LA Care Formulary
Transcript of LA Care Formulary
LA Care FormularyMarch 2014
INTRODUCTION
ForewordThis document represents the efforts of L.A. Care Health Plan’s Pharmacy Therapeutics and New TechnologyCommittee (PT&T) to provide physicians and pharmacists with a method to begin to evaluate the various drug productsavailable. The medical treatment of patients is frequently relative to the practical application of drug therapy. Due to thevast availability of medication therapy and treatment modalities, a reasonable program of drug product selection anddrug usage must be developed. The goal of the L.A. Care Formulary is to enhance the physician and pharmacist’sabilities to provide optimal cost effective drug therapy for patients. The development, maintenance, and improvement of this process are evolutionary and require constant attention. Thisis accomplished by the L.A. Care PT&T Committee. The Formulary is a continually reviewed and revised list of drugs,which mirror the prevailing clinical opinion of the PT&T Committee. Unfortunately, this dynamic process does not allowthis document to be completely accurate at all times. To accommodate the necessary changes of this document,updates are available online at: http://www.lacare.org. As you use this Formulary, you are encouraged to review theinformation and provide your input and comments to the L.A. Care PT&T Committee. The L.A. Care PT&T Committee uses the following criteria in the evaluation of drug selection for the L.A. CareFormulary:
• Drug safety profile• Drug efficacy• Comparison of relevant drug benefits to current formulary agents of similar use, while minimizing duplications• Equitable cost and outcomes of the total cost of drug and medical care
How to Use the FormularyThe Formulary is a list of covered and preferred drug agents for L.A. Care members. All drugs are listed by theirgeneric names and most common proprietary (branded) name. The Formulary may be accessed by using the index,either by generic or proprietary name (in small capital letters) and by therapeutic drug category. Any non-genericallyavailable drug not found in this Formulary listing, or any Formulary updates published by L.A. Care shall be considereda Non-Formulary drug. All drugs are listed in each category in alphabetical order by generic name. Where an FDA approved generic isavailable for the listed generic name, the generic name is bolded. For certain agents within the Drug Formulary, a recommended prescribing guideline may apply. These are denotedthroughout the document using the following symbols: Symbol Restriction Description
AGE Age Edit Coverage may depend on patient age
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Symbol Restriction Description
COM Carve Out Edit Carve out for Medi-Cal members (covered by Medi-Cal fee-for-service), no restrictions for Healthy Kids and Healthy Families
COM/MD Carve Out / Physician SpecialtyEdit
Carve out for Medi-Cal members (covered by Medi-Cal fee-for-service) / Coverage may depend on prescribing physician’sspecialty or board certification for Healthy Kids and HealthyFamilies
COM/PA Carve Out / Prior Authorization Carve out for Medi-Cal members (covered by Medi-Cal fee-for-service) / Prior Authorization required for Healthy Kids andHealthy Families
G Gender Edit Coverage may depend on patient gender
MD Physician Specialty Edit Coverage may depend on prescribing physician’s specialty orboard certification
PA Prior Authorization Requires specific physician request process
QL Quantity Limit Coverage may be limited to specific quantities per prescriptionand/or time period
ST Step Therapy Coverage may depend on previous use of another drug
OTC Over the Counter Coverage of OTC medication for all lines of businesses,including Healthy Families and Healthy Kids.
Please refer to the prescribing guideline appendix within this document for details regarding specific agents.
Benefit Coverage and LimitationsThis printed Formulary does not provide information regarding the specific coverage and limitations an individualmember may have. Many members have specific benefit inclusions, exclusions, copays, or a lack of coverage, whichare not reflected in the Formulary. The Formulary applies only to outpatient drugs provided to members, and does not apply to medications used ininpatient settings. If a member has any specific questions regarding their coverage, they should contact their L.A. CareHealth Plan Member Services department at 1-888-839-9909 (TTY 1-866-522-2731).
Depending upon a member’s specific benefit parameters, the following topicsmay apply: 1. Generic Substitution
• When available, FDA approved generic drugs are to be used in all situations, regardless of the brand nameindicated. The generic names are bolded in the formulary listing wherever an FDA approved generic drugproduct is available. Greater economy is realized through the use of generic equivalents. This policy is notmeant to preclude or supplant any state statutes that may exist. All drugs that are or become availablegenerically are subject to review by L.A. Care’s PT&T Committee.
• Drug product will be approved for generic substitution by the L.A. Care PT&T Committee. This list is reviewed and updated periodically based on the clinical literature and available pharmacokineticprinciples of the drug products. If a member or physician requests a brand name product in lieu of an approved generic, the member and thephysician determines that there is a documented medical need for the brand equivalent, a request for coveragemay be made using the medication request process.
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2. Step TherapyL.A. Care uses Step Therapy to promote cost-effective pharmaceutical management when there are multipleeffective drugs to treat a condition. Drugs that are listed in the Formulary as Step Therapy (ST) require one ormore “prerequisite” first step drugs to be tried before progressing to the second step drug. If medically necessary,a second step medication can be obtained without first trying a first step medication by submitting a completedMedication Request Form. Each request will be reviewed on an individual patient need. Approval will be given if adocumented medical need exists. The following basic guidelines are used:• The use of the first step drug is contraindicated in the patient.• The first step drug is not suited for the present patient care need, and the drug selected is required for patient
safety.• The use of the first step drug may provoke an underlying condition, which would be detrimental to patient care.
3. Medication Request Process
Depending upon plan benefit design, a medication request process may apply as follows:A. Formulary Agents
Drugs that are listed in the Formulary as Prior Authorization (PA) require evaluation, per L.A. Care PT&TCommittee Prior Authorization guidelines prior to dispensing at a network pharmacy. Each request will bereviewed on individual patient need. If the request does not meet the guidelines established by the PT&TCommittee, the request will not be approved and alternative therapy may be recommended.
B. Non-Formulary AgentsAny non-generically available drug not found in the Formulary listing, or any Formulary updates published byL.A. Care, shall be considered a Non-Formulary drug. Coverage for non-formulary agents may be applied forin advance by the physician. Each request will be reviewed on individual patient need. Approval will be given ifa documented medical need exists. The following basic guidelines are used:• The use of Formulary Drugs is contraindicated in the patient.• The patient has failed an appropriate trial of Formulary or related agents.• The choices available in the Formulary are not suited for the present patient care need, and the drug
selected is required for patient safety.• The use of a Formulary drug may provoke an underlying condition, which would be detrimental to patient
care.C. Obtaining Coverage
Coverage, questions or information regarding the medication request or formulary process may be obtainedby:1. Faxing a fully completed and signed Medication Request Form to MedImpact at (800) 681-7651.2. Contacting MedImpact at (800) 788-2949 and providing all necessary information requested. MedImpact will provide an authorization number, specific for the medical need, for all approved requests. Non-approved requests may be appealed. The prescriber must provide information to support the appeal on thebasis of medical necessity. Prior Authorization is generally not available for drugs that are specificallyexcluded by benefit design.
4. Therapeutic InterchangeL.A. Care may use Therapeutic Interchange to promote rational pharmaceutical therapy when evidence suggeststhat outcomes can be improved by substituting a drug that is therapeutically equivalent but chemically differentfrom the prescribed drug. Improved outcomes include, but are not limited to, enhanced compliance, superior side-effect or risk profile, clinically superior results, and equivalent clinical results at a reduced cost. TherapeuticInterchange protocols are never automatic; a dispensing provider may not substitute an alternate, therapeuticallyequivalent, drug for a prescribed drug without the knowledge and authorization of the prescribing practitioner. Drugs may be considered for Therapeutic Interchange if they are:1. High risk2. High volume3. High cost4. Overused in routine conditions.
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In designing Therapeutic Interchange protocols, drug characteristics are considered including:1. Efficacy2. Effectiveness3. Dosage Formulation4. Safety5. Cost6. Pharmacoeconomic variables
5. General ExclusionsA. Over the Counter (OTC) medications or their equivalents are not covered for Healthy Families or Healthy Kids
members, unless otherwise specified in the Formulary listing. OTC medications are available for Medi-Calmembers subject to formulary coverage of these agents.
B. Drugs specifically listed as not covered are not covered.C. Any drug products used for cosmetic purposes are not covered.D. Infertility AgentsE. Experimental drug products, or any drug product used in an experimental manner, are not covered.F. Non self-administered injectable drug products are not covered unless otherwise specified in the Formulary
listing.G. Foreign drugs or drugs not approved by the United States Food & Drug Administration are not covered. The PT&T Committee recognizes that not all medical needs can be met with this document and encourageinquiries about alternative therapies.
Pharmacist and Physician CommunicationThe Formulary is a tool to promote cost-effective prescription drug use. The PT&T Committee has made every attemptto create a document that meets all therapeutic needs; however, the art of medicine makes this a formidable task. L.A.Care welcomes the participation of physicians, pharmacists, and ancillary medical providers, in this dynamic process.Physicians and pharmacists are highly encouraged to direct any suggestions, comments or formulary additions to L.A.Care via e-mail to [email protected] or by mail at the following address:
Chairperson, Pharmacy & Therapeutics CommitteeL.A. Care Health Plan1055 W 7th Street, 9th FloorLos Angeles, CA 90017
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ALLERGY2nd Gen Antihistamine & Decongestant
CombinationsT1 cetirizine
hcl/pseudoephedrineCETIRIZINE-PSEUDOEPHEDRINE(OTC)
QL
T1 fexofenadine/pseudoephedrine
ALLERGY RELIEFD(OTC)
ST
T1 loratadine/pseudoephedrine
LORATADINE-D(TABER 12H)(OTC)
QL
T1 loratadine/pseudoephedrine
LORATADINE-D(TABER 24H)(OTC)
QL
T1 p-ephedsul/loratadine
ALLERGY RELIEF D-24(OTC)
QL
Antihistamines - 1st GenerationT1 chlorpheniramine
maleateALLERGY(OTC)
T1 chlorpheniraminemaleate
DIABETICTUSSIN(OTC)
T1 clemastine fumarate CLEMASTINEFUMARATE
T1 clemastine fumarate CLEMASTINEFUMARATE(OTC)
T1 cyproheptadine hcl CYPROHEPTADINEHCL
T1 dexchlorpheniraminemaleate
DEXCHLORPHENIRAMINE MALEATE
T1 diphenhydramine hcl DIPHENHYDRAMINEHCL
T1 diphenhydramine hcl DIPHENHYDRAMINEHCL(OTC)
T1 hydroxyzine hcl HYDROXYZINE HCLT1 hydroxyzine pamoateHYDROXYZINE
PAMOATET1 promethazine hcl PROMETHAZINE HCLAGE
Antihistamines - 2nd GenerationT1 cetirizine hcl CETIRIZINE HCLT1 cetirizine hcl CETIRIZINE
HCL(SOLUTION)(OTC)
T1 cetirizine hcl CETIRIZINE HCL(TABCHEW)(OTC)
PA, QL
T1 cetirizine hcl CETIRIZINEHCL(TAB)(OTC)
QL
T1 fexofenadine hcl FEXOFENADINE HCL STT1 fexofenadine hcl FEXOFENADINE
HCL(OTC)ST
T1 loratadine CHILDREN'SCLARITIN(OTC)
PA, QL
T1 loratadine LORATADINE(SOLUTION)(OTC)
AGE,QL
T1 loratadine LORATADINE(TABRDP DIS)(OTC)
AGE,QL
T1 loratadine LORATADINE(TAB)(OTC)
QL
Nasal AntihistamineT1 azelastine hcl ASTEPROT1 azelastine hcl AZELASTINE HCL
Nasal Anti-inflammatory SteroidsT1 budesonide RHINOCORT AQUA PAT1 flunisolide FLUNISOLIDET1 fluticasone furoate VERAMYST PA, QLT1 fluticasone
propionateFLUTICASONEPROPIONATE
QL
T1 mometasone furoate NASONEX PA, QLT1 triamcinolone
acetonideTRIAMCINOLONEACETONIDE
Nasal Mast Cell Stabilizers AgentsT1 cromolyn sodium CROMOLYN
SODIUM(OTC)
ANTIEMESIS/ANTIVERTIGOAntiemetic/antivertigo AgentsT1 aprepitant EMENDT1 dimenhydrinate DRIMINATE(OTC)T1 doxylamine/pyridoxine
hclDICLEGIS PA
T1 dronabinol DRONABINOL PAT1 granisetron hcl GRANISETRON HCL QLT1 meclizine hcl MECLIZINE HCLT1 meclizine hcl MECLIZINE
HCL(OTC)T1 ondansetron ONDANSETRON
ODT(TAB RDP DIS)(4MG)
QL
T1 ondansetron ONDANSETRONODT(TAB RDP DIS)(8MG)
QL
T1 ondansetron hcl ONDANSETRON HCLT1 phosp
acid/dextrose/fructose
ANTI-NAUSEA(OTC)
T1 prochlorperazineedisylate
COMPAZINE
T1 prochlorperazinemaleate
PROCHLORPERAZINE MALEATE
T1 promethazine hcl PROMETHEGAN AGET1 trimethobenzamide
hclTRIMETHOBENZAMIDE HCL
ASTHMABeta-adrenergic AgentsT1 albuterol sulfate ALBUTEROL
SULFATET1 albuterol sulfate VENTOLIN HFA QLT1 arformoterol tartrate BROVANA STT1 formoterol fumarate FORADIL PAT1 levalbuterol hcl LEVALBUTEROL HCL STT1 metaproterenol
sulfateMETAPROTERENOLSULFATE
T1 salmeterol xinafoate SEREVENT DISKUS PA
Commercial Formulary
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T1 terbutaline sulfate TERBUTALINESULFATE
Beta-adrenergic And Anticholinergic
CombinationsT1 ipratropium/albuterol
sulfateCOMBIVENT
T1 ipratropium/albuterolsulfate
COMBIVENTRESPIMAT
T1 ipratropium/albuterolsulfate
IPRATROPIUM-ALBUTEROL
Beta-adrenergic And Glucocorticoid
CombinationsT1 budesonide/formoterol
fumarateSYMBICORT PA
T1 fluticasone/salmeterol ADVAIR DISKUS PAT1 fluticasone/salmeterol ADVAIR HFA PAT1 fluticasone/vilanterol BREO ELLIPTA PAT1 mometasone/formoter
olDULERA
General Bronchodilator AgentsT1 ipratropium bromide ATROVENT HFAT1 ipratropium bromide IPRATROPIUM
BROMIDET1 tiotropium bromide SPIRIVA
Glucocorticoids, Orally InhaledT1 beclomethasone
dipropionateQVAR
T1 budesonide BUDESONIDE AGET1 budesonide PULMICORT AGET1 budesonide PULMICORT
FLEXHALERST
T1 fluticasone propionate FLOVENT DISKUST1 fluticasone propionate FLOVENT HFAT1 mometasone furoate ASMANEX(AER POW
BA)(110MCG(30))ST
T1 mometasone furoate ASMANEX(AER POWBA)(220MCG 120)
ST
T1 mometasone furoate ASMANEX(AER POWBA)(220MCG(14))
PA
T1 mometasone furoate ASMANEX(AER POWBA)(220MCG(30))
PA
T1 mometasone furoate ASMANEX(AER POWBA)(220MCG(60))
ST
Leukotriene Receptor AntagonistsT1 montelukast sodium MONTELUKAST
SODIUMT1 zafirlukast ZAFIRLUKAST PA
Mast Cell StabilizersT1 cromolyn sodium CROMOLYN SODIUM
Respiratory Aids,devices,equipmentT1 inhaler, assist devices ACE AEROSOL
CLOUD ENHANCERAGE,QL
T1 inhaler, assist devices AEROCHAMBER MINIAGE,QL
T1 inhaler, assist devices AEROCHAMBERPLUS FLOW-VU
AGE,QL
T1 inhaler, assist devices AEROCHAMBERPLUS Z STAT
AGE,QL
T1 inhaler, assist devices BREATHERITE AGE,QL
T1 inhaler, assist devices BREATHRITE AGE,QL
T1 inhaler, assist devices EASIVENT AGE,QL
T1 inhaler, assist devices E-Z SPACER AGE,QL
T1 inhaler, assist devices LITEAIRE AGE,QL
T1 inhaler, assist devices MICROCHAMBER AGE,QL
T1 inhaler, assist devices MICROSPACER AGE,QL
T1 inhaler, assist devices MONAGHAN Z STAT AGE,QL
T1 inhaler, assist devices POCKET CHAMBER AGE,QL
T1 inhaler, assist devices PRIMEAIRE AGE,QL
T1 inhaler, assist devices PROCHAMBER AGE,QL
T1 inhaler, assist devices RITEFLO AGE,QL
T1 inhaler, assist devices VORTEX AGE,QL
T1 inhaler, assist devices VORTEX VHC FROGMASK
AGE,QL
T1 inhaler, assist devices VORTEX VHCLADYBUG MASK
AGE,QL
T1 inhaler, assist devices WATCHHALER AGE,QL
T1 inhaler, assist devices WINDMILLTRAINER(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
EASIVENT AGE,QL
T1 inhaler,assistdevice,accesory
LITETOUCH AGE,QL
T1 inhaler,assistdevice,accesory
MOUTHPIECE(OTC) AGE,QL
T1 inhaler,assistdevice,accesory
ONE WAYMOUTHPIECE(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
OPTICHAMBER AGE,QL
T1 inhaler,assistdevice,accesory
OPTICHAMBERDIAMOND
AGE,QL
T1 inhaler,assistdevice,accesory
PANDA MASK(OTC) AGE,QL
T1 inhaler,assistdevice,accesory
PEDIATRICMASK(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
PEDIATRIC PANDAMASK(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
SIDESTREAMMASK(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
SIDESTREAMPEDIATRIC(OTC)
AGE,QL
Commercial Formulary
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T1 inhaler,assistdevice,accesory
SILICONE MASK AGE,QL
T1 inhaler,assistdevice,accesory
SILICONEMASK(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
VORTEX FROGMASK(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
VORTEX LADYBUGMASK(OTC)
AGE,QL
T1 inhaler,assistdevice,accesory
VORTEX(OTC) AGE,QL
T1 peak flow meter AIRZONE PEAKFLOW METER(OTC)
T1 peak flow meter AIRZONE(OTC)T1 peak flow meter ASSESS(OTC)T1 peak flow meter ASTHMA
CHECK(OTC)T1 peak flow meter ASTHMAMENTOR(OT
C)T1 peak flow meter IN-CHECK NASAL
WITH MASK(OTC)T1 peak flow meter IN-CHECK
ORAL(OTC)T1 peak flow meter INCHECK(OTC)T1 peak flow meter MICROLIFE PEAK
FLOW(OTC)T1 peak flow meter MINI-WRIGHT PEAK
FLOW METERT1 peak flow meter PEAK FLOW
METER(OTC)T1 peak flow meter PEAK-AIR(OTC)T1 peak flow meter PERSONAL
BEST(OTC)T1 peak flow meter PIKO 1(OTC)T1 peak flow meter POCKET PEAK(OTC)T1 peak flow meter POCKETPEAK(OTC)T1 peak flow meter TRUZONE PEAK
FLOW METERT1 peak flow meter/inh
asst devAEROGEAR ASTHMAACTION KIT
T1 peak flow meter/inhasst dev
ASTHMAPACKCHILDREN'S
T1 spirometers andaccessories
IN-CHECK DIAL(OTC) AGE,QL
T1 spirometers andaccessories
PFLEX TRAINER AGE,QL
T1 spirometers andaccessories
THRESHOLD IMT AGE,QL
T1 spirometers andaccessories
THRESHOLD PEP AGE,QL
T1 spirometers andaccessories
WINDMILLTRAINER(OTC)
AGE,QL
XanthinesT1 aminophylline AMINOPHYLLINET1 caffeine citrated CAFFEINE CITRATE QLT1 theophylline anhydrousTHEO-24T1 theophylline
anhydrousTHEOPHYLLINEANHYDROUS
AUTONOMIC NERVOUS SYSTEM
DISORDERSAlzheimer's Therapy, Nmda Receptor
AntagonistsT1 memantine hcl NAMENDA STT1 memantine hcl NAMENDA XR ST
Cholinesterase InhibitorsT1 donepezil hcl DONEPEZIL HCLT1 galantamine hbr GALANTAMINE HBRT1 neostigmine bromide PROSTIGMINT1 pyridostigmine
bromideMESTINON
T1 pyridostigminebromide
PYRIDOSTIGMINEBROMIDE
T1 rivastigmine EXELONT1 rivastigmine tartrate EXELONT1 rivastigmine tartrate RIVASTIGMINE
BEHAVIORAL HEALTH -
ANTIDEPRESSANTSAlpha-2 Receptor Antagonist
AntidepressantsT1 mirtazapine MIRTAZAPINE
Norepinephrine And Dopamine Reuptake
InhibT1 bupropion hcl BUPROPION XL(TAB
ER 24H)(150 MG)QL
T1 bupropion hcl BUPROPION XL(TABER 24H)(300 MG)
Selective Serotonin Reuptake InhibitorT1 citalopram
hydrobromideCITALOPRAMHBR(SOLUTION)
AGE,QL
T1 citalopramhydrobromide
CITALOPRAMHBR(TAB)(10 MG)
AGE,QL
T1 citalopramhydrobromide
CITALOPRAMHBR(TAB)(20 MG)
AGE,QL
T1 citalopramhydrobromide
CITALOPRAMHBR(TAB)(40 MG)
AGE,QL
T1 escitalopram oxalate ESCITALOPRAMOXALATE
T1 fluoxetine hcl FLUOXETINE HCLT1 fluvoxamine maleate FLUVOXAMINE
MALEATE(CAP ER24H)
ST
T1 fluvoxamine maleate FLUVOXAMINEMALEATE(TAB)
T1 paroxetine hcl PAROXETINEHCL(TAB ER 24H)
AGE,QL, ST
T1 paroxetine hcl PAROXETINEHCL(TAB)
AGE
Commercial Formulary
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T1 paroxetine hcl PAXIL AGET1 sertraline hcl SERTRALINE HCL
Serotonin-2 Antagonist/reuptake InhibitorsT1 nefazodone hcl NEFAZODONE HCLT1 trazodone hcl TRAZODONE HCL
Serotonin-norepinephrine Reuptake-inhibT1 venlafaxine hcl VENLAFAXINE HCL
ER
Ssri & 5ht1a Partial Agonist AntidepressantT1 vilazodone
hydrochlorideVIIBRYD PA
Tricyclic Antidepressant/benzodiazepine
CombinatnsT1 amitrip
hcl/chlordiazepoxideCHLORDIAZEPOXIDE-AMITRIPTYLINE
Tricyclic Antidepressant/phenothiazine
CombinatnsT1 perphenazine/amitrip
tyline hclPERPHENAZINE-AMITRIPTYLINE
Tricyclic Antidepressants & Rel. Non-sel. Ru-
inhibT1 amitriptyline hcl AMITRIPTYLINE HCLT1 amoxapine AMOXAPINET1 clomipramine hcl CLOMIPRAMINE HCLT1 desipramine hcl DESIPRAMINE HCLT1 doxepin hcl DOXEPIN HCLT1 imipramine hcl IMIPRAMINE HCLT1 imipramine pamoate IMIPRAMINE
PAMOATET1 maprotiline hcl MAPROTILINE HCLT1 nortriptyline hcl NORTRIPTYLINE HCLT1 protriptyline hcl PROTRIPTYLINE HCL
BEHAVIORAL HEALTH - OTHERAdrenergics, Aromatic, Non-catecholamineT1 amphet
asp/amphet/d-amphet
AMPHETAMINE SALTCOMBO
AGE,QL
T1 dextroamphetaminesulfate
DEXTROAMPHETAMINE SULFATE
T1 dextroamphetamine/amphetamine
AMPHETAMINE SALTCOMBO
AGE,QL
Anti-alcoholic PreparationsT1 disulfiram DISULFIRAM
Anti-anxiety DrugsT1 alprazolam ALPRAZOLAMT1 alprazolam ALPRAZOLAM
INTENSOLT1 buspirone hcl BUSPIRONE HCL
T1 chlordiazepoxide hcl CHLORDIAZEPOXIDEHCL
T1 clorazepatedipotassium
CLORAZEPATEDIPOTASSIUM
T1 diazepam DIAZEPAMT1 lorazepam LORAZEPAMT1 meprobamate MEPROBAMATET1 oxazepam OXAZEPAM
Antipsychotics,atypical,dopamine,&
Serotonin AntagT1 olanzapine OLANZAPINET1 risperidone
microspheresRISPERDAL CONSTA
T1 ziprasidone mesylate GEODON
BarbituratesT1 phenobarbital PHENOBARBITAL
Hypnotics, Melatonin Mt1/mt2 Receptor
AgonistsT1 ramelteon ROZEREM QL, ST
Narcolepsy And Sleep Disorder Therapy
AgentsT1 modafinil MODAFINIL PA, QL
Sedative-hypnotics,non-barbiturateT1 diphenhydramine hcl SLEEP TABS(OTC)T1 diphenhydramine hcl ZZZQUIL(OTC)T1 doxepin hcl SILENOR QL, STT1 doxylamine
succinateUNISOM SLEEPAID(OTC)
T1 estazolam ESTAZOLAMT1 eszopiclone LUNESTA QL, STT1 flurazepam hcl FLURAZEPAM HCLT1 temazepam TEMAZEPAMT1 triazolam TRIAZOLAMT1 zaleplon ZALEPLON QLT1 zolpidem tartrate EDLUAR QL, STT1 zolpidem tartrate INTERMEZZO QL, STT1 zolpidem tartrate ZOLPIDEM
TARTRATEQL
T1 zolpidem tartrate ZOLPIMIST QL, ST
Tx For Attention Deficit-
hyperact(adhd)/narcolepsyT1 methylphenidate hcl METHYLPHENIDATE
ER(TAB ER 24H)(18MG)
AGE,QL
T1 methylphenidate hcl METHYLPHENIDATEER(TAB ER 24H)(27MG)
AGE,QL
T1 methylphenidate hcl METHYLPHENIDATEER(TAB ER 24H)(36MG)
AGE,QL
Commercial Formulary
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T1 methylphenidate hcl METHYLPHENIDATEER(TAB ER 24H)(54MG)
AGE,QL
CARDIOVASCULAR DISEASE -
ARRHYTHMIAAntiarrhythmicsT1 amiodarone hcl AMIODARONE HCLT1 disopyramide
phosphateDISOPYRAMIDEPHOSPHATE
T1 disopyramidephosphate
NORPACE CR
T1 dofetilide TIKOSYNT1 flecainide acetate FLECAINIDE
ACETATET1 mexiletine hcl MEXILETINE HCLT1 procainamide hcl PROCAINAMIDE HCLT1 procainamide hcl PRONESTYLT1 propafenone hcl PROPAFENONE HCLT1 quinidine gluconate QUINIDINE
GLUCONATET1 quinidine sulfate QUINIDINE SULFATE
CARDIOVASCULAR DISEASE -
CARDIAC STIMULANTDigitalis GlycosidesT1 digoxin DIGOXT1 digoxin DIGOXIN
CARDIOVASCULAR DISEASE -
HYPERTENSIONAce Inhibitor/calcium Channel Blocker
CombinationT1 amlodipine
besylate/benazeprilAMLODIPINEBESYLATE-BENAZEPRIL
Ace Inhibitor/thiazide & Thiazide-like DiureticT1 benazepril/hydrochlo
rothiazideBENAZEPRIL-HYDROCHLOROTHIAZIDE
T1 captopril/hydrochlorothiazide
CAPTOPRIL-HYDROCHLOROTHIAZIDE
T1 enalapril/hydrochlorothiazide
ENALAPRIL-HYDROCHLOROTHIAZIDE
T1 fosinopril/hydrochlorothiazide
FOSINOPRIL-HYDROCHLOROTHIAZIDE
T1 lisinopril/hydrochlorothiazide
LISINOPRIL-HYDROCHLOROTHIAZIDE
T1 moexipril/hydrochlorothiazide
MOEXIPRIL-HYDROCHLOROTHIAZIDE
T1 quinapril/hydrochlorothiazide
QUINAPRIL-HYDROCHLOROTHIAZIDE
Alpha/beta-adrenergic Blocking AgentsT1 carvedilol CARVEDILOLT1 labetalol hcl LABETALOL HCL
Alpha-adrenergic Blocking AgentsT1 doxazosin mesylate DOXAZOSIN
MESYLATET1 phenoxybenzamine hclDIBENZYLINET1 prazosin hcl PRAZOSIN HCLT1 terazosin hcl TERAZOSIN HCL
Angioten.receptr Antag./cal.chanl
Blkr/thiazide CbT1 amlodipine/valsartan/h
cthiazidEXFORGE HCT ST
Angiotensin Receptor Antag./thiazide
Diuretic CombT1 azilsartan
med/chlorthalidoneEDARBYCLOR ST
T1 candesartan/hydrochlorothiazid
CANDESARTAN-HYDROCHLOROTHIAZID
T1 eprosartan/hydrochlorothiazide
TEVETEN HCT
T1 irbesartan/hydrochlorothiazide
IRBESARTAN-HYDROCHLOROTHIAZIDE
T1 losartan/hydrochlorothiazide
LOSARTAN-HYDROCHLOROTHIAZIDE
T1 olmesartan/hydrochlorothiazide
BENICAR HCT
T1 valsartan/hydrochlorothiazide
VALSARTAN-HYDROCHLOROTHIAZIDE
ST
Angiotensin Receptor Antgnst &
Calc.channel BlockrT1 amlodipine
bes/olmesartan medAZOR ST
T1 amlodipine/valsartan EXFORGE ST
Antihypertensives, Ace InhibitorsT1 benazepril hcl BENAZEPRIL HCLT1 captopril CAPTOPRILT1 enalapril maleate ENALAPRIL
MALEATET1 fosinopril sodium FOSINOPRIL
SODIUMT1 lisinopril LISINOPRILT1 moexipril hcl MOEXIPRIL HCL
Commercial Formulary
LA Care Page 9 of 59
T1 quinapril hcl QUINAPRIL HCLT1 ramipril RAMIPRILT1 trandolapril TRANDOLAPRIL
Antihypertensives, Angiotensin Receptor
AntagonistT1 azilsartan medoxomil EDARBI STT1 candesartan cilexetil CANDESARTAN
CILEXETILT1 eprosartan mesylate EPROSARTAN
MESYLATET1 irbesartan IRBESARTANT1 losartan potassium LOSARTAN
POTASSIUMT1 olmesartan medoxomil BENICART1 telmisartan TELMISARTANT1 valsartan DIOVAN ST
Antihypertensives, SympatholyticT1 clonidine CLONIDINE QLT1 clonidine hcl CLONIDINE HCLT1 guanfacine hcl GUANFACINE HCLT1 methyldopa ALDOMETT1 methyldopa METHYLDOPAT1 reserpine RESERPINE
Antihypertensives, VasodilatorsT1 hydralazine hcl HYDRALAZINE HCLT1 minoxidil MINOXIDIL
Beta-adrenergic Blocking AgentsT1 acebutolol hcl ACEBUTOLOL HCLT1 atenolol ATENOLOLT1 bisoprolol fumarate BISOPROLOL
FUMARATET1 metoprolol succinate METOPROLOL
SUCCINATET1 metoprolol tartrate METOPROLOL
TARTRATET1 nadolol NADOLOLT1 nebivolol hcl BYSTOLIC STT1 pindolol PINDOLOLT1 propranolol hcl PROPRANOLOL HCLT1 sotalol hcl SOTALOLT1 timolol maleate TIMOLOL MALEATE
Beta-adrenergic Blocking Agents/thiazide &
RelatedT1 atenolol/chlorthalido
neATENOLOL-CHLORTHALIDONE
T1 bisoprololfumarate/hctz
BISOPROLOL-HYDROCHLOROTHIAZIDE
T1 metoprolol/hydrochlorothiazide
METOPROLOL-HYDROCHLOROTHIAZIDE
Calcium Channel Blocking AgentsT1 amlodipine besylate AMLODIPINE
BESYLATE
T1 diltiazem hcl DILTIAZEM 24HR ERT1 felodipine FELODIPINE ERT1 nicardipine hcl NICARDIPINE HCLT1 nifedipine NIFEDIPINE ERT1 verapamil hcl VERAPAMIL ER
Loop DiureticsT1 bumetanide BUMETANIDET1 furosemide FUROSEMIDE
Potassium Sparing DiureticsT1 eplerenone EPLERENONE STT1 spironolactone SPIRONOLACTONE
Potassium Sparing Diuretics In CombinationT1 spironolact/hydrochl
orothiazidSPIRONOLACTONE-HCTZ
T1 triamterene/hydrochlorothiazid
TRIAMTERENE-HCTZ
Pulm.anti-htn,sel.c-gmp Phosphodiesterase
T5 InhibT1 sildenafil citrate SILDENAFIL PA
Pulmonary Anti-htn, Endothelin Receptor
AntagonistT1 ambrisentan LETAIRIS PAT1 bosentan TRACLEER PA
Renin Inhib, Direct/calc. Channel
Blkr/thiazide CbT1 aliskiren/amlodipin/hct
hiazideAMTURNIDE PA
Renin Inhibitor, DirectT1 aliskiren hemifumarate TEKTURNA PA
Renin Inhibitor, Direct & Calcium Channel
BlockerT1 aliskiren/amlodipine
besylateTEKAMLO PA
Renin Inhibitor, Direct/thiazide Diuretic
CombT1 aliskiren/hydrochlorothi
azideTEKTURNA HCT PA, ST
Thiazide And Related DiureticsT1 chlorthalidone CHLORTHALIDONET1 hydrochlorothiazide HYDROCHLOROTHIA
ZIDET1 indapamide INDAPAMIDET1 metolazone METOLAZONE
Commercial Formulary
LA Care Page 10 of 59
CARDIOVASCULAR DISEASE - LIPID
IRREGULARITYAntihyperlip.hmg Coa Reduct
Inhib&cholest.ab.inhibT1 ezetimibe/simvastatin VYTORIN(TAB)(10
MG-10MG)ST
T1 ezetimibe/simvastatin VYTORIN(TAB)(10MG-20MG)
ST
T1 ezetimibe/simvastatin VYTORIN(TAB)(10MG-40MG)
ST
T1 ezetimibe/simvastatin VYTORIN(TAB)(10MG-80MG)
Antihyperlipidemic - Apo B-100 Synthesis
InhibitorT1 mipomersen sodium KYNAMRO PA
Antihyperlipidemic - Hmg Coa Reductase
InhibitorsT1 atorvastatin calcium ATORVASTATIN
CALCIUMT1 fluvastatin sodium FLUVASTATIN
SODIUMST
T1 lovastatin LOVASTATINT1 pitavastatin calcium LIVALO PAT1 pravastatin sodium PRAVASTATIN
SODIUMT1 simvastatin SIMVASTATIN(TAB)
(10 MG)T1 simvastatin SIMVASTATIN(TAB)
(20 MG)T1 simvastatin SIMVASTATIN(TAB)
(40 MG)T1 simvastatin SIMVASTATIN(TAB)(5
MG)T1 simvastatin SIMVASTATIN(TAB)
(80 MG)ST
Bile Salt SequestrantsT1 cholestyramine (with
sugar)CHOLESTYRAMINE
T1 cholestyramine/aspartame
CHOLESTYRAMINELIGHT
T1 colesevelam hcl WELCHOL STT1 colestipol hcl COLESTIPOL HCL
LipotropicsT1 ezetimibe ZETIA STT1 fenofibrate FENOFIBRATET1 fenofibrate FENOGLIDE STT1 fenofibrate LIPOFEN STT1 fenofibrate
nanocrystallizedFENOFIBRATE
T1 fenofibrate,micronized
FENOFIBRATE
T1 fenofibric acid FENOFIBRIC ACID
T1 gemfibrozil GEMFIBROZILT1 niacin NIACIN ER PAT1 omega-3 acid ethyl
estersLOVAZA PA
Niacin PreparationsT1 niacin NIACIN(OTC)T1 niacinamide NIACINAMIDE(OTC)
CARDIOVASCULAR DISEASE -
MISCELLANEOUS AGENTSAdrenergic Vasopressor AgentsT1 midodrine hcl MIDODRINE HCL
CARDIOVASCULAR DISEASE -
VASODILATIONVasodilators,coronaryT1 isosorbide dinitrate ISORDILT1 isosorbide dinitrate ISOSORBIDE
DINITRATET1 isosorbide
mononitrateISOSORBIDEMONONITRATE ER
T1 nitroglycerin NITRO-BIDT1 nitroglycerin NITRO-DURT1 nitroglycerin NITROGLYCERIN
PATCHT1 nitroglycerin NITROSTAT
CONTRACEPTION/OXYTOCICSContraceptives, Intravaginal, SystemicT1 etonogestrel/ethinyl
estradiolNUVARING G
Contraceptives,injectableT1 medroxyprogesteron
e acetateMEDROXYPROGESTERONE ACETATE
Contraceptives,intravaginalT1 nonoxynol 9 CONCEPTROL(OTC)T1 nonoxynol 9 GYNOL II(OTC)T1 nonoxynol 9 VCF(OTC)
Contraceptives,oralT1 desogestrel-ethinyl
estradiolAPRI G
T1 desog-et estra/ethinestra
VIORELE G
T1 drospir/ethestra/levomefol ca
BEYAZ G, ST
T1 drospir/ethestra/levomefol ca
SAFYRAL G, ST
T1 estradiolvalerate/dienogest
NATAZIA G, ST
T1 ethinylestradiol/drospirenone
OCELLA G, ST
Commercial Formulary
LA Care Page 11 of 59
T1 ethynodiol d-ethinylestradiol
ZOVIA 1-35E G
T1 levonorgestrel NEXT CHOICE ONEDOSE
G, QL
T1 levonorgestrel-ethestradiol
AMETHYST G
T1 levonorgestrel-ethestradiol
LEVORA-28 G
T1 l-norgest-ethestr/ethin estra
CAMRESE G
T1 noreth a-et estra/fefumarate
LO LOESTRIN FE G, ST
T1 noreth a-et estra/fefumarate
MICROGESTIN FE G
T1 noreth-ethinylestradiol/iron
ZENCHENT FE G
T1 norethindrone NORA-BE GT1 norethindrone a-e
estradiolMICROGESTIN G
T1 norethindrone-ethinyl estrad
NECON G
T1 norethindrone-mestranol
NECON G
T1 norgestimate-ethinylestradiol
ORTHO TRI-CYCLENLO
G, ST
T1 norgestimate-ethinylestradiol
SPRINTEC G
T1 norgestrel-ethinylestradiol
CRYSELLE G
T1 ulipristal acetate ELLA G
Contraceptives,transdermalT1 norelgestromin/ethin.e
stradiolORTHO EVRA G
Diaphragms/cervical CapT1 diaphragm fitting
set,arcsprngORTHO ALL-FLEX
T1 diaphragms, arc-springORTHO ALL-FLEXT1 diaphragms, wide seal WIDE SEAL
DIAPHRAGM
OxytocicsT1 methylergonovine
maleateMETHYLERGONOVINE MALEATE
COUGH AND COLD1st Gen Antihistamine & Decongestant
CombinationsT1 phenylephrine
hcl/prometh hclPROMETHAZINE VC AGE
T1 pseudoephedrine/brompheniramin
Q-TAPP(OTC) AGE
T1 pseudoephedrine/triprolidine
APRODINE(OTC) AGE
Analgesic, Non-sal.- 1st Generation
AntihistamineT1 acetaminophen/diphe
nhydramineMAPAP PM(OTC) AGE
Antitussives,non-narcoticT1 benzonatate BENZONATATE
ExpectorantsT1 guaifenesin MUCINEX(OTC) AGET1 guaifenesin Q-TUSSIN(OTC) AGE
Narcotic Antituss-1st Gen. Antihistamine-
decongestT1 promethazine/phenyl
eph/codeinePROMETHAZINE VC-CODEINE
AGE
Narcotic Antituss-decongestant-expectorant
CombT1 p-ephed
hcl/codeine/guaifenCHERATUSSINDAC(OTC)
AGE
Narcotic Antitussive-1st Generation
AntihistamineT1 hydrocodone/chlorph
en polisHYDROCODONE-CHLORPHENIRAMINE
AGE
T1 hydrocodone/chlorphen polis
TUSSICAPS AGE
T1 promethazinehcl/codeine
PROMETHAZINE-CODEINE
AGE
Narcotic Antitussive-anticholinergic Comb.T1 hydrocodone
bit/homatrop me-brHYDROCODONE-HOMATROPINE MBR
AGE,QL
Narcotic Antitussive-expectorant
CombinationT1 guaifenesin/codeine
phosphateCHERATUSSINAC(OTC)
AGE
Non-narc Antituss-1st Gen. Antihistamine-
decongestT1 brompheniram/pheny
lephrine/dmDIMAPHEN DM(OTC) AGE
T1 brompheniram/phenylephrine/dm
TUSSI PRES-B(OTC) AGE
T1 d-methorphan hb/p-epd hcl/bpm
BROMFED DM AGE
T1 d-methorphan hb/p-ephed hcl/cp
KIDKARE(OTC) AGE
T1 d-methorphan hb/p-ephed hcl/cp
RESCON-DM(OTC) AGE
Commercial Formulary
LA Care Page 12 of 59
Non-narc Antitussive-1st Gen Antihistamine
Comb.T1 d-methorphan
hb/prometh hclPROMETHAZINE-DM AGE
Non-narcotic Antituss-decongestant-
expectorant CmbT1 guaifenesin/d-
methorphan hb/peROBITUSSIN COUGH& COLD CF(OTC)
AGE
T1 guaifenesin/d-methorphan hb/pe
TUSSIN CF(OTC) AGE
Non-narcotic Antitussive And Expectorant
Comb.T1 guaifenesin/dextromet
horphanFENESIN DM IR(OTC)AGE
T1 guaifenesin/dextromethorphan
MUCINEXCOUGH(OTC)
AGE
T1 guaifenesin/dextromethorphan
MUCINEX DM(OTC) AGE
T1 guaifenesin/dextromethorphan
Q-TUSSIN DM(OTC) AGE
T1 guaifenesin/dextromethorphan
SCOT-TUSSINSENIOR(OTC)
AGE
T1 guaifenesin/dextromethorphan
VICKS 44E COUGH &CHEST(OTC)
AGE
Nose Preparations, VasoconstrictorsT1 oxymetazoline hcl NASAL
DECONGESTANT(OTC)
AGE
Sympathomimetic AgentsT1 pseudoephedrine hcl NEXAFED(OTC) AGE,
QLT1 pseudoephedrine hcl SUDAFED 24-
HOUR(OTC)AGE,QL
T1 pseudoephedrine hcl SUDOGEST(TABER)(OTC)
AGE,QL
T1 pseudoephedrine hcl SUDOGEST(TAB)(30MG)(OTC)
AGE,QL
T1 pseudoephedrine hcl SUDOGEST(TAB)(60MG)(OTC)
AGE,QL
DERMATOLOGY - ACNEAcne Agents,systemicT1 isotretinoin ABSORICA STT1 isotretinoin CLARAVIS ST
Acne Agents,topicalT1 clindamycin
phos/benzoyl peroxCLINDAMYCIN-BENZOYL PEROXIDE
T1 sulfacetamidesodium
SULFACETAMIDESODIUM
Keratolytic-glucocorticoid CombinationsT1 benzoyl
peroxide/hydrocortisonVANOXIDE-HC
Rosacea Agents, TopicalT1 metronidazole METRONIDAZOLE
Topical Preparations,antibacterialsT1 hydrocortisone/iodoq
uinolHYDROCORTISONE-IODOQUINOL
T1 povidone-iodine FIRST AIDANTISEPTIC(OTC)
Vitamin A DerivativesT1 tretinoin TRETINOIN AGET1 tretinoin
microspheresTRETINOINMICROSPHERE
AGE
Vitamin A Derivatives, Topical Cosmetic
AgentsT1 tazarotene AVAGE PAT1 tretinoin/emollient
baseREFISSA
DERMATOLOGY - ANTIINFECTIVEAntiparasiticsT1 nitazoxanide ALINIA PA
Topical AntibioticsT1 bacitracin BACITRACIN(OTC)T1 bacitracin zinc BACITRACIN
ZINC(OTC)T1 bacitracin/polymyxin
b sulfateBACITRACIN-POLYMYXIN(OTC)
T1 bacitracin/polymyxin bsulfate
POLYSPORIN(OTC)
T1 clindamycinphosphate
CLINDAMYCINPHOSPHATE
T1 erythromycinbase/ethanol
ERYTHROMYCIN
T1 erythromycin/benzoylperoxide
BENZAMYCINPAK
T1 erythromycin/benzoyl peroxide
ERYTHROMYCIN-BENZOYL PEROXIDE
T1 gentamicin sulfate GENTAMICINSULFATE
T1 mupirocin MUPIROCINT1 neomy
sulf/bacitra/polymyxin b
TRIPLEANTIBIOTIC(OTC)
T1 neomy sulf/bacitraczn/poly
TRIPLEANTIBIOTIC(OTC)
T1 neomy sulf/polymyxb sulf/pram
NEOSPORIN + PAINRELIEF(OTC)
T1 neomycin/bacitraczn/polymyxin
FIRST AID(OTC)
T1 neomycn/bacizn/pmyx bs/pramox
TRIPLE ANTIBIOTICPLUS(OTC)
Commercial Formulary
LA Care Page 13 of 59
Topical Antifungal/antiinflammatory,steriod
AgentT1 clotrimazole/betamet
hasone dipCLOTRIMAZOLE-BETAMETHASONE
Topical AntifungalsT1 ciclopirox CICLOPIROX(GEL)T1 ciclopirox CICLOPIROX(SHAMP
OO)T1 ciclopirox CICLOPIROX(SOLUTI
ON)AGE
T1 ciclopirox olamine CICLOPIROXT1 clotrimazole CLOTRIMAZOLET1 clotrimazole CLOTRIMAZOLE(OT
C)T1 econazole nitrate ECONAZOLE
NITRATET1 ketoconazole KETOCONAZOLET1 miconazole nitrate FUNGOID
TINCTURE(OTC)T1 miconazole nitrate LOTRIMIN AF(OTC)T1 miconazole nitrate MICONAZOLE
NITRATE(OTC)T1 naftifine hcl NAFTINT1 nystatin NYSTATINT1 nystatin/triamcin NYSTATIN-
TRIAMCINOLONET1 sulconazole nitrate EXELDERMT1 terbinafine hcl LAMISIL(OTC) PAT1 terbinafine hcl TERBINAFINE(OTC) AGE,
QLT1 tolnaftate TINACTIN(OTC)T1 tolnaftate TOLNAFTATE(OTC)
Topical AntiparasiticsT1 crotamiton EURAXT1 lindane LINDANET1 malathion MALATHION STT1 permethrin PERMETHRINT1 permethrin PERMETHRIN(OTC)T1 pip
butox/pyrethrins/permeth
RID(OTC)
T1 pipbutox/pyrethrins/resmeth
LICETREATMENT(OTC)
T1 piperonylbutoxide/pyrethrins
LICE KILLING(OTC)
T1 piperonylbutoxide/pyrethrins
TRIPLE X(OTC)
T1 potasshyd/glyco/pq10/he-cell
LICE EGGREMOVER(OTC)
Topical AntiviralsT1 acyclovir ACYCLOVIR PAT1 acyclovir ZOVIRAX PAT1 penciclovir DENAVIR PA
Topical Pleuromutilin DerivativesT1 retapamulin ALTABAX ST
Topical SulfonamidesT1 silver sulfadiazine SILVER
SULFADIAZINET1 sulfacetamide
sod/sulfur/ureaSODIUMSULFACETAMIDE-SULFUR
T1 sulfacetamidesodium/sulfur
SODIUMSULFACETAMIDE-SULFUR
DERMATOLOGY -
ANTIINFLAMMATORYTopical
Antibiotics/antiinflammatory,steroidalT1 neomycin/bacitra/poly
myxin/hcCORTISPORIN
T1 neomycin/polymyxin bsulf/hc
CORTISPORIN
Topical Anti-inflammatory SteroidalT1 alclometasone
dipropionateALCLOMETASONEDIPROPIONATE
T1 amcinonide AMCINONIDET1 betamethasone
dipropionateBETAMETHASONEDIPROPIONATE
T1 betamethasonevalerate
BETAMETHASONEVALERATE
T1 betamethasone/propylene glyc
BETAMETHASONEDIPROPIONATE
T1 clobetasolpropionate
CLOBETASOLPROPIONATE
T1 clobetasol propionate CLOBEXT1 clobetasol
propionate/emollCLOBETASOLEMOLLIENT
T1 desonide DESONIDET1 desoximetasone DESOXIMETASONET1 diflorasone diacetate DIFLORASONE
DIACETATET1 diflorasone
diacetate/emollAPEXICON E
T1 fluocinoloneacetonide
FLUOCINOLONEACETONIDE
T1 fluocinonide FLUOCINONIDET1 fluocinonide/emollien
t baseFLUOCINONIDE-E
T1 fluticasonepropionate
FLUTICASONEPROPIONATE
T1 halobetasolpropionate
HALOBETASOLPROPIONATE
T1 hydrocortisone CORTAID(OTC)T1 hydrocortisone FIRST-
HYDROCORTISONET1 hydrocortisone HYDROCORTISONET1 hydrocortisone HYDROCORTISONE
(OTC)
Commercial Formulary
LA Care Page 14 of 59
T1 hydrocortisone TEXACORTT1 hydrocortisone
acetateANTI-ITCH(OTC)
T1 hydrocortisoneacetate/alo ver
HYDROCORTISONEW/ALOE(OTC)
T1 hydrocortisoneacetate/urea
U-CORT
T1 hydrocortisonebutyrate
HYDROCORTISONEBUTYRATE
T1 hydrocortisonebutyrate
LOCOID
T1 hydrocortisonebutyrate/emoll
HYDROCORTISONEBUTYRATE
T1 hydrocortisonebutyrate/emoll
LOCOID LIPOCREAM
T1 hydrocortisoneprobutate
PANDEL
T1 hydrocortisonevalerate
HYDROCORTISONEVALERATE
T1 hydrocortisone/aloevera
HYDROCORTISONE-ALOE(OTC)
T1 mometasone furoate MOMETASONEFUROATE
T1 prednicarbate PREDNICARBATET1 triamcinolone
acetonideKENALOG
T1 triamcinoloneacetonide
TRIAMCINOLONEACETONIDE
Topical Anti-inflammatory, NsaidsT1 diclofenac sodium VOLTAREN ST
DERMATOLOGY - ANTIPRURITIC
DRUGSAntipruritics,topicalT1 diphenhydramine hcl ANTI-ITCH(OTC)T1 diphenhydramine hcl DERMA-PAX(OTC)T1 diphenhydramine
hcl/zinc acetANTI-ITCH(OTC)
DERMATOLOGY - MISCELLANEOUSAntiseborrheic AgentsT1 selenium sulfide SELENIUM SULFIDET1 sulfacetamide sodium OVACE PLUST1 sulfacetamide
sodiumSODIUMSULFACETAMIDE
Antiseptics,generalT1 alcohol antiseptic pads ALCOHOL
PADS(OTC)T1 alcohol antiseptic pads ALCOHOL PREP
PADS(OTC)T1 alcohol antiseptic pads ALCOHOL PREP
SWABS(OTC)T1 alcohol antiseptic pads ALCOHOL
SWAB(OTC)T1 alcohol antiseptic pads ALCOHOL
SWABS(OTC)
T1 alcohol antiseptic pads ALCOHOLWIPES(OTC)
T1 alcohol antiseptic pads B-D SINGLE USEALCOHOLSWAB(OTC)
T1 alcohol antiseptic pads CURITY ALCOHOLPREPS(OTC)
T1 alcohol antiseptic pads EASY TOUCHALCOHOL PREPPADS(OTC)
T1 alcohol antiseptic pads IV ANTISEPTICWIPES(OTC)
T1 alcohol antiseptic pads IV PREP WIPES(OTC)T1 alcohol antiseptic pads SINGLE USE
SWAB(OTC)T1 alcohol antiseptic pads SURE COMFORT
ALCOHOL(OTC)T1 alcohol antiseptic pads SURE-PREP
ALCOHOL PREPPADS(OTC)
T1 alcohol antiseptic pads ULTILET ALCOHOLSWAB(OTC)
T1 alcohol antisepticpads
WEBCOL ALCOHOLPREPSMEDIUM(OTC)
T1 alcohol antiseptic pads WEBCOL(OTC)
EmollientsT1 ammonium lactate AMMONIUM LACTATET1 ammonium lactate AMMONIUM
LACTATE(OTC)T1 glycerin GLYCERIN(OTC)T1 lanolin LAN-O-
SOOTHE(OTC)T1 lanolin
alcohol/mo/w.pet/ceres
DRY SKINTHERAPY(OTC)
T1 mineral oil NUTRADERM(OTC)T1 mineral oil/i-prop
myr/waterMINERINLOTION(OTC)
T1 mineraloil/petrolatum,white
HYDROCERIN(OTC)
T1 petrolatum,white HYDROLATUM(OTC)T1 petrolatum,white VASELINE WHITE
PETROLEUMQL
T1 vitamins a and d VITAMIN A & D(OTC)T1 vits a & d/white
pet/lanolinVITAMIN A & D(OTC)
IrrigantsT1 nacl irrigat/decyl
glucosideSEA-CLENS(OTC)
T1 sodium chloride irrigsolution
SODIUM CHLORIDE
Irritants/counter-irritantsT1 capsaicin CAPSAICIN(OTC)T1 capsaicin MEDI-GEN(OTC)
KeratolyticsT1 benzoyl peroxide BENZOYL
PEROXIDE(OTC)QL
Commercial Formulary
LA Care Page 15 of 59
T1 benzoyl peroxide BP WASH QLT1 podofilox CONDYLOXT1 podofilox PODOFILOXT1 salicylic acid DUOFILM(OTC)T1 salicylic
acid/collodion, flexSALACTIC FILM(OTC)
T1 silver nitrate SILVER NITRATE
Oxidizing AgentsT1 hydrogen peroxide HYDROGEN
PEROXIDE(OTC)
ProtectivesT1 calamine CALAMINE(OTC)T1 calamine/zinc oxide CALAMINE(OTC)T1 petrolatum,white AMERICERIN(OTC)T1 vit a/vitamin
d3/e/aloe v/znoxPERIGUARD(OTC)
T1 zinc oxide BOUDREAUXS(OTC)T1 zinc oxide ZINC OXIDE(OTC)
Shampoos/lotionT1 glycerin AQUA
GLYCOLIC(OTC)
Topical Anti-inflammatory Steroid-local
AnestheticT1 hydrocortisone/pram
oxineHYDROCORTISONE-PRAMOXINE HCL
T1 hydrocortisone/pramoxine
PRAMOSONE
T1 hydrocortisone/pramoxine/emoll
PRAMOSONE E
Topical Antineoplastic & Premalignant
Lesion AgntsT1 bexarotene TARGRETIN PAT1 fluorouracil FLUOROURACILT1 ingenol mebutate PICATO PA
Topical Local AnestheticsT1 lidocaine LIDOCAINE PAT1 lidocaine/prilocaine LIDOCAINE-
PRILOCAINE
Topical Preparations,miscellaneousT1 calcium
acetate/aluminumsulf
ASTRINGENTSOLUTION(OTC)
T1 chlorhexgl/glycerin/he-cell
LUBRICATINGJELLY(OTC)
T1 povidone-iodine POVIDONE-IODINE(OTC)
T1 sodium chloride NORMLGEL(OTC)T1 sodium chloride WOUND WASH
SALINE(OTC)T1 surgical lubricant SURGILUBE(OTC)
DERMATOLOGY - PIGMENTATION
DISORDERSTopical Hyperpigmentation AgentsT1 methoxsalen OXSORALEN
DERMATOLOGY -
PSORIASIS/ECZEMAAntipsoriatic Agents,systemicT1 acitretin ACITRETINT1 methoxsalen 8-MOPT1 methoxsalen, rapid OXSORALEN-ULTRA
Antipsoriatics AgentsT1 calcipotriene CALCIPOTRIENE STT1 calcipotriene DOVONEXT1 tazarotene TAZORAC PA
Topical Agents,miscellaneousT1 skin cleanser comb
no.15AQUANIL(OTC)
Topical Immunosuppressive AgentsT1 pimecrolimus ELIDEL STT1 tacrolimus PROTOPIC ST
DIABETESAntihypergly, (dpp-4) Inhibitor & Biguanide
Comb.T1 linagliptin/metformin
hclJENTADUETO QL, ST
T1 saxagliptinhcl/metformin hcl
KOMBIGLYZE XR PA
T1 sitagliptinphos/metformin hcl
JANUMET QL, ST
T1 sitagliptinphos/metformin hcl
JANUMET XR QL, ST
Antihypergly,incretin MimeticT1 exenatide
microspheresBYDUREON PA
T1 liraglutide VICTOZA 2-PAK PAT1 liraglutide VICTOZA 3-PAK PA
Antihyperglycemc-sod/gluc
Cotransport2(sglt2)inhibT1 canagliflozin INVOKANA PA
Antihyperglycemic, Alpha-glucosidase InhibT1 acarbose ACARBOSE
Antihyperglycemic, Dpp-4 InhibitorsT1 linagliptin TRADJENTA QL, STT1 saxagliptin hcl ONGLYZA PA
Commercial Formulary
LA Care Page 16 of 59
T1 sitagliptin phosphate JANUVIA QL, ST
Antihyperglycemic, Insulin-release Stimulant
TypeT1 chlorpropamide CHLORPROPAMIDET1 glimepiride GLIMEPIRIDET1 glipizide GLIPIZIDET1 glyburide DIABETAT1 glyburide GLYBURIDET1 nateglinide NATEGLINIDET1 tolazamide TOLAZAMIDET1 tolbutamide TOLBUTAMIDE
Antihyperglycemic, Insulin-response
EnhancerT1 pioglitazone hcl PIOGLITAZONE HCL ST
Antihyperglycemic,biguanide TypeT1 metformin hcl METFORMIN
HCL(TAB)(1000 MG)QL
T1 metformin hcl METFORMINHCL(TAB)(500 MG)
QL
T1 metformin hcl METFORMINHCL(TAB)(850 MG)
T1 metformin hcl RIOMET AGE
Antihyperglycemic,insulin-rel Stim.&
Biguanide CmbT1 glipizide/metformin
hclGLIPIZIDE-METFORMIN
ST
T1 glyburide/metforminhcl
GLYBURIDE-METFORMIN HCL
Antihyperglycemic,insulin-response &
Release Comb.T1 pioglitazone
hcl/glimepiridePIOGLITAZONE-GLIMEPIRIDE
ST
Antihyperglycemic-glucocorticoid Receptor
BlockerT1 mifepristone KORLYM PA
Antihyperglycm,insul-resp.enhancer &
Biguanide CmbT1 pioglitazone
hcl/metformin hclACTOPLUS MET XR ST
T1 pioglitazonehcl/metformin hcl
PIOGLITAZONE-METFORMIN
ST
Blood Sugar DiagnosticsT1 blood sugar diagnostic FREESTYLE
INSULINX(OTC)QL
T1 blood sugar diagnostic FREESTYLELITE(OTC)
QL
T1 blood sugar diagnostic FREESTYLE(OTC) QLT1 blood sugar diagnostic OPTIUM EZ(OTC) QL
T1 blood sugar diagnostic OPTIUM(OTC) QLT1 blood sugar diagnostic PRECISION PCX
PLUS(OTC)QL
T1 blood sugar diagnostic PRECISIONPCX(OTC)
QL
T1 blood sugar diagnostic PRECISION POINTOF CARE(OTC)
QL
T1 blood sugar diagnostic PRECISION Q-I-D(OTC)
QL
T1 blood sugar diagnostic PRECISIONXTRA(OTC)
QL
T1 blood sugar diagnostic ULTIMA(OTC) QL
Diabetic SuppliesT1 blood-glucose meter FREESTYLE FLASH
SYSTEM(OTC)QL
T1 blood-glucose meter FREESTYLEFREEDOM LITE(OTC)
QL
T1 blood-glucose meter FREESTYLEFREEDOM(OTC)
QL
T1 blood-glucose meter FREESTYLEINSULINX(OTC)
QL
T1 blood-glucose meter FREESTYLE LITEMETER(OTC)
QL
T1 blood-glucose meter FREESTYLESIDEKICK II(OTC)
QL
T1 blood-glucose meter FREESTYLESYSTEM(OTC)
QL
T1 blood-glucose meter PRECISIONXTRA(OTC)
QL
T1 blood-glucose meter PRECISION(OTC) QLT1 lancing device/lancets ONE TOUCH
SURESOFT(OTC)
Diabetic Ulcer Preparations,topicalT1 becaplermin REGRANEX PA
HyperglycemicsT1 dextrose DEX4
GLUCOSE(OTC)
InsulinsT1 hum insulin nph/reg
insulin hmHUMULIN 70/30KWIKPEN(OTC)
T1 hum insulin nph/reginsulin hm
HUMULIN 70-30(OTC)
T1 hum insulin nph/reginsulin hm
NOVOLIN 70-30(OTC)
T1 insulin aspart NOVOLOGT1 insulin aspart NOVOLOG FLEXPENT1 insulin detemir LEVEMIR STT1 insulin
glargine,hum.rec.anlogLANTUS
T1 insulinglargine,hum.rec.anlog
LANTUS SOLOSTAR
T1 insulin glulisine APIDRA STT1 insulin glulisine APIDRA SOLOSTART1 insulin lispro HUMALOGT1 insulin npl/insulin lisproHUMALOG MIX 50-50T1 insulin npl/insulin lisproHUMALOG MIX 75-25T1 insulin regular, human HUMULIN R(OTC)T1 insulin regular, human NOVOLIN R(OTC)
Commercial Formulary
LA Care Page 17 of 59
T1 insuln asp prt/insulinaspart
NOVOLOG MIX 70-30
T1 insuln asp prt/insulinaspart
NOVOLOG MIX 70-30FLEXPEN
T1 nph, human insulinisophane
HUMULIN N(OTC)
T1 nph, human insulinisophane
NOVOLIN NINNOLET(OTC)
T1 nph, human insulinisophane
NOVOLIN N(OTC)
EAR - GENERAL DISORDERSEar Preparations, Misc. Anti-infectivesT1 acetic acid ACETIC ACIDT1 acetic acid/aluminum
acetateACETIC ACID-ALUMINUM
T1 aceticacid/hydrocortisone
HYDROCORTISONE-ACETIC ACID
Ear Preparations,antibioticsT1 neomycin/polymyxin
b sulf/hcNEOMYCIN-POLYMYXIN-HC
Ear Preparations,ear Wax RemoversT1 carbamide peroxide EAR DROPS(OTC)
Ear Preparations,local AnestheticsT1 antipyrine/benzocain
e/glycerinANTIPYRINE-BENZOCAINE
Otic Preparations,anti-inflammatory-
antibioticsT1 ciprofloxacin
hcl/dexamethCIPRODEX
ELECTROLYTE REGULATIONElectrolyte DepletersT1 calcium acetate CALCIUM ACETATE QLT1 lanthanum carbonate FOSRENOL PAT1 sevelamer carbonate RENVELA PAT1 sevelamer hcl RENAGEL PAT1 sodium polystyrene
sulfonateSPS
Electrolyte MaintenanceT1 electrolyte,oral PEDIATRIC
ELECTROLYTE(OTC)
Potassium ReplacementT1 pot chloride/pot
bicarb/cit acPOTASSIUMCHLORIDE
T1 potassiumbicarbonate/cit ac
KLOR-CON-EF
T1 potassium chloride POTASSIUMCHLORIDE
Sodium/saline PreparationsT1 sodium chloride SODIUM
CHLORIDE(OTC)
ENDOCRINE DISORDER - FERTILITYFollicle-stimulating HormoneT1 follitropin beta,recomb FOLLISTIM AQT1 urofollitropin BRAVELLE
Human Chorionic GonadotropinT1 chorionic
gonadotropin, humanCHORIONICGONADOTROPIN
T1 chorionicgonadotropin, human
NOVAREL
T1 chorionicgonadotropin, human
PREGNYL
ENDOCRINE DISORDER - OTHERAdrenocorticotrophic HormonesT1 corticotropin H.P. ACTHAR PA
Antidiuretic And Vasopressor HormonesT1 desmopressin
(nonrefrigerated)DESMOPRESSINACETATE
T1 desmopressin acetate DDAVPT1 desmopressin
acetateDESMOPRESSINACETATE
T1 desmopressin acetate STIMATE
Antineoplastic Lhrh(gnrh) Agonist,pituitary
Suppr.T1 leuprolide acetate ELIGARD PA
Bone Resorption InhibitorsT1 alendronate sodium ALENDRONATE
SODIUM(SOLUTION)QL
T1 alendronate sodium ALENDRONATESODIUM(TAB)(10 MG)
QL
T1 alendronate sodium ALENDRONATESODIUM(TAB)(35 MG)
QL
T1 alendronate sodium ALENDRONATESODIUM(TAB)(40 MG)
QL
T1 alendronate sodium ALENDRONATESODIUM(TAB)(5 MG)
QL
T1 alendronate sodium ALENDRONATESODIUM(TAB)(70 MG)
QL
T1 calcitonin,salmon,synthetic
CALCITONIN-SALMON
T1 denosumab PROLIA PAT1 denosumab XGEVA PAT1 ibandronate sodium IBANDRONATE
SODIUMQL, ST
T1 raloxifene hcl EVISTA QLT1 risedronate sodium ACTONEL(TAB)(150
MG)PA
T1 risedronate sodium ACTONEL(TAB)(30MG)
PA, QL
T1 risedronate sodium ACTONEL(TAB)(35MG)
PA, QL
T1 risedronate sodium ACTONEL(TAB)(5MG)
PA, QL
T1 risedronate sodium ATELVIA PA
Commercial Formulary
LA Care Page 18 of 59
Growth HormonesT1 somatropin GENOTROPINT1 somatropin HUMATROPE PAT1 somatropin NORDITROPIN
FLEXPROPA
T1 somatropin NORDITROPINNORDIFLEX
PA
T1 somatropin OMNITROPET1 somatropin SAIZEN PAT1 somatropin SEROSTIM PAT1 somatropin TEV-TROPIN PAT1 somatropin ZORBTIVE PA
Hyperparathyroid Tx Agents - Vitamin D
Analog-typeT1 doxercalciferol DOXERCALCIFEROLT1 doxercalciferol HECTOROLT1 paricalcitol PARICALCITOL PA
Insulin-like Growth Factor-1 (igf-1)
HormonesT1 mecasermin INCRELEX PA
Lhrh(gnrh) Antagonist,pituitary Suppressant
AgentsT1 ganirelix acetate GANIRELIX ACETATE
Luteinizing Hormone Releasing Hormone
-lhrhT1 gonadorelin acetate LUTREPULSE PA
Pituitary Suppressive AgentsT1 cabergoline CABERGOLINE QLT1 danazol DANAZOL
ENDOCRINE DISORDER - THYROIDAntithyroid PreparationsT1 methimazole METHIMAZOLET1 propylthiouracil PROPYLTHIOURACIL
Iodine Containing AgentsT1 potassium iodide SSKI
Thyroid HormonesT1 levothyroxine
sodiumLEVOTHYROXINESODIUM
T1 liothyronine sodium LIOTHYRONINESODIUM
T1 thyroid,pork ARMOUR THYROIDT1 thyroid,pork NP THYROID
EYE - GENERAL DISORDERSEye Antibiotic-corticoid CombinationsT1 neo/polymyx b
sulf/dexamethNEOMYCIN-POLYMYXIN-DEXAMETH
T1 neomy sulf/bacitraczn/poly/hc
NEOMYCIN-BACITRACIN-POLY-HC
T1 neomycin sulfate/dexna ph
NEOMYCINW/DEXAMETHASONE
T1 tobramycin/dexamethasone
TOBRADEX
T1 tobramycin/dexamethasone
TOBRAMYCIN-DEXAMETHASONE
Eye AntihistaminesT1 alcaftadine LASTACAFT AGE,
QL, STT1 azelastine hcl AZELASTINE HCL STT1 ketotifen fumarate KETOTIFEN
FUMARATE(OTC)T1 olopatadine hcl PATADAY QL, STT1 olopatadine hcl PATANOL AGE,
QL, ST
Eye Antihistamine-vasoconstrictor
CombinationsT1 naphazoline
hcl/pheniramineVISINE-A(OTC)
Eye Antiinflammatory AgentsT1 dexamethasone sod
phosphateDEXAMETHASONESODIUMPHOSPHATE
T1 diclofenac sodium DICLOFENACSODIUM
T1 fluorometholone FLUOROMETHOLONE
T1 fluorometholone FML FORTET1 fluorometholone FML S.O.P.T1 fluorometholone
acetateFLAREX
T1 flurbiprofen sodium FLURBIPROFENSODIUM
T1 ketorolactromethamine
KETOROLACTROMETHAMINE
T1 prednisolone acetate PRED MILDT1 prednisolone acetate PREDNISOLONE
ACETATET1 prednisolone sod
phosphatePREDNISOLONESODIUMPHOSPHATE
Eye AntiviralsT1 trifluridine TRIFLURIDINE
Eye SulfonamidesT1 na sulfacetm/prednis
spSULFALONE
Commercial Formulary
LA Care Page 19 of 59
Commercial Formulary
T1 sulfacetamidesodium
SULFACETAMIDESODIUM
T1 sulfacetamide/prednisolone sp
SULFACETAMIDE-PREDNISOLONE
T1 sulfacetm na/prednisolac
BLEPHAMIDE
T1 sulfacetm na/prednisolac
BLEPHAMIDE S.O.P.
Eye VasoconstrictorsT1 naphazoline hcl NAPHAZOLINE HCLT1 naphazoline hcl/peg
300REDNESSRELIEF(OTC)
T1 naphazolinehcl/pheniramine
EYE ALLERGYRELIEF(OTC)
T1 tetrahydrozoline hcl EYE DROPS(OTC)T1 tetrahydrz/dext
70/peg 400/pvpADVANCEDFORMULA EYEDROPS(OTC)
Ophthalmic AntibioticsT1 bacitracin/polymyxin
b sulfateAK-POLY-BAC
T1 ciprofloxacin hcl CIPROFLOXACINHCL
T1 erythromycin base ERYTHROMYCINT1 gentamicin sulfate GENTAMICIN
SULFATET1 levofloxacin LEVOFLOXACINT1 neomy
sulf/bacitra/polymyxin b
NEOMYCIN-BACITRACIN-POLYMYXIN
T1 neomycin/polymyxnb/gramicidin
NEOMYCIN-POLYMYXIN-GRAMICIDIN
T1 ofloxacin OFLOXACINT1 polymyxin b
sulf/trimethoprimPOLYMYXIN B SUL-TRIMETHOPRIM
Ophthalmic Anti-inflammatory
Immunomodulator-typeT1 cyclosporine RESTASIS PA
Ophthalmic Mast Cell StabilizersT1 cromolyn sodium CROMOLYN SODIUMT1 lodoxamide
tromethamineALOMIDE PA
T1 nedocromil sodium ALOCRIL PA
Ophthalmic Preparations, MiscellaneousT1 sodium chloride SODIUM
CHLORIDE(OTC)
EYE - GLAUCOMACarbonic Anhydrase InhibitorsT1 acetazolamide ACETAZOLAMIDET1 methazolamide METHAZOLAMIDE
Miotics/other Intraoc. Pressure ReducersT1 apraclonidine hcl APRACLONIDINE
HCLT1 betaxolol hcl BETAXOLOL HCLT1 betaxolol hcl BETOPTIC ST1 bimatoprost LUMIGAN PAT1 brimonidine tartrate ALPHAGAN PT1 brimonidine tartrate BRIMONIDINE
TARTRATET1 brimonidine
tartrate/timololCOMBIGAN ST
T1 brinzolamide/brimonidtart
SIMBRINZA ST
T1 carbachol ISOPTO CARBACHOLT1 carteolol hcl CARTEOLOL HCLT1 dorzolamide hcl DORZOLAMIDE HCLT1 dorzolamide
hcl/timolol maleatDORZOLAMIDE-TIMOLOL
T1 latanoprost LATANOPROSTT1 levobunolol hcl LEVOBUNOLOL HCLT1 metipranolol METIPRANOLOLT1 pilocarpine hcl PILOCARPINE HCLT1 timolol BETIMOLT1 timolol maleate TIMOLOL MALEATET1 travoprost TRAVATAN Z PAT1 unoprostone isopropyl RESCULA PA
MydriaticsT1 atropine sulfate ATROPINE SULFATET1 cyclopentolate hcl CYCLOGYLT1 cyclopentolate hcl CYCLOPENTOLATE
HCLT1 homatropine hbr HOMATROPAIRET1 homatropine hbr ISOPTO
HOMATROPINET1 tropicamide TROPICAMIDE
EYE - MISCELLANEOUSArtificial TearsT1 dextran
70/hypromelloseARTIFICIALTEARS(OTC)
T1 dextran70/hypromellose/pf
BION TEARS(OTC)
T1 dextran70/hypromellose/pf
TEARS NATURALEFREE(OTC)
T1 glycerin/propyleneglycol
ARTIFICIALTEARS(OTC)
T1 hypromellose NATURE'STEARS(OTC)
T1 polyvinyl alcohol ARTIFICIALTEARS(OTC)
T1 polyvinylalcohol/povidone
ARTIFICIALTEARS(OTC)
Contact Lens PreparationsT1 sodium chloride SALINE(OTC)
Eye IrrigationsT1 sod borate/boric
ac/water/naclEYE IRRIGATINGSOLUTION(OTC)
Commercial Formulary
LA Care Page 20 of 59
T1 sodium/potassium/sod chl
EYE WASH(OTC)
Eye Preparations, MiscellaneousT1 lanolin/min
oil/petrolat,whtAKWA TEARS(OTC)
T1 mineraloil/petrolatum,white
ARTIFICIALTEARS(OTC)
T1 mineraloil/petrolatum,white
REFRESH LACRI-LUBE(OTC)
Ophth Vasc. Endothelial Growth Factor
AntagonistsT1 aflibercept EYLEA PA
Ophthalmic Cystine Depleting AgentsT1 cysteamine hcl CYSTARAN PA
Topical Hypertrichotic Agents, EyelashesT1 bimatoprost LATISSE PA
GOUT AND RELATED DISEASESColchicineT1 colchicine COLCHICINET1 colchicine COLCRYST1 colchicine/probeneci
dPROBENECID-COLCHICINE
Hyperuricemia Tx - Purine InhibitorsT1 allopurinol ALLOPURINOLT1 febuxostat ULORIC PA
Uricosuric AgentsT1 probenecid PROBENECID
HEMATOLOGICAL DISORDERSAnticoagulants,coumarin TypeT1 warfarin sodium WARFARIN SODIUM
Antifibrinolytic AgentsT1 aminocaproic acid AMINOCAPROIC
ACID
Antihemophilic FactorsT1 antihemoph.fviii
plas/alb freeADVATE PA
T1 antihemoph.fviiiplas/alb free
ADVATE H PA
T1 antihemoph.fviiiplas/alb free
ADVATE L PA
T1 antihemoph.fviiiplas/alb free
ADVATE M PA
T1 antihemoph.fviiiplas/alb free
ADVATE SH PA
T1 antihemoph.fviiiplas/alb free
ADVATE UH PA
T1 antihemoph.fviiiplas/alb free
XYNTHA PA
T1 antihemophilic factor,hum rec
BIOCLATE PA
T1 antihemophilic factor,hum rec
HELIXATE FS PA
T1 antihemophilic factor,hum rec
KOGENATE FS(KIT) PA
T1 antihemophilic factor,hum rec
KOGENATE FS(VIAL) PA
T1 antihemophilic factor,hum rec
RECOMBINATE(VIAL)(1000 (+/-))
PA
T1 antihemophilic factor,hum rec
RECOMBINATE(VIAL)(1500 (+/-))
PA
T1 antihemophilic factor,hum rec
RECOMBINATE(VIAL)(2000 (+/-))
PA
T1 antihemophilic factor,hum rec
RECOMBINATE(VIAL)(250 (+/-))
PA
T1 antihemophilic factor,hum rec
RECOMBINATE(VIAL)(500 (+/-))
PA
T1 antihemophilic factor,human
HEMOFIL M PA
T1 antihemophilic factor,human
KOATE-DVI(VIAL)(1000 (+/-))
PA
T1 antihemophilic factor,human
KOATE-DVI(VIAL)(250(+/-))
PA
T1 antihemophilic factor,human
KOATE-DVI(VIAL)(500(+/-))
PA
T1 antihemophilic factor,human
MONOCLATE-P PA
T1 antihemophilicfactor/vwf
ALPHANATE PA
T1 antihemophilicfactor/vwf
HUMATE-P PA
T1 antihemophilicfactor/vwf
WILATE PA
T1 anti-inhibitor coagulantcomp.
FEIBA NF PA
T1 anti-inhibitor coagulantcomp.
FEIBA VH IMMUNO PA
T1 coagulation factorviia,recomb
NOVOSEVEN PA
T1 coagulation factorviia,recomb
NOVOSEVEN RT PA
Direct Factor Xa InhibitorsT1 rivaroxaban XARELTO PA
Factor Ix PreparationsT1 factor ix ALPHANINE SD PAT1 factor ix MONONINE PAT1 factor ix complex
humanBEBULIN PA
T1 factor ix complexhuman
BEBULIN VHIMMUNO
PA
T1 factor ix complexhuman
PROFILNINE SD PA
T1 factor ix humanrecombinant
BENEFIX PA
T1 factor ix humanrecombinant
RIXUBIS PA
Hematinics,otherT1 epoetin alfa EPOGEN PA
Commercial Formulary
LA Care Page 21 of 59
T1 epoetin alfa PROCRIT PA
Hemorrheologic AgentsT1 pentoxifylline PENTOXIFYLLINE
Heparin And Related PreparationsT1 enoxaparin sodium ENOXAPARIN
SODIUMT1 enoxaparin sodium ENOXAPARIN
SODIUM(SYRINGE)QL
T1 enoxaparin sodium ENOXAPARINSODIUM(VIAL)
PA
Leukocyte (wbc) StimulantsT1 filgrastim NEUPOGEN PAT1 pegfilgrastim NEULASTA PAT1 sargramostim LEUKINE PA
Platelet Aggregation InhibitorsT1 aspirin/dipyridamole AGGRENOX PAT1 cilostazol CILOSTAZOLT1 clopidogrel bisulfate CLOPIDOGRELT1 dipyridamole DIPYRIDAMOLET1 prasugrel hcl EFFIENT AGE,
STT1 ticagrelor BRILINTA STT1 ticlopidine hcl TICLOPIDINE HCL
Platelet Reducing AgentsT1 anagrelide hcl ANAGRELIDE HCL
Thrombin Inhibitors,selective,direct, &
ReversibleT1 dabigatran etexilate
mesylatePRADAXA PA
Vitamin K PreparationsT1 phytonadione MEPHYTON
HORMONAL DEFICIENCYAndrogenic AgentsT1 fluoxymesterone ANDROXY QLT1 methyltestosterone ANDROIDT1 methyltestosterone METHITESTT1 methyltestosterone TESTREDT1 testosterone ANDRODERM QLT1 testosterone ANDROGEL(GEL MD
PMP)(1.25G (1%))PA, QL
T1 testosterone ANDROGEL(GEL MDPMP)(20.25/1.25)
QL
T1 testosterone ANDROGEL(GELPACKET)(25MG(1%))
PA, QL
T1 testosterone ANDROGEL(GELPACKET)(50 MG(1%))
PA, QL
T1 testosterone AXIRON QLT1 testosterone FORTESTA PA, QLT1 testosterone STRIANT QLT1 testosterone TESTIM PA, QLT1 testosterone TESTOPEL QL
Estrogen/androgen CombinationsT1 estrogen,ester/me-
testosteroneESTROGEN &METHYLTESTOSTERONE
Estrogenic AgentsT1 estradiol ALORA QLT1 estradiol DIVIGEL QLT1 estradiol ELESTRIN QLT1 estradiol ESTRADIOL(PATCH
TDWK)QL
T1 estradiol ESTRADIOL(TAB) QLT1 estradiol ESTRASORB QLT1 estradiol ESTROGEL QLT1 estradiol EVAMIST QLT1 estradiol MENOSTAR QLT1 estradiol MINIVELLE QLT1 estradiol VIVELLE-DOT QLT1 estradiol/levonorgestre
lCLIMARA PRO QL
T1 estradiol/norethindroneacet
COMBIPATCH QL
T1 estradiol/norethindrone acet
ESTRADIOL-NORETHINDRONEACETAT
QL
T1 estradiol/norgestimate PREFEST QLT1 estrogen,con/m-
progest acetPREMPHASE
T1 estrogen,con/m-progest acet
PREMPRO QL
T1 estrogens, conjugated PREMARIN(TAB)(0.3MG)
QL
T1 estrogens, conjugated PREMARIN(TAB)(0.45MG)
QL
T1 estrogens, conjugated PREMARIN(TAB)(0.625 MG)
QL
T1 estrogens, conjugated PREMARIN(TAB)(0.9MG)
T1 estrogens, conjugated PREMARIN(TAB)(1.25MG)
QL
T1 estrogens,conj.,synthetic a
CENESTIN QL
T1 estrogens,conj.,synthetic b
ENJUVIA QL
T1 estrogens,esterified MENEST QLT1 estropipate ESTROPIPATE QLT1 norethind ac/ethinyl
estradiolFEMHRT QL
Progestational AgentsT1 hydroxyprogesterone
caproateMAKENA PA
T1 medroxyprogesterone acet
MEDROXYPROGESTERONE ACETATE
T1 medroxyprogesterone acetate
MEDROXYPROGESTERONE ACETATE
T1 norethindroneacetate
NORETHINDRONEACETATE
T1 progesterone,micronized
PROGESTERONE
Commercial Formulary
LA Care Page 22 of 59
IMMUNOSUPPRESSION/MODULATIONImmunomodulatorsT1 imiquimod IMIQUIMOD PAT1 imiquimod ZYCLARA PAT1 interferon alfa-
2b,recomb.INTRON A PA
T1 interferon alfa-n3 ALFERON N PAT1 interferon gamma-
1b,recomb.ACTIMMUNE PA
ImmunosuppressivesT1 azathioprine AZASANT1 azathioprine AZATHIOPRINET1 cyclosporine CYCLOSPORINET1 cyclosporine SANDIMMUNET1 cyclosporine,
modifiedCYCLOSPORINEMODIFIED
T1 everolimus ZORTRESST1 mycophenolate mofetil CELLCEPTT1 mycophenolate
mofetilMYCOPHENOLATEMOFETIL
T1 sirolimus RAPAMUNET1 sirolimus SIROLIMUST1 tacrolimus PROGRAFT1 tacrolimus TACROLIMUS
INFECTIOUS DISEASE - BACTERIALAbsorbable SulfonamidesT1 sulfamethoxazole/tri
methoprimSULFAMETHOXAZOLE-TRIMETHOPRIM
BetalactamsT1 aztreonam lysine CAYSTON PA
CephalosporinsT1 cephalexin
monohydrateCEPHALEXIN
Cephalosporins - 1st GenerationT1 cefadroxil hydrate CEFADROXILT1 cephalexin CEPHALEXIN
Cephalosporins - 2nd GenerationT1 cefaclor CEFACLORT1 cefprozil CEFPROZILT1 cefuroxime axetil CEFTINT1 cefuroxime axetil CEFUROXIME
Cephalosporins - 3rd GenerationT1 cefdinir CEFDINIRT1 cefixime SUPRAX QLT1 cefpodoxime proxetil CEFPODOXIME
PROXETIL(SUSPRECON)
AGE
T1 cefpodoxime proxetil CEFPODOXIMEPROXETIL(TAB)
Chemotherapeutics, Antibacterial, Misc.T1 trimethoprim TRIMETHOPRIM
KetolidesT1 telithromycin KETEK QL, ST
MacrolidesT1 azithromycin AZITHROMYCINT1 azithromycin ZMAXT1 clarithromycin CLARITHROMYCINT1 ery e-
succ/sulfisoxazoleERYTHROMYCIN-SULFISOXAZOLE
T1 erythromycin base ERY-TABT1 erythromycin base ERYTHROMYCINT1 erythromycin
ethylsuccinateE.E.S. 200
T1 erythromycinethylsuccinate
ERYPED 200
T1 erythromycinethylsuccinate
ERYPED 400
T1 erythromycinethylsuccinate
ERYTHROMYCINETHYLSUCCINATE
T1 erythromycinstearate
ERYTHROCINSTEARATE
T1 fidaxomicin DIFICID PA
Nitrofuran DerivativesT1 nitrofurantoin NITROFURANTOIN AGET1 nitrofurantoin
macrocrystalMACRODANTIN
T1 nitrofurantoinmacrocrystal
NITROFURANTOIN
T1 nitrofurantoinmonohyd/m-cryst
NITROFURANTOINMONO-MACRO
OxazolidinonesT1 linezolid ZYVOX PA
PenicillinsT1 amoxicillin AMOXICILLINT1 amoxicillin trihydrate AMOXICILLINT1 amoxicillin/potassiu
m clavAMOX TR-POTASSIUMCLAVULANATE
T1 amoxicillin/potassiumclav
AUGMENTIN
T1 ampicillin trihydrate AMPICILLINTRIHYDRATE
T1 dicloxacillin sodium DICLOXACILLINSODIUM
T1 oxacillin sodium BACTOCILL AGET1 penicillin v
potassiumPENICILLIN VPOTASSIUM
QuinolonesT1 ciprofloxacin CIPROT1 ciprofloxacin hcl CIPROFLOXACIN
HCLT1 ciprofloxacin/ciproflo
xa hclCIPROFLOXACINER(TBMP 24HR)(1000MG)
AGE
T1 ciprofloxacin/ciprofloxa hcl
CIPROFLOXACINER(TBMP 24HR)(500MG)
Commercial Formulary
LA Care Page 23 of 59
T1 levofloxacin LEVOFLOXACIN(SOLUTION)
QL
T1 levofloxacin LEVOFLOXACIN(TAB)(250 MG)
T1 levofloxacin LEVOFLOXACIN(TAB)(500 MG)
T1 levofloxacin LEVOFLOXACIN(TAB)(750 MG)
QL
T1 levofloxacin LEVOFLOXACIN(TAB)(750MG)
QL
T1 nalidixic acid NALIDIXIC ACID AGE
TetracyclinesT1 demeclocycline hcl DEMECLOCYCLINE
HCLT1 doxycycline hyclate DOXYCYCLINE
HYCLATET1 doxycycline
monohydrateDOXYCYCLINEMONOHYDRATE(CAP)
T1 doxycyclinemonohydrate
DOXYCYCLINEMONOHYDRATE(SUSP RECON)
T1 doxycyclinemonohydrate
DOXYCYCLINEMONOHYDRATE(TAB)
AGE
T1 minocycline hcl MINOCYCLINE HCLT1 tetracycline hcl TETRACYCLINE HCL
INFECTIOUS DISEASE - FUNGALAntifungal AgentsT1 clotrimazole CLOTRIMAZOLET1 fluconazole FLUCONAZOLET1 itraconazole SPORANOX PAT1 ketoconazole KETOCONAZOLET1 terbinafine hcl TERBINAFINE HCL QL
Antifungal AntibioticsT1 griseofulvin
ultramicrosizeGRISEOFULVINULTRAMICROSIZE
T1 griseofulvin,microsize
GRISEOFULVIN
T1 nystatin NYSTATIN
INFECTIOUS DISEASE -
MISCELLANEOUSAminoglycosidesT1 neomycin sulfate NEOMYCIN SULFATET1 tobramycin TOBI PODHALER PAT1 tobramycin in 0.225%
naclTOBRAMYCIN PA
AntileproticsT1 dapsone DAPSONET1 thalidomide THALOMID
Anti-mycobacterium AgentsT1 ethambutol hcl ETHAMBUTOL HCL
T1 isoniazid ISONIAZIDT1 pyrazinamide PYRAZINAMIDET1 rifabutin MYCOBUTIN PA
Antitubercular AntibioticsT1 rifampin RIFAMPIN
LincosamidesT1 clindamycin hcl CLINDAMYCIN
HCL(CAP)(150 MG)T1 clindamycin hcl CLINDAMYCIN
HCL(CAP)(300 MG)T1 clindamycin hcl CLINDAMYCIN
HCL(CAP)(75 MG)AGE
T1 clindamycinpalmitate hcl
CLINDAMYCINPALMITATE HCL
AGE
Rifamycins And Related Derivative
AntibioticsT1 rifaximin XIFAXAN PA
Vancomycin And DerivativesT1 vancomycin hcl VANCOMYCIN HCL PA
INFECTIOUS DISEASE - PARASITIC2nd Gen. Anaerobic Antiprotozoal-
antibacterialT1 tinidazole TINIDAZOLE PA
AmebacidesT1 iodoquinol YODOXINT1 paromomycin sulfate PAROMOMYCIN
SULFATE
Anaerobic Antiprotozoal-antibacterial
AgentsT1 metronidazole FLAGYL ERT1 metronidazole METRONIDAZOLE
AnthelminticsT1 praziquantel BILTRICIDE
Antimalarial DrugsT1 chloroquine
phosphateCHLOROQUINEPHOSPHATE
T1 hydroxychloroquinesulfate
HYDROXYCHLOROQUINE SULFATE
T1 mefloquine hcl MEFLOQUINE HCLT1 primaquine phosphate PRIMAQUINET1 pyrimethamine DARAPRIMT1 quinine sulfate QUININE SULFATE
Antiprotozoal Drugs,miscellaneousT1 pentamidine
isethionateNEBUPENT PA
T1 pentamidineisethionate
PENTAMIDINEISETHIONATE
PA
Commercial Formulary
LA Care Page 24 of 59
INFECTIOUS DISEASE - VIRALAntiviral Monoclonal AntibodiesT1 palivizumab SYNAGIS PA
Antivirals, GeneralT1 acyclovir ACYCLOVIRT1 cidofovir CIDOFOVIR PAT1 famciclovir FAMCICLOVIRT1 oseltamivir phosphate TAMIFLU(CAP)(30
MG)QL
T1 oseltamivir phosphate TAMIFLU(CAP)(45MG)
QL
T1 oseltamivir phosphate TAMIFLU(CAP)(75MG)
QL
T1 oseltamivir phosphate TAMIFLU(SUSPRECON)
AGE,QL
T1 ribavirin VIRAZOLE PAT1 rimantadine hcl RIMANTADINE HCLT1 valacyclovir hcl VALACYCLOVIRT1 valganciclovir hcl VALCYTE PA
Antivirals, Hiv-spec, Non-peptidic Protease
InhibT1 darunavir ethanolate PREZISTA PAT1 tipranavir APTIVUS PAT1 tipranavir/vitamin e
tpgsAPTIVUS PA
Antivirals, Hiv-spec, Nucleoside-nucleotide
AnalogT1 emtricitabine/tenofovir TRUVADA PA
Antivirals, Hiv-spec., Nucleoside Analog, Rti
CombT1 abacavir
sulfate/lamivudineEPZICOM PA
T1 abacavir/lamivudine/zidovudine
ABACAVIR-LAMIVUDINE-ZIDOVUDINE
PA
T1 lamivudine/zidovudine
COMBIVIR PA
Antivirals, Hiv-specific, Ccr5 Co-receptor
Antag.T1 maraviroc SELZENTRY PA
Antivirals, Hiv-specific, Fusion InhibitorsT1 enfuvirtide FUZEON PA
Antivirals, Hiv-specific, Non-nucleoside, RtiT1 delavirdine mesylate RESCRIPTOR PAT1 efavirenz SUSTIVA PAT1 etravirine INTELENCE PAT1 nevirapine NEVIRAPINE PAT1 nevirapine VIRAMUNE XR PAT1 rilpivirine hcl EDURANT PA
Antivirals, Hiv-specific, Nucleoside Analog,
RtiT1 abacavir sulfate ABACAVIR PAT1 abacavir sulfate ZIAGEN PAT1 didanosine DIDANOSINET1 emtricitabine EMTRIVA PAT1 lamivudine EPIVIR PAT1 lamivudine LAMIVUDINE PAT1 stavudine STAVUDINE PA
Antivirals, Hiv-specific, Nucleotide Analog,
RtiT1 tenofovir disoproxil
fumarateVIREAD
Antivirals, Hiv-specific, Protease Inhibitor
CombT1 lopinavir/ritonavir KALETRA
Antivirals, Hiv-specific, Protease InhibitorsT1 atazanavir sulfate REYATAZ PAT1 fosamprenavir calcium LEXIVA PAT1 indinavir sulfate CRIXIVAN PAT1 nelfinavir mesylate VIRACEPTT1 ritonavir NORVIR PAT1 saquinavir mesylate INVIRASE PA
Antivirals,hiv-1 Integrase Strand Transfer
InhibtrT1 raltegravir potassium ISENTRESS PA
Artv Cmb Nucleoside,nucleotide,&non-
nucleoside RtiT1 efavirenz/emtricitab/te
nofovirATRIPLA PA
T1 emtricitab/rilpivirine/tenofov
COMPLERA PA
Hepatitis C Treatment AgentsT1 peginterferon alfa-2a PEGASYS PAT1 peginterferon alfa-2a PEGASYS PROCLICK PAT1 peginterferon alfa-2b PEGINTRON PAT1 peginterferon alfa-2b PEGINTRON
REDIPENPA
T1 ribavirin REBETOL PAT1 ribavirin RIBAVIRIN
Hepatitis C Virus Ns3/4a Serine Protease
Inhib.T1 boceprevir VICTRELIST1 telaprevir INCIVEK
Commercial Formulary
LA Care Page 25 of 59
INFLAMMATORY DISEASEAnti-arthritic And Chelating AgentsT1 penicillamine CUPRIMINET1 penicillamine DEPEN
Anti-arthritic, Folate Antagonist AgentsT1 methotrexate sodium METHOTREXATE
Anti-flam. Interleukin-1 Receptor AntagonistT1 anakinra KINERET PA
Anti-inflammatory Tumor Necrosis Factor
InhibitorT1 adalimumab HUMIRA PAT1 etanercept ENBREL PAT1 golimumab SIMPONI PA
Anti-inflammatory, Pyrimidine Synthesis
InhibitorT1 leflunomide LEFLUNOMIDE ST
Antinflammatory, Sel.costim.mod.,t-cell
InhibitorT1 abatacept ORENCIA PA
Bradykinin B2 Receptor AntagonistsT1 icatibant acetate FIRAZYR PA
GlucocorticoidsT1 budesonide BUDESONIDE EC STT1 budesonide UCERIS PAT1 cortisone acetate CORTISONE
ACETATET1 dexamethasone DEXAMETHASONET1 hydrocortisone HYDROCORTISONET1 methylprednisolone MEDROLT1 methylprednisolone METHYLPREDNISOL
ONET1 methylprednisolone
acetateDEPO-MEDROL PA
T1 methylprednisoloneacetate
METHYLPREDNISOLONE ACETATE
PA
T1 methylprednisolonesod succ
METHYLPREDNISOLONE SOD SUCC
PA
T1 methylprednisolonesod succ
SOLU-MEDROL PA
T1 methylprednisolonesod succ/pf
SOLU-MEDROL PA
T1 prednisolone MILLIPREDT1 prednisolone MILLIPRED DPT1 prednisolone PREDNISOLONET1 prednisolone sod
phosphatePREDNISOLONESODIUMPHOSPHATE
T1 prednisone PREDNISONET1 prednisone PREDNISONE
INTENSOL
Janus Kinase (jak) InhibitorsT1 tofacitinib citrate XELJANZ PA
MineralocorticoidsT1 fludrocortisone
acetateFLUDROCORTISONEACETATE
Monoclonal Antibody-human Interleukin
12/23 InhibT1 ustekinumab STELARA
Nsaids (cox Non-specific Inhib)&
Prostaglandin CmbT1 diclofenac
sodium/misoprostolDICLOFENACSODIUM-MISOPROSTOL
Nsaids, Cyclooxygenase 2 Inhibitor - TypeT1 celecoxib CELEBREX(CAP)(100
MG)AGE,QL, ST
T1 celecoxib CELEBREX(CAP)(200MG)
AGE,QL, ST
T1 celecoxib CELEBREX(CAP)(400MG)
AGE,QL, ST
T1 celecoxib CELEBREX(CAP)(50MG)
AGE,QL, ST
Nsaids, Cyclooxygenase Inhibitor-typeT1 diclofenac potassiumDICLOFENAC
POTASSIUMT1 diclofenac sodium DICLOFENAC
SODIUMT1 etodolac ETODOLACT1 fenoprofen calcium FENOPROFEN
CALCIUMST
T1 flurbiprofen FLURBIPROFENT1 ibuprofen IBUPROFENT1 ibuprofen IBUPROFEN(OTC)T1 indomethacin INDOCINT1 indomethacin INDOMETHACINT1 ketoprofen KETOPROFENT1 ketorolac
tromethamineKETOROLACTROMETHAMINE
QL
T1 meclofenamatesodium
MECLOFENAMATESODIUM
T1 meloxicam MELOXICAM QLT1 nabumetone NABUMETONET1 naproxen NAPROXENT1 naproxen sodium NAPROXEN SODIUMT1 oxaprozin OXAPROZINT1 piroxicam PIROXICAMT1 sulindac SULINDAC
LOCAL ANESTHESIALocal AnestheticsT1 lidocaine hcl LIDOCAINE HCL
VISCOUS
Commercial Formulary
LA Care Page 26 of 59
LOWER GASTROINTESTINAL
DISORDERS - BOWEL INFLAMMATBowel Antiinflamatory AgentsT1 sulfadiazine SULFADIAZINET1 sulfamethoxazole/tri
methoprimSULFATRIM
T1 sulfasalazine SULFASALAZINE
Chronic Inflam. Colon Dx, 5-a-salicylat,rectal
TxT1 mesalamine MESALAMINE
Drug Tx-chronic Inflam. Colon Dx,5-
aminosalicylatT1 balsalazide disodium BALSALAZIDE
DISODIUMT1 mesalamine APRISO STT1 mesalamine DELZICOL ST
Hemorrhoidal Prep, Anti-infam Steroid/local
AnesthT1 hydrocortisone/pramox
ineANALPRAM HC
T1 hydrocortisone/pramoxine
HYDROCORTISONE-PRAMOXINE
Irritable Bowel Agents,guanylate Cylase-c
AgonistT1 linaclotide LINZESS PA
Rectal PreparationsT1 hydrocortisone PROCTOZONE-HCT1 hydrocortisone
acetateHYDROCORTISONEACETATE
Rectal/lower Bowel Prep.,glucocort.T1 hydrocortisone HYDROCORTISONE
LOWER GASTROINTESTINAL
DISORDERS - OTHERAmmonia InhibitorsT1 glycerol phenylbutyrateRAVICTI PAT1 lactulose GENERLAC
Antidiarrheal - G.i. Chloride Channel
InhibitorsT1 crofelemer FULYZAQ PA
AntidiarrhealsT1 bismuth
subsalicylateBISMATROL(OTC)
T1 bismuth subsalicylate CHILDREN'SKAOPECTATE(OTC)
T1 diphenoxylatehcl/atropine
DIPHENOXYLATE-ATROPINE
T1 loperamide hcl LOPERAMIDET1 loperamide hcl LOPERAMIDE(OTC)
Bile SaltsT1 ursodiol URSODIOL
Calcium ReplacementT1 sennosides SENNA
LAXATIVE(OTC)
Intestinal Adsorbents And ProtectivesT1 attapulgite KA-PEC(OTC)
Laxatives And CatharticsT1 bisacodyl BISACODYL(OTC)T1 docusate calcium DOCUSATE
CALCIUM(OTC)T1 docusate sodium DOC-Q-LACE(OTC)T1 fructooligosaccharid
es/polydexHYFIBER(OTC) PA
T1 lactulose LACTULOSET1 magnesium citrate MAGNESIUM
CITRATE(OTC)T1 magnesium
hydroxideMILK OFMAGNESIA(OTC)
T1 mineral oil MINERAL OIL(OTC)T1 na phos,m-b/na
phos,di-baORAL SALINELAXATIVE(OTC)
T1 peg 3350/nasulf,bicarb,cl/kcl
GAVILYTE-C
T1 peg 3350/nasulf,bicarb,cl/kcl
GOLYTELY
T1 polyethylene glycol3350
POLYETHYLENEGLYCOL 3350
T1 polyethylene glycol3350
POLYETHYLENEGLYCOL 3350(OTC)
T1 sennosides/docusatesodium
SENNA-DOCUSATESODIUM(OTC)
T1 sodiumchloride/nahco3/kcl/peg
GAVILYTE-N
Laxatives, Local/rectalT1 bisacodyl BISAC-EVAC(OTC)T1 bisacodyl BISACODYL(OTC)T1 docusate sodium COLACE(OTC)T1 docusate sodium ENEMEEZ(OTC)T1 glycerin PEDIA-LAX(OTC)T1 glycerin SANI-SUPP(OTC)T1 mineral oil MINERAL OIL(OTC)T1 na phos,m-b/na
phos,di-baENEMADISPOSABLE(OTC)
MISCELLANEOUS AGENTSAnaphylaxis Therapy AgentsT1 epinephrine AUVI-Q STT1 epinephrine EPIPEN 2-PAK
Commercial Formulary
LA Care Page 27 of 59
T1 epinephrine EPIPEN JR 2-PAK QL
Parasympathetic AgentsT1 bethanechol chloride BETHANECHOL
CHLORIDET1 cevimeline hcl CEVIMELINE HCLT1 pilocarpine hcl PILOCARPINE HCL
NEOPLASTIC DISEASEAlkylating AgentsT1 altretamine HEXALENT1 busulfan MYLERANT1 chlorambucil LEUKERANT1 cyclophosphamide CYCLOPHOSPHAMID
ET1 hydroxyurea HYDROXYUREAT1 lomustine LOMUSTINET1 melphalan ALKERANT1 temozolomide TEMOZOLOMIDE
Antiandrogenic AgentsT1 bicalutamide BICALUTAMIDET1 enzalutamide XTANDIT1 flutamide FLUTAMIDET1 nilutamide NILANDRON
Antibiotic AntineoplasticsT1 doxorubicin hcl peg-
liposomalLIPODOX PA
AntimetabolitesT1 capecitabine XELODA PAT1 mercaptopurine MERCAPTOPURINET1 methotrexate sodium METHOTREXATET1 methotrexate sodium TREXALLT1 thioguanine TABLOID
Antineoplast Egf Receptor Blocker Rcmb Mc
AntibodyT1 cetuximab ERBITUX PAT1 panitumumab VECTIBIX PA
Antineoplast Hum Vegf Inhibitor Recomb Mc
AntibodyT1 bevacizumab AVASTIN PA
Antineoplastic Aromatase InhibitorsT1 anastrozole ANASTROZOLE QLT1 exemestane EXEMESTANE QLT1 letrozole LETROZOLE QL
Antineoplastic - Hedgehog Pathway InhibitorT1 vismodegib ERIVEDGE PA
Antineoplastic - Mtor Kinase InhibitorsT1 everolimus AFINITOR
Antineoplastic - Topoisomerase I InhibitorsT1 topotecan hcl HYCAMTIN
Antineoplastic - Vegf-a,b & P1gf InhibitorT1 ziv-aflibercept ZALTRAP PA
Antineoplastic Immunomodulator AgentsT1 lenalidomide REVLIMIDT1 peginterferon alfa-2b SYLATRON PAT1 peginterferon alfa-2b SYLATRON 4-PACK PAT1 pomalidomide POMALYST PA
Antineoplastic Systemic Enzyme InhibitorsT1 axitinib INLYTAT1 bortezomib VELCADE PAT1 bosutinib BOSULIFT1 bosutinib BOSULIF(TAB)(100
MG)PA, QL
T1 bosutinib BOSULIF(TAB)(500MG)
PA, QL
T1 crizotinib XALKORI PAT1 dasatinib SPRYCEL PAT1 dasatinib SPRYCEL(TAB)(100
MG)PA, QL
T1 dasatinib SPRYCEL(TAB)(140MG)
PA, QL
T1 dasatinib SPRYCEL(TAB)(20MG)
PA, QL
T1 dasatinib SPRYCEL(TAB)(50MG)
PA, QL
T1 dasatinib SPRYCEL(TAB)(70MG)
PA, QL
T1 dasatinib SPRYCEL(TAB)(80MG)
PA, QL
T1 erlotinib hcl TARCEVA PAT1 imatinib mesylate GLEEVEC PAT1 lapatinib ditosylate TYKERB PAT1 nilotinib hcl TASIGNA PAT1 pazopanib hcl VOTRIENT PAT1 ponatinib hcl ICLUSIG(TAB)(15 MG)PA, QLT1 ponatinib hcl ICLUSIG(TAB)(45 MG)PA, QLT1 regorafenib STIVARGA PAT1 sorafenib tosylate NEXAVAR PAT1 sunitinib malate SUTENT PAT1 vandetanib CAPRELSA PA
Antineoplastic,histone Deacetylase
Inhibitors,hdisT1 vorinostat ZOLINZA PA
Antineoplastics Antibody/antibody-drug
ComplexesT1 ado-trastuzumab
emtansineKADCYLA PA
Antineoplastics,miscellaneousT1 etoposide ETOPOSIDET1 mitotane LYSODRENT1 procarbazine hcl MATULANET1 tretinoin TRETINOIN
Commercial Formulary
LA Care Page 28 of 59
Chemotherapy Rescue/antidote AgentsT1 leucovorin calcium LEUCOVORIN
CALCIUM
Selective Estrogen Receptor ModulatorsT1 tamoxifen citrate SOLTAMOXT1 tamoxifen citrate TAMOXIFEN CITRATET1 toremifene citrate FARESTON PA
Selective Retinoid X Receptor AgonistsT1 bexarotene TARGRETIN PA
Steroid AntineoplasticsT1 estramustine
phosphate sodiumEMCYT
T1 megestrol acetate MEGESTROLACETATE
NEUROLOGICAL DISEASE -
MISCELLANEOUSAgents To Treat Multiple SclerosisT1 fingolimod hcl GILENYA PAT1 glatiramer acetate COPAXONET1 interferon beta-1a AVONEX PAT1 interferon beta-1a AVONEX PEN PAT1 interferon beta-
1a/albuminREBIF
T1 interferon beta-1a/albumin
REBIF(SYRINGE)(22MCG/.5ML)
PA
T1 interferon beta-1a/albumin
REBIF(SYRINGE)(44MCG/.5ML)
PA
T1 interferon beta-1b BETASERON PAT1 interferon beta-1b EXTAVIA PAT1 teriflunomide AUBAGIO PA
Agts Tx Neuromusc Transmission Dis,pot-
chan BlkrT1 dalfampridine AMPYRA PA
Fibromyalgia Agents,serotonin-norepineph
Ru InhibT1 milnacipran hcl SAVELLA PA
Leukocyte Adhesion Inhib,alpha4-mediat
Igg4k Mc AbT1 natalizumab TYSABRI PA
ORAL/PHARYNGEAL DISORDERSDental Aids And PreparationsT1 chlorhexidine
gluconateCHLORHEXIDINEGLUCONATE
T1 triamcinoloneacetonide
TRIAMCINOLONEACETONIDE
Nose Preparations AntibioticsT1 mupirocin calcium BACTROBAN NASAL
Nose Preparations, MiscellaneousT1 ipratropium bromide IPRATROPIUM
BROMIDE
OTHER RESPIRATORY DISORDERSCystic Fib.transmemb
Conduct.reg.(cftr)potentiatorT1 ivacaftor KALYDECO PA
MucolyticsT1 acetylcysteine ACETYLCYSTEINET1 dornase alfa PULMOZYME PA
PAIN MANAGEMENT - ANALGESICSAnalgesic, Salicylate, Barbiturate,& Xanthine
CmbT1 butalbital/aspirin/caff
eineBUTALBITAL-ASPIRIN-CAFFEINE
Analgesic,non-
salicylate,barbiturate,&xanthine CmbT1 acetaminophen/caffei
ne/butalbAMERICET
T1 butalb/acetaminophen/caffeine
BUTALBITAL-ACETAMINOPHEN-CAFFE
Analgesic/antipyretics, SalicylatesT1 aspirin ASPIRIN EC(OTC)T1 diflunisal DIFLUNISALT1 salsalate SALSALATE
Analgesic/antipyretics,non-salicylateT1 acetaminophen FEVERALL(OTC)T1 acetaminophen Q-PAP(OTC)T1 acetaminophen/pyrila
m/pamabromPRE-MENSTRUALRELIEF(OTC)
AGE
Analgesics, Narcotic Agonist And Nsaid
CombinationT1 hydrocodone/ibuprof
enHYDROCODONE BIT-IBUPROFEN
QL
Analgesics,narcoticsT1 codeine sulfate CODEINE SULFATE QLT1 codeine/carisoprodol
/aspirinCARISOPRODOL-ASPIRIN-CODEINE
T1 fentanyl FENTANYL PAT1 fentanyl SUBSYS PAT1 fentanyl citrate ABSTRAL(TAB
SUBL)(100 MCG)PA, QL
Commercial Formulary
LA Care Page 29 of 59
T1 fentanyl citrate ABSTRAL(TABSUBL)(200 MCG)
PA
T1 fentanyl citrate ABSTRAL(TABSUBL)(300 MCG)
PA
T1 fentanyl citrate ABSTRAL(TABSUBL)(400 MCG)
PA
T1 fentanyl citrate ABSTRAL(TABSUBL)(600 MCG)
PA
T1 fentanyl citrate ABSTRAL(TABSUBL)(800 MCG)
PA
T1 fentanyl citrate FENTANYL CITRATE PAT1 fentanyl citrate FENTORA PAT1 fentanyl citrate LAZANDA PAT1 fentanyl citrate ONSOLIS PAT1 hydrocodone/acetam
inophenHYDROCODONE-ACETAMINOPHEN(SOLUTION)(2.5-167/5)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(SOLUTION)(5-334MG/10)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(SOLUTION)(7.5-325/15)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(SOLUTION)(7.5-500/15)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10-660MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10-750MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-300MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-325MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-500MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-650MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-500 MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(5 MG-500MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-300MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-325MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-300MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-325MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-500MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-650 MG)
QL
T1 hydrocodone/acetaminophen
HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-750MG)
QL
T1 hydromorphone hcl HYDROMORPHONEHCL(LIQUID)
T1 hydromorphone hcl HYDROMORPHONEHCL(SUPP)
QL
T1 hydromorphone hcl HYDROMORPHONEHCL(TAB)
QL
T1 meperidine hcl MEPERIDINE HCLT1 methadone hcl METHADONE
HCL(ORAL CONC)QL
T1 methadone hcl METHADONEHCL(TAB)(10 MG)
QL
T1 methadone hcl METHADONEHCL(TAB)(5 MG)
QL
T1 morphine sulfate KADIANT1 morphine sulfate MORPHINE SULFATE QLT1 morphine sulfate MORPHINE SULFATE
ER(CAP ER PEL)(20MG)
QL, ST
T1 morphine sulfate MORPHINE SULFATEER(CAP ER PEL)(30MG)
QL
T1 morphine sulfate MORPHINE SULFATEER(CAP ER PEL)(50MG)
QL, ST
T1 morphine sulfate MORPHINE SULFATEER(CAP ER PEL)(60MG)
QL, ST
T1 morphine sulfate MORPHINE SULFATEER(CAP ER PEL)(80MG)
QL, ST
T1 morphine sulfate MORPHINE SULFATEER(CPMP 24HR)
PA
T1 morphine sulfate MORPHINE SULFATEER(TAB ER)(100 MG)
QL
T1 morphine sulfate MORPHINE SULFATEER(TAB ER)(15 MG)
QL
T1 morphine sulfate MORPHINE SULFATEER(TAB ER)(200 MG)
T1 morphine sulfate MORPHINE SULFATEER(TAB ER)(30 MG)
QL
T1 morphine sulfate MORPHINE SULFATEER(TAB ER)(60 MG)
QL
T1 oxycodone hcl OXYCODONEHCL(CAP)
QL
T1 oxycodone hcl OXYCODONEHCL(SOLUTION)
T1 oxycodone hcl OXYCODONEHCL(TAB)(10 MG)
QL
T1 oxycodone hcl OXYCODONEHCL(TAB)(15 MG)
QL
Commercial Formulary
LA Care Page 30 of 59
T1 oxycodone hcl OXYCODONEHCL(TAB)(20 MG)
QL
T1 oxycodone hcl OXYCODONEHCL(TAB)(30 MG)
QL
T1 oxycodone hcl OXYCODONEHCL(TAB)(5 MG)
QL
T1 oxycodone hcl OXYCONTIN PAT1 oxycodone
hcl/acetaminophenOXYCODONE-ACETAMINOPHEN(CAP)
QL
T1 oxycodonehcl/acetaminophen
OXYCODONE-ACETAMINOPHEN(TAB)(2.5-325MG)
T1 oxycodonehcl/acetaminophen
OXYCODONE-ACETAMINOPHEN(TAB)(5MG-325MG)
QL
T1 oxycodonehcl/acetaminophen
OXYCODONE-ACETAMINOPHEN(TAB)(7.5-325MG)
QL
T1 oxycodonehcl/aspirin
OXYCODONE HCL-ASPIRIN
QL
T1 oxymorphone hcl NUMORPHAN PAT1 oxymorphone hcl OPANA PAT1 oxymorphone hcl OPANA ER PAT1 oxymorphone hcl OXYMORPHONE HCLPAT1 pentazocine
hcl/naloxone hclPENTAZOCINE-NALOXONE HCL
QL
T1 tapentadol hcl NUCYNTA PAT1 tapentadol hcl NUCYNTA ER PAT1 tramadol hcl TRAMADOL HCL QLT1 tramadol
hcl/acetaminophenTRAMADOL HCL-ACETAMINOPHEN
QL
Antimigraine PreparationsT1 almotriptan malate AXERT PA, QLT1 ergotamine tartrate ERGOMAR QL, STT1 ergotamine
tartrate/caffeineCAFERGOT QL
T1 ergotaminetartrate/caffeine
MIGERGOT QL
T1 isomethept/dichlphn/acetaminop
ISOMETHEPT-DICHLORALP-ACETAMIN
T1 naratriptan hcl NARATRIPTAN HCL QLT1 rizatriptan benzoate RIZATRIPTAN QLT1 sumatriptan SUMATRIPTAN PA, QLT1 sumatriptan
succ/naproxen sodTREXIMET PA, QL
T1 sumatriptan succinate ALSUMA QL, STT1 sumatriptan
succinateSUMATRIPTANSUCCINATE(CARTRIDGE)(4 MG/0.5ML)
QL, ST
T1 sumatriptansuccinate
SUMATRIPTANSUCCINATE(CARTRIDGE)(6 MG/0.5ML)
QL
T1 sumatriptansuccinate
SUMATRIPTANSUCCINATE(PENINJCTR)(4 MG/0.5ML)
QL, ST
T1 sumatriptansuccinate
SUMATRIPTANSUCCINATE(PENINJCTR)(6 MG/0.5ML)
QL
T1 sumatriptansuccinate
SUMATRIPTANSUCCINATE(TAB)
QL
T1 sumatriptan succinate SUMAVEL DOSEPRO QL, STT1 zolmitriptan ZOLMITRIPTAN QLT1 zolmitriptan ZOMIG QL, ST
Narc.& Non-sal.analgesic,barbiturate
&xanthine CmbT1 butalbit/acetamin/caff
/codeineBUTALB-CAFF-ACETAMINOPH-CODEIN
Narcotic & Salicylate Analgesics, Barb.&
XanthineT1 codeine/butalbital/as
a/caffeinBUTALBITALCOMPOUND-CODEINE
Narcotic Analgesic & Non-salicylate
Analgesic CombT1 acetaminophen with
codeineACETAMINOPHEN-CODEINE(SOLUTION)
QL
T1 acetaminophen withcodeine
ACETAMINOPHEN-CODEINE(TAB)(300MG-15MG)
QL
T1 acetaminophen withcodeine
ACETAMINOPHEN-CODEINE(TAB)(300MG-30MG)
QL
T1 acetaminophen withcodeine
ACETAMINOPHEN-CODEINE(TAB)(300MG-60MG)
QL
T1 acetaminophen withcodeine
CAPITAL W-CODEINE
T1 codeinephos/acetaminophen
ACETAMINOPHENW/CODEINE(ELIXIR)
QL
T1 codeinephos/acetaminophen
ACETAMINOPHENW/CODEINE(TAB)
QL
PARKINSONS DISEASEAntiparkinsonism Drugs,otherT1 bromocriptine
mesylateBROMOCRIPTINEMESYLATE
T1 carbidopa/levodopa CARBIDOPA-LEVODOPA
T1 carbidopa/levodopa/entacapone
CARBIDOPA-LEVODOPA-ENTACAPONE
ST
T1 entacapone ENTACAPONET1 pramipexole di-hcl MIRAPEX ER QL, STT1 pramipexole di-hcl PRAMIPEXOLE
DIHYDROCHLORIDET1 ropinirole hcl ROPINIROLE
HCL(TAB ER 24H)QL, ST
T1 ropinirole hcl ROPINIROLEHCL(TAB)
T1 rotigotine NEUPRO QLT1 selegiline hcl SELEGILINE HCL
Commercial Formulary
LA Care Page 31 of 59
Decarboxylase InhibitorsT1 carbidopa LODOSYN
SEIZURE DISORDERAnticonvulsantsT1 carbamazepine CARBAMAZEPINET1 clobazam ONFIT1 clonazepam CLONAZEPAMT1 diazepam DIASTAT ACUDIAL PA, QLT1 diazepam DIAZEPAM PA, QLT1 divalproex sodium DIVALPROEX
SODIUM ERT1 ethosuximide ETHOSUXIMIDET1 ezogabine POTIGA PAT1 felbamate FELBAMATET1 gabapentin GABAPENTINT1 lamotrigine LAMOTRIGINET1 levetiracetam LEVETIRACETAM(SO
LUTION)T1 levetiracetam LEVETIRACETAM(TA
B ER 24H)(500 MG)QL
T1 levetiracetam LEVETIRACETAM(TAB ER 24H)(750 MG)
QL
T1 levetiracetam LEVETIRACETAM(TAB)
T1 oxcarbazepine OXCARBAZEPINET1 oxcarbazepine OXTELLAR XR STT1 oxcarbazepine TRILEPTALT1 phenytoin PHENYTOINT1 phenytoin sodium
extendedDILANTIN
T1 phenytoin sodiumextended
PHENYTEK
T1 phenytoin sodiumextended
PHENYTOIN SODIUMEXTENDED
T1 primidone PRIMIDONET1 tiagabine hcl GABITRILT1 tiagabine hcl TIAGABINE HCLT1 topiramate TOPIRAMATET1 valproic acid VALPROIC ACIDT1 valproic acid (as
sodium salt)VALPROIC ACID
T1 vigabatrin SABRIL PAT1 zonisamide ZONISAMIDE
SKELETAL MUSCLE DISORDERSkeletal Muscle RelaxantsT1 baclofen BACLOFENT1 carisoprodol CARISOPRODOLT1 carisoprodol/aspirin CARISOPRODOL-
ASPIRINT1 chlorzoxazone CHLORZOXAZONET1 cyclobenzaprine hcl CYCLOBENZAPRINE
HCLT1 dantrolene sodium DANTROLENE
SODIUMT1 metaxalone METAXALONET1 methocarbamol METHOCARBAMOL
T1 orphenadrine citrate ORPHENADRINECITRATE
T1 orphenadrine/aspirin/caffeine
ORPHENADRINECOMPOUND FORTE
T1 tizanidine hcl TIZANIDINE HCL
SMOKING CESSATIONSmoking Deterrent AgentsT1 nicotine NICOTINE
PATCH(OTC)AGE
T1 nicotine polacrilex NICOTINE GUM(OTC) AGE
Smoking Deterrent-nicotinic Recept.partial
AgonistT1 varenicline tartrate CHANTIX PA
Smoking Deterrents, OtherT1 bupropion hcl BUPROBAN
UPPER GASTROINTESTINAL
DISORDERS - DIGESTIVEAntiflatulentsT1 simethicone GAS FREE(OTC)T1 simethicone GAS-X(OTC)
Pancreatic EnzymesT1 lipase/protease/amylas
eCREON
T1 lipase/protease/amylase
ULTRASE
T1 lipase/protease/amylase
ULTRASE MT 12
T1 lipase/protease/amylase
ULTRASE MT 18
T1 lipase/protease/amylase
ULTRASE MT 20
UPPER GASTROINTESTINAL
DISORDERS - SPASTIC DISEASEAnticholinergics/antispasmodicsT1 dicyclomine hcl DICYCLOMINE HCL
Belladonna AlkaloidsT1 belladonna
alkaloids/phenobarbSPASMOLIN
T1 hyoscyamine sulfate CYSTOSPAZ-MT1 hyoscyamine sulfate HYOSCYAMINE
SULFATET1 phenobarb/hyoscy/at
ropine/scopANTISPASMODIC
T1 phenobarb/hyoscy/atropine/scop
DONNATAL
Commercial Formulary
LA Care Page 32 of 59
UPPER GASTROINTESTINAL
DISORDERS - ULCER DISEASEAntacidsT1 calcium carbonate CALCIUM
ANTACID(OTC)T1 mag hydrox/al
hydrox/simethMINTOX PLUS(OTC)
T1 magnesiumhydroxide
MAGNESIA(OTC)
T1 magnesiumhydroxide/al hydrox
ANTACID(OTC)
T1 mgtrisilicate/alh/nahco3/aa
FOAMINGANTACID(OTC)
T1 sodium bicarbonate SODIUMBICARBONATE(OTC)
Anticholinergics,quaternary AmmoniumT1 chlordiazepoxide/clid
inium brCHLORDIAZEPOXIDE-CLIDINIUM
T1 glycopyrrolate GLYCOPYRROLATET1 propantheline
bromidePROPANTHELINEBROMIDE
Anti-ulcer PreparationsT1 misoprostol MISOPROSTOLT1 sucralfate CARAFATET1 sucralfate SUCRALFATE
Histamine H2-receptor InhibitorsT1 cimetidine CIMETIDINET1 cimetidine hcl CIMETIDINET1 famotidine FAMOTIDINET1 famotidine FAMOTIDINE(OTC)T1 famotidine PEPCID RPDT1 nizatidine NIZATIDINET1 ranitidine RANITIDINE 150MGT1 ranitidine hcl RANITIDINE HCLT1 ranitidine hcl RANITIDINE
HCL(OTC)
Intestinal Motility StimulantsT1 metoclopramide hcl METOCLOPRAMIDE
HCL INTENSOLQL
T1 metoclopramide hcl METOCLOPRAMIDEHCL(SOLUTION)
QL
T1 metoclopramide hcl METOCLOPRAMIDEHCL(TAB)
QL
Proton-pump InhibitorsT1 dexlansoprazole DEXILANT STT1 lansoprazole FIRST-
LANSOPRAZOLEPA
T1 lansoprazole PREVACID AGET1 lansoprazole PREVACID
24HR(OTC)QL, ST
T1 omeprazole FIRST-OMEPRAZOLE PAT1 omeprazole OMEPRAZOLET1 omeprazole OMEPRAZOLE(OTC) QL
T1 omeprazolemagnesium
OMEPRAZOLEMAGNESIUM(OTC)
PA
T1 omeprazolemagnesium
PRILOSEC PA
T1 omeprazolemagnesium
PRILOSEC OTC(OTC)PA, QL
T1 omeprazole/sodiumbicarbonate
OMEPRAZOLE-SODIUMBICARBONATE
QL, ST
T1 omeprazole/sodiumbicarbonate
OMEPRAZOLE-SODIUMBICARBONATE(OTC)
QL, ST
T1 omeprazole/sodiumbicarbonate
ZEGERID QL, ST
T1 pantoprazole sodium PANTOPRAZOLESODIUM
QL
URINARY TRACT - FUNCTIONAL
DISORDERSBenign Prostatic Hypertrophy/micturition
AgentsT1 alfuzosin hcl ALFUZOSIN HCLT1 finasteride FINASTERIDET1 tamsulosin hcl TAMSULOSIN HCL
Bph Agents,5-alpha-red Inh & Alpha-1-adr
Antg CmbT1 dutasteride/tamsulosin
hclJALYN PA
Urinary Ph ModifiersT1 citric acid/sodium
citrateCYTRA-2
T1 phosphorus #1 PHOSPHA 250NEUTRAL
T1 potassium citrate POTASSIUM CITRATET1 potassium
citrate/citric acidCYTRA-K
T1 sod/pot/k cit/sodcit/cit acid
CYTRA-3
Urinary Tract Analgesic AgentsT1 pentosan polysulfate
sodiumELMIRON
Urinary Tract Anesthetic/analgesic AgntT1 phenazopyridine hcl PHENAZOPYRIDINE
HCL
Urinary Tract Antispasmodic, M(3) Selective
Antag.T1 darifenacin
hydrobromideENABLEX PA
Commercial Formulary
LA Care Page 33 of 59
Urinary Tract
Antispasmodic/antiincontinence AgentT1 oxybutynin chloride OXYBUTYNIN
CHLORIDET1 tolterodine tartrate TOLTERODINE
TARTRATEST
T1 trospium chloride TROSPIUMCHLORIDE
ST
VAGINAL DISORDERSVaginal AntibioticsT1 clindamycin
phosphateCLINDAMYCINPHOSPHATE
T1 metronidazole METRONIDAZOLET1 metronidazole VANDAZOLE
Vaginal AntifungalsT1 butoconazole nitrate MYCELEX-3(OTC)T1 clotrimazole CLOTRIMAZOLE(OT
C)T1 miconazole nitrate MICONAZOLE
NITRATE(OTC)T1 miconazole nitrate MONISTAT 3(OTC)T1 terconazole TERCONAZOLET1 tioconazole TIOCONAZOLE
1(OTC)
Vaginal Estrogen PreparationsT1 estradiol ESTRACET1 estradiol ESTRING QLT1 estrogens, conjugated PREMARIN
Vaginal SulfonamidesT1 sulfanilamide AVC
VITAMIN AND/OR MINERAL
DEFICIENCYCalcium ReplacementT1 calcium carb
&gluconate/vit d2PARVA-CAL 500(OTC)QL
T1 calcium carbonate OYSTER SHELLCALCIUM(OTC)
QL
T1 calciumcarbonate/vitamin d2
OYSTER SHELLCALCIUM W-VITD(OTC)
QL
T1 calciumcarbonate/vitamin d3
OYSTER SHELLCALCIUM W-VITD(OTC)
QL
T1 calcium citrate CALCIUMCITRATE(OTC)
QL
T1 calcium citrate/vitamind3
CITRACAL + DMAXIMUM(OTC)
QL
T1 calciumcitrate/vitamin d3
CITRUS CALCIUM +D(OTC)
QL
T1 calcium gluconate CALCIUMGLUCONATE(OTC)
QL
T1 calcium lactate CALCIUMLACTATE(OTC)
QL
Fluoride PreparationsT1 sodium fluoride FLUORIDE QLT1 sodium fluoride FLUORITAB QLT1 sodium fluoride FLURA-DROPS QL
Folic Acid PreparationsT1 folic acid FOLIC ACID QLT1 folic acid FOLIC ACID(OTC) QL
Iron ReplacementT1 ferrous gluconate FERROUS
GLUCONATE(OTC)QL
T1 ferrous sulfate FERROUSSULFATE(OTC)
QL
Magnesium Salts ReplacementT1 magnesium oxide MAGNESIUM
OXIDE(OTC)QL
T1 magnesium oxide MAGOX 400(OTC) QL
Multivitamin PreparationsT1 folic acid/mu-vits-min
thVITE CON FORTE QL
T1 multivitamin CHEWABLE-VITE(OTC)
QL
T1 multivitamins MULTIVITAMIN(OTC) QLT1 multivitamins with
min no.7/faV-C FORTE QL
Pediatric Vitamin PreparationsT1 fluoride
ion/multivitaminsMULTIVITAMINSW/FLUORIDE
QL
T1 fluoride/iron/vit a,c&dTRI-VIT WITHFLUORIDE-IRON
QL
T1 multivitamin CHILD CHEWVITAMIN(OTC)
QL
T1 multivitamin w/iron,minerals
CEROVITE JR(OTC) QL
T1 multivitamins CHILDRENSCHEWABLE(OTC)
QL
T1 multivitamins w-iron CHILDRENSCHEWABLE +IRON(OTC)
QL
T1 multivitamins withfluoride
MULTIVITAMINSWITH FLUORIDE
QL
T1 multivitamins withiron
CHILD CHEW +IRON(OTC)
QL
T1 multivits with iron &fluoride
MULTIVITAMINS W-FLUORIDE-IRON
QL
T1 ped multivit #17/ironfumarate
FLINTSTONES WITHIRON(OTC)
QL
T1 ped multivit #46/ironsulfate
POLYVITAMIN WITHIRON(OTC)
QL
T1 ped mv a,c,d3 #21 w-fluoride
TRI-VITAMIN WITHFLUORIDE
QL
T1 pedi m.vit no.17 withfluoride
MULTIVITAMIN WITHFLUORIDE
QL
T1 pedi multivit 9/iron/fa KIDS VITAMINSCOMPLETE(OTC)
QL
Commercial Formulary
LA Care Page 34 of 59
T1 pedi multivits a,c,&d3no.21
TRI-VITAMIN(OTC) QL
T1 pedi mvi no.16 withfluoride
MULTIVITAMINSWITH FLUORIDE
QL
T1 pediatric multivit#36/iron
VITALETS(OTC) QL
T1 pediatric multivitcomb 8/fa
KIDS VITAMINS(OTC) QL
T1 pediatric multivitcomb no.20
POLY-VITAMIN(OTC) QL
Prenatal Vitamin PreparationsT1 pnv #14/ferrous
fum/folic acidCOMPLETENATE QL
T1 pnvcomb.no.44/iron/folicacid
VITASPIRE QL
T1 pnvcombo#47/iron/fa#1/dha
ZATEAN-PN DHA QL
T1 pnv no.118/ironfumarate/fa
PRENATAL 19(OTC) QL
T1 pnv no.22/ironcbn&gluc/fa/dss
VINACAL QL
T1 pnv w-ca #40/ironfum/fa cmb#1
PNV-SELECT QL
T1 pnv w-cano.37/iron/fa/omega-3
ULTIMATECARE ONE QL
T1 pnv with cano.36/iron/fa
PERRYPRENATAL(OTC)
QL
T1 pnv withca,no.71/iron/fa
PRENAPLUS QL
T1 pnv withca,no.72/iron,carb/fa
PRENATAL PLUS QL
T1 pnv withca,no.72/iron/fa
PRENATAL PLUS QL
T1 pnv/iron,carbonyl/docusate/fa
MYNATAL QL
T1 pnv119/ironfumarate/fa/dss
SE-NATAL 19 QL
T1 pnv19/iron bghc&succ-p/fa/om3
PR NATAL 400 EC QL
T1 pnv22/ironcbn&gluc/fa/dss/dha
PRENAISSANCE DHAQL
T1 pnv39/ironfumarate/fa/dss/dha
FOLIVANE-PRX DHANF
QL
T1 pnv53/iron b-g hcl-p/fa/omega3
PR NATAL 400 QL
T1 pnv7/fe aspgly/docusate/fa
VINATE PN CARE QL
T1 pnv95/ferrousfumarate/fa
PRENATAL(OTC) QL
T1 prenatal #103/ironfumarate/fa
TRICARE QL
T1 prenatal vit#76/iron,carb/fa
PRENATABS RX QL
T1 prenatal vit 15/ironcb/fa/dss
PRENATAL AD QL
T1 prenatal vit 16/ironcb/fa/dss
VINATE GT QL
T1 prenatal vit 18/ironcb/fa/dss
VINATE ULTRA QL
T1 prenatal vitno.78/iron/fa
PRENATABS FA QL
T1 prenatalvit#96/ferrous fum/fa
PRENATAL(OTC) QL
T1 prenatal vit/fefumarate/fa
PRENATAL VITAMINFORMULA(OTC)
QL
T1 prenatal vit/ironfumarate/fa
PRENATALVITAMINS(OTC)
QL
T1 prenatalvit27&calcium/iron/fa
VINATE ONE QL
T1 prenatal vits w-ca,fe,fa(<1mg)
PRENATALVITAMINS(OTC)
QL
Vitamin B1 PreparationsT1 thiamine hcl VITAMIN B-1(OTC) QLT1 thiamine mononitrate VITAMIN B-1(OTC) QL
Vitamin B12 PreparationsT1 cyanocobalamin VITAMIN B-12(OTC) QLT1 cyanocobalamin
(vitamin b-12)CYANOCOBALAMININJECTION
QL
T1 cyanocobalamin(vitamin b-12)
VITAMIN B-12(OTC) QL
Vitamin B6 PreparationsT1 pyridoxine hcl VITAMIN B-6(OTC) QLT1 pyridoxine/chromium
picolinateCHROMIUMPICOLINATEKLB6(OTC)
QL
Vitamin C PreparationsT1 ascorbic acid PROTEXIN(OTC) QLT1 ascorbic acid VITAMIN C(OTC) QLT1 ascorbic
acid/ascorbatesodium
ACEROLA C(OTC) QL
Vitamin D PreparationsT1 calcitriol CALCITRIOL QLT1 cholecalciferol VITAMIN D(OTC) QLT1 cholecalciferol
(vitamin d3)VITAMIN D3(OTC) QL
T1 dihydrotachysterol DHT QLT1 ergocalciferol
(vitamin d2)VITAMIN D2 QL
T1 ergocalciferol(vitamin d2)
VITAMIN D2(OTC) QL
WEIGHT REDUCTIONAnorexic AgentsT1 phendimetrazine
tartratePHENDIMETRAZINETARTRATE
PA
T1 phentermine hcl ADIPEX-P PAT1 phentermine hcl PHENTERMINE HCL PAT1 phentermine hcl SUPRENZA ODT PAT1 phentermine resin IONAMIN PAT1 phentermine/topiramat
eQSYMIA PA
Commercial Formulary
LA Care Page 35 of 59
Fat Absorption Decreasing AgentsT1 orlistat ALLI(OTC) PAT1 orlistat XENICAL PA
Commercial Formulary
LA Care Page 36 of 59
AGE RESTRICTIONS - FORMULARY • ACE AEROSOL CLOUDENHANCER <= 18 years• AEROCHAMBER MINI <= 18 years• AEROCHAMBER PLUS FLOW-VU <= 18 years• AEROCHAMBER PLUS Z STAT <= 18 years• AMPHETAMINE SALT COMBO >= 3 years• APRODINE(OTC) >= 4 years• BACTOCILL <= 12 years• BREATHERITE <= 18 years• BREATHRITE <= 18 years• BROMFED DM >= 2 years• BUDESONIDE < 9 years• CEFPODOXIME PROXETIL(SUSPRECON) <= 12 years• CELEBREX(CAP)(100 MG) >= 60 years• CELEBREX(CAP)(200 MG) >= 60 years• CELEBREX(CAP)(400 MG) >= 60 years• CELEBREX(CAP)(50 MG) < 18 years• CHERATUSSIN AC(OTC) >= 4 years;>= 6 years• CHERATUSSIN DAC(OTC) >= 4 years;>= 6 years• CICLOPIROX(SOLUTION) <= 18 years• CIPROFLOXACIN ER(TBMP24HR)(1000 MG) <= 12 years• CITALOPRAM HBR(SOLUTION) >= 18 years• CITALOPRAM HBR(TAB)(10 MG)>= 18 years• CITALOPRAM HBR(TAB)(20 MG)>= 18 years• CITALOPRAM HBR(TAB)(40 MG)>= 18 years• CLINDAMYCIN HCL(CAP)(75MG) <= 12 years• CLINDAMYCIN PALMITATEHCL <= 12 years• DIMAPHEN DM(OTC) >= 4 years• DOXYCYCLINEMONOHYDRATE(TAB) <= 12 years• EASIVENT <= 18 years• EFFIENT < 75 years• E-Z SPACER <= 18 years• FENESIN DM IR(OTC) >= 4 years• HYDROCODONE-CHLORPHENIRAMINE >= 6 years• HYDROCODONE-HOMATROPINE MBR >= 6 years• IN-CHECK DIAL(OTC) <= 18 years• KIDKARE(OTC) >= 4 years• LASTACAFT <= 12 years• LITEAIRE <= 18 years• LITETOUCH <= 18 years• LORATADINE(SOLUTION)(OTC) <= 5 years• LORATADINE(TAB RDPDIS)(OTC) <= 12 years• MAPAP PM(OTC) >= 4 years• METHYLPHENIDATE ER(TABER 24H)(18 MG) >= 6 years• METHYLPHENIDATE ER(TABER 24H)(27 MG) >= 6 years• METHYLPHENIDATE ER(TABER 24H)(36 MG) >= 6 years• METHYLPHENIDATE ER(TABER 24H)(54 MG) >= 6 years• MICROCHAMBER <= 18 years• MICROSPACER <= 18 years• MONAGHAN Z STAT <= 18 years
• MOUTHPIECE(OTC) <= 18 years• MUCINEX COUGH(OTC) >= 4 years• MUCINEX DM(OTC) >= 4 years• MUCINEX(OTC) >= 4 years• NALIDIXIC ACID <= 12 years• NASAL DECONGESTANT(OTC) >= 4 years• NEXAFED(OTC) >= 4 years• NICOTINE GUM(OTC) >= 18 years• NICOTINE PATCH(OTC) >= 18 years• NITROFURANTOIN <= 4 years• ONE WAY MOUTHPIECE(OTC) <= 18 years• OPTICHAMBER <= 18 years• OPTICHAMBER DIAMOND <= 18 years• PANDA MASK(OTC) <= 18 years• PAROXETINE HCL(TAB ER 24H) >= 18 years• PAROXETINE HCL(TAB) >= 18 years• PATANOL <= 12 years• PAXIL >= 18 years• PEDIATRIC MASK(OTC) <= 18 years• PEDIATRIC PANDA MASK(OTC) <= 18 years• PFLEX TRAINER <= 18 years• POCKET CHAMBER <= 18 years• PRE-MENSTRUAL RELIEF(OTC) >= 4 years• PREVACID <= 12 years• PRIMEAIRE <= 18 years• PROCHAMBER <= 18 years• PROMETHAZINE HCL >= 2 years• PROMETHAZINE VC >= 2 years• PROMETHAZINE VC-CODEINE >= 2 years;>= 6 years• PROMETHAZINE-CODEINE >= 2 years;>= 6 years• PROMETHAZINE-DM >= 2 years• PROMETHEGAN >= 2 years• PULMICORT < 9 years• Q-TAPP(OTC) >= 4 years• Q-TUSSIN DM(OTC) >= 4 years• Q-TUSSIN(OTC) >= 4 years• RESCON-DM(OTC) >= 4 years• RIOMET <= 12 years;>= 10 years• RITEFLO <= 18 years• ROBITUSSIN COUGH & COLDCF(OTC) >= 4 years• SCOT-TUSSIN SENIOR(OTC) >= 4 years• SIDESTREAM MASK(OTC) <= 18 years• SIDESTREAM PEDIATRIC(OTC) <= 18 years• SILICONE MASK <= 18 years• SILICONE MASK(OTC) <= 18 years• SUDAFED 24-HOUR(OTC) >= 4 years• SUDOGEST(TAB ER)(OTC) >= 4 years• SUDOGEST(TAB)(30 MG)(OTC) >= 4 years• SUDOGEST(TAB)(60 MG)(OTC) >= 4 years• TAMIFLU(SUSP RECON) >= 1 years• TERBINAFINE(OTC) >= 12 years• THRESHOLD IMT <= 18 years• THRESHOLD PEP <= 18 years• TRETINOIN < 25 years• TRETINOIN MICROSPHERE < 25 years• TUSSI PRES-B(OTC) >= 4 years• TUSSICAPS >= 6 years• TUSSIN CF(OTC) >= 4 years• VICKS 44E COUGH &CHEST(OTC) >= 4 years• VORTEX <= 18 years• VORTEX FROG MASK(OTC) <= 18 years
Preferred Drug List Medication Prescribing Limitations
LA Care Page 37 of 59
• VORTEX LADYBUG MASK(OTC)<= 18 years• VORTEX VHC FROG MASK <= 18 years• VORTEX VHC LADYBUG MASK <= 18 years• VORTEX(OTC) <= 18 years• WATCHHALER <= 18 years• WINDMILL TRAINER(OTC) <= 18 years
Preferred Drug List Medication Prescribing Limitations
LA Care Page 38 of 59
QUANTITY RESTRICTIONS - FORMULARY • ABSTRAL(TAB SUBL)(100 MCG) 4 units per 1 days• ACE AEROSOL CLOUDENHANCER 2 units per 365 days• ACEROLA C(OTC) 100 days• ACETAMINOPHENW/CODEINE(ELIXIR) 1800 ml per 23 days• ACETAMINOPHENW/CODEINE(TAB) 360 units per 23 days• ACETAMINOPHEN-CODEINE(SOLUTION) 1800 ml per 23 days• ACETAMINOPHEN-CODEINE(TAB)(300MG-15MG) 13 units per 1 days• ACETAMINOPHEN-CODEINE(TAB)(300MG-30MG) 360 units per 23 days• ACETAMINOPHEN-CODEINE(TAB)(300MG-60MG) 360 units per 23 days• ACTONEL(TAB)(30 MG) 1 units per 1 days• ACTONEL(TAB)(35 MG) 4 units per 28 days• ACTONEL(TAB)(5 MG) 1 units per 1 days• AEROCHAMBER MINI 2 units per 365 days• AEROCHAMBER PLUS FLOW-VU 2 units per 365 days• AEROCHAMBER PLUS Z STAT 2 units per 365 days• ALENDRONATESODIUM(SOLUTION) 300 ml per 28 days• ALENDRONATESODIUM(TAB)(10 MG) 1 units per 1 days• ALENDRONATESODIUM(TAB)(35 MG) 4 units per 28 days• ALENDRONATESODIUM(TAB)(40 MG) 1 units per 1 days• ALENDRONATESODIUM(TAB)(5 MG) 1 units per 1 days• ALENDRONATESODIUM(TAB)(70 MG) 4 units per 28 days• ALLERGY RELIEF D-24(OTC) 1 units per 1 days• ALORA 2 units per 7 days• ALSUMA 2 ml per 23 days;4 ml per
21 days• AMPHETAMINE SALT COMBO 2 units per 1 days• ANASTROZOLE 1 units per 1 days• ANDRODERM 1 units per 1 days• ANDROGEL(GEL MDPMP)(1.25G (1%)) 10 gm per 1 days• ANDROGEL(GEL MDPMP)(20.25/1.25) 5 gm per 1 days• ANDROGEL(GELPACKET)(25MG(1%)) 5 gm per 1 days• ANDROGEL(GEL PACKET)(50MG (1%)) 10 gm per 1 days• ANDROXY 4 units per 1 days• AXERT 12 units per 30 days• AXIRON 6 ml per 1 days• BENZOYL PEROXIDE(OTC) 1 gm per 23 days• BOSULIF(TAB)(100 MG) 4 units per 1 days• BOSULIF(TAB)(500 MG) 1 units per 1 days• BP WASH 1 gm per 23 days• BREATHERITE 2 units per 365 days• BREATHRITE 2 units per 365 days• BUPROPION XL(TAB ER24H)(150 MG) 2 units per 1 days• CABERGOLINE 8 units per fill• CAFERGOT 40 units per 28 days
• CAFFEINE CITRATE 60 ml per 365 days• CALCITRIOL 100 days• CALCIUM ACETATE 9 units per 1 days• CALCIUM CITRATE(OTC) 100 days• CALCIUM GLUCONATE(OTC) 100 days• CALCIUM LACTATE(OTC) 100 days• CELEBREX(CAP)(100 MG) 2 units per 1 days• CELEBREX(CAP)(200 MG) 2 units per 1 days• CELEBREX(CAP)(400 MG) 1 units per 1 days• CELEBREX(CAP)(50 MG) 2 units per 1 days• CENESTIN 1 units per 1 days• CEROVITE JR(OTC) 100 days• CETIRIZINE HCL(TABCHEW)(OTC) 1 units per 1 days• CETIRIZINE HCL(TAB)(OTC) 1 units per 1 days• CETIRIZINE-PSEUDOEPHEDRINE(OTC) 1 units per 1 days• CHEWABLE-VITE(OTC) 100 days• CHILD CHEW + IRON(OTC) 100 days• CHILD CHEW VITAMIN(OTC) 100 days• CHILDRENS CHEWABLE +IRON(OTC) 100 days• CHILDRENS CHEWABLE(OTC) 100 days• CHILDREN'S CLARITIN(OTC) 1 units per 1 days• CHROMIUM PICOLINATEKLB6(OTC) 100 days• CITALOPRAM HBR(SOLUTION) 600 ml per 30 days• CITALOPRAM HBR(TAB)(10 MG)4 units per 1 days• CITALOPRAM HBR(TAB)(20 MG)2 units per 1 days• CITALOPRAM HBR(TAB)(40 MG)1 units per 1 days• CITRACAL + D MAXIMUM(OTC)100 days• CITRUS CALCIUM + D(OTC) 100 days• CLIMARA PRO 1 units per 7 days• CLONIDINE 4 units per 21 days• CODEINE SULFATE 12 units per 1 days• COMBIPATCH 2 units per 7 days• COMPLETENATE 100 days• CYANOCOBALAMIN INJECTION100 days• DHT 100 days• DIASTAT ACUDIAL 1 units per 180 days• DIAZEPAM 1 units per 180 days• DIVIGEL 15 units per 14 days• EASIVENT 2 units per 365 days• EDLUAR 1 units per 1 days• ELESTRIN 26 gm per 28 days• ENJUVIA 1 units per 1 days• ENOXAPARINSODIUM(SYRINGE) 10 ml per fill;5 days• EPIPEN JR 2-PAK 2 units per 180 days• ERGOMAR 40 units per 28 days• ESTRADIOL(PATCH TDWK) 1 units per 7 days• ESTRADIOL(TAB) 1 units per 1 days• ESTRADIOL-NORETHINDRONEACETAT 1 units per 1 days• ESTRASORB 97.44 gm per 28 days• ESTRING 1 units per 90 days• ESTROGEL 50 gm per 28 days• ESTROPIPATE 1 units per 1 days• EVAMIST 16.2 ml per 28 days• EVISTA 1 units per 1 days• EXEMESTANE 1 units per 1 days• E-Z SPACER 2 units per 365 days• FEMHRT 1 units per 1 days
Preferred Drug List Medication Prescribing Limitations
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• FERROUS GLUCONATE(OTC) 100 days• FERROUS SULFATE(OTC) 100 days• FLINTSTONES WITH IRON(OTC) 100 days• FLUORIDE 100 days• FLUORITAB 100 days• FLURA-DROPS 100 days• FLUTICASONE PROPIONATE 16 gm per 23 days• FOLIC ACID 100 days• FOLIC ACID(OTC) 100 days• FOLIVANE-PRX DHA NF 100 days• FORTESTA 4 gm per 1 days• FREESTYLE FLASHSYSTEM(OTC) 1 units per 365 days• FREESTYLE FREEDOMLITE(OTC) 1 units per 365 days• FREESTYLE FREEDOM(OTC) 1 units per 365 days• FREESTYLE INSULINX(OTC) 1 units per 365 days• FREESTYLE INSULINX(OTC) 150 units per 23 days• FREESTYLE LITE METER(OTC) 1 units per 365 days• FREESTYLE LITE(OTC) 150 units per 23 days• FREESTYLE SIDEKICK II(OTC) 1 units per 365 days• FREESTYLE SYSTEM(OTC) 1 units per 365 days• FREESTYLE(OTC) 150 units per 23 days• GRANISETRON HCL 2 units per 1 days• HYDROCODONE BIT-IBUPROFEN 5 units per 1 days• HYDROCODONE-ACETAMINOPHEN(SOLUTION)(2.5-167/5) 3600 ml per 30 days• HYDROCODONE-ACETAMINOPHEN(SOLUTION)(5-334MG/10) 3600 ml per 30 days• HYDROCODONE-ACETAMINOPHEN(SOLUTION)(7.5-325/15) 5400 ml per 30 days• HYDROCODONE-ACETAMINOPHEN(SOLUTION)(7.5-500/15) 3600 ml per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10-660MG) 180 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10-750MG) 150 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-300MG) 390 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-325MG) 360 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-500MG) 240 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-650MG) 180 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-500MG) 240 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(5 MG-500MG) 240 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-300MG) 390 units per 30 days
• HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-325MG) 360 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-300MG) 390 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-325MG) 360 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-500MG) 240 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-650MG) 180 units per 30 days• HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-750MG) 150 units per 30 days• HYDROCODONE-HOMATROPINE MBR 30 ml per 1 days• HYDROMORPHONE HCL(SUPP) 60 units per 30 days• HYDROMORPHONE HCL(TAB) 6 units per 1 days• IBANDRONATE SODIUM 1 units per 30 days• ICLUSIG(TAB)(15 MG) 2 units per 1 days• ICLUSIG(TAB)(45 MG) 1 units per 1 days• IN-CHECK DIAL(OTC) 2 units per 365 days• INTERMEZZO 1 units per 1 days• JANUMET 2 units per 1 days• JANUMET XR 1 units per 1 days• JANUVIA 1 units per 1 days• JENTADUETO 2 units per 1 days• KETEK 20 units per 30 days• KETOROLAC TROMETHAMINE 20 units per fill• KIDS VITAMINSCOMPLETE(OTC) 100 days• KIDS VITAMINS(OTC) 100 days• LASTACAFT 1 ml per 23 days• LETROZOLE 1 units per 1 days• LEVETIRACETAM(TAB ER24H)(500 MG) 6 units per 1 days• LEVETIRACETAM(TAB ER24H)(750 MG) 4 units per 1 days• LEVOFLOXACIN(SOLUTION) 30 ml per 1 days• LEVOFLOXACIN(TAB)(750 MG) 1 units per 1 days• LEVOFLOXACIN(TAB)(750MG) 1 units per 1 days• LITEAIRE 2 units per 365 days• LITETOUCH 2 units per 365 days• LORATADINE(SOLUTION)(OTC) 240 ml per 23 days• LORATADINE(TAB RDPDIS)(OTC) 1 units per 1 days• LORATADINE(TAB)(OTC) 1 units per 1 days• LORATADINE-D(TAB ER12H)(OTC) 2 units per 1 days• LORATADINE-D(TAB ER24H)(OTC) 1 units per 1 days• LUNESTA 1 units per 1 days• MAGNESIUM OXIDE(OTC) 100 days• MAGOX 400(OTC) 100 days• MELOXICAM 1 units per 1 days• MENEST 1 units per 1 days• MENOSTAR 1 units per 7 days• METFORMIN HCL(TAB)(1000MG) 2 units per 1 days• METFORMIN HCL(TAB)(500MG) 5 units per 1 days
Preferred Drug List Medication Prescribing Limitations
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• METHADONE HCL(ORALCONC) 120 ml per 30 days• METHADONE HCL(TAB)(10 MG) 120 units per 30 days• METHADONE HCL(TAB)(5 MG) 240 units per 30 days• METHYLPHENIDATE ER(TABER 24H)(18 MG)
1 units per 1 days;18units after 90 days;2units per 1 days
• METHYLPHENIDATE ER(TABER 24H)(27 MG)
1 units per 1 days;2 unitsper 1 days;27 units after90 days
• METHYLPHENIDATE ER(TABER 24H)(36 MG) 2 units per 1 days• METHYLPHENIDATE ER(TABER 24H)(54 MG)
1 units per 1 days;2 unitsper 1 days;54 units after90 days
• METOCLOPRAMIDE HCLINTENSOL 1200 ml per 23 days• METOCLOPRAMIDEHCL(SOLUTION) 1200 ml per 23 days• METOCLOPRAMIDE HCL(TAB) 4 units per 1 days• MICROCHAMBER 2 units per 365 days• MICROSPACER 2 units per 365 days• MIGERGOT 20 units per 28 days• MINIVELLE 2 units per 7 days• MIRAPEX ER 1 units per 1 days• MODAFINIL 2 units per 1 days• MONAGHAN Z STAT 2 units per 365 days• MORPHINE SULFATE 120 units per 30 days• MORPHINE SULFATE ER(CAPER PEL)(20 MG) 90 units per 30 days• MORPHINE SULFATE ER(CAPER PEL)(30 MG) 90 units per 30 days• MORPHINE SULFATE ER(CAPER PEL)(50 MG) 90 units per 30 days• MORPHINE SULFATE ER(CAPER PEL)(60 MG) 90 units per 30 days• MORPHINE SULFATE ER(CAPER PEL)(80 MG) 90 units per 30 days• MORPHINE SULFATE ER(TABER)(100 MG) 90 units per 30 days• MORPHINE SULFATE ER(TABER)(15 MG) 90 units per 30 days• MORPHINE SULFATE ER(TABER)(30 MG) 90 units per 30 days• MORPHINE SULFATE ER(TABER)(60 MG) 90 units per 30 days• MOUTHPIECE(OTC) 2 units per 365 days• MULTIVITAMIN WITHFLUORIDE 100 days• MULTIVITAMIN(OTC) 100 days• MULTIVITAMINS W/FLUORIDE 100 days• MULTIVITAMINS W-FLUORIDE-IRON 100 days• MULTIVITAMINS WITHFLUORIDE 100 days• MYNATAL 100 days• NARATRIPTAN HCL 18 units per 30 days• NASONEX 17 gm per 23 days• NEUPRO 1 units per 1 days• NEXAFED(OTC) 8 units per 1 days• NEXT CHOICE ONE DOSE 2 units per 23 days• OMEPRAZOLE(OTC) 2 units per 1 days• OMEPRAZOLE-SODIUMBICARBONATE 60 units per 30 days
• OMEPRAZOLE-SODIUMBICARBONATE(OTC) 60 units per 30 days• ONDANSETRON ODT(TAB RDPDIS)(4 MG) 6 units per 1 days• ONDANSETRON ODT(TAB RDPDIS)(8 MG) 3 units per 1 days• ONE WAY MOUTHPIECE(OTC) 2 units per 365 days• OPTICHAMBER 2 units per 365 days• OPTICHAMBER DIAMOND 2 units per 365 days• OPTIUM EZ(OTC) 150 units per 23 days• OPTIUM(OTC) 150 units per 23 days• OXYCODONE HCL(CAP) 120 units per 23 days• OXYCODONE HCL(TAB)(10 MG) 120 units per 23 days• OXYCODONE HCL(TAB)(15 MG) 12 units per 1 days• OXYCODONE HCL(TAB)(20 MG) 120 units per 23 days• OXYCODONE HCL(TAB)(30 MG) 120 units per 23 days• OXYCODONE HCL(TAB)(5 MG) 12 units per 1 days• OXYCODONE HCL-ASPIRIN 360 units per 23 days• OXYCODONE-ACETAMINOPHEN(CAP) 240 units per 30 days• OXYCODONE-ACETAMINOPHEN(TAB)(5MG-325MG) 360 units per 30 days• OXYCODONE-ACETAMINOPHEN(TAB)(7.5-325MG) 360 units per 30 days• OYSTER SHELL CALCIUM W-VIT D(OTC) 100 days• OYSTER SHELL CALCIUM(OTC) 100 days• PANDA MASK(OTC) 2 units per 365 days• PANTOPRAZOLE SODIUM 2 units per 1 days• PAROXETINE HCL(TAB ER 24H) 1 units per 1 days• PARVA-CAL 500(OTC) 100 days• PATADAY 1 ml per 23 days• PATANOL 1 ml per 23 days• PEDIATRIC MASK(OTC) 2 units per 365 days• PEDIATRIC PANDA MASK(OTC) 2 units per 365 days• PENTAZOCINE-NALOXONEHCL 12 units per 1 days• PERRY PRENATAL(OTC) 100 days• PFLEX TRAINER 2 units per 365 days• PNV-SELECT 100 days• POCKET CHAMBER 2 units per 365 days• POLYVITAMIN WITHIRON(OTC) 100 days• POLY-VITAMIN(OTC) 100 days• PR NATAL 400 100 days• PR NATAL 400 EC 100 days• PRECISION PCX PLUS(OTC) 150 units per 23 days• PRECISION PCX(OTC) 150 units per 23 days• PRECISION POINT OFCARE(OTC) 150 units per 23 days• PRECISION Q-I-D(OTC) 150 units per 23 days• PRECISION XTRA(OTC) 1 units per 365 days• PRECISION XTRA(OTC) 150 units per 23 days• PRECISION(OTC) 1 units per 365 days• PREFEST 1 units per 1 days• PREMARIN(TAB)(0.3 MG) 1 units per 1 days• PREMARIN(TAB)(0.45MG) 1 units per 1 days• PREMARIN(TAB)(0.625 MG) 1 units per 1 days• PREMARIN(TAB)(1.25 MG) 1 units per 1 days• PREMPRO 1 units per 1 days• PRENAISSANCE DHA 100 days• PRENAPLUS 100 days• PRENATABS FA 100 days
Preferred Drug List Medication Prescribing Limitations
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• PRENATABS RX 100 days• PRENATAL 19(OTC) 100 days• PRENATAL AD 100 days• PRENATAL PLUS 100 days• PRENATAL VITAMINFORMULA(OTC) 100 days• PRENATAL VITAMINS(OTC) 100 days• PRENATAL(OTC) 100 days• PREVACID 24HR(OTC) 56 units per 21 days• PRILOSEC OTC(OTC) 56 units per 28 days• PRIMEAIRE 2 units per 365 days• PROCHAMBER 2 units per 365 days• PROTEXIN(OTC) 100 days• RITEFLO 2 units per 365 days• RIZATRIPTAN 18 units per 30 days• ROPINIROLE HCL(TAB ER 24H) 1 units per 1 days• ROZEREM 1 units per 1 days• SE-NATAL 19 100 days• SIDESTREAM MASK(OTC) 2 units per 365 days• SIDESTREAM PEDIATRIC(OTC) 2 units per 365 days• SILENOR 1 units per 1 days• SILICONE MASK 2 units per 365 days• SILICONE MASK(OTC) 2 units per 365 days• SPRYCEL(TAB)(100 MG) 1 units per 1 days• SPRYCEL(TAB)(140 MG) 1 units per 1 days• SPRYCEL(TAB)(20 MG) 2 units per 1 days• SPRYCEL(TAB)(50 MG) 1 units per 1 days• SPRYCEL(TAB)(70 MG) 1 units per 1 days• SPRYCEL(TAB)(80 MG) 1 units per 1 days• STRIANT 2 units per 1 days• SUDAFED 24-HOUR(OTC) 1 units per 1 days• SUDOGEST(TAB ER)(OTC) 2 units per 1 days• SUDOGEST(TAB)(30 MG)(OTC) 8 units per 1 days• SUDOGEST(TAB)(60 MG)(OTC) 4 units per 1 days• SUMATRIPTAN 12 units per 30 days• SUMATRIPTANSUCCINATE(CARTRIDGE)(4MG/0.5ML) 2 ml per 23 days• SUMATRIPTANSUCCINATE(CARTRIDGE)(6MG/0.5ML) 2 ml per 23 days• SUMATRIPTAN SUCCINATE(PENINJCTR)(4 MG/0.5ML) 2 ml per 23 days• SUMATRIPTAN SUCCINATE(PENINJCTR)(6 MG/0.5ML) 2 ml per 23 days• SUMATRIPTANSUCCINATE(TAB) 18 units per 30 days• SUMAVEL DOSEPRO 4 ml per 21 days• SUPRAX 2 units per 365 days• TAMIFLU(CAP)(30 MG) 20 units per 365 days• TAMIFLU(CAP)(45 MG) 10 units per 365 days• TAMIFLU(CAP)(75 MG) 10 units per 365 days• TAMIFLU(SUSP RECON) 10 days• TERBINAFINE HCL 90 units per 365 days• TERBINAFINE(OTC) 1 gm per 23 days• TESTIM 10 gm per 1 days• TESTOPEL 6 units per 90 days• THRESHOLD IMT 2 units per 365 days• THRESHOLD PEP 2 units per 365 days• TRADJENTA 2 units per 1 days• TRAMADOL HCL 8 units per 1 days• TRAMADOL HCL-ACETAMINOPHEN 8 units per 1 days• TREXIMET 9 units per 30 days• TRICARE 100 days
• TRI-VIT WITH FLUORIDE-IRON 100 days• TRI-VITAMIN WITH FLUORIDE 100 days• TRI-VITAMIN(OTC) 100 days• ULTIMA(OTC) 150 units per 23 days• ULTIMATECARE ONE 100 days• VASELINE WHITE PETROLEUM 2 gm per 23 days• V-C FORTE 100 days• VENTOLIN HFA 36 gm per 23 days < 18
years• VERAMYST 1 gm per 23 days• VINACAL 100 days• VINATE GT 100 days• VINATE ONE 100 days• VINATE PN CARE 100 days• VINATE ULTRA 100 days• VITALETS(OTC) 100 days• VITAMIN B-1(OTC) 100 days• VITAMIN B-12(OTC) 100 days• VITAMIN B-6(OTC) 100 days• VITAMIN C(OTC) 100 days• VITAMIN D(OTC) 100 days• VITAMIN D2 100 days• VITAMIN D2(OTC) 100 days• VITAMIN D3(OTC) 100 days• VITASPIRE 100 days• VITE CON FORTE 100 days• VIVELLE-DOT 2 units per 7 days• VORTEX 2 units per 365 days• VORTEX FROG MASK(OTC) 2 units per 365 days• VORTEX LADYBUG MASK(OTC)2 units per 365 days• VORTEX VHC FROG MASK 2 units per 365 days• VORTEX VHC LADYBUG MASK 2 units per 365 days• VORTEX(OTC) 2 units per 365 days• WATCHHALER 2 units per 365 days• WINDMILL TRAINER(OTC) 2 units per 365 days• ZALEPLON 1 units per 1 days• ZATEAN-PN DHA 100 days• ZEGERID 60 units per 30 days• ZOLMITRIPTAN 12 units per 30 days• ZOLPIDEM TARTRATE 1 units per 1 days• ZOLPIMIST 7.7 ml per 23 days• ZOMIG 12 units per 30 days
Preferred Drug List Medication Prescribing Limitations
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STEP THERAPY EDITS - FORMULARY • ABSORICA Prior prescription for Benzamycinpak in 90 days• ACTOPLUS MET XR Prior prescription for Tolbutamide in 90 days• ALLERGY RELIEF D(OTC) Prior prescription for Wal-itin D 12 Hour in 90 days or Zyrtec-d in 90 days• ALSUMA Atleast 2 of Prior prescription for Sumatriptan Succinate in 180 days or Zolmitriptan
in 180 days• ALTABAX Prior prescription for Mupirocin in 90 days• APIDRA Prior prescription for Apidra in 90 days or Humalog in 90 days or Novolog Mix 70-
30 in 90 days• APRISO Atleast 3 of Prior prescription for Colazal in 90 days or Delzicol in 90 days or
Sulfazine in 90 days• ASMANEX(AER POW BA)(110MCG(30))Prior prescription for Flovent Hfa in 90 days or Qvar in 90 days• ASMANEX(AER POW BA)(220MCG120)
Prior prescription for Asmanex in 90 days or Flovent Diskus in 90 days or FloventHfa in 90 days or Qvar in 90 days
• ASMANEX(AER POW BA)(220MCG(60))Prior prescription for Asmanex in 90 days or Flovent Diskus in 90 days or FloventHfa in 90 days or Qvar in 90 days
• AUVI-Q Prior prescription for Auvi-q in 120 days or Twinject in 120 days• AZELASTINE HCL Prior prescription for Zyrtec Itchy Eye in 90 days• AZOR Prior prescription for Antihypertensives, Angiotensin Receptor Antagonist in 90 days• BEYAZ Atleast 3 of Prior prescription for Generess Fe in 365 days or Loseasonique in 365
days or Lybrel in 365 days or Microgestin Fe in 365 days or Microgestin in 365 daysor Necon in 365 days or Ortho Micronor in 365 days or Ortho-novum in 365 days orPirmella in 365 days or Portia in 365 days or Seasonale in 365 days or Seasonique in365 days or Sprintec in 365 days or Sronyx in 365 days or Tri-legest Fe in 365 daysor Tri-norinyl in 365 days or Trinessa in 365 days or Trivora-28 in 365 days or Werain 365 days or Yaz in 365 days or Zarah in 365 days or Zenchent in 365 days orZeosa in 365 days
• BRILINTA Prior prescription for Plavix in 120 days• BROVANA Prior prescription for in 90 days or Albuterol Sulfate in 90 days or Ventolin in 90
days or Xopenex Concentrate in 90 days or Xopenex in 90 days• BUDESONIDE EC Prior prescription for Glucocorticoids in 90 days• BYSTOLIC Atleast 2 of Prior prescription for Kerlone in 90 days or Levatol in 90 days or
Metoprolol Tartrate in 90 days or Nadolol in 90 days or Pindolol in 90 days orPropranolol Hcl in 90 days or Sectral in 90 days or Sotalol Hcl in 90 days orTenormin in 90 days or Timolol Maleate in 90 days or Toprol Xl in 90 days or Zebetain 90 days
• CALCIPOTRIENE Prior prescription for Dovonex in 90 days• CARBIDOPA-LEVODOPA-ENTACAPONE Prior prescription for Sinemet Cr in 90 days• CELEBREX(CAP)(100 MG) Atleast 2 of Prior prescription for in 90 days or Actron in 90 days or Diclofenac
Sodium in 90 days or Diclofenac Sodium-misoprostol in 90 days or Etodolac in 90days or Fenoprofen Calcium in 90 days or Flurbiprofen in 90 days or Ibuprofen in 90days or Ibuprohm in 90 days or Indocin in 90 days or Indomethacin in 90 days orInfants' Motrin in 90 days or Ketoprofen in 90 days or Ketorolac Tromethamine in 90days or Meclofenamate Sodium in 90 days or Mobic in 90 days or Motrin in 90 daysor Nalfon in 90 days or Naprelan in 90 days or Naproxen Sodium in 90 days orNaproxen in 90 days or Oxaprozin in 90 days or Piroxicam in 90 days or Ponstel in90 days or Relafen in 90 days or Sulindac in 90 days or Tolmetin Sodium in 90 daysor Toradol in 90 days or Voltaren in 90 days or Voltaren-xr in 90 days or Wal-profenin 90 days or Wal-proxen in 90 days or Zipsor in 90 days
• CELEBREX(CAP)(200 MG) Atleast 2 of Prior prescription for in 90 days or Actron in 90 days or DiclofenacSodium in 90 days or Diclofenac Sodium-misoprostol in 90 days or Etodolac in 90days or Fenoprofen Calcium in 90 days or Flurbiprofen in 90 days or Ibuprofen in 90days or Ibuprohm in 90 days or Indocin in 90 days or Indomethacin in 90 days orInfants' Motrin in 90 days or Ketoprofen in 90 days or Ketorolac Tromethamine in 90days or Meclofenamate Sodium in 90 days or Mobic in 90 days or Motrin in 90 daysor Nalfon in 90 days or Naprelan in 90 days or Naproxen Sodium in 90 days orNaproxen in 90 days or Oxaprozin in 90 days or Piroxicam in 90 days or Ponstel in90 days or Relafen in 90 days or Sulindac in 90 days or Tolmetin Sodium in 90 daysor Toradol in 90 days or Voltaren in 90 days or Voltaren-xr in 90 days or Wal-profenin 90 days or Wal-proxen in 90 days or Zipsor in 90 days
• CELEBREX(CAP)(400 MG) Atleast 2 of Prior prescription for in 90 days or Actron in 90 days or DiclofenacSodium in 90 days or Diclofenac Sodium-misoprostol in 90 days or Etodolac in 90days or Fenoprofen Calcium in 90 days or Flurbiprofen in 90 days or Ibuprofen in 90
Preferred Drug List Medication Prescribing Limitations
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days or Ibuprohm in 90 days or Indocin in 90 days or Indomethacin in 90 days orInfants' Motrin in 90 days or Ketoprofen in 90 days or Ketorolac Tromethamine in 90days or Meclofenamate Sodium in 90 days or Mobic in 90 days or Motrin in 90 daysor Nalfon in 90 days or Naprelan in 90 days or Naproxen Sodium in 90 days orNaproxen in 90 days or Oxaprozin in 90 days or Piroxicam in 90 days or Ponstel in90 days or Relafen in 90 days or Sulindac in 90 days or Tolmetin Sodium in 90 daysor Toradol in 90 days or Voltaren in 90 days or Voltaren-xr in 90 days or Wal-profenin 90 days or Wal-proxen in 90 days or Zipsor in 90 days
• CELEBREX(CAP)(50 MG) Atleast 2 of Prior prescription for in 90 days or Actron in 90 days or DiclofenacSodium in 90 days or Diclofenac Sodium-misoprostol in 90 days or Etodolac in 90days or Fenoprofen Calcium in 90 days or Flurbiprofen in 90 days or Ibuprofen in 90days or Ibuprohm in 90 days or Indocin in 90 days or Indomethacin in 90 days orInfants' Motrin in 90 days or Ketoprofen in 90 days or Ketorolac Tromethamine in 90days or Meclofenamate Sodium in 90 days or Mobic in 90 days or Motrin in 90 daysor Nalfon in 90 days or Naprelan in 90 days or Naproxen Sodium in 90 days orNaproxen in 90 days or Oxaprozin in 90 days or Piroxicam in 90 days or Ponstel in90 days or Relafen in 90 days or Sulindac in 90 days or Tolmetin Sodium in 90 daysor Toradol in 90 days or Voltaren in 90 days or Voltaren-xr in 90 days or Wal-profenin 90 days or Wal-proxen in 90 days or Zipsor in 90 days
• CLARAVIS Prior prescription for Benzamycinpak in 90 days• COMBIGAN Atleast 2 of Prior prescription for Dorzolamide-timolol in 120 days or Trusopt in 120
days• DELZICOL Atleast 2 of Prior prescription for Colazal in 90 days or Sulfazine in 90 days• DEXILANT Atleast 3 of Prior prescription for Prevacid Iv in 90 days or Protonix Iv in 90 days or
Zantac-ppi in 90 days• DIOVAN Atleast 2 of Prior prescription for Edarbi in 90 days or Edarbyclor in 90 days or
Irbesartan in 90 days or Irbesartan-hydrochlorothiazide in 90 days or LosartanPotassium in 90 days or Losartan-hydrochlorothiazide in 90 days
• EDARBI Atleast 3 of Prior prescription for Candesartan Cilexetil in 90 days or Irbesartan in 90days or Losartan Potassium in 90 days
• EDARBYCLOR Atleast 3 of Prior prescription for Candesartan-hydrochlorothiazid in 90 days orIrbesartan-hydrochlorothiazide in 90 days or Losartan-hydrochlorothiazide in 90days
• EDLUAR Atleast 5 of Prior prescription for Edluar in 120 days or Flurazepam Hcl in 120 daysor Prosom in 120 days or Temazepam in 120 days or Zaleplon in 120 days orZolpimist in 120 days
• EFFIENT Prior prescription for in 120 days or Plavix in 120 days• ELIDEL Prior prescription for Topical Anti-inflammatory Steroidal in 90 days• EPLERENONE Prior prescription for Spironolactone in 90 days• ERGOMAR Atleast 2 of Prior prescription for Ergotrate in 180 days or Zolmitriptan in 180 days• EXFORGE Prior prescription for Antihypertensives, Angiotensin Receptor Antagonist in 90 days• EXFORGE HCT Prior prescription for Antihypertensives, Angiotensin Receptor Antagonist in 90 days
or Exforge in 90 days• FENOGLIDE Atleast 2 of Prior prescription for Lopid in 120 days or Triglide in 120 days• FENOPROFEN CALCIUM Prior prescription for Wal-profen in 90 days• FEXOFENADINE HCL Prior prescription for Wal-vert in 90 days or Zyrtec in 90 days• FEXOFENADINE HCL(OTC) Prior prescription for Wal-vert in 90 days or Zyrtec in 90 days• FLUVASTATIN SODIUM Prior prescription for Fluvastatin Sodium in 90 days or Pravastatin Sodium in 90
days• FLUVOXAMINE MALEATE(CAP ER24H)
Prior prescription for Citalopram Hbr in 120 days or Lexapro in 120 days or LuvoxCr in 120 days or Paxil Cr in 120 days or Remeron in 120 days or Selfemra in 120days or Zoloft in 120 days or Zyban in 120 days
• GLIPIZIDE-METFORMIN Atleast 2 of Prior prescription for Glucotrol Xl in 90 days or Riomet in 90 days• IBANDRONATE SODIUM Prior prescription for Alendronate Sodium in 365 days or Alendronate
Sodium/vitamin D3 in 365 days• INTERMEZZO Atleast 5 of Prior prescription for Flurazepam Hcl in 120 days or Intermezzo in 120
days or Prosom in 120 days or Temazepam in 120 days or Zaleplon in 120 days orZolpimist in 120 days
• JANUMET Prior prescription for Riomet in 120 days• JANUMET XR Prior prescription for Riomet in 120 days• JANUVIA Prior prescription for Riomet in 120 days• JENTADUETO Prior prescription for Riomet in 120 days• KETEK Prior prescription for Macrolides in 120 days• LASTACAFT Atleast 2 of Prior prescription for Optivar in 90 days or Zyrtec Itchy Eye in 90 days• LEFLUNOMIDE Prior prescription for Trexall in 90 days
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• LEVALBUTEROL HCL Prior prescription for Albuterol Sulfate in 90 days• LEVEMIR Prior prescription for Lantus Solostar in 90 days• LIPOFEN Atleast 2 of Prior prescription for Lopid in 120 days or Triglide in 120 days• LO LOESTRIN FE Atleast 3 of Prior prescription for Generess Fe in 365 days or Loseasonique in 365
days or Lybrel in 365 days or Microgestin Fe in 365 days or Microgestin in 365 daysor Necon in 365 days or Ortho Micronor in 365 days or Ortho-novum in 365 days orPirmella in 365 days or Portia in 365 days or Seasonale in 365 days or Seasonique in365 days or Sprintec in 365 days or Sronyx in 365 days or Tri-legest Fe in 365 daysor Tri-norinyl in 365 days or Trinessa in 365 days or Trivora-28 in 365 days or Werain 365 days or Yaz in 365 days or Zarah in 365 days or Zenchent in 365 days orZeosa in 365 days
• LUNESTA Atleast 5 of Prior prescription for Flurazepam Hcl in 120 days or Lunesta in 120 daysor Prosom in 120 days or Temazepam in 120 days or Zaleplon in 120 days orZolpimist in 120 days
• MALATHION Atleast 4 of Prior prescription for Eurax in 365 days or Lindane in 365 days or Rid in365 days or Triple X in 365 days
• MIRAPEX ER Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in120 days
• MORPHINE SULFATE ER(CAP ERPEL)(20 MG) Prior prescription for Msir in 120 days• MORPHINE SULFATE ER(CAP ERPEL)(50 MG) Prior prescription for Msir in 120 days• MORPHINE SULFATE ER(CAP ERPEL)(60 MG) Prior prescription for Msir in 120 days• MORPHINE SULFATE ER(CAP ERPEL)(80 MG) Prior prescription for Msir in 120 days• NAMENDA Prior prescription for Donepezil Hcl Odt in 120 days or Exelon in 90 days or
Razadyne Er in 90 days or Rivastigmine in 90 days• NAMENDA XR Prior prescription for Donepezil Hcl Odt in 120 days or Exelon in 90 days or
Razadyne Er in 90 days or Rivastigmine in 90 days• NATAZIA Atleast 3 of Prior prescription for Generess Fe in 365 days or Loseasonique in 365
days or Lybrel in 365 days or Microgestin Fe in 365 days or Microgestin in 365 daysor Necon in 365 days or Ortho Micronor in 365 days or Ortho-novum in 365 days orPirmella in 365 days or Portia in 365 days or Seasonale in 365 days or Seasonique in365 days or Sprintec in 365 days or Sronyx in 365 days or Tri-legest Fe in 365 daysor Tri-norinyl in 365 days or Trinessa in 365 days or Trivora-28 in 365 days or Werain 365 days or Yaz in 365 days or Zarah in 365 days or Zenchent in 365 days orZeosa in 365 days
• OCELLA Atleast 3 of Prior prescription for Generess Fe in 365 days or Lo Loestrin Fe in 365days or Lomedia 24 Fe in 365 days or Loseasonique in 365 days or Lybrel in 365days or Microgestin Fe in 365 days or Microgestin in 365 days or Necon in 365 daysor Ortho Micronor in 365 days or Ortho-novum in 365 days or Ovcon-50 in 365 daysor Ovral-28 in 365 days or Pirmella in 365 days or Portia in 365 days or Seasonale in365 days or Seasonique in 365 days or Sprintec in 365 days or Sronyx in 365 days orTri-legest Fe in 365 days or Tri-lo-sprintec in 365 days or Tri-norinyl in 365 days orTrinessa in 365 days or Trivora-28 in 365 days or Velivet in 365 days or Viorele in365 days or Wera in 365 days or Zenchent in 365 days or Zeosa in 365 days or Zovia1-50e in 365 days
• OMEPRAZOLE-SODIUMBICARBONATE Prior prescription for Prilosec Otc in 180 days• OMEPRAZOLE-SODIUMBICARBONATE(OTC) Prior prescription for Prilosec Otc in 180 days• ORTHO TRI-CYCLEN LO Atleast 3 of Prior prescription for Generess Fe in 365 days or Loseasonique in 365
days or Lybrel in 365 days or Microgestin Fe in 365 days or Microgestin in 365 daysor Necon in 365 days or Ortho Micronor in 365 days or Ortho-novum in 365 days orPirmella in 365 days or Portia in 365 days or Seasonale in 365 days or Seasonique in365 days or Sprintec in 365 days or Sronyx in 365 days or Tri-legest Fe in 365 daysor Tri-norinyl in 365 days or Trinessa in 365 days or Trivora-28 in 365 days or Werain 365 days or Yaz in 365 days or Zarah in 365 days or Zenchent in 365 days orZeosa in 365 days
• OXTELLAR XR Prior prescription for Trileptal in 120 days• PAROXETINE HCL(TAB ER 24H) Prior prescription for Paxil Cr in 90 days or Paxil in 90 days• PATADAY Atleast 2 of Prior prescription for Optivar in 90 days or Zyrtec Itchy Eye in 90 days• PATANOL Atleast 2 of Prior prescription for Optivar in 90 days or Zyrtec Itchy Eye in 90 days• PIOGLITAZONE HCL Prior prescription for Tolbutamide in 90 days
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• PIOGLITAZONE-GLIMEPIRIDE Prior prescription for Glimepiride in 90 days or Pioglitazone Hcl in 90 days• PIOGLITAZONE-METFORMIN Prior prescription for Tolbutamide in 90 days• PREVACID 24HR(OTC) Prior prescription for Zantac-ppi in 90 days• PROTOPIC Prior prescription for Elidel in 90 days or Protopic in 90 days• PULMICORT FLEXHALER Prior prescription for Flovent Diskus in 90 days or Flovent Hfa in 90 days or
Pulmicort Flexhaler in 90 days or Qvar in 90 days• ROPINIROLE HCL(TAB ER 24H) Prior prescription for Pramipexole Dihydrochloride in 120 days or Ropinirole Hcl in
120 days• ROZEREM Atleast 5 of Prior prescription for Flurazepam Hcl in 120 days or Prosom in 120 days
or Temazepam in 120 days or Zaleplon in 120 days or Zolpimist in 120 days• SAFYRAL Atleast 3 of Prior prescription for Generess Fe in 365 days or Lo Loestrin Fe in 365
days or Lomedia 24 Fe in 365 days or Loseasonique in 365 days or Lybrel in 365days or Microgestin Fe in 365 days or Microgestin in 365 days or Necon in 365 daysor Ortho Micronor in 365 days or Ortho-novum in 365 days or Ovcon-50 in 365 daysor Ovral-28 in 365 days or Pirmella in 365 days or Portia in 365 days or Seasonale in365 days or Seasonique in 365 days or Sprintec in 365 days or Sronyx in 365 days orTri-legest Fe in 365 days or Tri-lo-sprintec in 365 days or Tri-norinyl in 365 days orTrinessa in 365 days or Trivora-28 in 365 days or Velivet in 365 days or Viorele in365 days or Wera in 365 days or Yaz in 365 days or Zarah in 365 days or Zenchent in365 days or Zeosa in 365 days or Zovia 1-50e in 365 days
• SILENOR Atleast 5 of Prior prescription for Flurazepam Hcl in 120 days or Prosom in 120 daysor Temazepam in 120 days or Zaleplon in 120 days or Zolpimist in 120 days
• SIMBRINZA Atleast 2 of Prior prescription for Dorzolamide-timolol in 120 days or Trusopt in 120days
• SIMVASTATIN(TAB)(80 MG) Prior prescription for Vytorin in 365 days• SUMATRIPTANSUCCINATE(CARTRIDGE)(4 MG/0.5ML) Prior prescription for Sumatriptan Succinate in 90 days• SUMATRIPTAN SUCCINATE(PENINJCTR)(4 MG/0.5ML) Prior prescription for Sumatriptan Succinate in 90 days• SUMAVEL DOSEPRO Prior prescription for Sumatriptan Succinate in 180 days• TEKTURNA HCT Prior prescription for Tekturna in 90 days• TOLTERODINE TARTRATE Prior prescription for Oxybutynin Chloride Er in 90 days• TRADJENTA Prior prescription for Riomet in 120 days• TROSPIUM CHLORIDE Prior prescription for Oxybutynin Chloride Er in 90 days• VALSARTAN-HYDROCHLOROTHIAZIDE
Atleast 2 of Prior prescription for Edarbi in 90 days or Edarbyclor in 90 days orIrbesartan in 90 days or Irbesartan-hydrochlorothiazide in 90 days or LosartanPotassium in 90 days or Losartan-hydrochlorothiazide in 90 days
• VOLTAREN Prior prescription for Voltaren-xr in 90 days• VYTORIN(TAB)(10 MG-10MG) Prior prescription for Advicor in 90 days and Crestor in 90 days and Lescol Xl in 90
days and Lipitor in 90 days and Mevacor in 90 days and Pravastatin Sodium in 90days and Vytorin in 90 days and Zetia in 90 days and Zocor in 90 days
• VYTORIN(TAB)(10 MG-20MG) Prior prescription for Advicor in 90 days and Crestor in 90 days and Lescol Xl in 90days and Lipitor in 90 days and Mevacor in 90 days and Pravastatin Sodium in 90days and Vytorin in 90 days and Zetia in 90 days and Zocor in 90 days
• VYTORIN(TAB)(10 MG-40MG) Prior prescription for Advicor in 90 days and Crestor in 90 days and Lescol Xl in 90days and Lipitor in 90 days and Mevacor in 90 days and Pravastatin Sodium in 90days and Vytorin in 90 days and Zetia in 90 days and Zocor in 90 days
• WELCHOL Prior prescription for Questran Light in 90 days or Questran in 90 days• ZEGERID Prior prescription for Prilosec Otc in 180 days• ZETIA Prior prescription for Advicor in 90 days or Crestor in 90 days or Lescol Xl in 90
days or Lipitor in 90 days or Mevacor in 90 days or Pravastatin Sodium in 90 days orVytorin in 90 days or Zocor in 90 days
• ZOLPIMIST Atleast 5 of Prior prescription for Flurazepam Hcl in 120 days or Prosom in 120 daysor Temazepam in 120 days or Zaleplon in 120 days or Zolpimist in 120 days
• ZOMIG Prior prescription for Zomig Zmt in 180 days
Preferred Drug List Medication Prescribing Limitations
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PRIOR AUTHORIZATION RESRICTION - FORMULARY • ABACAVIR• ABACAVIR-LAMIVUDINE-ZIDOVUDINE• ABSTRAL(TAB SUBL)(100 MCG)• ABSTRAL(TAB SUBL)(200 MCG)• ABSTRAL(TAB SUBL)(300 MCG)• ABSTRAL(TAB SUBL)(400 MCG)• ABSTRAL(TAB SUBL)(600 MCG)• ABSTRAL(TAB SUBL)(800 MCG)• ACTIMMUNE• ACTONEL(TAB)(150 MG)• ACTONEL(TAB)(30 MG)• ACTONEL(TAB)(35 MG)• ACTONEL(TAB)(5 MG)• ACYCLOVIR• ADIPEX-P• ADVAIR DISKUS• ADVAIR HFA• ADVATE• ADVATE H• ADVATE L• ADVATE M• ADVATE SH• ADVATE UH• AGGRENOX• ALFERON N• ALINIA• ALLI(OTC)• ALOCRIL• ALOMIDE• ALPHANATE• ALPHANINE SD• AMPYRA• AMTURNIDE• ANDROGEL(GEL MD PMP)(1.25G (1%))• ANDROGEL(GEL PACKET)(25MG(1%))• ANDROGEL(GEL PACKET)(50 MG (1%))• APTIVUS• ASMANEX(AER POW BA)(220MCG(14))• ASMANEX(AER POW BA)(220MCG(30))• ATELVIA• ATRIPLA• AUBAGIO• AVAGE• AVASTIN• AVONEX• AVONEX PEN• AXERT• BEBULIN• BEBULIN VH IMMUNO• BENEFIX• BETASERON• BIOCLATE• BOSULIF(TAB)(100 MG)• BOSULIF(TAB)(500 MG)• BREO ELLIPTA• BYDUREON• CAPRELSA• CAYSTON• CETIRIZINE HCL(TAB CHEW)(OTC)• CHANTIX• CHILDREN'S CLARITIN(OTC)• CIDOFOVIR• COMBIVIR
• COMPLERA• CRIXIVAN• CYSTARAN• DENAVIR• DEPO-MEDROL• DIASTAT ACUDIAL• DIAZEPAM• DICLEGIS• DIFICID• DRONABINOL• EDURANT• ELIGARD• EMTRIVA• ENABLEX• ENBREL• ENOXAPARIN SODIUM(VIAL)• EPIVIR• EPOGEN• EPZICOM• ERBITUX• ERIVEDGE• EXTAVIA• EYLEA• FARESTON• FEIBA NF• FEIBA VH IMMUNO• FENTANYL• FENTANYL CITRATE• FENTORA• FIRAZYR• FIRST-LANSOPRAZOLE• FIRST-OMEPRAZOLE• FORADIL• FORTESTA• FOSRENOL• FULYZAQ• FUZEON• GILENYA• GLEEVEC• H.P. ACTHAR• HELIXATE FS• HEMOFIL M• HUMATE-P• HUMATROPE• HUMIRA• HYFIBER(OTC)• ICLUSIG(TAB)(15 MG)• ICLUSIG(TAB)(45 MG)• IMIQUIMOD• INCRELEX• INTELENCE• INTRON A• INVIRASE• INVOKANA• IONAMIN• ISENTRESS• JALYN• KADCYLA• KALYDECO• KINERET• KOATE-DVI(VIAL)(1000 (+/-))• KOATE-DVI(VIAL)(250 (+/-))• KOATE-DVI(VIAL)(500 (+/-))
Preferred Drug List Medication Prescribing Limitations
LA Care Page 47 of 59
• KOGENATE FS(KIT)• KOGENATE FS(VIAL)• KOMBIGLYZE XR• KORLYM• KYNAMRO• LAMISIL(OTC)• LAMIVUDINE• LATISSE• LAZANDA• LETAIRIS• LEUKINE• LEXIVA• LIDOCAINE• LINZESS• LIPODOX• LIVALO• LOVAZA• LUMIGAN• LUTREPULSE• MAKENA• METHYLPREDNISOLONE ACETATE• METHYLPREDNISOLONE SOD SUCC• MODAFINIL• MONOCLATE-P• MONONINE• MORPHINE SULFATE ER(CPMP 24HR)• MYCOBUTIN• NASONEX• NEBUPENT• NEULASTA• NEUPOGEN• NEVIRAPINE• NEXAVAR• NIACIN ER• NORDITROPIN FLEXPRO• NORDITROPIN NORDIFLEX• NORVIR• NOVOSEVEN• NOVOSEVEN RT• NUCYNTA• NUCYNTA ER• NUMORPHAN• OMEPRAZOLE MAGNESIUM(OTC)• ONGLYZA• ONSOLIS• OPANA• OPANA ER• ORENCIA• OXYCONTIN• OXYMORPHONE HCL• PARICALCITOL• PEGASYS• PEGASYS PROCLICK• PEGINTRON• PEGINTRON REDIPEN• PENTAMIDINE ISETHIONATE• PHENDIMETRAZINE TARTRATE• PHENTERMINE HCL• PICATO• POMALYST• POTIGA• PRADAXA• PREZISTA• PRILOSEC• PRILOSEC OTC(OTC)
• PROCRIT• PROFILNINE SD• PROLIA• PULMOZYME• QSYMIA• RAVICTI• REBETOL• REBIF(SYRINGE)(22MCG/.5ML)• REBIF(SYRINGE)(44MCG/.5ML)• RECOMBINATE(VIAL)(1000 (+/-))• RECOMBINATE(VIAL)(1500 (+/-))• RECOMBINATE(VIAL)(2000 (+/-))• RECOMBINATE(VIAL)(250 (+/-))• RECOMBINATE(VIAL)(500 (+/-))• REGRANEX• RENAGEL• RENVELA• RESCRIPTOR• RESCULA• RESTASIS• REYATAZ• RHINOCORT AQUA• RIXUBIS• SABRIL• SAIZEN• SAVELLA• SELZENTRY• SEREVENT DISKUS• SEROSTIM• SILDENAFIL• SIMPONI• SOLU-MEDROL• SPORANOX• SPRYCEL• SPRYCEL(TAB)(100 MG)• SPRYCEL(TAB)(140 MG)• SPRYCEL(TAB)(20 MG)• SPRYCEL(TAB)(50 MG)• SPRYCEL(TAB)(70 MG)• SPRYCEL(TAB)(80 MG)• STAVUDINE• STIVARGA• SUBSYS• SUMATRIPTAN• SUPRENZA ODT• SUSTIVA• SUTENT• SYLATRON• SYLATRON 4-PACK• SYMBICORT• SYNAGIS• TARCEVA• TARGRETIN• TASIGNA• TAZORAC• TEKAMLO• TEKTURNA• TEKTURNA HCT• TESTIM• TEV-TROPIN• TINIDAZOLE• TOBI PODHALER• TOBRAMYCIN• TRACLEER• TRAVATAN Z
Preferred Drug List Medication Prescribing Limitations
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• TREXIMET• TRUVADA• TYKERB• TYSABRI• UCERIS• ULORIC• VALCYTE• VANCOMYCIN HCL• VECTIBIX• VELCADE• VERAMYST• VICTOZA 2-PAK• VICTOZA 3-PAK• VIIBRYD• VIRAMUNE XR• VIRAZOLE• VOTRIENT• WILATE• XALKORI• XARELTO• XELJANZ• XELODA• XENICAL• XGEVA• XIFAXAN• XYNTHA• ZAFIRLUKAST• ZALTRAP• ZIAGEN• ZOLINZA• ZORBTIVE• ZOVIRAX• ZYCLARA• ZYVOX
Preferred Drug List Medication Prescribing Limitations
LA Care Page 49 of 59
GENDER LIMITS - FORMULARY • AMETHYST Female Only• APRI Female Only• BEYAZ Female Only• CAMRESE Female Only• CRYSELLE Female Only• ELLA Female Only• LEVORA-28 Female Only• LO LOESTRIN FE Female Only• MICROGESTIN Female Only• MICROGESTIN FE Female Only• NATAZIA Female Only• NECON Female Only• NEXT CHOICE ONE DOSE Female Only• NORA-BE Female Only• NUVARING Female Only• OCELLA Female Only• ORTHO EVRA Female Only• ORTHO TRI-CYCLEN LO Female Only• SAFYRAL Female Only• SPRINTEC Female Only• VIORELE Female Only• ZENCHENT FE Female Only• ZOVIA 1-35E Female Only
Preferred Drug List Medication Prescribing Limitations
LA Care Page 50 of 59
- # -8-MOP...................................................................... 16- A -ABACAVIR..........................................................25, 47ABACAVIR SULFATE............................................... 25ABACAVIR SULFATE/LAMIVUDINE........................ 25ABACAVIR/LAMIVUDINE/ZIDOVUDINE..................25ABACAVIR-LAMIVUDINE-ZIDOVUDINE........... 25, 47ABATACEPT.............................................................26ABSORICA......................................................... 13, 43ABSTRAL(TAB SUBL)(100 MCG)................ 29, 39, 47ABSTRAL(TAB SUBL)(200 MCG)...................... 30, 47ABSTRAL(TAB SUBL)(300 MCG)...................... 30, 47ABSTRAL(TAB SUBL)(400 MCG)...................... 30, 47ABSTRAL(TAB SUBL)(600 MCG)...................... 30, 47ABSTRAL(TAB SUBL)(800 MCG)...................... 30, 47ACARBOSE..............................................................16ACE AEROSOL CLOUD ENHANCER........... 6, 37, 39ACEBUTOLOL HCL................................................. 10ACEROLA C(OTC).............................................35, 39ACETAMINOPHEN...................................................29ACETAMINOPHEN W/CODEINE(ELIXIR)......... 31, 39ACETAMINOPHEN W/CODEINE(TAB)..............31, 39ACETAMINOPHEN WITH CODEINE....................... 31ACETAMINOPHEN/CAFFEINE/BUTALB................. 29ACETAMINOPHEN/DIPHENHYDRAMINE.............. 12ACETAMINOPHEN/PYRILAM/PAMABROM............ 29ACETAMINOPHEN-CODEINE(SOLUTION)...... 31, 39ACETAMINOPHEN-CODEINE(TAB)(300MG-15MG)............................................................................31, 39ACETAMINOPHEN-CODEINE(TAB)(300MG-30MG)............................................................................31, 39ACETAMINOPHEN-CODEINE(TAB)(300MG-60MG)............................................................................31, 39ACETAZOLAMIDE....................................................20ACETIC ACID...........................................................18ACETIC ACID/ALUMINUM ACETATE......................18ACETIC ACID/HYDROCORTISONE........................18ACETIC ACID-ALUMINUM.......................................18ACETYLCYSTEINE..................................................29ACITRETIN...............................................................16ACTIMMUNE......................................................23, 47ACTONEL(TAB)(150 MG).................................. 18, 47ACTONEL(TAB)(30 MG).............................. 18, 39, 47ACTONEL(TAB)(35 MG).............................. 18, 39, 47ACTONEL(TAB)(5 MG)................................ 18, 39, 47ACTOPLUS MET XR..........................................17, 43ACYCLOVIR.................................................14, 25, 47ADALIMUMAB..........................................................26ADIPEX-P...........................................................35, 47ADO-TRASTUZUMAB EMTANSINE........................ 28ADVAIR DISKUS.................................................. 6, 47ADVAIR HFA.........................................................6, 47ADVANCED FORMULA EYE DROPS(OTC)........... 20ADVATE..............................................................21, 47ADVATE H.......................................................... 21, 47ADVATE L...........................................................21, 47ADVATE M..........................................................21, 47ADVATE SH........................................................21, 47ADVATE UH........................................................21, 47AEROCHAMBER MINI...................................6, 37, 39AEROCHAMBER PLUS FLOW-VU................6, 37, 39AEROCHAMBER PLUS Z STAT.................... 6, 37, 39AEROGEAR ASTHMA ACTION KIT.......................... 7AFINITOR................................................................. 28AFLIBERCEPT......................................................... 21AGGRENOX.......................................................22, 47AIRZONE PEAK FLOW METER(OTC)...................... 7AIRZONE(OTC)..........................................................7AK-POLY-BAC.......................................................... 20AKWA TEARS(OTC)................................................ 21ALBUTEROL SULFATE..............................................5ALCAFTADINE......................................................... 19ALCLOMETASONE DIPROPIONATE...................... 14ALCOHOL ANTISEPTIC PADS................................15ALCOHOL PADS(OTC)............................................ 15ALCOHOL PREP PADS(OTC)................................. 15ALCOHOL PREP SWABS(OTC)..............................15ALCOHOL SWAB(OTC)........................................... 15ALCOHOL SWABS(OTC).........................................15ALCOHOL WIPES(OTC)..........................................15ALDOMET................................................................ 10ALENDRONATE SODIUM........................................18ALENDRONATE SODIUM(SOLUTION).............18, 39ALENDRONATE SODIUM(TAB)(10 MG)........... 18, 39ALENDRONATE SODIUM(TAB)(35 MG)........... 18, 39ALENDRONATE SODIUM(TAB)(40 MG)........... 18, 39ALENDRONATE SODIUM(TAB)(5 MG)............. 18, 39ALENDRONATE SODIUM(TAB)(70 MG)........... 18, 39
ALFERON N....................................................... 23, 47ALFUZOSIN HCL..................................................... 33ALINIA................................................................ 13, 47ALISKIREN HEMIFUMARATE................................. 10ALISKIREN/AMLODIPIN/HCTHIAZIDE....................10ALISKIREN/AMLODIPINE BESYLATE.................... 10ALISKIREN/HYDROCHLOROTHIAZIDE................. 10ALKERAN.................................................................28ALLERGY RELIEF D(OTC)..................................5, 43ALLERGY RELIEF D-24(OTC).............................5, 39ALLERGY(OTC)......................................................... 5ALLI(OTC).......................................................... 36, 47ALLOPURINOL........................................................ 21ALMOTRIPTAN MALATE......................................... 31ALOCRIL............................................................ 20, 47ALOMIDE........................................................... 20, 47ALORA............................................................... 22, 39ALPHAGAN P...........................................................20ALPHANATE.......................................................21, 47ALPHANINE SD................................................. 21, 47ALPRAZOLAM............................................................8ALPRAZOLAM INTENSOL.........................................8ALSUMA.......................................................31, 39, 43ALTABAX............................................................ 14, 43ALTRETAMINE......................................................... 28AMBRISENTAN........................................................ 10AMCINONIDE...........................................................14AMERICERIN(OTC)................................................. 16AMERICET............................................................... 29AMETHYST........................................................ 12, 50AMINOCAPROIC ACID............................................21AMINOPHYLLINE.......................................................7AMIODARONE HCL...................................................9AMITRIP HCL/CHLORDIAZEPOXIDE....................... 8AMITRIPTYLINE HCL................................................ 8AMLODIPINE BES/OLMESARTAN MED...................9AMLODIPINE BESYLATE........................................ 10AMLODIPINE BESYLATE/BENAZEPRIL...................9AMLODIPINE BESYLATE-BENAZEPRIL...................9AMLODIPINE/VALSARTAN........................................9AMLODIPINE/VALSARTAN/HCTHIAZID....................9AMMONIUM LACTATE.............................................15AMMONIUM LACTATE(OTC)...................................15AMOX TR-POTASSIUM CLAVULANATE.................23AMOXAPINE.............................................................. 8AMOXICILLIN...........................................................23AMOXICILLIN TRIHYDRATE................................... 23AMOXICILLIN/POTASSIUM CLAV...........................23AMPHET ASP/AMPHET/D-AMPHET.........................8AMPHETAMINE SALT COMBO..................... 8, 37, 39AMPICILLIN TRIHYDRATE...................................... 23AMPYRA............................................................ 29, 47AMTURNIDE...................................................... 10, 47ANAGRELIDE HCL.................................................. 22ANAKINRA............................................................... 26ANALPRAM HC........................................................27ANASTROZOLE.................................................28, 39ANDRODERM.................................................... 22, 39ANDROGEL(GEL MD PMP)(1.25G (1%))......22, 39,4 7ANDROGEL(GEL MD PMP)(20.25/1.25)........... 22, 39ANDROGEL(GEL PACKET)(25MG(1%))......22, 39,4 7ANDROGEL(GEL PACKET)(50 MG (1%))......22, 39,4 7ANDROID................................................................. 22ANDROXY..........................................................22, 39ANTACID(OTC)........................................................ 33ANTIHEMOPH.FVIII PLAS/ALB FREE.................... 21ANTIHEMOPHILIC FACTOR, HUM REC.................21ANTIHEMOPHILIC FACTOR, HUMAN.................... 21ANTIHEMOPHILIC FACTOR/VWF...........................21ANTI-INHIBITOR COAGULANT COMP................... 21ANTI-ITCH(OTC)......................................................15ANTI-NAUSEA(OTC)..................................................5ANTIPYRINE/BENZOCAINE/GLYCERIN.................18ANTIPYRINE-BENZOCAINE....................................18ANTISPASMODIC.................................................... 32APEXICON E............................................................14APIDRA.............................................................. 17, 43APIDRA SOLOSTAR................................................ 17APRACLONIDINE HCL............................................ 20APREPITANT............................................................. 5APRI....................................................................11, 50APRISO.............................................................. 27, 43APRODINE(OTC)...............................................12, 37APTIVUS............................................................ 25, 47AQUA GLYCOLIC(OTC)...........................................16AQUANIL(OTC)........................................................16
ARFORMOTEROL TARTRATE..................................5ARMOUR THYROID.................................................19ARTIFICIAL TEARS(OTC)................................. 20, 21ASCORBIC ACID..................................................... 35ASCORBIC ACID/ASCORBATE SODIUM............... 35ASMANEX(AER POW BA)(110MCG(30))............ 6, 43ASMANEX(AER POW BA)(220MCG 120)........... 6, 43ASMANEX(AER POW BA)(220MCG(14))............6, 47ASMANEX(AER POW BA)(220MCG(30))............6, 47ASMANEX(AER POW BA)(220MCG(60))............6, 43ASPIRIN................................................................... 29ASPIRIN EC(OTC)................................................... 29ASPIRIN/DIPYRIDAMOLE....................................... 22ASSESS(OTC)........................................................... 7ASTEPRO...................................................................5ASTHMA CHECK(OTC)............................................. 7ASTHMAMENTOR(OTC)........................................... 7ASTHMAPACK CHILDREN'S.....................................7ASTRINGENT SOLUTION(OTC)............................. 16ATAZANAVIR SULFATE........................................... 25ATELVIA............................................................. 18, 47ATENOLOL...............................................................10ATENOLOL/CHLORTHALIDONE.............................10ATENOLOL-CHLORTHALIDONE............................ 10ATORVASTATIN CALCIUM...................................... 11ATRIPLA............................................................. 25, 47ATROPINE SULFATE...............................................20ATROVENT HFA........................................................ 6ATTAPULGITE..........................................................27AUBAGIO........................................................... 29, 47AUGMENTIN............................................................ 23AUVI-Q............................................................... 27, 43AVAGE................................................................13, 47AVASTIN.............................................................28, 47AVC...........................................................................34AVONEX............................................................. 29, 47AVONEX PEN.....................................................29, 47AXERT..........................................................31, 39, 47AXIRON..............................................................22, 39AXITINIB...................................................................28AZASAN................................................................... 23AZATHIOPRINE....................................................... 23AZELASTINE HCL......................................... 5, 19, 43AZILSARTAN MED/CHLORTHALIDONE...................9AZILSARTAN MEDOXOMIL.....................................10AZITHROMYCIN...................................................... 23AZOR....................................................................9, 43AZTREONAM LYSINE..............................................23- B -BACITRACIN............................................................13BACITRACIN ZINC...................................................13BACITRACIN ZINC(OTC).........................................13BACITRACIN(OTC)..................................................13BACITRACIN/POLYMYXIN B SULFATE............ 13, 20BACITRACIN-POLYMYXIN(OTC)............................ 13BACLOFEN.............................................................. 32BACTOCILL........................................................23, 37BACTROBAN NASAL.............................................. 29BALSALAZIDE DISODIUM...................................... 27B-D SINGLE USE ALCOHOL SWAB(OTC)............. 15BEBULIN............................................................ 21, 47BEBULIN VH IMMUNO...................................... 21, 47BECAPLERMIN........................................................17BECLOMETHASONE DIPROPIONATE.....................6BELLADONNA ALKALOIDS/PHENOBARB.............32BENAZEPRIL HCL..................................................... 9BENAZEPRIL/HYDROCHLOROTHIAZIDE................9BENAZEPRIL-HYDROCHLOROTHIAZIDE............... 9BENEFIX............................................................ 21, 47BENICAR..................................................................10BENICAR HCT........................................................... 9BENZAMYCINPAK................................................... 13BENZONATATE........................................................12BENZOYL PEROXIDE....................................... 15, 16BENZOYL PEROXIDE(OTC)............................. 15, 39BENZOYL PEROXIDE/HYDROCORTISON............ 13BETAMETHASONE DIPROPIONATE......................14BETAMETHASONE VALERATE...............................14BETAMETHASONE/PROPYLENE GLYC................ 14BETASERON......................................................29, 47BETAXOLOL HCL.................................................... 20BETHANECHOL CHLORIDE................................... 28BETIMOL..................................................................20BETOPTIC S............................................................ 20BEVACIZUMAB........................................................ 28BEXAROTENE................................................... 16, 29BEYAZ.......................................................... 11, 43, 50BICALUTAMIDE....................................................... 28BILTRICIDE.............................................................. 24
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Index
BIMATOPROST..................................................20, 21BIOCLATE.......................................................... 21, 47BION TEARS(OTC)..................................................20BISAC-EVAC(OTC).................................................. 27BISACODYL............................................................. 27BISACODYL(OTC)................................................... 27BISMATROL(OTC)................................................... 27BISMUTH SUBSALICYLATE....................................27BISOPROLOL FUMARATE...................................... 10BISOPROLOL FUMARATE/HCTZ........................... 10BISOPROLOL-HYDROCHLOROTHIAZIDE.............10BLEPHAMIDE.......................................................... 20BLEPHAMIDE S.O.P................................................ 20BLOOD SUGAR DIAGNOSTIC................................17BLOOD-GLUCOSE METER.....................................17BOCEPREVIR.......................................................... 25BORTEZOMIB.......................................................... 28BOSENTAN.............................................................. 10BOSULIF.................................................................. 28BOSULIF(TAB)(100 MG).............................. 28, 39, 47BOSULIF(TAB)(500 MG).............................. 28, 39, 47BOSUTINIB.............................................................. 28BOUDREAUXS(OTC)...............................................16BP WASH........................................................... 16, 39BRAVELLE............................................................... 18BREATHERITE...............................................6, 37, 39BREATHRITE................................................. 6, 37, 39BREO ELLIPTA.................................................... 6, 47BRILINTA............................................................22, 43BRIMONIDINE TARTRATE...................................... 20BRIMONIDINE TARTRATE/TIMOLOL......................20BRINZOLAMIDE/BRIMONID TART..........................20BROMFED DM................................................... 12, 37BROMOCRIPTINE MESYLATE............................... 31BROMPHENIRAM/PHENYLEPHRINE/DM..............12BROVANA............................................................ 5, 43BUDESONIDE............................................5, 6, 26, 37BUDESONIDE EC..............................................26, 43BUDESONIDE/FORMOTEROL FUMARATE............. 6BUMETANIDE.......................................................... 10BUPROBAN..............................................................32BUPROPION HCL................................................7, 32BUPROPION XL(TAB ER 24H)(150 MG).............7, 39BUPROPION XL(TAB ER 24H)(300 MG)...................7BUSPIRONE HCL...................................................... 8BUSULFAN...............................................................28BUTALB/ACETAMINOPHEN/CAFFEINE................. 29BUTALB-CAFF-ACETAMINOPH-CODEIN...............31BUTALBIT/ACETAMIN/CAFF/CODEINE..................31BUTALBITAL COMPOUND-CODEINE.....................31BUTALBITAL/ASPIRIN/CAFFEINE.......................... 29BUTALBITAL-ACETAMINOPHEN-CAFFE............... 29BUTALBITAL-ASPIRIN-CAFFEINE.......................... 29BUTOCONAZOLE NITRATE....................................34BYDUREON....................................................... 16, 47BYSTOLIC.......................................................... 10, 43- C -CABERGOLINE..................................................19, 39CAFERGOT........................................................31, 39CAFFEINE CITRATE............................................7, 39CAFFEINE CITRATED............................................... 7CALAMINE............................................................... 16CALAMINE(OTC)..................................................... 16CALAMINE/ZINC OXIDE..........................................16CALCIPOTRIENE...............................................16, 43CALCITONIN,SALMON,SYNTHETIC...................... 18CALCITONIN-SALMON............................................18CALCITRIOL...................................................... 35, 39CALCIUM ACETATE.......................................... 18, 39CALCIUM ACETATE/ALUMINUM SULF.................. 16CALCIUM ANTACID(OTC)....................................... 33CALCIUM CARB &GLUCONATE/VIT D2.................34CALCIUM CARBONATE.................................... 33, 34CALCIUM CARBONATE/VITAMIN D2..................... 34CALCIUM CARBONATE/VITAMIN D3..................... 34CALCIUM CITRATE................................................. 34CALCIUM CITRATE(OTC)................................. 34, 39CALCIUM CITRATE/VITAMIN D3............................ 34CALCIUM GLUCONATE.......................................... 34CALCIUM GLUCONATE(OTC).......................... 34, 39CALCIUM LACTATE.................................................34CALCIUM LACTATE(OTC).................................34, 39CAMRESE..........................................................12, 50CANAGLIFLOZIN..................................................... 16CANDESARTAN CILEXETIL....................................10CANDESARTAN/HYDROCHLOROTHIAZID............. 9CANDESARTAN-HYDROCHLOROTHIAZID............. 9CAPECITABINE........................................................28CAPITAL W-CODEINE............................................. 31
CAPRELSA........................................................ 28, 47CAPSAICIN.............................................................. 15CAPSAICIN(OTC).................................................... 15CAPTOPRIL............................................................... 9CAPTOPRIL/HYDROCHLOROTHIAZIDE..................9CAPTOPRIL-HYDROCHLOROTHIAZIDE................. 9CARAFATE............................................................... 33CARBACHOL........................................................... 20CARBAMAZEPINE...................................................32CARBAMIDE PEROXIDE.........................................18CARBIDOPA.............................................................32CARBIDOPA/LEVODOPA........................................ 31CARBIDOPA/LEVODOPA/ENTACAPONE...............31CARBIDOPA-LEVODOPA........................................ 31CARBIDOPA-LEVODOPA-ENTACAPONE........ 31, 43CARISOPRODOL.....................................................32CARISOPRODOL/ASPIRIN..................................... 32CARISOPRODOL-ASPIRIN..................................... 32CARISOPRODOL-ASPIRIN-CODEINE....................29CARTEOLOL HCL....................................................20CARVEDILOL............................................................. 9CAYSTON...........................................................23, 47CEFACLOR.............................................................. 23CEFADROXIL...........................................................23CEFADROXIL HYDRATE......................................... 23CEFDINIR.................................................................23CEFIXIME.................................................................23CEFPODOXIME PROXETIL.................................... 23CEFPODOXIME PROXETIL(SUSP RECON)......23,3 7CEFPODOXIME PROXETIL(TAB)........................... 23CEFPROZIL..............................................................23CEFTIN.....................................................................23CEFUROXIME..........................................................23CEFUROXIME AXETIL............................................ 23CELEBREX(CAP)(100 MG)................... 26, 37, 39, 43CELEBREX(CAP)(200 MG)................... 26, 37, 39, 43CELEBREX(CAP)(400 MG)................... 26, 37, 39, 43CELEBREX(CAP)(50 MG)..................... 26, 37, 39, 44CELECOXIB............................................................. 26CELLCEPT............................................................... 23CENESTIN......................................................... 22, 39CEPHALEXIN...........................................................23CEPHALEXIN MONOHYDRATE..............................23CEROVITE JR(OTC)..........................................34, 39CETIRIZINE HCL........................................................5CETIRIZINE HCL(SOLUTION)(OTC).........................5CETIRIZINE HCL(TAB CHEW)(OTC)............ 5, 39, 47CETIRIZINE HCL(TAB)(OTC).............................. 5, 39CETIRIZINE HCL/PSEUDOEPHEDRINE.................. 5CETIRIZINE-PSEUDOEPHEDRINE(OTC).......... 5, 39CETUXIMAB.............................................................28CEVIMELINE HCL....................................................28CHANTIX............................................................32, 47CHERATUSSIN AC(OTC).................................. 12, 37CHERATUSSIN DAC(OTC)................................12, 37CHEWABLE-VITE(OTC).................................... 34, 39CHILD CHEW + IRON(OTC)..............................34, 39CHILD CHEW VITAMIN(OTC)............................34, 39CHILDRENS CHEWABLE + IRON(OTC)...........34, 39CHILDRENS CHEWABLE(OTC)........................34, 39CHILDREN'S CLARITIN(OTC).......................5, 39, 47CHILDREN'S KAOPECTATE(OTC)..........................27CHLORAMBUCIL..................................................... 28CHLORDIAZEPOXIDE HCL.......................................8CHLORDIAZEPOXIDE/CLIDINIUM BR....................33CHLORDIAZEPOXIDE-AMITRIPTYLINE...................8CHLORDIAZEPOXIDE-CLIDINIUM......................... 33CHLORHEX GL/GLYCERIN/HE-CELL.....................16CHLORHEXIDINE GLUCONATE............................. 29CHLOROQUINE PHOSPHATE................................ 24CHLORPHENIRAMINE MALEATE.............................5CHLORPROPAMIDE................................................17CHLORTHALIDONE.................................................10CHLORZOXAZONE................................................. 32CHOLECALCIFEROL...............................................35CHOLECALCIFEROL (VITAMIN D3)....................... 35CHOLESTYRAMINE.................................................11CHOLESTYRAMINE (WITH SUGAR)...................... 11CHOLESTYRAMINE LIGHT..................................... 11CHOLESTYRAMINE/ASPARTAME.......................... 11CHORIONIC GONADOTROPIN...............................18CHORIONIC GONADOTROPIN, HUMAN............... 18CHROMIUM PICOLINATE KLB6(OTC)..............35, 39CICLOPIROX............................................................14CICLOPIROX OLAMINE.......................................... 14CICLOPIROX(GEL)..................................................14CICLOPIROX(SHAMPOO).......................................14CICLOPIROX(SOLUTION).................................14, 37
CIDOFOVIR........................................................25, 47CILOSTAZOL............................................................22CIMETIDINE.............................................................33CIMETIDINE HCL.....................................................33CIPRO...................................................................... 23CIPRODEX...............................................................18CIPROFLOXACIN.................................................... 23CIPROFLOXACIN ER(TBMP 24HR)(1000 MG)......23, 37CIPROFLOXACIN ER(TBMP 24HR)(500 MG).........23CIPROFLOXACIN HCL...................................... 20, 23CIPROFLOXACIN HCL/DEXAMETH....................... 18CIPROFLOXACIN/CIPROFLOXA HCL....................23CITALOPRAM HBR(SOLUTION)................... 7, 37, 39CITALOPRAM HBR(TAB)(10 MG)..................7, 37, 39CITALOPRAM HBR(TAB)(20 MG)..................7, 37, 39CITALOPRAM HBR(TAB)(40 MG)..................7, 37, 39CITALOPRAM HYDROBROMIDE..............................7CITRACAL + D MAXIMUM(OTC).......................34, 39CITRIC ACID/SODIUM CITRATE.............................33CITRUS CALCIUM + D(OTC)............................ 34, 39CLARAVIS.......................................................... 13, 44CLARITHROMYCIN................................................. 23CLEMASTINE FUMARATE........................................ 5CLEMASTINE FUMARATE(OTC).............................. 5CLIMARA PRO...................................................22, 39CLINDAMYCIN HCL.................................................24CLINDAMYCIN HCL(CAP)(150 MG)........................24CLINDAMYCIN HCL(CAP)(300 MG)........................24CLINDAMYCIN HCL(CAP)(75 MG)....................24, 37CLINDAMYCIN PALMITATE HCL.......................24, 37CLINDAMYCIN PHOS/BENZOYL PEROX.............. 13CLINDAMYCIN PHOSPHATE............................ 13, 34CLINDAMYCIN-BENZOYL PEROXIDE................... 13CLOBAZAM..............................................................32CLOBETASOL EMOLLIENT.....................................14CLOBETASOL PROPIONATE..................................14CLOBETASOL PROPIONATE/EMOLL.................... 14CLOBEX................................................................... 14CLOMIPRAMINE HCL................................................8CLONAZEPAM......................................................... 32CLONIDINE........................................................ 10, 39CLONIDINE HCL......................................................10CLOPIDOGREL........................................................22CLOPIDOGREL BISULFATE....................................22CLORAZEPATE DIPOTASSIUM................................ 8CLOTRIMAZOLE..........................................14, 24, 34CLOTRIMAZOLE(OTC)......................................14, 34CLOTRIMAZOLE/BETAMETHASONE DIP..............14CLOTRIMAZOLE-BETAMETHASONE.....................14COAGULATION FACTOR VIIA,RECOMB................21CODEINE PHOS/ACETAMINOPHEN...................... 31CODEINE SULFATE...........................................29, 39CODEINE/BUTALBITAL/ASA/CAFFEIN...................31CODEINE/CARISOPRODOL/ASPIRIN....................29COLACE(OTC).........................................................27COLCHICINE............................................................21COLCHICINE/PROBENECID...................................21COLCRYS................................................................ 21COLESEVELAM HCL............................................... 11COLESTIPOL HCL................................................... 11COMBIGAN........................................................ 20, 44COMBIPATCH.................................................... 22, 39COMBIVENT.............................................................. 6COMBIVENT RESPIMAT........................................... 6COMBIVIR..........................................................25, 47COMPAZINE...............................................................5COMPLERA....................................................... 25, 47COMPLETENATE...............................................35, 39CONCEPTROL(OTC)............................................... 11CONDYLOX..............................................................16COPAXONE..............................................................29CORTAID(OTC)........................................................14CORTICOTROPIN....................................................18CORTISONE ACETATE........................................... 26CORTISPORIN.........................................................14CREON.....................................................................32CRIXIVAN........................................................... 25, 47CRIZOTINIB............................................................. 28CROFELEMER.........................................................27CROMOLYN SODIUM......................................5, 6, 20CROMOLYN SODIUM(OTC)......................................5CROTAMITON..........................................................14CRYSELLE......................................................... 12, 50CUPRIMINE..............................................................26CURITY ALCOHOL PREPS(OTC)...........................15CYANOCOBALAMIN................................................ 35CYANOCOBALAMIN (VITAMIN B-12)......................35CYANOCOBALAMIN INJECTION...................... 35, 39
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Index
CYCLOBENZAPRINE HCL...................................... 32CYCLOGYL.............................................................. 20CYCLOPENTOLATE HCL........................................ 20CYCLOPHOSPHAMIDE...........................................28CYCLOSPORINE............................................... 20, 23CYCLOSPORINE MODIFIED...................................23CYCLOSPORINE, MODIFIED..................................23CYPROHEPTADINE HCL.......................................... 5CYSTARAN........................................................ 21, 47CYSTEAMINE HCL.................................................. 21CYSTOSPAZ-M........................................................ 32CYTRA-2.................................................................. 33CYTRA-3.................................................................. 33CYTRA-K..................................................................33- D -DABIGATRAN ETEXILATE MESYLATE.................. 22DALFAMPRIDINE.....................................................29DANAZOL.................................................................19DANTROLENE SODIUM..........................................32DAPSONE................................................................ 24DARAPRIM...............................................................24DARIFENACIN HYDROBROMIDE...........................33DARUNAVIR ETHANOLATE.................................... 25DASATINIB............................................................... 28DDAVP......................................................................18DELAVIRDINE MESYLATE...................................... 25DELZICOL.......................................................... 27, 44DEMECLOCYCLINE HCL........................................ 24DENAVIR............................................................ 14, 47DENOSUMAB...........................................................18DEPEN..................................................................... 26DEPO-MEDROL.................................................26, 47DERMA-PAX(OTC)...................................................15DESIPRAMINE HCL...................................................8DESMOPRESSIN (NONREFRIGERATED)............. 18DESMOPRESSIN ACETATE....................................18DESOGESTREL-ETHINYL ESTRADIOL................. 11DESOG-ET ESTRA/ETHIN ESTRA......................... 11DESONIDE...............................................................14DESOXIMETASONE................................................ 14DEX4 GLUCOSE(OTC)............................................17DEXAMETHASONE................................................. 26DEXAMETHASONE SOD PHOSPHATE................. 19DEXAMETHASONE SODIUM PHOSPHATE...........19DEXCHLORPHENIRAMINE MALEATE..................... 5DEXILANT.......................................................... 33, 44DEXLANSOPRAZOLE............................................. 33DEXTRAN 70/HYPROMELLOSE.............................20DEXTRAN 70/HYPROMELLOSE/PF....................... 20DEXTROAMPHETAMINE SULFATE..........................8DEXTROAMPHETAMINE/AMPHETAMINE............... 8DEXTROSE..............................................................17DHT.................................................................... 35, 39DIABETA...................................................................17DIABETIC TUSSIN(OTC)...........................................5DIAPHRAGM FITTING SET,ARCSPRNG................12DIAPHRAGMS, ARC-SPRING.................................12DIAPHRAGMS, WIDE SEAL....................................12DIASTAT ACUDIAL...................................... 32, 39, 47DIAZEPAM................................................8, 32, 39, 47DIBENZYLINE............................................................ 9DICLEGIS.............................................................5, 47DICLOFENAC POTASSIUM.....................................26DICLOFENAC SODIUM............................... 15, 19, 26DICLOFENAC SODIUM/MISOPROSTOL................26DICLOFENAC SODIUM-MISOPROSTOL................26DICLOXACILLIN SODIUM....................................... 23DICYCLOMINE HCL.................................................32DIDANOSINE........................................................... 25DIFICID...............................................................23, 47DIFLORASONE DIACETATE................................... 14DIFLORASONE DIACETATE/EMOLL...................... 14DIFLUNISAL.............................................................29DIGOX........................................................................ 9DIGOXIN.....................................................................9DIHYDROTACHYSTEROL.......................................35DILANTIN................................................................. 32DILTIAZEM 24HR ER............................................... 10DILTIAZEM HCL....................................................... 10DIMAPHEN DM(OTC)........................................ 12, 37DIMENHYDRINATE....................................................5DIOVAN.............................................................. 10, 44DIPHENHYDRAMINE HCL.............................. 5, 8, 15DIPHENHYDRAMINE HCL(OTC).............................. 5DIPHENHYDRAMINE HCL/ZINC ACET.................. 15DIPHENOXYLATE HCL/ATROPINE........................ 27DIPHENOXYLATE-ATROPINE................................ 27DIPYRIDAMOLE.......................................................22DISOPYRAMIDE PHOSPHATE................................. 9
DISULFIRAM..............................................................8DIVALPROEX SODIUM............................................32DIVALPROEX SODIUM ER......................................32DIVIGEL............................................................. 22, 39D-METHORPHAN HB/P-EPD HCL/BPM................. 12D-METHORPHAN HB/P-EPHED HCL/CP............... 12D-METHORPHAN HB/PROMETH HCL................... 13DOC-Q-LACE(OTC)................................................. 27DOCUSATE CALCIUM.............................................27DOCUSATE CALCIUM(OTC)...................................27DOCUSATE SODIUM...............................................27DOFETILIDE...............................................................9DONEPEZIL HCL....................................................... 7DONNATAL...............................................................32DORNASE ALFA...................................................... 29DORZOLAMIDE HCL............................................... 20DORZOLAMIDE HCL/TIMOLOL MALEAT............... 20DORZOLAMIDE-TIMOLOL...................................... 20DOVONEX................................................................16DOXAZOSIN MESYLATE...........................................9DOXEPIN HCL........................................................... 8DOXERCALCIFEROL.............................................. 19DOXORUBICIN HCL PEG-LIPOSOMAL..................28DOXYCYCLINE HYCLATE.......................................24DOXYCYCLINE MONOHYDRATE...........................24DOXYCYCLINE MONOHYDRATE(CAP)................. 24DOXYCYCLINE MONOHYDRATE(SUSP RECON)..................................................................................24DOXYCYCLINE MONOHYDRATE(TAB)............24, 37DOXYLAMINE SUCCINATE.......................................8DOXYLAMINE/PYRIDOXINE HCL.............................5DRIMINATE(OTC)...................................................... 5DRONABINOL......................................................5, 47DROSPIR/ETH ESTRA/LEVOMEFOL CA............... 11DRY SKIN THERAPY(OTC).....................................15DULERA..................................................................... 6DUOFILM(OTC)........................................................16DUTASTERIDE/TAMSULOSIN HCL........................ 33- E -E.E.S. 200................................................................ 23EAR DROPS(OTC)...................................................18EASIVENT......................................................6, 37, 39EASY TOUCH ALCOHOL PREP PADS(OTC).........15ECONAZOLE NITRATE........................................... 14EDARBI.............................................................. 10, 44EDARBYCLOR.....................................................9, 44EDLUAR......................................................... 8, 39, 44EDURANT.......................................................... 25, 47EFAVIRENZ.............................................................. 25EFAVIRENZ/EMTRICITAB/TENOFOVIR................. 25EFFIENT.......................................................22, 37, 44ELECTROLYTE,ORAL............................................. 18ELESTRIN.......................................................... 22, 39ELIDEL............................................................... 16, 44ELIGARD............................................................18, 47ELLA...................................................................12, 50ELMIRON................................................................. 33EMCYT..................................................................... 29EMEND.......................................................................5EMTRICITAB/RILPIVIRINE/TENOFOV....................25EMTRICITABINE...................................................... 25EMTRICITABINE/TENOFOVIR................................ 25EMTRIVA............................................................ 25, 47ENABLEX........................................................... 33, 47ENALAPRIL MALEATE.............................................. 9ENALAPRIL/HYDROCHLOROTHIAZIDE.................. 9ENALAPRIL-HYDROCHLOROTHIAZIDE..................9ENBREL............................................................. 26, 47ENEMA DISPOSABLE(OTC)................................... 27ENEMEEZ(OTC)...................................................... 27ENFUVIRTIDE..........................................................25ENJUVIA............................................................ 22, 39ENOXAPARIN SODIUM........................................... 22ENOXAPARIN SODIUM(SYRINGE).................. 22, 39ENOXAPARIN SODIUM(VIAL)...........................22, 47ENTACAPONE......................................................... 31ENZALUTAMIDE...................................................... 28EPINEPHRINE................................................... 27, 28EPIPEN 2-PAK......................................................... 27EPIPEN JR 2-PAK.............................................. 28, 39EPIVIR................................................................25, 47EPLERENONE................................................... 10, 44EPOETIN ALFA.................................................. 21, 22EPOGEN............................................................ 21, 47EPROSARTAN MESYLATE..................................... 10EPROSARTAN/HYDROCHLOROTHIAZIDE............. 9EPZICOM........................................................... 25, 47ERBITUX............................................................ 28, 47ERGOCALCIFEROL (VITAMIN D2)......................... 35
ERGOMAR................................................... 31, 39, 44ERGOTAMINE TARTRATE...................................... 31ERGOTAMINE TARTRATE/CAFFEINE....................31ERIVEDGE......................................................... 28, 47ERLOTINIB HCL.......................................................28ERY E-SUCC/SULFISOXAZOLE............................. 23ERYPED 200............................................................ 23ERYPED 400............................................................ 23ERY-TAB...................................................................23ERYTHROCIN STEARATE...................................... 23ERYTHROMYCIN.........................................13, 20, 23ERYTHROMYCIN BASE.................................... 20, 23ERYTHROMYCIN BASE/ETHANOL........................ 13ERYTHROMYCIN ETHYLSUCCINATE................... 23ERYTHROMYCIN STEARATE.................................23ERYTHROMYCIN/BENZOYL PEROXIDE............... 13ERYTHROMYCIN-BENZOYL PEROXIDE............... 13ERYTHROMYCIN-SULFISOXAZOLE......................23ESCITALOPRAM OXALATE...................................... 7ESTAZOLAM.............................................................. 8ESTRACE.................................................................34ESTRADIOL....................................................... 22, 34ESTRADIOL VALERATE/DIENOGEST.................... 11ESTRADIOL(PATCH TDWK)..............................22, 39ESTRADIOL(TAB).............................................. 22, 39ESTRADIOL/LEVONORGESTREL..........................22ESTRADIOL/NORETHINDRONE ACET..................22ESTRADIOL/NORGESTIMATE................................22ESTRADIOL-NORETHINDRONE ACETAT........22, 39ESTRAMUSTINE PHOSPHATE SODIUM............... 29ESTRASORB..................................................... 22, 39ESTRING............................................................34, 39ESTROGEL........................................................ 22, 39ESTROGEN & METHYLTESTOSTERONE............. 22ESTROGEN,CON/M-PROGEST ACET................... 22ESTROGEN,ESTER/ME-TESTOSTERONE............22ESTROGENS, CONJUGATED...........................22, 34ESTROGENS,CONJ.,SYNTHETIC A.......................22ESTROGENS,CONJ.,SYNTHETIC B.......................22ESTROGENS,ESTERIFIED.....................................22ESTROPIPATE................................................... 22, 39ESZOPICLONE.......................................................... 8ETANERCEPT..........................................................26ETHAMBUTOL HCL................................................. 24ETHINYL ESTRADIOL/DROSPIRENONE............... 11ETHOSUXIMIDE...................................................... 32ETHYNODIOL D-ETHINYL ESTRADIOL.................12ETODOLAC.............................................................. 26ETONOGESTREL/ETHINYL ESTRADIOL...............11ETOPOSIDE.............................................................28ETRAVIRINE............................................................ 25EURAX..................................................................... 14EVAMIST............................................................ 22, 39EVEROLIMUS.................................................... 23, 28EVISTA............................................................... 18, 39EXELDERM..............................................................14EXELON..................................................................... 7EXEMESTANE................................................... 28, 39EXENATIDE MICROSPHERES............................... 16EXFORGE............................................................ 9, 44EXFORGE HCT....................................................9, 44EXTAVIA............................................................. 29, 47EYE ALLERGY RELIEF(OTC)................................. 20EYE DROPS(OTC)...................................................20EYE IRRIGATING SOLUTION(OTC)....................... 20EYE WASH(OTC).....................................................21EYLEA................................................................ 21, 47E-Z SPACER.................................................. 6, 37, 39EZETIMIBE............................................................... 11EZETIMIBE/SIMVASTATIN.......................................11EZOGABINE.............................................................32- F -FACTOR IX...............................................................21FACTOR IX COMPLEX HUMAN.............................. 21FACTOR IX HUMAN RECOMBINANT..................... 21FAMCICLOVIR......................................................... 25FAMOTIDINE............................................................33FAMOTIDINE(OTC)..................................................33FARESTON........................................................ 29, 47FEBUXOSTAT.......................................................... 21FEIBA NF........................................................... 21, 47FEIBA VH IMMUNO........................................... 21, 47FELBAMATE.............................................................32FELODIPINE............................................................ 10FELODIPINE ER...................................................... 10FEMHRT.............................................................22, 39FENESIN DM IR(OTC).......................................13, 37FENOFIBRATE......................................................... 11FENOFIBRATE NANOCRYSTALLIZED................... 11
LA Care Page 53 of 59
Index
FENOFIBRATE,MICRONIZED................................. 11FENOFIBRIC ACID...................................................11FENOGLIDE....................................................... 11, 44FENOPROFEN CALCIUM..................................26, 44FENTANYL......................................................... 29, 47FENTANYL CITRATE................................... 29, 30, 47FENTORA...........................................................30, 47FERROUS GLUCONATE......................................... 34FERROUS GLUCONATE(OTC)......................... 34, 40FERROUS SULFATE............................................... 34FERROUS SULFATE(OTC)............................... 34, 40FEVERALL(OTC)..................................................... 29FEXOFENADINE HCL..........................................5, 44FEXOFENADINE HCL(OTC)................................5, 44FEXOFENADINE/PSEUDOEPHEDRINE...................5FIDAXOMICIN.......................................................... 23FILGRASTIM............................................................ 22FINASTERIDE..........................................................33FINGOLIMOD HCL...................................................29FIRAZYR............................................................ 26, 47FIRST AID ANTISEPTIC(OTC)................................ 13FIRST AID(OTC)...................................................... 13FIRST-HYDROCORTISONE.................................... 14FIRST-LANSOPRAZOLE................................... 33, 47FIRST-OMEPRAZOLE....................................... 33, 47FLAGYL ER..............................................................24FLAREX....................................................................19FLECAINIDE ACETATE............................................. 9FLINTSTONES WITH IRON(OTC).....................34, 40FLOVENT DISKUS.....................................................6FLOVENT HFA........................................................... 6FLUCONAZOLE....................................................... 24FLUDROCORTISONE ACETATE.............................26FLUNISOLIDE............................................................ 5FLUOCINOLONE ACETONIDE............................... 14FLUOCINONIDE.......................................................14FLUOCINONIDE/EMOLLIENT BASE.......................14FLUOCINONIDE-E...................................................14FLUORIDE......................................................... 34, 40FLUORIDE ION/MULTIVITAMINS............................34FLUORIDE/IRON/VIT A,C&D...................................34FLUORITAB........................................................34, 40FLUOROMETHOLONE............................................19FLUOROMETHOLONE ACETATE...........................19FLUOROURACIL......................................................16FLUOXETINE HCL.....................................................7FLUOXYMESTERONE.............................................22FLURA-DROPS..................................................34, 40FLURAZEPAM HCL....................................................8FLURBIPROFEN......................................................26FLURBIPROFEN SODIUM.......................................19FLUTAMIDE..............................................................28FLUTICASONE FUROATE.........................................5FLUTICASONE PROPIONATE.................. 5, 6, 14, 40FLUTICASONE/SALMETEROL................................. 6FLUTICASONE/VILANTEROL................................... 6FLUVASTATIN SODIUM..................................... 11, 44FLUVOXAMINE MALEATE........................................ 7FLUVOXAMINE MALEATE(CAP ER 24H)........... 7, 44FLUVOXAMINE MALEATE(TAB)............................... 7FML FORTE............................................................. 19FML S.O.P................................................................ 19FOAMING ANTACID(OTC)...................................... 33FOLIC ACID....................................................... 34, 40FOLIC ACID(OTC)..............................................34, 40FOLIC ACID/MU-VITS-MIN TH................................ 34FOLIVANE-PRX DHA NF................................... 35, 40FOLLISTIM AQ.........................................................18FOLLITROPIN BETA,RECOMB............................... 18FORADIL.............................................................. 5, 47FORMOTEROL FUMARATE......................................5FORTESTA...................................................22, 40, 47FOSAMPRENAVIR CALCIUM..................................25FOSINOPRIL SODIUM...............................................9FOSINOPRIL/HYDROCHLOROTHIAZIDE................ 9FOSINOPRIL-HYDROCHLOROTHIAZIDE................9FOSRENOL........................................................18, 47FREESTYLE FLASH SYSTEM(OTC)................ 17, 40FREESTYLE FREEDOM LITE(OTC)................. 17, 40FREESTYLE FREEDOM(OTC)..........................17, 40FREESTYLE INSULINX(OTC)........................... 17, 40FREESTYLE LITE METER(OTC).......................17, 40FREESTYLE LITE(OTC).................................... 17, 40FREESTYLE SIDEKICK II(OTC)........................17, 40FREESTYLE SYSTEM(OTC).............................17, 40FREESTYLE(OTC).............................................17, 40FRUCTOOLIGOSACCHARIDES/POLYDEX............27FULYZAQ........................................................... 27, 47FUNGOID TINCTURE(OTC)....................................14
FUROSEMIDE..........................................................10FUZEON.............................................................25, 47- G -GABAPENTIN...........................................................32GABITRIL................................................................. 32GALANTAMINE HBR..................................................7GANIRELIX ACETATE............................................. 19GAS FREE(OTC)......................................................32GAS-X(OTC).............................................................32GAVILYTE-C.............................................................27GAVILYTE-N.............................................................27GEMFIBROZIL..........................................................11GENERLAC..............................................................27GENOTROPIN..........................................................19GENTAMICIN SULFATE.....................................13, 20GEODON....................................................................8GILENYA............................................................ 29, 47GLATIRAMER ACETATE..........................................29GLEEVEC...........................................................28, 47GLIMEPIRIDE...........................................................17GLIPIZIDE................................................................ 17GLIPIZIDE/METFORMIN HCL................................. 17GLIPIZIDE-METFORMIN................................... 17, 44GLYBURIDE............................................................. 17GLYBURIDE/METFORMIN HCL.............................. 17GLYBURIDE-METFORMIN HCL.............................. 17GLYCERIN....................................................15, 16, 27GLYCERIN(OTC)......................................................15GLYCERIN/PROPYLENE GLYCOL......................... 20GLYCEROL PHENYLBUTYRATE............................ 27GLYCOPYRROLATE................................................33GOLIMUMAB............................................................26GOLYTELY............................................................... 27GONADORELIN ACETATE...................................... 19GRANISETRON HCL........................................... 5, 40GRISEOFULVIN....................................................... 24GRISEOFULVIN ULTRAMICROSIZE.......................24GRISEOFULVIN, MICROSIZE................................. 24GUAIFENESIN......................................................... 12GUAIFENESIN/CODEINE PHOSPHATE................. 12GUAIFENESIN/DEXTROMETHORPHAN................13GUAIFENESIN/D-METHORPHAN HB/PE............... 13GUANFACINE HCL.................................................. 10GYNOL II(OTC)........................................................ 11- H -H.P. ACTHAR..................................................... 18, 47HALOBETASOL PROPIONATE............................... 14HECTOROL..............................................................19HELIXATE FS..................................................... 21, 47HEMOFIL M........................................................21, 47HEXALEN.................................................................28HOMATROPAIRE..................................................... 20HOMATROPINE HBR...............................................20HUM INSULIN NPH/REG INSULIN HM................... 17HUMALOG................................................................17HUMALOG MIX 50-50..............................................17HUMALOG MIX 75-25..............................................17HUMATE-P......................................................... 21, 47HUMATROPE..................................................... 19, 47HUMIRA..............................................................26, 47HUMULIN 70/30 KWIKPEN(OTC)............................17HUMULIN 70-30(OTC)............................................. 17HUMULIN N(OTC)....................................................18HUMULIN R(OTC)....................................................17HYCAMTIN...............................................................28HYDRALAZINE HCL................................................ 10HYDROCERIN(OTC)................................................15HYDROCHLOROTHIAZIDE.....................................10HYDROCODONE BIT/HOMATROP ME-BR............ 12HYDROCODONE BIT-IBUPROFEN.................. 29, 40HYDROCODONE/ACETAMINOPHEN.....................30HYDROCODONE/CHLORPHEN POLIS..................12HYDROCODONE/IBUPROFEN...............................29HYDROCODONE-ACETAMINOPHEN(SOLUTION)(2.5-167/5)...... 30, 40HYDROCODONE-ACETAMINOPHEN(SOLUTION)(5-334MG/10)......30,4 0HYDROCODONE-ACETAMINOPHEN(SOLUTION)(7.5-325/15)......30,4 0HYDROCODONE-ACETAMINOPHEN(SOLUTION)(7.5-500/15)......30,4 0HYDROCODONE-ACETAMINOPHEN(TAB)(10-660MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(10-750MG)...............................................................30, 40
HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-300MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-325MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-500MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(10MG-650MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(2.5-500MG).....................................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(5 MG-500MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-300MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(5MG-325MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-300MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-325MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-500MG)...............................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-650MG).....................................................................30, 40HYDROCODONE-ACETAMINOPHEN(TAB)(7.5-750MG)...............................................................30, 40HYDROCODONE-CHLORPHENIRAMINE........ 12, 37HYDROCODONE-HOMATROPINE MBR......12, 37,4 0HYDROCORTISONE............................. 14, 15, 26, 27HYDROCORTISONE ACETATE........................ 15, 27HYDROCORTISONE ACETATE/ALO VER..............15HYDROCORTISONE ACETATE/UREA................... 15HYDROCORTISONE BUTYRATE........................... 15HYDROCORTISONE BUTYRATE/EMOLL.............. 15HYDROCORTISONE PROBUTATE.........................15HYDROCORTISONE VALERATE............................ 15HYDROCORTISONE W/ALOE(OTC)...................... 15HYDROCORTISONE(OTC)..................................... 14HYDROCORTISONE/ALOE VERA.......................... 15HYDROCORTISONE/IODOQUINOL....................... 13HYDROCORTISONE/PRAMOXINE...................16, 27HYDROCORTISONE/PRAMOXINE/EMOLL............16HYDROCORTISONE-ACETIC ACID....................... 18HYDROCORTISONE-ALOE(OTC)...........................15HYDROCORTISONE-IODOQUINOL....................... 13HYDROCORTISONE-PRAMOXINE.........................27HYDROCORTISONE-PRAMOXINE HCL................ 16HYDROGEN PEROXIDE......................................... 16HYDROGEN PEROXIDE(OTC)............................... 16HYDROLATUM(OTC)...............................................15HYDROMORPHONE HCL....................................... 30HYDROMORPHONE HCL(LIQUID).........................30HYDROMORPHONE HCL(SUPP)..................... 30, 40HYDROMORPHONE HCL(TAB)........................ 30, 40HYDROXYCHLOROQUINE SULFATE.................... 24HYDROXYPROGESTERONE CAPROATE............. 22HYDROXYUREA......................................................28HYDROXYZINE HCL..................................................5HYDROXYZINE PAMOATE........................................5HYFIBER(OTC).................................................. 27, 47HYOSCYAMINE SULFATE.......................................32HYPROMELLOSE....................................................20- I -IBANDRONATE SODIUM.............................18, 40, 44IBUPROFEN.............................................................26IBUPROFEN(OTC)...................................................26ICATIBANT ACETATE.............................................. 26ICLUSIG(TAB)(15 MG)................................. 28, 40, 47ICLUSIG(TAB)(45 MG)................................. 28, 40, 47IMATINIB MESYLATE.............................................. 28IMIPRAMINE HCL...................................................... 8IMIPRAMINE PAMOATE............................................ 8IMIQUIMOD........................................................23, 47IN-CHECK DIAL(OTC)................................... 7, 37, 40IN-CHECK NASAL WITH MASK(OTC)...................... 7IN-CHECK ORAL(OTC)..............................................7INCHECK(OTC)..........................................................7INCIVEK................................................................... 25INCRELEX..........................................................19, 47INDAPAMIDE............................................................10INDINAVIR SULFATE............................................... 25INDOCIN...................................................................26INDOMETHACIN......................................................26INGENOL MEBUTATE............................................. 16INHALER, ASSIST DEVICES.................................... 6INHALER,ASSIST DEVICE,ACCESORY...............6, 7INLYTA......................................................................28INSULIN ASPART.................................................... 17
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Index
INSULIN DETEMIR.................................................. 17INSULIN GLARGINE,HUM.REC.ANLOG.................17INSULIN GLULISINE................................................17INSULIN LISPRO..................................................... 17INSULIN NPL/INSULIN LISPRO.............................. 17INSULIN REGULAR, HUMAN..................................17INSULN ASP PRT/INSULIN ASPART......................18INTELENCE....................................................... 25, 47INTERFERON ALFA-2B,RECOMB.......................... 23INTERFERON ALFA-N3...........................................23INTERFERON BETA-1A...........................................29INTERFERON BETA-1A/ALBUMIN..........................29INTERFERON BETA-1B...........................................29INTERFERON GAMMA-1B,RECOMB..................... 23INTERMEZZO................................................ 8, 40, 44INTRON A...........................................................23, 47INVIRASE...........................................................25, 47INVOKANA......................................................... 16, 47IODOQUINOL...........................................................24IONAMIN............................................................ 35, 47IPRATROPIUM BROMIDE................................... 6, 29IPRATROPIUM/ALBUTEROL SULFATE....................6IPRATROPIUM-ALBUTEROL.................................... 6IRBESARTAN........................................................... 10IRBESARTAN/HYDROCHLOROTHIAZIDE............... 9IRBESARTAN-HYDROCHLOROTHIAZIDE............... 9ISENTRESS....................................................... 25, 47ISOMETHEPT/DICHLPHN/ACETAMINOP.............. 31ISOMETHEPT-DICHLORALP-ACETAMIN...............31ISONIAZID................................................................24ISOPTO CARBACHOL.............................................20ISOPTO HOMATROPINE.........................................20ISORDIL....................................................................11ISOSORBIDE DINITRATE........................................11ISOSORBIDE MONONITRATE................................ 11ISOSORBIDE MONONITRATE ER.......................... 11ISOTRETINOIN........................................................ 13ITRACONAZOLE......................................................24IV ANTISEPTIC WIPES(OTC)..................................15IV PREP WIPES(OTC).............................................15IVACAFTOR............................................................. 29- J -JALYN.................................................................33, 47JANUMET.....................................................16, 40, 44JANUMET XR...............................................16, 40, 44JANUVIA...................................................... 17, 40, 44JENTADUETO.............................................. 16, 40, 44- K -KADCYLA...........................................................28, 47KADIAN.................................................................... 30KALETRA................................................................. 25KALYDECO........................................................ 29, 47KA-PEC(OTC).......................................................... 27KENALOG................................................................ 15KETEK..........................................................23, 40, 44KETOCONAZOLE.............................................. 14, 24KETOPROFEN......................................................... 26KETOROLAC TROMETHAMINE................. 19, 26, 40KETOTIFEN FUMARATE......................................... 19KETOTIFEN FUMARATE(OTC)............................... 19KIDKARE(OTC)..................................................12, 37KIDS VITAMINS COMPLETE(OTC)...................34, 40KIDS VITAMINS(OTC)........................................35, 40KINERET............................................................ 26, 47KLOR-CON-EF.........................................................18KOATE-DVI(VIAL)(1000 (+/-))............................ 21, 47KOATE-DVI(VIAL)(250 (+/-)).............................. 21, 47KOATE-DVI(VIAL)(500 (+/-)).............................. 21, 47KOGENATE FS(KIT).......................................... 21, 48KOGENATE FS(VIAL)........................................ 21, 48KOMBIGLYZE XR...............................................16, 48KORLYM.............................................................17, 48KYNAMRO..........................................................11, 48- L -LABETALOL HCL....................................................... 9LACTULOSE............................................................ 27LAMISIL(OTC)....................................................14, 48LAMIVUDINE......................................................25, 48LAMIVUDINE/ZIDOVUDINE.....................................25LAMOTRIGINE.........................................................32LANCING DEVICE/LANCETS..................................17LANOLIN.................................................................. 15LANOLIN ALCOHOL/MO/W.PET/CERES................15LANOLIN/MIN OIL/PETROLAT,WHT....................... 21LAN-O-SOOTHE(OTC)............................................ 15LANSOPRAZOLE.....................................................33LANTHANUM CARBONATE.................................... 18LANTUS....................................................................17LANTUS SOLOSTAR............................................... 17
LAPATINIB DITOSYLATE.........................................28LASTACAFT........................................... 19, 37, 40, 44LATANOPROST....................................................... 20LATISSE............................................................. 21, 48LAZANDA........................................................... 30, 48LEFLUNOMIDE.................................................. 26, 44LENALIDOMIDE.......................................................28LETAIRIS............................................................ 10, 48LETROZOLE...................................................... 28, 40LEUCOVORIN CALCIUM.........................................29LEUKERAN.............................................................. 28LEUKINE............................................................ 22, 48LEUPROLIDE ACETATE..........................................18LEVALBUTEROL HCL..........................................5, 45LEVEMIR............................................................17, 45LEVETIRACETAM.................................................... 32LEVETIRACETAM(SOLUTION)............................... 32LEVETIRACETAM(TAB ER 24H)(500 MG)........ 32, 40LEVETIRACETAM(TAB ER 24H)(750 MG)........ 32, 40LEVETIRACETAM(TAB)...........................................32LEVOBUNOLOL HCL...............................................20LEVOFLOXACIN................................................ 20, 24LEVOFLOXACIN(SOLUTION)........................... 24, 40LEVOFLOXACIN(TAB)(250 MG)..............................24LEVOFLOXACIN(TAB)(500 MG)..............................24LEVOFLOXACIN(TAB)(750 MG)........................24, 40LEVOFLOXACIN(TAB)(750MG).........................24, 40LEVONORGESTREL............................................... 12LEVONORGESTREL-ETH ESTRADIOL..................12LEVORA-28........................................................12, 50LEVOTHYROXINE SODIUM....................................19LEXIVA............................................................... 25, 48LICE EGG REMOVER(OTC)....................................14LICE KILLING(OTC).................................................14LICE TREATMENT(OTC)......................................... 14LIDOCAINE........................................................ 16, 48LIDOCAINE HCL...................................................... 26LIDOCAINE HCL VISCOUS.....................................26LIDOCAINE/PRILOCAINE....................................... 16LIDOCAINE-PRILOCAINE....................................... 16LINACLOTIDE.......................................................... 27LINAGLIPTIN............................................................16LINAGLIPTIN/METFORMIN HCL.............................16LINDANE.................................................................. 14LINEZOLID............................................................... 23LINZESS.............................................................27, 48LIOTHYRONINE SODIUM....................................... 19LIPASE/PROTEASE/AMYLASE...............................32LIPODOX............................................................28, 48LIPOFEN.............................................................11, 45LIRAGLUTIDE.......................................................... 16LISINOPRIL................................................................9LISINOPRIL/HYDROCHLOROTHIAZIDE.................. 9LISINOPRIL-HYDROCHLOROTHIAZIDE..................9LITEAIRE........................................................6, 37, 40LITETOUCH................................................... 6, 37, 40LIVALO................................................................11, 48L-NORGEST-ETH ESTR/ETHIN ESTRA................. 12LO LOESTRIN FE........................................ 12, 45, 50LOCOID....................................................................15LOCOID LIPOCREAM..............................................15LODOSYN................................................................ 32LODOXAMIDE TROMETHAMINE............................20LOMUSTINE.............................................................28LOPERAMIDE.......................................................... 27LOPERAMIDE HCL..................................................27LOPERAMIDE(OTC)................................................ 27LOPINAVIR/RITONAVIR...........................................25LORATADINE............................................................. 5LORATADINE(SOLUTION)(OTC).................. 5, 37, 40LORATADINE(TAB RDP DIS)(OTC)...............5, 37, 40LORATADINE(TAB)(OTC).................................... 5, 40LORATADINE/PSEUDOEPHEDRINE........................ 5LORATADINE-D(TAB ER 12H)(OTC)...................5, 40LORATADINE-D(TAB ER 24H)(OTC)...................5, 40LORAZEPAM..............................................................8LOSARTAN POTASSIUM.........................................10LOSARTAN/HYDROCHLOROTHIAZIDE...................9LOSARTAN-HYDROCHLOROTHIAZIDE...................9LOTRIMIN AF(OTC).................................................14LOVASTATIN............................................................ 11LOVAZA.............................................................. 11, 48LUBRICATING JELLY(OTC).................................... 16LUMIGAN........................................................... 20, 48LUNESTA....................................................... 8, 40, 45LUTREPULSE.................................................... 19, 48LYSODREN.............................................................. 28- M -MACRODANTIN.......................................................23
MAG HYDROX/AL HYDROX/SIMETH.....................33MAGNESIA(OTC).....................................................33MAGNESIUM CITRATE........................................... 27MAGNESIUM CITRATE(OTC)................................. 27MAGNESIUM HYDROXIDE............................... 27, 33MAGNESIUM HYDROXIDE/AL HYDROX............... 33MAGNESIUM OXIDE............................................... 34MAGNESIUM OXIDE(OTC)............................... 34, 40MAGOX 400(OTC)............................................. 34, 40MAKENA............................................................ 22, 48MALATHION....................................................... 14, 45MAPAP PM(OTC)............................................... 12, 37MAPROTILINE HCL................................................... 8MARAVIROC............................................................ 25MATULANE.............................................................. 28MECASERMIN......................................................... 19MECLIZINE HCL........................................................ 5MECLIZINE HCL(OTC).............................................. 5MECLOFENAMATE SODIUM.................................. 26MEDI-GEN(OTC)......................................................15MEDROL.................................................................. 26MEDROXYPROGESTERONE ACET.......................22MEDROXYPROGESTERONE ACETATE.......... 11, 22MEFLOQUINE HCL..................................................24MEGESTROL ACETATE.......................................... 29MELOXICAM...................................................... 26, 40MELPHALAN............................................................28MEMANTINE HCL......................................................7MENEST.............................................................22, 40MENOSTAR........................................................22, 40MEPERIDINE HCL................................................... 30MEPHYTON............................................................. 22MEPROBAMATE........................................................ 8MERCAPTOPURINE................................................28MESALAMINE.......................................................... 27MESTINON.................................................................7METAPROTERENOL SULFATE................................ 5METAXALONE......................................................... 32METFORMIN HCL....................................................17METFORMIN HCL(TAB)(1000 MG)................... 17, 40METFORMIN HCL(TAB)(500 MG)..................... 17, 40METFORMIN HCL(TAB)(850 MG)........................... 17METHADONE HCL...................................................30METHADONE HCL(ORAL CONC).....................30, 41METHADONE HCL(TAB)(10 MG)...................... 30, 41METHADONE HCL(TAB)(5 MG)........................ 30, 41METHAZOLAMIDE...................................................20METHIMAZOLE........................................................19METHITEST............................................................. 22METHOCARBAMOL.................................................32METHOTREXATE.............................................. 26, 28METHOTREXATE SODIUM............................... 26, 28METHOXSALEN.......................................................16METHOXSALEN, RAPID..........................................16METHYLDOPA......................................................... 10METHYLERGONOVINE MALEATE......................... 12METHYLPHENIDATE ER(TAB ER 24H)(18 MG)......8,37, 41METHYLPHENIDATE ER(TAB ER 24H)(27 MG)......8,37, 41METHYLPHENIDATE ER(TAB ER 24H)(36 MG)......8,37, 41METHYLPHENIDATE ER(TAB ER 24H)(54 MG)......9,37, 41METHYLPHENIDATE HCL.....................................8, 9METHYLPREDNISOLONE.......................................26METHYLPREDNISOLONE ACETATE............... 26, 48METHYLPREDNISOLONE SOD SUCC............ 26, 48METHYLPREDNISOLONE SOD SUCC/PF.............26METHYLTESTOSTERONE...................................... 22METIPRANOLOL......................................................20METOCLOPRAMIDE HCL....................................... 33METOCLOPRAMIDE HCL INTENSOL.............. 33, 41METOCLOPRAMIDE HCL(SOLUTION).............33, 41METOCLOPRAMIDE HCL(TAB)........................ 33, 41METOLAZONE......................................................... 10METOPROLOL SUCCINATE................................... 10METOPROLOL TARTRATE..................................... 10METOPROLOL/HYDROCHLOROTHIAZIDE........... 10METOPROLOL-HYDROCHLOROTHIAZIDE...........10METRONIDAZOLE.......................................13, 24, 34MEXILETINE HCL...................................................... 9MG TRISILICATE/ALH/NAHCO3/AA........................33MICONAZOLE NITRATE....................................14, 34MICONAZOLE NITRATE(OTC)..........................14, 34MICROCHAMBER..........................................6, 37, 41MICROGESTIN.................................................. 12, 50MICROGESTIN FE.............................................12, 50MICROLIFE PEAK FLOW(OTC)................................ 7
LA Care Page 55 of 59
Index
MICROSPACER............................................. 6, 37, 41MIDODRINE HCL..................................................... 11MIFEPRISTONE.......................................................17MIGERGOT........................................................ 31, 41MILK OF MAGNESIA(OTC)..................................... 27MILLIPRED...............................................................26MILLIPRED DP.........................................................26MILNACIPRAN HCL.................................................29MINERAL OIL.....................................................15, 27MINERAL OIL(OTC).................................................27MINERAL OIL/I-PROP MYR/WATER.......................15MINERAL OIL/PETROLATUM,WHITE............... 15, 21MINERIN LOTION(OTC).......................................... 15MINIVELLE.........................................................22, 41MINI-WRIGHT PEAK FLOW METER.........................7MINOCYCLINE HCL.................................................24MINOXIDIL............................................................... 10MINTOX PLUS(OTC)............................................... 33MIPOMERSEN SODIUM.......................................... 11MIRAPEX ER............................................... 31, 41, 45MIRTAZAPINE............................................................7MISOPROSTOL....................................................... 33MITOTANE............................................................... 28MODAFINIL.................................................... 8, 41, 48MOEXIPRIL HCL........................................................9MOEXIPRIL/HYDROCHLOROTHIAZIDE.................. 9MOEXIPRIL-HYDROCHLOROTHIAZIDE.................. 9MOMETASONE FUROATE.............................. 5, 6, 15MOMETASONE/FORMOTEROL................................6MONAGHAN Z STAT......................................6, 37, 41MONISTAT 3(OTC)...................................................34MONOCLATE-P..................................................21, 48MONONINE........................................................21, 48MONTELUKAST SODIUM......................................... 6MORPHINE SULFATE........................................30, 41MORPHINE SULFATE ER(CAP ER PEL)(20 MG)......30, 41, 45MORPHINE SULFATE ER(CAP ER PEL)(30 MG)......30, 41MORPHINE SULFATE ER(CAP ER PEL)(50 MG)......30, 41, 45MORPHINE SULFATE ER(CAP ER PEL)(60 MG)......30, 41, 45MORPHINE SULFATE ER(CAP ER PEL)(80 MG)......30, 41, 45MORPHINE SULFATE ER(CPMP 24HR)...........30, 48MORPHINE SULFATE ER(TAB ER)(100 MG)......30,4 1MORPHINE SULFATE ER(TAB ER)(15 MG)......30,4 1MORPHINE SULFATE ER(TAB ER)(200 MG)......... 30MORPHINE SULFATE ER(TAB ER)(30 MG)......30,4 1MORPHINE SULFATE ER(TAB ER)(60 MG)......30,4 1MOUTHPIECE(OTC)......................................6, 37, 41MUCINEX COUGH(OTC)...................................13, 37MUCINEX DM(OTC)...........................................13, 37MUCINEX(OTC)................................................. 12, 37MULTIVITAMIN.........................................................34MULTIVITAMIN W/IRON, MINERALS...................... 34MULTIVITAMIN WITH FLUORIDE..................... 34, 41MULTIVITAMIN(OTC).........................................34, 41MULTIVITAMINS...................................................... 34MULTIVITAMINS W/FLUORIDE.........................34, 41MULTIVITAMINS W-FLUORIDE-IRON...............34, 41MULTIVITAMINS W-IRON........................................34MULTIVITAMINS WITH FLUORIDE............. 34, 35, 41MULTIVITAMINS WITH IRON.................................. 34MULTIVITAMINS WITH MIN NO.7/FA......................34MULTIVITS WITH IRON & FLUORIDE.................... 34MUPIROCIN............................................................. 13MUPIROCIN CALCIUM............................................29MYCELEX-3(OTC)................................................... 34MYCOBUTIN...................................................... 24, 48MYCOPHENOLATE MOFETIL.................................23MYLERAN................................................................ 28MYNATAL........................................................... 35, 41- N -NA PHOS,M-B/NA PHOS,DI-BA.............................. 27NA SULFACETM/PREDNIS SP............................... 19NABUMETONE........................................................ 26NACL IRRIGAT/DECYL GLUCOSIDE......................15NADOLOL................................................................ 10NAFTIFINE HCL.......................................................14NAFTIN.....................................................................14NALIDIXIC ACID................................................ 24, 37NAMENDA............................................................7, 45NAMENDA XR......................................................7, 45
NAPHAZOLINE HCL................................................ 20NAPHAZOLINE HCL/PEG 300................................ 20NAPHAZOLINE HCL/PHENIRAMINE................ 19, 20NAPROXEN..............................................................26NAPROXEN SODIUM.............................................. 26NARATRIPTAN HCL...........................................31, 41NASAL DECONGESTANT(OTC)....................... 13, 37NASONEX...................................................... 5, 41, 48NATALIZUMAB......................................................... 29NATAZIA....................................................... 11, 45, 50NATEGLINIDE.......................................................... 17NATURE'S TEARS(OTC)......................................... 20NEBIVOLOL HCL..................................................... 10NEBUPENT........................................................ 24, 48NECON...............................................................12, 50NEDOCROMIL SODIUM..........................................20NEFAZODONE HCL...................................................8NELFINAVIR MESYLATE.........................................25NEO/POLYMYX B SULF/DEXAMETH..................... 19NEOMY SULF/BACITRA/POLYMYXIN B...........13, 20NEOMY SULF/BACITRAC ZN/POLY....................... 13NEOMY SULF/BACITRAC ZN/POLY/HC.................19NEOMY SULF/POLYMYX B SULF/PRAM............... 13NEOMYCIN SULFATE..............................................24NEOMYCIN SULFATE/DEX NA PH......................... 19NEOMYCIN W/DEXAMETHASONE........................ 19NEOMYCIN/BACITRA/POLYMYXIN/HC..................14NEOMYCIN/BACITRAC ZN/POLYMYXIN................13NEOMYCIN/POLYMYXIN B SULF/HC...............14, 18NEOMYCIN/POLYMYXN B/GRAMICIDIN................20NEOMYCIN-BACITRACIN-POLY-HC.......................19NEOMYCIN-BACITRACIN-POLYMYXIN................. 20NEOMYCIN-POLYMYXIN-DEXAMETH................... 19NEOMYCIN-POLYMYXIN-GRAMICIDIN..................20NEOMYCIN-POLYMYXIN-HC.................................. 18NEOMYCN/BACI ZN/PMYX BS/PRAMOX...............13NEOSPORIN + PAIN RELIEF(OTC)........................ 13NEOSTIGMINE BROMIDE.........................................7NEULASTA......................................................... 22, 48NEUPOGEN....................................................... 22, 48NEUPRO............................................................ 31, 41NEVIRAPINE......................................................25, 48NEXAFED(OTC)...........................................13, 37, 41NEXAVAR........................................................... 28, 48NEXT CHOICE ONE DOSE......................... 12, 41, 50NIACIN......................................................................11NIACIN ER..........................................................11, 48NIACIN(OTC)............................................................11NIACINAMIDE.......................................................... 11NIACINAMIDE(OTC)................................................ 11NICARDIPINE HCL.................................................. 10NICOTINE.................................................................32NICOTINE GUM(OTC)....................................... 32, 37NICOTINE PATCH(OTC)....................................32, 37NICOTINE POLACRILEX.........................................32NIFEDIPINE..............................................................10NIFEDIPINE ER........................................................10NILANDRON.............................................................28NILOTINIB HCL........................................................28NILUTAMIDE............................................................ 28NITAZOXANIDE....................................................... 13NITRO-BID................................................................11NITRO-DUR..............................................................11NITROFURANTOIN............................................23, 37NITROFURANTOIN MACROCRYSTAL...................23NITROFURANTOIN MONOHYD/M-CRYST............ 23NITROFURANTOIN MONO-MACRO.......................23NITROGLYCERIN.....................................................11NITROGLYCERIN PATCH........................................ 11NITROSTAT.............................................................. 11NIZATIDINE.............................................................. 33NONOXYNOL 9........................................................ 11NORA-BE........................................................... 12, 50NORDITROPIN FLEXPRO.................................19, 48NORDITROPIN NORDIFLEX.............................19, 48NORELGESTROMIN/ETHIN.ESTRADIOL.............. 12NORETH A-ET ESTRA/FE FUMARATE.................. 12NORETH-ETHINYL ESTRADIOL/IRON...................12NORETHIND AC/ETHINYL ESTRADIOL.................22NORETHINDRONE..................................................12NORETHINDRONE ACETATE.................................22NORETHINDRONE A-E ESTRADIOL......................12NORETHINDRONE-ETHINYL ESTRAD..................12NORETHINDRONE-MESTRANOL.......................... 12NORGESTIMATE-ETHINYL ESTRADIOL............... 12NORGESTREL-ETHINYL ESTRADIOL................... 12NORMLGEL(OTC)....................................................16NORPACE CR............................................................ 9NORTRIPTYLINE HCL...............................................8
NORVIR..............................................................25, 48NOVAREL.................................................................18NOVOLIN 70-30(OTC)............................................. 17NOVOLIN N INNOLET(OTC)................................... 18NOVOLIN N(OTC)....................................................18NOVOLIN R(OTC)....................................................17NOVOLOG................................................................17NOVOLOG FLEXPEN.............................................. 17NOVOLOG MIX 70-30..............................................18NOVOLOG MIX 70-30 FLEXPEN............................ 18NOVOSEVEN.....................................................21, 48NOVOSEVEN RT............................................... 21, 48NP THYROID............................................................19NPH, HUMAN INSULIN ISOPHANE........................ 18NUCYNTA...........................................................31, 48NUCYNTA ER.....................................................31, 48NUMORPHAN.................................................... 31, 48NUTRADERM(OTC).................................................15NUVARING......................................................... 11, 50NYSTATIN.......................................................... 14, 24NYSTATIN/TRIAMCIN.............................................. 14NYSTATIN-TRIAMCINOLONE................................. 14- O -OCELLA........................................................11, 45, 50OFLOXACIN.............................................................20OLANZAPINE.............................................................8OLMESARTAN MEDOXOMIL.................................. 10OLMESARTAN/HYDROCHLOROTHIAZIDE............. 9OLOPATADINE HCL.................................................19OMEGA-3 ACID ETHYL ESTERS............................11OMEPRAZOLE.........................................................33OMEPRAZOLE MAGNESIUM..................................33OMEPRAZOLE MAGNESIUM(OTC)..................33, 48OMEPRAZOLE(OTC).........................................33, 41OMEPRAZOLE/SODIUM BICARBONATE...............33OMEPRAZOLE-SODIUM BICARBONATE......33, 41,4 5OMEPRAZOLE-SODIUM BICARBONATE(OTC)......33, 41, 45OMNITROPE............................................................19ONDANSETRON........................................................5ONDANSETRON HCL................................................5ONDANSETRON ODT(TAB RDP DIS)(4 MG)......5,4 1ONDANSETRON ODT(TAB RDP DIS)(8 MG)......5,4 1ONE TOUCH SURESOFT(OTC)..............................17ONE WAY MOUTHPIECE(OTC).................... 6, 37, 41ONFI......................................................................... 32ONGLYZA...........................................................16, 48ONSOLIS............................................................30, 48OPANA............................................................... 31, 48OPANA ER......................................................... 31, 48OPTICHAMBER............................................. 6, 37, 41OPTICHAMBER DIAMOND........................... 6, 37, 41OPTIUM EZ(OTC).............................................. 17, 41OPTIUM(OTC)....................................................17, 41ORAL SALINE LAXATIVE(OTC).............................. 27ORENCIA........................................................... 26, 48ORLISTAT.................................................................36ORPHENADRINE CITRATE.....................................32ORPHENADRINE COMPOUND FORTE................. 32ORPHENADRINE/ASPIRIN/CAFFEINE...................32ORTHO ALL-FLEX................................................... 12ORTHO EVRA.................................................... 12, 50ORTHO TRI-CYCLEN LO............................ 12, 45, 50OSELTAMIVIR PHOSPHATE................................... 25OVACE PLUS........................................................... 15OXACILLIN SODIUM................................................23OXAPROZIN.............................................................26OXAZEPAM................................................................ 8OXCARBAZEPINE................................................... 32OXSORALEN........................................................... 16OXSORALEN-ULTRA...............................................16OXTELLAR XR...................................................32, 45OXYBUTYNIN CHLORIDE.......................................34OXYCODONE HCL............................................ 30, 31OXYCODONE HCL(CAP).................................. 30, 41OXYCODONE HCL(SOLUTION)............................. 30OXYCODONE HCL(TAB)(10 MG)......................30, 41OXYCODONE HCL(TAB)(15 MG)......................30, 41OXYCODONE HCL(TAB)(20 MG)......................31, 41OXYCODONE HCL(TAB)(30 MG)......................31, 41OXYCODONE HCL(TAB)(5 MG)........................31, 41OXYCODONE HCL/ACETAMINOPHEN.................. 31OXYCODONE HCL/ASPIRIN...................................31OXYCODONE HCL-ASPIRIN............................ 31, 41OXYCODONE-ACETAMINOPHEN(CAP).......... 31, 41
LA Care Page 56 of 59
Index
OXYCODONE-ACETAMINOPHEN(TAB)(2.5-325MG)..................................................................................31OXYCODONE-ACETAMINOPHEN(TAB)(5MG-325MG)...............................................................31, 41OXYCODONE-ACETAMINOPHEN(TAB)(7.5-325MG)............................................................................31, 41OXYCONTIN...................................................... 31, 48OXYMETAZOLINE HCL........................................... 13OXYMORPHONE HCL.......................................31, 48OYSTER SHELL CALCIUM W-VIT D(OTC).......34, 41OYSTER SHELL CALCIUM(OTC)..................... 34, 41- P -PALIVIZUMAB.......................................................... 25PANDA MASK(OTC)...................................... 6, 37, 41PANDEL....................................................................15PANITUMUMAB....................................................... 28PANTOPRAZOLE SODIUM............................... 33, 41PARICALCITOL.................................................. 19, 48PAROMOMYCIN SULFATE......................................24PAROXETINE HCL.................................................7, 8PAROXETINE HCL(TAB ER 24H)............7, 37, 41, 45PAROXETINE HCL(TAB)..................................... 7, 37PARVA-CAL 500(OTC).......................................34, 41PATADAY...................................................... 19, 41, 45PATANOL................................................19, 37, 41, 45PAXIL....................................................................8, 37PAZOPANIB HCL..................................................... 28PEAK FLOW METER................................................. 7PEAK FLOW METER(OTC)....................................... 7PEAK FLOW METER/INH ASST DEV....................... 7PEAK-AIR(OTC).........................................................7PED MULTIVIT #17/IRON FUMARATE....................34PED MULTIVIT #46/IRON SULFATE....................... 34PED MV A,C,D3 #21 W-FLUORIDE.........................34PEDI M.VIT NO.17 WITH FLUORIDE......................34PEDI MULTIVIT 9/IRON/FA......................................34PEDI MULTIVITS A,C,&D3 NO.21........................... 35PEDI MVI NO.16 WITH FLUORIDE......................... 35PEDIA-LAX(OTC).....................................................27PEDIATRIC ELECTROLYTE(OTC).......................... 18PEDIATRIC MASK(OTC)................................6, 37, 41PEDIATRIC MULTIVIT #36/IRON.............................35PEDIATRIC MULTIVIT COMB 8/FA......................... 35PEDIATRIC MULTIVIT COMB NO.20...................... 35PEDIATRIC PANDA MASK(OTC).................. 6, 37, 41PEG 3350/NA SULF,BICARB,CL/KCL..................... 27PEGASYS.......................................................... 25, 48PEGASYS PROCLICK....................................... 25, 48PEGFILGRASTIM.....................................................22PEGINTERFERON ALFA-2A................................... 25PEGINTERFERON ALFA-2B............................. 25, 28PEGINTRON...................................................... 25, 48PEGINTRON REDIPEN..................................... 25, 48PENCICLOVIR......................................................... 14PENICILLAMINE...................................................... 26PENICILLIN V POTASSIUM.....................................23PENTAMIDINE ISETHIONATE...........................24, 48PENTAZOCINE HCL/NALOXONE HCL................... 31PENTAZOCINE-NALOXONE HCL..................... 31, 41PENTOSAN POLYSULFATE SODIUM.................... 33PENTOXIFYLLINE................................................... 22PEPCID RPD............................................................33P-EPHED HCL/CODEINE/GUAIFEN....................... 12P-EPHED SUL/LORATADINE.................................... 5PERIGUARD(OTC).................................................. 16PERMETHRIN..........................................................14PERMETHRIN(OTC)................................................14PERPHENAZINE/AMITRIPTYLINE HCL................... 8PERPHENAZINE-AMITRIPTYLINE........................... 8PERRY PRENATAL(OTC)..................................35, 41PERSONAL BEST(OTC)............................................7PETROLATUM,WHITE.......................................15, 16PFLEX TRAINER........................................... 7, 37, 41PHENAZOPYRIDINE HCL....................................... 33PHENDIMETRAZINE TARTRATE......................35, 48PHENOBARB/HYOSCY/ATROPINE/SCOP.............32PHENOBARBITAL......................................................8PHENOXYBENZAMINE HCL.....................................9PHENTERMINE HCL......................................... 35, 48PHENTERMINE RESIN............................................35PHENTERMINE/TOPIRAMATE............................... 35PHENYLEPHRINE HCL/PROMETH HCL................12PHENYTEK.............................................................. 32PHENYTOIN.............................................................32PHENYTOIN SODIUM EXTENDED.........................32PHOSP ACID/DEXTROSE/FRUCTOSE.................... 5PHOSPHA 250 NEUTRAL....................................... 33PHOSPHORUS #1................................................... 33PHYTONADIONE..................................................... 22
PICATO...............................................................16, 48PIKO 1(OTC).............................................................. 7PILOCARPINE HCL........................................... 20, 28PIMECROLIMUS......................................................16PINDOLOL............................................................... 10PIOGLITAZONE HCL......................................... 17, 45PIOGLITAZONE HCL/GLIMEPIRIDE....................... 17PIOGLITAZONE HCL/METFORMIN HCL................ 17PIOGLITAZONE-GLIMEPIRIDE......................... 17, 46PIOGLITAZONE-METFORMIN.......................... 17, 46PIP BUTOX/PYRETHRINS/PERMETH....................14PIP BUTOX/PYRETHRINS/RESMETH....................14PIPERONYL BUTOXIDE/PYRETHRINS..................14PIROXICAM..............................................................26PITAVASTATIN CALCIUM.........................................11PNV #14/FERROUS FUM/FOLIC ACID...................35PNV COMB.NO.44/IRON/FOLIC ACID....................35PNV COMBO#47/IRON/FA #1/DHA.........................35PNV NO.118/IRON FUMARATE/FA......................... 35PNV NO.22/IRON CBN&GLUC/FA/DSS.................. 35PNV W-CA #40/IRON FUM/FA CMB#1....................35PNV W-CA NO.37/IRON/FA/OMEGA-3................... 35PNV WITH CA NO.36/IRON/FA............................... 35PNV WITH CA,NO.71/IRON/FA............................... 35PNV WITH CA,NO.72/IRON,CARB/FA.................... 35PNV WITH CA,NO.72/IRON/FA............................... 35PNV/IRON,CARBONYL/DOCUSATE/FA................. 35PNV119/IRON FUMARATE/FA/DSS........................ 35PNV19/IRON BG HC&SUCC-P/FA/OM3..................35PNV22/IRON CBN&GLUC/FA/DSS/DHA.................35PNV39/IRON FUMARATE/FA/DSS/DHA................. 35PNV53/IRON B-G HCL-P/FA/OMEGA3................... 35PNV7/FE ASP GLY/DOCUSATE/FA........................ 35PNV95/FERROUS FUMARATE/FA..........................35PNV-SELECT..................................................... 35, 41POCKET CHAMBER......................................6, 37, 41POCKET PEAK(OTC)................................................ 7POCKETPEAK(OTC)................................................. 7PODOFILOX.............................................................16POLYETHYLENE GLYCOL 3350............................. 27POLYETHYLENE GLYCOL 3350(OTC)................... 27POLYMYXIN B SULF/TRIMETHOPRIM...................20POLYMYXIN B SUL-TRIMETHOPRIM.....................20POLYSPORIN(OTC).................................................13POLYVINYL ALCOHOL............................................20POLYVINYL ALCOHOL/POVIDONE........................20POLYVITAMIN WITH IRON(OTC)......................34, 41POLY-VITAMIN(OTC)......................................... 35, 41POMALIDOMIDE......................................................28POMALYST........................................................ 28, 48PONATINIB HCL...................................................... 28POT CHLORIDE/POT BICARB/CIT AC................... 18POTASS HYD/GLYCO/PQ10/HE-CELL................... 14POTASSIUM BICARBONATE/CIT AC..................... 18POTASSIUM CHLORIDE......................................... 18POTASSIUM CITRATE.............................................33POTASSIUM CITRATE/CITRIC ACID...................... 33POTASSIUM IODIDE............................................... 19POTIGA.............................................................. 32, 48POVIDONE-IODINE........................................... 13, 16POVIDONE-IODINE(OTC)....................................... 16PR NATAL 400....................................................35, 41PR NATAL 400 EC..............................................35, 41PRADAXA.......................................................... 22, 48PRAMIPEXOLE DI-HCL...........................................31PRAMIPEXOLE DIHYDROCHLORIDE....................31PRAMOSONE.......................................................... 16PRAMOSONE E.......................................................16PRASUGREL HCL................................................... 22PRAVASTATIN SODIUM...........................................11PRAZIQUANTEL...................................................... 24PRAZOSIN HCL......................................................... 9PRECISION PCX PLUS(OTC)........................... 17, 41PRECISION PCX(OTC)......................................17, 41PRECISION POINT OF CARE(OTC).................17, 41PRECISION Q-I-D(OTC).................................... 17, 41PRECISION XTRA(OTC)................................... 17, 41PRECISION(OTC)..............................................17, 41PRED MILD.............................................................. 19PREDNICARBATE................................................... 15PREDNISOLONE..................................................... 26PREDNISOLONE ACETATE.................................... 19PREDNISOLONE SOD PHOSPHATE............... 19, 26PREDNISOLONE SODIUM PHOSPHATE.........19, 26PREDNISONE..........................................................26PREDNISONE INTENSOL.......................................26PREFEST........................................................... 22, 41PREGNYL................................................................ 18PREMARIN...............................................................34
PREMARIN(TAB)(0.3 MG)................................. 22, 41PREMARIN(TAB)(0.45MG)................................ 22, 41PREMARIN(TAB)(0.625 MG)............................. 22, 41PREMARIN(TAB)(0.9 MG)....................................... 22PREMARIN(TAB)(1.25 MG)............................... 22, 41PRE-MENSTRUAL RELIEF(OTC)..................... 29, 37PREMPHASE........................................................... 22PREMPRO......................................................... 22, 41PRENAISSANCE DHA.......................................35, 41PRENAPLUS......................................................35, 41PRENATABS FA................................................. 35, 41PRENATABS RX................................................ 35, 42PRENATAL #103/IRON FUMARATE/FA.................. 35PRENATAL 19(OTC).......................................... 35, 42PRENATAL AD................................................... 35, 42PRENATAL PLUS...............................................35, 42PRENATAL VIT #76/IRON,CARB/FA....................... 35PRENATAL VIT 15/IRON CB/FA/DSS......................35PRENATAL VIT 16/IRON CB/FA/DSS......................35PRENATAL VIT 18/IRON CB/FA/DSS......................35PRENATAL VIT NO.78/IRON/FA..............................35PRENATAL VIT#96/FERROUS FUM/FA..................35PRENATAL VIT/FE FUMARATE/FA......................... 35PRENATAL VIT/IRON FUMARATE/FA.....................35PRENATAL VIT27&CALCIUM/IRON/FA...................35PRENATAL VITAMIN FORMULA(OTC)............. 35, 42PRENATAL VITAMINS(OTC)..............................35, 42PRENATAL VITS W-CA,FE,FA(<1MG).................... 35PRENATAL(OTC)............................................... 35, 42PREVACID..........................................................33, 37PREVACID 24HR(OTC)............................... 33, 42, 46PREZISTA.......................................................... 25, 48PRILOSEC......................................................... 33, 48PRILOSEC OTC(OTC).................................33, 42, 48PRIMAQUINE...........................................................24PRIMAQUINE PHOSPHATE.................................... 24PRIMEAIRE....................................................6, 37, 42PRIMIDONE............................................................. 32PROBENECID..........................................................21PROBENECID-COLCHICINE...................................21PROCAINAMIDE HCL................................................9PROCARBAZINE HCL............................................. 28PROCHAMBER..............................................6, 37, 42PROCHLORPERAZINE EDISYLATE.........................5PROCHLORPERAZINE MALEATE............................5PROCRIT............................................................22, 48PROCTOZONE-HC.................................................. 27PROFILNINE SD................................................ 21, 48PROGESTERONE................................................... 22PROGESTERONE,MICRONIZED............................22PROGRAF................................................................23PROLIA.............................................................. 18, 48PROMETHAZINE HCL.........................................5, 37PROMETHAZINE HCL/CODEINE............................12PROMETHAZINE VC......................................... 12, 37PROMETHAZINE VC-CODEINE........................12, 37PROMETHAZINE/PHENYLEPH/CODEINE.............12PROMETHAZINE-CODEINE..............................12, 37PROMETHAZINE-DM........................................ 13, 37PROMETHEGAN..................................................5, 37PRONESTYL..............................................................9PROPAFENONE HCL................................................ 9PROPANTHELINE BROMIDE..................................33PROPRANOLOL HCL.............................................. 10PROPYLTHIOURACIL..............................................19PROSTIGMIN.............................................................7PROTEXIN(OTC)............................................... 35, 42PROTOPIC......................................................... 16, 46PROTRIPTYLINE HCL...............................................8PSEUDOEPHEDRINE HCL..................................... 13PSEUDOEPHEDRINE/BROMPHENIRAMIN........... 12PSEUDOEPHEDRINE/TRIPROLIDINE................... 12PULMICORT.........................................................6, 37PULMICORT FLEXHALER...................................6, 46PULMOZYME.....................................................29, 48PYRAZINAMIDE.......................................................24PYRIDOSTIGMINE BROMIDE...................................7PYRIDOXINE HCL................................................... 35PYRIDOXINE/CHROMIUM PICOLINATE................ 35PYRIMETHAMINE....................................................24- Q -Q-PAP(OTC).............................................................29QSYMIA..............................................................35, 48Q-TAPP(OTC).....................................................12, 37Q-TUSSIN DM(OTC)..........................................13, 37Q-TUSSIN(OTC).................................................12, 37QUINAPRIL HCL...................................................... 10QUINAPRIL/HYDROCHLOROTHIAZIDE...................9QUINAPRIL-HYDROCHLOROTHIAZIDE.................. 9
LA Care Page 57 of 59
Index
QUINIDINE GLUCONATE.......................................... 9QUINIDINE SULFATE................................................ 9QUININE SULFATE.................................................. 24QVAR..........................................................................6- R -RALOXIFENE HCL...................................................18RALTEGRAVIR POTASSIUM...................................25RAMELTEON..............................................................8RAMIPRIL.................................................................10RANITIDINE............................................................. 33RANITIDINE 150MG.................................................33RANITIDINE HCL..................................................... 33RANITIDINE HCL(OTC)........................................... 33RAPAMUNE..............................................................23RAVICTI..............................................................27, 48REBETOL........................................................... 25, 48REBIF....................................................................... 29REBIF(SYRINGE)(22MCG/.5ML).......................29, 48REBIF(SYRINGE)(44MCG/.5ML).......................29, 48RECOMBINATE(VIAL)(1000 (+/-))..................... 21, 48RECOMBINATE(VIAL)(1500 (+/-))..................... 21, 48RECOMBINATE(VIAL)(2000 (+/-))..................... 21, 48RECOMBINATE(VIAL)(250 (+/-))....................... 21, 48RECOMBINATE(VIAL)(500 (+/-))....................... 21, 48REDNESS RELIEF(OTC).........................................20REFISSA.................................................................. 13REFRESH LACRI-LUBE(OTC)................................ 21REGORAFENIB........................................................28REGRANEX....................................................... 17, 48RENAGEL.......................................................... 18, 48RENVELA...........................................................18, 48RESCON-DM(OTC)............................................12, 37RESCRIPTOR.................................................... 25, 48RESCULA...........................................................20, 48RESERPINE.............................................................10RESTASIS.......................................................... 20, 48RETAPAMULIN.........................................................14REVLIMID.................................................................28REYATAZ............................................................25, 48RHINOCORT AQUA.............................................5, 48RIBAVIRIN................................................................ 25RID(OTC)..................................................................14RIFABUTIN...............................................................24RIFAMPIN.................................................................24RIFAXIMIN................................................................24RILPIVIRINE HCL.................................................... 25RIMANTADINE HCL................................................. 25RIOMET..............................................................17, 37RISEDRONATE SODIUM.........................................18RISPERDAL CONSTA................................................8RISPERIDONE MICROSPHERES.............................8RITEFLO........................................................ 6, 37, 42RITONAVIR.............................................................. 25RIVAROXABAN........................................................ 21RIVASTIGMINE.......................................................... 7RIVASTIGMINE TARTRATE.......................................7RIXUBIS............................................................. 21, 48RIZATRIPTAN.....................................................31, 42RIZATRIPTAN BENZOATE.......................................31ROBITUSSIN COUGH & COLD CF(OTC)......... 13, 37ROPINIROLE HCL................................................... 31ROPINIROLE HCL(TAB ER 24H).................31, 42, 46ROPINIROLE HCL(TAB).......................................... 31ROTIGOTINE........................................................... 31ROZEREM......................................................8, 42, 46- S -SABRIL...............................................................32, 48SAFYRAL......................................................11, 46, 50SAIZEN...............................................................19, 48SALACTIC FILM(OTC).............................................16SALICYLIC ACID......................................................16SALICYLIC ACID/COLLODION, FLEX.................... 16SALINE(OTC)...........................................................20SALMETEROL XINAFOATE...................................... 5SALSALATE............................................................. 29SANDIMMUNE......................................................... 23SANI-SUPP(OTC).................................................... 27SAQUINAVIR MESYLATE........................................25SARGRAMOSTIM.................................................... 22SAVELLA............................................................ 29, 48SAXAGLIPTIN HCL..................................................16SAXAGLIPTIN HCL/METFORMIN HCL...................16SCOT-TUSSIN SENIOR(OTC)...........................13, 37SEA-CLENS(OTC)................................................... 15SELEGILINE HCL.................................................... 31SELENIUM SULFIDE............................................... 15SELZENTRY.......................................................25, 48SE-NATAL 19......................................................35, 42SENNA LAXATIVE(OTC)......................................... 27
SENNA-DOCUSATE SODIUM(OTC)....................... 27SENNOSIDES.......................................................... 27SENNOSIDES/DOCUSATE SODIUM...................... 27SEREVENT DISKUS............................................5, 48SEROSTIM.........................................................19, 48SERTRALINE HCL..................................................... 8SEVELAMER CARBONATE.....................................18SEVELAMER HCL................................................... 18SIDESTREAM MASK(OTC)........................... 6, 37, 42SIDESTREAM PEDIATRIC(OTC).................. 6, 37, 42SILDENAFIL....................................................... 10, 48SILDENAFIL CITRATE............................................. 10SILENOR........................................................8, 42, 46SILICONE MASK............................................7, 37, 42SILICONE MASK(OTC)..................................7, 37, 42SILVER NITRATE..................................................... 16SILVER SULFADIAZINE...........................................14SIMBRINZA........................................................ 20, 46SIMETHICONE.........................................................32SIMPONI............................................................ 26, 48SIMVASTATIN...........................................................11SIMVASTATIN(TAB)(10 MG).................................... 11SIMVASTATIN(TAB)(20 MG).................................... 11SIMVASTATIN(TAB)(40 MG).................................... 11SIMVASTATIN(TAB)(5 MG)...................................... 11SIMVASTATIN(TAB)(80 MG).............................. 11, 46SINGLE USE SWAB(OTC).......................................15SIROLIMUS..............................................................23SITAGLIPTIN PHOS/METFORMIN HCL..................16SITAGLIPTIN PHOSPHATE..................................... 17SKIN CLEANSER COMB NO.15..............................16SLEEP TABS(OTC).................................................... 8SOD BORATE/BORIC AC/WATER/NACL................20SOD/POT/K CIT/SOD CIT/CIT ACID....................... 33SODIUM BICARBONATE.........................................33SODIUM BICARBONATE(OTC)...............................33SODIUM CHLORIDE..............................15, 16, 18, 20SODIUM CHLORIDE IRRIG SOLUTION................. 15SODIUM CHLORIDE(OTC)................................18, 20SODIUM CHLORIDE/NAHCO3/KCL/PEG............... 27SODIUM FLUORIDE................................................ 34SODIUM POLYSTYRENE SULFONATE..................18SODIUM SULFACETAMIDE.....................................15SODIUM SULFACETAMIDE-SULFUR..................... 14SODIUM/POTASSIUM/SOD CHL............................ 21SOLTAMOX.............................................................. 29SOLU-MEDROL................................................. 26, 48SOMATROPIN..........................................................19SORAFENIB TOSYLATE......................................... 28SOTALOL................................................................. 10SOTALOL HCL......................................................... 10SPASMOLIN............................................................. 32SPIRIVA......................................................................6SPIROMETERS AND ACCESSORIES......................7SPIRONOLACT/HYDROCHLOROTHIAZID.............10SPIRONOLACTONE................................................ 10SPIRONOLACTONE-HCTZ..................................... 10SPORANOX....................................................... 24, 48SPRINTEC......................................................... 12, 50SPRYCEL........................................................... 28, 48SPRYCEL(TAB)(100 MG).............................28, 42, 48SPRYCEL(TAB)(140 MG).............................28, 42, 48SPRYCEL(TAB)(20 MG)...............................28, 42, 48SPRYCEL(TAB)(50 MG)...............................28, 42, 48SPRYCEL(TAB)(70 MG)...............................28, 42, 48SPRYCEL(TAB)(80 MG)...............................28, 42, 48SPS.......................................................................... 18SSKI......................................................................... 19STAVUDINE........................................................25, 48STELARA................................................................. 26STIMATE.................................................................. 18STIVARGA..........................................................28, 48STRIANT............................................................ 22, 42SUBSYS............................................................. 29, 48SUCRALFATE.......................................................... 33SUDAFED 24-HOUR(OTC)..........................13, 37, 42SUDOGEST(TAB ER)(OTC)........................ 13, 37, 42SUDOGEST(TAB)(30 MG)(OTC)................. 13, 37, 42SUDOGEST(TAB)(60 MG)(OTC)................. 13, 37, 42SULCONAZOLE NITRATE.......................................14SULFACETAMIDE SOD/SULFUR/UREA.................14SULFACETAMIDE SODIUM.........................13, 15, 20SULFACETAMIDE SODIUM/SULFUR..................... 14SULFACETAMIDE/PREDNISOLONE SP.................20SULFACETAMIDE-PREDNISOLONE...................... 20SULFACETM NA/PREDNISOL AC.......................... 20SULFADIAZINE........................................................ 27SULFALONE............................................................ 19SULFAMETHOXAZOLE/TRIMETHOPRIM........ 23, 27
SULFAMETHOXAZOLE-TRIMETHOPRIM.............. 23SULFANILAMIDE..................................................... 34SULFASALAZINE.....................................................27SULFATRIM..............................................................27SULINDAC................................................................26SUMATRIPTAN............................................ 31, 42, 48SUMATRIPTAN SUCC/NAPROXEN SOD............... 31SUMATRIPTAN SUCCINATE...................................31SUMATRIPTAN SUCCINATE(CARTRIDGE)(4MG/0.5ML)....................................................31, 42, 46SUMATRIPTAN SUCCINATE(CARTRIDGE)(6MG/0.5ML)..........................................................31, 42SUMATRIPTAN SUCCINATE(PEN INJCTR)(4MG/0.5ML)....................................................31, 42, 46SUMATRIPTAN SUCCINATE(PEN INJCTR)(6MG/0.5ML)..........................................................31, 42SUMATRIPTAN SUCCINATE(TAB)....................31, 42SUMAVEL DOSEPRO..................................31, 42, 46SUNITINIB MALATE.................................................28SUPRAX.............................................................23, 42SUPRENZA ODT................................................35, 48SURE COMFORT ALCOHOL(OTC)........................ 15SURE-PREP ALCOHOL PREP PADS(OTC)........... 15SURGICAL LUBRICANT..........................................16SURGILUBE(OTC)...................................................16SUSTIVA.............................................................25, 48SUTENT............................................................. 28, 48SYLATRON.........................................................28, 48SYLATRON 4-PACK...........................................28, 48SYMBICORT........................................................ 6, 48SYNAGIS............................................................25, 48- T -TABLOID...................................................................28TACROLIMUS.................................................... 16, 23TAMIFLU(CAP)(30 MG)......................................25, 42TAMIFLU(CAP)(45 MG)......................................25, 42TAMIFLU(CAP)(75 MG)......................................25, 42TAMIFLU(SUSP RECON)............................ 25, 37, 42TAMOXIFEN CITRATE.............................................29TAMSULOSIN HCL.................................................. 33TAPENTADOL HCL.................................................. 31TARCEVA........................................................... 28, 48TARGRETIN................................................. 16, 29, 48TASIGNA............................................................ 28, 48TAZAROTENE....................................................13, 16TAZORAC...........................................................16, 48TEARS NATURALE FREE(OTC)............................. 20TEKAMLO.......................................................... 10, 48TEKTURNA........................................................ 10, 48TEKTURNA HCT..........................................10, 46, 48TELAPREVIR........................................................... 25TELITHROMYCIN.................................................... 23TELMISARTAN.........................................................10TEMAZEPAM..............................................................8TEMOZOLOMIDE.....................................................28TENOFOVIR DISOPROXIL FUMARATE................. 25TERAZOSIN HCL.......................................................9TERBINAFINE HCL......................................14, 24, 42TERBINAFINE(OTC)....................................14, 37, 42TERBUTALINE SULFATE.......................................... 6TERCONAZOLE.......................................................34TERIFLUNOMIDE.................................................... 29TESTIM........................................................ 22, 42, 48TESTOPEL......................................................... 22, 42TESTOSTERONE.................................................... 22TESTRED.................................................................22TETRACYCLINE HCL.............................................. 24TETRAHYDROZOLINE HCL....................................20TETRAHYDRZ/DEXT 70/PEG 400/PVP.................. 20TEVETEN HCT...........................................................9TEV-TROPIN...................................................... 19, 48TEXACORT.............................................................. 15THALIDOMIDE......................................................... 24THALOMID............................................................... 24THEO-24.....................................................................7THEOPHYLLINE ANHYDROUS................................ 7THIAMINE HCL........................................................ 35THIAMINE MONONITRATE..................................... 35THIOGUANINE.........................................................28THRESHOLD IMT.......................................... 7, 37, 42THRESHOLD PEP......................................... 7, 37, 42THYROID,PORK...................................................... 19TIAGABINE HCL...................................................... 32TICAGRELOR.......................................................... 22TICLOPIDINE HCL...................................................22TIKOSYN....................................................................9TIMOLOL..................................................................20TIMOLOL MALEATE.......................................... 10, 20TINACTIN(OTC)....................................................... 14
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Index
TINIDAZOLE...................................................... 24, 48TIOCONAZOLE........................................................34TIOCONAZOLE 1(OTC)...........................................34TIOTROPIUM BROMIDE........................................... 6TIPRANAVIR............................................................ 25TIPRANAVIR/VITAMIN E TPGS...............................25TIZANIDINE HCL......................................................32TOBI PODHALER...............................................24, 48TOBRADEX.............................................................. 19TOBRAMYCIN....................................................24, 48TOBRAMYCIN IN 0.225% NACL............................. 24TOBRAMYCIN/DEXAMETHASONE........................ 19TOBRAMYCIN-DEXAMETHASONE........................ 19TOFACITINIB CITRATE........................................... 26TOLAZAMIDE...........................................................17TOLBUTAMIDE........................................................ 17TOLNAFTATE...........................................................14TOLNAFTATE(OTC).................................................14TOLTERODINE TARTRATE............................... 34, 46TOPIRAMATE...........................................................32TOPOTECAN HCL................................................... 28TOREMIFENE CITRATE.......................................... 29TRACLEER........................................................ 10, 48TRADJENTA.................................................16, 42, 46TRAMADOL HCL............................................... 31, 42TRAMADOL HCL/ACETAMINOPHEN..................... 31TRAMADOL HCL-ACETAMINOPHEN............... 31, 42TRANDOLAPRIL...................................................... 10TRAVATAN Z...................................................... 20, 48TRAVOPROST......................................................... 20TRAZODONE HCL.....................................................8TRETINOIN.................................................. 13, 28, 37TRETINOIN MICROSPHERE.............................13, 37TRETINOIN MICROSPHERES................................ 13TRETINOIN/EMOLLIENT BASE.............................. 13TREXALL..................................................................28TREXIMET................................................... 31, 42, 49TRIAMCINOLONE ACETONIDE....................5, 15, 29TRIAMTERENE/HYDROCHLOROTHIAZID.............10TRIAMTERENE-HCTZ............................................. 10TRIAZOLAM............................................................... 8TRICARE............................................................35, 42TRIFLURIDINE.........................................................19TRILEPTAL...............................................................32TRIMETHOBENZAMIDE HCL....................................5TRIMETHOPRIM......................................................23TRIPLE ANTIBIOTIC PLUS(OTC)............................13TRIPLE ANTIBIOTIC(OTC)......................................13TRIPLE X(OTC)........................................................14TRI-VIT WITH FLUORIDE-IRON........................34, 42TRI-VITAMIN WITH FLUORIDE......................... 34, 42TRI-VITAMIN(OTC)............................................ 35, 42TROPICAMIDE.........................................................20TROSPIUM CHLORIDE..................................... 34, 46TRUVADA...........................................................25, 49TRUZONE PEAK FLOW METER...............................7TUSSI PRES-B(OTC).........................................12, 37TUSSICAPS....................................................... 12, 37TUSSIN CF(OTC)...............................................13, 37TYKERB............................................................. 28, 49TYSABRI............................................................ 29, 49- U -UCERIS.............................................................. 26, 49U-CORT....................................................................15ULIPRISTAL ACETATE............................................ 12ULORIC.............................................................. 21, 49ULTILET ALCOHOL SWAB(OTC)............................15ULTIMA(OTC).....................................................17, 42ULTIMATECARE ONE........................................35, 42ULTRASE................................................................. 32ULTRASE MT 12...................................................... 32ULTRASE MT 18...................................................... 32ULTRASE MT 20...................................................... 32UNISOM SLEEP AID(OTC)........................................8UNOPROSTONE ISOPROPYL................................20UROFOLLITROPIN.................................................. 18URSODIOL...............................................................27USTEKINUMAB........................................................26- V -VALACYCLOVIR...................................................... 25VALACYCLOVIR HCL.............................................. 25VALCYTE............................................................25, 49VALGANCICLOVIR HCL.......................................... 25VALPROIC ACID...................................................... 32VALPROIC ACID (AS SODIUM SALT).....................32VALSARTAN.............................................................10VALSARTAN/HYDROCHLOROTHIAZIDE................. 9VALSARTAN-HYDROCHLOROTHIAZIDE...........9, 46VANCOMYCIN HCL........................................... 24, 49
VANDAZOLE............................................................ 34VANDETANIB........................................................... 28VANOXIDE-HC......................................................... 13VARENICLINE TARTRATE.......................................32VASELINE WHITE PETROLEUM...................... 15, 42V-C FORTE.........................................................34, 42VCF(OTC).................................................................11VECTIBIX........................................................... 28, 49VELCADE...........................................................28, 49VENLAFAXINE HCL...................................................8VENLAFAXINE HCL ER.............................................8VENTOLIN HFA....................................................5, 42VERAMYST....................................................5, 42, 49VERAPAMIL ER....................................................... 10VERAPAMIL HCL..................................................... 10VICKS 44E COUGH & CHEST(OTC).................13, 37VICTOZA 2-PAK................................................. 16, 49VICTOZA 3-PAK................................................. 16, 49VICTRELIS............................................................... 25VIGABATRIN............................................................ 32VIIBRYD............................................................... 8, 49VILAZODONE HYDROCHLORIDE............................8VINACAL............................................................ 35, 42VINATE GT......................................................... 35, 42VINATE ONE...................................................... 35, 42VINATE PN CARE.............................................. 35, 42VINATE ULTRA.................................................. 35, 42VIORELE............................................................ 11, 50VIRACEPT................................................................25VIRAMUNE XR...................................................25, 49VIRAZOLE..........................................................25, 49VIREAD.................................................................... 25VISINE-A(OTC)........................................................ 19VISMODEGIB...........................................................28VIT A/VITAMIN D3/E/ALOE V/ZNOX....................... 16VITALETS(OTC)................................................. 35, 42VITAMIN A & D(OTC)............................................... 15VITAMIN B-1(OTC).............................................35, 42VITAMIN B-12(OTC)...........................................35, 42VITAMIN B-6(OTC).............................................35, 42VITAMIN C(OTC)................................................35, 42VITAMIN D(OTC)................................................35, 42VITAMIN D2........................................................35, 42VITAMIN D2(OTC)..............................................35, 42VITAMIN D3(OTC)..............................................35, 42VITAMINS A AND D................................................. 15VITASPIRE......................................................... 35, 42VITE CON FORTE..............................................34, 42VITS A & D/WHITE PET/LANOLIN.......................... 15VIVELLE-DOT.................................................... 22, 42VOLTAREN.........................................................15, 46VORINOSTAT...........................................................28VORTEX......................................................... 6, 37, 42VORTEX FROG MASK(OTC)........................ 7, 37, 42VORTEX LADYBUG MASK(OTC)..................7, 38, 42VORTEX VHC FROG MASK..........................6, 38, 42VORTEX VHC LADYBUG MASK................... 6, 38, 42VORTEX(OTC)............................................... 7, 38, 42VOTRIENT..........................................................28, 49VYTORIN(TAB)(10 MG-10MG)...........................11, 46VYTORIN(TAB)(10 MG-20MG)...........................11, 46VYTORIN(TAB)(10 MG-40MG)...........................11, 46VYTORIN(TAB)(10 MG-80MG).................................11- W -WARFARIN SODIUM............................................... 21WATCHHALER...............................................6, 38, 42WEBCOL ALCOHOL PREPS MEDIUM(OTC)......... 15WEBCOL(OTC)........................................................ 15WELCHOL.......................................................... 11, 46WIDE SEAL DIAPHRAGM....................................... 12WILATE...............................................................21, 49WINDMILL TRAINER(OTC)....................... 6, 7, 38, 42WOUND WASH SALINE(OTC)................................ 16- X -XALKORI............................................................ 28, 49XARELTO........................................................... 21, 49XELJANZ............................................................26, 49XELODA............................................................. 28, 49XENICAL............................................................ 36, 49XGEVA................................................................18, 49XIFAXAN............................................................ 24, 49XTANDI.....................................................................28XYNTHA............................................................. 21, 49- Y -YODOXIN................................................................. 24- Z -ZAFIRLUKAST..................................................... 6, 49ZALEPLON...........................................................8, 42ZALTRAP............................................................28, 49
ZATEAN-PN DHA............................................... 35, 42ZEGERID......................................................33, 42, 46ZENCHENT FE...................................................12, 50ZETIA..................................................................11, 46ZIAGEN.............................................................. 25, 49ZINC OXIDE............................................................. 16ZINC OXIDE(OTC)................................................... 16ZIPRASIDONE MESYLATE....................................... 8ZIV-AFLIBERCEPT...................................................28ZMAX........................................................................23ZOLINZA............................................................ 28, 49ZOLMITRIPTAN..................................................31, 42ZOLPIDEM TARTRATE........................................8, 42ZOLPIMIST.....................................................8, 42, 46ZOMIG..........................................................31, 42, 46ZONISAMIDE........................................................... 32ZORBTIVE..........................................................19, 49ZORTRESS.............................................................. 23ZOVIA 1-35E...................................................... 12, 50ZOVIRAX............................................................14, 49ZYCLARA........................................................... 23, 49ZYVOX............................................................... 23, 49ZZZQUIL(OTC)...........................................................8
LA Care Page 59 of 59
Index