Medicaid-Approved Preferred Drug List

Nebraska

Medicaid-Approved

Preferred Drug List

Effective November 1, 2021

Legend

In each class, drugs are listed alphabetically by either brand name or generic name.

Brand name drug: Uppercase in bold type

Generic drug: Lowercase in plain type

* : 599 CHIP benefits (Pregnant Women)

AL: Age Limit Restrictions

DO: Dose Optimization Program

GR: Gender Restriction

OTC: Over the counter medication available with a prescription. (Prescribers please indicate OTC on the prescription)

PA: Prior authorization is required. Prior authorization is the process of obtaining approval of benefits before certain prescriptions are filled.

QL: Quantity limits; certain prescription medications have specific quantity limits per prescription or per month.

SP: Specialty Pharmacy

ST: Step therapy is required. You may need to use one medication before benefits for the use of another medication can be authorized.

Drug Name Reference Notes

*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*

*ADHD AGENT - SELECTIVE ALPHA ADRENERGIC AGONISTS***

guanfacine hcl er oral tablet extended release 24 hour 1 mg, 2 mg, 3 mg, 4 mg

Intuniv AL; QL

*ADHD AGENT - SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR***

atomoxetine hcl oral capsule 10 mg, 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg

Strattera AL; QL

*AMPHETAMINE MIXTURES***

ADDERALL ORAL TABLET 10 MG, 12.5 MG, 15 MG, 20 MG, 30 MG, 5 MG, 7.5 MG

AL

ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 20 MG, 25 MG, 30 MG, 5 MG

AL

amphetamine-dextroamphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg

Adderall AL

*AMPHETAMINES***

VYVANSE ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG, 70 MG

AL

VYVANSE ORAL TABLET CHEWABLE 10 MG, 20 MG, 30 MG, 40 MG, 50 MG, 60 MG

AL

*ANALEPTICS***

caffeine citrate oral solution 20 mg/ml, 60 mg/3ml

*STIMULANTS - MISC.***

CONCERTA ORAL TABLET EXTENDED RELEASE 18 MG, 27 MG, 54 MG

AL

CONCERTA ORAL TABLET EXTENDED RELEASE 36 MG

AL; QL

dexmethylphenidate hcl oral tablet 10 mg, 2.5 mg, 5 mg

Focalin AL

FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG, 15 MG, 20 MG, 25 MG, 30 MG, 35 MG, 40 MG, 5 MG

AL

METHYLIN ORAL SOLUTION 10 MG/5ML, 5 MG/5ML* = 599 CHIP benefits (Pregnant Women)

2


methylphenidate hcl oral solution 10 mg/5ml, 5 mg/5ml

Methylin

methylphenidate hcl oral tablet 10 mg, 20 mg, 5 mg

Ritalin

QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 20 MG, 30 MG, 40 MG

AL

*AMINOGLYCOSIDES*

*AMINOGLYCOSIDES***

BETHKIS INHALATION NEBULIZATION SOLUTION 300 MG/4ML

SP; *

KITABIS PAK INHALATION NEBULIZATION SOLUTION 300 MG/5ML

SP; *

neomycin sulfate oral tablet 500 mg *

TOBI PODHALER INHALATION CAPSULE28 MG

SP; *

*ANALGESICS - ANTI-INFLAMMATORY*

*ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES***

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT 80 MG/0.8ML, 80 MG/0.8ML & 40MG/0.4ML

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.4ML

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML, 80 MG/0.8ML

QL

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML, 80 MG/0.8ML

QL

HUMIRA PEN-PEDIATRIC UC START SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML

HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 MG/0.8ML

QL

HUMIRA PEN-PSOR/UVEIT STARTER SUBCUTANEOUS PEN-INJECTOR KIT 80 MG/0.8ML & 40MG/0.4ML

* = 599 CHIP benefits (Pregnant Women)

3


HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.1ML, 20 MG/0.2ML, 40 MG/0.4ML

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 40 MG/0.8ML

QL

*CYCLOOXYGENASE 2 (COX-2) INHIBITORS***

celecoxib oral capsule 100 mg, 200 mg, 400 mg, 50 mg

CeleBREX

*GOLD COMPOUNDS***

RIDAURA ORAL CAPSULE 3 MG

*NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)***

diclofenac sodium oral tablet delayed release 25 mg, 50 mg, 75 mg

ec-naproxen oral tablet delayed release 375 mg, 500 mg

EC-Naprosyn

IBU ORAL TABLET 400 MG, 600 MG, 800 MG

ibuprofen oral suspension 100 mg/5ml Childrens Advil

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

IBU

indomethacin oral capsule 25 mg, 50 mg

ketorolac tromethamine oral tablet 10 mg QL

meloxicam oral tablet 15 mg, 7.5 mg Mobic

nabumetone oral tablet 500 mg, 750 mg Relafen

naproxen oral tablet 250 mg, 375 mg

naproxen oral tablet 500 mg Naprosyn

naproxen oral tablet delayed release 375 mg, 500 mg

EC-Naprosyn

sm ibuprofen ib childrens oral tablet chewable 100 mg

Advil Junior Strength OTC

sulindac oral tablet 150 mg, 200 mg

*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS***

OTEZLA ORAL TABLET 30 MG SP; QL

OTEZLA ORAL TABLET THERAPY PACK10 & 20 & 30 MG

SP; QL


4


*PYRIMIDINE SYNTHESIS INHIBITORS***

leflunomide oral tablet 10 mg, 20 mg Arava QL

*SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS***

ENBREL MINI SUBCUTANEOUS SOLUTION CARTRIDGE 50 MG/ML

QL

ENBREL SUBCUTANEOUS SOLUTION 25 MG/0.5ML

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML, 50 MG/ML

QL

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED 25 MG

QL

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR 50 MG/ML

QL

*ANALGESICS - NONNARCOTIC*

*ANALGESICS-SEDATIVES***

BAC ORAL TABLET 50-325-40 MG *; QL

butalbital-acetaminophen oral tablet 50-325 mg

Tencon *; QL

butalbital-apap-caffeine oral capsule 50-300-40 mg

Fioricet *; QL

butalbital-apap-caffeine oral capsule 50-325-40 mg

Esgic *; QL

butalbital-apap-caffeine oral tablet 50-325-40 mg

Bac *; QL

butalbital-asa-caffeine oral capsule 50-325-40 mg

QL

butalbital-aspirin-caffeine oral capsule 50-325-40 mg

*; QL

TENCON ORAL TABLET 50-325 MG *; QL

*ANALGESICS - OPIOID*

*CODEINE COMBINATIONS***

acetaminophen-codeine #2 oral tablet 300-15 mg

AL


AL


AL


5


acetaminophen-codeine oral solution 120-12 mg/5ml

AL

acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg, 300-60 mg

AL

*HYDROCODONE COMBINATIONS***

hydrocodone-acetaminophen oral solution 10-325 mg/15ml, 2.5-108 mg/5ml, 5-217 mg/10ml, 7.5-325 mg/15ml

hydrocodone-acetaminophen oral tablet 10-300 mg, 10-325 mg, 5-325 mg, 7.5-300 mg, 7.5-325 mg

hydrocodone-acetaminophen oral tablet 5-300 mg

Xodol

hydrocodone-ibuprofen oral tablet 10-200 mg, 5-200 mg, 7.5-200 mg

XODOL ORAL TABLET 5-300 MG

*OPIOID AGONISTS***

codeine sulfate oral tablet 15 mg, 30 mg, 60 mg

AL

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

QL

hydromorphone hcl oral tablet 2 mg, 4 mg, 8 mg

Dilaudid

morphine sulfate (concentrate) oral solution 10 mg/0.5ml, 100 mg/5ml, 20 mg/ml

morphine sulfate er oral tablet extended release 100 mg, 15 mg, 200 mg, 30 mg, 60 mg

MS Contin

morphine sulfate oral solution 10 mg/5ml, 20 mg/5ml

morphine sulfate oral tablet 15 mg, 30 mg

oxycodone hcl oral solution 5 mg/5ml

oxycodone hcl oral tablet 10 mg, 20 mg

oxycodone hcl oral tablet 15 mg, 30 mg Roxicodone

oxycodone hcl oral tablet 5 mg Oxaydo

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG

PA; QL

tramadol hcl er oral tablet extended release 24 hour 100 mg, 200 mg, 300 mg


6


tramadol hcl oral tablet 50 mg Ultram AL

*OPIOID COMBINATIONS***

ENDOCET ORAL TABLET 10-325 MG, 5-325 MG, 7.5-325 MG

ENDOCET ORAL TABLET 2.5-325 MG

oxycodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg

Endocet

PROLATE ORAL TABLET 10-300 MG, 5-300 MG, 7.5-300 MG

*OPIOID PARTIAL AGONISTS***

buprenorphine hcl sublingual tablet sublingual 2 mg, 8 mg

AL; QL

buprenorphine hcl-naloxone hcl sublingual tablet sublingual 2-0.5 mg, 8-2 mg

AL; QL

BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HR, 15 MCG/HR, 20 MCG/HR, 5 MCG/HR, 7.5 MCG/HR

QL

SUBOXONE SUBLINGUAL FILM 12-3 MG, 2-0.5 MG, 4-1 MG, 8-2 MG

PA; AL; QL

*TRAMADOL COMBINATIONS***

tramadol-acetaminophen oral tablet 37.5-325 mg

Ultracet AL

*ANDROGENS-ANABOLIC*

*ANDROGENS***

ANDROGEL PUMP TRANSDERMAL GEL20.25 MG/ACT (1.62%)

testosterone transdermal gel 12.5 mg/act (1%)

Vogelxo Pump

*ANORECTAL AND RELATED PRODUCTS*

*RECTAL STEROIDS***

ANUSOL-HC EXTERNAL CREAM 2.5 %

hydrocortisone (perianal) external cream 2.5 %

Anusol-HC

PROCTOCARE-HC EXTERNAL CREAM2.5 %

PROCTOCORT EXTERNAL CREAM 1 %

PROCTO-MED HC EXTERNAL CREAM 2.5 %


7


PROCTOSOL HC EXTERNAL CREAM 2.5 %

PROCTOZONE-HC EXTERNAL CREAM2.5 %

*ANTHELMINTICS*

*ANTHELMINTICS***

albendazole oral tablet 200 mg Albenza

BILTRICIDE ORAL TABLET 600 MG

ivermectin oral tablet 3 mg Stromectol

*ANTIANGINAL AGENTS*

*NITRATES***

isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg

isosorbide dinitrate oral tablet 40 mg, 5 mg Isordil Titradose

isosorbide mononitrate er oral tablet extended release 24 hour 120 mg, 30 mg, 60 mg

isosorbide mononitrate oral tablet 10 mg, 20 mg

nitroglycerin sublingual tablet sublingual 0.3 mg, 0.4 mg, 0.6 mg

Nitrostat

nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr

Nitro-Dur

*ANTIANXIETY AGENTS*

*ANTIANXIETY AGENTS - MISC.***

buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg

hydroxyzine pamoate oral capsule 25 mg, 50 mg

Vistaril QL

*BENZODIAZEPINES***

alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg

Xanax

chlordiazepoxide hcl oral capsule 10 mg, 25 mg, 5 mg

diazepam oral solution 5 mg/5ml

diazepam oral tablet 10 mg, 2 mg, 5 mg Valium

LORAZEPAM INTENSOL ORAL CONCENTRATE 2 MG/ML


8


lorazepam oral concentrate 1 mg/0.5ml, 2 mg/ml

LORazepam Intensol

lorazepam oral tablet 0.5 mg, 1 mg, 2 mg Ativan

*ANTIARRHYTHMICS*

*ANTIARRHYTHMICS TYPE I-A***

disopyramide phosphate oral capsule 100 mg, 150 mg

Norpace *

quinidine gluconate er oral tablet extended release 324 mg

*

quinidine sulfate oral tablet 200 mg, 300 mg *

*ANTIARRHYTHMICS TYPE I-B***

mexiletine hcl oral capsule 150 mg, 200 mg, 250 mg

*

*ANTIARRHYTHMICS TYPE I-C***

flecainide acetate oral tablet 100 mg, 150 mg, 50 mg

*; QL

propafenone hcl er oral capsule extended release 12 hour 225 mg, 325 mg, 425 mg

Rythmol SR *

propafenone hcl oral tablet 150 mg, 225 mg, 300 mg

*

*ANTIARRHYTHMICS TYPE III***

amiodarone hcl oral tablet 200 mg Pacerone *; QL

amiodarone hcl oral tablet 400 mg Pacerone *

PACERONE ORAL TABLET 200 MG *; QL

PACERONE ORAL TABLET 400 MG *

*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*

*ADRENERGIC COMBINATIONS***

ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100-50 MCG/DOSE, 250-50 MCG/DOSE, 500-50 MCG/DOSE

*; QL

ADVAIR HFA INHALATION AEROSOL115-21 MCG/ACT, 230-21 MCG/ACT, 45-21 MCG/ACT

*; QL

ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 62.5-25 MCG/INH

*

COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION 20-100 MCG/ACT

*


9


DULERA INHALATION AEROSOL 100-5 MCG/ACT, 200-5 MCG/ACT, 50-5 MCG/ACT

*

ipratropium-albuterol inhalation solution 0.5-2.5 (3) mg/3ml

*

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION 2.5-2.5 MCG/ACT

*

SYMBICORT INHALATION AEROSOL160-4.5 MCG/ACT, 80-4.5 MCG/ACT

*; QL

*ANTI-INFLAMMATORY AGENTS***

cromolyn sodium inhalation nebulization solution 20 mg/2ml

*

*BETA ADRENERGICS***

albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%, 0.63 mg/3ml, 1.25 mg/3ml, 2.5 mg/0.5ml

*

albuterol sulfate inhalation nebulization solution (5 mg/ml) 0.5%

albuterol sulfate oral syrup 2 mg/5ml *

PROAIR HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT

*

SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 50 MCG/DOSE

*

*BRONCHODILATORS - ANTICHOLINERGICS***

ATROVENT HFA INHALATION AEROSOL SOLUTION 17 MCG/ACT

*

ipratropium bromide inhalation solution 0.02 %

*

SPIRIVA HANDIHALER INHALATION CAPSULE 18 MCG

*

*INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA)***

FASENRA PEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR 30 MG/ML

SP; *; QL

*LEUKOTRIENE RECEPTOR ANTAGONISTS***

montelukast sodium oral tablet 10 mg Singulair *; QL


10


montelukast sodium oral tablet chewable 4 mg, 5 mg

Singulair AL; *; QL

*STEROID INHALANTS***

ASMANEX (120 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED 220 MCG/INH

*; QL


*; QL


AL; *; QL


*; QL


*; QL


AL; *; QL

FLOVENT HFA INHALATION AEROSOL110 MCG/ACT, 220 MCG/ACT, 44 MCG/ACT

*

PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED 180 MCG/ACT, 90 MCG/ACT

*

*XANTHINES***

theophylline er oral tablet extended release 12 hour 300 mg, 450 mg

*; QL

theophylline er oral tablet extended release 24 hour 400 mg, 600 mg

*; QL

theophylline oral solution 80 mg/15ml *

*ANTICOAGULANTS*

*COUMARIN ANTICOAGULANTS***

JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG

*

warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg

Jantoven *


11


*DIRECT FACTOR XA INHIBITORS***

ELIQUIS DVT/PE STARTER PACK ORAL TABLET THERAPY PACK 5 MG

*

ELIQUIS ORAL TABLET 2.5 MG, 5 MG *

XARELTO ORAL TABLET 10 MG, 15 MG, 2.5 MG, 20 MG

*; QL

XARELTO STARTER PACK ORAL TABLET THERAPY PACK 15 & 20 MG

*

*LOW MOLECULAR WEIGHT HEPARINS***

enoxaparin sodium injection solution 300 mg/3ml

Lovenox SP; *; QL

enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml

Lovenox SP; *; QL

*THROMBIN INHIBITORS - SELECTIVE DIRECT & REVERSIBLE***

PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG

*

*ANTICONVULSANTS*

*ANTICONVULSANTS - BENZODIAZEPINES***

clonazepam oral tablet 0.5 mg, 1 mg, 2 mg KlonoPIN *; QL

clonazepam oral tablet dispersible 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, 2 mg

*; QL

diazepam rectal gel 10 mg, 20 mg Diastat AcuDial *

diazepam rectal gel 2.5 mg Diastat Pediatric *

*ANTICONVULSANTS - MISC.***

carbamazepine er oral capsule extended release 12 hour 100 mg, 200 mg, 300 mg

Carbatrol AL; *; QL

carbamazepine er oral tablet extended release 12 hour 100 mg, 200 mg, 400 mg

TEGretol-XR AL; *; QL

carbamazepine oral suspension 100 mg/5ml TEGretol AL; *; QL

carbamazepine oral tablet 200 mg Epitol AL; *; QL

carbamazepine oral tablet chewable 100 mg AL; *; QL

EPITOL ORAL TABLET 200 MG AL; *; QL

gabapentin oral capsule 100 mg, 300 mg, 400 mg

Neurontin *


12


gabapentin oral solution 250 mg/5ml, 300 mg/6ml

Neurontin *

gabapentin oral tablet 600 mg, 800 mg Neurontin *

lamotrigine er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg

LaMICtal XR AL; *; QL

lamotrigine oral kit 25 & 50 & 100 mg LaMICtal ODT AL; *

lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg

Subvenite AL; *; QL

lamotrigine oral tablet chewable 25 mg, 5 mg

LaMICtal AL; *; QL

lamotrigine oral tablet dispersible 100 mg, 200 mg, 25 mg, 50 mg

LaMICtal ODT AL; *; QL

lamotrigine starter kit-blue oral kit 35 x 25 mg

Subvenite Starter Kit-Blue AL; *

lamotrigine starter kit-green oral kit 84 x 25 mg & 14x100 mg

Subvenite Starter Kit-Green

AL; *

lamotrigine starter kit-orange oral kit 42 x 25 mg & 7 x 100 mg

Subvenite Starter Kit-Orange

AL; *

levetiracetam er oral tablet extended release 24 hour 500 mg, 750 mg

Keppra XR *; QL

levetiracetam oral solution 100 mg/ml Keppra *

levetiracetam oral tablet 1000 mg, 250 mg, 750 mg

Keppra *

levetiracetam oral tablet 500 mg Roweepra *

oxcarbazepine oral suspension 300 mg/5ml Trileptal AL; *; QL

oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg

Trileptal AL; *; QL

pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 300 mg, 50 mg, 75 mg

Lyrica *; QL

pregabalin oral solution 20 mg/ml Lyrica *; QL

primidone oral tablet 250 mg, 50 mg Mysoline *

ROWEEPRA ORAL TABLET 500 MG *

SUBVENITE ORAL TABLET 100 MG, 150 MG, 200 MG, 25 MG

AL; *; QL

SUBVENITE STARTER KIT-BLUE ORAL KIT 35 X 25 MG

AL; *

SUBVENITE STARTER KIT-GREEN ORAL KIT 84 X 25 MG & 14X100 MG

AL; *


13


SUBVENITE STARTER KIT-ORANGE ORAL KIT 42 X 25 MG & 7 X 100 MG

AL; *

topiramate oral capsule sprinkle 15 mg, 25 mg

Topamax Sprinkle AL; *; QL

topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg

Topamax *; QL

zonisamide oral capsule 100 mg, 25 mg Zonegran *; QL

zonisamide oral capsule 50 mg *; QL

*CARBAMATES***

felbamate oral suspension 600 mg/5ml Felbatol *

felbamate oral tablet 400 mg, 600 mg Felbatol *

*GABA MODULATORS***

tiagabine hcl oral tablet 12 mg, 16 mg, 2 mg, 4 mg

Gabitril *

*HYDANTOINS***

PHENYTOIN INFATABS ORAL TABLET CHEWABLE 50 MG

*

phenytoin oral suspension 100 mg/4ml, 125 mg/5ml

Dilantin *

phenytoin oral tablet chewable 50 mg Phenytoin Infatabs *

phenytoin sodium extended oral capsule 100 mg

Dilantin *

phenytoin sodium extended oral capsule 200 mg, 300 mg

Phenytek *

*SUCCINIMIDES***

ethosuximide oral capsule 250 mg Zarontin *

ethosuximide oral solution 250 mg/5ml Zarontin *

*VALPROIC ACID***

divalproex sodium er oral tablet extended release 24 hour 250 mg, 500 mg

Depakote ER AL; *; QL

divalproex sodium oral capsule delayed release sprinkle 125 mg

Depakote Sprinkles AL; *; QL

divalproex sodium oral tablet delayed release 125 mg, 250 mg

Depakote AL; *; QL

divalproex sodium oral tablet delayed release 500 mg

Depakote *

valproic acid oral capsule 250 mg *; QL

valproic acid oral solution 250 mg/5ml *


14


*ANTIDEPRESSANTS*

*ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)***

mirtazapine oral tablet 15 mg, 30 mg Remeron AL; *; QL

mirtazapine oral tablet 45 mg, 7.5 mg AL; *; QL

mirtazapine oral tablet dispersible 15 mg, 30 mg, 45 mg

Remeron SolTab AL; *; QL

*ANTIDEPRESSANTS - MISC.***

bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg

Wellbutrin SR AL; *; QL

bupropion hcl er (sr) oral tablet extended release 12 hour 150 mg, 200 mg

Wellbutrin SR AL; *

bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg, 300 mg

Wellbutrin XL AL; *; QL

bupropion hcl oral tablet 100 mg, 75 mg AL; *; QL

*MONOAMINE OXIDASE INHIBITORS (MAOIS)***

phenelzine sulfate oral tablet 15 mg Nardil AL; *; QL

tranylcypromine sulfate oral tablet 10 mg Parnate AL; *; QL

*SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)***

citalopram hydrobromide oral solution 10 mg/5ml

*; QL

citalopram hydrobromide oral tablet 10 mg, 20 mg, 40 mg

CeleXA *; QL

escitalopram oxalate oral solution 5 mg/5ml *; QL

escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg

Lexapro *; QL

fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg

PROzac *; QL

fluoxetine hcl oral capsule delayed release 90 mg

*

fluoxetine hcl oral solution 20 mg/5ml *; QL

fluvoxamine maleate oral tablet 100 mg, 25 mg, 50 mg

*; QL

paroxetine hcl er oral tablet extended release 24 hour 12.5 mg, 25 mg, 37.5 mg

Paxil CR *; QL

paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg

Paxil *; QL


15


sertraline hcl oral concentrate 20 mg/ml Zoloft *; QL

sertraline hcl oral tablet 100 mg, 25 mg, 50 mg

Zoloft *; QL

*SEROTONIN MODULATORS***

nefazodone hcl oral tablet 100 mg, 50 mg AL; *; QL

nefazodone hcl oral tablet 150 mg, 200 mg, 250 mg

*; QL

trazodone hcl oral tablet 100 mg, 150 mg, 300 mg, 50 mg

*; QL

*SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)***

venlafaxine hcl er oral capsule extended release 24 hour 150 mg, 37.5 mg, 75 mg

Effexor XR *; QL

venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg

*; QL

*TRICYCLIC AGENTS***

amitriptyline hcl oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg

AL; *; QL

amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg

AL; *

clomipramine hcl oral capsule 25 mg, 50 mg, 75 mg

Anafranil AL; *; QL

desipramine hcl oral tablet 10 mg, 25 mg Norpramin AL; *; QL

desipramine hcl oral tablet 100 mg, 150 mg, 50 mg, 75 mg

AL; *; QL

doxepin hcl oral capsule 10 mg, 100 mg, 25 mg, 50 mg, 75 mg

*; QL

doxepin hcl oral capsule 150 mg AL; *; QL

doxepin hcl oral concentrate 10 mg/ml AL; *; QL

imipramine hcl oral tablet 10 mg, 25 mg, 50 mg

AL; *; QL

imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg

AL; *; QL

nortriptyline hcl oral capsule 10 mg, 25 mg, 50 mg, 75 mg

Pamelor AL; *; QL

nortriptyline hcl oral solution 10 mg/5ml AL; *; QL

protriptyline hcl oral tablet 10 mg, 5 mg AL; *; QL

trimipramine maleate oral capsule 100 mg, 25 mg, 50 mg

AL; *; QL


16


*ANTIDIABETICS*

*ALPHA-GLUCOSIDASE INHIBITORS***

acarbose oral tablet 100 mg, 25 mg, 50 mg Precose *

*BIGUANIDES***

metformin hcl er oral tablet extended release 24 hour 500 mg, 750 mg

*

metformin hcl oral tablet 1000 mg, 500 mg, 850 mg

*

*DIABETIC OTHER - COMBINATIONS***

cvs glucose oral tablet chewable 4-6 gm-mg Dex4 *; OTC

DEX4 GLUCOSE ORAL TABLET CHEWABLE 4-6 GM-MG

*; OTC

DEX4 NATURALS ORAL TABLET CHEWABLE 4-6 GM-MG

*; OTC

DEX4 ORAL TABLET CHEWABLE 4-6 GM-MG

*; OTC

DEX4 POUCH PACK ORAL TABLET CHEWABLE 4-6 GM-MG

*; OTC

glucose instant energy oral tablet chewable 4-6 gm-mg, 6-4 mg-gm

Dex4 *; OTC

glucose oral tablet chewable 4-6 gm-mg Dex4 *; OTC

glucose-vitamin c oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

gnp glucose oral tablet chewable 4-6 gm-mg Dex4 *; OTC

goodsense glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

hy-vee glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

kroger glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

leader glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

longs glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

meijer glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

preferred plus glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC


17


px glucose oral tablet chewable 4-6 gm-mg Dex4 *; OTC

ra glucose oral tablet chewable 4-6 gm-mg, 6-4 mg-gm

Dex4 *; OTC

RELION GLUCOSE ORAL TABLET CHEWABLE 4-6 GM-MG

*; OTC

sm glucose oral tablet chewable 4-6 gm-mg Dex4 *; OTC

SMART SENSE GLUCOSE ORAL TABLET CHEWABLE 4-6 GM-MG

*; OTC

tgt glucose oral tablet chewable 4-6 gm-mg Dex4 *; OTC

up & up glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

value plus glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

walgreens glucose oral tablet chewable 4-6 gm-mg

Dex4 *; OTC

*DIABETIC OTHER***

BAQSIMI ONE PACK NASAL POWDER 3 MG/DOSE

AL; *; QL

BAQSIMI TWO PACK NASAL POWDER 3 MG/DOSE

AL; *; QL

cvs glucose bits oral tablet chewable 1 gm *; OTC

cvs glucose oral gel 15 gm/38gm, 40 % Glutose 15 *; OTC

cvs glucose oral tablet chewable 4 gmDex4 Quick Dissolve Glucose

*; OTC

cvs soft glucose oral tablet chewable 4 gmDex4 Quick Dissolve Glucose

*; OTC

DEX4 QUICK DISSOLVE GLUCOSE ORAL TABLET CHEWABLE 4 GM

*; OTC

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED 1 MG

*; QL

glucagon emergency injection kit 1 mg *; QL

glucose oral gel 40 % Glutose 15 *; OTC

glucose oral tablet chewable 4 gmDex4 Quick Dissolve Glucose

*; OTC

GLUTOSE 15 ORAL GEL 40 % *; OTC



gnp glucose oral tablet chewable 4 gmDex4 Quick Dissolve Glucose

*; OTC


18


gnp quick dissolve glucose oral tablet chewable 4 gm

Dex4 Quick Dissolve Glucose

*; OTC

leader quick dissolve glucose oral tablet chewable 4 gm


*; OTC

PROGLYCEM ORAL SUSPENSION 50 MG/ML

*

RELION GLUCOSE ORAL GEL 15 GM/38GM

*; OTC

sm glucose oral tablet chewable 4 gmDex4 Quick Dissolve Glucose

*; OTC

SWEET CHEEKS ORAL GEL 40 % *; OTC

value plus glucose oral gel 40 % Glutose 15 *; OTC

walgreens glucose oral tablet chewable 4 gm


*; OTC

*DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS***

JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG

AL; *; QL

TRADJENTA ORAL TABLET 5 MG AL; *; QL

*DIPEPTIDYL PEPTIDASE-4 INHIBITOR-BIGUANIDE COMBINATIONS***

JANUMET ORAL TABLET 50-1000 MG, 50-500 MG

AL; *; QL

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG, 50-1000 MG, 50-500 MG

AL; *; QL

JENTADUETO ORAL TABLET 2.5-1000 MG, 2.5-500 MG, 2.5-850 MG

AL; *; QL

*HUMAN INSULIN***

HUMALOG JUNIOR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

*

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

*

HUMALOG MIX 50/50 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (50-50) 100 UNIT/ML

*

HUMALOG MIX 50/50 SUBCUTANEOUS SUSPENSION (50-50) 100 UNIT/ML

*


19


HUMALOG MIX 75/25 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (75-25) 100 UNIT/ML

*

HUMALOG MIX 75/25 SUBCUTANEOUS SUSPENSION (75-25) 100 UNIT/ML

*

HUMALOG SUBCUTANEOUS SOLUTION100 UNIT/ML

*

HUMALOG SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNIT/ML

*

HUMULIN 70/30 KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

*; OTC

HUMULIN 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

*; OTC

HUMULIN N KWIKPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR 100 UNIT/ML

*; OTC

HUMULIN N SUBCUTANEOUS SUSPENSION 100 UNIT/ML

*; OTC

HUMULIN R INJECTION SOLUTION 100 UNIT/ML

*; OTC

HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML

*

HUMULIN R U-500 KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 500 UNIT/ML

*

insulin asp prot & asp flexpen subcutaneous suspension pen-injector (70-30) 100 unit/ml

NovoLOG 70/30 FlexPen ReliOn

*

insulin aspart flexpen subcutaneous solution pen-injector 100 unit/ml

NovoLOG FlexPen *

insulin aspart penfill subcutaneous solution cartridge 100 unit/ml

NovoLOG PenFill *

insulin aspart prot & aspart subcutaneous suspension (70-30) 100 unit/ml

NovoLOG Mix 70/30 *

insulin aspart subcutaneous solution 100 unit/ml

NovoLOG *

insulin lispro (1 unit dial) subcutaneous solution pen-injector 100 unit/ml

HumaLOG KwikPen *

insulin lispro junior kwikpen subcutaneous solution pen-injector 100 unit/ml

HumaLOG Junior KwikPen

*


20


insulin lispro prot & lispro subcutaneous suspension pen-injector (75-25) 100 unit/ml

HumaLOG Mix 75/25 KwikPen

*

insulin lispro subcutaneous solution 100 unit/ml

HumaLOG *

LANTUS SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

*

LANTUS SUBCUTANEOUS SOLUTION100 UNIT/ML

*

LEVEMIR FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

*

LEVEMIR SUBCUTANEOUS SOLUTION100 UNIT/ML

*

NOVOLOG 70/30 FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

*

NOVOLOG FLEXPEN RELION SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

*

NOVOLOG FLEXPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML

*

NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR (70-30) 100 UNIT/ML

*

NOVOLOG MIX 70/30 RELION SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

*

NOVOLOG MIX 70/30 SUBCUTANEOUS SUSPENSION (70-30) 100 UNIT/ML

*

NOVOLOG PENFILL SUBCUTANEOUS SOLUTION CARTRIDGE 100 UNIT/ML

*

NOVOLOG RELION SUBCUTANEOUS SOLUTION 100 UNIT/ML

*

NOVOLOG SUBCUTANEOUS SOLUTION100 UNIT/ML

*

*INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)***

BYETTA 10 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MCG/0.04ML

*

BYETTA 5 MCG PEN SUBCUTANEOUS SOLUTION PEN-INJECTOR 5 MCG/0.02ML

*


21


TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.75 MG/0.5ML, 1.5 MG/0.5ML, 3 MG/0.5ML, 4.5 MG/0.5ML

*

VICTOZA SUBCUTANEOUS SOLUTION PEN-INJECTOR 18 MG/3ML

*

*MEGLITINIDE ANALOGUES***

repaglinide oral tablet 0.5 mg, 1 mg, 2 mg *

*SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS***

GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG

AL; *; QL

*SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS***

FARXIGA ORAL TABLET 10 MG, 5 MG *

INVOKANA ORAL TABLET 100 MG, 300 MG

*

JARDIANCE ORAL TABLET 10 MG, 25 MG

*; QL

*SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB***

INVOKAMET ORAL TABLET 150-1000 MG, 150-500 MG, 50-1000 MG, 50-500 MG

*

SYNJARDY ORAL TABLET 12.5-1000 MG, 12.5-500 MG, 5-1000 MG, 5-500 MG

AL; *; QL

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 MG, 10-500 MG, 2.5-1000 MG, 5-1000 MG, 5-500 MG

*; QL

*SULFONYLUREA-BIGUANIDE COMBINATIONS***

glipizide-metformin hcl oral tablet 2.5-250 mg, 2.5-500 mg, 5-500 mg

*

glyburide-metformin oral tablet 1.25-250 mg, 2.5-500 mg, 5-500 mg

*

*SULFONYLUREAS***

glimepiride oral tablet 1 mg, 2 mg, 4 mg Amaryl *

glipizide er oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Glucotrol XL *

glipizide oral tablet 10 mg, 5 mg *


22


glipizide xl oral tablet extended release 24 hour 10 mg, 2.5 mg, 5 mg

Glucotrol XL *

glyburide micronized oral tablet 1.5 mg, 3 mg, 6 mg

Glynase *

glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg *

*THIAZOLIDINEDIONES***

pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg

Actos *

*ANTIDIARRHEAL/PROBIOTIC AGENTS*

*ANTIPERISTALTIC AGENTS***

diphenoxylate-atropine oral liquid 2.5-0.025 mg/5ml

diphenoxylate-atropine oral tablet 2.5-0.025 mg

Lomotil

loperamide hcl oral capsule 2 mg Imodium A-D QL

*ANTIDOTES AND SPECIFIC ANTAGONISTS*

*ANTIDOTES - CHELATING AGENTS***

FERRIPROX ORAL TABLET 1000 MG PA; SP

*OPIOID ANTAGONISTS***

naloxone hcl injection solution 0.4 mg/ml, 4 mg/10ml

naloxone hcl injection solution cartridge 0.4 mg/ml

naloxone hcl injection solution prefilled syringe 2 mg/2ml

naltrexone hcl oral tablet 50 mg AL

NARCAN NASAL LIQUID 4 MG/0.1ML

*ANTIEMETICS*

*5-HT3 RECEPTOR ANTAGONISTS***

ondansetron hcl oral solution 4 mg/5ml QL

ondansetron hcl oral tablet 4 mg Zofran QL

ondansetron hcl oral tablet 8 mg QL

ondansetron oral tablet dispersible 4 mg, 8 mg


23


*ANTIEMETIC COMBINATIONS***

DICLEGIS ORAL TABLET DELAYED RELEASE 10-10 MG

PA; QL

*ANTIEMETICS - ANTICHOLINERGIC***

meclizine hcl oral tablet 12.5 mg

meclizine hcl oral tablet 25 mg Travel-Ease

motion sickness relief oral tablet 25 mg Travel-Ease OTC

TRANSDERM-SCOP (1.5 MG) TRANSDERMAL PATCH 72 HOUR 1 MG/3DAYS

*ANTIEMETICS - MISCELLANEOUS***

dronabinol oral capsule 10 mg, 2.5 mg, 5 mg Marinol AL

*SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS***

EMEND ORAL CAPSULE 80 MG

EMEND TRI-PACK ORAL CAPSULE 80 & 125 MG

*ANTIFUNGALS*

*ANTIFUNGALS***

griseofulvin microsize oral suspension 125 mg/5ml

*

griseofulvin microsize oral tablet 500 mg *

nystatin oral tablet 500000 unit *

terbinafine hcl oral tablet 250 mg *

*TRIAZOLES***

fluconazole oral suspension reconstituted 10 mg/ml, 40 mg/ml

Diflucan *

fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg

Diflucan *

*ANTIHISTAMINES*

*ANTIHISTAMINES - ETHANOLAMINES***

carbinoxamine maleate oral solution 4 mg/5ml

AL; *

carbinoxamine maleate oral tablet 4 mg AL; *


24


*ANTIHISTAMINES - NON-SEDATING***

cetirizine hcl oral solution 1 mg/ml KLS Aller-Tec Childrens *

levocetirizine dihydrochloride oral tablet 5 mg

Xyzal Allergy 24HR *

*ANTIHISTAMINES - PHENOTHIAZINES***

promethazine hcl oral solution 6.25 mg/5ml *

promethazine hcl oral syrup 6.25 mg/5ml *

promethazine hcl oral tablet 12.5 mg, 25 mg, 50 mg

*

promethazine hcl rectal suppository 12.5 mg, 25 mg

Promethegan *

PROMETHEGAN RECTAL SUPPOSITORY12.5 MG, 25 MG

*

*ANTIHISTAMINES - PIPERIDINES***

cyproheptadine hcl oral syrup 2 mg/5ml *

cyproheptadine hcl oral tablet 4 mg *

*ANTIHYPERLIPIDEMICS*

*ANTIHYPERLIPIDEMICS - MISC.***

omega-3-acid ethyl esters oral capsule 1 gm Lovaza *

*BILE ACID SEQUESTRANTS***

cholestyramine light oral packet 4 gm Prevalite *

cholestyramine light oral powder 4 gm/dose Prevalite *

cholestyramine oral packet 4 gm Questran *

cholestyramine oral powder 4 gm/dose Questran *

colestipol hcl oral tablet 1 gm Colestid *

PREVALITE ORAL PACKET 4 GM *

PREVALITE ORAL POWDER 4 GM/DOSE *

*FIBRIC ACID DERIVATIVES***

fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg

*

fenofibrate oral capsule 134 mg, 200 mg, 67 mg

*

fenofibrate oral tablet 145 mg, 48 mg Tricor *

fenofibrate oral tablet 160 mg, 54 mg *

gemfibrozil oral tablet 600 mg Lopid *


25


*HMG COA REDUCTASE INHIBITORS***

atorvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 80 mg

Lipitor *; QL

lovastatin oral tablet 10 mg, 20 mg, 40 mg *

pravastatin sodium oral tablet 10 mg, 20 mg, 80 mg

*

pravastatin sodium oral tablet 40 mg Pravachol *

rosuvastatin calcium oral tablet 10 mg, 20 mg, 40 mg, 5 mg

Crestor *

simvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg

Zocor *

simvastatin oral tablet 5 mg *

*INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS***

ezetimibe oral tablet 10 mg Zetia *

*NICOTINIC ACID DERIVATIVES***

niacin er (antihyperlipidemic) oral tablet extended release 1000 mg, 500 mg, 750 mg

Niaspan *

*ANTIHYPERTENSIVES*

*ACE INHIBITOR & CALCIUM CHANNEL BLOCKER COMBINATIONS***

amlodipine besy-benazepril hcl oral capsule 10-20 mg, 10-40 mg, 5-10 mg, 5-20 mg

Lotrel *

amlodipine besy-benazepril hcl oral capsule 2.5-10 mg, 5-40 mg

*

*ACE INHIBITORS & THIAZIDE/THIAZIDE-LIKE***

benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Lotensin HCT *

benazepril-hydrochlorothiazide oral tablet 5-6.25 mg

*

enalapril-hydrochlorothiazide oral tablet 10-25 mg

Vaseretic *

enalapril-hydrochlorothiazide oral tablet 5-12.5 mg

*

fosinopril sodium-hctz oral tablet 10-12.5 mg, 20-12.5 mg

*


26


lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Zestoretic *

quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg

Accuretic *

*ACE INHIBITORS***

benazepril hcl oral tablet 10 mg, 20 mg, 40 mg

Lotensin *

benazepril hcl oral tablet 5 mg *

enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg

Vasotec *

fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg

*

lisinopril oral tablet 10 mg, 2.5 mg, 30 mg, 40 mg, 5 mg

Zestril *

lisinopril oral tablet 20 mg Prinivil *

quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 mg

Accupril *

ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg

Altace *

*ANGIOTENSIN II RECEPTOR ANTAG & CA CHANNEL BLOCKER COMB***

amlodipine besylate-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg

Exforge *

amlodipine-olmesartan oral tablet 10-20 mg, 10-40 mg, 5-20 mg, 5-40 mg

Azor *

*ANGIOTENSIN II RECEPTOR ANTAG & THIAZIDE/THIAZIDE-LIKE***

irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg

Avalide *

losartan potassium-hctz oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg

Hyzaar *

olmesartan medoxomil-hctz oral tablet 20-12.5 mg, 40-12.5 mg, 40-25 mg

Benicar HCT *

valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg

Diovan HCT *

*ANGIOTENSIN II RECEPTOR ANTAGONISTS***

irbesartan oral tablet 150 mg, 300 mg, 75 mg

Avapro *


27


losartan potassium oral tablet 100 mg, 25 mg, 50 mg

Cozaar *

olmesartan medoxomil oral tablet 20 mg, 40 mg, 5 mg

Benicar *

valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg

Diovan *

*ANTIADRENERGICS - CENTRALLY ACTING***

CATAPRES-TTS-1 TRANSDERMAL PATCH WEEKLY 0.1 MG/24HR

*


*


*

clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg

*

guanfacine hcl oral tablet 1 mg, 2 mg *

methyldopa oral tablet 250 mg, 500 mg *

*ANTIADRENERGICS - PERIPHERALLY ACTING***

doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg, 8 mg

Cardura *

prazosin hcl oral capsule 1 mg, 2 mg, 5 mg Minipress *

terazosin hcl oral capsule 1 mg, 10 mg, 2 mg, 5 mg

*

*BETA BLOCKER & DIURETIC COMBINATIONS***

atenolol-chlorthalidone oral tablet 100-25 mg Tenoretic 100 *

atenolol-chlorthalidone oral tablet 50-25 mg Tenoretic 50 *

bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5-6.25 mg

Ziac *

*VASODILATORS***

hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg

*

minoxidil oral tablet 10 mg, 2.5 mg *

*ANTI-INFECTIVE AGENTS - MISC.*

*ANTI-INFECTIVE AGENTS - MISC.***

metronidazole oral tablet 250 mg, 500 mg

tinidazole oral tablet 250 mg, 500 mg


28


*ANTI-INFECTIVE MISC. - COMBINATIONS***

sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5ml

Sulfatrim Pediatric

sulfamethoxazole-trimethoprim oral tablet 400-80 mg

Bactrim

sulfamethoxazole-trimethoprim oral tablet 800-160 mg

Bactrim DS

SULFATRIM PEDIATRIC ORAL SUSPENSION 200-40 MG/5ML

*GLYCOPEPTIDES***

FIRVANQ ORAL SOLUTION RECONSTITUTED 25 MG/ML, 50 MG/ML

*LEPROSTATICS***

dapsone oral tablet 100 mg, 25 mg

*LINCOSAMIDES***

clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg

Cleocin

clindamycin palmitate hcl oral solution reconstituted 75 mg/5ml

Cleocin

*OXAZOLIDINONES***

linezolid oral tablet 600 mg Zyvox

*URINARY ANTI-INFECTIVES***

nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg, 50 mg

Macrodantin *

nitrofurantoin monohyd macro oral capsule 100 mg

Macrobid *

*ANTIMALARIALS*

*ANTIMALARIAL COMBINATIONS***

atovaquone-proguanil hcl oral tablet 250-100 mg, 62.5-25 mg

Malarone

*ANTIMALARIALS***

chloroquine phosphate oral tablet 250 mg, 500 mg

hydroxychloroquine sulfate oral tablet 200 mg

Plaquenil

mefloquine hcl oral tablet 250 mg QL

primaquine phosphate oral tablet 26.3 (15 base) mg


29


*ANTIMYASTHENIC/CHOLINERGIC AGENTS*

*ANTIMYASTHENIC/CHOLINERGIC AGENTS***

pyridostigmine bromide er oral tablet extended release 180 mg

Mestinon

pyridostigmine bromide oral solution 60 mg/5ml

Mestinon

pyridostigmine bromide oral tablet 60 mg Mestinon

*ANTIMYCOBACTERIAL AGENTS*

*ANTIMYCOBACTERIAL AGENTS***

ethambutol hcl oral tablet 100 mg *

ethambutol hcl oral tablet 400 mg Myambutol *

isoniazid oral syrup 50 mg/5ml *

isoniazid oral tablet 100 mg, 300 mg *

PRIFTIN ORAL TABLET 150 MG *

pyrazinamide oral tablet 500 mg *

rifabutin oral capsule 150 mg Mycobutin *

rifampin oral capsule 150 mg, 300 mg *

*ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES*

*ALKYLATING AGENTS***

MYLERAN ORAL TABLET 2 MG SP

*ANDROGEN BIOSYNTHESIS INHIBITORS***

abiraterone acetate oral tablet 250 mg, 500 mg

Zytiga SP; AL; QL

*ANTIANDROGENS***

bicalutamide oral tablet 50 mg Casodex AL

flutamide oral capsule 125 mg AL

XTANDI ORAL CAPSULE 40 MG SP; AL; QL

XTANDI ORAL TABLET 40 MG, 80 MG SP

*ANTIESTROGENS***

tamoxifen citrate oral tablet 10 mg, 20 mg AL

*ANTIMETABOLITES***

mercaptopurine oral tablet 50 mg

methotrexate oral tablet 2.5 mg


30


methotrexate sodium (pf) injection solution 1 gm/40ml, 250 mg/10ml, 50 mg/2ml

methotrexate sodium injection solution 250 mg/10ml, 50 mg/2ml

methotrexate sodium injection solution reconstituted 1 gm

methotrexate sodium oral tablet 2.5 mg

TABLOID ORAL TABLET 40 MG

XELODA ORAL TABLET 150 MG, 500 MG SP

*ANTINEOPLASTIC - ALK INHIBITORS***

ALECENSA ORAL CAPSULE 150 MG SP

*ANTINEOPLASTIC - BCL-2 INHIBITORS***

VENCLEXTA ORAL TABLET 10 MG, 100 MG, 50 MG

SP

VENCLEXTA STARTING PACK ORAL TABLET THERAPY PACK 10 & 50 & 100 MG

SP

*ANTINEOPLASTIC - BCR-ABL KINASE INHIBITORS***

imatinib mesylate oral tablet 100 mg, 400 mg

Gleevec

SPRYCEL ORAL TABLET 100 MG, 140 MG, 20 MG, 50 MG, 70 MG, 80 MG

*ANTINEOPLASTIC - BRAF KINASE INHIBITORS***

TAFINLAR ORAL CAPSULE 50 MG, 75 MG

SP

*ANTINEOPLASTIC - BTK INHIBITORS***

IMBRUVICA ORAL CAPSULE 140 MG, 70 MG

SP

IMBRUVICA ORAL TABLET 140 MG, 280 MG, 420 MG, 560 MG

SP

*ANTINEOPLASTIC - EGFR INHIBITORS***

TAGRISSO ORAL TABLET 40 MG, 80 MG QL


31


*ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS***

ERIVEDGE ORAL CAPSULE 150 MG SP

*ANTINEOPLASTIC - MEK INHIBITORS***

MEKINIST ORAL TABLET 0.5 MG, 2 MG SP

*ANTINEOPLASTIC - MULTIKINASE INHIBITORS***

CAPRELSA ORAL TABLET 100 MG, 300 MG

SP

SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG

SP

VOTRIENT ORAL TABLET 200 MG SP

*ANTINEOPLASTICS MISC.***

hydroxyurea oral capsule 500 mg Hydrea

MATULANE ORAL CAPSULE 50 MG SP

*AROMATASE INHIBITORS***

anastrozole oral tablet 1 mg Arimidex AL

exemestane oral tablet 25 mg Aromasin AL

letrozole oral tablet 2.5 mg Femara AL

*CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS***

IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG

SP; QL

IBRANCE ORAL TABLET 100 MG, 125 MG, 75 MG

*FOLIC ACID ANTAGONISTS RESCUE AGENTS***

leucovorin calcium oral tablet 10 mg, 15 mg, 25 mg, 5 mg

*IMIDAZOTETRAZINES***

temozolomide oral capsule 100 mg, 140 mg, 180 mg, 250 mg

Temodar

temozolomide oral capsule 20 mg, 5 mg

*JANUS ASSOCIATED KINASE (JAK) INHIBITORS***

JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG

SP


32


*MITOTIC INHIBITORS***

etoposide oral capsule 50 mg

*NITROGEN MUSTARDS AND RELATED ANALOGUES***

ALKERAN ORAL TABLET 2 MG

cyclophosphamide oral capsule 25 mg, 50 mg

cyclophosphamide oral tablet 25 mg, 50 mg SP

LEUKERAN ORAL TABLET 2 MG

*POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS***

LYNPARZA ORAL TABLET 100 MG, 150 MG

ZEJULA ORAL CAPSULE 100 MG SP; QL

*RETINOIDS***

tretinoin oral capsule 10 mg AL

*URINARY TRACT PROTECTIVE AGENTS***

MESNEX ORAL TABLET 400 MG PA

*VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) INHIBITORS***

INLYTA ORAL TABLET 1 MG, 5 MG SP

LENVIMA (10 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 10 MG

LENVIMA (12 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 3 X 4 MG

LENVIMA (14 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 10 & 4 MG

LENVIMA (18 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 10 MG & 2 X 4 MG


LENVIMA (24 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 2 X 10 MG & 4 MG

LENVIMA (4 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 4 MG


33



*ANTIPARKINSON AND RELATED THERAPY AGENTS*

*ANTIPARKINSON ANTICHOLINERGICS***

benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 mg

trihexyphenidyl hcl oral solution 0.4 mg/ml

trihexyphenidyl hcl oral tablet 2 mg, 5 mg

*ANTIPARKINSON DOPAMINERGICS***

amantadine hcl oral capsule 100 mg

amantadine hcl oral solution 50 mg/5ml

amantadine hcl oral tablet 100 mg

*ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS***

selegiline hcl oral capsule 5 mg

selegiline hcl oral tablet 5 mg

*LEVODOPA COMBINATIONS***

carbidopa-levodopa er oral tablet extended release 25-100 mg, 50-200 mg

carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg

Sinemet

carbidopa-levodopa oral tablet 25-250 mg

carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg

Stalevo 50


Stalevo 75

carbidopa-levodopa-entacapone oral tablet 25-100-200 mg

Stalevo 100


Stalevo 125


Stalevo 150

carbidopa-levodopa-entacapone oral tablet 50-200-200 mg

Stalevo 200


34


*NONERGOLINE DOPAMINE RECEPTOR AGONISTS***

pramipexole dihydrochloride oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg

ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg

*ANTIPSYCHOTICS/ANTIMANIC AGENTS*

*ANTIMANIC AGENTS***

lithium carbonate er oral tablet extended release 300 mg

Lithobid AL; *; QL

lithium carbonate er oral tablet extended release 450 mg

AL; *; QL

lithium carbonate oral capsule 150 mg, 300 mg, 600 mg

AL; *; QL

lithium carbonate oral tablet 300 mg AL; *; QL

*ANTIPSYCHOTICS - MISC.***

ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg

Geodon AL; *; QL

*BENZISOXAZOLES***

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 117 MG/0.75ML, 156 MG/ML, 234 MG/1.5ML, 39 MG/0.25ML, 78 MG/0.5ML

*; QL

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 273 MG/0.875ML, 410 MG/1.315ML, 546 MG/1.75ML, 819 MG/2.625ML

*; QL

paliperidone er oral tablet extended release 24 hour 1.5 mg, 3 mg, 6 mg, 9 mg

Invega AL; *; QL

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 12.5 MG, 25 MG, 37.5 MG, 50 MG

*; QL

risperidone oral solution 1 mg/ml RisperDAL AL; *; QL

risperidone oral tablet 0.25 mg AL; *; QL

risperidone oral tablet 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

RisperDAL AL; *; QL


35


*BUTYROPHENONES***

haloperidol decanoate intramuscular solution 100 mg/ml, 50 mg/ml

Haldol Decanoate *; QL

haloperidol lactate injection solution 5 mg/ml *

haloperidol lactate oral concentrate 2 mg/ml AL; *

haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg

AL; *; QL

*DIBENZODIAZEPINES***

clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 mg

Clozaril AL; *; QL

*DIBENZO-OXEPINO PYRROLES***

asenapine maleate sublingual tablet sublingual 10 mg, 2.5 mg, 5 mg

Saphris *; QL

*DIBENZOTHIAZEPINES***

quetiapine fumarate er oral tablet extended release 24 hour 150 mg, 200 mg, 300 mg, 400 mg, 50 mg

SEROquel XR AL; *; QL

quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 300 mg, 400 mg, 50 mg

SEROquel AL; *; QL

*DIBENZOXAZEPINES***

loxapine succinate oral capsule 10 mg, 25 mg, 5 mg, 50 mg

*; QL

*PHENOTHIAZINES***

chlorpromazine hcl oral tablet 10 mg, 100 mg, 200 mg, 25 mg, 50 mg

AL; *; QL

fluphenazine decanoate injection solution 25 mg/ml

AL; *

fluphenazine hcl injection solution 2.5 mg/ml *

fluphenazine hcl oral concentrate 5 mg/ml *; QL

fluphenazine hcl oral elixir 2.5 mg/5ml *; QL

fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg

*; QL

perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg

AL; *; QL

prochlorperazine maleate oral tablet 10 mg, 5 mg

*

thioridazine hcl oral tablet 10 mg, 100 mg, 25 mg, 50 mg

AL; *; QL


36


trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg

*; QL

trifluoperazine hcl oral tablet 5 mg AL; *; QL

*QUINOLINONE DERIVATIVES***

ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE 300 MG, 400 MG

*; QL

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER 300 MG, 400 MG

*

aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg

Abilify AL; *; QL

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE 1064 MG/3.9ML, 441 MG/1.6ML, 662 MG/2.4ML, 882 MG/3.2ML

*; QL

*THIENBENZODIAZEPINES***

olanzapine intramuscular solution reconstituted 10 mg

ZyPREXA *; QL

olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg

ZyPREXA AL; *; QL

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION RECONSTITUTED 210 MG, 300 MG, 405 MG

*; QL

*THIOXANTHENES***

thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg

*; QL

*ANTIVIRALS*

*ANTIRETROVIRAL COMBINATIONS***

abacavir sulfate-lamivudine oral tablet 600-300 mg

Epzicom SP

ATRIPLA ORAL TABLET 600-200-300 MG SP

BIKTARVY ORAL TABLET 50-200-25 MG SP

CIMDUO ORAL TABLET 300-300 MG SP

COMPLERA ORAL TABLET 200-25-300 MG

SP

DELSTRIGO ORAL TABLET 100-300-300 MG

SP; QL

DESCOVY ORAL TABLET 200-25 MG SP

EVOTAZ ORAL TABLET 300-150 MG SP


37


GENVOYA ORAL TABLET 150-150-200-10 MG

SP; QL

KALETRA ORAL TABLET 100-25 MG, 200-50 MG

SP

lamivudine-zidovudine oral tablet 150-300 mg

Combivir SP

lopinavir-ritonavir oral solution 400-100 mg/5ml

Kaletra SP

ODEFSEY ORAL TABLET 200-25-25 MG SP

STRIBILD ORAL TABLET 150-150-200-300 MG

SP

SYMFI LO ORAL TABLET 400-300-300 MG

SP; QL

SYMFI ORAL TABLET 600-300-300 MG SP

TRIUMEQ ORAL TABLET 600-50-300 MG SP

TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG, 200-300 MG

SP

*ANTIRETROVIRALS - CCR5 ANTAGONISTS (ENTRY INHIBITOR)***

SELZENTRY ORAL SOLUTION 20 MG/ML SP

SELZENTRY ORAL TABLET 150 MG, 25 MG, 300 MG, 75 MG

SP

*ANTIRETROVIRALS - FUSION INHIBITORS***

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED 90 MG

SP

*ANTIRETROVIRALS - INTEGRASE INHIBITORS***

ISENTRESS HD ORAL TABLET 600 MG SP

ISENTRESS ORAL PACKET 100 MG SP

ISENTRESS ORAL TABLET 400 MG SP

ISENTRESS ORAL TABLET CHEWABLE100 MG, 25 MG

SP

TIVICAY ORAL TABLET 10 MG, 25 MG, 50 MG

SP

*ANTIRETROVIRALS - PROTEASE INHIBITORS***

atazanavir sulfate oral capsule 150 mg, 200 mg, 300 mg

Reyataz SP

LEXIVA ORAL SUSPENSION 50 MG/ML SP* = 599 CHIP benefits (Pregnant Women)

38


LEXIVA ORAL TABLET 700 MG SP

ritonavir oral tablet 100 mg Norvir SP

*ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE ANALOGUES***

efavirenz oral capsule 200 mg, 50 mg Sustiva SP

efavirenz oral tablet 600 mg Sustiva SP

INTELENCE ORAL TABLET 100 MG, 200 MG, 25 MG

SP

PIFELTRO ORAL TABLET 100 MG SP; QL

*ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES***

abacavir sulfate oral solution 20 mg/ml Ziagen SP

abacavir sulfate oral tablet 300 mg Ziagen SP

*ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PYRIMIDINES***

EMTRIVA ORAL CAPSULE 200 MG SP

EMTRIVA ORAL SOLUTION 10 MG/ML SP

lamivudine oral solution 10 mg/ml Epivir SP

lamivudine oral tablet 150 mg, 300 mg Epivir SP

*ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-THYMIDINES***

zidovudine oral capsule 100 mg Retrovir SP

zidovudine oral syrup 50 mg/5ml Retrovir SP

zidovudine oral tablet 300 mg SP

*ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES***

tenofovir disoproxil fumarate oral tablet 300 mg

Viread SP

*CMV AGENTS***

valganciclovir hcl oral solution reconstituted 50 mg/ml

Valcyte SP; QL

valganciclovir hcl oral tablet 450 mg Valcyte SP; QL

*HEPATITIS B AGENTS***

entecavir oral tablet 0.5 mg, 1 mg Baraclude SP

lamivudine oral tablet 100 mg Epivir HBV SP


39


*HEPATITIS C AGENT - COMBINATIONS***

MAVYRET ORAL TABLET 100-40 MG PA; AL; QL

sofosbuvir-velpatasvir oral tablet 400-100 mg

Epclusa AL; QL

VOSEVI ORAL TABLET 400-100-100 MG PA; QL

*HEPATITIS C AGENTS***

PEGASYS SUBCUTANEOUS SOLUTION180 MCG/ML

PA; QL

PEGASYS SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 180 MCG/0.5ML

ribavirin oral capsule 200 mg PA

ribavirin oral tablet 200 mg PA

*HERPES AGENTS - PURINE ANALOGUES***

acyclovir oral capsule 200 mg *

acyclovir oral tablet 400 mg, 800 mg *

valacyclovir hcl oral tablet 1 gm, 500 mg Valtrex *

*HERPES AGENTS - THYMIDINE ANALOGUES***

famciclovir oral tablet 125 mg, 250 mg, 500 mg

*

*NEURAMINIDASE INHIBITORS***

oseltamivir phosphate oral capsule 30 mg, 45 mg, 75 mg

Tamiflu *; QL

oseltamivir phosphate oral suspension reconstituted 6 mg/ml

Tamiflu *; QL

*BETA BLOCKERS*

*ALPHA-BETA BLOCKERS***

carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg

Coreg *

labetalol hcl oral tablet 100 mg, 200 mg, 300 mg

*

*BETA BLOCKERS CARDIO-SELECTIVE***

atenolol oral tablet 100 mg, 25 mg, 50 mg Tenormin *

bisoprolol fumarate oral tablet 10 mg, 5 mg *


40


metoprolol succinate er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 50 mg

Toprol XL *

metoprolol tartrate oral tablet 100 mg, 50 mg Lopressor *

metoprolol tartrate oral tablet 25 mg, 37.5 mg, 75 mg

*

*BETA BLOCKERS NON-SELECTIVE***

propranolol hcl er oral capsule extended release 24 hour 120 mg, 160 mg, 60 mg, 80 mg

Inderal LA *

propranolol hcl oral solution 20 mg/5ml, 40 mg/5ml

*

propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

*

SORINE ORAL TABLET 120 MG, 160 MG, 240 MG, 80 MG

*

sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg

Betapace AF *

sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, 80 mg

Sorine *

*CALCIUM CHANNEL BLOCKERS*

*CALCIUM CHANNEL BLOCKERS***

AFEDITAB CR ORAL TABLET EXTENDED RELEASE 24 HOUR 30 MG, 60 MG

amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 mg

Norvasc *

CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG

*

diltiazem hcl er beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg, 360 mg

Taztia XT *

diltiazem hcl er beads oral capsule extended release 24 hour 420 mg

Tiadylt ER *

diltiazem hcl er coated beads oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg, 300 mg

Cartia XT *

diltiazem hcl er coated beads oral capsule extended release 24 hour 360 mg

Cardizem CD *


41


diltiazem hcl er oral capsule extended release 12 hour 120 mg, 60 mg, 90 mg

*

diltiazem hcl er oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

*

diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg

Cardizem *

diltiazem hcl oral tablet 90 mg *

dilt-xr oral capsule extended release 24 hour 120 mg, 180 mg, 240 mg

*

nifedipine er oral tablet extended release 24 hour 30 mg, 60 mg

Afeditab CR *

nifedipine er oral tablet extended release 24 hour 90 mg

*

nifedipine er osmotic release oral tablet extended release 24 hour 30 mg, 60 mg, 90 mg

Procardia XL *

TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG

*

TIADYLT ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 MG, 300 MG, 360 MG, 420 MG

*

verapamil hcl er oral tablet extended release 120 mg, 180 mg, 240 mg

Calan SR *

verapamil hcl oral tablet 120 mg, 40 mg, 80 mg

*

*CARDIOTONICS*

*CARDIAC GLYCOSIDES***

DIGITEK ORAL TABLET 125 MCG, 250 MCG

QL

DIGOX ORAL TABLET 125 MCG, 250 MCG

QL

digoxin oral solution 0.05 mg/ml

digoxin oral tablet 125 mcg, 250 mcg Digitek QL

*CARDIOVASCULAR AGENTS - MISC.*

*NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB***

ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG

PA; QL


42


*PROSTAGLANDIN VASODILATORS***

TYVASO INHALATION SOLUTION 0.6 MG/ML

SP; QL

TYVASO REFILL INHALATION SOLUTION0.6 MG/ML

SP; QL

TYVASO STARTER INHALATION SOLUTION 0.6 MG/ML

SP; QL

VENTAVIS INHALATION SOLUTION 10 MCG/ML, 20 MCG/ML

SP; QL

*PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS***

ambrisentan oral tablet 10 mg, 5 mg Letairis SP

TRACLEER ORAL TABLET 125 MG, 62.5 MG

SP

*PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS***

ALYQ ORAL TABLET 20 MG

sildenafil citrate oral tablet 20 mg Revatio PA

tadalafil (pah) oral tablet 20 mg Alyq

*CEPHALOSPORINS*

*CEPHALOSPORINS - 1ST GENERATION***

cefadroxil oral capsule 500 mg *

cefadroxil oral suspension reconstituted 250 mg/5ml, 500 mg/5ml

*

cephalexin oral capsule 250 mg, 500 mg *

cephalexin oral capsule 750 mg Keflex *

cephalexin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

*

*CEPHALOSPORINS - 2ND GENERATION***

cefprozil oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

*

cefprozil oral tablet 250 mg, 500 mg *

cefuroxime axetil oral tablet 250 mg, 500 mg *


43


*CEPHALOSPORINS - 3RD GENERATION***

cefdinir oral capsule 300 mg *

cefdinir oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

*

*CONTRACEPTIVES*

*BIPHASIC CONTRACEPTIVES - ORAL***

AZURETTE ORAL TABLET 0.15-0.02/0.01 MG (21/5)

desogestrel-ethinyl estradiol oral tablet 0.15-0.02/0.01 mg (21/5)

Azurette

KARIVA ORAL TABLET 0.15-0.02/0.01 MG (21/5)

LO LOESTRIN FE ORAL TABLET 1 MG-10 MCG / 10 MCG

MIRCETTE ORAL TABLET 0.15-0.02/0.01 MG (21/5)

PIMTREA ORAL TABLET 0.15-0.02/0.01 MG (21/5)

SIMLIYA ORAL TABLET 0.15-0.02/0.01 MG (21/5)

viorele oral tablet 0.15-0.02/0.01 mg (21/5) Azurette

VOLNEA ORAL TABLET 0.15-0.02/0.01 MG (21/5)

*COMBINATION CONTRACEPTIVES - ORAL***

AFIRMELLE ORAL TABLET 0.1-20 MG-MCG

ALTAVERA ORAL TABLET 0.15-30 MG-MCG

alyacen 1/35 oral tablet 1-35 mg-mcg Cyclafem 1/35

APRI ORAL TABLET 0.15-30 MG-MCG

AUBRA EQ ORAL TABLET 0.1-20 MG-MCG

AUBRA ORAL TABLET 0.1-20 MG-MCG

AUROVELA 1.5/30 ORAL TABLET 1.5-30 MG-MCG

AUROVELA 1/20 ORAL TABLET 1-20 MG-MCG


44


AUROVELA 24 FE ORAL TABLET 1-20 MG-MCG(24)

AUROVELA FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG

AUROVELA FE 1/20 ORAL TABLET 1-20 MG-MCG

AVIANE ORAL TABLET 0.1-20 MG-MCG

AYUNA ORAL TABLET 0.15-30 MG-MCG

BALCOLTRA ORAL TABLET 0.1-20 MG-MCG(21)

BALZIVA ORAL TABLET 0.4-35 MG-MCG

BEYAZ ORAL TABLET 3-0.02-0.451 MG

BLISOVI 24 FE ORAL TABLET 1-20 MG-MCG(24)

BLISOVI FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG

BLISOVI FE 1/20 ORAL TABLET 1-20 MG-MCG

briellyn oral tablet 0.4-35 mg-mcg Balziva

CHARLOTTE 24 FE ORAL TABLET CHEWABLE 1-20 MG-MCG(24)

CHATEAL EQ ORAL TABLET 0.15-30 MG-MCG

CHATEAL ORAL TABLET 0.15-30 MG-MCG

CRYSELLE-28 ORAL TABLET 0.3-30 MG-MCG

CYCLAFEM 1/35 ORAL TABLET 1-35 MG-MCG

CYRED EQ ORAL TABLET 0.15-30 MG-MCG

CYRED ORAL TABLET 0.15-30 MG-MCG

DASETTA 1/35 ORAL TABLET 1-35 MG-MCG

DELYLA ORAL TABLET 0.1-20 MG-MCG

desogestrel-ethinyl estradiol oral tablet 0.15-30 mg-mcg

Apri

drospiren-eth estrad-levomefol oral tablet 3-0.02-0.451 mg

Beyaz


45


drospiren-eth estrad-levomefol oral tablet 3-0.03-0.451 mg

Safyral

drospirenone-ethinyl estradiol oral tablet 3-0.02 mg

Jasmiel

drospirenone-ethinyl estradiol oral tablet 3-0.03 mg

Ocella

ELINEST ORAL TABLET 0.3-30 MG-MCG

EMOQUETTE ORAL TABLET 0.15-30 MG-MCG

ENSKYCE ORAL TABLET 0.15-30 MG-MCG

ESTARYLLA ORAL TABLET 0.25-35 MG-MCG

ethynodiol diac-eth estradiol oral tablet 1-35 mg-mcg

Kelnor 1/35

ethynodiol diac-eth estradiol oral tablet 1-50 mg-mcg

Kelnor 1/50

FALMINA ORAL TABLET 0.1-20 MG-MCG

FEMYNOR ORAL TABLET 0.25-35 MG-MCG

GEMMILY ORAL CAPSULE 1-20 MG-MCG(24)

GENERESS FE ORAL TABLET CHEWABLE 0.8-25 MG-MCG

HAILEY 1.5/30 ORAL TABLET 1.5-30 MG-MCG

HAILEY 24 FE ORAL TABLET 1-20 MG-MCG(24)

HAILEY FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG

HAILEY FE 1/20 ORAL TABLET 1-20 MG-MCG

ISIBLOOM ORAL TABLET 0.15-30 MG-MCG

JASMIEL ORAL TABLET 3-0.02 MG

JULEBER ORAL TABLET 0.15-30 MG-MCG

JUNEL 1.5/30 ORAL TABLET 1.5-30 MG-MCG

JUNEL 1/20 ORAL TABLET 1-20 MG-MCG


46


JUNEL FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG

JUNEL FE 1/20 ORAL TABLET 1-20 MG-MCG

JUNEL FE 24 ORAL TABLET 1-20 MG-MCG(24)

KAITLIB FE ORAL TABLET CHEWABLE0.8-25 MG-MCG

KALLIGA ORAL TABLET 0.15-30 MG-MCG

KELNOR 1/35 ORAL TABLET 1-35 MG-MCG

KELNOR 1/50 ORAL TABLET 1-50 MG-MCG

KURVELO ORAL TABLET 0.15-30 MG-MCG

LARIN 1.5/30 ORAL TABLET 1.5-30 MG-MCG

LARIN 1/20 ORAL TABLET 1-20 MG-MCG

LARIN 24 FE ORAL TABLET 1-20 MG-MCG(24)

LARIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG

LARIN FE 1/20 ORAL TABLET 1-20 MG-MCG

LARISSIA ORAL TABLET 0.1-20 MG-MCG

LAYOLIS FE ORAL TABLET CHEWABLE0.8-25 MG-MCG

LESSINA ORAL TABLET 0.1-20 MG-MCG

levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg

Afirmelle

levonorgestrel-ethinyl estrad oral tablet 0.15-30 mg-mcg

Altavera

LEVORA 0.15/30 (28) ORAL TABLET 0.15-30 MG-MCG

LILLOW ORAL TABLET 0.15-30 MG-MCG

LOESTRIN 1.5/30 (21) ORAL TABLET 1.5-30 MG-MCG

LOESTRIN 1/20 (21) ORAL TABLET 1-20 MG-MCG


47


LOESTRIN FE 1.5/30 ORAL TABLET 1.5-30 MG-MCG

LOESTRIN FE 1/20 ORAL TABLET 1-20 MG-MCG

LORYNA ORAL TABLET 3-0.02 MG

LOW-OGESTREL ORAL TABLET 0.3-30 MG-MCG

LO-ZUMANDIMINE ORAL TABLET 3-0.02 MG

LUTERA ORAL TABLET 0.1-20 MG-MCG

marlissa oral tablet 0.15-30 mg-mcg Altavera

MERZEE ORAL CAPSULE 1-20 MG-MCG(24)

MIBELAS 24 FE ORAL TABLET CHEWABLE 1-20 MG-MCG(24)

MICROGESTIN 1.5/30 ORAL TABLET 1.5-30 MG-MCG

MICROGESTIN 1/20 ORAL TABLET 1-20 MG-MCG

MICROGESTIN 24 FE ORAL TABLET 1-20 MG-MCG

MICROGESTIN FE 1.5/30 ORAL TABLET1.5-30 MG-MCG

MICROGESTIN FE 1/20 ORAL TABLET 1-20 MG-MCG

MILI ORAL TABLET 0.25-35 MG-MCG

MINASTRIN 24 FE ORAL TABLET CHEWABLE 1-20 MG-MCG(24)

MONO-LINYAH ORAL TABLET 0.25-35 MG-MCG

NECON 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG

NECON 1/35 (28) ORAL TABLET 1-35 MG-MCG

NIKKI ORAL TABLET 3-0.02 MG

norethin ace-eth estrad-fe oral capsule 1-20 mg-mcg(24)

Gemmily

norethin ace-eth estrad-fe oral tablet 1.5-30 mg-mcg

Aurovela Fe 1.5/30

norethin ace-eth estrad-fe oral tablet 1-20 mg-mcg

Aurovela FE 1/20


48


norethin ace-eth estrad-fe oral tablet chewable 1-20 mg-mcg(24)

Charlotte 24 Fe

norethindrone acet-ethinyl est oral tablet 1.5-30 mg-mcg

Aurovela 1.5/30

norethindrone acet-ethinyl est oral tablet 1-20 mg-mcg

Aurovela 1/20

norethin-eth estradiol-fe oral tablet chewable 0.4-35 mg-mcg

Wymzya Fe

norethin-eth estradiol-fe oral tablet chewable 0.8-25 mg-mcg

Generess FE

norgestimate-eth estradiol oral tablet 0.25-35 mg-mcg

Estarylla

NORTREL 0.5/35 (28) ORAL TABLET 0.5-35 MG-MCG

NORTREL 1/35 (21) ORAL TABLET 1-35 MG-MCG

NORTREL 1/35 (28) ORAL TABLET 1-35 MG-MCG

NYMYO ORAL TABLET 0.25-35 MG-MCG

OCELLA ORAL TABLET 3-0.03 MG

ORSYTHIA ORAL TABLET 0.1-20 MG-MCG

PHILITH ORAL TABLET 0.4-35 MG-MCG

PIRMELLA 1/35 ORAL TABLET 1-35 MG-MCG

PORTIA-28 ORAL TABLET 0.15-30 MG-MCG

PREVIFEM ORAL TABLET 0.25-35 MG-MCG

RECLIPSEN ORAL TABLET 0.15-30 MG-MCG

SAFYRAL ORAL TABLET 3-0.03-0.451 MG

SOLIA ORAL TABLET 0.15-30 MG-MCG

SPRINTEC 28 ORAL TABLET 0.25-35 MG-MCG

SRONYX ORAL TABLET 0.1-20 MG-MCG

SYEDA ORAL TABLET 3-0.03 MG

TARINA 24 FE ORAL TABLET 1-20 MG-MCG(24)


49


TARINA FE 1/20 EQ ORAL TABLET 1-20 MG-MCG

TARINA FE 1/20 ORAL TABLET 1-20 MG-MCG

TAYTULLA ORAL CAPSULE 1-20 MG-MCG(24)

TYDEMY ORAL TABLET 3-0.03-0.451 MG

VESTURA ORAL TABLET 3-0.02 MG

VIENVA ORAL TABLET 0.1-20 MG-MCG

VYFEMLA ORAL TABLET 0.4-35 MG-MCG

VYLIBRA ORAL TABLET 0.25-35 MG-MCG

WERA ORAL TABLET 0.5-35 MG-MCG

WYMZYA FE ORAL TABLET CHEWABLE0.4-35 MG-MCG

YASMIN 28 ORAL TABLET 3-0.03 MG

YAZ ORAL TABLET 3-0.02 MG

ZARAH ORAL TABLET 3-0.03 MG

ZOVIA 1/35 (28) ORAL TABLET 1-35 MG-MCG

ZOVIA 1/35E (28) ORAL TABLET 1-35 MG-MCG

ZUMANDIMINE ORAL TABLET 3-0.03 MG

*CONTINUOUS CONTRACEPTIVES - ORAL***

AMETHYST ORAL TABLET 90-20 MCG

levonorgestrel-ethinyl estrad oral tablet 90-20 mcg

Amethyst

*EMERGENCY CONTRACEPTIVES***

AFTERA ORAL TABLET 1.5 MG OTC

AFTERPILL ORAL TABLET 1.5 MG OTC

ECONTRA EZ ORAL TABLET 1.5 MG OTC

ECONTRA ONE-STEP ORAL TABLET 1.5 MG

OTC

ELLA ORAL TABLET 30 MG

levonorgestrel oral tablet 1.5 mg AfterPill OTC

MY CHOICE ORAL TABLET 1.5 MG OTC

MY WAY ORAL TABLET 1.5 MG OTC


50


NEW DAY ORAL TABLET 1.5 MG OTC

OPCICON ONE-STEP ORAL TABLET 1.5 MG

OTC

OPTION 2 ORAL TABLET 1.5 MG OTC

PLAN B ONE-STEP ORAL TABLET 1.5 MG

OTC

REACT ORAL TABLET 1.5 MG OTC

TAKE ACTION ORAL TABLET 1.5 MG OTC

*EXTENDED-CYCLE CONTRACEPTIVES - ORAL***

AMETHIA ORAL TABLET 0.15-0.03 &0.01 MG

ASHLYNA ORAL TABLET 0.15-0.03 &0.01 MG

CAMRESE LO ORAL TABLET 0.1-0.02 & 0.01 MG

CAMRESE ORAL TABLET 0.15-0.03 &0.01 MG

DAYSEE ORAL TABLET 0.15-0.03 &0.01 MG

FAYOSIM ORAL TABLET 42-21-21-7 DAYS

ICLEVIA ORAL TABLET 0.15-0.03 MG

INTROVALE ORAL TABLET 0.15-0.03 MG

JAIMIESS ORAL TABLET 0.15-0.03 &0.01 MG

JOLESSA ORAL TABLET 0.15-0.03 MG

levonorgest-eth est & eth est oral tablet 42-21-21-7 days

Fayosim

levonorgest-eth estrad 91-day oral tablet 0.1-0.02 & 0.01 mg

Camrese Lo

levonorgest-eth estrad 91-day oral tablet 0.15-0.03 &0.01 mg

Amethia

levonorgest-eth estrad 91-day oral tablet 0.15-0.03 mg

Iclevia

LOJAIMIESS ORAL TABLET 0.1-0.02 & 0.01 MG

LOSEASONIQUE ORAL TABLET 0.1-0.02 & 0.01 MG


51


QUARTETTE ORAL TABLET 42-21-21-7 DAYS

RIVELSA ORAL TABLET 42-21-21-7 DAYS

SEASONIQUE ORAL TABLET 0.15-0.03 &0.01 MG

SETLAKIN ORAL TABLET 0.15-0.03 MG

SIMPESSE ORAL TABLET 0.15-0.03 &0.01 MG

*FOUR PHASE CONTRACEPTIVES - ORAL***

NATAZIA ORAL TABLET 3/2-2/2-3/1 MG

*PROGESTIN CONTRACEPTIVES - INJECTABLE***

medroxyprogesterone acetate intramuscular suspension 150 mg/ml

Depo-Provera AL

medroxyprogesterone acetate intramuscular suspension prefilled syringe 150 mg/ml

Depo-Provera AL

*PROGESTIN CONTRACEPTIVES - ORAL***

CAMILA ORAL TABLET 0.35 MG

DEBLITANE ORAL TABLET 0.35 MG

ERRIN ORAL TABLET 0.35 MG

HEATHER ORAL TABLET 0.35 MG

INCASSIA ORAL TABLET 0.35 MG

JENCYCLA ORAL TABLET 0.35 MG

LYLEQ ORAL TABLET 0.35 MG

LYZA ORAL TABLET 0.35 MG

NORA-BE ORAL TABLET 0.35 MG

norethindrone oral tablet 0.35 mg Camila

NORLYDA ORAL TABLET 0.35 MG

NORLYROC ORAL TABLET 0.35 MG

SHAROBEL ORAL TABLET 0.35 MG

SLYND ORAL TABLET 4 MG

TULANA ORAL TABLET 0.35 MG


52


*TRIPHASIC CONTRACEPTIVES - ORAL***

alyacen 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

Cyclafem 7/7/7

ARANELLE ORAL TABLET 0.5/1/0.5-35 MG-MCG

CAZIANT ORAL TABLET 0.1/0.125/0.15 -0.025 MG

CESIA ORAL TABLET 0.1/0.125/0.15 -0.025 MG

CYCLAFEM 7/7/7 ORAL TABLET0.5/0.75/1-35 MG-MCG

DASETTA 7/7/7 ORAL TABLET 0.5/0.75/1-35 MG-MCG

ENPRESSE-28 ORAL TABLET 50-30/75-40/ 125-30 MCG

ESTROSTEP FE ORAL TABLET 1-20/1-30/1-35 MG-MCG

LEENA ORAL TABLET 0.5/1/0.5-35 MG-MCG

LEVONEST ORAL TABLET 50-30/75-40/ 125-30 MCG

levonorg-eth estrad triphasic oral tablet 50-30/75-40/ 125-30 mcg

Enpresse-28

norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 mg-25 mcg

Tri-Lo-Estarylla

norgestim-eth estrad triphasic oral tablet 0.18/0.215/0.25 mg-35 mcg

Tri Femynor

NORTREL 7/7/7 ORAL TABLET 0.5/0.75/1-35 MG-MCG

NYLIA 7/7/7 ORAL TABLET 0.5/0.75/1-35 MG-MCG

PIRMELLA 7/7/7 ORAL TABLET0.5/0.75/1-35 MG-MCG

TILIA FE ORAL TABLET 1-20/1-30/1-35 MG-MCG

TRI FEMYNOR ORAL TABLET0.18/0.215/0.25 MG-35 MCG

TRI-ESTARYLLA ORAL TABLET0.18/0.215/0.25 MG-35 MCG


53


TRI-LEGEST FE ORAL TABLET 1-20/1-30/1-35 MG-MCG

TRI-LINYAH ORAL TABLET0.18/0.215/0.25 MG-35 MCG

TRI-LO-ESTARYLLA ORAL TABLET0.18/0.215/0.25 MG-25 MCG

TRI-LO-MARZIA ORAL TABLET0.18/0.215/0.25 MG-25 MCG

TRI-LO-MILI ORAL TABLET0.18/0.215/0.25 MG-25 MCG

TRI-LO-SPRINTEC ORAL TABLET0.18/0.215/0.25 MG-25 MCG

TRI-MILI ORAL TABLET 0.18/0.215/0.25 MG-35 MCG

TRINESSA (28) ORAL TABLET0.18/0.215/0.25 MG-35 MCG

TRI-NYMYO ORAL TABLET0.18/0.215/0.25 MG-35 MCG

TRI-PREVIFEM ORAL TABLET0.18/0.215/0.25 MG-35 MCG

TRI-SPRINTEC ORAL TABLET0.18/0.215/0.25 MG-35 MCG

TRIVORA (28) ORAL TABLET 50-30/75-40/ 125-30 MCG

TRI-VYLIBRA LO ORAL TABLET0.18/0.215/0.25 MG-25 MCG

TRI-VYLIBRA ORAL TABLET0.18/0.215/0.25 MG-35 MCG

VELIVET ORAL TABLET 0.1/0.125/0.15 -0.025 MG

*CORTICOSTEROIDS*

*GLUCOCORTICOSTEROIDS***

budesonide oral capsule delayed release particles 3 mg

Entocort EC *

DECADRON ORAL TABLET 0.5 MG *

DECADRON ORAL TABLET 0.75 MG, 4 MG, 6 MG

*

dexamethasone oral elixir 0.5 mg/5ml *

dexamethasone oral solution 0.5 mg/5ml *


54


dexamethasone oral tablet 0.5 mg, 0.75 mg, 4 mg, 6 mg

Decadron *

dexamethasone oral tablet 1 mg, 1.5 mg, 2 mg

*

hydrocortisone oral tablet 10 mg, 20 mg, 5 mg

Cortef *

methylprednisolone oral tablet 4 mg Medrol *

methylprednisolone oral tablet therapy pack 4 mg

Medrol *

PEDIAPRED ORAL SOLUTION 6.7 (5 BASE) MG/5ML

prednisolone oral solution 15 mg/5ml *

prednisolone oral syrup 15 mg/5ml

prednisolone sodium phosphate oral solution 15 mg/5ml, 25 mg/5ml

*

prednisolone sodium phosphate oral solution 6.7 (5 base) mg/5ml

Pediapred *

prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 mg, 5 mg, 50 mg

*

prednisone oral tablet therapy pack 10 mg (21), 10 mg (48), 5 mg (21), 5 mg (48)

*

*MINERALOCORTICOIDS***

fludrocortisone acetate oral tablet 0.1 mg *

*COUGH/COLD/ALLERGY*

*MISC. RESPIRATORY INHALANTS***

sodium chloride inhalation nebulization solution 0.9 %, 10 %, 3 %

*

sodium chloride inhalation nebulization solution 7 %

HyperSal *

*MUCOLYTICS***

acetylcysteine inhalation solution 10 %, 20 %

*

*DERMATOLOGICALS*

*ACNE ANTIBIOTICS***

CLINDACIN ETZ EXTERNAL SWAB 1 %

CLINDACIN-P EXTERNAL SWAB 1 %

clindamycin phosphate external solution 1 %

clindamycin phosphate external swab 1 % Clindacin ETZ

ERYGEL EXTERNAL GEL 2 %


55


erythromycin external gel 2 % Erygel

erythromycin external solution 2 %

*ACNE COMBINATIONS***

benzoyl peroxide-erythromycin external gel 5-3 %

Benzamycin

clindamycin phos-benzoyl perox external gel 1.2-5 %

Neuac

*ACNE PRODUCTS***

AZELEX EXTERNAL CREAM 20 % AL

DIFFERIN EXTERNAL CREAM 0.1 %

DIFFERIN EXTERNAL GEL 0.3 %

DIFFERIN EXTERNAL LOTION 0.1 %

RETIN-A EXTERNAL CREAM 0.025 %, 0.05 %, 0.1 %

AL

RETIN-A EXTERNAL GEL 0.01 %, 0.025 % AL

*ANTIBIOTICS - TOPICAL***

antibiotic external ointment 500 unit/gm Bacitraycin Plus OTC

mupirocin external ointment 2 % Centany

*ANTIFUNGALS - TOPICAL COMBINATIONS***

clotrimazole-betamethasone external cream 1-0.05 %

*

nystatin-triamcinolone external cream 100000-0.1 unit/gm-%

*

nystatin-triamcinolone external ointment 100000-0.1 unit/gm-%

*

*ANTIFUNGALS - TOPICAL***

NYAMYC EXTERNAL POWDER 100000 UNIT/GM

*

nystatin external cream 100000 unit/gm *

nystatin external ointment 100000 unit/gm *

nystatin external powder 100000 unit/gm Nyamyc *

NYSTOP EXTERNAL POWDER 100000 UNIT/GM

*

*ANTINEOPLASTIC ANTIMETABOLITES - TOPICAL***

fluorouracil external cream 5 % Efudex QL

fluorouracil external solution 2 %


56


fluorouracil external solution 5 % QL

*ANTIPSORIATICS - SYSTEMIC***

acitretin oral capsule 10 mg, 25 mg Soriatane

acitretin oral capsule 17.5 mg

*ANTIPSORIATICS***

calcipotriene external cream 0.005 % Dovonex

calcipotriene external ointment 0.005 % Calcitrene

calcipotriene external solution 0.005 %

CALCITRENE EXTERNAL OINTMENT0.005 %

*ANTIVIRALS - TOPICAL***

acyclovir external ointment 5 % Zovirax

*BURN PRODUCTS***

silver sulfadiazine external cream 1 % SSD

SSD EXTERNAL CREAM 1 %

THERMAZENE EXTERNAL CREAM 1 %

*CORTICOSTEROIDS - TOPICAL***

ala-cort external cream 1 % Aveeno Anti-Itch Max St

ala-cort external cream 2.5 %

clobetasol prop emollient base external cream 0.05 %

clobetasol propionate e external cream 0.05 %

clobetasol propionate external cream 0.05 % Temovate

clobetasol propionate external gel 0.05 %

clobetasol propionate external ointment 0.05 %

Temovate

clobetasol propionate external solution 0.05 %

fluticasone propionate external cream 0.05 %

fluticasone propionate external ointment 0.005 %

halobetasol propionate external cream 0.05 %

halobetasol propionate external ointment 0.05 %

hydrocortisone external cream 2.5 %


57


hydrocortisone external lotion 2.5 %

hydrocortisone external ointment 1 %Aquaphor Itch Relief Max Str

hydrocortisone external ointment 2.5 %

mometasone furoate external cream 0.1 %

mometasone furoate external ointment 0.1 %

mometasone furoate external solution 0.1 %

triamcinolone acetonide external cream 0.025 %

triamcinolone acetonide external cream 0.1 %, 0.5 %

Triderm

triamcinolone acetonide external lotion 0.025 %, 0.1 %

triamcinolone acetonide external ointment 0.025 %, 0.1 %, 0.5 %

triamcinolone acetonide external ointment 0.05 %

Trianex

triamcinolone in absorbase external ointment 0.05 %

Trianex

TRIDERM EXTERNAL CREAM 0.1 %, 0.5 %

*IMIDAZOLE-RELATED ANTIFUNGALS - TOPICAL***

clotrimazole external cream 1 % Desenex *

ketoconazole external cream 2 % *

ketoconazole external shampoo 2 % *

*IMMUNOMODULATORS IMIDAZOQUINOLINAMINES - TOPICAL***

imiquimod external cream 5 % Aldara

*LOCAL ANESTHETICS - TOPICAL***

lidocaine external patch 5 % Lidoderm PA; QL

lidocaine hcl external solution 4 % QL

lidocaine hcl urethral/mucosal external gel 2 %


58


*MACROLIDE IMMUNOSUPPRESSANTS - TOPICAL***

ELIDEL EXTERNAL CREAM 1 % AL

*PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL***

EUCRISA EXTERNAL OINTMENT 2 % AL

*SCABICIDES & PEDICULICIDES***

NATROBA EXTERNAL SUSPENSION 0.9 %

permethrin external cream 5 %

*TOPICAL ANESTHETIC COMBINATIONS***

lidocaine-prilocaine external cream 2.5-2.5 %

QL

*DIAGNOSTIC PRODUCTS*

*DIAGNOSTIC DRUGS***

GLUCAGEN DIAGNOSTIC INJECTION SOLUTION RECONSTITUTED 1 MG

QL

*DIAGNOSTIC TESTS***

GNP TRUE METRIX GLUCOSE STRIPS IN VITRO STRIP

*; OTC; QL

RELION TRUE METRIX TEST STRIPS IN VITRO STRIP

*; OTC; QL

TRUE METRIX BLOOD GLUCOSE TEST IN VITRO STRIP

*; OTC; QL

TRUETEST TEST IN VITRO STRIP PA; *; OTC; QL

*MULTIPLE URINE TESTS***

CHEMSTRIP UGK IN VITRO STRIP OTC; QL

CVS KETONE CARE IN VITRO STRIP OTC; QL

KETO-DIASTIX IN VITRO STRIP OTC; QL

*DIGESTIVE AIDS*

*DIGESTIVE ENZYMES***

CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000-38000 UNIT, 24000-76000 UNIT, 3000-9500 UNIT, 36000-114000 UNIT, 6000-19000 UNIT


59


ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000-32000 UNIT, 15000-47000 UNIT, 20000-63000 UNIT, 25000-79000 UNIT, 3000-10000 UNIT, 40000-126000 UNIT, 5000-24000 UNIT

*DIURETICS*

*CARBONIC ANHYDRASE INHIBITORS***

acetazolamide er oral capsule extended release 12 hour 500 mg

*

acetazolamide oral tablet 125 mg, 250 mg *

methazolamide oral tablet 25 mg, 50 mg *

*DIURETIC COMBINATIONS***

amiloride-hydrochlorothiazide oral tablet 5-50 mg

*

spironolactone-hctz oral tablet 25-25 mg Aldactazide *

triamterene-hctz oral capsule 37.5-25 mg *

triamterene-hctz oral tablet 37.5-25 mg Maxzide-25 *

triamterene-hctz oral tablet 75-50 mg Maxzide *

*LOOP DIURETICS***

bumetanide oral tablet 0.5 mg Bumex *

bumetanide oral tablet 1 mg, 2 mg *

furosemide oral solution 10 mg/ml, 8 mg/ml *

furosemide oral tablet 20 mg, 40 mg, 80 mg Lasix *

torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg

*

*POTASSIUM SPARING DIURETICS***

amiloride hcl oral tablet 5 mg *

spironolactone oral tablet 100 mg, 25 mg, 50 mg

Aldactone *

*THIAZIDES AND THIAZIDE-LIKE DIURETICS***

chlorthalidone oral tablet 25 mg, 50 mg *

hydrochlorothiazide oral capsule 12.5 mg *

hydrochlorothiazide oral tablet 12.5 mg, 25 mg, 50 mg

*

indapamide oral tablet 1.25 mg, 2.5 mg *

metolazone oral tablet 10 mg, 2.5 mg, 5 mg *


60


*ENDOCRINE AND METABOLIC AGENTS - MISC.*

*BISPHOSPHONATES***

alendronate sodium oral tablet 10 mg, 35 mg, 5 mg

QL

alendronate sodium oral tablet 70 mg Fosamax QL

ibandronate sodium oral tablet 150 mg Boniva QL

*CALCITONINS***

calcitonin (salmon) nasal solution 200 unit/act

Miacalcin QL

*CARNITINE REPLENISHER - AGENTS***

levocarnitine oral tablet 330 mg Carnitor

*DOPAMINE RECEPTOR AGONISTS***

cabergoline oral tablet 0.5 mg QL

*GNRH/LHRH ANTAGONISTS***

ORILISSA ORAL TABLET 150 MG, 200 MG

QL

*GROWTH HORMONES***

GENOTROPIN MINIQUICK SUBCUTANEOUS SOLUTION RECONSTITUTED 0.2 MG, 0.4 MG, 0.6 MG, 0.8 MG, 1 MG, 1.2 MG, 1.4 MG, 1.6 MG, 1.8 MG, 2 MG

PA; SP

GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED 12 MG

SP

GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED 5 MG

PA; SP; QL

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION PEN-INJECTOR 10 MG/1.5ML, 15 MG/1.5ML, 30 MG/3ML, 5 MG/1.5ML

*HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS***

calcitriol oral capsule 0.25 mcg, 0.5 mcg Rocaltrol PA

calcitriol oral solution 1 mcg/ml Rocaltrol PA


61


*PARATHYROID HORMONE AND DERIVATIVES***

teriparatide (recombinant) subcutaneous solution pen-injector 620 mcg/2.48ml

Forteo

*SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)***

raloxifene hcl oral tablet 60 mg Evista QL

*SOMATOSTATIC AGENTS***

octreotide acetate injection solution 100 mcg/ml, 50 mcg/ml, 500 mcg/ml

SandoSTATIN PA; SP

octreotide acetate injection solution 1000 mcg/ml, 200 mcg/ml

PA; SP

octreotide acetate subcutaneous solution prefilled syringe 100 mcg/ml, 50 mcg/ml, 500 mcg/ml

SP

*UREA CYCLE DISORDER - AGENTS***

sodium phenylbutyrate oral powder 3 gm/tsp Buphenyl PA; SP; QL

sodium phenylbutyrate oral tablet 500 mg Buphenyl PA; SP; QL

*VASOPRESSIN***

desmopressin ace spray refrig nasal solution 0.01 %

desmopressin acetate oral tablet 0.1 mg, 0.2 mg

DDAVP QL

desmopressin acetate spray nasal solution 0.01 %

*ESTROGENS*

*ESTROGEN & PROGESTIN***

AMABELZ ORAL TABLET 0.5-0.1 MG, 1-0.5 MG

estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg

Amabelz

FYAVOLV ORAL TABLET 0.5-2.5 MG-MCG, 1-5 MG-MCG

JINTELI ORAL TABLET 1-5 MG-MCG

MIMVEY ORAL TABLET 1-0.5 MG

norethindrone-eth estradiol oral tablet 0.5-2.5 mg-mcg, 1-5 mg-mcg

Fyavolv


62


*ESTROGEN-PROGESTIN-GNRH ANTAGONIST***

ORIAHNN ORAL CAPSULE THERAPY PACK 300-1-0.5 & 300 MG

*ESTROGENS***

estradiol oral tablet 0.5 mg, 1 mg, 2 mg Estrace

estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr

Climara QL

*FLUOROQUINOLONES*

*FLUOROQUINOLONES***

ciprofloxacin hcl oral tablet 100 mg, 750 mg *

ciprofloxacin hcl oral tablet 250 mg, 500 mg Cipro *

levofloxacin oral tablet 250 mg, 500 mg, 750 mg

Levaquin *

*GASTROINTESTINAL AGENTS - MISC.*

*GALLSTONE SOLUBILIZING AGENTS***

ursodiol oral capsule 300 mg

ursodiol oral tablet 250 mg Urso 250

ursodiol oral tablet 500 mg Urso Forte

*GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS***

AMITIZA ORAL CAPSULE 24 MCG, 8 MCG

AL; QL

*GASTROINTESTINAL STIMULANTS***

metoclopramide hcl oral solution 10 mg/10ml, 5 mg/5ml

metoclopramide hcl oral tablet 10 mg, 5 mg Reglan

*IBS AGENT - GUANYLATE CYCLASE-C (GC-C) AGONISTS***

LINZESS ORAL CAPSULE 145 MCG, 290 MCG, 72 MCG

AL; QL

*INFLAMMATORY BOWEL AGENTS***

APRISO ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.375 GM


63


CANASA RECTAL SUPPOSITORY 1000 MG

LIALDA ORAL TABLET DELAYED RELEASE 1.2 GM

ROWASA RECTAL KIT 4 GM

sulfasalazine oral tablet 500 mg Azulfidine

sulfasalazine oral tablet delayed release 500 mg

Azulfidine EN-tabs

*INTESTINAL ACIDIFIERS***

enulose oral solution 10 gm/15ml

generlac oral solution 10 gm/15ml

lactulose encephalopathy oral solution 10 gm/15ml

*PERIPHERAL OPIOID RECEPTOR ANTAGONISTS***

MOVANTIK ORAL TABLET 12.5 MG, 25 MG

QL

*PHOSPHATE BINDER AGENTS***

calcium acetate (phos binder) oral capsule 667 mg

PhosLo

calcium acetate (phos binder) oral tablet 667 mg

Calphron

calcium acetate oral tablet 667 mg Calphron

PHOSLO ORAL CAPSULE 667 MG

RENVELA ORAL TABLET 800 MG

*GENITOURINARY AGENTS - MISCELLANEOUS*

*5-ALPHA REDUCTASE INHIBITORS***

dutasteride oral capsule 0.5 mg Avodart

finasteride oral tablet 5 mg Proscar PA

*ALPHA 1-ADRENOCEPTOR ANTAGONISTS***

alfuzosin hcl er oral tablet extended release 24 hour 10 mg

Uroxatral

tamsulosin hcl oral capsule 0.4 mg Flomax

*CITRATES***

pot & sod cit-cit ac oral solution 550-500-334 mg/5ml


64


potassium citrate er oral tablet extended release 10 meq (1080 mg)

Urocit-K 10


Urocit-K 15


Urocit-K 5

*GENITOURINARY IRRIGANTS***

ARGYLE STERILE SALINE IRRIGATION SOLUTION 0.9 %

CURITY STERILE SALINE IRRIGATION SOLUTION 0.9 %

sodium chloride irrigation solution 0.9 % Argyle Sterile Saline

*GOUT AGENTS*

*GOUT AGENT COMBINATIONS***

colchicine-probenecid oral tablet 0.5-500 mg

*GOUT AGENTS***

allopurinol oral tablet 100 mg, 300 mg Zyloprim

MITIGARE ORAL CAPSULE 0.6 MG

*URICOSURICS***

probenecid oral tablet 500 mg

*HEMATOLOGICAL AGENTS - MISC.*

*ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES***

HEMLIBRA SUBCUTANEOUS SOLUTION105 MG/0.7ML, 150 MG/ML, 30 MG/ML, 60 MG/0.4ML

SP

*ANTIHEMOPHILIC PRODUCTS***

ALPHANATE INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1500 UNIT, 2000 UNIT, 250 UNIT, 500 UNIT

SP

BENEFIX INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 3000 UNIT, 500 UNIT

SP

COAGADEX INTRAVENOUS SOLUTION RECONSTITUTED 250 UNIT, 500 UNIT

CORIFACT INTRAVENOUS KIT 1000-1600 UNIT

PA; SP


65


HUMATE-P INTRAVENOUS SOLUTION RECONSTITUTED 1000-2400 UNIT, 250-600 UNIT, 500-1200 UNIT

SP

NOVOEIGHT INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 1500 UNIT, 2000 UNIT, 250 UNIT, 3000 UNIT, 500 UNIT

NOVOSEVEN RT INTRAVENOUS SOLUTION RECONSTITUTED 1 MG, 2 MG, 5 MG, 8 MG

SP

NUWIQ INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 2500 UNIT, 3000 UNIT, 4000 UNIT, 500 UNIT

NUWIQ INTRAVENOUS SOLUTION RECONSTITUTED 1000 UNIT, 2000 UNIT, 250 UNIT, 2500 UNIT, 3000 UNIT, 4000 UNIT, 500 UNIT

WILATE INTRAVENOUS KIT 1000-1000 UNIT, 500-500 UNIT

SP

XYNTHA INTRAVENOUS KIT 1000 UNIT, 2000 UNIT, 250 UNIT, 500 UNIT

SP

XYNTHA SOLOFUSE INTRAVENOUS KIT1000 UNIT, 2000 UNIT, 250 UNIT, 3000 UNIT, 500 UNIT

SP

*BRADYKININ B2 RECEPTOR ANTAGONISTS***

icatibant acetate subcutaneous solution 30 mg/3ml

Sajazir SP

SAJAZIR SUBCUTANEOUS SOLUTION 30 MG/3ML

SP

*C1 INHIBITORS***

BERINERT INTRAVENOUS KIT 500 UNIT SP

HAEGARDA SUBCUTANEOUS SOLUTION RECONSTITUTED 2000 UNIT, 3000 UNIT

PA; QL

*DIRECT-ACTING P2Y12 INHIBITORS***

BRILINTA ORAL TABLET 60 MG, 90 MG

*HEMATORHEOLOGIC AGENTS***

pentoxifylline er oral tablet extended release 400 mg


66


*PLATELET AGGREGATION INHIBITORS***

dipyridamole oral tablet 25 mg, 50 mg, 75 mg

*THIENOPYRIDINE DERIVATIVES***

clopidogrel bisulfate oral tablet 300 mg

clopidogrel bisulfate oral tablet 75 mg Plavix

prasugrel hcl oral tablet 10 mg, 5 mg Effient

*HEMATOPOIETIC AGENTS*

*AGENTS FOR GAUCHER DISEASE***

ZAVESCA ORAL CAPSULE 100 MG PA

*COBALAMINS***

cyanocobalamin injection solution 1000 mcg/ml

*CYTOTOXIC AGENTS***

DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG

*ERYTHROPOIESIS-STIMULATING AGENTS (ESAS)***

RETACRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML, 40000 UNIT/ML

*FOLIC ACID/FOLATES***

folic acid oral tablet 1 mg

*GRANULOCYTE COLONY-STIMULATING FACTORS (G-CSF)***

NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6ML

*THROMBOPOIETIN (TPO) RECEPTOR AGONISTS***

PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG

PA; SP

*HEMOSTATICS*

*HEMOSTATICS - SYSTEMIC***

aminocaproic acid oral tablet 500 mg Amicar QL

tranexamic acid oral tablet 650 mg Lysteda QL


67


*HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS*

*BARBITURATE HYPNOTICS***

phenobarbital oral elixir 20 mg/5ml QL

phenobarbital oral tablet 100 mg, 15 mg, 16.2 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg

QL

*BENZODIAZEPINE HYPNOTICS***

temazepam oral capsule 15 mg, 30 mg Restoril QL

*NON-BENZODIAZEPINE - GABA-RECEPTOR MODULATORS***

zaleplon oral capsule 10 mg, 5 mg

zolpidem tartrate oral tablet 10 mg, 5 mg Ambien

*LAXATIVES*

*BOWEL EVACUANT COMBINATIONS***

GAVILYTE-C ORAL SOLUTION RECONSTITUTED 240 GM

*; QL

GAVILYTE-G ORAL SOLUTION RECONSTITUTED 236 GM

*; QL

GAVILYTE-N WITH FLAVOR PACK ORAL SOLUTION RECONSTITUTED 420 GM

*; QL

peg 3350-kcl-na bicarb-nacl oral solution reconstituted 420 gm

GaviLyte-N with Flavor Pack

*; QL

peg-3350/electrolytes oral solution reconstituted 236 gm

GaviLyte-G *; QL

*LAXATIVES - MISCELLANEOUS***

constulose oral solution 10 gm/15ml *; QL

lactulose oral solution 10 gm/15ml, 20 gm/30ml

*; QL

*MACROLIDES*

*AZITHROMYCIN***

azithromycin oral packet 1 gm Zithromax *

azithromycin oral suspension reconstituted 100 mg/5ml, 200 mg/5ml

Zithromax *

azithromycin oral tablet 250 mg, 500 mg Zithromax *

azithromycin oral tablet 600 mg *


68


*CLARITHROMYCIN***

clarithromycin oral suspension reconstituted 125 mg/5ml, 250 mg/5ml

*

clarithromycin oral tablet 250 mg, 500 mg *

*ERYTHROMYCINS***

erythromycin ethylsuccinate oral suspension reconstituted 200 mg/5ml

E.E.S. Granules *

*MEDICAL DEVICES AND SUPPLIES*

*APPLICATORS,COTTON BALLS,ETC***

alcohol prep padBD Swab Single Use Regular

OTC

alcohol prep pad 70 %BD Swab Single Use Regular

OTC

alcohol swabs pad , 70 %BD Swab Single Use Regular

OTC

BD SWAB SINGLE USE REGULAR PAD OTC

BD SWABS SINGLE USE BUTTERFLY PAD

OTC

CARETOUCH ALCOHOL PREP PAD 70 % OTC

CURITY ALCOHOL PREPS PAD 70 % OTC

CURITY ALCOHOL SWABS PAD OTC

cvs alcohol prep pads pad 70 %BD Swab Single Use Regular

OTC

cvs prep pad 70 %BD Swab Single Use Regular

OTC

easy comfort alcohol pads padBD Swab Single Use Regular

OTC

EASY TOUCH ALCOHOL PREP MEDIUM PAD 70 %

OTC

eql alcohol swabs pad 70 %BD Swab Single Use Regular

OTC

FIFTY50 ALCOHOL PREP PAD 70 % OTC

gnp alcohol swabs pad 70 %BD Swab Single Use Regular

OTC

h-e-b incontrol alcohol padBD Swab Single Use Regular

OTC

hm sterile alcohol prep padBD Swab Single Use Regular

OTC


69


meijer alcohol swabs pad 70 %BD Swab Single Use Regular

OTC

pure comfort alcohol prep padBD Swab Single Use Regular

OTC

qc alcohol swabs pad 70 %BD Swab Single Use Regular

OTC

ra alcohol swabs pad 70 %BD Swab Single Use Regular

OTC

reality swabs padBD Swab Single Use Regular

OTC

RELION ALCOHOL SWABS PAD OTC

RELION ALCOHOL SWABS PAD 70 % OTC

saps health alcohol prep padBD Swab Single Use Regular

OTC

saps health care alcohol prep pad 70 %BD Swab Single Use Regular

OTC

sb alcohol prep pad 70 %BD Swab Single Use Regular

OTC

sm alcohol prep pad , 70 %BD Swab Single Use Regular

OTC

sure comfort alcohol prep pad 70 %BD Swab Single Use Regular

OTC

SURE-PREP ALCOHOL PREP PAD 70 % OTC

true comfort alcohol prep pads pad 70 %BD Swab Single Use Regular

OTC

true comfort pro alcohol prep pad 70 %BD Swab Single Use Regular

OTC

ULTICARE ALCOHOL SWABS PAD OTC

ULTICARE ALCOHOL SWABS PAD 70 % OTC

ultilet alcohol swabs padBD Swab Single Use Regular

OTC

ultra-care alcohol prep pads pad 70 %BD Swab Single Use Regular

OTC

WEBCOL ALCOHOL PREP LARGE PAD70 %

OTC

WEBCOL ALCOHOL PREP MEDIUM PAD70 %

OTC

*DIAPHRAGMS***

CAYA VAGINAL DIAPHRAGM QL


70


OMNIFLEX DIAPHRAGM VAGINAL DIAPHRAGM

WIDE-SEAL DIAPHRAGM 60 VAGINAL DIAPHRAGM 2 %


QL


QL


QL


QL


QL



*GLUCOSE MONITORING TEST SUPPLIES***

1st tier unilet comfortouchAgaMatrix Ultra-Thin Lancets

*; OTC; QL

acti-lance 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

acti-lance lite lancets 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

acti-lance special lancets 17gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

acti-lance universal 23gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

adjustable lancing device Advocate Lancing Device OTC

advanced mobile lancetAgaMatrix Ultra-Thin Lancets

*; OTC; QL

ADVOCATE LANCING DEVICE OTC

AGAMATRIX ULTRA-THIN LANCETS *; OTC; QL

aimsco twist lancets 32gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

AIMSCO TWIST LANCETS 33G *; OTC; QL

ASSURE HAEMOLANCE PLUS HIGH *; OTC; QL

ASSURE HAEMOLANCE PLUS LOW *; OTC; QL


71


ASSURE HAEMOLANCE PLUS MICRO *; OTC; QL

ASSURE HAEMOLANCE PLUS NORMAL *; OTC; QL

ASSURE HAEMOLANCE PLUS PED *; OTC; QL

ASSURE LANCE LANCETS *; OTC; QL

ASSURE LANCE LANCETS 21G *; OTC; QL

ASSURE LANCE PLUS SAFETY 25G *; OTC; QL

ASSURE LANCE PLUS SAFETY 30G *; OTC; QL

ASSURE LANCE SAFETY LANCET 28G *; OTC; QL

aurora lancet super thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

aurora lancet thin 23gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

AUTO-LANCET OTC

AUTO-LANCET MINI OTC

AUTOLET II CLINISAFE KIT OTC

AUTOLET LANCING DEVICE OTC

AUTOLET LITE CLINISAFE KIT OTC

AUTOLET LITE STARTER PACK KIT OTC

AUTOLET MINI OTC

AUTOLET PLATFORMS OTC; QL

AUTOLET PLUS OTC

CARDIOCOM LANCING DEVICE OTC

careone advanced lancing dev Advocate Lancing Device OTC

CAREONE LANCET SUPER THIN 30G *; OTC; QL

careone lancet thin 23gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

CARESENS LANCETS *; OTC; QL

CLEANLET LANCETS 28G *; OTC; QL

comfort assured lancets 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

comfort assured lancets 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

comfort lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

cvs lancets 21gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

cvs lancets micro thin 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL


72


cvs lancets originalAgaMatrix Ultra-Thin Lancets

*; OTC; QL

cvs lancets thin 26gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

cvs lancets ultra thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

cvs lancets ultra-thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

cvs lancing device Advocate Lancing Device OTC

cvs ultra thin lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

DEXCOM G4 PLAT PED RCV/SHARE DEVICE

PA; QL

DEXCOM G4 PLAT PED RECEIVER DEVICE

PA; QL

DEXCOM G4 PLATINUM RCV/SHARE DEVICE

PA; QL

DEXCOM G4 PLATINUM RECEIVER DEVICE

PA; QL

DEXCOM G4 PLATINUM TRANSMITTER PA; QL

DEXCOM G5 MOB/G4 PLAT SENSOR PA; QL

DEXCOM G5 MOBILE RECEIVER DEVICE PA; QL

DEXCOM G5 MOBILE TRANSMITTER PA; QL

DEXCOM G5 RECEIVER KIT DEVICE PA; QL

DEXCOM G6 RECEIVER DEVICE PA; QL

DEXCOM G6 SENSOR PA; QL

DEXCOM G6 TRANSMITTER PA; QL

DIATHRIVE LANCET ULTRA THIN 30 *; OTC; QL

DIATHRIVE LANCETS *; OTC; QL

DIATHRIVE LANCING DEVICE OTC

DROPLET LANCETS ULTRA THIN 30G *; OTC; QL

DROPLET LANCING DEVICE OTC

DROPLET PERSONAL LANCETS 30G *; OTC

drug mart lancets thin 26gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

DRUG MART LANCING DEVICE OTC

DRUG MART ON-THE-GO LANCET 30G *; OTC; QL

DRUG MART UNILET LANCETS 28G *; OTC; QL



73



EASY TOUCH LANCETS 21G *; OTC; QL




EASY TOUCH LANCETS 28G/TWIST *; OTC; QL






EASY TOUCH LANCING DEVICE OTC

EASY TOUCH SAFETY LANCETS 21G *; OTC; QL




EMBRACE PRESSURE ACTIVATED 21G OTC

EMBRACE PRESSURE ACTIVATED 28G OTC

eql color lancets 21gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

eql color lancets micro 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

eql super thin lancets 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

eql thin lancets 26gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

E-Z JECT LANCET MICRO-THIN 33G *; OTC; QL

E-Z JECT LANCET SUPER THIN 30G *; OTC; QL

E-Z JECT LANCETS *; OTC; QL

E-Z JECT LANCETS 21G *; OTC; QL

E-Z JECT LANCETS THIN 26G *; OTC; QL

EZ-LETS LANCETS 21G *; OTC; QL




FIFTY50 SAFETY SEAL LANCETS *; OTC; QL

FIFTY50 UNILET LANCETS 33G *; OTC; QL


74


FINE 30 *; OTC; QL

FORA LANCETS *; OTC; QL

FORA LANCING DEVICE OTC

freds pharmacy autolet lancing Advocate Lancing Device OTC

freds pharmacy unilet lanc 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

freds pharmacy unilet lanc 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

FREESTYLE LIBRE 14 DAY READER DEVICE

PA; QL

FREESTYLE LIBRE 14 DAY SENSOR PA; QL

FREESTYLE LIBRE 2 READER DEVICE PA; QL

FREESTYLE LIBRE 2 SENSOR PA; QL

FREESTYLE LIBRE READER DEVICE PA; QL

GENTEEL BUTTERFLY TOUCH LANCET *; OTC; QL

GENTEEL CONTACT TIPS (BLUE) OTC; QL

GENTEEL CONTACT TIPS (CLEAR) OTC; QL

GENTEEL CONTACT TIPS (GREEN) OTC; QL

GENTEEL CONTACT TIPS (ORANGE) OTC; QL

GENTEEL CONTACT TIPS (RAINBOW) OTC; QL

GENTEEL CONTACT TIPS (VIOLET) OTC; QL

GENTEEL CONTACT TIPS (YELLOW) OTC; QL

GENTEEL LANCING KIT (BLUE) KIT OTC

GENTEEL NOZZLES OTC; QL

GENTEEL PLUS LANCING (BLACK) OTC

GENTEEL PLUS LANCING (PURPLE) OTC

GENTEEL PLUS LANCING (WHITE) OTC

GENTEEL PLUS LANCING DEV(BLUE) OTC

GENTEEL PLUS LANCING DEV(PINK) OTC

GENTLE-LET GP LANCETS *; OTC; QL

GENTLE-LET LANCETS *; OTC; QL

GENTLE-LET PLATFORMS OTC; QL

GLUCOCOM LANCETS 28G *; OTC; QL



gnp lancets 21gAgaMatrix Ultra-Thin Lancets

*; OTC; QL


75


gnp lancets micro thin 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

gnp lancets super thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

gnp lancets thin 26gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

gnp sterile lancets 28gAgaMatrix Ultra-Thin Lancets

*; OTC


*; OTC


*; OTC

GNP TRUE METRIX AIR METER KITW/DEVICE

OTC

GNP TRUE METRIX GLUCOSE METER KIT W/DEVICE

OTC

goodsense color lancets 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

goodsense lancets 26g univAgaMatrix Ultra-Thin Lancets

*; OTC; QL

goodsense lancets 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL


*; OTC; QL

goodsense lancets 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL


*; OTC; QL

goodsense lancing device Advocate Lancing Device OTC

HAEMOLANCE *; OTC; QL

HAEMOLANCE LOW FLOW LANCETS *; OTC; QL

HAEMOLANCE PLUS *; OTC; QL

HAEMOLANCE PLUS HIGH FLOW *; OTC; QL

HAEMOLANCE PLUS LOW FLOW *; OTC; QL

HAEMOLANCE PLUS MAX FLOW *; OTC; QL

HAEMOLANCE PLUS PEDIATRIC FLOW *; OTC; QL

HEALTH CARE LANCING DEVICE OTC

healthy accents lancing device Advocate Lancing Device OTC

healthy accents unilet lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL


76


h-e-b incontrol adv lancing Advocate Lancing Device OTC

h-e-b incontrol lancets 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL


*; OTC; QL


*; OTC; QL

HYPOLANCE AST LANCING KIT OTC

HY-VEE LANCETS *; OTC; QL

hy-vee thin lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

IN TOUCH LANCING DEVICE OTC

IN TOUCH STERILE LANCETS 30G *; OTC; QL

kinney lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kinney thin lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

KROGER AUTOLET LANCING DEVICE OTC

KROGER HEALTHPRO LANCET 26G *; OTC; QL

kroger lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kroger lancets 21gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kroger lancets micro thin 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kroger lancets super thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kroger lancets thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kroger lancets thin 26gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kroger lancets ultrathin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

kroger lancing device Advocate Lancing Device OTC

lancet device Advocate Lancing Device OTC

lancet transporter case Autolet Platforms OTC; QL

lancetsAgaMatrix Ultra-Thin Lancets

OTC; QL

lancets 30gAgaMatrix Ultra-Thin Lancets

OTC; QL


77


lancets 33gAgaMatrix Ultra-Thin Lancets

OTC; QL

lancets micro thin 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

lancets super thin 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

lancets thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

LANCETS ULTRA THIN *; OTC; QL

lancets ultra thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

lancing device Advocate Lancing Device OTC

LANZO OTC

leader advanced lancing device Advocate Lancing Device OTC

LIBERTY MINI LANCING DEVICE OTC

lite touch lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

LITE TOUCH LANCING PEN OTC

LITETOUCH LANCETS *; OTC; QL

live better adv lancing device Advocate Lancing Device OTC

live better lancet super thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

live better lancet ultra thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

longs lancets standardAgaMatrix Ultra-Thin Lancets

*; OTC; QL

longs lancets thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

longs lancets ultra thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

medichoice safety lancetAgaMatrix Ultra-Thin Lancets

*; OTC; QL

medichoice safety lancet extraAgaMatrix Ultra-Thin Lancets

*; OTC; QL

medichoice safety lancet normAgaMatrix Ultra-Thin Lancets

*; OTC; QL

MEDLANCE EXTRA 21G *; OTC; QL

MEDLANCE LITE 25G *; OTC; QL

MEDLANCE PLUS EXTRA 21G *; OTC; QL

MEDLANCE PLUS LANCETS *; OTC; QL


78


MEDLANCE PLUS LITE 25G *; OTC; QL

MEDLANCE PLUS SPECIAL 0.8MM *; OTC; QL

MEDLANCE PLUS SUPERLITE 30G *; OTC; QL

MEDLANCE PLUS UNIVERSAL 21G *; OTC; QL

MEDLANCE UNIVERSAL 21G *; OTC; QL

MEIJER LANCETS *; OTC; QL

MEIJER LANCETS THIN *; OTC; QL

MEIJER LANCETS UNIVERSAL 21G *; OTC; QL



MEIJER SUPER THIN LANCETS *; OTC; QL

mini lancing device Advocate Lancing Device OTC

MM LANCING DEVICE OTC

MM TWIST LANCETS *; OTC; QL

MONOLET LANCETS *; OTC; QL

MONOLET OPD LANCETS *; OTC; QL

MONOLETTOR SAFETY LANCETS *; OTC; QL

mpd safety lancet 21gAgaMatrix Ultra-Thin Lancets

*; OTC; QL


*; OTC; QL


*; OTC; QL


*; OTC; QL

multi-lancet device Advocate Lancing Device OTC

MULTI-LANCET DEVICE 2 KIT OTC

MYGLUCOHEALTH LANCETS 30G *; OTC; QL

NOVA SAFETY LANCETS 23G *; OTC; QL

NOVA SAFETY LANCETS 28G *; OTC; QL

NOVA SUREFLEX LANCETS *; OTC; QL

NOVA SUREFLEX LANCING DEVICE OTC

pc lancets super thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

PERFECT LANCETS 28G *; OTC; QL

PERFECT LANCETS 30G *; OTC; QL

PHARMACY COUNTER LANCETS *; OTC; QL


79


pip lancets 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

pip lancets 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

PRECISION THINS GP LANCETS *; OTC; QL

preferred plus lancets coloredAgaMatrix Ultra-Thin Lancets

*; OTC; QL

preferred plus lancets thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

PSS SELECT GP LANCETS *; OTC; QL

PSS SELECT PLATFORMS OTC; QL

PSS SELECT SAFETY LANCETS *; OTC; QL

px advanced lancing device Advocate Lancing Device OTC

px lancets ultra thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

px lancets ultra thin 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

qc advanced lancing device Advocate Lancing Device OTC

qc lancets super thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

qc lancets ultra thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

qc unilet lancets 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

qc unilet lancets micro thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

RA E-ZJECT LANCETS 28G *; OTC; QL

RA E-ZJECT LANCETS THIN 26G *; OTC; QL

RA E-ZJECT LANCETS THIN 28G *; OTC; QL

RA E-ZJECT LANCETS ULTRA THIN *; OTC; QL

READYLANCE SAFETY LANCETS *; OTC; QL

reality lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

reality trigger lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

RELION LANCET DEVICES 30G OTC

RELION LANCETS MICRO-THIN 33G *; OTC; QL

RELION LANCETS THIN 26G *; OTC; QL

RELION LANCETS ULTRA-THIN 30G *; OTC; QL


80


RELION LANCING DEVICE OTC

RELION LANCING DEVICE KIT OTC

RELION TRUE MET AIR GLUC METER KIT W/DEVICE

OTC; QL

RELION ULTRA THIN LANCETS 30G *; OTC; QL

RELION ULTRA THIN PLUS LANCETS *; OTC; QL

REXALL LANCETS ULTRA THIN 30G *; OTC; QL

RIGHTEST ALTERNATE SITE ADAPT OTC; QL

RIGHTEST GD500 LANCING DEVICE OTC

RIGHTEST GL300 LANCETS *; OTC; QL

SAFE-T-LANCE *; OTC; QL

SAFE-T-LANCE PLUS *; OTC; QL

SAFETY LANCETS 21G *; OTC; QL

sb lancets thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

sb lancets ultra thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

select-lite device/lancets kit Autolet II Clinisafe OTC

select-lite lancing device Advocate Lancing Device OTC

SHOPKO AUTOLET LANCING DEVICE OTC

SHOPKO ON-THE-GO LANCETS 30G *; OTC; QL

SHOPKO UNILET LANCETS 28G *; OTC; QL

SHOPKO UNILET LANCETS 30G *; OTC; QL

sm lancets 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

SMART SENSE COLOR LANCETS 33G *; OTC; QL

SMART SENSE STANDARD LANCETS *; OTC; QL

SMART SENSE SUPER THIN LANCETS *; OTC; QL

SMART SENSE THIN LANCETS 26G *; OTC; QL

SMARTEST LANCETS 28G *; OTC; QL

STERILANCE PA OTC; QL

STERILANCE TL *; OTC; QL

super thin lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

sure comfort lancets 18gAgaMatrix Ultra-Thin Lancets

*; OTC; QL


*; OTC; QL


81



*; OTC; QL


*; OTC; QL


*; OTC; QL

sure comfort lancing pen Advocate Lancing Device OTC

SURELITE LANCETS *; OTC; QL

TECHLITE AST LANCETS *; OTC; QL

TECHLITE LANCETS *; OTC; QL

TECHLITE LANCETS 30G *; OTC; QL

tgt lancet micro thin 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

tgt lancet thin 26gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

tgt lancet ultra thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

tgt lancing device Advocate Lancing Device OTC

THINLETS GP LANCETS *; OTC; QL

todays health lancing device Advocate Lancing Device OTC

todays health thin lancets 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

todays health thin lancets 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

topcare lancets micro-thin 33gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

travel lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

TRAVEL LANCETS ADVANCED 28G *; OTC; QL

TRUE METRIX AIR GLUCOSE METER DEVICE

OTC

TRUE METRIX AIR GLUCOSE METER KITW/DEVICE

OTC; QL

TRUE METRIX GO GLUCOSE METER KITW/DEVICE

OTC; QL

TRUE METRIX LEVEL 1 IN VITRO SOLUTION LOW

OTC

TRUE METRIX LEVEL 2 IN VITRO SOLUTION NORMAL

OTC


82


TRUE METRIX LEVEL 3 IN VITRO SOLUTION HIGH

OTC

TRUE METRIX METER DEVICE OTC; QL

TRUE METRIX METER KIT W/DEVICE OTC; QL

TRUEDRAW LANCING DEVICE OTC

TRUEPLUS LANCETS 26G *; OTC; QL




TRUEPLUS SAFETY LANCETS 28G *; OTC; QL

ULTRA-THIN II AUTO LANCET *; OTC; QL

ULTRA-THIN II LANCETS *; OTC; QL

UNILET COMFORTOUCH LANCET *; OTC; QL

UNILET EXCELITE *; OTC; QL

UNILET EXCELITE II *; OTC; QL

UNILET G.P. LANCET *; OTC; QL

UNILET G.P. SUPERLITE LANCET *; OTC; QL

UNILET GP 28 ULTRA THIN *; OTC; QL

UNILET LANCET *; OTC; QL

UNILET MICRO-THIN 33G *; OTC; QL

UNILET SUPERLITE LANCET *; OTC; QL

UNILET SUPER-THIN 30G *; OTC; QL

UNILET ULTRA-THIN 28G *; OTC; QL

UNISTIK 1 OTC; QL

UNISTIK 2 OTC; QL

UNISTIK 2 COMFORT OTC; QL

UNISTIK 2 EXTRA OTC; QL

UNISTIK 2 NEONATAL OTC; QL

UNISTIK 2 NORMAL OTC; QL

UNISTIK 2 SUPER OTC; QL

UNISTIK 3 OTC; QL

UNISTIK 3 COMFORT OTC; QL

UNISTIK 3 EXTRA OTC; QL

UNISTIK 3 GENTLE *; OTC; QL

UNISTIK 3 NEONATAL OTC; QL

UNISTIK 3 NORMAL OTC; QL


83


UNISTIK CZT COMFORT OTC; QL

UNISTIK CZT NORMAL OTC; QL

UNISTIK NORMAL OTC; QL

UNISTIK PRO SAFETY LANCET *; OTC; QL

UNISTIK SAFETY LANCETS 28G *; OTC; QL

UNISTIK SAFETY LANCETS 30G *; OTC; QL

UNISTIK TOUCH SAFETY LANC 21G *; OTC; QL




UNIVERSAL 1 LANCETS THIN 26G *; OTC; QL

UNIVERSAL 1 LANCETS THIN 33G *; OTC; QL

UNIVERSAL 1 LANCETS ULTRA THIN *; OTC; QL

value plus lancet standard 21gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

value plus lancets super thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

value plus lancets thin 26gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

value plus lancing device Advocate Lancing Device OTC

valumark lancet super thin 30gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

valumark lancet ultra thin 28gAgaMatrix Ultra-Thin Lancets

*; OTC; QL

VIDA MIA AUTOLET LANCING DEV OTC

VIDA MIA UNILET LANCETS 28G *; OTC; QL

VIDA MIA UNILET LANCETS 30G *; OTC; QL

VIVAGUARD LANCETS *; OTC; QL

VIVAGUARD LANCING DEVICE OTC

walgreens adv travel lancetsAgaMatrix Ultra-Thin Lancets

*; OTC; QL

WALGREENS LANCETS *; OTC; QL

walgreens lancets micro thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

walgreens lancets super thinAgaMatrix Ultra-Thin Lancets

*; OTC; QL

WALGREENS THIN LANCETS *; OTC; QL

WALGREENS ULTRA THIN LANCETS *; OTC; QL


84


*INSULIN ADMINISTRATION SUPPLIES***

OMNIPOD 5 PACK PA; QL

OMNIPOD DASH 5 PACK PODS PA; QL

OMNIPOD STARTER KIT PA; QL

*NEEDLES & SYRINGES***

BD AUTOSHIELD 29G X 5MM , 29G X 8MM

OTC; QL

BD AUTOSHIELD DUO 30G X 5 MM OTC; QL

BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML

OTC; QL

BD INSULIN SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML, 26G X 1/2" 1 ML, 27.5G X 5/8" 2 ML, 27G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, U-100 1 ML

OTC; QL

BD INSULIN SYRINGE HALF-UNIT 31G X 5/16" 0.3 ML

OTC

BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML

OTC; QL

BD INSULIN SYRINGE U/F 1/2UNIT 31G X 5/16" 0.3 ML

OTC; QL

BD INSULIN SYRINGE U/F 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML

OTC; QL

BD INSULIN SYRINGE U-500 31G X 6MM 0.5 ML

QL

BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 31G X 5/16" 0.5 ML

OTC; QL

BD LUER-LOK SYRINGE 20G X 1" 1 ML, 25G X 5/8" 1 ML

OTC

BD PEN NEEDLE MICRO U/F 32G X 6 MM OTC; QL

BD PEN NEEDLE MINI U/F 31G X 5 MM OTC; QL

BD PEN NEEDLE NANO 2ND GEN 32G X 4 MM

OTC; QL

BD PEN NEEDLE NANO U/F 32G X 4 MM QL


85


BD PEN NEEDLE ORIGINAL U/F 29G X 12.7MM

OTC; QL

BD PEN NEEDLE SHORT U/F 31G X 8 MM OTC; QL

BD SAFETYGLIDE INSULIN SYRINGE29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 30G X 5/16" 0.5 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 1 ML, 31G X 5/16" 0.3 ML

OTC; QL

BD SAFETYGLIDE INSULIN SYRINGE31G X 15/64" 0.3 ML

QL

BD SAFETY-LOK INSULIN SYRINGE 29G X 1/2" 1 ML

OTC; QL

BD VEO INSULIN SYR U/F 1/2UNIT 31G X 15/64" 0.3 ML

OTC; QL

BD VEO INSULIN SYRINGE U/F 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 1 ML

OTC; QL

*RESPIRATORY THERAPY SUPPLIES***

BREATHERITE VALVED MDI CHAMBER DEVICE

QL

IN-CHECK INSPIRATORY FLOW MTR DEVICE

QL

VORTEX HOLD CHMBR/MASK/CHILD DEVICE

VORTEX HOLD CHMBR/MASK/TODDLER DEVICE

*SPACER/AEROSOL-HOLDING CHAMBERS & SUPPLIES***

AEROVENT PLUS DEVICE QL

COMPACT SPACE CHAMBER DEVICE QL

COMPACT SPACE CHAMBER/LG MASK DEVICE

QL

COMPACT SPACE CHAMBER/MED MASK DEVICE

QL

MICROCHAMBER DEVICE QL

OPTICHAMBER DIAMOND QL

OPTICHAMBER DIAMOND-LG MASK DEVICE

OPTICHAMBER DIAMOND-MD MASK

OPTICHAMBER DIAMOND-SM MASK


86


POCKET CHAMBER DEVICE QL

RITEFLO DEVICE QL

VORTEX VALVED HOLDING CHAMBER DEVICE

QL

*MIGRAINE PRODUCTS*

*CALCITONIN GENE-RELATED PEPTIDE RECEPTOR ANTAG (CGRP)***

UBRELVY ORAL TABLET 100 MG, 50 MG AL; QL

*CGRP RECEPTOR ANTAGONISTS - MONOCOLONAL ANTIBODIES***

AJOVY SUBCUTANEOUS SOLUTION AUTO-INJECTOR 225 MG/1.5ML

AJOVY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 225 MG/1.5ML

QL

EMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR 120 MG/ML

EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 120 MG/ML

QL

*SELECTIVE SEROTONIN AGONISTS 5-HT(1)***

IMITREX NASAL SOLUTION 20 MG/ACT, 5 MG/ACT

QL

rizatriptan benzoate oral tablet 10 mg Maxalt QL

rizatriptan benzoate oral tablet 5 mg QL

rizatriptan benzoate oral tablet dispersible 10 mg

Maxalt-MLT QL

rizatriptan benzoate oral tablet dispersible 5 mg

QL

sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg

Imitrex QL

sumatriptan succinate refill subcutaneous solution cartridge 4 mg/0.5ml, 6 mg/0.5ml

Imitrex STATdose Refill QL

sumatriptan succinate subcutaneous solution 6 mg/0.5ml

Imitrex QL

sumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5ml, 6 mg/0.5ml

Imitrex STATdose System QL


87


*MINERALS & ELECTROLYTES*

*CALCIUM COMBINATIONS***

calcitrate plus d oral tablet 315-200 mg-unit OTC

calcium + d oral tablet 315-200 mg-unit OTC

calcium + d3 oral tablet 600-800 mg-unit Pronutrients Calcium+D3 OTC

calcium + vitamin d3 oral tablet 600-10 mg-mcg, 600-5 mg-mcg

OTC

calcium 500 + d oral tablet 500-125 mg-unit OTC

calcium 500 + d oral tablet 500-200 mg-unit Os-Cal Calcium + D3 OTC

calcium 500 + d3 oral tablet 500-200 mg-unit Os-Cal Calcium + D3 OTC

calcium 500 + d3 oral tablet 500-600 mg-unit Os-Cal Extra D3 OTC

calcium 500 +d oral tablet 500-400 mg-unit Oystercal-D OTC

calcium 500/d oral tablet 500-200 mg-unit Os-Cal Calcium + D3 OTC

calcium 500/d oral tablet chewable 500-400 mg-unit

OTC

calcium 500/vitamin d oral tablet 500-125 mg-unit

OTC

calcium 500+d high potency oral tablet 500-400 mg-unit

Oystercal-D OTC

calcium 500+d oral tablet 500-200 mg-unit Os-Cal Calcium + D3 OTC

calcium 500+d oral tablet 500-400 mg-unit Oystercal-D OTC

calcium 500+d3 oral tablet 500-200 mg-unit Os-Cal Calcium + D3 OTC

calcium 500+d3 oral tablet 500-400 mg-unit Oystercal-D OTC

calcium 600 + d oral tablet 600-200 mg-unit OTC

calcium 600 + minerals oral tablet 600-200 mg-unit

OTC

calcium 600/vitamin d oral tablet 600-400 mg-unit

OTC

calcium 600/vitamin d oral tablet chewable 600-400 mg-unit

OTC

calcium 600/vitamin d3 oral tablet 600-800 mg-unit

Pronutrients Calcium+D3 OTC

calcium 600+d high potency oral tablet 600-400 mg-unit

OTC

calcium 600+d oral tablet 600-200 mg-unit, 600-400 mg-unit

OTC

calcium 600+d oral tablet 600-800 mg-unit Pronutrients Calcium+D3 OTC

calcium 600+d plus minerals oral tablet 600-400 mg-unit

OTC


88


calcium 600+d plus minerals oral tablet chewable 600-400 mg-unit

OTC

calcium 600+d3 oral tablet 600-200 mg-unit, 600-400 mg-unit

OTC

calcium 600+d3 oral tablet 600-800 mg-unit Pronutrients Calcium+D3 OTC

calcium 600+d3 plus minerals oral tablet 600-800 mg-unit

Caltrate 600+D Plus Minerals

OTC

calcium 600+d3 plus minerals oral tablet chewable 600-800 mg-unit


OTC

calcium carb-cholecalciferol oral tablet 500-125 mg-unit, 600-400 mg-unit

OTC

calcium carb-cholecalciferol oral tablet chewable 500-10 mg-mcg

OTC

calcium carbonate-vitamin d oral capsule 600-200 mg-unit

OTC

calcium carbonate-vitamin d oral tablet 600-200 mg-unit, 600-400 mg-unit

OTC

calcium carbonate-vitamin d3 oral tablet 600-400 mg-unit

OTC

calcium citrate + d oral tablet 250-200 mg-unit, 315-200 mg-unit

OTC

calcium citrate + d oral tablet 315-250 mg-unit

Calcitrate OTC

calcium citrate + d3 maximum oral tablet 315-250 mg-unit

Calcitrate OTC

calcium citrate + d3 oral tablet 200-250 mg-unit

Citracal Petites/Vitamin D OTC

calcium citrate + d3 oral tablet 250-200 mg-unit, 315-5 mg-mcg

OTC

calcium citrate + d3 oral tablet 315-250 mg-unit

Calcitrate OTC

calcium citrate + oral tablet 315-200 mg-unit OTC

calcium citrate +d oral tablet 315-250 mg-unit

Calcitrate OTC

calcium citrate+d3 oral tablet 315-250 mg-unit

Calcitrate OTC

calcium citrate+d3 petites oral tablet 200-250 mg-unit


calcium citrate-vitamin d oral tablet 200-125 mg-unit, 315-200 mg-unit

OTC


89


calcium citrate-vitamin d oral tablet 315-250 mg-unit

Calcitrate OTC

calcium citrate-vitamin d3 oral tablet 315-250 mg-unit, 315-6.25 mg-mcg

Calcitrate OTC

calcium creamies oral tablet chewable 600-400 mg-unit

OTC

calcium extra d3 oral tablet 500-600 mg-unit Os-Cal Extra D3 OTC

calcium for women oral tablet chewable 500-100-40

OTC

calcium high potency/vitamin d oral tablet 600-200 mg-unit

OTC

calcium magnesium zinc oral tablet 333-133-5 mg

OTC

calcium plus vitamin d oral tablet 500-5 mg-mcg

Os-Cal Calcium + D3 OTC

calcium plus vitamin d3 oral capsule 600-500 mg-unit

OTC

calcium plus vitamin d3 oral tablet 600-800 mg-unit


calcium/c/d oral tablet chewable 500-10-250 mg-mg-unit

OTC

calcium+d3 gradual release oral tablet extended release 24 hour 600-40-500 mg-mg-unit

Citracal Slow Release OTC

calcium+d3 oral tablet 500-10 mg-mcg Oystercal-D OTC

calcium+d3 oral tablet 500-15 mg-mcg Os-Cal Extra D3 OTC

calcium+d3 oral tablet 600-20 mg-mcg, 600-800 mg-unit


calcium-magnesium oral tablet 500-250 mg Cal-Mag OTC

calcium-magnesium-zinc oral tablet 333-133-5 mg, 333-133-8.3 mg, 333.33-133.33-5 mg

OTC

calcium-vitamin d oral tablet 500-400 mg-unit

Oystercal-D OTC

calcium-vitamin d oral tablet 600-400 mg-unit

OTC

calcium-vitamin d3 oral capsule 600-400 mg-unit, 600-500 mg-unit

OTC

calcium-vitamin d3 oral tablet 250-125 mg-unit, 600-200 mg-unit, 600-400 mg-unit

OTC


90


calcium-vitamin d3 oral tablet 500-400 mg-unit

Oystercal-D OTC

calcium-vitamin d-minerals oral tablet chewable 600-400 mg-unit

OTC

calcium-vitamin d-minerals oral tablet chewable 600-800 mg-unit


OTC

CAL-MAG ORAL TABLET 500-250 MG OTC

chewable calcium oral tablet chewable 500-200-40 mg-unt-mcg

OTC

citrus calcium/vitamin d oral tablet 200-250 mg-unit


cvs calcium + d3 oral tablet 600-20 mg-mcg Pronutrients Calcium+D3 OTC

cvs calcium 600 & vitamin d3 oral tablet 600-800 mg-unit


cvs calcium 600 + d/minerals oral tablet 600-800 mg-unit


OTC

cvs calcium 600 + d/minerals oral tablet chewable 600-800 mg-unit


OTC

cvs calcium 600+d oral tablet 600-800 mg-unit


cvs calcium citrate+d3 oral tablet 315-250 mg-unit

Calcitrate OTC

cvs calcium citrate+d3 petites oral tablet 200-6.25 mg-mcg


cvs calcium-magnesium-zinc oral tablet 333-133-5 mg

OTC

cvs oyster shell calcium-vit d oral tablet 500-125 mg-unit

OTC

eq calcium 500+d oral tablet 500-200 mg-unit


eq calcium 600+d oral tablet 600-800 mg-unit


eq calcium 600+d+minerals oral tablet 600-800 mg-unit


OTC

eq calcium citrate+d oral tablet 315-250 mg-unit

Calcitrate OTC

eq calcium citrate+d3 oral tablet 315-250 mg-unit

Calcitrate OTC

eq calcium citrate+d3 petites oral tablet 200-250 mg-unit



91


eql calcium citrate/vitamin d oral tablet 315-250 mg-unit

Calcitrate OTC

eql calcium citrate/vitamin d3 oral tablet 315-250 mg-unit

Calcitrate OTC

eql calcium soft chews oral tablet chewable 500-200-40 mg-unt-mcg

OTC

eql calcium/vitamin d oral tablet 600-400 mg-unit

OTC

eql calcium/vitamin d3 oral tablet 600-800 mg-unit


gnp calcium 500 +d3 oral tablet 500-600 mg-unit

Os-Cal Extra D3 OTC

gnp calcium 600 +d/minerals oral tablet 600-800 mg-unit


OTC

gnp calcium 600 +d3 oral tablet 600-800 mg-unit


gnp calcium 600 +d3/minerals oral tablet chewable 600-800 mg-unit


OTC

gnp calcium citrate +d3 oral tablet 315-250 mg-unit

Calcitrate OTC

hm calcium citrate+d3 petite oral tablet 200-250 mg-unit


hm calcium-vitamin d-minerals oral tablet 600-400 mg-unit

OTC

kp calcium 600+d oral capsule 600-500 mg-unit

OTC

kp calcium 600+d oral tablet 600-400 mg-unit

OTC

kp calcium 600+d oral tablet 600-800 mg-unit


kp calcium 600+d3 oral capsule 600-500 mg-unit

OTC

kp calcium citrate+d oral tablet 315-250 mg-unit

Calcitrate OTC

kp calcium-magnesium-zinc oral tablet 333-133-5 mg

OTC

liquid calcium with d3 oral capsule 600-500 mg-unit

OTC

liquid calcium/vitamin d oral capsule 600-200 mg-unit

OTC


92


nat-rul oyster calcium+vit d oral tablet 500-125 mg-unit

OTC

OS-CAL CALCIUM + D3 ORAL TABLET500-200 MG-UNIT

OTC

OS-CAL EXTRA D3 ORAL TABLET 500-600 MG-UNIT

OTC

OYSCO 500+D ORAL TABLET 500-200 MG-UNIT

OTC

oyster calcium/d3 oral tablet 500-200 mg-unit


oyster shell calcium + d oral tablet 500-200 mg-unit


oyster shell calcium + d oral tablet 500-400 mg-unit

Oystercal-D OTC

oyster shell calcium + d3 oral tablet 500-400 mg-unit

Oystercal-D OTC

oyster shell calcium 250+d oral tablet 250-125 mg-unit

OTC

oyster shell calcium 500 + d oral tablet 500-125 mg-unit

OTC

oyster shell calcium 500+d oral tablet chewable 500-400 mg-unit

OTC

oyster shell calcium oral tablet 500-400 mg-unit

Oystercal-D OTC

oyster shell calcium plus d oral tablet 500-125 mg-unit

OTC

oyster shell calcium plus d oral tablet 500-200 mg-unit


oyster shell calcium/d oral tablet 250-125 mg-unit, 500-200 mg-unit

OTC

oyster shell calcium/d oral tablet 500-400 mg-unit

Oystercal-D OTC

oyster shell calcium/d oral tablet 500-5 mg-mcg


oyster shell calcium/d3 oral tablet 500-400 mg-unit

Oystercal-D OTC

oyster shell calcium/vit d3 oral tablet 250-3.12 mg-mcg

OTC

oyster shell calcium/vitamin d oral tablet 250-125 mg-unit

OTC


93


oyster shell calcium/vitamin d oral tablet 500-200 mg-unit


OYSTERCAL-D ORAL TABLET 500-400 MG-UNIT

OTC

PRONUTRIENTS CALCIUM+D3 ORAL TABLET 600-800 MG-UNIT

OTC

px calcium&d oral tablet 600-400 mg-unit OTC

qc calcium 600 +d3/minerals oral tablet chewable 600-800 mg-unit


OTC

qc calcium/minerals/vitamin d oral tablet 600-400 mg-unit

OTC

ra calcium 600/vit d/minerals oral tablet 600-200 mg-unit

OTC

ra calcium 600/vit d/minerals oral tablet chewable 600-400 mg-unit

OTC

ra calcium 600/vitamin d-3 oral tablet 600-400 mg-unit

OTC

ra calcium cit plus vit d-3 oral tablet 315-250 mg-unit

Calcitrate OTC

ra calcium citrate plus vit d oral tablet 315-200 mg-unit

OTC

ra calcium cit-vit d-3 petites oral tablet 200-250 mg-unit


ra calcium plus vitamin d oral tablet 600-200 mg-unit, 600-400 mg-unit

OTC

ra calcium plus vitamin d3 oral tablet 600-400 mg-unit

OTC

ra calcium/vitamin d/minerals oral tablet 600-400 mg-unit

OTC

RA HI CAL ORAL TABLET 500-200 MG-UNIT

OTC

risacal-d oral tablet 105-81-120 mg-mg-unit OTC

sb calcium + d oral tablet 600-200 mg-unit OTC

sm calcium 500/vitamin d3 oral tablet 500-400 mg-unit

Oystercal-D OTC

sm calcium 600/vitamin d oral tablet 600-400 mg-unit

OTC

sm calcium 600+d plus minerals oral tablet chewable 600-800 mg-unit


OTC

sm calcium 600+d3 oral tablet 600-800 mg-unit



94


sm calcium citrate+/vit d3 oral tablet 315-250 mg-unit

Calcitrate OTC

sm calcium citrate+d3 petite oral tablet 200-250 mg-unit


sm calcium citrate+vit d3 max oral tablet 315-250 mg-unit

Calcitrate OTC

sm calcium citrate-vit d oral tablet 315-200 mg-unit

OTC

sm calcium soft chews oral tablet chewable 500-100-40 , 500-200-40 mg-unt-mcg

OTC

sm calcium/vitamin d oral tablet 500-200 mg-unit


sm calcium/vitamin d oral tablet 600-800 mg-unit


sm calcium/vitamin d3 oral tablet 600-800 mg-unit


OTC

sm calcium-magnesium-zinc oral tablet 333-133-5 mg, 333-133-8.3 mg

OTC

sm calcium-vitamin d oral tablet 500-200 mg-unit


sm calcium-vitamin d oral tablet 600-400 mg-unit

OTC

sm oyster shell calcium/vit d oral tablet 500-400 mg-unit

Oystercal-D OTC

sm oyster shell calcium/vit d3 oral tablet 500-400 mg-unit

Oystercal-D OTC

super calcium 600 + d 400 oral tablet 600-400 mg-unit

OTC

super calcium 600 + d3 oral tablet 600-400 mg-unit

OTC

*CALCIUM***

calcium 600 high potency oral tablet 600 mg OTC

calcium 600 oral tablet 1500 (600 ca) mg, 600 mg

OTC

calcium carbonate oral tablet 1250 (500 ca) mg, 1500 (600 ca) mg, 600 mg

OTC

calcium citrate oral tablet 250 mg, 950 (200 ca) mg

OTC

calcium high potency oral tablet 1500 (600 ca) mg

OTC


95


calcium oyster shell oral tablet 1250 (500 ca) mg

OTC

calcium oyster shell oral tablet 500 mg Oystercal OTC

cvs calcium carbonate oral tablet 1250 (500 ca) mg

OTC

cvs calcium oral tablet 600 mg OTC

gnp calcium oral tablet 1500 (600 ca) mg OTC

hm calcium oral tablet 1500 (600 ca) mg OTC

oyster shell calcium oral tablet 500 mg Oystercal OTC

OYSTERCAL ORAL TABLET 500 MG OTC

pure calcium carbonate oral tablet 1500 (600 ca) mg

OTC

qc calcium fast dissolution oral tablet 1500 (600 ca) mg

OTC

ra calcium 600 oral tablet 1500 (600 ca) mg OTC

ra calcium high potency oral tablet 600 mg OTC

sb oyster shell calcium oral tablet 500 mg Oystercal OTC

super calcium oral tablet 1500 (600 ca) mg OTC

*FLUORIDE***

NAFRINSE ORAL TABLET CHEWABLE2.2 (1 F) MG

sodium fluoride oral solution 1.1 (0.5 f) mg/ml

sodium fluoride oral tablet chewable 0.55 (0.25 f) mg, 1.1 (0.5 f) mg

sodium fluoride oral tablet chewable 2.2 (1 f) mg

NaFrinse

*PHOSPHATE***

PHOSPHA 250 NEUTRAL ORAL TABLET155-852-130 MG

phosphorous oral tablet 155-852-130 mg Phospha 250 Neutral

PHOSPHO-TRIN 250 NEUTRAL ORAL TABLET 155-852-130 MG

virt-phos 250 neutral oral tablet 155-852-130 mg

Phospha 250 Neutral

*POTASSIUM***

KLOR-CON 10 ORAL TABLET EXTENDED RELEASE 10 MEQ


96


KLOR-CON M10 ORAL TABLET EXTENDED RELEASE 10 MEQ



KLOR-CON ORAL PACKET 20 MEQ

KLOR-CON ORAL TABLET EXTENDED RELEASE 8 MEQ

potassium chloride crys er oral tablet extended release 10 meq

Klor-Con M10


Klor-Con M15


Klor-Con M20

potassium chloride er oral capsule extended release 10 meq, 8 meq

potassium chloride er oral tablet extended release 10 meq

Klor-Con 10


K-Tab


Klor-Con

potassium chloride oral packet 20 meq Klor-Con

potassium chloride oral solution 10 %, 20 meq/15ml (10%), 40 meq/15ml (20%)

*MISCELLANEOUS THERAPEUTIC CLASSES*

*CHELATING AGENTS***

penicillamine oral tablet 250 mg Depen Titratabs PA; SP; QL

trientine hcl oral capsule 250 mg Syprine PA; QL

*CYCLOSPORINE ANALOGS***

cyclosporine modified oral capsule 100 mg, 25 mg

Gengraf SP

GENGRAF ORAL CAPSULE 100 MG, 25 MG

SP

*IMMUNOMODULATORS FOR MYELODYSPLASTIC SYNDROMES***

REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG

SP; QL


97


*INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS***

mycophenolate mofetil oral capsule 250 mg CellCept SP

mycophenolate mofetil oral tablet 500 mg CellCept SP

*MACROLIDE IMMUNOSUPPRESSANTS***

RAPAMUNE ORAL SOLUTION 1 MG/ML SP

RAPAMUNE ORAL TABLET 0.5 MG, 1 MG, 2 MG

SP

tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg Prograf SP

ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG, 1 MG

SP

*POTASSIUM REMOVING AGENTS***

SPS ORAL SUSPENSION 15 GM/60ML

*PURINE ANALOGS***

azathioprine oral tablet 50 mg Imuran

*MOUTH/THROAT/DENTAL AGENTS*

*ANESTHETICS TOPICAL ORAL***

lidocaine hcl mouth/throat solution 4 % QL

lidocaine viscous hcl mouth/throat solution 2 %

QL

*ANTI-INFECTIVES - THROAT***

clotrimazole mouth/throat troche 10 mg

nystatin mouth/throat suspension 100000 unit/ml

*ANTISEPTICS - MOUTH/THROAT***

chlorhexidine gluconate mouth/throat solution 0.12 %

Paroex QL

PAROEX MOUTH/THROAT SOLUTION0.12 %

QL

PERIOGARD MOUTH/THROAT SOLUTION 0.12 %

QL

*FLUORIDE DENTAL PRODUCTS***

CAVAREST DENTAL GEL 1.1 %

DENTA 5000 PLUS DENTAL CREAM 1.1 %

DENTAGEL DENTAL GEL 1.1 %

sf 5000 plus dental cream 1.1 % Denta 5000 Plus


98


sf dental gel 1.1 % Cavarest

sodium fluoride 5000 plus dental cream 1.1 %

Denta 5000 Plus

sodium fluoride 5000 ppm dental cream 1.1 %

Denta 5000 Plus

sodium fluoride dental cream 1.1 % Denta 5000 Plus

sodium fluoride dental gel 1.1 % Cavarest

sodium fluoride mouth/throat solution 0.2 % PreviDent

*SALIVA STIMULANTS***

pilocarpine hcl oral tablet 5 mg, 7.5 mg Salagen QL

*STEROIDS - MOUTH/THROAT/DENTAL***

ORALONE MOUTH/THROAT PASTE 0.1 %

triamcinolone acetonide mouth/throat paste 0.1 %

Oralone

*MULTIVITAMINS*

*PED MULTI VITAMINS W/FL & FE***

multi-vit/iron/fluoride oral solution 0.25-10 mg/ml

OTC

multi-vitamin/fluoride/iron oral solution 0.25-10 mg/ml

*PED MV W/ FLUORIDE***

multivitamin/fluoride oral solution 0.25 mg/ml Floriva Plus

multi-vitamin/fluoride oral solution 0.25 mg/ml

Floriva Plus

multivitamin/fluoride oral solution 0.5 mg/ml Quflora Pediatric

multi-vitamin/fluoride oral solution 0.5 mg/ml Quflora Pediatric

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg

Quflora Pediatric

polyvitamin/fluoride oral solution 0.25 mg/ml Floriva Plus

*PED VITAMINS ACD W/ FLUORIDE***

adc/f (0.5mg/ml) oral solution 0.5 mg/ml

tri-vitamin/fluoride oral solution 0.25 mg/ml

tri-vite/fluoride oral solution 0.25 mg/ml, 0.5 mg/ml

vitamins acd-fluoride oral solution 0.25 mg/ml


99


*PRENATAL MV & MIN W/FE-FA***

completenate oral tablet chewable 29-1 mg *

CONCEPT DHA ORAL CAPSULE 53.5-38-1 MG

*

CONCEPT OB ORAL CAPSULE 130-92.4-1 MG

*

m-natal plus oral tablet 27-1 mg NeoNatal Plus *

prenatal 19 oral tablet chewable 29-1 mg

prenatal oral tablet 27-1 mg NeoNatal Plus

prenatal vitamin plus low iron oral tablet 27-1 mg

NeoNatal Plus *

preplus oral tablet 27-1 mg NeoNatal Plus *

westab plus oral tablet 27-1 mg NeoNatal Plus *

*PRENATAL MV & MIN W/FE-FA-DHA***

TARON-PREX ORAL CAPSULE 30-1.2-265 MG

*MUSCULOSKELETAL THERAPY AGENTS*

*CENTRAL MUSCLE RELAXANTS***

baclofen oral tablet 10 mg, 20 mg, 5 mg

chlorzoxazone oral tablet 250 mg, 500 mg

chlorzoxazone oral tablet 375 mg, 750 mg Lorzone

cyclobenzaprine hcl oral tablet 10 mg, 5 mg QL

cyclobenzaprine hcl oral tablet 7.5 mg Fexmid

methocarbamol oral tablet 500 mg, 750 mg

tizanidine hcl oral tablet 2 mg

tizanidine hcl oral tablet 4 mg Zanaflex

*NASAL AGENTS - SYSTEMIC AND TOPICAL*

*NASAL AGENTS - MISC.***

NOZIN NASAL SANITIZER POPSWAB NASAL SWAB

OTC

*NASAL ANTICHOLINERGICS***

ipratropium bromide nasal solution 0.03 %, 0.06 %


100


*NASAL ANTIHISTAMINES***

azelastine hcl nasal solution 0.1 %, 137 mcg/spray

*NEUROMUSCULAR AGENTS*

*BENZATHIAZOLES***

riluzole oral tablet 50 mg Rilutek PA; QL

*OPHTHALMIC AGENTS*

*BETA-BLOCKERS - OPHTHALMIC COMBINATIONS***

COMBIGAN OPHTHALMIC SOLUTION0.2-0.5 %

dorzolamide hcl-timolol mal ophthalmic solution 22.3-6.8 mg/ml

Cosopt

*BETA-BLOCKERS - OPHTHALMIC***

levobunolol hcl ophthalmic solution 0.5 %

timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 %

Timoptic-XE

timolol maleate ophthalmic solution 0.25 %, 0.5 %

Timoptic

*CYCLOPLEGIC MYDRIATICS***

ALTAFRIN OPHTHALMIC SOLUTION 10 %, 2.5 %

atropine sulfate ophthalmic solution 1 % Isopto Atropine QL

ISOPTO ATROPINE OPHTHALMIC SOLUTION 1 %

QL

phenylephrine hcl ophthalmic solution 10 %, 2.5 %

Altafrin

*LYMPHOCYTE FUNCTION-ASSOCIATED ANTIGEN-1 (LFA-1) ANTAG***

XIIDRA OPHTHALMIC SOLUTION 5 %

*MIOTICS - DIRECT ACTING***

ISOPTO CARPINE OPHTHALMIC SOLUTION 1 %, 2 %, 4 %

pilocarpine hcl ophthalmic solution 1 %, 2 %, 4 %

Isopto Carpine

*OPHTHALMIC ANTIALLERGIC***

cromolyn sodium ophthalmic solution 4 %


101


*OPHTHALMIC ANTIBIOTICS***

ciprofloxacin hcl ophthalmic solution 0.3 % Ciloxan

erythromycin ophthalmic ointment 5 mg/gm

GENTAK OPHTHALMIC OINTMENT 0.3 %

gentamicin sulfate ophthalmic solution 0.3 %

ofloxacin ophthalmic solution 0.3 % Ocuflox

tobramycin ophthalmic solution 0.3 % Tobrex

*OPHTHALMIC ANTI-INFECTIVE COMBINATIONS***

ak-poly-bac ophthalmic ointment 500-10000 unit/gm

Polycin

bacitracin-polymyxin b ophthalmic ointment 500-10000 unit/gm

Polycin

POLYCIN OPHTHALMIC OINTMENT 500-10000 UNIT/GM

polymyxin b-trimethoprim ophthalmic solution 10000-0.1 unit/ml-%

Polytrim

*OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS***

dorzolamide hcl ophthalmic solution 2 % Trusopt

*OPHTHALMIC IMMUNOMODULATORS***

RESTASIS MULTIDOSE OPHTHALMIC EMULSION 0.05 %

RESTASIS OPHTHALMIC EMULSION 0.05 %

*OPHTHALMIC KINASE INHIBITORS - COMBINATIONS***

ROCKLATAN OPHTHALMIC SOLUTION0.02-0.005 %

*OPHTHALMIC NONSTEROIDAL ANTI-INFLAMMATORY AGENTS***

diclofenac sodium ophthalmic solution 0.1 %

ketorolac tromethamine ophthalmic solution 0.5 %

Acular

*OPHTHALMIC RHO KINASE INHIBITORS***

RHOPRESSA OPHTHALMIC SOLUTION0.02 %

PA


102


*OPHTHALMIC SELECTIVE ALPHA ADRENERGIC AGONISTS***

brimonidine tartrate ophthalmic solution 0.2 %

*OPHTHALMIC STEROID COMBINATIONS***

neomycin-polymyxin-dexameth ophthalmic ointment 3.5-10000-0.1

Maxitrol

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

Maxitrol

sulfacetamide-prednisolone ophthalmic solution 10-0.23 %

TOBRADEX OPHTHALMIC OINTMENT0.3-0.1 %

TOBRADEX OPHTHALMIC SUSPENSION0.3-0.1 %

*OPHTHALMIC STEROIDS***

ALREX OPHTHALMIC SUSPENSION 0.2 %

fluorometholone ophthalmic suspension 0.1 %

FML Liquifilm

LOTEMAX OPHTHALMIC SUSPENSION0.5 %

MAXIDEX OPHTHALMIC SUSPENSION0.1 %

PRED MILD OPHTHALMIC SUSPENSION0.12 %

*PROSTAGLANDINS - OPHTHALMIC***

latanoprost ophthalmic solution 0.005 % Xalatan

TRAVATAN Z OPHTHALMIC SOLUTION0.004 %

*OTIC AGENTS*

*OTIC AGENTS - MISCELLANEOUS***

acetic acid otic solution 2 %

*OTIC ANTI-INFECTIVES***

ofloxacin otic solution 0.3 %


103


*OTIC STEROID-ANTI-INFECTIVE COMBINATIONS***

antibiotic ear otic solution 3.5-10000-1

CIPRODEX OTIC SUSPENSION 0.3-0.1 %

neomycin-polymyxin-hc otic solution 1 %, 3.5-10000-1

neomycin-polymyxin-hc otic suspension 3.5-10000-1

*OXYTOCICS*

*OXYTOCICS***

METHERGINE ORAL TABLET 0.2 MG

methylergonovine maleate oral tablet 0.2 mg Methergine

*PASSIVE IMMUNIZING AND TREATMENT AGENTS*

*ANTIVIRAL MONOCLONAL ANTIBODIES***

SYNAGIS INTRAMUSCULAR SOLUTION100 MG/ML, 50 MG/0.5ML

PA; SP

*IMMUNE SERUMS***

GAMUNEX-C INJECTION SOLUTION 1 GM/10ML, 10 GM/100ML, 2.5 GM/25ML, 20 GM/200ML, 40 GM/400ML, 5 GM/50ML

PA; SP

OCTAGAM INTRAVENOUS SOLUTION 1 GM/20ML, 10 GM/200ML, 2 GM/20ML, 2.5 GM/50ML, 25 GM/500ML, 5 GM/100ML

PA; SP

*PENICILLINS*

*AMINOPENICILLINS***

amoxicillin oral capsule 250 mg, 500 mg *

amoxicillin oral suspension reconstituted 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml

*

amoxicillin oral tablet 500 mg, 875 mg *

amoxicillin oral tablet chewable 125 mg, 250 mg

*

ampicillin oral capsule 500 mg *

*NATURAL PENICILLINS***

penicillin v potassium oral solution reconstituted 125 mg/5ml, 250 mg/5ml

*


104


penicillin v potassium oral tablet 250 mg, 500 mg

*

*PENICILLIN COMBINATIONS***

amoxicillin-pot clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 250-62.5 mg/5ml, 400-57 mg/5ml

*

amoxicillin-pot clavulanate oral suspension reconstituted 600-42.9 mg/5ml

Augmentin ES-600 *

amoxicillin-pot clavulanate oral tablet 250-125 mg, 875-125 mg

*

amoxicillin-pot clavulanate oral tablet 500-125 mg

Augmentin *

*PENICILLINASE-RESISTANT PENICILLINS***

dicloxacillin sodium oral capsule 250 mg, 500 mg

*

*PROGESTINS*

*PROGESTINS***

MAKENA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 275 MG/1.1ML

PA

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.*

*BENZODIAZEPINES & TRICYCLIC AGENTS***

chlordiazepoxide-amitriptyline oral tablet 10-25 mg, 5-12.5 mg

PA; AL

*CHOLINOMIMETICS - ACHE INHIBITORS***

donepezil hcl oral tablet 10 mg, 5 mg Aricept

donepezil hcl oral tablet dispersible 10 mg, 5 mg

EXELON TRANSDERMAL PATCH 24 HOUR 13.3 MG/24HR, 4.6 MG/24HR, 9.5 MG/24HR

*MOVEMENT DISORDER DRUG THERAPY***

AUSTEDO ORAL TABLET 12 MG, 6 MG, 9 MG

tetrabenazine oral tablet 12.5 mg, 25 mg Xenazine SP


105


*MULTIPLE SCLEROSIS AGENTS - INTERFERONS***

AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT 30 MCG/0.5ML

QL

AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT 30 MCG/0.5ML

QL

BETASERON SUBCUTANEOUS KIT 0.3 MG

PA; QL

*MULTIPLE SCLEROSIS AGENTS - MONOCLONAL ANTIBODIES***

KESIMPTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR 20 MG/0.4ML

PA

*MULTIPLE SCLEROSIS AGENTS - NRF2 PATHWAY ACTIVATORS***

TECFIDERA ORAL 120 & 240 MG SP

TECFIDERA ORAL CAPSULE DELAYED RELEASE 120 MG, 240 MG

SP

*MULTIPLE SCLEROSIS AGENTS***

COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML

QL

*N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONISTS***

memantine hcl oral tablet 10 mg, 5 mg

memantine hcl oral tablet 28 x 5 mg & 21 x 10 mg

Namenda Titration Pak

*PHENOTHIAZINES & TRICYCLIC AGENTS***

perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-10 mg, 4-25 mg, 4-50 mg

PA; AL

*PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.***

pimozide oral tablet 1 mg, 2 mg PA; QL

*SMOKING DETERRENTS***

bupropion hcl er (smoking det) oral tablet extended release 12 hour 150 mg

PA; *

cvs nicotine mouth/throat gum 2 mg KLS Quit2 PA; *; OTC

cvs nicotine mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

cvs nicotine mouth/throat lozenge 2 mg KLS Quit2 PA; *; OTC


106


cvs nicotine polacrilex mouth/throat gum 2 mg

KLS Quit2 PA; *; OTC

cvs nicotine polacrilex mouth/throat gum 4 mg


cvs nicotine polacrilex mouth/throat lozenge 2 mg


cvs nicotine polacrilex mouth/throat lozenge 4 mg


cvs nicotine transdermal patch 24 hour 14 mg/24hr, 7 mg/24hr

Nicoderm CQ PA; *; OTC

cvs nicotine transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC

eq nicotine mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

eq nicotine mouth/throat lozenge 4 mg KLS Quit4 PA; *; OTC

eq nicotine polacrilex mouth/throat gum 2 mg


eq nicotine polacrilex mouth/throat gum 4 mg


eq nicotine polacrilex mouth/throat lozenge 2 mg


eq nicotine polacrilex mouth/throat lozenge 4 mg


eq nicotine step 3 transdermal patch 24 hour 7 mg/24hr


eq nicotine transdermal patch 24 hour 14 mg/24hr


eq nicotine transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC

eql nicotine polacrilex mouth/throat lozenge 2 mg


eql nicotine polacrilex mouth/throat lozenge 4 mg


gnp nicotine mini mouth/throat lozenge 2 mg KLS Quit2 PA; *; OTC

gnp nicotine mini mouth/throat lozenge 4 mg KLS Quit4 PA; *; OTC

gnp nicotine mouth/throat gum 2 mg KLS Quit2 PA; *; OTC

gnp nicotine mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

gnp nicotine polacrilex mouth/throat gum 2 mg


gnp nicotine polacrilex mouth/throat gum 4 mg



107


gnp nicotine polacrilex mouth/throat lozenge 2 mg


gnp nicotine polacrilex mouth/throat lozenge 4 mg


gnp nicotine transdermal patch 24 hour 14 mg/24hr, 7 mg/24hr


gnp nicotine transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC

goodsense nicotine mouth/throat gum 2 mg KLS Quit2 PA; *; OTC

goodsense nicotine mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

goodsense nicotine mouth/throat lozenge 2 mg


goodsense nicotine mouth/throat lozenge 4 mg


HABITROL TRANSDERMAL PATCH 24 HOUR 21 MG/24HR

PA; *; OTC

hm nicotine polacrilex mouth/throat gum 2 mg


hm nicotine polacrilex mouth/throat gum 4 mg


hm nicotine polacrilex mouth/throat lozenge 2 mg


hm nicotine polacrilex mouth/throat lozenge 4 mg


hm nicotine transdermal patch 24 hour 14 mg/24hr, 7 mg/24hr


hm nicotine transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC

KLS QUIT2 MOUTH/THROAT GUM 2 MG PA; *; OTC

KLS QUIT2 MOUTH/THROAT LOZENGE 2 MG

PA; *; OTC

KLS QUIT4 MOUTH/THROAT GUM 4 MG PA; *; OTC

KLS QUIT4 MOUTH/THROAT LOZENGE 4 MG

PA; *; OTC

NICODERM CQ TRANSDERMAL PATCH 24 HOUR 14 MG/24HR, 21 MG/24HR, 7 MG/24HR

PA; OTC

NICORELIEF MOUTH/THROAT GUM 2 MG OTC; QL

NICORETTE MINI MOUTH/THROAT LOZENGE 2 MG, 4 MG

PA; OTC


108


NICORETTE MOUTH/THROAT GUM 2 MG, 4 MG

PA; OTC

NICORETTE MOUTH/THROAT LOZENGE2 MG, 4 MG

PA; OTC

NICORETTE STARTER KIT MOUTH/THROAT GUM 2 MG, 4 MG

PA; OTC

nicotine mini mouth/throat lozenge 2 mg KLS Quit2 PA; *; OTC

nicotine mini mouth/throat lozenge 4 mg KLS Quit4 PA; *; OTC

nicotine polacrilex mini mouth/throat lozenge 2 mg


nicotine polacrilex mouth/throat gum 2 mg KLS Quit2 PA; *; OTC

nicotine polacrilex mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

nicotine polacrilex mouth/throat lozenge 2 mg


nicotine polacrilex mouth/throat lozenge 4 mg


nicotine step 1 transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC





nicotine transdermal kit 21-14-7 mg/24hr PA; *; OTC

nicotine transdermal patch 24 hour 14 mg/24hr, 7 mg/24hr


nicotine transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC

NICOTROL INHALATION INHALER 10 MG PA; *

NICOTROL NS NASAL SOLUTION 10 MG/ML

PA; *

px stop smoking aid mouth/throat gum 2 mg KLS Quit2 PA; *; OTC

px stop smoking aid mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

px stop smoking aid mouth/throat lozenge 2 mg


px stop smoking aid mouth/throat lozenge 4 mg


qc nicotine transdermal system transdermal patch 24 hour 14 mg/24hr


qc nicotine transdermal system transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC


109


ra mini nicotine mouth/throat lozenge 2 mg KLS Quit2 PA; *; OTC

ra mini nicotine mouth/throat lozenge 4 mg KLS Quit4 PA; *; OTC

ra nicotine gum mouth/throat gum 2 mg KLS Quit2 PA; *; OTC

ra nicotine gum mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

ra nicotine mouth/throat gum 2 mg KLS Quit2 PA; *; OTC

ra nicotine mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

ra nicotine polacrilex mouth/throat lozenge 2 mg


ra nicotine polacrilex mouth/throat lozenge 4 mg


ra nicotine transdermal patch 24 hour 14 mg/24hr


ra nicotine transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC

sm nicotine mouth/throat gum 4 mg KLS Quit4 PA; *; OTC

sm nicotine mouth/throat lozenge 2 mg KLS Quit2 PA; *; OTC

sm nicotine polacrilex mouth/throat gum 2 mg


sm nicotine polacrilex mouth/throat gum 4 mg


sm nicotine polacrilex mouth/throat lozenge 2 mg


sm nicotine polacrilex mouth/throat lozenge 4 mg


sm nicotine transdermal patch 24 hour 14 mg/24hr, 7 mg/24hr


sm nicotine transdermal patch 24 hour 21 mg/24hr

Habitrol PA; *; OTC

THRIVE MOUTH/THROAT GUM 2 MG PA; *; OTC

varenicline tartrate oral tablet 0.5 mg, 1 mg PA; *

*RESPIRATORY AGENTS - MISC.*

*PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS***

OFEV ORAL CAPSULE 100 MG, 150 MG SP; QL

*SULFONAMIDES*

*SULFONAMIDES***

sulfadiazine oral tablet 500 mg


110


*TETRACYCLINES*

*TETRACYCLINES***

doxycycline hyclate oral capsule 100 mg Morgidox *

doxycycline hyclate oral capsule 50 mg *

doxycycline hyclate oral tablet 100 mg, 20 mg

*

doxycycline hyclate oral tablet 150 mg, 75 mg

Acticlate *

doxycycline hyclate oral tablet 50 mg TargaDOX

doxycycline monohydrate oral capsule 100 mg

Mondoxyne NL *

doxycycline monohydrate oral capsule 50 mg

*

doxycycline monohydrate oral suspension reconstituted 25 mg/5ml

Vibramycin *

doxycycline monohydrate oral tablet 100 mg, 150 mg, 50 mg, 75 mg

*

minocycline hcl oral capsule 100 mg Minocin *

minocycline hcl oral capsule 50 mg, 75 mg *

minocycline hcl oral tablet 100 mg, 50 mg, 75 mg

*

MONDOXYNE NL ORAL CAPSULE 100 MG

*

MORGIDOX ORAL CAPSULE 100 MG *

*THYROID AGENTS*

*ANTITHYROID AGENTS***

methimazole oral tablet 10 mg, 5 mg Tapazole *

propylthiouracil oral tablet 50 mg *

*THYROID HORMONES***

ARMOUR THYROID ORAL TABLET 120 MG, 15 MG, 180 MG, 240 MG, 30 MG, 300 MG, 60 MG, 90 MG

*

levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 50 mcg, 75 mcg, 88 mcg

Levoxyl *

levothyroxine sodium oral tablet 25 mcg Levoxyl

levothyroxine sodium oral tablet 300 mcg Unithroid


111


LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG

*

liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 mcg

Cytomel *

np thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

Armour Thyroid *

UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG

*

*TOXOIDS*

*TOXOID COMBINATIONS***

DAPTACEL INTRAMUSCULAR SUSPENSION 23-15-5

AL; *

INFANRIX INTRAMUSCULAR SUSPENSION 25-58-10

AL; *

TDVAX INTRAMUSCULAR SUSPENSION2-2 LF/0.5ML

AL; *

TENIVAC INTRAMUSCULAR INJECTABLE 5-2 LFU

AL; *

tetanus-diphtheria toxoids td intramuscular suspension 2-2 lf/0.5ml

TDVAX AL; *

*ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS*

*ANTISPASMODICS***

dicyclomine hcl oral capsule 10 mg *

dicyclomine hcl oral solution 10 mg/5ml *

dicyclomine hcl oral tablet 20 mg *

*H-2 ANTAGONISTS***

famotidine oral suspension reconstituted 40 mg/5ml

*

famotidine oral tablet 20 mgMM Acid-Pep Maximum Strength

*

famotidine oral tablet 40 mg Pepcid *

nizatidine oral solution 15 mg/ml *

*MISC. ANTI-ULCER***

sucralfate oral tablet 1 gm Carafate *


112


*PROTON PUMP INHIBITORS***

omeprazole oral capsule delayed release 10 mg

*


QL


*; QL

pantoprazole sodium oral tablet delayed release 20 mg, 40 mg

Protonix *; QL

PROTONIX ORAL PACKET 40 MG *

*QUATERNARY ANTICHOLINERGICS***

glycopyrrolate oral tablet 1 mg, 2 mg *

*ULCER ANTI-INFECTIVE W/ BISMUTH COMBINATIONS***

HELIDAC THERAPY ORAL *

PYLERA ORAL CAPSULE 140-125-125 MG

*

*ULCER DRUGS - PROSTAGLANDINS***

misoprostol oral tablet 100 mcg, 200 mcg Cytotec

*URINARY ANTISPASMODICS*

*URINARY ANTISPASMODIC - ANTIMUSCARINIC (ANTICHOLINERGIC)***

oxybutynin chloride er oral tablet extended release 24 hour 10 mg, 5 mg

Ditropan XL

oxybutynin chloride er oral tablet extended release 24 hour 15 mg

oxybutynin chloride oral syrup 5 mg/5ml

oxybutynin chloride oral tablet 5 mg

solifenacin succinate oral tablet 10 mg, 5 mg VESIcare

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG, 8 MG

*URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS***

bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg


113


*VACCINES*

*BACTERIAL VACCINES***

PNEUMOVAX 23 INJECTION INJECTABLE 25 MCG/0.5ML

AL; *

PREVNAR 13 INTRAMUSCULAR SUSPENSION

AL; *

*VIRAL VACCINE COMBINATIONS***

M-M-R II INJECTION SOLUTION RECONSTITUTED

AL; *

*VIRAL VACCINES***

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION

AL; *

AFLURIA QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.25 ML, 0.5 ML

AL; *

FLUARIX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

AL; *

FLUBLOK QUADRIVALENT INTRAMUSCULAR SOLUTION PREFILLED SYRINGE 0.5 ML

AL; *

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION

AL; *

FLUCELVAX QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

AL; *

FLULAVAL QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

AL; *

FLUMIST QUADRIVALENT NASAL SUSPENSION

AL; *

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION , 0.5 ML

AL; *

FLUZONE QUADRIVALENT INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 ML

AL; *

GARDASIL 9 INTRAMUSCULAR SUSPENSION

AL; *

GARDASIL 9 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

AL; *


114


HAVRIX INTRAMUSCULAR SUSPENSION1440 EL U/ML, 720 EL U/0.5ML

AL; *

janssen covid-19 vaccine intramuscular suspension 0.5 ml

*

moderna covid-19 vaccine intramuscular suspension 100 mcg/0.5ml

AL; *

pfizer covid-19 vac-tris 5-11y intramuscular suspension 10 mcg/0.2ml

AL

pfizer-biont covid-19 vac-tris intramuscular suspension 30 mcg/0.3ml

AL

pfizer-biontech covid-19 vacc intramuscular suspension 30 mcg/0.3ml

AL; *

SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED 50 MCG/0.5ML

AL; *

VAQTA INTRAMUSCULAR SUSPENSION25 UNIT/0.5ML, 50 UNIT/ML

AL; *

*VAGINAL AND RELATED PRODUCTS*

*VAGINAL ANTI-INFECTIVES***

CLEOCIN VAGINAL SUPPOSITORY 100 MG

clindamycin phosphate vaginal cream 2 % Cleocin

CLINDESSE VAGINAL CREAM 2 %

NUVESSA VAGINAL GEL 1.3 %

VANDAZOLE VAGINAL GEL 0.75 %

*VAGINAL ESTROGENS***

estradiol vaginal tablet 10 mcg Yuvafem

YUVAFEM VAGINAL TABLET 10 MCG

*VASOPRESSORS*

*ANAPHYLAXIS THERAPY AGENTS***

epinephrine injection solution auto-injector 0.15 mg/0.3ml

EpiPen Jr 2-Pak QL

epinephrine injection solution auto-injector 0.3 mg/0.3ml

Auvi-Q QL

*VASOPRESSORS***

midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg


115


*VITAMINS*

*VITAMIN D***

ergocalciferol oral capsule 1.25 mg (50000 ut)

Drisdol AL

vitamin d (ergocalciferol) oral capsule 1.25 mg (50000 ut)

Drisdol AL

*VITAMIN K***

phytonadione oral tablet 5 mg Mephyton


116


117

Documents

Medicaid-Approved Preferred Drug List