Rx Formulary Std Il 2014

2656-A IL Prime Therapeutics LLC 01/14

Contents

Introduction .................................................................... I How formulary drugs are selected ................................... I How member payment is determined .............................. I How to use this list ........................................................... I Generic drugs ................................................................. II Coverage considerations ............................................... III Specialty drugs .............................................................. IV Abbreviation key ............................................................. V

Therapeutic Class Drug List ........................................ 1 Anti-Infective Drugs ........................................................ 1 Cancer Drugs .................................................................. 3 Hormones, Diabetes and Related Drugs ........................ 3 Heart and Circulatory Drugs ........................................... 5 Respiratory Agents ......................................................... 7 Gastrointestinal Drugs .................................................... 8 Genitourinary Drugs ........................................................ 9 Central Nervous System Drugs .................................... 10 Pain Relief Drugs .......................................................... 11 Neuromuscular Drugs ................................................... 12 Supplements ................................................................. 13 Blood Modifying Drugs .................................................. 14 Topical Drugs ................................................................ 14 Miscellaneous Categories (includes Supplies and Devices) ............................................................... 17

Index ............................................................................. 19

Please consider talking to your doctor about prescribing formulary medications, which may help reduce your out-of-pocket costs. This list may help guide you and your doctor in selecting an appropriate medication for you.

The drug formulary is regularly updated. Please visit bcbsil.com for the most up-to-date information.

To search for a drug name within this PDF document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search.

January 2014

Standard Drug Formulary

Blue Cross and Blue Shield of Illinois January 2014 Drug Formulary I

Introduction

Blue Cross and Blue Shield of Illinois is pleased to present the 2014 Drug Formulary. This is a list of formulary drugs which includes Formulary Brand drugs and a partial listing of generic drugs. Members are encouraged to show this list to their physicians and pharmacists. Physicians are encouraged to prescribe drugs on this list, when right for the member. However decisions regarding therapy and treatment are always between members and their physician.

Drug formulary updates This list is regularly updated as generic drugs become available and changes take place in the pharmaceuticals market. For the most up-to-date information, visit bcbsil.com and log in to Blue Access for MembersSM or call the number on the back of your ID card. Physicians can access the list from the provider portal at bcbsil.com.

How formulary drugs are selected

Drugs on this list are selected based on the recommendations of a committee made up of physicians and pharmacists from throughout the country. The committee, which includes at least one representative from your health plan, reviews drugs regulated by the U.S. Food and Drug Administration (FDA).

Both drugs that are newly approved by the FDA as well as those that have been on the market for some time are considered. Drugs are selected based on safety, efficacy, cost and how they compare to other drugs currently on the list.

How member payment is determined

This list shows prescription drug products in tiers. Generally, each drug is placed into one of three or four member payment tiers: generic, Formulary Brand or Non-Formulary Brand (not listed in this document). Specialty drugs can either be within the previous three tiers or can be a separate fourth tier depending on your benefit design. To verify your payment amount for a drug, visit bcbsil.com and log in to Blue Access for Members or call the number on the back of your ID card.

Your pharmacy benefit includes coverage for many prescription drugs, although some exclusions may apply. For example, drugs indicated for cosmetic purposes, e.g., Propecia, for hair growth, may not be covered. Prescription products that have over-the-counter (OTC) equivalents may not be covered. Drugs that are not FDA-approved for self-administration may be available through your medical benefit.

How to use this list

Generic drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand drug in (parentheses). The reference brand drug is a non-formulary (NF) brand and is only included as a reference to the brand. Some generic products have no reference brand.

Example: atorvastatin (Lipitor brand is NF)

Formulary brand drugs are listed in all CAPITAL letters.

Drugs used to treat multiple conditions

Some drugs in the same dosage form may be used to treat more than one medical condition. In these instances, each medication is classified according to its first FDA-approved use. Please check the index if you do not find your particular medication in the class/condition section that corresponds to your use.

Blue Cross and Blue Shield of Illinois January 2014 Drug Formulary II

Generic drugs

Using generic drugs, when right for you, can help you save on your out-of-pocket medication costs. Generic drugs must be approved by the FDA just as brand drugs are, and must meet the same strict standards.

There are two types of generic drugs:

A generic equivalent is made with the same active ingredient(s) at the same dosage as the reference drug. A generic alternative is a drug typically used to treat the same condition, but the active ingredient(s)

differs from the brand drug.

According to the FDA, compared to its brand counterpart, an FDA-approved generic drug:

Is chemically the same

Works just as well in the body

Is as safe and effective

Meets the same standards set by the FDA

The main difference between the reference brand drug and the generic equivalent is that the generic often costs much less.

Formulary brand drugs typically move to a non-formulary brand tier after a generic equivalent becomes available. You may be responsible for the non-formulary brand member payment amount plus the difference in cost between the brand and generic equivalent if you or your doctor requests the reference brand rather than the generic. Generic drugs have the lowest member payment amount.

Consider talking to your doctor about generic drugs

If your doctor writes a prescription for a brand drug that does not have a generic equivalent, consider asking if an appropriate generic alternative is available.

You can also let your pharmacist know that you would like a generic equivalent for a brand drug, whenever one is available. Your pharmacist can usually substitute a generic equivalent for its brand counterpart without a new prescription from your doctor.

Only your doctor can determine whether a generic alternative is right for you and must prescribe the medication.

Blue Cross and Blue Shield of Illinois January 2014 Drug Formulary III

Coverage considerations

Most prescription drug benefit plans provide coverage for up to a 30-day supply of medication, with some exceptions. Your plan may also provide coverage for up to a 90-day supply of maintenance medications. Maintenance medications are those drugs you may take on an ongoing basis for conditions such as high blood pressure, diabetes or high cholesterol. Some plans may exclude coverage for certain agents or drug categories, like those used for erectile dysfunction or weight loss.

Over-the-counter exclusions: Your benefit plan may not provide coverage for prescription medications that have an over-the-counter version. You should refer to your benefit plan material for details about your particular benefits.

Compounded medications: Your benefit plan may not provide coverage for compounded medications. Please see your plan materials or call the number on the back of your ID card to determine whether compounded medications are covered and/or verify your payment amount.

Repackaged medications: Repackaged versions of medications already available on the market are not covered.

Prior Authorization (PA): Your benefit plan may require prior authorization for certain drugs that are high-cost or have the potential for misuse. This means that your doctor will need to submit a prior authorization request for coverage of these medications, and the request will need to be approved, before the medication will be covered under your plan. For the formulary medications listed in this document, if a prior authorization is commonly required, it will generally be noted next to the medication with a dot under the prior authorization column. Some plans may have prior authorization on additional medications beyond those noted in this document.

Step Therapy (ST): Your benefit plan may include a step therapy program. This means you may need to try another proven, cost-effective medication before coverage may be available for the drug included in the program. Many brand drugs have less-expensive generic or brand alternatives that might be an option for you. For the formulary medications listed in this document, if a step therapy is commonly required, it will generally be noted next to the medication with a dot under the step therapy column. Some plans may have step therapy programs on additional medications beyond those noted in this document.

Dispensing Limits (DL): Drug Dispensing limits help encourage medication use as intended by the FDA. Coverage limits are placed on medications in certain drug categories. For the formulary medications listed in this document, if a dispensing limit applies, it will generally be noted next to the medication with a dot under the dispensing limits column. Limits may include: quantity of covered medication per prescription, quantity of covered medication in a given time period, coverage only for members within a certain age range, and coverage only for members of a specific gender. If your doctor prescribes a greater quantity of medication than what the dispensing limit allows, you can still get the medication. However, you will be responsible for the full cost of the prescription beyond what your coverage allows. For a list of medications and their dispensing limits, visit bcbsil.com.

Remember, medication decisions are between you and your doctor. Only your doctor can determine which medication is right for you. Discuss any questions or concerns you have about medications you are taking or are prescribed with your doctor.

Blue Cross and Blue Shield of Illinois January 2014 Drug Formulary IV

Specialty drugs

Specialty drugs are used in the treatment of medical conditions such as hepatitis, hemophilia, multiple sclerosis and rheumatoid arthritis. Specialty drugs may be oral, topical or injectable medications that can either be self-administered or administered by a health care professional. For a current list of specialty medications, visit myprime.com or bcbsil.com and log in to Blue Access for Members.

Note that some drug classes may be excluded by some plans and therefore may not be covered under your pharmacy benefit. Your plan may have a different coverage level for specialty drugs. If you have questions about your coverage for specialty medications or your prescription drug benefit, call the number on the back of your ID card.

Prime Therapeutics Specialty Pharmacy Program

Through Prime Therapeutics Specialty Pharmacy, members can have covered specialty medications delivered directly to them or their doctors office. When you receive specialty medications through Prime, you also receive at no additional charge the following services:

Coordination of coverage between you, your doctor and your health plan

Educational materials about your particular condition and information about managing potential medication side effects

Syringes, sharps containers and other supplies with every shipment for self-injectables

24/7/365 phone access to a pharmacist for urgent medication issues

To order through Prime Therapeutics Specialty Pharmacy:

Have your doctor call or fax your prescription to Prime Therapeutics Specialty Pharmacy. Your doctor can call 877-627-6337 or fax to 877-828-3939.

If you have an existing prescription for a covered specialty medication, you can call 877-627-6337 to transfer your prescription.

A Prime Therapeutics coordinator will contact you to arrange delivery of your medication.

The prescription can be shipped directly to you or your prescribing doctors office. Each package is individually marked for each member. Refrigerated drugs are shipped in temperature-controlled packaging.

If you have questions, please contact Prime Therapeutics Specialty Pharmacy at 877-627-6337, visit www.PrimeTherapeutics.com/specialty, or call the number on the back of your ID card.

* Blue Cross and Blue Shield of Illinois is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC). HCSC is an independent licensee of the Blue Cross Blue Shield Association. HCSC contracts with Prime Therapeutics to provide pharmacy benefit management and mail order pharmacy services and to administer this specialty pharmacy program. HCSC, as well as several other independent Blue Cross and Blue Shield licensees, has an ownership interest in Prime Therapeutics LLC.

Blue Cross and Blue Shield of Illinois January 2014 Drug Formulary V

Abbreviation key

caps .................................................................... capsules chew tabs ............................................. chewable tablets conc .............................................................. concentrate crm ......................................................................... cream DL ........................................................... dispensing limits ext-release ........................................... extended-release inhal................................................................... inhalation inj ......................................................................... injection lotn ........................................................................... lotion NF ............................................................... non-formulary ODT ....................................... orally disintegrating tablets

oint ..................................................................... ointment ophth ............................................................... ophthalmic OSM ......................................................... osmotic-release PA ........................................................ prior authorization SL ..................................................................... sublingual soln ....................................................................... solution supp ............................................................ suppositories susp ................................................................ suspension ST ................................................................. step therapy tabs ......................................................................... tablets

2014

Blue Cross and Blue Shield of Illinois January 2014 Drug Formulary 1

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ANTI-INFECTIVE DRUGSPENICILLINSamoxicillin/potassium

clavulanate (Augmentin brand isNF)

amoxicillin/potassium clavulanateext-release (Augmentin XR brand isNF)

amoxicillin, NF = chew tabsampicillin capsdicloxacillinpenicillin v potassiumCEPHALOSPORINScefaclor capscefadroxilcefdinircefpodoximecefprozilceftriaxone (Rocephin brand is NF)cefuroxime (Ceftin brand is NF)cephalexin, NF = tabs (Keflex brand

is NF)SUPRAX tabsMACROLIDESazithromycin susp (Zithromax brand

is NF)azithromycin tabs (Zithromax brand

is NF)

clarithromycin (Biaxin brand is NF)clarithromycin ext-release (Biaxin XL

brand is NF)

erythromycin delayed-release capsZITHROMAX packetsTETRACYCLINESdemeclocyclinedoxycycline hyclate (Vibramycin

brand is NF)

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doxycycline monohydrate (Adoxa,Monodox - brands are NF)

minocycline (Dynacin, Minocin brands are NF)

FLUOROQUINOLONESciprofloxacin (Cipro brand is NF)ciprofloxacin ext-release (Cipro XR

brand is NF)

levofloxacin (Levaquin brand is NF)ofloxacin tabsAMINOGLYCOSIDESneomycin sulfateparomomycinTOBI, NF = Podhaler TUBERCULOSISethambutol (Myambutol brand is NF)isoniazid tabsisoniazid/rifampin (Rifamate brand is

NF)MYCOBUTINPRIFTINpyrazinamiderifampin (Rifadin brand is NF)FUNGAL INFECTIONSfluconazole (Diflucan brand is NF)flucytosine (Ancobon brand is NF)griseofulvin microsize (Grifulvin V

brand is NF)itraconazole (Sporanox brand is NF)NOXAFIL nystatin oralterbinafine (Lamisil brand is NF)voriconazole (Vfend brand is NF) VIRAL INFECTIONSCytomegalovirusVALCYTE

2014

2 Blue Cross and Blue Shield of Illinois January 2014 Drug Formulary

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Hepatitisadefovir (Hepsera brand is NF)BARACLUDEINCIVEK PEGASYS ribavirin (Copegus, Rebetol brands

are NF)

VICTRELIS Herpesacyclovir (Zovirax brand is NF)famciclovir (Famvir brand is NF)valacyclovir (Valtrex brand is NF)HIV/AIDSabacavir tabs (Ziagen brand is NF) APTIVUS ATRIPLA CRIXIVAN didanosine delayed-release (Videx EC

brand is NF)

EMTRIVA EPIVIR soln EPZICOM FUZEON INTELENCE INVIRASE ISENTRESS KALETRA lamivudine (Epivir tabs brand is NF) lamivudine/zidovudine (Combivir

brand is NF)

LEXIVA nevirapine tabs (Viramune brand is

NF)

NORVIR PREZISTA RESCRIPTOR

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REYATAZ SELZENTRY stavudine (Zerit brand is NF) STRIBILD SUSTIVA TIVICAY TRIZIVIR TRUVADA VIDEX VIRACEPT VIRAMUNE susp VIRAMUNE XR VIREAD ZIAGEN soln zidovudine (Retrovir brand is NF) MALARIAatovaquone/proguanil

250-100 mg (Malarone brand is NF)chloroquine phosphate (Aralen

brand is NF)DARAPRIMhydroxychloroquine (Plaquenil

brand is NF)MALARONE 62.5-25 mgmefloquinePRIMAQUINEWORM INFECTIONSALBENZABILTRICIDESTROMECTOLOTHER ANTI-INFECTIVESclindamycin (Cleocin, Cleocin

Pediatric brands are NF)DAPSONEerythromycin/sulfisoxazole

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metronidazole tabs (Flagyl brand isNF)

sulfamethoxazole/trimethoprim (Bactrim brand is NF)

trimethoprimvancomycin (Vancocin brand is NF)XIFAXAN 550 mg ZYVOX CANCER DRUGSAFINITOR, NF = DISPERZ ALKERAN tabsanastrozole (Arimidex brand is NF)bicalutamide (Casodex brand is NF)CYCLOPHOSPHAMIDE tabsEMCYTexemestane (Aromasin brand is NF)FARESTONflutamideGLEEVEC hydroxyurea (Hydrea brand is NF)letrozole (Femara brand is NF)LEUCOVORIN CALCIUM tabs, 10 mg,

15 mgleucovorin calcium tabs, 5 mg,

25 mgLEUKERANmegestrol (Megace brand is NF)MEKINIST mercaptopurine (Purinethol brand is

NF)MESNEX tabsmethotrexateMYLERANNEXAVAR NILANDRONSPRYCEL

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SUTENT SYLATRON TABLOIDTAFINLAR tamoxifenTARCEVA TASIGNA temozolomide (Temodar brand is NF) tretinoin caps TREXALLVOTRIENT XALKORI XELODA ZELBORAF ZYTIGA HORMONES, DIABETES AND RELATED DRUGSCORTICOSTEROIDSbudesonide ext-release (Entocort EC

brand is NF)CORTISONEdexamethasone elixir; tabs, 0.5 mg,

0.75 mg, 1.5 mg, 4 mg, 6 mgDEXAMETHASONE soln, 0.5 mg/5 mLfludrocortisonehydrocortisone (Cortef brand is NF)methylprednisolone (Medrol brand is

NF)prednisolone (Prelone brand is NF)prednisolone sodium soln (Orapred

brand is NF)PREDNISONE soln, 5 mg/5 mL; tabs,

50 mgprednisone tabs, 1 mg, 2.5 mg, 5 mg,

10 mg, 20 mgPREDNISONE INTENSOLMALE HORMONES

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ANDRODERM ANDROGEL ANDROXY danazol testosterone cypionate (Depo-

Testosterone brand is NF)

testosterone enanthate (Delatestryl brand is NF)

ESTROGENSCOMBIPATCHDIVIGELENJUVIAestradiol patches (Climara brand is

NF)

estradiol tabs (Estrace brand is NF)estradiol/norethindrone

acetate (Activella brand is NF)estropipate, NF = 3 mgVIVELLE-DOT PROGESTINSmedroxyprogesterone

acetate (Provera brand is NF)norethindrone acetate (Aygestin

brand is NF)progesterone micronized (Prometrium

brand is NF)BIRTH CONTROLELLA levonorgestrel (Plan B, Plan B One-

Step brands are NF)

medroxyprogesterone acetate inj,150 mg/mL (Depo-Provera brand isNF)

NUVARING oral contraceptives all generics ORTHO EVRA INFERTILITY

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chorionic gonadotropin clomiphene (Clomid brand is NF) FOLLISTIM AQ GANIRELIX ACETATE REPRONEX DIABETESacarbose (Precose brand is NF)glimepiride (Amaryl brand is NF)glipizide (Glucotrol brand is NF)glipizide ext-release (Glucotrol XL

brand is NF)glipizide/metformin (Metaglip brand

is NF)GLUCAGON EMERGENCY KITglyburideglyburide micronized (Glynase

brand is NF)glyburide/metformin (Glucovance

brand is NF)JANUMET JANUMET XR JANUVIA JUVISYNC KOMBIGLYZE XR metformin (Glucophage brand is NF)metformin ext-release (Glucophage

XR brand is NF)metformin ext-release OSM (Fortamet

brand is NF)nateglinide (Starlix brand is NF)ONGLYZA pioglitazone (Actos brand is NF)pioglitazone/metformin (Actoplus Met

brand is NF)repaglinide (Prandin brand is NF)VICTOZA DIABETES - INSULINS

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Rapid-Acting InsulinsHUMALOG NOVOLOG Short-Acting InsulinsHUMULIN R NOVOLIN R Intermediate-Acting InsulinsHUMALOG MIX 50/50, 75/25 HUMULIN N HUMULIN 70/30 NOVOLIN N NOVOLIN 70/30 NOVOLOG MIX 70/30 Basal InsulinsLANTUS LEVEMIR THYROID REGULATIONlevothyroxine (Synthroid brand is NF)liothyronine (Cytomel brand is NF)methimazole (Tapazole brand is NF)propylthiouracilGROWTH HORMONEINCRELEX OMNITROPE OTHER HORMONES AND RELATED DRUGSACTONEL alendronate tabs, 5 mg, 10 mg,

35 mg, 70 mg (Fosamax brand isNF)

cabergolinecalcitonin-salmon (Miacalcin brand is

NF)calcitriol (Rocaltrol brand is NF)desmopressin (DDAVP brand is NF)EVISTAFORTEO

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ibandronate (Boniva brand is NF) levocarnitine (Carnitor brand is NF)methylergonovineoctreotide (Sandostatin brand is NF) ORFADIN paricalcitol (Zemplar brand is NF)SENSIPARSTIMATEHEART AND CIRCULATORY DRUGSANGIOTENSIN CONVERTING ENZYME (ACE)INHIBITORS AND COMBINATIONSbenazepril (Lotensin brand is NF)benazepril/

hydrochlorothiazide (Lotensin HCT brand is NF)

captoprilenalapril (Vasotec brand is NF)enalapril/

hydrochlorothiazide (Vaseretic brand is NF)

fosinoprilfosinopril/hydrochlorothiazidelisinopril (Prinivil, Zestril brands are

NF)lisinopril/

hydrochlorothiazide (Zestoretic brand is NF)

moexipril (Univasc brand is NF)moexipril/

hydrochlorothiazide (Uniretic brand is NF)

perindopril (Aceon brand is NF)quinapril (Accupril brand is NF)quinapril/

hydrochlorothiazide (Accuretic brand is NF)

ramipril (Altace brand is NF)trandolapril (Mavik brand is NF)

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ANGIOTENSIN II RECEPTOR ANTAGONISTS (ARBS)AND COMBINATIONSBENICARBENICAR HCTirbesartan (Avapro brand is NF)irbesartan/

hydrochlorothiazide (Avalide brand is NF)

losartan (Cozaar brand is NF)losartan/hydrochlorothiazide (Hyzaar

brand is NF)valsartan/hydrochlorothiazide (Diovan

HCT brand is NF)BETA BLOCKERS AND COMBINATIONSacebutolol (Sectral brand is NF)atenolol (Tenormin brand is NF)atenolol/chlorthalidone (Tenoretic

brand is NF)bisoprolol (Zebeta brand is NF)bisoprolol/hydrochlorothiazide (Ziac

brand is NF)carvedilol (Coreg brand is NF)INNOPRAN XLlabetalol (Trandate brand is NF)metoprolol succinate ext-

release (Toprol XL brand is NF)metoprolol tartrate (Lopressor brand

is NF)nadolol (Corgard brand is NF)PROPRANOLOL solnpropranolol tabspropranolol ext-release (Inderal LA

brand is NF)TIMOLOL tabsCALCIUM CHANNEL BLOCKERS ANDCOMBINATIONSamlodipine (Norvasc brand is NF)

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amlodipine/benazepril (Lotrel brandis NF)

diltiazem (Cardizem brand is NF)diltiazem ext-release (Cardizem CD,

Cardizem LA, Dilacor XR, Tiazac brands are NF)

felodipine ext-releasenifedipine ext-release (Adalat CC,

Procardia XL brands are NF)verapamil ext-release (Calan SR,

Isoptin SR, Verelan, Verelan PM brands are NF)

verapamil, NF = 40 mg (Calan brandis NF)

CHEST PAINisosorbide dinitrate, NF = SL

tabs (Isordil brand is NF)isosorbide mononitrate (Monoket

brand is NF)isosorbide mononitrate ext-

release (Imdur brand is NF)nitroglycerin (Nitro-Dur brand is NF)NITROSTATCHOLESTEROL LOWERINGatorvastatin (Lipitor brand is NF)cholestyramine (Questran, Questran

Light brands are NF)colestipol (Colestid brand is NF)CRESTORfenofibrate (Lofibra, Tricor brands

are NF)fenofibrate micronized (Lofibra

brand is NF)fenofibric acid delayed-

release (Trilipix brand is NF)gemfibrozil (Lopid brand is NF)lovastatin (Mevacor brand is NF)niacin ext-release (Niaspan brand is

NF)

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pravastatin (Pravachol brand is NF)simvastatin (Zocor brand is NF)WELCHOLFLUID RETENTIONacetazolamide 250 mgacetazolamide ext-release (Diamox

Sequels brand is NF)amilorideamiloride/hydrochlorothiazidebumetanidechlorothiazidefurosemide, NF = soln, 8 mg/

mL (Lasix brand is NF)hydrochlorothiazide caps (Microzide

brand is NF)hydrochlorothiazide tabsindapamidemethazolamide (Neptazane brand is

NF)metolazone (Zaroxolyn brand is NF)spironolactone (Aldactone brand is

NF)spironolactone/

hydrochlorothiazide (Aldactazide brand is NF)

torsemide (Demadex brand is NF)triamterene/hydrochlorothiazide

(Dyazide, Maxzide, Maxzide-25 brands are NF)

HEART RHYTHMamiodarone (Cordarone brand is NF)disopyramide (Norpace brand is NF)flecainidemexiletineMULTAQpropafenone (Rythmol brand is NF)

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propafenone ext-release (Rythmol SR brand is NF)

quinidine gluconate ext-releasequinidine sulfate, NF = ext-releasesotalol (Betapace, Betapace AF

brands are NF)OTHER HEART RELATED DRUGSADCIRCA clonidine (Catapres, Catapres-TTS

brands are NF)DIBENZYLINEdigoxin tabs (Lanoxin brand is NF)doxazosin (Cardura brand is NF)eplerenone (Inspra brand is NF)guanfacine (Tenex brand is NF)hydralazineLETAIRIS methyldopamidodrineminoxidilprazosin (Minipress brand is NF)sildenafil (Revatio brand is NF) terazosinTRACLEER ERECTILE DYSFUNCTIONCIALIS BEE STING KITSEPIPENEPIPEN-JRRESPIRATORY AGENTSANTIHISTAMINEScetirizine syrupcyproheptadinepromethazine, NF = supp, 50 mgNASAL PRODUCTSASTEPRO

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azelastine (Astelin brand is NF) flunisolide (Flunisolide brand is NF) fluticasone propionate (Flonase

brand is NF)

ipratropium (Atrovent brand is NF) NASONEX triamcinolone (Nasacort AQ brand is

NF)

COUGH/COLD/ALLERGYacetylcysteineASTHMA/COPDADVAIR DISKUS ADVAIR HFA albuterol inhal soln, 0.083%, 0.5% albuterol syrup, tabsalbuterol 0.63 mg/3 mL,

1.25 mg/3 mL (Accuneb brand isNF)

ASMANEX ATROVENT HFA BREO ELLIPTA budesonide (Pulmicort Respules

brand is NF)

COMBIVENT COMBIVENT RESPIMAT cromolyn inhal soln DULERA FLOVENT DISKUS FLOVENT HFA FORADIL AEROLIZER ipratropium inhal soln ipratropium/albuterol (Duoneb brand

is NF)

montelukast (Singulair brand is NF)PROAIR HFA QVAR

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SPIRIVA HANDIHALER SYMBICORT terbutalinetheophylline ext-releaseVENTOLIN HFA zafirlukast (Accolate brand is NF)OTHER RESPIRATORY DRUGSFIRAZYR KALYDECO PULMOZYME GASTROINTESTINAL DRUGSLAXATIVESlactulosePEG electrolytes for soln (Colyte,

Golytely, Nulytely brands are NF)ULCER/GERDcimetidinedicyclomine caps, tabs (Bentyl

brand is NF)famotidine (Pepcid brand is NF)glycopyrrolate (Robinul brand is NF)hyoscyamine (Anaspaz, Levsin,

Levsin/SL brands are NF)hyoscyamine ext-release (Levbid,

Symax DuoTab brands are NF)lansoprazole delayed-

release (Prevacid brand is NF)

methscopolamine (Pamine, PamineForte brands are NF)

misoprostol (Cytotec brand is NF)NEXIUM omeprazole delayed-release (Prilosec

brand is NF)

pantoprazole delayed-release (Protonix brand is NF)

ranitidine (Zantac brand is NF)sucralfate (Carafate brand is NF)

2014


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NAUSEA AND VOMITINGEMEND caps granisetron meclizine (Antivert brand is NF)ondansetron (Zofran, Zofran ODT

brands are NF)

ondansetron 24 mg trimethobenzamide (Tigan brand is

NF)DIGESTIVE ENZYMESCREONZENPEPOTHER GASTROINTESTINAL DRUGSASACOL HDbalsalazide (Colazal brand is NF)calcium acetate (Eliphos, Phoslo

brands are NF)CANASACHENODAL DELZICOLdiphenoxylate/atropine tabs (Lomotil

brand is NF)lactuloseLIALDAloperamidemesalaminemetoclopramide (Reglan brand is

NF)PENTASARENVELAsulfasalazine (Azulfidine brand is NF)sulfasalazine delayed-

release (Azulfidine EN-Tabs brandis NF)

ursodiol (Actigall, Urso 250, Urso Forte brands are NF)

GENITOURINARY DRUGS

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URINARY TRACT INFECTIONSnitrofurantoin (Furadantin brand is

NF)nitrofurantoin

macrocrystalline (Macrodantin brand is NF)

nitrofurantoin monohydrate/macrocrystalline (Macrobid brandis NF)

URINARY TRACT SPASMSDETROL LAoxybutyninoxybutynin ext-release (Ditropan XL

brand is NF)tolterodine (Detrol brand is NF)VESICAREVAGINAL PRODUCTSCLEOCIN suppclindamycin (Cleocin brand is NF)CRINONE ESTRACE crmmetronidazole (MetroGel-Vaginal

brand is NF)terconazole (Terazol brand is NF)VAGIFEMOTHER GENITOURINARY DRUGSalfuzosin ext-release (Uroxatral

brand is NF)AVODARTCYSTAGON finasteride (Proscar brand is NF)POTASSIUM CITRATEpotassium citrate/citric acid

powder (Polycitra-K brand is NF)sodium citrate/citric acid (Shohl's

brand is NF)tamsulosin (Flomax brand is NF)

2014


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CENTRAL NERVOUS SYSTEM DRUGSANXIETYalprazolam (Xanax brand is NF)alprazolam ext-release (Xanax XR

brand is NF)

buspironeDIAZEPAM oral soln, 1 mg/mLdiazepam tabs (Valium brand is NF)hydroxyzine hclhydroxyzine pamoate 25 mg,

50 mg (Vistaril brand is NF)lorazepam (Ativan brand is NF)lorazepam conc (Lorazepam Intensol

brand is NF)DEPRESSIONamitriptylinebupropion (Wellbutrin brand is NF)bupropion ext-release (Wellbutrin SR,

Wellbutrin XL brands are NF)citalopram (Celexa brand is NF)clomipramine (Anafranil brand is NF)desipramine (Norpramin brand is NF)doxepin, NF = caps, 75 mgescitalopram (Lexapro brand is NF)fluoxetine, NF = 60 mg (Prozac

brand is NF)fluvoxamineimipramine hcl (Tofranil brand is NF)mirtazapine, NF = 7.5 mg (Remeron,

Remeron SolTab brands are NF)nortriptyline caps (Pamelor brand is

NF)paroxetine hcl (Paxil brand is NF)paroxetine hcl ext-release (Paxil CR

brand is NF)phenelzine (Nardil brand is NF)sertraline (Zoloft brand is NF)

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tranylcypromine (Parnate brand isNF)

trazodonevenlafaxinevenlafaxine ext-release caps (Effexor

XR brand is NF)venlafaxine ext-release tabs, NF =

225 mg

PSYCHOTIC AND BIPOLAR DISORDERSchlorpromazineclozapine (Clozaril brand is NF) FLUPHENAZINE HCL conc, elixirfluphenazine hcl tabshaloperidol decanoate (Haldol brand

is NF)haloperidol lactate oral conchaloperidol tabslithium carbonatelithium carbonate ext-release

300 mg (Lithobid brand is NF)lithium carbonate ext-release 450 mgloxapine (Loxitane brand is NF)olanzapine (Zyprexa, Zyprexa Zydis

brands are NF)

perphenazineprochlorperazinequetiapine (Seroquel brand is NF) risperidone (Risperdal, Risperdal M-

Tab brands are NF)

SEROQUEL XR thiothixenetrifluoperazineziprasidone (Geodon brand is NF) SLEEP AIDSestazolamphenobarbital soln; tabs, 16.2 mg,

32.4 mg

2014


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temazepam (Restoril brand is NF)zaleplon (Sonata brand is NF) zolpidem (Ambien brand is NF) zolpidem ext-release (Ambien CR

brand is NF)

HYPERACTIVITY/NARCOLEPSYamphetamine/

dextroamphetamine (Adderall brand is NF)

amphetamine/dextroamphetamineext-release (Adderall XR brand isNF)

caffeine citrate (Cafcit brand is NF)dextroamphetamine dextroamphetamine ext-

release (Dexedrine Spansule brandis NF)

INTUNIV methylphenidate tabs (Ritalin brand

is NF)

methylphenidate ext-release caps;tabs, 20 mg (Metadate CD, RitalinLA, Ritalin SR brands are NF)

modafinil (Provigil brand is NF) VYVANSE MULTIPLE SCLEROSISBETASERON COPAXONE REBIF TECFIDERA OTHER CENTRAL NERVOUS SYSTEM DRUGSbupropion ext-release (Zyban brand

is NF)CHANTIXdisulfiram (Antabuse brand is NF)donepezil (Aricept, Aricept ODT

brands are NF)EXELON patches, soln

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galantamine (Razadyne brand is NF)galantamine ext-release (Razadyne

ER brand is NF)naltrexone (ReVia brand is NF) NICOTROL INHALERNICOTROL NSNUEDEXTAORAPrivastigmine caps (Exelon brand is

NF)PAIN RELIEF DRUGSNON-NARCOTIC DRUGSbutalbital/acetaminophenbutalbital/acetaminophen/caffeine

(Esgic, Esgic-Plus, Fioricet brandsare NF)

butalbital/aspirin/caffeinecaps (Fiorinal brand is NF)

salsalateNARCOTIC DRUGSacetaminophen/codeine (Tylenol w/

Codeine brand is NF)buprenorphine buprenorphine/naloxone SL tabs butalbital/aspirin/caffeine/

codeine (Fiorinal w/Codeine brandis NF)

CODEINE SULFATE 15 mgfentanyl lollipop (Actiq brand is NF) fentanyl patches (Duragesic brand is

NF)

hydrocodone/acetaminophen, NF =tabs, 2.5-325 mg (Lortab brand isNF)

hydrocodone/ibuprofen (Ibudone,Reprexain, Vicoprofen brands areNF)

2014


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hydromorphone soln, tabs (Dilaudid brand is NF)

KADIAN methadone conc (Methadose brand

is NF)methadone solnmethadone tabs (Dolophine brand is

NF)morphine sulfate conc, soln morphine sulfate ext-release (Kadian) morphine sulfate ext-release (MS

Contin brand is NF)

MORPHINE SULFATE supp, tabsNUCYNTA ER oxycodone (Roxicodone brand is NF)oxycodone caps, conc, solnoxycodone/acetaminophen (Percocet

brand is NF)oxycodone/aspirin (Percodan brand

is NF)OXYCONTIN SUBOXONE film tramadol (Ultram brand is NF) tramadol/acetaminophen (Ultracet

brand is NF)RHEUMATOID AND OSTEOARTHRITISCELEBREX diclofenac potassium (Cataflam

brand is NF)diclofenac sodium delayed-releasediclofenac sodium ext-

release (Voltaren-XR brand is NF)ENBREL etodolacflurbiprofenHUMIRA ibuprofen

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indomethacinketoprofenleflunomide (Arava brand is NF)meloxicam tabs (Mobic brand is NF)nabumetonenaproxen (Naprosyn brand is NF)naproxen delayed-release (EC-

Naprosyn brand is NF)naproxen sodium (Anaprox brand is

NF)oxaprozin (Daypro brand is NF)piroxicam (Feldene brand is NF)sulindac (Clinoril brand is NF)MIGRAINE HEADACHESacetaminophen/isometheptene/

dichloralphenazoneIMITREX nasal spray MIGRANAL naratriptan (Amerge brand is NF) rizatriptan (Maxalt, Maxalt-MLT

brands are NF)

sumatriptan inj, tabs (Imitrex brandis NF)

GOUTallopurinol (Zyloprim brand is NF)COLCRYSprobenecidprobenecid/colchicineNEUROMUSCULAR DRUGSSEIZUREScarbamazepine (Tegretol brand is

NF)carbamazepine ext-release

(Carbatrol, Tegretol-XR brands areNF)

CELONTINclonazepam (Klonopin brand is NF)

2014


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DIASTAT DILANTIN 30 mgdivalproex delayed-release

(Depakote, Depakote Sprinkles brands are NF)

divalproex ext-release (Depakote ER brand is NF)

ethosuximide (Zarontin brand is NF)gabapentin (Neurontin brand is NF)GABITRIL 12 mg, 16 mglamotrigine (Lamictal brand is NF)levetiracetam (Keppra brand is NF)LYRICA capsoxcarbazepine (Trileptal brand is NF)phenytoin chew tabs (Dilantin Infatabs

brand is NF)phenytoin sodium ext-release

(Dilantin, Phenytek brands are NF)phenytoin susp (Dilantin brand is NF)primidone (Mysoline brand is NF)SABRILTEGRETOL-XR 100 mgtopiramate (Topamax, Topamax

Sprinkle brands are NF)valproic acid (Depakene brand is NF)zonisamide (Zonegran brand is NF)PARKINSON'S DISEASEamantadine, NF = tabsAPOKYN AZILECTbenztropinebromocriptine (Parlodel brand is NF)carbidopa/levodopa (Parcopa,

Sinemet brands are NF)carbidopa/levodopa ext-

release (Sinemet CR brand is NF)entacapone (Comtan brand is NF)

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pramipexole (Mirapex brand is NF)ropinirole (Requip brand is NF)selegiline caps (Eldepryl brand is NF)selegiline tabstrihexyphenidylMUSCLE RELAXANTSbaclofenchlorzoxazone (Parafon Forte DSC

brand is NF)cyclobenzaprinedantrolene (Dantrium brand is NF)metaxalone (Skelaxin brand is NF)methocarbamol (Robaxin brand is

NF)orphenadrine citrate ext-releaseorphenadrine/aspirin/caffeine

25-385-30 mgtizanidine (Zanaflex brand is NF) OTHER NEUROMUSCULAR DRUGSMESTINON syrupMESTINON TIMESPANpyridostigmine (Mestinon brand is

NF)riluzole (Rilutek brand is NF)SUPPLEMENTSVITAMINSergocalciferol (Drisdol brand is NF)MEPHYTONMULTIVITAMINSpediatric multivitaminspediatric vitamins ADCPRENAPLUSPRENATABS FAPRENATAL VITAMINS PLUSPRENATAL 19, PRENATAL LOW

IRON, PRENATAL PLUS

2014


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SE-NATAL 19MINERALS AND ELECTROLYTESK-PHOSpotassium bicarbonate/chloride

effervescent tabs, 25 mEqpotassium chloride packets; soln,

10%potassium chloride ext-release (K-

Tabs brand is NF)potassium chloride ext-release

caps (Micro-K brand is NF)potassium phosphate/sodium

phosphates (K-Phos Neutral brandis NF)

sodium fluoride chew tabs,soln (Luride brand is NF)

BLOOD MODIFYING DRUGSADVATE ALPHANATE ALPHANINE SD anagrelide (Agrylin brand is NF)ARANESP BEBULIN BEBULIN VH BENEFIX cilostazol (Pletal brand is NF)clopidogrel (Plavix brand is NF)CORIFACT cyanocobalamin injdipyridamole (Persantine brand is

NF)DROXIAenoxaparin (Lovenox brand is NF) EPOGEN FEIBA NF FEIBA VH IMMUNO folic acid 1 mg

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HELIXATE FS HEMOFIL M HUMATE-P KOATE-DVI KOGENATE FS KOGENATE FS BIO-SET MONOCLATE-P MONONINE NEULASTA NEUPOGEN NOVOSEVEN RT pentoxifylline ext-release (Trental

brand is NF)PROCRIT PROFILNINE SD RECOMBINATE RIXUBIS warfarin (Coumadin brand is NF)WILATE XARELTO XYNTHA XYNTHA SOLOFUSE TOPICAL DRUGSEYEAnti-infectivesBACITRACIN ointbacitracin/polymyxin B ointciprofloxacin soln (Ciloxan brand is

NF)erythromycin ointgentamicin oint, soln (Garamycin

brand is NF)NATACYNneomycin/polymyxin B/bacitracin

oint

2014


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neomycin/polymyxin B/gramicidinsoln (Neosporin brand is NF)

ofloxacin soln (Ocuflox brand is NF)polymyxin B/trimethoprim

soln (Polytrim brand is NF)sulfacetamide sodium soln (Bleph-10

brand is NF)tobramycin soln (Tobrex brand is

NF)trifluridine soln (Viroptic brand is NF)VIGAMOXSteroids and Combination Productsdexamethasone sodium phosphate

solnfluorometholone susp (FML Liquifilm

brand is NF)LOTEMAXneomycin/polymyxin B/bacitracin/

hydrocortisone ointneomycin/polymyxin B/

dexamethasone oint, susp (Maxitrol brand is NF)

prednisolone acetate susp (Pred Forte brand is NF)

PREDNISOLONE SODIUMPHOSPHATE soln, 1%

sulfacetamide sodium/prednisolonesoln

TOBRADEX ointtobramycin/dexamethasone

susp (Tobradex brand is NF)ZYLETGlaucomaALPHAGAN P 0.1%AZOPTbrimonidine soln, 0.15% (Alphagan P

brand is NF)brimonidine soln, 0.2%

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carteolol solndorzolamide soln (Trusopt brand is

NF)dorzolamide/timolol maleate

soln (Cosopt brand is NF)latanoprost soln (Xalatan brand is

NF)

levobunolol soln, 0.5% (Betagan brand is NF)

LUMIGAN metipranolol soln (Optipranolol

brand is NF)pilocarpine soln (Isopto Carpine

brand is NF)SIMBRINZAtimolol maleate soln (Timoptic,

Timoptic-XE brands are NF)TRAVATAN Z Other Eye Productsatropine sulfate soln (Isopto Atropine

brand is NF)azelastine soln (Optivar brand is NF)cromolyn solncyclopentolate soln (Cyclogyl brand

is NF)diclofenac soln (Voltaren brand is

NF)flurbiprofen soln (Ocufen brand is

NF)homatropine soln (Isopto Homatropine

brand is NF)ketorolac soln (Acular, Acular LS

brands are NF)PATADAYtropicamide soln (Mydriacyl brand is

NF)EARacetic acid soln

2014


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benzocaine/antipyrine solnCIPRODEXhydrocortisone/acetic acid

soln (Vosol HC brand is NF)neomycin/polymyxin B/

hydrocortisone soln,susp (Cortisporin brand is NF)

ofloxacin solnMOUTH AND THROAT (local)cevimeline (Evoxac brand is NF)chlorhexidine oral rinse (Peridex

brand is NF)clotrimazole trochelidocaine viscousnystatin susppilocarpine (Salagen brand is NF)sodium fluoride (Prevident brand is

NF)triamcinolone dental pasteANORECTAL AGENTSCORTIFOAMhydrocortisone acetate crm, supp

(Anusol-HC, Proctocort brands areNF)

hydrocortisone enema (Cortenema brand is NF)

SKIN CONDITIONS/PRODUCTSAcneadapalene (Differin brand is NF) clindamycin (Cleocin-T brand is NF)clindamycin/benzoyl peroxide

(Benzaclin, Duac brands are NF)DIFFERIN gel, 0.3% erythromycin pads, solnerythromycin/benzoyl

peroxide (Benzamycin brand is NF)FINACEA

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isotretinoin, NF = 30 mgmetronidazole (Metrocream, Metrogel,

Metrolotion brands are NF)sulfacetamide sodium (Klaron brand

is NF)sulfacetamide sodium/sulfur, NF =

susp, 10-5%TAZORACtretinoin (Retin-A brand is NF) tretinoin microsphere (Retin-A Micro

brand is NF)

Anti-infectivesciclopirox crm, gel, shampoo,

susp (Loprox brand is NF)ciclopirox soln (Penlac brand is NF)econazoleketoconazole crmketoconazole shampoo, 2% (Nizoral

brand is NF)mupirocin (Bactroban brand is NF)nystatin topicalsilver sulfadiazine (Silvadene brand

is NF)Corticosteroidsalclometasone (Aclovate brand is

NF)amcinonide crmbetamethasone dipropionatebetamethasone dipropionate,

augmented (Diprolene brand is NF)betamethasone valerateclobetasol (Clobex, Olux, Temovate

brands are NF)desonide (Desowen brand is NF)desoximetasone crm, 0.25%; gel;

oint, 0.25% (Topicort brand is NF)diflorasone oint

2014


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fluocinolone (Derma-Smoothe/FS,Synalar brands are NF)

fluocinonidefluticasone propionate (Cutivate

brand is NF)halobetasol (Ultravate brand is NF)hydrocortisone topicalhydrocortisone valerate (Westcort

brand is NF)mometasone (Elocon brand is NF)nystatin/triamcinolone crmtriamcinolone crm; lotn; oint,

0.025%, 0.1%Other Skin Productsacitretin (Soriatane brand is NF)aluminum chloride (Drysol brand is

NF)calcipotriene (Dovonex brand is NF)CARACELIDELFLUOROPLEXfluorouracil (Efudex brand is NF)imiquimod (Aldara brand is NF) lidocaine patches (Lidoderm brand is

NF)lidocaine topical, NF = lotn (Xylocaine

brand is NF)lidocaine/prilocaine crm (Emla

brand is NF)lindanemalathion (Ovide brand is NF)permethrin (Elimite brand is NF)podofilox (Condylox brand is NF)PROTOPICselenium sulfideSOLARAZEVOLTAREN

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XERAC ACZYCLARA ZYCLARA PUMP MISCELLANEOUS CATEGORIESDIABETIC SUPPLIESINSULIN PEN NEEDLES BD

ULTRAFINE, NOVOFINE,NOVOTWIST

INSULIN SYRINGES BD LANCETS BAYER FINGERSTIX,

MICROLET, SINGLE-LETLANCETS BD MICROTAINER,

ULTRAFINELANCETS ROCHE ACCU-CHEK

FASTCLIX, MULTICLIX, SOFTTOUCH, SOFTCLIX

TEST STRIPS BAYER ASCENSIAAUTODISC, BREEZE 2, CONTOUR,CONTOUR NEXT

TEST STRIPS ROCHE ACCU-CHEKACTIVE, AVIVA, AVIVA PLUS,COMFORT CURVE, COMPACT,SMARTVIEW

TEST STRIPS ROCHEACCUTREND

MEDICAL DEVICESBREATHERITEMISCELLANEOUS DRUGSazathioprine (Imuran brand is NF)CELLCEPTCHEMETCUPRIMINE cyclosporine (Sandimmune brand is

NF)cyclosporine modified caps, 25 mg,

100 mg; soln (Neoral brand is NF)CYCLOSPORINE MODIFIED caps,

50 mgmycophenolate mofetil (Cellcept)

2014


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MYFORTICPROGRAFRAPAMUNEREVLIMID sodium polystyrene sulfonatetacrolimus (Prograf)THALOMID ZORTRESS

2014


INDEX

Aabacavir tabs...................................................................2acarbose.......................................................................... 4acebutolol........................................................................ 6acetaminophen/codeine............................................... 11acetaminophen/isometheptene/dichloralphenazone 12acetazolamide 250 mg................................................... 7acetazolamide ext-release............................................. 7acetic acid ear soln......................................................15acetylcysteine................................................................. 8acitretin.......................................................................... 17ACTONEL......................................................................... 5acyclovir.......................................................................... 2adapalene...................................................................... 16ADCIRCA..........................................................................7adefovir............................................................................ 2ADVAIR DISKUS..............................................................8ADVAIR HFA.................................................................... 8ADVATE..........................................................................14AFINITOR, NF = DISPERZ..............................................3ALBENZA..........................................................................2albuterol 0.63 mg/3 mL, 1.25 mg/3 mL......................... 8albuterol inhal soln, 0.083%, 0.5%................................8albuterol syrup, tabs...................................................... 8alclometasone............................................................... 16alendronate tabs, 5 mg, 10 mg, 35 mg, 70 mg............. 5alfuzosin ext-release...................................................... 9ALKERAN tabs................................................................. 3allopurinol......................................................................12ALPHAGAN P 0.1%....................................................... 15ALPHANATE...................................................................14ALPHANINE SD............................................................. 14alprazolam..................................................................... 10alprazolam ext-release................................................. 10aluminum chloride........................................................17amantadine, NF = tabs.................................................13amcinonide crm............................................................ 16amiloride.......................................................................... 7amiloride/hydrochlorothiazide.......................................7amiodarone......................................................................7amitriptyline...................................................................10amlodipine....................................................................... 6amlodipine/benazepril.................................................... 6amoxicillin, NF = chew tabs.......................................... 1amoxicillin/potassium clavulanate................................1amoxicillin/potassium clavulanate ext-release............1amphetamine/dextroamphetamine..............................11amphetamine/dextroamphetamine ext-release..........11ampicillin caps................................................................1anagrelide...................................................................... 14anastrozole...................................................................... 3ANDRODERM.................................................................. 4

ANDROGEL......................................................................4ANDROXY........................................................................ 4APOKYN......................................................................... 13APTIVUS...........................................................................2ARANESP.......................................................................14ASACOL HD.....................................................................9ASMANEX........................................................................ 8ASTEPRO.........................................................................7atenolol............................................................................ 6atenolol/chlorthalidone.................................................. 6atorvastatin......................................................................6atovaquone/proguanil 250-100 mg............................... 2ATRIPLA........................................................................... 2atropine sulfate eye soln............................................. 15ATROVENT HFA..............................................................8AVODART.........................................................................9azathioprine...................................................................17azelastine.........................................................................8azelastine eye soln.......................................................15AZILECT......................................................................... 13azithromycin susp.......................................................... 1azithromycin tabs........................................................... 1AZOPT............................................................................ 15Bbacitracin/polymyxin B eye oint................................. 14BACITRACIN eye oint.................................................... 14baclofen......................................................................... 13balsalazide.......................................................................9BARACLUDE.................................................................... 2BEBULIN.........................................................................14BEBULIN VH.................................................................. 14benazepril........................................................................ 5benazepril/hydrochlorothiazide.....................................5BENEFIX.........................................................................14BENICAR.......................................................................... 6BENICAR HCT................................................................. 6benzocaine/antipyrine ear soln................................... 16benztropine....................................................................13betamethasone dipropionate.......................................16betamethasone dipropionate, augmented................. 16betamethasone valerate...............................................16BETASERON..................................................................11bicalutamide.................................................................... 3BILTRICIDE...................................................................... 2bisoprolol.........................................................................6bisoprolol/hydrochlorothiazide..................................... 6BREATHERITE...............................................................17BREO ELLIPTA................................................................ 8brimonidine eye soln, 0.15%....................................... 15brimonidine eye soln, 0.2%......................................... 15bromocriptine................................................................13budesonide......................................................................8budesonide ext-release..................................................3bumetanide......................................................................7buprenorphine...............................................................11

2014


buprenorphine/naloxone SL tabs............................... 11bupropion...................................................................... 10bupropion ext-release.................................................. 10bupropion ext-release.................................................. 11buspirone.......................................................................10butalbital/acetaminophen.............................................11butalbital/acetaminophen/caffeine.............................. 11butalbital/aspirin/caffeine/codeine.............................. 11butalbital/aspirin/caffeine caps................................... 11Ccabergoline......................................................................5caffeine citrate.............................................................. 11calcipotriene..................................................................17calcitonin-salmon........................................................... 5calcitriol........................................................................... 5calcium acetate...............................................................9CANASA........................................................................... 9captopril...........................................................................5CARAC........................................................................... 17carbamazepine.............................................................. 12carbamazepine ext-release..........................................12carbidopa/levodopa...................................................... 13carbidopa/levodopa ext-release.................................. 13carteolol eye soln.........................................................15carvedilol......................................................................... 6cefaclor caps...................................................................1cefadroxil......................................................................... 1cefdinir............................................................................. 1cefpodoxime....................................................................1cefprozil........................................................................... 1ceftriaxone.......................................................................1cefuroxime.......................................................................1CELEBREX.....................................................................12CELLCEPT..................................................................... 17CELONTIN......................................................................12cephalexin, NF = tabs.................................................... 1cetirizine syrup............................................................... 7cevimeline......................................................................16CHANTIX........................................................................ 11CHEMET.........................................................................17CHENODAL...................................................................... 9chlorhexidine oral rinse...............................................16chloroquine phosphate..................................................2chlorothiazide..................................................................7chlorpromazine............................................................. 10chlorzoxazone............................................................... 13cholestyramine................................................................6chorionic gonadotropin................................................. 4CIALIS...............................................................................7ciclopirox crm, gel, shampoo, susp........................... 16ciclopirox soln.............................................................. 16cilostazol........................................................................14cimetidine........................................................................ 8CIPRODEX..................................................................... 16ciprofloxacin....................................................................1

ciprofloxacin ext-release................................................1ciprofloxacin eye soln..................................................14citalopram......................................................................10clarithromycin................................................................. 1clarithromycin ext-release............................................. 1CLEOCIN supp.................................................................9clindamycin..................................................................... 2clindamycin................................................................... 16clindamycin/benzoyl peroxide.....................................16clindamycin crm............................................................. 9clobetasol...................................................................... 16clomiphene...................................................................... 4clomipramine.................................................................10clonazepam................................................................... 12clonidine.......................................................................... 7clopidogrel.....................................................................14clotrimazole troche.......................................................16clozapine........................................................................10CODEINE SULFATE 15 mg...........................................11COLCRYS.......................................................................12colestipol......................................................................... 6COMBIPATCH.................................................................. 4COMBIVENT.....................................................................8COMBIVENT RESPIMAT.................................................8COPAXONE....................................................................11CORIFACT......................................................................14CORTIFOAM.................................................................. 16CORTISONE.....................................................................3CREON............................................................................. 9CRESTOR........................................................................ 6CRINONE......................................................................... 9CRIXIVAN......................................................................... 2cromolyn eye soln........................................................15cromolyn inhal soln....................................................... 8CUPRIMINE....................................................................17cyanocobalamin inj...................................................... 14cyclobenzaprine............................................................13cyclopentolate eye soln...............................................15CYCLOPHOSPHAMIDE tabs...........................................3cyclosporine..................................................................17cyclosporine modified caps, 25 mg, 100 mg; soln.... 17CYCLOSPORINE MODIFIED caps, 50 mg....................17cyproheptadine............................................................... 7CYSTAGON......................................................................9Ddanazol.............................................................................4dantrolene......................................................................13DAPSONE........................................................................ 2DARAPRIM....................................................................... 2DELZICOL........................................................................ 9demeclocycline............................................................... 1desipramine...................................................................10desmopressin..................................................................5desonide........................................................................ 16desoximetasone crm, 0.25%; gel; oint, 0.25%........... 16

2014


DETROL LA......................................................................9dexamethasone elixir; tabs, 0.5 mg, 0.75 mg, 1.5 mg,4 mg, 6 mg.................................................................... 3

dexamethasone sodium phosphate eye soln............ 15DEXAMETHASONE soln, 0.5 mg/5 mL........................... 3dextroamphetamine......................................................11dextroamphetamine ext-release..................................11DIASTAT.........................................................................13DIAZEPAM oral soln, 1 mg/mL...................................... 10diazepam tabs...............................................................10DIBENZYLINE.................................................................. 7diclofenac eye soln...................................................... 15diclofenac potassium...................................................12diclofenac sodium delayed-release............................ 12diclofenac sodium ext-release.................................... 12dicloxacillin..................................................................... 1dicyclomine caps, tabs.................................................. 8didanosine delayed-release...........................................2DIFFERIN gel, 0.3%.......................................................16diflorasone oint.............................................................16digoxin tabs.................................................................... 7DILANTIN 30 mg............................................................13diltiazem...........................................................................6diltiazem ext-release...................................................... 6diphenoxylate/atropine tabs.......................................... 9dipyridamole..................................................................14disopyramide...................................................................7disulfiram.......................................................................11divalproex delayed-release..........................................13divalproex ext-release..................................................13DIVIGEL............................................................................4donepezil....................................................................... 11dorzolamide/timolol maleate eye soln........................15dorzolamide eye soln...................................................15doxazosin........................................................................ 7doxepin, NF = caps, 75 mg..........................................10doxycycline hyclate........................................................1doxycycline monohydrate............................................. 1DROXIA.......................................................................... 14DULERA........................................................................... 8Eeconazole.......................................................................16ELIDEL............................................................................17ELLA................................................................................. 4EMCYT............................................................................. 3EMEND caps.................................................................... 9EMTRIVA.......................................................................... 2enalapril........................................................................... 5enalapril/hydrochlorothiazide........................................5ENBREL..........................................................................12ENJUVIA...........................................................................4enoxaparin.....................................................................14entacapone.................................................................... 13EPIPEN.............................................................................7EPIPEN-JR....................................................................... 7

EPIVIR soln...................................................................... 2eplerenone.......................................................................7EPOGEN.........................................................................14EPZICOM..........................................................................2ergocalciferol................................................................ 13erythromycin/benzoyl peroxide...................................16erythromycin/sulfisoxazole............................................2erythromycin delayed-release caps..............................1erythromycin eye oint.................................................. 14erythromycin pads, soln..............................................16escitalopram..................................................................10estazolam.......................................................................10ESTRACE crm..................................................................9estradiol/norethindrone acetate.................................... 4estradiol patches............................................................ 4estradiol tabs.................................................................. 4estropipate, NF = 3 mg.................................................. 4ethambutol.......................................................................1ethosuximide.................................................................13etodolac......................................................................... 12EVISTA............................................................................. 5EXELON patches, soln...................................................11exemestane..................................................................... 3Ffamciclovir....................................................................... 2famotidine........................................................................8FARESTON...................................................................... 3FEIBA NF....................................................................... 14FEIBA VH IMMUNO....................................................... 14felodipine ext-release.....................................................6fenofibrate....................................................................... 6fenofibrate micronized................................................... 6fenofibric acid delayed-release..................................... 6fentanyl.......................................................................... 11fentanyl lollipop............................................................ 11FINACEA........................................................................ 16finasteride........................................................................9FIRAZYR...........................................................................8flecainide......................................................................... 7FLOVENT DISKUS...........................................................8FLOVENT HFA.................................................................8fluconazole...................................................................... 1flucytosine....................................................................... 1fludrocortisone................................................................3flunisolide........................................................................ 8fluocinolone...................................................................17fluocinonide...................................................................17fluorometholone eye susp...........................................15FLUOROPLEX................................................................17fluorouracil.................................................................... 17fluoxetine, NF = 60 mg.................................................10FLUPHENAZINE HCL conc, elixir..................................10fluphenazine hcl tabs...................................................10flurbiprofen....................................................................12flurbiprofen eye soln....................................................15

2014


flutamide.......................................................................... 3fluticasone propionate................................................... 8fluticasone propionate................................................. 17fluvoxamine................................................................... 10folic acid 1 mg..............................................................14FOLLISTIM AQ.................................................................4FORADIL AEROLIZER.....................................................8FORTEO........................................................................... 5fosinopril..........................................................................5fosinopril/hydrochlorothiazide...................................... 5furosemide, NF = soln, 8 mg/mL...................................7FUZEON........................................................................... 2Ggabapentin.....................................................................13GABITRIL 12 mg, 16 mg................................................13galantamine................................................................... 11galantamine ext-release...............................................11GANIRELIX ACETATE.....................................................4gemfibrozil.......................................................................6gentamicin eye oint, soln............................................ 14GLEEVEC......................................................................... 3glimepiride.......................................................................4glipizide............................................................................4glipizide/metformin......................................................... 4glipizide ext-release....................................................... 4GLUCAGON EMERGENCY KIT...................................... 4glyburide..........................................................................4glyburide/metformin....................................................... 4glyburide micronized..................................................... 4glycopyrrolate................................................................. 8granisetron...................................................................... 9griseofulvin microsize....................................................1guanfacine....................................................................... 7Hhalobetasol.................................................................... 17haloperidol decanoate..................................................10haloperidol lactate oral conc.......................................10haloperidol tabs............................................................10HELIXATE FS.................................................................14HEMOFIL M....................................................................14homatropine eye soln.................................................. 15HUMALOG........................................................................5HUMALOG MIX 50/50, 75/25...........................................5HUMATE-P..................................................................... 14HUMIRA..........................................................................12HUMULIN 70/30............................................................... 5HUMULIN N......................................................................5HUMULIN R......................................................................5hydralazine...................................................................... 7hydrochlorothiazide caps.............................................. 7hydrochlorothiazide tabs...............................................7hydrocodone/acetaminophen, NF = tabs, 2.5-325mg.................................................................................11

hydrocodone/ibuprofen................................................11

hydrocortisone................................................................3hydrocortisone/acetic acid ear soln........................... 16hydrocortisone acetate rectal crm, supp................... 16hydrocortisone enema................................................. 16hydrocortisone topical.................................................17hydrocortisone valerate...............................................17hydromorphone soln, tabs.......................................... 12hydroxychloroquine....................................................... 2hydroxyurea.................................................................... 3hydroxyzine hcl............................................................ 10hydroxyzine pamoate 25 mg, 50 mg...........................10hyoscyamine................................................................... 8hyoscyamine ext-release............................................... 8Iibandronate..................................................................... 5ibuprofen....................................................................... 12imipramine hcl.............................................................. 10imiquimod......................................................................17IMITREX nasal spray..................................................... 12INCIVEK............................................................................2INCRELEX........................................................................ 5indapamide...................................................................... 7indomethacin.................................................................12INNOPRAN XL................................................................. 6INSULIN PEN NEEDLES BD ULTRAFINE,NOVOFINE, NOVOTWIST........................................... 17

INSULIN SYRINGES BD............................................ 17INTELENCE......................................................................2INTUNIV..........................................................................11INVIRASE......................................................................... 2ipratropium/albuterol......................................................8ipratropium inhal soln....................................................8ipratropium nasal........................................................... 8irbesartan.........................................................................6irbesartan/hydrochlorothiazide..................................... 6ISENTRESS......................................................................2isoniazid/rifampin........................................................... 1isoniazid tabs..................................................................1isosorbide dinitrate, NF = SL tabs................................6isosorbide mononitrate..................................................6isosorbide mononitrate ext-release..............................6isotretinoin, NF = 30 mg.............................................. 16itraconazole..................................................................... 1JJANUMET......................................................................... 4JANUMET XR...................................................................4JANUVIA...........................................................................4JUVISYNC........................................................................ 4KKADIAN...........................................................................12KALETRA..........................................................................2KALYDECO...................................................................... 8ketoconazole crm......................................................... 16

2014


ketoconazole shampoo, 2%.........................................16ketoprofen..................................................................... 12ketorolac eye soln........................................................ 15KOATE-DVI.....................................................................14KOGENATE FS.............................................................. 14KOGENATE FS BIO-SET.............................................. 14KOMBIGLYZE XR............................................................ 4K-PHOS.......................................................................... 14Llabetalol........................................................................... 6lactulose.......................................................................... 8lactulose.......................................................................... 9lamivudine....................................................................... 2lamivudine/zidovudine................................................... 2lamotrigine.....................................................................13LANCETS BAYER FINGERSTIX, MICROLET,SINGLE-LET................................................................. 17

LANCETS BD MICROTAINER, ULTRAFINE.............. 17LANCETS ROCHE ACCU-CHEK FASTCLIX,MULTICLIX, SOFT TOUCH, SOFTCLIX...................... 17

lansoprazole delayed-release........................................8LANTUS............................................................................5latanoprost eye soln.................................................... 15leflunomide....................................................................12LETAIRIS.......................................................................... 7letrozole........................................................................... 3LEUCOVORIN CALCIUM tabs, 10 mg, 15 mg.................3leucovorin calcium tabs, 5 mg, 25 mg......................... 3LEUKERAN.......................................................................3LEVEMIR.......................................................................... 5levetiracetam................................................................. 13levobunolol eye soln, 0.5%..........................................15levocarnitine....................................................................5levofloxacin..................................................................... 1levonorgestrel................................................................. 4levothyroxine...................................................................5LEXIVA............................................................................. 2LIALDA..............................................................................9lidocaine/prilocaine crm...............................................17lidocaine patches......................................................... 17lidocaine topical, NF = lotn......................................... 17lidocaine viscous..........................................................16lindane........................................................................... 17liothyronine..................................................................... 5lisinopril........................................................................... 5lisinopril/hydrochlorothiazide........................................5lithium carbonate..........................................................10lithium carbonate ext-release 300 mg........................ 10lithium carbonate ext-release 450 mg........................ 10loperamide.......................................................................9lorazepam...................................................................... 10lorazepam conc............................................................ 10losartan............................................................................ 6losartan/hydrochlorothiazide.........................................6LOTEMAX.......................................................................15

lovastatin......................................................................... 6loxapine......................................................................... 10LUMIGAN........................................................................15LYRICA caps.................................................................. 13MMALARONE 62.5-25 mg....

Rx Formulary Std Il 2014

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Transcript of Rx Formulary Std Il 2014