2016 Generic Centric Formulary Reference Guide - Optum · 2016 Generic-Centric Formulary Reference Guide ... Generic-Centric Formulary Reference Guide ... TM trademarks and logos

2016 Generic-Centric Formulary Reference Guide Effective 1/1/2016

Your formulary 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

Optum has chosen a closed formulary structure for our Generic-Centric Formulary. The

formulary structure features a closed formulary which limits preferred formulary options

to primarily generic medications across most major therapeutic drug categories. In

classes where there are limited generics options, the formulary is supplemented with

preferred brand drugs. Non-preferred brand drugs are excluded from coverage. In

keeping with the specialty drug clinical philosophy, most specialty medications are

included in coverage within the Generic-Centric Formulary and the Specialty Benefit

Design has been added to the formulary to provide clients with flexible, yet clinically

appropriate, coverage options. Standard specialty utilization management is required

to be used with this formulary in order to maintain control over this expensive category.

• Low Cost Generic drugs: Select low cost generic drugs are listed under “LOW

COST GENERIC”. Drugs listed under “LOW COST GENERIC” have the same

active ingredient as the brand-name versions but at a lower cost.

• 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.

• Brand drugs: Drugs listed under “BRAND” include preferred brand name drugs

to supplement the formulary where generic options are limited.

• Specialty drugs: Drugs listed under “GENERIC SPECIALTY”, “PREFERRED

BRAND SPECIALTY”, and “NON-PREFERRED BRAND SPECIALTY”

generally have the highest co-payment(s) and cost. Specialty drugs are

prescription medications that are sometimes used to treat complex and chronic

conditions. They may require special monitoring or handling.

Generic-Centric Formulary Reference Guide

REASONABLE MEDICAL MANAGEMENT

Optum’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 Optum 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,

Optum’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 Optum 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

low cost generic, 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.

Generic-Centric Formulary Reference Guide

CONSULTING THE PRESCRIBER’S OFFICE WHEN

APPROPRIATE

When employers and other health plans design their prescription drug plans, they may

choose to provide coverage only for certain medications, time periods, doses,

quantities, or for a specific indications (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, your pharmacy benefit 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 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: low cost

generics, generics, brand name, and specialty drugs.

OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer

health products. We are an OptumTM company — a leading provider of integrated health services. Learn more at

optum.com.

All OptumTM

trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or

registered marks of their respective owners. © 2015 Optum, Inc. All rights reserved.

*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 Optum. The presence of a medication on this formulary list does not guarantee coverage. To determine the most up-to-date formulary

status of your medication, please visit your member website or call member services at the number listed on your ID card.

Table of Contents

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FOURTH GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTINEOPLASTICS, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIBIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTINEOPLASTIC ENZYMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANGIOGENESIS INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTIBODIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CHEMOTHERAPY ADJUNCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

PHOSPHODIESTERASE INHBTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIPRURITICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

RANK LIGAND INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

GNRH/LHRH ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

GHRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

SOMATOMEDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

GH RECEPTOR ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CORTICOTROPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

VASOPRESSIN ANTAGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HEMATOLOGICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

LOCAL ANESTHETICS-INJ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Erythromycin Base

TETRACYCLINES

GENERIC

July 2016

demeclocycline HCL

doxycycline

ANTI-INFECTIVES

doxycycline hyclate

doxycycline hyclate DR

PENICILLINS

doxycycline monohydrate

LOW COST GENERIC

minocycline HCL

amoxicillin

minocycline HCL ER

dicloxacillin sodium

tetracycline hydrochloride

penicillin v potassium

Tetracycline HCL

GENERIC

amoxicillin/clavulanate potassium

QUINOLONES

amoxicillin/clavulanate potassium ER

LOW COST GENERIC

ampicillin

ciprofloxacin HCL

ampicillin sodium

GENERIC

ampicillin-sulbactam

ciprofloxacin

ampicillin/sulbactam

ciprofloxacin ER

nafcillin sodium

ciprofloxacin I.V.-IN D5W

oxacillin sodium

levofloxacin

penicillin G potassium

levofloxacin IN D5W

piperacillin sodium/ tazobactam sodium

moxifloxacin HCL

piperacillin sodium/tazobactam sodium

ofloxacin

piperacillin/tazobactam

Ciprofloxacin HCL

Amoxicillin/Clavulanate Potassium

Ofloxacin

Ampicillin-sulbactam

AMINOGLYCOSIDES

CEPHALOSPORIN GENERIC SPECIALTY

tobramycin

FIRST GENERATION

LOW COST GENERIC

LOW COST GENERIC

neomycin sulfate

cephalexin

PREFERRED BRAND SPECIALTY

GENERIC

Bethkis

cefadroxil

cefazolin sodium

SECOND GENERATION GENERIC

GENERIC amikacin sulfate

cefaclor gentamicin sulfate

cefotetan gentamicin sulfate pediatric

cefoxitin sodium gentamicin sulfate/0.9% sodium chloride

cefprozil isotonic gentamicin

cefuroxime axetil paromomycin sulfate

cefuroxime sodium tobramycin sulfate

Cefaclor

Cefuroxime Sodium ANTIMYCOBACTERIAL AGENTS

THIRD GENERATION

LOW COST GENERIC

GENERIC

isoniazid

cefdinir

GENERIC

cefixime

ethambutol HCL

cefotaxime sodium

pyrazinamide

cefpodoxime proxetil

rifabutin

ceftazidime

rifampin

ceftriaxone sodium

Ceftriaxone IN Iso-osmotic Dextrose

ANTIFUNGALS

FOURTH GENERATION

LOW COST GENERIC

GENERIC

fluconazole

cefepime

fluconazole IN NACL

ketoconazole

MACROLIDES

terbinafine HCL

LOW COST GENERIC

azithromycin

GENERIC

fluconazole IN dextrose

GENERIC

flucytosine

clarithromycin

griseofulvin microsize

clarithromycin ER

griseofulvin ultramicrosize

erythromycin

itraconazole

nystatin

voriconazole

Effective July 1, 2016 v.1

PA=Prior Auth Required; QL=Quantity Limits; All OptumTM trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. © 2016 Optum, Inc. All rights reserved.

1

ANTIVIRALS BRAND

Albenza

GENERIC SPECIALTY

Biltricide

adefovir dipivoxil

entecavirQL

MISC. ANTI-INFECTIVES

ribavirin

Moderiba 1200 Dose Pack LOW COST GENERIC

Moderiba 800 Dose Pack metronidazole

Ribasphere metronidazole IN NACL 0.79%

Ribasphere Ribapak sulfamethoxazole/trimethoprim

Ribatab sulfamethoxazole/trimethoprim DS

LOW COST GENERIC trimethoprim

acyclovir NON-PREFERRED BRAND SPECIALTY

NON-PREFERRED BRAND SPECIALTY CaystonPA

BaracludeQL

Moderiba

OlysioPA

GENERIC

Peg-intronPA

atovaquone

Peg-intron RedipenPA

aztreonam

Peg-intron Redipen PAK 4PA

bacitracin

PegintronPA

clindamycin

Rebetol

clindamycin palmitate HCL

TechnivieQL,PA

clindamycin phosphate

Tyzeka

clindamycin phosphate add-vantage

Victrelis

clindamycin phosphate pharmacy bulk package

Viekira PAKQL,PA

clindamycin phosphate IN D5W

Virazole

clindamycin HCL


colistimethate sodium

Daklinza

dapsone

HarvoniPA

imipenem/cilastatin

PegasysPA

lincomycin HCL

Pegasys ProclickPA

linezolid

SovaldiPA

meropenem

ZepatierPA

polymyxin b sulfate

GENERIC

tinidazole

abacavir

vancomycin HCL

abacavir sulfate/lamivudine/zidovudine

Linezolid

acyclovir sodium

cidofovir

ANTINEOPLASTICS, ETC

didanosine

ALKYLATING AGENTS

famciclovir

GENERIC SPECIALTY

ganciclovir

carboplatin

lamivudine

cisplatin

lamivudine/zidovudine

ifosfamide

nevirapine

melphalan hydrochloride

nevirapine ER

oxaliplatin

rimantadine HCL

temozolomidePA

stavudine

Lomustine

valacyclovir HCL

NON-PREFERRED BRAND SPECIALTY

valganciclovir

Cisplatin

zidovudine

Cyclophosphamide

BRAND

Gleostine

Evotaz

Ifex

Prezcobix

Ifosfamide

Vitekta

Thiotepa

ValchlorPA

ANTIMALARIALS


LOW COST GENERIC

Bicnu

chloroquine phosphate

Busulfex

hydroxychloroquine sulfate

Leukeran

GENERIC

Mustargen

atovaquone/proguanil HCL

Temodar

mefloquine HCL

Treanda

quinine sulfate

Zanosar

Primaquine Phosphate

GENERIC

cyclophosphamide

ANTHELMINTICS

GENERIC

ANTIBIOTICS

ivermectin

GENERIC SPECIALTY

bleomycin sulfate

Effective July 1, 2016

PA=Prior Auth Required; QL=Quantity Limits; 2

daunorubicin HCL GazyvaPA

doxorubicin HCL KadcylaPA

doxorubicin HCL liposome KeytrudaPA

epirubicin HCL OpdivoPA

idarubicin HCL RituxanPA

mitomycin Unituxin

mitoxantrone HCLPA Vectibix

Doxorubicin HCL Zevalin Y-90

Mitomycin PREFERRED BRAND SPECIALTY

NON-PREFERRED BRAND SPECIALTY AdcetrisPA

Adriamycin ArzerraPA

Cosmegen ErbituxPA

Epirubicin HCL HerceptinPA

Valstar PerjetaPA

PREFERRED BRAND SPECIALTY YervoyPA

Daunoxome

HORMONAL AGENTS

GENERIC SPECIALTY

ANTINEOPLASTIC ENZYMES leuprolide acetatePA



FirmagonQL,PA

Erwinaze

Hydroxyprogesterone Caproate

TrelstarQL,PA

Trelstar MixjectQL,PA


VantasQL,PA

Oncaspar

XtandiPA

ZytigaPA


ANTIMETABOLITES

EligardQL,PA

GENERIC SPECIALTY

Faslodex

azacitidine

Lupron DepotQL,PA

capecitabinePA

ZoladexQL

cytarabine

GENERIC

cytarabine aqueous

anastrozole

decitabinePA

bicalutamide

floxuridine

exemestane

fludarabine phosphate

flutamide

fluorouracil

letrozole

gemcitabine

megestrol acetate

gemcitabine HCL

tamoxifen citrate

mercaptopurine

Floxuridine

IMMUNOMODULATORS



Cytarabine

PomalystPA

Depocyt

RevlimidPA

Purixan



Alimta

ThalomidPA

Arranon

Clolar

GENERIC

FolotynPA

azathioprine

GENERIC

cyclosporine

cladribine

cyclosporine modified

methotrexate

mycophenolate mofetil

methotrexate sodium

mycophenolic acid DR

Methotrexate Sodium

sirolimus

tacrolimus

ANGIOGENESIS INHIBITORS

Azathioprine


CyramzaPA

BRAND

Atgam

Cellcept Intravenous


Prograf

Avastin

ZaltrapPA

MITOTIC INHIBITORS

GENERIC SPECIALTY

ANTIBODIES

docetaxel


etoposide

BlincytoPA

paclitaxel



vincristine sulfate NON-PREFERRED BRAND SPECIALTY

vinorelbine tartrate Camptosar

NON-PREFERRED BRAND SPECIALTY Hycamtin

Docefrez Irinotecan

Docetaxel Topotecan HCL

Etopophos

Marqibo ANTINEOPLASTICS MISC.

Paclitaxel

GENERIC SPECIALTY

Teniposide

bexarotenePA

Vinblastine Sulfate

dacarbazine


tretinoin

Abraxane


Etoposide

Dacarbazine

HalavenPA

Intron APA

Ixempra Kit

Intron A W/DiluentPA

JevtanaPA

Nipent

Photofrin

ENZYME INHIBITORS

SylatronPA

GENERIC SPECIALTY SynriboPA

imatinib mesylatePA PREFERRED BRAND SPECIALTY

NON-PREFERRED BRAND SPECIALTY Actimmune

Afinitor DisperzPA Alferon N

BeleodaqPA Matulane

BosulifPA Proleukin

CometriqPA Theracys

FarydakQL,PA Tice Bcg

GilotrifQL,PA Trisenox

IbrancePA GENERIC

IclusigPA hydroxyurea

ImbruvicaPA

InlytaPA CHEMOTHERAPY RESCUE

IressaPA

GENERIC SPECIALTY

Lenvima 10MG Daily DosePA

amifostine


dexrazoxane


mesna




Fusilev


Mesnex

LynparzaPA

Totect

SprycelPA

GENERIC

StivargaPA

leucovorin calcium

SutentPA

levoleucovorin

TarcevaQL,PA

levoleucovorin calcium

VotrientPA

ZelborafPA

CHEMOTHERAPY ADJUNCTS

ZydeligPA


ZykadiaPA

Kepivance


AfinitorQL,PA

CaprelsaQL,PA

ANTINEOPLASTIC COMBO

GleevecPA


IstodaxPA

LonsurfQL,PA

JakafiPA

KyprolisPA

MekinistPA

NexavarPA

CARDIOVASCULAR DRUGS

TafinlarPA

PHOSPHODIESTERASE INHBTR

TasignaPA

GENERIC

Torisel

milrinone lactate

TykerbPA

milrinone IN dextrose

VelcadePA

XalkoriPA

CARDIAC GLYCOSIDES

ZolinzaPA

LOW COST GENERIC

TOPOISOMERASE I INHIBITOR digoxin

GENERIC SPECIALTY

ANTIANGINAL AGENTS

irinotecan

irinotecan HCL LOW COST GENERIC

topotecan HCL isosorbide mononitrate ER



GENERIC Quinidine Sulfate ER

isosorbide dinitrate

isosorbide mononitrate

nitroglycerin lingual ACE INHIBITORS

nitroglycerin transdermal

LOW COST GENERIC

nitroglycerin ER

benazepril HCL

nitroglycerin IN dextrose 5%

enalapril maleate

nitroglycerin IN 5% dextrose

fosinopril sodium

Isosorbide Dinitrate

lisinopril

Nitroglycerin Lingual

moexipril HCL

quinapril HCL

BETA BLOCKERS

ramipril

LOW COST GENERIC trandolapril

atenolol GENERIC

bisoprolol fumarate captopril

carvedilol enalaprilat

metoprolol tartrate perindopril erbumine

GENERIC ANGIOTENSIN RCPTR BLOCKER

acebutolol HCL

LOW COST GENERIC

betaxolol HCL

losartan potassium

esmolol HCL

GENERIC

labetalol HCL

candesartan cilexetil

metoprolol succinate ER

irbesartan

nadolol

telmisartan

pindolol

valsartan

propranolol HCL

Eprosartan Mesylate

propranolol HCL ER

sotalol HCL

ANTIHYPERTENSIVES MISC.

sotalol HCL (AF)

LOW COST GENERIC

Metoprolol Tartrate

clonidine HCL

doxazosin

CALCIUM CHANNEL BLOCKERS

doxazosin mesylate

LOW COST GENERIC

guanfacine HCL

amlodipine besylate

methyldopa

verapamil HCL

prazosin HCL

GENERIC

terazosin HCL

diltiazem CD

GENERIC

diltiazem HCL

eplerenone

diltiazem HCL ER

fenoldopam mesylate

felodipine ER

hydralazine HCL

isradipine

minoxidil

nicardipine HCL

phenoxybenzamine hydrochloride

nifedipine

nifedipine ER

ANTIHYPERTENSIVE COMBO

nimodipine

LOW COST GENERIC

nisoldipine

atenolol/chlorthalidone

verapamil HCL ER

bisoprolol fumarate/hydrochlorothiazide

verapamil HCL SR

lisinopril/hydrochlorothiazide

losartan potassium/hydrochlorothiazide

ANTIARRHYTHMICS

GENERIC

GENERIC

adenosine

amlodipine besylate/benazepril hydrochloride

amiodarone hydrochloride

amlodipine besylate/benazepril HCL

amiodarone HCL

amlodipine besylate/valsartan

disopyramide phosphate

amlodipine/valsartan/hctz

dofetilide

benazepril HCL/hydrochlorothiazide

flecainide acetate

candesartan cilexetil/hydrochlorothiazide

ibutilide fumarate

enalapril maleate/hydrochlorothiazide

lidocaine HCL

fosinopril sodium/hydrochlorothiazide

lidocaine HCL IN D5W

irbesartan/hydrochlorothiazide

lidocaine HCL/dextrose

metoprolol/hydrochlorothiazide

mexiletine HCL

moexipril/hydrochlorothiazide

propafenone HCL

nadolol/bendroflumethiazide

propafenone HCL ER

quinapril/hydrochlorothiazide

quinidine gluconate CR

telmisartan/amlodipine

quinidine gluconate ER

telmisartan/hydrochlorothiazide

quinidine sulfate

trandolapril/verapamil HCL

Quinidine Sulfate

trandolapril/verapamil HCL ER



valsartan/hydrochlorothiazide SPECIALTY

GENERIC

DIURETICS cholestyramine

cholestyramine light

LOW COST GENERIC

colestipol HCL

amiloride/hydrochlorothiazide

fenofibrate

bumetanide

fenofibrate micronized

chlorothiazide

fenofibric acid DR

chlorthalidone

fluvastatin

furosemide

fluvastatin sodium ER

hydrochlorothiazide

lovastatin

indapamide

niacin ER

spironolactone

omega-3-acid ethyl esters

spironolactone/hydrochlorothiazide

pravastatin sodium

torsemide

rosuvastatin calcium

triamterene/hydrochlorothiazide

Fenofibrate

Chlorothiazide

Fenofibric Acid

Chlorthalidone

Triamterene/Hydrochlorothiazide

CARDIOVASCULAR - MISC.


KeveyisQL,PA GENERIC SPECIALTY

epoprostenol sodiumPA

sildenafilQL,PA

sildenafil citrateQL,PA

GENERIC


acetazolamide

AdcircaQL,PA

acetazolamide sodium

OrenitramPA

acetazolamide ER

RevatioQL,PA

amiloride HCL

TyvasoQL,PA

chlorothiazide sodium

Tyvaso RefillQL,PA

ethacrynate sodium

Tyvaso StarterQL,PA

mannitol

VentavisQL,PA

methazolamide


metolazone

AdempasQL,PA

Acetazolamide

LetairisQL,PA

OpsumitQL,PA

VASOPRESSORS

RemodulinPA


TracleerQL,PA

NortheraPA

VeletriPA

GENERIC

amlodipine besylate/atorvastatin calcium

GENERIC

cardioplegic

dobutamine HCL

papaverine HCL

dobutamine HCL/D5W

Papaverine-alprostadil

dobutamine/dextrose 5%

Papaverine-phentolamine Mes/Alprostadil

dopamine HCL

Papaverine-phentolamine Mesylate

dopamine HCL-dextrose 5%

Papaverine/Phentolamine Mes/Alprostadil

dopamine HCL/dextrose 5%

Phentolamine Mesylate-alprostadil

dopamine/D5W

BRAND

ephedrine sulfate

Cialis

midodrine HCL

Stendra

norepinephrine bitartrate

phenylephrine HCL

DERMATOLOGICALS

Dopamine HCL

ACNE PRODUCTS

Epinephrine

BRAND GENERIC

Epipen 2-PAK adapalene

Epipen-JR 2-PAK adapalene P.M.

benzoyl peroxide

ANTIHYPERLIPIDEMICS benzoyl peroxide SHORT contact


LOW COST GENERIC

clindamycin/benzoyl peroxide

atorvastatin calcium

erythromycin

gemfibrozil

erythromycin/benzoyl peroxide

simvastatin

sodium sulfacetamide


sodium sulfacetamide/sulfur

JuxtapidQL,PA

sodium sulfacetamide/sulfur cleanser

KynamroQL,PA

sodium sulfacetamide/sulfur cleansing cloths

RepathaQL,PA

sodium sulfacetamide/sulfur green

Repatha SureclickQL,PA

sodium sulfacetamide/sulfur w/sunscreen


sodium sulfacetamide/sulfur wash

PraluentQL,PA



sulfacetamide sodium GENERIC

sulfacetamide sodium/sulfur alclometasone dipropionate

sulfacetamide sodium/sulfur cleanser augmented betamethasone dipropionate

tretinoin betamethasone dipropionate

tretinoin microsphere betamethasone valerate

tretinoin microsphere P.M. calcipotriene/betamethasone dipropionate

clobetasol propionate

ROSACEA AGENTS clobetasol propionate emollient

desonide

GENERIC

desoximetasone

metronidazole

fluocinolone acetonide

Doxycycline

fluocinonide

fluocinonide-e

ANTIBIOTICS - TOPICAL

flurandrenolide

GENERIC

fluticasone propionate

mupirocin

halobetasol propionate

mupirocin calcium

hydrocortisone

hydrocortisone acetate/aloe

ANTIFUNGALS - TOPICAL

hydrocortisone butyrate

LOW COST GENERIC

hydrocortisone butyrate (lipid)

clotrimazole

hydrocortisone butyrate (lipophilic)

GENERIC

hydrocortisone valerate

ciclopirox

hydrocortisone IN absorbase

ciclopirox nail lacquer

mometasone furoate

ciclopirox olamine

prednicarbate

clotrimazole/betamethasone dipropionate

Amcinonide

econazole nitrate

Desoximetasone

ketoconazole

Diflorasone Diacetate

naftifine hydrochloride

nystatin

IMMUNOMODULATING AGENTS

nystatin/triamcinolone

GENERIC

oxiconazole nitrate

imiquimod

tacrolimus

ANTIVIRALS - TOPICAL

GENERIC

DERMATOLOGICALS - MISC.

acyclovir

GENERIC

ammonium lactate

ANTI-INFLAMMATORY AGENTS

episone CRE

GENERIC

lactic acid

diclofenac sodium

lactic acid e

lactic acid w/vitamin e

ANTIPRURITICS

lidocaine

GENERIC

lidocaine HCL

Doxepin Hydrochloride

lidocaine HCL jelly

lidocaine-prilocaine-cream base

ANTIPSORIATICS

lidocaine/prilocaine


lindane

CosentyxPA

malathion

Cosentyx Sensoready PenPA

permethrin

podofilox


salicylic acid

StelaraPA

salicylic acid cream

salicylic acid lotion

GENERIC

salicylic acid ER

acitretin

sodium hyaluronate

calcipotriene

urea

methoxsalen

urea topical

Calcitriol

urea IN zinc undecylenate/lactic acid vehicle

urea 40% nail film

ANTISEBORRHEIC AGENTS

GENERIC

ENDOCRINE AND METABOLIC

selenium sulfide

CORTICOSTEROIDS


LOW COST GENERIC

sodium sulfacetamide wash

dexamethasone

dexamethasone sodium phosphate

CORTICOSTEROIDS - TOPICAL

hydrocortisone

LOW COST GENERIC

methylprednisolone

triamcinolone acetonide

methylprednisolone acetate

methylprednisolone dose pack



methylprednisolone sodiumsuccinate Humulin R U-500 (concentrated)

prednisolone Humulin R U-500 Kwikpen

prednisolone sodium phosphate Humulin 70/30

prednisone Humulin 70/30 Kwikpen

Dexamethasone Lantus

Dexamethasone Sodium Phosphate Lantus Solostar

Prednisone Relion R

GENERIC Toujeo Solostar

betamethasone sodium phosphate/betamethasone acetate

Tresiba Flextouch

AMYLIN ANALOGS

budesonide

BRAND

fludrocortisone acetate

Symlinpen 120

prednisolone sodium phosphate odt

Symlinpen 60

INCRETIN MIMETIC AGENTS

ANDROGENS-ANABOLIC

BRAND

GENERIC

Bydureon

danazol

Byetta

methyltestosterone

Trulicity

oxandrolone

Victoza

testosterone cypionate

SULFONYLUREAS

testosterone enanthate

LOW COST GENERIC

BRAND

glimepiride

Androderm

glipizide

glipizide ER

ESTROGENS

glyburide

LOW COST GENERIC glyburide micronized

estradiol Glyburide

Estropipate

GENERIC GENERIC

estradiol valerate tolazamide

estradiol/norethindrone acetate Tolazamide

norethindrone acetate/ethinyl estradiol BIGUANIDES

LOW COST GENERIC

metformin HCL

CONTRACEPTIVES

GENERIC

LOW COST GENERIC

metformin HCL ER

levonorgestrel/ethinyl estradiol

MEGLITINIDE ANALOGUES

norethindrone

GENERIC

GENERIC

nateglinide

desogestrel/ethinyl estradiol

repaglinide

drospirenone/ethinyl estradiol

DIABETIC OTHER

levonorgestrel


levonorgestrel and ethinyl estradiol

Korlym

norethindrone & ethinyl estradiol ferrous fumarate

norethindrone acetate/ethinyl estradiol

norethindrone acetate/ethinyl estradiol/ferrous fumarate

norgestimate/ethinyl estradiol BRAND

Levonorgestrel Glucagon Emergency Kit

Invokana

PROGESTINS Jardiance

ALPHA-GLUCOSIDASE INHIBIT

LOW COST GENERIC

GENERIC

medroxyprogesterone acetate

acarbose

GENERIC

miglitol

megestrol acetate

DPP-4 INHIBITORS

norethindrone acetate

GENERIC

progesterone

Alogliptin

BRAND

ANTIDIABETIC AGENTS

Januvia

INSULIN

Onglyza

BRAND

INSULIN SENSITIZING AGENT

Afrezza

GENERIC

Humalog

pioglitazone HCL

Humalog Kwikpen

ANTIDIABETIC COMBINATIONS

Humalog Mix 50/50

GENERIC

Humalog Mix 50/50 Kwikpen

glipizide/metformin HCL

Humalog Mix 75/25

glyburide/metformin HCL

Humalog Mix 75/25 Kwikpen

pioglitazone HCL-glimepiride

Humulin N

pioglitazone HCL/metformin HCL

Humulin N Kwikpen

Alogliptin/Metformin HCL

Humulin R



Alogliptin/Pioglitazone Supprelin LAQL,PA

Repaglinide/Metformin Hydrochloride

BRAND GNRH/LHRH ANTAGONISTS

Invokamet


Janumet

Ganirelix AcetatePA

Janumet XR

Kombiglyze XR

Synjardy


CetrotidePA

BISPHOSPHONATES

GENERIC SPECIALTY

pamidronate disodium

GROWTH HORMONES

zoledronic acid



ZorbtivePA

Pamidronate Disodium

Zoledronic Acid

Zometa


GENERIC

Norditropin CartridgePA

alendronate sodium

Norditropin FlexproPA

ibandronate sodium

Norditropin Nordiflex PenPA

risedronate sodium

Nutropin AQ Nuspin 10PA

risedronate sodium DR



CALCITONINS

Nutropin AQ PenPA

GENERIC

SaizenPA

calcitonin salmon

Saizen Click.easyPA

calcitonin-salmon

SerostimPA

PARATHYROID HORMONE

GHRH



NatparaQL,PA

EgriftaQL,PA


ForteoQL,PA

SOMATOMEDINS


IncrelexPA

RANK LIGAND INHIBITORS


ProliaQL,PA

SOMATOSTATIC AGENTS

XgevaPA

GENERIC SPECIALTY

octreotide acetatePA

HORMONE RECEPTOR MDLTR


GENERIC

Sandostatin Lar DepotPA

raloxifene hydrochloride

SigniforQL,PA

Signifor LarQL,PA

FERTILITY REGULATORS

Somatuline DepotPA

GENERIC SPECIALTY

chorionic gonadotropinPA GH RECEPTOR ANTAGONISTS

LOW COST GENERIC


clomiphene citrate

SomavertPA


BravellePA

MenopurPA

Ovidrel

POSTERIOR PITUITARY


GENERIC

Follistim AQPA

desmopressin acetate

Gonal-fPA

vasopressin

Gonal-f RFFPA

Gonal-f RFF RedijectPA

CORTICOTROPIN


LHRH/GNRH AGONIST

H.p. ActharPA


Lupaneta PackQL,PA

PROLACTIN INHIBITORS


GENERIC

Lupron Depot-PEDQL,PA

cabergoline



VASOPRESSIN ANTAGONISTS cimetidine

cimetidine HCL


esomeprazole magnesium

SamscaQL

esomeprazole sodium

famotidine

glycopyrrolate

METABOLIC MODIFIERS

hyoscyamine sulfate

GENERIC SPECIALTY

hyoscyamine sulfate odt

sodium phenylbutyrate

hyoscyamine sulfate ER


hyoscyamine sulfate SR

Buphenyl

lansoprazole

MyaleptPA

lansoprazole/amoxicillin/clarithromycin

Orfadin

methscopolamine bromide

RavictiPA

misoprostol

VimizimPA

nizatidine


omeprazole/sodium bicarbonate

AldurazymePA

rabeprazole sodium

Carbaglu

ranitidine HCL

ElaprasePA

Esomeprazole Sodium

FabrazymePA

Famotidine

KuvanPA

Nizatidine

LumizymePA

MyozymePA

NaglazymePA

ANTIEMETICS

GENERIC

LOW COST GENERIC

calcitriol

meclizine HCL

doxercalciferol

GENERIC

levocarnitine

dronabinol

paricalcitol

granisetron HCL

sodium phenylacetate/sodium benzoate

ondansetron odt

BRAND

ondansetron HCL

Sensipar

trimethobenzamide HCL

THYROID AGENTS

LOW COST GENERIC

DIGESTIVE AIDS

levothyroxine sodium


GENERIC

Sucraid

liothyronine sodium

methimazole

propylthiouracil

BRAND

BRAND

Creon

Synthroid

Pancrelipase

Zenpep

GASTROINTESTINAL

LAXATIVES

GASTROINTESTINAL - MISC.

LOW COST GENERIC

LOW COST GENERIC

lactulose

metoclopramide HCL

GENERIC


peg 3350/electrolytes

EntyvioPA

peg-3350/electrolytes

GattexPA

peg-3350/NACL/NA bicarbonate/KCL

polyethylene glycol 3350


CimziaPA

ANTIDIARRHEALS

Cimzia Starter KitPA

GENERIC

RemicadePA

diphenoxylate/atropine

GENERIC

loperamide HCL

alosetron hydrochloride

opium

balsalazide disodium

opium tincture

calcium acetate

cromolyn sodium

ULCER DRUGS

hydrocort ene 100MG

LOW COST GENERIC

hydrocortisone

dicyclomine HCL

hydrocortisone acetate/lidocaine HCL

omeprazole

hydrocortisone acetate/pramoxine

pantoprazole sodium

lactulose

sucralfate

lidocaine HCL/hydrocortisone acetate

GENERIC

mesalamine

atropine sulfate

metoclopramide odt

chlordiazepoxide HCL/clidinium bromide

sulfasalazine



ursodiol NON-PREFERRED BRAND SPECIALTY

CerdelgaPA

BRAND ElelysoPA

Amitiza LeukinePA

Lialda MirceraPA

NeulastaPA

GENITOURINARY Neulasta Onpro KitPA

Omontys

URINARY ANTI-INFECTIVES

PromactaPA

GENERIC

VprivPA

methenamine hippurate

ZavescaPA

methenamine mandelate


nitrofurantoin

CerezymePA

nitrofurantoin macrocrystals

GranixPA

nitrofurantoin monohydrate

MozobilQL,PA

nitrofurantoin monohydrate/macrocrystals

NeumegaPA

NeupogenPA

URINARY ANTISPASMODICS

NplatePA

GENERIC

ProcritPA

bethanechol chloride

GENERIC

darifenacin hydrobromide ER

cyanocobalamin

darifenacin ER

folic acid

flavoxate HCL

folic acid/vitamin b-6/vitamin b-12

oxybutynin chloride

sodium ferric gluconate complex/sucrose

oxybutynin chloride ER

Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc

tolterodine tartrate

tolterodine tartrate ER

trospium chloride

ANTICOAGULANTS

trospium chloride ER

GENERIC SPECIALTY

BRAND

enoxaparin sodiumQL

Gelnique

fondaparinux sodiumQL

LOW COST GENERIC

VAGINAL PRODUCTS

warfarin sodium

GENERIC



FragminQL

metronidazole vaginal

terconazole

GENERIC

GENITOURINARY - MISC.

argatroban

LOW COST GENERIC

bivalirudin

citric acid/sodium citrate

heparin lock

finasteride

heparin lock flush

phenazopyridine HCL

heparin lock flush for flushing vascular access devices

sodium citrate/citric acid

heparin lock flush/NACL for flushing vascular access devices

tamsulosin HCL


heparin sodium

Cystagon

heparin sodium dcu

ProcysbiPA

heparin sodium lock flush

heparin sodium/sodium chloride 0.9% premix

GENERIC

heparin sodium/D5W

acetic acid 0.25%

heparin sodium/NACL 0.9%

alfuzosin HCL ER

BRAND

aminoacetic acid

Pradaxa

dutasteride

Savaysa

dutasteride/tamsulosin hydrochloride

Xarelto

dutasteride/tamsulosin HCL

Xarelto Starter Pack

glycine

neomycin/polymyxin b sulfates

HEMOSTATICS

potassium citrate ER

GENERIC

potassium citrate-citric acid crystals

aminocaproic acid

potassium citrate/citric acid

tranexamic acid

potassium citrate/sodium citrate/citric acid

sodium chloride

HEMATOLOGICAL - MISC.

sodium chloride 0.9%


tricitrates

Alprolix

Ceprotin

HEMATOLOGICAL

Eloctate

HEMATOPOIETIC AGENTS

Helixate FS

NON-

Ixinity



KalbitorPA LOW COST GENERIC

Kogenate FS buspirone HCL

Kogenate FS Bio-set hydroxyzine pamoate

Kovaltry hydroxyzine HCL

Novoeight Hydroxyzine Pamoate

Nuwiq GENERIC

RuconestPA alprazolam

Thrombate Iii W/10 ML Sterile Water alprazolam odt

Thrombate Iii W/20 ML Sterile Water alprazolam ER

Tretten chlordiazepoxide HCL

Xyntha clorazepate dipotassium

Xyntha Solofuse diazepam

PREFERRED BRAND SPECIALTY droperidol

Advate gene-xene TAB 15MG

Alphanate/Von Willebrand Factor Complex/Human gene-xene TAB 3.75MG

Alphanine SD gene-xene TAB 7.5MG

Bebulin lorazepam

Benefix meprobamate

BerinertPA oxazepam

CinryzePA Diazepam

Corifact

Feiba ANTIDEPRESSANTS

Feiba NF

LOW COST GENERIC

FirazyrPA

amitriptyline HCL

Hemofil M

doxepin HCL

Humate-p

fluoxetine HCL

Koate-dvi

mirtazapine

Monoclate-p

mirtazapine odt

Mononine

nortriptyline HCL

Novoseven

paroxetine HCL

Novoseven Rt

Doxepin HCL

Profilnine

GENERIC

Profilnine SD

bupropion HCL

Recombinate

bupropion HCL ER

Riastap

bupropion HCL SR

SolirisPA

bupropion HCL XL

Wilate

citalopram hydrobromide

GENERIC

clomipramine HCL

albumin human

desipramine HCL

anagrelide hydrochloride

duloxetine HCL

cilostazol

escitalopram oxalate

clopidogrel

fluoxetine DR

dipyridamole

fluvoxamine maleate

eptifibatide

fluvoxamine maleate ER

hetastarch 6%/NACL

imipramine pamoate

pentoxifylline ER

imipramine HCL

ticlopidine HCL

nefazodone HCL

Aspirin/Dipyridamole

paroxetine HCL ER

phenelzine sulfate

MOUTH/THROAT/DENTAL AGENT

protriptyline HCL

sertraline HCL

tranylcypromine sulfate

LOW COST GENERIC

trazodone HCL

chlorhexidine gluconate

trimipramine maleate

chlorhexidine gluconate oral rinse

venlafaxine HCL

lidocaine viscous

venlafaxine HCL ER

lidocaine HCL viscous

Amoxapine

GENERIC

Nefazodone HCL

cevimeline HCL

Nortriptyline HCL

clotrimazole

Venlafaxine HCL ER

nystatin

pilocarpine hydrochloride

pilocarpine HCL

ANTIPSYCHOTICS

stannous fluoride oral rinse

triamcinolone acetonide LOW COST GENERIC

triamcinolone IN orabase fluphenazine HCL

lithium carbonate

NEUROLOGY, CNS, PSYCH lithium carbonate ER

GENERIC

ANTIANXIETY AGENTS

aripiprazole



chlorpromazine HCL Methylphenidate HCL ER

clozapine

clozapine odt ANTICONVULSANTS

fluphenazine decanoate

LOW COST GENERIC

haloperidol

carbamazepine

haloperidol decanoate

primidone

haloperidol lactate

valproate sodium

loxapine

valproic acid

loxapine succinate

olanzapine


olanzapine odt

SabrilPA

paliperidone ER

perphenazine

prochlorperazine

GENERIC

prochlorperazine edisylate

carbamazepine ER

prochlorperazine maleate

clonazepam

quetiapine fumarate

clonazepam odt

risperidone

divalproex sodium

risperidone odt

divalproex sodium DR

thioridazine HCL

divalproex sodium ER

thiothixene

ethosuximide

trifluoperazine HCL

felbamate

ziprasidone HCL

fosphenytoin sodium

Aripiprazole Odt

gabapentin

Clozapine Odt

lamotrigine

lamotrigine odt

lamotrigine titration

HYPNOTICS

lamotrigine ER


levetiracetam

HetliozQL,PA

levetiracetam ER

oxcarbazepine

phenytoin

GENERIC phenytoin sodium

dexmedetomidine HCL phenytoin sodium extended

estazolam tiagabine hydrochloride

eszopiclone topiramate

flurazepam HCL zonisamide

phenobarbital

temazepam ANTIPARKINSON AGENTS

triazolam


zaleplon

ApokynQL,PA

zolpidem tartrate

zolpidem tartrate ER

GENERIC

Flurazepam HCL

amantadine HCL

Phenobarbital

benztropine mesylate

Phenobarbital Sodium

bromocriptine mesylate

Quazepam

carbidopa

Triazolam

carbidopa/levodopa

carbidopa/levodopa odt

ADHD, NARCOLEPSY, ETC.

carbidopa/levodopa ER

GENERIC

entacapone

amphetamine/dextroamphetamine

pramipexole dihydrochloride

armodafinil

pramipexole dihydrochloride ER

caffeine citrate

ropinirole ER

clonidine HCL ER

ropinirole HCL

dexmethylphenidate HCL

selegiline HCL

dexmethylphenidate HCL ER

tolcapone

dextroamphetamine sulfate

trihexyphenidyl HCL

dextroamphetamine sulfate ER

Carbidopa/Levodopa/Entacapone

doxapram HCL

guanfacine ER

NEUROLOGY, PSYCH - MISC.

methamphetamine HCL

GENERIC SPECIALTY

methylphenidate hydrochloride

glatopaQL,PA

methylphenidate HCL

tetrabenazinePA

methylphenidate HCL CD


methylphenidate HCL ER

AubagioQL,PA

methylphenidate HCL SR

GilenyaQL,PA

modafinil

LemtradaPA

Armodafinil

TysabriQL,PA



XyremQL,PA tizanidine HCL

PREFERRED BRAND SPECIALTY Metaxalone

AmpyraQL,PA Orphenadrine/Asa/Caffeine

AvonexQL,PA

CopaxoneQL,PA ANTIMYASTHENIC AGENTS

PlegridyQL,PA

GENERIC

Plegridy Starter PackQL,PA

neostigmine methylsulfate

TecfideraQL,PA

pyridostigmine bromide

Tecfidera Starter PackQL,PA

GENERIC

OPHTHALMOLOGY AND OTIC

acamprosate calcium DR

ANTI-INFECTIVES

disulfiram

LOW COST GENERIC

donepezil HCL

polymyxin b sulfate/trimethoprim sulfate

ergoloid mesylates

tobramycin sulfate

galantamine hydrobromide

trimethoprim sulfate/polymyxin b sulfate

memantine hydrochloride

GENERIC

memantine HCL

bacitracin/polymyxin b

memantine HCL titration PAK

ciprofloxacin HCL

olanzapine/fluoxetine

erythromycin

pimozide

gatifloxacin

rivastigmine tartrate

gentamicin sulfate

rivastigmine transdermal system

levofloxacin

Ergoloid Mesylates

neomycin/bacitracin/polymyxin

Galantamine Hydrobromide

neomycin/polymyxin/bacitracin zinc

Perphenazine/Amitriptyline

neomycin/polymyxin/gramicidin

ofloxacin

NEUROMUSCULAR AGENTS



sulfacetamide sodium

DysportPA

trifluridine

MyoblocPA

Bacitracin

XeominPA


BETA-BLOCKERS

BotoxPA

LOW COST GENERIC

timolol maleate

GENERIC

GENERIC

atracurium besylate

betaxolol HCL

cisatracurium besylate

carteolol HCL

pancuronium bromide

dorzolamide HCL/timolol maleate

riluzole

levobunolol HCL

rocuronium bromide

timolol maleate ophthalmic gel forming

vecuronium bromide

Metipranolol

MUSCULOSKELETAL AGENTS

OPHTHALMIC STEROIDS

LOW COST GENERIC

LOW COST GENERIC

baclofen

neomycin/polymyxin/dexamethasone

carisoprodol

cyclobenzaprine HCL


methocarbamol

Iluvien


Gel-onePA

GENERIC

Genvisc 850PA

dexamethasone sodium phosphate

HyalganPA

fluorometholone

MonoviscPA

neomycin/polymyxin/bacitracin/hydrocortisone

OrthoviscPA

prednisolone acetate

SupartzPA

sulfacetamide sodium/prednisolone sodium phosphate

Supartz FxPA

tobramycin/dexamethasone


BRAND

EuflexxaPA

FML Forte

SynviscPA

Synvisc OnePA

PROSTAGLANDINS

GENERIC

GENERIC

carisoprodol/aspirin

latanoprost

carisoprodol/aspirin/codeine

Bimatoprost

chlorzoxazone

BRAND

dantrolene sodium

Lumigan

metaxalone

Travatan Z

orphenadrine citrate

orphenadrine citrate ER



CYCLOPLEGIC MYDRIATICS butalbital/acetaminophen/caffeine

butalbital/aspirin/caffeine

LOW COST GENERIC

choline magnesium trisalicylate

atropine sulfate

clonidine HCL

GENERIC

diflunisal

cyclopentolate hydrochloride

salsalate

cyclopentolate HCL

homatropine HBR

ANALGESICS - OPIOID

DECONGESTANTS GENERIC

acetaminophen/caffeine/dihydrocodeine

GENERIC

acetaminophen/codeine

phenylephrine HCL

acetaminophen/codeine #2


MIOTICS


GENERIC

acetaminophen/codeine phosphate

pilocarpine HCL

alfentanil

buprenorphine HCL

ADRENERGIC AGENTS

buprenorphine HCL/naloxone HCL

GENERIC

butalbital/acetaminophen/caffeine/codeine

apraclonidine

butalbital/aspirin/caffeine/codeine

brimonidine tartrate

butorphanol tartrate

codeine sulfate

LOCAL ANESTHETICS

fentanyl

GENERIC

fentanyl citrate oral transmucosal

proparacaine HCL

hydrocodone bitartrate/acetaminophen

tetracaine HCL

hydrocodone/acetaminophen

hydrocodone/ibuprofen

OPHTHALMICS - MISC.

hydromorphone HCL


hydromorphone HCL dosette

CystaranQL,PA

hydromorphone HCL ER

Jetrea

meperidine HCL

methadone HCL

GENERIC

morphine sulfate

azelastine HCL

morphine sulfate ER

bromfenac

nalbuphine HCL

cromolyn sodium

oxycodone hydrochloride

diclofenac sodium

oxycodone HCL

dorzolamide HCL

oxycodone/acetaminophen

epinastine HCL

oxycodone/aspirin

flurbiprofen sodium

oxycodone/ibuprofen

ketorolac tromethamine

oxymorphone hydrochloride

olopatadine HCL

oxymorphone hydrochloride ER

pentazocine/naloxone HCL

tramadol hydrochloride

OTIC AGENTS

tramadol hydrochloride/acetaminophen

LOW COST GENERIC

tramadol HCL

antipyrine/benzocaine

tramadol HCL ER

GENERIC

Aspirin-caffeine-dihydrocodeine

acetic acid

Fentanyl

fluocinolone acetonide

Hydrocodone/Acetaminophen

fluocinolone acetonide ear drops

Hydromorphone HCL ER

hydrocortisone/acetic acid

Hydromorphone HCL/Sodium Chloride

neomycin/polymyxin/hydrocortisone

Morphine Sulfate

neomycin/polymyxin/HC

Morphine Sulfate ER

ofloxacin

Oxycodone HCL ER

Tramadol HCL ER

OXYTOCICS

BRAND

GENERIC

Opana ER (crush Resistant)

methylergonovine maleate

Oxycontin

oxytocin

ANTI-INFLAMMATORY

PAIN MANAGEMENT

LOW COST GENERIC

ANALGESICS - NONNARCOTIC indomethacin

meloxicam



Prialt

ActemraPA

ArcalystPA

GENERIC

EnbrelPA

butalbital/acetaminophen



Enbrel SureclickPA SPECIALTY

KineretPA GENERIC

OrenciaPA probenecid

OtezlaPA probenecid/colchicine

XeljanzPA BRAND

PREFERRED BRAND SPECIALTY Colchicine

HumiraPA Colcrys

Humira Pediatric Crohns Disease Starter PackPA

Humira PenPA LOCAL ANESTHETICS-INJ

Humira Pen-crohns DiseasestarterPA

GENERIC

Humira Pen-psoriasis StarterPA

bupivacaine HCL

IlarisQL,PA

bupivacaine/epinephrine

SimponiPA

chloroprocaine HCL

Simponi AriaPA

lidocaine HCL

GENERIC

lidocaine/epinephrine

celecoxib

ropivacaine

diclofenac potassium

ropivacaine HCL

diclofenac sodium DR

Tetracaine HCL

diclofenac sodium ER

diclofenac sodium/misoprostol

RESPIRATORY, ALLERGY, ETC

etodolac

ANTIHISTAMINES

etodolac ER

LOW COST GENERIC

flurbiprofen

promethazine HCL plain

ibuprofen

GENERIC

ibuprofen lysine

carbinoxamine maleate

indomethacin ER

cetirizine HCL

ketoprofen

clemastine fumarate

ketorolac tromethamine

cyproheptadine HCL

leflunomide

desloratadine

mefenamic acid

diphenhydramine HCL

nabumetone

levocetirizine dihydrochloride

naproxen

promethazine HCL

naproxen sodium

Clemastine Fumarate

naproxen sodium CR

Desloratadine Odt

naproxen sodium DS

naproxen sodium ER

NASAL AGENTS

oxaprozin

LOW COST GENERIC

piroxicam

ipratropium bromide

sulindac

GENERIC

tolmetin sodium

azelastine HCL

Fenoprofen Calcium

budesonide

Meclofenamate Sodium

flunisolide

Naproxen

fluticasone propionate

Tolmetin Sodium

mometasone furoate

olopatadine HCL

MIGRAINE PRODUCTS

triamcinolone acetonide

GENERIC

almotriptan malate

COUGH/COLD/ALLERGY

dihydroergotamine mesylate

LOW COST GENERIC

frovatriptan succinate

benzonatate

naratriptan HCL

promethazine-DM

rizatriptan benzoate

promethazine/dextromethorphan

rizatriptan benzoate odt

GENERIC

sumatriptan succinate

acetylcysteine

sumatriptan succinate refill

bromphen/pseudoephedrine HCL/dextromethorphan HBR

zolmitriptan

hydrocodone bitartrate/chlorpheniramine maleate/PSE

zolmitriptan odt

hydrocodone bitartrate/homatropine methylbromide

Dihydroergotamine Mesylate

hydrocodone polistirex/chlorpheniramine polistirex

Sumatriptan Succinate

hydrocodone/homatropine

phenylephrine/guaifenesin

BRAND

promethazine/codeine

Cafergot

promethazine/phenylephrine

promethazine/phenylephrine/codeine

GOUT AGENTS

sodium chloride

LOW COST GENERIC

allopurinol

ANTIASTHMATIC/COPD AGENTS


LOW COST GENERIC

KrystexxaPA

ipratropium bromide



PREFERRED BRAND SPECIALTY MEDICAL DEVICES

XolairPA

DIABETIC SUPPLIES

GENERIC

BRAND

albuterol

Accu-chek Safe-t-pro Lancets

albuterol sulfate

Accu-chek Safe-t-pro Pluslancets

albuterol sulfate ER

Accu-chek Soft Touch Lancets

albuterol TAB 4MG

Accu-chek Softclix Lancets

aminophylline

Active 1ST Blood Lancets 30G/Easy Twist CAP

budesonide

Advocate Lancets

epinephrine HCL

Advocate Lancets 30G

ipratropium bromide/albuterol sulfate

Advocate Safety Lancets

levalbuterol

Advocate Safety Lancets 26G

levalbuterol HCL

Agamatrix Ultra-thin Lancets 33G

montelukast sodium

Assure Haemolance Plus High Flow 18G

terbutaline sulfate

Assure Haemolance Plus Low Flow 25G

theophylline

Assure Haemolance Plus Micro Flow 28G

theophylline CR

Assure Haemolance Plus Normal Flow 21G

theophylline ER

Assure Haemolance Plus Pediatric Blade

zafirlukast

Assure Lance Lancets

Cromolyn Sodium

Assure Lance Lancets 21G

Assure Lance Plus Safety Lancets 25G

BRAND

Assure Lance Plus Safety Lancets 30G

Advair Diskus

Assure Lancets

Advair HFA

Aurora Lancet Super Thin 30G

Arnuity Ellipta

Aurora Lancet Thin 23G

Breo Ellipta

AF Lancets Super Thin

Combivent Respimat

AT Last Lancets

Daliresp

Bayer Microlet Lancets

Flovent Diskus

Bullseye Safety Lancets

Flovent HFA

BD Insulin Syringe LUER-LOK/U-100/1ML

Incruse Ellipta

BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2"

Proair HFA

BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2"

Pulmicort Flexhaler

BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8"

Serevent Diskus

BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2"

Spiriva Handihaler

BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2"

Spiriva Respimat

BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2"

Symbicort

BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8"

Ventolin HFA

BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2"

BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16"

RESPIRATORY AGENTS - MISC

BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2"


BD Insulin Syringe Safetyglide/1ML/29G X 1/2"

Aralast NPPA

BD Insulin Syringe Slip Tip/U-100/1ML

EsbrietPA

BD Insulin Syringe U-40/1ML/25G X 5/8"

GlassiaPA

BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16"

KalydecoPA

BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16"

OfevPA

BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16"

OrkambiQL,PA

BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2"

Prolastin-cPA

BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2"

ZemairaPA

BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2"


BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2"

PulmozymePA

BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2"



VITAMINS


BD Insulin Syringe Ultrafine/1ML/30G X 1/2"

VITAMINS

BD Insulin Syringe Ultrafine/1ML/31G X 5/16"

GENERIC

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1"

ascorbic acid

ergocalciferol

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/8"

phytonadione

thiamine HCL

BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2"

vitamin c 222MG

vitamin d

BD Insulin Syringe/U-100/0.5ML/30G X 1/2"

vitamin k1

BD Insulin Syringe/U-100/1ML/27G X 1/2"


MULTIVITAMINS

BD Insulin Syringe/U-100/2ML/27.5G X 5/8"

GENERIC


b-complex 100

BD Lancet Ultrafine 30G

niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper

BD Lancet Ultrafine 33G



BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2"

Gentle-let Lancets General Purpose Style/Medium Point

Gentle-let Lancets Safety Style/Fine Point

BD Microtainer Lancets

Gentle-let Lancets Safety Style/Medium Point

BD Pen Needle/Mini/Ultrafine/31G X 3/16"

Glucocom Lancets 28G

BD Pen Needle/Nano/Ultra Fine/32G X 4MM


BD Pen Needle/SHORT/Ultrafine/31G X 5/16"


BD Pen Needle/Ultrafine/29G X 12.7MM

Glucosource Lancets

BD Pen Needle/Ultrafine/29GX1/2" 12.7MM

Gmate Lancets 30G

BD Pen Needles SHORT/Ultrafine/31G X 5/16"

H&h Thinlet Lancets 26G

Careone Lancet Thin

H&h Thinlet Super Thin Lancets 30G

Careone Lancet Ultra Thin

Haemolance

Cleanlet Lancets 28G

Haemolance Low Flow Lancets

Clever Chek Lancets Ultrathin

Haemolance Plus

Clever Chek Lancets Ultrathin 30G

Haemolance Plus High Flow

Coaguchek Lancets

Haemolance Plus Low Flow

Comfort Lancets

Haemolance Plus Max Flow

Diastar Easy Test II Lancets 30G

Haemolance Plus Pediatric Flow

Diastar Easy Test Lancets30G

Hy-vee Lancets

Droplet Lancets Ultra Thin 30G

IN Touch Sterile Lancets 30G

Drug Mart On-the-go Lancets Gentle 30G

Lancets

Drug Mart Unilet Lancets Super Thin 30G

Lancets Bullseye Safety

Drug Mart Unilet Lancets Ultra Thin 28G

Lancets Safety Seal 21G

E-z Ject Lancets


E-z Ject Lancets Color


E-z Ject Lancets Super Thin


E-z Ject Lancets Super Thin 30G

Lancets Thin

E-z Ject Lancets Thin 26G

Lancets Twist Top

E-z Ject Lancets 21G

Lancets Ultra Fine

E-ZJECT Lancets Micro-thin 33G

Lancets Ultra Thin

Easy Touch Lancets 21G/Pressure Activated

Lancets 26G Twist Top


Lancets 28G


Lancets 30G

Easy Touch Lancets 26G/Pull-top


Easy Touch Lancets 26G/Twist

Lancets 30G/Twist Top




Lancets 33G Universal Design


Liberty Glucose Control Mid

Easy Touch Lancets 30G/Button-activated

Liberty Glucose Control Normal


Liberty Medical Lancets 30G


Lifescan Unistik II Lancets


Lifescan Unistik 2 Deep Penetration


Litetouch Lancets Micro Thin 33G


Live Better Lancet Super Thin 30G


Live Better Lancet Ultra Thin 28G


Medisense Thin Lancets

Easy Touch Safety Lancets21G/Pressure Activated

Medlance Plus Extra Lancets 21G


Medlance Plus Lancets

Easy Touch Safety Lancets26G/Button Activated

Medlance Plus Lancets Lite 25G


Medlance Plus Lite Lancets 25G

Easy Touch Safety Lancets28G/Button Activated

Medlance Plus Special Lancets 0.8MM


Medlance Plus Superlite 30G

Easy Twist & CAP Lancets

Medlance Plus Superlite 30G/Comfort Max

Easytest II Lancets

Medlance Plus Universal Lancets 21G

Easytest Lancets

Medlance Plus/Lite 25G

Embrace Lancets Ultra Thin 30G

Medlance/Extra

EZ Smart Blood Glucose Lancets

Medlance/Lite

EZ-lets Lancets 21G

Medlance/Universal

EZ-lets Lancets 23G

Meijer Lancets Universal 30G

EZ-lets Lancets 26G Super-soft

Meijer Super Thin Lancets

EZ-lets Lancets 28G Ultra-soft

Microlet Lancets

EZ-lets Lancets 30G

Microtainer Safety Flow Lancet/Sterile/Single-use

Fifty50 Safety Seal Lancets 30G

Monolet Lancets

Fifty50 Safety Seal Lancets 32G

Monolet Opd Lancets

Fifty50 Unilet Lancets 33G

Monolettor Safety Lancets

Fine 30

Myglucohealth Mgh Softlance Lancets 30G

Fingerstix Lancets

Netgroup Lancets

Fora Lancets

Nova Safety Lancets 23G

Freestyle Lancets

Nova Safety Lancets 28G

Freestyle Unistick II Lancets

Nova Sureflex Lancets

Gentle-let GP Lancets

Novofine Autocover 30GX8MM

Gentle-let Lancets General Purpose Style/Fine Point



Novofine 30GX8MM Safety Lancets

Novofine 32GX6MM Safety Lancets 21G

Novotwist 30GX8MM Safety Lancets 28G

Novotwist 32GX5MM Safety Let Lancets

On Call Lancets Safety Seal Lancets 28G

On Call Plus Lancets Safety Seal Lancets 30G

Onetouch Club Lancets Fine Point Shopko On-the-go Comfort Lancets 30G

Onetouch Combo Pack Shopko Unilet Lancets Super Thin 30G

Onetouch Delica Lancets Extra Fine 33G Shopko Unilet Lancets Ultra Thin 28G

Onetouch Delica Lancets Fine 30G Single-let

Onetouch Finepoint Lancets Smart Diabetes Vantage Universal Lancets 30G

Onetouch Lancets Smart Sense Color Lancets Universal 33G

Onetouch Ping Meter Remote Smart Sense Standard Lancets Universal 21G

Onetouch Ultra Blue Smart Sense Super Thin Lancets Universal 30G

Onetouch Ultra Control Smart Sense Thin Lancets Universal 26G

Onetouch Ultra Mini Smartest Lancets 28G

Onetouch Ultra 2 Solus V2 Pressure Activated Safety Lancets 28G

Onetouch Ultralink System (hex) Solus V2 Twist Lancets 30G

Onetouch Ultralink System (DEC) Sterilance TL

Onetouch Ultrasoft Lancets Sure-lance Flat Lancets

Onetouch Verio Control Solution High Sure-lance Lancets 26G

Onetouch Verio IQ Blood Glucose Monitoring System Sure-lance Thin Lancets 28G

Onetouch Verio Mid Control Solution Sure-lance Ultra Thin Lancets

Onetouch Verio Sync Bloodglucose Monitoring System Sure-touch Lancets Universal

Onetouch Verio Test Strips Surelite Lancets

Pen Needles 29G X 12MM Surestep Glucose Control

Pen Needles 29GX1/2" Surestep Glucose Control Solution

Pen Needles 30GX5/16" Surestep Pro High Glucosecontrol

Pen Needles 31G X 1/4" SHORT Surestep Pro Low Glucose Control

Pen Needles 31G X 3/16" Surestep Pro Normal Glucose Control

Pen Needles 31G X 6MM Techlite AST Lancets

Pen Needles 31GX5/16" Techlite Lancets

Perfect Lancets 30G Techlite Lancets 30G

Perfect Pressure Activated Safety Lancets 28G Thinlets GP Lancets

Pharmacist Choice Ultra Thin Lancets Thinlets Lancet

Pharmacist Choice Ultra Thin Lancets 28G Trueplus Lancets 26G


Pharmacist Choice Ultra Thin Lancets 31G Trueplus Lancets 28G Super Thin


Pharmacy Counter Lancets Trueplus Lancets 30G Ultra Thin

Precision Thin Lancets Trueplus Lancets 33G

Precision Thins GP Lancet Trueplus Lancets 33G Micro Thin

Precision Ultra Lancet Trueplus Safety Lancets 28G

Prodigy Pressure Activated Safety Lancets Ulticare Thin Lancets 30G

Prodigy Safety Lancets Ultilet Classic Lancets

Prodigy Twist Top Lancets Ultilet Lancets

Pss Select GP Lancets Ultilet Lancets 33G

Pss Select Safety Lancets Ultilet Safety Lancets 23G

Px Lancets Ultra Thin Ultra-thin II Auto Lancet

Qc Lancets Super Thin Ultra-thin II Lancets 28G

Qc Lancets Ultra Thin Ultra-thin II Lancets 30G

Relion Lancets Micro-thin33G Ultra-thin II Safety Autolancets 26G

Relion Lancets Standard 21G Unilet Comfortouch Lancet

Relion Lancets Thin 26G Unilet Excelite

Relion Lancets Ultra-thin30G Unilet Excelite II

Relion Thin Lancets Unilet G.p. Lancet

Relion Ultra Thin Lancets Unilet G.p. Superlite Lancet

Relion Ultra Thin Lancets30G Unilet GP 28 Ultra Thin

Relion Ultra Thin Plus Lancets 32G Unilet Lancet

Relion Ultra Thin Plus Lancets 33G Unilet Lancets Micro-thin33G

Renew Advanced Lancing Cartridge Refills Unilet Lancets Super-thin30G

Rexall Lancets Ultra Thin Unilet Lancets Ultra-thin 28G

Rightest Gl300 Lancets Unilet Superlite Lancet

Safe-t-lance Low Flow 25G Unistik Safety Lancets 28G

Safe-t-lance Normal Flow 21G Unistik Safety Lancets 30G

Safe-t-lance Plus Safety Lancet High Flow Unistik Touch Safety Lancets 21G

Safe-t-lance Plus Safety Lancet Low Flow Unistik Touch Safety Lancets 23G

Safe-t-lance Plus Safety Lancet Normal Flow Unistik Touch Safety Lancets 28G

Safety Lancet 21G/Pressure Activated Unistik Touch Safety Lancets 30G

Safety Lancet 28G/Pressure Activated Unistik 3 Gentle



Universal 1 Lancets Thin 26G

Universal 1 Lancets Ultra Thin 30G

Valumark Lancet Super Thin 30G

Valumark Lancet Ultra Thin 28G

Vida Mia Unilet Lancets Super Thin 30G

Vida Mia Unilet Lancets Ultra Thin 28G

Vitalet Pro Lancets

Vitalet Pro Plus Lancets

W&f Lancets Colored 21G

W&f Lancets 26G

Walgreens Lancets

Walgreens Thin Lancets

Walgreens Ultra Thin Lancets

1ST Choice Lancets Super Thin

1ST Choice Lancets Thin

1ST Choice Lancets Ultra Thin

MISCELLANEOUS


ExjadePA

FerriproxPA

JadenuPA

Effective July 1, 2016 v.1

PA=Prior Auth Required; QL=Quantity Limits; All OptumTM trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. © 2016 Optum, Inc. All rights reserved.

20

Index

A

allopurinol, 16 Aspirin/Dipyridamole, 12

almotriptan malate, 16 Assure Haemolance Plus High Flow 18G, 17

abacavir, 2

Alogliptin, 8

abacavir sulfate/lamivudine/zidovudine, 2

Alogliptin/Metformin HCL, 8 Assure Haemolance Plus Low Flow 25G, 17

Abraxane, 4

Alogliptin/Pioglitazone, 9

acamprosate calcium DR, 14

alosetron hydrochloride, 10 Assure Haemolance Plus Micro Flow 28G, 17

acarbose, 8

Alphanate/Von Willebrand Factor Complex/Human, 12

Accu-chek Safe-t-pro Lancets, 17

Assure Haemolance Plus Normal Flow 21G, 17

Accu-chek Safe-t-pro Pluslancets, 17

Alphanine SD, 12

Accu-chek Soft Touch Lancets, 17

alprazolam, 12 Assure Haemolance Plus Pediatric Blade, 17

Accu-chek Softclix Lancets, 17

alprazolam ER, 12

acebutolol HCL, 5

alprazolam odt, 12 Assure Lance Lancets, 17

acetaminophen/caffeine/dihydrocodeine, 15

Alprolix, 11 Assure Lance Lancets 21G, 17

amantadine HCL, 13 Assure Lance Plus Safety Lancets 25G, 17

acetaminophen/codeine, 15

Amcinonide, 7

acetaminophen/codeine #2, 15

amifostine, 4 Assure Lance Plus Safety Lancets 30G, 17


amikacin sulfate, 1


amiloride HCL, 6 Assure Lancets, 17

acetaminophen/codeine phosphate, 15

amiloride/hydrochlorothiazide, 6 AT Last Lancets, 17

acetazolamide, 6

aminoacetic acid, 11 atenolol, 5

Acetazolamide, 6

aminocaproic acid, 11 atenolol/chlorthalidone, 5

acetazolamide ER, 6

aminophylline, 17 Atgam, 3

acetazolamide sodium, 6

amiodarone HCL, 5 atorvastatin calcium, 6

acetic acid, 15

amiodarone hydrochloride, 5 atovaquone, 2

acetic acid 0.25%, 11

Amitiza, 11 atovaquone/proguanil HCL, 2

acetylcysteine, 16

amitriptyline HCL, 12 atracurium besylate, 14

acitretin, 7

amlodipine besylate, 5 atropine sulfate, 10, 15

Actemra, 15

amlodipine besylate/atorvastatin calcium, 6

Aubagio, 13

Actimmune, 4

augmented betamethasone dipropionate, 7

Active 1ST Blood Lancets 30G/Easy Twist CAP, 17

amlodipine besylate/benazepril HCL, 5

amlodipine besylate/benazepril hydrochloride, 5

Aurora Lancet Super Thin 30G, 17

acyclovir, 2, 7

Aurora Lancet Thin 23G, 17

acyclovir sodium, 2

amlodipine besylate/valsartan, 5 Avastin, 3

adapalene, 6

amlodipine/valsartan/hctz, 5 Avonex, 14

adapalene P.M., 6

ammonium lactate, 7 azacitidine, 3

Adcetris, 3

Amoxapine, 12 azathioprine, 3

Adcirca, 6

amoxicillin, 1 Azathioprine, 3

adefovir dipivoxil, 2

amoxicillin/clavulanate potassium, 1 azelastine HCL, 15, 16

Adempas, 6

Amoxicillin/Clavulanate Potassium, 1 azithromycin, 1

adenosine, 5

amoxicillin/clavulanate potassium ER, 1 aztreonam, 2

Adriamycin, 3

amphetamine/dextroamphetamine, 13 B

Advair Diskus, 17

ampicillin, 1

Advair HFA, 17

b-complex 100, 17

ampicillin sodium, 1

Advate, 12

bacitracin, 2

ampicillin-sulbactam, 1

Advocate Lancets, 17

Bacitracin, 14

Ampicillin-sulbactam, 1

Advocate Lancets 30G, 17

bacitracin/polymyxin b, 14

ampicillin/sulbactam, 1

Advocate Safety Lancets, 17

baclofen, 14

Ampyra, 14

Advocate Safety Lancets 26G, 17

balsalazide disodium, 10

anagrelide hydrochloride, 12

AF Lancets Super Thin, 17

Baraclude, 2

anastrozole, 3

Afinitor, 4

Bayer Microlet Lancets, 17

Androderm, 8

Afinitor Disperz, 4

BD Insulin Syringe LUER-LOK/U-100/1ML, 17

antipyrine/benzocaine, 15

Afrezza, 8

Apokyn, 13

Agamatrix Ultra-thin Lancets 33G, 17

BD Insulin Syringe Microfine IV/U-100/0.3ML/28G X 1/2", 17

apraclonidine, 15

Albenza, 2

Aralast NP, 17

albumin human, 12

BD Insulin Syringe Microfine IV/U-100/0.5ML/28G X 1/2", 17

Arcalyst, 15

albuterol, 17

argatroban, 11

albuterol sulfate, 17

BD Insulin Syringe Microfine IV/U-100/1ML/27G X 5/8", 17

aripiprazole, 12

albuterol sulfate ER, 17

Aripiprazole Odt, 13

albuterol TAB 4MG, 17

BD Insulin Syringe Microfine IV/U-100/1ML/28G X 1/2", 17

armodafinil, 13

alclometasone dipropionate, 7

Armodafinil, 13

Aldurazyme, 10

BD Insulin Syringe Microfine/U-100/0.3ML/28G X 1/2", 17

Arnuity Ellipta, 17

alendronate sodium, 9

Arranon, 3

alfentanil, 15

BD Insulin Syringe Microfine/U-100/0.5ML/28G X 1/2", 17

Arzerra, 3

Alferon N, 4

ascorbic acid, 17

alfuzosin HCL ER, 11

BD Insulin Syringe Microfine/U-100/1ML/27G X 5/8", 17

Aspirin-caffeine-dihydrocodeine, 15

Alimta, 3

BD Insulin Syringe Microfine/U-100/1ML/28G X 1/2", 17

MM, 18 calcipotriene/betamethasone dipropionate, 7

BD Pen Needles SHORT/Ultrafine/31G X 5/16", 18

BD Insulin Syringe Safetyglide/0.5ML/29G X 1/2", 17

calcitonin salmon, 9

Bebulin, 12 calcitonin-salmon, 9

BD Insulin Syringe Safetyglide/1ML/29G X 1/2", 17

Beleodaq, 4 Calcitriol, 7

benazepril HCL, 5 calcitriol, 10

BD Insulin Syringe Safetyglide/U-100/0.3ML/31G X 5/16", 17

benazepril HCL/hydrochlorothiazide, 5 calcium acetate, 10

Benefix, 12 Camptosar, 4

BD Insulin Syringe Slip Tip/U-100/1ML, 17

benzonatate, 16 candesartan cilexetil, 5

benzoyl peroxide, 6 candesartan cilexetil/hydrochlorothiazide, 5

BD Insulin Syringe U-40/1ML/25G X 5/8", 17

benzoyl peroxide SHORT contact, 6

benztropine mesylate, 13 capecitabine, 3

BD Insulin Syringe Ultrafine Half-unit/0.3ML/31G X 5/16", 17

Berinert, 12 Caprelsa, 4

betamethasone dipropionate, 7 captopril, 5

BD Insulin Syringe Ultrafine II/SHORT/0.5ML/31G X 5/16", 17

betamethasone sodium phosphate/betamethasone acetate, 8

Carbaglu, 10

carbamazepine, 13

BD Insulin Syringe Ultrafine II/SHORT/1ML/31G X 5/16", 17

betamethasone valerate, 7 carbamazepine ER, 13

betaxolol HCL, 5, 14 carbidopa, 13

BD Insulin Syringe Ultrafine/0.3ML/30G X 1/2", 17

bethanechol chloride, 11 carbidopa/levodopa, 13

Bethkis, 1 carbidopa/levodopa ER, 13


bexarotene, 4 carbidopa/levodopa odt, 13

bicalutamide, 3 Carbidopa/Levodopa/Entacapone, 13


Bicnu, 2 carbinoxamine maleate, 16

Biltricide, 2 carboplatin, 2


Bimatoprost, 14 cardioplegic, 6

bisoprolol fumarate, 5 Careone Lancet Thin, 18

BD Insulin Syringe Ultrafine/1ML/30G X 1/2", 17

bisoprolol fumarate/hydrochlorothiazide, 5

Careone Lancet Ultra Thin, 18

carisoprodol, 14

BD Insulin Syringe Ultrafine/1ML/31G X 5/16", 17

bivalirudin, 11 carisoprodol/aspirin, 14

bleomycin sulfate, 2 carisoprodol/aspirin/codeine, 14

BD Insulin Syringe Ultrafine/U-100/0.3ML/29G X 1/2", 17

Blincyto, 3 carteolol HCL, 14

Bosulif, 4 carvedilol, 5

BD Insulin Syringe Ultrafine/U-100/0.5ML/29G X 1/2", 17

Botox, 14 Cayston, 2

Bravelle, 9 cefaclor, 1

BD Insulin Syringe Ultrafine/U-100/1ML/29G X 1/2", 17

Breo Ellipta, 17 Cefaclor, 1

brimonidine tartrate, 15 cefadroxil, 1

BD Insulin Syringe Ultrafine/U-100/1ML/30G X 1/2", 17

bromfenac, 15 cefazolin sodium, 1

bromocriptine mesylate, 13 cefdinir, 1

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 1", 17

bromphen/pseudoephedrine HCL/dextromethorphan HBR, 16

cefepime, 1

cefixime, 1

BD Insulin Syringe/Detachable Needle/U-100/1ML/25G X 5/8", 17

budesonide, 8, 16, 17 cefotaxime sodium, 1

Bullseye Safety Lancets, 17 cefotetan, 1

BD Insulin Syringe/Detachable Needle/U-100/1ML/26G X 1/2", 17

bumetanide, 6 cefoxitin sodium, 1

Buphenyl, 10 cefpodoxime proxetil, 1

BD Insulin Syringe/U-100/0.5ML/30G X 1/2", 17

bupivacaine HCL, 16 cefprozil, 1

bupivacaine/epinephrine, 16 ceftazidime, 1

BD Insulin Syringe/U-100/1ML/27G X 1/2", 17

buprenorphine HCL, 15 Ceftriaxone IN Iso-osmotic Dextrose, 1

buprenorphine HCL/naloxone HCL, 15 ceftriaxone sodium, 1


bupropion HCL, 12 cefuroxime axetil, 1

bupropion HCL ER, 12 cefuroxime sodium, 1

BD Insulin Syringe/U-100/2ML/27.5G X 5/8", 17

bupropion HCL SR, 12 Cefuroxime Sodium, 1

bupropion HCL XL, 12 celecoxib, 16


buspirone HCL, 12 Cellcept Intravenous, 3

Busulfex, 2 cephalexin, 1

BD Lancet Ultrafine 30G, 17

butalbital/acetaminophen, 15 Ceprotin, 11

BD Lancet Ultrafine 33G, 17

butalbital/acetaminophen/caffeine, 15 Cerdelga, 11

BD LO-dose Insulin Syringe Microfine IV/0.5ML/28G X 1/2", 17

butalbital/acetaminophen/caffeine/codeine, 15

Cerezyme, 11

cetirizine HCL, 16

BD Microtainer Lancets, 18

butalbital/aspirin/caffeine, 15 Cetrotide, 9

BD Pen Needle/Mini/Ultrafine/31G X 3/16", 18

butalbital/aspirin/caffeine/codeine, 15 cevimeline HCL, 12

butorphanol tartrate, 15 chlordiazepoxide HCL, 12

BD Pen Needle/Nano/Ultra Fine/32G X 4MM, 18

Bydureon, 8 chlordiazepoxide HCL/clidinium bromide, 10

Byetta, 8

BD Pen Needle/SHORT/Ultrafine/31G X 5/16", 18

C chlorhexidine gluconate, 12

chlorhexidine gluconate oral rinse, 12

cabergoline, 9

BD Pen Needle/Ultrafine/29G X 12.7MM, 18

chloroprocaine HCL, 16

Cafergot, 16

chloroquine phosphate, 2

caffeine citrate, 13

BD Pen Needle/Ultrafine/29GX1/2" 12.7

chlorothiazide, 6

calcipotriene, 7

Chlorothiazide, 6

Colcrys, 16 diclofenac sodium, 7, 15

chlorothiazide sodium, 6

colestipol HCL, 6 diclofenac sodium DR, 16

chlorpromazine HCL, 13

colistimethate sodium, 2 diclofenac sodium ER, 16

chlorthalidone, 6

Combivent Respimat, 17 diclofenac sodium/misoprostol, 16

Chlorthalidone, 6

Cometriq, 4 dicloxacillin sodium, 1

chlorzoxazone, 14

Comfort Lancets, 18 dicyclomine HCL, 10

cholestyramine, 6

Copaxone, 14 didanosine, 2

cholestyramine light, 6

Corifact, 12 Diflorasone Diacetate, 7

choline magnesium trisalicylate, 15

Cosentyx, 7 diflunisal, 15

chorionic gonadotropin, 9

Cosentyx Sensoready Pen, 7 digoxin, 4

Cialis, 6

Cosmegen, 3 dihydroergotamine mesylate, 16

ciclopirox, 7

Creon, 10 Dihydroergotamine Mesylate, 16

ciclopirox nail lacquer, 7

cromolyn sodium, 10, 15 diltiazem CD, 5

ciclopirox olamine, 7

Cromolyn Sodium, 17 diltiazem HCL, 5

cidofovir, 2

cyanocobalamin, 11 diltiazem HCL ER, 5

cilostazol, 12

cyclobenzaprine HCL, 14 diphenhydramine HCL, 16

cimetidine, 10

cyclopentolate HCL, 15 diphenoxylate/atropine, 10

cimetidine HCL, 10

cyclopentolate hydrochloride, 15 dipyridamole, 12

Cimzia, 10

Cyclophosphamide, 2 disopyramide phosphate, 5

Cimzia Starter Kit, 10

cyclophosphamide, 2 disulfiram, 14

Cinryze, 12

cyclosporine, 3 divalproex sodium, 13

ciprofloxacin, 1

cyclosporine modified, 3 divalproex sodium DR, 13

ciprofloxacin ER, 1

cyproheptadine HCL, 16 divalproex sodium ER, 13

ciprofloxacin HCL, 1, 14

Cyramza, 3 dobutamine HCL, 6

Ciprofloxacin HCL, 1

Cystagon, 11 dobutamine HCL/D5W, 6

ciprofloxacin I.V.-IN D5W, 1

Cystaran, 15 dobutamine/dextrose 5%, 6

cisatracurium besylate, 14

cytarabine, 3 Docefrez, 4

cisplatin, 2

Cytarabine, 3 docetaxel, 3

Cisplatin, 2

cytarabine aqueous, 3 Docetaxel, 4

citalopram hydrobromide, 12

D dofetilide, 5

citric acid/sodium citrate, 11

donepezil HCL, 14

dacarbazine, 4

cladribine, 3

dopamine HCL, 6

Dacarbazine, 4

clarithromycin, 1

Dopamine HCL, 6

Daklinza, 2

clarithromycin ER, 1

dopamine HCL-dextrose 5%, 6

Daliresp, 17

Cleanlet Lancets 28G, 18

dopamine HCL/dextrose 5%, 6

danazol, 8

clemastine fumarate, 16

dopamine/D5W, 6

dantrolene sodium, 14

Clemastine Fumarate, 16

dorzolamide HCL, 15

dapsone, 2

Clever Chek Lancets Ultrathin, 18

dorzolamide HCL/timolol maleate, 14

darifenacin ER, 11

Clever Chek Lancets Ultrathin 30G, 18

doxapram HCL, 13

darifenacin hydrobromide ER, 11

clindamycin, 2

doxazosin, 5

daunorubicin HCL, 3

clindamycin HCL, 2

doxazosin mesylate, 5

Daunoxome, 3

clindamycin palmitate HCL, 2

doxepin HCL, 12

decitabine, 3

clindamycin phosphate, 2, 6, 11

Doxepin HCL, 12

demeclocycline HCL, 1

clindamycin phosphate add-vantage, 2

Doxepin Hydrochloride, 7

Depocyt, 3

clindamycin phosphate IN D5W, 2

doxercalciferol, 10

desipramine HCL, 12

clindamycin phosphate pharmacy bulk package, 2

doxorubicin HCL, 3

desloratadine, 16

Doxorubicin HCL, 3

Desloratadine Odt, 16

clindamycin/benzoyl peroxide, 6

doxorubicin HCL liposome, 3

desmopressin acetate, 9

clobetasol propionate, 7

doxycycline, 1

desogestrel/ethinyl estradiol, 8

clobetasol propionate emollient, 7

Doxycycline, 7

desonide, 7

Clolar, 3

doxycycline hyclate, 1

desoximetasone, 7

clomiphene citrate, 9

doxycycline hyclate DR, 1

Desoximetasone, 7

clomipramine HCL, 12

doxycycline monohydrate, 1

dexamethasone, 7

clonazepam, 13

dronabinol, 10

Dexamethasone, 8

clonazepam odt, 13

droperidol, 12

dexamethasone sodium phosphate, 7, 14

clonidine HCL, 5, 15

Droplet Lancets Ultra Thin 30G, 18

clonidine HCL ER, 13

drospirenone/ethinyl estradiol, 8

Dexamethasone Sodium Phosphate, 8

clopidogrel, 12

Drug Mart On-the-go Lancets Gentle 30G, 18

dexmedetomidine HCL, 13

clorazepate dipotassium, 12

dexmethylphenidate HCL, 13

clotrimazole, 7, 12

Drug Mart Unilet Lancets Super Thin 30G, 18

dexmethylphenidate HCL ER, 13

clotrimazole/betamethasone dipropionate, 7

dexrazoxane, 4

Drug Mart Unilet Lancets Ultra Thin 28G, 18

dextroamphetamine sulfate, 13

clozapine, 13

dextroamphetamine sulfate ER, 13

clozapine odt, 13

duloxetine HCL, 12

Diastar Easy Test II Lancets 30G, 18

Clozapine Odt, 13

dutasteride, 11

Diastar Easy Test Lancets30G, 18

Coaguchek Lancets, 18

dutasteride/tamsulosin HCL, 11

diazepam, 12

codeine sulfate, 15

dutasteride/tamsulosin hydrochloride, 11

Diazepam, 12

Colchicine, 16

Dysport, 14

diclofenac potassium, 16

E

epirubicin HCL, 3 Fifty50 Safety Seal Lancets 32G, 18

Epirubicin HCL, 3 Fifty50 Unilet Lancets 33G, 18

E-z Ject Lancets, 18

episone CRE, 7 finasteride, 11

E-z Ject Lancets 21G, 18

eplerenone, 5 Fine 30, 18

E-z Ject Lancets Color, 18

epoprostenol sodium, 6 Fingerstix Lancets, 18

E-z Ject Lancets Super Thin, 18

Eprosartan Mesylate, 5 Firazyr, 12

E-z Ject Lancets Super Thin 30G, 18

eptifibatide, 12 Firmagon, 3

E-z Ject Lancets Thin 26G, 18

Erbitux, 3 flavoxate HCL, 11

E-ZJECT Lancets Micro-thin 33G, 18

ergocalciferol, 17 flecainide acetate, 5

Easy Touch Lancets 21G/Pressure Activated, 18

ergoloid mesylates, 14 Flovent Diskus, 17

Ergoloid Mesylates, 14 Flovent HFA, 17


Erwinaze, 3 floxuridine, 3

erythromycin, 1, 6, 14 Floxuridine, 3


Erythromycin Base, 1 fluconazole, 1

erythromycin/benzoyl peroxide, 6 fluconazole IN dextrose, 1

Easy Touch Lancets 26G/Pull-top, 18

Esbriet, 17 fluconazole IN NACL, 1

Easy Touch Lancets 26G/Twist, 18

escitalopram oxalate, 12 flucytosine, 1


esmolol HCL, 5 fludarabine phosphate, 3

esomeprazole magnesium, 10 fludrocortisone acetate, 8


esomeprazole sodium, 10 flunisolide, 16


Esomeprazole Sodium, 10 fluocinolone acetonide, 7, 15

Easy Touch Lancets 30G/Button-activated, 18

estazolam, 13 fluocinolone acetonide ear drops, 15

estradiol, 8 fluocinonide, 7


estradiol valerate, 8 fluocinonide-e, 7

estradiol/norethindrone acetate, 8 fluorometholone, 14


Estropipate, 8 fluorouracil, 3


eszopiclone, 13 fluoxetine DR, 12


ethacrynate sodium, 6 fluoxetine HCL, 12

ethambutol HCL, 1 fluphenazine decanoate, 13


ethosuximide, 13 fluphenazine HCL, 12


etodolac, 16 flurandrenolide, 7


etodolac ER, 16 flurazepam HCL, 13

Easy Touch Safety Lancets21G/Pressure Activated, 18

Etopophos, 4 Flurazepam HCL, 13

etoposide, 3 flurbiprofen, 16


Etoposide, 4 flurbiprofen sodium, 15

Euflexxa, 14 flutamide, 3

Easy Touch Safety Lancets26G/Button Activated, 18

Evotaz, 2 fluticasone propionate, 7, 16

exemestane, 3 fluvastatin, 6


Exjade, 20 fluvastatin sodium ER, 6

EZ Smart Blood Glucose Lancets, 18 fluvoxamine maleate, 12

Easy Touch Safety Lancets28G/Button Activated, 18

EZ-lets Lancets 21G, 18 fluvoxamine maleate ER, 12

EZ-lets Lancets 23G, 18 FML Forte, 14


EZ-lets Lancets 26G Super-soft, 18 folic acid, 11

EZ-lets Lancets 28G Ultra-soft, 18 folic acid/vitamin b-6/vitamin b-12, 11

Easy Twist & CAP Lancets, 18

EZ-lets Lancets 30G, 18 Follistim AQ, 9

Easytest II Lancets, 18

F Folotyn, 3

Easytest Lancets, 18

fondaparinux sodium, 11

econazole nitrate, 7

Fabrazyme, 10

Fora Lancets, 18

Egrifta, 9

famciclovir, 2

Forteo, 9

Elaprase, 10

famotidine, 10

fosinopril sodium, 5

Elelyso, 11

Famotidine, 10

fosinopril sodium/hydrochlorothiazide, 5

Eligard, 3

Farydak, 4

fosphenytoin sodium, 13

Eloctate, 11

Faslodex, 3

Fragmin, 11

Embrace Lancets Ultra Thin 30G, 18

Feiba, 12

Freestyle Lancets, 18

enalapril maleate, 5

Feiba NF, 12

Freestyle Unistick II Lancets, 18

enalapril maleate/hydrochlorothiazide, 5

felbamate, 13

frovatriptan succinate, 16

enalaprilat, 5

felodipine ER, 5

furosemide, 6

Enbrel, 15

fenofibrate, 6

Fusilev, 4

Enbrel Sureclick, 16

Fenofibrate, 6

G

enoxaparin sodium, 11

fenofibrate micronized, 6

entacapone, 13

Fenofibric Acid, 6 gabapentin, 13

entecavir, 2

fenofibric acid DR, 6 galantamine hydrobromide, 14

Entyvio, 10

fenoldopam mesylate, 5 Galantamine Hydrobromide, 14

ephedrine sulfate, 6

Fenoprofen Calcium, 16 ganciclovir, 2

epinastine HCL, 15

fentanyl, 15 Ganirelix Acetate, 9

Epinephrine, 6

Fentanyl, 15 gatifloxacin, 14

epinephrine HCL, 17

fentanyl citrate oral transmucosal, 15 Gattex, 10

Epipen 2-PAK, 6

Ferriprox, 20 Gazyva, 3

Epipen-JR 2-PAK, 6

Fifty50 Safety Seal Lancets 30G, 18 Gel-one, 14

Gelnique, 11

Harvoni, 2 hydromorphone HCL, 15

gemcitabine, 3

Helixate FS, 11 hydromorphone HCL dosette, 15

gemcitabine HCL, 3

Hemofil M, 12 hydromorphone HCL ER, 15

gemfibrozil, 6

heparin lock, 11 Hydromorphone HCL ER, 15

gene-xene TAB 15MG, 12

heparin lock flush, 11 Hydromorphone HCL/Sodium Chloride, 15

gene-xene TAB 3.75MG, 12

heparin lock flush for flushing vascular access devices, 11

gene-xene TAB 7.5MG, 12

hydroxychloroquine sulfate, 2

gentamicin sulfate, 1, 14

heparin lock flush/NACL for flushing vascular access devices, 11

Hydroxyprogesterone Caproate, 3

gentamicin sulfate pediatric, 1

hydroxyurea, 4

gentamicin sulfate/0.9% sodium chloride, 1

heparin sodium, 11 hydroxyzine HCL, 12

heparin sodium dcu, 11 hydroxyzine pamoate, 12

Gentle-let GP Lancets, 18

heparin sodium lock flush, 11 Hydroxyzine Pamoate, 12

Gentle-let Lancets General Purpose Style/Fine Point, 18

heparin sodium/D5W, 11 hyoscyamine sulfate, 10

heparin sodium/NACL 0.9%, 11 hyoscyamine sulfate ER, 10

Gentle-let Lancets General Purpose Style/Medium Point, 18

heparin sodium/sodium chloride 0.9% premix, 11

hyoscyamine sulfate odt, 10

hyoscyamine sulfate SR, 10

Gentle-let Lancets Safety Style/Fine Point, 18

Herceptin, 3 I

hetastarch 6%/NACL, 12

ibandronate sodium, 9

Gentle-let Lancets Safety Style/Medium Point, 18

Hetlioz, 13

Ibrance, 4

homatropine HBR, 15

ibuprofen, 16

Genvisc 850, 14

Humalog, 8

ibuprofen lysine, 16

Gilenya, 13

Humalog Kwikpen, 8

ibutilide fumarate, 5

Gilotrif, 4

Humalog Mix 50/50, 8

Iclusig, 4

Glassia, 17

Humalog Mix 50/50 Kwikpen, 8

idarubicin HCL, 3

glatopa, 13

Humalog Mix 75/25, 8

Ifex, 2

Gleevec, 4

Humalog Mix 75/25 Kwikpen, 8

ifosfamide, 2

Gleostine, 2

Humate-p, 12

Ifosfamide, 2

glimepiride, 8

Humira, 16

Ilaris, 16

glipizide, 8

Humira Pediatric Crohns Disease Starter Pack, 16

Iluvien, 14

glipizide ER, 8

imatinib mesylate, 4

glipizide/metformin HCL, 8

Humira Pen, 16

Imbruvica, 4

Glucagon Emergency Kit, 8

Humira Pen-crohns Diseasestarter, 16

imipenem/cilastatin, 2

Glucocom Lancets 28G, 18

Humira Pen-psoriasis Starter, 16

imipramine HCL, 12


Humulin 70/30, 8

imipramine pamoate, 12


Humulin 70/30 Kwikpen, 8

imiquimod, 7

Glucosource Lancets, 18

Humulin N, 8

IN Touch Sterile Lancets 30G, 18

glyburide, 8

Humulin N Kwikpen, 8

Increlex, 9

Glyburide, 8

Humulin R, 8

Incruse Ellipta, 17

glyburide micronized, 8

Humulin R U-500 (concentrated), 8

indapamide, 6

glyburide/metformin HCL, 8

Humulin R U-500 Kwikpen, 8

indomethacin, 15

glycine, 11

Hy-vee Lancets, 18

indomethacin ER, 16

glycopyrrolate, 10

Hyalgan, 14

Inlyta, 4

Gmate Lancets 30G, 18

Hycamtin, 4

Intron A, 4

Gonal-f, 9

hydralazine HCL, 5

Intron A W/Diluent, 4

Gonal-f RFF, 9

hydrochlorothiazide, 6

Invokamet, 9

Gonal-f RFF Rediject, 9

hydrocodone bitartrate/acetaminophen, 15

Invokana, 8

granisetron HCL, 10

ipratropium bromide, 16(2)

Granix, 11

hydrocodone bitartrate/chlorpheniramine maleate/PSE, 16

ipratropium bromide/albuterol sulfate, 17

griseofulvin microsize, 1

irbesartan, 5

griseofulvin ultramicrosize, 1

hydrocodone bitartrate/homatropine methylbromide, 16

irbesartan/hydrochlorothiazide, 5

guanfacine ER, 13

Iressa, 4

guanfacine HCL, 5

hydrocodone polistirex/chlorpheniramine polistirex, 16

irinotecan, 4

H

Irinotecan, 4

hydrocodone/acetaminophen, 15

H&h Thinlet Lancets 26G, 18

irinotecan HCL, 4

Hydrocodone/Acetaminophen, 15

H&h Thinlet Super Thin Lancets 30G, 18

Iron Asp Gly/ Polysacch Compl/Ascorb CAL/B12/Fa/C Threon/Suc, 11

hydrocodone/homatropine, 16

H.p. Acthar, 9

hydrocodone/ibuprofen, 15

Haemolance, 18

isoniazid, 1

hydrocort ene 100MG, 10

Haemolance Low Flow Lancets, 18

isosorbide dinitrate, 5

hydrocortisone, 7(2), 10

Haemolance Plus, 18

Isosorbide Dinitrate, 5

hydrocortisone acetate/aloe, 7

Haemolance Plus High Flow, 18

isosorbide mononitrate, 5

hydrocortisone acetate/lidocaine HCL, 10

Haemolance Plus Low Flow, 18

isosorbide mononitrate ER, 4

hydrocortisone acetate/pramoxine, 10

Haemolance Plus Max Flow, 18

isotonic gentamicin, 1

hydrocortisone butyrate, 7

Haemolance Plus Pediatric Flow, 18

isradipine, 5

hydrocortisone butyrate (lipid), 7

Halaven, 4

Istodax, 4

hydrocortisone butyrate (lipophilic), 7

halobetasol propionate, 7

itraconazole, 1

hydrocortisone IN absorbase, 7

haloperidol, 13

ivermectin, 2

hydrocortisone valerate, 7

haloperidol decanoate, 13

Ixempra Kit, 4

hydrocortisone/acetic acid, 15

haloperidol lactate, 13

Ixinity, 11

J

Lemtrada, 13 Lumigan, 14

Lenvima 10MG Daily Dose, 4 Lumizyme, 10

Jadenu, 20

Lenvima 14MG Daily Dose, 4 Lupaneta Pack, 9

Jakafi, 4

Lenvima 18MG Daily Dose, 4 Lupron Depot, 3

Janumet, 9

Lenvima 20MG Daily Dose, 4 Lupron Depot-PED, 9

Janumet XR, 9

Lenvima 24MG Daily Dose, 4 Lynparza, 4

Januvia, 8

Lenvima 8MG Daily Dose, 4 M

Jardiance, 8

Letairis, 6

Jetrea, 15

malathion, 7

letrozole, 3

Jevtana, 4

mannitol, 6

leucovorin calcium, 4

Juxtapid, 6

Marqibo, 4

Leukeran, 2

K

Matulane, 4

Leukine, 11

meclizine HCL, 10

leuprolide acetate, 3

Kadcyla, 3

Meclofenamate Sodium, 16

levalbuterol, 17

Kalbitor, 12

Medisense Thin Lancets, 18

levalbuterol HCL, 17

Kalydeco, 17

Medlance Plus Extra Lancets 21G, 18

levetiracetam, 13

Kepivance, 4

Medlance Plus Lancets, 18

levetiracetam ER, 13

ketoconazole, 1, 7

Medlance Plus Lancets Lite 25G, 18

levobunolol HCL, 14

ketoprofen, 16

Medlance Plus Lite Lancets 25G, 18

levocarnitine, 10

ketorolac tromethamine, 15, 16

Medlance Plus Special Lancets 0.8MM, 18

levocetirizine dihydrochloride, 16

Keveyis, 6

levofloxacin, 1, 14

Keytruda, 3

Medlance Plus Superlite 30G, 18

levofloxacin IN D5W, 1

Kineret, 16

Medlance Plus Superlite 30G/Comfort Max, 18

levoleucovorin, 4

Koate-dvi, 12

levoleucovorin calcium, 4

Kogenate FS, 12

Medlance Plus Universal Lancets 21G, 18

levonorgestrel, 8

Kogenate FS Bio-set, 12

Levonorgestrel, 8

Kombiglyze XR, 9

Medlance Plus/Lite 25G, 18

levonorgestrel and ethinyl estradiol, 8

Korlym, 8

Medlance/Extra, 18

levonorgestrel/ethinyl estradiol, 8

Kovaltry, 12

Medlance/Lite, 18

levothyroxine sodium, 10

Krystexxa, 16

Medlance/Universal, 18

Lialda, 11

Kuvan, 10

medroxyprogesterone acetate, 8

Liberty Glucose Control Mid, 18

Kynamro, 6

mefenamic acid, 16

Liberty Glucose Control Normal, 18

Kyprolis, 4

mefloquine HCL, 2

Liberty Medical Lancets 30G, 18

L

megestrol acetate, 3, 8

lidocaine, 7

Meijer Lancets Universal 30G, 18

labetalol HCL, 5

lidocaine HCL, 5, 7, 16

Meijer Super Thin Lancets, 18

lactic acid, 7

lidocaine HCL IN D5W, 5

Mekinist, 4

lactic acid e, 7

lidocaine HCL jelly, 7

meloxicam, 15

lactic acid w/vitamin e, 7

lidocaine HCL viscous, 12

melphalan hydrochloride, 2

lactulose, 10(2)

lidocaine HCL/dextrose, 5

memantine HCL, 14

lamivudine, 2

lidocaine HCL/hydrocortisone acetate, 10

memantine HCL titration PAK, 14

lamivudine/zidovudine, 2

lidocaine viscous, 12

memantine hydrochloride, 14

lamotrigine, 13

lidocaine-prilocaine-cream base, 7

Menopur, 9

lamotrigine ER, 13

lidocaine/epinephrine, 16

meperidine HCL, 15

lamotrigine odt, 13

lidocaine/prilocaine, 7

meprobamate, 12

lamotrigine titration, 13

Lifescan Unistik 2 Deep Penetration, 18

mercaptopurine, 3

Lancets, 18

Lifescan Unistik II Lancets, 18

meropenem, 2

Lancets 26G Twist Top, 18

lincomycin HCL, 2

mesalamine, 10

Lancets 28G, 18

lindane, 7

mesna, 4

Lancets 30G, 18

linezolid, 2

Mesnex, 4


Linezolid, 2

metaxalone, 14

Lancets 30G/Twist Top, 18

liothyronine sodium, 10

Metaxalone, 14


lisinopril, 5

metformin HCL, 8

Lancets 33G Universal Design, 18

lisinopril/hydrochlorothiazide, 5

metformin HCL ER, 8

Lancets Bullseye Safety, 18

Litetouch Lancets Micro Thin 33G, 18

methadone HCL, 15

Lancets Safety Seal 21G, 18

lithium carbonate, 12

methamphetamine HCL, 13


lithium carbonate ER, 12

methazolamide, 6


Live Better Lancet Super Thin 30G, 18

methenamine hippurate, 11


Live Better Lancet Ultra Thin 28G, 18

methenamine mandelate, 11

Lancets Thin, 18

Lomustine, 2

methimazole, 10

Lancets Twist Top, 18

Lonsurf, 4

methocarbamol, 14

Lancets Ultra Fine, 18

loperamide HCL, 10

methotrexate, 3

Lancets Ultra Thin, 18

lorazepam, 12

methotrexate sodium, 3

lansoprazole, 10

losartan potassium, 5

Methotrexate Sodium, 3

lansoprazole/amoxicillin/clarithromycin, 10

losartan potassium/hydrochlorothiazide, 5

methoxsalen, 7

methscopolamine bromide, 10

Lantus, 8

lovastatin, 6

methyldopa, 5

Lantus Solostar, 8

loxapine, 13

methylergonovine maleate, 15

latanoprost, 14

loxapine succinate, 13

methylphenidate HCL, 13

leflunomide, 16

methylphenidate HCL CD, 13

Myozyme, 10 fumarate, 8

methylphenidate HCL ER, 13

norethindrone acetate, 8

N

Methylphenidate HCL ER, 13

norethindrone acetate/ethinyl estradiol, 8(2)

nabumetone, 16

methylphenidate HCL SR, 13

nadolol, 5

methylphenidate hydrochloride, 13

norethindrone acetate/ethinyl estradiol/ferrous fumarate, 8

nadolol/bendroflumethiazide, 5

methylprednisolone, 7

nafcillin sodium, 1

methylprednisolone acetate, 7

norgestimate/ethinyl estradiol, 8

naftifine hydrochloride, 7

methylprednisolone dose pack, 7

Northera, 6

Naglazyme, 10

methylprednisolone sodiumsuccinate, 8

nortriptyline HCL, 12

nalbuphine HCL, 15

methyltestosterone, 8

Nortriptyline HCL, 12

naproxen, 16

Metipranolol, 14

Nova Safety Lancets 23G, 18

Naproxen, 16

metoclopramide HCL, 10

Nova Safety Lancets 28G, 18

naproxen sodium, 16

metoclopramide odt, 10

Nova Sureflex Lancets, 18

naproxen sodium CR, 16

metolazone, 6

Novoeight, 12

naproxen sodium DS, 16

metoprolol succinate ER, 5

Novofine 30GX8MM, 19

naproxen sodium ER, 16

metoprolol tartrate, 5

Novofine 32GX6MM, 19

naratriptan HCL, 16

Metoprolol Tartrate, 5

Novofine Autocover 30GX8MM, 18

nateglinide, 8

metoprolol/hydrochlorothiazide, 5

Novoseven, 12

Natpara, 9

metronidazole, 2, 7

Novoseven Rt, 12

nefazodone HCL, 12

metronidazole IN NACL 0.79%, 2

Novotwist 30GX8MM, 19

Nefazodone HCL, 12

metronidazole vaginal, 11

Novotwist 32GX5MM, 19

neomycin sulfate, 1

mexiletine HCL, 5

Nplate, 11

neomycin/bacitracin/polymyxin, 14

Microlet Lancets, 18

Nutropin AQ Nuspin 10, 9

neomycin/polymyxin b sulfates, 11

Microtainer Safety Flow Lancet/Sterile/Single-use, 18


neomycin/polymyxin/bacitracin zinc, 14


neomycin/polymyxin/bacitracin/hydrocortisone, 14

midodrine HCL, 6

Nutropin AQ Pen, 9

miglitol, 8

Nuwiq, 12

neomycin/polymyxin/dexamethasone, 14

milrinone IN dextrose, 4

nystatin, 1, 7, 12

neomycin/polymyxin/gramicidin, 14

milrinone lactate, 4

nystatin/triamcinolone, 7

neomycin/polymyxin/HC, 15

minocycline HCL, 1

O

neomycin/polymyxin/hydrocortisone, 15

minocycline HCL ER, 1

octreotide acetate, 9

neostigmine methylsulfate, 14

minoxidil, 5

Ofev, 17

Netgroup Lancets, 18

Mircera, 11

ofloxacin, 1, 14, 15

Neulasta, 11

mirtazapine, 12

Ofloxacin, 1

Neulasta Onpro Kit, 11

mirtazapine odt, 12

olanzapine, 13

Neumega, 11

misoprostol, 10

olanzapine odt, 13

Neupogen, 11

mitomycin, 3

olanzapine/fluoxetine, 14

nevirapine, 2

Mitomycin, 3

olopatadine HCL, 15, 16

nevirapine ER, 2

mitoxantrone HCL, 3

Olysio, 2

Nexavar, 4

modafinil, 13

omega-3-acid ethyl esters, 6

niacin ER, 6

Moderiba, 2

omeprazole, 10

niacinamide/azelaic ac/ turmer/fa/b6/zinc ox/copper, 17

Moderiba 1200 Dose Pack, 2

omeprazole/sodium bicarbonate, 10

Moderiba 800 Dose Pack, 2

Omontys, 11

nicardipine HCL, 5

moexipril HCL, 5

On Call Lancets, 19

nifedipine, 5

moexipril/hydrochlorothiazide, 5

On Call Plus Lancets, 19

nifedipine ER, 5

mometasone furoate, 7, 16

Oncaspar, 3

nimodipine, 5

Monoclate-p, 12

ondansetron HCL, 10

Nipent, 4

Monolet Lancets, 18

ondansetron odt, 10

nisoldipine, 5

Monolet Opd Lancets, 18

Onetouch Club Lancets Fine Point, 19

nitrofurantoin, 11

Monolettor Safety Lancets, 18

Onetouch Combo Pack, 19

nitrofurantoin macrocrystals, 11

Mononine, 12

Onetouch Delica Lancets Extra Fine 33G, 19

nitrofurantoin monohydrate, 11

Monovisc, 14

nitrofurantoin monohydrate/macrocrystals, 11

montelukast sodium, 17

Onetouch Delica Lancets Fine 30G, 19

morphine sulfate, 15

Onetouch Finepoint Lancets, 19

nitroglycerin ER, 5

Morphine Sulfate, 15

Onetouch Lancets, 19

nitroglycerin IN 5% dextrose, 5

morphine sulfate ER, 15

Onetouch Ping Meter Remote, 19

nitroglycerin IN dextrose 5%, 5

Morphine Sulfate ER, 15

Onetouch Ultra 2, 19

nitroglycerin lingual, 5

moxifloxacin HCL, 1

Onetouch Ultra Blue, 19

Nitroglycerin Lingual, 5

Mozobil, 11

Onetouch Ultra Control, 19

nitroglycerin transdermal, 5

mupirocin, 7

Onetouch Ultra Mini, 19

nizatidine, 10

mupirocin calcium, 7

Onetouch Ultralink System (DEC), 19

Nizatidine, 10

Mustargen, 2

Onetouch Ultralink System (hex), 19

Norditropin Cartridge, 9

Myalept, 10

Onetouch Ultrasoft Lancets, 19

Norditropin Flexpro, 9

mycophenolate mofetil, 3

Onetouch Verio Control Solution High, 19

Norditropin Nordiflex Pen, 9

mycophenolic acid DR, 3

norepinephrine bitartrate, 6

Myglucohealth Mgh Softlance Lancets 30G, 18

Onetouch Verio IQ Blood Glucose Monitoring System, 19

norethindrone, 8

norethindrone & ethinyl estradiol ferrous

Myobloc, 14

Onetouch Verio Mid Control Solution, 19

Onetouch Verio Sync Bloodglucose Monitoring System, 19

Pen Needles 29GX1/2", 19 Pradaxa, 11

Pen Needles 30GX5/16", 19 Praluent, 6

Onetouch Verio Test Strips, 19

Pen Needles 31G X 1/4" SHORT, 19 pramipexole dihydrochloride, 13

Onglyza, 8

Pen Needles 31G X 3/16", 19 pramipexole dihydrochloride ER, 13

Opana ER (crush Resistant), 15

Pen Needles 31G X 6MM, 19 pravastatin sodium, 6

Opdivo, 3

Pen Needles 31GX5/16", 19 prazosin HCL, 5

opium, 10

penicillin G potassium, 1 Precision Thin Lancets, 19

opium tincture, 10

penicillin v potassium, 1 Precision Thins GP Lancet, 19

Opsumit, 6

pentazocine/naloxone HCL, 15 Precision Ultra Lancet, 19

Orencia, 16

pentoxifylline ER, 12 prednicarbate, 7

Orenitram, 6

Perfect Lancets 30G, 19 prednisolone, 8

Orfadin, 10

Perfect Pressure Activated Safety Lancets 28G, 19

prednisolone acetate, 14

Orkambi, 17

prednisolone sodium phosphate, 8

orphenadrine citrate, 14

perindopril erbumine, 5 prednisolone sodium phosphate odt, 8

orphenadrine citrate ER, 14

Perjeta, 3 prednisone, 8

Orphenadrine/Asa/Caffeine, 14

permethrin, 7 Prednisone, 8

Orthovisc, 14

perphenazine, 13 Prezcobix, 2

Otezla, 16

Perphenazine/Amitriptyline, 14 Prialt, 15

Ovidrel, 9

Pharmacist Choice Ultra Thin Lancets, 19

Primaquine Phosphate, 2

oxacillin sodium, 1

primidone, 13

oxaliplatin, 2

Pharmacist Choice Ultra Thin Lancets 28G, 19

Proair HFA, 17

oxandrolone, 8

probenecid, 16

oxaprozin, 16


probenecid/colchicine, 16

oxazepam, 12

prochlorperazine, 13

oxcarbazepine, 13


prochlorperazine edisylate, 13

oxiconazole nitrate, 7

prochlorperazine maleate, 13

oxybutynin chloride, 11


Procrit, 11

oxybutynin chloride ER, 11

Procysbi, 11

oxycodone HCL, 15

Pharmacy Counter Lancets, 19 Prodigy Pressure Activated Safety Lancets, 19

Oxycodone HCL ER, 15

phenazopyridine HCL, 11

oxycodone hydrochloride, 15

phenelzine sulfate, 12 Prodigy Safety Lancets, 19

oxycodone/acetaminophen, 15

phenobarbital, 13 Prodigy Twist Top Lancets, 19

oxycodone/aspirin, 15

Phenobarbital, 13 Profilnine, 12

oxycodone/ibuprofen, 15

Phenobarbital Sodium, 13 Profilnine SD, 12

Oxycontin, 15

phenoxybenzamine hydrochloride, 5 progesterone, 8

oxymorphone hydrochloride, 15

Phentolamine Mesylate-alprostadil, 6 Prograf, 3

oxymorphone hydrochloride ER, 15

phenylephrine HCL, 6, 15 Prolastin-c, 17

oxytocin, 15

phenylephrine/guaifenesin, 16 Proleukin, 4

P

phenytoin, 13 Prolia, 9

phenytoin sodium, 13 Promacta, 11

paclitaxel, 3

phenytoin sodium extended, 13 promethazine HCL, 16

Paclitaxel, 4

Photofrin, 4 promethazine HCL plain, 16

paliperidone ER, 13

phytonadione, 17 promethazine-DM, 16

pamidronate disodium, 9

pilocarpine HCL, 12, 15 promethazine/codeine, 16

Pamidronate Disodium, 9

pilocarpine hydrochloride, 12 promethazine/dextromethorphan, 16

Pancrelipase, 10

pimozide, 14 promethazine/phenylephrine, 16

pancuronium bromide, 14

pindolol, 5 promethazine/phenylephrine/codeine, 16

pantoprazole sodium, 10

pioglitazone HCL, 8 propafenone HCL, 5

papaverine HCL, 6

pioglitazone HCL-glimepiride, 8 propafenone HCL ER, 5

Papaverine-alprostadil, 6

pioglitazone HCL/metformin HCL, 8 proparacaine HCL, 15

Papaverine-phentolamine Mes/Alprostadil, 6

piperacillin sodium/ tazobactam sodium, 1

propranolol HCL, 5

propranolol HCL ER, 5

Papaverine-phentolamine Mesylate, 6

piperacillin sodium/tazobactam sodium, 1 propylthiouracil, 10

Papaverine/Phentolamine Mes/Alprostadil, 6

piperacillin/tazobactam, 1 protriptyline HCL, 12

piroxicam, 16 Pss Select GP Lancets, 19

paricalcitol, 10

Plegridy, 14 Pss Select Safety Lancets, 19

paromomycin sulfate, 1

Plegridy Starter Pack, 14 Pulmicort Flexhaler, 17

paroxetine HCL, 12

podofilox, 7 Pulmozyme, 17

paroxetine HCL ER, 12

polyethylene glycol 3350, 10 Purixan, 3

peg 3350/electrolytes, 10

polymyxin b sulfate, 2 Px Lancets Ultra Thin, 19

peg-3350/electrolytes, 10

polymyxin b sulfate/trimethoprim sulfate, 14

pyrazinamide, 1

peg-3350/NACL/NA bicarbonate/KCL, 10

pyridostigmine bromide, 14

Peg-intron, 2

Pomalyst, 3 Q

Peg-intron Redipen, 2

potassium citrate ER, 11

Peg-intron Redipen PAK 4, 2

Qc Lancets Super Thin, 19

potassium citrate-citric acid crystals, 11

Pegasys, 2

Qc Lancets Ultra Thin, 19

potassium citrate/citric acid, 11

Pegasys Proclick, 2

Quazepam, 13

potassium citrate/sodium citrate/citric acid, 11

Pegintron, 2

quetiapine fumarate, 13

Pen Needles 29G X 12MM, 19

quinapril HCL, 5

quinapril/hydrochlorothiazide, 5

Flow, 19 sodium sulfacetamide/sulfur, 6

quinidine gluconate CR, 5

Safe-t-lance Plus Safety Lancet Low Flow, 19

sodium sulfacetamide/sulfur cleanser, 6

quinidine gluconate ER, 5

sodium sulfacetamide/sulfur cleansing cloths, 6

quinidine sulfate, 5

Safe-t-lance Plus Safety Lancet Normal Flow, 19

Quinidine Sulfate, 5

sodium sulfacetamide/sulfur green, 6

Quinidine Sulfate ER, 5

Safety Lancet 21G/Pressure Activated, 19

sodium sulfacetamide/sulfur w/sunscreen, 6

quinine sulfate, 2

R

Safety Lancet 28G/Pressure Activated, 19

sodium sulfacetamide/sulfur wash, 6

Soliris, 12

rabeprazole sodium, 10

Safety Lancets, 19 Solus V2 Pressure Activated Safety Lancets 28G, 19

raloxifene hydrochloride, 9

Safety Lancets 21G, 19

ramipril, 5

Safety Lancets 28G, 19 Solus V2 Twist Lancets 30G, 19

ranitidine HCL, 10

Safety Let Lancets, 19 Somatuline Depot, 9

Ravicti, 10

Safety Seal Lancets 28G, 19 Somavert, 9

Rebetol, 2

Safety Seal Lancets 30G, 19 sotalol HCL, 5

Recombinate, 12

Saizen, 9 sotalol HCL (AF), 5

Relion Lancets Micro-thin33G, 19

Saizen Click.easy, 9 Sovaldi, 2

Relion Lancets Standard 21G, 19

salicylic acid, 7 Spiriva Handihaler, 17

Relion Lancets Thin 26G, 19

salicylic acid cream, 7 Spiriva Respimat, 17

Relion Lancets Ultra-thin30G, 19

salicylic acid ER, 7 spironolactone, 6

Relion R, 8

salicylic acid lotion, 7 spironolactone/hydrochlorothiazide, 6

Relion Thin Lancets, 19

salsalate, 15 Sprycel, 4

Relion Ultra Thin Lancets, 19

Samsca, 10 stannous fluoride oral rinse, 12

Relion Ultra Thin Lancets30G, 19

Sandostatin Lar Depot, 9 stavudine, 2

Relion Ultra Thin Plus Lancets 32G, 19

Savaysa, 11 Stelara, 7

Relion Ultra Thin Plus Lancets 33G, 19

selegiline HCL, 13 Stendra, 6

Remicade, 10

selenium sulfide, 7 Sterilance TL, 19

Remodulin, 6

Sensipar, 10 Stivarga, 4

Renew Advanced Lancing Cartridge Refills, 19

Serevent Diskus, 17 Sucraid, 10

Serostim, 9 sucralfate, 10

repaglinide, 8

sertraline HCL, 12 sulfacetamide sodium, 7, 14

Repaglinide/Metformin Hydrochloride, 9

Shopko On-the-go Comfort Lancets 30G, 19

sulfacetamide sodium/prednisolone sodium phosphate, 14

Repatha, 6

Repatha Sureclick, 6

Shopko Unilet Lancets Super Thin 30G, 19

sulfacetamide sodium/sulfur, 7

Revatio, 6

sulfacetamide sodium/sulfur cleanser, 7

Revlimid, 3

Shopko Unilet Lancets Ultra Thin 28G, 19

sulfamethoxazole/trimethoprim, 2

Rexall Lancets Ultra Thin, 19

sulfamethoxazole/trimethoprim DS, 2

Riastap, 12

Signifor, 9 sulfasalazine, 10

Ribasphere, 2

Signifor Lar, 9 sulindac, 16

Ribasphere Ribapak, 2

sildenafil, 6 sumatriptan succinate, 16

Ribatab, 2

sildenafil citrate, 6 Sumatriptan Succinate, 16

ribavirin, 2

Simponi, 16 sumatriptan succinate refill, 16

rifabutin, 1

Simponi Aria, 16 Supartz, 14

rifampin, 1

simvastatin, 6 Supartz Fx, 14

Rightest Gl300 Lancets, 19

Single-let, 19 Supprelin LA, 9

riluzole, 14

sirolimus, 3 Sure-lance Flat Lancets, 19

rimantadine HCL, 2

Smart Diabetes Vantage Universal Lancets 30G, 19

Sure-lance Lancets 26G, 19

risedronate sodium, 9

Sure-lance Thin Lancets 28G, 19

risedronate sodium DR, 9

Smart Sense Color Lancets Universal 33G, 19

Sure-lance Ultra Thin Lancets, 19

risperidone, 13

Sure-touch Lancets Universal, 19

risperidone odt, 13

Smart Sense Standard Lancets Universal 21G, 19

Surelite Lancets, 19

Rituxan, 3

Surestep Glucose Control, 19

rivastigmine tartrate, 14

Smart Sense Super Thin Lancets Universal 30G, 19

Surestep Glucose Control Solution, 19

rivastigmine transdermal system, 14

Surestep Pro High Glucosecontrol, 19

rizatriptan benzoate, 16

Smart Sense Thin Lancets Universal 26G, 19

Surestep Pro Low Glucose Control, 19

rizatriptan benzoate odt, 16

Surestep Pro Normal Glucose Control, 19

rocuronium bromide, 14

Smartest Lancets 28G, 19

ropinirole ER, 13

sodium chloride, 11, 16 Sutent, 4

ropinirole HCL, 13

sodium chloride 0.9%, 11 Sylatron, 4

ropivacaine, 16

sodium citrate/citric acid, 11 Symbicort, 17

ropivacaine HCL, 16

sodium ferric gluconate complex/sucrose, 11

Symlinpen 120, 8

rosuvastatin calcium, 6

Symlinpen 60, 8

Ruconest, 12

sodium hyaluronate, 7 Synjardy, 9

S

sodium phenylacetate/sodium benzoate, 10

Synribo, 4

Synthroid, 10

Sabril, 13

sodium phenylbutyrate, 10 Synvisc, 14

Safe-t-lance Low Flow 25G, 19

sodium sulfacetamide, 6, 7, 14 Synvisc One, 14

Safe-t-lance Normal Flow 21G, 19

sodium sulfacetamide wash, 7

Safe-t-lance Plus Safety Lancet High

T

Toujeo Solostar, 8 Unilet Excelite II, 19

Tracleer, 6 Unilet G.p. Lancet, 19

tacrolimus, 3, 7

tramadol HCL, 15 Unilet G.p. Superlite Lancet, 19

Tafinlar, 4

tramadol HCL ER, 15 Unilet GP 28 Ultra Thin, 19

tamoxifen citrate, 3

Tramadol HCL ER, 15 Unilet Lancet, 19

tamsulosin HCL, 11

tramadol hydrochloride, 15 Unilet Lancets Micro-thin33G, 19

Tarceva, 4

tramadol hydrochloride/acetaminophen, 15

Unilet Lancets Super-thin30G, 19

Tasigna, 4

Unilet Lancets Ultra-thin 28G, 19

Tecfidera, 14

trandolapril, 5 Unilet Superlite Lancet, 19

Tecfidera Starter Pack, 14

trandolapril/verapamil HCL, 5 Unistik 3 Gentle, 19

Techlite AST Lancets, 19

trandolapril/verapamil HCL ER, 5 Unistik Safety Lancets 28G, 19

Techlite Lancets, 19

tranexamic acid, 11 Unistik Safety Lancets 30G, 19

Techlite Lancets 30G, 19

tranylcypromine sulfate, 12 Unistik Touch Safety Lancets 21G, 19

Technivie, 2

Travatan Z, 14 Unistik Touch Safety Lancets 23G, 19

telmisartan, 5

trazodone HCL, 12 Unistik Touch Safety Lancets 28G, 19

telmisartan/amlodipine, 5

Treanda, 2 Unistik Touch Safety Lancets 30G, 19

telmisartan/hydrochlorothiazide, 5

Trelstar, 3 Unituxin, 3

temazepam, 13

Trelstar Mixject, 3 Universal 1 Lancets Thin 26G, 20

Temodar, 2

Tresiba Flextouch, 8 Universal 1 Lancets Ultra Thin 30G, 20

temozolomide, 2

tretinoin, 4, 7 urea, 7

Teniposide, 4

tretinoin microsphere, 7 urea 40% nail film, 7

terazosin HCL, 5

tretinoin microsphere P.M., 7 urea IN zinc undecylenate/lactic acid vehicle, 7

terbinafine HCL, 1

Tretten, 12

terbutaline sulfate, 17

triamcinolone acetonide, 7, 12, 16 urea topical, 7

terconazole, 11

triamcinolone IN orabase, 12 ursodiol, 11

testosterone cypionate, 8

triamterene/hydrochlorothiazide, 6 V

testosterone enanthate, 8

Triamterene/Hydrochlorothiazide, 6

tetrabenazine, 13

valacyclovir HCL, 2

triazolam, 13

tetracaine HCL, 15

Valchlor, 2

Triazolam, 13

Tetracaine HCL, 16

valganciclovir, 2

tricitrates, 11

Tetracycline HCL, 1

valproate sodium, 13

trifluoperazine HCL, 13

tetracycline hydrochloride, 1

valproic acid, 13

trifluridine, 14

Thalomid, 3

valsartan, 5

trihexyphenidyl HCL, 13

theophylline, 17

valsartan/hydrochlorothiazide, 6

trimethobenzamide HCL, 10

theophylline CR, 17

Valstar, 3

trimethoprim, 2

theophylline ER, 17

Valumark Lancet Super Thin 30G, 20

trimethoprim sulfate/polymyxin b sulfate, 14

Theracys, 4

Valumark Lancet Ultra Thin 28G, 20

thiamine HCL, 17

vancomycin HCL, 2

trimipramine maleate, 12

Thinlets GP Lancets, 19

Vantas, 3

Trisenox, 4

Thinlets Lancet, 19

vasopressin, 9

trospium chloride, 11

thioridazine HCL, 13

Vectibix, 3

trospium chloride ER, 11

Thiotepa, 2

vecuronium bromide, 14

Trueplus Lancets 26G, 19

thiothixene, 13

Velcade, 4


Thrombate Iii W/10 ML Sterile Water, 12

Veletri, 6

Trueplus Lancets 28G Super Thin, 19

Thrombate Iii W/20 ML Sterile Water, 12

venlafaxine HCL, 12


tiagabine hydrochloride, 13

venlafaxine HCL ER, 12

Trueplus Lancets 30G Ultra Thin, 19

Tice Bcg, 4

Venlafaxine HCL ER, 12


ticlopidine HCL, 12

Ventavis, 6

Trueplus Lancets 33G Micro Thin, 19

timolol maleate, 14

Ventolin HFA, 17

Trueplus Safety Lancets 28G, 19

timolol maleate ophthalmic gel forming, 14

verapamil HCL, 5

Trulicity, 8

verapamil HCL ER, 5

Tykerb, 4

tinidazole, 2

verapamil HCL SR, 5

Tysabri, 13

tizanidine HCL, 14

Victoza, 8

Tyvaso, 6

tobramycin, 1

Victrelis, 2

Tyvaso Refill, 6

tobramycin sulfate, 1, 14

Vida Mia Unilet Lancets Super Thin 30G, 20

Tyvaso Starter, 6

tobramycin/dexamethasone, 14

Tyzeka, 2

tolazamide, 8

Vida Mia Unilet Lancets Ultra Thin 28G, 20

U

Tolazamide, 8

tolcapone, 13

Ulticare Thin Lancets 30G, 19 Viekira PAK, 2

tolmetin sodium, 16

Ultilet Classic Lancets, 19 Vimizim, 10

Tolmetin Sodium, 16

Ultilet Lancets, 19 Vinblastine Sulfate, 4

tolterodine tartrate, 11

Ultilet Lancets 33G, 19 vincristine sulfate, 4

tolterodine tartrate ER, 11

Ultilet Safety Lancets 23G, 19 vinorelbine tartrate, 4

topiramate, 13

Ultra-thin II Auto Lancet, 19 Virazole, 2

topotecan HCL, 4

Ultra-thin II Lancets 28G, 19 Vitalet Pro Lancets, 20

Topotecan HCL, 4

Ultra-thin II Lancets 30G, 19 Vitalet Pro Plus Lancets, 20

Torisel, 4

Ultra-thin II Safety Autolancets 26G, 19 vitamin c 222MG, 17

torsemide, 6

Unilet Comfortouch Lancet, 19 vitamin d, 17

Totect, 4

Unilet Excelite, 19 vitamin k1, 17

Vitekta, 2

voriconazole, 1

Votrient, 4

Vpriv, 11

W

W&f Lancets 26G, 20

W&f Lancets Colored 21G, 20

Walgreens Lancets, 20

Walgreens Thin Lancets, 20

Walgreens Ultra Thin Lancets, 20

warfarin sodium, 11

Wilate, 12

X

Xalkori, 4

Xarelto, 11

Xarelto Starter Pack, 11

Xeljanz, 16

Xeomin, 14

Xgeva, 9

Xolair, 17

Xtandi, 3

Xyntha, 12

Xyntha Solofuse, 12

Xyrem, 14

Y

Yervoy, 3

Z

zafirlukast, 17

zaleplon, 13

Zaltrap, 3

Zanosar, 2

Zavesca, 11

Zelboraf, 4

Zemaira, 17

Zenpep, 10

Zepatier, 2

Zevalin Y-90, 3

zidovudine, 2

ziprasidone HCL, 13

Zoladex, 3

zoledronic acid, 9

Zoledronic Acid, 9

Zolinza, 4

zolmitriptan, 16

zolmitriptan odt, 16

zolpidem tartrate, 13

zolpidem tartrate ER, 13

Zometa, 9

zonisamide, 13

Zorbtive, 9

Zydelig, 4

Zykadia, 4

Zytiga, 3

1

1ST Choice Lancets Super Thin, 20

1ST Choice Lancets Thin, 20

1ST Choice Lancets Ultra Thin, 20

Documents

2016 Generic Centric Formulary Reference Guide - Optum · 2016 Generic-Centric Formulary Reference Guide ... Generic-Centric Formulary Reference Guide ... TM trademarks and logos