Medicaid List of Covered Drugs (Formulary)

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Medicaid List of Covered Drugs (Formulary)

HealthPartners

HealthPartners® Families and Children* HealthPartners® MinnesotaCare HealthPartners® Inspire (SNBC)

HealthPartners® Minnesota Senior Care Plus (MSC+)

HealthPartners® Families and Children/MinnesotaCare/SNBC counties: Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chisago, Clay, Cook, Crow Wing, Dakota, Hennepin, Kittson, Koochiching, Lake, Mahnomen, Marshall, Mille Lacs, Norman, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Roseau, Scott, St. Louis, Sherburne, Stearns, Washington, Wilkin, Wright

HealthPartners® MSC+ counties: Anoka, Benton, Carver, Chisago, Dakota, Hennepin, Ramsey, Scott, Sherburne, Stearns, Washington, Wright

HealthPartners 8170 33rd Ave. S. P.O. Box 1309 Bloomington, MN 55425

healthpartners.com/spp

Member Services: 952-967-7998 or 1-866-885-8880 (TTY 711) Monday – Friday, 8 a.m. to 6 p.m. CT

The information included in this list of covered drugs was correct as of 10/2021. To see the most current information, visit healthpartners.com/mhcpdruglist. If you have questions, contact Member Services at the number listed on this page. You can ask for a printed copy of this Medicaid List of Covered Drugs at any time.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Members must use HealthPartners network pharmacies to receive prescription drug benefits.

This list is subject to change and is not all-inclusive. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. Note to existing members: This list of covered drugs has changed since last year and may change throughout the year. Please review this document to make sure the drugs you take are still on the list. Please contact Member Services at the number listed on this page with questions. You can also find updates to this list at healthpartners.com/mhcpdruglist.

If you have Medicare, you need to get most of your prescription drugs through the Medicare Prescription Drug Program (Medicare Part D). You must be enrolled in a Medicare prescription drug plan to get prescription drug benefits.

*This is also known as the Prepaid Medical Assistance Program (PMAP). Updated 10/2021

20-814858 HPCare_001020 DHS Approved 05/27/2021

https://healthpartners.com/mhcpdruglist

https://healthpartners.com/mhcpdruglist

https://healthpartners.com/spp

1-866-885-8880 (TTY:711)

Attention. If you need free help interpreting this document, call the above number.

CB5 (MCOs) (5-2020)

Civil Rights Notice

Discrimination is against the law. HealthPartners does not discriminate on the basis of any of the following:

• Race • Color • National Origin • Creed • Religion • Sexual Orientation

• Public Assistance Status • Age • Disability (including physical or mental impairment) • Sex (including sex stereotypes and gender identity) • Marital Status • Political Beliefs

• Medical Condition • Health Status • Receipt of Health Care Services • Claims Experience • Medical History • Genetic Information

Auxiliary Aids and Services HealthPartners provides auxiliary aids and services, like qualified interpreters or information in accessible formats, free of charge and in a timely manner to ensure an equal opportunity to participate in our health care programs. Contact 1-866-885-8880.

Language Assistance Services HealthPartners provides translated documents and spoken language interpreting, free of charge and in a timely manner, when language assistance services are necessary to ensure limited English speakers have meaningful access to our information and services. Contact 1-866-885-8880.

Civil Rights Complaints You have the right to file a discrimination complaint if you believe you were treated in a discriminatory way by HealthPartners. You may contact any of the following three agencies directly to file a discrimination complaint.

U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) You have the right to file a complaint with the OCR, a federal agency, if you believe you have been discriminated against because of any of the following:

• Race • National Origin • Disability • Religion (in some cases) • Color • Age • Sex

Contact the OCR directly to file a complaint: U.S. Department of Health and Human Services Office of Civil Rights 200 Independence Avenue SW Room 515F HHH Building Washington, DC 20201 Customer Response Center: Toll-free: 800-368-1019

TDD: 800-537-7697 Email: [email protected]

mailto:[email protected]

Minnesota Department of Human Rights (MDHR) In Minnesota, you have the right to file a complaint with the MDHR if you believe you have been discriminated against because of any of the following:

• Race • Religion • Sexual Orientation • Public Assistance Status • Color • Creed • Marital Status • Disability • National Origin • Sex

Contact the MDHR directly to file a complaint: Minnesota Department of Human Rights 540 Fairview Avenue North Suite 201 St. Paul, MN 55104 651-539-1100 (voice) 800-657-3704 (toll free) 711 or 800-627-3529 (MN Relay) 651-296-9042 (fax) [email protected] (email)

Minnesota Department of Human Services (DHS) You have the right to file a complaint with DHS if you believe you have been discriminated against in our health care programs because of any of the following: • Race • Age • Medical Condition • Color • Disability (including physical or • Health Status • National Origin mental impairment) • Receipt of Health Care Services • Creed • Sex (including sex stereotypes and • Claims Experience • Religion gender identity) • Medical History • Sexual Orientation • Marital Status • Genetic Information • Public Assistance Status • Political Beliefs

Complaints must be in writing and filed within 180 days of the date you discovered the alleged discrimination. The complaint must contain your name and address and describe the discrimination you are complaining about. After we get your complaint, we will review it and notify you in writing about whether we have authority to investigate. If we do, we will investigate the complaint.

DHS will notify you in writing of the investigation’s outcome. You have a right to appeal the outcome if you disagree with the decision. To appeal, you must send a written request to have DHS review the investigation outcome period. Be brief and state why you disagree with the decision. Include additional information you think is important.

If you file a complaint in this way, the people who work for the agency named in the complaint cannot retaliate against you. This means they cannot punish you in any way for filing a complaint. Filing a complaint in this way does not stop you from seeking out other legal or administrative actions.

Contact DHS directly to file a discrimination complaint: Civil Rights Coordinator Minnesota Department of Human Services Equal Opportunity and Access Division P.O. Box 64997 St. Paul, MN 55164-0997 651-431-3040 (voice) or use your preferred relay service


HealthPartners Complaint Notice You have the right to file a complaint with HealthPartners if you believe you have been discriminated against because of any of the following: • Medical Condition • Health Status • Receipt of Health Care Services • Claims Experience • Medical History • Genetic Information • Disability (including physical or mental impairment) • Marital Status • Age

• Sex (including sex stereotypes and gender identity) • Sexual Orientation • National Origin • Race • Color • Religion • Creed • Public Assistance Status • Political Beliefs

You can file a complaint and ask for help in filing a complaint in person or by mail, phone, fax, or email at: Civil Rights Coordinator Office of Integrity and Compliance, MS 21103K HealthPartners P.O. Box 1309 Minneapolis, MN 55440-1309 1-844-363-8732 (toll free), 711 (TTY), 952-883-5522 (fax) [email protected] (email)

American Indian Health Statement American Indians can continue or begin to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For elders age 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral.


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Table of Contents

Important Information………………….....................………………………………………………………………………………………………….2 List of Covered Drugs……………………………………………………………………………….…………………………………………………….......9 Index of Covered Drugs………………………………………………………………………….…………………………………………………….....283

Table of Contents

Important Information………………….....................………………………………………………………………………………………………….2 List of Covered Drugs……………………………………………………………………………….…………………………………………………….......9 Index of Covered Drugs………………………………………………………………………….…………………………………………………….....283

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IMPORTANT INFORMATION

What is a list of covered drugs? A list of covered drugs includes the prescription drugs covered by HealthPartners. The drugs on the list are selected by HealthPartners with the help of a team of doctors and pharmacists. HealthPartners will generally cover the drugs listed in the list of covered drugs as long as the drug is medically necessary, the prescription is filled at a HealthPartners network pharmacy, and other requirements related to the drug are followed. Does the list of covered drugs ever change? The HealthPartners list of covered drugs can change during the course of a calendar year. If changes affect the coverage of a drug you are taking, HealthPartners will make reasonable efforts to contact you and your prescriber to tell you about the change. HealthPartners will also tell you about alternative drugs that are covered.

Examples of some changes that may occur are:

• A drug you are taking is no longer preferred. (See “What is a Preferred Drug List?” below.) • A drug is removed from the list of covered drugs for safety reasons. • Prior authorization requirements have changed. (See “Are there any restrictions on my coverage?”)

How are drugs listed in the list of covered drugs? There are two ways to find a drug:

• You can search alphabetically (if you know how to spell the drug), or

• You can search by drug type. To search alphabetically, go to the Index of Covered Drugs section. You can find it in the back of this book. The Index of Covered Drugs is an alphabetical list of all of the drugs included in the Drug List. Brand name drugs, generic drugs, and over-the-counter (OTC) drugs are listed in the index. To search by drug type, find the list of covered drugs starting on page 9. The drugs in this section are grouped into categories by type. A category starts with a title in a gray row. Drugs are listed below the category. For example, if you are taking a medicine for migraines, you should look in the “Antimigraine Agents” category title in gray. That is where you will find drugs that treat migraines. What is a Preferred Drug List? In Minnesota, all health plans are required to use the Department of Human Services’ (DHS) Preferred Drug List (PDL). The PDL is created by DHS, in consultation with the Drug Formulary Committee, to let prescribers and members know about drugs or drug classes that are cost effective. Generally, drugs that are “preferred” are more cost effective and drugs that are “non-preferred” are less cost effective. Preferred drugs are available to members with fewer restrictions. Non-preferred drugs require a prior authorization. To get a non-preferred drug, your doctor or health care provider must get prior authorization. The PDL is included as part of HealthPartners’ list of covered drugs. HealthPartners’ complete list of covered drugs includes other drugs in addition to those on the PDL. The PDL is available on DHS’s website at http://minnesota.magellanmedicaid.com/pdl.asp.

IMPORTANT INFORMATION

What is a list of covered drugs? A list of covered drugs includes the prescription drugs covered by HealthPartners. The drugs on the list are selected by HealthPartners with the help of a team of doctors and pharmacists. HealthPartners will generally cover the drugs listed in the list of covered drugs as long as the drug is medically necessary, the prescription is filled at a HealthPartners network pharmacy, and other requirements related to the drug are followed. Does the list of covered drugs ever change? The HealthPartners list of covered drugs can change during the course of a calendar year. If changes affect the coverage of a drug you are taking, HealthPartners will make reasonable efforts to contact you and your prescriber to tell you about the change. HealthPartners will also tell you about alternative drugs that are covered.

Examples of some changes that may occur are:

• A drug you are taking is no longer preferred. (See “What is a Preferred Drug List?” below.) • A drug is removed from the list of covered drugs for safety reasons. • Prior authorization requirements have changed. (See “Are there any restrictions on my coverage?”)

How are drugs listed in the list of covered drugs? There are two ways to find a drug:

• You can search alphabetically (if you know how to spell the drug), or

• You can search by drug type. To search alphabetically, go to the Index of Covered Drugs section. You can find it in the back of this book. The Index of Covered Drugs is an alphabetical list of all of the drugs included in the Drug List. Brand name drugs, generic drugs, and over-the-counter (OTC) drugs are listed in the index. To search by drug type, find the list of covered drugs starting on page 9. The drugs in this section are grouped into categories by type. A category starts with a title in a gray row. Drugs are listed below the category. For example, if you are taking a medicine for migraines, you should look in the “Antimigraine Agents” category title in gray. That is where you will find drugs that treat migraines. What is a Preferred Drug List? In Minnesota, all health plans are required to use the Department of Human Services’ (DHS) Preferred Drug List (PDL). The PDL is created by DHS, in consultation with the Drug Formulary Committee, to let prescribers and members know about drugs or drug classes that are cost effective. Generally, drugs that are “preferred” are more cost effective and drugs that are “non-preferred” are less cost effective. Preferred drugs are available to members with fewer restrictions. Non-preferred drugs require a prior authorization. To get a non-preferred drug, your doctor or health care provider must get prior authorization. The PDL is included as part of HealthPartners’ list of covered drugs. HealthPartners’ complete list of covered drugs includes other drugs in addition to those on the PDL. The PDL is available on DHS’s website at http://minnesota.magellanmedicaid.com/pdl.asp.

http://minnesota.magellanmedicaid.com/pdl.asp

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What are generic or biosimilar drugs? A generic drug is approved by the Food and Drug Administration (FDA) and has the same active ingredients as the brand name drug. It produces the same clinical effect as the brand name drug. A biosimilar drug is an FDA-approved biologic drug (most often an injectable prescription drug) that is highly similar to an already-approved biological product. It has no clinically meaningful differences in terms of safety and effectiveness. Biosimilar drugs are not the same as generic drugs, but like generics, biosimilar drugs may offer more affordable treatment options. Generic or biosimilar substitution means a generic version or biosimilar version of a drug is given instead of the brand name or non-biosimilar version of the drug. HealthPartners will cover the brand name or non-biosimilar version of the drug only when:

1. Your prescriber informs HealthPartners in writing that the brand name or non-biosimilar version of the drug is medically necessary; OR

2. HealthPartners may prefer the dispensing of certain brand name version over the generic or non-biosimilar version over the biosimilar version of the drug; OR

3. Minnesota law requires the dispensing of the brand name or non-biosimilar version of the drug. Within the list of covered drugs, brand name drugs are capitalized (e.g., HUMALOG) and generic drugs are listed in lowercase italics (e.g., atorvastatin). What are over-the-counter drugs? Drugs and products that are available for purchase without a prescription are referred to as over-the-counter (OTC). Although an OTC product is available without a prescription, if a doctor writes a prescription for an OTC product, HealthPartners may cover it. Within the list of covered drugs, OTC drugs and products are marked with an OTC symbol. What are specialty drugs? Specialty drugs are used by people with complex or chronic diseases. These drugs often require special handling, dispensing, or monitoring by a specially trained pharmacist. If you are prescribed a drug that is on the HealthPartners Specialty Drug List, your prescriber will need to send the prescription to one of HealthPartners’ specialty pharmacies listed here. Name of Specialty Pharmacy: Cystic Fibrosis & Hemophilia Medications

Fairview Specialty Pharmacy Phone: 612-672-5260 Toll-free: 1-800-595-7140 TTY: 711 Fax: 1-866-347-4939 Hours of Operation: Mon-Fri: 8 a.m. – 7 p.m. (CST) *call center only

Sat: 8 a.m. – 4 p.m. (CST) *call center only Sun: Closed

On-site prescription pick-up Mon-Fri: 8 a.m. - 4 p.m. (CST) Sat: Closed Sun: Closed

https://www.fairview.org/services/specialty-pharmacy

What are generic or biosimilar drugs? A generic drug is approved by the Food and Drug Administration (FDA) and has the same active ingredients as the brand name drug. It produces the same clinical effect as the brand name drug. A biosimilar drug is an FDA-approved biologic drug (most often an injectable prescription drug) that is highly similar to an already-approved biological product. It has no clinically meaningful differences in terms of safety and effectiveness. Biosimilar drugs are not the same as generic drugs, but like generics, biosimilar drugs may offer more affordable treatment options. Generic or biosimilar substitution means a generic version or biosimilar version of a drug is given instead of the brand name or non-biosimilar version of the drug. HealthPartners will cover the brand name or non-biosimilar version of the drug only when:

1. Your prescriber informs HealthPartners in writing that the brand name or non-biosimilar version of the drug is medically necessary; OR

2. HealthPartners may prefer the dispensing of certain brand name version over the generic or non-biosimilar version over the biosimilar version of the drug; OR

3. Minnesota law requires the dispensing of the brand name or non-biosimilar version of the drug. Within the list of covered drugs, brand name drugs are capitalized (e.g., HUMALOG) and generic drugs are listed in lowercase italics (e.g., atorvastatin). What are over-the-counter drugs? Drugs and products that are available for purchase without a prescription are referred to as over-the-counter (OTC). Although an OTC product is available without a prescription, if a doctor writes a prescription for an OTC product, HealthPartners may cover it. Within the list of covered drugs, OTC drugs and products are marked with an OTC symbol. What are specialty drugs? Specialty drugs are used by people with complex or chronic diseases. These drugs often require special handling, dispensing, or monitoring by a specially trained pharmacist. If you are prescribed a drug that is on the HealthPartners Specialty Drug List, your prescriber will need to send the prescription to one of HealthPartners’ specialty pharmacies listed here. Name of Specialty Pharmacy: Cystic Fibrosis & Hemophilia Medications

Fairview Specialty Pharmacy Phone: 612-672-5260 Toll-free: 1-800-595-7140 TTY: 711 Fax: 1-866-347-4939 Hours of Operation: Mon-Fri: 8 a.m. – 7 p.m. (CST) *call center only

Sat: 8 a.m. – 4 p.m. (CST) *call center only Sun: Closed

On-site prescription pick-up Mon-Fri: 8 a.m. - 4 p.m. (CST) Sat: Closed Sun: Closed



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Name of Specialty Pharmacy: Hemophilia Medications Fairview Pharmacy – Center for Bleeding and Clotting Disorders Phone: 612-273-5006 Toll-free: 1-833-310-1499 TTY: 711 Fax: 612-273-5010 Hours of Operation: Mon-Fri: 8:30 a.m. – 4:30 p.m. (CST)

Sat: Closed Sun: Closed Name of Specialty Pharmacy: Cystic Fibrosis & Hemophilia Medications

Children’s Home Care Pharmacy Phone: 612-813-7206 Toll-free: 1-866-656-1020 TTY: 711 Fax: 612-813-7207 Hours of Operation: Mon-Fri: 8 a.m. – 4:30 p.m. (CST)

Sat: Closed Sun: Closed Name of Specialty Pharmacy: Pulmonary Arterial Hypertension (PAH)

Accredo Specialty Pharmacy Phone: 1-866-344-4874 TTY: 711 Fax: 1-888-302-1028 Hours of Operation: Mon-Fri: 7 a.m. – 10 p.m. (CST)

Sat: 7 a.m. – 4:30 p.m. (CST) Sun: Closed https://www.accredo.com

All other specialty medications

Name of Specialty Pharmacy: CVS Caremark Specialty Pharmacy Phone: 1-800-368-1624 TTY: 711 Fax: 1-800-441-5809 Hours of Operation: Mon-Fri: 9 a.m. – 9 p.m. CST

Sat: 10 a.m. – 2 p.m. CST Sun: Closed https://www.cvsspecialty.com/wps/portal/specialty You will also need to call the specialty pharmacy where your prescription is sent to set up an account. You will need to have your HealthPartners member identification card when you call the specialty pharmacy.

Name of Specialty Pharmacy: Hemophilia Medications Fairview Pharmacy – Center for Bleeding and Clotting Disorders Phone: 612-273-5006 Toll-free: 1-833-310-1499 TTY: 711 Fax: 612-273-5010 Hours of Operation: Mon-Fri: 8:30 a.m. – 4:30 p.m. (CST)

Sat: Closed Sun: Closed Name of Specialty Pharmacy: Cystic Fibrosis & Hemophilia Medications

Children’s Home Care Pharmacy Phone: 612-813-7206 Toll-free: 1-866-656-1020 TTY: 711 Fax: 612-813-7207 Hours of Operation: Mon-Fri: 8 a.m. – 4:30 p.m. (CST)

Sat: Closed Sun: Closed Name of Specialty Pharmacy: Pulmonary Arterial Hypertension (PAH)

Accredo Specialty Pharmacy Phone: 1-866-344-4874 TTY: 711 Fax: 1-888-302-1028 Hours of Operation: Mon-Fri: 7 a.m. – 10 p.m. (CST)

Sat: 7 a.m. – 4:30 p.m. (CST) Sun: Closed https://www.accredo.com

All other specialty medications

Name of Specialty Pharmacy: CVS Caremark Specialty Pharmacy Phone: 1-800-368-1624 TTY: 711 Fax: 1-800-441-5809 Hours of Operation: Mon-Fri: 9 a.m. – 9 p.m. CST

Sat: 10 a.m. – 2 p.m. CST Sun: Closed https://www.cvsspecialty.com/wps/portal/specialty You will also need to call the specialty pharmacy where your prescription is sent to set up an account. You will need to have your HealthPartners member identification card when you call the specialty pharmacy.

https://www.accredo.com

https://www.cvsspecialty.com/wps/portal/specialty

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What if a drug is not on the list of covered drugs? Not all drugs are covered. If a drug you want to take is not listed in the list of covered drugs, you can call Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, and ask if the drug is covered. If not, it is considered a “non-formulary” drug. If you need a drug that is not included in the list of covered drugs, you can ask HealthPartners to make an exception to cover it. You can also ask us to change the rules on your drug. For example, HealthPartners may limit the amount of a drug we will cover. If your drug has a limit, you can ask us to change the limit and cover more. You can also ask us to drop step therapy restrictions or prior authorization requirements. To ask for an exception, call Member Services. A Member Services representative will work with you and your provider to help you ask for an exception. Once a complete request is submitted by your provider, we will give you a decision on your exception request within 24 hours. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include the following:

● Prior authorization: HealthPartners requires you or your doctor to get prior authorization for certain drugs. This means that you will need to get approval from HealthPartners before you fill your prescription. If you don’t get approval, HealthPartners may not cover the drug.

● Quantity limits: For certain drugs, HealthPartners limits the amount of the drug that we will cover.

● Age requirements: Some drugs have age requirements. A prior authorization may be needed depending on your age and the specific drug prescribed.

You can find out if your drug requires prior authorization, has quantity limits, or has an age requirement by looking in this list of covered drugs. An exception to a drug restriction or limit can be made if your doctor submits a statement or documentation supporting the request. See Section 7: Covered Services (Prescription Drugs) in your Member Handbook for more information. You can also get more information about the restrictions applied to specific covered drugs by calling Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, or by visiting our website at healthpartners.com/mhcpdruglist. Also see “Can I ask for an exception to the coverage restrictions?”

● Excluded drugs: Some drugs are excluded from the list of covered drugs. This means they are not covered. Excluded drugs include the following:

• Drugs used to treat sexual or erectile dysfunction • Drugs used to enhance fertility • Drugs used for cosmetic purposes, including drugs to treat hair loss • Drugs or products to promote weight loss • Drugs not clinically proven to be effective • Investigational or experimental drugs • Medical cannabis

What if a drug is not on the list of covered drugs? Not all drugs are covered. If a drug you want to take is not listed in the list of covered drugs, you can call Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, and ask if the drug is covered. If not, it is considered a “non-formulary” drug. If you need a drug that is not included in the list of covered drugs, you can ask HealthPartners to make an exception to cover it. You can also ask us to change the rules on your drug. For example, HealthPartners may limit the amount of a drug we will cover. If your drug has a limit, you can ask us to change the limit and cover more. You can also ask us to drop step therapy restrictions or prior authorization requirements. To ask for an exception, call Member Services. A Member Services representative will work with you and your provider to help you ask for an exception. Once a complete request is submitted by your provider, we will give you a decision on your exception request within 24 hours. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include the following:

● Prior authorization: HealthPartners requires you or your doctor to get prior authorization for certain drugs. This means that you will need to get approval from HealthPartners before you fill your prescription. If you don’t get approval, HealthPartners may not cover the drug.

● Quantity limits: For certain drugs, HealthPartners limits the amount of the drug that we will cover.

● Age requirements: Some drugs have age requirements. A prior authorization may be needed depending on your age and the specific drug prescribed.

You can find out if your drug requires prior authorization, has quantity limits, or has an age requirement by looking in this list of covered drugs. An exception to a drug restriction or limit can be made if your doctor submits a statement or documentation supporting the request. See Section 7: Covered Services (Prescription Drugs) in your Member Handbook for more information. You can also get more information about the restrictions applied to specific covered drugs by calling Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, or by visiting our website at healthpartners.com/mhcpdruglist. Also see “Can I ask for an exception to the coverage restrictions?”

● Excluded drugs: Some drugs are excluded from the list of covered drugs. This means they are not covered. Excluded drugs include the following:

• Drugs used to treat sexual or erectile dysfunction • Drugs used to enhance fertility • Drugs used for cosmetic purposes, including drugs to treat hair loss • Drugs or products to promote weight loss • Drugs not clinically proven to be effective • Investigational or experimental drugs • Medical cannabis

http://healthpartners.com/mhcpdruglist

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Can I ask for an exception to the coverage restrictions? Yes. You or your health care provider can get the Pharmacy Administration – Prior Authorization/Exception Form from https://www.healthpartners.com/hp/pharmacy/forms/index.html or by calling Member Services at 952-967-7998 or 1-866-885-8880, TTY 711. Your provider must return this form to the fax number or address listed on the document. To allow for a thorough review and to ensure that you or your health care provider gets a response within 24 hours, all information requested in the form should be provided, including documentation of which medications have been tried and failed, including the dosages used, and the reason for failure (e.g. side effects). What will a prescription cost? All copay information for prescriptions is listed in the Member Handbook in Section 6: Cost-Sharing. If you have additional questions, call Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, or visit our website at healthpartners.com/mhcpdruglist.

Can I ask for an exception to the coverage restrictions? Yes. You or your health care provider can get the Pharmacy Administration – Prior Authorization/Exception Form from https://www.healthpartners.com/hp/pharmacy/forms/index.html or by calling Member Services at 952-967-7998 or 1-866-885-8880, TTY 711. Your provider must return this form to the fax number or address listed on the document. To allow for a thorough review and to ensure that you or your health care provider gets a response within 24 hours, all information requested in the form should be provided, including documentation of which medications have been tried and failed, including the dosages used, and the reason for failure (e.g. side effects). What will a prescription cost? All copay information for prescriptions is listed in the Member Handbook in Section 6: Cost-Sharing. If you have additional questions, call Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, or visit our website at healthpartners.com/mhcpdruglist.

https://www.healthpartners.com/hp/pharmacy/forms/index.html

http://healthpartners.com/mhcpdruglist

LEGEND

TYPE DESCRIPTION

P Preferred Drug

NP Non-Preferred Drug

C Covered

TYPE DESCRIPTION

QL Quantity Limit There is a limit on the amount of this drug that is covered per

prescription, or within a specific time frame.

Prior Authorization

You (or your physician) are required to get prior authorization before

you fill your prescription for this drug. Without prior approval, we may

not cover this drug.

Step Therapy

In some cases, you may be required to first try certain drugs to treat

your medical condition before we will cover another drug for that

condition.

Age Limit This prescription drug may only be covered if you meet the minimum

or maximum age limit.

Specialty Drug

Specialty drugs are high-cost drugs used to treat complex or rare

conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis

C, and hemophilia.

PA

ST

AL1

S

Age Quantity Limit

There is a limit on the amount of drug covered per prescription, or

within a specific time frame. Must also fall into the specified age

range.

Trial Drug

Medicines marked with this symbol are in a trial drug program. The

first 6 fills may be limited to less than a month supply. If tolerated and

effective you will receive the remainder of the supply and pay no

more than one copay for each full month supply.

AQ1

TD

Medicines marked with this symbol may be covered under your

Medical Drug medical benefit. Go to

https://www.healthpartners.com/public/coverage-criteria/ for medical

benefit criteria or log on to your secure account.

New users will be limited to a 7 days supply for their first fill, and a

Opioid Program

total of 14 days supply for each episode. Longer therapy requires

prior authorization: Provider attestation, that therapy for this patient is

being managed per standard opioid prescribing guidelines, including

assessment and documentation of risk factors for chronic opioid use.

MED

OP

PAGE 7 LAST UPDATED 10/2021

https://www.healthpartners.com/public/coverage-criteria/

Oncology (cancer) medicines must be filled at a specialty pharmacy, ONC Oncology but are not subject to the specialty benefit. Your regular generic or

brand pharmacy copay or coinsurance will apply.

OTC OTC Drugs Medicines marked with this symbol are considered over the counter

PAGE 8 LAST UPDATED 10/2021

LAST UPDATED 10/2021

LIST OF COVERED PRESCRIPTION MEDICATIONS

DRUG DESCRIPTION (RX) TYPE LIMITS & RESTRICTIONS

ALPHA-ADRENERGIC BLOCKING AGENT(SYMPATH)

NON-SEL.ALPHA-ADRENERGIC BLOCKING AGENTS

phenoxybenzamine hcl C PA

SELECTIVE ALPHA-1-ADRENERGIC BLOCK.AGENT

alfuzosin hcl er P

FLOMAX tamsulosin hcl NP PA

RAPAFLO silodosin NP PA

silodosin NP PA

tamsulosin hcl P

ANALGESICS AND ANTIPYRETICS

ANALGESICS AND ANTIPYRETICS, MISC.

8 HOUR PAIN RELIEF acetaminophen C OTC

8HR ARTHRITIS PAIN acetaminophen C OTC

acetaminophen 120 mg suppos C OTC

acetaminophen 160 mg rapid tab C OTC

acetaminophen 160 mg/5 ml liq C OTC

acetaminophen 160 mg/5 ml sol C OTC

acetaminophen 160 mg/5 ml susp C OTC

acetaminophen 325 mg gelcap C OTC

acetaminophen 325 mg tablet C OTC

acetaminophen 500 mg caplet C OTC

acetaminophen 500 mg gelcap C OTC

acetaminophen 500 mg tablet C OTC

acetaminophen 650 mg suppos C OTC


acetaminophen 80 mg rapid tab C OTC

acetaminophen er C OTC

ARTHRITIS PAIN ER 650 MG CAPLT acetaminophen C OTC

ARTHRITIS PAIN RELF ER 650 MG acetaminophen C OTC

butalb-acetamin-caff 50-325-40 C QL 6 TABS / 1 DAY

butalbital-acetaminophn 50-325 C QL 6 TABS / 1 DAY

CHILD FEVER REDUCER acetaminophen C OTC

CHILD FEVER REDUCER-PAIN RELVR C OTC

CHILD PAIN RLF 160 MG/5 ML ELX C OTC

CHILD TYLENOL 160 MG POWD PKT acetaminophen C

children's acetaminophen C OTC

CHILDREN'S AUROPHEN PAIN-FEVER C OTC

CHILDREN'S FEVER REDUCER acetaminophen C OTC

CHILDREN'S PAIN-FEVER C OTC

cvs acetaminophen 325 mg gelcp C OTC

cvs acetaminophen 500 mg cplt C OTC

cvs acetaminophen 500 mg tab C OTC

cvs acetaminophen 500 mg/15 ml C OTC

CVS ARTHRIT PAIN RLF ER 650 MG acetaminophen C OTC

CVS PAIN RELIEVER 500 MG CPLT C OTC

EQ ARTHRITIS PAIN ER 650 MG acetaminophen C OTC

EQL ARTHRIT PAIN RLF ER 650 MG acetaminophen C OTC

FEVERALL acetaminophen C OTC



gnp acetaminophen 325 mg gelcp C OTC

gnp acetaminophen 500 mg tab C OTC

GNP ARTHRIT PAIN RLF ER 650 MG C OTC

GNP PAIN RELIEVER 500 MG TAB C OTC

GRALISE 30-DAY STARTER PACK gabapentin NP

QL 1 RX / YEAR

PA

GRALISE ER 300 MG TABLET gabapentin NP

QL 1 TAB / 1 DAY

PA

GRALISE ER 600 MG TABLET gabapentin NP

QL 3 TABS / 1 DAY

PA

GS ARTHRITIS PAIN ER 650 MG acetaminophen C OTC

HM ARTHRIT PAIN RLF ER 650 MG acetaminophen C OTC

HM ARTHRITIS PAIN ER 650 MG acetaminophen C OTC

HM PAIN RELIEF 325 MG TABLET C OTC

HM PAIN RELIEF 500 MG GELCAP C OTC

HM PAIN RELIEF 500 MG TABLET C OTC

HM PAIN RELIEF ER 650 MG CPLT acetaminophen C OTC

HM PAIN RELIEVER 500 MG TABLET C OTC

INFANTS' PAIN-FEVER C OTC

JR PAIN & FEVER C OTC

kro acetaminophen 325 mg tab C OTC

KRO ARTHRIT PAIN RLF ER 650 MG acetaminophen C OTC

LYRICA CR 165 MG TABLET pregabalin NP

QL 1 TAB / 1 DAY

PA

LYRICA CR 330 MG TABLET pregabalin NP

QL 2 TABS / 1 DAY

PA



LYRICA CR 82.5 MG TABLET pregabalin NP

QL 1 TAB / 1 DAY

PA

M-PAP C OTC

MAPAP 500 MG CAPSULE C OTC

MAPAP 500 MG/15 ML LIQUID C OTC

NON-ASPIRIN CHILD'S DROPS C OTC

PAIN RELIEF 160 MG/5 ML LIQUID C OTC

PAIN RELIEF 325 MG TABLET C OTC

PAIN RELIEF ADULT C OTC

PAIN RELIEF EXTRA STRENGTH C OTC

PAIN RELIEVER 500 MG CAPLET C OTC

PAIN RELIEVER 500 MG GELCAP C OTC

PAIN RELIEVER 500 MG TABLET C OTC

PAIN RELIEVER ADULT C OTC

PUB ARTHRITIS PAIN ER 650 MG acetaminophen C OTC

QC ARTHRITIS PAIN ER 650 MG acetaminophen C OTC

ra acetaminophen 325 mg tablet C OTC

RA ARTHRITIS PAIN ER 650 MG C OTC

SILAPAP C OTC

SM ARTHRIT PAIN RLF ER 650 MG acetaminophen C OTC

SM ARTHRITIS PAIN ER 650 MG acetaminophen C OTC

SM ARTHRITIS PAIN RELF ER 650 C OTC

SM PAIN RELIEVER 500 MG CAPLET C OTC

SM PAIN RELIEVER 500 MG GELCAP C OTC

SM PAIN RELIEVER 500 MG TABLET C OTC



TENCON butalbital/acetaminophen C QL 6 TABS / 1 DAY

ZEBUTAL butalbital/acetaminophen/caffeine C QL 6 CAPS / 1 DAY

OPIATE AGONISTS

acetamin-codein 300-30 mg/12.5 C AQ1 At least 12 yrs old; 60 /

1 DAY OP

acetaminop-codeine 120-12 mg/5 C

QL 40 ML / 1 DAY

AQ1 At least 12 yrs old; 60 /1 DAY

OP

acetaminophen-cod #2 tablet C AQ1 At least 12 yrs old; 8 /

1 DAY OP


1 DAY OP


1 DAY OP

codeine sulfate C AQ1 At least 12 yrs old; 8 /

1 DAYOP

DURAGESIC fentanyl NP

QL 10 PATCHES / 30DAYS

PA

EMBEDA ER 100-4 MG CAPSULE morphine sulfate/naltrexone hcl NP

QL 1 CAP / 1 DAY

PA

EMBEDA ER 20-0.8 MG CAPSULE morphine sulfate/naltrexone hcl NP

QL 4 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA

EMBEDA ER 50-2 MG CAPSULE morphine sulfate/naltrexone hcl NP

QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA




QL 1 CAP / 1 DAY

PA

ENDOCET 10-325 MG TABLET oxycodone hcl/acetaminophen C

QL 5 TABS / 1 DAY

OP

ENDOCET 5-325 TABLET oxycodone hcl/acetaminophen C

QL 8 TABS / 1 DAY

OP

ENDOCET 7.5-325 MG TABLET oxycodone hcl/acetaminophen C

QL 7 TABS / 1 DAY

OP

fentanyl 100 mcg/hr patch NP QL 10 PATCHES / 30

DAYS PA


DAYS PA

fentanyl 25 mcg/hr patch P QL 10 PATCHES / 30

DAYS PA

fentanyl 37.5 mcg/hr patch NP QL 10 PATCHES / 30

DAYS PA

fentanyl 50 mcg/hr patch P QL 10 PATCHES / 30

DAYS PA


DAYS PA


DAYS PA


DAYS PA

hydrocodone er 10 mg capsule NP

QL 4 CAPS / 1 DAY

PA

OP



hydrocodone er 100 mg tablet NP PA

hydrocodone er 120 mg tablet NP PA


QL 4 CAPS / 1 DAY

PA

OP


QL 4 CAPS / 1 DAY

PA

OP

hydrocodone er 20 mg tablet NP QL 4 TABS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA

OP


PA


QL 2 CAPS / 1 DAY

PA

OP


PA


QL 1 CAP / 1 DAY

PA

OP

hydrocodone er 60 mg tablet NP QL 1 TAB / 1 DAY

PA

hydrocodone er 80 mg tablet NP QL 1 TAB / 1 DAY

PA

hydrocodone-acetamin 10-325 mg C QL 8 TABS / 1 DAY

OP

hydrocodone-acetamin 2.5-108/5 C QL 120 ML / 1 DAY

OP



hydrocodone-acetamin 5-217/10 C QL 120 ML / 1 DAY

OP

hydrocodone-acetamin 5-325 mg C QL 8 TABS / 1 DAY

OP

hydrocodone-acetamin 7.5-325 C QL 8 TABS / 1 DAY

OP

hydrocodone-acetamn 7.5-325/15 C QL 120 ML / 1 DAY

OP

hydrocodone-ibuprofen 7.5-200 C QL 8 TABS / 1 DAY

OP

hydromorphone 1 mg/ml solution C QL 20 ML / 1 DAY

OP

hydromorphone 2 mg tablet C QL 8 TABS / 1 DAY

OP

hydromorphone 3 mg suppos C QL 4 SUPP / 1 DAY

OP


OP

hydromorphone 5 mg/5 ml soln C QL 20 ML / 1 DAY

OP


OP

hydromorphone hcl er 12 mg tab NP QL 1 TAB / 1 DAY

PA

hydromorphone hcl er 16 mg tab NP QL 2 TABS / 1 DAY

PA

hydromorphone hcl er 32 mg tab NP QL 1 TAB / 1 DAY

PA

hydromorphone hcl er 8 mg tab NP QL 4 TABS / 1 DAY

PA



HYSINGLA ER 100 MG TABLET hydrocodone bitartrate NP PA

HYSINGLA ER 120 MG TABLET hydrocodone bitartrate NP PA

HYSINGLA ER 20 MG TABLET hydrocodone bitartrate NP

QL 4 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 1 TAB / 1 DAY

PA


QL 1 TAB / 1 DAY

PA

KADIAN ER 10 MG CAPSULE morphine sulfate NP

QL 4 CAPS / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 4 CAPS / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA



LORCET hydrocodone bitartrate/acetaminophen C

QL 8 TABS / 1 DAY

OP

LORCET HD hydrocodone bitartrate/acetaminophen C

QL 8 TABS / 1 DAY

OP

LORCET PLUS hydrocodone bitartrate/acetaminophen C

QL 8 TABS / 1 DAY

OP

methadone 10 mg/5 ml solution NP QL 10 ML / 1 DAY

PA

methadone 10 mg/ml oral conc NP QL 2 ML / 1 DAY

PA

methadone 40 mg tablet dispr NP QL 1 TAB / 1 DAY

PA

methadone 5 mg/5 ml solution NP QL 20 ML / 1 DAY

PA

methadone hcl 10 mg tablet NP QL 2 TABS / 1 DAY

PA

methadone hcl 5 mg tablet NP QL 4 TABS / 1 DAY

PA

METHADONE INTENSOL methadone hcl C

QL 2 ML / 1 DAY

PA

METHADOSE 40 MG TABLET DISPR methadone hcl C

QL 1 TAB / 1 DAY

PA

MORPHABOND ER 100 MG TABLET morphine sulfate NP PA

MORPHABOND ER 15 MG TABLET morphine sulfate NP

QL 5 TABS / 1 DAY

PA

MORPHABOND ER 30 MG TABLET morphine sulfate NP

QL 2 TABS / 1 DAY

PA

MORPHABOND ER 60 MG TABLET morphine sulfate NP PA

morphine sulf 10 mg suppos C QL 6 SUPP / 1 DAY

OP



morphine sulf 10 mg/5 ml soln C QL 30 ML / 1 DAY

OP

morphine sulf 100 mg/5 ml conc C QL 4 ML / 1 DAY

OP


OP

morphine sulf 20 mg/5 ml soln C QL 20 ML / 1 DAY

OP


OP


OP

morphine sulf er 100 mg tablet P QL 1 TAB / 1 DAY

PA

morphine sulf er 15 mg tablet P QL 4 TABS / 1 DAY

PA


PA

morphine sulf er 30 mg tablet P QL 2 TABS / 1 DAY

PA


PA

morphine sulfate er 10 mg cap NP QL 4 CAPS / 1 DAY

PA

morphine sulfate er 100 mg cap NP QL 1 CAP / 1 DAY

PA


PA


PA




PA


PA


PA


PA


PA


PA


PA


PA

morphine sulfate ir 15 mg tab C QL 5 TABS / 1 DAY

OP

MORPHINE SULFATE IR 15 MG TAB (BRAND) morphine sulfate C

QL 5 TABS / 1 DAY

OP

morphine sulfate ir 30 mg tab C QL 2 TABS / 1 DAY

OP

MORPHINE SULFATE IR 30 MG TAB (BRAND) morphine sulfate C

QL 2 TABS / 1 DAY

OP

MS CONTIN ER 100 MG TABLET morphine sulfate NP

QL 1 TAB / 1 DAY

PA


QL 4 TABS / 1 DAY

PA


QL 1 TAB / 1 DAY

PA




QL 2 TABS / 1 DAY

PA


QL 1 TAB / 1 DAY

PA

NUCYNTA ER 100 MG TABLET tapentadol hcl NP

QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 4 TABS / 1 DAY

PA

oxycodone hcl 10 mg tablet C QL 5 TABS / 1 DAY

OP

oxycodone hcl 100 mg/5 ml conc C QL 2 ML / 1 DAY

OP


OP


OP

oxycodone hcl 30 mg tablet C

QL 2 TABS / 1 DAY

PA

OP

oxycodone hcl 5 mg capsule C QL 8 CAPS / 1 DAY

OP


OP

oxycodone hcl 5 mg/5 ml soln C QL 40 ML / 1 DAY

OP



oxycodone hcl er 10 mg tablet NP QL 4 TABS / 1 DAY

PA


PA


PA


PA


PA


PA


PA

oxycodone hcl-aspirin C QL 8 TABS / 1 DAY

OP

oxycodone-acetaminophen 10-325 C QL 5 TABS / 1 DAY

OP

oxycodone-acetaminophen 5-325 C QL 8 TABS / 1 DAY

OP

oxycodone-acetaminophn 7.5-325 C QL 7 TABS / 1 DAY

OP

OXYCONTIN ER 10 MG TABLET oxycodone hcl NP

QL 4 TABS / 1 DAY

PA


QL 3 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA




QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA

oxymorphone hcl er 10 mg tab NP QL 2 TABS / 1 DAY

PA


PA


PA


PA


PA

oxymorphone hcl er 5 mg tablet NP QL 4 TABS / 1 DAY

PA

oxymorphone hcl er 7.5 mg tab NP QL 3 TABS / 1 DAY

PA

tramadol hcl 50 mg tablet C

QL 8 TABS / 1 DAY

AL1 At least 12 yrs old

OP

tramadol hcl-acetaminophen C

QL 8 TABS / 1 DAY


OP

XTAMPZA ER oxycodone myristate NP

QL 2 CAPS / 1 DAY

PA

ZOHYDRO ER 10 MG CAPSULE hydrocodone bitartrate NP

QL 4 CAPS / 1 DAY

PA

OP




QL 4 CAPS / 1 DAY

PA

OP


QL 4 CAPS / 1 DAY

PA

OP


QL 2 CAPS / 1 DAY

PA

OP


QL 2 CAPS / 1 DAY

PA

OP


QL 1 CAP / 1 DAY

PA

OP

OPIATE PARTIAL AGONISTS

BELBUCA 150 MCG FILM buprenorphine hcl P

QL 4 FILMS / 1 DAY

PA


QL 4 FILMS / 1 DAY

PA


QL 4 FILMS / 1 DAY

PA


QL 3 FILMS / 1 DAY

PA


QL 4 FILMS / 1 DAY

PA


QL 2 FILMS / 1 DAY

PA


QL 2 FILMS / 1 DAY

PA



BUNAVAIL 2.1-0.3 MG FILM buprenorphine hcl/naloxone hcl NP

QL 6 FILMS / 1 DAY

PA

BUNAVAIL 4.2-0.7 MG FILM buprenorphine hcl/naloxone hcl NP

QL 3 FILMS / 1 DAY

PA

BUNAVAIL 6.3-1 MG FILM buprenorphine hcl/naloxone hcl NP

QL 2 FILMS / 1 DAY

PA

buprenorphine NP QL 4 PATCHES / 28

DAYS PA

buprenorphine 2 mg tablet sl NP QL 12 TABS / 1 DAY

PA

buprenorphine 8 mg tablet sl NP QL 3 TABS / 1 DAY

PA

buprenorphine-nalox 12-3mg flm NP QL 2 FILMS / 1 DAY

PA

buprenorphine-nalox 2-0.5mg fm NP QL 3 FILMS / 1 DAY

PA

buprenorphine-nalox 2-0.5mg tb P QL 3 TABS / 1 DAY

buprenorphine-nalox 4-1mg film NP QL 3 FILMS / 1 DAY

PA

buprenorphine-nalox 8-2 mg tab P QL 3 TABS / 1 DAY

buprenorphine-nalox 8-2mg film NP QL 3 FILMS / 1 DAY

PA

PROBUPHINE buprenorphine hcl NP PA

SUBLOCADE buprenorphine NP

PA

MED

SUBOXONE 12 MG-3 MG SL FILM buprenorphine hcl/naloxone hcl P QL 2 FILMS / 1 DAY

SUBOXONE 2 MG-0.5 MG SL FILM buprenorphine hcl/naloxone hcl P QL 3 FILMS / 1 DAY





ZUBSOLV NP

QL 12 TABS / 1 DAY

PA

0.7-0.18 MG TABLET SL buprenorphine hcl/naloxone hcl

ZUBSOLV NP

QL 12 TABS / 1 DAY

PA


ZUBSOLV 11.4-2.9 MG TABLET SL buprenorphine hcl/naloxone hcl NP

QL 1 TAB / 1 DAY

PA

ZUBSOLV NP

QL 4 TABS / 1 DAY

PA



QL 3 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


ANOREXIGENICS;RESPIRATORY,CNS STIMULANTS

AMPHETAMINES

ADDERALL XR dextroamphetamine sulf-saccharate/amphetamine sulf-aspartate

P QL 2 CAPS / 1 DAY

ADZENYS ER amphetamine NP

QL 15 ML / 1 DAY

PA

ADZENYS XR-ODT 12.5 MG TABLET amphetamine NP

QL 1 TAB / 1 DAY

PA


QL 1 TAB / 1 DAY

PA


QL 1 TAB / 1 DAY

PA


QL 2 TABS / 1 DAY

PA



QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA

amphetamine NP QL 15 ML / 1 DAY

PA

amphetamine sulfate 10 mg tab NP QL 6 TABS / 1 DAY

PA

amphetamine sulfate 5 mg tab NP QL 4 TABS / 1 DAY

PA

DEXEDRINE dextroamphetamine sulfate NP

QL 4 CAPS / 1 DAY

PA

dextroamp-amphetam 12.5 mg tab P QL 3 TABS / 1 DAY

dextroamp-amphetam 7.5 mg tab P QL 3 TABS / 1 DAY

dextroamp-amphetamin 10 mg tab P QL 3 TABS / 1 DAY

DEXTROAMP-AMPHETAMIN 15 MG TAB (Generic Adderall) P QL 3 TABS / 1 DAY

DEXTROAMP-AMPHETAMIN 20 MG TAB (Generic Adderall) P QL 3 TABS / 1 DAY

dextroamp-amphetamin 30 mg tab P QL 2 TABS / 1 DAY

dextroamp-amphetamine 5 mg tab P QL 3 TABS / 1 DAY

dextroamphetamine 10 mg tab P QL 3 TABS / 1 DAY





dextroamphetamine 5 mg/5 ml NP QL 60 ML / 1 DAY

PA

dextroamphetamine sulfate er P QL 4 CAPS / 1 DAY

dextroamphetamine-amphet er NP QL 2 CAPS / 1 DAY

PA



DYANAVEL XR amphetamine NP

QL 8 ML / 1 DAY

PA

EVEKEO 10 MG TABLET amphetamine sulfate NP

QL 6 TABS / 1 DAY

PA

EVEKEO 5 MG TABLET amphetamine sulfate NP

QL 4 TABS / 1 DAY

PA

MYDAYIS dextroamphetamine sulf-saccharate/amphetamine sulf-aspartate

NP QL 1 CAP / 1 DAY

PA

PROCENTRA dextroamphetamine sulfate NP

QL 60 ML / 1 DAY

PA

VYVANSE 10 MG CAPSULE lisdexamfetamine dimesylate P QL 2 CAPS / 1 DAY

VYVANSE 10 MG CHEWABLE TABLET lisdexamfetamine dimesylate NP

QL 2 CHEW TABS / 1 DAY

PA




PA




PA

VYVANSE 40 MG CAPSULE lisdexamfetamine dimesylate P QL 1 CAP / 1 DAY


QL 1 CHEW TAB / 1 DAY

PA




PA






PA


ZENZEDI 10 MG TABLET dextroamphetamine sulfate NP

QL 3 TABS / 1 DAY

PA


QL 3 TABS / 1 DAY

PA

ZENZEDI 2.5 MG TABLET dextroamphetamine sulfate NP

QL 3 TABS / 1 DAY

PA


QL 3 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 3 TABS / 1 DAY

PA

ZENZEDI 7.5 MG TABLET dextroamphetamine sulfate NP

QL 3 TABS / 1 DAY

PA

RESPIRATORY AND CNS STIMULANTS

ADHANSIA XR 25 MG CAPSULE methylphenidate hcl NP

QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA



APTENSIO XR 10 MG CAPSULE methylphenidate hcl NP

QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA

CONCERTA ER 18 MG TABLET methylphenidate hcl P QL 2 TABS / 1 DAY



CONCERTA ER 54 MG TABLET methylphenidate hcl P QL 1 TAB / 1 DAY

COTEMPLA XR-ODT methylphenidate NP

QL 2 TABS / 1 DAY

PA

DAYTRANA methylphenidate NP

QL 1 PATCH / 1 DAY

PA

dexmethylphenidate er 10 mg cp NP QL 2 CAPS / 1 DAY

PA


PA


PA



dexmethylphenidate er 25 mg cp NP QL 1 CAP / 1 DAY

PA


PA


PA


PA

dexmethylphenidate er 5 mg cap NP QL 2 CAPS / 1 DAY

PA

dexmethylphenidate hcl P QL 2 TABS / 1 DAY

FOCALIN dexmethylphenidate hcl NP

QL 2 TABS / 1 DAY

PA

FOCALIN XR 10 MG CAPSULE dexmethylphenidate hcl P QL 2 CAPS / 1 DAY



FOCALIN XR 25 MG CAPSULE dexmethylphenidate hcl P QL 1 CAP / 1 DAY





JORNAY PM methylphenidate hcl NP

QL 1 CAP / 1 DAY

PA

METADATE ER methylphenidate hcl C QL 3 TABS / 1 DAY

METHYLIN 10 MG/5 ML SOLUTION methylphenidate hcl P QL 30 ML / 1 DAY



METHYLIN 5 MG/5 ML SOLUTION methylphenidate hcl P QL 60 ML / 1 DAY

methylphenidate 10 mg chew tab NP QL 6 CHEW TABS / 1

DAY PA

methylphenidate 10 mg tablet P QL 3 TABS / 1 DAY

methylphenidate 10 mg/5 ml sol P QL 30 ML / 1 DAY

methylphenidate 2.5 mg chew tb NP QL 4 CHEW TABS / 1

DAY PA


methylphenidate 5 mg chew tab NP QL 4 CHEW TABS / 1

DAY PA


methylphenidate 5 mg/5 ml soln P QL 60 ML / 1 DAY

methylphenidate cd 10 mg cap NP QL 2 CAPS / 1 DAY

PA


PA


PA

methylphenidate cd 40 mg cap NP QL 1 CAP / 1 DAY

PA


PA


PA

methylphenidate er 10 mg cap (authorized generic) NP QL 2 CAPS / 1 DAY

PA

methylphenidate er 10 mg tab C QL 4 TABS / 1 DAY




PA

methylphenidate er 18 mg tab NP QL 2 TABS / 1 DAY

PA


PA

methylphenidate er 20 mg tab P QL 3 TABS / 1 DAY


PA


PA


PA

methylphenidate er 40 mg cap (authorized generic) NP QL 1 CAP / 1 DAY

PA


PA

methylphenidate er 54 mg tab NP QL 1 TAB / 1 DAY

PA


PA

methylphenidate er 72 mg tab NP QL 1 TAB / 1 DAY

PA

methylphenidate er(cd) 10mg cp NP QL 2 CAPS / 1 DAY

PA


PA


PA



methylphenidate er(cd) 40mg cp NP QL 1 CAP / 1 DAY

PA


PA


PA

methylphenidate er(la) 10mg cp NP QL 2 CAPS / 1 DAY

PA


PA


PA

methylphenidate er(la) 40mg cp NP QL 1 CAP / 1 DAY

PA

methylphenidate la 10 mg cap NP QL 2 CAPS / 1 DAY

PA


PA


PA

methylphenidate la 40 mg cap NP QL 1 CAP / 1 DAY

PA

methylphenidate la 60 mg cap NP QL 1 CAP / 1 DAY

PA

QUILLICHEW ER 20 MG CHEW TAB methylphenidate hcl NP


PA



PA



PA



QUILLIVANT XR methylphenidate hcl NP

QL 12 ML / 1 DAY

PA

RITALIN methylphenidate hcl NP

QL 3 TABS / 1 DAY

PA

RITALIN LA 10 MG CAPSULE methylphenidate hcl P QL 2 CAPS / 1 DAY



RITALIN LA 40 MG CAPSULE methylphenidate hcl P QL 1 CAP / 1 DAY

WAKEFULNESS-PROMOTING AGENTS

armodafinil 150 mg tablet C QL 1 TAB / 1 DAY



armodafinil 50 mg tablet C QL 2 TABS / 1 DAY

modafinil C QL 2 TABS / 1 DAY

SUNOSI solriamfetol hcl C

QL 1 TAB / 1 DAY

PA

WAKIX pitolisant hcl C

PA

S Specialty Drug


ANTI-INFECTIVE AGENTS

ANTHELMINTICS

albendazole C PA

ivermectin 3 mg tablet C

PIN-X C

PINAWAY C

PINWORM MEDICINE C

PINWORM TREATMENT C

praziquantel C


REESE'S PINWORM C

URINARY ANTI-INFECTIVES

fosfomycin tromethamine C QL 1 PACKET / Rx

nitrofurantoin 25 mg/5 ml susp C AL1 Up to 12 yrs old

nitrofurantoin mcr 100 mg cap C

nitrofurantoin mcr 25 mg cap C AL1 Up to 12 yrs old

nitrofurantoin mcr 50 mg cap C

nitrofurantoin mono-macro C

PHOSPHASAL C

trimethoprim C


ANTI-INFECTIVES (EENT)

ANTIBACTERIALS (EENT)

AK-POLY-BAC bacitracin/polymyxin b sulfate C

AZASITE azithromycin NP PA

bacitracin 500 unit/gm ophth C

bacitracin-polymyxin C

BESIVANCE besifloxacin hcl NP PA

BLEPH-10 sulfacetamide sodium C

BLEPHAMIDE S.O.P. sulfacetamide sodium/prednisolone acetate C

CILOXAN ciprofloxacin hcl NP PA

CIPRO HC ciprofloxacin hcl/hydrocortisone P

CIPRODEX ciprofloxacin hcl/dexamethasone P

ciprofloxacin 0.2% otic soln NP PA

ciprofloxacin 0.3% eye drop P

ciprofloxacin hcl-fluocinolone NP PA


ciprofloxacin-dexamethasone C

doxycycline hyclate 20 mg tab C

erythromycin 0.5% eye ointment C

gatifloxacin NP PA

GENTAK gentamicin sulfate C

levofloxacin 0.5% eye drops NP PA

MOXEZA moxifloxacin hcl NP PA

moxifloxacin 0.5% eye drops P

NEO-POLYCIN neomycin sulfate/bacitracin/polymyxin b C

neomycin-bacitracin-polymyxin C

neomycin-polymyxin-dexameth C

neomycin-polymyxin-gramicidin C

neomycin-polymyxin-hc ear susp P

neomycin-polymyxin-hydrocort P

OCUFLOX ofloxacin NP PA

ofloxacin 0.3% ear drops P

ofloxacin 0.3% eye drops P

OTIPRIO ciprofloxacin NP PA

OTOVEL ciprofloxacin hcl/fluocinolone acetonide NP PA

POLYCIN bacitracin/polymyxin b sulfate C

polymyxin b sul-trimethoprim C

sulfacetamide 10% eye drops C

sulfacetamide 10% eye ointment C

sulfacetamide-prednisolone C

TOBRADEX EYE OINTMENT tobramycin/dexamethasone C

tobramycin 0.3% eye drop C



tobramycin-dexamethasone C

TOBREX 0.3% EYE OINTMENT tobramycin C

VIGAMOX moxifloxacin hcl NP PA

ZYMAXID gatifloxacin NP PA

ANTIVIRALS (EENT)

trifluridine C

ZIRGAN ganciclovir C

EENT ANTI-INFECTIVES, MISCELLANEOUS

acetic acid 2% ear solution C

chlorhexidine gluconate C

EAR WAX REMOVAL C OTC

PAROEX chlorhexidine gluconate C

PERIOGARD chlorhexidine gluconate C


ANTI-INFECTIVES (SKIN, MUCOUS MEMBRANE)

ANTIBACTERIALS (SKIN, MUCOUS MEMBRANE)

ACANYA clindamycin phosphate/benzoyl peroxide NP PA

bacitracin 500 unit/gm ointmnt C OTC

bacitracin zinc C OTC

BENZACLIN clindamycin phosphate/benzoyl peroxide NP PA

CENTANY mupirocin NP PA

CENTANY AT mupirocin NP PA

CLEOCIN 100 MG VAGINAL OVULE clindamycin phosphate C

CLEOCIN T 1% GEL clindamycin phosphate NP PA


CLEOCIN T 1% LOTION clindamycin phosphate NP PA

CLINDACIN P clindamycin phosphate NP PA

CLINDACIN PAC clindamycin phosphate/skin cleanser comb no.19 NP PA

CLINDAGEL clindamycin phosphate NP PA

clindamycin 2% vaginal cream C

clindamycin ph 1% gel (generic for Cleocin T) P

clindamycin ph 1% solution P

clindamycin phos 1% pledget P

clindamycin phos-benzoyl perox P

clindamycin phos-tretinoin NP PA

clindamycin phosp 1% lotion P

clindamycin phosphate 1% foam NP PA

clindamycin phosphate 1% gel (generic for Clindagel) P

clindamycin-benzoyl perox 1-5% P

clindamycin-bnz perox 1-5% pmp NP PA

ERY erythromycin base in ethanol C

erythromycin 2% gel P

erythromycin 2% pledgets P

erythromycin 2% solution P QL 60 ML / 30 DAYS

erythromycin-benzoyl peroxide P

FIRST AID ANTIBIOTIC C OTC

gentamicin 0.1% cream C QL 30 GM / 30 DAYS

gentamicin 0.1% ointment C

HM TRIPLE ANTIBIOTIC OINTMENT C OTC

metronidazole 0.75% cream C

metronidazole 0.75% lotion C

metronidazole topical 0.75% gl C



metronidazole vaginal 0.75% gl C

mupirocin 2% cream NP QL 30 GM / 30 DAYS

PA

mupirocin 2% ointment P

NEOSPORIN neomycin sulfate/bacitracin zinc/polymyxin b C OTC

NEUAC 1.2-5% KIT clindamycin phosphate/benzoyl peroxide/emollient comb no.94 NP PA

NEUAC GEL clindamycin phosphate/benzoyl peroxide NP PA

ONEXTON 1.2%-3.75% GEL clindamycin phosphate/benzoyl peroxide NP PA

ONEXTON GEL PUMP clindamycin phosphate/benzoyl peroxide NP PA

qc bacitracin 500 unit/gm oint C OTC

ROSADAN 0.75% CREAM metronidazole C

TRIPLE ANTIBIOTIC OINTMENT neomycin sulfate/bacitracin zinc/polymyxin b C OTC

TRIPLE ANTIBIOTIC OINTMENT PKT neomycin sulfate/bacitracin zinc/polymyxin b C OTC

TRIPLE ANTIBIOTIC-PAIN RELIEF C OTC

XEPI ozenoxacin NP PA

ZIANA clindamycin phosphate/tretinoin NP PA

ANTIVIRALS (SKIN AND MUCOUS MEMBRANE)

acyclovir 5% cream NP QL 5 GM / RX

PA

acyclovir 5% ointment P

DENAVIR penciclovir P

XERESE acyclovir/hydrocortisone NP PA

ZOVIRAX 5% CREAM acyclovir NP PA



ZOVIRAX 5% OINTMENT acyclovir NP PA

LOCAL ANTI-INFECTIVES, MISCELLANEOUS

ALCOHOL PREP PADS alcohol antiseptic pads C OTC

BETADINE 10% SOLUTION povidone-iodine C OTC

DERMAZENE CREAM C

hydrocortisone-iodoquinol C

povidone-iodine 10% ointment C OTC

povidone-iodine 10% solution C OTC

selenium sulfide 2.5% lotion C

silver sulfadiazine C

sod sulface-sulfur 9-4.5% wash P

sodium sulf-sulfur cleanser C

sodium sulfacetamide 10% lotn P

sodium sulfacetamide 10% wash P

SSD silver sulfadiazine C

sulfacetamide sod 10% top susp P

SCABICIDES AND PEDICULICIDES

COMPLETE LICE TREATMENT P OTC

CROTAN crotamiton NP PA

EURAX 10% LOTION crotamiton NP PA

LICE KILLING P OTC

LICE SOLUTION C OTC

LICE TREATMENT P OTC

lindane NP PA

malathion NP PA

NATROBA spinosad P



OVIDE malathion NP PA

permethrin P

SKLICE ivermectin NP PA

spinosad NP PA


ANTI-INFLAMMATORY AGENTS (EENT)

CORTICOSTEROIDS (EENT)

24 HOUR ALLERGY fluticasone propionate C OTC

24 HOUR NASAL ALLERGY triamcinolone acetonide C OTC

ALLER-CORT triamcinolone acetonide C OTC

ALREX loteprednol etabonate NP PA

BECONASE AQ beclomethasone dipropionate NP PA

dexamethasone 0.1% eye drop C

flunisolide NP PA

fluocinolone acetonide oil C

fluorometholone P

fluticasone prop 50 mcg spray P OTC

fluticasone prop 50 mcg spray (Rx only) P OTC

FML S.O.P. fluorometholone C

gnp fluticasone prop 50 mcg sp C OTC

HM ALLERGY RELIEF 50 MCG SPRAY fluticasone propionate C

loteprednol etabonate 0.5% drp C

mometasone furoate 50 mcg spry P

NASONEX mometasone furoate NP PA

OMNARIS ciclesonide NP PA


prednisolone ac 1% eye drop (Generic Pred Forte) P

prednisolone sod 1% eye drop C

QNASL beclomethasone dipropionate NP PA

QNASL CHILDREN beclomethasone dipropionate NP PA

ra budesonide 32 mcg spray NP PA

OTC

SINUVA mometasone furoate NP

PA

MED

SM ALLERGY RELIEF 50 MCG SPRAY fluticasone propionate C

TICANASE fluticasone propionate/sodium chloride/sodium bicarbonate NP PA

triamcinolone 55 mcg nasal spr C OTC

XHANCE fluticasone propionate NP PA

ZETONNA ciclesonide NP PA

EENT ANTI-INFLAMMATORY AGENTS, MISC.

RESTASIS cyclosporine C PA

RESTASIS MULTIDOSE cyclosporine C PA

EENT NONSTEROIDAL ANTI-INFLAM. AGENTS

ACULAR ketorolac tromethamine NP PA

ACULAR LS ketorolac tromethamine NP PA

ACUVAIL ketorolac tromethamine/pf NP PA

bromfenac sodium NP PA

BROMSITE bromfenac sodium NP PA

diclofenac 0.1% eye drops P



flurbiprofen sodium NP PA

ketorolac 0.4% ophth solution P

ketorolac 0.5% ophth solution P

NEVANAC nepafenac NP PA

PROLENSA bromfenac sodium NP PA


ANTI-INFLAMMATORY AGENTS (RESPIRATORY)

INTERLEUKIN ANTAGONISTS

DUPIXENT 200 MG/1.14 ML PEN dupilumab NP

QL 2.28 ML / 28 DAYS

PA

S Specialty Drug

DUPIXENT 200 MG/1.14 ML SYRING dupilumab NP


PA

S Specialty Drug

FASENRA PEN benralizumab C

PA

S Specialty Drug

NUCALA 100 MG/ML AUTO-INJECTOR mepolizumab C

PA

S Specialty Drug

NUCALA 100 MG/ML SYRINGE mepolizumab C

PA

S Specialty Drug

LEUKOTRIENE MODIFIERS

ACCOLATE zafirlukast NP PA

montelukast sod 10 mg tablet P

montelukast sod 4 mg granules NP PA

montelukast sod 4 mg tab chew P

montelukast sod 5 mg tab chew P

SINGULAIR montelukast sodium NP PA

zafirlukast P

zileuton er NP PA


ZYFLO zileuton NP PA

MAST-CELL STABILIZERS

ALOCRIL nedocromil sodium NP PA

cromolyn 20 mg/2 ml neb soln C

cromolyn 4% eye drops P

NASALCROM cromolyn sodium C OTC


ANTI-INFLAMMATORY AGENTS (SKIN, MUCOUS)

ANTI-INFLAMMATORY AGENTS, MISC (SKIN)

EUCRISA crisaborole NP

QL 60 GM / 30 DAYS

PA

CORTICOSTEROIDS (SKIN, MUCOUS MEMBRANE)

ALA-CORT 1% CREAM hydrocortisone C

alclometasone dipropionate C

ANTI-ITCH 1% CREAM C OTC

ANUCORT-HC C

AQUANIL HC C OTC

AQUAPHOR ITCH RELIEF C OTC

betamethasone dipropionate C

betamethasone dp aug 0.05% crm C

betamethasone dp aug 0.05% gel C

betamethasone dp aug 0.05% lot C

betamethasone dp aug 0.05% oin C

betamethasone va 0.1% cream C

betamethasone va 0.1% lotion C

betamethasone valer 0.1% ointm C

clobetasol 0.05% cream C

clobetasol 0.05% gel C

clobetasol 0.05% ointment C


clobetasol 0.05% solution C

clobetasol emollient 0.05% crm C

COLOCORT hydrocortisone C

CORMAX clobetasol propionate C

CVS ANTI-ITCH 1% CREAM C OTC

desonide 0.05% cream C

desonide 0.05% lotion C

desonide 0.05% ointment C

desoximetasone 0.05% cream C

desoximetasone 0.05% gel C

desoximetasone 0.25% cream C

desoximetasone 0.25% ointment C

eq hydrocortisone 1% cream C OTC

EQL ANTI-ITCH 1% CREAM C OTC

fluocinolone 0.01% body oil C

fluocinolone 0.01% cream C

fluocinolone 0.01% scalp oil C

fluocinolone 0.01% solution C QL 60 ML / 30 DAYS

fluocinolone 0.025% cream C

fluocinolone 0.025% ointment C

fluocinonide C

fluocinonide-e C

fluticasone prop 0.005% oint C

fluticasone prop 0.05% cream C

gnp hydrocort acetate 1% cr C OTC

gnp hydrocortisone 1% ointment C OTC

GS ANTI-ITCH 1% CREAM C OTC

hydrocort-pramoxine 1%-1% crm C



hydrocort-pramoxine 2.5-1% crm C

hydrocortisone 0.5% cream C OTC

hydrocortisone 0.5% ointment C OTC

hydrocortisone 1% cream C OTC

hydrocortisone 1% cream packet C

hydrocortisone 1% lotion C OTC

hydrocortisone 1% ointment C OTC

hydrocortisone 100 mg/60 ml C

hydrocortisone 2.5% cream C

hydrocortisone 2.5% lotion C

hydrocortisone 2.5% ointment C

hydrocortisone ac 25 mg supp C

hydrocortisone buty 0.1% cream C

hydrocortisone butyr 0.1% oint C

hydrocortisone valerate C

HYDROCORTISONE-1% OINTMENT C OTC

hydrocortisone-aloe C OTC

lidocaine-hc 3-0.5% cream C

mometasone furoate 0.1% cream C

mometasone furoate 0.1% oint C

mometasone furoate 0.1% soln C

ORALONE triamcinolone acetonide C

PREPARATION H HC 1% CREAM C OTC

PROCTO-MED HC hydrocortisone C

PROCTOSOL-HC hydrocortisone C

PROCTOZONE-HC hydrocortisone C

QC ANTI-ITCH 1% CREAM C OTC



RA ANTI-ITCH 1% CREAM C OTC

sm hydrocortisone 0.5% ointmnt C OTC

sm hydrocortisone 1% ointment C OTC

triamcinolone 0.025% cream C

triamcinolone 0.025% lotion C

triamcinolone 0.025% oint C


triamcinolone 0.1% lotion C

triamcinolone 0.1% ointment C

triamcinolone 0.1% paste C


triamcinolone 0.5% ointment C

TRIDERM triamcinolone acetonide C


ANTIANEMIA DRUGS

IRON PREPARATIONS

children's ferrous sulfate C OTC

FERGON C OTC

FEROSUL C OTC

FERREX 150 PLUS C OTC

FERROCITE PLUS C OTC

ferrous fumarate C OTC

ferrous gluconate C OTC

ferrous sulf 15 mg iron/ml drp C OTC

ferrous sulf 220 mg/5 ml elix C OTC

ferrous sulf 220 mg/5 ml liq C OTC

ferrous sulf 300 mg/5 ml liq C OTC

ferrous sulf 300 mg/6.8ml soln C OTC


ferrous sulf 44 mg iron/5ml lq C OTC

ferrous sulf ec 325 mg tablet C OTC

ferrous sulfate 325 mg tablet C OTC

HEMATOGEN FORTE C OTC

iron C OTC

NU-IRON 150 iron polysaccharide complex C OTC

PEDIATRIC FE-VITE C OTC

pediatric iron C OTC

polysaccharide iron C OTC


ANTIARRHYTHMIC AGENTS

CLASS IA ANTIARRHYTHMICS

disopyramide phosphate C

NORPACE CR disopyramide phosphate C

quinidine sulfate C

CLASS IB ANTIARRHYTHMICS

mexiletine hcl C

CLASS IC ANTIARRHYTHMICS

flecainide acetate C

propafenone hcl C

CLASS III ANTIARRHYTHMICS

amiodarone hcl 100 mg tablet C



dofetilide C

MULTAQ dronedarone hcl C PA

PACERONE 100 MG TABLET amiodarone hcl C

PACERONE 200 MG TABLET amiodarone hcl C



ANTIBACTERIALS

AMINOGLYCOSIDE ANTIBIOTICS

BETHKIS tobramycin P

PA

S Specialty Drug

gentamicin 40 mg/ml vial C

gentamicin 80 mg/2 ml vial C

gentamicin 800 mg/20 ml vial C

KITABIS PAK tobramycin/nebulizer P

PA

S Specialty Drug

neomycin sulfate C

TOBI tobramycin in 0.225 % sodium chloride NP

PA

S Specialty Drug

TOBI PODHALER tobramycin NP

PA

S Specialty Drug

tobramycin 300 mg/4 ml ampule NP PA

S Specialty Drug

tobramycin 300 mg/5 ml ampule NP PA

S Specialty Drug

tobramycin pak 300 mg/5 ml NP PA

S Specialty Drug

tobramycin sulfate NP PA

QUINOLONE ANTIBIOTICS

BAXDELA 450 MG TABLET delafloxacin meglumine NP PA

CIPRO 10% SUSPENSION ciprofloxacin NP PA

CIPRO 250 MG TABLET ciprofloxacin hcl NP PA

CIPRO 5% SUSPENSION ciprofloxacin NP PA

CIPRO 500 MG TABLET ciprofloxacin hcl NP PA


ciprofloxacin NP PA

ciprofloxacin hcl 100 mg tab P




levofloxacin 25 mg/ml solution P

levofloxacin 250 mg tablet P



moxifloxacin hcl NP PA

ofloxacin 300 mg tablet NP PA

ofloxacin 400 mg tablet NP PA

SULFONAMIDE ANTIBIOTICS (SYSTEMIC)

AZULFIDINE sulfasalazine NP PA

sulfamethoxazole-tmp ds tablet C

sulfamethoxazole-tmp ss tablet C

sulfamethoxazole-tmp susp C

sulfasalazine P

sulfasalazine dr P

SULFATRIM sulfamethoxazole/trimethoprim C

TETRACYCLINE ANTIBIOTICS

demeclocycline hcl C

doxycycline 25 mg/5 ml susp C

doxycycline hyclate 100 mg cap C

doxycycline hyclate 100 mg tab C

doxycycline hyclate 50 mg cap C

doxycycline mono 100 mg cap C

doxycycline mono 100 mg tablet C

doxycycline mono 50 mg cap C



doxycycline mono 50 mg tablet C

minocycline 100 mg capsule C



OKEBO doxycycline monohydrate C


ANTIBACTERIALS, MISCELLANEOUS

GLYCOPEPTIDE ANTIBIOTICS

vancomycin hcl 125 mg capsule C

vancomycin hcl 250 mg capsule C

LINCOMYCIN ANTIBIOTICS

clindamycin (pediatric) C AL1 Up to 12 yrs old

clindamycin hcl C

OXAZOLIDINONE ANTIBIOTICS

linezolid 100 mg/5 ml susp C PA

linezolid 600 mg tablet C QL 28 TABLETS / Rx

SIVEXTRO 200 MG TABLET tedizolid phosphate C PA

PLEUROMUTILINS

XENLETA 600 MG TABLET lefamulin acetate C

QL 10 TABS / RX

PA

RIFAMYCIN ANTIBIOTICS

XIFAXAN rifaximin C PA

ANTICHOLINERGIC AGENTS

ANTIMUSCARINICS/ANTISPASMODICS

ANORO ELLIPTA umeclidinium bromide/vilanterol trifenatate P

ATROVENT HFA ipratropium bromide P

BEVESPI AEROSPHERE glycopyrrolate/formoterol fumarate NP PA


COMBIVENT RESPIMAT ipratropium bromide/albuterol sulfate P

CUVPOSA glycopyrrolate C PA

dicyclomine 10 mg capsule C

dicyclomine 10 mg/5 ml soln C

dicyclomine 20 mg tablet C

DUAKLIR PRESSAIR aclidinium bromide/formoterol fumarate NP PA

ED-SPAZ C

glycopyrrolate 1 mg tablet C

glycopyrrolate 2 mg tablet C

hyoscyamine 0.125 mg odt C

hyoscyamine 0.125 mg tab sl C

hyoscyamine 0.125 mg/5 ml elix C

hyoscyamine 0.125 mg/ml drop C

hyoscyamine sulf 0.125 mg tab C

hyoscyamine sulfate er C

hyoscyamine sulfate sr C

HYOSYNE C

INCRUSE ELLIPTA umeclidinium bromide NP PA

ipratropium br 0.02% soln P

ipratropium-albuterol P

LONHALA MAGNAIR REFILL glycopyrrolate/nebulizer accessories NP PA

LONHALA MAGNAIR STARTER glycopyrrolate/nebulizer and accessories NP PA

OSCIMIN C

OSCIMIN SL C

OSCIMIN SR C

propantheline bromide C

SEEBRI NEOHALER glycopyrrolate NP PA



SPIRIVA tiotropium bromide P

SPIRIVA RESPIMAT tiotropium bromide P

STIOLTO RESPIMAT tiotropium bromide/olodaterol hcl P

SYMAX-SR C

TUDORZA PRESSAIR aclidinium bromide P

YUPELRI revefenacin NP PA


ANTICOAGULANTS

ANTICOAGULANTS, MISCELLANEOUS

ARIXTRA fondaparinux sodium NP PA

fondaparinux sodium NP PA

THROMBATE III antithrombin iii (human plasma derived) C

S Specialty Drug

MED

COUMARIN DERIVATIVES

coumadin 1 mg tablet NP QL 10 TABS / 1 DAY

PA


PA


PA

coumadin 2.5 mg tablet NP QL 8 TABS / 1 DAY

PA


PA


PA


PA



PA

coumadin 7.5 mg tablet NP QL 3 TABS / 1 DAY

PA

jantoven 1 mg tablet P QL 10 TABS / 1 DAY



jantoven 2.5 mg tablet P QL 8 TABS / 1 DAY





jantoven 7.5 mg tablet P QL 3 TABS / 1 DAY

warfarin sodium 1 mg tablet P QL 10 TABS / 1 DAY



warfarin sodium 2.5 mg tablet P QL 8 TABS / 1 DAY





warfarin sodium 7.5 mg tablet P QL 3 TABS / 1 DAY

DIRECT FACTOR XA INHIBITORS

BEVYXXA betrixaban maleate NP PA

ELIQUIS 2.5 MG TABLET apixaban P QL 2 TABS / 1 DAY

ELIQUIS 5 MG TABLET apixaban P QL 2 TABS / 1 DAY



ELIQUIS DVT-PE TREAT START 5MG apixaban P QL 74 TABS / 30 DAYS

SAVAYSA edoxaban tosylate NP PA

XARELTO 10 MG TABLET rivaroxaban P QL 1 TAB / 1 DAY

XARELTO 15 MG TABLET rivaroxaban P QL 2 TABS / 1 DAY

XARELTO 2.5 MG TABLET rivaroxaban NP

QL 2 TABS / 1 DAY

PA

XARELTO 20 MG TABLET rivaroxaban P QL 1 TAB / 1 DAY

XARELTO DVT-PE TREAT START 30D rivaroxaban NP

QL 51 TABS / 30 DAYS

PA

DIRECT THROMBIN INHIBITORS

PRADAXA dabigatran etexilate mesylate P QL 2 CAPS / 1 DAY

HEPARINS

enoxaparin 100 mg/ml syringe P QL 28 ML / 14 DAYS

enoxaparin 120 mg/0.8 ml syr P QL 28 ML / 14 DAYS

enoxaparin 150 mg/ml syringe P QL 28 ML / 14 DAYS

enoxaparin 30 mg/0.3 ml syr P QL 8.4 ML / 14 DAYS

enoxaparin 300 mg/3 ml vial P QL 84 ML / 14 DAYS



enoxaparin 80 mg/0.8 ml syr P QL 28 ML / 14 DAYS

FRAGMIN 10,000 UNIT/ML SYRINGE dalteparin sodium,porcine NP

QL 10 ML / 14 DAYS

PA

FRAGMIN 12,500 UNIT/0.5 ML SYR dalteparin sodium,porcine NP

QL 14 ML / 14 DAYS

PA



PA



FRAGMIN 18,000 UNIT/0.72 ML dalteparin sodium,porcine NP

QL 20.16 ML / 14 DAYS

PA


QL 5.6 ML / 14 DAYS

PA


QL 5.6 ML / 14 DAYS

PA


QL 8.4 ML / 14 DAYS

PA

FRAGMIN 95,000 UNIT/3.8 ML VL dalteparin sodium,porcine P QL 22.8 ML / 14 DAYS

heparin 10,000 unit/10 ml vial C



heparin 5,000 unit/ml carpujct C



heparin sod 1,000 unit/ml vial C

heparin sod 10,000 unit/ml vl C

heparin sod 20,000 unit/ml vl C

heparin sod 5,000 unit/0.5 ml C

heparin sod 5,000 unit/ml syrg C

heparin sod 5,000 unit/ml vial C

LOVENOX 100 MG/ML SYRINGE enoxaparin sodium NP

QL 28 ML / 14 DAYS

PA

LOVENOX 120 MG/0.8 ML SYRINGE enoxaparin sodium NP

QL 28 ML / 14 DAYS

PA

LOVENOX 150 MG/ML SYRINGE enoxaparin sodium NP

QL 28 ML / 14 DAYS

PA


QL 8.4 ML / 14 DAYS

PA

LOVENOX 300 MG/3 ML VIAL enoxaparin sodium NP

QL 84 ML / 14 DAYS

PA





PA



PA


QL 28 ML / 14 DAYS

PA


ANTICONVULSANTS

ANTICONVULSANTS, MISCELLANEOUS

APTIOM eslicarbazepine acetate NP PA

BANZEL 200 MG TABLET rufinamide NP

QL 16 TABS / 1 DAY

PA

BANZEL 40 MG/ML SUSPENSION rufinamide NP

QL 80 ML / 1 DAY

PA

BANZEL 400 MG TABLET rufinamide NP

QL 8 TABS / 1 DAY

PA

BRIVIACT 10 MG TABLET brivaracetam NP PA

BRIVIACT 10 MG/ML ORAL SOLN brivaracetam NP PA





carbamazepine 100 mg tab chew P

carbamazepine 100 mg/5 ml susp P

carbamazepine 200 mg tablet P

carbamazepine 200 mg/10ml susp C

carbamazepine er 100 mg cap NP PA


carbamazepine er 100 mg tablet P





CARBATROL carbamazepine NP PA

DEPAKOTE divalproex sodium NP PA

DEPAKOTE ER divalproex sodium NP PA

DEPAKOTE SPRINKLE divalproex sodium NP PA

DIACOMIT 250 MG CAPSULE stiripentol NP

QL 12 CAPS / 1 DAY

PA

S Specialty Drug

DIACOMIT 250 MG POWDER PACKET stiripentol NP

QL 12 PACKETS / 1 DAY

PA

S Specialty Drug

DIACOMIT 500 MG CAPSULE stiripentol NP

QL 6 CAPS / 1 DAY

PA

S Specialty Drug

DIACOMIT 500 MG POWDER PACKET stiripentol NP


PA

S Specialty Drug

divalproex sodium P

divalproex sodium er P

EPIDIOLEX cannabidiol (cbd) NP

QL 20 ML / 1 DAY

PA

S Specialty Drug

EPITOL carbamazepine C

felbamate P



FELBATOL 400 MG TABLET felbamate NP PA

FELBATOL 600 MG TABLET felbamate NP PA

FELBATOL 600 MG/5 ML SUSP felbamate P

FINTEPLA fenfluramine hcl NP

PA

S Specialty Drug

FYCOMPA perampanel NP PA

gabapentin 100 mg capsule P QL 12 CAPS / 1 DAY

gabapentin 250 mg/5 ml soln P QL 72 ML / 1 DAY


gabapentin 300 mg/6 ml soln P QL 72 ML / 1 DAY


gabapentin 600 mg tablet P QL 6 TABS / 1 DAY

gabapentin 800 mg tablet P QL 4 TABS / 1 DAY

GABITRIL tiagabine hcl P

HORIZANT ER 300 MG TABLET gabapentin enacarbil NP

QL 1 TAB / 1 DAY

PA

HORIZANT ER 600 MG TABLET gabapentin enacarbil NP

QL 2 TABS / 1 DAY

PA

KEPPRA 1,000 MG TABLET levetiracetam NP PA

KEPPRA 100 MG/ML ORAL SOLN levetiracetam NP PA

KEPPRA 250 MG TABLET levetiracetam NP PA


KEPPRA 500 MG/5 ML VIAL levetiracetam NP

QL 3 ML / 1 DAY

PA




KEPPRA XR levetiracetam NP PA

LAMICTAL lamotrigine NP PA

LAMICTAL (BLUE) lamotrigine NP PA

LAMICTAL (GREEN) lamotrigine NP PA

LAMICTAL (ORANGE) lamotrigine NP PA

LAMICTAL ODT lamotrigine NP PA

LAMICTAL ODT (BLUE) lamotrigine NP PA

LAMICTAL ODT (GREEN) lamotrigine NP PA

LAMICTAL ODT (ORANGE) lamotrigine NP PA

LAMICTAL XR lamotrigine NP PA

LAMICTAL XR (BLUE) lamotrigine NP PA

LAMICTAL XR (GREEN) lamotrigine NP PA

LAMICTAL XR (ORANGE) lamotrigine NP PA

lamotrigine P

lamotrigine (blue) NP PA

lamotrigine (green) NP PA

lamotrigine (orange) NP PA

lamotrigine er P

lamotrigine odt NP PA

lamotrigine odt (blue) NP PA

lamotrigine odt (green) NP PA



lamotrigine odt (orange) NP PA

levetiracetam 1,000 mg tablet P

levetiracetam 100 mg/ml soln P

levetiracetam 1000 mg/10 ml P

levetiracetam 250 mg tablet P


levetiracetam 500 mg/5 ml soln P


levetiracetam er P

LYRICA 100 MG CAPSULE pregabalin NP

QL 3 CAPS / 1 DAY

PA


QL 3 CAPS / 1 DAY

PA

LYRICA 20 MG/ML ORAL SOLUTION pregabalin NP

QL 30 ML / 1 DAY

PA


QL 3 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 3 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 3 CAPS / 1 DAY

PA


QL 3 CAPS / 1 DAY

PA

NEURONTIN 100 MG CAPSULE gabapentin NP

QL 12 CAPS / 1 DAY

PA

NEURONTIN 250 MG/5 ML SOLN gabapentin NP

QL 72 ML / 1 DAY

PA



NEURONTIN 250 MG/5 ML SOLUTION gabapentin NP

QL 72 ML / 1 DAY

PA


QL 12 CAPS / 1 DAY

PA


QL 9 CAPS / 1 DAY

PA

NEURONTIN 600 MG TABLET gabapentin NP

QL 6 TABS / 1 DAY

PA

NEURONTIN 800 MG TABLET gabapentin NP

QL 4 TABS / 1 DAY

PA

oxcarbazepine P

OXTELLAR XR oxcarbazepine NP PA

pregabalin 100 mg capsule P QL 3 CAPS / 1 DAY


pregabalin 20 mg/ml solution NP QL 30 ML / 1 DAY

PA







QUDEXY XR topiramate NP PA

ROWEEPRA levetiracetam P

ROWEEPRA XR levetiracetam P

rufinamide 200 mg tablet C QL 16 TABS / 1 DAY

PA



rufinamide 40 mg/ml suspension NP QL 80 ML / 1 DAY

PA

rufinamide 400 mg tablet C QL 8 TABS / 1 DAY

PA

SABRIL vigabatrin NP

PA

S Specialty Drug

SPRITAM levetiracetam NP PA

SUBVENITE lamotrigine C

SUBVENITE (BLUE) lamotrigine C

SUBVENITE (GREEN) lamotrigine C

SUBVENITE (ORANGE) lamotrigine C

TEGRETOL carbamazepine NP PA

TEGRETOL XR carbamazepine NP PA

tiagabine hcl NP PA

TOPAMAX topiramate NP PA

topiramate P

topiramate er C PA

TRILEPTAL oxcarbazepine NP PA

TROKENDI XR topiramate NP PA

valproic acid 250 mg capsule P

valproic acid 250 mg/5 ml soln P

valproic acid 500 mg/10 ml sol P

vigabatrin NP PA

S Specialty Drug



VIGADRONE vigabatrin C

PA

S Specialty Drug

VIMPAT 10 MG/ML SOLUTION lacosamide NP

QL 40 ML / 1 DAY

PA

VIMPAT 100 MG TABLET lacosamide NP

QL 4 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 2 TABS / 1 DAY

PA


QL 8 TABS / 1 DAY

PA

XCOPRI 100 MG TABLET cenobamate NP

QL 1 TAB / 1 DAY

PA

XCOPRI 12.5-25 MG TITRATION PK cenobamate NP

QL 1 TAB / 1 DAY

PA


QL 1 TAB / 1 DAY

PA

XCOPRI 150-200 MG TITRATION PK cenobamate NP

QL 1 TAB / 1 DAY

PA


QL 2 TABS / 1 DAY

PA

XCOPRI 250 MG DAILY DOSE PACK cenobamate NP

QL 2 TABS / 1 DAY

PA

XCOPRI 350 MG DAILY DOSE PACK cenobamate NP

QL 2 TABS / 1 DAY

PA


QL 1 TAB / 1 DAY

PA

XCOPRI 50-100 MG TITRATION PAK cenobamate NP

QL 1 TAB / 1 DAY

PA



ZONEGRAN zonisamide NP PA

zonisamide P

BARBITURATES (ANTICONVULSANTS)

MYSOLINE primidone NP PA

primidone P

BENZODIAZEPINES (ANTICONVULSANTS)

clobazam 10 mg tablet P

clobazam 2.5 mg/ml suspension NP QL 16 ML / 1 DAY

PA

clobazam 20 mg tablet P

clonazepam 0.125 mg dis tab C QL 6 TABS / 1 DAY

clonazepam 0.125 mg odt C QL 6 TABS / 1 DAY


clonazepam 0.5 mg dis tablet C QL 6 TABS / 1 DAY


clonazepam 0.5 mg tablet C QL 6 TABS / 1 DAY

clonazepam 1 mg dis tablet C QL 4 TABS / 1 DAY

clonazepam 1 mg odt C QL 4 TABS / 1 DAY

clonazepam 1 mg tablet C QL 4 TABS / 1 DAY

clonazepam 2 mg odt C QL 2 TABS / 1 DAY

clonazepam 2 mg tablet C QL 2 TABS / 1 DAY

NAYZILAM midazolam NP PA

ONFI 10 MG TABLET clobazam NP

QL 4 TABS / 1 DAY

PA

ONFI 2.5 MG/ML SUSPENSION clobazam NP

QL 16 ML / 1 DAY

PA

ONFI 20 MG TABLET clobazam NP

QL 2 TABS / 1 DAY

PA



SYMPAZAN clobazam NP PA

HYDANTOINS

DILANTIN 100 MG CAPSULE phenytoin sodium extended P

DILANTIN 30 MG CAPSULE phenytoin sodium extended P

DILANTIN 50 MG INFATAB phenytoin NP PA

DILANTIN-125 phenytoin NP PA

PEGANONE ethotoin P

PHENYTEK phenytoin sodium extended P

phenytoin P

phenytoin sod ext 100 mg cap C

phenytoin sod ext 200 mg cap P

phenytoin sod ext 300 mg cap P

SUCCINIMIDES

CELONTIN methsuximide P

ethosuximide P

ZARONTIN ethosuximide NP PA


ANTIDEPRESSANTS

ANTIDEPRESSANTS, MISCELLANEOUS

APLENZIN bupropion hbr NP PA

bupropion hcl P

bupropion hcl sr P

bupropion hcl xl 150 mg tablet P

bupropion hcl xl 300 mg tablet P

bupropion hcl xl 450 mg tablet NP PA


FORFIVO XL bupropion hcl NP PA

mirtazapine P

REMERON mirtazapine NP PA

WELLBUTRIN SR bupropion hcl NP PA

WELLBUTRIN XL bupropion hcl NP PA

MONOAMINE OXIDASE INHIBITORS

phenelzine sulfate C

tranylcypromine sulfate C

SEL.SEROTONIN,NOREPI REUPTAKE INHIBITOR

CYMBALTA 20 MG CAPSULE duloxetine hcl NP

QL 2 CAPS / 1 DAY

PA


QL 3 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA

desvenlafaxine er NP PA

desvenlafaxine suc er 100 mg tablet (generic for Pristiq) NP PA



duloxetine hcl dr 20 mg cap P QL 2 CAPS / 1 DAY



EFFEXOR XR venlafaxine hcl NP PA

FETZIMA levomilnacipran hcl NP PA

PRISTIQ desvenlafaxine succinate NP PA



venlafaxine hcl P

venlafaxine hcl er 150 mg cap P

venlafaxine hcl er 150 mg tab NP PA


venlafaxine hcl er 37.5 mg cap P

venlafaxine hcl er 37.5 mg tab NP PA

venlafaxine hcl er 75 mg cap P


SELECTIVE-SEROTONIN REUPTAKE INHIBITORS

BRISDELLE paroxetine mesylate NP PA

CELEXA citalopram hydrobromide NP PA

citalopram hbr P

escitalopram oxalate P

fluoxetine 20 mg/5 ml solution P

fluoxetine dr NP PA

fluoxetine hcl 10 mg capsule P

fluoxetine hcl 10 mg tablet NP PA





fluvoxamine maleate P

fluvoxamine maleate er NP PA

LEXAPRO escitalopram oxalate NP PA

olanzapine-fluoxetine hcl NP PA

paroxetine cr NP PA

paroxetine er NP PA



paroxetine hcl P

paroxetine mesylate NP PA

PAXIL paroxetine hcl NP PA

PAXIL CR paroxetine hcl NP PA

PEXEVA paroxetine mesylate NP PA

PROZAC fluoxetine hcl NP PA

SARAFEM fluoxetine hcl NP PA

sertraline hcl P

SYMBYAX olanzapine/fluoxetine hcl NP PA

ZOLOFT sertraline hcl NP PA

SEROTONIN MODULATORS

nefazodone hcl P

trazodone hcl P

TRINTELLIX vortioxetine hydrobromide NP PA

VIIBRYD vilazodone hcl NP PA

TRICYCLICS, OTHER NOREPI-RU INHIBITORS

amitriptyline hcl C

clomipramine hcl C

desipramine hcl C

doxepin 10 mg capsule C

doxepin 10 mg/ml oral conc C








imipramine hcl C

nortriptyline hcl 10 mg cap C





ANTIDIABETIC AGENTS

ALPHA-GLUCOSIDASE INHIBITORS

acarbose P

GLYSET miglitol NP PA

miglitol NP PA

PRECOSE acarbose NP PA

AMYLINOMIMETICS

SYMLINPEN 120 pramlintide acetate P

SYMLINPEN 60 pramlintide acetate P

BIGUANIDES

METFORMIN HCL 1,000 MG TABLET (generic for GLUCOPHAGE) C

METFORMIN HCL 500 MG TABLET (generic for GLUCOPHAGE) C

metformin hcl 850 mg tablet C

metformin hcl er C

DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS

alogliptin NP QL 1 TAB / 1 DAY

PA

alogliptin-metformin NP QL 2 TABS / 1 DAY

PA

alogliptin-pioglitazone NP QL 1 TAB / 1 DAY

PA


JANUMET sitagliptin phosphate/metformin hcl P

JANUMET XR sitagliptin phosphate/metformin hcl NP

QL 2 TABS / 1 DAY

PA

JANUVIA sitagliptin phosphate P

JENTADUETO linagliptin/metformin hcl P

JENTADUETO XR linagliptin/metformin hcl NP

QL 2 TABS / 1 DAY

PA

KAZANO alogliptin benzoate/metformin hcl NP

QL 2 TABS / 1 DAY

PA

KOMBIGLYZE XR saxagliptin hcl/metformin hcl P

NESINA alogliptin benzoate NP

QL 1 TAB / 1 DAY

PA

ONGLYZA saxagliptin hcl P

OSENI alogliptin benzoate/pioglitazone hcl NP

QL 1 TAB / 1 DAY

PA

TRADJENTA linagliptin P

INCRETIN MIMETICS

ADLYXIN lixisenatide NP

QL 6 ML / 28 DAYS

PA

BYDUREON BCISE exenatide microspheres P

BYDUREON PEN exenatide microspheres C

BYETTA exenatide P

OZEMPIC 0.25-0.5 MG/DOSE PEN semaglutide NP

QL 1.5 ML / 28 DAYS

PA

OZEMPIC 1 MG/DOSE (2 MG/1.5ML) semaglutide NP

QL 3 ML / 28 DAYS

PA



OZEMPIC 1 MG/DOSE (4 MG/3 ML) semaglutide NP

QL 3 ML / 28 DAYS

PA

RYBELSUS semaglutide NP

QL 1 TAB / 1 DAY

PA

TRULICITY dulaglutide NP

QL 2 ML / 28 DAYS

PA

VICTOZA 2-PAK liraglutide P

VICTOZA 3-PAK liraglutide P

MEGLITINIDES

nateglinide C

repaglinide C

SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB

FARXIGA dapagliflozin propanediol P QL 1 TAB / 1 DAY

GLYXAMBI empagliflozin/linagliptin NP

QL 1 TAB / 1 DAY

PA

INVOKAMET canagliflozin/metformin hcl NP

QL 2 TABS / 1 DAY

PA

INVOKAMET XR canagliflozin/metformin hcl NP

QL 2 TABS / 1 DAY

PA

INVOKANA canagliflozin P QL 1 TAB / 1 DAY

JARDIANCE empagliflozin P QL 1 TAB / 1 DAY

QTERN dapagliflozin propanediol/saxagliptin hcl NP

QL 1 TAB / 1 DAY

PA

SEGLUROMET ertugliflozin pidolate/metformin hcl NP

QL 2 TABS / 1 DAY

PA

STEGLATRO ertugliflozin pidolate NP

QL 1 TAB / 1 DAY

PA



STEGLUJAN ertugliflozin pidolate/sitagliptin phosphate NP

QL 1 TAB / 1 DAY

PA

SYNJARDY empagliflozin/metformin hcl NP

QL 2 TABS / 1 DAY

PA

SYNJARDY XR empagliflozin/metformin hcl NP

QL 2 TABS / 1 DAY

PA

TRIJARDY XR 10-5-1,000 MG TAB empagliflozin/linagliptin/metformin hcl NP

QL 1 TAB / 1 DAY

PA

TRIJARDY XR 12.5-2.5-1,000 MG empagliflozin/linagliptin/metformin hcl NP

QL 2 TABS / 1 DAY

PA

TRIJARDY XR 25-5-1,000 MG TAB empagliflozin/linagliptin/metformin hcl NP

QL 1 TAB / 1 DAY

PA

TRIJARDY XR 5-2.5-1,000 MG TAB empagliflozin/linagliptin/metformin hcl NP

QL 2 TABS / 1 DAY

PA

XIGDUO XR dapagliflozin propanediol/metformin hcl NP

QL 1 TAB / 1 DAY

PA

SULFONYLUREAS

AMARYL glimepiride NP PA

glimepiride P

glipizide P

glipizide er P

glipizide xl P

glipizide-metformin C

GLUCOTROL glipizide NP PA

GLUCOTROL XL glipizide NP PA

glyburide P

glyburide micronized P

glyburide-metformin hcl C PA



GLYNASE glyburide,micronized NP PA

THIAZOLIDINEDIONES

ACTOPLUS MET pioglitazone hcl/metformin hcl NP PA

ACTOPLUS MET XR pioglitazone hcl/metformin hcl NP PA

AVANDIA rosiglitazone maleate NP PA

DUETACT pioglitazone hcl/glimepiride NP PA

pioglitazone hcl P

pioglitazone-glimepiride NP PA

pioglitazone-metformin NP PA


ANTIEMETICS

5-HT3 RECEPTOR ANTAGONISTS

granisetron hcl 1 mg tablet NP PA

ondansetron 4 mg/5 ml solution P

ondansetron hcl 24 mg tablet P



ondansetron odt P

SANCUSO granisetron NP PA

ZOFRAN ondansetron hcl NP PA

ZUPLENZ ondansetron NP PA

ANTIEMETICS, MISCELLANEOUS

dronabinol 10 mg capsule C QL 4 CAPS / 1 DAY

dronabinol 2.5 mg capsule C QL 6 CAPS / 1 DAY

dronabinol 5 mg capsule C QL 6 CAPS / 1 DAY

scopolamine C


ANTIHISTAMINES (GI DRUGS)

COMPRO prochlorperazine C

CVS MOTION SICKNESS RELIEF TAB C OTC

meclizine 12.5 mg caplet C OTC

meclizine 12.5 mg tablet C OTC

meclizine 25 mg tablet C

meclizine 25 mg tablet chew C OTC

MOTION SICKNESS RELIEF TB CHEW C OTC

prochlorperazine C

prochlorperazine maleate C

RA MOTION SICKNESS RLF TB CHEW C OTC

trimethobenzamide hcl C

NEUROKININ-1 RECEPTOR ANTAGONISTS

AKYNZEO 300-0.5 MG CAPSULE netupitant/palonosetron hcl NP PA

aprepitant C

EMEND 125 MG CAPSULE aprepitant C

EMEND 125 MG POWDER PACKET aprepitant C

EMEND 40 MG CAPSULE aprepitant C

VARUBI 180 MG DOSE(2X 90MG TB) rolapitant hcl NP PA

VARUBI 90 MG TABLET rolapitant hcl NP PA


ANTIFUNGAL (SYSTEMIC)

ALLYLAMINE ANTIFUNGALS

terbinafine hcl P

ANTIFUNGALS, MISCELLANEOUS

griseofulvin NP PA


griseofulvin ultramicrosize NP PA

AZOLE ANTIFUNGALS

CRESEMBA 186 MG CAPSULE isavuconazonium sulfate NP PA

DIFLUCAN fluconazole NP PA

fluconazole P

itraconazole 10 mg/ml solution NP PA

itraconazole 100 mg capsule NP PA

ketoconazole 200 mg tablet NP PA

NOXAFIL 40 MG/ML SUSPENSION posaconazole NP PA

NOXAFIL DR 100 MG TABLET posaconazole NP PA

ONMEL itraconazole NP PA

posaconazole NP PA

SPORANOX 10 MG/ML SOLUTION itraconazole NP PA

SPORANOX 100 MG CAPSULE itraconazole NP PA

TOLSURA itraconazole NP PA

voriconazole 200 mg tablet C PA

voriconazole 40 mg/ml susp C PA

voriconazole 50 mg tablet C PA

POLYENE ANTIFUNGALS

nystatin 100,000 unit/ml susp P

nystatin 500,000 unit oral tab NP PA

nystatin 500,000 unit/5 ml sus P

PYRIMIDINE ANTIFUNGALS

ANCOBON flucytosine NP PA



flucytosine NP PA


ANTIFUNGALS (SKIN AND MUCOUS MEMBRANE)

ALLYLAMINES (SKIN AND MUCOUS MEMBRANE)

ATHLETE'S FOOT 1% CREAM terbinafine hcl C OTC

EQ ATHLETE'S FOOT 1% CREAM terbinafine hcl C OTC

LAMISIL terbinafine hcl C OTC

naftifine hcl 1% cream NP PA

naftifine hcl 2% cream NP QL 60 GM / 30 DAYS

PA

NAFTIN 1% GEL naftifine hcl NP PA

NAFTIN 2% CREAM naftifine hcl NP

QL 60 GM / 30 DAYS

PA

NAFTIN 2% GEL naftifine hcl NP PA

terbinafine P OTC

AZOLES (SKIN AND MUCOUS MEMBRANE)

1-DAY C OTC

ANTI-FUNGAL POWDER P OTC

ANTIFUNGAL 1% TOPICAL CREAM P OTC

ANTIFUNGAL 2% TOPICAL CREAM P

ANTIFUNGAL POWDER P OTC

ATHLETE'S FOOT 2% POWDER P OTC

clotrimazole 1% solution C OTC

clotrimazole 1% topical cream P OTC

clotrimazole 1% vaginal cream C OTC

clotrimazole 10 mg troche C


CLOTRIMAZOLE-1% SOLUTION P OTC

clotrimazole-3 C OTC

clotrimazole-7 C OTC

clotrimazole-betamethasone crm P

clotrimazole-betamethasone lot NP PA

cvs clotrimazole 1% solution C OTC

cvs clotrimazole 1% top cream P OTC

DESENEX P OTC

econazole nitrate P

EXELDERM sulconazole nitrate NP PA

FUNGOID TINCTURE miconazole nitrate C OTC

GYNE-LOTRIMIN-7 clotrimazole C OTC

JUBLIA efinaconazole NP PA

ketoconazole 2% cream P

ketoconazole 2% foam NP PA

ketoconazole 2% shampoo P

KETODAN 2% FOAM ketoconazole C

LOTRIMIN AF 2% POWDER P OTC

LUZU luliconazole NP PA

MICATIN P OTC

miconazole 100 mg vag supp C OTC

miconazole 2% topical cream P OTC

miconazole 3 combo pack C OTC

miconazole 7 C OTC

MICONAZOLE 7 100 MG VAG SUPP miconazole nitrate C OTC



miconazole-7 C OTC

MICONAZORB AF P OTC

MICRO-GUARD P OTC

MONISTAT 3 C OTC

MONISTAT 7 miconazole nitrate C OTC

MYCOZYL AP P OTC

ORAVIG miconazole NP PA

oxiconazole nitrate NP QL 60 GM / 30 DAYS

PA

OXISTAT 1% CREAM oxiconazole nitrate NP

QL 60 GM / 30 DAYS

PA

QC ATHLETE'S FOOT 1% CREAM P OTC

qc clotrimazole 1% top cream P OTC

ra clotrimazole 1% vag cream C OTC

REMEDY ANTIFUNGAL P OTC

REMEDY PHYTOPLEX ANTIFUNGAL P OTC

sm clotrimazole 1% top cream P OTC

sm clotrimazole 1% vag cream C OTC

terconazole C

THERA ANTIFUNGAL 2% CREAM P

THERA ANTIFUNGAL 2% POWDER P OTC

tioconazole-1 C OTC

TRIPLE PASTE AF C OTC

VUSION miconazole nitrate/zinc oxide/petrolatum,white NP PA

ZEASORB P OTC

ZEASORB AF P OTC



HYDROXYPYRIDONES (SKIN, MUCOUS MEMBRANE)

CICLODAN 0.77% CREAM ciclopirox olamine NP PA

CICLODAN 8% SOLUTION ciclopirox NP PA

ciclopirox 0.77% cream P

ciclopirox 0.77% gel NP PA

ciclopirox 0.77% topical susp P

ciclopirox 1% shampoo NP PA

ciclopirox 8% solution P

LOPROX 0.77% CREAM ciclopirox olamine NP PA

LOPROX 0.77% TOPICAL SUSP ciclopirox olamine NP PA

LOPROX 1% SHAMPOO ciclopirox NP PA

PENLAC ciclopirox NP PA

OXABOROLES

KERYDIN tavaborole NP PA

tavaborole NP PA

POLYENES (SKIN AND MUCOUS MEMBRANE)

NYAMYC nystatin C QL 240 GM / Rx

nystatin 100,000 unit/gm cream P

nystatin 100,000 unit/gm oint P

nystatin 100,000 unit/gm powd P QL 240 GM / Rx

nystatin-triamcinolone cream P

nystatin-triamcinolone ointm NP PA

NYSTOP nystatin C QL 240 GM / Rx



THIOCARBAMATES(SKIN AND MUCOUS MEMBRANE)

ANTIFUNGAL 1% LIQUID SPRAY C OTC

CVS ATHLETE'S FOOT 1% LQ SPRAY C OTC

gnp tolnaftate 1% cream P OTC

MYCOZYL AL C

QC ANTIFUNGAL 1% CREAM P

qc tolnaftate 1% cream P OTC

RA ANTIFUNGAL 1% LIQUID SPRAY C OTC

TOLCYLEN C OTC

tolnaftate 1% cream P OTC

tolnaftate 1% spray powder C OTC


ANTIGLAUCOMA AGENTS

ALPHA-ADRENERGIC AGONISTS (EENT)

ALPHAGAN P brimonidine tartrate P

brimonidine 0.2% eye drop P

brimonidine tartrate 0.15% drp NP PA

COMBIGAN brimonidine tartrate/timolol maleate P

BETA-ADRENERGIC BLOCKING AGENTS (EENT)

betaxolol hcl 0.5% eye drop NP PA

BETOPTIC S betaxolol hcl NP PA

carteolol hcl NP PA

ISTALOL timolol maleate NP PA

levobunolol hcl NP PA

timolol 0.25% gel-solution P

timolol 0.25% gfs gel-solution P

timolol 0.5% eye drop (Generic for Istalol) NP PA


timolol 0.5% gel-solution P

timolol 0.5% gfs gel-solution P

timolol maleate 0.25% eye drop (generic for Timoptic) P

timolol maleate 0.5% eye drops (generic for Timoptic) P

TIMOPTIC timolol maleate NP PA

TIMOPTIC OCUDOSE timolol maleate/pf NP PA

TIMOPTIC-XE timolol maleate NP PA

CARBONIC ANHYDRASE INHIBITORS (EENT)

acetazolamide C

acetazolamide er C

AZOPT brinzolamide NP PA

brinzolamide C

COSOPT dorzolamide hcl/timolol maleate NP PA

COSOPT PF dorzolamide hcl/timolol maleate/pf NP PA

dorzolamide P

dorzolamide hcl P

dorzolamide-timolol 2%-0.5% NP PA

dorzolamide-timolol eye drops P

methazolamide C

SIMBRINZA brinzolamide/brimonidine tartrate NP PA

timolol-dorzolamide NP PA

TRUSOPT dorzolamide hcl NP PA

MIOTICS

pilocarpine 1% eye drops C





PROSTAGLANDIN ANALOGS

bimatoprost 0.03% eye drops NP PA

latanoprost P

LUMIGAN bimatoprost NP PA

TRAVATAN Z travoprost P

travoprost NP PA

VYZULTA latanoprostene bunod NP PA

XALATAN latanoprost NP PA

XELPROS latanoprost NP PA

ZIOPTAN tafluprost/pf NP PA

RHO KINASE INHIBITORS

RHOPRESSA netarsudil mesylate NP PA

ROCKLATAN netarsudil mesylate/latanoprost NP PA


ANTIHEMORRHAGIC AGENTS

HEMOSTATICS

ADVATE antihemophilic factor (fviii) recombinant,full length P

PA

S Specialty Drug

ADYNOVATE antihemophilic factor (fviii) recombinant, full length, peg NP

PA

S Specialty Drug

AFSTYLA antihemophilic factor viii recomb,single-chn,b-dom truncated NP

PA

S Specialty Drug

ALPHANATE antihemophilic factor, human/von willebrand factor,human P

PA

S Specialty Drug

ALPHANINE SD factor ix NP

PA

S Specialty Drug


ALPROLIX factor ix recombinant, fc fusion protein NP

PA

S Specialty Drug

aminocaproic acid 0.25 gram/ml C

aminocaproic acid 1,000 mg tab C

aminocaproic acid 500 mg tab C

BENEFIX factor ix human recombinant P

PA

S Specialty Drug

COAGADEX coagulation factor x P

PA

S Specialty Drug

CORIFACT factor xiii P

PA

S Specialty Drug

ELOCTATE antihemophilic factor (fviii) recombinant, fc fusion protein NP

PA

S Specialty Drug

ESPEROCT antihemophilic factor (fviii) rec, b-dom truncated peg-exei NP

PA

S Specialty Drug

FEIBA NF anti-inhibitor coagulant complex P

PA

S Specialty Drug

HELIXATE FS antihemophilic factor (fviii) recombinant,full length C

PA

S Specialty Drug

HEMLIBRA emicizumab-kxwh C

PA

S Specialty Drug

HEMOFIL M antihemophilic factor, human P

PA

S Specialty Drug

HUMATE-P antihemophilic factor, human/von willebrand factor,human P

PA

S Specialty Drug

IDELVION factor ix recombinant,albumin fusion protein NP

PA

S Specialty Drug

IXINITY factor ix human recombinant, threonine 148 NP

PA

S Specialty Drug

JIVI antihemophilic factor (fviii) rec, b-domain deleted peg-aucl NP

PA

S Specialty Drug



KOATE antihemophilic factor, human P

PA

S Specialty Drug

KOGENATE FS antihemophilic factor (fviii) recombinant,full length NP

PA

S Specialty Drug

KOVALTRY antihemophilic factor (fviii) recombinant,full length NP

PA

S Specialty Drug

MONONINE factor ix P

PA

S Specialty Drug

NOVOEIGHT antihemophilic factor viii recombinant, b-domain truncated P

PA

S Specialty Drug

NOVOSEVEN RT coagulation factor viia (recombinant) NP

PA

S Specialty Drug

NUWIQ antihemophilic factor viii rec hek cell, b-domain deleted P

PA

S Specialty Drug

OBIZUR antihemophilic factor viii, recombinant porcine sequence NP

PA

S Specialty Drug

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

PA

S Specialty Drug

REBINYN factor ix (human) recombinant, pegylated NP

PA

S Specialty Drug

RECOMBINATE antihemophilic factor viii, human recombinant NP

PA

S Specialty Drug

RIXUBIS factor ix human recombinant NP

PA

S Specialty Drug

SEVENFACT coagulation factor viia recombinant-jncw C

PA

S Specialty Drug

tranexamic acid 650 mg tablet C QL 30 TABS / RX

TRETTEN factor xiii a-subunit, recombinant P

PA

S Specialty Drug



VONVENDI von willebrand factor (recombinant) NP

PA

S Specialty Drug

WILATE antihemophilic factor, human/von willebrand factor,human P

PA

S Specialty Drug

XYNTHA antihemophilic factor (factor viii) recomb,b-domain deleted P

PA

S Specialty Drug

XYNTHA SOLOFUSE antihemophilic factor (factor viii) recomb,b-domain deleted P

PA

S Specialty Drug


ANTIHISTAMINE DRUGS

SECOND GENERATION ANTIHISTAMINES

ALL DAY ALLERGY cetirizine hcl P OTC

ALL DAY ALLERGY-D cetirizine hcl/pseudoephedrine hcl C OTC

ALLER-TEC D cetirizine hcl/pseudoephedrine hcl C OTC

ALLERGY (LORATADINE) 10 MG TAB loratadine C OTC

ALLERGY 10 MG TABLET cetirizine hcl P OTC

ALLERGY COMPLETE-D cetirizine hcl/pseudoephedrine hcl C OTC

ALLERGY RELIEF 10 MG TABLET loratadine C OTC

ALLERGY RELIEF D-12 loratadine/pseudoephedrine sulfate P OTC

ALLERGY RELIEF NASAL DECONGEST cetirizine hcl/pseudoephedrine hcl P OTC

ALLERGY RELIEF-D cetirizine hcl/pseudoephedrine hcl P OTC

ALLERGY RLF (CETRZN) 10 MG TAB cetirizine hcl P OTC

ALLERGY-CONGESTION RLF 12H TAB loratadine/pseudoephedrine sulfate P OTC

cetirizine hcl 1 mg/ml soln P OTC


cetirizine hcl 1 mg/ml syrup P OTC

cetirizine hcl 10 mg chew tab NP PA

OTC

cetirizine hcl 10 mg tablet P OTC

cetirizine hcl 5 mg chew tab NP PA

OTC

cetirizine hcl 5 mg tablet P OTC

cetirizine hcl 5 mg/5 ml soln P OTC

cetirizine-pseudoephedrine er P OTC

CHILD ALLERGY RELIEF 1 MG/ML cetirizine hcl C OTC

CHILD ALLERGY RELIEF 5 MG/5 ML loratadine C OTC

child loratadine 5 mg tab chew C OTC

child loratadine 5 mg/5 ml sol P OTC

child loratadine 5 mg/5 ml syr P OTC

CHILD'S CLARITIN 5 MG TAB CHEW loratadine C OTC

CLARINEX desloratadine NP PA

CLARINEX-D 12 HOUR desloratadine/pseudoephedrine sulfate NP PA

CLARITIN 10 MG LIQUI-GEL CAP loratadine C OTC

CLARITIN 10 MG TABLET loratadine C OTC

CVS ALLERGY (CETRZN) 10 MG TAB cetirizine hcl P OTC

CVS CHILD ALLERGY RLF 5 MG CHW loratadine C OTC

desloratadine NP PA

EQ ALLERGY (LORAT) 10 MG TAB loratadine C OTC



EQ CHILD ALLERGY 5 MG/5 ML SOL loratadine C OTC

EQL ALLERGY-CONGESTION 12H TAB loratadine/pseudoephedrine sulfate P OTC

GNP ALLERGY RELIEF 5 MG TABLET levocetirizine dihydrochloride C OTC

gnp chld loratadine 5 mg/5 ml P OTC

GS ALLERGY RELIEF 10 MG TABLET loratadine C OTC

HM ALLERGY RELIEF 10 MG TABLET cetirizine hcl P OTC

HM ALLERGY-CONGESTION 12HR TAB loratadine/pseudoephedrine sulfate P OTC

HM CHILD ALLERGY RLF 5 MG CHEW loratadine C OTC

hm child loratadine 5 mg/5 ml P OTC

levocetirizine 2.5 mg/5 ml sol P

levocetirizine 5 mg tablet P OTC

levocetirizine 5 mg tablet (Rx) P OTC

loratadine P OTC

loratadine allergy P OTC

LORATADINE-D loratadine/pseudoephedrine sulfate P OTC

RA ALLERGY-CONGESTION 12HR TAB P OTC

ra cetirizine hcl 10 mg tablet P OTC

SEMPREX-D pseudoephedrine hcl/acrivastine NP PA

WAL-ITIN loratadine C OTC


ANTIHYPOGLYCEMIC AGENTS

GLYCOGENOLYTIC AGENTS

BAQSIMI glucagon C

GLUCAGEN 1 MG HYPOKIT glucagon C


GLUCAGON EMERGENCY KIT glucagon C

glucagon hcl C

GVOKE HYPOPEN 1-PACK glucagon C

GVOKE HYPOPEN 2-PACK glucagon C

GVOKE PFS 1-PACK SYRINGE glucagon C

GVOKE PFS 2-PACK SYRINGE glucagon C


ANTILIPEMIC AGENTS

ANTILIPEMIC AGENTS, MISCELLANEOUS

fish oil 1,000 mg capsule C OTC

fish oil omega-3 C OTC

icosapent ethyl C PA

JUXTAPID lomitapide mesylate C

PA

S Specialty Drug

LOVAZA omega-3 acid ethyl esters NP PA

NEXLETOL bempedoic acid NP PA

NEXLIZET bempedoic acid/ezetimibe NP PA

niacin 100 mg tablet P OTC



niacin 500 mg capsule sa P OTC


niacin 500 mg tablet (Rx only) C OTC

niacin er P

niacin er 1,000 mg tablet P OTC


niacin er 250 mg capsule P OTC

niacin er 500 mg caplet P OTC

niacin er 500 mg capsule P OTC

niacin er 500 mg tablet P OTC

niacin sa 250 mg capsule P OTC

niacin tr 250 mg capsule P OTC

niacin tr 500 mg caplet P OTC

niacin tr 500 mg capsule P OTC

niacin tr 500 mg tablet P OTC

NIACOR niacin NP PA

NIASPAN niacin P

NIAVASC C OTC

omega-3 acid ethyl esters NP PA

plain niacin P OTC

ra niacin 100 mg tablet P OTC

ra niacin 500 mg tablet P OTC

SLO-NIACIN niacin P OTC

TRIKLO omega-3 acid ethyl esters C

VASCEPA icosapent ethyl NP PA

BILE ACID SEQUESTRANTS

cholestyramine P

cholestyramine light P

colesevelam hcl NP PA

COLESTID colestipol hcl NP PA



colestipol hcl P

PREVALITE cholestyramine/aspartame C

QUESTRAN cholestyramine (with sugar) NP PA

QUESTRAN LIGHT cholestyramine/aspartame NP PA

WELCHOL colesevelam hcl NP PA

CHOLESTEROL ABSORPTION INHIBITORS

ezetimibe P

ezetimibe-simvastatin NP PA

VYTORIN ezetimibe/simvastatin NP PA

ZETIA ezetimibe NP PA

FIBRIC ACID DERIVATIVES

ANTARA fenofibrate,micronized NP PA

fenofibrate 120 mg tablet NP PA

fenofibrate 130 mg capsule NP PA

fenofibrate 134 mg capsule P

fenofibrate 145 mg tablet P




fenofibrate 40 mg tablet NP PA








fenofibric acid 105 mg tablet NP PA

fenofibric acid 35 mg tablet NP PA

fenofibric acid dr 135 mg cap NP PA

fenofibric acid dr 45 mg cap NP PA

FENOGLIDE fenofibrate NP PA

FIBRICOR fenofibric acid NP PA

gemfibrozil P

LIPOFEN fenofibrate NP PA

LOPID gemfibrozil NP PA

TRICOR fenofibrate nanocrystallized NP PA

TRIGLIDE fenofibrate nanocrystallized NP PA

TRILIPIX fenofibric acid (choline) NP PA

HMG-COA REDUCTASE INHIBITORS

ALTOPREV lovastatin NP PA

amlodipine-atorvastatin NP PA

atorvastatin calcium P

CADUET amlodipine besylate/atorvastatin calcium NP PA

CRESTOR rosuvastatin calcium NP PA

EZALLOR SPRINKLE rosuvastatin calcium NP PA

fluvastatin er NP PA

fluvastatin sodium NP PA

LESCOL XL fluvastatin sodium NP PA



LIPITOR atorvastatin calcium NP PA

LIVALO pitavastatin calcium NP PA

lovastatin P

PRAVACHOL pravastatin sodium NP PA

pravastatin sodium P

rosuvastatin calcium P

simvastatin 10 mg tablet P





ZOCOR simvastatin NP PA

ZYPITAMAG pitavastatin magnesium NP PA

PCSK9 INHIBITORS

PRALUENT PEN alirocumab NP

QL 2 ML / 28 DAYS

PA

REPATHA PUSHTRONEX evolocumab NP

QL 3.5 ML / 28 DAYS

PA

REPATHA SURECLICK evolocumab NP

QL 2 ML / 28 DAYS

PA

REPATHA SYRINGE evolocumab NP

QL 2 ML / 28 DAYS

PA


ANTIMIGRAINE AGENTS

CALCITONIN GENE-RELATED PEPTIDE ANTAG.

AIMOVIG AUTOINJECTOR erenumab-aooe NP

QL 1 AUTOINJECTOR / 30 DAYS

PA

S Specialty Drug


AJOVY AUTOINJECTOR fremanezumab-vfrm P

QL 1.5 ML / 30 DAYS

PA

S Specialty Drug

AJOVY SYRINGE fremanezumab-vfrm P

QL 1.5 ML / 30 DAYS

PA

S Specialty Drug

EMGALITY 100 MG/ML SYR(1 OF 3) galcanezumab-gnlm C

QL 3 ML / 30 DAYS

PA

S Specialty Drug

EMGALITY 120 MG/ML SYRINGE galcanezumab-gnlm P

QL 1 ML / 30 DAYS

PA

S Specialty Drug

EMGALITY 300 MG (100 MG X3SYR) galcanezumab-gnlm C

QL 3 ML / 30 DAYS

PA

S Specialty Drug

EMGALITY PEN galcanezumab-gnlm P

QL 1 ML / 30 DAYS

PA

S Specialty Drug

NURTEC ODT rimegepant sulfate NP

QL 8 TABS / 30 DAYS

PA

UBRELVY ubrogepant P


PA

VYEPTI eptinezumab-jjmr NP

PA

MED

SELECTIVE SEROTONIN AGONISTS

almotriptan malate NP PA

AMERGE naratriptan hcl NP


PA

eletriptan hbr NP QL 18 TABS / 28 DAYS

PA



FROVA frovatriptan succinate NP


PA

frovatriptan succinate NP QL 12 TABS / 28 DAYS

PA

IMITREX 100 MG TABLET sumatriptan succinate NP


PA

IMITREX 20 MG NASAL SPRAY sumatriptan P QL 18 ML / 30 DAYS



PA

IMITREX 4 MG/0.5 ML CARTRIDGES sumatriptan succinate P QL 5 ML / 30 DAYS

IMITREX 4 MG/0.5 ML PEN INJECT sumatriptan succinate P QL 5 ML / 30 DAYS

IMITREX 5 MG NASAL SPRAY sumatriptan P QL 18 ML / 30 DAYS



PA

IMITREX 6 MG/0.5 ML CARTRIDGES sumatriptan succinate P QL 5 ML / 30 DAYS

IMITREX 6 MG/0.5 ML PEN INJECT sumatriptan succinate P QL 5 ML / 30 DAYS

IMITREX 6 MG/0.5 ML VIAL sumatriptan succinate P QL 5 ML / 30 DAYS

MAXALT rizatriptan benzoate NP


PA

MAXALT MLT rizatriptan benzoate NP


PA

naratriptan hcl NP QL 12 TABS / 30 DAYS

PA

ONZETRA XSAIL sumatriptan succinate NP

QL 16 CAPS / 30 DAYS

PA

RELPAX eletriptan hydrobromide P QL 18 TABS / 28 DAYS



REYVOW lasmiditan succinate NP

QL 8 TABS / 30 DAYS

PA

rizatriptan P QL 18 TABS / 28 DAYS

sumatriptan NP QL 18 ML / 30 DAYS

PA

sumatriptan 4 mg/0.5 ml cart NP QL 5 ML / 30 DAYS

PA

sumatriptan 4 mg/0.5 ml inject NP QL 5 ML / 30 DAYS

PA

sumatriptan 6 mg/0.5 ml cart NP QL 5 ML / 30 DAYS

PA

sumatriptan 6 mg/0.5 ml inject NP QL 5 ML / 30 DAYS

PA

sumatriptan 6 mg/0.5 ml syrng NP QL 5 ML / 30 DAYS

PA

sumatriptan 6 mg/0.5 ml vial NP QL 5 ML / 30 DAYS

PA

sumatriptan succ 100 mg tablet P QL 18 TABS / 28 DAYS



sumatriptan succ-naproxen sod NP QL 12 TABS / 28 DAYS

PA

TOSYMRA sumatriptan NP

QL 6 DOSES / 30 DAYS

PA

TREXIMET sumatriptan succinate/naproxen sodium NP


PA

ZEMBRACE SYMTOUCH sumatriptan succinate NP

QL 4 ML / 30 DAYS

PA

zolmitriptan 2.5 mg nasal spry NP QL 12 ML / 30 DAYS

PA



zolmitriptan 2.5 mg tablet NP QL 12 TABS / 28 DAYS

PA

zolmitriptan 5 mg nasal spray NP QL 12 ML / 30 DAYS

PA

zolmitriptan 5 mg tablet NP QL 12 TABS / 28 DAYS

PA

zolmitriptan odt NP QL 12 TABS / 28 DAYS

PA

ZOMIG 2.5 MG NASAL SPRAY zolmitriptan NP

QL 12 ML / 30 DAYS

PA

ZOMIG 2.5 MG TABLET zolmitriptan NP


PA

ZOMIG 5 MG NASAL SPRAY zolmitriptan NP

QL 12 ML / 30 DAYS

PA

ZOMIG 5 MG TABLET zolmitriptan NP


PA

ZOMIG ZMT zolmitriptan NP


PA


ANTIMYCOBACTERIALS

ANTIMYCOBACTERIALS, MISCELLANEOUS

dapsone 100 mg tablet C

dapsone 25 mg tablet C

ANTITUBERCULOSIS AGENTS

cycloserine C PA

ethambutol hcl C

isoniazid 100 mg tablet C

isoniazid 300 mg tablet C

isoniazid 50 mg/5 ml solution C

pretomanid C PA


PRIFTIN rifapentine C

pyrazinamide C

rifabutin C

rifampin 150 mg capsule C

rifampin 300 mg capsule C

SIRTURO bedaquiline fumarate C PA

TRECATOR ethionamide C PA

ANTINEOPLASTIC AGENTS

abiraterone 500 mg tablet C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

abiraterone acetate 250 mg tab C

QL 4 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

AFINITOR 10 MG TABLET everolimus C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC

AFINITOR DISPERZ 2 MG TABLET everolimus C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC



AFINITOR DISPERZ 5 MG TABLET everolimus C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

ALECENSA alectinib hcl C

QL 8 CAPS / 1 DAY

PA

S Specialty Drug

ONC

anastrozole C

AYVAKIT avapritinib C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

BALVERSA erdafitinib C

PA

S Specialty Drug

ONC

bicalutamide C

BOSULIF 100 MG TABLET bosutinib C

QL 4 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC


QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC


QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC



BRAFTOVI 50 MG CAPSULE encorafenib C

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

ONC

BRAFTOVI 75 MG CAPSULE encorafenib C

QL 6 CAPS / 1 DAY

PA

S Specialty Drug

ONC

BRUKINSA zanubrutinib C

PA

S Specialty Drug

ONC

CABOMETYX cabozantinib s-malate C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC

capecitabine C S Specialty Drug

ONC

CAPRELSA 100 MG TABLET vandetanib C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

ONC

CAPRELSA 300 MG TABLET vandetanib C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

COMETRIQ 100 MG DAILY-DOSE PK cabozantinib s-malate C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC



COMETRIQ 60 MG DAILY-DOSE PACK cabozantinib s-malate C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

COPIKTRA duvelisib C

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC

COTELLIC cobimetinib fumarate C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

ONC

cyclophosphamide 25 mg capsule C

cyclophosphamide 50 mg capsule C

DAURISMO 100 MG TABLET glasdegib maleate C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC

DAURISMO 25 MG TABLET glasdegib maleate C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

DROXIA 200 MG CAPSULE hydroxyurea P

QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 8 CAPS / 1 DAY

PA



EMCYT estramustine phosphate sodium C

ERIVEDGE vismodegib C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

TD

ONC

ERLEADA apalutamide C

PA

S Specialty Drug

ONC

erlotinib hcl 100 mg tablet C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC


QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC


QL 3 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

etoposide 50 mg capsule C

everolimus 2.5 mg tablet C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC



everolimus 7.5 mg tablet C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC

exemestane C

fluorouracil 2% topical soln C

fluorouracil 5% cream C

fluorouracil 5% topical soln C

flutamide C

FOTIVDA tivozanib hcl C


PA

S Specialty Drug

ONC

GAVRETO pralsetinib C

PA

S Specialty Drug

ONC

GILOTRIF afatinib dimaleate C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

GLEOSTINE lomustine C

HYCAMTIN topotecan hcl C

S Specialty Drug

ONC

hydroxyurea C

IBRANCE 100 MG CAPSULE palbociclib C


PA

S Specialty Drug

ONC





PA

S Specialty Drug

ONC

IBRANCE 125 MG TABLET palbociclib C


PA

S Specialty Drug

ONC



PA

S Specialty Drug

ONC

IBRANCE 75 MG TABLET palbociclib C


PA

S Specialty Drug

ONC

ICLUSIG 10 MG TABLET ponatinib hcl C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC


QL 2 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC


QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC



IDHIFA enasidenib mesylate C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

imatinib mesylate C

S Specialty Drug

TD

ONC

IMBRUVICA 140 MG CAPSULE ibrutinib C

QL 4 CAPS / 1 DAY

PA

S Specialty Drug

ONC

IMBRUVICA 420 MG TABLET ibrutinib C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

IMBRUVICA 560 MG TABLET ibrutinib C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

IMBRUVICA 70 MG CAPSULE ibrutinib C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

ONC

INLYTA 1 MG TABLET axitinib C

QL 6 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

INLYTA 5 MG TABLET axitinib C

QL 4 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC



INQOVI decitabine/cedazuridine C

QL 5 TABS / 28 DAYS

PA

S Specialty Drug

ONC

INREBIC fedratinib dihydrochloride C

PA

S Specialty Drug

ONC

IRESSA gefitinib C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

JAKAFI ruxolitinib phosphate C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

KISQALI 200 MG DAILY DOSE ribociclib succinate C


PA

S Specialty Drug

ONC



PA

S Specialty Drug

ONC



PA

S Specialty Drug

ONC

KISQALI FEMARA 200 MG CO-PACK ribociclib succinate/letrozole C


PA

S Specialty Drug

ONC





PA

S Specialty Drug

ONC



PA

S Specialty Drug

ONC

KOSELUGO 10 MG CAPSULE selumetinib sulfate/vitamin e tpgs C

QL 8 CAPS / 1 DAY

PA

S Specialty Drug

ONC

KOSELUGO 25 MG CAPSULE selumetinib sulfate/vitamin e tpgs C

QL 4 CAPS / 1 DAY

PA

S Specialty Drug

ONC

lapatinib C

QL 6 TABS / 1 DAY

PA

S Specialty Drug

ONC

LENVIMA 10 MG DAILY DOSE lenvatinib mesylate C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

TD

ONC

letrozole C

LEUKERAN chlorambucil C

LONSURF 15 MG-6.14 MG TABLET trifluridine/tipiracil hcl C


PA

S Specialty Drug

ONC



LONSURF 20 MG-8.19 MG TABLET trifluridine/tipiracil hcl C


PA

S Specialty Drug

ONC

LORBRENA 100 MG TABLET lorlatinib C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC

LORBRENA 25 MG TABLET lorlatinib C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

LUMAKRAS sotorasib C

PA

ONC

LYNPARZA olaparib C

QL 4 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

MATULANE procarbazine hcl C

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

ONC

MEKINIST 0.5 MG TABLET trametinib dimethyl sulfoxide C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

ONC

MEKINIST 2 MG TABLET trametinib dimethyl sulfoxide C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC



MEKTOVI binimetinib C

QL 6 TABS / 1 DAY

PA

S Specialty Drug

ONC

melphalan C

mercaptopurine C

methotrexate 2.5 mg tablet C

methotrexate 250 mg/10 ml vial C

methotrexate 50 mg/2 ml vial C

methotrexate sodium C

MYLERAN busulfan C

NERLYNX neratinib maleate C

QL 6 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

NEXAVAR sorafenib tosylate C

QL 4 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC

NINLARO ixazomib citrate C

QL 3 CAPS / 28 DAYS

PA

S Specialty Drug

ONC

NUBEQA darolutamide C

PA

S Specialty Drug

ONC

ODOMZO sonidegib phosphate C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

TD

ONC



ONUREG azacitidine C


PA

S Specialty Drug

ONC

PEMAZYRE pemigatinib C


PA

S Specialty Drug

ONC

PICATO ingenol mebutate C PA

POMALYST pomalidomide C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

ONC

QINLOCK ripretinib C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

ONC

RASUVO methotrexate/pf C PA

RETEVMO 40 MG CAPSULE selpercatinib C

QL 6 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC

RETEVMO 80 MG CAPSULE selpercatinib C

QL 4 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC

REVLIMID lenalidomide C

QL 1 CAP / 1 DAY

S Specialty Drug

ONC



ROZLYTREK entrectinib C

PA

S Specialty Drug

ONC

RYDAPT midostaurin C

PA

S Specialty Drug

ONC

SIKLOS hydroxyurea NP

QL 2 TABS / 1 DAY

PA

SPRYCEL dasatinib C

PA

S Specialty Drug

TD

ONC

STIVARGA regorafenib C

PA

S Specialty Drug

ONC

sunitinib malate C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

ONC

SUTENT sunitinib malate C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

ONC

TABLOID thioguanine C

TABRECTA capmatinib hydrochloride C

QL 4 TABS / 1 DAY

PA

S Specialty Drug

ONC

TAFINLAR dabrafenib mesylate C

QL 4 CAPS / 1 DAY

PA

S Specialty Drug

ONC



TAGRISSO osimertinib mesylate C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC

TASIGNA nilotinib hcl C

PA

S Specialty Drug

TD

ONC

TAZVERIK tazemetostat hydrobromide C

QL 8 TABS / 1 DAY

PA

S Specialty Drug

ONC

temozolomide C S Specialty Drug

ONC

TEPMETKO tepotinib hcl C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

ONC

TIBSOVO ivosidenib C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

ONC

tretinoin 10 mg capsule C S Specialty Drug

ONC

TRUSELTIQ infigratinib phosphate C

PA

ONC

TURALIO pexidartinib hydrochloride C

PA

S Specialty Drug

ONC



VALCHLOR mechlorethamine hcl C

QL 120 GM / 30 DAYS

PA

S Specialty Drug

ONC

VERZENIO abemaciclib C


PA

S Specialty Drug

ONC

VITRAKVI 100 MG CAPSULE larotrectinib sulfate C

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC

VITRAKVI 20 MG/ML SOLUTION larotrectinib sulfate C

QL 10 ML / 1 DAY

PA

S Specialty Drug

TD

ONC

VITRAKVI 25 MG CAPSULE larotrectinib sulfate C

QL 6 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC

VIZIMPRO dacomitinib C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

TD

ONC

VOTRIENT pazopanib hcl C

QL 4 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC



XALKORI crizotinib C

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC

XOSPATA gilteritinib fumarate C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

ONC

XPOVIO selinexor C

PA

S Specialty Drug

ONC

XTANDI enzalutamide C

PA

S Specialty Drug

TD

ONC

ZEJULA niraparib tosylate C

QL 3 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC

ZELBORAF vemurafenib C

QL 8 TABS / 1 DAY

PA

S Specialty Drug

ONC

ZOLINZA vorinostat C

QL 4 CAPS / 1 DAY

PA

S Specialty Drug

TD

ONC



ZYKADIA 150 MG TABLET ceritinib C

QL 3 TABS / 1 DAY

PA

S Specialty Drug

TD

ONC


ANTIPARKINSONIAN AGENTS (CNS)

ADAMANTANES (CNS)

amantadine C

GOCOVRI amantadine hcl NP PA

ANTICHOLINERGIC AGENTS (CNS)

benztropine mes 0.5 mg tab C

benztropine mes 1 mg tablet C

benztropine mes 2 mg tablet C

trihexyphenidyl hcl C

CATECHOL-O-METHYLTRANSFERASE(COMT)INHIB.

entacapone P

ONGENTYS opicapone NP PA

tolcapone NP PA

DOPAMINE PRECURSORS

carbidopa-levodopa P

carbidopa-levodopa er P

carbidopa-levodopa-entacapone P

INBRIJA levodopa NP

PA

S Specialty Drug

RYTARY carbidopa/levodopa NP PA

SINEMET 10-100 carbidopa/levodopa NP PA




SINEMET CR carbidopa/levodopa NP PA

STALEVO 100 carbidopa/levodopa/entacapone NP PA






MONOAMINE OXIDASE B INHIBITORS

rasagiline mesylate C PA

selegiline hcl C

XADAGO safinamide mesylate NP PA


ANTIPROTOZOALS

ANTIMALARIALS

atovaquone-proguanil hcl C

chloroquine phosphate C

hydroxychloroquine 200 mg tab C

mefloquine hcl C

ANTIPROTOZOALS, MISCELLANEOUS

atovaquone C

benznidazole C PA

LAMPIT nifurtimox C PA

metronidazole 250 mg tablet C

metronidazole 500 mg tablet C


nitazoxanide C PA


ANTIPSYCHOTIC AGENTS

ANTIPSYCHOTICS, MISCELLANEOUS

loxapine C

pimozide C

ATYPICAL ANTIPSYCHOTICS

ABILIFY aripiprazole NP PA

ABILIFY MAINTENA aripiprazole P AL1 At least 13 yrs old

ABILIFY MYCITE aripiprazole NP PA

aripiprazole P AL1 At least 13 yrs old

aripiprazole odt NP PA

ARISTADA aripiprazole lauroxil NP PA

ARISTADA INITIO aripiprazole lauroxil, submicronized NP PA

asenapine maleate NP PA


CAPLYTA lumateperone tosylate NP

QL 1 CAP / 1 DAY

PA

clozapine P AL1 At least 13 yrs old

clozapine odt P AL1 At least 13 yrs old

CLOZARIL 100 MG TABLET clozapine NP PA

CLOZARIL 200 MG TABLET clozapine NP

PA


CLOZARIL 25 MG TABLET clozapine NP PA

CLOZARIL 50 MG TABLET clozapine NP

PA



FANAPT iloperidone NP

PA


FAZACLO 100 MG ODT clozapine NP PA

FAZACLO 12.5 MG ODT clozapine NP PA


FAZACLO 200 MG ODT clozapine NP

PA



GEODON 20 MG CAPSULE ziprasidone hcl NP PA

GEODON 20 MG/ML VIAL ziprasidone mesylate NP PA




INVEGA paliperidone NP PA

INVEGA SUSTENNA paliperidone palmitate P AL1 At least 13 yrs old

INVEGA TRINZA paliperidone palmitate P AL1 At least 13 yrs old

LATUDA lurasidone hcl P AL1 At least 13 yrs old

NUPLAZID pimavanserin tartrate NP

PA

S Specialty Drug

TD

olanzapine P AL1 At least 13 yrs old

olanzapine odt NP PA

paliperidone er NP PA



PERSERIS risperidone NP PA

quetiapine fumarate P AL1 At least 13 yrs old

quetiapine fumarate er P AL1 At least 13 yrs old

REXULTI brexpiprazole NP PA

RISPERDAL risperidone NP PA

RISPERDAL CONSTA risperidone microspheres P AL1 At least 13 yrs old

risperidone P AL1 At least 13 yrs old

risperidone odt P AL1 At least 13 yrs old

SAPHRIS asenapine maleate NP

PA


SECUADO asenapine NP

PA


SEROQUEL quetiapine fumarate NP PA

SEROQUEL XR 150 MG TABLET quetiapine fumarate NP PA





SEROQUEL XR SAMPLE KIT quetiapine fumarate NP

PA


VERSACLOZ clozapine NP

PA


VRAYLAR 1.5 MG CAPSULE cariprazine hcl NP

QL 2 CAPS / 1 DAY

PA



VRAYLAR 1.5 MG-3 MG PACK cariprazine hcl NP

QL 2 CAPS / 1 DAY

PA

VRAYLAR 3 MG CAPSULE cariprazine hcl NP

QL 1 CAP / 1 DAY

PA

VRAYLAR 4.5 MG CAPSULE cariprazine hcl NP

QL 1 CAP / 1 DAY

PA

VRAYLAR 6 MG CAPSULE cariprazine hcl NP

QL 1 CAP / 1 DAY

PA

ziprasidone hcl P AL1 At least 13 yrs old

ziprasidone mesylate NP PA


ZYPREXA olanzapine NP PA

ZYPREXA RELPREVV olanzapine pamoate NP PA

ZYPREXA ZYDIS olanzapine NP

PA


BUTYROPHENONES

HALDOL haloperidol lactate C

HALDOL DECANOATE 100 haloperidol decanoate C

HALDOL DECANOATE 50 haloperidol decanoate C

haloperidol C

haloperidol decanoate C

haloperidol decanoate 100 C

haloperidol lactate C

PHENOTHIAZINES

chlorpromazine 10 mg tablet C


chlorpromazine 100 mg/ml conc C PA





chlorpromazine 30 mg/ml conc C PA


fluphenazine 1 mg tablet C


fluphenazine 2.5 mg tablet C

fluphenazine 2.5 mg/5 ml elix C


fluphenazine 5 mg/ml conc C

fluphenazine decanoate C

perphenazine C

thioridazine hcl C

trifluoperazine hcl C

THIOXANTHENES

thiothixene C


ANTIRETROVIRALS

HIV ENTRY AND FUSION INHIBITORS

FUZEON enfuvirtide C S Specialty Drug

RUKOBIA fostemsavir tromethamine C PA

SELZENTRY maraviroc C

HIV INTEGRASE INHIBITOR ANTIRETROVIRALS

ISENTRESS raltegravir potassium C

ISENTRESS HD raltegravir potassium C

JULUCA dolutegravir sodium/rilpivirine hcl C

TIVICAY dolutegravir sodium C


TIVICAY PD dolutegravir sodium C

VOCABRIA cabotegravir sodium C

HIV NONNUCLEOSIDE REV.TRANSCRIP. INHIB.

EDURANT rilpivirine hcl C

efavirenz C

etravirine C

INTELENCE etravirine C

nevirapine C

nevirapine er C

HIV NUCLEOSIDE, NUCLEOTIDE RT INHIBITORS

abacavir C

abacavir-lamivudine C

abacavir-lamivudine-zidovudine C

BIKTARVY bictegravir sodium/emtricitabine/tenofovir alafenamide fumar C

COMPLERA emtricitabine/rilpivirine hcl/tenofovir disoproxil fumarate C

DESCOVY emtricitabine/tenofovir alafenamide fumarate C

efavirenz-emtric-tenofov disop C

emtricitabine C

emtricitabine-tenofovir disop C

EPIVIR HBV lamivudine P

GENVOYA elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide C

lamivudine C

lamivudine hbv P

lamivudine-zidovudine C

ODEFSEY emtricitabine/rilpivirine hcl/tenofovir alafenamide fumarate C



STRIBILD elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil C

tenofovir disoproxil fumarate C

TRIUMEQ abacavir sulfate/dolutegravir sodium/lamivudine C

TRUVADA 100 MG-150 MG TABLET emtricitabine/tenofovir disoproxil fumarate C



VIREAD 150 MG TABLET tenofovir disoproxil fumarate C



VIREAD POWDER tenofovir disoproxil fumarate C

zidovudine C

HIV PROTEASE INHIBITOR ANTIRETROVIRALS

APTIVUS 100 MG/ML SOLUTION tipranavir/vitamin e tpgs C

APTIVUS 250 MG CAPSULE tipranavir C

atazanavir sulfate C

EVOTAZ atazanavir sulfate/cobicistat C

fosamprenavir calcium C

INVIRASE saquinavir mesylate C

KALETRA 100-25 MG TABLET lopinavir/ritonavir C

KALETRA 200-50 MG TABLET lopinavir/ritonavir C

LEXIVA 50 MG/ML SUSPENSION fosamprenavir calcium C



lopinavir-ritonavir C

NORVIR 80 MG/ML SOLUTION ritonavir C

PREZCOBIX darunavir ethanolate/cobicistat C

PREZISTA darunavir ethanolate C

REYATAZ 50 MG POWDER PACKET atazanavir sulfate C

ritonavir C

SYMTUZA darunavir eth/cobicistat/emtricitabine/tenofovir alafenamide C


ANTITHROMBOTIC AGENTS

ANTITHROMBOTIC AGENTS, MISCELLANEOUS

CABLIVI 11 MG KIT caplacizumab-yhdp C

PA

S Specialty Drug

PLATELET-AGGREGATION INHIBITORS

BRILINTA ticagrelor P

cilostazol C

clopidogrel P

EFFIENT prasugrel hcl NP PA

PLAVIX clopidogrel bisulfate NP PA

prasugrel hcl P

ZONTIVITY vorapaxar sulfate NP PA

PLATELET-REDUCING AGENTS

anagrelide hcl C

ANTITOXINS,IMMUNE GLOB,TOXOIDS,VACCINES

ALLERGENIC EXTRACTS (THERAPEUTIC)

GRASTEK allergenic extract,grass pollen-timothy,standard C PA


PALFORZIA peanut allergen powder-dnfp C

PA

S Specialty Drug

RAGWITEK allergenic extract-weed pollen-short ragweed C PA

ANTITOXINS AND IMMUNE GLOBULINS

BIVIGAM immune globulin,gamm(igg)/glycine/iga greater than 50 mcg/ml C

PA

S Specialty Drug

MED

CUVITRU 1 GRAM/5 ML VIAL immune globulin,gamm(igg)/glycine/iga greater than 50 mcg/ml C

PA

S Specialty Drug

MED


PA

S Specialty Drug

MED


PA

S Specialty Drug

MED

CUVITRU 8 GRAM/ 40 ML VIAL immune globulin,gamm(igg)/glycine/iga greater than 50 mcg/ml C

PA

S Specialty Drug

MED

FLEBOGAMMA DIF immune globulin,gamma (igg)/sorbitol/iga 0 to 50 mcg/ml C

PA

S Specialty Drug

MED

GAMASTAN immune globulin,gamma(igg)/glycine C

PA

S Specialty Drug

MED

GAMASTAN S-D immune globulin,gamma(igg)/glycine C

PA

S Specialty Drug

MED

GAMMAGARD LIQUID immune globulin,gamm(igg)/glycine/iga greater than 50 mcg/ml C

PA

S Specialty Drug

MED



GAMMAGARD S-D immune globulin,gamm(igg)/glycine/glucose/iga 0 to 50 mcg/ml C

PA

S Specialty Drug

MED

GAMMAKED immune globulin,gamma(igg)/glycine/iga average 46 mcg/ml C

PA

S Specialty Drug

MED

GAMMAPLEX 10 GRAM/100 ML VIAL immune globulin,gamma (igg)/glycine/iga 0 to 50 mcg/ml C

PA

S Specialty Drug

MED

GAMMAPLEX 10 GRAM/200 ML VIAL immune globulin,gamm(igg)/sorbitol/glycin/iga 0 to 50 mcg/ml C

PA

S Specialty Drug

MED


PA

S Specialty Drug

MED


PA

S Specialty Drug

MED


PA

S Specialty Drug

MED


PA

S Specialty Drug

MED

GAMUNEX-C immune globulin,gamma(igg)/glycine/iga average 46 mcg/ml C

PA

S Specialty Drug

MED

HYQVIA immune globulin,gamma(igg) human/hyaluronidase, human recomb

C

PA

S Specialty Drug

MED



OCTAGAM immune globulin,gamm(igg)/maltose/iga greater than 50 mcg/ml C

PA

S Specialty Drug

MED

PANZYGA immune globulin,gamma(igg)-ifas human/glycine C

PA

S Specialty Drug

TOXOIDS

ADACEL TDAP diphtheria,pertussis(acellular),tetanus vaccine/pf C

BOOSTRIX TDAP diphtheria,pertussis(acellular),tetanus vaccine C

DAPTACEL DTAP diphtheria, pertussis (acell), tetanus pediatric vaccine/pf C

diphtheria-tetanus toxoids-ped C

INFANRIX DTAP diphtheria, pertussis (acell), tetanus pediatric vaccine/pf C

tdvax C

TENIVAC tetanus and diphtheria toxoids, adsorbed, adult/pf C

VAXELIS diphtheria,pertus(acell),tetanus/hepb/polio/hib conj-meng/pf C

VACCINES

ACAM2000 (NATIONAL STOCKPILE) smallpox vaccine,live C

ACTHIB haemophilus b conjugate vaccine(tetanus toxoid conjugate)/pf C

adenovirus type 4 C

adenovirus type 4 and type 7 C

adenovirus type 7 C

AFLURIA QUAD 2019-20 (3YR UP) influenza virus vaccine quadrivalent 2019-20 (36 mos up)/pf C

AFLURIA QUAD 2019-20 (6-35MO) influenza virus vaccine quadrival 2019-20 (6 mos-35 mos)/pf C

AFLURIA QUAD 2019-2020 influenza virus vaccine quadrivalent 2019-20 (6 mos and up) C









ASTRAZENECA COVID19 VAC(UNAPP) covid-19 vaccine, azd-1222 (astrazeneca)/pf C

bcg vaccine (tice strain) C

BEXSERO meningococcal group b vaccine, 4-component C

BIOTHRAX anthrax vaccine C

COMIRNATY covid-19 vaccine, mrna, bnt162b2, lnp-s (pfizer)/pf C

ENGERIX-B ADULT hepatitis b virus vaccine recombinant/pf C

ENGERIX-B PEDIATRIC-ADOLESCENT hepatitis b virus vaccine recombinant/pf C

FLUAD 2019-2020 influenza vaccine tvs 2019-20 (65 yr up)/adjuvant mf59c.1/pf C

FLUAD 2020-2021 influenza vaccine tvs 2020-21 (65 yr up)/adjuvant mf59c.1/pf C

FLUAD QUAD 2020-2021 influenza vaccine quadrivalent 2020-21 (65 yr up)/mf59c.1/pf C

FLUAD QUAD 2021-2022 influenza vaccine quadrivalent 2021-22 (65 yr up)/mf59c.1/pf C

FLUARIX QUAD 2019-2020 influenza virus vaccine quadrival 2019-2020(6 mos and up)/pf C



FLUBLOK QUAD 2019-2020 influenza virus vaccine qv 2019-20(18 yrs and older)rcmb/pf C





FLUCELVAX QUAD 2019-2020 SYR flu vaccine quad 2019-2020(4 years and older)cell derived/pf C

FLUCELVAX QUAD 2019-2020 VIAL flu vaccine quadriv 2019-2020(4 years and older)cell derived C





FLULAVAL QUAD 2019-2020 SYR influenza virus vaccine quadrival 2019-2020(6 mos and up)/pf C

FLULAVAL QUAD 2019-2020 VIAL influenza virus vaccine quadrivalent 2019-20 (6 mos and up) C

FLULAVAL QUAD 2020-2021 influenza virus vaccine quadrival 2020-2021(6 mos and up)/pf C

FLULAVAL QUAD 2021-2022 influenza virus vaccine quadrival 2021-2022(6 mos and up)/pf C

FLUMIST QUAD 2019-2020 influenza vaccine quadrivalent live 2019-2020 (2 yrs-49 yrs) C



FLUZONE HIGH-DOSE 2019-2020 influenza virus vaccine trival split 2019-2020(65 yr up)/pf C

FLUZONE HIGH-DOSE QUAD 2020-21 influenza virus vaccine quadrival split 2020-21(65 yr up)/pf C

FLUZONE HIGH-DOSE QUAD 2021-22 influenza virus vaccine quadrival split 2021-22(65 yr up)/pf C

FLUZONE QUAD 2019-2020 influenza virus vaccine quadrival 2019-2020(6 mos and up)/pf C





FLUZONE QUAD PEDI 2019-2020 influenza virus vaccine quadrival 2019-20 (6 mos-35 mos)/pf C

FLUZONE QUAD SOUTH HEM 2020 VL influenza virus vacc quad 2020 south hem (6 mos and up) C

FLUZONE QUAD SOUTH HEM 2021 VL influenza virus vacc quad 2021 south hem (6 months and up) C

FLUZONE QUAD SOUTH HEM2020 SYR influenza virus vacc quad 2020 south hem (6 mos and up)/pf C

FLUZONE QUAD SOUTH HEM2021 SYR influenza virus vacc quad 2021 south hem (6 mos and up)/pf NP

GARDASIL 9 human papillomavirus vaccine, 9-valent/pf C

HAVRIX hepatitis a virus vaccine/pf C

HEPLISAV-B hepatitis b vaccine recombinant/vaccine adjuvant cpg 1018/pf C

HIBERIX haemophilus b conjugate vaccine(tetanus toxoid conjugate)/pf C

IMOVAX RABIES VACCINE rabies vaccine, human diploid cell/pf C

IPOL poliomyelitis vaccine, killed C

IXIARO japanese encephalitis vaccine/pf C

JANSSEN COVID-19 VACCINE (EUA) covid-19 vac, ad26.cov2.s (janssen)/pf C

JYNNEOS (NATIONAL STOCKPILE) smallpox and monkeypox vaccine, live, nonreplicating/pf C

KINRIX diphtheria, pertussis(acell),tetanus,polio vaccine/pf C

M-M-R II VACCINE measles, mumps, and rubella vaccine live/pf C

MENACTRA meningococcalvaccine a,c,y,w-135,diphtheria toxoid conj/pf C

MENQUADFI meningococcal vaccine a,c,y and w-135,conj tetanus toxoid/pf C

MENVEO A-C-Y-W-135-DIP meningococcalvaccine a,c,y,w-135,diphtheria toxoid conj/pf C



MENVEO MENA COMPONENT meningococcal a diphtheria-conj vaccine component 1 of 2/pf C

MENVEO MENCYW-135 COMPONENT meningococcal c,y,w-135,dip-conj vaccine component 2 of 2/pf C

MODERNA COVID-19 VACCINE (EUA) covid-19 vaccine, mrna-1273, lnp-s (moderna)/pf C

NOVAVAX COVID19 VAC,ADJ(UNAPP) covid-19 vaccine, nvx-cov2373 (novavax)/adjuvant-matrix/pf C

PEDIARIX hep b virus,rcmb/dipth,pertus(acell),tet,polio vaccine/pf C

PEDVAXHIB haemophilus b conjugate vaccine (meningococcal prot.conj)/pf C

PENTACEL diphtheria,pertussis(acell),tetanus,polio/haemophilus b/pf C

PENTACEL ACTHIB COMPONENT haemophilus b polysacc conj-tetanus tox,component 2 of 2/pf C

PENTACEL DTAP-IPV COMPONENT diphther,pertus(acel),tetanus,polio vacc,component 1 of 2/pf C

PFIZER COVID-19 VACCINE (EUA) covid-19 vaccine, mrna, bnt162b2, lnp-s (pfizer)/pf C

PNEUMOVAX 23 pneumococcal 23-valent polysaccharide vaccine C

PREVNAR 13 pneumococcal 13-valent conjugate vaccine (diphtheria crm)/pf C

PREVNAR 20 pneumococcal 20-valent conjugate vaccine (diphtheria crm)/pf C

PROQUAD measles, mumps, rubella, and varicella vaccine live/pf C

QUADRACEL DTAP-IPV diphtheria, pertussis(acell),tetanus,polio vaccine/pf C

RABAVERT rabies vaccine, purified chicken embryo cell (pcec)/pf C

RECOMBIVAX HB hepatitis b virus vaccine recombinant/pf C

ROTARIX rotavirus vaccine, live oral attenuated,89-12 strain, g1p(8) C

ROTATEQ rotavirus vaccine, live oral pentavalent C

SHINGRIX varicella-zoster virus glycoprotein e,rec/as01b adjuvant/pf C QL 1 DOSE / RX



SHINGRIX GE ANTIGEN COMPONENT varicella-zoster virus glycoprotein e,rec,component 2 of 2 C QL 1 DOSE / RX

STAMARIL yellow fever vaccine live/pf C

TRUMENBA neisseria meningitidis group b, lipidated fhbp recombinant C

TWINRIX hepatitis a virus and hepatitis b virus vaccine/pf C

TYPHIM VI typhoid vaccine vi capsular polysaccharide C

VAQTA hepatitis a virus vaccine/pf C

VARIVAX VACCINE varicella virus vaccine live/pf C

VAXCHORA ACTIVE COMPONENT cholera vaccine, live C

VAXCHORA VACCINE cholera vaccine, live C

VAXNEUVANCE pneumococcal 15-valent conjugate vaccine (diphtheria crm)/pf C

VIVOTIF typhoid vacc,live,attenuated C

YF-VAX yellow fever vaccine live/pf C

ZOSTAVAX zoster vaccine live/pf C AL1 At least 50 yrs old


ANTIULCER AGENTS AND ACID SUPPRESSANTS

ANTIULCER AGENTS AND ACID SUPPRESS.,MISC

TALICIA omeprazole magnesium/amoxicillin trihydrate/rifabutin C PA

HISTAMINE H2-ANTAGONISTS

ACID CONTROL 150 MG TABLET ranitidine hcl C OTC

ACID CONTROLLER famotidine C OTC

ACID REDUCER 10 MG TABLET famotidine C OTC

ACID REDUCER 20 MG TABLET famotidine C OTC


ACID-PEP famotidine C OTC

cimetidine 200 mg tablet C OTC

cimetidine 300 mg tablet C

cimetidine 300 mg/5 ml soln C


cimetidine 400 mg/6.67 ml soln C


CVS ACID REDUCER 150 MG TABLET ranitidine hcl C OTC

cvs cimetidine 200 mg tablet C OTC

CVS HEARTBURN RELIEF 200 MG TB cimetidine C OTC

EQ ACID REDUCER 10 MG TABLET famotidine C OTC

famotidine 10 mg tablet C OTC

famotidine 20 mg tablet C

famotidine 40 mg tablet C

famotidine 40 mg/5 ml susp C AL1 Up to 12 yrs old

GNP ACID CONTROL 150 MG TABLET C OTC

GNP ACID REDUCER 10 MG TABLET famotidine C OTC

gnp cimetidine 200 mg tablet C OTC

GS ACID REDUCER 10 MG TABLET famotidine C OTC

HEARTBURN RELIEF 200 MG TABLET cimetidine C OTC

PEPCID AC 10 MG TABLET famotidine C OTC

PUB ACID REDUCER 10 MG TABLET C OTC

RA ACID REDUCER 10 MG TABLET C OTC

ranitidine 15 mg/ml syrup C

ranitidine 150 mg tablet C OTC



ranitidine 150 mg/10 ml syrup C

ranitidine 300 mg tablet C

SM ACID REDUCER 10 MG TABLET famotidine C OTC

SM HEARTBURN RELIEF 200 MG TAB C OTC

ZANTAC-360(FAMOTIDINE) 20MG TB C

PROSTAGLANDINS

misoprostol C

PROTECTANTS

sucralfate 1 gm tablet C

PROTON-PUMP INHIBITORS

ACIPHEX rabeprazole sodium NP PA

ACIPHEX SPRINKLE rabeprazole sodium NP PA

cvs esomeprazole mag 20 mg cap C OTC

cvs omeprazole-bicarb 20-1,100 NP PA

OTC

DEXILANT dexlansoprazole NP PA

esomeprazole dr 10 mg packet NP PA



esomeprazole mag dr 20 mg cap C OTC

esomeprazole mag dr 40 mg cap P

esomeprazole strontium NP PA

gnp esomeprazole mag dr 20 mg C OTC

gs esomeprazole mag dr 20 mg C OTC

hm esomeprazole mag dr 20 mg C OTC

lansoprazole dr 15 mg capsule P



lansoprazole dr 15 mg capsule (Rx only) P

lansoprazole dr 30 mg capsule P

lansoprazole odt 15 mg tablet NP

PA

AL1 Up to 9 yrs old

OTC

lansoprazole odt 30 mg tablet NP PA

AL1 Up to 9 yrs old

NEXIUM DR 10 MG PACKET esomeprazole magnesium P

NEXIUM DR 2.5 MG PACKET esomeprazole magnesium P

NEXIUM DR 20 MG CAPSULE esomeprazole magnesium NP PA


NEXIUM DR 40 MG CAPSULE esomeprazole magnesium NP PA



omeprazole dr 10 mg capsule P



omeprazole-bicarb 20-1,100 cap NP PA

OTC

omeprazole-bicarb 20-1,680 pkt NP PA

omeprazole-bicarb 40-1,100 cap NP PA

omeprazole-bicarb 40-1,680 pkt NP PA

pantoprazole 40 mg suspension C

pantoprazole sod dr 20 mg tab P

pantoprazole sod dr 40 mg tab P

PREVACID 15 MG SOLUTAB lansoprazole NP

PA

AL1 Up to 9 yrs old



PREVACID 30 MG SOLUTAB lansoprazole NP

PA

AL1 Up to 9 yrs old

PREVACID DR 15 MG CAPSULE lansoprazole NP PA

PREVACID DR 30 MG CAPSULE lansoprazole NP PA

PRILOSEC omeprazole magnesium NP PA

PROTONIX pantoprazole sodium NP PA

qc esomeprazole mag dr 20 mg C OTC

ra esomeprazole mag dr 20 mg C OTC

rabeprazole sod dr 20 mg tab NP PA

sm esomeprazole mag dr 20 mg C OTC

ZEGERID omeprazole/sodium bicarbonate NP PA


ANTIVIRALS (SYSTEMIC)

ADAMANTANE ANTIVIRALS

rimantadine hcl C

ANTIVIRALS, MISCELLANEOUS

PREVYMIS 240 MG TABLET letermovir C

PREVYMIS 480 MG TABLET letermovir C

TPOXX (NATIONAL STOCKPILE) tecovirimat C PA

XOFLUZA 20 MG TAB (40 MG DOSE) baloxavir marboxil NP PA

XOFLUZA 40 MG TAB (80 MG DOSE) baloxavir marboxil NP PA

XOFLUZA 40 MG TABLET baloxavir marboxil NP PA

XOFLUZA 80 MG TABLET baloxavir marboxil NP PA


INTERFERON ANTIVIRALS

ALFERON N interferon alfa-n3 C S Specialty Drug

INTRON A interferon alfa-2b,recomb. C S Specialty Drug

PEGASYS peginterferon alfa-2a P S Specialty Drug

PEGASYS PROCLICK peginterferon alfa-2a P S Specialty Drug

PEGINTRON peginterferon alfa-2b NP

PA

S Specialty Drug

SYLATRON peginterferon alfa-2b C

S Specialty Drug

ONC

NEURAMINIDASE INHIBITOR ANTIVIRALS

oseltamivir 6 mg/ml suspension P QL 180 ML / FILL

oseltamivir phos 30 mg capsule P QL 20 CAPS / FILL



RELENZA zanamivir P QL 20 CAPS / FILL

TAMIFLU 30 MG CAPSULE oseltamivir phosphate NP

QL 20 CAPS / FILL

PA


QL 10 CAPS / FILL

PA

TAMIFLU 6 MG/ML SUSPENSION oseltamivir phosphate NP

QL 180 ML / FILL

PA


QL 10 CAPS / FILL

PA

NUCLEOSIDE AND NUCLEOTIDE ANTIVIRALS

acyclovir 200 mg capsule P

acyclovir 200 mg/5 ml susp P



acyclovir 400 mg tablet P

acyclovir 800 mg tablet P

adefovir dipivoxil P

BARACLUDE entecavir P

entecavir P

famciclovir NP PA

HEPSERA adefovir dipivoxil P

RIBASPHERE 600 MG TABLET ribavirin NP

PA

S Specialty Drug

RIBASPHERE RIBAPAK ribavirin NP

PA

S Specialty Drug

ribavirin 200 mg capsule P S Specialty Drug

ribavirin 200 mg tablet P S Specialty Drug

SITAVIG acyclovir NP PA

valacyclovir P

valganciclovir hcl C

VALTREX valacyclovir hcl NP PA

VEMLIDY tenofovir alafenamide NP PA

ZOVIRAX 200 MG/5 ML SUSP acyclovir NP PA


ANXIOLYTICS, SEDATIVES AND HYPNOTICS

ANXIOLYTICS,SEDATIVES,AND HYPNOTICS,MISC

AMBIEN zolpidem tartrate NP PA

AMBIEN CR zolpidem tartrate NP PA

BELSOMRA 10 MG TABLET suvorexant NP

QL 2 TABS / 1 DAY

PA



QL 1 TAB / 1 DAY

PA


QL 1 TAB / 1 DAY

PA


QL 2 TABS / 1 DAY

PA

buspirone hcl C

DAYVIGO lemborexant NP

QL 1 TAB / 1 DAY

PA

EDLUAR zolpidem tartrate NP PA

eszopiclone P

HETLIOZ tasimelteon NP

QL 1 CAP / 1 DAY

PA

S Specialty Drug

HETLIOZ LQ tasimelteon C

PA

S Specialty Drug

hydroxyzine 10 mg/5 ml soln C

hydroxyzine 10 mg/5 ml syrup C

hydroxyzine 50 mg/25 ml syrup C

hydroxyzine hcl 10 mg tablet C



hydroxyzine pamoate C

INTERMEZZO zolpidem tartrate NP PA

LUNESTA eszopiclone NP PA

ramelteon NP QL 1 TAB / 1 DAY

PA

ROZEREM ramelteon P



zaleplon P

zolpidem tart 1.75 mg tab sl NP PA

zolpidem tart 3.5 mg tablet sl NP PA

zolpidem tartrate 10 mg tablet P

zolpidem tartrate 5 mg tablet P

zolpidem tartrate er NP PA

ZOLPIMIST zolpidem tartrate NP PA

BARBITURATES (ANXIOLYTIC, SEDATIVE/HYP)

phenobarbital C

BENZODIAZEPINES (ANXIOLYTIC,SEDATIV/HYP)

alprazolam 0.25 mg tablet C QL 6 TABS / 1 DAY

alprazolam 0.5 mg tablet C QL 6 TABS / 1 DAY

alprazolam 1 mg tablet C QL 6 TABS / 1 DAY

alprazolam 2 mg tablet C QL 3 TABS / 1 DAY

alprazolam er 0.5 mg tablet C QL 6 TABS / 1 DAY

alprazolam er 1 mg tablet C QL 6 TABS / 1 DAY



alprazolam xr 0.5 mg tablet C QL 6 TABS / 1 DAY

alprazolam xr 1 mg tablet C QL 6 TABS / 1 DAY



chlordiazepoxide 10 mg capsule C QL 6 CAPS / 1 DAY



DIASTAT diazepam P QL 4 KITS / 30 DAYS



DIASTAT ACUDIAL diazepam P QL 4 KITS / 30 DAYS

diazepam 10 mg rectal gel syst NP QL 4 KIT / 30 DAYS

PA

diazepam 10 mg tablet C QL 4 TABS / 1 DAY


diazepam 2.5 mg rectal gel sys NP QL 4 KITS / 30 DAYS

PA

diazepam 20 mg rectal gel syst NP QL 4 KIT / 30 DAYS

PA


diazepam 5 mg/5 ml solution C QL 40 ML / 1 DAY

diazepam 5 mg/ml oral conc C QL 8 ML / 1 DAY

lorazepam 0.5 mg tablet C QL 6 TABS / 1 DAY

lorazepam 1 mg tablet C QL 6 TABS / 1 DAY

lorazepam 2 mg tablet C QL 5 TABS / 1 DAY

lorazepam 2 mg/ml oral concent C QL 5 ML / 1 DAY

LORAZEPAM INTENSOL lorazepam C QL 5 ML / 1 DAY

temazepam 15 mg capsule C QL 2 CAPS / 1 DAY

temazepam 30 mg capsule C QL 1 CAP / 1 DAY

VALTOCO diazepam P QL 1 CARTON / RX


AUTONOMIC DRUGS

AUTONOMIC DRUGS, MISCELLANEOUS

CHANTIX varenicline tartrate P

nicotine gum P OTC

nicotine lozenge P OTC

nicotine patch P OTC


NICOTROL nicotine NP PA

NICOTROL NS nicotine NP PA

QUIT 2 C OTC

QUIT 4 C OTC

PARASYMPATHOMIMETIC (CHOLINERGIC AGENTS)

ARICEPT donepezil hcl NP PA

bethanechol chloride C

cevimeline hcl C

donepezil hcl 10 mg tablet P

donepezil hcl 23 mg tablet NP PA

donepezil hcl 5 mg tablet P

donepezil hcl odt P

EXELON rivastigmine NP PA

galantamine er NP PA

galantamine hbr NP PA

galantamine hydrobromide NP PA

pilocarpine hcl 5 mg tablet C

pilocarpine hcl 7.5 mg tablet C

pyridostigmine br 30 mg tablet C QL 1 TAB / 1 DAY

pyridostigmine br 60 mg tablet C

pyridostigmine bromide er C PA

RAZADYNE galantamine hbr NP PA

RAZADYNE ER galantamine hbr NP PA

rivastigmine 1.5 mg capsule NP PA

rivastigmine 13.3 mg/24hr ptch NP PA



rivastigmine 3 mg capsule NP PA

rivastigmine 4.5 mg capsule NP PA

rivastigmine 4.6 mg/24hr patch NP PA

rivastigmine 6 mg capsule NP PA

rivastigmine 9.5 mg/24hr patch NP PA


BETA-3-ADRENERGIC AGONISTS

SELECTIVE BETA-3-ADRENERGIC AGONISTS

MYRBETRIQ mirabegron NP PA

BETA-ADRENERGIC AGONISTS

SELECTIVE BETA-2-ADRENERGIC AGONISTS

albuterol 100 mg/20 ml soln P

albuterol 2.5 mg/0.5 ml sol P

albuterol 5 mg/ml solution P

albuterol sul 0.63 mg/3 ml sol P

albuterol sul 1.25 mg/3 ml sol P

albuterol sul 2.5 mg/3 ml soln P

albuterol sulf 2 mg/5 ml syrup P

albuterol sulfate 2 mg tab NP PA

albuterol sulfate 4 mg tab NP PA

ALBUTEROL SULFATE 90 MCG HFA AER AD (GENERIC PROAIR) NP PA

Albuterol Sulfate 90 mcg hfa aer ad (Generic ProAir) NP PA

Albuterol Sulfate 90 mcg hfa aer ad (Generic Proventil) NP PA

Albuterol Sulfate 90 mcg hfa aer ad (Generic Ventolin) NP PA

albuterol sulfate er 4 mg tab NP PA

albuterol sulfate er 8 mg tab NP PA

albuterol sulfate hfa NP PA

ARCAPTA NEOHALER indacaterol maleate NP PA


BROVANA arformoterol tartrate NP PA

levalbuterol concentrate NP PA

levalbuterol hcl NP PA

levalbuterol tartrate hfa C

metaproterenol sulfate P

PERFOROMIST formoterol fumarate NP PA

PROAIR DIGIHALER albuterol sulfate NP PA

PROAIR HFA albuterol sulfate P

PROAIR RESPICLICK albuterol sulfate NP PA

PROVENTIL HFA albuterol sulfate NP PA

SEREVENT DISKUS salmeterol xinafoate P

STRIVERDI RESPIMAT olodaterol hcl NP PA

UTIBRON NEOHALER indacaterol maleate/glycopyrrolate NP PA

VENTOLIN HFA albuterol sulfate P

XOPENEX levalbuterol hcl NP PA

XOPENEX CONCENTRATE levalbuterol hcl NP PA

XOPENEX HFA levalbuterol tartrate P


BLOOD FORMATION, COAGULATION, THROMBOSIS

BLOOD FORM.,COAG,THROMBOSIS AGENTS MISC.

ADAKVEO crizanlizumab-tmca P

QL 60 ML / 28 DAYS

PA

S Specialty Drug

MED


OXBRYTA voxelotor P

QL 3 TABS / 1 DAY

PA

S Specialty Drug

HEMATOPOIETIC AGENTS

ARANESP darbepoetin alfa in polysorbate 80 P S Specialty Drug

EPOGEN epoetin alfa P S Specialty Drug

FULPHILA pegfilgrastim-jmdb C

GRANIX tbo-filgrastim C S Specialty Drug

LEUKINE sargramostim C

PA

S Specialty Drug

NYVEPRIA pegfilgrastim-apgf C PA

PROCRIT epoetin alfa NP

PA

S Specialty Drug

PROMACTA 12.5 MG SUSPEN PACKET eltrombopag olamine C

QL 1 PACKET / 1 DAY

PA

S Specialty Drug

PROMACTA 12.5 MG TABLET eltrombopag olamine C

PA

S Specialty Drug

PROMACTA 25 MG SUSPENSION PCKT eltrombopag olamine C


PA

S Specialty Drug

PROMACTA 25 MG TABLET eltrombopag olamine C

PA

S Specialty Drug


PA

S Specialty Drug


PA

S Specialty Drug



REBLOZYL luspatercept-aamt NP

PA

MED

RETACRIT epoetin alfa-epbx P S Specialty Drug

UDENYCA pegfilgrastim-cbqv C

ZIEXTENZO pegfilgrastim-bmez C

HEMORRHEOLOGIC AGENTS

pentoxifylline C


CALCIUM-CHANNEL BLOCKING AGENTS

CALCIUM-CHANNEL BLOCKING AGENTS, MISC.

CALAN verapamil hcl NP PA

CALAN SR verapamil hcl NP PA

CARDIZEM diltiazem hcl NP PA

CARDIZEM CD diltiazem hcl NP PA

CARDIZEM LA diltiazem hcl NP PA

CARTIA XT diltiazem hcl C

DILT-XR diltiazem hcl C

diltiazem 120 mg tablet P

diltiazem 12hr er P

diltiazem 24h er(cd) 120 mg cp P




diltiazem 24h er(la) 180 mg tb P




DILTIAZEM 24H ER(LA) 360 MG TB (generic for CARDIZEM LA) P


diltiazem 24hr er P

diltiazem 24hr er (xr) P

DILTIAZEM 24HR ER 360 MG CAP (generic for CARDIZEM CD) P




MATZIM LA 180 MG TABLET diltiazem hcl NP PA



MATZIM LA 360 MG TABLET (generic for CARDIZEM LA) diltiazem hcl NP PA


TAZTIA XT diltiazem hcl C

TIADYLT ER diltiazem hcl C

TIAZAC diltiazem hcl NP PA

verapamil 120 mg tablet P

verapamil 360 mg cap pellet P



verapamil er P

verapamil er pm P

verapamil sr P

VERELAN verapamil hcl NP PA



VERELAN PM verapamil hcl NP PA

DIHYDROPYRIDINES

ADALAT CC nifedipine NP PA

amlodipine besylate P

amlodipine besylate-benazepril P

amlodipine-olmesartan NP PA

amlodipine-valsartan P

amlodipine-valsartan-hctz P

AZOR amlodipine besylate/olmesartan medoxomil NP PA

EXFORGE amlodipine besylate/valsartan NP PA

EXFORGE HCT amlodipine besylate/valsartan/hydrochlorothiazide NP PA

felodipine er P

isradipine P

LOTREL amlodipine besylate/benazepril hcl NP PA

nicardipine 20 mg capsule P

nicardipine 30 mg capsule P

nifedipine P

nifedipine er P

nimodipine NP PA

nisoldipine NP PA

NORVASC amlodipine besylate NP PA

NYMALIZE nimodipine NP PA

PROCARDIA nifedipine NP PA

PROCARDIA XL nifedipine NP PA



SULAR nisoldipine NP PA


CARDIAC DRUGS

CARDIAC DRUGS, MISCELLANEOUS

CORLANOR ivabradine hcl C PA

VYNDAMAX tafamidis C

PA

S Specialty Drug

VYNDAQEL tafamidis meglumine C

PA

S Specialty Drug

CARDIOTONIC AGENTS

DIGITEK 125 MCG TABLET digoxin C

DIGITEK 250 MCG TABLET digoxin C AL1 Up to 64 yrs old

DIGOX digoxin C

digoxin 0.05 mg/ml solution C

digoxin 0.125 mg tablet C

digoxin 0.25 mg tablet C

digoxin 125 mcg tablet C

digoxin 250 mcg tablet C

CARDIOVASCULAR DRUGS

ALPHA-ADRENERGIC BLOCKING AGENTS

CARDURA doxazosin mesylate NP PA

CARDURA XL doxazosin mesylate NP PA

doxazosin mesylate P

prazosin hcl C

terazosin hcl P

BETA-ADRENERGIC BLOCKING AGENTS

acebutolol hcl NP PA


atenolol P

atenolol-chlorthalidone NP PA

BETAPACE sotalol hcl NP PA

BETAPACE AF sotalol hcl NP PA

betaxolol 10 mg tablet NP PA

betaxolol 20 mg tablet NP PA

bisoprolol fumarate P

bisoprolol-hydrochlorothiazide NP PA

BYSTOLIC nebivolol hcl NP PA

carvedilol P

carvedilol er NP PA

COREG carvedilol NP PA

COREG CR carvedilol phosphate NP PA

CORGARD nadolol NP PA

DUTOPROL metoprolol succinate/hydrochlorothiazide NP PA

HEMANGEOL propranolol hcl NP PA

INDERAL LA propranolol hcl NP PA

INDERAL XL propranolol hcl NP PA

INNOPRAN XL propranolol hcl NP PA

KAPSPARGO SPRINKLE metoprolol succinate NP PA

labetalol hcl 100 mg tablet P





LOPRESSOR 100 MG TABLET metoprolol tartrate NP PA

LOPRESSOR 50 MG TABLET metoprolol tartrate NP PA

LOPRESSOR HCT metoprolol tartrate/hydrochlorothiazide NP PA

metoprolol succinate P

metoprolol tartrate 100 mg tab P


metoprolol tartrate 37.5 mg tb P



metoprolol-hydrochlorothiazide NP PA

nadolol P

pindolol P

propranolol 10 mg tablet P


propranolol 20 mg/5 ml soln P


propranolol 40 mg/5 ml soln P



propranolol hcl er P

propranolol-hydrochlorothiazid C

SORINE sotalol hcl C

sotalol P

SOTALOL AF sotalol hcl P

SOTYLIZE sotalol hcl NP PA

TENORETIC 100 atenolol/chlorthalidone NP PA

TENORETIC 50 atenolol/chlorthalidone NP PA



TENORMIN atenolol NP PA

timolol maleate 10 mg tablet NP PA



TOPROL XL metoprolol succinate NP PA

ZIAC bisoprolol fumarate/hydrochlorothiazide NP PA


CENTRAL NERVOUS SYSTEM AGENTS

ANTIMANIC AGENTS

lithium C

lithium carbonate C

lithium carbonate er C

CENTRAL NERVOUS SYSTEM AGENTS, MISC.

acamprosate calcium C

atomoxetine hcl 10 mg capsule P QL 2 CAPS / 1 DAY

atomoxetine hcl 100 mg capsule P QL 1 CAP / 1 DAY






guanfacine hcl er 1 mg tablet P QL 3 TABS / 1 DAY

guanfacine hcl er 2 mg tablet P QL 2 TABS / 1 DAY

guanfacine hcl er 3 mg tablet P QL 1 TAB / 1 DAY

guanfacine hcl er 4 mg tablet P QL 1 TAB / 1 DAY

INTUNIV ER 1 MG TABLET guanfacine hcl NP

QL 3 TABS / 1 DAY

PA



QL 2 TABS / 1 DAY

PA


QL 1 TAB / 1 DAY

PA


QL 1 TAB / 1 DAY

PA

memantine 5-10 mg titration pk P

memantine hcl 10 mg tablet P

memantine hcl 2 mg/ml solution NP PA

memantine hcl 5 mg tablet P

memantine hcl er NP PA

NAMENDA 10 MG TABLET memantine hcl NP PA

NAMENDA 5 MG TABLET memantine hcl NP PA

NAMENDA 5-10 MG TITRATION PK memantine hcl NP PA

NAMENDA XR 14 MG CAPSULE memantine hcl NP PA




NAMENDA XR TITRATION PACK memantine hcl NP PA

NAMZARIC memantine hcl/donepezil hcl NP PA

NOURIANZ istradefylline NP

PA

S Specialty Drug

riluzole C

STRATTERA 10 MG CAPSULE atomoxetine hcl NP

QL 2 CAPS / 1 DAY

PA




QL 1 CAP / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 2 CAPS / 1 DAY

PA


QL 1 CAP / 1 DAY

PA


QL 1 CAP / 1 DAY

PA

XYREM sodium oxybate C

QL 18 ML / 1 DAY

PA

S Specialty Drug

XYWAV sodium oxybate/calcium oxybate/magnesium oxybate/pot oxybate

C

QL 18 ML / 1 DAY

PA

S Specialty Drug

FIBROMYALGIA AGENTS

SAVELLA 100 MG TABLET milnacipran hcl P QL 2 TABS / 1 DAY

SAVELLA 12.5 MG TABLET milnacipran hcl P QL 2 TABS / 1 DAY



SAVELLA TITRATION PACK milnacipran hcl P QL 55 TABS / 30 DAYS

OPIATE ANTAGONISTS

KLOXXADO naloxone hcl C

naloxone 0.4 mg/ml carpuject C



naloxone 0.4 mg/ml vial P

naloxone 2 mg/2 ml syringe P

naloxone 4 mg/10 ml vial P

naltrexone hcl C

NARCAN naloxone hcl P

VESICULAR MONOAMINE TRANSPORT2 INHIBITOR

AUSTEDO deutetrabenazine C

PA

S Specialty Drug

INGREZZA valbenazine tosylate C

PA

S Specialty Drug

INGREZZA INITIATION PACK valbenazine tosylate C

PA

S Specialty Drug

tetrabenazine C PA

S Specialty Drug


CEPHALOSPORIN ANTIBIOTICS

1ST GENERATION CEPHALOSPORIN ANTIBIOTICS

cefadroxil 1 gm tablet NP PA

cefadroxil 250 mg/5 ml susp P

cefadroxil 500 mg capsule P

cefadroxil 500 mg/5 ml susp P

cephalexin 125 mg/5 ml susp P

cephalexin 250 mg capsule P

cephalexin 250 mg tablet NP PA

cephalexin 250 mg/5 ml susp P


cephalexin 500 mg tablet NP PA


KEFLEX cephalexin NP PA


2ND GENERATION CEPHALOSPORIN ANTIBIOTICS

cefaclor P

cefaclor er NP PA

cefprozil P

cefuroxime P

3RD GENERATION CEPHALOSPORIN ANTIBIOTICS

cefdinir P

cefixime NP PA

cefpodoxime 100 mg tablet NP QL 14 TABS / RX

PA

cefpodoxime 100 mg/5 ml susp NP QL 100 ML / RX

PA

cefpodoxime 200 mg tablet NP QL 14 TABS / RX

PA

cefpodoxime 50 mg/5 ml susp NP QL 100 ML / RX

PA

ceftriaxone 1 gm add-vant vial C MED

SUPRAX 100 MG TABLET CHEWABLE cefixime NP PA

SUPRAX 100 MG/5 ML SUSPENSION cefixime NP PA

SUPRAX 200 MG TABLET CHEWABLE cefixime NP PA


SUPRAX 400 MG CAPSULE cefixime P





CORTICOSTEROIDS (RESPIRATORY TRACT)

ORALLY INHALED PREPARATIONS (STEROIDS)

ADVAIR DISKUS fluticasone propionate/salmeterol xinafoate P

ADVAIR HFA fluticasone propionate/salmeterol xinafoate P

AIRDUO RESPICLICK fluticasone propionate/salmeterol xinafoate NP PA

ALVESCO ciclesonide NP PA

ARNUITY ELLIPTA fluticasone furoate NP PA

ASMANEX mometasone furoate P

ASMANEX HFA mometasone furoate NP PA

BREO ELLIPTA fluticasone furoate/vilanterol trifenatate NP PA

BREZTRI AEROSPHERE budesonide/glycopyrrolate/formoterol fumarate NP PA

budesonide 0.25 mg/2 ml susp P

budesonide 0.5 mg/2 ml susp P

budesonide 1 mg/2 ml inh susp P

budesonide-formoterol fumarate NP PA

DULERA mometasone furoate/formoterol fumarate P

FLOVENT DISKUS fluticasone propionate P

FLOVENT HFA fluticasone propionate P

fluticasone-salmeterol 100-50 NP PA

FLUTICASONE-SALMETEROL 113-14 (generic for AIRDUO RESPICLICK) NP PA






PULMICORT budesonide NP PA

PULMICORT FLEXHALER budesonide P

QVAR REDIHALER beclomethasone dipropionate NP PA

SYMBICORT budesonide/formoterol fumarate P

TRELEGY ELLIPTA fluticasone furoate/umeclidinium bromide/vilanterol trifenat NP PA

WIXELA INHUB fluticasone propionate/salmeterol xinafoate NP PA


CYSTIC FIBROSIS (CFTR) MODULATORS

CYSTIC FIBROSIS (CFTR) CORRECTORS

SYMDEKO 100/150 MG-150 MG TABS tezacaftor/ivacaftor C

PA

S Specialty Drug

SYMDEKO 50/75 MG-75 MG TABLETS tezacaftor/ivacaftor C PA

TRIKAFTA elexacaftor/tezacaftor/ivacaftor C

PA

S Specialty Drug

CYSTIC FIBROSIS (CFTR) POTENTIATORS

KALYDECO 150 MG TABLET ivacaftor C

PA

S Specialty Drug

KALYDECO 50 MG GRANULES PACKET ivacaftor C

PA

S Specialty Drug

KALYDECO 75 MG GRANULES PACKET ivacaftor C

PA

S Specialty Drug

ORKAMBI lumacaftor/ivacaftor C

PA

S Specialty Drug


DEVICES

0.3C OTC

ML INSULIN SYRINGE syringe with needle,insulin,0.3 ml

0.5C OTC

ML INSULIN SYRINGE syringe with needle,insulin,0.5 ml

1 ML INSULIN SYRINGE syringe with needle,disposable,insulin 1 ml C OTC

2-in-1 lancet device lancets C OTC

accu-chek aviva plus meter blood-glucose meter P

QL 1 METER / 365 DAYS

OTC

accu-chek aviva solution blood glucose calibration control high and low C OTC

accu-chek compact plus control blood glucose calibration control high and low C OTC

accu-chek fastclix lancing dev lancing device/lancets C OTC

accu-chek guide control soln blood glucose calibration control high and low C OTC

accu-chek guide me glucose mtr blood-glucose meter P


OTC

accu-chek guide monitor system blood-glucose meter P


OTC

accu-chek multiclix lancet kit lancing device/lancets C OTC

accu-chek multiclix lancets lancets C OTC

accu-chek smartview contrl sol blood glucose calibration control solution, normal C OTC

accu-chek softclix lancet kit lancing device/lancets C OTC

accu-chek softclix lancets lancets C OTC

assure lance lancets C OTC

autolet lancing device lancing device C OTC



biotel care bgm-4 blood-glucose meter C


PA

OTC

BIOTENE MOISTURIZING MOUTH saliva stimulant combination no.3 C OTC

butterfly touch lancet lancets C OTC

caretouch safety lancets lancets C OTC

comfort touch plus safety lanc lancets C OTC

comfort touch ult thin lancet lancets C OTC

contour blood-glucose meter P


OTC

contour next blood-glucose meter P


OTC

contour next ez blood-glucose meter P


OTC

contour next glucose meter blood-glucose meter P


OTC

contour next link blood-glucose meter, wireless P


OTC

contour next link 2.4 blood-glucose meter, wireless P


OTC

contour next one blood-glucose meter P


OTC

dexcom blood-glucose meter,continuous NP PA

dexcom g4 (ped) receiver kit blood-glucose meter,continuous C OTC

dexcom g4 receiver kit blood-glucose meter,continuous C PA

dexcom g4 receiver-share (ped) blood-glucose meter,continuous C OTC



dexcom g4 receiver-share kit blood-glucose meter,continuous C OTC

dexcom g4 transmitter kit blood-glucose transmitter C PA

dexcom g5 receiver kit blood-glucose meter,continuous NP PA

dexcom g5 transmitter kit blood-glucose transmitter NP PA

dexcom g5-g4 sensor blood-glucose sensor NP PA

dexcom g6 receiver blood-glucose meter,continuous P

dexcom g6 sensor blood-glucose sensor P

dexcom g6 transmitter blood-glucose transmitter P

droplet genteel lancing device lancing device C OTC

droplet lancets lancets C OTC

easy touch blu link ctrl soln blood glucose calibration control high and low C

easy touch blu link gluc syst blood-glucose meter C


PA

easy trak ii control solution blood glucose calibration control solution, normal C OTC

embrace lancing device lancing device C OTC

embrace pro blood glucose mtr blood-glucose meter C


PA

OTC

ez-lets lancets C OTC

fora g20 blood glucose system blood-glucose meter NP


PA

OTC

fora ketone control solution blood-ketone control, normal C



fora tn'g advance pro monitor blood ketone and glucose monitor C


PA

fortiscare t1 blood gluc sys blood-glucose meter C


PA

freestyle freedom lite blood-glucose meter NP


PA

OTC

freestyle insulinx glucose sys blood-glucose meter NP


PA

OTC

freestyle libre 10 day reader flash glucose scanning reader C PA

freestyle libre 10 day sensor flash glucose sensor C PA

freestyle libre 14 day reader flash glucose scanning reader P

freestyle libre 14 day sensor flash glucose sensor P

freestyle libre 2 reader flash glucose scanning reader P

freestyle libre 2 sensor flash glucose sensor P

freestyle lite meter blood-glucose meter NP


PA

OTC

ge100 blood glucose system blood-glucose meter C OTC

ge333 blood glucose system blood-glucose meter C


PA

OTC

ge333 control solution normal blood glucose calibration control solution, normal C OTC

glucocard expression meter blood-glucose meter NP


PA

OTC



glucocard expression meter kit blood-glucose meter NP


PA

OTC

glucocard shine meter blood-glucose meter NP


PA

OTC

glucocard shine meter kit blood-glucose meter NP


PA

OTC

glucocard shine xl blood-glucose meter NP


PA

OTC

gojji glucose control solution blood glucose calibration control solution, normal C OTC

gojji ketone control solution blood-ketone control, normal C OTC

gojji lancet-glucose test strp lancets with blood glucose test strips C OTC

gojji lancets lancets C OTC

gojji multifunctional meter kt blood ketone and glucose monitor C


PA

onetouch delica lancing device/lancets C OTC

onetouch ultra2 blood-glucose meter NP


PA

OTC

onetouch ultramini blood-glucose meter NP


PA

OTC

onetouch verio flex meter blood-glucose meter NP


PA

OTC



onetouch verio flex startr kit blood-glucose meter NP


PA

OTC

onetouch verio iq meter blood-glucose meter NP


PA

OTC

onetouch verio iq system kit blood-glucose meter NP


PA

OTC

onetouch verio meter blood-glucose meter NP


PA

OTC

onetouch verio reflect kit blood-glucose meter C


PA

OTC

onetouch verio reflect meter blood-glucose meter C


PA

OTC

pip lancet lancets C OTC

pogo automatic blood gluc sys blood-glucose meter C


PA

OTC

pogo automatic test cartridge lancets with blood glucose test strips C OTC

precision xtra ketone-glucose blood ketone and glucose monitor NP


PA

OTC

precision xtra monitor blood-glucose meter NP


PA

OTC

premier classic glucose meter blood-glucose meter C


PA



prodigy blood-glucose meter NP


PA

OTC

prodigy autocode blood-glucose meter NP


PA

OTC

prodigy pocket blood-glucose meter NP


PA

OTC

prodigy voice blood-glucose meter NP


PA

OTC

pure comfort lancets lancets C OTC

pure comfort safety lancets lancets C OTC

rightest gc700 lev 2 ctrl soln blood glucose calibration control solution, normal C OTC

rightest gm700sb glucose meter blood-glucose meter C


PA

OTC

rightest gt333 glucose meter blood-glucose meter C


PA

OTC

rightest gt333 lev 2 ctrl soln blood glucose calibration control solution, normal C OTC

rightest max plus glucose mtr blood-glucose meter C


PA

OTC

soft touch lancets C OTC

t:slim x2 with basal-iq subcutaneous insulin pump C



TRUE METRIX AIR GLUCOSE METER blood-glucose meter NP


PA

OTC

TRUE METRIX BLOOD GLUCOSE MTR blood-glucose meter NP


PA

OTC

true metrix blood glucose mtr blood-glucose meter NP

QL 1 meter / 365 day(s)

PA

true metrix go blood-glucose meter NP


PA

OTC

true metrix level 1 ctrl soln blood glucose calibration control solution, low C OTC

true metrix level 2 ctrl soln blood glucose calibration control solution, normal C OTC

true metrix level 3 ctrl soln blood glucose calibration control solution, high C OTC

unilet lancets lancets C OTC

vivaguard ino ctrl soln-l1, l3 blood glucose calibration control high and low C OTC

vivaguard ino ctrl soln-l2 blood glucose calibration control solution, normal C OTC

vivaguard ino smart gluc meter blood-glucose meter C


PA

OTC

wavesense presto system kit blood-glucose meter NP


PA

OTC


DIAGNOSTIC AGENTS

ADRENOCORTICAL INSUFFICIENCY

ACTHAR corticotropin C

PA

S Specialty Drug


DIABETES MELLITUS

accu-chek aviva plus test strp blood sugar diagnostic P

QL 10 STRIPS / 1 DAY

OTC

accu-chek compact plus strips blood sugar diagnostic, drum-type P


OTC

accu-chek guide test strip blood sugar diagnostic P


OTC

accu-chek smartview test strip blood sugar diagnostic P


OTC

agamatrix presto blood sugar diagnostic C


PA

OTC

assure platinum test strip blood sugar diagnostic C


PA

OTC

breeze 2 blood sugar diagnostic, disc-type C


PA

OTC

caretouch test strip blood sugar diagnostic C


PA

OTC

contour next test strip blood sugar diagnostic P


OTC

contour test strip blood sugar diagnostic P


OTC

dario blood glucose test strip blood sugar diagnostic C


PA

OTC

easy touch blu link test strip blood sugar diagnostic C


PA



easy trak ii test strip blood sugar diagnostic C


PA

OTC

embrace pro test strip blood sugar diagnostic C


PA

OTC

fora g20 glucose test strips blood sugar diagnostic NP


PA

OTC

fora tn'g advan pro test strip blood sugar diagnostic C


PA

OTC

fora v10-v12-d10-d20 blood sugar diagnostic C


PA

OTC

fortiscare g1 test strip blood sugar diagnostic C


PA

freestyle insulinx test strip blood sugar diagnostic NP


PA

OTC

freestyle insulinx test strips blood sugar diagnostic NP


PA

OTC

freestyle lite test strip blood sugar diagnostic NP


PA

OTC

freestyle precision neo blood sugar diagnostic C


PA

OTC

freestyle test strips blood sugar diagnostic NP


PA

OTC



ge100 blood glucose test strip blood sugar diagnostic C


PA

OTC

ge333 blood glucose test strip blood sugar diagnostic C


PA

OTC

gluco navii blood sugar diagnostic C


PA

OTC

glucocard expression test strp blood sugar diagnostic NP


PA

OTC

glucocard shine test strips blood sugar diagnostic NP


PA

OTC

gojji blood glucose test strip blood sugar diagnostic C


PA

OTC

healthpro glucose test strips blood sugar diagnostic C


PA

OTC

nova max glucose test strips blood sugar diagnostic C


PA

OTC

onetouch ultra test strip blood sugar diagnostic NP


PA

OTC

onetouch verio test strip blood sugar diagnostic NP


PA

OTC



prodigy no coding blood sugar diagnostic NP


PA

OTC

rightest gs700 test strip blood sugar diagnostic C


PA

OTC

rightest gt333 test strip blood sugar diagnostic C


PA

OTC

rightest max test strip blood sugar diagnostic C


PA

OTC

true metrix glucose test strip blood sugar diagnostic NP


PA

OTC

ultima blood sugar diagnostic C


OTC

vivaguard ino test strip blood sugar diagnostic C


PA

OTC

wavesense presto test strips blood sugar diagnostic NP


PA

OTC


DIURETICS

LOOP DIURETICS

bumetanide 0.5 mg tablet C

bumetanide 1 mg tablet C

bumetanide 2 mg tablet C

furosemide 10 mg/ml solution C

furosemide 20 mg tablet C



furosemide 40 mg/5 ml soln C


torsemide C

POTASSIUM-SPARING DIURETICS

amiloride hcl C

amiloride-hydrochlorothiazide C

triamterene-hydrochlorothiazid C

THIAZIDE DIURETICS

hydrochlorothiazide C

THIAZIDE-LIKE DIURETICS

chlorthalidone C

indapamide C

metolazone C


DOPAMINE RECEPTOR AGONISTS

ERGOT-DERIV. DOPAMINE RECEPTOR AGONISTS

bromocriptine mesylate C

cabergoline C

CYCLOSET bromocriptine mesylate C PA

NONERGOT-DERIV.DOPAMINE RECEPTOR AGONIST

KYNMOBI apomorphine hcl NP PA

MIRAPEX pramipexole di-hcl NP PA

MIRAPEX ER pramipexole di-hcl NP PA

NEUPRO rotigotine C PA

pramipexole dihydrochloride P

pramipexole er NP PA

REQUIP XL ropinirole hcl NP PA

ropinirole er NP PA


ropinirole hcl P


ELECTROLYTIC, CALORIC, AND WATER BALANCE

ALKALINIZING AGENTS

potassium citrate er C

AMMONIA DETOXICANTS

CARBAGLU carglumic acid C

PA

S Specialty Drug

CONSTULOSE lactulose C

ENULOSE lactulose C

GENERLAC lactulose C

lactulose 10 gm/15 ml solution C

sodium phenylbutyrate powder C PA

S Specialty Drug

CALORIC AGENTS

CYCLINEX-1 infant formula, special metabolic, urea cycle disorder C

PA

OTC

CYCLINEX-2 nutritional therapy, urea cycle disorder C

PA

OTC

DOJOLVI triheptanoin C

PA

S Specialty Drug

ELECARE infant form. iron, lactose free/dha/arachidonic acid (ara) C

PA

OTC

ESSENTIAL AMINO ACID MIX nutritional therapy, urea cycle disorder without iron C

PA

OTC

glucose C OTC

glucose gel C OTC

GLUTAREX-1 inf form, glutaric aciduria i C

PA

OTC


GLUTAREX-2 nutritional therapy, glutaric aciduria type 1 C

PA

OTC

GLYTACTIN 15 PE BETTERMILK nutritional therapy for pku no.64 C

GLYTACTIN 20PE BETTERMILK LITE nutritional therapy for phenylketonuria(pku) with iron no.41 C

GLYTACTIN BUILD 20-20 nutritional therapy for pku no.64 C

GLYTACTIN BURST 10-10 nutritional therapy for pku no.64 C

GLYTACTIN BURST 20-20 nutritional therapy for pku no.64 C

GLYTACTIN RTD 10 PE nutritional therapy for phenylketonuria(pku) with iron no.41 C

GLYTACTIN RTD 15 PE nutritional therapy for phenylketonuria(pku) with iron no.41 C

HCU EXPRESS POWDER nutritional therapy, metabolic disorder, methionine-free C

PA

OTC

HOMINEX-1 infant formula, special metabolic, iron, methionine-free C

PA

OTC

HOMINEX-2 nutritional therapy, metabolic disorder, methionine-free C

PA

OTC

I-VALEX-1 infant formula,spec. metabolic,isovaleric acidemia with iron C

PA

OTC

I-VALEX-2 nutritional therapy for isovaleric acidemia with iron C

PA

OTC

JUVEN arginine/glutamine/calcium beta-hydroxy-beta-methylbutyrate C

PA

OTC

KETONEX-1 infant formula with iron,spec.metabolic,maple syrup urine dx C

PA

OTC

KETONEX-2 nutritional therapy for msud with iron C

PA

OTC

l-arginine C OTC



LANAFLEX nutritional therapy for phenylketonuria(pku) with iron no.25 C OTC

levocarnitine 330 mg tablet C OTC

LOPHLEX nutritional therapy for phenylketonuria (pku) with iron no.7 C OTC

MSUD AID nutritional therapy for msud with iron C

PA

OTC

MSUD EXPRESS COOLER nutritional therapy for msud with iron C

PA

OTC

MSUD EXPRESS15 nutritional therapy for msud with iron C OTC

NEOCATE INFANT DHA-ARA infant formula with iron/docosahexanoic acid/arachidonic ac C

PA

OTC

NEOCATE JUNIOR nutritional therapy for impaired digestive function C

PA

OTC

NUTRAMINE C PA

OTC

PERIFLEX ADVANCE nutritional tx for phenylketonuria (pku) with iron, comb #20 C OTC

PERIFLEX LQ PKU nutritional therapy for phenylketonuria (pku) with iron no.2 C OTC

PHENEX-1 infant formula for pku, iron, no.2 C OTC

PHENEX-2 nutritional therapy for phenylketonuria (pku) with iron no.1 C OTC

PHENYL-FREE 2 nutritional therapy for phenylketonuria(pku) with iron no.45 C OTC

PHENYL-FREE 2HP nutritional therapy for phenylketonuria(pku) with iron no.45 C OTC

PHENYLADE AMINO ACID POWDER nutritional therapy for phenylketonuria (pku) no.31 C OTC

PHENYLADE GMP nutritional therapy for phenylketonuria(pku) with iron no.57 C OTC

PHLEXY-10 DRINK MIX POWDER nutritional therapy for phenylketonuria (pku) no.8 C OTC



PHLEXY-10 TABLET nutritional therapy for phenylketonuria (pku) no.54 C OTC

PKU COOLER 10 nutritional therapy for phenylketonuria(pku) with iron no.4 C OTC



PKU EASY nutritional therapy for phenylketonuria(pku) no.56 C OTC

PKU EXPLORE10 nutritional therapy for phenylketonuria(pku) with iron no.52 C OTC

PKU EXPRESS15 nutritional therapy for phenylketonuria(pku) with iron no.52 C OTC

PKU EXPRESS20 nutritional therapy for phenylketonuria(pku) with iron no.52 C OTC

PKU GEL nutritional therapy for phenylketonuria with iron, no.47 C OTC

PKU GO nutritional therapy for phenylketonuria(pku) with iron no.60 C OTC

PKU LOPHLEX nutritional therapy for phenylketonuria(pku) with iron no.42 C OTC

PKU PERIFLEX JUNIOR PLUS nutritional therapy for phenylketonuria(pku) with iron no.55 C OTC

PKU SPHERE15 nutritional therapy for phenylketonuria (pku) no.67 C OTC

PKU SPHERE20 nutritional therapy for phenylketonuria (pku) no.67 C OTC

PRO-PHREE infant formula, special metabolic with iron C

PA

OTC

PROPIMEX-1 infant formula,spec. metabolic, propionic acidemia,with iron C

PA

OTC

TYR EASY nutritional therapy for tyrosinemia without iron C OTC

TYR EXPRESS nutritional therapy for tyrosinemia with iron C

PA

OTC

TYREX-1 infant formula, special metabolic, tyrosinemia, with iron C

PA

OTC



TYREX-2 nutritional therapy for tyrosinemia with iron C

PA

OTC

VILACTIN AA PLUS 20 PE nutritional therapy for msud with iron C

VITAL HIGH NITROGEN lactose-reduced food C

PA

OTC

XPHE MAXAMUM nutritional therapy for phenylketonuria (pku) with iron no.6 C OTC

REPLACEMENT PREPARATIONS

calcium 500 mg chewable tablet C OTC

calcium 500 mg tablet C OTC

calcium 500 mg-vit d3 5 mcg tb C OTC

calcium 500-vit d3 10 mcg chew C OTC

calcium 500-vit d3 125 caplet C OTC


calcium 500-vit d3 200 tablet C OTC

calcium 500-vit d3 400 chew tb C OTC


calcium 500mg-vit d3 10mcg tab C OTC

calcium 600 mg tablet C OTC

calcium 600 mg-d3 20 mcg cplt C

calcium 600 mg-d3 20 mcg tab C

calcium 600 mg-vit d3 10mcg tb C OTC

calcium 600 mg-vit d3 5 mcg tb C OTC

calcium 600-d3 20mcg(800 unit) C






calcium acetate 668 mg tablet P OTC

calcium carb 1,250 mg/5 ml sus C OTC

calcium cit 200 mg-d3 125 unit C OTC

calcium cit 250 mg-d3 200 unit C OTC

calcium citrate C OTC

calcium citrate - vitamin d C OTC

calcium citrate-vitamin d3 C OTC

CALCIUM MAGNESIUM calcium carbonate, gluconate/magnesium oxide, gluconate C OTC

CALTRATE 600 PLUS D3 calcium carbonate/cholecalciferol (vitamin d3) C OTC

cvs cal cit 315 mg-d3 6.25 mcg C OTC

cvs calcium 500-vit d3 125 tab C OTC

cvs calcium 600mg-d3 20mcg tab C

HI-CAL C OTC

hm calcium 500-vit d3 200 cplt C OTC

hm calcium 600-vit d3 400 tab C OTC

HYDRALYTE C OTC

KINDERLYTE C OTC

KLOR-CON M10 potassium chloride C



magnesium gluconate C OTC

MOUTHKOTE miscellaneous electrolyte replacement/yerba santa C OTC

OS-CAL 500-VIT D3 C OTC

OYSCO 500-VIT D3 C OTC



oyster shell calcium C OTC

oyster shell calcium-vit d3 C OTC

oyster shell-d C OTC

PEDIALYTE electrolytes/dextrose C OTC

PHOS-NAK sodium phosphate/potassium phosphates, monobasic and bibasic

C

phosphorus-sodium-potassium C OTC

potassium cl 10% (20 meq/15ml) C


potassium cl 20 meq packet C


potassium cl er 10 meq capsule C

potassium cl er 10 meq tablet C



potassium cl er 8 meq capsule C


qc calcium 600-vit d3 400 tab C OTC

ra calcium 600 mg tablet C OTC

ra calcium 600-vit d3 400 tab C OTC

sm calcium 500-vit d3 200 cplt C OTC

sm calcium 500-vit d3 400 tab C OTC

sm calcium 600 mg tablet C OTC

sm calcium 600-vit d3 400 tab C OTC

sodium chloride 1 gm tablet C OTC

sodium phosphate-potassium pho C OTC

sodium-potassium-phosphorus C OTC



super calcium 600-vit d3 C OTC

THERMOTABS sodium chloride/potassium chloride C OTC

zinc 50 mg capsule C OTC

zinc 50 mg tablet C OTC

zinc sulfate 220 mg (50mg) cap C OTC

zinc sulfate 220 mg capsule C OTC

zinc sulfate 50 mg (220 mg) tb C OTC

URICOSURIC AGENTS

probenecid C

probenecid-colchicine C


EMOLLIENTS, DEMULCENTS, AND PROTECTANTS

BASIC LOTIONS AND LINIMENTS

ammonium lactate 12% lotion C

calamine C OTC

LAC-HYDRIN FIVE ammonium lactate C OTC

BASIC OINTMENTS AND PROTECTANTS

ADVANCED HEALING C OTC

AMERIPHOR C OTC

ammonium lactate 12% cream C

BAZA PROTECT CREAM dimethicone/zinc oxide C OTC

DERMAPHOR C OTC

EUCERIN lanolin alcohols/mineral oil/petrolatum,white/ceresin C OTC

LANTISEPTIC lanolin C OTC

MINERIN C OTC

PETROLATUM BASE OINTMENT C OTC


SKIN PROTECTANT 50% CREAM C

zinc oxide paste C

ENZYMES

HYQVIA HY COMPONENT hyaluronidase, human recomb. C

PA

S Specialty Drug

MED

STRENSIQ asfotase alfa C

PA

S Specialty Drug

SUCRAID sacrosidase C

PA

S Specialty Drug


ESTROGENS AND ANTIESTROGENS

ESTROGEN AGONIST-ANTAGONISTS

EVISTA raloxifene hcl NP PA

raloxifene hcl P

SOLTAMOX tamoxifen citrate C

tamoxifen citrate C

ESTROGENS

DOTTI estradiol C

estradiol (once weekly) C

estradiol (twice weekly) C

estradiol 0.01% cream C

estradiol 0.5 mg tablet C

estradiol 1 mg tablet C

estradiol 10 mcg vaginal insrt C

estradiol 2 mg tablet C

FYAVOLV 1 MG-5 MCG TABLET norethindrone acetate-ethinyl estradiol C

JINTELI norethindrone acetate-ethinyl estradiol C


norethin-eth estrad 1 mg-5 mcg C

YUVAFEM estradiol C


EYE, EAR, NOSE AND THROAT (EENT) PREPS.

ANTIALLERGIC AGENTS

ALOMIDE lodoxamide tromethamine NP PA

azelastine 0.1% (137 mcg) spry P

azelastine 0.15% nasal spray P

azelastine hcl 0.05% drops NP PA

BEPREVE bepotastine besilate NP PA

CVS EYE ITCH RELIEF 0.025% DRP ketotifen fumarate P OTC

cvs olopatadine 0.1% eye drop C OTC

cvs olopatadine 0.2% eye drop C OTC

DYMISTA azelastine hcl/fluticasone propionate NP PA

epinastine hcl NP PA

EYE ALLERGY ITCH RELIEF olopatadine hcl C

EYE ALLERGY ITCH-REDNESS RLF olopatadine hcl C

EYE ITCH RELIEF 0.025% DROPS ketotifen fumarate P OTC

gnp olopatadine 0.1% eye drops C OTC

gnp olopatadine 0.2% eye drops C OTC

HM EYE ITCH RELIEF 0.025% DROP ketotifen fumarate P OTC

ketotifen fumarate P OTC

KRO EYE ITCH RLF 0.025% DROPS ketotifen fumarate P OTC

LASTACAFT alcaftadine NP PA


olopatadine 665 mcg nasal spry NP PA

olopatadine hcl 0.1% eye drops C OTC

olopatadine hcl 0.2% eye drop C OTC

PATADAY olopatadine hcl NP PA

PATANASE olopatadine hcl NP PA

PATANOL olopatadine hcl NP PA

PAZEO olopatadine hcl P

RA EYE ITCH RELIEF 0.025% DROP P OTC

SM EYE ITCH RELIEF 0.025% DROP ketotifen fumarate P OTC

ZADITOR ketotifen fumarate NP

PA

OTC

ZERVIATE cetirizine hcl NP PA

EENT DRUGS, MISCELLANEOUS

apraclonidine hcl NP PA

ARTIFICIAL EYE LUBRICANT C

ARTIFICIAL TEARS C OTC

ARTIFICIAL TEARS EYE DROPS C OTC

ARTIFICIALS TEARS DROPS C OTC

AYR sodium chloride C OTC

AYR SALINE sodium chloride C OTC

carboxymethylcellulose sodium C OTC

CVS LUBRICANT EYE DROPS C OTC

cvs sodium chloride 5% eye drp C OTC

cvs sodium chloride 5% eye ont C OTC



cvs sodium chloride 5% oint C OTC

CYSTADROPS cysteamine hcl C

QL 5 ML / RX

PA

S Specialty Drug

CYSTARAN cysteamine hcl C

QL 15 ML / RX

PA

S Specialty Drug

EQ GENTLE C OTC

FOR STY RELIEF C OTC

GENTEAL TEARS 0.1%-0.2%-0.3% dextran/hypromellose/glycerin C OTC

GENTEAL TEARS 0.1%-0.3% DROP dextran 70/hypromellose/pf C OTC

GENTEAL TEARS SEVERE 0.3% GEL hypromellose C OTC

IOPIDINE apraclonidine hcl NP PA

ipratropium 0.03% spray P

ipratropium 0.06% spray P

LUBRICANT EYE DROPS C OTC

LUBRICANT EYE OINTMENT C OTC

LUBRICANT GEL DROPS C OTC

LUBRICANT PM C OTC

LUBRICATING TEARS C

MURO-128 C OTC

NASAL MOISTURIZING C OTC

NIGHTTIME DRY-EYE RELIEF C OTC

OXERVATE cenegermin-bkbj C

QL 1 ML / 1 DAY

PA

S Specialty Drug

polyvinyl alcohol C OTC



PURE & GENTLE EYE DROPS C OTC

ra sodium chloride 5% eye drop C OTC

REFRESH CELLUVISC carboxymethylcellulose sodium C OTC

REFRESH CLASSIC polyvinyl alcohol/povidone/pf C OTC

REFRESH LIQUIGEL carboxymethylcellulose sodium C OTC

REFRESH OPTIVE carboxymethylcellulose sodium/glycerin C OTC

REFRESH OPTIVE SENSITIVE carboxymethylcellulose sodium/glycerin/pf C OTC

REFRESH P.M. mineral oil/petrolatum,white C OTC

REFRESH PLUS carboxymethylcellulose sodium C OTC

REFRESH RELIEVA carboxymethylcellulose sodium/glycerin C OTC

saline nasal spray C OTC

sodium chloride 5% eye drop C OTC

sodium chloride 5% eye oint C OTC

sodium chloride 5% opht soln C OTC

sodium chloride 5% ophth soln C OTC

SYSTANE GEL hypromellose C OTC

THERA TEARS 0.25% EYE DROPS carboxymethylcellulose sodium C OTC

THERA TEARS 1% LIQUID GEL C OTC

LOCAL ANESTHETICS (EENT)

GLYDO lidocaine hcl C

lidocaine hcl 2% jel urojet ac C

lidocaine hcl 2% jelly C

lidocaine hcl 2% jelly uro-jet C



lidocaine hcl 4% solution C

lidocaine hcl viscous C

MOUTHWASHES AND GARGLES

hydrogen peroxide C OTC

MYDRIATICS

atropine 1% eye drops C

atropine 1% eye ointment C

cyclopentolate 1% eye drop C

cyclopentolate 1% eye drops C

HOMATROPAIRE C

homatropine hydrobromide C

VASOCONSTRICTORS

12 HOUR NASAL RELIEF C OTC

ALLERGY EYE DROPS naphazoline hcl/pheniramine maleate C OTC

CHILD MUCINEX STUFFY NOSE SPRY C OTC

CVS EYE ALLERGY RELIEF EYE DRP C OTC

EYE ALLERGY RELIEF DROPS C OTC

EYE DROPS C OTC

EYE DROPS ADVANCED RELIEF C OTC

GNP EYE DROPS C OTC

MUCINEX SINUS-MAX C OTC

NAPHCON-A naphazoline hcl/pheniramine maleate C OTC

NASAL DECONGESTANT 0.05% SPRAY C OTC

phenylephrine 10% eye drops C

phenylephrine 2.5% eye drop C

PV ALLERGY EYE DROPS C OTC

VISINE-A naphazoline hcl/pheniramine maleate C OTC




FIRST GENERATION ANTIHISTAMINES

ETHANOLAMINE DERIVATIVES

ALLERGY 50 MG/20 ML SOLUTION C OTC

ALLERGY RELIEF 12.5 MG/5 ML C OTC

ALLERGY RELIEF 25 MG CAPSULE C OTC

ALLERGY RELIEF 25 MG SOFTGEL C OTC

BENADRYL ALLERGY C OTC

CHILD ALLERGY RLF 12.5 MG/5 ML C OTC

CHILDREN'S AURODRYL ALLERGY C OTC

CHILDREN'S WAL-DRYL ALLERGY C OTC

CVS ALLERGY RELIEF 25 MG CAP C OTC

CVS NIGHTTIME SLEEP 25 MG CAP C OTC

CVS SLEEP AID 50 MG SOFTGEL C OTC

diphenhydramine 12.5 mg/5 ml C OTC

diphenhydramine 25 mg caplet C OTC

diphenhydramine 25 mg capsule C OTC

diphenhydramine 25 mg tablet C OTC

diphenhydramine 25 mg/10 ml C OTC

diphenhydramine 50 mg capsule C OTC

EQ ALLERGY RELIEF 25 MG TABLET C OTC

EQ SLEEP AID 25 MG TABLET doxylamine succinate C OTC

EQL SLEEP AID 25 MG TABLET doxylamine succinate C OTC

EQL SLEEP AID 50 MG SOFTGEL C OTC

GERI-DRYL 12.5 MG/5 ML LIQUID C OTC

GNP ALLERGY RELIEF 25 MG LQ CP C OTC


GNP ALLERGY RELIEF 25 MG TAB C OTC

GNP ALLERGY RELIEF 50 MG/20 ML C OTC

GNP CHILD ALLERGY 12.5 MG/5 ML C OTC

GNP NIGHTTIME SLEEP AID 50 MG C OTC

GNP SLEEP AID 25 MG CAPLET C OTC

GS ALLERGY RELIEF 25 MG TABLET C OTC

GS NIGHTTIME SLEEP AID 25 MG C OTC

GS SLEEP AID 25 MG TABLET doxylamine succinate C OTC

HM ALLERGY RELIEF 25 MG CAP C OTC

HM ALLERGY RELIEF 25 MG TABLET C OTC

HM NIGHTTIME SLEEP 25 MG CPLT C OTC

HM NIGHTTIME SLEEP AID 50 MG C OTC

HM SLEEP AID 25 MG TABLET doxylamine succinate C OTC

M-DRYL C OTC

NIGHTTIME SEVERE COUGH-COLD C OTC

NIGHTTIME SLEEP AID 25 MG CPLT C OTC

QC CHILD ALLERGY 12.5 MG/5 ML C OTC

RA SLEEP AID 25 MG CAPLET C OTC

RA SLEEP AID 25 MG TABLET C OTC

SEVERE COLD COUGH-FLU C OTC

SLEEP AID 25 MG CAPLET C OTC

SLEEP AID 25 MG TABLET doxylamine succinate C OTC

SLEEP AID 50 MG LIQUIDGEL C OTC

SLEEP AID 50 MG SOFTGEL C OTC

SM ALLERGY RELIEF 1.34 MG TAB C OTC



SM ALLERGY RELIEF 25 MG CAP C OTC

SM SLEEP AID 25 MG TABLET doxylamine succinate C OTC

SM SLEEP AID SOFTGEL C OTC

SOMINEX C OTC

WAL-DRYL ALLERGY C OTC

WAL-SOM doxylamine succinate C OTC

FIRST GEN. ANTIHIST. DERIVATIVES, MISC.

cyproheptadine hcl C

PHENOTHIAZINE DERIVATIVES

PHENADOZ promethazine hcl C

promethazine 12.5 mg suppos C

promethazine 12.5 mg tablet C

promethazine 25 mg suppository C

promethazine 25 mg tablet C

promethazine 50 mg suppository C

promethazine 50 mg tablet C

promethazine 6.25 mg/5 ml soln C

promethazine 6.25 mg/5 ml syrp C

promethazine vc C

promethazine-phenylephrine C

PROMETHEGAN promethazine hcl C

PROPYLAMINE DERIVATIVES

ALLERGY RELIEF 4 MG TABLET C OTC

CHILD'S DIBROMM COLD-ALLERGY C OTC

CHILDREN'S COLD-ALLERGY C OTC

COLD-ALLERGY C OTC

CVS ALLERGY RELIEF 4 MG TABLET C OTC



DIMETAPP brompheniramine maleate/phenylephrine hcl C OTC

GNP ALLERGY RELIEF 4 MG TABLET C OTC

GS ALLERGY RELIEF 4 MG TABLET C OTC

HM ALLERGY RELIEF 4 MG TABLET C OTC

RA ALLERGY RELIEF 4 MG TABLET C OTC

RYNEX PSE C OTC

SINUS PE PLUS ALLERGY C OTC

SINUS-ALLERGY PE C OTC

SM ALLERGY RELIEF 4 MG TABLET C OTC

SUPHEDRINE PE SINUS-ALLERGY C OTC

VALU-TAPP C OTC


GASTROINTESTINAL DRUGS

ANTACIDS AND ADSORBENTS

alum-mag hydroxide-simethicone C OTC

aluminum hydroxide C OTC

ANTACID 500 MG CHEW TABLET C OTC

ANTACID 675-135 MG TAB CHEW C OTC

ANTACID 750 MG CHEWABLE TABLET C OTC

ANTACID ANTI-GAS LIQUID C OTC

ANTACID ANTI-GAS MAX STR LIQ C OTC

ANTACID EX-STR 750 MG TAB CHEW C OTC

ANTACID EX-STR TABLET CHEW C OTC

ANTACID EXTRA STRNGTH TAB CHEW C OTC

ANTACID LIQUID C OTC

ANTACID PLUS ANTI-GAS C OTC

ANTACID PLUS GAS RELIEF C OTC


ANTACID SUPREME C OTC

ANTACID SUSPENSION C OTC

ANTACID ULTRA STR 1,000 MG CHW C OTC

ANTACID-ANTIGAS LIQUID magnesium hydroxide/aluminum hydroxide/simethicone C OTC

CALCIUM ANTACID C OTC

calcium carbonate 648 mg tab C OTC

CVS ANTACID 750 MG CHEW TABLET C OTC

CVS ANTACID EX-STR 750 MG CHEW C OTC

CVS ANTACID ULTRA STR TAB CHEW C OTC

CVS ANTACID-ANTIGAS LIQUID C OTC

EQ ANTACID EX-STR 750 MG CHEW C OTC

EQ ANTACID EXTRA STR TAB CHEW C OTC

EZ CHAR activated charcoal C OTC

GAVISCON magnesium carbonate/aluminum hydroxide C OTC

GELUSIL magnesium hydroxide/aluminum hydroxide/simethicone C OTC

GERI-LANTA C OTC

GNP ANTACID EX-STR 750 MG CHEW C OTC

GNP ANTACID SUSPENSION C OTC

GS ANTACID 500 MG CHEWABLE TAB C OTC

HM ANTACID 500 MG CHEW TABLET C OTC

HM ANTACID EX-STR 750 MG CHEW C OTC

HM ANTACID-ANTIGAS SUSPENSION C OTC

INSTA-CHAR C OTC

MAALOX MAXIMUM STRENGTH C OTC

magnesium oxide 400 mg tablet C OTC



MAGOX 400 magnesium oxide C OTC

MI-ACID 400-400-40 MG/10 ML LQ C OTC

MI-ACID MAX STRENGTH LIQUID C OTC

MINTOX PLUS C OTC

MYLANTA MAXIMUM STRENGTH C OTC

pub calcium carb 1,000 mg tab C OTC

RA ANTACID 500 MG CHEWABLE TAB C OTC

RA ANTACID-ANTIGAS LIQUID C OTC

SM ANTACID 500 MG CHEW TABLET C OTC

SM ANTACID 750 MG CHEW TABLET C OTC

SM ANTACID-ANTIGAS LIQUID C OTC

sodium bicarb 10 grain tablet C OTC

sodium bicarb 325 mg tablet C OTC

sodium bicarb 650 mg tablet C OTC

ANTI-INFLAMMATORY AGENTS (GI DRUGS)

alosetron hcl C PA

APRISO mesalamine NP PA

ASACOL HD mesalamine NP PA

balsalazide disodium P

CANASA mesalamine P

COLAZAL balsalazide disodium NP PA

DELZICOL mesalamine P

DIPENTUM olsalazine sodium NP PA

LIALDA mesalamine NP PA



mesalamine 1,000 mg supp NP PA

mesalamine 4 gm/60 ml enema P

mesalamine 4 gm/60 ml kit P

mesalamine 800 mg dr tablet NP PA

mesalamine dr NP PA

mesalamine dr 1.2 gm tablet NP PA

mesalamine er NP PA

PENTASA mesalamine P

ROWASA 4 GM/60 ML ENEMA mesalamine NP PA

ROWASA 4 GM/60 ML ENEMA KIT mesalamine with cleansing wipes NP PA

SFROWASA mesalamine NP PA

ANTIDIARRHEA AGENTS

ANTI-DIARRHEAL 2 MG CAPLET loperamide hcl C OTC

ANTI-DIARRHEAL 2 MG SOFTGEL C OTC

bismuth subsalicylate C OTC

CVS ANTI-DIARRHEAL 2 MG CAPLET loperamide hcl C OTC

CVS ANTI-DIARRHEAL 2 MG SFTGEL C OTC

cvs loperamide 1 mg/7.5 ml sus C OTC

CVS STOMACH RELIEF MAX STR LIQ C OTC

CVS STOMACH RLF 262 MG CHEW TB C OTC

diphenoxylat-atrop 2.5-0.025/5 C QL 40 ML / 1 DAY

diphenoxylate-atrop 2.5-0.025 C QL 8 TABS / 1 DAY

EQ ANTI-DIARRHEAL 2 MG SFTGEL C OTC

eq loperamide 1 mg/7.5 ml susp C OTC



EQ STOMACH RLF 262 MG CHEW TAB C OTC

eql loperamide 1 mg/7.5 ml sus C OTC

EQL STOMACH RLF 262 MG CHEW TB C OTC

GERI-PECTATE C OTC

GNP ANTI-DIARRHEAL 2 MG SFTGEL C OTC

gnp loperamide 1 mg/7.5 ml liq C OTC

GNP STOMACH RELIEF 525MG/15 ML C OTC

GS ANTI-DIARRHEAL 1 MG/7.5 ML loperamide hcl C OTC

GS STOMACH RLF 262 MG CHEW TAB C OTC

HM ANTI-DIARRHEAL 2 MG SOFTGEL C OTC

hm loperamide 1 mg/7.5 ml liq C OTC

hm loperamide 2 mg softgel C OTC

HM STOMACH RELIEF 525 MG/15 ML C OTC

HM STOMACH RELIEF 525 MG/30 ML C OTC

HM STOMACH RLF 262 MG CHEW TAB C OTC

IMODIUM A-D loperamide hcl C OTC

KAOPECTATE C OTC

kro loperamide 1 mg/7.5 ml sus C OTC

KRO STOMACH RLF 262 MG CHEW TB C OTC

loperamide 1 mg/7.5 ml liquid C OTC

loperamide 1 mg/7.5 ml soln C OTC

loperamide 1 mg/7.5 ml susp C OTC

loperamide 2 mg capsule C OTC

loperamide hcl C OTC

paregoric C QL 40 ML / 1 DAY



PUB STOMACH RLF 262 MG CHEW TB C OTC

RA ANTI-DIARRHEAL 2 MG SOFTGEL C OTC

ra loperamide 1 mg/7.5 ml susp C OTC

SM ANTI-DIARRHEAL 2 MG SOFTGEL C OTC

sm loperamide 1 mg/7.5 ml liq C OTC

SM STOMACH RELIEF 525 MG/30 ML C OTC

SM STOMACH RLF 262 MG CHEW TAB C OTC

SOOTHE C OTC

STOMACH RELIEF 262 MG CHEW TAB C OTC

STOMACH RELIEF 525 MG/15 ML C OTC

STOMACH RLF 525 MG/30 ML SUSP C OTC

XERMELO telotristat etiprate C

PA

S Specialty Drug

ANTIFLATULENTS

ANTI-GAS C OTC

CVS GAS RELF(SIMETH) 80 MG CHW C OTC

GAS RELIEF (SIMETH) 80 MG CHEW simethicone C OTC

GAS RELIEF 125 MG CHEW TABLET C OTC

GAS RELIEF 180 MG SOFTGEL C OTC

GAS-X EX-STR 125 MG TAB CHEW simethicone C OTC

GAS-X EXTRA STRENGTH SOFTGEL C OTC

GNP GAS RLF(SIMETH) 80 MG CHEW C OTC

HM GAS RELIEF 125 MG CHEW TAB C OTC

HM GAS RELIEF(SIMETH) 80MG CHW C OTC

INFANT GAS RELIEF C OTC

INFANTS' GAS RELIEF C OTC



INFANTS' SIMETHICONE C OTC

LITTLE REMEDIES GAS RELIEF C OTC

MI-ACID GAS 80 MG TAB CHEW C OTC

simethicone C OTC

SM GAS RELIEF(SIMETH) 80MG CHW C OTC

CATHARTICS AND LAXATIVES

bisacodyl 10 mg suppository C OTC

bisacodyl ec 5 mg tablet C OTC

child glycerin suppository C OTC

CITROMA magnesium citrate C OTC

CITRUCEL methylcellulose C OTC

CLEARLAX POWDER polyethylene glycol 3350 C OTC

CLEARLAX POWDER PACKET polyethylene glycol 3350 C

COLACE CLEAR docusate sodium C OTC

cvs citrate of magnesia soln C OTC

CVS FIBER THERAPY 500 MG CAPLT C OTC

cvs glycerin suppository C OTC

CVS LAXATIVE 25 MG TABLET C OTC

CVS LAXATIVE PILLS C OTC

cvs magnesium citrate soln C OTC

cvs milk of magnesia susp C OTC

CVS STOOL SOFTENER 100 MG SFTG C OTC

CVS STOOL SOFTENER 50 MG SFTGL C OTC

CVS STOOL SOFTENER-STIM LAX TB C OTC



docusate sod 60 mg/15 ml syrp C OTC

docusate sodium 100 mg capsule C OTC

docusate sodium 100 mg softgel C OTC

docusate sodium 250 mg capsule C OTC

docusate sodium 250 mg softgel C OTC

docusate sodium 50 mg/5 ml liq C OTC

DOCUSOL C OTC

DULCOLAX 1,200 MG/15 ML LIQUID C OTC

EQ FIBER THERAPY 625 MG CAPLET C OTC

EQ FIBER THERAPY CAPLET C OTC

EQ LAXATIVE 25 MG TABLET C OTC

eq magnesium citrate solution C OTC

EQ MAX STR LAXATIVE PILL C OTC

eq milk of magnesia suspension C OTC

EQ NATURAL FIBER LAXATIVE POWD C OTC

EQ STOOL SOFTENER 100 MG SFTGL C OTC

EQ STOOL SOFTENER-STIM LAX TAB C OTC

EQL FIBER THERAPY 500 MG CPLT C OTC

EQL LAXATIVE 25 MG TABLET C OTC

eql magnesium citrate solution C OTC

eql milk of magnesia susp C OTC

EQL NATURAL FIBER LAXATIVE CAP C OTC

EVAC-U-GEN C OTC

EX-LAX MAXIMUM STRENGTH sennosides C OTC

FIBER LAXATIVE C OTC

FIBER SMOOTH C OTC



FIBER THERAPY 500 MG CAPLET C OTC

FIBER THERAPY CAPLET C OTC

FIBERCON calcium polycarbophil C OTC

FLEET BISACODYL 10 MG ENEMA bisacodyl C OTC

FLEET GLYCERIN 2 GM ADULT SUPP C OTC

FLEET GLYCERIN ADULT SUPPOS C OTC

GAVILAX polyethylene glycol 3350 C

GAVILYTE-C peg 3350/sod sulf/sod bicarb/sod chloride/potassium chloride C

GAVILYTE-G peg 3350/sod sulf/sod bicarb/sod chloride/potassium chloride C

GAVILYTE-N sodium chloride/sodium bicarbonate/potassium chloride/peg C

GENTLE LAXATIVE C OTC

GENTLELAX polyethylene glycol 3350 C

GERI-KOT C OTC

glycerin adult suppository C OTC

GLYCOLAX polyethylene glycol 3350 C

GNP FIBER THERAPY 500 MG CAPLT C OTC

GNP LAXATIVE 25 MG PILL C OTC

GNP LAXATIVE EC 5 MG TABLET C OTC

gnp milk of magnesia susp C OTC

GNP NATURAL FIBER LAXATIVE CAP C OTC

GNP NATURAL FIBER POWDER C OTC

GNP SENNA PLUS 8.6-50 MG TAB C OTC

GNP STOOL SOFTENER 100 MG SFGL C OTC



GNP STOOL SOFTENER 250 MG SFGL C OTC

GNP STOOL SOFTENER-STIM LAX TB C OTC

gs milk of magnesia suspension C OTC

HEALTHYLAX polyethylene glycol 3350 C OTC

HM FIBER POWDER C OTC

HM LAXATIVE EC 5 MG TABLET C OTC

hm magnesium citrate solution C OTC

hm milk of magnesia suspension C OTC

HM SENNA 8.6 MG TABLET C OTC

HM STOOL SOFTENER 100 MG SFTGL C OTC

HM STOOL SOFTENER 250 MG SFTGL C OTC

HM STOOL SOFTENER-STIM LAX TAB C OTC

hv milk of magnesia suspension C OTC

HYDROCIL INSTANT psyllium seed C OTC

KONSYL DAILY FIBER POWDER PKT psyllium husk C OTC

KONSYL ORIGINAL 6 GM POWD PKT psyllium husk C OTC

KONSYL ORIGINAL FIBER POWDER psyllium husk C OTC

KONSYL PSYLLIUM FIBER POWDER C OTC

kro milk of magnesia susp C OTC

KRO STOOL SOFTENER 100 MG SFGL C OTC

LAXACLEAR polyethylene glycol 3350 C

LAXATIVE 25 MG PILL C OTC

LAXATIVE 25 MG TABLET C OTC

LAXATIVE 5 MG TABLET C OTC



LAXATIVE EC 5 MG TABLET C OTC

LAXATIVE MAXIMUM STRENGTH C OTC

LAXATIVE PILLS C OTC

lubiprostone C QL 2 CAPS / 1 DAY

ST

magnesium citrate solution C OTC

milk of magnesia suspension C OTC

mineral oil C OTC

MINERAL OIL ENEMA mineral oil C OTC

MIRALAX polyethylene glycol 3350 C

NATURAL FIBER LAXATIVE CAPSULE C OTC

NATURAL FIBER POWDER C OTC

NATURAL LAXATIVE C OTC

NATURAL VEGETABLE LAXATIVE C OTC

NATURAL VEGETABLE POWDER C OTC

ORAL SALINE LAXATIVE C OTC

PEDIA-LAX glycerin C OTC

peg 3350 electrolyte soln C

peg 3350-electrolyte solution C

peg-3350 and electrolytes C

polyethylene glycol 3350 C OTC

POWDERLAX polyethylene glycol 3350 C

pub docusate sodium 100 mg cap C OTC

PUB LAXATIVE EC 5 MG TABLET C OTC

pub milk of magnesia susp C OTC



PURE AND GENTLE SALINE ENEMA C OTC

QC LAXATIVE 25 MG TABLET C OTC

qc magnesium citrate solution C OTC

qc milk of magnesia suspension C OTC

RA LAXATIVE 25 MG PILL C OTC

RA LAXATIVE EC 5 MG TABLET C OTC

ra milk of magnesia suspension C OTC

RA SENNA 8.6 MG TABLET C OTC

REGULOID LAXATIVE POWDER C OTC

SEN-O-TAB C OTC

SENEXON C OTC

SENEXON-S C OTC

SENNA 8.6 MG TABLET C OTC

senna 8.8 mg/5 ml liquid C OTC

senna 8.8 mg/5 ml syrup C OTC

SENNA LAX C OTC

SENNA LAXATIVE C OTC

SENNA PLUS 8.6-50 MG TABLET C OTC

SENNA PLUS TABLET C OTC

SENNA-S C OTC

SENNA-S LAXATIVE C OTC

SENNA-TIME 8.6 MG TABLET C OTC

SENNO C OTC

SENOKOT sennosides C OTC

SM FIBER POWDER C OTC

SM LAXATIVE TABLET C OTC



sm magnesium citrate solution C OTC

sm milk of magnesia suspension C OTC

SM STOOL SOFTENER 100 MG SFTGL C OTC

SMOOTHLAX C

sorbitol 70% solution sorbitol solution C OTC

STIMULANT LAXATIVE PLUS C OTC

STOOL SOFTENER 100 MG SOFTGEL docusate sodium C OTC

STOOL SOFTENER 250 MG SOFTGEL docusate sodium C OTC

STOOL SOFTENER-LAXATIVE C OTC

STOOL SOFTENER-STIM LAX TABLET C OTC

SUPREP sodium sulfate/potassium sulfate/magnesium sulfate C

TRILYTE WITH FLAVOR PACKETS sodium chloride/sodium bicarbonate/potassium chloride/peg C

VEGETABLE LAX-STOOL SOFTENER C OTC

VEGETABLE LAXATIVE C OTC

WOMEN'S LAXATIVE C OTC

CHOLELITHOLYTIC AGENTS

ursodiol 250 mg tablet C

ursodiol 300 mg capsule C

ursodiol 500 mg tablet C

DIGESTANTS

CREON lipase/protease/amylase P

LACTAID FAST ACT lactase C OTC

lactase C OTC

PANCREAZE lipase/protease/amylase NP PA



PERTZYE lipase/protease/amylase NP PA

VIOKACE lipase/protease/amylase NP PA

ZENPEP lipase/protease/amylase P

GI DRUGS, MISCELLANEOUS

CHOLBAM cholic acid C

PA

S Specialty Drug

ENDARI glutamine P


PA

S Specialty Drug

ENTYVIO vedolizumab NP

PA

MED

HUMIRA(CF) PEDI CROHN 80-40 MG adalimumab P

QL 2 SYRINGES / 28 DAYS

PA

S Specialty Drug

LINZESS linaclotide C

QL 1 CAP / 1 DAY

ST

MOVANTIK naloxegol oxalate C

QL 1 TAB / 1 DAY

PA

SYMPROIC naldemedine tosylate C PA

PROKINETIC AGENTS

GIMOTI metoclopramide hcl NP PA

metoclopramide 10 mg tablet C

metoclopramide 10 mg/10 ml sol C

metoclopramide 5 mg tablet C

metoclopramide 5 mg/5 ml soln C

metoclopramide hcl odt NP PA




GENITOURINARY SMOOTH MUSCLE RELAXANTS

ANTIMUSCARINICS

darifenacin er NP PA

DETROL tolterodine tartrate NP PA

DETROL LA tolterodine tartrate NP PA

DITROPAN XL oxybutynin chloride NP PA

ENABLEX darifenacin hydrobromide NP PA

flavoxate hcl NP PA

GELNIQUE oxybutynin chloride NP PA

oxybutynin chloride P

oxybutynin chloride er P

OXYTROL oxybutynin P

solifenacin succinate P

tolterodine tartrate P

tolterodine tartrate er P

TOVIAZ fesoterodine fumarate P

trospium chloride NP PA

trospium chloride er NP PA

VESICARE solifenacin succinate NP PA

VESICARE LS solifenacin succinate NP PA

GOLD COMPOUNDS

RIDAURA auranofin C



GONADOTROPINS AND ANTIGONADOTROPINS

ANTIGONADTROPINS

ORGOVYX relugolix C

PA

ONC

ORIAHNN elagolix sodium/estradiol/norethindrone acetate C

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

ORILISSA 150 MG TABLET elagolix sodium C


PA

S Specialty Drug

ORILISSA 200 MG TABLET elagolix sodium C


PA

S Specialty Drug

HCV ANTIVIRALS

HCV POLYMERASE INHIBITOR ANTIVIRALS

EPCLUSA sofosbuvir/velpatasvir NP

PA

S Specialty Drug

HARVONI ledipasvir/sofosbuvir NP

PA

S Specialty Drug

ledipasvir-sofosbuvir NP PA

S Specialty Drug

sofosbuvir-velpatasvir NP PA

S Specialty Drug

SOVALDI sofosbuvir NP

PA

S Specialty Drug

VOSEVI sofosbuvir/velpatasvir/voxilaprevir P

PA

S Specialty Drug

HCV PROTEASE INHIBITOR ANTIVIRALS

MAVYRET glecaprevir/pibrentasvir P

PA

S Specialty Drug


HCV REPLICATION COMPLEX INHIBITORS

VIEKIRA PAK ombitasvir/paritaprevir/ritonavir/dasabuvir sodium NP

PA

S Specialty Drug

ZEPATIER elbasvir/grazoprevir NP

PA

S Specialty Drug

HEAVY METAL ANTAGONISTS

CHEMET succimer C

D-PENAMINE penicillamine C PA

deferasirox 125 mg tb for susp C

PA

S Specialty Drug

TD

deferasirox 180 mg tablet C

PA

S Specialty Drug

TD


PA

S Specialty Drug

TD


PA

S Specialty Drug

TD


PA

S Specialty Drug

TD


PA

S Specialty Drug

TD

deferiprone C PA

S Specialty Drug

FERRIPROX deferiprone C

PA

S Specialty Drug



FERRIPROX (2 TIMES A DAY) deferiprone C

PA

S Specialty Drug

FERRIPROX (3 TIMES A DAY) deferiprone C

PA

S Specialty Drug

penicillamine 250 mg tablet C PA

S Specialty Drug


HORMONES AND SYNTHETIC SUBSTITUTES

ADRENALS

budesonide ec NP PA

budesonide er NP PA

DECADRON dexamethasone C

dexamethasone 0.5 mg tablet C

dexamethasone 0.5 mg/5 ml elx C

dexamethasone 0.5 mg/5 ml liq C


dexamethasone 1 mg tablet C


dexamethasone 10 mg/ml syring C

dexamethasone 120 mg/30 ml vl C


dexamethasone 20 mg/5 ml vial C


dexamethasone 4 mg/ml vial C


DEXAMETHASONE INTENSOL dexamethasone C

fludrocortisone acetate C

hydrocortisone 10 mg tablet C




MEDROL 2 MG TABLET methylprednisolone C

methylprednisolone C

prednisolone C

prednisolone 15 mg/5 ml soln C

prednisolone 5 mg/5 ml soln C

prednisolone sod ph 25 mg/5 ml C

prednisone C

PREDNISONE INTENSOL prednisone C

SOLU-CORTEF 100 MG ACT-O-VIAL hydrocortisone sodium succinate/pf C

SOLU-CORTEF 100 MG VIAL hydrocortisone sod succinate C

UCERIS budesonide NP PA

ANDROGENS

ANDRODERM testosterone P PA

ANDROGEL testosterone P PA

danazol C

FORTESTA testosterone NP PA

NATESTO testosterone NP PA

STRIANT testosterone NP PA

TESTIM testosterone NP PA

testosteron cyp 1,000 mg/10 ml C PA

testosteron cyp 2,000 mg/10 ml C PA

testosterone 1% (25mg/2.5g) pk NP PA

testosterone 1% (50 mg/5 g) pk NP PA

testosterone 1.62% (2.5 g) pkt NP PA



testosterone 1.62% gel pump NP PA

testosterone 1.62%(1.25 g) pkt NP PA

testosterone 10 mg gel pump NP PA

testosterone 12.5 mg/1.25 gram NP PA

testosterone 30 mg/1.5 ml pump NP PA

testosterone 50 mg/5 gram gel NP PA

testosterone 50 mg/5 gram pkt NP PA

testosterone cyp 1,000 mg/5 ml C PA

testosterone cyp 100 mg/ml C PA

testosterone cyp 200 mg/ml C PA

testosterone cyp 500 mg/2.5 ml C PA

testosterone cyp 500 mg/5 ml C PA

testosterone cyp 6,000 mg/30ml C PA

testosterone enanthate C PA

testosterone propionate C PA

VOGELXO testosterone NP PA

CONTRACEPTIVES

AFIRMELLE levonorgestrel/ethinyl estradiol C

AFTER PILL levonorgestrel C

ALTAVERA levonorgestrel/ethinyl estradiol C

ALYACEN norethindrone-ethinyl estradiol C

AMETHIA levonorgestrel/ethinyl estradiol and ethinyl estradiol C

AMETHIA LO levonorgestrel/ethinyl estradiol and ethinyl estradiol C

ANNOVERA segesterone acetate/ethinyl estradiol C QL 1 RING / YEAR



APRI desogestrel-ethinyl estradiol C

ARANELLE norethindrone-ethinyl estradiol C

ASHLYNA levonorgestrel/ethinyl estradiol and ethinyl estradiol C

AUBRA levonorgestrel/ethinyl estradiol C

AUBRA EQ levonorgestrel/ethinyl estradiol C

AUROVELA norethindrone acetate-ethinyl estradiol C

AUROVELA 24 FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

AUROVELA FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

AVIANE levonorgestrel/ethinyl estradiol C

AYUNA levonorgestrel/ethinyl estradiol C

AZURETTE desogestrel-ethinyl estradiol/ethinyl estradiol C

BALZIVA norethindrone-ethinyl estradiol C

BEKYREE desogestrel-ethinyl estradiol/ethinyl estradiol C

BLISOVI 24 FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

BLISOVI FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

BRIELLYN norethindrone-ethinyl estradiol C

CAMILA norethindrone C

CAMRESE levonorgestrel/ethinyl estradiol and ethinyl estradiol C

CAMRESE LO levonorgestrel/ethinyl estradiol and ethinyl estradiol C

CAZIANT desogestrel-ethinyl estradiol C



CHATEAL levonorgestrel/ethinyl estradiol C

CHATEAL EQ levonorgestrel/ethinyl estradiol C

CRYSELLE norgestrel-ethinyl estradiol C

CYCLAFEM norethindrone-ethinyl estradiol C

CYRED desogestrel-ethinyl estradiol C

CYRED EQ desogestrel-ethinyl estradiol C

DASETTA norethindrone-ethinyl estradiol C

DAYSEE levonorgestrel/ethinyl estradiol and ethinyl estradiol C

DEBLITANE norethindrone C

desogestr-eth estrad eth estra C

desogestrel-ethinyl estradiol C

drospirenone-ethinyl estradiol C

ELINEST norgestrel-ethinyl estradiol C

ELLA ulipristal acetate C

ELURYNG etonogestrel/ethinyl estradiol C

EMOQUETTE desogestrel-ethinyl estradiol C

ENPRESSE levonorgestrel/ethinyl estradiol C

ENSKYCE desogestrel-ethinyl estradiol C

ERRIN norethindrone C

ESTARYLLA norgestimate-ethinyl estradiol C

ethynodiol-ethinyl estradiol C



etonogestrel-ethinyl estradiol C

FALMINA levonorgestrel/ethinyl estradiol C

FEMYNOR norgestimate-ethinyl estradiol C

GIANVI ethinyl estradiol/drospirenone C

HAILEY norethindrone acetate-ethinyl estradiol C

HAILEY 24 FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

HAILEY FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

HEATHER norethindrone C

ICLEVIA levonorgestrel/ethinyl estradiol C

INCASSIA norethindrone C

INTROVALE levonorgestrel/ethinyl estradiol C

ISIBLOOM desogestrel-ethinyl estradiol C

JAIMIESS levonorgestrel/ethinyl estradiol and ethinyl estradiol C

JASMIEL ethinyl estradiol/drospirenone C

JENCYCLA norethindrone C

JOLESSA levonorgestrel/ethinyl estradiol C

JULEBER desogestrel-ethinyl estradiol C

JUNEL norethindrone acetate-ethinyl estradiol C

JUNEL FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

JUNEL FE 24 norethindrone acetate-ethinyl estradiol/ferrous fumarate C



KALLIGA desogestrel-ethinyl estradiol C

KARIVA desogestrel-ethinyl estradiol/ethinyl estradiol C

KELNOR 1-35 ethynodiol diacetate-ethinyl estradiol C

KELNOR 1-50 ethynodiol diacetate-ethinyl estradiol C

KURVELO levonorgestrel/ethinyl estradiol C

LARIN norethindrone acetate-ethinyl estradiol C

LARIN 24 FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

LARIN FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

LARISSIA levonorgestrel/ethinyl estradiol C

LEENA norethindrone-ethinyl estradiol C

LESSINA levonorgestrel/ethinyl estradiol C

LEVONEST levonorgestrel/ethinyl estradiol C

levono-e estrad 0.15-0.03-0.01 C

levonor-e estrad 0.1-0.02-0.01 C

levonor-eth estrad 0.1-0.02 mg C

levonor-eth estrad 0.15-0.03 C

levonor-eth estrad triphasic C

levonorgestrel C OTC

LEVORA-28 levonorgestrel/ethinyl estradiol C

LILLOW levonorgestrel/ethinyl estradiol C

LO-ZUMANDIMINE ethinyl estradiol/drospirenone C

LOJAIMIESS levonorgestrel/ethinyl estradiol and ethinyl estradiol C



LORYNA ethinyl estradiol/drospirenone C

LOW-OGESTREL norgestrel-ethinyl estradiol C

LUTERA levonorgestrel/ethinyl estradiol C

LYLEQ norethindrone C

LYZA norethindrone C

MARLISSA levonorgestrel/ethinyl estradiol C

MICROGESTIN norethindrone acetate-ethinyl estradiol C

MICROGESTIN FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

MILI norgestimate-ethinyl estradiol C

MONO-LINYAH norgestimate-ethinyl estradiol C

MY WAY levonorgestrel C OTC

NECON norethindrone-ethinyl estradiol C

NIKKI ethinyl estradiol/drospirenone C

NORA-BE norethindrone C

noreth-ee-fe 1-0.02(21)-75 tab C

noreth-ee-fe 1.5-0.03mg(21)-75 C

norethin-ee 1.5-0.03 mg(21) tb C

norethind-eth estrad 1-0.02 mg C

norethindrone C

norgestimate-ethinyl estradiol C

NORLYDA norethindrone C

NORTREL norethindrone-ethinyl estradiol C



NYLIA norethindrone-ethinyl estradiol C

NYMYO norgestimate-ethinyl estradiol C

OCELLA ethinyl estradiol/drospirenone C

OGESTREL norgestrel-ethinyl estradiol C

ORSYTHIA levonorgestrel/ethinyl estradiol C

PHILITH norethindrone-ethinyl estradiol C

PIMTREA desogestrel-ethinyl estradiol/ethinyl estradiol C

PIRMELLA norethindrone-ethinyl estradiol C

PLAN B ONE-STEP levonorgestrel C

PA

OTC

PORTIA levonorgestrel/ethinyl estradiol C

PREVIFEM norgestimate-ethinyl estradiol C

RECLIPSEN desogestrel-ethinyl estradiol C

SETLAKIN levonorgestrel/ethinyl estradiol C

SHAROBEL norethindrone C

SIMLIYA desogestrel-ethinyl estradiol/ethinyl estradiol C

SIMPESSE levonorgestrel/ethinyl estradiol and ethinyl estradiol C

SPRINTEC norgestimate-ethinyl estradiol C

SRONYX levonorgestrel/ethinyl estradiol C

SYEDA ethinyl estradiol/drospirenone C



TARINA 24 FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

TARINA FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

TARINA FE 1-20 EQ norethindrone acetate-ethinyl estradiol/ferrous fumarate C

TAYSOFY norethindrone acetate-ethinyl estradiol/ferrous fumarate C

TILIA FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

TRI FEMYNOR norgestimate-ethinyl estradiol C

TRI-ESTARYLLA norgestimate-ethinyl estradiol C

TRI-LEGEST FE norethindrone acetate-ethinyl estradiol/ferrous fumarate C

TRI-LINYAH norgestimate-ethinyl estradiol C

TRI-LO-ESTARYLLA norgestimate-ethinyl estradiol C

TRI-LO-MARZIA norgestimate-ethinyl estradiol C

TRI-LO-MILI norgestimate-ethinyl estradiol C

TRI-LO-SPRINTEC norgestimate-ethinyl estradiol C

TRI-MILI norgestimate-ethinyl estradiol C

TRI-NYMYO norgestimate-ethinyl estradiol C

TRI-PREVIFEM norgestimate-ethinyl estradiol C

TRI-SPRINTEC norgestimate-ethinyl estradiol C

TRI-VYLIBRA norgestimate-ethinyl estradiol C

TRI-VYLIBRA LO norgestimate-ethinyl estradiol C

TRIVORA-28 levonorgestrel/ethinyl estradiol C



TULANA norethindrone C

TWIRLA levonorgestrel/ethinyl estradiol C

TYBLUME levonorgestrel/ethinyl estradiol C

VELIVET desogestrel-ethinyl estradiol C

VESTURA ethinyl estradiol/drospirenone C

VIENVA levonorgestrel/ethinyl estradiol C

VIORELE desogestrel-ethinyl estradiol/ethinyl estradiol C

VOLNEA desogestrel-ethinyl estradiol/ethinyl estradiol C

VYFEMLA norethindrone-ethinyl estradiol C

VYLIBRA norgestimate-ethinyl estradiol C

WERA norethindrone-ethinyl estradiol C

XULANE norelgestromin/ethinyl estradiol C

ZARAH ethinyl estradiol/drospirenone C

ZOVIA 1-35 ethynodiol diacetate-ethinyl estradiol C

ZOVIA 1-35E ethynodiol diacetate-ethinyl estradiol C

ZUMANDIMINE ethinyl estradiol/drospirenone C

PITUITARY

desmopressin 0.01% solution C PA

desmopressin 1.5 mg/ml spray C PA

desmopressin 10 mcg/0.1 ml spr C PA

desmopressin acetate 0.1 mg tb C AL1 At least 8 yrs old



desmopressin acetate 0.2 mg tb C AL1 At least 8 yrs old

GENOTROPIN somatropin NP PA

HUMATROPE somatropin NP PA

NORDITROPIN FLEXPRO somatropin P PA

NUTROPIN AQ NUSPIN somatropin P PA

OMNITROPE somatropin NP PA

SAIZEN somatropin NP PA

SAIZEN-SAIZENPREP somatropin NP PA

SEROSTIM somatropin NP

PA

S Specialty Drug

STIMATE desmopressin acetate C PA

ZOMACTON somatropin NP PA

ZORBTIVE somatropin NP

PA

S Specialty Drug

PROGESTINS

medroxyprogesterone 10 mg tab C

medroxyprogesterone 2.5 mg tab C

medroxyprogesterone 5 mg tab C

MEGACE ES megestrol acetate NP PA

megestrol 20 mg tablet P

megestrol 40 mg tablet P

megestrol 625 mg/5 ml susp NP PA

megestrol acet 40 mg/ml susp P

megestrol acet 400 mg/10 ml P



norethindrone ac (lupaneta) C

norethindrone acetate C

progesterone 100 mg capsule C

progesterone 200 mg capsule C


HYPOTENSIVE AGENTS

CENTRAL ALPHA-AGONISTS

clonidine C

clonidine hcl 0.1 mg tablet C



clonidine hcl er C QL 4 TABS / 1 DAY

PA

guanfacine hcl C

methyldopa C

DIRECT VASODILATORS

hydralazine 10 mg tablet C




minoxidil C

INSULINS

INTERMEDIATE-ACTING INSULINS

HUMULIN 70-30 insulin nph human isophane/insulin regular, human P OTC

HUMULIN 70/30 KWIKPEN insulin nph human isophane/insulin regular, human NP

PA

OTC

HUMULIN N insulin nph human isophane P OTC

HUMULIN N KWIKPEN insulin nph human isophane NP

PA

OTC

NOVOLIN 70-30 100 UNIT/ML VIAL insulin nph human isophane/insulin regular, human P OTC


NOVOLIN 70-30 FLEXPEN insulin nph human isophane/insulin regular, human NP

PA

OTC

NOVOLIN N 100 UNIT/ML FLEXPEN insulin nph human isophane NP

PA

OTC

NOVOLIN N 100 UNIT/ML VIAL insulin nph human isophane P OTC

RELION NOVOLIN 70-30 FLEXPEN NP PA

OTC

RELION NOVOLIN 70-30 VIAL P OTC

RELION NOVOLIN N 100 UNIT/ML P OTC

RELION NOVOLIN N U-100 FLEXPEN NP PA

OTC

LONG-ACTING INSULINS

BASAGLAR KWIKPEN U-100 insulin glargine,human recombinant analog NP PA

LANTUS insulin glargine,human recombinant analog P

LANTUS SOLOSTAR insulin glargine,human recombinant analog P

LEVEMIR insulin detemir P

LEVEMIR FLEXTOUCH insulin detemir P

SEMGLEE insulin glargine,human recombinant analog NP PA

SEMGLEE PEN insulin glargine,human recombinant analog NP PA

SOLIQUA 100-33 insulin glargine,human recombinant analog/lixisenatide NP

QL 15 ML / 30 DAYS

PA

TOUJEO MAX SOLOSTAR insulin glargine,human recombinant analog NP PA

TOUJEO SOLOSTAR insulin glargine,human recombinant analog NP PA

TRESIBA insulin degludec NP PA



TRESIBA FLEXTOUCH U-100 insulin degludec NP PA

TRESIBA FLEXTOUCH U-200 insulin degludec NP PA

XULTOPHY 100-3.6 insulin degludec/liraglutide NP

QL 15 ML / 30 DAYS

PA

RAPID-ACTING INSULINS

ADMELOG insulin lispro NP PA

ADMELOG SOLOSTAR insulin lispro NP PA

AFREZZA insulin regular, human NP PA

APIDRA insulin glulisine NP PA

APIDRA SOLOSTAR insulin glulisine NP PA

FIASP insulin aspart (niacinamide) NP PA

FIASP FLEXTOUCH insulin aspart (niacinamide) NP PA

FIASP PENFILL insulin aspart (niacinamide) NP PA

HUMALOG insulin lispro P

HUMALOG JUNIOR KWIKPEN insulin lispro P

HUMALOG KWIKPEN U-100 insulin lispro P

HUMALOG KWIKPEN U-200 insulin lispro NP PA

HUMALOG MIX 50-50 insulin lispro protamine and insulin lispro P

HUMALOG MIX 50-50 KWIKPEN insulin lispro protamine and insulin lispro P

HUMALOG MIX 75-25 insulin lispro protamine and insulin lispro P

HUMALOG MIX 75-25 KWIKPEN insulin lispro protamine and insulin lispro P



INSULIN ASPART 100 UNIT/ML CRT insulin aspart NP PA

INSULIN ASPART 100 UNIT/ML PEN insulin aspart NP PA

INSULIN ASPART 100 UNIT/ML VL insulin aspart NP PA

INSULIN ASPART PROT-INSULN ASP insulin aspart protamine human/insulin aspart NP PA

INSULIN ASPART PROT-INSULN ASP insulin aspart protamine human/insulin aspart NP PA

INSULIN LISPRO 100 UNIT/ML PEN insulin lispro P

INSULIN LISPRO 100 UNIT/ML VL insulin lispro P

INSULIN LISPRO JR 100 UNIT/ML insulin lispro NP PA

INSULIN LISPRO MIX 75-25 KWKPN insulin lispro protamine and insulin lispro NP PA

LYUMJEV insulin lispro-aabc NP PA

LYUMJEV KWIKPEN U-100 insulin lispro-aabc NP PA

LYUMJEV KWIKPEN U-200 insulin lispro-aabc NP PA

NOVOLOG 100 UNIT/ML CARTRIDGE insulin aspart P

NOVOLOG 100 UNIT/ML FLEXPEN insulin aspart P

NOVOLOG 100 UNIT/ML VIAL insulin aspart P

NOVOLOG MIX 70-30 FLEXPEN insulin aspart protamine human/insulin aspart P

NOVOLOG MIX 70-30 VIAL insulin aspart protamine human/insulin aspart P

RELION NOVOLOG 100 UNIT/ML VL P

RELION NOVOLOG MIX 70-30 FLXPN P

RELION NOVOLOG MIX 70-30 VIAL P

RELION NOVOLOG U-100 FLEXPEN P



SHORT-ACTING INSULINS

HUMULIN R insulin regular, human P OTC

HUMULIN R U-500 insulin regular, human P

HUMULIN R U-500 KWIKPEN insulin regular, human P

NOVOLIN R 100 UNIT/ML FLEXPEN insulin regular, human NP

PA

OTC

NOVOLIN R 100 UNIT/ML VIAL insulin regular, human P OTC

RELION NOVOLIN R 100 UNIT/ML P OTC

RELION NOVOLIN R U-100 FLEXPEN NP PA

OTC


ION-REMOVING AGENTS

PHOSPHATE-REMOVING AGENTS

AURYXIA ferric citrate NP PA

calcium acetate 667 mg capsule P

calcium acetate 667 mg gelcap P

calcium acetate 667 mg tablet P

FOSRENOL lanthanum carbonate NP PA

lanthanum carbonate NP PA

PHOSLYRA calcium acetate P

RENAGEL sevelamer hcl NP PA

RENVELA sevelamer carbonate NP PA

sevelamer 0.8 gm powder packet NP PA

sevelamer 2.4 gm powder packet NP PA

sevelamer carbonate 800 mg tab P


sevelamer hcl NP PA

VELPHORO sucroferric oxyhydroxide NP PA

POTASSIUM-REMOVING AGENTS

KIONEX sodium polystyrene sulfonate/sorbitol solution C

sodium polystyrene sulfonate C

SPS 15 GM/60 ML SUSPENSION sodium polystyrene sulfonate/sorbitol solution C

LOCAL ANESTHETICS (PARENTERAL)

ropivacaine hcl-nacl C


MACROLIDE ANTIBIOTICS

ERYTHROMYCIN ANTIBIOTICS

E.E.S. 200 erythromycin ethylsuccinate NP PA

E.E.S. 400 erythromycin ethylsuccinate P

ERY-TAB erythromycin base NP PA

ERYPED 200 erythromycin ethylsuccinate NP PA

ERYPED 400 erythromycin ethylsuccinate NP PA

ERYTHROCIN STEARATE erythromycin stearate NP PA

erythromycin 250 mg filmtab NP PA

erythromycin 500 mg filmtab NP PA

erythromycin dr 250 mg cap P

erythromycin ethylsuccinate NP PA

OTHER MACROLIDE ANTIBIOTICS

azithromycin 1 gm pwd packet P

azithromycin 100 mg/5 ml susp P

azithromycin 200 mg/5 ml susp P


azithromycin 250 mg tablet P



clarithromycin 125 mg/5 ml sus NP PA

clarithromycin 250 mg tablet P

clarithromycin 250 mg/5 ml sus NP PA

clarithromycin 500 mg tablet P

clarithromycin er NP PA

DIFICID fidaxomicin C PA

ZITHROMAX 1 GM POWDER PACKET azithromycin NP PA

ZITHROMAX 100 MG/5 ML SUSP azithromycin NP PA

ZITHROMAX 200 MG/5 ML SUSP azithromycin NP PA

ZITHROMAX 250 MG TABLET azithromycin NP PA

ZITHROMAX 250 MG Z-PAK TABLET azithromycin NP PA

ZITHROMAX 500 MG TABLET azithromycin NP PA

ZITHROMAX TRI-PAK azithromycin NP PA


MISC. BETA-LACTAM ANTIBIOTICS

MONOBACTAM ANTIBIOTICS

CAYSTON aztreonam lysine NP

PA

S Specialty Drug

MISCELLANEOUS THERAPEUTIC AGENTS

5-ALPHA-REDUCTASE INHIBITORS

AVODART dutasteride NP PA

dutasteride P

dutasteride-tamsulosin NP PA


finasteride 5 mg tablet P

JALYN dutasteride/tamsulosin hcl NP PA

PROSCAR finasteride NP PA

ALCOHOL DETERRENTS

disulfiram C

ANTIDOTES

leucovorin calcium 10 mg tab C




ANTIGOUT AGENTS

allopurinol C

colchicine C

febuxostat C

BONE RESORPTION INHIBITORS

ACTONEL risedronate sodium NP PA

alendronate sodium P

ATELVIA risedronate sodium NP PA

BINOSTO alendronate sodium NP PA

BONIVA ibandronate sodium NP PA

etidronate disodium NP PA

FOSAMAX alendronate sodium NP PA

FOSAMAX PLUS D alendronate sodium/cholecalciferol (vitamin d3) NP PA

ibandronate 3 mg/3 ml vial C

ibandronate sodium 150 mg tab P

PROLIA denosumab NP

PA

MED



risedronate sodium NP PA

risedronate sodium dr NP PA

CARIOSTATIC AGENTS

DENTA 5000 PLUS C

DENTAGEL C

FLORIVA 0.25 MG/ML DROPS sodium fluoride/cholecalciferol (vitamin d3) C

fluoride C AL1 Up to 6 yrs old

FLUORITAB 0.5 MG TABLET CHEW C

FLUORITAB 1 MG TABLET CHEW fluoride (sodium) C

LUDENT FLUORIDE 0.5 MG TB CHEW C

LUDENT FLUORIDE 1 MG TAB CHEW C

SF C

SF 5000 PLUS C

sodium fluoride 0.25 (0.55) mg C AL1 Up to 6 yrs old

sodium fluoride 0.5 mg(1.1 mg) C AL1 Up to 6 yrs old

sodium fluoride 0.5 mg/ml drop C AL1 Up to 6 yrs old

OTC

sodium fluoride 1 mg (2.2 mg) C AL1 Up to 6 yrs old

sodium fluoride 1.1% cream C

sodium fluoride 1.1% gel C

SODIUM FLUORIDE 5000 PLUS C

sodium fluoride 5000 ppm cream C

COMPLEMENT INHIBITORS

BERINERT c1 esterase inhibitor P

PA

S Specialty Drug

CINRYZE c1 esterase inhibitor NP

PA

S Specialty Drug

FIRAZYR icatibant acetate NP

PA

S Specialty Drug



HAEGARDA c1 esterase inhibitor NP

PA

S Specialty Drug

icatibant NP PA

S Specialty Drug

KALBITOR ecallantide NP

PA

S Specialty Drug

ORLADEYO berotralstat hydrochloride C

QL 1 CAP / 1 DAY

PA

S Specialty Drug

RUCONEST c1 esterase inhibitor, recombinant NP

PA

S Specialty Drug

SAJAZIR icatibant acetate NP

PA

S Specialty Drug

TAKHZYRO lanadelumab-flyo NP

QL 4 ML / 30 DAYS

PA

S Specialty Drug

DISEASE-MODIFYING ANTIRHEUMATIC AGENTS

ACTEMRA 162 MG/0.9 ML SYRINGE tocilizumab NP

QL 3.6 ML / 28 DAYS

PA

S Specialty Drug

ACTEMRA 200 MG/10 ML VIAL tocilizumab NP

PA

S Specialty Drug

MED


PA

S Specialty Drug

MED


PA

S Specialty Drug

MED

ACTEMRA ACTPEN tocilizumab NP

PA

S Specialty Drug



AVSOLA infliximab-axxq NP

PA

MED

CIMZIA 200 MG VIAL KIT certolizumab pegol NP

PA

S Specialty Drug

MED

CIMZIA 2X200 MG/ML SYRINGE KIT certolizumab pegol NP


PA

S Specialty Drug

CIMZIA 2X200 MG/ML(X3)START KT certolizumab pegol NP


PA

S Specialty Drug

ENBREL 25 MG KIT etanercept P

QL 8 VIALS (8 ML) / 28 DAYS

PA

S Specialty Drug

ENBREL 25 MG/0.5 ML SYRINGE etanercept P

QL 4 ML (8 DOSES) / 28 DAYS

PA

S Specialty Drug

ENBREL 25 MG/0.5 ML VIAL etanercept P


PA

S Specialty Drug

ENBREL 50 MG/ML SYRINGE etanercept P


PA

S Specialty Drug

ENBREL MINI etanercept P


PA

S Specialty Drug

ENBREL SURECLICK etanercept P


PA

S Specialty Drug



HUMIRA adalimumab P


PA

S Specialty Drug

HUMIRA PEN adalimumab P

QL 2 PENS / 28 DAYS

PA

S Specialty Drug

HUMIRA PEN CROHN'S-UC-HS adalimumab P

QL 2 PENS / 28 DAYS

PA

S Specialty Drug

HUMIRA PEN PSOR-UVEITS-ADOL HS adalimumab P

QL 2 PENS / 28 DAYS

PA

S Specialty Drug

HUMIRA(CF) 10 MG/0.1 ML SYRING adalimumab P


PA

S Specialty Drug



PA

S Specialty Drug


QL 2 syringes / 28 day(s)

PA

S Specialty Drug

HUMIRA(CF) PEDI CROHN 80MG/0.8 adalimumab P


PA

S Specialty Drug

HUMIRA(CF) PEN 40 MG/0.4 ML adalimumab P

QL 2 PENS / 28 DAYS

PA

S Specialty Drug

HUMIRA(CF) PEN 80 MG/0.8 ML adalimumab P


PA

S Specialty Drug



HUMIRA(CF) PEN CROHN'S-UC-HS adalimumab P


PA

S Specialty Drug

HUMIRA(CF) PEN PEDIATRIC UC adalimumab P

QL 3 PENS / 28 DAYS

PA

S Specialty Drug

HUMIRA(CF) PEN PSOR-UV-ADOL HS adalimumab P

QL 3 PENS / 28 DAYS

PA

S Specialty Drug

INFLECTRA infliximab-dyyb NP

PA

MED

KEVZARA sarilumab NP

QL 2.8 ML / 28 DAYS

PA

S Specialty Drug

KINERET anakinra NP

QL 18.76 ML / 28 DAYS

PA

S Specialty Drug

leflunomide C

OLUMIANT baricitinib NP

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ORENCIA 125 MG/ML SYRINGE abatacept NP


PA

S Specialty Drug

ORENCIA 250 MG VIAL abatacept/maltose NP

PA

MED

ORENCIA 50 MG/0.4 ML SYRINGE abatacept NP

QL 1.6 ML / 28 DAYS

PA

S Specialty Drug

ORENCIA 87.5 MG/0.7 ML SYRINGE abatacept NP

QL 2.8 ML / 28 DAYS

PA

S Specialty Drug



ORENCIA CLICKJECT abatacept NP

QL 4 ML / 28 DAYS

PA

S Specialty Drug

OTEZLA 28 DAY STARTER PACK apremilast NP


PA

S Specialty Drug

OTEZLA 30 MG TABLET apremilast NP

QL 2 TABS / 1 DAY

PA

S Specialty Drug

OTEZLA STARTER PACK apremilast NP


PA

S Specialty Drug

REMICADE infliximab NP

PA

MED

RENFLEXIS infliximab-abda NP

PA

MED

RINVOQ upadacitinib NP

QL 1 TAB / 1 DAY

PA

S Specialty Drug

SIMPONI 100 MG/ML PEN INJECTOR golimumab NP

QL 1 SYRINGE / 28 DAYS

PA

S Specialty Drug

SIMPONI 100 MG/ML SYRINGE golimumab NP

QL 1 ML / 28 DAYS

PA

S Specialty Drug

SIMPONI 50 MG/0.5 ML PEN INJEC golimumab NP

QL 0.5 ML / 28 DAYS

PA

S Specialty Drug

SIMPONI 50 MG/0.5 ML SYRINGE golimumab NP

QL 0.5 ML / 28 DAYS

PA

S Specialty Drug



SIMPONI ARIA golimumab NP

QL 104 ML / 54 DAYS

PA

S Specialty Drug

XELJANZ 1 MG/ML SOLUTION tofacitinib citrate NP

QL 10 ML / 1 DAY

PA

S Specialty Drug

XELJANZ 10 MG TABLET tofacitinib citrate NP

QL 2 TABS / 1 DAY

PA

S Specialty Drug

XELJANZ 5 MG TABLET tofacitinib citrate NP

QL 2 TABS / 1 DAY

PA

S Specialty Drug

XELJANZ XR tofacitinib citrate NP

QL 1 TAB / 1 DAY

PA

S Specialty Drug

IMMUNOMODULATORY AGENTS

AUBAGIO teriflunomide P

QL 1 TAB / 1 DAY

S Specialty Drug

AVONEX 30 MCG VIAL KIT interferon beta-1a/albumin human P

QL 1 KIT / 28 DAYS

S Specialty Drug

AVONEX 30 MCG/0.5 ML SYRINGE interferon beta-1a P

QL 4 syringes / 28 day(s)

S Specialty Drug

AVONEX PEN interferon beta-1a P

QL 1 KIT / 28 DAYS

S Specialty Drug

AVONEX PREFILLED SYR 30 MCG KT interferon beta-1a P

QL 1 KIT / 28 DAYS

S Specialty Drug

BAFIERTAM monomethyl fumarate NP

QL 4 CAPS / 1 DAY

PA

S Specialty Drug

BETASERON interferon beta-1b P

QL 15 ML / 30 DAYS

S Specialty Drug



COPAXONE 20 MG/ML SYRINGE glatiramer acetate P

QL 30 ML / 30 DAYS

S Specialty Drug

COPAXONE 40 MG/ML SYRINGE glatiramer acetate NP

QL 12 ML / 28 DAYS

PA

S Specialty Drug

dimethyl fumarate NP

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

ENSPRYNG satralizumab-mwge C

PA

S Specialty Drug

EXTAVIA interferon beta-1b NP

QL 15 ML / 30 DAYS

PA

S Specialty Drug

GILENYA fingolimod hcl P

QL 1 CAP / 1 DAY

S Specialty Drug

glatiramer 20 mg/ml syringe NP

QL 30 ML / 30 DAYS

PA

S Specialty Drug

glatiramer 40 mg/ml syringe NP

QL 12 ML / 28 DAYS

PA

S Specialty Drug

GLATOPA 20 MG/ML SYRINGE glatiramer acetate NP

QL 30 ML / 30 DAYS

PA

S Specialty Drug

GLATOPA 40 MG/ML SYRINGE glatiramer acetate NP

QL 12 ML / 28 DAYS

PA

S Specialty Drug

KESIMPTA PEN ofatumumab NP

QL 0.4 ML / 28 DAYS

PA

S Specialty Drug



MAYZENT 0.25 MG STARTER PACK siponimod NP

QL 12 TABS / 4 DAYS

PA

S Specialty Drug

MAYZENT 0.25 MG TABLET siponimod NP

QL 4 TABS / 1 DAY

PA

S Specialty Drug

MAYZENT 2 MG TABLET siponimod NP

QL 1 TAB / 1 DAY

PA

S Specialty Drug

OCREVUS ocrelizumab NP

PA

S Specialty Drug

MED

PLEGRIDY peginterferon beta-1a NP

QL 1 ML / 28 DAYS

PA

S Specialty Drug

PLEGRIDY 125 MCG/0.5 ML SYRINGE (IM) peginterferon beta-1a C

QL 1 ML / 28 DAYS

S Specialty Drug

PLEGRIDY PEN peginterferon beta-1a NP

QL 1 ML / 28 DAYS

PA

S Specialty Drug

REBIF 22 MCG/0.5 ML SYRINGE interferon beta-1a/albumin human P

QL 6 ML / 28 DAYS

S Specialty Drug

REBIF 44 MCG/0.5 ML SYRINGE interferon beta-1a/albumin human P

QL 6 ML / 28 DAYS

S Specialty Drug

REBIF REBIDOSE 22 MCG/0.5 ML interferon beta-1a/albumin human P

QL 6 ML / 28 DAYS

S Specialty Drug

REBIF REBIDOSE 44 MCG/0.5 ML interferon beta-1a/albumin human P

QL 6 ML / 28 DAYS

S Specialty Drug

REBIF REBIDOSE TITRATION PACK interferon beta-1a/albumin human P

QL 4.2 ML / 28 DAYS

S Specialty Drug



REBIF TITRATION PACK interferon beta-1a/albumin human P

QL 4.2 ML / 28 DAYS

S Specialty Drug

REDITREX methotrexate/pf C PA

TECFIDERA dimethyl fumarate NP

QL 2 CAPS / 1 DAY

PA

S Specialty Drug

THALOMID thalidomide C

S Specialty Drug

ONC

TYSABRI natalizumab NP

PA

S Specialty Drug

MED

VUMERITY diroximel fumarate NP

PA

S Specialty Drug

ZEPOSIA ozanimod hydrochloride NP

PA

S Specialty Drug

IMMUNOSUPPRESSIVE AGENTS

ASTAGRAF XL tacrolimus NP PA

AZASAN azathioprine NP PA

azathioprine P

CELLCEPT 200 MG/ML ORAL SUSP mycophenolate mofetil P

CELLCEPT 250 MG CAPSULE mycophenolate mofetil NP PA

CELLCEPT 500 MG TABLET mycophenolate mofetil NP PA

cyclosporine 100 mg capsule P

cyclosporine 25 mg capsule P

cyclosporine modified P

ENVARSUS XR tacrolimus NP PA



everolimus 0.25 mg tablet NP PA



GENGRAF cyclosporine, modified C

IMURAN azathioprine NP PA

MAVENCLAD cladribine NP

PA

S Specialty Drug

mycophenolate 200 mg/ml susp NP PA

mycophenolate 250 mg capsule P

mycophenolate 500 mg tablet P

mycophenolic acid NP PA

MYFORTIC mycophenolate sodium NP PA

NEORAL cyclosporine, modified NP PA

PROGRAF 0.5 MG CAPSULE tacrolimus NP PA

PROGRAF 1 MG CAPSULE tacrolimus NP PA

PROGRAF 5 MG CAPSULE tacrolimus NP PA

RAPAMUNE sirolimus NP PA

SANDIMMUNE 100 MG CAPSULE cyclosporine NP PA

SANDIMMUNE 100 MG/ML SOLN cyclosporine NP PA

SANDIMMUNE 25 MG CAPSULE cyclosporine NP PA

sirolimus NP PA

tacrolimus 0.5 mg capsule (ir) P

tacrolimus 1 mg capsule (ir) P



tacrolimus 5 mg capsule (ir) P

ZORTRESS everolimus NP PA

OTHER MISCELLANEOUS THERAPEUTIC AGENTS

AMPYRA dalfampridine NP

QL 2 TABS / 1 DAY

PA

S Specialty Drug

ARCALYST rilonacept C

PA

S Specialty Drug

CERDELGA eliglustat tartrate C

PA

S Specialty Drug

co q-10 C OTC

co q10 C OTC

coenzyme q-10 C OTC

coenzyme q10 C OTC

CYSTAGON cysteamine bitartrate C

CYTOTINE POWDER C

dalfampridine er NP

QL 2 TABS / 1 DAY

PA

S Specialty Drug

EVRYSDI risdiplam C

PA

S Specialty Drug

EYE MULTIVITAMIN C OTC

GALAFOLD migalastat hcl C


PA

S Specialty Drug

ICAPS beta-carotene/ascorbic acid/vite ac/zinc oxide/cupric oxide C OTC

ILARIS canakinumab/pf NP

QL 2 ML / 28 DAYS

PA

S Specialty Drug



ISTURISA osilodrostat phosphate C

PA

S Specialty Drug

levocarnitine 1 g/10 ml soln C

levocarnitine sf C

miglustat C PA

S Specialty Drug

NATROL 5-HTP 5-hydroxytryptophan (5-htp) C OTC

PRESERVISION AREDS 2 SOFTGEL vit c/vit e acetate/zinc oxid/cupric oxide/lutein/zeaxanthin C

PRESERVISION LUTEIN ascorbic acid/vit e acetate/lutein/copper oxide/zinc oxide C OTC

REZUROCK belumosudil mesylate C

QL 1 TAB / 1 DAY

PA

S Specialty Drug

ONC

RUZURGI amifampridine C

QL 8 TABS / 1 DAY

PA

S Specialty Drug

sapropterin dihydrochloride C PA

S Specialty Drug

sodium chloride 1,000 mg tab C OTC

THIOLA tiopronin C

PA

S Specialty Drug

THIOLA EC tiopronin C

PA

S Specialty Drug

tiopronin C PA

S Specialty Drug

TYBOST cobicistat C

VISION FORMULA 2 C

ZOKINVY lonafarnib C

PA

S Specialty Drug



PROTECTIVE AGENTS

ELMIRON pentosan polysulfate sodium C

NONHORMONAL CONTRACEPTIVES

condoms condoms, latex, lubricated C OTC

GYNOL II C OTC


NONSTEROIDAL ANTI-INFLAMMATORY AGENTS

CYCLOOXYGENASE-2 (COX-2) INHIBITORS

CELEBREX celecoxib NP PA

celecoxib P

OTHER NONSTEROIDAL ANTI-INFLAM. AGENTS

ALL DAY PAIN RELIEF naproxen sodium C OTC

ARTHRITIS PAIN RELIEVER 1% GEL diclofenac sodium C OTC

ARTHROTEC 50 diclofenac sodium/misoprostol NP PA

ARTHROTEC 75 diclofenac sodium/misoprostol NP PA

CHILD MOTRIN 100 MG CHEW TAB ibuprofen C OTC

children's ibuprofen C OTC

cvs diclofenac sodium 1% gel C OTC

cvs ibuprofen 200 mg caplet C OTC

cvs ibuprofen 200 mg capsule C OTC

cvs ibuprofen 200 mg softgel C OTC

cvs ibuprofen 200 mg tablet C OTC

cvs naproxen sod 220 mg caplet P OTC

cvs naproxen sod 220 mg tablet P OTC

diclofenac epolamine NP PA


diclofenac potassium C

diclofenac sod dr 25 mg tab P



diclofenac sod ec 25 mg tab P



diclofenac sodium 1% gel C OTC

diclofenac sodium er P

diclofenac sodium-misoprostol NP PA

DUEXIS ibuprofen/famotidine NP PA

ec-naproxen P

eq ibuprofen 200 mg caplet C OTC

eq ibuprofen 200 mg softgel C OTC

eq ibuprofen 200 mg tablet C OTC

eq naproxen sod 220 mg caplet P OTC

eq naproxen sod 220 mg tablet P OTC

eql ibuprofen 200 mg caplet C OTC

eql ibuprofen 200 mg softgel C OTC

eql ibuprofen 200 mg tablet C OTC

eql naproxen sod 220 mg caplet P OTC

eql naproxen sod 220 mg tablet P OTC

etodolac C

etodolac er C

fenoprofen calcium NP PA

FLECTOR diclofenac epolamine P

flurbiprofen P



GNP ARTHRITIS PAIN 1% GEL diclofenac sodium C OTC

gnp ibuprofen 100 mg chew tab C OTC

gnp ibuprofen 200 mg caplet C OTC

gnp ibuprofen 200 mg mini sfgl C OTC

gnp ibuprofen 200 mg softgel C OTC

gnp ibuprofen 200 mg tablet C OTC

gnp naproxen sod 220 mg caplet P OTC

gnp naproxen sod 220 mg tablet P OTC

GS ARTHRITIS PAIN 1% GEL diclofenac sodium C OTC

gs ibuprofen 100 mg chew tab C OTC

gs ibuprofen 200 mg caplet C OTC

gs ibuprofen 200 mg liquid gel C OTC

gs ibuprofen 200 mg softgel C OTC

gs ibuprofen 200 mg tablet C OTC

gs naproxen sod 220 mg caplet P OTC

gs naproxen sod 220 mg tablet P OTC

gs naproxen sodium 220 mg tab P OTC

HM ARTHRITIS PAIN 1% GEL diclofenac sodium C OTC

hm ibuprofen 200 mg caplet C OTC

hm ibuprofen 200 mg capsule C OTC

hm ibuprofen 200 mg softgel C OTC

hm ibuprofen 200 mg tablet C OTC

hm naproxen sod 220 mg caplet P OTC

IBU ibuprofen C

ibuprofen 100 mg/5 ml susp C



ibuprofen 200 mg caplet C OTC

ibuprofen 200 mg capsule C OTC

ibuprofen 200 mg softgel C OTC

ibuprofen 200 mg tablet C OTC

ibuprofen 400 mg tablet P



ibuprofen ib C OTC

ibuprofen jr str 100 mg tb chw C OTC

indomethacin 20 mg capsule C

indomethacin 25 mg capsule P

indomethacin 50 mg capsule P

infant's ibuprofen C OTC

infants ibuprofen C OTC

infants' ibuprofen C OTC

ketoprofen P

ketorolac 10 mg tablet P QL 20 TABS / RX

kro ibuprofen 200 mg caplet C OTC

kro ibuprofen 200 mg tablet C OTC

kro naproxen sod 220 mg caplet P OTC

mb ibuprofen 200 mg tablet C OTC

mefenamic acid NP PA

meloxicam 15 mg tablet P

meloxicam 7.5 mg tablet P

MOBIC meloxicam NP PA

nabumetone P

naproxen 125 mg/5 ml suspen C



naproxen 250 mg tablet P


naproxen 500 mg kit P


naproxen dr 375 mg tablet P

naproxen dr 500 mg tablet P

naproxen sod cr 375 mg tablet P

naproxen sod cr 500 mg tablet P

naproxen sod cr 750 mg tablet C

naproxen sodium 220 mg caplet P OTC

naproxen sodium 220 mg tablet P OTC

naproxen sodium 275 mg tab P

naproxen sodium 550 mg tab P

naproxen sodium er P

oxaprozin NP PA

piroxicam C

pub ibuprofen 200 mg tablet C OTC

pub naproxen sod 220 mg tablet P OTC

qc diclofenac sodium 1% gel C OTC

qc ibuprofen 200 mg caplet C OTC

qc ibuprofen 200 mg softgel C OTC

qc ibuprofen 200 mg tablet C OTC

qc naproxen sod 220 mg tablet P OTC

ra ibuprofen 200 mg caplet C OTC

ra ibuprofen 200 mg liquid gel C OTC

ra ibuprofen 200 mg softgel C OTC

ra ibuprofen 200 mg tablet C OTC

ra naproxen sod 220 mg tablet P OTC



SM ARTHRITIS PAIN 1% GEL diclofenac sodium C OTC

sm ibuprofen 200 mg caplet C OTC

sm ibuprofen 200 mg softgel C OTC

sm ibuprofen 200 mg tablet C OTC

sm ibuprofen ib 200 mg caplet C OTC

sm naproxen sod 220 mg caplet P OTC

sm naproxen sod 220 mg tablet P OTC

sulindac P

VIMOVO naproxen/esomeprazole magnesium NP PA

ZIPSOR diclofenac potassium NP PA

ZORVOLEX diclofenac submicronized NP PA

SALICYLATES

aspirin C OTC

aspirin ec C OTC

BAYER CHEWABLE ASPIRIN aspirin C OTC

BUFFERIN C OTC

butalbital-asa-caffeine cap C QL 6 CAPS / 1 DAY

EXCEDRIN EXTRA STRENGTH aspirin/acetaminophen/caffeine C OTC

EXTRAPRIN C OTC

HEADACHE RELIEF C OTC

salsalate C

OXYTOCICS

methylergonovine 0.2 mg tablet C




PARATHYROID AND ANTIPARATHYROID AGENTS

ANTIPARATHYROID AGENTS

calcitonin-salmon 200 units sp P

cinacalcet hcl C

PARATHYROID AGENTS

FORTEO teriparatide NP

PA

S Specialty Drug

teriparatide P S Specialty Drug

TYMLOS abaloparatide NP

PA

S Specialty Drug

PENICILLIN ANTIBIOTICS

AMINOPENICILLIN ANTIBIOTICS

amox-clav 200-28.5 mg tab chew NP PA

amox-clav 200-28.5 mg/5 ml sus P

amox-clav 250-125 mg tablet P


amox-clav 400-57 mg tab chew NP PA

amox-clav 400-57 mg/5 ml susp P




amoxicillin C

amoxicillin-clavulanate pot er NP PA

ampicillin trihydrate C

AUGMENTIN XR amoxicillin/potassium clavulanate NP PA

NATURAL PENICILLIN ANTIBIOTICS

penicillin v potassium C


PENICILLINASE-RESISTANT PENICILLINS

dicloxacillin sodium C

PHARMACEUTICAL AIDS

aqua glycolic emollient base C OTC

SHINGRIX ADJUVANT COMPONENT vaccine adjuvant system, as01b/pf, component vial 1 of 2 C QL 1 DOSE / RX

VAXCHORA BUFFER COMPONENT cholera vaccine buffer component C


RENIN-ANGIOTENSIN-ALDOSTERONE SYS. INHIB

ANGIOTENSIN II RECEPTOR ANTAGONISTS

ATACAND candesartan cilexetil NP PA

ATACAND HCT candesartan cilexetil/hydrochlorothiazide NP PA

AVALIDE irbesartan/hydrochlorothiazide NP PA

AVAPRO irbesartan NP PA

BENICAR olmesartan medoxomil NP PA

BENICAR HCT olmesartan medoxomil/hydrochlorothiazide NP PA

candesartan cilexetil NP PA

candesartan-hydrochlorothiazid NP PA

COZAAR losartan potassium NP PA

DIOVAN valsartan NP PA

DIOVAN HCT valsartan/hydrochlorothiazide NP PA

EDARBI azilsartan medoxomil NP PA

EDARBYCLOR azilsartan medoxomil/chlorthalidone NP PA

ENTRESTO sacubitril/valsartan P


eprosartan mesylate NP PA

HYZAAR losartan potassium/hydrochlorothiazide NP PA

irbesartan P

irbesartan-hydrochlorothiazide P

losartan potassium P

losartan-hydrochlorothiazide P

MICARDIS telmisartan NP PA

MICARDIS HCT telmisartan/hydrochlorothiazide NP PA

olmesartan medoxomil NP PA

olmesartan-amlodipine-hctz NP PA

olmesartan-hydrochlorothiazide NP PA

telmisartan NP PA

telmisartan-amlodipine NP PA

telmisartan-hydrochlorothiazid NP PA

TRIBENZOR olmesartan medoxomil/amlodipine besylate/hydrochlorothiazide NP PA

TWYNSTA telmisartan/amlodipine besylate NP PA

valsartan P

valsartan-hydrochlorothiazide P

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS

ACCUPRIL quinapril hcl NP PA

ACCURETIC quinapril hcl/hydrochlorothiazide NP PA

ALTACE ramipril NP PA

benazepril hcl P

benazepril-hydrochlorothiazide P

captopril P



captopril-hydrochlorothiazide P

enalapril maleate P

enalapril-hydrochlorothiazide P

EPANED enalapril maleate NP PA

fosinopril sodium P

fosinopril-hydrochlorothiazide P

lisinopril P

lisinopril-hydrochlorothiazide P

LOTENSIN benazepril hcl NP PA

LOTENSIN HCT benazepril hcl/hydrochlorothiazide NP PA

moexipril hcl P

perindopril erbumine P

PRINIVIL lisinopril NP PA

QBRELIS lisinopril NP PA

quinapril hcl P

quinapril-hydrochlorothiazide P

ramipril P

TARKA trandolapril/verapamil hcl NP PA

trandolapril P

trandolapril-verapamil er NP PA

VASERETIC enalapril maleate/hydrochlorothiazide NP PA

VASOTEC enalapril maleate NP PA

ZESTORETIC lisinopril/hydrochlorothiazide NP PA

ZESTRIL lisinopril NP PA



MINERALOCORTICOID (ALDOSTERONE) ANTAGNTS

eplerenone C

spironolactone C

spironolactone-hctz C

RENIN INHIBITORS

aliskiren NP PA

TEKTURNA aliskiren hemifumarate NP PA

TEKTURNA HCT aliskiren hemifumarate/hydrochlorothiazide P


RESPIRATORY TRACT AGENTS

ANTIFIBROTIC AGENTS

ESBRIET pirfenidone C

PA

S Specialty Drug

OFEV nintedanib esylate C

PA

S Specialty Drug

ANTITUSSIVES

ADULT TUSSIN COUGH CONGEST DM C OTC

benzonatate C

CHEST CONGESTION RELIEF DM LIQ C OTC

CHILD DELSYM COUGH-CHEST DM C OTC

CHILD MUCINEX COUGH MINI-MELTS guaifenesin/dextromethorphan hbr C OTC

CHILD MUCINEX FREEFROM DAY CGH C OTC

CHILD MUCUS RELIEF COUGH C OTC

CHILD MUCUS-COUGH RELIEF C OTC

codeine-guaifenesin C QL 60 ML / 1 DAY

OTC

COLD HEAD CONGESTION NIGHTTIME C

COLD MAX DAYTIME C


DAYTIME COUGH C OTC

DELSYM dextromethorphan polistirex C OTC

GERI-TUSSIN DM C OTC

GILTUSS COUGH-CONGESTION C OTC

GILTUSS DIABETIC C OTC

GILTUSS HBP C OTC

GNP TUSSIN COUGH LIQUID C OTC

GUAIASORB DM C OTC

guaifenesin-codeine C QL 60 ML / 1 DAY

OTC

guaifenesin-dextromethorphan C OTC

MAXI-TUSS AC C QL 60 ML / 1 DAY

OTC

MAXI-TUSS G C OTC

MUCINEX FAST-MAX DM MAX C OTC

MUCUS RELIEF DM C OTC

MUCUS RELIEF DM MAX C OTC

NIGHTTIME COUGH C OTC

promethazine-dm C

ROBAFEN DM PEAK COLD C OTC

ROBITUSSIN COUGH-CHEST-CONG DM C OTC

ROBITUSSIN ER dextromethorphan polistirex C OTC

TUSNEL PEDIATRIC LIQUID guaifenesin/dextromethorphan hbr/pseudoephedrine hcl C OTC

TUSSIN COUGH LIQUID C OTC

TUSSIN DM C OTC

TUSSIN DM MAX C OTC



VIRTUSSIN AC C QL 60 ML / 1 DAY

EXPECTORANTS

CHEST CONGEST RLF 400 MG TAB C OTC

CHEST CONGESTION RELIEF SOLN guaifenesin C OTC

CHILD MUCINEX CHEST MINI-MELTS guaifenesin C OTC

CHILD MUCINEX STUFFY NOSE-CHST guaifenesin/phenylephrine hcl C OTC

DIABETIC TUSSIN C OTC

GERI-TUSSIN C OTC

guaifenesin C OTC

guaifenesin-pse er 600-60 mg C OTC

HM MUCUS RELIEF ER 1,200 MG TB guaifenesin C OTC

HM MUCUS RELIEF ER 600 MG TAB guaifenesin C OTC

MAXI-TUSS PE MAX C OTC

MUCINEX ER 1,200 MG TABLET guaifenesin C OTC

MUCINEX FAST-MAX CHEST-CONGEST C OTC

MUCOSA C OTC

MUCUS ER guaifenesin C OTC

MUCUS RELIEF C OTC

MUCUS RELIEF D guaifenesin/pseudoephedrine hcl C OTC

MUCUS RELIEF ER 1,200 MG TAB guaifenesin C OTC

MUCUS RELIEF ER 600 MG TABLET guaifenesin C OTC

QC MUCUS RELIEF ER 1,200 MG TB C OTC

sm guaifenesin-pse er 600-60 C OTC



TUSNEL-EX C OTC

TUSSIN MUCUS-CHEST CONGESTION C OTC

MUCOLYTIC AGENTS

acetylcysteine 10% vial C

acetylcysteine 20% vial C

PULMOZYME dornase alfa C

QL 150 ML / 30 DAYS

PA

S Specialty Drug

PHOSPHODIESTERASE TYPE 4 INHIBITORS

DALIRESP roflumilast NP PA

VASODILATING AGENTS (RESPIRATORY TRACT)

ADEMPAS riociguat NP

PA

S Specialty Drug

ambrisentan P PA

S Specialty Drug

bosentan NP PA

S Specialty Drug

epoprostenol sodium C PA

S Specialty Drug

FLOLAN 1.5 MG VIAL epoprostenol sodium (glycine) C

PA

S Specialty Drug

LETAIRIS ambrisentan NP

PA

S Specialty Drug

OPSUMIT macitentan NP

PA

S Specialty Drug

ORENITRAM ER treprostinil diolamine NP

PA

S Specialty Drug

TRACLEER 125 MG TABLET bosentan P

PA

S Specialty Drug



TRACLEER 32 MG TABLET FOR SUSP bosentan NP

PA

S Specialty Drug

TRACLEER 62.5 MG TABLET bosentan P

PA

S Specialty Drug

treprostinil C PA

S Specialty Drug

TYVASO treprostinil NP

PA

S Specialty Drug

TYVASO REFILL KIT treprostinil/nebulizer accessories NP

PA

S Specialty Drug

TYVASO STARTER KIT treprostinil/nebulizer and accessories NP

PA

S Specialty Drug

UPTRAVI 1,000 MCG TABLET selexipag NP

PA

S Specialty Drug


PA

S Specialty Drug


PA

S Specialty Drug


PA

S Specialty Drug

UPTRAVI 200 MCG TABLET selexipag NP

PA

S Specialty Drug

UPTRAVI 200-800 TITRATION PACK selexipag NP

PA

S Specialty Drug


PA

S Specialty Drug


PA

S Specialty Drug


PA

S Specialty Drug



VELETRI epoprostenol sodium C

PA

S Specialty Drug

VENTAVIS iloprost tromethamine NP

PA

S Specialty Drug


SKELETAL MUSCLE RELAXANTS

CENTRALLY ACTING SKELETAL MUSCLE RELAXNT

chlorzoxazone 500 mg tablet C

cyclobenzaprine 10 mg tablet C

cyclobenzaprine 5 mg tablet C

methocarbamol 500 mg tablet C

methocarbamol 750 mg tablet C

tizanidine hcl 2 mg tablet C

tizanidine hcl 4 mg tablet C

DIRECT-ACTING SKELETAL MUSCLE RELAXANTS

dantrolene sodium 100 mg cap C



GABA-DERIVATIVE SKELETAL MUSCLE RELAXANT

baclofen 10 mg tablet C



SKIN AND MUCOUS MEMBRANE AGENTS

ANTIPRURITICS AND LOCAL ANESTHETICS

ANODYNE LPT C

lidocaine 4% cream C OTC

lidocaine 5% patch NP QL 1 PATCH / 1 DAY

PA

lidocaine-hc 2.8-0.55% gel C

lidocaine-hc 3-0.5% cream kit C

lidocaine-hc 3-1% cream kit C


lidocaine-hc 3-2.5% gel kit C

lidocaine-hydrocort 3-2.5% gel C

lidocaine-prilocaine C QL 60 GM / FILL

LIDODERM lidocaine NP

QL 1 PATCH / 1 DAY

PA

phenazopyridine hcl C

ZTLIDO lidocaine NP PA

ASTRINGENTS

XERAC AC aluminum chloride C

CELL STIMULANTS AND PROLIFERANTS

ATRALIN tretinoin NP PA

AVITA tretinoin NP PA

RETIN-A tretinoin P

RETIN-A MICRO tretinoin microspheres NP PA

RETIN-A MICRO PUMP tretinoin microspheres NP PA

tretinoin 0.01% gel NP PA

tretinoin 0.025% cream NP PA





tretinoin microsphere NP PA

KERATOLYTIC AGENTS

ACNE CONTROL CLEANSER NP PA

OTC



ACNE MEDICATION 10% GEL benzoyl peroxide C OTC

ACNE MEDICATION 2.5% GEL C OTC

ACNE MEDICATION 5% GEL benzoyl peroxide C OTC

ACNE MEDICATION 5% LOTION benzoyl peroxide P OTC

ADVANCED EXFOLIATING CLEANSER NP PA

BENZEPRO 5.3% EMOLLIENT FOAM NP PA

OTC

BENZEPRO 5.8% FOAMING CLOTHS benzoyl peroxide micronized NP

PA

OTC

BENZEPRO 9.8% FOAM NP PA

OTC

benzoyl peroxide 10% gel P OTC

benzoyl peroxide 10% wash P OTC

benzoyl peroxide 2.5% gel P OTC

benzoyl peroxide 5% gel P OTC

benzoyl peroxide 5% wash P OTC

benzoyl peroxide 6% cleanser P OTC

BP 10-1 NP PA

BPO 4% GEL P

BPO 8% GEL P

BPO-10 NP PA

BPO-5 NP PA

CLEAN-CLEAR CONTINUOUS CONTROL NP PA

COMPOUND W C OTC

DAYLOGIC ACNE TREATMENT C OTC

DHS SAL C OTC



DURAGEL CALLUS REMOVERS C

OC8 benzoyl peroxide P OTC

PANOXYL C OTC

RIAX benzoyl peroxide C OTC

salicylic acid 6% gel C

SEBEX C OTC

sod sulfac-sulfur 9.8-4.8% crm P

sod sulfac-sulfur 9.8-4.8% lot P

sod sulface-sulf 9.8-4.8% clsr P

sod sulfacet-sulfur 10-2% clsr P

sod sulfacet-sulfur 10-4% pad P

sod sulfacet-sulfur 10-5% clsr P

sod sulfacetamide-sulfur lotn P

sod sulfacetamide-sulfur susp P

sodium sulfacet-sulfur wash P

SSS 10-5 CREAM P

sulfacetamide-sulfur 10-2% crm P

sulfacetamide-sulfur 10-5% crm P

sulfacetamide-sulfur 8-4% susp P

SULFACLEANSE 8-4 P

THERAPEUTIC DANDRUFF SHAMPOO C OTC

urea 40% cream C

urea 40% lotion C

WART REMOVER C OTC

KERATOPLASTIC AGENTS

DHS TAR coal tar C OTC

SKIN AND MUCOUS MEMBRANE AGENTS, MISC.

acitretin C



adapalene 0.1% cream NP PA

adapalene 0.1% gel NP PA

adapalene 0.1% gel (rx only) NP PA

adapalene 0.1% solution NP PA

adapalene 0.3% gel NP PA

adapalene 0.3% gel pump NP PA

adapalene-benzoyl peroxide NP PA

AKLIEF trifarotene NP PA

AMNESTEEM isotretinoin C

ANTI-ITCH 0.5%-0.5% LOTION C OTC

ARTHRITIS PAIN RELIEVING C OTC

azelaic acid C

calcipotriene 0.005% cream C QL 120 GM / 30 DAYS

calcipotriene 0.005% ointment C QL 120 GM / 30 DAYS

calcipotriene 0.005% solution C QL 120 GM / 30 DAYS

CALCITRENE calcipotriene C QL 120 GM / 30 DAYS

capsaicin 0.025% cream C OTC

capsaicin 0.1% cream C OTC

CLARAVIS isotretinoin C

COSENTYX (2 SYRINGES) secukinumab NP

PA

S Specialty Drug

COSENTYX PEN secukinumab NP

PA

S Specialty Drug

COSENTYX PEN (2 PENS) secukinumab NP

PA

S Specialty Drug

COSENTYX SYRINGE secukinumab NP

PA

S Specialty Drug



dapsone 5% gel NP PA

DIFFERIN 0.1% CREAM adapalene P

DIFFERIN 0.1% GEL adapalene C OTC

DIFFERIN 0.1% LOTION adapalene P

DIFFERIN 0.3% GEL adapalene NP PA

DIFFERIN 0.3% GEL PUMP adapalene P

DUPIXENT 300 MG/2 ML PEN dupilumab NP

QL 4 ML / 28 DAYS

PA

S Specialty Drug

DUPIXENT 300 MG/2 ML SYRINGE dupilumab NP

QL 4 ML / 28 DAYS

PA

S Specialty Drug

ELIDEL pimecrolimus NP PA

EPIDUO FORTE adapalene/benzoyl peroxide NP PA

FABIOR tazarotene NP

QL 50 GM / 30 DAYS

PA

ILUMYA tildrakizumab-asmn NP

PA

MED

imiquimod 5% cream packet C

isotretinoin 10 mg capsule C




MYORISAN isotretinoin C

pimecrolimus NP PA

podofilox C



PROTOPIC tacrolimus P

QUTENZA capsaicin/skin cleanser NP PA

SARNA ORIGINAL menthol/camphor C OTC

SILIQ brodalumab NP

QL 3 ML / 28 DAYS

PA

S Specialty Drug

SKYRIZI risankizumab-rzaa NP

PA

S Specialty Drug

SKYRIZI (2 SYRINGES) KIT risankizumab-rzaa NP

PA

S Specialty Drug

SKYRIZI PEN risankizumab-rzaa NP

PA

S Specialty Drug

STELARA 130 MG/26 ML VIAL ustekinumab NP

QL 4 VIALS / 54 DAYS

PA

S Specialty Drug

STELARA 45 MG/0.5 ML SYRINGE ustekinumab NP


PA

S Specialty Drug

STELARA 45 MG/0.5 ML VIAL ustekinumab NP

PA

S Specialty Drug

STELARA 90 MG/ML SYRINGE ustekinumab NP


PA

S Specialty Drug

tacrolimus 0.03% ointment NP PA

tacrolimus 0.1% ointment NP PA

TALTZ AUTOINJECTOR ixekizumab NP


PA

S Specialty Drug



TALTZ AUTOINJECTOR (2 PACK) ixekizumab NP


PA

S Specialty Drug

TALTZ AUTOINJECTOR (3 PACK) ixekizumab NP


PA

S Specialty Drug

TALTZ SYRINGE ixekizumab NP


PA

S Specialty Drug

tazarotene 0.1% cream NP PA

TAZORAC tazarotene P

TREMFYA 100 MG/ML INJECTOR guselkumab NP

QL 1 ML / 28 DAYS

PA

S Specialty Drug

TREMFYA 100 MG/ML SYRINGE guselkumab NP


PA

S Specialty Drug

ZENATANE isotretinoin C


SMOOTH MUSCLE RELAXANTS

RESPIRATORY SMOOTH MUSCLE RELAXANTS

theophylline anhydrous C

theophylline er 400 mg tablet C

theophylline er 600 mg tablet C

SOMATOSTATIN AGONISTS AND ANTAGONISTS

SOMATOSTATIN AGONISTS

BYNFEZIA octreotide acetate C

PA

S Specialty Drug

octreotide 1,000 mcg/5 ml vial C QL 7.5 ML / 1 DAY

S Specialty Drug


octreotide 1,000 mcg/ml vial C QL 45 ML / 30 DAYS

S Specialty Drug

octreotide 5,000 mcg/5 ml vial C QL 45 ML / 30 DAYS

S Specialty Drug

octreotide acet 0.05 mg/ml vl C QL 3 ML / 1 DAY

S Specialty Drug

octreotide acet 100 mcg/ml amp C QL 5 ML / 1 DAY

S Specialty Drug

octreotide acet 100 mcg/ml syr C S Specialty Drug

octreotide acet 100 mcg/ml vl C QL 5 ML / 1 DAY

S Specialty Drug

octreotide acet 200 mcg/ml vl C QL 7.5 ML / 1 DAY

S Specialty Drug


S Specialty Drug


octreotide acet 50 mcg/ml vial C QL 3 ML / 1 DAY

S Specialty Drug


S Specialty Drug


octreotide acet 500 mcg/ml vl C QL 7 ML / 1 DAY

S Specialty Drug

SANDOSTATIN LAR DEPOT 10 MG KT octreotide acetate, microspheres C

QL 1 KIT / 28 DAYS

S Specialty Drug

SANDOSTATIN LAR DEPOT 10 MG VL octreotide acetate, microspheres C

QL 1 KIT / 28 DAYS

S Specialty Drug


QL 2 KITS / 28 DAYS

S Specialty Drug




QL 2 KITS / 28 DAYS

S Specialty Drug


QL 3 KITS / 28 DAYS

S Specialty Drug


QL 3 KITS / 28 DAYS

S Specialty Drug

SIGNIFOR pasireotide diaspartate C

PA

S Specialty Drug


SYMPATHOMIMETIC (ADRENERGIC) AGENTS

ALPHA- AND BETA-ADRENERGIC AGONISTS

ADULT NASAL DECONGESTANT C OTC

EPINEPHRINE 0.15 MG AUTO-INJCT (Generic for Adrenaclick) NP PA

EPINEPHRINE 0.15 MG AUTO-INJCT (Generic for Epi-Pen Jr / Mylan) P

EPINEPHRINE 0.15 MG AUTO-INJCT (TEVA) NP PA

EPINEPHRINE 0.3 MG AUTO-INJECT (Generic for Adrenaclick) NP PA

EPINEPHRINE 0.3 MG AUTO-INJECT (Generic for Epi-Pen / Mylan) P

EPINEPHRINE 0.3 MG AUTO-INJECT (TEVA) NP PA

EPIPEN epinephrine NP PA

EPIPEN 2-PAK epinephrine NP PA

EPIPEN JR epinephrine NP PA

EPIPEN JR 2-PAK epinephrine NP PA

NASAL DECONGESTANT 30 MG TAB C OTC

pseudoephedrine hcl C OTC

QC NASAL DECONGEST 30 MG TAB C OTC


SINUS 12 HOUR pseudoephedrine hcl C OTC

SUDAFED 12 HOUR pseudoephedrine hcl C OTC

SUDOGEST 12 HOUR 120 MG CAPLET pseudoephedrine hcl C OTC

SUDOGEST 30 MG TABLET C OTC

SUDOGEST 60 MG TABLET C OTC

SYMJEPI epinephrine P

ALPHA-ADRENERGIC AGONISTS

midodrine hcl C

TETRACYCLINE ANTIBIOTICS

AMINOMETHYLCYCLINES

NUZYRA 150 MG TABLET omadacycline tosylate C PA

NUZYRA 150 MG TABLET-7 DAY omadacycline tosylate C PA

NUZYRA 150 MG-7 DAY WITH LOAD omadacycline tosylate C PA


THYROID AND ANTITHYROID AGENTS

ANTITHYROID AGENTS

methimazole C

propylthiouracil C

THYROID AGENTS

euthyrox C

levothyroxine 100 mcg tablet C













liothyronine sod 25 mcg tab C




URINE AND FECES CONTENTS

KETONES

ketostix reagent urine acetone test,strips C OTC

trueplus ketone test strip urine acetone test,strips C OTC

SUGAR

diastix reagent urine glucose test strip C OTC

Uncategorized

Unclassified



BP GEL benzoyl peroxide P OTC

VASODILATING AGENTS

NITRATES AND NITRITES

isosorbide dinitrate 10 mg tab C




isosorbide mononitrate C

isosorbide mononitrate er C

MINITRAN nitroglycerin C


NITRO-BID nitroglycerin C

nitroglycerin 0.3 mg tablet sl C



nitroglycerin patch C

PHOSPHODIESTERASE TYPE 5 INHIBITORS

ADCIRCA tadalafil NP

QL 2 TABS / 1 DAY

PA

S Specialty Drug

ALYQ tadalafil C

QL 2 TABS / 1 DAY

PA

S Specialty Drug

REVATIO 10 MG/ML ORAL SUSP sildenafil citrate P

PA

S Specialty Drug

REVATIO 20 MG TABLET sildenafil citrate NP

PA

S Specialty Drug

sildenafil 10 mg/ml oral susp NP PA

SILDENAFIL 20 MG TABLET (GENERIC FOR REVATIO) P PA

TADALAFIL 20 MG TABLET (GENERIC FOR ADCIRCA) NP QL 2 TABS / 1 DAY

PA

VASODILATING AGENTS, MISCELLANEOUS

aspirin-dipyridamole er NP PA

dipyridamole P

VERQUVO vericiguat C PA


VITAMINS

MULTIVITAMIN PREPARATIONS

ADULTS 50 PLUS MULTIVITAMIN C OTC

AQUADEKS CHEWABLE TABLET multivitamin, minerals no.51/folic acid/vit k1/ubidecarenone C OTC


AQUADEKS PEDIATRIC LIQUID pediatric multivitamin no.40/phytonadione (vit k1) C OTC

AZESCO prenatal vitamins no.147/ferrous gluconate/folic acid C

CADEAU DHA prenatal vitamins no.83/iron fumarate/folate combo no.6/dha C OTC

CENTRUM C OTC

CENTRUM COMPLETE C OTC

CENTRUM SILVER C OTC

CEROVITE JR pediatric multivitamin no.158/ferrous fumarate/phytonadione C OTC

CERTA PLUS C OTC

CERTAVITE SENIOR multivitamin with minerals/folic acid/lycopene/lutein C OTC

CERTAVITE-ANTIOXIDANT multivitamin/ferrous fumarate/folic acid C OTC

CHILD'S CHEWABLE VITAMIN TAB pediatric multivitamin no.144 C OTC

CHILDREN'S CHEW MULTIVITAMIN C OTC

CHILDRENS CHEW VITAMIN TAB C OTC

CITRANATAL B-CALM prenatal vitamin no.48/iron,carbonyl,gluconate/folic acid/b6 C

COMPLETE MV ADULT 50 PLUS C OTC

COMPLETE NATAL DHA C

COMPLETE SENIOR C OTC

COMPLETENATE C OTC

CONCEPT DHA mv-min 75/ferrous fum/iron ps cplx/folic ac/omega-3/dha/epa C

CONCEPT OB mv-mins no.74/ferrous fumarate/iron ps cplx/folic acid C

CVS HAIR, SKIN AND NAILS CPLT C OTC

DAILY VITAMIN + IRON multivitamin with iron C OTC



DAILY VITAMIN FORMULA-MINERALS C OTC

DAILY VITE WITH IRON multivitamin with iron C OTC

DAILY-VITE multivitamin with folic acid C OTC

DUET DHA 400 prenatal vits 106/sod feredetate-iron ps/folic acid/omega-3s C

DUET DHA BALANCED prenatal vits no.117/sod feredet.-iron ps/folic/om3/dha/epa C

ELITE-OB C

ENBRACE HR multivit no.41/iron cysteine glycinat/folate no.8/phosph-dha C

EQL ONE DAILY MEN'S TABLET C OTC

EYE HEALTH PLUS LUTEIN C OTC

FLORIVA 0.25 MG CHEW TABLET pediatric multivitamin no.85 with sodium fluoride C

FLORIVA 0.5 MG CHEWABLE TABLET pediatric multivitamin no.85 with sodium fluoride C

FLORIVA 1 MG CHEWABLE TABLET pediatric multivitamin no.85 with sodium fluoride C

gnp prenatal vitamins tablet C OTC

HAIR VITAMIN C OTC

HIGH POTENCY MULTIVITAMIN C

HM HAIR, SKIN AND NAILS CAPLET C OTC

KENWOOD THERAPEUTIC multivitamin,therapeutic C OTC

M-NATAL PLUS C

MEGA MULTI W-CHELATED MINERALS C OTC

MULTI-VITAMIN DAILY C OTC

multi-vitamin w-fluoride-iron C OTC

MULTILEX multivitamin with minerals/ferrous sulfate C OTC

multiple vitamin C OTC



multivit-fluor 0.25 mg/ml drop C OTC

multivit-fluor 0.5 mg tab chew C OTC

multivit-fluor 0.5 mg/ml drop C OTC

multivitamin C OTC

multivitamin-iron-fluoride C OTC

multivitamins with iron C OTC

multivitamins with minerals C OTC

MVC-FLUORIDE pediatric multivitamin no.12 with sodium fluoride C

MY FAVORITE MULTIPLE C OTC

MYNATAL PLUS C

MYNATAL-Z C

NATACHEW prenatal vitamin no.55/iron fumarate,bisglycinate/folic acid C

NEEVODHA multivit no.37/iron/l-mefolate calc./algal oil/soy lecithin C

NESTABS prenatal vitamin no.86/iron bis-glycinate/folic acid C

NESTABS ABC prenatal vitamin comb no.86/iron ps cmplx/folic acid/dha/epa C

NESTABS DHA prenatal vits with calcium no.87/iron bisgly/folic acid/dha C

NESTABS ONE multivit 42/iron carbonyl,b-g che/methyltetrahydrofolate/dha C

NEWGEN C

NIVA-PLUS C

O-CAL FA multivitamin with minerals no.61/ferrous fumarate/folic acid C

O-CAL PRENATAL prenatal vit with calcium no.127/ferrous fumarate/folic acid C

OB COMPLETE multivitamin with minerals no.69/iron,carbonyl/folic acid C

OB COMPLETE ONE prenatal vit no.85/iron carb,asp.gly/folic acid/dha/fish oil C



OB COMPLETE PETITE prenatal no56/iron carbonyl,asparto glycinate/folic acid/dha C

OB COMPLETE PREMIER prenatal vits no.83/iron,carbonyl,iron aspart.gly/folic acid C

OB COMPLETE WITH DHA prenatal vit no.30/iron carbonyl,asp glyc/folic acid/omega-3 C

ONCOVITE C OTC

ONE DAILY COMPLETE multivitamin with minerals C OTC

ONE DAILY ENERGY C OTC

ONE DAILY FOR WOMEN C OTC

ONE DAILY MULTIVITAMIN-MINERAL multivitamin with minerals/ferrous sulfate C OTC

ONE DAILY PLUS MINERALS multivitamin with minerals C OTC

ONE DAILY WITH IRON C OTC

ONE-A-DAY MAXIMUM FORMULA C OTC

ONE-DAILY MULTI-VITAMIN C OTC

OPTI-VITAMIN C OTC

pediatric poly-vitamin C OTC

pediatric tri-vitamin C OTC

PEDIATRIC TRI-VITE C OTC

PNV 29-1 C

pnv prenatal plus multivit tab C

PNV-DHA C

POLY-VI-FLOR 0.25 MG DROPS pediatric multivitamin no.37 with sodium fluoride C OTC

POLY-VI-FLOR 0.25 MG TAB CHEW pediatric multivitamin no.33 with sodium fluoride C OTC

POLY-VI-FLOR 0.5 MG TAB CHEW pediatric multivitamin no.33 with sodium fluoride C OTC

POLY-VI-FLOR 1 MG TAB CHEW pediatric multivitamin no.33 with sodium fluoride C OTC



POLY-VI-FLOR WITH IRON 0.25 MG pediatric multivit no.37/sodium fluoride/iron bisglycin.hcl C OTC

POLY-VI-FLOR WITH IRON 0.5 MG pediatric multivitamin no.33/sodium fluoride/iron carbonyl C OTC

POLY-VITA C OTC

PRENA1 TRUE C

PRENATA prenatal vitamins no.37/ferrous fumarate/folic acid C

PRENATABS FA prenatal vits with calcium no.78/ferrous fumarate/folic acid C

PRENATABS RX prenatal vitamin with calcium no.76/iron,carbonyl/folic acid C

prenatal C OTC

prenatal 19 C OTC

prenatal low iron C

prenatal plus iron tablet C

prenatal plus-dha C

prenatal tablet C OTC

prenatal vitamin C OTC

prenatal vitamin plus low iron C

prenatal vitamins tablet C OTC

prenatal-u C PA

PRENATE AM multivit no.38/methyltetrahydfolate glucos,folic acid/ginger C

PRENATE CHEWABLE multivitamin no.36/methyltetrahydrofolate gluc,folic acid C

PRENATE DHA multivitamin no.45/iron fumarate/folate comb no.6/dha C

PRENATE ELITE prenatal vitamins no.36/ferrous fumarate/folate comb. no.6 C

PRENATE ENHANCE prenatal vitamins no.68/iron fumarate/folate no.6/dha C

PRENATE ESSENTIAL multivitamin no.40/iron asparto glycinate/folate no.1/dha C



PRENATE MINI prenatal vits no.87/iron carb-asp.glycinate/folate no.1/dha C

PRENATE PIXIE prenatal vitamins no.85/iron asparto glycin/folate no.1/dha C

PRENATE RESTORE prenatal vitamins no.69/iron fumarate/folate comb no.6/dha C

PRENATE STAR prenatal vitamins no.77/ferrous asparto glycinate/folic acid C

PREPLUS C

PRETAB C

PRIMACARE prenatal vits no.118/iron asparto glycinate/folate no.6/dha C

PROVIDA DHA prenatal vitamins no.90/iron fum,polysac comp/folic acid/dha C

PROVIDA OB prenatal vits no.65/iron fumarate,polysac complex/folic acid C

PUREFE OB PLUS multivit-mins no.73/iron fumarate,polysacc comp/folic acid C

PUREFE PLUS multivitamin-minerals no.62/ferrous fumarate/folic acid C

QUFLORA PED 0.25 MG/ML DROP pediatric multivitamin no.83 with sodium fluoride C

QUFLORA PED 0.5 MG/ML DROP pediatric multivitamin no.84 with sodium fluoride C

SE-NATAL 19 C

SELECT-OB + DHA prenatal vitamins no.33/iron polysach complex/folic acid/dha C

SM HAIR, SKIN AND NAILS CAPLET C OTC

sm prenatal vitamins tablet C OTC

SPECTRAVITE ADULT C

SPECTRAVITE WOMEN C OTC

STRESS FORMULA TABLET multivitamin,stress formula C OTC

STRESS FORMULA WITH ZINC multivitamin,stress formula/zinc C OTC

SUPER MULTIPLE C OTC



TAB-A-VITE C OTC

TAB-A-VITE MULTIVIT WITH IRON multivitamin/ferrous fumarate/folic acid C OTC

TAB-A-VITE MULTIVIT WITH IRON (generic) C OTC

TARON-C DHA C

THERA-TABS C OTC

TRI-VI-FLOR pediatric multivitamin a,c,and d3 no.38 with sodium fluoride C OTC

tri-vitamin with fluoride C

TRICARE prenatal vits with calcium 103/ferrous fumarate/folic acid C

TRINATAL RX 1 C

TRINATE prenatal vits with calcium no.73/ferrous fumarate/folic acid C

TRISTART DHA prenatal vitamins no.93/iron carbonyl/folate comb no.9/dha C

TRUST NATAL DHA C

UNICOMPLEX-M multivitamin with iron and other minerals C OTC

V-C FORTE C OTC

VINATE CARE multivitamin combination no.43/ferrous fumarate/folic acid C OTC

VINATE ONE C OTC

VINATE-M C OTC

VIRT-C DHA C

VIRT-PN DHA C

VISION C OTC

VISION PLUS LUTEIN C OTC

VITAFOL GUMMIES prenatal vit no.112/iron phosph/folic acid/omega-3s/dha/epa C

VITAFOL ULTRA prenatal vit no.67/iron polysaccharides/folate comb.no.1/dha C

VITAFOL-OB prenatal vits with calcium no.10/ferrous fumarate/folic acid C



VITAFOL-ONE prenatal vits no.26/iron polysaccharide cplex/folic acid/dha C

VITAMEDMD ONE RX prenatal vits no.25/ferrous fumarate/folate comb. no.6/dha C

VITAMEDMD REDICHEW RX prenatal vitamins combination no.42/folic acid C

vitamin and minerals C OTC

vitamins a,c,d and fluoride C OTC

VITAPEARL prenatal vit no.71/iron fum-sodium feredetate/folic acid/dha C

VITATRUE prenatal vits no.105/iron amino acid chelate/folic acid/dha C

WOMEN'S DAILY FORMULA C OTC

ZALVIT C

ZATEAN-PN DHA C

ZINGIBER C

VITAMIN A

beta carotene C OTC

vitamin a C OTC

VITAMIN B COMPLEX

b complex C OTC

b complex number 1 C OTC

b-1 C OTC

b-12 500 mcg tablet C OTC

b-complex plus vitamin c C OTC

b-complex with c C OTC

b-complex with vitamin c C OTC

BALANCE B-100 C OTC

BALANCE B-50 C OTC

BALANCED B-50 C OTC



cvs folic acid 800 mcg tablet C OTC

cvs vit b-12 tr 1,000 mcg tab C OTC

cyanocobalamin injection C

eql vit b-12 er 1,000 mcg tab C OTC

eql vitamin b-12 500 mcg tab C OTC

fn vitamin b-12 1,000 mcg tab C OTC

FOLBEE C OTC

FOLBEE PLUS C OTC

folic acid 0.4 mg tablet C OTC

folic acid 0.8 mg tablet C OTC

folic acid 1 mg tablet C OTC

folic acid 1,000 mcg tablet C OTC

folic acid 400 mcg tablet C OTC

folic acid 800 mcg tablet C OTC

FOLTABS 800 C OTC

gnp folic acid 400 mcg tablet C OTC

gnp vit b-12 er 1,000 mcg tab C OTC

hm folic acid 400 mcg tablet C OTC

hm vit b-12 tr 1,000 mcg tab C OTC

hm vitamin b-12 500 mcg tablet C OTC

l-methylfolate 7.5 mg tablet C OTC

NEPHRONEX-SL vitamin b complex with vitamin c no.19/folic acid/vitamin d3 C

PA

OTC

ra folic acid 0.4 mg tablet C OTC

ra folic acid 800 mcg tablet C OTC

ra vit b12 1,000 mcg tab sa C OTC



ra vitamin b12 tr 1,000 mcg tb C OTC

riboflavin C OTC

sm folic acid 0.4 mg tablet C OTC

sm folic acid 400 mcg tablet C OTC

SM STRESS FORMULA+ZINC TABLET C OTC

sm vitamin b-12 500 mcg tablet C OTC

sm vitamin b12 1,000 mcg tab C OTC

SUPER B-50 COMPLEX PLUS C OTC

SUPER QUINTS C OTC

sv folic acid 800 mcg tablet C OTC

sv vitamin b12 tr 1,000 mcg tb C OTC

thiamine hcl C

ULTRA B-100 COMPLEX C OTC

vitamin b complex C OTC

vitamin b complex-vitamin c C OTC

vitamin b-1 C OTC

vitamin b-12 1,000 mcg tablet C OTC

vitamin b-12 100 mcg tablet C OTC



vitamin b-12 tr 1,000 mcg tab C OTC

vitamin b-2 C OTC

vitamin b-6 C OTC

vitamin b-complex with vit c C OTC

vitamin b12 1,000 mcg tab sa C OTC

vitamin b12 500 mcg tablet C OTC



WESTAB MAX C OTC

WESTAB MINI C

WESTAB ONE C OTC

VITAMIN C

cvs vitamin c 500 mg caplet C OTC

eql vitamin c 1,000 mg tablet C OTC

gnp vitamin c 1,000 mg tablet C OTC

gnp vitamin c 250 mg tablet C OTC

gnp vitamin c 500 mg tab chew C OTC

gnp vitamin c 500 mg tablet C OTC

gnp vitamin c er 500 mg tablet C OTC

hm vitamin c 500 mg tab chew C OTC

ra vit c-rose hips 500 mg tab C OTC

ra vitamin c 1,000 mg tablet C OTC

ra vitamin c 250 mg tablet C OTC

ra vitamin c 500 mg chew tab C OTC

ra vitamin c 500 mg tab chew C OTC

ra vitamin c 500 mg tablet C OTC

ra vitamin c tr 500 mg caplet C OTC

sm vitamin c 1,000 mg tablet C OTC

sm vitamin c 250 mg tablet C OTC

sm vitamin c 500 mg caplet C OTC

sm vitamin c 500 mg tab chew C OTC

sm vitamin c 500 mg tablet C OTC

sm vitamin c tr 500 mg tablet C OTC

sv vitamin c 500 mg tab chew C OTC



v-r vitamin c 1,000 mg tablet C OTC

v-r vitamin c 250 mg tab chew C OTC

v-r vitamin c 500 mg tab chew C OTC

v-r vitamin c 500 mg tablet C OTC

vitamin c 1,000 mg caplet C OTC

vitamin c 1,000 mg tablet C OTC

vitamin c 250 mg tablet C OTC

vitamin c 250 mg tablet chew C OTC

vitamin c 500 mg capsule sa C OTC

vitamin c 500 mg tablet C OTC

vitamin c 500 mg tablet chew C OTC

vitamin c er 500 mg capsule C OTC

vitamin c tr 500 mg caplet C OTC

vitamin c tr 500 mg tablet C OTC

vitamin c-500 mg tablet C OTC

VITAMIN D

CALCIDOL C OTC

calcitriol 0.25 mcg capsule C

calcitriol 0.5 mcg capsule C

calcitriol 1 mcg/ml solution C

cvs vitamin d3 125 mcg softgel C OTC

cvs vitamin d3 25 mcg softgel C OTC

cvs vitamin d3 5,000 unit sfgl C OTC

D-VI-SOL C OTC

eql vitamin d3 5,000 unit sfgl C OTC

ergocalciferol C OTC

gnp vitamin d3 1,000 unit tab C OTC



gnp vitamin d3 2,000 unit tab C OTC

gnp vitamin d3 25 mcg tablet C OTC

hm vitamin d3 2,000 unit sftgl C OTC

PEDIATRIC D-VITE C OTC

pediatric vitamin d3 C OTC

ra vitamin d3 1,000 unit tab C OTC

ra vitamin d3 2,000 unit sfgl C OTC

ra vitamin d3 2,000 unit sftgl C OTC

ra vitamin d3 5,000 unit sftgl C OTC

sm vitamin d3 2,000 unit sftgl C OTC

sm vitamin d3 25 mcg tablet C OTC

sv vitamin d3 1,000 unit sftgl C OTC



vitamin d-400 C OTC

vitamin d2 1.25mg(50,000 unit) C

vitamin d2 400 unit tablet C OTC

vitamin d3 1,000 unit softgel C OTC

vitamin d3 1,000 unit tablet C OTC

vitamin d3 125 mcg (5000 unit) C OTC

vitamin d3 125 mcg capsule C OTC

vitamin d3 125 mcg softgel C OTC


vitamin d3 2,000 unit tablet C OTC

vitamin d3 25 mcg (1,000 unit) C OTC

vitamin d3 25 mcg softgel C OTC



vitamin d3 25 mcg tablet C OTC

vitamin d3 400 unit tablet C OTC

vitamin d3 5,000 unit capsule C OTC


vitamin d3 50 mcg tablet C OTC

VITAMIN E

cvs vitamin e 180 mg softgel C OTC



eql vitamin e 1,000 unit sftgl C OTC

eql vitamin e 180 mg softgel C OTC

gnp vitamin e 180 mg softgel C OTC

gnp vitamin e 400 unit softgel C OTC

hm vitamin e 180 mg softgel C OTC

hm vitamin e 400 unit softgel C OTC

ra vitamin e 268 mg softgel C OTC

sm vitamin e 1,000 unit sftgel C OTC

sm vitamin e 200 unit softgel C OTC

sm vitamin e 400 unit capsule C OTC

sm vitamin e 400 unit softgel C OTC

sv vitamin e 180 mg softgel C OTC

sv vitamin e 400 unit softgel C OTC



vitamin e 1,000 unit capsule C OTC

vitamin e 1,000 unit softgel C OTC



vitamin e 15 unit/0.3 ml drop C OTC

vitamin e 180 mg softgel C OTC

vitamin e 180mg(400 unit) sfgl C OTC


vitamin e 400 unit capsule C OTC

vitamin e 400 unit softgel C OTC




VITAMIN K ACTIVITY

MEPHYTON phytonadione (vit k1) C

QL 3 TABS / FILL

PA

phytonadione 5 mg tablet C QL 3 TABS / FILL



Index of covered drugs 2 2-IN-1 LANCET DEVICE 160

24 HOUR ALLERGY 42

24 HOUR NASAL ALLERGY 42

5 5-HYDROXYTRYPTOPHAN (5-HTP) 239

8 8 HOUR PAIN RELIEF 9

8HR ARTHRITIS PAIN 9

A ABACAVIR SULFATE 123

ABACAVIR SULFATE/DOLUTEGRAVIR

SODIUM/LAMIVUDINE 124

ABACAVIR SULFATE/LAMIVUDINE 123

ABACAVIR SULFATE/LAMIVUDINE/ZIDOVUDINE 123

ABALOPARATIDE 246

ABATACEPT 231,232

ABATACEPT/MALTOSE 231

ABEMACICLIB 114

ABILIFY 118

ABILIFY MAINTENA 118

ABILIFY MYCITE 118

ABIRATERONE ACETATE 99

ACAM2000 (NATIONAL STOCKPILE) 128

ACAMPROSATE CALCIUM 153

ACANYA 38

ACARBOSE 71

ACCOLATE 44

ACCU-CHEK 160

ACCU-CHEK AVIVA PLUS 160,168

ACCU-CHEK COMPACT PLUS CONTROL 160

ACCU-CHEK COMPACT PLUS STRIPS 168

ACCU-CHEK FASTCLIX LANCING DEV 160

ACCU-CHEK GUIDE CONTROL SOLN 160

ACCU-CHEK GUIDE ME GLUCOSE MTR 160

ACCU-CHEK GUIDE MONITOR SYSTEM 160

ACCU-CHEK GUIDE TEST STRIP 168

ACCU-CHEK SMARTVIEW 160,168

ACCU-CHEK SOFTCLIX 160

ACCUPRIL 248

ACCURETIC 248

ACEBUTOLOL HCL 150

ACETAMINOPHEN 9,10,11,12

ACETAMINOPHEN WITH CODEINE PHOSPHATE 13

ACETAZOLAMIDE 83

ACETIC ACID 38

ACETYLCYSTEINE 253

ACID CONTROL 133

ACID CONTROLLER 133

ACID REDUCER 133,134,135

ACID-PEP 134

ACIPHEX 135

ACIPHEX SPRINKLE 135

ACITRETIN 258

ACLIDINIUM BROMIDE 54

ACLIDINIUM BROMIDE/FORMOTEROL

FUMARATE 53

ACNE MEDICATION 257

ACTEMRA 228

ACTEMRA ACTPEN 228

ACTHAR 167

ACTHIB 128

ACTIVATED CHARCOAL 191

ACTIVATED CHARCOAL/SORBITOL SOLUTION 191

ACTONEL 226

ACTOPLUS MET 75

ACTOPLUS MET XR 75

ACULAR 43

ACULAR LS 43

ACUVAIL 43

ACYCLOVIR 40,41,138,139

ACYCLOVIR/HYDROCORTISONE 40

ADACEL TDAP 128

ADAKVEO 145

ADALAT CC 149

ADALIMUMAB 203,230,231

ADAPALENE 259,260

ADAPALENE/BENZOYL PEROXIDE 259,260


ADCIRCA 267

ADDERALL XR 26

ADEFOVIR DIPIVOXIL 139

ADEMPAS 253

ADENOVIRUS LIVE TYPE-4 AND ADENOVIRUS

LIVE TYPE-7 VACCINE 128

ADENOVIRUS VACCINE LIVE TYPE-4 128

ADENOVIRUS VACCINE LIVE TYPE-7 128

ADHANSIA XR 29

ADLYXIN 72

ADMELOG 221

ADMELOG SOLOSTAR 221

ADVAIR DISKUS 158

ADVAIR HFA 158

ADVATE 84

ADVOCATE SYRINGES 160

ADYNOVATE 84

ADZENYS ER 26

ADZENYS XR-ODT 26,27

AFATINIB DIMALEATE 104

AFINITOR 99

AFINITOR DISPERZ 99,100

AFIRMELLE 209

AFLURIA QUAD 2019-20 (3YR UP) 128

AFLURIA QUAD 2019-20 (6-35MO) 128

AFLURIA QUAD 2019-2020 128



AFLURIA QUAD 2020-21 (6-35MO) 129



AFLURIA QUAD 2021-22 (6-35MO) 129

AFREZZA 221

AFSTYLA 84

AFTER PILL 209

AGAMATRIX PRESTO 168

AIMOVIG AUTOINJECTOR 94

AIRDUO RESPICLICK 158

AJOVY AUTOINJECTOR 95

AJOVY SYRINGE 95

AK-POLY-BAC 36

AKLIEF 259

AKYNZEO 76

ALA-CORT 45

ALBENDAZOLE 35

ALBUTEROL SULFATE 144,145

ALCAFTADINE 182

ALCLOMETASONE DIPROPIONATE 45

ALCOHOL ANTISEPTIC PADS 41

ALCOHOL PADS 41

ALECENSA 100

ALECTINIB HCL 100

ALEMTUZUMAB 234

ALENDRONATE SODIUM 226

ALENDRONATE SODIUM/CHOLECALCIFEROL

(VITAMIN D3) 226

ALFERON N 138

ALFUZOSIN HCL 9

ALIROCUMAB 94

ALISKIREN HEMIFUMARATE 250

ALISKIREN

HEMIFUMARATE/HYDROCHLOROTHIAZIDE 250

ALL DAY ALLERGY 87

ALL DAY ALLERGY-D 87

ALL DAY PAIN RELIEF 240

ALLER-CORT 42

ALLER-TEC D 87

ALLERGENIC EXTRACT,GRASS POLLEN-

TIMOTHY,STANDARD 125

ALLERGENIC EXTRACT-WEED POLLEN-SHORT

RAGWEED 126

ALLERGY 87

ALLERGY COMPLETE-D 87

ALLERGY EYE 186

ALLERGY RELIEF 42,43,87,88,89

ALLERGY RELIEF D-12 87

ALLERGY RELIEF NASAL DECONGEST 87

ALLERGY RELIEF-D 87

ALLERGY-CONGESTION 12HR 89

ALLERGY-CONGESTION RELIEF 12HR 87,89

ALLOPURINOL 226

ALMOTRIPTAN MALATE 95


ALOCRIL 45

ALOGLIPTIN BENZOATE 71,72

ALOGLIPTIN BENZOATE/METFORMIN HCL 71,72

ALOGLIPTIN BENZOATE/PIOGLITAZONE HCL 71,72

ALOMIDE 182

ALOSETRON HCL 192

ALPHAGAN P 82

ALPHANATE 84

ALPHANINE SD 84

ALPRAZOLAM 141

ALPROLIX 85

ALREX 42

ALTACE 248

ALTAVERA 209

ALTOPREV 93

ALUMINUM CHLORIDE 256

ALUMINUM HYDROXIDE 190

ALVESCO 158

ALYACEN 209

ALYQ 267

AMANTADINE HCL 116

AMARYL 74

AMBIEN 139

AMBIEN CR 139

AMBRISENTAN 253

AMERGE 95

AMETHIA 209

AMETHIA LO 209

AMIFAMPRIDINE 239

AMILORIDE HCL 172

AMILORIDE HCL/HYDROCHLOROTHIAZIDE 172

AMINO ACIDS 175

AMINOCAPROIC ACID 85

AMIODARONE HCL 49

AMITRIPTYLINE HCL 70

AMLODIPINE BESYLATE 149

AMLODIPINE BESYLATE/ATORVASTATIN

CALCIUM 93

AMLODIPINE BESYLATE/BENAZEPRIL HCL 149

AMLODIPINE BESYLATE/OLMESARTAN

MEDOXOMIL 149

AMLODIPINE BESYLATE/VALSARTAN 149

AMLODIPINE

BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE

149

AMMONIUM LACTATE 180

AMNESTEEM 259

AMOXICILLIN 246

AMOXICILLIN/POTASSIUM CLAVULANATE 246

AMPHETAMINE 26,27,28

AMPHETAMINE SULFATE 27,28

AMPICILLIN TRIHYDRATE 246

AMPYRA 238

ANAGRELIDE HCL 125

ANAKINRA 231

ANASTROZOLE 100

ANCOBON 77

ANDRODERM 208

ANDROGEL 208

ANNOVERA 209

ANORO ELLIPTA 52

ANTACID-ANTIGAS 191

ANTARA 92

ANTHRAX VACCINE 129

ANTI-DIARRHEAL 193,194

ANTI-INHIBITOR COAGULANT COMPLEX 85

ANTIHEMOPHILIC FACTOR (FACTOR VIII)

RECOMB,B-DOMAIN DELETED 87

ANTIHEMOPHILIC FACTOR (FVIII) REC, B-DOM

TRUNCATED PEG-EXEI 85

ANTIHEMOPHILIC FACTOR (FVIII) REC, B-DOMAIN

DELETED PEG-AUCL 85

ANTIHEMOPHILIC FACTOR (FVIII) RECOMBINANT,

FC FUSION PROTEIN 85

ANTIHEMOPHILIC FACTOR (FVIII) RECOMBINANT,

FULL LENGTH, PEG 84

ANTIHEMOPHILIC FACTOR (FVIII)

RECOMBINANT,FULL LENGTH 84,85,86

ANTIHEMOPHILIC FACTOR VIII REC HEK CELL, B-

DOMAIN DELETED 86

ANTIHEMOPHILIC FACTOR VIII RECOMB,SINGLE-

CHN,B-DOM TRUNCATED 84


ANTIHEMOPHILIC FACTOR VIII RECOMBINANT, B-

DOMAIN TRUNCATED 86

ANTIHEMOPHILIC FACTOR VIII, HUMAN

RECOMBINANT 86

ANTIHEMOPHILIC FACTOR VIII, RECOMBINANT

PORCINE SEQUENCE 86

ANTIHEMOPHILIC FACTOR, HUMAN 85,86

ANTIHEMOPHILIC FACTOR, HUMAN/VON

WILLEBRAND FACTOR,HUMAN 84,85,87

ANTITHROMBIN III (HUMAN PLASMA DERIVED) 54

APALUTAMIDE 103

APIDRA 221

APIDRA SOLOSTAR 221

APIXABAN 55,56

APLENZIN 67

APOMORPHINE HCL 172

APRACLONIDINE HCL 183,184

APREMILAST 232

APREPITANT 76

APRI 210

APRISO 192

APTENSIO XR 30

APTIOM 58

APTIVUS 124

AQUA GLYCOLIC 247

AQUADEKS 267,268

ARANELLE 210

ARANESP 146

ARCALYST 238

ARCAPTA NEOHALER 144

ARFORMOTEROL TARTRATE 145

ARGININE 174

ARGININE/GLUTAMINE/CALCIUM BETA-HYDROXY-

BETA-METHYLBUTYRATE 174

ARICEPT 143

ARIPIPRAZOLE 118

ARIPIPRAZOLE LAUROXIL 118

ARIPIPRAZOLE LAUROXIL, SUBMICRONIZED 118

ARISTADA 118

ARISTADA INITIO 118

ARIXTRA 54

ARMODAFINIL 35

ARNUITY ELLIPTA 158

ARTHRITIS PAIN 10,11,242,245

ARTHRITIS PAIN RELIEF 10,11,12

ARTHRITIS PAIN RELIEVER 240

ARTHROTEC 50 240

ARTHROTEC 75 240

ASACOL HD 192

ASCORBATE CALCIUM 279

ASCORBIC ACID 278,279

ASCORBIC ACID/ASCORBATE SODIUM 278

ASCORBIC ACID/VIT E ACETATE/LUTEIN/COPPER

OXIDE/ZINC OXIDE 239

ASENAPINE 120

ASENAPINE MALEATE 118,120

ASFOTASE ALFA 181

ASHLYNA 210

ASMANEX 158

ASMANEX HFA 158

ASPIRIN 245

ASPIRIN/ACETAMINOPHEN/CAFFEINE 245

ASPIRIN/CALCIUM CARBONATE/MAGNESIUM 245

ASPIRIN/DIPYRIDAMOLE 267

ASSURE LANCE 160

ASSURE PLATINUM TEST STRIP 168

ASTAGRAF XL 236

ASTRAZENECA COVID19 VAC(UNAPP) 129

ATACAND 247

ATACAND HCT 247

ATAZANAVIR SULFATE 124,125

ATAZANAVIR SULFATE/COBICISTAT 124

ATELVIA 226

ATENOLOL 151,153

ATENOLOL/CHLORTHALIDONE 151,152

ATHLETE'S FOOT 78

ATOMOXETINE HCL 153,154,155

ATORVASTATIN CALCIUM 93,94

ATOVAQUONE 117

ATOVAQUONE/PROGUANIL HCL 117

ATRALIN 256

ATROPINE SULFATE 186


ATROVENT HFA 52

AUBAGIO 233

AUBRA 210

AUBRA EQ 210

AUGMENTIN XR 246

AURANOFIN 204

AUROVELA 210

AUROVELA 24 FE 210

AUROVELA FE 210

AURYXIA 223

AUSTEDO 156

AUTOLET LANCING DEVICE 160

AVALIDE 247

AVANDIA 75

AVAPRITINIB 100

AVAPRO 247

AVIANE 210

AVITA 256

AVODART 225

AVONEX 233

AVONEX PEN 233

AVSOLA 229

AXITINIB 106

AYR 183

AYR SALINE 183

AYUNA 210

AYVAKIT 100

AZACITIDINE 111

AZASAN 236

AZASITE 36

AZATHIOPRINE 236,237

AZELAIC ACID 259

AZELASTINE HCL 182

AZELASTINE HCL/FLUTICASONE PROPIONATE 182

AZESCO 268

AZILSARTAN MEDOXOMIL 247

AZILSARTAN MEDOXOMIL/CHLORTHALIDONE 247

AZITHROMYCIN 36,224,225

AZOPT 83

AZOR 149

AZTREONAM LYSINE 225

AZULFIDINE 51

AZURETTE 210

B B-COMPLEX WITH VITAMIN C 275,277

BACITRACIN 36,38,40

BACITRACIN ZINC 38

BACITRACIN/POLYMYXIN B SULFATE 36,37

BACLOFEN 255

BAFIERTAM 233

BALOXAVIR MARBOXIL 137

BALSALAZIDE DISODIUM 192

BALVERSA 100

BALZIVA 210

BANZEL 58

BAQSIMI 89

BARACLUDE 139

BARICITINIB 231

BASAGLAR KWIKPEN U-100 220

BAXDELA 50

BAYER CHEWABLE ASPIRIN 245

BAZA PROTECT 180

BCG VACCINE, LIVE/PF 129

BECLOMETHASONE DIPROPIONATE 42,43,159

BECONASE AQ 42

BEDAQUILINE FUMARATE 99

BEKYREE 210

BELBUCA 24

BELSOMRA 139,140

BELUMOSUDIL MESYLATE 239

BEMPEDOIC ACID 90

BEMPEDOIC ACID/EZETIMIBE 90

BENAZEPRIL HCL 248,249

BENAZEPRIL

HCL/HYDROCHLOROTHIAZIDE 248,249

BENEFIX 85

BENICAR 247

BENICAR HCT 247

BENRALIZUMAB 44

BENZACLIN 38

BENZEPRO 257


BENZNIDAZOLE 117

BENZONATATE 250

BENZOYL PEROXIDE 256,257,258,266

BENZOYL PEROXIDE MICRONIZED 257

BENZTROPINE MESYLATE 116

BEPOTASTINE BESILATE 182

BEPREVE 182

BERINERT 227

BEROTRALSTAT HYDROCHLORIDE 228

BESIFLOXACIN HCL 36

BESIVANCE 36

BETA-CAROTENE 275

BETA-CAROTENE (VITAMIN A) WITH VITAMINS C

AND E/MINERALS 274

BETA-CAROTENE(A) W-C AND

E/LUTEIN/MINERALS 269,271

BETA-CAROTENE/ASCORBIC ACID/VITE AC/ZINC

OXIDE/CUPRIC OXIDE 238

BETADINE 41

BETAMETHASONE DIPROPIONATE 45

BETAMETHASONE DIPROPIONATE/PROPYLENE

GLYCOL 45

BETAMETHASONE VALERATE 45

BETAPACE 151

BETAPACE AF 151

BETASERON 233

BETAXOLOL HCL 82,151

BETHANECHOL CHLORIDE 143

BETHKIS 50

BETOPTIC S 82

BETRIXABAN MALEATE 55

BEVESPI AEROSPHERE 52

BEVYXXA 55

BEXSERO 129

BICALUTAMIDE 100

BICTEGRAVIR

SODIUM/EMTRICITABINE/TENOFOVIR

ALAFENAMIDE FUMAR 123

BIKTARVY 123

BIMATOPROST 84

BINIMETINIB 110

BINOSTO 226

BIOTEL CARE BGM-4 161

BIOTENE MOISTURIZING MOUTH 161

BIOTHRAX 129

BISACODYL 196,198,199,200,201,202

BISMUTH SUBSALICYLATE 193,194,195

BISOPROLOL FUMARATE 151

BISOPROLOL

FUMARATE/HYDROCHLOROTHIAZIDE 151,153

BIVIGAM 126

BLEPH-10 36

BLEPHAMIDE S.O.P. 36

BLISOVI 24 FE 210

BLISOVI FE 210

BLOOD GLUCOSE CALIBRATION CONTROL HIGH

AND LOW 160,162,167

BLOOD GLUCOSE CALIBRATION CONTROL

SOLUTION, HIGH 167


SOLUTION, LOW 167


SOLUTION, NORMAL 160,162,163,164,166,167

BLOOD KETONE AND GLUCOSE

MONITOR 163,164,165

BLOOD SUGAR DIAGNOSTIC 168,169,170,171

BLOOD SUGAR DIAGNOSTIC, DISC-TYPE 168

BLOOD SUGAR DIAGNOSTIC, DRUM-TYPE 168

BLOOD-GLUCOSE

METER 160,161,162,163,164,165,166,167

BLOOD-GLUCOSE METER, WIRELESS 161

BLOOD-GLUCOSE METER,CONTINUOUS 161,162

BLOOD-GLUCOSE SENSOR 162

BLOOD-GLUCOSE TRANSMITTER 162

BLOOD-KETONE CONTROL, NORMAL 162,164

BONIVA 226

BOOSTRIX TDAP 128

BOSENTAN 253,254

BOSULIF 100

BOSUTINIB 100

BP GEL 266

BRAFTOVI 101


BREEZE 2 168

BREO ELLIPTA 158

BREXPIPRAZOLE 120

BREZTRI AEROSPHERE 158

BRIELLYN 210

BRILINTA 125

BRIMONIDINE TARTRATE 82

BRIMONIDINE TARTRATE/TIMOLOL MALEATE 82

BRINZOLAMIDE 83

BRINZOLAMIDE/BRIMONIDINE TARTRATE 83

BRISDELLE 69

BRIVARACETAM 58

BRIVIACT 58

BRODALUMAB 261

BROMFENAC SODIUM 43,44

BROMOCRIPTINE MESYLATE 172

BROMPHENIRAMINE MALEATE/PHENYLEPHRINE

HCL 189,190

BROMPHENIRAMINE

MALEATE/PSEUDOEPHEDRINE HCL 190

BROMSITE 43

BROVANA 145

BRUKINSA 101

BUDESONIDE 43,158,159,207,208

BUDESONIDE/FORMOTEROL FUMARATE 158,159

BUDESONIDE/GLYCOPYRROLATE/FORMOTEROL

FUMARATE 158

BUMETANIDE 171

BUNAVAIL 25

BUPRENORPHINE 25

BUPRENORPHINE HCL 24,25

BUPRENORPHINE HCL/NALOXONE HCL 25,26

BUPROPION HBR 67

BUPROPION HCL 67,68

BUSPIRONE HCL 140

BUSULFAN 110

BUTALBITAL/ACETAMINOPHEN 10,13

BUTALBITAL/ACETAMINOPHEN/CAFFEINE 10,13

BUTALBITAL/ASPIRIN/CAFFEINE 245

BUTTERFLY TOUCH LANCET 161

BYDUREON BCISE 72

BYDUREON PEN 72

BYETTA 72

BYNFEZIA 262

BYSTOLIC 151

C C1 ESTERASE INHIBITOR 227,228

C1 ESTERASE INHIBITOR, RECOMBINANT 228

CABERGOLINE 172

CABLIVI 125

CABOMETYX 101

CABOTEGRAVIR SODIUM 123

CABOZANTINIB S-MALATE 101,102

CADEAU DHA 268

CADUET 93

CALAMINE/ZINC OXIDE 180

CALAN 147

CALAN SR 147

CALCIPOTRIENE 259

CALCITONIN,SALMON,SYNTHETIC 246

CALCITRENE 259

CALCITRIOL 279

CALCIUM ACETATE 178,223

CALCIUM CARBONATE 177,178,179,190,191,192

CALCIUM CARBONATE, GLUCONATE/MAGNESIUM

OXIDE, GLUCONATE 178

CALCIUM CARBONATE/CHOLECALCIFEROL

(VITAMIN D3) 177,178,179,180

CALCIUM CARBONATE/MAGNESIUM

HYDROXIDE 190,191

CALCIUM CITRATE 178

CALCIUM CITRATE/CHOLECALCIFEROL (VITAMIN

D3) 178

CALCIUM MAGNESIUM 178

CALCIUM POLYCARBOPHIL 197,198

CALTRATE 600 PLUS D3 178

CAMILA 210

CAMRESE 210

CAMRESE LO 210

CANAGLIFLOZIN 73

CANAGLIFLOZIN/METFORMIN HCL 73


CANAKINUMAB/PF 238

CANASA 192

CANDESARTAN CILEXETIL 247

CANDESARTAN

CILEXETIL/HYDROCHLOROTHIAZIDE 247

CANNABIDIOL (CBD) 59

CAPECITABINE 101

CAPLACIZUMAB-YHDP 125

CAPLYTA 118

CAPMATINIB HYDROCHLORIDE 112

CAPRELSA 101

CAPSAICIN 259

CAPSAICIN/SKIN CLEANSER 261

CAPTOPRIL 248

CAPTOPRIL/HYDROCHLOROTHIAZIDE 249

CARBAGLU 173

CARBAMAZEPINE 58,59,64

CARBAMIDE PEROXIDE 38

CARBATROL 59

CARBIDOPA/LEVODOPA 116,117

CARBIDOPA/LEVODOPA/ENTACAPONE 116,117

CARBOXYMETHYLCELLULOSE SODIUM 183,185

CARBOXYMETHYLCELLULOSE

SODIUM/GLYCERIN 185


SODIUM/GLYCERIN/PF 185


SODIUM/HYPROMELLOSE 184

CARDIZEM 147

CARDIZEM CD 147

CARDIZEM LA 147

CARDURA 150

CARDURA XL 150

CARETOUCH SAFETY LANCETS 161

CARETOUCH TEST STRIP 168

CARGLUMIC ACID 173

CARIPRAZINE HCL 120,121

CARTEOLOL HCL 82

CARTIA XT 147

CARVEDILOL 151

CARVEDILOL PHOSPHATE 151

CAYSTON 225

CAZIANT 210

CEFACLOR 157

CEFADROXIL 156

CEFDINIR 157

CEFIXIME 157

CEFPODOXIME PROXETIL 157

CEFPROZIL 157

CEFTRIAXONE SODIUM 157

CEFUROXIME AXETIL 157

CELEBREX 240

CELECOXIB 240

CELEXA 69

CELLCEPT 236

CELONTIN 67

CENEGERMIN-BKBJ 184

CENOBAMATE 65

CENTANY 38

CENTANY AT 38

CEPHALEXIN 156

CERDELGA 238

CERITINIB 115,116

CEROVITE JR 268

CERTAVITE SENIOR 268

CERTAVITE-ANTIOXIDANT 268

CERTOLIZUMAB PEGOL 229

CETIRIZINE HCL 87,88,89,183

CETIRIZINE HCL/PSEUDOEPHEDRINE HCL 87,88

CEVIMELINE HCL 143

CHANTIX 142

CHATEAL 211

CHATEAL EQ 211

CHEMET 206

CHEST CONGESTION RELIEF 252

CHILD FEVER REDUCER 10

CHILD MUCINEX CHEST MINI-MELTS 252

CHILD MUCINEX COUGH MINI-MELTS 250

CHILD MUCINEX STUFFY NOSE-CHST 252

CHILDREN'S ALLERGY 89

CHILDREN'S ALLERGY RELIEF 88,89

CHILDREN'S CHEWABLE VITAMIN 268


CHILDREN'S CLARITIN 88

CHILDREN'S FEVER REDUCER 10

CHILDREN'S MOTRIN 240

CHILDREN'S TYLENOL 10

CHLORAMBUCIL 108

CHLORDIAZEPOXIDE HCL 141

CHLORHEXIDINE GLUCONATE 38

CHLOROQUINE PHOSPHATE 117

CHLORPHENIRAMINE MALEATE 189,190

CHLORPHENIRAMINE MALEATE/PHENYLEPHRINE

HCL 189,190

CHLORPROMAZINE HCL 121,122

CHLORTHALIDONE 172

CHLORZOXAZONE 255

CHOLBAM 203

CHOLECALCIFEROL (VITAMIN D3) 279,280,281

CHOLERA VACCINE BUFFER COMPONENT 247

CHOLERA VACCINE, LIVE 133

CHOLESTYRAMINE (WITH SUGAR) 91,92

CHOLESTYRAMINE/ASPARTAME 91,92

CHOLIC ACID 203

CICLESONIDE 42,43,158

CICLODAN 81

CICLOPIROX 81

CICLOPIROX OLAMINE 81

CILOSTAZOL 125

CILOXAN 36

CIMETIDINE 134,135

CIMETIDINE HCL 134

CIMZIA 229

CINACALCET HCL 246

CINRYZE 227

CIPRO 50

CIPRO HC 36

CIPRODEX 36

CIPROFLOXACIN 37,50,51

CIPROFLOXACIN HCL 36,50,51

CIPROFLOXACIN HCL/DEXAMETHASONE 36,37

CIPROFLOXACIN HCL/FLUOCINOLONE

ACETONIDE 36,37

CIPROFLOXACIN HCL/HYDROCORTISONE 36

CITALOPRAM HYDROBROMIDE 69

CITRANATAL B-CALM 268

CITROMA 196

CITRUCEL 196

CLADRIBINE 237

CLARAVIS 259

CLARINEX 88

CLARINEX-D 12 HOUR 88

CLARITHROMYCIN 225

CLARITIN 88

CLEARLAX 196

CLEMASTINE FUMARATE 188

CLEOCIN 38

CLEOCIN T 38,39

CLINDACIN P 39

CLINDACIN PAC 39

CLINDAGEL 39

CLINDAMYCIN HCL 52

CLINDAMYCIN PALMITATE HCL 52

CLINDAMYCIN PHOSPHATE 38,39

CLINDAMYCIN PHOSPHATE/BENZOYL

PEROXIDE 38,39,40

CLINDAMYCIN PHOSPHATE/BENZOYL

PEROXIDE/EMOLLIENT COMB NO.94 40

CLINDAMYCIN PHOSPHATE/SKIN CLEANSER

COMB NO.19 39

CLINDAMYCIN PHOSPHATE/TRETINOIN 39,40

CLOBAZAM 66,67

CLOBETASOL PROPIONATE 45,46

CLOBETASOL PROPIONATE/EMOLLIENT BASE 46

CLOMIPRAMINE HCL 70

CLONAZEPAM 66

CLONIDINE 219

CLONIDINE HCL 219

CLOPIDOGREL BISULFATE 125

CLOTRIMAZOLE 78,79,80

CLOTRIMAZOLE/BETAMETHASONE

DIPROPIONATE 79

CLOZAPINE 118,119,120

CLOZARIL 118

COAGADEX 85


COAGULATION FACTOR VIIA (RECOMBINANT) 86

COAGULATION FACTOR VIIA RECOMBINANT-

JNCW 86

COAGULATION FACTOR X 85

COAL TAR 258

COBICISTAT 239

COBIMETINIB FUMARATE 102

CODEINE PHOSPHATE/GUAIFENESIN 250,251,252

CODEINE SULFATE 13

COLACE CLEAR 196

COLAZAL 192

COLCHICINE 226

COLESEVELAM HCL 91,92

COLESTID 91

COLESTIPOL HCL 91,92

COLOCORT 46

COMBIGAN 82

COMBIVENT RESPIMAT 53

COMETRIQ 101,102

COMFORT TOUCH PLUS SAFETY LANC 161

COMFORT TOUCH ULT THIN LANCET 161

COMIRNATY 129

COMPLERA 123

COMPRO 76

CONCEPT DHA 268

CONCEPT OB 268

CONCERTA 30

CONDOMS 240

CONDOMS, LATEX, LUBRICATED 240

CONSTULOSE 173

CONTOUR 161

CONTOUR NEXT 161

CONTOUR NEXT EZ 161

CONTOUR NEXT GLUCOSE METER 161

CONTOUR NEXT LINK 161

CONTOUR NEXT LINK 2.4 161

CONTOUR NEXT ONE 161

CONTOUR NEXT TEST STRIP 168

CONTOUR TEST STRIP 168

COPAXONE 234

COPIKTRA 102

COREG 151

COREG CR 151

CORGARD 151

CORIFACT 85

CORLANOR 150

CORMAX 46

CORTICOTROPIN 167

COSENTYX (2 SYRINGES) 259

COSENTYX PEN 259

COSENTYX PEN (2 PENS) 259

COSENTYX SYRINGE 259

COSOPT 83

COSOPT PF 83

COTELLIC 102

COTEMPLA XR-ODT 30

COVID-19 VAC, AD26.COV2.S (JANSSEN)/PF 131

COVID-19 VACCINE, AZD-1222

(ASTRAZENECA)/PF 129

COVID-19 VACCINE, MRNA, BNT162B2, LNP-S

(PFIZER)/PF 129,132

COVID-19 VACCINE, MRNA-1273, LNP-S

(MODERNA)/PF 132

COVID-19 VACCINE, NVX-COV2373

(NOVAVAX)/ADJUVANT-MATRIX/PF 132

COZAAR 247

CREATINE MONOHYDRATE 238

CREON 202

CRESEMBA 77

CRESTOR 93

CRISABOROLE 45

CRIZANLIZUMAB-TMCA 145

CRIZOTINIB 115

CROMOLYN SODIUM 45

CROTAMITON 41

CROTAN 41

CRYSELLE 211

CUVITRU 126

CUVPOSA 53

CYANOCOBALAMIN (VITAMIN B-12) 275,276,277

CYANOCOBALAMIN/FOLIC

ACID/PYRIDOXINE 276,278


CYCLAFEM 211

CYCLINEX-1 173

CYCLINEX-2 173

CYCLOBENZAPRINE HCL 255

CYCLOPENTOLATE HCL 186

CYCLOPHOSPHAMIDE 102

CYCLOSERINE 98

CYCLOSET 172

CYCLOSPORINE 43,236,237

CYCLOSPORINE, MODIFIED 236,237

CYMBALTA 68

CYPROHEPTADINE HCL 189

CYRED 211

CYRED EQ 211

CYSTADROPS 184

CYSTAGON 238

CYSTARAN 184

CYSTEAMINE BITARTRATE 238

CYSTEAMINE HCL 184

D D-PENAMINE 206

DABIGATRAN ETEXILATE MESYLATE 56

DABRAFENIB MESYLATE 112

DACOMITINIB 114

DAILY VITAMIN + IRON 268

DAILY VITE WITH IRON 269

DAILY-VITE 269

DALFAMPRIDINE 238

DALIRESP 253

DALTEPARIN SODIUM,PORCINE 56,57

DANAZOL 208

DANTROLENE SODIUM 255

DAPAGLIFLOZIN PROPANEDIOL 73

DAPAGLIFLOZIN PROPANEDIOL/METFORMIN

HCL 74

DAPAGLIFLOZIN PROPANEDIOL/SAXAGLIPTIN

HCL 73

DAPSONE 98,260

DAPTACEL DTAP 128

DARBEPOETIN ALFA IN POLYSORBATE 80 146

DARIFENACIN HYDROBROMIDE 204

DARIO BLOOD GLUCOSE TEST STRIP 168

DAROLUTAMIDE 110

DARUNAVIR

ETH/COBICISTAT/EMTRICITABINE/TENOFOVIR

ALAFENAMIDE 125

DARUNAVIR ETHANOLATE 125

DARUNAVIR ETHANOLATE/COBICISTAT 125

DASATINIB 112

DASETTA 211

DAURISMO 102

DAYSEE 211

DAYTRANA 30

DAYVIGO 140

DEBLITANE 211

DECADRON 207

DECITABINE/CEDAZURIDINE 107

DEFERASIROX 206

DEFERIPRONE 206,207

DELAFLOXACIN MEGLUMINE 50

DELSYM 251

DELZICOL 192

DEMECLOCYCLINE HCL 51

DENAVIR 40

DENOSUMAB 226

DEPAKOTE 59

DEPAKOTE ER 59

DEPAKOTE SPRINKLE 59

DESCOVY 123

DESIPRAMINE HCL 70

DESLORATADINE 88

DESLORATADINE/PSEUDOEPHEDRINE

SULFATE 88

DESMOPRESSIN ACETATE 217,218

DESMOPRESSIN ACETATE (NON-

REFRIGERATED) 217

DESOGESTREL-ETHINYL

ESTRADIOL 210,211,212,213,215,217

DESOGESTREL-ETHINYL ESTRADIOL/ETHINYL

ESTRADIOL 210,211,213,215,217

DESONIDE 46


DESOXIMETASONE 46

DESVENLAFAXINE 68

DESVENLAFAXINE SUCCINATE 68

DETROL 204

DETROL LA 204

DEUTETRABENAZINE 156

DEXAMETHASONE 207

DEXAMETHASONE INTENSOL 207

DEXAMETHASONE SODIUM PHOSPHATE 42,207

DEXAMETHASONE SODIUM PHOSPHATE/PF 207

DEXCOM 161

DEXCOM G4 161,162

DEXCOM G5 162

DEXCOM G5-G4 SENSOR 162

DEXCOM G6 162

DEXEDRINE 27

DEXILANT 135

DEXLANSOPRAZOLE 135

DEXMETHYLPHENIDATE HCL 30,31

DEXTRAN 70/HYPROMELLOSE 183,184

DEXTRAN 70/HYPROMELLOSE/PF 184

DEXTRAN/HYPROMELLOSE/GLYCERIN 184

DEXTROAMPHETAMINE SULF-

SACCHARATE/AMPHETAMINE SULF-

ASPARTATE 26,27,28

DEXTROAMPHETAMINE SULFATE 27,28,29

DEXTROMETHORPHAN HBR 251

DEXTROMETHORPHAN HBR/DOXYLAMINE

SUCCINATE 251

DEXTROMETHORPHAN HBR/PHENYLEPHRINE

HCL/ACETAMINOPHEN 250

DEXTROMETHORPHAN POLISTIREX 251

DEXTROMETHORPHAN/PHENYLEPHRINE/ACETAM

INOPHEN/CHLORPHENIRAMIN 250

DEXTROSE 173

DHS TAR 258

DIACOMIT 59

DIASTAT 141

DIASTAT ACUDIAL 142

DIASTIX REAGENT 266

DIAZEPAM 141,142

DICLOFENAC EPOLAMINE 240,241

DICLOFENAC POTASSIUM 241,245

DICLOFENAC SODIUM 43,240,241,242,244,245

DICLOFENAC SODIUM/MISOPROSTOL 240,241

DICLOFENAC SUBMICRONIZED 245

DICLOXACILLIN SODIUM 247

DICYCLOMINE HCL 53

DIFFERIN 260

DIFICID 225

DIFLUCAN 77

DIGITEK 150

DIGOX 150

DIGOXIN 150

DILANTIN 67

DILANTIN-125 67

DILT-XR 147

DILTIAZEM HCL 147,148

DIMETAPP 190

DIMETHICONE/ZINC OXIDE 180

DIMETHYL FUMARATE 234,236

DIOVAN 247

DIOVAN HCT 247

DIPENTUM 192

DIPHENHYDRAMINE HCL 187,188,189

DIPHENHYDRAMINE HCL/PHENYLEPHRINE

HCL/ACETAMINOPHEN 188

DIPHENOXYLATE HCL/ATROPINE SULFATE 193

DIPHTHER,PERTUS(ACEL),TETANUS,POLIO

VACC,COMPONENT 1 OF 2/PF 132

DIPHTHERIA, PERTUSSIS (ACELL), TETANUS

PEDIATRIC VACCINE/PF 128

DIPHTHERIA, PERTUSSIS(ACELL),TETANUS,POLIO

VACCINE/PF 131,132

DIPHTHERIA,PERTUS(ACELL),TETANUS/HEPB/POL

IO/HIB CONJ-MENG/PF 128

DIPHTHERIA,PERTUSSIS(ACELL),TETANUS,POLIO/

HAEMOPHILUS B/PF 132

DIPHTHERIA,PERTUSSIS(ACELLULAR),TETANUS

VACCINE 128

DIPHTHERIA,PERTUSSIS(ACELLULAR),TETANUS

VACCINE/PF 128


DIPYRIDAMOLE 267

DIROXIMEL FUMARATE 236

DISOPYRAMIDE PHOSPHATE 49

DISULFIRAM 226

DITROPAN XL 204

DIVALPROEX SODIUM 59

DOCUSATE SODIUM 196,197,198,199,200,202

DOFETILIDE 49

DOJOLVI 173

DOLUTEGRAVIR SODIUM 122,123

DOLUTEGRAVIR SODIUM/RILPIVIRINE HCL 122

DONEPEZIL HCL 143

DORNASE ALFA 253

DORZOLAMIDE HCL 83

DORZOLAMIDE HCL/PF 83

DORZOLAMIDE HCL/TIMOLOL MALEATE 83

DORZOLAMIDE HCL/TIMOLOL MALEATE/PF 83

DOTTI 181

DOXAZOSIN MESYLATE 150

DOXEPIN HCL 70,71

DOXYCYCLINE HYCLATE 37,51

DOXYCYCLINE MONOHYDRATE 51,52

DOXYLAMINE SUCCINATE 187,188,189

DRONABINOL 75

DRONEDARONE HCL 49

DROPLET GENTEEL LANCING DEVICE 162

DROPLET LANCETS 162

DROXIA 102

DUAKLIR PRESSAIR 53

DUET DHA 400 269

DUET DHA BALANCED 269

DUETACT 75

DUEXIS 241

DULAGLUTIDE 73

DULERA 158

DULOXETINE HCL 68

DUPILUMAB 44,260

DUPIXENT PEN 44,260

DUPIXENT SYRINGE 44,260

DURAGESIC 13

DUTASTERIDE 225

DUTASTERIDE/TAMSULOSIN HCL 225,226

DUTOPROL 151

DUVELISIB 102

DYANAVEL XR 28

DYMISTA 182

E E.E.S. 200 224

E.E.S. 400 224

EASY TOUCH BLU LINK CTRL SOLN 162

EASY TOUCH BLU LINK GLUC SYST 162

EASY TOUCH BLU LINK TEST STRIP 168

EASY TRAK II CONTROL SOLUTION 162

EASY TRAK II TEST STRIP 169

ECALLANTIDE 228

ECONAZOLE NITRATE 79

EDARBI 247

EDARBYCLOR 247

EDLUAR 140

EDOXABAN TOSYLATE 56

EDURANT 123

EFAVIRENZ 123

EFAVIRENZ/EMTRICITABINE/TENOFOVIR

DISOPROXIL FUMARATE 123

EFFEXOR XR 68

EFFIENT 125

EFINACONAZOLE 79

ELAGOLIX SODIUM 205

ELAGOLIX SODIUM/ESTRADIOL/NORETHINDRONE

ACETATE 205

ELBASVIR/GRAZOPREVIR 206

ELECARE 173

ELECTROLYTES/DEXTROSE 178,179

ELETRIPTAN HYDROBROMIDE 95,96

ELEXACAFTOR/TEZACAFTOR/IVACAFTOR 159

ELIDEL 260

ELIGLUSTAT TARTRATE 238

ELINEST 211

ELIQUIS 55,56

ELLA 211

ELMIRON 240


ELOCTATE 85

ELTROMBOPAG OLAMINE 146

ELURYNG 211

ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TEN

OFOVIR ALAFENAMIDE 123

ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TEN

OFOVIR DISOPROXIL 124

EMBEDA 13,14

EMBRACE LANCING DEVICE 162

EMBRACE PRO BLOOD GLUCOSE MTR 162

EMBRACE PRO TEST STRIP 169

EMCYT 103

EMEND 76

EMGALITY PEN 95

EMGALITY SYRINGE 95

EMICIZUMAB-KXWH 85

EMOLLIENT BASE 247

EMOQUETTE 211

EMPAGLIFLOZIN 73

EMPAGLIFLOZIN/LINAGLIPTIN 73

EMPAGLIFLOZIN/LINAGLIPTIN/METFORMIN HCL 74

EMPAGLIFLOZIN/METFORMIN HCL 74

EMTRICITABINE 123

EMTRICITABINE/RILPIVIRINE HCL/TENOFOVIR

ALAFENAMIDE FUMARATE 123

EMTRICITABINE/RILPIVIRINE HCL/TENOFOVIR

DISOPROXIL FUMARATE 123

EMTRICITABINE/TENOFOVIR ALAFENAMIDE

FUMARATE 123

EMTRICITABINE/TENOFOVIR DISOPROXIL

FUMARATE 123,124

ENABLEX 204

ENALAPRIL MALEATE 249

ENALAPRIL

MALEATE/HYDROCHLOROTHIAZIDE 249

ENASIDENIB MESYLATE 106

ENBRACE HR 269

ENBREL 229

ENBREL MINI 229

ENBREL SURECLICK 229

ENCORAFENIB 101

ENDARI 203

ENDOCET 14

ENFUVIRTIDE 122

ENGERIX-B ADULT 129

ENGERIX-B PEDIATRIC-ADOLESCENT 129

ENOXAPARIN SODIUM 56,57,58

ENPRESSE 211

ENSKYCE 211

ENSPRYNG 234

ENTACAPONE 116

ENTECAVIR 139

ENTRECTINIB 112

ENTRESTO 247

ENTYVIO 203

ENULOSE 173

ENVARSUS XR 236

ENZALUTAMIDE 115

EPANED 249

EPCLUSA 205

EPIDIOLEX 59

EPIDUO FORTE 260

EPINASTINE HCL 182

EPINEPHRINE 264,265

EPIPEN 264

EPIPEN 2-PAK 264

EPIPEN JR 264

EPIPEN JR 2-PAK 264

EPITOL 59

EPIVIR HBV 123

EPLERENONE 250

EPOETIN ALFA 146

EPOETIN ALFA-EPBX 147

EPOGEN 146

EPOPROSTENOL SODIUM 253,255

EPOPROSTENOL SODIUM (GLYCINE) 253

EPROSARTAN MESYLATE 248

EPTINEZUMAB-JJMR 95

ERDAFITINIB 100

ERENUMAB-AOOE 94

ERGOCALCIFEROL (VITAMIN D2) 279,280

ERIVEDGE 103


ERLEADA 103

ERLOTINIB HCL 103

ERRIN 211

ERTUGLIFLOZIN PIDOLATE 73

ERTUGLIFLOZIN PIDOLATE/METFORMIN HCL 73

ERTUGLIFLOZIN PIDOLATE/SITAGLIPTIN

PHOSPHATE 74

ERY 39

ERY-TAB 224

ERYPED 200 224

ERYPED 400 224

ERYTHROCIN STEARATE 224

ERYTHROMYCIN BASE 37,224

ERYTHROMYCIN BASE IN ETHANOL 39

ERYTHROMYCIN BASE/BENZOYL PEROXIDE 39

ERYTHROMYCIN ETHYLSUCCINATE 224

ERYTHROMYCIN STEARATE 224

ESBRIET 250

ESCITALOPRAM OXALATE 69

ESLICARBAZEPINE ACETATE 58

ESOMEPRAZOLE MAGNESIUM 135,136,137

ESOMEPRAZOLE STRONTIUM 135

ESPEROCT 85

ESSENTIAL AMINO ACID MIX 173

ESTARYLLA 211

ESTRADIOL 181,182

ESTRAMUSTINE PHOSPHATE SODIUM 103

ESZOPICLONE 140

ETANERCEPT 229

ETHAMBUTOL HCL 98

ETHINYL

ESTRADIOL/DROSPIRENONE 211,212,213,214,215,2

17

ETHIONAMIDE 99

ETHOSUXIMIDE 67

ETHOTOIN 67

ETHYNODIOL DIACETATE-ETHINYL

ESTRADIOL 211,213,217

ETIDRONATE DISODIUM 226

ETODOLAC 241

ETONOGESTREL/ETHINYL ESTRADIOL 211,212

ETOPOSIDE 103

ETRAVIRINE 123

EUCERIN 180

EUCRISA 45

EURAX 41

EVEKEO 28

EVEROLIMUS 99,100,103,104,237,238

EVISTA 181

EVOLOCUMAB 94

EVOTAZ 124

EVRYSDI 238

EX-LAX MAXIMUM STRENGTH 197

EXCEDRIN EXTRA STRENGTH 245

EXELDERM 79

EXELON 143

EXEMESTANE 104

EXENATIDE 72

EXENATIDE MICROSPHERES 72

EXFORGE 149

EXFORGE HCT 149

EXTAVIA 234

EYE ALLERGY ITCH RELIEF 182

EYE ALLERGY ITCH-REDNESS RLF 182

EYE ITCH RELIEF 182,183

EZ CHAR 191

EZ-LETS 162

EZALLOR SPRINKLE 93

EZETIMIBE 92

EZETIMIBE/SIMVASTATIN 92

F FABIOR 260

FACTOR IX 84,86

FACTOR IX (HUMAN) RECOMBINANT,

PEGYLATED 86

FACTOR IX COMPLEX, PROTHROMBIN CPLX

CONC(PCC) NO.4, 3-FACTOR 86

FACTOR IX HUMAN RECOMBINANT 85,86

FACTOR IX HUMAN RECOMBINANT, THREONINE

148 85


FACTOR IX RECOMBINANT, FC FUSION

PROTEIN 85

FACTOR IX RECOMBINANT,ALBUMIN FUSION

PROTEIN 85

FACTOR XIII 85

FACTOR XIII A-SUBUNIT, RECOMBINANT 86

FALMINA 212

FAMCICLOVIR 139

FAMOTIDINE 133,134,135

FANAPT 119

FARXIGA 73

FASENRA PEN 44

FAZACLO 119

FEBUXOSTAT 226

FEDRATINIB DIHYDROCHLORIDE 107

FEIBA NF 85

FELBAMATE 59,60

FELBATOL 60

FELODIPINE 149

FEMYNOR 212

FENFLURAMINE HCL 60

FENOFIBRATE 92,93

FENOFIBRATE NANOCRYSTALLIZED 92,93

FENOFIBRATE,MICRONIZED 92

FENOFIBRIC ACID 93

FENOFIBRIC ACID (CHOLINE) 93

FENOGLIDE 93

FENOPROFEN CALCIUM 241

FENTANYL 13,14

FERRIC CITRATE 223

FERRIPROX 206

FERRIPROX (2 TIMES A DAY) 207

FERRIPROX (3 TIMES A DAY) 207

FERROUS FUMARATE 48

FERROUS FUMARATE/ASCORBIC

ACID/CYANOCOBALAMIN/FOLIC ACID 49

FERROUS GLUCONATE 48

FERROUS SULFATE 48,49

FESOTERODINE FUMARATE 204

FETZIMA 68

FEVERALL 10

FIASP 221

FIASP FLEXTOUCH 221

FIASP PENFILL 221

FIBERCON 198

FIBRICOR 93

FIDAXOMICIN 225

FINASTERIDE 226

FINGOLIMOD HCL 234

FINTEPLA 60

FIRAZYR 227

FLASH GLUCOSE SCANNING READER 163

FLASH GLUCOSE SENSOR 163

FLAVOXATE HCL 204

FLEBOGAMMA DIF 126

FLECAINIDE ACETATE 49

FLECTOR 241

FLOLAN 253

FLOMAX 9

FLORIVA 227,269

FLOVENT DISKUS 158

FLOVENT HFA 158

FLU VACCINE QUAD 2019-2020(4 YEARS AND

OLDER)CELL DERIVED/PF 130





FLU VACCINE QUADRIV 2019-2020(4 YEARS AND

OLDER)CELL DERIVED 130





FLUAD 2019-2020 129

FLUAD 2020-2021 129

FLUAD QUAD 2020-2021 129

FLUAD QUAD 2021-2022 129

FLUARIX QUAD 2019-2020 129



FLUBLOK QUAD 2019-2020 129




FLUCELVAX QUAD 2019-2020 130



FLUCONAZOLE 77

FLUCYTOSINE 77,78

FLUDROCORTISONE ACETATE 207

FLULAVAL QUAD 2019-2020 130



FLUMIST QUAD 2019-2020 130



FLUNISOLIDE 42

FLUOCINOLONE ACETONIDE 46

FLUOCINOLONE ACETONIDE OIL 42

FLUOCINOLONE ACETONIDE/SHOWER CAP 46

FLUOCINONIDE 46

FLUOCINONIDE/EMOLLIENT BASE 46

FLUORIDE (SODIUM) 227

FLUORITAB 227

FLUOROMETHOLONE 42

FLUOROURACIL 104

FLUOXETINE HCL 69,70

FLUPHENAZINE DECANOATE 122

FLUPHENAZINE HCL 122

FLURBIPROFEN 241

FLURBIPROFEN SODIUM 44

FLUTAMIDE 104

FLUTICASONE FUROATE 158

FLUTICASONE FUROATE/UMECLIDINIUM

BROMIDE/VILANTEROL TRIFENAT 159

FLUTICASONE FUROATE/VILANTEROL

TRIFENATATE 158

FLUTICASONE PROPIONATE 42,43,46,158

FLUTICASONE PROPIONATE/SALMETEROL

XINAFOATE 158,159

FLUTICASONE PROPIONATE/SODIUM

CHLORIDE/SODIUM BICARBONATE 43

FLUVASTATIN SODIUM 93

FLUVOXAMINE MALEATE 69

FLUZONE HIGH-DOSE 2019-2020 130

FLUZONE HIGH-DOSE QUAD 2020-21 130

FLUZONE HIGH-DOSE QUAD 2021-22 130

FLUZONE QUAD 2019-2020 130



FLUZONE QUAD PEDI 2019-2020 131

FLUZONE QUAD SOUTHERN HEM 2020 131

FLUZONE QUAD SOUTHERN HEM 2021 131

FML S.O.P. 42

FOCALIN 31

FOCALIN XR 31

FOLIC ACID 276,277

FOLIC ACID/MULTIVIT WITH IRON,

MINERALS/LUTEIN 268

FOLIC ACID/MULTIVITAMIN WITH IRON,

MINERALS 271

FOLIC ACID/PYRIDOXINE HCL/CA PHOS DIBASIC &

TRIBASIC/GINGER 275

FOLIC ACID/VITAMIN B COMPLEX AND VITAMIN

C 276

FONDAPARINUX SODIUM 54

FORA G20 162,169

FORA KETONE CONTROL SOLUTION 162

FORA TN'G ADVAN PRO TEST STRIP 169

FORA TN'G ADVANCE PRO MONITOR 163

FORA V10-V12-D10-D20 169

FORFIVO XL 68

FORMOTEROL FUMARATE 145

FORTEO 246

FORTESTA 208

FORTISCARE G1 TEST STRIP 169

FORTISCARE T1 BLOOD GLUC SYS 163

FOSAMAX 226

FOSAMAX PLUS D 226

FOSAMPRENAVIR CALCIUM 124

FOSFOMYCIN TROMETHAMINE 36

FOSINOPRIL SODIUM 249

FOSINOPRIL

SODIUM/HYDROCHLOROTHIAZIDE 249


FOSRENOL 223

FOSTEMSAVIR TROMETHAMINE 122

FOTIVDA 104

FRAGMIN 56,57

FREESTYLE FREEDOM LITE 163

FREESTYLE INSULINX 163,169

FREESTYLE INSULINX TEST STRIPS 169

FREESTYLE LIBRE 10 DAY READER 163

FREESTYLE LIBRE 10 DAY SENSOR 163

FREESTYLE LIBRE 14 DAY READER 163

FREESTYLE LIBRE 14 DAY SENSOR 163

FREESTYLE LIBRE 2 READER 163

FREESTYLE LIBRE 2 SENSOR 163

FREESTYLE LITE METER 163

FREESTYLE LITE TEST STRIP 169

FREESTYLE PRECISION NEO 169

FREESTYLE TEST STRIPS 169

FREMANEZUMAB-VFRM 95

FROVA 96

FROVATRIPTAN SUCCINATE 96

FULPHILA 146

FUNGOID TINCTURE 79

FUROSEMIDE 171,172

FUZEON 122

FYAVOLV 181

FYCOMPA 60

G GABAPENTIN 11,60,62,63

GABAPENTIN ENACARBIL 60

GABITRIL 60

GALAFOLD 238

GALANTAMINE HBR 143

GALCANEZUMAB-GNLM 95

GAMASTAN 126

GAMASTAN S-D 126

GAMMAGARD LIQUID 126

GAMMAGARD S-D 127

GAMMAKED 127

GAMMAPLEX 127

GAMUNEX-C 127

GANCICLOVIR 38

GARDASIL 9 131

GAS RELIEF 195

GAS-X 195

GATIFLOXACIN 37,38

GAVILAX 198

GAVILYTE-C 198

GAVILYTE-G 198

GAVILYTE-N 198

GAVISCON 191

GAVRETO 104

GE100 BLOOD GLUCOSE SYSTEM 163

GE100 BLOOD GLUCOSE TEST STRIP 170

GE333 BLOOD GLUCOSE SYSTEM 163

GE333 BLOOD GLUCOSE TEST STRIP 170

GE333 CONTROL SOLUTION NORMAL 163

GEFITINIB 107

GELNIQUE 204

GELUSIL 191

GEMFIBROZIL 93

GENERLAC 173

GENGRAF 237

GENOTROPIN 218

GENTAK 37

GENTAMICIN SULFATE 37,39,50

GENTEAL TEARS 184

GENTEAL TEARS SEVERE 184

GENTLELAX 198

GENVOYA 123

GEODON 119

GIANVI 212

GILENYA 234

GILOTRIF 104

GILTERITINIB FUMARATE 115

GIMOTI 203

GLASDEGIB MALEATE 102

GLATIRAMER ACETATE 234

GLATOPA 234

GLECAPREVIR/PIBRENTASVIR 205

GLEOSTINE 104

GLIMEPIRIDE 74


GLIPIZIDE 74

GLIPIZIDE/METFORMIN HCL 74

GLUCAGEN 89

GLUCAGON 89,90

GLUCAGON EMERGENCY KIT 90

GLUCAGON HCL 90

GLUCO NAVII 170

GLUCOCARD EXPRESSION 163,164,170

GLUCOCARD SHINE 164,170

GLUCOCARD SHINE XL 164

GLUCOTROL 74

GLUCOTROL XL 74

GLUTAMINE 203

GLUTAREX-1 173

GLUTAREX-2 174

GLYBURIDE 74

GLYBURIDE,MICRONIZED 74,75

GLYBURIDE/METFORMIN HCL 74

GLYCERIN 196,198,200

GLYCOLAX 198

GLYCOPYRROLATE 53

GLYCOPYRROLATE/FORMOTEROL FUMARATE 52

GLYCOPYRROLATE/NEBULIZER ACCESSORIES 53

GLYCOPYRROLATE/NEBULIZER AND

ACCESSORIES 53

GLYDO 185

GLYNASE 75

GLYSET 71

GLYTACTIN 15 PE BETTERMILK 174

GLYTACTIN 20PE BETTERMILK LITE 174

GLYTACTIN BUILD 20-20 174

GLYTACTIN BURST 10-10 174

GLYTACTIN BURST 20-20 174

GLYTACTIN RTD 10 PE 174

GLYTACTIN RTD 15 PE 174

GLYXAMBI 73

GOCOVRI 116

GOJJI BLOOD GLUCOSE TEST STRIP 170

GOJJI GLUCOSE CONTROL SOLUTION 164

GOJJI KETONE CONTROL SOLUTION 164

GOJJI LANCET-GLUCOSE TEST STRP 164

GOJJI LANCETS 164

GOJJI MULTI-FUNCTIONAL METER 164

GOLIMUMAB 232,233

GRALISE 11

GRANISETRON 75

GRANISETRON HCL 75

GRANIX 146

GRASTEK 125

GRISEOFULVIN ULTRAMICROSIZE 77

GRISEOFULVIN, MICROSIZE 76

GUAIFENESIN 252,253

GUAIFENESIN/DEXTROMETHORPHAN HBR 250,251

GUAIFENESIN/DEXTROMETHORPHAN

HBR/PSEUDOEPHEDRINE HCL 251

GUAIFENESIN/PHENYLEPHRINE HCL 252

GUAIFENESIN/PSEUDOEPHEDRINE HCL 252

GUANFACINE HCL 153,154,219

GUSELKUMAB 262

GVOKE HYPOPEN 1-PACK 90

GVOKE HYPOPEN 2-PACK 90

GVOKE PFS 1-PACK SYRINGE 90

GVOKE PFS 2-PACK SYRINGE 90

GYNE-LOTRIMIN-7 79

H HAEGARDA 228

HAEMOPHILUS B CONJUGATE VACCINE

(MENINGOCOCCAL PROT.CONJ)/PF 132

HAEMOPHILUS B CONJUGATE VACCINE(TETANUS

TOXOID CONJUGATE)/PF 128,131

HAEMOPHILUS B POLYSACC CONJ-TETANUS

TOX,COMPONENT 2 OF 2/PF 132

HAILEY 212

HAILEY 24 FE 212

HAILEY FE 212

HALDOL 121

HALDOL DECANOATE 100 121

HALDOL DECANOATE 50 121

HALOPERIDOL 121

HALOPERIDOL DECANOATE 121

HALOPERIDOL LACTATE 121


HARVONI 205

HAVRIX 131

HCU EXPRESS POWDER 174

HEALTHPRO GLUCOSE TEST STRIPS 170

HEALTHYLAX 199

HEARTBURN RELIEF 134

HEATHER 212

HELIXATE FS 85

HEMANGEOL 151

HEMLIBRA 85

HEMOFIL M 85

HEP B

VIRUS,RCMB/DIPTH,PERTUS(ACELL),TET,POLIO

VACCINE/PF 132

HEPARIN SODIUM,PORCINE 57

HEPARIN SODIUM,PORCINE/PF 57

HEPATITIS A VIRUS AND HEPATITIS B VIRUS

VACCINE/PF 133

HEPATITIS A VIRUS VACCINE/PF 131,133

HEPATITIS B VACCINE RECOMBINANT/VACCINE

ADJUVANT CPG 1018/PF 131

HEPATITIS B VIRUS VACCINE

RECOMBINANT/PF 129,132

HEPLISAV-B 131

HEPSERA 139

HETLIOZ 140

HETLIOZ LQ 140

HIBERIX 131

HOMATROPINE HBR 186

HOMINEX-1 174

HOMINEX-2 174

HORIZANT 60

HUMALOG 221

HUMALOG JUNIOR KWIKPEN 221

HUMALOG KWIKPEN U-100 221

HUMALOG KWIKPEN U-200 221

HUMALOG MIX 50-50 221

HUMALOG MIX 50-50 KWIKPEN 221

HUMALOG MIX 75-25 221

HUMALOG MIX 75-25 KWIKPEN 221

HUMAN PAPILLOMAVIRUS VACCINE, 9-

VALENT/PF 131

HUMATE-P 85

HUMATROPE 218

HUMIRA 230

HUMIRA PEN 230

HUMIRA PEN CROHN'S-UC-HS 230

HUMIRA PEN PSOR-UVEITS-ADOL HS 230

HUMIRA(CF) 230

HUMIRA(CF) PEDIATRIC CROHN'S 203,230

HUMIRA(CF) PEN 230

HUMIRA(CF) PEN CROHN'S-UC-HS 231

HUMIRA(CF) PEN PEDIATRIC UC 231

HUMIRA(CF) PEN PSOR-UV-ADOL HS 231

HUMULIN 70-30 219

HUMULIN 70/30 KWIKPEN 219

HUMULIN N 219

HUMULIN N KWIKPEN 219

HUMULIN R 223

HUMULIN R U-500 223

HUMULIN R U-500 KWIKPEN 223

HYALURONIDASE, HUMAN RECOMB. 181

HYCAMTIN 104

HYDRALAZINE HCL 219

HYDROCHLOROTHIAZIDE 172

HYDROCIL INSTANT 199

HYDROCODONE BITARTRATE 14,15,17,23,24

HYDROCODONE

BITARTRATE/ACETAMINOPHEN 15,16,18

HYDROCODONE/IBUPROFEN 16

HYDROCORTISONE 45,46,47,48,207

HYDROCORTISONE ACETATE 45,46,47

HYDROCORTISONE ACETATE/LIDOCAINE

HCL/ALOE VERA 255,256

HYDROCORTISONE ACETATE/PRAMOXINE

HCL 46,47

HYDROCORTISONE BUTYRATE 47

HYDROCORTISONE SOD SUCCINATE 208

HYDROCORTISONE SODIUM SUCCINATE/PF 208

HYDROCORTISONE VALERATE 47

HYDROCORTISONE/ALOE VERA 47


HYDROCORTISONE/IODOQUINOL 41

HYDROGEN PEROXIDE 186

HYDROMORPHONE HCL 16

HYDROXYCHLOROQUINE SULFATE 117

HYDROXYUREA 102,104,112

HYDROXYZINE HCL 140

HYDROXYZINE PAMOATE 140

HYOSCYAMINE SULFATE 53,54

HYPROMELLOSE 184,185

HYQVIA 127

HYQVIA HY COMPONENT 181

HYQVIA IG COMPONENT 127

HYSINGLA ER 17

HYZAAR 248

I I-VALEX-1 174

I-VALEX-2 174

IBANDRONATE SODIUM 226

IBRANCE 104,105

IBRUTINIB 106

IBU 242

IBUPROFEN 240,241,242,243,244,245

IBUPROFEN/FAMOTIDINE 241

ICAPS 238

ICATIBANT ACETATE 227,228

ICLEVIA 212

ICLUSIG 105

ICOSAPENT ETHYL 90,91

IDELVION 85

IDHIFA 106

ILARIS 238

ILOPERIDONE 119

ILOPROST TROMETHAMINE 255

ILUMYA 260

IMATINIB MESYLATE 106

IMBRUVICA 106

IMIPRAMINE HCL 71

IMIQUIMOD 260

IMITREX 96

IMMUNE

GLOBULIN,GAMM(IGG)/GLYCINE/GLUCOSE/IGA 0

TO 50 MCG/ML 127

IMMUNE GLOBULIN,GAMM(IGG)/GLYCINE/IGA

GREATER THAN 50 MCG/ML 126,127

IMMUNE GLOBULIN,GAMM(IGG)/MALTOSE/IGA

GREATER THAN 50 MCG/ML 128

IMMUNE

GLOBULIN,GAMM(IGG)/SORBITOL/GLYCIN/IGA 0

TO 50 MCG/ML 127

IMMUNE GLOBULIN,GAMMA (IGG)/GLYCINE/IGA 0

TO 50 MCG/ML 127

IMMUNE GLOBULIN,GAMMA (IGG)/SORBITOL/IGA 0

TO 50 MCG/ML 126

IMMUNE GLOBULIN,GAMMA(IGG)

HUMAN/HYALURONIDASE, HUMAN RECOMB 127

IMMUNE GLOBULIN,GAMMA(IGG)-IFAS

HUMAN/GLYCINE 128

IMMUNE GLOBULIN,GAMMA(IGG)/GLYCINE 126

IMMUNE GLOBULIN,GAMMA(IGG)/GLYCINE/IGA

AVERAGE 46 MCG/ML 127

IMODIUM A-D 194

IMOVAX RABIES VACCINE 131

IMURAN 237

INBRIJA 116

INCASSIA 212

INCRUSE ELLIPTA 53

INDACATEROL MALEATE 144

INDACATEROL MALEATE/GLYCOPYRROLATE 145

INDAPAMIDE 172

INDERAL LA 151

INDERAL XL 151

INDOMETHACIN 243

INDOMETHACIN, SUBMICRONIZED 243

INF FORM, GLUTARIC ACIDURIA I 173

INFANRIX DTAP 128

INFANT FORM. IRON, LACTOSE

FREE/DHA/ARACHIDONIC ACID (ARA) 173

INFANT FORMULA FOR PKU, IRON, NO.2 175


INFANT FORMULA WITH

IRON,SPEC.METABOLIC,MAPLE SYRUP URINE

DX 174

INFANT FORMULA WITH IRON/DOCOSAHEXANOIC

ACID/ARACHIDONIC AC 175

INFANT FORMULA, SPECIAL METABOLIC WITH

IRON 176

INFANT FORMULA, SPECIAL METABOLIC, IRON,

METHIONINE-FREE 174

INFANT FORMULA, SPECIAL METABOLIC,

TYROSINEMIA, WITH IRON 176

INFANT FORMULA, SPECIAL METABOLIC, UREA

CYCLE DISORDER 173

INFANT FORMULA,SPEC. METABOLIC, PROPIONIC

ACIDEMIA,WITH IRON 176

INFANT FORMULA,SPEC. METABOLIC,ISOVALERIC

ACIDEMIA WITH IRON 174

INFIGRATINIB PHOSPHATE 113

INFLECTRA 231

INFLIXIMAB 232

INFLIXIMAB-ABDA 232

INFLIXIMAB-AXXQ 229

INFLIXIMAB-DYYB 231

INFLUENZA VACCINE QUADRIVALENT 2020-21 (65

YR UP)/MF59C.1/PF 129

INFLUENZA VACCINE QUADRIVALENT 2021-22 (65

YR UP)/MF59C.1/PF 129

INFLUENZA VACCINE QUADRIVALENT LIVE 2019-

2020 (2 YRS-49 YRS) 130


2021 (2 YRS-49 YRS) 130


2022 (2 YRS-49 YRS) 130

INFLUENZA VACCINE TVS 2019-20 (65 YR

UP)/ADJUVANT MF59C.1/PF 129

INFLUENZA VACCINE TVS 2020-21 (65 YR

UP)/ADJUVANT MF59C.1/PF 129

INFLUENZA VIRUS VACC QUAD 2020 SOUTH HEM

(6 MOS AND UP) 131


(6 MOS AND UP)/PF 131


(6 MONTHS AND UP) 131


(6 MOS AND UP)/PF 131

INFLUENZA VIRUS VACCINE QUADRIVAL 2019-20

(6 MOS-35 MOS)/PF 128,131

INFLUENZA VIRUS VACCINE QUADRIVAL 2019-

2020(6 MOS AND UP)/PF 129,130


2021(6 MOS AND UP)/PF 129,130


(6 MOS-35 MOS)/PF 129


2022(6 MOS AND UP)/PF 129,130,131


(6 MOS-35 MOS)/PF 129

INFLUENZA VIRUS VACCINE QUADRIVAL SPLIT

2020-21(65 YR UP)/PF 130

INFLUENZA VIRUS VACCINE QUADRIVAL SPLIT

2021-22(65 YR UP)/PF 130

INFLUENZA VIRUS VACCINE QUADRIVALENT

2019-20 (36 MOS UP)/PF 128


2019-20 (6 MOS AND UP) 128,130


2020-21 (36 MOS UP)/PF 129


2020-21 (6 MOS AND UP) 128


2021-22 (36 MOS UP)/PF 129


2021-22 (6 MOS AND UP) 129

INFLUENZA VIRUS VACCINE QV 2019-20(18 YRS

AND OLDER)RCMB/PF 129





INFLUENZA VIRUS VACCINE TRIVAL SPLIT 2019-

2020(65 YR UP)/PF 130

INGENOL MEBUTATE 111


INGREZZA 156

INGREZZA INITIATION PACK 156

INLYTA 106

INNOPRAN XL 151

INQOVI 107

INREBIC 107

INSULIN ASPART 222

INSULIN ASPART (NIACINAMIDE) 221

INSULIN ASPART FLEXPEN 222

INSULIN ASPART PENFILL 222

INSULIN ASPART PROT MIX 70-30 222

INSULIN ASPART PROTAMINE HUMAN/INSULIN

ASPART 222

INSULIN DEGLUDEC 220,221

INSULIN DEGLUDEC/LIRAGLUTIDE 221

INSULIN DETEMIR 220

INSULIN GLARGINE,HUMAN RECOMBINANT

ANALOG 220

INSULIN GLARGINE,HUMAN RECOMBINANT

ANALOG/LIXISENATIDE 220

INSULIN GLULISINE 221

INSULIN LISPRO 221,222

INSULIN LISPRO JUNIOR KWIKPEN 222

INSULIN LISPRO KWIKPEN U-100 222

INSULIN LISPRO PROTAMINE AND INSULIN

LISPRO 221,222

INSULIN LISPRO PROTAMINE MIX 222

INSULIN LISPRO-AABC 222

INSULIN NPH HUMAN ISOPHANE 219,220

INSULIN NPH HUMAN ISOPHANE/INSULIN

REGULAR, HUMAN 219,220

INSULIN REGULAR, HUMAN 221,223

INTELENCE 123

INTERFERON ALFA-2B,RECOMB. 138

INTERFERON ALFA-N3 138

INTERFERON BETA-1A 233

INTERFERON BETA-1A/ALBUMIN

HUMAN 233,235,236

INTERFERON BETA-1B 233,234

INTERMEZZO 140

INTRON A 138

INTROVALE 212

INTUNIV 153,154

INVEGA 119

INVEGA SUSTENNA 119

INVEGA TRINZA 119

INVIRASE 124

INVOKAMET 73

INVOKAMET XR 73

INVOKANA 73

IOPIDINE 184

IPOL 131

IPRATROPIUM BROMIDE 52,53,184

IPRATROPIUM BROMIDE/ALBUTEROL SULFATE 53

IRBESARTAN 247,248

IRBESARTAN/HYDROCHLOROTHIAZIDE 247,248

IRESSA 107

IRON ASP GLY,PS CMPLX/ASCORB CALCIUM/CA-

THR/SUCCINIC ACID 48

IRON POLYSACCHARIDE COMPLEX 49

IRON/FOLIC ACID/VITAMIN B COMP AND

C/MINERALS 48

ISAVUCONAZONIUM SULFATE 77

ISENTRESS 122

ISENTRESS HD 122

ISIBLOOM 212

ISONIAZID 98

ISOSORBIDE DINITRATE 266

ISOSORBIDE MONONITRATE 266

ISOTRETINOIN 259,260,262

ISRADIPINE 149

ISTALOL 82

ISTRADEFYLLINE 154

ISTURISA 239

ITRACONAZOLE 77

IVABRADINE HCL 150

IVACAFTOR 159

IVERMECTIN 35,42

IVOSIDENIB 113

IXAZOMIB CITRATE 110

IXEKIZUMAB 261,262

IXIARO 131


IXINITY 85

J JAIMIESS 212

JAKAFI 107

JALYN 226

JANSSEN COVID-19 VACCINE (EUA) 131

JANUMET 72

JANUMET XR 72

JANUVIA 72

JAPANESE ENCEPHALITIS VACCINE/PF 131

JARDIANCE 73

JASMIEL 212

JENCYCLA 212

JENTADUETO 72

JENTADUETO XR 72

JINTELI 181

JIVI 85

JOLESSA 212

JORNAY PM 31

JUBLIA 79

JULEBER 212

JULUCA 122

JUNEL 212

JUNEL FE 212

JUNEL FE 24 212

JUVEN 174

JUXTAPID 90

JYNNEOS (NATIONAL STOCKPILE) 131

K KADIAN 17

KALBITOR 228

KALETRA 124

KALLIGA 213

KALYDECO 159

KAPSPARGO SPRINKLE 151

KARIVA 213

KAZANO 72

KEFLEX 156

KELNOR 1-35 213

KELNOR 1-50 213

KENWOOD THERAPEUTIC 269

KEPPRA 60,61

KEPPRA XR 61

KERYDIN 81

KESIMPTA PEN 234

KETOCONAZOLE 77,79

KETODAN 79

KETONEX-1 174

KETONEX-2 174

KETOPROFEN 243

KETOROLAC TROMETHAMINE 43,44,243

KETOROLAC TROMETHAMINE/PF 43

KETOSTIX REAGENT 266

KETOTIFEN FUMARATE 182,183

KEVZARA 231

KINERET 231

KINRIX 131

KIONEX 224

KISQALI 107

KISQALI FEMARA CO-PACK 107,108

KITABIS PAK 50

KLOR-CON M10 178

KLOR-CON M15 178

KLOR-CON M20 178

KLOXXADO 155

KOATE 86

KOGENATE FS 86

KOMBIGLYZE XR 72

KONSYL 199

KOSELUGO 108

KOVALTRY 86

KURVELO 213

KYNMOBI 172

L LABETALOL HCL 151

LAC-HYDRIN FIVE 180

LACOSAMIDE 65

LACTAID FAST ACT 202

LACTASE 202


LACTOSE-REDUCED FOOD 177

LACTULOSE 173

LAMICTAL 61

LAMICTAL (BLUE) 61

LAMICTAL (GREEN) 61

LAMICTAL (ORANGE) 61

LAMICTAL ODT 61

LAMICTAL ODT (BLUE) 61

LAMICTAL ODT (GREEN) 61

LAMICTAL ODT (ORANGE) 61

LAMICTAL XR 61

LAMICTAL XR (BLUE) 61

LAMICTAL XR (GREEN) 61

LAMICTAL XR (ORANGE) 61

LAMISIL 78

LAMIVUDINE 123

LAMIVUDINE/ZIDOVUDINE 123

LAMOTRIGINE 61,62,64

LAMPIT 117

LANADELUMAB-FLYO 228

LANAFLEX 175

LANCETS 160,161,162,164,165,166,167

LANCETS WITH BLOOD GLUCOSE TEST

STRIPS 164,165

LANCING DEVICE 160,162

LANCING DEVICE/LANCETS 160,164

LANOLIN 180,181

LANOLIN ALCOHOLS/MINERAL

OIL/PETROLATUM,WHITE/CERESIN 180

LANSOPRAZOLE 135,136,137

LANTHANUM CARBONATE 223

LANTISEPTIC 180

LANTUS 220

LANTUS SOLOSTAR 220

LAPATINIB DITOSYLATE 108

LARIN 213

LARIN 24 FE 213

LARIN FE 213

LARISSIA 213

LAROTRECTINIB SULFATE 114

LASMIDITAN SUCCINATE 97

LASTACAFT 182

LATANOPROST 84

LATANOPROSTENE BUNOD 84

LATUDA 119

LAXACLEAR 199

LEDIPASVIR/SOFOSBUVIR 205

LEENA 213

LEFAMULIN ACETATE 52

LEFLUNOMIDE 231

LEMBOREXANT 140

LEMTRADA 234

LENALIDOMIDE 111

LENVATINIB MESYLATE 108

LENVIMA 108

LESCOL XL 93

LESSINA 213

LETAIRIS 253

LETERMOVIR 137

LETROZOLE 108

LEUCOVORIN CALCIUM 226

LEUKERAN 108

LEUKINE 146

LEVALBUTEROL HCL 145

LEVALBUTEROL TARTRATE 145

LEVEMIR 220

LEVEMIR FLEXTOUCH 220

LEVETIRACETAM 60,61,62,63,64

LEVOBUNOLOL HCL 82

LEVOCARNITINE 175,239

LEVOCARNITINE (WITH SUGAR) 239

LEVOCETIRIZINE DIHYDROCHLORIDE 89

LEVODOPA 116

LEVOFLOXACIN 37,51

LEVOMEFOLATE CALCIUM 276

LEVOMILNACIPRAN HCL 68

LEVONEST 213

LEVONORGESTREL 209,213,214,215

LEVONORGESTREL/ETHINYL

ESTRADIOL 209,210,211,212,213,214,215,216,217

LEVONORGESTREL/ETHINYL ESTRADIOL AND

ETHINYL ESTRADIOL 209,210,211,212,213,215


LEVORA-28 213

LEVOTHYROXINE SODIUM 265,266

LEXAPRO 69

LEXIVA 124

LIALDA 192

LIDOCAINE 255,256

LIDOCAINE HCL 185,186

LIDOCAINE HCL/HYDROCORTISONE

ACETATE 47,255,256

LIDOCAINE/PRILOCAINE 255,256

LIDODERM 256

LILLOW 213

LINACLOTIDE 203

LINAGLIPTIN 72

LINAGLIPTIN/METFORMIN HCL 72

LINDANE 41

LINEZOLID 52

LINZESS 203

LIOTHYRONINE SODIUM 266

LIPASE/PROTEASE/AMYLASE 202,203

LIPITOR 94

LIPOFEN 93

LIRAGLUTIDE 73

LISDEXAMFETAMINE DIMESYLATE 28,29

LISINOPRIL 249

LISINOPRIL/HYDROCHLOROTHIAZIDE 249

LITHIUM CARBONATE 153

LITHIUM CITRATE 153

LIVALO 94

LIXISENATIDE 72

LO-ZUMANDIMINE 213

LODOXAMIDE TROMETHAMINE 182

LOJAIMIESS 213

LOMITAPIDE MESYLATE 90

LOMUSTINE 104

LONAFARNIB 239

LONHALA MAGNAIR REFILL 53

LONHALA MAGNAIR STARTER 53

LONSURF 108,109

LOPERAMIDE HCL 193,194,195

LOPHLEX 175

LOPID 93

LOPINAVIR/RITONAVIR 124,125

LOPRESSOR 152

LOPRESSOR HCT 152

LOPROX 81

LORATADINE 87,88,89

LORATADINE-D 89

LORATADINE/PSEUDOEPHEDRINE SULFATE 87,89

LORAZEPAM 142

LORAZEPAM INTENSOL 142

LORBRENA 109

LORCET 18

LORCET HD 18

LORCET PLUS 18

LORLATINIB 109

LORYNA 214

LOSARTAN POTASSIUM 247,248

LOSARTAN

POTASSIUM/HYDROCHLOROTHIAZIDE 248

LOTENSIN 249

LOTENSIN HCT 249

LOTEPREDNOL ETABONATE 42

LOTREL 149

LOVASTATIN 93,94

LOVAZA 90

LOVENOX 57,58

LOW-OGESTREL 214

LOXAPINE SUCCINATE 118

LUBIPROSTONE 200

LULICONAZOLE 79

LUMACAFTOR/IVACAFTOR 159

LUMAKRAS 109

LUMATEPERONE TOSYLATE 118

LUMIGAN 84

LUNESTA 140

LURASIDONE HCL 119

LUSPATERCEPT-AAMT 147

LUTERA 214

LUZU 79

LYLEQ 214

LYNPARZA 109


LYRICA 62

LYRICA CR 11,12

LYUMJEV 222

LYUMJEV KWIKPEN U-100 222

LYUMJEV KWIKPEN U-200 222

LYZA 214

M M-M-R II VACCINE 131

MACITENTAN 253

MAGNESIUM CARBONATE/ALUMINUM

HYDROXIDE 190,191

MAGNESIUM CITRATE 196,197,199,200,201,202

MAGNESIUM GLUCONATE 178

MAGNESIUM

HYDROXIDE 196,197,198,199,200,201,202

MAGNESIUM HYDROXIDE/ALUMINUM

HYDROXIDE/SIMETHICONE 190,191,192

MAGNESIUM OXIDE 191,192

MAGOX 400 192

MALATHION 41,42

MARAVIROC 122

MARLISSA 214

MATULANE 109

MATZIM LA 148

MAVENCLAD 237

MAVYRET 205

MAXALT 96

MAXALT MLT 96

MAYZENT 235

MEASLES, MUMPS, AND RUBELLA VACCINE

LIVE/PF 131

MEASLES, MUMPS, RUBELLA, AND VARICELLA

VACCINE LIVE/PF 132

MECHLORETHAMINE HCL 114

MECLIZINE HCL 76

MEDROL 208

MEDROXYPROGESTERONE ACETATE 218

MEFENAMIC ACID 243

MEFLOQUINE HCL 117

MEGACE ES 218

MEGESTROL ACETATE 218

MEKINIST 109

MEKTOVI 110

MELOXICAM 243

MELPHALAN 110

MEMANTINE HCL 154

MEMANTINE HCL/DONEPEZIL HCL 154

MENACTRA 131

MENINGOCOCCAL A DIPHTHERIA-CONJ VACCINE

COMPONENT 1 OF 2/PF 132

MENINGOCOCCAL C,Y,W-135,DIP-CONJ VACCINE

COMPONENT 2 OF 2/PF 132

MENINGOCOCCAL GROUP B VACCINE, 4-

COMPONENT 129

MENINGOCOCCAL VACCINE A,C,Y AND W-

135,CONJ TETANUS TOXOID/PF 131

MENINGOCOCCALVACCINE A,C,Y,W-

135,DIPHTHERIA TOXOID CONJ/PF 131

MENQUADFI 131

MENTHOL/CAMPHOR 259,261

MENVEO A-C-Y-W-135-DIP 131

MENVEO MENA COMPONENT 132

MENVEO MENCYW-135 COMPONENT 132

MEPHYTON 282

MEPOLIZUMAB 44

MERCAPTOPURINE 110

MESALAMINE 192,193

MESALAMINE WITH CLEANSING WIPES 193

METADATE ER 31

METAPROTERENOL SULFATE 145

METFORMIN HCL 71

METHADONE HCL 18

METHADONE INTENSOL 18

METHADOSE 18

METHAZOLAMIDE 83

METHENAMINE/METHYLENE BLUE/SOD

PHOS/P.SALICYLATE/HYOSCYAMINE 36

METHIMAZOLE 265

METHOCARBAMOL 255

METHOTREXATE SODIUM 110

METHOTREXATE SODIUM/PF 110


METHOTREXATE/PF 111,236

METHSUXIMIDE 67

METHYLCELLULOSE 196,197,198

METHYLDOPA 219

METHYLERGONOVINE MALEATE 245

METHYLIN 31,32

METHYLPHENIDATE 30

METHYLPHENIDATE HCL 29,30,31,32,33,34,35

METHYLPREDNISOLONE 208

METOCLOPRAMIDE HCL 203

METOLAZONE 172

METOPROLOL SUCCINATE 151,152,153

METOPROLOL

SUCCINATE/HYDROCHLOROTHIAZIDE 151

METOPROLOL TARTRATE 152

METOPROLOL

TARTRATE/HYDROCHLOROTHIAZIDE 152

METRONIDAZOLE 39,40,117

MEXILETINE HCL 49

MICARDIS 248

MICARDIS HCT 248

MICONAZOLE 80

MICONAZOLE 7 79

MICONAZOLE NITRATE 78,79,80

MICONAZOLE NITRATE/ZINC

OXIDE/PETROLATUM,WHITE 80

MICROGESTIN 214

MICROGESTIN FE 214

MIDAZOLAM 66

MIDODRINE HCL 265

MIDOSTAURIN 112

MIGALASTAT HCL 238

MIGLITOL 71

MIGLUSTAT 239

MILI 214

MILNACIPRAN HCL 155

MINERAL OIL 200

MINERAL OIL ENEMA 200

MINERAL OIL/PETROLATUM,HYDROPHILIC 180

MINERAL OIL/PETROLATUM,WHITE 183,184,185

MINITRAN 266

MINOCYCLINE HCL 52

MINOXIDIL 219

MIRABEGRON 144

MIRALAX 200

MIRAPEX 172

MIRAPEX ER 172

MIRTAZAPINE 68

MISCELLANEOUS ELECTROLYTE

REPLACEMENT/YERBA SANTA 178

MISOPROSTOL 135

MOBIC 243

MODAFINIL 35

MODERNA COVID-19 VACCINE (EUA) 132

MOEXIPRIL HCL 249

MOMETASONE FUROATE 42,43,47,158

MOMETASONE FUROATE/FORMOTEROL

FUMARATE 158

MONISTAT 7 80

MONO-LINYAH 214

MONOMETHYL FUMARATE 233

MONONINE 86

MONTELUKAST SODIUM 44

MORPHABOND ER 18

MORPHINE SULFATE 17,18,19,20,21

MORPHINE SULFATE/NALTREXONE HCL 13,14

MOUTHKOTE 178

MOVANTIK 203

MOXEZA 37

MOXIFLOXACIN HCL 37,38,51

MS CONTIN 20,21

MSUD AID 175

MSUD EXPRESS COOLER 175

MSUD EXPRESS15 175

MUCINEX 252

MUCUS ER 252

MUCUS RELIEF D 252

MUCUS RELIEF ER 252

MULTAQ 49

MULTILEX 269

MULTIVIT 42/IRON CARBONYL,B-G

CHE/METHYLTETRAHYDROFOLATE/DHA 270


MULTIVIT NO.37/IRON/L-MEFOLATE CALC./ALGAL

OIL/SOY LECITHIN 270

MULTIVIT NO.38/METHYLTETRAHYDFOLATE

GLUCOS,FOLIC ACID/GINGER 272

MULTIVIT NO.41/IRON CYSTEINE

GLYCINAT/FOLATE NO.8/PHOSPH-DHA 269

MULTIVIT WITH CALCIUM, IRON, AND OTHER

MINERALS 275

MULTIVIT-MINS NO.73/IRON

FUMARATE,POLYSACC COMP/FOLIC ACID 273

MULTIVITAMIN 268,269,270,271

MULTIVITAMIN COMBINATION NO.43/FERROUS

FUMARATE/FOLIC ACID 274


FUM/FOLATE NO.1/DHA 271,274,275



MULTIVITAMIN

NO.36/METHYLTETRAHYDROFOLATE GLUC,FOLIC

ACID 272

MULTIVITAMIN NO.40/IRON ASPARTO

GLYCINATE/FOLATE NO.1/DHA 272

MULTIVITAMIN NO.45/IRON FUMARATE/FOLATE

COMB NO.6/DHA 272

MULTIVITAMIN WITH FOLIC ACID 269,274

MULTIVITAMIN WITH IRON 268,269,270,271

MULTIVITAMIN WITH IRON AND OTHER

MINERALS 268,273,274

MULTIVITAMIN WITH

MINERALS 268,269,270,271,273

MULTIVITAMIN WITH MINERALS NO.61/FERROUS


MULTIVITAMIN WITH MINERALS

NO.69/IRON,CARBONYL/FOLIC ACID 269,270

MULTIVITAMIN WITH MINERALS NO.7/FOLIC

ACID 274

MULTIVITAMIN WITH MINERALS/FERROUS

GLUCONATE 268

MULTIVITAMIN WITH MINERALS/FERROUS

SULFATE 269,271

MULTIVITAMIN WITH MINERALS/FOLIC

ACID/LYCOPENE/LUTEIN 267,268

MULTIVITAMIN WITH MINERALS/LUTEIN 274

MULTIVITAMIN, MINERALS NO.51/FOLIC ACID/VIT

K1/UBIDECARENONE 267

MULTIVITAMIN,STRESS FORMULA 273

MULTIVITAMIN,STRESS FORMULA/ZINC 273

MULTIVITAMIN,THERAPEUTIC 269,271,274

MULTIVITAMIN,THERAPEUTIC WITH MINERALS 275

MULTIVITAMIN-MINERALS NO.60/FERROUS


MULTIVITAMIN-MINERALS NO.62/FERROUS


MULTIVITAMIN/FERROUS FUMARATE/FOLIC

ACID 268,269,273,274

MULTIVITAMIN/FERROUS SULFATE/FOLIC

ACID 274

MUPIROCIN 38,40

MUPIROCIN CALCIUM 40

MV-MIN 75/FERROUS FUM/IRON PS CPLX/FOLIC

AC/OMEGA-3/DHA/EPA 268,274

MV-MINS NO.74/FERROUS FUMARATE/IRON PS

CPLX/FOLIC ACID 268

MVC-FLUORIDE 270

MY WAY 214

MYCOPHENOLATE MOFETIL 236,237

MYCOPHENOLATE SODIUM 237

MYDAYIS 28

MYFORTIC 237

MYLERAN 110

MYORISAN 260

MYRBETRIQ 144

MYSOLINE 66

N NABUMETONE 243

NADOLOL 151,152

NAFTIFINE HCL 78

NAFTIN 78

NALDEMEDINE TOSYLATE 203

NALOXEGOL OXALATE 203


NALOXONE HCL 155,156

NALTREXONE HCL 156

NAMENDA 154

NAMENDA XR 154

NAMZARIC 154

NAPHAZOLINE HCL/PHENIRAMINE MALEATE 186

NAPHCON-A 186

NAPROXEN 241,243,244

NAPROXEN SODIUM 240,241,242,243,244,245

NAPROXEN/ESOMEPRAZOLE MAGNESIUM 245

NARATRIPTAN HCL 95,96

NARCAN 156

NASALCROM 45

NASONEX 42

NATACHEW 270

NATALIZUMAB 236

NATEGLINIDE 73

NATESTO 208

NATROBA 41

NATROL 5-HTP 239

NAYZILAM 66

NEBIVOLOL HCL 151

NECON 214

NEDOCROMIL SODIUM 45

NEEVODHA 270

NEFAZODONE HCL 70

NEISSERIA MENINGITIDIS GROUP B, LIPIDATED

FHBP RECOMBINANT 133

NEO-POLYCIN 37

NEOCATE INFANT DHA-ARA 175

NEOCATE JUNIOR 175

NEOMYCIN SULF/BACITRACIN ZINC/POLYMYXIN B

SULF/PRAMOXINE HCL 40

NEOMYCIN SULFATE 50

NEOMYCIN SULFATE/BACITRACIN

ZINC/POLYMYXIN B 39,40

NEOMYCIN SULFATE/BACITRACIN/POLYMYXIN

B 37

NEOMYCIN SULFATE/POLYMYXIN B

SULFATE/GRAMICIDIN D 37

NEOMYCIN SULFATE/POLYMYXIN B

SULFATE/HYDROCORTISONE 37

NEOMYCIN/POLYMYXIN B

SULFATE/DEXAMETHASONE 37

NEORAL 237

NEOSPORIN 40

NEPAFENAC 44

NEPHRONEX-SL 276

NERATINIB MALEATE 110

NERLYNX 110

NESINA 72

NESTABS 270

NESTABS ABC 270

NESTABS DHA 270

NESTABS ONE 270

NETARSUDIL MESYLATE 84

NETARSUDIL MESYLATE/LATANOPROST 84

NETUPITANT/PALONOSETRON HCL 76

NEUAC 40

NEUPRO 172

NEURONTIN 62,63

NEVANAC 44

NEVIRAPINE 123

NEXAVAR 110

NEXIUM 136

NEXLETOL 90

NEXLIZET 90

NIACIN 90,91

NIACOR 91

NIASPAN 91

NICARDIPINE HCL 149

NICOTINE 142,143

NICOTINE POLACRILEX 142,143

NICOTROL 143

NICOTROL NS 143

NIFEDIPINE 149

NIFURTIMOX 117

NIKKI 214

NILOTINIB HCL 113

NIMODIPINE 149

NINLARO 110


NINTEDANIB ESYLATE 250

NIRAPARIB TOSYLATE 115

NISOLDIPINE 149,150

NITAZOXANIDE 118

NITRO-BID 267

NITROFURANTOIN 36

NITROFURANTOIN MACROCRYSTAL 36

NITROFURANTOIN

MONOHYDRATE/MACROCRYSTALS 36

NITROGLYCERIN 266,267

NONOXYNOL 9 240

NORA-BE 214

NORDITROPIN FLEXPRO 218

NORELGESTROMIN/ETHINYL ESTRADIOL 217

NORETHINDRONE 210,211,212,214,215,217

NORETHINDRONE ACETATE 219

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL 181,182,210,212,213,214

NORETHINDRONE ACETATE-ETHINYL

ESTRADIOL/FERROUS

FUMARATE 210,212,213,214,216

NORETHINDRONE-ETHINYL

ESTRADIOL 209,210,211,213,214,215,217

NORGESTIMATE-ETHINYL

ESTRADIOL 211,212,214,215,216,217

NORGESTREL-ETHINYL ESTRADIOL 211,214,215

NORLYDA 214

NORPACE CR 49

NORTREL 214

NORTRIPTYLINE HCL 71

NORVASC 149

NORVIR 125

NOURIANZ 154

NOVA MAX GLUCOSE TEST STRIPS 170

NOVAVAX COVID19 VAC,ADJ(UNAPP) 132

NOVOEIGHT 86

NOVOLIN 70-30 219

NOVOLIN 70-30 FLEXPEN 220

NOVOLIN N 220

NOVOLIN N FLEXPEN 220

NOVOLIN R 223

NOVOLIN R FLEXPEN 223

NOVOLOG 222

NOVOLOG FLEXPEN 222

NOVOLOG MIX 70-30 222

NOVOLOG MIX 70-30 FLEXPEN 222

NOVOSEVEN RT 86

NOXAFIL 77

NU-IRON 150 49

NUBEQA 110

NUCALA 44

NUCYNTA ER 21

NUPLAZID 119

NURTEC ODT 95

NUTRITIONAL THERAPY FOR IMPAIRED

DIGESTIVE FUNCTION 175

NUTRITIONAL THERAPY FOR ISOVALERIC

ACIDEMIA WITH IRON 174

NUTRITIONAL THERAPY FOR MSUD WITH

IRON 174,175,177

NUTRITIONAL THERAPY FOR PHENYLKETONURIA

(PKU) NO.31 175


(PKU) NO.54 176


(PKU) NO.67 176


(PKU) NO.8 175


(PKU) WITH IRON NO.1 175








WITH IRON, NO.47 176

NUTRITIONAL THERAPY FOR

PHENYLKETONURIA(PKU) NO.56 176


PHENYLKETONURIA(PKU) WITH IRON NO.25 175


















NUTRITIONAL THERAPY FOR PKU NO.64 174

NUTRITIONAL THERAPY FOR TYROSINEMIA WITH

IRON 176,177

NUTRITIONAL THERAPY FOR TYROSINEMIA

WITHOUT IRON 176

NUTRITIONAL THERAPY, GLUTARIC ACIDURIA

TYPE 1 174

NUTRITIONAL THERAPY, METABOLIC DISORDER,

METHIONINE-FREE 174

NUTRITIONAL THERAPY, UREA CYCLE

DISORDER 173

NUTRITIONAL THERAPY, UREA CYCLE DISORDER

WITHOUT IRON 173

NUTRITIONAL TX FOR PHENYLKETONURIA (PKU)

WITH IRON, COMB #20 175

NUTROPIN AQ NUSPIN 218

NUWIQ 86

NUZYRA 265

NYAMYC 81

NYLIA 215

NYMALIZE 149

NYMYO 215

NYSTATIN 77,81

NYSTATIN/TRIAMCINOLONE ACETONIDE 81

NYSTOP 81

NYVEPRIA 146

O O-CAL FA 270

O-CAL PRENATAL 270

OB COMPLETE 270

OB COMPLETE ONE 270

OB COMPLETE PETITE 271

OB COMPLETE PREMIER 271

OB COMPLETE WITH DHA 271

OBIZUR 86

OC8 258

OCELLA 215

OCRELIZUMAB 235

OCREVUS 235

OCTAGAM 128

OCTREOTIDE ACETATE 262,263

OCTREOTIDE ACETATE, MICROSPHERES 263,264

OCUFLOX 37

ODEFSEY 123

ODOMZO 110

OFATUMUMAB 234

OFEV 250

OFLOXACIN 37,51

OGESTREL 215

OKEBO 52

OLANZAPINE 119,121

OLANZAPINE PAMOATE 121

OLANZAPINE/FLUOXETINE HCL 69,70

OLAPARIB 109

OLMESARTAN MEDOXOMIL 247,248

OLMESARTAN MEDOXOMIL/AMLODIPINE

BESYLATE/HYDROCHLOROTHIAZIDE 248

OLMESARTAN

MEDOXOMIL/HYDROCHLOROTHIAZIDE 247,248

OLODATEROL HCL 145

OLOPATADINE HCL 182,183

OLSALAZINE SODIUM 192

OLUMIANT 231

OMADACYCLINE TOSYLATE 265


OMBITASVIR/PARITAPREVIR/RITONAVIR/DASABU

VIR SODIUM 206

OMEGA-3 ACID ETHYL ESTERS 90,91

OMEGA-3 FATTY ACIDS/FISH OIL 90

OMEPRAZOLE 136

OMEPRAZOLE MAGNESIUM 137

OMEPRAZOLE MAGNESIUM/AMOXICILLIN

TRIHYDRATE/RIFABUTIN 133

OMEPRAZOLE/SODIUM BICARBONATE 135,136,137

OMNARIS 42

OMNITROPE 218

ONDANSETRON 75

ONDANSETRON HCL 75

ONE DAILY COMPLETE 271

ONE DAILY MULTIVITAMIN-MINERAL 271

ONE DAILY PLUS MINERALS 271

ONETOUCH DELICA 164

ONETOUCH ULTRA TEST STRIP 170

ONETOUCH ULTRA2 164

ONETOUCH ULTRAMINI 164

ONETOUCH VERIO FLEX METER 164

ONETOUCH VERIO FLEX STARTR KIT 165

ONETOUCH VERIO IQ METER 165

ONETOUCH VERIO IQ SYSTEM KIT 165

ONETOUCH VERIO METER 165

ONETOUCH VERIO REFLECT KIT 165

ONETOUCH VERIO REFLECT METER 165

ONETOUCH VERIO TEST STRIP 170

ONEXTON 40

ONFI 66

ONGENTYS 116

ONGLYZA 72

ONMEL 77

ONUREG 111

ONZETRA XSAIL 96

OPICAPONE 116

OPSUMIT 253

ORALONE 47

ORAVIG 80

ORENCIA 231

ORENCIA CLICKJECT 232

ORENITRAM ER 253

ORGOVYX 205

ORIAHNN 205

ORILISSA 205

ORKAMBI 159

ORLADEYO 228

ORSYTHIA 215

OSELTAMIVIR PHOSPHATE 138

OSENI 72

OSILODROSTAT PHOSPHATE 239

OSIMERTINIB MESYLATE 113

OTEZLA 232

OTIPRIO 37

OTOVEL 37

OVIDE 42

OXAPROZIN 244

OXBRYTA 146

OXCARBAZEPINE 63,64

OXERVATE 184

OXICONAZOLE NITRATE 80

OXISTAT 80

OXTELLAR XR 63

OXYBUTYNIN 204

OXYBUTYNIN CHLORIDE 204

OXYCODONE HCL 21,22,23

OXYCODONE HCL/ACETAMINOPHEN 14,22

OXYCODONE HCL/ASPIRIN 22

OXYCODONE MYRISTATE 23

OXYCONTIN 22,23

OXYMETAZOLINE HCL 186

OXYMORPHONE HCL 23

OXYTROL 204

OZANIMOD HYDROCHLORIDE 236

OZEMPIC 72,73

OZENOXACIN 40

P PACERONE 49

PAIN RELIEF 11

PALBOCICLIB 104,105

PALFORZIA 126


PALIPERIDONE 119

PALIPERIDONE PALMITATE 119

PANCREAZE 202

PANTOPRAZOLE SODIUM 136,137

PANZYGA 128

PAREGORIC 194

PAROEX 38

PAROXETINE HCL 69,70

PAROXETINE MESYLATE 69,70

PASIREOTIDE DIASPARTATE 264

PATADAY 183

PATANASE 183

PATANOL 183

PAXIL 70

PAXIL CR 70

PAZEO 183

PAZOPANIB HCL 114

PEANUT ALLERGEN POWDER-DNFP 126

PEDIA-LAX 200

PEDIALYTE 179

PEDIARIX 132

PEDIATRIC MULTIVIT NO.37/SODIUM

FLUORIDE/IRON BISGLYCIN.HCL 272

PEDIATRIC MULTIVIT WITH A,C,D3 NO.21/SODIUM

FLUORIDE 274,275

PEDIATRIC MULTIVITAMIN A,C,AND D3 NO.38

WITH SODIUM FLUORIDE 274

PEDIATRIC MULTIVITAMIN NO.12 WITH SODIUM

FLUORIDE 270

PEDIATRIC MULTIVITAMIN NO.144 268

PEDIATRIC MULTIVITAMIN NO.158/FERROUS

FUMARATE/PHYTONADIONE 268

PEDIATRIC MULTIVITAMIN NO.16/SODIUM

FLUORIDE 270

PEDIATRIC MULTIVITAMIN NO.17 268

PEDIATRIC MULTIVITAMIN NO.171 271,272


FLUORIDE 270


FLUORIDE 271


FLUORIDE/IRON CARBONYL 272


FLUORIDE 271

PEDIATRIC MULTIVITAMIN NO.40/PHYTONADIONE

(VIT K1) 268


FLUORIDE/FERROUS SULFATE 269,270


FLUORIDE 273


FLUORIDE 273


FLUORIDE 269

PEDVAXHIB 132

PEG 3350/SOD SULF/SOD BICARB/SOD

CHLORIDE/POTASSIUM CHLORIDE 198,200

PEGANONE 67

PEGASYS 138

PEGASYS PROCLICK 138

PEGFILGRASTIM-APGF 146

PEGFILGRASTIM-BMEZ 147

PEGFILGRASTIM-CBQV 147

PEGFILGRASTIM-JMDB 146

PEGINTERFERON ALFA-2A 138

PEGINTERFERON ALFA-2B 138

PEGINTERFERON BETA-1A 235

PEGINTRON 138

PEMAZYRE 111

PEMIGATINIB 111

PENCICLOVIR 40

PENICILLAMINE 206,207

PENICILLIN V POTASSIUM 246

PENLAC 81

PENTACEL 132

PENTACEL ACTHIB COMPONENT 132

PENTACEL DTAP-IPV COMPONENT 132

PENTASA 193

PENTOSAN POLYSULFATE SODIUM 240

PENTOXIFYLLINE 147

PEPCID AC 134


PERAMPANEL 60

PERFOROMIST 145

PERIFLEX ADVANCE 175

PERIFLEX LQ PKU 175

PERINDOPRIL ERBUMINE 249

PERIOGARD 38

PERMETHRIN 41,42

PERPHENAZINE 122

PERSERIS 120

PERTZYE 203

PETROLATUM,WHITE 180

PEXEVA 70

PEXIDARTINIB HYDROCHLORIDE 113

PFIZER COVID-19 VACCINE (EUA) 132

PHENADOZ 189

PHENAZOPYRIDINE HCL 256

PHENELZINE SULFATE 68

PHENEX-1 175

PHENEX-2 175

PHENOBARBITAL 141

PHENOXYBENZAMINE HCL 9

PHENYL-FREE 2 175

PHENYL-FREE 2HP 175

PHENYLADE 175

PHENYLADE GMP 175

PHENYLEPHRINE HCL 186

PHENYLEPHRINE HCL/PROMETHAZINE HCL 189

PHENYTEK 67

PHENYTOIN 67

PHENYTOIN SODIUM EXTENDED 67

PHILITH 215

PHLEXY-10 175,176

PHOS-NAK 179

PHOSLYRA 223

PHYTONADIONE (VIT K1) 282

PICATO 111

PILOCARPINE HCL 83,143

PIMAVANSERIN TARTRATE 119

PIMECROLIMUS 260

PIMOZIDE 118

PIMTREA 215

PINDOLOL 152

PIOGLITAZONE HCL 75

PIOGLITAZONE HCL/GLIMEPIRIDE 75

PIOGLITAZONE HCL/METFORMIN HCL 75

PIP LANCET 165

PIPERONYL BUTOXIDE/PYRETHRINS 41

PIPERONYL

BUTOXIDE/PYRETHRINS/PERMETHRIN 41

PIRFENIDONE 250

PIRMELLA 215

PIROXICAM 244

PITAVASTATIN CALCIUM 94

PITAVASTATIN MAGNESIUM 94

PITOLISANT HCL 35

PKU COOLER 10 176

PKU COOLER 15 176

PKU COOLER 20 176

PKU EASY 176

PKU EXPLORE10 176

PKU EXPRESS15 176

PKU EXPRESS20 176

PKU GEL 176

PKU GO 176

PKU LOPHLEX 176

PKU PERIFLEX JUNIOR PLUS 176

PKU SPHERE15 176

PKU SPHERE20 176

PLAN B ONE-STEP 215

PLAVIX 125

PLEGRIDY 235

PLEGRIDY PEN 235

PNEUMOCOCCAL 13-VALENT CONJUGATE

VACCINE (DIPHTHERIA CRM)/PF 132





PNEUMOCOCCAL 23-VALENT POLYSACCHARIDE

VACCINE 132

PNEUMOVAX 23 132


PNV NO.72/FERROUS FUMARATE/FOLIC

ACID/OMEGA-3/DHA 272

PODOFILOX 260

POGO AUTOMATIC BLOOD GLUC SYS 165

POGO AUTOMATIC TEST CARTRIDGE 165

POLIOMYELITIS VACCINE, KILLED 131

POLY-VI-FLOR 271

POLY-VI-FLOR WITH IRON 272

POLYCIN 37

POLYETHYLENE GLYCOL 3350 196,198,199,200,202

POLYMYXIN B SULFATE/TRIMETHOPRIM 37

POLYVINYL ALCOHOL 184

POLYVINYL ALCOHOL/POVIDONE/PF 185

POMALIDOMIDE 111

POMALYST 111

PONATINIB HCL 105

PORTIA 215

POSACONAZOLE 77

POTASSIUM CHLORIDE 178,179

POTASSIUM CITRATE 173

POVIDONE-IODINE 41

POWDERLAX 200

PRADAXA 56

PRALSETINIB 104

PRALUENT PEN 94

PRAMIPEXOLE DI-HCL 172

PRAMLINTIDE ACETATE 71

PRASUGREL HCL 125

PRAVACHOL 94

PRAVASTATIN SODIUM 94

PRAZIQUANTEL 35

PRAZOSIN HCL 150

PRECISION XTRA 165,170

PRECISION XTRA KETONE-GLUCOSE 165

PRECOSE 71

PREDNISOLONE 208

PREDNISOLONE ACETATE 43

PREDNISOLONE SODIUM PHOSPHATE 43,208

PREDNISONE 208

PREDNISONE INTENSOL 208

PREGABALIN 11,12,62,63

PREMIER CLASSIC GLUCOSE METER 165

PRENATA 272

PRENATABS FA 272

PRENATABS RX 272

PRENATAL NO56/IRON CARBONYL,ASPARTO

GLYCINATE/FOLIC ACID/DHA 271

PRENATAL VIT NO.112/IRON PHOSPH/FOLIC

ACID/OMEGA-3S/DHA/EPA 274

PRENATAL VIT NO.30/IRON CARBONYL,ASP

GLYC/FOLIC ACID/OMEGA-3 271

PRENATAL VIT NO.67/IRON

POLYSACCHARIDES/FOLATE COMB.NO.1/DHA 274

PRENATAL VIT NO.71/IRON FUM-SODIUM

FEREDETATE/FOLIC ACID/DHA 275

PRENATAL VIT NO.85/IRON CARB,ASP.GLY/FOLIC

ACID/DHA/FISH OIL 270

PRENATAL VIT WITH CALCIUM NO.127/FERROUS


PRENATAL VIT WITH CALCIUM NO.130/FERROUS


PRENATAL VITAMIN 27 WITH CALCIUM/FERROUS


PRENATAL VITAMIN COMB NO.86/IRON PS

CMPLX/FOLIC ACID/DHA/EPA 270

PRENATAL VITAMIN

NO.48/IRON,CARBONYL,GLUCONATE/FOLIC

ACID/B6 268

PRENATAL VITAMIN NO.52/IRON/FOLIC

ACID/OMEGA-3/DHA 268,274

PRENATAL VITAMIN NO.55/IRON

FUMARATE,BISGLYCINATE/FOLIC ACID 270

PRENATAL VITAMIN NO.86/IRON BIS-

GLYCINATE/FOLIC ACID 270

PRENATAL VITAMIN WITH CALCIUM

NO.76/IRON,CARBONYL/FOLIC ACID 271,272

PRENATAL VITAMINS COMBINATION NO.42/FOLIC

ACID 275

PRENATAL VITAMINS NO.14/FERROUS



GLUCONATE/FOLIC ACID 268,275


PRENATAL VITAMINS NO.33/IRON POLYSACH

COMPLEX/FOLIC ACID/DHA 273


FUMARATE/FOLATE COMB. NO.6 272



PRENATAL VITAMINS NO.68/IRON

FUMARATE/FOLATE NO.6/DHA 272


FUMARATE/FOLATE COMB NO.6/DHA 273

PRENATAL VITAMINS NO.77/FERROUS ASPARTO

GLYCINATE/FOLIC ACID 273


FUMARATE/FOLATE COMBO NO.6/DHA 268

PRENATAL VITAMINS NO.85/IRON ASPARTO

GLYCIN/FOLATE NO.1/DHA 273

PRENATAL VITAMINS NO.90/IRON FUM,POLYSAC

COMP/FOLIC ACID/DHA 273


CARBONYL/FOLATE COMB NO.9/DHA 274

PRENATAL VITAMINS WITH CALCIUM/FERROUS


PRENATAL VITS 106/SOD FEREDETATE-IRON

PS/FOLIC ACID/OMEGA-3S 269

PRENATAL VITS NO.105/IRON AMINO ACID

CHELATE/FOLIC ACID/DHA 272,275

PRENATAL VITS NO.117/SOD FEREDET.-IRON

PS/FOLIC/OM3/DHA/EPA 269

PRENATAL VITS NO.118/IRON ASPARTO

GLYCINATE/FOLATE NO.6/DHA 273

PRENATAL VITS NO.25/FERROUS

FUMARATE/FOLATE COMB. NO.6/DHA 275

PRENATAL VITS NO.26/IRON POLYSACCHARIDE

CPLEX/FOLIC ACID/DHA 275

PRENATAL VITS NO.65/IRON

FUMARATE,POLYSAC COMPLEX/FOLIC ACID 273

PRENATAL VITS NO.83/IRON,CARBONYL,IRON

ASPART.GLY/FOLIC ACID 271

PRENATAL VITS NO.87/IRON CARB-

ASP.GLYCINATE/FOLATE NO.1/DHA 273

PRENATAL VITS WITH CALCIUM 103/FERROUS



FUMARATE/FOLIC ACID 272,273






FUMARATE/FOLIC ACID 269,272,273

PRENATAL VITS WITH CALCIUM NO.10/FERROUS



FUMARATE/FOLIC ACID 269,271,272,273

PRENATAL VITS WITH CALCIUM

NO.72/IRON,CARBONYL/FOLIC ACID 272






FUMARATE/FOLIC ACID 272,273

PRENATAL VITS WITH CALCIUM NO.87/IRON

BISGLY/FOLIC ACID/DHA 270

PRENATE AM 272

PRENATE CHEWABLE 272

PRENATE DHA 272

PRENATE ELITE 272

PRENATE ENHANCE 272

PRENATE ESSENTIAL 272

PRENATE MINI 273

PRENATE PIXIE 273

PRENATE RESTORE 273

PRENATE STAR 273

PRESERVISION AREDS 2 239

PRESERVISION LUTEIN 239

PRETOMANID 98

PREVACID 136,137

PREVALITE 92

PREVIFEM 215

PREVNAR 13 132


PREVNAR 20 132

PREVYMIS 137

PREZCOBIX 125

PREZISTA 125

PRIFTIN 99

PRILOSEC 137

PRIMACARE 273

PRIMIDONE 66

PRINIVIL 249

PRISTIQ 68

PRO-PHREE 176

PROAIR DIGIHALER 145

PROAIR HFA 145

PROAIR RESPICLICK 145

PROBENECID 180

PROBENECID/COLCHICINE 180

PROBUPHINE 25

PROCARBAZINE HCL 109

PROCARDIA 149

PROCARDIA XL 149

PROCENTRA 28

PROCHLORPERAZINE 76

PROCHLORPERAZINE MALEATE 76

PROCRIT 146

PROCTO-MED HC 47

PROCTOSOL-HC 47

PROCTOZONE-HC 47

PRODIGY 166

PRODIGY AUTOCODE 166

PRODIGY NO CODING 171

PRODIGY POCKET 166

PRODIGY VOICE 166

PROFILNINE 86

PROGESTERONE, MICRONIZED 219

PROGRAF 237

PROLENSA 44

PROLIA 226

PROMACTA 146

PROMETHAZINE HCL 189

PROMETHAZINE HCL/DEXTROMETHORPHAN

HBR 251

PROMETHEGAN 189

PROPAFENONE HCL 49

PROPANTHELINE BROMIDE 53

PROPIMEX-1 176

PROPRANOLOL HCL 151,152

PROPRANOLOL HCL/HYDROCHLOROTHIAZIDE 152

PROPYLENE GLYCOL/POLYETHYLENE GLYCOL

400 183,184

PROPYLTHIOURACIL 265

PROQUAD 132

PROSCAR 226

PROTONIX 137

PROTOPIC 261

PROVENTIL HFA 145

PROVIDA DHA 273

PROVIDA OB 273

PROZAC 70

PSEUDOEPHEDRINE HCL 264,265

PSEUDOEPHEDRINE HCL/ACRIVASTINE 89

PSYLLIUM HUSK 197,198,199,200

PSYLLIUM HUSK (WITH SUGAR) 199,201

PSYLLIUM SEED 197,199,200,201

PSYLLIUM SEED (WITH SUGAR) 200

PSYLLIUM SEED/ASPARTAME 197,198

PULMICORT 159

PULMICORT FLEXHALER 159

PULMOZYME 253

PURE COMFORT LANCETS 166

PURE COMFORT SAFETY LANCETS 166

PUREFE OB PLUS 273

PUREFE PLUS 273

PYRANTEL PAMOATE 35,36

PYRAZINAMIDE 99

PYRIDOSTIGMINE BROMIDE 143

PYRIDOXINE HCL (VITAMIN B6) 277

Q QBRELIS 249

QINLOCK 111

QNASL 43

QNASL CHILDREN 43


QTERN 73

QUADRACEL DTAP-IPV 132

QUDEXY XR 63

QUESTRAN 92

QUESTRAN LIGHT 92

QUETIAPINE FUMARATE 120

QUFLORA 273

QUILLICHEW ER 34

QUILLIVANT XR 35

QUINAPRIL HCL 248,249

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE 248,249

QUINIDINE SULFATE 49

QUTENZA 261

QVAR REDIHALER 159

R RABAVERT 132

RABEPRAZOLE SODIUM 135,137

RABIES VACCINE, HUMAN DIPLOID CELL/PF 131

RABIES VACCINE, PURIFIED CHICKEN EMBRYO

CELL (PCEC)/PF 132

RAGWITEK 126

RALOXIFENE HCL 181

RALTEGRAVIR POTASSIUM 122

RAMELTEON 140

RAMIPRIL 248,249

RANITIDINE HCL 133,134,135

RAPAFLO 9

RAPAMUNE 237

RASAGILINE MESYLATE 117

RASUVO 111

RAZADYNE 143

RAZADYNE ER 143

REBIF 235,236

REBIF REBIDOSE 235

REBINYN 86

REBLOZYL 147

RECLIPSEN 215

RECOMBINATE 86

RECOMBIVAX HB 132

REDITREX 236

REFRESH CELLUVISC 185

REFRESH CLASSIC 185

REFRESH LIQUIGEL 185

REFRESH OPTIVE 185

REFRESH OPTIVE SENSITIVE 185

REFRESH P.M. 185

REFRESH PLUS 185

REFRESH RELIEVA 185

REGORAFENIB 112

RELENZA 138

RELPAX 96

RELUGOLIX 205

REMERON 68

REMICADE 232

RENAGEL 223

RENFLEXIS 232

RENVELA 223

REPAGLINIDE 73

REPATHA PUSHTRONEX 94

REPATHA SURECLICK 94

REPATHA SYRINGE 94

REQUIP XL 172

RESTASIS 43

RESTASIS MULTIDOSE 43

RETACRIT 147

RETEVMO 111

RETIN-A 256

RETIN-A MICRO 256

RETIN-A MICRO PUMP 256

REVATIO 267

REVEFENACIN 54

REVLIMID 111

REXULTI 120

REYATAZ 125

REYVOW 97

REZUROCK 239

RHOPRESSA 84

RIAX 258

RIBASPHERE 139

RIBASPHERE RIBAPAK 139

RIBAVIRIN 139


RIBOCICLIB SUCCINATE 107

RIBOCICLIB SUCCINATE/LETROZOLE 107,108

RIBOFLAVIN (VITAMIN B2) 277

RIDAURA 204

RIFABUTIN 99

RIFAMPIN 99

RIFAPENTINE 99

RIFAXIMIN 52

RIGHTEST GC700 LEV 2 CTRL SOLN 166

RIGHTEST GM700SB GLUCOSE METER 166

RIGHTEST GS700 TEST STRIP 171

RIGHTEST GT333 GLUCOSE METER 166

RIGHTEST GT333 LEV 2 CTRL SOLN 166

RIGHTEST GT333 TEST STRIP 171

RIGHTEST MAX PLUS GLUCOSE MTR 166

RIGHTEST MAX TEST STRIP 171

RILONACEPT 238

RILPIVIRINE HCL 123

RILUZOLE 154

RIMANTADINE HCL 137

RIMEGEPANT SULFATE 95

RINVOQ 232

RIOCIGUAT 253

RIPRETINIB 111

RISANKIZUMAB-RZAA 261

RISDIPLAM 238

RISEDRONATE SODIUM 226,227

RISPERDAL 120

RISPERDAL CONSTA 120

RISPERIDONE 120

RISPERIDONE MICROSPHERES 120

RITALIN 35

RITALIN LA 35

RITONAVIR 125

RIVAROXABAN 56

RIVASTIGMINE 143,144

RIVASTIGMINE TARTRATE 143,144

RIXUBIS 86

RIZATRIPTAN BENZOATE 96,97

ROBITUSSIN ER 251

ROCKLATAN 84

ROFLUMILAST 253

ROLAPITANT HCL 76

ROPINIROLE HCL 172,173

ROPIVACAINE HCL IN SODIUM CHLORIDE, ISO-

OSMOTIC/PF 224

ROSADAN 40

ROSIGLITAZONE MALEATE 75

ROSUVASTATIN CALCIUM 93,94

ROTARIX 132

ROTATEQ 132

ROTAVIRUS VACCINE, LIVE ORAL

ATTENUATED,89-12 STRAIN, G1P(8) 132

ROTAVIRUS VACCINE, LIVE ORAL

PENTAVALENT 132

ROTIGOTINE 172

ROWASA 193

ROWEEPRA 63

ROWEEPRA XR 63

ROZEREM 140

ROZLYTREK 112

RUCONEST 228

RUFINAMIDE 58,63,64

RUKOBIA 122

RUXOLITINIB PHOSPHATE 107

RUZURGI 239

RYBELSUS 73

RYDAPT 112

RYTARY 116

S SABRIL 64

SACROSIDASE 181

SACUBITRIL/VALSARTAN 247

SAFINAMIDE MESYLATE 117

SAIZEN 218

SAIZEN-SAIZENPREP 218

SAJAZIR 228

SALICYLIC ACID 257,258

SALICYLIC ACID/SULFUR 258

SALIVA STIMULANT COMBINATION NO.3 161

SALMETEROL XINAFOATE 145


SALSALATE 245

SANCUSO 75

SANDIMMUNE 237

SANDOSTATIN LAR DEPOT 263,264

SAPHRIS 120

SAPROPTERIN DIHYDROCHLORIDE 239

SAQUINAVIR MESYLATE 124

SARAFEM 70

SARGRAMOSTIM 146

SARILUMAB 231

SARNA ORIGINAL 261

SATRALIZUMAB-MWGE 234

SAVAYSA 56

SAVELLA 155

SAXAGLIPTIN HCL 72

SAXAGLIPTIN HCL/METFORMIN HCL 72

SCOPOLAMINE 75

SECUADO 120

SECUKINUMAB 259

SEEBRI NEOHALER 53

SEGESTERONE ACETATE/ETHINYL

ESTRADIOL 209

SEGLUROMET 73

SELECT-OB + DHA 273

SELEGILINE HCL 117

SELENIUM SULFIDE 41

SELEXIPAG 254

SELINEXOR 115

SELPERCATINIB 111

SELUMETINIB SULFATE/VITAMIN E TPGS 108

SELZENTRY 122

SEMAGLUTIDE 72,73

SEMGLEE 220

SEMGLEE PEN 220

SEMPREX-D 89

SENNOSIDES 196,197,198,199,200,201,202

SENNOSIDES/DOCUSATE

SODIUM 196,197,198,199,201,202

SENOKOT 201

SEREVENT DISKUS 145

SEROQUEL 120

SEROQUEL XR 120

SEROSTIM 218

SERTRALINE HCL 70

SETLAKIN 215

SEVELAMER CARBONATE 223

SEVELAMER HCL 223,224

SEVENFACT 86

SFROWASA 193

SHAROBEL 215

SHINGRIX 132

SHINGRIX ADJUVANT COMPONENT 247

SHINGRIX GE ANTIGEN COMPONENT 133

SIGNIFOR 264

SIKLOS 112

SILDENAFIL CITRATE 267

SILIQ 261

SILODOSIN 9

SILVER SULFADIAZINE 41

SIMBRINZA 83

SIMETHICONE 195,196

SIMLIYA 215

SIMPESSE 215

SIMPONI 232

SIMPONI ARIA 233

SIMVASTATIN 94

SINEMET 10-100 116

SINEMET 25-100 116

SINEMET 25-250 117

SINEMET CR 117

SINGULAIR 44

SINUS 12 HOUR 265

SINUVA 43

SIPONIMOD 235

SIROLIMUS 237

SIRTURO 99

SITAGLIPTIN PHOSPHATE 72

SITAGLIPTIN PHOSPHATE/METFORMIN HCL 72

SITAVIG 139

SIVEXTRO 52

SKLICE 42

SKYRIZI 261


SKYRIZI (2 SYRINGES) KIT 261

SKYRIZI PEN 261

SLEEP AID 187,188,189

SLO-NIACIN 91

SMALLPOX AND MONKEYPOX VACCINE, LIVE,

NONREPLICATING/PF 131

SMALLPOX VACCINE,LIVE 128

SODIUM BICARBONATE 192

SODIUM CHLORIDE 179,183,184,185,239

SODIUM CHLORIDE/POTASSIUM CHLORIDE 180

SODIUM CHLORIDE/SODIUM

BICARBONATE/POTASSIUM

CHLORIDE/PEG 198,200,202

SODIUM FLUORIDE/CHOLECALCIFEROL (VITAMIN

D3) 227

SODIUM OXYBATE 155

SODIUM OXYBATE/CALCIUM

OXYBATE/MAGNESIUM OXYBATE/POT

OXYBATE 155

SODIUM PHENYLBUTYRATE 173

SODIUM PHOSPHATE,MONOBASIC/SODIUM

PHOSPHATE,DIBASIC 200,201

SODIUM PHOSPHATE/POTASSIUM PHOSPHATES,

MONOBASIC AND BIBASIC 179

SODIUM POLYSTYRENE SULFONATE 224

SODIUM POLYSTYRENE SULFONATE/SORBITOL

SOLUTION 224

SODIUM SULFATE/POTASSIUM

SULFATE/MAGNESIUM SULFATE 202

SOFOSBUVIR 205

SOFOSBUVIR/VELPATASVIR 205

SOFOSBUVIR/VELPATASVIR/VOXILAPREVIR 205

SOFT TOUCH 166

SOLIFENACIN SUCCINATE 204

SOLIQUA 100-33 220

SOLRIAMFETOL HCL 35

SOLTAMOX 181

SOLU-CORTEF 208

SOMATROPIN 218

SONIDEGIB PHOSPHATE 110

SORAFENIB TOSYLATE 110

SORBITOL 202

SORBITOL SOLUTION 202

SORINE 152

SOTALOL AF 152

SOTALOL HCL 151,152

SOTORASIB 109

SOTYLIZE 152

SOVALDI 205

SPINOSAD 41,42

SPIRIVA 54

SPIRIVA RESPIMAT 54

SPIRONOLACTONE 250

SPIRONOLACTONE/HYDROCHLOROTHIAZIDE 250

SPORANOX 77

SPRINTEC 215

SPRITAM 64

SPRYCEL 112

SPS 224

SRONYX 215

SSD 41

STALEVO 100 117

STALEVO 125 117

STALEVO 150 117

STALEVO 200 117

STALEVO 50 117

STALEVO 75 117

STAMARIL 133

STEGLATRO 73

STEGLUJAN 74

STELARA 261

STIMATE 218

STIOLTO RESPIMAT 54

STIRIPENTOL 59

STIVARGA 112

STOOL SOFTENER 202

STRATTERA 154,155

STRENSIQ 181

STRESS FORMULA 273

STRESS FORMULA WITH ZINC 273

STRIANT 208

STRIBILD 124


STRIVERDI RESPIMAT 145

SUBCUTANEOUS INSULIN PUMP 166

SUBLOCADE 25

SUBOXONE 25,26

SUBVENITE 64

SUBVENITE (BLUE) 64

SUBVENITE (GREEN) 64

SUBVENITE (ORANGE) 64

SUCCIMER 206

SUCRAID 181

SUCRALFATE 135

SUCROFERRIC OXYHYDROXIDE 224

SUDAFED 12 HOUR 265

SUDOGEST 265

SULAR 150

SULCONAZOLE NITRATE 79

SULFACETAMIDE SODIUM 36,37,41

SULFACETAMIDE SODIUM/PREDNISOLONE

ACETATE 36

SULFACETAMIDE SODIUM/PREDNISOLONE

SODIUM PHOSPHATE 37

SULFACETAMIDE SODIUM/SULFUR 257,258

SULFACETAMIDE SODIUM/SULFUR/SKIN

CLEANSER COMB NO.23 41

SULFACETAMIDE SODIUM/SULFUR/UREA 41

SULFAMETHOXAZOLE/TRIMETHOPRIM 51

SULFASALAZINE 51

SULFATRIM 51

SULINDAC 245

SUMATRIPTAN 96,97

SUMATRIPTAN SUCCINATE 96,97

SUMATRIPTAN SUCCINATE/NAPROXEN

SODIUM 97

SUNITINIB MALATE 112

SUNOSI 35

SUPRAX 157

SUPREP 202

SUTENT 112

SUVOREXANT 139,140

SYEDA 215

SYLATRON 138

SYMBICORT 159

SYMBYAX 70

SYMDEKO 159

SYMJEPI 265

SYMLINPEN 120 71

SYMLINPEN 60 71

SYMPAZAN 67

SYMPROIC 203

SYMTUZA 125

SYNJARDY 74

SYNJARDY XR 74

SYRINGE WITH NEEDLE,DISPOSABLE,INSULIN 1

ML 160

SYRINGE WITH NEEDLE,INSULIN,0.3 ML 160

SYRINGE WITH NEEDLE,INSULIN,0.5 ML 160

SYSTANE GEL 185

T T:SLIM X2 WITH BASAL-IQ 166

TAB-A-VITE MULTIVIT WITH IRON 274

TABLOID 112

TABRECTA 112

TACROLIMUS 236,237,238,261

TADALAFIL 267

TAFAMIDIS 150

TAFAMIDIS MEGLUMINE 150

TAFINLAR 112

TAFLUPROST/PF 84

TAGRISSO 113

TAKHZYRO 228

TALICIA 133

TALTZ AUTOINJECTOR 261

TALTZ AUTOINJECTOR (2 PACK) 262

TALTZ AUTOINJECTOR (3 PACK) 262

TALTZ SYRINGE 262

TAMIFLU 138

TAMOXIFEN CITRATE 181

TAMSULOSIN HCL 9

TAPENTADOL HCL 21

TARINA 24 FE 216

TARINA FE 216


TARINA FE 1-20 EQ 216

TARKA 249

TASIGNA 113

TASIMELTEON 140

TAVABOROLE 81

TAYSOFY 216

TAZAROTENE 260,262

TAZEMETOSTAT HYDROBROMIDE 113

TAZORAC 262

TAZTIA XT 148

TAZVERIK 113

TBO-FILGRASTIM 146

TECFIDERA 236

TECOVIRIMAT 137

TEDIZOLID PHOSPHATE 52

TEGRETOL 64

TEGRETOL XR 64

TEKTURNA 250

TEKTURNA HCT 250

TELMISARTAN 248

TELMISARTAN/AMLODIPINE BESYLATE 248

TELMISARTAN/HYDROCHLOROTHIAZIDE 248

TELOTRISTAT ETIPRATE 195

TEMAZEPAM 142

TEMOZOLOMIDE 113

TENCON 13

TENIVAC 128

TENOFOVIR ALAFENAMIDE 139

TENOFOVIR DISOPROXIL FUMARATE 124

TENORETIC 100 152

TENORETIC 50 152

TENORMIN 153

TEPMETKO 113

TEPOTINIB HCL 113

TERAZOSIN HCL 150

TERBINAFINE HCL 76,78

TERCONAZOLE 80

TERIFLUNOMIDE 233

TERIPARATIDE 246

TESTIM 208

TESTOSTERONE 208,209

TESTOSTERONE CYPIONATE 208,209

TESTOSTERONE ENANTHATE 209

TESTOSTERONE PROPIONATE 209

TETANUS AND DIPHTHERIA TOXOIDS,

ADSORBED, ADULT/PF 128

TETANUS AND DIPHTHERIA TOXOIDS, ADULT 128

TETANUS,DIPHTHERIA TOXOID PED/PF 128

TETRABENAZINE 156

TETRAHYDROZOLINE HCL/DEXTRAN

70/POLYETHYLENE GL 400/POVIDONE 186

TEZACAFTOR/IVACAFTOR 159

THALIDOMIDE 236

THALOMID 236

THEOPHYLLINE ANHYDROUS 262

THERA TEARS 185

THERMOTABS 180

THIAMINE HCL 275,277

THIOGUANINE 112

THIOLA 239

THIOLA EC 239

THIORIDAZINE HCL 122

THIOTHIXENE 122

THROMBATE III 54

TIADYLT ER 148

TIAGABINE HCL 60,64

TIAZAC 148

TIBSOVO 113

TICAGRELOR 125

TICANASE 43

TILDRAKIZUMAB-ASMN 260

TILIA FE 216

TIMOLOL MALEATE 82,83,153

TIMOLOL MALEATE/PF 83

TIMOPTIC 83

TIMOPTIC OCUDOSE 83

TIMOPTIC-XE 83

TIOCONAZOLE 78,80

TIOPRONIN 239

TIOTROPIUM BROMIDE 54

TIOTROPIUM BROMIDE/OLODATEROL HCL 54

TIPRANAVIR 124


TIPRANAVIR/VITAMIN E TPGS 124

TIVICAY 122

TIVICAY PD 123

TIVOZANIB HCL 104

TIZANIDINE HCL 255

TOBI 50

TOBI PODHALER 50

TOBRADEX 37

TOBRAMYCIN 37,38,50

TOBRAMYCIN IN 0.225 % SODIUM CHLORIDE 50

TOBRAMYCIN SULFATE 50

TOBRAMYCIN/DEXAMETHASONE 37,38

TOBRAMYCIN/NEBULIZER 50

TOBREX 38

TOCILIZUMAB 228

TOFACITINIB CITRATE 233

TOLCAPONE 116

TOLNAFTATE 82

TOLSURA 77

TOLTERODINE TARTRATE 204

TOPAMAX 64

TOPIRAMATE 63,64

TOPOTECAN HCL 104

TOPROL XL 153

TORSEMIDE 172

TOSYMRA 97

TOUJEO MAX SOLOSTAR 220

TOUJEO SOLOSTAR 220

TOVIAZ 204

TPOXX (NATIONAL STOCKPILE) 137

TRACLEER 253,254

TRADJENTA 72

TRAMADOL HCL 23

TRAMADOL HCL/ACETAMINOPHEN 23

TRAMETINIB DIMETHYL SULFOXIDE 109

TRANDOLAPRIL 249

TRANDOLAPRIL/VERAPAMIL HCL 249

TRANEXAMIC ACID 86

TRANYLCYPROMINE SULFATE 68

TRAVATAN Z 84

TRAVOPROST 84

TRAZODONE HCL 70

TRECATOR 99

TRELEGY ELLIPTA 159

TREMFYA 262

TREPROSTINIL 254

TREPROSTINIL DIOLAMINE 253

TREPROSTINIL SODIUM 254

TREPROSTINIL/NEBULIZER ACCESSORIES 254

TREPROSTINIL/NEBULIZER AND

ACCESSORIES 254

TRESIBA 220

TRESIBA FLEXTOUCH U-100 221

TRESIBA FLEXTOUCH U-200 221

TRETINOIN 113,256

TRETINOIN MICROSPHERES 256

TRETTEN 86

TREXIMET 97

TRI FEMYNOR 216

TRI-ESTARYLLA 216

TRI-LEGEST FE 216

TRI-LINYAH 216

TRI-LO-ESTARYLLA 216

TRI-LO-MARZIA 216

TRI-LO-MILI 216

TRI-LO-SPRINTEC 216

TRI-MILI 216

TRI-NYMYO 216

TRI-PREVIFEM 216

TRI-SPRINTEC 216

TRI-VI-FLOR 274

TRI-VYLIBRA 216

TRI-VYLIBRA LO 216

TRIAMCINOLONE ACETONIDE 42,43,47,48

TRIAMTERENE/HYDROCHLOROTHIAZIDE 172

TRIBENZOR 248

TRICARE 274

TRICOR 93

TRIDERM 48

TRIFAROTENE 259

TRIFLUOPERAZINE HCL 122

TRIFLURIDINE 38


TRIFLURIDINE/TIPIRACIL HCL 108,109

TRIGLIDE 93

TRIHEPTANOIN 173

TRIHEXYPHENIDYL HCL 116

TRIJARDY XR 74

TRIKAFTA 159

TRIKLO 91

TRILEPTAL 64

TRILIPIX 93

TRILYTE WITH FLAVOR PACKETS 202

TRIMETHOBENZAMIDE HCL 76

TRIMETHOPRIM 36

TRINATE 274

TRINTELLIX 70

TRIPLE ANTIBIOTIC 40

TRISTART DHA 274

TRIUMEQ 124

TRIVORA-28 216

TROKENDI XR 64

TROSPIUM CHLORIDE 204

TRUE METRIX 167

TRUE METRIX AIR GLUCOSE METER 167

TRUE METRIX BLOOD GLUCOSE MTR 167

TRUE METRIX GLUCOSE TEST STRIP 171

TRUE METRIX GO 167

TRUEPLUS KETONE TEST STRIP 266

TRULICITY 73

TRUMENBA 133

TRUSELTIQ 113

TRUSOPT 83

TRUVADA 124

TUDORZA PRESSAIR 54

TULANA 217

TURALIO 113

TUSNEL PEDIATRIC 251

TWINRIX 133

TWIRLA 217

TWYNSTA 248

TYBLUME 217

TYBOST 239

TYMLOS 246

TYPHIM VI 133

TYPHOID VACC,LIVE,ATTENUATED 133

TYPHOID VACCINE VI CAPSULAR

POLYSACCHARIDE 133

TYR EASY 176

TYR EXPRESS 176

TYREX-1 176

TYREX-2 177

TYSABRI 236

TYVASO 254

TYVASO REFILL KIT 254

TYVASO STARTER KIT 254

U UBIDECARENONE 238

UBRELVY 95

UBROGEPANT 95

UCERIS 208

UDENYCA 147

UKONIQ 113

ULIPRISTAL ACETATE 211

ULTIMA 171

UMBRALISIB TOSYLATE 113

UMECLIDINIUM BROMIDE 53

UMECLIDINIUM BROMIDE/VILANTEROL

TRIFENATATE 52

UNICOMPLEX-M 274

UNILET LANCETS 167

UPADACITINIB 232

UPTRAVI 254

UREA 258

URINE ACETONE TEST,STRIPS 266

URINE GLUCOSE TEST STRIP 266

URSODIOL 202

USTEKINUMAB 261

UTIBRON NEOHALER 145

V VACCINE ADJUVANT SYSTEM, AS01B/PF,

COMPONENT VIAL 1 OF 2 247

VALACYCLOVIR HCL 139


VALBENAZINE TOSYLATE 156

VALCHLOR 114

VALGANCICLOVIR HCL 139

VALPROIC ACID 64

VALPROIC ACID (AS SODIUM SALT) (VALPROATE

SODIUM) 64

VALSARTAN 247,248

VALSARTAN/HYDROCHLOROTHIAZIDE 247,248

VALTOCO 142

VALTREX 139

VANCOMYCIN HCL 52

VANDETANIB 101

VAQTA 133

VARENICLINE TARTRATE 142

VARICELLA VIRUS VACCINE LIVE/PF 133

VARICELLA-ZOSTER VIRUS GLYCOPROTEIN

E,REC,COMPONENT 2 OF 2 133

VARICELLA-ZOSTER VIRUS GLYCOPROTEIN

E,REC/AS01B ADJUVANT/PF 132

VARIVAX VACCINE 133

VARUBI 76

VASCEPA 91

VASERETIC 249

VASOTEC 249

VAXCHORA ACTIVE COMPONENT 133

VAXCHORA BUFFER COMPONENT 247

VAXCHORA VACCINE 133

VAXELIS 128

VAXNEUVANCE 133

VEDOLIZUMAB 203

VELETRI 255

VELIVET 217

VELPHORO 224

VEMLIDY 139

VEMURAFENIB 115

VENLAFAXINE HCL 68,69

VENTAVIS 255

VENTOLIN HFA 145

VERAPAMIL HCL 147,148,149

VERELAN 148

VERELAN PM 149

VERICIGUAT 267

VERQUVO 267

VERSACLOZ 120

VERZENIO 114

VESICARE 204

VESICARE LS 204

VESTURA 217

VICTOZA 2-PAK 73

VICTOZA 3-PAK 73

VIEKIRA PAK 206

VIENVA 217

VIGABATRIN 64,65

VIGADRONE 65

VIGAMOX 38

VIIBRYD 70

VILACTIN AA PLUS 20 PE 177

VILAZODONE HCL 70

VIMOVO 245

VIMPAT 65

VINATE CARE 274

VIOKACE 203

VIORELE 217

VIREAD 124

VISINE-A 186

VISMODEGIB 103

VIT C/VIT E ACETATE/ZINC OXID/CUPRIC

OXIDE/LUTEIN/ZEAXANTHIN 239

VITAFOL GUMMIES 274

VITAFOL ULTRA 274

VITAFOL-OB 274

VITAFOL-ONE 275

VITAL HIGH NITROGEN 177

VITAMEDMD ONE RX 275

VITAMEDMD REDICHEW RX 275

VITAMIN A 275

VITAMIN A PALMITATE/ASCORBIC

ACID/CHOLECALCIFEROL (VIT D3) 271

VITAMIN B COMPLEX 275,277

VITAMIN B COMPLEX WITH VITAMIN C

NO.19/FOLIC ACID/VITAMIN D3 276

VITAMIN B COMPLEX/FOLIC ACID 275


VITAMIN B COMPLEX/MINERALS 277

VITAMIN E 281,282

VITAMIN E (DL-ALPHA TOCOPHERYL

ACETATE) 281,282

VITAMIN E ACETATE 281

VITAPEARL 275

VITATRUE 275

VITRAKVI 114

VIVAGUARD INO CONTROL SOLUTION 167

VIVAGUARD INO SMART GLUC METER 167

VIVAGUARD INO TEST STRIP 171

VIVOTIF 133

VIZIMPRO 114

VOCABRIA 123

VOGELXO 209

VOLNEA 217

VON WILLEBRAND FACTOR (RECOMBINANT) 87

VONVENDI 87

VORAPAXAR SULFATE 125

VORICONAZOLE 77

VORINOSTAT 115

VORTIOXETINE HYDROBROMIDE 70

VOSEVI 205

VOTRIENT 114

VOXELOTOR 146

VRAYLAR 120,121

VUMERITY 236

VUSION 80

VYEPTI 95

VYFEMLA 217

VYLIBRA 217

VYNDAMAX 150

VYNDAQEL 150

VYTORIN 92

VYVANSE 28,29

VYZULTA 84

W WAKIX 35

WAL-ITIN 89

WAL-SOM 189

WARFARIN SODIUM 54,55

WAVESENSE PRESTO 167,171

WELCHOL 92

WELLBUTRIN SR 68

WELLBUTRIN XL 68

WERA 217

WILATE 87

WIXELA INHUB 159

X XADAGO 117

XALATAN 84

XALKORI 115

XARELTO 56

XCOPRI 65

XELJANZ 233

XELJANZ XR 233

XELPROS 84

XENLETA 52

XEPI 40

XERAC AC 256

XERESE 40

XERMELO 195

XHANCE 43

XIFAXAN 52

XIGDUO XR 74

XOFLUZA 137

XOPENEX 145

XOPENEX CONCENTRATE 145

XOPENEX HFA 145

XOSPATA 115

XPHE MAXAMUM 177

XPOVIO 115

XTAMPZA ER 23

XTANDI 115

XULANE 217

XULTOPHY 100-3.6 221

XYNTHA 87

XYNTHA SOLOFUSE 87

XYREM 155

XYWAV 155


Y YELLOW FEVER VACCINE LIVE/PF 133

YF-VAX 133

YUPELRI 54

YUVAFEM 182

Z ZADITOR 183

ZAFIRLUKAST 44

ZALEPLON 141

ZANAMIVIR 138

ZANUBRUTINIB 101

ZARAH 217

ZARONTIN 67

ZEBUTAL 13

ZEGERID 137

ZEJULA 115

ZELBORAF 115

ZEMBRACE SYMTOUCH 97

ZENATANE 262

ZENPEP 203

ZENZEDI 29

ZEPATIER 206

ZEPOSIA 236

ZERVIATE 183

ZESTORETIC 249

ZESTRIL 249

ZETIA 92

ZETONNA 43

ZIAC 153

ZIANA 40

ZIDOVUDINE 124

ZIEXTENZO 147

ZILEUTON 44,45

ZINC GLUCONATE 180

ZINC OXIDE 181

ZINC SULFATE 180

ZIOPTAN 84

ZIPRASIDONE HCL 119,121

ZIPRASIDONE MESYLATE 119,121

ZIPSOR 245

ZIRGAN 38

ZITHROMAX 225

ZITHROMAX TRI-PAK 225

ZOCOR 94

ZOFRAN 75

ZOHYDRO ER 23,24

ZOKINVY 239

ZOLINZA 115

ZOLMITRIPTAN 97,98

ZOLOFT 70

ZOLPIDEM TARTRATE 139,140,141

ZOLPIMIST 141

ZOMACTON 218

ZOMIG 98

ZOMIG ZMT 98

ZONEGRAN 66

ZONISAMIDE 66

ZONTIVITY 125

ZORBTIVE 218

ZORTRESS 238

ZORVOLEX 245

ZOSTAVAX 133

ZOSTER VACCINE LIVE/PF 133

ZOVIA 1-35 217

ZOVIA 1-35E 217

ZOVIRAX 40,41,139

ZTLIDO 256

ZUBSOLV 26

ZUMANDIMINE 217

ZUPLENZ 75

ZYFLO 45

ZYKADIA 115,116

ZYMAXID 38

ZYPITAMAG 94

ZYPREXA 121

ZYPREXA RELPREVV 121

ZYPREXA ZYDIS 121

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If you have questions, please call HealthPartners Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, 8 a.m. to 6 p.m. CT, Monday – Friday. Or visit healthpartners.com/spp.

20-814858 Updated 10/2021

PAGE 332

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If you have questions, please call HealthPartners Member Services at 952-967-7998 or 1-866-885-8880, TTY 711, 8 a.m. to 6 p.m. CT, Monday – Friday. Or visit healthpartners.com/spp.

20-814858 Updated 10/2021

http://healthpartners.com/spp

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