Your 2020 Comprehensive Formulary - OptumRx · 2020-04-18 · 3 Formulary design The formulary...

Optum Insurance of Ohio, Inc. is a Medicare-approved Part D sponsor and administers this plan through its pharmacy benefit manager, OptumRx, on behalf of your employer, union, or trustees of a fund. If you need this information in another language or alternate format (braille, large print, audio), please contact OptumRx at the number listed on your member ID card. Formulary ID 20069 Version 7 S8841_20_MC-DS11_C_MCC

State Health Plan PPO Medicare Prescription Drug Plan (PDP)

Your 2020 Comprehensive Formulary

Administered by OptumRx®

Effective January 1, 2020

Please read: this document contains information about the drugs we cover in this plan. This comprehensive formulary was updated on August 28, 2019, and is a complete list of drugs covered by our plan. For more recent information or if you have questions, please contact:

OptumRx Member Services

Phone (toll-free): 1-866-635-5941 TTY users: 711 Hours of operation: 24 hours a day, 7 days a week Website: optumrx.com

Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to “we,” “us,” or “our,” it means OptumRx. When it refers to “plan” or “our plan,” it means State Health Plan PPO Medicare Prescription Drug Plan. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, premium, and/or copayments/coinsurance may change on January 1, 2021.

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What is the Comprehensive Formulary?

A formulary is a list of covered drugs selected by State Health Plan PPO in consultation with OptumRx and a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. This plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at an OptumRx network pharmacy, and other plan rules are followed.

Can the formulary (drug list) change?

Yes. If you are taking a drug on our 2020 formulary that is covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2020 coverage year except when a new, less-expensive generic drug becomes available, or when new adverse information about the safety or effectiveness of a drug is released. If we make a negative change to our formulary (i.e. add prior authorization, quantity limits, and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, when applicable), we must notify affected members. Members will receive a notice regarding the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe, or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of January 1, 2020. To get updated information about covered drugs, please contact OptumRx. You may also visit our website at optumrx.com where you will find the most up-to-date information about our list of covered drugs (formulary) by using the “Drug Information” tool (found under the “Member Tools” tab). Our contact information is shown on the front and back cover pages.

How do I use the formulary?

There are two ways to find your drug within the formulary:

Medical Condition

The formulary begins on page 7. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category “Cardiovascular Agents.” If you know what your drug is used for, look for the category name in the list that begins on page 7. Then, look under the category name for your drug.

Alphabetical Listing

If you are not sure what category to look under, you should look for your drug in the Index that begins page 145. The Index provides an alphabetical list of all drugs included in this document. Both brand-name drugs and generic drugs are listed in the Index.

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Formulary design

The formulary structure features generic drugs, preferred brand-name drugs, and non-preferred brand-name drugs.

Drug Tier Helpful Tips

Tier 1 Most generic drugs are listed under Tier 1 and have the lowest copayments.

Tier 2 Drugs listed under Tier 2 generally include preferred brand-name drugs that have lower copayments than non-preferred brand-name drugs.

Tier 3 Drugs listed under Tier 3 generally have higher copayments than preferred brand-name drugs and may include some specialty or high-cost drugs*.

* High-cost (or some Specialty) drugs are those that cost $670 or more for up to a 30-day maximum

supply. These types of drugs are labeled in the formulary as “NDS” under the Requirements/Limits column, and will not be dispensed in more than a 30-day supply.

Please refer to your Evidence of Coverage for more information.

What are generic drugs?

Our plan covers both brand-name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand-name drug. Generally, generic drugs cost less than brand-name drugs.

Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

Prior Authorization (PA) You or your physician may need to get prior authorization for certain drugs. This means you will need to get approval from OptumRx before you fill your prescriptions. If you do not get approval, the drug may not be covered.

Quantity Limits (QL) For certain drugs, there is a limit on the amount of the drug we will cover.

Step Therapy (ST) In some cases, it is required that you first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

To find out if your drug has any additional requirements or limits, look in the formulary that begins on page 7. You can also get more information about restrictions applied to specific covered drugs by visiting our website or by calling OptumRx. Our contact information, along with the date we last updated the formulary, is shown on the front and back cover pages.

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You can ask OptumRx to make an exception to these restrictions or limits, or for a list of other similar drugs that may treat your health condition. See the section “How do I request an exception to the formulary?” on page 4 for additional information.

What if my drug is not on the formulary?

If your drug is not included in this formulary (list of covered drugs), you should first contact OptumRx and ask if your drug is covered. Our contact information, along with the date we last updated the formulary, is shown on the front and back cover pages. If your drug is not covered, you have two options:

You can ask OptumRx for a list of similar drugs that are covered. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered.

You can ask OptumRx to make an exception and cover your drug. See below for information about how to request an exception.

State Health Plan PPO offers supplemental coverage (also called WRAP coverage) on some prescription drugs not normally covered under Medicare Part D. Please contact OptumRx for any questions regarding your supplemental coverage.

How do I request an exception to the formulary?

You can ask OptumRx to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:

You can ask us to cover a drug even if it is not on our formulary. If approved, the drug will be covered at a predetermined cost-sharing level, and you will not be able to ask us to provide the drug at a lower cost-sharing level.

You can ask us to cover a formulary drug at a lower cost-sharing level. If approved, this would lower the amount you must pay for your drug.

You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, we may limit the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount.

Please Note: If we grant your request to cover a drug that is not on our formulary, you may not ask us to provide a higher level of coverage for the drug. Generally, we will only approve your request for an exception if the drug is included on the plan’s formulary, or if additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact OptumRx for an initial coverage decision for a formulary, tier, or utilization

restriction exception. When you request a formulary, tier, or utilization restriction exception, you

must submit a statement from your doctor (or other prescriber) supporting your request.

Generally, we must make our decision within 72 hours of getting your doctor’s (or other prescriber’s) supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get a supporting statement from your doctor (or other prescriber).

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What do I do before I can talk to my doctor about changing my drugs or requesting an exception?

As a new or continuing member in our plan, you may be taking drugs that are not on our formulary, or you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor (or other prescriber) to decide if you should switch to an appropriate drug that we cover or request a formulary exception. While you talk to your doctor (or other prescriber) to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs not on our formulary, or if your ability to get your drugs is limited, we will cover a temporary 30-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 30-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with 31-day transition supply, written for as many pills as necessary, unless you have a prescription written for fewer days. We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary, or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you get a formulary exception. If you are a current enrollee with a level-of-care change and you need a drug that is not on our formulary, or if your ability to get your drugs is limited, we will cover a temporary 31-day transition supply (unless you have a prescription written for fewer days) while you seek a formulary exception. If you are in the process of seeking an exception, we will consider allowing continued coverage until a decision is made.

For more information

For more detailed information about your prescription drug coverage, please review your other plan materials. If you have questions about the plan, please call OptumRx. Our contact information, along with the date we last updated the formulary, is shown on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, 7 days a week. You may also visit medicare.gov.

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Formulary

The formulary below provides information about your covered drugs. If you have trouble finding your

drug in the list, turn to the Index that begins on page 145.

The first column of the chart lists the drug name. Brand-name drugs are capitalized (e.g., COZAAR),

and generic drugs are listed in lower-case italics (e.g., atenolol). The abbreviations in the

“Requirements/Limits” column tell you if there are any special requirements for coverage of your

drug

Requirements/Limits Helpful Tips

B/D

This prescription drug has a Part B versus D administrative prior authorization requirement. This drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

NDS Non-Extended Days' Supply. This prescription drug is not available for an extended days' supply.

PA

Prior Authorization. Our plan requires you or your physician to get prior authorization for certain drugs. This means you will need to get approval from OptumRx before you fill your prescriptions. If you do not get approval, your drug may not be covered.

QL Quantity Limit. For certain drugs, our plan limits the amount of the drug that will be covered.

ST

Step Therapy. In some cases, our plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B.

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Drug Name Drug Tier Requirements/Limits

Analgesics

Analgesics

allzital oral tablet 3 PA; NDS

bupap oral tablet 3 PA; NDS

butalbital-acetaminophen oral capsule

1 PA

butalbital-acetaminophen oral tablet

1 PA

butalbital-apap-caffeine oral capsule

1 PA

butalbital-aspirin-caffeine oral capsule

1 PA

butalbital-aspirin-caffeine oral tablet

1 PA

capacet oral capsule 50-325-40 mg

1 PA

esgic oral capsule 1 PA

fioricet oral capsule 3 PA

FIORINAL ORAL CAPSULE

3 PA

marten-tab oral tablet 50-325 mg

1 PA

phrenilin forte oral capsule

1 PA

tencon oral tablet 1 PA

vanatol lq oral solution 3 PA; NDS

zebutal oral capsule 1 PA

Nonsteroidal Anti-inflammatory Drugs

ANAPROX DS ORAL TABLET

3

ARTHROTEC ORAL TABLET DELAYED RELEASE

3

CALDOLOR INTRAVENOUS SOLUTION

3

CAMBIA ORAL PACKET

3

CELEBREX ORAL CAPSULE

3 QL (60 EA per 30 days)


celecoxib oral capsule 1 QL (60 EA per 30 days)

DAYPRO ORAL TABLET

3

diclofenac epolamine transdermal patch

1 PA; QL (60 EA per 30 days)

diclofenac potassium oral tablet

3

diclofenac sodium er oral tablet extended release 24 hour

3

diclofenac sodium oral tablet delayed release

3

diclofenac sodium transdermal gel 1 %

1 QL (1000 GM per 30 days)

diclofenac sodium transdermal gel 3 %

3

diclofenac-misoprostol oral tablet delayed release

3

diflunisal oral tablet 1

DUEXIS ORAL TABLET 3 QL (90 EA per 30 days); NDS

EC-NAPROSYN ORAL TABLET DELAYED RELEASE

3

ec-naproxen oral tablet delayed release

1

etodolac er oral tablet extended release 24 hour

1

etodolac oral capsule 1

etodolac oral tablet 1

FELDENE ORAL CAPSULE

3

fenoprofen calcium oral capsule

1

fenoprofen calcium oral tablet

1

fenortho oral capsule 1

FLECTOR TRANSDERMAL PATCH


flurbiprofen oral tablet 1

8


ibu oral tablet 1

ibuprofen oral suspension

1

ibuprofen oral tablet 400 mg, 600 mg, 800 mg

1

INDOCIN ORAL SUSPENSION

3

INDOCIN RECTAL SUPPOSITORY

3

indomethacin er oral capsule extended release

1

indomethacin oral capsule

1

indomethacin sodium intravenous solution reconstituted

1

ketoprofen er oral capsule extended release 24 hour

1

ketoprofen oral capsule 1

ketorolac tromethamine injection solution

1

ketorolac tromethamine intramuscular solution

1

ketorolac tromethamine oral tablet


lodine oral tablet 3 NDS

meclofenamate sodium oral capsule

1

mefenamic acid oral capsule

1

meloxicam oral tablet 1

MOBIC ORAL TABLET 3

nabumetone oral tablet 1

NALFON ORAL CAPSULE

3

nalfon oral tablet 3

NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 375 MG, 500 MG

3 NDS


NAPRELAN ORAL TABLET EXTENDED RELEASE 24 HOUR 750 MG

3

NAPROSYN ORAL SUSPENSION

3

NAPROSYN ORAL TABLET 500 MG

3

naproxen dr oral tablet delayed release

1

naproxen oral suspension

1

naproxen oral tablet 1

naproxen sodium er oral tablet extended release 24 hour

1

naproxen sodium oral tablet 275 mg, 550 mg

1

oxaprozin oral tablet 1

piroxicam oral capsule 1

profeno oral tablet 600 mg

1

QMIIZ ODT ORAL TABLET DISPERSIBLE

3

salsalate oral tablet 1

SPRIX NASAL SOLUTION

3 QL (5 EA per 30 days); NDS

sulindac oral tablet 1

TIVORBEX ORAL CAPSULE

3

tolmetin sodium oral capsule

1

tolmetin sodium oral tablet

1

VIMOVO ORAL TABLET DELAYED RELEASE

3 PA; QL (60 EA per 30 days); NDS

VIVLODEX ORAL CAPSULE

3

VOLTAREN TRANSDERMAL GEL


ZIPSOR ORAL CAPSULE

3 NDS

9


ZORVOLEX ORAL CAPSULE

3

Opioid Analgesics, Long-acting

ARYMO ER ORAL TABLET EXTENDED RELEASE ABUSE-DETERRENT

3 ST; NDS

BELBUCA BUCCAL FILM


BUPRENEX INJECTION SOLUTION

3 NDS

buprenorphine hcl injection solution

3 NDS

buprenorphine transdermal patch weekly 10 mcg/hr, 15 mcg/hr, 20 mcg/hr, 5 mcg/hr


buprenorphine transdermal patch weekly 7.5 mcg/hr


BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HR, 15 MCG/HR, 20 MCG/HR, 5 MCG/HR


BUTRANS TRANSDERMAL PATCH WEEKLY 7.5 MCG/HR


CONZIP ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3 PA; NDS

DOLOPHINE ORAL TABLET

3 NDS

DURAGESIC-100 TRANSDERMAL PATCH 72 HOUR

3 NDS


3 NDS


3 NDS



3 NDS


3 NDS

EMBEDA ORAL CAPSULE EXTENDED RELEASE

2 NDS

EXALGO ORAL TABLET ER 24 HOUR ABUSE-DETERRENT 12 MG, 16 MG, 32 MG, 8 MG

3 NDS

fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hr, 50 mcg/hr, 62.5 mcg/hr, 75 mcg/hr

1 NDS

fentanyl transdermal patch 72 hour 87.5 mcg/hr

3 NDS

hydromorphone hcl er oral tablet er 24 hour abuse-deterrent 12 mg, 16 mg, 8 mg

1 NDS

hydromorphone hcl er oral tablet er 24 hour abuse-deterrent 32 mg

3 NDS

HYSINGLA ER ORAL TABLET ER 24 HOUR ABUSE-DETERRENT

2 PA; NDS

INFUMORPH 200 INJECTION SOLUTION

3 NDS

INFUMORPH 500 INJECTION SOLUTION

3 NDS

KADIAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3 NDS

levorphanol tartrate oral tablet

1 NDS

methadone hcl injection solution

3 NDS

methadone hcl intensol oral concentrate

1 NDS

10


methadone hcl oral concentrate

1 NDS

methadone hcl oral solution

1 NDS

methadone hcl oral tablet

1 NDS

methadose oral concentrate 10 mg/ml

1 NDS

methadose sugar-free oral concentrate

1 NDS

mitigo injection solution 1 NDS

MORPHABOND ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT

3 PA; NDS

morphine sulfate er beads oral capsule extended release 24 hour

1 NDS

morphine sulfate er oral capsule extended release 24 hour 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 80 mg

1 NDS

morphine sulfate er oral capsule extended release 24 hour 100 mg

3 NDS

morphine sulfate er oral tablet extended release

1 NDS

morphine sulfate intramuscular device

1 NDS

MS CONTIN ORAL TABLET EXTENDED RELEASE

3 NDS

NUCYNTA ER ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG, 150 MG, 50 MG

2 NDS

NUCYNTA ER ORAL TABLET EXTENDED RELEASE 12 HOUR 200 MG, 250 MG

3 NDS


OPANA ER ORAL TABLET ER 12 HOUR ABUSE-DETERRENT 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 5 MG, 7.5 MG

3 ST; NDS

oxycodone hcl er oral tablet er 12 hour abuse-deterrent 10 mg, 15 mg, 20 mg, 30 mg, 40 mg

2 NDS

oxycodone hcl er oral tablet er 12 hour abuse-deterrent 60 mg, 80 mg

3 NDS

OXYCONTIN ORAL TABLET ER 12 HOUR ABUSE-DETERRENT

2 NDS

oxymorphone hcl er oral tablet extended release 12 hour

1 NDS

tramadol hcl er (biphasic) oral tablet extended release 24 hour

1 NDS

tramadol hcl er oral capsule extended release 24 hour

3 PA; NDS

tramadol hcl er oral tablet extended release 24 hour

1 NDS

XTAMPZA ER ORAL CAPSULE ER 12 HOUR ABUSE-DETERRENT

3 ST; NDS

ZOHYDRO ER ORAL CAPSULE ER 12 HOUR ABUSE-DETERRENT

3 PA; NDS

Opioid Analgesics, Short-acting

ABSTRAL SUBLINGUAL TABLET SUBLINGUAL

3 PA; NDS

acetaminophen-codeine #3 oral tablet

1 NDS

acetaminophen-codeine oral solution

1 NDS

11


acetaminophen-codeine oral tablet 300-15 mg, 300-60 mg

1 NDS

ACTIQ BUCCAL LOZENGE ON A HANDLE

3 PA; NDS

APADAZ ORAL TABLET

3 NDS

apap-caff-dihydrocodeine oral capsule


apap-caff-dihydrocodeine oral tablet 325-30-16 mg

1 NDS

ascomp-codeine oral capsule

1 PA; NDS

butalbital-apap-caff-cod oral capsule

1 PA; NDS

butalbital-asa-caff-codeine oral capsule

1 PA; NDS

butorphanol tartrate injection solution

1 NDS

butorphanol tartrate nasal solution

1 NDS

carisoprodol-aspirin-codeine oral tablet

1 PA; NDS

codeine sulfate oral tablet

1 NDS

DEMEROL INJECTION SOLUTION

3 NDS

DEMEROL ORAL TABLET 100 MG

3 NDS

DILAUDID INJECTION SOLUTION

3 NDS

DILAUDID ORAL LIQUID

3 NDS

DILAUDID ORAL TABLET

3 NDS

DURAMORPH INJECTION SOLUTION

1 NDS

dvorah oral tablet 3 NDS

endocet oral tablet 1 NDS

fentanyl citrate (pf) injection solution

1 B/D; NDS


fentanyl citrate (pf) injection solution cartridge

1 B/D; NDS

fentanyl citrate buccal lozenge on a handle

3 PA; NDS

fentanyl citrate buccal tablet

3 PA; NDS

FENTORA BUCCAL TABLET

3 PA; NDS

fioricet/codeine oral capsule

3 PA; NDS

FIORINAL/CODEINE #3 ORAL CAPSULE

3 PA; NDS

hydrocodone-acetaminophen oral solution 10-325 mg/15ml, 7.5-325 mg/15ml

1 NDS

hydrocodone-acetaminophen oral tablet

1 NDS

hydrocodone-ibuprofen oral tablet

1 NDS

hydromorphone hcl injection solution 1 mg/ml, 2 mg/ml, 4 mg/ml

1 NDS

hydromorphone hcl oral liquid

1 NDS

hydromorphone hcl oral tablet

1 NDS

hydromorphone hcl pf injection solution 1 mg/ml, 10 mg/ml, 2 mg/ml, 4 mg/ml, 50 mg/5ml

1 NDS

IBUDONE ORAL TABLET 10-200 MG

3 NDS

ibudone oral tablet 5-200 mg

1 NDS

LAZANDA NASAL SOLUTION

3 PA; NDS

lorcet hd oral tablet 1 NDS

lorcet oral tablet 1 NDS

lorcet plus oral tablet 1 NDS

LORTAB ORAL ELIXIR 3 NDS

12


meperidine hcl injection solution

1 NDS

meperidine hcl oral solution

1 NDS

meperidine hcl oral tablet

1 NDS

morphine sulfate (concentrate) oral solution 100 mg/5ml

1 NDS

morphine sulfate (pf) injection solution 0.5 mg/ml, 1 mg/ml, 2 mg/ml

1 NDS

morphine sulfate (pf) injection solution 10 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml

1 B/D; NDS

morphine sulfate (pf) intravenous solution

1 NDS

morphine sulfate injection solution 10 mg/ml, 4 mg/ml, 8 mg/ml

1 NDS

MORPHINE SULFATE INJECTION SOLUTION 2 MG/ML, 5 MG/ML

1 NDS

morphine sulfate intravenous solution 1 mg/ml, 150 mg/30ml

1 B/D; NDS

morphine sulfate intravenous solution 25 mg/ml, 50 mg/ml

1 NDS

morphine sulfate oral solution

1 NDS

MORPHINE SULFATE ORAL TABLET

1 NDS

nalbuphine hcl injection solution

1 NDS

NALOCET ORAL TABLET

1 NDS

norco oral tablet 3 NDS

NUCYNTA ORAL TABLET

3 NDS

OPANA ORAL TABLET 3 NDS


OXAYDO ORAL TABLET ABUSE-DETERRENT

3 NDS

oxycodone hcl oral capsule

1 NDS

oxycodone hcl oral concentrate 100 mg/5ml

1 NDS

oxycodone hcl oral solution

1 NDS

oxycodone hcl oral tablet

1 NDS

oxycodone-acetaminophen oral solution 5-325 mg/5ml

1 NDS

oxycodone-acetaminophen oral tablet

1 NDS

oxycodone-aspirin oral tablet

1 NDS

oxycodone-ibuprofen oral tablet

1 NDS

oxymorphone hcl oral tablet

1 NDS

panlor oral tablet 325-30-16 mg

1 NDS

pentazocine-naloxone hcl oral tablet

1 NDS

percocet oral tablet 3 NDS

primlev oral tablet 3 NDS

ROXICODONE ORAL TABLET

3 NDS

ROXYBOND ORAL TABLET ABUSE-DETERRENT

3 NDS

SUBSYS SUBLINGUAL LIQUID

3 PA; NDS

tramadol hcl oral tablet 1 NDS

tramadol-acetaminophen oral tablet

1 NDS

trezix oral capsule 3 QL (300 EA per 30 days); NDS

tylenol with codeine #3 oral tablet

3 NDS

13


tylenol with codeine #4 oral tablet

3 NDS

ULTRACET ORAL TABLET

3 NDS

ULTRAM ORAL TABLET

3 NDS

vicodin es oral tablet 1 NDS

vicodin hp oral tablet 1 NDS

vicodin oral tablet 1 NDS

xylon oral tablet 10-200 mg

1 NDS

Anesthetics

Local Anesthetics

7t lido external gel 1 PA; QL (30 GM per 30 days)

ARTICADENT DENTAL INJECTION SOLUTION CARTRIDGE

3

bupivacaine hcl (pf) injection solution

1

bupivacaine hcl injection solution 0.5 %

1

bupivacaine in dextrose intrathecal solution

1

bupivacaine spinal intrathecal solution

1

bupivacaine-epinephrine (pf) injection solution

1

bupivacaine-epinephrine injection solution

1

CARBOCAINE INJECTION SOLUTION

3

CARBOCAINE PRESERVATIVE-FREE INJECTION SOLUTION

3

chloroprocaine hcl (pf) injection solution

1

glydo external gel 1 PA; QL (30 ML per 30 days)

lidocaine external ointment

1 PA; QL (150 GM per 30 days)

lidocaine external patch 1 PA


lidocaine hcl (pf) injection solution

1

lidocaine hcl external solution

1 PA; QL (250 ML per 30 days)

lidocaine hcl injection solution

1

lidocaine hcl urethral/mucosal external gel


lidocaine in dextrose solution

1

lidocaine-epinephrine injection solution

1

lidocaine-prilocaine external cream


LIDOCAINE-TETRACAINE EXTERNAL CREAM


LIDODERM EXTERNAL PATCH

3 PA

LIDOTREX EXTERNAL GEL

3 PA

MARCAINE INJECTION SOLUTION 0.5 %, 0.75 %

3

MARCAINE PRESERVATIVE FREE INJECTION SOLUTION

3

MARCAINE SPINAL INTRATHECAL SOLUTION

3

MARCAINE/EPINEPHRINE INJECTION SOLUTION

3

MARCAINE/EPINEPHRINE PF INJECTION SOLUTION

3

NAROPIN INJECTION SOLUTION

3

NESACAINE INJECTION SOLUTION

3

NESACAINE-MPF INJECTION SOLUTION

3

PLIAGLIS EXTERNAL CREAM


14


polocaine injection solution

1

polocaine-mpf injection solution

1

ropivacaine hcl injection solution 10 mg/ml, 2 mg/ml, 5 mg/ml, 7.5 mg/ml

1

sensorcaine injection solution 0.5 %

1

sensorcaine/epinephrine injection solution

1

sensorcaine-mpf injection solution

1

sensorcaine-mpf spinal intrathecal solution 0.75-8.25 %

1

sensorcaine-mpf/epinephrine injection solution 0.25% -1:200000, 0.5% -1:200000

1

SENSORCAINE-MPF/EPINEPHRINE INJECTION SOLUTION 0.75-1:200000 %

3

SYNERA EXTERNAL PATCH

3 NDS

xylocaine dental injection solution

1

XYLOCAINE INJECTION SOLUTION

3

XYLOCAINE/EPINEPHRINE INJECTION SOLUTION

3

XYLOCAINE-MPF INJECTION SOLUTION

3

XYLOCAINE-MPF/EPINEPHRINE INJECTION SOLUTION

3

ZTLIDO EXTERNAL PATCH


Anti-Addiction/Substance Abuse Treatment Agents


Alcohol Deterrents/Anti-craving

acamprosate calcium oral tablet delayed release

1

antabuse oral tablet 3

disulfiram oral tablet 1

VIVITROL INTRAMUSCULAR SUSPENSION RECONSTITUTED

3 NDS

Opioid Dependence Treatments

BUNAVAIL BUCCAL FILM 2.1-0.3 MG

3 ST; QL (180 EA per 30 days)

BUNAVAIL BUCCAL FILM 4.2-0.7 MG


BUNAVAIL BUCCAL FILM 6.3-1 MG


buprenorphine hcl sublingual tablet sublingual

1 NDS

buprenorphine hcl-naloxone hcl sublingual film 12-3 mg, 4-1 mg


buprenorphine hcl-naloxone hcl sublingual film 2-0.5 mg, 8-2 mg


buprenorphine hcl-naloxone hcl sublingual tablet sublingual 2-0.5 mg


buprenorphine hcl-naloxone hcl sublingual tablet sublingual 8-2 mg


LUCEMYRA ORAL TABLET


naltrexone hcl oral tablet

1

SUBLOCADE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 NDS

15


SUBOXONE SUBLINGUAL FILM 12-3 MG, 4-1 MG


SUBOXONE SUBLINGUAL FILM 2-0.5 MG, 8-2 MG


ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 0.7-0.18 MG, 5.7-1.4 MG


ZUBSOLV SUBLINGUAL TABLET SUBLINGUAL 1.4-0.36 MG








Opioid Reversal Agents

EVZIO INJECTION SOLUTION AUTO-INJECTOR

3 ST; NDS

naloxone hcl injection solution

1

naloxone hcl injection solution cartridge

1

naloxone hcl injection solution prefilled syringe

1

NARCAN NASAL LIQUID

3

Smoking Cessation Agents

bupropion hcl er (smoking det) oral tablet extended release 12 hour



CHANTIX CONTINUING MONTH PAK ORAL TABLET


CHANTIX ORAL TABLET


CHANTIX STARTING MONTH PAK ORAL TABLET


NICOTROL INHALATION INHALER


NICOTROL NS NASAL SOLUTION

2 QL (360 ML per 365 days)

ZYBAN ORAL TABLET EXTENDED RELEASE 12 HOUR 150 MG


Antibacterials

Aminoglycosides

amikacin sulfate injection solution

1

ARIKAYCE INHALATION SUSPENSION

3 NDS

gentak ophthalmic ointment

1

gentamicin in saline intravenous solution

1

gentamicin sulfate external cream

1

gentamicin sulfate external ointment

1

gentamicin sulfate injection solution

1

gentamicin sulfate intravenous solution 10 mg/ml

1

gentamicin sulfate ophthalmic solution

1

neomycin sulfate oral tablet

1

neomycin-polymyxin b gu irrigation solution

1

paromomycin sulfate oral capsule

1

16


streptomycin sulfate intramuscular solution reconstituted

1

tobramycin ophthalmic solution

1

tobramycin sulfate injection solution 1.2 gm/30ml, 10 mg/ml, 80 mg/2ml

1

tobramycin sulfate injection solution reconstituted

1

TOBREX OPHTHALMIC OINTMENT

3

TOBREX OPHTHALMIC SOLUTION

3

ZEMDRI INTRAVENOUS SOLUTION

3

Antibacterials, Other

AEMCOLO ORAL TABLET DELAYED RELEASE

3 PA

ALTABAX EXTERNAL OINTMENT

3

baciim intramuscular solution reconstituted

1

bacitracin intramuscular solution reconstituted

1

bacitracin ophthalmic ointment

1

BACTROBAN EXTERNAL CREAM 2 %

3

BACTROBAN NASAL NASAL OINTMENT 2 %

3

CENTANY EXTERNAL OINTMENT

3

chloramphenicol sod succinate intravenous solution reconstituted

1


CLEOCIN IN D5W INTRAVENOUS SOLUTION 300 MG/50ML, 600 MG/50ML, 900 MG/50ML

3

CLEOCIN ORAL CAPSULE

3

cleocin oral solution reconstituted

3

CLEOCIN PHOSPHATE INJECTION SOLUTION 300 MG/2ML, 600 MG/4ML, 9 GM/60ML

3

cleocin phosphate injection solution 900 mg/6ml

3

CLEOCIN PHOSPHATE INTRAVENOUS SOLUTION

3

CLEOCIN VAGINAL CREAM

3

CLEOCIN VAGINAL SUPPOSITORY

3

CLEOCIN-T EXTERNAL GEL

3

CLEOCIN-T EXTERNAL LOTION

3

CLEOCIN-T EXTERNAL SOLUTION 1 %

3

CLEOCIN-T EXTERNAL SWAB 1 %

3

clindacin etz external swab

1

clindacin-p external swab

1

CLINDAGEL EXTERNAL GEL

3 NDS

clindamycin hcl oral capsule

1

clindamycin palmitate hcl oral solution reconstituted

1

17


clindamycin phosphate external foam

1

clindamycin phosphate external gel

1

clindamycin phosphate external lotion

1

clindamycin phosphate external solution

1

clindamycin phosphate external swab

1

clindamycin phosphate in d5w intravenous solution

1

clindamycin phosphate in nacl intravenous solution

1

clindamycin phosphate injection solution

1

clindamycin phosphate intravenous solution

1

clindamycin phosphate vaginal cream

1

CLINDESSE VAGINAL CREAM

3

colistimethate sodium (cba) injection solution reconstituted

1

COLY-MYCIN M INJECTION SOLUTION RECONSTITUTED

3

CORTISPORIN EXTERNAL CREAM

3

CORTISPORIN EXTERNAL OINTMENT

3

CUBICIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

CUBICIN RF INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

DALVANCE INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS


DAPTOMYCIN INTRAVENOUS SOLUTION RECONSTITUTED 350 MG

3 NDS

daptomycin intravenous solution reconstituted 500 mg

3 NDS

EVOCLIN EXTERNAL FOAM

3

FIRVANQ ORAL SOLUTION RECONSTITUTED

3

FLAGYL ORAL CAPSULE

3

FLAGYL ORAL TABLET

3

FURADANTIN ORAL SUSPENSION

3 NDS

HIPREX ORAL TABLET 3

IMPAVIDO ORAL CAPSULE

3 NDS

LINCOCIN INJECTION SOLUTION

3

lincomycin hcl injection solution

1

linezolid intravenous solution

3 NDS

linezolid oral suspension reconstituted

3 QL (1800 ML per 28 days); NDS

linezolid oral tablet 1 QL (56 EA per 28 days)

MACROBID ORAL CAPSULE

3

MACRODANTIN ORAL CAPSULE

3

mafenide acetate external packet

1

methenamine hippurate oral tablet

1

methenamine mandelate oral tablet

1

METROGEL-VAGINAL VAGINAL GEL

3

18


metronidazole in nacl intravenous solution 500-0.74 mg/100ml-%, 500-0.79 mg/100ml-%

1

metronidazole intravenous solution

1

metronidazole oral capsule

1

metronidazole oral tablet

1

metronidazole vaginal gel

1

MONUROL ORAL PACKET

3

mupirocin calcium external cream

1

mupirocin external ointment

1

neo-synalar external cream

3

nitrofurantoin macrocrystal oral capsule

1

nitrofurantoin monohydrate macrocrystals oral capsule

1

nitrofurantoin oral suspension

1

NUVESSA VAGINAL GEL

3

ORBACTIV INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

polymyxin b sulfate injection solution reconstituted

1

PRIMSOL ORAL SOLUTION

3

SILVADENE EXTERNAL CREAM

3

silver sulfadiazine external cream

1


SIVEXTRO INTRAVENOUS SOLUTION RECONSTITUTED


SIVEXTRO ORAL TABLET


SSD EXTERNAL CREAM

1

SULFAMYLON EXTERNAL CREAM

3

SULFAMYLON EXTERNAL PACKET

3 NDS

SYNERCID INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

tigecycline intravenous solution reconstituted

3 NDS

trimethoprim oral tablet 1

TRIMPEX ORAL SOLUTION 50 MG/5ML

3

TYGACIL INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

VANCOCIN HCL ORAL CAPSULE 125 MG


VANCOCIN HCL ORAL CAPSULE 250 MG


vancomycin hcl in dextrose intravenous solution 1-5 gm/200ml-%, 500-5 mg/100ml-%, 750-5 mg/150ml-%

1

vancomycin hcl in nacl intravenous solution 1-0.9 gm/200ml-%, 500-0.9 mg/100ml-%, 750-0.9 mg/150ml-%

1

vancomycin hcl intravenous solution 1000 mg/200ml, 1500 mg/300ml

1

19


vancomycin hcl intravenous solution reconstituted 1 gm, 1.25 gm, 1.5 gm, 10 gm, 100 gm, 5 gm, 500 mg, 5000 mg, 750 mg

1

VANCOMYCIN HCL INTRAVENOUS SOLUTION RECONSTITUTED 250 MG

1

vancomycin hcl oral capsule 125 mg


vancomycin hcl oral capsule 250 mg


VANDAZOLE VAGINAL GEL

1

VIBATIV INTRAVENOUS SOLUTION RECONSTITUTED

3

XIFAXAN ORAL TABLET

3 PA; NDS

ZYVOX INTRAVENOUS SOLUTION

3 NDS

ZYVOX ORAL SUSPENSION RECONSTITUTED


ZYVOX ORAL TABLET 3 QL (56 EA per 28 days); NDS

Beta-lactam, Cephalosporins

AVYCAZ INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

CEDAX ORAL CAPSULE 400 MG

3

CEDAX ORAL SUSPENSION RECONSTITUTED 180 MG/5ML

3

cefaclor er oral tablet extended release 12 hour

3

cefaclor oral capsule 3


cefaclor oral suspension reconstituted

3

cefadroxil oral capsule 1

cefadroxil oral suspension reconstituted

1

cefadroxil oral tablet 1

cefazolin sodium injection solution reconstituted

1

cefazolin sodium intravenous solution reconstituted

1

cefazolin sodium-dextrose intravenous solution

1

cefazolin sodium-dextrose intravenous solution reconstituted

1

cefdinir oral capsule 1

cefdinir oral suspension reconstituted

1

cefditoren pivoxil oral tablet

1

cefepime hcl injection solution reconstituted

1

cefepime hcl intravenous solution

1

cefepime-dextrose intravenous solution reconstituted

1

cefixime oral capsule 1

cefixime oral suspension reconstituted

1

CEFOTAN INJECTION SOLUTION RECONSTITUTED

3

cefotaxime sodium injection solution reconstituted

1

cefotetan disodium injection solution reconstituted

1

20


cefotetan disodium-dextrose intravenous solution reconstituted

1

cefoxitin sodium injection solution reconstituted

1

cefoxitin sodium intravenous solution reconstituted

1

cefoxitin sodium-dextrose intravenous solution reconstituted

1

cefpodoxime proxetil oral suspension reconstituted

1

cefpodoxime proxetil oral tablet

1

cefprozil oral suspension reconstituted

1

cefprozil oral tablet 1

ceftazidime and dextrose intravenous solution reconstituted

1

ceftazidime injection solution reconstituted

1

ceftibuten oral capsule 400 mg

1

ceftibuten oral suspension reconstituted 180 mg/5ml

1

CEFTIN ORAL SUSPENSION RECONSTITUTED 125 MG/5ML, 250 MG/5ML

3

ceftriaxone sodium in dextrose intravenous solution

1

ceftriaxone sodium injection solution reconstituted

1

ceftriaxone sodium intravenous solution reconstituted

1


ceftriaxone sodium-dextrose intravenous solution reconstituted

1

cefuroxime axetil oral tablet

1

cefuroxime sodium injection solution reconstituted

1

cefuroxime sodium intravenous solution reconstituted

1

cephalexin oral capsule 1

cephalexin oral suspension reconstituted

1

cephalexin oral tablet 1

DAXBIA ORAL CAPSULE 333 MG

3

KEFLEX ORAL CAPSULE

3

MAXIPIME INJECTION SOLUTION RECONSTITUTED

3

MAXIPIME INTRAVENOUS SOLUTION RECONSTITUTED

3

SPECTRACEF ORAL TABLET

3

SUPRAX ORAL CAPSULE

2

suprax oral suspension reconstituted 100 mg/5ml, 200 mg/5ml

3

SUPRAX ORAL SUSPENSION RECONSTITUTED 500 MG/5ML

3 NDS

suprax oral tablet chewable

2

tazicef injection solution reconstituted

1

tazicef intravenous solution reconstituted

1

21


TEFLARO INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

ZERBAXA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

Beta-lactam, Other

AZACTAM IN DEXTROSE INTRAVENOUS SOLUTION 1 GM/50ML

3

AZACTAM INJECTION SOLUTION RECONSTITUTED 1 GM

3

AZACTAM INJECTION SOLUTION RECONSTITUTED 2 GM

3 NDS

aztreonam injection solution reconstituted 1 gm

1

aztreonam injection solution reconstituted 2 gm

1 NDS

DORIPENEM INTRAVENOUS SOLUTION RECONSTITUTED

3

ertapenem sodium injection solution reconstituted

1

imipenem-cilastatin intravenous solution reconstituted

1

INVANZ INJECTION SOLUTION RECONSTITUTED

3

INVANZ INTRAVENOUS SOLUTION RECONSTITUTED 1 GM

3

meropenem intravenous solution reconstituted

1


meropenem-sodium chloride intravenous solution reconstituted 1 gm/50ml

1 NDS

meropenem-sodium chloride intravenous solution reconstituted 500-0.9 mg-%

1

MERREM INTRAVENOUS SOLUTION RECONSTITUTED 1 GM

3 NDS

MERREM INTRAVENOUS SOLUTION RECONSTITUTED 500 MG

3

PRIMAXIN IV INTRAVENOUS SOLUTION RECONSTITUTED

3

VABOMERE INTRAVENOUS SOLUTION RECONSTITUTED

3

Beta-lactam, Penicillins

amoxicillin oral capsule 1

amoxicillin oral suspension reconstituted

1

amoxicillin oral tablet 1

amoxicillin oral tablet chewable

1

amoxicillin-potassium clavulanate er oral tablet extended release 12 hour

1

amoxicillin-potassium clavulanate oral suspension reconstituted

1

amoxicillin-potassium clavulanate oral tablet

1

amoxicillin-potassium clavulanate oral tablet chewable

1

22


ampicillin oral capsule 1

ampicillin sodium injection solution reconstituted

1

ampicillin sodium intravenous solution reconstituted

1

ampicillin-sulbactam sodium injection solution reconstituted

1

ampicillin-sulbactam sodium intravenous solution reconstituted

1

AUGMENTIN ES-600 ORAL SUSPENSION RECONSTITUTED

3

AUGMENTIN ORAL SUSPENSION RECONSTITUTED

3 NDS

AUGMENTIN ORAL TABLET

3 NDS

AUGMENTIN XR ORAL TABLET EXTENDED RELEASE 12 HOUR 1000-62.5 MG

3 NDS

BACTOCILL IN DEXTROSE INTRAVENOUS SOLUTION

3

BICILLIN C-R 900/300 INTRAMUSCULAR SUSPENSION

3

BICILLIN C-R INTRAMUSCULAR SUSPENSION

3

BICILLIN L-A INTRAMUSCULAR SUSPENSION

3

dicloxacillin sodium oral capsule

1

MOXATAG ORAL TABLET EXTENDED RELEASE 24 HOUR 775 MG

3

nafcillin sodium in dextrose intravenous solution

1 NDS


nafcillin sodium injection solution reconstituted 1 gm, 2 gm

1

nafcillin sodium intravenous solution reconstituted 1 gm

1


1 NDS


3 NDS

oxacillin sodium injection solution reconstituted 1 gm, 2 gm

1

oxacillin sodium injection solution reconstituted 10 gm

3 NDS

PENICILLIN G POT IN DEXTROSE INTRAVENOUS SOLUTION

3

penicillin g potassium injection solution reconstituted

1

penicillin g procaine intramuscular suspension

1

penicillin g sodium injection solution reconstituted

3 NDS

penicillin v potassium oral solution reconstituted

1

penicillin v potassium oral tablet

1

pfizerpen injection solution reconstituted

1

piperacillin sod-tazobactam so intravenous solution reconstituted

1

UNASYN INJECTION SOLUTION RECONSTITUTED

3

23


ZOSYN INTRAVENOUS SOLUTION

3

ZOSYN INTRAVENOUS SOLUTION RECONSTITUTED

3

Macrolides

AZASITE OPHTHALMIC SOLUTION

3

azithromycin intravenous solution reconstituted

1

AZITHROMYCIN ORAL PACKET

1

azithromycin oral suspension reconstituted

1

azithromycin oral tablet 1

clarithromycin er oral tablet extended release 24 hour

1

clarithromycin oral suspension reconstituted

1

clarithromycin oral tablet

1

DIFICID ORAL TABLET 3 NDS

e.e.s. 400 oral tablet 1

E.E.S. GRANULES ORAL SUSPENSION RECONSTITUTED

3

ery external pad 1

ERYGEL EXTERNAL GEL

3

ERYPED 200 ORAL SUSPENSION RECONSTITUTED

3

ERYPED 400 ORAL SUSPENSION RECONSTITUTED

3 NDS

ery-tab oral tablet delayed release

2


erythrocin lactobionate intravenous solution reconstituted

1

erythrocin stearate oral tablet

3

erythromycin base oral capsule delayed release particles

1

erythromycin base oral tablet

1

erythromycin base oral tablet delayed release

1

erythromycin ethylsuccinate oral suspension reconstituted

1

erythromycin ethylsuccinate oral tablet

1

erythromycin external gel

1

erythromycin external pad

1

erythromycin external solution

1

erythromycin ophthalmic ointment

1

PCE ORAL TABLET DELAYED RELEASE 333 MG, 500 MG

3

ZITHROMAX INTRAVENOUS SOLUTION RECONSTITUTED

3

ZITHROMAX ORAL PACKET

3

ZITHROMAX ORAL SUSPENSION RECONSTITUTED

3

ZITHROMAX ORAL TABLET

3

ZITHROMAX TRI-PAK ORAL TABLET

3

ZITHROMAX Z-PAK ORAL TABLET

3

24


ZMAX ORAL SUSPENSION RECONSTITUTED 2 GM

3

Quinolones

AVELOX INTRAVENOUS SOLUTION

3

AVELOX ORAL TABLET 400 MG

3

BAXDELA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

BAXDELA ORAL TABLET

3 NDS

BESIVANCE OPHTHALMIC SUSPENSION

3

CETRAXAL OTIC SOLUTION

3 ST

CILOXAN OPHTHALMIC OINTMENT

3

CILOXAN OPHTHALMIC SOLUTION

3

CIPRO IN D5W INTRAVENOUS SOLUTION 400 MG/200ML

3

CIPRO ORAL SUSPENSION RECONSTITUTED

3

CIPRO ORAL TABLET 3

ciprofloxacin hcl ophthalmic solution

1

ciprofloxacin hcl oral tablet

1

CIPROFLOXACIN HCL OTIC SOLUTION

1

ciprofloxacin in d5w intravenous solution

1

ciprofloxacin intravenous solution 200 mg/20ml, 400 mg/40ml

1


ciprofloxacin oral suspension reconstituted

1

ciprofloxacin-ciproflox hcl er oral tablet extended release 24 hour 1000 mg, 500 mg

1

FLOXIN OTIC OTIC SOLUTION

3

gatifloxacin ophthalmic solution

1

LEVAQUIN ORAL TABLET

3

levofloxacin in d5w intravenous solution

1

levofloxacin intravenous solution

1

levofloxacin ophthalmic solution

1

levofloxacin oral solution

1

levofloxacin oral tablet 1

MOXEZA OPHTHALMIC SOLUTION

3

moxifloxacin hcl in nacl intravenous solution

1

moxifloxacin hcl intravenous solution

1

moxifloxacin hcl ophthalmic solution

1

moxifloxacin hcl oral tablet

1

OCUFLOX OPHTHALMIC SOLUTION

3

ofloxacin ophthalmic solution

1

ofloxacin oral tablet 1

ofloxacin otic solution 1

OTOVEL OTIC SOLUTION

3 ST

VIGAMOX OPHTHALMIC SOLUTION

3

25


XEPI EXTERNAL CREAM

3

ZYMAXID OPHTHALMIC SOLUTION

3

Sulfonamides

AVC VAGINAL VAGINAL CREAM

3

BACTRIM DS ORAL TABLET

3

BACTRIM ORAL TABLET

3

bleph-10 ophthalmic solution

3

KLARON EXTERNAL LOTION

3

sulfacetamide sodium (acne) external lotion

3

sulfacetamide sodium ophthalmic ointment

1

sulfacetamide sodium ophthalmic solution

1

sulfadiazine oral tablet 1

sulfamethoxazole-trimethoprim intravenous solution

1

sulfamethoxazole-trimethoprim oral suspension

1

sulfamethoxazole-trimethoprim oral tablet

1

sulfatrim pediatric oral suspension

1

Tetracyclines

avidoxy oral tablet 1

coremino oral tablet extended release 24 hour

1

demeclocycline hcl oral tablet

1

DORYX MPC ORAL TABLET DELAYED RELEASE

3


DORYX ORAL TABLET DELAYED RELEASE 200 MG

3 NDS

DORYX ORAL TABLET DELAYED RELEASE 50 MG

3

doxy 100 intravenous solution reconstituted

1

doxycycline hyclate intravenous solution reconstituted

1

doxycycline hyclate oral capsule

1

doxycycline hyclate oral tablet

1

doxycycline hyclate oral tablet delayed release 100 mg, 150 mg, 200 mg, 50 mg, 75 mg

1

doxycycline hyclate oral tablet delayed release 80 mg

3 NDS

doxycycline monohydrate oral capsule

1

doxycycline monohydrate oral suspension reconstituted

1

doxycycline monohydrate oral tablet

1

MINOCIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

MINOCIN ORAL CAPSULE

3 NDS

minocycline hcl er oral tablet extended release 24 hour 105 mg, 115 mg, 65 mg, 80 mg

1 NDS

minocycline hcl er oral tablet extended release 24 hour 135 mg, 45 mg, 90 mg

1

26


minocycline hcl er oral tablet extended release 24 hour 55 mg

3 NDS

minocycline hcl oral capsule

1

minocycline hcl oral tablet

1

MINOLIRA ORAL TABLET EXTENDED RELEASE 24 HOUR

3

mondoxyne nl oral capsule

1

MONODOX ORAL CAPSULE 100 MG, 75 MG

3

MORGIDOX COMBINATION KIT 1 X 50 MG

3

morgidox oral capsule 1

NUZYRA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

NUZYRA ORAL TABLET

3 NDS

okebo oral capsule 1

SEYSARA ORAL TABLET

3 NDS

SOLODYN ORAL TABLET EXTENDED RELEASE 24 HOUR

3 NDS

soloxide oral tablet delayed release

1

targadox oral tablet 3

tetracycline hcl oral capsule

1

VIBRAMYCIN ORAL CAPSULE

3

VIBRAMYCIN ORAL SUSPENSION RECONSTITUTED

3

VIBRAMYCIN ORAL SYRUP

3


XERAVA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

XIMINO ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

Anticonvulsants

Anticonvulsants, Other

APTIOM ORAL TABLET

3 NDS

BRIVIACT INTRAVENOUS SOLUTION

3 PA; NDS

BRIVIACT ORAL SOLUTION

3 PA; NDS

BRIVIACT ORAL TABLET

3 PA; NDS

EPIDIOLEX ORAL SOLUTION

3 PA; NDS

FYCOMPA ORAL SUSPENSION

3

FYCOMPA ORAL TABLET 10 MG, 12 MG, 4 MG, 6 MG

3 NDS

FYCOMPA ORAL TABLET 2 MG, 8 MG

3

KEPPRA INTRAVENOUS SOLUTION

3 NDS

KEPPRA ORAL SOLUTION

3 NDS

KEPPRA ORAL TABLET 1000 MG, 500 MG, 750 MG

3 NDS

KEPPRA ORAL TABLET 250 MG

3

KEPPRA XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3 NDS

levetiracetam er oral tablet extended release 24 hour

1

levetiracetam in nacl intravenous solution

1

27


levetiracetam intravenous solution

1

levetiracetam oral solution

1

levetiracetam oral tablet 1

phenobarbital oral elixir 1 PA

phenobarbital sodium injection solution

1 PA

roweepra oral tablet 1

roweepra xr oral tablet extended release 24 hour

1

SPRITAM ORAL TABLET DISINTEGRATING SOLUBLE

3

Calcium Channel Modifying Agents

CELONTIN ORAL CAPSULE

3

ethosuximide oral capsule

1

ethosuximide oral solution

1

LYRICA ORAL CAPSULE 100 MG, 150 MG, 200 MG, 225 MG, 25 MG, 50 MG, 75 MG


LYRICA ORAL CAPSULE 300 MG


LYRICA ORAL SOLUTION


pregabalin oral capsule 100 mg, 150 mg, 200 mg, 225 mg, 25 mg, 50 mg, 75 mg


pregabalin oral capsule 300 mg


pregabalin oral solution 1 QL (900 ML per 30 days)

ZARONTIN ORAL CAPSULE

3

zarontin oral solution 3

ZONEGRAN ORAL CAPSULE

3 NDS


zonisamide oral capsule 1

Gamma-aminobutyric Acid (GABA) Augmenting Agents

clobazam oral suspension

1 NDS

clobazam oral tablet 10 mg

1

clobazam oral tablet 20 mg

1 NDS

clonazepam oral tablet 0.5 mg, 1 mg


clonazepam oral tablet 2 mg


clonazepam oral tablet dispersible 0.125 mg, 0.25 mg, 0.5 mg, 1 mg


clonazepam oral tablet dispersible 2 mg


DEPACON INTRAVENOUS SOLUTION

3

DEPAKENE ORAL CAPSULE

3

DEPAKENE ORAL SOLUTION 250 MG/5ML

3 NDS

DEPAKOTE ER ORAL TABLET EXTENDED RELEASE 24 HOUR

3

DEPAKOTE ORAL TABLET DELAYED RELEASE

3

DEPAKOTE SPRINKLES ORAL CAPSULE DELAYED RELEASE SPRINKLE

3

DIACOMIT ORAL CAPSULE

3 PA; NDS

DIACOMIT ORAL PACKET

3 PA; NDS

DIASTAT ACUDIAL RECTAL GEL

3

DIASTAT PEDIATRIC RECTAL GEL

3

diazepam rectal gel 1

28


divalproex sodium er oral tablet extended release 24 hour

1

divalproex sodium oral capsule delayed release sprinkle

1

divalproex sodium oral tablet delayed release

1

gabapentin oral capsule 100 mg, 300 mg


gabapentin oral capsule 400 mg


gabapentin oral solution 250 mg/5ml


gabapentin oral tablet 600 mg


gabapentin oral tablet 800 mg


GABITRIL ORAL TABLET 12 MG, 16 MG, 2 MG

3

GABITRIL ORAL TABLET 4 MG

3 NDS

KLONOPIN ORAL TABLET 0.5 MG, 1 MG


KLONOPIN ORAL TABLET 2 MG


MYSOLINE ORAL TABLET

3 NDS

NEURONTIN ORAL CAPSULE 100 MG, 300 MG


NEURONTIN ORAL CAPSULE 400 MG


NEURONTIN ORAL SOLUTION


NEURONTIN ORAL TABLET 600 MG


NEURONTIN ORAL TABLET 800 MG


ONFI ORAL SUSPENSION

3 NDS

ONFI ORAL TABLET 3 NDS

phenobarbital oral tablet 1 PA

primidone oral tablet 1


SABRIL ORAL PACKET

3 PA; NDS

SABRIL ORAL TABLET 3 PA; NDS

SYMPAZAN ORAL FILM

3 NDS

tiagabine hcl oral tablet 1

valproate sodium intravenous solution 100 mg/ml

1

valproic acid oral capsule

1

valproic acid oral solution

1

vigabatrin oral packet 3 PA; NDS

vigabatrin oral tablet 1 PA; NDS

vigadrone oral packet 3 PA; NDS

Glutamate Reducing Agents

felbamate oral suspension

3 NDS

felbamate oral tablet 1

FELBATOL ORAL SUSPENSION

3 NDS

FELBATOL ORAL TABLET

3 NDS

LAMICTAL ODT ORAL KIT 21 X 25 MG & 7 X 50 MG, 25 & 50 & 100 MG

3

LAMICTAL ODT ORAL KIT 42 X 50 MG & 14X100 MG

3 NDS

LAMICTAL ODT ORAL TABLET DISPERSIBLE

3

LAMICTAL ORAL TABLET

3 NDS

LAMICTAL ORAL TABLET CHEWABLE 25 MG

3 NDS

LAMICTAL ORAL TABLET CHEWABLE 5 MG

3

29


LAMICTAL STARTER ORAL KIT 35 X 25 MG, 42 X 25 MG & 7 X 100 MG

3

LAMICTAL STARTER ORAL KIT 84 X 25 MG & 14X100 MG

3 NDS

LAMICTAL XR ORAL KIT

3

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 250 MG, 300 MG, 50 MG

3 NDS

LAMICTAL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 25 MG

3

lamotrigine er oral tablet extended release 24 hour

1

lamotrigine oral kit 21 x 25 mg & 7 x 50 mg, 25 & 50 & 100 mg

1

lamotrigine oral kit 42 x 50 mg & 14x100 mg

1 NDS

lamotrigine oral tablet 1

lamotrigine oral tablet chewable

1

lamotrigine oral tablet dispersible

1

lamotrigine starter kit-blue oral kit

1

lamotrigine starter kit-green oral kit

1

lamotrigine starter kit-orange oral kit

1

QUDEXY XR ORAL CAPSULE ER 24 HOUR SPRINKLE 100 MG, 200 MG, 25 MG, 50 MG

3

QUDEXY XR ORAL CAPSULE ER 24 HOUR SPRINKLE 150 MG

3 NDS

subvenite oral tablet 1


subvenite starter kit-blue oral kit

1

subvenite starter kit-green oral kit

1

subvenite starter kit-orange oral kit

1

TOPAMAX ORAL TABLET 100 MG, 200 MG, 50 MG

3 NDS

TOPAMAX ORAL TABLET 25 MG

3

TOPAMAX SPRINKLE ORAL CAPSULE SPRINKLE 15 MG

3

TOPAMAX SPRINKLE ORAL CAPSULE SPRINKLE 25 MG

3 NDS

topiramate er oral capsule er 24 hour sprinkle

1

topiramate oral capsule sprinkle

1

topiramate oral tablet 1

TROKENDI XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 25 MG, 50 MG

3

TROKENDI XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 200 MG

3 NDS

Sodium Channel Agents

BANZEL ORAL SUSPENSION

3 NDS

BANZEL ORAL TABLET

3 NDS

carbamazepine er oral capsule extended release 12 hour

1

carbamazepine er oral tablet extended release 12 hour

1

carbamazepine oral suspension

1

30


carbamazepine oral tablet

1

carbamazepine oral tablet chewable

1

CARBATROL ORAL CAPSULE EXTENDED RELEASE 12 HOUR

3

CEREBYX INJECTION SOLUTION

3

dilantin infatabs oral tablet chewable

3

dilantin oral capsule 3

DILANTIN ORAL SUSPENSION

3

epitol oral tablet 1

fosphenytoin sodium injection solution

1

oxcarbazepine oral suspension

1

oxcarbazepine oral tablet

1

OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG, 300 MG

3

OXTELLAR XR ORAL TABLET EXTENDED RELEASE 24 HOUR 600 MG

3 NDS

PEGANONE ORAL TABLET

3

phenytek oral capsule 3

phenytoin infatabs oral tablet chewable

1

phenytoin oral suspension

1

phenytoin oral tablet chewable

1

phenytoin sodium extended oral capsule

1

phenytoin sodium injection solution

1

TEGRETOL ORAL SUSPENSION

3


TEGRETOL ORAL TABLET

3

TEGRETOL-XR ORAL TABLET EXTENDED RELEASE 12 HOUR

3

TRILEPTAL ORAL SUSPENSION

3 NDS

TRILEPTAL ORAL TABLET 150 MG, 300 MG

3

TRILEPTAL ORAL TABLET 600 MG

3 NDS

VIMPAT INTRAVENOUS SOLUTION

3

VIMPAT ORAL SOLUTION

3

VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG

3 NDS

VIMPAT ORAL TABLET 50 MG

3

Antidementia Agents

Antidementia Agents, Other

ergoloid mesylates oral tablet

3

NAMZARIC ORAL CAPSULE ER 24 HOUR THERAPY PACK


NAMZARIC ORAL CAPSULE EXTENDED RELEASE 24 HOUR


Cholinesterase Inhibitors

ARICEPT ORAL TABLET

3

donepezil hcl oral tablet 1

donepezil hcl oral tablet dispersible

1

EXELON TRANSDERMAL PATCH 24 HOUR

3

31


galantamine hydrobromide er oral capsule extended release 24 hour

1

galantamine hydrobromide oral solution

1

galantamine hydrobromide oral tablet

1

RAZADYNE ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

RAZADYNE ORAL TABLET

3

rivastigmine tartrate oral capsule

1

rivastigmine transdermal patch 24 hour

1

N-methyl-D-aspartate (NMDA) Receptor Antagonist

memantine hcl er oral capsule extended release 24 hour


memantine hcl oral solution

1

memantine hcl oral tablet 10 mg, 5 mg

1

MEMANTINE HCL ORAL TABLET 28 X 5 MG & 21 X 10 MG

1

NAMENDA ORAL TABLET

3

NAMENDA TITRATION PAK ORAL TABLET

3

NAMENDA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR


NAMENDA XR TITRATION PACK ORAL CAPSULE EXTENDED RELEASE 24 HOUR


Antidepressants

Antidepressants, Other


APLENZIN ORAL TABLET EXTENDED RELEASE 24 HOUR

3 ST; QL (30 EA per 30 days); NDS

bupropion hcl er (sr) oral tablet extended release 12 hour 100 mg


bupropion hcl er (sr) oral tablet extended release 12 hour 150 mg, 200 mg


bupropion hcl er (xl) oral tablet extended release 24 hour 150 mg






bupropion hcl oral tablet 1

FORFIVO XL ORAL TABLET EXTENDED RELEASE 24 HOUR


mirtazapine oral tablet 1

mirtazapine oral tablet dispersible

1

REMERON ORAL TABLET

3

REMERON SOLTAB ORAL TABLET DISPERSIBLE

3

SPRAVATO (56 MG DOSE) NASAL SOLUTION THERAPY PACK

3 PA; NDS

SPRAVATO (84 MG DOSE) NASAL SOLUTION THERAPY PACK

3 PA; NDS

WELLBUTRIN SR ORAL TABLET EXTENDED RELEASE 12 HOUR 100 MG


32


WELLBUTRIN SR ORAL TABLET EXTENDED RELEASE 12 HOUR 150 MG, 200 MG


WELLBUTRIN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG


WELLBUTRIN XL ORAL TABLET EXTENDED RELEASE 24 HOUR 300 MG


Monoamine Oxidase Inhibitors

EMSAM TRANSDERMAL PATCH 24 HOUR


MARPLAN ORAL TABLET

3

NARDIL ORAL TABLET 3

PARNATE ORAL TABLET

3 NDS

phenelzine sulfate oral tablet

1

tranylcypromine sulfate oral tablet

1

SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitor

BRISDELLE ORAL CAPSULE


CELEXA ORAL TABLET

3

citalopram hydrobromide oral solution

1

citalopram hydrobromide oral tablet

1

CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES 20 MG, 60 MG



CYMBALTA ORAL CAPSULE DELAYED RELEASE PARTICLES 30 MG


desvenlafaxine er oral tablet extended release 24 hour 100 mg


desvenlafaxine er oral tablet extended release 24 hour 50 mg


DESVENLAFAXINE FUMARATE ER ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG


DESVENLAFAXINE FUMARATE ER ORAL TABLET EXTENDED RELEASE 24 HOUR 50 MG


desvenlafaxine succinate er oral tablet extended release 24 hour 100 mg


desvenlafaxine succinate er oral tablet extended release 24 hour 25 mg, 50 mg


duloxetine hcl oral capsule delayed release particles 20 mg, 60 mg


duloxetine hcl oral capsule delayed release particles 30 mg, 40 mg


EFFEXOR XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

escitalopram oxalate oral solution

1

escitalopram oxalate oral tablet

1

FETZIMA ORAL CAPSULE EXTENDED RELEASE 24 HOUR


FETZIMA TITRATION ORAL CAPSULE ER 24 HOUR THERAPY PACK


33


fluoxetine hcl (pmdd) oral capsule

1

fluoxetine hcl (pmdd) oral tablet

1

fluoxetine hcl oral capsule

1

fluoxetine hcl oral capsule delayed release


fluoxetine hcl oral solution

1

fluoxetine hcl oral tablet 1

fluvoxamine maleate er oral capsule extended release 24 hour


fluvoxamine maleate oral tablet

1

KHEDEZLA ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG


KHEDEZLA ORAL TABLET EXTENDED RELEASE 24 HOUR 50 MG


LEXAPRO ORAL TABLET

3

maprotiline hcl oral tablet

1

nefazodone hcl oral tablet

3

olanzapine-fluoxetine hcl oral capsule 12-25 mg, 12-50 mg, 6-50 mg


olanzapine-fluoxetine hcl oral capsule 3-25 mg, 6-25 mg


paroxetine hcl er oral tablet extended release 24 hour

1

paroxetine hcl oral tablet

1

paroxetine mesylate oral capsule


PAXIL CR ORAL TABLET EXTENDED RELEASE 24 HOUR

3


PAXIL ORAL SUSPENSION

3

PAXIL ORAL TABLET 3

PEXEVA ORAL TABLET 10 MG, 20 MG, 40 MG


PEXEVA ORAL TABLET 30 MG


PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HOUR 100 MG


PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HOUR 25 MG, 50 MG


PROZAC ORAL CAPSULE 10 MG, 20 MG

3

PROZAC ORAL CAPSULE 40 MG

3 NDS

SARAFEM ORAL TABLET

3

sertraline hcl oral concentrate

1

sertraline hcl oral tablet 1

SYMBYAX ORAL CAPSULE 12-25 MG, 12-50 MG, 6-50 MG


SYMBYAX ORAL CAPSULE 3-25 MG, 6-25 MG


trazodone hcl oral tablet 1

TRINTELLIX ORAL TABLET


venlafaxine hcl er oral capsule extended release 24 hour

1

venlafaxine hcl er oral tablet extended release 24 hour

1

venlafaxine hcl oral tablet

1

VIIBRYD ORAL TABLET


34


VIIBRYD STARTER PACK ORAL KIT


ZOLOFT ORAL CONCENTRATE 20 MG/ML

3

ZOLOFT ORAL TABLET

3

Tricyclics

amitriptyline hcl oral tablet

1 PA

amoxapine oral tablet 1

ANAFRANIL ORAL CAPSULE

3 NDS

chlordiazepoxide-amitriptyline oral tablet

1 PA

clomipramine hcl oral capsule

1

desipramine hcl oral tablet

1

doxepin hcl oral capsule 1 PA

doxepin hcl oral concentrate

1 PA

imipramine hcl oral tablet

1

imipramine pamoate oral capsule

1

NORPRAMIN ORAL TABLET

3

nortriptyline hcl oral capsule

1

nortriptyline hcl oral solution

1

PAMELOR ORAL CAPSULE

3 NDS

perphenazine-amitriptyline oral tablet

1 PA

protriptyline hcl oral tablet

1

SURMONTIL ORAL CAPSULE 100 MG, 25 MG, 50 MG

3

tofranil oral tablet 10 mg 3

tofranil oral tablet 25 mg, 50 mg

3 NDS


trimipramine maleate oral capsule

1

Antiemetics

Antiemetics, Other

AKYNZEO ORAL CAPSULE

3 B/D; QL (2 EA per 30 days)

BONJESTA ORAL TABLET EXTENDED RELEASE


compro rectal suppository

1

DICLEGIS ORAL TABLET DELAYED RELEASE


dimenhydrinate injection solution

1 PA

doxylamine-pyridoxine oral tablet delayed release


droperidol injection solution

1

meclizine hcl oral tablet 1

phenadoz rectal suppository

1 PA

PHENERGAN INJECTION SOLUTION

3 PA

phenergan rectal suppository 12.5 mg, 25 mg, 50 mg

1 PA

prochlorperazine edisylate injection solution

1

prochlorperazine maleate oral tablet

1

prochlorperazine rectal suppository

1

promethazine hcl injection solution

1 PA

promethazine hcl oral syrup

1 PA

promethazine hcl oral tablet

1 PA

promethazine hcl rectal suppository

1 PA

35


promethegan rectal suppository

1 PA

scopolamine transdermal patch 72 hour

1

TIGAN INTRAMUSCULAR SOLUTION

3

TIGAN ORAL CAPSULE

3 B/D

TRANSDERM SCOP (1.5 MG) TRANSDERMAL PATCH 72 HOUR

3

TRANSDERM-SCOP (1.5 MG) TRANSDERMAL PATCH 72 HOUR

3

trimethobenzamide hcl oral capsule

1 B/D

Emetogenic Therapy Adjuncts

ALOXI INTRAVENOUS SOLUTION

3 NDS

ANZEMET ORAL TABLET 100 MG

3 B/D; QL (5 EA per 30 days); NDS

ANZEMET ORAL TABLET 50 MG


aprepitant oral capsule 125 mg




aprepitant oral capsule 80 & 125 mg




CESAMET ORAL CAPSULE


CINVANTI INTRAVENOUS EMULSION

3

dronabinol oral capsule 1 PA; QL (60 EA per 30 days)


EMEND INTRAVENOUS SOLUTION RECONSTITUTED

2

EMEND ORAL CAPSULE 125 MG






EMEND ORAL SUSPENSION RECONSTITUTED


EMEND TRI-PACK ORAL CAPSULE


granisetron hcl intravenous solution

1

granisetron hcl oral tablet


MARINOL ORAL CAPSULE 10 MG, 5 MG


MARINOL ORAL CAPSULE 2.5 MG


ondansetron hcl injection solution

1

ondansetron hcl oral solution

1 B/D; QL (450 ML per 30 days)

ondansetron hcl oral tablet 24 mg


ondansetron hcl oral tablet 4 mg, 8 mg

1 B/D

ondansetron odt oral tablet dispersible

1 B/D

palonosetron hcl intravenous solution 0.25 mg/2ml

1

palonosetron hcl intravenous solution 0.25 mg/5ml

1 NDS

palonosetron hcl intravenous solution prefilled syringe

1

36


SANCUSO TRANSDERMAL PATCH


SUSTOL SUBCUTANEOUS PREFILLED SYRINGE

3 QL (1.2 ML per 30 days); NDS

SYNDROS ORAL SOLUTION

3 PA; QL (120 ML per 30 days); NDS

VARUBI INTRAVENOUS EMULSION 166.5 MG/92.5ML

3

VARUBI ORAL TABLET 3 B/D; QL (4 EA per 30 days)

ZOFRAN ODT ORAL TABLET DISPERSIBLE 4 MG, 8 MG

3 B/D; NDS

ZOFRAN ORAL SOLUTION 4 MG/5ML

3 B/D; QL (450 ML per 30 days); NDS

ZOFRAN ORAL TABLET

3 B/D; NDS

ZUPLENZ ORAL FILM 4 MG

3 B/D

ZUPLENZ ORAL FILM 8 MG

3 B/D; NDS

Antifungals

Antifungals

ABELCET INTRAVENOUS SUSPENSION

3 B/D; NDS

AMBISOME INTRAVENOUS SUSPENSION RECONSTITUTED

3 B/D; NDS

amphotericin b intravenous solution reconstituted

1 B/D

ANCOBON ORAL CAPSULE

3 NDS

CANCIDAS INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS


caspofungin acetate intravenous solution reconstituted

3 NDS

ciclodan external cream 0.77 %

1

ciclodan external solution

1 PA

ciclopirox external gel 1

ciclopirox external shampoo

1

ciclopirox external solution

1 PA

ciclopirox olamine external cream

1

ciclopirox olamine external suspension

1

clotrimazole external cream

1

clotrimazole external solution

1

clotrimazole mouth/throat lozenge

1

clotrimazole-betamethasone external cream

1

clotrimazole-betamethasone external lotion

1

CRESEMBA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

CRESEMBA ORAL CAPSULE

3 NDS

DIFLUCAN ORAL SUSPENSION RECONSTITUTED

3

DIFLUCAN ORAL TABLET 100 MG, 150 MG, 50 MG

3

DIFLUCAN ORAL TABLET 200 MG

3 NDS

econazole nitrate external cream

1

37


ERAXIS INTRAVENOUS SOLUTION RECONSTITUTED 100 MG

3 NDS

ERAXIS INTRAVENOUS SOLUTION RECONSTITUTED 50 MG

3

ERTACZO EXTERNAL CREAM

3 NDS

EXELDERM EXTERNAL CREAM

3

EXELDERM EXTERNAL SOLUTION

3

EXTINA EXTERNAL FOAM

3 NDS

fluconazole in dextrose intravenous solution 200 mg/100ml

1

fluconazole in sodium chloride intravenous solution

1

fluconazole oral suspension reconstituted

1

fluconazole oral tablet 1

flucytosine oral capsule 3 NDS

griseofulvin microsize oral suspension

1

griseofulvin microsize oral tablet

1

griseofulvin ultramicrosize oral tablet

1

GRIS-PEG ORAL TABLET 125 MG, 250 MG

3

gynazole-1 vaginal cream

3

itraconazole oral capsule

1 PA

itraconazole oral solution

1 PA; NDS


JUBLIA EXTERNAL SOLUTION

3

KERYDIN EXTERNAL SOLUTION

3 PA; NDS

ketoconazole external cream

1

ketoconazole external foam

1

ketoconazole external shampoo

1

ketoconazole oral tablet 1

LAMISIL ORAL TABLET


LOPROX EXTERNAL CREAM

3

LOPROX EXTERNAL SHAMPOO

3 NDS

LOPROX EXTERNAL SUSPENSION

3

LOTRISONE EXTERNAL CREAM

3

LULICONAZOLE EXTERNAL CREAM

3

LUZU EXTERNAL CREAM

3

MENTAX EXTERNAL CREAM

3

miconazole 3 vaginal suppository

1

miconazole-zinc oxide-petrolat external ointment

1

MYCAMINE INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

naftifine hcl external cream

1

naftifine hcl external gel 1 %

1

NAFTIN EXTERNAL CREAM

3

NAFTIN EXTERNAL GEL

3

38


NATACYN OPHTHALMIC SUSPENSION

3

NIZORAL EXTERNAL SHAMPOO

3

NOXAFIL INTRAVENOUS SOLUTION

3 NDS

NOXAFIL ORAL SUSPENSION

3 NDS

NOXAFIL ORAL TABLET DELAYED RELEASE

3 NDS

nyamyc external powder

1

nyata external powder 100000 unit/gm

1

nystatin external cream 1

nystatin external ointment

1

nystatin external powder

1

nystatin mouth/throat suspension

1

nystatin oral tablet 1

nystatin-triamcinolone external cream

1

nystatin-triamcinolone external ointment

1

nystop external powder 1

ONMEL ORAL TABLET 200 MG

3 PA; NDS

ORAVIG BUCCAL TABLET

3

oxiconazole nitrate external cream

1

OXISTAT EXTERNAL CREAM

3

OXISTAT EXTERNAL LOTION

3

PENLAC EXTERNAL SOLUTION

3 PA; NDS

SPORANOX ORAL CAPSULE

3 PA; NDS


SPORANOX ORAL SOLUTION

3 PA; NDS

SPORANOX PULSEPAK ORAL CAPSULE

3 PA; NDS

TERAZOL 7 VAGINAL CREAM

3

terbinafine hcl oral tablet


terconazole vaginal cream

1

terconazole vaginal suppository

1

TOLSURA ORAL CAPSULE

3 PA; NDS

VFEND IV INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

VFEND ORAL SUSPENSION RECONSTITUTED

3 NDS

VFEND ORAL TABLET 3 NDS

voriconazole intravenous solution reconstituted

1 NDS

voriconazole oral suspension reconstituted

3 NDS

voriconazole oral tablet 1 NDS

VUSION EXTERNAL OINTMENT

3

Antigout Agents

Antigout Agents

allopurinol oral tablet 1

allopurinol sodium intravenous solution reconstituted

1

ALOPRIM INTRAVENOUS SOLUTION RECONSTITUTED

3

COLCHICINE ORAL CAPSULE

2

colchicine oral tablet 2

39


colchicine-probenecid oral tablet

1

COLCRYS ORAL TABLET

2

DUZALLO ORAL TABLET 200-200 MG, 200-300 MG

3 ST

febuxostat oral tablet 1

KRYSTEXXA INTRAVENOUS SOLUTION

3 PA; NDS

MITIGARE ORAL CAPSULE

3

probenecid oral tablet 1

ULORIC ORAL TABLET

2 ST

ZURAMPIC ORAL TABLET 200 MG

3 ST

ZYLOPRIM ORAL TABLET

3

Anti-inflammatory Agents

Glucocorticoids

anusol-hc rectal cream 3

EPIFOAM EXTERNAL FOAM

3

hydrocortisone rectal cream

1

KENALOG EXTERNAL AEROSOL SOLUTION

3

PROCTOCORT RECTAL CREAM

3

procto-med hc rectal cream

1

procto-pak rectal cream 1

proctosol hc rectal cream

1

proctozone-hc rectal cream

1

triamcinolone acetonide external aerosol solution

1


ZILRETTA INTRA-ARTICULAR SUSPENSION RECONSTITUTED ER

3

Antimigraine Agents

Ergot Alkaloids

cafergot oral tablet 3

D.H.E. 45 INJECTION SOLUTION

3 NDS

dihydroergotamine mesylate injection solution

3 NDS

dihydroergotamine mesylate nasal solution


ERGOMAR SUBLINGUAL TABLET SUBLINGUAL

2

ergotamine-caffeine oral tablet

1

migergot rectal suppository

3 NDS

MIGRANAL NASAL SOLUTION


Prophylactic

AIMOVIG SUBCUTANEOUS SOLUTION AUTO-INJECTOR 140 MG/ML


AIMOVIG 3 PA; QL (2 ML per 30 days)

AJOVY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; QL (4.5 ML per 90 days)

EMGALITY (300 MG DOSE) SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


EMGALITY SUBCUTANEOUS SOLUTION AUTO-INJECTOR


40


EMGALITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


Serotonin (5-HT) 1b/1d Receptor Agonists

almotriptan malate oral tablet


AMERGE ORAL TABLET


AXERT ORAL TABLET 12.5 MG


AXERT ORAL TABLET 6.25 MG


eletriptan hydrobromide oral tablet


FROVA ORAL TABLET 3 QL (12 EA per 30 days)

frovatriptan succinate oral tablet


IMITREX NASAL SOLUTION


IMITREX ORAL TABLET


IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE 4 MG/0.5ML


IMITREX STATDOSE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE 6 MG/0.5ML


IMITREX STATDOSE SYSTEM SUBCUTANEOUS SOLUTION AUTO-INJECTOR 4 MG/0.5ML


IMITREX STATDOSE SYSTEM SUBCUTANEOUS SOLUTION AUTO-INJECTOR 6 MG/0.5ML



IMITREX SUBCUTANEOUS SOLUTION


MAXALT ORAL TABLET


MAXALT-MLT ORAL TABLET DISPERSIBLE


naratriptan hcl oral tablet


ONZETRA XSAIL NASAL EXHALER POWDER


RELPAX ORAL TABLET


rizatriptan benzoate oral tablet


rizatriptan benzoate oral tablet dispersible


sumatriptan nasal solution


sumatriptan succinate oral tablet


SUMATRIPTAN SUCCINATE REFILL SUBCUTANEOUS SOLUTION CARTRIDGE


sumatriptan succinate subcutaneous solution


sumatriptan succinate subcutaneous solution auto-injector


sumatriptan succinate subcutaneous solution prefilled syringe


sumatriptan-naproxen sodium oral tablet


SUMAVEL DOSEPRO SUBCUTANEOUS SOLUTION JET-INJECTOR 6 MG/0.5ML


TREXIMET ORAL TABLET 10-60 MG


TREXIMET ORAL TABLET 85-500 MG


41


ZEMBRACE SYMTOUCH SUBCUTANEOUS SOLUTION AUTO-INJECTOR


zolmitriptan oral tablet 1 QL (12 EA per 30 days)

zolmitriptan oral tablet dispersible 2.5 mg


zolmitriptan oral tablet dispersible 5 mg


ZOMIG NASAL SOLUTION 2.5 MG


ZOMIG NASAL SOLUTION 5 MG


ZOMIG ORAL TABLET 3 QL (12 EA per 30 days); NDS

ZOMIG ZMT ORAL TABLET DISPERSIBLE 2.5 MG


ZOMIG ZMT ORAL TABLET DISPERSIBLE 5 MG


Antimyasthenic Agents

Parasympathomimetics

GUANIDINE HCL ORAL TABLET

3

MESTINON ORAL SYRUP

3 NDS

MESTINON ORAL TABLET

3 NDS

MESTINON ORAL TABLET EXTENDED RELEASE

3 NDS

pyridostigmine bromide er oral tablet extended release

1

pyridostigmine bromide oral solution

1 NDS

pyridostigmine bromide oral tablet 30 mg

3 NDS

pyridostigmine bromide oral tablet 60 mg

1


REGONOL INTRAVENOUS SOLUTION

3

Antimycobacterials

Antimycobacterials, Other

dapsone oral tablet 1

MYCOBUTIN ORAL CAPSULE

3 NDS

rifabutin oral capsule 1

Antituberculars

CAPASTAT SULFATE INJECTION SOLUTION RECONSTITUTED

3

cycloserine oral capsule 1

ethambutol hcl oral tablet

1

isoniazid injection solution

1

isoniazid oral syrup 1

isoniazid oral tablet 1

MYAMBUTOL ORAL TABLET

3

paser oral packet 3

PRIFTIN ORAL TABLET

3

pyrazinamide oral tablet 1

RIFADIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

RIFADIN ORAL CAPSULE

3

rifamate oral capsule 3

rifampin intravenous solution reconstituted

1

rifampin oral capsule 1

RIFATER ORAL TABLET

3

SIRTURO ORAL TABLET

3 NDS

TRECATOR ORAL TABLET

3

42


Antineoplastics

Alkylating Agents

ALKERAN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

BELRAPZO INTRAVENOUS SOLUTION

3 NDS

bendamustine hcl intravenous solution

1 NDS

BENDEKA INTRAVENOUS SOLUTION

3 NDS

BICNU INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

busulfan intravenous solution

3 NDS

BUSULFEX INTRAVENOUS SOLUTION

3 NDS

carboplatin intravenous solution

1

carmustine intravenous solution reconstituted

1 NDS

cisplatin intravenous solution

1

cyclophosphamide injection solution reconstituted

3 NDS

cyclophosphamide oral capsule

1 B/D

dacarbazine intravenous solution reconstituted

1

EVOMELA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

GLEOSTINE ORAL CAPSULE

3

HEXALEN ORAL CAPSULE 50 MG

3 NDS


IFEX INTRAVENOUS SOLUTION RECONSTITUTED

3

ifosfamide intravenous solution

1

ifosfamide intravenous solution reconstituted

1

KISQALI FEMARA (400 MG DOSE) ORAL TABLET THERAPY PACK

3 PA; NDS

KISQALI FEMARA (600 MG DOSE) ORAL TABLET THERAPY PACK

3 PA; NDS

KISQALI FEMARA(200 MG DOSE) ORAL TABLET THERAPY PACK

3 PA; NDS

LEUKERAN ORAL TABLET

3 NDS

MATULANE ORAL CAPSULE

3 NDS

melphalan hcl intravenous solution reconstituted

3 NDS

MUSTARGEN INJECTION SOLUTION RECONSTITUTED 10 MG

3 NDS

oxaliplatin intravenous solution 100 mg/20ml

1

oxaliplatin intravenous solution 50 mg/10ml

1 NDS

oxaliplatin intravenous solution reconstituted 100 mg

1 NDS

oxaliplatin intravenous solution reconstituted 50 mg

3 NDS

TEMODAR INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

43


TEPADINA INJECTION SOLUTION RECONSTITUTED 100 MG

3 NDS

thiotepa injection solution reconstituted

3 NDS

TREANDA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

VALCHLOR EXTERNAL GEL

3 PA; NDS

YONDELIS INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

ZANOSAR INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

Antiandrogens

abiraterone acetate oral tablet

1 PA; NDS

bicalutamide oral tablet 1

CASODEX ORAL TABLET

3

ERLEADA ORAL TABLET

3 PA; NDS

flutamide oral capsule 1

NILANDRON ORAL TABLET

3 NDS

nilutamide oral tablet 3 NDS

XTANDI ORAL CAPSULE

3 PA; NDS

YONSA ORAL TABLET 3 PA; NDS

ZYTIGA ORAL TABLET 3 PA; NDS

Antiangiogenic Agents

POMALYST ORAL CAPSULE

3 PA; NDS

REVLIMID ORAL CAPSULE

3 PA; NDS

THALOMID ORAL CAPSULE

3 PA; NDS


Antiestrogens/Modifiers

EMCYT ORAL CAPSULE

3 NDS

FARESTON ORAL TABLET

3 NDS

FASLODEX INTRAMUSCULAR SOLUTION

3 NDS

fulvestrant intramuscular solution

1 NDS

SOLTAMOX ORAL SOLUTION

3 NDS

tamoxifen citrate oral tablet

1

toremifene citrate oral tablet

1 NDS

Antimetabolites

adrucil intravenous solution

1 B/D

ALIMTA INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

ARRANON INTRAVENOUS SOLUTION

3 NDS

CARAC EXTERNAL CREAM

3 NDS

cladribine intravenous solution

3 B/D; NDS

clofarabine intravenous solution

1 NDS

CLOLAR INTRAVENOUS SOLUTION

3 NDS

cytarabine (pf) injection solution

1 B/D

cytarabine injection solution

1 B/D

DROXIA ORAL CAPSULE

3

EFUDEX EXTERNAL CREAM

3

floxuridine injection solution reconstituted

1 B/D; NDS

44


fluorouracil external cream 0.5 %

3 NDS

fluorouracil external cream 5 %

1

fluorouracil external solution

1

fluorouracil intravenous solution

1 B/D

FOLOTYN INTRAVENOUS SOLUTION

3 PA; NDS

GEMCITABINE HCL INTRAVENOUS SOLUTION 1 GM/10ML, 1.5 GM/15ML, 2 GM/20ML, 200 MG/2ML

3 NDS

gemcitabine hcl intravenous solution 1 gm/26.3ml, 2 gm/52.6ml, 200 mg/5.26ml

1 NDS

gemcitabine hcl intravenous solution reconstituted

1 NDS

GEMZAR INTRAVENOUS SOLUTION RECONSTITUTED 1 GM, 200 MG

3 NDS

HYDREA ORAL CAPSULE

3

hydroxyurea oral capsule

1

INFUGEM INTRAVENOUS SOLUTION

3 NDS

LONSURF ORAL TABLET

3 PA; NDS

mercaptopurine oral tablet

1

NIPENT INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

PURIXAN ORAL SUSPENSION

3 NDS


SIKLOS ORAL TABLET 1000 MG

3 NDS

TABLOID ORAL TABLET

3

TOLAK EXTERNAL CREAM

3

VYXEOS INTRAVENOUS SUSPENSION RECONSTITUTED

3 PA; NDS

Antineoplastics

XPOVIO (100 MG ONCE WEEKLY) ORAL TABLET THERAPY PACK

3 PA; NDS


3 PA; NDS


3 PA; NDS

XPOVIO (80 MG TWICE WEEKLY) ORAL TABLET THERAPY PACK

3 PA; NDS

Antineoplastics, Other

ABRAXANE INTRAVENOUS SUSPENSION RECONSTITUTED

3 NDS

adriamycin intravenous solution

1 B/D

adriamycin intravenous solution reconstituted

1 B/D

amifostine intravenous solution reconstituted 500 mg

3 NDS

arsenic trioxide intravenous solution

1

azacitidine injection suspension reconstituted

3 NDS

45


BELEODAQ INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

BLEO 15K INJECTION SOLUTION RECONSTITUTED 15 (15000 IU) UNIT

3 B/D

bleomycin sulfate injection solution reconstituted

1 B/D

BORTEZOMIB INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

BRAFTOVI ORAL CAPSULE

3 PA; NDS

cisplatin intravenous solution reconstituted

3 NDS

COPIKTRA ORAL CAPSULE

3 PA; NDS

COSMEGEN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

COTELLIC ORAL TABLET

3 PA; NDS

DACOGEN INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

DACTINOMYCIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

daunorubicin hcl intravenous solution

1

DAURISMO ORAL TABLET

3 PA; NDS

decitabine intravenous solution reconstituted

3 PA; NDS

DOCEFREZ INTRAVENOUS SOLUTION RECONSTITUTED 20 MG

3 NDS


docetaxel (non-alcohol) intravenous solution 160 mg/8ml, 20 mg/ml, 80 mg/4ml

3 NDS

docetaxel intravenous concentrate 160 mg/8ml, 20 mg/0.5ml, 20 mg/ml, 80 mg/2ml, 80 mg/4ml

3 NDS

DOCETAXEL INTRAVENOUS CONCENTRATE 200 MG/10ML

3 NDS

docetaxel intravenous solution

3 NDS

DOXIL INTRAVENOUS INJECTABLE

3 NDS

doxorubicin hcl intravenous solution

1 B/D

doxorubicin hcl intravenous solution reconstituted 10 mg, 50 mg

1 B/D

DOXORUBICIN HCL LIPOSOMAL INJECTABLE 2 MG/ML INTRAVENOUS

1 NDS

doxorubicin hcl liposomal injectable 2 mg/ml intravenous

1 NDS

ELLENCE INTRAVENOUS SOLUTION

3 NDS

ELZONRIS INTRAVENOUS SOLUTION

3 PA; NDS

epirubicin hcl intravenous solution

1

ERWINAZE INJECTION SOLUTION RECONSTITUTED

3 NDS

ETHYOL INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

FARYDAK ORAL CAPSULE

3 PA; NDS

46


fludarabine phosphate intravenous solution

1 NDS

fludarabine phosphate intravenous solution reconstituted

1

FUSILEV INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

HALAVEN INTRAVENOUS SOLUTION

3 PA; NDS

IBRANCE ORAL CAPSULE

3 PA; NDS

IDAMYCIN PFS INTRAVENOUS SOLUTION

3 NDS

IDARUBICIN HCL SOLUTION 10 MG/10ML INTRAVENOUS

3 NDS

idarubicin hcl solution 10 mg/10ml intravenous

3 NDS


3 NDS


3 NDS


3 NDS


3 NDS

ISTODAX (OVERFILL) INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

IXEMPRA KIT INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

JEVTANA INTRAVENOUS SOLUTION

3 PA; NDS


KISQALI (200 MG DOSE) ORAL TABLET THERAPY PACK

3 PA; NDS


3 PA; NDS


3 PA; NDS

leucovorin calcium injection solution 100 mg/10ml

1 B/D

leucovorin calcium injection solution 500 mg/50ml

1

leucovorin calcium injection solution reconstituted

1

leucovorin calcium oral tablet

1

levoleucovorin calcium intravenous solution

3 NDS

levoleucovorin calcium intravenous solution reconstituted

3 NDS

levoleucovorin calcium pf intravenous solution

3 NDS

lipodox 50 intravenous injectable 2 mg/ml

3 NDS

LORBRENA ORAL TABLET

3 PA; NDS

LYNPARZA ORAL CAPSULE 50 MG

3 PA; NDS

LYNPARZA ORAL TABLET

3 PA; NDS

MARQIBO INTRAVENOUS SUSPENSION

3 NDS

MEKTOVI ORAL TABLET

3 PA; NDS

mitomycin intravenous solution reconstituted

3 NDS

mitoxantrone hcl intravenous concentrate

1 PA

47


MUTAMYCIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

NAVELBINE INTRAVENOUS SOLUTION

3

NERLYNX ORAL TABLET


NINLARO ORAL CAPSULE

3 PA; NDS

ONCASPAR INJECTION SOLUTION

3 NDS

paclitaxel intravenous concentrate

1

PIQRAY (200 MG DAILY DOSE) ORAL TABLET THERAPY PACK

3 PA; NDS


3 PA; NDS


3 PA; NDS

PROLEUKIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

ROMIDEPSIN INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

RYDAPT ORAL CAPSULE

3 PA; NDS

SYLATRON SUBCUTANEOUS KIT

3 PA; NDS

SYNRIBO SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

TALZENNA ORAL CAPSULE

3 PA; NDS


TAXOTERE INTRAVENOUS CONCENTRATE

3 NDS

teniposide intravenous solution

3 NDS

THERACYS INTRAVESICAL SUSPENSION RECONSTITUTED 81 MG/VIAL

3 NDS

TICE BCG INTRAVESICAL SUSPENSION RECONSTITUTED

3

TRISENOX INTRAVENOUS SOLUTION

3 NDS

valrubicin intravesical solution

1 NDS

VALSTAR INTRAVESICAL SOLUTION

3 NDS

VELCADE INJECTION SOLUTION RECONSTITUTED

3 PA; NDS

VERZENIO ORAL TABLET

3 PA; NDS

VIDAZA INJECTION SUSPENSION RECONSTITUTED

3 NDS

vinblastine sulfate intravenous solution

1 B/D

vincasar pfs intravenous solution 1 mg/ml

1 B/D

vincristine sulfate intravenous solution

1 B/D

vinorelbine tartrate intravenous solution

1

VITRAKVI ORAL CAPSULE

3 PA; NDS

VITRAKVI ORAL SOLUTION

3 PA; NDS

ZALTRAP INTRAVENOUS SOLUTION

3 PA; NDS

ZOLINZA ORAL CAPSULE

3 PA; NDS

48


ZYKADIA ORAL TABLET

3 PA; NDS

Aromatase Inhibitors, 3rd Generation

anastrozole oral tablet 1

ARIMIDEX ORAL TABLET

3

AROMASIN ORAL TABLET

3 NDS

exemestane oral tablet 1

FEMARA ORAL TABLET

3

letrozole oral tablet 1

Enzyme Inhibitors

BALVERSA ORAL TABLET

3 PA; NDS

CAMPTOSAR INTRAVENOUS SOLUTION

3

ETOPOPHOS INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

etoposide intravenous solution

1

HYCAMTIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

irinotecan hcl intravenous solution

1

KYPROLIS INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

ONIVYDE INTRAVENOUS INJECTABLE

3 NDS

toposar intravenous solution

1

topotecan hcl intravenous solution reconstituted

3 NDS

topotecan hcl solution 4 mg/4ml intravenous

1 NDS


topotecan hcl solution 4 mg/4ml intravenous

3 NDS

ZYDELIG ORAL TABLET

3 PA; NDS

Molecular Target Inhibitors

AFINITOR DISPERZ ORAL TABLET SOLUBLE

3 PA; NDS

AFINITOR ORAL TABLET


ALECENSA ORAL CAPSULE

3 PA; NDS

ALIQOPA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

ALUNBRIG ORAL TABLET 180 MG, 90 MG


ALUNBRIG ORAL TABLET 30 MG


ALUNBRIG ORAL TABLET THERAPY PACK


BOSULIF ORAL TABLET

3 PA; NDS

CABOMETYX ORAL TABLET

3 PA; NDS

CALQUENCE ORAL CAPSULE

3 PA; NDS

CAPRELSA ORAL TABLET 100 MG


CAPRELSA ORAL TABLET 300 MG

3 PA; NDS

COMETRIQ (100 MG DAILY DOSE) ORAL KIT

3 PA; NDS


3 PA; NDS


3 PA; NDS

49


ERIVEDGE ORAL CAPSULE

3 PA; NDS

erlotinib hcl oral tablet 1 PA; NDS

GILOTRIF ORAL TABLET


GLEEVEC ORAL TABLET

3 PA; NDS

ICLUSIG ORAL TABLET 15 MG


ICLUSIG ORAL TABLET 45 MG

3 PA; NDS

IDHIFA ORAL TABLET 3 PA; QL (30 EA per 30 days); NDS

imatinib mesylate oral tablet

3 PA; NDS

IMBRUVICA ORAL CAPSULE

3 PA; NDS

IMBRUVICA ORAL TABLET

3 PA; NDS

INLYTA ORAL TABLET 3 PA; NDS

IRESSA ORAL TABLET 3 PA; NDS

JAKAFI ORAL TABLET 10 MG


JAKAFI ORAL TABLET 15 MG, 20 MG, 25 MG, 5 MG

3 PA; NDS

LENVIMA (10 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK

3 PA; NDS


3 PA; NDS


3 PA; NDS


3 PA; NDS



3 PA; NDS


3 PA; NDS


3 PA; NDS


3 PA; NDS

MEKINIST ORAL TABLET

3 PA; NDS

NEXAVAR ORAL TABLET

3 PA; NDS

ODOMZO ORAL CAPSULE

3 PA; NDS

RUBRACA ORAL TABLET

3 PA; NDS

SPRYCEL ORAL TABLET

3 PA; NDS

STIVARGA ORAL TABLET

3 PA; NDS

SUTENT ORAL CAPSULE

3 PA; NDS

TAFINLAR ORAL CAPSULE

3 PA; NDS

TAGRISSO ORAL TABLET 40 MG


TAGRISSO ORAL TABLET 80 MG

3 PA; NDS

TARCEVA ORAL TABLET

3 PA; NDS

TASIGNA ORAL CAPSULE

3 PA; NDS

temsirolimus intravenous solution

1 NDS

TIBSOVO ORAL TABLET

3 PA; NDS

50


TORISEL INTRAVENOUS SOLUTION

3 NDS

TYKERB ORAL TABLET

3 PA; NDS

VENCLEXTA ORAL TABLET 10 MG, 50 MG

2 PA

VENCLEXTA ORAL TABLET 100 MG

3 PA; NDS

VENCLEXTA STARTING PACK ORAL TABLET THERAPY PACK

3 PA; NDS

VIZIMPRO ORAL TABLET

3 PA; NDS

VOTRIENT ORAL TABLET

3 PA; NDS

XALKORI ORAL CAPSULE

3 PA; NDS

XOSPATA ORAL TABLET

3 PA; NDS

ZEJULA ORAL CAPSULE

3 PA; NDS

ZELBORAF ORAL TABLET

3 PA; NDS

ZYKADIA ORAL CAPSULE

3 PA; NDS

Monoclonal Antibody/Antibody-Drug Conjugate

ADCETRIS INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

ARZERRA INTRAVENOUS CONCENTRATE

3 PA; NDS

AVASTIN INTRAVENOUS SOLUTION

3 NDS

BAVENCIO INTRAVENOUS SOLUTION

3 PA; NDS

BESPONSA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS


BLINCYTO INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

CYRAMZA INTRAVENOUS SOLUTION

3 PA; NDS

DARZALEX INTRAVENOUS SOLUTION

3 PA; NDS

EMPLICITI INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

ERBITUX INTRAVENOUS SOLUTION

3 PA; NDS

GAZYVA INTRAVENOUS SOLUTION

3 PA; NDS

HERCEPTIN HYLECTA SUBCUTANEOUS SOLUTION

3 PA; NDS

HERCEPTIN INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

IMFINZI INTRAVENOUS SOLUTION

3 PA; NDS

KADCYLA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

KEYTRUDA INTRAVENOUS SOLUTION

3 PA; NDS

KEYTRUDA INTRAVENOUS SOLUTION RECONSTITUTED 50 MG

3 PA; NDS

LARTRUVO INTRAVENOUS SOLUTION

3 PA; NDS

LIBTAYO INTRAVENOUS SOLUTION

3 PA; NDS

51


LUMOXITI INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

MYLOTARG INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

OPDIVO INTRAVENOUS SOLUTION

3 PA; NDS

PERJETA INTRAVENOUS SOLUTION

3 PA; NDS

POLIVY INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

PORTRAZZA INTRAVENOUS SOLUTION

3 PA; NDS

POTELIGEO INTRAVENOUS SOLUTION

3 PA; NDS

RITUXAN HYCELA SUBCUTANEOUS SOLUTION

3 PA; NDS

RITUXAN INTRAVENOUS SOLUTION

3 PA; NDS

TECENTRIQ INTRAVENOUS SOLUTION

3 PA; NDS

UNITUXIN INTRAVENOUS SOLUTION

3 NDS

VECTIBIX INTRAVENOUS SOLUTION

3 NDS

YERVOY INTRAVENOUS SOLUTION

3 PA; NDS

ZEVALIN Y-90 INTRAVENOUS KIT

3 NDS

Retinoids

bexarotene oral capsule 3 PA; NDS


PANRETIN EXTERNAL GEL

3 NDS

TARGRETIN EXTERNAL GEL

3 PA; NDS

TARGRETIN ORAL CAPSULE

3 PA; NDS

tretinoin oral capsule 3 NDS

Treatment Adjuncts

dexrazoxane hcl intravenous solution reconstituted

3 NDS

ELITEK INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

KHAPZORY INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

mesna intravenous solution

1

MESNEX INTRAVENOUS SOLUTION

3

MESNEX ORAL TABLET

3 NDS

TOTECT INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

ZINECARD INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

Antiparasitics

Anthelmintics

albendazole oral tablet 1 NDS

ALBENZA ORAL TABLET

3 NDS

BENZNIDAZOLE ORAL TABLET

2

BILTRICIDE ORAL TABLET

2

emverm oral tablet chewable

3 NDS

52


ivermectin oral tablet 1

praziquantel oral tablet 1

STROMECTOL ORAL TABLET

3

Antiprotozoals

ALINIA ORAL SUSPENSION RECONSTITUTED

3 NDS

ALINIA ORAL TABLET 3 NDS

ARAKODA ORAL TABLET

3

atovaquone oral suspension

3 NDS

atovaquone-proguanil hcl oral tablet

1

chloroquine phosphate oral tablet

1

COARTEM ORAL TABLET

3

DARAPRIM ORAL TABLET

3 PA; NDS

hydroxychloroquine sulfate oral tablet

1

KRINTAFEL ORAL TABLET

3

MALARONE ORAL TABLET

3

mefloquine hcl oral tablet

1

MEPRON ORAL SUSPENSION

3 NDS

NEBUPENT INHALATION SOLUTION RECONSTITUTED

3 B/D

PENTAM INJECTION SOLUTION RECONSTITUTED

3

pentamidine isethionate injection solution reconstituted

1

PLAQUENIL ORAL TABLET

3

primaquine phosphate oral tablet

1


QUALAQUIN ORAL CAPSULE

3 PA

quinine sulfate oral capsule

1 PA

SOLOSEC ORAL PACKET

3

TINDAMAX ORAL TABLET 500 MG

3

tinidazole oral tablet 1

Pediculicides/Scabicides

crotan external lotion 1

ELIMITE EXTERNAL CREAM

3

EURAX EXTERNAL CREAM

3

EURAX EXTERNAL LOTION

3

lindane external shampoo

3

malathion external lotion

1

NATROBA EXTERNAL SUSPENSION

3

ovide external lotion 3

permethrin external cream

1

SKLICE EXTERNAL LOTION

3

spinosad external suspension

1

ULESFIA EXTERNAL LOTION

3

Antiparkinson Agents

Anticholinergics

benztropine mesylate injection solution

1

benztropine mesylate oral tablet

1

COGENTIN INJECTION SOLUTION

3 NDS

trihexyphenidyl hcl oral elixir 0.4 mg/ml

1

53


trihexyphenidyl hcl oral tablet

1

Antiparkinson Agents, Other

COMTAN ORAL TABLET

3 NDS

entacapone oral tablet 1

GOCOVRI ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3 PA; NDS

OSMOLEX ER ORAL TABLET EXTENDED RELEASE 24 HOUR

3 PA

TASMAR ORAL TABLET

3 NDS

tolcapone oral tablet 3 NDS

Dopamine Agonists

APOKYN SUBCUTANEOUS SOLUTION CARTRIDGE


bromocriptine mesylate oral capsule

3

bromocriptine mesylate oral tablet

3

INBRIJA INHALATION CAPSULE

3 PA; NDS

MIRAPEX ER ORAL TABLET EXTENDED RELEASE 24 HOUR

3

MIRAPEX ORAL TABLET

3

NEUPRO TRANSDERMAL PATCH 24 HOUR

3 ST

PARLODEL ORAL CAPSULE

3

PARLODEL ORAL TABLET

3

pramipexole dihydrochloride er oral tablet extended release 24 hour

1

pramipexole dihydrochloride oral tablet

1


REQUIP ORAL TABLET

3

REQUIP XL ORAL TABLET EXTENDED RELEASE 24 HOUR 12 MG

3 NDS

REQUIP XL ORAL TABLET EXTENDED RELEASE 24 HOUR 2 MG, 4 MG, 6 MG, 8 MG

3

ropinirole hcl er oral tablet extended release 24 hour

1

ropinirole hcl oral tablet 1

Dopamine Precursors/L- Amino Acid Decarboxylase Inhibitors

carbidopa oral tablet 3 NDS

carbidopa-levodopa er oral tablet extended release

1

carbidopa-levodopa oral tablet

1

carbidopa-levodopa oral tablet dispersible

1

carbidopa-levodopa-entacapone oral tablet

1

DUOPA ENTERAL SUSPENSION

3 PA; NDS

LODOSYN ORAL TABLET

3 NDS

RYTARY ORAL CAPSULE EXTENDED RELEASE

3 ST

SINEMET CR ORAL TABLET EXTENDED RELEASE

3

SINEMET ORAL TABLET

3

STALEVO 100 ORAL TABLET

3 NDS


3 NDS


3 NDS

54



3 NDS


3


3

Monoamine Oxidase B (MAO-B) Inhibitors

AZILECT ORAL TABLET

3

ELDEPRYL ORAL CAPSULE 5 MG

3

rasagiline mesylate oral tablet

1

selegiline hcl oral capsule

1

selegiline hcl oral tablet 1

XADAGO ORAL TABLET


ZELAPAR ORAL TABLET DISPERSIBLE

3 NDS

Antipsychotics

1st Generation/Typical

chlorpromazine hcl injection solution

1

chlorpromazine hcl oral tablet

1

fluphenazine decanoate injection solution

1

fluphenazine hcl injection solution

1

fluphenazine hcl oral concentrate

1

fluphenazine hcl oral elixir

1

fluphenazine hcl oral tablet

1

HALDOL DECANOATE INTRAMUSCULAR SOLUTION

3

HALDOL INJECTION SOLUTION

3

haloperidol decanoate intramuscular solution

1


haloperidol lactate injection solution

1

haloperidol lactate oral concentrate

1

haloperidol oral tablet 1

loxapine succinate oral capsule

1

molindone hcl oral tablet

1

ORAP ORAL TABLET 1 MG, 2 MG

3

perphenazine oral tablet 1

pimozide oral tablet 1

thioridazine hcl oral tablet

1 PA

thiothixene oral capsule 1

trifluoperazine hcl oral tablet

1

2nd Generation/Atypical

ABILIFY MAINTENA INTRAMUSCULAR PREFILLED SYRINGE

3 NDS

ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION RECONSTITUTED ER

3 NDS

ABILIFY MYCITE ORAL TABLET


ABILIFY ORAL TABLET 3 QL (30 EA per 30 days); NDS

aripiprazole oral solution


aripiprazole oral tablet 1 QL (30 EA per 30 days)

aripiprazole oral tablet dispersible


ARISTADA INITIO INTRAMUSCULAR PREFILLED SYRINGE

3 NDS

ARISTADA INTRAMUSCULAR PREFILLED SYRINGE

3 NDS

55


FANAPT ORAL TABLET 1 MG, 2 MG, 4 MG


FANAPT ORAL TABLET 10 MG, 12 MG, 6 MG, 8 MG


FANAPT TITRATION PACK ORAL TABLET


GEODON INTRAMUSCULAR SOLUTION RECONSTITUTED


GEODON ORAL CAPSULE


INVEGA ORAL TABLET EXTENDED RELEASE 24 HOUR 1.5 MG, 3 MG, 9 MG


INVEGA ORAL TABLET EXTENDED RELEASE 24 HOUR 6 MG


INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 117 MG/0.75ML, 156 MG/ML, 234 MG/1.5ML, 78 MG/0.5ML

3 NDS

INVEGA SUSTENNA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 39 MG/0.25ML

3

INVEGA TRINZA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

3 NDS

LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG


LATUDA ORAL TABLET 80 MG


NUPLAZID ORAL CAPSULE

3 PA; NDS

NUPLAZID ORAL TABLET

3 PA; NDS


olanzapine intramuscular solution reconstituted

1

olanzapine oral tablet 1 QL (30 EA per 30 days)

olanzapine oral tablet dispersible


paliperidone er oral tablet extended release 24 hour 1.5 mg, 3 mg


paliperidone er oral tablet extended release 24 hour 6 mg


paliperidone er oral tablet extended release 24 hour 9 mg


PERSERIS SUBCUTANEOUS PREFILLED SYRINGE

3 PA; NDS

quetiapine fumarate er oral tablet extended release 24 hour 150 mg, 300 mg, 400 mg, 50 mg


quetiapine fumarate er oral tablet extended release 24 hour 200 mg


quetiapine fumarate oral tablet 100 mg, 200 mg, 25 mg, 50 mg


quetiapine fumarate oral tablet 300 mg, 400 mg


REXULTI ORAL TABLET


RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 12.5 MG, 25 MG

3

RISPERDAL CONSTA INTRAMUSCULAR SUSPENSION RECONSTITUTED 37.5 MG, 50 MG

3 NDS

RISPERDAL M-TAB ORAL TABLET DISPERSIBLE 0.5 MG, 1 MG


56


RISPERDAL M-TAB ORAL TABLET DISPERSIBLE 3 MG, 4 MG


RISPERDAL ORAL SOLUTION


RISPERDAL ORAL TABLET 0.25 MG, 0.5 MG, 1 MG


RISPERDAL ORAL TABLET 2 MG, 3 MG, 4 MG


risperidone oral solution 1 QL (240 ML per 30 days)

risperidone oral tablet 1 QL (60 EA per 30 days)

risperidone oral tablet dispersible


SAPHRIS SUBLINGUAL TABLET SUBLINGUAL


SEROQUEL ORAL TABLET 100 MG, 200 MG, 25 MG, 50 MG


SEROQUEL ORAL TABLET 300 MG, 400 MG


SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150 MG, 300 MG, 50 MG


SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 200 MG


SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HOUR 400 MG


VRAYLAR ORAL CAPSULE


VRAYLAR ORAL CAPSULE THERAPY PACK



ziprasidone hcl oral capsule


ZYPREXA INTRAMUSCULAR SOLUTION RECONSTITUTED

3

ZYPREXA ORAL TABLET 10 MG, 2.5 MG, 5 MG, 7.5 MG


ZYPREXA ORAL TABLET 15 MG, 20 MG


ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION RECONSTITUTED 210 MG

3

ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION RECONSTITUTED 300 MG, 405 MG

3 NDS

ZYPREXA ZYDIS ORAL TABLET DISPERSIBLE 10 MG, 5 MG


ZYPREXA ZYDIS ORAL TABLET DISPERSIBLE 15 MG, 20 MG


Treatment-Resistant

clozapine oral tablet 100 mg, 25 mg


clozapine oral tablet 200 mg


clozapine oral tablet 50 mg


clozapine oral tablet dispersible 100 mg, 25 mg


clozapine oral tablet dispersible 12.5 mg


clozapine oral tablet dispersible 150 mg


clozapine oral tablet dispersible 200 mg


CLOZARIL ORAL TABLET 100 MG


57


CLOZARIL ORAL TABLET 25 MG


FAZACLO ORAL TABLET DISPERSIBLE 100 MG


FAZACLO ORAL TABLET DISPERSIBLE 12.5 MG








VERSACLOZ ORAL SUSPENSION


Antispasticity Agents

Antispasticity Agents

baclofen intrathecal solution

1 B/D

baclofen oral tablet 1

BOTOX INJECTION SOLUTION RECONSTITUTED

3 PA

DANTRIUM INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

DANTRIUM ORAL CAPSULE

3

dantrolene sodium oral capsule

1

DYSPORT INTRAMUSCULAR SOLUTION RECONSTITUTED

3 PA

GABLOFEN INTRATHECAL SOLUTION 10000 MCG/20ML, 20000 MCG/20ML

3 B/D


GABLOFEN INTRATHECAL SOLUTION 40000 MCG/20ML

3 B/D; NDS

GABLOFEN INTRATHECAL SOLUTION PREFILLED SYRINGE

3 B/D

LIORESAL INTRATHECAL INTRATHECAL SOLUTION 2000 MCG/ML

3 B/D; NDS

LIORESAL INTRATHECAL INTRATHECAL SOLUTION 500 MCG/ML

3 B/D

LIORESAL INTRATHECAL SOLUTION 0.05 MG/ML

3 B/D

MYOBLOC INTRAMUSCULAR SOLUTION 10000 UNIT/2ML

3 PA; NDS

MYOBLOC INTRAMUSCULAR SOLUTION 2500 UNIT/0.5ML, 5000 UNIT/ML

3 PA

revonto intravenous solution reconstituted

1

tizanidine hcl oral capsule

1

tizanidine hcl oral tablet 1

XEOMIN INTRAMUSCULAR SOLUTION RECONSTITUTED 100 UNIT, 50 UNIT

3 PA

XEOMIN INTRAMUSCULAR SOLUTION RECONSTITUTED 200 UNIT

3 PA; NDS

ZANAFLEX ORAL CAPSULE

3

58


ZANAFLEX ORAL TABLET

3

Antivirals

Anti-cytomegalovirus (CMV) Agents

cidofovir intravenous solution

3 NDS

CYTOVENE INTRAVENOUS SOLUTION RECONSTITUTED

3 B/D

ganciclovir sodium intravenous solution

1 B/D

ganciclovir sodium intravenous solution reconstituted

1 B/D

PREVYMIS INTRAVENOUS SOLUTION

3 NDS

PREVYMIS ORAL TABLET

3 NDS

VALCYTE ORAL SOLUTION RECONSTITUTED

3 NDS

VALCYTE ORAL TABLET

3 NDS

valganciclovir hcl oral solution reconstituted

1 NDS

valganciclovir hcl oral tablet

3 NDS

ZIRGAN OPHTHALMIC GEL

3

Anti-hepatitis B (HBV) Agents

adefovir dipivoxil oral tablet

3 NDS

BARACLUDE ORAL SOLUTION


BARACLUDE ORAL TABLET


entecavir oral tablet 1 QL (30 EA per 30 days)

EPIVIR HBV ORAL SOLUTION

3


EPIVIR HBV ORAL TABLET

3

HEPSERA ORAL TABLET

3 NDS

INTRON A INJECTION SOLUTION

3 PA; NDS

INTRON A INJECTION SOLUTION RECONSTITUTED

3 PA; NDS

lamivudine oral tablet 100 mg

1

VEMLIDY ORAL TABLET

3 NDS

Anti-hepatitis C (HCV) Agents, Direct Acting Agents

DAKLINZA ORAL TABLET 30 MG, 60 MG, 90 MG


EPCLUSA ORAL TABLET


HARVONI ORAL TABLET


ledipasvir-sofosbuvir oral tablet


MAVYRET ORAL TABLET


OLYSIO ORAL CAPSULE 150 MG


sofosbuvir-velpatasvir oral tablet


SOVALDI ORAL TABLET


TECHNIVIE ORAL TABLET 12.5-75-50 MG


VIEKIRA PAK ORAL TABLET THERAPY PACK


59


VIEKIRA XR ORAL TABLET EXTENDED RELEASE 24 HOUR 200-8.33-50- 33.33 MG


VOSEVI ORAL TABLET 3 PA; QL (84 EA per 365 days); NDS

ZEPATIER ORAL TABLET


Anti-hepatitis C (HCV) Agents, Other

COPEGUS ORAL TABLET 200 MG

3

MODERIBA 1200 DOSE PACK ORAL TABLET 600 MG

3 NDS

MODERIBA 800 DOSE PACK ORAL TABLET 400 MG

3 NDS

moderiba oral tablet 200 mg

1

MODERIBA ORAL TABLET THERAPY PACK 200 & 400 MG, 400 & 600 MG

3 NDS

PEGASYS PROCLICK SUBCUTANEOUS SOLUTION

3 PA; NDS

PEGASYS SUBCUTANEOUS SOLUTION

3 PA; NDS

PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS KIT 120 MCG/0.5ML

3 PA; NDS

PEGINTRON SUBCUTANEOUS KIT

3 PA; NDS

REBETOL ORAL CAPSULE 200 MG

3

REBETOL ORAL SOLUTION 40 MG/ML

3 NDS

ribasphere oral capsule 1

ribasphere oral tablet 200 mg

1

RIBASPHERE ORAL TABLET 400 MG

3 NDS


ribasphere oral tablet 600 mg

1 NDS

RIBASPHERE RIBAPAK ORAL TABLET 400 MG

3 NDS

ribasphere ribapak oral tablet 600 mg

3 NDS

RIBASPHERE RIBAPAK ORAL TABLET THERAPY PACK 200 & 400 MG

3 NDS

ribasphere ribapak oral tablet therapy pack 400 & 600 mg

3 NDS

ribavirin oral capsule 1

ribavirin oral tablet 1

Antiherpetic Agents

acyclovir external cream 1 NDS

acyclovir external ointment

1

acyclovir oral capsule 1

acyclovir oral suspension

1

acyclovir oral tablet 1

acyclovir sodium intravenous solution

1 B/D

acyclovir sodium intravenous solution reconstituted 500 mg

1 B/D

DENAVIR EXTERNAL CREAM

3 NDS

famciclovir oral tablet 1

trifluridine ophthalmic solution

1

valacyclovir hcl oral tablet


VALTREX ORAL TABLET


VIROPTIC OPHTHALMIC SOLUTION 1 %

3

XERESE EXTERNAL CREAM

3 NDS

60


ZOVIRAX EXTERNAL CREAM

3 NDS

ZOVIRAX EXTERNAL OINTMENT

3 NDS

ZOVIRAX ORAL CAPSULE

3

ZOVIRAX ORAL SUSPENSION

3

ZOVIRAX ORAL TABLET

3

Anti-HIV Agents, Integrase Inhibitors (INSTI)

BIKTARVY ORAL TABLET


DELSTRIGO ORAL TABLET


DOVATO ORAL TABLET


GENVOYA ORAL TABLET


ISENTRESS ORAL PACKET

3 NDS

ISENTRESS ORAL TABLET CHEWABLE 100 MG

3 NDS

ISENTRESS ORAL TABLET CHEWABLE 25 MG

2

JULUCA ORAL TABLET


STRIBILD ORAL TABLET


TIVICAY ORAL TABLET 10 MG

3

TIVICAY ORAL TABLET 25 MG, 50 MG

3 NDS

TRIUMEQ ORAL TABLET


Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)

ATRIPLA ORAL TABLET



COMPLERA ORAL TABLET


EDURANT ORAL TABLET

3 NDS

efavirenz oral capsule 200 mg

1 NDS

efavirenz oral capsule 50 mg

1

efavirenz oral tablet 3 NDS

INTELENCE ORAL TABLET 100 MG, 200 MG

3 NDS

INTELENCE ORAL TABLET 25 MG

3

nevirapine er oral tablet extended release 24 hour

1

nevirapine oral suspension

1

nevirapine oral tablet 1

ODEFSEY ORAL TABLET


PIFELTRO ORAL TABLET

3 NDS

RESCRIPTOR ORAL TABLET

3

SUSTIVA ORAL CAPSULE 200 MG

3 NDS

SUSTIVA ORAL CAPSULE 50 MG

3

SUSTIVA ORAL TABLET

3 NDS

SYMFI LO ORAL TABLET


SYMFI ORAL TABLET 3 QL (30 EA per 30 days); NDS

VIRAMUNE ORAL SUSPENSION

3 NDS

VIRAMUNE ORAL TABLET

3 NDS

VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

61


Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)

abacavir sulfate oral solution

1

abacavir sulfate oral tablet

1

abacavir sulfate-lamivudine oral tablet


abacavir-lamivudine-zidovudine oral tablet


CIMDUO ORAL TABLET


COMBIVIR ORAL TABLET


DESCOVY ORAL TABLET


didanosine oral capsule delayed release

1

EMTRIVA ORAL CAPSULE

3

EMTRIVA ORAL SOLUTION

3

EPIVIR ORAL SOLUTION

3

EPIVIR ORAL TABLET 3

EPZICOM ORAL TABLET


lamivudine oral solution 1

lamivudine oral tablet 150 mg, 300 mg

1

lamivudine-zidovudine oral tablet


RETROVIR INTRAVENOUS SOLUTION

3

RETROVIR ORAL CAPSULE

3

RETROVIR ORAL SYRUP

3

stavudine oral capsule 1

tenofovir disoproxil fumarate oral tablet

1


TRIZIVIR ORAL TABLET


TRUVADA ORAL TABLET


VIDEX EC ORAL CAPSULE DELAYED RELEASE

3

VIDEX ORAL SOLUTION RECONSTITUTED

3

VIREAD ORAL POWDER

3 NDS

VIREAD ORAL TABLET 3 NDS

ZERIT ORAL CAPSULE

3

ZERIT ORAL SOLUTION RECONSTITUTED 1 MG/ML

3

ZIAGEN ORAL SOLUTION

3

ZIAGEN ORAL TABLET 3

zidovudine oral capsule 1

zidovudine oral syrup 1

zidovudine oral tablet 1

Anti-HIV Agents, Other

FUZEON SUBCUTANEOUS SOLUTION RECONSTITUTED


ISENTRESS HD ORAL TABLET

3 NDS

ISENTRESS ORAL TABLET

3 NDS

SELZENTRY ORAL SOLUTION

3 NDS

SELZENTRY ORAL TABLET 150 MG, 300 MG, 75 MG

3 NDS

SELZENTRY ORAL TABLET 25 MG

3

TROGARZO INTRAVENOUS SOLUTION

3 NDS

62


TYBOST ORAL TABLET

2

Anti-HIV Agents, Protease Inhibitors

APTIVUS ORAL CAPSULE

3 NDS

APTIVUS ORAL SOLUTION

3 NDS

atazanavir sulfate oral capsule

3 NDS

CRIXIVAN ORAL CAPSULE

2

EVOTAZ ORAL TABLET


fosamprenavir calcium oral tablet

3 NDS

INVIRASE ORAL CAPSULE 200 MG

3 NDS

INVIRASE ORAL TABLET

3 NDS

KALETRA ORAL SOLUTION

3 NDS

KALETRA ORAL TABLET 100-25 MG

3

KALETRA ORAL TABLET 200-50 MG

3 NDS

LEXIVA ORAL SUSPENSION

3

LEXIVA ORAL TABLET 3 NDS

lopinavir-ritonavir oral solution

1 NDS

NORVIR ORAL CAPSULE 100 MG

3

NORVIR ORAL PACKET

3

NORVIR ORAL SOLUTION

3

NORVIR ORAL TABLET

3

PREZCOBIX ORAL TABLET


PREZISTA ORAL SUSPENSION

3 NDS


PREZISTA ORAL TABLET 150 MG, 75 MG

3

PREZISTA ORAL TABLET 600 MG, 800 MG

3 NDS

REYATAZ ORAL CAPSULE

3 NDS

REYATAZ ORAL PACKET

3 NDS

ritonavir oral tablet 1

SYMTUZA ORAL TABLET


VIRACEPT ORAL TABLET

3 NDS

Anti-influenza Agents

amantadine hcl oral capsule

1

amantadine hcl oral syrup

1

amantadine hcl oral tablet

1

FLUMADINE ORAL TABLET

3

oseltamivir phosphate oral capsule 30 mg






oseltamivir phosphate oral suspension reconstituted


RAPIVAB INTRAVENOUS SOLUTION

3 NDS

RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH ACTIVATED


rimantadine hcl oral tablet

1

TAMIFLU ORAL CAPSULE 30 MG


63






TAMIFLU ORAL SUSPENSION RECONSTITUTED


XOFLUZA ORAL TABLET THERAPY PACK


Anxiolytics

Anxiolytics, Other

buspirone hcl oral tablet 1

meprobamate oral tablet

3

Benzodiazepines

alprazolam er oral tablet extended release 24 hour 0.5 mg, 1 mg


alprazolam er oral tablet extended release 24 hour 2 mg


alprazolam er oral tablet extended release 24 hour 3 mg


alprazolam intensol oral concentrate

1 PA

alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg


alprazolam oral tablet 2 mg


alprazolam oral tablet dispersible 0.25 mg, 0.5 mg, 1 mg


alprazolam oral tablet dispersible 2 mg


alprazolam xr oral tablet extended release 24 hour 0.5 mg, 1 mg


alprazolam xr oral tablet extended release 24 hour 2 mg



alprazolam xr oral tablet extended release 24 hour 3 mg


ATIVAN INJECTION SOLUTION

3 PA

ATIVAN ORAL TABLET 0.5 MG, 1 MG


ATIVAN ORAL TABLET 2 MG


chlordiazepoxide hcl oral capsule 10 mg






clorazepate dipotassium oral tablet 15 mg


clorazepate dipotassium oral tablet 3.75 mg


clorazepate dipotassium oral tablet 7.5 mg


diazepam injection solution

1

diazepam oral concentrate

1

diazepam oral solution 1

diazepam oral tablet 10 mg






DORAL ORAL TABLET 3 QL (30 EA per 30 days)

estazolam oral tablet 1 PA; QL (30 EA per 30 days)

HALCION ORAL TABLET


lorazepam injection solution

1 PA

64


lorazepam intensol oral concentrate

1 PA

lorazepam oral concentrate

1 PA

lorazepam oral tablet 0.5 mg, 1 mg


lorazepam oral tablet 2 mg


midazolam hcl injection solution

1

midazolam hcl oral syrup

1

oxazepam oral capsule 1 PA; QL (120 EA per 30 days)

quazepam oral tablet 1 QL (30 EA per 30 days)

RESTORIL ORAL CAPSULE


temazepam oral capsule


TRANXENE-T ORAL TABLET


triazolam oral tablet 1 PA; QL (60 EA per 30 days)

VALIUM ORAL TABLET 10 MG






XANAX ORAL TABLET 0.25 MG, 0.5 MG, 1 MG


XANAX ORAL TABLET 2 MG


XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 0.5 MG, 1 MG


XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 2 MG



XANAX XR ORAL TABLET EXTENDED RELEASE 24 HOUR 3 MG


Bipolar Agents

Mood Stabilizers

EQUETRO ORAL CAPSULE EXTENDED RELEASE 12 HOUR

3

lithium carbonate er oral tablet extended release

1

lithium carbonate oral capsule

1

lithium carbonate oral tablet

1

LITHIUM ORAL SOLUTION

1

LITHOBID ORAL TABLET EXTENDED RELEASE

3

Blood Glucose Regulators

Antidiabetic Agents

acarbose oral tablet 1

ACTOPLUS MET ORAL TABLET

3

ACTOPLUS MET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 15-1000 MG, 30-1000 MG

3

ACTOS ORAL TABLET 3

ADLYXIN STARTER PACK SUBCUTANEOUS PEN-INJECTOR KIT

3 ST; QL (12 ML per 365 days)

ADLYXIN SUBCUTANEOUS SOLUTION PEN-INJECTOR


alogliptin benzoate oral tablet

3 ST

ALOGLIPTIN-METFORMIN HCL ORAL TABLET

3 ST

65


alogliptin-pioglitazone oral tablet

3 ST

AMARYL ORAL TABLET

3

AVANDIA ORAL TABLET

3

BYDUREON BCISE AUTOINJECTOR SUBCUTANEOUS AUTO-INJECTOR

3 ST; QL (3.4 ML per 28 days)

BYDUREON PEN 3 ST; QL (4 EA per 28 days)

BYDUREON SUBCUTANEOUS SUSPENSION RECONSTITUTED ER 2 MG


BYETTA 10 MCG PEN 3 QL (2.4 ML per 28 days)

BYETTA 5 MCG PEN 3 QL (4.8 ML per 28 days)

chlorpropamide oral tablet 100 mg, 250 mg

1

CYCLOSET ORAL TABLET

3

DUETACT ORAL TABLET

3

FARXIGA ORAL TABLET

3 ST

FORTAMET ORAL TABLET EXTENDED RELEASE 24 HOUR

3 NDS

glimepiride oral tablet 1

glipizide er oral tablet extended release 24 hour

1

glipizide oral tablet 1

glipizide xl oral tablet extended release 24 hour

1

glipizide-metformin hcl oral tablet

1

GLUCOPHAGE ORAL TABLET

3


GLUCOPHAGE XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

GLUCOTROL ORAL TABLET

3

GLUCOTROL XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

GLUCOVANCE ORAL TABLET 2.5-500 MG, 5-500 MG

3

GLUMETZA ORAL TABLET EXTENDED RELEASE 24 HOUR

3 PA; NDS

glyburide micronized oral tablet

1

glyburide oral tablet 1

glyburide-metformin oral tablet

1

GLYNASE ORAL TABLET

3

GLYSET ORAL TABLET

3

GLYXAMBI ORAL TABLET

2 ST

INVOKAMET ORAL TABLET

2 ST

INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2 ST

INVOKANA ORAL TABLET

2 ST

JANUMET ORAL TABLET

2 ST

JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2 ST

JANUVIA ORAL TABLET

2 ST

JARDIANCE ORAL TABLET

2 ST

JENTADUETO ORAL TABLET

2 ST

66


JENTADUETO XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2 ST

KAZANO ORAL TABLET

3 ST

KOMBIGLYZE XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3 ST

metformin hcl er (mod) oral tablet extended release 24 hour

1 PA; NDS

metformin hcl er (osm) oral tablet extended release 24 hour

1

metformin hcl er oral tablet extended release 24 hour

1

METFORMIN HCL ORAL SOLUTION

3

metformin hcl oral tablet 1

miglitol oral tablet 1

nateglinide oral tablet 1

NESINA ORAL TABLET 3 ST

ONGLYZA ORAL TABLET

3 ST

OSENI ORAL TABLET 3 ST

OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 0.25 OR 0.5 MG/DOSE


OZEMPIC SUBCUTANEOUS SOLUTION PEN-INJECTOR 1 MG/DOSE


pioglitazone hcl oral tablet

1

pioglitazone hcl-glimepiride oral tablet

1

pioglitazone hcl-metformin hcl oral tablet

1

prandin oral tablet 1 mg 3

prandin oral tablet 2 mg 3 NDS


PRECOSE ORAL TABLET

3

QTERN ORAL TABLET 3 ST

repaglinide oral tablet 1

repaglinide-metformin hcl oral tablet

1

RIOMET ORAL SOLUTION

3

SEGLUROMET ORAL TABLET

3 ST

STARLIX ORAL TABLET

3

STEGLATRO ORAL TABLET

3 ST

STEGLUJAN ORAL TABLET

3 ST

SYMLINPEN 120 3 PA; NDS

SYMLINPEN 60 3 PA; NDS

SYNJARDY ORAL TABLET

2 ST

SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR

2 ST

TANZEUM SUBCUTANEOUS PEN-INJECTOR 30 MG, 50 MG


tolazamide oral tablet 250 mg, 500 mg

1

tolbutamide oral tablet 1

TRADJENTA ORAL TABLET

2 ST

TRULICITY SUBCUTANEOUS SOLUTION PEN-INJECTOR


VICTOZA 2 ST; QL (9 ML per 30 days)

XIGDUO XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3 ST

Glycemic Agents

GLUCAGEN HYPOKIT INJECTION SOLUTION RECONSTITUTED

3

67


GLUCAGON EMERGENCY INJECTION KIT

2

PROGLYCEM ORAL SUSPENSION

3 NDS

Insulins

ADMELOG SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 ST

ADMELOG SUBCUTANEOUS SOLUTION

3 ST

AFREZZA INHALATION POWDER 12 UNIT, 30 X 4 UNIT & 60X8 UNIT, 4 & 8 & 12 UNIT, 4 UNIT, 60 X 4 UNIT & 30X8 UNIT, 60 X 8 UNIT & 30X12 UNIT, 8 UNIT, 90 X 4 UNIT & 90X8 UNIT

3 PA

AFREZZA INHALATION POWDER 90 X 8 UNIT & 90X12 UNIT

3 PA; NDS

APIDRA SOLOSTAR 3

APIDRA VIAL INJECTION SOLUTION

3

BASAGLAR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 ST

FIASP FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 ST

FIASP SUBCUTANEOUS SOLUTION

3 ST

HUMALOG KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

HUMALOG MIX 50/50 KWIKPEN

2


HUMALOG MIX 50/50 VIAL SUBCUTANEOUS SUSPENSION

2

HUMALOG MIX 75/25 KWIKPEN

2

HUMALOG MIX 75/25 VIAL SUBCUTANEOUS SUSPENSION

2

HUMALOG U-100 JUNIOR KWIKPEN SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

HUMALOG U-100 VIAL AND CARTRIDGE SUBCUTANEOUS SOLUTION

2

HUMALOG U-100 VIAL AND CARTRIDGE SUBCUTANEOUS SOLUTION CARTRIDGE

2

HUMULIN 70/30 KWIKPEN

2

HUMULIN 70/30 VIAL SUBCUTANEOUS SUSPENSION

2

HUMULIN N KWIKPEN 2

HUMULIN N VIAL SUBCUTANEOUS SUSPENSION

2

HUMULIN R U-500 KWIKPEN

2

HUMULIN R U-500 VIAL (CONCENTRATED) SUBCUTANEOUS SOLUTION

2

HUMULIN R VIAL INJECTION SOLUTION

2

insulin lispro subcutaneous solution

2

insulin lispro subcutaneous solution pen-injector

2

LANTUS U-100 SOLOSTAR

2

68


LANTUS U-100 VIAL SUBCUTANEOUS SOLUTION

2

LEVEMIR U-100 FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

LEVEMIR U-100 VIAL SUBCUTANEOUS SOLUTION

2

NOVOLIN 70/30 FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN-INJECTOR

2

NOVOLIN 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN-INJECTOR

2

NOVOLIN 70/30 RELION SUBCUTANEOUS SUSPENSION

2

NOVOLIN 70/30 VIAL SUBCUTANEOUS SUSPENSION

2

NOVOLIN N RELION SUBCUTANEOUS SUSPENSION

2

NOVOLIN N VIAL SUBCUTANEOUS SUSPENSION

2

NOVOLIN R RELION INJECTION SOLUTION

2

NOVOLIN R VIAL INJECTION SOLUTION

2

NOVOLOG U-100 FLEXPEN

2

NOVOLOG MIX 70/30 FLEXPEN

2

NOVOLOG MIX 70/30 VIAL SUBCUTANEOUS SUSPENSION

2

NOVOLOG U-100 PENFILL

2


NOVOLOG U-100 VIAL SUBCUTANEOUS SOLUTION

2

SOLIQUA SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 ST

TOUJEO MAX SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

TOUJEO SOLOSTAR SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

TRESIBA FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR

2

TRESIBA SUBCUTANEOUS SOLUTION

2

XULTOPHY SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 ST; NDS

Blood Products/Modifiers/Volume Expanders

Anticoagulants

argatroban in sodium chloride intravenous solution 250-0.9 mg/250ml-%, 50 mg/50ml

1 NDS

argatroban intravenous solution 125 mg/125ml

1 NDS

argatroban intravenous solution 250 mg/2.5ml, 50 mg/50ml

3 NDS

ARIXTRA SUBCUTANEOUS SOLUTION 10 MG/0.8ML


69


ARIXTRA SUBCUTANEOUS SOLUTION 2.5 MG/0.5ML


ARIXTRA SUBCUTANEOUS SOLUTION 5 MG/0.4ML


ARIXTRA SUBCUTANEOUS SOLUTION 7.5 MG/0.6ML


BEVYXXA ORAL CAPSULE


CEPROTIN INTRAVENOUS SOLUTION RECONSTITUTED 500 UNIT

3

COUMADIN ORAL TABLET

3

ELIQUIS ORAL TABLET 2.5 MG


ELIQUIS ORAL TABLET 5 MG


ELIQUIS STARTER PACK ORAL TABLET


enoxaparin sodium injection solution


enoxaparin sodium subcutaneous solution 100 mg/ml, 150 mg/ml


enoxaparin sodium subcutaneous solution 120 mg/0.8ml, 80 mg/0.8ml


enoxaparin sodium subcutaneous solution 30 mg/0.3ml

1 QL (10.5 ML per 90 days)






fondaparinux sodium subcutaneous solution 10 mg/0.8ml


fondaparinux sodium subcutaneous solution 2.5 mg/0.5ml


fondaparinux sodium subcutaneous solution 5 mg/0.4ml


fondaparinux sodium subcutaneous solution 7.5 mg/0.6ml


FRAGMIN SUBCUTANEOUS SOLUTION 10000 UNIT/ML


FRAGMIN SUBCUTANEOUS SOLUTION 12500 UNIT/0.5ML




FRAGMIN SUBCUTANEOUS SOLUTION 18000 UNT/0.72ML


FRAGMIN SUBCUTANEOUS SOLUTION 2500 UNIT/0.2ML, 5000 UNIT/0.2ML






heparin (porcine) in nacl injection solution

1

70


heparin (porcine) in nacl intravenous solution 1000-0.9 ut/500ml-%, 12500-0.45 ut/250ml-%, 2000-0.9 unit/l-%, 25000-0.45 ut/500ml-%

1

heparin sod (porcine) in d5w intravenous solution

1

heparin sodium (porcine) injection solution

1

heparin sodium (porcine) pf injection solution

1

IPRIVASK SUBCUTANEOUS SOLUTION RECONSTITUTED 15 MG

3 NDS

jantoven oral tablet 1

LOVENOX INJECTION SOLUTION


LOVENOX SUBCUTANEOUS SOLUTION 100 MG/ML, 150 MG/ML


LOVENOX SUBCUTANEOUS SOLUTION 120 MG/0.8ML, 80 MG/0.8ML


LOVENOX SUBCUTANEOUS SOLUTION 30 MG/0.3ML






PRADAXA ORAL CAPSULE



SAVAYSA ORAL TABLET


warfarin sodium oral tablet

1

XARELTO ORAL TABLET 10 MG, 20 MG


XARELTO ORAL TABLET 15 MG, 2.5 MG


XARELTO STARTER PACK ORAL TABLET THERAPY PACK


Blood Formation Modifiers

AGRYLIN ORAL CAPSULE

3

anagrelide hcl oral capsule

1

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 100 MCG/ML, 200 MCG/ML, 300 MCG/ML, 60 MCG/ML

3 PA; NDS

ARANESP (ALBUMIN FREE) INJECTION SOLUTION 25 MCG/ML, 40 MCG/ML

3 PA

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 10 MCG/0.4ML, 25 MCG/0.42ML, 40 MCG/0.4ML, 60 MCG/0.3ML

3 PA

ARANESP (ALBUMIN FREE) INJECTION SOLUTION PREFILLED SYRINGE 100 MCG/0.5ML, 150 MCG/0.3ML, 200 MCG/0.4ML, 300 MCG/0.6ML, 500 MCG/ML

3 PA; NDS

DOPTELET ORAL TABLET

3 PA; NDS

71


EPOGEN INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML

3 PA

EPOGEN INJECTION SOLUTION 20000 UNIT/ML

3 PA; NDS

FULPHILA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

GRANIX SUBCUTANEOUS SOLUTION

3 ST; NDS

GRANIX SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 ST; NDS

LEUKINE INJECTION SOLUTION RECONSTITUTED

3 PA; NDS

MIRCERA INJECTION SOLUTION PREFILLED SYRINGE

3 PA

MOZOBIL SUBCUTANEOUS SOLUTION

3 PA; QL (38.4 ML per 365 days); NDS

MULPLETA ORAL TABLET

3 PA; NDS

NEULASTA ONPRO SUBCUTANEOUS PREFILLED SYRINGE KIT

3 PA; NDS

NEULASTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

NEUPOGEN INJECTION SOLUTION

3 ST; NDS

NEUPOGEN INJECTION SOLUTION PREFILLED SYRINGE

3 ST; NDS

NIVESTYM INJECTION SOLUTION

3 ST; NDS


NIVESTYM INJECTION SOLUTION PREFILLED SYRINGE

3 ST; NDS

NPLATE SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

PROCRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML

3 PA

PROCRIT INJECTION SOLUTION 20000 UNIT/ML, 40000 UNIT/ML

3 PA; NDS

PROMACTA ORAL PACKET

3 PA; NDS

PROMACTA ORAL TABLET

3 PA; NDS

UDENYCA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

ZARXIO INJECTION SOLUTION PREFILLED SYRINGE

3 NDS

Blood Products/Modifiers/Volume Expanders

SOLIRIS INTRAVENOUS SOLUTION

3 PA; NDS

ULTOMIRIS INTRAVENOUS SOLUTION

3 PA; NDS

Hemostasis Agents

AMICAR ORAL SOLUTION

3 NDS

AMICAR ORAL TABLET

3 NDS

aminocaproic acid intravenous solution

1

aminocaproic acid oral tablet

1

72


CYKLOKAPRON INTRAVENOUS SOLUTION

3

LYSTEDA ORAL TABLET

3 NDS

RETACRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 3000 UNIT/ML, 4000 UNIT/ML

3 PA

RETACRIT INJECTION SOLUTION 40000 UNIT/ML

3 PA; NDS

TAVALISSE ORAL TABLET

3 PA; NDS

tranexamic acid intravenous solution

1

tranexamic acid oral tablet

1

Platelet Modifying Agents

AGGRENOX ORAL CAPSULE EXTENDED RELEASE 12 HOUR

3

aspirin-dipyridamole er oral capsule extended release 12 hour

1

ASPIRIN-OMEPRAZOLE ORAL TABLET DELAYED RELEASE


BRILINTA ORAL TABLET

2

CABLIVI INJECTION KIT


cilostazol oral tablet 1

clopidogrel bisulfate oral tablet

1

dipyridamole oral tablet 1

DURLAZA ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

EFFIENT ORAL TABLET

3


eptifibatide intravenous solution

1 NDS

INTEGRILIN INTRAVENOUS SOLUTION

3 NDS

KENGREAL INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

PLAVIX ORAL TABLET 3

prasugrel hcl oral tablet 1

REOPRO INTRAVENOUS SOLUTION

3

YOSPRALA ORAL TABLET DELAYED RELEASE


ZONTIVITY ORAL TABLET

3

Cardiovascular Agents

Alpha-adrenergic Agonists

CATAPRES ORAL TABLET

3

CATAPRES-TTS-1 TRANSDERMAL PATCH WEEKLY

3


3


3

clonidine hcl oral tablet 1

clonidine transdermal patch weekly

1

CLORPRES ORAL TABLET 0.1-15 MG, 0.2-15 MG, 0.3-15 MG

3

guanfacine hcl oral tablet

1

methyldopa oral tablet 1

methyldopa-hydrochlorothiazide oral tablet

1

73


methyldopate hcl intravenous solution 250 mg/5ml

1

midodrine hcl oral tablet 1

phenylephrine hcl intravenous solution

1

VAZCULEP INTRAVENOUS SOLUTION

3

Alpha-adrenergic Blocking Agents

DIBENZYLINE ORAL CAPSULE

3 NDS

MINIPRESS ORAL CAPSULE

3

phenoxybenzamine hcl oral capsule

3 NDS

phentolamine mesylate injection solution reconstituted

1

prazosin hcl oral capsule

1

Angiotensin II Receptor Antagonists

ATACAND HCT ORAL TABLET

3

ATACAND ORAL TABLET

3

AVALIDE ORAL TABLET

3

AVAPRO ORAL TABLET

3

BENICAR HCT ORAL TABLET

3

BENICAR ORAL TABLET

3

candesartan cilexetil oral tablet

1

candesartan cilexetil-hctz oral tablet

1

COZAAR ORAL TABLET

3

DIOVAN HCT ORAL TABLET

3


DIOVAN ORAL TABLET

3

EDARBI ORAL TABLET 3

EDARBYCLOR ORAL TABLET

3

eprosartan mesylate oral tablet

1

HYZAAR ORAL TABLET

3

irbesartan oral tablet 1

irbesartan-hydrochlorothiazide oral tablet

1

losartan potassium oral tablet

1

losartan potassium-hctz oral tablet

1

MICARDIS HCT ORAL TABLET

3

MICARDIS ORAL TABLET

3

olmesartan medoxomil oral tablet

1

olmesartan medoxomil-hctz oral tablet

1

telmisartan oral tablet 1

telmisartan-hctz oral tablet

1

valsartan oral tablet 1

valsartan-hydrochlorothiazide oral tablet

1

Angiotensin-converting Enzyme (ACE) Inhibitors

ACCUPRIL ORAL TABLET

3

ACCURETIC ORAL TABLET

3

ALTACE ORAL CAPSULE

3

benazepril hcl oral tablet

1

74


benazepril-hydrochlorothiazide oral tablet

1

captopril oral tablet 1

captopril-hydrochlorothiazide oral tablet

1

enalapril maleate oral tablet

1

enalaprilat intravenous injectable

1

enalapril-hydrochlorothiazide oral tablet

1

EPANED ORAL SOLUTION

3 NDS

fosinopril sodium oral tablet

1

fosinopril sodium-hctz oral tablet

1

lisinopril oral tablet 1

lisinopril-hydrochlorothiazide oral tablet

1

LOTENSIN HCT ORAL TABLET

3

LOTENSIN ORAL TABLET

3

moexipril hcl oral tablet 1

moexipril-hydrochlorothiazide oral tablet 15-12.5 mg, 15-25 mg, 7.5-12.5 mg

1

perindopril erbumine oral tablet

1

PRESTALIA ORAL TABLET

3

PRINIVIL ORAL TABLET

3

QBRELIS ORAL SOLUTION

3

quinapril hcl oral tablet 1

quinapril-hydrochlorothiazide oral tablet

1


ramipril oral capsule 1

TARKA ORAL TABLET EXTENDED RELEASE

3

trandolapril oral tablet 1

trandolapril-verapamil hcl er oral tablet extended release

1

VASERETIC ORAL TABLET

3

VASOTEC ORAL TABLET 10 MG, 20 MG

3 NDS

VASOTEC ORAL TABLET 2.5 MG, 5 MG

3

ZESTORETIC ORAL TABLET

3

ZESTRIL ORAL TABLET

3

Antiarrhythmics

ADENOCARD INTRAVENOUS SOLUTION

3

adenosine intravenous solution 12 mg/4ml, 6 mg/2ml

1

amiodarone hcl intravenous solution

1

amiodarone hcl oral tablet

1

BETAPACE AF ORAL TABLET 120 MG

3 NDS

BETAPACE AF ORAL TABLET 160 MG, 80 MG

3

BETAPACE ORAL TABLET 120 MG

3 NDS

BETAPACE ORAL TABLET 160 MG, 80 MG

3

CORVERT INTRAVENOUS SOLUTION

3

disopyramide phosphate oral capsule

1

dofetilide oral capsule 1

75


flecainide acetate oral tablet

1

ibutilide fumarate intravenous solution

1

lidocaine hcl (cardiac) intravenous solution 20 mg/ml

1

lidocaine hcl (cardiac) intravenous solution prefilled syringe

1

lidocaine hcl (cardiac) pf intravenous solution

1

lidocaine hcl (cardiac) pf intravenous solution prefilled syringe

1

lidocaine in d5w intravenous solution 4-5 mg/ml-%, 8-5 mg/ml-%

1

mexiletine hcl oral capsule

1

MULTAQ ORAL TABLET

2

NEXTERONE INTRAVENOUS SOLUTION 150-4.21 MG/100ML-%

3

NEXTERONE INTRAVENOUS SOLUTION 360-4.14 MG/200ML-%

3 NDS

NORPACE CR ORAL CAPSULE EXTENDED RELEASE 12 HOUR

3

NORPACE ORAL CAPSULE

3

pacerone oral tablet 1

procainamide hcl injection solution

1

propafenone hcl er oral capsule extended release 12 hour

1

propafenone hcl oral tablet

1

quinidine gluconate er oral tablet extended release

1


quinidine gluconate injection solution 80 mg/ml

1

quinidine sulfate oral tablet

1

RYTHMOL SR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 225 MG

3

RYTHMOL SR ORAL CAPSULE EXTENDED RELEASE 12 HOUR 325 MG, 425 MG

3 NDS

sorine oral tablet 1

sotalol hcl (af) oral tablet

1

sotalol hcl intravenous solution

3 NDS

sotalol hcl oral tablet 1

SOTYLIZE ORAL SOLUTION

3

TIKOSYN ORAL CAPSULE

3

XYLOCAINE (CARDIAC) INTRAVENOUS SOLUTION 20 MG/ML

3

Beta-adrenergic Blocking Agents

acebutolol hcl oral capsule

1

atenolol oral tablet 1

atenolol-chlorthalidone oral tablet

1

betaxolol hcl oral tablet 1

bisoprolol fumarate oral tablet

1

bisoprolol-hydrochlorothiazide oral tablet

1

BREVIBLOC IN NACL INTRAVENOUS SOLUTION

3

BREVIBLOC INTRAVENOUS SOLUTION

3

76


BREVIBLOC PREMIXED DS INTRAVENOUS SOLUTION

3

BREVIBLOC PREMIXED INTRAVENOUS SOLUTION

3

BYSTOLIC ORAL TABLET

2

BYVALSON ORAL TABLET 5-80 MG

3 ST

carvedilol oral tablet 1

carvedilol phosphate er oral capsule extended release 24 hour

1

COREG CR ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

COREG ORAL TABLET 3

CORGARD ORAL TABLET

3

CORZIDE ORAL TABLET 40-5 MG, 80-5 MG

3

DUTOPROL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

esmolol hcl intravenous solution 100 mg/10ml

1

ESMOLOL HCL INTRAVENOUS SOLUTION 2000 MG/100ML, 2500 MG/250ML

3

esmolol hcl-sodium chloride intravenous solution

1

HEMANGEOL ORAL SOLUTION

3

INDERAL LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 160 MG

3 NDS


INDERAL LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR 60 MG, 80 MG

3

INDERAL XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

INNOPRAN XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

KAPSPARGO SPRINKLE ORAL CAPSULE ER 24 HOUR SPRINKLE

3

labetalol hcl intravenous solution

1

labetalol hcl oral tablet 1

LOPRESSOR HCT ORAL TABLET

3

LOPRESSOR ORAL TABLET

3

metoprolol succinate er oral tablet extended release 24 hour

1

metoprolol tartrate intravenous solution

1

metoprolol tartrate intravenous solution cartridge

1

metoprolol tartrate oral tablet

1

metoprolol-hctz er oral tablet extended release 24 hour

1

metoprolol-hydrochlorothiazide oral tablet

1

nadolol oral tablet 1

nadolol-bendroflumethiazide oral tablet 40-5 mg, 80-5 mg

1

pindolol oral tablet 1

propranolol hcl er oral capsule extended release 24 hour

1

77


propranolol hcl intravenous solution

1

propranolol hcl oral solution

1

propranolol hcl oral tablet

1

propranolol-hctz oral tablet

1

TENORETIC 100 ORAL TABLET

3

TENORETIC 50 ORAL TABLET

3

TENORMIN ORAL TABLET

3

timolol maleate oral tablet

1

TOPROL XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

ZIAC ORAL TABLET 3

Calcium Channel Blocking Agents

ADALAT CC ORAL TABLET EXTENDED RELEASE 24 HOUR

3

afeditab cr oral tablet extended release 24 hour

1

amlodipine besylate oral tablet

1

amlodipine besylate-benazepril hcl oral capsule

1

amlodipine besylate-valsartan oral tablet

1

amlodipine-atorvastatin oral tablet

1

amlodipine-olmesartan oral tablet

1

amlodipine-valsartan-hctz oral tablet

1

AZOR ORAL TABLET 3

CADUET ORAL TABLET

3

CALAN ORAL TABLET 3


CALAN SR ORAL TABLET EXTENDED RELEASE

3

CARDENE IV INTRAVENOUS SOLUTION

3

CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 240 MG, 300 MG, 360 MG

3 NDS

CARDIZEM CD ORAL CAPSULE EXTENDED RELEASE 24 HOUR 180 MG

3

CARDIZEM LA ORAL TABLET EXTENDED RELEASE 24 HOUR

3

CARDIZEM ORAL TABLET 120 MG, 60 MG

3 NDS

CARDIZEM ORAL TABLET 30 MG

3

cartia xt oral capsule extended release 24 hour

1

diltiazem hcl er beads oral capsule extended release 24 hour

1

diltiazem hcl er coated beads oral capsule extended release 24 hour

1

diltiazem hcl er coated beads oral tablet extended release 24 hour

1

diltiazem hcl er oral capsule extended release 12 hour

1

diltiazem hcl er oral capsule extended release 24 hour

1

diltiazem hcl intravenous solution

1

diltiazem hcl intravenous solution reconstituted

1

78


diltiazem hcl oral tablet 1

dilt-xr oral capsule extended release 24 hour

1

EXFORGE HCT ORAL TABLET

3

EXFORGE ORAL TABLET

3

felodipine er oral tablet extended release 24 hour

1

isradipine oral capsule 3

LOTREL ORAL CAPSULE

3

matzim la oral tablet extended release 24 hour

1

nicardipine hcl intravenous solution

3

nicardipine hcl oral capsule

3

nifedical xl oral tablet extended release 24 hour

1

nifedipine er oral tablet extended release 24 hour

1

nifedipine er osmotic release oral tablet extended release 24 hour

1

nifedipine oral capsule 3

nimodipine oral capsule 3 NDS

nisoldipine er oral tablet extended release 24 hour

1

NORVASC ORAL TABLET

3

NYMALIZE ORAL SOLUTION 60 MG/20ML

3 NDS

olmesartan-amlodipine-hctz oral tablet

1

PROCARDIA ORAL CAPSULE

3


PROCARDIA XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

SULAR ORAL TABLET EXTENDED RELEASE 24 HOUR

3

taztia xt oral capsule extended release 24 hour

1

telmisartan-amlodipine oral tablet

1

TIAZAC ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

TRIBENZOR ORAL TABLET

3

TWYNSTA ORAL TABLET

3

verapamil hcl er oral capsule extended release 24 hour 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg

1

VERAPAMIL HCL ER ORAL CAPSULE EXTENDED RELEASE 24 HOUR 360 MG

1

verapamil hcl er oral tablet extended release

1

verapamil hcl intravenous solution

1

verapamil hcl oral tablet 1

VERELAN ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

VERELAN PM ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

Cardiovascular Agents, Other

ADRENALIN INJECTION SOLUTION

3

aliskiren fumarate oral tablet

1

atropine sulfate injection solution

1

79


atropine sulfate injection solution prefilled syringe

1

CORLANOR ORAL TABLET


DEFITELIO INTRAVENOUS SOLUTION

3 NDS

DEMSER ORAL CAPSULE

3 NDS

digitek oral tablet 1

digox oral tablet 1

digoxin injection solution

1

DIGOXIN ORAL SOLUTION

1

digoxin oral tablet 1

dobutamine hcl intravenous solution 500 mg/40ml

1 B/D

dobutamine in d5w intravenous solution

1 B/D

dopamine hcl intravenous solution

1 B/D

dopamine in d5w intravenous solution

1 B/D

ENTRESTO ORAL TABLET


ibuprofen lysine intravenous solution

1 NDS

LANOXIN INJECTION SOLUTION

3

LANOXIN ORAL TABLET

3

LANOXIN PEDIATRIC INJECTION SOLUTION

3

LEVOPHED INTRAVENOUS SOLUTION

3

mannitol intravenous solution

1

milrinone lactate in dextrose intravenous solution

1 B/D

milrinone lactate intravenous solution

1 B/D


NATRECOR INTRAVENOUS SOLUTION RECONSTITUTED 1.5 MG

3 NDS

NEOPROFEN INTRAVENOUS SOLUTION

3

norepinephrine bitartrate intravenous solution

1

NORTHERA ORAL CAPSULE

3 PA; NDS

osmitrol intravenous solution

1

pentoxifylline er oral tablet extended release

3

PRALUENT SUBCUTANEOUS SOLUTION PEN-INJECTOR


RANEXA ORAL TABLET EXTENDED RELEASE 12 HOUR

2

ranolazine er oral tablet extended release 12 hour

1

REPATHA PUSHTRONEX SYSTEM SUBCUTANEOUS SOLUTION CARTRIDGE


REPATHA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


REPATHA SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR


TAKHZYRO SUBCUTANEOUS SOLUTION

3 PA; NDS

TEKTURNA HCT ORAL TABLET

3

TEKTURNA ORAL TABLET

3

80


vecamyl oral tablet 3 NDS

VYNDAQEL ORAL CAPSULE


Diuretics, Carbonic Anhydrase Inhibitors

acetazolamide sodium injection solution reconstituted

3 NDS

Diuretics, Loop

bumetanide injection solution

1

bumetanide oral tablet 1

BUMEX ORAL TABLET 3

DEMADEX ORAL TABLET 10 MG, 20 MG

3

EDECRIN ORAL TABLET

3 NDS

ethacrynate sodium intravenous solution reconstituted

1 NDS

ethacrynic acid oral tablet

3 NDS

furosemide injection solution

1

furosemide oral solution 1

furosemide oral tablet 1

LASIX ORAL TABLET 3

SODIUM EDECRIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

torsemide oral tablet 1

Diuretics, Potassium-sparing

ALDACTAZIDE ORAL TABLET

3

ALDACTONE ORAL TABLET

3

amiloride hcl oral tablet 1

amiloride-hydrochlorothiazide oral tablet

1


CAROSPIR ORAL SUSPENSION

3

DYAZIDE ORAL CAPSULE

3

DYRENIUM ORAL CAPSULE

3

eplerenone oral tablet 1

INSPRA ORAL TABLET 3

MAXZIDE ORAL TABLET

3

MAXZIDE-25 ORAL TABLET

3

spironolactone oral tablet

1

spironolactone-hctz oral tablet

1

triamterene oral capsule 1

triamterene-hctz oral capsule

1

triamterene-hctz oral tablet

1

Diuretics, Thiazide

chlorothiazide oral tablet

1

chlorothiazide sodium intravenous solution reconstituted

1

chlorthalidone oral tablet

1

DIURIL ORAL SUSPENSION

3

hydrochlorothiazide oral capsule

1

hydrochlorothiazide oral tablet

1

indapamide oral tablet 1

methyclothiazide oral tablet 5 mg

1

metolazone oral tablet 1

MICROZIDE ORAL CAPSULE 12.5 MG

3

81


SODIUM DIURIL INTRAVENOUS SOLUTION RECONSTITUTED

3

Dyslipidemics, Fibric Acid Derivatives

ANTARA ORAL CAPSULE

3

fenofibrate micronized oral capsule

1

fenofibrate oral capsule 150 mg, 50 mg

1

fenofibrate oral tablet 1

fenofibric acid oral capsule delayed release

1

FENOFIBRIC ACID ORAL TABLET 105 MG

1

fenofibric acid oral tablet 35 mg

1

FENOGLIDE ORAL TABLET

3

FIBRICOR ORAL TABLET

3

gemfibrozil oral tablet 1

LIPOFEN ORAL CAPSULE

3

LOPID ORAL TABLET 3

TRICOR ORAL TABLET

3

TRIGLIDE ORAL TABLET

3

TRILIPIX ORAL CAPSULE DELAYED RELEASE

3

Dyslipidemics, HMG CoA Reductase Inhibitors

ALTOPREV ORAL TABLET EXTENDED RELEASE 24 HOUR

3 ST

atorvastatin calcium oral tablet

1

CRESTOR ORAL TABLET

3


EZALLOR SPRINKLE ORAL CAPSULE SPRINKLE

3 ST

FLOLIPID ORAL SUSPENSION

3 ST

fluvastatin sodium er oral tablet extended release 24 hour

1

fluvastatin sodium oral capsule

1

LESCOL XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

LIPITOR ORAL TABLET

3

LIVALO ORAL TABLET 2 ST

lovastatin oral tablet 1

PRAVACHOL ORAL TABLET

3

pravastatin sodium oral tablet

1

rosuvastatin calcium oral tablet

1

simvastatin oral tablet 1

ZOCOR ORAL TABLET 3

ZYPITAMAG ORAL TABLET

3 ST

Dyslipidemics, Other

cholestyramine light oral packet

1

cholestyramine light oral powder

1

cholestyramine oral packet

1

cholestyramine oral powder

1

colesevelam hcl oral packet

1

colesevelam hcl oral tablet

1

COLESTID FLAVORED ORAL GRANULES

3

COLESTID FLAVORED ORAL PACKET

3

82


COLESTID ORAL GRANULES

3

COLESTID ORAL PACKET

3

COLESTID ORAL TABLET

3

colestipol hcl oral granules

1

colestipol hcl oral packet

1

colestipol hcl oral tablet 1

ezetimibe oral tablet 1

ezetimibe-simvastatin oral tablet

1

JUXTAPID ORAL CAPSULE


KYNAMRO SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


LOVAZA ORAL CAPSULE

3

niacin (antihyperlipidemic) oral tablet

1

niacin er (antihyperlipidemic) oral tablet extended release

1

niacor oral tablet 1

NIASPAN ORAL TABLET EXTENDED RELEASE

3

omega-3-acid ethyl esters oral capsule

1

prevalite oral packet 1

prevalite oral powder 1

questran light oral powder

3

questran oral packet 3

QUESTRAN ORAL POWDER

3

triklo oral capsule 1 gm 1


VASCEPA ORAL CAPSULE

2

VYTORIN ORAL TABLET

3

WELCHOL ORAL PACKET

3

WELCHOL ORAL TABLET

3

ZETIA ORAL TABLET 3

Vasodilators, Direct-acting Arterial

CORLOPAM INTRAVENOUS SOLUTION

3

hydralazine hcl injection solution

1

hydralazine hcl oral tablet

1

minoxidil oral tablet 3

Vasodilators, Direct-acting Arterial/Venous

BIDIL ORAL TABLET 2

DILATRATE-SR ORAL CAPSULE EXTENDED RELEASE

3

GONITRO SUBLINGUAL PACKET

3

ISORDIL TITRADOSE ORAL TABLET 40 MG

3 NDS

ISORDIL TITRADOSE ORAL TABLET 5 MG

3

isosorbide dinitrate er oral tablet extended release

1

isosorbide dinitrate oral tablet

1

isosorbide mononitrate er oral tablet extended release 24 hour

1

isosorbide mononitrate oral tablet

1

minitran transdermal patch 24 hour

1

nitro-bid transdermal ointment

3

83


NITRO-DUR TRANSDERMAL PATCH 24 HOUR

3

nitroglycerin in d5w intravenous solution

1

nitroglycerin intravenous solution

1

nitroglycerin sublingual tablet sublingual

1

nitroglycerin transdermal patch 24 hour

1

nitroglycerin translingual solution

1

NITROLINGUAL TRANSLINGUAL SOLUTION

3

NITROMIST TRANSLINGUAL AEROSOL SOLUTION

3

NITROPRESS INTRAVENOUS SOLUTION

3

nitroprusside sodium intravenous solution

1

NITROSTAT SUBLINGUAL TABLET SUBLINGUAL

3

Central Nervous System Agents

Attention Deficit Hyperactivity Disorder Agents, Amphetamines

ADDERALL ORAL TABLET 10 MG, 12.5 MG, 15 MG, 30 MG


adderall oral tablet 20 mg, 5 mg, 7.5 mg


ADDERALL XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR


ADZENYS ER ORAL SUSPENSION EXTENDED RELEASE



ADZENYS XR-ODT ORAL TABLET EXTENDED RELEASE DISPERSIBLE


amphetamine sulfate oral tablet


amphetamine-dextroamphetamine er oral capsule extended release 24 hour


amphetamine-dextroamphetamine oral tablet


DESOXYN ORAL TABLET


DEXEDRINE ORAL CAPSULE EXTENDED RELEASE 24 HOUR 10 MG






dextroamphetamine sulfate er oral capsule extended release 24 hour 10 mg






dextroamphetamine sulfate oral solution


dextroamphetamine sulfate oral tablet 10 mg


84


dextroamphetamine sulfate oral tablet 5 mg


DYANAVEL XR ORAL SUSPENSION EXTENDED RELEASE


EVEKEO ODT ORAL TABLET DISPERSIBLE 10 MG, 5 MG


EVEKEO ODT ORAL TABLET DISPERSIBLE 15 MG


EVEKEO ODT ORAL TABLET DISPERSIBLE 20 MG


evekeo oral tablet 3 PA; QL (180 EA per 30 days)

methamphetamine hcl oral tablet


MYDAYIS ORAL CAPSULE EXTENDED RELEASE 24 HOUR


procentra oral solution 3 PA; QL (1800 ML per 30 days)

VYVANSE ORAL CAPSULE


VYVANSE ORAL TABLET CHEWABLE


zenzedi oral tablet 10 mg


zenzedi oral tablet 15 mg, 2.5 mg, 20 mg, 7.5 mg


zenzedi oral tablet 30 mg


zenzedi oral tablet 5 mg 1 PA; QL (90 EA per 30 days)

Attention Deficit Hyperactivity Disorder Agents, Non-amphetamines


ADHANSIA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 25 MG


ADHANSIA XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR 35 MG, 45 MG, 55 MG, 70 MG, 85 MG


APTENSIO XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR


atomoxetine hcl oral capsule 10 mg


atomoxetine hcl oral capsule 100 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg


clonidine hcl er oral tablet extended release 12 hour

1

CONCERTA ORAL TABLET EXTENDED RELEASE 18 MG, 27 MG, 54 MG


CONCERTA ORAL TABLET EXTENDED RELEASE 36 MG


COTEMPLA XR-ODT ORAL TABLET EXTENDED RELEASE DISPERSIBLE 17.3 MG






DAYTRANA TRANSDERMAL PATCH


dexmethylphenidate hcl er oral capsule extended release 24 hour


85


dexmethylphenidate hcl oral tablet


FOCALIN ORAL TABLET


FOCALIN XR ORAL CAPSULE EXTENDED RELEASE 24 HOUR


guanfacine hcl er oral tablet extended release 24 hour

1

INTUNIV ORAL TABLET EXTENDED RELEASE 24 HOUR

3

JORNAY PM ORAL CAPSULE EXTENDED RELEASE 24 HOUR


KAPVAY ORAL TABLET EXTENDED RELEASE 12 HOUR

3

metadate er oral tablet extended release


METHYLIN ORAL SOLUTION

3 PA

methylphenidate hcl er (cd) oral capsule extended release


methylphenidate hcl er (la) oral capsule extended release 24 hour


methylphenidate hcl er oral tablet extended release 10 mg


methylphenidate hcl er oral tablet extended release 18 mg, 27 mg, 54 mg, 72 mg




methylphenidate hcl er oral tablet extended release 24 hour 18 mg, 27 mg, 54 mg


methylphenidate hcl er oral tablet extended release 24 hour 36 mg





methylphenidate hcl oral solution

1 PA

methylphenidate hcl oral tablet


methylphenidate hcl oral tablet chewable 10 mg


methylphenidate hcl oral tablet chewable 2.5 mg, 5 mg


QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 20 MG, 40 MG


QUILLICHEW ER ORAL TABLET CHEWABLE EXTENDED RELEASE 30 MG


QUILLIVANT XR ORAL SUSPENSION RECONSTITUTED


relexxii oral tablet extended release


RITALIN LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR


RITALIN ORAL TABLET


STRATTERA ORAL CAPSULE 10 MG


STRATTERA ORAL CAPSULE 100 MG, 18 MG, 25 MG, 40 MG, 60 MG, 80 MG


Central Nervous System, Other

AUSTEDO ORAL TABLET


butalbital-apap-caffeine oral tablet

1 PA

86


CAFCIT INTRAVENOUS SOLUTION

3

caffeine citrate intravenous solution

1

caffeine citrate oral solution 60 mg/3ml

1

clonidine hcl (analgesia) epidural solution

1 B/D

DURACLON EPIDURAL SOLUTION

3 B/D

esgic oral tablet 3 PA

flumazenil intravenous solution

1

GRALISE ORAL TABLET 300 MG


GRALISE ORAL TABLET 600 MG


GRALISE STARTER ORAL


HORIZANT ORAL TABLET EXTENDED RELEASE


INGREZZA ORAL CAPSULE 40 MG


INGREZZA ORAL CAPSULE 80 MG


INGREZZA ORAL CAPSULE THERAPY PACK


NUEDEXTA ORAL CAPSULE

3 PA

PRIALT INTRATHECAL SOLUTION

3 B/D; NDS

RADICAVA INTRAVENOUS SOLUTION

3 PA; NDS

RILUTEK ORAL TABLET

3 PA; NDS

riluzole oral tablet 1 PA

tetrabenazine oral tablet 3 PA; NDS


TIGLUTIK ORAL SUSPENSION

3 PA; NDS

XENAZINE ORAL TABLET

3 PA; NDS

Fibromyalgia Agents

LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HOUR 165 MG, 82.5 MG


LYRICA CR ORAL TABLET EXTENDED RELEASE 24 HOUR 330 MG


SAVELLA ORAL TABLET


SAVELLA TITRATION PACK ORAL


Multiple Sclerosis Agents

AMPYRA ORAL TABLET EXTENDED RELEASE 12 HOUR


AUBAGIO ORAL TABLET


AVONEX PEN INTRAMUSCULAR AUTO-INJECTOR KIT


AVONEX PREFILLED INTRAMUSCULAR PREFILLED SYRINGE KIT


AVONEX VIAL INTRAMUSCULAR KIT INTRAMUSCULAR KIT 30 MCG


BETASERON SUBCUTANEOUS KIT


COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML


87


COPAXONE SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 40 MG/ML


dalfampridine er oral tablet extended release 12 hour


EXTAVIA SUBCUTANEOUS KIT


GILENYA ORAL CAPSULE


glatiramer acetate subcutaneous solution prefilled syringe 20 mg/ml


glatiramer acetate subcutaneous solution prefilled syringe 40 mg/ml


glatopa subcutaneous solution prefilled syringe 20 mg/ml


glatopa subcutaneous solution prefilled syringe 40 mg/ml


MAVENCLAD (10 TABS) ORAL TABLET THERAPY PACK

3 PA; NDS


3 PA; NDS


3 PA; NDS


3 PA; NDS


3 PA; NDS


3 PA; NDS



3 PA; NDS

MAYZENT ORAL TABLET 0.25 MG


MAYZENT ORAL TABLET 2 MG


MAYZENT STARTER PACK ORAL TABLET THERAPY PACK


OCREVUS INTRAVENOUS SOLUTION


PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PEN-INJECTOR


PLEGRIDY STARTER PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


PLEGRIDY SUBCUTANEOUS SOLUTION PEN-INJECTOR


PLEGRIDY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


REBIF REBIDOSE SUBCUTANEOUS SOLUTION AUTO-INJECTOR


REBIF REBIDOSE TITRATION PACK SUBCUTANEOUS SOLUTION AUTO-INJECTOR


REBIF SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


88


REBIF TITRATION PACK SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


TECFIDERA STARTER PACK


TECFIDERA ORAL CAPSULE DELAYED RELEASE


TYSABRI INTRAVENOUS CONCENTRATE

3 PA; NDS

ZINBRYTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 150 MG/ML


Dental and Oral Agents

Dental and Oral Agents

ARESTIN DENTAL 3 NDS

cevimeline hcl oral capsule

1

chlorhexidine gluconate mouth/throat solution

1

CITANEST PLAIN DENTAL INJECTION SOLUTION

3

EVOXAC ORAL CAPSULE

3

fluoridex daily renewal mouth/throat concentrate

1

KEPIVANCE INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

lidocaine hcl mouth/throat solution

1

lidocaine viscous hcl mouth/throat solution

1

oralone mouth/throat paste

1


paroex mouth/throat solution

1

PERIDEX MOUTH/THROAT SOLUTION

3

periogard mouth/throat solution

1

pilocarpine hcl oral tablet

1

SALAGEN ORAL TABLET

3

triamcinolone acetonide mouth/throat paste

1

Dermatological Agents

Dermatological Agents

ABSORICA ORAL CAPSULE

3 PA; NDS

ACANYA EXTERNAL GEL

3

acitretin oral capsule 10 mg, 25 mg

1

acitretin oral capsule 17.5 mg

3 NDS

ACZONE EXTERNAL GEL

3

adapalene external cream

1

adapalene external gel 1

adapalene external lotion

1

adapalene external pad 1

adapalene external solution

1 NDS

adapalene-benzoyl peroxide external gel

1

AKTIPAK EXTERNAL PACKET

3

ALDARA EXTERNAL CREAM

3 NDS

ALTRENO EXTERNAL LOTION

3 PA

ammonium lactate external cream

1

89


ammonium lactate external lotion

1

amnesteem oral capsule

1 PA

ATRALIN EXTERNAL GEL

3 PA

AVITA EXTERNAL CREAM

1 PA

AVITA EXTERNAL GEL 1 PA

azelaic acid external gel 1

AZELEX EXTERNAL CREAM

3

BENZACLIN EXTERNAL GEL

3

BENZACLIN WITH PUMP EXTERNAL GEL

3

BENZAMYCIN EXTERNAL GEL

3

BENZOYL PEROXIDE EXTERNAL GEL 6.5 %

1 NDS

BENZOYL PEROXIDE FORTE- HC EXTERNAL LOTION

1 NDS

benzoyl peroxide-erythromycin external gel

1

bp wash external liquid 7 %

1

calcipotriene external cream


calcipotriene external ointment


calcipotriene external solution


calcipotriene-betameth diprop external ointment

3 QL (400 GM per 30 days); NDS

calcitrene external ointment


CALCITRIOL EXTERNAL OINTMENT

1

claravis oral capsule 1 PA

clindacin etz external kit 1

clindacin pac external kit

1


clindamycin phos-benzoyl perox external gel

1

clindamycin-tretinoin external gel

1

CONDYLOX EXTERNAL GEL

3

COSENTYX (300 MG DOSE) SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

COSENTYX SENSOREADY (300 MG) SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

dapsone external gel 1

diclofenac sodium transdermal solution

1 PA

DIFFERIN EXTERNAL CREAM

3

DIFFERIN EXTERNAL GEL

3

DIFFERIN EXTERNAL LOTION

3

DOVONEX EXTERNAL CREAM


doxepin hcl external cream


doxycycline oral capsule delayed release

1

DUAC EXTERNAL GEL 3

DUOBRII EXTERNAL LOTION

3 PA; NDS

DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 300 MG/2ML


ELIDEL EXTERNAL CREAM

3

ENSTILAR EXTERNAL FOAM


90


EPIDUO EXTERNAL GEL

3

EPIDUO FORTE EXTERNAL GEL

3

EUCRISA EXTERNAL OINTMENT

3 PA

FABIOR EXTERNAL FOAM

3

FINACEA EXTERNAL FOAM

2

FINACEA EXTERNAL GEL

2

hydrocortisone ace-pramoxine rectal cream 1-1 %

1

ILUMYA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

imiquimod external cream

1

imiquimod pump external cream

1 NDS

isotretinoin oral capsule 1 PA

klofensaid ii transdermal solution 1.5 %

1 PA

LAC-HYDRIN EXTERNAL CREAM

3

LAC-HYDRIN EXTERNAL LOTION 12 %

3

lactic acid external lotion

1

LEVULAN KERASTICK EXTERNAL SOLUTION RECONSTITUTED

3

methoxsalen rapid oral capsule

3 NDS

METROCREAM EXTERNAL CREAM

3

METROGEL EXTERNAL GEL

3

METROLOTION EXTERNAL LOTION

3 NDS

metronidazole external cream

1


metronidazole external gel

1

metronidazole external lotion

1

MIRVASO EXTERNAL GEL

3 PA

myorisan oral capsule 1 PA

neuac external gel 1

NORITATE EXTERNAL CREAM

3 NDS

ONEXTON EXTERNAL GEL

3

ORACEA ORAL CAPSULE DELAYED RELEASE

3

OXSORALEN ULTRA ORAL CAPSULE

3 NDS

PENNSAID TRANSDERMAL SOLUTION

3 PA; NDS

PICATO EXTERNAL GEL

3 NDS

pimecrolimus external cream

1

podofilox external solution

1

PROCTOFOAM HC RECTAL FOAM

3

PROTOPIC EXTERNAL OINTMENT

3

PRUDOXIN EXTERNAL CREAM


RECTIV RECTAL OINTMENT

3

REGRANEX EXTERNAL GEL

3 PA; NDS

RETIN-A EXTERNAL CREAM

3 PA

RETIN-A EXTERNAL GEL

3 PA

RETIN-A MICRO EXTERNAL GEL

3 PA

RETIN-A MICRO PUMP EXTERNAL GEL 0.04 %

3 PA

91


RETIN-A MICRO PUMP EXTERNAL GEL 0.06 %, 0.08 %

3 PA; NDS

RHOFADE EXTERNAL CREAM

3 PA

RIAX EXTERNAL FOAM

3

rosadan external cream 1

rosadan external gel 1

SANTYL EXTERNAL OINTMENT

3

selenium sulfide external lotion

1

SILIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

SOOLANTRA EXTERNAL CREAM

3

SORIATANE ORAL CAPSULE

3 NDS

SORILUX EXTERNAL FOAM

3 NDS

STELARA INTRAVENOUS SOLUTION

3 PA; NDS

STELARA SUBCUTANEOUS SOLUTION

3 PA; NDS

STELARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

SYNALAR (CREAM) EXTERNAL KIT

3

SYNALAR TS EXTERNAL KIT

3

TACLONEX EXTERNAL OINTMENT


TACLONEX EXTERNAL SUSPENSION


tacrolimus external ointment

1


TALTZ SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

TALTZ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

tazarotene external cream

1

TAZORAC EXTERNAL CREAM

3

TAZORAC EXTERNAL GEL

3

TREMFYA SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 PA; NDS

TREMFYA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

tretinoin external cream 1 PA

tretinoin external gel 1 PA

tretinoin microsphere external gel

1 PA

tretinoin microsphere pump external gel

1 PA

TRETIN-X EXTERNAL CREAM 0.075 %

3 PA

UVADEX INJECTION SOLUTION 20 MCG/ML

3

VECTICAL EXTERNAL OINTMENT

3 NDS

VELTIN EXTERNAL GEL

3

VEREGEN EXTERNAL OINTMENT

3 NDS

XERAC AC EXTERNAL SOLUTION

3

zenatane oral capsule 1 PA

ZIANA EXTERNAL GEL 3 NDS

ZONALON EXTERNAL CREAM


ZYCLARA EXTERNAL CREAM

3 NDS

92


ZYCLARA PUMP EXTERNAL CREAM

3 NDS

Electrolytes/Minerals/Metals/Vitamins

Electrolyte/Mineral Replacement

aminosyn ii/electrolytes intravenous solution 8.5 %

1 B/D

AMINOSYN M INTRAVENOUS SOLUTION 3.5 %

3 B/D

AMINOSYN/ELECTROLYTES INTRAVENOUS SOLUTION 7 %

3 B/D

aminosyn/electrolytes intravenous solution 8.5 %

1 B/D

calcium gluconate intravenous solution

1

calcium gluconate-nacl intravenous solution 1-0.675 gm/50ml-%

1

CARBAGLU ORAL TABLET

3 NDS

CLINIMIX E/DEXTROSE (2.75/10) INTRAVENOUS SOLUTION

3 B/D


3 B/D


3 B/D


3 B/D


3 B/D


CLINIMIX E/DEXTROSE (5/15) INTRAVENOUS SOLUTION

3 B/D

CLINIMIX E/DEXTROSE (5/20) INTRAVENOUS SOLUTION

3 B/D

CLINIMIX E/DEXTROSE (5/25) INTRAVENOUS SOLUTION 5 %

3 B/D

CLINIMIX N14G30E INTRAVENOUS SOLUTION

3 B/D


3 B/D


3 B/D

CLINIMIX/DEXTROSE (2.75/5) INTRAVENOUS SOLUTION 2.75 %

3 B/D

CLINIMIX/DEXTROSE (4.25/10) INTRAVENOUS SOLUTION

3 B/D

CLINIMIX/DEXTROSE (4.25/20) INTRAVENOUS SOLUTION 4.25 %

3 B/D


3 B/D


3 B/D

CLINIMIX/DEXTROSE (5/15) INTRAVENOUS SOLUTION

3 B/D


3 B/D

93



3 B/D

CRYSVITA SUBCUTANEOUS SOLUTION

3 PA; NDS

dextrose 5%/electrolyte #48 intravenous solution

1

dextrose in lactated ringers intravenous solution

1

DEXTROSE INTRAVENOUS SOLUTION 10 %

1

dextrose intravenous solution 20 %, 250 mg/ml, 30 %, 40 %, 5 %, 50 %, 70 %

1

DEXTROSE-NACL INTRAVENOUS SOLUTION 10-0.2 %, 10-0.45 %, 2.5-0.45 %, 5-0.2 %, 5-0.225 %, 5-0.33 %, 5-0.45 %, 5-0.9 %

1

dextrose-nacl intravenous solution 10-0.225 %, 5-0.3 %

1

EFFER-K ORAL TABLET EFFERVESCENT 20 MEQ

3

FLUORABON ORAL SOLUTION

3

fluoritab oral solution 1

fluoritab oral tablet chewable 1.1 (0.5 f) mg, 2.2 (1 f) mg

1

FLURA-DROPS ORAL SOLUTION

3

glucose intravenous solution

1

IONOSOL-B IN D5W INTRAVENOUS SOLUTION

3


IONOSOL-MB IN D5W INTRAVENOUS SOLUTION

3

ISOLYTE-P IN D5W INTRAVENOUS SOLUTION

3

ISOLYTE-S INTRAVENOUS SOLUTION

3

ISOLYTE-S PH 7.4 INTRAVENOUS SOLUTION

3

KABIVEN INTRAVENOUS EMULSION

3 B/D

kcl in d5w lactated ringers intravenous solution

1

KCL IN DEXTROSE-NACL INTRAVENOUS SOLUTION 10-5-0.45 MEQ/L-%-%, 20-5-0.2 MEQ/L-%-%, 20-5-0.33 MEQ/L-%-%, 20-5-0.45 MEQ/L-%-%, 20-5-0.9 MEQ/L-%-%, 30-5-0.45 MEQ/L-%-%, 40-5-0.45 MEQ/L-%-%, 40-5-0.9 MEQ/L-%-%

1

kcl in dextrose-nacl intravenous solution 20-5-0.225 meq/l-%-%

1

KCL-LACTATED RINGERS-D5W INTRAVENOUS SOLUTION

1

KLOR-CON 10 ORAL TABLET EXTENDED RELEASE

1

klor-con m10 oral tablet extended release

1


1


1

klor-con oral packet 1

94


KLOR-CON ORAL TABLET EXTENDED RELEASE

1

klor-con sprinkle oral capsule extended release

1

klor-con/ef oral tablet effervescent

1

K-TAB ORAL TABLET EXTENDED RELEASE

3

lactated ringers intravenous solution

1

LMD IN NACL INTRAVENOUS SOLUTION

3

ludent oral tablet chewable

1

magnesium sulfate in d5w intravenous solution 1-5 gm/100ml-%

1

MAGNESIUM SULFATE INJECTION SOLUTION 50 %

1

magnesium sulfate injection solution 50 % (10ml syringe)

1

magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, 40 gm/1000ml

1

nafrinse drops oral solution

1

NORMOSOL-M IN D5W INTRAVENOUS SOLUTION

3

NORMOSOL-R IN D5W INTRAVENOUS SOLUTION

3

NORMOSOL-R INTRAVENOUS SOLUTION

3

NORMOSOL-R PH 7.4 INTRAVENOUS SOLUTION

3


PERIKABIVEN INTRAVENOUS EMULSION

3 B/D; NDS

PLASMA-LYTE 148 INTRAVENOUS SOLUTION

3

PLASMA-LYTE A INTRAVENOUS SOLUTION

3

PLASMA-LYTE-56 IN D5W INTRAVENOUS SOLUTION

3

potassium acetate intravenous solution

1

potassium chloride crys er oral tablet extended release

1

potassium chloride er oral capsule extended release

1

potassium chloride er oral tablet extended release

1

POTASSIUM CHLORIDE IN DEXTROSE INTRAVENOUS SOLUTION

1

potassium chloride in nacl intravenous solution 20-0.45 meq/l-%

1

POTASSIUM CHLORIDE IN NACL INTRAVENOUS SOLUTION 20-0.9 MEQ/L-%, 40-0.9 MEQ/L-%

1

POTASSIUM CHLORIDE INTRAVENOUS SOLUTION 10 MEQ/100ML, 20 MEQ/100ML, 40 MEQ/100ML

1

95


potassium chloride intravenous solution 10 meq/50ml, 2 meq/ml, 2 meq/ml (20 ml), 20 meq/50ml

1

potassium chloride oral packet

1

potassium chloride oral solution

1

potassium chloride proamp intravenous solution 2 meq/ml

1

potassium citrate er oral tablet extended release

1

PROCALAMINE INTRAVENOUS SOLUTION

3 B/D

ringers intravenous solution

1

sodium acetate intravenous solution

1

sodium bicarbonate injection solution 8.4 %

1

sodium bicarbonate intravenous solution

1

sodium bicarbonate-dextrose intravenous solution

1

sodium chloride injection solution

1

SODIUM CHLORIDE INTRAVENOUS SOLUTION 0.45 %, 3 %, 5 %

1

sodium chloride intravenous solution 0.9 %, 4 meq/ml

1

sodium fluoride oral solution

1

sodium fluoride oral tablet

1

sodium fluoride oral tablet chewable

1

SODIUM LACTATE INTRAVENOUS SOLUTION

1


sodium phosphates intravenous solution

1

TPN ELECTROLYTES INTRAVENOUS SOLUTION

1

UROCIT-K 10 ORAL TABLET EXTENDED RELEASE

3


3


3

Electrolyte/Mineral/Metal Modifiers

CHEMET ORAL CAPSULE

3 NDS

CUPRIMINE ORAL CAPSULE

3 PA; NDS

deferasirox oral tablet soluble

1 PA; NDS

DEPEN TITRATABS ORAL TABLET

3 NDS

D-PENAMINE ORAL TABLET

3 NDS

EXJADE ORAL TABLET SOLUBLE

3 PA; NDS

FERRIPROX ORAL SOLUTION

3 PA; NDS

FERRIPROX ORAL TABLET 500 MG

3 PA; NDS

JADENU ORAL TABLET

3 PA; NDS

JADENU SPRINKLE ORAL PACKET

3 PA; NDS

JYNARQUE ORAL TABLET 15 MG


JYNARQUE ORAL TABLET 30 MG


JYNARQUE ORAL TABLET THERAPY PACK


kionex oral powder 1

kionex oral suspension 1

96


LOKELMA ORAL PACKET


penicillamine oral capsule

1 PA

SAMSCA ORAL TABLET 15 MG


SAMSCA ORAL TABLET 30 MG


sodium polystyrene sulfonate oral powder

1

sodium polystyrene sulfonate oral suspension

1

sodium polystyrene sulfonate rectal suspension 30 gm/120ml

1

sps oral suspension 1

SYPRINE ORAL CAPSULE

3 PA; NDS

trientine hcl oral capsule 3 PA; NDS

VELTASSA ORAL PACKET

3 NDS

Phosphate Binders

AURYXIA ORAL TABLET

3 PA; NDS

calcium acetate (phos binder) oral capsule

1

calcium acetate (phos binder) oral tablet

1

FOSRENOL ORAL PACKET

3 NDS

FOSRENOL ORAL TABLET CHEWABLE

3 NDS

lanthanum carbonate oral tablet chewable

3 NDS

PHOSLYRA ORAL SOLUTION

2

RENAGEL ORAL TABLET

2

RENVELA ORAL PACKET

3 NDS

RENVELA ORAL TABLET

3 NDS


sevelamer carbonate oral packet

3 NDS

sevelamer carbonate oral tablet

1

sevelamer hcl oral tablet

1

VELPHORO ORAL TABLET CHEWABLE

3 NDS

Vitamins

adc/f (0.5mg/ml) oral solution

1

floriva plus oral solution 1

multi-vit/iron/fluoride oral solution

1

multivitamin/fluoride oral solution

1

multivitamin/fluoride oral tablet chewable 0.25 mg, 0.5 mg, 1 mg

1

multivitamin/fluoride/iron oral solution

1

multivitamins/fluoride oral tablet chewable

1

mvc-fluoride oral tablet chewable

1

POLY-VI-FLOR ORAL SUSPENSION

3

POLY-VI-FLOR ORAL TABLET CHEWABLE

3

POLY-VI-FLOR/IRON ORAL SUSPENSION

3

POLY-VI-FLOR/IRON ORAL TABLET CHEWABLE

3

prenatal oral tablet 27-1 mg

3

quflora pediatric oral tablet chewable 0.5 mg, 1 mg

1

RAYALDEE ORAL CAPSULE EXTENDED RELEASE

3 NDS

TL-FLUORIVITE ORAL TABLET CHEWABLE

3

97


TRI-VI-FLOR ORAL SUSPENSION

3

tri-vitamin/fluoride oral solution

1

vitamins acd-fluoride oral solution

1

Gastrointestinal Agents

Antispasmodics, Gastrointestinal

BENTYL INTRAMUSCULAR SOLUTION

3

BENTYL ORAL CAPSULE 10 MG

3

CUVPOSA ORAL SOLUTION

3

dicyclomine hcl intramuscular solution

1

dicyclomine hcl oral capsule

1

dicyclomine hcl oral solution

1

dicyclomine hcl oral tablet

1

glycate oral tablet 1

glycopyrrolate injection solution

1

glycopyrrolate oral tablet

1

glycopyrrolate pf injection solution prefilled syringe

1

methscopolamine bromide oral tablet

3

propantheline bromide oral tablet

3

ROBINUL INJECTION SOLUTION 0.2 MG/ML, 0.4 MG/2ML, 1 MG/5ML, 4 MG/20ML

3

ROBINUL ORAL TABLET 1 MG

3

ROBINUL-FORTE ORAL TABLET 2 MG

3


Gastrointestinal Agents, Other

ACTIGALL ORAL CAPSULE

3 NDS

AKYNZEO INTRAVENOUS SOLUTION RECONSTITUTED

3

amoxicill-clarithro-lansopraz oral

1

CALCIUM DISODIUM VERSENATE INJECTION SOLUTION

3 NDS

chenodal oral tablet 3 NDS

CHOLBAM ORAL CAPSULE

3 PA; NDS

cromolyn sodium oral concentrate

1

diphenoxylate-atropine oral liquid

3

diphenoxylate-atropine oral tablet

3

GASTROCROM ORAL CONCENTRATE

3 NDS

GATTEX SUBCUTANEOUS KIT

3 PA; NDS

LOMOTIL ORAL TABLET

3

loperamide hcl oral capsule

1

metoclopramide hcl injection solution

1

metoclopramide hcl oral solution 5 mg/5ml

1

metoclopramide hcl oral tablet

1

metoclopramide hcl oral tablet dispersible

1

MOTEGRITY ORAL TABLET


MOTOFEN ORAL TABLET

3

MOVANTIK ORAL TABLET


98


MYTESI ORAL TABLET DELAYED RELEASE


OCALIVA ORAL TABLET


OMECLAMOX-PAK ORAL

3

opium oral tincture 1

paregoric oral tincture 1

PREVPAC ORAL 3 NDS

PYLERA ORAL CAPSULE

3 NDS

REGLAN ORAL TABLET

3

RELISTOR ORAL TABLET


RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6ML, 12 MG/0.6ML (0.6ML SYRINGE)

3 ST; QL (18 ML per 30 days); NDS

RELISTOR SUBCUTANEOUS SOLUTION 8 MG/0.4ML

3 ST; QL (12 ML per 30 days); NDS

SYMPROIC ORAL TABLET


TRULANCE ORAL TABLET


URSO 250 ORAL TABLET

3

URSO FORTE ORAL TABLET

3

ursodiol oral capsule 1

ursodiol oral tablet 1

XERMELO ORAL TABLET


Histamine2 (H2) Receptor Antagonists

cimetidine hcl oral solution

1

cimetidine oral tablet 1


famotidine intravenous solution

1

famotidine oral suspension reconstituted

1

famotidine oral tablet 20 mg, 40 mg

1

famotidine premixed intravenous solution

1

nizatidine oral capsule 1

nizatidine oral solution 1

PEPCID ORAL SUSPENSION RECONSTITUTED 40 MG/5ML

3

pepcid oral tablet 20 mg 3

pepcid oral tablet 40 mg 3 NDS

ranitidine hcl injection solution 150 mg/6ml, 50 mg/2ml

1

ranitidine hcl oral capsule

1

ranitidine hcl oral syrup 75 mg/5ml

1

ranitidine hcl oral tablet 150 mg, 300 mg

1

ZANTAC INJECTION SOLUTION

3

ZANTAC ORAL TABLET

3

Irritable Bowel Syndrome Agents

alosetron hcl oral tablet 3 PA; NDS

AMITIZA ORAL CAPSULE


LINZESS ORAL CAPSULE


LOTRONEX ORAL TABLET

3 PA; NDS

VIBERZI ORAL TABLET


Laxatives

CLENPIQ ORAL SOLUTION

2

99


COLYTE WITH FLAVOR PACKS ORAL SOLUTION RECONSTITUTED

3

constulose oral solution 1

enulose oral solution 1

gavilyte-c oral solution reconstituted

1

gavilyte-g oral solution reconstituted

1

gavilyte-h oral kit 1

gavilyte-n with flavor pack oral solution reconstituted

1

generlac oral solution 1

GOLYTELY ORAL SOLUTION RECONSTITUTED

3

kristalose oral packet 3

lactulose encephalopathy oral solution

1

lactulose oral packet 1

lactulose oral solution 10 gm/15ml

1

MOVIPREP ORAL SOLUTION RECONSTITUTED

3

NULYTELY WITH FLAVOR PACKS ORAL SOLUTION RECONSTITUTED

3

OSMOPREP ORAL TABLET

3

peg 3350/electrolytes oral solution reconstituted

1

peg 3350-kcl-na bicarb-nacl oral solution reconstituted

1

peg-3350/electrolytes oral solution reconstituted

1

peg-prep oral kit 1


PLENVU ORAL SOLUTION RECONSTITUTED

3

polyethylene glycol 3350 oral packet

1

polyethylene glycol 3350 oral powder

1

PREPOPIK ORAL PACKET

3

SUPREP BOWEL PREP KIT ORAL SOLUTION

2

trilyte oral solution reconstituted

1

Protectants

CARAFATE ORAL SUSPENSION

3

CARAFATE ORAL TABLET

3

CYTOTEC ORAL TABLET

3

misoprostol oral tablet 1

sucralfate oral tablet 1

Proton Pump Inhibitors

ACIPHEX ORAL TABLET DELAYED RELEASE


ACIPHEX SPRINKLE ORAL CAPSULE SPRINKLE


DEXILANT ORAL CAPSULE DELAYED RELEASE


esomeprazole magnesium oral capsule delayed release 20 mg


esomeprazole magnesium oral capsule delayed release 40 mg


esomeprazole sodium intravenous solution reconstituted

1

100


ESOMEPRAZOLE STRONTIUM ORAL CAPSULE DELAYED RELEASE


lansoprazole oral capsule delayed release


lansoprazole oral tablet dispersible


NEXIUM I.V. INTRAVENOUS SOLUTION RECONSTITUTED

3

NEXIUM ORAL CAPSULE DELAYED RELEASE 20 MG


NEXIUM ORAL CAPSULE DELAYED RELEASE 40 MG


NEXIUM ORAL PACKET


omeppi oral capsule 3 QL (30 EA per 30 days); NDS

omeprazole oral capsule delayed release


omeprazole-sodium bicarbonate oral capsule


omeprazole-sodium bicarbonate oral packet


pantoprazole sodium intravenous solution reconstituted

1

pantoprazole sodium oral tablet delayed release


PREVACID ORAL CAPSULE DELAYED RELEASE


PREVACID SOLUTAB ORAL TABLET DISPERSIBLE


PRILOSEC ORAL PACKET


PROTONIX INTRAVENOUS SOLUTION RECONSTITUTED

3


PROTONIX ORAL PACKET


PROTONIX ORAL TABLET DELAYED RELEASE


rabeprazole sodium oral capsule sprinkle


rabeprazole sodium oral tablet delayed release


ZEGERID ORAL CAPSULE


ZEGERID ORAL PACKET


Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

Genetic or Enzyme Disorder: Replacement, Modifiers, Treatment

ADAGEN INTRAMUSCULAR SOLUTION 250 UNIT/ML

3 NDS

ALDURAZYME INTRAVENOUS SOLUTION

3 PA; NDS

BUPHENYL ORAL POWDER

3 NDS

BUPHENYL ORAL TABLET

3 NDS

CERDELGA ORAL CAPSULE

3 PA; NDS

CEREZYME INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

CREON ORAL CAPSULE DELAYED RELEASE PARTICLES

2

CYSTADANE ORAL POWDER

3 NDS

CYSTAGON ORAL CAPSULE

3

101


ELAPRASE INTRAVENOUS SOLUTION

3 PA; NDS

ELELYSO INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

EXONDYS 51 INTRAVENOUS SOLUTION

3 PA; NDS

FABRAZYME INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

GALAFOLD ORAL CAPSULE


KANUMA INTRAVENOUS SOLUTION

3 PA; NDS

KUVAN ORAL PACKET 3 PA; NDS

KUVAN ORAL TABLET SOLUBLE

3 PA; NDS

LUMIZYME INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

miglustat oral capsule 3 PA; NDS

NAGLAZYME INTRAVENOUS SOLUTION

3 PA; NDS

NITYR ORAL TABLET 3 NDS

ONPATTRO INTRAVENOUS SOLUTION

3 PA; NDS

ORFADIN ORAL CAPSULE

3 NDS

ORFADIN ORAL SUSPENSION

3 NDS

PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 10 MG/0.5ML



PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 2.5 MG/0.5ML


PALYNZIQ SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 20 MG/ML


PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 10500 UNIT, 16800 UNIT, 2600 UNIT, 4200 UNIT

3 ST

PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 21000 UNIT

3 ST; NDS

PERTZYE ORAL CAPSULE DELAYED RELEASE PARTICLES 16000 UNIT

3 ST; NDS

PERTZYE ORAL CAPSULE DELAYED RELEASE PARTICLES 24000-86250 UNIT, 4000 UNIT, 8000 UNIT

3 ST

PROCYSBI ORAL CAPSULE DELAYED RELEASE

3 PA; NDS

RAVICTI ORAL LIQUID 3 PA; NDS

REVCOVI INTRAMUSCULAR SOLUTION

3 PA; NDS

sodium phenylbutyrate oral powder

3 NDS

sodium phenylbutyrate oral tablet

1 NDS

STRENSIQ SUBCUTANEOUS SOLUTION

3 PA; NDS

SUCRAID ORAL SOLUTION

3 NDS

102


TEGSEDI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

VIMIZIM INTRAVENOUS SOLUTION

3 PA; NDS

VIOKACE ORAL TABLET 10440 UNIT

3 ST

VIOKACE ORAL TABLET 20880 UNIT

3 ST; NDS

VPRIV INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

XIAFLEX INJECTION SOLUTION RECONSTITUTED

3 PA; NDS

XURIDEN ORAL PACKET


ZAVESCA ORAL CAPSULE

3 PA; NDS

ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES

2

Genitourinary Agents

Antispasmodics, Urinary

darifenacin hydrobromide er oral tablet extended release 24 hour

1

DETROL LA ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3

DETROL ORAL TABLET

3

DITROPAN XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

ENABLEX ORAL TABLET EXTENDED RELEASE 24 HOUR

3

flavoxate hcl oral tablet 1

GELNIQUE PUMP TRANSDERMAL GEL

3


GELNIQUE TRANSDERMAL GEL

3

MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HOUR

2

oxybutynin chloride er oral tablet extended release 24 hour

1

oxybutynin chloride oral syrup

1

oxybutynin chloride oral tablet

1

OXYTROL TRANSDERMAL PATCH TWICE WEEKLY


solifenacin succinate oral tablet

1

tolterodine tartrate er oral capsule extended release 24 hour

1

tolterodine tartrate oral tablet

1

TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HOUR

3 ST

trospium chloride er oral capsule extended release 24 hour

1

trospium chloride oral tablet

1

VESICARE ORAL TABLET

2

Benign Prostatic Hypertrophy Agents

alfuzosin hcl er oral tablet extended release 24 hour

1

AVODART ORAL CAPSULE

3

CARDURA ORAL TABLET

3

CARDURA XL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

103


CIALIS ORAL TABLET 2.5 MG, 5 MG


doxazosin mesylate oral tablet

1

dutasteride oral capsule 1

dutasteride-tamsulosin hcl oral capsule

1

finasteride oral tablet 5 mg

1

FLOMAX ORAL CAPSULE

3

JALYN ORAL CAPSULE

3

PROSCAR ORAL TABLET

3

RAPAFLO ORAL CAPSULE

2

silodosin oral capsule 1

tadalafil oral tablet 2.5 mg, 5 mg


tamsulosin hcl oral capsule

1

terazosin hcl oral capsule

1

UROXATRAL ORAL TABLET EXTENDED RELEASE 24 HOUR

3

Genitourinary Agents, Other

acetic acid irrigation solution

1

bethanechol chloride oral tablet

1

ELMIRON ORAL CAPSULE

3

LITHOSTAT ORAL TABLET

3 NDS

phenazo oral tablet 200 mg

1

phenazopyridine hcl oral tablet 100 mg, 200 mg

1

PYRIDIUM ORAL TABLET

3


RENACIDIN IRRIGATION SOLUTION

3

RIMSO-50 INTRAVESICAL SOLUTION

3

THIOLA EC ORAL TABLET DELAYED RELEASE

3 NDS

THIOLA ORAL TABLET 3 NDS

urecholine oral tablet 3

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)

Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)

ala scalp external lotion 3

ala-cort external cream 1

alclometasone dipropionate external cream

1

alclometasone dipropionate external ointment

1

amcinonide external cream

1

amcinonide external lotion

1

amcinonide external ointment

1

apexicon e external cream

3 NDS

beser external lotion 1

betamethasone dipropionate aug external cream

1

betamethasone dipropionate aug external gel

1

betamethasone dipropionate aug external lotion

1

betamethasone dipropionate aug external ointment

1

104


betamethasone dipropionate external cream

1

betamethasone dipropionate external lotion

1

betamethasone dipropionate external ointment

1

betamethasone sod phos & acet injection suspension 6 (3-3) mg/ml

1

betamethasone valerate external cream

1

betamethasone valerate external foam


betamethasone valerate external lotion

1

betamethasone valerate external ointment

1

BRYHALI EXTERNAL LOTION

3

CAPEX EXTERNAL SHAMPOO

3

CELESTONE SOLUSPAN INJECTION SUSPENSION

3

clobetasol propionate e external cream

1

clobetasol propionate emulsion external foam

1

clobetasol propionate external cream

1

clobetasol propionate external foam

1

clobetasol propionate external gel

1

clobetasol propionate external liquid

1

clobetasol propionate external lotion

1

clobetasol propionate external ointment

1


clobetasol propionate external shampoo

1

clobetasol propionate external solution

1

CLOBEX EXTERNAL LOTION

3

CLOBEX EXTERNAL SHAMPOO

3 NDS

CLOBEX SPRAY EXTERNAL LIQUID

3

clocortolone pivalate external cream

1

clocortolone pivalate pump external cream 0.1 %

1

clodan external shampoo

1

CLODERM EXTERNAL CREAM

3

CLODERM PUMP EXTERNAL CREAM 0.1 %

3

CORDRAN EXTERNAL CREAM

3

CORDRAN EXTERNAL LOTION

3 NDS

CORDRAN EXTERNAL OINTMENT

3

CORDRAN EXTERNAL TAPE

3

cormax scalp application external solution 0.05 %

1

CORTEF ORAL TABLET

3

CORTIFOAM RECTAL FOAM

3

cortisone acetate oral tablet

1

CUTIVATE EXTERNAL LOTION

3 NDS

DECADRON ORAL ELIXIR

3

DECADRON ORAL TABLET

3

105


deltasone oral tablet 1

DEPO-MEDROL INJECTION SUSPENSION

3

DERMA-SMOOTHE/FS BODY EXTERNAL OIL

3

DERMA-SMOOTHE/FS SCALP EXTERNAL OIL

3

DESONATE EXTERNAL GEL

1

desonide external cream

1

desonide external lotion 1

desonide external ointment

1

DESOWEN EXTERNAL CREAM

3

desowen external lotion 0.05 %

3

desoximetasone external cream

1

desoximetasone external gel

1

desoximetasone external liquid

1

desoximetasone external ointment

1

dexamethasone (la) injection suspension

1

dexamethasone ace & sod phos injection suspension

1

dexamethasone intensol oral concentrate

1

dexamethasone oral elixir

1

dexamethasone oral solution

1

dexamethasone oral tablet

1

dexamethasone oral tablet therapy pack

1


dexamethasone sod phosphate pf injection solution

1

dexamethasone sodium phosphate injection solution

1

DEXPAK 10 DAY ORAL TABLET THERAPY PACK

3

dexpak 13 day oral tablet therapy pack

3

DEXPAK 6 DAY ORAL TABLET THERAPY PACK

3

diflorasone diacetate external cream

1

diflorasone diacetate external ointment


DIPROLENE AF EXTERNAL CREAM

3

DIPROLENE EXTERNAL OINTMENT

3

DXEVO 11-DAY ORAL TABLET THERAPY PACK

3

ELOCON EXTERNAL CREAM

3

ELOCON EXTERNAL OINTMENT 0.1 %

3

EMFLAZA ORAL SUSPENSION

3 PA; NDS

EMFLAZA ORAL TABLET

3 PA; NDS

fludrocortisone acetate oral tablet

1

fluocinolone acetonide body external oil

1

fluocinolone acetonide external cream

1

fluocinolone acetonide external ointment

1

fluocinolone acetonide external solution

1

fluocinolone acetonide scalp external oil

1

106


fluocinonide emulsified base external cream

1

fluocinonide external cream 0.05 %

1

fluocinonide external cream 0.1 %


fluocinonide external gel 1

fluocinonide external ointment

1

fluocinonide external solution

1

flurandrenolide external cream

1

flurandrenolide external lotion

1 NDS

flurandrenolide external ointment

1

fluticasone propionate external cream

1

fluticasone propionate external lotion

1

fluticasone propionate external ointment

1

halobetasol propionate external cream

1

HALOBETASOL PROPIONATE EXTERNAL FOAM

3 NDS

halobetasol propionate external ointment

1

HALOG EXTERNAL CREAM

3 NDS

HALOG EXTERNAL OINTMENT

3

HIDEX 6-DAY ORAL TABLET THERAPY PACK

3

hydrocortisone butyrate external cream

1

hydrocortisone butyrate external lotion

1

hydrocortisone butyrate external ointment

1


hydrocortisone butyrate external solution

1

hydrocortisone external cream 1 %, 2.5 %

1

hydrocortisone external lotion 2.5 %

1

hydrocortisone external ointment 1 %


hydrocortisone external ointment 2.5 %

1

hydrocortisone in absorbase external ointment 1 %


hydrocortisone oral tablet

1

hydrocortisone valerate external cream


hydrocortisone valerate external ointment

1

IMPOYZ EXTERNAL CREAM

3

INTRAROSA VAGINAL INSERT


KENALOG INJECTION SUSPENSION

3

KENALOG-80 INJECTION SUSPENSION

3

LEXETTE EXTERNAL FOAM

3 NDS

LOCOID EXTERNAL CREAM

3

LOCOID EXTERNAL LOTION

3

LOCOID EXTERNAL OINTMENT 0.1 %

3

LOCOID EXTERNAL SOLUTION

3

LOCOID LIPOCREAM EXTERNAL CREAM

3

LOCORT 11-DAY ORAL TABLET THERAPY PACK 1.5 MG (41)

3 ST

107


LOCORT 7-DAY ORAL TABLET THERAPY PACK 1.5 MG (27)

3 ST

LUXIQ EXTERNAL FOAM


MEDROL ORAL TABLET

3

MEDROL ORAL TABLET THERAPY PACK

3

methylprednisolone acetate injection suspension

1

methylprednisolone oral tablet

1

methylprednisolone oral tablet therapy pack

1

methylprednisolone sodium succ injection solution reconstituted

1

micort-hc external cream

3

MILLIPRED DP ORAL TABLET THERAPY PACK

3

MILLIPRED ORAL SOLUTION 10 MG/5ML

3

millipred oral tablet 3

mometasone furoate external cream

1

mometasone furoate external ointment

1

mometasone furoate external solution

1

nolix external cream 1

nolix external lotion 1 NDS

OLUX EXTERNAL FOAM

3 NDS

OLUX-E EXTERNAL FOAM

3 NDS

ORAPRED ODT ORAL TABLET DISPERSIBLE

3

PANDEL EXTERNAL CREAM

3 NDS


PEDIAPRED ORAL SOLUTION

3

prednicarbate external cream

1

prednicarbate external ointment

1

prednisolone oral solution

1

prednisolone sodium phosphate oral solution

1

prednisolone sodium phosphate oral tablet dispersible

1

prednisone intensol oral concentrate

1

prednisone oral solution 1

prednisone oral tablet 1

prednisone oral tablet therapy pack

1

psorcon external cream 3

RAYOS ORAL TABLET DELAYED RELEASE

3 NDS

SERNIVO EXTERNAL EMULSION

3 NDS

SOLU-CORTEF INJECTION SOLUTION RECONSTITUTED

3

SOLU-MEDROL INJECTION SOLUTION RECONSTITUTED

3

SYNALAR EXTERNAL CREAM

3

synalar external ointment

1

SYNALAR EXTERNAL SOLUTION

3

taperdex 12-day oral tablet therapy pack

3


3


3

TEMOVATE EXTERNAL CREAM

3

108


TEMOVATE EXTERNAL OINTMENT

3

texacort external solution

3

topicort external cream 3

topicort external gel 3

TOPICORT EXTERNAL OINTMENT 0.05 %

3

topicort external ointment 0.25 %

3

TOPICORT SPRAY EXTERNAL LIQUID

3

triamcinolone acetonide external cream

1

triamcinolone acetonide external lotion

1

triamcinolone acetonide external ointment

1

triamcinolone acetonide injection suspension

1

triamcinolone diacetate injection suspension

1

trianex external ointment

3 NDS

triderm external cream 1

TRIDESILON EXTERNAL CREAM

3

UCERIS RECTAL FOAM

3

ULTRAVATE EXTERNAL CREAM 0.05 %

3

ULTRAVATE EXTERNAL LOTION

3 NDS

ULTRAVATE EXTERNAL OINTMENT 0.05 %

3

VANOS EXTERNAL CREAM


VERIPRED 20 ORAL SOLUTION 20 MG/5ML

3

WESTCORT EXTERNAL OINTMENT 0.2 %

3


ZODEX 12-DAY ORAL TABLET THERAPY PACK 1.5 MG (49)

3

ZONACORT 11 DAY ORAL TABLET THERAPY PACK 1.5 MG (41)

3 ST

ZONACORT 7 DAY ORAL TABLET THERAPY PACK 1.5 MG (27)

3 ST

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary)

Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary)

ACTHAR INJECTION GEL

3 PA; NDS

chorionic gonadotropin intramuscular solution reconstituted

3 PA

DDAVP INJECTION SOLUTION

3 NDS

DDAVP NASAL SOLUTION

3 NDS

DDAVP ORAL TABLET 0.1 MG

3

DDAVP ORAL TABLET 0.2 MG

3 NDS

DDAVP RHINAL TUBE NASAL SOLUTION

3

desmopressin ace rhinal tube nasal solution 0.01 %

1

desmopressin ace spray refrig nasal solution

1

desmopressin acetate injection solution

1

desmopressin acetate oral tablet

1

EGRIFTA SUBCUTANEOUS SOLUTION RECONSTITUTED


109


GENOTROPIN MINIQUICK SUBCUTANEOUS SOLUTION RECONSTITUTED 0.2 MG

3 PA

GENOTROPIN MINIQUICK SUBCUTANEOUS SOLUTION RECONSTITUTED 0.4 MG, 0.6 MG, 0.8 MG, 1 MG, 1.2 MG, 1.4 MG, 1.6 MG, 1.8 MG, 2 MG

3 PA; NDS

GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

HUMATROPE INJECTION SOLUTION RECONSTITUTED

3 PA; NDS

INCRELEX SUBCUTANEOUS SOLUTION

3 PA; NDS

NOCDURNA SUBLINGUAL TABLET SUBLINGUAL

3

NOCTIVA NASAL EMULSION

3

NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION

3 PA; NDS

NOVAREL INTRAMUSCULAR SOLUTION RECONSTITUTED

3 PA

NUTROPIN AQ NUSPIN 10 SUBCUTANEOUS SOLUTION

3 PA; NDS


3 PA; NDS


3 PA; NDS


OMNITROPE SUBCUTANEOUS SOLUTION

3 PA; NDS

OMNITROPE SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

PREGNYL INTRAMUSCULAR SOLUTION RECONSTITUTED

3 PA

SAIZEN CLICK.EASY INJECTION SOLUTION RECONSTITUTED 8.8 MG

3 PA; NDS

SAIZEN INJECTION SOLUTION RECONSTITUTED

3 PA; NDS

SAIZENPREP INJECTION SOLUTION RECONSTITUTED

3 PA; NDS

SEROSTIM SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

STIMATE NASAL SOLUTION

3 NDS

VAPRISOL INTRAVENOUS SOLUTION

3 NDS

VASOSTRICT INTRAVENOUS SOLUTION

3

ZOMACTON SUBCUTANEOUS SOLUTION RECONSTITUTED 10 MG

3 PA; NDS

ZOMACTON SUBCUTANEOUS SOLUTION RECONSTITUTED 5 MG

3 PA

ZORBTIVE SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

110


Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins)

Hormonal Agents, Stimulant/Replacement/Modifying (Prostaglandins)

CERVIDIL VAGINAL INSERT

3

HEMABATE INTRAMUSCULAR SOLUTION

3 NDS

KORLYM ORAL TABLET


mifepristone oral tablet 1

PREPIDIL VAGINAL GEL

3

PROSTIN E2 VAGINAL SUPPOSITORY

3 NDS

Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers)

Anabolic Steroids

ANADROL-50 ORAL TABLET

3 PA; NDS

oxandrolone oral tablet 10 mg


oxandrolone oral tablet 2.5 mg


Androgens

ANDRODERM TRANSDERMAL PATCH 24 HOUR

2 PA

ANDROGEL PUMP TRANSDERMAL GEL

2 PA

ANDROGEL TRANSDERMAL GEL 20.25 MG/1.25GM (1.62%), 40.5 MG/2.5GM (1.62%)

2 PA


ANDROGEL TRANSDERMAL GEL 25 MG/2.5GM (1%), 50 MG/5GM (1%)

3 PA

ANDROID ORAL CAPSULE 10 MG

3 PA; NDS

ANDROXY ORAL TABLET 10 MG

3 PA

AVEED INTRAMUSCULAR SOLUTION

3 PA

danazol oral capsule 1

depo-testosterone intramuscular solution

3 PA

FORTESTA TRANSDERMAL GEL

3 PA

methitest oral tablet 3 PA

methyltestosterone oral capsule

3 PA; NDS

NATESTO NASAL GEL 3 PA

STRIANT BUCCAL 3 PA

TESTIM TRANSDERMAL GEL

3 PA

testosterone cypionate intramuscular solution

1 PA

testosterone enanthate intramuscular solution

1 PA

testosterone transdermal gel 10 mg/act (2%), 20.25 mg/1.25gm (1.62%), 20.25 mg/act (1.62%), 40.5 mg/2.5gm (1.62%)

1 PA

testosterone transdermal gel 12.5 mg/act (1%), 25 mg/2.5gm (1%), 50 mg/5gm (1%)

2 PA

testosterone transdermal solution

1 PA

TESTRED ORAL CAPSULE 10 MG

3 PA; NDS

VOGELXO PUMP TRANSDERMAL GEL

3 PA

VOGELXO TRANSDERMAL GEL

3 PA

111


XYOSTED SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA

Estrogens

ACTIVELLA ORAL TABLET

3

afirmelle oral tablet 1

ALORA TRANSDERMAL PATCH TWICE WEEKLY

3

altavera oral tablet 1

alyacen 1/35 oral tablet 1

alyacen 7/7/7 oral tablet 1

amabelz oral tablet 1

amethia lo oral tablet 1 QL (91 EA per 91 days)

amethia oral tablet 1 QL (91 EA per 91 days)

amethyst oral tablet 1

ANGELIQ ORAL TABLET

3

apri oral tablet 1

aranelle oral tablet 1

ashlyna oral tablet 1 QL (91 EA per 91 days)

aubra oral tablet 1

aurovela 1.5/30 oral tablet

1

aurovela 1/20 oral tablet 1

aurovela 24 fe oral tablet

1

aurovela fe 1.5/30 oral tablet

1

aurovela fe 1/20 oral tablet

1

aviane oral tablet 1

ayuna oral tablet 1

azurette oral tablet 1

balziva oral tablet 1

bekyree oral tablet 1


BEYAZ ORAL TABLET 3

BIJUVA ORAL CAPSULE

3

blisovi 24 fe oral tablet 1

blisovi fe 1.5/30 oral tablet

1

blisovi fe 1/20 oral tablet 1-20 mg-mcg

1

briellyn oral tablet 1

camrese lo oral tablet 1 QL (91 EA per 91 days)

camrese oral tablet 1 QL (91 EA per 91 days)

caziant oral tablet 1

chateal eq oral tablet 1

chateal oral tablet 1

CLIMARA PRO TRANSDERMAL PATCH WEEKLY

3

CLIMARA TRANSDERMAL PATCH WEEKLY

3

COMBIPATCH TRANSDERMAL PATCH TWICE WEEKLY

3

cryselle-28 oral tablet 1

cyclafem 1/35 oral tablet

1

cyclafem 7/7/7 oral tablet

1

cyred oral tablet 1

dasetta 1/35 oral tablet 1

dasetta 7/7/7 oral tablet 1

daysee oral tablet 1 QL (91 EA per 91 days)

DELESTROGEN INTRAMUSCULAR OIL

3

delyla oral tablet 1

depo-estradiol intramuscular oil

3

112


DESOGEN ORAL TABLET 0.15-30 MG-MCG

3

desogestrel-ethinyl estradiol oral tablet

1

DIVIGEL TRANSDERMAL GEL

3

dotti transdermal patch twice weekly

1

drospiren-eth estrad-levomefol oral tablet

1

drospirenone-ethinyl estradiol oral tablet

1

DUAVEE ORAL TABLET

3

ELESTRIN TRANSDERMAL GEL

3

elinest oral tablet 1

emoquette oral tablet 1

enpresse-28 oral tablet 1

enskyce oral tablet 1

estarylla oral tablet 1

estrace oral tablet 3

estrace vaginal cream 3

estradiol oral tablet 1

estradiol transdermal patch twice weekly

1

estradiol transdermal patch weekly

1

estradiol vaginal cream 1

estradiol vaginal tablet 1

estradiol valerate intramuscular oil

1

estradiol-norethindrone acet oral tablet

1

ESTRING VAGINAL RING


estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg

1

ESTROSTEP FE ORAL TABLET

3

ethynodiol diac-eth estradiol oral tablet

1


EVAMIST TRANSDERMAL SOLUTION

3

falmina oral tablet 1

fayosim oral tablet 1 QL (91 EA per 91 days)

FEMHRT LOW DOSE ORAL TABLET

3

FEMRING VAGINAL RING


femynor oral tablet 1

fyavolv oral tablet 1

GENERESS FE ORAL TABLET CHEWABLE

3

gianvi oral tablet 1

gildagia oral tablet 0.4-35 mg-mcg

1

gildess fe 1.5/30 oral tablet 1.5-30 mg-mcg

1

gildess fe 1/20 oral tablet 1-20 mg-mcg

1

hailey 1.5/30 oral tablet 1

hailey 24 fe oral tablet 1

IMVEXXY MAINTENANCE PACK VAGINAL INSERT

2 PA

IMVEXXY STARTER PACK VAGINAL INSERT

2 PA

introvale oral tablet 1 QL (91 EA per 91 days)

isibloom oral tablet 1

jasmiel oral tablet 1

jevantique lo oral tablet 0.5-2.5 mg-mcg

1

jinteli oral tablet 1

jolessa oral tablet 1 QL (91 EA per 91 days)

juleber oral tablet 1

junel 1.5/30 oral tablet 1

junel 1/20 oral tablet 1

junel fe 1.5/30 oral tablet

1

113


junel fe 1/20 oral tablet 1

junel fe 24 oral tablet 1

kaitlib fe oral tablet chewable

1

kalliga oral tablet 1

kariva oral tablet 1

kelnor 1/35 oral tablet 1

kelnor 1/50 oral tablet 1

kimidess oral tablet 0.15-0.02/0.01 mg (21/5)

1

kurvelo oral tablet 1

larin 1.5/30 oral tablet 1

larin 1/20 oral tablet 1

larin 24 fe oral tablet 1

larin fe 1.5/30 oral tablet 1

larin fe 1/20 oral tablet 1

larissia oral tablet 1

LAYOLIS FE ORAL TABLET CHEWABLE

1

leena oral tablet 1

lessina oral tablet 1

levonest oral tablet 1

levonorgest-eth est & eth est oral tablet


levonorgest-eth estrad 91-day oral tablet


levonorgestrel-ethinyl estrad oral tablet

1

levonorg-eth estrad triphasic oral tablet

1

levora 0.15/30 (28) oral tablet

1

lillow oral tablet 1

LO LOESTRIN FE ORAL TABLET

3

loestrin 1.5/30 (21) oral tablet

3

loestrin 1/20 (21) oral tablet

3


loestrin fe 1.5/30 oral tablet

3

loestrin fe 1/20 oral tablet

3

lomedia 24 fe oral tablet 1-20 mg-mcg(24)

1

lopreeza oral tablet 1

loryna oral tablet 1

LOSEASONIQUE ORAL TABLET


low-ogestrel oral tablet 1

lo-zumandimine oral tablet

1

lutera oral tablet 1

marlissa oral tablet 1

melodetta 24 fe oral tablet chewable

1

menest oral tablet 3

MENOSTAR TRANSDERMAL PATCH WEEKLY

3

mibelas 24 fe oral tablet chewable

1

microgestin 1.5/30 oral tablet

1

microgestin 1/20 oral tablet

1

microgestin fe 1.5/30 oral tablet

1

microgestin fe 1/20 oral tablet

1

mili oral tablet 1

mimvey lo oral tablet 1

mimvey oral tablet 1

MINASTRIN 24 FE ORAL TABLET CHEWABLE

3

MINIVELLE TRANSDERMAL PATCH TWICE WEEKLY

3

MIRCETTE ORAL TABLET

3

114


mono-linyah oral tablet 1

MONONESSA ORAL TABLET

1

myzilra oral tablet 1

NATAZIA ORAL TABLET

3

necon 0.5/35 (28) oral tablet

1

necon 1/35 (28) oral tablet

1

necon 1/50 (28) oral tablet 1-50 mg-mcg

1

necon 7/7/7 oral tablet 0.5/0.75/1-35 mg-mcg

1

nikki oral tablet 1

norethin ace-eth estrad-fe oral tablet

1

norethin ace-eth estrad-fe oral tablet chewable

1

norethindrone acet-ethinyl est oral tablet

1

norethindrone acet-ethinyl est oral tablet chewable 1-20 mg-mcg(24)

1

norethindrone-eth estradiol oral tablet

1

norethin-eth estradiol-fe oral tablet chewable

1

norgestimate-eth estradiol oral tablet

1

norgestimate-ethinyl estradiol triphasic oral tablet

1

nortrel 0.5/35 (28) oral tablet

1

nortrel 1/35 (21) oral tablet

1

nortrel 1/35 (28) oral tablet

1

nortrel 7/7/7 oral tablet 1

NUVARING VAGINAL RING

3

ocella oral tablet 1


ogestrel oral tablet 1

orsythia oral tablet 1

ORTHO TRI-CYCLEN (28) ORAL TABLET 0.18/0.215/0.25 MG-35 MCG

3

ORTHO TRI-CYCLEN LO ORAL TABLET

3

ORTHO-CYCLEN (28) ORAL TABLET 0.25-35 MG-MCG

3

ORTHO-NOVUM 1/35 (28) ORAL TABLET

3

ORTHO-NOVUM 7/7/7 (28) ORAL TABLET

3

philith oral tablet 1

pimtrea oral tablet 1

pirmella 1/35 oral tablet 1

pirmella 7/7/7 oral tablet 1

portia-28 oral tablet 1

prefest oral tablet 3

PREMARIN INJECTION SOLUTION RECONSTITUTED

3

PREMARIN ORAL TABLET

3

PREMARIN VAGINAL CREAM

2

PREMPHASE ORAL TABLET

3

PREMPRO ORAL TABLET

3

previfem oral tablet 1

QUARTETTE ORAL TABLET


quasense oral tablet 0.15-0.03 mg


rajani oral tablet 3-0.02-0.451 mg

1

reclipsen oral tablet 1

rivelsa oral tablet 1 QL (91 EA per 91 days)

115


SAFYRAL ORAL TABLET

3

SEASONIQUE ORAL TABLET


setlakin oral tablet 1 QL (91 EA per 91 days)

simliya oral tablet 1

simpesse oral tablet 1 QL (91 EA per 91 days)

sprintec 28 oral tablet 1

sronyx oral tablet 1

syeda oral tablet 1

tarina 24 fe oral tablet 1

tarina fe 1/20 oral tablet 1

TAYTULLA ORAL CAPSULE

3

tilia fe oral tablet 1

tri femynor oral tablet 1

tri-estarylla oral tablet 1

tri-legest fe oral tablet 1

tri-linyah oral tablet 1

tri-lo-estarylla oral tablet 1

tri-lo-marzia oral tablet 1

tri-lo-mili oral tablet 1

tri-lo-sprintec oral tablet 1

tri-mili oral tablet 1

trinessa (28) oral tablet 1

trinessa lo oral tablet 0.18/0.215/0.25 mg-25 mcg

1

TRI-NORINYL (28) ORAL TABLET 0.5/1/0.5-35 MG-MCG

3

tri-previfem oral tablet 1

tri-sprintec oral tablet 1

trivora (28) oral tablet 1

tri-vylibra lo oral tablet 1

tri-vylibra oral tablet 1

tydemy oral tablet 1


VAGIFEM VAGINAL TABLET

3

velivet oral tablet 1

vestura oral tablet 3-0.02 mg

1

vienva oral tablet 1

viorele oral tablet 1

VIVELLE-DOT TRANSDERMAL PATCH TWICE WEEKLY

3

vyfemla oral tablet 1

vylibra oral tablet 1

wera oral tablet 1

wymzya fe oral tablet chewable

1

xulane transdermal patch weekly

1

YASMIN 28 ORAL TABLET

3

YAZ ORAL TABLET 3

yuvafem vaginal tablet 1

zarah oral tablet 1

zenchent oral tablet 0.4-35 mg-mcg

1

zovia 1/35e (28) oral tablet

1

zovia 1/50e (28) oral tablet 1-50 mg-mcg

1

zumandimine oral tablet 1

Progesterone Agonists/Antagonists

ELLA ORAL TABLET 2

MAKENA SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

Progestins

aygestin oral tablet 3

camila oral tablet 1

CRINONE VAGINAL GEL

3 PA

116


deblitane oral tablet 1

DEPO-PROVERA INTRAMUSCULAR SUSPENSION 150 MG/ML


DEPO-PROVERA INTRAMUSCULAR SUSPENSION 400 MG/ML


DEPO-PROVERA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE


DEPO-SUBQ PROVERA 104 SUBCUTANEOUS SUSPENSION PREFILLED SYRINGE


errin oral tablet 1

heather oral tablet 1

hydroxyprogesterone caproate intramuscular oil

1 PA; NDS

hydroxyprogesterone caproate intramuscular solution

3 PA; NDS

incassia oral tablet 1

jencycla oral tablet 1

JOLIVETTE ORAL TABLET 0.35 MG

1

KYLEENA INTRAUTERINE INTRAUTERINE DEVICE

3

levonorgestrel oral tablet

1

LILETTA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE

3

lyza oral tablet 1

MAKENA INTRAMUSCULAR OIL

3 PA; NDS

medroxyprogesterone acetate intramuscular suspension



medroxyprogesterone acetate intramuscular suspension prefilled syringe


medroxyprogesterone acetate oral tablet

1

MEGACE ES ORAL SUSPENSION

3 PA; NDS

megestrol acetate oral suspension 40 mg/ml, 625 mg/5ml

1 PA

megestrol acetate oral tablet

1 PA

MIRENA (52 MG) INTRAUTERINE INTRAUTERINE DEVICE

3

NEXPLANON SUBCUTANEOUS IMPLANT

3

nora-be oral tablet 1

norethindrone acetate oral tablet

1

norethindrone oral tablet

1

norlyda oral tablet 1

norlyroc oral tablet 1

ORTHO MICRONOR ORAL TABLET

3

progesterone intramuscular oil

1

progesterone micronized oral capsule

1

PROMETRIUM ORAL CAPSULE

3

PROVERA ORAL TABLET

3

sharobel oral tablet 1

SKYLA INTRAUTERINE INTRAUTERINE DEVICE

3 NDS

SLYND ORAL TABLET 3

tulana oral tablet 1

117


Selective Estrogen Receptor Modifying Agents

clomiphene citrate oral tablet

1 PA

EVISTA ORAL TABLET 3

OSPHENA ORAL TABLET


raloxifene hcl oral tablet 1

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)

Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)

ARMOUR THYROID ORAL TABLET

3

CYTOMEL ORAL TABLET

3

euthyrox oral tablet 1

LEVO-T ORAL TABLET 3

levothyroxine sodium intravenous solution

3 NDS

levothyroxine sodium intravenous solution reconstituted

3 NDS

levothyroxine sodium oral tablet

1

levothyroxine-liothyronine oral tablet 120 mg, 15 mg, 30 mg, 60 mg, 90 mg

1

LEVOXYL ORAL TABLET

3

liothyronine sodium intravenous solution

1

liothyronine sodium oral tablet

1

nature-throid oral tablet 130 mg, 16.25 mg, 195 mg, 32.5 mg, 65 mg

1

np thyroid oral tablet 1

SYNTHROID ORAL TABLET

3


THYROLAR-1 ORAL TABLET 60 (12.5-50) MG (MCG)

3

THYROLAR-1/2 ORAL TABLET 30 (6.25-25) MG (MCG)

3

THYROLAR-1/4 ORAL TABLET 15 (3.1-12.5) MG (MCG)

3

THYROLAR-2 ORAL TABLET 120 (25-100) MG (MCG)

3

THYROLAR-3 ORAL TABLET 180 (37.5-150) MG (MCG)

3

TIROSINT ORAL CAPSULE

3

TIROSINT-SOL ORAL SOLUTION

3

TRIOSTAT INTRAVENOUS SOLUTION

3 NDS

UNITHROID ORAL TABLET

3

westhroid oral tablet 130 mg, 32.5 mg, 65 mg

1

Hormonal Agents, Suppressant (Adrenal)

Hormonal Agents, Suppressant (Adrenal)

LYSODREN ORAL TABLET

3 NDS

Hormonal Agents, Suppressant (Pituitary)

Hormonal Agents, Suppressant (Pituitary)

cabergoline oral tablet 1

ELIGARD SUBCUTANEOUS KIT 22.5 MG


ELIGARD SUBCUTANEOUS KIT 30 MG


118


ELIGARD SUBCUTANEOUS KIT 45 MG


ELIGARD SUBCUTANEOUS KIT 7.5 MG


FIRMAGON SUBCUTANEOUS SOLUTION RECONSTITUTED 120 MG


FIRMAGON SUBCUTANEOUS SOLUTION RECONSTITUTED 80 MG


leuprolide acetate injection kit

3 PA; NDS

LUPANETA PACK COMBINATION KIT 11.25 & 5 MG


LUPANETA PACK COMBINATION KIT 3.75 & 5 MG


LUPRON DEPOT (1-MONTH) INTRAMUSCULAR KIT


LUPRON DEPOT (3-MONTH) INTRAMUSCULAR KIT


LUPRON DEPOT (4-MONTH) INTRAMUSCULAR KIT 30MG INTRAMUSCULAR KIT


LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG INTRAMUSCULAR KIT


LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT


LUPRON DEPOT-PED (3-MONTH) INTRAMUSCULAR KIT



octreotide acetate injection solution 100 mcg/ml, 200 mcg/ml, 50 mcg/ml

1 PA

octreotide acetate injection solution 1000 mcg/ml, 500 mcg/ml

3 PA; NDS

ORILISSA ORAL TABLET 150 MG


ORILISSA ORAL TABLET 200 MG


SANDOSTATIN INJECTION SOLUTION 100 MCG/ML, 1000 MCG/ML, 200 MCG/ML, 500 MCG/ML

3 PA; NDS

SANDOSTATIN INJECTION SOLUTION 50 MCG/ML

3 PA

SANDOSTATIN LAR DEPOT INTRAMUSCULAR KIT

3 PA; NDS

SIGNIFOR LAR INTRAMUSCULAR SUSPENSION RECONSTITUTED ER


SIGNIFOR SUBCUTANEOUS SOLUTION


SOMATULINE DEPOT SUBCUTANEOUS SOLUTION

3 PA; NDS

SOMAVERT SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

SUPPRELIN LA SUBCUTANEOUS KIT


SYNAREL NASAL SOLUTION

3 NDS

TRELSTAR MIXJECT INTRAMUSCULAR SUSPENSION RECONSTITUTED 11.25 MG


119






TRIPTODUR INTRAMUSCULAR SUSPENSION RECONSTITUTED ER


VANTAS SUBCUTANEOUS KIT


ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG


ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG


Hormonal Agents, Suppressant (Thyroid)

Antithyroid Agents

methimazole oral tablet 1

propylthiouracil oral tablet

1

tapazole oral tablet 3

Immunological Agents

Angioedema Agents

BERINERT INTRAVENOUS KIT

3 PA; NDS

FIRAZYR SUBCUTANEOUS SOLUTION

3 PA; NDS

icatibant acetate subcutaneous solution

1 PA; NDS

KALBITOR SUBCUTANEOUS SOLUTION

3 PA; NDS

RUCONEST INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

Immune Suppressants


ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG, 1 MG

3 B/D

ASTAGRAF XL ORAL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG

3 B/D; NDS

azasan oral tablet 3 B/D

azathioprine oral tablet 1 B/D

azathioprine sodium injection solution reconstituted

1 B/D

BENLYSTA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

BENLYSTA SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

BENLYSTA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

CELLCEPT INTRAVENOUS INTRAVENOUS SOLUTION RECONSTITUTED

3 B/D

CELLCEPT ORAL CAPSULE

3 B/D; NDS

CELLCEPT ORAL SUSPENSION RECONSTITUTED

3 B/D; NDS

CELLCEPT ORAL TABLET

3 B/D; NDS

CIMZIA PREFILLED KIT SUBCUTANEOUS KIT

3 PA; NDS

CIMZIA STARTER KIT SUBCUTANEOUS KIT

3 PA; NDS

CIMZIA SUBCUTANEOUS KIT

3 PA; NDS

cyclosporine intravenous solution

1

120


cyclosporine modified oral capsule

1 B/D

cyclosporine modified oral solution

1 B/D

cyclosporine oral capsule

1 B/D

ENBREL MINI SUBCUTANEOUS SOLUTION CARTRIDGE

3 PA; NDS

ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

ENBREL SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

ENBREL SURECLICK SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HOUR 0.75 MG, 1 MG

3 B/D

ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HOUR 4 MG

3 B/D; NDS

gengraf oral capsule 1 B/D

gengraf oral solution 1 B/D

HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE KIT

3 PA; NDS

HUMIRA PEN SUBCUTANEOUS PEN-INJECTOR KIT

3 PA; NDS

HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT

3 PA; NDS


HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT

3 PA; NDS

HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT

3 PA; NDS

IMURAN ORAL TABLET

3 B/D

INFLECTRA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

KINERET SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

methotrexate (anti-rheumatic) oral tablet 2.5 mg

1

methotrexate oral tablet 1

methotrexate sodium (pf) injection solution

1

methotrexate sodium injection solution 50 mg/2ml

1

methotrexate sodium injection solution reconstituted

1

mycophenolate mofetil hcl intravenous solution reconstituted

1 B/D

mycophenolate mofetil oral capsule

1 B/D

mycophenolate mofetil oral suspension reconstituted

3 B/D; NDS

mycophenolate mofetil oral tablet

1 B/D

mycophenolate sodium oral tablet delayed release

1 B/D

MYFORTIC ORAL TABLET DELAYED RELEASE 180 MG

3 B/D

121


MYFORTIC ORAL TABLET DELAYED RELEASE 360 MG

3 B/D; NDS

NEORAL ORAL CAPSULE

3 B/D

NEORAL ORAL SOLUTION

3 B/D

NULOJIX INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

ORENCIA CLICKJECT SUBCUTANEOUS SOLUTION AUTO-INJECTOR


ORENCIA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

ORENCIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

OTREXUP SUBCUTANEOUS SOLUTION AUTO-INJECTOR


PROGRAF INTRAVENOUS SOLUTION

3

PROGRAF ORAL CAPSULE 0.5 MG, 1 MG

3 B/D

PROGRAF ORAL CAPSULE 5 MG

3 B/D; NDS

PROGRAF ORAL PACKET

3 B/D; NDS

RAPAMUNE ORAL SOLUTION

3 B/D; NDS

RAPAMUNE ORAL TABLET 0.5 MG

3 B/D

RAPAMUNE ORAL TABLET 1 MG, 2 MG

3 B/D; NDS


RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 10 MG/0.2ML


RASUVO SUBCUTANEOUS SOLUTION AUTO-INJECTOR 12.5 MG/0.25ML
















REMICADE INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

122


RENFLEXIS INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

SANDIMMUNE INTRAVENOUS SOLUTION

3

SANDIMMUNE ORAL CAPSULE 100 MG

3 B/D; NDS

SANDIMMUNE ORAL CAPSULE 25 MG

3 B/D

SANDIMMUNE ORAL SOLUTION

3 B/D

SIMPONI SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

SIMPONI SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

sirolimus oral solution 1 B/D; NDS

sirolimus oral tablet 0.5 mg, 1 mg

1 B/D

sirolimus oral tablet 2 mg

3 B/D; NDS

SKYRIZI (150 MG DOSE) SUBCUTANEOUS PREFILLED SYRINGE KIT

3 PA; NDS

tacrolimus oral capsule 1 B/D

trexall oral tablet 3

XATMEP ORAL SOLUTION

3

ZORTRESS ORAL TABLET

3 PA; NDS

Immunizing Agents, Passive

ATGAM INTRAVENOUS INJECTABLE

3 NDS

BIVIGAM INTRAVENOUS SOLUTION

3 PA; NDS


CARIMUNE NF INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

CUTAQUIG SUBCUTANEOUS SOLUTION

3 PA; NDS

CUVITRU SUBCUTANEOUS SOLUTION

3 PA; NDS

CYTOGAM INTRAVENOUS INJECTABLE

3 PA; NDS

FLEBOGAMMA DIF INTRAVENOUS SOLUTION

3 PA; NDS

GAMASTAN INTRAMUSCULAR INJECTABLE

2 PA

GAMASTAN S/D INTRAMUSCULAR INJECTABLE

2 PA

GAMMAGARD INJECTION SOLUTION

3 PA; NDS

GAMMAGARD S/D LESS IGA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

GAMMAKED INJECTION SOLUTION

3 PA; NDS

GAMMAPLEX INTRAVENOUS SOLUTION

3 PA; NDS

GAMUNEX-C INJECTION SOLUTION

3 PA; NDS

HEPAGAM B INJECTION SOLUTION

3 B/D; NDS

HIZENTRA SUBCUTANEOUS SOLUTION

3 PA; NDS

HYPERHEP B S/D INTRAMUSCULAR SOLUTION

3 B/D; NDS

HYPERRAB INJECTION SOLUTION

2 B/D

123


HYPERRAB S/D INJECTION SOLUTION

2 B/D

HYPERRHO S/D INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

3

HYQVIA SUBCUTANEOUS KIT

3 PA; NDS

IMOGAM RABIES-HT INJECTION SOLUTION

3 B/D

KEDRAB INJECTION SOLUTION

3 B/D

MICRHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

3

NABI-HB INTRAMUSCULAR SOLUTION

3 B/D; NDS

OCTAGAM INTRAVENOUS SOLUTION

3 PA; NDS

PANZYGA INTRAVENOUS SOLUTION

3 PA; NDS

PRIVIGEN INTRAVENOUS SOLUTION

3 PA; NDS

RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

3

RHOPHYLAC INJECTION SOLUTION PREFILLED SYRINGE

3

SYNAGIS INTRAMUSCULAR SOLUTION

3 PA; NDS

THYMOGLOBULIN INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

WINRHO SDF INJECTION SOLUTION

3 NDS

Immunomodulators


ACTEMRA ACTPEN SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

ACTEMRA INTRAVENOUS SOLUTION

3 PA; NDS

ACTEMRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


ACTIMMUNE SUBCUTANEOUS SOLUTION

3 PA; NDS

ARAVA ORAL TABLET 3 NDS

ARCALYST SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

ENTYVIO INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

GAMIFANT INTRAVENOUS SOLUTION

3 PA; NDS

ILARIS (150MG DELIVERED) SUBCUTANEOUS SOLUTION RECONSTITUTED 180 MG


ILARIS SUBCUTANEOUS SOLUTION


KEVZARA SUBCUTANEOUS SOLUTION AUTO-INJECTOR

3 PA; NDS

KEVZARA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

leflunomide oral tablet 1

LEMTRADA INTRAVENOUS SOLUTION

3 PA; NDS

124


OLUMIANT ORAL TABLET

3 PA; NDS

OTEZLA ORAL TABLET

3 PA; NDS

OTEZLA ORAL TABLET THERAPY PACK

3 PA; NDS

RIDAURA ORAL CAPSULE

3 NDS

SIMPONI ARIA INTRAVENOUS SOLUTION

3 PA; NDS

SIMULECT INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

SYLVANT INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

XELJANZ ORAL TABLET

3 PA; NDS

XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HOUR

3 PA; NDS

ZINPLAVA INTRAVENOUS SOLUTION

3 NDS

Vaccines

ACTHIB INTRAMUSCULAR SOLUTION RECONSTITUTED

2

ADACEL INTRAMUSCULAR SUSPENSION

2

BCG VACCINE INJECTION INJECTABLE

2

BEXSERO INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

2


BOOSTRIX INTRAMUSCULAR SUSPENSION 5-2.5-18.5 , 5-2.5-18.5 (0.5ML SYRINGE)

2

DAPTACEL INTRAMUSCULAR SUSPENSION

2

DIPHTHERIA-TETANUS TOXOIDS DT INTRAMUSCULAR SUSPENSION

1

ENGERIX-B INJECTION SUSPENSION

2 B/D

GARDASIL 9 INTRAMUSCULAR SUSPENSION

2

GARDASIL 9 INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

2

HAVRIX INTRAMUSCULAR SUSPENSION

2

HEPLISAV-B INTRAMUSCULAR SOLUTION

2 B/D

HEPLISAV-B INTRAMUSCULAR SOLUTION PREFILLED SYRINGE

2 B/D

HIBERIX INJECTION SOLUTION RECONSTITUTED

2

IMOVAX RABIES INTRAMUSCULAR INJECTABLE

2 B/D

INFANRIX INTRAMUSCULAR SUSPENSION

2

IPOL INJECTION INJECTABLE

2

IXIARO INTRAMUSCULAR SUSPENSION

2

125


KINRIX INTRAMUSCULAR SUSPENSION

2

MENACTRA INTRAMUSCULAR INJECTABLE

2

MENHIBRIX INTRAMUSCULAR SOLUTION RECONSTITUTED 5-5-2.5 MCG

2

MENVEO INTRAMUSCULAR SOLUTION RECONSTITUTED

2

M-M-R II SUBCUTANEOUS INJECTABLE

2

PEDIARIX INTRAMUSCULAR SUSPENSION

2

PEDVAX HIB INTRAMUSCULAR SUSPENSION

2

PENTACEL INTRAMUSCULAR SUSPENSION RECONSTITUTED

2

PROQUAD SUBCUTANEOUS SUSPENSION RECONSTITUTED

2

QUADRACEL INTRAMUSCULAR SUSPENSION

2

RABAVERT INTRAMUSCULAR SUSPENSION RECONSTITUTED

2 B/D

RECOMBIVAX HB INJECTION SUSPENSION

2 B/D

ROTARIX ORAL SUSPENSION RECONSTITUTED

2

ROTATEQ ORAL SOLUTION

2


SHINGRIX INTRAMUSCULAR SUSPENSION RECONSTITUTED

2

STAMARIL INJECTION SUSPENSION RECONSTITUTED

2

TDVAX INTRAMUSCULAR SUSPENSION

2

TENIVAC INTRAMUSCULAR INJECTABLE

2

TRUMENBA INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

2

TWINRIX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE

2

TYPHIM VI INTRAMUSCULAR SOLUTION

2

VAQTA INTRAMUSCULAR SUSPENSION

2

VARIVAX SUBCUTANEOUS INJECTABLE

2

VARIZIG INTRAMUSCULAR SOLUTION

2 PA

YF-VAX SUBCUTANEOUS INJECTABLE

2

ZOSTAVAX SUBCUTANEOUS SUSPENSION RECONSTITUTED

2

Inflammatory Bowel Disease Agents

Aminosalicylates

APRISO ORAL CAPSULE EXTENDED RELEASE 24 HOUR

2

126


ASACOL HD ORAL TABLET DELAYED RELEASE

3

balsalazide disodium oral capsule

1

CANASA RECTAL SUPPOSITORY

3 NDS

colazal oral capsule 3 NDS

DELZICOL ORAL CAPSULE DELAYED RELEASE

3

DIPENTUM ORAL CAPSULE

3 NDS

GIAZO ORAL TABLET 1.1 GM

3 NDS

LIALDA ORAL TABLET DELAYED RELEASE

3

mesalamine oral capsule delayed release

1

mesalamine oral tablet delayed release

1

mesalamine rectal enema

1

mesalamine rectal suppository

1 NDS

mesalamine-cleanser rectal kit

1

PENTASA ORAL CAPSULE EXTENDED RELEASE

3

ROWASA RECTAL KIT 3 NDS

SFROWASA RECTAL ENEMA

3 NDS

Glucocorticoids

budesonide er oral tablet extended release 24 hour

1 NDS

budesonide oral capsule delayed release particles

1

colocort rectal enema 1

CORTENEMA RECTAL ENEMA

3


ENTOCORT EC ORAL CAPSULE DELAYED RELEASE PARTICLES

3 NDS

hydrocortisone rectal enema

1

UCERIS ORAL TABLET EXTENDED RELEASE 24 HOUR

3 NDS

Sulfonamides

AZULFIDINE EN-TABS ORAL TABLET DELAYED RELEASE

3

AZULFIDINE ORAL TABLET

3

sulfasalazine oral tablet 1

sulfasalazine oral tablet delayed release

1

Metabolic Bone Disease Agents

Metabolic Bone Disease Agents

ACTONEL ORAL TABLET 150 MG


ACTONEL ORAL TABLET 30 MG, 5 MG

3

ACTONEL ORAL TABLET 35 MG


alendronate sodium oral solution

1

alendronate sodium oral tablet 10 mg, 35 mg, 40 mg, 5 mg

1

alendronate sodium oral tablet 70 mg


ATELVIA ORAL TABLET DELAYED RELEASE


BINOSTO ORAL TABLET EFFERVESCENT


BONIVA INTRAVENOUS SOLUTION

3

BONIVA ORAL TABLET


127


calcitonin (salmon) nasal solution


calcitriol intravenous solution

1

calcitriol oral capsule 1

calcitriol oral solution 1

cinacalcet hcl oral tablet 1 NDS

doxercalciferol intravenous solution

1

doxercalciferol oral capsule

1

etidronate disodium oral tablet

1

EVENITY SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


FORTEO SUBCUTANEOUS SOLUTION

3 PA; NDS

FOSAMAX ORAL TABLET


FOSAMAX PLUS D ORAL TABLET


HECTOROL INTRAVENOUS SOLUTION

3

HECTOROL ORAL CAPSULE 0.5 MCG

3

HECTOROL ORAL CAPSULE 1 MCG, 2.5 MCG

3 NDS

ibandronate sodium intravenous solution

1

ibandronate sodium oral tablet


MIACALCIN INJECTION SOLUTION

3 NDS

NATPARA SUBCUTANEOUS CARTRIDGE


pamidronate disodium intravenous solution

1


pamidronate disodium intravenous solution reconstituted

1

paricalcitol intravenous solution

1

paricalcitol oral capsule 1

PROLIA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE


RECLAST INTRAVENOUS SOLUTION

3

risedronate sodium oral tablet 150 mg


risedronate sodium oral tablet 30 mg, 5 mg

1

risedronate sodium oral tablet 35 mg, 35 mg (12 pack), 35 mg (4 pack)


RISEDRONATE SODIUM ORAL TABLET DELAYED RELEASE


ROCALTROL ORAL CAPSULE

3

ROCALTROL ORAL SOLUTION

3

SENSIPAR ORAL TABLET

3 NDS

TYMLOS SUBCUTANEOUS SOLUTION PEN-INJECTOR

3 PA; NDS

XGEVA SUBCUTANEOUS SOLUTION

3 PA; NDS

ZEMPLAR INTRAVENOUS SOLUTION 2 MCG/ML

3

ZEMPLAR INTRAVENOUS SOLUTION 5 MCG/ML

3 NDS

ZEMPLAR ORAL CAPSULE 1 MCG

3

ZEMPLAR ORAL CAPSULE 2 MCG

3 NDS

128


zoledronic acid intravenous concentrate

1

zoledronic acid intravenous solution

1

zoledronic acid intravenous solution reconstituted 4 mg

1 NDS

ZOMETA INTRAVENOUS CONCENTRATE 4 MG/5ML

3 NDS

ZOMETA INTRAVENOUS SOLUTION 4 MG/100ML

3 NDS

Miscellaneous Therapeutic Agents

Miscellaneous Therapeutic Agents

ACETADOTE INTRAVENOUS SOLUTION

3

acetylcysteine intravenous solution

1

alcohol prep pads pad 70 %

2

AMINO ACID INTRAVENOUS SOLUTION 10 %

3 B/D

AMINOSYN II INTRAVENOUS SOLUTION

3 B/D

AMINOSYN INTRAVENOUS SOLUTION 10 %, 8.5 %

3 B/D

AMINOSYN-HBC INTRAVENOUS SOLUTION 7 %

3 B/D

AMINOSYN-PF INTRAVENOUS SOLUTION

3 B/D

AMINOSYN-RF INTRAVENOUS SOLUTION 5.2 %

3 B/D

AMMONUL INTRAVENOUS SOLUTION

3 NDS


argyle sterile saline irrigation solution

1

argyle sterile water irrigation solution

1

CARNITOR INTRAVENOUS SOLUTION

3

CARNITOR ORAL SOLUTION

3

CARNITOR ORAL TABLET

3

CARNITOR SF ORAL SOLUTION

3

CETYLEV ORAL TABLET EFFERVESCENT 2.5 GM, 500 MG

3

CINRYZE INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

clinisol sf intravenous solution

1 B/D

CLINOLIPID INTRAVENOUS EMULSION

3 B/D

curity sterile saline irrigation solution

1

cvs gauze sterile pad 2"x2"

2

deferoxamine mesylate injection solution reconstituted

1 B/D

DESFERAL INJECTION SOLUTION RECONSTITUTED

3 B/D; NDS

ENDARI ORAL PACKET

3 PA; NDS

ENLON INJECTION SOLUTION 10 MG/ML

3

FIRDAPSE ORAL TABLET


fomepizole intravenous solution

1 NDS

129


FREAMINE HBC INTRAVENOUS SOLUTION

3 B/D

FREAMINE III INTRAVENOUS SOLUTION

3 B/D

GRASTEK SUBLINGUAL TABLET SUBLINGUAL


HAEGARDA SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

HEPATAMINE INTRAVENOUS SOLUTION

3 B/D

insulin pen needles 29g x 12mm


insulin syringes 28g x 1/2" 0.5 ml, 29g 0.3 ml, 29g x 1/2" 1 ml


INSULIN SYRINGES 32G X 5/16" 0.5 ML, 32G X 5/16" 1 ML


INTRALIPID INTRAVENOUS EMULSION

3 B/D

KEVEYIS ORAL TABLET


lactated ringers irrigation solution

1

levocarnitine oral solution

1

LEVOCARNITINE ORAL TABLET

1

methergine oral tablet 3 NDS

methylergonovine maleate injection solution

1

methylergonovine maleate oral tablet

3 NDS

METOPIRONE ORAL CAPSULE

3


MYALEPT SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

NEPHRAMINE INTRAVENOUS SOLUTION

3 B/D

NUTRESTORE ORAL PACKET 5 GM

3

NUTRILIPID INTRAVENOUS EMULSION

3 B/D

OMEGAVEN INTRAVENOUS EMULSION

3 B/D

OMNIPOD 2 QL (30 EA per 30 days)

OMNIPOD 5 PACK 2 QL (30 EA per 30 days)

OMNIPOD DASH 5 PACK


OMNIPOD DASH SYSTEM KIT


OMNIPOD STARTER KIT


ORALAIR ADULT SAMPLE KIT SUBLINGUAL TABLET SUBLINGUAL


ORALAIR ADULT STARTER PACK SUBLINGUAL TABLET SUBLINGUAL


ORALAIR CHILDRENS SAMPLE KIT SUBLINGUAL THERAPY PACK


ORALAIR CHILDRENS STARTER PACK SUBLINGUAL TABLET SUBLINGUAL


ORALAIR SUBLINGUAL TABLET SUBLINGUAL


oxytocin injection solution

1

130


PHYSIOLYTE IRRIGATION SOLUTION

3

PHYSIOSOL IRRIGATION IRRIGATION SOLUTION

3

PITOCIN INJECTION SOLUTION

3

plenamine intravenous solution

1 B/D

premasol intravenous solution 10 %

3 B/D

premasol intravenous solution 6 %

1 B/D

PROSOL INTRAVENOUS SOLUTION

3 B/D

PROTOPAM CHLORIDE INTRAVENOUS SOLUTION RECONSTITUTED

3

RAGWITEK SUBLINGUAL TABLET SUBLINGUAL


ringers irrigation irrigation solution

1

RUZURGI ORAL TABLET


SMOFLIPID INTRAVENOUS EMULSION

3 B/D

sod benz-sod phenylacet intravenous solution

3 NDS

SODIUM CHLORIDE IRRIGATION SOLUTION

1

SPINRAZA INTRATHECAL SOLUTION

3 PA; NDS

sterile water for irrigation irrigation solution

1


SYNTHAMIN 17 INTRAVENOUS SOLUTION

3 B/D

tis-u-sol irrigation solution

1

TRAVASOL INTRAVENOUS SOLUTION

3 B/D

TROPHAMINE INTRAVENOUS SOLUTION

3 B/D

V-GO 20 KIT 2

V-GO 30 KIT 2

V-GO 40 KIT 2

VISTOGARD ORAL PACKET

3 NDS

VOLUVEN INTRAVENOUS SOLUTION

3

XENICAL ORAL CAPSULE

3 PA

Ophthalmic Agents

Ophthalmic Prostaglandin and Prostamide Analogs

bimatoprost ophthalmic solution


latanoprost ophthalmic solution

1

LUMIGAN OPHTHALMIC SOLUTION


RESCULA OPHTHALMIC SOLUTION 0.15 %


TRAVATAN Z OPHTHALMIC SOLUTION


VYZULTA OPHTHALMIC SOLUTION


XALATAN OPHTHALMIC SOLUTION

3

131


XELPROS OPHTHALMIC EMULSION


ZIOPTAN OPHTHALMIC SOLUTION


Ophthalmic Agents, Other

AKTEN OPHTHALMIC GEL

3

ALCAINE OPHTHALMIC SOLUTION

3

altacaine ophthalmic solution

1

ATROPINE SULFATE OPHTHALMIC SOLUTION

1

bacitracin-polymyxin b ophthalmic ointment

1

CEQUA OPHTHALMIC SOLUTION

3 PA

CYCLOGYL OPHTHALMIC SOLUTION

3

cyclopentolate hcl ophthalmic solution

1

CYSTARAN OPHTHALMIC SOLUTION


EYLEA INTRAVITREAL SOLUTION

3 PA; NDS

isopto atropine ophthalmic solution

1

LACRISERT OPHTHALMIC INSERT

3

LUCENTIS INTRAVITREAL SOLUTION

3 NDS

LUCENTIS INTRAVITREAL SOLUTION PREFILLED SYRINGE

3 NDS

neomycin-bacitracin zn-polymyx ophthalmic ointment

1


neomycin-polymyxin-gramicidin ophthalmic solution

1

neo-polycin ophthalmic ointment

1

NEOSPORIN OPHTHALMIC SOLUTION 1.75-10000-.025

3

OXERVATE OPHTHALMIC SOLUTION


polycin ophthalmic ointment

1

polymyxin b-trimethoprim ophthalmic solution

1

POLYTRIM OPHTHALMIC SOLUTION

3

proparacaine hcl ophthalmic solution

1

RESTASIS OPHTHALMIC EMULSION

2

RHOPRESSA OPHTHALMIC SOLUTION


tetcaine ophthalmic solution

1

tetracaine hcl ophthalmic solution

1

tetravisc forte ophthalmic solution

1

tetravisc ophthalmic solution

1

VISUDYNE INTRAVENOUS SOLUTION RECONSTITUTED

3 NDS

XIIDRA OPHTHALMIC SOLUTION


Ophthalmic Anti-allergy Agents

ALOCRIL OPHTHALMIC SOLUTION

3

132


altafrin ophthalmic solution

1

azelastine hcl ophthalmic solution

1

BEPREVE OPHTHALMIC SOLUTION

3

cromolyn sodium ophthalmic solution

1

ELESTAT OPHTHALMIC SOLUTION 0.05 %

3

EMADINE OPHTHALMIC SOLUTION 0.05 %

3

epinastine hcl ophthalmic solution

1

LASTACAFT OPHTHALMIC SOLUTION

2

olopatadine hcl ophthalmic solution

1

PATADAY OPHTHALMIC SOLUTION

2

PATANOL OPHTHALMIC SOLUTION

3

PAZEO OPHTHALMIC SOLUTION

3

phenylephrine hcl ophthalmic solution

1

Ophthalmic Antiglaucoma Agents

acetazolamide er oral capsule extended release 12 hour

1

acetazolamide oral tablet

1

ALPHAGAN P OPHTHALMIC SOLUTION 0.1 %

2

ALPHAGAN P OPHTHALMIC SOLUTION 0.15 %

3


apraclonidine hcl ophthalmic solution

1

AZOPT OPHTHALMIC SUSPENSION

2

BETAGAN OPHTHALMIC SOLUTION 0.5 %

3

betaxolol hcl ophthalmic solution

1

BETIMOL OPHTHALMIC SOLUTION

3

BETOPTIC-S OPHTHALMIC SUSPENSION

3

BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.15 %

1

brimonidine tartrate ophthalmic solution 0.2 %

1

carteolol hcl ophthalmic solution

1

COMBIGAN OPHTHALMIC SOLUTION

2

COSOPT OPHTHALMIC SOLUTION

3

COSOPT PF OPHTHALMIC SOLUTION 22.3-6.8 MG/ML

3

dorzolamide hcl ophthalmic solution

1

dorzolamide hcl-timolol mal ophthalmic solution

1

dorzolamide hcl-timolol mal pf ophthalmic solution 22.3-6.8 mg/ml

1

IOPIDINE OPHTHALMIC SOLUTION

3

ISOPTO CARPINE OPHTHALMIC SOLUTION

3

133


ISTALOL OPHTHALMIC SOLUTION

3

levobunolol hcl ophthalmic solution

1

methazolamide oral tablet

1

metipranolol ophthalmic solution 0.3 %

1

MIOCHOL-E INTRAOCULAR SOLUTION RECONSTITUTED

3

NEPTAZANE ORAL TABLET 25 MG

3

PHOSPHOLINE IODIDE OPHTHALMIC SOLUTION RECONSTITUTED

3

pilocarpine hcl ophthalmic solution

1

ROCKLATAN OPHTHALMIC SOLUTION


SIMBRINZA OPHTHALMIC SUSPENSION

3

timolol maleate ophthalmic gel forming solution

1

timolol maleate ophthalmic solution

1

TIMOPTIC OCUDOSE OPHTHALMIC SOLUTION

3

TIMOPTIC OPHTHALMIC SOLUTION

3

TIMOPTIC-XE OPHTHALMIC GEL FORMING SOLUTION

3

TRUSOPT OPHTHALMIC SOLUTION

3

Ophthalmic Anti-inflammatories


ACULAR LS OPHTHALMIC SOLUTION

3

ACULAR OPHTHALMIC SOLUTION

3

ACUVAIL OPHTHALMIC SOLUTION

3 ST

ALOMIDE OPHTHALMIC SOLUTION

3

ALREX OPHTHALMIC SUSPENSION

3

bacitra-neomycin-polymyxin-hc ophthalmic ointment

1

BLEPHAMIDE OPHTHALMIC SUSPENSION

3

blephamide s.o.p. ophthalmic ointment

3

bromfenac sodium (once-daily) ophthalmic solution

1

BROMSITE OPHTHALMIC SOLUTION

3 ST

dexamethasone sodium phosphate ophthalmic solution

1

diclofenac sodium ophthalmic solution

1

DUREZOL OPHTHALMIC EMULSION

3

FLAREX OPHTHALMIC SUSPENSION

2

fluorometholone ophthalmic suspension

1

flurbiprofen sodium ophthalmic solution

1

FML FORTE OPHTHALMIC SUSPENSION

2

134


FML LIQUIFILM OPHTHALMIC SUSPENSION

2

FML OPHTHALMIC OINTMENT

2

ILEVRO OPHTHALMIC SUSPENSION


INVELTYS OPHTHALMIC SUSPENSION

3

ketorolac tromethamine ophthalmic solution

1

LOTEMAX OPHTHALMIC GEL


LOTEMAX OPHTHALMIC OINTMENT


LOTEMAX OPHTHALMIC SUSPENSION

3

LOTEMAX SM OPHTHALMIC GEL


loteprednol etabonate ophthalmic suspension

1

MAXIDEX OPHTHALMIC SUSPENSION

2

MAXITROL OPHTHALMIC OINTMENT

3

MAXITROL OPHTHALMIC SUSPENSION

3

neomycin-polymyxin-dexameth ophthalmic ointment

1

neomycin-polymyxin-dexameth ophthalmic suspension 3.5-10000-0.1

1

neomycin-polymyxin-hc ophthalmic suspension

1

neo-polycin hc ophthalmic ointment

1

NEVANAC OPHTHALMIC SUSPENSION



OMNIPRED OPHTHALMIC SUSPENSION 1 %

3

PRED FORTE OPHTHALMIC SUSPENSION

2

PRED MILD OPHTHALMIC SUSPENSION

2

PRED-G OPHTHALMIC SUSPENSION

3

PRED-G S.O.P. OPHTHALMIC OINTMENT

3

prednisolone acetate ophthalmic suspension

1

prednisolone acetate p-f ophthalmic suspension

1

prednisolone sodium phosphate ophthalmic solution

1

PREDNISOLON-MOXIFLOX-KETOROLAC OPHTHALMIC SOLUTION 1-0.5-0.5 %

3

PROLENSA OPHTHALMIC SOLUTION


sulfacetamide-prednisolone ophthalmic solution

1

TOBRADEX OPHTHALMIC OINTMENT

3

TOBRADEX OPHTHALMIC SUSPENSION

3

TOBRADEX ST OPHTHALMIC SUSPENSION

3

tobramycin-dexamethasone ophthalmic suspension

1

TRIESENCE INTRAOCULAR SUSPENSION

3

135


ZYLET OPHTHALMIC SUSPENSION

3

Otic Agents

Otic Agents

acetasol hc otic solution 1

acetic acid otic solution 1

CIPRO HC OTIC SUSPENSION

3

CIPRODEX OTIC SUSPENSION

2

COLY-MYCIN S OTIC SUSPENSION

3

DERMOTIC OTIC OIL 3

flac otic oil 1

fluocinolone acetonide otic oil

1

hydrocortisone-acetic acid otic solution

1

neomycin-polymyxin-hc otic solution 1 %

1

neomycin-polymyxin-hc otic suspension

1

Respiratory Tract/Pulmonary Agents

Antihistamines

ASTEPRO NASAL SOLUTION


azelastine hcl nasal solution 0.1 %, 0.15 %


carbinoxamine maleate oral solution

1 PA

carbinoxamine maleate oral tablet 4 mg

1 PA

carbinoxamine maleate oral tablet 6 mg

1 PA; NDS

cetirizine hcl oral solution 1 mg/ml

1

CLARINEX ORAL SYRUP 0.5 MG/ML

3

CLARINEX ORAL TABLET

3


CLARINEX-D 12 HOUR ORAL TABLET EXTENDED RELEASE 12 HOUR

3

clemastine fumarate oral tablet 2.68 mg

1 PA

cyproheptadine hcl oral syrup

1 PA

cyproheptadine hcl oral tablet

1 PA

desloratadine oral tablet 1

desloratadine oral tablet dispersible

1

dexchlorpheniramine maleate oral solution

1 PA

diphenhydramine hcl injection solution

1

diphenhydramine hcl oral elixir

1 PA

hydroxyzine hcl intramuscular solution

1 PA

hydroxyzine hcl oral syrup

1 PA

hydroxyzine hcl oral tablet

1 PA

hydroxyzine pamoate oral capsule

1 PA

KARBINAL ER ORAL SUSPENSION EXTENDED RELEASE

3 PA

levocetirizine dihydrochloride oral solution

1

levocetirizine dihydrochloride oral tablet

1

olopatadine hcl nasal solution

1 QL (30.5 GM per 30 days)

PATANASE NASAL SOLUTION


ryclora oral solution 3 PA

ryvent oral tablet 1 PA

SEMPREX-D ORAL CAPSULE

3

136


VISTARIL ORAL CAPSULE

3 PA

Anti-inflammatories, Inhaled Corticosteroids

AEROSPAN INHALATION AEROSOL SOLUTION 80 MCG/ACT


ALVESCO INHALATION AEROSOL SOLUTION


ARMONAIR RESPICLICK 113 INHALATION AEROSOL POWDER BREATH ACTIVATED 113 MCG/ACT






ARNUITY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED


ASMANEX (120 METERED DOSES) INHALATION AEROSOL POWDER BREATH ACTIVATED











ASMANEX HFA INHALATION AEROSOL


BECONASE AQ NASAL SUSPENSION


BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED


budesonide inhalation suspension


budesonide nasal suspension


DYMISTA NASAL SUSPENSION


FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 100 MCG/BLIST, 50 MCG/BLIST


FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED 250 MCG/BLIST


FLOVENT HFA INHALATION AEROSOL 110 MCG/ACT, 220 MCG/ACT


FLOVENT HFA INHALATION AEROSOL 44 MCG/ACT


flunisolide nasal solution


137


fluticasone propionate nasal suspension

1

mometasone furoate nasal suspension


NASONEX NASAL SUSPENSION


NUCALA SUBCUTANEOUS SOLUTION RECONSTITUTED


OMNARIS NASAL SUSPENSION


PULMICORT FLEXHALER INHALATION AEROSOL POWDER BREATH ACTIVATED


PULMICORT SUSPENSION INHALATION SUSPENSION


QNASL CHILDRENS NASAL AEROSOL SOLUTION


QNASL NASAL AEROSOL SOLUTION


QVAR INHALATION AEROSOL SOLUTION 40 MCG/ACT


QVAR INHALATION AEROSOL SOLUTION 80 MCG/ACT


QVAR REDIHALER INHALATION AEROSOL BREATH ACTIVATED


triamcinolone acetonide nasal aerosol

1

XHANCE NASAL EXHALER SUSPENSION

3

ZETONNA NASAL AEROSOL SOLUTION


Antileukotrienes

ACCOLATE ORAL TABLET

3


montelukast sodium oral packet

1

montelukast sodium oral tablet

1

montelukast sodium oral tablet chewable

1

SINGULAIR ORAL PACKET

3

SINGULAIR ORAL TABLET

3

SINGULAIR ORAL TABLET CHEWABLE

3

zafirlukast oral tablet 1

zileuton er oral tablet extended release 12 hour

3 ST; NDS

ZYFLO CR ORAL TABLET EXTENDED RELEASE 12 HOUR 600 MG

3 ST; NDS

ZYFLO ORAL TABLET 3 ST; NDS

Bronchodilators, Anticholinergic

ATROVENT HFA INHALATION AEROSOL SOLUTION


COMBIVENT RESPIMAT INHALATION AEROSOL SOLUTION


INCRUSE ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED


ipratropium bromide inhalation solution

1 B/D; QL (312.5 ML per 30 days)

ipratropium bromide nasal solution

1

ipratropium-albuterol inhalation solution


LONHALA MAGNAIR REFILL KIT INHALATION SOLUTION


138


LONHALA MAGNAIR STARTER KIT INHALATION SOLUTION


SEEBRI NEOHALER INHALATION CAPSULE

3

SPIRIVA HANDIHALER INHALATION CAPSULE


SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 1.25 MCG/ACT


SPIRIVA RESPIMAT INHALATION AEROSOL SOLUTION 2.5 MCG/ACT


TUDORZA PRESSAIR INHALATION AEROSOL POWDER BREATH ACTIVATED


YUPELRI INHALATION SOLUTION


Bronchodilators, Sympathomimetic

albuterol sulfate er oral tablet extended release 12 hour

3

ALBUTEROL SULFATE HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT


ALBUTEROL SULFATE HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT (BRAND EQUIVALENT PROVENTIL)


ALBUTEROL SULFATE HFA INHALATION AEROSOL SOLUTION 108 (90 BASE) MCG/ACT (BRAND EQUIVALENT VENTOLIN)



albuterol sulfate inhalation nebulization solution (2.5 mg/3ml) 0.083%


albuterol sulfate inhalation nebulization solution (5 mg/ml) 0.5%


albuterol sulfate inhalation nebulization solution 0.63 mg/3ml, 1.25 mg/3ml


albuterol sulfate oral syrup

3

albuterol sulfate oral tablet

3

ARCAPTA NEOHALER INHALATION CAPSULE


AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.1 MG/0.1ML


AUVI-Q INJECTION SOLUTION AUTO-INJECTOR 0.15 MG/0.15ML, 0.3 MG/0.3ML

3 ST; NDS

BEVESPI AEROSPHERE INHALATION AEROSOL

3 ST; QL (10.7 GM per 30 days)

BROVANA INHALATION NEBULIZATION SOLUTION


epinephrine injection solution 0.3 mg/0.3ml

3

ST; Applies to products manufactured by Impax or Lineage Therapeutics

epinephrine injection solution auto-injector 0.15 mg/0.15ml

3 ST


2

139



2

Applies to product manufactured by Mylan Specialty L.P. Only

EPIPEN 2-PAK INJECTION SOLUTION AUTO-INJECTOR

2

EPIPEN JR 2-PAK INJECTION SOLUTION AUTO-INJECTOR

2

isoproterenol hcl injection solution

1

ISUPREL INJECTION SOLUTION

3

levalbuterol hcl inhalation nebulization solution 0.31 mg/3ml, 0.63 mg/3ml


levalbuterol hcl inhalation nebulization solution 1.25 mg/0.5ml


levalbuterol hcl inhalation nebulization solution 1.25 mg/3ml


levalbuterol hfa inhalation aerosol 45 mcg/act


metaproterenol sulfate oral syrup

3

metaproterenol sulfate oral tablet 10 mg, 20 mg

3

PERFOROMIST INHALATION NEBULIZATION SOLUTION


PROAIR HFA INHALATION AEROSOL SOLUTION


PROAIR RESPICLICK INHALATION AEROSOL POWDER BREATH ACTIVATED


PROVENTIL HFA INHALATION AEROSOL SOLUTION

3 ST; QL (13.4 GM per 30 days)


SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED


STRIVERDI RESPIMAT INHALATION AEROSOL SOLUTION


SYMJEPI INJECTION SOLUTION PREFILLED SYRINGE

3 ST

terbutaline sulfate injection solution

3 NDS

terbutaline sulfate oral tablet

3

UTIBRON NEOHALER INHALATION CAPSULE

3 ST

VENTOLIN HFA INHALATION AEROSOL SOLUTION

3 ST; QL (48 GM per 30 days)

XOPENEX CONCENTRATE INHALATION NEBULIZATION SOLUTION


XOPENEX HFA INHALATION AEROSOL


XOPENEX INHALATION NEBULIZATION SOLUTION 0.31 MG/3ML, 0.63 MG/3ML


XOPENEX INHALATION NEBULIZATION SOLUTION 1.25 MG/3ML


Cystic Fibrosis Agents

BETHKIS INHALATION NEBULIZATION SOLUTION

3 B/D; NDS

CAYSTON INHALATION SOLUTION RECONSTITUTED

3 PA; NDS

140


KALYDECO ORAL PACKET

3 PA; NDS

KALYDECO ORAL TABLET

3 PA; NDS

KITABIS PAK INHALATION NEBULIZATION SOLUTION

3 B/D; NDS

ORKAMBI ORAL PACKET


ORKAMBI ORAL TABLET


PULMOZYME INHALATION SOLUTION

3 PA; NDS

SYMDEKO ORAL TABLET THERAPY PACK


TOBI NEBULIZER INHALATION NEBULIZATION SOLUTION

3 B/D; NDS

TOBI PODHALER INHALATION CAPSULE


tobramycin inhalation nebulization solution

3 B/D; NDS

Mast Cell Stabilizers

cromolyn sodium inhalation nebulization solution

1 B/D

Phosphodiesterase Inhibitors, Airways Disease

aminophylline intravenous solution

1

DALIRESP ORAL TABLET

3 PA

ELIXOPHYLLIN ORAL ELIXIR

3

theo-24 oral capsule extended release 24 hour

3


theochron oral tablet extended release 12 hour

1

theophylline er oral tablet extended release 12 hour

1

theophylline er oral tablet extended release 24 hour

1

theophylline in d5w intravenous solution

1

theophylline oral solution

1

Pulmonary Antihypertensives

ADCIRCA ORAL TABLET


ADEMPAS ORAL TABLET


alyq oral tablet 1 PA; QL (60 EA per 30 days); NDS

ambrisentan oral tablet 1 PA; QL (30 EA per 30 days); NDS

bosentan oral tablet 1 PA; QL (60 EA per 30 days)

epoprostenol sodium intravenous solution reconstituted

3 PA; NDS

FLOLAN INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

LETAIRIS ORAL TABLET


OPSUMIT ORAL TABLET


ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG

3 PA

141


ORENITRAM ORAL TABLET EXTENDED RELEASE 0.25 MG, 1 MG, 2.5 MG, 5 MG

3 PA; NDS

REMODULIN INJECTION SOLUTION

3 PA; NDS

REVATIO INTRAVENOUS SOLUTION

3 PA; NDS

REVATIO ORAL SUSPENSION RECONSTITUTED

3 PA; NDS

REVATIO ORAL TABLET


sildenafil citrate intravenous solution

3 PA; NDS

sildenafil citrate oral suspension reconstituted

1 PA; NDS

sildenafil citrate oral tablet 20 mg


tadalafil (pah) oral tablet 1 PA; QL (60 EA per 30 days); NDS

TRACLEER 62.5 MG, 125 MG


TRACLEER 32 MG 3 PA; QL (112 EA per 28 days); NDS

treprostinil injection solution

1 PA; NDS

TYVASO INHALATION SOLUTION


TYVASO REFILL INHALATION SOLUTION


TYVASO STARTER INHALATION SOLUTION


UPTRAVI ORAL TABLET



UPTRAVI ORAL TABLET THERAPY PACK


VELETRI INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

VENTAVIS INHALATION SOLUTION


Pulmonary Fibrosis Agents

ESBRIET ORAL TABLET

3 PA; NDS

Respiratory Tract Agents, Other

acetylcysteine inhalation solution

1 B/D

ADVAIR DISKUS INHALATION AEROSOL POWDER BREATH ACTIVATED


ADVAIR HFA INHALATION AEROSOL


AIRDUO RESPICLICK 113/14 INHALATION AEROSOL POWDER BREATH ACTIVATED






ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED


ARALAST NP INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

CINQAIR INTRAVENOUS SOLUTION

3 PA; NDS

142


DULERA INHALATION AEROSOL


DUPIXENT SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 200 MG/1.14ML


ESBRIET ORAL CAPSULE

3 PA; NDS

FASENRA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

fluticasone-salmeterol inhalation aerosol powder breath activated 100-50 mcg/dose, 250-50 mcg/dose, 500-50 mcg/dose


fluticasone-salmeterol inhalation aerosol powder breath activated 113-14 mcg/act, 232-14 mcg/act, 55-14 mcg/act


GLASSIA INTRAVENOUS SOLUTION

3 PA; NDS

HYPERSAL INHALATION NEBULIZATION SOLUTION

3 B/D

nebusal inhalation nebulization solution 3 %

1 B/D

NEBUSAL INHALATION NEBULIZATION SOLUTION 6 %

3 B/D

NUCALA SUBCUTANEOUS SOLUTION AUTO-INJECTOR


NUCALA SUBCUTANEOUS SOLUTION PREFILLED SYRINGE



ODACTRA SUBLINGUAL TABLET SUBLINGUAL


OFEV ORAL CAPSULE 3 PA; NDS

PROLASTIN-C INTRAVENOUS SOLUTION

3 PA; NDS

PROLASTIN-C INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

promethazine vc plain oral solution 6.25-5 mg/5ml

1 PA

promethazine-phenylephrine oral syrup

1 PA

pulmosal inhalation nebulization solution

1 B/D

ribavirin inhalation solution reconstituted

3 NDS

sodium chloride inhalation nebulization solution

1 B/D

STIOLTO RESPIMAT INHALATION AEROSOL SOLUTION


SYMBICORT INHALATION AEROSOL 160-4.5 MCG/ACT


SYMBICORT INHALATION AEROSOL 80-4.5 MCG/ACT


TRELEGY ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED


VIRAZOLE INHALATION SOLUTION RECONSTITUTED

3 NDS

wixela inhub inhalation aerosol powder breath activated


143


XOLAIR SUBCUTANEOUS SOLUTION PREFILLED SYRINGE

3 PA; NDS

XOLAIR SUBCUTANEOUS SOLUTION RECONSTITUTED

3 PA; NDS

ZEMAIRA INTRAVENOUS SOLUTION RECONSTITUTED

3 PA; NDS

Skeletal Muscle Relaxants

Skeletal Muscle Relaxants

AMRIX ORAL CAPSULE EXTENDED RELEASE 24 HOUR

3 PA; NDS

ANECTINE INJECTION SOLUTION

3

carisoprodol oral tablet 1 PA

carisoprodol-aspirin oral tablet

1 PA

CHLORZOXAZONE ORAL TABLET 250 MG

3 PA; NDS

chlorzoxazone oral tablet 375 mg, 500 mg, 750 mg

1 PA

cisatracurium besylate (pf) intravenous solution 10 mg/5ml

1

cyclobenzaprine hcl er oral capsule extended release 24 hour

1 PA

cyclobenzaprine hcl oral tablet

1 PA

fexmid oral tablet 3 PA

lorzone oral tablet 3 PA

metaxall oral tablet 800 mg

1 PA

metaxalone oral tablet 1 PA

methocarbamol injection solution

1 PA

methocarbamol oral tablet

1 PA


NIMBEX INTRAVENOUS SOLUTION 10 MG/5ML

3

NORGESIC FORTE ORAL TABLET

3 PA; NDS

orphenadrine citrate er oral tablet extended release 12 hour

1 PA

orphenadrine citrate injection solution

1

orphenadrine-aspirin-caffeine oral tablet

1 PA

ORPHENGESIC FORTE ORAL TABLET

3 PA

QUELICIN INJECTION SOLUTION

3

ROBAXIN INJECTION SOLUTION

3 PA; NDS

ROBAXIN ORAL TABLET 500 MG

3 PA

ROBAXIN-750 ORAL TABLET

3 PA

SKELAXIN ORAL TABLET

3 PA

SOMA ORAL TABLET 250 MG

3 PA

SOMA ORAL TABLET 350 MG

3 PA; NDS

succinylcholine chloride injection solution

1

Sleep Disorder Agents

GABA Receptor Modulators

AMBIEN CR ORAL TABLET EXTENDED RELEASE


AMBIEN ORAL TABLET


EDLUAR SUBLINGUAL TABLET SUBLINGUAL


eszopiclone oral tablet 1 QL (30 EA per 30 days)

flurazepam hcl oral capsule


144


INTERMEZZO SUBLINGUAL TABLET SUBLINGUAL


LUNESTA ORAL TABLET


SONATA ORAL CAPSULE 10 MG


SONATA ORAL CAPSULE 5 MG


zaleplon oral capsule 10 mg


zaleplon oral capsule 5 mg


zolpidem tartrate er oral tablet extended release


zolpidem tartrate oral tablet


zolpidem tartrate sublingual tablet sublingual


ZOLPIMIST ORAL SOLUTION


Sleep Disorders, Other

armodafinil oral tablet 150 mg, 200 mg, 250 mg


armodafinil oral tablet 50 mg


BELSOMRA ORAL TABLET


BUTISOL SODIUM ORAL TABLET

3 PA

HETLIOZ ORAL CAPSULE


modafinil oral tablet 1 PA; QL (30 EA per 30 days)

NEMBUTAL INJECTION SOLUTION

3 PA

NUVIGIL ORAL TABLET 150 MG, 200 MG, 250 MG


NUVIGIL ORAL TABLET 50 MG



pentobarbital sodium injection solution

1 PA

PROVIGIL ORAL TABLET


ramelteon oral tablet 1 QL (30 EA per 30 days)

ROZEREM ORAL TABLET


SECONAL ORAL CAPSULE

3 PA; NDS

SILENOR ORAL TABLET


SUNOSI ORAL TABLET


XYREM ORAL SOLUTION


145

Index of Drugs

7 7t lido ..................................... 13 A abacavir sulfate ...................... 61 abacavir sulfate-lamivudine.... 61 abacavir-lamivudine-zidovudine

.......................................... 61 ABELCET .............................. 36 ABILIFY ................................. 54 ABILIFY MAINTENA .............. 54 ABILIFY MYCITE ................... 54 abiraterone acetate ................ 43 ABRAXANE ........................... 44 ABSORICA ............................ 88 ABSTRAL .............................. 10 acamprosate calcium ............. 14 ACANYA ................................ 88 acarbose ................................ 64 ACCOLATE ......................... 137 ACCUPRIL ............................ 73 ACCURETIC .......................... 73 acebutolol hcl ......................... 75 ACETADOTE ....................... 128 acetaminophen-codeine ... 10, 11 acetaminophen-codeine #3 .... 10 acetasol hc .......................... 135 acetazolamide...................... 132 acetazolamide er ................. 132 acetazolamide sodium ........... 80 acetic acid .................... 103, 135 acetylcysteine .............. 128, 141 ACIPHEX ............................... 99 ACIPHEX SPRINKLE ............ 99 acitretin .................................. 88 ACTEMRA ........................... 123 ACTEMRA ACTPEN ............ 123 ACTHAR .............................. 108 ACTHIB ............................... 124 ACTIGALL ............................. 97 ACTIMMUNE ....................... 123 ACTIQ ................................... 11 ACTIVELLA ......................... 111 ACTONEL ............................ 126 ACTOPLUS MET ................... 64 ACTOPLUS MET XR ............. 64 ACTOS .................................. 64 ACULAR .............................. 133 ACULAR LS ......................... 133 ACUVAIL ............................. 133 acyclovir................................. 59 acyclovir sodium .................... 59 ACZONE ................................ 88

ADACEL .............................. 124 ADAGEN ............................. 100 ADALAT CC .......................... 77 adapalene ............................. 88 adapalene-benzoyl peroxide .. 88 adc/f (0.5mg/ml) .................... 96 ADCETRIS ............................ 50 ADCIRCA ............................ 140 adderall ................................. 83 ADDERALL ........................... 83 ADDERALL XR ..................... 83 adefovir dipivoxil .................... 58 ADEMPAS ........................... 140 ADENOCARD ....................... 74 adenosine .............................. 74 ADHANSIA XR ...................... 84 ADLYXIN ............................... 64 ADLYXIN STARTER PACK ... 64 ADMELOG ............................ 67 ADMELOG SOLOSTAR ........ 67 ADRENALIN .......................... 78 adriamycin ............................. 44 adrucil ................................... 43 ADVAIR DISKUS ................. 141 ADVAIR HFA ....................... 141 ADZENYS ER ....................... 83 ADZENYS XR-ODT ............... 83 AEMCOLO ............................ 16 AEROSPAN ........................ 136 afeditab cr ............................. 77 AFINITOR ............................. 48 AFINITOR DISPERZ ............. 48 afirmelle ............................... 111 AFREZZA .............................. 67 AGGRENOX ......................... 72 AGRYLIN .............................. 70 AIMOVIG ............................... 39 AIRDUO RESPICLICK 113/14

........................................ 141 AIRDUO RESPICLICK 232/14

........................................ 141 AIRDUO RESPICLICK 55/14

........................................ 141 AJOVY .................................. 39 AKTEN ................................ 131 AKTIPAK ............................... 88 AKYNZEO ....................... 34, 97 ala scalp .............................. 103 ala-cort ................................ 103 albendazole ........................... 51 ALBENZA .............................. 51 albuterol sulfate ................... 138

albuterol sulfate er .............. 138 ALBUTEROL SULFATE HFA

........................................ 138 ALCAINE ............................ 131 alclometasone dipropionate 103 alcohol prep pads ................ 128 ALDACTAZIDE ..................... 80 ALDACTONE ........................ 80 ALDARA ............................... 88 ALDURAZYME ................... 100 ALECENSA ........................... 48 alendronate sodium............. 126 alfuzosin hcl er .................... 102 ALIMTA ................................. 43 ALINIA .................................. 52 ALIQOPA .............................. 48 aliskiren fumarate .................. 78 ALKERAN ............................. 42 allopurinol ............................. 38 allopurinol sodium ................. 38 allzital ...................................... 7 almotriptan malate ................ 40 ALOCRIL ............................ 131 alogliptin benzoate ................ 64 ALOGLIPTIN-METFORMIN

HCL ................................... 64 alogliptin-pioglitazone ............ 65 ALOMIDE ............................ 133 ALOPRIM .............................. 38 ALORA................................ 111 alosetron hcl ......................... 98 ALOXI ................................... 35 ALPHAGAN P ..................... 132 alprazolam ............................ 63 alprazolam er ........................ 63 alprazolam intensol ............... 63 alprazolam xr ........................ 63 ALREX ................................ 133 ALTABAX .............................. 16 altacaine ............................. 131 ALTACE ................................ 73 altafrin ................................. 132 altavera ............................... 111 ALTOPREV ........................... 81 ALTRENO ............................. 88 ALUNBRIG ........................... 48 ALVESCO ........................... 136 alyacen 1/35 ....................... 111 alyacen 7/7/7....................... 111 alyq ..................................... 140 amabelz .............................. 111 amantadine hcl ...................... 62

146

AMARYL ................................ 65 AMBIEN ............................... 143 AMBIEN CR ......................... 143 AMBISOME ........................... 36 ambrisentan ......................... 140 amcinonide .......................... 103 AMERGE ............................... 40 amethia ................................ 111 amethia lo ............................ 111 amethyst .............................. 111 AMICAR................................. 71 amifostine .............................. 44 amikacin sulfate ..................... 15 amiloride hcl .......................... 80 amiloride-hydrochlorothiazide 80 AMINO ACID ....................... 128 aminocaproic acid .................. 71 aminophylline ....................... 140 AMINOSYN ......................... 128 AMINOSYN II....................... 128 aminosyn ii/electrolytes .......... 92 AMINOSYN M........................ 92 aminosyn/electrolytes ............ 92 AMINOSYN/ELECTROLYTES

.......................................... 92 AMINOSYN-HBC ................. 128 AMINOSYN-PF .................... 128 AMINOSYN-RF .................... 128 amiodarone hcl ...................... 74 AMITIZA ................................ 98 amitriptyline hcl ...................... 34 amlodipine besylate ............... 77 amlodipine besylate-benazepril

hcl ...................................... 77 amlodipine besylate-valsartan 77 amlodipine-atorvastatin .......... 77 amlodipine-olmesartan ........... 77 amlodipine-valsartan-hctz ...... 77 ammonium lactate ........... 88, 89 AMMONUL .......................... 128 amnesteem ............................ 89 amoxapine ............................. 34 amoxicill-clarithro-lansopraz ... 97 amoxicillin .............................. 21 amoxicillin-potassium

clavulanate ......................... 21 amoxicillin-potassium

clavulanate er .................... 21 amphetamine sulfate.............. 83 amphetamine-

dextroamphetamine ........... 83 amphetamine-

dextroamphetamine er ....... 83 amphotericin b ....................... 36

ampicillin ............................... 22 ampicillin sodium ................... 22 ampicillin-sulbactam sodium .. 22 AMPYRA ............................... 86 AMRIX ................................. 143 ANADROL-50 ...................... 110 ANAFRANIL .......................... 34 anagrelide hcl ........................ 70 ANAPROX DS ......................... 7 anastrozole ............................ 48 ANCOBON ............................ 36 ANDRODERM ..................... 110 ANDROGEL ........................ 110 ANDROGEL PUMP ............. 110 ANDROID ............................ 110 ANDROXY .......................... 110 ANECTINE .......................... 143 ANGELIQ ............................ 111 ANORO ELLIPTA ................ 141 antabuse ............................... 14 ANTARA ................................ 81 anusol-hc ............................... 39 ANZEMET ............................. 35 APADAZ ................................ 11 apap-caff-dihydrocodeine ...... 11 apexicon e ........................... 103 APIDRA SOLOSTAR ............. 67 APIDRA VIAL ........................ 67 APLENZIN ............................. 31 APOKYN ............................... 53 apraclonidine hcl ................. 132 aprepitant .............................. 35 apri ...................................... 111 APRISO ............................... 125 APTENSIO XR ...................... 84 APTIOM ................................ 26 APTIVUS ............................... 62 ARAKODA ............................. 52 ARALAST NP ...................... 141 aranelle ............................... 111 ARANESP (ALBUMIN FREE) 70 ARAVA ................................ 123 ARCALYST ......................... 123 ARCAPTA NEOHALER ....... 138 ARESTIN ............................... 88 argatroban ............................. 68 argatroban in sodium chloride 68 argyle sterile saline .............. 128 argyle sterile water .............. 128 ARICEPT ............................... 30 ARIKAYCE ............................ 15 ARIMIDEX ............................. 48 aripiprazole ............................ 54 ARISTADA ............................ 54

ARISTADA INITIO ................ 54 ARIXTRA ........................ 68, 69 armodafinil .......................... 144 ARMONAIR RESPICLICK 113

........................................ 136 ARMONAIR RESPICLICK 232

........................................ 136 ARMONAIR RESPICLICK 55

........................................ 136 ARMOUR THYROID ........... 117 ARNUITY ELLIPTA ............. 136 AROMASIN ........................... 48 ARRANON ............................ 43 arsenic trioxide ...................... 44 ARTHROTEC .......................... 7 ARTICADENT DENTAL ........ 13 ARYMO ER ............................. 9 ARZERRA ............................. 50 ASACOL HD ....................... 126 ascomp-codeine .................... 11 ashlyna ............................... 111 ASMANEX (120 METERED

DOSES) .......................... 136 ASMANEX (14 METERED




DOSES) .......................... 136 ASMANEX HFA .................. 136 aspirin-dipyridamole er .......... 72 ASPIRIN-OMEPRAZOLE ...... 72 ASTAGRAF XL ................... 119 ASTEPRO ........................... 135 ATACAND ............................. 73 ATACAND HCT .................... 73 atazanavir sulfate .................. 62 ATELVIA ............................. 126 atenolol ................................. 75 atenolol-chlorthalidone .......... 75 ATGAM ............................... 122 ATIVAN ................................. 63 atomoxetine hcl ..................... 84 atorvastatin calcium .............. 81 atovaquone ........................... 52 atovaquone-proguanil hcl ...... 52 ATRALIN ............................... 89 ATRIPLA ............................... 60 atropine sulfate ............... 78, 79 ATROPINE SULFATE ......... 131 ATROVENT HFA ................ 137 AUBAGIO ............................. 86

147

aubra ................................... 111 AUGMENTIN ......................... 22 AUGMENTIN ES-600 ............ 22 AUGMENTIN XR ................... 22 aurovela 1.5/30 .................... 111 aurovela 1/20 ....................... 111 aurovela 24 fe ...................... 111 aurovela fe 1.5/30 ................ 111 aurovela fe 1/20 ................... 111 AURYXIA ............................... 96 AUSTEDO ............................. 85 AUVI-Q ................................ 138 AVALIDE ............................... 73 AVANDIA ............................... 65 AVAPRO ................................ 73 AVASTIN ............................... 50 AVC VAGINAL ....................... 25 AVEED ................................ 110 AVELOX ................................ 24 aviane .................................. 111 avidoxy .................................. 25 AVITA .................................... 89 AVODART ........................... 102 AVONEX PEN ....................... 86 AVONEX PREFILLED ........... 86 AVONEX VIAL

INTRAMUSCULAR KIT ..... 86 AVYCAZ ................................ 19 AXERT .................................. 40 aygestin ............................... 115 ayuna ................................... 111 azacitidine .............................. 44 AZACTAM ............................. 21 AZACTAM IN DEXTROSE..... 21 azasan ................................. 119 AZASITE ................................ 23 azathioprine ......................... 119 azathioprine sodium ............. 119 azelaic acid ............................ 89 azelastine hcl ............... 132, 135 AZELEX ................................. 89 AZILECT ................................ 54 azithromycin .......................... 23 AZITHROMYCIN ................... 23 AZOPT ................................ 132 AZOR .................................... 77 aztreonam .............................. 21 AZULFIDINE ........................ 126 AZULFIDINE EN-TABS ....... 126 azurette................................ 111 B baciim .................................... 16 bacitracin ............................... 16 bacitracin-polymyxin b ......... 131

bacitra-neomycin-polymyxin-hc ........................................ 133

baclofen................................. 57 BACTOCILL IN DEXTROSE . 22 BACTRIM .............................. 25 BACTRIM DS ........................ 25 BACTROBAN ........................ 16 BACTROBAN NASAL ........... 16 balsalazide disodium ........... 126 BALVERSA ........................... 48 balziva ................................. 111 BANZEL ................................ 29 BARACLUDE ........................ 58 BASAGLAR KWIKPEN .......... 67 BAVENCIO ............................ 50 BAXDELA .............................. 24 BCG VACCINE .................... 124 BECONASE AQ .................. 136 bekyree ............................... 111 BELBUCA ............................... 9 BELEODAQ .......................... 45 BELRAPZO ........................... 42 BELSOMRA ........................ 144 benazepril hcl ........................ 73 benazepril-hydrochlorothiazide

.......................................... 74 bendamustine hcl .................. 42 BENDEKA ............................. 42 BENICAR .............................. 73 BENICAR HCT ...................... 73 BENLYSTA ......................... 119 BENTYL ................................ 97 BENZACLIN .......................... 89 BENZACLIN WITH PUMP ..... 89 BENZAMYCIN ....................... 89 BENZNIDAZOLE ................... 51 BENZOYL PEROXIDE .......... 89 BENZOYL PEROXIDE FORTE-

HC ..................................... 89 benzoyl peroxide-erythromycin

.......................................... 89 benztropine mesylate ............ 52 BEPREVE ........................... 132 BERINERT .......................... 119 beser ................................... 103 BESIVANCE .......................... 24 BESPONSA .......................... 50 BETAGAN ........................... 132 betamethasone dipropionate 104 betamethasone dipropionate

aug .................................. 103 betamethasone sod phos & acet

........................................ 104 betamethasone valerate ...... 104

BETAPACE ........................... 74 BETAPACE AF ..................... 74 BETASERON ........................ 86 betaxolol hcl .................. 75, 132 bethanechol chloride ........... 103 BETHKIS ............................ 139 BETIMOL ............................ 132 BETOPTIC-S ...................... 132 BEVESPI AEROSPHERE ... 138 BEVYXXA ............................. 69 bexarotene ............................ 51 BEXSERO .......................... 124 BEYAZ ................................ 111 bicalutamide .......................... 43 BICILLIN C-R ........................ 22 BICILLIN C-R 900/300 .......... 22 BICILLIN L-A ......................... 22 BICNU................................... 42 BIDIL ..................................... 82 BIJUVA ............................... 111 BIKTARVY ............................ 60 BILTRICIDE .......................... 51 bimatoprost ......................... 130 BINOSTO ............................ 126 bisoprolol fumarate ............... 75 bisoprolol-hydrochlorothiazide75 BIVIGAM ............................. 122 BLEO 15K ............................. 45 bleomycin sulfate .................. 45 bleph-10 ................................ 25 BLEPHAMIDE ..................... 133 blephamide s.o.p. ................ 133 BLINCYTO ............................ 50 blisovi 24 fe ......................... 111 blisovi fe 1.5/30 ................... 111 blisovi fe 1/20 ...................... 111 BONIVA .............................. 126 BONJESTA ........................... 34 BOOSTRIX ......................... 124 BORTEZOMIB ...................... 45 bosentan ............................. 140 BOSULIF .............................. 48 BOTOX ................................. 57 bp wash ................................ 89 BRAFTOVI ............................ 45 BREO ELLIPTA .................. 136 BREVIBLOC ......................... 75 BREVIBLOC IN NACL .......... 75 BREVIBLOC PREMIXED ...... 76 BREVIBLOC PREMIXED DS 76 briellyn ................................ 111 BRILINTA .............................. 72 brimonidine tartrate ............. 132 BRIMONIDINE TARTRATE 132

148

BRISDELLE ........................... 32 BRIVIACT .............................. 26 bromfenac sodium (once-daily)

........................................ 133 bromocriptine mesylate .......... 53 BROMSITE .......................... 133 BROVANA ........................... 138 BRYHALI ............................. 104 budesonide .................. 126, 136 budesonide er ...................... 126 bumetanide ............................ 80 BUMEX .................................. 80 BUNAVAIL ............................. 14 bupap ......................................7 BUPHENYL ......................... 100 bupivacaine hcl ...................... 13 bupivacaine hcl (pf) ................ 13 bupivacaine in dextrose ......... 13 bupivacaine spinal ................. 13 bupivacaine-epinephrine ........ 13 bupivacaine-epinephrine (pf) .. 13 BUPRENEX .............................9 buprenorphine..........................9 buprenorphine hcl .............. 9, 14 buprenorphine hcl-naloxone hcl

.......................................... 14 bupropion hcl ......................... 31 bupropion hcl er (smoking det)

.......................................... 15 bupropion hcl er (sr) ............... 31 bupropion hcl er (xl) ............... 31 buspirone hcl ......................... 63 busulfan ................................. 42 BUSULFEX ............................ 42 butalbital-acetaminophen .........7 butalbital-apap-caff-cod ......... 11 butalbital-apap-caffeine ...... 7, 85 butalbital-asa-caff-codeine ..... 11 butalbital-aspirin-caffeine .........7 BUTISOL SODIUM .............. 144 butorphanol tartrate ............... 11 BUTRANS ...............................9 BYDUREON .......................... 65 BYDUREON BCISE

AUTOINJECTOR ............... 65 BYETTA 10 MCG PEN .......... 65 BYETTA 5 MCG PEN ............ 65 BYSTOLIC ............................. 76 BYVALSON ........................... 76 C cabergoline .......................... 117 CABLIVI ................................. 72 CABOMETYX ........................ 48 CADUET ................................ 77

CAFCIT ................................. 86 cafergot ................................. 39 caffeine citrate ....................... 86 CALAN .................................. 77 CALAN SR ............................ 77 calcipotriene .......................... 89 calcipotriene-betameth diprop 89 calcitonin (salmon) .............. 127 calcitrene ............................... 89 calcitriol ............................... 127 CALCITRIOL ......................... 89 calcium acetate (phos binder) 96 CALCIUM DISODIUM

VERSENATE ..................... 97 calcium gluconate .................. 92 calcium gluconate-nacl .......... 92 CALDOLOR ............................ 7 CALQUENCE ........................ 48 CAMBIA .................................. 7 camila .................................. 115 CAMPTOSAR........................ 48 camrese .............................. 111 camrese lo ........................... 111 CANASA ............................. 126 CANCIDAS ............................ 36 candesartan cilexetil .............. 73 candesartan cilexetil-hctz ...... 73 capacet.................................... 7 CAPASTAT SULFATE .......... 41 CAPEX ................................ 104 CAPRELSA ........................... 48 captopril................................. 74 captopril-hydrochlorothiazide . 74 CARAC.................................. 43 CARAFATE ........................... 99 CARBAGLU .......................... 92 carbamazepine ................ 29, 30 carbamazepine er .................. 29 CARBATROL ........................ 30 carbidopa .............................. 53 carbidopa-levodopa ............... 53 carbidopa-levodopa er ........... 53 carbidopa-levodopa-entacapone

.......................................... 53 carbinoxamine maleate ....... 135 CARBOCAINE ....................... 13 CARBOCAINE

PRESERVATIVE-FREE .... 13 carboplatin ............................. 42 CARDENE IV ........................ 77 CARDIZEM ........................... 77 CARDIZEM CD ..................... 77 CARDIZEM LA ...................... 77 CARDURA .......................... 102

CARDURA XL ..................... 102 CARIMUNE NF ................... 122 carisoprodol ........................ 143 carisoprodol-aspirin ............. 143 carisoprodol-aspirin-codeine . 11 carmustine ............................ 42 CARNITOR ......................... 128 CARNITOR SF .................... 128 CAROSPIR ........................... 80 carteolol hcl ......................... 132 cartia xt ................................. 77 carvedilol ............................... 76 carvedilol phosphate er ......... 76 CASODEX ............................ 43 caspofungin acetate .............. 36 CATAPRES .......................... 72 CATAPRES-TTS-1................ 72 CATAPRES-TTS-2................ 72 CATAPRES-TTS-3................ 72 CAYSTON .......................... 139 caziant ................................ 111 CEDAX ................................. 19 cefaclor ................................. 19 cefaclor er ............................. 19 cefadroxil .............................. 19 cefazolin sodium ................... 19 cefazolin sodium-dextrose..... 19 cefdinir .................................. 19 cefditoren pivoxil ................... 19 cefepime hcl .......................... 19 cefepime-dextrose ................ 19 cefixime ................................. 19 CEFOTAN ............................. 19 cefotaxime sodium ................ 19 cefotetan disodium ................ 19 cefotetan disodium-dextrose . 20 cefoxitin sodium .................... 20 cefoxitin sodium-dextrose...... 20 cefpodoxime proxetil ............. 20 cefprozil ................................ 20 ceftazidime ............................ 20 ceftazidime and dextrose ...... 20 ceftibuten .............................. 20 CEFTIN ................................. 20 ceftriaxone sodium ................ 20 ceftriaxone sodium in dextrose

.......................................... 20 ceftriaxone sodium-dextrose . 20 cefuroxime axetil ................... 20 cefuroxime sodium ................ 20 CELEBREX ............................. 7 celecoxib ................................. 7 CELESTONE SOLUSPAN .. 104 CELEXA ................................ 32

149

CELLCEPT .......................... 119 CELLCEPT INTRAVENOUS 119 CELONTIN ............................ 27 CENTANY ............................. 16 cephalexin ............................. 20 CEPROTIN ............................ 69 CEQUA ................................ 131 CERDELGA ......................... 100 CEREBYX ............................. 30 CEREZYME ......................... 100 CERVIDIL ............................ 110 CESAMET ............................. 35 cetirizine hcl ......................... 135 CETRAXAL ............................ 24 CETYLEV ............................ 128 cevimeline hcl ........................ 88 CHANTIX ............................... 15 CHANTIX CONTINUING

MONTH PAK ..................... 15 CHANTIX STARTING MONTH

PAK ................................... 15 chateal ................................. 111 chateal eq ............................ 111 CHEMET ............................... 95 chenodal ................................ 97 chloramphenicol sod succinate

.......................................... 16 chlordiazepoxide hcl .............. 63 chlordiazepoxide-amitriptyline 34 chlorhexidine gluconate ......... 88 chloroprocaine hcl (pf) ........... 13 chloroquine phosphate ........... 52 chlorothiazide ........................ 80 chlorothiazide sodium ............ 80 chlorpromazine hcl ................. 54 chlorpropamide ...................... 65 chlorthalidone ........................ 80 chlorzoxazone...................... 143 CHLORZOXAZONE............. 143 CHOLBAM ............................. 97 cholestyramine....................... 81 cholestyramine light ............... 81 chorionic gonadotropin ......... 108 CIALIS ................................. 103 ciclodan ................................. 36 ciclopirox ................................ 36 ciclopirox olamine .................. 36 cidofovir ................................. 58 cilostazol ................................ 72 CILOXAN ............................... 24 CIMDUO ................................ 61 cimetidine .............................. 98 cimetidine hcl ......................... 98 CIMZIA ................................ 119

CIMZIA PREFILLED KIT ..... 119 CIMZIA STARTER KIT ........ 119 cinacalcet hcl ....................... 127 CINQAIR ............................. 141 CINRYZE ............................ 128 CINVANTI ............................. 35 CIPRO ................................... 24 CIPRO HC ........................... 135 CIPRO IN D5W ..................... 24 CIPRODEX ......................... 135 ciprofloxacin .......................... 24 ciprofloxacin hcl ..................... 24 CIPROFLOXACIN HCL ......... 24 ciprofloxacin in d5w ............... 24 ciprofloxacin-ciproflox hcl er .. 24 cisatracurium besylate (pf)... 143 cisplatin ........................... 42, 45 citalopram hydrobromide ....... 32 CITANEST PLAIN DENTAL .. 88 cladribine ............................... 43 claravis .................................. 89 CLARINEX .......................... 135 CLARINEX-D 12 HOUR ...... 135 clarithromycin ........................ 23 clarithromycin er .................... 23 clemastine fumarate ............ 135 CLENPIQ .............................. 98 cleocin ................................... 16 CLEOCIN .............................. 16 CLEOCIN IN D5W ................. 16 cleocin phosphate ................. 16 CLEOCIN PHOSPHATE ....... 16 CLEOCIN-T ........................... 16 CLIMARA ............................ 111 CLIMARA PRO .................... 111 clindacin etz .................... 16, 89 clindacin pac ......................... 89 clindacin-p ............................. 16 CLINDAGEL .......................... 16 clindamycin hcl ...................... 16 clindamycin palmitate hcl ....... 16 clindamycin phosphate .......... 17 clindamycin phosphate in d5w

.......................................... 17 clindamycin phosphate in nacl

.......................................... 17 clindamycin phosphate-benzoyl

peroxide ............................ 89 clindamycin-tretinoin .............. 89 CLINDESSE .......................... 17 CLINIMIX E/DEXTROSE

(2.75/10) ............................ 92 CLINIMIX E/DEXTROSE

(2.75/5) .............................. 92

CLINIMIX E/DEXTROSE (4.25/10)............................ 92

CLINIMIX E/DEXTROSE (4.25/25)............................ 92

CLINIMIX E/DEXTROSE (4.25/5) ............................. 92

CLINIMIX E/DEXTROSE (5/15) .......................................... 92



CLINIMIX N14G30E .............. 92 CLINIMIX N9G15E ................ 92 CLINIMIX N9G20E ................ 92 CLINIMIX/DEXTROSE (2.75/5)

.......................................... 92 CLINIMIX/DEXTROSE (4.25/10)




.......................................... 92 CLINIMIX/DEXTROSE (5/15) 92 CLINIMIX/DEXTROSE (5/20) 92 CLINIMIX/DEXTROSE (5/25) 93 clinisol sf ............................. 128 CLINOLIPID ........................ 128 clobazam .............................. 27 clobetasol propionate .......... 104 clobetasol propionate e ....... 104 clobetasol propionate emulsion

........................................ 104 CLOBEX ............................. 104 CLOBEX SPRAY ................ 104 clocortolone pivalate ........... 104 clocortolone pivalate pump .. 104 clodan ................................. 104 CLODERM .......................... 104 CLODERM PUMP ............... 104 clofarabine ............................ 43 CLOLAR ............................... 43 clomiphene citrate ............... 117 clomipramine hcl ................... 34 clonazepam .......................... 27 clonidine ................................ 72 clonidine hcl .......................... 72 clonidine hcl (analgesia) ........ 86 clonidine hcl er ...................... 84 clopidogrel bisulfate .............. 72 clorazepate dipotassium ....... 63 CLORPRES .......................... 72

150

clotrimazole ........................... 36 clotrimazole-betamethasone .. 36 clozapine ............................... 56 CLOZARIL ....................... 56, 57 COARTEM ............................. 52 codeine sulfate....................... 11 COGENTIN ............................ 52 colazal ................................. 126 colchicine ............................... 38 COLCHICINE......................... 38 colchicine-probenecid ............ 39 COLCRYS ............................. 39 colesevelam hcl ..................... 81 COLESTID ............................. 82 COLESTID FLAVORED ......... 81 colestipol hcl .......................... 82 colistimethate sodium (cba) ... 17 colocort ................................ 126 COLY-MYCIN M .................... 17 COLY-MYCIN S ................... 135 COLYTE WITH FLAVOR

PACKS .............................. 99 COMBIGAN ......................... 132 COMBIPATCH ..................... 111 COMBIVENT RESPIMAT .... 137 COMBIVIR ............................. 61 COMETRIQ (100 MG DAILY

DOSE) ............................... 48 COMETRIQ (140 MG DAILY

DOSE) ............................... 48 COMETRIQ (60 MG DAILY

DOSE) ............................... 48 COMPLERA .......................... 60 compro .................................. 34 COMTAN ............................... 53 CONCERTA .......................... 84 CONDYLOX .......................... 89 constulose ............................. 99 CONZIP ...................................9 COPAXONE .................... 86, 87 COPEGUS ............................. 59 COPIKTRA ............................ 45 CORDRAN .......................... 104 COREG ................................. 76 COREG CR ........................... 76 coremino ................................ 25 CORGARD ............................ 76 CORLANOR .......................... 79 CORLOPAM .......................... 82 cormax scalp application ...... 104 CORTEF .............................. 104 CORTENEMA ...................... 126 CORTIFOAM ....................... 104 cortisone acetate ................. 104

CORTISPORIN ..................... 17 CORVERT ............................. 74 CORZIDE .............................. 76 COSENTYX (300 MG DOSE) 89 COSENTYX SENSOREADY

(300 MG) ........................... 89 COSMEGEN ......................... 45 COSOPT ............................. 132 COSOPT PF ....................... 132 COTELLIC ............................. 45 COTEMPLA XR-ODT ............ 84 COUMADIN ........................... 69 COZAAR ............................... 73 CREON ............................... 100 CRESEMBA .......................... 36 CRESTOR ............................. 81 CRINONE ............................ 115 CRIXIVAN ............................. 62 cromolyn sodium ... 97, 132, 140 crotan .................................... 52 cryselle-28 ........................... 111 CRYSVITA ............................ 93 CUBICIN ............................... 17 CUBICIN RF .......................... 17 CUPRIMINE .......................... 95 curity sterile saline ............... 128 CUTAQUIG ......................... 122 CUTIVATE .......................... 104 CUVITRU ............................ 122 CUVPOSA ............................. 97 cvs gauze sterile .................. 128 cyclafem 1/35 ...................... 111 cyclafem 7/7/7 ..................... 111 cyclobenzaprine hcl ............. 143 cyclobenzaprine hcl er ......... 143 CYCLOGYL ......................... 131 cyclopentolate hcl ................ 131 cyclophosphamide ................. 42 cycloserine ............................ 41 CYCLOSET ........................... 65 cyclosporine ................ 119, 120 cyclosporine modified .......... 120 CYKLOKAPRON ................... 72 CYMBALTA ........................... 32 cyproheptadine hcl .............. 135 CYRAMZA ............................. 50 cyred ................................... 111 CYSTADANE ...................... 100 CYSTAGON ........................ 100 CYSTARAN ......................... 131 cytarabine .............................. 43 cytarabine (pf) ....................... 43 CYTOGAM .......................... 122 CYTOMEL ........................... 117

CYTOTEC ............................. 99 CYTOVENE .......................... 58 D D.H.E. 45 .............................. 39 dacarbazine .......................... 42 DACOGEN ............................ 45 DACTINOMYCIN .................. 45 DAKLINZA ............................ 58 dalfampridine er .................... 87 DALIRESP .......................... 140 DALVANCE .......................... 17 danazol ............................... 110 DANTRIUM ........................... 57 dantrolene sodium ................ 57 dapsone .......................... 41, 89 DAPTACEL ......................... 124 daptomycin ........................... 17 DAPTOMYCIN ...................... 17 DARAPRIM ........................... 52 darifenacin hydrobromide er 102 DARZALEX ........................... 50 dasetta 1/35 ........................ 111 dasetta 7/7/7 ....................... 111 daunorubicin hcl .................... 45 DAURISMO .......................... 45 DAXBIA ................................. 20 DAYPRO ................................. 7 daysee ................................ 111 DAYTRANA .......................... 84 DDAVP ............................... 108 DDAVP RHINAL TUBE ....... 108 deblitane ............................. 116 DECADRON ....................... 104 decitabine ............................. 45 deferasirox ............................ 95 deferoxamine mesylate ....... 128 DEFITELIO ........................... 79 DELESTROGEN ................. 111 DELSTRIGO ......................... 60 deltasone ............................ 105 delyla .................................. 111 DELZICOL .......................... 126 DEMADEX ............................ 80 demeclocycline hcl ................ 25 DEMEROL ............................ 11 DEMSER .............................. 79 DENAVIR .............................. 59 DEPACON ............................ 27 DEPAKENE .......................... 27 DEPAKOTE .......................... 27 DEPAKOTE ER .................... 27 DEPAKOTE SPRINKLES...... 27 DEPEN TITRATABS ............. 95 depo-estradiol ..................... 111

151

DEPO-MEDROL .................. 105 DEPO-PROVERA ................ 116 DEPO-SUBQ PROVERA 104

........................................ 116 depo-testosterone ................ 110 DERMA-SMOOTHE/FS BODY

........................................ 105 DERMA-SMOOTHE/FS SCALP

........................................ 105 DERMOTIC ......................... 135 DESCOVY ............................. 61 DESFERAL .......................... 128 desipramine hcl ...................... 34 desloratadine ....................... 135 desmopressin ace rhinal tube

........................................ 108 desmopressin ace spray refrig

........................................ 108 desmopressin acetate .......... 108 DESOGEN ........................... 112 desogestrel-ethinyl estradiol 112 DESONATE ......................... 105 desonide .............................. 105 desowen .............................. 105 DESOWEN .......................... 105 desoximetasone ................... 105 DESOXYN ............................. 83 desvenlafaxine er ................... 32 DESVENLAFAXINE

FUMARATE ER ................. 32 desvenlafaxine succinate er ... 32 DETROL .............................. 102 DETROL LA ......................... 102 dexamethasone ................... 105 dexamethasone (la) ............. 105 dexamethasone ace & sod phos

........................................ 105 dexamethasone intensol ...... 105 dexamethasone sod phosphate

pf ..................................... 105 dexamethasone sodium

phosphate ................ 105, 133 dexchlorpheniramine maleate

........................................ 135 DEXEDRINE .......................... 83 DEXILANT ............................. 99 dexmethylphenidate hcl ......... 85 dexmethylphenidate hcl er ..... 84 DEXPAK 10 DAY ................. 105 dexpak 13 day ..................... 105 DEXPAK 6 DAY ................... 105 dexrazoxane hcl ..................... 51 dextroamphetamine sulfate ... 83,

84

dextroamphetamine sulfate er 83 dextrose ................................ 93 DEXTROSE .......................... 93 dextrose 5%/electrolyte #48 .. 93 dextrose in lactated ringers .... 93 dextrose-nacl ......................... 93 DEXTROSE-NACL ................ 93 DIACOMIT ............................. 27 DIASTAT ACUDIAL ............... 27 DIASTAT PEDIATRIC ........... 27 diazepam ......................... 27, 63 DIBENZYLINE ....................... 73 DICLEGIS ............................. 34 diclofenac epolamine ............... 7 diclofenac potassium ............... 7 diclofenac sodium ...... 7, 89, 133 diclofenac sodium er................ 7 diclofenac-misoprostol ............. 7 dicloxacillin sodium ................ 22 dicyclomine hcl ...................... 97 didanosine ............................. 61 DIFFERIN .............................. 89 DIFICID ................................. 23 diflorasone diacetate ........... 105 DIFLUCAN ............................ 36 diflunisal .................................. 7 digitek .................................... 79 digox ..................................... 79 digoxin ................................... 79 DIGOXIN ............................... 79 dihydroergotamine mesylate .. 39 dilantin ................................... 30 DILANTIN .............................. 30 dilantin infatabs ..................... 30 DILATRATE-SR .................... 82 DILAUDID ............................. 11 diltiazem hcl .................... 77, 78 diltiazem hcl er ...................... 77 diltiazem hcl er beads ............ 77 diltiazem hcl er coated beads 77 dilt-xr ..................................... 78 dimenhydrinate ...................... 34 DIOVAN ................................ 73 DIOVAN HCT ........................ 73 DIPENTUM ......................... 126 diphenhydramine hcl ........... 135 diphenoxylate-atropine .......... 97 DIPHTHERIA-TETANUS

TOXOIDS DT .................. 124 DIPROLENE ....................... 105 DIPROLENE AF .................. 105 dipyridamole .......................... 72 disopyramide phosphate ....... 74 disulfiram ............................... 14

DITROPAN XL .................... 102 DIURIL .................................. 80 divalproex sodium ................. 28 divalproex sodium er ............. 28 DIVIGEL .............................. 112 dobutamine hcl ...................... 79 dobutamine in d5w ................ 79 DOCEFREZ .......................... 45 docetaxel .............................. 45 DOCETAXEL ........................ 45 docetaxel (non-alcohol) ......... 45 dofetilide ............................... 74 DOLOPHINE ........................... 9 donepezil hcl ......................... 30 dopamine hcl......................... 79 dopamine in d5w ................... 79 DOPTELET ........................... 70 DORAL ................................. 63 DORIPENEM ........................ 21 DORYX ................................. 25 DORYX MPC ........................ 25 dorzolamide hcl ................... 132 dorzolamide hcl-timolol mal . 132 dorzolamide hcl-timolol mal pf

........................................ 132 dotti ..................................... 112 DOVATO ............................... 60 DOVONEX ............................ 89 doxazosin mesylate............. 103 doxepin hcl ...................... 34, 89 doxercalciferol ..................... 127 DOXIL ................................... 45 doxorubicin hcl ...................... 45 doxorubicin hcl liposomal ...... 45 DOXORUBICIN HCL

LIPOSOMAL ..................... 45 doxy 100 ............................... 25 doxycycline ........................... 89 doxycycline hyclate ............... 25 doxycycline monohydrate ...... 25 doxylamine-pyridoxine .......... 34 D-PENAMINE ....................... 95 dronabinol ............................. 35 droperidol .............................. 34 drospiren-eth estrad-levomefol

........................................ 112 drospirenone-ethinyl estradiol

........................................ 112 DROXIA ................................ 43 DUAC ................................... 89 DUAVEE ............................. 112 DUETACT ............................. 65 DUEXIS .................................. 7 DULERA ............................. 142

152

duloxetine hcl ......................... 32 DUOBRII ................................ 89 DUOPA .................................. 53 DUPIXENT .................... 89, 142 DURACLON .......................... 86 DURAGESIC-100 ....................9 DURAGESIC-12 ......................9 DURAGESIC-25 ......................9 DURAGESIC-50 ......................9 DURAGESIC-75 ......................9 DURAMORPH ....................... 11 DUREZOL ........................... 133 DURLAZA .............................. 72 dutasteride ........................... 103 dutasteride-tamsulosin hcl ... 103 DUTOPROL ........................... 76 DUZALLO .............................. 39 dvorah ................................... 11 DXEVO 11-DAY ................... 105 DYANAVEL XR ...................... 84 DYAZIDE ............................... 80 DYMISTA ............................. 136 DYRENIUM ........................... 80 DYSPORT ............................. 57 E e.e.s. 400 ............................... 23 E.E.S. GRANULES ................ 23 EC-NAPROSYN ......................7 ec-naproxen .............................7 econazole nitrate ................... 36 EDARBI ................................. 73 EDARBYCLOR ...................... 73 EDECRIN .............................. 80 EDLUAR .............................. 143 EDURANT ............................. 60 efavirenz ................................ 60 EFFER-K ............................... 93 EFFEXOR XR ........................ 32 EFFIENT ................................ 72 EFUDEX ................................ 43 EGRIFTA ............................. 108 ELAPRASE .......................... 101 ELDEPRYL ............................ 54 ELELYSO ............................ 101 ELESTAT ............................. 132 ELESTRIN ........................... 112 eletriptan hydrobromide ......... 40 ELIDEL .................................. 89 ELIGARD ..................... 117, 118 ELIMITE................................. 52 elinest .................................. 112 ELIQUIS ................................ 69 ELIQUIS STARTER PACK .... 69 ELITEK .................................. 51

ELIXOPHYLLIN ................... 140 ELLA ................................... 115 ELLENCE .............................. 45 ELMIRON ............................ 103 ELOCON ............................. 105 ELZONRIS ............................ 45 EMADINE ............................ 132 EMBEDA ................................. 9 EMCYT.................................. 43 EMEND ................................. 35 EMEND TRI-PACK ................ 35 EMFLAZA ............................ 105 EMGALITY ...................... 39, 40 EMGALITY (300 MG DOSE) . 39 emoquette ........................... 112 EMPLICITI ............................. 50 EMSAM ................................. 32 EMTRIVA .............................. 61 emverm ................................. 51 ENABLEX ............................ 102 enalapril maleate ................... 74 enalaprilat .............................. 74 enalapril-hydrochlorothiazide . 74 ENBREL .............................. 120 ENBREL MINI ..................... 120 ENBREL SURECLICK ......... 120 ENDARI ............................... 128 endocet ................................. 11 ENGERIX-B ........................ 124 ENLON ................................ 128 enoxaparin sodium ................ 69 enpresse-28 ........................ 112 enskyce ............................... 112 ENSTILAR ............................. 89 entacapone ........................... 53 entecavir ................................ 58 ENTOCORT EC .................. 126 ENTRESTO ........................... 79 ENTYVIO ............................ 123 enulose.................................. 99 ENVARSUS XR ................... 120 EPANED ............................... 74 EPCLUSA ............................. 58 EPIDIOLEX ........................... 26 EPIDUO ................................ 90 EPIDUO FORTE ................... 90 EPIFOAM .............................. 39 epinastine hcl ...................... 132 epinephrine ................. 138, 139 EPIPEN 2-PAK .................... 139 EPIPEN JR 2-PAK .............. 139 epirubicin hcl ......................... 45 epitol ..................................... 30 EPIVIR .................................. 61

EPIVIR HBV .......................... 58 eplerenone ............................ 80 EPOGEN .............................. 71 epoprostenol sodium ........... 140 eprosartan mesylate.............. 73 eptifibatide ............................ 72 EPZICOM ............................. 61 EQUETRO ............................ 64 ERAXIS ................................. 37 ERBITUX .............................. 50 ergoloid mesylates ................ 30 ERGOMAR ........................... 39 ergotamine-caffeine .............. 39 ERIVEDGE ........................... 49 ERLEADA ............................. 43 erlotinib hcl ............................ 49 errin .................................... 116 ERTACZO ............................. 37 ertapenem sodium ................ 21 ERWINAZE ........................... 45 ery ......................................... 23 ERYGEL ............................... 23 ERYPED 200 ........................ 23 ERYPED 400 ........................ 23 ery-tab................................... 23 erythrocin lactobionate .......... 23 erythrocin stearate ................ 23 erythromycin ......................... 23 erythromycin base ................. 23 erythromycin ethylsuccinate .. 23 ESBRIET .....................141, 142 escitalopram oxalate ............. 32 esgic ................................. 7, 86 esmolol hcl ............................ 76 ESMOLOL HCL .................... 76 esmolol hcl-sodium chloride .. 76 esomeprazole magnesium .... 99 esomeprazole sodium ........... 99 ESOMEPRAZOLE

STRONTIUM ................... 100 estarylla .............................. 112 estazolam ............................. 63 estrace ................................ 112 estradiol .............................. 112 estradiol valerate ................. 112 estradiol-norethindrone acet 112 ESTRING ............................ 112 estropipate .......................... 112 ESTROSTEP FE ................. 112 eszopiclone ......................... 143 ethacrynate sodium ............... 80 ethacrynic acid ...................... 80 ethambutol hcl ....................... 41 ethosuximide ......................... 27

153

ethynodiol diac-eth estradiol 112 ETHYOL ................................ 45 etidronate disodium ............. 127 etodolac ...................................7 etodolac er ...............................7 ETOPOPHOS ........................ 48 etoposide ............................... 48 EUCRISA ............................... 90 EURAX .................................. 52 euthyrox ............................... 117 EVAMIST ............................. 112 evekeo ................................... 84 EVEKEO ODT ....................... 84 EVENITY ............................. 127 EVISTA ................................ 117 EVOCLIN ............................... 17 EVOMELA ............................. 42 EVOTAZ ................................ 62 EVOXAC ................................ 88 EVZIO .................................... 15 EXALGO ..................................9 EXELDERM ........................... 37 EXELON ................................ 30 exemestane ........................... 48 EXFORGE ............................. 78 EXFORGE HCT ..................... 78 EXJADE................................. 95 EXONDYS 51 ...................... 101 EXTAVIA ............................... 87 EXTINA.................................. 37 EYLEA ................................. 131 EZALLOR SPRINKLE ............ 81 ezetimibe ............................... 82 ezetimibe-simvastatin ............ 82 F FABIOR ................................. 90 FABRAZYME ....................... 101 falmina ................................. 112 famciclovir .............................. 59 famotidine .............................. 98 famotidine premixed............... 98 FANAPT ................................ 55 FANAPT TITRATION PACK .. 55 FARESTON ........................... 43 FARXIGA ............................... 65 FARYDAK .............................. 45 FASENRA ............................ 142 FASLODEX ........................... 43 fayosim ................................ 112 FAZACLO .............................. 57 febuxostat .............................. 39 felbamate ............................... 28 FELBATOL ............................ 28 FELDENE ................................7

felodipine er ........................... 78 FEMARA ............................... 48 FEMHRT LOW DOSE ......... 112 FEMRING ............................ 112 femynor ............................... 112 fenofibrate ............................. 81 fenofibrate micronized ........... 81 fenofibric acid ........................ 81 FENOFIBRIC ACID ............... 81 FENOGLIDE ......................... 81 fenoprofen calcium .................. 7 fenortho ................................... 7 fentanyl.................................... 9 fentanyl citrate ....................... 11 fentanyl citrate (pf) ................. 11 FENTORA ............................. 11 FERRIPROX ......................... 95 FETZIMA ............................... 32 FETZIMA TITRATION ........... 32 fexmid ................................. 143 FIASP .................................... 67 FIASP FLEXTOUCH ............. 67 FIBRICOR ............................. 81 FINACEA ............................... 90 finasteride ............................ 103 fioricet ..................................... 7 fioricet/codeine ...................... 11 FIORINAL ................................ 7 FIORINAL/CODEINE #3 ........ 11 FIRAZYR ............................. 119 FIRDAPSE .......................... 128 FIRMAGON ......................... 118 FIRVANQ .............................. 17 flac ...................................... 135 FLAGYL ................................ 17 FLAREX .............................. 133 flavoxate hcl ........................ 102 FLEBOGAMMA DIF ............ 122 flecainide acetate .................. 75 FLECTOR ............................... 7 FLOLAN .............................. 140 FLOLIPID .............................. 81 FLOMAX ............................. 103 floriva plus ............................. 96 FLOVENT DISKUS ............. 136 FLOVENT HFA .................... 136 FLOXIN OTIC ........................ 24 floxuridine .............................. 43 fluconazole ............................ 37 fluconazole in dextrose .......... 37 fluconazole in sodium chloride

.......................................... 37 flucytosine ............................. 37 fludarabine phosphate ........... 46

fludrocortisone acetate ........ 105 FLUMADINE ......................... 62 flumazenil .............................. 86 flunisolide ............................ 136 fluocinolone acetonide .105, 135 fluocinolone acetonide body 105 fluocinolone acetonide scalp 105 fluocinonide ......................... 106 fluocinonide emulsified base 106 FLUORABON ........................ 93 fluoridex daily renewal ........... 88 fluoritab ................................. 93 fluorometholone .................. 133 fluorouracil ............................ 44 fluoxetine hcl ......................... 33 fluoxetine hcl (pmdd) ............. 33 fluphenazine decanoate ........ 54 fluphenazine hcl .................... 54 FLURA-DROPS .................... 93 flurandrenolide .................... 106 flurazepam hcl ..................... 143 flurbiprofen .............................. 7 flurbiprofen sodium ............. 133 flutamide ............................... 43 fluticasone propionate ..106, 137 fluticasone-salmeterol ......... 142 fluvastatin sodium ................. 81 fluvastatin sodium er ............. 81 fluvoxamine maleate ............. 33 fluvoxamine maleate er ......... 33 FML .................................... 134 FML FORTE........................ 133 FML LIQUIFILM .................. 134 FOCALIN .............................. 85 FOCALIN XR ........................ 85 FOLOTYN ............................. 44 fomepizole .......................... 128 fondaparinux sodium ............. 69 FORFIVO XL......................... 31 FORTAMET .......................... 65 FORTEO ............................. 127 FORTESTA ......................... 110 FOSAMAX .......................... 127 FOSAMAX PLUS D............. 127 fosamprenavir calcium .......... 62 fosinopril sodium ................... 74 fosinopril sodium-hctz ........... 74 fosphenytoin sodium ............. 30 FOSRENOL .......................... 96 FRAGMIN ............................. 69 FREAMINE HBC ................. 129 FREAMINE III ..................... 129 FROVA ................................. 40 frovatriptan succinate ............ 40

154

FULPHILA ............................. 71 fulvestrant .............................. 43 FURADANTIN........................ 17 furosemide ............................. 80 FUSILEV ................................ 46 FUZEON ................................ 61 fyavolv ................................. 112 FYCOMPA ............................. 26 G gabapentin ............................. 28 GABITRIL .............................. 28 GABLOFEN ........................... 57 GALAFOLD ......................... 101 galantamine hydrobromide..... 31 galantamine hydrobromide er 31 GAMASTAN ........................ 122 GAMASTAN S/D .................. 122 GAMIFANT .......................... 123 GAMMAGARD ..................... 122 GAMMAGARD S/D LESS IGA

........................................ 122 GAMMAKED ........................ 122 GAMMAPLEX ...................... 122 GAMUNEX-C ....................... 122 ganciclovir sodium ................. 58 GARDASIL 9 ....................... 124 GASTROCROM ..................... 97 gatifloxacin ............................. 24 GATTEX ................................ 97 gavilyte-c ............................... 99 gavilyte-g ............................... 99 gavilyte-h ............................... 99 gavilyte-n with flavor pack ...... 99 GAZYVA ................................ 50 GELNIQUE .......................... 102 GELNIQUE PUMP ............... 102 gemcitabine hcl ...................... 44 GEMCITABINE HCL .............. 44 gemfibrozil ............................. 81 GEMZAR ............................... 44 GENERESS FE ................... 112 generlac ................................. 99 gengraf ................................ 120 GENOTROPIN ..................... 109 GENOTROPIN MINIQUICK . 109 gentak .................................... 15 gentamicin in saline ............... 15 gentamicin sulfate .................. 15 GENVOYA ............................. 60 GEODON ............................... 55 gianvi ................................... 112 GIAZO ................................. 126 gildagia ................................ 112 gildess fe 1.5/30 ................... 112

gildess fe 1/20 ..................... 112 GILENYA ............................... 87 GILOTRIF .............................. 49 GLASSIA ............................. 142 glatiramer acetate .................. 87 glatopa .................................. 87 GLEEVEC ............................. 49 GLEOSTINE .......................... 42 glimepiride ............................. 65 glipizide er ............................. 65 glipizide ir .............................. 65 glipizide xl .............................. 65 glipizide-metformin hcl ........... 65 GLUCAGEN HYPOKIT .......... 66 GLUCAGON EMERGENCY .. 67 GLUCOPHAGE ..................... 65 GLUCOPHAGE XR ............... 65 glucose .................................. 93 GLUCOTROL ........................ 65 GLUCOTROL XL ................... 65 GLUCOVANCE ..................... 65 GLUMETZA ........................... 65 glyburide ................................ 65 glyburide micronized.............. 65 glyburide-metformin ............... 65 glycate ................................... 97 glycopyrrolate ........................ 97 glycopyrrolate pf .................... 97 glydo ..................................... 13 GLYNASE ............................. 65 GLYSET ................................ 65 GLYXAMBI ............................ 65 GOCOVRI ............................. 53 GOLYTELY ........................... 99 GONITRO ............................. 82 GRALISE ............................... 86 GRALISE STARTER ............. 86 granisetron hcl ....................... 35 GRANIX ................................ 71 GRASTEK ........................... 129 griseofulvin microsize ............ 37 griseofulvin ultramicrosize ..... 37 GRIS-PEG ............................. 37 guanfacine hcl ....................... 72 guanfacine hcl er ................... 85 GUANIDINE HCL .................. 41 gynazole-1 ............................. 37 H HAEGARDA ........................ 129 hailey 1.5/30 ........................ 112 hailey 24 fe .......................... 112 HALAVEN ............................. 46 HALCION .............................. 63 HALDOL ................................ 54

HALDOL DECANOATE ........ 54 halobetasol propionate ........ 106 HALOBETASOL PROPIONATE

........................................ 106 HALOG ............................... 106 haloperidol ............................ 54 haloperidol decanoate ........... 54 haloperidol lactate ................. 54 HARVONI ............................. 58 HAVRIX .............................. 124 heather................................ 116 HECTOROL ........................ 127 HEMABATE ........................ 110 HEMANGEOL ....................... 76 HEPAGAM B....................... 122 heparin (porcine) in nacl .. 69, 70 heparin sod (porcine) in d5w . 70 heparin sodium (porcine) ...... 70 heparin sodium (porcine) pf ... 70 HEPATAMINE ..................... 129 HEPLISAV-B ....................... 124 HEPSERA ............................. 58 HERCEPTIN ......................... 50 HERCEPTIN HYLECTA ........ 50 HETLIOZ ............................. 144 HEXALEN ............................. 42 HIBERIX ............................. 124 HIDEX 6-DAY ..................... 106 HIPREX ................................ 17 HIZENTRA .......................... 122 HORIZANT ........................... 86 HUMALOG KWIKPEN .......... 67 HUMALOG MIX 50/50

KWIKPEN ......................... 67 HUMALOG MIX 50/50 VIAL .. 67 HUMALOG MIX 75/25

KWIKPEN ......................... 67 HUMALOG MIX 75/25 VIAL .. 67 HUMALOG U-100 JUNIOR

KWIKPEN ......................... 67 HUMALOG U-100 VIAL AND

CARTRIDGE ..................... 67 HUMATROPE ..................... 109 HUMIRA .............................. 120 HUMIRA PEDIATRIC CROHNS

START ............................ 120 HUMIRA PEN ..................... 120 HUMIRA PEN-CD/UC/HS

STARTER ....................... 120 HUMIRA PEN-PS/UV/ADOL HS

START ............................ 120 HUMULIN 70/30 KWIKPEN .. 67 HUMULIN 70/30 VIAL ........... 67 HUMULIN N KWIKPEN ......... 67

155

HUMULIN N VIAL .................. 67 HUMULIN R U-500 KWIKPEN

.......................................... 67 HUMULIN R U-500 VIAL

(CONCENTRATED) ........... 67 HUMULIN R VIAL .................. 67 HYCAMTIN ............................ 48 hydralazine hcl ....................... 82 HYDREA ................................ 44 hydrochlorothiazide ................ 80 hydrocodone-acetaminophen . 11 hydrocodone-ibuprofen .......... 11 hydrocortisone ....... 39, 106, 126 hydrocortisone ace-pramoxine

.......................................... 90 hydrocortisone butyrate ....... 106 hydrocortisone in absorbase 106 hydrocortisone valerate ........ 106 hydrocortisone-acetic acid ... 135 hydromorphone hcl ................ 11 hydromorphone hcl er ..............9 hydromorphone hcl pf ............ 11 hydroxychloroquine sulfate .... 52 hydroxyprogesterone caproate

........................................ 116 hydroxyurea ........................... 44 hydroxyzine hcl .................... 135 hydroxyzine pamoate ........... 135 HYPERHEP B S/D ............... 122 HYPERRAB ......................... 122 HYPERRAB S/D .................. 123 HYPERRHO S/D ................. 123 HYPERSAL ......................... 142 HYQVIA ............................... 123 HYSINGLA ER .........................9 HYZAAR ................................ 73 I ibandronate sodium ............. 127 IBRANCE ............................... 46 ibu ............................................8 ibudone .................................. 11 IBUDONE .............................. 11 ibuprofen ..................................8 ibuprofen lysine ...................... 79 ibutilide fumarate ................... 75 icatibant acetate ................... 119 ICLUSIG ................................ 49 IDAMYCIN PFS ..................... 46 idarubicin hcl .......................... 46 IDARUBICIN HCL .................. 46 IDHIFA ................................... 49 IFEX ...................................... 42 ifosfamide .............................. 42 ILARIS ................................. 123

ILARIS (150MG DELIVERED) ........................................ 123

ILEVRO ............................... 134 ILUMYA ................................. 90 imatinib mesylate ................... 49 IMBRUVICA .......................... 49 IMFINZI ................................. 50 imipenem-cilastatin ................ 21 imipramine hcl ....................... 34 imipramine pamoate .............. 34 imiquimod .............................. 90 imiquimod pump .................... 90 IMITREX ................................ 40 IMITREX STATDOSE REFILL

.......................................... 40 IMITREX STATDOSE SYSTEM

.......................................... 40 IMOGAM RABIES-HT ......... 123 IMOVAX RABIES ................ 124 IMPAVIDO ............................. 17 IMPOYZ .............................. 106 IMURAN .............................. 120 IMVEXXY MAINTENANCE

PACK .............................. 112 IMVEXXY STARTER PACK 112 INBRIJA ................................ 53 incassia ............................... 116 INCRELEX .......................... 109 INCRUSE ELLIPTA ............. 137 indapamide ............................ 80 INDERAL LA ......................... 76 INDERAL XL ......................... 76 INDOCIN ................................. 8 indomethacin ........................... 8 indomethacin er ....................... 8 indomethacin sodium ............... 8 INFANRIX ........................... 124 INFLECTRA ........................ 120 INFUGEM .............................. 44 INFUMORPH 200 .................... 9 INFUMORPH 500 .................... 9 INGREZZA ............................ 86 INLYTA.................................. 49 INNOPRAN XL ...................... 76 INSPRA ................................. 80 insulin lispro .......................... 67 insulin pen needles .............. 129 insulin syringes .................... 129 INSULIN SYRINGES ........... 129 INTEGRILIN .......................... 72 INTELENCE .......................... 60 INTERMEZZO ..................... 144 INTRALIPID ........................ 129 INTRAROSA ....................... 106

INTRON A ............................. 58 introvale .............................. 112 INTUNIV ............................... 85 INVANZ ................................. 21 INVEGA ................................ 55 INVEGA SUSTENNA ............ 55 INVEGA TRINZA .................. 55 INVELTYS .......................... 134 INVIRASE ............................. 62 INVOKAMET ......................... 65 INVOKAMET XR ................... 65 INVOKANA ........................... 65 IONOSOL-B IN D5W ............. 93 IONOSOL-MB IN D5W .......... 93 IOPIDINE ............................ 132 IPOL ................................... 124 ipratropium bromide ............ 137 ipratropium-albuterol ........... 137 IPRIVASK ............................. 70 irbesartan .............................. 73 irbesartan-hydrochlorothiazide

.......................................... 73 IRESSA ................................. 49 irinotecan hcl ......................... 48 ISENTRESS ................... 60, 61 ISENTRESS HD ................... 61 isibloom ............................... 112 ISOLYTE-P IN D5W .............. 93 ISOLYTE-S ........................... 93 ISOLYTE-S PH 7.4 ............... 93 isoniazid ................................ 41 isoproterenol hcl .................. 139 isopto atropine .................... 131 ISOPTO CARPINE.............. 132 ISORDIL TITRADOSE .......... 82 isosorbide dinitrate ................ 82 isosorbide dinitrate er ............ 82 isosorbide mononitrate .......... 82 isosorbide mononitrate er ...... 82 isotretinoin ............................ 90 isradipine .............................. 78 ISTALOL ............................. 133 ISTODAX (OVERFILL) .......... 46 ISUPREL ............................ 139 itraconazole .......................... 37 ivermectin ............................. 52 IXEMPRA KIT ....................... 46 IXIARO................................ 124 J JADENU ............................... 95 JADENU SPRINKLE ............. 95 JAKAFI.................................. 49 JALYN................................. 103 jantoven ................................ 70

156

JANUMET .............................. 65 JANUMET XR ........................ 65 JANUVIA ............................... 65 JARDIANCE .......................... 65 jasmiel ................................. 112 jencycla................................ 116 JENTADUETO ....................... 65 JENTADUETO XR ................. 66 jevantique lo ........................ 112 JEVTANA .............................. 46 jinteli .................................... 112 jolessa ................................. 112 JOLIVETTE ......................... 116 JORNAY PM .......................... 85 JUBLIA .................................. 37 juleber .................................. 112 JULUCA................................. 60 junel 1.5/30 .......................... 112 junel 1/20 ............................. 112 junel fe 1.5/30 ...................... 112 junel fe 1/20 ......................... 113 junel fe 24 ............................ 113 JUXTAPID ............................. 82 JYNARQUE ........................... 95 K KABIVEN ............................... 93 KADCYLA .............................. 50 KADIAN ...................................9 kaitlib fe ............................... 113 KALBITOR ........................... 119 KALETRA .............................. 62 kalliga .................................. 113 KALYDECO ......................... 140 KANUMA ............................. 101 KAPSPARGO SPRINKLE ...... 76 KAPVAY ................................ 85 KARBINAL ER ..................... 135 kariva ................................... 113 KAZANO ................................ 66 kcl in d5w lactated ringers ...... 93 kcl in dextrose-nacl ................ 93 KCL IN DEXTROSE-NACL .... 93 KCL-LACTATED RINGERS-

D5W ................................... 93 KEDRAB .............................. 123 KEFLEX ................................. 20 kelnor 1/35 ........................... 113 kelnor 1/50 ........................... 113 KENALOG ..................... 39, 106 KENALOG-80 ...................... 106 KENGREAL ........................... 72 KEPIVANCE .......................... 88 KEPPRA ................................ 26 KEPPRA XR .......................... 26

KERYDIN .............................. 37 ketoconazole ......................... 37 ketoprofen ............................... 8 ketoprofen er ........................... 8 ketorolac tromethamine ... 8, 134 KEVEYIS ............................. 129 KEVZARA ........................... 123 KEYTRUDA ........................... 50 KHAPZORY .......................... 51 KHEDEZLA ........................... 33 kimidess .............................. 113 KINERET ............................. 120 KINRIX ................................ 125 kionex .................................... 95 KISQALI (200 MG DOSE) ..... 46 KISQALI (400 MG DOSE) ..... 46 KISQALI (600 MG DOSE) ..... 46 KISQALI FEMARA (400 MG

DOSE) ............................... 42 KISQALI FEMARA (600 MG

DOSE) ............................... 42 KISQALI FEMARA(200 MG

DOSE) ............................... 42 KITABIS PAK ...................... 140 KLARON ............................... 25 klofensaid ii ........................... 90 KLONOPIN ............................ 28 klor-con ................................. 93 KLOR-CON ........................... 94 KLOR-CON 10 ...................... 93 klor-con m10 ......................... 93 klor-con m15 ......................... 93 klor-con m20 ......................... 93 klor-con sprinkle .................... 94 klor-con/ef ............................. 94 KOMBIGLYZE XR ................. 66 KORLYM ............................. 110 KRINTAFEL .......................... 52 kristalose ............................... 99 KRYSTEXXA ......................... 39 K-TAB ................................... 94 kurvelo ................................ 113 KUVAN ................................ 101 KYLEENA ............................ 116 KYNAMRO ............................ 82 KYPROLIS ............................ 48 L labetalol hcl ........................... 76 LAC-HYDRIN ........................ 90 LACRISERT ........................ 131 lactated ringers .............. 94, 129 lactic acid .............................. 90 lactulose ................................ 99 lactulose encephalopathy ...... 99

LAMICTAL ............................ 28 LAMICTAL ODT .................... 28 LAMICTAL STARTER ........... 29 LAMICTAL XR ...................... 29 LAMISIL ................................ 37 lamivudine ....................... 58, 61 lamivudine-zidovudine ........... 61 lamotrigine ............................ 29 lamotrigine er ........................ 29 lamotrigine starter kit-blue ..... 29 lamotrigine starter kit-green ... 29 lamotrigine starter kit-orange . 29 LANOXIN .............................. 79 LANOXIN PEDIATRIC .......... 79 lansoprazole ....................... 100 lanthanum carbonate ............ 96 LANTUS SOLOSTAR ........... 67 LANTUS U-100 VIAL ............ 68 larin 1.5/30 .......................... 113 larin 1/20 ............................. 113 larin 24 fe ............................ 113 larin fe 1.5/30 ...................... 113 larin fe 1/20 ......................... 113 larissia................................. 113 LARTRUVO .......................... 50 LASIX ................................... 80 LASTACAFT ....................... 132 latanoprost .......................... 130 LATUDA ................................ 55 LAYOLIS FE ....................... 113 LAZANDA ............................. 11 ledipasvir-sofosbuvir ............. 58 leena ................................... 113 leflunomide ......................... 123 LEMTRADA ........................ 123 LENVIMA (10 MG DAILY

DOSE) .............................. 49 LENVIMA (12 MG DAILY





DOSE) .............................. 49 LENVIMA (4 MG DAILY DOSE)

.......................................... 49 LENVIMA (8 MG DAILY DOSE)

.......................................... 49 LESCOL XL .......................... 81 lessina................................. 113 LETAIRIS ............................ 140

157

letrozole ................................. 48 leucovorin calcium ................. 46 LEUKERAN ........................... 42 LEUKINE ............................... 71 leuprolide acetate ................ 118 levalbuterol hcl ..................... 139 levalbuterol hfa .................... 139 LEVAQUIN ............................ 24 LEVEMIR U-100 FLEXTOUCH

.......................................... 68 LEVEMIR U-100 VIAL ............ 68 levetiracetam ......................... 27 levetiracetam er ..................... 26 levetiracetam in nacl .............. 26 levobunolol hcl ..................... 133 levocarnitine ........................ 129 LEVOCARNITINE ................ 129 levocetirizine dihydrochloride

........................................ 135 levofloxacin ............................ 24 levofloxacin in d5w ................. 24 levoleucovorin calcium ........... 46 levoleucovorin calcium pf ....... 46 levonest ............................... 113 levonorgest-eth est & eth est113 levonorgest-eth estrad 91-day

........................................ 113 levonorgestrel ...................... 116 levonorgestrel-ethinyl estrad 113 levonorg-eth estrad triphasic 113 LEVOPHED ........................... 79 levora 0.15/30 (28) ............... 113 levorphanol tartrate ..................9 LEVO-T................................ 117 levothyroxine sodium ........... 117 levothyroxine-liothyronine .... 117 LEVOXYL ............................ 117 LEVULAN KERASTICK ......... 90 LEXAPRO .............................. 33 LEXETTE ............................. 106 LEXIVA .................................. 62 LIALDA ................................ 126 LIBTAYO ............................... 50 lidocaine ................................ 13 lidocaine hcl ..................... 13, 88 lidocaine hcl (cardiac) ............ 75 lidocaine hcl (cardiac) pf ........ 75 lidocaine hcl (pf) ..................... 13 lidocaine hcl urethral/mucosal 13 lidocaine in d5w ..................... 75 lidocaine in dextrose .............. 13 lidocaine viscous hcl .............. 88 lidocaine-epinephrine ............. 13 lidocaine-prilocaine ................ 13

LIDOCAINE-TETRACAINE ... 13 LIDODERM ........................... 13 LIDOTREX ............................ 13 LILETTA (52 MG) ................ 116 lillow .................................... 113 LINCOCIN ............................. 17 lincomycin hcl ........................ 17 lindane .................................. 52 linezolid ................................. 17 LINZESS ............................... 98 LIORESAL ............................. 57 LIORESAL INTRATHECAL ... 57 liothyronine sodium ............. 117 LIPITOR ................................ 81 lipodox 50 .............................. 46 LIPOFEN ............................... 81 lisinopril ................................. 74 lisinopril-hydrochlorothiazide . 74 LITHIUM ................................ 64 lithium carbonate ................... 64 lithium carbonate er ............... 64 LITHOBID .............................. 64 LITHOSTAT ........................ 103 LIVALO.................................. 81 LMD IN NACL........................ 94 LO LOESTRIN FE ............... 113 LOCOID .............................. 106 LOCOID LIPOCREAM ......... 106 LOCORT 11-DAY ................ 106 LOCORT 7-DAY .................. 107 lodine ...................................... 8 LODOSYN ............................. 53 loestrin 1.5/30 (21) .............. 113 loestrin 1/20 (21) ................. 113 loestrin fe 1.5/30 .................. 113 loestrin fe 1/20 ..................... 113 LOKELMA ............................. 96 lomedia 24 fe ....................... 113 LOMOTIL .............................. 97 LONHALA MAGNAIR REFILL

KIT................................... 137 LONHALA MAGNAIR

STARTER KIT ................. 138 LONSURF ............................. 44 loperamide hcl ....................... 97 LOPID ................................... 81 lopinavir-ritonavir ................... 62 lopreeza .............................. 113 LOPRESSOR ........................ 76 LOPRESSOR HCT ................ 76 LOPROX ............................... 37 lorazepam ....................... 63, 64 lorazepam intensol ................ 64 LORBRENA .......................... 46

lorcet ..................................... 11 lorcet hd ................................ 11 lorcet plus ............................. 11 LORTAB ............................... 11 loryna .................................. 113 lorzone ................................ 143 losartan potassium ................ 73 losartan potassium-hctz ........ 73 LOSEASONIQUE ............... 113 LOTEMAX ........................... 134 LOTEMAX SM .................... 134 LOTENSIN ............................ 74 LOTENSIN HCT .................... 74 loteprednol etabonate ......... 134 LOTREL ................................ 78 LOTRISONE ......................... 37 LOTRONEX .......................... 98 lovastatin ............................... 81 LOVAZA ................................ 82 LOVENOX ............................ 70 low-ogestrel ........................ 113 loxapine succinate ................ 54 lo-zumandimine ................... 113 LUCEMYRA .......................... 14 LUCENTIS .......................... 131 ludent .................................... 94 LULICONAZOLE ................... 37 LUMIGAN ........................... 130 LUMIZYME ......................... 101 LUMOXITI ............................. 51 LUNESTA ........................... 144 LUPANETA PACK .............. 118 LUPRON DEPOT (1-MONTH)

........................................ 118 LUPRON DEPOT (3-MONTH)

........................................ 118 LUPRON DEPOT (4-MONTH)

INTRAMUSCULAR KIT 30MG .............................. 118

LUPRON DEPOT (6-MONTH) INTRAMUSCULAR KIT 45MG .............................. 118

LUPRON DEPOT-PED (1-MONTH).......................... 118

LUPRON DEPOT-PED (3-MONTH).......................... 118

lutera ................................... 113 LUXIQ ................................. 107 LUZU .................................... 37 LYNPARZA ........................... 46 LYRICA ................................. 27 LYRICA CR ........................... 86 LYSODREN ........................ 117 LYSTEDA ............................. 72

158

lyza ...................................... 116 M MACROBID ........................... 17 MACRODANTIN .................... 17 mafenide acetate ................... 17 magnesium sulfate ................. 94 MAGNESIUM SULFATE ........ 94 magnesium sulfate in d5w ..... 94 MAKENA ..................... 115, 116 MALARONE .......................... 52 malathion ............................... 52 mannitol ................................. 79 maprotiline hcl........................ 33 MARCAINE ............................ 13 MARCAINE PRESERVATIVE

FREE ................................. 13 MARCAINE SPINAL .............. 13 MARCAINE/EPINEPHRINE ... 13 MARCAINE/EPINEPHRINE PF

.......................................... 13 MARINOL .............................. 35 marlissa ............................... 113 MARPLAN ............................. 32 MARQIBO .............................. 46 marten-tab ...............................7 MATULANE ........................... 42 matzim la ............................... 78 MAVENCLAD (10 TABS) ....... 87 MAVENCLAD (4 TABS) ......... 87 MAVENCLAD (5 TABS) ......... 87 MAVENCLAD (6 TABS) ......... 87 MAVENCLAD (7 TABS) ......... 87 MAVENCLAD (8 TABS) ......... 87 MAVENCLAD (9 TABS) ......... 87 MAVYRET ............................. 58 MAXALT ................................ 40 MAXALT-MLT ........................ 40 MAXIDEX ............................ 134 MAXIPIME ............................. 20 MAXITROL .......................... 134 MAXZIDE ............................... 80 MAXZIDE-25 ......................... 80 MAYZENT ............................. 87 MAYZENT STARTER PACK . 87 meclizine hcl .......................... 34 meclofenamate sodium ............8 MEDROL ............................. 107 medroxyprogesterone acetate

........................................ 116 mefenamic acid ........................8 mefloquine hcl........................ 52 MEGACE ES ....................... 116 megestrol acetate ................ 116 MEKINIST .............................. 49

MEKTOVI .............................. 46 melodetta 24 fe .................... 113 meloxicam ............................... 8 melphalan hcl ........................ 42 memantine hcl ....................... 31 MEMANTINE HCL ................. 31 memantine hcl er ................... 31 MENACTRA ........................ 125 menest ................................ 113 MENHIBRIX ........................ 125 MENOSTAR ........................ 113 MENTAX ............................... 37 MENVEO ............................. 125 meperidine hcl ....................... 12 meprobamate ........................ 63 MEPRON .............................. 52 mercaptopurine ..................... 44 meropenem ........................... 21 meropenem-sodium chloride . 21 MERREM .............................. 21 mesalamine ......................... 126 mesalamine-cleanser .......... 126 mesna ................................... 51 MESNEX ............................... 51 MESTINON ........................... 41 metadate er ........................... 85 metaproterenol sulfate ......... 139 metaxall ............................... 143 metaxalone .......................... 143 metformin hcl er ..................... 66 metformin hcl er (mod) .......... 66 metformin hcl er (osm) ........... 66 metformin hcl ir ...................... 66 METFORMIN HCL IR ............ 66 methadone hcl ................... 9, 10 methadone hcl intensol ............ 9 methadose ............................ 10 methadose sugar-free ........... 10 methamphetamine hcl ........... 84 methazolamide .................... 133 methenamine hippurate ......... 17 methenamine mandelate ....... 17 methergine .......................... 129 methimazole ........................ 119 methitest .............................. 110 methocarbamol .................... 143 methotrexate ....................... 120 methotrexate (anti-rheumatic)

........................................ 120 methotrexate sodium ........... 120 methotrexate sodium (pf) ..... 120 methoxsalen rapid ................. 90 methscopolamine bromide..... 97 methyclothiazide .................... 80

methyldopa ........................... 72 methyldopa-hydrochlorothiazide

.......................................... 72 methyldopate hcl ................... 73 methylergonovine maleate .. 129 METHYLIN ............................ 85 methylphenidate hcl .............. 85 methylphenidate hcl er .......... 85 methylphenidate hcl er (cd) ... 85 methylphenidate hcl er (la) .... 85 methylprednisolone ............. 107 methylprednisolone acetate 107 methylprednisolone sodium

succ ................................ 107 methyltestosterone .............. 110 metipranolol ........................ 133 metoclopramide hcl ............... 97 metolazone ........................... 80 METOPIRONE .................... 129 metoprolol succinate er ......... 76 metoprolol tartrate ................. 76 metoprolol-hctz er ................. 76 metoprolol-hydrochlorothiazide

.......................................... 76 METROCREAM .................... 90 METROGEL .......................... 90 METROGEL-VAGINAL ......... 17 METROLOTION .................... 90 metronidazole ................. 18, 90 metronidazole in nacl ............ 18 mexiletine hcl ........................ 75 MIACALCIN ........................ 127 mibelas 24 fe....................... 113 MICARDIS ............................ 73 MICARDIS HCT .................... 73 miconazole 3 ......................... 37 miconazole-zinc oxide-petrolat

.......................................... 37 micort-hc ............................. 107 MICRHOGAM ULTRA-

FILTERED PLUS ............ 123 microgestin 1.5/30 ............... 113 microgestin 1/20 .................. 113 microgestin fe 1.5/30 ........... 113 microgestin fe 1/20 .............. 113 MICROZIDE .......................... 80 midazolam hcl ....................... 64 midodrine hcl......................... 73 mifepristone ........................ 110 migergot ................................ 39 miglitol................................... 66 miglustat ............................. 101 MIGRANAL ........................... 39 mili ...................................... 113

159

millipred ............................... 107 MILLIPRED .......................... 107 MILLIPRED DP .................... 107 milrinone lactate ..................... 79 milrinone lactate in dextrose .. 79 mimvey ................................ 113 mimvey lo ............................ 113 MINASTRIN 24 FE .............. 113 MINIPRESS ........................... 73 minitran .................................. 82 MINIVELLE .......................... 113 MINOCIN ............................... 25 minocycline hcl ...................... 26 minocycline hcl er ............ 25, 26 MINOLIRA ............................. 26 minoxidil................................. 82 MIOCHOL-E ........................ 133 MIRAPEX .............................. 53 MIRAPEX ER......................... 53 MIRCERA .............................. 71 MIRCETTE .......................... 113 MIRENA (52 MG) ................. 116 mirtazapine ............................ 31 MIRVASO .............................. 90 misoprostol ............................ 99 MITIGARE ............................. 39 mitigo ..................................... 10 mitomycin .............................. 46 mitoxantrone hcl .................... 46 M-M-R II ............................... 125 MOBIC .....................................8 modafinil .............................. 144 moderiba ................................ 59 MODERIBA ........................... 59 MODERIBA 1200 DOSE PACK

.......................................... 59 MODERIBA 800 DOSE PACK

.......................................... 59 moexipril hcl ........................... 74 moexipril-hydrochlorothiazide 74 molindone hcl ........................ 54 mometasone furoate .... 107, 137 mondoxyne nl ........................ 26 MONODOX ............................ 26 mono-linyah ......................... 114 MONONESSA ..................... 114 montelukast sodium ............. 137 MONUROL ............................ 18 morgidox ................................ 26 MORGIDOX ........................... 26 MORPHABOND ER ............... 10 morphine sulfate .............. 10, 12 MORPHINE SULFATE .......... 12

morphine sulfate (concentrate) .......................................... 12

morphine sulfate (pf).............. 12 morphine sulfate er ................ 10 morphine sulfate er beads ..... 10 MOTEGRITY ......................... 97 MOTOFEN ............................ 97 MOVANTIK ........................... 97 MOVIPREP ........................... 99 MOXATAG ............................ 22 MOXEZA ............................... 24 moxifloxacin hcl ..................... 24 moxifloxacin hcl in nacl .......... 24 MOZOBIL .............................. 71 MS CONTIN .......................... 10 MULPLETA ........................... 71 MULTAQ ............................... 75 multi-vit/iron/fluoride .............. 96 multivitamin/fluoride ............... 96 multivitamin/fluoride/iron ........ 96 multivitamins/fluoride ............. 96 mupirocin ............................... 18 mupirocin calcium .................. 18 MUSTARGEN ....................... 42 MUTAMYCIN......................... 47 mvc-fluoride ........................... 96 MYALEPT ........................... 129 MYAMBUTOL........................ 41 MYCAMINE ........................... 37 MYCOBUTIN ......................... 41 mycophenolate mofetil ......... 120 mycophenolate mofetil hcl ... 120 mycophenolate sodium ........ 120 MYDAYIS .............................. 84 MYFORTIC ................. 120, 121 MYLOTARG .......................... 51 MYOBLOC ............................ 57 myorisan ................................ 90 MYRBETRIQ ....................... 102 MYSOLINE ............................ 28 MYTESI ................................. 98 myzilra ................................. 114 N NABI-HB .............................. 123 nabumetone ............................ 8 nadolol .................................. 76 nadolol-bendroflumethiazide .. 76 nafcillin sodium ...................... 22 nafcillin sodium in dextrose.... 22 nafrinse drops........................ 94 naftifine hcl ............................ 37 NAFTIN ................................. 37 NAGLAZYME ...................... 101 nalbuphine hcl ....................... 12

nalfon ...................................... 8 NALFON ................................. 8 NALOCET ............................. 12 naloxone hcl .......................... 15 naltrexone hcl........................ 14 NAMENDA ............................ 31 NAMENDA TITRATION PAK 31 NAMENDA XR ...................... 31 NAMENDA XR TITRATION

PACK ................................ 31 NAMZARIC ........................... 30 NAPRELAN ............................ 8 NAPROSYN ............................ 8 naproxen ................................. 8 naproxen dr ............................. 8 naproxen sodium .................... 8 naproxen sodium er ................ 8 naratriptan hcl ....................... 40 NARCAN ............................... 15 NARDIL ................................. 32 NAROPIN ............................. 13 NASONEX .......................... 137 NATACYN ............................. 38 NATAZIA ............................. 114 nateglinide ............................ 66 NATESTO ........................... 110 NATPARA ........................... 127 NATRECOR .......................... 79 NATROBA ............................ 52 nature-throid ....................... 117 NAVELBINE .......................... 47 NEBUPENT .......................... 52 nebusal ............................... 142 NEBUSAL ........................... 142 necon 0.5/35 (28) ................ 114 necon 1/35 (28) ................... 114 necon 1/50 (28) ................... 114 necon 7/7/7 ......................... 114 nefazodone hcl ...................... 33 NEMBUTAL ........................ 144 neomycin sulfate ................... 15 neomycin-bacitracin zn-polymyx

........................................ 131 neomycin-polymyxin b gu ...... 15 neomycin-polymyxin-dexameth

........................................ 134 neomycin-polymyxin-gramicidin

........................................ 131 neomycin-polymyxin-hc 134, 135 neo-polycin ......................... 131 neo-polycin hc ..................... 134 NEOPROFEN ....................... 79 NEORAL ............................. 121 NEOSPORIN ...................... 131

160

neo-synalar ............................ 18 NEPHRAMINE ..................... 129 NEPTAZANE ....................... 133 NERLYNX .............................. 47 NESACAINE .......................... 13 NESACAINE-MPF ................. 13 NESINA ................................. 66 neuac ..................................... 90 NEULASTA ............................ 71 NEULASTA ONPRO .............. 71 NEUPOGEN .......................... 71 NEUPRO ............................... 53 NEURONTIN ......................... 28 NEVANAC ........................... 134 nevirapine .............................. 60 nevirapine er .......................... 60 NEXAVAR ............................. 49 NEXIUM............................... 100 NEXIUM I.V. ........................ 100 NEXPLANON....................... 116 NEXTERONE ........................ 75 niacin (antihyperlipidemic)...... 82 niacin er (antihyperlipidemic) . 82 niacor ..................................... 82 NIASPAN ............................... 82 nicardipine hcl ........................ 78 NICOTROL ............................ 15 NICOTROL NS ...................... 15 nifedical xl .............................. 78 nifedipine ............................... 78 nifedipine er ........................... 78 nifedipine er osmotic release . 78 nikki ..................................... 114 NILANDRON ......................... 43 nilutamide .............................. 43 NIMBEX ............................... 143 nimodipine ............................. 78 NINLARO ............................... 47 NIPENT ................................. 44 nisoldipine er ......................... 78 nitro-bid.................................. 82 NITRO-DUR .......................... 83 nitrofurantoin .......................... 18 nitrofurantoin macrocrystal ..... 18 nitrofurantoin monohydrate

macrocrystals ..................... 18 nitroglycerin ........................... 83 nitroglycerin in d5w ................ 83 NITROLINGUAL .................... 83 NITROMIST ........................... 83 NITROPRESS ....................... 83 nitroprusside sodium .............. 83 NITROSTAT .......................... 83 NITYR .................................. 101

NIVESTYM ............................ 71 nizatidine ............................... 98 NIZORAL ............................... 38 NOCDURNA ....................... 109 NOCTIVA ............................ 109 nolix ..................................... 107 nora-be ................................ 116 norco ..................................... 12 NORDITROPIN FLEXPRO .. 109 norepinephrine bitartrate ....... 79 norethin ace-eth estrad-fe ... 114 norethindrone ...................... 116 norethindrone acetate .......... 116 norethindrone acet-ethinyl est

........................................ 114 norethindrone-eth estradiol .. 114 norethin-eth estradiol-fe ....... 114 NORGESIC FORTE ............ 143 norgestimate-eth estradiol ... 114 norgestimate-ethinyl estradiol

triphasic ........................... 114 NORITATE ............................ 90 norlyda ................................ 116 norlyroc ............................... 116 NORMOSOL-M IN D5W ........ 94 NORMOSOL-R ...................... 94 NORMOSOL-R IN D5W ........ 94 NORMOSOL-R PH 7.4 .......... 94 NORPACE ............................ 75 NORPACE CR ...................... 75 NORPRAMIN ........................ 34 NORTHERA .......................... 79 nortrel 0.5/35 (28) ................ 114 nortrel 1/35 (21) ................... 114 nortrel 1/35 (28) ................... 114 nortrel 7/7/7 ......................... 114 nortriptyline hcl ...................... 34 NORVASC ............................ 78 NORVIR ................................ 62 NOVAREL ........................... 109 NOVOLIN 70/30 FLEXPEN ... 68 NOVOLIN 70/30 FLEXPEN

RELION ............................. 68 NOVOLIN 70/30 RELION ...... 68 NOVOLIN 70/30 VIAL ............ 68 NOVOLIN N RELION ............ 68 NOVOLIN N VIAL .................. 68 NOVOLIN R RELION ............ 68 NOVOLIN R VIAL .................. 68 NOVOLOG FLEXPEN ........... 68 NOVOLOG MIX 70/30

FLEXPEN .......................... 68 NOVOLOG MIX 70/30 VIAL .. 68 NOVOLOG PENFILL ............. 68

NOVOLOG U-100 VIAL ........ 68 NOXAFIL .............................. 38 np thyroid ............................ 117 NPLATE ................................ 71 NUCALA ......................137, 142 NUCYNTA ............................ 12 NUCYNTA ER ....................... 10 NUEDEXTA .......................... 86 NULOJIX ............................. 121 NULYTELY WITH FLAVOR

PACKS .............................. 99 NUPLAZID ............................ 55 NUTRESTORE ................... 129 NUTRILIPID ........................ 129 NUTROPIN AQ NUSPIN 10 109 NUTROPIN AQ NUSPIN 20 109 NUTROPIN AQ NUSPIN 5 .. 109 NUVARING ......................... 114 NUVESSA ............................. 18 NUVIGIL ............................. 144 NUZYRA ............................... 26 nyamyc ................................. 38 nyata ..................................... 38 NYMALIZE ............................ 78 nystatin ................................. 38 nystatin-triamcinolone ........... 38 nystop ................................... 38 O OCALIVA .............................. 98 ocella .................................. 114 OCREVUS ............................ 87 OCTAGAM .......................... 123 octreotide acetate ............... 118 OCUFLOX ............................ 24 ODACTRA .......................... 142 ODEFSEY ............................. 60 ODOMZO .............................. 49 OFEV .................................. 142 ofloxacin ................................ 24 ogestrel ............................... 114 okebo .................................... 26 olanzapine ............................ 55 olanzapine-fluoxetine hcl ....... 33 olmesartan medoxomil .......... 73 olmesartan medoxomil-hctz .. 73 olmesartan-amlodipine-hctz .. 78 olopatadine hcl .............132, 135 OLUMIANT ......................... 124 OLUX .................................. 107 OLUX-E .............................. 107 OLYSIO ................................ 58 OMECLAMOX-PAK .............. 98 omega-3-acid ethyl esters ..... 82 OMEGAVEN ....................... 129

161

omeppi ................................. 100 omeprazole .......................... 100 omeprazole-sodium bicarbonate

........................................ 100 OMNARIS ............................ 137 OMNIPOD ........................... 129 OMNIPOD 5 PACK .............. 129 OMNIPOD DASH 5 PACK ... 129 OMNIPOD DASH SYSTEM . 129 OMNIPOD STARTER .......... 129 OMNIPRED ......................... 134 OMNITROPE ....................... 109 ONCASPAR .......................... 47 ondansetron hcl ..................... 35 ondansetron odt ..................... 35 ONEXTON ............................. 90 ONFI ...................................... 28 ONGLYZA ............................. 66 ONIVYDE .............................. 48 ONMEL .................................. 38 ONPATTRO ......................... 101 ONZETRA XSAIL .................. 40 OPANA .................................. 12 OPANA ER ............................ 10 OPDIVO................................. 51 opium ..................................... 98 OPSUMIT ............................ 140 ORACEA ............................... 90 ORALAIR ............................. 129 ORALAIR ADULT SAMPLE KIT

........................................ 129 ORALAIR ADULT STARTER

PACK ............................... 129 ORALAIR CHILDRENS

SAMPLE KIT .................... 129 ORALAIR CHILDRENS

STARTER PACK ............. 129 oralone .................................. 88 ORAP .................................... 54 ORAPRED ODT .................. 107 ORAVIG................................. 38 ORBACTIV ............................ 18 ORENCIA ............................ 121 ORENCIA CLICKJECT ........ 121 ORENITRAM ............... 140, 141 ORFADIN ............................ 101 ORILISSA ............................ 118 ORKAMBI ............................ 140 orphenadrine citrate ............. 143 orphenadrine citrate er ......... 143 orphenadrine-aspirin-caffeine

........................................ 143 ORPHENGESIC FORTE ..... 143 orsythia ................................ 114

ORTHO MICRONOR ........... 116 ORTHO TRI-CYCLEN (28) .. 114 ORTHO TRI-CYCLEN LO ... 114 ORTHO-CYCLEN (28) ........ 114 ORTHO-NOVUM 1/35 (28) .. 114 ORTHO-NOVUM 7/7/7 (28) . 114 oseltamivir phosphate ............ 62 OSENI ................................... 66 osmitrol.................................. 79 OSMOLEX ER ....................... 53 OSMOPREP ......................... 99 OSPHENA ........................... 117 OTEZLA .............................. 124 OTOVEL ................................ 24 OTREXUP ........................... 121 ovide ..................................... 52 oxacillin sodium ..................... 22 oxaliplatin .............................. 42 oxandrolone ........................ 110 oxaprozin ................................. 8 OXAYDO ............................... 12 oxazepam .............................. 64 oxcarbazepine ....................... 30 OXERVATE ......................... 131 oxiconazole nitrate ................ 38 OXISTAT ............................... 38 OXSORALEN ULTRA ........... 90 OXTELLAR XR ...................... 30 oxybutynin chloride .............. 102 oxybutynin chloride er .......... 102 oxycodone hcl ....................... 12 oxycodone hcl er ................... 10 oxycodone-acetaminophen.... 12 oxycodone-aspirin ................. 12 oxycodone-ibuprofen ............. 12 OXYCONTIN ......................... 10 oxymorphone hcl ................... 12 oxymorphone hcl er ............... 10 oxytocin ............................... 129 OXYTROL ........................... 102 OZEMPIC .............................. 66 P pacerone ............................... 75 paclitaxel ............................... 47 paliperidone er ....................... 55 palonosetron hcl .................... 35 PALYNZIQ .......................... 101 PAMELOR ............................. 34 pamidronate disodium ......... 127 PANCREAZE ...................... 101 PANDEL .............................. 107 panlor .................................... 12 PANRETIN ............................ 51 pantoprazole sodium ........... 100

PANZYGA ........................... 123 paregoric ............................... 98 paricalcitol ........................... 127 PARLODEL ........................... 53 PARNATE ............................. 32 paroex ................................... 88 paromomycin sulfate ............. 15 paroxetine hcl........................ 33 paroxetine hcl er ................... 33 paroxetine mesylate .............. 33 paser ..................................... 41 PATADAY ........................... 132 PATANASE ......................... 135 PATANOL ........................... 132 PAXIL ................................... 33 PAXIL CR ............................. 33 PAZEO................................ 132 PCE ...................................... 23 PEDIAPRED ....................... 107 PEDIARIX ........................... 125 PEDVAX HIB ...................... 125 peg 3350/electrolytes ............ 99 peg 3350-kcl-na bicarb-nacl .. 99 peg-3350/electrolytes ............ 99 PEGANONE ......................... 30 PEGASYS ............................. 59 PEGASYS PROCLICK .......... 59 PEGINTRON......................... 59 PEG-INTRON REDIPEN PAK 4

.......................................... 59 peg-prep ............................... 99 penicillamine ......................... 96 PENICILLIN G POT IN

DEXTROSE ...................... 22 penicillin g potassium ............ 22 penicillin g procaine............... 22 penicillin g sodium ................. 22 penicillin v potassium ............ 22 PENLAC ............................... 38 PENNSAID ........................... 90 PENTACEL ......................... 125 PENTAM ............................... 52 pentamidine isethionate ........ 52 PENTASA ........................... 126 pentazocine-naloxone hcl...... 12 pentobarbital sodium ........... 144 pentoxifylline er ..................... 79 pepcid ................................... 98 PEPCID ................................ 98 percocet ................................ 12 PERFOROMIST .................. 139 PERIDEX .............................. 88 PERIKABIVEN ...................... 94 perindopril erbumine ............. 74

162

periogard ............................... 88 PERJETA .............................. 51 permethrin ............................. 52 perphenazine ......................... 54 perphenazine-amitriptyline ..... 34 PERSERIS ............................ 55 PERTZYE ............................ 101 PEXEVA ................................ 33 pfizerpen ................................ 22 phenadoz ............................... 34 phenazo ............................... 103 phenazopyridine hcl ............. 103 phenelzine sulfate .................. 32 phenergan ............................. 34 PHENERGAN ........................ 34 phenobarbital ................... 27, 28 phenobarbital sodium............. 27 phenoxybenzamine hcl .......... 73 phentolamine mesylate .......... 73 phenylephrine hcl ........... 73, 132 phenytek ................................ 30 phenytoin ............................... 30 phenytoin infatabs .................. 30 phenytoin sodium ................... 30 phenytoin sodium extended ... 30 philith ................................... 114 PHOSLYRA ........................... 96 PHOSPHOLINE IODIDE ...... 133 phrenilin forte ...........................7 PHYSIOLYTE ...................... 130 PHYSIOSOL IRRIGATION .. 130 PICATO ................................. 90 PIFELTRO ............................. 60 pilocarpine hcl ................ 88, 133 pimecrolimus ......................... 90 pimozide ................................ 54 pimtrea ................................ 114 pindolol .................................. 76 pioglitazone hcl ...................... 66 pioglitazone hcl-glimepiride .... 66 pioglitazone hcl-metformin hcl 66 piperacillin sod-tazobactam so

.......................................... 22 PIQRAY (200 MG DAILY

DOSE) ............................... 47 PIQRAY (250 MG DAILY

DOSE) ............................... 47 PIQRAY (300 MG DAILY

DOSE) ............................... 47 pirmella 1/35 ........................ 114 pirmella 7/7/7 ....................... 114 piroxicam .................................8 PITOCIN .............................. 130 PLAQUENIL .......................... 52

PLASMA-LYTE 148 ............... 94 PLASMA-LYTE A .................. 94 PLASMA-LYTE-56 IN D5W ... 94 PLAVIX.................................. 72 PLEGRIDY ............................ 87 PLEGRIDY STARTER PACK 87 plenamine ............................ 130 PLENVU ................................ 99 PLIAGLIS .............................. 13 podofilox ................................ 90 POLIVY ................................. 51 polocaine ............................... 14 polocaine-mpf ........................ 14 polycin ................................. 131 polyethylene glycol 3350 ....... 99 polymyxin b sulfate ................ 18 polymyxin b-trimethoprim .... 131 POLYTRIM .......................... 131 POLY-VI-FLOR ..................... 96 POLY-VI-FLOR/IRON ............ 96 POMALYST ........................... 43 portia-28 .............................. 114 PORTRAZZA......................... 51 potassium acetate ................. 94 potassium chloride ................ 95 POTASSIUM CHLORIDE ...... 94 potassium chloride crys er ..... 94 potassium chloride er ............ 94 POTASSIUM CHLORIDE IN

DEXTROSE ....................... 94 potassium chloride in nacl ..... 94 POTASSIUM CHLORIDE IN

NACL ................................. 94 potassium chloride proamp .... 95 potassium citrate er ............... 95 POTELIGEO ......................... 51 PRADAXA ............................. 70 PRALUENT ........................... 79 pramipexole dihydrochloride .. 53 pramipexole dihydrochloride er

.......................................... 53 prandin .................................. 66 prasugrel hcl .......................... 72 PRAVACHOL ........................ 81 pravastatin sodium ................ 81 praziquantel ........................... 52 prazosin hcl ........................... 73 PRECOSE ............................. 66 PRED FORTE ..................... 134 PRED MILD ......................... 134 PRED-G .............................. 134 PRED-G S.O.P. ................... 134 prednicarbate ...................... 107 prednisolone ........................ 107

prednisolone acetate ........... 134 prednisolone acetate p-f ...... 134 prednisolone sodium phosphate

.................................107, 134 PREDNISOLON-MOXIFLOX-

KETOROLAC .................. 134 prednisone .......................... 107 prednisone intensol ............. 107 prefest ................................. 114 pregabalin ............................. 27 PREGNYL ........................... 109 PREMARIN ......................... 114 premasol ............................. 130 PREMPHASE ..................... 114 PREMPRO .......................... 114 prenatal ................................. 96 PREPIDIL ........................... 110 PREPOPIK ........................... 99 PRESTALIA .......................... 74 PREVACID ......................... 100 PREVACID SOLUTAB ........ 100 prevalite ................................ 82 previfem .............................. 114 PREVPAC ............................. 98 PREVYMIS ........................... 58 PREZCOBIX ......................... 62 PREZISTA ............................ 62 PRIALT ................................. 86 PRIFTIN ................................ 41 PRILOSEC .......................... 100 primaquine phosphate ........... 52 PRIMAXIN IV ........................ 21 primidone .............................. 28 primlev .................................. 12 PRIMSOL .............................. 18 PRINIVIL ............................... 74 PRISTIQ ............................... 33 PRIVIGEN ........................... 123 PROAIR HFA ...................... 139 PROAIR RESPICLICK ........ 139 probenecid ............................ 39 procainamide hcl ................... 75 PROCALAMINE .................... 95 PROCARDIA......................... 78 PROCARDIA XL ................... 78 procentra ............................... 84 prochlorperazine ................... 34 prochlorperazine edisylate .... 34 prochlorperazine maleate ...... 34 PROCRIT .............................. 71 PROCTOCORT .................... 39 PROCTOFOAM HC .............. 90 procto-med hc ....................... 39 procto-pak ............................. 39

163

proctosol hc ........................... 39 proctozone-hc ........................ 39 PROCYSBI .......................... 101 profeno ....................................8 progesterone ....................... 116 progesterone micronized ..... 116 PROGLYCEM ........................ 67 PROGRAF ........................... 121 PROLASTIN-C ..................... 142 PROLENSA ......................... 134 PROLEUKIN .......................... 47 PROLIA ............................... 127 PROMACTA .......................... 71 promethazine hcl ................... 34 promethazine vc plain .......... 142 promethazine-phenylephrine 142 promethegan ......................... 35 PROMETRIUM .................... 116 propafenone hcl ..................... 75 propafenone hcl er ................. 75 propantheline bromide ........... 97 proparacaine hcl .................. 131 propranolol hcl ....................... 77 propranolol hcl er ................... 76 propranolol-hctz ..................... 77 propylthiouracil..................... 119 PROQUAD .......................... 125 PROSCAR ........................... 103 PROSOL .............................. 130 PROSTIN E2 ....................... 110 PROTONIX .......................... 100 PROTOPAM CHLORIDE ..... 130 PROTOPIC ............................ 90 protriptyline hcl....................... 34 PROVENTIL HFA ................ 139 PROVERA ........................... 116 PROVIGIL ............................ 144 PROZAC ................................ 33 PRUDOXIN ............................ 90 psorcon ................................ 107 PULMICORT FLEXHALER .. 137 PULMICORT SUSPENSION137 pulmosal .............................. 142 PULMOZYME ...................... 140 PURIXAN ............................... 44 PYLERA ................................ 98 pyrazinamide ......................... 41 PYRIDIUM ........................... 103 pyridostigmine bromide .......... 41 pyridostigmine bromide er ...... 41 Q QBRELIS ............................... 74 QMIIZ ODT ..............................8 QNASL ................................ 137

QNASL CHILDRENS ........... 137 QTERN.................................. 66 QUADRACEL ...................... 125 QUALAQUIN ......................... 52 QUARTETTE....................... 114 quasense ............................. 114 quazepam ............................. 64 QUDEXY XR ......................... 29 QUELICIN ........................... 143 questran ................................ 82 QUESTRAN .......................... 82 questran light ......................... 82 quetiapine fumarate ............... 55 quetiapine fumarate er ........... 55 quflora pediatric ..................... 96 QUILLICHEW ER .................. 85 QUILLIVANT XR ................... 85 quinapril hcl ........................... 74 quinapril-hydrochlorothiazide . 74 quinidine gluconate ............... 75 quinidine gluconate er ........... 75 quinidine sulfate .................... 75 quinine sulfate ....................... 52 QVAR .................................. 137 QVAR REDIHALER ............. 137 R RABAVERT ......................... 125 rabeprazole sodium ............. 100 RADICAVA ............................ 86 RAGWITEK ......................... 130 rajani ................................... 114 raloxifene hcl ....................... 117 ramelteon ............................ 144 ramipril .................................. 74 RANEXA ............................... 79 ranitidine hcl .......................... 98 ranolazine er ......................... 79 RAPAFLO ........................... 103 RAPAMUNE ........................ 121 RAPIVAB ............................... 62 rasagiline mesylate ................ 54 RASUVO ............................. 121 RAVICTI .............................. 101 RAYALDEE ........................... 96 RAYOS................................ 107 RAZADYNE ........................... 31 RAZADYNE ER ..................... 31 REBETOL ............................. 59 REBIF ................................... 87 REBIF REBIDOSE ................ 87 REBIF REBIDOSE TITRATION

PACK ................................ 87 REBIF TITRATION PACK ..... 88 RECLAST ............................ 127

reclipsen ............................. 114 RECOMBIVAX HB .............. 125 RECTIV ................................. 90 REGLAN ............................... 98 REGONOL ............................ 41 REGRANEX .......................... 90 RELENZA DISKHALER ........ 62 relexxii................................... 85 RELISTOR ............................ 98 RELPAX ................................ 40 REMERON ........................... 31 REMERON SOLTAB ............. 31 REMICADE ......................... 121 REMODULIN ...................... 141 RENACIDIN ........................ 103 RENAGEL ............................. 96 RENFLEXIS ........................ 122 RENVELA ............................. 96 REOPRO .............................. 72 repaglinide ............................ 66 repaglinide-metformin hcl ...... 66 REPATHA ............................. 79 REPATHA PUSHTRONEX

SYSTEM ........................... 79 REPATHA SURECLICK ........ 79 REQUIP ................................ 53 REQUIP XL ........................... 53 RESCRIPTOR ...................... 60 RESCULA ........................... 130 RESTASIS .......................... 131 RESTORIL ............................ 64 RETACRIT ............................ 72 RETIN-A ............................... 90 RETIN-A MICRO GEL 0.04 %,

0.1 % ................................. 90 RETIN-A MICRO PUMP . 90, 91 RETROVIR ........................... 61 REVATIO ............................ 141 REVCOVI ............................ 101 REVLIMID ............................. 43 revonto .................................. 57 REXULTI ............................... 55 REYATAZ ............................. 62 RHOFADE ............................ 91 RHOGAM ULTRA-FILTERED

PLUS .............................. 123 RHOPHYLAC...................... 123 RHOPRESSA ..................... 131 RIAX ..................................... 91 ribasphere ............................. 59 RIBASPHERE ....................... 59 ribasphere ribapak ................ 59 RIBASPHERE RIBAPAK ...... 59 ribavirin ......................... 59, 142

164

RIDAURA ............................ 124 rifabutin .................................. 41 RIFADIN ................................ 41 rifamate.................................. 41 rifampin .................................. 41 RIFATER ............................... 41 RILUTEK ............................... 86 riluzole ................................... 86 rimantadine hcl ...................... 62 RIMSO-50 ............................ 103 ringers ................................... 95 ringers irrigation ................... 130 RIOMET ................................. 66 risedronate sodium .............. 127 RISEDRONATE SODIUM .... 127 RISPERDAL .......................... 56 RISPERDAL CONSTA ........... 55 RISPERDAL M-TAB ........ 55, 56 risperidone ............................. 56 RITALIN ................................. 85 RITALIN LA ........................... 85 ritonavir .................................. 62 RITUXAN ............................... 51 RITUXAN HYCELA ................ 51 rivastigmine ........................... 31 rivastigmine tartrate ............... 31 rivelsa .................................. 114 rizatriptan benzoate ............... 40 ROBAXIN ............................ 143 ROBAXIN-750 ..................... 143 ROBINUL ............................... 97 ROBINUL-FORTE ................. 97 ROCALTROL ....................... 127 ROCKLATAN ....................... 133 ROMIDEPSIN ........................ 47 ropinirole hcl .......................... 53 ropinirole hcl er ...................... 53 ropivacaine hcl ....................... 14 rosadan.................................. 91 rosuvastatin calcium .............. 81 ROTARIX ............................. 125 ROTATEQ ........................... 125 ROWASA ............................. 126 roweepra ................................ 27 roweepra xr ............................ 27 ROXICODONE ...................... 12 ROXYBOND .......................... 12 ROZEREM ........................... 144 RUBRACA ............................. 49 RUCONEST ........................ 119 RUZURGI ............................ 130 ryclora .................................. 135 RYDAPT ................................ 47 RYTARY ................................ 53

RYTHMOL SR ....................... 75 ryvent .................................. 135 S SABRIL ................................. 28 SAFYRAL ............................ 115 SAIZEN ............................... 109 SAIZEN CLICK.EASY ......... 109 SAIZENPREP...................... 109 SALAGEN ............................. 88 salsalate .................................. 8 SAMSCA ............................... 96 SANCUSO ............................ 36 SANDIMMUNE .................... 122 SANDOSTATIN ................... 118 SANDOSTATIN LAR DEPOT

........................................ 118 SANTYL ................................ 91 SAPHRIS .............................. 56 SARAFEM ............................. 33 SAVAYSA ............................. 70 SAVELLA .............................. 86 SAVELLA TITRATION PACK 86 scopolamine .......................... 35 SEASONIQUE ..................... 115 SECONAL ........................... 144 SEEBRI NEOHALER ........... 138 SEGLUROMET ..................... 66 selegiline hcl .......................... 54 selenium sulfide ..................... 91 SELZENTRY ......................... 61 SEMPREX-D ....................... 135 SENSIPAR .......................... 127 sensorcaine ........................... 14 sensorcaine/epinephrine ....... 14 sensorcaine-mpf .................... 14 sensorcaine-mpf spinal .......... 14 sensorcaine-mpf/epinephrine 14 SENSORCAINE-

MPF/EPINEPHRINE .......... 14 SEREVENT DISKUS ........... 139 SERNIVO ............................ 107 SEROQUEL .......................... 56 SEROQUEL XR .................... 56 SEROSTIM ......................... 109 sertraline hcl .......................... 33 setlakin ................................ 115 sevelamer carbonate ............. 96 sevelamer hcl ........................ 96 SEYSARA ............................. 26 SFROWASA ........................ 126 sharobel .............................. 116 SHINGRIX ........................... 125 SIGNIFOR ........................... 118 SIGNIFOR LAR ................... 118

SIKLOS ................................. 44 sildenafil citrate ................... 141 SILENOR ............................ 144 SILIQ .................................... 91 silodosin .............................. 103 SILVADENE .......................... 18 silver sulfadiazine .................. 18 SIMBRINZA ........................ 133 simliya ................................. 115 simpesse ............................. 115 SIMPONI ............................. 122 SIMPONI ARIA ................... 124 SIMULECT .......................... 124 simvastatin ............................ 81 SINEMET .............................. 53 SINEMET CR ........................ 53 SINGULAIR ........................ 137 sirolimus .............................. 122 SIRTURO .............................. 41 SIVEXTRO ............................ 18 SKELAXIN .......................... 143 SKLICE ................................. 52 SKYLA ................................ 116 SKYRIZI (150 MG DOSE) ... 122 SLYND ................................ 116 SMOFLIPID ........................ 130 sod benz-sod phenylacet .... 130 sodium acetate ...................... 95 sodium bicarbonate ............... 95 sodium bicarbonate-dextrose 95 sodium chloride ............. 95, 142 SODIUM CHLORIDE .... 95, 130 SODIUM DIURIL ................... 81 SODIUM EDECRIN............... 80 sodium fluoride ...................... 95 SODIUM LACTATE............... 95 sodium phenylbutyrate ........ 101 sodium phosphates ............... 95 sodium polystyrene sulfonate 96 sofosbuvir-velpatasvir ........... 58 solifenacin succinate ........... 102 SOLIQUA .............................. 68 SOLIRIS ................................ 71 SOLODYN ............................ 26 SOLOSEC ............................ 52 soloxide ................................. 26 SOLTAMOX .......................... 43 SOLU-CORTEF .................. 107 SOLU-MEDROL .................. 107 SOMA ................................. 143 SOMATULINE DEPOT ....... 118 SOMAVERT ........................ 118 SONATA ............................. 144 SOOLANTRA ........................ 91

165

SORIATANE .......................... 91 SORILUX ............................... 91 sorine ..................................... 75 sotalol hcl ............................... 75 sotalol hcl (af) ........................ 75 SOTYLIZE ............................. 75 SOVALDI ............................... 58 SPECTRACEF ....................... 20 spinosad ................................ 52 SPINRAZA ........................... 130 SPIRIVA HANDIHALER ....... 138 SPIRIVA RESPIMAT ........... 138 spironolactone ....................... 80 spironolactone-hctz ................ 80 SPORANOX .......................... 38 SPORANOX PULSEPAK ....... 38 SPRAVATO (56 MG DOSE) .. 31 SPRAVATO (84 MG DOSE) .. 31 sprintec 28 ........................... 115 SPRITAM ............................... 27 SPRIX ......................................8 SPRYCEL .............................. 49 sps ......................................... 96 sronyx .................................. 115 SSD ....................................... 18 STALEVO 100 ....................... 53 STALEVO 125 ....................... 53 STALEVO 150 ....................... 53 STALEVO 200 ....................... 54 STALEVO 50 ......................... 54 STALEVO 75 ......................... 54 STAMARIL ........................... 125 STARLIX ................................ 66 stavudine ............................... 61 STEGLATRO ......................... 66 STEGLUJAN ......................... 66 STELARA .............................. 91 sterile water for irrigation ...... 130 STIMATE ............................. 109 STIOLTO RESPIMAT .......... 142 STIVARGA ............................ 49 STRATTERA ......................... 85 STRENSIQ .......................... 101 streptomycin sulfate ............... 16 STRIANT ............................. 110 STRIBILD .............................. 60 STRIVERDI RESPIMAT ...... 139 STROMECTOL ...................... 52 SUBLOCADE......................... 14 SUBOXONE .......................... 15 SUBSYS ................................ 12 subvenite ............................... 29 subvenite starter kit-blue ........ 29 subvenite starter kit-green ..... 29

subvenite starter kit-orange ... 29 succinylcholine chloride ....... 143 SUCRAID ............................ 101 sucralfate ............................... 99 SULAR .................................. 78 sulfacetamide sodium ............ 25 sulfacetamide sodium (acne) . 25 sulfacetamide-prednisolone . 134 sulfadiazine ........................... 25 sulfamethoxazole-trimethoprim

.......................................... 25 SULFAMYLON ...................... 18 sulfasalazine ....................... 126 sulfatrim pediatric .................. 25 sulindac ................................... 8 sumatriptan ........................... 40 sumatriptan succinate ............ 40 SUMATRIPTAN SUCCINATE

REFILL .............................. 40 sumatriptan-naproxen sodium 40 SUMAVEL DOSEPRO .......... 40 SUNOSI .............................. 144 SUPPRELIN LA ................... 118 suprax ................................... 20 SUPRAX ............................... 20 SUPREP BOWEL PREP KIT . 99 SURMONTIL ......................... 34 SUSTIVA ............................... 60 SUSTOL ................................ 36 SUTENT ................................ 49 syeda .................................. 115 SYLATRON ........................... 47 SYLVANT ............................ 124 SYMBICORT ....................... 142 SYMBYAX ............................. 33 SYMDEKO .......................... 140 SYMFI ................................... 60 SYMFI LO ............................. 60 SYMJEPI ............................. 139 SYMLINPEN 120 ................... 66 SYMLINPEN 60 ..................... 66 SYMPAZAN .......................... 28 SYMPROIC ........................... 98 SYMTUZA ............................. 62 SYNAGIS ............................ 123 synalar ................................ 107 SYNALAR ........................... 107 SYNALAR (CREAM) ............. 91 SYNALAR TS ........................ 91 SYNAREL ........................... 118 SYNDROS ............................ 36 SYNERA ............................... 14 SYNERCID ............................ 18 SYNJARDY ........................... 66

SYNJARDY XR ..................... 66 SYNRIBO .............................. 47 SYNTHAMIN 17 .................. 130 SYNTHROID ....................... 117 SYPRINE .............................. 96 T TABLOID .............................. 44 TACLONEX .......................... 91 tacrolimus ..................... 91, 122 tadalafil ............................... 103 tadalafil (pah) ...................... 141 TAFINLAR ............................ 49 TAGRISSO ........................... 49 TAKHZYRO .......................... 79 TALTZ ................................... 91 TALZENNA ........................... 47 TAMIFLU ........................ 62, 63 tamoxifen citrate .................... 43 tamsulosin hcl ..................... 103 TANZEUM ............................ 66 tapazole .............................. 119 taperdex 12-day .................. 107 taperdex 6-day .................... 107 taperdex 7-day .................... 107 TARCEVA ............................. 49 targadox ................................ 26 TARGRETIN ......................... 51 tarina 24 fe .......................... 115 tarina fe 1/20 ....................... 115 TARKA .................................. 74 TASIGNA .............................. 49 TASMAR ............................... 53 TAVALISSE .......................... 72 TAXOTERE .......................... 47 TAYTULLA .......................... 115 tazarotene ............................. 91 tazicef ................................... 20 TAZORAC ............................. 91 taztia xt ................................. 78 TDVAX ................................ 125 TECENTRIQ ......................... 51 TECFIDERA ......................... 88 TECHNIVIE ........................... 58 TEFLARO ............................. 21 TEGRETOL .......................... 30 TEGRETOL-XR .................... 30 TEGSEDI ............................ 102 TEKTURNA .......................... 79 TEKTURNA HCT .................. 79 telmisartan ............................ 73 telmisartan-amlodipine .......... 78 telmisartan-hctz ..................... 73 temazepam ........................... 64 TEMODAR ............................ 42

166

TEMOVATE ................. 107, 108 temsirolimus .......................... 49 tencon ......................................7 teniposide .............................. 47 TENIVAC ............................. 125 tenofovir disoproxil fumarate .. 61 TENORETIC 100 ................... 77 TENORETIC 50 ..................... 77 TENORMIN ........................... 77 TEPADINA ............................. 43 TERAZOL 7 ........................... 38 terazosin hcl ........................ 103 terbinafine hcl ........................ 38 terbutaline sulfate ................ 139 terconazole ............................ 38 TESTIM ............................... 110 testosterone ......................... 110 testosterone cypionate ......... 110 testosterone enanthate ........ 110 TESTRED ............................ 110 tetcaine ................................ 131 tetrabenazine ......................... 86 tetracaine hcl ....................... 131 tetracycline hcl ....................... 26 tetravisc ............................... 131 tetravisc forte ....................... 131 texacort ................................ 108 THALOMID ............................ 43 theo-24 ................................ 140 theochron ............................. 140 theophylline ......................... 140 theophylline er ..................... 140 theophylline in d5w .............. 140 THERACYS ........................... 47 THIOLA................................ 103 THIOLA EC .......................... 103 thioridazine hcl ....................... 54 thiotepa .................................. 43 thiothixene ............................. 54 THYMOGLOBULIN .............. 123 THYROLAR-1 ...................... 117 THYROLAR-1/2 ................... 117 THYROLAR-1/4 ................... 117 THYROLAR-2 ...................... 117 THYROLAR-3 ...................... 117 tiagabine hcl .......................... 28 TIAZAC .................................. 78 TIBSOVO ............................... 49 TICE BCG .............................. 47 TIGAN ................................... 35 tigecycline .............................. 18 TIGLUTIK .............................. 86 TIKOSYN ............................... 75 tilia fe ................................... 115

timolol maleate .............. 77, 133 TIMOPTIC ........................... 133 TIMOPTIC OCUDOSE ........ 133 TIMOPTIC-XE ..................... 133 TINDAMAX ............................ 52 tinidazole ............................... 52 TIROSINT ........................... 117 TIROSINT-SOL ................... 117 tis-u-sol................................ 130 TIVICAY ................................ 60 TIVORBEX .............................. 8 tizanidine hcl ......................... 57 TL-FLUORIVITE .................... 96 TOBI NEBULIZER ............... 140 TOBI PODHALER ............... 140 TOBRADEX ........................ 134 TOBRADEX ST ................... 134 tobramycin ..................... 16, 140 tobramycin sulfate ................. 16 tobramycin-dexamethasone 134 TOBREX ............................... 16 tofranil ................................... 34 TOLAK .................................. 44 tolazamide ............................. 66 tolbutamide ............................ 66 tolcapone ............................... 53 tolmetin sodium ....................... 8 TOLSURA ............................. 38 tolterodine tartrate ............... 102 tolterodine tartrate er ........... 102 TOPAMAX ............................. 29 TOPAMAX SPRINKLE .......... 29 topicort ................................ 108 TOPICORT .......................... 108 TOPICORT SPRAY ............. 108 topiramate ............................. 29 topiramate er ......................... 29 toposar .................................. 48 topotecan hcl ......................... 48 TOPROL XL .......................... 77 toremifene citrate ................... 43 TORISEL ............................... 50 torsemide .............................. 80 TOTECT ................................ 51 TOUJEO MAX SOLOSTAR ... 68 TOUJEO SOLOSTAR ........... 68 TOVIAZ ............................... 102 TPN ELECTROLYTES .......... 95 TRACLEER ......................... 141 TRADJENTA ......................... 66 tramadol hcl er ....................... 10 tramadol hcl er (biphasic) ...... 10 tramadol hcl ir ........................ 12 tramadol-acetaminophen ....... 12

trandolapril ............................ 74 trandolapril-verapamil hcl er .. 74 tranexamic acid ..................... 72 TRANSDERM SCOP (1.5 MG)

.......................................... 35 TRANSDERM-SCOP (1.5 MG)

.......................................... 35 TRANXENE-T ....................... 64 tranylcypromine sulfate ......... 32 TRAVASOL ......................... 130 TRAVATAN Z ...................... 130 trazodone hcl ........................ 33 TREANDA ............................. 43 TRECATOR .......................... 41 TRELEGY ELLIPTA ............ 142 TRELSTAR MIXJECT ..118, 119 TREMFYA ............................. 91 treprostinil ........................... 141 TRESIBA .............................. 68 TRESIBA FLEXTOUCH ........ 68 tretinoin ........................... 51, 91 tretinoin microsphere ............. 91 tretinoin microsphere pump ... 91 TRETIN-X ............................. 91 trexall .................................. 122 TREXIMET ............................ 40 trezix ..................................... 12 tri femynor ........................... 115 triamcinolone acetonide . 39, 88,

108, 137 triamcinolone diacetate ....... 108 triamterene ............................ 80 triamterene-hctz .................... 80 trianex ................................. 108 triazolam ............................... 64 TRIBENZOR ......................... 78 TRICOR ................................ 81 triderm................................. 108 TRIDESILON ...................... 108 trientine hcl ........................... 96 TRIESENCE ....................... 134 tri-estarylla .......................... 115 trifluoperazine hcl .................. 54 trifluridine .............................. 59 TRIGLIDE ............................. 81 trihexyphenidyl hcl .......... 52, 53 triklo ...................................... 82 tri-legest fe .......................... 115 TRILEPTAL ........................... 30 tri-linyah .............................. 115 TRILIPIX ............................... 81 tri-lo-estarylla ...................... 115 tri-lo-marzia ......................... 115 tri-lo-mili .............................. 115

167

tri-lo-sprintec ........................ 115 trilyte ...................................... 99 trimethobenzamide hcl ........... 35 trimethoprim ........................... 18 tri-mili ................................... 115 trimipramine maleate ............. 34 TRIMPEX ............................... 18 trinessa (28) ......................... 115 trinessa lo ............................ 115 TRI-NORINYL (28) .............. 115 TRINTELLIX .......................... 33 TRIOSTAT ........................... 117 tri-previfem ........................... 115 TRIPTODUR ........................ 119 TRISENOX ............................ 47 tri-sprintec ............................ 115 TRIUMEQ .............................. 60 TRI-VI-FLOR ......................... 97 tri-vitamin/fluoride .................. 97 trivora (28) ........................... 115 tri-vylibra .............................. 115 tri-vylibra lo .......................... 115 TRIZIVIR ................................ 61 TROGARZO .......................... 61 TROKENDI XR ...................... 29 TROPHAMINE ..................... 130 trospium chloride ................. 102 trospium chloride er ............. 102 TRULANCE ........................... 98 TRULICITY ............................ 66 TRUMENBA ........................ 125 TRUSOPT ........................... 133 TRUVADA ............................. 61 TUDORZA PRESSAIR ........ 138 tulana ................................... 116 TWINRIX ............................. 125 TWYNSTA ............................. 78 TYBOST ................................ 62 tydemy ................................. 115 TYGACIL ............................... 18 TYKERB ................................ 50 tylenol with codeine #3 ........... 12 tylenol with codeine #4 ........... 13 TYMLOS .............................. 127 TYPHIM VI ........................... 125 TYSABRI ............................... 88 TYVASO .............................. 141 TYVASO REFILL ................. 141 TYVASO STARTER............. 141 U UCERIS ....................... 108, 126 UDENYCA ............................. 71 ULESFIA ................................ 52 ULORIC ................................. 39

ULTOMIRIS ........................... 71 ULTRACET ........................... 13 ULTRAM ............................... 13 ULTRAVATE ....................... 108 UNASYN ............................... 22 UNITHROID ........................ 117 UNITUXIN ............................. 51 UPTRAVI ............................. 141 urecholine ............................ 103 UROCIT-K 10 ........................ 95 UROCIT-K 15 ........................ 95 UROCIT-K 5 .......................... 95 UROXATRAL ...................... 103 URSO 250 ............................. 98 URSO FORTE ....................... 98 ursodiol.................................. 98 UTIBRON NEOHALER ........ 139 UVADEX ............................... 91 V VABOMERE .......................... 21 VAGIFEM ............................ 115 valacyclovir hcl ...................... 59 VALCHLOR ........................... 43 VALCYTE .............................. 58 valganciclovir hcl ................... 58 VALIUM ................................. 64 valproate sodium ................... 28 valproic acid .......................... 28 valrubicin ............................... 47 valsartan ................................ 73 valsartan-hydrochlorothiazide 73 VALSTAR .............................. 47 VALTREX .............................. 59 vanatol lq ................................. 7 VANCOCIN HCL ................... 18 vancomycin hcl ................ 18, 19 VANCOMYCIN HCL .............. 19 vancomycin hcl in dextrose.... 18 vancomycin hcl in nacl ........... 18 VANDAZOLE......................... 19 VANOS................................ 108 VANTAS .............................. 119 VAPRISOL .......................... 109 VAQTA ................................ 125 VARIVAX ............................. 125 VARIZIG .............................. 125 VARUBI ................................. 36 VASCEPA ............................. 82 VASERETIC .......................... 74 VASOSTRICT ..................... 109 VASOTEC ............................. 74 VAZCULEP ........................... 73 vecamyl ................................. 80 VECTIBIX .............................. 51

VECTICAL ............................ 91 VELCADE ............................. 47 VELETRI ............................. 141 velivet ................................. 115 VELPHORO .......................... 96 VELTASSA ........................... 96 VELTIN ................................. 91 VEMLIDY .............................. 58 VENCLEXTA......................... 50 VENCLEXTA STARTING PACK

.......................................... 50 venlafaxine hcl ...................... 33 venlafaxine hcl er .................. 33 VENTAVIS .......................... 141 VENTOLIN HFA .................. 139 verapamil hcl ......................... 78 verapamil hcl er ..................... 78 VERAPAMIL HCL ER ........... 78 VEREGEN ............................ 91 VERELAN ............................. 78 VERELAN PM ....................... 78 VERIPRED 20 ..................... 108 VERSACLOZ ........................ 57 VERZENIO ........................... 47 VESICARE .......................... 102 vestura ................................ 115 VFEND.................................. 38 VFEND IV ............................. 38 V-GO 20 .............................. 130 V-GO 30 .............................. 130 V-GO 40 .............................. 130 VIBATIV ................................ 19 VIBERZI ................................ 98 VIBRAMYCIN ........................ 26 vicodin................................... 13 vicodin es .............................. 13 vicodin hp .............................. 13 VICTOZA .............................. 66 VIDAZA ................................. 47 VIDEX ................................... 61 VIDEX EC ............................. 61 VIEKIRA PAK........................ 58 VIEKIRA XR .......................... 59 vienva ................................. 115 vigabatrin .............................. 28 vigadrone .............................. 28 VIGAMOX ............................. 24 VIIBRYD ............................... 33 VIIBRYD STARTER PACK ... 34 VIMIZIM .............................. 102 VIMOVO ................................. 8 VIMPAT ................................ 30 vinblastine sulfate ................. 47 vincasar pfs ........................... 47

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vincristine sulfate ................... 47 vinorelbine tartrate ................. 47 VIOKACE ............................. 102 viorele .................................. 115 VIRACEPT ............................. 62 VIRAMUNE ............................ 60 VIRAMUNE XR ...................... 60 VIRAZOLE ........................... 142 VIREAD ................................. 61 VIROPTIC .............................. 59 VISTARIL ............................. 136 VISTOGARD ....................... 130 VISUDYNE .......................... 131 vitamins acd-fluoride .............. 97 VITRAKVI .............................. 47 VIVELLE-DOT ..................... 115 VIVITROL .............................. 14 VIVLODEX ...............................8 VIZIMPRO ............................. 50 VOGELXO ........................... 110 VOGELXO PUMP ................ 110 VOLTAREN .............................8 VOLUVEN ........................... 130 voriconazole .......................... 38 VOSEVI ................................. 59 VOTRIENT ............................ 50 VPRIV .................................. 102 VRAYLAR .............................. 56 VUSION ................................. 38 vyfemla ................................ 115 vylibra .................................. 115 VYNDAQEL ........................... 80 VYTORIN ............................... 82 VYVANSE .............................. 84 VYXEOS ................................ 44 VYZULTA ............................ 130 W warfarin sodium ..................... 70 WELCHOL ............................. 82 WELLBUTRIN SR ............ 31, 32 WELLBUTRIN XL .................. 32 wera ..................................... 115 WESTCORT ........................ 108 westhroid ............................. 117 WINRHO SDF...................... 123 wixela inhub ......................... 142 wymzya fe ............................ 115 X XADAGO ............................... 54 XALATAN ............................ 130 XALKORI ............................... 50 XANAX .................................. 64 XANAX XR ............................ 64 XARELTO .............................. 70

XARELTO STARTER PACK . 70 XATMEP ............................. 122 XELJANZ ............................ 124 XELJANZ XR....................... 124 XELPROS ........................... 131 XENAZINE ............................ 86 XENICAL ............................. 130 XEOMIN ................................ 57 XEPI ...................................... 25 XERAC AC ............................ 91 XERAVA ................................ 26 XERESE ................................ 59 XERMELO ............................. 98 XGEVA ................................ 127 XHANCE ............................. 137 XIAFLEX ............................. 102 XIFAXAN ............................... 19 XIGDUO XR .......................... 66 XIIDRA ................................ 131 XIMINO ................................. 26 XOFLUZA .............................. 63 XOLAIR ............................... 143 XOPENEX ........................... 139 XOPENEX CONCENTRATE139 XOPENEX HFA ................... 139 XOSPATA ............................. 50 XPOVIO (100 MG ONCE

WEEKLY) .......................... 44 XPOVIO (60 MG ONCE

WEEKLY) .......................... 44 XPOVIO (80 MG ONCE

WEEKLY) .......................... 44 XPOVIO (80 MG TWICE

WEEKLY) .......................... 44 XTAMPZA ER ....................... 10 XTANDI ................................. 43 xulane ................................. 115 XULTOPHY ........................... 68 XURIDEN ............................ 102 XYLOCAINE .......................... 14 XYLOCAINE (CARDIAC) ...... 75 xylocaine dental ..................... 14 XYLOCAINE/EPINEPHRINE . 14 XYLOCAINE-MPF ................. 14 XYLOCAINE-

MPF/EPINEPHRINE .......... 14 xylon ...................................... 13 XYOSTED ........................... 111 XYREM ............................... 144 Y YASMIN 28 ......................... 115 YAZ ..................................... 115 YERVOY ............................... 51 YF-VAX ............................... 125

YONDELIS ............................ 43 YONSA ................................. 43 YOSPRALA .......................... 72 YUPELRI ............................ 138 yuvafem .............................. 115 Z zafirlukast ............................ 137 zaleplon .............................. 144 ZALTRAP .............................. 47 ZANAFLEX ..................... 57, 58 ZANOSAR ............................ 43 ZANTAC ............................... 98 zarah ................................... 115 zarontin ................................. 27 ZARONTIN ........................... 27 ZARXIO ................................ 71 ZAVESCA ........................... 102 zebutal .................................... 7 ZEGERID ............................ 100 ZEJULA ................................ 50 ZELAPAR ............................. 54 ZELBORAF ........................... 50 ZEMAIRA ............................ 143 ZEMBRACE SYMTOUCH ..... 41 ZEMDRI ................................ 16 ZEMPLAR ........................... 127 zenatane ............................... 91 zenchent ............................. 115 ZENPEP ............................. 102 zenzedi ................................. 84 ZEPATIER ............................ 59 ZERBAXA ............................. 21 ZERIT ................................... 61 ZESTORETIC ....................... 74 ZESTRIL ............................... 74 ZETIA ................................... 82 ZETONNA ........................... 137 ZEVALIN Y-90 ...................... 51 ZIAC ..................................... 77 ZIAGEN ................................ 61 ZIANA ................................... 91 zidovudine ............................. 61 zileuton er ........................... 137 ZILRETTA ............................. 39 ZINBRYTA ............................ 88 ZINECARD ........................... 51 ZINPLAVA .......................... 124 ZIOPTAN ............................ 131 ziprasidone hcl ...................... 56 ZIPSOR .................................. 8 ZIRGAN ................................ 58 ZITHROMAX ......................... 23 ZITHROMAX TRI-PAK .......... 23 ZITHROMAX Z-PAK ............. 23

169

ZMAX .................................... 24 ZOCOR.................................. 81 ZODEX 12-DAY ................... 108 ZOFRAN ................................ 36 ZOFRAN ODT ....................... 36 ZOHYDRO ER ....................... 10 ZOLADEX ............................ 119 zoledronic acid ..................... 128 ZOLINZA ............................... 47 zolmitriptan ............................ 41 ZOLOFT ................................ 34 zolpidem tartrate .................. 144 zolpidem tartrate er .............. 144 ZOLPIMIST .......................... 144 ZOMACTON ........................ 109 ZOMETA .............................. 128 ZOMIG ................................... 41 ZOMIG ZMT .......................... 41

ZONACORT 11 DAY ........... 108 ZONACORT 7 DAY ............. 108 ZONALON ............................. 91 ZONEGRAN .......................... 27 zonisamide ............................ 27 ZONTIVITY ........................... 72 ZORBTIVE .......................... 109 ZORTRESS ......................... 122 ZORVOLEX ............................. 9 ZOSTAVAX ......................... 125 ZOSYN .................................. 23 zovia 1/35e (28) ................... 115 zovia 1/50e (28) ................... 115 ZOVIRAX .............................. 60 ZTLIDO ................................. 14 ZUBSOLV ............................. 15 zumandimine ....................... 115 ZUPLENZ .............................. 36

ZURAMPIC ........................... 39 ZYBAN .................................. 15 ZYCLARA ............................. 91 ZYCLARA PUMP .................. 92 ZYDELIG .............................. 48 ZYFLO ................................ 137 ZYFLO CR .......................... 137 ZYKADIA ........................ 48, 50 ZYLET................................. 135 ZYLOPRIM ........................... 39 ZYMAXID .............................. 25 ZYPITAMAG ......................... 81 ZYPREXA ............................. 56 ZYPREXA RELPREVV ......... 56 ZYPREXA ZYDIS .................. 56 ZYTIGA ................................. 43 ZYVOX.................................. 19

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This formulary was updated on August 28, 2019, and is a complete list of drugs covered by our plan. For a complete listing or other questions, please contact:

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