SmithRx Standard Formulary · 2019-10-31 · + SmithRx Standard Formulary Understanding the costs...

Welcome to the SmithRx Standard Formulary. The Standard Formulary is a list of drugs that your doctor may prescribe for you and includes information related to the coverage and cost of these drugs. This list may change over time, so please refer to plan documents or formulary update documents for detailed information about your drug benefit coverage.

The drugs included on the Standard Formulary are organized by categories depending on the type of medical conditions that they are used to treat. Medications are listed as Tier 1 Generic, Tier 2 Preferred Brand, and Tier 3 Non-Preferred Brand. Medications listed as “Specialty Drugs” are used to treat complex medical conditions that require special handling, administration, and member care management. Depending on your pharmacy benefit design, specialty drugs may be part of a specialty benefit with specific coverage and copay requirements that differ from drugs in Tiers 1 – 3. If you do not have a defined specialty benefit, your copay may be based on whether the drug is Generic or Brand, therefore Tier 1 or Tier 3 copays may apply. Please refer to your plan document for detailed information about your Tiers and Copay structures.

Our Pharmacy and Therapeutics Committee (P&T) and Value Assessment Committee (VAC) dedicates many hours to the clinical analysis and evaluation of peer reviewed literature and medical care guidelines to determine a drug’s safety and efficacy. After this rigorous clinical evaluation, the committee weighs the financial implications of a drug compared to other similar drugs and selects appropriate Tier placement based on the drugs’ safety, efficacy and cost- effectiveness. Please note all drugs on the SmithRx Standard Formulary are subjected to periodic review and amendment.

Please keep in mind when a generic medication is chosen, patients pay the lowest copay available under their pharmacy benefit plan. When clinically appropriate, please consider talking to your doctor about choosing a generic product.

For the most up-to-date Standard Formulary, visit our website at www.smithrx.com. If you have any questions about the SmithRx Standard Formulary, please call our dedicated customer service team at (844) 454-5201.

+ SmithRx Standard FormularyUnderstanding the costs of your prescriptions

1 Last Updated: 06/04/19

Tier Definitions T1 Tier 1 – Generics

T2 Tier 2 – Preferred Brands

T3 Tier 3 – Non-Preferred Brands

Utilization Management Definitions

S Specialty Drug

Specialty drugs are high-cost drugs used to treat complex or rare conditions. Some examples of the diseases include; multiple sclerosis, rheumatoid arthritis, hepatitis C, and hemophilia.

PA Prior Authorization

Your provider is required to get prior authorization before you fill your prescription, which ensures appropriate use of the selected drug. Without prior approval, we may not cover this drug.

ST Step Therapy In some cases, you may be required to first try certain drugs to treat your medical condition before you move up a “step” to other drug options.

QL Quantity Limit There is a limit on the amount of this drug that is covered per prescription, or within a specific time frame.


PRODUCT TIER

ADRENALIN T3DOPAMINE HCL T1DOPAMINE HCL IN 5% DEXTROSE T1EPINEPHRINE T1EPINEPHRINE HCL-0.9% NACL T1EPINEPHRINE HCL-D5W T1EPINEPHRINE-0.9% NACL T1EPINEPHRINE-D5W T1ISUPREL T3LEVOPHED BITARTRATE T3NOREPINEPHRINE BITAR-0.9% NACL T1NOREPINEPHRINE BITARTRATE T1NOREPINEPHRINE BITARTRATE-D5W T1

MIDODRINE HCL T1NORTHERA T3 S PA QL

ADRENACLICK T3 PA QLAUVI-Q T3 PA QLEPINEPHRINE T1 QLEPINEPHRINESNAP-EMS T3 QLEPINEPHRINESNAP-V T3 QLEPIPEN T3 PA QLEPIPEN 2-PAK T3 PA QLEPIPEN JR T3EPIPEN JR 2-PAK T3 PA QLSYMJEPI T3 PA QL

MYRBETRIQ T2 QL

EPHEDRINE SULFATE T1EPHEDRINE SULFATE-0.9% NACL T1PHENYLEPHRINE HCL T1PHENYLEPHRINE HCL-0.9% NACL T1PHENYLEPHRINE HCL-D5W T1PHENYLEPHRINE HCL-WATER T1

ALDACTONE T3CAROSPIR T2 PAEPLERENONE T1

ADRENERGICS

ALDOSTERONE ANTAGONISTS

ADRENERGIC AGENTS,CATECHOLAMINES

ADRENERGIC VASOPRESSOR AGENTS

ANAPHYLAXIS THERAPY AGENTS

OVERACTIVE BLADDER AGENTS, BETA-3 ADRENERGIC RECEP

SYMPATHOMIMETIC AGENTS

POTASSIUM SPARING DIURETICS

UTILIZATION MANAGEMENT


PRODUCT TIER UTILIZATION MANAGEMENTINSPRA T3SPIRONOLACTONE T1

ADIPEX-P T3 PA QLBENZPHETAMINE HCL T1 PA QLDIETHYLPROPION HCL T1 PA QLDIETHYLPROPION HCL ER T1 PA QLLOMAIRA T1 PA QLPHENDIMETRAZINE TARTRATE T1 PA QLPHENDIMETRAZINE TARTRATE ER T1 PA QLPHENTERMINE HCL T1 PA QLQSYMIA T3 PA QLREGIMEX T3 PA QL

SAXENDA T3 PA QL

BELVIQ T3 PA QLBELVIQ XR T3 PA QL

CONTRAVE T3 PA QL

XENICAL T3

ABSORICA T3 PAAMNESTEEM T1 PACLARAVIS T1 PAISOTRETINOIN T1 PAMYORISAN T1 PAZENATANE T1 PA

ACANYA T3 PA QLACZONE T3 PA QLADAPALENE-BENZOYL PEROXIDE T1 QLAZELEX T3 QLBENZACLIN T3 PA QLCLINDAMYCIN PHOS-BENZOYL PEROX T1 PA QLCLINDAMYCIN PHOS-TRETINOIN T1 QLCLINDAMYCIN-BENZOYL PEROXIDE T1 QLDAPSONE T1 QLDUAC T3 PA QLEPIDUO T3 QL

ALL OTHER ANTIOBESITY PREPS

ALL OTHER DERMATOLOGICALS

ANTI-OBESITY SEROTONIN 2C RECEPTOR AGONISTS

ANTI-OBESITY-OPIOID ANTAG-NOREPI,DOPAMINE RU INHIB

FAT ABSORPTION DECREASING AGENTS

ACNE AGENTS,SYSTEMIC

ACNE AGENTS,TOPICAL

ANTI-OBESITY - ANOREXIC AGENTS

ANTI-OBESITY GLUCAGON-LIKE PEPTIDE-1 RECEP AGONIST


PRODUCT TIER UTILIZATION MANAGEMENTEPIDUO FORTE T3 QLKLARON T3 QLNEUAC T1 QLONEXTON T3 QLSULFACETAMIDE SODIUM T1 QLVELTIN T3 PA QL

DRYSOL T3XERAC AC T3

ANTI-ITCH T1DOXEPIN HCL T1 PA QLPRUDOXIN T3 PA QLSP ANTIPRURITIC T3WAL-DRYL T1ZONALON T3 PA QL

ACITRETIN T1 QLCOSENTYX (2 SYRINGES) T3 S PA QLCOSENTYX PEN T3 S PA QLCOSENTYX PEN (2 PENS) T3 S PA QLCOSENTYX SYRINGE T3 S PA QLMETHOXSALEN T1OXSORALEN-ULTRA T3SILIQ T3 S PASORIATANE T3 QLTALTZ AUTOINJECTOR T3 S PA QLTALTZ AUTOINJECTOR (2 PACK) T3 S PA QLTALTZ AUTOINJECTOR (3 PACK) T3 S PA QLTALTZ SYRINGE T3 S PA QLTALTZ SYRINGE (2 PACK) T3 S PA QLTALTZ SYRINGE (3 PACK) T3 S PA QLTREMFYA T3 S PA QL

CALCIPOTRIENE T1 QLCALCITRENE T1 QLCALCITRIOL T1 QLDOVONEX T3 QLDRITHOCREME HP T3DUOBRII T3 PASORILUX T3 QLTAZAROTENE T1 QLTAZORAC T3 QL

ANTIPERSPIRANTS

ANTIPRURITICS,TOPICAL

ANTIPSORIATIC AGENTS,SYSTEMIC

ANTIPSORIATICS AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTVECTICAL T3 QL

DHS ZINC T3LOUTREX T3OVACE T3 QLOVACE PLUS T3 QLOVACE PLUS WASH T3 QLPROMISEB T3SEB-PREV T1 QLSELENIUM SULFIDE T1SELRX T3SODIUM SULFACETAMIDE T1 QLTERSI FOAM T3

MEDICATED PADS T1

FRESHNET T3HEX-ON LIGHT T3ODOR ELIMINATOR DROPS T3ULTRA-FRESH T3

REGRANEX T3 QL

VANIQA T3

BLANCHE T1C-CLARIFYING SERUM T3C-THERAPY NIGHT CREAM T3HYDROQUINONE T1NU-DERM SUNFADER T3TRI-LUMA T3

IMIQUIMOD T1 QL

PINE TAR T1QUTENZA T3 S

VANOXIDE-HC T3 QL

BENSAL HP T3BENZEFOAM T3 QLBENZEFOAM ULTRA T3 QLBENZEPRO T1

ANTISEBORRHEIC AGENTS

IRRITANTS/COUNTER-IRRITANTS

KERATOLYTIC-GLUCOCORTICOID COMBINATIONS

KERATOLYTICS

ASTRINGENTS

DEODORANTS

DIABETIC ULCER PREPARATIONS,TOPICAL

HAIR GROWTH REDUCTION AGENTS

HYPOPIGMENTATION AGENTS

IMMUNOMODULATORS


PRODUCT TIER UTILIZATION MANAGEMENTBENZOYL PEROXIDE T1 QLBP-50% UREA T1BPO T1 QLCONDYLOX T3KERALAC T3KERALYT T3OIL-FREE ACNE WASH T1PACNEX T1PODOCON-25 T3PODOFILOX T1PR BENZOYL PEROXIDE T1SALACYN T1SALEX T3SALICYLIC ACID T1SALICYLIC ACID ER T1SALIMEZ FORTE T3SALVAX T3SILVER NITRATE APPLICATOR T3ULTRASAL-ER T3UREA T1UTOPIC T3VIRASAL T3

BEESWAX WHITE T1BEESWAX YELLOW T1LANOLIN ANHYDROUS T1PARAFFIN WAX T1PETROLATUM T1STEARYL ALCOHOL T1

TETRIX T3

AZELAIC ACID T3 PA QLFINACEA T3 PA QLMETROCREAM T3METROGEL T3METROLOTION T3METRONIDAZOLE T1MIRVASO T2 QLNORITATE T3RHOFADE T3 PA QLROSADAN T1SOOLANTRA T2 QL

OINTMENT/CREAM BASES

PROTECTIVES

ROSACEA AGENTS, TOPICAL


PRODUCT TIER UTILIZATION MANAGEMENT

ARTISS T3TISSEEL VHSD T3

EUCRISA T2 ST QL

PYROGALLIC ACID T1TRI-CHLOR T3TRICHLOROACETIC ACID T1

QBREXZA T3 PA QL

BIMATOPROST T1LATISSE T3

ELIDEL T2 ST QLPIMECROLIMUS T1 ST QLPROTOPIC T3 ST QLTACROLIMUS T1 ST QL

CALCIPOTRIENE-BETAMETHASONE DP T1 PA QLENSTILAR T3 PA QLTACLONEX T3 PA QL

ADAPALENE T1 QLALTRENO T3 QLATRALIN T3 QLAVITA T1DIFFERIN T3 QLPLIXDA T3 QLRETIN-A T3RETIN-A MICRO T3 QLRETIN-A MICRO PUMP T3 QLTRETIN-X T3TRETINOIN T1 QLTRETINOIN MICROSPHERE T1 PA QL

FABIOR T3 PA QL

AVAGE T3 QLREFISSA T3RENOVA T3RENOVA PUMP T3

TOPICAL VIT D ANALOG/ANTI-INFLAMMATORY STEROID

VITAMIN A DERIVATIVES

VITAMIN A DERIVATIVES, TOPICAL ACNE AGENTS

VITAMIN A DERIVATIVES, TOPICAL COSMETIC AGENTS

TISSUE/WOUND ADHESIVES

TOP. ANTI-INFLAM.,PHOSPHODIESTERASE-4 (PDE4) INHIB

TOPICAL AGENTS,MISCELLANEOUS

TOPICAL ANTICHOLINERGIC HYPERHIDROSIS TX AGENTS

TOPICAL HYPERTRICHOTIC AGENTS, EYELASHES

TOPICAL IMMUNOSUPPRESSIVE AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTTRETINOIN T1

ACACIA T3ACREMONIUM T3ALDER T3ALTERNARIA T3AMERICAN BEECH T3AMERICAN COCKROACH EXTRACT T3AMERICAN ELM T3AMERICAN SYCAMORE T3ARIZONA CYPRESS T3ASPERGILLUS FUMIGATUS T3AUREOBASIDIUM T3AUSTRALIAN PINE T3BAHIA T3BALD CYPRESS T3BAYBERRY T3BLACK WALNUT POLLEN T3BLACK WILLOW T3BOTRYTIS T3BOX ELDER T3BROME T3CALIFORNIA PEPPER TREE T3CANDIDA ALBICANS T3CARELESSWEED T3CATTLE EPITHELIUM T3CEDAR ELM T3CLADOSPORIUM CLADOSPORIOIDES T3CLADOSPORIUM SPHAEROSPERMUM T3COCKLEBUR T3CORN POLLEN T3CORN SMUT T3CURVULARIA T3D.FARINAE MITE EXTRACT T3D.PTERONYSSINUS MITE EXTRACT T3DOG EPITHELIUM EXTRACT T3DOG FENNEL T3DRECHSLERA T3EASTERN COTTONWOOD T3ENGLISH PLANTAIN T3EPICOCCUM T3FIRE ANT T3

ALLERGENSALLERGENIC EXTRACTS, THERAPEUTIC


PRODUCT TIER UTILIZATION MANAGEMENTFUSARIUM T3GERMAN COCKROACH T3GOLDENROD T3GRASTEK T3 PA QLHACKBERRY T3HORSE EPITHELIUM T3JOHNSON GRASS T3KAPOK T3KOCHIA T3LAMB'S QUARTERS T3MELALEUCA T3MESQUITE T3MIXED ASPERGILLUS T3MIXED COCKROACH T3MIXED FEATHERS T3MIXED RAGWEED EXTRACT T3MOSQUITO T3MOUNTAIN CEDAR T3MOUSE EPITHELIUM T3MUCOR T3MUGWORT T3ODACTRA T3 PA QLOLIVE TREE T3ORALAIR T3 S PAPECAN POLLEN T3PENICILLIUM NOTATUM T3PHOMA T3PRIVET T3QUACK GRASS T3QUEEN PALM T3RABBIT EPITHELIUM T3RAGWITEK T3 PA QLRED BIRCH T3RED CEDAR T3RED MAPLE T3RED MULBERRY T3RED OAK T3RHIZOPUS T3ROUGH MARSH ELDER T3ROUGH PIGWEED T3RUSSIAN THISTLE T3SACCHAROMYCES CEREVISIAE T3SAGEBRUSH T3


PRODUCT TIER UTILIZATION MANAGEMENTSHAGBARK HICKORY T3SHEEP SORREL T3SHEEP SORREL-YELLOW DOCK T3SHORT RAGWEED T3SPINY PIGWEED T3STANDARD BERMUDA GRASS POLLEN T3STANDARD MIXED MITE EXTRACT T3STANDARD RYE GRASS POLLEN T3STANDARD SWEET VERNAL GRASS T3STANDARDIZED CAT HAIR T3STANDARDIZED JUNE GRASS POLLEN T3STANDARDIZED MEADOW FESCUE T3STANDARDIZED ORCHARD GRASS T3STANDARDIZED RED TOP GRASS T3STANDARDIZED TIMOTHY GRASS T3 QLSWEETGUM T3TALL RAGWEED T3TRICHOPHYTON T3VIRGINIA LIVE OAK T3WESTERN JUNIPER T3WESTERN RAGWEED T3WHITE ASH T3WHITE BIRCH T3WHITE MULBERRY T3WHITE OAK EXTRACT T3WHITE PINE T3YELLOW DOCK T3

CANDIN T3

ADDERALL T3 ST QLADDERALL XR T3 ST QLADZENYS ER T3 ST QLADZENYS XR-ODT T3 ST QLAMPHETAMINE SULFATE T1 QLDESOXYN T3 ST QLDEXEDRINE T3 ST QLDEXTROAMPHETAMINE SULFATE T1 QLDEXTROAMPHETAMINE SULFATE ER T1 QLDEXTROAMPHETAMINE-AMPHET ER T1 QLDEXTROAMPHETAMINE-AMPHETAMINE T1 QLDYANAVEL XR T3 ST QL

AMPHETAMINE PREPARATIONS

ANTIGENIC SKIN TESTS

ADRENERGICS, AROMATIC, NON-CATECHOLAMINE


PRODUCT TIER UTILIZATION MANAGEMENTEVEKEO T3 ST QLMETHAMPHETAMINE HCL T1 QLMYDAYIS T3 ST QLPROCENTRA T3 ST QLVYVANSE T2 QLZENZEDI T1 ST QL

ANADROL-50 T3ANDROXY T3 PAOXANDRIN T3 PAOXANDROLONE T1 PA

INTRAROSA T3 QL

ANDRODERM T2 PA QLANDROGEL T3 PA QLANDROID T3 PAAVEED T3 S PAAXIRON T3 PA QLDELATESTRYL T3 PADEPO-TESTOSTERONE T3FORTESTA T3 PA QLMETHITEST T3 PAMETHYLTESTOSTERONE T1NATESTO T3 PA QLSTRIANT T3 PATESTIM T3 PA QLTESTOPEL T1 S PATESTOSTERONE T1 PA QLTESTOSTERONE CYPIONATE T1TESTOSTERONE ENANTHATE T1TESTRED T3 PAVOGELXO T3 PA QLXYOSTED T3 PA

BUFFERED LIDOCAINE T3BUPIVACAINE HCL T1BUPIVACAINE HCL-0.9% NACL T1BUPIVACAINE HCL-EPINEPHRINE T1BUPIVACAINE-DEXTROSE T1

ANDROGENIC AGENTS

ANDROGEN/ESTROGEN PREPS FOR FEMALE SEXUAL DYSFUNC

ANDROGENIC AGENTS

LOCAL ANESTHETICS

ANABOLICS

ANDROGENS

ANESTHETIC LOCAL TOPICAL


PRODUCT TIER UTILIZATION MANAGEMENTCARBOCAINE T3CHLOROPROCAINE HCL T1EXPAREL T3GLYDO T1LIDOCAINE HCL T1LIDOCAINE HCL IN 7.5% DEXTROSE T1LIDOCAINE HCL VISCOUS T1LIDOCAINE HCL-0.9% NACL T1LIDOCAINE HCL-EPINEPHRINE T1LIDOCAINE-EPINEPHRINE T1MARCAINE T3MARCAINE SPINAL T3MARCAINE-EPINEPHRINE T3MEPIVACAINE HCL T1NAROPIN T3NESACAINE T3NESACAINE-MPF T3ORASEP T3POLOCAINE T1POLOCAINE-MPF T1ROPIVACAINE HCL T1SENSORCAINE T1SENSORCAINE WITH DEXTROSE T1SENSORCAINE-EPINEPHRINE T1SENSORCAINE-MPF T1SENSORCAINE-MPF EPINEPHRINE T1VIVACAINE T1XYLOCAINE T3XYLOCAINE DENTAL-EPINEPHRINE T1XYLOCAINE WITH EPINEPHRINE T3XYLOCAINE-MPF T3XYLOCAINE-MPF WITH EPINEPHRINE T3ZINGO T3

ANALPRAM HC T3EPIFOAM T3HYDROCORTISONE-PRAMOXINE T1LIDOCAINE-HYDROCORTISONE T1NOVACORT T3PRAMOSONE T3PRAMOSONE E T3

ADAZIN T3

TOPICAL ANTI-INFLAMMATORY STEROID-LOCAL ANESTHETIC

TOPICAL LOCAL ANESTHETICS


PRODUCT TIER UTILIZATION MANAGEMENTANACAINE T3ANASTIA T3APRIZIO PAK T3 PACETACAINE T3ETHYL CHLORIDE T1LENZAPATCH T3 QLLIDOCAINE T1 QLLIDOCAINE HCL T1LIDOCAINE-PRILOCAINE T1LIDOCAINE-TETRACAINE T1LIDODERM T3 QLLIDODOSE T2 PA QLLIDOPIN T1LIDOPRIL T1LIDOTREX T3LIDTOPIC MAX T3NUMBONEX T3PAIN EASE T3PLIAGLIS T3PONTOCAINE T3PRE-ATTACHED LTA KIT T3PRIKAAN T1PRIKAAN LITE T1RADIAGUARD T3REGENECARE T3SPRAY AND STRETCH T3SYNERA T3TEROCIN T3ZTLIDO T3 PA QL

PHENAZOPYRIDINE HCL T1PYRIDIUM T3

FORANE T3ISOFLURANE T1SEVOFLURANE T1TERRELL T1ULTANE T3

AMIDATE T3BREVITAL SODIUM T3

ANESTHETICS GEN INHALANT

ANESTHETICS GEN INJECT

URINARY TRACT ANESTHETIC/ANALGESIC AGNT (AZO-DYE)

GENERAL ANESTHETICS,INHALANT

GENERAL ANESTHETICS,INJECTABLE


PRODUCT TIER UTILIZATION MANAGEMENTDIPRIVAN T3ETOMIDATE T1KETALAR T3KETAMINE HCL T1KETAMINE HCL-0.9% NACL T1METHOHEXITAL-STERILE WATER T1MIDAZOLAM HCL T1PROPOFOL T1

MIDAZOLAM HCL T1MIDAZOLAM HCL-0.9% NACL T1MIDAZOLAM HCL-D5W T1MIDAZOLAM-0.9% NACL T1

ANTACID T1ANTACID EXTRA STRENGTH T1

CARAFATE T2CYTOTEC T3MISOPROSTOL T1SUCRALFATE T1

LANSOPRAZOL-AMOXICIL-CLARITHRO T1 QLOMECLAMOX-PAK T3 PA QLPREVPAC T3 PA QLPYLERA T2 PA QL

BALSALAZIDE DISODIUM T1COLAZAL T3GIAZO T3

CIMETIDINE T1FAMOTIDINE T1FAMOTIDINE-0.9% NACL T1NIZATIDINE T1 QLPEPCID T3RANITIDINE HCL T1ZANTAC T3

KEPIVANCE T3 S

ACIPHEX T3 ST QL

GENERAL ANESTHETICS,INJECTABLE-BENZODIAZEPINE TYPE

ANTACIDS

ANTI-ULCER PREPARATIONS

ANTI-ULCER-H.PYLORI AGENTS

DRUG TX-CHRONIC INFLAM. COLON DX,5-AMINOSALICYLAT

HISTAMINE H2-RECEPTOR INHIBITORS

ANTI-ULCER PREPS/GASTROINTESTINAL PREPS

KERATINOCYTE GROWTH FACTOR (KGF)

PROTON-PUMP INHIBITORS


PRODUCT TIER UTILIZATION MANAGEMENTACIPHEX SPRINKLE T3 ST QLDEXILANT T2 ST QLESOMEPRAZOLE MAGNESIUM T1 QLESOMEPRAZOLE SODIUM T1ESOMEPRAZOLE STRONTIUM T1 ST QLHEARTBURN TREATMENT T1 QLLANSOPRAZOLE T1 QLNEXIUM T3 ST QLNEXIUM I.V. T3OMEPRAZOLE T1 QLOMEPRAZOLE-SODIUM BICARBONATE T1 STPANTOPRAZOLE SODIUM T1 QLPREVACID T3 ST QLPRILOSEC T3 STPROTONIX T3 ST QLPROTONIX IV T3RABEPRAZOLE SODIUM T1 QLZEGERID T3 ST QL

SALSALATE T1

CUPRIMINE T3D-PENAMINE T2DEPEN T2

OTREXUP T3 PA QLRASUVO T3 PA QL

KINERET T3 S PA QL

ENBREL T3 S PA QLENBREL MINI T3 S PA QLENBREL SURECLICK T3 S PA QLHUMIRA T3 S PA QLHUMIRA PEDIATRIC CROHN'S T3 S PA QLHUMIRA PEN T3 S PA QLHUMIRA PEN CROHN'S-UC-HS T3 S PA QLHUMIRA PEN PSOR-UVEITS-ADOL HS T3 S PA QLHUMIRA(CF) T3 S PA QLHUMIRA(CF) PEDIATRIC CROHN'S T3 S PA QLHUMIRA(CF) PEN T3 S PA QLHUMIRA(CF) PEN CROHN'S-UC-HS T3 S PA QL

ANTIARTHRITICS

ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR

ANALGESIC/ANTIPYRETICS, SALICYLATES

ANTI-ARTHRITIC AND CHELATING AGENTS

ANTI-ARTHRITIC, FOLATE ANTAGONIST AGENTS

ANTI-INFLAM. INTERLEUKIN-1 RECEPTOR ANTAGONIST


PRODUCT TIER UTILIZATION MANAGEMENTHUMIRA(CF) PEN PSOR-UV-ADOL HS T3 S PA QLSIMPONI T3 S PA QLSIMPONI ARIA T3 S PA QL

ARAVA T3LEFLUNOMIDE T1

OTEZLA T3 S PA QL

DUROLANE T3 S PAEUFLEXXA T3 S PAGEL-ONE T3 S PAGENVISC 850 T3 S PAHYALGAN T3 S PAHYMOVIS T3 S PAMONOVISC T3 S PAORTHOVISC T3 S PASUPARTZ FX T3 S PASYNVISC T3 S PASYNVISC-ONE T3 S PATRIVISC T3 S PA

ORENCIA T3 S PA QLORENCIA CLICKJECT T3 S PA QL

COLCHICINE T1 QLCOLCRYS T2 QLMITIGARE T3 ST QL

RIDAURA T2

ELITEK T3 SKRYSTEXXA T3 S PA QL

ALLOPURINOL T1 QLALLOPURINOL SODIUM T1ALOPRIM T3ULORIC T2 ST QLZYLOPRIM T3 QL

OLUMIANT T3 S PA QLXELJANZ T3 S PA QLXELJANZ XR T3 S PA QL

ANTI-INFLAMMATORY, PYRIMIDINE SYNTHESIS INHIBITOR

ANTI-INFLAMMATORY,PHOSPHODIESTERASE-4(PDE4) INHIB.

ANTI-INFLAMMATORY/ANTIARTHRITICS AGENTS, MISC.

ANTINFLAMMATORY, SEL.COSTIM.MOD.,T-CELL INHIBITOR

COLCHICINE

GOLD SALTS

HYPERURICEMIA TX - URATE-OXIDASE ENZYME-TYPE

HYPERURICEMIA TX - XANTHINE OXIDASE INHIBITORS

JANUS KINASE (JAK) INHIBITORS



DUEXIS T3 PA QL

VIMOVO T3 ST QL

ANSAID T3NABUMETONE T1NAPROXEN T1NAPROXEN SODIUM T1

ANAPROX DS T3CALDOLOR T3DAYPRO T3DICLOFENAC SODIUM T1DICLOFENAC SODIUM ER T1DYLOJECT T3EC-NAPROSYN T3EC-NAPROXEN T3ETODOLAC T1ETODOLAC ER T1FELDENE T3FENOPROFEN CALCIUM T1FENORTHO T3FLURBIPROFEN T1IBU T1IBUPROFEN T1INDOCIN T3 QLINDOMETHACIN T1INDOMETHACIN ER T1KETOPROFEN T1LODINE T3MECLOFENAMATE SODIUM T1MELOXICAM T1 QLMOBIC T3 QLNABUMETONE T1NALFON T3 PANAPRELAN T3 QLNAPROSYN T3NAPROXEN T1NAPROXEN SODIUM T1NAPROXEN SODIUM CR T1NAPROXEN SODIUM DS T1NAPROXEN SODIUM ER T1

NSAID AND HISTAMINE H2 RECEPTOR ANTAGONIST COMB.

NSAID,COX INHIBITOR-TYPE AND PROTON-PUMP INHIBITOR

NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPE

NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPE ANALGESICS


PRODUCT TIER UTILIZATION MANAGEMENTOXAPROZIN T1PIROXICAM T1PROFENO T1SULINDAC T1TIVORBEX T3TOLMETIN SODIUM T1VIVLODEX T3 PA QLVOLTAREN-XR T3ZORVOLEX T3 PA QL

CELEBREX T3 QLCELECOXIB T1 QL

ARTHROTEC 50 T3ARTHROTEC 75 T3DICLOFENAC SODIUM-MISOPROSTOL T1

DICLOVIX T3 PA

DICLOFENAC EPOLAMINE T1 QLDICLOFENAC SODIUM T1 QLFLECTOR T3 QLKLOFENSAID II T1PENNSAID T3 PA QLVOLTAREN T3 QL

PROBENECID T1 QLPROBENECID-COLCHICINE T1 QLZURAMPIC T3 PA QL

DUZALLO T3 PA QL

COUMADIN T2JANTOVEN T1WARFARIN SODIUM T1

ACD SOLUTION A T1ACD-A T3ANTICOAGULANT SODIUM CITRATE T1CITRATE PHOSPHATE DEXTROSE T3SODIUM CITRATE T1TRICITRASOL T3

ANTICOAGULANTS

TOPICAL ANTI-INFLAMMATORY NSAID-LOCAL ANESTHETIC

TOPICAL ANTI-INFLAMMATORY, NSAIDS

URICOSURIC AGENTS

URICOSURIC AND XANTHINE OXIDASE INHIBITOR COMB.

ANTICOAGULANTS,COUMARIN TYPE

CITRATES AS ANTICOAGULANTS

NSAIDS,CYCLOOXYGENASE-2(COX-2) SELECTIVE INHIBITOR

NSAIDS(COX NON-SPEC.INHIB)AND PROSTAGLANDIN ANALOG



BEVYXXA T3 PA QLELIQUIS T2 QLSAVAYSA T3 PA QLXARELTO T2 QL

ARIXTRA T3 SENOXAPARIN SODIUM T1FONDAPARINUX SODIUM T1 SFRAGMIN T3 SHEPARIN FLUSH T1HEPARIN LOCK T1HEPARIN SODIUM T1HEPARIN SODIUM IN 0.45% NACL T1HEPARIN SODIUM-0.45% NACL T1HEPARIN SODIUM-0.9% NACL T1HEPARIN SODIUM-D5W T1LOVENOX T3

AGGRASTAT T3AGGRENOX T3 QLASPIRIN-DIPYRIDAMOLE ER T1 QLBRILINTA T2 QLCILOSTAZOL T1 QLCLOPIDOGREL T1 QLDIPYRIDAMOLE T1 QLDURLAZA T3 PA QLEFFIENT T3 QLEPTIFIBATIDE T1INTEGRILIN T3KENGREAL T3PLAVIX T3 QLPRASUGREL HCL T1 QLREOPRO T3TICLOPIDINE HCL T1 QLZONTIVITY T3 PA QL

ARGATROBAN T1ARGATROBAN-0.9% NACL T1ARGATROBAN-SODIUM CHLORIDE T1PRADAXA T2 QL

ANGIOMAX T3

DIRECT FACTOR XA INHIBITORS

HEPARIN AND RELATED PREPARATIONS

PLATELET AGGREGATION INHIBITORS

THROMBIN INHIBITORS, SELECTIVE, DIRECT, REVERSIBLE

THROMBIN INHIBITORS,SEL,DIRECT,REVERS-HIRUDIN TYPE


PRODUCT TIER UTILIZATION MANAGEMENTBIVALIRUDIN T1BIVALIRUDIN-0.9% NACL T1IPRIVASK T3 S

CLOBAZAM T1 S PACLONAZEPAM T1 QLDIASTAT T3 QLDIASTAT ACUDIAL T3 QLDIAZEPAM T1 QLKLONOPIN T3 QLONFI T3 S PASYMPAZAN T3 S PA QL

EPIDIOLEX T3 S PA QL

APTIOM T3BANZEL T3BRIVIACT T3 PA QLCARBAMAZEPINE T1CARBAMAZEPINE ER T1CARBATROL T3CELONTIN T3CEREBYX T3DEPACON T3DEPAKENE T3DEPAKOTE T3DEPAKOTE ER T2DEPAKOTE SPRINKLE T2DILANTIN T2DILANTIN-125 T2DIVALPROEX SODIUM T1DIVALPROEX SODIUM ER T1EPITOL T1ETHOSUXIMIDE T1FELBAMATE T1FELBATOL T3 PAFOSPHENYTOIN SODIUM T1FYCOMPA T3 QLGABAPENTIN T1 QLGABITRIL T3KEPPRA T3KEPPRA XR T3

ANTICONVULSANTS

ANTICONVULSANT - CANNABINOID TYPE

ANTICONVULSANTS

ANTICONVULSANT - BENZODIAZEPINE TYPE


PRODUCT TIER UTILIZATION MANAGEMENTLAMICTAL T3LAMICTAL (BLUE) T3LAMICTAL (GREEN) T3LAMICTAL (ORANGE) T3LAMICTAL ODT T3LAMICTAL ODT (BLUE) T3LAMICTAL ODT (GREEN) T3LAMICTAL ODT (ORANGE) T3LAMICTAL XR T3LAMICTAL XR (BLUE) T3LAMICTAL XR (GREEN) T3LAMICTAL XR (ORANGE) T3LAMOTRIGINE T1LAMOTRIGINE (BLUE) T1LAMOTRIGINE (GREEN) T1LAMOTRIGINE (ORANGE) T1LAMOTRIGINE ER T1LAMOTRIGINE ODT T1LAMOTRIGINE ODT (BLUE) T1LAMOTRIGINE ODT (GREEN) T1LAMOTRIGINE ODT (ORANGE) T1LEVETIRACETAM T1 QLLEVETIRACETAM ER T1LEVETIRACETAM-NACL T1LYRICA T2 QLMYSOLINE T3NEURONTIN T3 QLOXCARBAZEPINE T1OXTELLAR XR T3PEGANONE T3PHENYTEK T2PHENYTOIN T1PHENYTOIN SODIUM T1PHENYTOIN SODIUM EXTENDED T1POTIGA T3 PA QLPRIMIDONE T1QUDEXY XR T3 STROWEEPRA T1ROWEEPRA XR T1SABRIL T3 S PA QLSPRITAM T3 QLSUBVENITE T1SUBVENITE (BLUE) T1


PRODUCT TIER UTILIZATION MANAGEMENTSUBVENITE (GREEN) T1SUBVENITE (ORANGE) T1TEGRETOL T3TEGRETOL XR T3TIAGABINE HCL T1TOPAMAX T2TOPIRAMATE T1TOPIRAMATE ER T1TRILEPTAL T3TROKENDI XR T3 STVALPROATE SODIUM T1VALPROIC ACID T1VIGABATRIN T1 S PA QLVIMPAT T3ZARONTIN T2ZONEGRAN T2ZONISAMIDE T1

MYTESI T3 S

XERMELO T3 S PA

DIPHENOXYLATE-ATROPINE T1LOMOTIL T3MOTOFEN T3OPIUM TINCTURE T1 QLPAREGORIC T1STOMACH RELIEF T1

METHYLENE BLUE T1

ACETADOTE T3ACTIVATED CHARCOAL T3CHARCOCAPS T1CYANOKIT T3DIGIFAB T3FOMEPIZOLE T1SODIUM NITRITE T1

ANASCORP T3ANTIVENIN LATRODECTUS MACTANS T1

ANTIDIARRHEALS

ANTIDOTES

ANTIDIARRHEAL - G.I. CHLORIDE CHANNEL INHIBITORS

ANTIDIARRHEAL - TRYPTOPHAN HYDROXYLASE INHIBITOR

ANTIDIARRHEALS

ACID AND ALKALI POISON ANTIDOTES

ANTIDOTES,MISCELLANEOUS

ANTIVENINS


PRODUCT TIER UTILIZATION MANAGEMENTANTIVENIN MICRURUS FULVIUS T1CROFAB T3

AMIFOSTINE T1 SDEXRAZOXANE T1 S PAETHYOL T3 SFUSILEV T3 SKHAPZORY T3 SLEUCOVORIN CALCIUM T1 SLEVOLEUCOVORIN CALCIUM T1 SMESNA T1 SMESNEX T3 SVISTOGARD T3 SVORAXAZE T3 SZINECARD T3 S PA

DUODOTE T3

PRALIDOXIME CHLORIDE T1PROTOPAM CHLORIDE T3

CALCIUM DISODIUM VERSENATE T1

BAL IN OIL T3CA-DTPA T1CHEMET T3DEFEROXAMINE MESYLATE T1DESFERAL T3DESFERAL MESYLATE T3FERRIPROX T3 S PAGALZIN T3NITHIODOTE T3PENTETATE CALCIUM TRISODIUM T1PENTETATE ZINC TRISODIUM T1RADIOGARDASE T3SODIUM THIOSULFATE T1SYPRINE T3 S PATRIENTINE HCL T1 S PAZN-DTPA T1

MOVANTIK T2 PA QLRELISTOR T3 PASYMPROIC T2 PA QL

METALLIC POISON,AGENTS TO TREAT

MU-OPIOID RECEPTOR ANTAGONISTS,PERIPHERALLY-ACTING

CHEMOTHERAPY RESCUE/ANTIDOTE AGENTS

CHOLINESTERASE REACTIVAT.-MUSCARINIC ANTG.ANTIDOTE

CHOLINESTERASE REACTIVATING,ORGANOPHOS. ANTIDOTES

LEAD POISONING, AGENTS TO TREAT (CHELATING-TYPE)



DEPADE T1REVIA T3

NALOXONE HCL T1NALTREXONE HCL T1NARCAN T2 QL

ANCOBON T3CLOTRIMAZOLE T1CRESEMBA T3 PADIFLUCAN T3 QLFLUCONAZOLE T1 QLFLUCONAZOLE IN DEXTROSE T1FLUCONAZOLE IN SALINE T1FLUCONAZOLE-NACL T1FLUCYTOSINE T1ITRACONAZOLE T1KETOCONAZOLE T1LAMISIL T3NOXAFIL T3ONMEL T3 PAORAVIG T3SPORANOX T3TERBINAFINE HCL T1TOLSURA T3 S PATRIACETIN T1VFEND T3 QLVFEND IV T3 PAVORICONAZOLE T1 PA QL

ABELCET T3AMBISOME T3AMPHOTERICIN B T1CANCIDAS T3CASPOFUNGIN ACETATE T1ERAXIS (WATER DILUENT) T3GRIS-PEG T3GRISEOFULVIN T1GRISEOFULVIN ULTRAMICROSIZE T1MYCAMINE T3NYSTATIN T1

ANTIFUNGALS

NARCOTIC ANTAGONISTS

OPIOID ANTAGONISTS

ANTIFUNGAL AGENTS

ANTIFUNGAL ANTIBIOTICS



NATACYN T3 QL

CLOTRIMAZOLE-BETAMETHASONE T1LOTRISONE T3

ATHLETE'S FOOT T1CICLODAN T1 QLCICLOPIROX T1 QLCLOTRIMAZOLE T1CNL 8 T3ECONAZOLE NITRATE T1ECOZA T3ERTACZO T3EXELDERM T3EXODERM T1EXTINA T3JUBLIA T3 PA QLKERYDIN T3 PA QLKETOCONAZOLE T1LOPROX T3LULICONAZOLE T1 PA QLMENTAX T3MICONAZOLE-ZINC OXIDE-PETROLTM T1NAFTIFINE HCL T1NAFTIN T3NIZORAL T3NYAMYC T1NYSTATIN T1NYSTATIN-TRIAMCINOLONE T1NYSTOP T1OXICONAZOLE NITRATE T1OXISTAT T3PENLAC T3 QLTRIPLE DYE T3VUSION T3XOLEGEL T3

GYNAZOLE 1 T3MICONAZOLE 3 T3TERAZOL 7 T3TERCONAZOLE T1 QL

OPHTHALMIC ANTIFUNGAL AGENTS

TOPICAL ANTIFUNGAL/ANTI-INFLAMMATORY,STEROID AGENT

TOPICAL ANTIFUNGALS

VAGINAL ANTIFUNGALS

ANTIHISTAMINES



ALLER-CHLOR T1ALLERGY T1ALLERGY RELIEF T1CARBINOXAMINE MALEATE T1CLEMASTINE FUMARATE T1CYPROHEPTADINE HCL T1DEXCHLORPHENIRAMINE MALEATE T1DIPHENHYDRAMINE HCL T1DIPHENHYDRAMINE-0.9% NACL T1HISTEX PD T3HYDROXYZINE HCL T1HYDROXYZINE PAMOATE T1KARBINAL ER T3PHENERGAN T3PROMETHAZINE HCL T1PROMETHAZINE HCL-0.9% NACL T1RYCLORA T3RYVENT T3 STVISTARIL T3WAL-DRYL T1

CETIRIZINE HCL T1 QLCLARINEX T3 PA QLDESLORATADINE T1 QLFEXOFENADINE HCL T1 QLLEVOCETIRIZINE DIHYDROCHLORIDE T1 QLXYZAL T3 QL

AZELASTINE HCL T1 QLBEPREVE T3 QLELESTAT T3 QLEMADINE T3 QLEPINASTINE HCL T1 QLKETOTIFEN FUMARATE T1 QLLASTACAFT T3 QLOLOPATADINE HCL T1 QLPATADAY T3 QLPATANOL T3 QLPAZEO T2 QL

ARAKODA T3 PA

EYE ANTIHISTAMINES

ANTIMALARIAL DRUGS

ANTIHISTAMINES - 1ST GENERATION

ANTIHISTAMINES - 2ND GENERATION

ANTIMALARIALS


PRODUCT TIER UTILIZATION MANAGEMENTATOVAQUONE-PROGUANIL HCL T1 PACHLOROQUINE PHOSPHATE T1COARTEM T3HYDROXYCHLOROQUINE SULFATE T1KRINTAFEL T3MALARONE T3 PAMEFLOQUINE HCL T1PLAQUENIL T3PRIMAQUINE T1QUALAQUIN T3 PA QLQUININE SULFATE T1 PA QL

CESAMET T3 S PA QLDRONABINOL T1 QLMARINOL T3 PA QLSYNDROS T3 PA QL

AKYNZEO T3 PA QLANTIVERT T3ANZEMET T3 QLAPREPITANT T1 QLBONJESTA T3 PA QLCINVANTI T3 SCOMPAZINE T1COMPRO T1DICLEGIS T3 PA QLDIMENHYDRINATE T1EMEND T3 S QLGRANISETRON HCL T1 S QLMECLIZINE HCL T1ONDANSETRON HCL T1 S QLONDANSETRON HCL-0.9% NACL T1 SONDANSETRON HCL-D5W T1 SONDANSETRON ODT T1 QLPHENADOZ T1PHENERGAN T1PROCHLORPERAZINE T1PROCHLORPERAZINE EDISYLATE T1PROCHLORPERAZINE MALEATE T1PROMETHAZINE HCL T1PROMETHEGAN T1SANCUSO T3 QL

ANTIEMETIC, CANNABINOID-TYPE

ANTIEMETIC/ANTIVERTIGO AGENTS

ANTINAUSEANTS


PRODUCT TIER UTILIZATION MANAGEMENTSCOPOLAMINE T1TIGAN T3TRANSDERM-SCOP T3TRIMETHOBENZAMIDE HCL T1VARUBI T3 S PA QLZOFRAN T3 S QLZOFRAN ODT T3 QLZUPLENZ T3 QL

METOCLOPRAMIDE HCL T1METOCLOPRAMIDE HCL ODT T1REGLAN T3

BEXAROTENE T1 S PATARGRETIN T3 S PA

ARZERRA T3 S PAGAZYVA T3 S PARITUXAN T3 S PARITUXAN HYCELA T3 S PA

TECENTRIQ T3 S PA

ADRIAMYCIN T1 SBLEOMYCIN SULFATE T1 SCOSMEGEN T3 SDACTINOMYCIN T1 SDAUNORUBICIN HCL T1 SDOXIL T3 SDOXORUBICIN HCL T1 SDOXORUBICIN HCL LIPOSOME T1 SELLENCE T3 SEPIRUBICIN HCL T1 SIDAMYCIN PFS T3 SIDARUBICIN HCL T1 SMITOMYCIN T1 SMUTAMYCIN T1 SVALRUBICIN T1 SVALSTAR T3 SZANOSAR T3 S

AVASTIN T3 S PA

INTESTINAL MOTILITY STIMULANTS

ANP - SELECTIVE RETINOID X RECEPTOR AGONISTS (RXR)

ANTI-CD20 (B LYMPHOCYTE) MONOCLONAL ANTIBODY

ANTI-PROGRAMMED CELL DEATH-LIGAND 1 (PD-L1) MAB

ANTIBIOTIC ANTINEOPLASTICS

ANTINEOPLAST HUM VEGF INHIBITOR RECOMB MC ANTIBODY

ANTINEOPLASTICS



BELEODAQ T3 S PAFARYDAK T3 S PAISTODAX T3 S PAROMIDEPSIN T3 S PAZOLINZA T3 S PA QL

ALKERAN T3 SBENDAMUSTINE HCL T1 SBICNU T3 SBUSULFAN T3 SBUSULFEX T3 SCARBOPLATIN T1 SCARMUSTINE T1 SCISPLATIN T1 SCYCLOPHOSPHAMIDE T1 S PAEVOMELA T3 SGLEOSTINE T3GLIADEL T3HEXALEN T3 S PAHYDREA T3HYDROXYUREA T1IFEX T3 SIFOSFAMIDE T1 SIFOSFAMIDE-MESNA T1 SLEUKERAN T3MELPHALAN T1MELPHALAN HCL T1 SMUSTARGEN T3 SMYLERAN T3 SOXALIPLATIN T1 STEMODAR T3 S PATEMOZOLOMIDE T1 S PATHIOTEPA T1 STREANDA T3 S PA

DARZALEX T3 S PA

BICALUTAMIDE T1CASODEX T3ERLEADA T3 S PA QLFLUTAMIDE T1NILANDRON T3 S

ANTINEOPLAST,HISTONE DEACETYLASE (HDAC) INHIBITORS

ANTINEOPLASTIC - ALKYLATING AGENTS

ANTINEOPLASTIC - ANTI-CD38 MONOCLONAL ANTIBODY

ANTINEOPLASTIC - ANTIANDROGENIC AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTNILUTAMIDE T1 SXTANDI T3 S PA QLYONSA T3 S PA QLZYTIGA T3 S PA QL

ADRUCIL T1 SALIMTA T3 S PAARRANON T3 SAZACITIDINE T1 SCAPECITABINE T1 S PACLADRIBINE T1 SCLOFARABINE T1 SCLOLAR T3 SCYTARABINE T1 SDACOGEN T3 SDECITABINE T1 SDEPOCYT T3 SFLOXURIDINE T1 SFLUDARABINE PHOSPHATE T1 SFLUOROURACIL T1 SFOLOTYN T3 S PAGEMCITABINE HCL T1 SGEMZAR T3 SLONSURF T3 S PA QLMERCAPTOPURINE T1METHOTREXATE T1METHOTREXATE SODIUM T1NIPENT T3 SPURIXAN T3 S PATABLOID T3 STREXALL T2VIDAZA T3 SXATMEP T3 PA QLXELODA T3 S PA QL

ANASTROZOLE T1ARIMIDEX T3AROMASIN T3EXEMESTANE T1FEMARA T3 PALETROZOLE T1

BRAFTOVI T3 S PAANTINEOPLASTIC - BRAF KINASE INHIBITORS

ANTINEOPLASTIC - ANTIMETABOLITES

ANTINEOPLASTIC - AROMATASE INHIBITORS


PRODUCT TIER UTILIZATION MANAGEMENTTAFINLAR T3 S PA QLZELBORAF T3 S PA QL

IXEMPRA T3 S

HALAVEN T3 S PA

DAURISMO T3 S PA QLERIVEDGE T3 S PA QLODOMZO T3 S PA QL

PROVENGE T3 S PA QL

JAKAFI T3 S PA QL

COTELLIC T3 S PA QLMEKINIST T3 S PA QLMEKTOVI T3 S PA

AFINITOR T3 S PA QLAFINITOR DISPERZ T3 S PATEMSIROLIMUS T1 S PA QLTORISEL T3 S PA QL

CAMPTOSAR T3 SHYCAMTIN T3 S PAIRINOTECAN HCL T1 STOPOTECAN HCL T1 S

ZALTRAP T3 S PA

CYRAMZA T3 S PA

MARQIBO T3 S PANAVELBINE T3 SVINBLASTINE SULFATE T1 SVINCASAR PFS T1 SVINCRISTINE SULFATE T1 SVINORELBINE TARTRATE T1 S

KISQALI FEMARA CO-PACK T3 S PA QL

ERBITUX T3 S PA

ANTINEOPLASTIC - EPOTHILONES AND ANALOGS

ANTINEOPLASTIC - HALICHONDRIN B ANALOGS

ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITOR

ANTINEOPLASTIC - IMMUNOTHERAPY, THERAPEUTIC VAC

ANTINEOPLASTIC - JANUS KINASE (JAK) INHIBITORS

ANTINEOPLASTIC COMB - KINASE AND AROMATASE INHIBIT

ANTINEOPLASTIC EGF RECEPTOR BLOCKER MCLON ANTIBODY

ANTINEOPLASTIC - MEK1 AND MEK2 KINASE INHIBITORS

ANTINEOPLASTIC - MTOR KINASE INHIBITORS

ANTINEOPLASTIC - TOPOISOMERASE I INHIBITORS

ANTINEOPLASTIC - VEGF-A,B AND PLGF INHIBITORS

ANTINEOPLASTIC - VEGFR ANTAGONIST

ANTINEOPLASTIC - VINCA ALKALOIDS


PRODUCT TIER UTILIZATION MANAGEMENTHERCEPTIN T3 S PAPERJETA T3 S PAVECTIBIX T3 S PA

POMALYST T3 S PA QLREVLIMID T3 S PA QLSYLATRON T3 S PA

ELIGARD T3 S PALEUPROLIDE ACETATE T1 S PALUPRON DEPOT T3 S PATRELSTAR T3 S PAVANTAS T3 S PAZOLADEX T3 S PA

FIRMAGON T3 S PA

ALECENSA T3 S PA QLALUNBRIG T3 S PA QLBORTEZOMIB T3 S PABOSULIF T3 S PA QLCABOMETYX T3 S PA QLCALQUENCE T3 S PA QLCAPRELSA T3 S PA QLCOMETRIQ T3 S PA QLCOPIKTRA T3 S PAGILOTRIF T3 S PA QLGLEEVEC T3 S PA QLIBRANCE T3 S PA QLICLUSIG T3 S PA QLIMATINIB MESYLATE T1 S PA QLIMBRUVICA T3 S PA QLINLYTA T3 S PA QLIRESSA T3 S PA QLKISQALI T3 S PA QLKYPROLIS T3 S PALENVIMA T3 S PA QLLORBRENA T3 S PA QLLYNPARZA T3 S PANERLYNX T3 S PA QLNEXAVAR T3 S PA QLNINLARO T3 S PA QLRUBRACA T3 S PA QL

ANTINEOPLASTIC IMMUNOMODULATOR AGENTS

ANTINEOPLASTIC LHRH(GNRH) AGONIST,PITUITARY SUPPR.

ANTINEOPLASTIC LHRH(GNRH) ANTAGONIST,PITUIT.SUPPRS

ANTINEOPLASTIC SYSTEMIC ENZYME INHIBITORS


PRODUCT TIER UTILIZATION MANAGEMENTRYDAPT T3 S PA QLSPRYCEL T3 S PA QLSTIVARGA T3 S PA QLSUTENT T3 S PA QLTAGRISSO T3 S PA QLTALZENNA T3 S PATARCEVA T3 S PA QLTASIGNA T3 S PA QLTYKERB T3 S PA QLVELCADE T3 S PAVERZENIO T3 S PA QLVITRAKVI T3 S PA QLVIZIMPRO T3 S PAVOTRIENT T3 S PA QLXALKORI T3 S PA QLXOSPATA T3 S PA QLZEJULA T3 S PA QLZYDELIG T3 S PA QLZYKADIA T3 S PA QL

MYLOTARG T3 S

VENCLEXTA T3 S PA QLVENCLEXTA STARTING PACK T3 S PA QL

LUMOXITI T3 S PA

SYLVANT T3 S PA

IDHIFA T3 S PA QLTIBSOVO T3 S PA

KEYTRUDA T3 S PAOPDIVO T3 S PA

ADCETRIS T3 S PABLINCYTO T3 SCAMPATH T3 S PAKADCYLA T3 S PAUNITUXIN T3 S PAZEVALIN T3 S

ABRAXANE T3 S PA

ANTINEOPLASTICS ANTIBODY/ANTIBODY-DRUG COMPLEXES

ANTINEOPLASTICS,MISCELLANEOUS

ANTINEOPLASTIC- CD33 ANTIBODY-CYTOTOXIC ANTIBIOTIC

ANTINEOPLASTIC-B CELL LYMPHOMA-2(BCL-2) INHIBITORS

ANTINEOPLASTIC-CD22 DIRECT ANTIBODY/CYTOTOXIN CONJ

ANTINEOPLASTIC-INTERLEUKIN-6(IL-6)INHIB,ANTIBODY

ANTINEOPLASTIC-ISOCITRATE DEHYDROGENASE INHIBITORS

ANTINEOPLASTIC,ANTI-PROGRAMMED DEATH-1 (PD-1) MAB


PRODUCT TIER UTILIZATION MANAGEMENTARSENIC TRIOXIDE T1 SBCG (TICE STRAIN) T3 SDACARBAZINE T1 SDOCEFREZ T3 SDOCETAXEL T1 SERWINAZE T3 SETOPOPHOS T3 SETOPOSIDE T1 SJEVTANA T3 S PA QLLYSODREN T3 SMATULANE T3 SMITOXANTRONE HCL T1 S PAONCASPAR T3 SONXOL T1 SPACLITAXEL T1 SSYNRIBO T3 S PATAXOTERE T3 STENIPOSIDE T1 STOPOSAR T1 STRETINOIN T1 S QLTRISENOX T3 S

YERVOY T3 S PA

ACTIMMUNE T3 SALFERON N T3 SINTRON A T3 S PAPROLEUKIN T3 S PA

LEVULAN T3

PHOTOFRIN T3 SUVADEX T3 S

FARESTON T3FASLODEX T3 S PA QLSOLTAMOX T3TAMOXIFEN CITRATE T1TOREMIFENE CITRATE T1

EMCYT T3 SMEGESTROL ACETATE T1

CYTOTOXIC T-LYMPHOCYTE ANTIGEN(CTLA-4)RMC ANTIBODY

IMMUNOMODULATORS

PHOTOACT,TOPICAL ANTINEOPLAST,PREMALIGNANT LESIONS

PHOTOACTIVATED, ANTINEOPLASTIC AGENTS (SYSTEMIC)

SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)

STEROID ANTINEOPLASTICS

TOPICAL ANTINEOPLASTIC & PREMALIGNANT LESION AGNTS


PRODUCT TIER UTILIZATION MANAGEMENTFLUOROURACIL T1

CARAC T2DICLOFENAC SODIUM T1 PA QLEFUDEX T3FLUOROPLEX T2FLUOROURACIL T1PANRETIN T3PICATO T3 STSOLARAZE T3 PA QLTARGRETIN T3 S PATOLAK T3 ST QLVALCHLOR T3 S PA QL

SOLOSEC T3 QLTINDAMAX T3TINIDAZOLE T1

PAROMOMYCIN SULFATE T1

FLAGYL T3FLAGYL ER T3METRO IV T3METRONIDAZOLE T1

ALBENDAZOLE T1 PA QLALBENZA T3 PA QLBILTRICIDE T3 PAEGATEN T3 PAEMVERM T2 PAIVERMECTIN T1 PAPRAZIQUANTEL T1 PASTROMECTOL T3 PA

DAPSONE T1

ALINIA T3 PA

ATOVAQUONE T1 PABENZNIDAZOLE T2 QLIMPAVIDO T3 SMEPRON T3 PA

ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL AGENTS

ANTHELMINTICS

ANTILEPROTICS

ANTIPARASITICS

ANTIPROTOZOAL DRUGS,MISCELLANEOUS

TOPICAL ANTINEOPLASTIC PREMALIGNANT LESION AGENTS

2ND GEN. ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL

AMEBICIDES

ANTIPARASITICS


PRODUCT TIER UTILIZATION MANAGEMENTNEBUPENT T3PENTAM 300 T3PENTAMIDINE ISETHIONATE T1

CROTAN T1ELIMITE T3EURAX T3 STLINDANE T1MALATHION T1NATROBA T3 STOVIDE T3 STPERMETHRIN T1SKLICE T3 STSPINOSAD T1ULESFIA T3 ST

BENZTROPINE MESYLATE T1COGENTIN T3TRIHEXYPHENIDYL HCL T1

AMANTADINE T1APOKYN T3 S PA QLAZILECT T3BROMOCRIPTINE MESYLATE T1CARBIDOPA-LEVODOPA T1CARBIDOPA-LEVODOPA ER T1CARBIDOPA-LEVODOPA-ENTACAPONE T1COMTAN T3DUOPA T3 S PA QLELDEPRYL T3ENTACAPONE T1GOCOVRI T3 S PA QLMIRAPEX T3MIRAPEX ER T3NEUPRO T3OSMOLEX ER T3 S PA QLPARLODEL T3PRAMIPEXOLE DIHYDROCHLORIDE T1PRAMIPEXOLE ER T1RASAGILINE MESYLATE T1REQUIP T3REQUIP XL T3

ANTIPARKINSON

TOPICAL ANTIPARASITICS

ANTIPARKINSONISM DRUGS,ANTICHOLINERGIC

ANTIPARKINSONISM DRUGS,OTHER


PRODUCT TIER UTILIZATION MANAGEMENTROPINIROLE ER T1 QLROPINIROLE HCL T1RYTARY T3SELEGILINE HCL T1SINEMET 10-100 T3SINEMET 25-100 T3SINEMET 25-250 T3SINEMET CR T3STALEVO 100 T3STALEVO 125 T3STALEVO 150 T3STALEVO 200 T3STALEVO 50 T3STALEVO 75 T3TASMAR T3TOLCAPONE T1XADAGO T3 PA QLZELAPAR T3

CARBIDOPA T1LODOSYN T3

CHLORDIAZEPOXIDE-CLIDINIUM T1CUVPOSA T3GLYCOPYRROLATE T1GLYCOPYRROLATE-WATER T1GLYRX-PF T3LIBRAX T3PROPANTHELINE BROMIDE T1ROBINUL T3ROBINUL FORTE T3

BENTYL T3DICYCLOMINE HCL T1

ANASPAZ T3ATROPINE SULFATE T1BELLADONNA-PHENOBARBITAL T1DONNATAL T3ED-SPAZ T1HYOSCYAMINE SULFATE T1HYOSCYAMINE SULFATE ER T1

DECARBOXYLASE INHIBITORS

ANTICHOLINERGICS,QUATERNARY AMMONIUM

ANTICHOLINERGICS/ANTISPASMODICS

BELLADONNA ALKALOIDS

ANTISPASMODIC AND ANTICHOLINERGIC AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTHYOSCYAMINE SULFATE SR T1HYOSYNE T1LEVBID T3LEVSIN T3LEVSIN-SL T3METHSCOPOLAMINE BROMIDE T1NULEV T1OSCIMIN T1OSCIMIN SL T1OSCIMIN SR T1PHENOHYTRO T1SYMAX T1SYMAX DUOTAB T3SYMAX-SL T1SYMAX-SR T1

ATROPEN T3

DARIFENACIN ER T1 QLENABLEX T3 QLSOLIFENACIN SUCCINATE T1 QLVESICARE T2 QL

DETROL T3 QLDETROL LA T3 QLDITROPAN XL T3 QLFLAVOXATE HCL T1GELNIQUE T3 ST QLOXYBUTYNIN CHLORIDE T1 QLOXYBUTYNIN CHLORIDE ER T1 QLOXYTROL T3 ST QLTOLTERODINE TARTRATE T1 QLTOLTERODINE TARTRATE ER T1 QLTOVIAZ T3 QLTROSPIUM CHLORIDE T1 QLTROSPIUM CHLORIDE ER T1 QL

METHIMAZOLE T1PROPYLTHIOURACIL T1TAPAZOLE T3

ANTITHYROID PREPARATIONS

ANTIRETROVIRAL-INTEGRASE INHIBITOR AND NNRTI COMB.

ANTITHYROID PREPS

ANTIVIRALS

MUSCARINIC RECEPTOR ANTAGONISTS (ANTICHOLINERGIC)

URINARY TRACT ANTISPASMODIC, M(3) SELECTIVE ANTAG.

URINARY TRACT ANTISPASMODIC/ANTIINCONTINENCE AGENT


PRODUCT TIER UTILIZATION MANAGEMENTJULUCA T3 S QL

TRIUMEQ T3 S

SYMTUZA T3 S

SYNAGIS T3 S PA

ACYCLOVIR T1ACYCLOVIR SODIUM T1ACYCLOVIR SODIUM-D5W T1CIDOFOVIR T1 SCYTOVENE T3 SFAMCICLOVIR T1FLUMADINE T3FOSCARNET SODIUM T1FOSCAVIR T3GANCICLOVIR T1 SGANCICLOVIR SODIUM T1 SOSELTAMIVIR PHOSPHATE T1 QLPREVYMIS T3 S PARELENZA T3 QLRIBAVIRIN T1RIMANTADINE HCL T1SITAVIG T3 PA QLTAMIFLU T3 QLVALACYCLOVIR T1VALCYTE T3 QLVALGANCICLOVIR HCL T1 QLVALTREX T3VIRAZOLE T3XOFLUZA T3 QLZOVIRAX T3

APTIVUS T3 SPREZCOBIX T3 SPREZISTA T3 S

CIMDUO T3 SDESCOVY T3 S QLTRUVADA T3 S

ABACAVIR-LAMIVUDINE T1 S

ANTIRETROVIRAL-NRTIS AND INTEGRASE INHIBITORS COMB

ANTIRETROVIRAL-NUCLEOSIDE,NUCLEOTIDE,PROTEASE INH.

ANTIVIRAL MONOCLONAL ANTIBODIES

ANTIVIRALS, GENERAL

ANTIVIRALS, HIV-SPEC, NON-PEPTIDIC PROTEASE INHIB

ANTIVIRALS, HIV-SPEC, NUCLEOSIDE-NUCLEOTIDE ANALOG

ANTIVIRALS, HIV-SPEC., NUCLEOSIDE ANALOG, RTI COMB


PRODUCT TIER UTILIZATION MANAGEMENTABACAVIR-LAMIVUDINE-ZIDOVUDINE T1 SCOMBIVIR T3 SEPZICOM T3 SLAMIVUDINE-ZIDOVUDINE T1 STRIZIVIR T3 S

SELZENTRY T3 S

FUZEON T3 S QL

EDURANT T3 SEFAVIRENZ T1 SINTELENCE T3 SNEVIRAPINE T1 SNEVIRAPINE ER T1 SPIFELTRO T3 SRESCRIPTOR T3 SSUSTIVA T3 SVIRAMUNE T3 SVIRAMUNE XR T3 S

ABACAVIR T1 SDIDANOSINE T1 SEMTRIVA T3 SEPIVIR T3 SLAMIVUDINE T1 SRETROVIR T3 SSTAVUDINE T1 SVIDEX T3 SVIDEX EC T3 SZERIT T3 SZIAGEN T3 SZIDOVUDINE T1 S

TENOFOVIR DISOPROXIL FUMARATE T1 SVIREAD T3 S

KALETRA T3 SLOPINAVIR-RITONAVIR T1 S

ATAZANAVIR SULFATE T1 SCRIXIVAN T3 SEVOTAZ T3 S

ANTIVIRALS, HIV-SPECIFIC, NUCLEOSIDE ANALOG, RTI

ANTIVIRALS, HIV-SPECIFIC, NUCLEOTIDE ANALOG, RTI

ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITOR COMB

ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITORS

ANTIVIRALS, HIV-SPECIFIC, CCR5 CO-RECEPTOR ANTAG.

ANTIVIRALS, HIV-SPECIFIC, FUSION INHIBITORS

ANTIVIRALS, HIV-SPECIFIC, NON-NUCLEOSIDE, RTI


PRODUCT TIER UTILIZATION MANAGEMENTFOSAMPRENAVIR CALCIUM T1 SINVIRASE T3 SLEXIVA T3 SNORVIR T3 SREYATAZ T3 SRITONAVIR T1 SVIRACEPT T3 S

ISENTRESS T3 SISENTRESS HD T3 STIVICAY T3 S

ATRIPLA T3 SCOMPLERA T3 SDELSTRIGO T3 SODEFSEY T3 SSYMFI T3 SSYMFI LO T3 S

BIKTARVY T3 SGENVOYA T3 SSTRIBILD T3 S

VIEKIRA PAK T3 S PA QLVIEKIRA XR T3 S PA QL

VOSEVI T3 S PA QL

EPCLUSA T3 S PA QLHARVONI T3 S PA QLLEDIPASVIR-SOFOSBUVIR T3 S PA QLSOFOSBUVIR-VELPATASVIR T3 S PA QL

SOVALDI T3 S PA QL

ADEFOVIR DIPIVOXIL T1 SBARACLUDE T3 S PA QLENTECAVIR T1 S QLEPIVIR HBV T3 SHEPSERA T3 S PA QLLAMIVUDINE T1 SLAMIVUDINE HBV T1 SVEMLIDY T3 S PA QL

ANTIVIRALS,HIV-1 INTEGRASE STRAND TRANSFER INHIBTR

ARTV NUCLEOSIDE,NUCLEOTIDE,NON-NUCLEOSIDE RTI COMB

ARV-NUCLEOSIDE,NUCLEOTIDE RTI,INTEGRASE INHIBITORS

HEP C - NS5A, NS3/4A, NON-NUCLEO.NS5B INHIB COMB.

HEP C - NS5A, NS3/4A, NUCLEOTIDE NS5B INHIB COMBO

HEP C VIRUS-NS5B POLYMERASE AND NS5A INHIB. COMBO.

HEP C VIRUS,NUCLEOTIDE ANALOG NS5B POLYMERASE INH

HEPATITIS B TREATMENT AGENTS



COPEGUS T3 S PA QLMODERIBA T1 S PA QLPEGASYS T3 S PAPEGASYS PROCLICK T3 S PAPEGINTRON T3 S PAREBETOL T3 S PA QLRIBASPHERE T1 S PA QLRIBASPHERE RIBAPAK T3 S PA QLRIBAVIRIN T1 S PA QL

DAKLINZA T3 S PA QL

OLYSIO T3 S PA QL

MAVYRET T3 S PA QLTECHNIVIE T3 S PA QLZEPATIER T3 S PA QL

XERESE T3 PA QL

ACYCLOVIR T1DENAVIR T3 PA QLZOVIRAX T2 PA QL

VEREGEN T3 PA

ALPRAZOLAM T1 QLALPRAZOLAM ER T1 QLALPRAZOLAM INTENSOL T3 QLALPRAZOLAM ODT T1 QLALPRAZOLAM XR T1 QLATIVAN T3 QLCHLORDIAZEPOXIDE HCL T1 QLCLORAZEPATE DIPOTASSIUM T1 QLDIAZEPAM T1LORAZEPAM T1 QLLORAZEPAM INTENSOL T1 QLOXAZEPAM T1 QLTRANXENE T-TAB T3 QLVALIUM T3XANAX T3 QL

HEPATITIS C TREATMENT AGENTS

HEPATITIS C VIRUS - NS5A REPLICATION COMPLEX INHIB

HEPATITIS C VIRUS NS3/4A SERINE PROTEASE INHIB.

HEPATITIS C VIRUS- NS5A AND NS3/4A INHIBITOR COMB

TOPICAL ANTIVIRAL AND ANTI-INFLAMMATORY STEROID

TOPICAL ANTIVIRALS

TOPICAL GENITAL WART-HPV TREATMENT AGENTS

ANTI-ANXIETY - BENZODIAZEPINESATARACTICS-TRANQUILIZERS


PRODUCT TIER UTILIZATION MANAGEMENTXANAX XR T3 QL

ALPRAZOLAM T1 QLALPRAZOLAM ER T1 QLBUSPIRONE HCL T1DIAZEPAM T1LORAZEPAM T1 QLMEPROBAMATE T1

FLUPHENAZINE HCL T1

ORAP T3PIMOZIDE T1

VRAYLAR T3 ST QL

CLOZAPINE T1 QLCLOZAPINE ODT T1 QLCLOZARIL T3 QLFANAPT T3 ST QLFAZACLO T3 QLGEODON T3 ST QLINVEGA T3 ST QLINVEGA SUSTENNA T3 PA QLINVEGA TRINZA T3 PA QLLATUDA T3 QLOLANZAPINE T1 QLOLANZAPINE ODT T1 QLPALIPERIDONE ER T1 QLPERSERIS T3 PA QLQUETIAPINE FUMARATE T1 QLQUETIAPINE FUMARATE ER T1 QLRISPERDAL T3 QLRISPERDAL CONSTA T3 PA QLRISPERDAL M-TAB T3 QLRISPERIDONE T1 QLRISPERIDONE ODT T1 QLSAPHRIS T3 QLSEROQUEL T3 QLSEROQUEL XR T3 QLVERSACLOZ T3 QLZIPRASIDONE HCL T1 QLZYPREXA T3 QL

ANTIPSYCHOTIC,ATYPICAL,DOPAMINE,SEROTONIN ANTAGNST

ANTI-ANXIETY DRUGS

ANTI-PSYCHOTICS,PHENOTHIAZINES

ANTIPSYCH,DOPAMINE ANTAG.,DIPHENYLBUTYLPIPERIDINES

ANTIPSYCHOTIC-ATYPICAL,D3/D2 PARTIAL AG-5HT MIXED


PRODUCT TIER UTILIZATION MANAGEMENTZYPREXA RELPREVV T3 PA QLZYPREXA ZYDIS T3 QL

ABILIFY T3 QLABILIFY MAINTENA T3 PA QLABILIFY MYCITE T3 PA QLARIPIPRAZOLE T1 QLARIPIPRAZOLE ODT T1 QLARISTADA T3 PA QLARISTADA INITIO T3 PA QLREXULTI T3 PA QL

ADASUVE T3LOXAPINE T1

OLANZAPINE T1 QLQUETIAPINE FUMARATE T1 QLRISPERIDONE T1 QLSAPHRIS T3 QL

THIOTHIXENE T1

DROPERIDOL T1HALDOL T3HALDOL DECANOATE 100 T3HALDOL DECANOATE 50 T3HALOPERIDOL T1HALOPERIDOL DECANOATE T1HALOPERIDOL DECANOATE 100 T1HALOPERIDOL LACTATE T1

MOLINDONE HCL T1

CHLORPROMAZINE HCL T1FLUPHENAZINE DECANOATE T1FLUPHENAZINE HCL T1PERPHENAZINE T1THIORIDAZINE HCL T1TRIFLUOPERAZINE HCL T1

NUPLAZID T3 S PA QL

ANTIPSYCHOTICS, ATYP, D2 PARTIAL AGONIST/5HT MIXED

ANTIPSYCHOTICS, DOPAMINE AND SEROTONIN ANTAGONISTS

ANTIPSYCHOTICS,ATYPICAL,DOPAMINE,& SEROTONIN ANTAG

ANTIPSYCHOTICS,DOPAMINE ANTAGONISTS, THIOXANTHENES

ANTIPSYCHOTICS,DOPAMINE ANTAGONISTS,BUTYROPHENONES

ANTIPSYCHOTICS,DOPAMINE ANTAGONST,DIHYDROINDOLONES

ANTIPSYCHOTICS,PHENOTHIAZINES

SELECTIVE SEROTONIN 5-HT2A INVERSE AGONISTS (SSIA)

MULTIVITAMIN PREPARATIONSB COMPLEX WITH VITAMIN C


PRODUCT TIER UTILIZATION MANAGEMENTB-COMPLEX WITH VITAMIN C T3SUPPORT-500 T3

ACTIGALL T3CHENODAL T3 SCHOLBAM T3 S PA QLURSO T3URSO FORTE T3URSODIOL T1

KINEVAC T3

OCALIVA T3 S PA QL

ALMOND T3APLISOL T3APPLE T3AVOCADO T3BANANA T3BEEF T3CANTALOUPE T3CASEIN T3CHICKEN MEAT T3COCOA BEAN T3CRAB T3EGG WHITE T3OAT GRAIN T3ORANGE T3PEANUT T3PECAN NUT T3PISTACHIO NUT T3PORK T3PRE-PEN T3RICE T3SESAME SEED T3SHRIMP T3SOYBEAN T3SPHERUSOL T3STRAWBERRY T3SWEET CORN T3TUBERSOL T3

BILE SALTS

CHOLERETICS

BILE THERAPY

BIOLOGICALS

FARNESOID X RECEPTOR (FXR) AGONIST, BILE AC ANALOG

ANTIGENIC SKIN TESTS


PRODUCT TIER UTILIZATION MANAGEMENTWHOLE EGG T3

BIVIGAM T3 S PACARIMUNE NF NANOFILTERED T3 S PACUTAQUIG T3 S PACUVITRU T3 S PACYTOGAM T3 SFLEBOGAMMA DIF T3 S PAGAMASTAN T3 S PAGAMASTAN S-D T3 S PAGAMMAGARD LIQUID T3 S PAGAMMAGARD S-D T3 S PAGAMMAKED T3 S PAGAMMAPLEX T3 S PAGAMUNEX-C T3 S PAHEPAGAM B T3 SHIZENTRA T3 S PAHYPERHEP B S-D T3 SHYPERRAB T3 SHYPERRAB S-D T3 SHYPERRHO S-D T3 SHYPERTET S-D T3 SHYQVIA T3 S PAHYQVIA IG COMPONENT T3 S PAIMOGAM RABIES-HT T3 SKEDRAB T3 SMICRHOGAM ULTRA-FILTERED PLUS T3 SNABI-HB T3 SOCTAGAM T3 S PAPANZYGA T3 S PAPRIVIGEN T3 S PARHOGAM ULTRA-FILTERED PLUS T3 SRHOPHYLAC T3 SVARIZIG T3 SWINRHO SDF T3 S

IPOL T2ROTARIX T2ROTATEQ T2

TYPHIM VI T2VIVOTIF T2VIVOTIF BERNA T2

GRAM (-) BACILLI (NON-ENTERIC) VACCINES

ANTISERA

ENTERIC VIRUS VACCINES



BEXSERO T2MENACTRA T2MENOMUNE-A-C-Y-W-135 T2MENVEO A-C-Y-W-135-DIP T2MENVEO MENA COMPONENT T2MENVEO MENCYW-135 COMPONENT T2TRUMENBA T3

PNEUMOVAX 23 T2PREVNAR 13 T2

AFLURIA 2016-2017 T2AFLURIA 2017-2018 T2AFLURIA 2018-2019 T2AFLURIA QUAD 2016-2017 T2AFLURIA QUAD 2017-2018 T2AFLURIA QUAD 2018-2019 T2EZ FLU 16-17 (FLUZON QUAD PED) T2EZ FLU 2016-2017 (AFLURIA) T2EZ FLU 2016-2017 (FLUVIRIN) T2EZ FLU 2018-2019 (FLUCELVAX) T2FLUAD 2016-2017 T2FLUAD 2017-2018 T2FLUAD 2018-2019 T2FLUARIX QUAD 2016-2017 T2FLUARIX QUAD 2017-2018 T2FLUARIX QUAD 2018-2019 T2FLUBLOK 2016-2017 T2FLUBLOK 2017-2018 T2FLUBLOK QUAD 2017-2018 T2FLUBLOK QUAD 2018-2019 T2FLUCELVAX QUAD 2016-2017 T2FLUCELVAX QUAD 2017-2018 T2FLUCELVAX QUAD 2018-2019 T2FLULAVAL QUAD 2016-2017 T2FLULAVAL QUAD 2017-2018 T2FLULAVAL QUAD 2018-2019 T2FLUMIST QUAD 2018-2019 T2FLUVIRIN 2016-2017 T2FLUVIRIN 2017-2018 T2FLUZONE HIGH-DOSE 2016-2017 T2FLUZONE HIGH-DOSE 2017-2018 T2

GRAM NEGATIVE COCCI VACCINES

GRAM POSITIVE COCCI VACCINES

INFLUENZA VIRUS VACCINES


PRODUCT TIER UTILIZATION MANAGEMENTFLUZONE HIGH-DOSE 2018-2019 T2FLUZONE INTRADERM QUAD 2016-17 T2FLUZONE INTRADERM QUAD 2017-18 T2FLUZONE QUAD 2016-2017 T2FLUZONE QUAD 2017-2018 T2FLUZONE QUAD 2018-2019 T2FLUZONE QUAD PEDI 2016-2017 T2FLUZONE QUAD PEDI 2017-2018 T2FLUZONE QUAD PEDI 2018-2019 T2

FASENRA T3 S PA

NUCALA T3 S PA QL

IMOVAX RABIES VACCINE T2IXIARO T2RABAVERT T2STAMARIL T2YF-VAX T2

TAKHZYRO T3 S PA QL

EPIFIX AMNIOTIC MEMBRANE T3GRAFIX CORE T3GRAFIX PRIME T3STRAVIX T3

BCG VACCINE (TICE STRAIN) T3BIOTHRAX T2VAXCHORA ACTIVE COMPONENT T2VAXCHORA VACCINE T2

ACTHIB T2ADACEL TDAP T2BOOSTRIX TDAP T2DAPTACEL DTAP T2DIPHTHERIA-TETANUS TOXOIDS-PED T1HIBERIX T2INFANRIX DTAP T2KINRIX T2M-M-R II VACCINE T2PEDVAXHIB T2PENTACEL T2

INTERLEUKIN-5(IL-5) RECEPTOR ALPHA ANTAGONIST, MAB

MONOCLONAL ANTIBODY - INTERLEUKIN-5 ANTAGONISTS

NEUROTOXIC VIRUS VACCINES

PLASMA KALLIKREIN INHIBITORS

SKIN TISSUE REPLACEMENT

TOXIN-PRODUCING BACILLI VACCINES/TOXOIDS

VACCINE/TOXOID PREPARATIONS,COMBINATIONS


PRODUCT TIER UTILIZATION MANAGEMENTPENTACEL ACTHIB COMPONENT T3PENTACEL DTAP-IPV COMPONENT T2PROQUAD T2QUADRACEL DTAP-IPV T2TDVAX T1TENIVAC T2

ENGERIX-B ADULT T2ENGERIX-B PEDIATRIC-ADOLESCENT T2GARDASIL 9 T2HAVRIX T2HEPLISAV-B T2PEDIARIX T2RECOMBIVAX HB T2SHINGRIX T2SHINGRIX GE ANTIGEN COMPONENT T2TWINRIX T2VAQTA T2VARIVAX VACCINE T2ZOSTAVAX T2

ZILEUTON ER T1 ST QLZYFLO T3 ST QLZYFLO CR T3 ST QL

INCRUSE ELLIPTA T2 QLLONHALA MAGNAIR REFILL T3 PA QLLONHALA MAGNAIR STARTER T3 PA QLSEEBRI NEOHALER T3 PA QLSPIRIVA T2 QLSPIRIVA RESPIMAT T2 QLTUDORZA PRESSAIR T3 PA QLYUPELRI T3 PA QL

ATROVENT HFA T3 QLIPRATROPIUM BROMIDE T1 QL

ALBUTEROL SULFATE T1METAPROTERENOL SULFATE T1TERBUTALINE SULFATE T1

ALBUTEROL SULFATE T1 QL

5-LIPOXYGENASE INHIBITORS

ANTICHOLINERGICS, ORALLY INHALED LONG ACTING

ANTICHOLINERGICS, ORALLY INHALED SHORT ACTING

BETA-ADRENERGIC AGENTS

BETA-ADRENERGIC AGENTS, INHALED, SHORT ACTING

VIRAL/TUMORIGENIC VACCINES

BRONCHIAL DILATORS


PRODUCT TIER UTILIZATION MANAGEMENTALBUTEROL SULFATE HFA T3 PA QLLEVALBUTEROL CONCENTRATE T1LEVALBUTEROL HCL T1LEVALBUTEROL TARTRATE HFA T3 PA QLPROAIR HFA T1 QLPROAIR RESPICLICK T2 QLPROVENTIL HFA T3 PA QLVENTOLIN HFA T1 QLXOPENEX T3XOPENEX CONCENTRATE T3XOPENEX HFA T3 PA QL

ARCAPTA NEOHALER T3 ST QLSTRIVERDI RESPIMAT T3 ST QL

BROVANA T3 QLFORADIL T3 QLPERFOROMIST T3 QLSEREVENT DISKUS T2 QL

ANORO ELLIPTA T2 QLBEVESPI AEROSPHERE T3 PA QLCOMBIVENT RESPIMAT T2 QLIPRATROPIUM-ALBUTEROL T1STIOLTO RESPIMAT T2 QLUTIBRON NEOHALER T3 PA QL

ADVAIR DISKUS T2 QLADVAIR HFA T2 QLAIRDUO RESPICLICK T3 PA QLBREO ELLIPTA T2 QLDULERA T3 PA QLFLUTICASONE-SALMETEROL T1 QLSYMBICORT T2 QLWIXELA INHUB T1 QL

TRELEGY ELLIPTA T2 QL

ACCOLATE T3 QLMONTELUKAST SODIUM T1 QLSINGULAIR T3 QLZAFIRLUKAST T1 QL

BETA-ADRENERGIC AGENTS, INHALED, ULTRA-LONG ACTING

BETA-ADRENERGIC AGENTS, ORALLY INHALED,LONG ACTING

BETA-ADRENERGIC AND ANTICHOLINERGIC COMBO, INHALED

BETA-ADRENERGIC AND GLUCOCORTICOID COMBO, INHALED

BETA-ADRENERGIC-ANTICHOLINERGIC-GLUCOCORT, INHALED

LEUKOTRIENE RECEPTOR ANTAGONISTS

MAST CELL STABILIZERS, ORALLY INHALED


PRODUCT TIER UTILIZATION MANAGEMENTCROMOLYN SODIUM T1

CEFADROXIL T1CEFAZOLIN SOD-WATER T1CEFAZOLIN SODIUM T1CEFAZOLIN SODIUM-0.9% NACL T1CEFAZOLIN SODIUM-D5W T1CEFAZOLIN SODIUM-DEXTROSE T1CEFAZOLIN SODIUM-STERILE WATER T1CEFAZOLIN-D5W T1CEPHALEXIN T1DAXBIA T3 ST QLKEFLEX T3

CEFACLOR T1CEFACLOR ER T1 QLCEFOTAN T3CEFOTETAN T1CEFOTETAN & DEXTROSE T1CEFOXITIN T1CEFOXITIN SODIUM T1CEFPROZIL T1CEFTIN T2CEFUROXIME T1CEFUROXIME SODIUM T1ZINACEF T3

AVYCAZ T3CEDAX T3CEFDINIR T1CEFDITOREN PIVOXIL T1CEFIXIME T1 QLCEFOTAXIME SODIUM T1CEFPODOXIME PROXETIL T1CEFTAZIDIME T1CEFTIBUTEN T1CEFTRIAXONE T1CLAFORAN T3FORTAZ T3FORTAZ IN ISO-OSMOTIC DEXTROSE T3SPECTRACEF T3SUPRAX T3 QL

CEPHALOSPORIN ANTIBIOTICS - 1ST GENERATION

CEPHALOSPORIN ANTIBIOTICS - 2ND GENERATION

CEPHALOSPORIN ANTIBIOTICS - 3RD GENERATION

CEPHALOSPORINS


PRODUCT TIER UTILIZATION MANAGEMENTTAZICEF T1

CEFEPIME T1CEFEPIME HCL T1CEFEPIME-DEXTROSE T1MAXIPIME T3

CEFADROXIL T1CEFAZOLIN SODIUM T1CEPHALEXIN T1

CEFACLOR T1CEFPROZIL T1CEFUROXIME T1CEFUROXIME SODIUM T1MEFOXIN T3

CEDAX T3CEFDINIR T1CEFOTAXIME SODIUM T1CEFPODOXIME PROXETIL T1CEFTRIAXONE T1CLAFORAN T3

TEFLARO T3 PA

CHLORAMPHENICOL SOD SUCCINATE T1

CHOLESTYRAMINE T1 QLCHOLESTYRAMINE LIGHT T1 QLCOLESEVELAM HCL T1 QLCOLESTID T3 QLCOLESTIPOL HCL T1 QLPREVALITE T1 QLQUESTRAN T3 QLQUESTRAN LIGHT T3 QLWELCHOL T3 QL

DOPRAM T3DOXAPRAM HCL T1

CNS STIMULANTS

CEPHALOSPORIN ANTIBIOTICS - 4TH GENERATION

CEPHALOSPORINS - 1ST GENERATION

CEPHALOSPORINS - 2ND GENERATION

CEPHALOSPORINS - 3RD GENERATION

CEPHALOSPORINS - 5TH GENERATION

CHLORAMPHENICOL ANTIBIOTICS AND DERIVATIVES

BILE SALT SEQUESTRANTS

CENTRAL NERVOUS SYSTEM STIMULANTS

CHLORAMPHENICOL

CHOLESTEROL REDUCERS



NICOTROL T3 QLNICOTROL NS T3 QL

CHANTIX T3 QL

APTENSIO XR T3 ST QLCONCERTA T3 ST QLCOTEMPLA XR-ODT T3 ST QLDAYTRANA T3 ST QLDEXMETHYLPHENIDATE HCL T1 QLDEXMETHYLPHENIDATE HCL ER T1 QLFOCALIN T3 ST QLFOCALIN XR T3 ST QLJORNAY PM T3 STMETADATE CD T3 ST QLMETADATE ER T1 QLMETHYLIN T3 ST QLMETHYLPHENIDATE ER T1 QLMETHYLPHENIDATE ER (LA) T1 QLMETHYLPHENIDATE HCL T1 QLMETHYLPHENIDATE HCL CD T1 QLMETHYLPHENIDATE HCL ER (CD) T1 QLMETHYLPHENIDATE LA T1 QLQUILLICHEW ER T3 ST QLQUILLIVANT XR T3 ST QLRELEXXII T1 QLRITALIN T3 ST QLRITALIN LA T3 ST QL

COAL TAR T1

RESPA A.R. T3

NASAL DECONGESTANT T1PSEUDOEPHEDRINE ER T1

15DM-5PEH-2CPM T3

ABATUSS DMX T1BROMFED DM T1

COAL TAR

COLD AND COUGH PREPARATIONS

SMOKING DETERRENT-NICOTINIC RECEPT.PARTIAL AGONIST

TX FOR ATTENTION DEFICIT-HYPERACT(ADHD)/NARCOLEPSY

IRRITANTS/COUNTER-IRRITANTS

1ST GEN ANTIHIST-DECONGEST-ANTICHOLINERGIC COMB

DECONGESTANTS, ORAL

NON-NARC ANTITUSS-1ST GEN. ANTIHISTAMINE-DECONGEST

NON-OPIOID ANTITUS-1ST GEN.ANTIHISTAMINE-DECONGEST

SMOKING DETERRENT AGENTS (GANGLIONIC STIM,OTHERS)


PRODUCT TIER UTILIZATION MANAGEMENTBROMPHENIRAMINE-PSEUDOEPHED-DM T1CENTERGY DM T1HISTEX-DM T3NEOTUSS PLUS T3NIVA-HIST DM T1

CORICIDIN HBP T3PROMETHAZINE-DM T1

DAYTIME COLD-FLU T1

HYDROCOD-CPM-PSEUDOEPHEDRINE T1 QLPROMETHAZINE VC-CODEINE T1 QLPROMETHAZINE-PHENYLEPH-CODEINE T1 QLZODRYL DAC 50 T3ZODRYL DAC 60 T3ZODRYL DAC 80 T3ZUTRIPRO T3 QL

HYDROCODONE-CHLORPHENIRAMNE ER T1 QLPROMETHAZINE-CODEINE T1TUSSICAPS T3 QLTUSSIONEX T3 QLTUXARIN ER T3 QLTUZISTRA XR T3 QLVITUZ T3 QL

HYDROCODONE-HOMATROPINE MBR T1 QLHYDROMET T1 QLTUSSIGON T1 QL

REZIRA T3 QL

FEMCAP T3WIDE SEAL DIAPHRAGM T3

KYLEENA T3 SLILETTA T3 SMIRENA T3 SPARAGARD T 380-A T3 SSKYLA T3 S

CONTRACEPTIVES, NON-SYSTEMIC

CORTICOTROPINS

NON-OPIOID ANTITUSSIVE-1ST GEN ANTIHISTAMINE COMB.

NON-OPIOID ANTITUSSIVE-DECONGESTANT-ANALGESIC COMB

OPIOID ANTITUSSIV-1ST GEN. ANTIHISTAMINE-DECONGEST

OPIOID ANTITUSSIVE-1ST GENERATION ANTIHISTAMINE

OPIOID ANTITUSSIVE-ANTICHOLINERGIC COMBINATIONS

OPIOID ANTITUSSIVE-DECONGESTANT COMBINATIONS

DIAPHRAGMS/CERVICAL CAP

INTRA-UTERINE DEVICES (IUDS)



ACTHREL T3 S PACORTROSYN T3COSYNTROPIN T1H.P. ACTHAR T3 S PA

BENZONATATE T1TESSALON PERLE T3

GILPHEX TR T3TUSNEL PEDIATRIC T3

MAXIFED CDX T3MAXIPHEN CD T3MAXIPHEN CDX T3

ALLFEN CDX T3

30PSE-150GFN-15DM T3Z-COF I T3

GILTUSS TR T3TUSNEL T3TUSNEL DM PEDIATRIC T3TUSSI-PRES PEDIATRIC T3TUSSLIN T1

GUAIFENESIN DAC T1HYCOFENIX T3 QLLORTUSS EX T1ZODRYL DEC 50 T3ZODRYL DEC 60 T3ZODRYL DEC 80 T3

CODEINE-GUAIFENESIN T1 QLFLOWTUSS T3 QLGUAIFENESIN-CODEINE T1 QLHYDROCODONE-GUAIFENESIN T1 QLOBREDON T3 QL

GLUCAGEN T2

COUGH PREPARATIONS/EXPECTORANTSANTITUSSIVES, NON-OPIOID

DECONGESTANT-EXPECTORANT COMBINATIONS

NARCOTIC ANTITUSS-DECONGESTANT-EXPECTORANT COMB

NARCOTIC ANTITUSSIVE-EXPECTORANT COMBINATION

NON-NARCOTIC ANTITUSS-DECONGESTANT-EXPECTORANT CMB

NON-OPIOID ANTITUSSIVE-DECONGESTANT-EXPECTORANT

ADRENOCORTICOTROPHIC HORMONES

OPIOID ANTITUSSIVE-DECONGESTANT-EXPECTORANT COMB

OPIOID ANTITUSSIVE-EXPECTORANT COMBINATION

AGENTS TO TREAT HYPOGLYCEMIA (HYPERGLYCEMICS)DIABETIC THERAPY


PRODUCT TIER UTILIZATION MANAGEMENTGLUCAGON EMERGENCY KIT T2PROGLYCEM T3

ALOGLIPTIN-PIOGLITAZONE T3 PA QLOSENI T3 PA QL

ADLYXIN T3 PA QLBYDUREON T2 QLBYDUREON BCISE T2 QLBYDUREON PEN T2 QLBYETTA T2 QLOZEMPIC T2 QLTANZEUM T3 PA QLTRULICITY T2 QLVICTOZA 2-PAK T2 QLVICTOZA 3-PAK T2 QL

SOLIQUA 100-33 T2 PA QLXULTOPHY 100-3.6 T3 PA QL

FARXIGA T3 PA QLINVOKANA T2 QLJARDIANCE T2 QLSTEGLATRO T3 PA QL

CYCLOSET T3 PA QL

KORLYM T3 S PA

INVOKAMET T2 QLINVOKAMET XR T2 QLSEGLUROMET T3 PA QLSYNJARDY T2 QLSYNJARDY XR T2 QLXIGDUO XR T3 PA QL

ACARBOSE T1 QLGLYSET T3 QLMIGLITOL T1 QLPRECOSE T3 QL

SYMLINPEN 120 T2 PA QLSYMLINPEN 60 T2 PA QL

ANTIHYPERGLYCEMC-SOD/GLUC COTRANSPORT2(SGLT2)INHIB

ANTIHYPERGLYCEMIC - DOPAMINE RECEPTOR AGONISTS

ANTIHYPERGLYCEMIC-GLUCOCORTICOID RECEPTOR BLOCKER

ANTIHYPERGLYCEMIC-SGLT2 INHIBITOR-BIGUANIDE COMBS.

ANTIHYPERGLYCEMIC, ALPHA-GLUCOSIDASE INHIBITORS

ANTIHYPERGLYCEMIC, AMYLIN ANALOG-TYPE

ANTIHYPERGLY,DPP-4 ENZYME INHIB.-THIAZOLIDINEDIONE

ANTIHYPERGLY,INCRETIN MIMETIC(GLP-1 RECEP.AGONIST)

ANTIHYPERGLY,INSULIN,LONG ACT-GLP-1 RECEPT.AGONIST



GLUCOPHAGE T3 QLGLUCOPHAGE XR T3 QLMETFORMIN HCL T1 QLMETFORMIN HCL ER T1 QLRIOMET T3 QL

ALOGLIPTIN T3 PA QLJANUVIA T2 QLNESINA T3 PA QLONGLYZA T3 PA QLTRADJENTA T2 QL

AMARYL T3CHLORPROPAMIDE T1 QLGLIMEPIRIDE T1GLIPIZIDE T1GLIPIZIDE ER T1GLIPIZIDE XL T1GLUCOTROL T3GLUCOTROL XL T3GLYBURIDE T1GLYBURIDE MICRONIZED T1GLYNASE T3NATEGLINIDE T1 QLPRANDIN T3 QLREPAGLINIDE T1 QLSTARLIX T3 QLTOLAZAMIDE T1 QLTOLBUTAMIDE T1 QL

GLYXAMBI T2 QLQTERN T3 PA QLSTEGLUJAN T3 PA QL

ACTOPLUS MET T3 QLACTOPLUS MET XR T2 ST QLAVANDAMET T2 PA QLPIOGLITAZONE-METFORMIN T1 QL

DUETACT T3 QLPIOGLITAZONE-GLIMEPIRIDE T1 QL

ANTIHYPERGLYCEMIC, BIGUANIDE TYPE

ANTIHYPERGLYCEMIC, DPP-4 INHIBITORS

ANTIHYPERGLYCEMIC, INSULIN-RELEASE STIMULANT TYPE

ANTIHYPERGLYCEMIC, SGLT-2 AND DPP-4 INHIBITOR COMB

ANTIHYPERGLYCEMIC, THIAZOLIDINEDIONE AND BIGUANIDE

ANTIHYPERGLYCEMIC, THIAZOLIDINEDIONE-SULFONYLUREA

ANTIHYPERGLYCEMIC,DPP-4 INHIBITOR-BIGUANIDE COMBS.


PRODUCT TIER UTILIZATION MANAGEMENTALOGLIPTIN-METFORMIN T3 PA QLJANUMET T2 QLJANUMET XR T2 QLJENTADUETO T2 QLJENTADUETO XR T2 QLKAZANO T3 PA QLKOMBIGLYZE XR T3 PA QL

GLYBURIDE-METFORMIN HCL T1 QL

GLIPIZIDE-METFORMIN T1 QLGLUCOVANCE T3 QLGLYBURIDE-METFORMIN HCL T1 QLREPAGLINIDE-METFORMIN HCL T1 QL

AVANDAMET T2 PA QL

ACTOS T3 QLAVANDIA T2 PA QLPIOGLITAZONE HCL T1 QL

ADMELOG T3 STADMELOG SOLOSTAR T3 STAFREZZA T3 PAAPIDRA T3 STAPIDRA SOLOSTAR T3 STBASAGLAR KWIKPEN U-100 T3 PAFIASP T3 STFIASP FLEXTOUCH T3 STHUMALOG T2HUMALOG JUNIOR KWIKPEN T2HUMALOG KWIKPEN U-100 T2HUMALOG KWIKPEN U-200 T2HUMALOG MIX 50-50 T2HUMALOG MIX 50-50 KWIKPEN T2HUMALOG MIX 75-25 T2HUMALOG MIX 75-25 KWIKPEN T2HUMULIN 70-30 T2HUMULIN 70/30 KWIKPEN T2HUMULIN N T2HUMULIN N KWIKPEN T2HUMULIN R T2HUMULIN R U-500 T2

ANTIHYPERGLYCEMIC,THIAZOLIDINEDIONE(PPARG AGONIST)

INSULINS

ANTIHYPERGLYCEMIC,INSULIN-REL STIM.& BIGUANIDE CMB

ANTIHYPERGLYCEMIC,INSULIN-RELEASE STIM.-BIGUANIDE

ANTIHYPERGLYCEMIC,THIAZOLIDINEDIONE & BIGUANIDE


PRODUCT TIER UTILIZATION MANAGEMENTHUMULIN R U-500 KWIKPEN T2LANTUS T2LANTUS SOLOSTAR T2LEVEMIR T2LEVEMIR FLEXTOUCH T2NOVOLIN 70-30 T2NOVOLIN 70-30 FLEXPEN T2NOVOLIN N T2NOVOLIN R T2NOVOLOG T2NOVOLOG FLEXPEN T2NOVOLOG MIX 70-30 T2NOVOLOG MIX 70-30 FLEXPEN T2TOUJEO MAX SOLOSTAR T2TOUJEO SOLOSTAR T2TRESIBA T2TRESIBA FLEXTOUCH U-100 T2TRESIBA FLEXTOUCH U-200 T2

ADREVIEW T3

IC GREEN T3INDOCYANINE GREEN T1SINOGRAFIN T3

ACCU-CHEK AVIVA PLUS T2 QLACCU-CHEK COMPACT PLUS STRIPS T2 QLACCU-CHEK GUIDE TEST STRIP T2 QLACCU-CHEK SMARTVIEW T2 QLACCUTREND GLUCOSE T3 PA QLACURA TEST STRIPS T3 PA QLADVANCED GLUCOSE TEST STRIP T3 PA QLADVANCED GLUCOSE TEST STRIPS T3 PA QLAGAMATRIX AMP T3 PA QLASSURE 4 T3 PA QLASSURE PLATINUM T3 PA QLASSURE PRISM MULTI T3 PA QLBLOOD GLUCOSE TEST STRIP T3 PA QLBREEZE 2 T3 PA QLCARESENS N T3 PA QLCARETOUCH TEST STRIP T3 PA QLCHOICEDM CLARUS TEST STRIPS T3 PA QL

ADRENAL RADIOACTIVE DIAGNOSTICS

BILIARY DIAGNOSTICS,RADIOPAQUE

BLOOD SUGAR DIAGNOSTICS

DIAGNOSTICS


PRODUCT TIER UTILIZATION MANAGEMENTCONTOUR NEXT TEST STRIP T3 PA QLCONTOUR TEST STRIP T3 PA QLCOOL GLUCOSE TEST STRIP T3 PA QLDARIO BLOOD GLUCOSE TEST STRIP T3 PA QLEASY CHECK TEST STRIP T3 PA QLEASY GLUCO G2 T3 PA QLEASY PLUS II T3 PA QLEASY STEP T3 PA QLEASY TALK T3 PA QLEASY TOUCH TEST STRIP T3 PA QLEASY TRAK T3 PA QLEASYGLUCO PLUS T3 PA QLEASYGLUCO TEST STRIPS T3 PA QLEASYMAX T3 PA QLEASYMAX 15 T3 PA QLELEMENT COMPACT T3 PA QLELEMENT TEST STRIPS T3 PA QLEVENCARE T3 PA QLEVENCARE G2 T3 PA QLEVENCARE G3 T3 PA QLEVENCARE MINI GLUCOSE TEST STR T3 PA QLEVENCARE PROVIEW TEST STRIP T3 PA QLEVOLUTION TEST STRIPS T3 PA QLEZ SMART T3 PA QLEZ SMART PLUS T3 PA QLFORA 6 CONNECT GLUCOSE STRIP T3 PA QLFORA D40-G31 TEST STRIPS T3 PA QLFORA G20 T3 PA QLFORA GD50 TEST STRIPS T3 PA QLFORA GTEL GLUCOSE TEST STRIP T3 PA QLFORA TEST STRIP T3 PA QLFORA TN'G VOICE TEST STRIPS T3 PA QLFORA V10 T3 PA QLFORA V10-V12-D10-D20 T3 PA QLFORA V12 T3 PA QLFORACARE GD20 T3 PA QLFORACARE GD40 T3 PA QLFORTISCARE GLUCOSE TEST STRIPS T3 PA QLFREESTYLE PRECISION NEO T3 PA QLG-4 T3 PA QLGE100 BLOOD GLUCOSE TEST STRIP T3 PA QLGENSTRIP T3 PA QLGENULTIMATE TEST STRIP T3 PA QL


PRODUCT TIER UTILIZATION MANAGEMENTGLUCO NAVII T3 PA QLGLUCOCARD 01 SENSOR PLUS T3 PA QLGLUCOCARD EXPRESSION T3 PA QLGLUCOCARD SHINE T3 PA QLGLUCOCARD VITAL T3 PA QLGLUCOCARD VITAL SENSOR T3 PA QLGLUCOCOM GLUCOSE T3 PA QLGLUCOSE TEST STRIP T3 PA QLGOODLIFE AC-302 TEST STRIP T3 PA QLHARMONY GLUCOSE TEST STRIP T3 PA QLHEALTHPRO TEST STRIPS T3 PA QLIGLUCOSE TEST STRIP T3 PA QLINFINITY TEST STRIPS T3 PA QLINFINITY VOICE TEST STRIP T3 PA QLLIBERTY TEST STRIPS T3 PA QLMAXIMA T3 PA QLMICRO T3 PA QLMICRODOT T3 PA QLMICRODOT XTRA T3 PA QLMYGLUCOHEALTH T3 PA QLNEUTEK 2TEK TEST STRIPS T3 PA QLNOVA MAX GLUCOSE TEST STRIPS T3 PA QLON CALL EXPRESS TEST STRIP T3 PA QLON CALL PLUS TEST STRIP T3 PA QLON CALL VIVID TEST STRIP T3 PA QLONETOUCH ULTRA BLUE TEST STRP T2 QLONETOUCH VERIO T2 QLOPTIUM T3 PA QLOPTIUM EZ T3 PA QLOPTUMRX T3 PA QLPRECISION PCX T3 PA QLPRECISION PCX PLUS T3 PA QLPRECISION POINT OF CARE T3 PA QLPRECISION Q-I-D T3 PA QLPRECISION XTRA T3 PA QLPREMIER TEST STRIP T3 PA QLPREMIUM BLOOD GLUCOSE TEST T3 PA QLPREMIUM V10 T3 PA QLPRO VOICE V8-V9 TEST STRIP T3 PA QLPRODIGY NO CODING T3 PA QLQUINTET T3 PA QLQUINTET AC T3 PA QLREFUAH PLUS T3 PA QL


PRODUCT TIER UTILIZATION MANAGEMENTRELION CONFIRM-MICRO T3 PA QLRELION PRIME TEST STRIPS T3 PA QLREVEAL TEST STRIP T3 PA QLRIGHTEST GS100 TEST STRIPS T3 PA QLRIGHTEST GS250S TEST STRIPS T3 PA QLRIGHTEST GS260 TEST STRIPS T3 PA QLRIGHTEST GS300 TEST STRIPS T3 PA QLRIGHTEST GS550 TEST STRIPS T3 PA QLSMART SENSE TEST STRIPS T3 PA QLSMARTEST TEST T3 PA QLSOLUS V2 TEST STRIPS T3 PA QLSURE-TEST EASYPLUS MINI T3 PA QLTD GOLD TEST STRIP T3 PA QLTELCARE T3 PA QLTEST N'GO T3 PA QLTEST STRIPS T3 PA QLTRUE METRIX GLUCOSE TEST STRIP T3 PA QLTRUE METRIX PRO TEST STRIP T3 PA QLTRUETEST TEST STRIPS T3 PA QLTRUETRACK TEST STRIP T3 PA QLULTIMA T3 PA QLULTRATRAK T3 PA QLULTRATRAK ULTIMATE T3 PA QLUNISTRIP1 T3 PA QLVERASENS TEST STRIP T3 PA QLVIVAGUARD INO TEST STRIP T3 PA QLWAVESENSE JAZZ T3 PA QLWAVESENSE PRESTO T3 PA QL

ACCUTREND PLUS T3COAGUCHEK XS T3 QLFORA 6 CONNECT KETONE STRIP T3FORA GTEL KETONE TEST STRIP T3NOVAMAX PLUS T3 PA QLPRECISION XTRA T3 QL

THALLOUS CHLORIDE TL-201 T1

ISOVUE-200 T3ISOVUE-250 T3ISOVUE-300 T3ISOVUE-370 T3ISOVUE-M 200 T3

BLOOD TESTING PREPARATIONS

CARDIOVASCULAR DIAGNOSTICS - RADIOACTIVE

CARDIOVASCULAR DIAGNOSTICS-RADIOPAQUE


PRODUCT TIER UTILIZATION MANAGEMENTISOVUE-M 300 T3MYOVIEW T3OMNIPAQUE T3OPTIRAY 240 T3OPTIRAY 300 T3OPTIRAY 320 T3OPTIRAY 350 T3ULTRAVIST T3VISIPAQUE T3

ADENOSCAN T3ADENOSINE T1DEFINITY T3DIPYRIDAMOLE T1LEXISCAN T3OPTISON T3

CERETEC T3INDIUM IN-111 DTPA T1

DOTAREM T3MAGNEVIST T3MULTIHANCE T3MULTIHANCE MULTIPACK T3OMNISCAN T3OMNISCAN PREFILL PLUS T3OPTIMARK T3PROHANCE T3PROHANCE MULTIPACK T3

DMSA T3DRAXIMAGE DTPA T3GADAVIST T3GLUCAGEN T2GLUCAGON HCL T1LYMPHAZURIN T3PROVOCHOLINE T3TOXICOLOGY SALIVA COLLECTION T3

AMYVID T3

DATSCAN T3

DIAGNOSTIC RADIOPHARM - AMYLOID PLAQUE IMAGING

DIAGNOSTIC RADIOPHARM - DOPAMINE TRANSPORTER (DAT)

EYE DIAGNOSTIC AGENTS

CARDIOVASCULAR DIAGNOSTICS,NON-RADIOPAQUE AGENTS

CEREBRAL SPINAL RADIOACTIVE DIAGNOSTICS

CEREBRAL SPINAL RADIOPAQUE DIAGNOSTICS

DIAGNOSTIC PREPARATIONS,MISCELLANEOUS


PRODUCT TIER UTILIZATION MANAGEMENTAK-FLUOR T1FLUORESCITE T3GREEN GLO T1

CERETEC T3

E-Z-HD T3E-Z-PAQUE T3GASTROMARK T3LIQUID E-Z PAQUE T3READI-CAT 2 T3SITZMARKS T3TAGITOL T3VARIBAR NECTAR T3VARIBAR PUDDING T3

EOVIST T3FERIDEX I.V. T3

PROSTASCINT T3

OCTREOSCAN T3

INDIUM IN-111 OXYQUINOLINE T1

FLUDEOXYGLUCOSE F 18 T1

CONRAY T3CONRAY-30 T3CONRAY-43 T3CYSTO-CONRAY II T3CYSTOGRAFIN T3CYSTOGRAFIN-DILUTE T3GASTROGRAFIN T3MD-76 R T3MD-GASTROVIEW T1

CHEMSTRIP K T3 QLKETONE CARE TEST STRIP T3KETONE TEST STRIP T3 QLKETOSTIX REAGENT T3 QLTRUEPLUS KETONE TEST STRIP T3 QL

GASTROINTESTINAL RADIOACTIVE DIAGNOSTICS

GASTROINTESTINAL RADIOPAQUE DIAGNOSTICS

HEPATIC DIAGNOSTICS

URINE GLUCOSE TEST AIDS

NEOPLASM MONOCLONAL DIAGNOSTIC AGENTS

RADIOACTIVE DIAGNOSTICS, GENERAL

RADIOACTIVE DX RADIOLABEL OF AUTOLOGOUS LEUKOCYTES

RADIOACTIVE METABOLIC FUNCTION DIAGNOSTICS

URINARY TRACT RADIOPAQUE DIAGNOSTICS

URINE ACETONE TEST AIDS


PRODUCT TIER UTILIZATION MANAGEMENTDIASTIX REAGENT T3 QLNO-STICK GLUCOSE T3

CHEMSTRIP UGK T3KETO-DIASTIX REAGENT T3

CHEK-STIX T3 QLCHEMSTRIP T3CHEMSTRIP 10 WITH SG T3CHEMSTRIP 2 GP T3CHEMSTRIP 50B T3CHEMSTRIP 7 T3CHEMSTRIP 9 T3COMBISTIX REAGENT T3HEMA-COMBISTIX T3LABSTIX REAGENT T3MULTISTIX T3MULTISTIX 10 SG T3MULTISTIX 5 T3MULTISTIX 7 T3MULTISTIX 8 SG T3MULTISTIX 9 T3MULTISTIX 9 SG T3URISTIX 4 T3URISTIX REAGENT T3

ALBUSTIX REAGENT T3AZO T3CHEMSTRIP 2 LN T3CHEMSTRIP MICRAL T3ICTOTEST T3NITRATEST PAPER T3

HYDROCHLORIC ACID T1

SUCRAID T3 S

DIGITEK T1DIGOX T1DIGOXIN T1LANOXIN T2

DIGITALIS PREPARATIONS

URINE GLUCOSE/ACETONE TEST AIDS,STRIPS

URINE MULTIPLE TEST AIDS

URINE TEST AIDS,MISCELLANEOUS

ACID REPLACEMENT

GASTRIC ENZYMES

DIGESTANTS

DIGITALIS GLYCOSIDES


PRODUCT TIER UTILIZATION MANAGEMENTLANOXIN PEDIATRIC T2

JYNARQUE T3 S PA QLSAMSCA T3 S PA QLVAPRISOL-5% DEXTROSE T3

ACETAZOLAMIDE T1ACETAZOLAMIDE ER T1ACETAZOLAMIDE SODIUM T1DIAMOX SEQUELS T3METHAZOLAMIDE T1NEPTAZANE T3

AMMONIUM CHLORIDE T1

BUMETANIDE T1DEMADEX T3EDECRIN T3ETHACRYNATE SODIUM T1ETHACRYNIC ACID T1FUROSEMIDE T1FUROSEMIDE-0.9% NACL T1FUROSEMIDE-D5W T1LASIX T3SODIUM EDECRIN T3TORSEMIDE T1

MANNITOL T1OSMITROL T1RESECTISOL T3

AMILORIDE HCL T1DYRENIUM T3

ALDACTAZIDE T3AMILORIDE-HYDROCHLOROTHIAZIDE T1DYAZIDE T3MAXZIDE T3MAXZIDE-25 MG T3SPIRONOLACTONE-HCTZ T1TRIAMTERENE-HYDROCHLOROTHIAZID T1

DIURETICS

POTASSIUM SPARING DIURETICS

POTASSIUM SPARING DIURETICS IN COMBINATION

THIAZIDE AND RELATED DIURETICS

ARGININE VASOPRESSIN (AVP) RECEPTOR ANTAGONISTS

CARBONIC ANHYDRASE INHIBITORS

INORGANIC SALT DIURETICS

LOOP DIURETICS

OSMOTIC DIURETICS


PRODUCT TIER UTILIZATION MANAGEMENTCHLOROTHIAZIDE T1CHLOROTHIAZIDE SODIUM T1CHLORTHALIDONE T1DIURIL T3HYDROCHLOROTHIAZIDE T1INDAPAMIDE T1METHYCLOTHIAZIDE T1METOLAZONE T1MICROZIDE T3SODIUM DIURIL T3

ACAMPROSATE CALCIUM T1VIVITROL T3 S PA

SODIUM ACETATE T1SODIUM BICARBONATE T1SODIUM LACTATE T1VAXCHORA BUFFER COMPONENT T2

CALCI-MAX T1CALCIUM + VITAMIN D3 T3CALCIUM CARBONATE T3CALCIUM CHLORIDE T1CALCIUM CITRATE - VITAMIN D T1CALCIUM CITRATE-VITAMIN D T1CALCIUM GLUCONATE T1CALCIUM GLUCONATE-0.9% NACL T1CALCIUM GLUCONATE-D5W T1CALCIUM GLUCONATE-NACL T1CALCIUM PHOSPHATE T3

DELFLEX WITH 1.5% DEXTROSE T1DELFLEX WITH 2.5% DEXTROSE T3DELFLEX WITH 4.25% DEXTROSE T3DIANEAL PD-2 W-1.5% DEXTROSE T3DIANEAL PD-2 W-2.5% DEXTROSE T3DIANEAL PD-2 W-4.25% DEXTROSE T3DIANEAL WITH 1.5% DEXTROSE T3DIANEAL WITH 2.5% DEXTROSE T3DIANEAL WITH 4.25% DEXTROSE T3EXTRANEAL ICODEXTRIN DIALYSIS T3PRISMASOL T3

ELECTROLYTES & MISCELLANEOUS NUTRIENTSANTI-ALCOHOLIC PREPARATIONS

BICARBONATE PRODUCING/CONTAINING AGENTS

CALCIUM REPLACEMENT

DIALYSIS SOLUTIONS



ALBUMAX T3BOOST T3DUOCAL T3EGG-PRO T3ENSURE ACTIVE HEART HEALTH T3ENSURE HIGH PROTEIN T3ENSURE LIQUID T3ENSURE ORIGINAL T3ENSURE POWDER T3PROMOD T3SOL CARB T3

THAM T3TROMETHAMINE-STERILE WATER T1

AURYXIA T3CALCIUM ACETATE T1ELIPHOS T3FOSRENOL T3KAYEXALATE T3KIONEX T1LANTHANUM CARBONATE T1LOKELMA T3 QLPHOSLYRA T3RENAGEL T3RENVELA T3SEVELAMER CARBONATE T1SEVELAMER HCL T1SODIUM POLYSTYRENE SULFONATE T1SPS T1VELPHORO T3VELTASSA T3 QL

DEXTROSE 5%-ELECTROLYTE #48 T1IONOSOL B WITH DEXTROSE 5% T3IONOSOL MB-DEXTROSE 5% T3ISOLYTE P WITH DEXTROSE T3ISOLYTE S T3LACTATED RINGERS T1NORMOSOL-M AND DEXTROSE T1NORMOSOL-R T3NORMOSOL-R AND DEXTROSE T3

DIETARY SUPPLEMENT, MISCELLANEOUS

DRUGS USED TO TREAT ACIDOSIS

ELECTROLYTE DEPLETERS

ELECTROLYTE MAINTENANCE


PRODUCT TIER UTILIZATION MANAGEMENTNORMOSOL-R PH 7.4 T3PLASMA-LYTE 148 T3PLASMA-LYTE A PH 7.4 T3RINGERS INJECTION T1TPN ELECTROLYTES T1TPN ELECTROLYTES II T1

DEXTROSE IN LACTATED RINGERS T1

DEXTROSE IN RINGERS INJECTION T1

DEXTROSE 10%-0.2% NACL T1DEXTROSE 10%-0.45% NACL T1DEXTROSE 10%-0.9% NACL T1DEXTROSE 10%-1/4NS T1DEXTROSE 2.5%-0.45% NACL T1DEXTROSE 5%-0.2% NACL T1DEXTROSE 5%-0.225% NACL T1DEXTROSE 5%-0.3% NACL T1DEXTROSE 5%-0.33% NACL T1DEXTROSE 5%-0.45% NACL T1DEXTROSE 5%-0.9% NACL T1

DEXTROSE IN WATER T1

MAGNESIUM SULFATE T1MAGNESIUM SULFATE-0.9% NACL T1MAGNESIUM SULFATE-D5W T1MAGNESIUM-LACTATED RINGERS T1

CHROMIUM T1CHROMIUM PICOLINATE T1COPPER CHLORIDE T1MANGANESE T1

XURIDEN T3 S

ACERFLEX T3BCAD 2 T3ELECARE JR T3FRUITIVITS T3GA T3GA EXPRESS 15 T3

IV SOLUTIONS: DEXTROSE AND RINGERS

IV SOLUTIONS: DEXTROSE-SALINE

IV SOLUTIONS: DEXTROSE-WATER

MAGNESIUM SALTS REPLACEMENT

MINERAL REPLACEMENT, MISCELLANEOUS

NUCLEIC ACID/NUCLEOTIDE SUPPLEMENTS

IV SOLUTIONS: DEXTROSE AND LACTATED RINGERS

NUTRITIONAL THERAPY, MED COND SPECIAL FORMULATION


PRODUCT TIER UTILIZATION MANAGEMENTGA GEL T3GLUTAREX-2 T3GLYCOSADE T3HCU EXPRESS POWDER T3HCU EXPRESS20 T3HCU GEL T3HCY 2 T3HOM 2 T3HOMINEX-2 T3I-VALEX-2 T3KETOCAL 3:1 T3KETOCAL 4:1 T3KETONEX-2 T3LIPISTART T3LMD T3MCT PRO-CAL T3METHIONAID T3

EAA T3GLYTACTIN 15 PE BETTERMILK T3GLYTACTIN RTD 10 PE T3GLYTACTIN RTD 15 PE T3LANAFLEX T3PHENYLADE GMP T3PHENYLADE GMP MIX-IN T3

AMINOSYN T3AMINOSYN II T3AMINOSYN II WITH ELECTROLYTES T1AMINOSYN M T3AMINOSYN WITH ELECTROLYTES T1AMINOSYN-HBC T3AMINOSYN-PF T3AMINOSYN-RF T3CLINIMIX T3CLINIMIX E T3CLINISOL T1FREAMINE HBC T3FREAMINE III T3HEPATAMINE T1NEPHRAMINE T3PLENAMINE T1PREMASOL T1

NUTRITIONAL TX, PHENYLKETONURIA (PKU) FORMULATIONS

PARENTERAL AMINO ACID SOLUTIONS AND COMBINATIONS


PRODUCT TIER UTILIZATION MANAGEMENTPROCALAMINE T3PROSOL T3TRAVASOL T3TROPHAMINE T3

POTASSIUM PHOSPHATE T1POTASSIUM PHOSPHATE-0.9% NACL T1POTASSIUM PHOSPHATE-D5W T1SODIUM PHOSPHATE T1SODIUM PHOSPHATE-0.9% NACL T1SODIUM PHOSPHATE-D5W T1

DEXTROSE 5%-0.2% NACL-KCL T1DEXTROSE 5%-0.225% NACL-KCL T1DEXTROSE 5%-0.3% NACL-KCL T1DEXTROSE 5%-0.33% NACL-KCL T1DEXTROSE 5%-0.45% NACL-KCL T1DEXTROSE 5%-1/2NS-KCL T1DEXTROSE 5%-1/4NS-KCL T1DEXTROSE 5%-NS-KCL T1DEXTROSE 5%-POTASSIUM CHLORIDE T1EFFER-K T1K EFFERVESCENT T1K-TAB ER T3KLOR-CON T1KLOR-CON 10 T1KLOR-CON 8 T1KLOR-CON M10 T1KLOR-CON M15 T1KLOR-CON M20 T1KLOR-CON SPRINKLE T1KLOR-CON-EF T1POTASSIUM ACETATE T1POTASSIUM BICARBONATE T1POTASSIUM CHLORIDE T1POTASSIUM CHLORIDE IN D5LR T1POTASSIUM CHLORIDE PROAMP T1POTASSIUM CHLORIDE-NACL T1POTASSIUM CL-LIDOCAINE-NS T1

KENDALL 0.9% NACL WITH CAP T1MONOJECT 0.9% SODIUM CHLORIDE T1MONOJECT PREFILL ADVANCED T1

PHOSPHATE REPLACEMENT

POTASSIUM REPLACEMENT

SODIUM/SALINE PREPARATIONS


PRODUCT TIER UTILIZATION MANAGEMENTMONOJECT SODIUM CHLORIDE FLUSH T1NORMAL SALINE FLUSH T1SODIUM CHLORIDE T1SWABFLUSH T1

ZINC CHLORIDE T1

AMMONIUM LACTATE T1ATOPADERM T3AVO CREAM T3BIAFINE T3CERAMAX T1DEXERYL T3ELETONE T3EMULSION SB T3ENTTY T3GLYCINE SOYA PROTEIN T1HPR T3HPR PLUS T3HYLATOPIC T3HYLATOPICPLUS T3LACTIC ACID T1LUXAMEND T1MIMYX T3NEOSALUS T3NEOSALUS CP T3NIVATOPIC PLUS T3OLIVE OIL T1PRESERA T3PRUCLAIR T3PRUMYX T3PRUTECT T3SONAFINE T3SYNERDERM T3TL-CERMIDE T3UNSCENTED COLD CREAM T1XCLAIR T3

BEAU RX T3BENZOIN T1BENZOIN COMPOUND T1BIONECT T3

EMOLLIENTS PROTECTIVES

ZINC REPLACEMENT

EMOLLIENTS

PROTECTIVES


PRODUCT TIER UTILIZATION MANAGEMENTGENADUR T3HYGEL T3MICROCYN HYDROGEL T3NUVAIL T3RECEDO T3VASELINE WHITE PETROLEUM T3

XIAFLEX T3 S PA

CREON T2PANCREAZE T3 PAPERTZYE T3 PAVIOKACE T3 PAZENPEP T2

PALYNZIQ T3 S PA QL

HYLENEX T3HYQVIA HY COMPONENT T3 S PASANTYL T3VITRASE T3

AZITHROMYCIN T1 QLCLARITHROMYCIN T1CLARITHROMYCIN ER T1E.E.S. 200 T3E.E.S. 400 T3ERY-TAB T3ERYPED 200 T2ERYPED 400 T3ERYTHROCIN LACTOBIONATE T3ERYTHROCIN STEARATE T3ERYTHROMYCIN T1ERYTHROMYCIN ETHYLSUCCINATE T1PCE T3ZITHROMAX T3 QLZITHROMAX TRI-PAK T3ZMAX T2 QL

AZITHROMYCIN T1 QL

ENZYMES

ERYTHROMYCINS

ESTROGENS

TOPICAL/MUCOUS MEMBR./SUBCUT. ENZYMES

MACROLIDE ANTIBIOTICS

MACROLIDES

JOINT CONTRACTURE THERAPY, COLLAGENASE ENZYME

PANCREATIC ENZYMES

PKU TREATMENT AGENTS - PHENYLALANINE AMMONIA LYASE



BIJUVA T3 QL

ANGELIQ T3 QL

DUAVEE T2

COVARYX T1COVARYX H.S. T1EEMT T1EEMT H.S. T1ESTROGEN-METHYLTESTOSTERONE T1

ACTIVELLA T3 QLALORA T3 QLAMABELZ T1 QLCLIMARA T3 QLCLIMARA PRO T2 QLCOMBIPATCH T3 QLDELESTROGEN T3DEPO-ESTRADIOL T3DIVIGEL T2ELESTRIN T3ESTRACE T3 QLESTRADIOL T1 QLESTRADIOL VALERATE T1ESTRADIOL-NORETHINDRONE ACETAT T1 QLESTROGEL T3 QLESTROPIPATE T1 QLEVAMIST T3 QLFEMHRT T3 QLFYAVOLV T1JEVANTIQUE LO T1JINTELI T1 QLLOPREEZA T1 QLMENEST T2 QLMENOSTAR T3 QLMIMVEY T1 QLMIMVEY LO T1MINIVELLE T3 QLNORETHINDRON-ETHINYL ESTRADIOL T1OGEN T3 QLPREFEST T3 QL

ESTROGEN AND PROGESTIN COMBINATIONS

ESTROGEN-PROGESTIN WITH ANTIMINERALOCORTICOID COMB

ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MOD(SERM)COMB

ESTROGEN/ANDROGEN COMBINATIONS

ESTROGENIC AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTPREMARIN T2 QLPREMPHASE T2 QLPREMPRO T2 QLVIVELLE-DOT T3 QL

IMVEXXY T3 QL

ESTRACE T3 QLESTRADIOL T1 QLESTRING T2 QLFEMRING T3 QLPREMARIN T2 QLVAGIFEM T3 QLYUVAFEM T1 QL

AQUASOL A T3

CALCITRIOL T1DRISDOL T3OPTIMAL D3 T1ROCALTROL T3VITAMIN D2 T1

WHEAT GERM OIL T1

FOLIC ACID T1L-METHYLFOLATE CALCIUM T1UROSEX T1

AMINOACETIC ACID T1GLYCINE T1

TEA TREE OIL T3

GLUTARALDEHYDE T1GUAIACOL T1PHENOL T1

MONUROL T3

ANTISEPTICS,MISCELLANEOUS

CHEMOTHERAPEUTICS, ANTIBACTERIAL, MISC.

IRRIGANTS

FAT SOLUBLE VITAMINS

FOLIC ACID PREPARATIONS

VITAMIN A PREPARATIONS

VITAMIN D PREPARATIONS

VITAMIN E PREPARATIONS

FOLIC ACID PREPARATIONS

ANTIBACTERIAL AGENTS,MISCELLANEOUS

ANTISEPTICS,GENERAL

VAGINAL ESTROGEN FOR SEXUAL DYSFUNCTION

VAGINAL ESTROGEN PREPARATIONS

GENERAL ANTIBACTERIALS AND ANTISEPTICS


PRODUCT TIER UTILIZATION MANAGEMENTCURITY T1PHYSIOLYTE T1PHYSIOSOL T1SODIUM CHLORIDE T1VASHE WOUND THERAPY T1WATER T1

ATRAPRO DERMAL SPRAY T3HYCLODEX T3MICROCYN T3

BENZALKONIUM CHLORIDE T1

FORMADON T1FORMALDEHYDE T1

ALA-QUIN T3DERMAZENE T1HYDROCORTISONE-IODOQUINOL T1IODINE T1IODOFLEX T3IODOSORB T3LUGOL'S T1SILVASORB T3SILVRSTAT T3

A-HYDROCORT T3A-METHAPRED T1ARISTOSPAN T3BETAMETHASONE ACETATE-SOD PHOS T1BETAMETHASONE SOD PHOS-ACETATE T1BUDESONIDE EC T1 PABUDESONIDE ER T1 PACELESTONE T3CORTEF T3CORTISONE ACETATE T1DECADRON T1DELTASONE T1DEPO-MEDROL T3DEXAMETHASONE T1DEXAMETHASONE ACETATE LA T1DEXAMETHASONE ACETATE-SOD PHOS T1

OXIDIZING AGENTS

SURFACE ACTIVE AGENTS

TOPICAL ANTISEPTIC DRYING AGENTS

TOPICAL PREPARATIONS,ANTIBACTERIALS

GLUCOCORTICOIDSGLUCOCORTICOIDS


PRODUCT TIER UTILIZATION MANAGEMENTDEXAMETHASONE INTENSOL T2DEXAMETHASONE SODIUM PHOSPHATE T1DEXAMETHASONE-0.9% NACL T1DEXPAK T3DXEVO T3EMFLAZA T3 S PAENTOCORT EC T3 PAHIDEX T1HYDROCORTISONE T1KENALOG-10 T3KENALOG-40 T3LOCORT T3MEDROL T2METHYLPREDNISOLONE T1METHYLPREDNISOLONE ACETATE T1METHYLPREDNISOLONE SODIUM SUCC T1MILLIPRED T3MILLIPRED DP T3ORAPRED ODT T3PREDNISOLONE T1PREDNISOLONE SODIUM PHOS ODT T1PREDNISOLONE SODIUM PHOSPHATE T1PREDNISONE T1PREDNISONE INTENSOL T3RAYOS T3 PASOLU-CORTEF T3SOLU-MEDROL T3TRIAMCINOLONE ACETONIDE T1TRIAMCINOLONE DIACETATE T1UCERIS T3 PAVERIPRED 20 T3ZODEX T3ZONACORT T3

AEROSPAN T2 QLALVESCO T3 PA QLARMONAIR RESPICLICK T3 PA QLARNUITY ELLIPTA T2 QLASMANEX T3 PA QLASMANEX HFA T3 PA QLBUDESONIDE T1 QLFLOVENT DISKUS T2 QLFLOVENT HFA T2 QL

GLUCOCORTICOIDS, ORALLY INHALED


PRODUCT TIER UTILIZATION MANAGEMENTPULMICORT T3 QLPULMICORT FLEXHALER T2 QLQVAR T2 QLQVAR REDIHALER T2 QL

COLOCORT T1CORTENEMA T3CORTIFOAM T3HYDROCORTISONE T1UCERIS T3

ALA-CORT T1ALA-SCALP T3ALCLOMETASONE DIPROPIONATE T1AMCINONIDE T1ANUSOL-HC T3APEXICON E T3BESER T1BESER KIT T3 PABETAMETHASONE DIPROP AUGMENTED T1BETAMETHASONE DIPROPIONATE T1BETAMETHASONE VALERATE T1BRYHALI T3 PACAPEX SHAMPOO T3CLOBETASOL EMOLLIENT T1CLOBETASOL EMULSION T1CLOBETASOL PROPIONATE T1CLOBEX T3CLOCORTOLONE PIVALATE T1CLODAN T1CLODERM T3CORDRAN T3 QLCORMAX T1CUTIVATE T3DERMA-SMOOTHE-FS T3DERMATOP T3DESONATE T3DESONIDE T1DESOWEN T3DESOXIMETASONE T1DIFLORASONE DIACETATE T1DIPROLENE T3DIPROLENE AF T3

TOPICAL ANTI-INFLAMMATORY STEROIDAL

RECTAL/LOWER BOWEL PREP.,GLUCOCORT. (NON-HEMORR)


PRODUCT TIER UTILIZATION MANAGEMENTELOCON T3FLUOCINOLONE ACETONIDE T1FLUOCINONIDE T1FLUOCINONIDE-E T1FLURANDRENOLIDE T3 QLFLUTICASONE PROPIONATE T1HALOBETASOL PROPIONATE T1 PAHALOG T3 PAHYDROCORTISONE T1HYDROCORTISONE BUTYRATE T1HYDROCORTISONE VALERATE T1IMPOYZ T3 QLKENALOG T3LEXETTE T3 PALOCOID T3LUXIQ T3MICORT-HC T1MOMETASONE FUROATE T1NOLIX T3 QLNUCORT T3OLUX T3OLUX-E T3PANDEL T3PREDNICARBATE T1PROCTO-MED HC T1PROCTO-PAK T1PROCTOCORT T3PROCTOSOL-HC T1PROCTOZONE-HC T1PSORCON T3SANADERMRX T1SCALACORT T1SERNIVO T3SYNALAR T3TEMOVATE T3TEMOVATE EMOLLIENT T3TEXACORT T3TOPICORT T3 PATRIAMCINOLONE ACETONIDE T1TRIANEX T3TRIDERM T1TRIDESILON T3ULTRAVATE T3


PRODUCT TIER UTILIZATION MANAGEMENTVERDESO T3

MOZOBIL T3 S PA

ARANESP T3 S PAEPOGEN T3 S PAMIRCERA T3 S PAPROCRIT T3 S PARETACRIT T3 S PA

FERAHEME T3 SFEROTRINSIC T1FERRLECIT T3 SINFED T1 SINJECTAFER T3 SIRO-PLEX T3POLYSACCHARIDE IRON FORTE T1SIDEROL T3SOD FERRIC GLUCONATE COMPLEX T1 STRIFERIC T3 SVENOFER T3 S

FULPHILA T3 S PAGRANIX T3 S PALEUKINE T3 S PANEULASTA T3 S PANEUPOGEN T3 S PANIVESTYM T3 S PAUDENYCA T3 S PA QLZARXIO T3 S PA QL

B-PLEX PLUS T1

ANALPRAM HC T3HYDROCORTISONE-PRAMOXINE T1LIDOCAINE-HYDROCORTISONE T1PROCORT T3PROCTOFOAM-HC T2

HEMORRHOIDAL SUPPOSITORY T1PRAMOXINE HCL T1

HEMORRHOIDAL PREPARATIONS

CXCR4 CHEMOKINE RECEPTOR ANTAGONIST

ERYTHROPOIESIS-STIMULATING AGENTS

IRON REPLACEMENT

LEUKOCYTE (WBC) STIMULANTS

MULTIVITAMIN PREPARATIONS

HEMATINICS & BLOOD CELL STIMULATORS

HEMORRHOID PREP,ANTI-INFLAM STEROID-LOCAL ANESTHET

HEMORRHOIDAL PREPARATIONS



AMICAR T3AMINOCAPROIC ACID T1CYKLOKAPRON T3 SLYSTEDA T3 QLRIASTAP T3 STRANEXAMIC ACID T1 S QL

PROTAMINE SULFATE T1

DOPTELET T3 S PANPLATE T3 S PAPROMACTA T3 S PA

AVITENE T3ENDO-AVITENE T3EVARREST T3EVICEL T3GELFOAM JMI T3MONSEL'S T3RECOTHROM T3 SSYRINGE AVITENE T3TACHOSIL T3THROMBI-GEL T3THROMBI-PAD T3THROMBIN-JMI T3TISSEEL VHSD T3ULTRAFOAM T3

BCAD 1 T3CYCLINEX-1 T3ELECARE T3GLUTAREX-1 T3HCY 1 T3HOMINEX-1 T3I-VALEX-1 T3KETONEX-1 T3

LUGOL'S T1SSKI T3

HEMOSTATICS

INFANT FORMULAS

IODINE THERAPY

INFANT FORMULAS

IODINE CONTAINING AGENTS

ANTIFIBRINOLYTIC AGENTS

COAGULANTS

THROMBOPOIETIN RECEPTOR AGONISTS

TOPICAL HEMOSTATICS


PRODUCT TIER UTILIZATION MANAGEMENTSTRONG IODINE T1

AMITIZA T3 PA QLCLENPIQ T3COLYTE WITH FLAVOR PACKETS T3CONSTULOSE T1GAVILYTE-C T1GAVILYTE-G T1GAVILYTE-N T1GOLYTELY T3HYDROCIL INSTANT T3KONSYL T3KRISTALOSE T1LACTULOSE T1MIRALAX T3MOVIPREP T3NATURAL FIBER T3NATURAL FIBER POWDER T3NULYTELY WITH FLAVOR PACKS T3OSMOPREP T3PEG 3350-ELECTROLYTE T1PEG-3350 AND ELECTROLYTES T1PEG-3350 WITH FLAVOR PACKS T1PEG-PREP T1PLENVU T3POLYETHYLENE GLYCOL 3350 T1PREPOPIK T3 QLSUPREP T3 QLTRILYTE WITH FLAVOR PACKETS T1

MINERAL OIL T1

EZETIMIBE-SIMVASTATIN T1 QLVYTORIN T3 QL

KYNAMRO T3 S PA QL

PRAVASTATIN SODIUM T1 QLSIMVASTATIN T1 PA QL

JUXTAPID T3 S PA QL

LAXATIVES

LIPOTROPICS

ANTIHYPERLIPIDEMIC - HMG COA REDUCTASE INHIBITORS

ANTIHYPERLIPIDEMIC - MTP INHIBITOR

LAXATIVES AND CATHARTICS

LAXATIVES, LOCAL/RECTAL

ANTIHYPERLIP.HMG COA REDUCT INHIB-CHOLEST.AB.INHIB

ANTIHYPERLIPIDEMIC - APO B-100 SYNTHESIS INHIBITOR



PRALUENT PEN T3 S PA QLREPATHA PUSHTRONEX T3 S PA QLREPATHA SURECLICK T3 S PA QLREPATHA SYRINGE T3 S PA QL

ALTOPREV T3 ST QLATORVASTATIN CALCIUM T1 QLCRESTOR T3 ST QLFLOLIPID T3 ST QLFLUVASTATIN ER T1 QLFLUVASTATIN SODIUM T1 QLLESCOL T3 ST QLLESCOL XL T3 ST QLLIPITOR T3 ST QLLIVALO T2 ST QLLOVASTATIN T1 QLPRAVACHOL T3 ST QLPRAVASTATIN SODIUM T1 QLROSUVASTATIN CALCIUM T1 QLSIMVASTATIN T1 PA QLZOCOR T3 PA ST QLZYPITAMAG T3 ST QL

ANTARA T3 PA QLEZETIMIBE T1 QLFENOFIBRATE T1 QLFENOFIBRIC ACID T1 QLFENOGLIDE T3 QLFIBRICOR T3 QLGEMFIBROZIL T1 QLLIPOFEN T3 PA QLLOPID T3 QLLOVAZA T3 QLNIACIN ER T1 QLNIACOR T3 QLNIASPAN T3 QLOMEGA-3 T1OMEGA-3 ACID ETHYL ESTERS T1 QLTHEROMEGA SPORT T1TRICOR T3 QLTRIGLIDE T3 PA QLTRIKLO T1 QL

ANTIHYPERLIPIDEMIC - PCSK9 INHIBITORS

ANTIHYPERLIPIDEMIC-HMGCOA REDUCTASE INHIB(STATINS)

LIPOTROPICS


PRODUCT TIER UTILIZATION MANAGEMENTTRILIPIX T3 QLVASCEPA T3 QLZETIA T3 QL

ACTICOAT T1ACTICOAT 7 T3ACTICOAT ABSORBENT T3ACTICOAT FLEX 3 T3ACTICOAT FLEX 7 T3ACTICOAT MOISTURE CONTROL T3ACTICOAT SITE T3ACTICOAT SURGICAL T1ALLEVYN T1ALLEVYN ADHESIVE T1ALLEVYN AG T1ALLEVYN AG ADHESIVE T3ALLEVYN AG GENTLE T1ALLEVYN HEEL T1ALLEVYN LIFE T1ALLEVYN SACRUM T3AQUAFLO T3BIOGUARD PACKING T3BIOSTEP T3BIOSTEP AG T3CARRASYN HYDROGEL WOUND T1CURAFIL T3CURITY T3CURITY AMD T3CURITY IODOFORM T3DURAFIBER T3EXCILON AMD T3HYDROFERA BLUE T3HYDROFERA BLUE READY T1INTRASITE T3KENDALL T3KERLIX AMD T3KERLIX AMD BANDAGE T3MEDIHONEY T3OASIS ULTRA T3REPLICARE T1REPLICARE ULTRA T1REPLICARE ULTRA SACRUM T3

MEDICAL SUPPLIESBANDAGES AND RELATED SUPPLIES


PRODUCT TIER UTILIZATION MANAGEMENTRESTORE T3RESTORE CALCIUM ALGINATE T3RESTORE CONTACT LAYER SILVER T3SILVERSEAL HYDROGEL T3SPECTRAGEL T3TEGADERM AG MESH T3VACUSTIM BLACK T3WOUND MATRIX T3XEROFORM T3XEROFORM PETROLATUM DRESSING T3

BLOOD COLLECTION SET T1BLOOD SET T1BLOOD SET 78-SL, Y-TYPE T3BLOOD SET 82-SL T1BLOOD SET W-PUMP-SL T1BLOOD WARMING COIL T1BLOOD Y-TYPE PUMP SET T3HEMA BLOOD SECONDARY PUMP T3HEMA BLOOD SET T3HEMA Y-TYPE BLOOD SET T3PLATELET CONCENTRATE INFUSION T1SAFETY-LOK COLLECTION SET T3

HYDROFLUORIC ACID T3

ADD-A-FOLEY CATH-PRE-FILL SYRN T3ADVANCE PLUS INTERMITTENT T3APOGEE HC INTERMITTENT T1APOGEE IC INTERMITTENT CATHETR T3ASSURA T3BARD CENTER ENTRY CLOSE SYSTEM T3BARDIA URINARY DRAINAGE BAG T3BEDSIDE DRAINAGE COLLECTION T3CURITY T3CURITY FOLEY CATHETER KIT T3CURITY ULTRAMER IRRG 3WAY CATH T3CURITY UNIVERSAL W-O DRAINAGE T3CURITY URETH CATH CLOSED SYSTM T3CURITY URETH CATH OPEN SYSTEM T3CURITY URETHRAL CATHETER T3DAVOL URINARY DRAINAGE BAG T3DISPOZ-A-BAG LEG BAG LARGE T3

BLOOD ADMINISTRATION SETS

BULK CHEMICALS

CATHETERS AND RELATED DEVICES


PRODUCT TIER UTILIZATION MANAGEMENTDISPOZ-A-BAG LEG BAG MEDIUM T3DISPOZ-A-BAG LEG BAG SMALL T3DOVER CATHETER T3DOVER COATED LATEX FOLEY T3DOVER LATEX FOLEY CATHETER T3DOVER RED RUBBER ROBIBSON CATH T3DOVER UNIVERSAL T3DOVER URINE LEG BAG T3FEMALE SELF CATHETER T1FEMALE URINARY POUCH T3FOLEY CATHETER T3FOLEY CATHETER TRAY T3FREEDOM DRAINAGE BAG T3FREEDOM LEG BAG T3FREEDOM T-TAP LEG BAG KIT T3FREEDOM TWIST PORT LEG BAG KIT T3KENGUARD T3KENLINE ADD-A-FOLEY TRAY 30CC T3MAGIC3 INTERMITTENT CATHETER T3MONO-FLO T3PLATINUM UROSTOMY POUCH T3ROBINSON CLEAR VINYL CATHETER T3SPEEDICATH T3TEXAS CATHETER T3TOUCH-TROL T3URI-DRAIN T3URINARY DRAINAGE BAG T3URINARY LEG BAG T3URINARY LEG MEDIUM BAG T3URO-SAN LEG BAG T3UROSTOMY NIGHT BAG T3VAPRO PLUS INTERMITT CATHETER T3VENT URIN LEG BAG SYS,COMBO PK T3

CONCEPTION T1

2TEK T3ACCU-CHEK T2ACCU-CHEK AVIVA CONNECT T2ACCU-CHEK AVIVA PLUS T2ACCU-CHEK COMPACT BLUE CONTROL T2ACCU-CHEK COMPACT PLUS CONTROL T2ACCU-CHEK FASTCLIX LANCING DEV T2

DIABETIC SUPPLIES

CONCEPTION ASSISTANCE SUPPLIES


PRODUCT TIER UTILIZATION MANAGEMENTACCU-CHEK GUIDE CONTROL SOLN T2ACCU-CHEK GUIDE ME GLUCOSE MTR T2ACCU-CHEK GUIDE MONITOR SYSTEM T2ACCU-CHEK NANO SMARTVIEW T2ACCU-CHEK SMARTVIEW T2ACCU-CHEK SOFTCLIX T2ACCU-CHEK VOICEMATE T2ACCUTREND GLUCOSE T3ADJUSTABLE LANCING DEVICE T2ADVANCED GLUCOSE METER T3 PAADVANCED LANCING DEVICE T2ADVOCATE LANCING DEVICE T2AGAMATRIX AMP T3 PAAGAMATRIX CONTROL T3ALKALINE BATTERIES T3ALTERNATE SITE LANCING DEVICE T2AQUA LANCE LANCING DEVICE T2ASSURE 4 T3 PAASSURE DOSE T3ASSURE PLATINUM T3 PAASSURE PRISM T3ASSURE PRISM MULTI T3 PAAUTO-LANCET MINI T2AUTOJECT 2 T3 S PAAUTOLET IMPRESSION T2AUTOLET LANCING DEVICE T2AUTOLET PLUS T2BLOOD GLUCOSE CONTROL T3BLOOD GLUCOSE METER T3 PABLOOD GLUCOSE MONITOR T3 PABLOOD GLUCOSE MONITORING T3 PABLOOD-GLUCOSE CONTROL T3BREEZE 2 T3CARELANCE ULT LANCING DEVICE T2CAREONE T2CARESENS T3CARESENS N T3 PACARESENS N VOICE T3 PACARESENS PREM LANCING DEVICE T2CARETOUCH GLUCOSE MONITORING T3 PACARETOUCH LANCING DEVICE T2CHEMSTRIP BG DIARY T3 PACHOICEDM CLARUS T3 PA


PRODUCT TIER UTILIZATION MANAGEMENTCHOICEDM CLARUS CONTROL SOLN T3CONTOUR T3 PACONTOUR LINK T3 PACONTOUR NEXT T3 PACONTOUR NEXT CONTROL SOLUTION T3CONTOUR NEXT EZ T3 PACONTOUR NEXT LINK T3 PACONTOUR NEXT LINK 2.4 T3 PACONTOUR NEXT ONE T3 PACONTROL AST T3 PACONTROL SOLUTION T3COOL BLOOD GLUCOSE T3 PACOOL BLOOD GLUCOSE METER T3 PACOOL CONTROL SOLUTION T3DROPLET LANCING DEVICE T2EASY CHECK T3 PAEASY CHECK CONTROL SOLUTION T3EASY CLICK T2EASY MINI EJECT LANCING DEVICE T2EASY PLUS II T3 PAEASY STEP T3 PAEASY STEP CONTROL SOLUTION T3EASY TALK T3 PAEASY TOUCH CONTROL SOLUTION T3EASY TOUCH GLUCOSE MONITOR T3 PAEASY TOUCH LANCING DEVICE T2EASY TRAK T3 PAEASY-TOUCH T3 PAEASYGLUCO T3 PAEASYGLUCO METER T3 PAEASYGLUCO METER STARTER KIT T3 PAEASYGLUCO PLUS T3 PAEASYGLUCO PLUS CONTROL NORMAL T3EASYMAX T3EASYMAX 15 T3EASYMAX L T3 PAEASYMAX NG T3 PAEASYMAX V SPEAKING T3 PAEASYMAX V2 T3 PAELEMENT COMPACT T3 PAELEMENT COMPACT CONTROL SOLN T3ELEMENT COMPACT V T3 PAELEMENT CONTROL SOLUTION T3


PRODUCT TIER UTILIZATION MANAGEMENTELEMENT PLUS T3 PAENLITE T3EVENCARE T3 PAEVENCARE G2 T3 PAEVENCARE G3 T3 PAEVENCARE MINI GLUCOSE CONTROL T3EVENCARE MINI MONITOR SYSTEM T3 PAEVENCARE PROVIEW CONTROL SOLN T3EVERSENSE SENSOR-HOLDER T3EVOLUTION BLOOD GLUCOSE METER T3 PAEVOLUTION CONTROL SOLUTION T3EZ SMART T3 PAEZ SMART PLUS T3 PAEZ-VAC T3FORA CONTROL SOLUTION T3FORA D40D GLUCOSE-BP MONITOR T3 PAFORA D40G GLUCOSE-BP MONITOR T3 PAFORA GD50 T3 PAFORA LANCING DEVICE T2FORA PREMIUM V10 T3 PAFORA TEST N'GO VOICE T3 PAFORA TN'G VOICE T3 PAFORA V12 T3 PAFORA V30A T3 PAFORACARE GD20 T3 PAFORACARE GD40A T3 PAFORACARE GD40B T3 PAFORTISCARE T3FORTISCARE BLOOD GLUCOSE SYST T3 PAFREESTYLE LIBRE 10 DAY READER T2 PAFREESTYLE LIBRE 10 DAY SENSOR T2 PAFREESTYLE LIBRE 14 DAY READER T2 PAFREESTYLE LIBRE 14 DAY SENSOR T2 PAFREESTYLE PRECISION NEO METER T3 PAGDRIVE T3 PAGE100 BLOOD GLUCOSE SYSTEM T3 PAGE100 CONTROL SOLUTION NORMAL T3GENTEEL VACUUM LANCING DEVICE T2GLUCO NAVII T3 PAGLUCOCARD 01 T3 PAGLUCOCARD 01 CONTROL T3GLUCOCARD EXPRESSION T3 PAGLUCOCARD SHINE T3 PA


PRODUCT TIER UTILIZATION MANAGEMENTGLUCOCARD SHINE CONNEX METER T3 PAGLUCOCARD SHINE EXPRESS METER T3 PAGLUCOCARD SHINE XL T3 PAGLUCOCARD VITAL T3 PAGLUCOCOM BLOOD GLUCOSE T3 PAGLUCOCOM CONTROL SOLUTION T3GLUCOSE CONTROL T3GLUCOSE CONTROL SOLUTION T3GOODLIFE AC-302 GLUCOSE METER T3 PAHARMONY CONTROL SOLUTION T3HEALTHPRO GLUCOSE CONTROL SOLN T3HEALTHPRO GLUCOSE MONITOR T3 PAHEALTHY ACCENTS AUTOLET T2HYPOLANCE T2IGLUCOSE BLOOD GLUCOSE MONITOR T3 PAINCONTROL LANCING DEVICE T2INFINITY T3 PAINFINITY CONTROL SOLUTION T3INFINITY VOICE CONTROL SOLN T3INFINITY VOICE GLUCOSE MONITOR T3 PAINSUL-CAP T3INSUL-EZE T3JAZZ WIRELESS 2 T3 PALANCING DEVICE T2LANCING SYSTEM T2LANZO T2LIBERTY LEV 1 GLUCOSE CONTROL T3LIBERTY LEV 2 GLUCOSE CONTROL T3LIBERTY MONITOR T3 PALITE TOUCH T2MAGNI-GUIDE MAGNIFIER T3MEDISENSE T3 PAMEDISENSE GLUCOSE KETONE T3 PAMEDISENSE GLUCOSE KETONE CONTR T3METER-CHECK T3MICRO T3 PAMICRODOT T3 PAMICROLET 2 T2MICROLET NEXT LANCING DEVICE T2MINI LANCING DEVICE T2MINILINK REAL-TIME TRANSMITTER T3MULTI-LANCET T2MYGLUCOHEALTH T3 PA


PRODUCT TIER UTILIZATION MANAGEMENTMYGLUCOHEALTH CONTROL SOLUTION T3NOVA MAX BLOOD GLUCOSE METER T3 PANOVA MAX GLUCOSE CONTROL SOLN T3NOVAMAX PLUS GLU-KET T3 PAON CALL EXPRESS CONTROL SOLN T3ON CALL EXPRESS METER T3 PAON CALL LANCING DEVICE T2ON CALL PLUS CONTROL T3ON CALL PLUS LANCING DEVICE T2ON CALL PLUS METER T3 PAON CALL VIVID CONTROL T3ON CALL VIVID METER T3 PAON CALL VIVID PAL T3 PAONETOUCH DELICA T2ONETOUCH ULTRA CONTROL SOLN T2ONETOUCH ULTRA2 T2ONETOUCH ULTRAMINI T2ONETOUCH VERIO T2ONETOUCH VERIO FLEX T2 QLONETOUCH VERIO IQ T2ONETOUCH VERIO SYNC T2OPTUMRX T3 PAPARADIGM REAL-TIME T3PARADIGM REMOTE CONTROL T3PRECISION XTRA T3 PAPREMIER BLU T3 PAPREMIER VOICE T3 PAPREMIUM BLOOD GLUCOSE T3 PAPREMIUM V10 T3 PAPRESTO PRO T3 PAPRO VOICE V8 GLUCOSE MONITOR T3 PAPRO VOICE V9 GLUCOSE MONITOR T3 PAPRODIGY T3 PAPRODIGY AUTOCODE T3 PAPRODIGY CONTROL SOLUTION T3PRODIGY LANCING DEVICE T2PRODIGY POCKET T3 PAPRODIGY VOICE T3 PAQUINTET T3 PAQUINTET AC T3 PAREFUAH PLUS T3 PAREFUAH PLUS GLUCOSE CONTROL T3RELIAMED MINI LANCING DEVICE T2


PRODUCT TIER UTILIZATION MANAGEMENTRELION ALL-IN-ONE T3 PARELION CONFIRM T3 PARELION MICRO T3 PARELION PRIME T3 PAREPLACEMENT PEDIATRIC MONITOR T3REVEAL BLOOD GLUCOSE METER T3 PARIGHTEST CONTROL SOLUTION T3RIGHTEST GC250S CONTROL SOLN T3RIGHTEST GD500 T2RIGHTEST GM100 SYSTEM T3 PARIGHTEST GM250S METER T3 PARIGHTEST GM260 METER T3 PARIGHTEST GM300 SYSTEM T3 PARIGHTEST GM550 SYSTEM T3 PASAFE-CLIP T3SIDEKICK T3 PASMART CARESENS N T3 PASMART SENSE MONITORING SYSTEM T3 PASMARTDIABETES VANTAGE T2SMARTEST T3SMARTEST EJECT T3 PASMARTEST PERSONA T3 PASMARTEST PRONTO T3 PASMARTEST PROTEGE T3 PASMARTEST SMART CODE T3 PASMARTEST TALKING T3 PASOF-SENSOR T3SOFTCLIX T2SOLUS V2 T3 PASOLUS V2 CONTROL SOLUTION T3SOLUS V2 LANCING DEVICE T2SURE COMFORT LANCING PEN T2SURE-PEN T2SURE-TEST EASYPLUS MINI T3 PASUREFLEX T2TD GOLD BLOOD GLUCOSE MONITOR T3 PATD GOLD LEVEL 1 CONTROL SOL T3TD GOLD LEVEL 2 CONTROL SOL T3TD GOLD LEVEL 3 CONTROL SOL T3TD GOLD VOICE GLUCOSE MONITOR T3 PATELCARE T3 PATELCARE CONTROL SOLUTION T3TEST N'GO T3 PA


PRODUCT TIER UTILIZATION MANAGEMENTTRUE METRIX T3TRUE METRIX AIR GLUCOSE METER T3 PATRUE METRIX BLOOD GLUCOSE MTR T3 PATRUE METRIX GO T3 PATRUE2GO BLOOD GLUCOSE SYSTEM T3 PATRUECONTROL T3TRUEDRAW T2TRUERESULT BLOOD GLUCOSE METER T3 PATRUERESULT BLOOD GLUCOSE SYSTM T3 PATRUETEST GLUCOSE CONTROL T3TRUETRACK BLOOD GLUCOSE SYSTEM T3 PATRUETRACK SMART SYSTEM T3 PAULTI-LANCE T2ULTIMA T3 PAULTRATRAK T3 PAULTRATRAK PRO T3 PAULTRATRAK ULTIMATE T3 PAUNISTIK 2 T2UNISTIK 2 EXTRA T2UNISTIK 2 NORMAL T2UNISTIK 3 T2UNISTIK 3 COMFORT T2UNISTIK 3 NEONATAL T2UNISTRIP T3VERASENS BLOOD GLUCOSE METER T3 PAVERASENS CONTROL SOLUTION T3VERASENS METER STARTER KIT T3VIVAGUARD INO GLUCOSE METER T3 PAVIVAGUARD LANCING DEVICE T2WAVESENSE AMP T3 PAWAVESENSE CONTROL SOLUTION T3WAVESENSE PRESTO T3 PA

1ST TIER UNILET COMFORTOUCH T2ACCU-CHEK T2ACCU-CHEK FASTCLIX LANCET DRUM T2ACCU-CHEK SAFE-T-PRO T2ACCU-CHEK SAFE-T-PRO PLUS T2ACCU-CHEK SOFTCLIX T2ACTI-LANCE T2ADVANCED TRAVEL LANCETS T2ALTERNATE SITE LANCETS T2ASSURE HAEMOLANCE PLUS T2

DURABLE MEDICAL EQUIPMENT,MISC(GROUP 1)


PRODUCT TIER UTILIZATION MANAGEMENTASSURE LANCE T2ASSURE LANCE PLUS T2BD MICROTAINER LANCETS T2BD ULTRA-FINE T2BD ULTRA-FINE II T2BLOOD LANCETS T2BULLSEYE MINI SAFETY LANCETS T2CAREONE T2CARESENS T2CARETOUCH TWIST LANCET T2COAGUCHEK T2COLOR LANCETS T2COMFORT LANCETS T2DROPLET LANCETS T2E-Z JECT LANCETS T2E-ZJECT LANCETS T2EASY COMFORT T2EASY TOUCH T2EASY TOUCH LANCETS T2EASY TWIST & CAP LANCETS T2EZ SMART LANCETS T2FIFTY50 SAFETY SEAL LANCETS T2FINE 30 UNIVERSAL LANCETS T2FINGERSTIX T2FORA LANCETS T2FORA V10-V12-D10-D20 T3 PAGLUCOCOM T2GLUCOCOM LANCETS T2HEALTHY ACCENTS UNILET LANCET T2INCONTROL SUPER THIN LANCETS T2INCONTROL ULTRA THIN LANCETS T2INJECT EASE LANCETS T2INVACARE LANCETS T2LANCETS T2LANCETS THIN T2LANCETS ULTRA THIN T2LITE TOUCH T2MEDISENSE THIN LANCETS T2MEDLANCE PLUS T2MEDLANCE PLUS SPECIAL BLADE T2MICRO THIN LANCET T2MICRO THIN LANCETS T2MICROLET T2


PRODUCT TIER UTILIZATION MANAGEMENTMICROTAINER LANCETS T2MONOLET LANCETS T2MONOLET THIN LANCETS T2MYGLUCOHEALTH LANCETS T2NOVA SAFETY LANCETS T2NOVA SUREFLEX T2ON CALL LANCET T2ON CALL PLUS LANCET T2ON-THE-GO T2ONETOUCH DELICA T2ONETOUCH LANCETS T2ONETOUCH SURESOFT T2PRESSURE ACTIVATED LANCETS T2PRO COMFORT LANCET T2PRO COMFORT LANCETS T2PRODIGY LANCETS T2PRODIGY TWIST TOP LANCET T2PUSH BUTTON SAFETY LANCETS T2READYLANCE SAFETY LANCETS T2RELIAMED T2RELIAMED SAFETY SEAL LANCETS T2RELION THIN T2RIGHTEST GL300 LANCETS T2SAFETY LANCETS T2SAFETY SEAL LANCETS T2SAFETY-LET T2SINGLE-LET T2SMART SENSE T2SMART SENSE LANCETS T2SMARTEST LANCET T2SOFT TOUCH T2SOLUS V2 T2SOLUS V2 LANCETS T2STERILANCE TL T2SUPER THIN LANCETS T2SURE COMFORT LANCETS T2SURE-LANCE T2SURE-TOUCH T2TECHLITE LANCETS T2TELCARE T2THIN LANCETS T2TOPCARE UNIVERSAL1 LANCET T2TOPCARE UNIVERSAL1 THIN LANCET T2


PRODUCT TIER UTILIZATION MANAGEMENTTRUE COMFORT LANCET T2TRUEPLUS LANCET T2TRUEPLUS LANCETS T2TWIST LANCETS T2ULTILET BASIC T2ULTILET CLASSIC T2ULTILET LANCETS T2ULTILET SAFETY T2ULTRA FINE LANCETS T2ULTRA THIN LANCET T2ULTRA THIN LANCETS T2ULTRA THIN PLUS T2ULTRA THIN PLUS LANCETS T2ULTRA-CARE LANCETS T2ULTRA-THIN II T2ULTRALANCE T2UNILET COMFORTOUCH T2UNILET EXCELITE T2UNILET EXCELITE II T2UNILET GP LANCET T2UNILET LANCET T2UNILET LANCETS T2UNISTIK 3 T2UNISTIK 3 EXTRA T2UNISTIK CZT T2UNISTIK PRO T2UNISTIK SAFETY T2UNISTIK TOUCH T2UNIVERSAL 1 T2VIVAGUARD LANCET T2

AERONEB GO T3AIR FILTER T1ALL FLOW 1000 T3ALL FLOW 3000 KIT T3ALL FLOW 3000 PFT T3ALL FLOW 4000 T3ALL FLOW 5000 T3ALL FLOW 6000 T3AMBER GLASS BOTTLE T1AMBER GLASS SERUM BOTTLE T1AMBER ROUND GLASS BOTTLE T1BABY CONVERSION KIT T3

DURABLE MEDICAL EQUIPMENT,MISCELLANEOUS


PRODUCT TIER UTILIZATION MANAGEMENTBABY CONVERSION PACK 1 T1BABY CONVERSION PACK 2 T1CLEAR GLASS SERUM BOTTLE T1CURITY SPNG COUNTER BAG STRIPS T3E-Z SPACER PEDSPAK T3ENEMA BOTTLE T1ERAPID NEBULIZER HANDSET T3EYELID CLEANSING PADS T3FILTER PAD T1FILTER, VALVE SET FOR LL & LC T1INNOSPIRE REPLACEMENT FILTER T3INSPIRATION ELITE FILTER T1INSUL-TRAY T3JETCO-SPRAY CANNULA T3MASK SET WITH Y-PIECE T1MOUTHPIECE T1NOSE CLIP T3ORAL MEDICATION SYRINGE T3PARI LC PLUS NEBULIZER T3PEDI-SMALL MOUTH ADAPTOR T3PILLOW MASK FOR CHILDREN T1PLASTIC WHITE HDPE BOTTLE T1PRECISEDOSE DISPENSER SYRINGE T3REUSABLE NEBULIZER KIT T1RUBBER MOUTHPIECE T2SAMI THE SEAL MASK T3SIDESTREAM MASK T3SILICONE MASK T1SMARTMASK KIDS T1STERILE CLEAR GLASS VIAL T1SUPPOSISTRIP T3SUPPOSITORY BOX T1SUPPOSITORY SHELL, MEDIUM T1SUPPOSITORY SHELL, SMALL T1TENS 502 T3TENS 504 T3TREK S PORTABLE PWR KIT T1TROCHE MOLD T3

ARGYLE T3ENTERAL GRAVITY BAG SET-ENFIT T3KANGAROO 100ML RIGID BURETTE T3KANGAROO 924 SAFETY SCREW T3

FEEDING DEVICES


PRODUCT TIER UTILIZATION MANAGEMENTKANGAROO ENTERAL-FEED-IRRIG KT T3KANGAROO EPUMP SET T3KANGAROO GRAVITY SET T3KANGAROO NASOGASTRIC FEED TUBE T3KANGAROO PUMP EXTENSION SET T3

LATEX GLOVES T1

IRRIGATION SET T3NONVENTED T-U-R SET T3

ALCOH-GLOVE T2ALCOH-WIPE T1

AIRS PEDIATRIC DISPOSABLE MASK T3EAR POPPER T1FACE MASK T3MD JAR AIRLESS T3MD PEN AIRLESS T3MD PUMP ACTUATOR A T3MD PUMP ACTUATOR B T3MD PUMP ACTUATOR C T3MD PUMP BOTTLE AIRLESS T3MD SYRINGE AIRLESS T3MEGAPUMP AIRLESS T3MEGAPUMP MEZZO T3PILLOW MASK T1RECTAL-VAGINAL PERFORATION TIP T1TOPI-CLICK T3VAGINAL SUPPOSITORY APPLICATOR T1

1ST TIER UNIFINE PENTIPS T21ST TIER UNIFINE PENTIPS PLUS T2ADVOCATE PEN NEEDLE T2ASSURE ID PEN NEEDLE T2AUTOSHIELD DUO PEN NEEDLE T2BLUNT NEEDLE T3CAREFINE PEN NEEDLE T2CARETOUCH PEN NEEDLE T2CLICKFINE T2COMFORT EZ PEN NEEDLE T2DROPLET PEN NEEDLE T2DROPSAFE PEN NEEDLE T2

GLOVES

IRRIGATION ADMINISTRATION SETS

MEDICAL SUPPLIES,MISCELLANEOUS

MEDICAL SUPPLIES,MISCELLANEOUS(GROUP 2)

NEEDLES/NEEDLELESS DEVICES


PRODUCT TIER UTILIZATION MANAGEMENTEASY COMFORT PEN NEEDLE T2EASY COMFORT PEN NEEDLES T2EASY GLIDE PEN NEEDLE T2EASY TOUCH FLIPLOCK NEEDLES T3EASY TOUCH PEN NEEDLE T2ECLIPSE NEEDLE T3EXEL HYPODERMIC NEEDLE T3EXEL MTI DRAWING NEEDLE T1FILTER ASPIRATOR NEEDLE T3FILTER NEEDLE T1HEALTHWISE PEN NEEDLE T2HEALTHY ACCENTS UNIFINE PENTIP T2HYPODERMIC NEEDLE T3INCONTROL PEN NEEDLE T2INSULIN PEN NEEDLE T2INSUPEN T2INTEGRA PRECISIONGLIDE NEEDLE T3LITE TOUCH T2MAXICOMFORT SAFETY PEN NEEDLE T2MICRODOT INSULIN PEN NEEDLE T2MINI ULTRA-THIN II T2MONOJECT BLOOD COLLECTION T3MONOJECT FILTER NEEDLE T3NANO 2ND GEN PEN NEEDLE T2NEEDLE T3NEEDLES T2NOVOFINE T2NOVOFINE 32 T2NOVOFINE AUTOCOVER T2NOVOFINE PLUS T2NOVOTWIST T2PEN NEEDLE T2PEN NEEDLES T2PENTIPS T2PHASEAL PROTECTOR T1POLY HUB NEEDLE T3PREVENT DROPSAFE PEN NEEDLE T2PRO COMFORT PEN NEEDLE T2RELION PEN NEEDLES T2SAFETY PEN NEEDLE T2SAFETYGLIDE NEEDLE T3SURE COMFORT T2SURE-FINE PEN NEEDLES T2


PRODUCT TIER UTILIZATION MANAGEMENTTECHLITE PEN NEEDLE T2TERUMO SURGUARD2 T3TOPCARE CLICKFINE T2TRUE COMFORT PEN NEEDLE T2TRUEPLUS PEN NEEDLE T2ULTICARE PEN NEEDLE T2ULTILET PEN NEEDLE T2ULTRA FLO PEN NEEDLE T2ULTRA-FINE MICRO PEN NEEDLE T2ULTRA-FINE MINI PEN NEEDLE T2ULTRA-FINE NANO PEN NEEDLE T2ULTRA-FINE ORIGINAL PEN NEEDLE T2ULTRA-FINE SHORT PEN NEEDLE T2ULTRA-THIN II T2ULTRACARE PEN NEEDLE T2UNIFINE PENTIPS T2UNIFINE PENTIPS PLUS T2VERIFINE PEN NEEDLE T2YALE NEEDLE T3

ACTIVE LIFE CLOSED-END POUCH T3ACTIVE LIFE CONVEX T3ACTIVE LIFE DRAINABLE POUCH T3ACTIVE LIFE UROSTOMY POUCH T3ADAPT BARRIER T3ADAPT CONVEX BARRIER T3ADAPT PASTE T3ADAPT STOMA POWDER T3ADHESIVE BARRIER T3ADHESIVE BARRIERS T3ADHESIVE REMOVER T3ALLKARE PROTECT BARRIER WIPE T3ASSURA T3ASSURA 2PC DRAINABLE T3ASSURA 2PC IRRIGATION SLEEVE T3ASSURA AC T3ASSURA EASICLOSE T3ASSURA EXTRA T3ASSURA FLANGE T3ASSURA FLANGE CONVEX T3ASSURA IRRIGATION FACE PLATE T3ASSURA LIGHT EASICLOSE DRAIN T3ASSURA NON-CONVEX DRAINABLE T3

OSTOMY SUPPLIES


PRODUCT TIER UTILIZATION MANAGEMENTASSURA OSTOMY BELT T3ASSURA PEDIATRIC POUCH T3ASSURA POUCH T3ASSURA STANDARD WEAR T3ASSURA WOUND MANAGER T3BARDIC ADAPTER-TUBING T3CENTERPOINTLOCK CLOSED POUCH T3CENTERPOINTLOCK FLEXTEND SKIN T3COLOPLAST PASTE T3COLOPLAST SKIN BARRIER T3CONTOUR I T3CONVATEC NIGHT DRAIN CONTAINER T3CONVATEC NIGHT DRAINAGE TUBING T3CONVEX SYN BARR W-FLOAT FLANGE T3CPL DRAINABLE POUCH T3CYMED SEAL T3DRAIN POUCH-FILTER-FLANGE T3DRAINABLE MINI-POUCH W-FLANGE T3DRAINABLE POUCH T3DRAINABLE POUCH CLAMP T3DRAINABLE POUCH W-FILTR-FLANGE T3DRAINABLE POUCH WITH FLANGE T3DUOLOCK CURVED TAIL CLOSURE T3DURAHESIVE MOLDABLE CONVEX T3EAKIN COHESIVE T3EAKIN COHESIVE SEALS T3EAKIN COHESIVE SLIMS T3EAKIN COHESIVE STOMAWRAP T3EASICLOSE WIDE OUTLET T3ENEMA BAG T3ESTEEM CLOSED POUCH T3ESTEEM DRAINABLE POUCH T3ESTEEM SYNERGY T3ESTEEM SYNERGY CLOSED POUCH T3ESTEEM SYNERGY DRAINABLE POUCH T3ESTEEM SYNERGY+ T3ESTEEM+ CLOSED POUCH T3ESTEEM+ DURAHESIVE PLUS T3FECAL COLLECTOR T3FECAL COLLECTOR, DRAINABLE T3FILTER REPLACEMENT T3FLEXI-SEAL FMS T3FLEXI-TRAK ANCHORING DEVICE T3


PRODUCT TIER UTILIZATION MANAGEMENTFLEXTEND SKIN BARRIER T3HOLLIHESIVE SKIN BARRIER T3ILE-SORB T3IRRIGATION SET T3IRRIGATION SLEEVE T3LITTLE ONES ACTIVE LIFE POUCH T3LITTLE ONES CLOSED-END POUCH T3LITTLE ONES DRAINABLE POUCH T3LITTLE ONES SKIN BARRIER T3LITTLE ONES UROSTOMY POUCH T3LO-PROFILE UROSTOMY POUCH T3LOOP OSTOMY BRIDGE, STERILE T3MEDICAL ADHESIVE T3MICROHESIVE STOMA PASTE T3MICROSKIN BARRIER T3MINI-DRAIN OPEN END POUCH T3NATURA CLOSED POUCH T3NATURA DRAINABLE POUCH T3NATURA DURAHESIVE SKIN BARRIER T3NATURA STOMAHESIVE SKN BARRIER T3NEW IMAGE T3NEW IMAGE CERAPLUS SKN BARRIER T3NEW IMAGE CLOSED MINI-POUCH T3NEW IMAGE CLOSED POUCH T3NEW IMAGE DRAINABLE MINI-POUCH T3NEW IMAGE DRAINABLE POUCH T3NEW IMAGE FLEXTEND T3NEW IMAGE FLEXWEAR T3NEW IMAGE IRRIGATION SLEEVE T3NEW IMAGE SKIN BARRIER T3NEW IMAGE SKIN BARRIER-FLANGE T3NEW IMAGE UROSTOMY T3NEW IMAGE UROSTOMY POUCH T1NIGHT DRAIN ADAPTER T3NUTRIPORT BALLOON T3O.A.D. T3ODOR ELIMINATOR T3ONE-PIECE DRAINABLE POUCH T3OSTOMY APPLIANCE BELT T3OSTOMY BELT T3OSTOMY PASTE T3OSTOMY PROTECTIVE POWDER T3POUCH CLAMP T3


PRODUCT TIER UTILIZATION MANAGEMENTPOUCHKINS PEDIATRIC BELT T3POUCHKINS POUCH T3POUCHKINS UROSTOMY POUCH T3PREMIER CLOSED MINI-POUCH T3PREMIER CLOSED POUCH T3PREMIER DRAINABLE MINI-POUCH T3PREMIER DRAINABLE POUCH T3PREMIER LOCK N ROLL T3PREMIER PRE-SIZED MINI-POUCH T3PREMIER SKN BARR W-FLOAT FLANG T3PREMIER SKN BARR W/FLOAT FLANG T3PREMIER UROSTOMY POUCH T1PREMIER UROSTOMY POUCH/FLANGE T3PREMIUM SKIN BARRIER T3PROTECTIVE BARRIER FILM T3PROTECTIVE BARRIER WIPES T3SENSI-CARE SKIN BARRIER WIPE T3SENSURA CLICK OSTOMY POUCH T3SENSURA EASICLOSE WIDE OUTLET T3SENSURA FLEX OSTOMY BASE PLATE T3SENSURA FLEX OSTOMY POUCH T3SENSURA OSTOMY BASE PLATE T3SKIN BARRIER W-FLOATING FLANGE T3SKIN GEL PROTECTIVE DRESSING T3SKIN-PREP T3SOFTFLEX SKIN BARRIER T3STOMA CONE W-CONNECTOR UNIT T3STOMA IRRIGATOR DRAIN W-FLANGE T3STOMA LUBRICANT T3STOMAHESIVE T3STOMAHESIVE PROTECTIVE T3STOMAHESIVE SKIN BARRIER T3STOMASEAL T3SUR-FIT NAT IRRIG FACEPLATE T3SUR-FIT NATURA ADAPTOR T3SUR-FIT NATURA CLOSED-END PCH T3SUR-FIT NATURA CONVEX INSERTS T3SUR-FIT NATURA DRAINABLE POUCH T3SUR-FIT NATURA DURAHESIVE T3SUR-FIT NATURA HIGH OUTPUT T3SUR-FIT NATURA LITTLE ONES T3SUR-FIT NATURA LOW-PRESSURE T3SUR-FIT NATURA MINI-POUCH T3


PRODUCT TIER UTILIZATION MANAGEMENTSUR-FIT NATURA POUCH T3SUR-FIT NATURA POUCH-WAFER T3SUR-FIT NATURA STOMAHESIVE T3SUR-FIT NATURA UROSTOMY POUCH T3SUR-FIT-ACT LIFE-TAIL CLOSURES T3ULTRA-FRESH T3URI-KLEEN T3UROSTOMY DRAIN TUBE ADAPTER T3UROSTOMY MICRO-POUCH T3UROSTOMY MULTI-CHAMBER T3UROSTOMY MULTI-CHAMBER POUCH T3UROSTOMY POUCH WITH FLANGE T3VISI-FLOW IRRIGATOR STOMA CONE T3VISI-FLOW SLEEVE TAIL CLOSURES T3VISI-FLOW STOMA CONE T3

ACE AEROSOL CLOUD ENHANCER T3AEROCHAMBER MINI T2AEROCHAMBER MV T2AEROCHAMBER PLUS FLOW-VU T2AEROCHAMBER WITH FLOWSIGNAL T2AEROCHAMBER Z-STAT PLUS T2AEROECLIPSE II T3AEROGEAR ASTHMA ACTION KIT T3AERONEB GO NEBULIZER T3AEROTRACH PLUS T3AEROVENT PLUS T3AIRS DISPOSABLE NEBULIZER T3ALTERA NEBULIZER T3ASTHMA CHECK T3ASTHMAPACK CHILDREN'S T3BABY NEBULIZER T3BREATHERITE T3BREATHERITE SPACER-ADULT MASK T3BREATHERITE SPACER-INFANT MASK T3BREATHERITE SPACER-LARGE MASK T3BREATHERITE SPACER-LG CHLD MSK T3BREATHERITE SPACER-MEDIUM MASK T3BREATHERITE SPACER-NEONATE MSK T3BREATHERITE SPACER-SM CHLD MSK T3BREATHERITE SPACER-SMALL MASK T3BREATHRITE T3COMP-AIR ELITE COMPRESSOR SYST T3

RESPIRATORY AIDS,DEVICES,EQUIPMENT


PRODUCT TIER UTILIZATION MANAGEMENTCOMP-AIR NEBULIZER COMPRESSOR T3COMPACT COMPRESSOR NEBULIZER T3COMPACT SPACE CHAMBER T3COMPACT ULTRASONIC NEBULIZER T3DEVILBISS PULMONEB LT COMP-NEB T3DEVILBISS TRAVELER T3E-Z SPACER T3EASIVENT T3EBASE CONTROLLER T3ERAPID NEBULIZER T3FLEXICHAMBER T3FLEXICHAMBER MASK T2FLYP NEBULIZER T3HOME NEBULIZER PLUS SIDESTREAM T3IN-CHECK DIAL T3IN-CHECK NASAL WITH MASK T3IN-CHECK ORAL T3INNOSPIRE DELUXE T3INNOSPIRE ELEGANCE T3INNOSPIRE ESSENCE T3INNOSPIRE GO NEBULIZER T3INNOSPIRE MINI T3INSPIRACHAMBER T3LC PLUS T1LC PLUS NEBULIZER-PED MASK T3LC SPRINT NEBULIZER T3LC STAR T3LITEAIRE T3LITETOUCH T3MICRO AIR T3MICROCHAMBER T3MICROSPACER T3MINI PLUS NEBULIZER T3MINI-WRIGHT PEAK FLOW METER T3MISTERNEB COMPRESSOR T3MISTERNEB PEDIATRIC COMPRESSOR T3MY MDI PORTABLE NEBULISER T3NASONEB NASAL NEBULIZER T3OMBRA COMPRESSOR SYSTEM T3OPTICHAMBER T1OPTICHAMBER DIAMOND T3PARI LC SPRINT SINUS T3PARI SINUS AEROSOL SYSTEM T3


PRODUCT TIER UTILIZATION MANAGEMENTPEDIATRIC DINOSAUR NEBULIZER T3PEDIATRIC DOG NEBULIZER T3PEDIATRIC FROG NEBULIZER T3PFLEX TRAINER T3POCKET CHAMBER T3PORTABLE NEBULIZER SYSTEM T3PRIMEAIRE T3PRO COMFORT SPACER WITH MASK T3PROCARE COMPRESSOR NEBULIZER T3PROCHAMBER T3PRODIGY MINI-MIST T3PRONEB ULTRA II T3PROVENT T3PULMO-AIDE T3QUAKE T3RITEFLO T3SAMI THE SEAL T3SIDESTREAM T3SIDESTREAM NEBULIZER T3SIDESTREAM PEDIATRIC T3SIDESTREAM PLUS T3SILICONE MASK T1SINUSTAR T3SOOTHENEB COMPRESSOR NEBULIZER T3SOOTHENEB MESH NEBULIZER T3SUNRISE COMPRESSOR-NEBULIZER T1THRESHOLD IMT T3THRESHOLD PEP T3TREK S COMBO PACK T3TREK S COMPACT COMPRESSOR T3TRUNEB NEBULIZER T3TRUZONE PEAK FLOW METER T3VIOS AEROSOL DELIVERY SYSTEM T3VIXONE NEBULIZER T3VORTEX T3VORTEX HOLDING CHAMBER-CHILD T3VORTEX HOLDING CHAMBER-TODDLER T3VORTEX VHC FROG MASK T3VORTEX VHC LADYBUG MASK T3WILLIS THE WHALE COMPRESSR NEB T3WINDMILL TRAINER T3

RAPPORT VACUUM THERAPY T3SEXUAL DYSFUNCTION DEVICES



EMS ANTI-EMBOLISM STOCKING T3T.E.D. ANTI-EMBOLISM STOCKING T3

ALLERGIST TRAY T3ALLERGIST TRAY SYR-DETACH NDL T3ALLERGIST TRAY SYR-PERM NEEDLE T3ALLERGY SYRINGE T3ASSURE ID INSULIN SAFETY T2CAREPOINT LUER SLIP SYRINGE T3CARETOUCH INSULIN SYRINGE T2COMFORT EZ INSULIN SYRINGE T2DROPLET INSULIN SYRINGE T2EASY COMFORT INSULIN SYRINGE T2EASY GLIDE INSULIN SYRINGE T2EASY GLIDE LUER LOCK SYRINGE T3EASY GLIDE LUER SLIP TB SYRING T3EASY TOUCH T2EASY TOUCH FLIPLOCK INSULIN T2EASY TOUCH FLIPLOCK SYRINGES T2EASY TOUCH FLURINGE T2EASY TOUCH FLURINGE FLU TRAY T2EASY TOUCH INSULIN SAFETY T2EASY TOUCH INSULIN SYRINGE T2EASY TOUCH SHEATHLOCK INSULIN T2EASY TOUCH SYR ALLERGY TRAY T2EASY TOUCH UNI-SLIP T2EASY-TOUCH INSULIN SYRINGE T2ECLIPSE LUER-LOK SYRINGE T3ECLIPSE SYRINGE T2ECLIPSE SYRINGE-NEEDLE T3EXEL TUBERCULIN SYRINGE T1HEALTHWISE INSULIN SYRINGE T2HUMATROPEN T3 S PAINPERSOL PERITONEAL CATH. 11FR T3INSULIN SYRINGE T2INSULIN SYRINGE U-500 T2INTERLINK SYRINGE T3LIFESHIELD BLUNT CANNULA T3LITE TOUCH T2LITETOUCH INSULIN SYRINGE T2LUER LOCK SYRINGE T1LUER SLIP TIP SYRINGE TRAY T3

SUPPORT HOSIERY

SYRINGES AND ACCESSORIES


PRODUCT TIER UTILIZATION MANAGEMENTLUER-LOK SYRINGE T2LUER-LOK SYRINGE-NEEDLE T3MAGELLAN INSULIN SAFETY SYRNG T2MAGELLAN INSULIN SYRINGE T2MAGELLAN SAFETY SYRINGE T3MAGELLAN TUBERCULIN SYRINGE T3MAXI-COMFORT T2MONOJECT T2MONOJECT ALLERGY TRAY-NEEDLE T3MONOJECT CONTROL SYRINGE T3MONOJECT ENFIT SYRINGE T1MONOJECT ENFIT SYRINGE CAP T1MONOJECT INSULIN SAFETY SYRNG T2MONOJECT INSULIN SYRINGE T2MONOJECT LUER LOCK TB SYRINGE T3MONOJECT MAGELLAN T3MONOJECT MEGELLAN TB SYRINGE T3MONOJECT PHARMACY TRAY T3MONOJECT SAFETY SYRINGE T3MONOJECT SMARTIP CANNULA T3MONOJECT SYRINGE T3MONOJECT SYRINGE PHARMACY TRAY T3MONOJECT TB SYRINGE T3MONOJECT TUBERCULIN SAFETY SYR T3MONOJECT TUBERCULIN SYRINGE T3NORM-JECT T3NORM-JECT SYRINGE T3NORM-JECT TUBERKULIN SYRINGE T3PRO COMFORT INSULIN SYRINGE T2PRODIGY COUNT-A-DOSE T3PRODIGY INSULIN SYRINGE T2Q-CLIQ PEN (FOR NATPARA) T3 S PASAFESNAP INSULIN SYRINGE T2SAFETY SYRINGE WITH SHIELD T3SAFETY SYRINGE-NEEDLE T3SAFETYGLIDE ALLERGY T3SAFETYGLIDE ALLERGY SYRINGE T3SAFETYGLIDE INSULIN SYRINGE T2SAFETYGLIDE SYRINGE T2SAFETYGLIDE TB SYRINGE T3SUPOR T1SURE COMFORT T2SURE COMFORT INSULIN SYRINGE T2


PRODUCT TIER UTILIZATION MANAGEMENTSURE-JECT INSULIN SYRINGE T2SYRINGE T3SYRINGE FILTER, MILLEX-GP T3SYRINGE WITHOUT NEEDLE T3SYRINGE-NEEDLE T3TB SYRINGE T3TECHLITE INSULIN SYRINGE T2TERUMO HYPODERMIC NEEDLE-SYRIN T3TERUMO INSULIN SYRINGE T2TERUMO SURGUARD2 T3TERUMO SYRINGE T3THINPRO INSULIN SYRINGE T2TOOMEY SYRINGE T1TOPCARE ULTRA COMFORT T2TRUE COMFORT INSULIN SYRINGE T2TRUEPLUS INSULIN SYRINGE T2TUBERCULIN SYRINGE T3ULTICARE T2ULTICARE INSULIN SYRINGE T2ULTICARE SAFETY SYRINGE T2ULTICARE TB SAFETY SYRINGE T3ULTILET INSULIN SYRINGE T2ULTRA COMFORT T2ULTRA-THIN II T2ULTRACARE INSULIN SYRINGE T2VANISHPOINT T2VANISHPOINT SYRINGE T3VEO INSULIN SYRINGE T2

FLUDROCORTISONE ACETATE T1

PROMETHAZINE VC T1

CENTERGY T1CONEX T3HISTEX-PE T3PROMETHAZINE VC T1PROMETHAZINE-PHENYLEPHRINE T1

CLARINEX-D 12 HOUR T3 QLSEMPREX-D T3 QL

MINERALOCORTICOIDS

MISCELLANEOUS

MINERALOCORTICOIDS

1ST GEN ANTIHISTAMINE & DECONGESTANT COMBINATIONS

1ST GEN ANTIHISTAMINE AND DECONGESTANT COMBINATION

2ND GEN ANTIHISTAMINE AND DECONGESTANT COMBINATION



MIFEPREX T3MIFEPRISTONE T1

DEBACTEROL T3ORAFATE T1 SPROTHELIAL T1 S

AUBAGIO T3 S PA QLAVONEX T3 S PA QLAVONEX PEN T3 S PA QLBETASERON T3 S PA QLCOPAXONE T3 S PA QLEXTAVIA T3 S PA QLGILENYA T3 S PA QLGLATIRAMER ACETATE T3 S PA QLGLATOPA T3 S PA QLPLEGRIDY T3 S PA QLPLEGRIDY PEN T3 S PA QLREBIF T3 S PA QLREBIF REBIDOSE T3 S PA QLTECFIDERA T3 S PA QLZINBRYTA T3 S PA QL

KEVEYIS T3 S PA QL

AMPYRA T3 S PA QLDALFAMPRIDINE ER T1 S PA QL

MEMANTINE HCL T1 QLMEMANTINE HCL ER T1NAMENDA T3NAMENDA XR T3 ST

NAMZARIC T3 ST

AMMONUL T3BUPHENYL T3 SCARBAGLU T3 SENULOSE T1GENERLAC T1LACTULOSE T1LITHOSTAT T3

ALZHEIMER'S THX,NMDA RECEPTOR ANTAG-CHOLINES INHIB

AMMONIA INHIBITORS

ABORTIFACIENT-PROGESTERONE RECEPTOR ANTAGONISTS

AGENTS FOR STOMATOLOGICAL USE

AGENTS TO TREAT MULTIPLE SCLEROSIS

AGENTS TO TX PERIODIC PARALYSIS - CARBON ANHYD INH

AGTS TX NEUROMUSC TRANSMISSION DIS,POT-CHAN BLKR

ALZHEIMER'S THERAPY, NMDA RECEPTOR ANTAGONISTS


PRODUCT TIER UTILIZATION MANAGEMENTRAVICTI T3 S PA QLSODIUM PHENYLACET-SOD BENZOATE T1SODIUM PHENYLBUTYRATE T1 S

TEGSEDI T3 S PA

RILUTEK T3RILUZOLE T1TIGLUTIK T3 PA

ANTABUSE T3DISULFIRAM T1

ARCALYST T3 S PA

CIMZIA T3 S PA QLINFLECTRA T3 S PA QLREMICADE T3 S PA QLRENFLEXIS T3 S PA QL

ILARIS T3 S PA QL

BUTYLATED HYDROXYTOLUENE(BHT) T1SODIUM BISULFITE T1

VSL#3 DS T3

ESBRIET T3 S PA QL

ADVATE T3 S PAADVATE H T3 S PAADVATE L T3 S PAADVATE M T3 S PAADVATE SH T3 S PAADVATE UH T3 S PAADYNOVATE T3 S PAAFSTYLA T3 S PAALPHANATE T3 S PAELOCTATE T3 S PAFEIBA NF T3 S PAFEIBA VH IMMUNO T3 S PAHELIXATE FS T3 S PAHEMOFIL M T3 S PA

AMYLOIDOSIS AGENTS-TRANSTHYRETIN (TTR) SUPPRESSION

AMYOTROPHIC LATERAL SCLEROSIS AGENTS

ANTI-ALCOHOLIC PREPARATIONS

ANTI-INFLAM. INTERLEUKIN-1 RECEPTOR ANTAGONIST

ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITOR

ANTI-INFLAMMATORY, INTERLEUKIN-1 BETA BLOCKERS

ANTICORROSIVE AGENTS

ANTIDIARRHEAL MICROORGANISMS AGENTS

ANTIFIBROTIC THERAPY - PYRIDONE ANALOGS

ANTIHEMOPHILIC FACTORS


PRODUCT TIER UTILIZATION MANAGEMENTHUMATE-P T3 S PAKOATE T3 S PAKOGENATE FS T3 S PAKOVALTRY T3 S PAMONOCLATE-P T3 SNOVOEIGHT T3 S PANOVOSEVEN RT T3 S PANUWIQ T3 S PAOBIZUR T3 S PARECOMBINATE T3 S PAWILATE T3 S PAXYNTHA T3 S PAXYNTHA SOLOFUSE T3 S PA

ALPHA LIPOIC ACID T1

PANHEMATIN T3

MEGACE ES T3MEGESTROL ACETATE T1

ALFUZOSIN HCL ER T1 QLAVODART T3 QLDUTASTERIDE T1 QLFINASTERIDE T1 QLFLOMAX T3 QLPROSCAR T3 QLRAPAFLO T2 QLSILODOSIN T1 QLTAMSULOSIN HCL T1 QLUROXATRAL T3 QL

FLUMAZENIL T1

VONVENDI T3 S PA

FORTEO T3 S PA

FOSAMAX PLUS D T3 QL

ACTONEL T3 QLALENDRONATE SODIUM T1 QLATELVIA T3 ST QL

ANTIOXIDANT AGENTS

ANTIPORPHYRIA FACTORS

APPETITE STIM. FOR ANOREXIA,CACHEXIA,WASTING SYND.

BENIGN PROSTATIC HYPERTROPHY/MICTURITION AGENTS

BENZODIAZEPINE ANTAGONISTS

BLOOD FACTORS,MISCELLANEOUS

BONE FORMATION STIM. AGENTS - PARATHYROID HORMONE

BONE RESORPTION INHIBITOR AND VITAMIN D COMBS.

BONE RESORPTION INHIBITORS


PRODUCT TIER UTILIZATION MANAGEMENTBINOSTO T3 QLBONIVA T3 S QLETIDRONATE DISODIUM T1EVISTA T3 QLFOSAMAX T3 QLIBANDRONATE SODIUM T1 S QLPAMIDRONATE DISODIUM T1 SPROLIA T3 S PA QLRALOXIFENE HCL T1RECLAST T3 SRISEDRONATE SODIUM T1 QLRISEDRONATE SODIUM DR T1XGEVA T3 S PA QLZOLEDRONIC ACID T1 SZOMETA T3 S

DUTASTERIDE-TAMSULOSIN T1 QLJALYN T3 QL

FIRAZYR T3 S PA

1ST BASE T32-DEOXY-D-GLUCOSE T32-METHOXYESTRADIOL T34-AMINOBENZOIC ACID POTASSIUM T34-AMINOPYRIDINE T35-AMINOSALICYLIC ACID T35-METHYLTETRAHYDROFOLATE CALC T37-KETO DHEA T3ACACIA T3ACEBUTOLOL HCL T3ACEPROMAZINE MALEATE T3ACESULFAME POTASSIUM T3ACETAMINOPHEN T3ACETARSONE T3ACETAZOLAMIDE T3ACETIC ACID T3ACETIC ACID GLACIAL T3ACETYL HEXAPEPTIDE-8 T3ACETYL SALICYLIC ACID T3ACETYL-D-GLUCOSAMINE T3ACETYL-L-CARNITINE HCL T3ACETYLCHOLINE CHLORIDE T3

BPH 5-ALPHA-REDUCTASE INHIB-ALPHA1-ADRENOCEP ANTAG

BRADYKININ B2 RECEPTOR ANTAGONISTS

BULK CHEMICALS


PRODUCT TIER UTILIZATION MANAGEMENTACETYLCYSTEINE T3ACIDOPHILUS LACTOBACILLUS T3ACTIVATED CHARCOAL T3ACYCLOVIR T3ADEMETIONINE DISULFATE TOSYLAT T3ADENOSINE T3ADENOSINE-5-TRIPHOSPHATE T3ADENOSYLCOBALAMIN T3ADRENOCORTICOTROPHIC HORMONE T3ALANINE T3ALBA-DERM T3ALBENDAZOLE T3ALBUTEROL SULFATE T3ALDOSTERONE T3ALFALFA T3ALFALFA FLAVOR T3ALGINIC ACID T3ALKYL (C12-15) BENZOATE T3ALKYL ACRYLATE CROSSPOLYMER T3ALLANTOIN T3ALLOPURINOL T3ALMOND OIL T3ALOE VERA T3ALPAWASH T3ALPHA LIPOIC ACID T3ALPHA PINENE T3ALPHA TOCOPHEROL T3ALPHA-KETOGLUTARIC ACID T3ALPRAZOLAM T3ALPROSTADIL T3ALTADERM CREAM BASE T3ALUM POWDER T3ALUMINUM ACETATE T3ALUMINUM CHLORIDE T3ALUMINUM CHLOROHYDRATE T3ALUMINUM HYDROXIDE T3ALUMINUM POTASSIUM SULFATE T3ALUMINUM SULFATE T3AMANTADINE HCL T3AMERICAN GINSENG ROOT T3AMIKACIN SULFATE T3AMINOBENZOIC ACID T3AMINOBUTYRIC ACID T3


PRODUCT TIER UTILIZATION MANAGEMENTAMINOCAPROIC ACID T3AMINOLEVULINIC ACID HCL T3AMINOPHYLLINE T3AMINOSALICYLIC ACID T3AMITRIPTYLINE HCL T3AMLODIPINE BESILATE T3AMLODIPINE BESYLATE T3AMMONIUM ALUM T3AMMONIUM BROMIDE T3AMMONIUM CHLORIDE T3AMMONIUM LACTATE T3AMMONIUM LAURYL SULFATE T3AMMONIUM SULFATE T3AMMONIUM TETRATHIOMOLYBDATE T3AMOXICILLIN TRIHYDRATE T3AMPHOTERICIN B T3ANASTROZOLE T3ANDROSTENEDIONE T3ANHYDROUS BASE T3ANHYDROUS GEL T3ANHYDROUS OINTMENT T3ANISE EXTRACT FLAVOR T3ANISINDIONE T3ANTHRALIN T3ANTIMONY SULFIDE T3ANTIMONY TRICHLORIDE T3ANTIPYRINE T3APOMORPHINE HCL T3APOTHEDERM TRANSDERMAL T3APOTHESAR 2 T3APOTHESAR PLUS T3APOTHESIL BASE T3APPLE T3APPLE FLAVOR T3APPLE-ADE FLAVOR T3APRICOT FLAVOR T3ARBEM H-COSMETIC T3ARBEM LIPOPEN T3ARGININE T3ARGININE HCL T3ARIDA T3ARLACEL 165 T3ARNICA FLOWER T3


PRODUCT TIER UTILIZATION MANAGEMENTARNICA LG T3ARROWROOT STARCH T3ARSENIC TRIOXIDE T3ASCORBIC ACID T3ASCORBYL PALMITATE T3ASPARAGINE MONOHYDRATE T3ASPARTAME T3ASPARTIC ACID T3ASPARTIC ACID MAGNESIUM SALT T3ASPARTIC ACID POTASSIUM SALT T3ASPIRIN T3ASTRAGALUS ROOT T3ATENOLOL T3ATREVIS HYDROGEL T3ATROPINE SULFATE T3ATTAPULGITE T3AUXIPRO VANISHING CREAM T3AVOCADO OIL T3AZ T3AZATHIOPRINE T3AZELAIC ACID T3AZELASTINE HCL T3AZITHROMYCIN T3BACITRACIN T3BACITRACIN MICRONIZED T3BACITRACIN ZINC T3BACLOFEN T3BANANA CREAM FLAVOR T3BANANA CREME T3BANANA FLAVOR T3BARIUM SULFATE T3BASE 7542 T3BASE C POLYETHYLENE GLYCOL 300 T3BASE CREAM T3BASE E-POLYETHYLENE GLYCOL T3BASE G ALMOND OIL T3BASE GELATIN GUMMY TROCHE T3BASE H-CARBOXYMETHYLCELLULOSE T3BASE HORMONE CREAM T3BASE W301 T3BASE X T3BASE-I SORBITAN MONOPALMITATE T3BASE, CUSTOM POLYGLYCOL T3


PRODUCT TIER UTILIZATION MANAGEMENTBASE, PCCA ACACIA T3BASE, PCCA BITTER DRUG T3BASE, PCCA COBASE #1 T3BASE, PCCA DMAE COMPLEX T3BASE, PCCA EMULSIFIX-205 T3BASE, PCCA FIXED OIL SUSP T3BASE, PCCA LOXASPERSE T3BASE, PCCA LOXORAL T3BASE, PCCA MUCOLOX T3BASE, PCCA OCCLUSADERM T3BASE, PCCA PLASTICIZED T3BASE, PCCA POLOXAMER 407 T3BASE, PCCA POLYPEG T3BASE, PCCA PRACAMAC OIL T3BASE, PCCA RAPID DISSOLVE T3BASE, PCCA RDT-PLUS T3BASE, PCCA RHEOSPRAY T3BASE, PCCA SORBITOL LOLLIPOP T3BASE, PCCA SPIRA-WASH T3BASE, PCCA SUSPENDALL T3BASE, PCCA VANISHING CRM-LOT T3BASE, PCCA VANPEN T3BASE, PCCA VERSABASE T3BASE, PCCA XEMATOP T3BASE, PCCA XYLIFOS T3BASIC FUCHSIN HYDROCHLORIDE T3BECLOMETHASONE DIPROPIONATE T3BELLADONNA T3BELLADONNA LEAF POWDER T3BENACTYZINE HCL T3BENAZEPRIL HCL T3BENZALKONIUM CHLORIDE T3BENZETHONIUM CHLORIDE T3BENZOCAINE T3BENZOIC ACID T3BENZOIN T3BENZOIN COMPOUND T3BENZOIN GUM T3BENZOQUINONE T3BENZOYL PEROXIDE T3BENZYL ALCOHOL T3BENZYL BENZOATE T3BETA CAROTENE T3


PRODUCT TIER UTILIZATION MANAGEMENTBETA GLUCAN T3BETA GLUCAN (1-3) NQ T3BETAHISTINE T3BETAHISTINE HCL T3BETAINE T3BETAINE HYDROCHLORIDE T3BETAMETHASONE ACETATE MICRO T3BETAMETHASONE DIPROPIONATE T3BETAMETHASONE SODIUM PHOSPHATE T3BETAMETHASONE VALERATE T3BETHANECHOL CHLORIDE T3BHRT BASE T3BIMATOPROST T3BIOFLAVONOID CITRUS T3BIOFLAVONOID LEMON T3BIOFLAVONOIDS CITRUS T3BIOPEPTIDE BIOCOSMETIC BASE T3BIOTIN T3BIOTIN-D T3BISABOLOL T3BISACODYL T3BISMUTH CITRATE T3BISMUTH SUBCARBONATE T3BISMUTH SUBGALLATE T3BISMUTH SUBNITRATE T3BISMUTH SUBSALICYLATE T3BITTER ALMOND OIL T3BITTER STOP FLAVOR T3BITTERNESS MASK FLAVOR T3BITTERNESS REDUCING AGENT T3BITTERNESS SUPPRESSOR T3BLACKBERRY FLAVOR T3BLUE AGAVE T3BLUEBERRY FLAVOR T3BORIC ACID T3BORON T3BORON CITRATE T3BOSWELLIA SERRATA EXTRACT T3BRIJ 35 T3BRIJ 700 T3BRIJ 93 T3BRILLIANT BLUE G T3BRILLIANT GREEN T3


PRODUCT TIER UTILIZATION MANAGEMENTBRIMONIDINE TARTRATE T3BROMELAIN T3BROMFENAC SODIUM T3BROMHEXINE HCL T3BROMOCRIPTINE MESYLATE T3BROMPHENIRAMINE MALEATE T3BUBBLE GUM FLAVOR T3BUDESONIDE MICRONIZED T3BUFFER CREAM T3BUFLOMEDIL HCL T3BUPIVACAINE HCL T3BUPRENORPHINE HCL T3BUPROPION HCL T3BUSPIRONE HCL T3BUTALBITAL T3BUTORPHANOL TARTRATE T3BUTTER FLAVOR T3BUTTER RUM T3BUTTER RUM FLAVOR T3BUTTERSCOTCH FLAVOR T3BUTYL ALCOHOL T3BUTYLATED HYDROXYANISOLE T3BUTYLENE GLYCOL T3BUTYLPARABEN T3CAFFEINE T3CAFFEINE CITRATE T3CALAMINE T3CALCIPOTRIENE MONOHYDRATE T3CALCIPOTRIOL T3CALCITRIOL T3CALCITRIOL IN ALMOND OIL T3CALCIUM ACETATE T3CALCIUM ALGINATE T3CALCIUM AMINO ACID CHELATE T3CALCIUM ASCORBATE T3CALCIUM CARBONATE T3CALCIUM CHLORIDE T3CALCIUM CITRATE T3CALCIUM FOLINATE T3CALCIUM GLUBIONATE T3CALCIUM GLUCONATE T3CALCIUM GLUCONATE MONOHYDRATE T3CALCIUM HYDROXIDE T3


PRODUCT TIER UTILIZATION MANAGEMENTCALCIUM LACTATE T3CALCIUM LEVULINATE DIHYDRATE T3CALCIUM PANTOTHENATE T3CALCIUM PHOSPHATE T3CALCIUM PHOSPHATE TRIBASIC T3CALCIUM PYRUVATE T3CALCIUM SACCHARATE T3CALCIUM SULFATE T3CALCIUM THIOGLYCOLATE TRIHYDR T3CAMPHOR T3CANADA BALSAM T3CANTHARIDIN T3CAPRYLIC ACID T3CAPRYLIC-CAPRIC TRIGLYCERIDE T3CAPSAICIN T3CAPSAICIN PALMITATE T3CAPSICUM OLEORESIN T3CAPTOPRIL T3CARAMEL FLAVOR T3CARBACHOL T3CARBAMAZEPINE T3CARBAMIDE PEROXIDE T3CARBAZOCHROME T3CARBAZOCHROME REAGENT T3CARBIDOPA T3CARBIMAZOLE T3CARBOGEL T3CARBOHOL T3CARBOMER 934P T3CARBOMER 940 T3CARBOMER GEL-AQUEOUS T3CARBOMER GEL-HYDROALCOHOLIC T3CARBOMER HOMOPOLYMER TYPE C T3CARBOXYMETHYLCELLULOSE SODIUM T3CARISOPRODOL T3CARNAUBA WAX T3CARRAGEENAN T3CASCARA SAGRADA T3CEDAR LEAF OIL T3CEFTAZIDIME T3CEFTAZIDIME-SODIUM CARBONATE T3CEFTRIAXONE SODIUM T3CELA CREAM BASE T3


PRODUCT TIER UTILIZATION MANAGEMENTCELECOXIB T3CELLULASE T3CERESIN T3CESIUM CHLORIDE T3CETEARYL ALCOHOL-CETEARETH-20 T3CETYL ALCOHOL T3CETYL ESTERS T3CETYL MYRISTOLEATE T3CETYLPYRIDINIUM CHLORIDE T3CHAMOMILE FLOWER T3CHEESECAKE FLAVOR T3CHERRY CONCENTRATE T3CHERRY FLAVOR T3CHERRY SYRUP T3CHERRY-ADE FLAVOR T3CHLORAL HYDRATE T3 PACHLORAMBUCIL T3CHLORAMPHENICOL T3CHLORAMPHENICOL PALMITATE T3CHLORHEXIDINE DIACETATE T3CHLORHEXIDINE FLAVOR T3CHLORHEXIDINE GLUCONATE T3CHLOROACETIC ACID T3CHLOROBUTANOL T3CHLOROPHYLLIN SODIUM COPPER T3CHLOROQUINE PHOSPHATE T3CHLOROXINE T3CHLOROXYLENOL T3CHLORPHENIRAMINE MALEATE T3CHLORPROMAZINE HCL T3CHOCOLATE FLAVOR T3CHOCOLATE HAZELNUT FLAVOR T3CHOLECALCIFEROL T3CHOLESTEROL T3CHOLESTYRAMINE RESIN T3CHOLINE BITARTRATE T3CHOLINE CHLORIDE T3CHOLINE MAGNESIUM TRISALICYLAT T3CHONDROITIN SULFATE T3CHONDROITIN SULFATE SODIUM T3CHORIONIC GONADOTROPIN T1 SCHROMIUM PICOLINATE T3CHROMIUM POLYNICOTINATE T3


PRODUCT TIER UTILIZATION MANAGEMENTCHROMIUM POT SULF DODECAHYDR T3CHRYSADERM DAY CREAM T3CHRYSADERM NIGHT CREAM T3CHRYSIN T3CHYMOTRYPSIN T3CICLOPIROX OLAMINE T3CIDOFOVIR T3CIMETIDINE T3CINNAMON T3CINNAMON BARK T3CIPROFLOXACIN HCL T3CITRIC ACID T3CITRUS BERGAMOT T3CLARITHROMYCIN T3CLEMASTINE FUMARATE T3CLEMIZOLE HCL T3CLIDINIUM BROMIDE T3CLINDAMYCIN HCL T3CLINDAMYCIN PHOSPHATE T3CLIOQUINOL T3CLOBETASOL PROPIONATE MICRO T3CLOFAZIMINE T3CLOMIPHENE CITRATE T3CLOMIPRAMINE HCL T3CLONAZEPAM T3CLONIDINE HCL T3CLOPIDOGREL BISULFATE T3CLOTRIMAZOLE T3CLOVE T3CLOVE OIL T3COAL TAR T3COBAMAMIDE T3COCAINE HCL T3COCAMIDE DEA T3COCOA BUTTER T3COCONUT FLAVOR T3COCONUT OIL T3COD LIVER OIL T3CODEINE PHOSPHATE T3COENZYME Q10 T3COFFEE FLAVOR T3COLA FLAVOR T3COLCHICINE T3


PRODUCT TIER UTILIZATION MANAGEMENTCOLISTIMETHATE SODIUM T3COLISTIN SULFATE T3COLLAGEN HYDROLYSATE T3COLLAGENASE T3COLLODION T3COLLOIDAL SILICON DIOXIDE T3COMPOUNDMAX BASE CREAM T3COPASIL T3COPPER GLUCONATE T3COPPER GLYCINATE T3COPPER PEPTIDE GHK-CU T3COPPER SULFATE T3CORAL CALCIUM T3CORN OIL T3CORN STARCH T3CORTICOTROPHIN T3CORTISONE ACETATE T3COTTON CANDY FLAVOR T3COTTONSEED OIL T3COUMARIN T3CRAN-RASPBERRY FLAVOR T3CRANBERRY EXTRACT T3CREAM CONCENTRATE T3CREATINE T3CREATINE MONOHYDRATE T3CREATININE T3CREME DE MENTHE T3CREME DE MENTHE FLAVOR T3CRESOL (M) T3CRESOL (M) ACETATE T3CROMOLYN SODIUM T3CROTAMITON T3CROTON OIL T3CUPRIC SULFATE T3CURCUMIN T3CUSTOM BASE PCCA LIPODERM T3CUTIS PLUS T3CYANOCOBALAMIN T3CYCLANDELATE T3CYCLOBENZAPRINE HCL T3CYCLODEXTRIN REAGENT T3CYCLODEXTRIN-BETA T3CYCLOMETHICONE T3


PRODUCT TIER UTILIZATION MANAGEMENTCYCLOPENTOLATE HCL T3CYCLOPHOSPHAMIDE T3CYCLOPHOSPHAMIDE MONOHYDRATE T3CYCLOSERINE T3CYCLOSPORINE T3CYPROHEPTADINE HCL T3CYSTEAMINE HCL T3CYSTEINE T3CYSTEINE-L HYDROCHLORIDE T3D & C GREEN #6 T3D-BIOTIN T3D-GALACTOSE T3D-MANNOSE T3D-RIBOSE T3D-XYLOSE T3DANAZOL T3DANTROLENE SODIUM T3DAPIPRAZOLE HCL T3DAPSONE T3DEGLYCYRRHIZINATED LICORICE T3DEHYDROEPIANDROSTERONE T3DEMECARIUM BROMIDE T3DEOXYCHOLIC ACID T3DESIPRAMINE HCL T3DESMOPRESSIN ACETATE T3DESONIDE MICRONIZED T3DESOXIMETASONE T3DESOXYCORTICOSTERONE ACETATE T3DEVIL'S CLAW T3DEXAMETHASONE ACETATE T3DEXAMETHASONE ACETATE MICRO T3DEXAMETHASONE ISONICOTINATE T3DEXAMETHASONE MICRONIZED T3DEXAMETHASONE SODIUM PHOSPHATE T3DEXPANTHENOL T3DEXTROMETHORPHAN HBR T3DEXTROSE T3DEXTROSE ANHYDROUS T3DHEA MICRONIZED T3DIAMINOPYRIDINE T3DIAZEPAM T3DIAZOXIDE T3DIBUCAINE T3


PRODUCT TIER UTILIZATION MANAGEMENTDIBUCAINE HCL T3DIBUTYL SQUARATE T3DICHLORALPHENAZONE T3DICHLOROACETIC ACID T3DICLOFENAC SODIUM T3DICLOFENAC SODIUM MICRONIZED T3DICUMAROL T3DICYCLOMINE HCL T3DIETHANOLAMINE T3DIETHYL-M-TOLUAMIDE T3DIETHYLCARBAMAZINE CITRATE T3DIETHYLEN GLYCOL M-ETHYL ETHER T3DIETHYLPROPION HCL T3DIETHYLSTILBESTROL T3DIGOXIN T3DIGOXIN MICRONIZED T3DIHYDROCODEINE BITARTRATE T3DIHYDROERGOTAMINE MESYLATE T3DIHYDROXYACETONE T3DIINDOLYLMETHANE T3DIIODO-L-THYRONINE T3DILTIAZEM HCL T3DIMENHYDRINATE T3DIMERCAPTOPROPANESULFONATE SOD T3DIMETHIPAC T3DIMETHYL FUMARATE T3DIMETHYL SULFONE T3DIMETHYL SULFOXIDE T3DIMETHYLACETAMIDE T3DIMETHYLAMINOETHANOL BITART T3DIMETHYLGLYCINE HYDROCHLORIDE T3DINITROCHLOROBENZENE T3DIOSGENIN T3DIOSMIN T3DIOXYBENZONE T3DIPHENHYDRAMINE HCL T3DIPHENIDOL HCL T3DIPHENYLCYCLOPROPENONE T3DIPYRIDAMOLE T3DISTILLED WATER T3DISULFIRAM T3DL-3-HYDROXYBUTYRIC ACID SOD T3DL-LEUCINE T3


PRODUCT TIER UTILIZATION MANAGEMENTDL-MALIC ACID T3DMAE T3DMSA T3DOCOSANOL T3Docusate Sodium T3DOPAMINE HCL T3DOXAZOSIN MESYLATE T3DOXEPIN HCL T3DOXYCYCLINE HYCLATE T3DOXYCYCLINE MONOHYDRATE T3DOXYLAMINE SUCCINATE T3DROPERIDOL T3DULOXETINE HCL T3DUTASTERIDE T3DYCLONINE HCL T3DYPHYLLINE T3ECONAZOLE NITRATE T3EDETATE ACID T3EDETATE CALCIUM DISODIUM T3EDETATE DISODIUM T3EDETATE TETRASODIUM T3EDROPHONIUM CHLORIDE T3EFFERVESCENT T3EGCG T3EGME T3ELEUTHEROCOCCUS SENTICOSUS T3EMOLIVAN T3EMOLLIENT CREAM T3EMU OIL T3EMULSIFYING WAX T3EMULSION CONCENTRATE T3ENALAPRIL MALEATE T3ENGLISH TOFFEE FLAVOR T3EPHEDRINE HCL T3EPHEDRINE SULFATE T3EPINEPHRINE T3EPINEPHRINE BITARTRATE T3EPSOM SALT T3ERGOCALCIFEROL T3ERGOLOID MESYLATES T3ERGOTAMINE TARTRATE T3ERYTHROMYCIN T3ERYTHROMYCIN ESTOLATE T3


PRODUCT TIER UTILIZATION MANAGEMENTERYTHROMYCIN ETHYLSUCCINATE T3ESPUMIL T3ESTRADIOL T3ESTRADIOL BENZOATE T3ESTRADIOL CYPIONATE T3ESTRADIOL HEMIHYDRATE T3ESTRADIOL HEMIHYDRATE MICRO T3ESTRADIOL MICRONIZED T3ESTRADIOL VALERATE T3ESTRIOL T3ESTRIOL MICRONIZED T3ESTRONE T3ETHANOLAMINE T3ETHER T3ETHINYL ESTRADIOL T3ETHOSUXIMIDE T3ETHOXY DIGLYCOL T3ETHYL ALCOHOL T3ETHYL OLEATE T3ETHYLENEDIAMINE T3ETOMIDATE T3ETOPOSIDE T3EUGENOL T3EVANS BLUE T3FAGRON CAPFILL PRO T3FAGRON DISPERSAPRO T3FAGRON LS PLUS T3FAGRON LS ULTRA T3FAGRON NATURAL CREAM T3FAGRON SUPREME CREAM T3FAGRON VERSIFIX T3FAMOTIDINE T3FATTIBASE T3FATTYBLEND T3FD AND C RED NO. 40 T3FD&C BLUE #1 T3FD&C BLUE #2 T3FD&C GREEN #3 T3FD&C RED #3 T3FD&C YELLOW #5 T3FD&C YELLOW #6 T3FENOPROFEN CALCIUM T3FENTANYL BASE T3


PRODUCT TIER UTILIZATION MANAGEMENTFENTANYL CITRATE T3FERRIC AMMONIUM CITRATE T3FERRIC CHLORIDE T3FERRIC SUBSULFATE T3FERRIC SULFATE T3FERROUS BISGLYCINATE CHELATE T3FERROUS FUMARATE T3FERROUS GLUCONATE T3FERROUS SULFATE T3FERULIC ACID T3FEVERFEW EXTRACT T3FEXOFENADINE HCL T3FINASTERIDE T3FITALITE T3FIXED OIL SUSPENSION T3FLAVORX T3FLEXIBLE COLLODION T3FLIBANSERIN T3FLOXURIDINE T3FLUCONAZOLE T3FLUCYTOSINE T3FLUDROCORTISONE ACETATE T3FLUMAZENIL T3FLUNISOLIDE T3FLUOCINOLONE ACETONIDE T3FLUOCINONIDE MICRONIZED T3FLUORESCEIN POWDER T3FLUORESCEIN SODIUM T3FLUOROURACIL T3FLUOXETINE HCL T3FLUPHENAZINE DECANOATE T3FLURBIPROFEN T3FLUTICASONE PROPIONATE T3FLUTICASONE PROPIONATE MICRO T3FOLIC ACID T3FOOD COLOR BLACK T3FOOD COLOR BLUE T3FOOD COLOR BLUE ROYAL T3FOOD COLOR BROWN T3FOOD COLOR GREEN T3FOOD COLOR LIME GREEN T3FOOD COLOR ORANGE T3FOOD COLOR PINK T3


PRODUCT TIER UTILIZATION MANAGEMENTFOOD COLOR RED T3FOOD COLOR VIOLET T3FOOD COLOR WHITE T3FOOD COLOR YELLOW T3FORMALDEHYDE T3FORMOTEROL FUMARATE T3FREE & CLEAR T3FREEDOM PEG TROCHE BASE T3FRUCTOSE T3FULLER'S EARTH T3FURAZOLIDONE T3FUROSEMIDE T3GABAPENTIN T3GAMMA-AMINOBUTYRIC ACID T3GARDENIA FRAGRANCE OIL T3GATIFLOXACIN SESQUIHYDRATE T3GEMFIBROZIL T3GENISTEIN T3GENTAMICIN SULFATE T3GENTIAN VIOLET T3GERANIUM OIL T3GERMALL PLUS T3GINGER ROOT T3GINSENG ROOT T3GLACIAL ACETIC ACID T3GLIPIZIDE T3GLUCONOLACTONE T3GLUCOSAMINE HCL T3GLUCOSAMINE SULFATE KCL T3GLUCOSAMINE SULFATE SODIUM T3GLUTAMINE T3GLUTARALDEHYDE T3GLUTATHIONE T3GLUTATHIONE-L T3GLYBURIDE T3GLYCERIN T3GLYCEROL FORMAL T3GLYCEROL MONOOLEATE T3GLYCINE T3GLYCOFUROL T3GLYCOLIC ACID T3GLYCOPYRROLATE T3GLYCOSAMINOGLYCANS T3


PRODUCT TIER UTILIZATION MANAGEMENTGLYCYRRHIZIC ACID T3GOLD SODIUM THIOMALATE T3GOWEY TINCTURE T3GRAMICIDIN D T3GRAPE ARTIFICIAL FLAVOR T3GRAPE CONCENTRATE FLAVOR T3GRAPE FLAVOR T3GRAPEFRUIT T3GRAPESEED OIL T3GREEN SOAP T3GREEN TEA EXTRACT T3GREEN TEA FRAGRANCE OIL T3GRISEOFULVIN T3GRISEOFULVIN MICRONIZED T3GUAIFENESIN T3GUANABENZ ACETATE T3GUANETHIDINE HEMISULFATE T3GUANIDINEACETIC ACID T3GUARANA SEED EXTRACT T3GUAVA FLAVOR T3GUM BASE T3GYMNEMA SYLVESTRIS LEAF T3H2O GEL BASE T3HALOPERIDOL T3HALOPERIDOL DECANOATE T3HAWTHORNE BERRY T3HEMATOXYLIN, C.I. 75290 T3HEPARIN SODIUM T3HEPES T3HEPTAMINOL T3HISTAMINE PHOSPHATE T3HISTIDINE HCL T3HOMATROPINE METHYLBROMIDE T3HONEY ALMOND FRAGRANCE T3HONEY FLAVOR T3HRT BASE T3HRT BASE BOTANICAL T3HRT BASE HEAVY T3HRT CREAM T3HRT CREAM BASE WOMEN T3HRT ESSENTIAL CREAM T3HRT GEL BASE MEN T3HUMCO BASE, PAIN MGMT T3


PRODUCT TIER UTILIZATION MANAGEMENTHUPERZINE SERRATE A T3HYALURONIC ACID SODIUM SALT T3HYALURONIDASE T3HYDRALAZINE HCL T3HYDRAZINE SULFATE T3HYDROCHLORIC ACID T3HYDROCHLOROTHIAZIDE T3HYDROCODONE BITARTRATE T3HYDROCORTISONE T3HYDROCORTISONE ACETATE T3HYDROGEL T3HYDROGEN PEROXIDE T3HYDROLYZED HYALURONIC ACID T3HYDROMORPHONE HCL T3HYDROPHILIC OINTMENT BASE T3HYDROQUINONE T3HYDROUS EMULSIFIED BASE T3HYDROXOCOBALAMIN T3HYDROXYAMPHETAMINE HBR T3HYDROXYAPATITE T3HYDROXYCHLOROQUINE SULFATE T3HYDROXYETHYL METHACRYLATE T3HYDROXYETHYLCELLULOSE T3HYDROXYPROGESTERONE CAPROATE T3HYDROXYPROPY-BETA-CYCLODEXTRIN T3HYDROXYQUINOLINE SULFATE T3HYDROXYTRYPTOPHAN T3HYDROXYUREA T3HYDROXYZINE HCL T3HYDROXYZINE PAMOATE T3HYOSCYAMINE SULFATE T3IBUPROFEN T3ICHTHAMMOL T3IDEALBASE T3IDEBENONE T3IDOXURIDINE T3IMIDUREA T3IMIPRAMINE HCL T3IMIQUIMOD T3INDOCYANINE GREEN T3INDOLE-3-CARBINOL T3INDOMETHACIN T3INOSITOL T3


PRODUCT TIER UTILIZATION MANAGEMENTINOSITOL HEXANICOTINATE T3IODINE T3IODOFORM T3IODOQUINOL T3IOPANOIC ACID T3IPRATROPIUM BROMIDE T3ISOLEUCINE T3ISOMETHEPTENE MUCATE T3ISONIAZID T3ISOPROPAMIDE IODIDE T3ISOPROPYL MYRISTATE T3ISOPROPYL PALMITATE T3ISOPROTERENOL HCL T3ISOSORBIDE T3ISOTRETINOIN T3ISOXSUPRINE HCL T3ITRACONAZOLE T3ITRACONAZOLE MICRONIZED T3IVERMECTIN T3JASMINE FRAGRANCE T3JELENE T3JESSNER'S T3JOJOBA OIL T3JUNIPER TAR T3KAHLUA FLAVOR T3KANAMYCIN SULFATE T3KAOLIN T3KARAYA GUM T3KETAMINE HYDROCHLORIDE T3KETOCONAZOLE T3KETOCONAZOLE MICRONIZED T3KETOGLUTARIC ACID T3KETOPROFEN T3KETOPROFEN MICRONIZED T3KETOROLAC TROMETHAMINE T3KETOTIFEN FUMARATE T3KIDNEY BEAN EXTRACT T3KINETIN T3KIWI FRAGRANCE T3KOJIC ACID T3KRISGEL 100 T3KRYSTAL SF CANDY BASE T3KUDZU ROOT T3


PRODUCT TIER UTILIZATION MANAGEMENTL-5 METHYLTETRAHYDROFOLATE CAL T3L-ALANINE T3L-ARGININE BASE T3L-ARGININE HCL T3L-ARGININE MONOHYDROCHLORIDE T3L-ASPARTIC ACID T3L-CARNITINE T3L-CARNOSINE T3L-CITRULLINE T3L-CYSTEINE T3L-CYSTEINE HYDROCHLORIDE T3L-CYSTINE T3L-GLUTAMIC ACID T3L-GLUTAMINE T3L-GLUTATHIONE T3L-HISTIDINE T3L-ISOLEUCINE T3L-LEUCINE T3L-METHIONINE T3L-METHYLFOLATE CALCIUM T3L-ORNITHINE HCL T3L-PROLINE T3L-SERINE T3L-THEANINE T3L-THREONINE T3L-VALINE T3LABETALOL HCL T3LACTASE T3LACTIC ACID T3LACTOSE T3LAMOTRIGINE T3LANOLIN T3LANOLIN ALCOHOL T3LANOLIN OIL T3LANSOPRAZOLE T3LATANOPROST T3LAURETH-9 T3LAURIC ACID T3LAVARE WOUND WASH T3LEAD (II) ACETATE TRIHYDRATE T3LEAD TETROXIDE T3LECITHIN T3LECITHIN ISOPROPYL PALMITATE T3


PRODUCT TIER UTILIZATION MANAGEMENTLECITHIN ORGANOGEL T3LECITHIN SOYA T3LEMON T3LEMON OIL T3LEMONADE FLAVOR T3LETROZOLE T3LEUCINE T3LEUCOVORIN CALCIUM T3LEUPROLIDE ACETATE T3LEVALBUTEROL HCL T3LEVAMISOLE HCL T3LEVETIRACETAM T3LEVOCARNITINE T3LEVOCETIRIZINE DIHYDROCHLORIDE T3LEVODOPA T3LEVOFLOXACIN HEMIHYDRATE T3LEVOMEFOLATE CALCIUM T3LEVORPHANOL TARTRATE T3LEVOTHYROXINE SODIUM T3LEVOTHYROXINE SODIUM DILUTION T3LICORICE FLAVOR T3LICORICE ROOT T3LIDOCAINE T3LIDOCAINE HCL T3LIME FLAVOR T3LIME OIL T3LIMONENE FLAVOR T3LINCOMYCIN HCL T3LINOLEIC ACID T3LIOTHYRONINE SODIUM T3LIP BALM T3LIP BALM NATURAL T3LIPMAX T3LIPO CREAM BASE T3LIPOBASE T3LIPOBASE HEAVY T3LIPOBASE REGULAR T3LIPOIC ACID T3LIPOIL T3LIPOPEN ABSORPTN ENHANCE BASE T3LIPOPEN ANHYDROUS T3LIPOPEN ULTRA BASE T3LIPOSOMAL HEAVY T3


PRODUCT TIER UTILIZATION MANAGEMENTLIPOVAN T3LIPOZYME BASE T3LIQUIGEL COMPLEX T3LISINOPRIL T3LISSAMINE GREEN B T3LITHIUM CARBONATE T3LITHIUM CITRATE TETRAHYDRATE T3LOCUST BEAN GUM T3LOLLIBASE T3LORATADINE T3LORATADINE MICRONIZED T3LORAZEPAM T3LOZIBASE T3LOZIBASE S T3LUTEIN T3LYSINE HCL T3MACA ROOT T3MAGNASWEET 110 T3MAGNASWEET 135 T3MAGNESIUM ALUMINUM SILICATE T3MAGNESIUM AMINO ACID CHELATE T3MAGNESIUM ASCORBATE T3MAGNESIUM BISGLYCINATE CHELATE T3MAGNESIUM CARBONATE T3MAGNESIUM CHLORIDE T3MAGNESIUM CITRATE T3MAGNESIUM GLUCONATE T3MAGNESIUM GLYCINATE T3MAGNESIUM HYDROXIDE T3MAGNESIUM MALATE T3MAGNESIUM OXIDE T3MAGNESIUM PHOSPHATE T3MAGNESIUM SULFATE T3MALEIC ACID T3MALIC ACID T3MALTODEXTRIN T3MANDELIC ACID T3MANGANESE CHLORIDE T3MANGANESE GLUCONATE T3MANGANESE SULFATE T3MANGO FLAVOR T3MANNITOL T3MAPLE FLAVOR T3


PRODUCT TIER UTILIZATION MANAGEMENTMARSHMALLOW FLAVOR T3MEBENDAZOLE T3MECAMYLAMINE HCL T3MECHLORETHAMINE HCL T3MECLIZINE HCL T3MECLOFENAMATE SODIUM T3MECLOFENOXATE HCL T3MEDI-RDT BASE T3MEDIBASE C T3MEDIDERM T3MEDIHOL GEL BASE ALCOHOL T3MEDIUM CHAIN TRIGLYCERIDES T3MEDIUM CREAM T3MEDROXYPROGESTERONE AC MICRO T3MEFENAMIC ACID T3MEGESTROL ACETATE T3MELATONIN T3MELOXICAM T3MEMANTINE HCL T3MENADIONE T3MENADIONE SODIUM BISULFITE T3MENTHOL T3MEPERIDINE HCL T3MEQUINOL T3MERCAPTOPURINE T3MESALAMINE T3METAPROTERENOL SULFATE T3METFORMIN HCL T3METHACHOLINE CHLORIDE T3METHACRYLIC ACID COPOLYMER T3METHADONE HCL T3METHANESULFONIC ACID T3METHAZOLAMIDE T3METHENAMINE T3METHENAMINE MANDELATE T3METHIMAZOLE T3METHIONINE T3METHIONINE DL T3METHOCARBAMOL T3METHOCEL K 100 M T3METHOTREXATE T3METHOXSALEN T3METHSCOPOLAMINE BROMIDE T3


PRODUCT TIER UTILIZATION MANAGEMENTMETHYL 5-AMINOLEVULINATE HCL T3METHYL SULFONE T3METHYLCELLULOSE T3METHYLCOBALAMIN T3METHYLPARABEN T3METHYLPHENIDATE HCL T3METHYLPREDNISOLONE T3METHYLPREDNISOLONE AC MICRO T3METHYLPYRAZOLE T3METHYLTESTOSTERONE T3METHYLTESTOSTERONE MICRONIZED T3METHYLTETRAHYDROFOLATE CALCIUM T3METHYLTETRAHYDROFOLIC ACID T3METHYSERGIDE MALEATE T3METOCLOPRAMIDE HCL T3METOPROLOL TARTRATE T3METRONIDAZOLE T3METRONIDAZOLE BENZOATE T3MEXILETINE HCL T3MICONAZOLE T3MICONAZOLE NITRATE T3MICROCRYS-CELLULOSE-CMC NA T3MICROCRYSTALLINE CELLULOSE T3MICRODERM BASE CREAM T3MICROSOME BASE CREAM T3MIDAZOLAM T3MILK THISTLE T3MINERAL OIL HEAVY T3MINERAL OIL LIGHT T3MINOCYCLINE HCL T3MINOXIDIL T3MINT CHOCOLATE CHIP FLAVOR T3MISOPROSTOL T3MISOPROSTOL HPMC T3MITOMYCIN T3MITOTANE T3MOLYBDENUM T3MOMETASONE FUROATE T3MONOBENZONE T3MONOSODIUM GLUTAMATE T3MONTELUKAST SODIUM T3MORPHINE SULFATE T3 PAMOXIFLOXACIN HCL T3


PRODUCT TIER UTILIZATION MANAGEMENTMOXISYLYTE HCL T3MULTIBASE T3MULTIUSE BASE T3MUPIROCIN T3NABUMETONE T3NABUMETONE MICRONIZED T3NADOLOL T3NALBUPHINE HCL T3NALIDIXIC ACID T3NALOXONE HCL T3NALTREXONE BASE MONOHYDRATE T3NALTREXONE HCL T3NALTREXONE HCL DIHYDRATE T3NANDROLONE DECANOATE T3NAPHTHOL T3NAPROXEN T3NAPROXEN SODIUM T3NATURAL BITTERNESS MASKING T3NATURAL MIXED TOCOPHEROLS T3NEOMYCIN SULFATE T3NEOSTIGMINE METHYLSULFATE T3NETTLE LEAF T3NEXTOL SF CANDY BASE T3NIACIN T3NIACINAMIDE T3NIAOULI OIL T3NICLOSAMIDE T3NICOTINAMIDE ADENINE T3NICOTINE POLACRILEX T3 QLNICOTINE TARTRATE T3NICOTINIC ACID T3NIFEDIPINE T3NIFEDIPINE MICRONIZED T3NITRIC ACID T3NITROFURANTOIN T3NITROFURAZONE T3NOREPINEPHRINE BITARTRATE T3NORETHINDRONE T3NORETHINDRONE ACETATE T3NORTRIPTYLINE HCL T3NOURILITE T3NOURISIL T3NOURIVAN ANTIOX T3


PRODUCT TIER UTILIZATION MANAGEMENTNOXI-K T3NYLIDRIN HCL T3NYSTATIN T3OCCLUVAN T3OCTINOXATE T3OINTMENT BASE T3OLEABASE PLASTICIZED T3OMEPRAZOLE T3ONDANSETRON HCL T3ORA-HESIVE BASE T3ORANGE CONCENTRATE T3ORANGE CREAM FLAVOR T3ORANGE FLAVOR T3ORIGANUM OIL T3ORNITHINE (L) HCL T3ORPHENADRINE CITRATE T3OSELTAMIVIR PHOSPHATE T3OXALIC ACID T3OXANDROLONE T3OXYBENZONE T3OXYBUTYNIN CHLORIDE T3OXYCODONE HYDROCHLORIDE T3OXYMETAZOLINE HCL T3OXYTETRACYCLINE HCL T3OXYTOCIN T3PALMAROSA OIL T3PALMITOYL PENTAPEPTIDE-4 T3PANCREATIN T3PANCREATIN 8X T3PANTHENOL T3PAPAIN T3PAPAVERINE HCL T3PARACHLOROPHENOL T3PAROMOMYCIN SULFATE T3PASSION FRUIT FLAVOR T3PCCA ALADERM BASE T3PCCA ANHYDROUS LIPODERMA T3PCCA BASE ANHYDROUS T3PCCA COSMETIC HRT BASE T3PCCA CUSTOM LIPO-MAX CREAM T3PCCA EFFERVESCENT T3PCCA LIPODERM BASE T3PCCA LIPODERM HMW T3


PRODUCT TIER UTILIZATION MANAGEMENTPCCA MBK BASE T3PCCA MVC CREAM T3PCCA NATACREAM T3PCCA POLOXAMER 407 NF T3PCCA POLYGLYCOL TROCHE BASE T3PCCA STEVIOSIDE T3PCCA T3 SODIUM DILUTION T3PCCA T4 SODIUM DILUTION T3PCCA VANISHING BASE T3PEACH FLAVOR T3PEANUT BUTTER FLAVOR T3PECTIN T3PEG 400 MONOSTEARATE T3PEG OINTMENT T3PEG SUPPOSIBASE T3PEG-40 CASTOR OIL T3PEGBLEND T3PENCREAM T3PENDERM T3PENICILLAMINE T3PENICILLAMINE(D-) T3PENNYROYAL OIL T3PENSOMAL T3PENTOBARBITAL SODIUM T3PENTOSAN POLYSULFATE SODIUM T3PENTOXIFYLLINE T3PENTRAVAN T3PENTRAVAN PLUS T3PENTYLENE GLYCOL T3PENTYLENETETRAZOLE T3PEPPERMINT T3PEPSIN 3,000 DIGESTION T3PERFLUORODECALIN T3PERMETHRIN T3PERPHENAZINE T3PERUVIAN BALSAM T3PETROLATUM T3PEUCEDANUM OSTRUTHIUM EXTRACT T3PFCB T3PHARMABASE T3PHARMABASE HEAVY T3PHARMABASE LIGHT T3PHARMABASE NATURAL T3


PRODUCT TIER UTILIZATION MANAGEMENTPHARMABASE VAGINAL T3PHENAZOPYRIDINE HCL T3PHENELZINE SULFATE T3PHENINDIONE T3PHENOBARBITAL T3PHENOL T3PHENOLSULFONIC ACID T3PHENOXYBENZAMINE HCL T3PHENOXYETHANOL T3PHENTERMINE HCL T3PHENTOLAMINE MESYLATE T3PHENYL SALICYLATE T3PHENYLALANINE T3PHENYLALANINE (DL) T3PHENYLBUTAZONE T3PHENYLEPHRINE HCL T3PHENYLETHYLAMINE HCL T3PHENYLMERCURIC ACETATE T3PHENYLMERCURIC NITRATE T3PHENYLTOLOXAMINE DIHYD CIT T3PHENYTOIN T3PHENYTOIN SODIUM T3PHOSPHATIDYL SERINE T3PHOSPHATIDYLCHOLINE T3PHOSPHATIDYLSERINE T3PHOSPHORIC ACID T3PHYTIC ACID T3PHYTOBASE T3PHYTONADIONE T3PICODERM T3PILOCARPINE HCL T3PILOCARPINE NITRATE T3PINA COLADA FLAVOR T3PINE OIL T3PINEAPPLE EXTRACT T3PINEAPPLE FLAVOR T3PIPERINE T3PIROXICAM T3PLACEBO #00 T3PLO GEL MEDIFLO T3PLO GEL MEDIFLO PRE-MIXED T3PLO GEL PREMIUM LECITHIN T3PLO TRANSDERMAL T3


PRODUCT TIER UTILIZATION MANAGEMENTPLO20 T3PLO20 FLOWABLE T3PLURONIC T3PLURONIC F-127 T3PLURONIC L64 T3PNA-HRT BASE CREAM T3PODOFILOX T3PODOPHYLLUM RESIN T3POLOX T3POLOXAMER 188 T3POLOXAMER 407 T3POLYBASE T3POLYETHYLENE GLYCOL T3POLYETHYLENE GLYCOL 1450 T3POLYETHYLENE GLYCOL 300 T3POLYETHYLENE GLYCOL 3350 T1POLYETHYLENE GLYCOL 400 T3POLYETHYLENE GLYCOL 4500 T3POLYETHYLENE GLYCOL 600 T3POLYETHYLENE GLYCOL 8000 T3POLYHEXAMETHYLENE BIGUANIDE T3POLYMYXIN B SULFATE T3POLYOX WSR-301 T3POLYOXYL 40 STEARATE T3POLYPEG SUPPOSITORY T3POLYSORBATE 20 T3POLYSORBATE 40 T3POLYVINYL ALCOHOL T3POTASSIUM ACETATE T3POTASSIUM ACID TARTRATE T3POTASSIUM AZELAOYL DIGLYCINATE T3POTASSIUM BICARBONATE T3POTASSIUM BROMIDE T3POTASSIUM CHLORIDE T3POTASSIUM CITRATE T3POTASSIUM CITRATE MONOHYDRATE T3POTASSIUM GLUCONATE T3POTASSIUM HYDROXIDE T3POTASSIUM IODIDE T3POTASSIUM METABISULFITE T3POTASSIUM NITRATE T3POTASSIUM P-AMINOBENZOATE T3POTASSIUM PERCHLORATE T3


PRODUCT TIER UTILIZATION MANAGEMENTPOTASSIUM PERMANGANATE T3POTASSIUM PHOSPHATE T3POTASSIUM SORBATE T3POTASSIUM SULFATE T3POVIDONE T3POVIDONE IODINE T3POVIDONE K-30 T3POWDER SCENT FRAGRANCE T3PRACASIL TM-PLUS T3PRALINES AND CREAM FLAVOR T3PRAMOXINE HCL T3PRAZIQUANTEL T3PRAZOSIN HCL T3PREDNISOLONE T3PREDNISOLONE ACETATE MICRONIZE T3PREDNISOLONE MICRONIZED T3PREDNISOLONE SODIUM PHOSPHATE T3PREDNISONE T3PREDNISONE MICRONIZED T3PREGABALIN T3PREGNENOLONE T3PREGNENOLONE MICRONIZED T3PRILOCAINE HCL T3PRIMIDONE T3PROCAINAMIDE HCL T3PROCAINE HCL T3PROCARBAZINE HCL T3PROCHLORPERAZINE EDISYLATE T3PROCHLORPERAZINE MALEATE T3PROGESTERONE T3PROGESTERONE MICRONIZED T3PROMAZINE HCL T3PROMETHAZINE HCL T3PROPANTHELINE BROMIDE T3PROPARACAINE HCL T3PROPRANOLOL HCL T3PROPYL GALLATE T3PROPYLENE GLYCOL T3PROPYLENE GLYCOL M-STEARATE T3PROPYLPARABEN T3PROPYLTHIOURACIL T3PROSTAGLANDIN E1 T3PROTAMINE SULFATE T3


PRODUCT TIER UTILIZATION MANAGEMENTPROTIRELIN T3PSEUDOEPHEDRINE HCL T3PSYLLIUM HUSK T3PUMICE T3PUMPKIN FLAVOR T3PURIFIED WATER T3PYRANTEL PAMOATE T3PYRAZINAMIDE T3PYRIDOSTIGMINE BROMIDE T3PYRIDOXAL-5-PHOSPHATE T3PYRIDOXINE HCL T3PYRILAMINE MALEATE T3PYRIMETHAMINE T3PYROGALLOL T3PYRUVIC ACID T3PYRUVIC ACID SODIUM SALT T3Q-DERM T3QUATERNIUM-15 T3QUERCETIN DIHYDRATE T3QUINACRINE DIHYDROCHLORIDE T3QUINACRINE HCL T3QUINIDINE SULFATE T3QUININE HCL T3QUININE SULFATE T3RACEPINEPHRINE HCL T3RANITIDINE HCL T3RAPESEED OIL T3RAPID DISSOLVE TABLET T3RASAGILINE MESYLATE T3RASPBERRY T3RASPBERRY CONCENTRATE FLAVOR T3RASPBERRY FLAVOR T3RAUWOLFIA SERPENTINA T3RECURA T3RED ALGAE T3RED YEAST RICE T3RED YEAST RICE EXTRACT T3REJUVACARE PLUS T3RENEWCREAM HRT T3RESERPINE T3RESORCINOL T3RESVERATROL T3RETINALDEHYDE T3


PRODUCT TIER UTILIZATION MANAGEMENTRETINOIC ACID T3RIBOFLAVIN T3RIBOFLAVIN-5-PHOSPHATE SODIUM T3RICE STARCH T3RIFAMPIN T3RIFAXIMIN T3ROCURONIUM BROMIDE T3ROOT BEER FLAVOR T3ROPIVACAINE HCL T3ROSE BENGAL T3ROSIN T3RUBIDIUM CHLORIDE T3RUTIN T3SA3DERM T3SACCHARIN SODIUM T3SAFFLOWER OIL T3SALICYLIC ACID T3SALSALATE T3SALT DURABLE T3SALTSTABLE LO T3SALTSTABLE LS T3SANARE ADV SCAR THERAPY BASE T3SAW PALMETTO BERRY T3SCAR CARE BASE ENHANCED T3SCARLET RED T3SCOPOLAMINE HYDROBROMIDE T3SCOPOLAMINE METHYL NITRATE T3SECRETIN-MANNITOL T3SEDANARE T3SELEGILINE HCL T3SELENIUM SULFIDE T3SELENIUM YEAST T3SELENOMETHIONINE T3SEPINEO P 600 T3SERMORELIN ACETATE T3SEROTONIN HCL T3SERTRALINE HCL T3SHARK CARTILAGE T3SHEA BUTTER T3SHOWER FRESH FRAGRANCE T3SILDENAFIL CITRATE T3SILICA GEL T3SILICA GEL MICRONIZED T3


PRODUCT TIER UTILIZATION MANAGEMENTSILICON DIOXIDE T3SILOSOME T3SILVER PROTEIN T3SILVER SULFADIAZINE T3Simethicone T3SIMPLGEL 30 T3SIMVASTATIN T3SIROLIMUS T3SKYYDERM CREAM BASE T3SODIUM 4-AMINOSALICYLATE T3SODIUM ACETATE T3SODIUM ACETATE TRIHYDRATE T3SODIUM ALGINATE T3SODIUM ASCORBATE T3SODIUM BENZOATE T3SODIUM BICARBONATE T3SODIUM BORATE T3SODIUM BROMIDE T3SODIUM BUTYRATE T3SODIUM CACODYLATE T3SODIUM CAPRATE T3SODIUM CARBONATE T3SODIUM CHLORIDE T3SODIUM CHLORITE T3SODIUM CITRATE T3SODIUM CITRATE DIHYDRATE T3SODIUM DEOXYCHOLATE T3SODIUM DICHLOROACETATE T3SODIUM FLUORIDE T3SODIUM FLUOROPHOSPHATE T3SODIUM GLUCONATE T3SODIUM HYALURONATE T3SODIUM HYALURONIC ACID T3SODIUM HYDROXIDE T3SODIUM IODIDE T3SODIUM L-ASPARTATE MONOHYDRATE T3SODIUM LACTATE T3SODIUM LAURETH SULFATE T3SODIUM LAURYL SULFATE T3SODIUM METABISULFITE T3SODIUM NITRATE T3SODIUM NITRITE T3SODIUM OLEATE T3


PRODUCT TIER UTILIZATION MANAGEMENTSODIUM PERBORATE T3SODIUM PHENYLBUTYRATE T3 SSODIUM PHOSPHATE T3SODIUM PROPIONATE T3SODIUM PYRROLIDONE CARBOXYLATE T3SODIUM SACCHARIN T3SODIUM SALICYLATE T3SODIUM SELENITE T3SODIUM STEARATE T3SODIUM STEARYL FUMARATE T3SODIUM SULFATE T3SODIUM SULFITE T3SODIUM TARTRATE DIHYDRATE T3SODIUM TETRADECYL SULFATE T3SODIUM THIOSALICYLATE T3SODIUM THIOSULFATE T3SODIUM VALPROATE T3SODIUM-L-ASCORBYL-2-PHOSPHATE T3SOLU-K T3SORBIC ACID T3SORBITAN MONOLAURATE T3SORBITAN MONOOLEATE T3SORBITOL CANDY BASE T3SOYBEAN CASEIN DIGEST MEDIUM T3SOYBEAN OIL T3SPERMACETI T3SPG SUPPOSI-BASE T3SPIRONOLACTONE T3SPIRULINA T3SQUALANE T3SQUARIC ACID T3SQUARIC ACID DIBUTYLESTER T3SQUARIC ACID IN BUTANOL T3ST. JOHN'S WORT T3STANNOUS CHLORIDE DIHYDRATE T3STANOZOLOL T3STANOZOLOL MICRONIZED T3STEARIC ACID T3STERA BASE T3STEVIA T3STEVIA EXTRACT T3STEVIOL GLYCOSIDES T3STRAWBERRY T3


PRODUCT TIER UTILIZATION MANAGEMENTSTRAWBERRY CREAM FLAVOR T3STRAWBERRY FLAVOR T3STREPTOMYCIN SULFATE T3STRONG AMMONIA T3STRONTIUM CHLORIDE HEXAHYDRATE T3STRONTIUM NITRATE T3SUBSOLV RDT T3SUCCIMER DMSA T3SUCCINIC ACID T3SUCCINYLCHOLINE CHLORIDE T3SUCRALFATE T3SUCROSE T3SUCROSE OCTAACETATE T3SUFENTANIL CITRATE T3SULFACETAMIDE T3SULFACETAMIDE SOD MONOHYDRATE T3SULFACETAMIDE SODIUM T3SULFADIAZINE T3SULFADIAZINE SODIUM T3SULFAMERAZINE T3SULFAMETHOXAZOLE T3SULFANILAMIDE T3SULFAPYRIDINE T3SULFASALAZINE T3SULFATHIAZOLE T3SULFISOXAZOLE T3SULFOSALICYLIC ACID DIHYDRATE T3SULFUR T3SULFURATED POTASH T3SULFURIC ACID T3SULINDAC T3SULPHAN BLUE T3SUMATRIPTAN T3SUMATRIPTAN SUCCINATE T3SUPER SYNERSWEET FLAVOR T3SUPEROXIDE DISMUTASE T3SUPPOSI-PLEX R36 T3SUPPOSI-PLEX V33 T3SUPPOSIBASE F T3SUPPOSIBLEND T3SWEETNESS ENHANCER FLAVOR T3SYNAPSIN T3TACROLIMUS T3


PRODUCT TIER UTILIZATION MANAGEMENTTACROLIMUS MICRONIZED T3TADALAFIL T3TALC T3TAMOXIFEN CITRATE T3TANGERINE FLAVOR T3TANGERINE SWEETENED FLAVOR T3TANNIC ACID T3TARTARIC ACID T3TAURINE T3TAZAROTENE T3TDC MAX T3TEA TREE T3TEABERRY OIL FLAVOR T3TECHNA 20 SF TROCHE BASE T3TERBINAFINE HCL T3TERBUTALINE SULFATE T3TERODERM T3TERODERM PLUS T3TERPIN HYDRATE T3TESTOSTERONE T3TESTOSTERONE CYPIONATE T3TESTOSTERONE CYPIONATE MICRO T3TESTOSTERONE ENANTHATE T3TESTOSTERONE MICRONIZED T1TESTOSTERONE PROPIONATE T3TETRACAINE T3TETRACAINE HCL T3TETRACYCLINE HCL T3TETRAHYDRO-L-BIOPTERIN DI-HCL T3TETRAHYDROBIOPTERIN DI-HCL T3TETRAHYDROBIOPTERIN HCL T3TETRAHYDROCURCUMINOIDS T3TETRAHYDROZOLINE HCL T3THEANINE T3THEOBROMINE T3THEOPHYLLINE ANHYDROUS T3THEOPHYLLINE ETHYLENEDIAMINE T3THIABENDAZOLE T3THIAMINE HCL T3THIOGUANINE T3THIORIDAZINE HYDROCHLORIDE T3THIOTEPA T3THREONINE T3


PRODUCT TIER UTILIZATION MANAGEMENTTHREONINE-L T3THYMOL T3THYMOL IODIDE T3THYMUS T3THYROID T3TICARCILLIN DISOD-CLAVULANATE T3TIMOLOL MALEATE T3TINIDAZOLE T3TIOPRONIN T3TITANIUM DIOXIDE T3TIZANIDINE HCL T3TOBRAMYCIN T3TOBRAMYCIN SULFATE T3TOCOPHERYL ACID SUCCINATE T3TOLAZOLINE HCL T3TOLNAFTATE T3TOLUIDINE BLUE O T3TOMMY GEL T3TOPIRAMATE T3TRAMADOL HCL T3TRANEXAMIC ACID T3TRANILAST T3TRANSDERMAL PAIN BASE T3TRAZODONE HCL T3TRETINOIN T3TRETINOIN ACID T3TRIAMCINOLONE T3TRIAMCINOLONE ACETONIDE T3TRIAMCINOLONE DIACETATE T3TRIAMCINOLONE DIACETATE MICRO T3TRIAMCINOLONE HEXACETONIDE T3TRIAMTERENE T3TRICHLORMETHIAZIDE T3TRICHLOROACETIC ACID T3TRICLOSAN T3TRIETHANOLAMINE LAURYL SULFATE T3TRIFLURIDINE T3TRIMEPRAZINE TARTRATE T3TRIMETHOBENZAMIDE HCL T3TRIMETHOPRIM T3TRIMETHOPRIM MICRONIZED T3TRIOXSALEN T3TRIPELENNAMINE HCL T3


PRODUCT TIER UTILIZATION MANAGEMENTTRIPROLIDINE HCL T3TROCHE BASE T3TROCHIBASE T3TROCHIBASE S T3Trolamine T3TROMETHAMINE T3TROPICAL PUNCH FLAVOR T3TROPICAMIDE T3TRYPAN BLUE T3TRYPSIN T3TRYPTOPHAN (L) T3TURMERIC T3TURMERIC ROOT T3TURPENTINE T3TUTTI FRUTTI FLAVOR T3TYROSINE T3U-BASE T3UBIDECARENONE T3UBIQUINOL T3ULTRADERM BASE T3UNDECYLENIC ACID T3UNIBASE T3UNIVERSAL WATER GEL T3UREA T3UREA PEROXIDE T3URIDINE T3URSODIOL T3V-MAX T3VALACYCLOVIR HCL T3VALERIAN ROOT T3VALINE T3VALPROIC ACID T3VANADIUM T3VANADYL SULFATE T3VANCOMYCIN HCL T3VANIBASE T3VANILLA BUTTERNUT FLAVOR T3VANILLA EXTRACT FLAVOR T3VANILLA FLAVOR T3VANILLIN FLAVOR T3VANISH-PEN CREAM BASE T3VANISHING T3VANISHING BOTANICAL T3


PRODUCT TIER UTILIZATION MANAGEMENTVANISHING CREAM T3VECURONIUM BROMIDE T3VEEGUM T3VERAPAMIL HCL T3VERSABASE T3VERSABASEA T3VERSAPRO CREAM BASE T3VERSAPRO GEL BASE T3VERSAPRO LOTION BASE T3VERSASKIN T3VERSATILE T3VERSATILE RICH T3VERSIGEL T3VIDARABINE T3VIDARABINE MONOHYDRATE T3VINPOCETINE T3VITAMIN A ACETATE T3VITAMIN A PALMITATE T3VITAMIN D3 T3VITAMIN E ACETATE T3VITAMIN E SUCCINATE T3VITAMIN K T3VITAMIN K-1 T3VITAMIN K2 T3VORICONAZOLE T3WARFARIN SODIUM T3WATER T3WATERMELON T3WATERMELON FLAVOR T3WAX PARAFFIN T3WHEY PROTEIN ISOLATE T3WHITE WILLOW BARK T3WILD CHERRY FLAVOR T3WILEY BASIC ELEMENTS BHRT BASE T3WITCH HAZEL EXTRACT T3WITEPSOL H-15 T3WITEPSOL H15 T3WOUND CARE CREAM BASE T3XANTHAN GUM T3XCEL 100 T3XYLITOL T3XYLOMETAZOLINE HCL T3XYLOSE T3


PRODUCT TIER UTILIZATION MANAGEMENTYEAST EXTRACT T3YLANG-YLANG FRAGRANCE T3YOHIMBINE HCL T3ZEAXANTHIN T3ZINC ACETATE T3ZINC CHLORIDE T3ZINC CITRATE T3ZINC GLUCONATE T3ZINC MONOMETHIONINE T3ZINC OXIDE T3ZINC PICOLINATE T3ZINC PYRITHIONE T3ZINC SULFATE T3ZINC UNDECYLENATE T3ZOLMITRIPTAN T3 QLZONISAMIDE T3

BERINERT T3 S PACINRYZE T3 S PAHAEGARDA T3 S PA QLRUCONEST T3 S PA QL

SENSIPAR T3 S PA QL

CANASA T2MESALAMINE T1ROWASA T3SFROWASA T3

METHYLENE BLUE T3

CRYOSERV T3

KALYDECO T3 S PA QL

ORKAMBI T3 S PA QLSYMDEKO T3 S PA QL

CYSTAGON T3 S PA QLPROCYSBI T3 S PA QL

TYBOST T3 S

C1 ESTERASE INHIBITORS

CALCIMIMETIC,PARATHYROID CALCIUM ENHANCER

CHRONIC INFLAM. COLON DX, 5-A-SALICYLAT,RECTAL TX

COLORING AGENTS AND DYES

CRYOPRESERVATIVE AGENTS

CYSTIC FIB-TRANSMEMB CONDUCT.REG.(CFTR)POTENTIATOR

CYSTIC FIBROSIS-CFTR POTENTIATOR-CORRECTOR COMBIN.

CYSTINE-DEPLETING AGENTS, NEPHROPATHIC CYSTINOSIS

CYTOCHROME P450 INHIBITORS

DENTAL AIDS AND PREPARATIONS


PRODUCT TIER UTILIZATION MANAGEMENTCHLORHEXIDINE GLUCONATE T1ORALONE T1PAROEX T1PERIDEX T3PERIOGARD T1TRIAMCINOLONE ACETONIDE T1

AVAILNEX T3CYSTEX CRANBERRY T3DAFLONEX-XL T3K-PAX IMMUNE BOOSTER T3PROTEOLIN T3TRI-PASE 16 T3TRI-PASE 8 T3

DILUENT FOR ELITEK T3DILUENT FOR EPOPROSTENOL T1DILUENT FOR FLOLAN T3DILUENT FOR ROTARIX T3DILUENT FOR TREPROSTINIL T1DILUENT-MERCK LIVE VIRUS VACC T3DILUTING MEDIUM FOR NOVOLOG T3ELLIOTTS B T3PH 12 DILUENT FOR FLOLAN T3

CAVERJECT T3CIALIS T3 QLEDEX T3LEVITRA T3 QLMUSE T3PAPAVERINE-ALPROSTADIL T1PHENTOLAMINE-ALPROSTADIL T1SILDENAFIL CITRATE T1 QLSTAXYN T3 QLSTENDRA T3 QLTADALAFIL T1 QLVARDENAFIL HCL T1 QLVIAGRA T3 QLYOHIMBINE HCL T1

NITYR T3 S PAORFADIN T3 S PA

DRUGS TO TREAT ERECTILE DYSFUNCTION (ED)

DRUGS TO TREAT HEREDITARY TYROSINEMIA

DRUGS TO TREAT MOVEMENT DISORDERS

DIETARY SUPPLEMENT, MISCELLANEOUS

DILUENT SOLUTIONS


PRODUCT TIER UTILIZATION MANAGEMENTAUSTEDO T3 S PA QLHORIZANT T3 PA QLINGREZZA T3 S PA QLINGREZZA INITIATION PACK T3 S PA QLTETRABENAZINE T1 S PAXENAZINE T3 S PA

CERDELGA T3 S PA QLMIGLUSTAT T1 S PAZAVESCA T3 S PA

BEBULIN T3 S PAKCENTRA T3PROFILNINE T3 S PA

ALPHANINE SD T3 SALPROLIX T3 S PABENEFIX T3 S PAIDELVION T3 S PAIXINITY T3 S PAMONONINE T3 S PARIXUBIS T3 S PA

COAGADEX T3 S PA

CORIFACT T3 STRETTEN T3 S PA

SAVELLA T3 ST QL

ANISE OIL T1ETHYL ACETATE T1EUCALYPTOL T1EUCALYPTUS FLAVOR T1LEMON FLAVOR EXTRACT T1LEMON OIL T1ORANGE OIL T1RASPBERRY FLAVOR T1SASSAFRAS OIL T1SPEARMINT OIL T1

CLINPRO 5000 T1DENTA 5000 PLUS T1

DRUGS TO TX GAUCHER DX-TYPE 1, SUBSTRATE REDUCING

FACTOR IX COMPLEX (PCC) PREPARATIONS

FACTOR IX PREPARATIONS

FACTOR X PREPARATIONS

FACTOR XIII PREPARATIONS

FIBROMYALGIA AGENTS,SEROTONIN-NOREPINEPH RU INHIB

FLAVORING AGENTS

FLUORIDE PREPARATIONS


PRODUCT TIER UTILIZATION MANAGEMENTDENTAGEL T1FLUORIDEX T1PREVIDENT T3PREVIDENT 5000 T3PREVIDENT 5000 ENAMEL PROTECT T3PREVIDENT 5000 PLUS T3PREVIDENT 5000 SENSITIVE T3SF T1SF 5000 PLUS T1

PEANUT OIL T1

HYPER-SAL T3NEBUSAL T1PULMOSAL T1SODIUM CHLORIDE T1

SOMAVERT T3 S

HEMLIBRA T3 S PA QL

CINNAMON OIL T1LAVENDER FRAGRANCE OIL T1LAVENDER OIL T1LINSEED OIL T1PEPPERMINT OIL T1ROSEMARY OIL T1SAGE LEAF T1THERACRAN HP FOR KIDS T3

ADDYI T3 PA QL

SOLIRIS T3 S PA

HONEY BEE VENOM PROTEIN T3MIXED VESPID VENOM PROTEIN T1WASP VENOM PROTEIN T1WHITE FACED HORNET VENOM T3WHITE-FACED HORNET VENOM T3YELLOW HORNET VENOM PROTEIN T1YELLOW JACKET VENOM PROTEIN T1

DOXERCALCIFEROL T1 S

GENERAL INHALATION AGENTS

GROWTH HORMONE RECEPTOR ANTAGONISTS

HEMOPHILIA TREATMENT AGENTS,NON-FACTOR REPLACEMENT

HERBAL DRUGS

HSDD AGENTS-MIXED SEROTONIN AGONIST/ANTAGONISTS

HUMAN MONOCLONAL ANTIBODY COMPLEMENT(C5) INHIBITOR

FOOD OILS

HYMENOPTERA-DERIVED AGENTS

HYPERPARATHYROID TX AGENTS - VITAMIN D ANALOG-TYPE


PRODUCT TIER UTILIZATION MANAGEMENTHECTOROL T3 SPARICALCITOL T1 SRAYALDEE T3 SZEMPLAR T3 S PA

FINASTERIDE T1PROPECIA T3

VIBERZI T2 PA QL

LINZESS T2 ST QLTRULANCE T3 PA QL

BENLYSTA T3 S PA QL

SIMULECT T3

ASTAGRAF XL T3 S PA QLATGAM T3 SAZASAN T3AZATHIOPRINE T1AZATHIOPRINE SODIUM T1CELLCEPT T3 SCYCLOSPORINE T1 SCYCLOSPORINE MODIFIED T1 SENVARSUS XR T3 S PA QLGENGRAF T1 SIMURAN T3MYCOPHENOLATE MOFETIL T1 SMYCOPHENOLIC ACID T1 SMYFORTIC T3 SNEORAL T3 SNULOJIX T3 S PAPROGRAF T2 SRAPAMUNE T3 SSANDIMMUNE T3 SSIROLIMUS T1 STACROLIMUS T1 STHYMOGLOBULIN T3ZORTRESS T3 S PA

ENTYVIO T3 S PA QL

IMMUNOSUPP - MONOCLONAL AB INHIBITING T LYMPH FXN

IMMUNOSUPPRESSIVES

INTEGRIN RECEPTOR ANTAGONIST, MONOCLONAL ANTIBODY

INTERLEUKIN-4(IL-4) RECEPTOR ALPHA ANTAGONIST, MAB

HYPERTRICHOTIC AGENTS, SYSTEMIC/INCL. COMBINATIONS

IBS AGENTS,MIXED OPIOID RECEP AGONISTS/ANTAGONISTS

IBS-C/CIC AGENTS, GUANYLATE CYCLASE-C AGONIST

IMMUNOMODULATOR,B-LYMPHOCYTE STIM(BLYS)-SPEC INHIB


PRODUCT TIER UTILIZATION MANAGEMENTDUPIXENT T3 S PA QL

ACTEMRA T3 S PA QLACTEMRA ACTPEN T3 S PA QLKEVZARA T3 S PA QL

SCLEROSOL T3STERILE TALC T3

ACETIC ACID T1LACTATED RINGERS T1NEOMYCIN-POLYMYXIN B T1NEOSPORIN G.U. IRRIGANT T3RINGERS IRRIGATION T1SORBITOL T1SORBITOL-MANNITOL T1

ALOSETRON HCL T1LOTRONEX T3 PA

INTRALIPID T1LIPOSYN II T3LIPOSYN III T1NUTRILIPID T1OMEGAVEN T3SMOFLIPID T3

CARTICEL T3

THIOLA T3

TYSABRI T3 S PA QL

RECTIV T3

CUROSURF T3INFASURF T3SURVANTA T3

CROMOLYN SODIUM T1GASTROCROM T3

OSPHENA T3

INTERLEUKIN-6 (IL-6) RECEPTOR INHIBITORS

INTRAPLEURAL SCLEROSING AGENTS, ANTINEOPLAST. ADJ.

LOCAL ANORECTAL NITRATE PREPARATIONS

LUNG SURFACTANTS

MAST CELL STABILIZERS

MENOPAUSAL SYMPT SUPP-SEL ESTROGEN RECEP MODULATOR

IRRIGANTS

IRRITABLE BOWEL SYNDROME AGENTS, 5-HT3 ANTAGONIST

IV FAT EMULSIONS

JOINT TISSUE REPLACEMENT

KIDNEY STONE AGENTS

LEUKOCYTE ADHESION INHIB,ALPHA4-MEDIAT IGG4K MC AB



BRISDELLE T3 QLPAROXETINE MESYLATE T1 QL

CARNITOR T3CARNITOR SF T3CYSTADANE T3 SLEVOCARNITINE T1

STRENSIQ T3 S PA

FABRAZYME T3 S PA

CEREZYME T3 S PAELELYSO T3 S PAVPRIV T3 S PA

LUMIZYME T3 S PA

ALDURAZYME T3 S PAELAPRASE T3 S PANAGLAZYME T3 S PAVIMIZIM T3 S

ADAGEN T3 SREVCOVI T3 S

DEFERASIROX T1 S PAEXJADE T3 S PAJADENU T3 S PAJADENU SPRINKLE T3 S PA

NEXAVIR T3

XOLAIR T3 S PA

STELARA T3 S PA QL

ENTEREG T3

ACETYLCYSTEINE T1PULMOZYME T3 S PA QL

MENOPAUSAL SYMPTOMS SUPPRESSANT - SSRIS

METABOLIC DEFICIENCY AGENTS

METALLIC POISON,AGENTS TO TREAT

MISCELLANEOUS AGENTS

MONOCLONAL ANTIBODIES TO IMMUNOGLOBULIN E (IGE)

MONOCLONAL ANTIBODY-HUMAN INTERLEUKIN 12/23 INHIB

MU-OPIOID RECEPTOR ANTAGONISTS,PERIPHERALLY-ACTING

MUCOLYTICS

METABOLIC DISEASE ENZYME REPLACE, HYPOPHOSPHATASIA

METABOLIC DISEASE ENZYME REPLACEMENT, FABRY'S DX

METABOLIC DISEASE ENZYME REPLACEMENT, GAUCHER'S DX

METABOLIC DISEASE ENZYME REPLACEMENT,POMPE DISEASE

METABOLIC DX ENZYME REPLACE, MUCOPOLYSACCHARIDOSIS

METABOLIC DX ENZYME REPLACEMT,SEV.COMB.IMMUNE DEF.

NEUROPATHIC AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTLYRICA CR T3 PA QL

LUCEMYRA T3 PA QL

BUNAVAIL T3 PA QLBUPRENORPHINE HCL T1 PA QLBUPRENORPHINE-NALOXONE T1 PA QLSUBLOCADE T3 S PA QLSUBOXONE T2 PA QLZUBSOLV T2 PA QL

EPISIL T3MUCOTROL T3

VIASPAN BELZER-UW T3

PINE NEEDLE OIL T1ROSE OIL T1

DOXYCYCLINE HYCLATE T1

CAPSUBLEND-H T3CAPSUBLEND-P T3CAPSUBLEND-S T3Magnesium Stearate T3MICROCRYSTALLINE CELLULOSE T3STEARIC ACID T1

GALAFOLD T3 S PA

DALIRESP T3 PA QL

KUVAN T3 S PA

HESPAN T3HETASTARCH-0.9% NACL T1HEXTEND LACTATED ELECTROLYTE T3 QLLMD 10% WITH 0.9% SOD CHLORIDE T3LMD 10% WITH 5% DEXTROSE T3VOLUVEN T3

KALBITOR T3 S PA

PERIODONTAL COLLAGENASE INHIBITORS

PHARMACEUTICAL ADJUVANTS,TABLET,CAPSULE COMPONENTS

PHARMACOLOGICAL CHAPERONE-ALPHA-GALACTOSID.A STABZ

PHOSPHODIESTERASE-4 (PDE4) INHIBITORS

PKU TX AGENT-COFACTOR OF PHENYLALANINE HYDROXYLASE

PLASMA EXPANDERS

OPIOID WITHDRAWAL THER, ALPHA-2 ADRENERGIC AGONIST

OPIOID WITHDRAWAL THERAPY AGENTS, OPIOID-TYPE

ORAL MUCOSITIS/STOMATITIS ANTI-INFLAMMATORY AGENT

ORGAN TRANSPLANTATION PRESERVATION SOLUTIONS

PERFUMES

PLASMA KALLIKREIN INHIBITORS

PLASMA PROTEINS


PRODUCT TIER UTILIZATION MANAGEMENTALBUKED-25 T1ALBUKED-5 T1ALBUMIN (HUMAN) T1ALBUMINEX T3ALBURX T1ALBUTEIN T1ATRYN T3 SBUMINATE T1FLEXBUMIN T1KEDBUMIN T1OCTAPLAS T3PLASBUMIN-25 T1PLASBUMIN-5 T1PLASMANATE T3THROMBATE III T3 S

AGRYLIN T3 QLANAGRELIDE HCL T1 QL

GRALISE T3 ST QL

NUEDEXTA T2 PA

OFEV T3 S PA QL

HICON T3 SMETASTRON T3 SQUADRAMET T3 SXOFIGO T3 S PA

INDICLOR T3

ANUCORT-HC T1ANUSOL-HC T1HEMMOREX-HC T1HYDROCORTISONE ACETATE T1PROCTOCORT T3

NUMOISYN T3

AQUORAL T3CAPHOSOL T3MUCOSITISRX T3

RADIOACTIVE THERAPEUTIC AGENTS

RADIOPHARMACEUTICALS ELEMENTS

RECTAL PREPARATIONS

SALIVA STIMULANT AGENTS

SALIVA SUBSTITUTE AGENTS

PLATELET REDUCING AGENTS

POSTHERPETIC NEURALGIA AGENTS

PSEUDOBULBAR AFFECT (PBA) AGENTS, NMDA ANTAGONISTS

PULMONARY FIBROSIS - SYSTEMIC ENZYME INHIBITORS


PRODUCT TIER UTILIZATION MANAGEMENTNEUTRASAL T3NUMOISYN T3SALIVAMAX T3SALIVATERX T3

GATTEX T3 S PA

DROXIA T3ENDARI T3 S PA QLSIKLOS T3 S

APLIGRAF T3DERMAGRAFT T3ENDOFORM T3

BUPROPION HCL SR T1 QLZYBAN T3 QL

SODIUM CHLORIDE T1

ALCOHOL,DENATURED T1ISOPROPANOL T1ISOPROPYL ALCOHOL T1ISOPROPYL PALMITATE T1METHANOL T1MINERAL OIL HEAVY T1MINERAL OIL LIGHT T3MURI-LUBE MINERAL OIL T3SESAME OIL T1SODIUM SUCCINATE T1

TAVALISSE T3 S PA

LUMOXITI IV SOLN STABILIZER T3 S PAPOLYSORBATE 60 T1POLYSORBATE 80 T1TRITON X-100 T3

BENTONITE T3GELATIN T3GELATIN BASE T3GELFILM T3GUAR GUM T3

SBS - GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOGS

SURFACTANTS

SUSPENDING AGENTS

SICKLE CELL ANEMIA AGENTS

SKIN TISSUE REPLACEMENT

SMOKING DETERRENTS, OTHER

SODIUM/SALINE PREPARATIONS

SOLVENTS

SPLEEN TYROSINE KINASE INHIBITORS


PRODUCT TIER UTILIZATION MANAGEMENTHYDROXYPROPYLCELLULOSE T3HYPROMELLOSE T3METHOCEL E 4 M T1OLEIC ACID T1SODIUM SILICATE T1TRAGACANTH T1

SACCHARIN T1SORBITOL T1

ARALAST NP T3 S PAGLASSIA T3 S PAPROLASTIN C T3 S PAZEMAIRA T3 S PA

SOLESTA T3 S

CORTISPORIN T3 QLNEO-SYNALAR T3

CYTRA-K T1K-PHOS ORIGINAL T3POTASSIUM CITRATE ER T1POTASSIUM CITRATE-CITRIC ACID T1SHOHL'S MODIFIED T3TARON-CRYSTALS T1UROCIT-K T3UROQID-ACID NO.2 T3

SHINGRIX ADJUVANT COMPONENT T2

BASE, PCCA SYRUP VEHICLE T3COCOA BUTTER T3ORA PLUS T3ORA SWEET T3ORA-BLEND T3ORA-BLEND SF T3ORA-SWEET SF T3ORAL MIX T3ORAL MIX SF T3ORAL SUSPEND T1ORAL SYRUP T1ORAL SYRUP SF T1

SWEETENERS

SYSTEMIC ENZYME INHIBITORS

TISSUE BULKING IMPLANTS - NON-COSMETIC

TOPICAL ANTIBIOTIC AND ANTI-INFLAMMATORY STEROID

URINARY PH MODIFIERS

VACCINE ADJUVANTS

VEHICLES


PRODUCT TIER UTILIZATION MANAGEMENTRASPBERRY SYRUP T1SIMPLE SYRUP T1SORBITOL T1SORBITOL SOLUTION T1SWEET-SF T3VERSA FREE T3VERSA PLUS T3

STERILE WATER FOR KCENTRA T1WATER T1

RADIGEL T3VENELEX T3

BIOCEL T1DAILY MULTIPLE T1DAILY MULTIPLE VITAMIN T1INFUVITE ADULT T1M.V.I. ADULT T3M.V.I.-12 T3NUTRIVIT T3SUPPORT T3THERAPEUTIC VITAMIN W-MINERALS T1VITACEL T1

INFUVITE PEDIATRIC T1M.V.I. PEDIATRIC T3MVW COMPLETE FORMLTN PEDIATRIC T3MVW COMPLETE FORMULATION D3000 T3

ATABEX EC T3CADEAU DHA T3DOTHELLE DHA T3ELITE OB DHA T3ELITE-OB T3ELITE-OB 400 T3FOCALGIN 90 DHA T3FOCALGIN CA T3LEVOMEFOLATE DHA T3M-NATAL PLUS T3MATERNITY T1MYNATAL T3

PEDIATRIC VITAMIN PREPARATIONS

PRENATAL VITAMIN PREPARATIONS

WATER

WOUND HEALING AGENTS, LOCAL

MULTIVITAMIN PREPARATIONSMULTIVITAMINS


PRODUCT TIER UTILIZATION MANAGEMENTMYNATAL ADVANCE T3MYNATAL PLUS T3MYNATAL-Z T3MYNATE 90 PLUS T3NEWGEN T3OBSTETRIX EC T3OBSTETRIX ONE T1OBTREX DHA T3PNV 29-1 T3PNV-DHA + DOCUSATE T3PNV-OMEGA T3PNV-VP-U T3PRENA1 CHEW T3PRENA1 PEARL T3PRENA1 TRUE T3PRENATABS RX T3PRENATAL LOW IRON T3PRENATAL-U T3PREPLUS T3PRETAB T3PROVIDA DHA T3PROVIDA OB T3R-NATAL OB T3RULAVITE DHA T3THERANATAL OVAVITE T3THERANATAL PLUS T3THRIVITE RX T3TRI-TABS DHA T3TRICARE PRENATAL T3TRINATE T3TRIVEEN-ONE T3TRIVEEN-U T3TRUST NATAL DHA T3VENATAL COMPLETE DHA T3VINACAL B T3VINATE DHA T3VINATE DHA RF T3VINATE GT T3VINATE II T3VINATE ONE T3VINATE PN CARE T3VINATE ULTRA T3VINATE-M T3


PRODUCT TIER UTILIZATION MANAGEMENTVIRT-ADVANCE T3VIRT-C DHA T3VIRT-NATE T3VIRT-NATE DHA T3VIRT-PN T3VIRT-PN DHA T3VIRT-PN PLUS T3VITAFOL GUMMIES T3VITASPIRE T3VITATRUE T3VIVA DHA T3VP-CH-PNV T3VP-HEME OB T3VP-HEME ONE T3VP-PNV-DHA T3VYNATAL-FA T1

AZESCO T3

FOLBECAL T3

BOTOX T3 S PADYSPORT T3 S PAMYOBLOC T3 S PAXEOMIN T3 S PA

BOTOX COSMETIC T3 S PA

AMRIX T3 STBACLOFEN T1CARISOPRODOL T1CARISOPRODOL COMPOUND T1CARISOPRODOL-ASPIRIN T1CHLORZOXAZONE T1CYCLOBENZAPRINE HCL T1CYCLOBENZAPRINE HCL ER T1DANTRIUM T3DANTROLENE SODIUM T1FEXMID T3LORZONE T1METAXALL T1METAXALONE T1

PRENATAL VITAMINS WITH LOW OR NO IRON

PRENATAL VITAMINS WITHOUT IRON

NEUROMUSCULAR BLOCKING AGENTS

NEUROMUSCULAR BLOCKING AGENTS (COSMETIC)

SKELETAL MUSCLE RELAXANTS

MUSCLE RELAXANTS


PRODUCT TIER UTILIZATION MANAGEMENTMETHOCARBAMOL T1NORGESIC FORTE T3 STORPHENADRINE CITRATE T1ORPHENADRINE CITRATE ER T1PARAFON FORTE DSC T3REVONTO T1ROBAXIN T3ROBAXIN-750 T3SKELAXIN T3SOMA T3TIZANIDINE HCL T1ZANAFLEX T3

CORICIDIN HBP T3

ALLZITAL T1 QLBUPAP T1 QLBUTALBITAL-ACETAMINOPHEN T1 QLMARTEN-TAB T1 QLTENCON T1 QL

BUTALBITAL-ASPIRIN-CAFFEINE T1 QLFIORINAL T3 QL

BUTALBITAL-ACETAMINOPHEN-CAFFE T1 QLCAPACET T1 QLESGIC T1 QLFIORICET T3 QLPHRENILIN FORTE T1 QLVANATOL LQ T3ZEBUTAL T1 QL

CHOLINE MAG TRISALICYLATE T1DIFLUNISAL T1GOODY'S EXTRA STRENGTH T3LEVACET T3 PA

OFIRMEV T3 QL

PRIALT T3 S

DURACLON T3

ANALGESIC, NON-SAL.- 1ST GENERATION ANTIHISTAMINE

ANALGESIC, NON-SALICYLATE AND BARBITURATE COMBINAT

ANALGESIC, SALICYLATE, BARBITURATE, XANTHINE COMB.

NON-OPIOID ANALGESICS

ANALGESIC,NON-SALICYLATE,BARBITURATE,XANTHINE COMB

ANALGESIC/ANTIPYRETICS, SALICYLATES

ANALGESIC/ANTIPYRETICS,NON-SALICYLATE

ANALGESICS, NEURONAL-TYPE CALCIUM CHANNEL BLOCKERS

ANALGESICS, NON-NARCOTICS



CLONIDINE HCL T1DURACLON T3

AIMOVIG AUTOINJECTOR T2 PA QLAIMOVIG AUTOINJECTOR (2 PACK) T2 PA QLAJOVY T3 PA QLALMOTRIPTAN MALATE T1 QLALSUMA T3 ST QLAMERGE T3 ST QLAXERT T3 ST QLCAFERGOT T3CAMBIA T3 PA QLD.H.E.45 T3 PA QLDIHYDROERGOTAMINE MESYLATE T1 PA QLELETRIPTAN HBR T1 QLEMGALITY PEN T2 PA QLEMGALITY SYRINGE T2 PA QLERGOMAR T3ERGOTAMINE-CAFFEINE T1FROVA T3 ST QLFROVATRIPTAN SUCCINATE T1 QLIMITREX T3 ST QLISOMETHEPT-CAFF-ACETAMINOPHEN T1ISOMETHEPT-DICHLORALP-ACETAMIN T1MAXALT T3 ST QLMAXALT MLT T3 ST QLMIGERGOT T3MIGRANAL T3 PA QLNARATRIPTAN HCL T1 QLNODOLOR T1ONZETRA XSAIL T3 STPRODRIN T3RELPAX T3 ST QLRIZATRIPTAN T1 QLSUMATRIPTAN T1 QLSUMATRIPTAN SUCC-NAPROXEN SOD T1 QLSUMATRIPTAN SUCCINATE T1 QLSUMAVEL DOSEPRO T3 ST QLTREXIMET T3 ST QLZEMBRACE SYMTOUCH T3 ST QLZOLMITRIPTAN T1 QLZOLMITRIPTAN ODT T1 QL

ANTIMIGRAINE PREPARATIONS

ANALGESICS, NON-OPIOID


PRODUCT TIER UTILIZATION MANAGEMENTZOMIG T3 ST QLZOMIG ZMT T3 ST QL

APRISO T2ASACOL HD T3 PAAZULFIDINE T3DELZICOL T3 PADIPENTUM T3 PALIALDA T3 PAMESALAMINE T1 PAMESALAMINE DR T1PENTASA T3SULFASALAZINE T1SULFASALAZINE DR T1

SPRIX T3 PA QL

KETOROLAC TROMETHAMINE T1 QL

DICLOFENAC POTASSIUM T1KETOROLAC TROMETHAMINE T1 QLMEFENAMIC ACID T1 QLPONSTEL T3 QLZIPSOR T3 PA QL

ELMIRON T2 PA QLRIMSO-50 T3

ACETYLCYSTEINE-WATER T1 QLLACRISERT T3

BETADINE T3POVIDONE IODINE T1

ACULAR T3 QLACULAR LS T3 QLACUVAIL T3 QLALREX T3 QLBROMFENAC SODIUM T1 QLBROMSITE T3 PA QLDEXAMETHASONE SODIUM PHOSPHATE T1 QLDICLOFENAC SODIUM T1 QL

OPHTHALMIC PREPARATIONS

DRUG TX-CHRONIC INFLAM. COLON DX,5-AMINOSALICYLAT

NASAL NSAIDS, COX NON-SELECTIVE,SYSTEMIC ANALGESIC

NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPE

NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPE ANALGESICS

URINARY TRACT ANALGESIC AGENTS

ARTIFICIAL TEARS

EYE ANTI-INFECTIVES (RX ONLY)

EYE ANTI-INFLAMMATORY AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTDUREZOL T3 QLFLAREX T3 QLFLUOROMETHOLONE T1 QLFLURBIPROFEN SODIUM T1 QLFML T3 QLFML FORTE T3 QLFML S.O.P. T3 QLILEVRO T3 PA QLILUVIEN T3 S QLINVELTYS T3 PA QLKETOROLAC TROMETHAMINE T1 QLLOTEMAX T3 QLLOTEMAX SM T3 QLLOTEPREDNOL ETABONATE T1 QLMAXIDEX T3 QLNEVANAC T3 PA QLOMNIPRED T3 QLOZURDEX T3 S QLPRED FORTE T3 QLPRED MILD T3 QLPREDNISOLONE ACETATE T1 QLPREDNISOLONE SODIUM PHOSPHATE T1 QLPROLENSA T2 QLRETISERT T3 S QLTRIESENCE T3 QLYUTIQ T3 S

MAXITROL T3 QLNEO-POLYCIN HC T1 QLNEOMYCIN-BACITRACIN-POLY-HC T1 QLNEOMYCIN-POLYMYXIN-DEXAMETH T1 QLNEOMYCIN-POLYMYXIN-HC T1 QLPRED-G T3 QLTOBRADEX T3 QLTOBRADEX ST T3 QLTOBRAMYCIN-DEXAMETHASONE T1 QLZYLET T3 QL

TRIFLURIDINE T1VIROPTIC T3ZIRGAN T3 QL

BALANCED SALT T1

EYE ANTIBIOTIC AND GLUCOCORTICOID COMBINATIONS

EYE ANTIVIRALS

EYE IRRIGATIONS


PRODUCT TIER UTILIZATION MANAGEMENTBSS T1BSS PLUS T3

AKTEN T3PROPARACAINE HCL T1TETCAINE T1TETRACAINE HCL T1TETRAVISC T1

ALOCRIL T3 QLALOMIDE T3 QLCROMOLYN SODIUM T1 QL

OMIDRIA T3

GELFILM T3

BLEPH-10 T3 QLBLEPHAMIDE T3 QLBLEPHAMIDE S.O.P. T3 QLSULFACETAMIDE SODIUM T1 QLSULFACETAMIDE-PREDNISOLONE T1 QL

PHENYLEPHRINE HCL T1

VISINE TOTALITY T3

ALPHAGAN P T2 QLAPRACLONIDINE HCL T1 QLAZOPT T2 QLBETAGAN T3 QLBETAXOLOL HCL T1 QLBETIMOL T3 QLBETOPTIC S T3 QLBIMATOPROST T1 QLBRIMONIDINE TARTRATE T1 QLCARTEOLOL HCL T1 QLCOMBIGAN T2 QLCOSOPT T3 QLCOSOPT PF T3 QLDORZOLAMIDE HCL T1 QLDORZOLAMIDE-TIMOLOL T1 QLIOPIDINE T3 QL

EYE LOCAL ANESTHETICS

EYE MAST CELL STABILIZERS

EYE MYDRIATIC AND NSAID COMBINATIONS

EYE PREPARATIONS, MISCELLANEOUS (OTC)

EYE SULFONAMIDES

EYE VASOCONSTRICTORS

EYE VASOCONSTRICTORS (OTC ONLY)

MIOTICS AND OTHER INTRAOCULAR PRESSURE REDUCERS


PRODUCT TIER UTILIZATION MANAGEMENTISOPTO CARPINE T3 QLISTALOL T3 QLLATANOPROST T1 QLLEVOBUNOLOL HCL T1 QLLUMIGAN T2 QLMETIPRANOLOL T1 QLMIOCHOL-E T3MIOSTAT T3PHOSPHOLINE IODIDE T3PILOCARPINE HCL T1 QLRHOPRESSA T3 PA QLSIMBRINZA T2 QLTIMOLOL MALEATE T1 QLTIMOPTIC T3 QLTIMOPTIC OCUDOSE T3 QLTIMOPTIC-XE T3 QLTRAVATAN Z T2 QLTRUSOPT T3 QLVYZULTA T3 ST QLXALATAN T3 QLXELPROS T3 ST QLZIOPTAN T3 QL

ATROPINE SULFATE T1CYCLOGYL T3CYCLOMYDRIL T3CYCLOPENTOLATE HCL T1CYCLOPENTOLATE-LIDOC-PE-TROPIC T1HOMATROPAIRE T1HOMATROPINE HYDROBROMIDE T1MYDRIACYL T3PAREMYD T3TROPICAMIDE T1

VISUDYNE T3 S

EYLEA T3 S PA QLMACUGEN T3 S PA QL

BEVACIZUMAB T1 S PALUCENTIS T3 S PA QL

CEQUA T3 PA QLOPHTHALMIC ANTI-INFLAMMATORY IMMUNOMODULATOR-TYPE

MYDRIATICS

OCULAR PHOTOACTIVATED VESSEL-OCCLUDING AGENTS

OPHTH VASC. ENDOTHELIAL GROWTH FACTOR ANTAGONISTS

OPHTH. VEGF-A RECEPTOR ANTAG. RCMB MC ANTIBODY


PRODUCT TIER UTILIZATION MANAGEMENTRESTASIS T2 PARESTASIS MULTIDOSE T2 PAXIIDRA T2 PA QL

AZASITE T3 QLBACITRACIN T1 QLBACITRACIN-POLYMYXIN T1 QLBESIVANCE T3 QLCILOXAN T3 QLCIPROFLOXACIN HCL T1 QLERYTHROMYCIN T1 QLGATIFLOXACIN T1 QLGENTAK T1 QLGENTAMICIN SULFATE T1 QLLEVOFLOXACIN T1 QLMOXEZA T2 QLMOXIFLOXACIN T1 QLNEO-POLYCIN T1 QLNEOMYCIN-BACITRACIN-POLYMYXIN T1 QLNEOMYCIN-POLYMYXIN-GRAMICIDIN T1 QLOCUFLOX T3 QLOFLOXACIN T1 QLPOLYCIN T1 QLPOLYMYXIN B SUL-TRIMETHOPRIM T1 QLPOLYTRIM T3 QLTOBRAMYCIN T1 QLTOBREX T3 QLVANCOMYCIN HCL T1VIGAMOX T2 QLZYMAXID T3 QL

CYSTARAN T3 S PA QL

OXERVATE T3 S PA QL

AMVISC T3AMVISC PLUS T3AVENOVA T3DISCOVISC T3DUOVISC T3PROVISC T3VISCOAT T3

OPHTHALMIC ANTIBIOTICS

OPHTHALMIC CYSTINE DEPLETING AGENTS

OPHTHALMIC HUMAN NERVE GROWTH FACTOR (HNGF)

OPHTHALMIC PREPARATIONS, MISCELLANEOUS

OPHTHALMIC PROTEOLYTIC ENZYME AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTJETREA T3 S PA

CELLUGEL T3MEMBRANEBLUE T3OCUCOAT T1

FENTANYL CITRATE T1SUFENTANIL CITRATE T1

OXYCODONE HCL-IBUPROFEN T1 QLREPREXAIN T3 QL

BUTORPHANOL TARTRATE T1 QLCODEINE SULFATE T1 QLOPANA ER T3 PA QLOXYCODONE HCL T1 QLPERCOCET T3 QLTRAMADOL HCL T1 QL

ACETAMINOPHEN-CODEINE T1 QL

ACETAMINOPHEN-CODEINE T1 QLHYDROCODONE-ACETAMINOPHEN T1 QLOXYCODONE-ACETAMINOPHEN T1 QL

FIORICET WITH CODEINE T3 QL

ACETAMINOPHEN-CODEINE T1 QLCAPITAL W-CODEINE T3 QLENDOCET T1 QLHYCET T3 QLHYDROCODONE-ACETAMINOPHEN T1 QLLORCET T1 QLLORCET HD T1 QLLORCET PLUS T1 QLLORTAB T3 QLNALOCET T3 QLNORCO T3 QLOXYCODONE-ACETAMINOPHEN T1 QLPERCOCET T3 QLPRIMLEV T3 QLTRAMADOL HCL-ACETAMINOPHEN T1 QL

OPIOID ANALGESICS

NARCOTIC,NON-SALICY.ANALGESIC,BARBITURATE,XANTHINE

OPIOID ANALGESIC AND NON-SALICYLATE ANALGESICS

OPHTHALMIC SURGICAL AIDS

ANALGESICS NARCOTIC, ANESTHETIC ADJUNCT AGENTS

ANALGESICS, NARCOTIC AGONIST AND NSAID COMBINATION

ANALGESICS, NARCOTICS

NARCOTIC ANALGESIC & NON-SALICYLATE ANALGESIC COMB

NARCOTIC ANALGESIC AND NON-SALICYLATE ANALGESIC


PRODUCT TIER UTILIZATION MANAGEMENTTYLENOL-CODEINE NO.3 T3 QLTYLENOL-CODEINE NO.4 T3 QLULTRACET T3 QLVERDROCET T1 QLVICODIN T1 QLVICODIN ES T1 QLVICODIN HP T1 QLXODOL 10-300 T3 QLXODOL 5-300 T3 QLXODOL 7.5-300 T3 QLZAMICET T3 QL

HYDROCODONE-IBUPROFEN T1 QLIBUDONE T1 QLOXYCODONE HCL-IBUPROFEN T1 QLREPREXAIN T1 QLXYLON 10 T1

OXYCODONE HCL-ASPIRIN T1 QL

ALFENTANIL HCL T1FENTANYL CITRATE T1REMIFENTANIL HCL T1SUFENTANIL CITRATE T1ULTIVA T3

ASPIRIN-CAFFEINE-DIHYDROCODEIN T1 QLSYNALGOS-DC T3 QL

ACETAMIN-CAFF-DIHYDROCODEINE T1 QLDVORAH T3 QLPANLOR T1 QLTREZIX T3 QL

ABSTRAL T3 PA QLACTIQ T3 PA QLARYMO ER T3 PA QLASTRAMORPH-PF T1 QLBELBUCA T3 PA QLBELLADONNA-OPIUM T1 QLBUPRENEX T3 QLBUPRENORPHINE T1 PA QLBUPRENORPHINE HCL T1 QL

OPIOID ANALGESIC AND NSAID COMBINATION

OPIOID ANALGESIC AND SALICYLATE ANALGESIC COMB

OPIOID ANALGESIC, ANESTHETIC ADJUNCT AGENTS

OPIOID ANALGESIC, SALICYLATE, AND XANTHINE COMB.

OPIOID ANALGESIC,NON-SALICYLATE,XANTHINE COMB

OPIOID ANALGESICS


PRODUCT TIER UTILIZATION MANAGEMENTBUTORPHANOL TARTRATE T1 QLBUTRANS T3 PA QLCODEINE SULFATE T1 QLCONZIP T3 PA QLDEMEROL T3 QLDILAUDID T3 QLDOLOPHINE HCL T3 PA QLDSUVIA T3DURAGESIC T3 PA QLDURAMORPH T1 QLEMBEDA T2 PA QLEXALGO T3 PA QLFENTANYL T1 PA QLFENTANYL CITRATE T1 PA QLFENTANYL CITRATE-0.9% NACL T1 QLFENTANYL CITRATE-D5W T1FENTANYL-BUPIVACAINE-0.9% NACL T1FENTANYL-ROPIVACAINE-0.9% NACL T1 QLFENTORA T3 PA QLHYDROMORPH-BUPIVAC-0.9% NACL T1 QLHYDROMORPH-ROPIVA-0.9% NACL T1 QLHYDROMORPHONE ER T1 PA QLHYDROMORPHONE HCL T1 QLHYDROMORPHONE HCL-0.9% NACL T1 QLHYDROMORPHONE HCL-D5W T1HYSINGLA ER T2 PA QLIONSYS T3 QLKADIAN T3 PA QLLAZANDA T3 PA QLMEPERIDINE HCL T1 QLMEPERIDINE HCL-0.9% NACL T1 QLMETHADONE HCL T1 PA QLMETHADONE HCL-0.9% NACL T1METHADONE INTENSOL T1 PA QLMETHADOSE T3 PA QLMORPHABOND ER T3 PA QLMORPHINE SULFATE T1 PA QLMORPHINE SULFATE ER T1 PA QLMORPHINE SULFATE-0.9% NACL T1 PA QLMORPHINE SULFATE-D5W T1 PAMS CONTIN T3 PA QLNALBUPHINE HCL T1 QLNUCYNTA T3 QL


PRODUCT TIER UTILIZATION MANAGEMENTNUCYNTA ER T3 PA QLOPANA T3 QLOPANA ER T3 PA QLOXAYDO T3 QLOXYCODONE HCL T1 QLOXYCODONE HCL ER T1 PA QLOXYCONTIN T2 PA QLOXYMORPHONE HCL T1 QLOXYMORPHONE HCL ER T1 PA QLPENTAZOCINE-NALOXONE HCL T1 QLROXICODONE T3 QLROXYBOND T3 QLSUBSYS T3 PA QLTALWIN T3 QLTRAMADOL HCL T1 QLTRAMADOL HCL ER T1 PA QLULTRAM T3 QLXTAMPZA ER T3 PA QLZOHYDRO ER T3 PA QL

ASCOMP WITH CODEINE T1 QLBUTALBITAL COMPOUND-CODEINE T1 QLFIORINAL WITH CODEINE #3 T3 QL

BUTALB-ACETAMINOPH-CAFF-CODEIN T1 QLBUTALB-CAFF-ACETAMINOPH-CODEIN T1 QL

CARISOPRODOL COMPOUND-CODEINE T1 QLCARISOPRODOL-ASPIRIN-CODEINE T1 QL

MYCOBUTIN T3RIFABUTIN T1

BACIIM T1BACITRACIN T1

THALOMID T3 S PA QL

AZACTAM T3AZACTAM-ISO-OSMOTIC DEXTROSE T3AZTREONAM T1CAYSTON T3 S PA

OTHER ANTIBIOTICS

ANTIBIOTICS, MISCELLANEOUS, OTHER

ANTILEPROTICS

BETALACTAMS

OPIOID AND SALICYLATE ANALGESICS,BARBIT,XANTHINE

OPIOID,NON-SALICYL.ANALGESIC,BARBITURATE,XANTHINE

SKELETAL MUSCLE RELAXANT,SALICYLAT,OPIOID ANALGESC

ANTI-MYCOBACTERIUM AGENTS



DORIBAX T3DORIPENEM T1IMIPENEM-CILASTATIN SODIUM T1INVANZ T3MEROPENEM T1MEROPENEM-0.9% NACL T1MERREM T3PRIMAXIN T3

CUBICIN T3CUBICIN RF T3DAPTOMYCIN T1

TIGECYCLINE T1TYGACIL T3

KETEK T3

CLEOCIN HCL T3 QLCLEOCIN PALMITATE T3 QLCLEOCIN PHOSPHATE T3CLEOCIN PHOSPHATE IN D5W T3CLINDAMYCIN HCL T1 QLCLINDAMYCIN PALMITATE HCL T1 QLCLINDAMYCIN PEDIATRIC T1 QLCLINDAMYCIN PHOSPHATE T1CLINDAMYCIN PHOSPHATE-D5W T1CLINDAMYCIN-0.9% NACL T1LINCOCIN T3LINCOMYCIN HCL T1 QL

CLEOCIN HCL T3 QLCLINDAMYCIN HCL T1 QL

VIBATIV T3

DIFICID T3 PA

LINEZOLID T1 QLLINEZOLID-0.9% NACL T1LINEZOLID-D5W T1SIVEXTRO T3 PA QL

CARBAPENEM ANTIBIOTICS (THIENAMYCINS)

CYCLIC LIPOPEPTIDES

GLYCYLCYCLINES

KETOLIDE ANTIBIOTICS

LINCOSAMIDE ANTIBIOTICS

LINCOSAMIDES

LIPOGLYCOPEPTIDE ANTIBIOTICS

MACROLIDE ANTIBIOTICS

OXAZOLIDINONE ANTIBIOTICS


PRODUCT TIER UTILIZATION MANAGEMENTZYVOX T3 PA QL

POLYMYXIN B SULFATE T1

COLISTIMETHATE T1COLY-MYCIN M PARENTERAL T3POLYMYXIN B SULFATE T1

AVELOX T3 QLAVELOX IV T3BAXDELA T3 PA QLCIPRO T3 QLCIPRO I.V. T3CIPRO XR T3 QLCIPROFLOXACIN T1 QLCIPROFLOXACIN ER T1 QLCIPROFLOXACIN HCL T1 QLCIPROFLOXACIN-D5W T1FACTIVE T3 PA QLMOXIFLOXACIN T1MOXIFLOXACIN HCL T1 QLOFLOXACIN T1 QL

CIPROFLOXACIN HCL T1 QLCIPROFLOXACIN-D5W T1

AEMCOLO T3XIFAXAN T3 PA

SYNERCID T3

ALTABAX T3 PA

AKTIPAK T3 PABACTROBAN T3BENZAMYCIN T3 PA QLCENTANY T3 PACLEOCIN T T3 QLCLINDACIN ETZ T1CLINDACIN P T1CLINDAGEL T3 PA QLCLINDAMYCIN PHOSPHATE T1 PA QLERY T1

POLYMYXIN AND DERIVATIVES

POLYMYXIN ANTIBIOTICS AND DERIVATIVES

QUINOLONE ANTIBIOTICS

QUINOLONES

RIFAMYCINS AND RELATED DERIVATIVE ANTIBIOTICS

STREPTOGRAMIN ANTIBIOTICS

TOPICAL ANTIBIOTIC PLEUROMUTILIN DERIVATIVES

TOPICAL ANTIBIOTICS


PRODUCT TIER UTILIZATION MANAGEMENTERYGEL T3 QLERYTHROMYCIN T1 QLERYTHROMYCIN-BENZOYL PEROXIDE T1 QLEVOCLIN T3 QLGENTAMICIN SULFATE T1MUPIROCIN T1XEPI T3 PA

CLEOCIN T2CLINDAMYCIN PHOSPHATE T1CLINDESSE T3METRONIDAZOLE T1NUVESSA T3VANDAZOLE T1

AMLODIPINE BESYLATE-BENAZEPRIL T1 QLLOTREL T3 QLPRESTALIA T3 ST QLTARKA T3 QLTRANDOLAPRIL-VERAPAMIL ER T1

ACCURETIC T3 QLBENAZEPRIL-HYDROCHLOROTHIAZIDE T1 QLCAPTOPRIL-HYDROCHLOROTHIAZIDE T1 QLENALAPRIL-HYDROCHLOROTHIAZIDE T1 QLFOSINOPRIL-HYDROCHLOROTHIAZIDE T1 QLLISINOPRIL-HYDROCHLOROTHIAZIDE T1 QLLOTENSIN HCT T3 QLMOEXIPRIL-HYDROCHLOROTHIAZIDE T1 QLQUINAPRIL-HYDROCHLOROTHIAZIDE T1 QLVASERETIC T3 QLZESTORETIC T3 QL

AMLODIPINE BESYLATE-BENAZEPRIL T1 QL

LISINOPRIL-HYDROCHLOROTHIAZIDE T1 QL

CARDURA T3CARDURA XL T3 ST QLDOXAZOSIN MESYLATE T1MINIPRESS T3PRAZOSIN HCL T1

OTHER ANTIHYPERTENSIVES

ACE INHIBITOR/THIAZIDE & THIAZIDE-LIKE DIURETIC

ALPHA-ADRENERGIC BLOCKING AGENTS

VAGINAL ANTIBIOTICS

ACE INHIBITOR-CALCIUM CHANNEL BLOCKER COMBINATION

ACE INHIBITOR-THIAZIDE OR THIAZIDE-LIKE DIURETIC

ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATION


PRODUCT TIER UTILIZATION MANAGEMENTTERAZOSIN HCL T1

AMLODIPINE-VALSARTAN-HCTZ T1 QLEXFORGE HCT T3 QLOLMESARTAN-AMLODIPINE-HCTZ T1 QLTRIBENZOR T3 QL

BYVALSON T2 QL

ATACAND HCT T3 QLAVALIDE T3 QLBENICAR HCT T3 QLCANDESARTAN-HYDROCHLOROTHIAZID T1 QLDIOVAN HCT T3 QLEDARBYCLOR T3 ST QLHYZAAR T3 QLIRBESARTAN-HYDROCHLOROTHIAZIDE T1 QLLOSARTAN-HYDROCHLOROTHIAZIDE T1 QLMICARDIS HCT T3 QLOLMESARTAN-HYDROCHLOROTHIAZIDE T1 QLTELMISARTAN-HYDROCHLOROTHIAZID T1 QLVALSARTAN-HYDROCHLOROTHIAZIDE T1 QL

LOSARTAN-HYDROCHLOROTHIAZIDE T1 QL

AMLODIPINE-OLMESARTAN T1 QLAMLODIPINE-VALSARTAN T1 QLAZOR T3 QLEXFORGE T3 QLTELMISARTAN-AMLODIPINE T1 QLTWYNSTA T3 QL

ACCUPRIL T3 QLALTACE T3 QLBENAZEPRIL HCL T1 QLCAPTOPRIL T1 QLENALAPRIL MALEATE T1 QLENALAPRILAT T1EPANED T3 QLFOSINOPRIL SODIUM T1 QLLISINOPRIL T1 QLLOTENSIN T3 QLMOEXIPRIL HCL T1 QL

ANGIOTEN.RECEPTR ANTAG-CALCIUM CHANL BLKR-THIAZIDE

ANGIOTENSIN II RECEPTOR BLOCKER-BETA BLOCKER COMB.

ANGIOTENSIN RECEPTOR ANTAG.-THIAZIDE DIURETIC COMB

ANGIOTENSIN RECEPTOR ANTAG./THIAZIDE DIURETIC COMB

ANGIOTENSIN RECEPTOR BLOCKR-CALCIUM CHANNEL BLOCKR

ANTIHYPERTENSIVES, ACE INHIBITORS


PRODUCT TIER UTILIZATION MANAGEMENTPERINDOPRIL ERBUMINE T1 QLPRINIVIL T3 QLQBRELIS T3 QLQUINAPRIL HCL T1 QLRAMIPRIL T1 QLTRANDOLAPRIL T1 QLVASOTEC T3 QLZESTRIL T3 QL

ATACAND T3 QLAVAPRO T3 QLBENICAR T3 QLCANDESARTAN CILEXETIL T1 QLCOZAAR T3 QLDIOVAN T3 QLEDARBI T3 ST QLEPROSARTAN MESYLATE T1 QLIRBESARTAN T1 QLLOSARTAN POTASSIUM T1 QLMICARDIS T3 QLOLMESARTAN MEDOXOMIL T1 QLTELMISARTAN T1 QLVALSARTAN T1 QL

VECAMYL T3 S PA

DEMSER T3NITROPRESS T1SODIUM NITROPRUSSIDE T1

CATAPRES T3CATAPRES-TTS 1 T3 QLCATAPRES-TTS 2 T3 QLCATAPRES-TTS 3 T3 QLCLONIDINE T1 QLCLONIDINE HCL T1CLORPRES T3GUANFACINE HCL T1METHYLDOPA T1METHYLDOPA-HYDROCHLOROTHIAZIDE T1METHYLDOPATE HCL T1

CORLOPAM T3

ANTIHYPERTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONIST

ANTIHYPERTENSIVES, GANGLIONIC BLOCKERS

ANTIHYPERTENSIVES, MISCELLANEOUS

ANTIHYPERTENSIVES, SYMPATHOLYTIC

ANTIHYPERTENSIVES, VASODILATORS


PRODUCT TIER UTILIZATION MANAGEMENTHYDRALAZINE HCL T1MINOXIDIL T1

ADEMPAS T3 S PA QL

ADCIRCA T3 S PA QLALYQ T1 S PA QLREVATIO T3 S PA QLSILDENAFIL T1 S PA QLSILDENAFIL CITRATE T1 S PATADALAFIL T1 S PA QL

AMBRISENTAN T1 S PA QLLETAIRIS T3 S PA QLOPSUMIT T3 S PA QLTRACLEER T3 S PA QL

EPOPROSTENOL SODIUM T1 SFLOLAN T3 S PAORENITRAM ER T3 S PA QLREMODULIN T3 S PATREPROSTINIL T1 S PATYVASO T3 S PA QLTYVASO INSTITUTIONAL START KIT T3 S PA QLTYVASO REFILL KIT T3 S PA QLTYVASO STARTER KIT T3 S PA QLUPTRAVI T3 S PA QLVELETRI T3 S PAVENTAVIS T3 S PA QL

ALISKIREN T1 ST QLTEKTURNA T3 ST QL

TEKAMLO T3 QL

TEKTURNA HCT T3 ST QL

BIDIL T3 QL

DIBENZYLINE T3PHENOXYBENZAMINE HCL T1PHENTOLAMINE MESYLATE T1

OTHER CARDIOVASCULAR PREPS

PULMONARY ANTIHYPERTENSIVES, PROSTACYCLIN-TYPE

RENIN INHIBITOR, DIRECT

RENIN INHIBITOR,DIRECT AND CALCIUM CHANNEL BLOCKER

RENIN INHIBITOR,DIRECT AND THIAZIDE DIURETIC COMB

VASODILATORS, COMBINATION

ALPHA-ADRENERGIC BLOCKING AGENTS

PULM ANTI-HTN,SOLUBLE GUANYLATE CYCLASE STIMULATOR

PULM.ANTI-HTN,SEL.C-GMP PHOSPHODIESTERASE T5 INHIB

PULMONARY ANTI-HTN, ENDOTHELIN RECEPTOR ANTAGONIST



CARVEDILOL T1CARVEDILOL ER T1 QLCOREG T3COREG CR T3 QLLABETALOL HCL T1LABETALOL HCL-D5W T1

ENTRESTO T3 QL

RANEXA T3 QLRANOLAZINE ER T1 QL

ADENOCARD T3ADENOSINE T1AMIODARONE HCL T1CORVERT T3DISOPYRAMIDE PHOSPHATE T1DOFETILIDE T1 SFLECAINIDE ACETATE T1IBUTILIDE FUMARATE T1LIDOCAINE HCL T1LIDOCAINE HCL IN 5% DEXTROSE T1MEXILETINE HCL T1MULTAQ T3 PANEXTERONE T3NORPACE T3NORPACE CR T2PACERONE T1PROCAINAMIDE HCL T1PROPAFENONE HCL T1PROPAFENONE HCL ER T1QUINIDINE GLUCONATE T1QUINIDINE SULFATE T1RYTHMOL SR T3TIKOSYN T3 SXYLOCAINE IV T3

AMLODIPINE-ATORVASTATIN T1 QLCADUET T3 QL

ACEBUTOLOL HCL T1ATENOLOL T1

ALPHA/BETA-ADRENERGIC BLOCKING AGENTS

ANGIOTENSIN RECEPT-NEPRILYSIN INHIBITOR COMB(ARNI)

ANTIANGINAL, ANTI-ISCHEMIC AGENTS,NON-HEMODYNAMIC

ANTIARRHYTHMICS

ANTIHYPERLIPID- HMG-COA RI-CALCIUM CHANNEL BLOCKER

BETA-ADRENERGIC BLOCKING AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTBETAPACE T3BETAPACE AF T3BETAXOLOL HCL T1BISOPROLOL FUMARATE T1BREVIBLOC T3BYSTOLIC T2 QLCORGARD T3ESMOLOL HCL T1ESMOLOL HCL-SODIUM CHLORIDE T1HEMANGEOL T3 SINDERAL LA T3INDERAL XL T3 STINNOPRAN XL T3 STKAPSPARGO SPRINKLE T3LEVATOL T3LOPRESSOR T3METOPROLOL SUCCINATE T1METOPROLOL TARTRATE T1NADOLOL T1PINDOLOL T1PROPRANOLOL HCL T1PROPRANOLOL HCL ER T1SORINE T1SOTALOL T1SOTALOL AF T1SOTALOL HCL T1SOTYLIZE T3TENORMIN T3TIMOLOL MALEATE T1TOPROL XL T3

ATENOLOL-CHLORTHALIDONE T1BISOPROLOL-HYDROCHLOROTHIAZIDE T1CORZIDE T3DUTOPROL T3LOPRESSOR HCT T3METOPROLOL-HYDROCHLOROTHIAZIDE T1NADOLOL-BENDROFLUMETHIAZIDE T1PROPRANOLOL-HYDROCHLOROTHIAZID T1TENORETIC 100 T3TENORETIC 50 T3ZIAC T3

BETA-BLOCKERS AND THIAZIDE,THIAZIDE-LIKE DIURETICS

CALCIUM CHANNEL BLOCKING AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTADALAT CC T3 QLAFEDITAB CR T1 QLAMLODIPINE BESYLATE T1 QLCALAN T3 QLCALAN SR T3 QLCARDENE I.V. T3CARDENE SR T3 QLCARDIZEM T3 QLCARDIZEM CD T3 QLCARDIZEM LA T3 QLCARTIA XT T1 QLCLEVIPREX T3DILT-XR T1 QLDILTIAZEM 12HR ER T1DILTIAZEM 24HR ER T1 QLDILTIAZEM 24HR ER (CD) T1 QLDILTIAZEM 24HR ER (LA) T1 QLDILTIAZEM 24HR ER (XR) T1 QLDILTIAZEM HCL T1 QLDILTIAZEM HCL-0.9% NACL T1DILTIAZEM-D5W T1FELODIPINE ER T1 QLISRADIPINE T1 QLMATZIM LA T1 QLNICARDIPINE HCL T1NICARDIPINE HCL-0.9% NACL T1NICARDIPINE HCL-D5W T1NIFEDIPINE T1 QLNIFEDIPINE ER T1 QLNIMODIPINE T1NISOLDIPINE T1 QLNORVASC T3 QLNYMALIZE T3 QLPROCARDIA T3 QLPROCARDIA XL T3 QLSULAR T3 QLTAZTIA XT T1 QLTIAZAC T3 QLVERAPAMIL ER T1 QLVERAPAMIL ER PM T1 QLVERAPAMIL HCL T1 QLVERAPAMIL SR T1 QLVERELAN T3 QL


PRODUCT TIER UTILIZATION MANAGEMENTVERELAN PM T3 QL

CARDIOPLEGIA HIGH POTASSIUM T3CARDIOPLEGIC T1PLEGISOL T3

CORLANOR T3 ST QL

PENTOXIFYLLINE T1

DOBUTAMINE HCL T1DOBUTAMINE HCL IN DEXTROSE T1MILRINONE IN 5% DEXTROSE T1MILRINONE LACTATE T1

IBUPROFEN LYSINE T1INDOCIN I.V. T3INDOMETHACIN T1NEOPROFEN T3

ACTIVASE T3 SCATHFLO ACTIVASE T3 STNKASE T3

NATRECOR T3

ALPROSTADIL T1PROSTIN VR PEDIATRIC T3

ASCLERA T3ETHAMOLIN T3SOTRADECOL T1

DDAVP T3DESMOPRESSIN ACETATE T1NOCDURNA T3 PA QLNOCTIVA T3 PA QLSTIMATE T3 SVASOPRESSIN-0.9% NACL T1VASOPRESSIN-D5W T1VASOPRESSIN-NS T1

OTHER HORMONES

CARDIOPLEGIC SOLUTIONS

HEART RATE REDUCING, SELECTIVE I(F) CURRENT INHIB.

HEMORRHEOLOGIC AGENTS

INOTROPIC DRUGS

BONE FORMATION STIMULATING AGTS - PTH REL PEPTIDES

PATENT DUCTUS ARTERIOSUS TREAT. AGENTS, NSAID-TYPE

THROMBOLYTIC ENZYMES

VASOACTIVE NATRIURETIC PEPTIDES

VASODILATORS,MISCELLANEOUS

VENOSCLEROSING AGENTS

ANTIDIURETIC AND VASOPRESSOR HORMONES


PRODUCT TIER UTILIZATION MANAGEMENTTYMLOS T3 S PA QL

CALCITONIN-SALMON T1 QLMIACALCIN T3 S

CLOMIPHENE CITRATE T1SEROPHENE T1

MENOPUR T3 S PA

BRAVELLE T3 S PAFOLLISTIM AQ T3 S PAGONAL-F T3 S PAGONAL-F RFF T3 S PAGONAL-F RFF REDI-JECT T3 S PA

EGRIFTA T3 S PA QL

GENOTROPIN T3 S PAHUMATROPE T3 S PANORDITROPIN FLEXPRO T3 S PANUTROPIN AQ NUSPIN T3 S PAOMNITROPE T3 S PASAIZEN T3 S PASAIZEN-SAIZENPREP T3 S PASEROSTIM T3 S PA QLZOMACTON T3 S PAZORBTIVE T3 S PA QL

CHORIONIC GONADOTROPIN T1 SNOVAREL T3 S PAOVIDREL T3 S PAPREGNYL T3 S PA

INCRELEX T3 S PA

MYALEPT T3 S PA

LUPRON DEPOT T3 S PALUPRON DEPOT (LUPANETA) T3 S PASYNAREL T3 S PA

CETROTIDE T3 S PA

BONE RESORPTION INHIBITORS

FERTILITY STIMULATING PREPARATIONS,NON-FSH

FOLLICLE-STIMULATING AND LUTEINIZING HORMONES

FOLLICLE-STIMULATING HORMONE (FSH)

GROWTH HORMONE RELEASING HORMONE(GHRH) AND ANALOGS

GROWTH HORMONES

HUMAN CHORIONIC GONADOTROPIN (HCG)

INSULIN-LIKE GROWTH FACTOR-1 (IGF-1) HORMONES

LEPTIN HORMONE ANALOGS

LHRH (GNRH) AGONIST ANALOG PITUITARY SUPPRESSANTS

LHRH(GNRH) ANTAGONIST,PITUITARY SUPPRESSANT AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTGANIRELIX ACETATE T1 SORILISSA T2 PA QL

LUPRON DEPOT-PED T3 S PASUPPRELIN LA T3 S PA

CHIRHOSTIM T3MACRILEN T3 S PAMETOPIRONE T3R-GENE 10 T3

NATPARA T3 S PA

MELATONIN T1

CABERGOLINE T1DANAZOL T1

CRINONE T3 QLENDOMETRIN T2 QL

HYDROXYPROGESTERONE CAPROATE T1 S PAMAKENA T3 S PA

OCTREOTIDE ACETATE T1 S PASANDOSTATIN T3 S PA QLSANDOSTATIN LAR DEPOT T3 S PA QLSIGNIFOR T3 S PASIGNIFOR LAR T3 S PA QLSOMATULINE DEPOT T3 S PA QL

CERVIDIL T3HEMABATE T3METHERGINE T1METHYLERGONOVINE MALEATE T1OXYTOCIN T1OXYTOCIN-0.9% NACL T1OXYTOCIN-D5W T1OXYTOCIN-LACTATED RINGERS T1PITOCIN T3PREPIDIL T3PROSTIN E2 VAGINAL SUPPOSITORY T3

OXYTOCICS

LHRH(GNRH)AGNST PIT.SUP-CENTRAL PRECOCIOUS PUBERTY

METABOLIC FUNCTION DIAGNOSTICS

PARATHYROID HORMONES

PINEAL HORMONE AGENTS

PITUITARY SUPPRESSIVE AGENTS

PREGNANCY FACILITATING/MAINTAINING AGENT,HORMONAL

PREGNANCY MAINTAINING AGENT,HORMONAL

SOMATOSTATIC AGENTS

OXYTOCICS



ARICEPT T3BLOXIVERZ T3DONEPEZIL HCL T1DONEPEZIL HCL ODT T1ENLON T3ENLON-PLUS T3EXELON T3GALANTAMINE ER T1GALANTAMINE HBR T1GALANTAMINE HYDROBROMIDE T1MESTINON T3NEOSTIGMINE METHYLSULFATE T1PHYSOSTIGMINE SALICYLATE T1PYRIDOSTIGMINE BROMIDE T1PYRIDOSTIGMINE BROMIDE ER T1RAZADYNE T3RAZADYNE ER T3REGONOL T3RIVASTIGMINE T1

BETHANECHOL CHLORIDE T1CEVIMELINE HCL T1EVOXAC T3GUANIDINE HCL T1PILOCARPINE HCL T1SALAGEN T3URECHOLINE T3

AMOXICILLIN T1AMOXICILLIN-CLAVULANATE POT ER T1AMOXICILLIN-CLAVULANATE POTASS T1AMPICILLIN SODIUM T1AMPICILLIN TRIHYDRATE T1AMPICILLIN-SULBACTAM T1AUGMENTIN T3AUGMENTIN ES-600 T3AUGMENTIN XR T3BICILLIN C-R T3BICILLIN L-A T3DICLOXACILLIN SODIUM T1

PARASYMPATHETIC AGENTS

PENICILLINS

CHOLINESTERASE INHIBITORS

PARASYMPATHETIC AGENTS

PENICILLIN ANTIBIOTICS


PRODUCT TIER UTILIZATION MANAGEMENTMOXATAG T3NAFCILLIN T3NAFCILLIN SODIUM T1OXACILLIN T3OXACILLIN SODIUM T1PENICILLIN G POTASSIUM T1PENICILLIN G PROCAINE T1PENICILLIN G SODIUM T1PENICILLIN GK-ISO-OSM DEXTROSE T1PENICILLIN V POTASSIUM T1PFIZERPEN T3PIPERACILLIN-TAZOBACTAM T1UNASYN T3ZOSYN T3

AMOXICILLIN-CLAVULANATE POTASS T1AMPICILLIN SODIUM T1AMPICILLIN-SULBACTAM T1PENICILLIN V POTASSIUM T1PIPERACILLIN-TAZOBACTAM T1

AYGESTIN T3CRINONE T3DEPO-PROVERA T3HYDROXYPROGESTERONE CAPROATE T1 S PAMEDROXYPROGESTERONE ACETATE T1NORETHINDRONE AC (LUPANETA) T1NORETHINDRONE ACETATE T1PROGESTERONE T1PROMETRIUM T3PROVERA T3

NUTRESTORE T3 S

AMINOSYN WITH ELECTROLYTES T1ARGININE T3GLYCINE T3IMMULIFE T3ISOLEUCINE T3K-PAX T3L-METHIONINE T3

PENICILLINS

PROGESTATIONAL AGENTS

NUTRITIONAL THERAPY, MED COND SPECIAL FORMULATION

PROTEIN REPLACEMENT

PROGESTERONE

PROTEIN LYSATES


PRODUCT TIER UTILIZATION MANAGEMENTL-VALINE T3TYROSINE T1

MIRTAZAPINE T1 QLREMERON T3 QL

EQUETRO T3LITHIUM T1LITHIUM CARBONATE T1LITHIUM CARBONATE ER T1LITHOBID T3

MARPLAN T3 QLNARDIL T3 QLPARNATE T3 QLPHENELZINE SULFATE T1 QLTRANYLCYPROMINE SULFATE T1 QL

EMSAM T3 QL

ARMODAFINIL T1 PA QLMODAFINIL T1 PA QLNUVIGIL T3 PA QLPROVIGIL T3 PA QL

APLENZIN T3 QLBUPROPION HCL T1 QLBUPROPION HCL SR T1 QLBUPROPION XL T1 QLFORFIVO XL T3 QLWELLBUTRIN SR T3 QLWELLBUTRIN XL T3 QL

CELEXA T3 QLCITALOPRAM HBR T1 QLESCITALOPRAM OXALATE T1 QLFLUOXETINE DR T1 QLFLUOXETINE HCL T1 QLFLUVOXAMINE MALEATE T1 QLFLUVOXAMINE MALEATE ER T1 QLLEXAPRO T3 QLPAROXETINE CR T1 QL

MAOIS -NON-SELECTIVE,IRREVERSIBLE ANTIDEPRESSANTS

MONOAMINE OXIDASE (MAO) INHIBITOR ANTIDEPRESSANTS

NARCOLEPSY AND SLEEP DISORDER THERAPY AGENTS

NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIB (NDRIS)

ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTS

BIPOLAR DISORDER DRUGS

PSYCHOSTIMULANTS-ANTIDEPRESSANTS

SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS)


PRODUCT TIER UTILIZATION MANAGEMENTPAROXETINE ER T1 QLPAROXETINE HCL T1 QLPAXIL T3 PA QLPAXIL CR T3 QLPEXEVA T3 PA QLPROZAC T3 QLPROZAC WEEKLY T3 QLSARAFEM T3 QLSERTRALINE HCL T1 QLZOLOFT T3 QL

NEFAZODONE HCL T1 QLTRAZODONE HCL T1 QL

CYMBALTA T3 QLDESVENLAFAXINE ER T1 QLDESVENLAFAXINE FUMARATE ER T1 QLDESVENLAFAXINE SUCCINATE ER T1 QLDULOXETINE HCL T1 QLEFFEXOR XR T3 QLFETZIMA T3 ST QLIRENKA T3 QLKHEDEZLA T3 QLPRISTIQ T3 QLVENLAFAXINE HCL T1VENLAFAXINE HCL ER T1 QL

VIIBRYD T3 QL

OLANZAPINE-FLUOXETINE HCL T1 QLSYMBYAX T3 QL

TRINTELLIX T3 ST QL

CHLORDIAZEPOXIDE-AMITRIPTYLINE T1

PERPHENAZINE-AMITRIPTYLINE T1

ELAVIL T3

AMITRIPTYLINE HCL T1AMOXAPINE T1ANAFRANIL T3

TRICYCLIC ANTIDEPRESSANT-BENZODIAZEPINE COMBINATNS

TRICYCLIC ANTIDEPRESSANT-PHENOTHIAZINE COMBINATNS

TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIB

TRICYCLIC ANTIDEPRESSANTS,REL.NON-SEL.REUPT-INHIB

SEROTONIN-2 ANTAGONIST/REUPTAKE INHIBITORS (SARIS)

SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS)

SSRI AND 5HT1A PARTIAL AGONIST ANTIDEPRESSANTS

SSRI-ANTIPSYCH, ATYPICAL,DOPAMINE,SEROTONIN ANTAG

SSRI, SEROTONIN RECEPTOR MODULATOR ANTIDEPRESSANTS


PRODUCT TIER UTILIZATION MANAGEMENTCLOMIPRAMINE HCL T1DESIPRAMINE HCL T1DOXEPIN HCL T1IMIPRAMINE HCL T1IMIPRAMINE PAMOATE T1MAPROTILINE HCL T1NORPRAMIN T3NORTRIPTYLINE HCL T1PAMELOR T3PROTRIPTYLINE HCL T1SURMONTIL T3TOFRANIL T3TRIMIPRAMINE MALEATE T1

CLONIDINE HCL ER T1 QLGUANFACINE HCL ER T1 QLINTUNIV T3 QLKAPVAY T3 ST QL

ATOMOXETINE HCL T1 QLSTRATTERA T3 QL

BUTISOL SODIUM T3LUMINAL SODIUM T3NEMBUTAL SODIUM T3PHENOBARBITAL T1PHENOBARBITAL SODIUM T1SECONAL SODIUM T3

ALCOHOL,DEHYDRATED T1

XYREM T3 S PA QL

MIDNITE FOR MENOPAUSE T3MIDNITE MENOPAUSE T3MIDNITE PM T3

HETLIOZ T3 S PA QLROZEREM T3 ST QL

ATIVAN T3

SEDATIVE BARBITURATE

SEDATIVE NON-BARBITURATE

TX FOR ADHD - SELECTIVE ALPHA-2 RECEPTOR AGONIST

TX FOR ATTENTION DEFICIT-HYPERACT.(ADHD), NRI-TYPE

BARBITURATES

ALCOHOL,SYSTEMIC USE

ANTI-NARCOLEPSY,ANTI-CATAPLEXY,SEDATIVE-TYPE AGENT

HYPNOTICS, MELATONIN AND HERBAL COMBINATIONS

HYPNOTICS, MELATONIN MT1/MT2 RECEPTOR AGONISTS

SEDATIVE-HYPNOTICS - BENZODIAZEPINES


PRODUCT TIER UTILIZATION MANAGEMENTDORAL T3 QLESTAZOLAM T1 QLFLURAZEPAM HCL T1 QLHALCION T3 QLLORAZEPAM T1LORAZEPAM-0.9% NACL T1LORAZEPAM-D5W T1MIDAZOLAM HCL T1QUAZEPAM T1 QLRESTORIL T3 QLTEMAZEPAM T1 QLTRIAZOLAM T1 QL

AMBIEN T3 ST QLAMBIEN CR T3 ST QLATIVAN T1BELSOMRA T3 STDEXMEDETOMIDINE HCL T1DEXMEDETOMIDINE-0.9% NACL T1EDLUAR T3 ST QLESZOPICLONE T1 QLINTERMEZZO T3 ST QLLORAZEPAM T1LUNESTA T3 ST QLPRECEDEX T3SILENOR T3 QLSONATA T3 ST QLTEMAZEPAM T1 QLZALEPLON T1 QLZOLPIDEM TARTRATE T1 QLZOLPIDEM TARTRATE ER T1 QLZOLPIMIST T3 QL

AMIKACIN SULFATE T1ARIKAYCE T3 S PA QLBETHKIS T3 S PAGENTAMICIN SULFATE T1GENTAMICIN SULFATE IN NS T1KITABIS PAK T3 S PANEOMYCIN SULFATE T1STREPTOMYCIN SULFATE T1TOBI T3 S PA

STREPTOMYCINS

SEDATIVE-HYPNOTICS,NON-BARBITURATE

AMINOGLYCOSIDE ANTIBIOTICS


PRODUCT TIER UTILIZATION MANAGEMENTTOBI PODHALER T3 S PATOBRAMYCIN T1 S PATOBRAMYCIN SULFATE T1TOBRAMYCIN SULFATE IN NS T1

GENTAMICIN-SODIUM CITRATE T1

GENTAMICIN SULFATE T1TOBRAMYCIN SULFATE T1

VANCOMYCIN HCL T1

FIRVANQ T3VANCOCIN HCL T3VANCOMYCIN T1VANCOMYCIN HCL T1VANCOMYCIN HCL-0.9% NACL T1VANCOMYCIN HCL-D5W T1

BACTRIM T3BACTRIM DS T3SULFADIAZINE T1SULFAMETHOXAZOLE-TRIMETHOPRIM T1SULFATRIM T1

AVAR T1AVAR LS T3AVAR-E T1AVAR-E GREEN T1AVAR-E LS T3BP 10-1 T1CLEANSING WASH T1PLEXION T3ROSANIL T1SILVADENE T3SILVER SULFADIAZINE T1SODIUM SULFACETAMIDE-SULFUR T1SSD T1SSS 10-5 T1SULFACETAMIDE SODIUM-SULFUR T1SULFACLEANSE 8-4 T1SULFAMYLON T3

SULFONAMIDESABSORBABLE SULFONAMIDE ANTIBACTERIAL AGENTS

TOPICAL SULFONAMIDES

AMINOGLYCOSIDE-ANTICOAGULANT COMBINATIONS

AMINOGLYCOSIDES

VANCOMYCIN AND DERIVATIVES

VANCOMYCIN ANTIBIOTICS AND DERIVATIVES


PRODUCT TIER UTILIZATION MANAGEMENTSUMADAN T3SUMAXIN T3SUMAXIN TS T3ZENCIA T1

AVC T3

NUVARING T2

NEXPLANON T3 S

DEPO-PROVERA T3DEPO-SUBQ PROVERA 104 T3 PA QLMEDROXYPROGESTERONE ACETATE T1 QL

ALTAVERA T1ALYACEN T1AMETHIA T1 QLAMETHIA LO T1 QLAMETHYST T1 QLAPRI T1ARANELLE T1ASHLYNA T1AUBRA T1AUBRA EQ T1AUROVELA T1AUROVELA 24 FE T1AUROVELA FE T1AVIANE T1AZURETTE T1BALCOLTRA T3BALZIVA T1BEKYREE T1BEYAZ T3BLISOVI 24 FE T1BLISOVI FE T1BREVICON T3BRIELLYN T1CAMILA T1CAMRESE T1 QLCAMRESE LO T1 QLCAZIANT T1

SYSTEMIC CONTRACEPTIVES

VAGINAL SULFONAMIDES

CONTRACEPTIVES, INTRAVAGINAL, SYSTEMIC

CONTRACEPTIVES,IMPLANTABLE

CONTRACEPTIVES,INJECTABLE

CONTRACEPTIVES,ORAL


PRODUCT TIER UTILIZATION MANAGEMENTCHATEAL T1CHATEAL EQ T1CRYSELLE T1CYCLAFEM T1CYCLESSA T3CYRED T1CYRED EQ T1DASETTA T1DAYSEE T1 QLDEBLITANE T1DELYLA T1DESOGESTR-ETH ESTRAD ETH ESTRA T1DESOGESTREL-ETHINYL ESTRADIOL T1DROSPIRENONE-ETH ESTRA-LEVOMEF T1DROSPIRENONE-ETHINYL ESTRADIOL T1ELINEST T1ELLA T3 QLEMOQUETTE T1ENPRESSE T1ENSKYCE T1ERRIN T1ESTARYLLA T1ESTROSTEP FE T3ETHYNODIOL-ETHINYL ESTRADIOL T1FALMINA T1FAYOSIM T1 QLFEMCON FE T3FEMYNOR T1GENERESS FE T3GIANVI T1GILDAGIA T1HAILEY 24 FE T1HEATHER T1INCASSIA T1INTROVALE T1 QLISIBLOOM T1JASMIEL T1JENCYCLA T1JOLESSA T1 QLJOLIVETTE T1JULEBER T1JUNEL T1JUNEL FE T1


PRODUCT TIER UTILIZATION MANAGEMENTJUNEL FE 24 T1KAITLIB FE T1KARIVA T1KELNOR 1-35 T1KELNOR 1-50 T1KIMIDESS T1KURVELO T1LARIN T1LARIN 24 FE T1LARIN FE T1LARISSIA T1LAYOLIS FE T1LEENA T1LESSINA T1LEVONEST T1LEVONORG-ETH ESTRAD ETH ESTRAD T1 QLLEVONORGESTREL T1 QLLEVONORGESTREL-ETH ESTRADIOL T1LEVORA-28 T1LILLOW T1LO LOESTRIN FE T3LOESTRIN T3LOESTRIN FE T3LOMEDIA 24 FE T1LORYNA T1LOSEASONIQUE T3 QLLOW-OGESTREL T1LUTERA T1LYZA T1MARLISSA T1MELODETTA 24 FE T1MIBELAS 24 FE T1MICROGESTIN T1MICROGESTIN 24 FE T1MICROGESTIN FE T1MILI T1MINASTRIN 24 FE T3MIRCETTE T3MONO-LINYAH T1MONONESSA T1MYZILRA T1NATAZIA T2NECON T1


PRODUCT TIER UTILIZATION MANAGEMENTNIKKI T1NORA-BE T1NORETHIN-ETH ESTRA-FERROUS FUM T1NORETHINDRON-ETHINYL ESTRADIOL T1NORETHINDRONE T1NORGESTIMATE-ETHINYL ESTRADIOL T1NORINYL 1-35 T3NORLYDA T1NORLYROC T1NORTREL T1OCELLA T1OGESTREL T1ORSYTHIA T1ORTHO MICRONOR T3ORTHO TRI-CYCLEN T3ORTHO TRI-CYCLEN LO T3ORTHO-CYCLEN T3ORTHO-NOVUM T3OVCON-35 T3PHILITH T1PIMTREA T1PIRMELLA T1PORTIA T1PREVIFEM T1QUARTETTE T3QUASENSE T1 QLRAJANI T1RECLIPSEN T1RIVELSA T1 QLSAFYRAL T3SEASONIQUE T3 QLSETLAKIN T1 QLSHAROBEL T1SIMLIYA T1SPRINTEC T1SRONYX T1SYEDA T1TARINA 24 FE T1TARINA FE T1TARINA FE 1-20 EQ T1TAYTULLA T3TILIA FE T1TRI FEMYNOR T1


PRODUCT TIER UTILIZATION MANAGEMENTTRI-ESTARYLLA T1TRI-LEGEST FE T1TRI-LINYAH T1TRI-LO-ESTARYLLA T1TRI-LO-MARZIA T1TRI-LO-SPRINTEC T1TRI-MILI T1TRI-NORINYL T3TRI-PREVIFEM T1TRI-SPRINTEC T1TRI-VYLIBRA T1TRI-VYLIBRA LO T1TRINESSA T1TRINESSA LO T1TRIVORA-28 T1TULANA T1TYDEMY T1VELIVET T1VESTURA T1VIENVA T1VIORELE T1VYFEMLA T1VYLIBRA T1WERA T1WYMZYA FE T1YASMIN 28 T3YAZ T3ZARAH T1ZENCHENT T1ZENCHENT FE T1ZOVIA 1-35E T1ZOVIA 1-50E T1

XULANE T3 QL

ETHAMBUTOL HCL T1ISONIAZID T1MYAMBUTOL T3PASER T3PYRAZINAMIDE T1TRECATOR T3

TB PREPARATIONS

CONTRACEPTIVES,TRANSDERMAL

ANTI-MYCOBACTERIUM AGENTS

ANTITUBERCULAR ANTIBIOTICS


PRODUCT TIER UTILIZATION MANAGEMENTCAPASTAT SULFATE T3CYCLOSERINE T1PRIFTIN T3 QLRIFADIN T3RIFAMATE T3RIFAMPIN T1RIFATER T3SIRTURO T3 PA

ACTICLATE T3 STAVIDOXY T1COREMINO T1 ST QLDEMECLOCYCLINE HCL T1DORYX T3 ST QLDORYX MPC T3 STDOXY 100 T1DOXYCYCLINE HYCLATE T1 ST QLDOXYCYCLINE IR-DR T1 QLDOXYCYCLINE MONOHYDRATE T1 QLMINOCIN T3MINOCYCLINE HCL T1MINOCYCLINE HCL ER T1 ST QLMINOLIRA ER T3 PA QLMONDOXYNE NL T1MONODOX T3 STMORGIDOX T1NUZYRA T3 PAOKEBO T1ORACEA T3 PA QLSEYSARA T3 PA QLSOLOXIDE T1TARGADOX T3 STTETRACYCLINE HCL T1VIBRAMYCIN T3 STXIMINO T3 PA

MINOCYCLINE HCL T1MINOCYCLINE HCL ER T1 ST QL

THYROGEN T3 S PA

TETRACYCLINES

THYROID PREPS

TETRACYCLINES

THYROID FUNCTION DIAGNOSTIC AGENTS

THYROID HORMONES

TETRACYCLINE ANTIBIOTICS


PRODUCT TIER UTILIZATION MANAGEMENTARMOUR THYROID T3CYTOMEL T3EUTHYROX T1LEVO-T T1LEVOTHYROXINE SODIUM T1LEVOXYL T1LIOTHYRONINE SODIUM T1NATURE-THROID T3NP THYROID T1SYNTHROID T2THYROID T1THYROLAR-1 T3THYROLAR-1/2 T3THYROLAR-1/4 T3THYROLAR-2 T3THYROLAR-3 T3TIROSINT T3 QLTIROSINT-SOL T3 QLTRIOSTAT T3UNITHROID T1WESTHROID T3WP THYROID T3

DERMOTIC T3FLAC OTIC OIL T1FLUOCINOLONE ACETONIDE OIL T1

ACETIC ACID T1ACETIC ACID-ALUMINUM T1HYDROCORTISONE-ACETIC ACID T1

CETRAXAL T3 QLCIPROFLOXACIN HCL T1 QLCOLY-MYCIN S T3 QLFLOXIN T3 QLNEOMYCIN-POLYMYXIN-HC T1 QLNEOMYCIN-POLYMYXIN-HYDROCORT T1 QLOFLOXACIN T1 QLOTIPRIO T3

BECONASE AQ T3 QLBUDESONIDE T1 QL

TOPICAL NASAL AND OTIC PREPARATIONSEAR PREPARATIONS ANTI-INFLAMMATORY

EAR PREPARATIONS, MISC. ANTI-INFECTIVES

EAR PREPARATIONS,ANTIBIOTICS

NASAL ANTI-INFLAMMATORY STEROIDS


PRODUCT TIER UTILIZATION MANAGEMENTFLUNISOLIDE T1 QLFLUTICASONE PROPIONATE T1 QLMOMETASONE FUROATE T1 QLNASONEX T3 QLOMNARIS T3 QLQNASL T3 QLQNASL CHILDREN T3 QLTRIAMCINOLONE ACETONIDE T1 QLXHANCE T3 ST QLZETONNA T3 QL

ASTEPRO T3 QLAZELASTINE HCL T1 QLOLOPATADINE HCL T1 QLPATANASE T3 QL

DYMISTA T2 QL

BACTROBAN NASAL T2 PA

IPRATROPIUM BROMIDE T1 QL

ADRENALIN CHLORIDE T3 PATYZINE T3

NASAL SPRAY ORIGINAL T1

CIPRO HC T3 QLCIPRODEX T2 QLOTOVEL T3

PRIMSOL T3TRIMETHOPRIM T1TRIMPEX T3 QL

CYSTEX PLUS T3HIPREX T3HYOPHEN T1ME-NAPHOS-MB-HYO 1 T1METHENAMINE HIPPURATE T1METHENAMINE MANDELATE T1

TRIMETHOPRIM

URINARY ANTIBACTERIALS

NOSE PREPARATIONS, VASOCONSTRICTORS (RX)

NOSE PREPARATIONS, VASOCONSTRICTORS(OTC)

OTIC PREPARATIONS,ANTI-INFLAMMATORY-ANTIBIOTICS



NASAL ANTIHISTAMINE

NASAL ANTIHISTAMINE AND ANTI-INFLAM. STEROID COMB.

NOSE PREPARATIONS ANTIBIOTICS

NOSE PREPARATIONS, MISCELLANEOUS (RX)


PRODUCT TIER UTILIZATION MANAGEMENTPHOSPHASAL T1PROSED-DS T3UR N-C T1URELLE T1URETRON D-S T1URIBEL T1 QLURIMAR-T T1URIN D.S. T1URO-458 T1UROGESIC-BLUE T3URYL T1USTELL T1UTA T1UTIRA-C T1

FURADANTIN T3MACROBID T3MACRODANTIN T3NITROFURANTOIN T1NITROFURANTOIN MONO-MACRO T1

LEVAQUIN T3 QLLEVOFLOXACIN T1 QLLEVOFLOXACIN-D5W T1

LEVOFLOXACIN T1 QL

FEM PH T3

DILATRATE-SR T3 QLGONITRO T3 PA QLISOCHRON T1 QLISORDIL T3 QLISORDIL TITRADOSE T3 QLISOSORBIDE DINITRATE T1 QLISOSORBIDE DINITRATE ER T1 QLISOSORBIDE MONONITRATE T1 QLISOSORBIDE MONONITRATE ER T1 QLMINITRAN T1 QLNITRO-BID T2 QLNITRO-DUR T3 QL

VAGINAL ANTISEPTICS

VASODILATORS,CORONARY

VAGINAL CLEANSERS

VASODILATORS CORONARY

QUINOLONE ANTIBIOTICS

QUINOLONES

NITROFURAN DERIVATIVES ANTIBACTERIAL AGENTS


PRODUCT TIER UTILIZATION MANAGEMENTNITRO-TIME T1 QLNITROGLYCERIN T1 QLNITROGLYCERIN IN D5W T1NITROGLYCERIN PATCH T1 QLNITROLINGUAL T3 QLNITROMIST T3 QLNITROSTAT T3 QL

ERGOLOID MESYLATES T1ISOXSUPRINE HCL T1PAPAVERINE HCL T1

MEPHYTON T3PHYTONADIONE T1VITAMIN K1 T1

CITRUS BIOFLAVONOIDS T3

NIACIN T1

ARKALIOX T1NEPHRONEX-SL T1POTABA T3

THIAMINE HCL T1

B-12 COMPLIANCE T3CYANOCOBALAMIN INJECTION T1HYDROXOCOBALAMIN T1NASCOBAL T3VITAMIN B-12 T1

PYRIDOXINE HCL T1

ASCOR T3ASCORBIC ACID T1

AMINOPHYLLINE T1CAFFEINE CITRATE T1

WATER SOLUBLE VITAMINS

XANTHINE DERIVATIVES

VASODILATORS PERIPHERAL

VITAMIN K

VITAMIN B12 PREPARATIONS


VITAMIN C PREPARATIONS

XANTHINES

VASODILATORS,PERIPHERAL

VITAMIN K PREPARATIONS

BIOFLAVONOIDS

NIACIN PREPARATIONS

VITAMIN B PREPARATIONS



PRODUCT TIER UTILIZATION MANAGEMENTELIXOPHYLLIN T3THEO-24 T3THEOCHRON T1THEOPHYLLINE T1THEOPHYLLINE ANHYDROUS T1THEOPHYLLINE IN 5% DEXTROSE T1


SmithRx Standard Formulary · 2019-10-31 · + SmithRx Standard Formulary Understanding the costs...

Documents

Transcript of SmithRx Standard Formulary · 2019-10-31 · + SmithRx Standard Formulary Understanding the costs...