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Listahan ng Mga Sakop na Gamot (Formulary)

L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)

2020

Na-update ang formulary na ito noong Mayo 1, 2020.

Kung mayroon kayong tanong, mangyaring tumawag sa Mga Serbisyo sa Miyembro ng L.A. Care Cal MediConnect Plan sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kasama ang mga holiday. Para sa karagdagang impormasyon, pumunta sa www.calmediconnectla.org.

H8258_15103_2020_Formulary_TA_ApprovedFormulary ID: 00020319, Version: 13

http://www.calmediconnectla.org

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Kung mayroon kayong mga tanong, pakitawagan ang L.A. Care Cal MediConnect Plan sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kabilang ang mga holiday. Libre ang pagtawag. Para sa higit pang impormasyon, puntahan ang www.calmediconnectla.org.

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PanimulaAng dokumentong ito ay tinatawag na Listahan ng Mga Sakop na Gamot (kilala rin bilang Listahan ng Gamot). Nakasaad dito kung aling mga inireresetang gamot at over-the-counter na gamot at item ang sinasakop ng L.A. Care Cal MediConnect Plan. Isinasaad din sa iyo ng Listahan ng Gamot kung mayroong anumang espesyal na panuntunan o paghihigpit sa anumang gamot na sinasakop ng L.A. Care Cal MediConnect Plan. Makikita ang mahahalagang termino at ang kahulugan ng mga ito sa huling kabanata ng Handbook ng Miyembro.


Talaan ng mga NilalamanA. Mga Disclaimer ....................................................................................................................................................... ii

B. Mga Madalas Italong (FAQ) .................................................................................................................................. iv

B1. Anong mga inireresetang gamot ang nasa Listahan ng Mga Sinasakop na Gamot? (Tinatawag namin ang Listahan ng Mga Sinasakop na Gamot na “Listahan ng Gamot” para maikli.) ........................................................................iv

B2. Nagbabago ba ang Listahan ng Gamot? ..............................................................................................................................................iv

B3. Ano ang mangyayari kapag may nagbago sa Listahan ng Gamot? ............................................................................................v

B4. Mayroon bang anumang paghihigpit o limitasyon sa sakop sa gamot o anumang kinakailangang gawing pagkilos upang makakuha ng ilang partikular na gamot? ............................................................................................................vi

B5. Paano ninyo malalaman kung mayroong mga limitasyon ang gusto ninyong gamot o kung mayroong mga kinakailangang gawing pagkilos upang makuha ang gamot? ...................................................................................................vi

B6. Ano ang mangyayari kung baguhin namin ang aming mga panuntunan tungkol sa ilang gamot (halimbawa, mga paghihigpit na paunang pahintulot (pag-apruba), mga limitasyon sa dami, at/o step therapy)? .....................vii

B7. Paano ninyo mahahanap ang isang gamot ay nasa Listahan ng Gamot? ...............................................................................vii

B8. Paano kung wala sa Listahan ng Gamot ang gamot na gusto ninyong inumin? ................................................................vii

B9. Paano kung bagong miyembro kayo ng L.A. Care Cal MediConnect Plan at hindi ninyo mahanap ang inyong gamot sa Listahan ng Gamot o mayroon kayong problema sa pagkuha ng inyong gamot? .......................................vii

B10. Makakahingi ba kayo ng eksepsiyon upang masakop ang inyong gamot? .........................................................................ix

B11. Paano kayo makakahingi ng isang eksepsiyon? ...............................................................................................................................ix

B12. Gaano katagal ang pagkuha ng isang eksepsiyon? ........................................................................................................................ix

B13. Ano ang generic na mga gamot? ...........................................................................................................................................................ix

B14. Ano ang mga OTC na gamot? .................................................................................................................................................................ix

B15. Sinasaklaw ba ng L.A. Care Cal MediConnect Plan ang mga OTC na produktong hindi gamot? .................................x

B16. Ano ang inyong copay? ...............................................................................................................................................................................x

C. Listahan ng Mga Sinasakop Gamot ...................................................................................................................... x

D. Listahan ng Mga Gamot ayon sa Medikal na Kondisyon .................................................................................. xii

E. Index ng Mga Sinasakop na Gamot ..................................................................................................................108

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A. Mga DisclaimerIto ay isang listahan ng mga gamot na makukuha ng mga miyembro sa L.A. Care Cal MediConnect Plan.

• Ang L.A. Cal MediConnect Plan (Medicare-Medicaid Plan) ay isang plan sa kalusugan na may kontrata sa Medicare at Medi-Cal upang magbigay ng mga benepisyo mula sa parehong programang ito sa mga naka-enroll.

• ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-522-1298 (TTY: 711), 24 hours a day, 7 days a week, including holidays. The call is free.

• ATENCIÓN: Si usted habla español, los servicios de asistencia con el idioma estarán disponibles para usted sin costo. Llame al 1-888-522-1298 (TTY: 711), las 24 horas del día, los 7 días de la semana, incluso los días festivos. La llamada es gratuita.

• 請注意：如果您說中文，您可免費獲得語言協助服務。請致電 1-888-522-1298

（TTY：711），服務時間為每週 7 天，每天 24 小時（包含假日）。這是免費電話。

• XIN LƯU Ý: Nếu quy vị nói tiếng Việt, hiện có các dịch vụ hỗ trợ ngôn ngữ miễn phí cho quy vị. Gọi 1-888-522-1298 (TTY: 711), 24 giờ một ngày, 7 ngày một tuần, kể cả các ngày lễ. Cuộc gọi này miễn phí.

• 알림: 한국어를 사용하실 경우 언어지원서비스를 무료로 이용하실 수 있습니다. 주 7일, 하루 24시간(공휴일 포함) 동안 이용 가능한 1-888-522-1298 (TTY: 711) 번으로 전화하십시오. 통화료는 무료입니다.

• ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, լեզվական աջակցության ծառայությունները հասանելի են Ձեզ անվճար։ Զանգահարեք 1-888-522-1298 հեռախոսահամարով (TTY: 711), օրը 24 ժամ, շաբաթը 7 օր, ներառյալ տոնական օրերը։ Հեռախոսազանգն անվճար է:

تنبيه: إذا كنت تتحدث اللغة العربية، فإن خدمات المساعدة اللغوية، متوفرة لك، مجانا. اتصل على 1-888-522-1298 •(TTY: 711) 24 ساعة في اليوم و7 أيام في الأسبوع، بما في ذلك أيام العطلات. هذه المكالمة مجانية.

• ВНИМАНИЕ! Если вы говорите по-русски, вы можете воспользоваться бесплатными услугами переводчика. Звоните по телефону 1-888-522-1298 (TTY: 711), круглосуточно, без выходных, включая праздничные дни. Звонок бесплатный.

• 注意事項：日本語のサービスを無料でご利用いただけます。1-888-522-1298（TTY: 711）までお電話ください。このサービスは年中無休（祝祭日を含む）でご利用いただけます。通話料は無料です。

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توجه: اگر به زبان فارسی صحبت می کنيد، خدمات کمک در زمينه زبان بطور رايگان در اختيار شما قرار •دارد. می توانيد در تمام 24 ساعت شبانه روز و 7 روز هفته، حتی روزهای تعطيل با 1-888-522-1298

(TTY: 711) تماس بگيريد. تماس رايگان می باشد.

• धयान द: अगर आप हिदी बोलत ि, तो मफत म भयाषया सियातया सवयाए, आपक ललए उपलबध िl अवकयाश क हदनो समत, हदन क 24 घट, सपयाि क 7 हदन 1-888-522-1298 (TTY: 711) पर कॉल कर। कॉल लन:शलक िl

• ចណាបអារមមណៈ បបើសនអនកនយាយភាសាខមរ បសវាជនយខាងភាសាឥតគតថលៃ គមានសរាបអនក។ សមទរសពទទប�ប� 1-888-522-1298 (TTY: 711) បាន 24 បមាោ ងមយថៃ 7 ថៃមយអាទតយ រមទាងថ ៃបណយផង។ ការ ប� គ ឥត បចញ ថ លៃ ប�ើយ។

• PAUNAWA: Kung nagsasalita ka ng Tagalog, magagamit mo ang mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kabilang ang mga piyesta opisyal. Libre ang pagtawag.

• โปรดทราบ: หากทานพดภาษาไทย เรามบรการชวยเหลอดานภาษาใหคณโดยไมเสยคาใชจาย โปรดโทรฟรท�หมายเลข 1-888-522-1298 (TTY: 711) ไดตลอด 24 ช�วโมง ทกวน ไมเวนวนหยด

• ກະລນາຟງ: ຖາວາ ທານເວ າພາສາລາວ, ມ ບ ລ ການຊວຍເຫ ອດານພາສາໃຫທານໂດຍບ ເສຽຄ າ. ໂທຣ 1-888-522-1298 (TTY: 711), ໄດ ຕະຫ ອດ 24 ຊ ວໂມງ, 7 ວ ນຕ ອາທ ດ, ລວມເຖ ງ ວ ນພ ກຕ າງໆ. ເບ ໂທຣນ ແມ ນບ ເສ ຽຄ າ.

• CEEB TOOM: Yog koj hais lus Hmoob, muaj kev pab txhais lus pub dawb rau koj, hu rau 1-888-522-1298 (TTY: 711), 24 teev hauv ib hnub, 7 hnub hauv ib asthiv, suav nrog cov hnub so tib si. Qhov hu no yog hu dawb xwb.

• ਧਿਆਨ ਧਿਓ: ਜ ਤਸੀ ਪਜਾਬੀ ਬਲਿ ਹ, ਤਾ ਤਹਾਡ ਲਈ ਮਫਤ ਭਾਸਾ ਸਹਾਇਤਾ ਸਵਾਵਾ ਉਪਲਬਿ ਹਨ। ਛਟੀ ਵਾਲ ਧਿਨਾ ਸਮਤ 24 ਘਟ, 7 ਧਿਨ 1-888-522-1298 (TTY: 711) ‘ਤ ਕਾਲ ਕਰ।ਕਾਲ ਮਫਤ ਹ।

• Makukuha ninyo ang impormasyong ito nang libre sa ibang mga anyo, tulad ng malalaking letra, braille, o audio. Tumawag sa1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kasama ang mga holiday. Libre ang tawag.

• Kung gusto ninyong tumanggap ng mga materyal, ngayon at sa hinaharap, sa isang wikang iba sa Ingles o sa isang alternatibong anyo, tawagan ang Mga Serbisyo sa Miyembro sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kabilang ang mga holiday. Libre ang tawag.

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B. Mga Pinakamadalas Itanong (FAQ)Hanapin dito ang mga sagot sa mga katanungan ninyo tungkol dito sa Listahan ng mga Sinasakop na Gamot. Mababasa ninyo ang lahat ng Mga Pinakamadalas Itanong (Frequently Asked Questions, FAQ) para alamin pa, o hanapin ang isang katanungan at sagot.

B1. Anong mga inireresetang gamot ang nasa Listahan ng Mga Sinasakop na Gamot? (Tinatawag namin ang Listahan ng Mga Sinasakop na Gamot na “Listahan ng Gamot” para maikli.)

Ang mga gamot na nasa Listahan ng Gamot ay ang mga gamot na sinasakop ng L.A. Care Cal MediConnect Plan. Makukuha ang mga gamot sa mga parmasyang nasa aming network. Ang isang parmasya ay nasa aming network kung kami ay may kasunduan sa kanila na makipagtulungan sa amin at magbigay sa inyo ng mga serbisyo. Tinutukoy namin ang mga parmasyang ito na “mga parmasyang kasama sa network.”

• Sasakupin ng L.A. Care Cal MediConnect Plan ang lahat ng medikal na kailangan na mga gamot na nasa Listahan ng Gamot kung:

º sabihin ng inyong doktor o ng iba pang tagareseta na kailangan ninyo ang mga ito upang gumaling o manatiling malusog, at

º pinunan ninyo ang reseta sa isang parmasyang kasama sa network ng L.A. Care Cal MediConnect Plan.• Sa ilang sitwasyon, mayroon kayong kailangang gawin bago kayo makakuha ng gamot (tingnan ang

tanong B4 sa ibaba).Maaari ninyo ring makita ang pinakabagong listahan ng mga gamot na sakop namin sa aming website sa www.calmediconnectla.org o tawagan ang Mga Serbisyo sa Miyembro sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kasama ang mga holiday.

B2. Nagbabago ba ang Listahan ng Gamot?Oo, at kailangang sundin ng L.A. Care Cal MediConnect Plan ang mga panuntunan ng Medicare at Medicaid kapag nagsasagawa ng mga pagbabago. Maaari kaming magdagdag o matanggal ng mga gamot sa Listahan ng Gamot sa loob ng taon.Maaari rin naming baguhin ang aming mga panuntunan tungkol sa mga gamot. Halimbawa, maaari kaming:

• Magpasiyang humiling o hindi humiling ng paunang pag-apruba para sa isang gamot. (Ang paunang pag-apruba ay pahintulot mula sa L.A. Care Cal MediConnect Plan bago kayong maaaring makakuha ng isang gamot.)

• Dagdagan o baguhin ang dami ng gamot na maaari ninyong kunin (tinatawag na mga limitasyon sa dami).

• Magdagdag o magbago ng mga paghihigpit sa step therapy sa isang gamot. (Ang step therapy ay nangangahulugang dapat kayong sumubok ng isang gamot bago namin saklawin ang isa pang gamot.)

Para sa higit pang impormasyon tungkol sa mga panuntunang ito sa gamot, tingnan ang tanong B4.

Kung umiinom kayo ng gamot na sinasaklaw sa simula ng taon, karaniwan ay hindi namin aalisin o babaguhin ang saklaw na gamot na iyon sa kabuuan ng taon maliban kung:

• magkaroon ng bago at mas murang gamot na nasa market na kasing bisa ng gamot na nasa Listahan ng Gamot ngayon, o

• malaman naming hindi ligtas ang isang gamot, o• alisin ang isang gamot sa merkado.


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Mayroong higit pang impormasyon sa mga tanong B3 at B6 sa ibaba tungkol sa kung ano ang mangyayari kapag nagbago ang Listahan ng Gamot.

• Palagi ninyong matitingnan ang up to date na Listahan ng Gamot ng L.A. Care Cal MediConnect Plan online sa www.calmediconnectla.org.

• Maaari rin ninyong tawagan ang Mga Serbisyo sa Miyembro para tingnan ang kasalukuyang Listahan ng Gamot sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kasama ang holiday.

B3. Ano ang mangyayari kapag may pagbabago sa Listahan ng Gamot?Agad na mangyayari ang ilang pagbabago sa Listahan ng Gamot. Halimbawa:

• Makakakuha ng bagong generic na gamot. Minsan, magkaroon ng bagong generic na gamot na kasing bisa ng gamot na may tatak na nasa Listahan ng Gamot ngayon. Kapag mangyari iyon, maaari naming alisin ang gamot na may tatak at magdadagdag ng bagong generic na gamot, ngunit ang inyong gastos para sa bagong gamot ay mananatili pareho o mas magiging mababa. Kapag idinagdag namin ang bagong generic na gamot, maaari din kaming magpasyang panatilihin sa listahan ang gamot na may tatak ngunit baguhin ang mga panuntunan o limitasyon sa sakop nito.

º Maaaring hindi namin ipaalam sa inyo bago namin gawin ang pagbabagong ito, ngunit papadalhan namin kayo ng impormasyon tungkol sa partikular na pagbabagong ginawa namin sa sandaling mangyari ito.

º Kayo o ang inyong provider ay maaaring humiling ng eksepsiyon sa mga pagbabagong ito. Papadalhan namin kayo ng abiso kasama ng mga hakbang na maaari ninyong gawin upang humiling ng eksepsiyon. Pakitingnan ang tanong B10 para sa higit pang impormasyon tungkol sa mga eksepsiyon.

• Inalis ang isang gamot sa merkado. Kung sabihin ng Food and Drug Administration (FDA) na hindi ligtas ang isang gamot na iniinom ninyo o kung alisin ng manufacturer ng gamot ang isang gamot sa merkado, aalisin namin ito sa Listahan ng Gamot. Kung iniinom ninyo ang gamot, ipapaalam namin ito sa inyo. Kung makatanggap kayo ng isa sa mga liham na ito, mangyaring makipag-usap sa inyong doktor upang humanap ng ibang gamot na ligtas para sa inyo.

Maaari kaming gumawa ng iba pang pagbabagong makakaapekto sa mga gamot na iniinom ninyo. Ipapaalam namin sa inyo nang mas maaga ang tungkol sa iba pang pagbabagong ito sa Listahan ng Gamot. Maaaring mangyari ang mga pagbabagong ito kung:

• Magbigay ang FDA ng bagong gabay o may mga bagong klinikal na alituntunin tungkol sa isang gamot.• Magdadagdag kami ng generic na gamot na bago sa merkado at

º Magpalit ng gamot na may tatak na kasalukuyang nasa Listahan ng Gamot o º Baguhin namin ang mga panuntunan o limitasyon sa saklaw para sa gamot na may tatak.

• Nagdagdag kami ng isang generic na gamot at… º Pinalitan ang isang may branded na gamot na kasalukuyang nasa Listahan ng Gamot o º Baguhin ang mga panuntunan o limitasyon sa coverage para sa branded na gamot.

Kapag naganap na ang mga pagbabagong ito, kami ay:• Magsasabi sa inyo ng kahit man lang 30 araw bago kami magsagawa ng pagbabago sa Listahan ng

Gamot o • Ipaalam sa inyo at bigyan kayo ng 30 araw na supply ng gamot pagkatapos ninyong humiling ng

pagpupuno sa reseta.


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Magbibigay ito sa inyo ng oras na makipag-usap sa inyong doktor o ibang tagapagreseta. Siya ay makakatulong sa inyong makapagpasya:

• Kung may katulad na gamot sa Listahan ng Gamot na iinumin ninyo sa halip o • Kung hihiling ng isang eksepsiyon mula sa mga pagbabagong ito. Para alamin pa ang tungkol sa

mga eksepsiyon, tingnan ang tanong B10.B4. Mayroon bang anumang paghihigpit o limitasyon sa sakop sa gamot o anumang

kinakailangang gawing pagkilos upang makakuha ng ilang partikular na gamot?Oo, may mga limitasyon sa dami o panuntunan sa pagsakop ang ilang gamot na makukuha ninyo. Sa ilang mga kaso, kailangan ninyo o inyong doktor o iba pang nagrereseta ay dapat gumawa ng isang bagay bago kayo makakuha ng isang gamot. Halimbawa:

• Paunang pag-apruba (o paunang pahintulot): Para sa ilang gamot, kailangan kumuha kayo o ang inyong doktor o iba pang nagrereseta ng pahintulot mula L.A. Care Cal MediConnect Plan bago punan ang inyong reseta. Maaaring hindi saklawin ng L.A. Care Cal MediConnect Plan ang gamot kung hindi kayo maaprubahan.

• Mga limitasyon sa dami: Minsan nililimitahan ng L.A. Care Cal MediConnect Plan ang dami ng isang gamot na makukuha ninyo.

• Step therapy: Minsan hinihiling sa iyo ng L.A. Cal MediConnect Plan na gawin ninyo ang step therapy. Ang ibig sabihin nito ay na dapat ninyong subukan ang mga gamot sa isang inatas ng pagkakasunuod-sunod para sa inyong medikal na kondisyon. Maaaring mayroon ninyong subukan ang isang gamot bago namin sakupin ang iba pang gamot. Kung sa tingin ng inyong doktor na ang unang gamot ay hindi gumagana para sa inyo, sasakupin namin ang pangalawang gamot.

Malalaman ninyo kung ang inyong gamot ay may karagdagang mga kinakailangan o limitasyon sa pamamagitan ng pagtingin sa mga talahanayan sa pahina xi. Makakakuha rin kayo ng karagdagang impormasyon sa pamamagitan ng pagbisita sa aming web site sa www.calmediconnectla.org. Nag-post kami ng mga online na dokumentong nagpapaliwanag ng amingmga paghihigpit na paunang pahintulot at step therapy. Maaari rin kayong humingi sa amin ng isang kopya.

Maaari kayong humiling ng eksepsiyon sa mga limitasyong ito. Magbibigay ito sa inyo ng oras na makipag-usap sa inyong doktor o ibang nagrereseta. Maaaring din siyang makatulong sa inyong magpasiya kung mayroong isang katulad na gamot sa Listahan ng Gamot na maaari ninyong inumin sa halip o kung dapat na kayong humiling ng eksepsiyon. Pakitingnan ang mga tanong B10-B12 para sa higit pang impormasyon tungkol sa mga eksepsiyon.

B5. Paano ninyo malalaman kung ang gamot ay may mga limitasyon o kung may mga kinakailangang aksyon na dapat gawin upang makuha ang gamot?

Ang Listahan ng Mga Sinasaklaw na Gamot sa pahina 1 na may hanay na label na “Mahahalagangaksyon, paghihigpit, o limitasyon sa paggamit” (“Necessary actions, restrictions, or limits on use”).

B6. Ano ang mangyayari kung baguhin namin ang aming mga panuntunan tungkol sa ilang gamot (halimbawa, mga paghihigpit sa paunang pahintulot (pag-apruba), mga limitasyon sa dami, at/o step therapy)?

Sa ilang sitwasyon, ipapaalam namin sa inyo nang mas maaga kung dagdagan o baguhin namin ang mga paghihigpit na paunang pag-apruba, mga limitasyon sa dami, at/o step therapy sa isang gamot. Tingnan ang tanong B3 para sa higit pang impormasyon tungkol sa maagang abisong ito at mga sitwasyon kung saan maaaring hindi namin maipaalam sa inyo nang mas maaga kapag nagbago ang aming mga panuntunan tungkol sa mga gamot na nasa Listahan ng Gamot.


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B7. Paano ninyo mahahanap ang isang gamot ay nasa Listahan ng Gamot?May dalawang paraan upang mahanap ang isang gamot:

• Maaari kayong maghanap ayon sa pagkakasunod-sunod sa alpabeto (kung alam ninyo ang spelling ng gamot), o

• Mahahanap ninyo ito ayon sa medikal na kondisyon.Upang maghanap ayon sa pagkakasunod-sunod sa alpabeto, pumunta sa seksyong Index ng Mga Sinasaklaw na Gamot. Makikita ninyo ang mga ito sa dulo ng listahan ng gamot, ito ay tinatawag na Index. Nakalista ang mga gamot nang magkakasunod ayon sa alpabeto.

Upang maghanap ayon sa medikal na kondisyon, hanapin ang seksyong may label na “Listahan ng mga gamot ayon sa medikal na kondisyon” sa pahina xii. Ang mga gamot sa seksyong ito ay nakagrupo sa mga kategorya depende sa uri ng mga medikal na kundisyong ginagamit ng mga ito na panggamot. Halimbawa, kung kayo ay may kondisyon sa puso, dapat kayong tumingin sa kategorya, cardiovascular agents – Misc. Doon ninyo mahahanap ang mga gamot na gumagamot sa mga kondisyon sa puso.

B8. Paano kung ang gamot na gusto ninyong inumin ay wala sa Listahan ng Gamot?Kung hindi ninyo makita ang inyong gamot sa Listahan ng Gamot, tawagan ang mga Serbisyo sa Miyembro sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kasama ang mga holiday at magtanong tungkol dito. Kung malaman ninyong hindi masasakop ng L.A. Care Cal MediConnect Plan ang gamot, maaari ninyong gawin ang isa sa mga bagay na ito:

• Humiling sa mga Serbisyo sa Miyembro ng isang listahan ng mga gamot na tulad ng isa na gusto ninyong inumin. Pagkatapos ipakita ang listahan sa inyong doktor o iba pang nagrereseta. Maaaring niyang ireseta ang isang gamot sa Listahan ng Gamot na katulad ng gusto mong inumin. O

• Maaari mong hilingin ang planong pangkalusugan na gumawa ng eksepsiyon para masakop ang inyong gamot. Pakitingnan ang mga tanong B10-B12 para sa higit pang impormasyon tungkol sa mga eksepsiyon.

B9. Paano kung bagong miyembro kayo ng L.A. Care Cal MediConnect Plan at hindi ninyo mahanap ang inyong gamot sa Listahan ng Gamot o mayroon kayong problema sa pagkuha ng inyong gamot?

Matutulungan namin kayo. Maaari naming sakupin ang isang pansamantalang 30-araw na supply ng inyong gamot sa unang 90 araw na miyembro kayo ng L.A. Care Cal MediConnect Plan. Magbibigay ito sa inyo ng oras na makipag-usap sa inyong doktor o ibang nagrereseta. Maaaring din siyang makatulong sa inyong magpasiya kung mayroong isang katulad na gamot sa Listahan ng Gamot na maaari ninyong inumin sa halip o kung dapat na kayong humiling ng eksepsiyon.Kung ang nakasulat sa inyong reseta ay para sa mas kaunti pang araw, papayagan namin ang maraming pagpupuno ng gamot upang makapagbigay ng hanggang sa maximum na 30 araw na gamot. Sasakupin namin ang 30-araw na supply ng inyong gamot kung:

• umiinom kayo ng gamot na wala sa aming Listahan ng Gamot, o• hindi kayo pinapayagan ng mga panuntunan ng planong pangkalusugan na makuha ang dami na

inorder ng inyong nagrereseta, o• kinakailangan para sa gamot ang paunang pag-apruba ng L.A. Care Cal MediConnect Plan, o• umiinom kayo ng gamot na bahagi ng isang paghihigpit sa step therapy.

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Kung kayo ay nasa isang nursing home o iba pang pasilidad ng pangmatagalang pangangalaga at kailangan ninyo ng gamot na wala sa Listahan ng Gamot o kung hindi ninyo makuha ang gamot na kailangan ninyo sa madaling paraan, maaari kaming tumulong. Kung kayo ay nasa plano nang mahigit sa 90 araw, natira sa isang pasilidad ng pangmatagalang pangangalaga, at kailangan agad ng supply:

• Sasakupin namin ang isang 31 araw na supply ng gamot na kailangan ninyo (maliban kung mayroon kayong reseta para sa mas kaunting araw), kung bagong miyembro man kayo ng L.A. Care Cal MediConnect Plan o hindi.

• Karagdagan ito sa pansamantalang supply sa unang 90 araw na miyembro kayo ng L.A. Care Cal MediConnect Plan.

Mga Pagbabago sa Antas ng Pag-aalagaMagbibigay kami ng isang tempraryong supply ng inyong gamot kapag nakakaranas kayo ng pagbabago sa antas ng pag-aalaga.Mga halimbawa ng antas ng mga pagbabago ng pag-aalaga ay maaaring kasama ang sumusunod:

1. mga miyembrong pumasok sa mga pasilidad ng pangmatagalang pangangalaga mula sa mga ospital;2. mga miyembrong pinalabas mula sa ospital papunta sa bahay;3. mga miyembrong tinapos na ang kanilang Medicare Part A na pananatili sa skilled nursing facility

at kailangang bumalik sa kanilang formulary ng plano sa Part D;4. mga miyembrong isinuko ang katayuan para sa hospisyo upang bumalik sa mga karaniwang

benepisyo sa Medicare Part A at B;5. mga myembrong tinapos ang pananatili sa pasilidad ng pangmatagalang pangangalaga at bumalik

sa komunidad;6. ang mga miyembrong pinalabas mula sa mga ospital ng sakit sa isip na may mga gamot na

kailangan ay lubos na ibinabagay.Maaaring makipag-ugnayan ang mga parmasya sa Mga Serbisyo sa Parmasya ng L.A. Care Cal MediConnnect Plan sa 1-877-795-2227 upang iproseso ang mga override sa lugar ng pagbebenta upang matiyak na makatanggap ang mga miyembro ng access sa kanilang mga gamot nang walang anumang mga pagkakaantala.

B10. Makakahingi ba kayo ng eksepsiyon upang masakop ang inyong gamot?Oo. Maaari ninyong hilingin sa L.A. Care Cal MediConnect Plan na gumawa ng eksepsiyon upang masakop ang isang gamot na wala sa Listahan ng Gamot.

Maaari ninyo ring hilingin baguhin namin ang mga panuntunan sa inyong gamot.

• Halimbawa, maaaring limitahan ng L.A. Care Cal MediConnect Plan ang dami ng isang gamot na sinasakop namin. Kung may limitasyon ang inyong gamot, maaari ninyong hilingin sa amin na baguhin ang limitasyon at damihan ang aming sinasakop.

• Iba pang halimbawa: Maaari ninyong hilingin sa amin na alisin ang mga paghiihigpit sa step therapy o mga kinakailangang paunang pag-apruba.

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B11. Paano kayo makakahingi ng isang eksepsiyon?Upang humingi ng isang eksepsiyon, tawagan ang Mga Serbisyo sa Miyembro. Makikipagtulungan din sa iyo at sa inyong provider ang mga Serbisyo sa Miyembro upang tulungan kayong humingi ng eksepsiyon. Maaari din ninyong basahin ang Kabanata 9 ng Handbook ng Miyembro upang matuto pa tungkol sa mga eksepsyon.

B12. Gaano katagal ang pagkuha ng isang eksepsiyon?Una, dapat kaming makakuha ng isang pahayag mula sa inyong nagrereseta na sumusuporta sa inyong kahilingan para sa eksepsiyon. Pagkatapos naming makuha ang pahayag, bibigyan namin kayo ng desisyon sa iyong paghiling ng eksepsiyon sa loob ng 72 oras.

Kung sa inyong palagay o sa palagay ng inyong nagrereseta na mapipinsala ang inyong kalusugan kung maghihintay kayo ng 72 oras para sa isang desisyon, maaari kayong humiling ng isang pinabilis na eksepsiyon. Mas mabilis na desisyon ito. Kung sinusuportahan ng inyong nagrereseta ang inyong kahilingan, ibibigay namin sa inyo ng desisyon sa loob ng 24 na oras pagkatapos naming makuha ang sumusuportang pahayag ng inyong nagrereseta.

B13. Ano ang generic na mga gamot?Ang generic na mga gamot ay may mga sangkap na kapareho ng mga gamot na may tatak. Karaniwang mas mura sila kaysa sa may mga gamot na may tatak at ang kanilang mga pangalan ay hindi masyadong kilala. Inaprubahan ng Food and Drug Administration (FDA) ang mga generic na gamot.

Sinasakop ng L.A. Care Cal MediConnect Plan ang mga gamot na may tatak at generic na gamot.

B14. Ano ang OTC na mga gamot? Ang OTC ay nangangahulugan na “nabibili nang walang reseta” (over-the-counter). Ang L.A. Care Cal MediConnect Plan ay sumasakop sa ilang OTC na mga gamot kapag ang mga ito ay isinulat bilang mga gamot ng inyong provider.

Maaari ninyong basahin ang Listahan ng mga Gamot ng L.A. Care Cal MediConnect Plan upang makita kung anong mga OTC na gamot ang sakop.

B15. Sinasakop ba ng L.A. Care Cal MediConnect Plan ang mga OTC na produktong hindi gamot?

Ang L.A. Care Cal MediConnect Plan ay sinsasakop ang ilang OTC na mga produktong hindi gamot kapag ang mga ito ay isinulat bilang mga gamot ng inyong provider.

Maaari ninyong basahin ang Listahan ng mga Gamot ng L.A. Care Cal MediConnect Plan upang makita kung anong mga OTC na hindi gamot na produkto ang sakop.

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B16. Ano ang inyong copay?Maaari ninyong basahin ang Listahan ng Gamot ng L.A. Care Cal MediConnect Plan para alamin pa ang tungkol sa copay para sa bawat gamot. Ang mga miyembro ng L.A. Care Cal MediConnect Plan na naninirahan sa mga nursing home o ibang mga pasilidad ng pangmatagalang pangangalaga ay hindi magkakaroon ng mga copay. Ang ilang miyembro na tumatanggap ng pangmatagalang pangangalaga sa komunidad ay hindi rin magkakaroon ng mga copay.

Nakalista ang mga copay ayon sa mga tier. Ang mga tier ay mga grupo ng mga gamot na may parehong copay.

• Tier 1 na mga gamot. Ang mga ito ay generic na mga gamot. Ang copay ay $0. • Tier 2 na mga gamot. Ang mga ito ay mga gamot na may tatak. Ang copay ay mula sa $0 hanggang

$8,95, depende sa antas ng inyong pagiging karapat-dapat sa Medi-Cal. • Tier 3 na mga gamot. Ang mga ito ay mga inireresetang gamot na hindi mula sa Medicare na

sinasakop ng Medi-Cal. Ang copay ay $0.• Tier 4 na mga gamot. Ang mga ito ay hindi mula sa Medicare na hindi kailangan ng reseta na mga

gamot. Ang copay ay $0.

C. Listahan ng Mga Sinasakop na GamotAng sumusunod na listahan ng mga sinasakop na gamot ay nagbibigay sa inyo ng impormasyon tungkol sa mga gamot na sinasakop ng L.A. Care Cal MediConnect Plan. Kung may problema kayo sa paghahanap ng inyong gamot sa listahan, pumunta sa Index ng Mga Sinasakop na Gamot na nagsisimula sa pahina 108. Nakalista sa Index ang lahat ng gamot na sinasakop ng L.A. Care Cal MediConnect Plan ayon sa pagkakasunod-sunod sa alpabeto.

Ang unang hanay ng chart ay inililista ang pangalan ng gamot. Nakasulat sa malalaking titik ang mga gamot na may tatak (hal., GLYSET) at nakalista sa maliliit na titik na naka-italic ang mga generic na gamot (hal., miglitol).Ang impormasyon sa hanay na “Mga kinakailangang aksiyon, paghihigpit, o limitasyon sa paggamit” (“Necessary actions, restrictions, or limits on use”) ay nagsasabi sa inyo kung may mga panuntunan ang L.A. Care Cal MediConnect Plan sa pagsakop sa inyong gamot.

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MGA PAGPAPAIKLI SA MGA ITINALA TUNGKOL SA PAGSAKOPMga Paghihigpit sa Pamamahala ng Paggamit

PAGPAPAIKLI PAGLALARAWAN PALIWANAGPA Paghihipit sa Paunang

Pahintulot (Prior Authorization Restriction)

Knakailangan ninyo (o ng inyong doktor) na kumuha ng paunang pahintulot mula sa L.A. Care Cal MediConnect Plan bago ninyo makuha ang reseta para sa gamot na ito. Kung walang paunang pahintulot, maaaring hindi masakop ng L.A. Care Cal MediConnect Plan ang gamot na ito.

PA BvD Paghihigpit sa Paunang Pahintulot para sa Part B vs Part D na Pagpapasya (Prior Authorization Restriction For Part B vs Part D Determination)

Maaaring karapat-dapat ang gamot na ito sa ilalim ng Medicare Part B o Part D. Kinakailangan ninyo (o ng inyong doktor) ng paunang pahintulot mula sa L.A. Care Cal MediConnect Plan para malaman kung ang gamot na ito ay sakop sa ilalim ng Medicare Part D bago punan ang reseta para sa gamot na ito. Kung walang paunang pahintulot, maaaring hindi sakupin ng L.A. Care Cal MediConnect Plan ang gamot na ito.

PA NSO Paghihigpit sa Paunang Pahintulot para sa Nagsisimula Pa Lang (Prior Authorization Restriction for New Starts Only)

Kung bago ang ng resetang ito para sa inyo, ibig sabihin, ito ang unang beses na inireseta ang gamot na ito para sa inyo, kinakailangan ninyo (o ng inyong doktor) na kumuha ng paunang pahintulot mula sa L.A. Care Cal MediConnect Plan bago punan ang inyong reseta para sa gamot na ito. Kung walang nauunang pahintulot, maaaring hindi masakop ng L.A. Care Cal MediConnect Plan ang gamot na ito.

QL Paghihigpit sa Limitasyon ng Dami (Quantity Limit Restriction)

Nililimita ng L.A. Care Cal MediConnect Plan ang dami na masasakop sa loob ng isang partikular na takdang panahon para sa gamot na ito.

ST Paghihigpit sa Step Therapy (Step Therapy Restriction)

Bago sakupin ng L.A. Care Cal MediConnect Plan ang gamot na ito, kailangan mo munang subukan ang ibang (mga) gamot sa formulary para gamutin ang inyong medikal na kondisyon. Ang gamot na ito ay maaari lang masakop kung ang iba pang (mga) gamot ay hindi gumagana para sa inyo.

ST NSO Step Therapy para sa Nagsisimula Pa Lang (Step Therapy for New Starts Only)

Kung isa itong bagong reseta para sa inyo, ibig sabihin, ang unang beses na inireseta sa inyo ang gamot na ito, bago magbigay ng saklaw ang L.A. Care Cal MediConnect Plan para sa gamot na ito, dapat muna kayong sumubok ng iba pang (mga) gamot na nasa pormularyo upang gamutin ang inyong medikal na kundisyon. Maaari lang masakop ang gamot na ito kung ang iba pang (mga) gamot ay hindi gumagana para sa inyo.

Iba pang mga Espesyal na Kinakailangan para sa PagsakopLD Gamot na Limitado ang

Distribusyon (Limited Distribution Drug)

Makukuha lang ang gamot na ito sa ilang parmasiya. Para sa karagdagang impormasyon basahin ang inyong Direktoryo ng Provider/Parmasya o tawagan ang mga Serbisyo nsa Miyembro sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang araw, 7 araw sa isang linggo, kasama ang mga holiday.

NDS Hindi Pinalawig na Araw para sa Supply (Non-Extended Day Supply)

Ang mga gamot na nakalistang “NDS” ay limitado sa 1 buwan na supply para sa Retail at Mail Order.

Tandaan: Ang asterisk (*) sa tabi ng isang gamot ay nangangahulugang ang gamot ay hindi isang “Part D na gamot.” Hindi hihilingin sa inyo na magbayad ng isang copay para sa mga gamot na ito. Ang mga gamot na ito ay mayroon ding iba't ibang panuntunan para sa apela.

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• Isang pormal na paraan ang apela para hilingin na suriin namin ang isang desisyon na ginawa namin tungkol sa inyong pagsakop at para baguhin ito kung sa palagay ninyong nagkamali kami. Halimbawa, maaari kaming magpasya na hindi sakop o hindi na masasakop ng Medicare o Medi-Cal ang isang gamot na gusto ninyo.

• Kung kayo o ang inyong doktor ay hindi sumasang-ayon sa aming desisyon, maaari kayong mag-apela. Kung sakaling mayroon kang tanong, tumawag sa mga Serbisyo sa Miyembro sa 1-888-522-1298 (TTY: 711), 24 na oras sa isang linggo, kasama ang mga holiday. Maaari rin ninyong basahin ang Kabanata 9 ng Handbook ng Miyembro para malaman kung paano mag-apela ng isang desisyon.

D. Listahan ng mga Gamot batay sa Medikal na KondisyonAng mga gamot sa seksiyong ito ay nakagrupo sa mga kategorya depende sa uri ng mga kondisyong medikal na ginagamit ang mga ito na panggamot. Halimbawa, kung kayo ay may kondisyon sa puso, dapat kayong tumingin sa kategorya, cardiovascular agents – Atbp. (cardiovascular agents – Misc.) Doon ninyo mahahanap ang mga gamot na gumagamot sa mga kondisyon ng puso.


You can find information on what the symbols and abbreviations in this table mean by going to page XI.

1

Name of drug What the drug will cost you (tier level)

Necessary actions,restrictions, or limits on use

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS AMPHETAMINES

amphetamine/dextroamphetamine 10mg ER cap 1 amphetamine/dextroamphetamine 10mg tab 1 amphetamine/dextroamphetamine 12.5mg tab 1 amphetamine/dextroamphetamine 15mg ER cap 1 amphetamine/dextroamphetamine 15mg tab 1 amphetamine/dextroamphetamine 20mg ER cap 1 amphetamine/dextroamphetamine 20mg tab 1 amphetamine/dextroamphetamine 25mg ER cap 1 amphetamine/dextroamphetamine 30mg ER cap 1 amphetamine/dextroamphetamine 30mg tab 1 amphetamine/dextroamphetamine 5mg ER cap 1 amphetamine/dextroamphetamine 5mg tab 1 amphetamine/dextroamphetamine 7.5mg tab 1 dextroamphetamine sulfate 10mg er cap 1 dextroamphetamine sulfate 10mg tab 1 dextroamphetamine sulfate 15mg er cap 1 dextroamphetamine sulfate 5mg er cap 1 dextroamphetamine sulfate 5mg tab 1

ANOREXIANTS NON-AMPHETAMINE phentermine cap 15mg* 3 PA phentermine cap 30mg* 3 PA phentermine cap 37.5mg* 3 PA phentermine tab 37.5mg* 3 PA QSYMIA CAP 11.25-69MG* 3 PA QSYMIA CAP 15-92MG* 3 PA QSYMIA CAP 3.75-23MG* 3 PA QSYMIA CAP 7.5-46MG* 3 PA

ANTI-OBESITY AGENTS BELVIQ TAB 10MG* 3 PA

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) AGENTS atomoxetine 100mg cap 1 QL=60 EA/30 Days atomoxetine 10mg cap 1 QL=60 EA/30 Days atomoxetine 18mg cap 1 QL=60 EA/30 Days atomoxetine 25mg cap 1 QL=60 EA/30 Days atomoxetine 40mg cap 1 QL=60 EA/30 Days atomoxetine 60mg cap 1 QL=60 EA/30 Days atomoxetine 80mg cap 1 QL=60 EA/30 Days guanfacine 1mg er tab 1 guanfacine 2mg er tab 1 guanfacine 3mg er tab 1 guanfacine 4mg er tab 1


2

DOPAMINE AND NOREPINEPHRINE REUPTAKE INHIBITORS (DNRIS) SUNOSI 150MG TAB 2 NDS PA QL=30 EA/30 Days SUNOSI 75MG TAB 2 NDS PA QL=30 EA/30 Days

HISTAMINE H3-RECEPTOR ANTAGONIST/INVERSE AGONISTS WAKIX 17.8MG TAB 2 NDS PA QL=60 EA/30 Days WAKIX 4.45MG TAB 2 NDS PA QL=60 EA/30 Days

STIMULANTS - MISC. armodafinil 150mg tab 1 PA QL=30 EA/30 Days armodafinil 200mg tab 1 PA QL=30 EA/30 Days armodafinil 250mg tab 1 PA QL=30 EA/30 Days armodafinil 50mg tab 1 PA QL=30 EA/30 Days dexmethylphenidate 10mg er cap 1 dexmethylphenidate 10mg tab 1 dexmethylphenidate 15mg er cap 1 dexmethylphenidate 2.5mg tab 1 dexmethylphenidate 20mg er cap 1 dexmethylphenidate 25mg er cap 1 dexmethylphenidate 30mg er cap 1 dexmethylphenidate 35mg er cap 1 dexmethylphenidate 40mg er cap 1 dexmethylphenidate 5mg er cap 1 dexmethylphenidate 5mg tab 1 metadate 20mg er tab 1 methylphenidate 10mg cr cap 1 methylphenidate 10mg er tab 1 methylphenidate 10mg la cap 1 methylphenidate 10mg tab 1 methylphenidate 18mg sr tab 1 methylphenidate 1mg/ml oral soln 1 methylphenidate 20mg cr cap 1 methylphenidate 20mg er tab 1 methylphenidate 20mg la cap 1 methylphenidate 20mg tab 1 methylphenidate 27mg sr tab 1 methylphenidate 2mg/ml oral soln 1 methylphenidate 30mg cr cap 1 methylphenidate 30mg la cap 1 methylphenidate 36mg sr tab 1 methylphenidate 40mg cr cap 1 methylphenidate 40mg la cap 1 methylphenidate 50mg cr cap 1 methylphenidate 54mg sr tab 1 methylphenidate 5mg tab 1




3

methylphenidate 60mg cr cap 1 modafinil 100mg tab 1 PA QL=60 EA/30 Days modafinil 200mg tab 1 PA QL=60 EA/30 Days



AMINOGLYCOSIDES AMINOGLYCOSIDES

amikacin 250mg/ml inj 1 ARIKAYCE 70.3MG/ML INH SOLN 2 NDS PA QL=252 ML/30 Days GENTAMICIN SULFATE 0.8MG/ML INJ 1 gentamicin sulfate 1.2mg/ml inj 1 GENTAMICIN SULFATE 1.6MG/ML INJ 1 GENTAMICIN SULFATE 1MG/ML INJ 1 gentamicin sulfate 40mg/ml inj 1 neomycin sulfate 500mg tab 1 paromomycin 250mg cap 1 STREPTOMYCIN 100MG INJ 2 TOBI PODHALER KIT 28MG PACK 2 NDS PA TOBRAMYCIN 10MG/ML INJ 1 tobramycin 40mg/ml inj 1 tobramycin 60mg/ml inh soln 1 NDS PA

ANALGESICS - ANTI-INFLAMMATORY ANTIRHEUMATIC - ENZYME INHIBITORS

OLUMIANT 1MG TAB 2 PA OLUMIANT 2MG TAB 2 PA RINVOQ 15MG ER TAB 2 NDS PA XELJANZ 10MG TAB 2 NDS PA XELJANZ 5MG TAB 2 NDS PA

ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES HUMIRA 10MG/0.1ML SYRINGE 2 NDS PA HUMIRA 10MG/0.2ML SYRINGE 2 NDS PA HUMIRA 20MG/0.2ML SYRINGE 2 NDS PA HUMIRA 20MG/0.4ML SYRINGE 2 NDS PA HUMIRA 40MG/0.4ML PEN INJECTOR 2 NDS PA HUMIRA 40MG/0.4ML SYRINGE 2 NDS PA HUMIRA 40MG/0.8ML AUTO-INJECTOR 2 NDS PA HUMIRA 40MG/0.8ML SYRINGE 2 NDS PA HUMIRA PEDIATRIC CROHN'S STARTER PACK (3) 80MG/0.8ML INJ

2 NDS PA

HUMIRA PEDIATRIC CROHN'S STARTER PACK SYRINGE (2) 40MG/0.4ML 80MG/0.8ML

2 NDS PA

HUMIRA PEN - CROHN'S STARTER PACK 40MG/0.8ML INJ

2 NDS PA

HUMIRA PEN - CROHN'S STARTER PACK 80MG/0.8ML INJ

2 NDS PA


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HUMIRA PEN - PSORIASIS STARTER PACK 40MG/0.8ML INJ

2 NDS PA

HUMIRA PEN - PSORIASIS STARTER PACK 80MG/0.8ML INJ

2 NDS PA

SIMPONI 100MG/ML AUTO-INJECTOR 2 NDS PA SIMPONI 100MG/ML INJ 2 NDS PA SIMPONI 50MG/0.5ML AUTO-INJECTOR 2 NDS PA SIMPONI 50MG/0.5ML SYRINGE 2 NDS PA

GOLD COMPOUNDS RIDAURA 3MG CAP 2

INTERLEUKIN-1 BLOCKERS ARCALYST 220MG INJ 2 NDS PA

INTERLEUKIN-6 RECEPTOR INHIBITORS ACTEMRA 162MG/0.9ML AUTO-INJECTOR 2 NDS PA ACTEMRA 162MG/0.9ML SYRINGE 2 NDS PA KEVZARA 150MG/1.14ML PF INJ 2 NDS PA KEVZARA 200MG/1.14ML PF INJ 2 NDS PA

NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) celecoxib 100mg cap 1 QL=60 EA/30 Days celecoxib 200mg cap 1 QL=60 EA/30 Days celecoxib 400mg cap 1 QL=60 EA/30 Days celecoxib 50mg cap 1 QL=60 EA/30 Days diclofenac potassium 50mg tab 1 diclofenac sodium 100mg er tab 1 diclofenac sodium 25mg dr tab 1 diclofenac sodium 50mg dr tab 1 diclofenac sodium 50mg/misoprostol 0.2mg tab 1 diclofenac sodium 75mg dr tab 1 diclofenac sodium 75mg/misoprostol 0.2mg tab 1 etodolac 200mg cap 1 etodolac 300mg cap 1 etodolac 400mg tab 1 etodolac 500mg tab 1 ibu 600mg tab 1 ibu 800mg tab 1 ibuprofen 20mg/ml susp 1 ibuprofen 400mg tab 1 ibuprofen 600mg tab 1 ibuprofen 800mg tab 1 ibuprofen cap 200mg* 4 ibuprofen chew tab 100mg* 4 ibuprofen susp 20mg/ml* 4 ibuprofen susp 40mg/ml* 4




5

ibuprofen tab 100mg* 4 ibuprofen tab 200mg* 4 KETOPROFEN 25MG CAP 1 ketorolac tromethamine 10mg tab 1 QL=20 EA/5 Days meloxicam 15mg tab 1 meloxicam 7.5mg tab 1 nabumetone 500mg tab 1 nabumetone 750mg tab 1 naproxen 250mg tab 1 naproxen 375mg dr tab 1 naproxen 375mg tab 1 naproxen 500mg dr tab 1 naproxen 500mg tab 1 naproxen sodium 275mg tab 1 naproxen sodium 550mg tab 1 naproxen sodium tab 220mg* 4 oxaprozin 600mg tab 1 piroxicam 10mg cap 1 piroxicam 20mg cap 1 sulindac 150mg tab 1 sulindac 200mg tab 1

PHOSPHODIESTERASE 4 (PDE4) INHIBITORS OTEZLA 28-DAY STARTER PACK 2 NDS PA OTEZLA 30MG TAB 2 NDS PA

PYRIMIDINE SYNTHESIS INHIBITORS leflunomide 10mg tab 1 leflunomide 20mg tab 1

SELECTIVE COSTIMULATION MODULATORS ORENCIA 125MG/ML AUTO-INJECTOR 2 NDS PA ORENCIA 125MG/ML SYRINGE 2 NDS PA ORENCIA 50MG/0.4ML SYRINGE 2 NDS PA ORENCIA 87.5MG/0.7ML SYRINGE 2 NDS PA

SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS ENBREL 25MG INJ 2 NDS PA ENBREL 25MG/0.5ML SYRINGE 2 NDS PA ENBREL 50MG/ML CARTRIDGE 2 NDS PA ENBREL 50MG/ML SURECLICK INJ 2 NDS PA ENBREL 50MG/ML SYRINGE 2 NDS PA



ANALGESICS - NONNARCOTIC ANALGESICS OTHER

acetaminophen CR tab 650mg* 4 acetaminophen liquid 160mg/5ml* 4 acetaminophen liquid 167mg/5ml* 4


6

acetaminophen soln 160mg/5ml* 4 acetaminophen susp 160mg/5ml* 4 acetaminophen tab 325mg* 4 acetaminophen tab 500mg* 4

SALICYLATES aspirin chew tab 81mg* 4 aspirin EC tab 325mg* 4 aspirin EC tab 500mg* 4 aspirin EC tab 81mg* 4 aspirin tab 325mg* 4 diflunisal 500mg tab 1



ANALGESICS - OPIOID OPIOID AGONISTS

codeine sulfate 30mg tab 1 QL=240 EA/30 Days codeine sulfate 60mg tab 1 QL=180 EA/30 Days duramorph 0.5mg/ml inj 1 PA BvD duramorph 1mg/ml inj 1 PA BvD fentanyl 0.012mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.025mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.05mg/hr patch 1 QL=10 EA/30 Days fentanyl 0.075mg/hr patch 1 QL=10 EA/30 Days FENTANYL 0.1MG BUCCAL TAB 2 PA QL=120 EA/30 Days fentanyl 0.1mg/hr patch 1 QL=10 EA/30 Days FENTANYL 0.2MG BUCCAL TAB 2 PA QL=120 EA/30 Days fentanyl 0.2mg lozenge 1 PA QL=120 EA/30 Days FENTANYL 0.4MG BUCCAL TAB 2 PA QL=120 EA/30 Days fentanyl 0.4mg lozenge 1 PA QL=120 EA/30 Days FENTANYL 0.6MG BUCCAL TAB 2 PA QL=120 EA/30 Days fentanyl 0.6mg lozenge 1 PA QL=120 EA/30 Days FENTANYL 0.8MG BUCCAL TAB 2 PA QL=120 EA/30 Days fentanyl 0.8mg lozenge 1 PA QL=120 EA/30 Days fentanyl 1.2mg lozenge 1 PA QL=120 EA/30 Days fentanyl 1.6mg lozenge 1 PA QL=120 EA/30 Days FENTORA 100MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 200MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 400MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 600MCG BUCCAL TAB 2 PA QL=120 EA/30 Days FENTORA 800MCG BUCCAL TAB 2 PA QL=120 EA/30 Days hydromorphone 10mg/ml (1ml) inj 1 hydromorphone 10mg/ml (5ml) inj 1 hydromorphone 1mg/ml oral soln 1 QL=1500 ML/30 Days hydromorphone 2mg tab 1 QL=270 EA/30 Days hydromorphone 4mg tab 1 QL=240 EA/30 Days

You can can find information on what the symbols and abbreviations in this table mean by going to page XI.

7

hydromorphone 8mg tab 1 QL=120 EA/30 Days HYSINGLA 100MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 120MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 20MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 30MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 40MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 60MG ER TAB 2 QL=30 EA/30 Days HYSINGLA 80MG ER TAB 2 QL=30 EA/30 Days methadone 10mg tab 1 QL=210 EA/30 Days methadone 5mg tab 1 QL=360 EA/30 Days morphine sulfate 100mg er tab 1 QL=60 EA/30 Days morphine sulfate 15mg er tab 1 QL=90 EA/30 Days morphine sulfate 15mg tab 1 QL=180 EA/30 Days morphine sulfate 200mg er tab 1 QL=30 EA/30 Days morphine sulfate 20mg/ml oral soln 1 QL=180 ML/30 Days morphine sulfate 2mg/ml oral soln 1 QL=1800 ML/30 Days morphine sulfate 30mg er tab 1 QL=90 EA/30 Days morphine sulfate 30mg tab 1 QL=180 EA/30 Days morphine sulfate 4mg/ml oral soln 1 QL=900 ML/30 Days morphine sulfate 60mg er tab 1 QL=90 EA/30 Days NUCYNTA 100MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 150MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 200MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 250MG ER TAB 2 QL=60 EA/30 Days NUCYNTA 50MG ER TAB 2 QL=60 EA/30 Days oxycodone 10mg tab 1 QL=180 EA/30 Days oxycodone 15mg tab 1 QL=180 EA/30 Days oxycodone 1mg/ml oral soln 1 QL=5400 ML/30 Days oxycodone 20mg tab 1 QL=180 EA/30 Days oxycodone 20mg/ml oral soln 1 QL=210 ML/30 Days oxycodone 30mg tab 1 QL=150 EA/30 Days oxycodone 5mg cap 1 QL=360 EA/30 Days oxycodone 5mg tab 1 QL=180 EA/30 Days oxymorphone 10mg tab 1 QL=210 EA/30 Days oxymorphone 5mg tab 1 QL=360 EA/30 Days tramadol 100mg er tab 1 QL=60 EA/30 Days tramadol 100mg er tab (matrix delivery) 1 QL=60 EA/30 Days tramadol 200mg er tab 1 QL=30 EA/30 Days tramadol 200mg er tab (matrix delivery) 1 QL=30 EA/30 Days tramadol 300mg er tab 1 QL=30 EA/30 Days tramadol 300mg er tab (matrix delivery) 1 QL=30 EA/30 Days tramadol 50mg tab 1 QL=240 EA/30 Days XTAMPZA 13.5MG ER CAP 2 QL=120 EA/30 Days




8

XTAMPZA 18MG ER CAP 2 QL=120 EA/30 Days XTAMPZA 27MG ER CAP 2 QL=120 EA/30 Days XTAMPZA 36MG ER CAP 2 QL=120 EA/30 Days XTAMPZA 9MG ER CAP 2 QL=120 EA/30 Days

OPIOID COMBINATIONS acetaminophen 21.7mg/ml/hydrocodone bitartrate 0.5mg/ml oral soln

1 QL=5400 ML/30 Days

acetaminophen 24mg/ml/codeine phosphate 2.4mg/ml oral soln

1 QL=4500 ML/30 Days

acetaminophen 300mg/codeine phosphate 15mg tab 1 QL=360 EA/30 Days acetaminophen 300mg/codeine phosphate 30mg tab 1 QL=360 EA/30 Days acetaminophen 300mg/codeine phosphate 60mg tab 1 QL=180 EA/30 Days acetaminophen 300mg/hydrocodone bitartrate 10mg tab

1 QL=390 EA/30 Days

acetaminophen 300mg/hydrocodone bitartrate 5mg tab

1 QL=390 EA/30 Days

acetaminophen 300mg/hydrocodone bitartrate 7.5mg tab

1 QL=390 EA/30 Days


1 QL=240 EA/30 Days


1 QL=240 EA/30 Days


1 QL=180 EA/30 Days

acetaminophen 325mg/oxycodone 10mg tab 1 QL=180 EA/30 Days acetaminophen 325mg/oxycodone 2.5mg tab 1 QL=360 EA/30 Days acetaminophen 325mg/oxycodone 5mg tab 1 QL=240 EA/30 Days acetaminophen 325mg/oxycodone 7.5mg tab 1 QL=240 EA/30 Days acetaminophen 325mg/tramadol 37.5mg tab 1 QL=240 EA/30 Days aspirin 325mg/oxycodone 4.84mg tab 1 QL=360 EA/30 Days endocet 10-325mg tab 1 QL=180 EA/30 Days endocet 5-325mg tab 1 QL=240 EA/30 Days endocet 7.5-325mg tab 1 QL=240 EA/30 Days hydrocodone 10mg/ibuprofen 200mg tab 1 QL=150 EA/30 Days hydrocodone 5mg/ibuprofen 200mg tab 1 QL=150 EA/30 Days hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab 1 QL=150 EA/30 Days IBUPROFEN 400MG/OXYCODONE 5MG TAB 1 QL=120 EA/30 Days lorcet 10-325mg tab 1 QL=240 EA/30 Days lorcet 5-325mg tab 1 QL=240 EA/30 Days lorcet 7.5-325mg tab 1 QL=180 EA/30 Days

OPIOID PARTIAL AGONISTS buprenorphine 2mg sl tab 1 buprenorphine 2mg/naloxone 0.5mg sl tab 1




9

buprenorphine 8mg sl tab 1 buprenorphine 8mg/naloxone 2mg sl tab 1 buprenorphine/naloxone 12-3mg strip 1 buprenorphine/naloxone 2-0.5mg strip 1 buprenorphine/naloxone 4-1mg strip 1 buprenorphine/naloxone 8-2mg strip 1 butorphanol tartrate 10mg/ml nasal spray 1 QL=10 ML/30 Days ZUBSOLV 11.4-2.9MG SL TAB 2 QL=60 EA/30 Days ZUBSOLV 1.4-0.36MG SL TAB 2 QL=90 EA/30 Days ZUBSOLV 2.9-0.71MG SL TAB 2 QL=90 EA/30 Days ZUBSOLV 5.7-1.4MG SL TAB 2 QL=90 EA/30 Days ZUBSOLV 8.6-2.1MG SL TAB 2 QL=60 EA/30 Days



ANDROGENS-ANABOLIC ANABOLIC STEROIDS

ANADROL-50 50MG TAB 2 oxandrolone 10mg tab 1 oxandrolone 2.5mg tab 1

ANDROGENS ANDRODERM 2MG/24HR PATCH 2 PA QL=60 EA/30 Days ANDRODERM 4MG/24HR PATCH 2 PA QL=30 EA/30 Days danazol 100mg cap 1 danazol 200mg cap 1 danazol 50mg cap 1 testosterone 1% (25mg) gel 1 PA QL=300 GM/30 Days testosterone 1% (50mg) gel 1 PA QL=300 GM/30 Days TESTOSTERONE 1% GEL PUMP 1 PA QL=300 GM/30 Days testosterone 1.62% (1.25gm) gel 1 PA QL=75 GM/30 Days testosterone 1.62% (2.5gm) gel 1 PA QL=150 GM/30 Days testosterone 1.62% gel pump 1 PA QL=150 GM/30 Days testosterone cypionate (1ml) 200mg/ml inj 1 testosterone cypionate 100mg/ml inj 1 testosterone cypionate 200mg/ml inj 1 testosterone enanthate 200mg/ml inj 1

ANORECTAL AGENTS INTRARECTAL STEROIDS

hydrocortisone 1.67mg/ml enema 1 UCERIS 2MG/ACT FOAM 2 PA

RECTAL COMBINATIONS hydrocortisone/pramoxine 1-1% rectal cream 1

RECTAL STEROIDS procto-med 2.5% cream 1 procto-pak 1% rectal cream 1 proctosol 2.5% cream 1


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proctozone hc 2.5% cream 1 VASODILATING AGENTS

RECTIV 0.4% RECTAL OINTMENT 2 QL=30 GM/30 Days



ANTACIDS ANTACID COMBINATIONS

aluminum hydroxide/magnesium trisilicate chew tab 80-20mg*

4

aluminum/magnesium hydroxide/simethicone chew tab 200-200-25mg*

4

aluminum/magnesium hydroxide/simethicone susp 200-200-20mg/5ml*

4


4

ANTACIDS - ALUMINUM SALTS ALUMINUM HYDROXIDE GEL SUSP 320MG/5ML* 4

ANTACIDS - BICARBONATE sodium bicarbonate tab 325mg* 4 sodium bicarbonate tab 650mg* 4

ANTACIDS - CALCIUM SALTS calcium carbonate (antacid) chew tab 1000mg* 4 calcium carbonate (antacid) chew tab 500mg* 4 calcium carbonate (antacid) chew tab 648mg* 4 calcium carbonate (antacid) chew tab 750mg* 4 calcium carbonate susp 1250mg/5ml* 4

ANTACIDS - MAGNESIUM SALTS magnesium oxide tab 250mg* 4 magnesium oxide tab 400mg* 4

ANTHELMINTICS ANTHELMINTICS

albendazole 200mg tab 1 NDS BENZNIDAZOLE 100MG TAB 2 PA BENZNIDAZOLE 12.5MG TAB 2 PA ivermectin 3mg tab 1 pyrantel pamoate susp 144mg/ml* 4

ANTIANGINAL AGENTS ANTIANGINALS-OTHER

ranolazine 1000mg er tab 1 ranolazine 500mg er tab 1

NITRATES isosorbide dinitrate 10mg tab 1 isosorbide dinitrate 20mg tab 1 ISOSORBIDE DINITRATE 30MG TAB 1 isosorbide dinitrate 5mg tab 1


11

isosorbide mononitrate 10mg tab 1 isosorbide mononitrate 120mg er tab 1 isosorbide mononitrate 20mg tab 1 isosorbide mononitrate 30mg er tab 1 isosorbide mononitrate 60mg er tab 1 minitran 0.1mg/hr patch 1 minitran 0.2mg/hr patch 1 minitran 0.4mg/hr patch 1 minitran 0.6mg/hr patch 1 NITRO-BID 2% OINTMENT 2 NITRO-DUR 0.3MG/HR PATCH 2 NITRO-DUR 0.8MG/HR PATCH 2 nitroglycerin 0.1mg/hr patch 1 nitroglycerin 0.2mg/hr patch 1 nitroglycerin 0.3mg sl tab 1 nitroglycerin 0.4mg sl tab 1 nitroglycerin 0.4mg/act spray 1 nitroglycerin 0.4mg/hr patch 1 nitroglycerin 0.6mg sl tab 1 nitroglycerin 0.6mg/hr patch 1



ANTIANXIETY AGENTS ANTIANXIETY AGENTS - MISC.

buspirone 10mg tab 1 buspirone 15mg tab 1 buspirone 30mg tab 1 buspirone 5mg tab 1 buspirone 7.5mg tab 1 hydroxyzine 10mg tab 1 hydroxyzine 25mg tab 1 hydroxyzine 2mg/ml oral soln 1 hydroxyzine 50mg tab 1 HYDROXYZINE PAMOATE 100MG CAP 1 hydroxyzine pamoate 25mg cap 1 hydroxyzine pamoate 50mg cap 1

BENZODIAZEPINES alprazolam 0.25mg tab 1 alprazolam 0.5mg tab 1 alprazolam 1mg tab 1 alprazolam 2mg tab 1 chlordiazepoxide 10mg cap 1 chlordiazepoxide 25mg cap 1 chlordiazepoxide 5mg cap 1 clorazepate dipotassium 15mg tab 1


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clorazepate dipotassium 3.75mg tab 1 clorazepate dipotassium 7.5mg tab 1 diazepam 10mg tab 1 DIAZEPAM 1MG/ML ORAL SOLN 1 diazepam 2mg tab 1 diazepam 5mg tab 1 diazepam 5mg/ml oral soln 1 lorazepam 0.5mg tab 1 lorazepam 1mg tab 1 lorazepam 2mg tab 1 lorazepam 2mg/ml conc 1 OXAZEPAM 10MG CAP 1 oxazepam 15mg cap 1 OXAZEPAM 30MG CAP 1



ANTIARRHYTHMICS ANTIARRHYTHMICS TYPE I-A

disopyramide 100mg cap 1 PA disopyramide 150mg cap 1 PA NORPACE 100MG ER CAP 2 PA NORPACE 150MG ER CAP 2 PA quinidine gluconate 324mg er tab 1 QUINIDINE SULFATE 200MG TAB 1 QUINIDINE SULFATE 300MG TAB 1

ANTIARRHYTHMICS TYPE I-B MEXILETINE 150MG CAP 2 MEXILETINE 200MG CAP 2 MEXILETINE 250MG CAP 2

ANTIARRHYTHMICS TYPE I-C flecainide acetate 100mg tab 1 flecainide acetate 150mg tab 1 flecainide acetate 50mg tab 1 propafenone 150mg tab 1 propafenone 225mg er cap 1 propafenone 225mg tab 1 propafenone 300mg tab 1 propafenone 325mg er cap 1 propafenone 425mg sr cap 1

ANTIARRHYTHMICS TYPE III amiodarone 200mg tab 1 amiodarone 400mg tab 1 dofetilide 125mcg cap 1 dofetilide 250mcg cap 1 dofetilide 500mcg cap 1


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MULTAQ 400MG TAB 2 PA pacerone 200mg tab 1 pacerone 400mg tab 1



ANTIASTHMATIC AND BRONCHODILATOR AGENTS ANTIASTHMATIC - MONOCLONAL ANTIBODIES

DUPIXENT 200MG/ML PF SYRINGE 2 NDS PA FASENRA 30MG/ML AUTO-INJECTOR 2 PA FASENRA 30MG/ML SYRINGE 2 PA NUCALA 100MG INJ 2 NDS PA NUCALA 100MG/ML AUTO-INJECTOR 2 NDS PA NUCALA 100MG/ML SYRINGE 2 NDS PA XOLAIR 150MG INJ 2 NDS PA XOLAIR 150MG/ML PF INJ 2 NDS PA XOLAIR 75MG/0.5ML PF INJ 2 NDS PA

ANTI-INFLAMMATORY AGENTS cromolyn sodium 10mg/ml inh soln 1 PA BvD

BRONCHODILATORS - ANTICHOLINERGICS ATROVENT 17MCG INH 2 QL=25.80 GM/30 Days INCRUSE 62.5MCG INH 2 ipratropium bromide 0.02% inh soln 1 PA BvD SPIRIVA 1.25MCG RESPIMAT INH 2 ST QL=4 GM/30 Days

LEUKOTRIENE MODULATORS montelukast 10mg tab 1 QL=30 EA/30 Days montelukast 4mg chew tab 1 QL=30 EA/30 Days montelukast 4mg granules 1 QL=30 EA/30 Days montelukast 5mg chew tab 1 QL=30 EA/30 Days zafirlukast 10mg tab 1 QL=60 EA/30 Days zafirlukast 20mg tab 1 QL=60 EA/30 Days

SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS DALIRESP 250MCG TAB 2 DALIRESP 500MCG TAB 2

STEROID INHALANTS ARNUITY 100MCG INH 2 QL=30 EA/30 Days ARNUITY 200MCG INH 2 QL=30 EA/30 Days ARNUITY 50MCG INH 2 QL=30 EA/30 Days ASMANEX 100MCG (120ACT) HFA INH 2 QL=13 GM/30 Days ASMANEX 110MCG (30ACT) INH 2 QL=1 EA/30 Days ASMANEX 200MCG (120ACT) HFA INH 2 QL=13 GM/30 Days ASMANEX 220MCG (120ACT) INH 2 QL=1 EA/30 Days ASMANEX 220MCG (30ACT) INH 2 QL=1 EA/30 Days ASMANEX 220MCG (60ACT) INH 2 QL=1 EA/30 Days budesonide 0.125mg/ml inh soln 1 PA BvD QL=120 ML/30 Days budesonide 0.25mg/ml inh soln 1 PA BvD QL=120 ML/30 Days


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budesonide 0.5mg/ml inh soln 1 PA BvD QL=120 ML/30 Days FLOVENT 100MCG DISKUS 2 QL=60 EA/30 Days FLOVENT 110MCG HFA INH 2 QL=24 GM/30 Days FLOVENT 220MCG HFA INH 2 QL=24 GM/30 Days FLOVENT 250MCG DISKUS 2 QL=60 EA/30 Days FLOVENT 44MCG HFA INH 2 QL=21.20 GM/30 Days FLOVENT 50MCG DISKUS 2 QL=60 EA/30 Days

SYMPATHOMIMETICS ADVAIR 115-21MCG HFA INH 2 QL=12 GM/30 Days ADVAIR 230-21MCG HFA INH 2 QL=12 GM/30 Days ADVAIR 45-21MCG HFA INH 2 QL=12 GM/30 Days albuterol 0.21mg/ml (0.63mg/3ml) inh soln 1 PA BvD albuterol 0.417mg/ml (1.25mg/3ml) inh soln 1 PA BvD albuterol 0.4mg/ml (2mg/5ml) oral oral soln 1 albuterol 0.83mg/ml (0.083%) inh soln 1 PA BvD albuterol 1mg/ml (0.5%) inh soln 1 PA BvD albuterol 2mg tab 1 ALBUTEROL 4MG ER TAB 1 albuterol 4mg tab 1 ALBUTEROL 8MG ER TAB 1 ANORO 62.5-25MCG ELLIPTA INH 2 QL=60 EA/30 Days BREO 100-25MCG ELLIPTA INH 2 QL=60 EA/30 Days BREO 200-25MCG ELLIPTA INH 2 QL=60 EA/30 Days COMBIVENT RESPIMAT 20-100MCG INH 2 QL=4 GM/20 Days DULERA 100-5MCG INH 2 QL=13 GM/30 Days DULERA 200-5MCG INH 2 QL=13 GM/30 Days fluticasone propionate/salmeterol 100-50mcg/act dry powder inh

1 QL=60 EA/30 Days

fluticasone propionate/salmeterol 250-50mcg/act dry powder inh

1 QL=60 EA/30 Days


1 QL=60 EA/30 Days

FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE 113-14MCG/ACT POWDER INH

1 QL=1 EA/30 Days


1 QL=1 EA/30 Days


1 QL=1 EA/30 Days

ipratropium/albuterol 0.5-2.5mg/3ml inh soln 1 PA BvD levalbuterol 0.31mg inh soln 1 PA BvD levalbuterol 0.63mg inh soln 1 PA BvD levalbuterol 1.25mg inh soln 1 PA BvD levalbuterol 2.5mg inh soln 1 PA BvD




15

METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

2

SEREVENT 50MCG/DOSE INH 2 STIOLTO 2.5-2.5MCG INH 2 QL=4 GM/30 Days terbutaline sulfate 2.5mg tab 1 terbutaline sulfate 5mg tab 1 TRELEGY 62.5-25MCG ELLIPTA INH 2 QL=60 EA/30 Days VENTOLIN 108MCG INH 1 QL=36 GM/30 Days wixela 100-50mcg inh 1 QL=60 EA/30 Days wixela 250-50mcg inh 1 QL=60 EA/30 Days wixela 500-50mcg inh 1 QL=60 EA/30 Days

XANTHINES theophylline 300mg er tab 1 theophylline 400mg er tab 1 theophylline 5.33mg/ml oral soln 1 theophylline 600mg er tab 1



ANTICOAGULANTS COUMARIN ANTICOAGULANTS

jantoven 10mg tab 1 jantoven 1mg tab 1 jantoven 2.5mg tab 1 jantoven 2mg tab 1 jantoven 3mg tab 1 jantoven 4mg tab 1 jantoven 5mg tab 1 jantoven 6mg tab 1 jantoven 7.5mg tab 1 warfarin sodium 10mg tab 1 warfarin sodium 1mg tab 1 warfarin sodium 2.5mg tab 1 warfarin sodium 2mg tab 1 warfarin sodium 3mg tab 1 warfarin sodium 4mg tab 1 warfarin sodium 5mg tab 1 warfarin sodium 6mg tab 1 warfarin sodium 7.5mg tab 1

DIRECT FACTOR XA INHIBITORS ELIQUIS 2.5MG TAB 2 ELIQUIS 30-DAY STARTER PACK 2 ELIQUIS 5MG TAB 2 XARELTO 10MG TAB 2 XARELTO 15MG TAB 2 XARELTO 2.5MG TAB 2


16

XARELTO 20MG TAB 2 XARELTO STARTER PACK 2

HEPARINS AND HEPARINOID-LIKE AGENTS enoxaparin sodium 100mg/1ml syringe 1 QL=60 ML/30 Days enoxaparin sodium 120mg/0.8ml syringe 1 QL=48 ML/30 Days enoxaparin sodium 150mg/1ml syringe 1 QL=60 ML/30 Days enoxaparin sodium 30mg/0.3ml syringe 1 QL=18 ML/30 Days enoxaparin sodium 40mg/0.4ml syringe 1 QL=24 ML/30 Days enoxaparin sodium 60mg/0.6ml syringe 1 QL=36 ML/30 Days enoxaparin sodium 80mg/0.8ml syringe 1 QL=48 ML/30 Days fondaparinux sodium 12.5mg/ml (0.4ml) syringe 1 PA fondaparinux sodium 12.5mg/ml (0.6ml) syringe 1 PA fondaparinux sodium 12.5mg/ml (0.8ml) syringe 1 PA fondaparinux sodium 5mg/ml syringe 1 PA FRAGMIN 10000UNIT/ML SYRINGE 2 FRAGMIN 12500UNIT/0.5ML SYRINGE 2 FRAGMIN 15000UNIT/0.6ML SYRINGE 2 FRAGMIN 18000UNIT/0.72ML SYRINGE 2 FRAGMIN 2500UNIT/0.2ML SYRINGE 2 FRAGMIN 5000UNIT/0.2ML SYRINGE 2 FRAGMIN 7500UNIT/0.3ML SYRINGE 2 FRAGMIN 95000UNIT/3.8ML INJ 2 heparin sodium porcine 10000unit/ml inj 1 PA BvD heparin sodium porcine 1000unit/ml inj 1 PA BvD heparin sodium porcine 20000unit/ml inj 1 PA BvD heparin sodium porcine 5000unit/ml inj 1 PA BvD

THROMBIN INHIBITORS PRADAXA 110MG CAP 2 PRADAXA 150MG CAP 2 PRADAXA 75MG CAP 2



ANTICONVULSANTS AMPA GLUTAMATE RECEPTOR ANTAGONISTS

FYCOMPA 0.5MG/ML SUSP 2 PA NSO FYCOMPA 10MG TAB 2 PA NSO FYCOMPA 12MG TAB 2 PA NSO FYCOMPA 2MG TAB 2 PA NSO FYCOMPA 4MG TAB 2 PA NSO FYCOMPA 6MG TAB 2 PA NSO FYCOMPA 8MG TAB 2 PA NSO

ANTICONVULSANTS - BENZODIAZEPINES clobazam 10mg tab 1 clobazam 2.5mg/ml susp 1 clobazam 20mg tab 1


17

clonazepam 0.125mg odt 1 clonazepam 0.25mg odt 1 clonazepam 0.5mg odt 1 clonazepam 0.5mg tab 1 clonazepam 1mg odt 1 clonazepam 1mg tab 1 clonazepam 2mg odt 1 clonazepam 2mg tab 1 DIASTAT 10MG APPLICATOR 2 DIASTAT 2.5MG APPLICATOR 2 DIASTAT 20MG APPLICATOR 2 DIAZEPAM 10MG/2ML RECTAL GEL 2 DIAZEPAM 2.5MG/0.5ML RECTAL GEL 2 NAYZILAM 5MG/0.1ML NASAL SPRAY 2 SYMPAZAN 10MG STRIP 2 ST_NSO SYMPAZAN 20MG STRIP 2 ST_NSO SYMPAZAN 5MG STRIP 2 ST_NSO VALTOCO 10MG DOSE KIT 10MG/0.1ML PACK 2 VALTOCO 15MG DOSE KIT 7.5MG/0.1ML PACK 2 VALTOCO 20MG DOSE KIT 10MG/0.1ML PACK 2 VALTOCO 5MG DOSE KIT 5MG/0.1ML PACK 2

ANTICONVULSANTS - MISC. APTIOM 200MG TAB 2 PA NSO APTIOM 400MG TAB 2 PA NSO APTIOM 600MG TAB 2 PA NSO APTIOM 800MG TAB 2 PA NSO BANZEL 200MG TAB 2 BANZEL 400MG TAB 2 BANZEL 40MG/ML SUSP 2 BRIVIACT 100MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 10MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 10MG/ML ORAL SOLN 2 PA NSO BRIVIACT 25MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 50MG TAB 2 PA NSO QL=60 EA/30 Days BRIVIACT 75MG TAB 2 PA NSO QL=60 EA/30 Days carbamazepine 100mg chew tab 1 carbamazepine 100mg er cap 1 carbamazepine 100mg er tab 1 carbamazepine 200mg er cap 1 carbamazepine 200mg er tab 1 carbamazepine 200mg tab 1 carbamazepine 20mg/ml susp 1 carbamazepine 300mg er cap 1




18

carbamazepine 400mg er tab 1 EPIDIOLEX 100MG/ML ORAL SOLN 2 PA NSO epitol 200mg tab 1 gabapentin 100mg cap 1 gabapentin 300mg cap 1 gabapentin 400mg cap 1 gabapentin 50mg/ml oral soln 1 gabapentin 600mg tab 1 gabapentin 800mg tab 1 LAMICTAL XR BLUE KIT 2 LAMICTAL XR GREEN KIT 2 LAMICTAL XR ORANGE KIT 2 lamotrigine 100mg er tab 1 lamotrigine 100mg odt 1 lamotrigine 100mg tab 1 lamotrigine 150mg tab 1 lamotrigine 200mg er tab 1 lamotrigine 200mg odt 1 lamotrigine 200mg tab 1 lamotrigine 250mg er tab 1 lamotrigine 25mg (35) tab starter pack 1 lamotrigine 25mg chew tab 1 lamotrigine 25mg er tab 1 lamotrigine 25mg odt 1 lamotrigine 25mg tab 1 lamotrigine 300mg er tab 1 lamotrigine 50mg er tab 1 lamotrigine 50mg odt 1 lamotrigine 5mg chew tab 1 lamotrigine tab 25mg (42)/100mg (7) starter pack 1 lamotrigine tab 25mg (84)/100mg (14) starter pack 1 levetiracetam 1000mg tab 1 levetiracetam 100mg/ml oral soln 1 levetiracetam 250mg tab 1 levetiracetam 500mg er tab 1 levetiracetam 500mg tab 1 levetiracetam 750mg er tab 1 levetiracetam 750mg tab 1 oxcarbazepine 150mg tab 1 oxcarbazepine 300mg tab 1 oxcarbazepine 600mg tab 1 oxcarbazepine 60mg/ml susp 1 OXTELLAR 150MG XR TAB 2




19

OXTELLAR 300MG XR TAB 2 OXTELLAR 600MG XR TAB 2 pregabalin 100mg cap 1 pregabalin 150mg cap 1 pregabalin 200mg cap 1 pregabalin 20mg/ml oral soln 1 pregabalin 225mg cap 1 pregabalin 25mg cap 1 pregabalin 300mg cap 1 pregabalin 50mg cap 1 pregabalin 75mg cap 1 primidone 250mg tab 1 primidone 50mg tab 1 QUDEXY 100MG XR CAP 2 PA NSO QUDEXY 150MG XR CAP 2 PA NSO QUDEXY 200MG XR CAP 2 PA NSO QUDEXY 25MG XR CAP 2 PA NSO QUDEXY 50MG XR CAP 2 PA NSO roweepra 1000mg tab 1 roweepra 500mg er tab 1 roweepra 500mg tab 1 roweepra 750mg er tab 1 roweepra 750mg tab 1 SPRITAM 1000MG ODT 2 PA NSO SPRITAM 250MG ODT 2 PA NSO SPRITAM 500MG ODT 2 PA NSO SPRITAM 750MG ODT 2 PA NSO TOPIRAMATE 100MG ER CAP 2 PA NSO topiramate 100mg tab 1 TOPIRAMATE 150MG ER CAP 2 PA NSO topiramate 15mg cap 1 TOPIRAMATE 200MG ER CAP 2 PA NSO topiramate 200mg tab 1 topiramate 25mg cap 1 TOPIRAMATE 25MG ER CAP 2 PA NSO topiramate 25mg tab 1 TOPIRAMATE 50MG ER CAP 2 PA NSO topiramate 50mg tab 1 TROKENDI 100MG XR CAP 2 PA NSO TROKENDI 200MG XR CAP 2 PA NSO TROKENDI 25MG XR CAP 2 PA NSO TROKENDI 50MG XR CAP 2 PA NSO VIMPAT 100MG TAB 2 QL=60 EA/30 Days




20

VIMPAT 10MG/ML ORAL SOLN 2 VIMPAT 150MG TAB 2 QL=60 EA/30 Days VIMPAT 200MG TAB 2 QL=60 EA/30 Days VIMPAT 50MG TAB 2 QL=60 EA/30 Days zonisamide 100mg cap 1 zonisamide 25mg cap 1 zonisamide 50mg cap 1

CARBAMATES felbamate 120mg/ml susp 1 felbamate 400mg tab 1 felbamate 600mg tab 1

GABA MODULATORS tiagabine 12mg tab 1 tiagabine 16mg tab 1 tiagabine 2mg tab 1 tiagabine 4mg tab 1 vigabatrin 500mg tab 1 NDS PA NSO vigabatrin 50mg/ml oral soln 1 NDS PA NSO vigadrone 500mg oral soln 1 NDS PA NSO

HYDANTOINS DILANTIN 30MG ER CAP 2 PEGANONE 250MG TAB 2 phenytoin 25mg/ml susp 1 phenytoin 50mg chew tab 1 phenytoin sodium 100mg er cap 1 phenytoin sodium 200mg er cap 1 phenytoin sodium 300mg er cap 1

SUCCINIMIDES CELONTIN 300MG CAP 2 ethosuximide 250mg cap 1 ethosuximide 50mg/ml oral soln 1

VALPROIC ACID divalproex sodium 125mg dr cap 1 divalproex sodium 125mg dr tab 1 divalproex sodium 250mg dr tab 1 divalproex sodium 250mg er tab 1 divalproex sodium 500mg dr tab 1 divalproex sodium 500mg er tab 1 valproic acid 250mg cap 1 valproic acid 50mg/ml oral soln 1



ANTIDEPRESSANTS ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)

mirtazapine 15mg odt 1


21

mirtazapine 15mg tab 1 mirtazapine 30mg odt 1 mirtazapine 30mg tab 1 mirtazapine 45mg odt 1 mirtazapine 45mg tab 1 mirtazapine 7.5mg tab 1

ANTIDEPRESSANTS - MISC. APLENZIN 174MG ER TAB 2 ST_NSO APLENZIN 348MG ER TAB 2 ST_NSO APLENZIN 522MG ER TAB 2 ST_NSO bupropion 100mg sr tab 1 bupropion 100mg tab 1 bupropion 150mg sr (12 hr) tab 1 bupropion 150mg xl (24 hr) tab 1 bupropion 200mg sr tab 1 bupropion 300mg xl tab 1 bupropion 75mg tab 1 MAPROTILINE 25MG TAB 1 MAPROTILINE 50MG TAB 1 MAPROTILINE 75MG TAB 1

MONOAMINE OXIDASE INHIBITORS (MAOIS) EMSAM 12MG/24HR PATCH 2 EMSAM 6MG/24HR PATCH 2 EMSAM 9MG/24HR PATCH 2 MARPLAN 10MG TAB 2 phenelzine 15mg tab 1 tranylcypromine 10mg tab 1

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) citalopram 10mg tab 1 citalopram 20mg tab 1 citalopram 2mg/ml oral soln 1 citalopram 40mg tab 1 escitalopram 10mg tab 1 escitalopram 1mg/ml oral soln 1 escitalopram 20mg tab 1 escitalopram 5mg tab 1 fluoxetine 10mg cap 1 fluoxetine 10mg tab 1 fluoxetine 20mg cap 1 fluoxetine 20mg tab 1 fluoxetine 40mg cap 1 fluoxetine 4mg/ml oral soln 1 fluvoxamine maleate 100mg er cap 1 ST_NSO




22

fluvoxamine maleate 100mg tab 1 fluvoxamine maleate 150mg er cap 1 ST_NSO fluvoxamine maleate 25mg tab 1 fluvoxamine maleate 50mg tab 1 paroxetine 10mg tab 1 PA NSO paroxetine 12.5mg er tab 1 PA NSO paroxetine 20mg tab 1 PA NSO paroxetine 25mg er tab 1 PA NSO paroxetine 30mg tab 1 PA NSO paroxetine 37.5mg er tab 1 PA NSO paroxetine 40mg tab 1 PA NSO PAXIL 10MG/5ML SUSP 2 PA NSO PEXEVA 10MG TAB 2 PA NSO PEXEVA 20MG TAB 2 PA NSO PEXEVA 30MG TAB 2 PA NSO PEXEVA 40MG TAB 2 PA NSO sertraline 100mg tab 1 sertraline 20mg/ml oral soln 1 sertraline 25mg tab 1 sertraline 50mg tab 1

SEROTONIN MODULATORS NEFAZODONE 100MG TAB 2 NEFAZODONE 150MG TAB 2 NEFAZODONE 200MG TAB 2 NEFAZODONE 250MG TAB 2 NEFAZODONE 50MG TAB 2 trazodone 100mg tab 1 trazodone 150mg tab 1 trazodone 300mg tab 1 trazodone 50mg tab 1 TRINTELLIX 10MG TAB 2 ST_NSO QL=30 EA/30 Days TRINTELLIX 20MG TAB 2 ST_NSO QL=30 EA/30 Days TRINTELLIX 5MG TAB 2 ST_NSO QL=30 EA/30 Days VIIBRYD 10/20MG STARTER PACK 2 ST_NSO QL=30 EA/30 Days VIIBRYD 10MG TAB 2 ST_NSO QL=30 EA/30 Days VIIBRYD 20MG TAB 2 ST_NSO QL=30 EA/30 Days VIIBRYD 40MG TAB 2 ST_NSO QL=30 EA/30 Days

SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) desvenlafaxine succinate 100mg er tab 1 desvenlafaxine succinate 25mg er tab 1 desvenlafaxine succinate 50mg er tab 1 DRIZALMA 20MG DR CAP 2 ST_NSO DRIZALMA 30MG DR CAP 2 ST_NSO




23

DRIZALMA 40MG DR CAP 2 ST_NSO DRIZALMA 60MG DR CAP 2 ST_NSO duloxetine 20mg dr cap 1 duloxetine 30mg dr cap 1 duloxetine 40mg dr cap 1 ST_NSO QL=30 EA/30 Days duloxetine 60mg dr cap 1 FETZIMA 120MG ER CAP 2 ST_NSO QL=30 EA/30 Days FETZIMA 20MG ER CAP 2 ST_NSO QL=30 EA/30 Days FETZIMA 40MG ER CAP 2 ST_NSO QL=30 EA/30 Days FETZIMA 80MG ER CAP 2 ST_NSO QL=30 EA/30 Days FETZIMA PACK 2 ST_NSO QL=30 EA/30 Days venlafaxine 100mg tab 1 venlafaxine 150mg er cap 1 venlafaxine 25mg tab 1 venlafaxine 37.5mg er cap 1 venlafaxine 37.5mg tab 1 venlafaxine 50mg tab 1 venlafaxine 75mg er cap 1 venlafaxine 75mg tab 1

TRICYCLIC AGENTS amitriptyline 100mg tab 1 PA NSO amitriptyline 10mg tab 1 PA NSO amitriptyline 150mg tab 1 PA NSO amitriptyline 25mg tab 1 PA NSO amitriptyline 50mg tab 1 PA NSO amitriptyline 75mg tab 1 PA NSO AMOXAPINE 100MG TAB 2 PA NSO AMOXAPINE 150MG TAB 2 PA NSO AMOXAPINE 25MG TAB 2 PA NSO AMOXAPINE 50MG TAB 2 PA NSO clomipramine 25mg cap 1 PA NSO clomipramine 50mg cap 1 PA NSO clomipramine 75mg cap 1 PA NSO desipramine 100mg tab 1 PA NSO desipramine 10mg tab 1 PA NSO desipramine 150mg tab 1 PA NSO desipramine 25mg tab 1 PA NSO desipramine 50mg tab 1 PA NSO desipramine 75mg tab 1 PA NSO doxepin 100mg cap 1 PA NSO doxepin 10mg cap 1 PA NSO doxepin 10mg/ml oral soln 1 PA NSO doxepin 150mg cap 1 PA NSO




24

doxepin 25mg cap 1 PA NSO doxepin 50mg cap 1 PA NSO doxepin 75mg cap 1 PA NSO imipramine 10mg tab 1 PA NSO imipramine 25mg tab 1 PA NSO imipramine 50mg tab 1 PA NSO imipramine pamoate 100mg cap 1 PA NSO imipramine pamoate 125mg cap 1 PA NSO imipramine pamoate 150mg cap 1 PA NSO imipramine pamoate 75mg cap 1 PA NSO nortriptyline 10mg cap 1 nortriptyline 25mg cap 1 NORTRIPTYLINE 2MG/ML ORAL SOLN 2 nortriptyline 50mg cap 1 nortriptyline 75mg cap 1 protriptyline 10mg tab 1 PA NSO protriptyline 5mg tab 1 PA NSO trimipramine 100mg cap 1 PA NSO trimipramine 25mg cap 1 PA NSO trimipramine 50mg cap 1 PA NSO



ANTIDIABETICS ALPHA-GLUCOSIDASE INHIBITORS

acarbose 100mg tab 1 acarbose 25mg tab 1 acarbose 50mg tab 1 miglitol 100mg tab 1 miglitol 25mg tab 1 miglitol 50mg tab 1

ANTIDIABETIC COMBINATIONS ALOGLIPTIN 12.5MG/METFORMIN 1000MG TAB 2 ALOGLIPTIN 12.5MG/METFORMIN 500MG TAB 2 ALOGLIPTIN 12.5MG/PIOGLITAZONE 15MG TAB 2 ALOGLIPTIN 12.5MG/PIOGLITAZONE 30MG TAB 2 ALOGLIPTIN 12.5MG/PIOGLITAZONE 45MG TAB 2 ALOGLIPTIN 25MG/PIOGLITAZONE 15MG TAB 2 ALOGLIPTIN 25MG/PIOGLITAZONE 30MG TAB 2 ALOGLIPTIN 25MG/PIOGLITAZONE 45MG TAB 2 glipizide 2.5mg/metformin 250mg tab 1 glipizide 2.5mg/metformin 500mg tab 1 glipizide 5mg/metformin 500mg tab 1 glyburide 1.25mg/metformin 250mg tab 1 glyburide 2.5mg/metformin 500mg tab 1 glyburide 5mg/metformin 500mg tab 1


25

JANUMET 100-1000MG XR TAB 2 QL=30 EA/30 Days JANUMET 50-1000MG TAB 2 QL=60 EA/30 Days JANUMET 50-1000MG XR TAB 2 QL=60 EA/30 Days JANUMET 50-500MG TAB 2 QL=60 EA/30 Days JANUMET 50-500MG XR TAB 2 QL=60 EA/30 Days SEGLUROMET 2.5-1000MG TAB 2 QL=60 EA/30 Days SEGLUROMET 2.5-500MG TAB 2 QL=120 EA/30 Days SEGLUROMET 7.5-1000MG TAB 2 QL=60 EA/30 Days SEGLUROMET 7.5-500MG TAB 2 QL=60 EA/30 Days SYNJARDY 12.5-1000MG TAB 2 QL=60 EA/30 Days SYNJARDY 12.5-500MG TAB 2 QL=60 EA/30 Days SYNJARDY 5-1000MG TAB 2 QL=60 EA/30 Days SYNJARDY 5-500MG TAB 2 QL=60 EA/30 Days SYNJARDY XR 10-1000MG TAB 2 QL=30 EA/30 Days SYNJARDY XR 12.5-1000MG TAB 2 QL=60 EA/30 Days SYNJARDY XR 25-1000MG TAB 2 QL=30 EA/30 Days SYNJARDY XR 5-1000MG TAB 2 QL=60 EA/30 Days

BIGUANIDES metformin 1000mg tab 1 metformin 500mg er tab 1 metformin 500mg tab 1 metformin 750mg er tab 1 metformin 850mg tab 1

DIABETIC OTHER BAQSIMI 3MG/DOSE NASAL POWDER 2 QL=2 EA/7 Days DEX-4 CHEW 1GM* 4 GLUCAGEN 1MG INJ 2 QL=2 EA/7 Days GLUCAGON 1MG INJ 2 QL=2 EA/7 Days GLUCOSE CHEW TAB 4GM* 4 GLUCOSE CHEW TAB 5GM* 4 glucose gel 40%* 4 GVOKE 0.5MG/0.1ML SYRINGE 2 QL=.20 ML/7 Days GVOKE 1MG/0.2ML SYRINGE 2 QL=.40 ML/7 Days KORLYM 300MG TAB 2 NDS PA PROGLYCEM 50MG/ML SUSP 2

DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS ALOGLIPTIN 12.5MG TAB 2 ALOGLIPTIN 25MG TAB 2 ALOGLIPTIN 6.25MG TAB 2 JANUVIA 100MG TAB 2 QL=30 EA/30 Days JANUVIA 25MG TAB 2 QL=30 EA/30 Days JANUVIA 50MG TAB 2 QL=30 EA/30 Days

INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)




26

BYDUREON 2.35MG/ML AUTO-INJECTOR 2 QL=3.40 ML/28 Days BYDUREON 2MG PEN INJ 2 QL=4 EA/28 Days OZEMPIC 2MG/1.5ML PEN INJ 2 QL=1.50 ML/28 Days OZEMPIC 2MG/1.5ML PEN INJ (1MG DOSE) 2 QL=3 ML/28 Days RYBELSUS 14MG TAB 2 QL=30 EA/30 Days RYBELSUS 3MG TAB 2 QL=30 EA/30 Days RYBELSUS 7MG TAB 2 QL=30 EA/30 Days TRULICITY 0.75MG/0.5ML AUTO-INJECTOR 2 QL=2 ML/28 Days TRULICITY 1.5MG/0.5ML AUTO-INJECTOR 2 QL=2 ML/28 Days VICTOZA 18MG/3ML PEN INJ 2 QL=9 ML/30 Days

INSULIN BASAGLAR 100UNIT/ML PEN INJ 2 FIASP 100UNIT/ML CARTRIDGE 2 FIASP 100UNIT/ML INJ 2 PA BvD FIASP 100UNIT/ML PEN INJ 2 HUMULIN R 500UNIT/ML INJ 2 PA BvD HUMULIN R 500UNIT/ML PEN INJ 2 NOVOLIN 100UNIT/ML INJ 2 NOVOLIN N 100UNIT/ML INJ 2 NOVOLIN R 100UNIT/ML INJ 2 NOVOLOG 100UNIT/ML FLEXPEN 2 NOVOLOG 100UNIT/ML INJ 2 PA BvD NOVOLOG 100UNIT/ML PENFILL 2 NOVOLOG MIX 100UNIT/ML FLEXPEN 2 NOVOLOG MIX 100UNIT/ML INJ 2

INSULIN SENSITIZING AGENTS AVANDIA 2MG TAB 2 AVANDIA 4MG TAB 2 pioglitazone 15mg tab 1 pioglitazone 30mg tab 1 pioglitazone 45mg tab 1

MEGLITINIDE ANALOGUES nateglinide 120mg tab 1 nateglinide 60mg tab 1 repaglinide 0.5mg tab 1 repaglinide 1mg tab 1 repaglinide 2mg tab 1

SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS JARDIANCE 10MG TAB 2 QL=30 EA/30 Days JARDIANCE 25MG TAB 2 QL=30 EA/30 Days STEGLATRO 15MG TAB 2 QL=30 EA/30 Days STEGLATRO 5MG TAB 2 QL=30 EA/30 Days

SULFONYLUREAS




27

glimepiride 1mg tab 1glimepiride 2mg tab 1glimepiride 4mg tab 1glipizide 10mg er tab 1glipizide 10mg tab 1glipizide 2.5mg er tab 1glipizide 5mg er tab 1glipizide 5mg tab 1


Necessary actions, restrictions, or limits on use

ANTIDIARRHEAL/PROBIOTIC AGENTS ANTIDIARRHEAL/PROBIOTIC AGENTS - MISC.

bismuth subsalicylate susp 262mg/15ml* 4 ANTIPERISTALTIC AGENTS

atropine sulfate 0.005mg/ml/diphenoxylate 0.5mg/ml oral soln

1

atropine sulfate 0.025mg/diphenoxylate 2.5mg tab 1loperamide 2mg cap 1

ANTIDIARRHEALS ANTIDIARRHEAL AGENTS - MISC.

bismuth subsalicylate chew tab 262mg* 4bismuth subsalicylate susp 525mg/15ml* 4bismuth subsalicylate tab 262mg* 4

ANTIPERISTALTIC AGENTS loperamide liquid 1mg/7.5ml* 4loperamide tab 2mg* 4

ANTIDOTES ANTIDOTES - CHELATING AGENTS

FERRIPROX 100MG/ML ORAL SOLN 2 NDS PA JADENU 180MG TAB 2 NDS

ANTIDOTES AND SPECIFIC ANTAGONISTS ANTIDOTES - CHELATING AGENTS

deferasirox 125mg tab for oral susp 1 NDS deferasirox 250mg tab for oral susp 1 NDS deferasirox 360mg tab 1 NDS deferasirox 500mg tab for oral susp 1 NDS deferasirox 90mg tab 1 NDS FERRIPROX 1000MG TAB 2 NDS PA FERRIPROX 500MG TAB 2 NDS PA JADENU 180MG GRANULE PACKET 2 NDS JADENU 360MG GRANULE PACKET 2 NDS JADENU 90MG GRANULE PACKET 2 NDS

OPIOID ANTAGONISTS NALOXONE 0.4MG/ML CARTRIDGE 1 QL=2 ML/2 Days naloxone 0.4mg/ml inj 1 QL=2 ML/2 Days


28

NALOXONE 1MG/ML SYRINGE 1 QL=4 ML/2 Days naltrexone 50mg tab 1 NARCAN 4MG/0.1ML NASAL SPRAY 2



ANTIEMETICS 5-HT3 RECEPTOR ANTAGONISTS

granisetron 1mg tab 1 PA BvD QL=60 EA/30 Days ondansetron 0.8mg/ml oral soln 1 PA BvD ondansetron 24mg tab 1 PA BvD ondansetron 4mg odt 1 PA BvD ondansetron 4mg tab 1 PA BvD ondansetron 8mg odt 1 PA BvD ondansetron 8mg tab 1 PA BvD

ANTIEMETICS - ANTICHOLINERGIC dimenhydrinate tab 50mg* 4 meclizine 12.5mg tab 1 meclizine 12.5mg tab(OTC)* 4 meclizine 25mg tab 1 meclizine 25mg tab(OTC)* 4 meclizine chew tab 25mg(OTC)* 4 scopolamine 0.0139mg/hr patch 1

ANTIEMETICS - MISCELLANEOUS dronabinol 10mg cap 1 PA dronabinol 2.5mg cap 1 PA dronabinol 5mg cap 1 PA

SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS aprepitant 125mg cap 1 PA BvD QL=3 EA/2 Days aprepitant 125mg/80mg pack 1 PA BvD QL=6 EA/4 Days aprepitant 40mg cap 1 PA BvD QL=3 EA/2 Days aprepitant 80mg cap 1 PA BvD QL=6 EA/4 Days VARUBI 90MG TAB 2 PA BvD QL=4 EA/28 Days

ANTIFUNGALS ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)

CASPOFUNGIN ACETATE 50MG INJ 2 NDS PA CASPOFUNGIN ACETATE 70MG INJ 2 NDS PA ERAXIS 50MG INJ 2 MYCAMINE 100MG INJ 2 PA MYCAMINE 50MG INJ 2 PA

ANTIFUNGALS ABELCET 5MG/ML INJ 2 PA AMBISOME 50MG INJ 2 PA AMPHOTERICIN B 50MG INJ 2 PA BvD flucytosine 250mg cap 1 flucytosine 500mg cap 1


29

griseofulvin 25mg/ml susp 1 nystatin 500000unit tab 1 terbinafine 250mg tab 1

IMIDAZOLE-RELATED ANTIFUNGALS fluconazole 100mg tab 1 fluconazole 10mg/ml susp 1 fluconazole 150mg tab 1 fluconazole 200mg tab 1 fluconazole 2mg/ml (100ml) inj 1 fluconazole 2mg/ml inj 1 fluconazole 40mg/ml susp 1 fluconazole 50mg tab 1 itraconazole 100mg cap 1 PA ketoconazole 200mg tab 1 NOXAFIL 40MG/ML SUSP 2 PA posaconazole 100mg dr tab 1 NDS PA voriconazole 200mg inj 1 PA voriconazole 200mg tab 1 NDS PA voriconazole 40mg/ml susp 1 PA voriconazole 50mg tab 1 NDS PA



ANTIHISTAMINES ANTIHISTAMINES - ALKYLAMINES

chlorpheniramine caleate tab 4mg* 4 chlorpheniramine maleate CR tab 12mg* 4 chlorpheniramine maleate syrup 2mg/5ml* 4

ANTIHISTAMINES - ETHANOLAMINES clemastine fumarate tab 1.34mg* 4 diphenhydramine cap 25mg* 4 diphenhydramine cap 50mg* 4 diphenhydramine liquid 12.5mg/5ml* 4 diphenhydramine liquid 6.25mg/ml* 4 diphenhydramine tab 25mg* 4

ANTIHISTAMINES - NON-SEDATING cetirizine 1mg/ml oral soln 1 cetirizine 1mg/ml oral soln* 4 cetirizine chew tab 10mg* 4 cetirizine chew tab 5mg* 4 cetirizine tab 10mg* 4 QL=30 EA/30 Days cetirizine tab 5mg* 4 QL=30 EA/30 Days desloratadine 5mg tab 1 levocetirizine 0.5mg/ml oral soln 1 levocetirizine 5mg tab 1 loratadine rapidly-disintegrating tab 10mg* 4 QL=30 EA/30 Days


30

loratadine syrup 5mg/5ml* 4 QL=300 ML/30 Days loratadine tab 10mg* 4 QL=30 EA/30 Days

ANTIHISTAMINES - PHENOTHIAZINES phenadoz 12.5mg rectal supp 1 promethazine 1.25mg/ml oral soln 1 promethazine 12.5mg rectal supp 1 promethazine 12.5mg tab 1 promethazine 25mg rectal supp 1 promethazine 25mg tab 1 promethazine 50mg tab 1 promethegan 25mg rectal supp 1 promethegan 50mg rectal supp 1



ANTIHYPERLIPIDEMICS ANTIHYPERLIPIDEMICS - MISC.

omega-3 acid ethyl esters (usp) 1000mg cap 1 QL=120 EA/30 Days VASCEPA 1GM CAP 2 PA QL=120 EA/30 Days VASCEPA 500MG CAP 2 PA QL=120 EA/30 Days

BILE ACID SEQUESTRANTS cholestyramine resin 4gm sf powder for oral susp 1 cholestyramine resin 66.7mg/ml susp 1 colesevelam hcl 625mg tab 1 colestipol 1000mg tab 1 colestipol 5000mg granules 1 prevalite 4gm/dose susp 1

FIBRIC ACID DERIVATIVES fenofibrate 134mg cap 1 fenofibrate 145mg tab 1 fenofibrate 160mg tab 1 fenofibrate 200mg cap 1 fenofibrate 48mg tab 1 fenofibrate 54mg tab 1 fenofibrate 67mg cap 1 fenofibric acid 135mg dr cap 1 fenofibric acid 45mg dr cap 1 gemfibrozil 600mg tab 1 QL=60 EA/30 Days

HMG COA REDUCTASE INHIBITORS atorvastatin 10mg tab 1 atorvastatin 20mg tab 1 atorvastatin 40mg tab 1 atorvastatin 80mg tab 1 fluvastatin 20mg cap 1 fluvastatin 40mg cap 1 fluvastatin 80mg er tab 1


31

lovastatin 10mg tab 1 lovastatin 20mg tab 1 lovastatin 40mg tab 1 pravastatin sodium 10mg tab 1 pravastatin sodium 20mg tab 1 pravastatin sodium 40mg tab 1 pravastatin sodium 80mg tab 1 rosuvastatin 10mg tab 1 rosuvastatin 20mg tab 1 rosuvastatin 40mg tab 1 rosuvastatin 5mg tab 1 simvastatin 10mg tab 1 simvastatin 20mg tab 1 simvastatin 40mg tab 1 simvastatin 5mg tab 1 simvastatin 80mg tab 1

INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS ezetimibe 10mg tab 1 QL=30 EA/30 Days

MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN (MTP) INHIBITORS JUXTAPID 10MG CAP 2 NDS PA JUXTAPID 20MG CAP 2 NDS PA JUXTAPID 30MG CAP 2 NDS PA JUXTAPID 40MG CAP 2 NDS PA JUXTAPID 5MG CAP 2 NDS PA JUXTAPID 60MG CAP 2 NDS PA

NICOTINIC ACID DERIVATIVES niacin 1000mg er tab 1 niacin 500mg er tab 1 niacin 750mg er tab 1

PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 INHIBITORS PRALUENT 150MG/ML AUTO-INJECTOR 2 NDS PA QL=2 ML/28 Days PRALUENT 75MG/ML AUTO-INJECTOR 2 NDS PA QL=2 ML/28 Days REPATHA 120MG/ML CARTRIDGE 2 NDS PA QL=3.50 ML/28 Days REPATHA 140MG/ML AUTO-INJECTOR 2 NDS PA QL=2 ML/28 Days REPATHA 140MG/ML SYRINGE 2 NDS PA QL=2 ML/28 Days



ANTIHYPERTENSIVES ACE INHIBITORS

benazepril 10mg tab 1 benazepril 20mg tab 1 benazepril 40mg tab 1 benazepril 5mg tab 1 captopril 100mg tab 1 captopril 12.5mg tab 1


32

captopril 25mg tab 1 captopril 50mg tab 1 enalapril maleate 10mg tab 1 enalapril maleate 2.5mg tab 1 enalapril maleate 20mg tab 1 enalapril maleate 5mg tab 1 fosinopril sodium 10mg tab 1 fosinopril sodium 20mg tab 1 fosinopril sodium 40mg tab 1 lisinopril 10mg tab 1 lisinopril 2.5mg tab 1 lisinopril 20mg tab 1 lisinopril 30mg tab 1 lisinopril 40mg tab 1 lisinopril 5mg tab 1 QBRELIS 1MG/ML ORAL SOLN 2 PA quinapril 10mg tab 1 quinapril 20mg tab 1 quinapril 40mg tab 1 quinapril 5mg tab 1 ramipril 1.25mg cap 1 ramipril 10mg cap 1 ramipril 2.5mg cap 1 ramipril 5mg cap 1

AGENTS FOR PHEOCHROMOCYTOMA DEMSER 250MG CAP 2 NDS phenoxybenzamine 10mg cap 1

ANGIOTENSIN II RECEPTOR ANTAGONISTS irbesartan 150mg tab 1 irbesartan 300mg tab 1 irbesartan 75mg tab 1 losartan potassium 100mg tab 1 losartan potassium 25mg tab 1 losartan potassium 50mg tab 1 olmesartan medoxomil 20mg tab 1 olmesartan medoxomil 40mg tab 1 olmesartan medoxomil 5mg tab 1 telmisartan 20mg tab 1 telmisartan 40mg tab 1 telmisartan 80mg tab 1 valsartan 160mg tab 1 valsartan 320mg tab 1 valsartan 40mg tab 1




33

valsartan 80mg tab 1 ANTIADRENERGIC ANTIHYPERTENSIVES

clonidine 0.00417mg/hr patch 1 clonidine 0.00833mg/hr patch 1 clonidine 0.0125mg/hr patch 1 clonidine 0.1mg tab 1 clonidine 0.2mg tab 1 clonidine 0.3mg tab 1 doxazosin 1mg tab 1 doxazosin 2mg tab 1 doxazosin 4mg tab 1 doxazosin 8mg tab 1 prazosin 1mg cap 1 prazosin 2mg cap 1 prazosin 5mg cap 1 terazosin 10mg cap 1 terazosin 1mg cap 1 terazosin 2mg cap 1 terazosin 5mg cap 1

ANTIHYPERTENSIVE COMBINATIONS amlodipine 10mg/benazepril 20mg cap 1 amlodipine 10mg/benazepril 40mg cap 1 amlodipine 10mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab

1

amlodipine 10mg/hydrochlorothiazide 25mg/valsartan 160mg tab

1


1

amlodipine 10mg/olmesartan medoxomil 20mg tab 1 amlodipine 10mg/olmesartan medoxomil 40mg tab 1 amlodipine 10mg/valsartan 160mg tab 1 amlodipine 10mg/valsartan 320mg tab 1 amlodipine 2.5mg/benazepril 10mg cap 1 amlodipine 5mg/benazepril 10mg cap 1 amlodipine 5mg/benazepril 20mg cap 1 amlodipine 5mg/benazepril 40mg cap 1 amlodipine 5mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab

1


1

amlodipine 5mg/olmesartan medoxomil 20mg tab 1 amlodipine 5mg/olmesartan medoxomil 40mg tab 1 amlodipine 5mg/valsartan 160mg tab 1




34

amlodipine 5mg/valsartan 320mg tab 1 atenolol 100mg/chlorthalidone 25mg tab 1 atenolol 50mg/chlorthalidone 25mg tab 1 benazepril 10mg/hydrochlorothiazide 12.5mg tab 1 benazepril 20mg/hydrochlorothiazide 12.5mg tab 1 benazepril 20mg/hydrochlorothiazide 25mg tab 1 benazepril 5mg/hydrochlorothiazide 6.25mg tab 1 bisoprolol fumarate 10mg/hydrochlorothiazide 6.25mg tab

1

bisoprolol fumarate 2.5mg/hydrochlorothiazide 6.25mg tab

1

bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

1

captopril 25mg/hydrochlorothiazide 15mg tab 1 CAPTOPRIL 25MG/HYDROCHLOROTHIAZIDE 25MG TAB

1

captopril 50mg/hydrochlorothiazide 15mg tab 1 CAPTOPRIL 50MG/HYDROCHLOROTHIAZIDE 25MG TAB

1

enalapril maleate 10mg/hydrochlorothiazide 25mg tab

1

enalapril maleate 5mg/hydrochlorothiazide 12.5mg tab

1

fosinopril sodium 10mg/hydrochlorothiazide 12.5mg tab

1

fosinopril sodium 20mg/hydrochlorothiazide 12.5mg tab

1

hydrochlorothiazide 12.5mg/irbesartan 150mg tab 1 hydrochlorothiazide 12.5mg/irbesartan 300mg tab 1 hydrochlorothiazide 12.5mg/lisinopril 10mg tab 1 hydrochlorothiazide 12.5mg/lisinopril 20mg tab 1 hydrochlorothiazide 12.5mg/losartan potassium 100mg tab

1

hydrochlorothiazide 12.5mg/losartan potassium 50mg tab

1

hydrochlorothiazide 12.5mg/olmesartan medoxomil 20mg tab

1


1

hydrochlorothiazide 12.5mg/quinapril 10mg tab 1 hydrochlorothiazide 12.5mg/quinapril 20mg tab 1 hydrochlorothiazide 12.5mg/telmisartan 40mg tab 1 hydrochlorothiazide 12.5mg/telmisartan 80mg tab 1




35

hydrochlorothiazide 12.5mg/valsartan 160mg tab 1 hydrochlorothiazide 12.5mg/valsartan 320mg tab 1 hydrochlorothiazide 12.5mg/valsartan 80mg tab 1 hydrochlorothiazide 25mg/lisinopril 20mg tab 1 hydrochlorothiazide 25mg/losartan potassium 100mg tab

1

hydrochlorothiazide 25mg/metoprolol tartrate 100mg tab

1


1

hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

1

hydrochlorothiazide 25mg/propranolol 40mg tab 1 hydrochlorothiazide 25mg/propranolol 80mg tab 1 hydrochlorothiazide 25mg/quinapril 20mg tab 1 hydrochlorothiazide 25mg/telmisartan 80mg tab 1 hydrochlorothiazide 25mg/valsartan 160mg tab 1 hydrochlorothiazide 25mg/valsartan 320mg tab 1 hydrochlorothiazide 50mg/metoprolol tartrate 100mg tab

1

DIRECT RENIN INHIBITORS aliskiren 150mg tab 1 aliskiren 300mg tab 1

SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS) eplerenone 25mg tab 1 eplerenone 50mg tab 1

VASODILATORS hydralazine 100mg tab 1 hydralazine 10mg tab 1 hydralazine 25mg tab 1 hydralazine 50mg tab 1 minoxidil 10mg tab 1 minoxidil 2.5mg tab 1



ANTI-INFECTIVE AGENTS - MISC. ANTI-INFECTIVE AGENTS - MISC.

metronidazole 250mg tab 1 metronidazole 375mg cap 1 metronidazole 500mg tab 1 metronidazole 5mg/ml inj 1 PENTAM 300MG INJ 2 pentamidine isethionate 300mg inj 1 pentamidine isethionate 50mg/ml inh soln 1 PA BvD tinidazole 250mg tab 1


36

tinidazole 500mg tab 1 trimethoprim 100mg tab 1 XIFAXAN 200MG TAB 2 QL=9 EA/3 Days XIFAXAN 550MG TAB 2 PA QL=60 EA/30 Days

ANTI-INFECTIVE MISC. - COMBINATIONS sulfamethoxazole 400mg/trimethoprim 80mg tab 1 sulfamethoxazole 40mg/ml/trimethoprim 8mg/ml susp 1 sulfamethoxazole 800mg/trimethoprim 160mg tab 1

ANTIPROTOZOAL AGENTS ALINIA 100MG/5ML SUSP 2 PA QL=150 ML/3 Days ALINIA 500MG TAB 2 PA QL=6 EA/3 Days atovaquone 150mg/ml susp 1

CARBAPENEMS cilastatin 2.5mg/ml/imipenem 2.5mg/ml inj 1 cilastatin 5mg/ml/imipenem 5mg/ml inj 1 ertapenem 1gm inj 1 meropenem 1gm inj 1 meropenem 500mg inj 1

CYCLIC LIPOPEPTIDES DAPTOMYCIN 350MG INJ 2 NDS daptomycin 500mg inj 1 NDS

GLYCOPEPTIDES DALVANCE 500MG INJ 2 NDS FIRVANQ 25MG/ML ORAL SOLN 1 FIRVANQ 50MG/ML ORAL SOLN 1 vancomycin 100mg/ml inj 1 vancomycin 125mg cap 1 ST QL=120 EA/30 Days vancomycin 250mg cap 1 ST QL=120 EA/30 Days VANCOMYCIN 250MG INJ 1 vancomycin 50mg/ml inj 1 VANCOMYCIN 50MG/ML ORAL SOLN 1 vancomycin 5mg/ml inj 1 vancomycin 750mg inj 1

LEPROSTATICS dapsone 100mg tab 1 dapsone 25mg tab 1

LINCOSAMIDES clindamycin 12mg/ml inj 1 clindamycin 150mg cap 1 clindamycin 150mg/ml (2ml) inj 1 clindamycin 150mg/ml (4ml) inj 1 clindamycin 150mg/ml (6ml) inj 1 clindamycin 15mg/ml oral soln 1




37

clindamycin 18mg/ml inj 1 clindamycin 300mg cap 1 clindamycin 6mg/ml inj 1 clindamycin 75mg cap 1

MONOBACTAMS aztreonam 333mg/ml inj 1 CAYSTON 75MG INH SOLN 2 NDS PA

OXAZOLIDINONES linezolid 20mg/ml susp 1 PA linezolid 2mg/ml inj 1 NDS PA linezolid 600mg tab 1 PA SIVEXTRO 200MG INJ 2 NDS PA QL=6 EA/6 Days SIVEXTRO 200MG TAB 2 NDS PA QL=6 EA/6 Days

POLYMYXINS colistin 75mg/ml inj 1 polymyxin b 250000unit/ml inj 1



ANTIMALARIALS ANTIMALARIAL COMBINATIONS

atovaquone 250mg/proguanil 100mg tab 1 atovaquone 62.5mg/proguanil 25mg tab 1 COARTEM 20-120MG TAB 2

ANTIMALARIALS CHLOROQUINE PHOSPHATE 250MG TAB 1 chloroquine phosphate 500mg tab 1 DARAPRIM 25MG TAB 2 NDS QL=90 EA/30 Days hydroxychloroquine sulfate 200mg tab 1 KRINTAFEL 150MG TAB 2 MEFLOQUINE 250MG TAB 2 PRIMAQUINE PHOSPHATE 26.3MG TAB 1 quinine sulfate 324mg cap 1

ANTIMYASTHENIC/CHOLINERGIC AGENTS ANTIMYASTHENIC/CHOLINERGIC AGENTS

GUANIDINE 125MG TAB 2 pyridostigmine bromide 180mg er tab 1 pyridostigmine bromide 60mg tab 1 RUZURGI 10MG TAB 2 NDS PA

ANTIMYCOBACTERIAL AGENTS ANTI TB COMBINATIONS

RIFAMATE 150-300MG CAP 2 RIFATER 50-120-300MG TAB 2

ANTIMYCOBACTERIAL AGENTS ethambutol 100mg tab 1 ethambutol 400mg tab 1


38

isoniazid 100mg tab 1 ISONIAZID 10MG/ML ORAL SOLN 2 isoniazid 300mg tab 1 PASER D/R 4GM GRANULES 2 PRIFTIN 150MG TAB 2 pyrazinamide 500mg tab 1 rifabutin 150mg cap 1 rifampin 150mg cap 1 rifampin 300mg cap 1 rifampin 60mg/ml inj 1 SIRTURO 100MG TAB 2 NDS PA TRECATOR 250MG TAB 2



ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES ALKYLATING AGENTS

CYCLOPHOSPHAMIDE 25MG CAP 2 PA BvD CYCLOPHOSPHAMIDE 50MG CAP 2 PA BvD GLEOSTINE 100MG CAP 2 GLEOSTINE 10MG CAP 2 GLEOSTINE 40MG CAP 2 LEUKERAN 2MG TAB 2

ANTIMETABOLITES mercaptopurine 50mg tab 1 methotrexate 2.5mg tab 1 methotrexate 250mg/10ml inj 1 methotrexate 50mg/2ml inj 1 PURIXAN 2000MG/100ML SUSP 2 TABLOID 40MG TAB 2 TREXALL 10MG TAB 2 TREXALL 15MG TAB 2 TREXALL 5MG TAB 2 TREXALL 7.5MG TAB 2 XATMEP 2.5MG/ML ORAL SOLN 2 PA

ANTINEOPLASTIC - BCL-2 INHIBITORS VENCLEXTA 10/100/50MG STARTING PACK 2 NDS PA NSO VENCLEXTA 100MG TAB 2 NDS PA NSO VENCLEXTA 10MG TAB 2 PA NSO VENCLEXTA 50MG TAB 2 PA NSO

ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS DAURISMO 100MG TAB 2 NDS PA NSO DAURISMO 25MG TAB 2 NDS PA NSO ERIVEDGE 150MG CAP 2 NDS PA NSO ODOMZO 200MG CAP 2 NDS PA NSO

ANTINEOPLASTIC - HORMONAL AND RELATED AGENTS


39

abiraterone 250mg tab 1 NDS QL=120 EA/30 Days anastrozole 1mg tab 1 bicalutamide 50mg tab 1 DEPO-PROVERA 400MG/ML INJ 2 ELIGARD 22.5MG SYRINGE 2 ELIGARD 30MG SYRINGE 2 ELIGARD 45MG SYRINGE 2 ELIGARD 7.5MG SYRINGE 2 EMCYT 140MG CAP 2 ERLEADA 60MG TAB 2 NDS PA NSO QL=120 EA/30 Days exemestane 25mg tab 1 FIRMAGON 120MG INJ 2 PA NSO FIRMAGON 80MG INJ 2 PA NSO flutamide 125mg cap 1 letrozole 2.5mg tab 1 leuprolide acetate 5mg/ml inj 1 LUPRON 11.25MG (1.5ML) SYRINGE 2 LUPRON 22.5MG SYRINGE 2 LUPRON 3.75MG SYRINGE 2 LUPRON 30MG SYRINGE 2 LUPRON 45MG SYRINGE 2 LUPRON 7.5MG SYRINGE 2 LYSODREN 500MG TAB 2 megestrol acetate 20mg tab 1 PA NSO megestrol acetate 40mg tab 1 PA NSO megestrol acetate 40mg/ml susp 1 PA nilutamide 150mg tab 1 NUBEQA 300MG TAB 2 NDS PA NSO QL=120 EA/30 Days SOLTAMOX 10MG/5ML ORAL SOLN 2 PA NSO tamoxifen 10mg tab 1 tamoxifen 20mg tab 1 toremifene 60mg tab 1 TRELSTAR 11.25MG INJ 2 TRELSTAR 22.5MG INJ 2 TRELSTAR 3.75MG INJ 2 XTANDI 40MG CAP 2 NDS PA NSO QL=120 EA/30 Days

ANTINEOPLASTIC - IMMUNOMODULATORS POMALYST 1MG CAP 2 NDS PA NSO POMALYST 2MG CAP 2 NDS PA NSO POMALYST 3MG CAP 2 NDS PA NSO POMALYST 4MG CAP 2 NDS PA NSO

ANTINEOPLASTIC - XPO1 INHIBITORS XPOVIO 100MG ONCE WEEKLY PACK 2 NDS PA NSO




40

XPOVIO 60MG ONCE WEEKLY PACK 2 NDS PA NSO XPOVIO 80MG ONCE WEEKLY PACK 2 NDS PA NSO XPOVIO 80MG TWICE WEEKLY PACK 2 NDS PA NSO

ANTINEOPLASTIC COMBINATIONS KISQALI/FEMARA TAB CO-PACK 200MG 2 NDS PA NSO QL=49 EA/28 Days KISQALI/FEMARA TAB CO-PACK 400MG 2 NDS PA NSO QL=70 EA/28 Days KISQALI/FEMARA TAB CO-PACK 600MG 2 NDS PA NSO QL=91 EA/28 Days LONSURF 15-6.14MG TAB 2 NDS PA NSO LONSURF 20-8.19MG TAB 2 NDS PA NSO

ANTINEOPLASTIC ENZYME INHIBITORS AFINITOR 10MG TAB 2 NDS PA NSO QL=30 EA/30 Days AFINITOR 2MG SUSP 2 NDS PA NSO AFINITOR 3MG SUSP 2 NDS PA NSO AFINITOR 5MG SUSP 2 NDS PA NSO ALECENSA 150MG CAP 2 NDS PA NSO QL=240 EA/30 Days ALUNBRIG 180MG TAB 2 NDS PA NSO QL=30 EA/30 Days ALUNBRIG 30MG TAB 2 NDS PA NSO QL=120 EA/30 Days ALUNBRIG 90MG TAB 2 NDS PA NSO QL=30 EA/30 Days ALUNBRIG TAB STARTER PACK 2 NDS PA NSO QL=30 EA/30 Days AYVAKIT 100MG TAB 2 NDS PA NSO QL=30 EA/30 Days AYVAKIT 200MG TAB 2 NDS PA NSO QL=30 EA/30 Days AYVAKIT 300MG TAB 2 NDS PA NSO QL=30 EA/30 Days BALVERSA 3MG TAB 2 NDS PA NSO QL=60 EA/30 Days BALVERSA 4MG TAB 2 NDS PA NSO QL=60 EA/30 Days BALVERSA 5MG TAB 2 NDS PA NSO QL=30 EA/30 Days BOSULIF 100MG TAB 2 NDS PA NSO BOSULIF 400MG TAB 2 NDS PA NSO BOSULIF 500MG TAB 2 NDS PA NSO BRAFTOVI 75MG CAP 2 NDS PA NSO QL=180 EA/30 Days BRUKINSA 80MG CAP 2 NDS PA NSO QL=120 EA/30 Days CABOMETYX 20MG TAB 2 NDS PA NSO CABOMETYX 40MG TAB 2 NDS PA NSO CABOMETYX 60MG TAB 2 NDS PA NSO CALQUENCE 100MG CAP 2 NDS PA NSO QL=60 EA/30 Days CAPRELSA 100MG TAB 2 NDS PA NSO QL=60 EA/30 Days CAPRELSA 300MG TAB 2 NDS PA NSO QL=30 EA/30 Days COMETRIQ 100MG DAILY DOSE CARTON PACK 2 NDS PA NSO COMETRIQ 140MG DAILY DOSE CARTON PACK 2 NDS PA NSO COMETRIQ 60MG DAILY DOSE CARTON PACK 2 NDS PA NSO COPIKTRA 15MG CAP 2 NDS PA NSO QL=60 EA/30 Days COPIKTRA 25MG CAP 2 NDS PA NSO QL=60 EA/30 Days COTELLIC 20MG TAB 2 NDS PA NSO QL=63 EA/28 Days erlotinib 100mg tab 1 NDS PA NSO




41

erlotinib 150mg tab 1 NDS PA NSO erlotinib 25mg tab 1 NDS PA NSO everolimus 2.5mg tab 1 NDS PA NSO QL=30 EA/30 Days everolimus 5mg tab 1 NDS PA NSO QL=30 EA/30 Days everolimus 7.5mg tab 1 NDS PA NSO QL=30 EA/30 Days FARYDAK 10MG CAP 2 NDS PA NSO FARYDAK 20MG CAP 2 NDS PA NSO GILOTRIF 20MG TAB 2 NDS PA NSO QL=30 EA/30 Days GILOTRIF 30MG TAB 2 NDS PA NSO QL=30 EA/30 Days GILOTRIF 40MG TAB 2 NDS PA NSO QL=30 EA/30 Days IBRANCE 100MG CAP 2 NDS PA NSO QL=21 EA/28 Days IBRANCE 125MG CAP 2 NDS PA NSO QL=21 EA/28 Days IBRANCE 75MG CAP 2 NDS PA NSO QL=21 EA/28 Days ICLUSIG 15MG TAB 2 NDS PA NSO QL=60 EA/30 Days ICLUSIG 45MG TAB 2 NDS PA NSO QL=30 EA/30 Days IDHIFA 100MG TAB 2 NDS PA NSO QL=30 EA/30 Days IDHIFA 50MG TAB 2 NDS PA NSO QL=30 EA/30 Days imatinib 100mg tab 1 PA NSO imatinib 400mg tab 1 PA NSO IMBRUVICA 140MG CAP 2 NDS PA NSO QL=90 EA/30 Days IMBRUVICA 140MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 280MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 420MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 560MG TAB 2 NDS PA NSO QL=30 EA/30 Days IMBRUVICA 70MG CAP 2 NDS PA NSO QL=30 EA/30 Days INLYTA 1MG TAB 2 NDS PA NSO INLYTA 5MG TAB 2 NDS PA NSO INREBIC 100MG CAP 2 NDS PA NSO QL=120 EA/30 Days IRESSA 250MG TAB 2 NDS PA NSO JAKAFI 10MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 15MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 20MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 25MG TAB 2 NDS PA NSO QL=60 EA/30 Days JAKAFI 5MG TAB 2 NDS PA NSO QL=60 EA/30 Days KISQALI 200MG DAILY DOSE PACK 2 NDS PA NSO QL=21 EA/28 Days KISQALI 400MG DAILY DOSE PACK 2 NDS PA NSO QL=42 EA/28 Days KISQALI 600MG DAILY DOSE PACK 2 NDS PA NSO QL=63 EA/28 Days LENVIMA (10) 10MG PACK 2 NDS PA NSO LENVIMA (12) 4MG PACK 2 NDS PA NSO LENVIMA (14) PACK 2 NDS PA NSO LENVIMA (18) PACK 2 NDS PA NSO LENVIMA (20) 10MG PACK 2 NDS PA NSO LENVIMA (24) PACK 2 NDS PA NSO




42

LENVIMA (4) 4MG PACK 2 NDS PA NSO LENVIMA (8) 4MG PACK 2 NDS PA NSO LORBRENA 100MG TAB 2 NDS PA NSO QL=30 EA/30 Days LORBRENA 25MG TAB 2 NDS PA NSO QL=90 EA/30 Days LYNPARZA 100MG TAB 2 NDS PA NSO QL=120 EA/30 Days LYNPARZA 150MG TAB 2 NDS PA NSO QL=120 EA/30 Days MEKINIST 0.5MG TAB 2 NDS PA NSO QL=90 EA/30 Days MEKINIST 2MG TAB 2 NDS PA NSO QL=30 EA/30 Days MEKTOVI 15MG TAB 2 NDS PA NSO QL=180 EA/30 Days NERLYNX 40MG TAB 2 NDS PA NSO NEXAVAR 200MG TAB 2 NDS PA NSO NINLARO 2.3MG CAP 2 NDS PA NSO NINLARO 3MG CAP 2 NDS PA NSO NINLARO 4MG CAP 2 NDS PA NSO PIQRAY 200MG DAILY DOSE PACK 2 NDS PA NSO QL=30 EA/30 Days PIQRAY 250MG DAILY DOSE PACK 2 NDS PA NSO QL=60 EA/30 Days PIQRAY 300MG DAILY DOSE 150MG PACK 2 NDS PA NSO QL=60 EA/30 Days ROZLYTREK 100MG CAP 2 NDS PA NSO QL=30 EA/30 Days ROZLYTREK 200MG CAP 2 NDS PA NSO QL=90 EA/30 Days RUBRACA 200MG TAB 2 NDS PA NSO QL=120 EA/30 Days RUBRACA 250MG TAB 2 NDS PA NSO QL=120 EA/30 Days RUBRACA 300MG TAB 2 NDS PA NSO QL=120 EA/30 Days RYDAPT 25MG CAP 2 NDS PA NSO SPRYCEL 100MG TAB 2 NDS PA NSO SPRYCEL 140MG TAB 2 NDS PA NSO SPRYCEL 20MG TAB 2 NDS PA NSO SPRYCEL 50MG TAB 2 NDS PA NSO SPRYCEL 70MG TAB 2 NDS PA NSO SPRYCEL 80MG TAB 2 NDS PA NSO STIVARGA 40MG TAB 2 NDS PA NSO QL=120 EA/30 Days SUTENT 12.5MG CAP 2 NDS PA NSO SUTENT 25MG CAP 2 NDS PA NSO SUTENT 37.5MG CAP 2 NDS PA NSO SUTENT 50MG CAP 2 NDS PA NSO TAFINLAR 50MG CAP 2 NDS PA NSO QL=120 EA/30 Days TAFINLAR 75MG CAP 2 NDS PA NSO QL=120 EA/30 Days TAGRISSO 40MG TAB 2 NDS PA NSO TAGRISSO 80MG TAB 2 NDS PA NSO TALZENNA 0.25MG CAP 2 NDS PA NSO QL=90 EA/30 Days TALZENNA 1MG CAP 2 NDS PA NSO QL=30 EA/30 Days TASIGNA 150MG CAP 2 NDS PA NSO TASIGNA 200MG CAP 2 NDS PA NSO TASIGNA 50MG CAP 2 NDS PA NSO




43

TAZVERIK 200MG TAB 2 NDS PA NSO QL=240 EA/30 Days TIBSOVO 250MG TAB 2 NDS PA NSO QL=60 EA/30 Days TURALIO 200MG CAP 2 NDS PA NSO QL=120 EA/30 Days TYKERB 250MG TAB 2 NDS PA NSO VERZENIO 100MG TAB 2 NDS PA NSO QL=56 EA/28 Days VERZENIO 150MG TAB 2 NDS PA NSO QL=56 EA/28 Days VERZENIO 200MG TAB 2 NDS PA NSO QL=56 EA/28 Days VERZENIO 50MG TAB 2 NDS PA NSO QL=56 EA/28 Days VITRAKVI 100MG CAP 2 NDS PA NSO VITRAKVI 20MG/ML ORAL SOLN 2 NDS PA NSO VITRAKVI 25MG CAP 2 NDS PA NSO VIZIMPRO 15MG TAB 2 NDS PA NSO QL=30 EA/30 Days VIZIMPRO 30MG TAB 2 NDS PA NSO QL=30 EA/30 Days VIZIMPRO 45MG TAB 2 NDS PA NSO QL=30 EA/30 Days VOTRIENT 200MG TAB 2 NDS PA NSO XALKORI 200MG CAP 2 NDS PA NSO QL=60 EA/30 Days XALKORI 250MG CAP 2 NDS PA NSO QL=60 EA/30 Days XOSPATA 40MG TAB 2 NDS PA NSO ZEJULA 100MG CAP 2 NDS PA NSO QL=90 EA/30 Days ZELBORAF 240MG TAB 2 NDS PA NSO QL=240 EA/30 Days ZOLINZA 100MG CAP 2 NDS PA NSO ZYDELIG 100MG TAB 2 NDS PA NSO QL=60 EA/30 Days ZYDELIG 150MG TAB 2 NDS PA NSO QL=60 EA/30 Days ZYKADIA 150MG TAB 2 NDS PA NSO QL=150 EA/30 Days

ANTINEOPLASTICS MISC. ACTIMMUNE 2000000UNIT/0.5ML INJ 2 NDS PA NSO bexarotene 75mg cap 1 NDS PA NSO hydroxyurea 500mg cap 1 INTRON A 10MU INJ 2 INTRON A 18MU INJ 2 NDS INTRON A 25MU INJ 2 INTRON A 50MU INJ 2 NDS INTRON A 6000000UNIT/ML INJ 2 MATULANE 50MG CAP 2 NDS SYLATRON 200MCG INJ 2 NDS PA NSO SYLATRON 300MCG INJ 2 NDS PA NSO SYNRIBO 3.5MG INJ 2 NDS tretinoin 10mg cap 1

CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS LEUCOVORIN 10MG TAB 1 LEUCOVORIN 15MG TAB 1 leucovorin 25mg tab 1 leucovorin 5mg tab 1




44

MESNEX 400MG TAB 2



ANTIPARKINSON AGENTS ANTIPARKINSON DOPAMINERGICS

amantadine 100mg cap 1 amantadine 10mg/ml oral soln 1 bromocriptine 2.5mg tab 1 bromocriptine 5mg cap 1 carbidopa 10mg/levodopa 100mg odt 1 carbidopa 10mg/levodopa 100mg tab 1 CARBIDOPA 12.5MG/ENTACAPONE 200MG/LEVODOPA 50MG TAB

2

CARBIDOPA 18.75MG/ENTACAPONE 200MG/LEVODOPA 75MG TAB

2

CARBIDOPA 25MG/ENTACAPONE 200MG/LEVODOPA 100MG TAB

2

carbidopa 25mg/levodopa 100mg er tab 1 carbidopa 25mg/levodopa 100mg odt 1 carbidopa 25mg/levodopa 100mg tab 1 carbidopa 25mg/levodopa 250mg odt 1 CARBIDOPA 31.25MG/ENTACAPONE 200MG/LEVODOPA 125MG TAB

2


2


2

carbidopa 50mg/levodopa 200mg er tab 1 NEUPRO 1MG/24HR PATCH 2 QL=30 EA/30 Days NEUPRO 2MG/24HR PATCH 2 QL=30 EA/30 Days NEUPRO 3MG/24HR PATCH 2 QL=30 EA/30 Days NEUPRO 4MG/24HR PATCH 2 QL=30 EA/30 Days NEUPRO 6MG/24HR PATCH 2 QL=30 EA/30 Days NEUPRO 8MG/24HR PATCH 2 QL=30 EA/30 Days pramipexole 0.125mg tab 1 pramipexole 0.25mg tab 1 pramipexole 0.5mg tab 1 pramipexole 0.75mg tab 1 pramipexole 1.5mg tab 1 pramipexole 1mg tab 1 ropinirole 0.25mg tab 1 ropinirole 0.5mg tab 1 ropinirole 3mg tab 1 ropinirole 4mg tab 1 ropinirole 5mg tab 1


45



ANTIPARKINSON AND RELATED THERAPY AGENTS ANTIPARKINSON ADJUVANTS

carbidopa 25mg tab 1 ANTIPARKINSON ANTICHOLINERGICS

benztropine mesylate 0.5mg tab 1 benztropine mesylate 1mg tab 1 benztropine mesylate 2mg tab 1 trihexyphenidyl 0.4mg/ml oral soln 1 trihexyphenidyl 2mg tab 1 trihexyphenidyl 5mg tab 1

ANTIPARKINSON COMT INHIBITORS entacapone 200mg tab 1 tolcapone 100mg tab 1

ANTIPARKINSON DOPAMINERGICS amantadine 100mg tab 1 APOKYN 10MG/ML CARTRIDGE 2 NDS carbidopa 25mg/levodopa 250mg tab 1 ropinirole 1mg tab 1 ropinirole 2mg tab 1

ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS rasagiline 0.5mg tab 1 rasagiline 1mg tab 1 selegiline 5mg cap 1 selegiline 5mg tab 1

ANTIPSYCHOTICS/ANTIMANIC AGENTS ANTIMANIC AGENTS

lithium carbonate 150mg cap 1 lithium carbonate 300mg cap 1 lithium carbonate 300mg er tab 1 lithium carbonate 300mg tab 1 lithium carbonate 450mg er tab 1 lithium carbonate 600mg cap 1 lithium citrate 60mg/ml oral soln 1

ANTIPSYCHOTICS - MISC. EQUETRO 100MG ER CAP 2 EQUETRO 200MG ER CAP 2 EQUETRO 300MG ER CAP 2 GEODON 20MG INJ 2 LATUDA 120MG TAB 2 ST_NSO QL=30 EA/30 Days LATUDA 20MG TAB 2 ST_NSO QL=30 EA/30 Days LATUDA 40MG TAB 2 ST_NSO QL=30 EA/30 Days LATUDA 60MG TAB 2 ST_NSO QL=30 EA/30 Days LATUDA 80MG TAB 2 ST_NSO QL=30 EA/30 Days


46

NUPLAZID 10MG TAB 2 PA NSO QL=30 EA/30 Days NUPLAZID 34MG CAP 2 PA NSO QL=30 EA/30 Days VRAYLAR 1.5/3MG MIXED PACK 2 PA NSO QL=30 EA/30 Days VRAYLAR 1.5MG CAP 2 PA NSO QL=30 EA/30 Days VRAYLAR 3MG CAP 2 PA NSO QL=30 EA/30 Days VRAYLAR 4.5MG CAP 2 PA NSO QL=30 EA/30 Days VRAYLAR 6MG CAP 2 PA NSO QL=30 EA/30 Days ziprasidone 20mg cap 1 ziprasidone 40mg cap 1 ziprasidone 60mg cap 1 ziprasidone 80mg cap 1

BENZISOXAZOLES FANAPT 10MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 12MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 1MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 2MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 4MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 6MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT 8MG TAB 2 PA NSO QL=60 EA/30 Days FANAPT TITRATION PACK 2 PA NSO QL=60 EA/30 Days INVEGA 117MG/0.75ML SYRINGE 2 PA NSO INVEGA 156MG/ML SYRINGE 2 PA NSO INVEGA 234MG/1.5ML SYRINGE 2 PA NSO INVEGA 273MG/0.875ML SYRINGE 2 PA NSO INVEGA 39MG/0.25ML SYRINGE 2 PA NSO INVEGA 410MG/1.315ML SYRINGE 2 PA NSO INVEGA 546MG/1.75ML SYRINGE 2 PA NSO INVEGA 78MG/0.5ML SYRINGE 2 PA NSO INVEGA 819MG/2.625ML SYRINGE 2 PA NSO paliperidone 1.5mg er tab 1 PA NSO QL=30 EA/30 Days paliperidone 3mg er tab 1 PA NSO QL=30 EA/30 Days paliperidone 6mg er tab 1 PA NSO QL=60 EA/30 Days paliperidone 9mg er tab 1 PA NSO QL=30 EA/30 Days PERSERIS 120MG SYRINGE 2 NDS PA NSO PERSERIS 90MG SYRINGE 2 NDS PA NSO RISPERDAL 12.5MG INJ 2 PA NSO RISPERDAL 25MG INJ 2 PA NSO RISPERDAL 37.5MG INJ 2 PA NSO RISPERDAL 50MG INJ 2 PA NSO risperidone 0.25mg odt 1 risperidone 0.25mg tab 1 risperidone 0.5mg odt 1 risperidone 0.5mg tab 1




47

risperidone 1mg odt 1 risperidone 1mg tab 1 risperidone 1mg/ml oral soln 1 risperidone 2mg odt 1 risperidone 2mg tab 1 risperidone 3mg odt 1 risperidone 3mg tab 1 risperidone 4mg odt 1 risperidone 4mg tab 1

BUTYROPHENONES haloperidol 0.5mg tab 1 haloperidol 10mg tab 1 haloperidol 1mg tab 1 haloperidol 20mg tab 1 haloperidol 2mg tab 1 haloperidol 2mg/ml oral soln 1 haloperidol 5mg tab 1 haloperidol 5mg/ml inj 1 haloperidol decanoate 100mg/ml inj 1 haloperidol decanoate 500mg/5ml inj 1 haloperidol decanoate 50mg/ml inj 1

DIBENZAPINES clozapine 100mg odt 1 clozapine 100mg tab 1 clozapine 12.5mg odt 1 CLOZAPINE 150MG ODT 2 CLOZAPINE 200MG ODT 2 clozapine 200mg tab 1 clozapine 25mg odt 1 clozapine 25mg tab 1 clozapine 50mg tab 1 loxapine 10mg cap 1 loxapine 25mg cap 1 loxapine 50mg cap 1 loxapine 5mg cap 1 olanzapine 10mg inj 1 olanzapine 10mg odt 1 olanzapine 10mg tab 1 olanzapine 15mg odt 1 olanzapine 15mg tab 1 olanzapine 2.5mg tab 1 olanzapine 20mg odt 1 olanzapine 20mg tab 1




48

olanzapine 5mg odt 1 olanzapine 5mg tab 1 olanzapine 7.5mg tab 1 quetiapine 100mg tab 1 quetiapine 150mg xr tab 1 quetiapine 200mg tab 1 quetiapine 200mg xr tab 1 quetiapine 25mg tab 1 quetiapine 300mg tab 1 quetiapine 300mg xr tab 1 quetiapine 400mg tab 1 quetiapine 400mg xr tab 1 quetiapine 50mg tab 1 quetiapine 50mg xr tab 1 SAPHRIS 10MG SL TAB 2 PA NSO QL=60 EA/30 Days SAPHRIS 2.5MG SL TAB 2 PA NSO QL=60 EA/30 Days SAPHRIS 5MG SL TAB 2 PA NSO QL=60 EA/30 Days SECUADO 3.8MG/24HR PATCH 2 PA NSO QL=30 EA/30 Days SECUADO 5.7MG/24HR PATCH 2 PA NSO QL=30 EA/30 Days SECUADO 7.6MG/24HR PATCH 2 PA NSO QL=30 EA/30 Days VERSACLOZ 50MG/ML SUSP 2 ZYPREXA 210MG INJ 2

DIHYDROINDOLONES MOLINDONE 10MG TAB 2 MOLINDONE 25MG TAB 2 MOLINDONE 5MG TAB 2

PHENOTHIAZINES chlorpromazine 100mg tab 1 chlorpromazine 10mg tab 1 chlorpromazine 200mg tab 1 chlorpromazine 25mg tab 1 chlorpromazine 50mg tab 1 compro 25mg rectal supp 1 FLUPHENAZINE 0.5MG/ML ORAL SOLN 1 fluphenazine 10mg tab 1 fluphenazine 1mg tab 1 fluphenazine 2.5mg tab 1 FLUPHENAZINE 2.5MG/ML INJ 2 fluphenazine 5mg tab 1 FLUPHENAZINE 5MG/ML ORAL SOLN 1 fluphenazine decanoate 25mg/ml inj 1 perphenazine 16mg tab 1 perphenazine 2mg tab 1




49

perphenazine 4mg tab 1 perphenazine 8mg tab 1 prochlorperazine 10mg tab 1 prochlorperazine 25mg rectal supp 1 prochlorperazine 5mg tab 1 thioridazine 100mg tab 1 thioridazine 10mg tab 1 thioridazine 25mg tab 1 thioridazine 50mg tab 1 trifluoperazine 10mg tab 1 trifluoperazine 1mg tab 1 trifluoperazine 2mg tab 1 trifluoperazine 5mg tab 1

QUINOLINONE DERIVATIVES ABILIFY 300MG MAINTENA INJ 2 NDS PA NSO ABILIFY 300MG MAINTENA PF SYRINGE 2 NDS PA NSO ABILIFY 400MG MAINTENA INJ 2 NDS PA NSO ABILIFY 400MG MAINTENA PF SYRINGE 2 NDS PA NSO aripiprazole 10mg odt 1 PA NSO QL=60 EA/30 Days aripiprazole 10mg tab 1 aripiprazole 15mg odt 1 PA NSO QL=60 EA/30 Days aripiprazole 15mg tab 1 aripiprazole 1mg/ml oral soln 1 PA NSO aripiprazole 20mg tab 1 aripiprazole 2mg tab 1 aripiprazole 30mg tab 1 aripiprazole 5mg tab 1 ARISTADA 1064MG/3.9ML SYRINGE 2 PA NSO ARISTADA 441MG/1.6ML SYRINGE 2 NDS PA NSO ARISTADA 662MG/2.4ML SYRINGE 2 NDS PA NSO ARISTADA 675MG/2.4ML SYRINGE 2 NDS PA NSO ARISTADA 882MG/3.2ML SYRINGE 2 PA NSO REXULTI 0.25MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 0.5MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 1MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 2MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 3MG TAB 2 PA NSO QL=30 EA/30 Days REXULTI 4MG TAB 2 PA NSO QL=30 EA/30 Days

THIOXANTHENES thiothixene 10mg cap 1 thiothixene 1mg cap 1 thiothixene 2mg cap 1 thiothixene 5mg cap 1




50



ANTISEPTICS & DISINFECTANTS IODINE ANTISEPTICS

povidone-iodine soln 10%* 4 povidone/iodine topical soln 7.5%* 4

ANTIVIRALS ANTIRETROVIRALS

abacavir 20mg/ml oral soln 1 abacavir 300mg tab 1 abacavir 300mg/lamivudine 150mg/zidovudine 300mg tab

1

abacavir 600mg/lamivudine 300mg tab 1 NDS APTIVUS 100MG/ML ORAL SOLN 2 NDS APTIVUS 250MG CAP 2 NDS atazanavir 150mg cap 1 atazanavir 200mg cap 1 atazanavir 300mg cap 1 ATRIPLA 600-200-300MG TAB 2 NDS BIKTARVY 50-200-25MG TAB 2 NDS CIMDUO 300-300MG TAB 2 NDS COMPLERA 200-25-300MG TAB 2 NDS CRIXIVAN 200MG CAP 2 CRIXIVAN 400MG CAP 2 DELSTRIGO 100-300-300MG TAB 2 NDS DESCOVY 200-25MG TAB 2 NDS didanosine 200mg dr cap 1 didanosine 250mg dr cap 1 didanosine 400mg dr cap 1 DOVATO 50-300MG TAB 2 NDS EDURANT 25MG TAB 2 NDS efavirenz 200mg cap 1 efavirenz 50mg cap 1 efavirenz 600mg cap 1 EMTRIVA 10MG/ML ORAL SOLN 2 EMTRIVA 200MG CAP 2 EVOTAZ 300-150MG TAB 2 NDS fosamprenavir 700mg tab 1 NDS FUZEON 90MG INJ 2 NDS GENVOYA 150-150-200-10MG TAB 2 NDS INTELENCE 100MG TAB 2 NDS INTELENCE 200MG TAB 2 NDS INTELENCE 25MG TAB 2 INVIRASE 500MG TAB 2 NDS ISENTRESS 100MG CHEW TAB 2 NDS


51

ISENTRESS 100MG SUSP 2 ISENTRESS 25MG CHEW TAB 2 ISENTRESS 400MG TAB 2 NDS ISENTRESS 600MG TAB 2 NDS JULUCA 50-25MG TAB 2 NDS KALETRA 100-25MG TAB 2 KALETRA 200-50MG TAB 2 NDS lamivudine 10mg/ml oral soln 1 lamivudine 150mg tab 1 lamivudine 150mg/zidovudine 300mg tab 1 lamivudine 300mg tab 1 LEXIVA 50MG/ML SUSP 2 lopinavir 80mg/ml/ritonavir 20mg/ml oral solution 1 NDS nevirapine 100mg er tab 1 nevirapine 10mg/ml oral susp 1 nevirapine 200mg tab 1 nevirapine 400mg er tab 1 NORVIR 100MG POWDER PACKET 2 NORVIR 80MG/ML ORAL SOLN 2 ODEFSEY 200-25-25MG TAB 2 NDS PIFELTRO 100MG TAB 2 NDS PREZCOBIX 800-150MG TAB 2 NDS PREZISTA 100MG/ML SUSP 2 PREZISTA 150MG TAB 2 PREZISTA 600MG TAB 2 NDS PREZISTA 75MG TAB 2 PREZISTA 800MG TAB 2 NDS RESCRIPTOR 200MG TAB 2 REYATAZ 50MG ORAL POWDER 2 NDS ritonavir 100mg tab 1 SELZENTRY 150MG TAB 2 NDS SELZENTRY 20MG/ML ORAL SOLN 2 NDS SELZENTRY 25MG TAB 2 SELZENTRY 300MG TAB 2 NDS SELZENTRY 75MG TAB 2 NDS stavudine 15mg cap 1 stavudine 20mg cap 1 stavudine 30mg cap 1 stavudine 40mg cap 1 STRIBILD 150-150-200-300MG TAB 2 NDS SYMFI 600-300-300MG TAB 2 SYMFI LO 400-300-300MG TAB 2 SYMTUZA 800-150-200-10MG TAB 2 NDS




52

tenofovir disoproxil fumarate 300mg tab 1 NDS TIVICAY 10MG TAB 2 TIVICAY 25MG TAB 2 TIVICAY 50MG TAB 2 NDS TRIUMEQ 600-50-300MG TAB 2 NDS TRUVADA 100-150MG TAB 2 NDS TRUVADA 133-200MG TAB 2 NDS TRUVADA 167-250MG TAB 2 NDS TRUVADA 200-300MG TAB 2 NDS TYBOST 150MG TAB 2 VIDEX 125MG DR CAP 2 VIDEX 2GM ORAL SOLN 2 VIRACEPT 250MG TAB 2 NDS VIRACEPT 625MG TAB 2 NDS VIREAD 150MG TAB 2 NDS VIREAD 200MG TAB 2 NDS VIREAD 250MG TAB 2 NDS VIREAD 40MG/GM ORAL POWDER 2 zidovudine 100mg cap 1 zidovudine 10mg/ml oral soln 1 zidovudine 300mg tab 1

CMV AGENTS PREVYMIS 240MG TAB 2 NDS PA QL=30 EA/30 Days PREVYMIS 480MG TAB 2 NDS PA QL=30 EA/30 Days valganciclovir 450mg tab 1 NDS valganciclovir 50mg/ml oral soln 1 NDS

HEPATITIS AGENTS adefovir dipivoxil 10mg tab 1 BARACLUDE 0.05MG/ML ORAL SOLN 2 entecavir 0.5mg tab 1 entecavir 1mg tab 1 EPIVIR HBV 5MG/ML ORAL SOLN 2 lamivudine 100mg tab 1 MAVYRET 100-40MG TAB 2 NDS PA QL=90 EA/30 Days PEGASYS 180MCG/0.5ML AUTO-INJECTOR 2 NDS PEGASYS 180MCG/0.5ML SYRINGE 2 NDS PEGASYS 180MCG/ML INJ 2 NDS ribavirin 200mg cap 1 ribavirin 200mg tab 1 SOFOSBUVIR/VELPATASVIR 400-100MG TAB 2 NDS PA QL=30 EA/30 Days VEMLIDY 25MG TAB 2 NDS VOSEVI 400-100-100MG TAB 2 NDS PA QL=30 EA/30 Days

HERPES AGENTS




53

acyclovir 200mg cap 1 acyclovir 400mg tab 1 acyclovir 40mg/ml susp 1 acyclovir 50mg/ml inj 1 PA BvD acyclovir 800mg tab 1 famciclovir 125mg tab 1 famciclovir 250mg tab 1 famciclovir 500mg tab 1 valacyclovir 1000mg tab 1 valacyclovir 500mg tab 1

INFLUENZA AGENTS oseltamivir 30mg cap 1 QL=84 EA/180 Days oseltamivir 45mg cap 1 QL=42 EA/180 Days oseltamivir 6mg/ml oral susp 1 QL=540 ML/180 Days oseltamivir 75mg cap 1 QL=42 EA/180 Days RELENZA 5MG/BLISTER INH 2 QL=120 EA/30 Days rimantadine 100mg tab 1



ASSORTED CLASSES IMMUNOSUPPRESSIVE AGENTS

AZASAN 100MG TAB 2 PA BvD AZASAN 75MG TAB 2 PA BvD azathioprine 50mg tab 1 PA BvD cyclosporine 100mg cap 1 PA BvD cyclosporine 25mg cap 1 PA BvD cyclosporine modified 100mg cap 1 PA BvD cyclosporine modified 25mg cap 1 PA BvD gengraf 100mg cap 1 PA BvD gengraf 100mg/ml oral soln 1 PA BvD gengraf 25mg cap 1 PA BvD mycophenolate mofetil 200mg/ml susp 1 PA BvD mycophenolate mofetil 250mg cap 1 PA BvD mycophenolate mofetil 500mg tab 1 PA BvD mycophenolic acid 180mg dr tab 1 PA BvD mycophenolic acid 360mg dr tab 1 PA BvD SANDIMMUNE 100MG/ML ORAL SOLN 2 PA BvD sirolimus 0.5mg tab 1 PA BvD sirolimus 1mg tab 1 PA BvD sirolimus 2mg tab 1 PA BvD tacrolimus 0.5mg cap 1 PA BvD tacrolimus 1mg cap 1 PA BvD tacrolimus 5mg cap 1 PA BvD

POTASSIUM REMOVING RESINS kionex 250mg/ml susp 1


54

sodium polystyrene sulfonate 15gm oral susp 1 sodium polystyrene sulfonate 250mg/ml susp 1 sps 250mg/ml oral susp 1



BETA BLOCKERS ALPHA-BETA BLOCKERS

carvedilol 12.5mg tab 1 carvedilol 25mg tab 1 carvedilol 3.125mg tab 1 carvedilol 6.25mg tab 1 labetalol 100mg tab 1 labetalol 200mg tab 1 labetalol 300mg tab 1

BETA BLOCKERS CARDIO-SELECTIVE acebutolol 200mg cap 1 acebutolol 400mg cap 1 atenolol 100mg tab 1 atenolol 25mg tab 1 atenolol 50mg tab 1 betaxolol 10mg tab 1 betaxolol 20mg tab 1 bisoprolol fumarate 10mg tab 1 bisoprolol fumarate 5mg tab 1 BYSTOLIC 10MG TAB 2 BYSTOLIC 2.5MG TAB 2 BYSTOLIC 20MG TAB 2 BYSTOLIC 5MG TAB 2 metoprolol succinate 100mg er tab 1 metoprolol succinate 200mg er tab 1 metoprolol succinate 25mg er tab 1 metoprolol succinate 50mg er tab 1 metoprolol tartrate 100mg tab 1 metoprolol tartrate 25mg tab 1 metoprolol tartrate 50mg tab 1

BETA BLOCKERS NON-SELECTIVE INNOPRAN 120MG XL CAP 2 INNOPRAN 80MG XL CAP 2 nadolol 20mg tab 1 nadolol 40mg tab 1 nadolol 80mg tab 1 pindolol 10mg tab 1 pindolol 5mg tab 1 propranolol 10mg tab 1 propranolol 120mg er cap 1


55

propranolol 160mg er cap 1 propranolol 20mg tab 1 propranolol 40mg tab 1 PROPRANOLOL 4MG/ML ORAL SOLN 1 propranolol 60mg er cap 1 propranolol 60mg tab 1 propranolol 80mg er cap 1 propranolol 80mg tab 1 PROPRANOLOL 8MG/ML ORAL SOLN 1 sorine 120mg tab 1 sorine 160mg tab 1 sorine 240mg tab 1 sorine 80mg tab 1 sotalol 120mg tab 1 sotalol 160mg tab 1 sotalol 240mg tab 1 sotalol 80mg tab 1 sotalol af 120mg tab 1 timolol 10mg tab 1 timolol 20mg tab 1 timolol 5mg tab 1



CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS

amlodipine 10mg tab 1 amlodipine 2.5mg tab 1 amlodipine 5mg tab 1 cartia 120mg er cap 1 cartia 180mg er cap 1 cartia 240mg er cap 1 cartia 300mg er cap 1 dilt 120mg xr cap 1 dilt 180mg xr cap 1 dilt 240mg xr cap 1 diltiazem 120mg er (12 hr) cap 1 diltiazem 120mg er (24 hr) cap 1 diltiazem 120mg tab 1 diltiazem 180mg er cap 1 diltiazem 240mg er cap 1 diltiazem 300mg er cap 1 diltiazem 30mg tab 1 diltiazem 360mg er cap 1 diltiazem 420mg er cap 1 diltiazem 60mg er cap 1


56

diltiazem 60mg tab 1 diltiazem 90mg er cap 1 diltiazem 90mg tab 1 felodipine 10mg er tab 1 felodipine 2.5mg er tab 1 felodipine 5mg er tab 1 matzim 180mg er tab 1 matzim 240mg er tab 1 matzim 300mg er tab 1 matzim 360mg er tab 1 matzim 420mg er tab 1 nicardipine 20mg cap 1 nicardipine 30mg cap 1 nifedipine 30mg er tab 1 nifedipine 30mg osmotic er tab 1 nifedipine 60mg er tab 1 nifedipine 60mg osmotic er tab 1 nifedipine 90mg er tab 1 nifedipine 90mg osmotic er tab 1 nimodipine 30mg cap 1 NISOLDIPINE 25.5MG ER TAB 1 taztia 120mg er cap 1 taztia 180mg er cap 1 taztia 240mg er cap 1 taztia 300mg er cap 1 taztia 360mg er cap 1 tiadylt 120mg er cap 1 tiadylt 180mg er cap 1 tiadylt 240mg er cap 1 tiadylt 300mg er cap 1 tiadylt 360mg er cap 1 tiadylt 420mg er cap 1 verapamil 100mg er cap 1 verapamil 120mg er cap 1 verapamil 120mg er tab 1 verapamil 120mg tab 1 verapamil 180mg er cap 1 verapamil 180mg er tab 1 verapamil 200mg er cap 1 verapamil 240mg er cap 1 verapamil 240mg er tab 1 verapamil 300mg er cap 1 VERAPAMIL 360MG SR CAP 1




57

verapamil 40mg tab 1 verapamil 80mg tab 1



CARDIOTONICS CARDIAC GLYCOSIDES

digitek 0.125mg tab 1 digitek 0.25mg tab 1 digox 0.125mg tab 1 digox 0.25mg tab 1 digoxin 0.05mg/ml oral soln 1 digoxin 0.125mg tab 1 digoxin 0.25mg tab 1

CARDIOVASCULAR AGENTS - MISC. CARDIOVASCULAR AGENTS MISC. - COMBINATIONS

BIDIL 20-37.5MG TAB 2 ENTRESTO 24-26MG TAB 2 PA QL=60 EA/30 Days ENTRESTO 49-51MG TAB 2 PA QL=60 EA/30 Days ENTRESTO 97-103MG TAB 2 PA QL=60 EA/30 Days

PROSTAGLANDIN VASODILATORS ORENITRAM 0.125MG ER TAB 2 NDS PA ORENITRAM 0.25MG ER TAB 2 NDS PA ORENITRAM 1MG ER TAB 2 NDS PA ORENITRAM 2.5MG ER TAB 2 NDS PA ORENITRAM 5MG ER TAB 2 NDS PA VENTAVIS 10MCG/ML INH SOLN 2 NDS PA VENTAVIS 20MCG/ML INH SOLN 2 NDS PA

PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS ambrisentan 10mg tab 1 NDS PA QL=30 EA/30 Days ambrisentan 5mg tab 1 NDS PA QL=30 EA/30 Days bosentan 125mg tab 1 NDS PA QL=60 EA/30 Days bosentan 62.5mg tab 1 NDS PA QL=60 EA/30 Days LETAIRIS 10MG TAB 2 NDS PA QL=30 EA/30 Days LETAIRIS 5MG TAB 2 NDS PA QL=30 EA/30 Days OPSUMIT 10MG TAB 2 NDS PA QL=30 EA/30 Days TRACLEER 32MG TAB FOR ORAL SUSP 2 NDS PA QL=120 EA/30 Days

PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS alyq 20mg tab 1 NDS PA sildenafil 20mg tab 1 PA tadalafil 20mg tab(PAH) 1 NDS PA

PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST UPTRAVI 1000MCG TAB 2 NDS PA UPTRAVI 1200MCG TAB 2 NDS PA UPTRAVI 1400MCG TAB 2 NDS PA UPTRAVI 1600MCG TAB 2 NDS PA


58

UPTRAVI 200MCG TAB 2 NDS PA UPTRAVI 400MCG TAB 2 NDS PA UPTRAVI 600MCG TAB 2 NDS PA UPTRAVI 800MCG TAB 2 NDS PA UPTRAVI TITRATION PACK 2 NDS PA QL=200 EA/28 Days

PULMONARY HYPERTENSION - SOL GUANYLATE CYCLASE STIMULATOR ADEMPAS 0.5MG TAB 2 NDS PA ADEMPAS 1.5MG TAB 2 NDS PA ADEMPAS 1MG TAB 2 NDS PA ADEMPAS 2.5MG TAB 2 NDS PA ADEMPAS 2MG TAB 2 NDS PA

SINUS NODE INHIBITORS CORLANOR 5MG TAB 2 PA CORLANOR 5MG/5ML ORAL SOLN 2 PA CORLANOR 7.5MG TAB 2 PA

TRANSTHYRETIN STABILIZERS VYNDAMAX 61MG CAP 2 NDS PA QL=30 EA/30 Days



CEPHALOSPORINS CEPHALOSPORIN COMBINATIONS

AVYCAZ 2-0.5GM INJ 2 NDS ZERBAXA 1.5GM INJ 2 NDS

CEPHALOSPORINS - 1ST GENERATION cefadroxil 1000mg tab 1 cefadroxil 100mg/ml susp 1 cefadroxil 500mg cap 1 cefadroxil 50mg/ml susp 1 cefazolin 1gm inj 1 cefazolin 200mg/ml inj 1 cefazolin 500mg inj 1 cephalexin 250mg cap 1 cephalexin 25mg/ml susp 1 cephalexin 500mg cap 1 cephalexin 50mg/ml susp 1

CEPHALOSPORINS - 2ND GENERATION cefaclor 250mg cap 1 CEFACLOR 25MG/ML SUSP 1 cefaclor 500mg cap 1 CEFACLOR 50MG/ML SUSP 1 CEFACLOR 75MG/ML SUSP 1 cefotetan 1000mg inj 1 cefotetan 2000mg inj 1 cefoxitin 1000mg inj 1 cefoxitin 2000mg inj 1


59

cefoxitin 200mg/ml inj 1 cefprozil 250mg tab 1 cefprozil 25mg/ml susp 1 cefprozil 500mg tab 1 cefprozil 50mg/ml susp 1 cefuroxime 1.5gm inj 1 cefuroxime 250mg tab 1 cefuroxime 500mg tab 1 cefuroxime 750mg inj 1 cefuroxime 95mg/ml inj 1

CEPHALOSPORINS - 3RD GENERATION cefdinir 25mg/ml susp 1 cefdinir 300mg cap 1 cefdinir 50mg/ml susp 1 cefixime 20mg/ml susp 1 cefixime 400mg cap 1 cefixime 40mg/ml susp 1 cefpodoxime 100mg tab 1 cefpodoxime 10mg/ml susp 1 cefpodoxime 200mg tab 1 cefpodoxime 20mg/ml susp 1 ceftazidime 1000mg inj 1 ceftazidime 2000mg inj 1 ceftazidime 200mg/ml inj 1 ceftriaxone 1000mg inj 1 ceftriaxone 100mg/ml inj 1 ceftriaxone 2000mg inj 1 ceftriaxone 250mg inj 1 ceftriaxone 500mg inj 1 tazicef 1gm inj 1 tazicef 2gm inj 1 tazicef 6gm inj 1

CEPHALOSPORINS - 4TH GENERATION cefepime 1gm inj 1 cefepime 2gm inj 1

CEPHALOSPORINS - 5TH GENERATION TEFLARO 400MG INJ 2 NDS TEFLARO 600MG INJ 2 NDS



CONTRACEPTIVES COMBINATION CONTRACEPTIVES - ORAL

altavera 28 day pack 1 alyacen 1/35 28 day pack 1 amethia 91 day pack 1


60

amethia lo 91 day pack 1 apri 28 day pack 1 aranelle 28 pack 1 ashlyna 91 day pack 1 aubra 28 day pack 1 aviane 28 pack 1 balziva 28 day pack 1 blisovi 21 fe 1.5/30 28 day 1 blisovi 24 fe 1/20 28 day pack 1 briellyn 28 day pack 1 camrese lo 91 day pack 1 caziant 28 day pack 1 cryselle 28 pack 1 cyclafem 1/35 28 day pack 1 cyclafem 7/7/7 28 day pack 1 cyred 28 day pack 1 desogestrel/ethinyl estradiol 28 day pack 1 desogestrel/ethinyl estradiol pack 1 drospirenone 3mg/ethinyl estradiol 0.02mg/inert 1 mg pack

1

drospirenone 3mg/ethinyl estradiol 0.03mg/inert ingredients 1mg pack

1

emoquette pack 1 enpresse 28 day pack 1 enskyce 28 day pack 1 estarylla 28 day pack 1 ethinyl estradiol 0.01mg/ethinyl estradiol 0.02mg/levonorgestrel 0.1mg 91 day pack

1

ethinyl estradiol 0.01mg/ethinyl estradiol 0.03mg/levonorgestrel 0.15mg pack

1

ethinyl estradiol 0.025mg/ferrous fumarate 75mg/norethindrone 0.8mg pack

1

ethinyl estradiol 0.025mg/inert/norgestimate 0.18mg/0.215mg/0.25mg pack

1

ethinyl estradiol 0.02mg/inert ingredients 1mg/levonorgestrel 0.1mg pack

1

ethinyl estradiol 0.02mg/norethindrone 1mg 21 day pack

1

ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack 1 ethinyl estradiol 0.035mg/ferrous fumarate 75mg/norethindrone 0.4mg pack

1

ethinyl estradiol 0.035mg/inert/norgestimate 0.18mg/0.215mg/0.25mg pack

1




61

ethinyl estradiol 0.035mg/norgestimate 0.25mg pack 1 ethinyl estradiol 0.03mg/0.04mg /inert/levonorgestrel 0.05mg/ 0.075mg pack

1


1

ethinyl estradiol 0.03mg/levonorgestrel 0.15mg tab 28 day pack

1

ethinyl estradiol 0.05mg/ethynodiol 1mg/inert ingredients 1mg 28 day pack

1

ethinyl estradiol/levonorgestrel 91 day pack 1 falmina 28 day pack 1 fayosim 91 day pack 1 femynor 28 day pack 1 gianvi 28-day pack 1 hailey 24 fe 28 day pack 1 introvale 91 day pack 1 isibloom 28 day pack 1 jasmiel 28 day pack 1 juleber 28 day pack 1 junel 1.5/30 21 day pack 1 junel 1/20 21 day pack 1 junel fe 1.5/30 28 day pack 1 junel fe 1/20 28 day pack 1 junel fe 24 1/20 28 day pack 1 kaitlib fe 28 day pack 1 kariva 28 day pack 1 kelnor 1/35 28 day pack 1 kelnor 1/50 28 day pack 1 kurvelo 28 day pack 1 larin 1.5/30 pack 1 larin 1/20 pack 1 larin fe 1.5/30 pack 1 larin fe 1/20 pack 1 larissia 28 day pack 1 layolis fe 28 pack 1 leena 28 day pack 1 lessina 28 day pack 1 levonest 28 day pack 1 levora 0.15/30 28 day pack 1 loryna 28 day pack 1 low-ogestrel 28 day pack 1 lutera 28 day pack 1 marlissa 28 day pack 1




62

microgestin 1.5/30 21 day pack 1 microgestin 1/20 21 day pack 1 microgestin fe 1.5/30 28 day pack 1 microgestin fe 1/20 28 day pack 1 mili 28 day pack 1 necon 0.5/35 28 day pack 1 nikki 28 day pack 1 nortrel 0.5/35 28 day pack 1 nortrel 1/35 21 day pack 1 nortrel 1/35 28 day pack 1 nortrel 7/7/7 28 day pack 1 ocella 28 day pack 1 orsythia 28 day pack 1 pimtrea pack 1 pirmella 1/35 28 day pack 1 portia 28 day pack 1 previfem 28 day pack 1 reclipsen 28 day pack 1 rivelsa 91 day pack 1 setlakin 91 day pack 1 sprintec 28 day pack 1 sronyx 28 day pack 1 syeda 28 day pack 1 tarina 24 fe 1/20 28 day pack 1 tarina fe 1/20 28 day pack 1 tri-estarylla 28 day pack 1 tri-legest 28 day pack 1 tri-lo-estarylla 28 day pack 1 tri-lo-sprintec 28 day pack 1 tri-mili 28 day pack 1 tri-previfem 28 day pack 1 tri-sprintec 28 day pack 1 tri-vylibra 28 day pack 1 tri-vylibra lo 28 day pack 1 trivora 28 day pack 1 velivet 28 day pack 1 vienva 28 day pack 1 vyfemla 28 day pack 1 vylibra 28 day pack 1 wymzya fe 28 day pack 1 zarah 3-0.03mg pack 1 zovia 1/35e 28 day pack 1

COMBINATION CONTRACEPTIVES - TRANSDERMAL




63

XULANE 150-35MCG PATCH 2 COMBINATION CONTRACEPTIVES - VAGINAL

eluryng 0.120-0.015mg/24hr vaginal ring 1 etonogestrel-ethinyl estradiol 0.120-0.015mg/24hr vaginal ring

1

EMERGENCY CONTRACEPTIVES levonorgestrel 1.5mg tab (OTC)* 4

PROGESTIN CONTRACEPTIVES - INJECTABLE medroxyprogesterone acetate 150mg/ml inj 1 medroxyprogesterone acetate 150mg/ml syringe 1

PROGESTIN CONTRACEPTIVES - ORAL camila 28 day 0.35mg pack 1 deblitane 28 day 0.35mg pack 1 errin 28 day 0.35mg pack 1 incassia 28 day 0.35mg pack 1 lyza 0.35mg pack 1 nora-be 28 day 0.35mg pack 1 norethindrone 0.35mg pack 1 sharobel 28 day 0.35mg pack 1



CORTICOSTEROIDS GLUCOCORTICOSTEROIDS

budesonide 3mg dr cap 1 budesonide 9mg er tab 1 PA QL=30 EA/30 Days CORTISONE ACETATE 25MG TAB 2 dexamethasone 0.1mg/ml oral soln 1 dexamethasone 0.5mg tab 1 dexamethasone 0.75mg tab 1 dexamethasone 1.5mg tab 1 DEXAMETHASONE 1MG TAB 1 DEXAMETHASONE 1MG/ML ORAL SOLN 1 DEXAMETHASONE 2MG TAB 1 dexamethasone 4mg tab 1 dexamethasone 6mg tab 1 hydrocortisone 10mg tab 1 hydrocortisone 20mg tab 1 hydrocortisone 5mg tab 1 MEDROL 2MG TAB 2 PA BvD methylprednisolone 16mg tab 1 PA BvD methylprednisolone 32mg tab 1 PA BvD methylprednisolone 4mg pack 1 methylprednisolone 4mg tab 1 PA BvD methylprednisolone 8mg tab 1 PA BvD prednisolone 1mg/ml oral soln 1 PA BvD


64

PREDNISOLONE 3MG/ML ORAL SOLN 1 PA BvD PREDNISONE 10MG (21) TAB PACK 2 PREDNISONE 10MG (48) TAB PACK 2 prednisone 10mg tab 1 PA BvD prednisone 1mg tab 1 PA BvD PREDNISONE 1MG/ML ORAL SOLN 1 PA BvD prednisone 2.5mg tab 1 PA BvD prednisone 20mg tab 1 PA BvD PREDNISONE 50MG TAB 1 PA BvD PREDNISONE 5MG (21) TAB PACK 2 PREDNISONE 5MG (48) TAB PACK 2 prednisone 5mg tab 1 PA BvD PREDNISONE 5MG/ML ORAL SOLN 2 PA BvD

MINERALOCORTICOIDS fludrocortisone 0.1mg tab 1



COUGH/COLD/ALLERGY ANTITUSSIVES

benzonatate cap 100mg* 3 benzonatate cap 200mg* 3 hydrocodone/homatropine syrup 5-1.5mg/5ml* 3 hydrocodone/homatropine tab 5-1.5mg* 3

COUGH/COLD/ALLERGY COMBINATIONS BROMFED DM SYRUP 30-2-10 MG/5ML* 3 brompheniramine/phenylephrine elixir 1-2.5mg/5ml* 4 BROMPHENIRAMINE/PHENYLEPHRINE TAB 4-10MG*

4

brompheniramine/pseudoephedrine elixir 1-15mg/5ml*

4

chlorpheniramine/phenylephrine liquid 4-10mg/5ml* 4 chlorpheniramine/phenylephrine tab 4-10mg* 4 chlorpheniramine/pseudoephedrine tab 4-60mg* 4 CLARINEX-D 2.5-120MG ER TAB 2 dextromethorphan/guaifenesin liquid 10-100mg/5ml* 4 dextromethorphan/guaifenesin liquid 10-200mg/5ml* 4 dextromethorphan/guaifenesin liquid 5-100mg/5ml* 4 dextromethorphan/guaifenesin syrup 10-100mg/5ml* 4 GUAIFENESIN/CODEINE LIQUID 200-8MG/5ML* 4 guaifenesin/codeine liquid 225-7.5mg/5ml* 4 guaifenesin/codeine soln 100-10mg/5ml* 4 GUAIFENESIN/CODEINE SOLN 100-6.3MG/5ML* 4 LOHIST-D LIQUID 2-30MG/5ML* 4 PHENYLEPHRINE 1MG/ML/PROMETHAZINE 1.25MG/ML ORAL SOLN

1


65

promethazine DM syrup 6.25-15mg/5ml* 3 promethazine w/codeine syrup 6.25-10mg/5ml* 3 pseudoephedrine/brompheniramine DM syrup 30-2-10mg/5ml*

3

triprolidine/pseudoephedrine tab 2.5-60mg* 4 MUCOLYTICS

acetylcysteine 10% inh soln 1 PA BvD acetylcysteine 20% inh soln 1 PA BvD



DERMATOLOGICALS ACNE PRODUCTS

adapalene 0.3% gel 1 PA amnesteem 10mg cap 1 amnesteem 20mg cap 1 amnesteem 40mg cap 1 avita 0.025% cream 1 PA avita 0.025% gel 1 PA benzoyl peroxide gel 10%* 4 BENZOYL PEROXIDE GEL 2.5%* 4 benzoyl peroxide gel 5%* 4 benzoyl peroxide liquid 10%* 4 benzoyl peroxide liquid 5%* 4 benzoyl peroxide liquid 6%* 4 BENZOYL PEROXIDE LOTION 10%* 4 BENZOYL PEROXIDE LOTION 5%* 4 claravis 10mg cap 1 claravis 20mg cap 1 claravis 30mg cap 1 claravis 40mg cap 1 clindacin 1% pad 1 clindamycin 1% foam 1 clindamycin 1% gel 1 clindamycin 1% lotion 1 clindamycin 1% topical soln 1 QL=300 ML/30 Days clindamycin/benzoyl peroxide 1-5% gel 1 ery 2% pad 1 erythromycin 2% gel 1 erythromycin 2% topical soln 1 erythromycin/benzoyl peroxide 5-3% gel 1 isotretinoin 10mg cap 1 isotretinoin 20mg cap 1 isotretinoin 30mg cap 1 isotretinoin 40mg cap 1 myorisan 10mg cap 1


66

myorisan 20mg cap 1 myorisan 30mg cap 1 myorisan 40mg cap 1 sulfacetamide sodium 10% lotion 1 tretinoin 0.01% gel 1 PA tretinoin 0.025% cream 1 PA tretinoin 0.025% gel 1 PA tretinoin 0.05% cream 1 PA tretinoin 0.05% gel 1 PA tretinoin 0.1% cream 1 PA tretinoin 0.1% gel 1 PA zenatane 10mg cap 1 zenatane 20mg cap 1 zenatane 30mg cap 1 zenatane 40mg cap 1

ANTIBIOTICS - TOPICAL bacitracin ointment 500unit/gm* 4 bacitracin/polymyxin b ointment* 4 bacitracin/zinc ointment 500unit/gm* 4 gentamicin sulfate 0.1% cream 1 gentamicin sulfate 0.1% ointment 1 mupirocin 2% ointment 1 QL=220 GM/30 Days triple antibiotic ointment* 4

ANTIFUNGALS - TOPICAL betamethasone/clotrimazole 1-0.05% cream 1 betamethasone/clotrimazole 1-0.05% lotion 1 ciclopirox 0.77% cream 1 ciclopirox 0.77% gel 1 ciclopirox 1% shampoo 1 ciclopirox 8% topical soln 1 clotrimazole 1% cream 1 clotrimazole 1% cream(OTC)* 4 clotrimazole 1% topical soln 1 clotrimazole topical soln 1%* 4 ketoconazole 2% cream 1 ketoconazole 2% shampoo 1 ketoconazole 20mg/ml foam 1 ketodan 2% foam 1 miconazole nitrate cream 2%* 4 miconazole nitrate powder 2%* 4 naftifine 2% cream 1 nyamyc 100000unit/gm powder 1 nystatin 100000unit/ml cream 1




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nystatin 100unit/mg ointment 1 nystatin 100unit/mg powder 1 nystop 100000unit/gm powder 1 terbinafine cream 1%* 4 tolnaftate aerosol 1%* 4 tolnaftate aerosol powder 1%* 4 tolnaftate cream 1%* 4 tolnaftate powder 1%* 4

ANTI-INFLAMMATORY AGENTS - TOPICAL diclofenac sodium 1% gel 1 QL=1000 GM/30 Days

ANTINEOPLASTIC OR PREMALIGNANT LESION AGENTS - TOPICAL diclofenac sodium 3% gel 1 PA QL=300 GM/30 Days FLUOROPLEX 1% CREAM 2 FLUOROURACIL 0.5% CREAM 2 FLUOROURACIL 2% TOPICAL SOLN 2 fluorouracil 5% cream 1 FLUOROURACIL 5% TOPICAL SOLN 2 PANRETIN 0.1% GEL 2 NDS PICATO 0.015% GEL 2 NDS QL=3 EA/10 Days PICATO 0.05% GEL 2 NDS QL=2 EA/10 Days TARGRETIN 1% GEL 2 NDS PA NSO TOLAK 4% CREAM 2 VALCHLOR 0.016% GEL 2 NDS PA NSO QL=240 GM/30 Days

ANTIPSORIATICS acitretin 10mg cap 1 acitretin 17.5mg cap 1 acitretin 25mg cap 1 calcipotriene 0.005% cream 1 QL=120 GM/30 Days calcipotriene 0.005% ointment 1 QL=120 GM/30 Days calcipotriene 0.005% topical soln 1 QL=120 ML/30 Days COSENTYX 150MG/ML AUTO-INJECTOR 2 NDS PA COSENTYX 150MG/ML SYRINGE 2 NDS PA methoxsalen 10mg cap 1 SKYRIZI 150MG DOSE PACK 75MG/0.83ML 2 PA STELARA 45MG/0.5ML INJ 2 PA STELARA 45MG/0.5ML SYRINGE 2 PA STELARA 90MG/ML SYRINGE 2 PA tazarotene 1% cream 1 TAZORAC 0.05% GEL 2 TAZORAC 0.1% GEL 2

ANTISEBORRHEIC PRODUCTS selenium sulfide 1% lotion/shampoo* 4 selenium sulfide 2.5% lotion/shampoo 1




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ANTIVIRALS - TOPICAL ABREVA CREAM 10%* 4 acyclovir 5% ointment 1 DENAVIR 1% CREAM 2

BURN PRODUCTS silver sulfadiazine 1% cream 1 ssd 1% cream 1 SULFAMYLON 85MG/GM CREAM 2

CORTICOSTEROIDS - TOPICAL ala-cort 1% cream 1 ala-cort 1% cream* 4 alclometasone dipropionate 0.05% cream 1 alclometasone dipropionate 0.05% ointment 1 AMCINONIDE 0.1% CREAM 2 PA AMCINONIDE 0.1% OINTMENT 2 PA beser 0.05% lotion 1 PA betamethasone 0.05% aug cream 1 betamethasone 0.05% aug lotion 1 betamethasone 0.05% aug ointment 1 betamethasone 0.05% cream 1 betamethasone 0.05% lotion 1 betamethasone 0.05% ointment 1 betamethasone 0.1% cream 1 betamethasone 0.1% lotion 1 betamethasone 0.1% ointment 1 betamethasone valerate 0.12% foam 1 PA clobetasol propionate 0.05% cream 1 clobetasol propionate 0.05% e cream 1 clobetasol propionate 0.05% e foam 1 PA clobetasol propionate 0.05% foam 1 PA clobetasol propionate 0.05% gel 1 clobetasol propionate 0.05% lotion 1 PA clobetasol propionate 0.05% ointment 1 clobetasol propionate 0.05% shampoo 1 PA clobetasol propionate 0.05% spray 1 PA clobetasol propionate 0.05% topical soln 1 QL=450 ML/30 Days clodan 0.05% shampoo 1 PA desonide 0.05% cream 1 PA desonide 0.05% lotion 1 PA desonide 0.05% ointment 1 desoximetasone 0.05% cream 1 desoximetasone 0.05% gel 1 desoximetasone 0.25% cream 1




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desoximetasone 0.25% ointment 1 fluocinolone acetonide 0.01% cream 1 fluocinolone acetonide 0.01% topical soln 1 fluocinolone acetonide 0.025% cream 1 fluocinolone acetonide 0.025% ointment 1 fluocinolone acetonide 0.1mg/ml oil 1 fluocinonide 0.05% e cream 1 fluocinonide 0.05% gel 1 fluocinonide 0.05% ointment 1 fluocinonide 0.05% topical soln 1 fluticasone propionate 0.005% ointment 1 fluticasone propionate 0.05% cream 1 fluticasone propionate 0.05% lotion 1 PA halobetasol propionate 0.05% cream 1 halobetasol propionate 0.05% ointment 1 hydrocortisone 1% cream 1 hydrocortisone 1% ointment* 4 hydrocortisone 2.5% cream 1 hydrocortisone 2.5% lotion 1 hydrocortisone 2.5% ointment 1 hydrocortisone cream 0.5%* 4 hydrocortisone lotion 1%* 4 hydrocortisone ointment 0.5%* 4 hydrocortisone soln 1%* 4 hydrocortisone valerate 0.2% cream 1 hydrocortisone valerate 0.2% ointment 1 hydrocortisone/aloe vera cream 0.5%* 4 hydrocortisone/aloe vera cream 1%* 4 mometasone furoate 0.1% cream 1 mometasone furoate 0.1% lotion 1 mometasone furoate 0.1% ointment 1 PREDNICARBATE 0.1% CREAM 2 PREDNICARBATE 0.1% OINTMENT 2 tovet 0.05% e foam 1 PA triamcinolone acetonide 0.025% cream 1 triamcinolone acetonide 0.025% lotion 1 triamcinolone acetonide 0.025% ointment 1 triamcinolone acetonide 0.1% cream 1 triamcinolone acetonide 0.1% lotion 1 triamcinolone acetonide 0.1% ointment 1 triamcinolone acetonide 0.147mg/ml spray 1 triamcinolone acetonide 0.5% cream 1 triamcinolone acetonide 0.5% ointment 1




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triderm 0.1% cream 1 ECZEMA AGENTS

DUPIXENT 300MG/2ML PF SYRINGE 2 NDS PA EMOLLIENTS

ammonium lactate 12% cream 1 ammonium lactate 12% lotion 1 lactic acid lotion 5%* 4

ENZYMES - TOPICAL SANTYL 250UNIT/GM OINTMENT 2 QL=90 GM/30 Days

IMMUNOMODULATING AGENTS - TOPICAL imiquimod 5% cream 1 ZYCLARA 2.5% CREAM 2

IMMUNOSUPPRESSIVE AGENTS - TOPICAL pimecrolimus 1% cream 1 tacrolimus 0.03% ointment 1 QL=100 GM/30 Days tacrolimus 0.1% ointment 1 QL=100 GM/30 Days

KERATOLYTIC/ANTIMITOTIC AGENTS podofilox 0.5% topical soln 1

LOCAL ANESTHETICS - TOPICAL ARTHRITIS PAIN CREAM 0.075%* 4 capsaicin cream 0.025%* 4 capsaicin cream 0.1%* 4 lidocaine 2% gel 1 lidocaine 4% topical soln 1 lidocaine 5% ointment 1 PA QL=107 GM/30 Days lidocaine 5% patch 1 PA QL=90 EA/30 Days lidocaine/prilocaine 2.5-2.5% cream 1 PA QL=60 GM/30 Days

MISC. TOPICAL CALAMINE LOTTION* 4 CALAMINE/ZINC OXIDE LOTION 8-8%* 4 zinc oxide ointment 10%* 4 zinc oxide ointment 20%* 4

ROSACEA AGENTS azelaic acid 15% gel 1 metronidazole 0.75% cream 1 metronidazole 0.75% gel 1 metronidazole 0.75% lotion 1 metronidazole 1% gel 1

SCABICIDES & PEDICULICIDES lindane 1% shampoo 1 malathion 0.5% lotion 1 permethrin 5% cream 1 permethrin creme rinse 1%* 4




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permethrin lotion 1%* 4 pyrethrins/piperonyl butoxide liquid 0.3-3%* 4 pyrethrins/piperonyl butoxide liquid 0.33-4%* 4 pyrethrins/piperonyl butoxide shampoo 0.33-4%* 4 PYRETHRINS/PIPERONYL BUTOXIDE SHAMPOO KIT 0.33-4%*

4

WOUND CARE PRODUCTS REGRANEX 0.01% GEL 2 NDS QL=30 GM/15 Days



DIAGNOSTIC PRODUCTS DIAGNOSTIC TESTS

ASSURE PLATINUM TEST STRIPS* 4 DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS

NUTRITIONAL SUPPLEMENTS NUTRITIONAL SUPPLEMENT LIQUID* 4 PA

DIGESTIVE AIDS DIGESTIVE ENZYMES

CREON 12000-38000-60000UNIT DR CAP 2 CREON 24000-76000-120000UNIT DR CAP 2 CREON 3000-9500-15000UNIT DR CAP 2 CREON 36000-114000-180000UNIT DR CAP 2 CREON 6000-19000-30000UNIT DR CAP 2 SUCRAID 8500UNIT/ML ORAL SOLN 2 NDS PA ZENPEP 10000-32000-42000UNIT DR CAP 2 ST ZENPEP 15000-47000-63000UNIT DR CAP 2 ST ZENPEP 20000-63000-84000UNIT DR CAP 2 ST ZENPEP 25000-79000-105000UNIT DR CAP 2 ST ZENPEP 3000-10000-14000UNIT DR CAP 2 ST ZENPEP 40000-126000-168000UNIT DR CAP 2 ST ZENPEP 5000-17000-24000UNIT DR CAP 2 ST

DIURETICS CARBONIC ANHYDRASE INHIBITORS

acetazolamide 125mg tab 1 acetazolamide 250mg tab 1 acetazolamide 500mg er cap 1 methazolamide 25mg tab 1 methazolamide 50mg tab 1

DIURETIC COMBINATIONS amiloride 5mg/hydrochlorothiazide 50mg tab 1 hydrochlorothiazide 25mg/spironolactone 25mg tab 1 hydrochlorothiazide 25mg/triamterene 37.5mg cap 1 hydrochlorothiazide 25mg/triamterene 37.5mg tab 1 hydrochlorothiazide 50mg/triamterene 75mg tab 1

LOOP DIURETICS


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bumetanide 0.25mg/ml inj 1 bumetanide 0.5mg tab 1 bumetanide 1mg tab 1 bumetanide 2mg tab 1 ethacrynic acid 25mg tab 1 furosemide 10mg/ml inj 1 furosemide 10mg/ml oral soln 1 furosemide 10mg/ml syringe 1 furosemide 20mg tab 1 furosemide 40mg tab 1 furosemide 80mg tab 1 FUROSEMIDE 8MG/ML ORAL SOLN 1 torsemide 100mg tab 1 torsemide 10mg tab 1 torsemide 20mg tab 1 torsemide 5mg tab 1

POTASSIUM SPARING DIURETICS amiloride 5mg tab 1 spironolactone 100mg tab 1 spironolactone 25mg tab 1 spironolactone 50mg tab 1 triamterene 100mg cap 1 triamterene 50mg cap 1

THIAZIDES AND THIAZIDE-LIKE DIURETICS chlorthalidone 25mg tab 1 chlorthalidone 50mg tab 1 DIURIL 250MG/5ML SUSP 2 hydrochlorothiazide 12.5mg cap 1 hydrochlorothiazide 12.5mg tab 1 hydrochlorothiazide 25mg tab 1 hydrochlorothiazide 50mg tab 1 indapamide 1.25mg tab 1 indapamide 2.5mg tab 1 metolazone 10mg tab 1 metolazone 2.5mg tab 1 metolazone 5mg tab 1



ENDOCRINE AND METABOLIC AGENTS - MISC. BONE DENSITY REGULATORS

ALENDRONATE 0.933MG/ML ORAL SOLN 2 alendronate 10mg tab 1 alendronate 35mg tab 1 alendronate 70mg tab 1 FORTEO 600MCG/2.4ML PEN INJ 2 NDS


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ibandronate 150mg tab 1 ST QL=1 EA/30 Days NATPARA 100MCG CARTRIDGE 2 NDS PA NATPARA 25MCG CARTRIDGE 2 NDS PA NATPARA 50MCG CARTRIDGE 2 NDS PA NATPARA 75MCG CARTRIDGE 2 NDS PA PROLIA 60MG/ML SYRINGE 2 PA risedronate sodium 150mg tab 1 risedronate sodium 30mg tab 1 ST risedronate sodium 35mg (12) pack 1 ST risedronate sodium 35mg (4) pack 1 ST risedronate sodium 35mg tab 1 ST risedronate sodium 5mg tab 1 ST salmon calcitonin 200unit/act nasal spray 1 TYMLOS 2MG/ML PEN INJECTOR 2 NDS XGEVA 120MG/1.7ML INJ 2 NDS PA

GNRH/LHRH ANTAGONISTS ORILISSA 150MG TAB 2 PA QL=30 EA/30 Days ORILISSA 200MG TAB 2 PA QL=60 EA/30 Days

GROWTH HORMONE RECEPTOR ANTAGONISTS SOMAVERT 10MG INJ 2 NDS PA SOMAVERT 15MG INJ 2 NDS PA SOMAVERT 20MG INJ 2 NDS PA SOMAVERT 25MG INJ 2 NDS PA SOMAVERT 30MG INJ 2 NDS PA

GROWTH HORMONES GENOTROPIN 0.2MG SYRINGE 2 NDS PA GENOTROPIN 0.4MG SYRINGE 2 NDS PA GENOTROPIN 0.6MG SYRINGE 2 NDS PA GENOTROPIN 0.8MG SYRINGE 2 NDS PA GENOTROPIN 1.2MG SYRINGE 2 NDS PA GENOTROPIN 1.4MG SYRINGE 2 NDS PA GENOTROPIN 1.6MG SYRINGE 2 NDS PA GENOTROPIN 1.8MG SYRINGE 2 NDS PA GENOTROPIN 12MG CARTRIDGE 2 NDS PA GENOTROPIN 1MG SYRINGE 2 NDS PA GENOTROPIN 2MG SYRINGE 2 NDS PA GENOTROPIN 5MG CARTRIDGE 2 NDS PA

HORMONE RECEPTOR MODULATORS OSPHENA 60MG TAB 2 PA raloxifene 60mg tab 1 QL=30 EA/30 Days

INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS) INCRELEX 40MG/4ML INJ 2 NDS PA

LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS




74

LUPANETA PACK 1-MONTH PACK 2 NDS LUPANETA PACK 3-MONTH PACK 2 SYNAREL 2MG/ML NASAL SPRAY 2 NDS

METABOLIC MODIFIERS calcitriol 0.00025mg cap 1 PA BvD calcitriol 0.0005mg cap 1 PA BvD calcitriol 0.001mg/ml oral soln 1 PA BvD CARBAGLU 200MG SUSP 2 PA cinacalcet 30mg tab 1 PA BvD cinacalcet 60mg tab 1 PA BvD cinacalcet 90mg tab 1 PA BvD doxercalciferol 0.0005mg cap 1 PA BvD doxercalciferol 0.001mg cap 1 PA BvD doxercalciferol 0.0025mg cap 1 PA BvD GALAFOLD 123MG CAP 2 NDS PA QL=15 EA/30 Days KUVAN 100MG POWDER FOR ORAL SOLN 2 NDS PA KUVAN 100MG TAB 2 NDS PA KUVAN 500MG POWDER FOR ORAL SOLN 2 NDS PA levocarnitine 100mg/ml oral soln 1 PA BvD levocarnitine 330mg tab 1 PA BvD ORFADIN 10MG CAP 2 NDS PA ORFADIN 20MG CAP 2 NDS PA ORFADIN 2MG CAP 2 NDS PA ORFADIN 4MG/ML SUSP 2 NDS PA ORFADIN 5MG CAP 2 NDS PA PALYNZIQ 10MG/0.5ML SYRINGE 2 NDS PA PALYNZIQ 2.5MG/0.5ML SYRINGE 2 NDS PA PALYNZIQ 20MG/ML SYRINGE 2 NDS PA paricalcitol 0.001mg cap 1 PA BvD paricalcitol 0.002mg cap 1 PA BvD paricalcitol 0.004mg cap 1 PA BvD RAVICTI 1.1GM/ML ORAL SOLN 2 NDS PA sodium phenylbutyrate 0.94mg/mg oral powder 1

POSTERIOR PITUITARY HORMONES desmopressin acetate 0.01% nasal spray 1 desmopressin acetate 0.1mg tab 1 desmopressin acetate 0.2mg tab 1 STIMATE 1.5MG/ML NASAL SPRAY 2

PROLACTIN INHIBITORS cabergoline 0.5mg tab 1

SOMATOSTATIC AGENTS octreotide 0.05mg/ml inj 1 octreotide 0.1mg/ml inj 1




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octreotide 0.2mg/ml inj 1 octreotide 0.5mg/ml inj 1 octreotide 1mg/ml inj 1 SIGNIFOR 0.3MG/ML INJ 2 NDS PA QL=60 ML/30 Days SIGNIFOR 0.6MG/ML INJ 2 NDS PA QL=60 ML/30 Days SIGNIFOR 0.9MG/ML INJ 2 NDS PA QL=60 ML/30 Days SOMATULINE 120MG/0.5ML SYRINGE 2 NDS SOMATULINE 60MG/0.2ML SYRINGE 2 NDS SOMATULINE 90MG/0.3ML SYRINGE 2 NDS

VASOPRESSIN RECEPTOR ANTAGONISTS JYNARQUE 15MG TAB 2 NDS PA QL=120 EA/30 Days JYNARQUE 30MG TAB 2 NDS PA QL=120 EA/30 Days JYNARQUE 45/15 THERAPY PACK 2 NDS PA QL=60 EA/30 Days JYNARQUE 60/30 THERAPY PACK 2 NDS PA QL=60 EA/30 Days JYNARQUE 90/30 THERAPY PACK 2 NDS PA QL=60 EA/30 Days



ESTROGENS ESTROGEN COMBINATIONS

amabelz 0.5/0.1mg 28 day pack 1 amabelz 1/0.5mg 28 day pack 1 estradiol 0.5mg/norethindrone acetate 0.1mg pack 1 estradiol 1mg/norethindrone acetate 0.5mg pack 1 ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg tab

1

ethinyl estradiol 0.005mg/norethindrone acetate 1mg tab

1

fyavolv 0.5mg-2.5mcg tab 1 fyavolv 1mg-5mcg tab 1 jinteli tab 1 lopreeza 1/0.5mg 28 day pack 1 mimvey pack 1 PREMPHASE 28 DAY PACK 2 PREMPRO 0.3/1.5MG 28 DAY PACK 2 PREMPRO 0.45/1.5 28 DAY PACK 2 PREMPRO 0.625/2.5MG 28 DAY PACK 2 PREMPRO 0.625/5MG 28 DAY PACK 2

ESTROGENS dotti 0.025mg/24hr patch 1 dotti 0.0375mg/24hr patch 1 dotti 0.05mg/24hr patch 1 dotti 0.075mg/24hr patch 1 dotti 0.1mg/24hr patch 1 estradiol 0.00104mg/hr twice weekly patch 1 estradiol 0.00104mg/hr weekly patch 1


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estradiol 0.00156mg/hr twice weekly patch 1 estradiol 0.00156mg/hr weekly patch 1 estradiol 0.00208mg/hr twice weekly patch 1 estradiol 0.00208mg/hr weekly patch 1 estradiol 0.0025mg/hr weekly patch 1 estradiol 0.00312mg/hr weekly patch 1 estradiol 0.00313mg/hr twice weekly patch 1 estradiol 0.00417mg/hr twice weekly patch 1 estradiol 0.00417mg/hr weekly patch 1 estradiol 0.5mg tab 1 estradiol 1mg tab 1 estradiol 20mg/ml inj 1 estradiol 2mg tab 1 estradiol 40mg/ml inj 1 PREMARIN 0.3MG TAB 2 PREMARIN 0.45MG TAB 2 PREMARIN 0.625MG TAB 2 PREMARIN 0.9MG TAB 2 PREMARIN 1.25MG TAB 2



FLUOROQUINOLONES FLUOROQUINOLONES

ciprofloxacin 250mg tab 1 ciprofloxacin 2mg/ml inj 1 ciprofloxacin 500mg tab 1 ciprofloxacin 750mg tab 1 levofloxacin 250mg tab 1 levofloxacin 25mg/ml inj 1 levofloxacin 25mg/ml oral soln 1 levofloxacin 500mg tab 1 levofloxacin 5mg/ml (150ml) inj 1 levofloxacin 5mg/ml inj 1 levofloxacin 750mg tab 1 moxifloxacin 1.6mg/ml inj 1 moxifloxacin 400mg tab 1

GASTROINTESTINAL AGENTS - MISC. ANTIFLATULENTS

simethicone cap 125mg* 4 simethicone cap 180mg* 4 simethicone chew tab 125mg* 4 simethicone chew tab 80mg* 4 simethicone liquid 40mg/0.6ml* 4 SIMETHICONE ORAL STRIP 62.5MG* 4 simethicone susp 40mg/0.6ml* 4


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BILE ACID SYNTHESIS DISORDER AGENTS CHOLBAM 250MG CAP 2 NDS PA CHOLBAM 50MG CAP 2 NDS PA

FARNESOID X RECEPTOR (FXR) AGONISTS OCALIVA 10MG TAB 2 NDS PA QL=30 EA/30 Days OCALIVA 5MG TAB 2 NDS PA QL=30 EA/30 Days

GALLSTONE SOLUBILIZING AGENTS CHENODAL 250MG TAB 2 NDS ursodiol 250mg tab 1 ursodiol 300mg cap 1 ursodiol 500mg tab 1

GASTROINTESTINAL ANTIALLERGY AGENTS cromolyn sodium 20mg/ml oral soln 1

GASTROINTESTINAL STIMULANTS metoclopramide 10mg tab 1 metoclopramide 1mg/ml oral soln 1 metoclopramide 5mg tab 1

INFLAMMATORY BOWEL AGENTS balsalazide disodium 750mg cap 1 CIMZIA 200MG INJ 2 NDS PA CIMZIA 200MG/ML SYRINGE 2 NDS PA DIPENTUM 250MG CAP 2 mesalamine 1000mg rectal supp 1 mesalamine 375mg er cap 1 mesalamine 66.7mg/ml enema 1 sulfasalazine 500mg dr tab 1 sulfasalazine 500mg tab 1

INTESTINAL ACIDIFIERS enulose 10gm/15ml oral soln 1 generlac 10gm/15ml oral soln 1

IRRITABLE BOWEL SYNDROME (IBS) AGENTS alosetron 0.5mg tab 1 alosetron 1mg tab 1 LINZESS 145MCG CAP 2 PA LINZESS 290MCG CAP 2 PA LINZESS 72MCG CAP 2 PA

PERIPHERAL OPIOID RECEPTOR ANTAGONISTS MOVANTIK 12.5MG TAB 2 PA MOVANTIK 25MG TAB 2 PA RELISTOR 12MG/0.6ML INJ 2 PA RELISTOR 12MG/0.6ML SYRINGE 2 PA RELISTOR 8MG/0.4ML SYRINGE 2 PA SYMPROIC 0.2MG TAB 2 PA




78

PHOSPHATE BINDER AGENTS AURYXIA 210MG TAB 2 PA calcium acetate 667mg cap 1 calcium acetate 667mg tab 1 FOSRENOL 1000MG ORAL POWDER 2 FOSRENOL 750MG ORAL POWDER 2 lanthanum carbonate 1000mg chew tab 1 lanthanum carbonate 500mg chew tab 1 lanthanum carbonate 750mg chew tab 1 PHOSLYRA 667MG/5ML ORAL SOLN 2 sevelamer carbonate 2400mg oral susp 1 sevelamer carbonate 800mg oral susp 1 sevelamer carbonate 800mg tab 1

SHORT BOWEL SYNDROME (SBS) AGENTS GATTEX 5MG INJ 2 NDS PA



GENITOURINARY AGENTS - MISCELLANEOUS ALKALINIZERS

potassium citrate 10meq er tab 1 potassium citrate 15 meq er tab 1 potassium citrate 5 meq er tab 1

CYSTINOSIS AGENTS CYSTAGON 150MG CAP 2 PA CYSTAGON 50MG CAP 2 PA

GENITOURINARY IRRIGANTS sodium chloride 0.9% soln 1

INTERSTITIAL CYSTITIS AGENTS ELMIRON 100MG CAP 2

PROSTATIC HYPERTROPHY AGENTS alfuzosin 10mg er tab 1 dutasteride 0.5mg cap 1 dutasteride 0.5mg/tamsulosin 0.4mg cap 1 finasteride 5mg tab 1 silodosin 4mg cap 1 silodosin 8mg cap 1 tamsulosin 0.4mg cap 1

URINARY ANALGESICS phenazopyridine tab 95mg* 4 phenazopyridine tab 97.5mg* 4

URINARY STONE AGENTS LITHOSTAT 250MG TAB 2 THIOLA 100MG DR TAB 2 THIOLA 100MG TAB 2 THIOLA 300MG DR TAB 2


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GOUT AGENTS GOUT AGENT COMBINATIONS

colchicine 0.5mg/probenecid 500mg tab 1 GOUT AGENTS

allopurinol 100mg tab 1 allopurinol 300mg tab 1 COLCHICINE 0.6MG TAB 2 PA febuxostat 40mg tab 1 ST febuxostat 80mg tab 1 ST MITIGARE 0.6MG CAP 2

URICOSURICS probenecid 500mg tab 1

HEMATOLOGICAL AGENTS - MISC. BRADYKININ B2 RECEPTOR ANTAGONISTS

icatibant 10mg/ml syringe 1 NDS PA COMPLEMENT INHIBITORS

BERINERT 500UNIT INJ 2 NDS PA CINRYZE 500UNIT INJ 2 NDS PA HAEGARDA 2000UNT INJ 2 NDS PA HAEGARDA 3000UNT INJ 2 NDS PA RUCONEST 2100UNIT INJ 2 NDS PA

HEMATAOLOGIC - TYROSINE KINASE INHIBITORS TAVALISSE 100MG TAB 2 NDS PA QL=60 EA/30 Days TAVALISSE 150MG TAB 2 NDS PA QL=60 EA/30 Days

HEMATORHEOLOGIC AGENTS pentoxifylline 400mg er tab 1

PLATELET AGGREGATION INHIBITORS anagrelide 0.5mg cap 1 anagrelide 1mg cap 1 aspirin 25mg/dipyridamole 200mg cap 1 BRILINTA 60MG TAB 2 BRILINTA 90MG TAB 2 cilostazol 100mg tab 1 cilostazol 50mg tab 1 clopidogrel 75mg tab 1 prasugrel 10mg tab 1 prasugrel 5mg tab 1

HEMATOPOIETIC AGENTS AGENTS FOR GAUCHER DISEASE

CERDELGA 84MG CAP 2 NDS PA QL=60 EA/30 Days miglustat 100mg cap 1 NDS PA

AGENTS FOR SICKLE CELL ANEMIA DROXIA 200MG CAP 2


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DROXIA 300MG CAP 2 DROXIA 400MG CAP 2 ENDARI 5000MG POWDER FOR ORAL SOLN 2 NDS PA QL=180 EA/30 Days

COBALAMINS cyanocobalamin inj 1000mcg/ml* 3 docusate sodium enema 283mg* 4 vitamin B-12 CR tab 1000mg* 4 vitamin B-12 er tab 2000mcg* 4 vitamin B-12 SL tab 2500mcg* 4 vitamin B-12 SL tab 3000mcg* 4 vitamin B-12 SL tab 5000mcg* 4 vitamin B-12 SL tab 500mcg* 4 vitamin B-12 tab 1000mcg* 4 vitamin B-12 tab 100mcg* 4 VITAMIN B-12 TAB 2000MCG* 4 vitamin B-12 tab 250mcg* 4 vitamin B-12 tab 500mcg* 4 vitamin B-12 tab 50mcg* 4

FOLIC ACID/FOLATES FOLIC ACID INJ 5MG/ML* 3 folic acid tab 1mg* 3 folic acid tab 400mcg* 4 folic acid tab 800mcg* 4

HEMATOPOIETIC GROWTH FACTORS ARANESP 100MCG/0.5ML SYRINGE 2 PA BvD ST ARANESP 100MCG/ML INJ 2 PA BvD ST ARANESP 10MCG/0.4ML SYRINGE 2 PA BvD ST ARANESP 150MCG/0.3ML SYRINGE 2 PA BvD ST ARANESP 200MCG/0.4ML SYRINGE 2 PA BvD ST ARANESP 200MCG/ML INJ 2 PA BvD ST ARANESP 25MCG/0.42ML SYRINGE 2 PA BvD ST ARANESP 25MCG/ML INJ 2 PA BvD ST ARANESP 300MCG/0.6ML SYRINGE 2 PA BvD ST ARANESP 300MCG/ML INJ 2 PA BvD ST ARANESP 40MCG/0.4ML SYRINGE 2 PA BvD ST ARANESP 40MCG/ML INJ 2 PA BvD ST ARANESP 500MCG/ML SYRINGE 2 PA BvD ST ARANESP 60MCG/0.3ML SYRINGE 2 PA BvD ST ARANESP 60MCG/ML INJ 2 PA BvD ST DOPTELET 20MG TAB 2 NDS PA QL=60 EA/30 Days DOPTELET 40MG DAILY DOSE PACK 2 NDS PA QL=10 EA/5 Days DOPTELET 60MG DAILY DOSE PACK 2 NDS PA QL=15 EA/5 Days FULPHILA 6/0.6ML SYRINGE 2 NDS




81

LEUKINE 250MCG INJ 2 NDS PA MULPLETA 3MG TAB 2 NDS PA QL=7 EA/7 Days NIVESTYM 300MCG/0.5ML PF INJ 2 NDS NIVESTYM 300MCG/1ML INJ 2 NDS NIVESTYM 480MCG/0.8ML PF INJ 2 NDS NIVESTYM 480MCG/1.6ML INJ 2 NDS PROMACTA 12.5MG POWDER FOR ORAL SUSP 2 NDS PA PROMACTA 12.5MG TAB 2 NDS PA PROMACTA 25MG TAB 2 NDS PA PROMACTA 50MG TAB 2 NDS PA PROMACTA 75MG TAB 2 NDS PA RETACRIT 10000UNIT/ML INJ 2 PA BvD RETACRIT 2000UNIT/ML INJ 2 PA BvD RETACRIT 3000UNIT/ML INJ 2 PA BvD RETACRIT 40000UNIT/ML INJ 2 PA BvD RETACRIT 4000UNIT/ML INJ 2 PA BvD UDENYCA 6MG/0.6ML SYRINGE 2 NDS ZARXIO 300MCG/0.5ML SYRINGE 2 NDS ZARXIO 480MCG/0.8ML SYRINGE 2 NDS ZIEXTENZO 6MG/0.6ML SYRINGE 2 NDS

IRON ferrous sulfate CR tab 142mg* 4 ferrous sulfate CR tab 160mg* 4 ferrous sulfate CR tab 45mg* 4 ferrous sulfate CR tab 47.5mg* 4 ferrous sulfate CR tab 50mg* 4 FERROUS SULFATE EC TAB 324MG* 4 ferrous sulfate EC tab 325mg* 4 ferrous sulfate elixir 220mg/5ml* 4 FERROUS SULFATE LIQUID 220MG/5ML* 4 ferrous sulfate oral soln 75mg/ml* 4 FERROUS SULFATE SYRUP 300MG/5ML* 4 ferrous sulfate tab 27mg* 4 ferrous sulfate tab 325mg* 4 ferrous sulfate tab er 143mg* 4 VENOFER INJ 20MG/ML* 3



HEMOSTATICS HEMOSTATICS - SYSTEMIC

tranexamic acid 650mg tab 1 HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS

ANTIHISTAMINE HYPNOTICS doxylamine succinate tab 25mg* 4

BARBITURATE HYPNOTICS


82

phenobarbital 100mg tab 1 phenobarbital 15mg tab 1 phenobarbital 16.2mg tab 1 phenobarbital 30mg tab 1 phenobarbital 32.4mg tab 1 phenobarbital 4mg/ml oral soln 1 phenobarbital 60mg tab 1 phenobarbital 64.8mg tab 1 phenobarbital 97.2mg tab 1

NON-BARBITURATE HYPNOTICS eszopiclone 1mg tab 1 PA QL=30 EA/30 Days eszopiclone 2mg tab 1 PA QL=30 EA/30 Days eszopiclone 3mg tab 1 PA QL=30 EA/30 Days temazepam 15mg cap 1 temazepam 22.5mg cap 1 temazepam 30mg cap 1 temazepam 7.5mg cap 1 triazolam 0.125mg tab 1 triazolam 0.25mg tab 1 zaleplon 10mg cap 1 QL=30 EA/30 Days zaleplon 5mg cap 1 QL=30 EA/30 Days zolpidem tartrate 10mg tab 1 PA QL=30 EA/30 Days zolpidem tartrate 5mg tab 1 PA QL=60 EA/30 Days

SELECTIVE MELATONIN RECEPTOR AGONISTS HETLIOZ 20MG CAP 2 NDS PA QL=30 EA/30 Days ramelteon 8mg tab 1 QL=30 EA/30 Days



LAXATIVES BULK LAXATIVES

calcium polycarbophil tab 625mg* 4 METAMUCIL WAFER* 4 psyllium powder 28.3%* 4 psyllium powder 48.57%* 4 psyllium powder 51.7%* 4 PSYLLIUM POWDER 52.3%* 4 psyllium powder 58.6%* 4 psyllium powder 68%* 4 PSYLLIUM POWDER PACKET 100%* 4 PSYLLIUM POWDER PACKET 28%* 4 PSYLLIUM POWDER PACKET 28.3%* 4 PSYLLIUM POWDER PACKET 58.12%* 4 PSYLLIUM POWDER PACKET 58.6%* 4 PSYLLIUM POWDER PACKET 95%* 4

LAXATIVE COMBINATIONS


83

CLENPIQ POWDER 2 gavilyte-c oral soln 1 gavilyte-g powder for oral soln 1 gavilyte-n powder for oral soln 1 peg 3350/electrolyte oral soln 1 peg 3350/kcl/sodium bicarbonate/sodium chloride powder for oral soln

1

trilyte powder for oral soln 1 LAXATIVES - MISCELLANEOUS

constulose 10gm/15ml oral soln 1 glycerin supp 1.2gm* 4 glycerin supp 1gm* 4 glycerin supp 2.1gm* 4 glycerin supp 2gm* 4 glycerin supp 80.7%* 4 lactulose 667mg/ml oral soln 1 polyethylene glycol 3350 oral powder (OTC)* 4 polyethylene glycol 3350 powder packet (OTC)* 4

LUBRICANT LAXATIVES MINERAL OIL (BULK)* 4 mineral oil enema* 4 mineral oil* 4

SALINE LAXATIVES magnesium citrate soln* 4 magnesium hydroxide susp 400mg/5ml* 4 sodium phosphates enema* 4 sodium phosphates pediatric enema* 4

STIMULANT LAXATIVES bisacodyl supp 10mg* 4 bisacodyl tab delayed release 5mg* 4 sennosides syrup 8.8mg/5ml* 4 sennosides tab 15mg* 4 sennosides tab 17.2mg* 4 sennosides tab 25mg* 4 sennosides tab 8.6mg* 4

SURFACTANT LAXATIVES docusate calcium cap 240mg* 4 docusate sodium cap 100mg* 4 docusate sodium cap 250mg* 4 docusate sodium liquid 150mg/15ml* 4 docusate sodium syrup 60mg/15ml* 4 docusate sodium tab 100mg* 4 ENEMEEZ MINI ENEMA 283MG* 4




84



MACROLIDES AZITHROMYCIN

azithromycin 20mg/ml susp 1 azithromycin 250mg pack 1 azithromycin 250mg tab 1 azithromycin 2mg/ml inj 1 azithromycin 40mg/ml susp 1 azithromycin 500mg (3) tab pack 1 azithromycin 500mg tab 1 azithromycin 600mg tab 1

CLARITHROMYCIN clarithromycin 250mg tab 1 CLARITHROMYCIN 25MG/ML SUSP 1 clarithromycin 500mg er tab 1 clarithromycin 500mg tab 1 CLARITHROMYCIN 50MG/ML SUSP 1

ERYTHROMYCINS ERYTHROCIN LACTOBIONATE 500MG INJ 2 erythromycin 250mg dr cap 1 erythromycin 250mg tab 1 erythromycin 500mg tab 1 erythromycin ethylsuccinate 40mg/ml susp 1 erythromycin ethylsuccinate 80mg/ml oral susp 1

MEDICAL DEVICES PARENTERAL THERAPY SUPPLIES

INSULIN SYRINGE (DISP) U-100 1/2ML 1 MEDICAL DEVICES AND SUPPLIES

BANDAGES-DRESSINGS-TAPE GAUZE PAD 1

CONTRACEPTIVES CONDOMS LATEX LUBRICATED* 4 CONDOMS LATEX NON-LUBRICATED* 4

DIABETIC SUPPLIES LANCETS* 4

MISC. DEVICES ISOPROPYL ALCOHOL 0.7ML/ML PAD 1

PARENTERAL THERAPY SUPPLIES INSULIN PEN NEEDLE 2 INSULIN SYRINGE (DISP) U-100 0.3ML 1 INSULIN SYRINGE (DISP) U-100 1ML 1 INSULIN SYRINGE MIS 1ML/29G 1

RESPIRATORY THERAPY SUPPLIES PEAK FLOW METER* 4


85



MIGRAINE PRODUCTS MIGRAINE PRODUCTS

DIHYDROERGOTAMINE MESYLATE 0.5MG/ACT NASAL SPRAY

2 QL=16 ML/30 Days

SEROTONIN AGONISTS naratriptan 1mg tab 1 QL=18 EA/30 Days naratriptan 2.5mg tab 1 QL=18 EA/30 Days rizatriptan 10mg odt 1 QL=36 EA/60 Days rizatriptan 10mg tab 1 QL=36 EA/60 Days rizatriptan 5mg odt 1 QL=36 EA/60 Days rizatriptan 5mg tab 1 QL=36 EA/60 Days sumatriptan 100mg tab 1 QL=18 EA/30 Days sumatriptan 12mg/ml auto-injector 1 QL=5 ML/30 Days sumatriptan 12mg/ml inj 1 QL=5 ML/30 Days SUMATRIPTAN 12MG/ML SYRINGE 2 QL=5 ML/30 Days sumatriptan 20mg/act nasal spray 1 QL=12 EA/30 Days sumatriptan 25mg tab 1 QL=18 EA/30 Days sumatriptan 4mg cartridge 1 QL=5 ML/30 Days sumatriptan 50mg tab 1 QL=18 EA/30 Days sumatriptan 5mg/act nasal spray 1 QL=12 EA/30 Days sumatriptan 6mg cartridge 1 QL=5 ML/30 Days sumatriptan 8mg/ml auto-injector 1 QL=5 ML/30 Days zolmitriptan 2.5mg odt 1 QL=18 EA/30 Days zolmitriptan 2.5mg tab 1 QL=18 EA/30 Days zolmitriptan 5mg odt 1 QL=18 EA/30 Days zolmitriptan 5mg tab 1 QL=18 EA/30 Days ZOMIG 2.5MG NASAL SPRAY 2 QL=16 EA/30 Days ZOMIG 5MG NASAL SPRAY 2 QL=12 EA/30 Days

MINERALS & ELECTROLYTES CALCIUM

CALCI-CHEW 4 CALCIUM CARBONATE 260MG CHEW* 4 calcium carbonate tab 1250mg* 4 calcium carbonate tab 1500mg* 4 calcium carbonate tab 600mg* 4 calcium carbonate/vitamin D cap 600mg-200unit* 4 calcium carbonate/vitamin D cap 600mg-500unit* 4 calcium carbonate/vitamin D chew tab 500mg-100unit*

4

calcium carbonate/vitamin D chew tab 500mg-400unit*

4


4


86

calcium carbonate/vitamin D tab 200mg-250unit* 4 calcium carbonate/vitamin D tab 250mg-125unit* 4 calcium carbonate/vitamin D tab 250mg-200unit* 4 calcium carbonate/vitamin D tab 315mg-200unit* 4 calcium carbonate/vitamin D tab 315mg-250unit* 4 calcium carbonate/vitamin D tab 500mg-125unit* 4 calcium carbonate/vitamin D tab 500mg-200unit* 4 calcium carbonate/vitamin D tab 500mg-400unit* 4 calcium carbonate/vitamin D tab 500mg-600unit* 4 calcium carbonate/vitamin D tab 600mg-125unit* 4 calcium carbonate/vitamin D tab 600mg-200unit* 4 calcium carbonate/vitamin D tab 600mg-400unit* 4 calcium carbonate/vitamin D tab 600mg-800unit* 4 CALCIUM GLUCONATE TAB 50MG* 4 calcium tab 600mg* 4 CALTRATE CHEW TAB 600MG-800UNIT* 4 oyster shell calcium tab 500mg* 4 RISCAL-D TAB* 4

ELECTROLYTE MIXTURES GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0342 MEQ/ML INJ

1 PA BvD

GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0769 MEQ/ML INJ

1 PA BvD


1

glucose 50 mg/ml/potassium chloride 0.04meq/ml/sodium chloride 4.5mg/ml inj

1

glucose 50mg/ml/potassium chloride 0.01 meq/ml/sodium chloride 0.0769 meq/ml inj

1

glucose 50mg/ml/potassium chloride 0.02 meq/ml inj 1 glucose 50mg/ml/potassium chloride 0.02 meq/ml/sodium chloride 0.0342 meq/ml inj

1


1

glucose 50mg/ml/potassium chloride 0.02meq/ml/sodium chloride 4.5mg/ml inj

1


1

GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04 MEQ/ML INJ

1

GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04 MEQ/ML/SODIUM CHLORIDE 0.154 MEQ/ML INJ

1

glucose 50mg/ml/sodium chloride 0.0342 meq/ml inj 1




87


1

glucose 50mg/ml/sodium chloride 4.5mg/ml inj 1 glucose 50mg/ml/sodium chloride 9mg/ml inj 1 ISOLYTE P INJ 2 ISOLYTE S INJ 2 KCL/D5W/LR INJ 0.15% 2 NORMOSOL-M INJ 1 NORMOSOL-R IN 5% DEXTROSE INJ 2 NORMOSOL-R INJ 2 oral electrolyte solution* 4 PLASMA-LYTE 148 INJ 2 PLASMALYTE A INJ 2 potassium chloride 0.02 meq/ml/sodium chloride 0.0769 meq/ml inj

1

potassium chloride 0.02 meq/ml/sodium chloride 0.154 meq/ml inj

1


1

TPN ELECTROLYTES INJ 1 PA BvD MAGNESIUM

magnesium oxide tab 200mg* 4 magnesium oxide tab 250mg* 4 magnesium oxide tab 400mg* 4 magnesium oxide tab 500mg* 4 magnesium sulfate 50% inj 1 magnesium sulfate 50% syringe 1 magnesium tab 100mg* 4 MAGNESIUM TAB 200MG* 4 magnesium tab 200mg* 4 magnesium tab 250mg* 4

POTASSIUM K-TAB 20MEQ ER TAB 1 K-TAB 8MEQ ER TAB 1 klor-con 10meq er micro tab 1 klor-con 10meq er tab 1 KLOR-CON 15MEQ ER TAB 1 klor-con 20meq er micro tab 1 klor-con 20meq powder 1 klor-con 8meq er tab 1 potassium chloride 0.1 meq/ml inj 1 potassium chloride 0.2meq/ml inj 1 potassium chloride 0.4meq/ml inj 1




88

potassium chloride 10% oral soln 1 potassium chloride 10meq er cap 1 potassium chloride 10meq er micro tab 1 potassium chloride 10meq er tab 1 potassium chloride 20% oral soln 1 potassium chloride 20meq er micro tab 1 POTASSIUM CHLORIDE 20MEQ ER TAB 1 potassium chloride 20meq powder for oral soln 1 potassium chloride 2meq/ml inj 1 potassium chloride 40meq/20ml inj 1 potassium chloride 8 meq er cap 1 potassium chloride 8 meq er tab 1

SODIUM sodium chloride 0.45% inj 1 sodium chloride 0.9% inj 1 sodium chloride 3% inj 1 sodium chloride 5% inj 1 sodium chloride flush IV soln 0.9%* 3



MISCELLANEOUS THERAPEUTIC CLASSES CHELATING AGENTS

DEPEN 250MG TAB 2 penicillamine 250mg tab 1 trientine 250mg tab 1 PA

IMMUNOMODULATORS REVLIMID 10MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 15MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 2.5MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 20MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 25MG CAP 2 NDS PA NSO QL=30 EA/30 Days REVLIMID 5MG CAP 2 NDS PA NSO QL=30 EA/30 Days THALOMID 100MG CAP 2 NDS PA NSO THALOMID 150MG CAP 2 NDS PA NSO THALOMID 200MG CAP 2 NDS PA NSO THALOMID 50MG CAP 2 NDS PA NSO

IMMUNOSUPPRESSIVE AGENTS ASTAGRAF 0.5MG XL CAP 2 PA BvD ASTAGRAF 1MG XL CAP 2 PA BvD ASTAGRAF 5MG XL CAP 2 PA BvD cyclosporine modified 100mg/ml oral soln 1 PA BvD CYCLOSPORINE MODIFIED 50MG CAP 1 PA BvD ENVARSUS 0.75MG ER TAB 2 PA BvD ENVARSUS 1MG ER TAB 2 PA BvD ENVARSUS 4MG ER TAB 2 PA BvD


89

PROGRAF 0.2MG GRANULES PACKET 2 PA BvD PROGRAF 1MG GRANULES PACKET 2 PA BvD sirolimus 1mg/ml oral soln 1 PA BvD ZORTRESS 0.25MG TAB 2 PA BvD ZORTRESS 0.5MG TAB 2 PA BvD ZORTRESS 0.75MG TAB 2 PA BvD ZORTRESS 1MG TAB 2 PA BvD

POTASSIUM REMOVING AGENTS LOKELMA 10GM PACKET 2 PA LOKELMA 5GM PACKET 2 PA VELTASSA 16.8GM POWDER FOR ORAL SUSP 2 PA VELTASSA 25.2GM POWDER FOR ORAL SUSP 2 PA VELTASSA 8.4GM POWDER FOR ORAL SUSP 2 PA

SYSTEMIC LUPUS ERYTHEMATOSUS AGENTS BENLYSTA 200MG/ML AUTO-INJECTOR 2 NDS PA QL=4 ML/28 Days BENLYSTA 200MG/ML SYRINGE 2 NDS PA QL=4 ML/28 Days



MOUTH/THROAT/DENTAL AGENTS ANESTHETICS TOPICAL ORAL

lidocaine 2% topical soln 1 ANTI-INFECTIVES - THROAT

clotrimazole 10mg lozenge 1nystatin 100000unit/ml susp 1

ANTISEPTICS - MOUTH/THROAT chlorhexidine gluconate 0.12% mouthwash 1

STEROIDS - MOUTH/THROAT triamcinolone acetonide 0.1% paste 1

THROAT PRODUCTS - MISC. cevimeline 30mg cap 1pilocarpine 5mg tab 1pilocarpine 7.5mg tab 1

MULTIVITAMINS B-COMPLEX W/ C

B-complex w/vitamin C cap* 4 MULTIPLE VITAMINS W/ MINERALS

multiple vitamins w/minerals tab* 4 MULTIVITAMINS

multiple vitamin tab* 4 PRENATAL VITAMINS

PRENATAL VITAMIN (OTC)* 4 MUSCULOSKELETAL THERAPY AGENTS

CENTRAL MUSCLE RELAXANTS baclofen 10mg tab 1baclofen 20mg tab 1


90

carisoprodol 350mg tab 1 PA QL=90 EA/30 Days CHLORZOXAZONE 500MG TAB 1 PA cyclobenzaprine 10mg tab 1 PA QL=90 EA/30 Days cyclobenzaprine 5mg tab 1 PA QL=90 EA/30 Days cyclobenzaprine 7.5mg tab 1 PA QL=90 EA/30 Days METAXALONE 400MG TAB 2 PA metaxalone 800mg tab 1 PA methocarbamol 500mg tab 1 PA methocarbamol 750mg tab 1 PA orphenadrine citrate 100mg er tab 1 PA tizanidine 2mg cap 1 tizanidine 2mg tab 1 tizanidine 4mg cap 1 tizanidine 4mg tab 1 tizanidine 6mg cap 1

DIRECT MUSCLE RELAXANTS dantrolene sodium 100mg cap 1 dantrolene sodium 25mg cap 1 dantrolene sodium 50mg cap 1



NASAL AGENTS - SYSTEMIC AND TOPICAL NASAL AGENTS - MISC.

saline nasal spray 0.65%* 4 NASAL ANTIALLERGY

azelastine 0.1% (137mcg) nasal inhaler 1 azelastine 0.15% (205.5mcg) nasal inhaler 1 cromolyn sodium nasal aerosol soln 5.2 mg/act (4%)* 4 olopatadine 0.6% nasal inhaler 1

NASAL ANTICHOLINERGICS ipratropium bromide 0.03% nasal inhaler 1 ipratropium bromide 0.06% nasal inhaler 1

NASAL STEROIDS FLUNISOLIDE 25MCG NASAL INHALER 2 QL=50 ML/30 Days fluticasone propionate 50mcg nasal inhaler 1 QL=32 GM/30 Days triamcinolone acetonide nasal suspension 55mcg (OTC)*

4

SYMPATHOMIMETIC DECONGESTANTS pseudoephedrine liquid 15mg/5ml* 4 pseudoephedrine tab 30mg* 4 pseudoephedrine tab 60mg* 4

NEUROMUSCULAR AGENTS ALS AGENTS

riluzole 50mg tab 1 NUTRIENTS


91

CARBOHYDRATES glucose 10% inj 1 PA BvD glucose 100mg/ml inj 1

LIPIDS intralipid 200mg/ml inj 1 PA BvD nutrilipid 20% iv soln 1 PA BvD

MISC. NUTRITIONAL SUBSTANCES omega-3 fatty acids cap 1000mg* 4 omega-3 fatty acids cap 1200mg* 4

PROTEINS AMINOSYN II 10% INJ 2 PA BvD AMINOSYN-PF 10% SULFITE-FREE INJ 2 PA BvD AMINOSYN-PF 7% INJ 2 PA BvD CLINIMIX 4.25/10 INJ 2 PA BvD CLINIMIX 4.25/5 INJ 2 PA BvD CLINIMIX 5/15 INJ 2 PA BvD CLINIMIX 5/20 INJ 2 PA BvD CLINIMIX E 2.75/5 INJ 2 PA BvD CLINIMIX E 4.25/10 INJ 2 PA BvD CLINIMIX E 4.25/5 INJ 2 PA BvD CLINIMIX E 5/15 INJ 2 PA BvD CLINIMIX E 5/20 INJ 2 PA BvD clinisol 15% inj 1 PA BvD FREAMINE 6.9% INJ 2 PA BvD HEPATAMINE 8% INJ 2 PA BvD NEPHRAMINE 5.4% INJ 2 PA BvD plenamine 15% inj 1 PA BvD PREMASOL 10% INJ 2 PA BvD PROCALAMINE 3% INJ 2 PA BvD PROSOL 20% INJ 2 PA BvD TRAVASOL 10% INJ 2 PA BvD TROPHAMINE 10% INJ 2 PA BvD



OPHTHALMIC AGENTS ARTIFICIAL TEARS AND LUBRICANTS

artificial tears ophth soln 1.4%* 4 dextran 70/hypromellose ophth soln 0.1-0.3%* 4 genteal tear moderate soln* 4 LACRISERT 5MG IMPLANT 2 white petrolatum/mineral oil ophth ointment* 4

BETA-BLOCKERS - OPHTHALMIC betaxolol 0.5% ophth soln 1 BETIMOL 0.25% OPHTH SOLN 2 BETIMOL 0.5% OPHTH SOLN 2


92

BETOPTIC S 0.25% OPHTH SUSP 2 CARTEOLOL 1% OPHTH SOLN 1 COMBIGAN 0.2-0.5% OPHTH SOLN 2 dorzolamide 20mg/ml/timolol 5mg/ml ophth soln 1 dorzolamide/timolol 22.3-6.8mg/ml ophth soln (preservative-free)

1

levobunolol 0.5% ophth soln 1 TIMOLOL 0.25% OPHTH GEL 2 timolol 0.25% ophth soln 1 TIMOLOL 0.5% OPHTH GEL 2 timolol 0.5% ophth soln 1 timolol 5mg/ml ophth 24hr ophth soln 1 TIMOPTIC-XE 0.25% OPHTH GEL 2 TIMOPTIC-XE 0.5% OPHTH GEL 2

CYCLOPLEGIC MYDRIATICS ATROPINE SULFATE 1% OPHTH SOLN 1

MIOTICS PHOSPHOLINE IODIDE 0.125% OPHTH SOLN 2 pilocarpine 1% ophth soln 1 pilocarpine 2% ophth soln 1 pilocarpine 4% ophth soln 1

OPHTHALMIC ADRENERGIC AGENTS ALPHAGAN P 0.1% OPHTH SOLN 2 brimonidine tartrate 0.15% ophth soln 1 brimonidine tartrate 0.2% ophth soln 1 IOPIDINE 1% OPHTH SOLN 2 SIMBRINZA 1-0.2% OPHTH SUSP 2

OPHTHALMIC ANTI-INFECTIVES AZASITE 1% OPHTH SOLN 2 BACITRACIN 0.5UNIT/MG OPHTH OINTMENT 1 bacitracin 0.5unit/mg/polymyxin b 10unit/mg ophth ointment

1

ciprofloxacin 0.3% ophth soln 1 erythromycin 0.005mg/mg ophth ointment 1 gatifloxacin 0.5% ophth soln 1 ST GENTAK 0.3% OPHTH OINTMENT 1 gentamicin sulfate 0.3% ophth soln 1 GRAMICIDIN 0.025MG/ML/NEOMYCIN 1.75MG/ML/POLYMYXIN B 10000UNIT/ML OPHTH SOLN

1

levofloxacin 0.5% ophth soln 1 moxifloxacin 0.5% ophth soln 1 NATACYN 5% OPHTH SUSP 2




93

neomycin/bacitracin/polymyxin ophth ointment 5(3.5)mg-400unit-10000unit

1

ofloxacin 0.3% ophth soln 1 polymyxin b 10000unit/ml/trimethoprim 1mg/ml ophth soln

1

SULFACETAMIDE SODIUM 10% OPHTH OINTMENT 1 sulfacetamide sodium 10% ophth soln 1 tobramycin 0.3% ophth soln 1 TRIFLURIDINE 1% SOLN 1 ZIRGAN 0.15% OPHTH GEL 2

OPHTHALMIC DECONGESTANTS naphazoline w/pheniramine ophth soln 0.025-0.3%* 4 naphazoline w/pheniramine ophth soln 0.027-0.315% *

4

OPHTHALMIC IMMUNOMODULATORS RESTASIS 0.05% OPHTH SUSP 2

OPHTHALMIC LOCAL ANESTHETICS proparacaine 0.5% ophth soln 1

OPHTHALMIC STEROIDS ALREX 0.2% OPHTH SUSP 2 BLEPHAMIDE 10-0.2% OPHTH SUSP 2 DEXAMETHASONE 0.1% OPHTH SOLN 1 dexamethasone/neomycin/polymyxin b 0.1% ophth ointment

1

dexamethasone/neomycin/polymyxin b 0.1% ophth susp

1

dexamethasone/tobramycin 0.3-0.1% ophth susp 1 DUREZOL 0.05% OPHTH SUSP 2 fluorometholone 0.1% ophth susp 1 LOTEMAX 0.5% OPHTH GEL 2 LOTEMAX 0.5% OPHTH OINTMENT 2 loteprednol etabonate 0.5% ophth susp 1 neomycin/polymyxin/bacitracin/hydrocortisone ophth ointmentment 1%

1

PRED MILD 0.12% OPHTH SUSP 2 PRED-G 0.3-1% OPHTH SUSP 2 PREDNISOLONE 1% OPHTH SOLN 1 PREDNISOLONE ACETATE 1% OPHTH SUSP 1 PREDNISOLONE SODIUM PHOSPHATE 2.5MG/ML/SULFACETAMIDE SODIUM 100MG/ML OPHTH SOLN

1

TOBRADEX 0.3-0.1% OPHTH OINTMENT 2 OPHTHALMICS - MISC.




94

ALOMIDE 0.1% OPHTH SOLN 2 azelastine 0.05% ophth soln 1 AZOPT 1% OPHTH SUSP 2 cromolyn sodium 4% ophth soln 1 CYSTARAN 0.44% OPHTH SOLN 2 NDS PA QL=60 ML/30 Days diclofenac sodium 0.1% ophth soln 1 dorzolamide 2% ophth soln 1 epinastine 0.05% ophth soln 1 eye wash soln* 4 flurbiprofen sodium 0.03% ophth soln 1 ILEVRO 0.3% OPHTH SUSP 2 ketorolac tromethamine 0.4% ophth soln 1 ketorolac tromethamine 0.5% ophth soln 1 ketotifen fumarate ophth soln 0.025%* 4 NEVANAC 0.1% OPHTH SUSP 2 olopatadine 1mg/ml ophth soln 1 olopatadine 2% ophth soln 1 sodium chloride hypertonic ophth ointment 5%* 4 sodium chloride hypertonic ophth soln 5%* 4

PROSTAGLANDINS - OPHTHALMIC bimatoprost 0.03% ophth soln 1 QL=5 ML/30 Days latanoprost 0.005% ophth soln 1 QL=5 ML/30 Days LUMIGAN 0.01% OPHTH SOLN 2 QL=5 ML/30 Days travoprost 0.004% ophth soln 1 QL=5 ML/30 Days



OTIC AGENTS OTIC AGENTS - MISCELLANEOUS

acetic acid 2% otic soln 1 carbamide peroxide 6.5% otic soln* 4

OTIC ANTI-INFECTIVES CETRAXAL 0.2% OTIC SOLN 2 CIPROFLOXACIN 0.2% OTIC SOLN 2 ofloxacin 0.3% otic soln 1

OTIC COMBINATIONS CIPRODEX 0.3-0.1% OTIC SUSP 2 hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic soln

1

hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic susp

1

OTIC STEROIDS acetic acid/hydrocortisone 1-2% otic soln 1 fluocinolone acetonide 0.01% otic oil 1 fluocinolone acetonide 0.01% otic soln 1

PASSIVE IMMUNIZING AND TREATMENT AGENTS


95

IMMUNE SERUMS BIVIGAM 5GM/50ML INJ 2 NDS PA FLEBOGAMMA 10% INJ 2 NDS PA GAMMAGARD 10GM INJ 2 NDS PA GAMMAGARD 2.5GM/25ML INJ 2 NDS PA GAMMAGARD 5GM INJ 2 NDS PA GAMMAKED 1GM/10ML INJ 2 NDS PA GAMMAPLEX 10GM/100ML INJ 2 NDS PA GAMMAPLEX 10GM/200ML INJ 2 NDS PA GAMMAPLEX 20GM/200ML INJ 2 NDS PA GAMMAPLEX 5GM/50ML INJ 2 NDS PA GAMUNEX 1GM/10ML INJ 2 NDS PA OCTAGAM 25GM/500ML INJ 2 NDS PA OCTAGAM 2GM/20ML INJ 2 NDS PA PANZYGA 10GM/100ML IV SOLN 2 NDS PA PANZYGA 1GM/10ML IV SOLN 2 NDS PA PANZYGA 2.5GM/25ML IV SOLN 2 NDS PA PANZYGA 20GM/200ML IV SOLN 2 NDS PA PANZYGA 30GM/300ML IV SOLN 2 NDS PA PANZYGA 5GM/50ML IV SOLN 2 NDS PA PRIVIGEN 20GM/200ML INJ 2 NDS PA VARIZIG 124.8/1.2ML INJ 2 NDS



PENICILLINS AMINOPENICILLINS

amoxicillin 125mg chew tab 1 amoxicillin 250mg cap 1 AMOXICILLIN 250MG CHEW TAB 1 amoxicillin 25mg/ml susp 1 amoxicillin 40mg/ml susp 1 amoxicillin 500mg cap 1 amoxicillin 500mg tab 1 amoxicillin 50mg/ml susp 1 amoxicillin 80mg/ml susp 1 amoxicillin 875mg tab 1 ampicillin 100mg/ml inj 1 AMPICILLIN 125MG/ML INJ 2 ampicillin 250mg/ml inj 1 AMPICILLIN 500MG CAP 1

NATURAL PENICILLINS BICILLIN L-A 1200000UNIT/2ML SYRINGE 2 BICILLIN L-A 2400000UNIT/4ML SYRINGE 2 BICILLIN L-A 600000UNIT/ML SYRINGE 2 penicillin g potassium 1000000unit/ml inj 1


96

PENICILLIN G POTASSIUM 40000UNIT/ML INJ 1 PENICILLIN G POTASSIUM 60000UNIT/ML INJ 1 PENICILLIN G PROCAINE 600000UNIT/ML SYRINGE

2

PENICILLIN G SODIUM 100000UNIT/ML INJ 2 penicillin v potassium 250mg tab 1 PENICILLIN V POTASSIUM 25MG/ML ORAL SOLN 1 penicillin v potassium 500mg tab 1 PENICILLIN V POTASSIUM 50MG/ML ORAL SOLN 1

PENICILLIN COMBINATIONS AMOXICILLIN 1000MG/CLAVULANATE 62.5MG ER TAB

1

amoxicillin 120mg/ml/clavulanate 8.58mg/ml susp 1 AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

2

amoxicillin 250mg/clavulanate 125mg tab 1 AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB

2

amoxicillin 40mg/ml/clavulanate 5.7mg/ml susp 1 amoxicillin 500mg/clavulanate 125mg tab 1 amoxicillin 50mg/ml/clavulanate 12.5mg/ml susp 1 amoxicillin 80mg/ml/clavulanate 11.4mg/ml susp 1 amoxicillin 875mg/clavulanate 125mg tab 1 ampicillin 20mg/ml/sulbactam 10mg/ml inj 1 ampicillin 250mg/ml/sulbactam 125mg/ml inj 1 BICILLIN 300000-300000UNIT/ML SYRINGE 2 BICILLIN 450000-150000UNIT/ML SYRINGE 2 piperacillin 2000mg/tazobactam 250mg inj 1 piperacillin 200mg/ml/tazobactam 25mg/ml inj 1 piperacillin 3000mg/tazobactam 375mg inj 1 piperacillin 4000mg/tazobactam 500mg inj 1

PENICILLINASE-RESISTANT PENICILLINS dicloxacillin 250mg cap 1 dicloxacillin 500mg cap 1 nafcillin 100mg/ml inj 1 nafcillin 1gm inj 1 nafcillin 2gm inj 1 oxacillin 100mg/ml inj 1 oxacillin 1gm inj 1 oxacillin 2000mg inj 1 OXACILLIN 20MG/ML INJ 2 OXACILLIN 40MG/ML INJ 2



PROGESTINS


97

PROGESTINS medroxyprogesterone acetate 10mg tab 1 medroxyprogesterone acetate 2.5mg tab 1 medroxyprogesterone acetate 5mg tab 1 megestrol acetate 125mg/ml susp 1 PA norethindrone acetate 5mg tab 1 progesterone 100mg cap 1 progesterone 200mg cap 1



PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. AGENTS FOR CHEMICAL DEPENDENCY

acamprosate calcium 333mg dr tab 1 disulfiram 250mg tab 1 disulfiram 500mg tab 1

ANTI-CATAPLECTIC AGENTS XYREM 500MG/ML ORAL SOLN 2 NDS PA QL=540 ML/30 Days

ANTIDEMENTIA AGENTS donepezil 10mg odt 1 QL=30 EA/30 Days donepezil 10mg tab 1 QL=60 EA/30 Days donepezil 23mg tab 1 ST QL=30 EA/30 Days donepezil 5mg odt 1 QL=30 EA/30 Days donepezil 5mg tab 1 QL=60 EA/30 Days galantamine 12mg tab 1 galantamine 4mg tab 1 galantamine 8mg tab 1 galantamine hydrobromide 16mg er cap 1 galantamine hydrobromide 24mg er cap 1 GALANTAMINE HYDROBROMIDE 4MG/ML ORAL SOLN

2

galantamine hydrobromide 8mg er cap 1 memantine 10mg tab 1 QL=60 EA/30 Days memantine 10mg/memantine 5mg pack 1 memantine 14mg er cap 1 QL=30 EA/30 Days memantine 21mg er cap 1 QL=30 EA/30 Days memantine 28mg er cap 1 QL=30 EA/30 Days memantine 2mg/ml oral soln 1 QL=300 ML/30 Days memantine 5mg tab 1 QL=60 EA/30 Days memantine 7mg er cap 1 QL=30 EA/30 Days rivastigmine 1.5mg cap 1 rivastigmine 13.3mg/24hr patch 1 QL=30 EA/30 Days rivastigmine 3mg cap 1 rivastigmine 4.5mg cap 1 rivastigmine 4.6mg/24hr patch 1 QL=30 EA/30 Days rivastigmine 6mg cap 1


98

rivastigmine 9.5mg/24hr patch 1 QL=30 EA/30 Days COMBINATION PSYCHOTHERAPEUTICS

AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB 1 AMITRIPTYLINE 10MG/PERPHENAZINE 4MG TAB 1 amitriptyline 12.5mg/chlordiazepoxide 5mg tab 1 amitriptyline 25mg/chlordiazepoxide 10mg tab 1 AMITRIPTYLINE 25MG/PERPHENAZINE 2MG TAB 1 AMITRIPTYLINE 25MG/PERPHENAZINE 4MG TAB 1 AMITRIPTYLINE 50MG/PERPHENAZINE 4MG TAB 1 fluoxetine 25mg/olanzapine 12mg cap 1 fluoxetine 25mg/olanzapine 3mg cap 1 fluoxetine 25mg/olanzapine 6mg cap 1 fluoxetine 50mg/olanzapine 12mg cap 1 fluoxetine 50mg/olanzapine 6mg cap 1

FIBROMYALGIA AGENTS SAVELLA 100MG TAB 2 QL=60 EA/30 Days SAVELLA 12.5MG TAB 2 QL=60 EA/30 Days SAVELLA 25MG TAB 2 QL=60 EA/30 Days SAVELLA 4-WEEK TITRATION PACK 2 SAVELLA 50MG TAB 2 QL=60 EA/30 Days

MOVEMENT DISORDER DRUG THERAPY AUSTEDO 12MG TAB 2 NDS PA AUSTEDO 6MG TAB 2 NDS PA AUSTEDO 9MG TAB 2 NDS PA INGREZZA 40MG CAP 2 NDS PA INGREZZA 80MG CAP 2 NDS PA tetrabenazine 12.5mg tab 1 NDS PA tetrabenazine 25mg tab 1 NDS PA

MULTIPLE SCLEROSIS AGENTS AUBAGIO 14MG TAB 2 NDS AUBAGIO 7MG TAB 2 NDS AVONEX 30MCG/0.5ML AUTO-INJECTOR 2 NDS AVONEX 30MCG/0.5ML SYRINGE 2 NDS dalfampridine 10mg er tab 1 PA QL=60 EA/30 Days EXTAVIA 0.3MG INJ 2 NDS GILENYA 0.5MG CAP 2 NDS glatiramer 20mg/ml syringe 1 NDS glatiramer 40mg/ml syringe 1 NDS glatopa 20mg/ml syringe 1 NDS glatopa 40mg/ml syringe 1 NDS MAYZENT 0.25MG TAB 2 NDS MAYZENT 2MG TAB 2 NDS PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR 2 NDS




99

PLEGRIDY 125MCG/0.5ML SYRINGE 2 NDS PLEGRIDY PEN STARTER PACK 2 NDS PLEGRIDY STARTER PACK 2 NDS TECFIDERA 120MG DR CAP 2 NDS TECFIDERA 240MG DR CAP 2 NDS TECFIDERA 30-DAY STARTER PACK 2 NDS

PSEUDOBULBAR AFFECT (PBA) AGENTS NUEDEXTA 20-10MG CAP 2 PA QL=60 EA/30 Days

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. ERGOLOID MESYLATES 1MG TAB 2 PIMOZIDE 1MG TAB 2 PIMOZIDE 2MG TAB 2

SMOKING DETERRENTS bupropion 150mg sr tab 1 CHANTIX 0.5MG TAB 2 CHANTIX 1MG TAB 2 CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

2

CHANTIX FIRST MONTH OF THERAPY PACK 2 nicotine patch 14mg/24hr* 4 QL=182 EA/365 Days nicotine patch 21mg/24hr* 4 QL=182 EA/365 Days nicotine patch 7mg/24hr* 4 QL=182 EA/365 Days NICOTINE PATCH KIT* 4 QL=182 EA/365 Days nicotine polacrilex gum 2mg* 4 QL=4320 EA/365 Days nicotine polacrilex gum 4mg* 4 QL=4320 EA/365 Days nicotine polacrilex lozenge 2mg* 4 QL=3600 EA/365 Days nicotine polacrilex lozenge 4mg* 4 QL=3600 EA/365 Days NICOTROL 10MG INHALER 2 NICOTROL 10MG/ML NASAL INHALER 2

TRANSTHYRETIN AMYLOIDOSIS AGENTS TEGSEDI 189MG/ML SYRINGE 2 NDS PA QL=6 ML/28 Days



RESPIRATORY AGENTS - MISC. ALPHA-PROTEINASE INHIBITOR (HUMAN)

ARALAST 500MG INJ 2 NDS GLASSIA 1000MG/50ML INJ 2 NDS PROLASTIN 1000MG INJ 2 NDS ZEMAIRA 1000MG INJ 2 NDS

CYSTIC FIBROSIS AGENTS KALYDECO 150MG TAB 2 NDS PA QL=60 EA/30 Days KALYDECO 25MG GRANULES 2 NDS PA QL=60 EA/30 Days KALYDECO 50MG GRANULES PACKET 2 NDS PA QL=60 EA/30 Days KALYDECO 75MG GRANULES PACKET 2 NDS PA QL=60 EA/30 Days ORKAMBI 100-125MG GRANULES PACKET 2 NDS PA QL=60 EA/30 Days


100

ORKAMBI 100-125MG TAB 2 NDS PA QL=120 EA/30 Days ORKAMBI 188-150MG GRANULES PACKET 2 NDS PA QL=60 EA/30 Days ORKAMBI 200-125MG TAB 2 NDS PA QL=120 EA/30 Days PULMOZYME 1MG/ML INH SOLN 2 NDS PA BvD SYMDEKO 50-75MG/75MG PACK 2 NDS PA QL=60 EA/30 Days SYMDEKO TAB 4-WEEK PACK 2 NDS PA QL=60 EA/30 Days

PULMONARY FIBROSIS AGENTS ESBRIET 267MG CAP 2 NDS PA ESBRIET 267MG TAB 2 NDS PA ESBRIET 801MG TAB 2 NDS PA OFEV 100MG CAP 2 NDS PA OFEV 150MG CAP 2 NDS PA



SULFONAMIDES SULFONAMIDES

SULFADIAZINE 500MG TAB 1 TETRACYCLINES

GLYCYLCYCLINES TIGECYCLINE 50MG INJ 2 NDS

TETRACYCLINES doxy 100mg inj 1 doxycycline hyclate 100mg cap 1 doxycycline hyclate 100mg tab 1 doxycycline hyclate 20mg tab 1 doxycycline hyclate 50mg cap 1 doxycycline monohydrate 100mg cap 1 doxycycline monohydrate 100mg tab 1 doxycycline monohydrate 50mg cap 1 doxycycline monohydrate 50mg tab 1 doxycycline monohydrate 5mg/ml susp 1 doxycycline monohydrate 75mg tab 1 minocycline 100mg cap 1 minocycline 100mg tab 1 minocycline 50mg cap 1 minocycline 50mg tab 1 minocycline 75mg cap 1 minocycline 75mg tab 1 mondoxyne 100mg cap 1 tetracycline 250mg cap 1 tetracycline 500mg cap 1

THYROID AGENTS ANTITHYROID AGENTS

methimazole 10mg tab 1 methimazole 5mg tab 1


101

propylthiouracil 50mg tab 1 THYROID HORMONES

euthyrox 100mcg tab 1 euthyrox 112mcg tab 1 euthyrox 125mcg tab 1 euthyrox 137mcg tab 1 euthyrox 150mcg tab 1 euthyrox 175mcg tab 1 euthyrox 200mcg tab 1 euthyrox 25mcg tab 1 euthyrox 50mcg tab 1 euthyrox 75mcg tab 1 euthyrox 88mcg tab 1 levo-t 100mcg tab 1 levo-t 112mcg tab 1 levo-t 125mcg tab 1 levo-t 137mcg tab 1 levo-t 150mcg tab 1 levo-t 175mcg tab 1 levo-t 200mcg tab 1 levo-t 25mcg tab 1 levo-t 300mcg tab 1 levo-t 50mcg tab 1 levo-t 75mcg tab 1 levo-t 88mcg tab 1 levothyroxine sodium 100mcg tab 1 levothyroxine sodium 112mcg tab 1 levothyroxine sodium 125mcg tab 1 levothyroxine sodium 137mcg tab 1 levothyroxine sodium 150mcg tab 1 levothyroxine sodium 175mcg tab 1 levothyroxine sodium 200mcg tab 1 levothyroxine sodium 25mcg tab 1 levothyroxine sodium 300mcg tab 1 levothyroxine sodium 50mcg tab 1 levothyroxine sodium 75mcg tab 1 levothyroxine sodium 88mcg tab 1 levoxyl 100mcg tab 1 levoxyl 112mcg tab 1 levoxyl 125mcg tab 1 levoxyl 137mcg tab 1 levoxyl 150mcg tab 1 levoxyl 175mcg tab 1




102

levoxyl 200mcg tab 1 levoxyl 25mcg tab 1 levoxyl 50mcg tab 1 levoxyl 75mcg tab 1 levoxyl 88mcg tab 1 liothyronine sodium 0.005mg tab 1 liothyronine sodium 0.025mg tab 1 liothyronine sodium 0.05mg tab 1 unithroid 100mcg tab 1 unithroid 112mcg tab 1 unithroid 125mcg tab 1 unithroid 150mcg tab 1 unithroid 175mcg tab 1 unithroid 200mcg tab 1 unithroid 25mcg tab 1 unithroid 300mcg tab 1 unithroid 50mcg tab 1 unithroid 75mcg tab 1 unithroid 88mcg tab 1



TOXOIDS TOXOID COMBINATIONS

ADACEL INJ 2 ADACEL SYRINGE 2 BOOSTRIX INJ 2 BOOSTRIX SYRINGE 2 DAPTACEL INJ 2 DIPHTHERIA/TETANUS TOXOID INJ 2 PA BvD INFANRIX INJ 2 KINRIX INJ 2 KINRIX PF INJ 2 PEDIARIX INJ 2 QUADRACEL INJ 2 TENIVAC SYRINGE 2 PA BvD TETANUS/DIPHTHERIA TOXOID INJ 2 PA BvD

ULCER DRUGS H-2 ANTAGONISTS

cimetidine 200mg tab 1 cimetidine 300mg tab 1 cimetidine 400mg tab 1 cimetidine 800mg tab 1 famotidine 20mg tab 1 famotidine 40mg tab 1 famotidine 8mg/ml susp 1


103

famotidine tab 10mg(OTC)* 4 ranitidine 150mg cap 1 ranitidine 15mg/ml oral soln 1 ranitidine 300mg cap 1 ranitidine hcl tab 75mg (OTC)* 4

MISC. ANTI-ULCER sucralfate 1000mg tab 1

PROTON PUMP INHIBITORS lansoprazole 15mg dr cap 1 lansoprazole 30mg dr cap 1 omeprazole 10mg dr cap 1 omeprazole 20mg dr cap 1 omeprazole 40mg dr cap 1 pantoprazole 20mg dr tab 1 pantoprazole 40mg dr tab 1

ULCER DRUGS - PROSTAGLANDINS misoprostol 0.1mg tab 1 misoprostol 0.2mg tab 1



ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS ANTISPASMODICS

dicyclomine 10mg cap 1 dicyclomine 20mg tab 1 dicyclomine 2mg/ml oral soln 1 glycopyrrolate 1mg tab 1 glycopyrrolate 2mg tab 1

H-2 ANTAGONISTS CIMETIDINE 60MG/ML ORAL SOLN 1 ranitidine 150mg tab 1 ranitidine 300mg tab 1

MISC. ANTI-ULCER sucralfate 100mg/ml susp 1

PROTON PUMP INHIBITORS lansoprazole 15mg dr cap(OTC)* 4

ULCER THERAPY COMBINATIONS amoxicillin 500mg/clarithromycin 500mg/lansoprazole 30mg pack

1

PYLERA 140-125-125MG CAP 2 URINARY ANTI-INFECTIVES URINARY ANTI-INFECTIVES

methenamine hippurate 1000mg tab 1 nitrofurantoin 5mg/ml susp 1 nitrofurantoin macro 100mg cap 1 nitrofurantoin macro 25mg cap 1


104

nitrofurantoin macro 25mg/nitrofurantoin mono 75mg cap

1

nitrofurantoin macro 50mg cap 1



URINARY ANTISPASMODICS URINARY ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOLINERGIC)

oxybutynin chloride 10mg er tab 1 oxybutynin chloride 15mg er tab 1 oxybutynin chloride 1mg/ml oral soln 1 oxybutynin chloride 5mg er tab 1 oxybutynin chloride 5mg tab 1 tolterodine tartrate 1mg tab 1 tolterodine tartrate 2mg er cap 1 QL=30 EA/30 Days tolterodine tartrate 2mg tab 1 tolterodine tartrate 4mg er cap 1 QL=30 EA/30 Days trospium chloride 20mg tab 1 trospium chloride 60mg er cap 1

URINARY ANTISPASMODICS - BETA-3 ADRENERGIC AGONISTS MYRBETRIQ 25MG ER TAB 2 MYRBETRIQ 50MG ER TAB 2

URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS bethanechol chloride 10mg tab 1 bethanechol chloride 25mg tab 1 bethanechol chloride 50mg tab 1 bethanechol chloride 5mg tab 1

URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS flavoxate 100mg tab 1

VACCINES BACTERIAL VACCINES

ACTHIB INJ 2 BCG LIVE TICE STRAIN 50MG/ML INJ 2 BEXSERO SYRINGE 2 HIBERIX INJ 2 MENACTRA INJ 2 MENVEO INJ 2 PEDVAXHIB 7.5MCG/0.5ML INJ 2 TRUMENBA SYRINGE 2 TYPHIM VI 25MCG/0.5ML INJ 2 TYPHIM VI 25MCG/0.5ML SYRINGE 2

VIRAL VACCINES ENGERIX-B 10MCG/0.5ML SYRINGE 2 PA BvD ENGERIX-B 20MCG/ML SYRINGE 2 PA BvD GARDASIL 9 INJ 2 GARDASIL 9 SYRINGE 2


105

HAVRIX 1440UNIT INJ 2 HAVRIX 1440UNIT SYRINGE 2 HAVRIX 720UNIT INJ 2 HAVRIX 720UNIT SYRINGE 2 IMOVAX 2.5UNIT/ML INJ 2 PA BvD IPOL INJ 2 IXIARO SYRINGE 2 M-M-R II INJ 2 PROQUAD INJ 2 RABAVERT 2.5UNIT/ML INJ 2 PA BvD RECOMBIVAX 10MCG/ML SYRINGE 2 PA BvD RECOMBIVAX 40MCG/ML INJ 2 PA BvD RECOMBIVAX 5MCG/0.5ML SYRINGE 2 PA BvD RECOMBIVAX HB 10MCG/ML INJ 2 PA BvD ROTARIX SUSP 2 ROTATEQ SUSP 2 SHINGRIX INJ 2 TWINRIX 720UNIT SYRINGE 2 VAQTA 25UNIT/0.5ML SYRINGE 2 VAQTA 50UNIT/0.5ML INJ 2 VAQTA 50UNIT/1ML INJ 2 VAQTA 50UNIT/ML SYRINGE 2 VARIVAX 1350PFU/0.5ML INJ 2 YF-VAX 4000UNIT/ML INJ 2 ZOSTAVAX 19400UNIT/0.65ML INJ 2



VAGINAL PRODUCTS SPERMICIDES

NONOXYNOL-9 FOAM 12.5%* 4 NONOXYNOL-9 GEL 3%* 4 nonoxynol-9 gel 4%* 4

VAGINAL ANTI-INFECTIVES clindamycin 2% vaginal cream 1 clotrimazole vaginal cream 1%* 4 clotrimazole vaginal cream 2%* 4 metronidazole 0.75% vaginal gel 1 miconazole nitrate vaginal cream 2%* 4 miconazole nitrate vaginal cream 4%* 4 miconazole nitrate vaginal kit* 4 miconazole nitrate vaginal supp 100mg* 4 miconazole nitrate vaginal supp 1200mg/2% cream kit*

4

miconazole nitrate vaginal supp 200mg/2% cream 9gm kit*

4


106

terconazole 0.4% vaginal cream 1 TERCONAZOLE 0.8% VAGINAL CREAM 1 terconazole 80mg vaginal supp 1 tioconazole vaginal ointment 6.5%* 4 vandazole 0.75% vaginal gel 1

VAGINAL ESTROGENS estradiol 0.1mg/ml vaginal cream 1 ESTRING 2MG VAGINAL RING 2 ST PREMARIN 0.625MG/GM VAGINAL CREAM 2

VAGINAL PROGESTINS CRINONE 4% VAGINAL GEL 2 PA CRINONE 8% VAGINAL GEL 2 PA



VASOPRESSORS ANAPHYLAXIS THERAPY AGENTS

EPINEPHRINE 0.15MG/0.3ML AUTO-INJECTOR 2 QL=2 EA/15 Days epinephrine 0.3mg/0.3ml auto-injector 1 QL=2 EA/15 Days SYMJEPI 0.15MG/0.3ML SYRINGE 2 QL=2 EA/15 Days SYMJEPI 0.3MG/0.3ML SYRINGE 2 QL=2 EA/15 Days

NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS NORTHERA 100MG CAP 2 NDS PA NORTHERA 200MG CAP 2 NDS PA NORTHERA 300MG CAP 2 NDS PA

VASOPRESSORS midodrine 10mg tab 1 midodrine 2.5mg tab 1 midodrine 5mg tab 1

VITAMINS OIL SOLUBLE VITAMINS

AQUASOL A INJ 50000/ML* 3 cholecalciferol cap 2000unit* 4 cholecalciferol cap 400unit* 4 cholecalciferol tab 2000unit* 4 ergocalciferol cap 50000unit* 3 ergocalciferol soln 8000unit/ml* 4 ERGOCALCIFEROL TAB 2000UNIT* 4 ERGOCALCIFEROL TAB 400UNIT* 4 phytonadione tab 100mcg* 4 phytonadione tab 5 mg* 3 vitamin D cap 1000unit* 4 vitamin D drops 400unit/0.028ml* 4 vitamin D3 cap 10000unit* 4 vitamin D3 cap 50000unit* 4 vitamin D3 cap 5000unit* 4


107

vitamin D3 drops 5000unit/ml* 4 vitamin D3 oral liquid 400unit/ml* 4 vitamin D3 tab 1000unit* 4 vitamin D3 tab 400unit* 4 vitamin D3 tab 50000unit(OTC)* 4 vitamin D3 tab 5000unit* 4 vitamin E cap 1000unit* 4 vitamin E cap 100unit* 4 vitamin E cap 200unit* 4 vitamin E cap 400unit* 4

WATER SOLUBLE VITAMINS niacin CR cap 250mg* 4 NIACIN CR TAB 1000MG* 4 niacin CR tab 250mg* 4 niacin CR tab 500mg* 4 niacin CR tab 750mg* 4 niacin ER cap 500mg* 4 niacin tab 100mg* 4 niacin tab 250mg* 4 niacin tab 500mg* 4 niacin tab 50mg* 4 pyridoxine tab 100mg* 4 vitamin B-1 mononitrate tab 100mg* 4 vitamin B-1 tab 100mg* 4 vitamin B-1 tab 250mg* 4 vitamin B-1 tab 50mg* 4 vitamin B-2 tab 100mg* 4 vitamin B-2 tab 25mg* 4 vitamin B-2 tab 50mg* 4 vitamin B-6 tab 500mg* 4 vitamin B-6 tab 250mg* 4 vitamin B-6 tab 25mg* 4 vitamin B-6 tab 50mg* 4 vitamin C 100mg tab* 4 vitamin C chew tab 100mg* 4 vitamin C chew tab 250mg* 4 vitamin C chew tab 500mg* 4 vitamin C tab 1000mg* 4 vitamin C tab 250mg* 4 vitamin C tab 500mg* 4



ALPHABETICAL LISTING OF DRUGS

108

A

abacavir 20mg/ml oral soln

50

abacavir 300mg tab 50 abacavir 300mg/lamivudine 150mg/zidovudine 300mg tab

50

abacavir 600mg/lamivudine 300mg tab

50

ABELCET 5MG/ML INJ 28 ABILIFY 300MG MAINTENA INJ

49

ABILIFY 300MG MAINTENA PF SYRINGE

49

ABILIFY 400MG MAINTENA INJ

49

ABILIFY 400MG MAINTENA PF SYRINGE

49

abiraterone 250mg tab 39 ABREVA CREAM 10%* 68 acamprosate calcium 333mg dr tab

97

acarbose 100mg tab 24 acarbose 25mg tab 24 acarbose 50mg tab 24 acebutolol 200mg cap 54 acebutolol 400mg cap 54 acetaminophen 21.7mg/ml/hydrocodone bitartrate 0.5mg/ml oral soln

8

acetaminophen 24mg/ml/codeine phosphate 2.4mg/ml oral soln

8

acetaminophen 300mg/codeine phosphate 15mg tab

8


8


8


8


8


8


8


8


8

acetaminophen 325mg/oxycodone 10mg tab

8

acetaminophen 325mg/oxycodone 2.5mg tab

8

acetaminophen 325mg/oxycodone 5mg tab

8

acetaminophen 325mg/oxycodone 7.5mg tab

8

acetaminophen 325mg/tramadol 37.5mg tab

8

acetaminophen CR tab 650mg*

5

acetaminophen liquid 160mg/5ml*

5

acetaminophen liquid 167mg/5ml*

5

acetaminophen soln 160mg/5ml*

6

acetaminophen susp 160mg/5ml*

6

acetaminophen tab 325mg*

6

acetaminophen tab 500mg*

6

acetazolamide 125mg tab 71acetazolamide 250mg tab 71acetazolamide 500mg er cap

71

acetic acid 2% otic soln 94acetic acid/hydrocortisone 1-2%otic soln

94

acetylcysteine 10% inh soln

65

acetylcysteine 20% inh soln

65

acitretin 10mg cap 67acitretin 17.5mg cap 67acitretin 25mg cap 67ACTEMRA 162MG/0.9MLAUTO-INJECTOR

4

ACTEMRA 162MG/0.9ML SYRINGE

4

ACTHIB INJ 104ACTIMMUNE 2000000UNIT/0.5ML INJ

43

acyclovir 200mg cap 53acyclovir 400mg tab 53acyclovir 40mg/ml susp 53acyclovir 5% ointment 68acyclovir 50mg/ml inj 53acyclovir 800mg tab 53ADACEL INJ 102ADACEL SYRINGE 102adapalene 0.3% gel 65adefovir dipivoxil 10mg tab

52

ADEMPAS 0.5MG TAB 58ADEMPAS 1.5MG TAB 58ADEMPAS 1MG TAB 58ADEMPAS 2.5MG TAB 58


109

ADEMPAS 2MG TAB 58 ADVAIR 115-21MCG HFA INH

14

ADVAIR 230-21MCG HFA INH

14

ADVAIR 45-21MCG HFA INH

14

AFINITOR 10MG TAB 40 AFINITOR 2MG SUSP 40 AFINITOR 3MG SUSP 40 AFINITOR 5MG SUSP 40 ala-cort 1% cream 68 ala-cort 1% cream* 68 albendazole 200mg tab 10 albuterol 0.21mg/ml (0.63mg/3ml) inh soln

14

albuterol 0.417mg/ml (1.25mg/3ml) inh soln

14

albuterol 0.4mg/ml (2mg/5ml) oral oral soln

14

albuterol 0.83mg/ml (0.083%) inh soln

14

albuterol 1mg/ml (0.5%) inh soln

14

albuterol 2mg tab 14 ALBUTEROL 4MG ER TAB

14

albuterol 4mg tab 14 ALBUTEROL 8MG ER TAB

14

alclometasone dipropionate 0.05% cream

68

alclometasone dipropionate 0.05% ointment

68

ALECENSA 150MG CAP 40 ALENDRONATE 0.933MG/ML ORAL SOLN

72

alendronate 10mg tab 72 alendronate 35mg tab 72 alendronate 70mg tab 72 alfuzosin 10mg er tab 78

ALINIA 100MG/5ML SUSP

36

ALINIA 500MG TAB 36 aliskiren 150mg tab 35 aliskiren 300mg tab 35 allopurinol 100mg tab 79 allopurinol 300mg tab 79 ALOGLIPTIN 12.5MG TAB

25

ALOGLIPTIN 12.5MG/METFORMIN 1000MG TAB

24

ALOGLIPTIN 12.5MG/METFORMIN 500MG TAB

24

ALOGLIPTIN 12.5MG/PIOGLITAZONE 15MG TAB

24


24


24

ALOGLIPTIN 25MG TAB 25 ALOGLIPTIN 25MG/PIOGLITAZONE 15MG TAB

24

ALOGLIPTIN 25MG/PIOGLITAZONE 30MG TAB

24

ALOGLIPTIN 25MG/PIOGLITAZONE 45MG TAB

24

ALOGLIPTIN 6.25MG TAB

25

ALOMIDE 0.1% OPHTH SOLN

94

alosetron 0.5mg tab 77 alosetron 1mg tab 77 ALPHAGAN P 0.1% OPHTH SOLN

92

alprazolam 0.25mg tab 11 alprazolam 0.5mg tab 11 alprazolam 1mg tab 11

alprazolam 2mg tab 11 ALREX 0.2% OPHTH SUSP

93

altavera 28 day pack 59 ALUMINUM HYDROXIDE GEL SUSP 320MG/5ML*

10

aluminum hydroxide/magnesium trisilicate chew tab 80-20mg*

10

aluminum/magnesium hydroxide/simethicone chew tab 200-200-25mg*

10


10


10

ALUNBRIG 180MG TAB 40 ALUNBRIG 30MG TAB 40 ALUNBRIG 90MG TAB 40 ALUNBRIG TAB STARTER PACK

40

alyacen 1/35 28 day pack 59 alyq 20mg tab 57 amabelz 0.5/0.1mg 28 day pack

75

amabelz 1/0.5mg 28 day pack

75

amantadine 100mg cap 44 amantadine 100mg tab 45 amantadine 10mg/ml oral soln

44

AMBISOME 50MG INJ 28 ambrisentan 10mg tab 57 ambrisentan 5mg tab 57 AMCINONIDE 0.1% CREAM

68

AMCINONIDE 0.1% OINTMENT

68

amethia 91 day pack 59 amethia lo 91 day pack 60 amikacin 250mg/ml inj 3


110

amiloride 5mg tab 72 amiloride 5mg/hydrochlorothiazide 50mg tab

71

AMINOSYN II 10% INJ 91 AMINOSYN-PF 10% SULFITE-FREE INJ

91

AMINOSYN-PF 7% INJ 91 amiodarone 200mg tab 12 amiodarone 400mg tab 12 amitriptyline 100mg tab 23 amitriptyline 10mg tab 23 AMITRIPTYLINE 10MG/PERPHENAZINE 2MG TAB

98

AMITRIPTYLINE 10MG/PERPHENAZINE 4MG TAB

98

amitriptyline 12.5mg/chlordiazepoxide 5mg tab

98

amitriptyline 150mg tab 23 amitriptyline 25mg tab 23 amitriptyline 25mg/chlordiazepoxide 10mg tab

98


98


98

amitriptyline 50mg tab 23 AMITRIPTYLINE 50MG/PERPHENAZINE 4MG TAB

98

amitriptyline 75mg tab 23 amlodipine 10mg tab 55 amlodipine 10mg/benazepril 20mg cap

33

amlodipine 10mg/benazepril 40mg cap

33

amlodipine 10mg/hydrochlorothiazid e 12.5mg/valsartan 160mg tab

33

amlodipine 10mg/hydrochlorothiazid e 25mg/valsartan 160mg tab

33

amlodipine 10mg/hydrochlorothiazid e 25mg/valsartan 320mg tab

33

amlodipine 10mg/olmesartan medoxomil 20mg tab

33


33

amlodipine 10mg/valsartan 160mg tab

33


33

amlodipine 2.5mg tab 55 amlodipine 2.5mg/benazepril 10mg cap

33

amlodipine 5mg tab 55 amlodipine 5mg/benazepril 10mg cap

33


33


33

amlodipine 5mg/hydrochlorothiazide 12.5mg/valsartan 160mg tab

33


33


33


33


33


34

ammonium lactate 12% cream

70

ammonium lactate 12% lotion

70

amnesteem 10mg cap 65 amnesteem 20mg cap 65 amnesteem 40mg cap 65 AMOXAPINE 100MG TAB

23

AMOXAPINE 150MG TAB

23

AMOXAPINE 25MG TAB 23 AMOXAPINE 50MG TAB 23 AMOXICILLIN 1000MG/CLAVULANAT E 62.5MG ER TAB

96

amoxicillin 120mg/ml/clavulanate 8.58mg/ml susp

96

amoxicillin 125mg chew tab

95

AMOXICILLIN 200MG/CLAVULANATE 28.5MG CHEW TAB

96

amoxicillin 250mg cap 95 AMOXICILLIN 250MG CHEW TAB

95

amoxicillin 250mg/clavulanate 125mg tab

96

amoxicillin 25mg/ml susp 95 AMOXICILLIN 400MG/CLAVULANATE 57MG CHEW TAB

96

amoxicillin 40mg/ml susp 95


111

amoxicillin 40mg/ml/clavulanate 5.7mg/ml susp

96

amoxicillin 500mg cap 95 amoxicillin 500mg tab 95 amoxicillin 500mg/clarithromycin 500mg/lansoprazole 30mg pack

103

amoxicillin 500mg/clavulanate 125mg tab

96

amoxicillin 50mg/ml susp 95 amoxicillin 50mg/ml/clavulanate 12.5mg/ml susp

96

amoxicillin 80mg/ml susp 95 amoxicillin 80mg/ml/clavulanate 11.4mg/ml susp

96

amoxicillin 875mg tab 95 amoxicillin 875mg/clavulanate 125mg tab

96

amphetamine/dextroamph etamine 10mg ER cap

1

amphetamine/dextroamph etamine 10mg tab

1

amphetamine/dextroamph etamine 12.5mg tab

1


1


1


1


1


1


1


1


1


1

amphetamine/dextroamph etamine 7.5mg tab

1

AMPHOTERICIN B 50MG INJ

28

ampicillin 100mg/ml inj 95 AMPICILLIN 125MG/ML INJ

95

ampicillin 20mg/ml/sulbactam 10mg/ml inj

96

ampicillin 250mg/ml inj 95 ampicillin 250mg/ml/sulbactam 125mg/ml inj

96

AMPICILLIN 500MG CAP

95

ANADROL-50 50MG TAB

9

anagrelide 0.5mg cap 79 anagrelide 1mg cap 79 anastrozole 1mg tab 39 ANDRODERM 2MG/24HR PATCH

9

ANDRODERM 4MG/24HR PATCH

9

ANORO 62.5-25MCG ELLIPTA INH

14

APLENZIN 174MG ER TAB

21


21


21

APOKYN 10MG/ML CARTRIDGE

45

aprepitant 125mg cap 28 aprepitant 125mg/80mg pack

28

aprepitant 40mg cap 28 aprepitant 80mg cap 28 apri 28 day pack 60

APTIOM 200MG TAB 17 APTIOM 400MG TAB 17 APTIOM 600MG TAB 17 APTIOM 800MG TAB 17 APTIVUS 100MG/ML ORAL SOLN

50

APTIVUS 250MG CAP 50 AQUASOL A INJ 50000/ML*

106

ARALAST 500MG INJ 99 aranelle 28 pack 60 ARANESP 100MCG/0.5ML SYRINGE

80

ARANESP 100MCG/ML INJ

80

ARANESP 10MCG/0.4ML SYRINGE

80


80


80


80


80


80


80


80


80


80

ARANESP 500MCG/ML SYRINGE

80


80


112


80

ARCALYST 220MG INJ 4 ARIKAYCE 70.3MG/ML INH SOLN

3

aripiprazole 10mg odt 49 aripiprazole 10mg tab 49 aripiprazole 15mg odt 49 aripiprazole 15mg tab 49 aripiprazole 1mg/ml oral soln

49

aripiprazole 20mg tab 49 aripiprazole 2mg tab 49 aripiprazole 30mg tab 49 aripiprazole 5mg tab 49 ARISTADA 1064MG/3.9ML SYRINGE

49

ARISTADA 441MG/1.6ML SYRINGE

49


49


49


49

armodafinil 150mg tab 2 armodafinil 200mg tab 2 armodafinil 250mg tab 2 armodafinil 50mg tab 2 ARNUITY 100MCG INH 13 ARNUITY 200MCG INH 13 ARNUITY 50MCG INH 13 ARTHRITIS PAIN CREAM 0.075%*

70

artificial tears ophth soln 1.4%*

91

ashlyna 91 day pack 60 ASMANEX 100MCG (120ACT) HFA INH

13

ASMANEX 110MCG (30ACT) INH

13

ASMANEX 200MCG (120ACT) HFA INH

13


13


13


13

aspirin 25mg/dipyridamole 200mg cap

79

aspirin 325mg/oxycodone 4.84mg tab

8

aspirin chew tab 81mg* 6 aspirin EC tab 325mg* 6 aspirin EC tab 500mg* 6 aspirin EC tab 81mg* 6 aspirin tab 325mg* 6 ASSURE PLATINUM TEST STRIPS*

71

ASTAGRAF 0.5MG XL CAP

88

ASTAGRAF 1MG XL CAP 88 ASTAGRAF 5MG XL CAP 88 atazanavir 150mg cap 50 atazanavir 200mg cap 50 atazanavir 300mg cap 50 atenolol 100mg tab 54 atenolol 100mg/chlorthalidone 25mg tab

34

atenolol 25mg tab 54 atenolol 50mg tab 54 atenolol 50mg/chlorthalidone 25mg tab

34

atomoxetine 100mg cap 1 atomoxetine 10mg cap 1 atomoxetine 18mg cap 1 atomoxetine 25mg cap 1 atomoxetine 40mg cap 1 atomoxetine 60mg cap 1 atomoxetine 80mg cap 1 atorvastatin 10mg tab 30 atorvastatin 20mg tab 30 atorvastatin 40mg tab 30 atorvastatin 80mg tab 30

atovaquone 150mg/ml susp

36

atovaquone 250mg/proguanil 100mg tab

37

atovaquone 62.5mg/proguanil 25mg tab

37

ATRIPLA 600-200-300MG TAB

50

atropine sulfate 0.005mg/ml/diphenoxylat e 0.5mg/ml oral soln

27

atropine sulfate 0.025mg/diphenoxylate 2.5mg tab

27

ATROPINE SULFATE 1% OPHTH SOLN

92

ATROVENT 17MCG INH 13 AUBAGIO 14MG TAB 98 AUBAGIO 7MG TAB 98 aubra 28 day pack 60 AURYXIA 210MG TAB 78 AUSTEDO 12MG TAB 98 AUSTEDO 6MG TAB 98 AUSTEDO 9MG TAB 98 AVANDIA 2MG TAB 26 AVANDIA 4MG TAB 26 aviane 28 pack 60 avita 0.025% cream 65 avita 0.025% gel 65 AVONEX 30MCG/0.5ML AUTO-INJECTOR

98

AVONEX 30MCG/0.5ML SYRINGE

98

AVYCAZ 2-0.5GM INJ 58 AYVAKIT 100MG TAB 40 AYVAKIT 200MG TAB 40 AYVAKIT 300MG TAB 40 AZASAN 100MG TAB 53 AZASAN 75MG TAB 53 AZASITE 1% OPHTH SOLN

92

azathioprine 50mg tab 53 azelaic acid 15% gel 70


113

azelastine 0.05% ophth soln

94

azelastine 0.1% (137mcg) nasal inhaler

90

azelastine 0.15% (205.5mcg) nasal inhaler

90

azithromycin 20mg/ml susp

84

azithromycin 250mg pack 84 azithromycin 250mg tab 84 azithromycin 2mg/ml inj 84 azithromycin 40mg/ml susp

84

azithromycin 500mg (3) tab pack

84

azithromycin 500mg tab 84 azithromycin 600mg tab 84 AZOPT 1% OPHTH SUSP 94 aztreonam 333mg/ml inj 37

B

BACITRACIN 0.5UNIT/MG OPHTH OINTMENT

92

bacitracin 0.5unit/mg/polymyxin b 10unit/mg ophth ointment

92

bacitracin ointment 500unit/gm*

66

bacitracin/polymyxin b ointment*

66

bacitracin/zinc ointment 500unit/gm*

66

baclofen 10mg tab 89 baclofen 20mg tab 89 balsalazide disodium 750mg cap

77

BALVERSA 3MG TAB 40 BALVERSA 4MG TAB 40 BALVERSA 5MG TAB 40 balziva 28 day pack 60 BANZEL 200MG TAB 17 BANZEL 400MG TAB 17 BANZEL 40MG/ML SUSP

17

BAQSIMI 3MG/DOSE NASAL POWDER

25

BARACLUDE 0.05MG/ML ORAL SOLN

52

BASAGLAR 100UNIT/ML PEN INJ

26

BCG LIVE TICE STRAIN 50MG/ML INJ

104

B-complex w/vitamin C cap*

89

BELVIQ TAB 10MG* 1 benazepril 10mg tab 31 benazepril 10mg/hydrochlorothiazid e 12.5mg tab

34

benazepril 20mg tab 31 benazepril 20mg/hydrochlorothiazid e 12.5mg tab

34

benazepril 20mg/hydrochlorothiazid e 25mg tab

34

benazepril 40mg tab 31 benazepril 5mg tab 31 benazepril 5mg/hydrochlorothiazide 6.25mg tab

34

BENLYSTA 200MG/ML AUTO-INJECTOR

89

BENLYSTA 200MG/ML SYRINGE

89

BENZNIDAZOLE 100MG TAB

10

BENZNIDAZOLE 12.5MG TAB

10

benzonatate cap 100mg* 64 benzonatate cap 200mg* 64 benzoyl peroxide gel 10% *

65

BENZOYL PEROXIDE GEL 2.5%*

65

benzoyl peroxide gel 5%* 65 benzoyl peroxide liquid 10%*

65

benzoyl peroxide liquid 5%*

65

benzoyl peroxide liquid 6%*

65

BENZOYL PEROXIDE LOTION 10%*

65

BENZOYL PEROXIDE LOTION 5%*

65

benztropine mesylate 0.5mg tab

45

benztropine mesylate 1mg tab

45

benztropine mesylate 2mg tab

45

BERINERT 500UNIT INJ 79 beser 0.05% lotion 68 betamethasone 0.05% aug cream

68

betamethasone 0.05% aug lotion

68

betamethasone 0.05% aug ointment

68

betamethasone 0.05% cream

68

betamethasone 0.05% lotion

68

betamethasone 0.05% ointment

68

betamethasone 0.1% cream

68

betamethasone 0.1% lotion

68

betamethasone 0.1% ointment

68

betamethasone valerate 0.12% foam

68

betamethasone/clotrimaz ole 1-0.05% cream

66

betamethasone/clotrimaz ole 1-0.05% lotion

66

betaxolol 0.5% ophth soln

91

betaxolol 10mg tab 54 betaxolol 20mg tab 54


114

bethanechol chloride 10mg tab

104


104


104


104

BETIMOL 0.25% OPHTH SOLN

91

BETIMOL 0.5% OPHTH SOLN

91

BETOPTIC S 0.25% OPHTH SUSP

92

bexarotene 75mg cap 43 BEXSERO SYRINGE 104 bicalutamide 50mg tab 39 BICILLIN 300000-300000UNIT/ML SYRINGE

96

BICILLIN 450000-150000UNIT/ML SYRINGE

96

BICILLIN L-A 1200000UNIT/2ML SYRINGE

95

BICILLIN L-A 2400000UNIT/4ML SYRINGE

95

BICILLIN L-A 600000UNIT/ML SYRINGE

95

BIDIL 20-37.5MG TAB 57 BIKTARVY 50-200-25MG TAB

50

bimatoprost 0.03% ophth soln

94

bisacodyl supp 10mg* 83 bisacodyl tab delayed release 5mg*

83

bismuth subsalicylate chew tab 262mg*

27

bismuth subsalicylate susp 262mg/15ml*

27

bismuth subsalicylate susp 525mg/15ml*

27

bismuth subsalicylate tab 262mg*

27

bisoprolol fumarate 10mg tab

54

bisoprolol fumarate 10mg/hydrochlorothiazid e 6.25mg tab

34

bisoprolol fumarate 2.5mg/hydrochlorothiazid e 6.25mg tab

34

bisoprolol fumarate 5mg tab

54

bisoprolol fumarate 5mg/hydrochlorothiazide 6.25mg tab

34

BIVIGAM 5GM/50ML INJ

95

BLEPHAMIDE 10-0.2% OPHTH SUSP

93

blisovi 21 fe 1.5/30 28 day

60

blisovi 24 fe 1/20 28 day pack

60

BOOSTRIX INJ 102 BOOSTRIX SYRINGE 102 bosentan 125mg tab 57 bosentan 62.5mg tab 57 BOSULIF 100MG TAB 40 BOSULIF 400MG TAB 40 BOSULIF 500MG TAB 40 BRAFTOVI 75MG CAP 40 BREO 100-25MCG ELLIPTA INH

14

BREO 200-25MCG ELLIPTA INH

14

briellyn 28 day pack 60 BRILINTA 60MG TAB 79 BRILINTA 90MG TAB 79 brimonidine tartrate 0.15% ophth soln

92

brimonidine tartrate 0.2% ophth soln

92

BRIVIACT 100MG TAB 17

BRIVIACT 10MG TAB 17 BRIVIACT 10MG/ML ORAL SOLN

17

BRIVIACT 25MG TAB 17 BRIVIACT 50MG TAB 17 BRIVIACT 75MG TAB 17 BROMFED DM SYRUP 30-2-10 MG/5ML*

64

bromocriptine 2.5mg tab 44 bromocriptine 5mg cap 44 brompheniramine/phenyl ephrine elixir 1-2.5mg/5ml*

64

BROMPHENIRAMINE/P HENYLEPHRINE TAB 4-10MG*

64

brompheniramine/pseudo ephedrine elixir 1-15mg/5ml*

64

BRUKINSA 80MG CAP 40 budesonide 0.125mg/ml inh soln

13

budesonide 0.25mg/ml inh soln

13

budesonide 0.5mg/ml inh soln

14

budesonide 3mg dr cap 63 budesonide 9mg er tab 63 bumetanide 0.25mg/ml inj 72 bumetanide 0.5mg tab 72 bumetanide 1mg tab 72 bumetanide 2mg tab 72 buprenorphine 2mg sl tab 8 buprenorphine 2mg/naloxone 0.5mg sl tab

8

buprenorphine 8mg sl tab 9 buprenorphine 8mg/naloxone 2mg sl tab

9

buprenorphine/naloxone 12-3mg strip

9

buprenorphine/naloxone 2-0.5mg strip

9


9


115


9

bupropion 100mg sr tab 21 bupropion 100mg tab 21 bupropion 150mg sr (12 hr) tab

21

bupropion 150mg sr tab 99 bupropion 150mg xl (24 hr) tab

21

bupropion 200mg sr tab 21 bupropion 300mg xl tab 21 bupropion 75mg tab 21 buspirone 10mg tab 11 buspirone 15mg tab 11 buspirone 30mg tab 11 buspirone 5mg tab 11 buspirone 7.5mg tab 11 butorphanol tartrate 10mg/ml nasal spray

9

BYDUREON 2.35MG/ML AUTO-INJECTOR

26

BYDUREON 2MG PEN INJ

26

BYSTOLIC 10MG TAB 54 BYSTOLIC 2.5MG TAB 54 BYSTOLIC 20MG TAB 54 BYSTOLIC 5MG TAB 54

C

cabergoline 0.5mg tab 74 CABOMETYX 20MG TAB

40

CABOMETYX 40MG TAB

40

CABOMETYX 60MG TAB

40

CALAMINE LOTTION* 70 CALAMINE/ZINC OXIDE LOTION 8-8%*

70

CALCI-CHEW 85 calcipotriene 0.005% cream

67

calcipotriene 0.005% ointment

67

calcipotriene 0.005% topical soln

67

calcitriol 0.00025mg cap 74 calcitriol 0.0005mg cap 74 calcitriol 0.001mg/ml oral soln

74

calcium acetate 667mg cap

78

calcium acetate 667mg tab

78

calcium carbonate (antacid) chew tab 1000mg*

10


10


10


10

CALCIUM CARBONATE 260MG CHEW*

85

calcium carbonate susp 1250mg/5ml*

10

calcium carbonate tab 1250mg*

85


85


85

calcium carbonate/vitamin D cap 600mg-200unit*

85

calcium carbonate/vitamin D cap 600mg-500unit*

85


85


85


85

calcium carbonate/vitamin D tab 200mg-250unit*

86


86


86


86


86


86


86


86


86


86


86


86


86

CALCIUM GLUCONATE TAB 50MG*

86


116

calcium polycarbophil tab 625mg*

82

calcium tab 600mg* 86 CALQUENCE 100MG CAP

40

CALTRATE CHEW TAB 600MG-800UNIT*

86

camila 28 day 0.35mg pack

63

camrese lo 91 day pack 60 CAPRELSA 100MG TAB 40 CAPRELSA 300MG TAB 40 capsaicin cream 0.025%* 70 capsaicin cream 0.1%* 70 captopril 100mg tab 31 captopril 12.5mg tab 31 captopril 25mg tab 32 captopril 25mg/hydrochlorothiazid e 15mg tab

34

CAPTOPRIL 25MG/HYDROCHLOROT HIAZIDE 25MG TAB

34

captopril 50mg tab 32 captopril 50mg/hydrochlorothiazid e 15mg tab

34

CAPTOPRIL 50MG/HYDROCHLOROT HIAZIDE 25MG TAB

34

CARBAGLU 200MG SUSP

74

carbamazepine 100mg chew tab

17

carbamazepine 100mg er cap

17

carbamazepine 100mg er tab

17


17


17

carbamazepine 200mg tab

17

carbamazepine 20mg/ml susp

17


17


18

carbamide peroxide 6.5% otic soln*

94

carbidopa 10mg/levodopa 100mg odt

44

carbidopa 10mg/levodopa 100mg tab

44


44


44

carbidopa 25mg tab 45 CARBIDOPA 25MG/ENTACAPONE 200MG/LEVODOPA 100MG TAB

44

carbidopa 25mg/levodopa 100mg er tab

44


44


44


44


45


44


44


44

carbidopa 50mg/levodopa 200mg er tab

44

carisoprodol 350mg tab 90 CARTEOLOL 1% OPHTH SOLN

92

cartia 120mg er cap 55 cartia 180mg er cap 55 cartia 240mg er cap 55 cartia 300mg er cap 55 carvedilol 12.5mg tab 54 carvedilol 25mg tab 54 carvedilol 3.125mg tab 54 carvedilol 6.25mg tab 54 CASPOFUNGIN ACETATE 50MG INJ

28

CASPOFUNGIN ACETATE 70MG INJ

28

CAYSTON 75MG INH SOLN

37

caziant 28 day pack 60 cefaclor 250mg cap 58 CEFACLOR 25MG/ML SUSP

58

cefaclor 500mg cap 58 CEFACLOR 50MG/ML SUSP

58

CEFACLOR 75MG/ML SUSP

58

cefadroxil 1000mg tab 58 cefadroxil 100mg/ml susp 58 cefadroxil 500mg cap 58 cefadroxil 50mg/ml susp 58


117

cefazolin 1gm inj 58 cefazolin 200mg/ml inj 58 cefazolin 500mg inj 58 cefdinir 25mg/ml susp 59 cefdinir 300mg cap 59 cefdinir 50mg/ml susp 59 cefepime 1gm inj 59 cefepime 2gm inj 59 cefixime 20mg/ml susp 59 cefixime 400mg cap 59 cefixime 40mg/ml susp 59 cefotetan 1000mg inj 58 cefotetan 2000mg inj 58 cefoxitin 1000mg inj 58 cefoxitin 2000mg inj 58 cefoxitin 200mg/ml inj 59 cefpodoxime 100mg tab 59 cefpodoxime 10mg/ml susp

59

cefpodoxime 200mg tab 59 cefpodoxime 20mg/ml susp

59

cefprozil 250mg tab 59 cefprozil 25mg/ml susp 59 cefprozil 500mg tab 59 cefprozil 50mg/ml susp 59 ceftazidime 1000mg inj 59 ceftazidime 2000mg inj 59 ceftazidime 200mg/ml inj 59 ceftriaxone 1000mg inj 59 ceftriaxone 100mg/ml inj 59 ceftriaxone 2000mg inj 59 ceftriaxone 250mg inj 59 ceftriaxone 500mg inj 59 cefuroxime 1.5gm inj 59 cefuroxime 250mg tab 59 cefuroxime 500mg tab 59 cefuroxime 750mg inj 59 cefuroxime 95mg/ml inj 59 celecoxib 100mg cap 4 celecoxib 200mg cap 4 celecoxib 400mg cap 4 celecoxib 50mg cap 4 CELONTIN 300MG CAP 20 cephalexin 250mg cap 58

cephalexin 25mg/ml susp 58 cephalexin 500mg cap 58 cephalexin 50mg/ml susp 58 CERDELGA 84MG CAP 79 cetirizine 1mg/ml oral soln

29

cetirizine 1mg/ml oral soln*

29

cetirizine chew tab 10mg* 29 cetirizine chew tab 5mg* 29 cetirizine tab 10mg* 29 cetirizine tab 5mg* 29 CETRAXAL 0.2% OTIC SOLN

94

cevimeline 30mg cap 89 CHANTIX 0.5MG TAB 99 CHANTIX 1MG TAB 99 CHANTIX CONTINUING MONTHS OF THERAPY 1MG PACK

99

CHANTIX FIRST MONTH OF THERAPY PACK

99

CHENODAL 250MG TAB 77 chlordiazepoxide 10mg cap

11

chlordiazepoxide 25mg cap

11

chlordiazepoxide 5mg cap

11

chlorhexidine gluconate 0.12% mouthwash

89

CHLOROQUINE PHOSPHATE 250MG TAB

37

chloroquine phosphate 500mg tab

37

chlorpheniramine caleate tab 4mg*

29

chlorpheniramine maleate CR tab 12mg*

29

chlorpheniramine maleate syrup 2mg/5ml*

29

chlorpheniramine/phenyl ephrine liquid 4-10mg/5ml*

64

chlorpheniramine/phenyl ephrine tab 4-10mg*

64

chlorpheniramine/pseudo ephedrine tab 4-60mg*

64

chlorpromazine 100mg tab

48

chlorpromazine 10mg tab 48 chlorpromazine 200mg tab

48

chlorpromazine 25mg tab 48 chlorpromazine 50mg tab 48 chlorthalidone 25mg tab 72 chlorthalidone 50mg tab 72 CHLORZOXAZONE 500MG TAB

90

CHOLBAM 250MG CAP 77 CHOLBAM 50MG CAP 77 cholecalciferol cap 2000unit*

106

cholecalciferol cap 400unit*

106

cholecalciferol tab 2000unit*

106

cholestyramine resin 4gm sf powder for oral susp

30

cholestyramine resin 66.7mg/ml susp

30

ciclopirox 0.77% cream 66 ciclopirox 0.77% gel 66 ciclopirox 1% shampoo 66 ciclopirox 8% topical soln 66 cilastatin 2.5mg/ml/imipenem 2.5mg/ml inj

36

cilastatin 5mg/ml/imipenem 5mg/ml inj

36

cilostazol 100mg tab 79 cilostazol 50mg tab 79 CIMDUO 300-300MG TAB

50

cimetidine 200mg tab 102 cimetidine 300mg tab 102 cimetidine 400mg tab 102


118

CIMETIDINE 60MG/ML ORAL SOLN

103

cimetidine 800mg tab 102 CIMZIA 200MG INJ 77 CIMZIA 200MG/ML SYRINGE

77

cinacalcet 30mg tab 74 cinacalcet 60mg tab 74 cinacalcet 90mg tab 74 CINRYZE 500UNIT INJ 79 CIPRODEX 0.3-0.1% OTIC SUSP

94

CIPROFLOXACIN 0.2% OTIC SOLN

94

ciprofloxacin 0.3% ophth soln

92

ciprofloxacin 250mg tab 76 ciprofloxacin 2mg/ml inj 76 ciprofloxacin 500mg tab 76 ciprofloxacin 750mg tab 76 citalopram 10mg tab 21 citalopram 20mg tab 21 citalopram 2mg/ml oral soln

21

citalopram 40mg tab 21 claravis 10mg cap 65 claravis 20mg cap 65 claravis 30mg cap 65 claravis 40mg cap 65 CLARINEX-D 2.5-120MG ER TAB

64

clarithromycin 250mg tab 84 CLARITHROMYCIN 25MG/ML SUSP

84

clarithromycin 500mg er tab

84

clarithromycin 500mg tab 84 CLARITHROMYCIN 50MG/ML SUSP

84

clemastine fumarate tab 1.34mg*

29

CLENPIQ POWDER 83 clindacin 1% pad 65 clindamycin 1% foam 65 clindamycin 1% gel 65

clindamycin 1% lotion 65 clindamycin 1% topical soln

65

clindamycin 12mg/ml inj 36 clindamycin 150mg cap 36 clindamycin 150mg/ml (2ml) inj

36

clindamycin 150mg/ml (4ml) inj

36

clindamycin 150mg/ml (6ml) inj

36

clindamycin 15mg/ml oral soln

36

clindamycin 18mg/ml inj 37 clindamycin 2% vaginal cream

105

clindamycin 300mg cap 37 clindamycin 6mg/ml inj 37 clindamycin 75mg cap 37 clindamycin/benzoyl peroxide 1-5% gel

65

CLINIMIX 4.25/10 INJ 91 CLINIMIX 4.25/5 INJ 91 CLINIMIX 5/15 INJ 91 CLINIMIX 5/20 INJ 91 CLINIMIX E 2.75/5 INJ 91 CLINIMIX E 4.25/10 INJ 91 CLINIMIX E 4.25/5 INJ 91 CLINIMIX E 5/15 INJ 91 CLINIMIX E 5/20 INJ 91 clinisol 15% inj 91 clobazam 10mg tab 16 clobazam 2.5mg/ml susp 16 clobazam 20mg tab 16 clobetasol propionate 0.05% cream

68

clobetasol propionate 0.05% e cream

68

clobetasol propionate 0.05% e foam

68

clobetasol propionate 0.05% foam

68

clobetasol propionate 0.05% gel

68

clobetasol propionate 0.05% lotion

68

clobetasol propionate 0.05% ointment

68

clobetasol propionate 0.05% shampoo

68

clobetasol propionate 0.05% spray

68

clobetasol propionate 0.05% topical soln

68

clodan 0.05% shampoo 68 clomipramine 25mg cap 23 clomipramine 50mg cap 23 clomipramine 75mg cap 23 clonazepam 0.125mg odt 17 clonazepam 0.25mg odt 17 clonazepam 0.5mg odt 17 clonazepam 0.5mg tab 17 clonazepam 1mg odt 17 clonazepam 1mg tab 17 clonazepam 2mg odt 17 clonazepam 2mg tab 17 clonidine 0.00417mg/hr patch

33

clonidine 0.00833mg/hr patch

33

clonidine 0.0125mg/hr patch

33

clonidine 0.1mg tab 33 clonidine 0.2mg tab 33 clonidine 0.3mg tab 33 clopidogrel 75mg tab 79 clorazepate dipotassium 15mg tab

11

clorazepate dipotassium 3.75mg tab

12

clorazepate dipotassium 7.5mg tab

12

clotrimazole 1% cream 66 clotrimazole 1% cream(OTC)*

66

clotrimazole 1% topical soln

66

clotrimazole 10mg lozenge

89


119

clotrimazole topical soln 1%*

66

clotrimazole vaginal cream 1%*

105

clotrimazole vaginal cream 2%*

105

clozapine 100mg odt 47 clozapine 100mg tab 47 clozapine 12.5mg odt 47 CLOZAPINE 150MG ODT

47

CLOZAPINE 200MG ODT

47

clozapine 200mg tab 47 clozapine 25mg odt 47 clozapine 25mg tab 47 clozapine 50mg tab 47 COARTEM 20-120MG TAB

37

codeine sulfate 30mg tab 6 codeine sulfate 60mg tab 6 colchicine 0.5mg/probenecid 500mg tab

79

COLCHICINE 0.6MG TAB

79

colesevelam hcl 625mg tab

30

colestipol 1000mg tab 30 colestipol 5000mg granules

30

colistin 75mg/ml inj 37 COMBIGAN 0.2-0.5% OPHTH SOLN

92

COMBIVENT RESPIMAT 20-100MCG INH

14

COMETRIQ 100MG DAILY DOSE CARTON PACK

40


40


40

COMPLERA 200-25-300MG TAB

50

compro 25mg rectal supp 48 CONDOMS LATEX LUBRICATED*

84

CONDOMS LATEX NON-LUBRICATED*

84

constulose 10gm/15ml oral soln

83

COPIKTRA 15MG CAP 40 COPIKTRA 25MG CAP 40 CORLANOR 5MG TAB 58 CORLANOR 5MG/5ML ORAL SOLN

58

CORLANOR 7.5MG TAB 58 CORTISONE ACETATE 25MG TAB

63

COSENTYX 150MG/ML AUTO-INJECTOR

67

COSENTYX 150MG/ML SYRINGE

67

COTELLIC 20MG TAB 40 CREON 12000-38000-60000UNIT DR CAP

71

CREON 24000-76000-120000UNI T DR CAP

71

CREON 3000-9500-15000UNIT DR CAP

71

CREON 36000-114000-180000U NIT DR CAP

71

CREON 6000-19000-30000UNIT DR CAP

71

CRINONE 4% VAGINAL GEL

106

CRINONE 8% VAGINAL GEL

106

CRIXIVAN 200MG CAP 50 CRIXIVAN 400MG CAP 50 cromolyn sodium 10mg/ml inh soln

13

cromolyn sodium 20mg/ml oral soln

77

cromolyn sodium 4% ophth soln

94

cromolyn sodium nasal aerosol soln 5.2 mg/act (4%)*

90

cryselle 28 pack 60 cyanocobalamin inj 1000mcg/ml*

80

cyclafem 1/35 28 day pack

60

cyclafem 7/7/7 28 day pack

60

cyclobenzaprine 10mg tab

90

cyclobenzaprine 5mg tab 90 cyclobenzaprine 7.5mg tab

90

CYCLOPHOSPHAMIDE 25MG CAP

38

CYCLOPHOSPHAMIDE 50MG CAP

38

cyclosporine 100mg cap 53 cyclosporine 25mg cap 53 cyclosporine modified 100mg cap

53

cyclosporine modified 100mg/ml oral soln

88

cyclosporine modified 25mg cap

53

CYCLOSPORINE MODIFIED 50MG CAP

88

cyred 28 day pack 60 CYSTAGON 150MG CAP 78 CYSTAGON 50MG CAP 78 CYSTARAN 0.44% OPHTH SOLN

94

D

dalfampridine 10mg er tab

98

DALIRESP 250MCG TAB 13 DALIRESP 500MCG TAB 13 DALVANCE 500MG INJ 36


120

danazol 100mg cap 9 danazol 200mg cap 9 danazol 50mg cap 9 dantrolene sodium 100mg cap

90

dantrolene sodium 25mg cap

90

dantrolene sodium 50mg cap

90

dapsone 100mg tab 36 dapsone 25mg tab 36 DAPTACEL INJ 102 DAPTOMYCIN 350MG INJ

36

daptomycin 500mg inj 36 DARAPRIM 25MG TAB 37 DAURISMO 100MG TAB 38 DAURISMO 25MG TAB 38 deblitane 28 day 0.35mg pack

63

deferasirox 125mg tab for oral susp

27

deferasirox 250mg tab for oral susp

27

deferasirox 360mg tab 27 deferasirox 500mg tab for oral susp

27

deferasirox 90mg tab 27 DELSTRIGO 100-300-300MG TAB

50

DEMSER 250MG CAP 32 DENAVIR 1% CREAM 68 DEPEN 250MG TAB 88 DEPO-PROVERA 400MG/ML INJ

39

DESCOVY 200-25MG TAB

50

desipramine 100mg tab 23 desipramine 10mg tab 23 desipramine 150mg tab 23 desipramine 25mg tab 23 desipramine 50mg tab 23 desipramine 75mg tab 23 desloratadine 5mg tab 29

desmopressin acetate 0.01% nasal spray

74

desmopressin acetate 0.1mg tab

74

desmopressin acetate 0.2mg tab

74

desogestrel/ethinyl estradiol 28 day pack

60

desogestrel/ethinyl estradiol pack

60

desonide 0.05% cream 68 desonide 0.05% lotion 68 desonide 0.05% ointment 68 desoximetasone 0.05% cream

68

desoximetasone 0.05% gel

68

desoximetasone 0.25% cream

68

desoximetasone 0.25% ointment

69

desvenlafaxine succinate 100mg er tab

22


22


22

DEX-4 CHEW 1GM* 25 DEXAMETHASONE 0.1% OPHTH SOLN

93

dexamethasone 0.1mg/ml oral soln

63

dexamethasone 0.5mg tab 63 dexamethasone 0.75mg tab

63

dexamethasone 1.5mg tab 63 DEXAMETHASONE 1MG TAB

63

DEXAMETHASONE 1MG/ML ORAL SOLN

63

DEXAMETHASONE 2MG TAB

63

dexamethasone 4mg tab 63 dexamethasone 6mg tab 63

dexamethasone/neomycin /polymyxin b 0.1% ophth ointment

93

dexamethasone/neomycin /polymyxin b 0.1% ophth susp

93

dexamethasone/tobramyc in 0.3-0.1% ophth susp

93

dexmethylphenidate 10mg er cap

2

dexmethylphenidate 10mg tab

2


2

dexmethylphenidate 2.5mg tab

2


2


2


2


2


2


2

dexmethylphenidate 5mg tab

2

dextran 70/hypromellose ophth soln 0.1-0.3%*

91

dextroamphetamine sulfate 10mg er cap

1

dextroamphetamine sulfate 10mg tab

1


1


1

dextroamphetamine sulfate 5mg tab

1

dextromethorphan/guaife nesin liquid 10-100mg/5ml*

64


121


64


64

dextromethorphan/guaife nesin syrup 10-100mg/5ml*

64

DIASTAT 10MG APPLICATOR

17

DIASTAT 2.5MG APPLICATOR

17

DIASTAT 20MG APPLICATOR

17

diazepam 10mg tab 12 DIAZEPAM 10MG/2ML RECTAL GEL

17

DIAZEPAM 1MG/ML ORAL SOLN

12

DIAZEPAM 2.5MG/0.5ML RECTAL GEL

17

diazepam 2mg tab 12 diazepam 5mg tab 12 diazepam 5mg/ml oral soln

12

diclofenac potassium 50mg tab

4

diclofenac sodium 0.1% ophth soln

94

diclofenac sodium 1% gel 67 diclofenac sodium 100mg er tab

4

diclofenac sodium 25mg dr tab

4

diclofenac sodium 3% gel 67 diclofenac sodium 50mg dr tab

4

diclofenac sodium 50mg/misoprostol 0.2mg tab

4

diclofenac sodium 75mg dr tab

4

diclofenac sodium 75mg/misoprostol 0.2mg tab

4

dicloxacillin 250mg cap 96 dicloxacillin 500mg cap 96 dicyclomine 10mg cap 103 dicyclomine 20mg tab 103 dicyclomine 2mg/ml oral soln

103

didanosine 200mg dr cap 50 didanosine 250mg dr cap 50 didanosine 400mg dr cap 50 diflunisal 500mg tab 6 digitek 0.125mg tab 57 digitek 0.25mg tab 57 digox 0.125mg tab 57 digox 0.25mg tab 57 digoxin 0.05mg/ml oral soln

57

digoxin 0.125mg tab 57 digoxin 0.25mg tab 57 DIHYDROERGOTAMINE MESYLATE 0.5MG/ACT NASAL SPRAY

85

DILANTIN 30MG ER CAP

20

dilt 120mg xr cap 55 dilt 180mg xr cap 55 dilt 240mg xr cap 55 diltiazem 120mg er (12 hr) cap

55

diltiazem 120mg er (24 hr) cap

55

diltiazem 120mg tab 55 diltiazem 180mg er cap 55 diltiazem 240mg er cap 55 diltiazem 300mg er cap 55 diltiazem 30mg tab 55 diltiazem 360mg er cap 55 diltiazem 420mg er cap 55 diltiazem 60mg er cap 55 diltiazem 60mg tab 56 diltiazem 90mg er cap 56 diltiazem 90mg tab 56

dimenhydrinate tab 50mg*

28

DIPENTUM 250MG CAP 77 diphenhydramine cap 25mg*

29

diphenhydramine cap 50mg*

29

diphenhydramine liquid 12.5mg/5ml*

29

diphenhydramine liquid 6.25mg/ml*

29

diphenhydramine tab 25mg*

29

DIPHTHERIA/TETANUS TOXOID INJ

102

disopyramide 100mg cap 12 disopyramide 150mg cap 12 disulfiram 250mg tab 97 disulfiram 500mg tab 97 DIURIL 250MG/5ML SUSP

72

divalproex sodium 125mg dr cap

20

divalproex sodium 125mg dr tab

20


20

divalproex sodium 250mg er tab

20


20

divalproex sodium 500mg er tab

20

docusate calcium cap 240mg*

83

docusate sodium cap 100mg*

83

docusate sodium cap 250mg*

83

docusate sodium enema 283mg*

80

docusate sodium liquid 150mg/15ml*

83

docusate sodium syrup 60mg/15ml*

83


122

docusate sodium tab 100mg*

83

dofetilide 125mcg cap 12 dofetilide 250mcg cap 12 dofetilide 500mcg cap 12 donepezil 10mg odt 97 donepezil 10mg tab 97 donepezil 23mg tab 97 donepezil 5mg odt 97 donepezil 5mg tab 97 DOPTELET 20MG TAB 80 DOPTELET 40MG DAILY DOSE PACK

80

DOPTELET 60MG DAILY DOSE PACK

80

dorzolamide 2% ophth soln

94

dorzolamide 20mg/ml/timolol 5mg/ml ophth soln

92

dorzolamide/timolol 22.3-6.8mg/ml ophth soln (preservative-free)

92

dotti 0.025mg/24hr patch 75 dotti 0.0375mg/24hr patch

75

dotti 0.05mg/24hr patch 75 dotti 0.075mg/24hr patch 75 dotti 0.1mg/24hr patch 75 DOVATO 50-300MG TAB 50 doxazosin 1mg tab 33 doxazosin 2mg tab 33 doxazosin 4mg tab 33 doxazosin 8mg tab 33 doxepin 100mg cap 23 doxepin 10mg cap 23 doxepin 10mg/ml oral soln

23

doxepin 150mg cap 23 doxepin 25mg cap 24 doxepin 50mg cap 24 doxepin 75mg cap 24 doxercalciferol 0.0005mg cap

74

doxercalciferol 0.001mg cap

74

doxercalciferol 0.0025mg cap

74

doxy 100mg inj 100 doxycycline hyclate 100mg cap

100

doxycycline hyclate 100mg tab

100

doxycycline hyclate 20mg tab

100

doxycycline hyclate 50mg cap

100

doxycycline monohydrate 100mg cap

100

doxycycline monohydrate 100mg tab

100

doxycycline monohydrate 50mg cap

100


100

doxycycline monohydrate 5mg/ml susp

100


100

doxylamine succinate tab 25mg*

81

DRIZALMA 20MG DR CAP

22


22


23


23

dronabinol 10mg cap 28 dronabinol 2.5mg cap 28 dronabinol 5mg cap 28 drospirenone 3mg/ethinyl estradiol 0.02mg/inert 1 mg pack

60

drospirenone 3mg/ethinyl estradiol 0.03mg/inert ingredients 1mg pack

60

DROXIA 200MG CAP 79

DROXIA 300MG CAP 80 DROXIA 400MG CAP 80 DULERA 100-5MCG INH 14 DULERA 200-5MCG INH 14 duloxetine 20mg dr cap 23 duloxetine 30mg dr cap 23 duloxetine 40mg dr cap 23 duloxetine 60mg dr cap 23 DUPIXENT 200MG/ML PF SYRINGE

13

DUPIXENT 300MG/2ML PF SYRINGE

70

duramorph 0.5mg/ml inj 6 duramorph 1mg/ml inj 6 DUREZOL 0.05% OPHTH SUSP

93

dutasteride 0.5mg cap 78 dutasteride 0.5mg/tamsulosin 0.4mg cap

78

E

EDURANT 25MG TAB 50 efavirenz 200mg cap 50 efavirenz 50mg cap 50 efavirenz 600mg cap 50 ELIGARD 22.5MG SYRINGE

39

ELIGARD 30MG SYRINGE

39

ELIGARD 45MG SYRINGE

39

ELIGARD 7.5MG SYRINGE

39

ELIQUIS 2.5MG TAB 15 ELIQUIS 30-DAY STARTER PACK

15

ELIQUIS 5MG TAB 15 ELMIRON 100MG CAP 78 eluryng 0.120-0.015mg/24hr vaginal ring

63

EMCYT 140MG CAP 39 emoquette pack 60


123

EMSAM 12MG/24HR PATCH

21


21


21

EMTRIVA 10MG/ML ORAL SOLN

50

EMTRIVA 200MG CAP 50 enalapril maleate 10mg tab

32

enalapril maleate 10mg/hydrochlorothiazid e 25mg tab

34

enalapril maleate 2.5mg tab

32

enalapril maleate 20mg tab

32

enalapril maleate 5mg tab

32

enalapril maleate 5mg/hydrochlorothiazide 12.5mg tab

34

ENBREL 25MG INJ 5 ENBREL 25MG/0.5ML SYRINGE

5

ENBREL 50MG/ML CARTRIDGE

5

ENBREL 50MG/ML SURECLICK INJ

5

ENBREL 50MG/ML SYRINGE

5

ENDARI 5000MG POWDER FOR ORAL SOLN

80

endocet 10-325mg tab 8 endocet 5-325mg tab 8 endocet 7.5-325mg tab 8 ENEMEEZ MINI ENEMA 283MG*

83

ENGERIX-B 10MCG/0.5ML SYRINGE

104

ENGERIX-B 20MCG/ML SYRINGE

104

enoxaparin sodium 100mg/1ml syringe

16

enoxaparin sodium 120mg/0.8ml syringe

16

enoxaparin sodium 150mg/1ml syringe

16


16


16


16


16

enpresse 28 day pack 60 enskyce 28 day pack 60 entacapone 200mg tab 45 entecavir 0.5mg tab 52 entecavir 1mg tab 52 ENTRESTO 24-26MG TAB

57

ENTRESTO 49-51MG TAB

57

ENTRESTO 97-103MG TAB

57

enulose 10gm/15ml oral soln

77

ENVARSUS 0.75MG ER TAB

88

ENVARSUS 1MG ER TAB 88 ENVARSUS 4MG ER TAB 88 EPIDIOLEX 100MG/ML ORAL SOLN

18

epinastine 0.05% ophth soln

94

EPINEPHRINE 0.15MG/0.3ML AUTO-INJECTOR

106

epinephrine 0.3mg/0.3ml auto-injector

106

epitol 200mg tab 18 EPIVIR HBV 5MG/ML ORAL SOLN

52

eplerenone 25mg tab 35 eplerenone 50mg tab 35

EQUETRO 100MG ER CAP

45


45


45

ERAXIS 50MG INJ 28 ergocalciferol cap 50000unit*

106

ergocalciferol soln 8000unit/ml*

106

ERGOCALCIFEROL TAB 2000UNIT*

106

ERGOCALCIFEROL TAB 400UNIT*

106

ERGOLOID MESYLATES 1MG TAB

99

ERIVEDGE 150MG CAP 38 ERLEADA 60MG TAB 39 erlotinib 100mg tab 40 erlotinib 150mg tab 41 erlotinib 25mg tab 41 errin 28 day 0.35mg pack 63 ertapenem 1gm inj 36 ery 2% pad 65 ERYTHROCIN LACTOBIONATE 500MG INJ

84

erythromycin 0.005mg/mg ophth ointment

92

erythromycin 2% gel 65 erythromycin 2% topical soln

65

erythromycin 250mg dr cap

84

erythromycin 250mg tab 84 erythromycin 500mg tab 84 erythromycin ethylsuccinate 40mg/ml susp

84

erythromycin ethylsuccinate 80mg/ml oral susp

84

erythromycin/benzoyl peroxide 5-3% gel

65


124

ESBRIET 267MG CAP 100 ESBRIET 267MG TAB 100 ESBRIET 801MG TAB 100 escitalopram 10mg tab 21 escitalopram 1mg/ml oral soln

21

escitalopram 20mg tab 21 escitalopram 5mg tab 21 estarylla 28 day pack 60 estradiol 0.00104mg/hr twice weekly patch

75

estradiol 0.00104mg/hr weekly patch

75

estradiol 0.00156mg/hr twice weekly patch

76


76


76


76


76


76


76


76


76

estradiol 0.1mg/ml vaginal cream

106

estradiol 0.5mg tab 76 estradiol 0.5mg/norethindrone acetate 0.1mg pack

75

estradiol 1mg tab 76 estradiol 1mg/norethindrone acetate 0.5mg pack

75

estradiol 20mg/ml inj 76 estradiol 2mg tab 76 estradiol 40mg/ml inj 76

ESTRING 2MG VAGINAL 106 RING eszopiclone 1mg tab 82 eszopiclone 2mg tab 82 eszopiclone 3mg tab 82 ethacrynic acid 25mg tab 72 ethambutol 100mg tab 37 ethambutol 400mg tab 37 ethinyl estradiol 0.0025mg/norethindrone acetate 0.5mg tab

75

ethinyl estradiol 0.005mg/norethindrone acetate 1mg tab

75

ethinyl estradiol 0.01mg/ethinyl estradiol 0.02mg/levonorgestrel 0.1mg 91 day pack

60

ethinyl estradiol 0.01mg/ethinyl estradiol 0.03mg/levonorgestrel 0.15mg pack

60


60

ethinyl estradiol 0.025mg/inert/norgestima te 0.18mg/0.215mg/0.25mg pack

60


60

ethinyl estradiol 0.02mg/norethindrone 1mg 21 day pack

60

ethinyl estradiol 0.035mg/ethynodiol 1mg 28 day pack

60


60

ethinyl estradiol 0.035mg/inert/norgestima te 0.18mg/0.215mg/0.25mg pack

60

ethinyl estradiol 0.035mg/norgestimate 0.25mg pack

61

ethinyl estradiol 0.03mg/0.04mg /inert/levonorgestrel 0.05mg/ 0.075mg pack

61


61

ethinyl estradiol 0.03mg/levonorgestrel 0.15mg tab 28 day pack

61

ethinyl estradiol 0.05mg/ethynodiol 1mg/inert ingredients 1mg 28 day pack

61

ethinyl estradiol/levonorgestrel 91 day pack

61

ethosuximide 250mg cap 20 ethosuximide 50mg/ml oral soln

20

etodolac 200mg cap 4 etodolac 300mg cap 4 etodolac 400mg tab 4 etodolac 500mg tab 4 etonogestrel-ethinyl estradiol 0.120-0.015mg/24hr vaginal ring

63

euthyrox 100mcg tab 101 euthyrox 112mcg tab 101 euthyrox 125mcg tab 101


125

euthyrox 137mcg tab 101 euthyrox 150mcg tab 101 euthyrox 175mcg tab 101 euthyrox 200mcg tab 101 euthyrox 25mcg tab 101 euthyrox 50mcg tab 101 euthyrox 75mcg tab 101 euthyrox 88mcg tab 101 everolimus 2.5mg tab 41 everolimus 5mg tab 41 everolimus 7.5mg tab 41 EVOTAZ 300-150MG TAB

50

exemestane 25mg tab 39 EXTAVIA 0.3MG INJ 98 eye wash soln* 94 ezetimibe 10mg tab 31

F

falmina 28 day pack 61 famciclovir 125mg tab 53 famciclovir 250mg tab 53 famciclovir 500mg tab 53 famotidine 20mg tab 102 famotidine 40mg tab 102 famotidine 8mg/ml susp 102 famotidine tab 10mg(OTC)*

103

FANAPT 10MG TAB 46 FANAPT 12MG TAB 46 FANAPT 1MG TAB 46 FANAPT 2MG TAB 46 FANAPT 4MG TAB 46 FANAPT 6MG TAB 46 FANAPT 8MG TAB 46 FANAPT TITRATION PACK

46

FARYDAK 10MG CAP 41 FARYDAK 20MG CAP 41 FASENRA 30MG/ML AUTO-INJECTOR

13

FASENRA 30MG/ML SYRINGE

13

fayosim 91 day pack 61 febuxostat 40mg tab 79

febuxostat 80mg tab 79 felbamate 120mg/ml susp 20 felbamate 400mg tab 20 felbamate 600mg tab 20 felodipine 10mg er tab 56 felodipine 2.5mg er tab 56 felodipine 5mg er tab 56 femynor 28 day pack 61 fenofibrate 134mg cap 30 fenofibrate 145mg tab 30 fenofibrate 160mg tab 30 fenofibrate 200mg cap 30 fenofibrate 48mg tab 30 fenofibrate 54mg tab 30 fenofibrate 67mg cap 30 fenofibric acid 135mg dr cap

30

fenofibric acid 45mg dr cap

30

fentanyl 0.012mg/hr patch

6

fentanyl 0.025mg/hr patch

6

fentanyl 0.05mg/hr patch 6 fentanyl 0.075mg/hr patch

6

FENTANYL 0.1MG BUCCAL TAB

6

fentanyl 0.1mg/hr patch 6 FENTANYL 0.2MG BUCCAL TAB

6

fentanyl 0.2mg lozenge 6 FENTANYL 0.4MG BUCCAL TAB

6


6


6

fentanyl 0.8mg lozenge 6 fentanyl 1.2mg lozenge 6 fentanyl 1.6mg lozenge 6 FENTORA 100MCG BUCCAL TAB

6

FENTORA 200MCG BUCCAL TAB

6


6


6


6

FERRIPROX 1000MG TAB

27

FERRIPROX 100MG/ML ORAL SOLN

27

FERRIPROX 500MG TAB 27 ferrous sulfate CR tab 142mg*

81

ferrous sulfate CR tab 160mg*

81


81

ferrous sulfate CR tab 47.5mg*

81


81

FERROUS SULFATE EC TAB 324MG*

81

ferrous sulfate EC tab 325mg*

81

ferrous sulfate elixir 220mg/5ml*

81

FERROUS SULFATE LIQUID 220MG/5ML*

81

ferrous sulfate oral soln 75mg/ml*

81

FERROUS SULFATE SYRUP 300MG/5ML*

81

ferrous sulfate tab 27mg* 81 ferrous sulfate tab 325mg*

81

ferrous sulfate tab er 143mg*

81

FETZIMA 120MG ER CAP

23

FETZIMA 20MG ER CAP 23 FETZIMA 40MG ER CAP 23 FETZIMA 80MG ER CAP 23


126

FETZIMA PACK 23 FIASP 100UNIT/ML CARTRIDGE

26

FIASP 100UNIT/ML INJ 26 FIASP 100UNIT/ML PEN INJ

26

finasteride 5mg tab 78 FIRMAGON 120MG INJ 39 FIRMAGON 80MG INJ 39 FIRVANQ 25MG/ML ORAL SOLN

36

FIRVANQ 50MG/ML ORAL SOLN

36

flavoxate 100mg tab 104 FLEBOGAMMA 10% INJ 95 flecainide acetate 100mg tab

12

flecainide acetate 150mg tab

12

flecainide acetate 50mg tab

12

FLOVENT 100MCG DISKUS

14

FLOVENT 110MCG HFA INH

14


14


14


14


14

fluconazole 100mg tab 29 fluconazole 10mg/ml susp 29 fluconazole 150mg tab 29 fluconazole 200mg tab 29 fluconazole 2mg/ml (100ml) inj

29

fluconazole 2mg/ml inj 29 fluconazole 40mg/ml susp 29 fluconazole 50mg tab 29 flucytosine 250mg cap 28 flucytosine 500mg cap 28 fludrocortisone 0.1mg tab 64

FLUNISOLIDE 25MCG NASAL INHALER

90

fluocinolone acetonide 0.01% cream

69

fluocinolone acetonide 0.01% otic oil

94

fluocinolone acetonide 0.01% otic soln

94

fluocinolone acetonide 0.01% topical soln

69

fluocinolone acetonide 0.025% cream

69

fluocinolone acetonide 0.025% ointment

69

fluocinolone acetonide 0.1mg/ml oil

69

fluocinonide 0.05% e cream

69

fluocinonide 0.05% gel 69 fluocinonide 0.05% ointment

69

fluocinonide 0.05% topical soln

69

fluorometholone 0.1% ophth susp

93

FLUOROPLEX 1% CREAM

67

FLUOROURACIL 0.5% CREAM

67

FLUOROURACIL 2% TOPICAL SOLN

67

fluorouracil 5% cream 67 FLUOROURACIL 5% TOPICAL SOLN

67

fluoxetine 10mg cap 21 fluoxetine 10mg tab 21 fluoxetine 20mg cap 21 fluoxetine 20mg tab 21 fluoxetine 25mg/olanzapine 12mg cap

98

fluoxetine 25mg/olanzapine 3mg cap

98


98

fluoxetine 40mg cap 21 fluoxetine 4mg/ml oral soln

21


98


98

FLUPHENAZINE 0.5MG/ML ORAL SOLN

48

fluphenazine 10mg tab 48 fluphenazine 1mg tab 48 fluphenazine 2.5mg tab 48 FLUPHENAZINE 2.5MG/ML INJ

48

fluphenazine 5mg tab 48 FLUPHENAZINE 5MG/ML ORAL SOLN

48

fluphenazine decanoate 25mg/ml inj

48

flurbiprofen sodium 0.03% ophth soln

94

flutamide 125mg cap 39 fluticasone propionate 0.005% ointment

69

fluticasone propionate 0.05% cream

69

fluticasone propionate 0.05% lotion

69

fluticasone propionate 50mcg nasal inhaler

90


14


14


127


14

FLUTICASONE PROPIONATE/SALMETE ROL XINAFOATE 113-14MCG/ACT POWDER INH

14


14


14

fluvastatin 20mg cap 30 fluvastatin 40mg cap 30 fluvastatin 80mg er tab 30 fluvoxamine maleate 100mg er cap

21

fluvoxamine maleate 100mg tab

22

fluvoxamine maleate 150mg er cap

22


22


22

FOLIC ACID INJ 5MG/ML*

80

folic acid tab 1mg* 80 folic acid tab 400mcg* 80 folic acid tab 800mcg* 80 fondaparinux sodium 12.5mg/ml (0.4ml) syringe

16

fondaparinux sodium 12.5mg/ml (0.6ml) syringe

16

fondaparinux sodium 12.5mg/ml (0.8ml) syringe

16

fondaparinux sodium 5mg/ml syringe

16

FORTEO 600MCG/2.4ML PEN INJ

72

fosamprenavir 700mg tab 50 fosinopril sodium 10mg tab

32

fosinopril sodium 10mg/hydrochlorothiazid e 12.5mg tab

34

fosinopril sodium 20mg tab

32

fosinopril sodium 20mg/hydrochlorothiazid e 12.5mg tab

34

fosinopril sodium 40mg tab

32

FOSRENOL 1000MG ORAL POWDER

78

FOSRENOL 750MG ORAL POWDER

78

FRAGMIN 10000UNIT/ML SYRINGE

16

FRAGMIN 12500UNIT/0.5ML SYRINGE

16


16


16


16


16


16

FRAGMIN 95000UNIT/3.8ML INJ

16

FREAMINE 6.9% INJ 91 FULPHILA 6/0.6ML SYRINGE

80

furosemide 10mg/ml inj 72 furosemide 10mg/ml oral soln

72

furosemide 10mg/ml syringe

72

furosemide 20mg tab 72 furosemide 40mg tab 72 furosemide 80mg tab 72 FUROSEMIDE 8MG/ML ORAL SOLN

72

FUZEON 90MG INJ 50 fyavolv 0.5mg-2.5mcg tab 75 fyavolv 1mg-5mcg tab 75 FYCOMPA 0.5MG/ML SUSP

16

FYCOMPA 10MG TAB 16 FYCOMPA 12MG TAB 16 FYCOMPA 2MG TAB 16 FYCOMPA 4MG TAB 16 FYCOMPA 6MG TAB 16 FYCOMPA 8MG TAB 16

G

gabapentin 100mg cap 18 gabapentin 300mg cap 18 gabapentin 400mg cap 18 gabapentin 50mg/ml oral soln

18

gabapentin 600mg tab 18 gabapentin 800mg tab 18 GALAFOLD 123MG CAP 74 galantamine 12mg tab 97 galantamine 4mg tab 97 galantamine 8mg tab 97 galantamine hydrobromide 16mg er cap

97

galantamine hydrobromide 24mg er cap

97

GALANTAMINE HYDROBROMIDE 4MG/ML ORAL SOLN

97

galantamine hydrobromide 8mg er cap

97


128

GAMMAGARD 10GM INJ

95

GAMMAGARD 2.5GM/25ML INJ

95

GAMMAGARD 5GM INJ 95 GAMMAKED 1GM/10ML INJ

95

GAMMAPLEX 10GM/100ML INJ

95


95


95


95

GAMUNEX 1GM/10ML INJ

95

GARDASIL 9 INJ 104 GARDASIL 9 SYRINGE 104 gatifloxacin 0.5% ophth soln

92

GATTEX 5MG INJ 78 GAUZE PAD 84 gavilyte-c oral soln 83 gavilyte-g powder for oral soln

83

gavilyte-n powder for oral soln

83

gemfibrozil 600mg tab 30 generlac 10gm/15ml oral soln

77

gengraf 100mg cap 53 gengraf 100mg/ml oral soln

53

gengraf 25mg cap 53 GENOTROPIN 0.2MG SYRINGE

73

GENOTROPIN 0.4MG SYRINGE

73


73


73


73


73


73


73

GENOTROPIN 12MG CARTRIDGE

73

GENOTROPIN 1MG SYRINGE

73

GENOTROPIN 2MG SYRINGE

73

GENOTROPIN 5MG CARTRIDGE

73

GENTAK 0.3% OPHTH OINTMENT

92

gentamicin sulfate 0.1% cream

66

gentamicin sulfate 0.1% ointment

66

gentamicin sulfate 0.3% ophth soln

92

GENTAMICIN SULFATE 0.8MG/ML INJ

3

gentamicin sulfate 1.2mg/ml inj

3

GENTAMICIN SULFATE 1.6MG/ML INJ

3

GENTAMICIN SULFATE 1MG/ML INJ

3

gentamicin sulfate 40mg/ml inj

3

genteal tear moderate soln*

91

GENVOYA 150-150-200-10MG TAB

50

GEODON 20MG INJ 45 gianvi 28-day pack 61 GILENYA 0.5MG CAP 98 GILOTRIF 20MG TAB 41 GILOTRIF 30MG TAB 41 GILOTRIF 40MG TAB 41 GLASSIA 1000MG/50ML INJ

99

glatiramer 20mg/ml syringe

98

glatiramer 40mg/ml syringe

98

glatopa 20mg/ml syringe 98 glatopa 40mg/ml syringe 98 GLEOSTINE 100MG CAP 38 GLEOSTINE 10MG CAP 38 GLEOSTINE 40MG CAP 38 glimepiride 1mg tab 27 glimepiride 2mg tab 27 glimepiride 4mg tab 27 glipizide 10mg er tab 27 glipizide 10mg tab 27 glipizide 2.5mg er tab 27 glipizide 2.5mg/metformin 250mg tab

24

glipizide 2.5mg/metformin 500mg tab

24

glipizide 5mg er tab 27 glipizide 5mg tab 27 glipizide 5mg/metformin 500mg tab

24

GLUCAGEN 1MG INJ 25 GLUCAGON 1MG INJ 25 glucose 10% inj 91 glucose 100mg/ml inj 91 GLUCOSE 100MG/ML/SODIUM CHLORIDE 0.0342 MEQ/ML INJ

86


86


86

glucose 50 mg/ml/potassium chloride 0.04meq/ml/sodium chloride 4.5mg/ml inj

86


129


86

glucose 50mg/ml/potassium chloride 0.02 meq/ml inj

86


86


86

glucose 50mg/ml/potassium chloride 0.02meq/ml/sodium chloride 4.5mg/ml inj

86


86

GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04 MEQ/ML INJ

86

GLUCOSE 50MG/ML/POTASSIUM CHLORIDE 0.04 MEQ/ML/SODIUM CHLORIDE 0.154 MEQ/ML INJ

86

glucose 50mg/ml/sodium chloride 0.0342 meq/ml inj

86


87

glucose 50mg/ml/sodium chloride 4.5mg/ml inj

87

glucose 50mg/ml/sodium chloride 9mg/ml inj

87

GLUCOSE CHEW TAB 4GM*

25

GLUCOSE CHEW TAB 5GM*

25

glucose gel 40%* 25 glyburide 1.25mg/metformin 250mg tab

24

glyburide 2.5mg/metformin 500mg tab

24

glyburide 5mg/metformin 500mg tab

24

glycerin supp 1.2gm* 83 glycerin supp 1gm* 83 glycerin supp 2.1gm* 83 glycerin supp 2gm* 83 glycerin supp 80.7%* 83 glycopyrrolate 1mg tab 103 glycopyrrolate 2mg tab 103 GRAMICIDIN 0.025MG/ML/NEOMYCI N 1.75MG/ML/POLYMYXI N B 10000UNIT/ML OPHTH SOLN

92

granisetron 1mg tab 28 griseofulvin 25mg/ml susp

29

GUAIFENESIN/CODEINE LIQUID 200-8MG/5ML*

64

guaifenesin/codeine liquid 225-7.5mg/5ml*

64

guaifenesin/codeine soln 100-10mg/5ml*

64

GUAIFENESIN/CODEINE SOLN 100-6.3MG/5ML*

64

guanfacine 1mg er tab 1 guanfacine 2mg er tab 1 guanfacine 3mg er tab 1 guanfacine 4mg er tab 1

GUANIDINE 125MG TAB 37 GVOKE 0.5MG/0.1ML SYRINGE

25

GVOKE 1MG/0.2ML SYRINGE

25

H

HAEGARDA 2000UNT INJ

79

HAEGARDA 3000UNT INJ

79

hailey 24 fe 28 day pack 61 halobetasol propionate 0.05% cream

69

halobetasol propionate 0.05% ointment

69

haloperidol 0.5mg tab 47 haloperidol 10mg tab 47 haloperidol 1mg tab 47 haloperidol 20mg tab 47 haloperidol 2mg tab 47 haloperidol 2mg/ml oral soln

47

haloperidol 5mg tab 47 haloperidol 5mg/ml inj 47 haloperidol decanoate 100mg/ml inj

47

haloperidol decanoate 500mg/5ml inj

47

haloperidol decanoate 50mg/ml inj

47

HAVRIX 1440UNIT INJ 105 HAVRIX 1440UNIT SYRINGE

105

HAVRIX 720UNIT INJ 105 HAVRIX 720UNIT SYRINGE

105

heparin sodium porcine 10000unit/ml inj

16


16


16


16


130

HEPATAMINE 8% INJ 91 HETLIOZ 20MG CAP 82 HIBERIX INJ 104 HUMIRA 10MG/0.1ML SYRINGE

3

HUMIRA 10MG/0.2ML SYRINGE

3


3


3

HUMIRA 40MG/0.4ML PEN INJECTOR

3


3

HUMIRA 40MG/0.8ML AUTO-INJECTOR

3


3

HUMIRA PEDIATRIC CROHN'S STARTER PACK (3) 80MG/0.8ML INJ

3

HUMIRA PEDIATRIC CROHN'S STARTER PACK SYRINGE (2) 40MG/0.4ML 80MG/0.8ML

3

HUMIRA PEN -CROHN'S STARTER PACK 40MG/0.8ML INJ

3

HUMIRA PEN -CROHN'S STARTER PACK 80MG/0.8ML INJ

3

HUMIRA PEN -PSORIASIS STARTER PACK 40MG/0.8ML INJ

4

HUMIRA PEN -PSORIASIS STARTER PACK 80MG/0.8ML INJ

4

HUMULIN R 500UNIT/ML INJ

26

HUMULIN R 500UNIT/ML PEN INJ

26

hydralazine 100mg tab 35

hydralazine 10mg tab 35 hydralazine 25mg tab 35 hydralazine 50mg tab 35 hydrochlorothiazide 12.5mg cap

72

hydrochlorothiazide 12.5mg tab

72

hydrochlorothiazide 12.5mg/irbesartan 150mg tab

34

hydrochlorothiazide 12.5mg/irbesartan 300mg tab

34

hydrochlorothiazide 12.5mg/lisinopril 10mg tab

34

hydrochlorothiazide 12.5mg/lisinopril 20mg tab

34


34


34


34


34

hydrochlorothiazide 12.5mg/quinapril 10mg tab

34

hydrochlorothiazide 12.5mg/quinapril 20mg tab

34

hydrochlorothiazide 12.5mg/telmisartan 40mg tab

34

hydrochlorothiazide 12.5mg/telmisartan 80mg tab

34

hydrochlorothiazide 12.5mg/valsartan 160mg tab

35


35


35

hydrochlorothiazide 25mg tab

72

hydrochlorothiazide 25mg/lisinopril 20mg tab

35

hydrochlorothiazide 25mg/losartan potassium 100mg tab

35


35


35

hydrochlorothiazide 25mg/olmesartan medoxomil 40mg tab

35

hydrochlorothiazide 25mg/propranolol 40mg tab

35

hydrochlorothiazide 25mg/propranolol 80mg tab

35

hydrochlorothiazide 25mg/quinapril 20mg tab

35

hydrochlorothiazide 25mg/spironolactone 25mg tab

71

hydrochlorothiazide 25mg/telmisartan 80mg tab

35

hydrochlorothiazide 25mg/triamterene 37.5mg cap

71

hydrochlorothiazide 25mg/triamterene 37.5mg tab

71


131

hydrochlorothiazide 25mg/valsartan 160mg tab

35

hydrochlorothiazide 25mg/valsartan 320mg tab

35

hydrochlorothiazide 50mg tab

72


35

hydrochlorothiazide 50mg/triamterene 75mg tab

71

hydrocodone 10mg/ibuprofen 200mg tab

8

hydrocodone 5mg/ibuprofen 200mg tab

8

hydrocodone bitartrate 7.5mg/ibuprofen 200mg tab

8

hydrocodone/homatropin e syrup 5-1.5mg/5ml*

64

hydrocodone/homatropin e tab 5-1.5mg*

64

hydrocortisone 1% cream 69 hydrocortisone 1% ointment*

69

hydrocortisone 1.67mg/ml enema

9

hydrocortisone 10mg tab 63 hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic soln

94

hydrocortisone 10mg/ml/neomycin 3.5mg/ml/polymyxin b 10000unit/ml otic susp

94

hydrocortisone 2.5% cream

69

hydrocortisone 2.5% lotion

69

hydrocortisone 2.5% ointment

69

hydrocortisone 20mg tab 63 hydrocortisone 5mg tab 63 hydrocortisone cream 0.5%*

69

hydrocortisone lotion 1% *

69

hydrocortisone ointment 0.5%*

69

hydrocortisone soln 1%* 69 hydrocortisone valerate 0.2% cream

69

hydrocortisone valerate 0.2% ointment

69

hydrocortisone/aloe vera cream 0.5%*

69

hydrocortisone/aloe vera cream 1%*

69

hydrocortisone/pramoxin e 1-1% rectal cream

9

hydromorphone 10mg/ml (1ml) inj

6

hydromorphone 10mg/ml (5ml) inj

6

hydromorphone 1mg/ml oral soln

6

hydromorphone 2mg tab 6 hydromorphone 4mg tab 6 hydromorphone 8mg tab 7 hydroxychloroquine sulfate 200mg tab

37

hydroxyurea 500mg cap 43 hydroxyzine 10mg tab 11 hydroxyzine 25mg tab 11 hydroxyzine 2mg/ml oral soln

11

hydroxyzine 50mg tab 11 HYDROXYZINE PAMOATE 100MG CAP

11

hydroxyzine pamoate 25mg cap

11

hydroxyzine pamoate 50mg cap

11

HYSINGLA 100MG ER TAB

7


7


7


7


7


7


7

I

ibandronate 150mg tab 73 IBRANCE 100MG CAP 41 IBRANCE 125MG CAP 41 IBRANCE 75MG CAP 41 ibu 600mg tab 4 ibu 800mg tab 4 ibuprofen 20mg/ml susp 4 ibuprofen 400mg tab 4 IBUPROFEN 400MG/OXYCODONE 5MG TAB

8

ibuprofen 600mg tab 4 ibuprofen 800mg tab 4 ibuprofen cap 200mg* 4 ibuprofen chew tab 100mg*

4

ibuprofen susp 20mg/ml* 4 ibuprofen susp 40mg/ml* 4 ibuprofen tab 100mg* 5 ibuprofen tab 200mg* 5 icatibant 10mg/ml syringe 79 ICLUSIG 15MG TAB 41 ICLUSIG 45MG TAB 41 IDHIFA 100MG TAB 41 IDHIFA 50MG TAB 41 ILEVRO 0.3% OPHTH SUSP

94

imatinib 100mg tab 41 imatinib 400mg tab 41


132

IMBRUVICA 140MG CAP

41

IMBRUVICA 140MG TAB 41 IMBRUVICA 280MG TAB 41 IMBRUVICA 420MG TAB 41 IMBRUVICA 560MG TAB 41 IMBRUVICA 70MG CAP 41 imipramine 10mg tab 24 imipramine 25mg tab 24 imipramine 50mg tab 24 imipramine pamoate 100mg cap

24

imipramine pamoate 125mg cap

24


24


24

imiquimod 5% cream 70 IMOVAX 2.5UNIT/ML INJ

105

incassia 28 day 0.35mg pack

63

INCRELEX 40MG/4ML INJ

73

INCRUSE 62.5MCG INH 13 indapamide 1.25mg tab 72 indapamide 2.5mg tab 72 INFANRIX INJ 102 INGREZZA 40MG CAP 98 INGREZZA 80MG CAP 98 INLYTA 1MG TAB 41 INLYTA 5MG TAB 41 INNOPRAN 120MG XL CAP

54

INNOPRAN 80MG XL CAP

54

INREBIC 100MG CAP 41 INSULIN PEN NEEDLE 84 INSULIN SYRINGE (DISP) U-100 0.3ML

84

INSULIN SYRINGE (DISP) U-100 1/2ML

84

INSULIN SYRINGE (DISP) U-100 1ML

84

INSULIN SYRINGE MIS 1ML/29G

84

INTELENCE 100MG TAB 50 INTELENCE 200MG TAB 50 INTELENCE 25MG TAB 50 intralipid 200mg/ml inj 91 INTRON A 10MU INJ 43 INTRON A 18MU INJ 43 INTRON A 25MU INJ 43 INTRON A 50MU INJ 43 INTRON A 6000000UNIT/ML INJ

43

introvale 91 day pack 61 INVEGA 117MG/0.75ML SYRINGE

46

INVEGA 156MG/ML SYRINGE

46

INVEGA 234MG/1.5ML SYRINGE

46


46


46


46


46


46


46

INVIRASE 500MG TAB 50 IOPIDINE 1% OPHTH SOLN

92

IPOL INJ 105 ipratropium bromide 0.02% inh soln

13

ipratropium bromide 0.03% nasal inhaler

90

ipratropium bromide 0.06% nasal inhaler

90

ipratropium/albuterol 0.5-2.5mg/3ml inh soln

14

irbesartan 150mg tab 32 irbesartan 300mg tab 32 irbesartan 75mg tab 32 IRESSA 250MG TAB 41 ISENTRESS 100MG CHEW TAB

50

ISENTRESS 100MG SUSP

51

ISENTRESS 25MG CHEW TAB

51

ISENTRESS 400MG TAB 51 ISENTRESS 600MG TAB 51 isibloom 28 day pack 61 ISOLYTE P INJ 87 ISOLYTE S INJ 87 isoniazid 100mg tab 38 ISONIAZID 10MG/ML ORAL SOLN

38

isoniazid 300mg tab 38 ISOPROPYL ALCOHOL 0.7ML/ML PAD

84

isosorbide dinitrate 10mg tab

10


10

ISOSORBIDE DINITRATE 30MG TAB

10


10

isosorbide mononitrate 10mg tab

11

isosorbide mononitrate 120mg er tab

11

isosorbide mononitrate 20mg tab

11


11


11

isotretinoin 10mg cap 65 isotretinoin 20mg cap 65 isotretinoin 30mg cap 65 isotretinoin 40mg cap 65


133

itraconazole 100mg cap 29 ivermectin 3mg tab 10 IXIARO SYRINGE 105

J

JADENU 180MG GRANULE PACKET

27

JADENU 180MG TAB 27 JADENU 360MG GRANULE PACKET

27

JADENU 90MG GRANULE PACKET

27

JAKAFI 10MG TAB 41 JAKAFI 15MG TAB 41 JAKAFI 20MG TAB 41 JAKAFI 25MG TAB 41 JAKAFI 5MG TAB 41 jantoven 10mg tab 15 jantoven 1mg tab 15 jantoven 2.5mg tab 15 jantoven 2mg tab 15 jantoven 3mg tab 15 jantoven 4mg tab 15 jantoven 5mg tab 15 jantoven 6mg tab 15 jantoven 7.5mg tab 15 JANUMET 100-1000MG XR TAB

25

JANUMET 50-1000MG TAB

25

JANUMET 50-1000MG XR TAB

25

JANUMET 50-500MG TAB

25

JANUMET 50-500MG XR TAB

25

JANUVIA 100MG TAB 25 JANUVIA 25MG TAB 25 JANUVIA 50MG TAB 25 JARDIANCE 10MG TAB 26 JARDIANCE 25MG TAB 26 jasmiel 28 day pack 61 jinteli tab 75 juleber 28 day pack 61 JULUCA 50-25MG TAB 51

junel 1.5/30 21 day pack 61 junel 1/20 21 day pack 61 junel fe 1.5/30 28 day pack

61

junel fe 1/20 28 day pack 61 junel fe 24 1/20 28 day pack

61

JUXTAPID 10MG CAP 31 JUXTAPID 20MG CAP 31 JUXTAPID 30MG CAP 31 JUXTAPID 40MG CAP 31 JUXTAPID 5MG CAP 31 JUXTAPID 60MG CAP 31 JYNARQUE 15MG TAB 75 JYNARQUE 30MG TAB 75 JYNARQUE 45/15 THERAPY PACK

75

JYNARQUE 60/30 THERAPY PACK

75

JYNARQUE 90/30 THERAPY PACK

75

K

kaitlib fe 28 day pack 61 KALETRA 100-25MG TAB

51

KALETRA 200-50MG TAB

51

KALYDECO 150MG TAB 99 KALYDECO 25MG GRANULES

99

KALYDECO 50MG GRANULES PACKET

99

KALYDECO 75MG GRANULES PACKET

99

kariva 28 day pack 61 KCL/D5W/LR INJ 0.15% 87 kelnor 1/35 28 day pack 61 kelnor 1/50 28 day pack 61 ketoconazole 2% cream 66 ketoconazole 2% shampoo

66

ketoconazole 200mg tab 29 ketoconazole 20mg/ml foam

66

ketodan 2% foam 66 KETOPROFEN 25MG CAP

5

ketorolac tromethamine 0.4% ophth soln

94

ketorolac tromethamine 0.5% ophth soln

94

ketorolac tromethamine 10mg tab

5

ketotifen fumarate ophth soln 0.025%*

94

KEVZARA 150MG/1.14ML PF INJ

4

KEVZARA 200MG/1.14ML PF INJ

4

KINRIX INJ 102KINRIX PF INJ 102kionex 250mg/ml susp 53KISQALI 200MG DAILY DOSE PACK

41

KISQALI 400MG DAILY DOSE PACK

41

KISQALI 600MG DAILY DOSE PACK

41

KISQALI/FEMARA TAB CO-PACK 200MG

40


40


40

klor-con 10meq er micro tab

87

klor-con 10meq er tab 87KLOR-CON 15MEQ ER TAB

87

klor-con 20meq er micro tab

87

klor-con 20meq powder 87klor-con 8meq er tab 87KORLYM 300MG TAB 25KRINTAFEL 150MG TAB 37K-TAB 20MEQ ER TAB 87K-TAB 8MEQ ER TAB 87kurvelo 28 day pack 61


134

KUVAN 100MG POWDER FOR ORAL SOLN

74

KUVAN 100MG TAB 74 KUVAN 500MG POWDER FOR ORAL SOLN

74

L

labetalol 100mg tab 54 labetalol 200mg tab 54 labetalol 300mg tab 54 LACRISERT 5MG IMPLANT

91

lactic acid lotion 5%* 70 lactulose 667mg/ml oral soln

83

LAMICTAL XR BLUE KIT

18

LAMICTAL XR GREEN KIT

18

LAMICTAL XR ORANGE KIT

18

lamivudine 100mg tab 52 lamivudine 10mg/ml oral soln

51

lamivudine 150mg tab 51 lamivudine 150mg/zidovudine 300mg tab

51

lamivudine 300mg tab 51 lamotrigine 100mg er tab 18 lamotrigine 100mg odt 18 lamotrigine 100mg tab 18 lamotrigine 150mg tab 18 lamotrigine 200mg er tab 18 lamotrigine 200mg odt 18 lamotrigine 200mg tab 18 lamotrigine 250mg er tab 18 lamotrigine 25mg (35) tab starter pack

18

lamotrigine 25mg chew tab

18

lamotrigine 25mg er tab 18 lamotrigine 25mg odt 18

lamotrigine 25mg tab 18 lamotrigine 300mg er tab 18 lamotrigine 50mg er tab 18 lamotrigine 50mg odt 18 lamotrigine 5mg chew tab 18 lamotrigine tab 25mg (42)/100mg (7) starter pack

18

lamotrigine tab 25mg (84)/100mg (14) starter pack

18

LANCETS* 84 lansoprazole 15mg dr cap 103 lansoprazole 15mg dr cap(OTC)*

103

lansoprazole 30mg dr cap 103 lanthanum carbonate 1000mg chew tab

78

lanthanum carbonate 500mg chew tab

78

lanthanum carbonate 750mg chew tab

78

larin 1.5/30 pack 61 larin 1/20 pack 61 larin fe 1.5/30 pack 61 larin fe 1/20 pack 61 larissia 28 day pack 61 latanoprost 0.005% ophth soln

94

LATUDA 120MG TAB 45 LATUDA 20MG TAB 45 LATUDA 40MG TAB 45 LATUDA 60MG TAB 45 LATUDA 80MG TAB 45 layolis fe 28 pack 61 leena 28 day pack 61 leflunomide 10mg tab 5 leflunomide 20mg tab 5 LENVIMA (10) 10MG PACK

41

LENVIMA (12) 4MG PACK

41

LENVIMA (14) PACK 41 LENVIMA (18) PACK 41


41

LENVIMA (24) PACK 41 LENVIMA (4) 4MG PACK

42


42

lessina 28 day pack 61 LETAIRIS 10MG TAB 57 LETAIRIS 5MG TAB 57 letrozole 2.5mg tab 39 LEUCOVORIN 10MG TAB

43

LEUCOVORIN 15MG TAB

43

leucovorin 25mg tab 43 leucovorin 5mg tab 43 LEUKERAN 2MG TAB 38 LEUKINE 250MCG INJ 81 leuprolide acetate 5mg/ml inj

39

levalbuterol 0.31mg inh soln

14


14


14


14

levetiracetam 1000mg tab 18 levetiracetam 100mg/ml oral soln

18

levetiracetam 250mg tab 18 levetiracetam 500mg er tab

18

levetiracetam 500mg tab 18 levetiracetam 750mg er tab

18

levetiracetam 750mg tab 18 levobunolol 0.5% ophth soln

92

levocarnitine 100mg/ml oral soln

74

levocarnitine 330mg tab 74


135

levocetirizine 0.5mg/ml oral soln

29

levocetirizine 5mg tab 29 levofloxacin 0.5% ophth soln

92

levofloxacin 250mg tab 76 levofloxacin 25mg/ml inj 76 levofloxacin 25mg/ml oral soln

76

levofloxacin 500mg tab 76 levofloxacin 5mg/ml (150ml) inj

76

levofloxacin 5mg/ml inj 76 levofloxacin 750mg tab 76 levonest 28 day pack 61 levonorgestrel 1.5mg tab (OTC)*

63

levora 0.15/30 28 day pack

61

levo-t 100mcg tab 101 levo-t 112mcg tab 101 levo-t 125mcg tab 101 levo-t 137mcg tab 101 levo-t 150mcg tab 101 levo-t 175mcg tab 101 levo-t 200mcg tab 101 levo-t 25mcg tab 101 levo-t 300mcg tab 101 levo-t 50mcg tab 101 levo-t 75mcg tab 101 levo-t 88mcg tab 101 levothyroxine sodium 100mcg tab

101

levothyroxine sodium 112mcg tab

101


101


101


101


101


101


101


101


101


101


101

levoxyl 100mcg tab 101 levoxyl 112mcg tab 101 levoxyl 125mcg tab 101 levoxyl 137mcg tab 101 levoxyl 150mcg tab 101 levoxyl 175mcg tab 101 levoxyl 200mcg tab 102 levoxyl 25mcg tab 102 levoxyl 50mcg tab 102 levoxyl 75mcg tab 102 levoxyl 88mcg tab 102 LEXIVA 50MG/ML SUSP 51 lidocaine 2% gel 70 lidocaine 2% topical soln 89 lidocaine 4% topical soln 70 lidocaine 5% ointment 70 lidocaine 5% patch 70 lidocaine/prilocaine 2.5-2.5% cream

70

lindane 1% shampoo 70 linezolid 20mg/ml susp 37 linezolid 2mg/ml inj 37 linezolid 600mg tab 37 LINZESS 145MCG CAP 77 LINZESS 290MCG CAP 77 LINZESS 72MCG CAP 77 liothyronine sodium 0.005mg tab

102

liothyronine sodium 0.025mg tab

102

liothyronine sodium 0.05mg tab

102

lisinopril 10mg tab 32 lisinopril 2.5mg tab 32 lisinopril 20mg tab 32

lisinopril 30mg tab 32 lisinopril 40mg tab 32 lisinopril 5mg tab 32 lithium carbonate 150mg cap

45

lithium carbonate 300mg cap

45

lithium carbonate 300mg er tab

45

lithium carbonate 300mg tab

45

lithium carbonate 450mg er tab

45

lithium carbonate 600mg cap

45

lithium citrate 60mg/ml oral soln

45

LITHOSTAT 250MG TAB 78 LOHIST-D LIQUID 2-30MG/5ML*

64

LOKELMA 10GM PACKET

89

LOKELMA 5GM PACKET

89

LONSURF 15-6.14MG TAB

40

LONSURF 20-8.19MG TAB

40

loperamide 2mg cap 27 loperamide liquid 1mg/7.5ml*

27

loperamide tab 2mg* 27 lopinavir 80mg/ml/ritonavir 20mg/ml oral solution

51

lopreeza 1/0.5mg 28 day pack

75

loratadine rapidly-disintegrating tab 10mg*

29

loratadine syrup 5mg/5ml*

30

loratadine tab 10mg* 30 lorazepam 0.5mg tab 12 lorazepam 1mg tab 12


136

lorazepam 2mg tab 12 lorazepam 2mg/ml conc 12 LORBRENA 100MG TAB 42 LORBRENA 25MG TAB 42 lorcet 10-325mg tab 8 lorcet 5-325mg tab 8 lorcet 7.5-325mg tab 8 loryna 28 day pack 61 losartan potassium 100mg tab

32

losartan potassium 25mg tab

32

losartan potassium 50mg tab

32

LOTEMAX 0.5% OPHTH GEL

93

LOTEMAX 0.5% OPHTH OINTMENT

93

loteprednol etabonate 0.5% ophth susp

93

lovastatin 10mg tab 31 lovastatin 20mg tab 31 lovastatin 40mg tab 31 low-ogestrel 28 day pack 61 loxapine 10mg cap 47 loxapine 25mg cap 47 loxapine 50mg cap 47 loxapine 5mg cap 47 LUMIGAN 0.01% OPHTH SOLN

94

LUPANETA PACK 1-MONTH PACK

74

LUPANETA PACK 3-MONTH PACK

74

LUPRON 11.25MG (1.5ML) SYRINGE

39

LUPRON 22.5MG SYRINGE

39


39

LUPRON 30MG SYRINGE

39

LUPRON 45MG SYRINGE

39


39

lutera 28 day pack 61 LYNPARZA 100MG TAB 42 LYNPARZA 150MG TAB 42 LYSODREN 500MG TAB 39 lyza 0.35mg pack 63

M

magnesium citrate soln* 83 magnesium hydroxide susp 400mg/5ml*

83

magnesium oxide tab 200mg*

87


10


10


10


10


87

magnesium sulfate 50% inj

87

magnesium sulfate 50% syringe

87

magnesium tab 100mg* 87 MAGNESIUM TAB 200MG*

87

magnesium tab 200mg* 87 magnesium tab 250mg* 87 malathion 0.5% lotion 70 MAPROTILINE 25MG TAB

21

MAPROTILINE 50MG TAB

21

MAPROTILINE 75MG TAB

21

marlissa 28 day pack 61 MARPLAN 10MG TAB 21 MATULANE 50MG CAP 43 matzim 180mg er tab 56 matzim 240mg er tab 56

matzim 300mg er tab 56 matzim 360mg er tab 56 matzim 420mg er tab 56 MAVYRET 100-40MG TAB

52

MAYZENT 0.25MG TAB 98 MAYZENT 2MG TAB 98 meclizine 12.5mg tab 28 meclizine 12.5mg tab(OTC)*

28

meclizine 25mg tab 28 meclizine 25mg tab(OTC) *

28

meclizine chew tab 25mg(OTC)*

28

MEDROL 2MG TAB 63 medroxyprogesterone acetate 10mg tab

97

medroxyprogesterone acetate 150mg/ml inj

63

medroxyprogesterone acetate 150mg/ml syringe

63

medroxyprogesterone acetate 2.5mg tab

97

medroxyprogesterone acetate 5mg tab

97

MEFLOQUINE 250MG TAB

37

megestrol acetate 125mg/ml susp

97

megestrol acetate 20mg tab

39

megestrol acetate 40mg tab

39

megestrol acetate 40mg/ml susp

39

MEKINIST 0.5MG TAB 42 MEKINIST 2MG TAB 42 MEKTOVI 15MG TAB 42 meloxicam 15mg tab 5 meloxicam 7.5mg tab 5 memantine 10mg tab 97 memantine 10mg/memantine 5mg pack

97


137

memantine 14mg er cap 97 memantine 21mg er cap 97 memantine 28mg er cap 97 memantine 2mg/ml oral soln

97

memantine 5mg tab 97 memantine 7mg er cap 97 MENACTRA INJ 104 MENVEO INJ 104 mercaptopurine 50mg tab 38 meropenem 1gm inj 36 meropenem 500mg inj 36 mesalamine 1000mg rectal supp

77

mesalamine 375mg er cap 77 mesalamine 66.7mg/ml enema

77

MESNEX 400MG TAB 44 metadate 20mg er tab 2 METAMUCIL WAFER* 82 METAPROTERENOL SULFATE 2MG/ML ORAL SOLN

15

METAXALONE 400MG TAB

90

metaxalone 800mg tab 90 metformin 1000mg tab 25 metformin 500mg er tab 25 metformin 500mg tab 25 metformin 750mg er tab 25 metformin 850mg tab 25 methadone 10mg tab 7 methadone 5mg tab 7 methazolamide 25mg tab 71 methazolamide 50mg tab 71 methenamine hippurate 1000mg tab

103

methimazole 10mg tab 100 methimazole 5mg tab 100 methocarbamol 500mg tab

90

methocarbamol 750mg tab

90

methotrexate 2.5mg tab 38

methotrexate 250mg/10ml inj

38

methotrexate 50mg/2ml inj

38

methoxsalen 10mg cap 67 methylphenidate 10mg cr cap

2

methylphenidate 10mg er tab

2

methylphenidate 10mg la cap

2

methylphenidate 10mg tab

2

methylphenidate 18mg sr tab

2

methylphenidate 1mg/ml oral soln

2

methylphenidate 20mg cr cap

2

methylphenidate 20mg er tab

2


2

methylphenidate 20mg tab

2


2

methylphenidate 2mg/ml oral soln

2


2


2


2


2


2


2


2

methylphenidate 5mg tab 2


3

methylprednisolone 16mg tab

63


63

methylprednisolone 4mg pack

63


63


63

metoclopramide 10mg tab 77 metoclopramide 1mg/ml oral soln

77

metoclopramide 5mg tab 77 metolazone 10mg tab 72 metolazone 2.5mg tab 72 metolazone 5mg tab 72 metoprolol succinate 100mg er tab

54

metoprolol succinate 200mg er tab

54


54


54

metoprolol tartrate 100mg tab

54


54


54

metronidazole 0.75% cream

70

metronidazole 0.75% gel 70 metronidazole 0.75% lotion

70

metronidazole 0.75% vaginal gel

105

metronidazole 1% gel 70 metronidazole 250mg tab 35 metronidazole 375mg cap 35 metronidazole 500mg tab 35 metronidazole 5mg/ml inj 35


138

MEXILETINE 150MG CAP

12


12


12

miconazole nitrate cream 2%*

66

miconazole nitrate powder 2%*

66

miconazole nitrate vaginal cream 2%*

105

miconazole nitrate vaginal cream 4%*

105

miconazole nitrate vaginal kit*

105

miconazole nitrate vaginal supp 100mg*

105

miconazole nitrate vaginal supp 1200mg/2% cream kit*

105

miconazole nitrate vaginal supp 200mg/2% cream 9gm kit*

105

microgestin 1.5/30 21 day pack

62

microgestin 1/20 21 day pack

62

microgestin fe 1.5/30 28 day pack

62

microgestin fe 1/20 28 day pack

62

midodrine 10mg tab 106 midodrine 2.5mg tab 106 midodrine 5mg tab 106 miglitol 100mg tab 24 miglitol 25mg tab 24 miglitol 50mg tab 24 miglustat 100mg cap 79 mili 28 day pack 62 mimvey pack 75 MINERAL OIL (BULK)* 83 mineral oil enema* 83 mineral oil* 83 minitran 0.1mg/hr patch 11

minitran 0.2mg/hr patch 11 minitran 0.4mg/hr patch 11 minitran 0.6mg/hr patch 11 minocycline 100mg cap 100 minocycline 100mg tab 100 minocycline 50mg cap 100 minocycline 50mg tab 100 minocycline 75mg cap 100 minocycline 75mg tab 100 minoxidil 10mg tab 35 minoxidil 2.5mg tab 35 mirtazapine 15mg odt 20 mirtazapine 15mg tab 21 mirtazapine 30mg odt 21 mirtazapine 30mg tab 21 mirtazapine 45mg odt 21 mirtazapine 45mg tab 21 mirtazapine 7.5mg tab 21 misoprostol 0.1mg tab 103 misoprostol 0.2mg tab 103 MITIGARE 0.6MG CAP 79 M-M-R II INJ 105 modafinil 100mg tab 3 modafinil 200mg tab 3 MOLINDONE 10MG TAB 48 MOLINDONE 25MG TAB 48 MOLINDONE 5MG TAB 48 mometasone furoate 0.1% cream

69

mometasone furoate 0.1% lotion

69

mometasone furoate 0.1% ointment

69

mondoxyne 100mg cap 100 montelukast 10mg tab 13 montelukast 4mg chew tab

13

montelukast 4mg granules

13

montelukast 5mg chew tab

13

morphine sulfate 100mg er tab

7


7

morphine sulfate 15mg tab

7


7

morphine sulfate 20mg/ml oral soln

7


7


7

morphine sulfate 30mg tab

7


7


7

MOVANTIK 12.5MG TAB 77 MOVANTIK 25MG TAB 77 moxifloxacin 0.5% ophth soln

92

moxifloxacin 1.6mg/ml inj 76 moxifloxacin 400mg tab 76 MULPLETA 3MG TAB 81 MULTAQ 400MG TAB 13 multiple vitamin tab* 89 multiple vitamins w/minerals tab*

89

mupirocin 2% ointment 66 MYCAMINE 100MG INJ 28 MYCAMINE 50MG INJ 28 mycophenolate mofetil 200mg/ml susp

53

mycophenolate mofetil 250mg cap

53

mycophenolate mofetil 500mg tab

53

mycophenolic acid 180mg dr tab

53

mycophenolic acid 360mg dr tab

53

myorisan 10mg cap 65 myorisan 20mg cap 66 myorisan 30mg cap 66 myorisan 40mg cap 66


139

MYRBETRIQ 25MG ER TAB

104

MYRBETRIQ 50MG ER TAB

104

N

nabumetone 500mg tab 5 nabumetone 750mg tab 5 nadolol 20mg tab 54 nadolol 40mg tab 54 nadolol 80mg tab 54 nafcillin 100mg/ml inj 96 nafcillin 1gm inj 96 nafcillin 2gm inj 96 naftifine 2% cream 66 NALOXONE 0.4MG/ML CARTRIDGE

27

naloxone 0.4mg/ml inj 27 NALOXONE 1MG/ML SYRINGE

28

naltrexone 50mg tab 28 naphazoline w/pheniramine ophth soln 0.025-0.3%*

93

naphazoline w/pheniramine ophth soln 0.027-0.315%*

93

naproxen 250mg tab 5 naproxen 375mg dr tab 5 naproxen 375mg tab 5 naproxen 500mg dr tab 5 naproxen 500mg tab 5 naproxen sodium 275mg tab

5

naproxen sodium 550mg tab

5

naproxen sodium tab 220mg*

5

naratriptan 1mg tab 85 naratriptan 2.5mg tab 85 NARCAN 4MG/0.1ML NASAL SPRAY

28

NATACYN 5% OPHTH SUSP

92

nateglinide 120mg tab 26

nateglinide 60mg tab 26 NATPARA 100MCG CARTRIDGE

73

NATPARA 25MCG CARTRIDGE

73


73


73

NAYZILAM 5MG/0.1ML NASAL SPRAY

17

necon 0.5/35 28 day pack 62 NEFAZODONE 100MG TAB

22

NEFAZODONE 150MG TAB

22


22


22

NEFAZODONE 50MG TAB

22

neomycin sulfate 500mg tab

3

neomycin/bacitracin/poly myxin ophth ointment 5(3.5)mg-400unit-10000u nit

93

neomycin/polymyxin/bacit racin/hydrocortisone ophth ointmentment 1%

93

NEPHRAMINE 5.4% INJ 91 NERLYNX 40MG TAB 42 NEUPRO 1MG/24HR PATCH

44

NEUPRO 2MG/24HR PATCH

44


44


44


44


44

NEVANAC 0.1% OPHTH SUSP

94

nevirapine 100mg er tab 51 nevirapine 10mg/ml oral susp

51

nevirapine 200mg tab 51 nevirapine 400mg er tab 51 NEXAVAR 200MG TAB 42 niacin 1000mg er tab 31 niacin 500mg er tab 31 niacin 750mg er tab 31 niacin CR cap 250mg* 107 NIACIN CR TAB 1000MG*

107

niacin CR tab 250mg* 107 niacin CR tab 500mg* 107 niacin CR tab 750mg* 107 niacin ER cap 500mg* 107 niacin tab 100mg* 107 niacin tab 250mg* 107 niacin tab 500mg* 107 niacin tab 50mg* 107 nicardipine 20mg cap 56 nicardipine 30mg cap 56 nicotine patch 14mg/24hr*

99

nicotine patch 21mg/24hr*

99

nicotine patch 7mg/24hr* 99 NICOTINE PATCH KIT* 99 nicotine polacrilex gum 2mg*

99

nicotine polacrilex gum 4mg*

99

nicotine polacrilex lozenge 2mg*

99

nicotine polacrilex lozenge 4mg*

99

NICOTROL 10MG INHALER

99

NICOTROL 10MG/ML NASAL INHALER

99

nifedipine 30mg er tab 56 nifedipine 30mg osmotic er tab

56


140


56


56

nikki 28 day pack 62 nilutamide 150mg tab 39 nimodipine 30mg cap 56 NINLARO 2.3MG CAP 42 NINLARO 3MG CAP 42 NINLARO 4MG CAP 42 NISOLDIPINE 25.5MG ER TAB

56

NITRO-BID 2% OINTMENT

11

NITRO-DUR 0.3MG/HR PATCH

11

NITRO-DUR 0.8MG/HR PATCH

11

nitrofurantoin 5mg/ml susp

103

nitrofurantoin macro 100mg cap

103


103

nitrofurantoin macro 25mg/nitrofurantoin mono 75mg cap

104


104

nitroglycerin 0.1mg/hr patch

11


11

nitroglycerin 0.3mg sl tab 11 nitroglycerin 0.4mg sl tab 11 nitroglycerin 0.4mg/act spray

11


11

nitroglycerin 0.6mg sl tab 11 nitroglycerin 0.6mg/hr patch

11

NIVESTYM 300MCG/0.5ML PF INJ

81

NIVESTYM 300MCG/1ML INJ

81

NIVESTYM 480MCG/0.8ML PF INJ

81

NIVESTYM 480MCG/1.6ML INJ

81

NONOXYNOL-9 FOAM 12.5%*

105

NONOXYNOL-9 GEL 3% *

105

nonoxynol-9 gel 4%* 105 nora-be 28 day 0.35mg pack

63

norethindrone 0.35mg pack

63

norethindrone acetate 5mg tab

97

NORMOSOL-M INJ 87 NORMOSOL-R IN 5% DEXTROSE INJ

87

NORMOSOL-R INJ 87 NORPACE 100MG ER CAP

12

NORPACE 150MG ER CAP

12

NORTHERA 100MG CAP 106 NORTHERA 200MG CAP 106 NORTHERA 300MG CAP 106 nortrel 0.5/35 28 day pack

62

nortrel 1/35 21 day pack 62 nortrel 1/35 28 day pack 62 nortrel 7/7/7 28 day pack 62 nortriptyline 10mg cap 24 nortriptyline 25mg cap 24 NORTRIPTYLINE 2MG/ML ORAL SOLN

24

nortriptyline 50mg cap 24 nortriptyline 75mg cap 24 NORVIR 100MG POWDER PACKET

51

NORVIR 80MG/ML ORAL SOLN

51

NOVOLIN 100UNIT/ML INJ

26

NOVOLIN N 100UNIT/ML INJ

26

NOVOLIN R 100UNIT/ML INJ

26

NOVOLOG 100UNIT/ML FLEXPEN

26

NOVOLOG 100UNIT/ML INJ

26

NOVOLOG 100UNIT/ML PENFILL

26

NOVOLOG MIX 100UNIT/ML FLEXPEN

26

NOVOLOG MIX 100UNIT/ML INJ

26

NOXAFIL 40MG/ML SUSP

29

NUBEQA 300MG TAB 39 NUCALA 100MG INJ 13 NUCALA 100MG/ML AUTO-INJECTOR

13

NUCALA 100MG/ML SYRINGE

13

NUCYNTA 100MG ER TAB

7


7


7


7

NUCYNTA 50MG ER TAB

7

NUEDEXTA 20-10MG CAP

99

NUPLAZID 10MG TAB 46 NUPLAZID 34MG CAP 46 nutrilipid 20% iv soln 91 NUTRITIONAL SUPPLEMENT LIQUID*

71

nyamyc 100000unit/gm powder

66

nystatin 100000unit/ml cream

66


141

nystatin 100000unit/ml susp

89

nystatin 100unit/mg ointment

67

nystatin 100unit/mg powder

67

nystatin 500000unit tab 29 nystop 100000unit/gm powder

67

O

OCALIVA 10MG TAB 77 OCALIVA 5MG TAB 77 ocella 28 day pack 62 OCTAGAM 25GM/500ML INJ

95

OCTAGAM 2GM/20ML INJ

95

octreotide 0.05mg/ml inj 74 octreotide 0.1mg/ml inj 74 octreotide 0.2mg/ml inj 75 octreotide 0.5mg/ml inj 75 octreotide 1mg/ml inj 75 ODEFSEY 200-25-25MG TAB

51

ODOMZO 200MG CAP 38 OFEV 100MG CAP 100 OFEV 150MG CAP 100 ofloxacin 0.3% ophth soln 93 ofloxacin 0.3% otic soln 94 olanzapine 10mg inj 47 olanzapine 10mg odt 47 olanzapine 10mg tab 47 olanzapine 15mg odt 47 olanzapine 15mg tab 47 olanzapine 2.5mg tab 47 olanzapine 20mg odt 47 olanzapine 20mg tab 47 olanzapine 5mg odt 48 olanzapine 5mg tab 48 olanzapine 7.5mg tab 48 olmesartan medoxomil 20mg tab

32

olmesartan medoxomil 40mg tab

32

olmesartan medoxomil 5mg tab

32

olopatadine 0.6% nasal inhaler

90

olopatadine 1mg/ml ophth soln

94

olopatadine 2% ophth soln

94

OLUMIANT 1MG TAB 3 OLUMIANT 2MG TAB 3 omega-3 acid ethyl esters (usp) 1000mg cap

30

omega-3 fatty acids cap 1000mg*

91

omega-3 fatty acids cap 1200mg*

91

omeprazole 10mg dr cap 103 omeprazole 20mg dr cap 103 omeprazole 40mg dr cap 103 ondansetron 0.8mg/ml oral soln

28

ondansetron 24mg tab 28 ondansetron 4mg odt 28 ondansetron 4mg tab 28 ondansetron 8mg odt 28 ondansetron 8mg tab 28 OPSUMIT 10MG TAB 57 oral electrolyte solution* 87 ORENCIA 125MG/ML AUTO-INJECTOR

5

ORENCIA 125MG/ML SYRINGE

5

ORENCIA 50MG/0.4ML SYRINGE

5

ORENCIA 87.5MG/0.7ML SYRINGE

5

ORENITRAM 0.125MG ER TAB

57


57

ORENITRAM 1MG ER TAB

57


57

ORENITRAM 5MG ER TAB

57

ORFADIN 10MG CAP 74 ORFADIN 20MG CAP 74 ORFADIN 2MG CAP 74 ORFADIN 4MG/ML SUSP

74

ORFADIN 5MG CAP 74 ORILISSA 150MG TAB 73 ORILISSA 200MG TAB 73 ORKAMBI 100-125MG GRANULES PACKET

99

ORKAMBI 100-125MG TAB

100

ORKAMBI 188-150MG GRANULES PACKET

100

ORKAMBI 200-125MG TAB

100

orphenadrine citrate 100mg er tab

90

orsythia 28 day pack 62 oseltamivir 30mg cap 53 oseltamivir 45mg cap 53 oseltamivir 6mg/ml oral susp

53

oseltamivir 75mg cap 53 OSPHENA 60MG TAB 73 OTEZLA 28-DAY STARTER PACK

5

OTEZLA 30MG TAB 5 oxacillin 100mg/ml inj 96 oxacillin 1gm inj 96 oxacillin 2000mg inj 96 OXACILLIN 20MG/ML INJ

96

OXACILLIN 40MG/ML INJ

96

oxandrolone 10mg tab 9 oxandrolone 2.5mg tab 9 oxaprozin 600mg tab 5 OXAZEPAM 10MG CAP 12 oxazepam 15mg cap 12 OXAZEPAM 30MG CAP 12 oxcarbazepine 150mg tab 18 oxcarbazepine 300mg tab 18


142

oxcarbazepine 600mg tab 18 oxcarbazepine 60mg/ml susp

18

OXTELLAR 150MG XR TAB

18


19


19

oxybutynin chloride 10mg er tab

104


104

oxybutynin chloride 1mg/ml oral soln

104


104

oxybutynin chloride 5mg tab

104

oxycodone 10mg tab 7 oxycodone 15mg tab 7 oxycodone 1mg/ml oral soln

7

oxycodone 20mg tab 7 oxycodone 20mg/ml oral soln

7

oxycodone 30mg tab 7 oxycodone 5mg cap 7 oxycodone 5mg tab 7 oxymorphone 10mg tab 7 oxymorphone 5mg tab 7 oyster shell calcium tab 500mg*

86

OZEMPIC 2MG/1.5ML PEN INJ

26

OZEMPIC 2MG/1.5ML PEN INJ (1MG DOSE)

26

P

pacerone 200mg tab 13 pacerone 400mg tab 13 paliperidone 1.5mg er tab 46 paliperidone 3mg er tab 46 paliperidone 6mg er tab 46 paliperidone 9mg er tab 46

PALYNZIQ 10MG/0.5ML SYRINGE

74

PALYNZIQ 2.5MG/0.5ML SYRINGE

74

PALYNZIQ 20MG/ML SYRINGE

74

PANRETIN 0.1% GEL 67 pantoprazole 20mg dr tab 103 pantoprazole 40mg dr tab 103 PANZYGA 10GM/100ML IV SOLN

95

PANZYGA 1GM/10ML IV SOLN

95

PANZYGA 2.5GM/25ML IV SOLN

95


95


95


95

paricalcitol 0.001mg cap 74 paricalcitol 0.002mg cap 74 paricalcitol 0.004mg cap 74 paromomycin 250mg cap 3 paroxetine 10mg tab 22 paroxetine 12.5mg er tab 22 paroxetine 20mg tab 22 paroxetine 25mg er tab 22 paroxetine 30mg tab 22 paroxetine 37.5mg er tab 22 paroxetine 40mg tab 22 PASER D/R 4GM GRANULES

38

PAXIL 10MG/5ML SUSP 22 PEAK FLOW METER* 84 PEDIARIX INJ 102 PEDVAXHIB 7.5MCG/0.5ML INJ

104

peg 3350/electrolyte oral soln

83

peg 3350/kcl/sodium bicarbonate/sodium chloride powder for oral soln

83

PEGANONE 250MG TAB 20 PEGASYS 180MCG/0.5ML AUTO-INJECTOR

52

PEGASYS 180MCG/0.5ML SYRINGE

52

PEGASYS 180MCG/ML INJ

52

penicillamine 250mg tab 88 penicillin g potassium 1000000unit/ml inj

95

PENICILLIN G POTASSIUM 40000UNIT/ML INJ

96

PENICILLIN G POTASSIUM 60000UNIT/ML INJ

96

PENICILLIN G PROCAINE 600000UNIT/ML SYRINGE

96

PENICILLIN G SODIUM 100000UNIT/ML INJ

96

penicillin v potassium 250mg tab

96

PENICILLIN V POTASSIUM 25MG/ML ORAL SOLN

96

penicillin v potassium 500mg tab

96

PENICILLIN V POTASSIUM 50MG/ML ORAL SOLN

96

PENTAM 300MG INJ 35 pentamidine isethionate 300mg inj

35

pentamidine isethionate 50mg/ml inh soln

35

pentoxifylline 400mg er tab

79

permethrin 5% cream 70 permethrin creme rinse 1%*

70

permethrin lotion 1%* 71


143

perphenazine 16mg tab 48 perphenazine 2mg tab 48 perphenazine 4mg tab 49 perphenazine 8mg tab 49 PERSERIS 120MG SYRINGE

46

PERSERIS 90MG SYRINGE

46

PEXEVA 10MG TAB 22 PEXEVA 20MG TAB 22 PEXEVA 30MG TAB 22 PEXEVA 40MG TAB 22 phenadoz 12.5mg rectal supp

30

phenazopyridine tab 95mg*

78

phenazopyridine tab 97.5mg*

78

phenelzine 15mg tab 21 phenobarbital 100mg tab 82 phenobarbital 15mg tab 82 phenobarbital 16.2mg tab 82 phenobarbital 30mg tab 82 phenobarbital 32.4mg tab 82 phenobarbital 4mg/ml oral soln

82

phenobarbital 60mg tab 82 phenobarbital 64.8mg tab 82 phenobarbital 97.2mg tab 82 phenoxybenzamine 10mg cap

32

phentermine cap 15mg* 1 phentermine cap 30mg* 1 phentermine cap 37.5mg* 1 phentermine tab 37.5mg* 1 PHENYLEPHRINE 1MG/ML/PROMETHAZI NE 1.25MG/ML ORAL SOLN

64

phenytoin 25mg/ml susp 20 phenytoin 50mg chew tab 20 phenytoin sodium 100mg er cap

20

phenytoin sodium 200mg er cap

20

phenytoin sodium 300mg er cap

20

PHOSLYRA 667MG/5ML ORAL SOLN

78

PHOSPHOLINE IODIDE 0.125% OPHTH SOLN

92

phytonadione tab 100mcg*

106

phytonadione tab 5 mg* 106 PICATO 0.015% GEL 67 PICATO 0.05% GEL 67 PIFELTRO 100MG TAB 51 pilocarpine 1% ophth soln

92

pilocarpine 2% ophth soln

92

pilocarpine 4% ophth soln

92

pilocarpine 5mg tab 89 pilocarpine 7.5mg tab 89 pimecrolimus 1% cream 70 PIMOZIDE 1MG TAB 99 PIMOZIDE 2MG TAB 99 pimtrea pack 62 pindolol 10mg tab 54 pindolol 5mg tab 54 pioglitazone 15mg tab 26 pioglitazone 30mg tab 26 pioglitazone 45mg tab 26 piperacillin 2000mg/tazobactam 250mg inj

96

piperacillin 200mg/ml/tazobactam 25mg/ml inj

96

piperacillin 3000mg/tazobactam 375mg inj

96

piperacillin 4000mg/tazobactam 500mg inj

96

PIQRAY 200MG DAILY DOSE PACK

42

PIQRAY 250MG DAILY DOSE PACK

42

PIQRAY 300MG DAILY DOSE 150MG PACK

42

pirmella 1/35 28 day pack 62 piroxicam 10mg cap 5 piroxicam 20mg cap 5 PLASMA-LYTE 148 INJ 87 PLASMALYTE A INJ 87 PLEGRIDY 125MCG/0.5ML AUTO-INJECTOR

98

PLEGRIDY 125MCG/0.5ML SYRINGE

99

PLEGRIDY PEN STARTER PACK

99

PLEGRIDY STARTER PACK

99

plenamine 15% inj 91 podofilox 0.5% topical soln

70

polyethylene glycol 3350 oral powder (OTC)*

83

polyethylene glycol 3350 powder packet (OTC)*

83

polymyxin b 10000unit/ml/trimethopri m 1mg/ml ophth soln

93

polymyxin b 250000unit/ml inj

37

POMALYST 1MG CAP 39 POMALYST 2MG CAP 39 POMALYST 3MG CAP 39 POMALYST 4MG CAP 39 portia 28 day pack 62 posaconazole 100mg dr tab

29


87


87


87


144

potassium chloride 0.1 meq/ml inj

87

potassium chloride 0.2meq/ml inj

87

potassium chloride 0.4meq/ml inj

87

potassium chloride 10% oral soln

88

potassium chloride 10meq er cap

88

potassium chloride 10meq er micro tab

88

potassium chloride 10meq er tab

88

potassium chloride 20% oral soln

88

potassium chloride 20meq er micro tab

88

POTASSIUM CHLORIDE 20MEQ ER TAB

88

potassium chloride 20meq powder for oral soln

88

potassium chloride 2meq/ml inj

88

potassium chloride 40meq/20ml inj

88

potassium chloride 8 meq er cap

88

potassium chloride 8 meq er tab

88

potassium citrate 10meq er tab

78

potassium citrate 15 meq er tab

78

potassium citrate 5 meq er tab

78

povidone/iodine topical soln 7.5%*

50

povidone-iodine soln 10%*

50

PRADAXA 110MG CAP 16 PRADAXA 150MG CAP 16 PRADAXA 75MG CAP 16

PRALUENT 150MG/ML AUTO-INJECTOR

31

PRALUENT 75MG/ML AUTO-INJECTOR

31

pramipexole 0.125mg tab 44 pramipexole 0.25mg tab 44 pramipexole 0.5mg tab 44 pramipexole 0.75mg tab 44 pramipexole 1.5mg tab 44 pramipexole 1mg tab 44 prasugrel 10mg tab 79 prasugrel 5mg tab 79 pravastatin sodium 10mg tab

31

pravastatin sodium 20mg tab

31


31


31

prazosin 1mg cap 33 prazosin 2mg cap 33 prazosin 5mg cap 33 PRED MILD 0.12% OPHTH SUSP

93

PRED-G 0.3-1% OPHTH SUSP

93

PREDNICARBATE 0.1% CREAM

69

PREDNICARBATE 0.1% OINTMENT

69

PREDNISOLONE 1% OPHTH SOLN

93

prednisolone 1mg/ml oral soln

63

PREDNISOLONE 3MG/ML ORAL SOLN

64

PREDNISOLONE ACETATE 1% OPHTH SUSP

93

PREDNISOLONE SODIUM PHOSPHATE 2.5MG/ML/SULFACETA MIDE SODIUM 100MG/ML OPHTH SOLN

93

PREDNISONE 10MG (21) TAB PACK

64


64

prednisone 10mg tab 64 prednisone 1mg tab 64 PREDNISONE 1MG/ML ORAL SOLN

64

prednisone 2.5mg tab 64 prednisone 20mg tab 64 PREDNISONE 50MG TAB

64


64


64

prednisone 5mg tab 64 PREDNISONE 5MG/ML ORAL SOLN

64

pregabalin 100mg cap 19 pregabalin 150mg cap 19 pregabalin 200mg cap 19 pregabalin 20mg/ml oral soln

19

pregabalin 225mg cap 19 pregabalin 25mg cap 19 pregabalin 300mg cap 19 pregabalin 50mg cap 19 pregabalin 75mg cap 19 PREMARIN 0.3MG TAB 76 PREMARIN 0.45MG TAB 76 PREMARIN 0.625MG TAB

76

PREMARIN 0.625MG/GM VAGINAL CREAM

106

PREMARIN 0.9MG TAB 76 PREMARIN 1.25MG TAB 76 PREMASOL 10% INJ 91


145

PREMPHASE 28 DAY PACK

75

PREMPRO 0.3/1.5MG 28 DAY PACK

75

PREMPRO 0.45/1.5 28 DAY PACK

75

PREMPRO 0.625/2.5MG 28 DAY PACK

75

PREMPRO 0.625/5MG 28 DAY PACK

75

PRENATAL VITAMIN (OTC)*

89

prevalite 4gm/dose susp 30 previfem 28 day pack 62 PREVYMIS 240MG TAB 52 PREVYMIS 480MG TAB 52 PREZCOBIX 800-150MG TAB

51

PREZISTA 100MG/ML SUSP

51

PREZISTA 150MG TAB 51 PREZISTA 600MG TAB 51 PREZISTA 75MG TAB 51 PREZISTA 800MG TAB 51 PRIFTIN 150MG TAB 38 PRIMAQUINE PHOSPHATE 26.3MG TAB

37

primidone 250mg tab 19 primidone 50mg tab 19 PRIVIGEN 20GM/200ML INJ

95

probenecid 500mg tab 79 PROCALAMINE 3% INJ 91 prochlorperazine 10mg tab

49

prochlorperazine 25mg rectal supp

49

prochlorperazine 5mg tab 49 procto-med 2.5% cream 9 procto-pak 1% rectal cream

9

proctosol 2.5% cream 9 proctozone hc 2.5% cream

10

progesterone 100mg cap 97 progesterone 200mg cap 97 PROGLYCEM 50MG/ML SUSP

25

PROGRAF 0.2MG GRANULES PACKET

89

PROGRAF 1MG GRANULES PACKET

89

PROLASTIN 1000MG INJ 99 PROLIA 60MG/ML SYRINGE

73

PROMACTA 12.5MG POWDER FOR ORAL SUSP

81

PROMACTA 12.5MG TAB

81

PROMACTA 25MG TAB 81 PROMACTA 50MG TAB 81 PROMACTA 75MG TAB 81 promethazine 1.25mg/ml oral soln

30

promethazine 12.5mg rectal supp

30

promethazine 12.5mg tab 30 promethazine 25mg rectal supp

30

promethazine 25mg tab 30 promethazine 50mg tab 30 promethazine DM syrup 6.25-15mg/5ml*

65

promethazine w/codeine syrup 6.25-10mg/5ml*

65

promethegan 25mg rectal supp

30

promethegan 50mg rectal supp

30

propafenone 150mg tab 12 propafenone 225mg er cap

12

propafenone 225mg tab 12 propafenone 300mg tab 12 propafenone 325mg er cap

12

propafenone 425mg sr cap

12

proparacaine 0.5% ophth soln

93

propranolol 10mg tab 54 propranolol 120mg er cap

54

propranolol 160mg er cap

55

propranolol 20mg tab 55 propranolol 40mg tab 55 PROPRANOLOL 4MG/ML ORAL SOLN

55

propranolol 60mg er cap 55 propranolol 60mg tab 55 propranolol 80mg er cap 55 propranolol 80mg tab 55 PROPRANOLOL 8MG/ML ORAL SOLN

55

propylthiouracil 50mg tab

101

PROQUAD INJ 105 PROSOL 20% INJ 91 protriptyline 10mg tab 24 protriptyline 5mg tab 24 pseudoephedrine liquid 15mg/5ml*

90

pseudoephedrine tab 30mg*

90

pseudoephedrine tab 60mg*

90

pseudoephedrine/bromph eniramine DM syrup 30-2-10mg/5ml*

65

psyllium powder 28.3%* 82 psyllium powder 48.57%* 82 psyllium powder 51.7%* 82 PSYLLIUM POWDER 52.3%*

82

psyllium powder 58.6%* 82 psyllium powder 68%* 82 PSYLLIUM POWDER PACKET 100%*

82

PSYLLIUM POWDER PACKET 28%*

82

PSYLLIUM POWDER PACKET 28.3%*

82


146


82


82

PSYLLIUM POWDER PACKET 95%*

82

PULMOZYME 1MG/ML INH SOLN

100

PURIXAN 2000MG/100ML SUSP

38

PYLERA 140-125-125MG CAP

103

pyrantel pamoate susp 144mg/ml*

10

pyrazinamide 500mg tab 38 pyrethrins/piperonyl butoxide liquid 0.3-3%*

71

pyrethrins/piperonyl butoxide liquid 0.33-4%*

71

pyrethrins/piperonyl butoxide shampoo 0.33-4%*

71

PYRETHRINS/PIPERON YL BUTOXIDE SHAMPOO KIT 0.33-4%*

71

pyridostigmine bromide 180mg er tab

37

pyridostigmine bromide 60mg tab

37

pyridoxine tab 100mg* 107

Q

QBRELIS 1MG/ML ORAL SOLN

32

QSYMIA CAP 11.25-69MG*

1

QSYMIA CAP 15-92MG* 1 QSYMIA CAP 3.75-23MG*

1

QSYMIA CAP 7.5-46MG* 1 QUADRACEL INJ 102 QUDEXY 100MG XR CAP

19

QUDEXY 150MG XR CAP

19

QUDEXY 200MG XR CAP

19

QUDEXY 25MG XR CAP 19 QUDEXY 50MG XR CAP 19 quetiapine 100mg tab 48 quetiapine 150mg xr tab 48 quetiapine 200mg tab 48 quetiapine 200mg xr tab 48 quetiapine 25mg tab 48 quetiapine 300mg tab 48 quetiapine 300mg xr tab 48 quetiapine 400mg tab 48 quetiapine 400mg xr tab 48 quetiapine 50mg tab 48 quetiapine 50mg xr tab 48 quinapril 10mg tab 32 quinapril 20mg tab 32 quinapril 40mg tab 32 quinapril 5mg tab 32 quinidine gluconate 324mg er tab

12

QUINIDINE SULFATE 200MG TAB

12

QUINIDINE SULFATE 300MG TAB

12

quinine sulfate 324mg cap

37

R

RABAVERT 2.5UNIT/ML 105 INJ raloxifene 60mg tab 73 ramelteon 8mg tab 82 ramipril 1.25mg cap 32 ramipril 10mg cap 32 ramipril 2.5mg cap 32 ramipril 5mg cap 32 ranitidine 150mg cap 103 ranitidine 150mg tab 103 ranitidine 15mg/ml oral soln

103

ranitidine 300mg cap 103 ranitidine 300mg tab 103 ranitidine hcl tab 75mg (OTC)*

103

ranolazine 1000mg er tab 10 ranolazine 500mg er tab 10 rasagiline 0.5mg tab 45 rasagiline 1mg tab 45 RAVICTI 1.1GM/ML ORAL SOLN

74

reclipsen 28 day pack 62 RECOMBIVAX 10MCG/ML SYRINGE

105

RECOMBIVAX 40MCG/ML INJ

105

RECOMBIVAX 5MCG/0.5ML SYRINGE

105

RECOMBIVAX HB 10MCG/ML INJ

105

RECTIV 0.4% RECTAL OINTMENT

10

REGRANEX 0.01% GEL 71 RELENZA 5MG/BLISTER INH

53

RELISTOR 12MG/0.6ML INJ

77

RELISTOR 12MG/0.6ML SYRINGE

77

RELISTOR 8MG/0.4ML SYRINGE

77

repaglinide 0.5mg tab 26 repaglinide 1mg tab 26 repaglinide 2mg tab 26 REPATHA 120MG/ML CARTRIDGE

31

REPATHA 140MG/ML AUTO-INJECTOR

31

REPATHA 140MG/ML SYRINGE

31

RESCRIPTOR 200MG TAB

51

RESTASIS 0.05% OPHTH SUSP

93

RETACRIT 10000UNIT/ML INJ

81


81


81


147


81


81

REVLIMID 10MG CAP 88 REVLIMID 15MG CAP 88 REVLIMID 2.5MG CAP 88 REVLIMID 20MG CAP 88 REVLIMID 25MG CAP 88 REVLIMID 5MG CAP 88 REXULTI 0.25MG TAB 49 REXULTI 0.5MG TAB 49 REXULTI 1MG TAB 49 REXULTI 2MG TAB 49 REXULTI 3MG TAB 49 REXULTI 4MG TAB 49 REYATAZ 50MG ORAL POWDER

51

ribavirin 200mg cap 52 ribavirin 200mg tab 52 RIDAURA 3MG CAP 4 rifabutin 150mg cap 38 RIFAMATE 150-300MG CAP

37

rifampin 150mg cap 38 rifampin 300mg cap 38 rifampin 60mg/ml inj 38 RIFATER 50-120-300MG TAB

37

riluzole 50mg tab 90 rimantadine 100mg tab 53 RINVOQ 15MG ER TAB 3 RISCAL-D TAB* 86 risedronate sodium 150mg tab

73

risedronate sodium 30mg tab

73

risedronate sodium 35mg (12) pack

73

risedronate sodium 35mg (4) pack

73


73


73

RISPERDAL 12.5MG INJ 46 RISPERDAL 25MG INJ 46 RISPERDAL 37.5MG INJ 46 RISPERDAL 50MG INJ 46 risperidone 0.25mg odt 46 risperidone 0.25mg tab 46 risperidone 0.5mg odt 46 risperidone 0.5mg tab 46 risperidone 1mg odt 47 risperidone 1mg tab 47 risperidone 1mg/ml oral soln

47

risperidone 2mg odt 47 risperidone 2mg tab 47 risperidone 3mg odt 47 risperidone 3mg tab 47 risperidone 4mg odt 47 risperidone 4mg tab 47 ritonavir 100mg tab 51 rivastigmine 1.5mg cap 97 rivastigmine 13.3mg/24hr patch

97

rivastigmine 3mg cap 97 rivastigmine 4.5mg cap 97 rivastigmine 4.6mg/24hr patch

97

rivastigmine 6mg cap 97 rivastigmine 9.5mg/24hr patch

98

rivelsa 91 day pack 62 rizatriptan 10mg odt 85 rizatriptan 10mg tab 85 rizatriptan 5mg odt 85 rizatriptan 5mg tab 85 ropinirole 0.25mg tab 44 ropinirole 0.5mg tab 44 ropinirole 1mg tab 45 ropinirole 2mg tab 45 ropinirole 3mg tab 44 ropinirole 4mg tab 44 ropinirole 5mg tab 44 rosuvastatin 10mg tab 31 rosuvastatin 20mg tab 31 rosuvastatin 40mg tab 31 rosuvastatin 5mg tab 31

ROTARIX SUSP 105 ROTATEQ SUSP 105 roweepra 1000mg tab 19 roweepra 500mg er tab 19 roweepra 500mg tab 19 roweepra 750mg er tab 19 roweepra 750mg tab 19 ROZLYTREK 100MG CAP

42

ROZLYTREK 200MG CAP

42

RUBRACA 200MG TAB 42 RUBRACA 250MG TAB 42 RUBRACA 300MG TAB 42 RUCONEST 2100UNIT INJ

79

RUZURGI 10MG TAB 37 RYBELSUS 14MG TAB 26 RYBELSUS 3MG TAB 26 RYBELSUS 7MG TAB 26 RYDAPT 25MG CAP 42

S

saline nasal spray 0.65% *

90

salmon calcitonin 200unit/act nasal spray

73

SANDIMMUNE 100MG/ML ORAL SOLN

53

SANTYL 250UNIT/GM OINTMENT

70

SAPHRIS 10MG SL TAB 48 SAPHRIS 2.5MG SL TAB 48 SAPHRIS 5MG SL TAB 48 SAVELLA 100MG TAB 98 SAVELLA 12.5MG TAB 98 SAVELLA 25MG TAB 98 SAVELLA 4-WEEK TITRATION PACK

98

SAVELLA 50MG TAB 98 scopolamine 0.0139mg/hr patch

28

SECUADO 3.8MG/24HR PATCH

48


148


48


48

SEGLUROMET 2.5-1000MG TAB

25


25


25


25

selegiline 5mg cap 45 selegiline 5mg tab 45 selenium sulfide 1% lotion/shampoo*

67

selenium sulfide 2.5% lotion/shampoo

67

SELZENTRY 150MG TAB 51 SELZENTRY 20MG/ML ORAL SOLN

51

SELZENTRY 25MG TAB 51 SELZENTRY 300MG TAB 51 SELZENTRY 75MG TAB 51 sennosides syrup 8.8mg/5ml*

83

sennosides tab 15mg* 83 sennosides tab 17.2mg* 83 sennosides tab 25mg* 83 sennosides tab 8.6mg* 83 SEREVENT 50MCG/DOSE INH

15

sertraline 100mg tab 22 sertraline 20mg/ml oral soln

22

sertraline 25mg tab 22 sertraline 50mg tab 22 setlakin 91 day pack 62 sevelamer carbonate 2400mg oral susp

78

sevelamer carbonate 800mg oral susp

78

sevelamer carbonate 800mg tab

78

sharobel 28 day 0.35mg pack

63

SHINGRIX INJ 105 SIGNIFOR 0.3MG/ML INJ

75

SIGNIFOR 0.6MG/ML INJ

75

SIGNIFOR 0.9MG/ML INJ

75

sildenafil 20mg tab 57 silodosin 4mg cap 78 silodosin 8mg cap 78 silver sulfadiazine 1% cream

68

SIMBRINZA 1-0.2% OPHTH SUSP

92

simethicone cap 125mg* 76 simethicone cap 180mg* 76 simethicone chew tab 125mg*

76

simethicone chew tab 80mg*

76

simethicone liquid 40mg/0.6ml*

76

SIMETHICONE ORAL STRIP 62.5MG*

76

simethicone susp 40mg/0.6ml*

76

SIMPONI 100MG/ML AUTO-INJECTOR

4

SIMPONI 100MG/ML INJ 4 SIMPONI 50MG/0.5ML AUTO-INJECTOR

4

SIMPONI 50MG/0.5ML SYRINGE

4

simvastatin 10mg tab 31 simvastatin 20mg tab 31 simvastatin 40mg tab 31 simvastatin 5mg tab 31 simvastatin 80mg tab 31 sirolimus 0.5mg tab 53 sirolimus 1mg tab 53 sirolimus 1mg/ml oral soln

89

sirolimus 2mg tab 53

SIRTURO 100MG TAB 38 SIVEXTRO 200MG INJ 37 SIVEXTRO 200MG TAB 37 SKYRIZI 150MG DOSE PACK 75MG/0.83ML

67

sodium bicarbonate tab 325mg*

10

sodium bicarbonate tab 650mg*

10

sodium chloride 0.45% inj

88

sodium chloride 0.9% inj 88 sodium chloride 0.9% soln

78

sodium chloride 3% inj 88 sodium chloride 5% inj 88 sodium chloride flush IV soln 0.9%*

88

sodium chloride hypertonic ophth ointment 5%*

94

sodium chloride hypertonic ophth soln 5% *

94

sodium phenylbutyrate 0.94mg/mg oral powder

74

sodium phosphates enema*

83

sodium phosphates pediatric enema*

83

sodium polystyrene sulfonate 15gm oral susp

54

sodium polystyrene sulfonate 250mg/ml susp

54

SOFOSBUVIR/VELPATA SVIR 400-100MG TAB

52

SOLTAMOX 10MG/5ML ORAL SOLN

39

SOMATULINE 120MG/0.5ML SYRINGE

75


75


75

SOMAVERT 10MG INJ 73


149

SOMAVERT 15MG INJ 73 SOMAVERT 20MG INJ 73 SOMAVERT 25MG INJ 73 SOMAVERT 30MG INJ 73 sorine 120mg tab 55 sorine 160mg tab 55 sorine 240mg tab 55 sorine 80mg tab 55 sotalol 120mg tab 55 sotalol 160mg tab 55 sotalol 240mg tab 55 sotalol 80mg tab 55 sotalol af 120mg tab 55 SPIRIVA 1.25MCG RESPIMAT INH

13

spironolactone 100mg tab

72

spironolactone 25mg tab 72 spironolactone 50mg tab 72 sprintec 28 day pack 62 SPRITAM 1000MG ODT 19 SPRITAM 250MG ODT 19 SPRITAM 500MG ODT 19 SPRITAM 750MG ODT 19 SPRYCEL 100MG TAB 42 SPRYCEL 140MG TAB 42 SPRYCEL 20MG TAB 42 SPRYCEL 50MG TAB 42 SPRYCEL 70MG TAB 42 SPRYCEL 80MG TAB 42 sps 250mg/ml oral susp 54 sronyx 28 day pack 62 ssd 1% cream 68 stavudine 15mg cap 51 stavudine 20mg cap 51 stavudine 30mg cap 51 stavudine 40mg cap 51 STEGLATRO 15MG TAB 26 STEGLATRO 5MG TAB 26 STELARA 45MG/0.5ML INJ

67

STELARA 45MG/0.5ML SYRINGE

67

STELARA 90MG/ML SYRINGE

67

STIMATE 1.5MG/ML NASAL SPRAY

74

STIOLTO 2.5-2.5MCG INH

15

STIVARGA 40MG TAB 42 STREPTOMYCIN 100MG INJ

3

STRIBILD 150-150-200-300MG TAB

51

SUCRAID 8500UNIT/ML ORAL SOLN

71

sucralfate 1000mg tab 103 sucralfate 100mg/ml susp 103 sulfacetamide sodium 10% lotion

66

SULFACETAMIDE SODIUM 10% OPHTH OINTMENT

93

sulfacetamide sodium 10% ophth soln

93

SULFADIAZINE 500MG TAB

100

sulfamethoxazole 400mg/trimethoprim 80mg tab

36

sulfamethoxazole 40mg/ml/trimethoprim 8mg/ml susp

36

sulfamethoxazole 800mg/trimethoprim 160mg tab

36

SULFAMYLON 85MG/GM CREAM

68

sulfasalazine 500mg dr tab

77

sulfasalazine 500mg tab 77 sulindac 150mg tab 5 sulindac 200mg tab 5 sumatriptan 100mg tab 85 sumatriptan 12mg/ml auto-injector

85

sumatriptan 12mg/ml inj 85 SUMATRIPTAN 12MG/ML SYRINGE

85

sumatriptan 20mg/act nasal spray

85

sumatriptan 25mg tab 85 sumatriptan 4mg cartridge

85

sumatriptan 50mg tab 85 sumatriptan 5mg/act nasal spray

85

sumatriptan 6mg cartridge

85

sumatriptan 8mg/ml auto-injector

85

SUNOSI 150MG TAB 2 SUNOSI 75MG TAB 2 SUTENT 12.5MG CAP 42 SUTENT 25MG CAP 42 SUTENT 37.5MG CAP 42 SUTENT 50MG CAP 42 syeda 28 day pack 62 SYLATRON 200MCG INJ 43 SYLATRON 300MCG INJ 43 SYMDEKO 50-75MG/75MG PACK

100

SYMDEKO TAB 4-WEEK 100 PACK SYMFI 600-300-300MG TAB

51

SYMFI LO 400-300-300MG TAB

51

SYMJEPI 0.15MG/0.3ML SYRINGE

106

SYMJEPI 0.3MG/0.3ML SYRINGE

106

SYMPAZAN 10MG STRIP

17

SYMPAZAN 20MG STRIP

17

SYMPAZAN 5MG STRIP 17 SYMPROIC 0.2MG TAB 77 SYMTUZA 800-150-200-10MG TAB

51

SYNAREL 2MG/ML NASAL SPRAY

74

SYNJARDY 12.5-1000MG TAB

25


150

SYNJARDY 12.5-500MG TAB

25

SYNJARDY 5-1000MG TAB

25

SYNJARDY 5-500MG TAB

25

SYNJARDY XR 10-1000MG TAB

25

SYNJARDY XR 12.5-1000MG TAB

25


25


25

SYNRIBO 3.5MG INJ 43

T

TABLOID 40MG TAB 38 tacrolimus 0.03% ointment

70

tacrolimus 0.1% ointment 70 tacrolimus 0.5mg cap 53 tacrolimus 1mg cap 53 tacrolimus 5mg cap 53 tadalafil 20mg tab(PAH) 57 TAFINLAR 50MG CAP 42 TAFINLAR 75MG CAP 42 TAGRISSO 40MG TAB 42 TAGRISSO 80MG TAB 42 TALZENNA 0.25MG CAP 42 TALZENNA 1MG CAP 42 tamoxifen 10mg tab 39 tamoxifen 20mg tab 39 tamsulosin 0.4mg cap 78 TARGRETIN 1% GEL 67 tarina 24 fe 1/20 28 day pack

62

tarina fe 1/20 28 day pack

62

TASIGNA 150MG CAP 42 TASIGNA 200MG CAP 42 TASIGNA 50MG CAP 42 TAVALISSE 100MG TAB 79 TAVALISSE 150MG TAB 79 tazarotene 1% cream 67

tazicef 1gm inj 59 tazicef 2gm inj 59 tazicef 6gm inj 59 TAZORAC 0.05% GEL 67 TAZORAC 0.1% GEL 67 taztia 120mg er cap 56 taztia 180mg er cap 56 taztia 240mg er cap 56 taztia 300mg er cap 56 taztia 360mg er cap 56 TAZVERIK 200MG TAB 43 TECFIDERA 120MG DR CAP

99

TECFIDERA 240MG DR CAP

99

TECFIDERA 30-DAY STARTER PACK

99

TEFLARO 400MG INJ 59 TEFLARO 600MG INJ 59 TEGSEDI 189MG/ML SYRINGE

99

telmisartan 20mg tab 32 telmisartan 40mg tab 32 telmisartan 80mg tab 32 temazepam 15mg cap 82 temazepam 22.5mg cap 82 temazepam 30mg cap 82 temazepam 7.5mg cap 82 TENIVAC SYRINGE 102 tenofovir disoproxil fumarate 300mg tab

52

terazosin 10mg cap 33 terazosin 1mg cap 33 terazosin 2mg cap 33 terazosin 5mg cap 33 terbinafine 250mg tab 29 terbinafine cream 1%* 67 terbutaline sulfate 2.5mg tab

15

terbutaline sulfate 5mg tab

15

terconazole 0.4% vaginal cream

106

TERCONAZOLE 0.8% VAGINAL CREAM

106

terconazole 80mg vaginal supp

106

testosterone 1% (25mg) gel

9

testosterone 1% (50mg) gel

9

TESTOSTERONE 1% GEL PUMP

9

testosterone 1.62% (1.25gm) gel

9

testosterone 1.62% (2.5gm) gel

9

testosterone 1.62% gel pump

9

testosterone cypionate (1ml) 200mg/ml inj

9

testosterone cypionate 100mg/ml inj

9

testosterone cypionate 200mg/ml inj

9

testosterone enanthate 200mg/ml inj

9

TETANUS/DIPHTHERIA TOXOID INJ

102

tetrabenazine 12.5mg tab 98 tetrabenazine 25mg tab 98 tetracycline 250mg cap 100 tetracycline 500mg cap 100 THALOMID 100MG CAP 88 THALOMID 150MG CAP 88 THALOMID 200MG CAP 88 THALOMID 50MG CAP 88 theophylline 300mg er tab

15

theophylline 400mg er tab

15

theophylline 5.33mg/ml oral soln

15

theophylline 600mg er tab

15

THIOLA 100MG DR TAB 78 THIOLA 100MG TAB 78 THIOLA 300MG DR TAB 78 thioridazine 100mg tab 49 thioridazine 10mg tab 49


151

thioridazine 25mg tab 49 thioridazine 50mg tab 49 thiothixene 10mg cap 49 thiothixene 1mg cap 49 thiothixene 2mg cap 49 thiothixene 5mg cap 49 tiadylt 120mg er cap 56 tiadylt 180mg er cap 56 tiadylt 240mg er cap 56 tiadylt 300mg er cap 56 tiadylt 360mg er cap 56 tiadylt 420mg er cap 56 tiagabine 12mg tab 20 tiagabine 16mg tab 20 tiagabine 2mg tab 20 tiagabine 4mg tab 20 TIBSOVO 250MG TAB 43 TIGECYCLINE 50MG INJ 100 TIMOLOL 0.25% OPHTH GEL

92

timolol 0.25% ophth soln 92 TIMOLOL 0.5% OPHTH GEL

92

timolol 0.5% ophth soln 92 timolol 10mg tab 55 timolol 20mg tab 55 timolol 5mg tab 55 timolol 5mg/ml ophth 24hr ophth soln

92

TIMOPTIC-XE 0.25% OPHTH GEL

92

TIMOPTIC-XE 0.5% OPHTH GEL

92

tinidazole 250mg tab 35 tinidazole 500mg tab 36 tioconazole vaginal ointment 6.5%*

106

TIVICAY 10MG TAB 52 TIVICAY 25MG TAB 52 TIVICAY 50MG TAB 52 tizanidine 2mg cap 90 tizanidine 2mg tab 90 tizanidine 4mg cap 90 tizanidine 4mg tab 90 tizanidine 6mg cap 90

TOBI PODHALER KIT 28MG PACK

3

TOBRADEX 0.3-0.1% OPHTH OINTMENT

93

tobramycin 0.3% ophth soln

93

TOBRAMYCIN 10MG/ML INJ

3

tobramycin 40mg/ml inj 3 tobramycin 60mg/ml inh soln

3

TOLAK 4% CREAM 67 tolcapone 100mg tab 45 tolnaftate aerosol 1%* 67 tolnaftate aerosol powder 1%*

67

tolnaftate cream 1%* 67 tolnaftate powder 1%* 67 tolterodine tartrate 1mg tab

104

tolterodine tartrate 2mg er cap

104

tolterodine tartrate 2mg tab

104

tolterodine tartrate 4mg er cap

104

TOPIRAMATE 100MG ER CAP

19

topiramate 100mg tab 19 TOPIRAMATE 150MG ER CAP

19

topiramate 15mg cap 19 TOPIRAMATE 200MG ER CAP

19

topiramate 200mg tab 19 topiramate 25mg cap 19 TOPIRAMATE 25MG ER CAP

19

topiramate 25mg tab 19 TOPIRAMATE 50MG ER CAP

19

topiramate 50mg tab 19 toremifene 60mg tab 39 torsemide 100mg tab 72 torsemide 10mg tab 72

torsemide 20mg tab 72 torsemide 5mg tab 72 tovet 0.05% e foam 69 TPN ELECTROLYTES INJ 87 TRACLEER 32MG TAB FOR ORAL SUSP

57

tramadol 100mg er tab 7 tramadol 100mg er tab (matrix delivery)

7


7


7

tramadol 50mg tab 7 tranexamic acid 650mg tab

81

tranylcypromine 10mg tab

21

TRAVASOL 10% INJ 91 travoprost 0.004% ophth soln

94

trazodone 100mg tab 22 trazodone 150mg tab 22 trazodone 300mg tab 22 trazodone 50mg tab 22 TRECATOR 250MG TAB 38 TRELEGY 62.5-25MCG ELLIPTA INH

15

TRELSTAR 11.25MG INJ 39 TRELSTAR 22.5MG INJ 39 TRELSTAR 3.75MG INJ 39 tretinoin 0.01% gel 66 tretinoin 0.025% cream 66 tretinoin 0.025% gel 66 tretinoin 0.05% cream 66 tretinoin 0.05% gel 66 tretinoin 0.1% cream 66 tretinoin 0.1% gel 66 tretinoin 10mg cap 43 TREXALL 10MG TAB 38 TREXALL 15MG TAB 38 TREXALL 5MG TAB 38 TREXALL 7.5MG TAB 38


152

triamcinolone acetonide 0.025% cream

69

triamcinolone acetonide 0.025% lotion

69

triamcinolone acetonide 0.025% ointment

69


69

triamcinolone acetonide 0.1% lotion

69


69

triamcinolone acetonide 0.1% paste

89

triamcinolone acetonide 0.147mg/ml spray

69


69


69

triamcinolone acetonide nasal suspension 55mcg (OTC)*

90

triamterene 100mg cap 72 triamterene 50mg cap 72 triazolam 0.125mg tab 82 triazolam 0.25mg tab 82 triderm 0.1% cream 70 trientine 250mg tab 88 tri-estarylla 28 day pack 62 trifluoperazine 10mg tab 49 trifluoperazine 1mg tab 49 trifluoperazine 2mg tab 49 trifluoperazine 5mg tab 49 TRIFLURIDINE 1% SOLN 93 trihexyphenidyl 0.4mg/ml oral soln

45

trihexyphenidyl 2mg tab 45 trihexyphenidyl 5mg tab 45 tri-legest 28 day pack 62 tri-lo-estarylla 28 day pack

62

tri-lo-sprintec 28 day pack

62

trilyte powder for oral soln

83

trimethoprim 100mg tab 36 tri-mili 28 day pack 62 trimipramine 100mg cap 24 trimipramine 25mg cap 24 trimipramine 50mg cap 24 TRINTELLIX 10MG TAB 22 TRINTELLIX 20MG TAB 22 TRINTELLIX 5MG TAB 22 triple antibiotic ointment*

66

tri-previfem 28 day pack 62 triprolidine/pseudoephed rine tab 2.5-60mg*

65

tri-sprintec 28 day pack 62 TRIUMEQ 600-50-300MG TAB

52

trivora 28 day pack 62 tri-vylibra 28 day pack 62 tri-vylibra lo 28 day pack 62 TROKENDI 100MG XR CAP

19

TROKENDI 200MG XR CAP

19


19


19

TROPHAMINE 10% INJ 91 trospium chloride 20mg tab

104

trospium chloride 60mg er cap

104

TRULICITY 0.75MG/0.5ML AUTO-INJECTOR

26

TRULICITY 1.5MG/0.5ML AUTO-INJECTOR

26

TRUMENBA SYRINGE 104 TRUVADA 100-150MG TAB

52

TRUVADA 133-200MG TAB

52


52


52

TURALIO 200MG CAP 43 TWINRIX 720UNIT SYRINGE

105

TYBOST 150MG TAB 52 TYKERB 250MG TAB 43 TYMLOS 2MG/ML PEN INJECTOR

73

TYPHIM VI 25MCG/0.5ML INJ

104

TYPHIM VI 25MCG/0.5ML SYRINGE

104

U

UCERIS 2MG/ACT FOAM 9 UDENYCA 6MG/0.6ML SYRINGE

81

unithroid 100mcg tab 102 unithroid 112mcg tab 102 unithroid 125mcg tab 102 unithroid 150mcg tab 102 unithroid 175mcg tab 102 unithroid 200mcg tab 102 unithroid 25mcg tab 102 unithroid 300mcg tab 102 unithroid 50mcg tab 102 unithroid 75mcg tab 102 unithroid 88mcg tab 102 UPTRAVI 1000MCG TAB 57 UPTRAVI 1200MCG TAB 57 UPTRAVI 1400MCG TAB 57 UPTRAVI 1600MCG TAB 57 UPTRAVI 200MCG TAB 58 UPTRAVI 400MCG TAB 58 UPTRAVI 600MCG TAB 58 UPTRAVI 800MCG TAB 58 UPTRAVI TITRATION PACK

58

ursodiol 250mg tab 77 ursodiol 300mg cap 77 ursodiol 500mg tab 77

V


153

valacyclovir 1000mg tab 53 valacyclovir 500mg tab 53 VALCHLOR 0.016% GEL 67 valganciclovir 450mg tab 52 valganciclovir 50mg/ml oral soln

52

valproic acid 250mg cap 20 valproic acid 50mg/ml oral soln

20

valsartan 160mg tab 32 valsartan 320mg tab 32 valsartan 40mg tab 32 valsartan 80mg tab 33 VALTOCO 10MG DOSE KIT 10MG/0.1ML PACK

17

VALTOCO 15MG DOSE KIT 7.5MG/0.1ML PACK

17

VALTOCO 20MG DOSE KIT 10MG/0.1ML PACK

17

VALTOCO 5MG DOSE KIT 5MG/0.1ML PACK

17

vancomycin 100mg/ml inj 36 vancomycin 125mg cap 36 vancomycin 250mg cap 36 VANCOMYCIN 250MG INJ

36

vancomycin 50mg/ml inj 36 VANCOMYCIN 50MG/ML ORAL SOLN

36

vancomycin 5mg/ml inj 36 vancomycin 750mg inj 36 vandazole 0.75% vaginal gel

106

VAQTA 25UNIT/0.5ML SYRINGE

105

VAQTA 50UNIT/0.5ML INJ

105

VAQTA 50UNIT/1ML INJ 105 VAQTA 50UNIT/ML SYRINGE

105

VARIVAX 1350PFU/0.5ML INJ

105

VARIZIG 124.8/1.2ML INJ

95

VARUBI 90MG TAB 28

VASCEPA 1GM CAP 30 VASCEPA 500MG CAP 30 velivet 28 day pack 62 VELTASSA 16.8GM POWDER FOR ORAL SUSP

89

VELTASSA 25.2GM POWDER FOR ORAL SUSP

89

VELTASSA 8.4GM POWDER FOR ORAL SUSP

89

VEMLIDY 25MG TAB 52 VENCLEXTA 10/100/50MG STARTING PACK

38

VENCLEXTA 100MG TAB

38

VENCLEXTA 10MG TAB 38 VENCLEXTA 50MG TAB 38 venlafaxine 100mg tab 23 venlafaxine 150mg er cap 23 venlafaxine 25mg tab 23 venlafaxine 37.5mg er cap

23

venlafaxine 37.5mg tab 23 venlafaxine 50mg tab 23 venlafaxine 75mg er cap 23 venlafaxine 75mg tab 23 VENOFER INJ 20MG/ML*

81

VENTAVIS 10MCG/ML INH SOLN

57

VENTAVIS 20MCG/ML INH SOLN

57

VENTOLIN 108MCG INH 15 verapamil 100mg er cap 56 verapamil 120mg er cap 56 verapamil 120mg er tab 56 verapamil 120mg tab 56 verapamil 180mg er cap 56 verapamil 180mg er tab 56 verapamil 200mg er cap 56 verapamil 240mg er cap 56 verapamil 240mg er tab 56

verapamil 300mg er cap 56 VERAPAMIL 360MG SR CAP

56

verapamil 40mg tab 57 verapamil 80mg tab 57 VERSACLOZ 50MG/ML SUSP

48

VERZENIO 100MG TAB 43 VERZENIO 150MG TAB 43 VERZENIO 200MG TAB 43 VERZENIO 50MG TAB 43 VICTOZA 18MG/3ML PEN INJ

26

VIDEX 125MG DR CAP 52 VIDEX 2GM ORAL SOLN 52 vienva 28 day pack 62 vigabatrin 500mg tab 20 vigabatrin 50mg/ml oral soln

20

vigadrone 500mg oral soln

20

VIIBRYD 10/20MG STARTER PACK

22

VIIBRYD 10MG TAB 22 VIIBRYD 20MG TAB 22 VIIBRYD 40MG TAB 22 VIMPAT 100MG TAB 19 VIMPAT 10MG/ML ORAL SOLN

20

VIMPAT 150MG TAB 20 VIMPAT 200MG TAB 20 VIMPAT 50MG TAB 20 VIRACEPT 250MG TAB 52 VIRACEPT 625MG TAB 52 VIREAD 150MG TAB 52 VIREAD 200MG TAB 52 VIREAD 250MG TAB 52 VIREAD 40MG/GM ORAL POWDER

52

vitamin B-1 mononitrate tab 100mg*

107

vitamin B-1 tab 100mg* 107 vitamin B-1 tab 250mg* 107 vitamin B-1 tab 50mg* 107


154

vitamin B-12 CR tab 1000mg*

80

vitamin B-12 er tab 2000mcg*

80

vitamin B-12 SL tab 2500mcg*

80


80


80


80

vitamin B-12 tab 1000mcg*

80


80

VITAMIN B-12 TAB 2000MCG*

80


80


80

vitamin B-12 tab 50mcg* 80 vitamin B-2 tab 100mg* 107 vitamin B-2 tab 25mg* 107 vitamin B-2 tab 50mg* 107 vitamin B-6 tab 500mg* 107 vitamin B-6 tab 250mg* 107 vitamin B-6 tab 25mg* 107 vitamin B-6 tab 50mg* 107 vitamin C 100mg tab* 107 vitamin C chew tab 100mg*

107

vitamin C chew tab 250mg*

107

vitamin C chew tab 500mg*

107

vitamin C tab 1000mg* 107 vitamin C tab 250mg* 107 vitamin C tab 500mg* 107 vitamin D cap 1000unit* 106 vitamin D drops 400unit/0.028ml*

106

vitamin D3 cap 10000unit*

106

vitamin D3 cap 50000unit*

106

vitamin D3 cap 5000unit* 106 vitamin D3 drops 5000unit/ml*

107

vitamin D3 oral liquid 400unit/ml*

107

vitamin D3 tab 1000unit* 107 vitamin D3 tab 400unit* 107 vitamin D3 tab 50000unit(OTC)*

107

vitamin D3 tab 5000unit* 107 vitamin E cap 1000unit* 107 vitamin E cap 100unit* 107 vitamin E cap 200unit* 107 vitamin E cap 400unit* 107 VITRAKVI 100MG CAP 43 VITRAKVI 20MG/ML ORAL SOLN

43

VITRAKVI 25MG CAP 43 VIZIMPRO 15MG TAB 43 VIZIMPRO 30MG TAB 43 VIZIMPRO 45MG TAB 43 voriconazole 200mg inj 29 voriconazole 200mg tab 29 voriconazole 40mg/ml susp

29

voriconazole 50mg tab 29 VOSEVI 400-100-100MG TAB

52

VOTRIENT 200MG TAB 43 VRAYLAR 1.5/3MG MIXED PACK

46

VRAYLAR 1.5MG CAP 46 VRAYLAR 3MG CAP 46 VRAYLAR 4.5MG CAP 46 VRAYLAR 6MG CAP 46 vyfemla 28 day pack 62 vylibra 28 day pack 62 VYNDAMAX 61MG CAP 58

W

WAKIX 17.8MG TAB 2 WAKIX 4.45MG TAB 2

warfarin sodium 10mg tab

15

warfarin sodium 1mg tab 15 warfarin sodium 2.5mg tab

15

warfarin sodium 2mg tab 15 warfarin sodium 3mg tab 15 warfarin sodium 4mg tab 15 warfarin sodium 5mg tab 15 warfarin sodium 6mg tab 15 warfarin sodium 7.5mg tab

15

white petrolatum/mineral oil ophth ointment*

91

wixela 100-50mcg inh 15 wixela 250-50mcg inh 15 wixela 500-50mcg inh 15 wymzya fe 28 day pack 62

X

XALKORI 200MG CAP 43 XALKORI 250MG CAP 43 XARELTO 10MG TAB 15 XARELTO 15MG TAB 15 XARELTO 2.5MG TAB 15 XARELTO 20MG TAB 16 XARELTO STARTER PACK

16

XATMEP 2.5MG/ML ORAL SOLN

38

XELJANZ 10MG TAB 3 XELJANZ 5MG TAB 3 XGEVA 120MG/1.7ML INJ

73

XIFAXAN 200MG TAB 36 XIFAXAN 550MG TAB 36 XOLAIR 150MG INJ 13 XOLAIR 150MG/ML PF INJ

13

XOLAIR 75MG/0.5ML PF INJ

13

XOSPATA 40MG TAB 43 XPOVIO 100MG ONCE WEEKLY PACK

39


155

XPOVIO 60MG ONCE WEEKLY PACK

40

XPOVIO 80MG ONCE WEEKLY PACK

40

XPOVIO 80MG TWICE WEEKLY PACK

40

XTAMPZA 13.5MG ER CAP

7

XTAMPZA 18MG ER CAP

8

XTAMPZA 27MG ER CAP

8

XTAMPZA 36MG ER CAP

8

XTAMPZA 9MG ER CAP 8 XTANDI 40MG CAP 39 XULANE 150-35MCG PATCH

63

XYREM 500MG/ML ORAL SOLN

97

Y

YF-VAX 4000UNIT/ML INJ

105

Z

zafirlukast 10mg tab 13 zafirlukast 20mg tab 13 zaleplon 10mg cap 82 zaleplon 5mg cap 82 zarah 3-0.03mg pack 62 ZARXIO 300MCG/0.5ML SYRINGE

81

ZARXIO 480MCG/0.8ML SYRINGE

81

ZEJULA 100MG CAP 43 ZELBORAF 240MG TAB 43 ZEMAIRA 1000MG INJ 99 zenatane 10mg cap 66 zenatane 20mg cap 66 zenatane 30mg cap 66 zenatane 40mg cap 66 ZENPEP 10000-32000-42000UNIT DR CAP

71

ZENPEP 15000-47000-63000UNIT DR CAP

71


71

ZENPEP 25000-79000-105000UNI T DR CAP

71


71

ZENPEP 40000-126000-168000U NIT DR CAP

71


71

ZERBAXA 1.5GM INJ 58 zidovudine 100mg cap 52 zidovudine 10mg/ml oral soln

52

zidovudine 300mg tab 52 ZIEXTENZO 6MG/0.6ML SYRINGE

81

zinc oxide ointment 10%* 70 zinc oxide ointment 20%* 70 ziprasidone 20mg cap 46 ziprasidone 40mg cap 46 ziprasidone 60mg cap 46 ziprasidone 80mg cap 46 ZIRGAN 0.15% OPHTH GEL

93

ZOLINZA 100MG CAP 43 zolmitriptan 2.5mg odt 85 zolmitriptan 2.5mg tab 85 zolmitriptan 5mg odt 85 zolmitriptan 5mg tab 85 zolpidem tartrate 10mg tab

82

zolpidem tartrate 5mg tab 82 ZOMIG 2.5MG NASAL SPRAY

85

ZOMIG 5MG NASAL SPRAY

85

zonisamide 100mg cap 20 zonisamide 25mg cap 20 zonisamide 50mg cap 20 ZORTRESS 0.25MG TAB 89 ZORTRESS 0.5MG TAB 89 ZORTRESS 0.75MG TAB 89 ZORTRESS 1MG TAB 89 ZOSTAVAX 19400UNIT/0.65ML INJ

105

zovia 1/35e 28 day pack 62 ZUBSOLV SL TAB

11.4-2.9MG 9

ZUBSOLV 1.4-0.36MG SL TAB

9


9


9


9

ZYCLARA 2.5% CREAM 70 ZYDELIG 100MG TAB 43 ZYDELIG 150MG TAB 43 ZYKADIA 150MG TAB 43 ZYPREXA 210MG INJ 48

LA0959_TA 05/20

Walang Bayad: 1.888.522.1298 | TTY: 711 lacare.org


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