2004 Express Scripts National P - Michigan€¦ · choline mag trisalicylate CHROMAGEN CHROMAGEN FA CHROMAGEN FORTE CILOXAN * cimetidine cimetidine hcl CIPRO * 10% SUSPENSION CIPRO

ESI National Preferred Formulary

Created 12/29/2003 Please note this document is subject to change. Any changes/updates to this document can viewed at Express-Script's web site atwww.express-scripts.com

2004 Express Scripts National Preferred Alpha Formulary List (1q-04) The following is a list of the most commonly prescribed drugs. It represents an abbreviated version of the drug list (formulary) that is at the core of your pharmacy benefit plan. The list is not all-inclusive and does not guarantee coverage. In addition to using this list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate.

PLEASE NOTE: The symbol * next to a drug signifies subject to non-formulary status when generic is available throughout the year. Not all the drugs listed are covered by all pharmacy benefit programs, check your benefit materials for the specific drugs covered and the copay information for your pharmacy benefit program. For specific questions about your coverage, please call the phone number printed on your ID card.

KEY The symbol [G] next to a drug name indicates that a generic is available for at least one or more strengths of the brand medication. The symbol [SNRI] stands for Serotonin-Norepinephrine Reuptake Inhibitor.

For the member: Generic medications contain the same active ingredients as their corresponding brand name medications, although they may look different in color or shape. They have been FDA-approved under strict standards.

For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate.

Brand name drugs are listed in CAPITAL letters. Example: MOTRIN Generic drugs are listed in lower case letters. Example: ibuprofen

This is a list of formulary products only.

8-MOP a/b otic aber-tuss hc ABILIFY abletex pse ACCU-CHEK ACCU-CHEK III ACCU-CHEK SIMPLICITY acebutolol hcl acetaminophen w/butalbital acetaminophen w/codeine acetaminophen-codeineacetasol hc acetazolamideacetic acid ACETIC ACID GLACIAL acetic acid/aluminum acetic acid/hydrocortisone ACETOHEXAMIDE acetylcysteineachromycin v acidic vaginal acticinACTONEL ACTOS

acycloviradc w/fluoride ADDERALL XR ADEFLOR M ADVAIR DISKUS ADVICOR aero otic hc AEROCHAMBER AEROCHAMBER MV AEROHIST aerohist plus AEROKID AEROLATE SR afeditab cr AGENERASE AGGRENOX AGRYLIN AH-CHEW D AIRWATCH ak-conak-dilate akorn balanced salt ak-pentolateak-poly-bacak-pred

ak-spore h.c. aktobak-tracin ak-trol ALACOL ala-cort 1% lotion ALBAFORT ALBALYBE ALBATUSSIN ALBATUSSIN CF ALBATUSSIN DM ALBATUSSIN NN ALBATUSSIN PEDIATRIC ALBATUSSIN SR CAPLET ALBATUSSIN SR F ALBATUSSIN-NN ALBENZA albuterolalbuterol sulfate ALDEX ali-flex ALINIA ALKERAN ALLEGRA ALLEGRA-D



allergenallergy relief ALLERX DOSE PACK TABLET ALLFEN JR allfen-mallopurinolALOMIDE alphaquin hp alprazolamALPRAZOLAM INTENSOL ALTACE aluminum acetate aluminum chloride aluminum chloride hexahydrate amantadineamantadine hcl AMARYL ambi 45/800/30 AMBI 5/15/100 AMBIEN AMBIFED-G AMBIFED-G DM amcinonideamdry-camdry-damericaine aerosol americetAMERIFED AMERIFED DM AMERITUSS AD amibid dm amibid la amidalamidrineamigesicamiloride hcl amiloride hcl w/hctz aminate w/90mg iron amino acid cervical aminobenzoate potassium aminocaproic acid aminophylline 100mg tablet AMINOPHYLLINE 105MG/5ML LIQ aminophylline 200mg tablet amiodarone hcl ami-tex la ami-tex pse amitriptyline hcl amitriptyline w/perphenazine amitriptyline/chlordiazepoxide ammonium lactate amnesteemamox tr/potassium clavulanate amox tr-potassium clavulanate amoxapineamoxicillin

amoxicillin trihydrate amphetamine salt combo ampicillin trihydrate amyl nitrite anabarANADROL-50 ANALPRAM-HC 1% CREAM ANALPRAM-HC 2.5% CREAM ANCOBON ANDEHIST DM ANDEHIST DROPS andehist nr oral drops andehist nr syrup ANDEHIST SYRUP andehist-dmANDRODERM anemagenanemagen fa ANEMAGEN OB anolor-300ANTABUSE ANTAGON anthralinantibenantibiotic ear solution antibiotic ear suspension antipyrine w/benzocaine antispasantispasmodicanucort-hcanudil hc anumed-hcANVIT anxapap/dichlphen/isomethepteneapriaquabid-dmAQUACHLORAL aquamistAQUATAB DM SYRUP ARAVA arcetargesic-saARICEPT ARIMIDEX AROMASIN ARTHROTEC 50 ARTHROTEC 75 ASACOL ascomp w/codeine aspasp 300/200/20 a-spas-s/laspirinaspirin w/codeine ASTELIN

atametatenololatenolol w/chlorthalidone atropine care atropine sulfate ATROVENT INHALER ATUSS-12 DX AUGMENTIN 125-31.25 SUSPEN AUGMENTIN 125-31.25 TAB CHEW AUGMENTIN 250-125 TABLET AUGMENTIN 250-62.5 SUSPEN AUGMENTIN 250-62.5 TAB CHEW AUGMENTIN ES-600 AUGMENTIN XR aurobiotic-hcaurodex ear drops auroguardaurotoAVALIDE AVANDAMET AVANDIA AVAPRO AVELOX AVELOX ABC PACK avianeAVITA 0.025% GEL AVODART azathioprineAZOPT bacitracinbacitracin/polymyxin b baclofenBACMIN BACTOCILL BACTROBAN 2% CREAM BACTROBAN 2% OINTMENT [G] BACTROBAN NASAL balaganBALAMINE DM DROPS BALTUSSIN baltussin hc BARBIDONNA b-complex plus vitamin b-complex vitamin plus belladonna & opium BELLADONNA LEAF LIQUID BELLADONNA TINCTURE belladonna w/phenobarbital bellahist-d la bellaminebellamine-sbellaspasbel-tabsBENZACLIN BENZAMYCIN [G] BENZAMYCINPAK



benzoinbenzonatatebenzopirinbenzoyl peroxide benztropine mesylate betamethasone dipropionate betamethasone dp augmented betamethasone valerate betanatebeta-valBETAVENT betaxolol hcl bethanechol chloride bethaprim ds BETOPTIC S BIAXIN BIAXIN XL BIDEX biodec-dm syrup BIOTECT PLUS BIO-THROID biotussin ac biotussin dac bisoprolol fumarate bisoprolol fumarate/hctz blanex-aboca-tex pse borofairb-plexb-plex plus BRAVELLE brimonidine tartrate BROFED bromatane dx bromaxefed dm rf bromaxefed rf bromdec dm brometane dx BROMFED TABLET bromfenexbromfenex pe bromfenex pe pediatric bromfenex-pdbromhistbromhist-dmbromocriptine mesylate bromophed dx brompheniramine w/pseudoephed bromplex dm bromplex hd BRONCOMAR GG BRONCOPECTOL BRONCOTRON-D SUSPENSION BRONKOPHYLLINE GG BRONTUSS SF BROVEX

BROVEX HC b-tussBUCALCIDE BUCALSEP bumetanidebupapBUPHENYL bupropion hcl buspirone hcl butalbital compound butalbital compound w/codeine butalbital/apap/caffeinebutalbital/caff/apap/codeinebutalbital-apap-caffeinebutalbital-asp-caffeinebutalbital-caff-apap-codeinebutorphanol tartrate CAFCIT CAFERGOT CALAFOL RX calcitriol 0.25mcg capsule calcitriol 0.5mcg capsule cal-natecamilaCANASA CAPEX SHAMPOO CAPITAL W/CODEINE captoprilcaptopril/hydrochlorothiazideCARAC CARAFATE 1GM/10ML SUSP carbamazepineCARBAPHEN 12 CARBAPHEN 12 PED CARBATROL CARBATUSS carbaxefed dm rf CARBA-XP carbidopa/levodopacarbihist carbinoxamine compound carbinoxamine drops carbinoxamine pd liquid CARBINOXAMINE PSE SYRUP CARBINOXAMINE SYRUP carbodex dm carbofed dm carbopticcarboxine-psecar-b-pen ta/chlor-tan cardeccardec dm carenate 600 carisoprodolcarisoprodol compound carisoprodol compound/codeine

CARNITOR caromegaCARRINGTON carteolol hcl cartia xt CASODEX ceberclonCEENU cefaclorcefaclor er cefadroxilcefadroxil monohydrate CEFTIN 125MG/5ML ORAL SUSP CEFTIN 250MG/5ML ORAL SUSP cefuroximecefuroxime axetil CEFZIL CELEXA CELLCEPT CELONTIN cena-kcephadyncephalexinCEREFOLIN CERTUSS-D cervical amino acid CETACAINE GEL CETACAINE LIQUID CETACAINE SPRAY ceta-plusCETROTIDE CHEMET CHEMSTRIP BG C-HIST-SR chlorafedchlorafed h.s. timecelles CHLORAL HYDRATE 500MG SUPP chloral hydrate 500mg/5ml CHLORAMPHENICOL CHLORDEX GP chlordiazepoxide hcl chlorex-achlorhexidine 0.12% rinse CHLORHEXIDINE GLUC 20% SOLN CHLORHEXIDINE GLUCONATE SOL chlor-mes d CHLOROQUINE PH 250MG TABLET chloroquine ph 500mg tablet chlorothiazide chlorpheniramine maleate chlorpheniramine tr chlorpromazine hcl chlorpropamideCHLORTHALIDONE 100MG TABLET chlorthalidone 25mg tablet chlorthalidone 50mg tablet



chlorzoxazonecholestyraminecholestyramine light choline mag trisalicylate CHROMAGEN CHROMAGEN FA CHROMAGEN FORTE CILOXAN * cimetidinecimetidine hcl CIPRO * 10% SUSPENSION CIPRO * 100MG TABLET CIPRO * 250MG TABLET CIPRO * 5% SUSPENSION CIPRO * 500MG TABLET CIPRO * 750MG TABLET CIPRO HC CITROLITH claravisCLARINEX clearplex v clearplex x clemastine fumarate CLEOCIN CLEOCIN PALMITATE clidinium w/chlordiazepoxide CLIMARA 0.025MG/DAY PATCH CLIMARA 0.0375MG/DAY PATCH CLIMARA 0.05MG/DAY PATCH [G] CLIMARA 0.06/MG DAY PATCH CLIMARA 0.075MG/DAY PATCH CLIMARA 0.1MG/DAY PATCH [G] CLINAC BPO clinda-dermclindamycin hcl clindamycin phosphate clioquinol w/hydrocortisone CLIOQUINOL/HYDROCORTISONE clobetasol e clobetasol propionate clomiphene citrate clomipramine hcl clonazepamclonidine hcl clorazepate dipotassium CLORFED CLORPRES clotrimazoleclotrimazole/betamethasoneclozapine 100mg tablet CLOZAPINE 12.5MG TABLET clozapine 25mg tablet COAL TAR SOLUTION cocaine hcl codafedcodal-dh

codal-dmCODEINE PHOSPHATE codeine sulfate codituss dh co-gesicCOGNEX colchicinecold & cough coldcoughcoldcough hc coldcough pd coldcough xp coldeccoldec d tablet COLDEC D TABLET SA coldec tr coldex-a sr coldmist dm coldmist la tablet coldtuss-drCOLESTID colfed-acolidrops col-probenecidCOLREX COMPOUND COLYTROL LIQUID COLYTROL PEDIATRIC DROPS colytrol tablet COMBIPATCH COMBIVENT COMBIVIR COMHIST complete allergy medicine comproCOMTAN CONCERTA CONDYLOX 0.5% GEL CONGESS JR CONPEC CONPEC LA constulosecopdCOPEGUS cophene no.2 tr cophene-sCOREG corfen-dmcortane-b aqueous drops cortane-b otic drops cort-biotic CORTEF 5MG TABLET corticcortic-nd CORTIFOAM cortisone acetate cortomycin

COSOPT cotuss-vcoughtussc-phed dm tannate c-phed tannate cpm 8/pse 90/msc 2.5 cpm pse cp-tanniccrantexcrantex er crantex hc crantex la CREON 10 CREON 20 CREON 5 CRESTOR CRIXIVAN cromolyn sodium crysellec-tanna 12 CUPRIMINE CYCLESSA cyclobenzaprine hcl cyclopentolate hcl cyclophosphamidecyclosporinecylatecyoticcyproheptadine hcl CYSTAGON CYTADREN CYTOMEL cytosolcytra-2cytra-3cytra-kcytuss hc DALLERGY TABLET DALLERGY-JR d-amine-srdanazolDANTRIUM DAPSONE DARAPRIM DDAVP 0.1MG TABLET DDAVP 0.2MG TABLET decahist-dmde-chlor dm de-chlor dr de-chlor g de-chlor hc de-chlor hd de-chlor mr de-chlor nx DECONAMINE TABLET CHEW decon-dm



decon-eDECONEX DECON-G decongestant ii de-congestine tr DECONSAL II dehistineDEKA del-aqua-5del-betaDEL-MYCIN delonidedeltussDEMSER DENAVIR denta 5000 plus dentagelDEPAKOTE DEPAKOTE ER DEPAKOTE SPRINKLE dermazenedesal-iidesipramine hcl desmopressin acetate desonidedesoximetasoneDESPEC DM DESPEC DROPS DESPEC SR DETROL DETROL LA dex gg dex pc dexamethasone 0.25mg tablet dexamethasone 0.5mg tablet dexamethasone 0.5mg/5ml elx DEXAMETHASONE 0.5MG/5ML LIQ dexamethasone 0.75mg tablet dexamethasone 1.5mg tablet dexamethasone 1mg tablet DEXAMETHASONE 2MG TABLET dexamethasone 4mg tablet dexamethasone 6mg tablet dexamethasone sodium phosphate dexaphendexasporindexchlordexchlor 6mg tablet sa DEXCHLORPHEN 2MG/5ML SYRUP dexchlorpheniramine 4mg tab dexchlorpheniramine 6mg tab DEXPAK dextroamphetamine sulfate d-feda ii d-gdg 200

DHT diabDIABETIC TUSSIN C dialyviteDIALYVITE 800 WITH IRON DIAMOX SEQUELS DIASTAT DIATX diazepamDIBENZYLINE diclofenac potassium diclofenac sodium dicloxacillin sodium dicyclomine hcl DIDRONEL diethylpropion hcl diflorasone diacetate DIFLUCAN diflunisalDIGESPLEN PLUS digitekDIGOXIN 0.5MG TABLET digoxin 125mcg tablet digoxin 250mcg tablet digoxin 50mcg/ml elix s/f digoxin 50mcg/ml elixir DILANTIN 30MG KAPSEAL DILANTIN 50MG INFATAB DILATRATE-SR dilor diltia xt diltiazem er diltiazem hcl diltiazem xr DIOVAN DIOVAN HCT diphenhydramine hcl diphenoxylate w/atropine dipivefrin hcl dipyridamoleDISOPHROL disopyramide phosphate DITROPAN XL dmD-METHORPHAN HB/PE/CP d-methorphan hb/pe/cpm liq docusate sodium dolacetdolagesicDOLGIC LQ dologesic capsule dolorexdolorex forte doloticdometuss cough/cold donnaphen

DOSTINEX DOVONEX doxazosin mesylate doxepin hcl doxycycline hyclate doxycycline monohydrate doxy-lemmondrexopheddrihist sr DRITHO-SCALP drituss dm drituss gp drixomeddrocon-csDROXIA drysecDUET DUONEB duotan dm duradal hd duradal hd plus duradrinduradrylduradryl jr durafedDURAFLU duraganidin dm DURAGESIC DURAHIST DURAHIST PE DURANEB W/PARI LC PLUS DURAPHEN DM DURAPHEN II DURICEF 250MG/5ML ORAL SUSP DURICEF 500MG/5ML ORAL SUSP dyflex-gdy-g liquid dyline-ggdylixdynahist er DYNAPEN dynatussdynatuss df dynatuss hcg dynatuss-exdyphyl-gdyphyllin gg dyphylline gg dyphylline-ggdyphysinDYTAN-CS DYTAN-D dytussear-gesiceasygeleconazole nitrate



ED A-HIST ED CYTE F ed doxy-caps ed k+10 ed tuss hc EDEX 10MCG KIT [G] EDEX 10MCG REFILL PACK [G] EDEX 10MCG STARTER PACK [G] EDEX 10MCG VIAL [G] EDEX 20MCG KIT [G] EDEX 20MCG REFILL PACK [G] EDEX 20MCG STARTER PACK [G] EDEX 20MCG VIAL [G] EDEX 40MCG KIT EDEX 40MCG REFILL PACK EDEX 40MCG STARTER PACK EDEX 40MCG VIAL [G] ed-flexed-tlceffer-kEFFEXOR EFFEXOR XR EFUDEX ELDERCAPS ELIDEL ELMIRONEMADINE embelineembeline e EMCYT EMEND EMLA ANESTHETIC DISC EMTRIVA enalapril maleate enalapril maleate/hctz encortendacof-hcENDAL HD endocetendodanenplus-hdenpresseentab-dmENTEX LA ENTEX PSE ENTOCORT EC ENTUSS TABLET entuss-d jr. liquid entuss-d jr. solution ENTUSS-D LIQUID enuloseENZYMAX eperbel-sepidrinEPIFOAM EPIFRIN 0.5% EYE DROPS

EPINAL epitolEPIVIR EPIVIR HBV ergocaff-pbERGOLOID MESYL 1MG TAB SL ergoloid mesylates 1mg tab ERITROGEN errin eryERY-TAB erythrocin stearate erythromycinerythromycin 2% gel erythromycin 250mg cap ec ERYTHROMYCIN 250MG FILMTAB erythromycin 500mg filmtab erythromycin estolate erythromycin ethylsuccinate erythromycin stearate erythromycin w/sulfisoxazole erythromycin-benzoyl peroxide ESCLIM estazolamESTRACE 0.01% CREAM estradiolestradiol transdermal patch ESTRATEST ESTRATEST H.S. ESTRING estropipateethambutol hydrochloride ethedentETHEZYME ethezyme 830 ETHMOZINE ethosuximideethyl acetate ethyl chloride etodolacetoposideEUDAL-SR EURAX EVISTA EVOXAC ex-dec-trEXELON exotic-hcextendryl chewable tablet EXTENDRYL SR famotidineFANSIDAR farbitalFARESTON FAST TAKE FAST TAKE MONITORING SYSTEM

fe c FELBATOL fem ph FEMARA FEMHRT fenoprofen calcium FEOCYTE FA feogenfeogen fa feogen forte FERGON PLUS feroconferotrinsicferragenferrex 150 forte ferrex-150ferrogels forte FERROMAR FERRO-PLEX HEMATINIC fe-tinic 150 forte FETRIN FINACEA flavoxate hcl flecainide acetate FLOMAX FLONASE * FLOVENT FLOVENT ROTADISK FLOXIN 0.3% EAR DROPS fludrocortisone acetate flunisolidefluocinolone 0.01% cream [G] fluocinolone 0.01% solution fluocinolone 0.025% cream fluocinolone 0.025% oint fluocinonidefluocinonide-eFLUORABON BASIC FLUORABON DROPS FLUORACAINE fluor-a-day 0.25mg tab chew fluor-a-day 0.5mg tab chew fluor-a-day 1mg tablet chew FLUOR-A-DAY 2.5MG/ML DROPS fluoridefluoritab 0.25mg tablet chw fluoritab 0.5mg tablet chew fluoritab 1mg tablet chew fluorometholoneFLUOROPLEX fluoxetine hcl FLUOXYMESTERONE fluphenazine hcl flurazepam hcl flurbiprofenflurbiprofen sodium



flutamideFLUTUSS HC fluvoxamine maleate FML S.O.P. FML-S FOLGARD OS FOLGARD RX 2.2 folic acid folic acid-cyancobal-pyridoxin folitab 500 FOLLISTIM FOLPACE RX foltrinFOLTX FOLYSINE FORADIL FORMALDEHYDE FORMA-RAY formula b plus formula-bfortabsFORTEO FORTOVASE FOSAMAX fosinopril sodium FREAMINE III FUMATINIC FURADANTIN furosemide 10mg/ml solution furosemide 20mg tablet furosemide 40mg tablet FUROSEMIDE 40MG/5ML SOLN furosemide 80mg tablet g p tex g/p 1200/60 GABITRIL GALZIN ganciclovirganidin nr gani-tuss nr gani-tuss-dm nr GANTRISIN GASTRINEX GASTROCROM gastrosedgdp-exgemfibrozilgenebrom-dmgenebronco-dGENECOF-HC LIQUID GENECOF-XP LIQUID genedelgenedotuss-dmGENELAN genepatussgenerlac

genesupp-500 liquid genetect plus geneticalgenetuss-2genexotic hc GENEXPECT DM GENEXPECT-PE GENEXPECT-SF gengrafGENHEMAT GENOTROPIN GENTAK 3MG/GM EYE OINTMENT gentak 3mg/ml eye drops gentamicin sulfate gentasolgeonegfn 1000/dm 50 gfn 1000/dm 60 gfn 1200/dm 20/pe 40 gfn 1200/dm 60 gfn 1200/dm 60/pse 120 gfn 1200/phenylephrine 40 gfn 1200/pse 50 gfn 550/pse 60 gfn 550/pse 60/dm 30 gfn 595/pse 48 tab gfn 595/pse 48/dm 32 tab gfn 600/phenylephrine 20 gfn 600/phenylephrine 40 gfn 795/pse 85 tab gfn 800/dm 30 gfn 800/pse 60 gfn 800/pse 60/dm 30 gfn/psegfn600/pse60/dm30gfn600-pse60-dm30gfn-dm-psegg 200 nr GILCHEW IR GILPHEX TR GILTUSS HC GILTUSS PED-C GILTUSS TR GLEEVEC glipizideglipizide er GLUCOTROL XL * 10MG TABLET SA [G] GLUCOTROL XL * 2.5MG TAB SA GLUCOTROL XL * 5MG TABLET SA [G] GLUCOVANCE * GLUTOFAC-MX glyburideglyburide micronized glyceringlycineglycron 1.5mg tablet

glycron 3mg tablet GLYCRON 4.5MG TABLET glycron 6mg tablet GONAL-F GONIOSOL g-pgp-500g-phedg-phed-pdgranul-dermGRIFULVIN V gripex pe GRIS-PEG g-tussgua c gua pc guaif/phenylphrine hcl GUAIFED GUAIFED-PD guaifen pse guaifen/dm hb/p-ephedrine guaifen/p-ephed hcl guaifen-car-b-pentane-peguaifen-dextrom-pseudoephedringuaifen-dextro-pseudoguaifenesinguaifenesin 600/pse 120 guaifenesin dm guaifenesin dm nr guaifenesin er guaifenesin la guaifenesin nr guaifenesin w/codeine guaifenesin w/dextromethorphan guaifenesin w/pseudoephedrine guaifenesin/codeine phosphate guaifenesin/dextromethorphanguaifenesin/d-methorphanguaifenesin/d-methorphan hb guaifenesin/p-ephed hcl guaifenesin/p-ephed hcl/hcod guaifenesin/phenylephrineguaifenesin/pseudoephedrineguaifenesin-dm nr guaifenesin-pguaifenesin-p-ephed hcl guaifenesin-phenylephrine-hcodguaifenesin-p-pdguaifenesin-pseudoephedrineguaifenesin-srguaifenex dm guaifenex g guaifenex gp guaifenex la guaifenex pse guaifenex-rx



GUAIFENEX-RX DM guaif-phenylphrine hcl guaitussin ac gual-cogual-dexguanabenz acetate guanfacine hcl guapetexgua-srguiadex dh guiadex dm guiadex pd guiadrine dm guiadrine g-1200 guiadrine gp GYNODIOL 1.5MG TABLET GYNODIOL 2MG TABLET [G] H 9600 SR HALFAN haloperidolhaloperidol lactate halotussin-achalotussin-dachaponalh-c tussive hc tussive-d hctz 12.5mg capsule HECTOROL helitene .5g microfibrillar hematinic plus hematinic w/folic acid hematogenhematogen fa hematogen forte HEMATRON HEMATRON P.O. HEMATRON-AF HEMOCYTE PLUS CAPSULE HEMOCYTE-F ELIXIR HEMORRHOIDAL hemorrhoidal hc hemrilhemril-hcHEPSERA HEXALEN hisdechistaclear d histadehistade mx HISTALET hista-vent da hista-vent pse HISTEX PD 12 HISTEX SR hist-hchistinex hc

histinex pv hist-plushistusshistuss pd HIVIDHMShomatropairehomatropine hydrobromide ht-tuss dm HUMALOG HUMALOG MIX 75/25 HUMATROPE HUMIBID HUMIBID DM HUMIBID LA HUMULIN 50/50 HUMULIN 70/30 HUMULIN L HUMULIN N HUMULIN R HUMULIN U hycoHYCOFED hycomal dh HYCOMINE COMPOUND hycorthydonehydralazine hcl HYDRA-ZIDE hydro gp HYDRO PC II hydro pro dm hydrochloric acid solution hydrochlorothiazide 25mg tb hydrochlorothiazide 50mg tb hydrocod bit/phenylephrine/cp hydrocodone bit-ibuprofen hydrocodone bt/homatropine mbr hydrocodone compound hydrocodone cp hydrocodone gf hydrocodone hd hydrocodone w/acetaminophen hydrocodone w/acetaminophen hs hydrocodone w/guaifenesin hydrocodone w-acetaminophen hydrocodone/acetaminophenhydrocodone/phenylephrine/cpm hydrocodone-acetaminophenhydrocortisone 1% cream hydrocortisone 1% lotion hydrocortisone 1% ointment hydrocortisone 100mg enema hydrocortisone 2.5% cream hydrocortisone 2.5% lotion hydrocortisone 2.5% oint

hydrocortisone 20mg tablet hydrocortisone acetate hydrocortisone iodoquinol hydrocortisone valerate hydrocortisone w/iodoquinol HYDROCORTISONEACETATE hydrocortisone-iodoquinolHYDROCORTONE hydromethydromorphone hcl hydron cp hydron ex hydron kgs hydron psc hydro-pc ii plus hydrophene dh hydroquinonehydro-tusshydro-tussin dhc hydro-tussin exp hydro-tussin hc hydro-tussin hd hydro-tussin xp hydroxychloroquine sulfate hydroxyureahydroxyzine hcl hydroxyzine pamoate hyflex-650hyflex-dshyoscyaminehyoscyamine sulfate hyospazhyosynehyphedhyphen-hdHYTAKEROL ibuprofenICAR PRENATAL icar-c plus ICAR-C PLUS SR iferex 150 forte imipramine hcl IMITREX inatal advance inatal gt inatal ultra indapamideINDERAL LA indomethacinINFERGEN INNOPRAN XL instat mch 1gm hemostat INTAL INHALER INTRON A INVIRASE iobid dm



iodochlorhydroxyquin w/hc IODOSORB iophen nr iophen-c nr iophen-dm nr IOPIDINE iosal ii iotex pse ipecacipratropium bromide IRESSA IROFOLIRON-CIRO-PLEX IRRIGATING SOLUTION G ISOETHARINE HCL isometh/d-chloralphenaz/apapisoniazidISOPTO CARBACHOL 0.75% DROPS ISOPTO CARBACHOL 1.5% DROPS isosorbide dinitrate isosorbide mononitrate isoxsuprine hcl jantovenJAY-GIC DS jay-phyl JAY-RX JAY-RX PD jolivettejuneljunel fe k cl-20 k cl-40 k effervescent k+ potassium KALETRA KAOCHLOR-EFF KAON kaon-cl 10 karidiumkarigelkarigel/nkarivaKEPPRA ketoconazoleketoprofenketorolac tromethamine kg-dal hd kg-dal hd plus kg-fedkg-fed pediatric kg-tuss hd kg-tussinKIE klor-conklor-con 10

klor-con 8 klor-con m10 klor-con m15 klor-con m20 klor-con/efK-LYTE DS K-LYTE/CL 50MEQ CITRUS TAB koviakovia ointment K-PHOS M.F. K-PHOS NO.2 K-PHOS ORIGINAL KRONOFED-A KRONOFED-A-JR k-tank-tan 4 k-vescentlabetalol hcl laclotionlactated ringers lactic acid lactuloselahey mixture #3 LAMICTAL LAMISIL 250MG TABLET LANOXICAPS LANTUS LANZATUSS-N.F LARODOPA LARTUS LAZERFORMALYDE LEMOHIST PLUS LEMOTUSSIN-DM lessinaLEUCOVORIN CALCIUM 10MG TAB LEUCOVORIN CALCIUM 15MG TAB leucovorin calcium 25mg tab leucovorin calcium 5mg tab LEUKERAN LEVALL 5.0 SYRUP LEVALL G LEVATOL levobunolol hcl levora-28 LEVORPHANOL TARTRATE levothyroxine sodium LEXAPRO LEXIVA lidocainelidocaine hcl lidocaine hcl viscous lidocaine-hclidocaine-prilocaineLIDODERM lidomar viscous lidox

LINDANE 1% LOTION lindane 1% shampoo LIPITOR lipram lipram-cr 10 lipram-cr20 lipram-cr5 lipram-pn10lipram-pn16lipram-pn20lipram-ul12lipram-ul18lipram-ul20liquibid 1200 LIQUIBID-PD lisinoprillisinopril-hctzlithium carbonate lithium citrate LITTLE COLDS LIVOSTIN lobac tablet LODOSYN LODRANE 12D TABLET SA LODRANE 12HR TABLET SA lodrane ld lonoxloperamide hcl lorazepamLORAZEPAM INTENSOL LORTUSS DM LORTUSS HC LOTEMAX LOTENSIN * LOTENSIN HCT * LOTREL LOTRONEX lovastatinlow-ogestrelloxapine succinate lozi-flur LUSONEX LYSIPLEX LYSODREN MACROBID mag-phenmagsalMALARONE maprotiline hcl marcofmargesicmargesic h marten-tabMARTINIC mar-zinc maternity



MATULANE MAXAIR AUTOHALER MAXIFED MAXIFED DMX MAXIFED-G MAXI-TUSS HCX m-clearmd-gastroviewMEBARAL mebendazolemeclizine hcl meclofenamate sodium medigesicmedroxyprogesterone acetate mefloquine hcl megatonmegestrol acetate melpaque hp melquin hp melquin-3M-END DM MENEST MENTAX meperidine hcl meperidine w/promethazine meperitabMEPHYTON meprobamatemeprolone unipak MEPRON MERIDIA mescolorMESNEX MESTINON 180MG TIMESPAN MESTINON 60MG/5ML SYRUP METADATE CD METADATE ER 10MG TABLET SA [G] metadate er 20mg tablet sa METAGLIP metaproterenol 0.4% soln metaproterenol 0.6% soln metaproterenol 10mg tablet metaproterenol 10mg/5ml syr METAPROTERENOL 20MG TABLET METAPROTERENOL 5% SOLUTION metaproterenol sul 0.4% sol metaproterenol sul 0.6% sol metformin hcl metformin hcl er methadexmethadoneMETHADONE 10MG/5ML SOLUTION methadone 10mg/ml oral conc methadone 40mg tablet dispr METHADONE 5MG/5ML SOLUTION methadone hcl 10mg tablet

methadone hcl 40mg disket methadone hcl 40mg tab disp methadone hcl 5mg tablet methadone intensol methadose 10mg tablet methadose 40mg tablet dispr methadose 5mg tablet methazolamidemethenamine hippurate methenamine mandelate METHERGINE methimazoleMETHITEST methocarbamolmethotrexatemethyclothiazidemethyldopamethyldopa/hydrochlorothiazidemethylinmethylin er methylphenidatemethylphenidate er methylphenidate hcl methylprednisolonemetipranololmetoclopramide hcl METOCLOPRAMIDE HCL INTENSOL metolazonemetoprolol tartrate METROCREAM METROGEL METROGEL-VAGINAL METROLOTION metronidazolemetrylmexiletine hcl mhp-amiconazole 3 MICROCHAMBER microgestinmicrogestin fe MICRO-K midazolam hcl midodrine hcl migergotmigquinMIGRANAL migratinemigrazonemigrin-aMILTUSS-EX mindal dm minocycline hcl minodixilminoxidilmintab d

mintab d tablet sa mintab dm tablet sa mintexmintex ct mintex pd MINTEZOL mintuss dr mintuss ex mintuss g mintuss hc mintuss hd mintuss ms MIRAPEX miraphen pse mirtazapinemisoprostolMOBAN moexipril hcl mometasone furoate MONOJECT MONOJECT INSULIN SAFETY SYRNG mononessaMONUROLmorphine sulf 100mg tab sa morphine sulf 10mg suppos morphine sulf 10mg/5ml soln morphine sulf 15mg tab sa morphine sulf 200mg tab sa morphine sulf 20mg suppos morphine sulf 20mg/5ml soln morphine sulf 20mg/ml soln morphine sulf 30mg suppos morphine sulf 30mg tab sa morphine sulf 5mg suppos morphine sulf 60mg tab sa MORPHINE SULFATE 10MG TAB morphine sulfate 15mg tab morphine sulfate 30mg tab morphine sulfate ir MS CONTIN [G] MSIR multi ferrous folic 500 multi vit w/fluoride multi vita-bets w/fluoride multifolmulti-ret folic 500 multi-vit w/fluoride & iron multi-vit/iron & fluoride multi-vita bets w/fluoride multivita bets w/fluoride/iron multi-vita bets/fluoride/iron multivitamin w/fluoride & iron multivitamins w/fluoride multivitamins/fluoride/iron multivite w/fluoride mupirocin



M-VIT MYCELEX MYCOBUTIN myconelmyferon-150 forte MYLERAN MYLOCEL mynatalmynatal advance mynatal plus mynatal-zmynate 90 plus n d clear n.t.a.nabumetonenadololnafrinsenafrinse pediatric nalexnalex jr nalex-a tablet naltrexone hydrochloride naphazolenaphazoline hcl naproxennaproxen sodium NARDIL NASACORT AQ nasatab la NASCOBAL NASONEX natacapsNATACYN natafolic-pnnatalcare cfe natalcare pic natalcare pic forte natalcare plus natalcare three natalfirstNATALVIT natatabnatatab cfe natatab fa NATELLE nature-throidND-GESIC NEBUPENT neconnefazodone hcl neo/polymyxin/dexamethasoneneocidinneocin-pgNEO-FRADIN neofrinneomycin sulfate

neomycin/bacitracin/poly/hc neomycin/bacitracin/polymyxin neomycin/polymyxin/dexameth neomycin/polymyxin/gramicidin neomycin/polymyxin/hc neosolNEOSPORIN G.U. IRRIGANT NEOTUSS-D NEPHPLEX RX NEPHRON FA nephro-vite rx NERVIDOX-6 NR NERVO B-12 NEURIN-SL NEURONTIN neutragard advanced NEXIUM niacinNIACOR NIAFOL NIASPAN nicardipine hcl NICOMIDE nicotinenifedical xl nifedipinenifedipine er NIFEREX-150 FORTE NILANDRON NIMOTOP nitrekNITRO-BID nitrofurantoin macrocrystal nitroglycerinnitroglycerin transdermal nitroglynnitroquicknitrotabnitro-timenizatidineNIZORAL 2% SHAMPOO nora-beNORDITROPIN norethindrone acetate NORM-JECT NORPACE CR 100MG CAPSULE SA nortrelnortriptyline hcl nortuss-exNORVASC NORVIR novagesicNOVANATAL NOVASTART NOVOFINE 30 NOVOLIN 70/30

NOVOLIN L NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX 70/30 NUCOFED CAPSULE NUCOFED SYRUP NUDAL-HD NU-IRON-V NUMOBID NUMOBID DX NUMONYL NUMONYL DX NUMONYL SR nuquin hp nutracort 2.5% lotion NUTRICAP nutrifac zx nutrinateNUTRIVIT NUTROPIN NUTROPIN AQ NUTROPIN DEPOT NUVARING nystatin 100000u/gm cream nystatin 100000u/gm oint nystatin 100000u/ml susp nystatin 500000u oral tab NYSTATIN VAGINAL TABLET nystatin w/triamcinolone OBSTETRIX-100 OBTREX O-CAL FA O-CAL PRENATAL OCLOCUFLOX * ocusulf-10ofloxacinogestrelomedia otic omeprazoleomnihist l.a. omnii med ONE TOUCH BASIC SYSTEM ONE TOUCH INDUO ONE TOUCH PROFILE SYSTEM ONE TOUCH TEST STRIPS ONE TOUCH ULTRA SMART ONE TOUCH ULTRA SYSTEM ONE TOUCH ULTRA TEST STRIPS OPIUM opticaineORACIT oramorph sr ORATUSS ORFADIN



organ-i nr orphenadrine citrate orphenadrine compound orphenadrine compound forte orphengesicorphengesic forte ORTHO EVRA ORTHO TRI-CYCLEN LO oticaineoticin hc ear solution otimarotocidinotomar-hcotomax-hcotomycet-hcotozoneotra nr oxacillin sodium OXANDRIN oxaprozinoxazepamOXICAL OXIPLEN OXSORALEN OXSORALEN-ULTRA oxybutynin chloride OXYCEL oxycodone hcl oxycodone hcl-acetaminophen oxycodone w/acetaminophen oxycodone w/aspirin oxycodone/apapoxycodone-acetaminophenOXYCONTIN * oxydosep chlor p chlor dm pacerone 200mg tablet PACERONE 400MG TABLET PALGIC 4MG TABLET palgic 4mg/5ml liquid PALGIC D PANATUSS PEDIATRIC DROPS PANCREASE MT 4 pancrelipasepancrelipase mt-16 pancron 10 pancron 20 pangestyme cn 10 pangestyme cn 20 pangestyme ec pangestyme mt 16 pangestyme ul 12 pangestyme ul 18 pangestyme ul 20 PANLOR DC

panmist dm panmist jr panmist la 800/80 tablet sa panmist s panokasepanokase-16panritis forte papain-urea-chlorophyllinpapaverine hcl paraldehyde liquid para-timeparegoricPARNATE paromomycin sulfate paroxetine hcl PATANOL PAXIL 10MG/5ML SUSPENSION PAXIL CR pcmpcm allergy pcm la pdm gg PEDIACOF PEDIATEX HC pediox 4mg/5ml liquid PEDIOX CHEWABLE TABLET peg 3350/electrolyte PEGANONE PEGASYS PEG-INTRON p-ehedrine-guaifenesin sr pemolinepenicillin v potassium PENLAC PENTASA pentazocine and naloxone hcl pentazocine/acetaminophenpentazocine/naloxonepentopakpentoxifyllinepentoxilPEPCID 40MG/5ML ORAL SUSP p-epd hcl/guaifenesin p-epd hcl/hcod bt/carbinox p-epd tan/chlor-tan p-ephed hcl/carbinox mal p-ephed hcl/chlor-mal p-ephed hcl/chlor-mal/scop p-ephedrine-guaifenesin la perfect choice pergolide mesylate perio med periogardperioselect take home care PERIOSTAT perisol

permethrinperphenazine 16mg tablet perphenazine 2mg tablet perphenazine 4mg tablet perphenazine 8mg tablet PERPHENAZINE ORAL SOLUTION PERRY PRENATAL TABLET PHANASIN PHANATUSS HC pharmaflurPHENABID PHENABID DM PHENACON CAPSULE SA phenadozPHENA-PLUS PHENA-S phenaventphenavent d phenavent ped phenazopyridine hcl phenclor tannate pediatric phendimetrazine tartrate PHENERGAN 12.5MG TABLET phenobarbitalphenolphenopticphentermine hcl PHENYDEX PEDIATRIC LIQUID phenyl chlor-tan PHENYLADE AMINO ACID phenyleph/hcod bt/cp phenylephrine hcl phenylephrine hcl/guaifenesin phenylephrine hd phenylephrine/chlor-mal/scopphenylephrine/guaifenesinphenyltoloxamine pe cpm phenytoinphenytoin sodium phenytoin sodium, extended PHOSLO phospha 250 neutral PHOSPHOLINE IODIDE PHOSPHORIC ACID pilocarpine hcl PILOPINE HS piloptic-1piloptic-2piloptic-3piloptic-4piloptic-6PIMA pindololpiroxicamPLAN B plaretase 8000



PLAVIX PLETAL PLEXION PLEXION SCT PLEXION TS PNEUMOTUSSIN podofiloxPOLY HIST FORTE poly-dexpoly-iron 150 forte polymyxin b sul/trimethoprim polymyxin b sulfate POLY-PRED POLY-TUSSIN DM poly-tussin hd POLY-VENT POLY-VI-FLOR/IRON .25MG TAB poly-vitamin w/fluoride poly-vitamin w/iron & fluoride polyvitamins w/fluoride poly-vitamins w/fluoride portiapot guaiaco/dm hb pot guaiaco/hydrocodone bit pot guaiaco/phenylephrine hcl potassiumpotassium bicarbonate potassium chloride 10% liq potassium chloride 20% liq potassium chloride 20% liq s/f potassium citrate/citric acid potassium cl 10% liquid potassium cl 10% liquid s/f potassium cl 10meq cap sa potassium cl 10meq tab sa potassium cl 10meq/50ml sol potassium cl 15meq tab potassium cl 20meq packet potassium cl 20meq tab sa potassium cl 20meq/50ml sol potassium cl 25meq tab eff potassium cl 8meq tablet sa PRANDIN prazosin hcl PRECARE PRECARE CONCEIVE PRECARE PRENATAL PRECISION PRECISION XTRA PRECOSE PRED MILD PRED-G prednisolprednisolone 15mg/5ml syrup prednisolone 5mg tablet PREDNISOLONE 5MG/5ML SYRUP

prednisolone acetate prednisolone sod phosphate prednisolone sodium phosphate prednisone 10mg tablet prednisone 1mg tablet PREDNISONE 2.5MG TABLET prednisone 20mg tablet prednisone 50mg tablet prednisone 5mg tablet PREDNISONE 5MG/5ML SOLUTION PRE-FOLIC PREHIST prehist d PREMARIN PREMESIS RX PREMPHASE PREMPRO 0.45/1.5MG TABLET PREMPRO 0.625/2.5MG TABLET PREMPRO 0.625/5MG TABLET PRENA-CAP prenatabs cbf prenatabs fa prenatabs rx prenatal 1 plus 1 prenatal 1+1 prenatal 19 prenatal ad prenatal formula 3 prenatal low iron prenatal mtr prenatal plus iron tablet prenatal plus nf prenatal plus w/27mg iron prenatal rx prenatal z prenatal-hprenatal-uPRENATE ADVANCE PRENATE GT PREVACID 15MG CAPSULE DR PREVACID 15MG SUSPENSION DR PREVACID 30MG CAPSULE DR PREVACID 30MG SUSPENSION DR prevalitePREVEN PREVIDENT 5000 BOOSTER GEL PREVPAC PRIFTIN PRIMACARE PRIMAQUINE primidonePRIMSOL PROAMATINE [G] probenecidprobenecid w/colchicine PROCAINAMIDE 1000MG TAB SA

procainamide 250mg capsule procainamide 500mg capsule procainamide 500mg tab sa procainamide 750mg tab sa prochlorperazineprochlorperazine maleate PRO-CLEAR pro-cofpro-cof d PROCTOFOAM-HC procto-kit 1% cream PROCTO-KIT 2.5% CREAM procto-pakproctosert hc proctosol-hcproctozone-hcprodec-dmpro-fast sr PROFERRIN-FORTE PROGRAF prolex dh solution PROMAR promethazine dm promethazine hcl promethazine vc promethazine vc w/codeine promethazine w/codeine promethazine w/dm promethazine-codeinepromethegan 12.5mg suppos promethegan 25mg supp [G] promethegan 50mg suppos [G] PROMETRIUM pro-oticpropafenone hcl PROPANTHELINE BROMIDE proparacaineproparacaine hcl propoxyphene hcl propoxyphene hcl w/apap propoxyphene hcl/apap propoxyphene napsylate w/apap propoxyphene napsylate-apap propranolol hcl propranolol hcl w/hctz PROPYLENE GLYCOL propylthiouracilPRO-RED PROSCAR proset d PROSTIGMIN pro-tannatePROTECT PLUS PROTECT PLUS NR PROTID PROTROPIN



PROVENTIL HFA PROVIGIL pse 120/msc 2.5 pse bpm pse brom pse carbinoxamine dm pse cpm pseubrompseubrom-pdpseudo cm pseudo dm gg pseudo gg tr pseudo max pseudo max dmx pseudoephedrine gg pseudoephedrine hcl pseudoephedrine w/chlorphenir pseudoephedrine w/guaifenesin pseudoephedrine/guaifenesin/dm pseudovent dm pseudovent ped pseudox m p-tanna 12 p-tuss dm PULMICORT .25MG/2ML RESPULE PULMICORT 0.5MG/2ML RESPULE PULMOZYME PURINETHOL P-V-TUSSIN TABLET pyrazinamidepyridostigmine bromide pyrilafen tannate-12 q-bid dm QDALL quad tann quad tann pediatric quadratussquad-tuss tannate quala-cetquala-tlaquindalquinidine gluconate quinidine sulfate quinine sulfate quintexquintex hc q-v tussin QVAR radiagelranitidine hcl RAPAMUNE re 10 re 40 REBETOL * REBETRON 1000 REBETRON 1200

REBETRON 600 REBIF rectasol-hcredermREGRANEX relacon-dmrelacon-hcRELAGESIC relax-ds RELIEFBAND MODEL WB-RL REMERON 15MG SOLTAB REMERON 30MG SOLTAB REMERON 45MG SOLTAB REMINYL RENACIDIN RENAGEL renal caps renaphrorena-vite rx RENAX rentaminerepanrepan-cfREPRONEX REQUIP rescon jr rescon-edRESCRIPTOR RESECTISOL reserpine RESPA-1ST RESPA-DM respahistRESPAIRE-60 RESPA-PE RESPI-TANN RESTASIS RETROVIR REYATAZ rhinacon a rhinatate-nfrhinoflexrhinoflex-650RICOBID RICOBID NR RICOBID-D RICOBID-H RICOTUSS ORAL SUSPENSION ricotuss tablet RIDAURA rifampin RILUTEK rimantadine hcl rinade-bidringer's lactated RISPERDAL 0.25MG TABLET

RISPERDAL 0.5MG TABLET RISPERDAL 1MG TABLET RISPERDAL 1MG/ML SOLUTION RISPERDAL 2MG TABLET RISPERDAL 3MG TABLET RISPERDAL 4MG TABLET rms-suppositoryrobafen ac robitussinROCALTROL 1MCG/ML ORAL SOLN [G] ROFERON-A rondaminerondamine dm ROSULA AQUEOUS GEL ROWASA roxicet 5/325 tablet ROXICODONE 15MG TABLET ROXICODONE 30MG TABLET roxicodone 5mg tablet roxicodone intensol r-tannar-tannic-sRUM-K ru-tussRU-TUSS 800 DM ru-tuss dm ru-tuss jr. rx-otic RYNA-12X ryna-p.e.c.ry-t-12SAFETY SYRINGE W/SHIELD SAIZEN 5MG VIAL [G] SAIZEN 8.8MG INJECTION SALAGEN SALICEPT salsalateSANDIMMUNE 100MG/ML SOLN sanfed a SARAFEM seba-gelsedapapselegiline hcl selenium sulfide sel-pensenetonicSENILEZOL SEREVENT SEREVENT DISKUS seropheneSEROQUEL sfsf 5000 plus SHOHL'S MODIFIED SIDEROL SILDEC



sildec-dmSILVER NITRATE APPLICATOR silver sulfadiazine [G] SINA-12X SINGULAIR sinufed timecelles sinumist-srsinutuss dm SINUVENT PE SITREX SKELAXIN SLOFED 60 sod fluoride .25mg(.55mg)tb sod fluoride .5mg(1.1mg)tab sod fluoride 0.5mg (1.1mg) sod fluoride 0.5mg(1.1mg)tb SOD FLUORIDE 1.1MG(0.5MG)TB sod fluoride 1mg (2.2mg)tab sod fluoride 1mg(2.2mg) tab sod fluoride 1mg(2.2mg) tablet sod fluoride 2.2mg(1mg) tab sod.sulfacetamide/sulfur tf sodium chloride .45% irrig. sodium chloride 0.9% ampule sodium chloride 0.9% irrig. sodium chloride 0.9% vial sodium citrate & citric acid sodium fluoride 0.125mg/drp sodium fluoride drops SODIUM FLUORIDE GEL sodium sulfacetamide/sulfur sodium sulfacetamide-sulfur soluvite-fSOMNOTE SONATA SORBUTUSS SORIATANE sorinesotalolsotalol hcl sotretspacol i.d. spasdelspastrinSPECTRAGEL spironolactonespironolactone w/hctz spironolactone/hctzSPORANOX sprintecSPS [G] SPS 15GM/60ML SUSPENSION [G] SPS 30GM/120ML ENEMA [G] SPS 50GM/200ML ENEMA ssdssd af

SSKI S-T FORTE 2 STA-D stagesicSTAGESIC-10 STAHIST stamoist e stanimaxstanimax perio rinse stannous fluoride STARLIX statuss dm STATUSS GREEN STIMATE STRATTERA STROMECTOL strong iodine STRONGSTART stroviteSTROVITE ADVANCE STROVITE FORTE SYRUP strovite plus SUBOXONE SUBUTEX SUCRAID sucralfatesudatuss dm sudatuss-2sudatuss-sfsulfacsulfacetamide 10% eye drops SULFACETAMIDE 10% EYE OINT sulfacetamide 10% ophth sol sulfacetamide w/prednisolone SULFADIAZINE sulfamethoxazole/trimethoprimsulfamideSULFAMYLON sulfasalazinesulfatrimsulfazinesulfazine ec SULFINPYRAZONE SULFISOXAZOLE sulindacsultrexSUPERVITE LIQUID supportSUPPORT-500 SURESTEP SUSTIVA su-tuss dm su-tuss hd symax-slsymax-srSYNAREL

syntest d.s. syntest h.s. SYNTHROID 100MCG TABLET [G] SYNTHROID 112MCG TABLET SYNTHROID 125MCG TABLET [G] SYNTHROID 137MCG TABLET SYNTHROID 150MCG TABLET [G] SYNTHROID 175MCG TABLET [G] SYNTHROID 200MCG TABLET SYNTHROID 25MCG TABLET [G] SYNTHROID 300MCG TABLET SYNTHROID 50MCG TABLET [G] SYNTHROID 75MCG TABLET [G] SYNTHROID 88MCG TABLET [G] TAMIFLU tamoxifen citrate tana r-12 tana t-12 TANAFED DMX TANAFED DP tanatan rf tanavantannate 12 s tannate-12tannic-12tannic-12 s tannihist-12tannihist-12 rf TARGRETIN TASMAR TAZORAC taztia xt tbctebamideTEGRETOL XR temazepamTEMODAR tenaketencettenconTEQUIN terakTERAZOL 3 TERAZOL 7 terazosin 10mg capsule terazosin 1mg capsule terazosin 2mg capsule terazosin 5mg capsule TERAZOSIN HCL 10MG TABLET terbutaline sulfate TESLAC TESTIM testomartetcainetetra tannate tetracaine hcl



tetracycline hcl tetra-magTHALOMID THEOMAR GG THEOPHYLLINE theophylline anhydrous THERA-FLUR-N theramycin z therapeutic hematinic therapeutic vitamin w/minerals thermazenetherobectherobec plus THIOGUANINE thioridazine hcl thiothixeneTHROMBOGEN 10000U SPRAY KIT THROMBOGEN 10000U VIAL THROMBOGEN 1000U VIAL thrombogen 20000u spray kit thrombogen 20000u vial thrombogen 5000u vial thyroidTHYROLAR-1 THYROLAR-1/2 THYROLAR-1/4 THYROLAR-2 THYROLAR-3 TIAZAC 420MG CAPSULE SA ticlopidine hcl TIKOSYN TILADE time-histtimolol maleate tis-u-soltizanidine hcl TOBRADEX tobramycin sulfate tobrasoltolazamidetolbutamidetolmetin sodium TOPAMAX TOPROL XL torsemidet-oticTOURO ALLERGY TOURO CC TOURO DM TOURO EX TOURO LA TRACLEER tramadol hcl TRAVATAN trazodonetrazodone hcl

tretinoinTREXALL tri tann triamcinolone 0.025% cream triamcinolone 0.025% lotion triamcinolone 0.025% oint TRIAMCINOLONE 0.05% OINT triamcinolone 0.1% cream triamcinolone 0.1% lotion triamcinolone 0.1% ointment triamcinolone 0.1% paste triamcinolone 0.5% cream triamcinolone 0.5% ointment TRIAMINIC triamterene w/hctz triamterene-hctzTRIANT-HC tri-a-vite w/fluoride TRIAZ 3% CLEANSER TRIAZ 3% GEL TRIAZ 6% CLEANSER TRIAZ 6% GEL TRIAZ 9% CLEANSER triazolam TRI-CHLOR trichloroacetic acid tricitrates tricontricosal 1000mg tablet TRICOSAL 500MG TABLET tricosal 750mg tablet TRIDAL tridermtridesilon 0.05% cream trifluoperazine hcl trifluridinetrihexyphenidyl hcl tri-histineTRI-K TRIKOF-D TRILEPTAL trimazidetrimethobenzamide hcl trimethoprim 100mg tablet TRIMETHOPRIM 200MG TABLET trimoxtrimox 125 trimox 250 trinatetrionatetrionate nf triotanntriotann-stri-otic triple antibiotic triple tannate

triple tannate pediatric triple tannate-s TRISPEC-DM TRISPEC-PE TRISPEC-SF TRITON X-100 TRITUSS trituss dm TRITUSS-A TRITUSS-ER tri-vent dm tri-vent dpc tri-vent hc tri-vit w/fluoride & iron tri-vit/fltri-vit/fluoridetri-vita bets w/fluoride tri-vitamin w/fluoride tri-vitamin w/iron & fluoride tri-vitamins w/fluoride trivora-28TRIZIVIR tropicacyltropicamideTRUSOPT TRYPTOPHAN TUBERCULIN SYRINGE TUSNEL TUSNEL PED-C tusnel pediatric drops TUSNEL PEDIATRIC LIQUID TUSNEL-DM TUSNEL-HC tussadur-hdtussafedtussafed-extussafed-laTUSSALL TUSSALL-ER tuss-axTUSS-DA tuss-dsTUSSEND TABLET tuss-hcTUSSI-12D TUSSI-12D S tussi-bidtussigontussin-vTUSSIONEX TUSSI-PRES TUSSIREX tussive hc tussizone-12 rf TUSSO-DF tuss-pd



TUSS-S tusstatU-CORT [G] ultraultra natalcare ultra-natalultratuss 12 s uni tuss hc uni-cof exp uni-fac zx uni-hist dm uni-oticuni-rex 600 UNI-SERP unithroidureaurelief plus urimar-turin d.s. urisepticuritact ds UROCIT-K urogesic-blueURSOursodioluseptv.v.s.VAGIFEM VALCYTE valproic acid VALTREX vanaconvanadomvanatripVANCOCIN HCL VAZOL-D v-c forte v-dec-mveetids 250mg tablet verapamil hcl VERELAN PM versacapsVESANOID VFEND VIAGRA vi-c forte vica-forteVI-CAL vicoclear dh VIDEX VIDEX EC VIGAMOX VINATAL FORTE vinate 90 VINATE GOOD START vinate ii

vinate ultra vinate-mVIOXX vi-q-tussVIRACEPT VIRAMUNE VIRAVAN DM VIRAVAN-T VIREAD vita s forte vitacelvitacon forte VITAFOL vitafol-obvitafol-pnvitalize plus vitamin d VITA-NUMONYL VITA-NUMONYL EX vitaplexvitaplex plus vitarocavitaroca plus vitussinVIVOTIF BERNA VOLTAREN 0.1% EYE DROPS VORTEX VOSPIRE ER v-tannvynatal-fawarfarin sodium water water for inhalation we mist ii WELCHOL WELLBUTRIN SR WELLBUTRIN XL westhroidWINSTROL XALATAN XELODA XENICAL xiralXIRATUSS SUSPENSION xiratuss tablet XOPENEX XYREM YASMIN 28 YODEFAN yohimbine hcl yohimexZADITOR ZANTAC 15MG/ML SYRUP ZAROXOLYN Z-COF LA ZELNORM

ZERIT ZETIA ZIAGEN zinc sulfate zincatezinkel-220zioxZITHROMAX ZOCOR zodeac-100ZOFRAN ZOFRAN IN DEXTROSE ZOFRAN ODT zolene hc ZOLOFTZOMIG 2.5MG TABLET ZOMIG 5MG TABLET ZOMIG ZMT ZONEGRAN 100MG CAPSULE zotane hc ZOTEX ZOTEX-LA zovia 1/35e zovia 1/50e ZOVIRAX 5% OINTMENT ZTUSS ZYBAN ZYMAR ZYMINE-D ZYPREXA (excluding Zydis) ZYVOX



1Q-2004 ESI National Preferred Formulary Changes Additions: 1Q, 2004

New Brand/Chemicals

Drug Name UseALDURAZYME INTRAVENOUS INFUSION Mucopolysaccharidosis I (MPS I)1

CIPRODEX OTIC SUSPENSION External & Middle Ear Infections FABRAZYME INTRAVENOUS INFUSION Fabry Disease2

HEMAX SR CAPLETS Iron supplement (long acting) LEVITRA TABS Erectile Dysfunction LEXIVA TABS HIV Infection MYFORTIC TABS Immunosuppressant Drug Used in Kidney Transplant NAMENDA TABS Alzheimer's Disease PREVACID NAPRAPAC NSAID - Associated with Gastric Ulcer RAPTIVA INJECTION Plaque Psoriasis ROZEX EMULSION Rosacea STALEVO TABS Parkinson’s Disease ZAVESCA CAPS Gaucher’s Disease3

1 MPS I is a rare, progressive disease affecting approximately 1,000 people in the U.S. It is an enzyme deficiency disease.

2 Fabry Disease is a genetic disorder affecting approximately 5,000 people worldwide. It is an enzyme deficiency disease.

3 Gaucher’s disease is a genetic lipid-storage disorder affecting over 10,000 people worldwide.

New Generics

Generic name Equivalent Brand name Usebenazepril LOTENSIN Hypertension benazepril/hctz LOTENSIN HCT Hypertension buproprion sr WELLBUTRIN SR Antidepressant methamphetamine hcl DESOXYN Attention-Deficit Hyperactivity Disorder nitrofurantoin monohyd macro MACROBID Urinary Anti-infective tri-sprintec ORTHO-TRICYCLEN Contraceptive velivet CYCLESSA Contraceptive

New Dosage Forms/Strengths

Drug Name Strength Dosage Form UseCARBATROL CAPS SA 100mg Epilepsy and Trigeminal neuralgia LEXAPRO TABS 5mg Major depressive disorder PACERONE TABS 100mg Ventricular arrhythmias

PREMPRO TABS 0.3mg/1.5mg Vasomotor symptoms associated with menopause; treatment of vulval and vaginal atrophy

REBETOL 40mg/ml solution Antiviral ZOMIG 5mg nasal spray Migraine Headache ZONEGRAN TABS 25mg and 50mg Epilepsy



Drug Name Strength Dosage Form Use

SALAGEN TABS 7.5mg Dry mouth from salivary gland hypofunction related to cancer or Sjogren's syndrome

FOSAMAX 70mg/75ml solution Osteoporosis

New Formulary Additions:

Drug Name UseACTIQ Cancer Pain ALDARA Genital and perianal warts, actinic keratosis AMOXIL Penicillins - antibiotic CORTEF 10MG TABS Glucocorticoid Drug

Deletions: 1Q, 2004

There were no deletions in the first quarter on this formulary.



2Q-2004 ESI National Preferred Formulary Changes

Additions: 2Q, 2004

New Brand/Chemicals

Drug Name Use CLIMARA PRO PATCH Treatment of menopausal symptoms. RHOPHYLAC 300MCG/2ML SYRINGE Pregnancy and Obstetrical Conditions1.

SENSIPAR TABLET Parathyroid carcinoma, Secondary hyperparathyroidism (HPT). SPIRIVA 18MCG CP-HANDIHALER Bronchospasm associated with COPD, including chronic bronchitis and emphysema. VIDAZA 100MG VIAL Myelodysplastic syndrome (MDS)2

1Routine antepartum and postpartum prevention of Rho(D) immunization in Rho(D)-negative women, for Rhesus prophylaxis in case of obstetric complications, for Rhesus prophylaxis in case of invasive procedures during pregnancy, and for the suppression of Rhesus immunization in Rho(D)-negative individuals transfused with Rho(D) positive red blood cells (RBCs) or blood components containing Rho(D)-positive RBCs

2 For the treatment of patients with the following MDS subtypes: Refractory anemia or refractory anemia with ringed sideroblasts (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia.

New Generics

Generic name Equivalent Brand name Use buproban, bupropion hcl sr tablet ZYBAN TABLET SA (150mg) Smoking cessation. calcitriol 1mcg/ml ampule CALCIJEX 1MCG/ML AMPULE Hyperparathyroidism and Hypocalcemia.

cefpodoxime tablet VANTIN TABLET Respiratory tract infections, Genitourinary infections and Skin infections.

ciprofloxacin tablet CIPRO TABLET Urinary Tract Infections, Skin infections, Lower respiratory tract infections.

ciprofloxacin 0.3% eye drop CILOXAN 0.3% EYE DROPS Conjunctivitis, Corneal ulcers.

dygase capsule KUTRASE CAPSULE

Enzyme replacement therapy in patients with deficient exocrine pancreatic secretions, such as in cystic fibrosis, chronic pancreatitis, postpancreatectomy etc.

fluticasone prop 0.005% ointment, cream CUTIVATE 0.005% OINTMENT, CREAM Corticosteroid-responsive dermatoses. glycolax powder MIRALAX POWDER Occasional constipation. ifosfamide 1gm vial IFEX 1GM VIAL Germ cell testicular cancer.metronidazole 0.75% cream METROCREAM 0.75% CREAM Rosacea. ofloxacin 0.3% eye drops OCUFLOX 0.3% EYE DROPS Conjunctivitis, Corneal ulcers. oxycodone hcl er 80mg tablet OXYCONTIN 80MG TABLET SA Moderate-to-severe pain for continuous analgesia. pergolide mesylate tablet PERMAX TABLET Parkinson’s disease. quinaretic tablet ACCURETIC TABLET Hypertension. ribasphere, ribavirin capsule REBETOL CAPSULE Chronic hepatitis C. terconazole 0.8% cream TERAZOL 3 CREAM Yeast infections (vulvovaginal candidiasis).

theophylline er tablet UNIPHYL TABLET SA Chronic asthma and other chronic lung diseases such as emphysema and chronic bronchitis.

vinate ii tablet DUET TABLET Prenatal Vitamin supplementation.



New Dosage Forms/Strengths

Drug Name Strength Dosage Form Use AMBIEN PAK TABLET 5mg, 10mg Short-term treatment of Insomnia. FABRAZYME VIAL 5mg Fabry disease1

FOLLISTIM 437.5 units AQ CARTRIDGE Infertility. GONAL-F VIAL 450 units Infertility. LOTRONEX TABLET 0.5mg Irritable bowel syndrome. TOPAMAX TABLET 50mg Epilepsy.

VFEND 40mg/ml SUSPENSION Esophageal candidiasis, Invasive aspergillosis and serious fungal infections.

VIRACEPT TABLET 625mg HIV. ZYPREXA 10mg VIAL Agitation associated with Schizophrenia and Bipolar I mania.

1Fabry Disease is a genetic disorder affecting approximately 5,000 people worldwide. It is an enzyme deficiency disease.

New Formulary Additions:

Drug Name Use CELEBREX Osteoarthritis (OA)/Adult rheumatoid arthritis (RA) and Primary dysmenorrhea. BEXTRA Osteoarthritis (OA)/Adult rheumatoid arthritis (RA) and Primary dysmenorrhea. LEVOXYL Hypothyroidism and Pituitary thyroid stimulating hormone (TSH) suppression.

Deletions: 2Q, 2004

New Formulary Deletions:

Drug Name Use LOTENSIN, - HCT TABLET* Hypertension. GLUCOTROL XL TABLET* Type 2 Diabetes.

*Removed from the formulary due to generic availability and MAC.

Documents

2004 Express Scripts National P - Michigan€¦ · choline mag trisalicylate CHROMAGEN CHROMAGEN FA CHROMAGEN FORTE CILOXAN * cimetidine cimetidine hcl CIPRO * 10% SUSPENSION CIPRO