......................37TYSABRI............................................................ 47, 76TYVASO............................................................. 12, 76TYZEKA....................................................................41TYZINE.....................................................................15- U -UCEPHAN................................................................ 44UCERIS.............................................................. 42, 74U-CORT....................................................................18UDAMIN SP..............................................................56ULESFIA...................................................................17ULIPRISTAL ACETATE............................................ 15ULORIC........................................................ 33, 64, 74ULTI-LANCE(OTC)................................................... 27ULTIMA(OTC).....................................................24, 27ULTIMATECARE ONE..............................................57ULTIMATECARE ONE NF........................................57ULTRACET............................................................... 50ULTRAFOAM............................................................35ULTRAM................................................................... 50ULTRASAL-ER......................................................... 20ULTRASE................................................................. 52ULTRASE MT 12...................................................... 52ULTRASE MT 18...................................................... 52ULTRASE MT 20...................................................... 52ULTRATRAK PRO(OTC).......................................... 27ULTRATRAK ULTIMATE(OTC)...........................24, 27ULTRATRAK(OTC).............................................24, 27ULTRAVATE..............................................................18ULTRAVATE X.......................................................... 18ULTRESA................................................................. 52UMECLIDINIUM BRM/VILANTEROL TR................... 5UMECTA PD.............................................................20UMECTA(EMULSN)................................................. 20UMECTA(NL FM SUSP)...........................................20UNIRETIC.................................................................10UNISTIK 2 EXTRA(OTC)..........................................27UNISTIK 2 NORMAL................................................ 27UNISTIK 2 NORMAL(OTC)...................................... 27UNISTIK 2(OTC).......................................................27UNISTIK 3 COMFORT(OTC)................................... 28UNISTIK 3 NEONATAL(OTC)...................................28
L.A. Care Page 94 of 96
Index
UNISTIK 3(OTC).......................................................28UNISTRIP1(OTC).....................................................25UNITHROID..............................................................31UNIVASC.................................................................. 11UNOPROSTONE ISOPROPYL................................33UR N-C..................................................................... 38URAMAXIN GT.........................................................20URAMAXIN(CREAM)............................................... 20URAMAXIN(FOAM)..................................................20URAMAXIN(GEL)..................................................... 20URAMAXIN(LOTION)...............................................20UREA..................................................................20, 21UREA/EMOLLIENT CMB NO.18..............................20UREA/EMOLLIENT COMBINATION #65................. 20UREA/HYALURONATE SODIUM.............................20UREA/LACTIC AC/ZN UNDECYLENATE................ 20UREA/LACTIC ACID/SALICYL ACID.......................20URECHOLINE.......................................................... 44URELLE....................................................................38URETRON D-S.........................................................38URIBEL.....................................................................38URIN D.S..................................................................38URINE GLUC-ACET COMB.TST,STRIP..................28URINE GLUCOSE TEST,STRIP...............................28URINE GLUCOSE TEST,TABLET............................28UROCIT-K.................................................................54UROFOLLITROPIN.................................................. 29UROLOGIC SOLUTION G(IRRIG SOLN)(3.24G-380)..................................................................................39UROLOGIC SOLUTION-G....................................... 39UROQID-ACID NO.2................................................ 54UROXATRAL............................................................ 53URSO....................................................................... 44URSO FORTE.......................................................... 44URSODIOL...............................................................44URYL........................................................................ 38USTEKINUMAB........................................................42UTA...........................................................................38- V -VAGIFEM..................................................................54VALACYCLOVIR HCL.............................................. 40VALCHLOR.........................................................21, 76VALCYTE..................................................................40VALGANCICLOVIR HCL.......................................... 40VALIUM.......................................................................8VALPROIC ACID...................................................... 52VALPROIC ACID (AS SODIUM SALT).....................52VALRUBICIN............................................................ 45VALSARTAN............................................................. 11VALSARTAN/HYDROCHLOROTHIAZIDE............... 11VALSTAR..................................................................45VALTREX..................................................................40VANCOCIN HCL.................................................40, 64VANCOMYCIN HCL................................................. 40VANDAZOLE............................................................ 54VANDETANIB........................................................... 46VANIQA.................................................................... 21VANOXIDE-HC......................................................... 16VANTAS....................................................................31VARDENAFIL HCL................................................... 29VARENICLINE TARTRATE.......................................52VASCEPA........................................................... 14, 64VASELINE WHITE PETROLEUM............................ 19VASERETIC..............................................................10VASOLEX................................................................. 21VASOTEC................................................................. 11V-C FORTE...............................................................56VCF(OTC)...........................................................14, 77VECAMYL...........................................................11, 76VECTIBIX........................................................... 45, 76VECTICAL.......................................................... 21, 74VEHICLE-N...............................................................19VEHICLE-N MILD.....................................................19VELCADE...........................................................46, 76VELETRI.............................................................12, 76VELPHORO..............................................................29VELTIN..................................................................... 16VEMURAFENIB........................................................46VENA-BAL DHA....................................................... 58VENATAL COMPLETE DHA.................................... 58VENLAFAXINE HCL...................................................7VENLAFAXINE HCL ER.............................................7VENTAVIS.......................................................... 12, 76VENTOLIN HFA..........................................................5VERAMYST....................................................4, 64, 74VERAPAMIL HCL..................................................... 12VERDESO................................................................ 18VEREGEN................................................................ 17VERELAN.................................................................12
VERIPRED 20.......................................................... 42VERSACLOZ..................................................8, 65, 74VESICARE......................................................... 54, 74VEXOL......................................................................32VFEND......................................................................39VIAGRA........................................................ 29, 65, 77VIBRAMYCIN........................................................... 39VI-CERT C1000 WITH B12...................................... 55VI-CERT C500..........................................................59VICOPROFEN..........................................................48VICTORY(OTC)..................................................25, 27VICTOZA 2-PAK........................................... 22, 65, 74VICTOZA 3-PAK........................................... 22, 65, 74VICTRELIS......................................................... 41, 76VIDAZA.....................................................................45VIDEX.................................................................41, 65VIDEX EC(CAP DR)(125 MG)............................41, 65VIDEX EC(CAP DR)(200 MG)............................41, 65VIDEX EC(CAP DR)(250 MG)..................................41VIDEX EC(CAP DR)(400 MG)..................................41VIGABATRIN............................................................ 52VIGAMOX.................................................................32VIIBRYD(TAB DS PK).......................................... 7, 74VIIBRYD(TAB)................................................ 7, 65, 74VILAZODONE HYDROCHLORIDE............................7VIMOVO............................................................. 43, 74VIMPAT(SOLUTION)................................................ 51VIMPAT(TAB)................................................51, 65, 74VINATE CARE.......................................................... 58VINATE DHA RF.......................................................57VINATE GT............................................................... 58VINATE II.................................................................. 58VINATE PN CARE.................................................... 58VINATE ULTRA........................................................ 58VINATE-M.................................................................57VINBLASTINE SULFATE..........................................47VINCRISTINE SULFATE LIPOSOMAL.................... 47VINORELBINE TARTRATE...................................... 47VIOKACE..................................................................52VIORELE............................................................ 14, 77VIOS AEROSOL DELIVERY SYSTEM...................... 6VIRACEPT................................................................41VIRAMUNE XR.........................................................41VIRAMUNE(ORAL SUSP)..................................41, 65VIRAMUNE(TAB)................................................41, 65VIRASAL.................................................................. 20VIRAZOLE................................................................40VIREAD(POWDER)............................................41, 65VIREAD(TAB)..................................................... 41, 65VIROPTIC.................................................................32VIRT-CAPS...............................................................59VIRT-VITE PLUS...................................................... 59VISMODEGIB...........................................................46VISTARIL.................................................................... 4VIT 3......................................................................... 56VIT A,C,E/ZINC/COPPER/LUT/ZEAX......................54VIT B CMPLX 3/FA/VIT C/BIOTIN............................59VIT B CMPLX NO3/FA/C/BIOT/ZINC....................... 59VIT B COMPLEX & C NO.13/FA/D3.........................59VIT B CPLX #11/FA/C/BIOT/ZN OX......................... 59VIT E/LIDOCAIN/ALO VER/COLAGN......................21VITAFOL................................................................... 55VITAFOL ULTRA...................................................... 57VITAFOL-OB.............................................................58VITAFOL-OB+DHA...................................................58VITAFOL-ONE.......................................................... 57VITAFOL-PN.............................................................57VITAJECT................................................................. 59VITAL-D RX.............................................................. 59VITAMEDMD ONE RX..............................................58VITAMEDMD PLUS RX............................................ 58VITAMEDMD REDICHEW RX..................................58VITAMIN B COMP AND VIT C NO.6........................ 56VITAMIN B COMPLEX............................................. 59VITAMIN D3(OTC)..............................................59, 60VITAMINS B1,B2,B3,B5,& B6...................................59VITA-RESPA.............................................................59VITASPIRE............................................................... 56VITE AC/GRAPE/HYALURONIC ACID.................... 20VITE CON FORTE....................................................55VITMAIN B-12...........................................................59VITUZ....................................................................... 15VIVA CT.................................................................... 58VIVACTIL.................................................................... 8VIVELLE-DOT.................................................... 36, 65VIVITROL................................................................... 8VIVOTIF BERNA...................................................... 37VOCAL POINT(OTC)................................................25VOL-TAB RX.............................................................58
VOLTAREN...............................................................19VOLTAREN-XR.........................................................43VORAXAZE.............................................................. 47VORICONAZOLE..................................................... 39VORINOSTAT...........................................................46VORTEX..................................................................... 6VORTEX VHC FROG MASK......................................6VORTEX VHC LADYBUG MASK............................... 6VORTIOXETINE HYDROBROMIDE.......................... 7VOSPIRE ER..............................................................5VOTRIENT................................................... 46, 65, 76VP CH ULTRA.......................................................... 57VP-CH-PNV..............................................................57VP-ERA OB PLUS....................................................56VP-HEME ONE.........................................................57VP-PNV-DHA............................................................58VUSION....................................................................17VYTORIN(TAB)(10 MG-10MG).................... 13, 65, 74VYTORIN(TAB)(10 MG-20MG).................... 13, 65, 74VYTORIN(TAB)(10 MG-40MG).................... 13, 65, 74VYTORIN(TAB)(10 MG-80MG).......................... 13, 65VYVANSE....................................................... 8, 65, 74- W -WARFARIN SODIUM............................................... 34WATCHHALER...........................................................6WATER..................................................................... 20WATER FOR IRRIGATION,STERILE.......................20WAVESENSE AMP(OTC).........................................27WAVESENSE JAZZ(OTC)..................................25, 27WAVESENSE PRESTO(OTC)............................25, 27WEED POLLEN-SHORT RAGWEED........................ 4WELCHOL................................................................13WELLBUTRIN XL....................................................... 7WESTCORT............................................................. 19WIDE SEAL DIAPHRAGM................................. 15, 77WILATE.....................................................................34- X -XALATAN..................................................................33XALKORI...................................................... 46, 65, 76XANAX........................................................................8XARELTO(TAB)(10 MG).....................................34, 65XARELTO(TAB)(15 MG).....................................34, 65XARELTO(TAB)(20 MG).....................................34, 65XARTEMIS XR......................................................... 50XCLAIR.....................................................................19XELJANZ............................................................42, 76XELODA(TAB)(150 MG)...............................45, 65, 76XELODA(TAB)(500 MG)...............................45, 65, 76XENAZINE................................................................47XENICAL.................................................................. 59XERAC AC............................................................... 19XERESE................................................................... 17XGEVA................................................................30, 76XIFAXAN(TAB)(200 MG).......................................... 40XIFAXAN(TAB)(550 MG).............................. 40, 65, 74XOLAIR.......................................................... 5, 65, 76XOLEGEL.................................................................17XOPENEX.................................................................. 5XOPENEX HFA.......................................................... 5XTANDI.........................................................45, 65, 76X-VIATE.................................................................... 20XYNTHA................................................................... 34XYNTHA SOLOFUSE...............................................34XYREM.................................................................8, 76XYZAL(SOLUTION)....................................... 4, 65, 74XYZAL(TAB)............................................................... 4- Y -YERVOY.............................................................47, 76YODOXIN................................................................. 40YOHIMAR.................................................................29YOHIMBINE HCL..................................................... 29YOHIMBINE HCL/ZINC SULFATE........................... 29YOHIMEX................................................................. 29- Z -ZAFIRLUKAST........................................................... 5ZALEPLON.................................................................9ZALTRAP............................................................46, 76ZAMICET............................................................49, 65ZANAFLEX............................................................... 52ZANAMIVIR.............................................................. 40ZANOSAR................................................................ 45ZANTAC....................................................................53ZARONTIN............................................................... 51ZAROXOLYN............................................................13ZATEAN-PN DHA..................................................... 57ZATEAN-PN PLUS................................................... 57ZEBETA.................................................................... 11ZEGERID(CAP)............................................53, 65, 74ZEGERID(PACKET)..................................... 53, 65, 74
L.A. Care Page 95 of 96
Index
ZELAPAR............................................................51, 65ZELBORAF...................................................46, 65, 76ZEMAIRA..................................................................45ZEMPLAR.................................................................31ZENCIA.....................................................................17ZENPEP(CAP DR)(10-34-55K)................................ 52ZENPEP(CAP DR)(15-51-82K)................................ 52ZENPEP(CAP DR)(20-68-109K).............................. 52ZENPEP(CAP DR)(25-85-136K).............................. 52ZENPEP(CAP DR)(3K-10K-16K)............................. 52ZENPEP(CAP DR)(5K-17K-27K)............................. 52ZENZEDI........................................................ 8, 65, 74ZERIT(CAP)........................................................41, 65ZERIT(SOLN RECON)....................................... 41, 65ZESTORETIC........................................................... 10ZESTRIL................................................................... 11ZETIA................................................................. 13, 65ZETONNA.......................................................4, 65, 74ZEVALIN................................................................... 46ZGESIC.................................................................... 15ZIAC..........................................................................12ZIAGEN(SOLUTION)..........................................41, 65ZIAGEN(TAB)..................................................... 41, 65ZIANA....................................................................... 16ZIDOVUDINE......................................................41, 65ZILEUTON.................................................................. 5ZINC CL/B-CAINE/CETYLPYRD CL........................48ZINC SULFATE.........................................................59ZIOPTAN...................................................... 33, 65, 74ZIPRASIDONE HCL................................................... 9ZIPSOR.................................................................... 43ZIRGAN.................................................................... 32ZITHRANOL....................................................... 21, 74ZITHRANOL-RR.................................................21, 74ZITHROMAX.............................................................38ZITHROMAX TRI-PAK..............................................38ZIV-AFLIBERCEPT...................................................46ZMAX........................................................................38ZOCOR.....................................................................13ZOFRAN ODT............................................................ 4ZOFRAN(SOLUTION).......................................... 4, 65ZOFRAN(TAB)............................................................4ZOHYDRO ER..........................................................49ZOLADEX...........................................................30, 76ZOLEDRONIC ACID.................................................30ZOLEDRONIC ACID/MANNITOL&WATER.............. 30ZOLINZA...................................................................46ZOLMITRIPTAN........................................................50ZOLOFT......................................................................7ZOLPIDEM TARTRATE........................................9, 65ZOLPIMIST.....................................................9, 65, 74ZOMETA................................................................... 30ZOMIG(SPRAY)(2.5 MG)............................. 50, 65, 74ZOMIG(SPRAY)(5 MG)................................ 50, 65, 74ZOMIG(TAB).................................................50, 65, 74ZONALON................................................................ 19ZONATUSS.............................................................. 15ZONEGRAN............................................................. 52ZONISAMIDE........................................................... 52ZORBTIVE..........................................................31, 76ZORTRESS.............................................................. 37ZORVOLEX.................................................. 43, 65, 74ZOVIA 1-35E...................................................... 14, 77ZOVIRAX..................................................................40ZOVIRAX(CREAM)...................................................17ZOVIRAX(OINT).......................................................17ZUBSOLV........................................................... 50, 76ZUPLENZ(FILM)(4 MG)..................................4, 65, 74ZUPLENZ(FILM)(8 MG)..................................4, 65, 74ZYCLARA(CREAM PACK)........................... 37, 65, 76ZYCLARA(CRM MD PMP)(2.5 %)................37, 65, 76ZYCLARA(CRM MD PMP)(3.75 %)............. 37, 65, 76ZYDONE.............................................................49, 65ZYFLO........................................................................ 5ZYFLO CR..................................................................5ZYKADIA............................................................ 46, 76ZYLET.......................................................................31ZYLOPRIM............................................................... 33ZYMAXID..................................................................32ZYPREXA.............................................................8, 65ZYPREXA RELPREVV...............................................8ZYTIGA.........................................................45, 65, 76ZYVOX............................................................... 38, 76
L.A. Care Page 96 of 96
Index