Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
Prime Detailed Formulary
Guide
v. 2019-10
Disclaimer: This information is confidential and proprietary and may not be reproduced or disclosed in whole or part unless authorized in
writing by an authorized representative of Universal Rx v. 2019-10
2
Prime Detailed Formulary Guide The Prime Formulary Guide outlines the tier coverage and suggested limitations of the most commonly prescribed medications. A formulary is the list of drugs available for certain conditions and organized by tiers (cost levels).
Drug Tier Types of Drugs Included Cost
1 Generic Drugs Lowest Copay
2 Preferred Brand Name Drugs Medium Copay
3 Non-Preferred Brand Name Drugs Higher Copay
Limits Description
INJ – Injectable Drug Product is administered via an injectable route of
administration and may be subject to a separate benefit.
QL – Quantity Limit Drug is subject to a specific quantity per days supply due to
patient safety or cost containment measures.
separate specialty benefit.
ST – Step Therapy A more cost-effective option must be tried before a Step
Therapy drug may be covered.
Preferred and non-preferred brand name medications are listed to help identify clinically appropriate and cost-effective options within drug categories. Unless specifically indicated, drug list products will include all dosage forms. This is not an all-inclusive list and does not guarantee coverage. Medications listed may change to a lower tier at any time. Medications may also be moved to non-preferred status twice a year on January 1 and July 1. A brand-name drug for which a generic product becomes available may be designated as a non-preferred option upon release of the generic product to the market. Products recently approved by the U.S. Food and Drug Administration (FDA) may not be covered upon release to the market. When a medication changes tiers, the member may have to pay a different amount for that medication. The
member's specific prescription benefit plan design may not cover certain products or categories regardless of their appearance in this document. For the most up-to-date list call customer service at the toll-free member phone number on the ID card.
Need assistance finding a drug on this formulary guide? An alphabetical index is included at the end of the
formulary listing. You may also press Control + F to search for the product name.
Drug is designated as a specialty drug and may be subject to a SP – Specialty Program
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
3
ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS
ADDERALL 3
ADDERALL XR 3
ADIPEX-P 3
ADZENYS ER 3
ADZENYS XR-ODT 3
amphetamine sulfate 1
amphetamine/dextroampheta 1
APTENSIO XR 3
armodafinil 1
atomoxetine 1
atomoxetine hydrochloride 1
BELVIQ 3
BELVIQ XR 3
caffeine citrate 1
clonidine hcl er 1
clonidine hydrochloride 1
clonidine hydrochloride e 1
CONCERTA 3
CONTRAVE 3
COTEMPLA XR-ODT 3
DAYTRANA 2
dexmethylphenidate hcl 1
dexmethylphenidate hcl er 1
dexmethylphenidate hydroc 1
dextroamphetamine sulfate 1
diethylpropion hcl 1
diethylpropion hcl er 1
DYANAVEL XR 2
EVEKEO 3
FOCALIN 3
FOCALIN XR 3
guanfacine er 1
guanfacine hydrochloride 1
INTUNIV 3
LOMAIRA 3
metadate er 1
methamphetamine hcl 1
METHYLIN 3
methylphenid cap 30mg er 1
METHYLPHENID CAP 60MG LA 2
modafinil 1
MYDAYIS 2
NUVIGIL 3
phendimetrazine tartrate 1
phentermine hcl 1
PROVIGIL 3
QSYMIA 3
QUILLICHEW ER 2
QUILLIVANT XR 2
RITALIN 3
RITALIN LA 3
SAXENDA 3 INJ
STRATTERA 3
VYVANSE 2
ZENZEDI 3
ALLERGENIC EXTRACTS/BIOLOGICALS MISC
GRASTEK 2
ODACTRA 2
RAGWITEK 2
Amebicides
SOLOSEC 3
Aminoglycosides
gentamicin sulfate 1 INJ
neomycin sulfate 1
paromomycin sulfate 1
TOBI PODHALER 2 SP
tobramycin 1 SP
ANALGESICS - ANTI-INFLAMMATORY
ACTEMRA 2 INJ SP
ARTHROTEC 75 3
CELEBREX 3
celecoxib 1
diclofenac potassium 1
diclofenac sodium dr 1
diclofenac sodium er 1
diclofenac sodium/misopro 1
DUEXIS 3
ENBREL 2 INJ SP
ENBREL MINI 2 INJ SP
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
4
ENBREL SURECLICK 2 INJ SP
etodolac 1
etodolac er 1
fenoprofen tab 600mg 1
FENOPROFEN CAP 400MG 3
FENORTHO 3
flurbiprofen 1
HUMIRA 2 INJ SP
HUMIRA PEDIATRIC CROHNS D 2 INJ SP
HUMIRA PEN 2 INJ SP
HUMIRA PEN-CD/UC/HS START 2 INJ SP
HUMIRA PEN-PS/UV STARTER 2 INJ SP
ibu 1
ibuprofen 1
ILARIS 2 INJ SP
INDOCIN 3
indomethacin 1
indomethacin er 1
KETOPROFEN 3
ketoprofen er 1
ketorolac tromethamine 1 QL
KEVZARA 3 INJ SP
KINERET 3 INJ SP
leflunomide 1
meclofenamate sodium 1
mefenamic acid 1
meloxicam 1
nabumetone 1
NAPRELAN 3
naproxen 1
naproxen dr 1
naproxen sodium 1
naproxen sodium cr 1
naproxen sodium er 1
OLUMIANT 2 SP
ORENCIA 3 INJ SP
ORENCIA CLICKJECT 3 INJ SP
OTEZLA 2 SP
OTREXUP 2 INJ
oxaprozin 1
piroxicam 1
RASUVO 2 INJ
RIDAURA 2
SIMPONI INJ 100MG/ML 2 INJ SP
SIMPONI INJ 50/0.5ML 3 INJ SP
SIMPONI ARIA 3 INJ SP
SPRIX 3
sulindac 1
TIVORBEX 3
tolmetin sodium 1
VIMOVO 3
VIVLODEX 3
XELJANZ 2 SP
XELJANZ XR 2 SP
ZIPSOR 3
ZORVOLEX 3
ANALGESICS - NonNarcotic
bupap 1
butalbital/acetaminophen 1
butalbital/acetaminophen/ 1
BUT/ASA/CAF TAB 2
diflunisal 1
esgic 1
FIORICET 3
FIORINAL 3
salsalate 1
VANATOL LQ 3
ANALGESICS - OPIOID
ABSTRAL 3
acetaminophen/caffeine/di 1
acetaminophen/codeine 1
acetaminophen/codeine #3 1
acetaminophen/codeine pho 1
ARYMO ER 3
ascomp/codeine 1
BELBUCA 2
BUNAVAIL 3
BUPRENORPHINE 3
buprenorphine hcl 1
buprenorphine hcl/naloxon 1
buprenorphine hydrochlori 1
but/asa/caf/ cap cod 30mg 1
butorphanol tartrate 1 QL
BUTRANS 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
5
codeine sulfate 1
CONZIP 3
DURAGESIC 3
EMBEDA 3
endocet 1
fentanyl 1
fentanyl citrate 1 INJ
fentanyl citrate oral tra 1
FENTORA 3
hydrocodone bitartrate/ac 1
hydrocodone/acetaminophen 1
hydrocodone/ibuprofen 1
hydromorphone hcl 1
hydromorphone hcl dosette 1 INJ
hydromorphone hcl er 1
HYSINGLA ER 2
IBUDONE 3
LEVORPHANOL TARTRATE 3
lorcet 1
lorcet hd 1
lorcet plus 1
LORTAB 3
meperidine hcl 1
METHADONE SOL 5MG/5ML 2
methadone tab 10mg 1
MORPHABOND ER 3
morphine sulfate 1
morphine sulfate er 1
NORCO 3
NUCYNTA 2
NUCYNTA ER 2
OXAYDO 3
oxycodone hcl 1
OXYCODONE HCL ER 3
oxycodone hydrochloride 1
oxycodone/acetaminophen 1
oxycodone/aspirin 1
OXYCONTIN 2
oxymorphone hydrochloride 1
pentazocine/naloxone hcl 1
PERCOCET 3
ROXICODONE 3
SUBOXONE 2
tramadol hcl 1
tramadol hcl tab 200mg er 1
TRAMADOL HCL CAP 150MG ER 3
tramadol hydrochloride/ac 1
TYLENOL/CODEINE #3 3
TYLENOL/CODEINE #4 3
ULTRAM 3
vicodin 1
vicodin es 1
vicodin hp 1
XTAMPZA ER 3
ZOHYDRO ER 3
ZUBSOLV 2
ANDROGENS-ANABOLIC
ANDRODERM 2
ANDROGEL GEL 1%(50MG) 3
ANDROGEL GEL 1.62% 3
ANDROGEL PUMP 3
AVEED 3 INJ SP
danazol 1
DEPO-TESTOSTERONE 3 INJ
FORTESTA 3
methyltestosterone 1
NATESTO 3
oxandrolone 1
STRIANT 3
TESTIM 3
TESTOPEL 3 INJ SP
testosterone cypionate 1 INJ
testosterone enanthate 1 INJ
testosterone topical solu 1
ANORECTAL AGENTS
ANALPRAM HC 3
ANALPRAM HC SINGLES 3
ANALPRAM-HC 3
anucort-hc 1
anusol-hc 1
colocort 1
CORTIFOAM 3
hemmorex-hc 1
hydrocortisone acetate 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
6
hydrocortisone acetate/pr 1
lidocaine hcl/hydrocortis 1
PROCTOCORT 3
PROCTOFOAM HC 3
procto-med hc 1
procto-pak 1
proctosol hc 1
proctozone-hc 1
RECTIV 2
UCERIS AER 2MG/ACT 3
Anthelmintics
albendazole 1
ALBENZA 3
BILTRICIDE 3
EMVERM 2
ivermectin 1
praziquantel 1
STROMECTOL 3
ANTIANGINAL AGENTS
isosorbide dinitrate 1
isosorbide mononitrate 1
isosorbide mononitrate er 1
NITRO-BID 2
NITRO-DUR 3
nitroglycerin 1
nitroglycerin er 1
nitroglycerin lingual 1
nitroglycerin transdermal 1
NITROSTAT 3
nitro-time 1
RANEXA 2
ANTIANXIETY AGENTS
alprazolam 1
alprazolam er 1
alprazolam odt 1
alprazolam xr 1
ATIVAN 3
buspirone hcl 1
buspirone hydrochloride 1
chlordiazepoxide hcl 1
clorazepate dipotassium 1
diazepam 1
diazepam intensol 1
hydroxyzine hcl 1
hydroxyzine hydrochloride 1
hydroxyzine pamoate 1
lorazepam 1
lorazepam intensol 1
oxazepam 1
VALIUM 3
XANAX 3
ANTIARRHYTHMICS
amiodarone hcl 1
amiodarone hydrochloride 1
disopyramide phosphate 1
dofetilide 1
flecainide acetate 1
mexiletine hcl 1
MULTAQ 3
NORPACE CR 3
pacerone 1
propafenone hcl 1
propafenone hcl er 1
propafenone hydrochloride 1
quinidine gluconate cr 1
RYTHMOL SR 3
TIKOSYN 3
ANTIASTHMATIC AND BRONCHODILATOR AGENTS
ADVAIR DISKUS 3
ADVAIR HFA 2
AIRDUO RESPICLICK 113/14 3
AIRDUO RESPICLICK 232/14 3
AIRDUO RESPICLICK 55/14 3
albuterol sulfate 1
albuterol sulfate er 1
ALVESCO 3
ANORO ELLIPTA 2
ARCAPTA NEOHALER 2
ARNUITY ELLIPTA 2
ASMANEX HFA 2
ASMANEX TWISTHALER 120 ME 2
ASMANEX TWISTHALER 14 MET 2
ASMANEX TWISTHALER 30 MET 2
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
7
ASMANEX TWISTHALER 60 MET 2
ATROVENT HFA 2
BEVESPI AEROSPHERE 2
BREO ELLIPTA 2
BROVANA 3
budesonide 1
COMBIVENT RESPIMAT 2
cromolyn sodium 1
DALIRESP 2
DULERA 2
FASENRA 2 INJ SP
FLOVENT DISKUS 2
FLOVENT HFA 2
FLUTICASONE PROPIONATE/SA 2
INCRUSE ELLIPTA 2
ipratropium bromide/albut 1
levalbuterol 1
levalbuterol hcl 1
levalbuterol hydrochlorid 1
LEVALBUTEROL TARTRATE HFA 3
montelukast sodium 1
NUCALA 2 INJ SP
PERFOROMIST 2
PROAIR HFA 2
PROAIR RESPICLICK 2
PROVENTIL HFA 3
PULMICORT 3
PULMICORT FLEXHALER 2
QVAR REDIHALER 2
SEEBRI NEOHALER 2
SEREVENT DISKUS 2
SINGULAIR 3
SPIRIVA HANDIHALER 2
SPIRIVA RESPIMAT 2
STIOLTO RESPIMAT 2
STRIVERDI RESPIMAT 2
SYMBICORT 2
terbutaline sulfate 1
THEO-24 3
theophylline er 1
TRELEGY ELLIPTA 2
TUDORZA PRESSAIR 2
UTIBRON NEOHALER 2
VENTOLIN HFA 2
XOLAIR 2 INJ SP
XOPENEX 3
XOPENEX HFA 3
YUPELRI 2
zafirlukast 1
zileuton er 1
ZYFLO 3 ST
ZYFLO CR 3 ST
ANTICOAGULANTS
COUMADIN 3
ELIQUIS 2
ELIQUIS STARTER PACK 2
enoxaparin sodium 1 INJ
fondaparinux sodium 1 INJ SP
FRAGMIN 2 INJ SP
heparin lock flush 1 INJ
heparin lock flush/nacl f 1 INJ
heparin sodium 1 INJ
heparin sodium dcu 1 INJ
heparin sodium lock flush 1 INJ
HEPARIN SODIUM/SODIUM CHL 3 INJ
jantoven 1
LOVENOX 3 INJ
PRADAXA 3
SAVAYSA 3
warfarin sodium 1
XARELTO 2
XARELTO STARTER PACK 2
ANTICONVULSANTS
APTIOM 3
BANZEL 2
BRIVIACT 3
carbamazepine 1
carbamazepine er 1
CARBATROL 3
CELONTIN 2
clobazam 1
clonazepam 1
clonazepam odt 1
DEPAKOTE 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
8
DEPAKOTE ER 3
DIACOMIT 2 SP
DIASTAT ACUDIAL 3
DIAZEPAM RECTAL GEL 2
DILANTIN CAP 100MG 3
DILANTIN CAP 30MG 2
DILANTIN INFATABS 3
divalproex sodium 1
divalproex sodium dr 1
divalproex sodium er 1
EPIDIOLEX 2 SP
epitol 1
ethosuximide 1
felbamate 1
FYCOMPA 2
gabapentin 1
KEPPRA 3
KEPPRA XR 3
KLONOPIN 3
LAMICTAL 3
LAMICTAL ODT 3
LAMICTAL XR 3
lamotrigine 1
lamotrigine er 1
lamotrigine odt 1
lamotrigine starter kit/o 1
levetiracetam 1
levetiracetam er 1
LYRICA 2
MYSOLINE 3
NEURONTIN 3
ONFI 3
oxcarbazepine 1
OXTELLAR XR 3
PHENYTEK 3
phenytoin 1
phenytoin infatabs 1
phenytoin sodium extended 1
primidone 1
QUDEXY XR 2
SABRIL 2 SP
SPRITAM 3
subvenite 1
TEGRETOL 3
TEGRETOL-XR 3
tiagabine hydrochloride 1
TOPAMAX 3
TOPAMAX SPRINKLE 3
topiramate 1
TOPIRAMATE ER 3
TRILEPTAL 3
TROKENDI XR 3
valproic acid 1
vigabatrin 1 SP
VIMPAT 2
ZARONTIN 3
ZONEGRAN 3
zonisamide 1
ANTIDEPRESSANTS
amitriptyline hcl 1
amitriptyline hydrochlori 1
APLENZIN 3 ST
bupropion hcl 1
bupropion hcl er 1
bupropion hcl sr 1
bupropion hcl xl 1
bupropion hydrochloride 1
bupropion hydrochloride e 1
bupropion hydrochloride s 1
bupropion hydrochloride x 1
CELEXA 3
citalopram 1
citalopram hydrobromide 1
clomipramine hcl 1
CYMBALTA 3
desipramine hcl 1
desipramine hydrochloride 1
desvenlafax tab 100mg er 1
DESVENLAFAX TAB 50MG ER 3
doxepin hcl 1
duloxetine hcl 1
duloxetine hydrochloride 1
EFFEXOR XR 3
EMSAM 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
9
escitalopram oxalate 1
FETZIMA 2 ST
FETZIMA TITRATION PACK 2 ST
fluoxetine dr 1
fluoxetine hcl 1
fluoxetine tab 10mg 1
FLUOXETINE TAB 60MG 2
fluvoxamine maleate 1
fluvoxamine maleate er 1
FORFIVO XL 3
imipramine hcl 1
imipramine hydrochloride 1
imipramine pamoate 1
LEXAPRO 3
maprotiline hcl 1
MARPLAN 3
mirtazapine 1
mirtazapine odt 1
nefazodone hcl 1
nefazodone hydrochloride 1
nortriptyline hcl 1
paroxetine hcl 1
paroxetine hcl er 1
paroxetine hydrochloride 1
PAXIL 3
PAXIL CR 3
phenelzine sulfate 1
PRISTIQ 3
protriptyline hcl 1
PROZAC 3
REMERON 3
sertraline hcl 1
sertraline hydrochloride 1
tranylcypromine sulfate 1
trazodone hydrochloride 1
trimipramine maleate 1
TRINTELLIX 3 ST
venlafaxine hcl 1
venlafaxine hcl er 1
venlafaxine hydrochloride 1
VIIBRYD 2 ST
VIIBRYD STARTER PACK 2 ST
WELLBUTRIN SR 3
WELLBUTRIN XL 3
ZOLOFT 3
ZULRESSO 2 INJ SP
ANTIDIABETICS
acarbose 1
ACTOPLUS MET XR 3
ADLYXIN 3 INJ
ADLYXIN STARTER PACK 3 INJ
ADMELOG 3 INJ
ADMELOG SOLOSTAR 3 INJ
AFREZZA 3
ALOGLIPTIN 3 ST
ALOGLIPTIN/METFORMIN HCL 3 ST
ALOGLIPTIN/PIOGLITAZONE 3
AMARYL 3
APIDRA 3 INJ
APIDRA SOLOSTAR 3 INJ
AVANDIA 3
BASAGLAR KWIKPEN 3 INJ
BYDUREON 2 INJ
BYDUREON BCISE 2 INJ
BYDUREON PEN 2 INJ
BYETTA 2 INJ
chlorpropamide 1
CYCLOSET 3
FARXIGA 2
FIASP 2 INJ
FIASP FLEXTOUCH 2 INJ
glimepiride 1
glipizide 1
glipizide er 1
glipizide xl 1
glipizide/metformin hcl 1
GLUCAGEN HYPOKIT 2 INJ
GLUCAGON EMERGENCY KIT 2 INJ
GLUCOPHAGE 3
GLUCOPHAGE XR 3
GLUCOTROL XL 3
GLUMETZA 3
glyburide 1
glyburide micronized 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
10
glyburide/metformin hcl 1
GLYXAMBI 2
HUMALOG 2 INJ
HUMALOG JUNIOR KWIKPEN 2 INJ
HUMALOG KWIKPEN 2 INJ
HUMALOG MIX 50/50 KWIKPEN 2 INJ
HUMALOG MIX 75/25 2 INJ
HUMALOG MIX 75/25 KWIKPEN 2 INJ
HUMULIN R U-500 (CONCENTR 2 INJ
HUMULIN R U-500 KWIKPEN 2 INJ
INSULIN LISPRO 3 INJ
INSULIN LISPRO KWIKPEN 3 INJ
INVOKAMET 2
INVOKAMET XR 2
INVOKANA 2
JANUMET 2
JANUMET XR 2
JANUVIA 2
JARDIANCE 2
JENTADUETO 2
JENTADUETO XR 2
KAZANO 3 ST
KOMBIGLYZE XR 3 ST
LANTUS 2 INJ
LANTUS SOLOSTAR 2 INJ
LEVEMIR 2 INJ
LEVEMIR FLEXTOUCH 2 INJ
metformin hcl 1
metformin hcl er 1
metformin hydrochloride 1
metformin hydrochloride e 1
miglitol 1
nateglinide 1
NESINA 3 ST
NOVOLOG 2 INJ
NOVOLOG FLEXPEN 2 INJ
NOVOLOG MIX 70/30 2 INJ
NOVOLOG MIX 70/30 PREFILL 2 INJ
NOVOLOG PENFILL 2 INJ
ONGLYZA 3 ST
OSENI 3
OZEMPIC 2 INJ
pioglitazone hcl 1
pioglitazone hcl/metformi 1
PROGLYCEM 2
QTERN 3
repaglinide 1
RIOMET 3
SEGLUROMET 2
SOLIQUA 100/33 2 INJ
STEGLATRO 2
STEGLUJAN 3
SYMLINPEN 120 2 INJ
SYMLINPEN 60 2 INJ
SYNJARDY 2
SYNJARDY XR 2
TOUJEO MAX SOLOSTAR 2 INJ
TOUJEO SOLOSTAR 2 INJ
TRADJENTA 2
TRESIBA FLEXTOUCH 2 INJ
TRULICITY 2 INJ
VICTOZA 2 INJ
XIGDUO XR 2
XULTOPHY 100/3.6 2 INJ
ANTIDIARRHEAL/PROBIOTIC AGENTS
diphenoxylate/atropine 1
loperamide hcl 1
MOTOFEN 3
MYTESI 3
opium 1
opium tincture 1
paregoric 1
RESTORA RX 3
VSL#3 DS 3
Antidotes and Specific Antagonists
CHEMET 2
EXJADE 2 SP
JADENU 2 SP
JADENU SPRINKLE 2 SP
naloxone hcl 1 INJ
naltrexone hcl 1
NARCAN 2
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
11
VIVITROL 2 INJ SP
ANTIEMETICS
AKYNZEO 2
aprepitant 1 QL
BONJESTA 3
DICLEGIS 3
dronabinol 1
EMEND 3 QL
granisetron hcl 1
meclizine hcl 1
meclizine hydrochloride 1
ondansetron hcl 1
ondansetron hydrochloride 1
ondansetron odt 1
SANCUSO 2
TRANSDERM-SCOP 3
trimethobenzamide hcl 1
VARUBI 2
ZOFRAN 3
ZUPLENZ 3
Antifungals
ABELCET 2 INJ
amphotericin b 1 INJ
CRESEMBA 2 SP
DIFLUCAN 3
fluconazole 1
griseofulvin microsize 1
griseofulvin ultramicrosi 1
itraconazole 1
ketoconazole 1
NOXAFIL 2
nystatin 1
SPORANOX 3
terbinafine hcl 1
terbinafine hydrochloride 1
voriconazole 1 INJ
ANTIHISTAMINES
carbinoxamine maleate 1
CLARINEX 3
clemastine fumarate 1
cyproheptadine hcl 1
desloratadine 1
desloratadine odt 1
diphenhydramine hcl 1
levocetirizine dihydrochl 1
phenadoz 1
promethazine hcl 1
promethazine hcl plain 1
promethazine hydrochlorid 1
promethegan 1
ryvent 1
ANTIHYPERLIPIDEMICS
ANTARA 3
atorvastatin calcium 1
cholestyramine 1
cholestyramine light 1
colesevelam hydrochloride 1
COLESTID 3
colestipol hcl 1
CRESTOR 3
ezetimibe 1
ezetimibe/simvastatin 1
fenofibrate tab 48mg 1
FENOFIBRATE CAP 50MG 3
fenofibrate micronized 1
FENOFIBRIC ACID 2
fenofibric acid dr 1
fluvastatin 1
fluvastatin sodium er 1
gemfibrozil 1
LESCOL XL 3
LIPITOR 3
LIPOFEN 2
LIVALO 2 ST
lovastatin 1
LOVAZA 3
niacin er 1
NIACOR 3
NIASPAN 3
omega-3-acid ethyl esters 1
PRALUENT 2 INJ SP
PRAVACHOL 3
pravastatin sodium 1
prevalite 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
12
QUESTRAN LIGHT 3
REPATHA 2 INJ SP
REPATHA PUSHTRONEX SYSTEM 2 INJ SP
REPATHA SURECLICK 2 INJ SP
rosuvastatin calcium 1
simvastatin 1
TRICOR 3
TRIGLIDE 3
TRILIPIX 3
VASCEPA 2
VYTORIN 3
WELCHOL 3
ZETIA 3
ANTIHYPERTENSIVES
ACCUPRIL 3
amlodipine besylate/benaz 1
amlodipine besylate/valsa 1
amlodipine/olmesartan med 1
amlodipine/valsartan/hctz 1
atenolol/chlorthalidone 1
AVAPRO 3
AZOR 3
benazepril hcl 1
benazepril hcl/hydrochlor 1
BENICAR 3
BENICAR HCT 3
bisoprolol fumarate/hydro 1
BYVALSON 2 ST
candesartan cilexetil 1
candesartan cilexetil/hyd 1
captopril 1
captopril/hydrochlorothia 1
CATAPRES-TTS-1 3
CATAPRES-TTS-3 3
clonidine hcl 1
COZAAR 3
DIOVAN 3
DIOVAN HCT 3
doxazosin mesylate 1
DUTOPROL 3
EDARBI 2 ST
EDARBYCLOR 2 ST
enalapril maleate 1
enalapril maleate/hydroch 1
EPANED 3
eplerenone 1
eprosartan mesylate 1
fosinopril sodium 1
fosinopril sodium/hydroch 1
guanfacine hcl 1
hydralazine hcl 1
HYZAAR 3
irbesartan 1
irbesartan/hydrochlorothi 1
lisinopril 1
lisinopril/hydrochlorothi 1
losartan potassium 1
losartan potassium/hydroc 1
LOTREL 3
methyldopa 1
methyldopa/hydrochlorothi 1
metoprolol/hydrochlorothi 1
MICARDIS 3
MICARDIS HCT 3
minoxidil 1
moexipril hcl 1
nadolol/bendroflumethiazi 1
olmesartan medoxomil 1
olmesartan medoxomil/amlo 1
olmesartan medoxomil/hydr 1
perindopril erbumine 1
prazosin hcl 1
propranolol/hydrochloroth 1
QBRELIS 3
quinapril hcl 1
quinapril hydrochloride 1
quinapril/hydrochlorothia 1
ramipril 1
TEKTURNA 2
TEKTURNA HCT 2
telmisartan 1
telmisartan/amlodipine 1
telmisartan/hydrochloroth 1
terazosin hcl 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
13
trandolapril 1
trandolapril/verapamil hc 1
TRIBENZOR 3
valsartan 1
valsartan/hydrochlorothia 1
ZESTRIL 3
Anti-infective Agents - Misc.
ALINIA 2
atovaquone 1
CAYSTON 2
clindamycin hcl 1
clindamycin hydrochloride 1
clindamycin palmitate hcl 1
dapsone 1
FIRST-METRONIDAZOLE 100 3
FIRST-METRONIDAZOLE 50 3
FIRST-VANCOMYCIN 25 3
FIRST-VANCOMYCIN 50 3
FIRVANQ 3
LINCOCIN 3 INJ
linezolid 1
meropenem 1 INJ
SIVEXTRO 3 SP
sulfamethoxazole/trimetho 1
sulfatrim pediatric 1
tinidazole 1
trimethoprim 1
vancomycin hcl 1 INJ
XIFAXAN 2
Antimalarials
atovaquone/proguanil hcl 1
chloroquine phosphate 1
COARTEM 2
hydroxychloroquine sulfat 1
MALARONE 3
mefloquine hcl 1
PLAQUENIL 3
quinine sulfate 1
Antimyasthenic/Cholinergic Agents
MESTINON TIMESPAN 3
pyridostigmine bromide 1
pyridostigmine bromide er 1
Antimycobacterial Agents
ethambutol hcl 1
isoniazid 1
PRIFTIN 2
rifabutin 1
rifampin 1
ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES
AFINITOR 2 SP
ALECENSA 2 SP
ALUNBRIG 3 SP
anastrozole 1
AROMASIN 3
AVASTIN 2 INJ SP
azacitidine 1 INJ SP
BALVERSA 2 SP
bicalutamide 1
BOSULIF 2 SP
BRAFTOVI 3 SP
CABOMETYX 2 SP
capecitabine 1 SP
CAPRELSA 2 SP
COMETRIQ 2 SP
CYCLOPHOSPH CAP 25MG 2
cyclophosph cap 50mg 1
ELIGARD 2 INJ SP
ERIVEDGE 2 SP
etoposide 1 SP
exemestane 1
FASLODEX 2 INJ SP
flutamide 1
GLEEVEC 3 SP
GLEOSTINE 2 SP
HERCEPTIN 2 INJ SP
hydroxyurea 1
IBRANCE 2 SP
ICLUSIG 2 SP
imatinib mesylate 1 SP
IMBRUVICA 2 SP
INLYTA 2 SP
INTRON A 2 INJ SP
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
14
JAKAFI 2 SP
KEYTRUDA 2 INJ SP
KISQALI 3 SP
KISQALI FEMARA 600 DOSE 3 SP
LENVIMA 12MG DAILY DOSE 2 SP
letrozole 1
leucovor ca tab 5mg 1
LEUCOVOR CA TAB 10MG 2
LEUKERAN 2
leuprolide acetate 1 INJ SP
LONSURF 2 SP
LUPRON DEPOT INJ 3.75MG 2 INJ SP
LUPRON DEPOT INJ 7.5MG 3 INJ SP
LUPRON DEPOT INJ 22.5MG 3 INJ SP
LUPRON DEPOT INJ 11.25MG 2 INJ SP
LUPRON DEPOT (4-MONTH) 3 INJ SP
LUPRON DEPOT (6-MONTH) 3 INJ SP
LYNPARZA 2 SP
MATULANE 2 SP
megestrol acetate 1
MEKINIST 2 SP
MEKTOVI 3 SP
mercaptopurine 1 SP
methotrexate 1
methotrexate sodium 1 INJ
NERLYNX 2 SP
NEXAVAR 2 SP
NINLARO 2 SP
OPDIVO 2 INJ SP
PERJETA 2 INJ SP
POMALYST 2 SP
PURIXAN 2 SP
RITUXAN 2 INJ SP
RUBRACA 2 SP
RYDAPT 2 SP
SPRYCEL 2 SP
STIVARGA 2 SP
SUTENT 2 SP
TABLOID 2 SP
TAFINLAR 2 SP
TAGRISSO 2 SP
TALZENNA 2 SP
tamoxifen citrate 1
TARCEVA 2 SP
TASIGNA 2 SP
temozolomide 1 SP
TREXALL 3
VELCADE 2 INJ SP
VENCLEXTA 2 SP
VENCLEXTA STARTING PACK 2 SP
VERZENIO 2 SP
VOTRIENT 2 SP
XALKORI 2 SP
XTANDI 2 SP
ZEJULA 2 SP
ZELBORAF 2 SP
ZOLADEX 2 INJ SP
ZYTIGA TAB 250MG 3 SP
ZYTIGA TAB 500MG 2 SP
ANTIPARKINSON AND RELATED THERAPY AGENTS
amantadine hcl 1
APOKYN 2 INJ SP
AZILECT 3
benztropine mesylate 1
bromocriptine mesylate 1
carbidopa 1
carbidopa/levodopa 1
carbidopa/levodopa er 1
carbidopa/levodopa odt 1
CARB/LEVO 75 TAB /ENTACAP 2
carb/levo100 tab /entacap 1
entacapone 1
GOCOVRI 3 SP
INBRIJA 2 SP
MIRAPEX 3
NEUPRO 3
pramipexole dihydrochlori 1
rasagiline mesylate 1
REQUIP 3
REQUIP XL 3
ropinirole er 1
ropinirole hcl 1
RYTARY 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
15
selegiline hcl 1
trihexyphenidyl hcl 1
ANTIPSYCHOTICS/ANTIMANIC AGENTS
ABILIFY 3
ABILIFY MAINTENA 2 INJ
aripiprazole 1
aripiprazole odt 1
ARISTADA 2 INJ SP
chlorpromazine hcl 1 INJ
clozapine 1
CLOZAPINE TAB 200/ODT 3
clozapine tab 25mg odt 1
compro 1
FANAPT 3 ST
fluphenazine decanoate 1 INJ
fluphenazine hcl 1
GEODON 3
haloperidol 1
haloperidol decanoate 1 INJ
haloperidol lactate 1 INJ
INVEGA 3
INVEGA SUSTENNA 3 INJ
INVEGA TRINZA 3 INJ
LATUDA 2 ST
lithium carbonate 1
lithium carbonate er 1
loxapine 1
loxapine succinate 1
olanzapine 1
olanzapine odt 1
paliperidone er 1
perphenazine 1
prochlorperazine 1
prochlorperazine maleate 1
quetiapine fumarate 1
quetiapine fumarate er 1
REXULTI 3
RISPERDAL 3
RISPERDAL CONSTA 2 INJ
risperidone 1
risperidone odt 1
SAPHRIS 3
SEROQUEL 3
SEROQUEL XR 3
thioridazine hcl 1
thiothixene 1
trifluoperazine hcl 1
VRAYLAR 3 SP ST
ziprasidone hcl 1
ZYPREXA 3
ZYPREXA ZYDIS 3
Antiseptics & Disinfectants
formaldehyde 1
HYDROGEN PEROXIDE 2
ANTIVIRALS
abacavir 1 SP
abacavir/lamivudine 1 SP
acyclovir 1
atazanavir 1 SP
atazanavir sulfate 1 SP
ATRIPLA 3 SP
BARACLUDE 3 SP
BIKTARVY 2 SP
cidofovir 1 INJ SP
COMPLERA 2 SP
DESCOVY 2 SP
DOVATO 2 SP
EDURANT 2 SP
efavirenz 1 SP
entecavir 1 SP
EPCLUSA 2 SP
EVOTAZ 3 SP
famciclovir 1
GENVOYA 2 SP
HARVONI 2 SP
ISENTRESS 2 SP
JULUCA 2 SP
KALETRA 2 SP
lamivudine 1 SP
lamivudine/zidovudine 1 SP
MAVYRET 2 SP
NORVIR 3 SP
ODEFSEY 2 SP
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
16
oseltamivir phosphate 1 QL
PEGASYS 2 INJ SP
PREZCOBIX 3 SP
PREZISTA 2 SP
RELENZA DISKHALER 2 QL
REYATAZ 3 SP
ribavirin 1 SP
ritonavir 1 SP
SITAVIG 3
STRIBILD 2 SP
SUSTIVA 3 SP
TAMIFLU 3 QL
tenofovir disoproxil fuma 1 SP
TIVICAY 2 SP
TRIUMEQ 2 SP
TRUVADA 2 SP
valacyclovir hcl 1
valacyclovir hydrochlorid 1
VALCYTE 3 SP
valganciclovir 1 SP
valganciclovir hydrochlor 1 SP
VALTREX 3
VEMLIDY 2 SP
VIREAD 3 SP
VOSEVI 2 SP
XOFLUZA 2
ZEPATIER 2 SP
zidovudine 1 SP
BETA BLOCKERS
acebutolol hcl 1
acebutolol hydrochloride 1
atenolol 1
BETAPACE 3
betaxolol hcl 1
bisoprolol fumarate 1
BYSTOLIC 2 ST
carvedilol 1
carvedilol phosphate 1
COREG 3
COREG CR 3
CORGARD 3
INDERAL LA 3
INDERAL XL 3 ST
INNOPRAN XL 3 ST
labetalol hcl 1
labetalol hydrochloride 1
metoprolol succinate er 1
metoprol tar tab 25mg 1
METOPROLOL TAB 75MG 2
nadolol 1
pindolol 1
propranolol hcl 1
propranolol hcl er 1
propranolol hydrochloride 1
sotalol hcl 1
sotalol hcl (af) 1
sotalol hydrochloride (af 1
sotalol hydrocholride 1
SOTYLIZE 2
TENORMIN 3
timolol maleate 1
TOPROL XL 3
Calcium Channel Blockers
amlodipine besylate 1
CARDIZEM LA 3
cartia xt 1
diltiazem hcl 1
diltiazem hcl cd 1
diltiazem hcl er 1
diltiazem hydrochloride e 1
dilt-xr 1
felodipine er 1
isradipine 1
matzim la 1
nifedipine 1
nifedipine er 1
nimodipine 1
nisoldipine er 1
NORVASC 3
PROCARDIA XL 3
taztia xt 1
TIAZAC 3
verapamil hcl 1
verapamil hcl er 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
17
verapamil hcl sr 1
verapamil hydrochloride 1
CARDIOTONICS
digitek 1
digox 1
digoxin 1
CARDIOVASCULAR AGENTS - MISC.
ADCIRCA 3 SP
ADEMPAS 2 SP
amlodipine besylate/atorv 1
BIDIL 3
CADUET 3
CAVERJECT IMPULSE 2 INJ QL
CIALIS 3 QL
CORLANOR 2
EDEX 3 INJ QL
ENTRESTO 2
LETAIRIS 2 SP
LEVITRA 3 QL ST
MUSE 2 QL
OPSUMIT 2 SP
ORENITRAM 3 SP
papaverine hcl 1 INJ
REMODULIN 2 INJ SP
REVATIO 3 SP
sildenafil 1 SP
sildenafil citrate 1 QL
STAXYN 3 QL ST
STENDRA 3 QL ST
tadalafil 1 QL
TRACLEER 2 SP
TYVASO 2 SP
TYVASO REFILL 2 SP
UPTRAVI 2 SP
vardenafil hydrochloride 1 QL
VIAGRA 3 QL
VYNDAQEL 2 SP
CEPHALOSPORINS
cefaclor 1
cefadroxil 1
cefdinir 1
cefepime 1 INJ
cefixime 1
cefpodoxime proxetil 1
cefprozil 1
ceftriaxone sodium 1 INJ
cefuroxime axetil 1
CEPHALEXIN TAB 250MG 2
cephalexin tab 500mg 1
SUPRAX 3
TEFLARO 2 INJ
CONTRACEPTIVES
altavera 1
alyacen 1/35 1
alyacen 7/7/7 1
amethia 1
amethia lo 1
amethyst 1
apri 1
aranelle 1
ashlyna 1
aubra 1
aubra eq 1
aviane 1
azurette 1
BALCOLTRA 3
balziva 1
bekyree 1
BEYAZ 3
blisovi 24 fe 1
blisovi fe 1.5/30 1
blisovi fe 1/20 1
briellyn 1
camila 1
camrese 1
camrese lo 1
caziant 1
chateal 1
cryselle-28 1
cyclafem 1/35 1
cyclafem 7/7/7 1
cyred 1
cyred eq 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
18
dasetta 1/35 1
dasetta 7/7/7 1
daysee 1
deblitane 1
DEPO-PROVERA CONTRACEPTIV 3 INJ
DEPO-SUBQ PROVERA 104 3 INJ
desogestrel/ethinyl estra 1
drospirenone/ethinyl estr 1
elinest 1
ELLA 3
emoquette 1
enpresse-28 1
enskyce 1
errin 1
estarylla 1
ESTROSTEP FE 3
ethynodiol diacetate/ethi 1
falmina 1
fayosim 1
femynor 1
GENERESS FE 3
gianvi 1
heather 1
introvale 1
isibloom 1
jencycla 1
jolessa 1
jolivette 1
juleber 1
junel 1.5/30 1
junel 1/20 1
junel fe 1.5/30 1
junel fe 1/20 1
junel fe 24 1
kaitlib fe 1
kariva 1
kelnor 1/35 1
kelnor 1/50 1
kurvelo 1
KYLEENA 2
larin 1.5/30 1
larin 1/20 1
larin 24 fe 1
larin fe 1.5/30 1
larin fe 1/20 1
larissia 1
layolis fe 1
leena 1
lessina 1
levonest 1
levonorgestrel and ethiny 1
levonorgestrel/ethinyl es 1
levora 0.15/30-28 1
LILETTA 3
lillow 1
LO LOESTRIN FE 2
LOESTRIN 1.5/30-21 3
LOESTRIN 1/20-21 3
LOESTRIN FE 1.5/30 3
LOESTRIN FE 1/20 3
loryna 1
LOSEASONIQUE 3
low-ogestrel 1
lutera 1
lyza 1
marlissa 1
medroxyprogesterone aceta 1 INJ
melodetta 24 fe 1
mibelas 24 fe 1
microgestin 1.5/30 1
microgestin 1/20 1
microgestin fe 1
microgestin fe 1.5/30 1
mili 1
MINASTRIN 24 FE 3
MIRCETTE 3
MIRENA 2
mono-linyah 1
mononessa 1
myzilra 1
NATAZIA 3
necon 0.5/35-28 1
NEXPLANON 2 INJ
nikki 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
19
nora-be 1
norethindrone 1
norethindrone & ethinyl e 1
norethindrone acetate/eth 1
norethindrone/ethinyl est 1
norgestimate/ethinyl estr 1
norlyda 1
nortrel 0.5/35 (28) 1
nortrel 1/35 1
nortrel 7/7/7 1
NUVARING 2
ocella 1
ogestrel 1
orsythia 1
ORTHO MICRONOR 3
ORTHO TRI-CYCLEN LO 3
ORTHO-CYCLEN 3
ORTHO-NOVUM 1/35 3
PARAGARD INTRAUTERINE COP 3
philith 1
pimtrea 1
pirmella 1/35 1
pirmella 7/7/7 1
portia-28 1
previfem 1
QUARTETTE 3
quasense 1
rajani 1
reclipsen 1
rivelsa 1
SAFYRAL 3
SEASONIQUE 3
setlakin 1
sharobel 1
SKYLA 2
sprintec 28 1
sronyx 1
syeda 1
tarina fe 1/20 1
tarina fe 1/20 eq 1
TAYTULLA 2
tilia fe 1
tri femynor 1
tri-estarylla 1
tri-legest fe 1
tri-linyah 1
tri-lo-estarylla 1
tri-lo-marzia 1
tri-lo-sprintec 1
tri-previfem 1
tri-sprintec 1
trivora-28 1
tri-vylibra 1
tulana 1
tydemy 1
velivet 1
vienva 1
viorele 1
vyfemla 1
vylibra 1
wera 1
wymzya fe 1
XULANE 2
YASMIN 28 3
YAZ 3
zarah 1
zovia 1/35e 1
CORTICOSTEROIDS
betamethasone sodium phos 1 INJ
budesonide er 1
BUPIVILOG KIT 3 INJ
CORTEF 3
DEPO-MEDROL 3 INJ
DEXAMETHASON SOL 0.5/5ML 2
dexamethason tab 0.75mg 1
DEXAMETHASONE INTENSOL 2
DEXPAK 10 DAY 3
DEXPAK 6 DAY 3
EMFLAZA 3 SP
ENTOCORT EC 3
fludrocortisone acetate 1
hydrocortisone 1
KENALOG-10 3 INJ
KENALOG-40 3 INJ
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
20
MEDROL 3
MEDROL DOSEPAK 3
methylprednisolone 1
methylprednisolone acetat 1 INJ
methylprednisolone dose p 1
methylprednisolone sodium 1 INJ
MILLIPRED TAB 5MG 2
MILLIPRED SOL 10MG/5ML 3
ORAPRED ODT 3
PHYSICIANS EZ USE JOINT T 3
PHYSICIANS EZ USE M-PRED 3 INJ
prednisolone 1
prednisolone sol 15mg/5ml 1
PREDNISOLONE SOL 25MG/5ML 2
prednisone tab 20mg 1
PREDNISONE PAK 5MG 2
PREDNISONE INTENSOL 2
RAYOS 3
SOLU-CORTEF 2 INJ
SOLU-MEDROL 3 INJ
TAPERDEX 6-DAY 3
UCERIS TAB 9MG 3
VERIPRED 20 2
COUGH/COLD/ALLERGY
acetylcysteine 1
benzonatate 1
bromfed dm 1
bromphen/pseudoephedrine 1
CLARINEX-D 12 HOUR 3
GILTUSS TR 3
hydrocodone bitartrate/ch 1
hydrocodone bitartrate/ho 1
hydrocodone polistirex/ch 1
hydrocodone/homatropine 1
hydromet 1
HYPERSAL 3
nebusal 1
promethazine/codeine 1
promethazine/dextromethor 1
promethazine/phenylephrin 1
promethazine-dm 1
SEMPREX-D 3
SSKI 3
TUZISTRA XR 3
DERMATOLOGICALS
ABSORICA 2
ACANYA 2
acitretin 1 SP
ACUICYN DAILY EYELID & EY 2
ACZONE 3
adapalene 1
adapalene pump 1
adapalene/benzoyl peroxid 1
AKTIPAK 3
ALA SCALP 3
ALA-QUIN 3
alclometasone dipropionat 1
ALCORTIN A 3
ALDARA 3
ALEVICYN ANTIPRURITIC SG 3
ALTABAX 3
amcinonide 1
amnesteem 1
ARZOL SILVER NITRATE APP 2
ASTERO 3
augmented betamethasone d 1
avar cleanser 1
AVAR LS 3
AVAR LS CLEANSER 3
avar-e green 1
AVAR-E LS 3
AVENOVA 3
avita 1
AZELEX 3
BENSAL HP 3
BENZACLIN 3
BENZACLIN WITH PUMP 3
BENZEFOAM 3
BENZEFOAM ULTRA 3
benzepro 1
benzepro creamy wash 1
benzepro foaming cloths 1
benzepro short contact 1
betamethasone dipropionat 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
21
betamethasone valerate 1
BIAFINE 3
bimatoprost 1
BIONECT 3
BOTOX COSMETIC 3 INJ SP
bp 10-1 1
bp foam 1
bp wash 1
BPO 2
calcipotriene 1
calcipotriene/betamethaso 1
calcitrene 1
CAPEX 3
celacyn 1
CERACADE 3
ceramax 1
ciclopirox 1
ciclopirox nail lacquer 1
ciclopirox olamine 1
claravis 1
CLINDACIN PAC 3
CLINDAGEL 3
clindamycin phosphate 1
CLINDAMYCIN PHOSPHATE/BEN 3
clindamycin phosphate/tre 1
clindamycin/benzoyl perox 1
clobetasol propionate 1
clobetasol propionate e 1
clobetasol propionate emo 1
CLOBEX 3
CLOCORTOLONE PIVALATE 3
CLOCORTOLONE PIVALATE PUM 3
clodan 1
CLODERM 3
CLODERM PUMP 3
clotrimazole/betamethason 1
COAL TAR 2
CONDYLOX 3
CORDRAN 3
CORTISPORIN 3
COSENTYX 2 INJ SP
COSENTYX SENSOREADY PEN 2 INJ SP
DENAVIR 3
DERMACINRX LEXITRAL PHARM 3
dermacinrx prizopak 1
DERMACINRX ZRM PAK 3
DERMA-SMOOTHE/FS SCALP 3
DERMASORB HC 3
DERMASORB XM 3
dermazene 1
DESONATE 3
desonide 1
desoximetasone 1
diclofenac sodium 1
DIFFERIN 3
diflorasone diacetate 1
doxepin hydrochloride 1
DOXYCYCLINE CAP 40MG 3
DRITHO-CREME HP 2
DRYSOL 3
DUAC 3
DUPIXENT 2 INJ SP
econazole nitrate 1
ECOZA 3
EFUDEX 3
ELETONE 2
ELETONE TWINPACK 2
ELIDEL 2
ELOCON 3
EMULSION SB 2
ENSTILAR 2
ENTTY SPRAY EMULSION 3
EPICERAM 3
EPIDUO 3
EPIDUO FORTE 2
EPIFOAM 3
ERTACZO 3 ST
ery 1
erythromycin 1
erythromycin/benzoyl pero 1
ethyl chloride/medium jet 1
ethyl chloride/medium str 1
EUCRISA 3
FABIOR 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
22
FINACEA 3
FLECTOR 2
fluocinolone acetonide 1
fluocinolone acetonide bo 1
fluocinolone acetonide sc 1
fluocinonide 1
fluocinonide emulsified 1
fluocinonide emulsified b 1
FLUOROPLEX 3
fluorouracil 1
flurandrenolide 1
GENADUR 3
halobetasol propionate 1
HALOG 3
HPR PLUS 2
HPR PLUS HYDROGEL KIT 2
HYCLODEX 3
hydrocortisone acetate & 1
hydrocortisone butyrate 1
hydrocortisone butyrate ( 1
hydrocortisone valerate 1
hydrocortisone/iodoquinol 1
hydroquinone 1
hydroquinone time release 1
HYLATOPIC PLUS 3
imiquimod 1
IMIQUIMOD PUMP 3
IMPOYZ 3
isotretinoin 1
JUBLIA 3 ST
KAMDOY 3
KERALAC 3
KERALYT 3
KERALYT SCALP 3
KERYDIN 3 ST
LATISSE 3
LEVICYN 3
levicyn dermal spray 1
LEVULAN KERASTICK 3
lidocaine 1
LIDOCAINE AND TETRACAINE 3
lidocaine hcl 1
lidocaine hcl jelly 1
lidocaine/prilocaine 1
lidocaine-prilocaine-crea 1
LIDODERM 3
lidopril 1
LIDORX 3
LIDOTRAL 3
lidozion 1
LOCOID 3
LOYON 3
LULICONAZOLE 3 ST
LUXAMEND 2
LUXIQ 3
LUZU 3 ST
malathion 1
MENTAX 3
methoxsalen 1
METROGEL 3
metronidazole 1
MICORT-HC 3
MIRVASO 2
mometasone furoate 1
mupirocin 1
myorisan 1
naftifine hcl 1
naftifine hydrochloride 1
NAFTIN 3 ST
NATROBA 3
NEO-SYNALAR 3
NEUAC KIT 3
NIVATOPIC PLUS 2
nolix 1
NORITATE 3
NUVAIL 3
nyamyc 1
nystatin/triamcinolone 1
nystatin/triamcinolone ac 1
nystop 1
OLUX-E 3
ONEXTON 2
ORACEA 2
OVACE PLUS 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
23
OVACE PLUS WASH 3
OVACE WASH 3
oxiconazole nitrate 1
OXISTAT 3 ST
PENLAC NAIL LACQUER 3
PENNSAID 3
permethrin 1
PICATO 2
PLEXION 3
PLEXION CLEANSER 3
PODOCON 25 IN BENZOIN TIN 3
podofilox 1
PRAMOSONE 3
prednicarbate 1
PROMISEB 3
PROPECIA 3
PROTOPIC 3
PRUMYX 2
PSORCON 3
QBREXZA 2
RECEDO 2
REGENECARE 3
REGRANEX 2
RENOVA 3
RETIN-A 3
RETIN-A MICRO 3
RETIN-A MICRO PUMP 3
RHOFADE 3
RIAX 3
rosadan 1
SALEX 3
SALEX CREAM 3
SALEX LOTION 3
salicylic acid 1
salicylic acid er 1
salicylic acid wart remov 1
SANTYL 2
selenium sulfide 1
selenium sulfide shampoo 1
SERNIVO 3
SILIQ 3 INJ SP
SIL-K PAD/LARGE 3
SILVADENE 3
SILVASORB 2
sodium sulfacetamide wash 1
SOD SUL/SULF EMU 10-5% 2
sod sul/sulf pad 10-4% 1
SOOLANTRA 2
SORILUX 3
SPINOSAD 2
ssd 1
SSS 10-5 2
STELARA INJ 45MG/0.5 2 INJ SP
sulfacetamid lot 10% 1
sulfacetamide sodium/sulf 1
sulfacleanse 8/4 1
SUMADAN WASH 3
SUMAXIN 3
SYNALAR 3
SYNERA 3
SYNERDERM 3
TACLONEX 2
tacrolimus 1
TALTZ 2 INJ SP
tazarotene 1
TAZORAC GEL 0.1% 2
TAZORAC CRE 0.1% 3
TEMOVATE 3
TETRIX 3
TEXACORT 3
TOLAK 3
TOPICORT 3
TREMFYA 2 INJ SP
tretinoin 1
tretinoin microsphere 1
tretinoin microsphere pum 1
triamcinolone acetonide 1
TRIANEX 2
triderm 1
TRIDESILON 3
TRI-LUMA 3
silver sulfadiazine 1
SKLICE 3
SKYRIZI 2 INJ SP
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
24
ULESFIA 3
ULTRAVATE 3
urea 1
urea nail 1
URE-K 3
UTOPIC 3
VANIQA 3
vanoxide-hc 1
VECTICAL 3
VELTIN 3
VENELEX 3
VERDESO 3
VEREGEN 3
VIRASAL 3
VOLTAREN 3
VUSION 3
VYTONE 3
XERAC AC 3
XERESE 3
XEROFORM OCCLUSIVE PETROL 2
XOLEGEL 3 ST
XRYLIX 3
ZIANA 3
ZITHRANOL 3
ZONALON 3
ZOVIRAX 2
ZTLIDO 2
ZYCLARA 3
ZYCLARA PUMP 3
DIAGNOSTIC PRODUCTS
THYROGEN 2 INJ SP
TUBERSOL 2 INJ
DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS
CEREFOLIN NAC 3
DEPLIN 15 3
DEPLIN 7.5 3
ELFOLATE TAB 15MG 3
ELFOLATE TAB 7.5MG 2
ENLYTE 3
ENTERAGAM 3
folbic 1
FOLBIC RF 3
FOLTANX 2
FOLTANX RF 3
FOLTX 3
FOSTEUM PLUS 3
LEVOMEFOLATE CALCIUM ALGA 3
LEVOMEFOLATE CALCIUM/N-AC 3
LEVOMEFOLATE CALCIUM/PYRI 3
LIMBREL 3
L-METHYL-B6-B12 2
L-METHYLFOLATE 2
L-METHYLFOLATE CA/S-ALGAL 3
L-METHYLFOLATE CALCIUM 2
L-METHYLFOLATE FORTE 3
L-METHYL-MC NAC 2
MEBOLIC 3
METAFOLBIC PLUS 2
METAFOLBIC PLUS RF 3
METANX 3
NICAPRIN 3
niva-fol 1
PODIAPN 3
RHEUMATE 3
VASCULERA 3
VAYARIN 3
VAYARIN PLUS 3
VISBIOME 3
XYZBAC 3
ZYVIT 3
DIGESTIVE AIDS
CREON 2
PANCREAZE 3
PERTZYE 3
SUCRAID 2 SP
VIOKACE 2
ZENPEP 2
DIURETICS
acetazolamide 1
acetazolamide er 1
ALDACTAZIDE 3
ALDACTONE 3
amiloride hcl 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
25
amiloride/hydrochlorothia 1
bumetanide 1
CAROSPIR 3
chlorothiazide 1
chlorthalidone 1
DIURIL 3
DYAZIDE 3
DYRENIUM 3
ethacrynic acid 1
furosemide 1
hydrochlorothiazide 1
indapamide 1
LASIX 3
MAXZIDE 3
methazolamide 1
methyclothiazide 1
metolazone 1
spironolactone 1
spironolactone/hydrochlor 1
torsemide 1
triamterene/hydrochloroth 1
ENDOCRINE AND METABOLIC AGENTS - MISC.
ALENDRONATE TAB 40MG 2
alendronate tab 35mg 1
BONIVA 3
cabergoline 1
calcitonin salmon 1
calcitonin-salmon 1
calcitriol 1
CARNITOR 3
CETROTIDE 2 INJ SP
chorionic gonadotropin 1 INJ SP
clomiphene citrate 1
DDAVP 2
desmopressin acetate 1
doxercalciferol 1 SP
EVISTA 3
FABRAZYME 2 INJ SP
FOLLISTIM AQ 3 INJ SP
FORTEO 2 INJ SP
FOSAMAX PLUS D 3 ST
GANIRELIX ACETATE 3 INJ SP
GENOTROPIN 2 INJ SP
GENOTROPIN MINIQUICK 2 INJ SP
GONAL-F 2 INJ SP
GONAL-F RFF REDIJECT 2 INJ SP
H.P. ACTHAR 3 INJ SP
HUMATROPE 2 INJ SP
ibandronate sodium 1
KUVAN 2 SP
levocarnitine 1
LUPANETA PACK 2 SP
LUPRON DEPOT-PED (1-MONTH 2 INJ SP
LUPRON DEPOT-PED (3-MONTH 2 INJ SP
MENOPUR 2 INJ SP
NATPARA 2 INJ SP
NOCTIVA 3
NORDITROPIN FLEXPRO 2 INJ SP
NOVAREL 2 INJ SP
NUTROPIN AQ NUSPIN 10 3 INJ SP
NUTROPIN AQ NUSPIN 20 3 INJ SP
octreotide acetate 1 INJ SP
OMNITROPE 3 INJ SP
ORILISSA 2
OSPHENA 3
OVIDREL 2 INJ SP
PALYNZIQ 2 INJ
paricalcitol 1 SP
PREGNYL W/DILUENT BENZYL 3 INJ SP
PROLIA 3 INJ SP
raloxifene hydrochloride 1
RAVICTI 2 SP
RAYALDEE 3
risedronate sodium 1
risedronate sodium dr 1
ROCALTROL 3
SANDOSTATIN LAR DEPOT 2 INJ SP
SENSIPAR 2 SP
SOMATULINE DEPOT 2 INJ SP
SOMAVERT 2 INJ SP
STIMATE 2 SP
SUPPRELIN LA 3 INJ SP
SYNAREL 2 SP
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
26
TYMLOS 2 INJ SP
XGEVA 2 INJ SP
zoledronic acid 1 INJ SP
ZOMACTON 3 INJ SP
Estrogens
ALORA 3
amabelz 1
ANGELIQ 3
CLIMARA 3
CLIMARA PRO 3
COMBIPATCH 2
DELESTROGEN 3 INJ
DEPO-ESTRADIOL 2 INJ
DIVIGEL 2
DUAVEE 2
eemt 1
eemt hs 1
esterified estrogens/meth 1
estradiol valerate 1 INJ
estradiol/norethindrone a 1
ESTROGEL 3
EVAMIST 3
fyavolv 1
jevantique lo 1
jinteli 1
lopreeza 1
MENEST 3
MENOSTAR 3
mimvey 1
MINIVELLE 3
PREMARIN 2
PREMPHASE 2
PREMPRO 2
VIVELLE-DOT 3
Fluoroquinolones
BAXDELA 3
CIPRO 3
ciprofloxacin er 1
ciprofloxacin hcl 1
ciprofloxacin hydrochlori 1
LEVAQUIN 3
levofloxacin 1
levofloxacin in d5w 1 INJ
moxifloxacin hcl 1
GASTROINTESTINAL AGENTS - MISC.
alosetron hydrochloride 1
AMITIZA 2
APRISO 3
ASACOL HD 3
AURYXIA 3
AZULFIDINE EN-TABS 3
balsalazide disodium 1
calcium acetate 1
CANASA 2
CIMZIA 3 INJ SP
CIMZIA STARTER KIT 3 INJ SP
DELZICOL 2
DIPENTUM 3
ENTYVIO 2 INJ SP
enulose 1
FOSRENOL 3
generlac 1
INFLECTRA 2 INJ SP
lanthanum carbonate 1
LIALDA 3
LINZESS 2
mesalamine 1
mesalamine dr 1
metoclopramide hcl 1
metoclopramide hydrochlor 1
METOCLOPRAMIDE ODT 2
MOVANTIK 2
OCALIVA 2 SP
PENTASA 2
RELISTOR 3 SP QL
REMICADE 2 INJ SP
RENAGEL 3
RENVELA 3
sevelamer carbonate 1
STELARA INJ 5MG/ML 3 INJ SP
sulfasalazine 1
SYMPROIC 2
TRULANCE 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
27
URSO 250 3
URSO FORTE 3
ursodiol 1
VELPHORO 2 SP
VIBERZI 2
XERMELO 2 SP
GENERAL ANESTHETICS
ketamine hcl 1 INJ
GENITOURINARY AGENTS - MISCELLANEOUS
acetic acid 0.25% 1
alfuzosin hcl er 1
AVODART 3 QL
CARDURA XL 3
dutasteride 1 QL
dutasteride/tamsulosin hc 1
dutasteride/tamsulosin hy 1
ELMIRON 2
finasteride 1
FLOMAX 3
JALYN 3
K-PHOS NO 2 3
ORACIT 3
phenazopyridine hcl 1
phenazopyridine hydrochlo 1
potassium citrate er 1
potassium citrate/citric 1
PROSCAR 3
PYRIDIUM 3
RAPAFLO 3
RIMSO-50 3 INJ
sodium chloride 0.9% 1
sodium chloride 0.9% 1
sodium citrate/citric aci 1
tamsulosin hcl 1
tamsulosin hydrochloride 1
THIOLA 3
tricitrates 1
UROCIT-K 10 3
Gout Agents
allopurinol 1
COLCHICINE CAP 0.6MG 3
COLCHICINE TAB 0.6MG 3
COLCRYS 2
KRYSTEXXA 2 INJ SP
MITIGARE 2
probenecid 1
probenecid/colchicine 1
ULORIC 2 ST
HEMATOLOGICAL AGENTS - MISC.
ADVATE 2 INJ SP
AGGRENOX 3
anagrelide hydrochloride 1
aspirin/dipyridamole 1
BENEFIX 2 INJ SP
BRILINTA 2
cilostazol 1
clopidogrel 1
dipyridamole 1
EFFIENT 3
ELOCTATE 3 INJ SP
FIRAZYR 2 INJ SP
IDELVION 3 INJ SP
pentoxifylline er 1
PLAVIX 3
prasugrel 1
RUCONEST 2 INJ SP
TAVALISSE 3 SP
YOSPRALA 3
ZONTIVITY 2
HEMATOPOIETIC AGENTS
ARANESP ALBUMIN FREE 2 INJ SP
CENTRATEX 2
CERDELGA 2 SP
chromagen 1
corvita 150 1
CORVITE FE 3
cyanocobalamin 1 INJ
DROXIA 2
EPOGEN 3 INJ SP
fabb 1
FERAHEME 2 INJ
FERIVA 21/7 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
28
ferocon 1
FERRALET 90 3
FERRAPLUS 90 2
folbee 1
folic acid/vitamin b-6/vi 1
FOLIVANE-F 2
FOLIVANE-PLUS 2
FULPHILA 2 INJ SP
FUSION PLUS 3
GRANIX 2 INJ SP
HEMATOGEN FA 2
hematogen forte 1
HEMOCYTE PLUS 3
hemocyte-f 1
hydroxocobalamin 1 INJ
iferex 150 forte 1
INTEGRA F 3
INTEGRA PLUS 3
IROSPAN 24/6 3
MULPLETA 2 SP
MULTIGEN 2
MULTIGEN PLUS 2
NASCOBAL 2
NEULASTA 2 INJ SP
NEULASTA ONPRO KIT 2 INJ SP
NEUPOGEN 2 INJ SP
NIFEREX 3
NOXIFOL-D 3
PHYSICIANS EZ USE B-12 CO 3 INJ
poly-iron 150 forte 1
PROCRIT 2 INJ SP
PROMACTA 2 SP
REVESTA 3
se-tan plus 1
tl gard rx 1
trigels-f forte 1
UDENYCA 2 INJ SP
VENOFER 2 INJ SP
virt-gard 1
VPRIV 3 INJ SP
ZARXIO 2 INJ SP
HEMOSTATICS
AMICAR 3
tranexamic acid 1
HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS
AMBIEN 3 QL
AMBIEN CR 3 QL
BELSOMRA 3 QL ST
DORAL 3
EDLUAR 3 QL ST
estazolam 1
eszopiclone 1 QL
flurazepam hcl 1
HALCION 3 QL
INTERMEZZO 3 QL
LUNESTA 3 QL
midazolam hcl 1
phenobarbital 1
ROZEREM 2 QL ST
SILENOR 3 ST
temazepam 1
triazolam 1 QL
zaleplon 1 QL
zolpidem tartrate 1 QL
zolpidem tartrate er 1 QL
LAXATIVES
CLENPIQ 2
COLYTE-FLAVOR PACKS 3
constulose 1
gavilyte-c 1
gavilyte-g 1
gavilyte-n/flavor pack 1
GOLYTELY 3
KRISTALOSE 3
lactulose 1
MOVIPREP 3
NULYTELY/FLAVOR PACKS 3
OSMOPREP 3
peg-3350/electrolytes 1
peg-3350/nacl/na bicarbon 1
PLENVU 3
polyethylene glycol 3350 1
PREPOPIK 2
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
29
SUPREP BOWEL PREP KIT 2
trilyte 1
LOCAL ANESTHETICS-Parenteral
bupivacaine hcl 1 INJ
MARCAINE 3 INJ
MARLIDO KIT 3 INJ
XYLOCAINE 3 INJ
XYLOCAINE-MPF 3 INJ
MACROLIDES
azithromycin sus 200/5ml 1
AZITHROMYCIN POW 1GM PAK 2
clarithromycin 1
clarithromycin er 1
DIFICID 3
e.e.s. 400 1
E.E.S. GRANULES 3
ERYPED 400 3
ERY-TAB 2
ERYTHROCIN STEARATE 2
erythromycin base 1
erythromycin ethylsuccina 1
ZITHROMAX 3
ZITHROMAX Z-PAK 3
MEDICAL DEVICES AND SUPPLIES
CAYA 3
FREESTYLE LIBRE/SENSOR/FL 2
FREESTYLE LIBRE/READER/FL 2
Migraine Products
AIMOVIG 2 INJ QL
AJOVY 2 INJ QL
almotriptan 1 QL
almotriptan malate 1 QL
CAMBIA 3 QL
dihydroergot inj 1mg/ml 1 INJ QL
DIHYDROERGOT SPR 4MG/ML 2 QL
eletriptan hydrobromide 1 QL
EMGALITY 2 INJ
ERGOMAR 3
ergotamine tartrate/caffe 1
FROVA 3 QL
frovatriptan succinate 1 QL
IMITREX 3 QL
IMITREX STATDOSE REFILL 3 INJ QL
IMITREX STATDOSE SYSTEM 3 INJ QL
MAXALT 3 QL
MAXALT-MLT 3 QL
naratriptan hcl 1 QL
ONZETRA XSAIL 3 QL ST
RELPAX 3 QL
rizatriptan benzoate 1 QL
rizatriptan benzoate odt 1 QL
sumatriptan 1 QL
sumatriptan succinate 1 INJ QL
sumatriptan succinate ref 1 INJ QL
sumatriptan/naproxen sodi 1 QL
TREXIMET 3 QL
ZEMBRACE SYMTOUCH 3 INJ QL ST
zolmitriptan 1 QL
zolmitriptan odt 1 QL
ZOMIG TAB 5MG 3 QL
ZOMIG SPR 5MG 2 QL
ZOMIG ZMT 3 QL
MINERALS AND ELECTROLYTES
bd posiflush 1 INJ
effer-k tab 25meq ef 1
EFFER-K TAB 20MEQ 3
effervescent pot chloride 1
FLUORABON 3
fluoride 1
FLURA-DROPS 3
GALZIN 3
iodine strong 1
k-effervescent 1
klor-con 1
klor-con 10 1
klor-con 8 1
klor-con m10 1
KLOR-CON M15 2
klor-con m20 1
klor-con sprinkle 1
klor-con/ef 1
K-PHOS 2
K-TAB TAB 8MEQ CR 2
K-TAB TAB 20MEQ 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
30
k-vescent 1
lactated ringers 1 INJ
ludent 1
monoject pharma grade flu 1 INJ
normal saline flush 1 INJ
normal saline flush for f 1 INJ
normal saline i.v. flush 1 INJ
phospha 250 neutral 1
phosphorous 1
phospho-trin 250 neutral 1
potassium chloride 1
potassium chloride cr 1
pot chloride tab 10meq er 1
POT CHLORIDE TAB 20MEQ ER 2
potassium chloride sr 1
saline flush 1 INJ
sodium chloride flush 1 INJ
sodium fluoride 1
virt-phos 250 neutral 1
Miscellaneous Therapeutic Classes
ASTAGRAF XL 3 SP
AZASAN 3 SP
azathioprine 1
BENLYSTA 2 INJ SP
CELLCEPT 3 SP
cyclosporine 1
cyclosporine cap 25mg mod 1
CYCLOSPORINE CAP 50MG MOD 2
ENVARSUS XR 3 SP
gengraf 1
HYLAFEM 3
HYLENEX 3 INJ
kionex 1
mycophenolate mofetil 1 SP
mycophenolic acid dr 1 SP
MYFORTIC 3 SP
NEORAL 3
PROGRAF CAP 3 SP
PROGRAF GRA 2 SP
PROSTIN VR PEDIATRIC 3 INJ
RAPAMUNE TAB 1MG 3 SP
RAPAMUNE SOL 1MG/ML 2 SP
REVLIMID 2 SP
SANDIMMUNE 2
sirolimus 1 SP
sodium polystyrene sulfon 1
sps 1
sterile water irrigation 1
SYPRINE 3
trientine hydrochloride 1
VELTASSA 2
XIAFLEX 2 INJ SP
ZORTRESS 2 SP
MOUTH/THROAT/DENTAL AGENTS
ARESTIN 3
CAPHOSOL 3
cevimeline hcl 1
chlorhexidine gluconate 1
clinpro 5000 1
clotrimazole 1
DEBACTEROL 3
denta 5000 plus 1
dentagel 1
FIRST-MOUTHWASH BLM 2
GELCLAIR 3
lidocaine viscous 1
MUGARD 3
NEUTRASAL 3
ORAMAGICRX 3
paroex 1
pilocarpine hcl 1
pilocarpine hydrochloride 1
PREVIDENT 5000 BOOSTER PL 3
PREVIDENT 5000 DRY MOUTH 3
PREVIDENT 5000 ENAMEL PRO 3
PREVIDENT 5000 PLUS 3
PREVIDENT 5000 SENSITIVE 3
PREVIDENT FLUORIDE 3
PREVIDENT RINSE 3
SALAGEN 3
SALIVAMAX 3
sf 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
31
sf 5000 plus 1
triamcinolone acetonide d 1
MULTIVITAMINS
CITRANATAL 90 DHA 3
CITRANATAL ASSURE 3
CITRANATAL B-CALM 3
CITRANATAL BLOOM 3
CITRANATAL DHA 3
CITRANATAL HARMONY 3
CITRANATAL RX 3
complete natal dha 1
completenate 1
CONCEPT DHA 3
CONCEPT OB 3
dialyvite 1
DIALYVITE/ZINC 2
elite-ob 1
ENBRACE HR 3
FLORIVA PLUS 3
folbee plus 1
FOLGARD OS 3
multi-vit/iron/fluoride 1
multivitamin with fluorid 1
multivit/fl dro 0.25mg 1
MULTIVIT/FL CHW 0.5MG 3
MULTIVIT/FL CHW 0.25MG 2
multi-vitamin/fluoride dr 1
multi-vitamin/fluoride/ir 1
NEEVO DHA 3
NEPHRO-VITE RX 2
NESTABS DHA 3
NESTABS ONE 3
NICADAN 3
NICOMIDE 3
NIVA-PLUS 3
OB COMPLETE ONE 3
OB COMPLETE PETITE 3
OB COMPLETE PREMIER 3
OB COMPLETE/DHA 3
PNV PRENATAL TAB PLUS 2
PRENATAL PLS MIS MV + DHA 3
PNV TABS 29-1 2
pnv-dha 1
PNV-DHA+DOCUSATE 2
POLY-VI-FLOR 3
PRENA 1 TRUE 2
PRENA1 PEARL 2
PRENAISSANCE 2
PRENATA 3
prenatabs rx 1
PRENATAL 2
PRENATAL 19 TAB 29-1MG 3
prenatal 19 chw tab 1
PRENATAL PLUS 2
PRENATAL PLUS IRON 2
PRENATAL VITAMINS PLUS LO 2
PRENATE 3
PRENATE DHA 3
PRENATE ELITE 3
PRENATE ENHANCE 3
PRENATE ESSENTIAL 3
PRENATE MINI 3
PRENATE PIXIE 3
PRENATE RESTORE 3
PREPLUS 2
PRIMACARE 3
PROVIDA DHA 3
PROVIDA OB 3
renal caps 1
reno caps 1
SELECT-OB+DHA 3
se-natal 19 1
TARON-C DHA 2
THRIVITE RX 3
TL G-FOL OS 2
TRICARE PRENATAL DHA ONE/ 3
trinatal rx 1 1
triphrocaps 1
TRISTART DHA 3
tri-vitamin/fluoride 1
ultimatecare one 1
v-c forte 1
VINATE M 2
vinate one 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
32
VIRT-C DHA 2
virt-caps 1
VIRT-PN 2
VIRT-PN DHA 2
VITAFOL 3
VITAFOL FE+ 3
VITAFOL GUMMIES 3
VITAFOL ULTRA 3
VITAFOL-NANO 3
VITAFOL-OB 3
VITAFOL-OB+DHA 3
VITAFOL-ONE 3
VITAMEDMD ONE RX/QUATREFO 3
VITAMEDMD REDICHEW RX 3
vitamins a/c/d/fluoride 1
VITAPEARL 3
VITATRUE 3
VOL-PLUS 2
VOL-TAB RX 2
VP-PNV-DHA 3
ZATEAN-PN DHA 2
ZATEAN-PN PLUS 2
MUSCULOSKELETAL THERAPY AGENTS
AMRIX 3 QL
baclofen tab 20mg 1
BACLOFEN TAB 5MG 3
carisoprodol 1
chlorzoxazon tab 500mg 1
CHLORZOXAZON TAB 250MG 2
cyclobenzaprine hcl 1
cyclobenzaprine hydrochlo 1
dantrolene sodium 1
EUFLEXXA 2 INJ SP
FIRST-BACLOFEN 5 2
GABLOFEN 2 INJ
GEL-ONE 3 INJ SP
HYALGAN 3 INJ SP
HYMOVIS 3 INJ SP
LORZONE 3
METAXALONE TAB 400MG 2
metaxalone tab 800mg 1
methocarbamol 1
MONOVISC 2 INJ SP
orphenadrine citrate er 1
ORTHOVISC 2 INJ SP
ROBAXIN-750 3
SOMA 3
SUPARTZ FX 3 INJ SP
SYNVISC 3 INJ SP
SYNVISC ONE 3 INJ SP
tizanidine hcl 1
tizanidine hydrochloride 1
NASAL AGENTS - SYSTEMIC AND TOPICAL
ADRENALIN SOL 1:1000 3
ASTEPRO 3
azelastine hcl 1
azelastine hydrochloride 1
BECONASE AQ 3 ST
DYMISTA 2 ST
FLONASE 3
flunisolide 1
fluticasone propionate 1
ipratropium bromide 1
NASONEX 3
PATANASE 3 ST
QNASL 2 ST
QNASL CHILDRENS 2 ST
SINUVA 3 SP
XHANCE 3
ZETONNA 3 ST
NEUROMUSCULAR AGENTS
BOTOX 2 INJ SP
DYSPORT 3 INJ SP
MYOBLOC 2 INJ SP
riluzole 1 SP
SPINRAZA 2 INJ SP
NUTRIENTS
dextrose 20% 1 INJ
dextrose 5% 1 INJ
intralipid 1 INJ
OPHTHALMIC AGENTS
ACULAR 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
33
ACULAR LS 3
ACUVAIL 3
ALOCRIL 3
ALPHAGAN P SOL 0.15% 3
ALPHAGAN P SOL 0.1% 2
ALREX 2
apraclonidine 1
atropine sulfate 1
AZASITE 2
AZOPT 3
BACITRACIN 2
bacitracin/polymyxin b 1
BEPREVE 2
BESIVANCE 3
BETIMOL 3
BETOPTIC-S 3
BLEPHAMIDE 3
BLEPHAMIDE S.O.P. 3
brimonidine tartrate 1
bromfenac 1
BROMSITE 3
carteolol hcl 1
CILOXAN 3
COMBIGAN 2
COSOPT 3
COSOPT PF 3
CYCLOMYDRIL 3
cyclopentolate hcl 1
cyclopentolate hydrochlor 1
dorzolamide hcl 1
dorzolamide hcl/timolol m 1
dorzolamide hydrochloride 1
DUREZOL 3
epinastine hcl 1
EYLEA 2 SP
fluorometholone 1
flurbiprofen sodium 1
FML 3
FML FORTE 3
FML LIQUIFILM 3
gatifloxacin 1
GENTAK 2
homatropine hbr 1
ILEVRO 2
INVELTYS 2
IOPIDINE 3
ISTALOL 3
LACRISERT 3
LASTACAFT 3
latanoprost 1
levobunolol hcl 1
LOTEMAX 2
LUMIGAN 2
MAXIDEX 3
MOXEZA 2
moxifloxacin hydrochlorid 1
NATACYN 2
neomycin/bacitracin/polym 1
neomycin/polymyxin/bacitr 1
neomycin/polymyxin/dexame 1
neomycin/polymyxin/gramic 1
neo-polycin 1
neo-polycin hc 1
NEOSPORIN 3
NEVANAC 2
OCUFLOX 3
ofloxacin 1
olopatadine hcl 1
olopatadine hydrochloride 1
OXERVATE 2 SP
OZURDEX 2 SP
PATADAY 3
PATANOL 3
PAZEO 2
PHOSPHOLINE IODIDE 2
polycin 1
polymyxin b sulfate/trime 1
POLYTRIM 3
PRED FORTE 3
PRED MILD 3
PRED-G S.O.P. 3
prednisolone acetate 1
PROLENSA 2
proparacaine hcl 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
34
RESTASIS 2
RESTASIS MULTIDOSE 2
RHOPRESSA 2
SIMBRINZA 3
sodium sulfacetamide 1
SULFACET SOD OIN 10% OP 2
sulfacetamide sodium/pred 1
tetracaine hcl 1
tetracaine hydrochloride 1
TIMOLOL GEL SOL 0.5% OP 3
timolol gel sol 0.25% op 1
TIMOPTIC 3
TIMOPTIC OCUDOSE 3
TOBRADEX SUS 0.3-0.1% 3
TOBRADEX OIN 0.3-0.1% 2
TOBRADEX ST 2
tobramycin sulfate 1
tobramycin/dexamethasone 1
TOBREX 3
TRAVATAN Z 2
trifluridine 1
trimethoprim sulfate/poly 1
tropicamide 1
TRUSOPT 3
VIGAMOX 3
VYZULTA 3
XALATAN 3
XIIDRA 2
ZIOPTAN 3
ZIRGAN 3
ZYLET 2
ZYMAXID 3
OTIC AGENTS
acetic acid 1
CIPRO HC 3
CIPRODEX 2
CIPROFLOXACIN 2
COLY-MYCIN S 3
hydrocortisone/acetic aci 1
neomycin/polymyxin/hc 1
neomycin/polymyxin/hydroc 1
OTOVEL 2
Oxytocics
methergine 1
methylergonovine maleate 1
PASSIVE IMMUNIZING AND TREATMENT AGENTS
FLEBOGAMMA DIF 3 INJ SP
HIZENTRA 2 INJ SP
HYPERRHO S/D 2 INJ SP
RHOGAM ULTRA-FILTERED PLU 3 INJ SP
SYNAGIS 2 INJ SP
PENICILLINS
amoxicillin 1
amoxicillin/clavulanate p 1
ampicillin 1
AUGMENTIN 2
BICILLIN L-A 2 INJ
dicloxacillin sodium 1
MOXATAG 3
penicillin v potassium 1
piperacillin/tazobactam 1 INJ
Progestins
hydroxyprogesterone capro 1 INJ SP
MAKENA INJ 250MG/ML 3 INJ SP
MAKENA INJ 275MG 3 INJ SP
norethindrone acetate 1
progesterone 1
PROMETRIUM 3
PROVERA 3
Psychotherapeutic and Neurological Agents - Misc.
acamprosate calcium dr 1
ADDYI 3 SP
AMPYRA 3 SP
AUBAGIO 3 SP
AUSTEDO 2 SP
AVONEX 2 INJ SP
AVONEX PEN 2 INJ SP
BETASERON 2 INJ SP
BRISDELLE 3
CHANTIX 2 QL
CHANTIX CONTINUING MONTH 2 QL
CHANTIX STARTING MONTH PA 2 QL
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
35
chlordiazepoxide/amitript 1
COPAXONE INJ 40MG/ML 2 INJ SP
COPAXONE INJ 20MG/ML 3 INJ SP
dalfampridine er 1 SP
disulfiram 1
donepezil hcl 1
donepezil hydrochloride 1
EXTAVIA 2 INJ SP
fluoxetine 1
galantamine hydrobromide 1
GILENYA 2 SP
glatiramer acetate 1 INJ SP
glatopa 1 INJ SP
GRALISE 2
GRALISE STARTER 2
HORIZANT 3
INGREZZA 3 SP
LYRICA CR 3
MAYZENT 2 SP
memantine hcl 1
memantine hcl titration p 1
memantine hydrochloride 1
memantine hydrochloride e 1
NAMENDA 3
NAMENDA XR 3
NAMZARIC 2
NICOTROL INHALER 3
NICOTROL NS 3
NUEDEXTA 2
OCREVUS 2 INJ SP
olanzapine/fluoxetine 1
ORAP 3
paroxetine 1
perphenazine/amitriptylin 1
pimozide 1
PLEGRIDY 2 INJ SP
REBIF 2 INJ SP
REBIF REBIDOSE 2 INJ SP
REBIF REBIDOSE TITRATION 2 INJ SP
rivastigmine tartrate 1
rivastigmine transdermal 1
SAVELLA 2
SAVELLA TITRATION PACK 2
TECFIDERA 2 SP
TECFIDERA STARTER PACK 2 SP
tetrabenazine 1 SP
TYSABRI 2 INJ SP
XENAZINE 3 SP
XYREM 2 SP
Respiratory Agents - Misc.
ESBRIET 2 SP
GLASSIA 2 INJ SP
OFEV 2 SP
ORKAMBI 2 SP
PROLASTIN-C 2 INJ SP
PULMOZYME 2 SP
SYMDEKO 2 SP
Tetracyclines
ACTICLATE 3
demeclocycline hcl 1
DORYX MPC 3
doxycycline sus 25mg/5ml 1
doxycycline hyclate 1
doxycycline hyclate dr 1
doxycycline monohydrate 1
minocycline hcl 1
minocycline hcl er 1
minocycline hydrochloride 1
okebo 1
SOLODYN 2
TARGADOX 3
tetracycline hydrochlorid 1
VIBRAMYCIN 3
XIMINO 3
THYROID AGENTS
ARMOUR THYROID 2
CYTOMEL 3
levothyroxine sodium 1
levothyroxine/liothyronin 1
levoxyl 1
liothyronine sodium 1
methimazole 1
NATURE-THROID 2
NATURE-THROID NT-2.5 2
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
36
np thyroid 120 1
np thyroid 15 1
np thyroid 30 1
np thyroid 60 1
np thyroid 90 1
propylthiouracil 1
SYNTHROID 3
TIROSINT 3
unithroid 1
WESTHROID 2
WP THYROID 3
Toxoids
ADACEL 2 INJ
BOOSTRIX 2 INJ
INFANRIX 2 INJ
TENIVAC 3 INJ
TETANUS/DIPHTHERIA TOXOID 2 INJ
ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS
ACIPHEX 3 QL
belladonna & opium 1
belladonna alkaloids & op 1
CARAFATE 2
chlordiazepoxide hcl/clid 1
cimetidine 1
cimetidine hcl 1
CUVPOSA 3
CYTOTEC 3
DEXILANT 3 QL ST
dicyclomine hcl 1
dicyclomine hydrochloride 1
DONNATAL 3
esomeprazole magnesium 1 QL
esomeprazole magnesium dr 1 QL
ESOMEPRAZOLE STRONTIUM 3
famotidine 1
FIRST-LANSOPRAZOLE 2 QL
FIRST-OMEPRAZOLE 2 QL
glycopyrrolate 1
hyoscyamine sulfate 1
hyoscyamine sulfate er 1
hyoscyamine sulfate odt 1
hyoscyamine sulfate sr 1
hyosyne 1
lansoprazole 1 QL
lansoprazole/amoxicillin/ 1
LEVSIN 3
LEVSIN/SL 3
methscopolamine bromide 1
misoprostol 1
NEXIUM GRA 10MG DR 2 QL
NEXIUM CAP 40MG 3 QL
nizatidine cap 150mg 1
NIZATIDINE SOL 15MG/ML 2
OMECLAMOX-PAK 3
omeprazole 1 QL
omeprazole dr 1 QL
omeprazole/sodium bicarbo 1
oscimin 1
oscimin sr 1
pantoprazole sodium 1 QL
pantoprazole sodium dr 1 QL
phenohytro 1
PREVACID 3 QL
PREVACID SOLUTAB 3 QL
PRILOSEC 3 QL
propantheline bromide 1
PROTONIX 3 QL
PYLERA 2
rabeprazole sodium 1 QL
ranitidine hcl 1
ranitidine hydrochloride 1
sucralfate tab 1gm 1
SUCRALFATE SUS 1GM/10ML 2
SYMAX DUOTAB 3
ZEGERID 3
Urinary Anti-infectives
HYOPHEN 2
MACROBID 3
MACRODANTIN 3
me/naphos/mb/hyo 1 1
methenamine hippurate 1
methenamine mandelate 1
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
37
MONUROL 3
nitrofurantoin 1
nitrofurantoin macrocryst 1
nitrofurantoin monohydrat 1
phosphasal 1
urelle 1
uribel 1
URIMAR-T 2
uro-458 1
UROGESIC-BLUE 2
uro-mp 1
ustell 1
vilamit mb 1
Urinary Antispasmodics
bethanechol chloride 1
darifenacin hydrobromide 1 QL
DETROL 3 QL
DETROL LA 3 QL
flavoxate hcl 1
GELNIQUE 2
MYRBETRIQ 2
oxybutynin chloride 1
oxybutynin chloride er 1 QL
tolterodine tartrate 1 QL
tolterodine tartrate er 1 QL
TOVIAZ 2 QL
trospium chloride 1 QL
trospium chloride er 1 QL
VESICARE 2 QL
VACCINES
AFLURIA 2018-2019 2 INJ
AFLURIA PF 2018-2019 2 INJ
AFLURIA QUADRIVALENT 2018 2 INJ
BEXSERO 2 INJ
ENGERIX-B 2 INJ
FLUAD 2018-2019 2 INJ
FLUARIX QUADRIVALENT 2018 2 INJ
FLUBLOK QUADRIVALENT 2018 2 INJ
FLUCELVAX QUADRIVALENT 20 2 INJ
FLULAVAL QUADRIVALENT 201 2 INJ
FLUMIST QUADRIVALENT 2
FLUZONE HIGH-DOSE PF 2018 2 INJ
FLUZONE QUADRIVALENT 2018 2 INJ
GARDASIL 9 2 INJ
HAVRIX 2 INJ
IMOVAX RABIES (H.D.C.V.) 2 INJ
IPOL INACTIVATED IPV 2 INJ
IXIARO 2 INJ
MENACTRA 2 INJ
MENVEO 3 INJ
M-M-R II 2 INJ
PNEUMOVAX 23 2 INJ
PNEUMOVAX 23/1 DOSE 2 INJ
PREVNAR 13 2 INJ
RABAVERT 2 INJ
RECOMBIVAX HB 2 INJ
SHINGRIX 2 INJ
STAMARIL 2 INJ
TRUMENBA 2 INJ
TWINRIX 2 INJ
TYPHIM VI 2 INJ
VAQTA 3 INJ
VARIVAX 2 INJ
VAXCHORA 2
VIVOTIF 2
YF-VAX 2 INJ
ZOSTAVAX 3 INJ
VAGINAL PRODUCTS
AVC 3
CLEOCIN 3
CLINDESSE 3
CRINONE 2
ENDOMETRIN 3
ESTRACE 3
estradiol 1
ESTRING 2
FEM PH 2
FEMRING 3
FIRST-PROGESTERONE VGS 10 3
FIRST-PROGESTERONE VGS 20 3
GYNAZOLE-1 3
IMVEXXY MAINTENANCE PACK 3
IMVEXXY STARTER PACK 3
INTRAROSA 3
Drug Name Drug Tier Limits Drug Name Drug Tier Limits
Bold Upper Case = Brand-name drug QL Quantity Limits SP Specialty Program
Lower Case = generic drug INJ Injectable ST Step Therapy
38
metronidazole vaginal 1
MICONAZOLE 3 2
NUVESSA 3
terconazole 1
VAGIFEM 3
vandazole 1
yuvafem 1
Vasopressors
ADRENALIN INJ 30/30ML 2 INJ
AUVI-Q 3 INJ SP
EPIPEN 2-PAK 2 INJ
EPIPEN-JR 2-PAK 2 INJ
midodrine hcl 1
midodrine hydrochloride 1
NORTHERA 3 SP
SYMJEPI 2 INJ
VITAMINS
ergocalciferol 1
MEPHYTON 3
phytonadione 1
vitamin k1 1 INJ
39
abacavir ______________ 15
abacavir/lamivudine ___ 15
ABELCET ______________ 11
ABILIFY _______________ 15
ABILIFY MAINTENA ____ 15
ABSORICA ____________ 20
ABSTRAL _______________ 4
acamprosate calcium dr 34
ACANYA ______________ 20
acarbose _______________ 9
ACCUPRIL _____________ 12
acebutolol hcl _________ 16
acebutolol hydrochloride
___________________ 16
acetaminophen/caffeine/di
____________________ 4
acetaminophen/codeine_ 4
acetaminophen/codeine
#3 __________________ 4
acetaminophen/codeine
pho_________________ 4
acetazolamide _________ 24
acetazolamide er ______ 24
acetic acid ________ 27, 34
acetic acid 0.25% ______ 27
acetylcysteine _________ 20
ACIPHEX ______________ 36
acitretin ______________ 20
ACTEMRA ______________ 3
ACTICLATE ____________ 35
ACTOPLUS MET XR _____ 9
ACUICYN DAILY EYELID &
EY _________________ 20
ACULAR __________ 32, 33
ACULAR LS ____________ 33
ACUVAIL ______________ 33
acyclovir ______________ 15
ACZONE ______________ 20
ADACEL_______________ 36
adapalene ____________ 20
adapalene pump_______ 20
adapalene/benzoyl peroxid
___________________ 20
ADCIRCA______________ 17
ADDERALL _____________ 3
ADDERALL XR __________ 3
ADDYI ________________ 34
ADEMPAS_____________ 17
ADHD/ANTI-
NARCOLEPSY/ANTI-
OBESITY/ANOREXIANTS
____________________ 3
ADIPEX-P ______________ 3
ADLYXIN _______________ 9
ADLYXIN STARTER PACK 9
ADMELOG _____________ 9
ADMELOG SOL OSTA R ___ 9
ADRENALIN INJ 30/30ML
___________________ 38
ADRENALIN SOL 1
1000 ______________ 32
ADVAIR DISKUS ________ 6
ADVAIR HFA ___________ 6
ADVATE ______________ 27
ADZENYS ER ___________ 3
ADZENYS XR-ODT ______ 3
AFINITOR _____________ 13
AFLURIA 2018-2019 ___ 37
AFLURIA PF 2018-2019_ 37
AFLURIA QUADRIVALENT
2018 ______________ 37
AFREZZA_______________ 9
AGGRENOX ___________ 27
AIMOVIG _____________ 29
AIRDUO RESPICLICK
113/14 _____________ 6
AIRDUO RESPICLICK
232/14 _____________ 6
AIRDUO RESPICLICK 55/14
____________________ 6
AJOVY________________ 29
AKTIPAK ______________ 20
AKYNZEO _____________ 11
ALA SCALP ____________ 20
ALA-QUIN ____________ 20
albendazole ____________ 6
ALBENZA ______________ 6
albuterol sulfate ________ 6
albuterol sulfate er _____ 6
alclometasone dipropionat
___________________ 20
ALCORTIN A __________ 20
ALDACTAZIDE _________ 24
ALDACTONE __________ 24
ALDARA ______________ 20
ALECENSA ____________ 13
alendronate tab 35mg _ 25
ALENDRONATE TAB 40MG
___________________ 25
ALEVICYN ANTIPRURITIC
SG_________________ 20
alfuzosin hcl er ________ 27
ALINIA _______________ 13
ALLERGENIC
EXTRACTS/BIOLOGICAL
S MISC ______________ 3
allopurinol ____________ 27
almotriptan ___________ 29
almotriptan malate ____ 29
ALOCRIL ______________ 33
ALOGLIPTIN____________ 9
ALOGLIPTIN/METFORMIN
HCL ________________ 9
ALOGLIPTIN/PIOGLITAZON
E ___________________ 9
ALORA _______________ 26
alosetron hydrochloride 26
ALPHAGAN P SOL 0.1% 33
ALPHAGAN P SOL 0.15%
___________________ 33
alprazolam ____________ 6
alprazolam er __________ 6
alprazolam odt _________ 6
alprazolam xr __________ 6
ALREX________________ 33
ALTABAX _____________ 20
altavera ______________ 17
ALUNBRIG ____________ 13
ALVESCO ______________ 6
alyacen 1/35 __________ 17
alyacen 7/7/7 _________ 17
amabelz ______________ 26
amantadine hcl _______ 14
AMARYL_______________ 9
AMBIEN ______________ 28
AMBIEN CR ___________ 28
amcinonide ___________ 20
Amebicides ____________ 3
amethia ______________ 17
amethia lo ____________ 17
amethyst _____________ 17
AMICAR ______________ 28
amiloride hcl __________ 24
amiloride/hydrochlorothia
___________________ 25
Aminoglycosides _______ 3
amiodarone hcl ________ 6
amiodarone hydrochloride
____________________ 6
AMITIZA______________ 26
amitriptyline hcl ________ 8
amitriptyline hydrochlori 8
amlodipine besylate 12, 16,
17
amlodipine besylate/atorv
___________________ 17
amlodipine besylate/benaz
___________________ 12
amlodipine besylate/valsa
___________________ 12
amlodipine/olmesartan
med _______________ 12
amlodipine/valsartan/hctz
___________________ 12
amnesteem ___________ 20
amoxicillin _________ 34, 36
amoxicillin/clavulanate p34
amphetamine sulfate ___ 3
amphetamine/dextroamph
eta _________________ 3
amphotericin b________ 11
ampicillin _____________ 34
AMPYRA _____________ 34
AMRIX _______________ 32
anagrelide hydrochloride
___________________ 27
ANALGESICS - ANTI-
INFLAMMATORY _____3
ANALGESICS - NonNarcotic
_____________________4
ANALGESICS - OPIOID ___4
ANALPRAM HC _________5
ANALPRAM HC SINGLES _5
ANALPRAM-HC _________5
anastrozole ___________ 13
ANDRODERM ___________5
ANDROGEL GEL
1%(50MG) ___________5
ANDROGEL GEL 1.62% _5
ANDROGEL PUMP_______5
ANDROGENS-ANABOLIC _5
ANGELIQ _____________ 26
ANORECTAL AGENTS ____5
ANORO ELLIPTA ________6
ANTARA _____________ 11
Anthelmintics __________6
ANTIANGINAL AGENTS __6
ANTIANXIETY AGENTS ___6
ANTIARRHY THMICS _____6
ANTIASTHMATIC AND
BRONCHODILATOR
AGENTS _____________6
ANTICOAGULANTS ______7
ANTICONVULSANTS _____7
ANTIDEPRESSANTS______8
ANTIDIABETICS _________9
ANTIDIARRHEAL/PROBIOT
IC AGENTS _________ 10
Antidotes and Specific
Antagonists________ 10
ANTIEM ETICS _________ 11
Antifungals ___________ 11
ANTIHISTAMINES _____ 11
ANTIHYPERLIPIDEMICS 11
ANTIHYPERTENSIVES __ 12
Anti-infective Agents -
Misc.______________ 13
Antimalarials _________ 13
Antimyasthenic/Cholinergi
c Agents ___________ 13
Antimycobacterial Agents
___________________ 13
ANTINEOPLASTICS AND
ADJUNCTIVE
THERAPIES ________ 13
ANTIPARKINSON AND
RELATED THERAPY
AGENTS ___________ 14
ANTIPSYCHOTICS/ANTIMA
NIC AGENTS _______ 15
40
Antiseptics & Disinfectants
___________________ 15
ANTIVIRALS ___________ 15
anucort-hc _____________ 5
anusol-hc ______________ 5
APIDRA ________________ 9
APIDRA SOLOSTAR _____ 9
APLENZIN ______________ 8
APOKYN ______________ 14
apraclonidine__________ 33
aprepitant ____________ 11
apri __________________ 17
APRISO _______________ 26
APTENSIO XR___________ 3
APTIOM _______________ 7
aranelle_______________ 17
ARANESP ALBUMIN FREE
___________________ 27
ARCAPTA NEOHAL ER ___ 6
ARESTIN ______________ 30
aripiprazole ___________ 15
aripiprazole odt________ 15
ARISTADA ____________ 15
armodafinil ____________ 3
ARMOUR THY ROID ____ 35
ARNUITY ELLIPTA _______ 6
AROMASIN ___________ 13
ARTHROTEC 75 _________ 3
ARYMO ER _____________ 4
ARZOL SILVER NITRATE
APP _______________ 20
ASACOL HD ___________ 26
ascomp/codeine ________ 4
ashlyna _______________ 17
ASMANEX HFA _________ 6
ASMANEX TWISTHALER
120 ME _____________ 6
ASMANEX TWISTHALER 14
MET ________________ 6
ASMANEX TWISTHALER 30
MET ________________ 6
ASMANEX TWISTHALER 60
MET ________________ 7
aspirin/dipyridamole ___ 27
ASTAGRAF XL _________ 30
ASTEPRO _____________ 32
ASTERO_______________ 20
atazanavir_____________ 15
atazanavir sulfate ______ 15
atenolol __________ 12, 16
atenolol/chlorthalidone 12
ATIVAN ________________ 6
atomoxetine ___________ 3
atomoxetine hydrochloride
____________________ 3
atorvastatin calcium ___ 11
atovaquone ___________ 13
atovaquone/proguanil hcl
___________________ 13
ATRIPLA ______________ 15
atropine sulfate _______ 33
ATROVENT HFA ________ 7
AUBAGIO _____________ 34
aubra ________________ 17
aubra eq______________ 17
augmented
betamethasone d ___ 20
AUGMENTIN __________ 34
AURYXIA _____________ 26
AUSTEDO _____________ 34
AUVI-Q _______________ 38
AVANDIA ______________ 9
AVAPRO ______________ 12
avar cleanser __________ 20
AVAR LS ______________ 20
AVAR LS CLEANSER ____ 20
avar-e green __________ 20
AVAR-E LS ____________ 20
AVASTIN _____________ 13
AVC __________________ 37
AVEED ________________ 5
AVENOVA ____________ 20
aviane ________________ 17
avita _________________ 20
AVODART ____________ 27
AVONEX ______________ 34
AVONEX PEN _________ 34
azacitidine ____________ 13
AZASAN ______________ 30
AZASITE ______________ 33
azathioprine __________ 30
azelastine hcl__________ 32
azelastine hydrochloride 32
AZELEX _______________ 20
AZILECT ______________ 14
AZITHROMYCIN POW 1GM
PAK _______________ 29
azithromycin sus 200/5ml
___________________ 29
AZOPT________________ 33
AZOR_________________ 12
AZULFIDINE EN-TABS __ 26
azurette ______________ 17
BACITRACIN __________ 33
bacitracin/polymyxin b _ 33
baclofen tab 20mg___ 32
BACLOFEN TAB 5MG_ 32
BALCOLTRA ___________ 17
balsalazide disodium ___ 26
BALVERSA ____________ 13
balziva________________ 17
BANZEL ________________ 7
BARACLUDE __________ 15
BASAGLAR KWIKPEN ___ 9
BAXDELA _____________ 26
bd posiflush ___________ 29
BECONASE AQ ________ 32
bekyree ______________ 17
BELBUCA ______________ 4
belladonna & opium ___ 36
belladonna alkaloids & op
___________________ 36
BELSOM RA ___________ 28
BELVIQ ________________ 3
BELVIQ XR _____________ 3
benazepril hcl _________ 12
benazepril hcl/hydrochlor
___________________ 12
BENEFIX ______________ 27
BENICAR _____________ 12
BENICAR HCT _________ 12
BENLYSTA ____________ 30
BENSAL HP ___________ 20
BENZACLIN ___________ 20
BENZACLIN WITH PUMP 20
BENZEFOAM __________ 20
BENZEFOAM UL TRA ___ 20
benzepro _____________ 20
benzepro creamy wash 20
benzepro foaming cloths20
benzepro short contact 20
benzonatate __________ 20
benztropine mesylate __ 14
BEPREVE _____________ 33
BESIVANCE ___________ 33
BETA BLOCKERS_______ 16
betamethasone
dipropionat ________ 20
betamethasone sodium
phos ______________ 19
betamethasone valerate 21
BETAPACE ____________ 16
BETASERON __________ 34
betaxolol hcl __________ 16
bethanechol chloride __ 37
BETIM OL _____________ 33
BETOPTIC-S ___________ 33
BEVESPI AEROSPHERE __ 7
BEXSERO _____________ 37
BEYAZ________________ 17
BIAFINE ______________ 21
bicalutamide __________ 13
BICILLIN L-A __________ 34
BIDIL _________________ 17
BIKTARVY ____________ 15
BILTRICIDE_____________ 6
bimatoprost __________ 21
BIONECT _____________ 21
bisoprolol fumarate 12, 16
bisoprolol fumarate/hydro
___________________ 12
BLEPHAMIDE _________ 33
BLEPHAMIDE S.O.P. ___ 33
blisovi 24 fe___________ 17
blisovi fe 1.5/30 _______ 17
blisovi fe 1/20_________ 17
BONIVA ______________ 25
BONJ ESTA ____________ 11
BOOSTRIX ____________ 36
BOSULIF ______________ 13
BOTOX ____________ 21, 32
BOTOX COSMETIC ____ 21
bp 10-1 ______________ 21
bp foam ______________ 21
bp wash ______________ 21
BPO _________________ 21
BRAFTOVI ____________ 13
BREO ELLIPTA __________7
briellyn_______________ 17
BRILINTA _____________ 27
brimonidine tartrate___ 33
BRISDELLE____________ 34
BRIVIACT_______________7
bromfed dm __________ 20
bromfenac ___________ 33
bromocriptine mesylate 14
bromphen/pseudoephedri
ne ________________ 20
BROMSITE____________ 33
BROVANA ______________7
budesonide_________ 7, 19
budesonide er ________ 19
bumetanide __________ 25
BUNAVAIL______________4
bupap__________________4
bupivacaine hcl _______ 29
BUPIVILOG KIT________ 19
BUPRENORPHINE _______4
buprenorphine hcl ______4
buprenorphine hcl/naloxon
_____________________4
buprenorphine hydrochlori
_____________________4
bupropion hcl___________8
bupropion hcl er ________8
bupropion hcl sr ________8
bupropion hcl xl_________8
bupropion hydrochloride_8
bupropion hydrochloride e
_____________________8
bupropion hydrochloride s
_____________________8
bupropion hydrochloride x
_____________________8
buspirone hcl ___________6
buspirone hydrochloride _6
BUT/ASA/CAF TA B _____4
but/asa/caf/ cap cod 30mg
_____________________4
butalbital/acetaminophen4
butalbital/acetaminophen/
_____________________4
butorphanol tartrate ____4
BUTRANS ______________4
BYDUREON _____________9
BYDUREON BCISE _______9
BYDUREON PEN ________9
BYETTA ________________9
BYSTOLIC_____________ 16
BYVALSON ___________ 12
41
cabergoline ___________ 25
CABOMETYX __________ 13
CADUET ______________ 17
caffeine citrate _________ 3
calcipotriene __________ 21
calcipotriene/betamethaso
___________________ 21
calcitonin salmon ______ 25
calcitonin-salmon ______ 25
calcitrene _____________ 21
calcitriol ______________ 25
calcium acetate________ 26
Calcium Channel Blockers
___________________ 16
CAMBIA ______________ 29
camila ________________ 17
camrese ______________ 17
camrese lo ____________ 17
CANASA ______________ 26
candesartan cilexetil ___ 12
candesartan cilexetil/hyd
___________________ 12
capecitabine __________ 13
CAPEX ________________ 21
CAPHOSOL ____________ 30
CAPRELSA_____________ 13
captopril ______________ 12
captopril/hydrochlorothia
___________________ 12
CARAFATE ____________ 36
CARB/LEVO 75 TAB
/ENTACAP _________ 14
carb/levo100 tab /entacap
___________________ 14
carbamazepine _________ 7
carbamazepine er_______ 7
CARBATROL ____________ 7
carbidopa _____________ 14
carbidopa/levodopa____ 14
carbidopa/levodopa er _ 14
carbidopa/levodopa odt 14
carbinoxamine maleate 11
CARDIOTONICS________ 17
CARDIOVASCULAR
AGENTS - MISC._____ 17
CARDIZEM LA _________ 16
CARDURA XL __________ 27
carisoprodol___________ 32
CARNITOR ____________ 25
CAROSPIR_____________ 25
carteolol hcl ___________ 33
cartia xt_______________ 16
carvedilol _____________ 16
carvedilol phosphate ___ 16
CATAPRES-TTS-1_______ 12
CATAPRES-TTS-3_______ 12
CAVERJECT IMPULSE ___ 17
CAYA _________________ 29
CAYSTON _____________ 13
caziant________________ 17
cefaclor_______________ 17
cefadroxil _____________ 17
cefdinir _______________ 17
cefepime _____________ 17
cefixime ______________ 17
cefpodoxime proxetil __ 17
cefprozil ______________ 17
ceftriaxone sodium ____ 17
cefuroxime axetil ______ 17
celacyn _______________ 21
CELEBREX______________ 3
celecoxib ______________ 3
CELEXA ________________ 8
CELLCEPT _____________ 30
CELONTIN _____________ 7
CENTRATEX ___________ 27
CEPHALEXIN TAB 250MG
___________________ 17
cephalexin tab 500mg_ 17
CEPHALOSPORINS _____ 17
CERACADE ____________ 21
ceramax ______________ 21
CERDELGA ____________ 27
CEREFOLIN NAC _______ 24
CETROTIDE ___________ 25
cevimeline hcl _________ 30
CHANTIX _____________ 34
CHANTIX CONTINUING
MONTH ___________ 34
CHANTIX STARTING
MONTH PA ________ 34
chateal _______________ 17
CHEMET ______________ 10
chlordiazepoxide hcl _ 6, 36
chlordiazepoxide hcl/clid36
chlordiazepoxide/amitript
___________________ 35
chlorhexidine gluconate 30
chloroquine phosphate_ 13
chlorothiazide _________ 25
chlorpromazine hcl ____ 15
chlorpropamide ________ 9
chlorthalidone _____12, 25
CHLORZOXAZON TAB
250MG ____________ 32
chlorzoxazon tab 500mg 32
cholestyramine ________ 11
cholestyramine light ___ 11
chorionic gonadotropin 25
chromagen ___________ 27
CIALIS ________________ 17
ciclopirox _____________ 21
ciclopirox nail lacquer __ 21
ciclopirox olamine _____ 21
cidofovir ______________ 15
cilostazol _____________ 27
CILOXAN _____________ 33
cimetidine ____________ 36
cimetidine hcl _________ 36
CIMZIA _______________ 26
CIMZIA STA RTER KIT___ 26
CIPRO _____________ 26, 34
CIPRO HC _____________ 34
CIPRODEX ____________ 34
CIPROFLOXACIN ______ 34
ciprofloxacin er _______ 26
ciprofloxacin hcl _______ 26
ciprofloxacin hydrochlori26
citalopram _____________ 8
citalopram hydrobromide 8
CITRANATAL 90 DHA __ 31
CITRANATAL ASSURE __ 31
CITRANATAL B-CALM __ 31
CITRANATAL BLOOM __ 31
CITRANATAL DHA _____ 31
CITRANATAL HARMONY 31
CITRANATAL RX _______ 31
claravis _______________ 21
CLARINEX _________ 11, 20
CLARINEX-D 12 HOUR _ 20
clarithromycin ________ 29
clarithromycin er ______ 29
clemastine fumarate___ 11
CLENPIQ______________ 28
CLEOCIN______________ 37
CLIMARA _____________ 26
CLIMARA PRO ________ 26
CLINDACIN PAC _______ 21
CLINDAGEL ___________ 21
clindamycin hcl________ 13
clindamycin hydrochloride
___________________ 13
clindamycin palmitate hcl
___________________ 13
clindamycin phosphate 21
CLINDAMYCIN
PHOSPHATE/BEN___ 21
clindamycin phosphate/tre
___________________ 21
clindamycin/benzoyl perox
___________________ 21
CLINDESSE____________ 37
clinpro 5000 __________ 30
clobazam ______________ 7
clobetasol propionate__ 21
clobetasol propionate e 21
clobetasol propionate emo
___________________ 21
CLOBEX ______________ 21
CLOCORTOLONE PIVALATE
___________________ 21
CLOCORTOLONE PIVALATE
PUM ______________ 21
clodan________________ 21
CLODERM ____________ 21
CLODERM PUMP ______ 21
clomiphene citrate ____ 25
clomipramine hcl _______ 8
clonazepam____________ 7
clonazepam odt ________ 7
clonidine hcl ________ 3, 12
clonidine hcl er _________3
clonidine hydrochloride __3
clonidine hydrochloride e 3
clopidogrel ___________ 27
clorazepate dipotassium _6
clotrimazole _______ 21, 30
clotrimazole/betamethaso
n _________________ 21
clozapine _____________ 15
CLOZAPINE TAB
200/ODT __________ 15
clozapine tab 25mg odt
___________________ 15
COAL TAR ____________ 21
COARTEM ____________ 13
codeine sulfate _________5
COLCHICINE CAP 0.6MG
___________________ 27
COLCHICINE TAB 0.6MG
___________________ 27
COLCRYS _____________ 27
colesevelam hydrochloride
___________________ 11
COLESTID ____________ 11
colestipol hcl _________ 11
colocort ________________5
COLY-MYCIN S ________ 34
COLYTE-FLAVOR PACKS 28
COMBIGAN___________ 33
COMBIPATCH_________ 26
COMBIVENT RESPIMAT__7
COMETRIQ ___________ 13
COMPLERA ___________ 15
complete natal dha ____ 31
completenate_________ 31
compro ______________ 15
CONCEPT DHA ________ 31
CONCEPT OB _________ 31
CONCERTA _____________3
CONDYLOX ___________ 21
constulose____________ 28
CONTRACEPTIVES _____ 17
CONTRAVE _____________3
CONZIP ________________5
COPAXONE INJ
20MG/ML _________ 35
COPAXONE INJ
40MG/ML _________ 35
CORDRA N ____________ 21
COREG _______________ 16
COREG CR ____________ 16
CORGARD ____________ 16
CORLANOR ___________ 17
CORTEF ___________ 19, 20
CORTICOSTEROIDS ____ 19
CORTIFOAM ____________5
CORTISPORIN_________ 21
corvita 150 ___________ 27
CORVITE FE___________ 27
42
COSENTYX ____________ 21
COSENTYX SENSOREADY
PEN _______________ 21
COSOPT ______________ 33
COSOPT PF____________ 33
COTEMPLA XR-ODT _____ 3
COUGH/COLD/ALLERGY 20
COUMADIN ____________ 7
COZAAR ______________ 12
CREON _______________ 24
CRESEMBA ____________ 11
CRESTOR _____________ 11
CRINONE _____________ 37
cromolyn sodium _______ 7
cryselle-28 ____________ 17
CUVPOSA _____________ 36
cyanocobalamin _______ 27
cyclafem 1/35 _________ 17
cyclafem 7/7/7 ________ 17
cyclobenzaprine hcl ____ 32
cyclobenzaprine hydrochlo
___________________ 32
CYCLOMYDRIL_________ 33
cyclopentolate hcl _____ 33
cyclopentolate hydrochlor
___________________ 33
CYCLOPHOSPH CAP 25MG
___________________ 13
cyclophosph cap 50mg _ 13
CYCLOSET ______________ 9
cyclosporine___________ 30
cyclosporine cap 25mg
mod _______________ 30
CYCLOSPORINE CAP 50MG
MOD ______________ 30
CYMBALTA_____________ 8
cyproheptadine hcl ____ 11
cyred _________________ 17
cyred eq ______________ 17
CYTOMEL _____________ 35
CYTOTEC ______________ 36
dalfampridine er _______ 35
DALIRESP ______________ 7
danazol ________________ 5
dantrolene sodium_____ 32
dapsone ______________ 13
darifenacin hydrobromide
___________________ 37
dasetta 1/35 __________ 18
dasetta 7/7/7 _________ 18
daysee________________ 18
DAYTRANA ____________ 3
DDAVP _______________ 25
DEBACTEROL __________ 30
deblitane _____________ 18
DELESTROGEN ________ 26
DELZICOL _____________ 26
demeclocycline hcl _____ 35
DENAVIR _____________ 21
denta 5000 plus _______ 30
dentagel ______________ 30
DEPAKOTE ___________ 7, 8
DEPAKOTE ER __________ 8
DEPLIN 15 ____________ 24
DEPLIN 7.5 ____________ 24
DEPO-ESTRADIOL _____ 26
DEPO-MEDROL ________ 19
DEPO-PROVERA
CONTRACEPTIV_____ 18
DEPO-SUBQ PROVERA 104
___________________ 18
DEPO-TESTOSTERONE __ 5
DERMACINRX LEXITRAL
PHARM ____________ 21
dermacinrx prizopak ___ 21
DERMACINRX ZRM PAK 21
DERMA-SMOOTHE/FS
SCALP _____________ 21
DERMASORB HC ______ 21
DERMASORB XM ______ 21
DERMATOLOGICALS ___ 20
dermazene____________ 21
DESCOVY _____________ 15
desipramine hcl ________ 8
desipramine hydrochloride
____________________ 8
desloratadine _________ 11
desloratadine odt______ 11
desmopressin acetate __ 25
desogestrel/ethinyl estra18
DESONATE____________ 21
desonide _____________ 21
desoximetasone _______ 21
desvenlafax tab 100mg er
____________________ 8
DESVENLAFAX TAB 50MG
ER__________________ 8
DETROL ______________ 37
DETROL LA ____________ 37
DEXAMETHASON SOL
0.5/5ML ___________ 19
dexamethason tab 0.75mg
___________________ 19
DEXAMETHASONE
INTENSOL __________ 19
DEXILANT_____________ 36
dexmethylphenidate hcl_ 3
dexmethylphenidate hcl er
____________________ 3
dexmethylphenidate
hydroc______________ 3
DEXPAK 10 DAY _______ 19
DEXPAK 6 DAY ________ 19
dextroamphetamine
sulfate ______________ 3
dextrose 20% _________ 32
dextrose 5%___________ 32
DIACOMIT _____________ 8
DIAGNOSTIC PRODUCTS24
dialyvite ______________ 31
DIALYVITE/ZINC _______ 31
DIASTAT ACUDIAL ______ 8
diazepam ______________ 6
diazepam intensol ______ 6
DIAZEPAM RECTAL GEL _ 8
DICLEGIS _____________ 11
diclofenac potassium ___ 3
diclofenac sodium ___ 3, 21
diclofenac sodium dr____ 3
diclofenac sodium er____ 3
diclofenac sodium/misopro
____________________ 3
dicloxacillin sodium ____ 34
dicyclomine hcl________ 36
dicyclomine hydrochloride
___________________ 36
DIETARY
PRODUCTS/DIETARY
MANAGEMENT
PRODUCTS_________ 24
diethylpropion hcl ______ 3
diethylpropion hcl er____ 3
DIFFERIN _____________ 21
DIFICID _______________ 29
diflorasone diacetate __ 21
DIFLUCAN ____________ 11
diflunisal ______________ 4
DIGESTIVE AIDS _______ 24
digitek _______________ 17
digox_________________ 17
digoxin _______________ 17
dihydroergot inj 1mg/ml 29
DIHYDROERGOT SPR
4MG/ML __________ 29
DILANTIN CAP 100MG 8
DILANTIN CAP 30MG _ 8
DILANTIN INFA TABS ____ 8
diltiazem hcl __________ 16
diltiazem hcl cd _______ 16
diltiazem hcl er________ 16
diltiazem hydrochloride e
___________________ 16
dilt-xr ________________ 16
DIOVAN ______________ 12
DIOVAN HCT__________ 12
DIPENTUM ___________ 26
diphenhydramine hcl __ 11
diphenoxylate/atropine 10
dipyridamole__________ 27
disopyramide phosphate 6
disulfiram ____________ 35
DIURETICS ____________ 24
DIURIL _______________ 25
divalproex sodium ______ 8
divalproex sodium dr ___ 8
divalproex sodium er ___ 8
DIVIGEL ______________ 26
dofetilide ______________ 6
donepezil hcl__________ 35
donepezil hydrochloride 35
DONNATAL ___________ 36
DORAL _______________ 28
DORYX MPC __________ 35
dorzolamide hcl _______ 33
dorzolamide hcl/timolol m
___________________ 33
dorzolamide hydrochloride
___________________ 33
DOVATO _____________ 15
doxazosin mesylate____ 12
doxepin hcl _____________8
doxepin hydrochloride _ 21
doxercalciferol ________ 25
DOXYCYCLINE CAP 40MG
___________________ 21
doxycycline sus 25mg/5ml
___________________ 35
doxycycline hyclate____ 35
doxycycline hyclate dr _ 35
doxycycline monohydrate
___________________ 35
DRITHO-CREME HP ____ 21
dronabinol ___________ 11
drospirenone/ethinyl estr
___________________ 18
DROXIA ______________ 27
DRYSOL ______________ 21
DUAC ________________ 21
DUAVEE______________ 26
DUEXIS_________________3
DULERA ________________7
duloxetine hcl___________8
duloxetine hydrochloride 8
DUPIXENT ____________ 21
DURAGESIC ____________5
DUREZOL _____________ 33
dutasteride ___________ 27
dutasteride/tamsulosin hc
___________________ 27
dutasteride/tamsulosin hy
___________________ 27
DUTOPROL ___________ 12
DYANAVEL XR __________3
DYAZIDE _____________ 25
DYMISTA _____________ 32
DYRENIUM ___________ 25
DYSPORT_____________ 32
e.e.s. 400_____________ 29
E.E.S. GRA NULES ______ 29
econazole nitrate _____ 21
ECOZA _______________ 21
EDARBI ______________ 12
EDARBYCLOR _________ 12
EDEX_________________ 17
EDLUAR ______________ 28
EDURANT ____________ 15
eemt_________________ 26
eemt hs ______________ 26
efavirenz _____________ 15
EFFER-K TAB 20MEQ 29
43
effer-k tab 25meq ef_ 29
effervescent pot chloride
___________________ 29
EFFEXOR XR____________ 8
EFFIENT_______________ 27
EFUDEX_______________ 21
ELETONE______________ 21
ELETONE TWINPACK ___ 21
eletriptan hydrobromide29
ELFOLATE TAB 15MG 24
ELFOLATE TAB 7.5MG 24
ELIDEL ________________ 21
ELIGARD ______________ 13
elinest ________________ 18
ELIQUIS________________ 7
ELIQUIS STARTER PACK _ 7
elite-ob _______________ 31
ELLA__________________ 18
ELMIRON _____________ 27
ELOCON ______________ 21
ELOCTA TE_____________ 27
EMBEDA _______________ 5
EMEND _______________ 11
EMFLAZA _____________ 19
EMGALITY ____________ 29
emoquette ____________ 18
EMSAM________________ 8
EMULSION SB _________ 21
EMVERM ______________ 6
enalapril maleate ______ 12
enalapril maleate/hydroch
___________________ 12
ENBRACE HR __________ 31
ENBREL ______________ 3, 4
ENBREL MINI___________ 3
ENBREL SURECLICK _____ 4
endocet________________ 5
ENDOCRINE AND
METABOLIC AGENTS -
MISC. ______________ 25
ENDOMETRIN _________ 37
ENGERIX-B ____________ 37
ENLYTE _______________ 24
enoxaparin sodium _____ 7
enpresse-28 ___________ 18
enskyce _______________ 18
ENSTILAR _____________ 21
entacapone ___________ 14
entecavir _____________ 15
ENTERAGAM __________ 24
ENTOCORT EC _________ 19
ENTRESTO ____________ 17
ENTTY SPRAY EMULSION
___________________ 21
ENTYVIO______________ 26
enulose _______________ 26
ENVARSUS XR _________ 30
EPANED ______________ 12
EPCLUSA ______________ 15
EPICERAM ____________ 21
EPIDIOLEX _____________ 8
EPIDUO ______________ 21
EPIDUO FORTE ________ 21
EPIFOAM _____________ 21
epinastine hcl _________ 33
EPIPEN 2-PAK _________ 38
EPIPEN-JR 2 -PAK ______ 38
epitol__________________ 8
eplerenone ___________ 12
EPOGEN ______________ 27
eprosartan mesylate ___ 12
ergocalciferol _________ 38
ERGOMAR ____________ 29
ergotamine tartrate/caffe
___________________ 29
ERIVEDGE ____________ 13
errin _________________ 18
ERTACZO _____________ 21
ery ___________________ 21
ERYPED 400___________ 29
ERY-TAB ______________ 29
ERYTHROCIN STEARATE 29
erythromycin_______21, 29
erythromycin base _____ 29
erythromycin ethylsuccina
___________________ 29
erythromycin/benzoyl pero
___________________ 21
ESBRIET ______________ 35
escitalopram oxalate ____ 9
esgic __________________ 4
esomeprazole magnesium
___________________ 36
esomeprazole magnesium
dr _________________ 36
ESOMEPRAZOLE
STRONTIUM _______ 36
estarylla ___________18, 19
estazolam_____________ 28
esterified estrogens/meth
___________________ 26
ESTRACE______________ 37
estradiol ___________26, 37
estradiol valerate ______ 26
estradiol/norethindrone a
___________________ 26
ESTRING ______________ 37
ESTROGEL ____________ 26
Estrogens _____________ 26
ESTROSTEP FE_________ 18
eszopiclone ___________ 28
ethacrynic acid ________ 25
ethambutol hcl ________ 13
ethosuximide __________ 8
ethyl chloride/medium jet
___________________ 21
ethyl chloride/medium str
___________________ 21
ethynodiol diacetate/ethi
___________________ 18
etodolac_______________ 4
etodolac er ____________ 4
etoposide ____________ 13
EUCRISA ______________ 21
EUFLEXXA ____________ 32
EVAMIST _____________ 26
EVEKEO _______________ 3
EVISTA _______________ 25
EVOTA Z ______________ 15
exemestane __________ 13
EXJADE_______________ 10
EXTAVIA _____________ 35
EYLEA ________________ 33
ezetimibe_____________ 11
ezetimibe/simvastatin _ 11
fabb _________________ 27
FABIOR_______________ 21
FABRAZYME __________ 25
falmina _______________ 18
famciclovir____________ 15
famotidine____________ 36
FANAPT ______________ 15
FARXIGA ______________ 9
FASENRA ______________ 7
FASLODEX ____________ 13
fayosim ______________ 18
felbamate _____________ 8
felodipine er __________ 16
FEM PH ______________ 37
FEMRING _____________ 37
femynor ___________ 18, 19
FENOFIBRATE CAP 50MG
___________________ 11
fenofibrate tab 48mg__ 11
fenofibrate micronized_ 11
FENOFIBRIC ACID _____ 11
fenofibric acid dr ______ 11
FENOPROFEN CAP
400MG _____________ 4
fenoprofen tab 600mg _ 4
FENORTHO ____________ 4
fentanyl _______________ 5
fentanyl citrate_________ 5
fentanyl citrate oral tra _ 5
FENTORA ______________ 5
FERAHEM E ___________ 27
FERIVA 21/7 __________ 27
ferocon_______________ 28
FERRALET 90 __________ 28
FERRAPLUS 90 ________ 28
FETZIMA ______________ 9
FETZIMA TITRATION PACK
____________________ 9
FIASP _________________ 9
FIASP FLEXTOUCH ______ 9
FINACEA _____________ 22
finasteride ____________ 27
FIORICET ______________ 4
FIORINAL ______________ 4
FIRAZYR ______________ 27
FIRST-BACLOFEN 5 ____ 32
FIRST-LANSOPRAZOLE _ 36
FIRST-METRONIDAZOLE
100 _______________ 13
FIRST-METRONIDAZOLE 50
___________________ 13
FIRST-MOUTHWASH BLM
___________________ 30
FIRST-OM EPRAZOLE___ 36
FIRST-PROGESTERONE
VGS 10 ____________ 37
FIRST-PROGESTERONE
VGS 20 ____________ 37
FIRST-VANCOMYCIN 25 13
FIRST-VANCOMYCIN 50 13
FIRVANQ _____________ 13
flavoxate hcl __________ 37
FLEBOGAMMA DIF ____ 34
flecainide acetate _______6
FLECTOR _____________ 22
FLOMAX _____________ 27
FLONASE _____________ 32
FLORIVA PLUS ________ 31
FLOVENT DISKUS________7
FLOVENT HFA ___________7
FLUAD 2018-2019 _____ 37
FLUARIX QUADRIVALENT
2018 ______________ 37
FLUBLOK QUADRIVALENT
2018 ______________ 37
FLUCELVAX
QUADRIVALENT 20 _ 37
fluconazole ___________ 11
fludrocortisone acetate 19
FLULAVAL QUADRIVALENT
201 _______________ 37
FLUMIST QUADRIVALENT
___________________ 37
flunisolide ____________ 32
fluocinolone acetonide 22
fluocinolone acetonide bo
___________________ 22
fluocinolone acetonide sc
___________________ 22
fluocinonide __________ 22
fluocinonide emulsified 22
fluocinonide emulsified b
___________________ 22
FLUORABON__________ 29
fluoride ____ 29, 30, 31, 32
fluorometholone ______ 33
FLUOROPLEX _________ 22
Fluoroquinolones _____ 26
fluorouracil ___________ 22
fluoxetine __________ 9, 35
fluoxetine tab 10mg ____9
FLUOXETINE TAB 60MG 9
fluoxetine dr____________9
fluoxetine hcl ___________9
fluphenazine decanoate 15
44
fluphenazine hcl _______ 15
FLURA-DROPS _________ 29
flurandrenolide ________ 22
flurazepam hcl_________ 28
flurbiprofen _________4, 33
flurbiprofen sodium ____ 33
flutamide _____________ 13
fluticasone propionate _ 32
FLUTICASONE
PROPIONATE/SA ____ 7
fluvastatin ____________ 11
fluvastatin sodium er___ 11
fluvoxamine maleate ____ 9
fluvoxamine maleate er _ 9
FLUZONE HIGH-DOSE PF
2018_______________ 37
FLUZONE QUADRIVALENT
2018_______________ 37
FML __________________ 33
FML FORTE____________ 33
FML LIQUIFILM ________ 33
FOCALIN _______________ 3
FOCALIN XR ____________ 3
folbee ____________ 28, 31
folbee plus ____________ 31
folbic _________________ 24
FOLBIC RF_____________ 24
FOLGARD OS __________ 31
folic acid/vitamin b-6/vi 28
FOLIVANE-F ___________ 28
FOLIVANE-PLUS _______ 28
FOLLISTIM AQ _________ 25
FOLTANX _____________ 24
FOLTANX RF __________ 24
FOLTX ________________ 24
fondaparinux sodium____ 7
FORFIV O XL ____________ 9
formaldehyde _________ 15
FORTEO ______________ 25
FORTESTA _____________ 5
FOSAMAX PLUS D _____ 25
fosinopril sodium ______ 12
fosinopril sodium/hydroch
___________________ 12
FOSRENOL ____________ 26
FOSTEUM PLUS________ 24
FRAGMIN ______________ 7
FREESTYLE
LIBRE/READER/FL ___ 29
FREESTYLE
LIBRE/SENSOR/FL ___ 29
FROVA _______________ 29
frovatriptan succinate __ 29
FULPHILA _____________ 28
furosemide____________ 25
FUSION PLUS__________ 28
fyavolv _______________ 26
FYCOMPA______________ 8
gabapentin_____________ 8
GABLOFEN ____________ 32
galantamine hydrobromide
___________________ 35
GALZIN _______________ 29
GANIRELIX ACETATE ___ 25
GARDASIL 9 ___________ 37
GASTROINTESTINAL
AGENTS - MISC. ____ 26
gatifloxacin ___________ 33
gavilyte-c _____________ 28
gavilyte-g _____________ 28
gavilyte-n/flavor pack __ 28
GELCLAIR _____________ 30
GELNIQUE ____________ 37
GEL-ONE______________ 32
gemfibrozil____________ 11
GENADUR ____________ 22
GENERAL ANESTHETICS 27
GENERESS FE__________ 18
generlac ______________ 26
gengraf _______________ 30
GENITOURINARY AGENTS -
MISCELLANEOUS ___ 27
GENOTROPIN _________ 25
GENOTROPIN MINIQUICK
___________________ 25
GENTAK ______________ 33
gentamicin sulfate ______ 3
GENVOYA ____________ 15
GEODON _____________ 15
gianvi ________________ 18
GILENYA ______________ 35
GILTUSS TR ___________ 20
GLASSIA ______________ 35
glatiramer acetate _____ 35
glatopa _______________ 35
GLEEVEC______________ 13
GLEOSTINE ___________ 13
glimepiride ____________ 9
glipizide _______________ 9
glipizide er _____________ 9
glipizide xl _____________ 9
glipizide/metformin hcl _ 9
GLUCAGEN HYPOKIT____ 9
GLUCAGON EMERGENCY
KIT _________________ 9
GLUCOPHAGE __________ 9
GLUCOPHAGE XR _______ 9
GLUCOTROL XL _________ 9
GLUMETZA ____________ 9
glyburide ___________ 9, 10
glyburide micronized____ 9
glyburide/metformin hcl 10
glycopyrrolate_________ 36
GLYXAMBI ____________ 10
GOCOVRI _____________ 14
GOLYTELY ____________ 28
GONAL-F _____________ 25
GONAL-F RFF REDIJECT 25
Gout Agents __________ 27
GRALISE ______________ 35
GRALISE STARTER _____ 35
granisetron hcl ________ 11
GRANIX ______________ 28
GRASTEK ______________ 3
griseofulvin microsize __ 11
griseofulvin ultramicrosi 11
guanfacine er __________ 3
guanfacine hcl ________ 12
guanfacine hydrochloride 3
GYNAZOLE-1 __________ 37
H.P. ACTHAR__________ 25
HALCION _____________ 28
halobetasol propionate 22
HALOG _______________ 22
haloperidol ___________ 15
haloperidol decanoate _ 15
haloperidol lactate ____ 15
HARVONI_____________ 15
HAVRIX ______________ 37
heather ______________ 18
HEMATOGEN FA ______ 28
hematogen forte ______ 28
HEMATOLOGICAL AGENTS
- MISC. ____________ 27
HEMATOPOIETIC AGENTS
___________________ 27
hemmorex-hc __________ 5
HEMOCYTE PL US ______ 28
hemocyte-f ___________ 28
HEMOSTATICS ________ 28
heparin lock flush ______ 7
heparin lock flush/nacl f_ 7
heparin sodium ________ 7
heparin sodium dcu ____ 7
heparin sodium lock flush 7
HEPARIN
SODIUM/SODIUM CHL 7
HERCEPTIN ___________ 13
HIZENTRA ____________ 34
homatropine hbr ______ 33
HORIZA NT ____________ 35
HPR PLUS_____________ 22
HPR PLUS HYDROGEL KIT
___________________ 22
HUMALOG ___________ 10
HUMALOG JUNIOR
KWIKPEN __________ 10
HUMALOG KWIKPEN __ 10
HUMALOG MIX 50/50
KWIKPEN __________ 10
HUMALOG MIX 75/25 _ 10
HUMALOG MIX 75/25
KWIKPEN __________ 10
HUMATROPE _________ 25
HUMIRA_______________ 4
HUMIRA PEDIATRIC
CROHNS D __________ 4
HUMIRA PEN __________ 4
HUMIRA PEN-CD/UC/HS
START ______________ 4
HUMIRA PEN-PS/UV
STARTER ____________4
HUMULIN R U-500
(CONCENTR________ 10
HUMULIN R U-500
KWIKPEN __________ 10
HYALGAN ____________ 32
HYCLODEX ___________ 22
hydralazine hcl________ 12
hydrochlorothiazide ___ 25
hydrocodone bitartrate/ac
_____________________5
hydrocodone bitartrate/ch
___________________ 20
hydrocodone bitartrate/ho
___________________ 20
hydrocodone polistirex/ch
___________________ 20
hydrocodone/acetaminoph
en __________________5
hydrocodone/homatropine
___________________ 20
hydrocodone/ibuprofen _5
hydrocortisone 5, 6, 19, 22,
34
hydrocortisone acetate5, 6,
22
hydrocortisone acetate &
___________________ 22
hydrocortisone acetate/pr
_____________________6
hydrocortisone butyrate 22
hydrocortisone butyrate (
___________________ 22
hydrocortisone valerate 22
hydrocortisone/acetic aci
___________________ 34
hydrocortisone/iodoquinol
___________________ 22
HYDROGEN PEROXIDE_ 15
hydromet ____________ 20
hydromorphone hcl _____5
hydromorphone hcl
dosette______________5
hydromorphone hcl er ___5
hydroquinone ________ 22
hydroquinone time release
___________________ 22
hydroxocobalamin ____ 28
hydroxychloroquine sulfat
___________________ 13
hydroxyprogesterone
capro _____________ 34
hydroxyurea __________ 13
hydroxyzine hcl _________6
hydroxyzine hydrochloride
_____________________6
hydroxyzine pamoate____6
HYLAFEM ____________ 30
HYLATOPIC PLUS______ 22
45
HYLENEX______________ 30
HYMOVIS _____________ 32
HYOPHEN_____________ 36
hyoscyamine sulfate ___ 36
hyoscyamine sulfate er _ 36
hyoscyamine sulfate odt 36
hyoscyamine sulfate sr _ 36
hyosyne ______________ 36
HYPERRHO S/D________ 34
HYPERSAL ____________ 20
HYPNOTICS/SEDATIVES/SL
EEP DISORDER AGENTS
___________________ 28
HYSINGLA ER___________ 5
HYZAAR ______________ 12
ibandronate sodium____ 25
IBRANCE ______________ 13
ibu ____________________ 4
IBUDONE ______________ 5
ibuprofen ____________ 4, 5
ICLUSIG_______________ 13
IDELVION _____________ 27
iferex 150 forte ________ 28
ILARIS _________________ 4
ILEVRO _______________ 33
imatinib mesylate______ 13
IMBRUVICA ___________ 13
imipramine hcl _________ 9
imipramine hydrochloride9
imipramine pamoate ____ 9
imiquimod ____________ 22
IMIQUIMOD PUMP ____ 22
IMITREX ______________ 29
IMITREX STATDOSE REFILL
___________________ 29
IMITREX STATDOSE
SYSTEM ____________ 29
IMOVAX RABIES (H.D.C.V.)
___________________ 37
IMPOYZ ______________ 22
IMVEXXY MAINTENANCE
PACK ______________ 37
IMVEXXY STARTER PACK
___________________ 37
INBRIJA _______________ 14
INCRUSE ELLIPTA _______ 7
indapamide ___________ 25
INDERAL LA ___________ 16
INDERAL XL ___________ 16
INDOCIN _______________ 4
indomethacin __________ 4
indomethacin er ________ 4
INFANRIX _____________ 36
INFLECTRA ____________ 26
INGREZZA _____________ 35
INLYTA _______________ 13
INNOPRAN XL _________ 16
INSULIN LISPRO _______ 10
INSULIN LISPRO KWIKPEN
___________________ 10
INTEGRA F ____________ 28
INTEGRA PLUS ________ 28
INTERMEZZO__________ 28
intralipid______________ 32
INTRAROSA ___________ 37
INTRON A ____________ 13
introvale______________ 18
INTUNIV _______________ 3
INVEGA ______________ 15
INVEGA SUSTENNA ____ 15
INVEGA TRINZA _______ 15
INVELTYS _____________ 33
INVOKAMET __________ 10
INVOKAMET XR _______ 10
INVOKANA ___________ 10
iodine strong __________ 29
IOPIDINE _____________ 33
IPOL INACTIVATED IPV _ 37
ipratropium bromide_ 7, 32
ipratropium bromide/albut
____________________ 7
irbesartan ____________ 12
irbesartan/hydrochlorothi
___________________ 12
IROSPAN 24/6 ________ 28
ISENTRESS ____________ 15
isibloom ______________ 18
isoniazid ______________ 13
isosorbide dinitrate _____ 6
isosorbide mononitrate _ 6
isosorbide mononitrate er6
isotretinoin ___________ 22
isradipine _____________ 16
ISTALOL ______________ 33
itraconazole___________ 11
ivermectin _____________ 6
IXIARO _______________ 37
JADENU ______________ 10
JADENU SPRINKLE _____ 10
JAKAFI _______________ 14
JALYN ________________ 27
jantoven _______________ 7
JANUMET_____________ 10
JANUMET XR__________ 10
JANUVIA _____________ 10
JARDIANCE ___________ 10
jencycla ______________ 18
JENTADUETO _________ 10
JENTADUETO XR ______ 10
jevantique lo __________ 26
jinteli_________________ 26
jolessa________________ 18
jolivette ______________ 18
JUBLIA _______________ 22
juleber _______________ 18
JULUCA_______________ 15
junel 1.5/30 ___________ 18
junel 1/20 ____________ 18
junel fe 1.5/30 ________ 18
junel fe 1/20 __________ 18
junel fe 24 ____________ 18
kaitlib fe______________ 18
KALETRA _____________ 15
KAMDOY _____________ 22
kariva ________________ 18
KAZANO______________ 10
k-effervescent ________ 29
kelnor 1/35 ___________ 18
kelnor 1/50 ___________ 18
KENALOG-10__________ 19
KENALOG-40__________ 19
KEPPRA _______________ 8
KEPPRA XR ____________ 8
KERALAC _____________ 22
KERALYT _____________ 22
KERALYT SCALP _______ 22
KERYDIN _____________ 22
ketamine hcl __________ 27
ketoconazole _________ 11
KETOPROFEN __________ 4
ketoprofen er __________ 4
ketorolac tromethamine 4
KEVZARA ______________ 4
KEYTRUDA ___________ 14
KINERET _______________ 4
kionex________________ 30
KISQALI ______________ 14
KISQALI FEMARA 600
DOSE______________ 14
KLONOPIN_____________ 8
klor-con ______________ 29
klor-con 10 ___________ 29
klor-con 8 ____________ 29
klor-con m10 _________ 29
KLOR-CON M15 _______ 29
klor-con m20 _________ 29
klor-con sprinkle ______ 29
klor-con/ef ___________ 29
KOMBIGLYZE XR ______ 10
K-PHOS ___________ 27, 29
K-PHOS NO 2 _________ 27
KRISTAL OSE __________ 28
KRYSTEXXA ___________ 27
K-TAB TAB 20MEQ _ 29
K-TAB TAB 8MEQ CR29
kurvelo _______________ 18
KUVAN _______________ 25
k-vescent _____________ 30
KYLEENA _____________ 18
labetalol hcl __________ 16
labetalol hydrochloride 16
LACRISERT____________ 33
lactated ringers _______ 30
lactulose _____________ 28
LAMICTAL _____________ 8
LAMICTAL ODT_________ 8
LAMICTAL XR __________ 8
lamivudine ___________ 15
lamivudine/zidovudine_ 15
lamotrigine ____________ 8
lamotrigine er __________8
lamotrigine odt _________8
lamotrigine starter kit/o _8
lansoprazole __________ 36
lansoprazole/amoxicillin/
___________________ 36
lanthanum carbonate__ 26
LANTUS ______________ 10
LANTUS SOLOSTAR____ 10
larin 1.5/30 ___________ 18
larin 1/20_____________ 18
larin 24 fe ____________ 18
larin fe 1.5/30_________ 18
larin fe 1/20 __________ 18
larissia _______________ 18
LASIX ________________ 25
LASTACAFT ___________ 33
latanoprost ___________ 33
LATISSE ______________ 22
LATUDA ______________ 15
LAXATIVES ___________ 28
layolis fe _____________ 18
leena ________________ 18
leflunomide ____________4
LENVIMA 12MG DAILY
DOSE _____________ 14
LESCOL XL ____________ 11
lessina _______________ 18
LETAIRIS _____________ 17
letrozole _____________ 14
LEUCOVOR CA TAB 10MG
___________________ 14
leucovor ca tab 5mg __ 14
LEUKERAN ___________ 14
leuprolide acetate _____ 14
levalbuterol ____________7
levalbuterol hcl _________7
levalbuterol hydrochlorid 7
LEVALBUTEROL TARTRATE
HFA _________________7
LEVAQUIN____________ 26
LEVEMIR _____________ 10
LEVEMIR FL EXTOUCH __ 10
levetiracetam ___________8
levetiracetam er ________8
LEVICYN______________ 22
levicyn dermal spray___ 22
LEVITRA ______________ 17
levobunolol hcl _______ 33
levocarnitine _________ 25
levocetirizine dihydrochl 11
levofloxacin __________ 26
levofloxacin in d5w ____ 26
LEVOMEFOLATE CALCIUM
ALGA _____________ 24
LEVOMEFOLATE
CALCIUM/N-AC ____ 24
LEVOMEFOLATE
CALCIUM/PYRI_____ 24
levonest______________ 18
46
levonorgestrel and ethiny
___________________ 18
levonorgestrel/ethinyl es18
levora 0.15/30-28______ 18
LEVORPHANOL TARTRATE
____________________ 5
levothyroxine sodium __ 35
levothyroxine/liothyronin
___________________ 35
levoxyl________________ 35
LEVSIN _______________ 36
LEVSIN/SL ____________ 36
LEVULAN KERASTICK___ 22
LEXAPRO ______________ 9
LIALDA _______________ 26
lidocaine ________ 6, 22, 30
LIDOCAINE AND
TETRACAINE________ 22
lidocaine hcl_________6, 22
lidocaine hcl jelly ______ 22
lidocaine hcl/hydrocortis 6
lidocaine viscous_______ 30
lidocaine/prilocaine ____ 22
lidocaine-prilocaine-crea22
LIDODERM ____________ 22
lidopril________________ 22
LIDORX _______________ 22
LIDOTRAL _____________ 22
lidozion _______________ 22
LILETTA _______________ 18
lillow _________________ 18
LIMBREL ______________ 24
LINCOCIN _____________ 13
linezolid ______________ 13
LINZESS_______________ 26
liothyronine sodium____ 35
LIPITOR _______________ 11
LIPOFEN ______________ 11
lisinopril ______________ 12
lisinopril/hydrochlorothi 12
lithium carbonate ______ 15
lithium carbonate er ___ 15
LIVALO _______________ 11
L-METHYL-B6-B12 _____ 24
L-METHYLFOLATE______ 24
L-METHYLFOLATE CA/S-
ALGAL _____________ 24
L-METHYLFOLATE
CALCIUM __________ 24
L-METHYLFOLATE FORTE
___________________ 24
L-METHYL-MC NAC ____ 24
LO LOESTRIN FE _______ 18
LOCAL ANESTHETICS-
Parenteral _________ 29
LOCOID _______________ 22
LOESTRIN 1.5/30-21 ___ 18
LOESTRIN 1/20-21 _____ 18
LOESTRIN FE 1.5/30____ 18
LOESTRIN FE 1/20 _____ 18
LOMAIRA ______________ 3
LONSURF _____________ 14
loperamide hcl ________ 10
lopreeza ______________ 26
lorazepam _____________ 6
lorazepam intensol _____ 6
lorcet _________________ 5
lorcet hd_______________ 5
lorcet plus _____________ 5
LORTAB _______________ 5
loryna ________________ 18
LORZONE _____________ 32
losartan potassium ____ 12
losartan potassium/hydroc
___________________ 12
LOSEASONIQUE _______ 18
LOTEMAX_____________ 33
LOTREL _______________ 12
lovastatin _____________ 11
LOVAZA ______________ 11
LOVENOX______________ 7
low-ogestrel __________ 18
loxapine ______________ 15
loxapine succinate _____ 15
LOYON _______________ 22
ludent ________________ 30
LULICONAZOLE________ 22
LUMIGAN_____________ 33
LUNESTA _____________ 28
LUPANETA PACK ______ 25
LUPRON DEPOT (4-
MONTH) ___________ 14
LUPRON DEPOT (6-
MONTH) ___________ 14
LUPRON DEPOT INJ
11.25MG __________ 14
LUPRON DEPOT INJ
22.5MG____________ 14
LUPRON DEPOT INJ
3.75MG____________ 14
LUPRON DEPOT INJ 7.5MG
___________________ 14
LUPRON DEPOT-PED (1-
MONTH ___________ 25
LUPRON DEPOT-PED (3-
MONTH ___________ 25
lutera ________________ 18
LUXAMEND ___________ 22
LUXIQ ________________ 22
LUZU _________________ 22
LYNPARZA ____________ 14
LYRICA _____________ 8, 35
LYRICA CR ____________ 35
lyza __________________ 18
MACROBID ___________ 36
MACRODANTIN _______ 36
MACROLIDES _________ 29
MAKENA INJ
250MG/ML ________ 34
MAKENA INJ 275MG 34
MALARONE___________ 13
malathion ____________ 22
maprotiline hcl _________ 9
MARCAINE ___________ 29
MARLIDO KIT _________ 29
marlissa ______________ 18
MARPLAN _____________ 9
MATULANE ___________ 14
matzim la_____________ 16
MAVYRET ____________ 15
MAXALT______________ 29
MAXALT-MLT _________ 29
MAXIDEX_____________ 33
MAXZIDE _____________ 25
MAYZENT ____________ 35
me/naphos/mb/hyo 1 _ 36
MEBOLIC _____________ 24
meclizine hcl __________ 11
meclizine hydrochloride 11
meclofenamate sodium _ 4
MEDICAL DEVICES AND
SUPPLIES __________ 29
MEDROL __________ 19, 20
MEDROL DOSEPAK ____ 20
medroxyprogesterone
aceta ______________ 18
mefenamic acid ________ 4
mefloquine hcl ________ 13
megestrol acetate _____ 14
MEKINIST ____________ 14
MEKTOVI _____________ 14
melodetta 24 fe _______ 18
meloxicam_____________ 4
memantine hcl ________ 35
memantine hcl titration p
___________________ 35
memantine hydrochloride
___________________ 35
memantine hydrochloride
e__________________ 35
MENACTRA ___________ 37
MENEST ______________ 26
MENOPUR____________ 25
MENOSTAR ___________ 26
MENTAX _____________ 22
MENVEO _____________ 37
meperidine hcl _________ 5
MEPHYTON___________ 38
mercaptopurine _______ 14
meropenem __________ 13
mesalamine___________ 26
mesalamine dr ________ 26
MESTINON TIMESPA N _ 13
metadate er ___________ 3
METAFOL BIC PLUS ____ 24
METAFOL BIC PLUS RF__ 24
METANX _____________ 24
METAXALONE TAB
400MG ____________ 32
metaxalone tab 800mg 32
metformin hcl ______ 9, 10
metformin hcl er ______ 10
metformin hydrochloride
___________________ 10
metformin hydrochloride e
___________________ 10
METHADONE SOL
5MG/5ML ___________5
methadone tab 10mg __5
methamphetamine hcl___3
methazolamide _______ 25
methenamine hippurate 36
methenamine mandelate
___________________ 36
methergine ___________ 34
methimazole _________ 35
methocarbamol _______ 32
methotrexate _________ 14
methotrexate sodium__ 14
methoxsalen__________ 22
methscopolamine bromide
___________________ 36
methyclothiazide______ 25
methyldopa __________ 12
methyldopa/hydrochloroth
i __________________ 12
methylergonovine maleate
___________________ 34
METHYLIN______________3
methylphenid cap 30mg er
_____________________3
METHYLPHENID CAP
60MG LA ____________3
methylprednisolone ___ 20
methylprednisolone acetat
___________________ 20
methylprednisolone dose p
___________________ 20
methylprednisolone
sodium ____________ 20
methyltestosterone _____5
metoclopramide hcl ___ 26
metoclopramide
hydrochlor_________ 26
METOCL OPRAMIDE ODT26
metolazone___________ 25
metoprol tar tab 25mg_ 16
METOPROLOL TAB 75MG
___________________ 16
metoprolol succinate er 16
metoprolol/hydrochlorothi
___________________ 12
METROGEL ___________ 22
metronidazole _____ 22, 38
metronidazole vaginal _ 38
mexiletine hcl___________6
mibelas 24 fe _________ 18
MICARDIS ____________ 12
MICARDIS HCT________ 12
MICONAZOLE 3 _______ 38
47
MICORT-HC ___________ 22
microgestin 1.5/30 _____ 18
microgestin 1/20 ______ 18
microgestin fe _________ 18
microgestin fe 1.5/30 __ 18
midazolam hcl _________ 28
midodrine hcl _________ 38
midodrine hydrochloride38
miglitol _______________ 10
Migraine Products _____ 29
mili___________________ 18
MILLIPRED SOL
10MG/5ML ________ 20
MILLIPRED TAB 5MG _ 20
mimvey _______________ 26
MINASTRIN 24 FE______ 18
MINERALS AND
ELECTROLYTES______ 29
MINIVELLE ____________ 26
minocycline hcl ________ 35
minocycline hcl er _____ 35
minocycline hydrochloride
___________________ 35
minoxidil______________ 12
MIRAPEX _____________ 14
MIRCETTE_____________ 18
MIRENA ______________ 18
mirtazapine ____________ 9
mirtazapine odt ________ 9
MIRVASO _____________ 22
Miscellaneous Therapeutic
Classes_____________ 30
misoprostol ___________ 36
MITIGARE_____________ 27
M-M-R II ______________ 37
modafinil ______________ 3
moexipril hcl __________ 12
mometasone furoate___ 22
monoject pharma grade flu
___________________ 30
mono-linyah __________ 18
mononessa____________ 18
MONOVISC ___________ 32
montelukast sodium ____ 7
MONUROL ____________ 37
MORPHABOND ER ______ 5
morphine sulfate _______ 5
morphine sulfate er _____ 5
MOTOFEN ____________ 10
MOUTH/THROAT/DENTAL
AGENTS____________ 30
MOVANTIK ___________ 26
MOVIPREP ____________ 28
MOXATAG ____________ 34
MOXEZA ______________ 33
moxifloxacin hcl _______ 26
moxifloxacin hydrochlorid
___________________ 33
MUGARD _____________ 30
MULPLETA ____________ 28
MULTAQ ______________ 6
MULTIGEN____________ 28
MULTIGEN PLUS ______ 28
MULTIVIT/FL CHW
0.25MG____________ 31
MULTIVIT/FL CHW 0.5MG
___________________ 31
multivit/fl dro 0.25mg _ 31
multi-vit/iron/fluoride _ 31
multivitamin with fluorid31
multi-vitamin/fluoride dr31
multi-vitamin/fluoride/ir31
MULTIVITAMINS ______ 31
mupirocin_____________ 22
MUSCULOSKELETAL
THERAPY AGENTS __ 32
MUSE ________________ 17
mycophenolate mofetil 30
mycophenolic acid dr __ 30
MYDAYIS ______________ 3
MYFORTIC ____________ 30
MYOBLOC ____________ 32
myorisan _____________ 22
MYRBETRIQ___________ 37
MYSOLINE _____________ 8
MYTESI _______________ 10
myzilra _______________ 18
nabumetone ___________ 4
nadolol ____________12, 16
nadolol/bendroflumethiazi
___________________ 12
naftifine hcl ___________ 22
naftifine hydrochloride _ 22
NAFTIN _______________ 22
naloxone hcl ________ 5, 10
naltrexone hcl _________ 10
NAMENDA ____________ 35
NAMENDA XR_________ 35
NAMZARIC ___________ 35
NAPRELAN_____________ 4
naproxen ___________ 4, 29
naproxen dr____________ 4
naproxen sodium _______ 4
naproxen sodium cr_____ 4
naproxen sodium er ____ 4
naratriptan hcl ________ 29
NARCAN______________ 10
NASAL AGENTS -
SYSTEMIC AND
TOPICAL ___________ 32
NASCOBAL ____________ 28
NASONEX_____________ 32
NATACYN_____________ 33
NATAZIA _____________ 18
nateglinide____________ 10
NATESTO ______________ 5
NATPARA _____________ 25
NATROBA ____________ 22
NATURE-THROID ______ 35
NATURE-THROID NT-2.5 35
nebusal ______________ 20
necon 0.5/35-28_______ 18
NEEV O DHA __________ 31
nefazodone hcl_________ 9
nefazodone hydrochloride
____________________ 9
neomycin sulfate _______ 3
neomycin/bacitracin/poly
m _________________ 33
neomycin/polymyxin/bacit
r __________________ 33
neomycin/polymyxin/dexa
me ________________ 33
neomycin/polymyxin/gram
ic _________________ 33
neomycin/polymyxin/hc 34
neomycin/polymyxin/hydr
oc_________________ 34
neo-polycin ___________ 33
neo-polycin hc ________ 33
NEORAL ______________ 30
NEOSPORIN __________ 33
NEO-SY NALAR ________ 22
NEPHRO-VITE RX ______ 31
NERLYNX _____________ 14
NESINA_______________ 10
NESTABS DHA ________ 31
NESTABS ONE_________ 31
NEUAC KIT____________ 22
NEULASTA ____________ 28
NEULASTA ONPRO KIT _ 28
NEUPOGEN ___________ 28
NEUPRO______________ 14
NEUROMUSCULAR
AGENTS ___________ 32
NEURONTIN ___________ 8
NEUTRASAL __________ 30
NEVANAC ____________ 33
NEXAVAR ____________ 14
NEXIUM CAP 40MG 36
NEXIUM GRA 10MG DR
___________________ 36
NEXPLANON __________ 18
niacin er ______________ 11
NIACOR ______________ 11
NIASPAN _____________ 11
NICADAN_____________ 31
NICAPRIN ____________ 24
NICOMIDE ____________ 31
NICOTROL INHALER ___ 35
NICOTROL NS _________ 35
nifedipine ____________ 16
nifedipine er __________ 16
NIFEREX ______________ 28
nikki _________________ 18
nimodipine ___________ 16
NINLARO _____________ 14
nisoldipine er _________ 16
NITRO-BID_____________ 6
NITRO-DUR ____________ 6
nitrofurantoin ________ 37
nitrofurantoin macrocryst
___________________ 37
nitrofurantoin monohydrat
___________________ 37
nitroglycerin ____________6
nitroglycerin er _________6
nitroglycerin lingual _____6
nitroglycerin transdermal 6
NITROSTAT _____________6
nitro-time ______________6
niva-fol_______________ 24
NIVA-PLUS ___________ 31
NIVATOPIC PLUS ______ 22
nizatidine cap 150mg _ 36
NIZATIDINE SOL
15MG/ML _________ 36
NOCTIVA _____________ 25
nolix _________________ 22
nora-be ______________ 19
NORCO ________________5
NORDITROPIN FLEXPRO 25
norethindrone __19, 26, 34
norethindrone & ethinyl e
___________________ 19
norethindrone acetate_ 19,
34
norethindrone acetate/eth
___________________ 19
norethindrone/ethinyl est
___________________ 19
norgestimate/ethinyl estr
___________________ 19
NORITATE ____________ 22
norlyda ______________ 19
normal saline flush ____ 30
normal saline flush for f 30
normal saline i.v. flush _ 30
NORPACE CR ___________6
NORTHERA ___________ 38
nortrel 0.5/35 (28) ____ 19
nortrel 1/35 __________ 19
nortrel 7/7/7 _________ 19
nortriptyline hcl _________9
NORVASC ____________ 16
NORVIR ______________ 15
NOVAREL ____________ 25
NOVOL OG____________ 10
NOVOL OG FLEXPEN ___ 10
NOVOL OG MIX 70/30 _ 10
NOVOLOG MIX 70/30
PREFILL____________ 10
NOVOL OG PENFILL ____ 10
NOXAFIL _____________ 11
NOXIFOL-D ___________ 28
np thyroid 120 ________ 36
np thyroid 15 _________ 36
np thyroid 30 _________ 36
np thyroid 60 _________ 36
np thyroid 90 _________ 36
48
NUCALA _______________ 7
NUCYNTA ______________ 5
NUCYNTA ER ___________ 5
NUEDEXTA ____________ 35
NULYTELY/FLAVOR PACKS
___________________ 28
NUTRIENTS ___________ 32
NUTROPIN AQ NUSPIN 10
___________________ 25
NUTROPIN AQ NUSPIN 20
___________________ 25
NUVAIL _______________ 22
NUVARING____________ 19
NUVESSA _____________ 38
NUVIGIL _______________ 3
nyamyc _______________ 22
nystatin___________ 11, 22
nystatin/triamcinolone _ 22
nystatin/triamcinolone ac
___________________ 22
nystop ________________ 22
OB COMPLETE ONE ____ 31
OB COMPLETE PETITE __ 31
OB COMPLETE PREMIER 31
OB COMPLETE/DHA ___ 31
OCALIVA______________ 26
ocella_________________ 19
OCREVUS _____________ 35
octreotide acetate _____ 25
OCUFLOX _____________ 33
ODACTRA ______________ 3
ODEFSEY ______________ 15
OFEV _________________ 35
ofloxacin ______________ 33
ogestrel___________ 18, 19
okebo ________________ 35
olanzapine ________ 15, 35
olanzapine odt ________ 15
olanzapine/fluoxetine __ 35
olmesartan medoxomil _ 12
olmesartan
medoxomil/amlo ___ 12
olmesartan
medoxomil/hydr ____ 12
olopatadine hcl ________ 33
olopatadine hydrochloride
___________________ 33
OLUMIANT_____________ 4
OLUX-E _______________ 22
OMECLAMOX-PAK _____ 36
omega-3-acid ethyl esters
___________________ 11
omeprazole ___________ 36
omeprazole dr_________ 36
omeprazole/sodium
bicarbo ____________ 36
OMNITROPE __________ 25
ondansetron hcl _______ 11
ondansetron hydrochloride
___________________ 11
ondansetron odt ______ 11
ONEXTON ____________ 22
ONFI __________________ 8
ONGLYZA _____________ 10
ONZETRA XSAIL _______ 29
OPDIVO ______________ 14
OPHTHALMIC AGENTS _ 32
opium _____________10, 36
opium tincture ________ 10
OPSUMIT _____________ 17
ORACEA ______________ 22
ORACIT _______________ 27
ORAMAGICRX_________ 30
ORAP ________________ 35
ORAPRED ODT ________ 20
ORENCIA ______________ 4
ORENCIA CLICKJECT ____ 4
ORENITRAM __________ 17
ORILISSA _____________ 25
ORKAMBI_____________ 35
orphenadrine citrate er 32
orsythia ______________ 19
ORTHO MICRONOR____ 19
ORTHO TRI-CYCLEN LO _ 19
ORTHO-CYCLEN _______ 19
ORTHO-NOVUM 1/35__ 19
ORTHOVISC ___________ 32
oscimin _______________ 36
oscimin sr_____________ 36
oseltamivir phosphate _ 16
OSENI ________________ 10
OSMOPREP ___________ 28
OSPHENA _____________ 25
OTEZLA ________________ 4
OTIC AGENTS _________ 34
OTOVEL ______________ 34
OTREXUP ______________ 4
OVACE PLUS _______22, 23
OVACE PLUS WASH ____ 23
OVACE WASH _________ 23
OVIDREL ______________ 25
oxandrolone ___________ 5
oxaprozin ______________ 4
OXAYDO_______________ 5
oxazepam _____________ 6
oxcarbazepine__________ 8
OXERVATE ____________ 33
oxiconazole nitrate ____ 23
OXISTAT ______________ 23
OXTELLAR XR __________ 8
oxybutynin chloride____ 37
oxybutynin chloride er _ 37
oxycodone hcl__________ 5
OXYCODONE HCL ER____ 5
oxycodone hydrochloride 5
oxycodone/acetaminophen
____________________ 5
oxycodone/aspirin ______ 5
OXYCONTIN ___________ 5
oxymorphone
hydrochloride _______ 5
Oxytocics_____________ 34
OZEMPIC _____________ 10
OZURDEX_____________ 33
pacerone ______________ 6
paliperidone er________ 15
PALYNZIQ ____________ 25
PANCREAZE __________ 24
pantoprazole sodium __ 36
pantoprazole sodium dr 36
papaverine hcl ________ 17
PARAGARD INTRAUTERINE
COP _______________ 19
paregoric _____________ 10
paricalcitol____________ 25
paroex _______________ 30
paromomycin sulfate ___ 3
paroxetine __________ 9, 35
paroxetine hcl__________ 9
paroxetine hcl er _______ 9
paroxetine hydrochloride 9
PASSIVE IMMUNIZING
AND TREATMENT
AGENTS ___________ 34
PATADAY_____________ 33
PATANASE____________ 32
PATANOL _____________ 33
PAXIL _________________ 9
PAXIL CR ______________ 9
PAZEO _______________ 33
peg-3350/electrolytes _ 28
peg-3350/nacl/na bicarbon
___________________ 28
PEGASYS _____________ 16
penicillin v potassium __ 34
PENICILLINS __________ 34
PENLAC NAIL LACQUER 23
PENNSAID ____________ 23
PENTA SA _____________ 26
pentazocine/naloxone hcl 5
pentoxifylline er _______ 27
PERCOCET _____________ 5
PERFOROMIST _________ 7
perindopril erbumine __ 12
PERJETA ______________ 14
permethrin ___________ 23
perphenazine ______ 15, 35
perphenazine/amitriptylin
___________________ 35
PERTZYE______________ 24
phenadoz_____________ 11
phenazopyridine hcl ___ 27
phenazopyridine hydrochlo
___________________ 27
phendimetrazine tartrate 3
phenelzine sulfate ______ 9
phenobarbital_________ 28
phenohytro ___________ 36
phentermine hcl________ 3
PHENYTEK______________8
phenytoin ______________8
phenytoin infatabs ______8
phenytoin sodium
extended ____________8
philith________________ 19
phospha 250 neutral __ 30
phosphasal ___________ 37
PHOSPHOLINE IODIDE _ 33
phosphorous _________ 30
phospho-trin 250 neutral
___________________ 30
PHYSICIANS EZ USE B-12
CO ________________ 28
PHYSICIANS EZ USE JOINT
T _________________ 20
PHYSICIANS EZ USE M-
PRED______________ 20
phytonadione_________ 38
PICATO ______________ 23
pilocarpine hcl ________ 30
pilocarpine hydrochloride
___________________ 30
pimozide _____________ 35
pimtrea ______________ 19
pindolol ______________ 16
pioglitazone hcl _______ 10
pioglitazone hcl/metformi
___________________ 10
piperacillin/tazobactam 34
pirmella 1/35 _________ 19
pirmella 7/7/7 ________ 19
piroxicam ______________4
PLAQUENIL ___________ 13
PLAVIX _______________ 27
PLEGRIDY ____________ 35
PLENVU ______________ 28
PLEXION _____________ 23
PLEXION CLEANSER ___ 23
PNEUM OVAX 23 ______ 37
PNEUMOVAX 23/1 DOSE
___________________ 37
PNV PRENATAL TAB PLUS
___________________ 31
PNV TABS 29-1 _______ 31
pnv-dha ______________ 31
PNV-DHA+DOCUSA TE _ 31
PODIAPN_____________ 24
PODOCON 25 IN BENZOIN
TIN _______________ 23
podofilox _____________ 23
polycin _______________ 33
polyethylene glycol 335028
poly-iron 150 forte ____ 28
polymyxin b sulfate/trime
___________________ 33
POLYTRIM ____________ 33
POLY-VI-FLOR ________ 31
POMALYST ___________ 14
portia-28 _____________ 19
49
pot chloride tab 10meq er
___________________ 30
POT CHLORIDE TAB
20MEQ ER _________ 30
potassium chloride_____ 30
potassium chloride cr __ 30
potassium chloride sr __ 30
potassium citrate er____ 27
potassium citrate/citric _ 27
PRADAXA ______________ 7
PRALUENT ____________ 11
pramipexole dihydrochlori
___________________ 14
PRAMOSONE__________ 23
prasugrel _____________ 27
PRAVACHOL __________ 11
pravastatin sodium ____ 11
praziquantel____________ 6
prazosin hcl ___________ 12
PRED FORTE __________ 33
PRED MILD____________ 33
PRED-G S.O.P. _________ 33
prednicarbate _________ 23
prednisolone ______ 20, 33
prednisolone acetate___ 33
prednisolone sol 15mg/5ml
___________________ 20
PREDNISOLONE SOL
25MG/5ML ________ 20
PREDNISONE PAK 5MG 20
prednisone tab 20mg _ 20
PREDNISONE INTENSOL 20
PREGNYL W/DILUENT
BENZYL ____________ 25
PREMARIN ____________ 26
PREMPHASE __________ 26
PREMPRO ____________ 26
PRENA 1 TRUE ________ 31
PRENA1 PEARL ________ 31
PRENAISSANCE ________ 31
PRENA TA _____________ 31
prenatabs rx __________ 31
PRENA TAL ____________ 31
prenatal 19 chw tab ___ 31
PRENATAL 19 TAB 29-
1MG_______________ 31
PRENATAL PLS MIS MV +
DHA _______________ 31
PRENA TAL PLUS _______ 31
PRENA TAL PLUS IRON__ 31
PRENATAL VITAMINS PLUS
LO _________________ 31
PRENA TE _____________ 31
PRENA TE DHA _________ 31
PRENA TE ELITE ________ 31
PRENA TE ENHANCE ____ 31
PRENA TE ESSENTIAL ___ 31
PRENA TE MINI ________ 31
PRENA TE PIXIE ________ 31
PRENA TE RESTORE ____ 31
PREPLUS______________ 31
PREPOPIK ____________ 28
PREVACID ____________ 36
PREVACID SOLUTA B ___ 36
prevalite ______________ 11
PREVIDENT 5000 BOOSTER
PL _________________ 30
PREVIDENT 5000 DRY
MOUTH____________ 30
PREVIDENT 5000 ENAMEL
PRO _______________ 30
PREVIDENT 5000 PLUS _ 30
PREVIDENT 5000
SENSITIVE__________ 30
PREVIDENT FLUORIDE _ 30
PREVIDENT RINSE _____ 30
previfem______________ 19
PREVNAR 13 __________ 37
PREZCOBIX ___________ 16
PREZISTA _____________ 16
PRIFTIN_______________ 13
PRILOSEC _____________ 36
PRIMACARE __________ 31
primidone _____________ 8
PRISTIQ _______________ 9
PROAIR HFA ___________ 7
PROAIR RESPICLICK _____ 7
probenecid ___________ 27
probenecid/colchicine _ 27
PROCARDIA XL ________ 16
prochlorperazine ______ 15
prochlorperazine maleate
___________________ 15
PROCRIT______________ 28
PROCTOCORT __________ 6
PROCTOFOAM HC ______ 6
procto-med hc _________ 6
procto-pak _____________ 6
proctosol hc____________ 6
proctozone-hc__________ 6
progesterone _________ 34
Progestins ____________ 34
PROGLYCEM __________ 10
PROGRAF CAP ______ 30
PROGRAF GRA ______ 30
PROLASTIN-C _________ 35
PROLENSA ____________ 33
PROLIA _______________ 25
PROMACTA ___________ 28
promethazine hcl ______ 11
promethazine hcl plain _ 11
promethazine hydrochlorid
___________________ 11
promethazine/codeine _ 20
promethazine/dextrometh
or _________________ 20
promethazine/phenylephri
n __________________ 20
promethazine-dm _____ 20
promethegan _________ 11
PROMETRIUM ________ 34
PROMISEB____________ 23
propafenone hcl________ 6
propafenone hcl er _____ 6
propafenone hydrochloride
____________________ 6
propantheline bromide 36
proparacaine hcl ______ 33
PROPECIA ____________ 23
propranolol hcl________ 16
propranolol hcl er _____ 16
propranolol hydrochloride
___________________ 16
propranolol/hydrochloroth
___________________ 12
propylthiouracil _______ 36
PROSCAR _____________ 27
PROSTIN VR PEDIATRIC 30
PROTONIX____________ 36
PROTOPIC ____________ 23
protriptyline hcl ________ 9
PROVENTIL HFA ________ 7
PROVERA __________ 18, 34
PROVIDA DHA ________ 31
PROVIDA OB__________ 31
PROVIGIL ______________ 3
PROZAC _______________ 9
PRUMYX _____________ 23
PSORCON ____________ 23
Psychotherapeutic and
Neurological Agents -
Misc. ______________ 34
PULMICORT ___________ 7
PULMICORT FLEXHALER 7
PULMOZYME _________ 35
PURIXAN _____________ 14
PYLERA_______________ 36
PYRIDIUM ____________ 27
pyridostigmine bromide 13
pyridostigmine bromide er
___________________ 13
QBRELIS ______________ 12
QBREXZA _____________ 23
QNASL _______________ 32
QNASL CHILDRENS ____ 32
QSYMIA _______________ 3
QTERN _______________ 10
QUARTETTE __________ 19
quasense _____________ 19
QUDEXY XR____________ 8
QUESTRAN LIGHT _____ 12
quetiapine fumarate ___ 15
quetiapine fumarate er 15
QUILLICHEW ER ________ 3
QUILLIVANT XR ________ 3
quinapril hcl __________ 12
quinapril hydrochloride 12
quinapril/hydrochlorothia
___________________ 12
quinidine gluconate cr __ 6
quinine sulfate ________ 13
QVAR REDIHALER _______7
RABAVERT ___________ 37
rabeprazole sodium ___ 36
RAGWITEK _____________3
rajani ________________ 19
raloxifene hydrochloride 25
ramipril ______________ 12
RANEXA ________________6
ranitidine hcl _________ 36
ranitidine hydrochloride 36
RAPAFLO _____________ 27
RAPAMUNE SOL
1MG/ML __________ 30
RAPAMUNE TAB 1MG 30
rasagiline mesylate ____ 14
RASUVO _______________4
RAVICTI ______________ 25
RAYALDEE____________ 25
RAYOS _______________ 20
REBIF ________________ 35
REBIF REBIDOSE ______ 35
REBIF REBIDOSE
TITRA TION ________ 35
RECEDO ______________ 23
reclipsen _____________ 19
RECOM BIVAX HB _____ 37
RECTIV _________________6
REGENECARE _________ 23
REGRA NEX ___________ 23
RELENZA DISKHALER __ 16
RELISTOR_____________ 26
RELPAX ______________ 29
REMERON ______________9
REMICADE ___________ 26
REMODULIN__________ 17
RENAGEL _____________ 26
renal caps ____________ 31
reno caps_____________ 31
RENOVA _____________ 23
RENVELA _____________ 26
repaglinide ___________ 10
REPATHA _____________ 12
REPATHA PUSHTRONEX
SYSTEM ___________ 12
REPATHA SURECLICK __ 12
REQUIP ______________ 14
REQUIP XL____________ 14
Respiratory Agents - Misc.
___________________ 35
RESTASIS _____________ 34
RESTASIS MULTIDOSE _ 34
RESTORA RX__________ 10
RETIN-A ______________ 23
RETIN-A MICRO _______ 23
RETIN-A MICRO PUMP 23
REVATIO _____________ 17
REVESTA _____________ 28
REVLIMID ____________ 30
REXUL TI______________ 15
50
REYATAZ______________ 16
RHEUMATE ___________ 24
RHOFADE _____________ 23
RHOGAM ULTRA-FILTERED
PLU________________ 34
RHOPRESSA ___________ 34
RIAX__________________ 23
ribavirin ______________ 16
RIDAURA ______________ 4
rifabutin ______________ 13
rifampin ______________ 13
riluzole _______________ 32
RIMSO-50_____________ 27
RIOMET ______________ 10
risedronate sodium ____ 25
risedronate sodium dr__ 25
RISPERDAL ____________ 15
RISPERDAL CONSTA____ 15
risperidone____________ 15
risperidone odt ________ 15
RITALIN________________ 3
RITALIN LA _____________ 3
ritonavir ______________ 16
RITUXA N _____________ 14
rivastigmine tartrate ___ 35
rivastigmine transdermal35
rivelsa ________________ 19
rizatriptan benzoate ___ 29
rizatriptan benzoate odt 29
ROBAXIN-750 _________ 32
ROCALTROL ___________ 25
ropinirole er___________ 14
ropinirole hcl __________ 14
rosadan_______________ 23
rosuvastatin calcium ___ 12
ROXICODONE __________ 5
ROZEREM _____________ 28
RUBRACA _____________ 14
RUCONEST ____________ 27
RYDAPT ______________ 14
RYTARY _______________ 14
RYTHMOL SR ___________ 6
ryvent ________________ 11
SABRIL ________________ 8
SAFYRAL ______________ 19
SALAGEN _____________ 30
SALEX ________________ 23
SALEX CREAM _________ 23
SALEX LOTION_________ 23
salicylic acid ___________ 23
salicylic acid er ________ 23
salicylic acid wart remov 23
saline flush ____________ 30
SALIVAMAX ___________ 30
salsalate _______________ 4
SANCUSO _____________ 11
SANDIMMUNE ________ 30
SANDOSTATIN LAR DEPOT
___________________ 25
SANTYL _______________ 23
SAPHRIS ______________ 15
SAVAYSA ______________ 7
SAVELLA______________ 35
SAVELLA TITRATION PACK
___________________ 35
SAXENDA ______________ 3
SEASONIQUE _________ 19
SEEBRI NEOHALER ______ 7
SEGLUROMET _________ 10
SELECT-OB+DHA ______ 31
selegiline hcl __________ 15
selenium sulfide _______ 23
selenium sulfide shampoo
___________________ 23
SEMPREX-D ___________ 20
se-natal 19 ____________ 31
SENSIPAR_____________ 25
SEREVENT DISKUS ______ 7
SERNIVO _____________ 23
SEROQUEL ____________ 15
SEROQUEL XR _________ 15
sertraline hcl ___________ 9
sertraline hydrochloride _ 9
se-tan plus ____________ 28
setlakin _______________ 19
sevelamer carbonate___ 26
sf 30, 31
sf 5000 plus ___________ 31
sharobel ______________ 19
SHINGRIX_____________ 37
sildenafil______________ 17
sildenafil citrate _______ 17
SILENOR ______________ 28
SILIQ _________________ 23
SIL-K PAD/LARGE______ 23
SILVADENE ___________ 23
SILVASORB ___________ 23
silver sulfadiazine______ 23
SIMBRINZA ___________ 34
SIMPONI INJ
100MG/ML _________ 4
SIMPONI INJ 50/0.5ML4
SIMPONI ARIA _________ 4
simvastatin ________11, 12
SINGULAIR_____________ 7
SINUVA ______________ 32
sirolimus______________ 30
SITAVIG ______________ 16
SIVEXTRO_____________ 13
SKLICE________________ 23
SKYLA ________________ 19
SKYRIZI _______________ 23
SOD SUL/SULF EMU 10-5%
___________________ 23
sod sul/sulf pad 10-4% _ 23
sodium chloride 0.9%__ 27
sodium chloride 0.9% __ 27
sodium chloride flush __ 30
sodium citrate/citric aci 27
sodium fluoride _______ 30
sodium polystyrene sulfon
___________________ 30
sodium sulfacetamide _23,
34
sodium sulfacetamide
wash ______________ 23
SOLIQUA 100/33 ______ 10
SOLODY N ____________ 35
SOLOSEC ______________ 3
SOLU-CORTEF_________ 20
SOLU-M EDROL ________ 20
SOMA ________________ 32
SOMATULINE DEPOT __ 25
SOMAVERT ___________ 25
SOOLANTRA __________ 23
SORILUX _____________ 23
sotalol hcl ____________ 16
sotalol hcl (af)_________ 16
sotalol hydrochloride (af 16
sotalol hydrocholride __ 16
SOTYLIZE _____________ 16
SPINOSAD ____________ 23
SPINRAZA ____________ 32
SPIRIVA HANDIHALER __ 7
SPIRIVA RESPIMAT _____ 7
spironolactone ________ 25
spironolactone/hydrochlor
___________________ 25
SPORANOX ___________ 11
sprintec 28 ___________ 19
SPRITAM ______________ 8
SPRIX _________________ 4
SPRYCEL ______________ 14
sps___________________ 30
sronyx________________ 19
ssd___________________ 23
SSKI__________________ 20
SSS 10-5 ______________ 23
STAMARIL ____________ 37
STAXYN ______________ 17
STEGLATRO___________ 10
STEGLUJAN ___________ 10
STELARA INJ 45MG/0.5
___________________ 23
STELARA INJ 5MG/ML
___________________ 26
STENDRA _____________ 17
sterile water irrigation _ 30
STIMATE _____________ 25
STIOL TO RESPIMAT_____ 7
STIVARGA ____________ 14
STRA TTERA ____________ 3
STRIANT_______________ 5
STRIBILD _____________ 16
STRIVERDI RESPIMA T___ 7
STROMECTOL __________ 6
SUBOXONE ____________ 5
subvenite______________ 8
SUCRAID _____________ 24
SUCRALFATE SUS
1GM/10ML ________ 36
sucralfate tab 1gm ___ 36
SULFACET SOD OIN 10%
OP ________________ 34
sulfacetamid lot 10% __ 23
sulfacetamide
sodium/pred _______ 34
sulfacetamide sodium/sulf
___________________ 23
sulfacleanse 8/4_______ 23
sulfamethoxazole/trimetho
___________________ 13
sulfasalazine __________ 26
sulfatrim pediatric_____ 13
sulindac ________________4
SUMADAN WA SH _____ 23
sumatriptan __________ 29
sumatriptan succinate _ 29
sumatriptan succinate ref
___________________ 29
sumatriptan/naproxen sodi
___________________ 29
SUMAXIN ____________ 23
SUPARTZ FX __________ 32
SUPPRELIN LA ________ 25
SUPRAX ______________ 17
SUPREP BOWEL PREP KIT
___________________ 29
SUSTIVA _____________ 16
SUTENT ______________ 14
syeda ________________ 19
SYMAX DUOTAB ______ 36
SYMBICORT ____________7
SYMDEKO ____________ 35
SYMJEPI______________ 38
SYMLINPEN 120 ______ 10
SYMLINPEN 60________ 10
SYMPROIC ___________ 26
SYNAGIS _____________ 34
SYNALAR __________ 22, 23
SYNAREL _____________ 25
SYNERA ______________ 23
SYNERDERM __________ 23
SYNJARDY ____________ 10
SYNJARDY XR _________ 10
SYNTHROID __________ 36
SYNVISC______________ 32
SYNVISC ONE _________ 32
SYPRINE______________ 30
TABLOID _____________ 14
TACLONEX ___________ 23
tacrolimus ____________ 23
tadalafil ______________ 17
TAFINLAR ____________ 14
TAGRISSO ____________ 14
TALTZ ________________ 23
TALZENNA ___________ 14
TAMIFLU _____________ 16
tamoxifen citrate______ 14
51
tamsulosin hcl _________ 27
tamsulosin hydrochloride
___________________ 27
TAPERDEX 6-DAY ______ 20
TARCEVA _____________ 14
TARGADOX ___________ 35
tarina fe 1/20 _________ 19
tarina fe 1/20 eq_______ 19
TARON-C DHA _________ 31
TASIGNA ______________ 14
TAVALISSE ____________ 27
TAYTULLA_____________ 19
tazarotene ____________ 23
TAZORAC CRE 0.1% _ 23
TAZORAC GEL 0.1%__ 23
taztia xt_______________ 16
TECFIDERA ____________ 35
TECFIDERA STARTER PACK
___________________ 35
TEFLARO______________ 17
TEGRETOL _____________ 8
TEGRETOL-XR __________ 8
TEKTURNA ____________ 12
TEKTURNA HCT________ 12
telmisartan____________ 12
telmisartan/amlodipine 12
telmisartan/hydrochloroth
___________________ 12
temazepam ___________ 28
TEMOVA TE ___________ 23
temozolomide _________ 14
TENIVAC ______________ 36
tenofovir disoproxil fuma
___________________ 16
TENORMIN ___________ 16
terazosin hcl __________ 12
terbinafine hcl _________ 11
terbinafine hydrochloride
___________________ 11
terbutaline sulfate ______ 7
terconazole ___________ 38
TESTIM ________________ 5
TESTOPEL ______________ 5
testosterone cypionate __ 5
testosterone enanthate _ 5
testosterone topical solu 5
TETANUS/DIPHTHERIA
TOXOID ____________ 36
tetrabenazine _________ 35
tetracaine hcl__________ 34
tetracaine hydrochloride34
tetracycline hydrochlorid
___________________ 35
Tetracyclines __________ 35
TETRIX________________ 23
TEXACORT ____________ 23
THEO-24 _______________ 7
theophylline er _________ 7
THIOLA _______________ 27
thioridazine hcl ________ 15
thiothixene ___________ 15
THRIVITE RX __________ 31
THYROGEN ___________ 24
THYROID AGENTS _____ 35
tiagabine hydrochloride _ 8
TIAZAC _______________ 16
TIKOSYN_______________ 6
tilia fe ________________ 19
timolol gel sol 0.25% op 34
TIMOLOL GEL SOL 0.5%
OP ________________ 34
timolol maleate _______ 16
TIMOPTIC ____________ 34
TIMOPTIC OCUDOSE ___ 34
tinidazole _____________ 13
TIROSINT _____________ 36
TIVICAY ______________ 16
TIVORBEX _____________ 4
tizanidine hcl __________ 32
tizanidine hydrochloride 32
tl gard rx______________ 28
TL G-FOL OS___________ 31
TOBI PODHALER________ 3
TOBRADEX OIN 0.3-0.1%
___________________ 34
TOBRADEX SUS 0.3-0.1%
___________________ 34
TOBRADEX ST _________ 34
tobramycin _________ 3, 34
tobramycin sulfate_____ 34
tobramycin/dexamethason
e __________________ 34
TOBREX ______________ 34
TOLAK________________ 23
tolmetin sodium ________ 4
tolterodine tartrate ____ 37
tolterodine tartrate er _ 37
TOPAMAX _____________ 8
TOPAMAX SPRINKLE____ 8
TOPICORT ____________ 23
topiramate_____________ 8
TOPIRAMA TE ER _______ 8
TOPROL XL____________ 16
torsemide ____________ 25
TOUJEO MAX SOLOSTAR
___________________ 10
TOUJEO SOLOSTAR ____ 10
TOVIAZ _______________ 37
Toxoids_______________ 36
TRACLEER ____________ 17
TRADJENTA ___________ 10
tramadol hcl ___________ 5
TRAMADOL HCL CAP
150MG ER __________ 5
tramadol hcl tab 200mg er
____________________ 5
tramadol hydrochloride/ac
____________________ 5
trandolapril ___________ 13
trandolapril/verapamil hc
___________________ 13
tranexamic acid _______ 28
TRANSDERM -SCOP ____ 11
tranylcypromine sulfate _ 9
TRAVATAN Z__________ 34
trazodone hydrochloride 9
TREL EGY ELLIPTA _______ 7
TREMFYA _____________ 23
TRESIBA FLEXTOUCH __ 10
tretinoin______________ 23
tretinoin microsphere__ 23
tretinoin microsphere pum
___________________ 23
TREXALL______________ 14
TREXIMET ____________ 29
tri femynor ___________ 19
triamcinolone acetonide
________________ 23, 31
triamcinolone acetonide d
___________________ 31
triamterene/hydrochloroth
___________________ 25
TRIANEX _____________ 23
triazolam _____________ 28
TRIBENZOR ___________ 13
TRICARE PRENATAL DHA
ONE/ ______________ 31
tricitrates _____________ 27
TRICOR_______________ 12
triderm_______________ 23
TRIDESILON __________ 23
trientine hydrochloride 30
tri-estarylla ___________ 19
trifluoperazine hcl _____ 15
trifluridine ____________ 34
trigels-f forte__________ 28
TRIGLIDE _____________ 12
trihexyphenidyl hcl ____ 15
tri-legest fe ___________ 19
TRILEPTAL _____________ 8
tri-linyah _____________ 19
TRILIPIX ______________ 12
tri-lo-estarylla _________ 19
tri-lo-marzia __________ 19
tri-lo-sprintec _________ 19
TRI-LUMA ____________ 23
trilyte ________________ 29
trimethobenzamide hcl 11
trimethoprim ______ 13, 34
trimethoprim sulfate/poly
___________________ 34
trimipramine maleate___ 9
trinatal rx 1 ___________ 31
TRINTELLIX ____________ 9
triphrocaps ___________ 31
tri-previfem___________ 19
tri-sprintec ___________ 19
TRISTART DHA ________ 31
TRIUM EQ_____________ 16
tri-vitamin/fluoride ____ 31
trivora-28 ____________ 19
tri-vylibra_____________ 19
TROKENDI XR___________8
tropicamide __________ 34
trospium chloride _____ 37
trospium chloride er ___ 37
TRULANCE ___________ 26
TRULICITY ____________ 10
TRUM ENBA __________ 37
TRUSOPT_____________ 34
TRUVADA ____________ 16
TUBERSOL ____________ 24
TUDORZA PRESSAIR _____7
tulana________________ 19
TUZISTRA XR _________ 20
TWINRIX _____________ 37
tydemy_______________ 19
TYLENOL/CODEINE #3 ___5
TYLENOL/CODEINE #4 ___5
TYMLOS______________ 26
TYPHIM VI ___________ 37
TYSABRI______________ 35
TYVASO ______________ 17
TYVASO REFILL _______ 17
UCERIS A ER 2MG/ACT 6
UCERIS TAB 9MG __ 20
UDENYCA ____________ 28
ULCER
DRUGS/ANTISPASMODI
CS/ANTICHOLINERGICS
___________________ 36
ULESFIA ______________ 24
ULORIC ______________ 27
ultimatecare one ______ 31
ULTRAM _______________5
ULTRAVATE __________ 24
unithroid _____________ 36
UPTRAVI _____________ 17
urea _________________ 24
urea nail _____________ 24
URE-K________________ 24
urelle ________________ 37
uribel ________________ 37
URIMAR-T____________ 37
Urinary Anti-infectives 36
Urinary Antispasmodics 37
uro-458 ______________ 37
UROCIT-K 10__________ 27
UROGESIC -BLUE ______ 37
uro-mp_______________ 37
URSO 250 ____________ 27
URSO FORTE__________ 27
ursodiol ______________ 27
ustell ________________ 37
UTIBRON NEOHALER ____7
UTOPIC ______________ 24
VACCINES ____________ 37
VAGIFEM_____________ 38
VAGINAL PRODUCTS __ 37
52
valacyclovir hcl ________ 16
valacyclovir hydrochlorid16
VALCYTE ______________ 16
valganciclovir__________ 16
valganciclovir hydrochlor16
VALIUM _______________ 6
valproic acid____________ 8
valsartan__________ 12, 13
valsartan/hydrochlorothia
___________________ 13
VALTREX______________ 16
VANATOL LQ ___________ 4
vancomycin hcl ________ 13
vandazole _____________ 38
VANIQA ______________ 24
vanoxide-hc ___________ 24
VAQTA _______________ 37
vardenafil hydrochloride 17
VARIVAX______________ 37
VARUBI _______________ 11
VASCEPA _____________ 12
VASCULERA ___________ 24
Vasopressors__________ 38
VAXCHORA ___________ 37
VAYARIN _____________ 24
VAYARIN PLUS ________ 24
v-c forte ______________ 31
VECTICAL _____________ 24
VELCADE______________ 14
velivet ________________ 19
VELPHORO____________ 27
VELTASSA _____________ 30
VELTIN _______________ 24
VEMLIDY _____________ 16
VENCLEXTA ___________ 14
VENCLEXTA STARTING
PACK ______________ 14
VENELEX ______________ 24
venlafaxine hcl _________ 9
venlafaxine hcl er _______ 9
venlafaxine hydrochloride9
VENOFER _____________ 28
VENTOLIN HFA _________ 7
verapamil hcl ______ 16, 17
verapamil hcl er _______ 16
verapamil hcl sr________ 17
verapamil hydrochloride 17
VERDESO _____________ 24
VEREGEN _____________ 24
VERIPRED 20 __________ 20
VERZENIO_____________ 14
VESICARE _____________ 37
VIAGRA_______________ 17
VIBERZI _______________ 27
VIBRAMYCIN __________ 35
vicodin ________________ 5
vicodin es ______________ 5
vicodin hp______________ 5
VICTOZA ______________ 10
vienva ________________ 19
vigabatrin______________ 8
VIGAMOX ____________ 34
VIIBRYD _______________ 9
VIIBRYD STARTER PACK _ 9
vilamit mb ____________ 37
VIMOVO_______________ 4
VIMPAT _______________ 8
VINATE M ____________ 31
vinate one ____________ 31
VIOKACE _____________ 24
viorele________________ 19
VIRASAL ______________ 24
VIREAD _______________ 16
VIRT-C DHA ___________ 32
virt-caps ______________ 32
virt-gard ______________ 28
virt-phos 250 neutral___ 30
VIRT-PN ______________ 32
VIRT-PN DHA _________ 32
VISBIOME ____________ 24
VITAFOL ______________ 32
VITAFOL FE+ __________ 32
VITAFOL GUMMIES ____ 32
VITAFOL UL TRA _______ 32
VITAFOL-NA NO _______ 32
VITAFOL-OB __________ 32
VITAFOL-OB+DHA _____ 32
VITAFOL-ONE _________ 32
VITAMEDMD ONE
RX/QUATREFO _____ 32
VITAMEDMD REDICHEW
RX ________________ 32
vitamin k1 ____________ 38
VITAMINS _________31, 38
vitamins a/c/d/fluoride_ 32
VITAPEARL____________ 32
VITATRUE ____________ 32
VIVELLE-DOT__________ 26
VIVITROL _____________ 11
VIVLODEX _____________ 4
VIVOTIF ______________ 37
VOL-PLUS_____________ 32
VOL-TAB RX___________ 32
VOLTAREN____________ 24
voriconazole __________ 11
VOSEVI _______________ 16
VOTRIENT ____________ 14
VP-PNV-DHA __________ 32
VPRIV ________________ 28
VRAYLAR _____________ 15
VSL#3 DS _____________ 10
VUSION ______________ 24
vyfemla_______________ 19
vylibra________________ 19
VYNDAQEL ___________ 17
VYTONE ______________ 24
VYTORIN _____________ 12
VYVANSE ______________ 3
VYZULTA _____________ 34
warfarin sodium________ 7
WELCHOL ____________ 12
WELLBUTRIN SR________ 9
WELLBUTRIN XL ________ 9
wera _________________ 19
WESTHROID __________ 36
WP THY ROID _________ 36
wymzya fe ____________ 19
XALATAN _____________ 34
XALKORI _____________ 14
XANAX ________________ 6
XARELTO ______________ 7
XARELTO STARTER PACK 7
XELJANZ_______________ 4
XELJANZ XR____________ 4
XENAZINE ____________ 35
XERAC AC ____________ 24
XERESE _______________ 24
XERMEL O ____________ 27
XEROFORM OCCLUSIVE
PETROL ____________ 24
XGEVA _______________ 26
XHANCE ______________ 32
XIAFLEX ______________ 30
XIFAXAN _____________ 13
XIGDUO XR ___________ 10
XIIDRA _______________ 34
XIMINO ______________ 35
XOFLUZA _____________ 16
XOLAIR________________ 7
XOLEGEL _____________ 24
XOPENEX ______________ 7
XOPENEX HFA _________ 7
XRYLIX _______________ 24
XTAMPZA ER __________ 5
XTANDI ______________ 14
XULANE ______________ 19
XULTOPHY 100/3.6 ____ 10
XYLOCAINE ___________ 29
XYLOCAINE-MPF ______ 29
XYREM _______________ 35
XYZBAC ______________ 24
YASMIN 28 ___________ 19
YAZ __________________ 19
YF-VAX _______________ 37
YOSPRALA ____________ 27
YUPELRI _______________ 7
yuvafem ______________ 38
zafirlukast _____________ 7
zaleplon ______________ 28
zarah_________________ 19
ZARONTIN_____________ 8
ZARXIO_______________ 28
ZATEAN-PN DHA ______ 32
ZATEAN-PN PLUS______ 32
ZEGERID _____________ 36
ZEJULA _______________ 14
ZELBORAF ____________ 14
ZEMBRACE SYM TOUCH 29
ZENPEP ______________ 24
ZENZEDI________________3
ZEPATIER_____________ 16
ZESTRIL ______________ 13
ZETIA ________________ 12
ZETONNA ____________ 32
ZIANA________________ 24
zidovudine ________ 15, 16
zileuton er______________7
ZIOPTAN _____________ 34
ziprasidone hcl ________ 15
ZIPSOR_________________4
ZIRGAN ______________ 34
ZITHRA NOL ___________ 24
ZITHROMAX __________ 29
ZITHROMAX Z-PAK ____ 29
ZOFRA N______________ 11
ZOHYDRO ER ___________5
ZOLADEX _____________ 14
zoledronic acid________ 26
zolmitriptan __________ 29
zolmitriptan odt_______ 29
ZOLOFT ________________9
zolpidem tartrate _____ 28
zolpidem tartrate er ___ 28
ZOMACTON __________ 26
ZOMIG SPR 5MG __ 29
ZOMIG TAB 5MG __ 29
ZOMIG ZMT __________ 29
ZONAL ON ____________ 24
ZONEGRA N_____________8
zonisamide _____________8
ZONTIVITY ___________ 27
ZORTRESS ____________ 30
ZORV OLEX _____________4
ZOSTAVAX ___________ 37
zovia 1/35e ___________ 19
ZOVIRAX _____________ 24
ZTLIDO _______________ 24
ZUBSOLV _______________5
ZULRESSO ______________9
ZUPLENZ _____________ 11
ZYCLARA _____________ 24
ZYCLARA PUMP _______ 24
ZYFLO__________________7
ZYFLO CR_______________7
ZYLET ________________ 34
ZYMAXID_____________ 34
ZYPREXA _____________ 15
ZYPREXA ZYDIS _______ 15
ZYTIGA TAB 250MG 14
ZYTIGA TAB 500MG 14
ZYVIT ________________ 24