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2015 Essential Health Benefits Formulary Reference Guide
List of covered drugs
INTRODUCTION
Catamaran utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically sound and that it supports patient health. This committee reviews and evaluates medications on the formulary based on safety and efficacy to help maintain clinical integrity in all therapeutic categories.
FORMULARY DESIGN
Catamaran has chosen a closed formulary structure for our standard Essential Health Benefits Formulary. The formulary structure features generics, preferred and non-preferred brand-name drugs, specialty drugs, and ACA (Affordable Care Act) preventive drugs. A closed formulary limits coverage to only those products listed in these levels. Products not listed on the formulary are generally not covered.
Generic drugs: Most generic drugs are listed under “GENERIC”. Drugs listed under “GENERIC” have the same active ingredient as the brand-name versions but at a lower cost.
Preferred drugs: Drugs listed under “PREFERRED” include preferred brand name drugs that will generally have lower co-payments than non-preferred brand name drugs.
Non-preferred drugs: Drugs listed under “NON PREFERRED” generally have higher co-payments than preferred brand name drugs.
Specialty drugs: Drugs listed under ‘SPECIALTY” generally have the highest co-payment and cost. Specialty drugs are prescription medications that are sometimes used to treat complex and chronic conditions. They may require special monitoring or handling.
ACA preventive drugs: Drugs listed under “PREVENTIVE” may have coverage and no co-payment when health care reform requirements are met for age, gender, and/or risk factors.
REASONABLE MEDICAL MANAGEMENT
Catamaran’s formulary also uses medical and utilization management functions to determine whether a prescription is medically necessary. These industry recognized and accepted management functions include but are not limited to quantity limits, step therapy, and prior authorization and help Catamaran and its clients determine whether the prescribed medication was prescribed in accordance with generally accepted medical practice standards, is clinically appropriate, and confirm that the prescribed medication is not more costly than an alternative product that is as likely to produce therapeutically equivalent results. As recommended by the
United States Department of Labor, Catamaran’s reasonable medical and utilization management functions apply to ACA preventive drugs.
USING THIS FORMULARY REFERENCE GUIDE TO HELP CONTAIN COSTS
Many health plans use the Catamaran formulary to help manage the overall cost of providing prescription drug benefits. This formulary offers a wide range of medications from which to choose. We realize that this formulary reference guide may not include every drug from every manufacturer. However, choosing a generic or preferred drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable.
SAVING ON OUT-OF-POCKET COSTS
Your health plan sets the co-payments for each formulary drug status which include generic, preferred brand-name, non-preferred brand-name, and specialty medications. Co-payments and deductibles for preventive products follow health care reform rules. Health plans often design prescription drug plans to encourage the use of generic and preferred brand-name drugs. Choosing non-preferred drugs (or specialty drugs) may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments, and deductible amounts) or not receiving coverage at all. Patients may also pay less for generic drugs.
PLEASE NOTE: Brand-name drugs may become non-formulary if a generic version becomes available.
CONSULTING THE PRESCRIBER’S OFFICE WHEN APPROPRIATE
When employers and other benefit sponsors design their prescription drug plans, they may choose to provide coverage only for certain medications, time periods, doses, quantities, or for specific conditions (e.g. they may exclude coverage for medications for unapproved, unproven, or cosmetic indications). When coverage for medications is provided based on use or quantity, Catamaran may contact your prescriber’s office for additional information to determine whether coverage is available under your plan. Patients who are unsure whether these coverage rules apply for a particular medication can consult their prescription drug benefit manual or contact a Catamaran Member Services representative to determine specific coverage requirements.
KNOWING HOW THE FORMULARY INFORMATION IS ORGANIZED
The following formulary reference guide is designed in the following order: generics, generic preventive, preferred brand name, non-preferred brand name, brand name preventive,
specialty drugs. In addition, immediately preceding the index is a section listing ACA preventive drugs by category.
*Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of catamaran. The presence of a medication on this formulary list does not guarantee coverage. To see the most up-to-date formulary, please visit your member website. You may also call Member Services at the number listed on your ID card to request a copy be mailed to you.
35756461v.2
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
FIFTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
AMEBICIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANGIOGENESIS INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
RADIOPHARMACEUTICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CELLULAR IMMUNOTHERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
PHOSPHODIESTERASE INHBTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
DIRECT RENIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
CALCIUM REGULATORS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ARTIFICIAL TEAR/LUBRICANT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
GENERAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
TOXOIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
ACA PREVENTIVE DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
ASPIRIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
FLUORIDE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
FOLIC ACID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
IMMUNIZATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
IRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
SMOKING CESSATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
VITAMIN D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
BOWEL PREPARATION AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
BREAST CANCER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Zinacef
Zinacef IN Iso-osmotic Diluent
THIRD GENERATION
GENERIC
April 2015
cefdinir
cefotaxime sodium
ANTI-INFECTIVES
cefpodoxime proxetil
ceftazidime
PENICILLINS
ceftriaxone sodium
GENERIC
tazicef
amoxicillin
tazidime
amoxicillin/clavulanate potassium
Cefditoren Pivoxil
amoxicillin/clavulanate potassium ER
Ceftazidime
ampicillin
Ceftazidime/Dextrose
ampicillin sodium
Ceftriaxone IN Iso-osmotic Dextrose
ampicillin-sulbactam
Ceftriaxone/Dextrose
dicloxacillin sodium
NON PREFERRED
nafcillin sodium
Cedax
oxacillin sodium
Ceftibuten
penicillin v potassium
Claforan
penicillin G potassium
Suprax
piperacillin sodium/ tazobactam sodium
FOURTH GENERATION
piperacillin sodium/tazobactam sodium
GENERIC
piperacillin/tazobactam
cefepime
Amoxicillin
Cefepime
Ampicillin
NON PREFERRED
Ampicillin Sodium
Maxipime
Ampicillin-sulbactam
FIFTH GENERATION
Nafcillin Sodium
NON PREFERRED
Penicillin G Potassium IN Iso-osmotic Dextrose
Teflaro
Penicillin G Procaine
Penicillin G Sodium
MACROLIDES
Pfizerpen-G
GENERIC
PREFERRED
azithromycin
Augmentin
clarithromycin
NON PREFERRED
clarithromycin ER
Amoxicillin ER
erythromycin
Bactocill IN Dextrose
Azithromycin
Bicillin C-R
E.e.s. 400
Bicillin L-a
Erythromycin Base
Moxatag
Erythromycin Ethylsuccinate
Timentin
NON PREFERRED
DificidQL
CEPHALOSPORIN
Ery-TAB
FIRST GENERATION
Erythrocin Lactobionate
GENERIC
PCE
cefadroxil
Zithromax
cefazolin sodium
cephalexin
TETRACYCLINES
Cefazolin Sodium
GENERIC
Cefazolin Sodium/Dextrose
avidoxy
Cephalexin
demeclocycline HCL
SECOND GENERATION
doxy 100
GENERIC
doxycycline
cefaclor
doxycycline hyclate
cefoxitin sodium
doxycycline hyclate DR
cefprozil
doxycycline monohydrate
cefuroxime axetil
minocycline HCL
cefuroxime sodium
minocycline HCL ER
Cefaclor
morgidox 1X100MG
Cefaclor ER
morgidox 2X100MG
Cefotetan
Minocin
Cefotetan/Dextrose
Tetracycline HCL
Cefoxitin Sodium
NON PREFERRED
Cefuroxime Sodium
Alodox Convenience Kit
Cefuroxime/Dextrose
Ocudox
NON PREFERRED
Solodyn
Ceftin
Mefoxin
Effective April 1, 2015 v.1
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; ©Catamaran 2015. All Rights Reserved. May not be copied or distributed without authorization.
1
QUINOLONES
griseofulvin ultramicrosize
itraconazolePA
GENERIC
ketoconazole
ciprofloxacin
nystatin
ciprofloxacin ER
terbinafine HCLQL
ciprofloxacin HCL
voriconazole
ciprofloxacin I.V.-IN D5W
Amphotericin B
levofloxacin
Fluconazole IN NACL
levofloxacin IN D5W
PREFERRED
moxifloxacin HCL
Cancidas
ofloxacin
Lamisil
Ciprofloxacin HCL
Mycamine
Ofloxacin
Noxafil
PREFERRED
SporanoxPA
Avelox
NON PREFERRED
NON PREFERRED
Abelcet
Factive
Ambisome
Noroxin
Amphotec
Eraxis
AMINOGLYCOSIDES
Terbinex
GENERIC
amikacin sulfate
ANTIVIRALS
gentamicin sulfate
GENERIC
gentamicin sulfate pediatric
abacavir
gentamicin sulfate/sodium chloride
abacavir sulfate/lamivudine/zidovudineQL
gentamicin sulfate/0.9% sodium chloride
acyclovir
isotonic gentamicin
acyclovir sodium
neomycin sulfate
cidofovir
paromomycin sulfate
didanosine
tobramycin sulfate
famciclovirQL
Gentamicin Sulfate/0.9% Sodium Chloride
ganciclovir
Isotonic Gentamicin
lamivudine
Streptomycin Sulfate
lamivudine/zidovudine
Tobramycin Sulfate/Sodium Chloride
nevirapine
SPECIALTY
nevirapine ER
tobramycinPA
rimantadine HCL
Tobi PodhalerQL
stavudine
valacyclovir HCLQL
SULFONAMIDES
zidovudine
GENERIC
Acyclovir Sodium
Sulfadiazine
Foscarnet Sodium
PREFERRED
ANTIMYCOBACTERIAL AGENTS
Aptivus
GENERIC
AtriplaQL
ethambutol HCL
CompleraQL
isoniazid
Crixivan
pyrazinamide
Edurant
rifabutin
Emtriva
rifampin
Epivir HBV
Isoniazid
Epzicom
PREFERRED
FuzeonQL,PA
Priftin
Intelence
Seromycin
Invirase
Sirturo
Isentress
NON PREFERRED
Kaletra
Capastat Sulfate
Lexiva
Cycloserine
Nevirapine
Paser
Norvir
Rifamate
Prezista
Rifater
Relenza DiskhalerQL
Trecator
Rescriptor
Retrovir IV Infusion
ANTIFUNGALS
Reyataz
GENERIC
SelzentryPA
bio-statin
StribildQL
fluconazole
Sustiva
fluconazole IN dextrose
TamifluQL
fluconazole IN NACL
TruvadaPA
flucytosine
Videx Pediatric
griseofulvin microsize
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 2
Viracept
clindamycin phosphate add-vantage
Viramune
clindamycin phosphate pharmacy bulk package
Viramune XR
clindamycin phosphate IN D5W
Viread
clindamycin HCL
Ziagen
colistimethate sodium
SPECIALTY
e.s.p.
adefovir dipivoxilQL,PA
imipenem/cilastatin
entecavirQL,PA
linezolid
moderiba
meropenem
ribasphere
metronidazole
ribavirin
metronidazole IN NACL 0.79%
valganciclovir
polymyxin b sulfate
BaracludeQL,PA
sulfamethoxazole/trimethoprim
HarvoniPA
sulfamethoxazole/trimethoprim DS
Infergen
sulfatrim pediatric
Moderiba
tinidazole
Moderiba 1200 Dose Pack
trimethoprim
Moderiba 800 Dose Pack
vancomycin HCL
OlysioPA
Bacitracin
Peg-intronPA
Chloramphenicol Sodium Succinate
Peg-intron RedipenPA
Clindamycin Phosphate
Peg-intron Redipen PAK 4PA
Dapsone
PegasysPA
Sulfamethoxazole/Trimethoprim
Pegasys ProclickPA
Vancomycin HCL
PegintronPA
Vancomycin HCL IN Dextrose
Rebetol
PREFERRED
Ribasphere
Alinia
Ribasphere Ribapak
Nebupent
Ribatab
SivextroQL
SovaldiPA
Tygacil
Tivicay
XifaxanPA
TyzekaQL,PA
ZyvoxQL
Valcyte
NON PREFERRED
VictrelisPA
Azactam IN Iso-osmotic Dextrose
Virazole
Cubicin
Doribax
ANTIMALARIALS
Flagyl ER
Invanz
GENERIC
Ketek
atovaquone/proguanil HCL
Lincocin
chloroquine phosphate
Primsol
hydroxychloroquine sulfate
Vibativ
mefloquine HCL
SPECIALTY
quinine sulfatePA
CaystonPA
Primaquine Phosphate
QualaquinPA
ANTINEOPLASTICS, ETC
PREFERRED
Coartem
ALKYLATING AGENTS
Daraprim
GENERIC
Lomustine
AMEBICIDES
PREFERRED
NON PREFERRED
Alkeran
Yodoxin
Gleostine
Leukeran
ANTHELMINTICS
SPECIALTY
GENERIC
carboplatin
ivermectin
cisplatin
PREFERRED
cyclophosphamide
Albenza
ifosfamide
NON PREFERRED
melphalan hydrochloride
Biltricide
oxaliplatin
temozolomidePA
MISC. ANTI-INFECTIVES
Bicnu
Busulfex
GENERIC
Carboplatin
atovaquone
Cisplatin
aztreonam
Cyclophosphamide
baciim
Eloxatin
bacitracin
Gliadel Wafer
clindamycin palmitate HCL
Hexalen
clindamycin phosphate
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 3
Ifex
PREFERRED
Ifosfamide
Bexxar
Mustargen
SPECIALTY
MyleranPA
AdcetrisPA
Temodar
ArzerraPA
Treanda
Erbitux
ValchlorPA
GazyvaPA
Zanosar
HerceptinPA
KadcylaPA
ANTIBIOTICS
PerjetaPA
RituxanPA
GENERIC
Vectibix
bleomycin sulfate
YervoyPA
SPECIALTY
Zevalin Y-90
adriamycin
daunorubicin HCL
HORMONAL AGENTS
doxorubicin HCL
doxorubicin HCL liposome
GENERIC
epirubicin HCL
anastrozole
idarubicin HCL
bicalutamide
lipodox
exemestane
lipodox 50
flutamide
mitomycin
letrozole
mitoxantrone HCLPA
megestrol acetate
Adriamycin
PREVENTIVE
Daunoxome
tamoxifen citrate
Epirubicin HCL
PREFERRED
Valstar
Depo-provera
Emcyt
ANTINEOPLASTIC ENZYMES
Fareston
Nilandron
SPECIALTY
Soltamox
Elspar
SPECIALTY
ErwinazePA
leuprolide acetatePA
Oncaspar
EligardQL,PA
Faslodex
ANTIMETABOLITES
FirmagonQL,PA
GENERIC
Lupron DepotQL,PA
adrucil
Lysodren
fluorouracil
Trelstar DepotQL,PA
methotrexate
Trelstar Depot MixjectQL,PA
methotrexate sodium
Trelstar LAQL,PA
PREFERRED
Trelstar LA MixjectQL,PA
Trexall
Trelstar MixjectQL,PA
SPECIALTY
VantasQL,PA
azacitidinePA
XtandiPA
capecitabinePA
ZoladexQL,PA
cladribine
ZytigaPA
cytarabine
cytarabine aqueous
IMMUNOMODULATORS
decitabinePA
GENERIC
floxuridine
azathioprine
fludarabine phosphate
cyclosporine
gemcitabine HCL
cyclosporine modified
mercaptopurine
gengraf
Alimta
hecoria
Arranon
mycophenolate mofetil
Clolar
mycophenolic acid DR
Cytarabine
sirolimus
Depocyt
tacrolimus
Folotyn
Cyclosporine Modified
Gemcitabine
PREFERRED
Tabloid
Azasan
Rapamune
ANGIOGENESIS INHIBITORS
Sandimmune
SPECIALTY
NON PREFERRED
Avastin
Atgam
ZaltrapPA
Cellcept Intravenous
NulojixPA
ANTIBODIES
Prograf
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 4
Simulect
Hycamtin
Thymoglobulin
Irinotecan
ZortressPA
Topotecan HCL
SPECIALTY
PomalystPA
RADIOPHARMACEUTICALS
RevlimidPA
PREFERRED
ThalomidPA
Bexxar 131 Iodine
Metastron
MITOTIC INHIBITORS
Quadramet
GENERIC
SPECIALTY
Docetaxel
Xofigo
PREFERRED
Teniposide
CELLULAR IMMUNOTHERAPY
SPECIALTY
PREFERRED
docetaxel
ProvengePA
etoposide
paclitaxel
ANTINEOPLASTICS MISC.
toposar
GENERIC
vincasar PFS
hydroxyurea
vincristine sulfate
PREFERRED
vinorelbine tartrate
Photofrin
Abraxane
Uvadex
Docefrez
SPECIALTY
Etopophos
dacarbazine
Etoposide
tretinoin
HalavenPA
Actimmune
Ixempra Kit
Alferon N
JevtanaPA
Dacarbazine
Marqibo
ErivedgePA
Paclitaxel
Intron APA
Vinblastine Sulfate
Intron-aPA
Intron-a W/DiluentPA
ENZYME INHIBITORS
Matulane
SPECIALTY
Nipent
AfinitorPA
Proleukin
Afinitor DisperzPA
SylatronPA
BosulifPA
SynriboPA
CaprelsaQL,PA
TargretinPA
CometriqPA
Theracys
GilotrifPA
Tice Bcg
GleevecPA
Trisenox
IclusigPA
ImbruvicaPA
CHEMOTHERAPY RESCUE
InlytaPA
GENERIC
IstodaxPA
leucovorin calcium
JakafiPA
Calcium Folinate
KyprolisPA
Leucovorin Calcium
MekinistPA
PREFERRED
NexavarPA
Fusilev
SprycelPA
SPECIALTY
StivargaPA
amifostine
SutentPA
dexrazoxane
TafinlarPA
mesna
TarcevaPA
Mesnex
TasignaPA
Totect
Torisel
Voraxaze
TykerbPA
VelcadePA
CHEMOTHERAPY ADJUNCTS
VotrientPA
SPECIALTY
XalkoriPA
Elitek
ZelborafPA
Kepivance
ZolinzaPA
ZydeligPA
ANTINEOPLASTIC COMBO
SPECIALTY
TOPOISOMERASE I INHIBITOR
Ifosfamide/Mesna
SPECIALTY
irinotecan
CARDIOVASCULAR DRUGS
topotecan HCL
PHOSPHODIESTERASE INHBTR
Camptosar
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 5
GENERIC
GENERIC
milrinone lactate
afeditab CR
milrinone IN dextrose
amlodipine besylate
cartia XT
CARDIAC GLYCOSIDES
dilt-CD
dilt-XR
GENERIC
diltiazem CD
digitek
diltiazem HCL
digox
diltiazem HCL CD
digoxin
diltiazem HCL ER
Digoxin
diltzac
felodipine ER
ANTIANGINAL AGENTS
matzim LA
GENERIC
nicardipine HCL
isoditrate ER
nifediac CC
isosorbide dinitrate
nifedical XL
isosorbide dinitrate ER
nifedipine
isosorbide mononitrate
nifedipine ER
isosorbide mononitrate ER
nimodipine
minitran
nisoldipine
nitro-time
taztia XT
nitroglycerin
verapamil HCL
nitroglycerin lingual
verapamil HCL ER
nitroglycerin transdermal
verapamil HCL SR
nitroglycerin ER
Diltiazem HCL
nitroglycerin IN dextrose 5%
Isradipine
nitroglycerin IN 5% dextrose
Nisoldipine
Isosorbide Dinitrate
Nisoldipine ER
Nitroglycerin
Verapamil HCL
Nitroglycerin IN Dextrose 5%
PREFERRED
NON PREFERRED
Dilatrate SR
Cardene IV
Nitro-bid
Cardizem LA
Nitrostat
RanexaPA
ANTIARRHYTHMICS
NON PREFERRED
GENERIC
Nitro-dur
adenosine
Nitroglycerin Lingual
amiodarone HCL
Nitromist
disopyramide phosphate
flecainide acetate
BETA BLOCKERS
ibutilide fumarate
GENERIC
lidocaine HCL
acebutolol HCL
lidocaine HCL IN D5W
atenolol
lidocaine HCL/dextrose
betaxolol HCL
mexiletine HCL
bisoprolol fumarate
pacerone
carvedilol
propafenone HCL
esmolol HCL
propafenone HCL ER
labetalol HCL
quinidine gluconate CR
metoprolol succinate ER
quinidine gluconate ER
metoprolol tartrate
quinidine sulfate
nadolol
Amiodarone HCL
pindolol
Lidocaine HCL
propranolol HCL
Procainamide HCL
propranolol HCL ER
Quinidine Gluconate
sorine
Quinidine Sulfate
sotalol HCL
Quinidine Sulfate ER
sotalol HCL (AF)
PREFERRED
Propranolol HCL
Tikosyn
Timolol Maleate
NON PREFERRED
PREFERRED
Multaq
Bystolic
Nexterone
Coreg CR
Norpace CR
NON PREFERRED
Inderal XL
ACE INHIBITORS
Innopran XL
GENERIC
Levatol
benazepril HCL
captopril
CALCIUM CHANNEL BLOCKERS
enalapril maleate
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 6
enalaprilat
Methyldopa/Hydrochlorothiazide
fosinopril sodium
Propranolol/Hydrochlorothiazide
lisinopril
PREFERRED
moexipril HCL
Amturnide
perindopril erbumine
Azor
quinapril HCL
Benicar HCT
ramipril
Tarka
trandolapril
Tekamlo
Tekturna HCT
ANGIOTENSIN RCPTR BLOCKER
Tribenzor
NON PREFERRED
GENERIC
EdarbyclorPA,ST
candesartan cilexetilPA,ST
Teveten HCTPA,ST
eprosartan mesylate
irbesartan
DIURETICS
losartan potassium
telmisartan
GENERIC
valsartan
acetazolamide
PREFERRED
acetazolamide sodium
Benicar
acetazolamide ER
NON PREFERRED
amiloride HCL
EdarbiPA,ST
amiloride/hydrochlorothiazide
bumetanide
DIRECT RENIN INHIBITORS
chlorothiazide
chlorothiazide sodium
PREFERRED
furosemide
Tekturna
hydrochlorothiazide
indapamide
ANTIHYPERTENSIVES MISC.
mannitol
GENERIC
methazolamide
clonidine HCL
metolazone
doxazosin mesylate
osmitrol viaflex
eplerenone
spironolactone
fenoldopam mesylate
spironolactone/hydrochlorothiazide
guanfacine HCL
torsemide
hydralazine HCL
triamterene/hydrochlorothiazide
methyldopa
Acetazolamide
minoxidil
Chlorothiazide
prazosin HCL
Chlorthalidone
terazosin HCL
Furosemide
Methyldopate HCL
Methyclothiazide
Phentolamine Mesylate
Torsemide
Reserpine
Triamterene/Hydrochlorothiazide
PREFERRED
Demser
NON PREFERRED
Dibenzyline
Dyrenium
Edecrin
ANTIHYPERTENSIVE COMBO
Sodium Edecrin
GENERIC
amlodipine besylate/benazepril hydrochloride
VASOPRESSORS
amlodipine besylate/benazepril HCL
GENERIC
amlodipine besylate/valsartan
dobutamine HCL
amlodipine/valsartan/hctz
dobutamine HCL/D5W
atenolol/chlorthalidone
dobutamine/dextrose 5%
benazepril HCL/hydrochlorothiazide
dopamine HCL
bisoprolol fumarate/hydrochlorothiazide
dopamine HCL-dextrose 5%
candesartan cilexetil/hydrochlorothiazide
dopamine HCL/dextrose 5%
enalapril maleate/hydrochlorothiazide
dopamine/D5W
fosinopril sodium/hydrochlorothiazide
ephedrine sulfate
irbesartan/hydrochlorothiazide
midodrine HCL
lisinopril/hydrochlorothiazide
norepinephrine bitartrate
losartan potassium/hydrochlorothiazide
phenylephrine HCL
metoprolol/hydrochlorothiazide
Dobutamine/Dextrose 5%
moexipril/hydrochlorothiazide
Dopamine HCL
nadolol/bendroflumethiazide
Epinephrine
quinapril/hydrochlorothiazide
Levophed
telmisartan/amlodipine
Phenylephrine HCL
telmisartan/hydrochloroth
PREFERRED
telmisartan/hydrochlorothiazide
Auvi-q
valsartan/hydrochlorothiazide
Epipen 2-PAK
Captopril/Hydrochlorothiazide
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 7
Epipen-JR 2-PAK
TyvasoQL,PA
Tyvaso RefillQL,PA
ANTIHYPERLIPIDEMICS
Tyvaso StarterQL,PA
VeletriPA
GENERIC
VentavisQL,PA
atorvastatin calcium
cholestyramine
DERMATOLOGICALS
cholestyramine light
colestipol HCL
ACNE PRODUCTS
colestipol HCL for oral suspension
GENERIC
fenofibrate
adapalenePA
fenofibrate micronized
amnesteem
fenofibric acid DR
avar cleanser
fluvastatin
avar-e emollient
gemfibrozil
avar-e green
lovastatin
avitaPA
micronized colestipol HCL
benzepro
niacin ER
benzepro SHORT contact
omega-3-acid ethyl esters
benziq wash
pravastatin sodium
benzoyl peroxide
prevalite
benzoyl peroxide wash acne treatment pack
simvastatin
benzoyl peroxide SHORT contact
Fenofibric Acid
bp cleansing wash
Niacor
bp foam
PREFERRED
bp foaming wash
Crestor
bp wash
Fenofibrate
bp 10-1
Lipofen
cerisa wash
Liptruzet
claravis
Simcor
claris clarifying wash
Vascepa
clearplex x
Vytorin
clindacin etz pledgets
Welchol
clindacin-p
Zetia
clindamax
NON PREFERRED
clindamycin phosphate
Altoprev
clindamycin/benzoyl peroxide
Fenoglide
ery
Fibricor
erythromycin
Livalo
erythromycin/benzoyl peroxide
Triglide
lavoclen-4 acne wash kit
SPECIALTY
lavoclen-8 acne wash kit
JuxtapidQL,PA
myorisan
KynamroQL,PA
neuac
oscion cleanser
CARDIOVASCULAR - MISC.
pr benzoyl peroxide wash
GENERIC
prascion
amlodipine besylate/atorvastatin calcium
prascion fc
cardioplegic
prascion ra with sunscreens
isoxsuprine HCL
rosanil cleanser
papaverine HCL
se bpo wash
Isoxsuprine HCL
se 10-5 ss
PREFERRED
sodium sulfacetamide
CaverjectQL
sodium sulfacetamide/sulfur
Caverject ImpulseQL
sodium sulfacetamide/sulfur cleanser
CialisQL
sodium sulfacetamide/sulfur cleansing cloths
MuseQL
sodium sulfacetamide/sulfur green
ViagraQL
sodium sulfacetamide/sulfur w/sunscreen
NON PREFERRED
sodium sulfacetamide/sulfur wash
Bidil
ss 10-2
SPECIALTY
sss 10-5
epoprostenol sodium
sss 10%-5%
sildenafilQL,PA
sulfacetamide sodium
sildenafil citrateQL,PA
sulfacetamide sodium/sulfur cleanser
AdcircaQL,PA
sulfacleanse 8/4
AdempasQL,PA
tretinoinPA
LetairisQL,PA
tretinoin microspherePA
OpsumitQL,PA
tretinoin microsphere P.M.PA
RemodulinPA
virti-sulf
RevatioQL,PA
zenatane
TracleerQL,PA
zencia
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 8
Bpo
Mentax
Bpo 3% Foaming Cloths
Naftin
Bpo 6% Foaming Cloths
Oxistat
Bpo 9% Foaming Cloths
Pedipirox-4 NailPA
Claravis
Xolegel
Lavoclen-4 Creamy Wash
Lavoclen-8 Creamy Wash
ANTIVIRALS - TOPICAL
Sodium Sulfacetamide/Sulfur
GENERIC
Sodium Sulfacetamide/Sulfur Cleanser IN Urea
acyclovir
Sodium Sulfacetamide/Sulfur IN Urea
PREFERRED
Zaclir Cleansing
Denavir
Zovirax
PREFERRED
Acanya
ANTI-INFLAMMATORY AGENTS
AtralinPA
GENERIC
DifferinPA
diclofenac sodiumQL,PA
EpiduoPA
PREFERRED
ZianaPA
VoltarenQL
NON PREFERRED
NON PREFERRED
Absorica
FlectorQL,PA
Azelex
Tretin-xPA
ANTIPRURITICS
VeltinPA
NON PREFERRED
Prudoxin
ROSACEA AGENTS
Zonalon
GENERIC
metronidazole
ANTIPSORIATICS
rosadan
GENERIC
Doxycycline
acitretin
PREFERRED
calcipotriene
Finacea
calcitrene
Oracea
methoxsalen
Calcitriol
ANTIBIOTICS - TOPICAL
Dritho-creme HP
GENERIC
PREFERRED
mupirocin
TazoracQL,PA
mupirocin calcium
8-mop
Centany
NON PREFERRED
Gentamicin Sulfate
Vectical
NON PREFERRED
SPECIALTY
Altabax
StelaraPA
Cortisporin
ANTISEBORRHEIC AGENTS
ANTIFUNGALS - TOPICAL
GENERIC
GENERIC
seb-prev wash
ciclodan
selenium sulfide
ciclopirox
sodium sulfacetamide
ciclopirox nail lacquer
sodium sulfacetamide wash
ciclopirox olamine
Glycolic Acid
ciclopirox treatmentPA
Glycolic Acid 70% High Purity
clotrimazole
Seb-prev
clotrimazole/betamethasone dipropionate
Selenium Sulfide
dermazene
Sodium Sulfacetamide/Urea
econazole nitrate
NON PREFERRED
exoderm
Ovace Plus
hydrocortisone/iodoquinol
ketoconazole
CORTICOSTEROIDS - TOPICAL
ketodan
GENERIC
nyamyc
ala cort
nystatin
alclometasone dipropionate
nystatin/triamcinolone
alphatrex
nystop
apexicon
pedi-dri
augmented betamethasone dipropionate
versiclear
betamethasone dipropionate
Ciclopirox Topical Solution Kit
betamethasone valerate
NON PREFERRED
calcipotriene/betamethasone dipropionateQL,PA
Cnl8 Nail KitPA
clobetasol propionate
Ertaczo
clobetasol propionate e
Exelderm
clobetasol propionate emollient
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 9
clodan
NON PREFERRED
cormax scalp application
Zyclara
desonide
Zyclara P.M.
desoximetasone
diflorasone diacetate
DERMATOLOGICALS - MISC.
fluocinolone acetonide
GENERIC
fluocinolone acetonide body
acticin
fluocinolone acetonide scalp
alphaquin HP
fluocinonide
ammonium lactate
fluocinonide-e
cerovel
fluticasone propionate
diclofenac sodium
halac
episone CRE
halobetasol propionate
finasteride
halonate PAC
fluorouracil
hydrocortisone
glydo
hydrocortisone acetate/aloe
grafco silver nitrate applicator
hydrocortisone acetate/pramoxine
hydroquinone
hydrocortisone butyrate
hydroquinone time release
hydrocortisone butyrate (lipid)
hygel
hydrocortisone butyrate (lipophilic)
hypercare
hydrocortisone valerate
laclotion
hydrocortisone IN absorbase
lactic acid
lokara
lactic acid e
mometasone furoate
lactic acid w/vitamin e
prednicarbate
latrix
scalacort
lidocaine
triamcinolone acetonide
lidocaine HCL
triderm
lidocaine HCL jelly
Amcinonide
lidocaine/prilocaine
Apexicon E
lidopin
Desoximetasone
lindane
Diflorasone Diacetate
mafenide acetate
Synalar
malathion
Triamcinolone Acetonide
melpaque HP
Trianex
melquin HP
U-cort
nuquin HP
PREFERRED
permethrin
Pramosone
podofilox
Pramosone E
pramox gel
TaclonexQL,PA
rea LO 39
Tucks Anti-itch
rea LO 40
NON PREFERRED
remergent HQ
Capex
remeven
Clocortolone Pivalate
salacyn
Clocortolone Pivalate P.M.
salicylic acid
Cloderm
salicylic acid cream
Cloderm P.M.
salicylic acid lotion
Cordran
salicylic acid wart remover
Cordran Tape
silver sulfadiazine
Dermasorb Ta
skin bleaching
Desonate
skin bleaching/sunscreen
Desowen Cream/Cetaphil Lotion
sodium hyaluronate
Desowen Lotion/Cetaphil Cream
ssd
Desowen Ointment/Cetaphil Lotion
thermazene
Halog
tropazone
Kenalog
u-kera e
Locoid
umecta mousse
Pediaderm HC
urea
Pediaderm Ta
urea hydrating
Texacort
urea nail
Ultravate PAC
urea topical
Verdeso
urea IN zinc undecylenate/lactic acid vehicle
urea 40% nail film
IMMUNOMODULATING AGENTS
urea-c40
GENERIC
x-viate
imiquimod
Arzol Silver Nitrate App Licators
tacrolimus
Cem-urea
PREFERRED
Coal TAR
Elidel
CARB-o-philic 40
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 10
CARB-o-philic/40
Rayos
Salvax
Solu-cortef
Silver Nitrate
Veripred 20
TL hydroquinone
PREFERRED
ANDROGENS-ANABOLIC
Carac
GENERIC
Condylox
danazol
Fluorouracil
oxandroloneQL,PA
Oxsoralen
testosterone cypionatePA
RegranexPA
testosterone enanthatePA
Sulfamylon
TestosteronePA,ST
NON PREFERRED
Testosterone P.M.PA,ST
Avage
PREFERRED
Eurax
Androgel
Fluoroplex
Androgel P.M.
Natroba
Androxy
Panretin
Axiron
Picato
Methitest
Refissa
NON PREFERRED
Renova
Anadrol-50PA
Renova P.M.
AndrodermPA,ST
Sklice
StriantPA,ST
Spinosad
Testim
Synera
VogelxoPA,ST
TargretinPA
Vogelxo P.M.PA,ST
Tretinoin Emollient
Ulesfia
ESTROGENS
Veregen
GENERIC
SPECIALTY
covaryx
ValchlorPA
covaryx HS
eemt
ENDOCRINE AND METABOLIC
eemt HS
CORTICOSTEROIDS
esterified estrogens/methltestosterone
esterified estrogens/methyltestosterone
GENERIC
esterified estrogens/methyltestosterone DS
a-methapred
esterified estrogens/methyltestosterone HS
baycadron
estradiol
betamethasone sodium phosphate/betamethasone acetate
estradiol valerate
budesonide
estradiol/norethindrone acetate
dexamethasone
estropipate
dexamethasone sodium phosphate
lopreeza
fludrocortisone acetate
mimvey
hydrocortisone
mimvey LO
methylprednisolone
ortho-est
methylprednisolone acetate
Estropipate
methylprednisolone dose pack
Jinteli
methylprednisolone sodiumsuccinate
PREFERRED
prednisolone
Cenestin
prednisolone sodium phosphate
Combipatch
prednisolone sodium phosphate odt
Enjuvia
prednisone
Evamist
A-hydrocort
Minivelle
Cortisone Acetate
Premarin
Dexamethasone
Premphase
Dexamethasone Sodium Phosphate
Prempro
Prednisolone Sodium Phosphate
NON PREFERRED
Prednisone
Alora
PREFERRED
Estrogel
Uceris
Menest
NON PREFERRED
Depo-medrol
CONTRACEPTIVES
Dexamethasone Intensol
GENERIC
Dexpak 10 Day
Amethyst
Dexpak 13 Day
Necon 1/50-28
Dexpak 6 Day
Necon 10/11-28
Millipred
Zovia 1/50e
Millipred DP
PREVENTIVE
Orapred Odt
altavera
Prednisone Intensol
alyacen 1/35
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 11
alyacen 7/7/7
microgestin FE
amethiaQL
microgestin FE 1.5/30
amethia LOQL
microgestin 1.5/30
apri
microgestin 1/20
aranelle
mono-linyah
aubra
mononessa
aviane
my way
azurette
myzilra
balziva
necon 0.5/35-28
briellyn
necon 1/35
camila
necon 7/7/7
camreseQL
next choice one dose
camrese LOQL
nikki
caziant
nora-be
cesia
norethindrone
chateal
norethindrone acetate/ethinyl estradiol
cryselle-28
norethindrone acetate/ethinyl estradiol/ferrous fumarate
cyclafem 1/35
norgestimate/ethinyl estradiol
cyclafem 7/7/7
norlyroc
dasetta 1/35
nortrel 0.5/35 (28)
dasetta 7/7/7
nortrel 1/35
dayseeQL
nortrel 7/7/7
deblitane
ocella
delyla
orsythia
desogestrel/ethinyl estradiol
philith
drospirenone/ethinyl estradiol
pimtrea
elinest
pirmella 1/35
emoquette
pirmella 7/7/7
enpresse-28
portia-28
enskyce
previfem
errin
quasenseQL
estarylla
reclipsen
falmina
sharobel
gianvi
solia
gildagia
sprintec 28
gildess FE 1.5/30
sronyx
gildess FE 1/20
syeda
gildess 1.5/30
tarina FE 1/20
gildess 1/20
tilia FE
gildess 24 FE
tri-estarylla
heather
tri-legest FE
introvaleQL
tri-linyah
jencycla
tri-previfem
jolessaQL
tri-sprintec
jolivette
trinessa
junel FE 1.5/30
trivora-28
junel FE 1/20
velivet
junel 1.5/30
vestura
junel 1/20
viorele
kariva
vyfemla
kelnor 1/35
wera
kurvelo
wymzya FE
larin FE 1.5/30
xulane
larin FE 1/20
zarah
larin 1.5/30
zenchent
larin 1/20
zenchent FE
leena
zovia 1/35e
lessina
Ogestrel
levonest
PREFERRED
levonorgestrel
Beyaz
levonorgestrel and ethinyl estradiolQL
LO Loestrin FE
levonorgestrel/ethinyl estradiol
Minastrin 24 FE
levora 0.15/30-28
Safyral
lomedia 24 FE
PREVENTIVE
loryna
Natazia
low-ogestrel
NuvaringQL
lutera
NON PREFERRED
lyza
Depo-subq Provera 104QL
marlissa
Ella
medroxyprogesterone acetateQL
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 12
PREVENTIVE
Glyburide
Implanon
Tolazamide
Mirena
Tolbutamide
Nexplanon
NON PREFERRED
Paragard Intrauterine Copper Contraceptive T380a
Diabeta
Skyla
BIGUANIDES
GENERIC
PROGESTINS
metformin HCL
metformin HCL ER
GENERIC
PREFERRED
medroxyprogesterone acetate
Riomet
norethindrone acetate
NON PREFERRED
progesterone
Glumetza
SPECIALTY
MEGLITINIDE ANALOGUES
MakenaPA
GENERIC
nateglinide
ANTIDIABETIC AGENTS
repaglinide
INSULIN
DIABETIC OTHER
PREFERRED
PREFERRED
Lantus
Glucagen
Lantus Solostar
Glucagen Hypokit
Novolin N
Glucagon Emergency Kit
Novolin N Relion
InvokanaPA
Novolin R
Proglycem
Novolin R Relion
NON PREFERRED
Novolin 70/30
Cycloset
Novolin 70/30 Relion
ALPHA-GLUCOSIDASE INHIBIT
Novolog
GENERIC
Novolog Flexpen
acarbose
Novolog Mix 70/30
NON PREFERRED
Novolog Mix 70/30 Prefilled Flexpen
Glyset
Novolog Penfill
DPP-4 INHIBITORS
NON PREFERRED
PREFERRED
ApidraPA,ST
Januvia
Apidra SolostarPA,ST
Onglyza
HumalogPA,ST
NON PREFERRED
Humalog KwikpenPA,ST
Tradjenta
Humalog Mix 50/50PA,ST
INSULIN SENSITIZING AGENT
Humalog Mix 50/50 KwikpenPA,ST
GENERIC
Humalog Mix 75/25PA,ST
pioglitazone HCL
Humalog Mix 75/25 KwikpenPA,ST
NON PREFERRED
Humulin NPA,ST
Avandia
Humulin N KwikpenPA,ST
ANTIDIABETIC COMBINATIONS
Humulin N U-100 PenPA,ST
GENERIC
Humulin RPA,ST
glipizide/metformin HCL
Humulin R U-500 (concentrated)PA,ST
glyburide/metformin HCL
Humulin 70/30PA,ST
pioglitazone HCL-glimepiride
Humulin 70/30 KwikpenPA,ST
pioglitazone HCL/metformin HCL
Humulin 70/30 PenPA,ST
PREFERRED
LevemirPA,ST
Actoplus Met XR
Levemir FlexpenPA,ST
Janumet
Levemir FlextouchPA,ST
Janumet XR
AMYLIN ANALOGS
Juvisync
PREFERRED
Kombiglyze XR
Symlinpen 120PA
Prandimet
Symlinpen 60PA
NON PREFERRED
INCRETIN MIMETIC AGENTS
Jentadueto
PREFERRED
Bydureon
BISPHOSPHONATES
Byetta
GENERIC
Victoza
alendronate sodium
SULFONYLUREAS
ibandronate sodiumQL
GENERIC
risedronate sodiumQL,PA,ST
glimepiride
Alendronate Sodium
glipizide
Etidronate Disodium
glipizide ER
PREFERRED
glipizide XL
Fosamax Plus DQL
glyburide
NON PREFERRED
glyburide micronized
ActonelPA,ST
tolazamide
Chlorpropamide
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 13
AtelviaQL,PA,ST
Humatrope Combo PackPA
BinostoQL
Norditropin CartridgePA
SPECIALTY
Norditropin FlexproPA
pamidronate disodium
Norditropin Nordiflex PenPA
zoledronic acidPA
NutropinPA
Pamidronate Disodium
Nutropin AQ Nuspin 10PA
Zoledronic AcidPA
Nutropin AQ Nuspin 20PA
ZometaPA
Nutropin AQ Nuspin 5PA
Nutropin AQ PenPA
CALCITONINS
OmnitropePA
SaizenPA
GENERIC
Saizen Click.easyPA
calcitonin salmonQL
SerostimPA
calcitonin-salmonQL
Tev-tropinPA
ForticalQL
ZorbtivePA
NON PREFERRED
Miacalcin
GHRH
PARATHYROID HORMONE
SPECIALTY
EgriftaQL,PA
SPECIALTY
ForteoQL
SOMATOMEDINS
RANK LIGAND INHIBITORS
SPECIALTY
IncrelexPA
SPECIALTY
ProliaQL,PA
SOMATOSTATIC AGENTS
XgevaPA
SPECIALTY
CALCIUM REGULATORS - MISC
octreotide acetatePA
Sandostatin Lar DepotPA
NON PREFERRED
SigniforQL,PA
Ganite
Somatuline DepotPA
HORMONE RECEPTOR MDLTR
GH RECEPTOR ANTAGONISTS
GENERIC
SPECIALTY
raloxifene hydrochloride
SomavertPA
FERTILITY REGULATORS
POSTERIOR PITUITARY
GENERIC
GENERIC
clomiphene citrate
desmopressin acetate
serophene
vasopressin
SPECIALTY
SPECIALTY
chorionic gonadotropinQL
Stimate
novarelQL
pregnyl w/diluent benzyl alcohol/NACLQL
CORTICOTROPIN
BravelleQL
Follistim AQQL
SPECIALTY
Gonal-fQL,PA
H.p. ActharPA
Gonal-f RFFQL,PA
Gonal-f RFF PenQL,PA
PROLACTIN INHIBITORS
Gonal-f RFF RedijectQL,PA
GENERIC
Menopur
cabergoline
OvidrelQL
RepronexQL
VASOPRESSIN ANTAGONISTS
SPECIALTY
LHRH/GNRH AGONIST
SamscaQL
SPECIALTY
Lupron Depot-PEDQL,PA
METABOLIC MODIFIERS
Supprelin LAQL,PA
GENERIC
Synarel
calcitriol
doxercalciferol
GNRH/LHRH ANTAGONISTS
levocarnitine
SPECIALTY
paricalcitol
CetrotideQL
PREFERRED
Ganirelix AcetateQL
SensiparPA
NON PREFERRED
GROWTH HORMONES
Hectorol
SPECIALTY
Paricalcitol
GenotropinPA
Zemplar
Genotropin MiniquickPA
SPECIALTY
HumatropePA
sodium phenylbutyrate
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 14
AldurazymePA
ANTIDIARRHEALS
Buphenyl
GENERIC
CarbagluPA
diphenoxylate/atropine
Cystadane
lofene
ElaprasePA
lonox
FabrazymePA
loperamide HCL
KuvanPA
opium
LumizymePA
opium tincture
MyaleptPA
Diphenoxylate/Atropine
MyozymePA
Opium Tincture (paregoric)
NaglazymePA
NON PREFERRED
Orfadin
Motofen
RavictiPA
VimizimPA
ANTACIDS
GENERIC
THYROID AGENTS
Sodium Bicarbonate
GENERIC
levothyroxine sodium
ULCER DRUGS
levoxyl
GENERIC
liothyronine sodium
atropine sulfate
methimazole
chlordiazepoxide HCL/clidinium bromide
propylthiouracil
cimetidine
unithroid
cimetidine HCL
unithroid direct
dicyclomine HCL
Levothyroxine Sodium
ed-spaz
Nature-throid
esomeprazole sodium
NP thyroid
famotidine
NP thyroid 30
glycopyrrolate
NP thyroid 60
hyomax-SL
NP thyroid 90
hyoscyamine sulfate
Westhroid
hyoscyamine sulfate odt
PREFERRED
hyoscyamine sulfate ER
Armour Thyroid
hyoscyamine sulfate SR
NON PREFERRED
hyosyne
Thyrolar-1
lansoprazoleQL
Thyrolar-1/2
lansoprazole/amoxicillin/clarithromycin
Thyrolar-1/4
methscopolamine bromide
Thyrolar-2
misoprostol
Thyrolar-3
nizatidine
nulev
GASTROINTESTINAL
omeprazoleQL
LAXATIVES
omeprazole/sodium bicarbonateQL
oscimin
GENERIC
oscimin SR
constulose
pantoprazole sodiumQL
lactulose
rabeprazole sodiumQL,PA,ST
pegylax
ranitidine HCL
polyethylene glycol 3350
sucralfate
Cascara Sagrada
symax fastabs
Mineral Oil Heavy
symax-SL
PREVENTIVE
symax-SR
gavilyte-c
Atropine Sulfate
gavilyte-n/flavor pack
Belladonna & Opium
gavilyte-G
Belladonna Alkaloids & Opium
peg 3350/electrolytes
Dicyclomine HCL
peg-3350/electrolytes
Esomeprazole Sodium
peg-3350/NACL/NA bicarbonate/KCL
Famotidine
trilyte
Famotidine Premixed
PREFERRED
Gastrinex NF
Moviprep
Propantheline Bromide
Suclear
Scopolamine Hydrobromide
Suprep Bowel Prep
PREFERRED
NON PREFERRED
Carafate
Colyte-flavor Packs
NexiumQL
Golytely
Pylera
Kristalose
NON PREFERRED
Osmoprep
Aciphex SprinkleQL,PA,ST
Prepopik
Atropen
Cantil
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 15
Cuvposa
procto-PAK
DexilantQL,PA,ST
proctosol HC
Donnatal
proctozone-HC
Donnatal Extentabs
rectacort-HC
Esomeprazole StrontiumQL,PA,ST
sulfasalazine
First-lansoprazole
sulfazine
Helidac
sulfazine EC
Omeclamox-PAK
ursodiol
Prevacid SolutabQL,PA,ST
Dexpanthenol
PrilosecQL,PA,ST
Lidocaine HCL-hydrocortisone Acetate With Aloe
ZegeridQL,PA,ST
PREFERRED
AmitizaQL
ANTIEMETICS
Analpram Advanced
Analpram-HC
GENERIC
Asacol HD
dronabinolQL,PA
Canasa
granisetron HCLQL
Chenodal
meclizine HCL
Cortifoam
ondansetron odtQL
Delzicol
ondansetron HCLQL
Fosrenol
trimethobenzamide HCL
Lialda
univert
LinzessQL
Dimenhydrinate
Lotronex
PREFERRED
Pentasa
Aloxi
Proctofoam HC
EmendQL
Rectiv
SancusoQL
RelistorPA
Transderm-scop
Renvela
NON PREFERRED
Sevelamer Carbonate
AnzemetQL
NON PREFERRED
CesametQL,PA
Apriso
GranisolQL
Dipentum
ZuplenzQL
Giazo
Phoslyra
DIGESTIVE AIDS
Renagel
PREFERRED
SPECIALTY
Creon
CimziaPA
Pancrelipase
Cimzia Starter KitPA
Viokace
GattexPA
NON PREFERRED
RemicadePA
PertzyePA,ST
UltresaPA,ST
GENITOURINARY
ZenpepPA,ST
SPECIALTY
URINARY ANTI-INFECTIVES
Sucraid
GENERIC
hyophen
GASTROINTESTINAL - MISC.
methenamine hippurate
GENERIC
methenamine mandelate
ana-lex
nitrofurantoin
anucort-HC
nitrofurantoin macrocrystals
balsalazide disodium
nitrofurantoin monohydrate
calcium acetate
nitrofurantoin monohydrate/macrocrystals
colocort
phosphasal
cromolyn sodium
ur n-c
enulose
urelle
generlac
uretron d/s
grx hicort 25
uribel
hemril-30
urin d/s
hydrocort ene 100MG
uro-blue
hydrocortisone
uro-l
hydrocortisone acetate
uro-mp
hydrocortisone acetate/lidocaine HCL
uryl
hydrocortisone acetate/pramoxine
ustell
hydrocortisone acetate/pramoxine HCL
uta
lactulose
uticap
lidazone HC
utira-c
lidocaine HCL/hydrocortisone acetate
utrona-c
mesalamine
Methenamine Mandelate
metoclopramide HCL
Urimar-t
pramcort
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 16
NON PREFERRED
potassium citrate ER
Monurol
potassium citrate-citric acid crystals
potassium citrate/citric acid
URINARY ANTISPASMODICS
potassium citrate/sodium citrate/citric acid
sodium chloride
GENERIC
sodium chloride 0.9%
bethanechol chloride
sodium citrate/citric acid
flavoxate HCL
tamsulosin HCL
oxybutynin chloride
taron-crystals
oxybutynin chloride ER
tricitrates
tolterodine tartrate
virtrate-3
tolterodine tartrate ER
Cytra-3
trospium chloride
Sorbitol
trospium chloride ER
Sorbitol-mannitol
PREFERRED
PREFERRED
Gelnique
Elmiron
Myrbetriq
Rapaflo
OxytrolQL
Renacidin
Oxytrol For WomenQL
NON PREFERRED
Toviaz
Avodart
Vesicare
Cardura XL
NON PREFERRED
Oracit
EnablexPA,ST
SPECIALTY
Cystagon
VAGINAL PRODUCTS
ProcysbiPA
GENERIC
clindamycin phosphate
HEMATOLOGICAL
metronidazole vaginal
terconazole
HEMATOPOIETIC AGENTS
vandazole
GENERIC
zazole
airavite
Miconazole 3
corvita 150
PREFERRED
cyanocobalamin
Clindesse
dexferrum
Endometrin
fabb
Estrace
ferocon
EstringQL
ferotrinsic
Vagifem
ferrocite plus
NON PREFERRED
ferrogels forte
Avc
folbee
Cleocin
folcaps
Gynazole-1
folic acid
PREVENTIVE
folic acid/vitamin b-6/vitamin b-12
Encare
folplex 2.2
Options Conceptrol Vaginal Contraceptive
foltrin
Options Gynol II Vaginal Contraceptive
hematinic plus vitamins/minerals
Shur-seal
hematinic/folic acid
Today Sponge
hematogen
Vcf Vaginal Contraceptive Film
hematogen forte
Vcf Vaginal Contraceptive Foam
hemocyte-f
SPECIALTY
hemocyte-plus
Crinone
iferex 150 forte
infed
GENITOURINARY - MISC.
myferon 150 forte
GENERIC
nufol
acetic acid 0.25%
poly-iron 150 forte
alfuzosin HCL ER
polysaccharide iron forte
aminoacetic acid
purevit dualfe plus
argyle sterile saline 100ML
se-tan plus
citric acid/sodium citrate
tricon
curity sterile saline
trigels-f forte
cytra k crystals
virt-vite
cytra-k
B-6 Folic Acid
cytra-2
Bp Vit 3
finasteride
Ed Cyte F
glycine
Ferraplus 90
hydrochloric acid
Folic Acid
neomycin/polymyxin b sulfates
FE c plus
phenazo
Hematogen Fa
phenazopyridine HCL
Hydroxocobalamin
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 17
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc
HM folic acid
HM iron
Multigen
HM iron slow release
Multigen Folic
PREFERRED
Multigen Plus
Droxia
Tandem F
Feraheme
TL gard RX
Ferrex 150 Forte Plus
TL icon
Ferrex 28
TL-fol 500
Nascobal
TL-hem 150
Venofer
PREVENTIVE
NON PREFERRED
bprotected pedia iron
Foltrate
eq slow-release iron
PREVENTIVE
eql folic acid
CVS Slow Release Iron
eql iron supplement therapy
Elite Iron
eql slow release iron
Fa-8
ezfe 200
Femiron
fa-8
Feosol
feosol
Ferretts Chewable Iron
fer-iron
Ferretts IPS
ferate
Ferrimin 150
ferosul
Ferro-sequels
ferretts
Ferrous Fumarate
ferrex 150
Ferrous Gluconate
ferric x-150
Ferrous Sulfate
ferro-bob
FE Aspartate
ferrocite
High Potency Iron
ferrotabs
Iron
ferrous drops
Iron Chews Pediatric
ferrous fumarate 324
Iron Up
ferrous gluconate
Mykidz Iron 10
ferrous sulfate
Novaferrum Pediatric Drops
ferrousul
Perfect Iron
ferus
Profe
gnp folic acid
Proferrin ES
gnp iron
Sm Slow Release Iron
gnp slow release iron
SPECIALTY
high potency iron
sodium ferric gluconate complex/sucrose
iferex 150
Aranesp Albumin FreePA
iron
CerezymePA
iron slow release
ElelysoPA
iron supplement
EpogenPA
iron supplement childrens
LeukinePA
kp ferrous gluconate
MozobilQL,PA
kp ferrous sulfate
NeulastaPA
kp folic acid
Neulasta Delivery KitPA
meijer ferrous sulfate
NeumegaPA
myferon 150
NeupogenPA
nu-iron 150
NplatePA
poly-iron 150
ProcritPA
px folic acid
PromactaPA
px iron
VprivPA
qc ferrous sulfate
ZavescaPA
ra folic acid
ra high potency iron
ANTICOAGULANTS
ra iron
GENERIC
ra slow release iron
argatroban
slow iron
enoxaparin sodiumQL
slow release iron
fondaparinux sodiumQL
sm folic acid
hep flush-10
sm iron
heparin lock
sm iron slow release
heparin lock flush
th folic acid
heparin lock flush for flushing vascular access devices
th iron
heparin lock flush/NACL for flushing vascular access devices
th slow release iron
wee care
heparin sodium
yl folic acid
heparin sodium dcu
CVS folic acid
heparin sodium lock flush
CVS iron
heparin sodium/sodium chloride 0.9% premix
FE gluconate
FE TABS
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 18
heparin sodium/D5W
Alphanine SD
heparin sodium/NACL 0.9%
Bebulin
jantoven
Bebulin VH
monoject pharma grade flush syringe/heparin lock
Benefix
monoject prefill advanced heparin lock flush
Berinert
sash kit for flushing vascular access devices
Ceprotin
warfarin sodium
Cinryze
Acd Formula A
Corifact
Acd Formula B
Eloctate
Acd-a Noclot-50
Feiba
Anticoagulant Citrate Dextrose Solution A
Feiba NF
Anticoagulant Sodium Citrate
Firazyr
Argatroban
Helixate FS
Heparin Lock Flush
Hemofil M
Heparin Sodium
Humate-p
Heparin Sodium/D5W
Kalbitor
Heparin Sodium/NACL 0.45%
Koate-dvi
Heparin Sodium/Sodium Chloride 0.9%
Kogenate FS
PREFERRED
Kogenate FS Bio-set
EliquisQL
Monoclate-p
PradaxaQL
Mononine
XareltoQL
Novoseven
Xarelto Starter PackQL
Novoseven Rt
NON PREFERRED
Profilnine SD
FragminQL
Recombinate
Riastap
HEMOSTATICS
Rixubis
SolirisPA
GENERIC
Thrombate Iii W/10 ML Sterile Water
aminocaproic acid
Thrombate Iii W/20 ML Sterile Water
tranexamic acid
Tretten
Aminocaproic Acid
Wilate
Xyntha
HEMATOLOGICAL - MISC.
Xyntha Solofuse
GENERIC
albuked 25
MOUTH/THROAT/DENTAL AGENT
albuked 5
albumin human
albumin-zlb
GENERIC
albuminar-25
cavarest
albuminar-5
cavirinse
alburx
cevimeline HCL
albutein
chlorhexidine gluconate
anagrelide hydrochloride
chlorhexidine gluconate oral rinse
buminate
clinpro 5000
cilostazol
clotrimazole
clopidogrel
controlrx
dipyridamole
denta 5000 plus
flexbumin
dentagel
hetastarch 6%/NACL
easygel
human albumin grifols
fluoridex daily defense
kedbumin
fluoridex daily defense enhanced whitening
pentoxifylline ER
fluoridex daily defense sensitivity relief
plasbumin-25
karigel
plasbumin-5
karigel-n
ticlopidine HCL
lidocaine viscous
LMD 10% Dextrose 5%
lidocaine HCL
LMD 10% Sodium Chloride 0.9%
lidocaine HCL viscous
Protamine Sulfate
neutragard advanced
PREFERRED
neutral sodium fluoride
Aggrenox
nystatin
Brilinta
oralone
Effient
paroex
Zontivity
perio MED
NON PREFERRED
periogard
Aggrastat
phos-flur
Integrilin
pilocarpine hydrochloride
SPECIALTY
pilocarpine HCL
Advate
stannous fluoride oral rinse
Alphanate/Von Willebrand Factor Complex/Human
topex topical anesthetic
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 19
triamcinolone acetonide
Desvenlafaxine ERQL
triamcinolone IN orabase
Doxepin HCL
Aquoral
Fluoxetine HCL
Numoisyn
Maprotiline HCL
SF
Nefazodone HCL
SF 5000 plus
Nortriptyline HCL
NON PREFERRED
Venlafaxine HCL ER
Oravig
PREFERRED
PristiqQL
NEUROLOGY, CNS, PSYCH
NON PREFERRED
AplenzinQL
ANTIANXIETY AGENTS
EmsamQL,PA
GENERIC
Forfivo XLQL
alprazolam
Marplan
alprazolam odt
Paxil
alprazolam ER
ViibrydQL
alprazolam XR
buspirone HCL
ANTIPSYCHOTICS
chlordiazepoxide HCL
GENERIC
clorazepate dipotassium
chlorpromazine HCL
diazepam
clozapineQL
diazepam intensol
compazine
droperidol
compro
gene-xene TAB 15MG
fluphenazine decanoate
gene-xene TAB 3.75MG
fluphenazine HCL
gene-xene TAB 7.5MG
haloperidol
hydroxyzine pamoate
haloperidol decanoate
hydroxyzine HCL
haloperidol lactate
lorazepam
lithium carbonate
meprobamate
lithium carbonate ER
oxazepam
loxapine
Diazepam
loxapine succinate
Hydroxyzine HCL
olanzapineQL
Hydroxyzine Pamoate
olanzapine odtQL
perphenazine
ANTIDEPRESSANTS
prochlorperazine
GENERIC
prochlorperazine edisylate
amitriptyline HCL
prochlorperazine maleate
budeprion SRQL
quetiapine fumarateQL
bupropion HCL
risperidoneQL
bupropion HCL ERQL
risperidone odtQL
bupropion HCL SRQL
risperidone M-TABQL
bupropion HCL XLQL
thioridazine HCL
citalopram hydrobromide
thiothixene
clomipramine HCL
trifluoperazine HCL
desipramine HCL
ziprasidone HCLQL
doxepin HCL
Chlorpromazine HCL
duloxetine HCLQL
Clozapine OdtQL
escitalopram oxalate
Fluphenazine HCL
fluoxetine DRQL
Lithium
fluoxetine HCL
Lithium Carbonate
fluvoxamine maleate
PREFERRED
fluvoxamine maleate ERQL
AbilifyQL
imipramine pamoate
Abilify DiscmeltQL
imipramine HCL
Abilify Maintena
mirtazapine
LatudaQL
mirtazapine odt
Risperdal Consta
nefazodone HCL
Seroquel XRQL
nortriptyline HCL
NON PREFERRED
paroxetine HCL
FanaptQL,PA,ST
paroxetine HCL ER
Fanapt Titration PackQL,PA,ST
phenelzine sulfate
FazacloQL
protriptyline HCL
Geodon
sertraline HCL
InvegaQL,PA,ST
tranylcypromine sulfate
Invega Sustenna
trazodone HCL
SaphrisQL,PA,ST
trimipramine maleate
venlafaxine HCLQL
HYPNOTICS
venlafaxine HCL ERQL
Amoxapine
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 20
GENERIC
GENERIC
dexmedetomidine HCL
carbamazepine
estazolam
carbamazepine ER
eszopicloneQL
clonazepam
flurazepam HCL
clonazepam odt
midazolam HCL
divalproex sodium
phenobarbital
divalproex sodium DR
temazepam
divalproex sodium ER
triazolam
epitol
zaleplonQL
ethosuximide
zolpidem tartrateQL
felbamate
zolpidem tartrate ERQL
fosphenytoin sodium
Flurazepam HCL
gabapentin
Phenobarbital
lamotrigine
Phenobarbital Sodium
lamotrigine odt
Quazepam
lamotrigine ER
PREFERRED
levetiracetam
RozeremQL
levetiracetam ER
NON PREFERRED
oxcarbazepine
IntermezzoQL
phenytoin
SilenorQL
phenytoin infatabs
SPECIALTY
phenytoin sodium
HetliozQL,PA
phenytoin sodium extended
primidone
ADHD, NARCOLEPSY, ETC.
tiagabine hydrochloride
topiragen
GENERIC
topiramate
amphetamine/dextroamphetamineQL
valproate sodium
benzphetamine HCLPA
valproic acid
caffeine citrate
zonisamide
clonidine HCL ER
Levetiracetam
dexedrineQL
dexmethylphenidate HCLQL
PREFERRED
dexmethylphenidate HCL ERQL
Banzel
dextroamphetamine sulfateQL
Celontin
dextroamphetamine sulfate ERQL
Diazepam
diethylpropion HCLPA
Dilantin
diethylpropion HCL ERPA
Fycompa
doxapram HCL
Gabitril
guanfacine ER
LyricaQL
metadate ERQL
Onfi
methamphetamine HCLQL
Peganone
methylphenidate hydrochloride
Potiga
methylphenidate HCLQL
Tegretol-XR
methylphenidate HCL CDQL
Vimpat
methylphenidate HCL ERQL
NON PREFERRED
methylphenidate HCL SRQL
Diastat Pediatric
modafinilQL,PA
Lamictal
phendimetrazine tartratePA
Lamictal Odt
phentermine HCLPA
Stavzor
zenzediQL
SPECIALTY
Caffeine/Sodium Benzoate
SabrilPA
Diethylpropion HCLPA
Methylphenidate HCL ERQL
ANTIPARKINSON AGENTS
Phendimetrazine Tartrate ERPA
ProcentraQL
GENERIC
PREFERRED
amantadine HCL
DaytranaQL
benztropine mesylate
NuvigilQL,PA
bromocriptine mesylate
Quillivant XRQL
carbidopa
StratteraQL
carbidopa/levodopa
VyvanseQL
carbidopa/levodopa odt
NON PREFERRED
carbidopa/levodopa ER
ConcertaQL
entacapone
Focalin XRQL
pramipexole dihydrochloride
Kapvay Dose Pack
ropinirole ER
XenicalPA
ropinirole HCL
selegiline HCL
ANTICONVULSANTS
trihexyphenidyl HCL
Amantadine HCL
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 21
Carbidopa/Levodopa/Entacapone
CVS nts step 1QL
PREFERRED
HM nicotine polacrilexQL
Azilect
HM nicotine transdermal systemQL
Mirapex ER
HM nicotine transdermal system step 3QL
NON PREFERRED
SR nicotine gumQL
Neupro
PREFERRED
Tasmar
Exelon
SPECIALTY
GraliseQL,PA
ApokynPA
Gralise StarterQL,PA
Namenda
NEUROLOGY, PSYCH - MISC.
Namenda Titration PAK
Namenda XRQL
GENERIC
Namenda XR Titration PackQL
acamprosate calcium DR
Nuedexta
disulfiram
SavellaQL
donepezil HCL
PREVENTIVE
ergoloid mesylates
ChantixQL
fluoxetine
Chantix Continuing Month PAKQL
galantamine
Chantix Starting Month PAKQL
galantamine hydrobromide
Nicotine Transdermal SystemQL
olanzapine/fluoxetine
NON PREFERRED
rivastigmine tartrate
HorizantQL,PA
Chlordiazepoxide/Amitriptyline
Orap
Galantamine Hydrobromide
PREVENTIVE
Perphenazine/Amitriptyline
Nicotrol InhalerQL
Nicotrol NsQL
PREVENTIVE
SPECIALTY
buprobanQL
AmpyraQL,PA
bupropion HCL SRQL
AubagioQL,PA
eq nicotineQL
AvonexQL,PA
eq nicotine gum refillQL
Avonex PenQL,PA
eq nicotine gum starterQL
BetaseronQL,PA
eq nicotine polacrilexQL
CopaxoneQL,PA
eq nicotine step 3QL
ExtaviaQL,PA
eql nicotineQL
GilenyaQL,PA
eql nicotine polacrilexQL
RebifQL,PA
eql nicotine polacrilex refillQL
Rebif RebidoseQL,PA
eql nicotine polacrilex starterQL
Rebif Rebidose Titration PackQL,PA
gnp nicotine polacrilexQL
Rebif Titration PackQL,PA
gnp nicotine polacrilex miniQL
TecfideraQL,PA
kls quit2QL
Tecfidera Starter PackQL,PA
kls quit4QL
TysabriQL,PA
nicoreliefQL
XenazinePA
nicotineQL
XyremQL,PA
nicotine polacrilexQL
nicotine polacrilex refillQL
NEUROMUSCULAR AGENTS
nicotine polacrilex starter kitQL
nicotine step 1QL
GENERIC
nicotine step 2QL
atracurium besylate
nicotine step 3QL
cisatracurium besylate
nicotine transdermal systemQL
pancuronium bromide
px stop smoking aidQL
riluzoleQL,PA
qc nicotine polacrilexQL
rocuronium bromide
ra mini nicotineQL
vecuronium bromide
ra nicotineQL
SPECIALTY
ra nicotine polacrilexQL
BotoxPA
ra nicotine transdermal system step 3QL
DysportPA
sm nicotineQL
MyoblocPA
sm nicotine polacrilexQL
XeominPA
sw nicotine polacrilexQL
tgt nicotine gumQL
MUSCULOSKELETAL AGENTS
tgt nicotine polacrilexQL
GENERIC
tgt nicotine step oneQL
baclofen
tgt nicotine step threeQL
carisoprodol
tgt nicotine step twoQL
carisoprodol/aspirin
thriveQL
carisoprodol/aspirin/codeine
CVS nicotineQL
chlorzoxazone
CVS nicotine polacrilexQL
cyclobenzaprine HCL
CVS nicotine polacrilex starterQL
dantrolene sodium
CVS nicotine transdermal systemQL
metaxalone
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 22
methocarbamol
NON PREFERRED
orphenadrine citrate
Azasite
orphenadrine citrate ER
Ciloxan
orphenadrine/asa/caffeine
Tobrex
revonto
Zirgan
tizanidine HCL
Carisoprodol
ARTIFICIAL TEAR/LUBRICANT
Dantrolene Sodium
NON PREFERRED
Enovarx-cyclobenzaprine HCL
Lacrisert
PREFERRED
Gablofen
BETA-BLOCKERS
Lioresal Intrathecal
GENERIC
NON PREFERRED
betaxolol HCL
Lorzone
carteolol HCL
SPECIALTY
dorzolamide HCL/timolol maleate
EuflexxaPA
levobunolol HCL
HyalganPA
timolol maleate
MonoviscPA
timolol maleate ophthalmic gel forming
OrthoviscPA
Istalol
SupartzPA
Levobunolol HCL
SynviscPA
Metipranolol
Synvisc OnePA
PREFERRED
Combigan
ANTIMYASTHENIC AGENTS
NON PREFERRED
GENERIC
Betimol
neostigmine methylsulfate
Betoptic-s
pyridostigmine bromide
Guanidine HCL
OPHTHALMIC STEROIDS
Regonol
GENERIC
PREFERRED
dexamethasone sodium phosphate
Mestinon
fluorometholone
Mestinon Timespan
neo-polycin HC
Prostigmin
neomycin/polymyxin/bacitracin/hydrocortisone
neomycin/polymyxin/dexamethasone
OPHTHALMOLOGY AND OTIC
poly-dex
ANTI-INFECTIVES
prednisolone acetate
sulfacetamide sodium/prednisolone sodium phosphate
GENERIC
tobramycin/dexamethasone
ak-poly-bac
Neomycin/Polymyxin/Hydrocortisone
bacitracin/polymyxin b
Prednisolone Sodium Phosphate
ciprofloxacin HCL
PREFERRED
erythromycin
Alrex
garamycin
FML
gatifloxacin
Lotemax
gentak
Pred Mild
gentamicin sulfate
Retisert
ilotycin
Tobradex
levofloxacin
Tobradex ST
neo-polycin
Zylet
neomycin/bacitracin/polymyxin
NON PREFERRED
neomycin/polymyxin/bacitracin zinc
Blephamide S.o.p.
neomycin/polymyxin/gramicidin
Durezol
ofloxacin
Flarex
polycin
Ozurdex
polycin b
Vexol
polymyxin b sulfate/trimethoprim sulfate
romycin
PROSTAGLANDINS
sodium sulfacetamide
sulfacetamide sodium
GENERIC
tobramycin sulfate
latanoprostQL
trifluridine
PREFERRED
trimethoprim sulfate/polymyxin b sulfate
LumiganQL
Bacitracin
Travatan ZQL
Sulfacetamide Sodium
TravoprostQL
PREFERRED
NON PREFERRED
Besivance
ZioptanQL
Moxeza
Natacyn
CYCLOPLEGIC MYDRIATICS
Vigamox
GENERIC
atropine sulfate
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 23
atropine-care
ful-GLO
cyclopentolate HCL
green GLO lissamine greenophthalmic strips
homatropaire
ketorolac tromethamine
homatropine HBR
lissamine green
mydral
ocucoat viscoadherent
tropicamide
Ak-fluor
Atropine Sulfate
PREFERRED
Bepreve
DECONGESTANTS
BromdayQL
IlevroQL
GENERIC
NevanacQL
altafrin
Pataday
neofrin
Patanol
phenylephrine HCL
ProlensaQL
Naphazoline HCL
NON PREFERRED
Acuvail
MIOTICS
Alocril
GENERIC
Alomide
pilocarpine HCL
Azopt
PREFERRED
Emadine
Phospholine Iodide
Lastacaft
Pilopine HS
SPECIALTY
NON PREFERRED
CystaranQL,PA
Isopto Carbachol
Eylea
Jetrea
ADRENERGIC AGENTS
Lucentis
GENERIC
Macugen
apraclonidine
Visudyne
brimonidine tartrate
PREFERRED
OTIC AGENTS
Alphagan P
GENERIC
NON PREFERRED
acetasol HC
Iopidine
acetic acid
aero otic HC
IMMUNOMODULATORS
antipyrine/benzocaine
PREFERRED
aurax
RestasisQL,PA
aurodex
cortic-nd
LOCAL ANESTHETICS
cyotic
GENERIC
exotic-HC
altacaine
fluocinolone acetonide
parcaine
fluocinolone acetonide ear drops
proparacaine HCL
hydrocortisone/acetic acid
tetcaine
neomycin/polymyxin/hydrocortisone
tetracaine HCL
neomycin/polymyxin/HC
tetravisc
ofloxacin
tetravisc forte
otic care
oticin
OPHTHALMICS - MISC.
oto-end 10
GENERIC
otomax-HC
ak-fluor
pramoxine-HC
akorn balanced salt solution
Acetic Acid/Aluminum Acetate
altafluor
Antipyrine/Benzocaine
azelastine HCL
Ciprofloxacin
balanced salt
Myoxin
balanced salt solution
Otozin
bio GLO
PREFERRED
bromfenac
Ciprodex
bss
NON PREFERRED
cromolyn sodium
Cipro HC
diclofenac sodium
Coly-mycin S
dorzolamide HCL
Cortisporin-tc
epinastine HCL
flucaine
OXYTOCICS
fluor-i-strips a.t.
fluorescein-benoxinate
GENERIC
fluorescein/proparacaine
methylergonovine maleate
fluorets
oxytocin
flurbiprofen sodium
flurox
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 24
PAIN MANAGEMENT
gnp adult aspirin low strength
gnp aspirin
ANALGESICS - NONNARCOTIC
gnp aspirin low dose
GENERIC
goodsense aspirin low dose
ali-flex
kls aspirin low dose
biogesic
kls aspirin EC
butalbital/acetaminophen
kp aspirin
butalbital/acetaminophen/caffeine
meijer aspirin EC
butalbital/apap/caffeine
miniprin low dose
butalbital/aspirin/caffeine
norwich aspirin
capacet
px aspirin
choline magnesium trisalicylate
px enteric aspirin
clonidine HCL
qc aspirin
diflunisal
qc aspirin low dose
dologesic
qc childrens aspirin
dolorex
ra aspirin
duraxin
ra aspirin adult low dose
ed-flex
ra aspirin adult low strength
esgic
ra aspirin childrens
margesic
ra aspirin EC
marten-TAB
ra aspirin EC adult low strength
salsalate
ra childrens aspirin
tencon
sm aspirin
zebutal
sm aspirin adult low strength
zflex
sm aspirin enteric coated
Alpain
sm aspirin low dose
Butalbital/Aspirin/Caffeine
sm aspirin EC low strength
Choline Magnesium Trisalicylate
sm childrens aspirin
Esgic
st joseph aspirin
Rhinoflex-650
tgt aspirin
Tencon
tgt aspirin low dose
Zgesic
tgt childrens aspirin
PREVENTIVE
tgt enteric-coated aspirin
adult aspirin EC low strength
th aspirin
aspir-low
th aspirin low dose
aspir-81
th enteric aspirin
aspirin
CVS aspirin
aspirin adult low strength
CVS aspirin adult low dose
aspirin childrens
CVS aspirin adult low strength
aspirin enteric coated adult low strength
CVS aspirin child
aspirin low dose
CVS aspirin low dose
aspirin low strength
CVS aspirin low strength
aspirin EC
CVS aspirin EC
aspirin EC low dose
CVS childrens aspirin
aspirin EC LO-dose
CVS enteric aspirin
aspirin 81
EC-81 aspirin
aspirin 81 low dose
HM aspirin
aspirtab
HM aspirin EC
bayer advanced aspirin regular strength
HM aspirin EC low dose
bayer aspirin
MM aspirin
bayer aspirin regimen
SB aspirin
bayer aspirin EC low dose
SB aspirin EC
bayer chewable low dose
SB childrens aspirin
bayer low dose
SB low dose asa EC
childrens aspirin
PREVENTIVE
childrens aspirin low strength
Adult Aspirin Low Strength
ecotrin low strength
Aspirin Low Dose
ecpirin
Medi-seltzer
enteric coated aspirin
SPECIALTY
eq adult aspirin low strength
Prialt
eq aspirin
eq aspirin adult low dose
ANALGESICS - OPIOID
eq aspirin low dose
GENERIC
eq aspirin EC
acetaminophen/codeine
eq childrens aspirin
acetaminophen/codeine #2
eql adult aspirin low strength
acetaminophen/codeine #3
eql aspirin
acetaminophen/codeine #4
eql aspirin low dose
acetaminophen/codeine phosphate
eql aspirin EC
alfentanil
eql childrens aspirin
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 25
ascomp/codeine
Tramadol HCL ERQL
astramorph
Trezix
buprenorphine HCLQL,PA
PREFERRED
buprenorphine HCL/naloxone HCLQL,PA
ButransQL,PA
butalbital/acetaminophen/caffeine/codeine
LazandaQL,PA
butalbital/aspirin/caffeine/codeine
NucyntaQL
butorphanol tartrateQL
Nucynta ERQL
codeine sulfate
Opana ER (crush Resistant)QL
duramorph
Oxycodone HCL ERQL
endocet
OxycontinQL
endodan
SuboxoneQL,PA
fentanylQL
NON PREFERRED
fentanyl citrate
AbstralQL,PA
fentanyl citrate oral transmucosalQL,PA
ConzipQL
hydrocodone bitartrate/acetaminophen
Depodur
hydrocodone/acetaminophen
EmbedaQL
hydrocodone/ibuprofen
ExalgoQL
hydrogesic
FentoraQL,PA
hydromorphone HCL
Hydromorphone HCL ERQL
hydromorphone HCL ERQL
Infumorph 200
ibudone
Infumorph 500
lorcet
KadianQL
lorcet plus
Oxecta
lorcet HD
SubsysQL,PA
lortab
Talwin
meperidine HCL
meperitab
ANTI-INFLAMMATORY
methadone HCL
GENERIC
methadone HCL intensol
celecoxibQL,PA
methadose
diclofenac potassium
morphine sulfate
diclofenac sodium DR
morphine sulfate ERQL
diclofenac sodium ER
nalbuphine HCL
diclofenac sodium/misoprostol
oxycodone HCL
etodolac
oxycodone/acetaminophen
etodolac ER
oxycodone/aspirin
flurbiprofen
oxycodone/ibuprofen
ibuprofen
oxymorphone hydrochloride
indomethacin
oxymorphone hydrochloride ERQL
indomethacin sodium
pentazocine/acetaminophen
indomethacin ER
pentazocine/naloxone HCL
ketoprofen
reprexain
ketorolac tromethamineQL
roxicet
leflunomide
stagesic
mefenamic acid
sufentanil citrate
meloxicam
tramadol hydrochloride/acetaminophenQL
nabumetone
tramadol HCLQL
naproxen
tramadol HCL ERQL
naproxen sodium
verdrocet
naproxen DR
vicodin
oxaprozin
vicodin ES
piroxicam
vicodin HP
sulindac
xylon
tolmetin sodium
zamicet
Fenoprofen Calcium
Acetaminophen/Caffeine/Dihydrocodeine Bitartrate
Indomethacin
Aspirin-caffeine-dihydrocodeine
Ketoprofen ER
Codeine Sulfate
Ketorolac Tromethamine
CO-gesic
Meclofenamate Sodium
Hydrocodone Bitartrate/Acetaminophen
Meloxicam
Hydrocodone/Acetaminophen
Tolmetin Sodium
Hydromorphone HCL
PREFERRED
Hydromorphone HCL Dosette
Ridaura
Levorphanol Tartrate
NON PREFERRED
Meperidine HCL
Nalfon
Methadone HCL
Naprelan
Methadose
Rheumatrex
Methadose Sugar-free
SprixQL
Morphine Sulfate
VimovoQL
Morphine Sulfate Add-vantage
Oxycodone HCL
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 26
SPECIALTY
polocaine
ActemraPA
polocaine-mpf
ArcalystPA
ropivacaine
EnbrelPA
ropivacaine HCL
Enbrel SureclickPA
sensorcaine
HumiraPA
sensorcaine-mpf
Humira Pediatric Crohns Disease Starter PackPA
sensorcaine-mpf spinal
Humira PenPA
sensorcaine-mpf/epinephrine
Humira Pen-crohns DiseasestarterPA
sensorcaine/epinephrine
Humira Pen-psoriasis StarterPA
xylocaine dental
IlarisPA
BD Pudendal/Local Block Tray 1% Lidocaine
KineretPA
Lidocaine HCL/Dextrose
OrenciaPA
Mepivacaine HCL
SimponiPA
Tetracaine HCL
Simponi AriaPA
XeljanzPA
GENERAL ANESTHETICS
GENERIC
MIGRAINE PRODUCTS
compound 347
GENERIC
etomidate
dihydroergotamine mesylate
fresenius propoven
isometheptene mucate/caffeine/acetaminophen
isoflurane
isometheptene/dichloralphenazone/acetaminophen
ketamine HCL
migragesic ida
propofol
naratriptan HCLQL
sevoflurane
nodolor
sojourn
rizatriptan benzoateQL
terrell
rizatriptan benzoate odtQL
sumatriptan succinateQL
RESPIRATORY, ALLERGY, ETC
sumatriptan succinate refillQL
ANTIHISTAMINES
zolmitriptanQL
GENERIC
zolmitriptan odtQL
arbinoxa
Dihydroergotamine MesylateQL
bpm
Isometheptene/Caffeine/Acetaminophen
carbinoxamine maleate
Migralam
cetirizine HCL
SumatriptanQL
clemastine fumarate
Sumatriptan SuccinateQL
cyproheptadine HCL
PREFERRED
desloratadine
RelpaxQL
desloratadine odt
NON PREFERRED
diphenhydramine HCL
AlsumaQL,PA,ST
levocetirizine dihydrochloride
AxertQL,PA,ST
pharbedryl
Cafergot
phenadoz
Ergomar
phenergan
FrovaQL,PA,ST
promethazine HCL
Sumavel DoseproQL,PA,ST
promethazine HCL plain
TreximetQL,PA,ST
promethegan
ZomigQL,PA,ST
Brompheniramine Tannate
Zomig Nasal SprayQL,PA,ST
Clemastine Fumarate
Dexchlorpheniramine Maleate
GOUT AGENTS
Respa-BR
GENERIC
NON PREFERRED
allopurinol
Clarinex
probenecid
probenecid/colchicine
NASAL AGENTS
PREFERRED
GENERIC
Colchicine
azelastine HCLQL
Colcrys
budesonideQL,PA,ST
Uloric
flunisolideQL
SPECIALTY
fluticasone propionateQL
KrystexxaPA
ipratropium bromideQL
olopatadine HCLQL
LOCAL ANESTHETICS-INJ
triamcinolone acetonideQL
GENERIC
FlunisolideQL
bupivacaine spinal
PREFERRED
bupivacaine HCL
DymistaQL
bupivacaine/epinephrine
NasonexQL
chloroprocaine HCL
NON PREFERRED
lidocaine HCL
Bactroban Nasal
lidocaine/epinephrine
Beconase AQQL,PA,ST
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 27
OmnarisQL,PA,ST
montelukast sodium
QnaslQL,PA,ST
terbutaline sulfate
Qnasl ChildrensPA,ST
theochron
Tyzine
theophylline
Tyzine Pediatric Nasal Drops
theophylline CR
VeramystQL,PA,ST
theophylline ER
ZetonnaQL,PA,ST
theophylline/D5W
zafirlukastPA
COUGH/COLD/ALLERGY
Cromolyn Sodium
Metaproterenol Sulfate
GENERIC
Theophylline/D5W
acetylcysteine
PREFERRED
benzonatate
Arcapta NeohalerQL
biotuss
Asmanex HFAQL
biotuss pediatric
Asmanex Twisthaler 120 Metered DosesQL
bpm pseudo
Asmanex Twisthaler 14 Metered DosesQL
bromfed DM
Asmanex Twisthaler 30 Me Tered DosesQL
bromphen/pseudoephedrine HCL/dextromethorphan HBR
Asmanex Twisthaler 30 Metered DosesQL
giltuss pediatric
Asmanex Twisthaler 60 Metered DosesQL
hydrocodone bitartrate/chlorpheniramine maleate/PSE
Asmanex Twisthaler 7 Metered DosesQL
hydrocodone bitartrate/homatropine methylbromide
Atrovent HFAQL
hydrocodone polistirex/chlorpheniramine polistirex
Combivent
hydrocodone/homatropine
Combivent RespimatQL
hydromet
Daliresp
nebusal
DuleraQL
nortuss-DE
Foradil AerolizerQL
phenylephrine/guaifenesin
PerforomistQL
promethazine VC
Proair HFAQL
promethazine VC/codeine
PulmicortQL
promethazine-DM
Pulmicort FlexhalerQL
promethazine/codeine
QvarQL
promethazine/dextromethorphan
Serevent DiskusQL
pulmosal
Spiriva HandihalerQL
sodium chloride
Spiriva RespimatQL
tgq 7.5PEH/4BRM/15DM
SymbicortQL
tussafed EX
Tudorza PressairQL
tussigon
NON PREFERRED
Albatussin NN
Advair DiskusQL,PA,ST
Dextromethorphan HBR/Chlorpheniramine/Phenylephrine HCL
Advair HFAQL,PA,ST
Giltuss TR
AlvescoQL,PA,ST
Nortuss-EX
Breo ElliptaQL,PA,ST
Promethazine VC Plain
BrovanaQL
Promethazine VC/Codeine
Elixophyllin
Rescon-JR
Flovent DiskusQL,PA,ST
Tgq 15DM/5PEH/2CPM
Flovent HFAQL,PA,ST
Tgq 30PSE/150GFN/15DM
Lufyllin
Tgq 30PSE/3BRM/15DM
Maxair AutohalerQL
Tgq 50PSE/3BRM/30DM
Proventil HFAQL
Theo-24
PREFERRED
Ventolin HFAQL
Tussicaps
Xopenex HFAQL
NON PREFERRED
ZyfloPA
Clarinex-d 12 HOUR
Zyflo CRPA
Clarinex-d 24 HOUR
SPECIALTY
Rezira
XolairPA
ANTIASTHMATIC/COPD AGENTS
RESPIRATORY AGENTS - MISC
GENERIC
SPECIALTY
albuterol sulfate
Aralast NPPA
albuterol sulfate ER
GlassiaPA
albuterol TAB 4MG
KalydecoPA
aminophylline
Prolastin-cPA
budesonide
PulmozymePA
difil-G forte
ZemairaPA
epinephrine HCL
ipratropium bromideQL
TOXOIDS
ipratropium bromide/albuterol sulfateQL
levalbuterolQL
PREFERRED
levalbuterol HCLQL
Tetanus Toxoid Adsorbed
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 28
PREVENTIVE
Influenza A (h1n1) Monovalent 2009
Adacel
Ipol Inactivated IPV
Boostrix
M-m-r II W/Diluent 10 Dose
Daptacel
Medical Provider EZ Flu Shot PF 2012-2013
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
Medical Provider EZ Flu Shot PF 2013-2014
Infanrix
Medical Provider EZ Flu Shot PF 2014-2015
Kinrix
Medical Provider EZ Flu Shot 2013-2014
Pediarix
Medical Provider EZ Flu Shot 2014-2015
Pentacel
Menactra
Tenivac
Menhibrix
Tetanus/Diphtheria Toxoids-adsorbed Adult
Menomune-a/C/Y/W-135
Menveo
VACCINES
Pedvax HIB
Physicians EZ Use Flu Kit 2012-2013
Pneumovax 23
GENERIC
Pneumovax 23/1 Dose
Bcg Vaccine
Pneumovax 23/5 Dose
PREFERRED
Prevnar 13
Biothrax
Proquad
Imovax Rabies (h.d.c.v.)
Recombivax HB
Ixiaro
Rotarix
Rabavert
Rotateq
Typhim VI
Trumenba
Vivotif Berna
Twinrix
Yf-vax
Vaqta
PREVENTIVE
Varivax
Acthib
Zostavax
Afluria PF 2012-2013
Afluria PF 2013-2014
VITAMINS
Afluria PF 2014-2015
Afluria 2012-2013
VITAMINS
Afluria 2013-2014
GENERIC
Afluria 2014-2015
ascorbic acid
Bexsero
decara
Cervarix
ergocalciferol
Comvax
mega-c/a plus
Engerix-b
ortho-CS 250
Fluarix Quadrivalent 2013-2014
phytonadione
Fluarix Quadrivalent 2014-2015
thiamine HCL
Fluarix 2013-2014
vitamin c 222MG
Fluarix 2014-2015
vitamin d
Flublok 2013-2014
vitamin k1
Flublok 2014-2015
Aminobenzoate Potassium
Flucelvax 2013-2014
Pyridoxine HCL
Flucelvax 2014-2015
Vitamin K1
Flulaval Quadrivalent 2013-2014
Wheat Germ
Flulaval Quadrivalent 2014-2015
PREVENTIVE
Flulaval 2013-2014
aqueous vitamin d infants
Flulaval 2014-2015
bio-d-mulsion
Flumist Nasal Vaccine 2012-2013
bio-d-mulsion forte
Flumist Quadrivalent
bprotected pedia d-vite
Fluvirin PF 2013-2014
d 1000
Fluvirin PF 2014-2015
d 10000
Fluvirin 2013-2014
d 2000
Fluvirin 2014-2015
d 400
Fluzone High-dose PF 2013-2014
d 5000
Fluzone High-dose PF 2014-2015
d-vita
Fluzone Intradermal
d-1000
Fluzone Intradermal Quadrivalent
d-1000 extra strength
Fluzone Pediatric PF 2013-2014
d-2000 maximum strength
Fluzone PF 2013-2014
d-3-5
Fluzone PF 2014-2015
d-400
Fluzone Quadrivalent 2013-2014
d-5000
Fluzone Quadrivalent 2014-2015
d-5000 maximum strength
Fluzone Split 2013-2014
delta d3
Fluzone Split 2014-2015
dialyvite vitamin d 5000
Gardasil
d2000 ultra strength
Gardasil 9
d3
Havrix
d3 adult
Hiberix
d3 high potency
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 29
d3 kids
Wellesse Vitamin D3
d3 maximum strength
d3 super strength
MULTIVITAMINS
d3 ultra strength
GENERIC
d3-1000
b-complex
d3-50
b-complex 100
eql childrens vitamin d gummies
b-plex
eql vitamin d-3
b-plex plus
eql vitamin d3
biocel
gnp vitamin d
choice-TABS
gnp vitamin d maximum strength
corvita
gnp vitamin d super strength
corvite free
gnp vitamin d3 extra strength
dialyvite
healthy kids vitamin d3
folbee plus
just d
folbee plus cz
kp vitamin d
infuvite
maximum d3
infuvite adult
nat-rul vitamin d
infuvite pediatric
optimal-d
lysiplex plus
optimal-d pack
mult-vitamin/fluoride
opurity vitamin d
multi vitamin/fluoride
pronutrients vitamin d3
multi-vit/fluoride
ra vitamin d-3
multi-vit/iron/fluoride
sm vitamin d
multi-vitamin/fluoride
sm vitamin d3
multi-vitamin/fluoride/iron
th vitamin d3
multivitamin with fluoride
thera-d rapid repletion
multivitamin/fluoride
thera-d sport
multivitamins/fluoride
thera-d 2000
mynephrocaps
vitamin d high potency
nephronex
vitamin d 400
niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper
vitamin d-1000
nutrifac ZX
vitamin d-1000 maximum strength
rena-vite RX
vitamin d-3
renal
vitamin d-400
renalpren
vitamin d3
reno CAPS
vitamin d3 adult gummies
strovite plus
vitamin d3 high potency
tri-vit/fluoride
vitamin d3 maximum strength
tri-vitamin/fluoride
vitamin d3 super strength
triphrocaps
CVS childrens vitamin d for bone health
triple-vitamin/fluoride
CVS vitamin d
urosex
CVS vitamin d infants
v-c forte
CVS vitamin d 5000 high-potency
vic-forte
CVS vitamin d3
virt-vite plus
HM vitamin d
virt-CAPS
HM vitamin d3
vita s forte
PA vitamin d-3
vita-min
PA vitamin d-3 gummy
vitacel
PREFERRED
vitamax pediatric
Mephyton
vitamin b-complex 100
NON PREFERRED
vitamins a/c/d/fluoride
Potaba
vol-care RX
PREVENTIVE
Bp Folinatal Plus B
CVS Vitamin D3
Bp Multinatal Plus
Ddrops
Cavan-EC Sod DHA
Dialyvite Vitamin D3 Max
Cod Liver Oil
D3
Complete Natal DHA
D3 Dots
Completenate
HM Vitamin D3
CO-natal Fa
Replesta
Elite-OB
Replesta Childrens
Escavite LQ
Replesta Nx
Folbecal
Sm Vitamin D3 Maximum Strength
Inatal Advance
Super Daily D3
Inatal GT
Thera-d 4000
Inatal Ultra
Vitamelts Vitamin D
M-vit
Vitamin D
Macnatal CN DHA
Vitamin D3
Mynatal Advance
Vitamin D3 400
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 30
Mynatal Plus
M.v.i. Adult
Mynatal Ultracaplet
M.v.i. Pediatric
Mynatal-z
M.v.i.-12 Without Vitamin K
Mynate 90 Plus
Neevo DHA
MVC-fluoride
Nicadan
Neurodep
Nicazel
Obstetrix EC
Nicazel Forte
OB-natal One
Nutricap
Pr Natal 400
Prefera OB
Pr Natal 400 EC
Prefera OB + DHA
Pr Natal 430
Preferaob One
Pr Natal 430 EC
Req 49+
Prenaissance Plus
Siderol
Prenaplus
Strovite One
Prenatabs Fa
Tri-zel
Prenatabs RX
Vinate DHA RF
Prenatal Ad
PREVENTIVE
Prenatal Low Iron
Atabex Prenatal
Prenatal Plus
Brainstrong Prenatal
Prenatal Plus Iron
Centrum Specialist Prenatal
Prenatal 19
CVS Prenatal
Prenatal-u
CVS Prenatal Gummy/DHA/Folic Acid
PNV-select
CVS Prenatal Multi+dha
PNV-DHA
Enfamil Expecta
Quflora Pediatric
Gnp Daily Prenatal
Se-natal 19
Gnp Prenatal
Se-tan DHA
Goodsense Prenatal Vitamins
Seton Et-EC
Healthy Mama Be Well Rounded
Setonet
HM One Daily Prenatal Combo
Strovite Forte
HM Prenatal
Taron-prex
Kp Prenatal Multivitamins
Tri-vit/Fluoride/Iron
Mission Prenatal
Triadvance
Nat-rul Prenatal Vitamins
Tricare
One A Day Womens Prenatal/DHA
Trinatal RX 1
One-a-day Womens Prenatal
Trinate
Prenatal Complete
Ultimatecare One
Prenatal Multi +dha
Ultimatecare One NF
Prenatal Multivitamin + DHA
Ultra TABS
Prenatal One Daily
Vinate C
Prenatal Plus DHA
Vinate Care
Prenatal/Omega-3/Folic Acid/Iron
Vinate GT
PA Prenatal Formula
Vinate IC
Qc Prenatal
Vinate II
Ra One Daily
Vinate M
Ra Prenatal Formula/Folicacid
Vinate One
Right Step Prenatal
Vinate Pn Care
Similac Prenatal Early Shield
Vinate Ultra
Sm One Daily Prenatal
Vitafol-OB
Stuart One
Vp-zel
Stuart Prenatal
PREVENTIVE
Stuart Prenatal + DHA
sm prenatal vitamins
Th Prenatal Vitamins
Classic Prenatal
Your Life Multi Prenatal
Eql Prenatal Formula
Gnp Prenatal Vitamins
MEDICAL DEVICES
Mission Prenatal HP
DIABETIC SUPPLIES
Multi Prenatal
PREFERRED
Perry Prenatal
Accu-chek Fastclix LancetsQL
Pre-natal Formula
Accu-chek Multiclix LancetsQL
Prenatal
Accu-chek Safe-t-pro LancetsQL
Prenatal And Iron
Accu-chek Safe-t-pro PluslancetsQL
Prenatal Formula
Accu-chek Soft Touch LancetsQL
Prenatal Forte
Accu-chek Softclix LancetsQL
Prenatal Vitamins
Acti-lance Lancets 28GQL
Px Prenatal Multivitamins
Acti-lance Lite Safety Lancets 28GQL
Ra Prenatal
Acti-lance Special Safety Lancets 17GQL
Sm Prenatal Vitamins
Acti-lance Special Safetylancets 17GQL
NON PREFERRED
Acti-lance Universal Safety Lancets 23GQL
AP-zel
Advocate LancetsQL
Bacmin
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 31
Advocate Safety LancetsQL
BD Pen Needle/Ultrafine/29G X 12.7MMQL
Agamatrix Ultra-thin Lancets 33GQL
BD Pen Needle/Ultrafine/29GX1/2" 12.7MMQL
Amigo Insulin P.M.
BD Pen Needles SHORT/Ultrafine/31G X 5/16"QL
Animas Vibe Insulin P.M.
Careone Lancet ThinQL
Animas Vibe Insulin P.M./Black
Careone Lancet Ultra ThinQL
Animas Vibe Insulin P.M./Blue
Cartridge IR 1000 3ML
Animas Vibe Insulin P.M./Limelight Green
Cartridge IR 1200
Animas Vibe Insulin P.M./Pink Glow
Cartridge P.M.
Assure Comfort Lancets Ultra Thin 28GQL
Cleanlet Lancets 28GQL
Assure Comfort Lancets Ultra Thin 30GQL
Clever Chek Lancets UltrathinQL
Assure Haemolance Plus High Flow 18GQL
Clever Chek Lancets Ultrathin 30GQL
Assure Haemolance Plus Low Flow 25GQL
Coaguchek LancetsQL
Assure Haemolance Plus Micro Flow 28GQL
Comfort Assured Lancets Micro Thin 33GQL
Assure Haemolance Plus Normal Flow 21GQL
Comfort Assured Lancets Super Thin 28GQL
Assure Haemolance Plus Pediatric BladeQL
Comfort Infusion Set 23"/17MM
Assure Lance LancetsQL
Comfort Infusion Set 31"/17MM
Assure LancetsQL
Comfort Infusion Set 43"/17MM
Aurora Lancet Super Thin 30GQL
Comfort LancetsQL
Aurora Lancet Thin 23GQL
Comfort SHORT Infusion Set 23"/13MM
AF Lancets Super ThinQL
Comfort SHORT Infusion Set 31"/13MM
AT Last LancetsQL
Comfort SHORT Infusion Set 43"/13MM
Bayer Microlet LancetsQL
Contact Detach Infusion Set 23" 6MM/29G
Bullseye Mini Safety LancetsQL
Contact Detach Infusion Set 23" 8MM/29G
Bullseye Safety LancetsQL
Contact Detach Infusion Set 43" 6MM/29G
BD Insulin Syringe LUER-LOK/U-100/1MLQL
Contact Detach Infusion Set 43" 8MM/29G
BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2"QL
CVS Lancets Micro Thin 33GQL
BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"QL
CVS Lancets OriginalQL
BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"QL
CVS Lancets Thin 26GQL
BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2"QL
CVS Lancets Ultra Thin 30GQL
BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"QL
CVS Lancets 21GQL
BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"QL
CVS Ultra Thin LancetsQL
BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"QL
Diastar Easy Test II Lancets 30GQL
BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2"QL
Diastar Easy Test Lancets30GQL
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16"QL
Droplet Lancets Ultra Thin 30GQL
Drug Mart Lancets ThinQL
BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2"QL
Drug Mart Lancets Ultra ThinQL
BD Insulin Syringe Safetyglide/1ML/29G X 1/2"QL
Drug Mart On-the-go Lancets Gentle 30GQL
BD Insulin Syringe Slip Tip/U-100/1MLQL
Drug Mart Unilet Lancets Super Thin 30GQL
BD Insulin Syringe U-40/1ML/25G X 5/8"QL
Drug Mart Unilet Lancets Ultra Thin 28GQL
BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"QL
Duane Reade Lancet Alternate Site 26GQL
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16"QL
Duane Reade Lancet Super Thin 30GQL
Duane Reade Lancet Ultra Thin 28GQL
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"QL
E-z Ject LancetsQL
BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"QL
E-z Ject Lancets ColorQL
BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"QL
E-z Ject Lancets Super ThinQL
BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"QL
E-z Ject Lancets Super Thin 30GQL
BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2"QL
E-z Ject Lancets Thin 26GQL
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"QL
E-z Ject Lancets 21GQL
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16"QL
E-ZJECT Lancets Micro-thin 33GQL
BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2"QL
Easy Comfort LancetsQL
BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16"QL
Easy Comfort Lancets 30G/Pull TopQL
BD Insulin Syringe Ultrafine/1ML/30G X 1/2"QL
Easy Comfort Lancets 30G/Thin TopQL
BD Insulin Syringe Ultrafine/1ML/31G X 5/16"QL
Easy Touch Lancets 21G/Pressure ActivatedQL
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1"QL
Easy Touch Lancets 23G/Pressure ActivatedQL
Easy Touch Lancets 26G/Pressure ActivatedQL
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/8"QL
Easy Touch Lancets 28G/Pressure ActivatedQL
Easy Touch Lancets 28G/TwistQL
BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2"QL
Easy Touch Lancets 30G/Pressure ActivatedQL
BD Insulin Syringe/U-100/0.5ML/30G X 1/2"QL
Easy Touch Lancets 30G/TwistQL
BD Insulin Syringe/U-100/1ML/27G X 1/2"QL
Easy Touch Lancets 32G/Pressure ActivatedQL
BD Insulin Syringe/U-100/1ML/28G X 1/2"QL
Easy Touch Lancets 32G/TwistQL
BD Insulin Syringe/U-100/2ML/27.5G X 5/8"QL
Easy Touch Lancets 33G/TwistQL
BD Insulin Syringe/U-100/2ML/29G X 1/2"QL
Easy Touch Safety Lancets21G/Pressure ActivatedQL
BD Lancet Ultrafine 30GQL
Easy Touch Safety Lancets23G/Pressure ActivatedQL
BD Lancet Ultrafine 33GQL
Easy Touch Safety Lancets26G/Button ActivatedQL
BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2"QL
Easy Touch Safety Lancets26G/Pressure ActivatedQL
Easy Touch Safety Lancets28G/Button ActivatedQL
BD Microtainer LancetsQL
Easy Touch Safety Lancets28G/Pressure ActivatedQL
BD Pen Needle/Mini/Ultrafine/31G X 3/16"QL
Easy Twist & CAP LancetsQL
BD Pen Needle/Nano/Ultra Fine/32G X 4MMQL
Easytest II LancetsQL
BD Pen Needle/SHORT/Ultrafine/31G X 5/16"QL
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 32
Easytest LancetsQL
Insulin P.M. IR2020 Blue
Embrace Lancets Ultra Thin 30GQL
Insulin P.M. IR2020 Green
Eql Color Lancets Micro Thin 33GQL
Insulin P.M. IR2020 Red
Eql Color Lancets 21GQL
Insulin P.M. IR2020 Silver
Eql Super Thin Lancets 30GQL
Kinney LancetsQL
Eql Thin Lancets 26GQL
Kinney Thin LancetsQL
EZ Smart Blood Glucose LancetsQL
Kroger LancetsQL
EZ-lets Lancets 21GQL
Kroger Lancets Micro Thin33GQL
EZ-lets Lancets 23GQL
Kroger Lancets Super ThinQL
EZ-lets Lancets 26G Super-softQL
Kroger Lancets ThinQL
EZ-lets Lancets 28G Ultra-softQL
Kroger Lancets Thin 26GQL
EZ-lets Lancets 30GQL
Kroger Lancets Ultrathin 30GQL
Fasttake Compact Monitoring SystemQL
Kroger Lancets 21GQL
Fasttake Test StripsQL
LancetsQL
Fifty50 Safety Seal Lancets 30GQL
Lancets Bullseye SafetyQL
Fifty50 Safety Seal Lancets 32GQL
Lancets Micro Thin 33GQL
Fine 30QL
Lancets Safety Seal 21GQL
Fingerstix LancetsQL
Lancets Safety Seal 26GQL
Fora LancetsQL
Lancets Safety Seal 28GQL
Freds Pharmacy Unilet Lancets Super Thin 30GQL
Lancets Safety Seal 30GQL
Freds Pharmacy Unilet Lancets Ultra Thin 28GQL
Lancets Super Thin 28GQL
Freestyle LancetsQL
Lancets ThinQL
Freestyle Unistick II LancetsQL
Lancets Twist TopQL
Gentle-let GP LancetsQL
Lancets Ultra FineQL
Gentle-let Lancets General Purpose Style/Fine PointQL
Lancets Ultra ThinQL
Gentle-let Lancets General Purpose Style/Medium PointQL
Lancets Ultra Thin 30GQL
Gentle-let Lancets Safety Style/Fine PointQL
Lancets 26G Twist TopQL
Gentle-let Lancets Safety Style/Medium PointQL
Lancets 28GQL
Global Inject Ease Lancets 28GQL
Lancets 30GQL
Global Inject Ease Lancets 30GQL
Lancets 30G Twist TopQL
Glucocom Lancets 28GQL
Lancets 31G Twist TopQL
Glucocom Lancets 30GQL
Leader Lancets ColoredQL
Glucocom Lancets 33GQL
Leader Super Thin LancetQL
Glucopro Syringe Reservoir/3ML/Needle/22G X 3/8"
Leader Thin LancetsQL
Glucose Control Normal
Liberty Blood Glucose MeterQL
Glucose Control Solution
Liberty Glucose Control Mid
Glucosource LancetsQL
Liberty Glucose Control Normal
Gmate Lancets 30GQL
Liberty Test StripsQL
Gnp LancetsQL
Lifescan Unistik II LancetsQL
Gnp Lancets Micro Thin 33GQL
Lifescan Unistik 2 Deep PenetrationQL
Gnp Lancets Super Thin 30GQL
Lite Touch LancetsQL
Gnp Lancets ThinQL
Litetouch Lancets Micro Thin 33GQL
Gnp Lancets Thin 26GQL
Live Better Lancet Super Thin 30GQL
Gnp Lancets 21GQL
Live Better Lancet Ultra Thin 28GQL
Gnp Micro Thin Lancets 33GQL
Longs Lancets StandardQL
Gnp Super Thin Lancets/30GQL
Longs Lancets ThinQL
H&h Thinlet Lancets 26GQL
Longs Lancets Ultra ThinQL
H&h Thinlet Super Thin Lancets 30GQL
Medichoice Pre-set Safety Lancet Dual UseQL
H-e-b Incontrol Lancets Super Thin 30GQL
Medichoice Pre-set Safety Lancet Low FlowQL
H-e-b Incontrol Lancets Ultra Thin 28GQL
Medichoice Pre-set Safety Lancet Medium FlowQL
HaemolanceQL
Medichoice Pre-set Safety Lancet Moderate FlowQL
Haemolance Low Flow LancetsQL
Medichoice Safety Lancet ExtraQL
Haemolance PlusQL
Medichoice Safety Lancet NormalQL
Haemolance Plus High FlowQL
Medicine Shoppe LancetsQL
Haemolance Plus Low FlowQL
Medicine Shoppe Lancets ThinQL
Haemolance Plus Max FlowQL
Medisense Thin LancetsQL
Haemolance Plus Pediatric FlowQL
Medlance Plus Extra Lancets 21GQL
Healthwise Lancets 30GQL
Medlance Plus LancetsQL
Healthy Accents Unilet Lancets Super Thin 30GQL
Medlance Plus Lancets Lite 25GQL
Hy-vee LancetsQL
Medlance Plus Lite Lancets 25GQL
Hy-vee Thin LancetsQL
Medlance Plus Special Lancets 0.8MMQL
HM Lancets Micro Thin 33GQL
Medlance Plus Superlite 30GQL
HM Lancets Ultra Thin 30GQL
Medlance Plus Superlite 30G/Comfort MaxQL
Inset Infusion Set 23" 6MM
Medlance Plus Universal Lancets 21GQL
Inset Infusion Set 23" 9MM
Medlance Plus/Lite 25GQL
Inset Infusion Set 43" 6MM
Medlance/ExtraQL
Inset Infusion Set 43" 9MM
Medlance/LiteQL
Inset 30 Infusion Set 23"
Medlance/UniversalQL
Inset 30 Infusion Set 43"
Meijer Color Lancets Universal 33GQL
Insulin P.M. IR2020 Black
Meijer LancetsQL
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 33
Meijer Lancets ThinQL
Pss Select Safety LancetsQL
Meijer Lancets Universal 33GQL
Px LancetsQL
Meijer Super Thin LancetsQL
Px Lancets Ultra ThinQL
Microlet LancetsQL
Qc LancetsQL
Microtainer Safety Flow Lancet/Sterile/Single-useQL
Qc Lancets Super ThinQL
Monolet LancetsQL
Qc Lancets ThinQL
Monolet Opd LancetsQL
Qc Lancets Ultra ThinQL
Monolettor Safety LancetsQL
Ra E-ZJECT Color Lancets Micro-thin 33GQL
Myglucohealth Mgh Softlance Lancets 30GQL
Ra E-ZJECT Lancets Thin 26GQL
Netgroup LancetsQL
Ra E-ZJECT Lancets Thin 28GQL
Nova Safety Lancets 23GQL
Ra E-ZJECT Lancets Ultra Thin 30GQL
Nova Safety Lancets 28GQL
Ra E-ZJECT Lancets 28GQL
Nova Sureflex LancetsQL
Reality LancetsQL
Novofine Autocover 30GX8MMQL
Reality Trigger LancetsQL
Novofine 30GX8MMQL
Relion LancetsQL
Novofine 32GX6MMQL
Relion Lancets Micro-thin33GQL
Novotwist 30GX8MMQL
Relion Lancets Standard 21GQL
Novotwist 32GX5MMQL
Relion Lancets Thin 26GQL
On Call LancetsQL
Relion Lancets Ultra-thin30GQL
On Call Plus LancetsQL
Relion Thin LancetsQL
Onetouch Basic SystemQL
Relion Ultra Thin LancetsQL
Onetouch Basic/Profile Test StripsQL
Relion Ultra Thin Lancets30GQL
Onetouch Club Lancets Fine PointQL
Relion Ultra Thin Plus Lancets 32GQL
Onetouch Combo PackQL
Relion Ultra Thin Plus Lancets 33GQL
Onetouch Delica Lancets Extra Fine 33GQL
Renew Advanced Lancing Cartridge RefillsQL
Onetouch Delica Lancets Fine 30GQL
Rexall Lancets Ultra ThinQL
Onetouch Finepoint LancetsQL
Rightest Gl300 LancetsQL
Onetouch LancetsQL
Safe-t-lance Low Flow 25GQL
Onetouch Ping Insulin P.M.
Safe-t-lance Normal Flow 21GQL
Onetouch Ping Meter Remote
Safe-t-lance Plus Safety Lancet High FlowQL
Onetouch Profile SystemQL
Safe-t-lance Plus Safety Lancet Low FlowQL
Onetouch Ultra BlueQL
Safe-t-lance Plus Safety Lancet Normal FlowQL
Onetouch Ultra Control
Safety Lancet 2MMQL
Onetouch Ultra MiniQL
Safety Lancet 21G/Pressure ActivatedQL
Onetouch Ultra System KitQL
Safety Lancet 28G/Pressure ActivatedQL
Onetouch Ultra 2QL
Safety LancetsQL
Onetouch Ultralink System (hex)QL
Safety Lancets 21GQL
Onetouch Ultralink System (DEC)QL
Safety Lancets 28GQL
Onetouch UltrasmartQL
Safety Let LancetsQL
Onetouch Ultrasoft LancetsQL
Safety Seal Lancets 28GQL
Onetouch VerioQL
Safety Seal Lancets 30GQL
Onetouch Verio Control Solution High
Sapscare Twist Top Lancets 30GQL
Onetouch Verio IQ Blood Glucose Monitoring SystemQL
Shopko On-the-go Comfort Lancets 30GQL
Onetouch Verio Mid Control Solution
Shopko Unilet Lancets Super Thin 30GQL
Onetouch Verio Sync Bloodglucose Monitoring SystemQL
Shopko Unilet Lancets Ultra Thin 28GQL
Onetouch Verio Test StripsQL
Single-letQL
Pen Needles 29G X 12MMQL
Sm Lancets 21GQL
Pen Needles 29GX1/2"QL
Sm Micro Thin Lancets 33GQL
Pen Needles 30GX5/16"QL
Sm Super Thin LancetsQL
Pen Needles 31G X 1/4" SHORTQL
Sm Super Thin Lancets 30GQL
Pen Needles 31G X 3/16"QL
Sm Thin Lancets 26GQL
Pen Needles 31G X 6MMQL
Smart Diabetes Vantage Universal Lancets 30GQL
Pen Needles 31GX5/16"QL
Smart Sense Color Lancets Universal 33GQL
Perfect Lancets 30GQL
Smart Sense Standard Lancets Universal 21GQL
Perfect Pressure Activated Safety Lancets 28GQL
Smart Sense Super Thin Lancets Universal 30GQL
Pharmacist Choice Ultra Thin LancetsQL
Smart Sense Thin Lancets Universal 26GQL
Pharmacist Choice Ultra Thin Lancets 28GQL
Smartest Lancets 28GQL
Pharmacist Choice Ultra Thin Lancets 30GQL
Solus V2 Pressure Activated Safety Lancets 28GQL
Pharmacist Choice Ultra Thin Lancets 31GQL
Solus V2 Twist Lancets 30GQL
Pharmacist Choice Ultra Thin Lancets 33GQL
Sterilance TLQL
Pharmacy Counter LancetsQL
Super Thin LancetsQL
Precision Thin LancetsQL
Sure Comfort Lancets 28GQL
Precision Thins GP LancetQL
Sure Comfort Lancets 30GQL
Precision Ultra LancetQL
Sure-lance Flat LancetsQL
Preferred Plus Lancets Colored 21GQL
Sure-lance Lancets 26GQL
Preferred Plus Lancets Super Thin 30GQL
Sure-lance Thin Lancets 28GQL
Preferred Plus Lancets Thin 26GQL
Sure-lance Ultra Thin LancetsQL
Prodigy Pressure Activated Safety LancetsQL
Sure-touch Lancets UniversalQL
Prodigy Twist Top LancetsQL
Surelite LancetsQL
Pss Select GP LancetsQL
Surestep Glucose Control
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 34
Surestep Glucose Control Solution
Walgreens Comfort Assuredlancets Super Thin/28GQL
Surestep Pro High Glucosecontrol
Walgreens LancetsQL
Surestep Pro Low Glucose Control
Walgreens Thin LancetsQL
Surestep Pro Normal Glucose Control
Walgreens Ultra Thin LancetsQL
Surestep Pro Test StripsQL
1ST Choice Lancets Super ThinQL
Surestep Test StripsQL
1ST Choice Lancets ThinQL
SB Lancets ThinQL
1ST Choice Lancets Ultra ThinQL
SB Lancets Ultra ThinQL
1ST Tier Unilet Comfortouch Lancets 28GQL
Techlite AST LancetsQL
1ST Tier Unilet Comfortouch Lancets 30GQL
Techlite LancetsQL
NON PREFERRED
Techlite Lancets 30GQL
Accu-chek Active Glucose Control Solution
Tgt Lancet Alternate SiteQL
Accu-chek Active StripsQL
Tgt Lancet Micro Thin 33GQL
Accu-chek AvivaQL
Tgt Lancet Super Thin 30GQL
Accu-chek Aviva PlusQL
Tgt Lancet Thin 23GQL
Accu-chek Combo
Tgt Lancet Thin 26GQL
Accu-chek Comfort Curve Control Solution (2 Levels)
Tgt Lancet Ultra Thin 28GQL
Accu-chek Comfort Curve Linearity Solution
Tgt Lancet Ultra Thin 30GQL
Accu-chek Comfort Curve Test StripsQL
Thinlets GP LancetsQL
Accu-chek Compact Blue Control Solution (2 Levels)
Thinlets LancetQL
Accu-chek Compact PlusQL
Todays Health Super Thin Lancets 30GQL
Accu-chek Compact Plus Care KitQL
Todays Health Ultra Thin Lancets 28GQL
Accu-chek Compact Plus Clear Control Solution (2 Levels)
Travel Lancets 30GQL
Accu-chek Compact Test DrumQL
Trueplus Lancets 26GQL
Accu-chek Fastclix Lancetdevice Kit
Trueplus Lancets 28GQL
Accu-chek Instant Glucosecontrol Solution (2 Levels)
Trueplus Lancets 28G Super ThinQL
Accu-chek Multiclix Lanc Et Device Kit
Trueplus Lancets 30GQL
Accu-chek Nano SmartviewQL
Trueplus Lancets 30G Ultra ThinQL
Accu-chek Rapid-d Infusion Set/24"/10MM
Trueplus Lancets 33GQL
Accu-chek Rapid-d Infusion Set/24"/6MM
Trueplus Lancets 33G Micro ThinQL
Accu-chek Rapid-d Infusion Set/24"/8MM
Trueplus Safety Lancets 28GQL
Accu-chek Rapid-d Infusion Set/31"/10MM
Ulticare Thin Lancets 30GQL
Accu-chek Rapid-d Infusion Set/31"/6MM
Ultilet Basic Lancets 30GQL
Accu-chek Rapid-d Infusion Set/31"/8MM
Ultilet Classic LancetsQL
Accu-chek Rapid-d Infusion Set/43"/10MM
Ultilet LancetsQL
Accu-chek Rapid-d Infusion Set/43"/6MM
Ultilet Lancets 33GQL
Accu-chek Rapid-d Infusion Set/43"/8MM
Ultilet Safety Lancets 23GQL
Accu-chek Smartview Control
Ultra Thin Lancets 28GQL
Accu-chek Smartview StripsQL
Ultra Thin Lancets 30GQL
Accu-chek Softclix Lancetdevice Kit
Ultra-thin II Auto LancetQL
Accu-chek Spirit Adapter Kit
Ultra-thin II Lancets 28GQL
Accu-chek Spirit Battery Kit
Ultra-thin II Lancets 30GQL
Accu-chek Spirit Insulin P.M. Kit
Ultra-thin II Safety Autolancets 26GQL
Accu-chek Tender II Infusion Set/24"/13MM
Unilet Comfortouch LancetQL
Accu-chek Tender II Infusion Set/24"/17MM
Unilet ExceliteQL
Accu-chek Tender II Infusion Set/31"/13MM
Unilet Excelite IIQL
Accu-chek Tender II Infusion Set/31"/17MM
Unilet G.p. LancetQL
Accu-chek Tender II Infusion Set/43"/17MM
Unilet G.p. Superlite LancetQL
Accu-chek VoicemateQL
Unilet GP 28 Ultra ThinQL
Liberty Mini Lancing Device
Unilet LancetQL
Onetouch Delica Lancing Device
Unilet Superlite LancetQL
Onetouch Suresoft Lancing Device/18G
Unistik 3 GentleQL
Onetouch Suresoft Lancing Device/21G
Universal 1 Lancets Thin 26GQL
Onetouch Suresoft Lancing Device/28G
Universal 1 Lancets Ultra Thin 30GQL
Prodigy Autocode Blood Glucose Monitoring SystemQL
V-go 20
Prodigy Autocode Blood Glucose Monitoring/TalkingQL
V-go 30
Prodigy NO Coding Blood Glucose Test StripsQL
V-go 40
Prodigy Pocket Blood Glucose Meter KitQL
Value Plus Lancets Standard 21GQL
Prodigy Voice Blood Glucose Meter KitQL
Value Plus Lancets Super Thin 30GQL
Value Plus Lancets Thin 26GQL
MEDICAL DEVICES - MISC
Valumark Lancet Super Thin 30GQL
PREFERRED
Valumark Lancet Ultra Thin 28GQL
Aerochamber Mini Aerosol ChamberQL
Vida Mia Unilet Lancets Super Thin 30GQL
Aerochamber MVQL
Vida Mia Unilet Lancets Ultra Thin 28GQL
Aerochamber Plus Flow VUQL
Vitalet Pro LancetsQL
Aerochamber Plus Flow-VUQL
Vitalet Pro Plus LancetsQL
Aerochamber Plus Flow-VU/Large MaskQL
W&f Lancets Colored 21GQL
Aerochamber Plus Flow-VU/MaskQL
W&f Lancets 26GQL
Aerochamber Plus Flow-VU/Medium MaskQL
Walgreens Advanced Travellancets 28GQL
Aerochamber Plus Flow-VU/Small MaskQL
Walgreens Comfort Assuredlancets Micro Thin/33GQL
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 35
Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VUQL
Panda Mask Small
Pediatric Panda Mask
Aerochamber Z-stat Plus/FlowsignalQL
Pharmacist Choice Alcoholprep Pads
Aerochamber Z-stat Plus/Large MaskQL
Pocket ChamberQL
Aerochamber Z-stat Plus/Medium MaskQL
Pocket SpacerQL
Aerochamber Z-stat Plus/Small MaskQL
Qc Alcohol Swabs
Aerochamber/FlowsignalQL
Ra Alcohol Swabs
Alcoh-glove Contoured Wipe
Reality Swabs
Alcoh-wipe 12" X 12"
Relion Alcohol Swabs
Alcohol Pads
RitefloQL
Alcohol Prep Pads
Saps Care Alcohol Prep Pads
Alcohol Swabs
Shopko Alcohol Swabs
Alcohol Wipes
Sm Alcohol Prep Pads
Arial ChamberQL
Sure Comfort Alcohol Prep Pads
BreatheriteQL
Sure-prep Alcohol Prep Pads
Breatherite Collapsible Adult Spacer W/MaskQL
SB Alcohol Prep Pads
Breatherite Collapsible Child Spacer W/MaskQL
Tgt Alcohol Swabs
Breatherite Collapsible Infant Spacer W/MaskQL
Ultilet Alcohol Swab
Breatherite Collapsible Small Child Spacer W/MaskQL
Ultilet Alcohol Swabs
Breatherite Collapsible Spacer W/ Neonate MaskQL
Valved Holding ChamberQL
Breatherite Rigid Spacer W/MaskQL
Vortex Valved Holding ChamberQL
Breatherite W/Large MaskQL
WatchhalerQL
Breatherite W/Medium MaskQL
Webcol Alcohol Prep Large 1 Ply
Breatherite W/Small MaskQL
Webcol Alcohol Prep Large 2 Ply
BD Swabs Single Use
Webcol Alcohol Prep Medium 2 Ply
BD Swabs Single Use Butterfly
Curity Alcohol Preps/Medium 2 Ply
MISCELLANEOUS
Curity Alcohol Swabs
CVS Alcohol Prep Swabs
GENERIC
CVS Alcohol Swabs
acetylcysteine
Detachable Face Mask
adenosine
E-z SpacerQL
alprostadil
E-z Spacer The Body Guards PackQL
amino acids
EasiventQL
aminosyn II 8.5%/electrolytes
Easivent/Mask-largeQL
aminosyn 8.5%/electrolytes
Easivent/Mask-mediumQL
aminosyn-hf
Easivent/Mask-smallQL
argyle sterile water 100ML
Easy Touch Alcohol Prep Pads/Medium
calcium chloride
Fifty50 Alcohol Prep Pads
calcium gluconate
Global Alcohol Prep Ease Pads
chloromag
Gnp Alcohol Swabs
chromium chloride
Healthwise Alcohol Prep Pads
clinisol SF 15%
Inspirachamber/Anti-static Valved/MouthpieceQL
cosyntropin
Inspirachamber/Soothermask/Inspiramask/MediumQL
cysteine HCL
Inspirachamber/Soothermask/Inspiramask/SmallQL
deferoxamine mesylate
Inspirease Bags
dehydrated alcohol
Inspirease Drug Delivery SystemQL
delflex-lm/1.5% dextrose
Inspirease Mouthpiece
delflex-LC/1.5% dextrose
Inspirease Reservoir Bags
dextrose 10%
LiteaireQL
dextrose 10% flex container
Mask Vortex/Baby Whirl Duckling
dextrose 2.5%/sodium chloride 0.45%
Mask Vortex/Child/Frog
dextrose 2.5%/NACL 0.45%
Mask Vortex/Spinner The Duck
dextrose 30%
Mask Vortex/Toddler/Lady Bug
dextrose 30% partial fill
Meijer Alcohol Swabs Extra-thick
dextrose 5%
MicrochamberQL
dextrose 5% viaflex
MicrospacerQL
dextrose 5%/lactated ringers
Nessi Spacer/Large MaskQL
dextrose 5%/potassium chloride 0.15%
Nessi Spacer/MouthpieceQL
dextrose 5%/ringers
Nessi Spacer/Small/MED MaskQL
dextrose 5%/sodium chloride 0.2%
Optichamber AdvantageQL
dextrose 5%/sodium chloride 0.33%
Optichamber DiamondQL
dextrose 5%/sodium chloride 0.45%
Optichamber Diamond/Largeface MaskQL
dextrose 5%/sodium chloride 0.9%
Optichamber Diamond/Medium Face MaskQL
dextrose 5%/NACL 0.2%
Optichamber Diamond/Smallface MaskQL
dextrose 5%/NACL 0.33%
Optichamber Valved Holding Chamber
dextrose 5%/NACL 0.45%
Optichamber/Mask
dextrose 5%/NACL 0.9%
OptihalerQL
dextrose 50%
Optihaler MDI Drug Delivery SystemQL
dextrose 70%
Panda Mask Large
Panda Mask Medium
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 36
dipyridamole
potassium chloride 0.15%/D5W
effer-k
potassium chloride 0.22% D5W/NACL 0.45%
effervescent pot chloride
potassium chloride 0.224%/D5W/NACL 0.45%
effervescent potassium
potassium chloride 0.224%D5W/NACL 0.45% viaflex
effervescent potassium/chloride
potassium chloride 0.3%/D5W
flumazenil
potassium chloride 0.3%/NACL 0.9%/viaflex
folastin
potassium phosphate
folbic
potassium phosphates
fomepizole
premasol
formadon
ringers injection
formaldehyde
ringers irrigation
hepatamine
saline flush
hepatasol
saline flush zr/sterile field
indigo carmine
scleromate sodium morrhuate
indocyanine green
sodium acetate
intralipid
sodium bicarbonate
isolyte-m/dextrose 5%
sodium bicarbonate partial fill
isosulfan blue
sodium chloride
k-effervescent
sodium chloride bacteriostatic
k-prime
sodium chloride flush
k-sol
sodium chloride pab
k-vescent
sodium chloride 0.45%
kendall sodium chloride flush
sodium chloride 0.45% viaflex
kionex
sodium phosphate
klor-CON
sodium polystyrene sulfonate
klor-CON m10
sodium thiosulfate
klor-CON m20
sterile diluent for epoprostenol sodium
klor-CON 10
sterile water for injection
klor-CON 8
sterile water irrigation
klor-CON/EF
sterile water irrigation plastic bottle
l-cysteine HCL
sterile water irrigation w/hanger
lactated ringers
swabflush saline flush
lactated ringers dextrose 5% viaflex
tis-u-sol
lactated ringers irrigation
tpn electrolytes
lactated ringers viaflex
virt-phos 250 neutral
lanolin
virt-vite forte
liposyn iii
vp-precip
magnesium chloride
zinc sulfate
magnesium sulfate
Ammonium Molybdate
methylene blue
Antivenin Latrodectus Mactans
monoject pharma grade flush syringe
Antivenin Micrurus Fulvius
monoject sodium chloride flush
BD posiflush
morrhuate sodium
Calcium-folic Acid Plus D
multitrace-4 concentrate
Chromium Chloride
multitrace-5 concentrate
Clinimix E 4.25%/Dextrose 25%
n-acetyl-l-cysteine
Clinimix 4.25%/Dextrose 10%
naloxone HCL
Clinimix 4.25%/Dextrose 20%
naltrexone HCL
Clinimix 4.25%/Dextrose 25%
normal saline flush
Copper Sulfate
normal saline flush for flushing vascular access devices
Copper Trace Metal
normal saline i.v. flush
Cysteine HCL
normosol-m IN D5W
Delflex-lm/2.5% Dextrose
nutrilipid
Delflex-lm/4.25% Dextrose
nutrilyte
Delflex-sm/1.5% Dextrose
nutrilyte II
Delflex-sm/2.5% Dextrose
phospha 250 neutral
Dextrose 10%/NACL 0.2%
physiolyte
Dextrose 10%/NACL 0.225%
physiosol irrigation
Dextrose 10%/NACL 0.45%
potassium acetate
Dextrose 20%
potassium bicarbonate
Dextrose 25%
potassium chloride
Dextrose 40%
potassium chloride CR
Dextrose 5% /Electrolyte #48 Viaflex
potassium chloride ER
Dextrose 5%/NACL 0.225%
potassium chloride SR
Dextrose 5%/NACL 0.3%
potassium chloride 0.15% /NACL 0.45% viaflex
Freamine Iii
potassium chloride 0.15% w/NACL 0.9% viaflex
Hyperlyte-CR
potassium chloride 0.15% D5W/NACL 0.33%
Imogam Rabies-ht
potassium chloride 0.15% D5W/NACL 0.45%
KCL 0.075%/D5W/NACL 0.45%
potassium chloride 0.15% D5W/NACL 0.45% viaflex
KCL 0.15%/D5W/ NACL 0.3%
potassium chloride 0.15% NACL 0.9%
KCL 0.15%/D5W/Lr
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 37
KCL 0.15%/D5W/NACL 0.2%
Magnebind 400
KCL 0.15%/D5W/NACL 0.225%
Metafolbic
KCL 0.15%/D5W/NACL 0.45%
Phisohex
KCL 0.15%/D5W/NACL 0.9%
Plasma-lyte A
KCL 0.3%/D5W/Lr IV Lac Ring
Plasma-lyte-148
KCL 0.3%/D5W/NACL 0.45%
Vayacog
KCL 0.3%/D5W/NACL 0.9%
Vayarin
L-methyl-b6-b12
Vayarol
L-methylfolate
Vita-respa
L-methylfolate Calcium
L-methylfolate CA/P-5-P.M.-CBL
SPECIALTY
Lecithin
AdagenPA
Lmthf/Pyridoxine HCL/Cyanocobalamin
BenlystaPA
Lozi-flur
BivigamPA
Magnesium Sulfate
Carimune NanofilteredPA
Magnesium Sulfate IN D5W
CytogamPA
Multitrace-4
ExjadePA
Multitrace-4 Neonatal
FerriproxPA
Multitrace-5
Flebogamma DifPA
MD-gastroview
Gamastan S/DPA
Naloxone HCL
Gammagard LiquidPA
Normosol -r
Gammagard S/DPA
Normosol-r IN D5W
Gammagard S/D Iga Less Than 1mcg/MLPA
Potassium Acetate
GammakedPA
Potassium Chloride
GammaplexPA
Potassium Chloride ER
Gamunex-cPA
Potassium Chloride 0.15% /NACL 0.45% Viaflex
Hepagam B
Potassium Chloride 0.15%/NACL 0.9%
HizentraPA
Potassium Chloride 0.3%/ NACL 0.9%
Hyperhep B S/D
Saccharin Sodium
Hyperrho S/D
Selenium
Hyperrho S/D Mini-dose
Sodium Chloride
Micrhogam Ultra-filtered Plus
Sodium Fluoride
Nabi-HB
Sodium Lactate
OctagamPA
Sodium Saccharin Dihydrate
PrivigenPA
Tryptophan
Rhogam Ultra-filtered Plus
Vp-gstn
Rhophylac
Zinc Sulfate
SynagisPA
Zinc Trace Metal
Syprine
PREVENTIVE
ThyrogenQL,PA
fluor-a-day
Vivitrol
fluoride
Winrho SDF
fluoritab
XiaflexPA
flura-drops
karidium
ACA PREVENTIVE DRUGS
ludent
ASPIRIN
nafrinse
PREVENTIVE
nafrinse drops
adult aspirin EC low strength
sodium fluoride
aspir-low
PREFERRED
aspir-81
Chemet
aspirin
Chemstrip-k
aspirin adult low strength
Cuprimine
aspirin childrens
Fluor-a-day
aspirin enteric coated adult low strength
Hyperrab S/D
aspirin low dose
K-phos
aspirin low strength
NON PREFERRED
aspirin EC
Botox Cosmetic
aspirin EC low dose
Cerefolin
aspirin EC LO-dose
Cyanocobalamin/Levomefolate Calcium/Pyridoxine HCL
aspirin 81
Depen Titratabs
aspirin 81 low dose
Effer-k
aspirtab
Fluorabon
bayer advanced aspirin regular strength
Flura-drops
bayer aspirin
Folbic RF
bayer aspirin regimen
Foltx
bayer aspirin EC low dose
Galzin
bayer chewable low dose
Isolyte-s
bayer low dose
Klor-CON M15
childrens aspirin
L-methyl-mc
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 38
childrens aspirin low strength
PREVENTIVE
ecotrin low strength
Adult Aspirin Low Strength
ecpirin
Aspirin Low Dose
enteric coated aspirin
Medi-seltzer
eq adult aspirin low strength
eq aspirin
CONTRACEPTIVES
eq aspirin adult low dose
GENERIC
eq aspirin low dose
Amethyst
eq aspirin EC
Necon 1/50-28
eq childrens aspirin
Necon 10/11-28
eql adult aspirin low strength
Zovia 1/50e
eql aspirin
PREVENTIVE
eql aspirin low dose
altavera
eql aspirin EC
alyacen 1/35
eql childrens aspirin
alyacen 7/7/7
gnp adult aspirin low strength
amethiaQL
gnp aspirin
amethia LOQL
gnp aspirin low dose
apri
goodsense aspirin low dose
aranelle
kls aspirin low dose
aubra
kls aspirin EC
aviane
kp aspirin
azurette
meijer aspirin EC
balziva
miniprin low dose
briellyn
norwich aspirin
camila
px aspirin
camreseQL
px enteric aspirin
camrese LOQL
qc aspirin
caziant
qc aspirin low dose
cesia
qc childrens aspirin
chateal
ra aspirin
cryselle-28
ra aspirin adult low dose
cyclafem 1/35
ra aspirin adult low strength
cyclafem 7/7/7
ra aspirin childrens
dasetta 1/35
ra aspirin EC
dasetta 7/7/7
ra aspirin EC adult low strength
dayseeQL
ra childrens aspirin
deblitane
sm aspirin
delyla
sm aspirin adult low strength
desogestrel/ethinyl estradiol
sm aspirin enteric coated
drospirenone/ethinyl estradiol
sm aspirin low dose
elinest
sm aspirin EC low strength
emoquette
sm childrens aspirin
enpresse-28
st joseph aspirin
enskyce
tgt aspirin
errin
tgt aspirin low dose
estarylla
tgt childrens aspirin
falmina
tgt enteric-coated aspirin
gianvi
th aspirin
gildagia
th aspirin low dose
gildess FE 1.5/30
th enteric aspirin
gildess FE 1/20
CVS aspirin
gildess 1.5/30
CVS aspirin adult low dose
gildess 1/20
CVS aspirin adult low strength
gildess 24 FE
CVS aspirin child
heather
CVS aspirin low dose
introvaleQL
CVS aspirin low strength
jencycla
CVS aspirin EC
jolessaQL
CVS childrens aspirin
jolivette
CVS enteric aspirin
junel FE 1.5/30
EC-81 aspirin
junel FE 1/20
HM aspirin
junel 1.5/30
HM aspirin EC
junel 1/20
HM aspirin EC low dose
kariva
MM aspirin
kelnor 1/35
SB aspirin
kurvelo
SB aspirin EC
larin FE 1.5/30
SB childrens aspirin
larin FE 1/20
SB low dose asa EC
larin 1.5/30
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 39
larin 1/20
zenchent FE
leena
zovia 1/35e
lessina
Ogestrel
levonest
PREFERRED
levonorgestrel
Beyaz
levonorgestrel and ethinyl estradiolQL
LO Loestrin FE
levonorgestrel/ethinyl estradiol
Minastrin 24 FE
levora 0.15/30-28
Safyral
lomedia 24 FE
PREVENTIVE
loryna
Natazia
low-ogestrel
NuvaringQL
lutera
NON PREFERRED
lyza
Depo-subq Provera 104QL
marlissa
PREVENTIVE
medroxyprogesterone acetateQL
Encare
microgestin FE
Fc Female Condom
microgestin FE 1.5/30
Fc2 Female Condom
microgestin 1.5/30
Femcap
microgestin 1/20
Omniflex Diaphragm
mono-linyah
Options Conceptrol Vaginal Contraceptive
mononessa
Options Gynol II Vaginal Contraceptive
my way
Ortho Diaphragm All-flex/65MM
myzilra
Ortho Diaphragm All-flex/70MM
necon 0.5/35-28
Ortho Diaphragm All-flex/75MM
necon 1/35
Ortho Diaphragm All-flex/80MM
necon 7/7/7
Ortho Diaphragm Coil Spring Kit 100
next choice one dose
Ortho Diaphragm Coil Spring Kit 105
nikki
Ortho Diaphragm Coil Spring Kit 50
nora-be
Ortho Diaphragm Flat Spring Kit 55
norethindrone
Ortho Diaphragm Flat Spring Kit 60
norethindrone acetate/ethinyl estradiol
Ortho Diaphragm Flat Spring Kit 65
norethindrone acetate/ethinyl estradiol/ferrous fumarate
Ortho Diaphragm Flat Spring Kit 70
norgestimate/ethinyl estradiol
Ortho Diaphragm Flat Spring Kit 75
norlyroc
Ortho Diaphragm Flat Spring Kit 80
nortrel 0.5/35 (28)
Ortho Diaphragm Flat Spring Kit 85
nortrel 1/35
Ortho Diaphragm Flat Spring Kit 90
nortrel 7/7/7
Ortho Diaphragm Flat Spring Kit 95
ocella
Prentif Cavity-rim Cervical CAP
orsythia
Prentif Fitting Set
philith
Shur-seal
pimtrea
Vcf Vaginal Contraceptive Film
pirmella 1/35
Vcf Vaginal Contraceptive Foam
pirmella 7/7/7
Wide-seal Silicone Diaphragm Kit 60
portia-28
Wide-seal Silicone Diaphragm Kit 65
previfem
Wide-seal Silicone Diaphragm Kit 70
quasenseQL
Wide-seal Silicone Diaphragm Kit 75
reclipsen
Wide-seal Silicone Diaphragm Kit 80
sharobel
Wide-seal Silicone Diaphragm Kit 85
solia
Wide-seal Silicone Diaphragm Kit 90
sprintec 28
Wide-seal Silicone Diaphragm Kit 95
sronyx
PREVENTIVE
syeda
Implanon
tarina FE 1/20
Mirena
tilia FE
Nexplanon
tri-estarylla
Skyla
tri-legest FE
tri-linyah
FLUORIDE
tri-previfem
GENERIC
tri-sprintec
Lozi-flur
trinessa
Sodium Fluoride
trivora-28
PREVENTIVE
velivet
fluor-a-day
vestura
fluoride
viorele
fluoritab
vyfemla
flura-drops
wera
karidium
wymzya FE
ludent
xulane
nafrinse
zarah
nafrinse drops
zenchent
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 40
sodium fluoride
IMMUNIZATIONS
PREFERRED
PREVENTIVE
Fluor-a-day
Acthib
NON PREFERRED
Adacel
Fluorabon
Afluria PF 2012-2013
Flura-drops
Afluria PF 2013-2014
Afluria PF 2014-2015
FOLIC ACID
Afluria 2012-2013
GENERIC
Afluria 2013-2014
M-vit
Afluria 2014-2015
Prenaplus
Bexsero
Prenatal Low Iron
Boostrix
Prenatal Plus
Cervarix
Tricare
Comvax
PREVENTIVE
Daptacel
eql folic acid
Diphtheria/Tetanus Toxoids Adsorbed Pediatric
fa-8
Engerix-b
folic acid
Fluarix Quadrivalent 2013-2014
gnp folic acid
Fluarix Quadrivalent 2014-2015
kp folic acid
Fluarix 2013-2014
px folic acid
Fluarix 2014-2015
ra folic acid
Flublok 2013-2014
sm folic acid
Flublok 2014-2015
sm prenatal vitamins
Flucelvax 2013-2014
th folic acid
Flucelvax 2014-2015
yl folic acid
Flulaval Quadrivalent 2013-2014
Classic Prenatal
Flulaval Quadrivalent 2014-2015
CVS folic acid
Flulaval 2013-2014
Eql Prenatal Formula
Flulaval 2014-2015
Gnp Prenatal Vitamins
Flumist Nasal Vaccine 2012-2013
HM folic acid
Flumist Quadrivalent
Mission Prenatal HP
Fluvirin PF 2013-2014
Multi Prenatal
Fluvirin PF 2014-2015
Perry Prenatal
Fluvirin 2013-2014
Pre-natal Formula
Fluvirin 2014-2015
Prenatal
Fluzone High-dose PF 2013-2014
Prenatal And Iron
Fluzone High-dose PF 2014-2015
Prenatal Formula
Fluzone Intradermal
Prenatal Forte
Fluzone Intradermal Quadrivalent
Prenatal Vitamins
Fluzone Pediatric PF 2013-2014
Px Prenatal Multivitamins
Fluzone PF 2013-2014
Ra Prenatal
Fluzone PF 2014-2015
Sm Prenatal Vitamins
Fluzone Quadrivalent 2013-2014
PREVENTIVE
Fluzone Quadrivalent 2014-2015
Atabex Prenatal
Fluzone Split 2013-2014
CVS Prenatal
Fluzone Split 2014-2015
Fa-8
Gardasil
Gnp Daily Prenatal
Gardasil 9
Gnp Prenatal
Havrix
Goodsense Prenatal Vitamins
Hiberix
HM One Daily Prenatal Combo
Infanrix
HM Prenatal
Influenza A (h1n1) Monovalent 2009
Kp Prenatal Multivitamins
Ipol Inactivated IPV
Mission Prenatal
Kinrix
Nat-rul Prenatal Vitamins
M-m-r II W/Diluent 10 Dose
One-a-day Womens Prenatal
Medical Provider EZ Flu Shot PF 2012-2013
Prenatal Complete
Medical Provider EZ Flu Shot PF 2013-2014
Prenatal Multi +dha
Medical Provider EZ Flu Shot PF 2014-2015
Prenatal One Daily
Medical Provider EZ Flu Shot 2013-2014
PA Prenatal Formula
Medical Provider EZ Flu Shot 2014-2015
Qc Prenatal
Menactra
Ra One Daily
Menomune-a/C/Y/W-135
Ra Prenatal Formula/Folicacid
Menveo
Right Step Prenatal
Pediarix
Sm One Daily Prenatal
Pedvax HIB
Stuart Prenatal
Pentacel
Stuart Prenatal + DHA
Physicians EZ Use Flu Kit 2012-2013
Th Prenatal Vitamins
Pneumovax 23
Pneumovax 23/1 Dose
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 41
Pneumovax 23/5 Dose
PREVENTIVE
Prevnar 13
CVS Slow Release Iron
Proquad
Elite Iron
Recombivax HB
Femiron
Rotarix
Feosol
Rotateq
Ferretts IPS
Tenivac
Ferrimin 150
Tetanus/Diphtheria Toxoids-adsorbed Adult
Ferro-sequels
Trumenba
Ferrous Fumarate
Twinrix
Ferrous Gluconate
Vaqta
Ferrous Sulfate
Varivax
FE Aspartate
Zostavax
High Potency Iron
Iron
IRON
Iron Chews Pediatric
Iron Up
PREVENTIVE
Mykidz Iron 10
bprotected pedia iron
Novaferrum Pediatric Drops
eq slow-release iron
Perfect Iron
eql iron supplement therapy
Profe
eql slow release iron
Proferrin ES
ezfe 200
Sm Slow Release Iron
feosol
fer-iron
SMOKING CESSATION
ferate
ferosul
PREVENTIVE
ferretts
buprobanQL
ferrex 150
bupropion HCL SRQL
ferric x-150
eq nicotineQL
ferro-bob
eq nicotine gum refillQL
ferrocite
eq nicotine gum starterQL
ferrotabs
eq nicotine polacrilexQL
ferrous drops
eq nicotine step 3QL
ferrous fumarate 324
eql nicotineQL
ferrous gluconate
eql nicotine polacrilexQL
ferrous sulfate
eql nicotine polacrilex refillQL
ferrousul
eql nicotine polacrilex starterQL
ferus
gnp nicotine polacrilexQL
gnp iron
gnp nicotine polacrilex miniQL
gnp slow release iron
kls quit2QL
high potency iron
kls quit4QL
iferex 150
nicoreliefQL
iron
nicotineQL
iron slow release
nicotine polacrilexQL
iron supplement
nicotine polacrilex refillQL
iron supplement childrens
nicotine polacrilex starter kitQL
kp ferrous gluconate
nicotine step 1QL
kp ferrous sulfate
nicotine step 2QL
meijer ferrous sulfate
nicotine step 3QL
myferon 150
nicotine transdermal systemQL
nu-iron 150
px stop smoking aidQL
poly-iron 150
qc nicotine polacrilexQL
px iron
ra mini nicotineQL
qc ferrous sulfate
ra nicotineQL
ra high potency iron
ra nicotine polacrilexQL
ra iron
ra nicotine transdermal system step 3QL
ra slow release iron
sm nicotineQL
slow iron
sm nicotine polacrilexQL
slow release iron
sw nicotine polacrilexQL
sm iron
tgt nicotine gumQL
sm iron slow release
tgt nicotine polacrilexQL
th iron
tgt nicotine step oneQL
th slow release iron
tgt nicotine step threeQL
wee care
tgt nicotine step twoQL
CVS iron
thriveQL
FE gluconate
CVS nicotineQL
FE TABS
CVS nicotine polacrilexQL
HM iron
CVS nicotine polacrilex starterQL
HM iron slow release
CVS nicotine transdermal systemQL
CVS nts step 1QL
Effective April 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; 42
HM nicotine polacrilexQL
vitamin d
HM nicotine transdermal systemQL
vitamin d high potency
HM nicotine transdermal system step 3QL
vitamin d 400
SR nicotine gumQL
vitamin d-1000
PREVENTIVE
vitamin d-1000 maximum strength
ChantixQL
vitamin d-3
Chantix Continuing Month PAKQL
vitamin d-400
Chantix Starting Month PAKQL
vitamin d3
Nicotine Transdermal SystemQL
vitamin d3 adult gummies
PREVENTIVE
vitamin d3 high potency
Nicotrol InhalerQL
vitamin d3 maximum strength
Nicotrol NsQL
vitamin d3 super strength
CVS childrens vitamin d for bone health
VITAMIN D
CVS vitamin d
CVS vitamin d infants
GENERIC
CVS vitamin d 5000 high-potency
decara
CVS vitamin d3
PREVENTIVE
HM vitamin d
aqueous vitamin d infants
HM vitamin d3
bio-d-mulsion
PA vitamin d-3
bio-d-mulsion forte
PA vitamin d-3 gummy
bprotected pedia d-vite
PREVENTIVE
d 1000
CVS Vitamin D3
d 10000
Ddrops
d 2000
Dialyvite Vitamin D3 Max
d 400
D3
d 5000
D3 Dots
d-vita
HM Vitamin D3
d-1000
Replesta
d-1000 extra strength
Replesta Childrens
d-2000 maximum strength
Replesta Nx
d-3-5
Sm Vitamin D3 Maximum Strength
d-400
Super Daily D3
d-5000
Thera-d 4000
d-5000 maximum strength
Vitamelts Vitamin D
delta d3
Vitamin D
dialyvite vitamin d 5000
Vitamin D3
d2000 ultra strength
Vitamin D3 400
d3
Wellesse Vitamin D3
d3 adult
d3 high potency
BOWEL PREPARATION AGENTS
d3 kids
d3 maximum strength
PREVENTIVE
d3 super strength
gavilyte-c
d3 ultra strength
gavilyte-n/flavor pack
d3-1000
gavilyte-G
d3-50
peg 3350/electrolytes
eql childrens vitamin d gummies
peg-3350/electrolytes
eql vitamin d-3
peg-3350/NACL/NA bicarbonate/KCL
eql vitamin d3
trilyte
gnp vitamin d
NON PREFERRED
gnp vitamin d maximum strength
Colyte-flavor Packs
gnp vitamin d super strength
Golytely
gnp vitamin d3 extra strength
healthy kids vitamin d3
BREAST CANCER
just d
PREVENTIVE
kp vitamin d
tamoxifen citrate
maximum d3
nat-rul vitamin d
optimal-d
optimal-d pack
opurity vitamin d
pronutrients vitamin d3
ra vitamin d-3
sm vitamin d
sm vitamin d3
th vitamin d3
thera-d rapid repletion
thera-d sport
thera-d 2000
Effective April 1, 2015 v.1
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; ©Catamaran 2015. All Rights Reserved. May not be copied or distributed without authorization.
43
Index
A
Accu-chek Softclix Lancets, 31
adult aspirin EC low strength, 25, 38
Accu-chek Spirit Adapter Kit, 35
Adult Aspirin Low Strength, 25, 39
A-hydrocort, 11
Accu-chek Spirit Battery Kit, 35
Advair Diskus, 28
a-methapred, 11
Accu-chek Spirit Insulin P.M. Kit, 35
Advair HFA, 28
abacavir, 2
Accu-chek Tender II Infusion Set/24"/13MM, 35
Advate, 19
abacavir sulfate/lamivudine/zidovudine, 2
Advocate Lancets, 31
Abelcet, 2
Accu-chek Tender II Infusion Set/24"/17MM, 35
Advocate Safety Lancets, 32
Abilify, 20
aero otic HC, 24
Abilify Discmelt, 20
Accu-chek Tender II Infusion Set/31"/13MM, 35
Aerochamber Mini Aerosol Chamber, 35
Abilify Maintena, 20
Aerochamber MV, 35
Abraxane, 5
Accu-chek Tender II Infusion Set/31"/17MM, 35
Aerochamber Plus Flow VU, 35
Absorica, 9
Aerochamber Plus Flow-VU, 35
Abstral, 26
Accu-chek Tender II Infusion Set/43"/17MM, 35
Aerochamber Plus Flow-VU/Large Mask, 35
acamprosate calcium DR, 22
Acanya, 9
Accu-chek Voicemate, 35
Aerochamber Plus Flow-VU/Mask, 35
acarbose, 13
Acd Formula A, 19
Aerochamber Plus Flow-VU/Medium Mask, 35
Accu-chek Active Glucose Control Solution, 35
Acd Formula B, 19
Acd-a Noclot-50, 19
Aerochamber Plus Flow-VU/Small Mask, 35
Accu-chek Active Strips, 35
acebutolol HCL, 6
Accu-chek Aviva, 35
Acetaminophen/Caffeine/Dihydrocodeine Bitartrate, 26
Aerochamber Z-stat Plus Valved Holding Chamber W/Flow VU, 36
Accu-chek Aviva Plus, 35
Accu-chek Combo, 35
acetaminophen/codeine, 25
Aerochamber Z-stat Plus/Flowsignal, 36
Accu-chek Comfort Curve Control Solution (2 Levels), 35
acetaminophen/codeine #2, 25
Aerochamber Z-stat Plus/Large Mask, 36
acetaminophen/codeine #3, 25
Aerochamber Z-stat Plus/Medium Mask, 36
Accu-chek Comfort Curve Linearity Solution, 35
acetaminophen/codeine #4, 25
acetaminophen/codeine phosphate, 25
Aerochamber Z-stat Plus/Small Mask, 36
Accu-chek Comfort Curve Test Strips, 35
acetasol HC, 24
Aerochamber/Flowsignal, 36
Accu-chek Compact Blue Control Solution (2 Levels), 35
acetazolamide, 7
AF Lancets Super Thin, 32
Acetazolamide, 7
afeditab CR, 6
Accu-chek Compact Plus, 35
acetazolamide ER, 7
Afinitor, 5
Accu-chek Compact Plus Care Kit, 35
acetazolamide sodium, 7
Afinitor Disperz, 5
Accu-chek Compact Plus Clear Control Solution (2 Levels), 35
acetic acid, 24
Afluria 2012-2013, 29, 41
acetic acid 0.25%, 17
Afluria 2013-2014, 29, 41
Accu-chek Compact Test Drum, 35
Acetic Acid/Aluminum Acetate, 24
Afluria 2014-2015, 29, 41
Accu-chek Fastclix Lancetdevice Kit, 35
acetylcysteine, 28, 36
Afluria PF 2012-2013, 29, 41
Accu-chek Fastclix Lancets, 31
Aciphex Sprinkle, 15
Afluria PF 2013-2014, 29, 41
Accu-chek Instant Glucosecontrol Solution (2 Levels), 35
acitretin, 9
Afluria PF 2014-2015, 29, 41
Actemra, 27
Agamatrix Ultra-thin Lancets 33G, 32
Accu-chek Multiclix Lanc Et Device Kit, 35
Acthib, 29, 41
Aggrastat, 19
Acti-lance Lancets 28G, 31
Aggrenox, 19
Accu-chek Multiclix Lancets, 31
Acti-lance Lite Safety Lancets 28G, 31
airavite, 17
Accu-chek Nano Smartview, 35
Acti-lance Special Safety Lancets 17G, 31
ak-fluor, 24
Accu-chek Rapid-d Infusion Set/24"/10MM, 35
Ak-fluor, 24
Acti-lance Special Safetylancets 17G, 31
ak-poly-bac, 23
Accu-chek Rapid-d Infusion Set/24"/6MM, 35
Acti-lance Universal Safety Lancets 23G, 31
akorn balanced salt solution, 24
ala cort, 9
Accu-chek Rapid-d Infusion Set/24"/8MM, 35
acticin, 10
Albatussin NN, 28
Actimmune, 5
Albenza, 3
Accu-chek Rapid-d Infusion Set/31"/10MM, 35
Actonel, 13
albuked 25, 19
Actoplus Met XR, 13
albuked 5, 19
Accu-chek Rapid-d Infusion Set/31"/6MM, 35
Acuvail, 24
albumin human, 19
acyclovir, 2, 9
albumin-zlb, 19
Accu-chek Rapid-d Infusion Set/31"/8MM, 35
acyclovir sodium, 2
albuminar-25, 19
Acyclovir Sodium, 2
albuminar-5, 19
Accu-chek Rapid-d Infusion Set/43"/10MM, 35
Adacel, 29, 41
alburx, 19
Adagen, 38
albutein, 19
Accu-chek Rapid-d Infusion Set/43"/6MM, 35
adapalene, 8
albuterol sulfate, 28
Adcetris, 4
albuterol sulfate ER, 28
Accu-chek Rapid-d Infusion Set/43"/8MM, 35
Adcirca, 8
albuterol TAB 4MG, 28
adefovir dipivoxil, 3
alclometasone dipropionate, 9
Accu-chek Safe-t-pro Lancets, 31
Adempas, 8
Alcoh-glove Contoured Wipe, 36
Accu-chek Safe-t-pro Pluslancets, 31
adenosine, 6, 36
Alcoh-wipe 12" X 12", 36
Accu-chek Smartview Control, 35
adriamycin, 4
Alcohol Pads, 36
Accu-chek Smartview Strips, 35
Adriamycin, 4
Alcohol Prep Pads, 36
Accu-chek Soft Touch Lancets, 31
adrucil, 4
Alcohol Swabs, 36
Accu-chek Softclix Lancetdevice Kit, 35
Alcohol Wipes, 36
amlodipine besylate/benazepril HCL, 7
Arcapta Neohaler, 28
Aldurazyme, 15
amlodipine besylate/benazepril hydrochloride, 7
argatroban, 18
alendronate sodium, 13
Argatroban, 19
Alendronate Sodium, 13
amlodipine besylate/valsartan, 7
argyle sterile saline 100ML, 17
alfentanil, 25
amlodipine/valsartan/hctz, 7
argyle sterile water 100ML, 36
Alferon N, 5
ammonium lactate, 10
Arial Chamber, 36
alfuzosin HCL ER, 17
Ammonium Molybdate, 37
Armour Thyroid, 15
ali-flex, 25
amnesteem, 8
Arranon, 4
Alimta, 4
Amoxapine, 20
Arzerra, 4
Alinia, 3
amoxicillin, 1
Arzol Silver Nitrate App Licators, 10
Alkeran, 3
Amoxicillin, 1
Asacol HD, 16
allopurinol, 27
Amoxicillin ER, 1
ascomp/codeine, 26
Alocril, 24
amoxicillin/clavulanate potassium, 1
ascorbic acid, 29
Alodox Convenience Kit, 1
amoxicillin/clavulanate potassium ER, 1
Asmanex HFA, 28
Alomide, 24
amphetamine/dextroamphetamine, 21
Asmanex Twisthaler 120 Metered Doses, 28
Alora, 11
Amphotec, 2
Aloxi, 16
Amphotericin B, 2
Asmanex Twisthaler 14 Metered Doses, 28
Alpain, 25
ampicillin, 1
Alphagan P, 24
Ampicillin, 1
Asmanex Twisthaler 30 Me Tered Doses, 28
Alphanate/Von Willebrand Factor Complex/Human, 19
ampicillin sodium, 1
Ampicillin Sodium, 1
Asmanex Twisthaler 30 Metered Doses, 28
Alphanine SD, 19
ampicillin-sulbactam, 1
alphaquin HP, 10
Ampicillin-sulbactam, 1
Asmanex Twisthaler 60 Metered Doses, 28
alphatrex, 9
Ampyra, 22
alprazolam, 20
Amturnide, 7
Asmanex Twisthaler 7 Metered Doses, 28
alprazolam ER, 20
ana-lex, 16
alprazolam odt, 20
Anadrol-50, 11
aspir-81, 25, 38
alprazolam XR, 20
anagrelide hydrochloride, 19
aspir-low, 25, 38
alprostadil, 36
Analpram Advanced, 16
aspirin, 25, 38
Alrex, 23
Analpram-HC, 16
aspirin 81, 25, 38
Alsuma, 27
anastrozole, 4
aspirin 81 low dose, 25, 38
Altabax, 9
Androderm, 11
aspirin adult low strength, 25, 38
altacaine, 24
Androgel, 11
aspirin childrens, 25, 38
altafluor, 24
Androgel P.M., 11
aspirin EC, 25, 38
altafrin, 24
Androxy, 11
aspirin EC LO-dose, 25, 38
altavera, 11, 39
Animas Vibe Insulin P.M., 32
aspirin EC low dose, 25, 38
Altoprev, 8
Animas Vibe Insulin P.M./Black, 32
aspirin enteric coated adult low strength, 25, 38
Alvesco, 28
Animas Vibe Insulin P.M./Blue, 32
alyacen 1/35, 11, 39
Animas Vibe Insulin P.M./Limelight Green, 32
aspirin low dose, 25, 38
alyacen 7/7/7, 12, 39
Aspirin Low Dose, 25, 39
amantadine HCL, 21
Animas Vibe Insulin P.M./Pink Glow, 32
aspirin low strength, 25, 38
Amantadine HCL, 21
Anticoagulant Citrate Dextrose Solution A, 19
Aspirin-caffeine-dihydrocodeine, 26
Ambisome, 2
aspirtab, 25, 38
Amcinonide, 10
Anticoagulant Sodium Citrate, 19
Assure Comfort Lancets Ultra Thin 28G, 32
amethia, 12, 39
antipyrine/benzocaine, 24
amethia LO, 12, 39
Antipyrine/Benzocaine, 24
Assure Comfort Lancets Ultra Thin 30G, 32
Amethyst, 11, 39
Antivenin Latrodectus Mactans, 37
amifostine, 5
Antivenin Micrurus Fulvius, 37
Assure Haemolance Plus High Flow 18G, 32
Amigo Insulin P.M., 32
anucort-HC, 16
amikacin sulfate, 2
Anzemet, 16
Assure Haemolance Plus Low Flow 25G, 32
amiloride HCL, 7
AP-zel, 31
amiloride/hydrochlorothiazide, 7
apexicon, 9
Assure Haemolance Plus Micro Flow 28G, 32
amino acids, 36
Apexicon E, 10
aminoacetic acid, 17
Apidra, 13
Assure Haemolance Plus Normal Flow 21G, 32
Aminobenzoate Potassium, 29
Apidra Solostar, 13
aminocaproic acid, 19
Aplenzin, 20
Assure Haemolance Plus Pediatric Blade, 32
Aminocaproic Acid, 19
Apokyn, 22
aminophylline, 28
apraclonidine, 24
Assure Lance Lancets, 32
aminosyn 8.5%/electrolytes, 36
apri, 12, 39
Assure Lancets, 32
aminosyn II 8.5%/electrolytes, 36
Apriso, 16
astramorph, 26
aminosyn-hf, 36
Aptivus, 2
AT Last Lancets, 32
amiodarone HCL, 6
aqueous vitamin d infants, 29, 43
Atabex Prenatal, 31, 41
Amiodarone HCL, 6
Aquoral, 20
Atelvia, 14
Amitiza, 16
Aralast NP, 28
atenolol, 6
amitriptyline HCL, 20
aranelle, 12, 39
atenolol/chlorthalidone, 7
amlodipine besylate, 6
Aranesp Albumin Free, 18
Atgam, 4
amlodipine besylate/atorvastatin calcium, 8
arbinoxa, 27
atorvastatin calcium, 8
Arcalyst, 27
atovaquone, 3
atovaquone/proguanil HCL, 3
Baraclude, 3
100/1ML/25G X 5/8", 32
atracurium besylate, 22
baycadron, 11
BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2", 32
Atralin, 9
bayer advanced aspirin regular strength, 25, 38
Atripla, 2
BD Insulin Syringe/U-100/0.5ML/30G X 1/2", 32
Atropen, 15
bayer aspirin, 25, 38
atropine sulfate, 15, 23
bayer aspirin EC low dose, 25, 38
BD Insulin Syringe/U-100/1ML/27G X 1/2", 32
Atropine Sulfate, 15, 24
bayer aspirin regimen, 25, 38
atropine-care, 24
bayer chewable low dose, 25, 38
BD Insulin Syringe/U-100/1ML/28G X 1/2", 32
Atrovent HFA, 28
bayer low dose, 25, 38
Aubagio, 22
Bayer Microlet Lancets, 32
BD Insulin Syringe/U-100/2ML/27.5G X 5/8", 32
aubra, 12, 39
Bcg Vaccine, 29
augmented betamethasone dipropionate, 9
BD Insulin Syringe LUER-LOK/U-100/1ML, 32
BD Insulin Syringe/U-100/2ML/29G X 1/2", 32
Augmentin, 1
BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2", 32
BD Lancet Ultrafine 30G, 32
aurax, 24
BD Lancet Ultrafine 33G, 32
aurodex, 24
BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2", 32
BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2", 32
Aurora Lancet Super Thin 30G, 32
Aurora Lancet Thin 23G, 32
BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8", 32
BD Microtainer Lancets, 32
Auvi-q, 7
BD Pen Needle/Mini/Ultrafine/31G X 3/16", 32
Avage, 11
BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2", 32
Avandia, 13
BD Pen Needle/Nano/Ultra Fine/32G X 4MM, 32
avar cleanser, 8
BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2", 32
avar-e emollient, 8
BD Pen Needle/SHORT/Ultrafine/31G X 5/16", 32
avar-e green, 8
BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2", 32
Avastin, 4
BD Pen Needle/Ultrafine/29G X 12.7MM, 32
Avc, 17
BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8", 32
Avelox, 2
BD Pen Needle/Ultrafine/29GX1/2" 12.7MM, 32
aviane, 12, 39
BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2", 32
avidoxy, 1
BD Pen Needles SHORT/Ultrafine/31G X 5/16", 32
avita, 8
BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2", 32
Avodart, 17
BD posiflush, 37
Avonex, 22
BD Insulin Syringe Safetyglide/1ML/29G X 1/2", 32
BD Pudendal/Local Block Tray 1% Lidocaine, 27
Avonex Pen, 22
Axert, 27
BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16", 32
BD Swabs Single Use, 36
Axiron, 11
BD Swabs Single Use Butterfly, 36
azacitidine, 4
BD Insulin Syringe Slip Tip/U-100/1ML, 32
Bebulin, 19
Azactam IN Iso-osmotic Dextrose, 3
Bebulin VH, 19
Azasan, 4
BD Insulin Syringe U-40/1ML/25G X 5/8", 32
Beconase AQ, 27
Azasite, 23
Belladonna & Opium, 15
azathioprine, 4
BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16", 32
Belladonna Alkaloids & Opium, 15
azelastine HCL, 24, 27
benazepril HCL, 6
Azelex, 9
BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16", 32
benazepril HCL/hydrochlorothiazide, 7
Azilect, 22
Benefix, 19
azithromycin, 1
BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16", 32
Benicar, 7
Azithromycin, 1
Benicar HCT, 7
Azopt, 24
BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2", 32
Benlysta, 38
Azor, 7
benzepro, 8
aztreonam, 3
BD Insulin Syringe Ultrafine/0.3ML/31G X 5/16", 32
benzepro SHORT contact, 8
azurette, 12, 39
benziq wash, 8
B
BD Insulin Syringe Ultrafine/0.5ML/30G X 1/2", 32
benzonatate, 28
benzoyl peroxide, 8
B-6 Folic Acid, 17
BD Insulin Syringe Ultrafine/0.5ML/31G X 5/16", 32
benzoyl peroxide SHORT contact, 8
b-complex, 30
benzoyl peroxide wash acne treatment pack, 8
b-complex 100, 30
BD Insulin Syringe Ultrafine/1ML/30G X 1/2", 32
b-plex, 30
benzphetamine HCL, 21
b-plex plus, 30
BD Insulin Syringe Ultrafine/1ML/31G X 5/16", 32
benztropine mesylate, 21
baciim, 3
Bepreve, 24
bacitracin, 3
BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2", 32
Berinert, 19
Bacitracin, 3, 23
Besivance, 23
bacitracin/polymyxin b, 23
BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2", 32
betamethasone dipropionate, 9
baclofen, 22
betamethasone sodium phosphate/betamethasone acetate, 11
Bacmin, 31
BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2", 32
Bactocill IN Dextrose, 1
betamethasone valerate, 9
Bactroban Nasal, 27
BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2", 32
Betaseron, 22
balanced salt, 24
betaxolol HCL, 6, 23
balanced salt solution, 24
BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1", 32
bethanechol chloride, 17
balsalazide disodium, 16
Betimol, 23
balziva, 12, 39
BD Insulin Syringe/Detachable Needle/U-
Betoptic-s, 23
Banzel, 21
Bexsero, 29, 41
bromfed DM, 28
capacet, 25
Bexxar, 4
bromfenac, 24
Capastat Sulfate, 2
Bexxar 131 Iodine, 5
bromocriptine mesylate, 21
capecitabine, 4
Beyaz, 12, 40
bromphen/pseudoephedrine HCL/dextromethorphan HBR, 28
Capex, 10
bicalutamide, 4
Caprelsa, 5
Bicillin C-R, 1
Brompheniramine Tannate, 27
captopril, 6
Bicillin L-a, 1
Brovana, 28
Captopril/Hydrochlorothiazide, 7
Bicnu, 3
bss, 24
Carac, 11
Bidil, 8
budeprion SR, 20
Carafate, 15
Biltricide, 3
budesonide, 11, 27, 28
CARB-o-philic 40, 10
Binosto, 14
Bullseye Mini Safety Lancets, 32
CARB-o-philic/40, 11
bio GLO, 24
Bullseye Safety Lancets, 32
Carbaglu, 15
bio-d-mulsion, 29, 43
bumetanide, 7
carbamazepine, 21
bio-d-mulsion forte, 29, 43
buminate, 19
carbamazepine ER, 21
bio-statin, 2
Buphenyl, 15
carbidopa, 21
biocel, 30
bupivacaine HCL, 27
carbidopa/levodopa, 21
biogesic, 25
bupivacaine spinal, 27
carbidopa/levodopa ER, 21
Biothrax, 29
bupivacaine/epinephrine, 27
carbidopa/levodopa odt, 21
biotuss, 28
buprenorphine HCL, 26
Carbidopa/Levodopa/Entacapone, 22
biotuss pediatric, 28
buprenorphine HCL/naloxone HCL, 26
carbinoxamine maleate, 27
bisoprolol fumarate, 6
buproban, 22, 42
carboplatin, 3
bisoprolol fumarate/hydrochlorothiazide, 7
bupropion HCL, 20
Carboplatin, 3
bupropion HCL ER, 20
Cardene IV, 6
Bivigam, 38
bupropion HCL SR, 20, 22, 42
cardioplegic, 8
bleomycin sulfate, 4
bupropion HCL XL, 20
Cardizem LA, 6
Blephamide S.o.p., 23
buspirone HCL, 20
Cardura XL, 17
Boostrix, 29, 41
Busulfex, 3
Careone Lancet Thin, 32
Bosulif, 5
butalbital/acetaminophen, 25
Careone Lancet Ultra Thin, 32
Botox, 22
butalbital/acetaminophen/caffeine, 25
Carimune Nanofiltered, 38
Botox Cosmetic, 38
butalbital/acetaminophen/caffeine/codeine, 26
carisoprodol, 22
bp 10-1, 8
Carisoprodol, 23
bp cleansing wash, 8
butalbital/apap/caffeine, 25
carisoprodol/aspirin, 22
bp foam, 8
butalbital/aspirin/caffeine, 25
carisoprodol/aspirin/codeine, 22
bp foaming wash, 8
Butalbital/Aspirin/Caffeine, 25
carteolol HCL, 23
Bp Folinatal Plus B, 30
butalbital/aspirin/caffeine/codeine, 26
cartia XT, 6
Bp Multinatal Plus, 30
butorphanol tartrate, 26
Cartridge IR 1000 3ML, 32
Bp Vit 3, 17
Butrans, 26
Cartridge IR 1200, 32
bp wash, 8
Bydureon, 13
Cartridge P.M., 32
bpm, 27
Byetta, 13
carvedilol, 6
bpm pseudo, 28
Bystolic, 6
Cascara Sagrada, 15
Bpo, 9
C
Cavan-EC Sod DHA, 30
Bpo 3% Foaming Cloths, 9
cavarest, 19
cabergoline, 14
Bpo 6% Foaming Cloths, 9
Caverject, 8
Cafergot, 27
Bpo 9% Foaming Cloths, 9
Caverject Impulse, 8
caffeine citrate, 21
bprotected pedia d-vite, 29, 43
cavirinse, 19
Caffeine/Sodium Benzoate, 21
bprotected pedia iron, 18, 42
Cayston, 3
calcipotriene, 9
Brainstrong Prenatal, 31
caziant, 12, 39
calcipotriene/betamethasone dipropionate, 9
Bravelle, 14
Cedax, 1
Breatherite, 36
cefaclor, 1
calcitonin salmon, 14
Breatherite Collapsible Adult Spacer W/Mask, 36
Cefaclor, 1
calcitonin-salmon, 14
Cefaclor ER, 1
calcitrene, 9
Breatherite Collapsible Child Spacer W/Mask, 36
cefadroxil, 1
Calcitriol, 9
cefazolin sodium, 1
calcitriol, 14
Breatherite Collapsible Infant Spacer W/Mask, 36
Cefazolin Sodium, 1
calcium acetate, 16
Cefazolin Sodium/Dextrose, 1
calcium chloride, 36
Breatherite Collapsible Small Child Spacer W/Mask, 36
cefdinir, 1
Calcium Folinate, 5
Cefditoren Pivoxil, 1
calcium gluconate, 36
Breatherite Collapsible Spacer W/ Neonate Mask, 36
cefepime, 1
Calcium-folic Acid Plus D, 37
Cefepime, 1
camila, 12, 39
Breatherite Rigid Spacer W/Mask, 36
cefotaxime sodium, 1
Camptosar, 5
Breatherite W/Large Mask, 36
Cefotetan, 1
camrese, 12, 39
Breatherite W/Medium Mask, 36
Cefotetan/Dextrose, 1
camrese LO, 12, 39
Breatherite W/Small Mask, 36
cefoxitin sodium, 1
Canasa, 16
Breo Ellipta, 28
Cefoxitin Sodium, 1
Cancidas, 2
briellyn, 12, 39
cefpodoxime proxetil, 1
candesartan cilexetil, 7
Brilinta, 19
cefprozil, 1
candesartan cilexetil/hydrochlorothiazide, 7
brimonidine tartrate, 24
ceftazidime, 1
Bromday, 24
Ceftazidime, 1
Cantil, 15
Ceftazidime/Dextrose, 1
ciclopirox nail lacquer, 9
Cloderm, 10
Ceftibuten, 1
ciclopirox olamine, 9
Cloderm P.M., 10
Ceftin, 1
Ciclopirox Topical Solution Kit, 9
Clolar, 4
Ceftriaxone IN Iso-osmotic Dextrose, 1
ciclopirox treatment, 9
clomiphene citrate, 14
ceftriaxone sodium, 1
cidofovir, 2
clomipramine HCL, 20
Ceftriaxone/Dextrose, 1
cilostazol, 19
clonazepam, 21
cefuroxime axetil, 1
Ciloxan, 23
clonazepam odt, 21
cefuroxime sodium, 1
cimetidine, 15
clonidine HCL, 7, 25
Cefuroxime Sodium, 1
cimetidine HCL, 15
clonidine HCL ER, 21
Cefuroxime/Dextrose, 1
Cimzia, 16
clopidogrel, 19
celecoxib, 26
Cimzia Starter Kit, 16
clorazepate dipotassium, 20
Cellcept Intravenous, 4
Cinryze, 19
clotrimazole, 9, 19
Celontin, 21
Cipro HC, 24
clotrimazole/betamethasone dipropionate, 9
Cem-urea, 10
Ciprodex, 24
Cenestin, 11
ciprofloxacin, 2
clozapine, 20
Centany, 9
Ciprofloxacin, 24
Clozapine Odt, 20
Centrum Specialist Prenatal, 31
ciprofloxacin ER, 2
Cnl8 Nail Kit, 9
cephalexin, 1
ciprofloxacin HCL, 2, 23
CO-gesic, 26
Cephalexin, 1
Ciprofloxacin HCL, 2
CO-natal Fa, 30
Ceprotin, 19
ciprofloxacin I.V.-IN D5W, 2
Coaguchek Lancets, 32
Cerefolin, 38
cisatracurium besylate, 22
Coal TAR, 10
Cerezyme, 18
cisplatin, 3
Coartem, 3
cerisa wash, 8
Cisplatin, 3
Cod Liver Oil, 30
cerovel, 10
citalopram hydrobromide, 20
codeine sulfate, 26
Cervarix, 29, 41
citric acid/sodium citrate, 17
Codeine Sulfate, 26
Cesamet, 16
cladribine, 4
Colchicine, 27
cesia, 12, 39
Claforan, 1
Colcrys, 27
cetirizine HCL, 27
claravis, 8
colestipol HCL, 8
Cetrotide, 14
Claravis, 9
colestipol HCL for oral suspension, 8
cevimeline HCL, 19
Clarinex, 27
colistimethate sodium, 3
Chantix, 22, 43
Clarinex-d 12 HOUR, 28
colocort, 16
Chantix Continuing Month PAK, 22, 43
Clarinex-d 24 HOUR, 28
Coly-mycin S, 24
Chantix Starting Month PAK, 22, 43
claris clarifying wash, 8
Colyte-flavor Packs, 15, 43
chateal, 12, 39
clarithromycin, 1
Combigan, 23
Chemet, 38
clarithromycin ER, 1
Combipatch, 11
Chemstrip-k, 38
Classic Prenatal, 31, 41
Combivent, 28
Chenodal, 16
Cleanlet Lancets 28G, 32
Combivent Respimat, 28
childrens aspirin, 25, 38
clearplex x, 8
Cometriq, 5
childrens aspirin low strength, 25, 39
clemastine fumarate, 27
Comfort Assured Lancets Micro Thin 33G, 32
Chloramphenicol Sodium Succinate, 3
Clemastine Fumarate, 27
chlordiazepoxide HCL, 20
Cleocin, 17
Comfort Assured Lancets Super Thin 28G, 32
chlordiazepoxide HCL/clidinium bromide, 15
Clever Chek Lancets Ultrathin, 32
Clever Chek Lancets Ultrathin 30G, 32
Comfort Infusion Set 23"/17MM, 32
Chlordiazepoxide/Amitriptyline, 22
clindacin etz pledgets, 8
Comfort Infusion Set 31"/17MM, 32
chlorhexidine gluconate, 19
clindacin-p, 8
Comfort Infusion Set 43"/17MM, 32
chlorhexidine gluconate oral rinse, 19
clindamax, 8
Comfort Lancets, 32
chloromag, 36
clindamycin HCL, 3
Comfort SHORT Infusion Set 23"/13MM, 32
chloroprocaine HCL, 27
clindamycin palmitate HCL, 3
chloroquine phosphate, 3
clindamycin phosphate, 3, 8, 17
Comfort SHORT Infusion Set 31"/13MM, 32
chlorothiazide, 7
Clindamycin Phosphate, 3
Chlorothiazide, 7
clindamycin phosphate add-vantage, 3
Comfort SHORT Infusion Set 43"/13MM, 32
chlorothiazide sodium, 7
clindamycin phosphate IN D5W, 3
chlorpromazine HCL, 20
clindamycin phosphate pharmacy bulk package, 3
compazine, 20
Chlorpromazine HCL, 20
Complera, 2
Chlorpropamide, 13
clindamycin/benzoyl peroxide, 8
Complete Natal DHA, 30
Chlorthalidone, 7
Clindesse, 17
Completenate, 30
chlorzoxazone, 22
Clinimix 4.25%/Dextrose 10%, 37
compound 347, 27
choice-TABS, 30
Clinimix 4.25%/Dextrose 20%, 37
compro, 20
cholestyramine, 8
Clinimix 4.25%/Dextrose 25%, 37
Comvax, 29, 41
cholestyramine light, 8
Clinimix E 4.25%/Dextrose 25%, 37
Concerta, 21
choline magnesium trisalicylate, 25
clinisol SF 15%, 36
Condylox, 11
Choline Magnesium Trisalicylate, 25
clinpro 5000, 19
constulose, 15
chorionic gonadotropin, 14
clobetasol propionate, 9
Contact Detach Infusion Set 23" 6MM/29G, 32
chromium chloride, 36
clobetasol propionate e, 9
Chromium Chloride, 37
clobetasol propionate emollient, 9
Contact Detach Infusion Set 23" 8MM/29G, 32
Cialis, 8
Clocortolone Pivalate, 10
ciclodan, 9
Clocortolone Pivalate P.M., 10
Contact Detach Infusion Set 43" 6MM/29G, 32
ciclopirox, 9
clodan, 10
Contact Detach Infusion Set 43" 8MM/29G, 32
CVS vitamin d 5000 high-potency, 30, 43
dasetta 1/35, 12, 39
CVS vitamin d infants, 30, 43
dasetta 7/7/7, 12, 39
controlrx, 19
CVS vitamin d3, 30, 43
daunorubicin HCL, 4
Conzip, 26
CVS Vitamin D3, 30, 43
Daunoxome, 4
Copaxone, 22
cyanocobalamin, 17
daysee, 12, 39
Copper Sulfate, 37
Cyanocobalamin/Levomefolate Calcium/Pyridoxine HCL, 38
Daytrana, 21
Copper Trace Metal, 37
Ddrops, 30, 43
Cordran, 10
cyclafem 1/35, 12, 39
deblitane, 12, 39
Cordran Tape, 10
cyclafem 7/7/7, 12, 39
decara, 29, 43
Coreg CR, 6
cyclobenzaprine HCL, 22
decitabine, 4
Corifact, 19
cyclopentolate HCL, 24
deferoxamine mesylate, 36
cormax scalp application, 10
cyclophosphamide, 3
dehydrated alcohol, 36
cortic-nd, 24
Cyclophosphamide, 3
delflex-LC/1.5% dextrose, 36
Cortifoam, 16
Cycloserine, 2
delflex-lm/1.5% dextrose, 36
Cortisone Acetate, 11
Cycloset, 13
Delflex-lm/2.5% Dextrose, 37
Cortisporin, 9
cyclosporine, 4
Delflex-lm/4.25% Dextrose, 37
Cortisporin-tc, 24
cyclosporine modified, 4
Delflex-sm/1.5% Dextrose, 37
corvita, 30
Cyclosporine Modified, 4
Delflex-sm/2.5% Dextrose, 37
corvita 150, 17
cyotic, 24
delta d3, 29, 43
corvite free, 30
cyproheptadine HCL, 27
delyla, 12, 39
cosyntropin, 36
Cystadane, 15
Delzicol, 16
covaryx, 11
Cystagon, 17
demeclocycline HCL, 1
covaryx HS, 11
Cystaran, 24
Demser, 7
Creon, 16
cysteine HCL, 36
Denavir, 9
Crestor, 8
Cysteine HCL, 37
denta 5000 plus, 19
Crinone, 17
cytarabine, 4
dentagel, 19
Crixivan, 2
Cytarabine, 4
Depen Titratabs, 38
cromolyn sodium, 16, 24
cytarabine aqueous, 4
Depo-medrol, 11
Cromolyn Sodium, 28
Cytogam, 38
Depo-provera, 4
cryselle-28, 12, 39
cytra k crystals, 17
Depo-subq Provera 104, 12, 40
Cubicin, 3
cytra-2, 17
Depocyt, 4
Cuprimine, 38
Cytra-3, 17
Depodur, 26
Curity Alcohol Preps/Medium 2 Ply, 36
cytra-k, 17
Dermasorb Ta, 10
Curity Alcohol Swabs, 36
D
dermazene, 9
curity sterile saline, 17
desipramine HCL, 20
d 1000, 29, 43
Cuvposa, 16
desloratadine, 27
d 10000, 29, 43
CVS Alcohol Prep Swabs, 36
desloratadine odt, 27
d 2000, 29, 43
CVS Alcohol Swabs, 36
desmopressin acetate, 14
d 400, 29, 43
CVS aspirin, 25, 39
desogestrel/ethinyl estradiol, 12, 39
d 5000, 29, 43
CVS aspirin adult low dose, 25, 39
Desonate, 10
d-1000, 29, 43
CVS aspirin adult low strength, 25, 39
desonide, 10
d-1000 extra strength, 29, 43
CVS aspirin child, 25, 39
Desowen Cream/Cetaphil Lotion, 10
d-2000 maximum strength, 29, 43
CVS aspirin EC, 25, 39
Desowen Lotion/Cetaphil Cream, 10
d-3-5, 29, 43
CVS aspirin low dose, 25, 39
Desowen Ointment/Cetaphil Lotion, 10
d-400, 29, 43
CVS aspirin low strength, 25, 39
desoximetasone, 10
d-5000, 29, 43
CVS childrens aspirin, 25, 39
Desoximetasone, 10
d-5000 maximum strength, 29, 43
CVS childrens vitamin d for bone health, 30, 43
Desvenlafaxine ER, 20
d-vita, 29, 43
Detachable Face Mask, 36
d2000 ultra strength, 29, 43
CVS enteric aspirin, 25, 39
dexamethasone, 11
d3, 29, 43
CVS folic acid, 18, 41
Dexamethasone, 11
D3, 30, 43
CVS iron, 18, 42
Dexamethasone Intensol, 11
d3 adult, 29, 43
CVS Lancets 21G, 32
dexamethasone sodium phosphate, 11, 23
D3 Dots, 30, 43
CVS Lancets Micro Thin 33G, 32
d3 high potency, 29, 43
CVS Lancets Original, 32
Dexamethasone Sodium Phosphate, 11
d3 kids, 30, 43
CVS Lancets Thin 26G, 32
Dexchlorpheniramine Maleate, 27
d3 maximum strength, 30, 43
CVS Lancets Ultra Thin 30G, 32
dexedrine, 21
d3 super strength, 30, 43
CVS nicotine, 22, 42
dexferrum, 17
d3 ultra strength, 30, 43
CVS nicotine polacrilex, 22, 42
Dexilant, 16
d3-1000, 30, 43
CVS nicotine polacrilex starter, 22, 42
dexmedetomidine HCL, 21
d3-50, 30, 43
CVS nicotine transdermal system, 22, 42
dexmethylphenidate HCL, 21
dacarbazine, 5
CVS nts step 1, 22, 42
dexmethylphenidate HCL ER, 21
Dacarbazine, 5
CVS Prenatal, 31, 41
Dexpak 10 Day, 11
Daliresp, 28
CVS Prenatal Gummy/DHA/Folic Acid, 31
Dexpak 13 Day, 11
danazol, 11
Dexpak 6 Day, 11
dantrolene sodium, 22
CVS Prenatal Multi+dha, 31
Dexpanthenol, 16
Dantrolene Sodium, 23
CVS Slow Release Iron, 18, 42
dexrazoxane, 5
Dapsone, 3
CVS Ultra Thin Lancets, 32
dextroamphetamine sulfate, 21
Daptacel, 29, 41
CVS vitamin d, 30, 43
dextroamphetamine sulfate ER, 21
Daraprim, 3
Dextromethorphan HBR/Chlorpheniramine/Phenylephrine HCL, 28
dihydroergotamine mesylate, 27
Drug Mart Unilet Lancets Super Thin 30G, 32
Dihydroergotamine Mesylate, 27
Dilantin, 21
Drug Mart Unilet Lancets Ultra Thin 28G, 32
Dilatrate SR, 6
dextrose 10%, 36
dilt-CD, 6
Duane Reade Lancet Alternate Site 26G, 32
dextrose 10% flex container, 36
dilt-XR, 6
Dextrose 10%/NACL 0.2%, 37
diltiazem CD, 6
Duane Reade Lancet Super Thin 30G, 32
Dextrose 10%/NACL 0.225%, 37
diltiazem HCL, 6
Dextrose 10%/NACL 0.45%, 37
Diltiazem HCL, 6
Duane Reade Lancet Ultra Thin 28G, 32
dextrose 2.5%/NACL 0.45%, 36
diltiazem HCL CD, 6
Dulera, 28
dextrose 2.5%/sodium chloride 0.45%, 36
diltiazem HCL ER, 6
duloxetine HCL, 20
diltzac, 6
duramorph, 26
Dextrose 20%, 37
Dimenhydrinate, 16
duraxin, 25
Dextrose 25%, 37
Dipentum, 16
Durezol, 23
dextrose 30%, 36
diphenhydramine HCL, 27
Dymista, 27
dextrose 30% partial fill, 36
diphenoxylate/atropine, 15
Dyrenium, 7
Dextrose 40%, 37
Diphenoxylate/Atropine, 15
Dysport, 22
dextrose 5%, 36
Diphtheria/Tetanus Toxoids Adsorbed Pediatric, 29, 41
E
Dextrose 5% /Electrolyte #48 Viaflex, 37
dextrose 5% viaflex, 36
E-z Ject Lancets, 32
dipyridamole, 19, 37
dextrose 5%/lactated ringers, 36
E-z Ject Lancets 21G, 32
disopyramide phosphate, 6
dextrose 5%/NACL 0.2%, 36
E-z Ject Lancets Color, 32
disulfiram, 22
Dextrose 5%/NACL 0.225%, 37
E-z Ject Lancets Super Thin, 32
divalproex sodium, 21
Dextrose 5%/NACL 0.3%, 37
E-z Ject Lancets Super Thin 30G, 32
divalproex sodium DR, 21
dextrose 5%/NACL 0.33%, 36
E-z Ject Lancets Thin 26G, 32
divalproex sodium ER, 21
dextrose 5%/NACL 0.45%, 36
E-z Spacer, 36
dobutamine HCL, 7
dextrose 5%/NACL 0.9%, 36
E-z Spacer The Body Guards Pack, 36
dobutamine HCL/D5W, 7
dextrose 5%/potassium chloride 0.15%, 36
E-ZJECT Lancets Micro-thin 33G, 32
dobutamine/dextrose 5%, 7
E.e.s. 400, 1
Dobutamine/Dextrose 5%, 7
dextrose 5%/ringers, 36
e.s.p., 3
Docefrez, 5
dextrose 5%/sodium chloride 0.2%, 36
Easivent, 36
Docetaxel, 5
dextrose 5%/sodium chloride 0.33%, 36
Easivent/Mask-large, 36
docetaxel, 5
dextrose 5%/sodium chloride 0.45%, 36
Easivent/Mask-medium, 36
dologesic, 25
dextrose 5%/sodium chloride 0.9%, 36
Easivent/Mask-small, 36
dolorex, 25
dextrose 50%, 36
Easy Comfort Lancets, 32
donepezil HCL, 22
dextrose 70%, 36
Easy Comfort Lancets 30G/Pull Top, 32
Donnatal, 16
Diabeta, 13
Easy Comfort Lancets 30G/Thin Top, 32
Donnatal Extentabs, 16
dialyvite, 30
Easy Touch Alcohol Prep Pads/Medium, 36
dopamine HCL, 7
dialyvite vitamin d 5000, 29, 43
Dopamine HCL, 7
Dialyvite Vitamin D3 Max, 30, 43
Easy Touch Lancets 21G/Pressure Activated, 32
dopamine HCL-dextrose 5%, 7
Diastar Easy Test II Lancets 30G, 32
dopamine HCL/dextrose 5%, 7
Diastar Easy Test Lancets30G, 32
Easy Touch Lancets 23G/Pressure Activated, 32
dopamine/D5W, 7
Diastat Pediatric, 21
Doribax, 3
diazepam, 20
Easy Touch Lancets 26G/Pressure Activated, 32
dorzolamide HCL, 24
Diazepam, 20, 21
dorzolamide HCL/timolol maleate, 23
diazepam intensol, 20
Easy Touch Lancets 28G/Pressure Activated, 32
doxapram HCL, 21
Dibenzyline, 7
doxazosin mesylate, 7
diclofenac potassium, 26
Easy Touch Lancets 28G/Twist, 32
doxepin HCL, 20
diclofenac sodium, 9, 10, 24
Easy Touch Lancets 30G/Pressure Activated, 32
Doxepin HCL, 20
diclofenac sodium DR, 26
doxercalciferol, 14
diclofenac sodium ER, 26
Easy Touch Lancets 30G/Twist, 32
doxorubicin HCL, 4
diclofenac sodium/misoprostol, 26
Easy Touch Lancets 32G/Pressure Activated, 32
doxorubicin HCL liposome, 4
dicloxacillin sodium, 1
doxy 100, 1
dicyclomine HCL, 15
Easy Touch Lancets 32G/Twist, 32
doxycycline, 1
Dicyclomine HCL, 15
Easy Touch Lancets 33G/Twist, 32
Doxycycline, 9
didanosine, 2
Easy Touch Safety Lancets21G/Pressure Activated, 32
doxycycline hyclate, 1
diethylpropion HCL, 21
doxycycline hyclate DR, 1
Diethylpropion HCL, 21
Easy Touch Safety Lancets23G/Pressure Activated, 32
doxycycline monohydrate, 1
diethylpropion HCL ER, 21
Dritho-creme HP, 9
Differin, 9
Easy Touch Safety Lancets26G/Button Activated, 32
dronabinol, 16
Dificid, 1
droperidol, 20
difil-G forte, 28
Easy Touch Safety Lancets26G/Pressure Activated, 32
Droplet Lancets Ultra Thin 30G, 32
diflorasone diacetate, 10
drospirenone/ethinyl estradiol, 12, 39
Diflorasone Diacetate, 10
Easy Touch Safety Lancets28G/Button Activated, 32
Droxia, 18
diflunisal, 25
Drug Mart Lancets Thin, 32
digitek, 6
Easy Touch Safety Lancets28G/Pressure Activated, 32
Drug Mart Lancets Ultra Thin, 32
digox, 6
Drug Mart On-the-go Lancets Gentle 30G, 32
digoxin, 6
Easy Twist & CAP Lancets, 32
Digoxin, 6
easygel, 19
Easytest II Lancets, 32
epinastine HCL, 24
esomeprazole sodium, 15
Easytest Lancets, 33
Epinephrine, 7
Esomeprazole Sodium, 15
EC-81 aspirin, 25, 39
epinephrine HCL, 28
Esomeprazole Strontium, 16
econazole nitrate, 9
Epipen 2-PAK, 7
estarylla, 12, 39
ecotrin low strength, 25, 39
Epipen-JR 2-PAK, 8
estazolam, 21
ecpirin, 25, 39
epirubicin HCL, 4
esterified estrogens/methltestosterone, 11
Ed Cyte F, 17
Epirubicin HCL, 4
ed-flex, 25
episone CRE, 10
esterified estrogens/methyltestosterone, 11
ed-spaz, 15
epitol, 21
Edarbi, 7
Epivir HBV, 2
esterified estrogens/methyltestosterone DS, 11
Edarbyclor, 7
eplerenone, 7
Edecrin, 7
Epogen, 18
esterified estrogens/methyltestosterone HS, 11
Edurant, 2
epoprostenol sodium, 8
eemt, 11
eprosartan mesylate, 7
Estrace, 17
eemt HS, 11
Epzicom, 2
estradiol, 11
effer-k, 37
eq adult aspirin low strength, 25, 39
estradiol valerate, 11
Effer-k, 38
eq aspirin, 25, 39
estradiol/norethindrone acetate, 11
effervescent pot chloride, 37
eq aspirin adult low dose, 25, 39
Estring, 17
effervescent potassium, 37
eq aspirin EC, 25, 39
Estrogel, 11
effervescent potassium/chloride, 37
eq aspirin low dose, 25, 39
estropipate, 11
Effient, 19
eq childrens aspirin, 25, 39
Estropipate, 11
Egrifta, 14
eq nicotine, 22, 42
eszopiclone, 21
Elaprase, 15
eq nicotine gum refill, 22, 42
ethambutol HCL, 2
Elelyso, 18
eq nicotine gum starter, 22, 42
ethosuximide, 21
Elidel, 10
eq nicotine polacrilex, 22, 42
Etidronate Disodium, 13
Eligard, 4
eq nicotine step 3, 22, 42
etodolac, 26
elinest, 12, 39
eq slow-release iron, 18, 42
etodolac ER, 26
Eliquis, 19
eql adult aspirin low strength, 25, 39
etomidate, 27
Elite Iron, 18, 42
eql aspirin, 25, 39
Etopophos, 5
Elite-OB, 30
eql aspirin EC, 25, 39
etoposide, 5
Elitek, 5
eql aspirin low dose, 25, 39
Etoposide, 5
Elixophyllin, 28
eql childrens aspirin, 25, 39
Euflexxa, 23
Ella, 12
eql childrens vitamin d gummies, 30, 43
Eurax, 11
Elmiron, 17
Eql Color Lancets 21G, 33
Evamist, 11
Eloctate, 19
Eql Color Lancets Micro Thin 33G, 33
Exalgo, 26
Eloxatin, 3
eql folic acid, 18, 41
Exelderm, 9
Elspar, 4
eql iron supplement therapy, 18, 42
Exelon, 22
Emadine, 24
eql nicotine, 22, 42
exemestane, 4
Embeda, 26
eql nicotine polacrilex, 22, 42
Exjade, 38
Embrace Lancets Ultra Thin 30G, 33
eql nicotine polacrilex refill, 22, 42
exoderm, 9
Emcyt, 4
eql nicotine polacrilex starter, 22, 42
exotic-HC, 24
Emend, 16
Eql Prenatal Formula, 31, 41
Extavia, 22
emoquette, 12, 39
eql slow release iron, 18, 42
Eylea, 24
Emsam, 20
Eql Super Thin Lancets 30G, 33
EZ Smart Blood Glucose Lancets, 33
Emtriva, 2
Eql Thin Lancets 26G, 33
EZ-lets Lancets 21G, 33
Enablex, 17
eql vitamin d-3, 30, 43
EZ-lets Lancets 23G, 33
enalapril maleate, 6
eql vitamin d3, 30, 43
EZ-lets Lancets 26G Super-soft, 33
enalapril maleate/hydrochlorothiazide, 7
Eraxis, 2
EZ-lets Lancets 28G Ultra-soft, 33
enalaprilat, 7
Erbitux, 4
EZ-lets Lancets 30G, 33
Enbrel, 27
ergocalciferol, 29
ezfe 200, 18, 42
Enbrel Sureclick, 27
ergoloid mesylates, 22
F
Encare, 17, 40
Ergomar, 27
fa-8, 18, 41
endocet, 26
Erivedge, 5
Fa-8, 18, 41
endodan, 26
errin, 12, 39
fabb, 17
Endometrin, 17
Ertaczo, 9
Fabrazyme, 15
Enfamil Expecta, 31
Erwinaze, 4
Factive, 2
Engerix-b, 29, 41
ery, 8
falmina, 12, 39
Enjuvia, 11
Ery-TAB, 1
famciclovir, 2
Enovarx-cyclobenzaprine HCL, 23
Erythrocin Lactobionate, 1
famotidine, 15
enoxaparin sodium, 18
erythromycin, 1, 8, 23
Famotidine, 15
enpresse-28, 12, 39
Erythromycin Base, 1
Famotidine Premixed, 15
enskyce, 12, 39
Erythromycin Ethylsuccinate, 1
Fanapt, 20
entacapone, 21
erythromycin/benzoyl peroxide, 8
Fanapt Titration Pack, 20
entecavir, 3
Escavite LQ, 30
Fareston, 4
enteric coated aspirin, 25, 39
escitalopram oxalate, 20
Faslodex, 4
enulose, 16
esgic, 25
Fasttake Compact Monitoring System, 33
ephedrine sulfate, 7
Esgic, 25
Epiduo, 9
esmolol HCL, 6
Fasttake Test Strips, 33
Fazaclo, 20
First-lansoprazole, 16
Flura-drops, 38, 41
Fc Female Condom, 40
Flagyl ER, 3
flurazepam HCL, 21
Fc2 Female Condom, 40
Flarex, 23
Flurazepam HCL, 21
FE Aspartate, 18, 42
flavoxate HCL, 17
flurbiprofen, 26
FE c plus, 17
Flebogamma Dif, 38
flurbiprofen sodium, 24
FE gluconate, 18, 42
flecainide acetate, 6
flurox, 24
FE TABS, 18, 42
Flector, 9
flutamide, 4
Feiba, 19
flexbumin, 19
fluticasone propionate, 10, 27
Feiba NF, 19
Flovent Diskus, 28
fluvastatin, 8
felbamate, 21
Flovent HFA, 28
Fluvirin 2013-2014, 29, 41
felodipine ER, 6
floxuridine, 4
Fluvirin 2014-2015, 29, 41
Femcap, 40
Fluarix 2013-2014, 29, 41
Fluvirin PF 2013-2014, 29, 41
Femiron, 18, 42
Fluarix 2014-2015, 29, 41
Fluvirin PF 2014-2015, 29, 41
fenofibrate, 8
Fluarix Quadrivalent 2013-2014, 29, 41
fluvoxamine maleate, 20
Fenofibrate, 8
Fluarix Quadrivalent 2014-2015, 29, 41
fluvoxamine maleate ER, 20
fenofibrate micronized, 8
Flublok 2013-2014, 29, 41
Fluzone High-dose PF 2013-2014, 29, 41
Fenofibric Acid, 8
Flublok 2014-2015, 29, 41
fenofibric acid DR, 8
flucaine, 24
Fluzone High-dose PF 2014-2015, 29, 41
Fenoglide, 8
Flucelvax 2013-2014, 29, 41
fenoldopam mesylate, 7
Flucelvax 2014-2015, 29, 41
Fluzone Intradermal, 29, 41
Fenoprofen Calcium, 26
fluconazole, 2
Fluzone Intradermal Quadrivalent, 29, 41
fentanyl, 26
fluconazole IN dextrose, 2
Fluzone Pediatric PF 2013-2014, 29, 41
fentanyl citrate, 26
fluconazole IN NACL, 2
Fluzone PF 2013-2014, 29, 41
fentanyl citrate oral transmucosal, 26
Fluconazole IN NACL, 2
Fluzone PF 2014-2015, 29, 41
Fentora, 26
flucytosine, 2
Fluzone Quadrivalent 2013-2014, 29, 41
feosol, 18, 42
fludarabine phosphate, 4
Fluzone Quadrivalent 2014-2015, 29, 41
Feosol, 18, 42
fludrocortisone acetate, 11
Fluzone Split 2013-2014, 29, 41
fer-iron, 18, 42
Flulaval 2013-2014, 29, 41
Fluzone Split 2014-2015, 29, 41
Feraheme, 18
Flulaval 2014-2015, 29, 41
FML, 23
ferate, 18, 42
Flulaval Quadrivalent 2013-2014, 29, 41
Focalin XR, 21
ferocon, 17
Flulaval Quadrivalent 2014-2015, 29, 41
folastin, 37
ferosul, 18, 42
flumazenil, 37
Folbecal, 30
ferotrinsic, 17
Flumist Nasal Vaccine 2012-2013, 29, 41
folbee, 17
Ferraplus 90, 17
Flumist Quadrivalent, 29, 41
folbee plus, 30
ferretts, 18, 42
flunisolide, 27
folbee plus cz, 30
Ferretts Chewable Iron, 18
Flunisolide, 27
folbic, 37
Ferretts IPS, 18, 42
fluocinolone acetonide, 10, 24
Folbic RF, 38
ferrex 150, 18, 42
fluocinolone acetonide body, 10
folcaps, 17
Ferrex 150 Forte Plus, 18
fluocinolone acetonide ear drops, 24
folic acid, 17, 41
Ferrex 28, 18
fluocinolone acetonide scalp, 10
Folic Acid, 17
ferric x-150, 18, 42
fluocinonide, 10
folic acid/vitamin b-6/vitamin b-12, 17
Ferrimin 150, 18, 42
fluocinonide-e, 10
Follistim AQ, 14
Ferriprox, 38
fluor-a-day, 38, 40
Folotyn, 4
ferro-bob, 18, 42
Fluor-a-day, 38, 41
folplex 2.2, 17
Ferro-sequels, 18, 42
fluor-i-strips a.t., 24
Foltrate, 18
ferrocite, 18, 42
Fluorabon, 38, 41
foltrin, 17
ferrocite plus, 17
fluorescein-benoxinate, 24
Foltx, 38
ferrogels forte, 17
fluorescein/proparacaine, 24
fomepizole, 37
ferrotabs, 18, 42
fluorets, 24
fondaparinux sodium, 18
ferrous drops, 18, 42
fluoride, 38, 40
Fora Lancets, 33
Ferrous Fumarate, 18, 42
fluoridex daily defense, 19
Foradil Aerolizer, 28
ferrous fumarate 324, 18, 42
fluoridex daily defense enhanced whitening, 19
Forfivo XL, 20
ferrous gluconate, 18, 42
formadon, 37
Ferrous Gluconate, 18, 42
fluoridex daily defense sensitivity relief, 19
formaldehyde, 37
ferrous sulfate, 18, 42
Forteo, 14
Ferrous Sulfate, 18, 42
fluoritab, 38, 40
Fortical, 14
ferrousul, 18, 42
fluorometholone, 23
Fosamax Plus D, 13
ferus, 18, 42
Fluoroplex, 11
Foscarnet Sodium, 2
Fibricor, 8
fluorouracil, 4, 10
fosinopril sodium, 7
Fifty50 Alcohol Prep Pads, 36
Fluorouracil, 11
fosinopril sodium/hydrochlorothiazide, 7
Fifty50 Safety Seal Lancets 30G, 33
fluoxetine, 22
fosphenytoin sodium, 21
Fifty50 Safety Seal Lancets 32G, 33
fluoxetine DR, 20
Fosrenol, 16
Finacea, 9
fluoxetine HCL, 20
Fragmin, 19
finasteride, 10, 17
Fluoxetine HCL, 20
Freamine Iii, 37
Fine 30, 33
fluphenazine decanoate, 20
Freds Pharmacy Unilet Lancets Super Thin 30G, 33
Fingerstix Lancets, 33
fluphenazine HCL, 20
Firazyr, 19
Fluphenazine HCL, 20
Freds Pharmacy Unilet Lancets Ultra Thin 28G, 33
Firmagon, 4
flura-drops, 38, 40
Freestyle Lancets, 33
Geodon, 20
gnp vitamin d, 30, 43
Freestyle Unistick II Lancets, 33
gianvi, 12, 39
gnp vitamin d maximum strength, 30, 43
fresenius propoven, 27
Giazo, 16
gnp vitamin d super strength, 30, 43
Frova, 27
gildagia, 12, 39
gnp vitamin d3 extra strength, 30, 43
ful-GLO, 24
gildess 1.5/30, 12, 39
Golytely, 15, 43
furosemide, 7
gildess 1/20, 12, 39
Gonal-f, 14
Furosemide, 7
gildess 24 FE, 12, 39
Gonal-f RFF, 14
Fusilev, 5
gildess FE 1.5/30, 12, 39
Gonal-f RFF Pen, 14
Fuzeon, 2
gildess FE 1/20, 12, 39
Gonal-f RFF Rediject, 14
Fycompa, 21
Gilenya, 22
goodsense aspirin low dose, 25, 39
G
Gilotrif, 5
Goodsense Prenatal Vitamins, 31, 41
giltuss pediatric, 28
grafco silver nitrate applicator, 10
gabapentin, 21
Giltuss TR, 28
Gralise, 22
Gabitril, 21
Glassia, 28
Gralise Starter, 22
Gablofen, 23
Gleevec, 5
granisetron HCL, 16
galantamine, 22
Gleostine, 3
Granisol, 16
galantamine hydrobromide, 22
Gliadel Wafer, 3
green GLO lissamine greenophthalmic strips, 24
Galantamine Hydrobromide, 22
glimepiride, 13
Galzin, 38
glipizide, 13
griseofulvin microsize, 2
Gamastan S/D, 38
glipizide ER, 13
griseofulvin ultramicrosize, 2
Gammagard Liquid, 38
glipizide XL, 13
grx hicort 25, 16
Gammagard S/D, 38
glipizide/metformin HCL, 13
guanfacine ER, 21
Gammagard S/D Iga Less Than 1mcg/ML, 38
Global Alcohol Prep Ease Pads, 36
guanfacine HCL, 7
Global Inject Ease Lancets 28G, 33
Guanidine HCL, 23
Gammaked, 38
Global Inject Ease Lancets 30G, 33
Gynazole-1, 17
Gammaplex, 38
Glucagen, 13
H
Gamunex-c, 38
Glucagen Hypokit, 13
ganciclovir, 2
H&h Thinlet Lancets 26G, 33
Glucagon Emergency Kit, 13
Ganirelix Acetate, 14
H&h Thinlet Super Thin Lancets 30G, 33
Glucocom Lancets 28G, 33
Ganite, 14
H-e-b Incontrol Lancets Super Thin 30G, 33
Glucocom Lancets 30G, 33
garamycin, 23
Glucocom Lancets 33G, 33
Gardasil, 29, 41
H-e-b Incontrol Lancets Ultra Thin 28G, 33
Glucopro Syringe Reservoir/3ML/Needle/22G X 3/8", 33
Gardasil 9, 29, 41
Gastrinex NF, 15
H.p. Acthar, 14
Glucose Control Normal, 33
gatifloxacin, 23
Haemolance, 33
Glucose Control Solution, 33
Gattex, 16
Haemolance Low Flow Lancets, 33
Glucosource Lancets, 33
gavilyte-c, 15, 43
Haemolance Plus, 33
Glumetza, 13
gavilyte-G, 15, 43
Haemolance Plus High Flow, 33
glyburide, 13
gavilyte-n/flavor pack, 15, 43
Haemolance Plus Low Flow, 33
Glyburide, 13
Gazyva, 4
Haemolance Plus Max Flow, 33
glyburide micronized, 13
Gelnique, 17
Haemolance Plus Pediatric Flow, 33
glyburide/metformin HCL, 13
Gemcitabine, 4
halac, 10
glycine, 17
gemcitabine HCL, 4
Halaven, 5
Glycolic Acid, 9
gemfibrozil, 8
halobetasol propionate, 10
Glycolic Acid 70% High Purity, 9
gene-xene TAB 15MG, 20
Halog, 10
glycopyrrolate, 15
gene-xene TAB 3.75MG, 20
halonate PAC, 10
glydo, 10
gene-xene TAB 7.5MG, 20
haloperidol, 20
Glyset, 13
generlac, 16
haloperidol decanoate, 20
Gmate Lancets 30G, 33
gengraf, 4
haloperidol lactate, 20
gnp adult aspirin low strength, 25, 39
Genotropin, 14
Harvoni, 3
Gnp Alcohol Swabs, 36
Genotropin Miniquick, 14
Havrix, 29, 41
gnp aspirin, 25, 39
gentak, 23
Healthwise Alcohol Prep Pads, 36
gnp aspirin low dose, 25, 39
gentamicin sulfate, 2, 23
Healthwise Lancets 30G, 33
Gnp Daily Prenatal, 31, 41
Gentamicin Sulfate, 9
Healthy Accents Unilet Lancets Super Thin 30G, 33
gnp folic acid, 18, 41
gentamicin sulfate pediatric, 2
gnp iron, 18, 42
gentamicin sulfate/0.9% sodium chloride, 2
healthy kids vitamin d3, 30, 43
Gnp Lancets, 33
Healthy Mama Be Well Rounded, 31
Gnp Lancets 21G, 33
Gentamicin Sulfate/0.9% Sodium Chloride, 2
heather, 12, 39
Gnp Lancets Micro Thin 33G, 33
hecoria, 4
Gnp Lancets Super Thin 30G, 33
gentamicin sulfate/sodium chloride, 2
Hectorol, 14
Gnp Lancets Thin, 33
Gentle-let GP Lancets, 33
Helidac, 16
Gnp Lancets Thin 26G, 33
Gentle-let Lancets General Purpose Style/Fine Point, 33
Helixate FS, 19
Gnp Micro Thin Lancets 33G, 33
hematinic plus vitamins/minerals, 17
gnp nicotine polacrilex, 22, 42
Gentle-let Lancets General Purpose Style/Medium Point, 33
hematinic/folic acid, 17
gnp nicotine polacrilex mini, 22, 42
hematogen, 17
Gnp Prenatal, 31, 41
Gentle-let Lancets Safety Style/Fine Point, 33
Hematogen Fa, 17
Gnp Prenatal Vitamins, 31, 41
hematogen forte, 17
gnp slow release iron, 18, 42
Gentle-let Lancets Safety Style/Medium Point, 33
hemocyte-f, 17
Gnp Super Thin Lancets/30G, 33
hemocyte-plus, 17
Hemofil M, 19
Humira Pen-psoriasis Starter, 27
hyoscyamine sulfate SR, 15
hemril-30, 16
Humulin 70/30, 13
hyosyne, 15
hep flush-10, 18
Humulin 70/30 Kwikpen, 13
hypercare, 10
Hepagam B, 38
Humulin 70/30 Pen, 13
Hyperhep B S/D, 38
heparin lock, 18
Humulin N, 13
Hyperlyte-CR, 37
heparin lock flush, 18
Humulin N Kwikpen, 13
Hyperrab S/D, 38
Heparin Lock Flush, 19
Humulin N U-100 Pen, 13
Hyperrho S/D, 38
heparin lock flush for flushing vascular access devices, 18
Humulin R, 13
Hyperrho S/D Mini-dose, 38
Humulin R U-500 (concentrated), 13
I
heparin lock flush/NACL for flushing vascular access devices, 18
Hy-vee Lancets, 33
ibandronate sodium, 13
Hy-vee Thin Lancets, 33
ibudone, 26
heparin sodium, 18
Hyalgan, 23
ibuprofen, 26
Heparin Sodium, 19
Hycamtin, 5
ibutilide fumarate, 6
heparin sodium dcu, 18
hydralazine HCL, 7
Iclusig, 5
heparin sodium lock flush, 18
hydrochloric acid, 17
idarubicin HCL, 4
heparin sodium/D5W, 19
hydrochlorothiazide, 7
iferex 150, 18, 42
Heparin Sodium/D5W, 19
hydrocodone bitartrate/acetaminophen, 26
iferex 150 forte, 17
Heparin Sodium/NACL 0.45%, 19
Ifex, 4
heparin sodium/NACL 0.9%, 19
Hydrocodone Bitartrate/Acetaminophen, 26
ifosfamide, 3
Heparin Sodium/Sodium Chloride 0.9%, 19
Ifosfamide, 4
hydrocodone bitartrate/chlorpheniramine maleate/PSE, 28
Ifosfamide/Mesna, 5
heparin sodium/sodium chloride 0.9% premix, 18
Ilaris, 27
hydrocodone bitartrate/homatropine methylbromide, 28
Ilevro, 24
hepatamine, 37
ilotycin, 23
hepatasol, 37
hydrocodone polistirex/chlorpheniramine polistirex, 28
Imbruvica, 5
Herceptin, 4
imipenem/cilastatin, 3
hetastarch 6%/NACL, 19
hydrocodone/acetaminophen, 26
imipramine HCL, 20
Hetlioz, 21
Hydrocodone/Acetaminophen, 26
imipramine pamoate, 20
Hexalen, 3
hydrocodone/homatropine, 28
imiquimod, 10
Hiberix, 29, 41
hydrocodone/ibuprofen, 26
Imogam Rabies-ht, 37
high potency iron, 18, 42
hydrocort ene 100MG, 16
Imovax Rabies (h.d.c.v.), 29
High Potency Iron, 18, 42
hydrocortisone, 10, 11, 16
Implanon, 13, 40
Hizentra, 38
hydrocortisone acetate, 16
Inatal Advance, 30
HM aspirin, 25, 39
hydrocortisone acetate/aloe, 10
Inatal GT, 30
HM aspirin EC, 25, 39
hydrocortisone acetate/lidocaine HCL, 16
Inatal Ultra, 30
HM aspirin EC low dose, 25, 39
hydrocortisone acetate/pramoxine, 10, 16
Increlex, 14
HM folic acid, 18, 41
indapamide, 7
HM iron, 18, 42
hydrocortisone acetate/pramoxine HCL, 16
Inderal XL, 6
HM iron slow release, 18, 42
indigo carmine, 37
HM Lancets Micro Thin 33G, 33
hydrocortisone butyrate, 10
indocyanine green, 37
HM Lancets Ultra Thin 30G, 33
hydrocortisone butyrate (lipid), 10
indomethacin, 26
HM nicotine polacrilex, 22, 43
hydrocortisone butyrate (lipophilic), 10
Indomethacin, 26
HM nicotine transdermal system, 22, 43
hydrocortisone IN absorbase, 10
indomethacin ER, 26
HM nicotine transdermal system step 3, 22, 43
hydrocortisone valerate, 10
indomethacin sodium, 26
hydrocortisone/acetic acid, 24
Infanrix, 29, 41
HM One Daily Prenatal Combo, 31, 41
hydrocortisone/iodoquinol, 9
infed, 17
HM Prenatal, 31, 41
hydrogesic, 26
Infergen, 3
HM vitamin d, 30, 43
hydromet, 28
Influenza A (h1n1) Monovalent 2009, 29, 41
HM vitamin d3, 30, 43
hydromorphone HCL, 26
HM Vitamin D3, 30, 43
Hydromorphone HCL, 26
Infumorph 200, 26
homatropaire, 24
Hydromorphone HCL Dosette, 26
Infumorph 500, 26
homatropine HBR, 24
hydromorphone HCL ER, 26
infuvite, 30
Horizant, 22
Hydromorphone HCL ER, 26
infuvite adult, 30
Humalog, 13
hydroquinone, 10
infuvite pediatric, 30
Humalog Kwikpen, 13
hydroquinone time release, 10
Inlyta, 5
Humalog Mix 50/50, 13
Hydroxocobalamin, 17
Innopran XL, 6
Humalog Mix 50/50 Kwikpen, 13
hydroxychloroquine sulfate, 3
Inset 30 Infusion Set 23", 33
Humalog Mix 75/25, 13
hydroxyurea, 5
Inset 30 Infusion Set 43", 33
Humalog Mix 75/25 Kwikpen, 13
hydroxyzine HCL, 20
Inset Infusion Set 23" 6MM, 33
human albumin grifols, 19
Hydroxyzine HCL, 20
Inset Infusion Set 23" 9MM, 33
Humate-p, 19
hydroxyzine pamoate, 20
Inset Infusion Set 43" 6MM, 33
Humatrope, 14
Hydroxyzine Pamoate, 20
Inset Infusion Set 43" 9MM, 33
Humatrope Combo Pack, 14
hygel, 10
Inspirachamber/Anti-static Valved/Mouthpiece, 36
Humira, 27
hyomax-SL, 15
Humira Pediatric Crohns Disease Starter Pack, 27
hyophen, 16
Inspirachamber/Soothermask/Inspiramask/Medium, 36
hyoscyamine sulfate, 15
Humira Pen, 27
hyoscyamine sulfate ER, 15
Inspirachamber/Soothermask/Inspiramask/Small, 36
Humira Pen-crohns Diseasestarter, 27
hyoscyamine sulfate odt, 15
Inspirease Bags, 36
Ixempra Kit, 5
klor-CON 10, 37
Inspirease Drug Delivery System, 36
Ixiaro, 29
klor-CON 8, 37
Inspirease Mouthpiece, 36
J
klor-CON m10, 37
Inspirease Reservoir Bags, 36
Klor-CON M15, 38
Jakafi, 5
Insulin P.M. IR2020 Black, 33
klor-CON m20, 37
jantoven, 19
Insulin P.M. IR2020 Blue, 33
klor-CON/EF, 37
Janumet, 13
Insulin P.M. IR2020 Green, 33
kls aspirin EC, 25, 39
Janumet XR, 13
Insulin P.M. IR2020 Red, 33
kls aspirin low dose, 25, 39
Januvia, 13
Insulin P.M. IR2020 Silver, 33
kls quit2, 22, 42
jencycla, 12, 39
Integrilin, 19
kls quit4, 22, 42
Jentadueto, 13
Intelence, 2
Koate-dvi, 19
Jetrea, 24
Intermezzo, 21
Kogenate FS, 19
Jevtana, 5
intralipid, 37
Kogenate FS Bio-set, 19
Jinteli, 11
Intron A, 5
Kombiglyze XR, 13
jolessa, 12, 39
Intron-a, 5
kp aspirin, 25, 39
jolivette, 12, 39
Intron-a W/Diluent, 5
kp ferrous gluconate, 18, 42
junel 1.5/30, 12, 39
introvale, 12, 39
kp ferrous sulfate, 18, 42
junel 1/20, 12, 39
Invanz, 3
kp folic acid, 18, 41
junel FE 1.5/30, 12, 39
Invega, 20
Kp Prenatal Multivitamins, 31, 41
junel FE 1/20, 12, 39
Invega Sustenna, 20
kp vitamin d, 30, 43
just d, 30, 43
Invirase, 2
Kristalose, 15
Juvisync, 13
Invokana, 13
Kroger Lancets, 33
Juxtapid, 8
Iopidine, 24
Kroger Lancets 21G, 33
K
Ipol Inactivated IPV, 29, 41
Kroger Lancets Micro Thin33G, 33
ipratropium bromide, 27, 28
Kroger Lancets Super Thin, 33
k-effervescent, 37
ipratropium bromide/albuterol sulfate, 28
Kroger Lancets Thin, 33
K-phos, 38
irbesartan, 7
Kroger Lancets Thin 26G, 33
k-prime, 37
irbesartan/hydrochlorothiazide, 7
Kroger Lancets Ultrathin 30G, 33
k-sol, 37
irinotecan, 5
Krystexxa, 27
k-vescent, 37
Irinotecan, 5
kurvelo, 12, 39
Kadcyla, 4
iron, 18, 42
Kuvan, 15
Kadian, 26
Iron, 18, 42
Kynamro, 8
Kalbitor, 19
Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc, 18
Kyprolis, 5
Kaletra, 2
L
Kalydeco, 28
Iron Chews Pediatric, 18, 42
Kapvay Dose Pack, 21
l-cysteine HCL, 37
iron slow release, 18, 42
karidium, 38, 40
L-methyl-b6-b12, 38
iron supplement, 18, 42
karigel, 19
L-methyl-mc, 38
iron supplement childrens, 18, 42
karigel-n, 19
L-methylfolate, 38
Iron Up, 18, 42
kariva, 12, 39
L-methylfolate CA/P-5-P.M.-CBL, 38
Isentress, 2
KCL 0.075%/D5W/NACL 0.45%, 37
L-methylfolate Calcium, 38
isoditrate ER, 6
KCL 0.15%/D5W/ NACL 0.3%, 37
labetalol HCL, 6
isoflurane, 27
KCL 0.15%/D5W/Lr, 37
laclotion, 10
isolyte-m/dextrose 5%, 37
KCL 0.15%/D5W/NACL 0.2%, 38
Lacrisert, 23
Isolyte-s, 38
KCL 0.15%/D5W/NACL 0.225%, 38
lactated ringers, 37
isometheptene mucate/caffeine/acetaminophen, 27
KCL 0.15%/D5W/NACL 0.45%, 38
lactated ringers dextrose 5% viaflex, 37
KCL 0.15%/D5W/NACL 0.9%, 38
lactated ringers irrigation, 37
Isometheptene/Caffeine/Acetaminophen, 27
KCL 0.3%/D5W/Lr IV Lac Ring, 38
lactated ringers viaflex, 37
KCL 0.3%/D5W/NACL 0.45%, 38
lactic acid, 10
isometheptene/dichloralphenazone/acetaminophen, 27
KCL 0.3%/D5W/NACL 0.9%, 38
lactic acid e, 10
kedbumin, 19
lactic acid w/vitamin e, 10
isoniazid, 2
kelnor 1/35, 12, 39
lactulose, 15, 16
Isoniazid, 2
Kenalog, 10
Lamictal, 21
Isopto Carbachol, 24
kendall sodium chloride flush, 37
Lamictal Odt, 21
isosorbide dinitrate, 6
Kepivance, 5
Lamisil, 2
Isosorbide Dinitrate, 6
ketamine HCL, 27
lamivudine, 2
isosorbide dinitrate ER, 6
Ketek, 3
lamivudine/zidovudine, 2
isosorbide mononitrate, 6
ketoconazole, 2, 9
lamotrigine, 21
isosorbide mononitrate ER, 6
ketodan, 9
lamotrigine ER, 21
isosulfan blue, 37
ketoprofen, 26
lamotrigine odt, 21
isotonic gentamicin, 2
Ketoprofen ER, 26
Lancets, 33
Isotonic Gentamicin, 2
ketorolac tromethamine, 24, 26
Lancets 26G Twist Top, 33
isoxsuprine HCL, 8
Ketorolac Tromethamine, 26
Lancets 28G, 33
Isoxsuprine HCL, 8
Kineret, 27
Lancets 30G, 33
Isradipine, 6
Kinney Lancets, 33
Lancets 30G Twist Top, 33
Istalol, 23
Kinney Thin Lancets, 33
Lancets 31G Twist Top, 33
Istodax, 5
Kinrix, 29, 41
Lancets Bullseye Safety, 33
itraconazole, 2
kionex, 37
Lancets Micro Thin 33G, 33
ivermectin, 3
klor-CON, 37
Lancets Safety Seal 21G, 33
Lancets Safety Seal 26G, 33
Lexiva, 2
lorcet plus, 26
Lancets Safety Seal 28G, 33
Lialda, 16
lortab, 26
Lancets Safety Seal 30G, 33
Liberty Blood Glucose Meter, 33
loryna, 12, 40
Lancets Super Thin 28G, 33
Liberty Glucose Control Mid, 33
Lorzone, 23
Lancets Thin, 33
Liberty Glucose Control Normal, 33
losartan potassium, 7
Lancets Twist Top, 33
Liberty Mini Lancing Device, 35
losartan potassium/hydrochlorothiazide, 7
Lancets Ultra Fine, 33
Liberty Test Strips, 33
Lancets Ultra Thin, 33
lidazone HC, 16
Lotemax, 23
Lancets Ultra Thin 30G, 33
lidocaine, 10
Lotronex, 16
lanolin, 37
lidocaine HCL, 6, 10, 19, 27
lovastatin, 8
lansoprazole, 15
Lidocaine HCL, 6
low-ogestrel, 12, 40
lansoprazole/amoxicillin/clarithromycin, 15
lidocaine HCL IN D5W, 6
loxapine, 20
lidocaine HCL jelly, 10
loxapine succinate, 20
Lantus, 13
lidocaine HCL viscous, 19
Lozi-flur, 38, 40
Lantus Solostar, 13
Lidocaine HCL-hydrocortisone Acetate With Aloe, 16
Lucentis, 24
larin 1.5/30, 12, 39
ludent, 38, 40
larin 1/20, 12, 40
lidocaine HCL/dextrose, 6
Lufyllin, 28
larin FE 1.5/30, 12, 39
Lidocaine HCL/Dextrose, 27
Lumigan, 23
larin FE 1/20, 12, 39
lidocaine HCL/hydrocortisone acetate, 16
Lumizyme, 15
Lastacaft, 24
lidocaine viscous, 19
Lupron Depot, 4
latanoprost, 23
lidocaine/epinephrine, 27
Lupron Depot-PED, 14
latrix, 10
lidocaine/prilocaine, 10
lutera, 12, 40
Latuda, 20
lidopin, 10
Lyrica, 21
lavoclen-4 acne wash kit, 8
Lifescan Unistik 2 Deep Penetration, 33
lysiplex plus, 30
Lavoclen-4 Creamy Wash, 9
Lifescan Unistik II Lancets, 33
Lysodren, 4
lavoclen-8 acne wash kit, 8
Lincocin, 3
lyza, 12, 40
Lavoclen-8 Creamy Wash, 9
lindane, 10
M
Lazanda, 26
linezolid, 3
M-m-r II W/Diluent 10 Dose, 29, 41
Leader Lancets Colored, 33
Linzess, 16
M-vit, 30, 41
Leader Super Thin Lancet, 33
Lioresal Intrathecal, 23
M.v.i. Adult, 31
Leader Thin Lancets, 33
liothyronine sodium, 15
M.v.i. Pediatric, 31
Lecithin, 38
lipodox, 4
M.v.i.-12 Without Vitamin K, 31
leena, 12, 40
lipodox 50, 4
Macnatal CN DHA, 30
leflunomide, 26
Lipofen, 8
Macugen, 24
lessina, 12, 40
liposyn iii, 37
mafenide acetate, 10
Letairis, 8
Liptruzet, 8
Magnebind 400, 38
letrozole, 4
lisinopril, 7
magnesium chloride, 37
leucovorin calcium, 5
lisinopril/hydrochlorothiazide, 7
magnesium sulfate, 37
Leucovorin Calcium, 5
lissamine green, 24
Magnesium Sulfate, 38
Leukeran, 3
Lite Touch Lancets, 33
Magnesium Sulfate IN D5W, 38
Leukine, 18
Liteaire, 36
Makena, 13
leuprolide acetate, 4
Litetouch Lancets Micro Thin 33G, 33
malathion, 10
levalbuterol, 28
Lithium, 20
mannitol, 7
levalbuterol HCL, 28
lithium carbonate, 20
Maprotiline HCL, 20
Levatol, 6
Lithium Carbonate, 20
margesic, 25
Levemir, 13
lithium carbonate ER, 20
marlissa, 12, 40
Levemir Flexpen, 13
Livalo, 8
Marplan, 20
Levemir Flextouch, 13
Live Better Lancet Super Thin 30G, 33
Marqibo, 5
levetiracetam, 21
Live Better Lancet Ultra Thin 28G, 33
marten-TAB, 25
Levetiracetam, 21
LMD 10% Dextrose 5%, 19
Mask Vortex/Baby Whirl Duckling, 36
levetiracetam ER, 21
LMD 10% Sodium Chloride 0.9%, 19
Mask Vortex/Child/Frog, 36
levobunolol HCL, 23
Lmthf/Pyridoxine HCL/Cyanocobalamin, 38
Mask Vortex/Spinner The Duck, 36
Levobunolol HCL, 23
Mask Vortex/Toddler/Lady Bug, 36
levocarnitine, 14
LO Loestrin FE, 12, 40
Matulane, 5
levocetirizine dihydrochloride, 27
Locoid, 10
matzim LA, 6
levofloxacin, 2, 23
lofene, 15
Maxair Autohaler, 28
levofloxacin IN D5W, 2
lokara, 10
maximum d3, 30, 43
levonest, 12, 40
lomedia 24 FE, 12, 40
Maxipime, 1
levonorgestrel, 12, 40
Lomustine, 3
MD-gastroview, 38
levonorgestrel and ethinyl estradiol, 12, 40
Longs Lancets Standard, 33
meclizine HCL, 16
Longs Lancets Thin, 33
Meclofenamate Sodium, 26
levonorgestrel/ethinyl estradiol, 12, 40
Longs Lancets Ultra Thin, 33
Medi-seltzer, 25, 39
Levophed, 7
lonox, 15
Medical Provider EZ Flu Shot 2013-2014, 29, 41
levora 0.15/30-28, 12, 40
loperamide HCL, 15
Levorphanol Tartrate, 26
lopreeza, 11
Medical Provider EZ Flu Shot 2014-2015, 29, 41
levothyroxine sodium, 15
lorazepam, 20
Levothyroxine Sodium, 15
lorcet, 26
Medical Provider EZ Flu Shot PF 2012-2013, 29, 41
levoxyl, 15
lorcet HD, 26
Medical Provider EZ Flu Shot PF 2013-2014, 29, 41
mesna, 5
midazolam HCL, 21
Mesnex, 5
midodrine HCL, 7
Medical Provider EZ Flu Shot PF 2014-2015, 29, 41
Mestinon, 23
migragesic ida, 27
Mestinon Timespan, 23
Migralam, 27
Medichoice Pre-set Safety Lancet Dual Use, 33
metadate ER, 21
Millipred, 11
Metafolbic, 38
Millipred DP, 11
Medichoice Pre-set Safety Lancet Low Flow, 33
Metaproterenol Sulfate, 28
milrinone IN dextrose, 6
Metastron, 5
milrinone lactate, 6
Medichoice Pre-set Safety Lancet Medium Flow, 33
metaxalone, 22
mimvey, 11
metformin HCL, 13
mimvey LO, 11
Medichoice Pre-set Safety Lancet Moderate Flow, 33
metformin HCL ER, 13
Minastrin 24 FE, 12, 40
methadone HCL, 26
Mineral Oil Heavy, 15
Medichoice Safety Lancet Extra, 33
Methadone HCL, 26
miniprin low dose, 25, 39
Medichoice Safety Lancet Normal, 33
methadone HCL intensol, 26
minitran, 6
Medicine Shoppe Lancets, 33
methadose, 26
Minivelle, 11
Medicine Shoppe Lancets Thin, 33
Methadose, 26
Minocin, 1
Medisense Thin Lancets, 33
Methadose Sugar-free, 26
minocycline HCL, 1
Medlance Plus Extra Lancets 21G, 33
methamphetamine HCL, 21
minocycline HCL ER, 1
Medlance Plus Lancets, 33
methazolamide, 7
minoxidil, 7
Medlance Plus Lancets Lite 25G, 33
methenamine hippurate, 16
Mirapex ER, 22
Medlance Plus Lite Lancets 25G, 33
methenamine mandelate, 16
Mirena, 13, 40
Medlance Plus Special Lancets 0.8MM, 33
Methenamine Mandelate, 16
mirtazapine, 20
methimazole, 15
mirtazapine odt, 20
Medlance Plus Superlite 30G, 33
Methitest, 11
misoprostol, 15
Medlance Plus Superlite 30G/Comfort Max, 33
methocarbamol, 23
Mission Prenatal, 31, 41
methotrexate, 4
Mission Prenatal HP, 31, 41
Medlance Plus Universal Lancets 21G, 33
methotrexate sodium, 4
mitomycin, 4
methoxsalen, 9
mitoxantrone HCL, 4
Medlance Plus/Lite 25G, 33
methscopolamine bromide, 15
MM aspirin, 25, 39
Medlance/Extra, 33
Methyclothiazide, 7
modafinil, 21
Medlance/Lite, 33
methyldopa, 7
moderiba, 3
Medlance/Universal, 33
Methyldopa/Hydrochlorothiazide, 7
Moderiba, 3
medroxyprogesterone acetate, 12, 13, 40
Methyldopate HCL, 7
Moderiba 1200 Dose Pack, 3
mefenamic acid, 26
methylene blue, 37
Moderiba 800 Dose Pack, 3
mefloquine HCL, 3
methylergonovine maleate, 24
moexipril HCL, 7
Mefoxin, 1
methylphenidate HCL, 21
moexipril/hydrochlorothiazide, 7
mega-c/a plus, 29
methylphenidate HCL CD, 21
mometasone furoate, 10
megestrol acetate, 4
methylphenidate HCL ER, 21
mono-linyah, 12, 40
Meijer Alcohol Swabs Extra-thick, 36
Methylphenidate HCL ER, 21
Monoclate-p, 19
meijer aspirin EC, 25, 39
methylphenidate HCL SR, 21
monoject pharma grade flush syringe, 37
Meijer Color Lancets Universal 33G, 33
methylphenidate hydrochloride, 21
monoject pharma grade flush syringe/heparin lock, 19
meijer ferrous sulfate, 18, 42
methylprednisolone, 11
Meijer Lancets, 33
methylprednisolone acetate, 11
monoject prefill advanced heparin lock flush, 19
Meijer Lancets Thin, 34
methylprednisolone dose pack, 11
Meijer Lancets Universal 33G, 34
methylprednisolone sodiumsuccinate, 11
monoject sodium chloride flush, 37
Meijer Super Thin Lancets, 34
Metipranolol, 23
Monolet Lancets, 34
Mekinist, 5
metoclopramide HCL, 16
Monolet Opd Lancets, 34
meloxicam, 26
metolazone, 7
Monolettor Safety Lancets, 34
Meloxicam, 26
metoprolol succinate ER, 6
mononessa, 12, 40
melpaque HP, 10
metoprolol tartrate, 6
Mononine, 19
melphalan hydrochloride, 3
metoprolol/hydrochlorothiazide, 7
Monovisc, 23
melquin HP, 10
metronidazole, 3, 9
montelukast sodium, 28
Menactra, 29, 41
metronidazole IN NACL 0.79%, 3
Monurol, 17
Menest, 11
metronidazole vaginal, 17
morgidox 1X100MG, 1
Menhibrix, 29
mexiletine HCL, 6
morgidox 2X100MG, 1
Menomune-a/C/Y/W-135, 29, 41
Miacalcin, 14
morphine sulfate, 26
Menopur, 14
Miconazole 3, 17
Morphine Sulfate, 26
Mentax, 9
Micrhogam Ultra-filtered Plus, 38
Morphine Sulfate Add-vantage, 26
Menveo, 29, 41
Microchamber, 36
morphine sulfate ER, 26
meperidine HCL, 26
microgestin 1.5/30, 12, 40
morrhuate sodium, 37
Meperidine HCL, 26
microgestin 1/20, 12, 40
Motofen, 15
meperitab, 26
microgestin FE, 12, 40
Moviprep, 15
Mephyton, 30
microgestin FE 1.5/30, 12, 40
Moxatag, 1
Mepivacaine HCL, 27
Microlet Lancets, 34
Moxeza, 23
meprobamate, 20
micronized colestipol HCL, 8
moxifloxacin HCL, 2
mercaptopurine, 4
Microspacer, 36
Mozobil, 18
meropenem, 3
Microtainer Safety Flow Lancet/Sterile/Single-use, 34
mult-vitamin/fluoride, 30
mesalamine, 16
Multaq, 6
Multi Prenatal, 31, 41
Naprelan, 26
Nicazel, 31
multi vitamin/fluoride, 30
naproxen, 26
Nicazel Forte, 31
multi-vit/fluoride, 30
naproxen DR, 26
nicorelief, 22, 42
multi-vit/iron/fluoride, 30
naproxen sodium, 26
nicotine, 22, 42
multi-vitamin/fluoride, 30
naratriptan HCL, 27
nicotine polacrilex, 22, 42
multi-vitamin/fluoride/iron, 30
Nascobal, 18
nicotine polacrilex refill, 22, 42
Multigen, 18
Nasonex, 27
nicotine polacrilex starter kit, 22, 42
Multigen Folic, 18
Nat-rul Prenatal Vitamins, 31, 41
nicotine step 1, 22, 42
Multigen Plus, 18
nat-rul vitamin d, 30, 43
nicotine step 2, 22, 42
Multitrace-4, 38
Natacyn, 23
nicotine step 3, 22, 42
multitrace-4 concentrate, 37
Natazia, 12, 40
nicotine transdermal system, 22, 42
Multitrace-4 Neonatal, 38
nateglinide, 13
Nicotine Transdermal System, 22, 43
Multitrace-5, 38
Natroba, 11
Nicotrol Inhaler, 22, 43
multitrace-5 concentrate, 37
Nature-throid, 15
Nicotrol Ns, 22, 43
multivitamin with fluoride, 30
Nebupent, 3
nifediac CC, 6
multivitamin/fluoride, 30
nebusal, 28
nifedical XL, 6
multivitamins/fluoride, 30
necon 0.5/35-28, 12, 40
nifedipine, 6
mupirocin, 9
necon 1/35, 12, 40
nifedipine ER, 6
mupirocin calcium, 9
Necon 1/50-28, 11, 39
nikki, 12, 40
Muse, 8
Necon 10/11-28, 11, 39
Nilandron, 4
Mustargen, 4
necon 7/7/7, 12, 40
nimodipine, 6
MVC-fluoride, 31
Neevo DHA, 31
Nipent, 5
my way, 12, 40
nefazodone HCL, 20
nisoldipine, 6
Myalept, 15
Nefazodone HCL, 20
Nisoldipine, 6
Mycamine, 2
neo-polycin, 23
Nisoldipine ER, 6
mycophenolate mofetil, 4
neo-polycin HC, 23
Nitro-bid, 6
mycophenolic acid DR, 4
neofrin, 24
Nitro-dur, 6
mydral, 24
neomycin sulfate, 2
nitro-time, 6
myferon 150, 18, 42
neomycin/bacitracin/polymyxin, 23
nitrofurantoin, 16
myferon 150 forte, 17
neomycin/polymyxin b sulfates, 17
nitrofurantoin macrocrystals, 16
Myglucohealth Mgh Softlance Lancets 30G, 34
neomycin/polymyxin/bacitracin zinc, 23
nitrofurantoin monohydrate, 16
neomycin/polymyxin/bacitracin/hydrocortisone, 23
nitrofurantoin monohydrate/macrocrystals, 16
Mykidz Iron 10, 18, 42
Myleran, 4
neomycin/polymyxin/dexamethasone, 23
nitroglycerin, 6
Mynatal Advance, 30
neomycin/polymyxin/gramicidin, 23
Nitroglycerin, 6
Mynatal Plus, 31
neomycin/polymyxin/HC, 24
nitroglycerin ER, 6
Mynatal Ultracaplet, 31
Neomycin/Polymyxin/Hydrocortisone, 23
nitroglycerin IN 5% dextrose, 6
Mynatal-z, 31
neomycin/polymyxin/hydrocortisone, 24
nitroglycerin IN dextrose 5%, 6
Mynate 90 Plus, 31
neostigmine methylsulfate, 23
Nitroglycerin IN Dextrose 5%, 6
mynephrocaps, 30
nephronex, 30
nitroglycerin lingual, 6
Myobloc, 22
Nessi Spacer/Large Mask, 36
Nitroglycerin Lingual, 6
myorisan, 8
Nessi Spacer/Mouthpiece, 36
nitroglycerin transdermal, 6
Myoxin, 24
Nessi Spacer/Small/MED Mask, 36
Nitromist, 6
Myozyme, 15
Netgroup Lancets, 34
Nitrostat, 6
Myrbetriq, 17
neuac, 8
nizatidine, 15
myzilra, 12, 40
Neulasta, 18
nodolor, 27
N
Neulasta Delivery Kit, 18
nora-be, 12, 40
Neumega, 18
Norditropin Cartridge, 14
n-acetyl-l-cysteine, 37
Neupogen, 18
Norditropin Flexpro, 14
Nabi-HB, 38
Neupro, 22
Norditropin Nordiflex Pen, 14
nabumetone, 26
Neurodep, 31
norepinephrine bitartrate, 7
nadolol, 6
neutragard advanced, 19
norethindrone, 12, 40
nadolol/bendroflumethiazide, 7
neutral sodium fluoride, 19
norethindrone acetate, 13
nafcillin sodium, 1
Nevanac, 24
norethindrone acetate/ethinyl estradiol, 12, 40
Nafcillin Sodium, 1
nevirapine, 2
nafrinse, 38, 40
Nevirapine, 2
norethindrone acetate/ethinyl estradiol/ferrous fumarate, 12, 40
nafrinse drops, 38, 40
nevirapine ER, 2
Naftin, 9
Nexavar, 5
norgestimate/ethinyl estradiol, 12, 40
Naglazyme, 15
Nexium, 15
norlyroc, 12, 40
nalbuphine HCL, 26
Nexplanon, 13, 40
normal saline flush, 37
Nalfon, 26
next choice one dose, 12, 40
normal saline flush for flushing vascular access devices, 37
naloxone HCL, 37
Nexterone, 6
Naloxone HCL, 38
niacin ER, 8
normal saline i.v. flush, 37
naltrexone HCL, 37
niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper, 30
Normosol -r, 38
Namenda, 22
normosol-m IN D5W, 37
Namenda Titration PAK, 22
Niacor, 8
Normosol-r IN D5W, 38
Namenda XR, 22
Nicadan, 31
Noroxin, 2
Namenda XR Titration Pack, 22
nicardipine HCL, 6
Norpace CR, 6
Naphazoline HCL, 24
nortrel 0.5/35 (28), 12, 40
octreotide acetate, 14
Opsumit, 8
nortrel 1/35, 12, 40
ocucoat viscoadherent, 24
Optichamber Advantage, 36
nortrel 7/7/7, 12, 40
Ocudox, 1
Optichamber Diamond, 36
nortriptyline HCL, 20
ofloxacin, 2, 23, 24
Optichamber Diamond/Largeface Mask, 36
Nortriptyline HCL, 20
Ofloxacin, 2
nortuss-DE, 28
Ogestrel, 12, 40
Optichamber Diamond/Medium Face Mask, 36
Nortuss-EX, 28
olanzapine, 20
Norvir, 2
olanzapine odt, 20
Optichamber Diamond/Smallface Mask, 36
norwich aspirin, 25, 39
olanzapine/fluoxetine, 22
Nova Safety Lancets 23G, 34
olopatadine HCL, 27
Optichamber Valved Holding Chamber, 36
Nova Safety Lancets 28G, 34
Olysio, 3
Nova Sureflex Lancets, 34
Omeclamox-PAK, 16
Optichamber/Mask, 36
Novaferrum Pediatric Drops, 18, 42
omega-3-acid ethyl esters, 8
Optihaler, 36
novarel, 14
omeprazole, 15
Optihaler MDI Drug Delivery System, 36
Novofine 30GX8MM, 34
omeprazole/sodium bicarbonate, 15
optimal-d, 30, 43
Novofine 32GX6MM, 34
Omnaris, 28
optimal-d pack, 30, 43
Novofine Autocover 30GX8MM, 34
Omniflex Diaphragm, 40
Options Conceptrol Vaginal Contraceptive, 17, 40
Novolin 70/30, 13
Omnitrope, 14
Novolin 70/30 Relion, 13
On Call Lancets, 34
Options Gynol II Vaginal Contraceptive, 17, 40
Novolin N, 13
On Call Plus Lancets, 34
Novolin N Relion, 13
Oncaspar, 4
opurity vitamin d, 30, 43
Novolin R, 13
ondansetron HCL, 16
Oracea, 9
Novolin R Relion, 13
ondansetron odt, 16
Oracit, 17
Novolog, 13
One A Day Womens Prenatal/DHA, 31
oralone, 19
Novolog Flexpen, 13
One-a-day Womens Prenatal, 31, 41
Orap, 22
Novolog Mix 70/30, 13
Onetouch Basic System, 34
Orapred Odt, 11
Novolog Mix 70/30 Prefilled Flexpen, 13
Onetouch Basic/Profile Test Strips, 34
Oravig, 20
Novolog Penfill, 13
Onetouch Club Lancets Fine Point, 34
Orencia, 27
Novoseven, 19
Onetouch Combo Pack, 34
Orfadin, 15
Novoseven Rt, 19
Onetouch Delica Lancets Extra Fine 33G, 34
orphenadrine citrate, 23
Novotwist 30GX8MM, 34
orphenadrine citrate ER, 23
Novotwist 32GX5MM, 34
Onetouch Delica Lancets Fine 30G, 34
orphenadrine/asa/caffeine, 23
Noxafil, 2
Onetouch Delica Lancing Device, 35
orsythia, 12, 40
NP thyroid, 15
Onetouch Finepoint Lancets, 34
Ortho Diaphragm All-flex/65MM, 40
NP thyroid 30, 15
Onetouch Lancets, 34
Ortho Diaphragm All-flex/70MM, 40
NP thyroid 60, 15
Onetouch Ping Insulin P.M., 34
Ortho Diaphragm All-flex/75MM, 40
NP thyroid 90, 15
Onetouch Ping Meter Remote, 34
Ortho Diaphragm All-flex/80MM, 40
Nplate, 18
Onetouch Profile System, 34
Ortho Diaphragm Coil Spring Kit 100, 40
nu-iron 150, 18, 42
Onetouch Suresoft Lancing Device/18G, 35
Ortho Diaphragm Coil Spring Kit 105, 40
Nucynta, 26
Ortho Diaphragm Coil Spring Kit 50, 40
Nucynta ER, 26
Onetouch Suresoft Lancing Device/21G, 35
Ortho Diaphragm Flat Spring Kit 55, 40
Nuedexta, 22
Ortho Diaphragm Flat Spring Kit 60, 40
nufol, 17
Onetouch Suresoft Lancing Device/28G, 35
Ortho Diaphragm Flat Spring Kit 65, 40
nulev, 15
Ortho Diaphragm Flat Spring Kit 70, 40
Nulojix, 4
Onetouch Ultra 2, 34
Ortho Diaphragm Flat Spring Kit 75, 40
Numoisyn, 20
Onetouch Ultra Blue, 34
Ortho Diaphragm Flat Spring Kit 80, 40
nuquin HP, 10
Onetouch Ultra Control, 34
Ortho Diaphragm Flat Spring Kit 85, 40
Nutricap, 31
Onetouch Ultra Mini, 34
Ortho Diaphragm Flat Spring Kit 90, 40
nutrifac ZX, 30
Onetouch Ultra System Kit, 34
Ortho Diaphragm Flat Spring Kit 95, 40
nutrilipid, 37
Onetouch Ultralink System (DEC), 34
ortho-CS 250, 29
nutrilyte, 37
Onetouch Ultralink System (hex), 34
ortho-est, 11
nutrilyte II, 37
Onetouch Ultrasmart, 34
Orthovisc, 23
Nutropin, 14
Onetouch Ultrasoft Lancets, 34
oscimin, 15
Nutropin AQ Nuspin 10, 14
Onetouch Verio, 34
oscimin SR, 15
Nutropin AQ Nuspin 20, 14
Onetouch Verio Control Solution High, 34
oscion cleanser, 8
Nutropin AQ Nuspin 5, 14
osmitrol viaflex, 7
Nutropin AQ Pen, 14
Onetouch Verio IQ Blood Glucose Monitoring System, 34
Osmoprep, 15
Nuvaring, 12, 40
otic care, 24
Nuvigil, 21
Onetouch Verio Mid Control Solution, 34
oticin, 24
nyamyc, 9
Onetouch Verio Sync Bloodglucose Monitoring System, 34
oto-end 10, 24
nystatin, 2, 9, 19
otomax-HC, 24
nystatin/triamcinolone, 9
Onetouch Verio Test Strips, 34
Otozin, 24
nystop, 9
Onfi, 21
Ovace Plus, 9
O
Onglyza, 13
Ovidrel, 14
Opana ER (crush Resistant), 26
oxacillin sodium, 1
OB-natal One, 31
opium, 15
oxaliplatin, 3
Obstetrix EC, 31
opium tincture, 15
oxandrolone, 11
ocella, 12, 40
Opium Tincture (paregoric), 15
oxaprozin, 26
Octagam, 38
oxazepam, 20
Pegintron, 3
Phisohex, 38
oxcarbazepine, 21
pegylax, 15
phos-flur, 19
Oxecta, 26
Pen Needles 29G X 12MM, 34
Phoslyra, 16
Oxistat, 9
Pen Needles 29GX1/2", 34
phospha 250 neutral, 37
Oxsoralen, 11
Pen Needles 30GX5/16", 34
phosphasal, 16
oxybutynin chloride, 17
Pen Needles 31G X 1/4" SHORT, 34
Phospholine Iodide, 24
oxybutynin chloride ER, 17
Pen Needles 31G X 3/16", 34
Photofrin, 5
oxycodone HCL, 26
Pen Needles 31G X 6MM, 34
Physicians EZ Use Flu Kit 2012-2013, 29, 41
Oxycodone HCL, 26
Pen Needles 31GX5/16", 34
Oxycodone HCL ER, 26
penicillin G potassium, 1
physiolyte, 37
oxycodone/acetaminophen, 26
Penicillin G Potassium IN Iso-osmotic Dextrose, 1
physiosol irrigation, 37
oxycodone/aspirin, 26
phytonadione, 29
oxycodone/ibuprofen, 26
Penicillin G Procaine, 1
Picato, 11
Oxycontin, 26
Penicillin G Sodium, 1
pilocarpine HCL, 19, 24
oxymorphone hydrochloride, 26
penicillin v potassium, 1
pilocarpine hydrochloride, 19
oxymorphone hydrochloride ER, 26
Pentacel, 29, 41
Pilopine HS, 24
oxytocin, 24
Pentasa, 16
pimtrea, 12, 40
Oxytrol, 17
pentazocine/acetaminophen, 26
pindolol, 6
Oxytrol For Women, 17
pentazocine/naloxone HCL, 26
pioglitazone HCL, 13
Ozurdex, 23
pentoxifylline ER, 19
pioglitazone HCL-glimepiride, 13
P
Perfect Iron, 18, 42
pioglitazone HCL/metformin HCL, 13
Perfect Lancets 30G, 34
piperacillin sodium/ tazobactam sodium, 1
PA Prenatal Formula, 31, 41
Perfect Pressure Activated Safety Lancets 28G, 34
PA vitamin d-3, 30, 43
piperacillin sodium/tazobactam sodium, 1
PA vitamin d-3 gummy, 30, 43
Perforomist, 28
piperacillin/tazobactam, 1
pacerone, 6
perindopril erbumine, 7
pirmella 1/35, 12, 40
paclitaxel, 5
perio MED, 19
pirmella 7/7/7, 12, 40
Paclitaxel, 5
periogard, 19
piroxicam, 26
pamidronate disodium, 14
Perjeta, 4
plasbumin-25, 19
Pamidronate Disodium, 14
permethrin, 10
plasbumin-5, 19
Pancrelipase, 16
perphenazine, 20
Plasma-lyte A, 38
pancuronium bromide, 22
Perphenazine/Amitriptyline, 22
Plasma-lyte-148, 38
Panda Mask Large, 36
Perry Prenatal, 31, 41
Pneumovax 23, 29, 41
Panda Mask Medium, 36
Pertzye, 16
Pneumovax 23/1 Dose, 29, 41
Panda Mask Small, 36
Pfizerpen-G, 1
Pneumovax 23/5 Dose, 29, 42
Panretin, 11
pharbedryl, 27
PNV-DHA, 31
pantoprazole sodium, 15
Pharmacist Choice Alcoholprep Pads, 36
PNV-select, 31
papaverine HCL, 8
Pharmacist Choice Ultra Thin Lancets, 34
Pocket Chamber, 36
Paragard Intrauterine Copper Contraceptive T380a, 13
Pocket Spacer, 36
Pharmacist Choice Ultra Thin Lancets 28G, 34
podofilox, 10
parcaine, 24
polocaine, 27
paricalcitol, 14
Pharmacist Choice Ultra Thin Lancets 30G, 34
polocaine-mpf, 27
Paricalcitol, 14
poly-dex, 23
paroex, 19
Pharmacist Choice Ultra Thin Lancets 31G, 34
poly-iron 150, 18, 42
paromomycin sulfate, 2
poly-iron 150 forte, 17
paroxetine HCL, 20
Pharmacist Choice Ultra Thin Lancets 33G, 34
polycin, 23
paroxetine HCL ER, 20
polycin b, 23
Paser, 2
Pharmacy Counter Lancets, 34
polyethylene glycol 3350, 15
Pataday, 24
phenadoz, 27
polymyxin b sulfate, 3
Patanol, 24
phenazo, 17
polymyxin b sulfate/trimethoprim sulfate, 23
Paxil, 20
phenazopyridine HCL, 17
PCE, 1
phendimetrazine tartrate, 21
polysaccharide iron forte, 17
pedi-dri, 9
Phendimetrazine Tartrate ER, 21
Pomalyst, 5
Pediaderm HC, 10
phenelzine sulfate, 20
portia-28, 12, 40
Pediaderm Ta, 10
phenergan, 27
Potaba, 30
Pediarix, 29, 41
phenobarbital, 21
potassium acetate, 37
Pediatric Panda Mask, 36
Phenobarbital, 21
Potassium Acetate, 38
Pedipirox-4 Nail, 9
Phenobarbital Sodium, 21
potassium bicarbonate, 37
Pedvax HIB, 29, 41
phentermine HCL, 21
potassium chloride, 37
peg 3350/electrolytes, 15, 43
Phentolamine Mesylate, 7
Potassium Chloride, 38
peg-3350/electrolytes, 15, 43
phenylephrine HCL, 7, 24
potassium chloride 0.15% /NACL 0.45% viaflex, 37
peg-3350/NACL/NA bicarbonate/KCL, 15, 43
Phenylephrine HCL, 7
phenylephrine/guaifenesin, 28
Potassium Chloride 0.15% /NACL 0.45% Viaflex, 38
Peg-intron, 3
phenytoin, 21
Peg-intron Redipen, 3
phenytoin infatabs, 21
potassium chloride 0.15% D5W/NACL 0.33%, 37
Peg-intron Redipen PAK 4, 3
phenytoin sodium, 21
Peganone, 21
phenytoin sodium extended, 21
potassium chloride 0.15% D5W/NACL 0.45%, 37
Pegasys, 3
philith, 12, 40
Pegasys Proclick, 3
potassium chloride 0.15% D5W/NACL 0.45% viaflex, 37
Preferred Plus Lancets Super Thin 30G, 34
Prodigy Pressure Activated Safety Lancets, 34
potassium chloride 0.15% NACL 0.9%, 37
Preferred Plus Lancets Thin 26G, 34
Prodigy Twist Top Lancets, 34
pregnyl w/diluent benzyl alcohol/NACL, 14
Prodigy Voice Blood Glucose Meter Kit, 35
potassium chloride 0.15% w/NACL 0.9% viaflex, 37
Premarin, 11
Profe, 18, 42
potassium chloride 0.15%/D5W, 37
premasol, 37
Proferrin ES, 18, 42
Potassium Chloride 0.15%/NACL 0.9%, 38
Premphase, 11
Profilnine SD, 19
Prempro, 11
progesterone, 13
potassium chloride 0.22% D5W/NACL 0.45%, 37
Prenaissance Plus, 31
Proglycem, 13
Prenaplus, 31, 41
Prograf, 4
potassium chloride 0.224%/D5W/NACL 0.45%, 37
Prenatabs Fa, 31
Prolastin-c, 28
Prenatabs RX, 31
Prolensa, 24
potassium chloride 0.224%D5W/NACL 0.45% viaflex, 37
Prenatal, 31, 41
Proleukin, 5
Prenatal 19, 31
Prolia, 14
Potassium Chloride 0.3%/ NACL 0.9%, 38
Prenatal Ad, 31
Promacta, 18
Prenatal And Iron, 31, 41
promethazine HCL, 27
potassium chloride 0.3%/D5W, 37
Prenatal Complete, 31, 41
promethazine HCL plain, 27
potassium chloride 0.3%/NACL 0.9%/viaflex, 37
Prenatal Formula, 31, 41
promethazine VC, 28
Prenatal Forte, 31, 41
Promethazine VC Plain, 28
potassium chloride CR, 37
Prenatal Low Iron, 31, 41
promethazine VC/codeine, 28
potassium chloride ER, 37
Prenatal Multi +dha, 31, 41
Promethazine VC/Codeine, 28
Potassium Chloride ER, 38
Prenatal Multivitamin + DHA, 31
promethazine-DM, 28
potassium chloride SR, 37
Prenatal One Daily, 31, 41
promethazine/codeine, 28
potassium citrate ER, 17
Prenatal Plus, 31, 41
promethazine/dextromethorphan, 28
potassium citrate-citric acid crystals, 17
Prenatal Plus DHA, 31
promethegan, 27
potassium citrate/citric acid, 17
Prenatal Plus Iron, 31
pronutrients vitamin d3, 30, 43
potassium citrate/sodium citrate/citric acid, 17
Prenatal Vitamins, 31, 41
propafenone HCL, 6
Prenatal-u, 31
propafenone HCL ER, 6
potassium phosphate, 37
Prenatal/Omega-3/Folic Acid/Iron, 31
Propantheline Bromide, 15
potassium phosphates, 37
Prentif Cavity-rim Cervical CAP, 40
proparacaine HCL, 24
Potiga, 21
Prentif Fitting Set, 40
propofol, 27
pr benzoyl peroxide wash, 8
Prepopik, 15
propranolol HCL, 6
Pr Natal 400, 31
Prevacid Solutab, 16
Propranolol HCL, 6
Pr Natal 400 EC, 31
prevalite, 8
propranolol HCL ER, 6
Pr Natal 430, 31
previfem, 12, 40
Propranolol/Hydrochlorothiazide, 7
Pr Natal 430 EC, 31
Prevnar 13, 29, 42
propylthiouracil, 15
Pradaxa, 19
Prezista, 2
Proquad, 29, 42
pramcort, 16
Prialt, 25
Prostigmin, 23
pramipexole dihydrochloride, 21
Priftin, 2
Protamine Sulfate, 19
Pramosone, 10
Prilosec, 16
protriptyline HCL, 20
Pramosone E, 10
Primaquine Phosphate, 3
Provenge, 5
pramox gel, 10
primidone, 21
Proventil HFA, 28
pramoxine-HC, 24
Primsol, 3
Prudoxin, 9
Prandimet, 13
Pristiq, 20
Pss Select GP Lancets, 34
prascion, 8
Privigen, 38
Pss Select Safety Lancets, 34
prascion fc, 8
Proair HFA, 28
Pulmicort, 28
prascion ra with sunscreens, 8
probenecid, 27
Pulmicort Flexhaler, 28
pravastatin sodium, 8
probenecid/colchicine, 27
pulmosal, 28
prazosin HCL, 7
Procainamide HCL, 6
Pulmozyme, 28
Pre-natal Formula, 31, 41
Procentra, 21
purevit dualfe plus, 17
Precision Thin Lancets, 34
prochlorperazine, 20
px aspirin, 25, 39
Precision Thins GP Lancet, 34
prochlorperazine edisylate, 20
px enteric aspirin, 25, 39
Precision Ultra Lancet, 34
prochlorperazine maleate, 20
px folic acid, 18, 41
Pred Mild, 23
Procrit, 18
px iron, 18, 42
prednicarbate, 10
procto-PAK, 16
Px Lancets, 34
prednisolone, 11
Proctofoam HC, 16
Px Lancets Ultra Thin, 34
prednisolone acetate, 23
proctosol HC, 16
Px Prenatal Multivitamins, 31, 41
prednisolone sodium phosphate, 11
proctozone-HC, 16
px stop smoking aid, 22, 42
Prednisolone Sodium Phosphate, 11, 23
Procysbi, 17
Pylera, 15
prednisolone sodium phosphate odt, 11
Prodigy Autocode Blood Glucose Monitoring System, 35
pyrazinamide, 2
prednisone, 11
pyridostigmine bromide, 23
Prednisone, 11
Prodigy Autocode Blood Glucose Monitoring/Talking, 35
Pyridoxine HCL, 29
Prednisone Intensol, 11
Q
Prefera OB, 31
Prodigy NO Coding Blood Glucose Test Strips, 35
Qc Alcohol Swabs, 36
Prefera OB + DHA, 31
qc aspirin, 25, 39
Preferaob One, 31
Prodigy Pocket Blood Glucose Meter Kit, 35
qc aspirin low dose, 25, 39
Preferred Plus Lancets Colored 21G, 34
qc childrens aspirin, 25, 39
qc ferrous sulfate, 18, 42
Reality Trigger Lancets, 34
ribasphere, 3
Qc Lancets, 34
Rebetol, 3
Ribasphere, 3
Qc Lancets Super Thin, 34
Rebif, 22
Ribasphere Ribapak, 3
Qc Lancets Thin, 34
Rebif Rebidose, 22
Ribatab, 3
Qc Lancets Ultra Thin, 34
Rebif Rebidose Titration Pack, 22
ribavirin, 3
qc nicotine polacrilex, 22, 42
Rebif Titration Pack, 22
Ridaura, 26
Qc Prenatal, 31, 41
reclipsen, 12, 40
rifabutin, 2
Qnasl, 28
Recombinate, 19
Rifamate, 2
Qnasl Childrens, 28
Recombivax HB, 29, 42
rifampin, 2
Quadramet, 5
rectacort-HC, 16
Rifater, 2
Qualaquin, 3
Rectiv, 16
Right Step Prenatal, 31, 41
quasense, 12, 40
Refissa, 11
Rightest Gl300 Lancets, 34
Quazepam, 21
Regonol, 23
riluzole, 22
quetiapine fumarate, 20
Regranex, 11
rimantadine HCL, 2
Quflora Pediatric, 31
Relenza Diskhaler, 2
ringers injection, 37
Quillivant XR, 21
Relion Alcohol Swabs, 36
ringers irrigation, 37
quinapril HCL, 7
Relion Lancets, 34
Riomet, 13
quinapril/hydrochlorothiazide, 7
Relion Lancets Micro-thin33G, 34
risedronate sodium, 13
Quinidine Gluconate, 6
Relion Lancets Standard 21G, 34
Risperdal Consta, 20
quinidine gluconate CR, 6
Relion Lancets Thin 26G, 34
risperidone, 20
quinidine gluconate ER, 6
Relion Lancets Ultra-thin30G, 34
risperidone M-TAB, 20
quinidine sulfate, 6
Relion Thin Lancets, 34
risperidone odt, 20
Quinidine Sulfate, 6
Relion Ultra Thin Lancets, 34
Riteflo, 36
Quinidine Sulfate ER, 6
Relion Ultra Thin Lancets30G, 34
Rituxan, 4
quinine sulfate, 3
Relion Ultra Thin Plus Lancets 32G, 34
rivastigmine tartrate, 22
Qvar, 28
Relion Ultra Thin Plus Lancets 33G, 34
Rixubis, 19
R
Relistor, 16
rizatriptan benzoate, 27
Relpax, 27
rizatriptan benzoate odt, 27
Ra Alcohol Swabs, 36
remergent HQ, 10
rocuronium bromide, 22
ra aspirin, 25, 39
remeven, 10
romycin, 23
ra aspirin adult low dose, 25, 39
Remicade, 16
ropinirole ER, 21
ra aspirin adult low strength, 25, 39
Remodulin, 8
ropinirole HCL, 21
ra aspirin childrens, 25, 39
rena-vite RX, 30
ropivacaine, 27
ra aspirin EC, 25, 39
Renacidin, 17
ropivacaine HCL, 27
ra aspirin EC adult low strength, 25, 39
Renagel, 16
rosadan, 9
ra childrens aspirin, 25, 39
renal, 30
rosanil cleanser, 8
Ra E-ZJECT Color Lancets Micro-thin 33G, 34
renalpren, 30
Rotarix, 29, 42
Renew Advanced Lancing Cartridge Refills, 34
Rotateq, 29, 42
Ra E-ZJECT Lancets 28G, 34
roxicet, 26
Ra E-ZJECT Lancets Thin 26G, 34
reno CAPS, 30
Rozerem, 21
Ra E-ZJECT Lancets Thin 28G, 34
Renova, 11
S
Ra E-ZJECT Lancets Ultra Thin 30G, 34
Renova P.M., 11
ra folic acid, 18, 41
Sabril, 21
Renvela, 16
ra high potency iron, 18, 42
Saccharin Sodium, 38
repaglinide, 13
ra iron, 18, 42
Safe-t-lance Low Flow 25G, 34
Replesta, 30, 43
ra mini nicotine, 22, 42
Safe-t-lance Normal Flow 21G, 34
Replesta Childrens, 30, 43
ra nicotine, 22, 42
Safe-t-lance Plus Safety Lancet High Flow, 34
Replesta Nx, 30, 43
ra nicotine polacrilex, 22, 42
reprexain, 26
ra nicotine transdermal system step 3, 22, 42
Safe-t-lance Plus Safety Lancet Low Flow, 34
Repronex, 14
Req 49+, 31
Ra One Daily, 31, 41
Safe-t-lance Plus Safety Lancet Normal Flow, 34
Rescon-JR, 28
Ra Prenatal, 31, 41
Rescriptor, 2
Ra Prenatal Formula/Folicacid, 31, 41
Safety Lancet 21G/Pressure Activated, 34
Reserpine, 7
ra slow release iron, 18, 42
Respa-BR, 27
ra vitamin d-3, 30, 43
Safety Lancet 28G/Pressure Activated, 34
Restasis, 24
Rabavert, 29
Retisert, 23
rabeprazole sodium, 15
Safety Lancet 2MM, 34
Retrovir IV Infusion, 2
raloxifene hydrochloride, 14
Safety Lancets, 34
Revatio, 8
ramipril, 7
Safety Lancets 21G, 34
Revlimid, 5
Ranexa, 6
Safety Lancets 28G, 34
revonto, 23
ranitidine HCL, 15
Safety Let Lancets, 34
Rexall Lancets Ultra Thin, 34
Rapaflo, 17
Safety Seal Lancets 28G, 34
Reyataz, 2
Rapamune, 4
Safety Seal Lancets 30G, 34
Rezira, 28
Ravicti, 15
Safyral, 12, 40
Rheumatrex, 26
Rayos, 11
Saizen, 14
Rhinoflex-650, 25
rea LO 39, 10
Saizen Click.easy, 14
Rhogam Ultra-filtered Plus, 38
rea LO 40, 10
salacyn, 10
Rhophylac, 38
Reality Lancets, 34
salicylic acid, 10
Riastap, 19
Reality Swabs, 36
salicylic acid cream, 10
salicylic acid lotion, 10
sildenafil citrate, 8
sodium citrate/citric acid, 17
salicylic acid wart remover, 10
Silenor, 21
Sodium Edecrin, 7
saline flush, 37
Silver Nitrate, 11
sodium ferric gluconate complex/sucrose, 18
saline flush zr/sterile field, 37
silver sulfadiazine, 10
salsalate, 25
Simcor, 8
Sodium Fluoride, 38, 40
Salvax, 11
Similac Prenatal Early Shield, 31
sodium fluoride, 38, 41
Samsca, 14
Simponi, 27
sodium hyaluronate, 10
Sancuso, 16
Simponi Aria, 27
Sodium Lactate, 38
Sandimmune, 4
Simulect, 5
sodium phenylbutyrate, 14
Sandostatin Lar Depot, 14
simvastatin, 8
sodium phosphate, 37
Saphris, 20
Single-let, 34
sodium polystyrene sulfonate, 37
Saps Care Alcohol Prep Pads, 36
sirolimus, 4
Sodium Saccharin Dihydrate, 38
Sapscare Twist Top Lancets 30G, 34
Sirturo, 2
sodium sulfacetamide, 8, 9, 23
sash kit for flushing vascular access devices, 19
Sivextro, 3
sodium sulfacetamide wash, 9
skin bleaching, 10
sodium sulfacetamide/sulfur, 8
Savella, 22
skin bleaching/sunscreen, 10
Sodium Sulfacetamide/Sulfur, 9
SB Alcohol Prep Pads, 36
Sklice, 11
sodium sulfacetamide/sulfur cleanser, 8
SB aspirin, 25, 39
Skyla, 13, 40
Sodium Sulfacetamide/Sulfur Cleanser IN Urea, 9
SB aspirin EC, 25, 39
slow iron, 18, 42
SB childrens aspirin, 25, 39
slow release iron, 18, 42
sodium sulfacetamide/sulfur cleansing cloths, 8
SB Lancets Thin, 35
Sm Alcohol Prep Pads, 36
SB Lancets Ultra Thin, 35
sm aspirin, 25, 39
sodium sulfacetamide/sulfur green, 8
SB low dose asa EC, 25, 39
sm aspirin adult low strength, 25, 39
Sodium Sulfacetamide/Sulfur IN Urea, 9
scalacort, 10
sm aspirin EC low strength, 25, 39
sodium sulfacetamide/sulfur w/sunscreen, 8
scleromate sodium morrhuate, 37
sm aspirin enteric coated, 25, 39
Scopolamine Hydrobromide, 15
sm aspirin low dose, 25, 39
sodium sulfacetamide/sulfur wash, 8
se 10-5 ss, 8
sm childrens aspirin, 25, 39
Sodium Sulfacetamide/Urea, 9
se bpo wash, 8
sm folic acid, 18, 41
sodium thiosulfate, 37
Se-natal 19, 31
sm iron, 18, 42
sojourn, 27
Se-tan DHA, 31
sm iron slow release, 18, 42
solia, 12, 40
se-tan plus, 17
Sm Lancets 21G, 34
Soliris, 19
Seb-prev, 9
Sm Micro Thin Lancets 33G, 34
Solodyn, 1
seb-prev wash, 9
sm nicotine, 22, 42
Soltamox, 4
selegiline HCL, 21
sm nicotine polacrilex, 22, 42
Solu-cortef, 11
Selenium, 38
Sm One Daily Prenatal, 31, 41
Solus V2 Pressure Activated Safety Lancets 28G, 34
selenium sulfide, 9
sm prenatal vitamins, 31, 41
Selenium Sulfide, 9
Sm Prenatal Vitamins, 31, 41
Solus V2 Twist Lancets 30G, 34
Selzentry, 2
Sm Slow Release Iron, 18, 42
Somatuline Depot, 14
Sensipar, 14
Sm Super Thin Lancets, 34
Somavert, 14
sensorcaine, 27
Sm Super Thin Lancets 30G, 34
Sorbitol, 17
sensorcaine-mpf, 27
Sm Thin Lancets 26G, 34
Sorbitol-mannitol, 17
sensorcaine-mpf spinal, 27
sm vitamin d, 30, 43
sorine, 6
sensorcaine-mpf/epinephrine, 27
sm vitamin d3, 30, 43
sotalol HCL, 6
sensorcaine/epinephrine, 27
Sm Vitamin D3 Maximum Strength, 30, 43
sotalol HCL (AF), 6
Serevent Diskus, 28
Sovaldi, 3
Seromycin, 2
Smart Diabetes Vantage Universal Lancets 30G, 34
Spinosad, 11
serophene, 14
Spiriva Handihaler, 28
Seroquel XR, 20
Smart Sense Color Lancets Universal 33G, 34
Spiriva Respimat, 28
Serostim, 14
spironolactone, 7
sertraline HCL, 20
Smart Sense Standard Lancets Universal 21G, 34
spironolactone/hydrochlorothiazide, 7
Seton Et-EC, 31
Sporanox, 2
Setonet, 31
Smart Sense Super Thin Lancets Universal 30G, 34
sprintec 28, 12, 40
Sevelamer Carbonate, 16
Sprix, 26
sevoflurane, 27
Smart Sense Thin Lancets Universal 26G, 34
Sprycel, 5
SF, 20
SR nicotine gum, 22, 43
SF 5000 plus, 20
Smartest Lancets 28G, 34
sronyx, 12, 40
sharobel, 12, 40
sodium acetate, 37
ss 10-2, 8
Shopko Alcohol Swabs, 36
Sodium Bicarbonate, 15
ssd, 10
Shopko On-the-go Comfort Lancets 30G, 34
sodium bicarbonate, 37
sss 10%-5%, 8
sodium bicarbonate partial fill, 37
sss 10-5, 8
Shopko Unilet Lancets Super Thin 30G, 34
sodium chloride, 17, 28, 37
st joseph aspirin, 25, 39
Sodium Chloride, 38
stagesic, 26
Shopko Unilet Lancets Ultra Thin 28G, 34
sodium chloride 0.45%, 37
stannous fluoride oral rinse, 19
sodium chloride 0.45% viaflex, 37
stavudine, 2
Shur-seal, 17, 40
sodium chloride 0.9%, 17
Stavzor, 21
Siderol, 31
sodium chloride bacteriostatic, 37
Stelara, 9
Signifor, 14
sodium chloride flush, 37
Sterilance TL, 34
sildenafil, 8
sodium chloride pab, 37
sterile diluent for epoprostenol sodium,
37
Sustiva, 2
terrell, 27
sterile water for injection, 37
Sutent, 5
Testim, 11
sterile water irrigation, 37
sw nicotine polacrilex, 22, 42
Testosterone, 11
sterile water irrigation plastic bottle, 37
swabflush saline flush, 37
testosterone cypionate, 11
sterile water irrigation w/hanger, 37
syeda, 12, 40
testosterone enanthate, 11
Stimate, 14
Sylatron, 5
Testosterone P.M., 11
Stivarga, 5
symax fastabs, 15
Tetanus Toxoid Adsorbed, 28
Strattera, 21
symax-SL, 15
Tetanus/Diphtheria Toxoids-adsorbed Adult, 29, 42
Streptomycin Sulfate, 2
symax-SR, 15
Striant, 11
Symbicort, 28
tetcaine, 24
Stribild, 2
Symlinpen 120, 13
tetracaine HCL, 24
Strovite Forte, 31
Symlinpen 60, 13
Tetracaine HCL, 27
Strovite One, 31
Synagis, 38
Tetracycline HCL, 1
strovite plus, 30
Synalar, 10
tetravisc, 24
Stuart One, 31
Synarel, 14
tetravisc forte, 24
Stuart Prenatal, 31, 41
Synera, 11
Tev-tropin, 14
Stuart Prenatal + DHA, 31, 41
Synribo, 5
Teveten HCT, 7
Suboxone, 26
Synvisc, 23
Texacort, 10
Subsys, 26
Synvisc One, 23
Tgq 15DM/5PEH/2CPM, 28
Suclear, 15
Syprine, 38
Tgq 30PSE/150GFN/15DM, 28
Sucraid, 16
T
Tgq 30PSE/3BRM/15DM, 28
sucralfate, 15
Tgq 50PSE/3BRM/30DM, 28
Tabloid, 4
sufentanil citrate, 26
tgq 7.5PEH/4BRM/15DM, 28
Taclonex, 10
sulfacetamide sodium, 8, 23
Tgt Alcohol Swabs, 36
tacrolimus, 4, 10
Sulfacetamide Sodium, 23
tgt aspirin, 25, 39
Tafinlar, 5
sulfacetamide sodium/prednisolone sodium phosphate, 23
tgt aspirin low dose, 25, 39
Talwin, 26
tgt childrens aspirin, 25, 39
Tamiflu, 2
sulfacetamide sodium/sulfur cleanser, 8
tgt enteric-coated aspirin, 25, 39
tamoxifen citrate, 4, 43
sulfacleanse 8/4, 8
Tgt Lancet Alternate Site, 35
tamsulosin HCL, 17
Sulfadiazine, 2
Tgt Lancet Micro Thin 33G, 35
Tandem F, 18
sulfamethoxazole/trimethoprim, 3
Tgt Lancet Super Thin 30G, 35
Tarceva, 5
Sulfamethoxazole/Trimethoprim, 3
Tgt Lancet Thin 23G, 35
Targretin, 5, 11
sulfamethoxazole/trimethoprim DS, 3
Tgt Lancet Thin 26G, 35
tarina FE 1/20, 12, 40
Sulfamylon, 11
Tgt Lancet Ultra Thin 28G, 35
Tarka, 7
sulfasalazine, 16
Tgt Lancet Ultra Thin 30G, 35
taron-crystals, 17
sulfatrim pediatric, 3
tgt nicotine gum, 22, 42
Taron-prex, 31
sulfazine, 16
tgt nicotine polacrilex, 22, 42
Tasigna, 5
sulfazine EC, 16
tgt nicotine step one, 22, 42
Tasmar, 22
sulindac, 26
tgt nicotine step three, 22, 42
tazicef, 1
Sumatriptan, 27
tgt nicotine step two, 22, 42
tazidime, 1
sumatriptan succinate, 27
th aspirin, 25, 39
Tazorac, 9
Sumatriptan Succinate, 27
th aspirin low dose, 25, 39
taztia XT, 6
sumatriptan succinate refill, 27
th enteric aspirin, 25, 39
Tecfidera, 22
Sumavel Dosepro, 27
th folic acid, 18, 41
Tecfidera Starter Pack, 22
Supartz, 23
th iron, 18, 42
Techlite AST Lancets, 35
Super Daily D3, 30, 43
Th Prenatal Vitamins, 31, 41
Techlite Lancets, 35
Super Thin Lancets, 34
th slow release iron, 18, 42
Techlite Lancets 30G, 35
Supprelin LA, 14
th vitamin d3, 30, 43
Teflaro, 1
Suprax, 1
Thalomid, 5
Tegretol-XR, 21
Suprep Bowel Prep, 15
Theo-24, 28
Tekamlo, 7
Sure Comfort Alcohol Prep Pads, 36
theochron, 28
Tekturna, 7
Sure Comfort Lancets 28G, 34
theophylline, 28
Tekturna HCT, 7
Sure Comfort Lancets 30G, 34
theophylline CR, 28
telmisartan, 7
Sure-lance Flat Lancets, 34
theophylline ER, 28
telmisartan/amlodipine, 7
Sure-lance Lancets 26G, 34
theophylline/D5W, 28
telmisartan/hydrochloroth, 7
Sure-lance Thin Lancets 28G, 34
Theophylline/D5W, 28
telmisartan/hydrochlorothiazide, 7
Sure-lance Ultra Thin Lancets, 34
thera-d 2000, 30, 43
temazepam, 21
Sure-prep Alcohol Prep Pads, 36
Thera-d 4000, 30, 43
Temodar, 4
Sure-touch Lancets Universal, 34
thera-d rapid repletion, 30, 43
temozolomide, 3
Surelite Lancets, 34
thera-d sport, 30, 43
tencon, 25
Surestep Glucose Control, 34
Theracys, 5
Tencon, 25
Surestep Glucose Control Solution, 35
thermazene, 10
Teniposide, 5
Surestep Pro High Glucosecontrol, 35
thiamine HCL, 29
Tenivac, 29, 42
Surestep Pro Low Glucose Control, 35
Thinlets GP Lancets, 35
terazosin HCL, 7
Surestep Pro Normal Glucose Control, 35
Thinlets Lancet, 35
terbinafine HCL, 2
thioridazine HCL, 20
Terbinex, 2
Surestep Pro Test Strips, 35
thiothixene, 20
terbutaline sulfate, 28
Surestep Test Strips, 35
thrive, 22, 42
terconazole, 17
Thrombate Iii W/10 ML Sterile Water, 19
tranexamic acid, 19
Trueplus Lancets 28G, 35
Thrombate Iii W/20 ML Sterile Water, 19
Transderm-scop, 16
Trueplus Lancets 28G Super Thin, 35
Thymoglobulin, 5
tranylcypromine sulfate, 20
Trueplus Lancets 30G, 35
Thyrogen, 38
Travatan Z, 23
Trueplus Lancets 30G Ultra Thin, 35
Thyrolar-1, 15
Travel Lancets 30G, 35
Trueplus Lancets 33G, 35
Thyrolar-1/2, 15
Travoprost, 23
Trueplus Lancets 33G Micro Thin, 35
Thyrolar-1/4, 15
trazodone HCL, 20
Trueplus Safety Lancets 28G, 35
Thyrolar-2, 15
Treanda, 4
Trumenba, 29, 42
Thyrolar-3, 15
Trecator, 2
Truvada, 2
tiagabine hydrochloride, 21
Trelstar Depot, 4
Tryptophan, 38
Tice Bcg, 5
Trelstar Depot Mixject, 4
Tucks Anti-itch, 10
ticlopidine HCL, 19
Trelstar LA, 4
Tudorza Pressair, 28
Tikosyn, 6
Trelstar LA Mixject, 4
tussafed EX, 28
tilia FE, 12, 40
Trelstar Mixject, 4
Tussicaps, 28
Timentin, 1
Tretin-x, 9
tussigon, 28
Timolol Maleate, 6
tretinoin, 5, 8
Twinrix, 29, 42
timolol maleate, 23
Tretinoin Emollient, 11
Tygacil, 3
timolol maleate ophthalmic gel forming, 23
tretinoin microsphere, 8
Tykerb, 5
tretinoin microsphere P.M., 8
Typhim VI, 29
tinidazole, 3
Tretten, 19
Tysabri, 22
tis-u-sol, 37
Trexall, 4
Tyvaso, 8
Tivicay, 3
Treximet, 27
Tyvaso Refill, 8
tizanidine HCL, 23
Trezix, 26
Tyvaso Starter, 8
TL gard RX, 18
tri-estarylla, 12, 40
Tyzeka, 3
TL hydroquinone, 11
tri-legest FE, 12, 40
Tyzine, 28
TL icon, 18
tri-linyah, 12, 40
Tyzine Pediatric Nasal Drops, 28
TL-fol 500, 18
tri-previfem, 12, 40
U
TL-hem 150, 18
tri-sprintec, 12, 40
U-cort, 10
Tobi Podhaler, 2
tri-vit/fluoride, 30
u-kera e, 10
Tobradex, 23
Tri-vit/Fluoride/Iron, 31
Uceris, 11
Tobradex ST, 23
tri-vitamin/fluoride, 30
Ulesfia, 11
tobramycin, 2
Tri-zel, 31
Uloric, 27
tobramycin sulfate, 2, 23
Triadvance, 31
Ulticare Thin Lancets 30G, 35
Tobramycin Sulfate/Sodium Chloride, 2
triamcinolone acetonide, 10, 20, 27
Ultilet Alcohol Swab, 36
tobramycin/dexamethasone, 23
Triamcinolone Acetonide, 10
Ultilet Alcohol Swabs, 36
Tobrex, 23
triamcinolone IN orabase, 20
Ultilet Basic Lancets 30G, 35
Today Sponge, 17
triamterene/hydrochlorothiazide, 7
Ultilet Classic Lancets, 35
Todays Health Super Thin Lancets 30G, 35
Triamterene/Hydrochlorothiazide, 7
Ultilet Lancets, 35
Trianex, 10
Ultilet Lancets 33G, 35
Todays Health Ultra Thin Lancets 28G, 35
triazolam, 21
Ultilet Safety Lancets 23G, 35
Tribenzor, 7
Ultimatecare One, 31
tolazamide, 13
Tricare, 31, 41
Ultimatecare One NF, 31
Tolazamide, 13
tricitrates, 17
Ultra TABS, 31
Tolbutamide, 13
tricon, 17
Ultra Thin Lancets 28G, 35
tolmetin sodium, 26
triderm, 10
Ultra Thin Lancets 30G, 35
Tolmetin Sodium, 26
trifluoperazine HCL, 20
Ultra-thin II Auto Lancet, 35
tolterodine tartrate, 17
trifluridine, 23
Ultra-thin II Lancets 28G, 35
tolterodine tartrate ER, 17
trigels-f forte, 17
Ultra-thin II Lancets 30G, 35
topex topical anesthetic, 19
Triglide, 8
Ultra-thin II Safety Autolancets 26G, 35
topiragen, 21
trihexyphenidyl HCL, 21
Ultravate PAC, 10
topiramate, 21
trilyte, 15, 43
Ultresa, 16
toposar, 5
trimethobenzamide HCL, 16
umecta mousse, 10
topotecan HCL, 5
trimethoprim, 3
Unilet Comfortouch Lancet, 35
Topotecan HCL, 5
trimethoprim sulfate/polymyxin b sulfate, 23
Unilet Excelite, 35
Torisel, 5
Unilet Excelite II, 35
torsemide, 7
trimipramine maleate, 20
Unilet G.p. Lancet, 35
Torsemide, 7
Trinatal RX 1, 31
Unilet G.p. Superlite Lancet, 35
Totect, 5
Trinate, 31
Unilet GP 28 Ultra Thin, 35
Toviaz, 17
trinessa, 12, 40
Unilet Lancet, 35
tpn electrolytes, 37
triphrocaps, 30
Unilet Superlite Lancet, 35
Tracleer, 8
triple-vitamin/fluoride, 30
Unistik 3 Gentle, 35
Tradjenta, 13
Trisenox, 5
unithroid, 15
tramadol HCL, 26
trivora-28, 12, 40
unithroid direct, 15
tramadol HCL ER, 26
tropazone, 10
Universal 1 Lancets Thin 26G, 35
Tramadol HCL ER, 26
tropicamide, 24
Universal 1 Lancets Ultra Thin 30G, 35
tramadol hydrochloride/acetaminophen, 26
trospium chloride, 17
univert, 16
trospium chloride ER, 17
ur n-c, 16
trandolapril, 7
Trueplus Lancets 26G, 35
urea, 10
urea 40% nail film, 10
Venlafaxine HCL ER, 20
Vitafol-OB, 31
urea hydrating, 10
Venofer, 18
Vitalet Pro Lancets, 35
urea IN zinc undecylenate/lactic acid vehicle, 10
Ventavis, 8
Vitalet Pro Plus Lancets, 35
Ventolin HFA, 28
vitamax pediatric, 30
urea nail, 10
Veramyst, 28
Vitamelts Vitamin D, 30, 43
urea topical, 10
verapamil HCL, 6
vitamin b-complex 100, 30
urea-c40, 10
Verapamil HCL, 6
vitamin c 222MG, 29
urelle, 16
verapamil HCL ER, 6
vitamin d, 29, 43
uretron d/s, 16
verapamil HCL SR, 6
Vitamin D, 30, 43
uribel, 16
Verdeso, 10
vitamin d 400, 30, 43
Urimar-t, 16
verdrocet, 26
vitamin d high potency, 30, 43
urin d/s, 16
Veregen, 11
vitamin d-1000, 30, 43
uro-blue, 16
Veripred 20, 11
vitamin d-1000 maximum strength, 30, 43
uro-l, 16
versiclear, 9
uro-mp, 16
Vesicare, 17
vitamin d-3, 30, 43
urosex, 30
vestura, 12, 40
vitamin d-400, 30, 43
ursodiol, 16
Vexol, 23
vitamin d3, 30, 43
uryl, 16
Viagra, 8
Vitamin D3, 30, 43
ustell, 16
Vibativ, 3
Vitamin D3 400, 30, 43
uta, 16
vic-forte, 30
vitamin d3 adult gummies, 30, 43
uticap, 16
vicodin, 26
vitamin d3 high potency, 30, 43
utira-c, 16
vicodin ES, 26
vitamin d3 maximum strength, 30, 43
utrona-c, 16
vicodin HP, 26
vitamin d3 super strength, 30, 43
Uvadex, 5
Victoza, 13
vitamin k1, 29
V
Victrelis, 3
Vitamin K1, 29
Vida Mia Unilet Lancets Super Thin 30G, 35
vitamins a/c/d/fluoride, 30
v-c forte, 30
Vivitrol, 38
V-go 20, 35
Vida Mia Unilet Lancets Ultra Thin 28G, 35
Vivotif Berna, 29
V-go 30, 35
Vogelxo, 11
V-go 40, 35
Videx Pediatric, 2
Vogelxo P.M., 11
Vagifem, 17
Vigamox, 23
vol-care RX, 30
valacyclovir HCL, 2
Viibryd, 20
Voltaren, 9
Valchlor, 4, 11
Vimizim, 15
Voraxaze, 5
Valcyte, 3
Vimovo, 26
voriconazole, 2
valganciclovir, 3
Vimpat, 21
Vortex Valved Holding Chamber, 36
valproate sodium, 21
Vinate C, 31
Votrient, 5
valproic acid, 21
Vinate Care, 31
Vp-gstn, 38
valsartan, 7
Vinate DHA RF, 31
vp-precip, 37
valsartan/hydrochlorothiazide, 7
Vinate GT, 31
Vp-zel, 31
Valstar, 4
Vinate IC, 31
Vpriv, 18
Value Plus Lancets Standard 21G, 35
Vinate II, 31
vyfemla, 12, 40
Value Plus Lancets Super Thin 30G, 35
Vinate M, 31
Vytorin, 8
Value Plus Lancets Thin 26G, 35
Vinate One, 31
Vyvanse, 21
Valumark Lancet Super Thin 30G, 35
Vinate Pn Care, 31
W
Valumark Lancet Ultra Thin 28G, 35
Vinate Ultra, 31
Valved Holding Chamber, 36
W&f Lancets 26G, 35
Vinblastine Sulfate, 5
vancomycin HCL, 3
W&f Lancets Colored 21G, 35
vincasar PFS, 5
Vancomycin HCL, 3
Walgreens Advanced Travellancets 28G, 35
vincristine sulfate, 5
Vancomycin HCL IN Dextrose, 3
vinorelbine tartrate, 5
vandazole, 17
Walgreens Comfort Assuredlancets Micro Thin/33G, 35
Viokace, 16
Vantas, 4
viorele, 12, 40
Vaqta, 29, 42
Walgreens Comfort Assuredlancets Super Thin/28G, 35
Viracept, 3
Varivax, 29, 42
Viramune, 3
Vascepa, 8
Walgreens Lancets, 35
Viramune XR, 3
vasopressin, 14
Walgreens Thin Lancets, 35
Virazole, 3
Vayacog, 38
Walgreens Ultra Thin Lancets, 35
Viread, 3
Vayarin, 38
warfarin sodium, 19
virt-CAPS, 30
Vayarol, 38
Watchhaler, 36
virt-phos 250 neutral, 37
Vcf Vaginal Contraceptive Film, 17, 40
Webcol Alcohol Prep Large 1 Ply, 36
virt-vite, 17
Vcf Vaginal Contraceptive Foam, 17, 40
Webcol Alcohol Prep Large 2 Ply, 36
virt-vite forte, 37
Vectibix, 4
Webcol Alcohol Prep Medium 2 Ply, 36
virt-vite plus, 30
Vectical, 9
wee care, 18, 42
virti-sulf, 8
vecuronium bromide, 22
Welchol, 8
virtrate-3, 17
Velcade, 5
Wellesse Vitamin D3, 30, 43
Visudyne, 24
Veletri, 8
wera, 12, 40
vita s forte, 30
velivet, 12, 40
Westhroid, 15
vita-min, 30
Veltin, 9
Wheat Germ, 29
Vita-respa, 38
venlafaxine HCL, 20
Wide-seal Silicone Diaphragm Kit 60, 40
vitacel, 30
venlafaxine HCL ER, 20
Wide-seal Silicone Diaphragm Kit 65, 40
Wide-seal Silicone Diaphragm Kit 70, 40
Zinacef, 1
Wide-seal Silicone Diaphragm Kit 75, 40
Zinacef IN Iso-osmotic Diluent, 1
Wide-seal Silicone Diaphragm Kit 80, 40
zinc sulfate, 37
Wide-seal Silicone Diaphragm Kit 85, 40
Zinc Sulfate, 38
Wide-seal Silicone Diaphragm Kit 90, 40
Zinc Trace Metal, 38
Wide-seal Silicone Diaphragm Kit 95, 40
Zioptan, 23
Wilate, 19
ziprasidone HCL, 20
Winrho SDF, 38
Zirgan, 23
wymzya FE, 12, 40
Zithromax, 1
X
Zoladex, 4
zoledronic acid, 14
x-viate, 10
Zoledronic Acid, 14
Xalkori, 5
Zolinza, 5
Xarelto, 19
zolmitriptan, 27
Xarelto Starter Pack, 19
zolmitriptan odt, 27
Xeljanz, 27
zolpidem tartrate, 21
Xenazine, 22
zolpidem tartrate ER, 21
Xenical, 21
Zometa, 14
Xeomin, 22
Zomig, 27
Xgeva, 14
Zomig Nasal Spray, 27
Xiaflex, 38
Zonalon, 9
Xifaxan, 3
zonisamide, 21
Xofigo, 5
Zontivity, 19
Xolair, 28
Zorbtive, 14
Xolegel, 9
Zortress, 5
Xopenex HFA, 28
Zostavax, 29, 42
Xtandi, 4
zovia 1/35e, 12, 40
xulane, 12, 40
Zovia 1/50e, 11, 39
xylocaine dental, 27
Zovirax, 9
xylon, 26
Zuplenz, 16
Xyntha, 19
Zyclara, 10
Xyntha Solofuse, 19
Zyclara P.M., 10
Xyrem, 22
Zydelig, 5
Y
Zyflo, 28
Zyflo CR, 28
Yervoy, 4
Zylet, 23
Yf-vax, 29
Zytiga, 4
yl folic acid, 18, 41
Zyvox, 3
Yodoxin, 3
1
Your Life Multi Prenatal, 31
Z
1ST Choice Lancets Super Thin, 35
1ST Choice Lancets Thin, 35
Zaclir Cleansing, 9
1ST Choice Lancets Ultra Thin, 35
zafirlukast, 28
1ST Tier Unilet Comfortouch Lancets 28G, 35
zaleplon, 21
Zaltrap, 4
1ST Tier Unilet Comfortouch Lancets 30G, 35
zamicet, 26
Zanosar, 4
8
zarah, 12, 40
Zavesca, 18
8-mop, 9
zazole, 17
zebutal, 25
Zegerid, 16
Zelboraf, 5
Zemaira, 28
Zemplar, 14
zenatane, 8
zenchent, 12, 40
zenchent FE, 12, 40
zencia, 8
Zenpep, 16
zenzedi, 21
Zetia, 8
Zetonna, 28
Zevalin Y-90, 4
zflex, 25
Zgesic, 25
Ziagen, 3
Ziana, 9
zidovudine, 2