Preferred Drug List - Passportpassporthealthplan.com/wp-content/uploads/2014/12/RXFLEX...What is the Passport Health Plan formulary? The formulary is a list of preferred drugs covered

Preferred Drug List (List of Covered Drugs)

This document includes Passport Health Plan’s complete 2015 formulary.

What is the Passport Health Plan formulary?

The formulary is a list of preferred drugs covered by Passport. To get a drug on our formulary, you must:

• BeaPassportmember;

• Needadrugthatismedicallynecessary;

• GettheprescriptionfilledataPassportHealthPlannetworkpharmacy.AnetworkpharmacyisonethatissignedupwithPassport;and

• FollowallPassportrules(seelimitsbelow).

The formulary is not a complete list of covered drugs by Passport. Some drugs not listed may be covered, if medically necessary. These drugs may or may not need prior-authorization.

How do I find my drug on the formulary?

• Youcansearchforadrugusingtheonlinesearchableformularyonourwebsiteatwww.passporthealthplan.com.

Are there any limits to the drugs you have been prescribed?

Some covered drugs may have limits on them. This could include:

• Prior-Authorization:SomemedicinesmustbeapprovedbyPassportbeforePassportwillcoverorpayforthem.Thismeansyourproviderwillneedtogetapprovalbeforeyoucanhaveyourprescriptionsfilled.Ifyoudonotgetapproval,Passportmaynot cover the drug.

• Quantity Limits:Forsomedrugs,therearelimitsontheamountPassportwillcover.Thismeansyoumaynotgetthestandard one month supply.

• Step Therapy:SometimesPassportrequiresyoutotrycertaindrugsfirsttotreatyourmedicalconditionbeforewewillcoveranotherdrugforthatcondition.Forexample,ifDrugAandDrugBbothtreatyourmedicalcondition,PassportmaynotcoverdrugBunlessyoutryDrugAfirst.IfDrugAdoesnotworkforyou,PassportwillthencoverDrugB.

• Too Early to Refill:Ifyouaregivenamonthsupplyofamedicine,Passportwillnotcoverarefilloftheprescriptionuntil30 days has passed.

What if my drug is not on the formulary?

Remember,notalldrugsarelistedontheformulary.IfPassportdoesnotcoveryourdrug,youhave3options:

1. Workwithyourpharmacyorprovidertofindthepreferreddrug.

2. YoucancallMemberServicesat1-800-578-0603andaskforalistofsimilardrugsthatareonPassport’sPreferredDrugList.

3. IfadrugisnotcoveredbyPassportorisnotlistedonourPreferredDrugList,yourdoctorcanrequestapprovalforit.

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Can the formulary change?

Yes.Passportmayaddorremovedrugsfromtheformularyduringtheyear.Togetupdatedinformationaboutcovereddrugs,pleasevisitourwebsiteatwww.passporthealthplan.comorcallMemberServicesat1-800-578-0603.

What are generic drugs?

Passportcoversbothbrand-nameandgenericdrugs.Agenericdrughasthesameactiveingredientasthebrand-namedrug.Thismeanstheyworkthesameandhavethesameeffect.GenericdrugsusuallycostlessthanbrandnamedrugsandareapprovedbytheFoodandDrugAdministration(FDA).

How much are my copays?

Aslongasyoutakegenericmedicines,youwillpay$0.Ifyoutakeapreferredbrandnamemedicine,yourcopaywillbe$2.Ifyoutakeanon-preferrednamebrandmedicine,yourcopaywillbe$4.

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LEGEND

TYPE DESCRIPTION

QL Quantity LimitThere is a limit on the amount of this drug that is covered perprescription, or within a specific time frame.

PA Prior AuthorizationYour provider is required to get prior authorization before you fill yourprescription, which ensures appropriate use of the selected drug.Without prior approval, we may not cover this drug.

ST Step TherapyIn some cases, you may be required to first try certain drugs to treatyour medical condition before you move up a “step” to other drugoptions.

GL Gender Limit This prescription drug is restricted for a single gender. .

AL Age LimitThis prescription drug may only be covered if you meet the minimumor maximum age limit.

C Custom This drug has unique restrictions.

S Specialty DrugSpecialty drugs are high-cost drugs used to treat complex or rareconditions. Some examples of the diseases include; multiple sclerosis,rheumatoid arthritis, hepatitis C, and hemophilia.

MED Medical DrugThis medication is not on our drug list. Click on the THERAPEUTICCLASS or sub class to find covered alternative medications. If youhave questions, please contact member services.

PAGE 4 LAST UPDATED 02/2016

LIST OF COVERED PRESCRIPTION MEDICATIONS DRUG DESCRIPTION (RX) BRAND/GEN LIMITS & RESTRICTIONS

ANALGESICS

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

butalbital/aspirin/caffeine 50-325-40 capsule generic QL

CELEBREX 50 MG CAPSULEcelecoxib

BRAND PA

choline sal/mag salicylate 500 mg/5ml liquid generic

diclofenac potassium 50 mg tablet generic

DICLOFENAC SODIUM (50 MG TABLET DR, 100 MGTAB ER 24H, 25 MG TABLET DR, 75 MG TABLET DR)

generic

DICLOFENAC SODIUM/MISOPROSTOL (50 IR, 75 IR) genericQL

PA

diflunisal 500 mg tablet generic

ETODOLAC (200 MG CAPSULE, 400 MG TAB ER 24H,400 MG TABLET, 300 MG CAPSULE, 500 MG TABLET,500 MG TAB ER 24H, 600 MG TAB ER 24H)

generic

FENOPROFEN CALCIUM (400 MG CAPSULE, 600 MGTABLET)

generic

FLURBIPROFEN (50 MG, 100 MG) generic

IBUPROFEN (400 MG, 600 MG, 800 MG) generic

INDOMETHACIN (25 MG, 75 MG ER, 50 MG) generic

indomethacin sodium 1 mg vial generic

KETOPROFEN (75 MG CAPSULE, 50 MG CAPSULE, 200MG CAP24H PEL)

generic

KETOROLAC TROMETHAMINE (15 MG/ML VIAL,30MG/ML(1) VIAL, 30 MG/ML CARTRIDGE, 10 MGTABLET, 30 MG/ML VIAL, 15 MG/ML CARTRIDGE, 60MG/2 ML VIAL, 60 MG/2 ML SYRINGE)

generic

MECLOFENAMATE SODIUM (50 MG, 100 MG) generic

mefenamic acid 250 mg capsule generic

MELOXICAM (15 MG TABLET, 7.5 MG TABLET, 7.5MG/5ML ORAL SUSP)

generic

NABUMETONE (500 MG, 750 MG) generic

NAPROXEN (125 MG/5ML ORAL SUSP, 500 MG TABLETDR, 250 MG TABLET, 375 MG TABLET, 500 MG TABLET,375 MG TABLET DR)

generic


DRUG DESCRIPTION (RX) BRAND/GEN LIMITS & RESTRICTIONS

NAPROXEN SODIUM (550 MG, 275 MG) generic

oxaprozin 600 mg tablet generic

PIROXICAM (20 MG, 10 MG) generic

SALSALATE (750 MG, 500 MG) generic

SULINDAC (200 MG, 150 MG) generic

TOLMETIN SODIUM (600 MG TABLET, 400 MGCAPSULE, 200 MG TABLET)

generic

OPIOID ANALGESICS, LONG-ACTING

DISKETS 40 MG TABLET DISPRmethadone hcl

BRAND QL

FENTANYL (37.5MCG/HR, 87.5MCG/HR, 62.5MCG/HR) generic

QL

PA

C 12 patches/28 days

FENTANYL (50MCG/HR, 25MCG/HR, 75MCG/HR, 12MCG/HR)

generic

QL

PA


fentanyl 100 mcg/hr patch td72 genericPA


HYDROMORPHONE HCL (16 MG ER, 12 MG ER) generic QL

hydromorphone hcl 32 mg tab er 24h generic QL

hydromorphone hcl 8 mg tab er 24h generic QL

levorphanol tartrate 2 mg tablet generic

methadone hcl 10 mg tablet generic QL

methadone hcl 10 mg/5 ml solution genericQL

C 40ml/day

methadone hcl 10 mg/ml oral conc genericQL

C 80ml/day

methadone hcl 10 mg/ml syringe generic QL

methadone hcl 10 mg/ml vial generic

methadone hcl 40 mg tablet sol generic QL

methadone hcl 5 mg tablet generic QL



methadone hcl 5 mg/5 ml solution genericQL

C 80ml/day

METHADONE INTENSOL 10 MG/MLmethadone hcl

BRAND QL

METHADOSE 10 MG/ML ORAL CONCmethadone hcl

BRAND QL

METHADOSE 40 MG TABLET DISPRmethadone hcl

BRAND QL

MORPHINE SULFATE (100 MG CAP ER PEL, 80 MGCAP ER PEL, 75 MG CPMP 24HR)

generic QL

MORPHINE SULFATE (100 MG ER, 200 MG ER) genericQL

PA

MORPHINE SULFATE (30 MG CPMP 24HR, 30 MG CAPER PEL)

generic QL

MORPHINE SULFATE (60 MG CPMP 24HR, 60 MG CAPER PEL, 50 MG CAP ER PEL)

generic QL

MORPHINE SULFATE (90 MG CPMP 24HR, 45 MGCPMP 24HR, 120 MG CPMP 24HR, 60 MG TABLET ER)

genericQL

PA

morphine sulfate 10 mg cap er pel generic QL

morphine sulfate 15 mg tablet er genericQL

PA

morphine sulfate 20 mg cap er pel generic QL

morphine sulfate 30 mg tablet er genericQL

PA

oxycodone hcl 10 mg tab er 12h genericQL

PA


PA


PA


PA

OXYCONTIN (30 MG, 40 MG)oxycodone hcl

BRANDQL

PA



OXYCONTIN (60 MG, 80 MG)oxycodone hcl

BRANDQL

PA

OXYCONTIN 10 MG TABLEToxycodone hcl

BRANDQL

PA


BRANDQL

PA


BRANDQL

PA

OXYMORPHONE HCL (20 MG ER, 15 MG ER) genericQL

PA

OXYMORPHONE HCL (40 MG ER, 30 MG ER) genericQL

PA

oxymorphone hcl 10 mg tab er 12h genericQL

PA

oxymorphone hcl 5 mg tab er 12h genericQL

PA

oxymorphone hcl 7.5 mg tab er 12h genericQL

PA

TRAMADOL HCL (100 MG CPBP 25-75, 100 MG TAB ER24H)

generic QL

TRAMADOL HCL (200 MG TBMP 24HR, 150 MG CPBP25-75, 100 MG TBMP 24HR, 300 MG TBMP 24HR)

genericQL

PA

TRAMADOL HCL (300 MG TAB ER 24H, 300 MG CPBP17-83, 200 MG TAB ER 24H, 200 MG CPBP 25-75)

generic QL

OPIOID ANALGESICS, SHORT-ACTING

acetaminophen with codeine 120-12mg/5 solution genericQL

C 150 ml/day

acetaminophen with codeine 300mg-15mg tablet generic QL





acetaminophen with codeine 300mg/12.5 solution generic C 150 ml/day

alfentanil hcl 500 mcg/ml ampul generic

ASCOMP WITH CODEINE CAPSULEcodeine phosphate/butalbital/aspirin/caffeine

BRAND QL

ASTRAMORPH-PF 1 MG/ML AMPULmorphine sulfate/pf

BRAND

BUTALBITAL/ACETAMINOPHEN/CAFFEINE/CODEINEPHOSPHATE (50-325-30, 50-300-30)

generic QL

BUTORPHANOL TARTRATE (2 MG/ML, 1 MG/ML) generic

butorphanol tartrate 10 mg/ml spray genericQL

C 2 nasal sprayers or5ml/month

codeine sulfate 15 mg tablet generic QL



codeine/butalbital/asa/caffein 30-50-325 capsule generic QL

dhcodeine bt/acetaminophn/caff 16-320.5mg capsule generic

dihydrocodeine/aspirin/caffein 16-356-30 capsule generic QL

DURAMORPH (5 ML, 10 ML)morphine sulfate/pf

BRAND

ENDOCET (10-325 MG, 2.5-325 MG)oxycodone hcl/acetaminophen

BRAND QL

ENDOCET 5-325 TABLEToxycodone hcl/acetaminophen

BRAND QL

ENDOCET 7.5-325 MG TABLEToxycodone hcl/acetaminophen

BRAND QL

ENDODAN 4.8355-325 MG TABLEToxycodone hcl/aspirin

BRAND QL

FENTANYL CITRATE (800 MCG, 1600 MCG, 1200 MCG) generic QL

fentanyl citrate 200 mcg lozenge hd generic QL



FENTANYL CITRATE IN 0.9 % SODIUM CHLORIDE/PF(10 MCG/ML SYRINGE, 20 MCG/ML PLAST. BAG)

generic

FENTANYL CITRATE/BUPIVACAINE HCL IN 0.9 % generic



SODIUM CHLORIDE/PF (4MCG/ML-.1, 2MCG/ML-.1, 2-625MCG/1, 2-1250MCG)

FENTANYL CITRATE/PF (50 MCG/ML AMPUL,100MCG/2ML SYRINGE, 50 MCG/ML VIAL)

generic

HYDROCODONE BITARTRATE/ACETAMINOPHEN (2.5-167/5, 7.5-325/15, 5-217MG/10, 2.5-108/5)

genericQL

C 32ml/day

HYDROCODONE BITARTRATE/ACETAMINOPHEN (5MG-325MG, 10MG-325MG, 5MG-300MG, 10MG-300MG,7.5-325MG, 7.5-300MG)

generic QL

hydrocodone/acetaminophen 2.5-325mg tablet generic QL

HYDROCODONE/IBUPROFEN (10MG-200MG, 5MG-200MG)

generic

hydrocodone/ibuprofen 2.5-200mg tablet generic QL

hydrocodone/ibuprofen 7.5-200 mg tablet generic QL

HYDROMORPHONE HCL (1 MG/ML SYRINGE, 2 MG/MLSYRINGE, 4 MG/ML SYRINGE, 2 MG/ML VIAL)

generic

hydromorphone hcl 1 mg/ml liquid generic QL

hydromorphone hcl 2 mg tablet generic QL

hydromorphone hcl 3 mg supp.rect generic QL



HYDROMORPHONE HCL/PF (1 MG/ML AMPUL, 10MG/ML AMPUL, 2 MG/ML AMPUL, 10 MG/ML VIAL, 4MG/ML AMPUL)

generic

ibuprofen/oxycodone hcl 400mg-5mg tablet generic QL

LORCET 5-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

LORCET HD 10-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

LORCET PLUS 7.5-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

LORTAB (10-325 MG, 5-325 MG, 7.5-325 MG)hydrocodone bitartrate/acetaminophen

BRAND QL

meperidine hcl 10 mg/ml cartridge generic

meperidine hcl 50 mg/5 ml solution generic QL



C 20ml/day

MORPHINE SULFATE (10 ML, 20 ML) genericQL

C 45ml/day

MORPHINE SULFATE (2 MG/ML CARTRIDGE,250MG/10ML VIAL PORT, 8 MG/ML VIAL, 4 MG/ML VIAL,25 MG/ML VIAL, 10 MG SUPP.RECT, 30 MGSUPP.RECT, 10 MG/ML VIAL, 10 MG/ML SYRINGE, 100MG/4ML VIAL PORT, 20 MG SUPP.RECT, 50 MG/MLVIAL, 15 MG/ML CARTRIDGE, 5 MG/ML VIAL, 15 MG/MLVIAL, 8 MG/ML SYRINGE, 4 MG/ML SYRINGE, 4 MG/MLCARTRIDGE, 2 MG/ML SYRINGE, 10 MG/MLCARTRIDGE, 30 MG/30ML PCA SYRING, 5 MG/MLSYRINGE, 5 MG SUPP.RECT)

generic

morphine sulfate 100 mg/5ml solution genericQL

C 9ml/day

morphine sulfate 15 mg tablet generic QL

morphine sulfate 30 mg tablet generic QL

MORPHINE SULFATE/PF (0.5 MG/ML, 1 MG/ML, 30MG/30ML PCA, 150MG/30ML PCA)

generic

morphine sulfate/pf 1 mg/2 ml syringe generic GL Male

NALBUPHINE HCL (10 MG/ML VIAL, 20 MG/ML VIAL, 10MG/ML AMPUL, 20 MG/ML AMPUL)

generic

OPIUM/BELLADONNA ALKALOIDS (60-16.2MG, 30-16.2MG)

generic

OXYCODONE HCL (10 MG, 5 MG, 30 MG, 15 MG) generic QL

oxycodone hcl 20 mg tablet generic QL

oxycodone hcl 20 mg/ml oral conc genericQL

C 8ml/day

oxycodone hcl 5 mg capsule generic QL

oxycodone hcl 5 mg/5 ml solution genericQL

C 80ml/day

OXYCODONE HCL/ACETAMINOPHEN (2.5-325MG, 5MG-325MG)

generic QL

oxycodone hcl/acetaminophen 10mg-325mg tablet generic QL

oxycodone hcl/acetaminophen 7.5-325mg tablet generic QL



oxycodone hcl/aspirin 4.8355-325 tablet generic QL

oxymorphone hcl 10 mg tablet generic QL

oxymorphone hcl 5 mg tablet generic QL

pentazocine hcl/naloxone hcl 50mg-0.5mg tablet generic QL

REPREXAIN (10-200 MG, 2.5-200 MG, 5-200 MG)hydrocodone/ibuprofen

BRAND QL

ROXICET 5-325 TABLEToxycodone hcl/acetaminophen

BRAND QL

SUBLIMAZE 50 MCG/ML AMPULEfentanyl citrate/pf

BRAND

SUFENTA (50 MCG/ML AMPUL, 250 MCG/5 MLAMPULE, 100 MCG/2 ML AMPUL)sufentanil citrate

BRAND

sufentanil citrate 50 mcg/ml ampul generic

tramadol hcl 50 mg tablet generic QL

tramadol hcl/acetaminophen 37.5-325mg tablet generic QL

VERDROCET 2.5-325 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

VICODIN 5-300 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

VICODIN ES 7.5-300 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

VICODIN HP 10-300 MG TABLEThydrocodone bitartrate/acetaminophen

BRAND QL

ZAMICET 10-325 MG/15 ML SOLNhydrocodone bitartrate/acetaminophen

BRAND C 32ml/day

ANESTHETICS

LOCAL ANESTHETICS

BUFFERED LIDOCAINE 1% SYRINGElidocaine hcl buffered with 8.4 % sodium bicarbonate

BRAND

BUPIVACAINE HCL (2.5 MG/ML, 5 MG/ML) generic

bupivacaine hcl/dex-water/pf 0.75 % ampul generic

BUPIVACAINE HCL/EPINEPHRINE (0.25-.0005, 0.5-1:200K)

generic

BUPIVACAINE HCL/EPINEPHRINE/PF (0.5-1:200K, 0.25-.0005)

generic



BUPIVACAINE HCL/PF (2.5 MG/ML VIAL, 2.5 MG/MLAMPUL, 7.5 MG/ML VIAL, 5 MG/ML VIAL, 5 MG/MLAMPUL, 7.5 MG/ML AMPUL)

generic

CARBOCAINE 1.5% VIALmepivacaine hcl/pf

BRAND

CHLOROPROCAINE HCL/PF (30 MG/ML, 20 MG/ML) generic

cocaine hcl 4 % solution generic

ethyl chloride 100 % spray generic

etomidate 2 mg/ml vial generic

GLYDO 2% JELLY SYRINGElidocaine hcl

BRAND

KETAMINE HCL (10 MG/ML, 50 MG/ML, 100 MG/ML) generic

lidocaine 5 % adh. patch generic PA

lidocaine 5 % oint. (g) generic

LIDOCAINE HCL (3 % CREAM (G), 20 MG/ML DISPSYRIN, 40 MG/ML SOLUTION, 100MG/10ML DISPSYRIN, 10 MG/ML DISP SYRIN, 30 MG/3 ML SYRINGE, 2% SOLUTION, 2 % JEL/PF APP, 4 % SOLUTION, 3 %LOTION, 2 % JEL (ML))

generic

lidocaine hcl/d7.5w/pf 5 % ampul generic

LIDOCAINE HCL/DEXTROSE 5%-WATER/PF (8 MG/ML,4 MG/ML)

generic

LIDOCAINE HCL/EPINEPHRINE (2 %-1:100K, 1%-1:100K, 0.5-1:200K)

generic

LIDOCAINE HCL/EPINEPHRINE/PF (2%-1:200K VIAL,1.5-1:200K VIAL, 1.5-1:200K AMPUL)

generic

LIDOCAINE HCL/PF (50 MG/5 ML SYRINGE, 15 MG/MLAMPUL, 5 MG/ML VIAL, 10 MG/ML VIAL, 20 MG/MLAMPUL LUER, 100 MG/5ML SYRINGE, 10 MG/MLAMPUL, 40 MG/ML AMPUL, 20 MG/ML VIAL)

generic

LIDOCAINE/PRILOCAINE (2.5 CREAM (G), 2.5 KIT) generic

LORENZA 4%-1% PATCHlidocaine/menthol

BRAND

NAROPIN (2 MG/ML INFUSION, 200 MG/100 ML INF,0.2% 400 MG/200 ML)ropivacaine hcl/pf

BRAND

PAIN RELIEF 5%-1% PATCHlidocaine hcl/menthol

BRAND

POLOCAINE 1% VIALmepivacaine hcl

BRAND



POLOCAINE-MPF (1.5%, 2%, 1%)mepivacaine hcl/pf

BRAND

PRE-ATTACHED LTA KITlidocaine hcl

BRAND

propofol 10 mg/ml vial generic

RELADOR PAK 2.5-2.5% CRM-DRESSlidocaine/prilocaine

BRAND

RELADOR PAK PLUS 2.5%-2.5%lidocaine/prilocaine

BRAND

SENSORCAINE 0.5% VIALbupivacaine hcl

BRAND

SENSORCAINE-EPINEPHRINE (0.25%-EPI 1:200000,0.5%-EPI 1:200,000)bupivacaine hcl/epinephrine

BRAND

SENSORCAINE-MPF 0.5% VIALbupivacaine hcl/pf

BRAND

tetracaine hcl/pf 10 mg/ml ampul generic

ANTI-ADDICTION/SUBSTANCE ABUSE TREATMENT AGENTS

ALCOHOL DETERRENTS/ANTI-CRAVING

acamprosate calcium 333 mg tablet dr generic

DEPADE 50 MG TABLETnaltrexone hcl

BRAND

DISULFIRAM (500 MG, 250 MG) generic

naltrexone hcl 50 mg tablet generic

OPIOID DEPENDENCE TREATMENTS

BUPRENORPHINE HCL (2 MG, 8 MG) genericQL

PA

buprenorphine hcl 0.3 mg/ml syringe generic PA

buprenorphine hcl 0.3 mg/ml vial generic

BUPRENORPHINE HCL/NALOXONE HCL (/NALOXONE8 MG-2 MG, /NALOXONE 2 MG-0.5MG)

genericQL

PA

SUBOXONE (12 MG-3 MG, 2 MG-0.5 MG, 4 MG-1 MG, 8MG-2 MG)buprenorphine hcl/naloxone hcl

BRANDQL

PA

OPIOID REVERSAL AGENTS



NALOXONE HCL (1 MG/ML, 0.4 MG/ML) generic QL

SMOKING CESSATION AGENTS

BUPROBAN 150 MG TABLETbupropion hcl

BRAND

bupropion hcl 150 mg tablet er generic

CHANTIX (0.5 MG, 1 MG)varenicline tartrate

BRAND QL

CHANTIX (1 MG CONT, STARTING)varenicline tartrate

BRAND

ANTIBACTERIALS

AMINOGLYCOSIDES

AMIKACIN SULFATE (1000MG/4ML, 500 MG/2ML) generic

GARAMYCIN (0.3%, 3 MG/ML)gentamicin sulfate

BRAND

GENTAK 0.3 % EYE OINTMENTgentamicin sulfate

BRAND

GENTAMICIN SULFATE (0.3 % OINT. (G), 20 MG/2 MLVIAL, 0.1 % OINT. (G), 0.3 % DROPS, 0.1 % CREAM (G),40 MG/ML VIAL)

generic

GENTAMICIN SULFATE IN SODIUM CHLORIDE, ISO-OSMOTIC (GENTAMIC90MG/100ML,GENTAMIC100MG/0.1L, GENTAMIC80 MG/50ML,GENTAMIC80MG/100ML, GENTAMIC60 MG/50ML,GENTAMIC70 MG/50ML)

generic

GENTAMICIN SULFATE/PF (20 MG/2 ML, 100MG/10MLPORT)

generic

neomycin sulfate 500 mg tablet generic

paromomycin sulfate 250 mg capsule generic

tobramycin 0.3 % drops generic

TOBRAMYCIN SULFATE (10 MG/ML, 40 MG/ML, 1.2 G) generic S Specialty Drug

TOBRAMYCIN SULFATE/SODIUM CHLORIDE (60MG/50ML, 80MG/100ML)

generic S Specialty Drug

ANTIBACTERIALS, OTHER

acetic acid 0.25 % irrig soln generic

BACIIM 50,000 UNITS VIALbacitracin

BRAND

bacitracin 50000 unit vial generic



BACTROBAN NASAL 2% OINTMENTmupirocin calcium

BRAND

chloramphenicol sod succ 1 g vial generic

CLINDACIN ETZ 1% PLEDGETclindamycin phosphate

BRAND

CLINDACIN P 1% PLEDGETSclindamycin phosphate

BRAND

CLINDAMYCIN HCL (150 MG, 75 MG, 300 MG) generic

clindamycin palmitate hcl 75 mg/5 ml soln recon generic

CLINDAMYCIN PHOSPHATE (1 % FOAM, 1 % LOTION,300 MG/2ML VIAL PORT, 2 % CREAM/APPL,900MG/6ML VIAL PORT, 600 MG/4ML VIAL PORT, 150MG/ML VIAL, 1 % MED. SWAB, 1 % GEL (GRAM), 1 %SOLUTION)

generic

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % INWATER (300MG/50ML, 900MG/50ML, 600MG/50ML)

generic

colistin (colistimethate na) 150 mg vial generic

erythromycin/benzoyl peroxide 3 %-5 % gel (gram) generic

HYOPHEN TABLETmethenamine/methylene blue/benzoicacid/salicylate/hyoscy

BRAND

lincomycin hcl 300 mg/ml vial generic

LINEZOLID (600MG/300 IV SOLN, 600 MG TABLET, 100MG/5ML SUSP RECON)

generic

linezolid-0.9% sodium chloride 600mg/300 iv soln generic PA

mafenide acetate 50 g packet generic

methen/sod phos/meth blue/hyos 81.6-.12mg tablet generic

methenamine hippurate 1 g tablet generic

METHENAMINE MANDELATE (500 MG, 1 G) generic

METRO IV 500 MG/100 MLmetronidazole in sodium chloride

BRAND

METRONIDAZOLE (250 MG TABLET, 0.75 % GELW/APPL, 500 MG TABLET, 375 MG CAPSULE)

generic

metronidazole/sodium chloride 500mg/0.1l piggyback generic

mupirocin 2 % oint. (g) generic

mupirocin calcium 2 % cream (g) generic

NEOMYCIN SULFATE/POLYMYXIN B SULFATE(AMPUL, VIAL)

generic



NITROFURANTOIN (25 MG/5 ML ORAL SUSP, 50 MGCAPSULE)

generic

NITROFURANTOIN MACROCRYSTAL (50 MG, 25 MG,100 MG)

generic

nitrofurantoin monohyd/m-cryst 100 mg capsule generic

PHOSPHASAL TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

polymyxin b sulfate 500k unit vial generic

SULFAMYLON 8.5% CREAMmafenide acetate

BRAND

TINIDAZOLE (250 MG, 500 MG) generic

trimethoprim 100 mg tablet generic

TYGACIL 50 MG VIALtigecycline

BRAND

UR N-C TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

URETRON D-S TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

URIMAR-T TABLETmethenamine/methylene blue/salicylate/sodiumphos/hyoscy

BRAND

URIN D.S. TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

URO-BLUE TABLETSmethenamine/sodium phosphate,monobasic/methblue/hyosc sul

BRAND

UROGESIC-BLUE TABLETmethenamine/sodium phosphate,monobasic/methblue/hyosc sul

BRAND

UROLET MB TABLETmethenamine/sodium phosphate,monobasic/methblue/hyosc sul

BRAND

UROPHEN MB TABLETmethenamine/methylene blue/benzoicacid/salicylate/hyoscy

BRAND

URYL TABLETmethenamine/sodium phosphate,monobasic/methblue/hyosc sul

BRAND



USTELL CAPSULEmethenamine/methylene blue/salicylate/sodiumphos/hyoscy

BRAND

UTIRA-C TABLETmethenamine/methylene blue/sodium phos/pnyl sal/hyoscsul

BRAND

VANCOMYCIN HCL (10 G VIAL, 250 MG CAPSULE, 500MG VIAL, 750 MG VIAL PORT, 125 MG CAPSULE, 1 GVIAL, 750 MG VIAL, 5 G VIAL, 1 G VIAL PORT, 500 MGVIAL PORT)

generic

VANCOMYCIN HCL/DEXTROSE 5 % IN WATER(500MG/0.1L FROZ.PIGGY, 1G/200ML FROZ.PIGGY,1.25 G/250 PLAST. BAG, 1.5G/250ML PLAST. BAG)

generic

VANCOMYCIN IN 0.9 % SODIUM CHLORIDE(1.5G/250ML, 750MG/.15L, 1.25 G/250)

generic

vancomycin in dextrose,iso-osm 750mg/.15l froz.piggy generic

VANDAZOLE VAGINAL 0.75% GELmetronidazole

BRAND

XIFAXAN (550 MG, 200 MG)rifaximin

BRAND

ZYVOX 100 MG/5 ML SUSPENSIONlinezolid

BRAND PA

BETA-LACTAM, CEPHALOSPORINS

CEFACLOR (500 MG TAB ER 12H, 125 MG/5ML SUSPRECON, 500 MG CAPSULE, 250 MG/5ML SUSP RECON,250 MG CAPSULE, 375 MG/5ML SUSP RECON)

generic

CEFADROXIL (500 MG CAPSULE, 500 MG/5ML SUSPRECON, 250 MG/5ML SUSP RECON, 1 G TABLET)

generic

CEFAZOLIN SODIUM (300G BULKBAGINJ, 1 G VIAL, 20G VIAL, 10 G VIAL, 500 MG VIAL, 1 G VIAL PORT, 100 GBULKBAGINJ)

generic

CEFAZOLIN SODIUM IN 0.9 % SODIUM CHLORIDE (0.92 G/100 ML PLAST. BAG, 0.9 2 G/50 ML PIGGYBACK,0.9 2 G/10 ML SYRGE)

generic

cefazolin sodium/d5w 2 g/100 ml plast. bag generic

CEFAZOLIN SODIUM/DEXTROSE, ISO-OSMOTIC (2 MLPIGGYBACK, 1 ML FROZ.PIGGY, 1 ML PIGGYBACK)

generic

CEFDINIR (125 MG/5ML SUSP RECON, 300 MGCAPSULE, 250 MG/5ML SUSP RECON)

generic

CEFDITOREN PIVOXIL (200 MG, 400 MG) generic

CEFEPIME HCL (2, 1) generic



CEFEPIME HCL/DEXTROSE, ISO-OSMOTIC (1 G/50 ML,2 G/100 ML)

generic

CEFIXIME (200, 100) generic

CEFOTAXIME SODIUM (10 G, 2 G, 1 G, 500 MG) generic

CEFOTETAN DISODIUM (2, 10, 1) generic

CEFOXITIN SODIUM (2, 1, 10) generic

CEFOXITIN SODIUM/DEXTROSE, ISO-OSMOTIC (2 ML,1 ML)

generic

CEFPODOXIME PROXETIL (100 MG TABLET, 100MG/5ML SUSP RECON, 50 MG/5 ML SUSP RECON, 200MG TABLET)

generic

CEFPROZIL (250 MG TABLET, 250 MG/5ML SUSPRECON, 125 MG/5ML SUSP RECON, 500 MG TABLET)

generic

CEFTAZIDIME (1, 2, 6) generic

CEFTIBUTEN (400 MG CAPSULE, 180 MG/5ML SUSPRECON)

generic

CEFTRIAXONE SODIUM (1 G, 2 G PORT, 1 G PORT, 10G, 500 MG, 250 MG, 2 G)

generic

CEFTRIAXONE SODIUM/DEXTROSE, ISO-OSMOTIC (2ML FROZ.PIGGY, 2 ML PIGGYBACK, 1 ML PIGGYBACK,1 ML FROZ.PIGGY)

generic

CEFUROXIME AXETIL (250 MG, 500 MG) generic

CEFUROXIME SODIUM (7.5G, 750 MG, 7.5 G, 1.5 G) generic

CEFUROXIME SODIUM/DEXTROSE, ISO-OSMOTIC(750MG/50ML, 1.5G/50ML)

generic

CEPHALEXIN (250 MG TABLET, 250 MG CAPSULE, 750MG CAPSULE, 500 MG TABLET, 250 MG/5ML SUSPRECON, 125 MG/5ML SUSP RECON, 500 MG CAPSULE)

generic

CLAFORAN-DEXTROSE (2 ML, 1 ML)cefotaxime sodium/dextrose, iso-osmotic

BRAND

BETA-LACTAM, OTHER

AZTREONAM (2, 1) generic

IMIPENEM/CILASTATIN SODIUM (250 MG, 500 MG) generic

MEROPENEM (500 MG, 1 G) generic

MEROPENEM IN 0.9 % SODIUM CHLORIDE (1 G/50 ML,500MG/50ML)

generic

BETA-LACTAM, PENICILLINS



AMOXICILLIN (250 MG CAPSULE, 500 MG TABLET, 400MG/5ML SUSP RECON, 500 MG CAPSULE, 125 MG TABCHEW, 250 MG TAB CHEW, 125 MG/5ML SUSP RECON,875 MG TABLET, 250 MG/5ML SUSP RECON, 200MG/5ML SUSP RECON)

generic

AMOXICILLIN/POTASSIUM CLAVULANATE (600-42.9/5SUSP RECON, 400-57MG TAB CHEW, 200-28.5MG TABCHEW, 875-125 MG TABLET, 400-57MG/5 SUSPRECON, 250-62.5/5 SUSP RECON, 250-125 MGTABLET, 200-28.5/5 SUSP RECON, 1000-62.5 TAB ER12H, 500-125 MG TABLET)

generic

AMPICILLIN SODIUM (500 MG, 10 G, 1 G, 2 G PORT, 2G, 1 G PORT, 250 MG, 125 MG)

generic

AMPICILLIN SODIUM/SULBACTAM SODIUM (15, 1.5PORT, 3, 3 PORT, 1.5)

generic

AMPICILLIN TRIHYDRATE (250 MG CAPSULE, 500 MGCAPSULE, 250 MG/5ML SUSP RECON, 125 MG/5MLSUSP RECON)

generic

DICLOXACILLIN SODIUM (500 MG, 250 MG) generic

NAFCILLIN IN DEXTROSE, ISO-OSMOTIC (1 G/50 ML, 2G/100 ML)

generic

NAFCILLIN SODIUM (2 PORT, 2, 1 PORT, 1, 10) generic

OXACILLIN SODIUM (10, 2 PORT, 1, 2, 1 PORT) generic

OXACILLIN SODIUM/DEXTROSE, ISO-OSMOTIC (2 ML,1 ML)

generic

PENICILLIN G POTASSIUM (5MM, 20MM) generic

PENICILLIN G PROCAINE (1.2MM/2 ML SYRINE,600000/ML SYRINE)

generic

penicillin g sodium 5mm unit vial generic

PENICILLIN V POTASSIUM (500 MG TABLET, 250 MGTABLET, 250 MG/5ML SOLN RECON, 125 MG/5MLSOLN RECON)

generic

PFIZERPEN (20 UNIT, 5 UNITS)penicillin g potassium

BRAND

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM (40.5,4.5, 3.375, 4.5 PORT, 3.375 PORT, 2.25 PORT, 2.25)

generic

MACROLIDES

AZITHROMYCIN (200 MG/5ML SUSP RECON, 500 MGVIAL PORT, 100 MG/5ML SUSP RECON, 500 MG VIAL, 1G PACKET, 250 MG TABLET)

generic

AZITHROMYCIN (500 MG, 600 MG) generic QL



CLARITHROMYCIN (250, 125) generic C 150ml/fill

CLARITHROMYCIN (500 MG, 250 MG) generic QL

clarithromycin 500 mg tab er 24h generic QL

E.E.S. 200 MG/5 ML GRANULESerythromycin ethylsuccinate

BRAND

E.E.S. 400 FILMTABerythromycin ethylsuccinate

BRAND

ERY 2% PADSerythromycin base/ethyl alcohol

BRAND

ery e-succ/sulfisoxazole 200-600/5 susp recon generic

ERY-TAB (250 MG, 500 MG, 333 MG)erythromycin base

BRAND

ERYGEL 2% GELerythromycin base/ethyl alcohol

BRAND

ERYPED 200 MG/5 ML SUSPENSIONerythromycin ethylsuccinate

BRAND

ERYPED 400 MG/5 ML SUSPENSIONerythromycin ethylsuccinate

BRAND

ERYTHROCIN 250 MG FILMTABerythromycin stearate

BRAND

ERYTHROMYCIN BASE (500 MG TABLET, 250 MGTABLET, 250 MG CAPSULE DR, 5 MG/G OINT. (G),5MG/G OINT. (G))

generic

ERYTHROMYCIN BASE/ETHYL ALCOHOL (2 MED.SWAB, 2 SOLUTION, 2 GEL (GRAM))

generic

erythromycin ethylsuccinate 400 mg tablet generic

QUINOLONES

AVELOX IV 400 MG/250 MLmoxifloxacin hcl/sodium chloride, iso-osmotic

BRAND

CIPRO (5%, 10%)ciprofloxacin

BRAND C 10ml/day; 150ml/fill

CIPROFLOXACIN HCL (0.3 DROPS, 0.2 DROPERETTE) generic

CIPROFLOXACIN HCL (100 MG, 500 MG, 750 MG) generic QL

ciprofloxacin hcl 250 mg tablet generic QL

CIPROFLOXACIN LACTATE (400MG/40ML,200MG/20ML)

generic

CIPROFLOXACIN LACTATE/DEXTROSE 5 % IN WATER generic



(400MG/0.2L, 200MG/0.1L)

CIPROFLOXACIN/CIPROFLOXACIN HCL (500 MG, 1000MG)

generic QL

gatifloxacin 0.5 % drops generic

LEVOFLOXACIN (0.5 % DROPS, 25 MG/ML VIAL) generic

LEVOFLOXACIN (500 MG, 750 MG, 250 MG) generic C 5 tablets/30 days

levofloxacin 250mg/10ml solution generic C 480ml/fill

LEVOFLOXACIN/DEXTROSE 5 % IN WATER(750MG/.15L, 250MG/50ML, 500MG/0.1L)

generic

MOXEZA 0.5% EYE DROPSmoxifloxacin hcl

BRAND

moxifloxacin hcl 400 mg tablet generic QL

moxifloxacin/sod.ace,sul/water 400mg/.25l piggyback generic

OFLOXACIN (0.3 % DROPS, 400 MG TABLET, 300 MGTABLET, 200 MG TABLET)

generic

SULFONAMIDES

silver sulfadiazine 1 % cream (g) generic

SSD 1% CREAMsilver sulfadiazine

BRAND

SULFACETAMIDE SODIUM (10 DROPS, 10SUSPENSION, 10 OINT. (G))

generic

sulfadiazine 500 mg tablet generic

SULFAMETHOXAZOLE/TRIMETHOPRIM (800-160/20ORAL SUSP, 200-40MG/5 ORAL SUSP, 80-16MG/MLVIAL, 400MG-80MG TABLET, 800-160 MG TABLET)

generic

SULFATRIM PEDIATRIC SUSPENSIONsulfamethoxazole/trimethoprim

BRAND

THERMAZENE 1% CREAMsilver sulfadiazine

BRAND

TETRACYCLINES

AVIDOXY 100 MG TABLETdoxycycline monohydrate

BRAND

DEMECLOCYCLINE HCL (150 MG, 300 MG) generic

DOXYCYCLINE MONOHYDRATE (150 MG TABLET, 75MG CAPSULE, 50 MG CAPSULE, 100 MG TABLET, 75MG TABLET, 100 MG CAPSULE, 40 MG CAP IR DR, 150MG CAPSULE, 50 MG TABLET, 25 MG/5 ML SUSPRECON)

generic



MINOCYCLINE HCL (135 MG TAB ER 24H, 100 MGCAPSULE, 90 MG TAB ER 24H, 75 MG CAPSULE, 45MG TAB ER 24H, 100 MG TABLET, 50 MG TABLET, 75MG TABLET, 50 MG CAPSULE)

generic

MONDOXYNE NL (50 MG, 75 MG, 100 MG)doxycycline monohydrate

BRAND

OCUDOX CONVENIENCE KITdoxycycline hyclate/eyelid clns no.3/eyelid emollient no.1

BRAND

TETRACYCLINE HCL (500 MG, 250 MG) generic

ANTICONVULSANTS

ANTICONVULSANTS, OTHER

LEVETIRACETAM (1000 MG TABLET, 500 MG/5MLSOLUTION, 500 MG TAB ER 24H, 100 MG/MLSOLUTION, 500 MG TABLET, 750 MG TABLET, 750 MGTAB ER 24H, 500 MG/5ML VIAL, 250 MG TABLET)

generic

POTIGA (50 MG, 300 MG, 200 MG, 400 MG)ezogabine

BRAND

CALCIUM CHANNEL MODIFYING AGENTS

CELONTIN 300 MG KAPSEALmethsuximide

BRAND

ETHOSUXIMIDE (250 MG/5ML SOLUTION, 250 MGCAPSULE)

generic

ZONISAMIDE (50 MG, 100 MG, 25 MG) generic

GAMMA-AMINOBUTYRIC ACID (GABA) AUGMENTING AGENTS

DIAZEPAM (12.5-15-20, 2.5 MG, 5-7.5-10MG) generic C 2 kits/30 days

DIVALPROEX SODIUM (125 MG TABLET DR, 250 MGTAB ER 24H, 125 MG CAP SPRINK, 500 MG TABLETDR, 500 MG TAB ER 24H, 250 MG TABLET DR)

generic

GABAPENTIN (250 MG/5ML SOLUTION, 800 MGTABLET, 100 MG CAPSULE, 300 MG/6ML SOLUTION,300 MG CAPSULE, 600 MG TABLET, 400 MG CAPSULE)

generic

GABITRIL (12 MG, 16 MG)tiagabine hcl

BRAND

ONFI (2.5 MG/ML SUSPENSION, 5 MG TABLET, 20 MGTABLET, 10 MG TABLET)clobazam

BRAND

PHENOBARBITAL (60 MG TABLET, 15 MG TABLET, 100MG TABLET, 64.8 MG TABLET, 30 MG TABLET, 97.2MGTABLET, 16.2 MG TABLET, 32.4 MG TABLET, 20 MG/5ML ELIXIR)

generic



PHENOBARBITAL SODIUM (130MG/ML, 65 MG/ML) generic

PRIMIDONE (250 MG, 50 MG) generic

SABRIL (500 MG TABLET, 500 MG POWDER PACKET)vigabatrin

BRAND S Specialty Drug

TIAGABINE HCL (4 MG, 2 MG) generic

VALPROIC ACID (AS SODIUM SALT) (VALPROATESODIUM) (500 MG/5ML VIAL, 250 MG/5ML SOLUTION,500MG/10ML SOLUTION)

generic

valproic acid 250 mg capsule generic

GLUTAMATE REDUCING AGENTS

FELBAMATE (400 MG TABLET, 600 MG TABLET, 600MG/5ML ORAL SUSP)

generic

LAMOTRIGINE (50 MG TAB RAPDIS, 100 MG TAB ER24, 25-50-100 TB RD DSPK, 300 MG TAB ER 24, 5 MGTB CHW DSP, 100 MG TAB RAPDIS, 25MG (35) TAB DSPK, 200 MG TABLET, 200 MG TAB ER 24, 25(21)-50 TBRD DSPK, 150 MG TABLET, 50 MG TAB ER 24, 100 MGTABLET, 25 MG TABLET, 25 MG TAB ER 24, 250 MGTAB ER 24, 200 MG TAB RAPDIS, 25 MG TAB RAPDIS,50(42)-100 TB RD DSPK, 25 MG TB CHW DSP)

generic

TOPIRAGEN (200 MG, 50 MG, 25 MG, 100 MG)topiramate

BRAND

TOPIRAMATE (25 MG CAP SPRINK, 200 MG TABLET,50 MG TABLET, 25 MG TABLET, 100 MG TABLET, 15MG CAP SPRINK)

generic

SODIUM CHANNEL AGENTS

BANZEL (400 MG TABLET, 40 MG/ML SUSPENSION,200 MG TABLET)rufinamide

BRAND

CARBAMAZEPINE (400 MG TAB ER 12H, 200 MGTABLET, 300 MG CPMP 12HR, 200 MG TAB ER 12H, 200MG CPMP 12HR, 100 MG CPMP 12HR, 100 MG/5MLORAL SUSP, 100 MG TAB CHEW)

generic

DILANTIN 30 MG CAPSULEphenytoin sodium extended

BRAND

EPITOL 200 MG TABLETcarbamazepine

BRAND

FOSPHENYTOIN SODIUM (500 PE/10, 100MG PE/2) generic

OXCARBAZEPINE (150 MG TABLET, 300 MG TABLET,600 MG TABLET, 300 MG/5ML ORAL SUSP)

generic

PEGANONE 250 MG TABLET BRAND



ethotoin

PHENYTOIN (50 MG TAB CHEW, 125 MG/5ML ORALSUSP, 100 MG/4ML ORAL SUSP)

generic

PHENYTOIN SODIUM (50 MG/ML SYRINGE, 50 MG/MLVIAL, 50 MG/ML AMPUL)

generic

PHENYTOIN SODIUM EXTENDED (300 MG, 100 MG,200 MG)

generic

TEGRETOL XR 100 MG TABLETcarbamazepine

BRAND

VIMPAT (200 MG/20 ML VIAL, 10 MG/ML SOLUTION, 150MG TABLET, 100 MG TABLET, 200 MG TABLET, 50 MGTABLET)lacosamide

BRAND

ANTIDEMENTIA AGENTS

ANTIDEMENTIA AGENTS, OTHER

ergoloid mesylates 1 mg tablet generic

ISOXSUPRINE HCL (20 MG, 10 MG) generic

papaverine hcl 30 mg/ml vial generic

CHOLINESTERASE INHIBITORS

DONEPEZIL HCL (10 MG TABLET, 5 MG TAB RAPDIS,10 MG TAB RAPDIS, 23 MG TABLET, 5 MG TABLET)

generic

GALANTAMINE HBR (12 MG TABLET, 24 MG CAP24HPEL, 4 MG TABLET, 8 MG CAP24H PEL, 8 MG TABLET,16 MG CAP24H PEL, 4 MG/ML SOLUTION)

generic

RIVASTIGMINE (13.3MG/24H, 9.5MG/24HR,4.6MG/24HR)

generic

RIVASTIGMINE TARTRATE (1.5 MG, 6 MG, 4.5 MG, 3MG)

generic

N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST

MEMANTINE HCL (10 MG, 5 MG) generic GL Male

MEMANTINE HCL (5 MG-10 MG TAB DS PK, 2 MG/MLSOLUTION)

generic

NAMENDA (10 MG TABLET, 5-10 MG TITRATION PK, 5MG TABLET, 2 MG/ML SOLUTION)memantine hcl

BRAND

ANTIDEPRESSANTS

ANTIDEPRESSANTS, OTHER



AMITRIPTYLINE HCL/CHLORDIAZEPOXIDE (25 MG-10MG, 12.5MG-5MG)

generic

BUDEPRION XL 300 MG TABLETbupropion hcl

BRAND QL

BUPROPION HCL (75 MG TABLET, 200 MG TABLET ER,150 MG TABLET ER, 100 MG TABLET ER, 300 MG TABER 24H, 100 MG TABLET)

generic

bupropion hcl 150 mg tab er 24h generic QL

MIRTAZAPINE (15 MG TABLET, 45 MG TABLET, 7.5 MGTABLET, 45 MG TAB RAPDIS, 15 MG TAB RAPDIS, 30MG TABLET, 30 MG TAB RAPDIS)

generic

OLANZAPINE/FLUOXETINE HCL (6MG-50MG, 6MG-25MG, 12MG-25MG, 12MG-50MG, 3 MG-25 MG)

generic

PERPHENAZINE/AMITRIPTYLINE HCL (4 MG-25 MG,4MG-10MG, 2 MG-10 MG, 4 MG-50 MG, 2 MG-25 MG)

generic

MONOAMINE OXIDASE INHIBITORS

phenelzine sulfate 15 mg tablet generic

tranylcypromine sulfate 10 mg tablet generic

SSRIS/SNRIS (SELECTIVE SEROTONIN REUPTAKE INHIBITORS/SEROTONIN AND NOREPINEPHRINEREUPTAKE INHIBITOR

CITALOPRAM HYDROBROMIDE (40 MG TABLET, 10MG TABLET, 20 MG TABLET, 10 MG/5 ML SOLUTION)

generic

ESCITALOPRAM OXALATE (20 MG TABLET, 10 MGTABLET, 5 MG/5 ML SOLUTION, 5 MG TABLET)

generic

FLUOXETINE HCL (20 MG TABLET, 40 MG CAPSULE,20 MG/5 ML SOLUTION, 90 MG CAPSULE DR, 10 MGTABLET, 20 MG CAPSULE, 10 MG CAPSULE)

generic

FLUVOXAMINE MALEATE (150 MG CAP ER 24H, 100MG CAP ER 24H, 25 MG TABLET, 100 MG TABLET, 50MG TABLET)

generic

MAPROTILINE HCL (25 MG, 75 MG, 50 MG) generic

PAROXETINE HCL (12.5 MG TAB ER 24H, 10 MGTABLET, 25 MG TAB ER 24H, 20 MG TABLET, 40 MGTABLET, 30 MG TABLET, 37.5 MG TAB ER 24H)

generic

SERTRALINE HCL (50 MG TABLET, 25 MG TABLET, 20MG/ML ORAL CONC, 100 MG TABLET)

generic

TRAZODONE HCL (100 MG, 50 MG, 300 MG, 150 MG) generic

VENLAFAXINE HCL (37.5 MG ER, 150 MG ER) generic

VENLAFAXINE HCL (50 MG, 25 MG, 37.5 MG, 100 MG) generic QL



venlafaxine hcl 225 mg tab er 24 generic QL

venlafaxine hcl 75 mg cap er 24h generic QL

venlafaxine hcl 75 mg tablet generic QL

TRICYCLICS

AMITRIPTYLINE HCL (50 MG, 75 MG, 100 MG, 25 MG,10 MG, 150 MG)

generic

AMOXAPINE (25 MG, 100 MG, 50 MG, 150 MG) generic

CLOMIPRAMINE HCL (50 MG, 75 MG, 25 MG) generic

DESIPRAMINE HCL (10 MG, 75 MG, 100 MG, 25 MG, 50MG, 150 MG)

generic

DOXEPIN HCL (150 MG CAPSULE, 75 MG CAPSULE, 50MG CAPSULE, 25 MG CAPSULE, 100 MG CAPSULE, 10MG/ML ORAL CONC, 10 MG CAPSULE)

generic

IMIPRAMINE HCL (25 MG, 10 MG, 50 MG) generic

IMIPRAMINE PAMOATE (150 MG, 75 MG, 100 MG, 125MG)

generic

NORTRIPTYLINE HCL (50 MG CAPSULE, 10 MG/5 MLSOLUTION, 25 MG CAPSULE, 10 MG CAPSULE, 75 MGCAPSULE)

generic

PROTRIPTYLINE HCL (5 MG, 10 MG) generic

ANTIEMETICS

ANTIEMETICS, OTHER

COMPRO 25 MG SUPPOSITORYprochlorperazine

BRAND

dimenhydrinate 50 mg/ml vial generic

MECLIZINE HCL (25 MG, 12.5 MG) generic

METOCLOPRAMIDE HCL (10 MG TABLET, 5 MG TABRAPDIS, 5 MG TABLET, 10 MG/10ML SOLUTION, 10 MGTAB RAPDIS, 5 MG/ML VIAL, 5 MG/5 ML SOLUTION)

generic

PERPHENAZINE (16 MG, 2 MG, 4 MG, 8 MG) generic

PHENADOZ (12.5 MG, 25 MG)promethazine hcl

BRAND

PHENERGAN (50 MG, 12.5 MG, 25 MG)promethazine hcl

BRAND

prochlorperazine 25 mg supp.rect generic

PROCHLORPERAZINE EDISYLATE (10 MG/2 ML, 5 generic



MG/ML)

PROCHLORPERAZINE MALEATE (5 MG, 10 MG) generic

PROMETHAZINE HCL (50 MG, 12.5 MG, 25 MG) generic

PROMETHEGAN (50 MG SUPPOSITORY, 25 MG SUPP,12.5 MG SUPPOS)promethazine hcl

BRAND

TRIMETHOBENZAMIDE HCL (300 MG CAPSULE, 100MG/ML VIAL)

generic

EMETOGENIC THERAPY ADJUNCTS

DRONABINOL (10 MG, 2.5 MG, 5 MG) generic

EMEND (TRIPACK, 40 MG CAPSULE, 125 MGCAPSULE, 80 MG CAPSULE, 150 MG VIAL)aprepitant


GRANISETRON HCL (1 MG/ML(1), 1 MG/ML) genericPA

S Specialty Drug

granisetron hcl 1 mg tablet generic S Specialty Drug

GRANISETRON HCL/PF (100 MCG/ML, 1 MG/ML(1)) genericPA

S Specialty Drug

GRANISOL 2 MG/10 ML SOLUTIONgranisetron hcl

BRANDPA

C 50ml/30 days

ONDANSETRON (8 MG, 4 MG) generic

ONDANSETRON HCL (8 MG TABLET, 4 MG/5 MLSOLUTION, 4 MG TABLET, 24 MG TABLET)

generic

ondansetron hcl 2 mg/ml vial generic PA

ondansetron hcl/pf 4 mg/2 ml syringe genericPA

S Specialty Drug

ondansetron hcl/pf 4 mg/2 ml vial generic S Specialty Drug

ANTIFUNGALS

amphotericin b 50 mg vial generic

CANCIDAS (70 MG, 50 MG)caspofungin acetate

BRAND

CICLODAN 0.77% CREAMciclopirox olamine

BRAND

CICLOPIROX (1 SHAMPOO, 0.77 GEL (GRAM), 8 generic



SOLUTION)

CICLOPIROX OLAMINE (0.77 CREAM (G), 0.77SUSPENSION)

generic

ciclopirox/ure/camph/menth/euc 8 % solution generic

econazole nitrate 1 % cream (g) generic

FIRST-BXN MOUTHWASHnystatin/lidocaine hcl/diphenhydramine hcl

BRAND

FLUCONAZOLE (10 MG/ML SUSP RECON, 50 MGTABLET, 40 MG/ML SUSP RECON, 100 MG TABLET)

generic

FLUCONAZOLE (150 MG, 200 MG) generic QL

FLUCONAZOLE IN DEXTROSE, ISO-OSMOTIC(400MG/0.2L, 200MG/0.1L)

generic

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-OSMOTIC(200MG/0.1L PGGYBK BTL, 400MG/0.2L PGGYBK BTL,100MG/50ML PGGYBK BTL, 200MG/0.1L PIGGYBACK,400MG/0.2L PIGGYBACK)

generic

FLUCYTOSINE (500 MG, 250 MG) generic

GRISEOFULVIN ULTRAMICROSIZE (125 MG, 250 MG) generic

GRISEOFULVIN, MICROSIZE (500 MG TABLET, 125MG/5ML ORAL SUSP)

generic

GYNAZOLE 1 2% CREAMbutoconazole nitrate

BRAND

itraconazole 100 mg capsule generic

KETOCONAZOLE (2 CREAM (G), 2 FOAM, 2 SHAMPOO) generic

ketoconazole 200 mg tablet generic QL

KETODAN (KIT, )ketoconazole/skin cleanser combination no.28

BRAND

LAMISIL (187.5 MG PACK, 125 MG PACKET)terbinafine hcl

BRAND

miconazole nitrate 200 mg supp.vag generic

MYCAMINE (50 MG, 100 MG)micafungin sodium

BRAND

naftifine hcl 2 % cream (g) generic

NATACYN EYE DROPSnatamycin

BRAND

NOXAFIL (40 MG/ML SUSPENSION, 300 MG/16.7 MLVIAL, DR 100 MG TABLET)posaconazole

BRAND



NYAMYC 100,000 UNITS/GM POWDERnystatin

BRAND

NYSTATIN (100000/ML ORAL SUSP, 500MM UNITPOWDER(EA), 150MM UNIT POWDER(EA), 100000/GPOWDER, 100000/G CREAM (G), 100000/G OINT. (G),50MM UNIT POWDER(EA), 500K UNIT TABLET)

generic

NYSTATIN/TRIAMCINOLONE ACETONIDE (CREAM,OINT.)

generic

NYSTOP 100,000 UNITS/GM POWDERnystatin

BRAND

PEDI-DRI TOPICAL POWDERnystatin

BRAND

SPORANOX 10 MG/ML SOLUTIONitraconazole

BRAND

terbinafine hcl 250 mg tablet generic C max 84 daystherapy/365 days

TERCONAZOLE (0.4 % CREAM/APPL, 80 MGSUPP.VAG, 0.8 % CREAM/APPL)

generic

triacetin 100 % liquid generic

VORICONAZOLE (200 MG VIAL, 200 MG/5ML SUSPRECON, 50 MG TABLET)

generic

voriconazole 200 mg tablet generic QL

ANTIGOUT AGENTS

ALLOPURINOL (300 MG, 100 MG) generic

allopurinol sodium 500 mg vial generic

ALOPRIM 500 MG VIALallopurinol sodium

BRAND

COLCHICINE (0.6 MG CAPSULE, 0.6 MG TABLET) generic

colchicine/probenecid 0.5-500mg tablet generic

COLCRYS 0.6 MG TABLETcolchicine

BRAND PA

probenecid 500 mg tablet generic

ULORIC (40 MG, 80 MG)febuxostat

BRAND

ANTIMIGRAINE AGENTS

ERGOT ALKALOIDS



DIHYDROERGOTAMINE MESYLATE (1 MG/ML AMPUL,1 MG/ML VIAL, 0.5MG/SPRY SPRAY/PUMP)

generic

ergotamine tartrate/caffeine 1 mg-100mg tablet generic

MIGERGOT SUPPOSITORYergotamine tartrate/caffeine

BRAND

SEROTONIN (5-HT) 1B/1D RECEPTOR AGONISTS

ALMOTRIPTAN MALATE (12.5 MG, 6.25 MG) generic

NARATRIPTAN HCL (2.5 MG, 1 MG) generic QL

RIZATRIPTAN BENZOATE (10 MG TABLET, 5 MGTABLET, 5 MG TAB RAPDIS, 10 MG TAB RAPDIS)

generic

SUMATRIPTAN (20 MG, 5 MG) generic C 6 nasal sprayers/month

SUMATRIPTAN SUCCINATE (50 MG, 100 MG, 25 MG) generic

SUMATRIPTAN SUCCINATE (6 PEN INJCTR, 6SYRINGE, 6 CARTRIDGE, 4 PEN INJCTR, 4CARTRIDGE, 6 VIAL)

generic C 4 injections (2kits)/month

ZOLMITRIPTAN (5 MG TAB RAPDIS, 2.5 MG TABRAPDIS, 5 MG TABLET, 2.5 MG TABLET)

generic

ZOMIG (2.5 MG, 5 MG)zolmitriptan

BRAND C 6 nasal sprayers/month

ANTIMYASTHENIC AGENTS

PARASYMPATHOMIMETICS

ENLON 10 MG/ML VIALedrophonium chloride

BRAND

guanidine hcl 125 mg tablet generic

MESTINON (180 MG TIMESPAN, 60 MG/5 ML SYRUP)pyridostigmine bromide

BRAND

NEOSTIGMINE METHYLSULFATE (4 MG/4 MLSYRINGE, 1 MG/ML VIAL, 2 MG/2 ML SYRINGE, 1:2000VIAL, 1:1000 VIAL, 3 MG/3 ML SYRINGE, 0.5 MG/MLVIAL)

generic

physostigmine salicylate 1 mg/ml ampul generic

PROSTIGMIN 15 MG TABLETneostigmine bromide

BRAND

PYRIDOSTIGMINE BROMIDE (180 MG ER, 60 MG) generic

REGONOL 10 MG/2 ML AMPULpyridostigmine bromide

BRAND

ANTIMYCOBACTERIALS



ANTIMYCOBACTERIALS, OTHER

DAPSONE (100 MG, 25 MG) generic

MYCOBUTIN 150 MG CAPSULErifabutin

BRAND

rifabutin 150 mg capsule generic

ANTITUBERCULARS

ETHAMBUTOL HCL (100 MG, 400 MG) generic

ISONIAZID (50 MG/5 ML SOLUTION, 100 MG/ML VIAL,300 MG TABLET, 100 MG TABLET)

generic

PRIFTIN 150 MG TABLETrifapentine

BRAND

pyrazinamide 500 mg tablet generic

RIFAMPIN (600 MG VIAL, 150 MG CAPSULE, 300 MGCAPSULE)

generic

SIRTURO 100 MG TABLETbedaquiline fumarate

BRAND

ANTINEOPLASTICS

ALKYLATING AGENTS

ALKERAN 2 MG TABLETmelphalan

BRAND

BICNU 100 MG VIALcarmustine

BRAND

BUSULFEX 60 MG/10 ML VIALbusulfan

BRAND

CYCLOPHOSPHAMIDE (25 MG TABLET, 2 G VIAL, 50MG TABLET, 500 MG VIAL, 1 G VIAL)

generic

GLEOSTINE (40 MG, 100 MG, 10 MG, 5 MG)lomustine

BRAND

HEXALEN 50 MG CAPSULEaltretamine


IFOSFAMIDE (1 G/20 ML, 3G/60ML, 3 G, 1 G) generic

IFOSFAMIDE/MESNA (1G-1G, 3G-1G) generic

LEUKERAN 2 MG TABLETchlorambucil


LOMUSTINE (100 MG, 10 MG, 40 MG) generic S Specialty Drug

MATULANE 50 MG CAPSULEprocarbazine hcl




melphalan hcl 50 mg vial generic

MUSTARGEN 10 MG VIALmechlorethamine hcl

BRAND MED Medical Drug

MYLERAN 2 MG TABLETbusulfan

BRAND

TEMODAR 100 MG VIALtemozolomide


TEMOZOLOMIDE (5 MG, 20 MG, 140 MG, 100 MG, 180MG, 250 MG)


TREANDA (100 MG, 25 MG)bendamustine hcl

BRAND

VALCHLOR 0.016% GELmechlorethamine hcl

BRAND

ANTIANDROGENS

bicalutamide 50 mg tablet generic S Specialty Drug

flutamide 125 mg capsule generic

NILANDRON 150 MG TABLETnilutamide


XTANDI 40 MG CAPSULEenzalutamide


ZYTIGA 250 MG TABLETabiraterone acetate


ANTIANGIOGENIC AGENTS

POMALYST (3 MG, 2 MG, 4 MG, 1 MG)pomalidomide


REVLIMID (2.5 MG, 15 MG, 5 MG, 10 MG, 25 MG, 20 MG)lenalidomide


THALOMID (50 MG, 150 MG, 100 MG, 200 MG)thalidomide


ANTIESTROGENS/MODIFIERS

EMCYT 140 MG CAPSULEestramustine phosphate sodium

BRAND

FARESTON 60 MG TABLETtoremifene citrate


TAMOXIFEN CITRATE (10 MG, 20 MG) generic

ANTIMETABOLITES



ADRUCIL (2,500 MG/50 ML, 500 MG/10 ML, 5 GRAM/100ML)fluorouracil


ALIMTA (500 MG, 100 MG)pemetrexed disodium

BRAND

CAPECITABINE (500 MG, 150 MG) generic S Specialty Drug

cladribine 10 mg/10ml vial generic

cytarabine 20 mg/ml vial generic S Specialty Drug

CYTARABINE/PF (2 G/20 ML, 100 MG, 1 G, 500 MG, 20MG/ML, 100 MG/5ML)


DROXIA (400 MG, 200 MG, 300 MG)hydroxyurea

BRAND

ELITEK (1.5 MG, 7.5 MG)rasburicase

BRAND

floxuridine 500 mg vial generic MED Medical Drug

FLUOROURACIL (2.5 G/50ML, 1 G/20 ML, 5 G/100 ML,500MG/10ML)


FLUOROURACIL (5 SOLUTION, 2 SOLUTION, 5 CREAM(G))

generic

FOLOTYN (20 MG/ML, 40 MG/2 ML)pralatrexate

BRAND

GEMCITABINE HCL (200 MG, 2 G, 1 G, 2 G/52.6ML,200MG/5.26, 1 G/26.3ML)

generic

hydroxyurea 500 mg capsule generic

mercaptopurine 50 mg tablet generic

pentostatin 10 mg vial generic

PURINETHOL 50 MG TABLETmercaptopurine

BRAND PA

TABLOID 40 MG TABLETthioguanine


ANTINEOPLASTICS, OTHER

ABRAXANE 100 MG VIALpaclitaxel protein-bound

BRAND

ADRIAMYCIN (50 MG, 10 MG, 2 MG/ML, 200 MG/100 ML,20 MG)doxorubicin hcl

BRAND

amifostine crystalline 500 mg vial generic

ARRANON 250 MG VIAL BRAND



nelarabine

CARBOPLATIN (10 MG/ML, 150 MG) generic

CERUBIDINE 20 MG VIALdaunorubicin hcl

BRAND

cisplatin 1 mg/ml vial generic

DACARBAZINE (200 MG, 100 MG) generic

dactinomycin 0.5 mg vial generic

DAUNORUBICIN HCL (20 MG, 5 MG/ML) generic

DAUNOXOME (2 MG/ML, 50 MG (2 MG/ML))daunorubicin citrate liposomal

BRAND

decitabine 50 mg vial generic

DEXRAZOXANE HCL (250 MG, 500 MG) generic

DOCETAXEL (20 MG/2 ML, 160 MG/8ML, FNL 20MG/2,20MG/ML(1), 200MG/20ML, 160MG/16ML, 140 MG/7ML,80 MG/8 ML, 80 MG/4 ML, FNL 80MG/8)

generic

DOXIL 2 MG/ML VIALdoxorubicin hcl pegylated liposomal

BRAND

DOXORUBICIN HCL (50 MG, 10 MG, 50 MG/25ML, 20MG/10ML, 2 MG/ML, 10 MG/5 ML)

generic

doxorubicin hcl peg-liposomal 2 mg/ml vial generic

ELOXATIN (200 MG/40 ML, 100 MG/20 ML, 50 MG/10ML)oxaliplatin

BRAND

EPIRUBICIN HCL (50 MG, 50 MG/25ML, 200 MG,200MG/0.1L)

generic

FLUDARABINE PHOSPHATE (50 MG, 50 MG/2 ML) generic

FUSILEV I.V. 50 MG VIALlevoleucovorin calcium

BRAND

idarubicin hcl 1 mg/ml vial generic

IRINOTECAN HCL (40 MG/2 ML, 100 MG/5ML,500MG/25ML)

generic

ISTODAX 10 MG VIALromidepsin

BRAND

IXEMPRA (15 MG, 45 MG)ixabepilone

BRAND

LEUCOVORIN CALCIUM (100 MG VIAL, 500MG/50MLVIAL, 500 MG VIAL, 50 MG VIAL, 200 MG VIAL, 350 MGVIAL, 10 MG TABLET, 5 MG TABLET, 25 MG TABLET, 15MG TABLET)




leucovorin calcium 10 mg/ml vial generic

levoleucovorin calcium 10 mg/ml vial generic

LIPODOX 2 MG/ML VIALdoxorubicin hcl pegylated liposomal

BRAND

LIPODOX 50 2 MG/ML VIALdoxorubicin hcl pegylated liposomal

BRAND

LYSODREN 500 MG TABLETmitotane


MARQIBO KITvincristine sulfate liposomal

BRAND

mesna 100 mg/ml vial generic

MESNEX 400 MG TABLETmesna

BRAND

MITOMYCIN (5 MG, 40 MG, 20 MG) generic

mitoxantrone hcl 2 mg/ml vial generic

ONXOL 30 MG/5 ML VIALpaclitaxel

BRAND

OXALIPLATIN (50 MG, 100 MG, 50 MG/10ML,100MG/20ML)

generic

paclitaxel 6 mg/ml vial generic

PHOTOFRIN 75 MG VIALporfimer sodium

BRAND

SYLATRON (200 MCG, 600 MCG, 300 MCG)peginterferon alfa-2b


SYLATRON 4-PACK (300 MCG, 200 MCG)peginterferon alfa-2b


SYLATRON 888 MCG 4-PACKpeginterferon alfa-2b

BRAND

teniposide 50 mg/5 ml ampul generic

THERACYS 81 MG VIALbcg live

BRAND MED Medical Drug

thiotepa 15 mg vial generic

TRISENOX 10 MG/10 ML AMPULEarsenic trioxide

BRAND

VINBLASTINE SULFATE (1 MG/ML, 10 MG) generic

VINCASAR PFS (2 MG/2 ML, 1 MG/ML)vincristine sulfate

BRAND

VINCRISTINE SULFATE (2 MG/2 ML, 1 MG/ML) generic



VINORELBINE TARTRATE (50 MG/5 ML, 10 MG/ML) generic

VUMON 50 MG/5 ML AMPULEteniposide

BRAND

ZANOSAR 1 GM POWDER VIALstreptozocin

BRAND

ZOLINZA 100 MG CAPSULEvorinostat


AROMATASE INHIBITORS, 3RD GENERATION

anastrozole 1 mg tablet generic S Specialty Drug

exemestane 25 mg tablet generic S Specialty Drug

letrozole 2.5 mg tablet generic S Specialty Drug

ENZYME INHIBITORS

ETOPOSIDE (20 MG/ML VIAL, 50 MG CAPSULE) generic S Specialty Drug

TOPOSAR (100 MG/5 ML, 500 MG/25 ML, 1,000 MG/50ML)etoposide


MOLECULAR TARGET INHIBITORS

AFINITOR (10 MG, 7.5 MG, 2.5 MG, 5 MG)everolimus


AFINITOR DISPERZ (2 MG, 5 MG, 3 MG)everolimus


BOSULIF (500 MG, 100 MG)bosutinib


CAPRELSA (300 MG, 100 MG)vandetanib


ERIVEDGE 150 MG CAPSULEvismodegib


GILOTRIF (20 MG, 40 MG, 30 MG)afatinib dimaleate


GLEEVEC (100 MG, 400 MG)imatinib mesylate


IBRANCE (125 MG, 100 MG, 75 MG)palbociclib

BRANDPA

S Specialty Drug

ICLUSIG 15 MG TABLETponatinib hcl


ICLUSIG 45 MG TABLETponatinib hcl

BRAND



IMATINIB MESYLATE (400 MG, 100 MG) generic S Specialty Drug

IMBRUVICA 140 MG CAPSULEibrutinib

BRAND

QL

PA

S Specialty Drug

INLYTA (5 MG, 1 MG)axitinib


JAKAFI (10 MG, 15 MG, 5 MG, 25 MG, 20 MG)ruxolitinib phosphate


MEKINIST (2 MG, 0.5 MG)trametinib dimethyl sulfoxide


NEXAVAR 200 MG TABLETsorafenib tosylate


SPRYCEL (80 MG, 20 MG, 140 MG, 70 MG, 100 MG, 50MG)dasatinib


STIVARGA 40 MG TABLETregorafenib


SUTENT (50 MG, 12.5 MG, 25 MG)sunitinib malate


TAFINLAR (50 MG, 75 MG)dabrafenib mesylate


TARCEVA (150 MG, 100 MG, 25 MG)erlotinib hcl


TASIGNA (150 MG, 200 MG)nilotinib hcl


TORISEL 25 MG KITtemsirolimus

BRAND

TYKERB 250 MG TABLETlapatinib ditosylate

BRANDPA

S Specialty Drug

VOTRIENT 200 MG TABLETpazopanib hcl


XALKORI (200 MG, 250 MG)crizotinib


ZELBORAF 240 MG TABLETvemurafenib


ZYDELIG (100 MG, 150 MG)idelalisib

BRANDPA

S Specialty Drug

ZYKADIA 150 MG CAPSULE BRAND QL



ceritinibPA

S Specialty Drug

MONOCLONAL ANTIBODIES

ARZERRA (1,000 MG/50 ML, 100 MG/5 ML)ofatumumab

BRAND

AVASTIN (100 MG/4 ML, 400 MG/16 ML)bevacizumab

BRAND

BEXXAR (14 MG/ML DOSIMETRIC, 14 MG/MLTHERAPEUTIC)tositumomab (with maltose)

BRAND

ERBITUX (100 MG/50 ML, 200 MG/100 ML)cetuximab

BRAND

HERCEPTIN 440 MG VIALtrastuzumab

BRAND PA

KADCYLA (160 MG, 100 MG)ado-trastuzumab emtansine

BRAND PA

PERJETA 420 MG/14 ML VIALpertuzumab

BRAND

RITUXAN 10 MG/ML VIALrituximab

BRAND PA

VECTIBIX (100 MG/5 ML, 400 MG/20 ML)panitumumab

BRAND

ZEVALIN Y-90 VIALkit for prep yttrium-90/ibritumomab tiuxetan/albumin human

BRAND

RETINOIDS

bexarotene 75 mg capsule generic

TARGRETIN (1% GEL, 75 MG CAPSULE)bexarotene


TARGRETIN 75 MG SOFTGELbexarotene

BRAND

tretinoin 10 mg capsule generic

ANTIPARASITICS

ANTIHELMINTHICS

ALBENZA 200 MG TABLETalbendazole

BRAND

STROMECTOL 3 MG TABLETivermectin

BRAND



ANTIPROTOZOALS

ALINIA (500 MG TABLET, 100 MG/5 ML SUSPENSION)nitazoxanide

BRAND

atovaquone 750 mg/5ml oral susp generic

ATOVAQUONE/PROGUANIL HCL (250-100 MG, 62.5-25MG)

generic

CHLOROQUINE PHOSPHATE (500 MG, 250 MG) generic

COARTEM TABLETSartemether/lumefantrine

BRAND

DARAPRIM 25 MG TABLETpyrimethamine

BRAND

hydroxychloroquine sulfate 200 mg tablet generic

mefloquine hcl 250 mg tablet generic

MEPRON 750 MG/5 ML SUSPENSIONatovaquone

BRAND

NEBUPENT 300 MG INHAL POWDERpentamidine isethionate

BRAND

quinine sulfate 324 mg capsule generic

PEDICULICIDES/SCABICIDES

EURAX (CREAM, LOTION)crotamiton

BRAND

LINDANE (1 LOTION, 1 SHAMPOO) generic C

60ml/fill; must trypermethrin andpiperonylbutoxide/pyrethrins

malathion 0.5 % lotion generic C

60ml/fill; must trypermethrin andpiperonylbutoxide/pyrethrins

permethrin 5 % cream (g) generic C 120ml/fill

ANTIPARKINSON AGENTS

ANTICHOLINERGICS

BENZTROPINE MESYLATE (2 MG/2 ML VIAL, 2 MG/2 MLAMPUL, 1 MG TABLET, 2 MG TABLET, 0.5 MG TABLET)

generic

TRIHEXYPHENIDYL HCL (2 MG/5 ML ELIXIR, 2 MGTABLET, 5 MG TABLET)

generic

ANTIPARKINSON AGENTS, OTHER



AMANTADINE HCL (100 MG TABLET, 100 MGCAPSULE, 50 MG/5 ML SOLUTION)

generic

CARBIDOPA/LEVODOPA/ENTACAPONE (50-200-200,37.5-150MG, 18.75-75MG, 25-100-200, 31.25-125, 12.5-50 MG)

generic

entacapone 200 mg tablet generic

TASMAR 100 MG TABLETtolcapone

BRAND

tolcapone 100 mg tablet generic

DOPAMINE AGONISTS

APOKYN 30 MG/3 ML CARTRIDGEapomorphine hcl


BROMOCRIPTINE MESYLATE (2.5 MG TABLET, 5 MGCAPSULE)

generic

PRAMIPEXOLE DI-HCL (0.375 MG TAB ER 24H, 1.5 MGTABLET, 0.125 MG TABLET, 2.25 MG TAB ER 24H, 0.5MG TABLET, 1.5 MG TAB ER 24H, 4.5 MG TAB ER 24H,0.25 MG TABLET, 0.75 MG TAB ER 24H, 3 MG TAB ER24H, 0.75 MG TABLET, 1 MG TABLET)

generic

ROPINIROLE HCL (3 MG TABLET, 2 MG TAB ER 24H, 8MG TAB ER 24H, 1 MG TABLET, 5 MG TABLET, 12 MGTAB ER 24H, 6 MG TAB ER 24H, 0.5 MG TABLET, 4 MGTABLET, 4 MG TAB ER 24H, 0.25 MG TABLET, 2 MGTABLET)

generic

DOPAMINE PRECURSORS/L-AMINO ACID DECARBOXYLASE INHIBITORS

carbidopa 25 mg tablet generic

CARBIDOPA/LEVODOPA (25MG-250MG TAB RAPDIS,25MG-250MG TABLET, 25MG-100MG TAB RAPDIS,25MG-100MG TABLET ER, 10MG-100MG TAB RAPDIS,50MG-200MG TABLET ER, 10MG-100MG TABLET,25MG-100MG TABLET)

generic

MONOAMINE OXIDASE B (MAO-B) INHIBITORS

SELEGILINE HCL (5 MG TABLET, 5 MG CAPSULE) generic

ANTIPSYCHOTICS

1ST GENERATION/TYPICAL

CHLORPROMAZINE HCL (100 MG TABLET, 200 MGTABLET, 25 MG TABLET, 10 MG TABLET, 25 MG/MLAMPUL, 50 MG TABLET)

generic

DROPERIDOL (2.5 MG/ML AMPUL, 2.5 MG/ML VIAL) generic

fluphenazine decanoate 25 mg/ml vial generic



FLUPHENAZINE HCL (2.5 MG/5ML ELIXIR, 10 MGTABLET, 5 MG TABLET, 2.5 MG TABLET, 5 MG/MLORAL CONC, 2.5 MG/ML VIAL, 1 MG TABLET)

generic

HALOPERIDOL (20 MG, 0.5 MG, 2 MG, 10 MG, 1 MG, 5MG)

generic

HALOPERIDOL DECANOATE (50 MG/ML VIAL, 100MG/ML AMPUL, 50 MG/ML AMPUL, 100 MG/ML VIAL)

generic

HALOPERIDOL LACTATE (2 MG/ML ORAL CONC, 5MG/ML VIAL, 5 MG/ML AMPUL)

generic

LOXAPINE SUCCINATE (10 MG, 5 MG, 50 MG, 25 MG) generic

MOLINDONE HCL (10 MG, 5 MG, 25 MG) generic GL Male

PIMOZIDE (2 MG, 1 MG) generic

THIORIDAZINE HCL (50 MG, 10 MG, 25 MG, 100 MG) generic

THIOTHIXENE (1 MG, 10 MG, 2 MG, 5 MG) generic

TRIFLUOPERAZINE HCL (10 MG, 1 MG, 2 MG, 5 MG) generic

2ND GENERATION/ATYPICAL

ABILIFY (10 MG, 30 MG, 20 MG, 15 MG, 5 MG)aripiprazole

BRAND QL

ABILIFY 1 MG/ML SOLUTIONaripiprazole

BRAND C 30ml/DAY

ABILIFY 2 MG TABLETaripiprazole

BRAND QL

ABILIFY 9.7 MG/1.3 ML VIALaripiprazole

BRAND C 30ml/day

ABILIFY DISCMELT (10 MG, 15 MG)aripiprazole

BRAND QL

ABILIFY MAINTENA ER 300 MG SYRaripiprazole

BRANDQL

PA

ABILIFY MAINTENA ER 300 MG VLaripiprazole

BRANDPA

C 30ml/day

ABILIFY MAINTENA ER 400 MG SYRaripiprazole

BRANDQL

PA

ABILIFY MAINTENA ER 400 MG VLaripiprazole

BRANDPA

C 30ml/DAY

ARIPIPRAZOLE (15 MG, 10 MG) generic QL

QL



ARIPIPRAZOLE (15 MG, 10 MG, 30 MG, 5 MG, 20 MG, 2MG)

generic

aripiprazole 1 mg/ml solution generic QL

GEODON 20 MG/ML VIALziprasidone mesylate

BRAND

INVEGA SUSTENNA (156 MG SY, 117 MG SY, 39 MGSYR, 234 MG SY, 78 MG SYR)paliperidone palmitate

BRANDPA

C must try 1 oralantipsychotic

INVEGA TRINZA (819 MG/2.625 ML, 546 MG/1.75 ML)paliperidone palmitate

BRANDQL

PA

INVEGA TRINZA 273 MG/0.875 MLpaliperidone palmitate

BRANDQL

PA

INVEGA TRINZA 410 MG/1.315 MLpaliperidone palmitate

BRANDQL

PA

OLANZAPINE (10 MG, 5 MG, 20 MG) genericQL

PA

OLANZAPINE (15 MG TAB RAPDIS, 10 MG VIAL) generic QL

OLANZAPINE (20 MG, 10 MG, 5 MG, 2.5 MG, 7.5 MG, 15MG)

generic QL

PALIPERIDONE (9 MG ER 24, 6 MG ER 24, 1.5 MG ER24, 3 MG ER 24)

generic

QUETIAPINE FUMARATE (200 MG, 50 MG, 400 MG, 25MG, 300 MG, 100 MG)

generic QL

RISPERDAL CONSTA (25 MG, 12.5 MG, 50 MG, 37.5MG)risperidone microspheres

BRAND PA

RISPERIDONE (1 MG TAB RAPDIS, 2 MG TABLET, 4 MGTAB RAPDIS, 4 MG TABLET, 0.25 MG TABLET, 1 MG/MLSOLUTION, 2 MG TAB RAPDIS, 0.25 MG TAB RAPDIS, 3MG TAB RAPDIS, 0.5 MG TAB RAPDIS, 1 MG TABLET, 3MG TABLET, 0.5 MG TABLET)

generic

SEROQUEL XR (200 MG, 150 MG, 400 MG, 300 MG)quetiapine fumarate

BRAND

QL

C

dosage <150mg/daybeyond initial 30 dayswill require PA forthosebetween 13-64yrs ofage

SEROQUEL XR 50 MG TABLETquetiapine fumarate

BRAND QL



C

dosage <150mg/daybeyond initial 30 dayswill require PA forthosebetween 13-64yrs ofage

SEROQUEL XR SAMPLE KITquetiapine fumarate

BRAND

ZIPRASIDONE HCL (80 MG, 60 MG, 20 MG, 40 MG) generic QL

TREATMENT-RESISTANT

CLOZAPINE (50 MG TABLET, 12.5 MG TAB RAPDIS, 200MG TABLET, 25 MG TABLET, 100 MG TABLET, 150 MGTAB RAPDIS, 25 MG TAB RAPDIS, 200 MG TABRAPDIS, 100 MG TAB RAPDIS)

generic

ANTIVIRALS

ANTI-CYTOMEGALOVIRUS (CMV) AGENTS

cidofovir 75 mg/ml vial generic

foscarnet sodium 24 mg/ml infus. btl generic

ganciclovir sodium 500 mg vial generic

VALCYTE (450 MG TABLET, 50 MG/ML SOLUTION)valganciclovir hcl

BRAND

valganciclovir hcl 450 mg tablet generic

ANTI-HEPATITIS B (HBV) AGENTS

adefovir dipivoxil 10 mg tablet generic

BARACLUDE 0.05 MG/ML SOLUTIONentecavir


ENTECAVIR (0.5 MG, 1 MG) genericQL

S Specialty Drug

EPIVIR HBV 25 MG/5 ML SOLNlamivudine

BRAND

lamivudine 100 mg tablet generic

TYZEKA 600 MG TABLETtelbivudine

BRAND

ANTI-HEPATITIS C (HCV) AGENTS

HARVONI 90-400 MG TABLETledipasvir/sofosbuvir

BRAND

QL

PA

S Specialty Drug



INCIVEK 375 MG TABLETtelaprevir

BRANDPA

S Specialty Drug

INFERGEN (15 MCG/0.5 ML, 9 MCG/0.3 ML)interferon alfacon-1

BRANDPA

S Specialty Drug

INTRON A (50 UNITS VIL, 6 UNIT/ML VL, 10 UNIT/ML, 18UNITS VIL, 10 UNITS VIL)interferon alfa-2b,recomb.

BRAND

MODERIBA 200 MG TABLETribavirin

BRANDPA

S Specialty Drug

PEGASYS (180 MCG/ML VIAL, 180 MCG/0.5 MLSYRINGE)peginterferon alfa-2a

BRANDPA

S Specialty Drug

PEGASYS PROCLICK (180, 135)peginterferon alfa-2a

BRANDPA

S Specialty Drug

RIBASPHERE (600 MG TABLET, 400 MG TABLET, 200MG TABLET, 200 MG CAPSULE)ribavirin

BRANDPA

S Specialty Drug

RIBASPHERE RIBAPAK (200-400 MG, 600-600 MG, 600-400 MG, 400-400 MG)ribavirin

BRANDPA

S Specialty Drug

RIBAVIRIN (200 MG CAPSULE, 200 MG TABLET) genericPA

S Specialty Drug

SOVALDI 400 MG TABLETsofosbuvir

BRAND

QL

PA

S Specialty Drug

TECHNIVIE DOSE PACKombitasvir/paritaprevir/ritonavir

BRAND

QL

PA

S Specialty Drug

VICTRELIS 200 MG CAPSULEboceprevir

BRANDPA

S Specialty Drug

ANTI-HIV AGENTS, INTEGRASE INHIBITORS (INSTI)

ISENTRESS (100 MG POWDER PACKET, 25 MGTABLET CHEW, 400 MG TABLET, 100 MG TABLETCHEW)raltegravir potassium

BRAND PA

STRIBILD TABLET BRAND



elvitegravir/cobicistat/emtricitabine/tenofovir

TIVICAY 50 MG TABLETdolutegravir sodium

BRAND

ANTI-HIV AGENTS, NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTI)

ATRIPLA TABLETefavirenz/emtricitabine/tenofovir disoproxil fumarate

BRAND

COMPLERA TABLETemtricitabine/rilpivirine hcl/tenofovir disoproxil fumarate

BRAND

EDURANT 25 MG TABLETrilpivirine hcl

BRAND

INTELENCE (25 MG, 200 MG, 100 MG)etravirine

BRAND

NEVIRAPINE (100 MG TAB ER 24H, 50 MG/5 ML ORALSUSP, 200 MG TABLET, 400 MG TAB ER 24H)

generic

RESCRIPTOR (100 MG, 200 MG)delavirdine mesylate

BRAND

SUSTIVA (200 MG CAPSULE, 600 MG TABLET, 50 MGCAPSULE)efavirenz

BRAND

VIRAMUNE XR (400 MG, 100 MG)nevirapine

BRAND

ANTI-HIV AGENTS, NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)

abacavir sulfate 300 mg tablet generic

abacavir/lamivudine/zidovudine 150-300mg tablet generic

DIDANOSINE (250 MG, 400 MG, 200 MG, 125 MG) generic

EMTRIVA (10 MG/ML SOLUTION, 200 MG CAPSULE)emtricitabine

BRAND

EPIVIR 10 MG/ML ORAL SOLNlamivudine

BRAND

EPZICOM TABLETabacavir sulfate/lamivudine

BRAND

LAMIVUDINE (300 MG TABLET, 10 MG/ML SOLUTION,150 MG TABLET)

generic

lamivudine/zidovudine 150-300mg tablet generic

STAVUDINE (30 MG CAPSULE, 40 MG CAPSULE, 15MG CAPSULE, 20 MG CAPSULE, 1 MG/ML SOLNRECON)

generic

TRUVADA 200 MG-300 MG TABLETemtricitabine/tenofovir disoproxil fumarate

BRAND



VIDEX (2, 4)didanosine

BRAND

VIREAD (POWDER, 300 MG TABLET, 200 MG TABLET,150 MG TABLET, 250 MG TABLET)tenofovir disoproxil fumarate

BRAND

ZIAGEN 20 MG/ML SOLUTIONabacavir sulfate

BRAND

ZIDOVUDINE (10 MG/ML SYRUP, 300 MG TABLET, 100MG CAPSULE)

generic

ANTI-HIV AGENTS, OTHER

FUZEON (90 MG VIAL, CONVENIENCE KIT)enfuvirtide

BRAND

SELZENTRY (300 MG, 150 MG)maraviroc

BRAND PA

ANTI-HIV AGENTS, PROTEASE INHIBITORS

APTIVUS (100 MG/ML SOLUTION, 250 MG CAPSULE)tipranavir

BRAND

CRIXIVAN (400 MG, 200 MG)indinavir sulfate

BRAND

INVIRASE (500 MG TABLET, 200 MG CAPSULE)saquinavir mesylate

BRAND

KALETRA (100-25 MG TABLET, 400-100/5 ML ORALSOLU, 200-50 MG TABLET)lopinavir/ritonavir

BRAND

LEXIVA (50 MG/ML SUSPENSION, 700 MG TABLET)fosamprenavir calcium

BRAND

NORVIR (80 MG/ML SOLUTION, 100 MG TABLET, 100MG SOFTGEL CAP)ritonavir

BRAND

PREZISTA (600 MG TABLET, 100 MG/ML SUSPENSION,150 MG TABLET, 400 MG TABLET, 800 MG TABLET, 75MG TABLET)darunavir ethanolate

BRAND

REYATAZ (200 MG, 100 MG, 300 MG, 150 MG)atazanavir sulfate

BRAND

VIRACEPT (625 MG, 250 MG)nelfinavir mesylate

BRAND

ANTI-INFLUENZA AGENTS

RELENZA 5 MG DISKHALERzanamivir

BRAND C max 10 day supply/fill



rimantadine hcl 100 mg tablet generic

TAMIFLU (45 MG, 30 MG)oseltamivir phosphate

BRAND

TAMIFLU 6 MG/ML SUSPENSIONoseltamivir phosphate

BRAND C 25ml/day

TAMIFLU 75 MG CAPSULEoseltamivir phosphate

BRAND C 20 capsules/180 days

ANTIHERPETIC AGENTS

ACYCLOVIR (200 MG CAPSULE, 400 MG TABLET, 800MG TABLET, 200 MG/5ML ORAL SUSP)

generic

acyclovir 5 % oint. (g) generic C 15gm/fill

ACYCLOVIR SODIUM (500 MG, 50 MG/ML, 1000 MG) generic

FAMCICLOVIR (500 MG, 250 MG, 125 MG) generic

trifluridine 1 % drops generic

VALACYCLOVIR HCL (500 MG, 1000 MG) generic

ZOVIRAX 5% CREAMacyclovir

BRAND C 5gm/fill

ANXIOLYTICS

ANXIOLYTICS, OTHER

BUSPIRONE HCL (5 MG, 30 MG, 7.5 MG, 10 MG, 15 MG) generic

MIDAZOLAM HCL (5 MG/ML(1) VIAL, 2 MG/ML SYRUP, 2MG/2 ML VIAL, 5 MG/ML VIAL, 5 MG/5 ML VIAL, 10 MG/2ML VIAL, 10 MG/10ML VIAL)

generic

MIDAZOLAM HCL/PF (5 MG/ML SYRINGE, 5 MG/MLCARTRIDGE, 5 MG/5 ML VIAL, 2 MG/2 ML CARTRIDGE,10 MG/2 ML VIAL, 2 MG/2 ML VIAL, 10 MG/2 MLSYRINGE, 5 MG/ML(1) VIAL, 2 MG/2 ML SYRINGE)

generic

BENZODIAZEPINES

ALPRAZOLAM (2 MG TAB RAPDIS, 1 MG TABLET, 0.25MG TAB RAPDIS, 0.5 MG TAB RAPDIS, 0.5 MG TAB ER24H, 2 MG TABLET, 3 MG TAB ER 24H, 1 MG TABRAPDIS, 1 MG TAB ER 24H, 0.25 MG TABLET, 2 MGTAB ER 24H, 0.5 MG TABLET)

generic

ALPRAZOLAM 1 MG/ML ORAL CONCalprazolam

BRAND

CHLORDIAZEPOXIDE HCL (25 MG, 5 MG, 10 MG) generic

CLONAZEPAM (0.125 MG TAB RAPDIS, 0.5 MGTABLET, 1 MG TAB RAPDIS, 0.25 MG TAB RAPDIS, 1 generic



MG TABLET, 0.5 MG TAB RAPDIS, 2 MG TAB RAPDIS, 2MG TABLET)

CLORAZEPATE DIPOTASSIUM (7.5 MG, 3.75 MG, 15MG)

generic

DIAZEPAM (2 MG TABLET, 10 MG TABLET, 5 MG/5 MLSOLUTION, 5 MG/ML SYRINGE, 5 MG/ML ORAL CONC,5 MG TABLET, 5 MG/ML VIAL)

generic

LORAZEPAM (4 MG/ML SYRINGE, 2 MG/ML SYRINGE,0.5 MG TABLET, 4 MG/ML VIAL, 2 MG/ML VIAL, 1 MGTABLET, 2 MG/ML ORAL CONC, 2 MG TABLET)

generic

LORAZEPAM INTENSOL 2 MG/MLlorazepam

BRAND

OXAZEPAM (10 MG, 15 MG, 30 MG) generic

BIPOLAR AGENTS

MOOD STABILIZERS

LITHIUM CARBONATE (300 MG TABLET ER, 300 MGTABLET, 300 MG CAPSULE, 600 MG CAPSULE, 150 MGCAPSULE, 450 MG TABLET ER)

generic

lithium citrate 8 meq/5 ml solution generic

BLOOD GLUCOSE REGULATORS

ANTIDIABETIC AGENTS

ACARBOSE (50 MG, 25 MG, 100 MG) generic

ACTOPLUS MET XR (30-1,000 MG, 15-1,000 MG)pioglitazone hcl/metformin hcl

BRAND PA

BYDUREON 2 MG PEN INJECTexenatide microspheres

BRANDPA

C 1 unit/7 days

BYDUREON 2 MG VIALexenatide microspheres

BRANDPA

C 1 unit/7 days

BYETTA (5 MCG, 10 MCG)exenatide

BRANDQL

PA

GLIMEPIRIDE (1 MG, 4 MG, 2 MG) generic

GLIPIZIDE (10 MG TAB ER 24, 5 MG TABLET, 10 MGTABLET, 5 MG TAB ER 24, 2.5 MG TAB ER 24)

generic

GLIPIZIDE/METFORMIN HCL (2.5-250 MG, 5 MG-500MG,2.5-500 MG)

generic

GLYBURIDE (2.5 MG, 5 MG, 1.25 MG) generic



GLYBURIDE,MICRONIZED (3 MG, 6 MG, 1.5 MG) generic

GLYBURIDE/METFORMIN HCL (2.5-500 MG, 1.25-250MG, 5 MG-500MG)

generic

INVOKAMET (50-1,000 MG, 50-500 MG, 150-500 MG,150-1,000 MG)canagliflozin/metformin hcl

BRANDQL

C must try metformin for6 months

INVOKANA (100 MG, 300 MG)canagliflozin

BRAND

JANUMET (50-1,000 MG, 50-500 MG)sitagliptin phosphate/metformin hcl

BRANDST

C must try metformin for6 mos

JANUMET XR (50-500 MG, 50-1,000 MG, 100-1,000 MG)sitagliptin phosphate/metformin hcl

BRANDST


JANUVIA (25 MG, 100 MG)sitagliptin phosphate

BRANDST


JANUVIA 50 MG TABLETsitagliptin phosphate

BRAND

PA

ST


JENTADUETO (2.5 MG-850 MG, 2.5 MG-1000 MG, 2.5MG-500 MG)linagliptin/metformin hcl

BRANDST


METFORMIN HCL (850 MG TABLET, 750 MG TAB ER24H, 1000 MG TABERGR24H, 1000 MG TAB ER 24, 500MG TABERGR24H, 1000 MG TABLET, 500 MG TAB ER24, 500 MG TAB ER 24H)

generic

metformin hcl 500 mg tablet generic GL Male

NATEGLINIDE (120 MG, 60 MG) generic PA

PIOGLITAZONE HCL (30 MG, 15 MG, 45 MG) generic

PIOGLITAZONE HCL/GLIMEPIRIDE (30 MG-4 MG, 30MG-2 MG)

generic

PIOGLITAZONE HCL/METFORMIN HCL (15MG-500MG,15MG-850MG)

generic

REPAGLINIDE (1 MG, 2 MG, 0.5 MG) generic

REPAGLINIDE/METFORMIN HCL (1MG-500MG, 2 MG-500MG)

generic

RIOMET 500 MG/5 ML SOLUTION BRAND



metformin hcl

SYMLINPEN 120 PEN INJECTORpramlintide acetate

BRAND PA

SYMLINPEN 60 PEN INJECTORpramlintide acetate

BRAND PA

TOLAZAMIDE (250 MG, 500 MG) generic

tolbutamide 500 mg tablet generic

TRADJENTA 5 MG TABLETlinagliptin

BRANDST


VICTOZA 2-PAK 18 MG/3 ML PENliraglutide

BRANDQL

PA

VICTOZA 3-PAK 18 MG/3 ML PENliraglutide

BRANDQL

PA

GLYCEMIC AGENTS

GLUCAGEN (1 MG HYPOKIT, DIAGNOSTIC 1 MG VIAL,1 MG HYPOKIT 2-PACK)glucagon,human recombinant

BRAND

GLUCAGON 1 MG EMERGENCY KITglucagon,human recombinant

BRAND

glucagon hcl 1 mg vial generic

PROGLYCEM 50 MG/ML ORAL SUSPdiazoxide

BRAND

INSULINS

HUMALOG 200 UNITS/ML KWIKPENinsulin lispro

BRAND

HUMULIN R 500 UNITS/ML VIALinsulin regular, human

BRAND

LANTUS 100 UNITS/ML VIALinsulin glargine,human recombinant analog

BRAND

LANTUS SOLOSTAR 100 UNITS/MLinsulin glargine,human recombinant analog

BRAND

LEVEMIR 100 UNITS/ML VIALinsulin detemir

BRAND

LEVEMIR FLEXPEN 100 UNITS/MLinsulin detemir

BRAND

LEVEMIR FLEXTOUCH 100 UNITS/MLinsulin detemir

BRAND



BLOOD PRODUCTS/MODIFIERS/VOLUME EXPANDERS

ANTICOAGULANTS

ACD INJECTION SOLUTIONdextrose-water/sodium citrate/citric acid

BRAND

ACD-A SOLUTIONcitrate dextrose solution

BRAND

argatroban in nacl,iso-osmotic 50 mg/50ml vial generic PA

citrate phosphate dextros soln 2.63 g/100 solution generic

ENOXAPARIN SODIUM (300MG/3ML VIAL, 150 MG/MLSYRINGE, 120MG/.8ML SYRINGE, 100 MG/MLSYRINGE, 40MG/0.4ML SYRINGE, 30MG/0.3MLSYRINGE, 80MG/0.8ML SYRINGE, 60MG/0.6MLSYRINGE)

generic C PA required if days'supply > or =11 days

FONDAPARINUX SODIUM (10MG/0.8ML, 2.5 MG/0.5,5MG/0.4ML, 7.5MG/0.6)

generic

PA

C PA required if days'supply > or =11 days

S Specialty Drug

HEPARIN 50 UNITS/5 ML (10/ML)heparin sodium,porcine/pf

BRAND

HEPARIN SODIUM,PORCINE (20000/ML VIAL, 10UNIT/ML VIAL, 1000/ML VIAL, 100/ML (1) SYRINGE, 10UNIT/ML SYRINGE, 300/3 ML SYRINGE, 100/ML VIAL,5000/ML VIAL, 200/2 ML SYRINGE, 5000/ML(1)CARTRIDGE, 500/5 ML SYRINGE, 10000/ML VIAL)

generic

HEPARIN SODIUM,PORCINE IN 0.45 % SODIUMCHLORIDE (HEPAR25000/500, HEPAR25000/250)

generic

HEPARIN SODIUM,PORCINE IN 0.9 % SODIUMCHLORIDE (1K/1000 ML IV SOLN, 100/ML KIT, 10UNIT/ML KIT, 6K/1000 ML IV SOLN)

generic

HEPARIN SODIUM,PORCINE IN 0.9 % SODIUMCHLORIDE/PF (2K/1000ML, 1000/500ML)

generic

HEPARIN SODIUM,PORCINE/DEXTROSE 5 % INWATER (25000/250, 20K/500ML, 12500/250, 25000/500)

generic

HEPARIN SODIUM,PORCINE/PF (5000/0.5ML SYRINGE,500/5 ML SYRINGE, 300/3 ML SYRINGE, 100/ML (1)VIAL, 10 UNIT/ML SYRINGE, 100/ML (1) SYRINGE,5000/0.5ML VIAL, 1000/10 ML SYRINGE, 200/2 MLSYRINGE, 1000/ML VIAL, 10 UNIT/ML VIAL, 1 UNIT/MLSYRINGE)

generic

JANTOVEN (7.5 MG, 6 MG, 5 MG, 2.5 MG, 2 MG, 4 MG, 3MG, 1 MG, 10 MG)warfarin sodium

BRAND



MONOJECT PREFILL ADVANCED (500 UNIT/5 ML(100/ML), 50 UNITS/5 ML (10/ML), 30 UNITS/3 ML(10/ML), 300 UNIT/3 ML (100/ML), 1,000 UNIT/10(100/ML), 100 UNIT/10 ML (10/ML))heparin sodium,porcine/pf

BRAND

PRADAXA (75 MG, 150 MG)dabigatran etexilate mesylate

BRAND PA

protamine sulfate 10 mg/ml vial generic

TRICITRASOL 46.7% VIALsodium citrate dihydrate

BRAND

WARFARIN SODIUM (5 MG, 2.5 MG, 7.5 MG, 1 MG, 2MG, 10 MG, 6 MG, 3 MG, 4 MG)

generic

XARELTO (15 MG, 20 MG, 10 MG)rivaroxaban

BRAND

BLOOD FORMATION MODIFIERS

ANAGRELIDE HCL (1 MG, 0.5 MG) generic

LEUKINE (250 MCG, 500 MCG/ML)sargramostim

BRANDPA

S Specialty Drug

MOZOBIL (24 MG/1.2 ML, 20 MG/ML)plerixafor

BRAND

NEULASTA (6 ML SYRINGE, ONPRO 6 ML KIT)pegfilgrastim

BRANDPA

S Specialty Drug

NEUMEGA 5 MG VIALoprelvekin


PROCRIT (20,000, 10,000, 2,000, 3,000, 40,000, 4,000)epoetin alfa

BRANDPA

S Specialty Drug

PROMACTA (75 MG, 50 MG, 25 MG, 12.5 MG)eltrombopag olamine


COAGULANTS

ADVATE (801-1,200, 401-800, 200-400, 3,601-4,800,1,201-1,800, 1,801-2,400)antihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 1,201-1,800 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 1,801-2,400 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 200-400 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)




ADVATE 401-800 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ADVATE 801-1,200 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


ALPHANATE (1,500-600, 1,000-400, 250-100, 500-200,2,000-800)antihemophilic factor, human/von willebrand factor,human


AMINOCAPROIC ACID (250 MG/ML VIAL, 250 MG/MLSOLUTION, 500 MG TABLET)

generic

BEBULIN 200-1,200 UNITS VIALfactor ix complex, prothrombin cplx conc(pcc) no.6, 3-factor

BRAND

BEBULIN VH IMMU 200-1,200 UNITfactor ix complex human


BENEFIX (3,000 KIT, 2,000 VIAL, 1,000 KIT, 250 KIT,2,000 KIT, 1,000 VIAL, 500 KIT, 250 VIAL, 500 VIAL)factor ix human recombinant


CORIFACT KITfactor xiii

BRAND

ELOCTATE (1,000, 250, 2,000, 3,000, 500, 1,500, 750)antihemophilic factor (fviii) recombinant, fc fusion protein

BRANDPA

S Specialty Drug

FEIBA NF (651-1,200 VIAL, 500 (NOMINAL), 1,750-3,250VIAL, 1,000 (NOMINAL), 2,500 (NOMINAL), 400-650VIAL)anti-inhibitor coagulant complex

BRAND

FEIBA VH IMMUNO 651-1,200 UNITanti-inhibitor coagulant complex

BRAND

HELIXATE FS (1,000, 250, 500, 2,000)antihemophilic factor viii, human recombinant

BRANDPA

S Specialty Drug

HELIXATE FS 3,000 UNITS VIALantihemophilic factor (fviii) recomb,full length (alb-free)


HUMATE-P (2,400, 1,200, 600)antihemophilic factor, human/von willebrand factor,human


IXINITY (1,000, 1,000 -2 VLS, 1,500, 1,500 -2 VLS, 500)factor ix human recombinant, threonine 148


KOATE-DVI (250 VIAL, 1,000 VIAL, 500 KIT)antihemophilic factor, human


KOATE-DVI 500 UNITS VIALantihemophilic factor, human

BRANDPA

S Specialty Drug

KOGENATE FS (2,000 UNIT VIAL, 1,000 UNIT-ADAPTER, 2,000 UNIT-ADAPTER, 3,000 UNITS VIAL, BRAND PA



250 UNIT VL-BIOSET, 500 UNIT VIAL, 1,000 UNIT-BIOSET, 500 UNIT VL-ADAPTR, 500 UNIT VL-BIOSET,1,000 UNITS VIAL)antihemophilic factor (fviii) recomb,full length (alb-free)

S Specialty Drug

KOGENATE FS (250 UNIT VIAL, 250 UNIT VL-ADAPTR,2,000 UNIT-BIOSET)antihemophilic factor (fviii) recomb,full length (alb-free)


MONONINE 1,000 UNITS KITfactor ix


MONSEL'S FERRIC SUBSULFATE SOLferric subsulfate

BRAND

NOVOEIGHT (250, 2,000, 1,000, 1,500, 500, 3,000)antihemophilic factor viii recombinant, b-domain truncated

BRAND

NOVOSEVEN RT (8 MG, 5 MG, 1 MG, 2 MG)coagulation factor viia (recombinant)

BRAND

PROFILNINE (500, 1,500, 1,000)factor ix complex, prothrombin cplx conc(pcc) no.4, 3-factor

BRANDPA

S Specialty Drug

PROFILNINE SD (1,500, 1,000, 500)factor ix complex human

BRANDPA

S Specialty Drug

RECOMBINATE (1,801-2,400, 1,241-1,800)antihemophilic factor viii, human recombinant

BRAND

RECOMBINATE (801-1,240 VL, 401-800 VIAL, 220-400VIAL)antihemophilic factor viii, human recombinant

BRANDPA

S Specialty Drug

RIASTAP VIALfibrinogen

BRAND

tranexamic acid 650 mg tablet generic

TRETTEN 2,500 UNIT VIALfactor xiii a-subunit, recombinant

BRAND

XYNTHA (500, 2,000, 250, 1,000)antihemophilic factor (factor viii) recomb,b-domain deleted

BRAND

XYNTHA SOLOFUSE (500 KIT, 3,000 KIT, 1,000 SYR,500 SYR, 3,000 SYR, 1,000 KIT, 2,000 SYR, 250 SYR,250 KIT, 2,000 KIT)antihemophilic factor (factor viii) recomb,b-domain deleted

BRAND

PLATELET MODIFYING AGENTS

aspirin/dipyridamole 25mg-200mg cpmp 12hr generic

BRILINTA (90 MG, 60 MG)ticagrelor

BRAND

CILOSTAZOL (50 MG, 100 MG) generic



CLOPIDOGREL BISULFATE (75 MG, 300 MG) generic

DIPYRIDAMOLE (75 MG TABLET, 25 MG TABLET, 50MG TABLET, 5 MG/ML VIAL)

generic

EFFIENT (10 MG, 5 MG)prasugrel hcl

BRAND

EPTIFIBATIDE (0.75 MG/ML, 2 MG/ML) generic PA

ZONTIVITY 2.08 MG TABLETvorapaxar sulfate

BRANDQL

PA

CARDIOVASCULAR AGENTS

ALPHA-ADRENERGIC AGONISTS

CLONIDINE (0.1MG/24HR, 0.2MG/24HR, 0.3MG/24HR) generic

CLONIDINE HCL (0.3 MG, 0.2 MG, 0.1 MG) generic

CLONIDINE HCL/PF (1000MCG/10, 5000MCG/10) generic

GUANFACINE HCL (2 MG, 1 MG) generic

METHYLDOPA (500 MG, 250 MG) generic

methyldopate hcl 250 mg/5ml vial generic

MIDODRINE HCL (5 MG, 2.5 MG, 10 MG) generic

ALPHA-ADRENERGIC BLOCKING AGENTS

DIBENZYLINE 10 MG CAPSULEphenoxybenzamine hcl

BRAND

DOXAZOSIN MESYLATE (4 MG, 1 MG, 2 MG, 8 MG) generic

phenoxybenzamine hcl 10 mg capsule generic

phentolamine mesylate 5 mg vial generic

PRAZOSIN HCL (1 MG, 2 MG, 5 MG) generic

RESERPINE (0.1 MG, 0.25 MG) generic

TERAZOSIN HCL (5 MG, 10 MG, 1 MG, 2 MG) generic

ANGIOTENSIN II RECEPTOR ANTAGONISTS

CANDESARTAN CILEXETIL (4 MG, 32 MG, 16 MG, 8MG)

generic

eprosartan mesylate 600 mg tablet generic

IRBESARTAN (75 MG, 300 MG, 150 MG) generic

LOSARTAN POTASSIUM (50 MG, 100 MG, 25 MG) generic

TELMISARTAN (80 MG, 20 MG, 40 MG) generic



VALSARTAN (80 MG, 320 MG, 40 MG, 160 MG) generic

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS

BENAZEPRIL HCL (20 MG, 5 MG, 40 MG, 10 MG) generic

CAPTOPRIL (50 MG, 25 MG, 100 MG, 12.5 MG) generic

ENALAPRIL MALEATE (5 MG, 20 MG, 2.5 MG, 10 MG) generic

enalaprilat dihydrate 1.25 mg/ml vial generic

FOSINOPRIL SODIUM (40 MG, 20 MG, 10 MG) generic

LISINOPRIL (10 MG, 30 MG, 40 MG, 2.5 MG, 5 MG, 20MG)

generic

MOEXIPRIL HCL (15 MG, 7.5 MG) generic

PERINDOPRIL ERBUMINE (4 MG, 8 MG, 2 MG) generic

QUINAPRIL HCL (5 MG, 10 MG, 40 MG, 20 MG) generic

RAMIPRIL (5 MG, 10 MG, 2.5 MG, 1.25 MG) generic

TRANDOLAPRIL (2 MG, 4 MG, 1 MG) generic

ANTIARRHYTHMICS

ADENOSINE (3 MG/ML SYRINGE, 3 MG/ML VIAL) generic

AMIODARONE HCL (50 MG/ML VIAL, 200 MG TABLET,100 MG TABLET, 50 MG/ML AMPUL, 400 MG TABLET,150 MG/3ML SYRINGE)

generic

FLECAINIDE ACETATE (50 MG, 150 MG, 100 MG) generic

ibutilide fumarate 0.1 mg/ml vial generic

MEXILETINE HCL (150 MG, 200 MG, 250 MG) generic

PACERONE (100 MG, 200 MG, 400 MG)amiodarone hcl

BRAND

PROCAINAMIDE HCL (500 MG/ML, 100 MG/ML) generic

PROPAFENONE HCL (300 MG TABLET, 425 MG CAPER 12H, 225 MG CAP ER 12H, 325 MG CAP ER 12H, 225MG TABLET, 150 MG TABLET)

generic

QUINIDINE GLUCONATE (80 MG/ML VIAL, 324 MGTABLET ER)

generic

QUINIDINE SULFATE (300 MG ER, 300 MG, 200 MG) generic

SORINE (80 MG, 160 MG, 240 MG, 120 MG)sotalol hcl

BRAND

SOTALOL HCL (240 MG, 160 MG, 120 MG, 80 MG) generic

TIKOSYN (500 MCG, 250 MCG, 125 MCG)dofetilide

BRAND



BETA-ADRENERGIC BLOCKING AGENTS

ACEBUTOLOL HCL (400 MG, 200 MG) generic

ATENOLOL (25 MG, 50 MG, 100 MG) generic

BETAXOLOL HCL (20 MG, 10 MG) generic

BISOPROLOL FUMARATE (5 MG, 10 MG) generic

CARVEDILOL (12.5 MG, 25 MG, 6.25 MG, 3.125 MG) generic

esmolol hcl 100mg/10ml vial generic

LABETALOL HCL (100 MG TABLET, 20 MG/4 MLSYRINGE, 5 MG/ML VIAL, 200 MG TABLET, 300 MGTABLET)

generic

METOPROLOL SUCCINATE (25 MG ER, 50 MG ER, 100MG ER, 200 MG ER)

generic

METOPROLOL TARTRATE (5 MG/5 ML SYRINGE, 5MG/5 ML AMPUL, 5 MG/5 ML VIAL, 50 MG TABLET, 25MG TABLET, 100 MG TABLET)

generic

NADOLOL (20 MG, 80 MG, 40 MG) generic

PINDOLOL (5 MG, 10 MG) generic

PROPRANOLOL HCL (60 MG CAP SA 24H, 80 MGTABLET, 80 MG CAP SA 24H, 60 MG TABLET, 10 MGTABLET, 20 MG/5 ML SOLUTION, 40 MG TABLET, 20MG TABLET, 120 MG CAP SA 24H, 1 MG/ML VIAL, 160MG CAP SA 24H, 40MG/5ML SOLUTION)

generic

TIMOLOL MALEATE (10 MG, 20 MG, 5 MG) generic

CALCIUM CHANNEL BLOCKING AGENTS

AFEDITAB CR (30 MG, 60 MG)nifedipine

BRAND

AMLODIPINE BESYLATE (5 MG, 2.5 MG, 10 MG) generic

CARTIA XT (120 MG, 300 MG, 180 MG, 240 MG)diltiazem hcl

BRAND

DILT-XR (120 MG, 180 MG, 240 MG)diltiazem hcl

BRAND

DILTIAZEM HCL (120 MG CAP ER 12H, 180 MG CAP ER24H, 30 MG TABLET, 120 MG CAP ER 24H, 420MGCAPSULE ER, 60 MG CAP ER 12H, 240 MG TAB ER24H, 5 MG/ML VIAL, 240 MG CAP ER DEG, 240 MG CAPER 24H, 100 MG VIAL PORT, 300 MG CAP ER 24H, 60MG TABLET, 120 MG CAP ER DEG, 240 MG CAPSULEER, 180 MG CAP ER DEG, 300 MG CAPSULE ER, 180MG TAB ER 24H, 180 MG CAPSULE ER, 420MG TAB ER24H, 300 MG TAB ER 24H, 360 MG CAP ER 24H, 90 MGCAP ER 12H, 360 MG CAPSULE ER, 120 MG CAPSULE

generic



ER, 90 MG TABLET, 360 MG TAB ER 24H, 120 MGTABLET)

FELODIPINE (5 MG ER, 2.5 MG ER, 10 MG ER) generic

ISRADIPINE (2.5 MG, 5 MG) generic

MATZIM LA (180 MG, 300 MG, 360 MG, 240 MG, 420MG)diltiazem hcl

BRAND

NICARDIPINE HCL (25 MG/10ML VIAL, 25 MG/10MLAMPUL, 20 MG CAPSULE, 30 MG CAPSULE)

generic

nicardipine hcl in 0.9% nacl 1 mg/10 ml syringe generic

NIFEDIAC CC 30 MG TABLETnifedipine

BRAND

NIFEDICAL XL (30 MG, 60 MG)nifedipine

BRAND

NIFEDIPINE (60 MG TABLET ER, 30 MG TAB ER 24, 60MG TAB ER 24, 30 MG TABLET ER, 90 MG TAB ER 24,90 MG TABLET ER)

generic

nimodipine 30 mg capsule generic

NISOLDIPINE (25.5 MG ER, 30 MG ER, 8.5MG ER, 40MG ER, 17 MG ER, 20 MG ER, 34 MG ER)

generic

TAZTIA XT (300 MG, 120 MG, 180 MG, 240 MG)diltiazem hcl

BRAND

VERAPAMIL HCL (300 MG CAP24H PCT, 2.5 MG/MLAMPUL, 2.5 MG/ML VIAL, 240 MG CAP24H PEL, 200 MGCAP24H PCT, 2.5 MG/ML SYRINGE, 180 MG TABLETER, 120 MG CAP24H PEL, 40 MG TABLET, 80 MGTABLET, 120 MG TABLET, 120 MG TABLET ER, 240 MGTABLET ER, 180 MG CAP24H PEL, 360 MG CAP24HPEL, 100 MG CAP24H PCT)

generic

CARDIOVASCULAR AGENTS, OTHER

alprostadil 500 mcg/ml vial generic

amiloride/hydrochlorothiazide 5 mg-50 mg tablet generic

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM (10MG-80MG, 10 MG-20MG, 2.5MG-20MG, 5 MG-20 MG,2.5MG-40MG, 2.5MG-10MG, 5 MG-80 MG, 10 MG-40MG,5 MG-40 MG, 5 MG-10 MG, 10 MG-10MG)

generic

AMLODIPINE BESYLATE/BENAZEPRIL HCL (2.5MG-10MG, 10 MG-40MG, 5 MG-40 MG, 10 MG-20MG, 5 MG-10 MG, 5 MG-20 MG)

generic

AMLODIPINE BESYLATE/VALSARTAN (10MG-160MG,5MG-320MG, 10MG-320MG)

generic QL



AMLODIPINEBESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE (5-160-25MG, 10MG-160MG, 5-160-12.5, 10-320-25, 10-160-25)

generic

amlodipine/valsartan 5 mg-160mg tablet generic

ATENOLOL/CHLORTHALIDONE (50 MG-25MG, 100MG-25MG)

generic

BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE (20-12.5MG, 10-12.5MG, 5-6.25MG, 20 MG-25MG)

generic

BISOPROLOL FUMARATE/HYDROCHLOROTHIAZIDE(10-6.25MG, 2.5-6.25MG, 5-6.25MG)

generic

CANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE(16-12.5MG, 32-12.5MG, 32MG-25MG)

generic

CAPTOPRIL/HYDROCHLOROTHIAZIDE (25 MG-25MG,25 MG-15MG, 50 MG-15MG, 50 MG-25MG)

generic

cardioplegic solution no.1 k+=16meq/l plst bg pf generic

CLORPRES (0.1-15, 0.2-15)clonidine hcl/chlorthalidone

BRAND

CORLANOR (5 MG, 7.5 MG)ivabradine hcl

BRAND QL

DEMSER 250 MG CAPSULEmetyrosine

BRAND

DIGITEK 250 MCG TABLETdigoxin

BRAND

DIGOX (250 MCG, 125 MCG)digoxin

BRAND

DIGOXIN (250 MCG/ML AMPUL, 125 MCG TABLET, 50MCG/ML SOLUTION, 250 MCG TABLET, 250 MCG/MLSYRINGE)

generic

DOBUTAMINE HCL (500MG/40ML, 250MG/20ML) generic

DOBUTAMINE HCL/DEXTROSE 5 % IN WATER(500MG/250, 250MG/250, 500 MG/500, 1000MG/250)

generic

DOPAMINE HCL (200 MG/5ML, 400 MG/5ML,800MG/10ML, 400MG/10ML, 800MG/5ML)

generic

DOPAMINE HCL/DEXTROSE 5 % IN WATER(400MG/0.5L, 200MG/.25L, 800MG/0.5L, 400MG/.25L,800MG/.25L)

generic

ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE(5MG-12.5MG, 10 MG-25MG)

generic

ephedrine sulfate 50 mg/ml vial generic



FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE (20-12.5 MG, 10-12.5MG)

generic

IRBESARTAN/HYDROCHLOROTHIAZIDE (300-12.5MG,150-12.5MG)

generic

LISINOPRIL/HYDROCHLOROTHIAZIDE (20-12.5 MG, 10-12.5MG, 20 MG-25MG, 20-25MG)

generic

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE(50-12.5 MG, 100-12.5MG, 100MG-25MG)

generic

METHYLDOPA/HYDROCHLOROTHIAZIDE (250MG-25MG, 250MG-15MG)

generic

METOPROLOL TARTRATE/HYDROCHLOROTHIAZIDE(50 MG-25MG, 100MG-50MG, 100MG-25MG)

generic

milrinone lactate 1 mg/ml vial generic

MILRINONE LACTATE/DEXTROSE 5 % IN WATER(40MG/200ML, 20MG/100ML)

generic

MOEXIPRIL HCL/HYDROCHLOROTHIAZIDE (15-25MG,15-12.5MG, 7.5-12.5MG)

generic

NADOLOL/BENDROFLUMETHIAZIDE (40 MG, 80 MG) generic

NOREPINEPHRINE BITARTRATE (1 MG/ML AMPUL, 1MG/ML VIAL)

generic

NOREPINEPHRINE BITARTRATE IN 0.9 % SODIUMCHLORIDE (8 MG/250ML, 4MG/250ML)

generic

NORTHERA (200 MG, 300 MG, 100 MG)droxidopa

BRANDQL

PA

pentoxifylline 400 mg tablet er generic

phenylephrine hcl 10 mg/ml vial generic

PHENYLEPHRINE HCL IN 0.9 % SODIUM CHLORIDE/PF(1 MG/10 ML SYRINGE, 80MG/250ML PLAST. BAG)

generic

phenylephrine hcl in 0.9% nacl 1 mg/10 ml syringe generic

PROPRANOLOL HCL/HYDROCHLOROTHIAZIDE (80,40)

generic

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE (10-12.5MG, 20 MG-25MG, 20-12.5 MG)

generic

spironolact/hydrochlorothiazid 25 mg-25mg tablet generic

TELMISARTAN/AMLODIPINE BESYLATE (80 MG-10MG,40 MG-10MG, 80 MG-5 MG, 40 MG-5 MG)

generic

TELMISARTAN/HYDROCHLOROTHIAZIDE (40-12.5 MG,80-12.5MG, 80 MG-25MG)

generic



TRANDOLAPRIL/VERAPAMIL HCL (1-240MG, 4-240MG,2-240MG, 2 MG-180MG)

generic

TRIAMTERENE/HYDROCHLOROTHIAZIDE (50 MG-25MG CAPSULE, 37.5-25 MG CAPSULE, 75 MG-50MGTABLET, 37.5-25 MG TABLET)

generic

VALSARTAN/HYDROCHLOROTHIAZIDE (160-12.5MG,160-25MG, 320MG-25MG, 80-12.5MG, 320-12.5MG)

generic

DIURETICS, CARBONIC ANHYDRASE INHIBITORS

ACETAZOLAMIDE (125 MG TABLET, 500 MG CAPSULEER, 250 MG TABLET)

generic

acetazolamide sodium 500 mg vial generic

DIURETICS, LOOP

BUMETANIDE (1 MG TABLET, 0.5 MG TABLET, 2 MGTABLET, 0.25 MG/ML VIAL)

generic

ethacrynate sodium 50 mg vial generic

FUROSEMIDE (80 MG TABLET, 20 MG TABLET, 10MG/ML SYRINGE, 40 MG TABLET, 10 MG/MLSOLUTION, 40MG/5ML SOLUTION, 10 MG/ML VIAL)

generic

TORSEMIDE (5 MG TABLET, 20 MG/2 ML VIAL, 10 MGTABLET, 20 MG TABLET, 100 MG TABLET)

generic

DIURETICS, POTASSIUM-SPARING

amiloride hcl 5 mg tablet generic

EPLERENONE (25 MG, 50 MG) generic

SPIRONOLACTONE (50 MG, 100 MG, 25 MG) generic

DIURETICS, THIAZIDE

CHLOROTHIAZIDE (250 MG, 500 MG) generic

chlorothiazide sodium 500 mg vial generic

CHLORTHALIDONE (25 MG, 50 MG) generic

HYDROCHLOROTHIAZIDE (12.5 MG CAPSULE, 50 MGTABLET, 12.5 MG TABLET, 25 MG TABLET)

generic

INDAPAMIDE (2.5 MG, 1.25 MG) generic

methyclothiazide 5 mg tablet generic

METOLAZONE (10 MG, 2.5 MG, 5 MG) generic

DYSLIPIDEMICS, FIBRIC ACID DERIVATIVES

FENOFIBRATE (50 MG CAPSULE, 40 MG TABLET, 54MG TABLET, 160 MG TABLET, 150 MG CAPSULE, 120MG TABLET)

generic



FENOFIBRATE NANOCRYSTALLIZED (145MG, 48 MG) generic

FENOFIBRATE,MICRONIZED (43 MG, 130 MG, 67 MG,134MG, 200 MG)

generic

FENOFIBRIC ACID (35 MG, 105 MG) generic

FENOFIBRIC ACID (CHOLINE) (45 MG, 135 MG) generic

gemfibrozil 600 mg tablet generic

DYSLIPIDEMICS, HMG COA REDUCTASE INHIBITORS

ATORVASTATIN CALCIUM (20 MG, 40 MG, 80 MG, 10MG)

generic

FLUVASTATIN SODIUM (40 MG CAPSULE, 80 MG TABER 24H, 20 MG CAPSULE)

generic

LOVASTATIN (10 MG, 40 MG, 20 MG) generic

PRAVASTATIN SODIUM (20 MG, 80 MG, 40 MG, 10 MG) generic

SIMVASTATIN (20 MG, 40 MG, 5 MG, 80 MG, 10 MG) generic

DYSLIPIDEMICS, OTHER

CHOLESTYRAMINE (WITH SUGAR) (SUAR) 4 POWDER,SUAR) 4 POWD PACK)

generic

CHOLESTYRAMINE/ASPARTAME (4 POWD PACK, 4POWDER)

generic

COLESTIPOL HCL (5 PACKET, 1 TABLET, 5 RANULES) generic

JUXTAPID (60 MG, 40 MG, 30 MG, 5 MG, 20 MG, 10 MG)lomitapide mesylate

BRANDPA

S Specialty Drug

NIACIN (1000 MG ER, 750 MG ER, 500 MG ER) generic

omega-3 acid ethyl esters 1 g capsule generic

PREVALITE (PACKET, POWDER)cholestyramine/aspartame

BRAND

VASCEPA 1 GM CAPSULEicosapent ethyl

BRAND

ZETIA 10 MG TABLETezetimibe

BRAND PA

VASODILATORS, DIRECT-ACTING ARTERIAL

CORLOPAM 10 MG/ML VIALfenoldopam mesylate

BRAND

HYDRALAZINE HCL (50 MG TABLET, 10 MG TABLET, 25MG TABLET, 20 MG/ML VIAL, 100 MG TABLET)

generic

MINOXIDIL (10 MG, 2.5 MG) generic



VASODILATORS, DIRECT-ACTING ARTERIAL/VENOUS

amyl nitrite 0.3 ml ampul generic

ISOSORBIDE DINITRATE (40 MG ER, 5 MG, 10 MG, 20MG, 30 MG)

generic

ISOSORBIDE MONONITRATE (10 MG TABLET, 60 MGTAB ER 24H, 30 MG TAB ER 24H, 20 MG TABLET, 120MG TAB ER 24H)

generic

NITRO-BID 2% OINTMENTnitroglycerin

BRAND

NITRO-TIME (ER 9 MG, ER 6.5 MG, ER 2.5 MG)nitroglycerin

BRAND

NITROGLYCERIN (2.5 MG CAPSULE ER, 0.2MG/HRPATCH TD24, 0.6MG/HR PATCH TD24, 400MCG/SPRSPRAY, 50 MG/10ML VIAL, 9 MG CAPSULE ER,0.4MG/HR PATCH TD24, 6.5 MG CAPSULE ER,0.1MG/HR PATCH TD24)

generic

NITROGLYCERIN/DEXTROSE 5 % IN WATER(50MG/500ML, 100MG/250, 200MG/500, 25MG/250ML,50MG/250ML)

generic

NITROSTAT (0.4 MG, 0.6 MG, 0.3 MG)nitroglycerin

BRAND

CENTRAL NERVOUS SYSTEM AGENTS

ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, AMPHETAMINES

DEXEDRINE 10 MG TABLETdextroamphetamine sulfate

BRAND

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE (30MG TABLET, 20 MG TABLET, 10 MG TABLET, 30 MGCAP ER 24H, 7.5 MG TABLET, 12.5 MG TABLET, 15 MGTABLET, 10 MG CAP ER 24H, 20 MG CAP ER 24H, 15MG CAP ER 24H, 5 MG CAP ER 24H, 25 MG CAP ER24H, 5 MG TABLET)

generic

DEXTROAMPHETAMINE SULFATE (15 MG CAPSULEER, 5 MG/5 ML SOLUTION, 5 MG TABLET, 5 MGCAPSULE ER, 10 MG TABLET, 10 MG CAPSULE ER)

generic

methamphetamine hcl 5 mg tablet generic PA

PROCENTRA 5 MG/5 ML SOLUTIONdextroamphetamine sulfate

BRAND

VYVANSE (60 MG, 20 MG, 50 MG, 30 MG, 10 MG, 70MG, 40 MG)lisdexamfetamine dimesylate

BRAND



ATTENTION DEFICIT HYPERACTIVITY DISORDER AGENTS, NON-AMPHETAMINES

clonidine hcl 0.1 mg tab er 12h generic

DEXMETHYLPHENIDATE HCL (30 MG CPBP 50-50, 5MG TABLET, 20 MG CPBP 50-50, 15 MG CPBP 50-50, 10MG CPBP 50-50, 40 MG CPBP 50-50, 5 MG CPBP 50-50,10 MG TABLET, 2.5 MG TABLET)

generic

GUANFACINE HCL (1 MG ER, 3 MG ER, 4 MG ER, 2 MGER)

generic

METADATE ER 20 MG TABLETmethylphenidate hcl

BRAND

METHYLPHENIDATE HCL (54 MG TAB ER 24, 10 MGTABLET, 10 MG TABLET ER, 27 MG TAB ER 24, 20 MGCPBP 30-70, 50 MG CPBP 30-70, 5 MG TABLET, 30 MGCPBP 50-50, 10 MG/5 ML SOLUTION, 5 MG/5 MLSOLUTION, 10 MG CPBP 30-70, 5 MG TAB CHEW, 40MG CPBP 50-50, 20 MG TABLET, 20 MG CPBP 50-50,2.5 MG TAB CHEW, 18 MG TAB ER 24, 40 MG CPBP 30-70, 10 MG TAB CHEW, 36 MG TAB ER 24, 60 MG CPBP30-70, 20 MG TABLET ER, 30 MG CPBP 30-70)

generic

STRATTERA (100 MG, 25 MG, 40 MG, 18 MG, 80 MG, 60MG, 10 MG)atomoxetine hcl

BRAND

CENTRAL NERVOUS SYSTEM, OTHER

ALAGESIC LQ ORAL SOLUTIONbutalbital/acetaminophen/caffeine

BRAND QL

benzphetamine hcl 50 mg tablet generic PA

butalbital/acetaminophen 50mg-325mg tablet generic

BUTALBITAL/ACETAMINOPHEN/CAFFEINE (50-300-40CAPSULE, 50-325-40 TABLET, 50-325-40 CAPSULE)

generic QL

CAPACET CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

DIETHYLPROPION HCL (75 MG ER, 25 MG) generic PA

ESGIC CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

MARGESIC CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

MARTEN-TAB 325-50 TABLETbutalbital/acetaminophen

BRAND

NUEDEXTA 20-10 MG CAPSULEdextromethorphan hbr/quinidine sulfate

BRAND

PHENDIMETRAZINE TARTRATE (35 MG TABLET, 105 generic PA



MG CAPSULE ER)

PHENTERMINE HCL (30 MG CAPSULE, 37.5 MGCAPSULE, 15 MG CAPSULE, 37.5 MG TABLET)

generic PA

riluzole 50 mg tablet generic

TENCON 50-325 MG TABLETbutalbital/acetaminophen

BRAND

TETRABENAZINE (12.5 MG, 25 MG) generic

XENAZINE (25 MG, 12.5 MG)tetrabenazine


ZEBUTAL 50-325-40 MG CAPSULEbutalbital/acetaminophen/caffeine

BRAND QL

FIBROMYALGIA AGENTS

DULOXETINE HCL (30 MG, 20 MG) generic

PA

CPA depends onindicaton. 60mg maxdaily

duloxetine hcl 60 mg capsule dr genericPA

C 2/ day .

LYRICA (50 MG CAPSULE, 100 MG CAPSULE, 300 MGCAPSULE, 225 MG CAPSULE, 150 MG CAPSULE, 200MG CAPSULE, 20 MG/ML ORAL SOLUTION, 75 MGCAPSULE, 25 MG CAPSULE)pregabalin

BRAND PA

SAVELLA (50 MG TABLET, 100 MG TABLET, TITRATIONPACK, 25 MG TABLET, 12.5 MG TABLET)milnacipran hcl

BRAND PA

MULTIPLE SCLEROSIS AGENTS

AMPYRA ER 10 MG TABLETdalfampridine

BRANDPA

S Specialty Drug

AVONEX (30 MCG KT, 30 MCG)interferon beta-1a

BRANDPA

S Specialty Drug

AVONEX ADMIN PACK 30 MCG VLinterferon beta-1a/albumin human

BRANDPA

S Specialty Drug

AVONEX PEN (30 ML, 30 ML KIT)interferon beta-1a

BRANDPA

S Specialty Drug

COPAXONE (20 MG/ML, 40 MG/ML)glatiramer acetate

BRANDPA

S Specialty Drug



EXTAVIA 0.3 MG KITinterferon beta-1b

BRANDPA

S Specialty Drug

GILENYA 0.5 MG CAPSULEfingolimod hcl

BRAND

QL

PA

S Specialty Drug

GLATOPA 20 MG/ML SYRINGEglatiramer acetate

BRANDPA

S Specialty Drug

REBIF (TITRATION PACK, 44 MCG/0.5 ML SYRINGE)interferon beta-1a/albumin human

BRANDPA

S Specialty Drug

REBIF 22 MCG/0.5 ML SYRINGEinterferon beta-1a/albumin human


REBIF REBIDOSE (44 ML, 22 ML)interferon beta-1a/albumin human


REBIF REBIDOSE TITRATION PACKinterferon beta-1a/albumin human

BRANDPA

S Specialty Drug

TECFIDERA (DR 240 MG CAPSULE, STARTER PACK,DR 120 MG CAPSULE)dimethyl fumarate

BRANDPA

S Specialty Drug

DENTAL AND ORAL AGENTS

cevimeline hcl 30 mg capsule generic

chlorhexidine gluconate 0.12 % mouthwash generic

DEBACTEROL SOLUTIONsulfuric acid/sulfonated phenol

BRAND

FIRST-MOUTHWASH BLM SUSPENSIONmag hydroxide/alhydroxide/simeth/diphenhydramine/lidocaine

BRAND

KEPIVANCE 6.25 MG VIALpalifermin

BRAND

PAROEX 0.12% ORAL RINSEchlorhexidine gluconate

BRAND

PERIOGARD 0.12% ORAL RINSEchlorhexidine gluconate

BRAND

PILOCARPINE HCL (7.5 MG, 5 MG) generic

DERMATOLOGICAL AGENTS



8-MOP 10 MG CAPSULEmethoxsalen

BRAND

ABSORICA (30 MG, 20 MG, 10 MG, 40 MG)isotretinoin

BRAND

ACITRETIN (17.5 MG, 10 MG, 25 MG) generic

ADAPALENE (0.1 (GRAM), 0.3 W/PUMP) genericQL

C 45gm/30 days

ADAPALENE (0.3 GEL (GRAM), 0.1 CREAM (G)) generic C 45gm/30 days

adapalene 0.1 % lotion generic C 59gm/30 days

ALPHAQUIN HP 4% CREAMoxybenzone/octinoxate/hydroquinone

BRAND

ammonium lactate 12 % cream (g) generic

AMNESTEEM (10 MG, 20 MG, 40 MG)isotretinoin

BRAND

APLIGRAF DISKcult skin subst,human-bovine

BRAND

AVAR CLEANSERsulfacetamide sodium/sulfur

BRAND

AVITA 0.025% CREAMtretinoin

BRAND C 20gm/30 days

BENZEPRO (6% FOAMING CLOTHS, 7% CREAMYWASH)benzoyl peroxide microspheres

BRAND

BENZOYL PEROXIDE (5 % GEL (GRAM), 7 %CLEANSER, 5 % GEL ALCOHL, 9.8 % FOAM, 5.3%FOAM)

generic

BP 10-1 WASHsulfacetamide sodium/sulfur

BRAND

BP CLEANSING WASHsulfacetamide sodium/sulfur/urea

BRAND

BP-50% UREA EMULSIONurea/lactic acid/zinc undecylenate

BRAND

BPO (8% GEL, 4% GEL, 3% FOAMING CLOTHS, 9%FOAMING CLOTHS, 6% FOAMING CLOTHS)benzoyl peroxide

BRAND

CALCIPOTRIENE (0.005 CREAM (G), 0.005 OINT. (G),0.005 SOLUTION)

generic

calcipotriene/betamethasone 0.005-.064 oint. (g) generic

CALCITRENE 0.005% OINTMENT BRAND



calcipotriene

calcitriol 3 mcg/g oint. (g) generic

CARB-O-PHILIC (GEL, CREAM)urea

BRAND

CEM-UREA 45% PRE-FILLED APPLurea

BRAND

CLARAVIS (40 MG, 30 MG, 20 MG, 10 MG)isotretinoin

BRAND

CLARIS CLARIFYING WASHsulfacetamide sodium/sulfur/urea

BRAND

CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE (1%-5 %, 1.2(1)%-5%)

generic

CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE (1-0.05 LOTION, 1 -0.05 CREAM (G))

generic

DERMAZENE CREAMhydrocortisone/iodoquinol

BRAND

DICLOFENAC SODIUM (1.5 DROPS, 3 GEL (GRAM)) generic

DRITHOCREME HP 1% CREAManthralin

BRAND

DRYSOL (DAB-O-MATIC, )aluminum chloride

BRAND

HYDROCORTISONE ACETATE/LIDOCAINE HCL/ALOEVERA (2 %-2 % KIT, 0.55%-2.8% GEL W/APPL, 2.5-3%(7G) KIT)

generic

HYDROCORTISONE ACETATE/PRAMOXINE HCL (1 %-1% CREAM/APPL, 2.5 %-1 % CREAM/APPL, 2.5 %-1 %CREAM (G), 2.5-1%(4G) CREAM/APPL)

generic

HYDROCORTISONEACETATE/PRAMOXINE/EMOLLIENT/PRAMOXINECOMB#1 (2.5%-1%-1%, 2.5-1%(4G))

generic

hydrocortisone/iodoquinol 1 %-1 % cream (g) generic

hydroquinone 4 % cream (g) generic

hydroquinone microspheres 4 % crm er (g) generic

HYPERCARE 20% SOLUTIONaluminum chloride

BRAND

imiquimod 5 % cream pack generic

LACLOTION 12% LOTIONammonium lactate

BRAND

LATRIX 50% TOPICAL SUSPENSIONurea/lactic acid/salicylic acid

BRAND



LATRIX XM 45% EMULSIONurea/lactic acid/zinc undecylenate

BRAND

LIDOCAINE HCL/HYDROCORTISONE ACETATE (3 %-0.5 % KIT, 3%-1%(7 G) KIT, 3 %-0.5 % CREAM (G), 3 %-0.5 % CREAM/APPL)

generic

lidocaine/prilocaine 2.5 %-2.5% cream (g) generic

LUSTRA-ULTRA 4% CREAMvitamin a/vitamin e/avobenzone/octinoxate/hydroquinone

BRAND

MELPAQUE HP 4% CREAMhydroquinone/ferric oxide

BRAND

MELQUIN HP 4% CREAMhydroquinone

BRAND

MELQUIN-3 SOLUTIONhydroquinone

BRAND

METRONIDAZOLE (0.75 GEL (GRAM), 0.75 CREAM (G),1 GEL W/PUMP, 0.75 LOTION, 1 GEL (GRAM))

generic

MYORISAN (10 MG, 30 MG, 20 MG, 40 MG)isotretinoin

BRAND

NEUAC GELclindamycin phosphate/benzoyl peroxide

BRAND

NU-DERM (BLENDER, CLEAR)hydroquinone

BRAND

NUQUIN HP (GEL, CREAM)dioxybenzone/padimate o/hydroquinone

BRAND

OBAGI ELASTIDERM SKIN 4% CREAMhydroquinone

BRAND

OXSORALEN-ULTRA 10 MG CAPmethoxsalen, rapid

BRAND

podofilox 0.5 % solution generic

PR BENZOYL PEROXIDE 7% WASHbenzoyl peroxide microspheres

BRAND

PR CREAM KITprotectives combination no.2/ceramides 1,3,6-11

BRAND

PRAMCORT 1% CREAMhydrocortisone acetate/pramoxine hcl

BRAND

REA LO 39 CREAMurea

BRAND

REA LO 40 (40 CM, 40 TION)urea

BRAND

RECTIV 0.4% OINTMENT BRAND



nitroglycerin

REGRANEX 0.01% GELbecaplermin

BRAND

REMEVEN 50% CREAMurea

BRAND

ROSADAN (GEL, CREAM)metronidazole

BRAND

ROSULA 10%-5% CLOTHSsulfacetamide sodium/sulfur

BRAND

SALACYN (CREAM, LOTION)salicylic acid

BRAND

SALICYLIC ACID (6 CREAM (G), 28.5 LIQ-FILM, 6 GEL(GRAM), 6 SHAMPOO, 27.5 LIQ-FILM, 6 CRM ER (G), 26LIQUID, 6 LOTION ER, 6 LOTION)

generic

salicylic acid/ammon lact/aloe 6 % foam generic

SALICYLIC ACID/CERAMIDES 1,3,6-11 (6 KIT CLCMER,6 COMBO. PKG)

generic

SALVAX 6% FOAMsalicylic acid

BRAND

SANTYL OINTMENTcollagenase clostridium histolyticum

BRAND

SE 10-5 SS CREAMsulfacetamide sodium/sulfur/witch hazel

BRAND

SE BPO 7% WASHbenzoyl peroxide microspheres

BRAND

SEB-PREV 10% WASHsulfacetamide sodium

BRAND

SELENIUM SULFIDE (2.5 SUSPENSION, 2.5 LOTION,2.25 SHAMPOO)

generic

SILVER NITRATE (50 SOLUTION, 10 OINT. (G), 10SOLUTION, 0.5 SOLUTION, 25 SOLUTION)

generic

silver nitrate applicator 75%-25% stick (ea) generic

spinosad 0.9 % suspension generic C

1420ml/fill; must trypermethrin andpiperonyl butoxide/pyrethrins andmalathion

SS 10-2 CLEANSERsulfacetamide sodium/sulfur

BRAND

SSS 10-5 (FOAM, CREAM)sulfacetamide sodium/sulfur

BRAND



sulfacetamide sod/sulfur/urea 10%-5%-10% cleanser generic

SULFACETAMIDE SODIUM (10 CLNSGEL ER, 10SHAMPOO, 10 CLEANSER)

generic

SULFACETAMIDE SODIUM/SULFUR (10 %-4 % MED.PAD, 8 %-4 % SUSPENSION, 10 %-5 % MED. PAD,9.8%-4.8% CLEANSER, 9 %-4.5 % CLEANSER, 10-5%(W/W) LOTION, 10-5%(W/V) LOTION, 10-5%(W/W)CREAM (G), 10-5%(W/W) CLEANSER, 10-5%(W/W)SUSPENSION, 9 %-4 % CLEANSER, 10 %-2 %CLEANSER, 10 %-5 % FOAM)

generic

sulfacetamide/sulfur/cleansr23 9 %-4.5 % kit generic

SULFACLEANSE 8-4 SUSPENSIONsulfacetamide sodium/sulfur

BRAND

TACROLIMUS (0.1, 0.03) genericQL

PA

TAZORAC (0.05% CREAM, 0.1% GEL, 0.05% GEL, 0.1%CREAM)tazarotene

BRAND

TRETINOIN (0.025 GEL (GRAM), 0.025 CREAM (G), 0.01GEL (GRAM))

generic QL

TRETINOIN (0.05, 0.1) generic QL

tretinoin 0.05 % gel (gram) generic QL

TRETINOIN MICROSPHERES (0.1 (GRAM), 0.04W/PUMP, 0.1 W/PUMP, 0.04 (GRAM))

generic QL

TRI-CHLOR 80% SOLUTIONtrichloroacetic acid

BRAND

UMECTA 40% MOUSSEurea

BRAND

UREA (35 FOAM, 45 LOTION, 45 GEL (ML), 45 CREAM(G), 40 LOTION, 39 CREAM (G), 50 SOL/PF APP, 40 GEL(ML), 40 CREAM (G), 40 NL FM SUSP, 50 CREAM (G))

generic

urea/hyaluronate sodium 40%-0.2% kit generic

urea/lactic ac/zn undecylenate 50 % emulsn(g) generic

urea/lactic acid/salicylic ac 50 % suspension generic

VASHE WOUND THERAPY SOLUTIONsodium chloride irrigating solution/hypochlorous acid

BRAND

VASOLEX OINTMENTtrypsin/balsam peru/castor oil

BRAND

VIRTI-SULF EMOLLIENT CREAM BRAND



sulfacetamide sodium/sulfur

X-VIATE (CREAM, LOTION, GEL)urea

BRAND

ZENCIA WASHsulfacetamide sodium/sulfur

BRAND

ENZYME REPLACEMENT/MODIFIERS

ALDURAZYME 2.9 MG/5 ML VIALlaronidase

BRAND

BUPHENYL 500 MG TABLETsodium phenylbutyrate

BRAND

CREON (12,000, 36,000, 24,000, 6,000, 3,000)lipase/protease/amylase

BRAND

CYSTADANE POWDERbetaine

BRAND

CYSTAGON (150 MG, 50 MG)cysteamine bitartrate


ELAPRASE 6 MG/3 ML VIALidursulfase

BRAND

ELELYSO 200 UNITS VIALtaliglucerase alfa

BRAND

FABRAZYME (35 MG, 5 MG)agalsidase beta

BRAND

KUVAN (100 MG TABLET, 100 MG POWDER PACKET,500 MG POWDER PACKET)sapropterin dihydrochloride

BRANDPA

S Specialty Drug

LUMIZYME 50 MG VIALalglucosidase alfa

BRAND

MYOZYME 50 MG VIALalglucosidase alfa

BRAND

NAGLAZYME 5 MG/5 ML VIALgalsulfase

BRAND

ORFADIN (5 MG, 2 MG, 10 MG)nitisinone

BRAND

RAVICTI 1.1 GRAM/ML LIQUIDglycerol phenylbutyrate

BRAND

sodium phenylbutyrate 0.94 g/g powder generic

STRENSIQ (18 MG/0.45 ML, 28 MG/0.7 ML, 80 MG/0.8ML, 40 MG/ML)asfotase alfa

BRANDPA

S Specialty Drug

SUCRAID 8,500 UNITS/ML SOLN BRAND S Specialty Drug



sacrosidase

VPRIV 400 UNITS VIALvelaglucerase alfa

BRAND

ZAVESCA 100 MG CAPSULEmiglustat


GASTROINTESTINAL AGENTS

ANTISPASMODICS, GASTROINTESTINAL

ANASPAZ 0.125 MG TABLET ODThyoscyamine sulfate

BRAND

ATROPINE SULFATE (1 MG/ML VIAL, 0.4 MG/ML VIAL,0.1 MG/ML DISP SYRIN, 0.05MG/ML SYRINGE, 0.1MG/ML SYRINGE)

generic

B-DONNA TABLETphenobarbital/hyoscyamine sulf/atropine sulf/scopolaminehb

BRAND

chlordiazepoxide/clidinium br 5 mg-2.5mg capsule generic

DICYCLOMINE HCL (10 MG CAPSULE, 10 MG/5 MLSOLUTION, 20 MG TABLET)

generic

ED-SPAZ 0.125 MG ODThyoscyamine sulfate

BRAND

GLYCOPYRROLATE (1 MG/5 ML SYRINGE, 0.2 MG/MLVIAL, 0.6MG/3ML SYRINGE, 0.4MG/2ML SYRINGE, 1MG TABLET, 2 MG TABLET)

generic

HYOSCYAMINE SULFATE (125MCG/5ML ELIXIR,0.125MG/ML DROPS, 0.125 MG TABLET, 0.375 MG TABER 12H, 0.125 MG TAB RAPDIS)

generic

HYOSYNE (125 MCG/5 ML ELIXIR, 0.125 MG/ML DROP)hyoscyamine sulfate

BRAND

ME-PB-HYOS TABLETphenobarbital/hyoscyamine sulf/atropine sulf/scopolaminehb

BRAND

OSCIMIN (0.125 MG TABLET, 0.125 MG ODT)hyoscyamine sulfate

BRAND

OSCIMIN SL 0.125 MG TABLEThyoscyamine sulfate

BRAND

OSCIMIN SR 0.375 MG TABLEThyoscyamine sulfate

BRAND

SYMAX FASTABS 0.125 MG TABLEThyoscyamine sulfate

BRAND

SYMAX-SL 0.125 MG TABLET SL BRAND



hyoscyamine sulfate

SYMAX-SR 0.375 MG TABLEThyoscyamine sulfate

BRAND

GASTROINTESTINAL AGENTS, OTHER

CHENODAL 250 MG TABLETchenodiol

BRAND

cromolyn sodium 20 mg/ml oral conc generic

dexpanthenol 250 mg/ml vial generic

DIPHENOXYLATE HCL/ATROPINE SULFATE (2.5-.025MG TABLET, 2.5-.025/5 LIQUID)

generic

GASTROCROM 100 MG/5 ML CONCcromolyn sodium

BRAND

lansoprazole/amoxiciln/clarith 30-500-500 combo. pkg generic

opium tincture 10 mg/ml tincture generic

paregoric 2 mg/5 ml liquid generic

RELISTOR (12 MG/0.6 ML KIT, 12 MG/0.6 ML VIAL, 12MG/0.6 ML SYRINGE, 8 MG/0.4 ML SYRINGE)methylnaltrexone bromide

BRAND

URSODIOL (250 MG TABLET, 300 MG CAPSULE, 500MG TABLET)

generic

VSL#3 DS PACKETlactobacillus combination no.2/s.thermophl/bif cmb no.1

BRAND

HISTAMINE2 (H2) RECEPTOR ANTAGONISTS

CIMETIDINE (300 MG, 800 MG, 400 MG) generic

cimetidine hcl 300 mg/5ml solution generic

FAMOTIDINE (40MG/5ML ORAL SUSP, 20 MG TABLET,10 MG/ML VIAL, 40 MG TABLET)

generic

famotidine/pf 20 mg/2 ml vial generic

NIZATIDINE (150MG/10ML SOLUTION, 300 MGCAPSULE, 150 MG CAPSULE)

generic

RANITIDINE HCL (25 MG/ML VIAL, 150 MG CAPSULE,50 MG/2 ML VIAL, 300 MG TABLET, 300 MG CAPSULE,150 MG TABLET, 15 MG/ML SYRUP)

generic

IRRITABLE BOWEL SYNDROME AGENTS

ALOSETRON HCL (0.5 MG, 1 MG) generic

LINZESS (290 MCG, 145 MCG)linaclotide

BRAND



LOTRONEX (1 MG, 0.5 MG)alosetron hcl

BRAND

LAXATIVES

ENULOSE 10 GM/15 ML SOLUTIONlactulose

BRAND

GAVILYTE-G SOLUTIONpeg 3350/sod sulf/sod bicarbonate/sod chloride/potassiumchl

BRAND

GAVILYTE-H AND BISACODYL KITbisacodyl/sodium chlor/sodium bicarb/potassium chl/peg3350

BRAND

GENERLAC 10 GM/15 ML SOLUTIONlactulose

BRAND

POLYETHYLENE GLYCOL 3350 (3350 17G POWDPACK, 3350 17G/DOSE POWDER)

generic

PROTECTANTS

CARAFATE 1 GM/10 ML SUSPsucralfate

BRAND

MISOPROSTOL (200 MCG, 100 MCG) generic

sucralfate 1 g tablet generic

PROTON PUMP INHIBITORS

esomeprazole magnesium 20 mg capsule dr generic

esomeprazole magnesium 40 mg capsule dr generic C

must try 3 wks oftherapy within the last12 mos of omeprazole,omeprazole OTC orpantoprazole

ESOMEPRAZOLE SODIUM (20 MG, 40 MG) generic

esomeprazole strontium 49.3 mg capsule dr generic

FIRST-LANSOPRAZOLE 3 MG/MLlansoprazole

BRAND C

no STEP required if<12 yrs old; must try 3weeks of therapy withinlast 12 months ofomeprazole,omeprazole OTC orpantoprazole

FIRST-OMEPRAZOLE 2 MG/ML SUSPomeprazole

BRAND C

no PA required if <12yrs old; must try 3weeks of therapy withinlast 12 months ofomeprazole,omeprazole OTC orpantoprazole

lansoprazole 15 mg capsule dr generic PA



lansoprazole 30 mg capsule dr generic C

must try 3 weeks oftherapy withinthe last 12months ofomeprazole,omeprazole OTC orpantoprazole

OMEPRAZOLE (10 MG, 40 MG, 20 MG) generic

OMEPRAZOLE/SODIUM BICARBONATE (20MG-1.1G,40MG-1.1G)

generic

PA

C


PANTOPRAZOLE SODIUM (20 MG TABLET DR, 40 MGVIAL, 40 MG TABLET DR)

generic

rabeprazole sodium 20 mg tablet dr generic

PA

C


GENITOURINARY AGENTS

ANTISPASMODICS, URINARY

flavoxate hcl 100 mg tablet generic

OXYBUTYNIN CHLORIDE (5 MG/5 ML SYRUP, 10 MGTAB ER 24, 5 MG TABLET, 5 MG TAB ER 24, 15 MG TABER 24)

generic

TOLTERODINE TARTRATE (4 MG CAP ER 24H, 1 MGTABLET, 2 MG TABLET, 2 MG CAP ER 24H)

generic

TROSPIUM CHLORIDE (60 MG CAP ER 24H, 20 MGTABLET)

generic

BENIGN PROSTATIC HYPERTROPHY AGENTS

alfuzosin hcl 10 mg tab er 24h generic

dutasteride 0.5 mg capsule generic QL

dutasteride/tamsulosin hcl 0.5-0.4 mg cpmp 24hr generic

finasteride 5 mg tablet generic

tamsulosin hcl 0.4 mg cap er 24h generic



GENITOURINARY AGENTS, OTHER

AMINOACETIC ACID 1.5% IRRIGglycine urologic solution

BRAND

BETHANECHOL CHLORIDE (5 MG, 25 MG, 10 MG, 50MG)

generic

citric acid/sodium citrate 334-500mg solution generic

CUPRIMINE 250 MG CAPSULEpenicillamine

BRAND

CYTRA-2 ORAL SOLUTIONcitric acid/sodium citrate

BRAND

CYTRA-3 SYRUPsodium/potassium/potassium citrate/sodium citrate/cit ac

BRAND

CYTRA-K (ORAL SOLUTION, CRYSTALS PACKET)potassium citrate/citric acid

BRAND

ELMIRON 100 MG CAPSULEpentosan polysulfate sodium

BRAND

FEM PH VAGINAL JELLYacetic acid/oxyquinoline sulfate

BRAND

glycine urologic solution 1.5 % irrig soln generic

K-PHOS #2 TABLETsodium phosphate,monobasic/potassiumphosphate,monobasic

BRAND

K-PHOS NEUTRAL TABLETphosphorus #1

BRAND

K-PHOS ORIGINAL TABLETpotassium phosphate,monobasic

BRAND

PHENAZOPYRIDINE HCL (200 MG, 100 MG) generic

PHOSPHA 250 NEUTRAL TABLETphosphorus #1

BRAND

POTASSIUM CITRATE (15 ER, 10 ER, 5 ER) generic

POTASSIUM CITRATE/CITRIC ACID (1100-334/5SOLUTION, 3300-1002 PACKET)

generic

RENACIDIN IRRIGATION SOLNcitric acid/gluconolactone/magnesium carbonate

BRAND

sod/pot/k cit/sod cit/cit acid 500-550/5 solution generic

TARON-CRYSTALS PACKETpotassium citrate/citric acid

BRAND

TRICITRATES ORAL SOLUTIONsodium/potassium/potassium citrate/sodium citrate/cit ac

BRAND



VIRT-PHOS 250 NEUTRAL TABLETphosphorus #1

BRAND

VIRTRATE-2 SOLUTIONcitric acid/sodium citrate

BRAND

VIRTRATE-3 SOLUTIONsodium/potassium/potassium citrate/sodium citrate/cit ac

BRAND

VIRTRATE-K SOLUTIONpotassium citrate/citric acid

BRAND

PHOSPHATE BINDERS

CALCIUM ACETATE (667 MG CAPSULE, 667 MGTABLET)

generic

ELIPHOS 667 MG TABLETcalcium acetate

BRAND

RENVELA (800 MG TABLET, 0.8 GM POWDER PACKET,2.4 GM POWDER PACKET)sevelamer carbonate

BRAND

sevelamer carbonate 800 mg tablet generic

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (ADRENAL)

A-HYDROCORT 100 MG VIALhydrocortisone sod succinate

BRAND

A-METHAPRED 40 MG UNIVIALmethylprednisolone sodium succinate

BRAND

ALA-CORT 1% CREAMhydrocortisone

BRAND

ALCLOMETASONE DIPROPIONATE (0.05 OINT., 0.05CREAM)

generic

AMCINONIDE (0.1 CREAM (G), 0.1 LOTION, 0.1 OINT.(G))

generic

APEXICON 0.05% OINTMENTdiflorasone diacetate

BRAND

APEXICON E 0.05% CREAMdiflorasone diacetate/emollient base

BRAND

betamet acet/betamet na ph 6 mg/ml vial generic

BETAMETHASONE DIPROPIONATE (0.05 LOTION, 0.05GEL (GRAM), 0.05 CREAM (G), 0.05 OINT. (G))

generic

BETAMETHASONE DIPROPIONATE/PROPYLENEGLYCOL (0.05 CREAM (G), 0.05 OINT. (G), 0.05 LOTION)

generic

BETAMETHASONE VALERATE (0.1 CREAM (G), 0.1LOTION, 0.12 FOAM, 0.1 OINT. (G))

generic



CLOBETASOL PROPIONATE (0.05 SOLUTION, 0.05LOTION, 0.05 SHAMPOO, 0.05 SPRAY, 0.05 CREAM (G),0.05 FOAM, 0.05 OINT. (G), 0.05 GEL (GRAM))

generic

CLOBETASOL PROPIONATE/EMOLLIENT BASE (0.05FOAM, 0.05 CREAM (G))

generic

CLODAN 0.05% SHAMPOOclobetasol propionate

BRAND

CORMAX 0.05% SOLUTIONclobetasol propionate

BRAND

cortisone acetate 25 mg tablet generic

DELTASONE 20 MG TABLETprednisone

BRAND

DESONIDE (0.05 LOTION, 0.05 CREAM (G), 0.05 OINT.(G))

generic

DESOXIMETASONE (0.05 CREAM (G), 0.25 OINT. (G),0.25 CREAM (G), 0.05 GEL (GRAM), 0.05 OINT. (G))

generic

DEXAMETHASONE (6 MG TABLET, 0.5 MG TABLET, 2MG TABLET, 0.75 MG TABLET, 4 MG TABLET, 1.5 MGTABLET, 0.5 MG/5ML ELIXIR, 1 MG TABLET, 0.5MG/5ML SOLUTION)

generic

DEXAMETHASONE INTENSOL 1MG/1MLdexamethasone

BRAND

DEXAMETHASONE SOD PHOSPHATE (10 MG/ML VIAL,4 MG/ML VIAL, 4 MG/ML SYRINGE)

generic

dexamethasone sod phosphate/pf 10 mg/ml vial generic

DIFLORASONE DIACETATE (0.05 OINT., 0.05 CREAM) generic

fludrocortisone acetate 0.1 mg tablet generic

FLUOCINOLONE ACETONIDE (0.025 OINT. (G), 0.01CREAM (G), 0.025 CREAM (G), 0.01 OIL, 0.01SOLUTION)

generic

fluocinolone/shower cap 0.01 % oil generic

FLUOCINONIDE (0.05 GEL (GRAM), 0.05 SOLUTION, 0.1CREAM (G), 0.05 CREAM (G), 0.05 OINT. (G))

generic

fluocinonide/emollient base 0.05 % cream (g) generic

FLUTICASONE PROPIONATE (0.005 OINT. (G), 0.05LOTION, 0.05 CREAM (G))

generic

GRX HICORT 25 MG SUPPOSITORYhydrocortisone acetate

BRAND

HALOBETASOL PROPIONATE (0.05 OINT., 0.05CREAM)

generic



HALONATE COMBO PACKhalobetasol propionate/ammonium lactate

BRAND

HALONATE PAC COMBO PACKhalobetasol propionate/ammonium lactate

BRAND

hc/mineral oil/petrolat,wht 1 % oint. (g) generic

HEMMOREX-HC (25 MG, 30 MG)hydrocortisone acetate

BRAND

HEMRIL-30 30 MG SUPPOSITORYhydrocortisone acetate

BRAND

HYDROCORTISONE (5 MG TABLET, 2.5 % LOTION, 10MG TABLET, 2.5 % CREAM (G), 1 % CREAM (G), 20 MGTABLET, 2.5 % OINT. (G))

generic

hydrocortisone acetate 25 mg supp.rect generic C only non-DESI NDCsare covered

hydrocortisone acetate 30 mg supp.rect generic

hydrocortisone acetate/aloe v 2 % gel (gram) generic

HYDROCORTISONE BUTYRATE (0.1 OINT. (G), 0.1SOLUTION, 0.1 CREAM (G))

generic

hydrocortisone butyrate/emoll 0.1 % cream (g) generic

HYDROCORTISONE VALERATE (0.2 CREAM, 0.2 OINT.) generic

METHYLPREDNISOLONE (4 MG TABLET, 16 MGTABLET, 8 MG TABLET, 4 MG TAB DS PK, 32 MGTABLET)

generic

METHYLPREDNISOLONE ACETATE (80 MG/ML, 40MG/ML)

generic

METHYLPREDNISOLONE SODIUM SUCCINATE (40 MG,1000 MG, 125 MG)

generic

MILLIPRED DP (5 MG 6-DAY, 5 MG 12-DAY)prednisolone

BRAND

MOMETASONE FUROATE (0.1 CREAM (G), 0.1 OINT.(G), 0.1 SOLUTION)

generic

PREDNICARBATE (0.1 CREAM, 0.1 OINT.) generic

prednisolone 15 mg/5 ml solution generic

PREDNISOLONE SOD PHOSPHATE (5 MG/5 MLSOLUTION, 10 MG TAB RAPDIS, 15 MG TAB RAPDIS,15 MG/5 ML SOLUTION, 30 MG TAB RAPDIS, 25 MG/5ML SOLUTION)

generic

PREDNISONE (2.5 MG TABLET, 5 MG TABLET, 1 MGTABLET, 50 MG TABLET, 5 MG/5 ML SOLUTION, 20 MGTABLET, 10 MG TABLET, 10 MG TAB DS PK, 5 MG TAB

generic



DS PK)

PREDNISONE 5 MG/ML SOLUTIONprednisone

BRAND

PROCTO-PAK 1% CREAMhydrocortisone

BRAND

PROCTOSOL-HC 2.5% CREAMhydrocortisone

BRAND

PROCTOZONE-HC 2.5% CREAMhydrocortisone

BRAND

RECTACORT-HC 25 MG SUPPOSITORYhydrocortisone acetate

BRAND

SCALACORT 2% LOTIONhydrocortisone

BRAND

TRIAMCINOLONE ACETONIDE (0.5 % OINT. (G), 0.1 %LOTION, 10 MG/ML VIAL, 0.025 % CREAM (G), 0.5 %CREAM (G), 0.1 % OINT. (G), 0.1 % CREAM (G),0.147MG/G AEROSOL, 40 MG/ML VIAL, 0.025 % OINT.(G), 0.025 % LOTION)

generic

TRIANEX 0.05% OINTMENTtriamcinolone acetonide

BRAND

TRIDERM 0.1% CREAMtriamcinolone acetonide

BRAND

VERIPRED 20 20 MG/5 ML SOLNprednisolone sod phosphate

BRAND

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (PITUITARY)

chorionic gonadotropin, human 10000 unit vial generic

cosyntropin 0.25 mg vial generic

desmopressin (nonrefrigerated) 10/spray spray/pump generic

DESMOPRESSIN ACETATE (4MCG/ML AMPUL, 0.1 MGTABLET, 0.2 MG TABLET, 0.1 MG/ML SOLUTION,4MCG/ML VIAL, 10/SPRAY SPRAY/PUMP)

generic

GONAL-F RFF (900, 450, 300)follitropin alfa, recomb

BRAND

GONAL-F RFF REDI-JECT (900, 300, 450)follitropin alfa, recomb


HP ACTHAR GEL 80 UNIT/ML VIALcorticotropin

BRANDPA

S Specialty Drug

INCRELEX 40 MG/4 ML VIALmecasermin

BRANDPA

S Specialty Drug



NORDITROPIN (5 ML, 15 ML)somatropin

BRANDPA

S Specialty Drug

NORDITROPIN FLEXPRO (10 MG/1.5, 5 MG/1.5, 30MG/3 ML, 15 MG/1.5)somatropin

BRANDPA

S Specialty Drug

NORDITROPIN NORDIFLEX (NORDIFLX 15 MG/1.5,NORDIFLX 10 MG/1.5, NORDIFLEX 5 MG/1.5,NORDIFLEX 30 MG/3)somatropin

BRANDPA

S Specialty Drug

NOVAREL 10,000 UNITS VIALchorionic gonadotropin, human

BRAND

STIMATE 1.5 MG/ML NASAL SPRAYdesmopressin acetate


vasopressin 20 unit/ml vial generic

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (SEX HORMONES/MODIFIERS)

ANDROGENS

ANDROGEL (1%(5G) PACKET, 1% PUMP)testosterone

BRAND QL

ANDROGEL (1.62%(1.25G) PCKT, 1.62% PUMP,1.62%(2.5G) PCKT, 1%(2.5G) PACKET)testosterone

BRAND

ANDROXY 10 MG TABLETfluoxymesterone


DANAZOL (200 MG, 50 MG, 100 MG) generic

METHITEST 10 MG TABLETmethyltestosterone

BRAND

methyltestosterone 10 mg capsule generic GL Male

OXANDROLONE (2.5 MG, 10 MG) generic

TESTOPEL 75 MG PELLETStestosterone

BRAND

TESTOSTERONE (1.25G (1%) MD PMP, 50 MG (1%)PACKET, 25MG(1%) PACKET)

generic QL

testosterone 10 mg (2%) gel md pmp generic PA

TESTOSTERONE CYPIONATE (100 MG/ML, 200 MG/ML) generic

testosterone enanthate 200 mg/ml vial generic

ESTROGENS



ALTAVERA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

ALYACEN (7-7-7-28, 1-35-28)norethindrone-ethinyl estradiol

BRAND

AMETHIA 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

AMETHIA LO TABLETlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

AMETHYST 90-20 MCG TABLETlevonorgestrel-ethinyl estradiol

BRAND

APRI 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

ARANELLE 28 TABLETnorethindrone-ethinyl estradiol

BRAND

ASHLYNA 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

AUBRA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

AVIANE-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

AZURETTE 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

BALZIVA 28 TABLETnorethindrone-ethinyl estradiol

BRAND

BEKYREE 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

BLISOVI 24 FE TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

BLISOVI FE (1.5-30, 1-20)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

BRIELLYN TABLETnorethindrone-ethinyl estradiol

BRAND

CAMRESE 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

CAMRESE LO TABLETlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

CAZIANT 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

CHATEAL-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND



CRYSELLE-28 TABLETnorgestrel-ethinyl estradiol

BRAND

CYCLAFEM (7-7-7-28, 1-35-28)norethindrone-ethinyl estradiol

BRAND

CYRED 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

DASETTA (7/7/7-28, 1-35-28)norethindrone-ethinyl estradiol

BRAND

DAYSEE 0.15-0.03-0.01 MG TABlevonorgestrel/ethinyl estradiol and ethinyl estradiol

BRAND

DELYLA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

desog-e.estradiol/e.estradiol 21-5 tablet generic

desogestrel-ethinyl estradiol 0.15-0.03 tablet generic

ELINEST-28 TABLETnorgestrel-ethinyl estradiol

BRAND

EMOQUETTE 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

ENPRESSE-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

ENSKYCE 28 TABLETdesogestrel-ethinyl estradiol

BRAND

ESTARYLLA 0.25-0.035 MG TABLETnorgestimate-ethinyl estradiol

BRAND

ESTRADIOL (.0375MG/24 PATCH TDWK, 0.05MG/24HPATCH TDSW, .075MG/24H PATCH TDWK, 2 MGTABLET, .025MG/24H PATCH TDWK, 0.5 MG TABLET,.025MG/24H PATCH TDSW, 0.06MG/24H PATCH TDWK,0.1MG/24HR PATCH TDWK, 1 MG TABLET, .0375MG/24PATCH TDSW, 0.05MG/24H PATCH TDWK, .075MG/24HPATCH TDSW)

generic

ESTRADIOL VALERATE (40 MG/ML, 20 MG/ML, 10MG/ML)

generic

ESTRADIOL/NORETHINDRONE ACETATE (0.5-0.1MG, 1MG-0.5MG)

generic

ESTROPIPATE (0.75 MG, 3 MG, 1.5 MG) generic

ETHINYL ESTRADIOL/DROSPIRENONE (0.03MG-3MG,0.02-3(24))

generic

FALMINA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

GIANVI 3 MG-0.02 MG TABLET BRAND



ethinyl estradiol/drospirenone

GILDAGIA 0.4 MG-0.035 MG TABnorethindrone-ethinyl estradiol

BRAND

GILDESS (1.5 MG-30 MCG, 1 MG-20 MCG)norethindrone acetate-ethinyl estradiol

BRAND

GILDESS 24 FE 1-0.02 MG TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

GILDESS FE (1-20, 1.5-30)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

INTROVALE 0.15-0.03 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

JINTELI 1 MG-5 MCG TABLETnorethindrone acetate-ethinyl estradiol

BRAND

JOLESSA 0.15 MG-0.03 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

JUNEL (1 MG-20 MCG, 1.5 MG-30 MCG)norethindrone acetate-ethinyl estradiol

BRAND

JUNEL FE (1.5 MG-30 MCG, 1 MG-20 MCG)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

JUNEL FE 24 TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

KAITLIB FE CHEWABLE TABLETnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

KARIVA 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

KELNOR 1-35 28 TABLETethynodiol diacetate-ethinyl estradiol

BRAND

KIMIDESS 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

KURVELO TABLETlevonorgestrel-ethinyl estradiol

BRAND

LARIN (21 1-20, 1.5 MG-30 MCG)norethindrone acetate-ethinyl estradiol

BRAND

LARIN 24 FE 1 MG-20 MCG TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

LARIN FE (1.5-30, 1-20)norethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

LEENA 28 TABLETnorethindrone-ethinyl estradiol

BRAND

LESSINA-28 TABLET BRAND



levonorgestrel-ethinyl estradiol

LEVONEST-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

LEVONORGESTREL (1.5 MG, 0.75 MG) generic

LEVONORGESTREL-ETHINYL ESTRADIOL (90-20MCGTABLET, 0.15-0.03 TBDSPK 3MO, 0.1-0.02 TABLET, 6-5-10 TABLET, 0.15-0.03 TABLET)

generic

LEVONORGESTREL/ETHINYL ESTRADIOL ANDETHINYL ESTRADIOL (150-30(84), 100-20(84))

generic

LEVORA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

LOMEDIA 24 FE 1 MG-20 MCG TABnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

LOPREEZA 1 MG-0.5 MG TABLETestradiol/norethindrone acetate

BRAND

LORYNA 3 MG-0.02 MG TABLETethinyl estradiol/drospirenone

BRAND

LOW-OGESTREL-28 TABLETnorgestrel-ethinyl estradiol

BRAND

LUTERA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

MARLISSA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

MENEST (1.25 MG, 0.625 MG, 2.5 MG, 0.3 MG)estrogens,esterified

BRAND

MICROGESTIN (21 1.5-30 TAB, 21 1-20 TABLET)norethindrone acetate-ethinyl estradiol

BRAND

MICROGESTIN 24 FE 1 MG-20 MCGnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

MICROGESTIN FE 1-20 TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

MIMVEY 1-0.5 MG TABLETestradiol/norethindrone acetate

BRAND

MIMVEY LO 0.5-0.1 MG TABLETestradiol/norethindrone acetate

BRAND

MONO-LINYAH 28 TABLETnorgestimate-ethinyl estradiol

BRAND

MONONESSA 28 TABLETnorgestimate-ethinyl estradiol

BRAND

MY WAY 1.5 MG TABLET BRAND



levonorgestrel

MYZILRA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

NECON (1-35-28, 7-7-7-28, 10-11-28, 1-50-28, 0.5-35-28)norethindrone-ethinyl estradiol

BRAND

NEXT CHOICE ONE DOSE 1.5 MG TBlevonorgestrel

BRAND

NIKKI 3 MG-0.02 MG TABLETethinyl estradiol/drospirenone

BRAND

noreth-ethinyl estradiol/iron 0.8-25(24) tab chew generic

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL(0.5MG-2.5, 1MG-20MCG, 1MG-5MCG)

generic

NORETHINDRONE ACETATE-ETHINYLESTRADIOL/FERROUS FUMARATE (1MG-20(24), 1MG-20(21))

generic

NORGESTIMATE-ETHINYL ESTRADIOL (0.25-0.035,7DAYSX3 28, 7DAYSX3 LO)

generic

NORTREL (7-7-7-28, 1-35, 0.5-35)norethindrone-ethinyl estradiol

BRAND

OCELLA 3 MG-0.03 MG TABLETethinyl estradiol/drospirenone

BRAND

OGEN 2.5 TABLETestropipate

BRAND

OGESTREL TABLETnorgestrel-ethinyl estradiol

BRAND

ORSYTHIA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

PHILITH 0.4-0.035 MG TABLETnorethindrone-ethinyl estradiol

BRAND

PIMTREA 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

PIRMELLA (1-35-28, 7-7-7-28)norethindrone-ethinyl estradiol

BRAND

PORTIA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

PREMPHASE 0.625-5 MG TABLETestrogens, conjugated/medroxyprogesterone acetate

BRAND

PREMPRO (0.625-5 MG, 0.625-2.5 MG, 0.45-1.5 MG, 0.3MG-1.5 MG)estrogens, conjugated/medroxyprogesterone acetate

BRAND



PREVIFEM TABLETnorgestimate-ethinyl estradiol

BRAND

QUASENSE 0.15-0.03 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

RECLIPSEN 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND

SETLAKIN 0.15 MG-0.03 MG TABlevonorgestrel-ethinyl estradiol

BRAND

SPRINTEC 28 DAY TABLETnorgestimate-ethinyl estradiol

BRAND

SRONYX 0.10-0.02 MG TABLETlevonorgestrel-ethinyl estradiol

BRAND

SYEDA 28 TABLETethinyl estradiol/drospirenone

BRAND

TARINA FE 1-20 TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

TRI-ESTARYLLA TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LEGEST FE-28 DAY TABLETnorethindrone acetate-ethinyl estradiol/ferrous fumarate

BRAND

TRI-LINYAH TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LO-ESTARYLLA TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LO-MARZIA TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-LO-SPRINTEC TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-PREVIFEM TABLETnorgestimate-ethinyl estradiol

BRAND

TRI-SPRINTEC TABLETnorgestimate-ethinyl estradiol

BRAND

TRINESSA TABLETnorgestimate-ethinyl estradiol

BRAND

TRIVORA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

VAGIFEM 10 MCG VAGINAL TABestradiol

BRAND

VELIVET 28 DAY TABLETdesogestrel-ethinyl estradiol

BRAND



VESTURA 3 MG-0.02 MG TABLETethinyl estradiol/drospirenone

BRAND

VIENVA-28 TABLETlevonorgestrel-ethinyl estradiol

BRAND

VIORELE 28 DAY TABLETdesogestrel-ethinyl estradiol/ethinyl estradiol

BRAND

VYFEMLA 28 TABLETnorethindrone-ethinyl estradiol

BRAND

WERA 0.5/0.035 MG 28 TABLETnorethindrone-ethinyl estradiol

BRAND

WYMZYA FE CHEWABLE TABLETnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

ZARAH TABLETethinyl estradiol/drospirenone

BRAND

ZENCHENT 0.4 MG-35 MCG TABLETnorethindrone-ethinyl estradiol

BRAND

ZENCHENT FE TABLET CHEWABLEnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

ZEOSA CHEWABLE TABLETnorethindrone-ethinyl estradiol/ferrous fumarate

BRAND

ZOVIA 1-35E TABLETethynodiol diacetate-ethinyl estradiol

BRAND

ZOVIA 1-50E TABLETethynodiol diacetate-ethinyl estradiol

BRAND

PROGESTINS

CAMILA TABLETnorethindrone

BRAND

DEBLITANE 0.35 MG TABLETnorethindrone

BRAND

DEPO-PROVERA 400 MG/ML VIALmedroxyprogesterone acetate

BRAND

ENDOMETRIN 100 MG SUPPOSITORYprogesterone,micronized


ERRIN 0.35 MG TABLETnorethindrone

BRAND

HEATHER TABLETnorethindrone

BRAND

IMPLANON 68 MG IMPLANTetonogestrel

BRAND

JENCYCLA 0.35 MG TABLET BRAND



norethindrone

JOLIVETTE TABLETnorethindrone

BRAND

LYZA 0.35 MG TABLETnorethindrone

BRAND

MAKENA 1,250 MG/5 ML VIALhydroxyprogesterone caproate

BRANDPA

GL Male

MEDROXYPROGESTERONE ACETATE (2.5 MGTABLET, 150 MG/ML VIAL, 5 MG TABLET, 150 MG/MLSYRINGE, 10 MG TABLET)

generic

MEGESTROL ACETATE (20 MG TABLET, 625MG/5MLORAL SUSP, 400MG/10ML ORAL SUSP, 40 MGTABLET)

generic

NORA-BE TABLETnorethindrone

BRAND

norethindrone 0.35 mg tablet generic

norethindrone acetate 5 mg tablet generic

NORLYROC 0.35 MG TABLETnorethindrone

BRAND

progesterone 50 mg/ml vial generic

PROGESTERONE,MICRONIZED (100 MG, 200 MG) generic

SHAROBEL 0.35 MG TABLETnorethindrone

BRAND

SELECTIVE ESTROGEN RECEPTOR MODIFYING AGENTS

raloxifene hcl 60 mg tablet generic

HORMONAL AGENTS, STIMULANT/REPLACEMENT/MODIFYING (THYROID)

ARMOUR THYROID (60 MG, 300 MG, 120 MG, 30 MG,90 MG, 240 MG, 180 MG, 15 MG)thyroid,pork

BRAND

LEVOTHYROXINE SODIUM (75 MCG, 300 MCG, 25MCG, 112 MCG, 137 MCG, 125 MCG, 100 MCG, 200MCG, 50 MCG, 175MCG, 88 MCG, 150 MCG)

generic

LEVOXYL (112 MCG, 125 MCG, 88 MCG, 50 MCG, 200MCG, 137 MCG, 75 MCG, 100 MCG, 150 MCG, 175 MCG,25 MCG)levothyroxine sodium

BRAND

LIOTHYRONINE SODIUM (25 MCG TABLET, 5 MCGTABLET, 50 MCG TABLET, 10 MCG/ML VIAL)

generic

NATURE-THROID (146.25 MG, 65 MG, 113.75 MG, 32.5 BRAND



MG, 81.25 MG, 162.5 MG, 130 MG, 16.25 MG, 325 MG,195 MG, 97.5 MG, 48.75 MG, 260 MG)thyroid,pork

NP THYROID (90 MG, 30 MG, 60 MG)thyroid,pork

BRAND

THYROLAR-1 STRENGTH TABLETliotrix

BRAND

THYROLAR-1/2 STRENGTH TABliotrix

BRAND

THYROLAR-1/4 STRENGTH TABliotrix

BRAND


BRAND


BRAND

UNITHROID (137 MCG, 88 MCG)levothyroxine sodium

BRAND

WESTHROID (130 MG, 97.5 MG, 16.25 MG, 65 MG, 48.75MG, 32.5 MG, 195 MG)thyroid,pork

BRAND

HORMONAL AGENTS, SUPPRESSANT (PARATHYROID)

SENSIPAR (30 MG, 60 MG)cinacalcet hcl

BRAND

QL

PA

S Specialty Drug

SENSIPAR 90 MG TABLETcinacalcet hcl

BRAND

QL

PA

S Specialty Drug

HORMONAL AGENTS, SUPPRESSANT (PITUITARY)

cabergoline 0.5 mg tablet generic

EGRIFTA 1 MG VIALtesamorelin acetate

BRAND PA

EGRIFTA 2 MG VIALtesamorelin acetate


LEUPROLIDE ACETATE (1 KIT, 1 VIAL) generic

LUPRON DEPOT (DEPOT 7.5 MG, DEPOT 22.5 MG3MO, DEPOT 11.25 MG 3MO, DEPOT-4 MONTH, DEPOT3.75 MG, DEPOT 45 MG 6MO)leuprolide acetate

BRANDPA

S Specialty Drug



LUPRON DEPOT-PED (11.25 MG 3MO, 30 MG 3MO KIT,7.5 MG KIT, 11.25 MG KIT, 15 MG KIT)leuprolide acetate

BRANDPA

S Specialty Drug

OCTREOTIDE ACETATE (500 MCG/ML, 50 MCG/ML, 100MCG/ML)

genericPA

S Specialty Drug

SIGNIFOR (0.6 MG/ML, 0.9 MG/ML, 0.3 MG/ML)pasireotide diaspartate


VANTAS 50 MG KIThistrelin acetate

BRAND PA

HORMONAL AGENTS, SUPPRESSANT (THYROID)

ANTITHYROID AGENTS

METHIMAZOLE (5 MG, 10 MG) generic

propylthiouracil 50 mg tablet generic

IMMUNOLOGICAL AGENTS

ANGIOEDEMA (HAE) AGENTS

FIRAZYR 30 MG/3 ML SYRINGEicatibant acetate

BRAND

IMMUNE SUPPRESSANTS

AZASAN (75 MG, 100 MG)azathioprine

BRAND

azathioprine 50 mg tablet generic

CELLCEPT (200 MG/ML ORAL SUSP, 500 MG VIAL)mycophenolate mofetil hcl

BRAND

CYCLOSPORINE (100 MG CAPSULE, 250 MG/5ML VIAL,250 MG/5ML AMPUL, 25 MG CAPSULE)

generic

CYCLOSPORINE, MODIFIED (50 MG CAPSULE, 100MG/ML SOLUTION, 100 MG CAPSULE, 25 MGCAPSULE)

generic

ENBREL (50 MG/ML SYRINGE, 25 MG KIT, 50 MG/MLSURECLICK SYR, 25 MG/0.5 ML SYRINGE)etanercept

BRANDPA

S Specialty Drug

GENGRAF (25 MG CAPSULE, 100 MG/ML SOLUTION,100 MG CAPSULE)cyclosporine, modified

BRAND

HECORIA (1 MG, 5 MG, 0.5 MG)tacrolimus

BRAND

HUMIRA (10 MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML)adalimumab

BRAND PA



S Specialty Drug

HUMIRA 40 MG/0.8 ML PENadalimumab

BRANDPA

S Specialty Drug

HUMIRA PEDIATRIC CROHN'S STARTadalimumab

BRANDPA

S Specialty Drug

HUMIRA PEN CROHN'S-UC-HS STARTadalimumab

BRANDPA

S Specialty Drug

HUMIRA PEN PSORIASIS START PKadalimumab

BRANDPA

S Specialty Drug

METHOTREXATE SODIUM (25 MG/ML VIAL, 2.5 MGTABLET)

generic

methotrexate sodium/pf 1 g vial generic

methotrexate sodium/pf 25 mg/ml vial generic S Specialty Drug

MYCOPHENOLATE MOFETIL (500 MG TABLET, 250 MGCAPSULE)

generic

MYCOPHENOLATE SODIUM (180 MG, 360 MG) generic

MYFORTIC (360 MG, 180 MG)mycophenolate sodium

BRAND

NULOJIX 250 MG VIALbelatacept

BRAND

PROGRAF 5 MG/ML AMPULEtacrolimus

BRAND

RAPAMUNE (1 MG TABLET, 1 MG/ML ORAL SOLN, 2MG TABLET)sirolimus

BRAND

REMICADE 100 MG VIALinfliximab

BRAND PA

SIROLIMUS (1 MG, 0.5 MG) generic

TACROLIMUS (1 MG, 5 MG, 0.5 MG) generic

TREXALL (15 MG, 10 MG, 7.5 MG, 5 MG)methotrexate sodium

BRAND

ZORTRESS (0.75 MG, 0.5 MG, 0.25 MG)everolimus


IMMUNIZING AGENTS, PASSIVE



BIVIGAM LIQUID 10% VIALimmune globulin,gamm(igg)/glycine/iga greater than 50mcg/ml

BRAND PA

FLEBOGAMMA DIF (10%, 5%)immune globulin,gamma (igg)/sorbitol/iga 0 to 50 mcg/ml

BRAND PA

GAMMAGARD LIQUID 10% VIALimmune globulin,gamm(igg)/glycine/iga greater than 50mcg/ml

BRAND PA

GAMMAPLEX 5% VIALimmune globulin,gamm(igg)/sorbitol/glycin/iga 0 to 50mcg/ml

BRAND PA

GAMUNEX 10% VIALimmune globulin,gamma caprylate (igg)

BRAND PA

GAMUNEX-C (2.5 GRAM/25 ML, 1 GRAM/10 ML, 10GRAM/100 ML, 20 GRAM/200 ML, 5 GRAM/50 ML)immune globulin,gamm(igg)/glycine/iga greater than 50mcg/ml

BRAND PA

HIZENTRA (10 GRAM/50 ML, 2 GRAM/10 ML, 1 GRAM/5ML, 4 GRAM/20 ML)immune globulin,gamma (igg)/proline/iga 0 to 50 mcg/ml

BRAND

HYPERRHO S-D 250 UNITS SYRINGErho(d) immune globulin

BRAND

PRIVIGEN 10% VIALimmune globulin,gamma (igg)/proline/iga 0 to 50 mcg/ml

BRAND PA

VARIZIG 125 UNIT VIALvaricella-zoster immune globulin (human)

BRAND

IMMUNOMODULATORS

ACTEMRA 162 MG/0.9 ML SYRINGEtocilizumab

BRAND PA

ACTIMMUNE 100 MCG/0.5 ML VIALinterferon gamma-1b,recomb.


ARCALYST 220 MG INJECTIONrilonacept


BENLYSTA (120 MG, 400 MG)belimumab

BRAND

ILARIS 180 MG VIALcanakinumab/pf

BRAND

LEFLUNOMIDE (20 MG, 10 MG) generic

RIDAURA 3 MG CAPSULEauranofin

BRAND

SYNAGIS (50 MG/0.5 ML, 100 MG/1 ML) BRAND PA



palivizumab

VACCINES

ADACEL TDAP VIALdiphtheria,pertussis(acell),tetanus vaccine/pf

BRAND

EZ FLU 2015-16 (FLUVIRIN) KITinfluenza virus vaccine trivalnt 2015-2016 (4 yr & older)/pf

BRAND

FLUBLOK 2014-2015 VIALinfluenza virus vaccine tv 2014-2015(18 yrs &older)rcmb/pf

BRAND C Approved for known orsuspected egg allergy

PNEUMOVAX 23 SYRINGEpneumococcal 23-valent polysaccharide vaccine

BRAND

PNEUMOVAX 23 VIALpneumococcal 23-valent polysaccharide vaccine

BRAND AL 1 to 65 yrs old

ZOSTAVAX VIALzoster vaccine live/pf

BRAND

INFLAMMATORY BOWEL DISEASE AGENTS

AMINOSALICYLATES

APRISO ER 0.375 GRAM CAPSULEmesalamine

BRAND

balsalazide disodium 750 mg capsule generic

CANASA 1,000 MG SUPPOSITORYmesalamine

BRAND

mesalamine 4 g/60 ml enema generic

mesalamine w/cleansing wipes 4 g/60 ml enema kit generic

PENTASA (500 MG, 250 MG)mesalamine

BRAND

GLUCOCORTICOIDS

budesonide 3 mg capdr - er generic

COLOCORT 100 MG ENEMAhydrocortisone

BRAND

CORTIFOAM 10% AEROSOLhydrocortisone acetate

BRAND

hydrocortisone 100mg/60ml enema generic

UCERIS 9 MG ER TABLETbudesonide

BRAND

SULFONAMIDES

SULFASALAZINE (500 MG, 500 MG DR) generic



SULFAZINE 500 MG TABLETsulfasalazine

BRAND

SULFAZINE EC 500 MG TABsulfasalazine

BRAND

METABOLIC BONE DISEASE AGENTS

ALENDRONATE SODIUM (10 MG TABLET, 70 MG/75MLSOLUTION, 40 MG TABLET, 35 MG TABLET, 70 MGTABLET, 5 MG TABLET)

generic

calcitonin,salmon,synthetic 200/spray spray/pump generic

CALCITRIOL (1 MCG/ML SOLUTION, 0.5 MCGCAPSULE, 0.25 MCG CAPSULE, 1 MCG/ML AMPUL)

generic

DOXERCALCIFEROL (1 MCG, 2.5 MCG, 0.5 MCG) generic S Specialty Drug

ETIDRONATE DISODIUM (200 MG, 400 MG) generic

FORTEO 600 MCG/2.4 ML PEN INJteriparatide

BRANDPA

S Specialty Drug

FORTICAL 200 UNITS NASAL SPRAYcalcitonin,salmon,synthetic

BRAND

HECTOROL (2 MCG/ML, 4 MCG/2 ML)doxercalciferol


ibandronate sodium 150 mg tablet generic

PARICALCITOL (2 MCG/ML VIAL, 2 MCG CAPSULE, 5MCG/ML VIAL, 4MCG CAPSULE, 1 MCG CAPSULE)

generic

RISEDRONATE SODIUM (5 MG, 30 MG, 35 MG DR, 150MG, 35 MG)

generic

MISCELLANEOUS THERAPEUTIC AGENTS

acetylcysteine 200 mg/ml vial generic PA

ALBUTEIN 25% VIALalbumin human

BRAND

AVITENE SHEET 70MMX70MMmicrofibrillar collagen

BRAND

coal tar 20 % solution generic

COMPOUND 347 INHALATIONenflurane

BRAND

dexmedetomidine hcl 200mcg/2ml vial generic

ENDO-AVITENE 5MM SHEETmicrofibrillar collagen

BRAND



EUFLEXXA 20 MG/2 ML SYRINGEhyaluronate sodium

BRAND PA

flumazenil 0.1 mg/ml vial generic

fomepizole 1 g/ml vial generic

FORANE LIQUIDisoflurane

BRAND

FORMA-RAY 20% SOLUTIONformaldehyde

BRAND

FORMADON 10% SOLUTIONformaldehyde

BRAND

formaldehyde 10 % sol w/appl generic

glutaraldehyde 25 % solution generic

glycine/sod/water/sod hydrox vial generic S Specialty Drug

HEMABATE 250 MCG/ML AMPULcarboprost tromethamine

BRAND

IC GREEN 25 MG VIALindocyanine green

BRAND

isoflurane 99.9 % liquid generic

isomethept/dichlphn/acetaminop 65-100-325 capsule generic

isomethepten/caf/acetaminophen 65-20-325 tablet generic

isosulfan blue 1 % vial generic

LMD 10% WITH 0.9% SOD CHL SOLNdextran 40 in 0.9 % sodium chloride

BRAND

LMD 10% WITH 5% DEXT SOLNdextran 40/dextrose 5 % in water

BRAND

LUGOL'S SOLUTIONpotassium iodide/iodine

BRAND

MANNITOL (25 VIAL, 20 IV SOLN, 5 IV SOLN, 10 IVSOLN)

generic

MD-GASTROVIEW 66%-10% SOLNdiatrizoate meglumine/diatrizoate sodium

BRAND

METHYLENE BLUE (1 VIAL, 1 AMPUL) generic

METHYLERGONOVINE MALEATE (0.2 MG TABLET,.2MG/ML(1) AMPUL)

generic

MIGRAGESIC IDA CAPSULEisometheptene mucate/dichloralphenazone/acetaminophen

BRAND

NODOLOR CAPSULEisometheptene mucate/dichloralphenazone/acetaminophen

BRAND



OSMITROL (20%, 15%)mannitol

BRAND

oxytocin 10 unit/ml vial generic

PANHEMATIN 313 MG VIALhemin

BRAND

phenol liquid generic

potassium iodide/iodine 5 % solution generic

PROTOPAM CHLORIDE 1 GM VIALpralidoxime chloride

BRAND

sevoflurane liquid generic

SITZMARKS CAPSULEradiopaque pvc markers/barium sulfate

BRAND

sodium morrhuate 50 mg/ml vial generic

SOJOURN INHALATION LIQUIDsevoflurane

BRAND

SOLIRIS 300 MG/30 ML VIALeculizumab

BRAND PA

SOTRADECOL 3% VIALsodium tetradecyl sulfate

BRAND

TERRELL LIQUIDisoflurane

BRAND

water for inj.,bacteriostatic vial generic

WATER FOR INJECTION,STERILE (IVSOLN, AMPUL,VIAL)

generic

water for irrigation,sterile irrig soln generic

water/me-paraben/propylparaben vial generic

OPHTHALMIC AGENTS

OPHTHALMIC AGENTS, OTHER

AKORN BALANCED SALT SOLNbalanced salt irrig soln no.2

BRAND

ALTACAINE 0.5% EYE DROPStetracaine hcl

BRAND

ALTAFLUOR EYE DROPSbenoxinate hcl/fluorescein sodium

BRAND

ATROPINE CARE 1% EYE DROPSatropine sulfate

BRAND

ATROPINE SULFATE (1 DROPS, 1 OINT. (G)) generic



balanced salt irrig soln no.2 irrig soln generic

benoxinate hcl/fluorescein na 0.4%-0.25% drops generic

BIOGLO 1 MG OPHTHALMIC STRIPSfluorescein sodium

BRAND

BSS EYE SOLUTIONbalanced salt irrig soln no.2

BRAND

CYCLOPENTOLATE HCL (0.5, 2, 1) generic

CYSTARAN 0.44% EYE DROPScysteamine hcl

BRAND

FLUCAINE EYE DROPSproparacaine hcl/fluorescein sodium

BRAND

FLUOR-I-STRIP ATfluorescein sodium

BRAND

FLUORESCITE 10% VIALfluorescein sodium

BRAND

FLUROX EYE DROPSbenoxinate hcl/fluorescein sodium

BRAND

FUL-GLO 1 MG OPTH STRIPSfluorescein sodium

BRAND

HOMATROPAIRE 5% EYE DROPShomatropine hbr

BRAND

homatropine hbr 5 % drops generic

naphazoline hcl 0.1 % drops generic

NEO-POLYCIN EYE OINTMENTneomycin sulfate/bacitracin/polymyxin b

BRAND

NEO-POLYCIN HC EYE OINTMENTneomycin sulfate/bacitracin zinc/polymyxinb/hydrocortisone

BRAND

neomycin su/baci zn/poly/hc 3.5-10k-1 oint. (g) generic

neomycin su/bacitra/polymyxin 3.5mg-400 oint. (g) generic

neomycin/polymyxin b sulf/hc 3.5-10k-10 drops susp generic

NEOMYCIN/POLYMYXIN BSULFATE/DEXAMETHASONE (0.1 % DROPS SUSP, 3.5-10K-.1 OINT. (G))

generic

neomycin/polymyxn b/gramicidin 1.75mg-10k drops generic

OCUCOAT VISCOADHERENT SYRINGEhypromellose

BRAND

PHENYLEPHRINE HCL (10, 2.5) generic



POLYCIN EYE OINTMENTbacitracin/polymyxin b sulfate

BRAND

polymyxin b sulf/trimethoprim 10000-1/ml drops generic

proparacaine hcl 0.5 % drops generic

proparacaine/fluorescein sod 0.5%-0.25% drops generic

RESTASIS 0.05% EYE EMULSIONcyclosporine

BRAND

sulfacetamide/prednisolone sp 10 %-0.23% drops generic

TETCAINE 0.5% EYE DROPStetracaine hcl

BRAND

tetracaine hcl 0.5 % drops generic

tetracaine hcl/pf 0.5 % drops generic

tobramycin/dexamethasone 0.3 %-0.1% drops susp generic

TROPICAMIDE (0.5, 1) generic

OPHTHALMIC ANTI-ALLERGY AGENTS

azelastine hcl 0.05 % drops generic

cromolyn sodium 4 % drops generic

epinastine hcl 0.05 % drops generic

olopatadine hcl 0.1 % drops generic

OPHTHALMIC ANTI-INFLAMMATORIES

bromfenac sodium 0.09% drops generic

dexamethasone sod phosphate 0.1 % drops generic

diclofenac sodium 0.1 % drops generic

fluorometholone 0.1 % drops susp generic

flurbiprofen sodium 0.03 % drops generic

KETOROLAC TROMETHAMINE (0.5, 0.4) generic

PRED MILD 0.12% EYE DROPSprednisolone acetate

BRAND

prednisolone acetate 1 % drops susp generic

prednisolone sod phosphate 1 % drops generic

OPHTHALMIC ANTIGLAUCOMA AGENTS

ALPHAGAN P 0.1% DROPSbrimonidine tartrate

BRAND

apraclonidine hcl 0.5 % drops generic



betaxolol hcl 0.5 % drops generic

BRIMONIDINE TARTRATE (0.2, 0.15) generic

carteolol hcl 1 % drops generic

dorzolamide hcl 2 % drops generic

dorzolamide hcl/timolol maleat 22.3-6.8/1 drops generic

levobunolol hcl 0.5 % drops generic

METHAZOLAMIDE (50 MG, 25 MG) generic

metipranolol 0.3 % drops generic

MIOSTAT VIALcarbachol

BRAND

PHOSPHOLINE IODIDE 0.125%echothiophate iodide

BRAND

PILOCARPINE HCL (4, 2, 1) generic

TIMOLOL MALEATE (0.25 DROPS, 0.5 SOL-GEL, 0.5DROPS, 0.25 SOL-GEL)

generic

OPHTHALMIC PROSTAGLANDIN AND PROSTAMIDE ANALOGS

bimatoprost 0.03 % drops generic

latanoprost 0.005 % drops generic

travoprost (benzalkonium) 0.004 % drops generic

OTIC AGENTS

ACETASOL HC EAR DROPSacetic acid/hydrocortisone

BRAND

acetic acid 2 % solution generic

acetic acid/aluminum acetate 2 % drops generic

acetic acid/hydrocortisone 2 %-1 % drops generic

AERO OTIC HC EAR DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

ANTIPYRINE/BENZOCAINE (5.4, 5.5) generic

AURODEX OTIC SOLUTIONantipyrine/benzocaine

BRAND

AUROGUARD OTIC SOLUTIONantipyrine/benzocaine

BRAND

CIPRODEX OTIC SUSPENSIONciprofloxacin hcl/dexamethasone

BRAND

CORTANE-B OTIC DROPS BRAND



hydrocortisone/pramoxine hcl/chloroxylenol/water

EXOTIC-HC EAR DROPhydrocortisone/pramoxine hcl/chloroxylenol

BRAND

fluocinolone acetonide oil 0.01 % drops generic

NEOMYCIN SULFATE/POLYMYXIN BSULFATE/HYDROCORTISONE (SOLUTION, DROPSSUSP)

generic

OTICIN HC DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

OTO-END 10 EAR DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

OTOMAX-HC EAR DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

OTOZIN EAR DROPSantipyrine/benzocaine/glycerin/zinc acetate

BRAND

PRAMOXINE-HC OTIC DROPShydrocortisone/pramoxine hcl/chloroxylenol

BRAND

RESPIRATORY TRACT/PULMONARY AGENTS

ANTI-INFLAMMATORIES, INHALED CORTICOSTEROIDS

ARNUITY ELLIPTA (200 MCG, 100 MCG)fluticasone furoate

BRAND QL

BUDESONIDE (1 MG/2 ML AMPUL-NEB, 32MCGSPRAY/PUMP)

generic

budesonide 0.25mg/2ml ampul-neb genericQL

C 2 vials (4ml)/day

budesonide 0.5 mg/2ml ampul-neb generic C 2 vials (4ml)/day

flunisolide 25 mcg spray generic

fluticasone propionate 50 mcg spray susp generic

PULMICORT FLEXHALER (90 MCG, 180 MCG)budesonide

BRAND

QVAR (80 MCG, 40 MCG)beclomethasone dipropionate

BRAND

triamcinolone acetonide 55 mcg spray generic

ANTIHISTAMINES

ARBINOXA (4 MG TABLET, 4 MG/5 ML LIQUID)carbinoxamine maleate

BRAND

AZELASTINE HCL (205.5MCG, 137 MCG) generic



CARBINOXAMINE MALEATE (4 MG TABLET, 4 MG/5 MLLIQUID)

generic

CLEMASTINE FUMARATE (2.68 MG TABLET,0.67MG/5ML SYRUP)

generic

CYPROHEPTADINE HCL (4 MG TABLET, 2 MG/5 MLSYRUP)

generic

DESLORATADINE (2.5 MG, 5 MG) generic C

must trycetirizine,cetirizine/pseudoephedrine,loratadine,loratadine/pseudoephedrine

desloratadine 5 mg tablet generic

PA

C

must trycetirizine,cetirizine/pseudoephedrine,loratadine,loratadine/pseudoephedrine

diphenhydramine hcl 50 mg/ml vial generic

HYDROXYZINE HCL (10 MG TABLET, 50 MG/ML VIAL,25 MG/ML VIAL, 50 MG/25ML SOLUTION, 10 MG/5 MLSOLUTION, 50 MG TABLET, 25 MG TABLET)

generic

HYDROXYZINE PAMOATE (100 MG, 50 MG, 25 MG) generic

levocetirizine dihydrochloride 2.5 mg/5ml solution generic

PA

C

must try cetirizine,cetirizine/pseudoephedrine, loratadine,loratadine/pseudoephedrine

levocetirizine dihydrochloride 5 mg tablet generic

PA

C

must try cetirizine,cetirizine/pseudoephedrine, loratadine,loratadine/pseudoephedrine

olopatadine hcl 0.6 % spray/pump generic

PALGIC (4 MG/5 ML LIQUID, 4 MG TABLET)carbinoxamine maleate

BRAND

PROMETHAZINE HCL (25 MG/ML VIAL, 25 MG TABLET,50 MG/ML AMPUL, 50 MG TABLET, 12.5 MG TABLET, 25MG/ML AMPUL, 6.25MG/5ML SYRUP, 50 MG/ML VIAL)

generic

ANTILEUKOTRIENES



MONTELUKAST SODIUM (4 MG GRAN PACK, 10 MGTABLET, 4 MG TAB CHEW, 5 MG TAB CHEW)

generic

zafirlukast 10 mg tablet generic PA

zafirlukast 20 mg tablet generic

BRONCHODILATORS, ANTICHOLINERGIC

ATROVENT HFA INHALERipratropium bromide

BRAND

IPRATROPIUM BROMIDE (42 MCG SPRAY, 21 MCGSPRAY, 0.2 MG/ML SOLUTION)

generic

SPIRIVA 18 MCG CP-HANDIHALERtiotropium bromide

BRAND

SPIRIVA RESPIMAT (2.5 MCG, 1.25 MCG)tiotropium bromide

BRAND

TUDORZA PRESSAIR 400 MCG INHaclidinium bromide

BRAND

BRONCHODILATORS, SYMPATHOMIMETIC

ADRENALIN 1 MG/ML VIALepinephrine

BRAND C 2 kits/fill

ADRENALIN CL 1 MG/ML VIALepinephrine

BRAND C 2 kits/fill

ALBUTEROL SULFATE (2 MG/5 ML SYRUP,1.25MG/3ML VIAL-NEB, 8 MG TAB ER 12H, 2.5 MG/3MLVIAL-NEB, 2.5 MG/0.5 VIAL-NEB, 4 MG TAB ER 12H, 2MG TABLET, 0.63MG/3ML VIAL-NEB, 5 MG/MLSOLUTION, 4 MG TABLET)

generic

EPINEPHRINE (1 MG/ML VIAL, 0.1 MG/ML SYRINGE,0.3MG/0.3 AUTO INJCT, 1 MG/ML(1) AMPUL, 0.15/0.15AUTO INJCT)

generic C 2 kits/fill

epinephrine hcl/pf 1 mg/ml(1) ampul generic C 2 kits/fill

epinephrine/pf 1 mg/ml(1) ampul generic C 2 kits/fill

EPIPEN 2-PAK 0.3 MG AUTO-INJCTepinephrine

BRAND C 2 kits/fill

EPIPEN JR 2-PAK 0.15 MG INJCTRepinephrine

BRAND C 2 kits/fill

LEVALBUTEROL HCL (0.63MG/3ML, 1.25MG/0.5,1.25MG/3ML, 0.31MG/3ML)

generic C 24 vials/month

METAPROTERENOL SULFATE (10 MG TABLET, 20 MGTABLET, 10 MG/5 ML SYRUP)

generic

PERFOROMIST 20 MCG/2 ML SOLN BRAND



formoterol fumarate

STRIVERDI RESPIMAT INHAL SPRAYolodaterol hcl

BRAND QL

TERBUTALINE SULFATE (5 MG TABLET, 2.5 MGTABLET, 1 MG/ML VIAL)

generic

VENTOLIN HFA 90 MCG INHALERalbuterol sulfate

BRAND QL

CYSTIC FIBROSIS AGENTS

CAYSTON 75 MG INHAL SOLUTIONaztreonam lysine

BRAND

QL

PA

C 3 vials/day; max 84vials/56 days

S Specialty Drug

KALYDECO (75 MG, 50 MG)ivacaftor

BRAND

QL

PA

C 2 packets/day

S Specialty Drug

KALYDECO 150 MG TABLETivacaftor

BRAND

QL

PA

S Specialty Drug

TOBI 300 MG/5 ML SOLUTIONtobramycin in 0.225 % sodium chloride

BRAND

QL

PA

C 2 vials/day

S Specialty Drug

TOBI PODHALER 28 MG INHALE CAPtobramycin

BRAND

QL

PA

C 8 capsules/day

S Specialty Drug

tobramycin in 0.225% nacl 300 mg/5ml ampul-neb generic

QL

PA

C 2 vials/day

S Specialty Drug

tobramycin/nebulizer 300 mg/5ml ampul-neb generic

QL

PA

S Specialty Drug



PHOSPHODIESTERASE INHIBITORS, AIRWAYS DISEASE

AMINOPHYLLINE (500MG/20ML VIAL, 250MG/10MLVIAL, 250MG/10ML AMPUL)

generic

CAFFEINE CITRATED (60 ML VIAL, 60 ML SOLUTION) generic

THEOCHRON (ER 300 MG, ER 200 MG, ER 100 MG)theophylline anhydrous

BRAND

THEOPHYLLINE ANHYDROUS (80 MG/15ML ELIXIR,300 MG TAB ER 12H, 600 MG TABLET ER, 400 MGTABLET ER, 100 MG TAB ER 12H, 450 MG TAB ER 12H,80 MG/15ML SOLUTION, 200 MG TAB ER 12H)

generic

THEOPHYLLINE/DEXTROSE 5 % IN WATER(800MG/.25L, 400MG/0.5L, 200MG/0.1L, 200MG/50ML,400MG/.25L)

generic

PULMONARY ANTIHYPERTENSIVES

ADCIRCA 20 MG TABLETtadalafil

BRANDPA

S Specialty Drug

ADEMPAS (0.5 MG, 1.5 MG, 1 MG, 2 MG, 2.5 MG)riociguat

BRANDPA

S Specialty Drug

EPOPROSTENOL SODIUM (GLYCINE) (1.5 MG, 0.5 MG) generic

LETAIRIS (5 MG, 10 MG)ambrisentan

BRANDPA

S Specialty Drug

OPSUMIT 10 MG TABLETmacitentan

BRANDPA

S Specialty Drug

REMODULIN (10 MG/ML, 5 MG/ML, 2.5 MG/ML, 1MG/ML)treprostinil sodium

BRANDPA

S Specialty Drug

REVATIO 10 MG/12.5 ML VIALsildenafil citrate

BRANDPA

S Specialty Drug

sildenafil citrate 10 mg/12.5 vial genericPA

S Specialty Drug

sildenafil citrate 20 mg tablet generic

QL

PA

S Specialty Drug

TRACLEER (125 MG, 62.5 MG)bosentan

BRANDPA

S Specialty Drug



TYVASO (INHALATION REFILL KIT, INSTITUTIONALSTART KIT, INHALATION STARTER KIT, 1.74 MG/2.9 MLSOLUTION)treprostinil/nebulizer/nebulizer accessories

BRANDPA

S Specialty Drug

VELETRI (1.5 MG, 0.5 MG)epoprostenol sodium (arginine)

BRANDPA

S Specialty Drug

VENTAVIS (10 ML, 20 ML)iloprost tromethamine

BRANDPA

S Specialty Drug

RESPIRATORY TRACT AGENTS, OTHER

ACETYLCYSTEINE (100 MG/ML, 200 MG/ML) generic

ARALAST 1,000 MG VIALalpha-1-proteinase inhibitor

BRAND

ARALAST NP (1,000 MG, 500 MG)alpha-1-proteinase inhibitor

BRAND

BENZONATATE (150 MG, 200 MG, 100 MG) generic

BREO ELLIPTA (200-25 MCG, 100-25 MCG)fluticasone furoate/vilanterol trifenatate

BRAND

CENTERGY PEDIATRIC DROPSchlorpheniramine maleate/phenylephrine hcl

BRAND

COMBIVENT RESPIMAT INHAL SPRAYipratropium bromide/albuterol sulfate

BRAND

cromolyn sodium 20 mg/2 ml ampul-neb generic

doxapram hcl 20 mg/ml vial generic

DULERA (200 MCG, 100 MCG)mometasone furoate/formoterol fumarate

BRAND

fexofenadine/pseudoephedrine 180-240mg tab er 24h generic

PA

C

must try cetirizine,cetirizine/pseudoephedrine,loratadine, loratadine/pseudoephedrine

hydrocodone/chlorphen p-stirex 10-8mg/5ml sus er 12h generic

ipratropium/albuterol sulfate 0.5-3mg/3 ampul-neb generic

phenylephrine hcl/prometh hcl 5-6.25mg/5 syrup generic

PROLASTIN (500 MG, 1,000 MG)alpha-1-proteinase inhibitor

BRAND

PROLASTIN C 1,000 MG VIALalpha-1-proteinase inhibitor

BRAND

promethazine hcl/codeine 6.25-10/5 syrup generic



promethazine/dextromethorphan 6.25-15/5 syrup generic

PULMOZYME 1 MG/ML AMPULdornase alfa

BRANDPA

S Specialty Drug

sodium chloride for inhalation 7 % vial-neb generic

STIOLTO RESPIMAT INHAL SPRAYtiotropium bromide/olodaterol hcl

BRAND QL

SYMBICORT (80-4.5 MCG, 160-4.5 MCG)budesonide/formoterol fumarate

BRAND

TUSSIGON 5-1.5 MG TABLEThydrocodone bitartrate/homatropine methylbromide

BRAND

XOLAIR 150 MG VIALomalizumab

BRANDPA

S Specialty Drug

ZEMAIRA 1,000 MG VIALalpha-1-proteinase inhibitor

BRAND

SKELETAL MUSCLE RELAXANTS

ANECTINE 20 MG/ML VIALsuccinylcholine chloride

BRAND

atracurium besylate 10 mg/ml vial generic

BACLOFEN (20 MG, 10 MG) generic

carisoprodol 250 mg tablet generic

chlorzoxazone 500 mg tablet generic

CYCLOBENZAPRINE HCL (10 MG, 5 MG, 7.5 MG) generic

DANTROLENE SODIUM (100 MG, 50 MG, 25 MG) generic

GABLOFEN (50 MCG/ML SYRINGE, 40,000 MCG/20 MLVIAL, 10,000 MCG/20 ML VIAL)baclofen


METAXALONE (800 MG, 400 MG) generic

METHOCARBAMOL (750 MG, 500 MG) generic

ORPHENADRINE CITRATE (100 MG TABLET ER, 30MG/ML AMPUL, 30 MG/ML VIAL)

generic

orphenadrine/aspirin/caffeine 50-770-60 tablet generic

pancuronium bromide 1 mg/ml vial generic

REVONTO 20 MG VIALdantrolene sodium

BRAND

ROCURONIUM BROMIDE (10 MG/ML VIAL,100MG/10ML SYRINGE, 50 MG/5 ML SYRINGE)

generic



succinylcholine chloride 200mg/10ml syringe generic

TIZANIDINE HCL (6 MG CAPSULE, 4 MG TABLET, 2 MGCAPSULE, 4 MG CAPSULE, 2 MG TABLET)

generic

VECURONIUM BROMIDE (20 MG, 10 MG) generic

SLEEP DISORDER AGENTS

GABA RECEPTOR MODULATORS

ESTAZOLAM (1 MG, 2 MG) generic

ESZOPICLONE (2 MG, 1 MG, 3 MG) generic

quazepam 15 mg tablet generic

TEMAZEPAM (7.5 MG, 15 MG, 30 MG, 22.5 MG) generic

TRIAZOLAM (0.25 MG, 0.125 MG) generic

ZALEPLON (10 MG, 5 MG) generic C

must try zolpidem andzaleplon for at least 2weeks of therapy in thepast 90 days

ZOLPIDEM TARTRATE (6.25 MG TAB MPHASE, 10 MGTABLET, 12.5 MG TAB MPHASE, 5 MG TABLET)

generic

SLEEP DISORDERS, OTHER

caffeine/sodium benzoate 250 mg/ml vial generic

FLURAZEPAM HCL (15 MG, 30 MG) generic

HETLIOZ 20 MG CAPSULEtasimelteon

BRAND

QL

PA

S Specialty Drug

MODAFINIL (100 MG, 200 MG) generic PA

ROZEREM 8 MG TABLETramelteon

BRAND

ST

C

must try zolpidem andzoleplon for at least 2weeks of therapy in thepast 90 days

SECONAL SODIUM 100 MG CAPSULEsecobarbital sodium

BRAND

XYREM 500 MG/ML ORAL SOLUTIONsodium oxybate


THERAPEUTIC NUTRIENTS/MINERALS/ELECTROLYTES

ELECTROLYTE/MINERAL MODIFIERS



CHEMET 100 MG CAPSULEsuccimer

BRAND

DEFEROXAMINE MESYLATE (2 G, 500 MG) generic

EXJADE (500 MG, 250 MG, 125 MG)deferasirox

BRAND PA

FERRIPROX 500 MG TABLETdeferiprone


KIONEX (15 GM/60 ML SUSPENSION, POWDER)sodium polystyrene sulfonate

BRAND

MARLEXATE POWDERsodium polystyrene sulfonate

BRAND

SAMSCA (30 MG, 15 MG)tolvaptan


SODIUM POLYSTYRENE SULFONATE (POWDER,30G/120ML ENEMA, 15 G/60 ML ORAL SUSP)

generic

SODIUM THIOSULFATE (1 G/10 ML, 12.5G/50ML) generic

SPS (15 GM/60 ML SUSPENSION, 30 GM/120 MLENEMA)sodium polystyrene sulfonate

BRAND

ELECTROLYTE/MINERAL REPLACEMENT

0.9 % SODIUM CHLORIDE (0.9 0.9 IV SOLN, 0.9 0.9SYRINGE, 0.9 PGGYBK PRT, 0.9 0.9 VIAL, 0.9 PGY VLPRT)

generic

CALCIUM CHLORIDE (100 MG/ML VIAL, 100 MG/MLSYRINGE)

generic

calcium gluconate 100 mg/ml vial generic

calcium/mag/d3/b12/fa/b6/boron 500-300-1 wafer generic

CARBAGLU 200 MG DISPER TABLETcarglumic acid


CENTRATEX CAPSULEferrous fumarate/folic acid/multivitamins with min no. 15

BRAND

chromic chloride 4mcg/ml vial generic

CORVITA 150 TABLETiron,carbonyl/folic acid/vit c/pyridoxine hcl/vit b12/zinc

BRAND

cupric chloride 0.4 mg/ml vial generic

DELFLEX WITH 1.5% DEXTROSEperitoneal dialysis no.6 with dextrose 1.5 %

BRAND


BRAND




BRAND

DEXTROSE 10 % AND 0.2 % SODIUM CHLORIDE (100.2 10 DEHP FR BG, 10 0.2 10 IV SOLN)

generic

dextrose 10 % and 0.45 % nacl 10%-0.45% iv soln generic

dextrose 10 % and 0.9 % nacl 10 %-0.9 % iv soln generic

dextrose 2.5 % and 0.45 % nacl 2.5%-0.45% iv soln generic



dextrose 5 %-0.2 % nacl 5 %-0.2 % iv soln generic

dextrose 5 %-0.45 % nacl 5 %-0.45 % iv soln generic

dextrose 5% in ringers 5 % iv soln generic

dextrose 5%-lactated ringers 5 % iv soln generic

EFFER-K 25 MEQ TABLET EFFpotassium bicarbonate/citric acid

BRAND

electrolyte-48 solution/d5w 5 % iv soln generic

FE 90 PLUS TABLETiron carbonyl,gluc/folic acid/vit b12/vit c/docusate sodium

BRAND

FE C PLUS TABLETiron,carbonyl/ascorbic acid/cyanocobalamin/folic acid

BRAND

FEROCON CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

FEROTRINSIC CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

FERRAPLUS 90 TABLETiron,carbonyl/folic acid/vitamin b12/vitamin c/docusate na

BRAND

FERREX 150 FORTE CAPSULEiron polysaccharide complex/cyanocobalamin/folic acid

BRAND

FERREX 150 FORTE PLUS CAPSULEiron asp gly&ps cmplx/ascorb.cal/vit b12/fa/ca-thr/succ.acid

BRAND

FERREX 28 TABLETiron asp.glycin & fumarate /vit c/fa/mv comb 11/ca-threonate

BRAND

FERROCITE PLUS TABLETiron/folic acid/vitamin b comp and c/minerals

BRAND

FERROGELS FORTE SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND

FLUOR-A-DAY (1 MG TABLET, 0.25 MG TAB, 0.5 MG BRAND



TAB)sodium fluoride/xylitol

FOCALGIN DSS TABLETiron carbonyl,gluc/folic acid/vit b12/vit c/docusate sodium

BRAND

FOLIVANE-F CAPSULEiron fumarate & polysac comp/folic acid/vitamin c/niacin

BRAND

FOLIVANE-PLUS CAPSULEiron fumarate,polysac cplex/folic acid/vit b comp with c #9

BRAND

HEMATINIC-FOLIC ACID TABLETferrous fumarate/folic acid

BRAND

HEMATINIC-VITAMIN-MINERAL TABiron/folic acid/vitamin b comp and c/minerals

BRAND

HEMATOGEN FA SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND

HEMATOGEN FORTE SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND

HEMATOGEN SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/stomachconc

BRAND

HEMETAB IRON SUPPLEMENT TABLETiron polysacchar complx/iron heme polypeptide/folicacid/b12

BRAND

INFED 100 MG/2 ML VIALiron dextran complex

BRANDPA

S Specialty Drug

K EFFERVESCENT 25 MEQ TABLETpotassium bicarbonate/citric acid

BRAND

K-SOL (10% (20, 20% (40)potassium chloride

BRAND

K-TAB ER 8 MEQ TABLETpotassium chloride

BRAND

KLOR-CON (25, 20)potassium chloride

BRAND

KLOR-CON 10 MEQ TABLETpotassium chloride

BRAND

KLOR-CON 8 MEQ TABLETpotassium chloride

BRAND

KLOR-CON M10 TABLETpotassium chloride

BRAND


BRAND




BRAND

KLOR-CON SPRINKLE (ER 8 CAP, ER 10 CP)potassium chloride

BRAND

KLOR-CON-EF 25 MEQ TAB EFFpotassium bicarbonate/citric acid

BRAND

magnesium chloride 200 mg/ml vial generic

MAGNESIUM SULFATE (4 SYRINGE, 4 VIAL) generic

MAGNESIUM SULFATE IN STERILE WATER (4 G/50 MLPIGGYBACK, 20 G/500ML IV SOLN, 4 G/100 MLPIGGYBACK, 40G/1000ML IV SOLN, 2 G/50 MLPIGGYBACK)

generic

manganese chloride 0.1 mg/ml vial generic

manganese sulfate 0.1 mg/ml vial generic

molybdenum(ammonium molybdate) 25 mcg/ml vial generic

MONOJECT 0.9% SODIUM CL SYRING0.9 % sodium chloride

BRAND

MONOJECT PREFILL 0.9% FLUSH0.9 % sodium chloride

BRAND

MONOJECT PREFILL 0.9% NA SYR0.9 % sodium chloride

BRAND

MULTIGEN CAPLETiron aspgly/ascorb.cal/vit b12/calciumthr/succ.acid/stomach

BRAND

MULTIGEN FOLIC CAPLETiron asp gly/ascorb.cal/vit b12/fa/ca-threonte/succinic acid

BRAND

MULTIGEN PLUS CAPLETiron fumarte &asp gly/ascorb.cal/vit b12/fa/ca-thr/succ.acid

BRAND

MULTITRACE-4 CONC VIALzinc sulfate/cupric sulfate/manganese sulf/chromic chloride

BRAND

MULTITRACE-5 CONC VIALzinc sulfate heptahydrate/cuso4 p-hyd/manganese/chromium/se

BRAND

NATALVIRT FLT TABLETiron carbonyl,gluc/folic acid/vit b12/vit c/docusate sodium

BRAND

NUTRILYTE II VIALsodium/potassium/magnesium/calcium/chloride/acetate

BRAND

NUTRILYTE VIALsodium/potassium/magnes/calcium/chloride/acetate/gluconate

BRAND



POLYSACCHARIDE IRON FORTEiron polysaccharide complex/cyanocobalamin/folic acid

BRAND

pot chloride/pot bicarb/cit ac 25 meq tablet eff generic

POTASSIUM ACETATE (2, 4) generic

potassium bicarbonate/cit ac 25 meq tablet eff generic

POTASSIUM CHLORIDE (40MEQ/0.1L PIGGYBACK, 10MEQ TAB ER PRT, 8 MEQ CAPSULE ER, 8 MEQTABLET ER, 10 MEQ CAPSULE ER, 10MEQ/50MLPIGGYBACK, 2 MEQ/ML VIAL, 20MEQ/50MLPIGGYBACK, 20 MEQ PACKET, 20MEQ/15ML LIQUID,10 MEQ TABLET ER, 30MEQ/0.1L PIGGYBACK,20MEQ/0.1L PIGGYBACK, 2 MEQ/ML IV SOLN, 20 MEQTABLET ER, 20 MEQ TAB ER PRT, 40MEQ/15MLLIQUID, 10MEQ/0.1L PIGGYBACK)

generic

POTASSIUM CHLORIDE IN 0.9 % SODIUM CHLORIDE(20, 40)

generic

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN WATER(40, 20, 30)

generic

POTASSIUM CHLORIDE IN DEXTROSE 5 % AND 0.9 %SODIUM CHLORIDE (40, 20)

generic

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 %SODIUM CHLORIDE (20, 10, 30, 40)

generic

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 %SODIUM CHLORIDE (10, 20, 40, 30)

generic

POTASSIUM CHLORIDE IN LACTATED RINGERS AND 5% DEXTROSE (40, 20)

generic

potassium chloride-0.45% nacl 20 meq/l iv soln generic

potassium chloride/d5-0.3%nacl 20 meq/l iv soln generic

potassium phos in 0.9 % nacl 15mmol/250 plast. bag generic

potassium phos,m-basic-d-basic 3mmol/ml vial generic

PROFERRIN-FORTE TABLETiron heme polypeptide/folic acid

BRAND

PUREVIT DUALFE PLUS CAPSULEiron fumarate-iron polysacchar/folic acid/mv comb18

BRAND

ringers solution iv soln generic

ringers solution,lactated iv soln generic

SE-TAN PLUS CAPSULEiron fumarate-iron polysacchar/folic acid/mv comb18

BRAND

selenium 40 mcg/ml vial generic

SODIUM ACETATE (4, 2) generic



SODIUM BICARBONATE (1 MEQ/ML SYRINGE,0.5MEQ/ML SYRINGE, 0.9MEQ/ML SYRINGE, 1 MEQ/MLVIAL, 10MEQ/10ML SYRINGE, 0.5MEQ/ML VIAL)

generic

SODIUM CHLORIDE 0.45 % (0.45 PGGYBK PRT, 0.450.45 IV SOLN)

generic

sodium chloride 3 % 3 % iv soln generic

sodium chloride 5 % 5 % iv soln generic

sodium chloride irrig solution 0.9 % irrig soln generic

sodium fluoride 0.25(0.55) tab chew generic

sodium lactate 5 meq/ml vial generic

sodium phos,m-basic-d-basic 3mmol/ml vial generic

SYREX SODIUM CHL 0.9% SYR0.9 % sodium chloride

BRAND

TARON FORTE CAPSULEiron bisgly,pscmplx/ascorbate calc/b12/folic acid/calc-threo

BRAND

TL G-FOL OS TABLETcalcium carb/mag oxide/vitamin d3/vit b12/fa/vit b6/boron

BRAND

TL ICON CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

TL-HEM 150 CAPLETiron,carbonyl/docusate sodium/b12-if/folic acid/multivit-min

BRAND

TRICON CAPSULEferrous fumarate/ascorbic acid/b12-if/folic acid

BRAND

TRIGELS-F FORTE SOFTGELferrous fumarate/ascorbic acid/cyanocobalamin/folic acid

BRAND

zinc chloride 1 mg/ml vial generic

ZINC SULFATE (1 MG/ML VIAL, 5 MG/ML VIAL,220(50)MG CAPSULE)

generic

AMINO ACIDS 15% SOLUTIONparenteral amino acid 15% combination no.1

BRAND

ascorbic acid 500 mg/ml vial generic

BAL-CARE DHA COMBO PACKprenatal vitamin no.81/sodium feredetate-ironpoly/fa/omega3

BRAND PA

cyanocobalamin (vitamin b-12) 1000mcg/ml vial generic

cysteine hcl 50 mg/ml vial generic

DEXTROSE 10 % IN WATER (10 10 IV SOLN, 10 10DEHP FR BG)

generic



dextrose 2.5 % in water 2.5 % iv soln generic

dextrose 20 % in water 20 % iv soln generic

dextrose 25 % in water 25 % syringe generic



DEXTROSE 5 % IN WATER (5 5 IV SOLN, 5 PGY VLPRT, 5 5 VIAL, 5 PGGYBK PRT)

generic

DEXTROSE 50 % IN WATER (50 50 IV SOLN, 50 50VIAL, 50 50 SYRGE)

generic


DIALYVITE TABLETfolic acid/vitamin b comp and c

BRAND

ergocalciferol (vitamin d2) 50000 unit capsule generic

ethyl alcohol 98 % ampul generic

FOLBEE PLUS TABLETfolic acid/vitamin b comp and c

BRAND

FOLIC ACID (5 MG/ML VIAL, 1 MG TABLET) generic

FREAMINE III 10% IV SOLN.parenteral amino acid 10% combination no. 4

BRAND

levocarnitine (with sugar) 100 mg/ml solution generic

levocarnitine 330 mg tablet generic

LEVOMEFOLATE CALCIUM/SCHIZOCHYTRIUM ALGALOIL (7.5-90.314, 15-90.314)

generic

LIPOSYN III (20%, 10%, 30%)fat emulsions

BRAND

MEPHYTON 5 MG TABLETphytonadione

BRAND

MYNATAL PLUS CAPTABprenatal vitamins with calcium/ferrous fumarate/folic acid

BRAND

MYNATAL-Z CAPTABprenatal vitamins with calcium/ferrous fumarate/folic acid

BRAND

MYNEPHROCAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

NEPHPLEX RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin/znox

BRAND

NEPHRO-VITE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND

NIVA-PLUS TABLET BRAND



prenatal vits with calcium #74/ferrous fumarate/folic acid

NUTRILIPID 20% IV FAT EMULSIONfat emulsions

BRAND

pedi mv #75/fluoride/iron 0.25-10/ml drops generic

PHYTONADIONE (10 MG/ML, 1MG/0.5ML) generic

PNV 29-1 TABLETprenatal vits with calcium #76/iron,carbonyl/folic acid

BRAND

pnv with ca,no.72/iron/fa 27 mg-1 mg tablet generic

pnv with ca,no.74/iron/fa 27 mg-1 mg tablet generic

PNV-SELECT TABLETprenatal vit with calcium no. 40/iron fumarate/fa cmb no.1

BRAND

PNV-VP-U CAPSULEprenatal vits without calc no5/ferrous fumarate/folic acid

BRAND

PREMASOL 10% IV SOLUTIONparenteral amino acid 10% combination no.7

BRAND

PRENA1 CHEW TABLETprenatal vitamins combination no.42/folic acid

BRAND

PRENAPLUS TABLETprenatal vits with calcium #74/ferrous fumarate/folic acid

BRAND

PREPLUS CA-FE 27 MG-FA 1 MG TBprenatal vits with calcium #72/ferrous fumarate/folic acid

BRAND

PRETAB 29 MG-1 MG TABLETprenatal vits with calcium #78/ferrous fumarate/folic acid

BRAND

RENA-VITE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND

RENAL CAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

RENO CAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

ringers solution irrig soln generic

ringers solution,lactated irrig soln generic

THERAPEUTIC VIT-MINERAL CAPmultivitamins with min no.7/folic acid

BRAND

thiamine hcl 100 mg/ml vial generic

THRIVITE RX TABLETprenatal vits with calcium #76/iron,carbonyl/folic acid

BRAND

TRAVASOL 10% SOLN VIAFLEXparenteral amino acid 10% combination no. 6

BRAND



VENA-BAL DHA COMBO PACKprenatal vitamin no.81/sodium feredetate-ironpoly/fa/omega3

BRAND PA

VIRT NATE TABLETprenatal vits with calcium #73/ferrous fumarate/folic acid

BRAND

VIRT-ADVANCE TABLETprenatal vitamin no.15/iron,carbonyl/folic acid/docusate sod

BRAND

VIRT-CAPS SOFTGELvitamin b complex & vitamin c no.20/folic acid

BRAND

VIRT-NATE DHA SOFTGELprenatal vitamins no.11/ferrous fumarate/folic acid/omega-3

BRAND

VIRT-NATE TABLETprenatal vits with calcium #73/ferrous fumarate/folic acid

BRAND

VIRT-PN TABLETprenatal vit with calcium no. 40/iron fumarate/fa cmb no.1

BRAND

VIRT-VITE GT TABLETprenatal vitamin no.16/iron,carbonyl/folic acid/docusate sod

BRAND

VIRTPREX CAPSULEprenatal vit with calcium no.66/iron fum/folic acid/dss/dha

BRAND

VITAFOL-OB CAPLETprenatal vitamins comb 10/ferrous fumarate/folic acid

BRAND

VITAFOL-PN CAPLETprenatal vit with calcium cmb 11/ferrous fumarate/folic acid

BRAND

VOL-CARE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND

VOL-PLUS TABLETprenatal vits with calcium #74/ferrous fumarate/folic acid

BRAND

VP-VITE RX TABLETvitamin b complx no.3/folic acid/ascorbic acid/biotin

BRAND

ZATEAN-PN TABLETprenatal vit with calcium no. 40/iron fumarate/fa cmb no.1

BRAND


Index of covered drugs00.9 % SODIUM CHLORIDE 116

88-MOP 67

AA-HYDROCORT 79

A-METHAPRED 79

ABACAVIR SULFATE 47

ABACAVIR SULFATE/LAMIVUDINE 46

ABACAVIR SULFATE/LAMIVUDINE/ZIDOVUDINE 46

ABILIFY 42

ABILIFY DISCMELT 42

ABILIFY MAINTENA 42

ABIRATERONE ACETATE 33

ABRAXANE 34

ABSORICA 68

ACAMPROSATE CALCIUM 14

ACARBOSE 49

ACD 51

ACD-A 52

ACEBUTOLOL HCL 57

ACETAMINOPHEN WITH CODEINE PHOSPHATE 8

ACETASOL HC 102

ACETAZOLAMIDE 62

ACETAZOLAMIDE SODIUM 62

ACETIC ACID 102

ACETIC ACID/ALUMINUM ACETATE 102

ACETIC ACID/HYDROCORTISONE 102

ACETIC ACID/OXYQUINOLINE SULFATE 78

ACETYLCYSTEINE 108

ACITRETIN 68

ACLIDINIUM BROMIDE 105

ACTEMRA 95

ACTIMMUNE 95

ACTOPLUS MET XR 49

ACYCLOVIR 48

ACYCLOVIR SODIUM 48

ADACEL TDAP 96

ADALIMUMAB 94

ADAPALENE 68

ADCIRCA 107

ADEFOVIR DIPIVOXIL 44

ADEMPAS 107

ADENOSINE 57

ADO-TRASTUZUMAB EMTANSINE 39

ADRENALIN 105

ADRENALIN CHLORIDE 105

ADRIAMYCIN 34

ADRUCIL 33

ADVATE 53

ADVATE H 54

ADVATE L 53

ADVATE M 53

ADVATE SH 53

ADVATE UH 53

AERO OTIC HC 102

AFATINIB DIMALEATE 37

AFEDITAB CR 58

AFINITOR 37

AFINITOR DISPERZ 37

AGALSIDASE BETA 73

AKORN BALANCED SALT 99

ALA-CORT 79

ALAGESIC LQ 65

ALBENDAZOLE 39

ALBENZA 39

ALBUMIN HUMAN 97

ALBUTEIN 97

ALBUTEROL SULFATE 106

ALCLOMETASONE DIPROPIONATE 79

ALDURAZYME 73

ALENDRONATE SODIUM 97

ALFENTANIL HCL 9

ALFUZOSIN HCL 77

ALGLUCOSIDASE ALFA 73

ALIMTA 34

ALINIA 39

ALKERAN 32

ALLOPURINOL 30


ALLOPURINOL SODIUM 30

ALMOTRIPTAN MALATE 31

ALOPRIM 30

ALOSETRON HCL 75

ALPHA-1-PROTEINASE INHIBITOR 109

ALPHAGAN P 101

ALPHANATE 54

ALPHAQUIN HP 68

ALPRAZOLAM 48

ALPRAZOLAM INTENSOL 48

ALPROSTADIL 59

ALTACAINE 99

ALTAFLUOR 99

ALTAVERA 83

ALTRETAMINE 32

ALUMINUM CHLORIDE 69

ALYACEN 84

AMANTADINE HCL 40

AMBRISENTAN 107

AMCINONIDE 79

AMETHIA 84

AMETHIA LO 84

AMETHYST 84

AMIFOSTINE CRYSTALLINE 34

AMIKACIN SULFATE 15

AMILORIDE HCL 62

AMILORIDE HCL/HYDROCHLOROTHIAZIDE 59

AMINO ACIDS 116

AMINOACETIC ACID 77

AMINOCAPROIC ACID 54

AMINOPHYLLINE 106

AMIODARONE HCL 57

AMITRIPTYLINE HCL 27

AMITRIPTYLINE HCL/CHLORDIAZEPOXIDE 25

AMLODIPINE BESYLATE 58

AMLODIPINE BESYLATE/ATORVASTATIN

CALCIUM 59

AMLODIPINE BESYLATE/BENAZEPRIL HCL 59

AMLODIPINE BESYLATE/VALSARTAN 60

AMLODIPINE

BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE

59

AMMONIUM LACTATE 69

AMNESTEEM 68

AMOXAPINE 27

AMOXICILLIN 19

AMOXICILLIN/POTASSIUM CLAVULANATE 20

AMPHOTERICIN B 28

AMPICILLIN SODIUM 20

AMPICILLIN SODIUM/SULBACTAM SODIUM 20

AMPICILLIN TRIHYDRATE 20

AMPYRA 66

AMYL NITRITE 63

ANAGRELIDE HCL 53

ANASPAZ 74

ANASTROZOLE 37

ANDROGEL 83

ANDROXY 83

ANECTINE 109

ANTHRALIN 69

ANTI-INHIBITOR COAGULANT COMPLEX 54

ANTIHEMOPHILIC FACTOR (FACTOR VIII)

RECOMB,B-DOMAIN DELETED 55

ANTIHEMOPHILIC FACTOR (FVIII) RECOMB,FULL

LENGTH (ALB-FREE) 55

ANTIHEMOPHILIC FACTOR (FVIII) RECOMBINANT,

FC FUSION PROTEIN 54

ANTIHEMOPHILIC FACTOR VIII RECOMBINANT, B-

DOMAIN TRUNCATED 55

ANTIHEMOPHILIC FACTOR VIII, HUMAN

RECOMBINANT 55

ANTIHEMOPHILIC FACTOR, HUMAN 54

ANTIHEMOPHILIC FACTOR, HUMAN/VON

WILLEBRAND FACTOR,HUMAN 54

ANTIPYRINE/BENZOCAINE 102

ANTIPYRINE/BENZOCAINE/GLYCERIN/ZINC

ACETATE 103

APEXICON 79

APEXICON E 79

APLIGRAF 68


APOKYN 41

APOMORPHINE HCL 41

APRACLONIDINE HCL 101

APREPITANT 28

APRI 84

APRISO 96

APTIVUS 47

ARALAST 108

ARALAST NP 108

ARANELLE 84

ARBINOXA 103

ARCALYST 95

ARGATROBAN IN SODIUM CHLORIDE, ISO-

OSMOTIC 52

ARIPIPRAZOLE 43

ARMOUR THYROID 91

ARNUITY ELLIPTA 103

ARRANON 34

ARSENIC TRIOXIDE 36

ARTEMETHER/LUMEFANTRINE 40

ARZERRA 39

ASCOMP WITH CODEINE 9

ASCORBIC ACID 116

ASFOTASE ALFA 73

ASHLYNA 84

ASPIRIN/DIPYRIDAMOLE 55

ASTRAMORPH-PF 9

ATAZANAVIR SULFATE 47

ATENOLOL 58

ATENOLOL/CHLORTHALIDONE 60

ATOMOXETINE HCL 65

ATORVASTATIN CALCIUM 63

ATOVAQUONE 40

ATOVAQUONE/PROGUANIL HCL 40

ATRACURIUM BESYLATE 109

ATRIPLA 46

ATROPINE CARE 99

ATROPINE SULFATE 99

ATROVENT HFA 105

AUBRA 84

AURANOFIN 95

AURODEX 102

AUROGUARD 102

AVAR 68

AVASTIN 39

AVELOX IV 21

AVIANE 84

AVIDOXY 22

AVITA 68

AVITENE 97

AVONEX 66

AVONEX ADMINISTRATION PACK 66

AVONEX PEN 66

AXITINIB 38

AZASAN 93

AZATHIOPRINE 93

AZELASTINE HCL 103

AZITHROMYCIN 20

AZTREONAM 19

AZTREONAM LYSINE 106

AZURETTE 84

BB-DONNA 74

BACIIM 15

BACITRACIN 15

BACITRACIN/POLYMYXIN B SULFATE 100

BACLOFEN 109

BACTROBAN NASAL 15

BAL-CARE DHA 116

BALANCED SALT IRRIG SOLN NO.2 100

BALSALAZIDE DISODIUM 96

BALZIVA 84

BANZEL 24

BARACLUDE 44

BCG LIVE 36

BEBULIN 54

BEBULIN VH IMMUNO 54

BECAPLERMIN 71

BECLOMETHASONE DIPROPIONATE 103

BEDAQUILINE FUMARATE 32

BEKYREE 84


BELATACEPT 94

BELIMUMAB 95

BENAZEPRIL HCL 57

BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE 60

BENDAMUSTINE HCL 33

BENEFIX 54

BENLYSTA 95

BENOXINATE HCL/FLUORESCEIN SODIUM 100

BENZEPRO 68

BENZONATATE 108

BENZOYL PEROXIDE 68

BENZOYL PEROXIDE MICROSPHERES 71

BENZPHETAMINE HCL 65

BENZTROPINE MESYLATE 40

BETAINE 73

BETAMETHASONE ACETATE/BETAMETHASONE

SODIUM PHOSPHATE 79

BETAMETHASONE DIPROPIONATE 79

BETAMETHASONE DIPROPIONATE/PROPYLENE

GLYCOL 79

BETAMETHASONE VALERATE 79

BETAXOLOL HCL 101

BETHANECHOL CHLORIDE 78

BEVACIZUMAB 39

BEXAROTENE 39

BEXXAR 39

BICALUTAMIDE 33

BICNU 32

BIMATOPROST 102

BIOGLO 100

BISACODYL/SODIUM CHLOR/SODIUM

BICARB/POTASSIUM CHL/PEG 3350 76

BISOPROLOL FUMARATE 58

BISOPROLOL

FUMARATE/HYDROCHLOROTHIAZIDE 60

BIVIGAM 94

BLISOVI 24 FE 84

BLISOVI FE 84

BOCEPREVIR 45

BOSENTAN 107

BOSULIF 37

BOSUTINIB 37

BP 10-1 68

BP-50% UREA 68

BPO 68

BREO ELLIPTA 108

BRIELLYN 84

BRILINTA 55

BRIMONIDINE TARTRATE 102

BROMFENAC SODIUM 101

BROMOCRIPTINE MESYLATE 41

BSS 100

BUDEPRION XL 26

BUDESONIDE 103

BUDESONIDE/FORMOTEROL FUMARATE 109

BUFFERED LIDOCAINE 12

BUMETANIDE 62

BUPHENYL 73

BUPIVACAINE HCL 14

BUPIVACAINE HCL/DEXTROSE-WATER/PF 12

BUPIVACAINE HCL/EPINEPHRINE 14

BUPIVACAINE HCL/EPINEPHRINE/PF 12

BUPIVACAINE HCL/PF 14

BUPRENORPHINE HCL 14

BUPRENORPHINE HCL/NALOXONE HCL 14

BUPROBAN 15

BUPROPION HCL 26

BUSPIRONE HCL 48

BUSULFAN 33

BUSULFEX 32

BUTALBITAL/ACETAMINOPHEN 66

BUTALBITAL/ACETAMINOPHEN/CAFFEINE 66

BUTALBITAL/ACETAMINOPHEN/CAFFEINE/CODEIN

E PHOSPHATE 9

BUTALBITAL/ASPIRIN/CAFFEINE 5

BUTOCONAZOLE NITRATE 29

BUTORPHANOL TARTRATE 9

BYDUREON 49

BYDUREON PEN 49

BYETTA 49


CCABERGOLINE 92

CAFFEINE CITRATED 107

CAFFEINE/SODIUM BENZOATE 110

CALCIPOTRIENE 68

CALCIPOTRIENE/BETAMETHASONE

DIPROPIONATE 68

CALCITONIN,SALMON,SYNTHETIC 97

CALCITRENE 68

CALCITRIOL 97

CALCIUM ACETATE 79

CALCIUM CARB/MAG OXIDE/VITAMIN D3/VIT

B12/FA/VIT B6/BORON 116

CALCIUM CHLORIDE 111

CALCIUM GLUCONATE 111

CAMILA 90

CAMRESE 84

CAMRESE LO 84

CANAGLIFLOZIN 50

CANAGLIFLOZIN/METFORMIN HCL 50

CANAKINUMAB/PF 95

CANASA 96

CANCIDAS 28

CANDESARTAN CILEXETIL 56

CANDESARTAN

CILEXETIL/HYDROCHLOROTHIAZIDE 60

CAPACET 65

CAPECITABINE 34

CAPRELSA 37

CAPTOPRIL 57

CAPTOPRIL/HYDROCHLOROTHIAZIDE 60

CARAFATE 76

CARB-O-PHILIC 69

CARBACHOL 102

CARBAGLU 111

CARBAMAZEPINE 25

CARBIDOPA 41

CARBIDOPA/LEVODOPA 41

CARBIDOPA/LEVODOPA/ENTACAPONE 41

CARBINOXAMINE MALEATE 104

CARBOCAINE 13

CARBOPLATIN 35

CARBOPROST TROMETHAMINE 98

CARDIOPLEGIC SOLUTION NO.1 60

CARGLUMIC ACID 111

CARISOPRODOL 109

CARMUSTINE 32

CARTEOLOL HCL 102

CARTIA XT 58

CARVEDILOL 58

CASPOFUNGIN ACETATE 28

CAYSTON 106

CAZIANT 84

CEFACLOR 18

CEFADROXIL 18

CEFAZOLIN SODIUM 18

CEFAZOLIN SODIUM IN 0.9 % SODIUM

CHLORIDE 18

CEFAZOLIN SODIUM/DEXTROSE 5 % IN WATER 18

CEFAZOLIN SODIUM/DEXTROSE, ISO-OSMOTIC 18

CEFDINIR 18

CEFDITOREN PIVOXIL 18

CEFEPIME HCL 18

CEFEPIME HCL/DEXTROSE, ISO-OSMOTIC 18

CEFIXIME 19

CEFOTAXIME SODIUM 19

CEFOTAXIME SODIUM/DEXTROSE, ISO-

OSMOTIC 19

CEFOTETAN DISODIUM 19

CEFOXITIN SODIUM 19

CEFOXITIN SODIUM/DEXTROSE, ISO-OSMOTIC 19

CEFPODOXIME PROXETIL 19

CEFPROZIL 19

CEFTAZIDIME 19

CEFTIBUTEN 19

CEFTRIAXONE SODIUM 19

CEFTRIAXONE SODIUM/DEXTROSE, ISO-

OSMOTIC 19

CEFUROXIME AXETIL 19

CEFUROXIME SODIUM 19


CEFUROXIME SODIUM/DEXTROSE, ISO-

OSMOTIC 19

CELEBREX 5

CELECOXIB 5

CELLCEPT 93

CELONTIN 23

CEM-UREA 69

CENTERGY 108

CENTRATEX 111

CEPHALEXIN 19

CERITINIB 38

CERUBIDINE 35

CETUXIMAB 39

CEVIMELINE HCL 67

CHANTIX 15

CHATEAL 84

CHEMET 110

CHENODAL 75

CHENODIOL 75

CHLORAMBUCIL 32

CHLORAMPHENICOL SOD SUCC 16

CHLORDIAZEPOXIDE HCL 48

CHLORDIAZEPOXIDE/CLIDINIUM BROMIDE 74

CHLORHEXIDINE GLUCONATE 67

CHLOROPROCAINE HCL/PF 13

CHLOROQUINE PHOSPHATE 40

CHLOROTHIAZIDE 62

CHLOROTHIAZIDE SODIUM 62

CHLORPHENIRAMINE MALEATE/PHENYLEPHRINE

HCL 108

CHLORPROMAZINE HCL 41

CHLORTHALIDONE 62

CHLORZOXAZONE 109

CHOLESTYRAMINE (WITH SUGAR) 63

CHOLESTYRAMINE/ASPARTAME 63

CHOLINE SALICYLATE/MAGNESIUM SALICYLATE 5

CHORIONIC GONADOTROPIN, HUMAN 83

CHROMIC CHLORIDE 111

CICLODAN 28

CICLOPIROX 28

CICLOPIROX OLAMINE 29

CICLOPIROX/UREA/CAMPHOR/MENTHOL/EUCALY

PTOL 29

CIDOFOVIR 44

CILOSTAZOL 55

CIMETIDINE 75

CIMETIDINE HCL 75

CINACALCET HCL 92

CIPRO 21

CIPRODEX 102

CIPROFLOXACIN 21

CIPROFLOXACIN HCL 21

CIPROFLOXACIN HCL/DEXAMETHASONE 102

CIPROFLOXACIN LACTATE 21

CIPROFLOXACIN LACTATE/DEXTROSE 5 % IN

WATER 21

CIPROFLOXACIN/CIPROFLOXACIN HCL 22

CISPLATIN 35

CITALOPRAM HYDROBROMIDE 26

CITRATE DEXTROSE SOLUTION 52

CITRATE PHOSPHATE DEXTROS SOLN 52

CITRIC ACID/GLUCONOLACTONE/MAGNESIUM

CARBONATE 78

CITRIC ACID/SODIUM CITRATE 79

CLADRIBINE 34

CLAFORAN-DEXTROSE 19

CLARAVIS 69

CLARIS 69

CLARITHROMYCIN 21

CLEANSING WASH 68

CLEMASTINE FUMARATE 104

CLINDACIN ETZ 16

CLINDACIN P 16

CLINDAMYCIN HCL 16

CLINDAMYCIN PALMITATE HCL 16

CLINDAMYCIN PHOSPHATE 16

CLINDAMYCIN PHOSPHATE/BENZOYL

PEROXIDE 70

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN

WATER 16

CLOBAZAM 23

CLOBETASOL PROPIONATE 80


CLOBETASOL PROPIONATE/EMOLLIENT BASE 80

CLODAN 80

CLOMIPRAMINE HCL 27

CLONAZEPAM 48

CLONIDINE 56

CLONIDINE HCL 64

CLONIDINE HCL/CHLORTHALIDONE 60

CLONIDINE HCL/PF 56

CLOPIDOGREL BISULFATE 55

CLORAZEPATE DIPOTASSIUM 49

CLORPRES 60

CLOTRIMAZOLE/BETAMETHASONE

DIPROPIONATE 69

CLOZAPINE 44

COAGULATION FACTOR VIIA (RECOMBINANT) 55

COAL TAR 97

COARTEM 40

COCAINE HCL 13

CODEINE

PHOSPHATE/BUTALBITAL/ASPIRIN/CAFFEINE 9

CODEINE SULFATE 9

COLCHICINE 30

COLCHICINE/PROBENECID 30

COLCRYS 30

COLESTIPOL HCL 63

COLISTIN (AS COLISTIMETHATE SODIUM) 16

COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 71

COLOCORT 96

COMBIVENT RESPIMAT 108

COMPLERA 46

COMPOUND 347 97

COMPRO 27

COPAXONE 66

CORIFACT 54

CORLANOR 60

CORLOPAM 63

CORMAX 80

CORTANE-B 102

CORTICOTROPIN 82

CORTIFOAM 96

CORTISONE ACETATE 80

CORVITA 150 111

COSYNTROPIN 82

CREON 73

CRIXIVAN 47

CRIZOTINIB 38

CROMOLYN SODIUM 108

CROTAMITON 40

CRYSELLE 84

CULT SKIN SUBST,HUMAN-BOVINE 68

CUPRIC CHLORIDE 111

CUPRIMINE 78

CYANOCOBALAMIN (VITAMIN B-12) 116

CYCLAFEM 85

CYCLOBENZAPRINE HCL 109

CYCLOPENTOLATE HCL 100

CYCLOPHOSPHAMIDE 32

CYCLOSPORINE 101

CYCLOSPORINE, MODIFIED 93

CYPROHEPTADINE HCL 104

CYRED 85

CYSTADANE 73

CYSTAGON 73

CYSTARAN 100

CYSTEAMINE BITARTRATE 73

CYSTEAMINE HCL 100

CYSTEINE HCL 116

CYTARABINE 34

CYTARABINE/PF 34

CYTRA-2 78

CYTRA-3 78

CYTRA-K 78

DDABIGATRAN ETEXILATE MESYLATE 53

DABRAFENIB MESYLATE 38

DACARBAZINE 35

DACTINOMYCIN 35

DALFAMPRIDINE 66

DANAZOL 83

DANTROLENE SODIUM 109

DAPSONE 31


DARAPRIM 40

DARUNAVIR ETHANOLATE 47

DASATINIB 38

DASETTA 85

DAUNORUBICIN CITRATE LIPOSOMAL 35

DAUNORUBICIN HCL 35

DAUNOXOME 35

DAYSEE 85

DEBACTEROL 67

DEBLITANE 90

DECITABINE 35

DEFERASIROX 111

DEFERIPRONE 111

DEFEROXAMINE MESYLATE 111

DELAVIRDINE MESYLATE 46

DELFLEX WITH 1.5% DEXTROSE 111



DELTASONE 80

DELYLA 85

DEMECLOCYCLINE HCL 22

DEMSER 60

DEPADE 14

DEPO-PROVERA 90

DERMAZENE 69

DESIPRAMINE HCL 27

DESLORATADINE 104

DESMOPRESSIN ACETATE 83

DESMOPRESSIN ACETATE (NON-

REFRIGERATED) 82

DESOGESTREL-ETHINYL ESTRADIOL 89

DESOGESTREL-ETHINYL ESTRADIOL/ETHINYL

ESTRADIOL 90

DESONIDE 80

DESOXIMETASONE 80

DEXAMETHASONE 80

DEXAMETHASONE INTENSOL 80

DEXAMETHASONE SOD PHOSPHATE 101

DEXAMETHASONE SODIUM PHOSPHATE/PF 80

DEXEDRINE 64

DEXMEDETOMIDINE HCL 97

DEXMETHYLPHENIDATE HCL 65

DEXPANTHENOL 75

DEXRAZOXANE HCL 35

DEXTRAN 40 IN 0.9 % SODIUM CHLORIDE 98

DEXTRAN 40/DEXTROSE 5 % IN WATER 98

DEXTROAMPHETAMINE SULF-

SACCHARATE/AMPHETAMINE SULF-

ASPARTATE 64

DEXTROAMPHETAMINE SULFATE 64

DEXTROMETHORPHAN HBR/QUINIDINE

SULFATE 65

DEXTROSE 10 % AND 0.2 % SODIUM

CHLORIDE 112


CHLORIDE 112


CHLORIDE 112

DEXTROSE 10 % IN WATER 116

DEXTROSE 2.5 % AND 0.45 % SODIUM

CHLORIDE 112

DEXTROSE 2.5 % IN WATER 116





DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE 112



CHLORIDE 112


DEXTROSE 5 % IN LACTATED RINGERS 112


DEXTROSE 5% IN RINGERS 112



DEXTROSE-WATER/SODIUM CITRATE/CITRIC

ACID 51

DIALYVITE 117

DIATRIZOATE MEGLUMINE/DIATRIZOATE

SODIUM 98

DIAZEPAM 49


DIAZOXIDE 51

DIBENZYLINE 56

DICLOFENAC POTASSIUM 5

DICLOFENAC SODIUM 101

DICLOFENAC SODIUM/MISOPROSTOL 5

DICLOXACILLIN SODIUM 20

DICYCLOMINE HCL 74

DIDANOSINE 46

DIETHYLPROPION HCL 65

DIFLORASONE DIACETATE 80

DIFLORASONE DIACETATE/EMOLLIENT BASE 79

DIFLUNISAL 5

DIGITEK 60

DIGOX 60

DIGOXIN 60

DIHYDROCODEINE

BITARTRATE/ACETAMINOPHEN/CAFFEINE 9

DIHYDROCODEINE

BITARTRATE/ASPIRIN/CAFFEINE 9

DIHYDROERGOTAMINE MESYLATE 30

DILANTIN 24

DILT-XR 58

DILTIAZEM HCL 59

DIMENHYDRINATE 27

DIMETHYL FUMARATE 67

DIOXYBENZONE/PADIMATE O/HYDROQUINONE 70

DIPHENHYDRAMINE HCL 104

DIPHENOXYLATE HCL/ATROPINE SULFATE 75

DIPHTHERIA,PERTUSSIS(ACELL),TETANUS

VACCINE/PF 96

DIPYRIDAMOLE 56

DISKETS 6

DISULFIRAM 14

DIVALPROEX SODIUM 23

DOBUTAMINE HCL 60

DOBUTAMINE HCL/DEXTROSE 5 % IN WATER 60

DOCETAXEL 35

DOFETILIDE 57

DOLUTEGRAVIR SODIUM 46

DONEPEZIL HCL 25

DOPAMINE HCL 60

DOPAMINE HCL/DEXTROSE 5 % IN WATER 60

DORNASE ALFA 109

DORZOLAMIDE HCL 102

DORZOLAMIDE HCL/TIMOLOL MALEATE 102

DOXAPRAM HCL 108

DOXAZOSIN MESYLATE 56

DOXEPIN HCL 27

DOXERCALCIFEROL 97

DOXIL 35

DOXORUBICIN HCL 35

DOXORUBICIN HCL PEGYLATED LIPOSOMAL 36

DOXYCYCLINE HYCLATE/EYELID CLNS

NO.3/EYELID EMOLLIENT NO.1 23

DOXYCYCLINE MONOHYDRATE 23

DRITHOCREME HP 69

DRONABINOL 28

DROPERIDOL 41

DROXIA 34

DROXIDOPA 61

DRYSOL 69

DULERA 108

DULOXETINE HCL 66

DURAMORPH 9

DUTASTERIDE 77

DUTASTERIDE/TAMSULOSIN HCL 77

EE.E.S. 200 21

E.E.S. 400 21

ECHOTHIOPHATE IODIDE 102

ECONAZOLE NITRATE 29

ECULIZUMAB 99

ED-SPAZ 74

EDROPHONIUM CHLORIDE 31

EDURANT 46

EFAVIRENZ 46

EFAVIRENZ/EMTRICITABINE/TENOFOVIR

DISOPROXIL FUMARATE 46

EFFER-K 112

EFFIENT 56

EGRIFTA 92


ELAPRASE 73

ELASTIDERM 70

ELECTROLYTE-48 SOLUTION/DEXTROSE 5 % IN

WATER 112

ELELYSO 73

ELINEST 85

ELIPHOS 79

ELITEK 34

ELMIRON 78

ELOCTATE 54

ELOXATIN 35

ELTROMBOPAG OLAMINE 53

ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TEN

OFOVIR 45

EMCYT 33

EMEND 28

EMOQUETTE 85

EMTRICITABINE 46

EMTRICITABINE/RILPIVIRINE HCL/TENOFOVIR

DISOPROXIL FUMARATE 46

EMTRICITABINE/TENOFOVIR DISOPROXIL

FUMARATE 46

EMTRIVA 46

ENALAPRIL MALEATE 57

ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE 60

ENALAPRILAT DIHYDRATE 57

ENBREL 93

ENDO-AVITENE 97

ENDOCET 9

ENDODAN 9

ENDOMETRIN 90

ENFLURANE 97

ENFUVIRTIDE 47

ENLON 31

ENOXAPARIN SODIUM 52

ENPRESSE 85

ENSKYCE 85

ENTACAPONE 41

ENTECAVIR 44

ENULOSE 76

ENZALUTAMIDE 33

EPHEDRINE SULFATE 60

EPINASTINE HCL 101

EPINEPHRINE 105

EPINEPHRINE HCL/PF 105

EPINEPHRINE/PF 105

EPIPEN 2-PAK 105

EPIPEN JR 2-PAK 105

EPIRUBICIN HCL 35

EPITOL 24

EPIVIR 46

EPIVIR HBV 44

EPLERENONE 62

EPOETIN ALFA 53

EPOPROSTENOL SODIUM (ARGININE) 108

EPOPROSTENOL SODIUM (GLYCINE) 107

EPROSARTAN MESYLATE 56

EPTIFIBATIDE 56

EPZICOM 46

ERBITUX 39

ERGOCALCIFEROL (VITAMIN D2) 117

ERGOLOID MESYLATES 25

ERGOTAMINE TARTRATE/CAFFEINE 31

ERIVEDGE 37

ERLOTINIB HCL 38

ERRIN 90

ERY 21

ERY-TAB 21

ERYGEL 21

ERYPED 200 21

ERYPED 400 21

ERYTHROCIN STEARATE 21

ERYTHROMYCIN BASE 21

ERYTHROMYCIN BASE/BENZOYL PEROXIDE 16

ERYTHROMYCIN BASE/ETHYL ALCOHOL 21

ERYTHROMYCIN ETHYLSUCCINATE 21

ERYTHROMYCIN

ETHYLSUCCINATE/SULFISOXAZOLE ACETYL 21

ERYTHROMYCIN STEARATE 21

ESCITALOPRAM OXALATE 26

ESGIC 65

ESMOLOL HCL 58


ESOMEPRAZOLE MAGNESIUM 76

ESOMEPRAZOLE SODIUM 76

ESOMEPRAZOLE STRONTIUM 76

ESTARYLLA 85

ESTAZOLAM 110

ESTRADIOL 89

ESTRADIOL VALERATE 85

ESTRADIOL/NORETHINDRONE ACETATE 87

ESTRAMUSTINE PHOSPHATE SODIUM 33

ESTROGENS,

CONJUGATED/MEDROXYPROGESTERONE

ACETATE 88

ESTROGENS,ESTERIFIED 87

ESTROPIPATE 88

ESZOPICLONE 110

ETANERCEPT 93

ETHACRYNATE SODIUM 62

ETHAMBUTOL HCL 32

ETHINYL ESTRADIOL/DROSPIRENONE 90

ETHOSUXIMIDE 23

ETHOTOIN 24

ETHYL ALCOHOL 117

ETHYL CHLORIDE 13

ETHYNODIOL DIACETATE-ETHINYL ESTRADIOL 90

ETIDRONATE DISODIUM 97

ETODOLAC 5

ETOMIDATE 13

ETONOGESTREL 90

ETOPOSIDE 37

ETRAVIRINE 46

EUFLEXXA 97

EURAX 40

EVEROLIMUS 94

EXEMESTANE 37

EXENATIDE 49

EXENATIDE MICROSPHERES 49

EXJADE 111

EXOTIC-HC 103

EXTAVIA 67

EZ FLU 2015-2016 (FLUVIRIN) 96

EZETIMIBE 63

EZOGABINE 23

FFABRAZYME 73

FACTOR IX 55

FACTOR IX COMPLEX HUMAN 55

FACTOR IX COMPLEX, PROTHROMBIN CPLX

CONC(PCC) NO.4, 3-FACTOR 55

FACTOR IX COMPLEX, PROTHROMBIN CPLX

CONC(PCC) NO.6, 3-FACTOR 54

FACTOR IX HUMAN RECOMBINANT 54

FACTOR IX HUMAN RECOMBINANT, THREONINE

148 54

FACTOR XIII 54

FACTOR XIII A-SUBUNIT, RECOMBINANT 55

FALMINA 85

FAMCICLOVIR 48

FAMOTIDINE 75

FAMOTIDINE/PF 75

FARESTON 33

FAT EMULSIONS 118

FE 90 PLUS 112

FE C PLUS 112

FEBUXOSTAT 30

FEIBA NF 54

FEIBA VH IMMUNO 54

FELBAMATE 24

FELODIPINE 59

FEM PH 78

FENOFIBRATE 62

FENOFIBRATE NANOCRYSTALLIZED 62

FENOFIBRATE,MICRONIZED 63

FENOFIBRIC ACID 63

FENOFIBRIC ACID (CHOLINE) 63

FENOLDOPAM MESYLATE 63

FENOPROFEN CALCIUM 5

FENTANYL 6

FENTANYL CITRATE 9

FENTANYL CITRATE IN 0.9 % SODIUM

CHLORIDE/PF 9


FENTANYL CITRATE/BUPIVACAINE HCL IN 0.9 %

SODIUM CHLORIDE/PF 9

FENTANYL CITRATE/PF 12

FEROCON 112

FEROTRINSIC 112

FERRAPLUS 90 112

FERREX 150 FORTE 112

FERREX 150 FORTE PLUS 112

FERREX 28 112

FERRIC SUBSULFATE 55

FERRIPROX 111

FERROCITE PLUS 112

FERROGELS FORTE 112

FERROUS FUMARATE/ASCORBIC ACID/B12-

IF/FOLIC ACID 116

FERROUS FUMARATE/ASCORBIC

ACID/CYANOCOBALAMIN/FOLIC ACID 116

FERROUS FUMARATE/ASCORBIC

ACID/CYANOCOBALAMIN/STOMACH CONC 113

FERROUS FUMARATE/FOLIC ACID 113

FERROUS FUMARATE/FOLIC

ACID/MULTIVITAMINS WITH MIN NO. 15 111

FEXOFENADINE HCL/PSEUDOEPHEDRINE HCL 108

FIBRINOGEN 55

FINASTERIDE 77

FINGOLIMOD HCL 67

FIRAZYR 93

FIRST-BXN 29

FIRST-LANSOPRAZOLE 76

FIRST-MOUTHWASH BLM 67

FIRST-OMEPRAZOLE 76

FLAVOXATE HCL 77

FLEBOGAMMA DIF 95

FLECAINIDE ACETATE 57

FLOXURIDINE 34

FLUBLOK 2014-2015 96

FLUCAINE 100

FLUCONAZOLE 29

FLUCONAZOLE IN DEXTROSE, ISO-OSMOTIC 29

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-

OSMOTIC 29

FLUCYTOSINE 29

FLUDARABINE PHOSPHATE 35

FLUDROCORTISONE ACETATE 80

FLUMAZENIL 98

FLUNISOLIDE 103

FLUOCINOLONE ACETONIDE 80

FLUOCINOLONE ACETONIDE OIL 103

FLUOCINOLONE ACETONIDE/SHOWER CAP 80

FLUOCINONIDE 80

FLUOCINONIDE/EMOLLIENT BASE 80

FLUOR-A-DAY 112

FLUOR-I-STRIP AT 100

FLUORESCEIN SODIUM 100

FLUORESCITE 100

FLUOROMETHOLONE 101

FLUOROURACIL 34

FLUOXETINE HCL 26

FLUOXYMESTERONE 83

FLUPHENAZINE DECANOATE 41

FLUPHENAZINE HCL 41

FLURAZEPAM HCL 110

FLURBIPROFEN 5

FLURBIPROFEN SODIUM 101

FLUROX 100

FLUTAMIDE 33

FLUTICASONE FUROATE 103

FLUTICASONE FUROATE/VILANTEROL

TRIFENATATE 108

FLUTICASONE PROPIONATE 103

FLUVASTATIN SODIUM 63

FLUVOXAMINE MALEATE 26

FOCALGIN DSS 113

FOLBEE PLUS 117

FOLIC ACID 117

FOLIC ACID/VITAMIN B COMP AND C 117

FOLIVANE-F 113

FOLIVANE-PLUS 113

FOLLITROPIN ALFA, RECOMB 82

FOLOTYN 34

FOMEPIZOLE 98

FONDAPARINUX SODIUM 52


FORANE 98

FORMA-RAY 98

FORMADON 98

FORMALDEHYDE 98

FORMOTEROL FUMARATE 105

FORTEO 97

FORTICAL 97

FOSAMPRENAVIR CALCIUM 47

FOSCARNET SODIUM 44

FOSINOPRIL SODIUM 57

FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE 60

FOSPHENYTOIN SODIUM 24

FREAMINE III 117

FUL-GLO 100

FUROSEMIDE 62

FUSILEV 35

FUZEON 47

GGABAPENTIN 23

GABITRIL 23

GABLOFEN 109

GALANTAMINE HBR 25

GALSULFASE 73

GAMMAGARD LIQUID 95

GAMMAPLEX 95

GAMUNEX 95

GAMUNEX-C 95

GANCICLOVIR SODIUM 44

GARAMYCIN 15

GASTROCROM 75

GATIFLOXACIN 22

GAVILYTE-G 76

GAVILYTE-H AND BISACODYL 76

GEMCITABINE HCL 34

GEMFIBROZIL 63

GENERLAC 76

GENGRAF 93

GENTAK 15

GENTAMICIN SULFATE 15

GENTAMICIN SULFATE IN SODIUM CHLORIDE,

ISO-OSMOTIC 15

GENTAMICIN SULFATE/PF 15

GEODON 43

GIANVI 85

GILDAGIA 86

GILDESS 86

GILDESS 24 FE 86

GILDESS FE 86

GILENYA 67

GILOTRIF 37

GLATIRAMER ACETATE 67

GLATOPA 67

GLEEVEC 37

GLEOSTINE 32

GLIMEPIRIDE 49

GLIPIZIDE 49

GLIPIZIDE/METFORMIN HCL 49

GLUCAGEN 51

GLUCAGON EMERGENCY KIT 51

GLUCAGON HCL 51

GLUCAGON,HUMAN RECOMBINANT 51

GLUTARALDEHYDE 98

GLYBURIDE 49

GLYBURIDE,MICRONIZED 49

GLYBURIDE/METFORMIN HCL 50

GLYCEROL PHENYLBUTYRATE 73

GLYCINE UROLOGIC SOLUTION 78

GLYCINE/SODIUM/WATER FOR

INJECTION,STERILE/SODIUM HYDROXIDE 98

GLYCOPYRROLATE 74

GLYDO 13

GONAL-F RFF 82

GONAL-F RFF REDI-JECT 82

GRANISETRON HCL 28

GRANISETRON HCL/PF 28

GRANISOL 28

GRISEOFULVIN ULTRAMICROSIZE 29

GRISEOFULVIN, MICROSIZE 29

GRX HICORT 25 80

GUANFACINE HCL 65


GUANIDINE HCL 31

GYNAZOLE 1 29

HH.P. ACTHAR 82

HALOBETASOL PROPIONATE 80

HALOBETASOL PROPIONATE/AMMONIUM

LACTATE 81

HALONATE 80

HALONATE PAC 81

HALOPERIDOL 42

HALOPERIDOL DECANOATE 42

HALOPERIDOL LACTATE 42

HARVONI 44

HEATHER 90

HECORIA 93

HECTOROL 97

HELIXATE FS 54

HEMABATE 98

HEMATINIC PLUS 113

HEMATINIC WITH FOLIC ACID 113

HEMATOGEN 113

HEMATOGEN FA 113

HEMATOGEN FORTE 113

HEMETAB 113

HEMIN 99

HEMMOREX-HC 81

HEMRIL 81

HEPARIN SODIUM,PORCINE 52

HEPARIN SODIUM,PORCINE IN 0.45 % SODIUM

CHLORIDE 52


CHLORIDE 52


CHLORIDE/PF 52

HEPARIN SODIUM,PORCINE/DEXTROSE 5 % IN

WATER 52

HEPARIN SODIUM,PORCINE/PF 52

HERCEPTIN 39

HETLIOZ 110

HEXALEN 32

HISTRELIN ACETATE 93

HIZENTRA 95

HOMATROPAIRE 100

HOMATROPINE HBR 100

HUMALOG KWIKPEN U-200 51

HUMATE-P 54

HUMIRA 93

HUMIRA PEDIATRIC CROHN'S 94

HUMIRA PEN 94

HUMIRA PEN CROHN'S-UC-HS 94

HUMIRA PEN PSORIASIS 94

HUMULIN R U-500 51

HYALURONATE SODIUM 97

HYDRALAZINE HCL 63

HYDROCHLOROTHIAZIDE 62

HYDROCODONE

BITARTRATE/ACETAMINOPHEN 12

HYDROCODONE BITARTRATE/HOMATROPINE

METHYLBROMIDE 109

HYDROCODONE

POLISTIREX/CHLORPHENIRAMINE POLISTIREX108

HYDROCODONE/IBUPROFEN 12

HYDROCORTISONE 96

HYDROCORTISONE ACETATE 96

HYDROCORTISONE ACETATE/ALOE VERA 81

HYDROCORTISONE ACETATE/LIDOCAINE

HCL/ALOE VERA 69

HYDROCORTISONE ACETATE/PRAMOXINE HCL 70

HYDROCORTISONE

ACETATE/PRAMOXINE/EMOLLIENT/PRAMOXINE

COMB#1 69

HYDROCORTISONE BUTYRATE 81

HYDROCORTISONE BUTYRATE/EMOLLIENT

BASE 81

HYDROCORTISONE SOD SUCCINATE 79

HYDROCORTISONE VALERATE 81

HYDROCORTISONE/IODOQUINOL 69

HYDROCORTISONE/MINERAL

OIL/PETROLATUM,WHITE 81

HYDROCORTISONE/PRAMOXINE

HCL/CHLOROXYLENOL 103


HYDROCORTISONE/PRAMOXINE

HCL/CHLOROXYLENOL/WATER 102

HYDROMORPHONE HCL 10

HYDROMORPHONE HCL/PF 10

HYDROQUINONE 70

HYDROQUINONE MICROSPHERES 69

HYDROQUINONE/FERRIC OXIDE 70

HYDROXYCHLOROQUINE SULFATE 40

HYDROXYPROGESTERONE CAPROATE 91

HYDROXYUREA 34

HYDROXYZINE HCL 104

HYDROXYZINE PAMOATE 104

HYOPHEN 16

HYOSCYAMINE SULFATE 75

HYOSYNE 74

HYPERCARE 69

HYPERRHO S-D 95

HYPROMELLOSE 100

IIBANDRONATE SODIUM 97

IBRANCE 37

IBRUTINIB 38

IBUPROFEN 5

IBUPROFEN/OXYCODONE HCL 10

IBUTILIDE FUMARATE 57

IC GREEN 98

ICATIBANT ACETATE 93

ICLUSIG 37

ICOSAPENT ETHYL 63

IDARUBICIN HCL 35

IDELALISIB 38

IDURSULFASE 73

IFOSFAMIDE 32

IFOSFAMIDE/MESNA 32

ILARIS 95

ILOPROST TROMETHAMINE 108

IMATINIB MESYLATE 37

IMBRUVICA 38

IMIPENEM/CILASTATIN SODIUM 19

IMIPRAMINE HCL 27

IMIPRAMINE PAMOATE 27

IMIQUIMOD 69

IMMUNE GLOBULIN,GAMM(IGG)/GLYCINE/IGA

GREATER THAN 50 MCG/ML 95

IMMUNE

GLOBULIN,GAMM(IGG)/SORBITOL/GLYCIN/IGA 0

TO 50 MCG/ML 95

IMMUNE GLOBULIN,GAMMA (IGG)/PROLINE/IGA 0

TO 50 MCG/ML 95

IMMUNE GLOBULIN,GAMMA (IGG)/SORBITOL/IGA 0

TO 50 MCG/ML 95

IMMUNE GLOBULIN,GAMMA CAPRYLATE (IGG) 95

IMPLANON 90

INCIVEK 44

INCRELEX 82

INDAPAMIDE 62

INDINAVIR SULFATE 47

INDOCYANINE GREEN 98

INDOMETHACIN 5

INDOMETHACIN SODIUM 5

INFED 113

INFERGEN 45

INFLIXIMAB 94

INFLUENZA VIRUS VACCINE TRIVALNT 2015-2016

(4 YR & OLDER)/PF 96

INFLUENZA VIRUS VACCINE TV 2014-2015(18 YRS

& OLDER)RCMB/PF 96

INLYTA 38

INSULIN DETEMIR 51

INSULIN GLARGINE,HUMAN RECOMBINANT

ANALOG 51

INSULIN LISPRO 51

INSULIN REGULAR, HUMAN 51

INTELENCE 46

INTERFERON ALFA-2B,RECOMB. 45

INTERFERON ALFACON-1 45

INTERFERON BETA-1A 66

INTERFERON BETA-1A/ALBUMIN HUMAN 67

INTERFERON BETA-1B 67

INTERFERON GAMMA-1B,RECOMB. 95

INTRON A 45


INTROVALE 86

INVEGA SUSTENNA 43

INVEGA TRINZA 43

INVIRASE 47

INVOKAMET 50

INVOKANA 50

IPRATROPIUM BROMIDE 105

IPRATROPIUM BROMIDE/ALBUTEROL

SULFATE 108

IRBESARTAN 56

IRBESARTAN/HYDROCHLOROTHIAZIDE 61

IRINOTECAN HCL 35

IRON ASP GLY&PS CMPLX/ASCORB.CAL/VIT

B12/FA/CA-THR/SUCC.ACID 112

IRON ASP GLY/ASCORB.CAL/VIT B12/FA/CA-

THREONTE/SUCCINIC ACID 114

IRON ASP.GLYCIN & FUMARATE /VIT C/FA/MV

COMB 11/CA-THREONATE 112

IRON ASPGLY/ASCORB.CAL/VIT B12/CALCIUM

THR/SUCC.ACID/STOMACH 114

IRON BISGLY,PSCMPLX/ASCORBATE

CALC/B12/FOLIC ACID/CALC-THREO 116

IRON CARBONYL,GLUC/FOLIC ACID/VIT B12/VIT

C/DOCUSATE SODIUM 114

IRON DEXTRAN COMPLEX 113

IRON FUMARATE & POLYSAC COMP/FOLIC

ACID/VITAMIN C/NIACIN 113

IRON FUMARATE,POLYSAC CPLEX/FOLIC

ACID/VIT B COMP WITH C #9 113

IRON FUMARATE-IRON POLYSACCHAR/FOLIC

ACID/MV COMB18 115

IRON FUMARTE &ASP GLY/ASCORB.CAL/VIT

B12/FA/CA-THR/SUCC.ACID 114

IRON HEME POLYPEPTIDE/FOLIC ACID 115

IRON POLYSACCHAR COMPLX/IRON HEME

POLYPEPTIDE/FOLIC ACID/B12 113

IRON POLYSACCHARIDE

COMPLEX/CYANOCOBALAMIN/FOLIC ACID 114

IRON,CARBONYL/ASCORBIC

ACID/CYANOCOBALAMIN/FOLIC ACID 112

IRON,CARBONYL/DOCUSATE SODIUM/B12-

IF/FOLIC ACID/MULTIVIT-MIN 116

IRON,CARBONYL/FOLIC ACID/VIT C/PYRIDOXINE

HCL/VIT B12/ZINC 111

IRON,CARBONYL/FOLIC ACID/VITAMIN

B12/VITAMIN C/DOCUSATE NA 112

IRON/FOLIC ACID/VITAMIN B COMP AND

C/MINERALS 113

ISENTRESS 45

ISOFLURANE 99

ISOMETHEPTENE

MUCATE/CAFFEINE/ACETAMINOPHEN 98

ISOMETHEPTENE

MUCATE/DICHLORALPHENAZONE/ACETAMINOPH

EN 98

ISONIAZID 32

ISOSORBIDE DINITRATE 64

ISOSORBIDE MONONITRATE 64

ISOSULFAN BLUE 98

ISOTRETINOIN 70

ISOXSUPRINE HCL 25

ISRADIPINE 59

ISTODAX 35

ITRACONAZOLE 30

IVABRADINE HCL 60

IVACAFTOR 106

IVERMECTIN 39

IXABEPILONE 35

IXEMPRA 35

IXINITY 54

JJAKAFI 38

JANTOVEN 52

JANUMET 50

JANUMET XR 50

JANUVIA 50

JENCYCLA 90

JENTADUETO 50

JINTELI 86

JOLESSA 86


JOLIVETTE 91

JUNEL 86

JUNEL FE 86

JUNEL FE 24 86

JUXTAPID 63

KK EFFERVESCENT 113

K-PHOS NEUTRAL 78

K-PHOS NO.2 78

K-PHOS ORIGINAL 78

K-SOL 113

K-TAB ER 113

KADCYLA 39

KAITLIB FE 86

KALETRA 47

KALYDECO 106

KARIVA 86

KELNOR 1-35 86

KEPIVANCE 67

KETAMINE HCL 13

KETOCONAZOLE 29

KETOCONAZOLE/SKIN CLEANSER COMBINATION

NO.28 29

KETODAN 29

KETOPROFEN 5

KETOROLAC TROMETHAMINE 101

KIMIDESS 86

KIONEX 111

KIT FOR PREP YTTRIUM-90/IBRITUMOMAB

TIUXETAN/ALBUMIN HUMAN 39

KLOR-CON 113

KLOR-CON 10 113

KLOR-CON 8 113

KLOR-CON M10 113

KLOR-CON M15 113

KLOR-CON M20 113

KLOR-CON SPRINKLE 114

KLOR-CON-EF 114

KOATE-DVI 54

KOGENATE FS 55

KURVELO 86

KUVAN 73

LLABETALOL HCL 58

LACLOTION 69

LACOSAMIDE 25

LACTOBACILLUS COMBINATION

NO.2/S.THERMOPHL/BIF CMB NO.1 75

LACTULOSE 76

LAMISIL 29

LAMIVUDINE 46

LAMIVUDINE/ZIDOVUDINE 46

LAMOTRIGINE 24

LANSOPRAZOLE 77

LANSOPRAZOLE/AMOXICILLIN

TRIHYDRATE/CLARITHROMYCIN 75

LANTUS 51

LANTUS SOLOSTAR 51

LAPATINIB DITOSYLATE 38

LARIN 86

LARIN 24 FE 86

LARIN FE 86

LARONIDASE 73

LATANOPROST 102

LATRIX 69

LATRIX XM 69

LEDIPASVIR/SOFOSBUVIR 44

LEENA 86

LEFLUNOMIDE 95

LENALIDOMIDE 33

LESSINA 86

LETAIRIS 107

LETROZOLE 37

LEUCOVORIN CALCIUM 35

LEUKERAN 32

LEUKINE 53

LEUPROLIDE ACETATE 92

LEVALBUTEROL HCL 105

LEVEMIR 51

LEVEMIR FLEXPEN 51


LEVEMIR FLEXTOUCH 51

LEVETIRACETAM 23

LEVOBUNOLOL HCL 102

LEVOCARNITINE 117

LEVOCARNITINE (WITH SUGAR) 117

LEVOCETIRIZINE DIHYDROCHLORIDE 104

LEVOFLOXACIN 22

LEVOFLOXACIN/DEXTROSE 5 % IN WATER 22

LEVOLEUCOVORIN CALCIUM 36

LEVOMEFOLATE CALCIUM/SCHIZOCHYTRIUM

ALGAL OIL 117

LEVONEST 87

LEVONORGESTREL 88

LEVONORGESTREL-ETHINYL ESTRADIOL 90

LEVONORGESTREL/ETHINYL ESTRADIOL AND

ETHINYL ESTRADIOL 87

LEVORA-28 87

LEVORPHANOL TARTRATE 6

LEVOTHYROXINE SODIUM 92

LEVOXYL 91

LEXIVA 47

LIDOCAINE 13

LIDOCAINE HCL 14

LIDOCAINE HCL BUFFERED WITH 8.4 % SODIUM

BICARBONATE 12

LIDOCAINE HCL/DEXTROSE 5%-WATER/PF 13

LIDOCAINE HCL/DEXTROSE 7.5%-WATER/PF 13

LIDOCAINE HCL/EPINEPHRINE 13

LIDOCAINE HCL/EPINEPHRINE/PF 13

LIDOCAINE HCL/HYDROCORTISONE ACETATE 70

LIDOCAINE HCL/MENTHOL 13

LIDOCAINE HCL/PF 13

LIDOCAINE/MENTHOL 13

LIDOCAINE/PRILOCAINE 70

LINACLOTIDE 75

LINAGLIPTIN 51

LINAGLIPTIN/METFORMIN HCL 50

LINCOMYCIN HCL 16

LINDANE 40

LINEZOLID 18

LINEZOLID IN 0.9 % SODIUM CHLORIDE 16

LINZESS 75

LIOTHYRONINE SODIUM 91

LIOTRIX 92

LIPASE/PROTEASE/AMYLASE 73

LIPODOX 36

LIPODOX 50 36

LIPOSYN III 117

LIRAGLUTIDE 51

LISDEXAMFETAMINE DIMESYLATE 64

LISINOPRIL 57

LISINOPRIL/HYDROCHLOROTHIAZIDE 61

LITHIUM CARBONATE 49

LITHIUM CITRATE 49

LMD 10% WITH 0.9% SOD CHLORIDE 98

LMD 10% WITH 5% DEXTROSE 98

LOMEDIA 24 FE 87

LOMITAPIDE MESYLATE 63

LOMUSTINE 32

LOPINAVIR/RITONAVIR 47

LOPREEZA 87

LORAZEPAM 49

LORAZEPAM INTENSOL 49

LORCET 10

LORCET HD 10

LORCET PLUS 10

LORENZA 13

LORTAB 10

LORYNA 87

LOSARTAN POTASSIUM 56

LOSARTAN

POTASSIUM/HYDROCHLOROTHIAZIDE 61

LOTRONEX 75

LOVASTATIN 63

LOW-OGESTREL 87

LOXAPINE SUCCINATE 42

LUGOL'S 98

LUMIZYME 73

LUPRON DEPOT 92

LUPRON DEPOT-PED 92

LUSTRA-ULTRA 70

LUTERA 87


LYRICA 66

LYSODREN 36

LYZA 91

MMACITENTAN 107

MAFENIDE ACETATE 17

MAG HYDROXIDE/AL

HYDROXIDE/SIMETH/DIPHENHYDRAMINE/LIDOCAI

NE 67

MAGNESIUM CHLORIDE 114

MAGNESIUM SULFATE 114

MAGNESIUM SULFATE IN STERILE WATER 114

MAKENA 91

MALATHION 40

MANGANESE CHLORIDE 114

MANGANESE SULFATE 114

MANNITOL 98

MAPROTILINE HCL 26

MARAVIROC 47

MARGESIC 65

MARLEXATE 111

MARLISSA 87

MARQIBO 36

MARTEN-TAB 65

MATULANE 32

MATZIM LA 59

MD-GASTROVIEW 98

ME-PB-HYOS 74

MECASERMIN 82

MECHLORETHAMINE HCL 33

MECLIZINE HCL 27

MECLOFENAMATE SODIUM 5

MEDROXYPROGESTERONE ACETATE 91

MEFENAMIC ACID 5

MEFLOQUINE HCL 40

MEGESTROL ACETATE 91

MEKINIST 38

MELOXICAM 5

MELPAQUE HP 70

MELPHALAN 32

MELPHALAN HCL 32

MELQUIN HP 70

MELQUIN-3 70

MEMANTINE HCL 25

MENEST 87

MEPERIDINE HCL 10

MEPHYTON 117

MEPIVACAINE HCL 13

MEPIVACAINE HCL/PF 13

MEPRON 40

MERCAPTOPURINE 34

MEROPENEM 19

MEROPENEM IN 0.9 % SODIUM CHLORIDE 19

MESALAMINE 96

MESALAMINE WITH CLEANSING WIPES 96

MESNA 36

MESNEX 36

MESTINON 31

METADATE ER 65

METAPROTERENOL SULFATE 105

METAXALONE 109

METFORMIN HCL 50

METHADONE HCL 7

METHADONE INTENSOL 7

METHADOSE 7

METHAMPHETAMINE HCL 64

METHAZOLAMIDE 102

METHENAMINE HIPPURATE 16

METHENAMINE MANDELATE 16

METHENAMINE/METHYLENE BLUE/BENZOIC

ACID/SALICYLATE/HYOSCY 17

METHENAMINE/METHYLENE

BLUE/SALICYLATE/SODIUM PHOS/HYOSCY 17

METHENAMINE/METHYLENE BLUE/SODIUM

PHOS/PNYL SAL/HYOSC SUL 18

METHENAMINE/SODIUM

PHOSPHATE,MONOBASIC/METH BLUE/HYOSC

SUL 17

METHIMAZOLE 93

METHITEST 83

METHOCARBAMOL 109


METHOTREXATE SODIUM 94

METHOTREXATE SODIUM/PF 94

METHOXSALEN 67

METHOXSALEN, RAPID 70

METHSUXIMIDE 23

METHYCLOTHIAZIDE 62

METHYLDOPA 56

METHYLDOPA/HYDROCHLOROTHIAZIDE 61

METHYLDOPATE HCL 56

METHYLENE BLUE 98

METHYLERGONOVINE MALEATE 98

METHYLNALTREXONE BROMIDE 75

METHYLPHENIDATE HCL 65

METHYLPREDNISOLONE 81

METHYLPREDNISOLONE ACETATE 81

METHYLPREDNISOLONE SODIUM SUCCINATE 81

METHYLTESTOSTERONE 83

METIPRANOLOL 102

METOCLOPRAMIDE HCL 27

METOLAZONE 62

METOPROLOL SUCCINATE 58

METOPROLOL TARTRATE 58

METOPROLOL

TARTRATE/HYDROCHLOROTHIAZIDE 61

METRO IV 16

METRONIDAZOLE 71

METRONIDAZOLE IN SODIUM CHLORIDE 16

METYROSINE 60

MEXILETINE HCL 57

MICAFUNGIN SODIUM 29

MICONAZOLE NITRATE 29

MICROFIBRILLAR COLLAGEN 97

MICROGESTIN 87

MICROGESTIN 24 FE 87

MICROGESTIN FE 87

MIDAZOLAM HCL 48

MIDAZOLAM HCL/PF 48

MIDODRINE HCL 56

MIGERGOT 31

MIGLUSTAT 74

MIGRAGESIC IDA 98

MILLIPRED DP 81

MILNACIPRAN HCL 66

MILRINONE LACTATE 61

MILRINONE LACTATE/DEXTROSE 5 % IN WATER61

MIMVEY 87

MIMVEY LO 87

MINOCYCLINE HCL 22

MINOXIDIL 63

MIOSTAT 102

MIRTAZAPINE 26

MISOPROSTOL 76

MITOMYCIN 36

MITOTANE 36

MITOXANTRONE HCL 36

MODAFINIL 110

MODERIBA 45

MOEXIPRIL HCL 57

MOEXIPRIL HCL/HYDROCHLOROTHIAZIDE 61

MOLINDONE HCL 42

MOLYBDENUM (AMMONIUM MOLYBDATE) 114

MOMETASONE FUROATE 81

MOMETASONE FUROATE/FORMOTEROL

FUMARATE 108

MONDOXYNE NL 23

MONO-LINYAH 87

MONOJECT 0.9% SODIUM CHLORIDE 114

MONOJECT PREFILL 114

MONOJECT PREFILL ADVANCED 114

MONONESSA 87

MONONINE 55

MONSEL'S 55

MONTELUKAST SODIUM 104

MORPHINE SULFATE 11

MORPHINE SULFATE/PF 11

MOXEZA 22

MOXIFLOXACIN HCL 22

MOXIFLOXACIN HCL IN SODIUM ACETATE AND

SULFATE,WATER,ISO-OSM 22

MOXIFLOXACIN HCL/SODIUM CHLORIDE, ISO-

OSMOTIC 21

MOZOBIL 53


MULTIGEN 114

MULTIGEN FOLIC 114

MULTIGEN PLUS 114

MULTITRACE-4 114

MULTITRACE-5 114

MULTIVITAMINS WITH MIN NO.7/FOLIC ACID 118

MUPIROCIN 16

MUPIROCIN CALCIUM 16

MUSTARGEN 33

MY WAY 87

MYCAMINE 29

MYCOBUTIN 32

MYCOPHENOLATE MOFETIL 94

MYCOPHENOLATE MOFETIL HCL 93

MYCOPHENOLATE SODIUM 94

MYFORTIC 94

MYLERAN 33

MYNATAL PLUS 117

MYNATAL-Z 117

MYNEPHROCAPS 117

MYORISAN 70

MYOZYME 73

MYZILRA 88

NNABUMETONE 5

NADOLOL 58

NADOLOL/BENDROFLUMETHIAZIDE 61

NAFCILLIN IN DEXTROSE, ISO-OSMOTIC 20

NAFCILLIN SODIUM 20

NAFTIFINE HCL 29

NAGLAZYME 73

NALBUPHINE HCL 11

NALOXONE HCL 14

NALTREXONE HCL 14

NAMENDA 25

NAPHAZOLINE HCL 100

NAPROXEN 5

NAPROXEN SODIUM 5

NARATRIPTAN HCL 31

NAROPIN 13

NATACYN 29

NATALVIRT FLT 114

NATAMYCIN 29

NATEGLINIDE 50

NATURE-THROID 91

NEBUPENT 40

NECON 88

NELARABINE 34

NELFINAVIR MESYLATE 47

NEO-POLYCIN 100

NEO-POLYCIN HC 100

NEOMYCIN SULFATE 15

NEOMYCIN SULFATE/BACITRACIN

ZINC/POLYMYXIN B/HYDROCORTISONE 100

NEOMYCIN SULFATE/BACITRACIN/POLYMYXIN

B 100

NEOMYCIN SULFATE/POLYMYXIN B SULFATE 16

NEOMYCIN SULFATE/POLYMYXIN B

SULFATE/GRAMICIDIN D 100

NEOMYCIN SULFATE/POLYMYXIN B

SULFATE/HYDROCORTISONE 103

NEOMYCIN/POLYMYXIN B

SULFATE/DEXAMETHASONE 100

NEOSTIGMINE BROMIDE 31

NEOSTIGMINE METHYLSULFATE 31

NEPHPLEX RX 117

NEPHRO-VITE RX 117

NEUAC 70

NEULASTA 53

NEUMEGA 53

NEVIRAPINE 46

NEXAVAR 38

NEXT CHOICE ONE DOSE 88

NIACIN 63

NICARDIPINE HCL 59

NICARDIPINE HCL IN 0.9 % SODIUM CHLORIDE 59

NIFEDIAC CC 59

NIFEDICAL XL 59

NIFEDIPINE 59

NIKKI 88

NILANDRON 33


NILOTINIB HCL 38

NILUTAMIDE 33

NIMODIPINE 59

NISOLDIPINE 59

NITAZOXANIDE 39

NITISINONE 73

NITRO-BID 64

NITRO-TIME 64

NITROFURANTOIN 16

NITROFURANTOIN MACROCRYSTAL 17

NITROFURANTOIN

MONOHYDRATE/MACROCRYSTALS 17

NITROGLYCERIN 70

NITROGLYCERIN/DEXTROSE 5 % IN WATER 64

NITROSTAT 64

NIVA-PLUS 117

NIZATIDINE 75

NODOLOR 98

NORA-BE 91

NORDITROPIN 82

NORDITROPIN FLEXPRO 83

NORDITROPIN NORDIFLEX 83

NOREPINEPHRINE BITARTRATE 61

NOREPINEPHRINE BITARTRATE IN 0.9 % SODIUM

CHLORIDE 61

NORETHINDRONE 91

NORETHINDRONE ACETATE 91

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL 88

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL/FERROUS FUMARATE 89

NORETHINDRONE-ETHINYL ESTRADIOL 90

NORETHINDRONE-ETHINYL

ESTRADIOL/FERROUS FUMARATE 90

NORGESTIMATE-ETHINYL ESTRADIOL 89

NORGESTREL-ETHINYL ESTRADIOL 88

NORLYROC 91

NORTHERA 61

NORTREL 88

NORTRIPTYLINE HCL 27

NORVIR 47

NOVAREL 83

NOVOEIGHT 55

NOVOSEVEN RT 55

NOXAFIL 29

NP THYROID 92

NU-DERM 70

NUEDEXTA 65

NULOJIX 94

NUQUIN HP 70

NUTRILIPID 118

NUTRILYTE 114

NUTRILYTE II 114

NYAMYC 29

NYSTATIN 30

NYSTATIN/LIDOCAINE HCL/DIPHENHYDRAMINE

HCL 29

NYSTATIN/TRIAMCINOLONE ACETONIDE 30

NYSTOP 30

OOCELLA 88

OCTREOTIDE ACETATE 93

OCUCOAT 100

OCUDOX 23

OFATUMUMAB 39

OFLOXACIN 22

OGEN 88

OGESTREL 88

OLANZAPINE 43

OLANZAPINE/FLUOXETINE HCL 26

OLODATEROL HCL 106

OLOPATADINE HCL 104

OMALIZUMAB 109

OMBITASVIR/PARITAPREVIR/RITONAVIR 45

OMEGA-3 ACID ETHYL ESTERS 63

OMEPRAZOLE 77

OMEPRAZOLE/SODIUM BICARBONATE 77

ONDANSETRON 28

ONDANSETRON HCL 28

ONDANSETRON HCL/PF 28

ONFI 23


ONXOL 36

OPIUM TINCTURE 75

OPIUM/BELLADONNA ALKALOIDS 11

OPRELVEKIN 53

OPSUMIT 107

ORFADIN 73

ORPHENADRINE CITRATE 109

ORPHENADRINE CITRATE/ASPIRIN/CAFFEINE 109

ORSYTHIA 88

OSCIMIN 74

OSCIMIN SL 74

OSCIMIN SR 74

OSELTAMIVIR PHOSPHATE 48

OSMITROL 98

OTICIN HC 103

OTO-END 10 103

OTOMAX-HC 103

OTOZIN 103

OXACILLIN SODIUM 20

OXACILLIN SODIUM/DEXTROSE, ISO-OSMOTIC 20

OXALIPLATIN 36

OXANDROLONE 83

OXAPROZIN 6

OXAZEPAM 49

OXCARBAZEPINE 24

OXSORALEN-ULTRA 70

OXYBENZONE/OCTINOXATE/HYDROQUINONE 68

OXYBUTYNIN CHLORIDE 77

OXYCODONE HCL 11

OXYCODONE HCL/ACETAMINOPHEN 12

OXYCODONE HCL/ASPIRIN 11

OXYCONTIN 8

OXYMORPHONE HCL 12

OXYTOCIN 99

PPACERONE 57

PACLITAXEL 36

PACLITAXEL PROTEIN-BOUND 34

PAIN RELIEF 13

PALBOCICLIB 37

PALGIC 104

PALIFERMIN 67

PALIPERIDONE 43

PALIPERIDONE PALMITATE 43

PALIVIZUMAB 95

PANCURONIUM BROMIDE 109

PANHEMATIN 99

PANITUMUMAB 39

PANTOPRAZOLE SODIUM 77

PAPAVERINE HCL 25

PAREGORIC 75

PARENTERAL AMINO ACID 10% COMBINATION

NO. 4 117


NO. 6 118


NO.7 118


NO.1 116

PARICALCITOL 97

PAROEX 67

PAROMOMYCIN SULFATE 15

PAROXETINE HCL 26

PASIREOTIDE DIASPARTATE 93

PAZOPANIB HCL 38

PEDI-DRI 30

PEDIATRIC MULTIVITAMIN COMBO

NO.75/FLUORIDE/FERROUS SULFATE 118

PEG 3350/SOD SULF/SOD BICARBONATE/SOD

CHLORIDE/POTASSIUM CHL 76

PEGANONE 24

PEGASYS 45

PEGASYS PROCLICK 45

PEGFILGRASTIM 53

PEGINTERFERON ALFA-2A 45

PEGINTERFERON ALFA-2B 36

PEMETREXED DISODIUM 34

PENICILLAMINE 78

PENICILLIN G POTASSIUM 20

PENICILLIN G PROCAINE 20

PENICILLIN G SODIUM 20


PENICILLIN V POTASSIUM 20

PENTAMIDINE ISETHIONATE 40

PENTASA 96

PENTAZOCINE HCL/NALOXONE HCL 12

PENTOSAN POLYSULFATE SODIUM 78

PENTOSTATIN 34

PENTOXIFYLLINE 61

PERFOROMIST 105

PERINDOPRIL ERBUMINE 57

PERIOGARD 67

PERITONEAL DIALYSIS NO.6 WITH DEXTROSE 1.5

% 111

PERITONEAL DIALYSIS NO.7 WITH DEXTROSE 2.5

% 111

PERITONEAL DIALYSIS NO.8 WITH DEXTROSE

4.25 % 111

PERJETA 39

PERMETHRIN 40

PERPHENAZINE 27

PERPHENAZINE/AMITRIPTYLINE HCL 26

PERTUZUMAB 39

PFIZERPEN 20

PHENADOZ 27

PHENAZOPYRIDINE HCL 78

PHENDIMETRAZINE TARTRATE 65

PHENELZINE SULFATE 26

PHENERGAN 27

PHENOBARBITAL 23

PHENOBARBITAL SODIUM 23

PHENOBARBITAL/HYOSCYAMINE SULF/ATROPINE

SULF/SCOPOLAMINE HB 74

PHENOL 99

PHENOXYBENZAMINE HCL 56

PHENTERMINE HCL 66

PHENTOLAMINE MESYLATE 56

PHENYLEPHRINE HCL 100

PHENYLEPHRINE HCL IN 0.9 % SODIUM

CHLORIDE 61

PHENYLEPHRINE HCL IN 0.9 % SODIUM

CHLORIDE/PF 61

PHENYLEPHRINE HCL/PROMETHAZINE HCL 108

PHENYTOIN 25

PHENYTOIN SODIUM 25

PHENYTOIN SODIUM EXTENDED 25

PHILITH 88

PHOSPHA 250 NEUTRAL 78

PHOSPHASAL 17

PHOSPHOLINE IODIDE 102

PHOSPHORUS #1 78

PHOTOFRIN 36

PHYSOSTIGMINE SALICYLATE 31

PHYTONADIONE 118

PILOCARPINE HCL 102

PIMOZIDE 42

PIMTREA 88

PINDOLOL 58

PIOGLITAZONE HCL 50

PIOGLITAZONE HCL/GLIMEPIRIDE 50

PIOGLITAZONE HCL/METFORMIN HCL 50

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 20

PIRMELLA 88

PIROXICAM 6

PLERIXAFOR 53

PNEUMOCOCCAL 23-VALENT POLYSACCHARIDE

VACCINE 96

PNEUMOVAX 23 96

PNV 29-1 118

PNV-SELECT 118

PNV-VP-U 118

PODOFILOX 70

POLOCAINE 13

POLOCAINE-MPF 13

POLYCIN 100

POLYETHYLENE GLYCOL 3350 76

POLYMYXIN B SULFATE 17

POLYMYXIN B SULFATE/TRIMETHOPRIM 101

POLYSACCHARIDE IRON FORTE 114

POMALIDOMIDE 33

POMALYST 33

PONATINIB HCL 37

PORFIMER SODIUM 36

PORTIA 88


POSACONAZOLE 29

POTASSIUM ACETATE 115

POTASSIUM BICARBONATE/CITRIC ACID 115

POTASSIUM CHLORIDE 115

POTASSIUM CHLORIDE IN 0.45 % SODIUM

CHLORIDE 115

POTASSIUM CHLORIDE IN 0.9 % SODIUM

CHLORIDE 115

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN

WATER 115

POTASSIUM CHLORIDE IN DEXTROSE 5 % AND 0.9

% SODIUM CHLORIDE 115

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 %

SODIUM CHLORIDE 115

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 %

SODIUM CHLORIDE 115

POTASSIUM CHLORIDE IN DEXTROSE 5% AND 0.3

% SODIUM CHLORIDE 115

POTASSIUM CHLORIDE IN LACTATED RINGERS

AND 5 % DEXTROSE 115

POTASSIUM CHLORIDE/POTASSIUM

BICARBONATE/CITRIC ACID 115

POTASSIUM CITRATE 78

POTASSIUM CITRATE/CITRIC ACID 79

POTASSIUM IODIDE/IODINE 99

POTASSIUM PHOS,M-BASIC-D-BASIC 115

POTASSIUM PHOSPHATE IN 0.9 % SODIUM

CHLORIDE 115

POTASSIUM PHOSPHATE,MONOBASIC 78

POTIGA 23

PR BENZOYL PEROXIDE 70

PR CREAM 70

PRADAXA 53

PRALATREXATE 34

PRALIDOXIME CHLORIDE 99

PRAMCORT 70

PRAMIPEXOLE DI-HCL 41

PRAMLINTIDE ACETATE 51

PRAMOXINE-HC 103

PRASUGREL HCL 56

PRAVASTATIN SODIUM 63

PRAZOSIN HCL 56

PRE-ATTACHED LTA KIT 14

PRED MILD 101

PREDNICARBATE 81

PREDNISOLONE 81

PREDNISOLONE ACETATE 101

PREDNISOLONE SOD PHOSPHATE 101

PREDNISONE 82

PREDNISONE INTENSOL 82

PREGABALIN 66

PREMASOL 118

PREMPHASE 88

PREMPRO 88

PRENA1 CHEW 118

PRENAPLUS 118

PRENATAL VIT WITH CALCIUM CMB 11/FERROUS

FUMARATE/FOLIC ACID 119

PRENATAL VIT WITH CALCIUM NO. 40/IRON

FUMARATE/FA CMB NO.1 119

PRENATAL VIT WITH CALCIUM NO.66/IRON

FUM/FOLIC ACID/DSS/DHA 119

PRENATAL VITAMIN

NO.15/IRON,CARBONYL/FOLIC ACID/DOCUSATE

SOD 119

PRENATAL VITAMIN

NO.16/IRON,CARBONYL/FOLIC ACID/DOCUSATE

SOD 119

PRENATAL VITAMIN NO.81/SODIUM FEREDETATE-

IRON POLY/FA/OMEGA3 118

PRENATAL VITAMINS COMB 10/FERROUS


PRENATAL VITAMINS COMBINATION NO.42/FOLIC

ACID 118

PRENATAL VITAMINS NO.11/FERROUS

FUMARATE/FOLIC ACID/OMEGA-3 119

PRENATAL VITAMINS WITH CALCIUM/FERROUS


PRENATAL VITS WITH CALCIUM #72/FERROUS







PRENATAL VITS WITH CALCIUM

#76/IRON,CARBONYL/FOLIC ACID 118



PRENATAL VITS WITHOUT CALC NO5/FERROUS


PREPLUS 118

PRETAB 118

PREVALITE 63

PREVIFEM 88

PREZISTA 47

PRIFTIN 32

PRIMIDONE 24

PRIVIGEN 95

PROBENECID 30

PROCAINAMIDE HCL 57

PROCARBAZINE HCL 32

PROCENTRA 64

PROCHLORPERAZINE 27

PROCHLORPERAZINE EDISYLATE 27

PROCHLORPERAZINE MALEATE 28

PROCRIT 53

PROCTO-PAK 82

PROCTOSOL-HC 82

PROCTOZONE-HC 82

PROFERRIN-FORTE 115

PROFILNINE 55

PROFILNINE SD 55

PROGESTERONE 91

PROGESTERONE,MICRONIZED 91

PROGLYCEM 51

PROGRAF 94

PROLASTIN 108

PROLASTIN C 108

PROMACTA 53

PROMETHAZINE HCL 104

PROMETHAZINE HCL/CODEINE 108

PROMETHAZINE HCL/DEXTROMETHORPHAN

HBR 108

PROMETHEGAN 28

PROPAFENONE HCL 57

PROPARACAINE HCL 101

PROPARACAINE HCL/FLUORESCEIN SODIUM 101

PROPOFOL 14

PROPRANOLOL HCL 58

PROPRANOLOL HCL/HYDROCHLOROTHIAZIDE 61

PROPYLTHIOURACIL 93

PROSTIGMIN 31

PROTAMINE SULFATE 53

PROTECTIVES COMBINATION NO.2/CERAMIDES

1,3,6-11 70

PROTOPAM CHLORIDE 99

PROTRIPTYLINE HCL 27

PULMICORT FLEXHALER 103

PULMOZYME 109

PUREVIT DUALFE PLUS 115

PURINETHOL 34

PYRAZINAMIDE 32

PYRIDOSTIGMINE BROMIDE 31

PYRIMETHAMINE 40

QQUASENSE 89

QUAZEPAM 110

QUETIAPINE FUMARATE 44

QUINAPRIL HCL 57

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE 61

QUINIDINE GLUCONATE 57

QUINIDINE SULFATE 57

QUININE SULFATE 40

QVAR 103

RRABEPRAZOLE SODIUM 77

RADIOPAQUE PVC MARKERS/BARIUM SULFATE 99

RALOXIFENE HCL 91

RALTEGRAVIR POTASSIUM 45

RAMELTEON 110

RAMIPRIL 57

RANITIDINE HCL 75


RAPAMUNE 94

RASBURICASE 34

RAVICTI 73

REA LO 39 70

REA LO 40 70

REBIF 67

REBIF REBIDOSE 67

RECLIPSEN 89

RECOMBINATE 55

RECTACORT-HC 82

RECTIV 70

REGONOL 31

REGORAFENIB 38

REGRANEX 71

RELADOR PAK 14

RELADOR PAK PLUS 14

RELENZA 47

RELISTOR 75

REMEVEN 71

REMICADE 94

REMODULIN 107

RENA-VITE RX 118

RENACIDIN 78

RENAL CAPS 118

RENO CAPS 118

RENVELA 79

REPAGLINIDE 50

REPAGLINIDE/METFORMIN HCL 50

REPREXAIN 12

RESCRIPTOR 46

RESERPINE 56

RESTASIS 101

REVATIO 107

REVLIMID 33

REVONTO 109

REYATAZ 47

RHO(D) IMMUNE GLOBULIN 95

RIASTAP 55

RIBASPHERE 45

RIBASPHERE RIBAPAK 45

RIBAVIRIN 45

RIDAURA 95

RIFABUTIN 32

RIFAMPIN 32

RIFAPENTINE 32

RIFAXIMIN 18

RILONACEPT 95

RILPIVIRINE HCL 46

RILUZOLE 66

RIMANTADINE HCL 47

RINGERS SOLUTION 118

RINGERS SOLUTION,LACTATED 118

RIOCIGUAT 107

RIOMET 50

RISEDRONATE SODIUM 97

RISPERDAL CONSTA 43

RISPERIDONE 43

RISPERIDONE MICROSPHERES 43

RITONAVIR 47

RITUXAN 39

RITUXIMAB 39

RIVAROXABAN 53

RIVASTIGMINE 25

RIVASTIGMINE TARTRATE 25

RIZATRIPTAN BENZOATE 31

ROCURONIUM BROMIDE 109

ROMIDEPSIN 35

ROPINIROLE HCL 41

ROPIVACAINE HCL/PF 13

ROSADAN 71

ROSULA 71

ROXICET 12

ROZEREM 110

RUFINAMIDE 24

RUXOLITINIB PHOSPHATE 38

SSABRIL 24

SACROSIDASE 73

SALACYN 71

SALICYLIC ACID 71


SALICYLIC ACID/AMMONIUM LACTATE/ALOE

VERA 71

SALICYLIC ACID/CERAMIDES 1,3,6-11 71

SALSALATE 6

SALVAX 71

SAMSCA 111

SANTYL 71

SAPROPTERIN DIHYDROCHLORIDE 73

SAQUINAVIR MESYLATE 47

SARGRAMOSTIM 53

SAVELLA 66

SCALACORT 82

SE 10-5 SS 71

SE BPO 71

SE-TAN PLUS 115

SEB-PREV 71

SECOBARBITAL SODIUM 110

SECONAL SODIUM 110

SELEGILINE HCL 41

SELENIUM 115

SELENIUM SULFIDE 71

SELZENTRY 47

SENSIPAR 92

SENSORCAINE 14

SENSORCAINE-EPINEPHRINE 14

SENSORCAINE-MPF 14

SEROQUEL XR 44

SERTRALINE HCL 26

SETLAKIN 89

SEVELAMER CARBONATE 79

SEVOFLURANE 99

SHAROBEL 91

SIGNIFOR 93

SILDENAFIL CITRATE 107

SILVER NITRATE 71

SILVER NITRATE/POTASSIUM NITRATE 71

SILVER SULFADIAZINE 22

SIMVASTATIN 63

SIROLIMUS 94

SIRTURO 32

SITAGLIPTIN PHOSPHATE 50

SITAGLIPTIN PHOSPHATE/METFORMIN HCL 50

SITZMARKS 99

SODIUM ACETATE 115

SODIUM BICARBONATE 115

SODIUM CHLORIDE 0.45 % 116

SODIUM CHLORIDE 3 % 116

SODIUM CHLORIDE 5 % 116

SODIUM CHLORIDE FOR INHALATION 109

SODIUM CHLORIDE IRRIGATING SOLUTION 116

SODIUM CHLORIDE IRRIGATING

SOLUTION/HYPOCHLOROUS ACID 72

SODIUM CITRATE DIHYDRATE 53

SODIUM FLUORIDE 116

SODIUM FLUORIDE/XYLITOL 112

SODIUM LACTATE 116

SODIUM MORRHUATE 99

SODIUM OXYBATE 110

SODIUM PHENYLBUTYRATE 73

SODIUM PHOS,M-BASIC-D-BASIC 116

SODIUM PHOSPHATE,MONOBASIC/POTASSIUM

PHOSPHATE,MONOBASIC 78

SODIUM POLYSTYRENE SULFONATE 111

SODIUM TETRADECYL SULFATE 99

SODIUM THIOSULFATE 111

SODIUM/POTASSIUM/MAGNES/CALCIUM/CHLORID

E/ACETATE/GLUCONATE 114

SODIUM/POTASSIUM/MAGNESIUM/CALCIUM/CHLO

RIDE/ACETATE 114

SODIUM/POTASSIUM/POTASSIUM

CITRATE/SODIUM CITRATE/CIT AC 79

SOFOSBUVIR 45

SOJOURN 99

SOLIRIS 99

SOMATROPIN 83

SORAFENIB TOSYLATE 38

SORINE 57

SOTALOL HCL 57

SOTRADECOL 99

SOVALDI 45

SPINOSAD 71

SPIRIVA 105


SPIRIVA RESPIMAT 105

SPIRONOLACTONE 62

SPIRONOLACTONE/HYDROCHLOROTHIAZIDE 61

SPORANOX 30

SPRINTEC 89

SPRYCEL 38

SPS 111

SRONYX 89

SS 10-2 71

SSD 22

SSS 10-5 71

STAVUDINE 46

STIMATE 83

STIOLTO RESPIMAT 109

STIVARGA 38

STRATTERA 65

STRENSIQ 73

STREPTOZOCIN 37

STRIBILD 45

STRIVERDI RESPIMAT 106

STROMECTOL 39

SUBLIMAZE 12

SUBOXONE 14

SUCCIMER 110

SUCCINYLCHOLINE CHLORIDE 109

SUCRAID 73

SUCRALFATE 76

SUFENTA 12

SUFENTANIL CITRATE 12

SULFACETAMIDE SODIUM 72

SULFACETAMIDE SODIUM/PREDNISOLONE

SODIUM PHOSPHATE 101

SULFACETAMIDE SODIUM/SULFUR 73

SULFACETAMIDE SODIUM/SULFUR/SKIN

CLEANSER COMB NO.23 72

SULFACETAMIDE SODIUM/SULFUR/UREA 71

SULFACETAMIDE SODIUM/SULFUR/WITCH

HAZEL 71

SULFACLEANSE 8-4 72

SULFADIAZINE 22

SULFAMETHOXAZOLE/TRIMETHOPRIM 22

SULFAMYLON 17

SULFASALAZINE 97

SULFATRIM 22

SULFAZINE 96

SULFAZINE EC 97

SULFURIC ACID/SULFONATED PHENOL 67

SULINDAC 6

SUMATRIPTAN 31

SUMATRIPTAN SUCCINATE 31

SUNITINIB MALATE 38

SUSTIVA 46

SUTENT 38

SYEDA 89

SYLATRON 36

SYLATRON 4-PACK 36

SYMAX 74

SYMAX-SL 74

SYMAX-SR 75

SYMBICORT 109

SYMLINPEN 120 51

SYMLINPEN 60 51

SYNAGIS 95

SYREX 116

TTABLOID 34

TACROLIMUS 94

TADALAFIL 107

TAFINLAR 38

TALIGLUCERASE ALFA 73

TAMIFLU 48

TAMOXIFEN CITRATE 33

TAMSULOSIN HCL 77

TARCEVA 38

TARGRETIN 39

TARINA FE 89

TARON FORTE 116

TARON-CRYSTALS 78

TASIGNA 38

TASIMELTEON 110

TASMAR 41


TAZAROTENE 72

TAZORAC 72

TAZTIA XT 59

TECFIDERA 67

TECHNIVIE 45

TEGRETOL XR 25

TELAPREVIR 44

TELBIVUDINE 44

TELMISARTAN 56

TELMISARTAN/AMLODIPINE BESYLATE 61

TELMISARTAN/HYDROCHLOROTHIAZIDE 61

TEMAZEPAM 110

TEMODAR 33

TEMOZOLOMIDE 33

TEMSIROLIMUS 38

TENCON 66

TENIPOSIDE 37

TENOFOVIR DISOPROXIL FUMARATE 47

TERAZOSIN HCL 56

TERBINAFINE HCL 30

TERBUTALINE SULFATE 106

TERCONAZOLE 30

TERIPARATIDE 97

TERRELL 99

TESAMORELIN ACETATE 92

TESTOPEL 83

TESTOSTERONE 83

TESTOSTERONE CYPIONATE 83

TESTOSTERONE ENANTHATE 83

TETCAINE 101

TETRABENAZINE 66

TETRACAINE HCL 101

TETRACAINE HCL/PF 101

TETRACYCLINE HCL 23

THALIDOMIDE 33

THALOMID 33

THEOCHRON 107

THEOPHYLLINE ANHYDROUS 107

THEOPHYLLINE/DEXTROSE 5 % IN WATER 107

THERACYS 36

THERAPEUTIC VITAMIN W-MINERALS 118

THERMAZENE 22

THIAMINE HCL 118

THIOGUANINE 34

THIORIDAZINE HCL 42

THIOTEPA 36

THIOTHIXENE 42

THRIVITE RX 118

THYROID,PORK 92

THYROLAR-1 92

THYROLAR-1/2 92

THYROLAR-1/4 92

THYROLAR-2 92

THYROLAR-3 92

TIAGABINE HCL 24

TICAGRELOR 55

TIGECYCLINE 17

TIKOSYN 57

TIMOLOL MALEATE 102

TINIDAZOLE 17

TIOTROPIUM BROMIDE 105

TIOTROPIUM BROMIDE/OLODATEROL HCL 109

TIPRANAVIR 47

TIVICAY 46

TIZANIDINE HCL 110

TL G-FOL OS 116

TL ICON 116

TL-HEM 150 116

TOBI 106

TOBI PODHALER 106

TOBRAMYCIN 106

TOBRAMYCIN IN 0.225 % SODIUM CHLORIDE 106

TOBRAMYCIN SULFATE 15

TOBRAMYCIN SULFATE/SODIUM CHLORIDE 15

TOBRAMYCIN/DEXAMETHASONE 101

TOBRAMYCIN/NEBULIZER 106

TOCILIZUMAB 95

TOLAZAMIDE 51

TOLBUTAMIDE 51

TOLCAPONE 41

TOLMETIN SODIUM 6

TOLTERODINE TARTRATE 77


TOLVAPTAN 111

TOPIRAGEN 24

TOPIRAMATE 24

TOPOSAR 37

TOREMIFENE CITRATE 33

TORISEL 38

TORSEMIDE 62

TOSITUMOMAB (WITH MALTOSE) 39

TRACLEER 107

TRADJENTA 51

TRAMADOL HCL 12

TRAMADOL HCL/ACETAMINOPHEN 12

TRAMETINIB DIMETHYL SULFOXIDE 38

TRANDOLAPRIL 57

TRANDOLAPRIL/VERAPAMIL HCL 61

TRANEXAMIC ACID 55

TRANYLCYPROMINE SULFATE 26

TRASTUZUMAB 39

TRAVASOL 118

TRAVOPROST (BENZALKONIUM) 102

TRAZODONE HCL 26

TREANDA 33

TREPROSTINIL SODIUM 107

TREPROSTINIL/NEBULIZER/NEBULIZER

ACCESSORIES 107

TRETINOIN 72

TRETINOIN MICROSPHERES 72

TRETTEN 55

TREXALL 94

TRI-CHLOR 72

TRI-ESTARYLLA 89

TRI-LEGEST FE 89

TRI-LINYAH 89

TRI-LO-ESTARYLLA 89

TRI-LO-MARZIA 89

TRI-LO-SPRINTEC 89

TRI-PREVIFEM 89

TRI-SPRINTEC 89

TRIACETIN 30

TRIAMCINOLONE ACETONIDE 103

TRIAMTERENE/HYDROCHLOROTHIAZIDE 62

TRIANEX 82

TRIAZOLAM 110

TRICHLOROACETIC ACID 72

TRICITRASOL 53

TRICITRATES 78

TRICON 116

TRIDERM 82

TRIFLUOPERAZINE HCL 42

TRIFLURIDINE 48

TRIGELS-F FORTE 116

TRIHEXYPHENIDYL HCL 40

TRIMETHOBENZAMIDE HCL 28

TRIMETHOPRIM 17

TRINESSA 89

TRISENOX 36

TRIVORA-28 89

TROPICAMIDE 101

TROSPIUM CHLORIDE 77

TRUVADA 46

TRYPSIN/BALSAM PERU/CASTOR OIL 72

TUDORZA PRESSAIR 105

TUSSIGON 109

TYGACIL 17

TYKERB 38

TYVASO 107

TYZEKA 44

UUCERIS 96

ULORIC 30

UMECTA 72

UNITHROID 92

UR N-C 17

UREA 73

UREA/HYALURONATE SODIUM 72

UREA/LACTIC ACID/SALICYLIC ACID 72

UREA/LACTIC ACID/ZINC UNDECYLENATE 72

URETRON D-S 17

URIMAR-T 17

URIN D.S. 17

URO-BLUE 17


UROGESIC-BLUE 17

UROLET MB 17

UROPHEN MB 17

URSODIOL 75

URYL 17

USTELL 17

UTIRA-C 18

VVAGIFEM 89

VALACYCLOVIR HCL 48

VALCHLOR 33

VALCYTE 44

VALGANCICLOVIR HCL 44

VALPROIC ACID 24

VALPROIC ACID (AS SODIUM SALT) (VALPROATE

SODIUM) 24

VALSARTAN 56

VALSARTAN/HYDROCHLOROTHIAZIDE 62

VANCOMYCIN HCL 18

VANCOMYCIN HCL/DEXTROSE 5 % IN WATER 18

VANCOMYCIN IN 0.9 % SODIUM CHLORIDE 18

VANCOMYCIN IN DEXTROSE, ISO-OSMOTIC 18

VANDAZOLE 18

VANDETANIB 37

VANTAS 93

VARENICLINE TARTRATE 15

VARICELLA-ZOSTER IMMUNE GLOBULIN

(HUMAN) 95

VARIZIG 95

VASCEPA 63

VASHE WOUND THERAPY 72

VASOLEX 72

VASOPRESSIN 83

VECTIBIX 39

VECURONIUM BROMIDE 110

VELAGLUCERASE ALFA 74

VELETRI 108

VELIVET 89

VEMURAFENIB 38

VENA-BAL DHA 118

VENLAFAXINE HCL 27

VENTAVIS 108

VENTOLIN HFA 106

VERAPAMIL HCL 59

VERDROCET 12

VERIPRED 20 82

VESTURA 89

VICODIN 12

VICODIN ES 12

VICODIN HP 12

VICTOZA 2-PAK 51

VICTOZA 3-PAK 51

VICTRELIS 45

VIDEX 46

VIENVA 90

VIGABATRIN 24

VIMPAT 25

VINBLASTINE SULFATE 36

VINCASAR PFS 36

VINCRISTINE SULFATE 36

VINCRISTINE SULFATE LIPOSOMAL 36

VINORELBINE TARTRATE 36

VIORELE 90

VIRACEPT 47

VIRAMUNE XR 46

VIREAD 47

VIRT NATE 119

VIRT-ADVANCE 119

VIRT-CAPS 119

VIRT-NATE 119

VIRT-NATE DHA 119

VIRT-PHOS 250 NEUTRAL 78

VIRT-PN 119

VIRT-VITE GT 119

VIRTI-SULF 72

VIRTPREX 119

VIRTRATE-2 79

VIRTRATE-3 79

VIRTRATE-K 79

VISMODEGIB 37

VITAFOL-OB 119


VITAFOL-PN 119

VITAMIN A/VITAMIN

E/AVOBENZONE/OCTINOXATE/HYDROQUINONE 70

VITAMIN B COMPLEX & VITAMIN C NO.20/FOLIC

ACID 119

VITAMIN B COMPLX NO.3/FOLIC ACID/ASCORBIC

ACID/BIOTIN 119

VITAMIN B COMPLX NO.3/FOLIC ACID/ASCORBIC

ACID/BIOTIN/ZNOX 117

VOL-CARE RX 119

VOL-PLUS 119

VORAPAXAR SULFATE 56

VORICONAZOLE 30

VORINOSTAT 37

VOTRIENT 38

VP-VITE RX 119

VPRIV 74

VSL#3 DS 75

VUMON 37

VYFEMLA 90

VYVANSE 64

WWARFARIN SODIUM 53

WATER FOR INJ.,BACTERIOSTATIC 99

WATER FOR

INJ.,BACTERIOSTATIC/METHYLPARABEN/PROPYL

PARABEN 99

WATER FOR INJECTION,STERILE 99

WATER FOR IRRIGATION,STERILE 99

WERA 90

WESTHROID 92

WYMZYA FE 90

XX-VIATE 73

XALKORI 38

XARELTO 53

XENAZINE 66

XIFAXAN 18

XOLAIR 109

XTANDI 33

XYNTHA 55

XYNTHA SOLOFUSE 55

XYREM 110

ZZAFIRLUKAST 105

ZALEPLON 110

ZAMICET 12

ZANAMIVIR 47

ZANOSAR 37

ZARAH 90

ZATEAN-PN 119

ZAVESCA 74

ZEBUTAL 66

ZELBORAF 38

ZEMAIRA 109

ZENCHENT 90

ZENCHENT FE 90

ZENCIA 73

ZEOSA 90

ZETIA 63

ZEVALIN 39

ZIAGEN 47

ZIDOVUDINE 47

ZINC CHLORIDE 116

ZINC SULFATE 116

ZINC SULFATE HEPTAHYDRATE/CUSO4 P-

HYD/MANGANESE/CHROMIUM/SE 114

ZINC SULFATE/CUPRIC SULFATE/MANGANESE

SULF/CHROMIC CHLORIDE 114

ZIPRASIDONE HCL 44

ZIPRASIDONE MESYLATE 43

ZOLINZA 37

ZOLMITRIPTAN 31

ZOLPIDEM TARTRATE 110

ZOMIG 31

ZONISAMIDE 23

ZONTIVITY 56

ZORTRESS 94

ZOSTAVAX 96


ZOSTER VACCINE LIVE/PF 96

ZOVIA 1-35E 90

ZOVIA 1-50E 90

ZOVIRAX 48

ZYDELIG 38

ZYKADIA 38

ZYTIGA 33

ZYVOX 18


Documents

Preferred Drug List - Passportpassporthealthplan.com/wp-content/uploads/2014/12/RXFLEX...What is the Passport Health Plan formulary? The formulary is a list of preferred drugs covered