Your 2019-2020 Prescription Drug List

Maricopa County OptumRx® HDHP Prescription Plan – effective July 1, 2019

Your 2019-2020 Prescription Drug List

Maricopa CountyOptumRx® HDHP Prescription Plan

Your Prescription Drug ListThis Prescription Drug List (PDL) outlines the most commonly prescribed medications for certain conditions and organizes them into cost levels, also known as tiers. An important part of the PDL is giving you choices so you and your doctor can choose the best course of treatment for you.

Go to myuhc.com® for complete drug informationSince the PDL may change, we encourage you to visit our website, myuhc.com. This website is the best source for up-to-date information about the medications your prescription benefit covers, possible lower-cost options, and cost comparisons.

At UnitedHealthcare, we want to help you …

Table of contentsDrug Tiers and Cost . . . . . . . . . . . 1

Programs and Limits . . . . . . . . . . 2

Drugs by Category . . . . . . . . . . . . 5

Anti-InfectivesAntibiotics . . . . . . . . . . . . . . . . . . . . . 5Antifungals . . . . . . . . . . . . . . . . . . . . 5Antivirals . . . . . . . . . . . . . . . . . . . . . . 5

Breast Cancer Prevention . . . . . . 5

Cancer . . . . . . . . . . . . . . . . . . . . . . . 5

Cardiovascular/Heart DiseaseBlood Clot/Platlet Therapy . . . . . . . 5Coagulation Therapy. . . . . . . . . . . . 6High Blood Pressure . . . . . . . . . . . . 6High Cholesterol . . . . . . . . . . . . . . . 7Other . . . . . . . . . . . . . . . . . . . . . . . . . 7

Central Nervous SystemAttention Deficit Disorder . . . . . . . . 7Depression . . . . . . . . . . . . . . . . . . . . 7Mental Health . . . . . . . . . . . . . . . . . . 8Migraine . . . . . . . . . . . . . . . . . . . . . . 8Multiple Sclerosis. . . . . . . . . . . . . . . 8Other . . . . . . . . . . . . . . . . . . . . . . . . . 8Sedatives/Hypnotics . . . . . . . . . . . . 8Seizure Disorders. . . . . . . . . . . . . . . 9

Dermatology . . . . . . . . . . . . . . . . . . 9

Diabetes/EndocrineBlood Glucose Monitoring . . . . . . . 9Insulin . . . . . . . . . . . . . . . . . . . . . . . . 10Non-Insulin . . . . . . . . . . . . . . . . . . . . 10

EndocrineGrowth Hormone. . . . . . . . . . . . . . . 10Other . . . . . . . . . . . . . . . . . . . . . . . . . 10Thyroid Hormone Replacement . . 10

Eye ConditionsAllergies. . . . . . . . . . . . . . . . . . . . . . . 10Antibiotics . . . . . . . . . . . . . . . . . . . . . 11Dry Eye Disease . . . . . . . . . . . . . . . . 11Glaucoma . . . . . . . . . . . . . . . . . . . . . 11

GastrointestinalAcid Suppression . . . . . . . . . . . . . . 11Nausea/Vomiting . . . . . . . . . . . . . . . 11Other . . . . . . . . . . . . . . . . . . . . . . . . . 11

Gout . . . . . . . . . . . . . . . . . . . . . . . . . 11

Hepatitis C. . . . . . . . . . . . . . . . . . . . 11

HIV/AIDS . . . . . . . . . . . . . . . . . . . . . 12

Infertility. . . . . . . . . . . . . . . . . . . . . . 12

Inflammatory Conditions: Rheumatoid Arthritis, Crohn’s Disease, Psoriasis, Ulcerative Colitis. . . . . . . 12

Miscellaneous . . . . . . . . . . . . . . . . 12

MusculoskeletalMuscle Spasms . . . . . . . . . . . . . . . . 13Osteoporosis . . . . . . . . . . . . . . . . . . 13Pain Relief . . . . . . . . . . . . . . . . . . . . . 13

Overactive Bladder . . . . . . . . . . . . 13

RespiratoryAllergies. . . . . . . . . . . . . . . . . . . . . . . 13Asthma/COPD . . . . . . . . . . . . . . . . . 14Pulmonary Arterial Hypertension . 14

Smoking Cessation . . . . . . . . . . . . 14

Transplant . . . . . . . . . . . . . . . . . . . . 14

Vitamins/Electrolytes . . . . . . . . . . 14

Women’s Health:Contraceptives . . . . . . . . . . . . . . . . . 15Hormone Replacement . . . . . . . . . 16Miscellaneous . . . . . . . . . . . . . . . . . 16

http://myuhc.com

Understand your medications optionsYour prescription benefit offers flexibility and choice in determining the right medication for you. To help you get the most out of your prescription benefit, we’ve included some of the most commonly asked questions about the Prescription Drug List.

What is a Prescription Drug List (PDL)?This document is a list of commonly prescribed medications. Drugs are listed by common categories or class. They are placed into cost levels known as tiers. It includes both brand and generic prescription medications approved by the U.S. Food and Drug Administration (FDA).

Please note: Where differences are noted between this PDL and your benefit plan documents, the benefit plan documents will rule. It is not a complete list of medications. Please look at your benefit plan documents provided by your employer or health plan to see what medications are covered under your plan. You may also log on to myuhc.com or call the toll-free member phone number on your health plan ID card for more information.

How do I use my Prescription Drug List?When choosing a medication, you and your doctor should consult the PDL. It will help you and your doctor choose the most cost-effective prescription drugs. This guide tells you if a medication is generic or brand, and if special programs apply. Bring this list with you when you see your doctor. It is organized by common medical conditions. Medications are then listed alphabetically.

If your medication is not listed in this document, please visit myuhc.com or call the toll-free member phone number on your health plan ID card.

What are tiers?Tiers are the different cost levels you pay for a medication. Each tier is assigned a cost, which is determined by your employer or health plan. This is how much you will pay when you fill a prescription. Tier 1 medications are your lowest-cost options. If your medication is placed in Tier 2 or 3, look to see if there is a Tier 1 option available. Discuss these options with your doctor.

Check your benefit plan documents to find out your specific pharmacy plan costs.

Drug Tier DescriptionTier 1 Lowest Cost

Lower-cost drugs. Some brands and generics are also included.Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2 Mid-range Cost

Mix of brands and generics.Use Tier 2 drugs, instead of Tier 3 to help reduce your out-of-pocket costs.

Tier 3 Highest Cost

Mostly higher-cost brand as well as select generic drugs.Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Please note: If you have a high deductible health plan, the tier cost levels may apply once you hit your deductible. Refer to your enrollment and plan materials on myuhc.com, or call the toll-free number on your health plan ID card for more information about your benefit plan.

Please read: This document contains information about commonly prescribed medications.

For additional information:Call us toll-free at 1-888-876-7098, TTY 711 Habla Español? Podemos ayudar.

Visit myuhc.com®• Locate a participating retail pharmacy by ZIP code.

• Look up possible lower-cost medication alternatives.

• Compare medication pricing and options.

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Maricopa CountyPrescription Drug List

http://myuhc.com

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When does the Prescription Drug List change?• Medications may move to a lower tier at any time.

• Medications may move to a higher tier when a generic becomes available.

• Medications may move to a higher tier or be excluded from coverage on July 1.

When a medication changes tiers, you may have to pay a different amount for that medication. For the most up-to-date list, call customer service at the number on your ID card.

Why are some medications excluded from coverage?Medications may be excluded from coverage under your prescription benefit when it works the same or similar as another prescription medication or an over-the-counter (OTC) medication. There may be other medication options available.

Should I talk to my doctor about over-the-counter (OTC) medications?An over-the-counter (OTC) medication may be the right treatment for some conditions. Talk to your doctor about available OTC options.

What is the difference between brand-name and generic medications?Generic medications contain the same active ingredients (what makes the medication work) as brand-name medications, but they often cost less. Once the patent of a brand-name medication ends, the FDA can approve a generic version with the same active ingredients. These types of medications are known as generic medications. Sometimes, the same company that makes a brand-name medication also makes the generic version.

Is it a generic or brand-name drug? The drug list shows brand-name drugs in blue type (for example, Invokana) and generic drugs in plain type (for example, Metformin).

Programs and LimitsSome medications are noted with letters next to them. The letters refer to our pharmacy benefit programs. Your benefit plan determines how these medications are covered. Call the number for Member Services listed on your ID card if you have any questions about your prescription drug coverage.

Code Pharmacy Benefit Programs

DSPDesignated Specialty ProgramSpecialty medications need to be filled at a designated specialty pharmacy for in-network coverage. Call the number on your ID card or call 1-855-427-4682 for more information.

H Health Care Reform PreventiveThis medication is part of a health care reform preventive and may be available at no cost to you.

PPreventive MedicationMedications are not subject to the deductible. Medications listed in Tier 1 and Tier 2 are not subject to coinsurance. Medications listed in Tier 3 are subject to 50% coinsurance.

PA Prior Authorization Required*Your doctor is required to provide additional information to us to determine coverage.

SL Supply LimitAmount of medication covered in a specific time period.

ST Step TherapyTrial of a different medication is required before another medication may be covered.

*Depending on your benefit you may have notification or prior authorization requirements for select medications.

To learn more about a pharmacy program or to find out if it applies to you, please visit myuhc.com or call the toll-free member phone number on your health plan ID card.

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http://myuhc.com

What if my doctor writes a brand-name prescription?The next time your doctor gives you a prescription for a brand-name medication, ask if a generic equivalent or lower-cost option is available and if it might be right for you. Generic medications are usually your lowest-cost option, but not always. For your benefit plan if a brand-name drug is prescribed and a generic equivalent is available, your cost share will be the coinsurance for the brand-name drug PLUS the cost difference between the brand-name drug and generic equivalent.

Are you taking a specialty medication?Specialty medications are high-cost and are used to treat rare or complex conditions that require additional care and support. For your plan, these medications are managed through the Specialty Pharmacy Program. Take advantage of personalized support designed to help you get the most out of your treatment plan. Visit UHCSpecialtyRx.com or call the toll-free phone number on your health plan ID card to learn more. Please note, not all specialty medications are listed here. If you’re taking a specialty medication that is on Tier 3, call the toll-free number on your health plan ID card to talk with a pharmacist about finding a lower-cost one.

How do I get updated information about my prescription benefit?Since the PDL may change during your plan year, we encourage you to visit myuhc.com or call the toll-free member phone number on your health plan ID card for more current information.

Log on to myuhc.com for the following prescription information and tools:

• Prescription benefit and coverage information

• Possible lower-cost medication options

• Medication interactions and side effects

• Participating retail pharmacies by ZIP code

• Your prescription history

Mail Service is included in your prescription benefit, you can also:

• Refill prescriptions

• Check the status of your order

• Set-up e-mail reminders for refills

• Manage your account

In certain documents, the Prescription Drug List (PDL) was referred to as the “Preferred Drug List (PDL).” This change in terms does not affect your benefit coverage .Medications are categorized by common therapeutic conditions in this PDL for ease of reference only. These categories do not determine coverage for the medication for your condition. Your benefit plan determines coverage for these medications .

For more informationCall the toll-free member phone number on your health plan ID card.

Or, visit myuhc.com®

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http://UHCSpecialtyRx.com

http://myuhc.com

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“My Medications” worksheetTake this worksheet with you each time you visit a doctor. Each of your doctors should be aware of every drug you take and you should have a list as well.

Name of medicine and strength

Drug Tier

I take this medicine for Directions Doctor

Example: Lisinopril, 20mg Tier 1 High blood pressure One tablet daily Dr . Johnson

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Blue type = Brand-name drugPlain type = Generic drug

DSP = Designated specialty programP = Preventive MedicationH = Health care reform preventive

PA = Prior authorization requiredSL = Supply limitST = Step therapy

Drug NameDrug Tier

Requirement and Limits

Anti-Infectives: Antibiotics

Amoxicillin Capsule, Chewable Tablet 1

Amoxicillin/Potassium Clavulanate Chewable Tablet, Tablet

1

Azithromycin Tablet 1

Cefadroxil Capsule, Tablet 1

Cefdinir Capsule 1

Cefixime Suspension 3

Cefprozil Tablet 1

Cefuroxime Tablet 1

Cephalexin Capsule 1

Ciprodex 3

Ciprofloxacin Tablet 1

Clarithromycin Tablet 1

Clindamycin Capsule 1

Dificid 3 SL

Doxycycline Hyclate 50, 100 mg Capsule, Tablet

2

Doxycycline Monohydrate 50, 100 mg Capsule

1

Levofloxacin Tablet 1

Metronidazole Tablet 1

Minocycline Capsule 1

Moxifloxacin Tablet 3

Nitrofurantoin Capsule 1

Nitrofurantoin Macrocrystal Capsule 1

Ofloxacin Otic Solution 2

Ofloxacin Tablet 1

Penicillin V Potassium Tablet 1

Sulfamethoxazole-Trimethoprim Tablet 1

Suprax Capsule, Chewable Tablet, Tablet

3

Anti-Infectives: Antifungals

Cresemba 3 SL

Econazole Cream 3 SL

Fluconazole Tablet 1

Itraconazole Capsule 1 SL

Ketoconazole Cream 1

Noxafil Tablet, Suspension 2

Nystatin Cream, Ointment 1

Terbinafine Tablet 1 SL

Drug NameDrug Tier


Anti-Infectives: Antivirals

Acyclovir Ointment 3 PA, SL, ST

Acyclovir Tablet 1

Famciclovir Tablet 2

Oseltamivir Capsule 2 SL

Valacyclovir Tablet 1 SL

Valganciclovir 1 SL

Breast Cancer Prevention

Anastrozole 1 P

Aromasin 2 P

Exemestane 2 P

Fareston 2 P

Cefixime Suspension 1 P

Letrozole 1 P

Tamoxifen 1 P

Cancer

Alunbrig 2 DSP, SL, PA

Bicalutamide 1

Bosulif 2 DSP, PA, SL, ST

Cyclophosphamide Capsule 2

Hydroxyurea Capsule 1

Imatinib Tablet 1 DSP, PA, SL

Idhifa 2 DSP, SL, PA

Imbruvica 2 DSP, PA, SL

Leucovorin Calcium Tablet 1

Mercaptopurine Tablet 1

Revlimid 2 DSP, PA, SL

Rydapt 2 DSP, SL, PA

Sutent 2 DSP, PA, SL

Targretin Capsule 2 DSP

Targretin Gel 3 SL

Tasigna 2 DSP, PA, SL, ST

Xeloda 1 DSP, SL

Zykadia 2 DSP, SL, PA

Zytiga 2 DSP, PA, SL

Cardiovascular/Heart Disease: Blood Clot/Platelet Therapy

Aggrenox 2 P

Aspirin-Dipyidamole 1 P

2019-2020 Prescription Drug List

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Drug NameDrug Tier


Brilinta 3 P

Cilostazol 1 P

Clopidogrel 1 P

Coumadin 3 P

Dipyridamole 1 P

Effient 3 P

Eliquis 3 SL, P

Enoxaparin 2 P

Enoxaparin Sodium 2 SL, P

Fondaparinux 2 P

Heparin 1 P

Lovenox 2 P

Persantine 1 P

Pletal 1 P

Pradaxa 2 SL, P

Savaysa 3 SL, P

Warfarin 1 P

Warfarin Sodium 1 P

Xarelto 2 SL, P

Zontivity 3 P

Cardiovascular/Heart Disease: Coagulation Therapy

Bevyxxa 3 SL

Prasurgel 1 SL

Cardiovascular/Heart Disease: High Blood Pressure

Accuretic 2 P

Acebutolol 1 P

Aldactazide 2 P

Altace 2 P

Amlodipine 1

Amlodipine-Benazepril 1 P

Amlodipine-Valsartan 2 P

Amiloride 1 P

Amiloride-Hydrochlorothiazide 1 P

Atenolol 1 P

Atenolol-Chlorthalidone 1 P

Benazepril 1 P

Benazepril-Hydrochlorothiazide 1 P

Bidil 2 P

Bisoprolol 1 P

Bisoprolol-Hydrochlorothiazide 1 P

Bumetanide 1 P

Drug NameDrug Tier


Bystolic 2 P

Candesartan 3 P

Candesartan-Hydrochlorothiazide 3 P

Cartia XT 2 P

Carvedilol 1 P

Chlorthalidone 1

Chlorothiazide 1 P

Clonidine Patch 3 P

Clonidine Tablet 1 P

Clorpress 2 P

Coreg 3 P

Diltiazem 1 P

Diltiazem Extended Release Table 1 P

Diltiazem 24 Hour CD 2 P

Diltiazem Sustained-Release Capsule 2 P

Diltiazem Sustained-Release Tablet 2 P

Doxazosin 1 P

Edarbi 3 SL, P

Edarbyclor 3 SL, P

Enalapril 1 P

Eplerenone 2 P

Eprosartan 3 P

Furosemide 1 P

Guanfacine 1 P

Hydralazine 1 P

Hydrochlorothiazide 1 P

Irbesartan 1 P

Irbesartan-Hydrochlorothiazide 1 P

Labetalol 1 P

Lisinopril 1 P

Lisinopril-Hydrochlorothiazide 1 P

Losartan 1 P

Losartan-Hydrochlorothiazide 1 P

Metolazone 1 P

Metoprolol-Hydrochlorothiazide 1 P

Metoprolol Succinate 50, 100, 200 mg 2 P

Metoprolol Tartrate 25, 50, 100 mg 1 P

Nadolol 1 P

Nifedipine 1 P

Nifedipine Extended-Release 1 P

Nimodipine 1 P

Nisoldipine 1 P

Olmesartan 2 SL, P

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Drug NameDrug Tier


Olmesartan-Hydrochlorothiazide 2 SL, P

Prazosin 1 P

Propranolol-Hydrochlorothiazide 1 P

Propranolol Extended-Release Capsule

2 P

Propranolol Tablet 1 P

Quinapril 1 P

Quinapril-Hydrochlorothiazide 2 P

Ramipril 1 P

Spironolactone 1 P

Tekturna 3 P

Tekturna-Hydrochlorothiazide 2 P

Telmisartan 2 P

Telmisartan-Hydrochlorothiazide 2 P

Terazosin 1 P

Trandolapril 1 P

Trandolapril-Verapamil 3 P

Triamterene-Hydrochlorothiazide 1 P

Valsartan 2 P

Valsartan-Hydrochlorothiazide 1 P

Cardiovascular/Heart Disease: High Cholesterol

Atorvastatin 1 SL, P

Cholestyramine 1 P

Cholestyramine Light 1 P

Colestipol 1 P

Ezetimibe Tablet 3 SL P

Fenofibrate 54, 160 mg Tablet 2 P

Fluvastatin 1 P

Fluvastatin Extended-Release Tablet 3 SL, ST, P

Gemfibrozil 1 P

Lovastatin 1 P

Niacin Extended-Release Tablet 3 P

Niaspan 2 P

Omega-3-Acid Ethyl Esters Capsule 3 PA, P

Praluent 2 DSP, PA, SL, ST

Pravastatin 1 P

Repatha 140 mg 3 DSP, PA, SL, ST

Rosuvastatin 2 SL, P

Simvastatin 1 P

Simvastatin/Ezetimibe 3 P, PA

Vascepa 3 P, PA

Welchol 2 P

Drug NameDrug Tier


Cardiovascular/Heart Disease: Other

Amiodarone 1

Corlanor 3 PA, SL

Digoxin 1

Entresto 3 PA, SL

Flecainide 1

Isosorbide Mononitrate ER 1

Multaq 3 PA

Nitroglycerin Sublingual Tablet 1

Ranexa 2

Sotalol 1

Central Nervous System: Attention Deficit Disorder

Adderall XR 2 PA, SL

Amphetamine Salt Combo 1 PA

Atomoxetine 1 SL

Concerta 2 PA, SL

Dexmethylphenidate Immediate-Release Capsule

1 PA

Dextroamphetamine-Amphetamine Immediate-Release Capsule

1 PA

Dextroamphetamine Sulfate Immediate-Release Tablet

3 PA

Guanfacine Extended-Release 2 SL

Methylphenidate Chewable Tablet 3 PA

Methylphenidate Extended-Release Capsule (generic Metadate CD, Ritalin LA)

2 PA, SL

Methylphenidate Extended-Release Tablet (Metadate ER)

Methylphenidate Tablet 1 PA

Vyvanse 2 PA, SL

Central Nervous System: Depression

Amitriptyline Tablet 1

Bupropion Extended-Release Tablet 1

Bupropion Sustained-Release Tablet 1

Bupropion Tablet 1

Citalopram Tablet 1

Desvenlafaxine Extended-Release Tablet 1 SL

Doxepin 1

Duloxetine Capsule 3 SL

Escitalopram Tablet 1

Fetzima 3 SL, ST

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Drug NameDrug Tier


Fluoxetine Tablet, Capsule (generic Prozac)

1

Fluvoxamine Tablet 1

Mirtazapine Tablet 1

Nortriptyline Capsule 1

Paroxetine Tablet 1

Sertraline Tablet 1

Trazodone Tablet 1

Trintellix 3 SL, ST

Venlafaxine Extended-Release Capsule 1

Venlafaxine Tablet 1

Viibryd 3 SL

Central Nervous System: Mental Health

Aripiprazole Tablet 2 P

Chlorpromazine 1 P

Clozapine 1 P

Fanapt 3 P

Haloperidol 1 P

Latuda 3 P

Olanzapine Tablet 3 P

Palperdone ER 1 P

Perphenazine 1 P

Quetiapine 1 P

Quetiapine ER 3 P

Rexulti 3 P

Risperidone Tablet 1 P

Saphris 3 P

Vraylar 3 P

Ziprasidone 2 P

Central Nervous System: Migraine

Acetaminophen/Butalbital/Caffeine 325 mg/50 mg/40 mg

1 SL

Aimovig 2 PA, ST, SL

Eltriptan 1 SL

Emgality 2 PA, ST, SL

Frovatriptan 3 SL

Naratriptan 1 SL

Rizatriptan ODT, Tablet 1 SL

Sumatriptan Nasal Spray 2 SL

Sumatriptan Succinate Tablet, Injection 1 SL

Drug NameDrug Tier


Central Nervous System: Multiple Sclerosis

Aubagio 3 DSP, PA, SL, P

Avonex 2 DSP, PA, SL, P

Betaseron 2 DSP, PA, SL, P

Dalfampridine er 2 DSP, PA, SL, P

Gilenya 3 DSP, PA, SL, P

Glatiamer acetate 2 DSP, PA, SL, P

Plegridy 3 DSP, PA, SL, P

Rebif 3 DSP, PA, SL, ST, P

Tecfidera 2 DSP, PA, SL, P

Zinbryta 3 DSP, PA, SL, P

Central Nervous System: Other

Alprazolam Extended-Release Tablet 1

Alprazolam Tablet 1

Aripiprazole Tablet 2 SL

Armodafinil 1 PA, SL

Austedo 2 DSP, PA, SL

Buspirone Tablet 1

Carbidopa-Levodopa 1

Diazepam Tablet 1

Donepezil 5, 10 mg ODT, Tablet 1

Ingrezza 3 DSP, PA, SL

Latuda 3 SL

Lithium Capsule 1

Lorazepam Tablet 1

Memantine Tablet 2

Modafinil Tablet 3 PA, SL

Naloxone Vials 1

Narcan Nasal Spray 2 SL

Olanzapine Tablet 1 SL

Pramipexole Tablet 1

Quetiapine Extended-Release Tablet 3 SL

Quetiapine Tablet 1

Risperidone Tablet 1

Ropinirole Tablet 1

Tolcapone 2

Xyrem 3 PA, SL

Zelapar 3

Ziprasidone Capsule 2 SL

Zubsolv 2 SL

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Drug NameDrug Tier


Central Nervous System: Sedatives/Hypnotics

Eszopiclone Tablet 2

Temazepam Capsule 1

Triazolam Tablet 1

Zaleplon Capsule 1

Zolpidem Tablet 1

Central Nervous System: Seizure Disorders

Carbamazepine Extended-Release Capsule

2

Carbamazepine Extended-Release Tablet

3

Carbamazepine Immediate-Release Tablet

1

Clonazepam Tablet 1

Diazepam Tablet 1

Divalproex Delayed-Release Tablet 1

Divalproex Extended-Release Tablet 2

Gabapentin Capsule, Tablet 1

Lamotrigine Immediate-Release Tablet 1

Levetiracetam Extended-Release Tablet 2

Levetiracetam Immediate-Release Tablet

1

Lyrica 3 SL, ST

Oxcarbazepine Tablet 1

Phenytoin Capsule, Suspension 1

Topiramate Immediate-Release Tablet 1

Zonisamide Capsule 1

Dermatology

Aczone 3 SL

Betamethasone Dipropionate 0.05% Augmented Lotion, Ointment

3

Betamethasone Dipropionate 0.05% Cream, Ointment

2

Calcipotriene/Betamethasone Ointment 3 SL

Carac 2

Ciclopirox Cream, Gel, Lotion, Solution 1

Claravis 2 PA

Clindamycin 1.2%/Benzoyl Peroxide 5% Gel

3 SL

Clindamycin Gel 3 SL

Clindamycin Lotion 3

Clindamycin Solution, Swabs 1

Clobetasol Propionate Cream, Ointment 2 SL

Drug NameDrug Tier


Clotrimazole-Betamethasone Cream 1 SL

Clotrimazole-Betamethasone Lotion 1

Desonide 0.05% Cream, Lotion, Ointment

3 SL

Diflorasone Diacetate 0.05% Cream, Ointment

3 SL

Dupixent 3 DSP, PA, SL, ST

Elidel 3 SL, ST

Enstilar Foam 3 SL

Eucrisa 3

Finacea 3

Fluocinolone Cream, Oil, Solution 3 SL

Fluocinolone Ointment 2 SL

Fluocinonide 0.05% Cream 1

Fluorouracil 0.5% Cream 3 SL

Halobetasol Ointment 2

Hydrocortisone 2.5% Cream, Ointment 1

Imiquimod 5% Cream 1 SL

Metronidazole 0.75% Topical Gel 1

Mirvaso 3 SL

Mometasone Furoate Cream, Lotion, Ointment

1

Mupirocin Ointment 1

Oracea 3

Oxsoralen-Ultra 2

Picato 3 SL

Regranex 2 PA, SL

Taclonex Suspension 3 SL

Rhofade 3 PA, SL

Tacrolimus Ointment 2 PA, SL

Tazorac 0.1% Cream 1 PA, SL

Tazorac Gel, 0.05% Cream 3 PA, SL

Tretinoin Cream 3 PA, SL

Triamcinolone Acetonide Cream, Lotion, Ointment

1

Vectical 3 SL

Diabetes: Blood Glucose Monitoring

Contour Next 2

Contour Next EZ 2

Countour Next One 2

Contour Next Test Strips 2 SL

OneTouch Test Strips 1 SL

OneTouch Ultra Mini 1

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Drug NameDrug Tier


OneTouch Ultra Test Strips 1 SL

OneTouch Verio 1

OneTouch Verio Flex 1

OneTouch Verio IQ 1

OneTouch Verio Sync 1

OneTouch Verio Test Strips 1 SL

Diabetes: Insulin

Basaglar 1 SL, P

Humalog KwikPens (all formulations) 2 SL

Humalog Vials (all formulations) 1 SL, P

Humulin KwikPens (all formulations) 2 SL

Humulin Vials (all formulations) 1 SL, P

Levemir FlexTouch 3 SL

Levemir Vials 3 SL, P

Soliqua 2 PA, SL, P

Diabetes: Non-Insulin

Adlyxin 3 SL, P

Bydureon 2 SL, P

Byetta 2 SL, P

Glimepiride 1 P

Glipizide 1 P

Glipzide-Metformin 2 P

Glipizide Extended-Release 1 P

Glyburide 1 P

Glyburide Micronized 1 P

Glyburide-Metformin 1 P

Glyxambi 2

Invokamet 2 SL, P

Invokamet XR 2 SL, P

Invokana 2 SL, ST, P

Janumet 3 SL, ST, P

Janumet XR 3 P, SL, ST

Januvia 3 SL, ST, P

Jardiance 2 SL, ST, P

Jentadueto 2 SL, P

Jentadueto XR 2 SL, P

Kazano 2 SL, P

Kombiglyze XR 2 SL, P

Metformin 1 P

Metformin Extended-Release Tablet (generic Glucophage XR)

1 P

Drug NameDrug Tier


Nesina 2 SL, P

Onglyza 2 SL, P

Oseni 2 SL, P

Ozempic 3 PA, SL

Pioglitazone 1 SL, P

Pioglitazone-Glimepiride 1 P, SL

Pioglitazone-Metformin 2 P, SL

Repaglinide 2 P, SL

Synjardy 2 SL, P

Tanzeum 2 P, SL

ACTOplus Met 2 P, SL

ACTOplus Met XR 3 P, SL

Soliqua 2 PA, SL

Tradjenta 2 SL, P

Tresiba 2 SL

Trulicity 3 SL, P

Victoza 2-Pak 2 SL, P

Victoza 3-Pak 3 SL, P

Endocrine: Growth Hormone

Nutropin, Nutropin AQ 2 DSP, PA, SL

Endocrine: Other

Calcitriol Capsule 1

Desmopressin Tablet 1

Dexamethasone Tablet 1

Methylprednisolone Tablet 1

Nocdurna 3 PA, SL

Prenisolone Oral Solution 1

Endocrine: Thyroid Hormone Replacement

Armour Thyroid 3

Levothyroxine Sodium Tablet 1

Liothyronine Sodium Tablet 2

Methimazole Tablet 1

NP Thyroid Tablet 1

Synthroid 2

Eye Conditions: Allergies

Azelastine 0.05% Ophthalmic Solution 1 SL

Lastacaft 3 SL

Olopatadine 0.1% Ophthalmic Solution 3 SL

10




Drug NameDrug Tier


Eye Conditions: Antibiotics

Erythromycin 0.5% Ophthalmic Ointment 1

Gentamicin Ophthalmic Ointment, Solution

1

Moxeza 3

Moxifloxacin Opthalmic Solution 1

Ofloxacin 0.3% Ophthalmic Solution 1

Tobramycin/Dexamethasone 0.3%-0.1% Ophthalmic Suspension

2

Tobramycin Ophthalmic Solution 1

Eye Conditions: Dry Eye Disease

Restasis Single Use Vials 3 PA, SL

Xiidra 3 PA, SL

Eye Conditions: Glaucoma

Alphagan P 0.1% 2 SL

Azopt 2 SL

Combigan 2 SL

Latanoprost 0.005% Ophthalmic Solution

1

Lumigan 2 SL

Timolol Maleate 0.25%, 0.5% Ophthalmic Solution

1

Travatan Z 2 SL

Gastrointestinal: Acid Suppression

Dexilant 3 SL

Omeclamox-Pak 3 SL

Omeprazole Capsule 1

Pantoprazole Tablet 1

Pylera 3 SL

Ranitadine Syrup 1

Rabeprazole Tablet 3 SL

Sucralfate Tablet 1

Gastrointestinal: Nausea/Vomiting

Akynzeo 3 SL

Aprepitant Capsule 2 SL

Emend Suspension 2 SL

Ondansetron 1

Ondansetron ODT 1

Transderm-Scop 3

Varubi 2 SL

Drug NameDrug Tier


Gastrointestinal: Other

Amitiza 3 PA, SL, ST

Apriso 2

Cortifoam 2

Creon 2

Diphenoxylate-Atropine Tablet 1

Golytely 2

Hyoscyamine Tablet 1

Lialda 2

Linzess 2 PA, SL

Mesalamine Suppositories 2

Metoclopramide Tablet 1

Moviprep 3

Plenvu 3

Polyethylene Glycol 3350 2

Prepopik 3

Suclear 3

Sulfasalazine Tablet 1

Suprep 3

Symproic 2 PA, SL

Uceris Foam 2

Uceris Tablet 3

Viberzi 3 PA, SL

Zenpep 2

Gout

Allopurinol Tablet 1

Mitigare 2

Uloric 3 SL, ST

Zurampic 3 PA, SL

Hepatitis C

Daklinza 3 DSP, PA, SL, ST

Epclusa 2 DSP, PA, SL

Harvoni 2 DSP, PA, SL

Mavyret 2 PA, SL, SP

Ribavirin Tablet 1 DSP

Sovaldi 2 DSP, PA, SL, ST

Technivie 3 DSP, PA, SL, ST

Viekira Pak 3 DSP, PA, SL, ST

Viekira XR 3 PA, SL, SP, ST

Vosevi 2 PA, SL, SP

Zepatier 2 DSP, PA, SL, ST

11





Drug NameDrug Tier


HIV/AIDS

Abacavir 1 DSP, P

Abacavir-Lamivudine 2 DSP, P

Abacavir-Lamivudine-Zidovudine 1 DSP, P

Aptivus 2 DSP, P

Atazanavir Capsule 1 SP, P

Cimduo 3 DSP, P

Complera 3 DSP, P

Crixivan 2 DSP, P

Descovy 3 DSP, P

Didanosine 1 DSP, P

Edurant 2 DSP, P

Efavirenz 1 DSP

Emtriva 2 DSP, P

Evotaz 2 DSP, P

Fuzeon 2 DSP, P

Genvoya 3 DSP, ST, P

Intelence 2 DSP, P

Isentress 2 DSP, P

Kaletra Tablet 2 DSP, P

Lamivudine 1 DSP, P

Lamivudine-Zidovudine 1 DSP, P

Lopinavir-Ritonavir Oral Solution 2 DSP, P

Nevirapine 1 DSP, P

Odefsey 3 DSP, P

Prezcobix 2 DSP, P

Prezista 2 DSP, P

Reyataz 2 DSP, P

Stavudine 1 DSP, P

Selzentry 2 DSP, PA, P

Stribild 3 DSP, ST, P

Sustiva 2 DSP, P

Symfi 2 DSP, P

Symfi Lo 2 DSP, P

Tenofovir Tablet 1 DSP

Tivicay 3 DSP, P

Triumeq 2 DSP, P

Truvada 3 DSP, PA, P

Tybost 2 DSP

Viracept 2 DSP, P

Viread 2 DSP, P

Viteka 2 DSP, P

Zidovudine 1 DSP, P

Drug NameDrug Tier


Infertility*

Cetrotide 2 DSP

Clomiphene 1 DSP

Crinone 2 PA, DSP

Endometrin 2 PA

Gonal-F 2 DSP

Ovidrel 3 DSP

Inflammatory Conditions: Rheumatoid Arthritis, Crohn’s Disease, Psoriasis, Ulcerative Colitis

Actemra 3 DSP, PA, SL, ST

Cimzia 2 DSP, PA, SL

Cosentyx 3 DSP, PA, SL, ST

Enbrel 3 DSP, PA, SL, ST

Haegarda 2 DSP, PA, SL

Humira 2 DSP, PA, SL

Hydroxychloroquine Sulfate 1

Kevzara 3 DSP, PA, SL, ST

Leflunomide 1

Methotrexate Tablet 1

Orencia 3 DSP, PA, SL, ST

Otezla 3 DSP, PA, SL, ST

Rasuvo 3 SL, ST

Siliq 3 DSP, PA, SL, ST

Simponi 2 DSP, PA, SL

Stelara 2 DSP, PA, SL

Takhzyro 2 DSP, PA, SL

Taltz 3 DSP, PA, SL, ST

Tremfya 2 DSP, PA, SL

Xeljanz 3 DSP, PA, SL, ST

Xeljanz XR 3 DSP, PA, SL, ST

Miscellaneous

Anastrozole Tablet 1

Aranesp 2 DSP, SL

Auryxia 3

Bethkis 2 DSP, PA, SL

Cayston 2 PA, SL

Cerdelga 2 DSP, PA

Chlorhexidine Gluconate 1

Chlorpheniramine/Hydrocodone/Pseudoephedrine Solution

2 SL

Epinephrine (generic EpiPen/EpiPen-Jr.)

2 SL

12




Drug NameDrug Tier


Hydrocodone/Chlorpheniramine 1 PA, SL

Lanthanum Chewable Tablet 1

Letrozole Tablet 1

Lidocaine Transdermal Patch 3 DSP, PA, SL

Mulpleta 2 DSP, P

Nityr 2 DSP, PA

Nuedexta 2

Obredon 3 SL, ST

Pegasys 2 DSP, PA, SL

Phenazopyridine 1

Procrit 2 DSP, SL

Promethazine/Codeine 1 SL

Promethazine/Dextromethorphan 1

Pulmozyme 2 DSP, PA, SL

Rectiv 3 SL

Rezira 3

Sevelamer 1

Syprine 3 DSP, PA

Tobi Podhaler 3 DSP, PA, SL

Velphoro 2

Veltassa 3 PA, SL

Zarxio 2 DSP

Musculoskeletal: Muscle Spasms

Baclofen Tablet 1

Carisoprodol 350 mg Tablet 1

Cyclobenzaprine 1

Metaxalone Tablet 3

Methocarbamol Tablet 1

Tizanidine Tablet 1

Musculoskeletal: Osteoporosis

Alendronate Sodium Tablet 1 P

Calcitonin 2 P

Forteo 2 DSP, PA, P

Ibandronate Tablet 2 SL, P

Raloxifene Tablet 2 P

Risedronate Sodium Tablet 3 SL, P

Tymlos 3 DSP, SP, P

Musculoskeletal: Pain Relief

Acetaminophen/Codeine Tablet 1 SL

Belbuca 3 PA, SL, ST

Drug NameDrug Tier


Celecoxib 2 SL

Diclofenac Tablet 1

Etodolac Capsule 1

Fentanyl 12, 25, 50, 75, 100 mcg Patch 2 SL

Fentanyl Citrate Lozenge 2 PA, SL

Hydrocodone/Acetaminophen 5/325, 7.5/325, 10/325 mg Tablet

1 SL

Hydrocodone/Ibuprofen Tablet 1

Hydromorphone Tablet 1

Ibuprofen Tablet 1

Indomethacin Capsule 1

Ketorolac Tablet 1

Lazanda 3 PA, SL

Meloxicam Tablet 1

Methadone Tablet, Oral Solution, Concentrate Solution

1 SL

Morphine Sulfate Extended-Release Tablet

1 SL

Morphine Sulfate Oral Solution 1

Nabumetone Tablet 1

Naproxen Tablet 1

Nucynta 3 SL

Nucynta ER 3 PA, SL

Oxycodone Tablet 1

Sprix 3

Tramadol-Acetaminophen 1

Tramadol Immediate-Release Tablet 1

Tramadol Sustained-Release Tablet 2 SL

Trezix 3 SL

Voltaren Gel 2

Xtampza ER 3 PA, SL

Zohydro ER 3 PA, SL, ST

Overactive Bladder

Dicyclomine Tablet 1

Oxybutynin Extended-Release Tablet 2

Oxybutynin Tablet 1

Toviaz 3

Respiratory: Allergies

Azelastine 0.1% Nasal Spray 3

Cyproheptadine Tablet 1

Fluticasone Nasal Spray 2 SL

Hydroxyzine Capsule, Tablet 1

13





Drug NameDrug Tier


Levocetirizine Tablet 1

Promethazine Tablet 1

Zetonna 3 SL

Respiratory: Asthma/COPD

Advair Diskus/HFA 3 SL, P

Aerospan 3 SL, P

Albuterol Nebs 1 P

Albuterol Sulfate Tablet 1 P

Alvesco 1 SL, P

Anoro Ellipta 3 SL, P

Arnuity Ellipta 3 SL, P

Asmanex TwistHaler, HFA 1 SL, P

Bevespi Aerosphere 2 SL, P

Breo Ellipta 3 SL, P

Budesonide Nebs 2 SL, P

Combivent Respimat 3 SL, P

Flovent Diskus/HFA 3 SL, P

Fluticasone/Salmerterol RespiClick 2 SL, P

Incruse Ellipta 2 SL, P

Ipratropium-Albuterol Nebs 1 P

Ipratropium Nebs 1 P

Levalbuterol HFA 3 SL, P

Metaproterenol 1 P

Perforomist 3 SL, P

ProAir HFA 3 SL, P

ProAir RespiClick 3 SL, P

Proventil HFA 3 SL, P

Pulmicort Flexhaler 3 SL, ST, P

QVAR 1 SL, P

Seebri Neohaler 3 SL, P

Serevent Diskus 3 SL, P

Spiriva Handihaler 2 SL, P

Spiriva Respimat 2 SL, P

Striverdi Respimat 2 SL, P

Symbicort 3 SL, P

Terbutaline 1 P

Trelegy Ellipta 3 SL, P

Tudorza 2 SL, P

Ventolin HFA 2 SL, P

Xopenex HFA 3 SL, P

Zafirlukast 1 P

Drug NameDrug Tier


Respiratory: Pulmonary Arterial Hypertension

Adempas 2 DSP, PA, SL

Letairis 2 DSP, PA, SL

Opsumit 2 DSP, PA, SL

Orenitram 3 DSP, PA, SL

Sildenafil Tablet 1 DSP, PA, SL

Tadalafil Tablet 10mg, 20mg 3 SL

Tadalafil Table 2.5mg, 5mg 3 ST, SL

Tracleer 2 DSP, PA, SL

Tyvaso 2 DSP, PA

Uptravi 3 DSP, PA, SL

Smoking Cessation

Bupropion Sustained-Release Tablet 1 H, PA

Chantix Tablet 3 H, PA

Nicoderm CQ 3 H, PA

Nicorette Gum 3 H, PA

Nicorette Lozenge 3 H, PA

Nicorette Mini-Lozenge 3 H, PA

Nicotine Gum 1 H, PA

Nicotine Lozenge 1 H, PA

Nicotine Patch 1 H, PA

Nicotrol Inhaler 3 H, PA

Nicotrol Nasal Spray 3 H, PA

Thrive Gum 1 H, PA

Transplant

Azathioprine Tablet 1

Cyclosporine Modified Capsule 1 DSP

Mycophenolate Capsule, Suspension 1 DSP

Mycophenolic Acid Tablet 2 DSP

Sirolimus Tablet 1 DSP

Tacrolimus Capsule 1 DSP

Vitamins/Electrolytes

Fluoride 1

Folic Acid 1

Klor-Con M10 1

Klor-Con M20 1

Lokelma 3 PA, SL

Potassium Chloride 1

Potassium Citrate 1

Prenatal Vitamins 1 P

14




Drug NameDrug Tier


Women’s Health: Contraceptives

Aftera 1 H

Altavera 1 H

Alyacen 7/7/7, 1/35 1 H

Amethia 1 P

Amethia Lo 1 P

Amethyst 1 P

Apri 1 H

Aranelle 1 H

Ashlyna 3 P

Aubra 1 H

Aviane 1 H

Azurette 2

Balziva 1 P

Bekyree 1 P

Blisovi 24 Fe 1 P

Blisovi Fe 1 H

Briellyn 1 P

Camila 1 H

Camrese 1 P

Camrese Lo 1 P

Caziant 1 H

Cesia 1 H

Chateal 1 H

Cryselle 1 H

Cyclafem 7/7/7, 1/35 1 H

Cyred 1 H

Dasetta 7/7/7, 1/35 1 H

Daysee 1 P

Deblitane 1 H

Delyla 1 H

Desogestrel-Ethinyl Estradiol (generic Ortho-Cept)

1 H

Drospirenone/Ethinul Estradiol 1 P

Econtra EZ 1 H

Elinest 1 H

Ella 1 H, SL

Emoquette 1 H

Enpresse 1 H

Enskyce 1 H

Errin 1 H

Estarylla 1 H

Fallback 1 H

Drug NameDrug Tier


Falmina 1 H

Fayosim 1 P

Gildess 24 Fe 1 P

Gildess 2

Gildess Fe 1 H

Heather 1 H

Introvale 2 H

Jencycla 1 H

Jolessa 2 H

Jolivette 1 H

Juleber 1 H

Junel 2

Junel 24 Fe 1 P

Junel Fe 1 H

Kariva 1 P

Kimidess 1 P

Kurvelo 1 H

Kelnor 1/35 1 H

Larin Fe 1 P

Larin 24 Fe 1 P

Larin Fe 1 H

Larissia 1 H

Leena 1 H

Lessina 1 H

Levonest 1 H

Levonorgestrel 1.5 mg 1 H

Levonorgestrel-Ethinyl Estradiol (generic Alesse, Nordette,Triphasil)

1 H

Levonorgestrel-Ethinyl Estradiol (generic Seasonale)

2 H

Levora-28 1 H

Lo Loestrin Fe 3

LoMedia 24 Fe 1 P

Loryna 3

Low-Ogestrel 1 H

Lutera 1 H

Lyza 1 H

Marlissa 1 H

Medroxyprogesterone Acetate 1 H

Microgestin 2

Microgestin Fe 1 H

Mono-Linyah 1 H

MonoNessa 1 H

My Way 1 H

15





Drug NameDrug Tier


Myzilra 1 H

Natazia 2

Necon 7/7/7, 0.5/35, 1/35, 1/50, 10/11

1 H

Next Choice 1 H

Nikki 1 P

Nora BE 1 H

Norethindrone 0.35 mg 1 H

Norethindrone-Ethinyl Estradiol-Ferrous Fumarate

1 H

Norgestimate-Ethinyl Estradiol (generic Ortho-Cyclen, Ortho Tri-Cyclen)

1 H

Norlyroc 1 H

Nortrel 7/7/7, 0.5/35, 1/35 1 H

Nuvaring 2 H

Ocella 1 P

Ogestrel 1 P

Opcicon 1 H

Orsythia 1 H

Philith 1 P

Pimtrea 1 P

Pirmella 7/7/7, 1/35 1 H

Plan B One Step 1 H

Portia 1 H

Previfem 1 H

Quasense 2 H

Reclipsen 1 H

Setlakin 2 H

Sharobel 1 H

Solia 1 H

Sprintec 1 H

Sronyx 1 H

Syeda 1 P

Take Action 1 H

Tarina Fe 1 H

Tilia Fe 1 P

Tri-Estarylla 1 H

Tri-Linyah 1 P

Tri-Lo-Estarylla 3

Tri-Lo-Marzia 3

Tri-Lo-Sprintec 3

Tri-Previfem 1 H

Tri-Sprintec 1 H

Trinessa 1 H

Drug NameDrug Tier


Trinessa Lo 3

Trivora-28 1 H

Velivet 1 H

Vestura 3

Vienva 1 H

Viorele 2

Vyflema 1 P

Wera 1 H

Wymza Fe 1 P

Xulane 3 H

Yasmin 28 2

Yaz 2

Zarah 1 P

Zenchent 1 P

Zenchent Fe 1 P

Zovia 1/35E, 1/50E 1 H

Women’s Health: Hormone Replacement

Climara Pro 3 SL

Duavee 3

Estradiol/Norethindrone Acetate Tablet

2

Estradiol Tablet 1

Estring 2 SL

Estrogen/Methyltestosterone Tablet 1

Evamist 2

Medroxyprogesterone 1

Minivelle 3 SL

Premarin 3

Premphase 3

Prempro 3

Progesterone Micronized Capsule 2

Vivelle-Dot 2 SL

Yuvafem 2

Women’s Health: Miscellaneous

Raloxifene 2 H, PA, P

Tamoxifen 1 H, PA, P

16

IndexAAbacavir . . . . . . . . . . . . . . . . . . . . . . . 12Abacavir-Lamivudine. . . . . . . . . . . . . 12Abacavir-Lamivudine-Zidovudine . . 12Accuretic . . . . . . . . . . . . . . . . . . . . . . . 6Acebutolol. . . . . . . . . . . . . . . . . . . . . . 6Acetaminophen/Butalbital/ Caffeine 325 mg/50 mg/40 mg . . . 8Acetaminophen/Codeine Tablet . . . 13Actemra. . . . . . . . . . . . . . . . . . . . . . . . 12ACTOplus Met . . . . . . . . . . . . . . . . . . 10ACTOplus Met XR . . . . . . . . . . . . . . . 10Acyclovir Ointment. . . . . . . . . . . . . . . 5Acyclovir Tablet . . . . . . . . . . . . . . . . . 5Aczone . . . . . . . . . . . . . . . . . . . . . . . . 9Adderall XR. . . . . . . . . . . . . . . . . . . . . 7Adempas. . . . . . . . . . . . . . . . . . . . . . . 14Adlyxin. . . . . . . . . . . . . . . . . . . . . . . . . 10Advair Diskus/HFA . . . . . . . . . . . . . . 14Aerospan. . . . . . . . . . . . . . . . . . . . . . . 14Aftera . . . . . . . . . . . . . . . . . . . . . . . . . . 15Aggrenox. . . . . . . . . . . . . . . . . . . . . . . 5Aimovig . . . . . . . . . . . . . . . . . . . . . . . . 8Akynzeo . . . . . . . . . . . . . . . . . . . . . . . 11Albuterol Nebs . . . . . . . . . . . . . . . . . . 14Albuterol Sulfate Tablet . . . . . . . . . . . 14Aldactazide. . . . . . . . . . . . . . . . . . . . . 6Alendronate Sodium Tablet . . . . . . . 13Allopurinol Tablet . . . . . . . . . . . . . . . . 11Alphagan P 0.1% . . . . . . . . . . . . . . . . 11Alprazolam Extended-Release Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 8Alprazolam Tablet . . . . . . . . . . . . . . . 8Altace. . . . . . . . . . . . . . . . . . . . . . . . . . 6Altavera . . . . . . . . . . . . . . . . . . . . . . . . 15Alunbrig. . . . . . . . . . . . . . . . . . . . . . . . 5Alvesco . . . . . . . . . . . . . . . . . . . . . . . . 14Alyacen 7/7/7, 1/35 . . . . . . . . . . . . . 15Amethia . . . . . . . . . . . . . . . . . . . . . . . . 15Amethia Lo . . . . . . . . . . . . . . . . . . . . . 15Amethyst . . . . . . . . . . . . . . . . . . . . . . . 15Amiloride. . . . . . . . . . . . . . . . . . . . . . . 6Amiloride-Hydrochlorothiazide . . . . 6Amiodarone . . . . . . . . . . . . . . . . . . . . 7Amitiza. . . . . . . . . . . . . . . . . . . . . . . . . 11Amitriptyline Tablet . . . . . . . . . . . . . . 7Amlodipine . . . . . . . . . . . . . . . . . . . . . 6Amlodipine-Benazepril . . . . . . . . . . . 6Amlodipine-Valsartan . . . . . . . . . . . . 6Amoxicillin Capsule, Chewable Tablet . . . . . . . . . . . . . . . . 5Amoxicillin/Potassium Clavulanate Chewable Tablet, Tablet . . . . . . . . . . 5Amphetamine Salt Combo. . . . . . . . 7Anastrozole . . . . . . . . . . . . . . . . . . . . . 5

Anastrozole Tablet . . . . . . . . . . . . . . . 12Anoro Ellipta . . . . . . . . . . . . . . . . . . . . 14Aprepitant Capsule . . . . . . . . . . . . . . 11Apri . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Apriso . . . . . . . . . . . . . . . . . . . . . . . . . 11Aptivus. . . . . . . . . . . . . . . . . . . . . . . . . 12Aranelle . . . . . . . . . . . . . . . . . . . . . . . . 15Aranesp. . . . . . . . . . . . . . . . . . . . . . . . 12Aripiprazole Tablet . . . . . . . . . . . . . . . 8Armodafinil . . . . . . . . . . . . . . . . . . . . . 8Armour Thyroid . . . . . . . . . . . . . . . . . 10Arnuity Ellipta . . . . . . . . . . . . . . . . . . . 14Aromasin. . . . . . . . . . . . . . . . . . . . . . . 5Ashlyna . . . . . . . . . . . . . . . . . . . . . . . . 15Asmanex TwistHaler, HFA. . . . . . . . . 14Aspirin-Dipyidamole. . . . . . . . . . . . . . 5Atazanavir Capsule . . . . . . . . . . . . . . 12Atenolol . . . . . . . . . . . . . . . . . . . . . . . . 6Atenolol-Chlorthalidone . . . . . . . . . . 6Atomoxetine . . . . . . . . . . . . . . . . . . . . 7Atorvastatin . . . . . . . . . . . . . . . . . . . . . 7Aubagio. . . . . . . . . . . . . . . . . . . . . . . . 8Aubra. . . . . . . . . . . . . . . . . . . . . . . . . . 15Auryxia. . . . . . . . . . . . . . . . . . . . . . . . . 12Austedo . . . . . . . . . . . . . . . . . . . . . . . . 8Aviane . . . . . . . . . . . . . . . . . . . . . . . . . 15Avonex. . . . . . . . . . . . . . . . . . . . . . . . . 8Azathioprine Tablet . . . . . . . . . . . . . . 14Azelastine 0.1% Nasal Spray . . . . . . 13Azelastine 0.05% Ophthalmic Solution . . . . . . . . . . . . . . . . . . . . . . . . 10Azithromycin Tablet . . . . . . . . . . . . . . 5Azopt . . . . . . . . . . . . . . . . . . . . . . . . . . 11Azurette. . . . . . . . . . . . . . . . . . . . . . . . 15

BBaclofen Tablet . . . . . . . . . . . . . . . . . 13Balziva . . . . . . . . . . . . . . . . . . . . . . . . . 15Basaglar . . . . . . . . . . . . . . . . . . . . . . . 10Bekyree . . . . . . . . . . . . . . . . . . . . . . . . 15Belbuca. . . . . . . . . . . . . . . . . . . . . . . . 13Benazepril . . . . . . . . . . . . . . . . . . . . . . 6Benazepril-Hydrochlorothiazide. . . . 6Betamethasone Dipropionate 0.05% Augmented Lotion, Ointment. . . . . . 9Betamethasone Dipropionate 0.05% Cream, Ointment . . . . . . . . . . 9Betaseron . . . . . . . . . . . . . . . . . . . . . . 8Bethkis. . . . . . . . . . . . . . . . . . . . . . . . . 12Bevespi Aerosphere . . . . . . . . . . . . . 14Bevyxxa . . . . . . . . . . . . . . . . . . . . . . . . 6Bicalutamide. . . . . . . . . . . . . . . . . . . . 5Bidil . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Bisoprolol . . . . . . . . . . . . . . . . . . . . . . 6Bisoprolol-Hydrochlorothiazide . . . . 6

Blisovi 24 Fe . . . . . . . . . . . . . . . . . . . . 15Blisovi Fe. . . . . . . . . . . . . . . . . . . . . . . 15Bosulif . . . . . . . . . . . . . . . . . . . . . . . . . 5Breo Ellipta . . . . . . . . . . . . . . . . . . . . . 14Briellyn. . . . . . . . . . . . . . . . . . . . . . . . . 15Brilinta . . . . . . . . . . . . . . . . . . . . . . . . . 6Budesonide Nebs . . . . . . . . . . . . . . . 14Bumetanide . . . . . . . . . . . . . . . . . . . . 6Bupropion Extended-Release Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 7Bupropion Sustained-Release Tablet . . . . . . . 7, 14Bupropion Tablet . . . . . . . . . . . . . . . . 7Buspirone Tablet . . . . . . . . . . . . . . . . 8Bydureon . . . . . . . . . . . . . . . . . . . . . . 10Byetta . . . . . . . . . . . . . . . . . . . . . . . . . 10Bystolic . . . . . . . . . . . . . . . . . . . . . . . . 6

CCalcipotriene/Betamethasone Ointment . . . . . . . . . . . . . . . . . . . . . . . 9Calcitonin . . . . . . . . . . . . . . . . . . . . . . 13Calcitriol Capsule. . . . . . . . . . . . . . . . 10Camila . . . . . . . . . . . . . . . . . . . . . . . . . 15Camrese . . . . . . . . . . . . . . . . . . . . . . . 15Camrese Lo . . . . . . . . . . . . . . . . . . . . 15Candesartan. . . . . . . . . . . . . . . . . . . . 6Candesartan-Hydrochlorothiazide. . 6Carac . . . . . . . . . . . . . . . . . . . . . . . . . . 9Carbamazepine Extended-Release Capsule . . . . . . . 9Carbamazepine Extended-Release Tablet . . . . . . . . . 9Carbamazepine Immediate-Release Tablet . . . . . . . . 9Carbidopa-Levodopa. . . . . . . . . . . . . 8Carisoprodol 350 mg Tablet . . . . . . 13Cartia XT . . . . . . . . . . . . . . . . . . . . . . . 6Carvedilol . . . . . . . . . . . . . . . . . . . . . . 6Cayston . . . . . . . . . . . . . . . . . . . . . . . . 12Caziant . . . . . . . . . . . . . . . . . . . . . . . . 15Cefadroxil Capsule, Tablet . . . . . . . . 5Cefdinir Capsule . . . . . . . . . . . . . . . . 5Cefixime Suspension . . . . . . . . . . . . 5Cefprozil Tablet . . . . . . . . . . . . . . . . . 5Cefuroxime Tablet . . . . . . . . . . . . . . . 5Celecoxib . . . . . . . . . . . . . . . . . . . . . . 13Cephalexin Capsule . . . . . . . . . . . . . 5Cerdelga . . . . . . . . . . . . . . . . . . . . . . . 12Cesia . . . . . . . . . . . . . . . . . . . . . . . . . . 15Cetrotide . . . . . . . . . . . . . . . . . . . . . . . 12Chantix Tablet. . . . . . . . . . . . . . . . . . . 14Chateal . . . . . . . . . . . . . . . . . . . . . . . . 15Chlorhexidine Gluconate . . . . . . . . . 12Chlorothiazide . . . . . . . . . . . . . . . . . . 6

17


Chlorpheniramine/Hydrocodone/Pseudoephedrine Solution. . . . . . . . 12Chlorpromazine . . . . . . . . . . . . . . . . . 8Chlorthalidone . . . . . . . . . . . . . . . . . . 6Cholestyramine . . . . . . . . . . . . . . . . . 7Cholestyramine Light . . . . . . . . . . . . 7Ciclopirox Cream, Gel, Lotion, Solution . . . . . . . . . . . . . . . . . . . . . . . . 9Cilostazol. . . . . . . . . . . . . . . . . . . . . . . 6Cimduo . . . . . . . . . . . . . . . . . . . . . . . . 12Cimzia . . . . . . . . . . . . . . . . . . . . . . . . . 12Ciprodex . . . . . . . . . . . . . . . . . . . . . . . 5Ciprofloxacin Tablet. . . . . . . . . . . . . . 5Citalopram Tablet. . . . . . . . . . . . . . . . 7Claravis . . . . . . . . . . . . . . . . . . . . . . . . 9Clarithromycin Tablet. . . . . . . . . . . . . 5Climara Pro. . . . . . . . . . . . . . . . . . . . . 16Clindamycin 1.2%/Benzoyl Peroxide 5% Gel . . . . . . . . . . . . . . . . 9Clindamycin Capsule . . . . . . . . . . . . 5Clindamycin Gel. . . . . . . . . . . . . . . . . 9Clindamycin Lotion . . . . . . . . . . . . . . 9Clindamycin Solution, Swabs. . . . . . 9Clobetasol Propionate Cream, Ointment . . . . . . . . . . . . . . . . . . . . . . . 9Clomiphene . . . . . . . . . . . . . . . . . . . . 12Clonazepam Tablet . . . . . . . . . . . . . . 9Clonidine Patch . . . . . . . . . . . . . . . . . 6Clonidine Tablet . . . . . . . . . . . . . . . . . 6Clopidogrel . . . . . . . . . . . . . . . . . . . . . 6Clorpress. . . . . . . . . . . . . . . . . . . . . . . 6Clotrimazole-Betamethasone Cream . . . . . . . . . . . . . . . . . . . . . . . . . 9Clotrimazole-Betamethasone Lotion. . . . . . . . . . . . . . . . . . . . . . . . . . 9Clozapine . . . . . . . . . . . . . . . . . . . . . . 8Colestipol . . . . . . . . . . . . . . . . . . . . . . 7Combigan . . . . . . . . . . . . . . . . . . . . . . 11Combivent Respimat. . . . . . . . . . . . . 14Complera . . . . . . . . . . . . . . . . . . . . . . 12Concerta . . . . . . . . . . . . . . . . . . . . . . . 7Contour Next . . . . . . . . . . . . . . . . . . . 9Contour Next EZ . . . . . . . . . . . . . . . . 9Contour Next Test Strips. . . . . . . . . . 9Coreg. . . . . . . . . . . . . . . . . . . . . . . . . . 6Corlanor . . . . . . . . . . . . . . . . . . . . . . . 7Cortifoam . . . . . . . . . . . . . . . . . . . . . . 11Cosentyx . . . . . . . . . . . . . . . . . . . . . . . 12Coumadin . . . . . . . . . . . . . . . . . . . . . . 6Countour Next One . . . . . . . . . . . . . . 9Creon. . . . . . . . . . . . . . . . . . . . . . . . . . 11Cresemba . . . . . . . . . . . . . . . . . . . . . . 5Crinone . . . . . . . . . . . . . . . . . . . . . . . . 12Crixivan . . . . . . . . . . . . . . . . . . . . . . . . 12Cryselle . . . . . . . . . . . . . . . . . . . . . . . . 15Cyclafem 7/7/7, 1/35. . . . . . . . . . . . 15Cyclobenzaprine . . . . . . . . . . . . . . . . 13Cyclophosphamide Capsule . . . . . . 5Cyclosporine Modified Capsule . . . 14

Cyproheptadine Tablet . . . . . . . . . . . 13Cyred . . . . . . . . . . . . . . . . . . . . . . . . . . 15

DDaklinza. . . . . . . . . . . . . . . . . . . . . . . . 11Dalfampridine er. . . . . . . . . . . . . . . . . 8Dasetta 7/7/7, 1/35 . . . . . . . . . . . . . 15Daysee. . . . . . . . . . . . . . . . . . . . . . . . . 15Deblitane. . . . . . . . . . . . . . . . . . . . . . . 15Delyla. . . . . . . . . . . . . . . . . . . . . . . . . . 15Descovy. . . . . . . . . . . . . . . . . . . . . . . . 12Desmopressin Tablet. . . . . . . . . . . . . 10Desogestrel-Ethinyl Estradiol (generic Ortho-Cept) . . . . . . . . . . . . . 15Desonide 0.05% Cream, Lotion, Ointment . . . . . . . . . . . . . . . . . . . . . . . 9Desvenlafaxine Extended-Release Tablet . . . . . . . . . 7Dexamethasone Tablet . . . . . . . . . . . 10Dexilant . . . . . . . . . . . . . . . . . . . . . . . . 11Dexmethylphenidate Immediate-Release Capsule . . . . . . 7Dextroamphetamine-Amphetamine Immediate-Release Capsule . . . . . . 7Dextroamphetamine Sulfate Immediate-Release Tablet . . . . . . . . 7Diazepam Tablet . . . . . . . . . . . . . . 8, 9Diclofenac Tablet . . . . . . . . . . . . . . . . 13Dicyclomine Tablet . . . . . . . . . . . . . . 13Didanosine . . . . . . . . . . . . . . . . . . . . . 12Dificid. . . . . . . . . . . . . . . . . . . . . . . . . . 5Diflorasone Diacetate 0.05% Cream, Ointment . . . . . . . . . . . . . . . . 9Digoxin . . . . . . . . . . . . . . . . . . . . . . . . 7Diltiazem . . . . . . . . . . . . . . . . . . . . . . . 6Diltiazem 24 Hour CD . . . . . . . . . . . . 6Diltiazem Extended Release Table . . . . . . . . . . . . . . . . . . . . . . . . . . 6Diltiazem Sustained-Release Capsule . . . . . . . . . . . . . . . . . . . . . . . . 6Diltiazem Sustained-Release Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 6Diphenoxylate-Atropine Tablet. . . . . 11Dipyridamole . . . . . . . . . . . . . . . . . . . 6Divalproex Delayed-Release Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 9Divalproex Extended-Release Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 9Donepezil 5, 10 mg ODT, Tablet . . . 8Doxazosin . . . . . . . . . . . . . . . . . . . . . . 6Doxepin . . . . . . . . . . . . . . . . . . . . . . . . 7Doxycycline Hyclate 50, 100 mg Capsule, Tablet . . . . . . . . . . . . . . . . . 5Doxycycline Monohydrate 50, 100 mg Capsule . . . . . . . . . . . . . . . . 5Drospirenone/Ethinul Estradiol . . . . 15Duavee . . . . . . . . . . . . . . . . . . . . . . . . 16Duloxetine Capsule . . . . . . . . . . . . . . 7Dupixent . . . . . . . . . . . . . . . . . . . . . . . 9

EEconazole Cream . . . . . . . . . . . . . . . 5Econtra EZ . . . . . . . . . . . . . . . . . . . . . 15Edarbi . . . . . . . . . . . . . . . . . . . . . . . . . 6Edarbyclor. . . . . . . . . . . . . . . . . . . . . . 6Edurant . . . . . . . . . . . . . . . . . . . . . . . . 12Efavirenz . . . . . . . . . . . . . . . . . . . . . . . 12Effient. . . . . . . . . . . . . . . . . . . . . . . . . . 6Elidel . . . . . . . . . . . . . . . . . . . . . . . . . . 9Elinest . . . . . . . . . . . . . . . . . . . . . . . . . 15Eliquis . . . . . . . . . . . . . . . . . . . . . . . . . 6Ella . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Eltriptan . . . . . . . . . . . . . . . . . . . . . . . . 8Emend Suspension . . . . . . . . . . . . . . 11Emgality. . . . . . . . . . . . . . . . . . . . . . . . 8Emoquette . . . . . . . . . . . . . . . . . . . . . 15Emtriva. . . . . . . . . . . . . . . . . . . . . . . . . 12Enalapril . . . . . . . . . . . . . . . . . . . . . . . 6Enbrel . . . . . . . . . . . . . . . . . . . . . . . . . 12Endometrin . . . . . . . . . . . . . . . . . . . . . 12Enoxaparin . . . . . . . . . . . . . . . . . . . . . 6Enoxaparin Sodium. . . . . . . . . . . . . . 6Enpresse . . . . . . . . . . . . . . . . . . . . . . . 15Enskyce. . . . . . . . . . . . . . . . . . . . . . . . 15Enstilar Foam . . . . . . . . . . . . . . . . . . . 9Entresto . . . . . . . . . . . . . . . . . . . . . . . . 7Epclusa . . . . . . . . . . . . . . . . . . . . . . . . 11Epinephrine (generic EpiPen/EpiPen-Jr.) . . . . . . . 12Eplerenone . . . . . . . . . . . . . . . . . . . . . 6Eprosartan . . . . . . . . . . . . . . . . . . . . . 6Errin . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Erythromycin 0.5% Ophthalmic Ointment . . . . . . . . . . . . 11Escitalopram Tablet . . . . . . . . . . . . . . 7Estarylla. . . . . . . . . . . . . . . . . . . . . . . . 15Estradiol/Norethindrone Acetate Tablet. . . . . . . . . . . . . . . . . . . 16Estradiol Tablet. . . . . . . . . . . . . . . . . . 16Estring . . . . . . . . . . . . . . . . . . . . . . . . . 16Estrogen/Methyltestosterone Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 16Eszopiclone Tablet. . . . . . . . . . . . . . . 9Etodolac Capsule. . . . . . . . . . . . . . . . 13Eucrisa. . . . . . . . . . . . . . . . . . . . . . . . . 9Evamist . . . . . . . . . . . . . . . . . . . . . . . . 16Evotaz . . . . . . . . . . . . . . . . . . . . . . . . . 12Exemestane . . . . . . . . . . . . . . . . . . . . 5Ezetimibe Tablet. . . . . . . . . . . . . . . . . 7

FFallback. . . . . . . . . . . . . . . . . . . . . . . . 15Falmina . . . . . . . . . . . . . . . . . . . . . . . . 15Famciclovir Tablet . . . . . . . . . . . . . . . 5Fanapt . . . . . . . . . . . . . . . . . . . . . . . . . 8Fareston . . . . . . . . . . . . . . . . . . . . . . . 5Fayosim . . . . . . . . . . . . . . . . . . . . . . . . 15Fenofibrate 54, 160 mg Tablet . . . . 7

18

Fentanyl 12, 25, 50, 75, 100 mcg Patch. . . . . . . . . . . . . . . . . . 13Fentanyl Citrate Lozenge . . . . . . . . . 13Fetzima . . . . . . . . . . . . . . . . . . . . . . . . 7Finacea . . . . . . . . . . . . . . . . . . . . . . . . 9Flecainide . . . . . . . . . . . . . . . . . . . . . . 7Flovent Diskus/HFA. . . . . . . . . . . . . . 14Fluconazole Tablet. . . . . . . . . . . . . . . 5Fluocinolone Cream, Oil, Solution. . 9Fluocinolone Ointment . . . . . . . . . . . 9Fluocinonide 0.05% Cream . . . . . . . 9Fluoride . . . . . . . . . . . . . . . . . . . . . . . . 14Fluorouracil 0.5% Cream . . . . . . . . . 9Fluoxetine Tablet, Capsule (generic Prozac). . . . . . . . . . . . . . . . . 8Fluticasone Nasal Spray . . . . . . . . . . 13Fluticasone/Salmerterol RespiClick. . . . . . . . . . . . . . . . . . . . . . 14Fluvastatin . . . . . . . . . . . . . . . . . . . . . . 7Fluvastatin Extended-Release Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 7Fluvoxamine Tablet . . . . . . . . . . . . . . 8Folic Acid . . . . . . . . . . . . . . . . . . . . . . 14Fondaparinux . . . . . . . . . . . . . . . . . . . 6Forteo . . . . . . . . . . . . . . . . . . . . . . . . . 13Frovatriptan . . . . . . . . . . . . . . . . . . . . . 8Furosemide. . . . . . . . . . . . . . . . . . . . . 6Fuzeon. . . . . . . . . . . . . . . . . . . . . . . . . 12

GGabapentin Capsule, Tablet. . . . . . . 9Gemfibrozil . . . . . . . . . . . . . . . . . . . . . 7Gentamicin Ophthalmic Ointment, Solution . . . . . . . . . . . . . . . 11Genvoya . . . . . . . . . . . . . . . . . . . . . . . 12Gildess . . . . . . . . . . . . . . . . . . . . . . . . 15Gildess 24 Fe . . . . . . . . . . . . . . . . . . . 15Gildess Fe . . . . . . . . . . . . . . . . . . . . . . 15Gilenya. . . . . . . . . . . . . . . . . . . . . . . . . 8Glatiamer acetate. . . . . . . . . . . . . . . . 8Glimepiride . . . . . . . . . . . . . . . . . . . . . 10Glipizide . . . . . . . . . . . . . . . . . . . . . . . 10Glipizide Extended-Release . . . . . . . 10Glipzide-Metformin . . . . . . . . . . . . . . 10Glyburide. . . . . . . . . . . . . . . . . . . . . . . 10Glyburide-Metformin . . . . . . . . . . . . . 10Glyburide Micronized . . . . . . . . . . . . 10Glyxambi . . . . . . . . . . . . . . . . . . . . . . . 10Golytely . . . . . . . . . . . . . . . . . . . . . . . . 11Gonal-F . . . . . . . . . . . . . . . . . . . . . . . . 12Guanfacine . . . . . . . . . . . . . . . . . . . . . 6Guanfacine Extended-Release. . . . . 7

HHaegarda . . . . . . . . . . . . . . . . . . . . . . 12Halobetasol Ointment . . . . . . . . . . . . 9Haloperidol . . . . . . . . . . . . . . . . . . . . . 8Harvoni . . . . . . . . . . . . . . . . . . . . . . . . 11

Heather . . . . . . . . . . . . . . . . . . . . . . . . 15Heparin . . . . . . . . . . . . . . . . . . . . . . . . 6Humalog KwikPens (all formulations). . . . . . . . . . . . . . . . . 10Humalog Vials (all formulations) . . . 10Humira. . . . . . . . . . . . . . . . . . . . . . . . . 12Humulin KwikPens (all formulations). . . . . . . . . . . . . . . . . 10Humulin Vials (all formulations) . . . . 10Hydralazine. . . . . . . . . . . . . . . . . . . . . 6Hydrochlorothiazide . . . . . . . . . . . . . 6Hydrocodone/Acetaminophen 5/325, 7.5/325, 10/325 mg Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 13Hydrocodone/Chlorpheniramine . . 13Hydrocodone/Ibuprofen Tablet . . . . 13Hydrocortisone 2.5% Cream, Ointment . . . . . . . . . . . . . . . . . . . . . . . 9Hydromorphone Tablet. . . . . . . . . . . 13Hydroxychloroquine Sulfate . . . . . . . 12Hydroxyurea Capsule . . . . . . . . . . . . 5Hydroxyzine Capsule, Tablet . . . . . . 13Hyoscyamine Tablet . . . . . . . . . . . . . 11

IIbandronate Tablet. . . . . . . . . . . . . . . 13Ibuprofen Tablet . . . . . . . . . . . . . . . . . 13Idhifa . . . . . . . . . . . . . . . . . . . . . . . . . . 5Imatinib Tablet . . . . . . . . . . . . . . . . . . 5Imbruvica . . . . . . . . . . . . . . . . . . . . . . 5Imiquimod 5% Cream . . . . . . . . . . . . 9Incruse Ellipta . . . . . . . . . . . . . . . . . . . 14Indomethacin Capsule . . . . . . . . . . . 13Ingrezza. . . . . . . . . . . . . . . . . . . . . . . . 8Intelence . . . . . . . . . . . . . . . . . . . . . . . 12Introvale. . . . . . . . . . . . . . . . . . . . . . . . 15Invokamet . . . . . . . . . . . . . . . . . . . . . . 10Invokamet XR . . . . . . . . . . . . . . . . . . . 10Invokana . . . . . . . . . . . . . . . . . . . . . . . 10Ipratropium-Albuterol Nebs . . . . . . . 14Ipratropium Nebs. . . . . . . . . . . . . . . . 14Irbesartan . . . . . . . . . . . . . . . . . . . . . . 6Irbesartan-Hydrochlorothiazide . . . . 6Isentress . . . . . . . . . . . . . . . . . . . . . . . 12Isosorbide Mononitrate ER. . . . . . . . 7Itraconazole Capsule. . . . . . . . . . . . . 5

JJanumet . . . . . . . . . . . . . . . . . . . . . . . 10Janumet XR . . . . . . . . . . . . . . . . . . . . 10Januvia . . . . . . . . . . . . . . . . . . . . . . . . 10Jardiance . . . . . . . . . . . . . . . . . . . . . . 10Jencycla . . . . . . . . . . . . . . . . . . . . . . . 15Jentadueto . . . . . . . . . . . . . . . . . . . . . 10Jentadueto XR . . . . . . . . . . . . . . . . . . 10Jolessa . . . . . . . . . . . . . . . . . . . . . . . . 15Jolivette . . . . . . . . . . . . . . . . . . . . . . . . 15

Juleber. . . . . . . . . . . . . . . . . . . . . . . . . 15Junel . . . . . . . . . . . . . . . . . . . . . . . . . . 15Junel 24 Fe. . . . . . . . . . . . . . . . . . . . . 15Junel Fe. . . . . . . . . . . . . . . . . . . . . . . . 15

KKaletra Tablet . . . . . . . . . . . . . . . . . . . 12Kariva. . . . . . . . . . . . . . . . . . . . . . . . . . 15Kazano . . . . . . . . . . . . . . . . . . . . . . . . 10Kelnor 1/35 . . . . . . . . . . . . . . . . . . . . 15Ketoconazole Cream. . . . . . . . . . . . . 5Ketorolac Tablet . . . . . . . . . . . . . . . . . 13Kevzara . . . . . . . . . . . . . . . . . . . . . . . . 12Kimidess . . . . . . . . . . . . . . . . . . . . . . . 15Klor-Con M10. . . . . . . . . . . . . . . . . . . 14Klor-Con M20. . . . . . . . . . . . . . . . . . . 14Kombiglyze XR. . . . . . . . . . . . . . . . . . 10Kurvelo . . . . . . . . . . . . . . . . . . . . . . . . 15

LLabetalol . . . . . . . . . . . . . . . . . . . . . . . 6Lamivudine . . . . . . . . . . . . . . . . . . . . . 12Lamivudine-Zidovudine . . . . . . . . . . 12Lamotrigine Immediate-Release Tablet . . . . . . . . 9Lanthanum Chewable Tablet . . . . . . 13Larin 24 Fe . . . . . . . . . . . . . . . . . . . . . 15Larin Fe . . . . . . . . . . . . . . . . . . . . . . . . 15Larissia . . . . . . . . . . . . . . . . . . . . . . . . 15Lastacaft . . . . . . . . . . . . . . . . . . . . . . . 10Latanoprost 0.005% Ophthalmic Solution . . . . . . . . . . . . . . . . . . . . . . . . 11Latuda . . . . . . . . . . . . . . . . . . . . . . . . . 8Lazanda . . . . . . . . . . . . . . . . . . . . . . . 13Leena. . . . . . . . . . . . . . . . . . . . . . . . . . 15Leflunomide . . . . . . . . . . . . . . . . . . . . 12Lessina . . . . . . . . . . . . . . . . . . . . . . . . 15Letairis . . . . . . . . . . . . . . . . . . . . . . . . . 14Letrozole . . . . . . . . . . . . . . . . . . . . . . . 5Letrozole Tablet . . . . . . . . . . . . . . . . . 13Leucovorin Calcium Tablet . . . . . . . . 5Levalbuterol HFA . . . . . . . . . . . . . . . . 14Levemir FlexTouch. . . . . . . . . . . . . . . 10Levemir Vials . . . . . . . . . . . . . . . . . . . 10Levetiracetam Extended-Release Tablet . . . . . . . . . 9Levetiracetam Immediate-Release Tablet . . . . . . . . 9Levocetirizine Tablet . . . . . . . . . . . . . 14Levofloxacin Tablet . . . . . . . . . . . . . . 5Levonest . . . . . . . . . . . . . . . . . . . . . . . 15Levonorgestrel 1.5 mg . . . . . . . . . . . 15Levonorgestrel-Ethinyl Estradiol (generic Alesse, Nordette, . . . . . . . . 15Levonorgestrel-Ethinyl Estradiol (generic Alesse, Nordette,Triphasil) 15Levonorgestrel-Ethinyl Estradiol (generic Seasonale) . . . . . 15

19


Levora-28 . . . . . . . . . . . . . . . . . . . . . . 15Levothyroxine Sodium Tablet . . . . . . 10Lialda . . . . . . . . . . . . . . . . . . . . . . . . . . 11Lidocaine Transdermal Patch . . . . . 13Linzess . . . . . . . . . . . . . . . . . . . . . . . . 11Liothyronine Sodium Tablet . . . . . . . 10Lisinopril . . . . . . . . . . . . . . . . . . . . . . . 6Lisinopril-Hydrochlorothiazide . . . . . 6Lithium Capsule . . . . . . . . . . . . . . . . . 8Lokelma. . . . . . . . . . . . . . . . . . . . . . . . 14Lo Loestrin Fe. . . . . . . . . . . . . . . . . . . 15LoMedia 24 Fe. . . . . . . . . . . . . . . . . . 15Lopinavir-Ritonavir Oral Solution . . . 12Lorazepam Tablet . . . . . . . . . . . . . . . 8Loryna . . . . . . . . . . . . . . . . . . . . . . . . . 15Losartan . . . . . . . . . . . . . . . . . . . . . . . 6Losartan-Hydrochlorothiazide . . . . . 6Lovastatin . . . . . . . . . . . . . . . . . . . . . . 7Lovenox. . . . . . . . . . . . . . . . . . . . . . . . 6Low-Ogestrel . . . . . . . . . . . . . . . . . . . 15Lumigan . . . . . . . . . . . . . . . . . . . . . . . 11Lutera. . . . . . . . . . . . . . . . . . . . . . . . . . 15Lyrica . . . . . . . . . . . . . . . . . . . . . . . . . . 9Lyza . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

MMarlissa . . . . . . . . . . . . . . . . . . . . . . . . 15Mavyret . . . . . . . . . . . . . . . . . . . . . . . . 11Medroxyprogesterone. . . . . . . . . . . . 16Medroxyprogesterone Acetate. . . . . 15Meloxicam Tablet. . . . . . . . . . . . . . . . 13Memantine Tablet . . . . . . . . . . . . . . . 8Mercaptopurine Tablet . . . . . . . . . . . 5Mesalamine Suppositories . . . . . . . . 11Metaproterenol . . . . . . . . . . . . . . . . . . 14Metaxalone Tablet . . . . . . . . . . . . . . . 13Metformin . . . . . . . . . . . . . . . . . . . . . . 10Metformin Extended-Release Tablet (generic Glucophage XR) . . . 10Methadone Tablet, Oral Solution, Concentrate Solution. . . . . . . . . . . . . 13Methimazole Tablet . . . . . . . . . . . . . . 10Methocarbamol Tablet . . . . . . . . . . . 13Methotrexate Tablet . . . . . . . . . . . . . . 12Methylphenidate Chewable Tablet . 7Methylphenidate Extended-Release Capsule (generic Metadate CD, Ritalin LA) . . . . . . . . . . . . . . . . . . . . . . 7Methylphenidate Extended-Release Tablet (Metadate ER). . . . . . . . . . . . . 7Methylphenidate Tablet. . . . . . . . . . . 7Methylprednisolone Tablet . . . . . . . . 10Metoclopramide Tablet . . . . . . . . . . . 11Metolazone . . . . . . . . . . . . . . . . . . . . . 6Metoprolol-Hydrochlorothiazide. . . . 6Metoprolol Succinate 50, 100, 200 mg . . . . . . . . . . . . . . . . . . . . . . . . 6Metoprolol Tartrate 25, 50, 100 mg . . . . . . . . . . . . . . . . . . . . . . . . 6

Metronidazole 0.75% Topical Gel . . 9Metronidazole Tablet . . . . . . . . . . . . . 5Microgestin . . . . . . . . . . . . . . . . . . . . . 15Microgestin Fe . . . . . . . . . . . . . . . . . . 15Minivelle . . . . . . . . . . . . . . . . . . . . . . . 16Minocycline Capsule . . . . . . . . . . . . . 5Mirtazapine Tablet . . . . . . . . . . . . . . . 8Mirvaso . . . . . . . . . . . . . . . . . . . . . . . . 9Mitigare . . . . . . . . . . . . . . . . . . . . . . . . 11Modafinil Tablet . . . . . . . . . . . . . . . . . 8Mometasone Furoate Cream, Lotion, Ointment . . . . . . . . . . . . . . . . 9Mono-Linyah. . . . . . . . . . . . . . . . . . . . 15MonoNessa . . . . . . . . . . . . . . . . . . . . 15Morphine Sulfate Extended-Release Tablet . . . . . . . . . 13Morphine Sulfate Oral Solution . . . . 13Moviprep . . . . . . . . . . . . . . . . . . . . . . . 11Moxeza . . . . . . . . . . . . . . . . . . . . . . . . 11Moxifloxacin Opthalmic Solution . . . 11Moxifloxacin Tablet . . . . . . . . . . . . . . 5Mulpleta . . . . . . . . . . . . . . . . . . . . . . . 13Multaq . . . . . . . . . . . . . . . . . . . . . . . . . 7Mupirocin Ointment. . . . . . . . . . . . . . 9Mycophenolate Capsule, Suspension. . . . . . . . . . . . . . . . . . . . . 14Mycophenolic Acid Tablet . . . . . . . . 14My Way . . . . . . . . . . . . . . . . . . . . . . . . 15Myzilra . . . . . . . . . . . . . . . . . . . . . . . . . 16

NNabumetone Tablet . . . . . . . . . . . . . . 13Nadolol . . . . . . . . . . . . . . . . . . . . . . . . 6Naloxone Vials . . . . . . . . . . . . . . . . . . 8Naproxen Tablet. . . . . . . . . . . . . . . . . 13Naratriptan . . . . . . . . . . . . . . . . . . . . . 8Narcan Nasal Spray. . . . . . . . . . . . . . 8Natazia . . . . . . . . . . . . . . . . . . . . . . . . 16Necon 7/7/7, 0.5/35, 1/35, 1/50, 10/11 . . . . . . . . . . . . . . . . . . . . 16Nesina . . . . . . . . . . . . . . . . . . . . . . . . . 10Nevirapine. . . . . . . . . . . . . . . . . . . . . . 12Next Choice . . . . . . . . . . . . . . . . . . . . 16Niacin Extended-Release Tablet . . . 7Niaspan . . . . . . . . . . . . . . . . . . . . . . . . 7Nicoderm CQ . . . . . . . . . . . . . . . . . . . 14Nicorette Gum . . . . . . . . . . . . . . . . . . 14Nicorette Lozenge . . . . . . . . . . . . . . . 14Nicorette Mini-Lozenge . . . . . . . . . . . 14Nicotine Gum . . . . . . . . . . . . . . . . . . . 14Nicotine Lozenge. . . . . . . . . . . . . . . . 14Nicotine Patch . . . . . . . . . . . . . . . . . . 14Nicotrol Inhaler . . . . . . . . . . . . . . . . . . 14Nicotrol Nasal Spray . . . . . . . . . . . . . 14Nifedipine . . . . . . . . . . . . . . . . . . . . . . 6Nifedipine Extended-Release. . . . . . 6Nikki. . . . . . . . . . . . . . . . . . . . . . . . . . . 16Nimodipine . . . . . . . . . . . . . . . . . . . . . 6Nisoldipine . . . . . . . . . . . . . . . . . . . . . 6

Nitrofurantoin Capsule . . . . . . . . . . . 5Nitrofurantoin Macrocrystal Capsule . . . . . . . . . . . . . . . . . . . . . . . . 5Nitroglycerin Sublingual Tablet . . . . 7Nityr . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Nocdurna . . . . . . . . . . . . . . . . . . . . . . 10Nora BE. . . . . . . . . . . . . . . . . . . . . . . . 16Norethindrone 0.35 mg . . . . . . . . . . 16Norethindrone-Ethinyl Estradiol-Ferrous Fumarate . . . . . . . 16Norgestimate-Ethinyl Estradiol (generic Ortho-Cyclen, Ortho Tri-Cyclen) . . . . . . . . . . . . . . . . . . . . . . 16Norlyroc. . . . . . . . . . . . . . . . . . . . . . . . 16Nortrel 7/7/7, 0.5/35, 1/35 . . . . . . . 16Nortriptyline Capsule. . . . . . . . . . . . . 8Noxafil Tablet, Suspension . . . . . . . . 5NP Thyroid Tablet . . . . . . . . . . . . . . . 10Nucynta . . . . . . . . . . . . . . . . . . . . . . . . 13Nucynta ER. . . . . . . . . . . . . . . . . . . . . 13Nuedexta. . . . . . . . . . . . . . . . . . . . . . . 13Nutropin, Nutropin AQ . . . . . . . . . . . 10Nuvaring . . . . . . . . . . . . . . . . . . . . . . . 16Nystatin Cream, Ointment . . . . . . . . 5

OObredon . . . . . . . . . . . . . . . . . . . . . . . 13Ocella . . . . . . . . . . . . . . . . . . . . . . . . . 16Odefsey . . . . . . . . . . . . . . . . . . . . . . . . 12Ofloxacin 0.3% Ophthalmic Solution . . . . . . . . . . . . . . . . . . . . . . . . 11Ofloxacin Otic Solution . . . . . . . . . . . 5Ofloxacin Tablet . . . . . . . . . . . . . . . . . 5Ogestrel. . . . . . . . . . . . . . . . . . . . . . . . 16Olanzapine Tablet . . . . . . . . . . . . . . . 8Olmesartan . . . . . . . . . . . . . . . . . . . . . 6Olmesartan-Hydrochlorothiazide. . . 7Olopatadine 0.1% Ophthalmic Solution . . . . . . . . . . . . . . . . . . . . . . . . 10Omeclamox-Pak. . . . . . . . . . . . . . . . . 11Omega-3-Acid Ethyl Esters Capsule . . . . . . . . . . . . . . . . . . . . . . . . 7Omeprazole Capsule . . . . . . . . . . . . 11Ondansetron. . . . . . . . . . . . . . . . . . . . 11Ondansetron ODT . . . . . . . . . . . . . . . 11OneTouch Test Strips . . . . . . . . . . . . 9OneTouch Ultra Mini . . . . . . . . . . . . . 9OneTouch Ultra Test Strips. . . . . . . . 10OneTouch Verio . . . . . . . . . . . . . . . . . 10OneTouch Verio Flex . . . . . . . . . . . . . 10OneTouch Verio IQ . . . . . . . . . . . . . . 10OneTouch Verio Sync . . . . . . . . . . . . 10OneTouch Verio Test Strips . . . . . . . 10Onglyza . . . . . . . . . . . . . . . . . . . . . . . . 10Opcicon. . . . . . . . . . . . . . . . . . . . . . . . 16Opsumit. . . . . . . . . . . . . . . . . . . . . . . . 14Oracea. . . . . . . . . . . . . . . . . . . . . . . . . 9Orencia . . . . . . . . . . . . . . . . . . . . . . . . 12Orenitram . . . . . . . . . . . . . . . . . . . . . . 14

20

Orsythia . . . . . . . . . . . . . . . . . . . . . . . . 16Oseltamivir Capsule. . . . . . . . . . . . . . 5Oseni . . . . . . . . . . . . . . . . . . . . . . . . . . 10Otezla. . . . . . . . . . . . . . . . . . . . . . . . . . 12Ovidrel . . . . . . . . . . . . . . . . . . . . . . . . . 12Oxcarbazepine Tablet . . . . . . . . . . . . 9Oxsoralen-Ultra. . . . . . . . . . . . . . . . . . 9Oxybutynin Extended-Release Tablet . . . . . . . . . 13Oxybutynin Tablet . . . . . . . . . . . . . . . 13Oxycodone Tablet . . . . . . . . . . . . . . . 13Ozempic . . . . . . . . . . . . . . . . . . . . . . . 10

PPalperdone ER. . . . . . . . . . . . . . . . . . 8Pantoprazole Tablet. . . . . . . . . . . . . . 11Paroxetine Tablet . . . . . . . . . . . . . . . . 8Pegasys. . . . . . . . . . . . . . . . . . . . . . . . 13Penicillin V Potassium Tablet . . . . . . 5Perforomist . . . . . . . . . . . . . . . . . . . . . 14Perphenazine . . . . . . . . . . . . . . . . . . . 8Persantine. . . . . . . . . . . . . . . . . . . . . . 6Phenazopyridine . . . . . . . . . . . . . . . . 13Phenytoin Capsule, Suspension . . . 9Philith. . . . . . . . . . . . . . . . . . . . . . . . . . 16Picato. . . . . . . . . . . . . . . . . . . . . . . . . . 9Pimtrea . . . . . . . . . . . . . . . . . . . . . . . . 16Pioglitazone . . . . . . . . . . . . . . . . . . . . 10Pioglitazone-Glimepiride . . . . . . . . . 10Pioglitazone-Metformin . . . . . . . . . . . 10Pirmella 7/7/7, 1/35 . . . . . . . . . . . . . 16Plan B One Step . . . . . . . . . . . . . . . . 16Plegridy . . . . . . . . . . . . . . . . . . . . . . . . 8Plenvu . . . . . . . . . . . . . . . . . . . . . . . . . 11Pletal . . . . . . . . . . . . . . . . . . . . . . . . . . 6Polyethylene Glycol 3350. . . . . . . . . 11Portia . . . . . . . . . . . . . . . . . . . . . . . . . . 16Potassium Chloride . . . . . . . . . . . . . . 14Potassium Citrate. . . . . . . . . . . . . . . . 14Pradaxa . . . . . . . . . . . . . . . . . . . . . . . . 6Praluent . . . . . . . . . . . . . . . . . . . . . . . . 7Pramipexole Tablet . . . . . . . . . . . . . . 8Prasurgel. . . . . . . . . . . . . . . . . . . . . . . 6Pravastatin . . . . . . . . . . . . . . . . . . . . . 7Prazosin . . . . . . . . . . . . . . . . . . . . . . . 7Premarin . . . . . . . . . . . . . . . . . . . . . . . 16Premphase . . . . . . . . . . . . . . . . . . . . . 16Prempro . . . . . . . . . . . . . . . . . . . . . . . 16Prenatal Vitamins . . . . . . . . . . . . . . . . 14Prenisolone Oral Solution. . . . . . . . . 10Prepopik . . . . . . . . . . . . . . . . . . . . . . . 11Previfem . . . . . . . . . . . . . . . . . . . . . . . 16Prezcobix . . . . . . . . . . . . . . . . . . . . . . 12Prezista . . . . . . . . . . . . . . . . . . . . . . . . 12ProAir HFA . . . . . . . . . . . . . . . . . . . . . 14ProAir RespiClick. . . . . . . . . . . . . . . . 14Procrit . . . . . . . . . . . . . . . . . . . . . . . . . 13Progesterone Micronized Capsule . 16

Promethazine/Codeine. . . . . . . . . . . 13Promethazine/Dextromethorphan. . 13Promethazine Tablet . . . . . . . . . . . . . 14Propranolol Extended-Release Capsule . . . . . . . . . . . . . . . . . . . . . . . . 7Propranolol-Hydrochlorothiazide. . . 7Propranolol Tablet . . . . . . . . . . . . . . . 7Proventil HFA . . . . . . . . . . . . . . . . . . . 14Pulmicort Flexhaler . . . . . . . . . . . . . . 14Pulmozyme. . . . . . . . . . . . . . . . . . . . . 13Pylera. . . . . . . . . . . . . . . . . . . . . . . . . . 11

QQuasense . . . . . . . . . . . . . . . . . . . . . . 16Quetiapine . . . . . . . . . . . . . . . . . . . . . 8Quetiapine ER . . . . . . . . . . . . . . . . . . 8Quetiapine Extended-Release Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 8Quetiapine Tablet. . . . . . . . . . . . . . . . 8Quinapril . . . . . . . . . . . . . . . . . . . . . . . 7Quinapril-Hydrochlorothiazide . . . . . 7QVAR. . . . . . . . . . . . . . . . . . . . . . . . . . 14

RRabeprazole Tablet . . . . . . . . . . . . . . 11Raloxifene . . . . . . . . . . . . . . . . . . . . . . 16Raloxifene Tablet . . . . . . . . . . . . . . . . 13Ramipril . . . . . . . . . . . . . . . . . . . . . . . . 7Ranexa . . . . . . . . . . . . . . . . . . . . . . . . 7Ranitadine Syrup . . . . . . . . . . . . . . . . 11Rasuvo . . . . . . . . . . . . . . . . . . . . . . . . 12Rebif . . . . . . . . . . . . . . . . . . . . . . . . . . 8Reclipsen . . . . . . . . . . . . . . . . . . . . . . 16Rectiv. . . . . . . . . . . . . . . . . . . . . . . . . . 13Regranex. . . . . . . . . . . . . . . . . . . . . . . 9Repaglinide. . . . . . . . . . . . . . . . . . . . . 10Repatha 140 mg . . . . . . . . . . . . . . . . 7Restasis Single Use Vials . . . . . . . . . 11Revlimid. . . . . . . . . . . . . . . . . . . . . . . . 5Rexulti . . . . . . . . . . . . . . . . . . . . . . . . . 8Reyataz . . . . . . . . . . . . . . . . . . . . . . . . 12Rezira. . . . . . . . . . . . . . . . . . . . . . . . . . 13Rhofade. . . . . . . . . . . . . . . . . . . . . . . . 9Ribavirin Tablet. . . . . . . . . . . . . . . . . . 11Risedronate Sodium Tablet . . . . . . . 13Risperidone Tablet. . . . . . . . . . . . . . . 8Rizatriptan ODT, Tablet . . . . . . . . . . . 8Ropinirole Tablet . . . . . . . . . . . . . . . . 8Rosuvastatin . . . . . . . . . . . . . . . . . . . . 7Rydapt . . . . . . . . . . . . . . . . . . . . . . . . . 5

SSaphris . . . . . . . . . . . . . . . . . . . . . . . . 8Savaysa . . . . . . . . . . . . . . . . . . . . . . . . 6Seebri Neohaler . . . . . . . . . . . . . . . . . 14Selzentry . . . . . . . . . . . . . . . . . . . . . . . 12Serevent Diskus . . . . . . . . . . . . . . . . . 14Sertraline Tablet . . . . . . . . . . . . . . . . . 8

Setlakin . . . . . . . . . . . . . . . . . . . . . . . . 16Sevelamer . . . . . . . . . . . . . . . . . . . . . . 13Sharobel . . . . . . . . . . . . . . . . . . . . . . . 16Sildenafil Tablet . . . . . . . . . . . . . . . . . 14Siliq . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Simponi . . . . . . . . . . . . . . . . . . . . . . . . 12Simvastatin . . . . . . . . . . . . . . . . . . . . . 7Simvastatin/Ezetimibe. . . . . . . . . . . . 7Sirolimus Tablet . . . . . . . . . . . . . . . . . 14Solia . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Soliqua . . . . . . . . . . . . . . . . . . . . . . . . 10Sotalol . . . . . . . . . . . . . . . . . . . . . . . . . 7Sovaldi. . . . . . . . . . . . . . . . . . . . . . . . . 11Spiriva Handihaler . . . . . . . . . . . . . . . 14Spiriva Respimat . . . . . . . . . . . . . . . . 14Spironolactone. . . . . . . . . . . . . . . . . . 7Sprintec . . . . . . . . . . . . . . . . . . . . . . . . 16Sprix. . . . . . . . . . . . . . . . . . . . . . . . . . . 13Sronyx . . . . . . . . . . . . . . . . . . . . . . . . . 16Stavudine . . . . . . . . . . . . . . . . . . . . . . 12Stelara . . . . . . . . . . . . . . . . . . . . . . . . . 12Stribild . . . . . . . . . . . . . . . . . . . . . . . . . 12Striverdi Respimat . . . . . . . . . . . . . . . 14Suclear . . . . . . . . . . . . . . . . . . . . . . . . 11Sucralfate Tablet . . . . . . . . . . . . . . . . 11Sulfamethoxazole-Trimethoprim Tablet . . . . . . . . . . . . . . . . . . . . . . . . . . 5Sulfasalazine Tablet . . . . . . . . . . . . . . 11Sumatriptan Nasal Spray . . . . . . . . . 8Sumatriptan Succinate Tablet, Injection. . . . . . . . . . . . . . . . . . . . . . . . 8Suprax Capsule, Chewable Tablet, Tablet . . . . . . . . . . . . . . . . . . . 5Suprep. . . . . . . . . . . . . . . . . . . . . . . . . 11Sustiva . . . . . . . . . . . . . . . . . . . . . . . . . 12Sutent . . . . . . . . . . . . . . . . . . . . . . . . . 5Syeda. . . . . . . . . . . . . . . . . . . . . . . . . . 16Symbicort . . . . . . . . . . . . . . . . . . . . . . 14Symfi . . . . . . . . . . . . . . . . . . . . . . . . . . 12Symfi Lo . . . . . . . . . . . . . . . . . . . . . . . 12Symproic . . . . . . . . . . . . . . . . . . . . . . . 11Synjardy. . . . . . . . . . . . . . . . . . . . . . . . 10Synthroid. . . . . . . . . . . . . . . . . . . . . . . 10Syprine . . . . . . . . . . . . . . . . . . . . . . . . 13

TTaclonex Suspension . . . . . . . . . . . . 9Tacrolimus Capsule . . . . . . . . . . . . . . 14Tacrolimus Ointment . . . . . . . . . . . . . 9Tadalafil Table 2.5mg, 5mg . . . . . . . 14Tadalafil Tablet 10mg, 20mg . . . . . . 14Take Action . . . . . . . . . . . . . . . . . . . . . 16Takhzyro . . . . . . . . . . . . . . . . . . . . . . . 12Taltz . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Tamoxifen . . . . . . . . . . . . . . . . . . . . 5, 16Tanzeum . . . . . . . . . . . . . . . . . . . . . . . 10Targretin Capsule. . . . . . . . . . . . . . . . 5Targretin Gel . . . . . . . . . . . . . . . . . . . . 5

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Tarina Fe . . . . . . . . . . . . . . . . . . . . . . . 16Tasigna . . . . . . . . . . . . . . . . . . . . . . . . 5Tazorac 0.1% Cream. . . . . . . . . . . . . 9Tazorac Gel, 0.05% Cream. . . . . . . . 9Tecfidera . . . . . . . . . . . . . . . . . . . . . . . 8Technivie . . . . . . . . . . . . . . . . . . . . . . . 11Tekturna . . . . . . . . . . . . . . . . . . . . . . . 7Tekturna-Hydrochlorothiazide . . . . . 7Telmisartan . . . . . . . . . . . . . . . . . . . . . 7Telmisartan-Hydrochlorothiazide . . . 7Temazepam Capsule . . . . . . . . . . . . 9Tenofovir Tablet . . . . . . . . . . . . . . . . . 12Terazosin. . . . . . . . . . . . . . . . . . . . . . . 7Terbinafine Tablet . . . . . . . . . . . . . . . 5Terbutaline . . . . . . . . . . . . . . . . . . . . . 14Thrive Gum. . . . . . . . . . . . . . . . . . . . . 14Tilia Fe . . . . . . . . . . . . . . . . . . . . . . . . . 16Timolol Maleate 0.25%, 0.5% Ophthalmic Solution . . . . . . . . . . . . . 11Tivicay . . . . . . . . . . . . . . . . . . . . . . . . . 12Tizanidine Tablet . . . . . . . . . . . . . . . . 13Tobi Podhaler . . . . . . . . . . . . . . . . . . . 13Tobramycin/Dexamethasone 0.3%-0.1% Ophthalmic Suspension. . . . . . . . . . . . . . . . . . . . . 11Tobramycin Ophthalmic Solution . . . . . . . . . . . . . . . . . . . . . . . . 11Tolcapone . . . . . . . . . . . . . . . . . . . . . . 8Topiramate Immediate-Release Tablet . . . . . . . . 9Toviaz. . . . . . . . . . . . . . . . . . . . . . . . . . 13Tracleer . . . . . . . . . . . . . . . . . . . . . . . . 14Tradjenta . . . . . . . . . . . . . . . . . . . . . . . 10Tramadol-Acetaminophen . . . . . . . . 13Tramadol Immediate-Release Tablet . . . . . . . . 13Tramadol Sustained-Release Tablet . . . . . . . . . 13Trandolapril . . . . . . . . . . . . . . . . . . . . . 7Trandolapril-Verapamil . . . . . . . . . . . 7Transderm-Scop . . . . . . . . . . . . . . . . 11Travatan Z . . . . . . . . . . . . . . . . . . . . . . 11Trazodone Tablet . . . . . . . . . . . . . . . . 8Trelegy Ellipta . . . . . . . . . . . . . . . . . . . 14Tremfya . . . . . . . . . . . . . . . . . . . . . . . . 12Tresiba. . . . . . . . . . . . . . . . . . . . . . . . . 10Tretinoin Cream . . . . . . . . . . . . . . . . . 9Trezix . . . . . . . . . . . . . . . . . . . . . . . . . . 13Triamcinolone Acetonide Cream, Lotion, Ointment . . . . . . . . . . . . . . . . 9Triamterene-Hydrochlorothiazide . . 7Triazolam Tablet . . . . . . . . . . . . . . . . . 9Tri-Estarylla . . . . . . . . . . . . . . . . . . . . . 16Tri-Linyah. . . . . . . . . . . . . . . . . . . . . . . 16Tri-Lo-Estarylla . . . . . . . . . . . . . . . . . . 16Tri-Lo-Marzia . . . . . . . . . . . . . . . . . . . . 16

Tri-Lo-Sprintec . . . . . . . . . . . . . . . . . . 16Trinessa. . . . . . . . . . . . . . . . . . . . . . . . 16Trinessa Lo . . . . . . . . . . . . . . . . . . . . . 16Trintellix . . . . . . . . . . . . . . . . . . . . . . . . 8Tri-Previfem . . . . . . . . . . . . . . . . . . . . . 16Tri-Sprintec . . . . . . . . . . . . . . . . . . . . . 16Triumeq . . . . . . . . . . . . . . . . . . . . . . . . 12Trivora-28 . . . . . . . . . . . . . . . . . . . . . . 16Trulicity . . . . . . . . . . . . . . . . . . . . . . . . 10Truvada . . . . . . . . . . . . . . . . . . . . . . . . 12Tudorza . . . . . . . . . . . . . . . . . . . . . . . . 14Tybost . . . . . . . . . . . . . . . . . . . . . . . . . 12Tymlos . . . . . . . . . . . . . . . . . . . . . . . . . 13Tyvaso . . . . . . . . . . . . . . . . . . . . . . . . . 14

UUceris Foam . . . . . . . . . . . . . . . . . . . . 11Uceris Tablet. . . . . . . . . . . . . . . . . . . . 11Uloric . . . . . . . . . . . . . . . . . . . . . . . . . . 11Uptravi . . . . . . . . . . . . . . . . . . . . . . . . . 14

VValacyclovir Tablet . . . . . . . . . . . . . . . 5Valganciclovir . . . . . . . . . . . . . . . . . . . 5Valsartan . . . . . . . . . . . . . . . . . . . . . . . 7Valsartan-Hydrochlorothiazide . . . . . 7Varubi . . . . . . . . . . . . . . . . . . . . . . . . . 11Vascepa. . . . . . . . . . . . . . . . . . . . . . . . 7Vectical . . . . . . . . . . . . . . . . . . . . . . . . 9Velivet . . . . . . . . . . . . . . . . . . . . . . . . . 16Velphoro . . . . . . . . . . . . . . . . . . . . . . . 13Veltassa . . . . . . . . . . . . . . . . . . . . . . . . 13Venlafaxine Extended-Release Capsule . . . . . . . . . . . . . . . . . . . . . . . . 8Venlafaxine Tablet . . . . . . . . . . . . . . . 8Ventolin HFA. . . . . . . . . . . . . . . . . . . . 14Vestura . . . . . . . . . . . . . . . . . . . . . . . . 16Viberzi . . . . . . . . . . . . . . . . . . . . . . . . . 11Victoza 2-Pak . . . . . . . . . . . . . . . . . . . 10Victoza 3-Pak . . . . . . . . . . . . . . . . . . . 10Viekira Pak . . . . . . . . . . . . . . . . . . . . . 11Viekira XR . . . . . . . . . . . . . . . . . . . . . . 11Vienva . . . . . . . . . . . . . . . . . . . . . . . . . 16Viibryd . . . . . . . . . . . . . . . . . . . . . . . . . 8Viorele . . . . . . . . . . . . . . . . . . . . . . . . . 16Viracept . . . . . . . . . . . . . . . . . . . . . . . . 12Viread . . . . . . . . . . . . . . . . . . . . . . . . . 12Viteka. . . . . . . . . . . . . . . . . . . . . . . . . . 12Vivelle-Dot . . . . . . . . . . . . . . . . . . . . . . 16Voltaren Gel . . . . . . . . . . . . . . . . . . . . 13Vosevi . . . . . . . . . . . . . . . . . . . . . . . . . 11Vraylar . . . . . . . . . . . . . . . . . . . . . . . . . 8Vyflema . . . . . . . . . . . . . . . . . . . . . . . . 16Vyvanse . . . . . . . . . . . . . . . . . . . . . . . . 7

WWarfarin. . . . . . . . . . . . . . . . . . . . . . . . 6Warfarin Sodium . . . . . . . . . . . . . . . . 6Welchol . . . . . . . . . . . . . . . . . . . . . . . . 7Wera . . . . . . . . . . . . . . . . . . . . . . . . . . 16Wymza Fe . . . . . . . . . . . . . . . . . . . . . . 16

XXarelto . . . . . . . . . . . . . . . . . . . . . . . . . 6Xeljanz . . . . . . . . . . . . . . . . . . . . . . . . . 12Xeljanz XR. . . . . . . . . . . . . . . . . . . . . . 12Xeloda . . . . . . . . . . . . . . . . . . . . . . . . . 5Xiidra . . . . . . . . . . . . . . . . . . . . . . . . . . 11Xopenex HFA . . . . . . . . . . . . . . . . . . . 14Xtampza ER . . . . . . . . . . . . . . . . . . . . 13Xulane . . . . . . . . . . . . . . . . . . . . . . . . . 16Xyrem. . . . . . . . . . . . . . . . . . . . . . . . . . 8

YYasmin 28 . . . . . . . . . . . . . . . . . . . . . . 16Yaz . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Yuvafem. . . . . . . . . . . . . . . . . . . . . . . . 16

ZZafirlukast . . . . . . . . . . . . . . . . . . . . . . 14Zaleplon Capsule. . . . . . . . . . . . . . . . 9Zarah . . . . . . . . . . . . . . . . . . . . . . . . . . 16Zarxio. . . . . . . . . . . . . . . . . . . . . . . . . . 13Zelapar . . . . . . . . . . . . . . . . . . . . . . . . 8Zenchent . . . . . . . . . . . . . . . . . . . . . . . 16Zenchent Fe . . . . . . . . . . . . . . . . . . . . 16Zenpep . . . . . . . . . . . . . . . . . . . . . . . . 11Zepatier . . . . . . . . . . . . . . . . . . . . . . . . 11Zetonna . . . . . . . . . . . . . . . . . . . . . . . . 14Zidovudine . . . . . . . . . . . . . . . . . . . . . 12Zinbryta . . . . . . . . . . . . . . . . . . . . . . . . 8Ziprasidone. . . . . . . . . . . . . . . . . . . . . 8Ziprasidone Capsule . . . . . . . . . . . . . 8Zohydro ER. . . . . . . . . . . . . . . . . . . . . 13Zolpidem Tablet . . . . . . . . . . . . . . . . . 9Zonisamide Capsule . . . . . . . . . . . . . 9Zontivity . . . . . . . . . . . . . . . . . . . . . . . . 6Zovia 1/35E, 1/50E. . . . . . . . . . . . . . 16Zubsolv . . . . . . . . . . . . . . . . . . . . . . . . 8Zurampic. . . . . . . . . . . . . . . . . . . . . . . 11Zykadia . . . . . . . . . . . . . . . . . . . . . . . . 5Zytiga . . . . . . . . . . . . . . . . . . . . . . . . . . 5

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Notes

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Notes

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Notice

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The content provided is for informational purposes only, and does not constitute medical advice. Always consult your doctor before making any decisions about medical care. The services outlined here do not necessarily reflect the services, vaccine, screenings or tests that will be covered under your benefit plan. Always refer to your plan documents for specific benefit coverage and limitations or call the toll-free member phone number on the back of your ID card. Certain procedures may not be fully covered under some benefit plans.

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Prescription Drug List – Maricopa County Advantage Three-Tier 7/19 Consumer 4/19 © 2019 United HealthCare Services, Inc.

Your 2019-2020 Prescription Drug List

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