Drug Target Maximum QuantityCADUET 10 MG-80 MG TABLET 30 tablets per prescription CADUET 2.5 MG-10 MG TABLET 30 tablets per prescription CADUET 2.5 MG-20 MG TABLET 30 tablets per prescription

Drug Target Maximum Quantity

ABILIFY 10 MG TABLET 30 tablets per prescription






ABILIFY DISCMELT 10 MG TABLET 60 tablets per prescription

ABILIFY DISCMELT 15 MG TABLET 60 tablets per prescription

ABSTRAL 100 MCG TAB SUBLINGUAL 90 units per 30 days






ACTIQ 1,200 MCG LOZENGE 90 units per 30 days

ACTIQ 1,600 MCG LOZENGE 90 units per 30 days

ACTIQ 200 MCG LOZENGE 90 units per 30 days




ACTONEL 150 MG TABLET 1 tablet per 30 days

ACTONEL 30 MG TABLET 30 tablets per prescription

ACTONEL 35 MG TABLET 4 tablets per 28 days

ACTONEL 5 MG TABLET 30 tablets per prescription

ACTONEL 75 MG TABLET 2 tablet per 30 days

ACTONEL WITH CALCIUM TABLETS 1 (28 day) Blister Package per prescription

ACTOPLUS MET 15 MG-500 MG TAB 90 tablets per prescription

ACTOPLUS MET 15 MG-850 MG TAB 90 tablets per prescription

ACTOPLUS MET XR 15-1,000 MG TB 60 tablets per prescription

ACTOPLUS MET XR 30-1,000 MG TB 30 tablets per prescription

ACTOS 15 MG TABLET 30 tablets per prescription



ADCIRCA 20 MG TABLET 60 tablets per prescription

ADLYXIN MAINTENANCE KIT 1 kit per presciption

ADLYXIN STARTER KIT 1 kit per presciption

ADRENACLICK 0.15 MG 2 units (1 carton) per prescription

ADRENACLICK 0.3 MG 2 units (1 carton) per prescription

ADVAIR 100-50 DISKUS 1 device (60 blisters) per prescription



To help make the use of prescription drugs safer and more affordable, our plan is now using a Drug Quantity Management

program. That is, for certain medications, you can receive an amount to last you a certain number of days. This gives you

the right amount to take the daily dose considered safe and effective, according to the recommendations of the U.S. Food

and Drug Administration (FDA). Based on the FDA’s guidelines and other medical information, our plan developed this

program together with Express Scripts, the company chosen to manage our prescription drug benefit.

The following limits are based on a 30-day supply. If your plan allows for additional days supply, your limits may be higher.

For instance, you may be able to get a 90-day supply of your medication through mail order service. Your doctor could also

request a prior authorization. If this request is approved, a prior authorization would let you receive more than the

recommended quantity.

This document list is effective January 1, 2017 through December 31, 2017. This list may not be all inclusive and is

subject to change. You can get more information and updates to this document at our website at Express-Scripts.com.

Data Class: Confidential

ADVAIR HFA 115-21 MCG INHALER 1 inhaler per prescription






ADVICOR 1,000 MG-20 MG TABLET 60 tablets per prescription

ADVICOR 500 MG-20 MG TABLET 30 tablets per prescription

ADVICOR 750 MG-20 MG TABLET 60 tablets per prescription

AEROBID/AEROBID-M 3 inhalers per prescriptions

AEROSPAN 80 MCG INHALER 18 g (2 inhalers, 8.9 g each) per prescription

AKYNZEO 300/0.5MG CAPSULE 1 capsule per chemotherapy course

ALECENSA 150 MG CAPSULE 240 capsules per prescription

ALLEGRA ALLERGY 12 HR 60 MG 60 tablets per prescription

ALLEGRA ALLERGY 24 HR 180 MG 30 tablets per prescription

ALLEGRA CHILDREN'S ALLERGY 30 MG TABLET 60 tablets per prescription

ALLEGRA-D 12 HOUR ALLERGY & CONGESTION 60 tablets per prescription

ALLEGRA-D 24 HOUR ALLERGY & CONGESTION 30 tablets per prescription

ALORA 0.025 MG PATCH 8 patches per 28 days




ALOXI 0.25 MG/5 ML VIAL 1 vial per prescription

ALSUMA 6 MG/0.5 ML AUTO-INJECT 1 kit/2 syringes per prescription

ALTOPREV 20 MG TABLET 30 tablets per prescription



ALVESCO 160 MCG INHALER 2 inhalers per prescriptions

ALVESCO 80 MCG INHALER 1 inhaler per prescription

AMBIEN 10 MG TABLET 30 tablets per prescription

AMBIEN 5 MG TABLET 30 tablets per prescription

AMBIEN CR 12.5 MG TABLET 30 tablets per prescription

AMBIEN CR 6.25 MG TABLET 30 tablets per prescription

AMERGE 1 MG TABLET 9 tablets per prescription

AMERGE 2.5 MG TABLET 9 tablets per prescription

ANORO ELLIPTA 62.5/25 MCG 14 blisters (institutional pack) per prescription

ANORO ELLIPTA 62.5/25 MCG 60 blisters per prescription

ANZEMET 100 MG TABLET 3 tablet per prescription

ANZEMET 50 MG TABLET 3 tablet per prescription

APLENZIN ER 174 MG TABLET 30 tablets per prescription



ARAVA 10 MG TABLET 30 tablets per prescription

ARAVA 20 MG TABLET 30 tablets per prescription

ARCAPTA NEOHALER 75 MCG CAP 1 package (30 capsules) per prescription

ARNUITY ELLIPTA 100 MCG INHALER 1 inhaler (30 blisters OR 14 blisters institutional pack) per presciption

ARNUITY ELLIPTA 200 MCG INHALER 1 inhaler (30 blisters OR 14 blisters institutional pack) per presciption

ASMANEX HFA 100 MCG INHALER 13 g (1 inhaler) per prescription

ASMANEX HFA 200 MCG INHALER 13 g (1 inhaler) per prescription

ASMANEX TWISTHALER 110 MCG #30 1 inhaler per prescription





ASMANEX TWISTHALR 220 MCG #120 1 inhaler per prescription

ASTELIN 137 MCG NASAL SPRAY 2 bottles per prescriptions

ATELVIA 35 MG TABLET 4 tablets per 28 days

ATROVENT 0.03% SPRAY 1 bottle per prescription

ATROVENT 0.06% SPRAY 2 bottles per prescriptions

ATROVENT HFA INHALER 2 inhalers per prescriptions

ATROVENT INHALER 2 inhalers per prescriptions

AUVI-Q 0.15 MG 2 units (1 carton) per prescription

AUVI-Q 0.3 MG 2 units (1 carton) per prescription


AVANDAMET 2 MG/500 MG TABLET 60 tablets per prescription

AVANDAMET 2 MG-1,000 MG TAB 60 tablets per prescription

AVANDAMET 4 MG/500 MG TABLET 60 tablets per prescription

AVANDAMET 4 MG-1,000 MG TABLET 60 tablets per prescription

AVANDARYL 4 MG-1 MG TABLET 30 tablets per prescription





AVANDIA 2 MG TABLET 60 tablets per prescription



AVINZA 120 MG CAPSULE 60 capsules per 30 days






AVONEX ADMIN PACK 30 MCG VL 4 vials per 28 days

AVONEX PEN 30 MCG/0.5 ML 1 box (4 pens) per 28 days

AVONEX PREFILLED SYR 30 MCG 4 syringes per 28 days

AXERT 12.5 MG TABLET 12 tablets per prescription

AXERT 6.25 MG TABLET 6 tablets per prescription

BECONASE AQ 0.042% SPRAY 2 inhalers per prescriptions

BELBUCA 150 MCG FILM 60 films per presciption







BELSOMRA 10 MG TABLET 30 tablets per prescription




BETASERON 0.3 MG KIT 14 vials per 30 days

BETHKIS 300 MG/4 ML AMPULE 56 ampules per prescription

BEVESPI AEROSPHERE 1 canister (120 inhalations per canister) per prescription

BINOSTO 70 MG TABLET EFF 4 tablets per 28 days

BONIVA 150 MG TABLET 1 tablet per 30 days

BOSULIF 100 MG TABLET 120 tablets per prescription

BOSULIF 500 MG TABLET 30 tablets per prescription

BREO ELLIPTA 100MCG/25MCG #28 28 blisters (1 inhaler) per prescription

BREO ELLIPTA 100MCG/25MCG #60 60 blisters per prescription

BREO ELLIPTA 200 MCG/25 MCG, PACKAGE SIZE 28 1 inhaler (28 blisters)

BREO ELLIPTA 200 MCG/25 MCG, PACKAGE SIZE 60 1 inhaler (60 blisters)

BRISDELLE 7.5 MG CAPSULE 30 capsules per prescription

BROVANA 15 MCG/2 ML SOLUTION 2 cartons (60 vials) per prescription

BUDEPRION SR 100 MG TABLET 60 tablets per prescription

BUDEPRION SR 150 MG TABLET 60 tablets per prescription

BUDEPRION XL 300 MG TABLET 30 tablets per prescription

BUNAVAIL 2.1 MG/0.3 MG FILM 30 films per presciption

BUNAVAIL 4.2 MG/0.7 MG FILM 60 films per presciption

BUNAVAIL 6.3 MG/1 MG FILM 60 films per presciption

BUTORPHANOL NASAL SPRAY 10 MG/ML 2 bottle per prescription

BYDUREON 2 MG PEN 4 Pens (1 package) per prescription

BYDUREON 2 MG VIAL 1 carton (4 single-dose trays) per prescription

BYETTA 10 MCG DOSE PEN INJ 1 syringe per prescription

BYETTA 5 MCG DOSE PEN INJ 1 syringe per prescription

CABOMETYX 20 MG TABLET 30 tablets per prescription

CADUET 10 MG-10 MG TABLET 30 tablets per prescription





CADUET 2.5 MG-10 MG TABLET 30 tablets per prescription







CAMBIA 50 MG POWDER PACKET 9 packets per prescription

CARDURA 1 MG TABLET 30 tablets per prescription




CARDURA XL 4 MG TABLET 30 tablets per prescription

CARDURA XL 8 MG TABLET 30 tablets per prescription

CATAPRES-TTS 1 PATCH 4 patches per 28 days



CAVERJECT 10 MCG KIT 12 units per prescription

CAVERJECT 20 MCG KIT 12 units per prescription

CAVERJECT 20 MCG VIAL 12 units per prescription

CAVERJECT 40 MCG VIAL 12 units per prescription

CAVERJECT 40 MCG/2 ML AMPUL 12 units per prescription

CAYSTON 75 MG INHAL SOLUTION 1 kit (84 vials of aztreonam and 88 vials of dliuent) per prescription

CELEXA 10 MG TABLET 30 tablets per prescription



CESAMET 1 MG PULVULE 30 capsules per prescription

CHILDREN'S QNASAL 40 MCG (4.9 G) 5 grams (1 bottle) per prescription

CHILD'S CLARITIN 5 MG TAB CHEW 30 tablets per prescription

CHLD ALLEGRA ALLERGY 30 MG ODT 60 tablets per prescription

CHOLBAM 50 MG CAPSULE 120 capsules per prescription

CHORIONIC GONAD 10000U VIAL 3 vials per prescription

CIALIS 10 MG TABLET 6 tablets per prescription

CIALIS 2.5 MG TABLET 30 tablets per prescription



CLARINEX 2.5 MG REDITABS 30 tablets per prescription

CLARINEX 5 MG REDITABS 30 tablets per prescription

CLARINEX-D 12 HOUR TABLET 60 tablets per prescription

CLARINEX-D 24 HOUR TABLET 30 tablets per prescription

CLARITIN 10 MG LIQUI-GEL CAP 30 tablets per prescription

CLARITIN 10 MG REDITABS 30 tablets per prescription

CLARITIN 10 MG TABLET 30 tablets per prescription

CLARITIN-D 12 HOUR TABLET 60 tablets per prescription

CLARITIN-D 24 HOUR TAB ER 30 tablets per prescription

CLIMARA 0.025 MG/DAY PATCH 4 patches per 28 days



CLIMARA 0.06/MG DAY PATCH 4 patches per 28 days



CLIMARA PRO PATCH 4 patches per 28 days

CLOBETASOL EMOLLIENT CREAM 120 grams per 28 days

CLOBETASOL FOAM, SOLUTION, EMOLLIENT FOAM 100 grams per 28 days

CLOBETASOL LOTION 118 grams per 28 days

CLOBETASOL OINTMENT, CREAM AND GEL 120 grams per 28 days

CLOBETASOL SHAMPOO 236 grams per 28 days

CLOBETASOL SPRAY 125 grams per 28 days

COMBIVENT INHALER 2 inhaler per prescription

COMBIVENT RESPIMAT INHAL SPRAY 2 inhaler per prescription

CONZIP ER 100 MG CAPSULE 30 tablets per prescription




COPAXONE 20 MG 1 kit (30 prefilled syringes) per 30 days

COPAXONE 40 MG/ML SYRINGE 12 syringes per 30 days

COTELLIC 20 MG TABLET 63 tablets per prescription

CRESTOR 10 MG TABLET 30 tablets per prescription




CYMBALTA 20 MG CAPSULE 60 capsules per prescription



DAKLINZA 30 MG TABLET 84 tablets per 365 days



DEPO-PROVERA 150 MG/ML SYRINGE 1 vial/syringe per 30 days

DEPO-SUBQ PROVERA 104 SYRINGE 1 syringe per 30 days

DESVENLAFAXINE ER 100 MG TABLET 30 tablets per prescription

DESVENLAFAXINE ER 50 MG TABLET 30 tablets per prescription

DEXILANT DR 30 MG CAPSULE 30 capsules per prescription

DEXILANT DR 60 MG CAPSULE 30 capsules per prescription

DIFLUCAN 150 MG TABLET 2 tablets per prescription

DIVIGEL 0.25 MG GEL PACKET 30 packets per prescription

DIVIGEL 0.5 MG GEL PACKET 30 packets per prescription

DIVIGEL 1 MG GEL PACKET 30 packets per prescription

DOSTINEX 0.5 MG TABLET 8 tablets per 28 days

DUETACT 30-2 MG TABLET 30 tablets per prescription

DUETACT 30-4 MG TABLET 30 tablets per prescription

DULERA 100 MCG/5 MCG INHALER 1 inhaler per prescription



DUONEB 0.5 MG-3 MG/3 ML SOLN 180 vials (package size 3) per prescription

DYMISTA NASAL SPRAY 1 bottle per prescription

EDEX 10 MCG KIT 12 cartridges per prescription

EDEX 20 MCG CARTRIDGE 2-PK KIT 12 cartridges per prescription




EDLUAR 10 MG SL TABLET 30 tablets per prescription

EDLUAR 5 MG SL TABLET 30 tablets per prescription

EFFEXOR 100 MG TABLET 90 tablets per prescription


EFFEXOR 37.5 MG TABLET 90 tablets per prescription



EFFEXOR XR 150 MG CAPSULE 30 tablets per prescription

EFFEXOR XR 37.5 MG CAPSULE 30 tablets per prescription

EFFEXOR XR 75 MG CAPSULE 90 tablets per prescription

ELESTRIN 0.06% GEL 52 grams (2 pumps) per prescription

ELIDEL CREAM 1% 100 grams per 30 days

ELLA 30 MG TABLET 1 tablet (1 dose) per prescription

EMBEDA 100-4 MG CAPSULE 90 capsules per 30 days

EMBEDA 20-0.8 MG CAPSULE 90 capsules per 30 days


EMBEDA 50-2 MG CAPSULE 90 capsules per 30 days



EMEND 125 MG CAPSULE 1 capsule per prescription

EMEND 125 MG ORAL SUSPENSION 3 packets per prescription

EMEND 150 MG VIAL 1 vial per prescription

EMEND 40 MG CAPSULE 1 capsule per prescription

EMEND 80 MG CAPSULE 2 capsules per prescription

EMEND TRIFOLD PACK 1 pack per prescription

ENBREL 25 MG/0.5 ML SYRINGE 8 vials/syringes per 28 days


ENBREL 50 MG/0.5 ML SYRINGE 4 vials/syringes per 28 days

ENTRESTO 24 MG/26 MG TABLET 60 tablets per prescription



EPCLUSA 84 tablets per 365 days

EPINEPHRINE 0.15 MG AUTO-INJCT (TWO PACK) 2 units (1 carton) per prescription

EPINEPHRINE 0.3 MG AUTO-INJECT (TWO PACK) 2 units (1 carton) per prescription

EPIPEN 0.3 MG AUTO-INJECTOR 3 units (package size 1), 2 units (package size 2) per prescription

EPIPEN JR 0.15 MG AUTO-INJCT 3 units (package size 1), 2 units (package size 2) per prescription

ERIVEDGE 150 MG CAPSULE 30 capsules per prescription

ESBRIET 267 MG CAPSULE: 14-DAY TITRATION BLISTER PACK 1 pack (63 capsules) per prescription

ESBRIET 267 MG CAPSULE 270 capsules per prescription

ESBRIET 267 MG CAPSULE: 4-WEEK MAINTENANCE BLISTER

PACK1 carton (252 capsules) per prescription

ESOMEPRAZOLE STRONTIUM 24.65 MG CAPSULE 30 capsules per prescription

ESTRADERM 0.05 MG PATCH 8 patches per 28 days

ESTRADERM 0.1 MG PATCH 8 patches per 28 days

ESTRASORB PACKET 56 packets (97.44 g) per prescription

ESTROGEL 0.06% GEL 1 pump bottle per prescription

EVAMIST 1.53 MG/SPRAY 2 pumps per prescription

EVZIO 0.4 MG AUTOINJECTOR 1 package (2 devices plus 1 trainer) per prescription

EVZIO 2MG/0.4 ML AUTOINJECTOR 1 kit (2 auto-injectors) per prescription

EXALGO ER 12 MG TABLET 60 tablets per 30 days




EXTAVIA 0.3 MG KIT 15 blister units/vials per 30 days

EXTAVIA 0.3MG VIAL 14 or 15 vials with prefilled diluent syringe per 30 days

FAMVIR 125 MG TABLET 21 tablets per prescription



FANAPT 1 MG TABLET 60 tablets per prescription







FANAPT TITRATION PACK 1 pack (8 tablets) per prescription

FARXIGA 10 MG TABLET 30 tablets per prescription

FARXIGA 5 MG TABLET 30 tablets per prescription

FARYDAK 10 MG CAPSULE 6 capsules per prescription



FENTORA 100 MCG BUCCAL TABLET 90 units per 30 days






FLECTOR 1.3% PATCH 60 patches per prescription

FLONASE 0.05% NASAL SPRAY 1 bottle per prescription

FLONASE ALLERGY RELIEF 50 MCG SRAY PACKAGE SIZE 15.8 1 unit per prescription

FLONASE ALLERGY RELIEF 50 MCG SRAY PACKAGE SIZE 9.9 1 unit per prescription

FLOVENT 100 MCG DISKUS 1 inhaler per prescription

FLOVENT 250 MCG DISKUS 4 inhalers per prescriptions

FLOVENT 50 MCG ROTADISK 1 inhaler per prescription

FLOVENT HFA 110 MCG INHALER 1 inhaler per prescription

FLOVENT HFA 220 MCG INHALER 2 inhalers per prescriptions

FLOVENT HFA 44 MCG INHALER 1 inhaler per prescription

FLUNISOLIDE 0.025% SPRAY 2 inhalers/bottles per prescriptions


FLUOCINONIDE OINTMENT, GEL, SOLUTION, OR CREAM

EMULSIFIED120 grams per 30 days

FLUOXETINE 10 MG CAPSULE 30 capsules, tablets per prescription

FLUOXETINE HCL 40 MG CAPSULE 60 capsules per prescription

FLUVOXAMINE 100 MG TABLET 90 capsules per prescription



FORADIL AEROLIZER 12 MCG CAP 1 package (package size 12) 12 capsules per prescription

FORADIL AEROLIZER 12 MCG CAP 1 package (package size 60) 60 capusules per prescription

FORTEO 600 MCG/2.4 ML PEN INJ 1 pen per 28 days

FORTIVO XL 450 MG TABLET 30 tablets per prescription

FOSAMAX 10 MG TABLET 30 tablets per prescription

FOSAMAX 35 MG TABLET 4 tablets per 28 days



FOSAMAX 70 MG TABLET 4 tablets per 28 days

FOSAMAX 70 MG/75 ML SOLUTION 4 bottles per 28 days

FOSAMAX PLUS D 70 MG-2,800 IU 4 tablets per 28 days

FOSAMAX PLUS D 70 MG-5,600 IU 4 tablets per 28 days

FROVA 2.5 MG TABLET 9 tablets per prescription

GELNIQUE 10% GEL SACHETS 30 sachets (1 carton) per prescription

GELNIQUE 3% GEL 1 pump per prescription

GEODON 20 MG CAPSULE 60 capsules per prescription




GILOTRIF 20 MG TABLET 30 tablets per prescription



GLEEVEC 100 MG TABLET 180 tablets per prescription

GLEEVEC 400 MG TABLET 60 capsules per prescription

GLYXAMBI 10 MG/5 MG TABLET 30 tablets per prescription

GLYXAMBI 25 MG/5 MG TABLET 30 tablets per prescription

GRANISOL 2 MG/10 ML SOLUTION 1 bottle per prescription

HARVONI 400 MG/90 MG TABLET 56 tablets per 365 days

HUMIRA 10 MG/0.2 ML SYRINGE 2 syringes per 28 days


HUMIRA 40 MG/0.8 ML PEN 2 pen per 28 days


HUMIRA CROHN'S STARTER PACK 2 syringes per 28 days

HUMIRA PSORIASIS STARTER PACK 2 syringes per 28 days

HYSINGLA ER 100 mg tablet 60 tablets per 30 days







HYTRIN 1 MG CAPSULE 30 capsules per prescription




IBRANCE 100 MG CAPSULE 21 capsules per prescription



ICLUSIG 15 MG 60 tablets per prescription

ICLUSIG 45 MG 30 tablets per prescription

IMITREX 100 MG TABLET 9 tablets per prescription

IMITREX 20 MG NASAL SPRAY 6 devices per prescription


IMITREX 4 MG/0.5 ML CARTRIDGES 2 vials per prescription

IMITREX 4 MG/0.5 ML PEN INJECT 1 kit per prescription

IMITREX 5 MG NASAL SPRAY 6 devices per prescription



IMITREX 6 MG/0.5 ML CARTRIDGE 2 vials per prescription

IMITREX 6 MG/0.5 ML PEN INJECT 1 kit per prescription

IMITREX 6 MG/0.5 ML SYRNG KIT 1 kit per prescription

IMITREX 6 MG/0.5 ML VIAL 2 vials per prescription

INCRUSE ELLIPTA 62.5 MCG INHALER 1 inhaler (30 blisters OR 7 blisters institutional pack) per prescription

INLYTA 1 MG TABLET 180 tablets per prescription

INLYTA 5 MG TABLET 120 tablets per prescription

INTERMEZZO 1.75 MG TAB SUBLING 30 tablets per prescription

INTERMEZZO 3.5 MG TAB SUBLING 30 tablets per prescription

INVEGA ER 1.5 MG TABLET 30 tablets per prescription

INVEGA ER 3 MG TABLET 30 tablets per prescription



INVOKAMET 150 MG/1000 MG TABLET 60 tablets per prescription




INVOKANA 100 MG TABLET 30 tablets per prescription

INVOKANA 300 MG TABLET 30 tablets per prescription

IRENKA (DULOXETINE) 40 MG CAPSULE 30 capsules per prescription

IRESSA 250 MG TABLET 30 tablets per prescription

JAKAFI 10 MG TABLET 60 tablets per prescription





JANUMET 50-1,000 MG TABLET 60 tablets per prescription

JANUMET 50-500 MG TABLET 30 tablets per prescription

JANUMET XR 100-1,000 MG TABLET 30 tablets per prescription

JANUMET XR 50-1,000 MG TABLET 60 tablets per prescription

JANUMET XR 50-500 MG TABLET 30 tablets per prescription

JANUVIA 100 MG TABLET 30 tablets per prescription



JARDIANCE 10 MG TABLET 30 tablets per prescription

JARDIANCE 25 MG TABLET 30 tablets per prescription

JENTADUETO 2.5 MG-1000 MG TAB 60 tablets per prescription



JENTADUETO XR 2.5 MG TABLET 60 tablets per prescription

JENTADUETO XR 5 MG TABLET 30 tablets per prescription

JUVISYNC 100-10 MG TABLET 30 tablets per prescription






KADIAN ER 10 MG CAPSULE 90 capsules per 30 days












KALYDECO 150 MG TABLET 60 tablets per prescription

KALYDECO 50 MG GRANULES PACKET 56 packets (1 package) per prescription

KALYDECO 75 MG GRANULES PACKET 56 packets (1 package) per prescription


KAZANO 12.5-1,000 MG TABLET 60 tablets per prescription

KAZANO 12.5-500 MG TABLET 60 tablets per prescription

KHEDEZLA 100 MG TABLET 30 tablets per prescription

KHEDEZLA 50 MG TABLET 30 tablets per prescription

KITABIS PACK 300 MG/5 ML SOLUTION 280 mL (1 package) per prescription

KOMBIGLYZE XR 2.5-1,000 MG TAB 60 tablets per prescription

KOMBIGLYZE XR 5-1,000 MG TAB 30 tablets per prescription

KOMBIGLYZE XR 5-500 MG TABLET 30 tablets per prescription

KYTRIL 1 MG TABLET 6 tablets per prescription

KYTRIL 2 MG/10 ML SOLUTION 1 bottle (30 mL) per prescription

LATUDA 120 MG TABLET 30 tablets per prescription





LAZANDA 100 MCG NASAL SPRAY 23 units (1 unit = 1 bottle with 8 sprays) per 30 days

LAZANDA 400 MCG NASAL SPRAY 23 units (1 unit = 1 bottle with 8 sprays) per 30 days

LESCOL 20 MG CAPSULE 30 capsules per prescription

LESCOL 40 MG CAPSULE 60 capsules per prescription

LESCOL XL 80 MG TABLET 30 tablets per prescription

LEVITRA 10 MG TABLET 6 tablets per prescription

LEVITRA 2.5 MG TABLET 6 tablets per prescription



LEVONORGESTREL 0.75 MG TABLET 2 tablets per prescription

LEVONORGESTREL 1.5 MG TABLET (various brands and generics

– for example, AFTERA, ECONTRA EZ, FALLBACK SOLO, MY

WAY, NEXT CHOICE ONE DOSE, OPCICON ONE-STEP, OPTION

2, PLAN B ONE-STEP, REACT, TAKE ACTION)

1 tablet per prescription

LEXAPRO 10 MG TABLET 30 tablets per prescription



LiDOCAINE 2.5%/PRILOCAINE 2.5% CREAM 30 grams per 30 days

LIDOCAINE JELLY 2% 60 mL per 30 days

LIDOCAINE OINTMENT One tube, 35.44 or 50 grams per 30 days

LIPITOR 10 MG TABLET 30 tablets per prescription




LIPTRUZET 10 MG TABLET 30 tablets per prescription




LIVALO 1 MG TABLET 30 tablets per prescription



LUNESTA 1 MG TABLET 30 tablets per prescription



LUVOX CR 100 MG CAPSULE 60 tablets per prescription

LUVOX CR 150 MG CAPSULE 60 tablets per prescription

MAXAIR AUTOHALER 0.2 MG AERO 1 inhaler per prescription

MAXALT 10 MG TABLET 18 tablets per prescription

MAXALT 5 MG TABLET 18 tablets per prescription

MAXALT MLT 10 MG TABLET 18 tablets per prescription

MAXALT MLT 5 MG TABLET 18 tablets per prescription

MEKINIST 0.5 MG TABLET 90 tablets per prescription

MEKINIST 2MG TABLET 30 tablets per prescription

MENOSTAR 14 MCG/DAY PATCH 4 patches per 28 days

MEVACOR 10MG TABLET 30 tablets per prescription

MEVACOR 20 MG TABLET 60 tablets per prescription

MEVACOR 40 MG TABLET 60 tablets per prescription

MIGRANAL 4 MG/ML NASAL SPRAY 8 spray devices = 1 kit per prescription


MINIVELLE 0.0375 MG PATCH 8 patches per 28 days




MOBIC 7.5 MG TABLET 30 tablets per prescription

MS CONTIN 100 MG TABLET

ORAMORPH SR 100 MG TABLET120 tablets per 30 days



MS CONTIN 200 MG TABLET 120 tablets per 30 days

MS CONTIN 30 MG TABLET SA




MUSE 1,000 MCG URETHRAL SUPP 12 urethral suppositories per prescription

MUSE 125 MCG URETHRAL SUPPOS 12 urethral suppositories per prescription



NARCAN 4 MG/0.1 NASAL SPRAY 1 pack (2 devices) per prescription

NASACORT AQ NASAL SPRAY 1 bottle per prescription

NASONEX 50 MCG NASAL SPRAY 1 bottle per prescription

NEBUPENT 300 MG INHAL POWDER 1 container (inhaler) per 28 days

NESINA 12.5 MG TABLET 30 tablets per prescription

NESINA 25 MG TABLET 30 tablets per prescription

NESINA 6.25 MG TABLET 30 tablets per prescription

NEULASTA 6 MG/0.6 ML SYRINGE 2 syringes per 30 days

NEXAVAR 200 MG TABLET 120 tablets per prescription

NEXIUM 2.5 MG PACKET 30 packets per prescription

NEXIUM 20 MG CAPSULE 30 capsules per prescription

NEXIUM 5 MG PACKET 30 packets per prescription

NEXIUM DR 10 MG PACKET 30 packets per prescription

NEXIUM DR 20 MG PACKET 30 packets per prescription

NINLARO 2.3 MG CAPSULE 30 tablets per prescription

NINLARO 3 MG CAPSULE 3 capsules per prescription

NINLARO 4 MG CAPSULE 3 capsules per prescription

NOVAREL 10,000 UNITS VIAL 3 vials per prescription

NUCALA 100 MG VIAL 1 vial per 28 days

NUCYNTA 100 MG TABLET 181 tablets per prescription



NUCYNTA ER 100 MG TABLET 60 tablets per 30 days





OCALIVA 10 MG TABLET 30 tablets per prescription

OCALIVA 5 MG TABLET 30 tablets per prescription

ODOMZO 200 MG CAPSULE 30 capsules per prescription

OFEV 100 MG CAPSULE 60 capsules per prescription

OFEV 150 MG CAPSULE 60 capsules per prescription

OLYSIO 150 MG CAPSULE 84 tablets per 365 days

OMECLAMOX-PAK COMBO PACK 80 caps/tabs (10 cards) = 1 combo pack per prescription

OMNARIS 50 MCG NASAL SPRAY 1 bottle per prescription

ONGLYZA 2.5 MG TABLET 30 tablets per prescription

ONGLYZA 5 MG TABLET 30 tablets per prescription

ONMEL 200 MG TABLET 15 tablets per prescription

ONSOLIS 1,200 MCG SOLUBLE FILM 90 films per 30 days

ONSOLIS 200 MCG SOLUBLE FILM 90 films per 30 days




ONZENTRA XSAIL 11 MG NOSEPIECE 1 kit (8 doses/16 nose pieces) per prescription

OPANA ER 10 MG TABLET 90 tablets per 30 days







OPANA ER 7.5 MG TABLET 90 tablets per 30 days

ORAMORPH SR 100 MG 120 tablets per 30 days




ORKAMBI 100 MCG/125 MG TABLET 112 tablets (1 box)

ORKAMBI 200 MCG/125 MG TABLET 112 tablets (1 package)

OSENI 12.5-15 MG TABLET 30 tablets per prescription



OSENI 25-15 MG TABLET 30 tablets per prescription



OXYCONTIN 10 MG TABLET 90 tablets per 30 days







OXYTROL 3.9 MG/24HR PATCH 8 patches per 28 days

PATANASE 0.6% NASAL SPRAY 1 bottle per prescription

PAXIL 10 MG TABLET 30 tablets per prescription




PAXIL CR 12.5 MG TABLET 60 tablets per prescription

PAXIL CR 25 MG TABLET 60 tablets per prescription

PAXIL CR 37.5 MG TABLET 60 tablets per prescription

PEGASYS 180 MCG/0.5 ML SYRINGE 1 box per 28 days

PEGASYS 180 MCG/0.5 ML SYRINGE 1 box per 28 days

PEGASYS 180 MCG/ML VIAL 4 vials per 28 days

PEGASYS PROCLICK 135 MCG/0.5 1 box per 28 days

PEGASYS PROCLICK 180 MCG/0.5 1 box per 28 days

PEGINTRON Redipen 150 MCG 4 pens per 28 days

PEGINTRON 120 MCG KIT 4 vials per 28 days







PENNSAID 2% SOLUTION 112 grams per 28 days

PENNSAID AND KLOFENSAID 1.5 DROPS 150 mL per 28 days

PERFOROMIST 20 MCG/2 ML SOLN 1 carton (60 vials) per prescription

PEXEVA 10 MG TABLET 30 tablets per prescription




PLEGRIDY 125 MCG/0.5 ML 2 units (Pen and Syringe) per 28 days

PLEGRIDY 63 MCG SINGLE DOSE AND 94 MCG SINGLE DOSE 1 starter pack (Pen and Syringe) per 365 days

PRALUENT 50 MG 2 pens/syringes per 28 days

PRALUENT 75 MG 2 pens/syringes per 28 days

PRANDIMET 1 MG-500 MG TABLET 150 tablets per prescription

PRANDIMET 2 MG-500 MG TABLET 150 tablets per prescription

PRAVACHOL 10 MG TABLET 30 tablets per prescription





Pregnyl 10,000 units vial 3 vials per prescription

PREVACID 15 MG CAPSULE DR 30 capsules per prescription

PREVACID 15 MG SOLUTAB 30 solutabs per prescription

PREVPAC PATIENT PAC 112 caps/tabs (14 cards) = 1 pack per prescription

PRILOSEC 10 MG CAPSULE DR 30 capsules per prescription

PRILOSEC 20 MG CAPSULE DR 30 capsules per prescription

PRILOSEC DR 10 MG SUSPENSION 30 packets per prescription

PRILOSEC DR 2.5 MG SUSPENSION 60 packets per prescription

PRISTIQ 25 MG TABLET 30 tablets per prescription

PRISTIQ ER 100 MG TABLET 30 tablets per prescription

PRISTIQ ER 50 MG TABLET 30 tablets per prescription

PROAIR HFA 90 MCG INHALER 2 inhalers per prescription

PROAIR RESPICLICK 90 MCG INHALER 2 inhalers per prescription

PROTONIX DR 20 MG TABLET 30 tablets per prescription

PROTOPIC OINTMENT 0.03% 100 grams per 30 days

PROTOPIC OINTMENT 0.10% 100 grams per 30 days

PROVENTIL HFA 90 MCG INHALER 2 inhalers per prescription

PROZAC 10 MG PULVULE 30 pulvules per prescription

PROZAC 40 MG PULVULE 60 pulvules per prescription

PROZAC WEEKLY 90 MG CAPSULE 4 capsules per prescription

PULMICORT 0.25 MG/2 ML RESPUL 60 respules per prescription

PULMICORT 0.5 MG/2 ML RESPULE 60 respules per prescription

PULMICORT 1 MG/2 ML RESPULE 30 respules per prescription

PULMICORT 180 MCG FLEXHALER 2 inhalers per prescription

PULMICORT 90 MCG FLEXHALER 1 inhaler per prescription

QNASL 80MCG NASAL SPRAY 1 bottle per prescription

QVAR 40 MCG INHALER 2 inhalers per prescription

QVAR 80 MCG INHALER 3 inhalers per prescription

Rebetron Combination (Rebetol capsules and Intron A injection)

RebetronTherapy Pak 10002 packages per 28 days





REBIF 22 MCG/0.5 ML SYRINGE 12 syringes per 28 days

REBIF 44 MCG/0.5 ML SYRINGE 12 syringes per 28 days

REBIF TITRATION PACK 1 package per 28 days

REGRANEX 0.01% GEL 1 tube per prescription

RELENZA 5 MG DISKHALER 20 blisters (1 carton) per prescription

RELPAX 20 MG TABLET 6 tablets per prescription

RELPAX 40 MG TABLET 6 tablets per prescription

REPATHA 140 MG 2 pens/syringes per 28 days

REPATHA PUSHTRONEX 1 pushtronex device per 28 days

RESTASIS 0.05% EYE EMULSION 60 vials per prescription

RESTASIS 5.5 ML MULTIDOSE VIAL 5.5 ml per prescription

REVATIO 10 MG/ML ORAL SUSPENSION 1 (112 ml) bottle per prescription

REVATIO 20 MG TABLET 90 tablets per prescription

REXULTI 0.25 MG TABLET 30 tablets per prescription

REXULTI 0.5 MG TABLET 30 tablets per prescription

REXULTI 1 MG TABLET 30 tablets per prescription




RHINOCORT ALLERGY SPRAY 32 MCG 9 gm (8.6 g = 1 bottle) and 5 g (1 bottle) per prescription

RHINOCORT AQUA NASAL SPRAY 2 bottles per prescription

RISPERDAL 0.25 MG TABLET 60 tablets per prescription

RISPERDAL 0.5 MG TABLET 60 tablets per prescription

RISPERDAL 1 MG TABLET 60 tablets per prescription




RISPERDAL M-TAB 0.5 MG ODT 60 tablets per prescription

RISPERDAL M-TAB 1 MG ODT 60 tablets per prescription





RISPERIDONE ODT (GENERIC ONLY) 0.25 MG TABLET 60 tablets per prescription

ROZEREM 8 MG TABLET 30 tablets per prescription

RYBIX ODT 50 MG TABLET 240 tablets per prescription

RYZOLT ER 100 MG TABLET 30 tablets per prescription



SAMSCA 15 MG TABLET 30 tablets per prescription

SAMSCA 30 MG TABLET 60 tablets per prescription

SANCUSO 3.1 MG/24 HR PATCH 1 patch per prescription

SAPHRIS 10 MG TAB SL BLK CHERY 60 tablets per prescription

SAPHRIS 2.5 MG TABLET 60 tablets per prescription

SAPHRIS 5 MG TAB SL BLK CHERRY 60 tablets per prescription

SARAFEM 10 MG TABLET 30 capsules or tablets per prescription

SARAFEM 15 MG TABLET 28 capsules per prescription

SARAFEM 20 MG TABLET 126 capsules per prescription

SAVELLA 100 MG TABLET 60 tablets per prescription

SAVELLA 12.5 MG TABLET 60 tablets per prescription



SAVELLA TITRATION PACK 55 tablets per prescription

SECONAL 100 MG CAPSULE 30 capsules per prescription

SEEBRI NEOHALER 15.6 MCG INHALATION POWDER 60 inhalations (1 package) per prescription

SEREVENT DISKUS 50 MCG 1 package per prescription

SEREVENT DISKUS 50 MCG 1 package per prescription

SEROQUEL 100 MG TABLET 90 tablets per prescription






SEROQUEL XR 150 MG TABLET 30 tablets per prescription





SILENOR 3 MG TABLET 30 tablets per prescription

SILENOR 6 MG TABLET 30 tablets per prescription

SIMCOR 1,000-20 MG TABLET 60 tablets per prescription

SIMCOR 1,000-40 MG TABLET 30 tablets per prescription

SIMCOR 500-20 MG TABLET 30 tablets per prescription



SOLARAZE 3% GEL 100 grams per 28 days

SOLIQUA 100 PACKAGE 1 package (5x3 ml syringes) per prescription

SONATA 10 MG CAPSULE 60 tablets per prescription

SONATA 5 MG CAPSULE 30 tablets per prescription

SOVALDI 400 MG TABLET 84 tablets per 365 days

SPIRIVA 18 MCG CP-HANDIHALER 1 package (30 doses) per prescription

SPIRIVA 28 INHALATIONS PACK AND 60 INHALATIONS PACK 1 inhaler (4 g) per prescription

SPIRIVA RESPIMAT 1.25 MCG INHALATION SPRAY 4 g = 1 inhaler (60 inhalations)

SPORANOX 100 MG CAPSULE 30 capsules per prescription

SPRIX 15.75 MG NASAL SPRAY 5 bottles per prescription

SPRYCEL 100 MG TABLET 30 tablets per prescription






STAXYN 10 MG ODT 6 tablets per prescription

STENDRA 100 MG TABLET 6 tablets per prescription





STIOLTO RESPIMAT 2.5/2.5 MCG INHALATION SPRAY 1 inhaler = 4 g (60 inhalations OR 28 inhalations institutional pack)

STIVARGA 40 MG 84 tablets per prescription

STRIVERDI RESPIMAT 28 INHALATIONS PACK, 60 INHALATIONS PACK1 inhaler (60 inhalations OR 28 inhalations institutional pack) per prescription

SUBOXONE 12 MG-3 MG SL FILM 60 tablets/films per prescription

SUBOXONE 2 MG-0.5 MG SL FILM 90 tablets/films per prescription

SUBOXONE 2 MG-0.5 MG TABLET SL 90 tablets/films per prescription



SUBOXONE 8 MG-2 MG TABLET SL 90 tablets/films per prescription

SUBSYS 1,200 MCG SPRAY 90 single spray units per 30 days

SUBSYS 1,600 MCG SPRAY 90 single spray units per 30 days

SUBSYS 100 MCG SPRAY 90 single spray units per 30 days





SUMAVEL DOSEPRO 4 MG/0.5 ML 3 mL (1 box) per prescription

SUMAVEL DOSEPRO 4 MG/0.5 ML 9 mL (3 boxes) per 28 days

SUMAVEL DOSEPRO 6 MG/0.5 ML 6 units per prescription

SUTENT 12.5 MG CAPSULE 90 capsules per prescription

SUTENT 25 MG CAPSULE 30 capsules per prescription

SUTENT 50 MG CAPSULE 30 capsules per prescription

SYMBICORT 160-4.5 MCG INHALER 1 package per prescription

SYMBICORT 80-4.5 MCG INHALER 1 package per prescription

SYMLINPEN 120 PEN INJECTOR 7 pens per prescription

SYMLINPEN 60 PEN INJECTOR 7 pens per prescription

SYNJARDY 12.5 MG/1000 MG TABLET 60 tablets per prescription

SYNJARDY 12.5 MG/500 MG TABLET 60 tablets per prescription

SYNJARDY 5 MG/1000 MG TABLET 60 tablets per prescription

SYNJARDY 5 MG/500 MG TABLET 60 tablets per prescription

TAFINLAR 50 MG 120 capsules per prescription

TAFINLAR 75 MG 120 capsules per prescription

TAGRISSO 40 MG TABLET 30 tablets per prescription

TAGRISSO 80 MG TABLET 30 tablets per prescription

TAMIFLU 12 MG/ML SUSPENSION 3 bottles per prescriptions

TAMIFLU 30 MG GELCAP 20 capsules per prescription


TAMIFLU 6 MG/ML SUSPENSION 3 bottles per prescriptions


TARCEVA 100 MG TABLET 30 tablets per prescription



TASIGNA 150 MG CAPSULE 112 capsules per prescription

TASIGNA 200 MG CAPSULE 112 capsules per prescription

TECHNIVIE DOSE PACK 3 cartons (168 tablets) per 365 days

TIVORBEX 20 MG CAPSULE 90 capsules per prescription

TOBI 300 MG/5 ML SOLUTION 56 ampoules per prescription

TOBI PODHALER 28 MG INHALE CAP 224 capsules per prescription

TORADOL 10 MG TABLET 20 tablets per prescription

TRADJENTA 5 MG TABLET 30 tablets per prescription

TRAMADOL HCL 50 MG TABLET 240 tablets per prescription

TRAMADOL HCL ER 150 MG CAPSULE 60 capsules per prescription

TREXIMET 10-60 MG TABLET 9 tablets per prescription

TREXIMET 85-500 MG TABLET 9 tablets per prescription

TRINTELLIX 10 MG TABLET 30 tablets per prescription



TRULICITY 0.75 MG/0.5 ML 4 units (Pen OR Syringe) per prescription

TRULICITY 1.5 MG/0.5 ML 4 units (Pen OR Syringe) per prescription

TUDORZA PRESSAIR 400 MCG INH 1 inhaler per prescription


TYKERB 250 MG TABLET 180 tablets per prescription

ULTRACET 37.5 MG-325 MG TABLET 240 tablets per prescription

ULTRAM 50 MG TABLET 240 tablets per prescription

ULTRAM ER 100 MG TABLET 30 tablets per prescription



UTIBRON NEOHALER 27.5/15.6 INHLATION POWDER (PACKAGE

SIZE 6)6 inhalations (1 package) per prescription

UTIBRON NEOHALER 27.5/15.6 INHLATION POWDER (PACKAGE

SIZE 60)60 inhalations (1 package) per prescription

VANDETANIB 100 MG TABLET 60 tablets per prescription

VANDETANIB 300 MG TABLET 30 tablets per prescription

VARUBI 90 MG TABLET 2 tablets (1 package) per prescription

VENCLEXTA STARTING PACK 1 Starting Pack = 42 tablets per prescription

VENLAFAXINE HCL ER 150 MG TAB 30 tablets per prescription


VENLAFAXINE HCL ER 37.5 MG TAB 30 tablets per prescription


VENTOLIN HFA 90 MCG INHALER 2 inhalers per prescriptions

VENTOLIN HFA 90 MCG INHALER 1 inhaler per prescription

VERAMYST 27.5 MCG NASAL SPRAY 1 bottle per prescription

VIAGRA 100 MG TABLET 6 tablets per prescription



VICTOZA 2-PAK 18 MG/3 ML PEN 1 package (2 pens) per prescription

VICTOZA 3-PAK 18 MG/3 ML PEN 1 package (3 pens) per prescription

VIEKIRA PAK 3 paks (336 tablets) per 365 days

VIEKIRA XR 252 tablets per 365 days

VIIBRYD 10 MG TABLET 30 tablets per prescription



VIIBRYD STARTER KIT 1 pack per prescription

VIVELLE-DOT 0.025 MG PATCH 8 patches per 28 days





VIVLODEX 5 MG CAPSULE 30 capsules per prescription

VOLTAREN 1% GEL 500 grams per 28 days

VOTRIENT 200 MG TABLET 120 tablets per prescription

VRAYLAR 1.5 MG CAPSULE 30 capsules per prescription

VRAYLAR 1.5 MG-3MG CAPSULE BLISTER PACK 30 capsules per prescription

VRAYLAR 3 MG CAPSULE 30 capsules per prescription

VRAYLAR 4.5 MG CAPSULE 30 capsules per prescription

VRAYLAR 6 MG CAPSULE 30 capsules per prescription

VYTORIN 10-10 MG TABLET 30 tablets per prescription




WELLBUTRIN SR 100 MG TABLET 60 tablets per prescription



WELLBUTRIN XL 150 MG TABLET 30 tablets per prescription

WELLBUTRIN XL 300 MG TABLET 30 tablets per prescription

XALKORI 200 MG CAPSULE 60 capsules per prescription

XALKORI 250 MG CAPSULE 60 capsules per prescription

XIFAXAN 200 MG TABLET 9 tablets

XIFAXAN 550 MG TABLET 60 tablets

XIGDUO ER 10 MG/1000 MG TABLET 30 tablets per prescription

XIGDUO ER 10 MG/500 MG TABLET 30 tablets per prescription

XIGDUO XR 5 MG/1000 MG TABLET 60 tablets per prescription

XIGDUO XR 5 MG/500 MG TABLET 30 tablets per prescription

XIIDRA 5% SOLUTION 60 vials per prescription

XOLAIR 150 MG VIAL 6 vials per 28 days


XTAMPZA 13.5 MG TABLET 90 capsules per 30 days

XTAMPZA 18 MG TABLET 90 capsules per 30 days




XTANDI 40 MG CAPSULE 120 capsules per prescription

XYZAL 5 MG TABLET 30 tablets per prescription

ZECUITY TDS 6.5 MG/4 HOUR 4 patches per prescription

ZEGERID 20 MG CAPSULE 30 capsules per prescription

ZEGERID 20 MG PACKET 30 packets per prescription

ZELBORAF 240 MG TABLET 240 tablets per prescription

ZEMBRACE 3 MG/0.5 ML SYRINGE 4 syringes (1 kit) per prescription

ZETONNA 37 MCG NASAL SPRAY 1 canister (60 actuations per canister) per prescription

ZINBRYTA 150 MG/ML SYRINGE 1 syringe per 28 days

ZOCOR 10 MG TABLET 30 tablets per prescription





ZOFRAN 24 MG TABLET 1 tablet per prescription

ZOFRAN 4 MG TABLET 9 tablets or orally disintegrating tablets per prescription

ZOFRAN 8 MG TABLET 9 tablets or orally disintegrating tablets per prescription

ZOFRAN ODT 4 MG TABLET 9 tablets or orally disintegrating tablets per prescription

ZOFRAN ODT 8 MG TABLET 9 tablets or orally disintegrating tablets per prescription

ZOFRAN SOLUTION 2 bottles per prescription

ZOLOFT 100 MG TABLET 60 tablets per prescription



ZOLPIMIST 5 MG ORAL SPRAY 1 bottle per prescription

ZOMIG 2.5 MG TABLET 6 tablets per prescription

ZOMIG 5 MG NASAL SPRAY 6 nasal spray devices per prescription

ZOMIG 5 MG TABLET 6 tablets per prescription

ZOMIG ZMT 2.5 MG TABLET 6 tablets per prescription

ZOMIG ZMT 5 MG TABLET 6 tablets per prescription

ZORVOLEX 18 MG CAPSULES 90 capsules per prescription

ZOVIRAX 5% CREAM 1 tube/5 grams per prescription

ZOVIRAX 5% OINTMENT 1 tube/30 grams per prescription

ZUBSOLV 1.4 MG/0.36 MG TABLET 30 tablets per prescription





ZUPLENZ 4 MG SOLUBLE FILM 9 films per prescription

ZUPLENZ 8 MG SOLUBLE FILM 9 films per prescription

ZYDELIG 100 MG TABLET 60 tablets per prescription

ZYDELIG 150 MG TABLET 60 tablets per prescription

ZYPREXA 10 MG TABLET 30 tablets per prescription


ZYPREXA 2.5 MG TABLET 30 tablets per prescription



ZYPREXA 7.5 MG TABLET 30 tablets per prescription

ZYPREXA ZYDIS 10 MG TABLET 30 tablets per prescription




ZYRTEC 10 MG CHEWABLE TABLET 30 tablets per prescription

ZYRTEC 10 MG TABLET 30 tablets per prescription

ZYRTEC 5 MG CHEWABLE TABLET 30 tablets per prescription

ZYRTEC 5 MG TABLET 30 tablets per prescription

ZYRTEC-D TABLET 60 tablets per prescription

ZYRTEC-D TABLET 60 tablets per prescription

ZYTIGA 250 MG TABLET 120 tablets per prescription


Documents

Drug Target Maximum QuantityCADUET 10 MG-80 MG TABLET 30 tablets per prescription CADUET 2.5 MG-10 MG TABLET 30 tablets per prescription CADUET 2.5 MG-20 MG TABLET 30 tablets per prescription