for North Dakota Medicaid Expansion Members · of commonly prescribed medications that are ... May be available only at certain pharmacies. ... 375 mg/5 ml 1 cefaclor oral tablet

2017 Formulary for North Dakota Medicaid Expansion Members

Please refer to the following list (formulary) of commonly prescribed medications that are covered by insurance. This is not a complete list; to view the full list, please log in in to your secure member portal at sanfordhealthplan.com/memberlogin and select the “Find a pharmacy/Link to Express Scripts” tab located under “My Information.”

When reviewing the list, please use the guide on page 3. For more information about your pharmacy benefits, covered drugs, copays and more, please check your Summary of Benefits and Coverage and Certificate of Coverage. This information can also be found online or by contacting our Pharmacy Management Team at (855) 305-5062; TTY (877) 652-1844 between 8 am and 5 pm CT Monday through Friday.

HP-2173_12-01-17

HP-2173_LZCA eff date 12-01-17

Table of Contents ANTI - INFECTIVES ............................................................................................................................................ 5

ANTINEOPLASTIC & IMMUNOSUPPRESSANT DRUGS .............................................................................. 13

AUTONOMIC & CNS DRUGS, NEUROLOGY & PSYCHOLOGY ............................................................. 14

CARDIOVASCULAR, HYPERTENSION & LIPIDS ......................................................................................... 31

DERMATOLOGICALS/TOPICAL THERAPY .................................................................................................. 40

DIAGNOSTICS & MISCELLANEOUS AGENTS ............................................................................................ 50

EAR, NOSE & THROAT MEDICATIONS ........................................................................................................ 52

ENDOCRINE/DIABETES .................................................................................................................................. 53

GASTROENTEROLOGY ................................................................................................................................... 59

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY ................................................................................... 65

MUSCULOSKELETAL & RHEUMATOLOGY ................................................................................................... 67

OBSTETRICS & GYNECOLOGY ..................................................................................................................... 68

OPHTHALMOLOGY ........................................................................................................................................ 75

RESPIRATORY, ALLERGY, COUGH & COLD ............................................................................................... 80

UROLOGICALS ................................................................................................................................................ 85

VITAMINS, HEMATINICS & ELECTROLYTES ................................................................................................ 87

INDEX ................................................................................................................................................................ 92

3

ABBREVIATIONS

Tier:

$0: These drugs take a $0 copay

1: Generics (these drugs take a $0 copay)

2: Brands (these drugs take a $3 copay)

LA (Limited Availability): May be available only at certain pharmacies. For more

information, please call Customer Service.

PA (Pre-Approval Needed):

You or your provider must get pre-approval for the

medicine with Sanford Health Plan before you can get the

prescription filled.

QL (Quantity Limit /Number

Allowed)

The Plan may limit the amount of medicine you can

receive of certain coverage medications.

SP (Specialty Medications):

. These drugs may require frequent dosing adjustments,

close monitoring, special training, compliance assistance,

or need special handling and/or administration. They may

also be limited in supply.

ST (Step Therapy):

With certain medications, you must first try lower cost

and/or generic versions before high cost options are

covered. If the first step medication does not work or you

have side effects, the next step may be covered.

You can find information on what the symbols and abbreviations on this table mean by

going to the beginning of this table.

5

Drug Name Tier Requirements - Limitations

ANTI - INFECTIVES

Antifungal Agents

clotrimazole mucous

membrane troche 10 mg 1

fluconazole oral

suspension for recon

10 mg/ml, 40 mg/ml

1

fluconazole oral tablet 50

mg,100mg,150mg,200mg 1

flucytosine oral capsule

250 mg, 500 mg 1

griseofulvin microsize oral

suspension 125 mg/5 ml 1

griseofulvin microsize oral

tablet 500 mg 1

griseofulvin ultramicrosize

oral tablet 125mg, 250mg 1

GRIS-PEG

(ULTRAMICROSIZE) ORAL

TABLET 125 MG, 250 MG

2

itraconazole oral capsule

100 mg 1 QL

ketoconazole oral tablet

200 mg 1

nystatin oral powder 150

million unit, 500 million unit 1

nystatin oral suspension

100,000 unit/ml 1

nystatin oral tablet 500,000

unit 1

terbinafine hcl oral tablet

250 mg 1

voriconazole oral

suspension for recon 200

mg/5 ml (40 mg/ml)

1


voriconazole oral tablet

200 mg, 50 mg 1

Antivirals

abacavir oral soln 20

mg/ml 1

abacavir oral tablet 300

mg 1

abacavir-lamivudine oral

tablet 600-300 mg 1

abacavir-lamivudine-

zidovudine oral tablet 300-

150-300 mg

1

acyclovir oral capsule 200

mg 1

acyclovir oral suspension

200 mg/5 ml 1

acyclovir oral tablet 400

mg, 800 mg 1

adefovir oral tablet 10 mg 1

amantadine hcl oral

capsule 100 mg 1

amantadine hcl oral soln

50 mg/5 ml 1

amantadine hcl oral

tablet 100 mg 1

APTIVUS ORAL CAPSULE

250 MG 2

APTIVUS ORAL SOLN 100

MG/ML 2

ATRIPLA ORAL TABLET 600-

200-300 MG 2

COMBIVIR ORAL TABLET

150-300 MG 2

COMPLERA ORAL TABLET

200-25-300 MG 2



6


CRIXIVAN ORAL CAPSULE

200 MG, 400 MG 2

DESCOVY ORAL TABLET

200-25 MG 2

didanosine oral capsule,

del-release(dr/ec) 125mg,

200mg 250mg,400mg

1

EDURANT ORAL TABLET 25

MG 2

EMTRIVA ORAL CAPSULE

200 MG 2

EMTRIVA ORAL SOLN 10

MG/ML 2

entecavir oral tablet 0.5

mg, 1 mg 1

EPCLUSA ORAL TABLET

400-100 MG 2 PA; SP

EPIVIR HBV ORAL SOLN 25

MG/5 ML (5 MG/ML) 2

EPIVIR HBV ORAL TABLET

100 MG 2

EPIVIR ORAL SOLN 10

MG/ML 2

EPIVIR ORAL TABLET 150

MG 2 QL

EPIVIR ORAL TABLET 300

MG 2

EPZICOM ORAL TABLET

600-300 MG 2

EVOTAZ ORAL TABLET 300-

150 MG 2

famciclovir oral tablet 125

mg, 250 mg, 500 mg 1 QL

fosamprenavir oral tablet

700 mg 1


GENVOYA ORAL TABLET

150-150-200-10 MG 2

INTELENCE ORAL TABLET

100 MG, 200 MG, 25 MG 2

INVIRASE ORAL CAPSULE

200 MG 2

INVIRASE ORAL TABLET 500

MG 2

ISENTRESS HD ORAL TABLET

600 MG 2

ISENTRESS ORAL POWDER

IN PACKET 100 MG 2

ISENTRESS ORAL TABLET 400

MG 2

ISENTRESS ORAL TABLET,

CHEW 25 MG, 100 MG 2

KALETRA ORAL SOLN 400-

100 MG/5 ML 2

KALETRA ORAL TABLET 100-

25 MG, 200-50 MG 2

lamivudine oral soln 10

mg/ml 1

lamivudine oral tablet 100

mg, 300 mg 1

lamivudine oral tablet 150

mg 1 QL

lamivudine-zidovudine

oral tablet 150-300 mg 1

LEXIVA ORAL SUSPENSION

50 MG/ML 2

LEXIVA ORAL TABLET 700

MG 2

lopinavir-ritonavir oral soln

400-100 mg/5 ml 1



7


MAVYRET ORAL TABLET

100-40 MG 2 PA; SP; QL

nevirapine oral suspension

50 mg/5 ml 1

nevirapine oral tablet 200

mg 1

nevirapine oral tablet

extended release 24 hr

100 mg, 400 mg

1

NORVIR ORAL CAPSULE

100 MG 2

NORVIR ORAL SOLN 80

MG/ML 2

NORVIR ORAL TABLET 100

MG 2

ODEFSEY ORAL TABLET

200-25-25 MG 2

oseltamivir oral capsule 30

mg, 45 mg 1

PREZCOBIX ORAL TABLET

800-150 MG-MG 2

PREZISTA ORAL

SUSPENSION 100 MG/ML 2

PREZISTA ORAL TABLET 150

MG, 600 MG, 75 MG, 800

MG

2

RELENZA DISKHALER

INHALATION BLISTER WITH

DEVICE 5 MG/ACTUATION

2 QL

RESCRIPTOR ORAL TABLET

200 MG 2

RESCRIPTOR ORAL TABLET,

DISPERSIBLE 100 MG 2

RETROVIR ORAL CAPSULE

100 MG 2


RETROVIR ORAL SYRUP 10

MG/ML 2

REYATAZ ORAL CAPSULE

150 MG, 200 MG, 300 MG 2

REYATAZ ORAL POWDER IN

PACKET 50 MG 2

ribavirin inhalation recon

soln 6 gram 1

rimantadine oral tablet

100 mg 1

SELZENTRY ORAL SOLN 20

MG/ML 2

SELZENTRY ORAL TABLET

150 MG, 25 MG, 300 MG,

75 MG

2

stavudine oral capsule 15

mg, 20 mg, 30 mg, 40 mg 1

stavudine oral recon soln

1 mg/ml 1

STRIBILD ORAL TABLET 150-

150-200-300 MG 2

SUSTIVA ORAL CAPSULE

200 MG, 50 MG 2

SUSTIVA ORAL TABLET 600

MG 2

TAMIFLU ORAL

SUSPENSION 6 MG/ML 2 QL

TECHNIVIE ORAL TABLET

12.5-75-50 MG 2 PA; SP

TIVICAY ORAL TABLET 10

MG, 25 MG, 50 MG 2

TRIUMEQ ORAL TABLET 600-

50-300 MG 2

TRIZIVIR ORAL TABLET 300-

150-300 MG 2



8


TRUVADA ORAL TABLET

100-150 MG, 133-200 MG,

167-250 MG, 200-300 MG

2

valacyclovir oral tablet 1

gram, 500 mg 1 QL

VALCYTE ORAL

RECONSTITUTE SOLUTION

50 MG/ML

2

VALCYTE ORAL TABLET 450

MG 2

valganciclovir oral recon

soln 50 mg/ml 1

valganciclovir oral tablet

450 mg 1

VEMLIDY ORAL TABLET 25

MG 2

VIDEX 2 GRAM PEDIATRIC

ORAL RECON SOLN 10

MG/ML (FINAL)

2

VIDEX EC ORAL CAPSULE,

DEL-REL(DR/EC) 125 MG,

200 MG, 250 MG, 400 MG

2

VIRACEPT ORAL TABLET

250 MG, 625 MG 2

VIRAMUNE ORAL SUSP 50

MG/5 ML 2

VIRAMUNE ORAL TABLET

200 MG 2

VIRAMUNE XR ORAL

TABLET EXT-REL 24 HR 100

MG, 400 MG

2

VIREAD ORAL POWDER 40

MG/SCOOP (40

MG/GRAM)

2


VIREAD ORAL TABLET 150

MG, 200 MG, 250 MG, 300

MG

2

ZERIT ORAL CAPSULE 15

MG, 20MG, 30MG, 40MG 2

ZERIT ORAL RECON SOLN

1 MG/ML 2

ZIAGEN ORAL SOLN

20 MG/ML 2

ZIAGEN ORAL TABLET 300

MG 2

zidovudine oral capsule

100 mg 1

zidovudine oral syrup 10

mg/ml 1

zidovudine oral tablet 300

mg 1

Cephalosporins

cefaclor oral capsule 250

mg, 500 mg 1

cefaclor oral suspension

for recon 125 mg/5 ml, 250

mg/5 ml, 375 mg/5 ml

1

cefaclor oral tablet ext-

release 12 hr 500 mg 1

cefadroxil oral capsule

500 mg 1

cefadroxil oral susp for

recon 250 mg/5 ml, 500

mg/5 ml

1

cefadroxil oral tablet 1 gm 1

cefdinir oral capsule 300

mg 1



9


cefdinir oral suspension for


mg/5 ml

1

cefditoren pivoxil oral

tablet 200 mg, 400 mg 1

cefixime oral suspension


mg/5 ml

1

cefpodoxime oral


mg/5 ml, 50 mg/5 ml

1

cefpodoxime oral tablet

100 mg, 200 mg 1

cefprozil oral suspension


mg/5 ml

1

cefprozil oral tablet 250

mg, 500 mg 1

CEFTIN ORAL SUSPENSION

FOR RECON 125 MG/5 ML,

250 MG/5 ML

2

cefuroxime axetil oral


cephalexin oral capsule

250 mg, 500 mg, 750 mg 1

cephalexin oral



1

cephalexin oral tablet 250

mg, 500 mg 1

Erythromycins & Other Macrolides

azithromycin oral pkt 1gm 1

azithromycin oral



1


azithromycin oral tablet

250 mg, 500 mg, 600 mg 1

clarithromycin oral susp for


mg/5 ml

1

clarithromycin oral tablet

250 mg, 500 mg 1

clarithromycin oral tablet

ext-release 24 hr 500 mg 1

e.e.s. 400 oral tablet 400

mg 1

ERYPED 200 ORAL

SUSPENSION FOR RECON

200 MG/5 ML

2

ERYPED 400 ORAL SUSP

FOR RECON 400 MG/5 ML 2

ery-tab oral tablet,

delayed release (dr/ec)

250 mg, 333 mg

1

ERY-TAB ORAL TABLET, DEL-

REL (DR/EC) 500 MG 2

erythrocin (as stearate)

oral tablet 250 mg 1

erythromycin

ethylsuccinate oral susp

for recon 200 mg/5 ml

1

erythromycin

ethylsuccinate oral tablet

400 mg

1

erythromycin oral capsule,

del-release(dr/ec) 250 mg 1

erythromycin oral tablet

250 mg, 500 mg 1

ZMAX ORAL SUSP,

EXTENDED RELEASE RECON

2 GRAM/60 ML

2



10


Miscellaneous Antiinfectives

ALBENZA ORAL TABLET 200

MG 2

ALINIA ORAL SUSPENSION

FOR RECON 100 MG/5 ML 2

ALINIA ORAL TABLET 500

MG 2

atovaquone oral


atovaquone-proguanil

oral tablet 250-100 mg,

62.5-25 mg

1

BETHKIS INHALATION SOLN

FOR NEBULIZATION 300

MG/4 ML

2 SP

BILTRICIDE ORAL TABLET

600 MG 2

chloroquine phosphate

oral tablet 250 mg,500 mg 1

clindamycin hcl oral

capsule 150 mg, 300 mg,

75 mg

1

clindamycin palmitate hcl

oral recon soln 75 mg/5 ml 1

clindamycin pediatric oral

recon soln 75 mg/5 ml 1

COARTEM ORAL TABLET

20-120 MG 2

CYCLOSERINE ORAL

CAPSULE 250 MG 2

dapsone oral tablet 100

mg, 25 mg 1

ethambutol oral tablet

100 mg, 400 mg 1


hydroxychloroquine oral

tablet 200 mg 1

isoniazid oral soln 50 mg/5

ml 1

isoniazid oral tablet 100

mg, 300 mg 1

ivermectin oral tablet 3mg 1

KITABIS PAK INHALATION

SOLN FOR NEBULIZATION

300 MG/5 ML

2 SP

linezolid oral suspension

for recon 100 mg/5 ml 1 PA

linezolid oral tablet 600

mg 1 PA

mefloquine oral tablet 250

mg 1

MEPRON ORAL

SUSPENSION 750 MG/5 ML 2

metronidazole oral

capsule 375 mg 1

metronidazole oral tablet

250 mg, 500 mg 1

MYCOBUTIN ORAL

CAPSULE 150 MG 2 QL

NEBUPENT INHALATION

RECON SOLN 300 MG 2 QL

neomycin oral tablet 500

mg 1

paromomycin oral

capsule 250 mg 1

PASER ORAL GRANULES

DR FOR SUSP IN PKT 4 GM 2

PRIFTIN ORAL TABLET 150

MG 2



11


PRIMAQUINE ORAL TABLET

26.3 MG 2

pyrazinamide oral tablet

500 mg 1

quinine sulfate oral

capsule 324 mg 1

rifabutin oral capsule 150

mg 1 QL

RIFAMATE ORAL CAPSULE

300-150 MG 2

rifampin oral capsule 150

mg, 300 mg 1

RIFATER ORAL TABLET 50-

120-300 MG 2

SIVEXTRO ORAL TABLET 200

MG 2 PA

STROMECTOL ORAL TABLET

3 MG 2

tinidazole oral tablet 250

mg, 500 mg 1

TRECATOR ORAL TABLET

250 MG 2

XIFAXAN ORAL TABLET 550

MG 2

Penicillins

amoxicillin oral capsule

250 mg, 500 mg 1

amoxicillin oral suspension


mg/5 ml, 250 mg/5 ml, 400

mg/5 ml

1

amoxicillin oral tablet 500

mg, 875 mg 1

amoxicillin oral tablet,

chewable 125 mg, 250 mg 1


amoxicillin-pot

clavulanate oral susp for

recon 200-28.5 mg/5 ml,

250-62.5 mg/5 ml, 400-57

mg/5 ml, 600-42.9 mg/5 ml

1

amoxicillin-pot

clavulanate oral tablet

250-125 mg, 500-125 mg,

875-125 mg

1

amoxicillin-pot

clavulanate oral tablet


1,000-62.5 mg

1

amoxicillin-pot

clavulanate oral tablet,

chewable 200-28.5 mg,

400-57 mg

1

ampicillin oral capsule 250

mg, 500 mg 1

AUGMENTIN ORAL


125-31.25 MG/5 ML

2

dicloxacillin oral capsule

250 mg, 500 mg 1

penicillin v potassium oral

recon soln 125 mg/5 ml,

250 mg/5 ml

1

penicillin v potassium oral


Quinolones

ciprofloxacin (mixture)

oral tablet, er multiphase

24 hr 1,000 mg, 500 mg

1

ciprofloxacin hcl oral

tablet 100 mg, 250 mg,

500 mg, 750 mg

1



12


ciprofloxacin oral

suspension, microcapsule


mg/5 ml

1

levofloxacin oral soln 250

mg/10 ml 1

levofloxacin oral tablet

250 mg, 500 mg, 750 mg 1

moxifloxacin oral tablet

400 mg 1

ofloxacin oral tablet 300

mg, 400 mg 1

Sulfa's & Related Agents

sulfadiazine oral tablet 500

mg 1

sulfamethoxazole-

trimethoprim oral

suspension 200-40 mg/5 ml

1

sulfamethoxazole-

trimethoprim oral tablet

400-80 mg, 800-160 mg

1

sulfatrim oral suspension

200-40 mg/5 ml 1

Tetracyclines

avidoxy oral tablet 100 mg 1

demeclocycline oral


doxycycline hyclate oral

capsule 100 mg, 50 mg 1


tablet 100 mg, 150 mg, 20

mg, 75 mg

1


tablet, delayed release

(dr/ec) 100 mg, 150 mg,

200 mg, 50 mg, 75 mg

1


doxycycline monohydrate

oral capsule 100 mg, 150

mg, 50 mg, 75 mg

1


oral suspension for recon

25 mg/5 ml

1


oral tablet 100 mg, 150

mg, 50 mg, 75 mg

1

minocycline oral capsule

100 mg, 50 mg, 75 mg 1

minocycline oral tablet

100 mg, 50 mg, 75 mg 1

minocycline oral tablet


135 mg, 45 mg, 90 mg

1

mondoxyne nl oral

capsule 50 mg, 75 mg, 100

mg

1

morgidox oral capsule 100

mg 1

tetracycline oral capsule

250 mg, 500 mg 1

Urinary Tract Agents

FURADANTIN ORAL


MACROBID ORAL

CAPSULE 100 MG 2

MACRODANTIN ORAL

CAPSULE 25 MG, 50 MG,

100 MG

2

methenamine hippurate

oral tablet 1 gram 1

methenamine mandelate

oral tablet 0.5 g, 1 gram 1

MONUROL ORAL PKT 3GM 2



13


nitrofurantoin

macrocrystal oral capsule

100 mg, 25 mg, 50 mg

1

nitrofurantoin monohyd/

m-cryst oral capsule 100

mg

1

nitrofurantoin oral


PRIMSOL ORAL SOLN 50

MG/5 ML 2

trimethoprim oral tablet

100 mg 1

Vancomycin

vancomycin oral capsule

125 mg, 250 mg 1

ANTINEOPLASTIC &

IMMUNOSUPPRESSANT DRUGS

Adjunctive Agents

leucovorin calcium oral


mg, 5 mg

1

MESNEX ORAL TABLET 400

MG 2

Antineoplastic & Immunosuppressant

Drugs

anastrozole oral tablet 1

mg 1

azathioprine oral tablet 50

mg 1

bicalutamide oral tablet

50 mg 1

CELLCEPT ORAL


200 MG/ML

2


cyclosporine modified oral


mg

1

cyclosporine modified oral

soln 100 mg/ml 1

cyclosporine oral capsule

100 mg, 25 mg 1

DROXIA ORAL CAPSULE

200 MG, 300 MG, 400 MG 2

EMCYT ORAL CAPSULE 140

MG 2

exemestane oral tablet 25

mg 1

FARESTON ORAL TABLET 60

MG 2

flutamide oral capsule 125

mg 1

gengraf oral capsule 100

mg, 25 mg, 50 mg 1

gengraf oral soln 100

mg/ml 1

HEXALEN ORAL CAPSULE

50 MG 2

hydroxyurea oral capsule

500 mg 1

letrozole oral tablet 2.5 mg 1

LEUKERAN ORAL TABLET 2

MG 2

LYSODREN ORAL TABLET

500 MG 2

MEGACE ES ORAL


megestrol oral suspension

400 mg/10 ml (40 mg/ml),

625 mg/5 ml

1



14


megestrol oral tablet 20

mg, 40 mg 1

mercaptopurine oral

tablet 50 mg 1

methotrexate sodium (pf)

injection recon soln 1

gram

1


injection soln 25 mg/ml 1

methotrexate sodium


methotrexate sodium oral

tablet 2.5 mg 1

mycophenolate mofetil

oral capsule 250 mg 1


oral suspension for recon

200 mg/ml

1



mycophenolate sodium

oral tablet, delayed

release (dr/ec) 180 mg,

360 mg

1

NILANDRON ORAL TABLET

150 MG 2

nilutamide oral tablet 150

mg 1

octreotide acetate

injection soln 1,000

mcg/ml, 100 mcg/ml, 200

mcg/ml, 50 mcg/ml, 500

mcg/ml

1 SP

octreotide acetate

injection syringe 100

mcg/ml (1 ml), 50 mcg/ml

(1 ml), 500 mcg/ml (1 ml)

1 SP


PURIXAN ORAL

SUSPENSION 20 MG/ML 2 SP

RAPAMUNE ORAL SOLN 1

MG/ML 2

RAPAMUNE ORAL TABLET

0.5 MG, 1 MG, 2 MG 2

SANDIMMUNE ORAL

CAPSULE 100 MG, 25 MG 2

SANDIMMUNE ORAL SOLN

100 MG/ML 2

sirolimus oral tablet 0.5

mg, 1 mg, 2 mg 1

TABLOID ORAL TABLET 40

MG 2

tacrolimus oral capsule 0.5

mg, 1 mg, 5 mg 1

tamoxifen oral tablet 10

mg, 20 mg $0

tretinoin (chemotherapy)

oral capsule 10 mg 1

TREXALL ORAL TABLET 10

MG, 15 MG, 5 MG, 7.5 MG 2

XERMELO ORAL TABLET 250

MG 2 PA; QL

ZORTRESS ORAL TABLET

0.25 MG, 0.5 MG, 0.75 MG 2

AUTONOMIC & CNS DRUGS,

NEUROLOGY & PSYCHOLOGY

Anticonvulsants

APTIOM ORAL TABLET 200

MG, 400 MG, 600 MG, 800

MG

2

BANZEL ORAL SUSPENSION

40 MG/ML 2



15


BANZEL ORAL TABLET 200

MG, 400 MG 2

BRIVIACT ORAL SOLN 10

MG/ML 2

BRIVIACT ORAL TABLET 10

MG, 100 MG, 25 MG, 50

MG, 75 MG

2

carbamazepine oral

capsule, er multiphase 12

hr 100 mg, 200 mg, 300

mg

1

carbamazepine oral


carbamazepine oral

tablet 200 mg 1

carbamazepine oral

tablet ext-release 12 hr

100 mg, 200 mg, 400 mg

1

carbamazepine oral

tablet, chewable 100 mg 1

CELONTIN ORAL CAPSULE

300 MG 2

clonazepam oral tablet

0.5 mg, 1 mg, 2 mg 1

clonazepam oral tablet,

disintegrating 0.125 mg,

0.25 mg, 0.5 mg, 1 mg, 2

mg

1

DIASTAT ACUDIAL RECTAL

KIT 12.5-15-17.5-20 MG, 5-

7.5-10 MG

2

DIASTAT RECTAL KIT 2.5 MG 2

diazepam rectal kit 12.5-

15-17.5-20 mg, 2.5 mg, 5-

7.5-10 mg

1


divalproex oral capsule,

del-rel sprinkle 125 mg 1

divalproex oral tablet


250 mg, 500 mg

1

divalproex oral tablet,


125 mg, 250 mg, 500 mg

1

ethosuximide oral capsule

250 mg 1

ethosuximide oral soln 250

mg/5 ml 1

felbamate oral suspension

600 mg/5 ml 1

felbamate oral tablet 400

mg, 600 mg 1

FYCOMPA ORAL

SUSPENSION 0.5 MG/ML 2

FYCOMPA ORAL TABLET 10

MG, 12 MG, 2 MG, 4 MG,

6 MG, 8 MG

2

gabapentin oral capsule

100 mg, 300 mg, 400 mg 1

gabapentin oral soln 250

mg/5 ml 1

gabapentin oral tablet

600 mg, 800 mg 1

GABITRIL ORAL TABLET 12

MG, 16 MG, 2 MG, 4 MG 2

GRALISE 30-DAY STARTER

PACK ORAL TABLET

EXTENDED RELEASE 24 HR

300 MG (9)- 600 MG (69)

2

GRALISE ORAL TABLET


300 MG, 600 MG

2



16


LAMICTAL ODT ORAL

TABLET, DISINTEGRATING

100 MG, 200 MG, 25 MG,

50 MG

2

LAMICTAL ODT STARTER

(BLUE) ORAL TABLET

DISINTEGRATING, DOSE PK

25 MG (21) -50 MG (7)

2


(GREEN) ORAL TABLET


50 MG (42) -100 MG (14)

2


(ORANGE) ORAL TABLET


25 MG(14)-50 MG (14)-100

MG (7)

2

LAMICTAL XR ORAL TABLET

EXTENDED RELEASE 24HR

100 MG, 200 MG, 25 MG,

250 MG, 300 MG, 50 MG

2

LAMICTAL XR STARTER

(BLUE) ORAL TABLET

EXTENDED REL,DOSE PACK

25 MG (21) -50 MG (7)

2

LAMICTAL XR STARTER

(GREEN) ORAL TABLET


50 MG(14)-100MG (14)-

200 MG (7)

2

LAMICTAL XR STARTER

(ORANGE) ORAL TABLET


25MG (14)-50 MG (14)-

100MG (7)

2

lamotrigine oral tablet 100

mg, 150 mg, 200 mg, 25

mg

1


lamotrigine oral tablet

disintegrating, dose pk 25

mg (21) -50 mg (7), 25

mg(14)-50 mg (14)-100 mg

(7), 50 mg (42) -100 mg

(14)

1

lamotrigine oral tablet

extended release 24hr 100

mg, 200 mg, 25 mg, 250

mg, 300 mg, 50 mg

1

lamotrigine oral tablet,

chewable dispersible 25

mg, 5 mg

1

lamotrigine oral tablet,

disintegrating 100 mg, 200

mg, 25 mg, 50 mg

1

lamotrigine oral tablets,

dose pack 25 mg (35), 25

mg (42) -100 mg (7), 25

mg (84) -100 mg (14)

1

levetiracetam oral soln

100 mg/ml, 500 mg/5 ml (5

ml)

1

levetiracetam oral tablet

1,000 mg, 250 mg, 500 mg,

750 mg

1

levetiracetam oral tablet


500 mg, 750 mg

1

LYRICA ORAL CAPSULE 100

MG, 150 MG, 200 MG, 225

MG, 25 MG, 300 MG, 50

MG, 75 MG

2 QL

LYRICA ORAL SOLUTION

20 MG/ML 2 QL

ONFI ORAL SUSPENSION

2.5 MG/ML 2



17


ONFI ORAL TABLET 10 MG,

20 MG 2

oxcarbazepine oral

suspension 300 mg/5 ml

(60 mg/ml)

1

oxcarbazepine oral tablet

150 mg, 300 mg, 600 mg 1

OXTELLAR XR ORAL TABLET


150 MG, 300 MG, 600 MG

2

PEGANONE ORAL TABLET

250 MG 2

phenobarbital oral elixir 20

mg/5 ml (4 mg/ml) 1

phenobarbital oral tablet

100 mg, 15 mg, 16.2 mg,

30 mg, 32.4 mg, 60 mg,

64.8 mg, 97.2 mg

1

PHENYTEK ORAL CAPSULE

200 MG, 300 MG 2

phenytoin oral suspension

125 mg/5 ml 1

phenytoin oral tablet,

chewable 50 mg 1

phenytoin sodium

extended oral capsule

100 mg, 200 mg, 300 mg

1

primidone oral tablet 250

mg, 50 mg 1

roweepra oral tablet 1,000

mg, 500 mg, 750 mg 1

SABRIL ORAL POWDER IN

PACKET 500 MG 2 SP; LA

SABRIL ORAL TABLET 500

MG 2 SP; LA


TEGRETOL ORAL TABLET

200 MG 2

tiagabine oral tablet 2

mg, 4 mg 1

topiramate oral capsule,

sprinkle 15 mg, 25 mg 1

TOPIRAMATE ORAL

CAPSULE,SPRINKLE,ER

24HR 100 MG, 150 MG, 200

MG, 25 MG, 50 MG

2

topiramate oral tablet 100

mg, 200 mg, 25 mg, 50 mg 1

TROKENDI XR CAPSULE,

EXT-REL 24HR 25 MG, 50

MG, 100 MG, 200 MG

2

valproic acid (as sodium

salt) oral soln 250 mg/5 ml 1

valproic acid oral capsule

250 mg 1

vigabatrin oral powder in

packet 500 mg 1

VIMPAT ORAL SOLN 10

MG/ML 2

VIMPAT ORAL TABLET

50MG, 100MG, 150MG,

200MG

2

zonisamide oral capsule

100 mg, 25 mg, 50 mg 1

Antiparkinsonism Agents

APOKYN SUBCUTANEOUS

CARTRIDGE 10 MG/ML 2 SP; LA

AZILECT ORAL TABLET 0.5

MG, 1 MG 2

benztropine oral tablet 0.5

mg, 1 mg, 2 mg 1



18


bromocriptine oral

capsule 5 mg 1

bromocriptine oral tablet

2.5 mg 1

carbidopa oral tablet 25

mg 1

carbidopa-levodopa oral

tablet 10-100 mg, 25-100

mg, 25-250 mg

1


tablet extended release

25-100 mg, 50-200 mg

1


tablet, disintegrating 10-

100 mg, 25-100 mg, 25-250

mg

1

carbidopa-levodopa-

entacapone oral tablet

12.5-50-200 mg, 18.75-75-

200 mg, 25-100-200 mg,

31.25-125-200 mg, 37.5-

150-200mg, 50-200-200 mg

1

COMTAN TABLET 200 MG 2

ELDEPRYL CAPSULE 5 MG 2

Entacapone tablet 200mg 1

LODOSYN TABLET 25 MG 2

MIRAPEX ER ORAL TABLET


0.375 MG, 0.75 MG, 1.5

MG, 2.25 MG, 3 MG, 3.75

MG, 4.5 MG

2

NEUPRO TRANSDERMAL

PATCH 24 HOUR

1 MG/24 HR, 2 MG/24 HR,

3 MG/24 HR, 4 MG/24 HR,

6 MG/24 HR, 8 MG/24 HR

2


pramipexole oral tablet

0.125 mg, 0.25 mg, 0.5 mg,

0.75 mg, 1 mg, 1.5 mg

1

pramipexole oral tablet

ext-rel 24 hr 0.375 mg, 0.75

mg, 1.5 mg, 2.25 mg, 3

mg, 3.75 mg, 4.5 mg

1

rasagiline oral tablet 0.5

mg, 1 mg 1

ropinirole oral tablet 0.25

mg, 0.5 mg, 1 mg, 2 mg, 3

mg, 4 mg, 5 mg

1

ropinirole oral tablet ext-

rel 24 hr 12 mg, 2 mg, 4

mg, 6 mg, 8 mg

1

selegiline hcl oral capsule

5 mg 1

selegiline hcl oral tablet 5

mg 1

TASMAR ORAL TABLET 100

MG 2

tolcapone oral tablet 100

mg 1

trihexyphenidyl oral elixir

0.4 mg/ml 1

trihexyphenidyl oral tablet

2 mg, 5 mg 1

Migraine & Cluster Headache Therapy

AXERT ORAL TABLET 12.5

MG, 6.25 MG 2 QL

D.H.E.45 INJECTION SOLN

1 MG/ML 2 QL

dihydroergotamine




19


dihydroergotamine nasal

spray, non-aerosol 0.5

mg/pump act. (4 mg/ml)

1 QL

ERGOMAR SUBLINGUAL

TABLET 2 MG 2

ergotamine-caffeine oral

tablet 1-100 mg 1

frovatriptan oral tablet 2.5

mg 1 QL

isomethepten-caffeine-

acetaminophen oral

tablet 65-20-325 mg

1

migergot rectal

suppository 2-100 mg 1

MIGRANAL NASAL SPRAY,

NON-AEROSOL 0.5

MG/PUMP ACT. (4

MG/ML)

2 QL

RELPAX ORAL TABLET 20

MG, 40 MG 2 QL

rizatriptan oral tablet 10

mg, 5 mg 1 QL

rizatriptan oral tablet,

disintegrating 10 mg, 5 mg 1 QL

sumatriptan succinate

oral tablet 25 mg, 50 mg,

100 mg

1 QL

Miscellaneous Neurological Therapy

AMPYRA ORAL TABLET EXT-

RELEASE 12 HR 10 MG 2 PA; SP; LA

donepezil oral tablet 10

mg, 23 mg, 5 mg 1

EXELON TRANSDERMAL

PATCH 24 HOUR 13.3

MG/24 HOUR, 4.6 MG/24

HR, 9.5 MG/24 HR

2


galantamine oral capsule,

ext rel. pellets 24 hr 16 mg,

24 mg, 8 mg

1

galantamine oral soln 4

mg/ml 1

galantamine oral tablet

12 mg, 4 mg, 8 mg 1

HORIZANT ORAL TABLET

EXTENDED RELEASE 300

MG, 600 MG

2

memantine oral soln 2

mg/ml 1

memantine oral tablet 10

mg, 5 mg 1

MEMANTINE TABLETS,

DOSE PACK 5-10 MG 2

NAMENDA TITRATION PAK

ORAL TABLETS, DOSE PACK

5-10 MG

2

NAMENDA XR ORAL

CAP,SPRINKLE,ER 24HR

DOSE PACK 7-14-21-28 MG

2 ST

NAMENDA XR CAPSULE,

SPRINKLE,ER 24HR 7 MG,

14 MG, 21 MG, 28 MG

2 ST

NUEDEXTA ORAL CAPSULE

20-10 MG 2

rivastigmine tartrate oral

capsule 1.5 mg, 3 mg, 4.5

mg, 6 mg

1

tetrabenazine oral tablet

12.5 mg, 25 mg 1 PA; SP

Muscle Relaxants & Antispasmodic

Therapy

baclofen oral tablet 10

mg, 20 mg 1



20


carisoprodol oral tablet

250 mg, 350 mg 1

carisoprodol-asa-codeine

oral tablet 200-325-16 mg 1

carisoprodol-aspirin oral

tablet 200-325 mg 1

chlorzoxazone oral tablet

250 mg, 500 mg 1

cyclobenzaprine oral

tablet 5 mg 7.5 mg,10mg 1

dantrolene oral capsule

100 mg, 25 mg, 50 mg 1

meprobamate oral tablet

200 mg, 400 mg 1

MESTINON ORAL SYRUP 60

MG/5 ML 2

MESTINON ORAL TABLET 60

MG 2

MESTINON TIMESPAN ORAL

TABLET EXT-REL 180 MG 2

metaxall oral tablet 800

mg 1

metaxalone oral tablet

400 mg, 800 mg 1

methocarbamol oral


orphenadrine citrate oral

tablet ext- release 100 mg 1

pyridostigmine bromide

oral tablet 60 mg 1

pyridostigmine bromide

oral tablet extended

release 180 mg

1

ROBAXIN-750 ORAL TABLET

750 MG 2


tizanidine oral capsule 2

mg, 4 mg, 6 mg 1

tizanidine oral tablet 2 mg,

4 mg 1

Narcotic Analgesics

acetaminophen-caffeine-

dihydrocodeine oral

capsule 320.5-30-16 mg

1

acetaminophen-codeine

oral soln 120-12 mg/5 ml 1


oral tablet 300-15 mg, 300-

30 mg, 300-60 mg

1

ascomp with codeine oral

capsule 30-50-325-40 mg 1

ASTRAMORPH-PF

INJECTION SOLN 0.5

MG/ML

2

butalbital compound

w/codeine oral capsule

30-50-325-40 mg

1

butalbital-acetamin-

caffeine-cod oral capsule

50-300-40-30 mg, 50-325-

40-30 mg

1

butalbital-acetaminophen


325 mg

1

butalbital-

acetaminophen-caffeine

oral capsule 50-300-40

mg, 50-325-40 mg

1

butalbital-

acetaminophen-caffeine

oral tablet 50-325-40 mg

1

butalbital-aspirin-caffeine

oral capsule 50-325-40 mg 1



21



oral tablet 50-325-40 mg 1

BUTRANS TRANSDERMAL

PATCH WEEKLY

5 MCG/HR, 7.5 MCG/HR,

10 MCG/HR, 15 MCG/HR,

20 MCG/HR

2 QL

capacet oral capsule 50-

325-40 mg 1

CAPITAL WITH CODEINE

ORAL SUSPENSION 120-12

MG/5 ML

2

codeine sulfate oral tablet

15 mg, 30 mg, 60 mg 1

diskets oral tablet, soluble

40 mg 1

EMBEDA ORAL CAPSULE,

ORAL ONLY, EXT.REL PELL

100-4 MG, 20-0.8 MG, 30-

1.2 MG, 50-2 MG, 60-2.4

MG, 80-3.2 MG

2

endocet oral tablet 10-325

mg, 2.5-325 mg, 5-325 mg,

7.5-325 mg

1

fentanyl citrate buccal

lozenge on a handle 200

mcg, 400 mcg, 600 mcg,

800 mcg, 1,200 mcg, 1,600

mcg

1

fentanyl transdermal

patch 72 hour 12 mcg/hr,

25 mcg/hr, 50 mcg/hr, 75

mcg/hr, 100 mcg/hr

1

hydrocodone-

acetaminophen oral soln

7.5-325 mg/15 ml

1


hydrocodone-

acetaminophen oral

tablet 2.5-325 mg, 5-300

mg, 5-325 mg, 7.5-300 mg,

7.5-325 mg, 10-300 mg, 10-

325 mg

1

hydrocodone-ibuprofen

oral tablet 5-200 mg, 7.5-

200 mg, 10-200 mg

1

HYDROMORPHONE

INJECTION SYRINGE 0.5

MG/0.5 ML

2

hydromorphone oral

tablet 2 mg, 4 mg, 8 mg 1

hydromorphone rectal

suppository 3 mg 1

ibuprofen-oxycodone oral

tablet 400-5 mg 1

INFUMORPH P/F INJECTION

SOLN 10 MG/ML, 25

MG/ML

2

levorphanol tartrate oral

tablet 2 mg 1

lorcet (hydrocodone) oral

tablet 5-325 mg 1

lorcet hd oral tablet 10-

325 mg 1

lorcet plus oral tablet 7.5-

325 mg 1

marten-tab oral tablet 50-

325 mg 1

meperidine oral soln 50

mg/5 ml 1

meperidine oral tablet 100

mg, 50 mg 1



22


methadose oral

concentrate 10 mg/ml 1

methadose oral tablet,

soluble 40 mg 1

morphine concentrate

oral soln 100 mg/5 ml (20

mg/ml)

1

morphine oral capsule,

extend. release pellets 10

mg, 20 mg, 30 mg, 50 mg,

60 mg, 80 mg, 100 mg

1

morphine oral soln 10

mg/5 ml, 20 mg/5 ml (4

mg/ml)

1

morphine oral tablet 15

mg, 30 mg 1

morphine oral tablet ext-

rel 15 mg, 30 mg, 60 mg.

100 mg, 200 mg

1

morphine rectal

suppository 5 mg, 10 mg,

20 mg, 30 mg

1

oxycodone oral capsule 5

mg 1

oxycodone oral


oxycodone oral solution

5 mg/5 ml 1

oxycodone oral tablet

5 mg, 10 mg, 15 mg, 20

mg, 30 mg

1

oxycodone-

acetaminophen oral soln

5-325 mg/5 ml

1


oxycodone-

acetaminophen oral

tablet 10-325 mg, 2.5-325

mg, 5-325 mg, 7.5-325 mg

1

oxycodone-aspirin oral

tablet 4.8355-325 mg 1

oxymorphone oral tablet

10 mg, 5 mg 1

SYNALGOS-DC ORAL

CAPSULE 356.4-30-16 MG 2

tencon oral tablet 50-325

mg 1

verdrocet oral tablet 2.5-

325 mg 1

vicodin es oral tablet 7.5-

300 mg 1

vicodin hp oral tablet 10-

300 mg 1

vicodin oral tablet 5-300

mg 1

xylon 10 oral tablet 10-200

mg 1

zamicet oral soln 10-325

mg/15 ml 1

zebutal oral capsule 50-

325-40 mg 1

Non-Narcotic Analgesics

aspirin low dose oral


(dr/ec) 81 mg

$0

aspirin oral tablet 325 mg $0

aspirin oral tablet,

chewable 81 mg $0



23


aspirin oral tablet,


325 mg, 81 mg

$0

bayer aspirin oral tablet

325 mg $0

butorphanol tartrate nasal

spray, non-aerosol 10

mg/ml

1 QL

celecoxib oral capsule 50

mg 100 mg, 200 mg, 400

mg

1

children's aspirin oral

tablet, chewable 81 mg $0

choline, magnesium

salicylate oral liquid 500

mg/5 ml

1

diclofenac potassium oral

tablet 50 mg 1

diclofenac sodium oral


24 hr 100 mg

1

diclofenac sodium oral

tablet, del-rel (dr/ec) 25

mg, 50 mg, 75 mg

1

diclofenac sodium topical

drops 1.5 % 1 QL


gel 1 % 1 QL

diclofenac-misoprostol

oral tablet, ir, delayed rel,

biphasic 50-200 mg-mcg,

75-200 mg-mcg

1

diflunisal oral tablet 500

mg 1

e.c. prin oral tablet, del-rel

(dr/ec) 325 mg $0


ecotrin low strength oral


(dr/ec) 81 mg

$0

ecotrin oral tablet,


325 mg

$0

etodolac oral capsule 200

mg, 300 mg 1

etodolac oral tablet 400

mg, 500 mg 1

etodolac oral tablet


400 mg, 500 mg, 600 mg

1

fenoprofen oral tablet 600

mg 1

FLECTOR TRANSDERMAL

PATCH 12 HOUR 1.3 % 2

flurbiprofen oral tablet 100

mg, 50 mg 1

ibuprofen oral tablet 400

mg, 600 mg, 800 mg 1

indomethacin oral


indomethacin oral

capsule, extended

release 75 mg

1

ketoprofen oral capsule

50 mg, 75 mg 1

ketoprofen oral capsule,

ext rel. pellets 24 hr 200mg 1

ketorolac injection syringe

15 mg/ml, 30 mg/ml 1

ketorolac intramuscular

syringe 60 mg/2 ml 1

ketorolac oral tablet 10

mg 1 QL



24


lite coat aspirin oral tablet

325 mg $0

meclofenamate oral


mefenamic acid oral

capsule 250 mg 1

meloxicam oral

suspension 7.5 mg/5 ml 1

meloxicam oral tablet 15

mg, 7.5 mg 1

nabumetone oral tablet

500 mg, 750 mg 1

naltrexone oral tablet 50

mg 1

naproxen oral suspension

125 mg/5 ml 1

naproxen oral tablet 250

mg, 375 mg, 500 mg 1

naproxen oral tablet,


375 mg, 500 mg

1

naproxen sodium oral

tablet 550 mg 1

naproxen sodium oral

tablet, er multiphase 24 hr

375 mg, 500 mg

1

NARCAN NASAL SPRAY,

NON-AEROSOL 4

MG/ACTUATION

2 QL

NUCYNTA ER ORAL TABLET


50 MG , 100 MG, 150 MG,

200 MG, 250 MG

2

oxaprozin oral tablet 600

mg 1


pentazocine-naloxone

oral tablet 50-0.5 mg 1

piroxicam oral capsule 10

mg, 20 mg 1

REVIA ORAL TABLET 50 MG 2

salsalate oral tablet 500

mg, 750 mg 1

sulindac oral tablet 150

mg, 200 mg 1

tolmetin oral capsule 400

mg 1

tolmetin oral tablet 200

mg, 600 mg 1

TRAMADOL ORAL

CAPSULE,ER BIPHASE 24 HR

17-83 300 MG

2

TRAMADOL ORAL

CAPSULE, ER BIPHASE 24

HR 25-75 100 MG, 150 MG,

200 MG

2

tramadol oral tablet 50

mg 1

tramadol oral tablet


100 mg, 200 mg, 300 mg

1

tramadol oral tablet, er

multiphase 24 hr 100 mg,

200 mg, 300 mg

1

tramadol-acetaminophen

oral tablet 37.5-325 mg 1

VOLTAREN TOPICAL GEL

1 % 2 QL



25


ZUBSOLV SUBLINGUAL

TABLET 0.7-0.18 MG, 1.4-

0.36 MG, 11.4-2.9 MG, 2.9-

0.71 MG, 5.7-1.4 MG, 8.6-

2.1 MG

2 PA

Psychotherapeutic Drugs

ABILIFY MAINTENA

INTRAMUSCULAR SUS, EXT-

REL RECON 300MG,400MG

2

ABILIFY MAINTENA

INTRAMUSCULAR SUSP,

EXT-REL SYRINGE 300 MG,

400 MG

2

ADZENYS XR-ODT ORAL

TABLET, DISINTEG ER

BIPHASE 24H 12.5 MG, 15.7

MG, 18.8 MG, 3.1 MG, 6.3

MG, 9.4 MG

2

alprazolam intensol oral


alprazolam tablet 0.25

mg, 0.5 mg, 1 mg, 2 mg 1

alprazolam oral tablet

extended release 24 hr 0.5

mg, 1 mg, 2 mg, 3 mg

1

alprazolam oral tablet,

disintegrating 0.25 mg, 0.5

mg, 1 mg, 2 mg

1

amitriptyline oral tablet 10

mg, 100 mg, 150 mg, 25

mg, 50 mg, 75 mg

1

amitriptyline-

chlordiazepoxide oral

tablet 12.5-5 mg, 25-10 mg

1

amoxapine oral tablet 100

mg, 150 mg, 25 mg, 50 mg 1


APTENSIO XR ORAL CAP,

ER SPRINKLE, BIPHASIC 40-

60 10 MG, 15 MG, 20 MG,

30 MG, 40 MG, 50 MG, 60

MG

2

aripiprazole oral solution

1 mg/ml 1

aripiprazole oral tablet 10

mg, 15 mg, 2 mg, 20 mg,

30 mg, 5 mg

1 QL

aripiprazole oral tablet,


mg

1 QL

ARISTADA

INTRAMUSCULAR SUSP,

EXTENDED REL SYRING

1,064 MG/3.9 ML, 441

MG/1.6 ML, 662 MG/2.4

ML, 882 MG/3.2 ML

2

armodafinil oral tablet 50

mg, 150 mg, 200 mg, 250

mg

1 QL

bupropion hcl oral tablet

100 mg, 75 mg 1



100 mg, 150 mg, 200 mg

1



150 mg, 300 mg

1

buspirone oral tablet 10

mg, 15 mg, 30 mg, 5 mg,

7.5 mg

1

chlordiazepoxide hcl oral


mg

1



26


chlorpromazine oral tablet

10 mg, 100 mg, 200 mg, 25

mg, 50 mg

1

citalopram oral soln 10

mg/5 ml 1

citalopram oral tablet 10

mg, 20 mg 1

citalopram oral tablet 40

mg 1 QL

clomipramine capsule 25

mg, 50 mg, 75 mg 1

clorazepate dipotassium

oral tablet 15 mg, 3.75

mg, 7.5 mg

1

clozapine oral tablet 100

mg, 200 mg, 25 mg, 50 mg 1

clozapine oral tablet,

disintegrating 100 mg, 12.5

mg, 25 mg

1

CLOZAPINE ORAL TABLET,

DISINTEGRATING 150 MG,

200 MG

2

COTEMPLA XR-ODT ORAL

TABLET,DISINTEG ER

BIPHASE 24H 17.3 MG, 25.9

MG, 8.6 MG

2

DAYTRANA TRANSDERMAL

PATCH 24 HOUR 10 MG/9

HR, 15 MG/9 HR, 20 MG/9

HR, 30 MG/9 HR

2

desipramine oral tablet 10

mg, 100 mg, 150 mg, 25

mg, 50 mg, 75 mg

1

DESOXYN TABLET 5 MG 2

DESVENLAFAXINE

FUMARATE TABLET EXT-REL

24HR 100 MG, 50 MG

2


DESVENLAFAXINE ORAL

TABLET EXTENDED RELEASE

24 HR 100 MG, 50 MG

2

DESVENLAFAXINE ORAL

TABLET EXTENDED RELEASE

24HR 100 MG, 50 MG

2

desvenlafaxine succinate


release 24 hr 100 mg, 25

mg, 50 mg

1

dexmethylphenidate oral

tablet 2.5mg, 5mg, 10mg 1

dextroamphetamine oral

capsule, ext-rel 10 mg, 15

mg, 5 mg

1


soln 5 mg/5 ml 1



dextroamphetamine-

amphetamine oral tablet

10 mg, 12.5 mg, 15 mg, 20

mg, 30 mg, 5 mg, 7.5 mg

1

diazepam intensol oral


diazepam oral soln 5 mg/5

ml (1 mg/ml) 1

diazepam oral tablet 10

mg, 2 mg, 5 mg 1

doxepin oral capsule 10

mg, 100 mg, 150 mg, 25

mg, 50 mg, 75 mg

1

doxepin oral concentrate

10 mg/ml 1

duloxetine oral capsule,

delayed release(dr/ec) 20

mg, 30 mg, 40 mg, 60 mg

1



27


DYANAVEL XR ORAL

SUSPEN, IR - ER, BIPHASIC

24HR 2.5 MG/ML

2

ergoloid oral tablet 1 mg 1

escitalopram oxalate oral

soln 5 mg/5 ml 1

escitalopram oxalate oral


estazolam oral tablet 1

mg, 2 mg 1

eszopiclone oral tablet 1

mg, 2 mg, 3 mg 1

EVEKEO ORAL TABLET 10

MG, 5 MG 2

FANAPT ORAL TABLET 1

MG, 10 MG, 12 MG, 2 MG,

4 MG, 6 MG, 8 MG

2

FANAPT ORAL TABLETS,

DOSE PACK 1MG(2)-

2MG(2)- 4MG(2)-6MG(2)

2

FAZACLO ORAL TABLET,

DISINTEGRATING 12.5 MG,

25 MG, 100 MG, 150 MG,

200 MG

2

FETZIMA ORAL CAPSULE,

EXT REL 24HR DOSE PACK

20 MG (2)- 40 MG (26)

2

FETZIMA ORAL CAPSULE,

EXT-REL 24 HR 120 MG, 20

MG, 40 MG, 80 MG

2

fluoxetine oral capsule 10

mg, 20 mg, 40 mg 1

fluoxetine oral soln 20

mg/5 ml (4 mg/ml) 1

fluoxetine oral tablet 10

mg, 20 mg 1


FLUOXETINE ORAL TABLET

60 MG 2

fluphenazine decanoate


fluphenazine hcl injection

soln 2.5 mg/ml 1

fluphenazine hcl oral


fluphenazine hcl oral elixir

2.5 mg/5 ml 1

fluphenazine hcl oral

tablet 1 mg, 10 mg, 2.5

mg, 5 mg

1

flurazepam oral capsule

15 mg, 30 mg 1

fluvoxamine oral capsule,


mg, 150 mg

1

fluvoxamine oral tablet

100 mg, 50 mg 1 QL

fluvoxamine oral tablet 25

mg 1

FOCALIN XR ORAL

CAPSULE,ER BIPHASIC 50-

50 10 MG, 15 MG, 20 MG,

25 MG, 30 MG, 35 MG, 40

MG, 5 MG

2

guanfacine oral tablet

extended release 24 hr 1


1

guanidine oral tablet 125

mg 1

HALDOL DECANOATE

INTRAMUSCULAR SOLN 100

MG/ML, 50 MG/ML

2



28


HALDOL INJECTION SOLN

5 MG/ML 2

haloperidol decanoate

intramuscular soln 100

mg/ml, 50 mg/ml

1

haloperidol lactate


haloperidol lactate oral


haloperidol oral tablet 0.5

mg, 1 mg, 10 mg, 2 mg, 20

mg, 5 mg

1

imipramine hcl oral tablet

10 mg, 25 mg, 50 mg 1

imipramine pamoate oral


150 mg, 75 mg

1

INVEGA SUSTENNA

INTRAMUSCULAR SYRINGE

39 MG/0.25 ML, 78 MG/0.5

ML, 117 MG/0.75 ML, 156

MG/ML, 234 MG/1.5 ML

2

INVEGA TRINZA


273 MG/0.875 ML, 410

MG/1.315 ML, 546

MG/1.75 ML, 819

MG/2.625 ML

2

KAPVAY ORAL TABLET


0.1 MG

2 ST

KHEDEZLA ORAL TABLET


100 MG, 50 MG

2

LATUDA ORAL TABLET 120

MG, 20 MG, 40 MG, 60

MG, 80 MG

2


lithium carbonate oral


600 mg

1


tablet 300 mg 1



300 mg, 450 mg

1

lithium citrate oral soln 8

meq/5 ml 1

lorazepam intensol oral


lorazepam oral


lorazepam oral tablet 0.5

mg, 1 mg, 2 mg 1

loxapine succinate oral


mg, 50 mg

1

maprotiline oral tablet 25

mg, 50 mg, 75 mg 1

methamphetamine oral

tablet 5 mg 1

methylphenidate hcl oral

capsule, er biphasic 30-70

10 mg, 20 mg, 30 mg, 40

mg, 50 mg, 60 mg

1


capsule, er biphasic 50-50

20 mg, 30 mg, 40 mg, 60

mg

1


solution 10 mg/5 ml, 5

mg/5 ml

1





29




10 mg, 20 mg

1


tablet ext-rel 24hr 18 mg,

27 mg, 36 mg, 54 mg

1


tablet, chewable 10 mg,

2.5 mg, 5 mg

1

midazolam oral syrup 2

mg/ml 1

mirtazapine oral tablet 15

mg, 30 mg, 45 mg, 7.5 mg 1

mirtazapine oral tablet,


mg, 45 mg

1

modafinil oral tablet 100

mg, 200 mg 1 QL

MYDAYIS CAPSULE, ER

TRIPHASIC 24 HR 12.5 MG,

25 MG, 37.5 MG, 50 MG

2

nefazodone oral tablet

100 mg, 150 mg, 200 mg,

250 mg, 50 mg

1

nortriptyline oral capsule

10 mg,25 mg,50 mg,75 mg 1

nortriptyline oral soln 10

mg/5 ml 1

NUPLAZID TABLET 17 MG 2 ST; SP; QL

NUVIGIL TABLET 150 MG,

200 MG, 250 MG, 50 MG 2 QL

olanzapine intramuscular

recon soln 10 mg 1

olanzapine oral tablet 10

mg, 15 mg, 2.5 mg, 20 mg,

5 mg, 7.5 mg

1


olanzapine oral tablet,


mg, 20 mg, 5 mg

1

olanzapine-fluoxetine oral

capsule 12-25 mg, 12-50

mg, 3-25 mg, 6-25 mg, 6-

50 mg

1

ORAP TABLET 1 MG, 2 MG 2

oxazepam oral capsule 10

mg, 15 mg, 30 mg 1

paliperidone oral tablet

extended release 24hr 1.5


1

paroxetine hcl tablet 10

mg, 20 mg, 30 mg, 40 mg 1 QL

paroxetine hcl oral tablet


12.5 mg, 25 mg, 37.5 mg

1

paroxetine mesylate oral

capsule 7.5 mg 1

PAXIL ORAL SUSPENSION

10 MG/5 ML 2

perphenazine oral tablet

16 mg, 2 mg, 4 mg, 8 mg 1

perphenazine-

amitriptyline oral tablet 2-

10 mg, 2-25 mg, 4-10 mg,

4-25 mg, 4-50 mg

1

PEXEVA ORAL TABLET 10

MG,20 MG, 30 MG, 40 MG 2

phenelzine tablet 15 mg 1

pimozide tablet 1 mg, 2

mg 1

PRISTIQ ORAL TABLET


100 MG, 25 MG, 50 MG

2



30


procentra oral solution

5 mg/5 ml 1

protriptyline oral tablet 10

mg, 5 mg 1

quazepam tablet 15 mg 1

quetiapine oral tablet 25

mg, 50 mg, 100 mg, 200

mg, 300 mg, 400 mg

1

quetiapine oral tablet


150 mg, 200 mg, 300 mg,

400 mg, 50 mg

1

QUILLICHEW ER ORAL

TABLET, CHEW,IR-

ER.BIPHASIC 24HR 20 MG,

30 MG, 40 MG

2

QUILLIVANT XR ORAL

SUSPENSION,EXT REL

24HR,RECON 5 MG/ML (25

MG/5 ML)

2

REXULTI ORAL TABLET 0.25

MG, 0.5 MG, 1 MG, 2 MG,

3 MG, 4 MG

2 QL

RISPERDAL CONSTA


12.5 MG/2 ML, 25 MG/2

ML, 37.5 MG/2 ML, 50

MG/2 ML

2

risperidone oral solution

1 mg/ml 1

risperidone oral tablet 0.25

mg, 0.5 mg, 1 mg, 2 mg, 3

mg, 4 mg

1

risperidone oral tablet,

disintegrating 0.25 mg, 0.5

mg, 1 mg, 2 mg, 3 mg, 4

mg

1


SAPHRIS (BLACK CHERRY)

SUBLINGUAL TABLET 10

MG, 2.5 MG, 5 MG

2

seconal sodium oral

capsule 100 mg 1

sertraline oral concentrate

20 mg/ml 1

sertraline oral tablet 100

mg, 25 mg, 50 mg 1

SURMONTIL ORAL

CAPSULE 100 MG, 25 MG,

50 MG

2

SYMBYAX ORAL CAPSULE

12-25 MG, 12-50 MG, 3-25

MG, 6-25 MG, 6-50 MG

2

temazepam capsule , 7.5

mg, 15 mg,22.5 mg, 30 mg 1

thioridazine oral tablet 10

mg, 100 mg, 25 mg, 50 mg 1

thiothixene oral capsule 1

mg, 10 mg, 2 mg, 5 mg 1

tranylcypromine oral

tablet 10 mg 1

trazodone tablet , 50 mg,

100 mg, 150 mg, 300 mg 1

triazolam oral tablet 0.125

mg, 0.25 mg 1

trifluoperazine oral tablet

1 mg, 10 mg, 2 mg, 5 mg 1

trimipramine oral capsule

100 mg, 25 mg, 50 mg 1

TRINTELLIX ORAL TABLET 10

MG, 20 MG, 5 MG 2

venlafaxine oral capsule,


mg, 37.5 mg, 75 mg

1



31


venlafaxine oral tablet 100

mg, 25 mg, 37.5 mg, 50

mg, 75 mg

1

venlafaxine oral tablet

ext-rel 24hr 150 mg, 225

mg, 37.5 mg, 75 mg

1

VIIBRYD ORAL TABLET 10

MG, 20 MG, 40 MG 2

VIIBRYD ORAL TABLETS,

DOSE PACK 10 MG (7)- 20

MG (23)

2

VRAYLAR ORAL CAPSULE

1.5MG,3MG,4.5MG,6 MG 2

VRAYLAR ORAL

CAPSULE,DOSE PACK 1.5

MG (1)- 3 MG (6)

2

VYVANSE ORAL CAPSULE

10 MG, 20 MG, 30 MG, 40

MG, 50 MG, 60 MG, 70MG

2

VYVANSE ORAL TABLET,

CHEWABLE 10 MG, 20 MG,

30MG,40MG,50 MG,60MG

2

zaleplon oral capsule 5

mg, 10 mg 1 QL

zenzedi oral tablet 10 mg,

5 mg 1

ZENZEDI ORAL TABLET 15

MG, 2.5 MG, 20 MG, 30

MG, 7.5 MG

2

ziprasidone hcl oral


mg, 80 mg

1

zolpidem oral tablet 10

mg, 5 mg 1 QL

zolpidem oral tablet, ext

release multiphase 12.5

mg, 6.25 mg

1


zolpidem sublingual tablet

1.75 mg, 3.5 mg 1

ZYPREXA INTRAMUSCULAR

RECON SOLN 10 MG 2

ZYPREXA RELPREVV

INTRAMUSCULAR


210 MG, 300 MG, 405 MG

2

CARDIOVASCULAR, HYPERTENSION &

LIPIDS

Antiarrhythmic Agents

amiodarone oral tablet

100 mg, 200 mg, 400 mg 1

disopyramide phosphate

oral capsule 10mg, 150mg 1

dofetilide oral capsule 125

mcg, 250 mcg, 500 mcg 1

flecainide oral tablet 100

mg, 150 mg, 50 mg 1

mexiletine oral capsule

150 mg, 200 mg, 250 mg 1

MULTAQ TABLET 400 MG 2

NORPACE CR ORAL

CAPSULE, EXTENDED

RELEASE 100 MG, 150 MG

2

NORPACE ORAL CAPSULE

100 MG, 150 MG 2

pacerone oral tablet 100

mg, 200 mg, 400 mg 1

propafenone oral

capsule, ext-rel 12 hr 225

mg, 325 mg, 425 mg

1

propafenone oral tablet

150 mg, 225 mg, 300 mg 1



32


quinidine gluconate oral

tablet ext-rel 324 mg 1

quinidine sulfate oral


sotalol af oral tablet 120

mg, 160 mg, 80 mg 1

sotalol oral tablet 120 mg,

160 mg, 240 mg, 80 mg 1

TIKOSYN ORAL CAPSULE

125 MCG, 250 MCG, 500

MCG

2

Antihypertensive Therapy

acebutolol oral capsule

200 mg, 400 mg 1

afeditab cr oral tablet ext-

rel 30 mg, 60 mg 1

amiloride oral tablet 5 mg 1

amiloride-

hydrochlorothiazide oral

tablet 5-50 mg

1

amlodipine oral tablet 10

mg, 2.5 mg, 5 mg 1

amlodipine-benazepril

oral capsule 10-20 mg, 10-

40 mg, 2.5-10 mg, 5-10

mg, 5-20 mg, 5-40 mg

1

amlodipine-olmesartan

oral tablet 10-20 mg, 10-40

mg, 5-20 mg, 5-40 mg

1

amlodipine-valsartan oral

tablet 10-160 mg, 10-320

mg, 5-160 mg, 5-320 mg

1


amlodipine-valsartan-


tablet 10-160-12.5 mg, 10-

160-25 mg, 10-320-25 mg,

5-160-12.5 mg, 5-160-25mg

1

atenolol oral tablet 100

mg, 25 mg, 50 mg 1

atenolol-chlorthalidone

tablet 100-25 mg,50-25 mg 1

benazepril oral tablet 10

mg, 20 mg, 40 mg, 5 mg 1

benazepril-


tablet 10-12.5 mg, 20-12.5

mg, 20-25 mg, 5-6.25 mg

1

betaxolol oral tablet 10

mg, 20 mg 1

BIDIL TABLET 20-37.5 MG 2

bisoprolol fumarate oral


bisoprolol-


tablet 10-6.25 mg, 2.5-6.25

mg, 5-6.25 mg

1

bumetanide oral tablet

0.5 mg, 1 mg, 2 mg 1

BYSTOLIC ORAL TABLET 10

MG, 2.5 MG, 20 MG, 5 MG 2

CALAN SR ORAL TABLET


MG, 180 MG, 240 MG

2

candesartan oral tablet

16 mg, 32 mg, 4 mg, 8 mg 1

candesartan-


tablet 16-12.5 mg, 32-12.5

mg, 32-25 mg

1



33


captopril oral tablet 12.5

mg, 25 mg,50 mg,100 mg 1

captopril-


tablet 25-15 mg, 25-25 mg,

50-15 mg, 50-25 mg

1

cartia xt oral capsule, ext-

release 24hr 120 mg, 180

mg, 240 mg, 300 mg

1

carvedilol oral tablet 3.125 mg,6.25 mg,12.5 mg,25mg

1

chlorothiazide oral tablet

250 mg, 500 mg 1

chlorthalidone oral tablet

25 mg, 50 mg 1

clonidine hcl oral tablet

0.1 mg, 0.2 mg, 0.3 mg 1

clonidine transdermal

patch weekly 0.1 mg/24hr,

0.2 mg/24hr, 0.3 mg/24hr

1

clorpres oral tablet 0.1-15

mg, 0.2-15 mg 1

CLORPRES ORAL TABLET

0.3-15 MG 2

COREG CR ORAL

CAPSULE, ER MULTIPHASE

24 HR 10 MG, 20 MG, 40

MG, 80 MG

2

DIBENZYLINE ORAL

CAPSULE 10 MG 2

diltiazem hcl oral capsule,

ex-.rel 24hr degradable

240 mg

1



120 mg, 60 mg, 90 mg

1




240 mg, 420 mg

1



mg, 180 mg, 240 mg, 300

mg, 360 mg

1

diltiazem hcl tablet 120

mg, 30 mg, 60 mg, 90 mg 1

diltiazem hcl tablet ext-rel

24 hr 180 mg, 240 mg, 300

mg, 360 mg

1

dilt-xr oral capsule, ext.rel

24h degradable 120 mg,

180 mg, 240 mg

1

DIOVAN HCT ORAL TABLET

160-12.5 MG, 160-25 MG,

320-12.5 MG, 320-25 MG,

80-12.5 MG

2

DIURIL ORAL SUSPENSION

250 MG/5 ML 2

doxazosin oral tablet 1

mg, 2 mg, 4 mg, 8 mg 1 QL

enalapril maleate oral

tablet 10 mg, 2.5 mg, 20

mg, 5 mg

1

enalapril-


tablet 10-25 mg, 5-12.5 mg

1

eplerenone oral tablet 25

mg, 50 mg 1

eprosartan tablet 600 mg 1

ethacrynic acid oral

tablet 25 mg 1

felodipine oral tablet


mg, 2.5 mg, 5 mg

1



34


fosinopril oral tablet 10

mg, 20 mg, 40 mg 1

fosinopril-

hydrochlorothiazide tablet

10-12.5 mg, 20-12.5 mg

1

furosemide oral soln 10

mg/ml, 40 mg/5 ml (8

mg/ml)

1

furosemide oral tablet 20

mg, 40 mg, 80 mg 1

guanfacine oral tablet 1

mg, 2 mg 1

hydralazine oral tablet 10

mg, 100 mg, 25 mg, 50 mg 1


capsule 12.5 mg 1


tablet 12.5mg,25mg,50mg 1

indapamide oral tablet

1.25 mg, 2.5 mg 1

irbesartan oral tablet 150

mg, 300 mg, 75 mg 1

irbesartan-


150-12.5 mg, 300-12.5 mg

1

isradipine oral capsule 2.5

mg, 5 mg 1

labetalol oral tablet 100

mg, 200 mg, 300 mg 1

lisinopril oral tablet 10 mg,

2.5 mg, 20 mg, 30 mg, 40

mg, 5 mg

1

lisinopril-


tablet 10-12.5 mg, 20-12.5

mg, 20-25 mg

1


losartan oral tablet 100

mg, 25 mg, 50 mg 1

losartan-


tablet 100-12.5 mg, 100-25

mg, 50-12.5 mg

1

matzim la oral tablet


180 mg, 240 mg, 300 mg,

360 mg, 420 mg

1

MAXZIDE-25MG ORAL

TABLET 37.5-25 MG 2

methyclothiazide oral

tablet 5 mg 1

methyldopa oral tablet

250 mg, 500 mg 1

methyldopa-


tablet 250-15mg,250-25mg

1

metolazone oral tablet 10

mg, 2.5 mg, 5 mg 1

metoprolol succinate oral


24 hr 100 mg, 200 mg, 25

mg, 50 mg

1

metoprolol tartrate-


tablet 100-25 mg, 100-50

mg, 50-25 mg

1

metoprolol tartrate oral

tablet 100 mg, 25 mg, 37.5

mg, 50 mg, 75 mg

1

minoxidil oral tablet 10

mg, 2.5 mg 1

moexipril oral tablet 15

mg, 7.5 mg 1



35


moexipril-


tablet 15-12.5 mg, 15-25

mg, 7.5-12.5 mg

1

nadolol oral tablet 20 mg,

40 mg, 80 mg 1

nadolol-

bendroflumethiazide oral

tablet 40-5 mg, 80-5 mg

1

nicardipine oral capsule

20 mg, 30 mg 1

nifedipine oral capsule 10

mg, 20 mg 1

nifedipine oral tablet


mg, 60 mg, 90 mg

1

nifedipine oral tablet

extended release 30 mg,

60 mg, 90 mg

1

nimodipine oral capsule

30 mg 1

nisoldipine oral tablet


mg, 20 mg, 25.5 mg, 30

mg, 34 mg, 40 mg, 8.5 mg

1

olmesartan oral tablet 20

mg, 40 mg, 5 mg 1

olmesartan-amlodipine-


20-5-12.5 mg, 40-10-12.5

mg, 40-10-25 mg, 40-5-12.5

mg, 40-5-25 mg

1

olmesartan-


tablet 20-12.5 mg, 40-12.5

mg, 40-25 mg

1


ORENITRAM ORAL TABLET

EXTENDED RELEASE 0.125

MG, 0.25 MG, 1 MG, 2.5

MG, 5 MG

2 PA; SP

perindopril erbumine oral


phenoxybenzamine oral

capsule 10 mg 1

pindolol oral tablet 10 mg,

5 mg 1

prazosin oral capsule 1

mg, 2 mg, 5 mg 1

propranolol oral capsule,


120 mg, 160 mg, 60 mg, 80

mg

1

propranolol oral soln 20

mg/5 ml (4 mg/ml), 40

mg/5 ml (8 mg/ml)

1

propranolol oral tablet 10

mg, 20 mg, 40 mg, 60 mg,

80 mg

1

propranolol-


tablet 40-25 mg, 80-25 mg

1

quinapril oral tablet 10

mg, 20 mg, 40 mg, 5 mg 1

quinapril-


tablet 10-12.5 mg, 20-12.5

mg, 20-25 mg

1

ramipril oral capsule 1.25

mg, 10 mg, 2.5 mg, 5 mg 1

spironolactone oral tablet

100 mg, 25 mg, 50 mg 1



36


spironolactone-


tablet 25-25 mg

1

TARKA ORAL TABLET, IR -

ER, BIPHASIC 24HR 1-240

MG, 2-180 MG, 2-240 MG,

4-240 MG

2

taztia xt oral capsule,


120 mg, 180 mg, 240 mg,

300 mg, 360 mg

1

TEKTURNA HCT TABLET 150-

12.5 MG, 150-25 MG, 300-

12.5 MG, 300-25 MG

2

TEKTURNA ORAL TABLET

150 MG, 300 MG 2

telmisartan oral tablet 20

mg, 40 mg, 80 mg 1

telmisartan-amlodipine


mg, 80-10 mg, 80-5 mg

1

telmisartan-


tablet 40-12.5 mg, 80-12.5

mg, 80-25 mg

1

terazosin oral capsule 1

mg, 10 mg, 2 mg, 5 mg 1 QL

timolol maleate oral tablet

10 mg, 20 mg, 5 mg 1

torsemide oral tablet 10

mg, 100 mg, 20 mg, 5 mg 1

trandolapril oral tablet 1

mg, 2 mg, 4 mg 1

trandolapril-verapamil oral

tablet, ir - er, biphasic 24hr

1-240 mg, 2-180 mg, 2-240

mg, 4-240 mg

1


triamterene-


capsule 37.5-25 mg, 50-25

mg

1

triamterene-


tablet 37.5-25 mg, 75-50

mg

1

valsartan oral tablet 160

mg, 320 mg, 40 mg, 80 mg 1

valsartan-


tablet 160-12.5 mg, 160-25

mg, 320-12.5 mg, 320-25

mg, 80-12.5 mg

1

verapamil oral capsule, 24

hr er pellet ct 100 mg, 200

mg, 300 mg

1

verapamil capsule, ext rel.

pellets 24 hr 120 mg, 180

mg, 240 mg, 360 mg

1

verapamil oral tablet 120

mg, 40 mg, 80 mg 1

verapamil oral tablet

extended release 120 mg,

180 mg, 240 mg

1

Cardiac Glycosides

digitek oral tablet 125

mcg, 250 mcg 1

digox oral tablet 125 mcg,

250 mcg 1

digoxin oral soln 50

mcg/ml 1

digoxin oral tablet 125

mcg, 250 mcg 1

LANOXIN ORAL TABLET 125

MCG, 250 MCG 2



37


Coagulation Therapy

AMICAR ORAL SOLN 250

MG/ML (25 %) 2

AMICAR ORAL TABLET

1,000 MG, 500 MG 2

ARIXTRA SUBCUTANEOUS

SYRINGE 10 MG/0.8 ML,

2.5 MG/0.5 ML, 5 MG/0.4

ML, 7.5 MG/0.6 ML

2

aspirin-dipyridamole oral

capsule, er multiphase 12

hr 25-200 mg

1

BRILINTA ORAL TABLET 60

MG, 90 MG 2

cilostazol oral tablet 100

mg, 50 mg 1

clopidogrel oral tablet 75

mg 1

COUMADIN ORAL TABLET

1 MG, 10 MG, 2 MG, 2.5

MG, 3 MG, 4 MG, 5 MG, 6

MG, 7.5 MG

2

dipyridamole oral tablet

25 mg, 50 mg, 75 mg 1

EFFIENT ORAL TABLET 10

MG, 5 MG 2

ELIQUIS ORAL TABLET 2.5

MG, 5 MG 2

enoxaparin subcutaneous

soln 300 mg/3 ml 1

enoxaparin subcutaneous

syringe 100 mg/ml, 120

mg/0.8 ml, 150 mg/ml, 30

mg/0.3 ml, 40 mg/0.4 ml,

60 mg/0.6 ml, 80 mg/0.8

ml

1


fondaparinux

subcutaneous syringe 10

mg/0.8 ml, 2.5 mg/0.5 ml,

5 mg/0.4 ml, 7.5 mg/0.6 ml

1

hep flush-10 (pf)

intravenous soln 10 unit/ml 1

heparin (porcine) in 5 %

dex intravenous

parenteral soln 20,000

unit/500 ml (40 unit/ml),

25,000 unit/250 ml(100

unit/ml), 25,000 unit/500 ml

(50 unit/ml)

1

heparin (porcine) in nacl

(pf) intravenous

parenteral soln 1,000

unit/500 ml, 2,000

unit/1,000 ml

1

heparin (porcine) injection

cartridge 5,000 unit/ml (1

ml)

1

heparin (porcine) injection

soln 1,000 unit/ml, 10,000

unit/ml, 20,000 unit/ml,

5,000 unit/ml

1

heparin flush(porcine)-

0.9nacl intravenous kit 100

unit/ml

1

heparin lock flush

(porcine) intravenous soln

100 unit/ml

1

heparin lock flush

intravenous soln 10 unit/ml 1

heparin lock flush

intravenous syringe 10

unit/ml

1



38


heparin lockflush

(porcine)(pf) intravenous

syringe 10 unit/ml, 100

unit/ml

1

heparin(porcine) in 0.45%

nacl intravenous

parenteral soln 100

unit/100 ml (1 unit/ml),

25,000 unit/250 ml, 25,000

unit/500 ml

1

heparin, porcine (pf)

injection soln 1,000 unit/ml,

5,000 unit/0.5 ml

1


injection syringe 5,000

unit/0.5 ml

1


intravenous soln 100

unit/ml (1 ml)

1


intravenous syringe 1

unit/ml, 10 unit/ml, 100

unit/ml

1

jantoven oral tablet 1 mg,

10 mg, 2 mg, 2.5 mg, 3

mg, 4 mg, 5 mg, 6 mg, 7.5

mg

1

MEPHYTON TABLET 5 MG 2

pentoxifylline oral tablet

extended release 400 mg 1

PRADAXA ORAL CAPSULE

110 MG, 150 MG, 75 MG 2

prasugrel oral tablet 10

mg, 5 mg 1

PROMACTA ORAL TABLET

12.5 MG, 25 MG, 50 MG,

75 MG

2 PA; SP; LA


ticlopidine tablet 250 mg 1

warfarin tablet 1 mg, 10

mg, 2 mg, 2.5 mg, 3 mg, 4

mg, 5 mg, 6 mg, 7.5 mg

1

XARELTO ORAL TABLET 10

MG, 15 MG, 20 MG 2

XARELTO ORAL TABLETS,

DOSE PACK 15 MG (42)-

20 MG (9)

2

Lipid/Cholesterol Lowering Agents

amlodipine-atorvastatin


mg, 10-40 mg, 10-80 mg,

2.5-10 mg, 2.5-20 mg, 2.5-

40 mg, 5-10 mg, 5-20 mg,

5-40 mg, 5-80 mg

1

atorvastatin oral tablet 10

mg, 20 mg, 40 mg, 80 mg 1

CADUET TABLET 10-10 MG,

10-20 MG, 10-40 MG, 10-80

MG, 5-10 MG, 5-20 MG, 5-

40 MG, 5-80 MG

2

cholestyramine (with

sugar) oral powder 4

gram

1


sugar) oral powder in

packet 4 gram

1

cholestyramine light oral

powder 4 gram 1

cholestyramine light oral

powder in packet 4 gram 1

colestipol oral granules 5

gram 1

colestipol oral packet 5

gram 1



39


colestipol oral tablet 1

gram 1

ezetimibe tablet 10 mg 1

ezetimibe-simvastatin oral

tablet 10-10 mg, 10-20 mg,

10-40 mg, 10-80 mg

1

fenofibrate micronized


mg, 200 mg, 43 mg, 67 mg

1

fenofibrate

nanocrystallized oral

tablet 145 mg, 48 mg

1

fenofibrate oral tablet 120

mg, 160 mg, 40 mg, 54 mg 1

fenofibric acid (choline)

oral capsule, del-rel

(dr/ec) 135 mg, 45 mg

1

fenofibric acid oral tablet

105 mg, 35 mg 1

fluvastatin oral capsule 20

mg, 40 mg 1

fluvastatin oral tablet ext-

rel 24 hr 80 mg 1 QL

gemfibrozil tablet 600 mg 1

lovastatin oral tablet 10

mg, 20 mg, 40 mg 1

LOVAZA CAPSULE 1 GRAM 2

niacin oral tablet


1,000 mg, 500 mg, 750 mg

1

omega-3 acid ethyl esters

oral capsule 1 gram 1

PRALUENT PEN INJECTOR

150 MG/ML, 75 MG/ML 2 PA; SP


pravastatin oral tablet 10

mg, 20 mg, 40 mg, 80 mg 1

prevalite oral powder 4

gram 1

prevalite oral powder in

packet 4 gram 1

QUESTRAN LIGHT ORAL

POWDER 4 GRAM 2

QUESTRAN ORAL POWDER

4 GRAM 2 QL

QUESTRAN ORAL POWDER

IN PACKET 4 GRAM 2

REPATHA PUSHTRONEX

SUBCUTANEOUS

WEARABLE INJECTOR 420

MG/3.5 ML

2 PA; SP

REPATHA SURECLICK

SUBCUTANEOUS PEN

INJECTOR 140 MG/ML

2 PA; SP

REPATHA SYRINGE

SUBCUTANEOUS SYRINGE

140 MG/ML

2 PA; SP

rosuvastatin oral tablet 10

mg, 20 mg 1 QL

rosuvastatin oral tablet 40

mg, 5 mg 1

simvastatin oral tablet 10

mg, 20 mg, 40 mg, 5 mg,

80 mg

1

triklo oral capsule 1 gram 1

TRILIPIX ORAL CAPSULE,

DELAYED RELEASE(DR/EC)

135 MG, 45 MG

2

WELCHOL ORAL POWDER

IN PACKET 3.75 GRAM 2



40


WELCHOL ORAL TABLET

625 MG 2

Miscellaneous Cardiovascular Agents

CORLANOR ORAL TABLET

5 MG, 7.5 MG 2

ENTRESTO ORAL TABLET 24-

26 MG, 49-51 MG, 97-103

MG

2 PA

RANEXA ORAL TABLET


1,000 MG, 500 MG

2

Nitrates

DILATRATE-SR ORAL

CAPSULE, EXTENDED

RELEASE 40 MG

2

ISORDIL TABLET 40 MG 2

ISORDIL TITRADOSE ORAL

TABLET 5 MG 2

isosorbide dinitrate oral


mg, 5 mg

1

isosorbide dinitrate tablet

extended release 40 mg 1

isosorbide mononitrate

oral tablet 10 mg, 20 mg 1

isosorbide mononitrate

oral tablet ext-rel 24 hr 120

mg, 30 mg, 60 mg

1

nitro-bid transdermal

ointment 2 % 1

nitroglycerin oral capsule,

extended release 2.5 mg,

6.5 mg, 9 mg

1

nitroglycerin sublingual

tablet 0.3 mg, 0.4 mg, 0.6

mg

1


nitroglycerin transdermal

patch 24 hour 0.1 mg/hr,

0.2 mg/hr, 0.4 mg/hr, 0.6

mg/hr

1

nitroglycerin translingual

aerosol, spray 400

mcg/spray

1

nitroglycerin translingual


mcg/spray

1

NITROSTAT SUBLINGUAL

TABLET 0.3 MG, 0.4 MG, 0.6

MG

2

DERMATOLOGICALS/TOPICAL THERAPY

Antipsoriatic / Antiseborrheic

acitretin oral capsule 10

mg, 17.5 mg, 25 mg 1

calcipotriene scalp soln

0.005 % 1

calcipotriene topical

cream 0.005 % 1

calcipotriene topical

ointment 0.005 % 1

calcipotriene-

betamethasone topical

ointment 0.005-0.064 %

1 QL

calcitrene topical

ointment 0.005 % 1

calcitriol topical ointment

3 mcg/gram 1

COAL TAR TOPICAL SOLN

20 % 2

COSENTYX (2 SYRINGES)


150 MG/ML

2 PA; SP



41


COSENTYX PEN (2 PENS)

SUBCUTANEOUS PEN

INJECTOR 150 MG/ML

2 PA; SP

DOVONEX TOPICAL

CREAM 0.005 % 2

drithocreme hp topical

cream 1 % 1

EPIFOAM TOPICAL FOAM

1-1 % 2

PRAMOSONE E TOPICAL

CREAM 2.5-1 % 2

PRAMOSONE TOPICAL

CREAM 1-1 %, 2.5-1 % 2

PRAMOSONE TOPICAL

LOTION 1-1 %, 2.5-1 % 2

PRAMOSONE TOPICAL

OINTMENT 1-1 %, 2.5-1 % 2

seb-prev topical cleanser

10 % 1

selenium sulfide topical

lotion 2.5 % 1

selenium sulfide topical

shampoo 2.25 % 1

SORILUX TOPICAL FOAM

0.005 % 2

sulfacetamide sodium

topical cleanser 10 % 1


topical cleanser, gel 10 % 1


topical shampoo 10 % 1

TACLONEX TOPICAL

OINTMENT 0.005-0.064 % 2 QL

TACLONEX TOPICAL

SUSPENSION 0.005-0.064 % 2 QL


Burn Therapy

silver sulfadiazine topical

cream 1 % 1

ssd topical cream 1 % 1

Keratolytics

salicylic acid er-ceramides

topical kit, cleanser and

cream er 6 %

1

salicylic acid topical

cream 6 % 1


cream, ext-rel 6 % 1

salicylic acid topical film

forming liq w/appl 27.5 % 1

salicylic acid topical film-

forming soln w/appl 28.5 % 1

salicylic acid topical foam

6 % 1

salicylic acid topical gel 6

% 1

salicylic acid topical liquid

26 % 1

salicylic acid topical lotion

6 % 1


lotion, ext-rel 6 % 1


shampoo 6 % 1

salvax topical foam 6 % 1

Miscellaneous Dermatologicals

avo cream topical

emulsion 1

bp-50% urea topical

emulsion 50 % 1



42


CARAC TOPICAL CREAM

0.5 % 2

celacyn topical gel with

pump 1

cem-urea topical gel 45 % 1

CONDYLOX TOPICAL GEL

0.5 % 2


gel 3 % 1 QL

doxepin topical cream 5% 1

DUPIXENT SUBCUTANEOUS

SYRINGE 300 MG/2 ML 2 PA; SP; QL

eletone topical cream 1

ELIDEL TOPICAL CREAM 1% 2

emulsion sb topical

emulsion 1

FLUOROPLEX TOPICAL

CREAM 1 % 2

fluorouracil topical cream

5 % 1

fluorouracil topical soln 2

%, 5 % 1

hpr plus hydrogel topical

kit,cream and gel 1

hpr plus topical cream 1

hpr plus topical foam 1

hpr topical foam 1

IODOFLEX TOPICAL PADS,

MEDICATED 0.9 % 2

IODOSORB TOPICAL GEL

0.9 % 2

mb hydrogel

(cyclomethicone) topical

kit, cream and gel

1


mb hydrogel topical kit,

cream and gel 96.53-3-0.4

-0.066 %

1

nivatopic plus topical

cream 1

podofilox topical solution

0.5 % 1

PROTOPIC TOPICAL

OINTMENT 0.03 %, 0.1 % 2

pruclair topical cream 1

prudoxin topical cream

5% 1

prumyx topical cream 1

prutect topical emulsion 1

rea lo 39 topical cream 39

% 1

rea lo 40 topical lotion 40

% 1

REGRANEX TOPICAL GEL

0.01 % 2 QL

silver nitrate applicators

topical stick 75-25 % 1

silver nitrate topical

ointment 10 % 1

silver nitrate topical soln

0.5 %, 10 %, 25 %, 50 % 1

sonafine topical emulsion 1

sp antipruritic topical gel 1

sp scar management

topical gel with pump 1

tacrolimus topical

ointment 0.03 %, 0.1 % 1

umecta topical foam 40 % 1



43


urea nail stick topical soln

50 % 1

urea topical cream 39 %,

40 %, 45 %, 47 %, 50 % 1

urea topical foam 35 % 1

urea topical gel 45 % 1

urea topical lotion 40 %,

45 % 1

ure-k topical cream 50 % 1

ZONALON TOPICAL

CREAM 5 % 2

Therapy For Acne

ACANYA TOPICAL GEL

WITH PUMP 1.2-2.5 % 2

ACZONE TOPICAL GEL 5 % 2

ACZONE TOPICAL GEL

WITH PUMP 7.5 % 2

adapalene topical gel 0.3

% 1

adapalene topical gel

with pump 0.3 % 1

adapalene-benzoyl

peroxide topical gel with

pump 0.1-2.5 %

1

avar topical cleanser 10-5

% (w/w) 1

avita topical cream 0.025

% 1

AZELEX TOPICAL CREAM

20 % 2

BENZACLIN PUMP TOPICAL

GEL WITH PUMP 1-5 % 2

BENZACLIN TOPICAL GEL

1-5 % 2


bp 10-1 topical cleanser

10-1 % 1

claravis oral capsule 10

mg, 20 mg, 30 mg, 40 mg 1

cleansing wash topical

cleanser 10-4-10 % 1

clindacin p topical swab 1

% 1

CLINDAGEL TOPICAL GEL

1 % 2

clindamycin phosphate

topical foam 1 % 1


topical gel 1 % 1


topical lotion 1 % 1


topical soln 1 % 1


topical swab 1 % 1

clindamycin-benzoyl

peroxide topical gel 1-5 %,

1.2 %(1 % base) -5 %

1

clindamycin-benzoyl

peroxide topical gel with

pump 1-5 %

1

clindamycin-tretinoin

topical gel 1.2-0.025 % 1

dapsone topical gel 5 % 1

DIFFERIN TOPICAL GEL 0.3

% 2

DIFFERIN TOPICAL GEL

WITH PUMP 0.3 % 2

DIFFERIN TOPICAL LOTION

0.1 % 2



44


EPIDUO FORTE TOPICAL

GEL WITH PUMP 0.3-2.5 % 2

EPIDUO TOPICAL GEL WITH

PUMP 0.1-2.5 % 2

ery pads topical swab 2 % 1

erygel topical gel 2 % 1

erythromycin with ethanol

topical gel 2 % 1


topical soln 2 % 1


topical swab 2 % 1

erythromycin-benzoyl

peroxide topical gel 3-5 % 1

FINACEA TOPICAL FOAM

15 % 2

FINACEA TOPICAL GEL 15

% 2

metronidazole topical

cream 0.75 % 1

metronidazole topical gel

0.75 %, 1 % 1

metronidazole topical gel

with pump 1 % 1

metronidazole topical

lotion 0.75 % 1

neuac topical gel 1.2 %(1

% base) -5 % 1

NORITATE TOPICAL CREAM

1 % 2

NUOX TOPICAL GEL 6-3 % 2

RETIN-A MICRO PUMP

TOPICAL GEL WITH PUMP

0.04 %, 0.1 %

2


RETIN-A MICRO TOPICAL

GEL 0.04 %, 0.1 % 2

rosadan topical cream

0.75 % 1

rosadan topical gel 0.75 % 1

rosula cleansing cloths

topical pads, medicated

10-5 %

1

sss 10-5 topical cream 10-5

% (w/w) 1

sss 10-5 topical foam 10-5

% 1

sulfacetamide sodium-

sulfur topical cleanser 10-2

%, 10-5 % (w/w), 9-4 %, 9-

4.5 %, 9.8-4.8 %

1


sulfur topical cream 10-2

%, 10-5 % (w/w), 9.8-4.8 %

1


sulfur topical lotion 10-5 %

(w/v), 10-5 % (w/w), 9.8-

4.8 %

1


sulfur topical pads,

medicated 10-4 %

1


sulfur topical suspension

10-5 %, 8-4 %

1

sulfacetamide sod-sulfur-

urea topical cleanser 10-

5-10 %

1

sulfacetamide-sulfur-

cleansr23 topical kit 9-4.5

%

1

sulfacleanse 8-4 topical

suspension 8-4 % 1



45


sulfact na-sul-avobnz-otn-

ocsa topical combo

pack,cleanser and cream

9 %-4.5 % -spf 25

1

tazarotene topical cream

0.1 % 1

TAZORAC TOPICAL

CREAM 0.05 %, 0.1 % 2

TAZORAC TOPICAL GEL

0.05 %, 0.1 % 2

tretinoin microspheres

topical gel 0.04 %, 0.1 % 1

tretinoin microspheres

topical gel with pump 0.04

%, 0.1 %

1

tretinoin topical cream

0.025 %, 0.05 %, 0.1 % 1

tretinoin topical gel 0.01

%, 0.025 %, 0.05 % 1

VANOXIDE-HC TOPICAL

SUSPENSION 5-0.5 % 2

zenatane oral capsule 10

mg, 20 mg, 30 mg, 40 mg 1

Topical Anesthetics

ethyl chloride topical

aerosol, spray 100 % 1

glydo mucous membrane

jelly in applicator 2 % 1 QL

lidocaine hcl

laryngotracheal soln 4 % 1

lidocaine hcl mucous

membrane jelly 2 % 1 QL


membrane jelly in

applicator 2 %

1 QL



membrane soln 4 % (40

mg/ml)

1

lidocaine hcl topical lotion

3 % 1

lidocaine hcl-

hydrocortisone ac topical

cream 3-0.5 %

1

lidocaine topical adhesive

patch, medicated 5 % 1

lidocaine topical ointment

5 % 1 QL

lidocaine viscous mucous

membrane soln 2 % 1

lidocaine-prilocaine

topical cream 2.5-2.5 % 1 QL

lidocaine-prilocaine

topical kit 2.5-2.5 % 1

LIDODERM TOPICAL

ADHESIVE

PATCH,MEDICATED 5 %

2

lido-k topical lotion 3 % 1

lta pre-attached

laryngotracheal soln 4 % 1

Topical Antibacterials

ALTABAX TOPICAL

OINTMENT 1 % 2

gentamicin topical cream

0.1 % 1

gentamicin topical

ointment 0.1 % 1

hydrocortisone-

iodoquinol-aloe topical

cream in packet 1.9-1 %

1

lugols topical soln 5-10 % 1



46


mupirocin calcium topical

cream 2 % 1

mupirocin topical

ointment 2 % 1


(acne) topical suspension

10 %

1

SULFAMYLON TOPICAL

CREAM 85 MG/G 2

SULFAMYLON TOPICAL

PACKET 50 GRAM 2

Topical Antifungals

ALA-QUIN TOPICAL

CREAM 3-0.5 % 2

ciclodan topical cream

0.77 % 1

ciclodan topical soln 8 % 1

ciclopirox topical cream

0.77 % 1

ciclopirox topical gel 0.77

% 1

ciclopirox topical

shampoo 1 % 1

ciclopirox topical soln 8 % 1

ciclopirox topical

suspension 0.77 % 1

ciclopirox-ure-camph-

menth-euc topical soln 8

%

1

clotrimazole-


cream 1-0.05 %

1

clotrimazole-


lotion 1-0.05 %

1


econazole topical cream

1 % 1

ERTACZO TOPICAL CREAM

2 % 2

EXELDERM TOPICAL

CREAM 1 % 2

EXELDERM TOPICAL SOLN

1 % 2

ketoconazole topical

cream 2 % 1


foam 2 % 1


shampoo 2 % 1

naftifine topical cream 1

%, 2 % 1

NIZORAL TOPICAL

SHAMPOO 2 % 2

nyamyc topical powder

100,000 unit/gram 1

nyata topical powder

100,000 unit/gram 1

nystatin topical cream

100,000 unit/gram 1

nystatin topical ointment

100,000 unit/gram 1

nystatin topical powder

100,000 unit/gram 1

nystatin-triamcinolone

topical cream 100,000-0.1

unit/g-%

1

nystatin-triamcinolone

topical ointment 100,000-

0.1 unit/gram-%

1



47


nystop topical powder

100,000 unit/gram 1

oxiconazole topical

cream 1 % 1

OXISTAT TOPICAL CREAM

1 % 2

OXISTAT TOPICAL LOTION 1

% 2

TRIACETIN LIQUID 100 % 2

Topical Antivirals

acyclovir topical ointment

5 % 1

DENAVIR TOPICAL CREAM

1 % 2

ZOVIRAX TOPICAL CREAM

5 % 2

ZOVIRAX TOPICAL

OINTMENT 5 % 2

Topical Corticosteroids

ala-cort topical cream 2.5

% 1

ALA-SCALP TOPICAL

LOTION 2 % 2

alclometasone topical

cream 0.05 % 1

alclometasone topical

ointment 0.05 % 1

amcinonide topical

cream 0.1 % 1

amcinonide topical lotion

0.1 % 1

amcinonide topical

ointment 0.1 % 1

apexicon e topical cream

0.05 % 1


betamethasone

dipropionate topical

cream 0.05 %

1

betamethasone


lotion 0.05 %

1

betamethasone


ointment 0.05 %

1

betamethasone valerate

topical cream 0.1 % 1


topical foam 0.12 % 1


topical lotion 0.1 % 1


topical ointment 0.1 % 1

betamethasone,

augmented topical

cream 0.05 %

1

betamethasone,

augmented topical gel

0.05 %

1

betamethasone,

augmented topical lotion

0.05 %

1

betamethasone,

augmented topical

ointment 0.05 %

1

clobetasol scalp soln 0.05

% 1

clobetasol topical cream

0.05 % 1

clobetasol topical foam

0.05 % 1



48


clobetasol topical gel 0.05

% 1

clobetasol topical lotion

0.05 % 1

clobetasol topical

ointment 0.05 % 1

clobetasol topical

shampoo 0.05 % 1

clobetasol topical spray,

non-aerosol 0.05 % 1

clobetasol-emollient


clobetasol-emollient

topical foam 0.05 % 1

CLOBEX TOPICAL LOTION

0.05 % 2

CLOBEX TOPICAL

SHAMPOO 0.05 % 2

CLOBEX TOPICAL SPRAY,

NON-AEROSOL 0.05 % 2

clodan topical shampoo

0.05 % 1

CORDRAN TAPE LARGE

ROLL TOPICAL TAPE 4

MCG/CM2

2 QL

CORDRAN TOPICAL

CREAM 0.05 % 2

CORDRAN TOPICAL

LOTION 0.05 % 2

CORDRAN TOPICAL

OINTMENT 0.05 % 2

cormax scalp soln 0.05 % 1

DERMA-SMOOTHE/FS

BODY OIL TOPICAL OIL

0.01 %

2


DERMA-SMOOTHE/FS

SCALP OIL SCALP OIL 0.01

%

2

DESONATE TOPICAL GEL

0.05 % 2

desonide topical cream

0.05 % 1

desonide topical lotion

0.05 % 1

desonide topical ointment

0.05 % 1

desoximetasone topical

cream 0.05 %, 0.25 % 1


gel 0.05 % 1


ointment 0.05 %, 0.25 % 1

diflorasone topical cream

0.05 % 1

diflorasone topical

ointment 0.05 % 1

fluocinolone and shower

cap scalp oil 0.01 % 1

fluocinolone topical

cream 0.01 %, 0.025 % 1

fluocinolone topical oil

0.01 % 1

fluocinolone topical

ointment 0.025 % 1

fluocinolone topical soln

0.01 % 1

fluocinonide topical

cream 0.05 %, 0.1 % 1

fluocinonide topical gel

0.05 % 1



49


fluocinonide topical

ointment 0.05 % 1

fluocinonide topical soln

0.05 % 1

fluocinonide-e topical

cream 0.05 % 1

fluocinonide-emollient


flurandrenolide topical

cream 0.05 % 1


lotion 0.05 % 1


ointment 0.05 % 1

fluticasone topical cream

0.05 % 1

fluticasone topical lotion

0.05 % 1

fluticasone topical

ointment 0.005 % 1

halobetasol propionate


halobetasol propionate


HALOG TOPICAL CREAM

0.1 % 2

HALOG TOPICAL

OINTMENT 0.1 % 2

hydrocortisone butyrate





topical soln 0.1 % 1


hydrocortisone butyr-

emollient topical cream

0.1 %

1

hydrocortisone topical

cream 2.5 % 1


lotion 2.5 % 1


ointment 2.5 % 1

hydrocortisone valerate


hydrocortisone valerate


hydrocortisone-min oil-wht

pet topical ointment 1 % 1

KENALOG TOPICAL

AEROSOL 0.147

MG/GRAM

2

LOCOID TOPICAL CREAM

0.1 % 2

LOCOID TOPICAL LOTION

0.1 % 2

LOCOID TOPICAL

OINTMENT 0.1 % 2

LOCOID TOPICAL SOLN 0.1

% 2

LUXIQ TOPICAL FOAM 0.12

% 2

mometasone topical

cream 0.1 % 1

mometasone topical

ointment 0.1 % 1

mometasone topical soln

0.1 % 1

nolix topical lotion 0.05 % 1



50


prednicarbate topical

cream 0.1 % 1

prednicarbate topical

ointment 0.1 % 1

scalacort topical lotion 2% 1

TEXACORT TOPICAL SOLN

2.5 % 2

TOPICORT TOPICAL

CREAM 0.05 %, 0.25 % 2

TOPICORT TOPICAL GEL

0.05 % 2

TOPICORT TOPICAL

OINTMENT 0.05 %, 0.25 % 2

TOPICORT TOPICAL SPRAY,

NON-AEROSOL 0.25 % 2

triamcinolone acetonide

topical aerosol 0.147

mg/gram

1


topical cream 0.025 %, 0.1

%, 0.5 %

1


topical lotion 0.025%, 0.1% 1


topical ointment 0.025 %,

0.1 %, 0.5 %

1

trianex topical ointment

0.05% 1

Topical Enzymes

SANTYL TOPICAL

OINTMENT 250 UNIT/GRAM 2

Topical Scabicides / Pediculicides

EURAX TOPICAL CREAM 10

% 2


lindane topical shampoo

1 % 1

NATROBA TOPICAL

SUSPENSION 0.9 % 2

permethrin topical cream

5 % 1

SKLICE TOPICAL LOTION

0.5 % 2

ULESFIA TOPICAL LOTION 5

% 2

DIAGNOSTICS & MISCELLANEOUS

AGENTS

Anorexiants

benzphetamine oral

tablet 25 mg, 50 mg 1 PA

diethylpropion oral tablet

25 mg 1 PA

diethylpropion oral tablet

extended release 75 mg 1 PA

phendimetrazine tartrate

oral capsule, extended

release 105 mg

1


oral tablet 35 mg 1

phentermine oral capsule

15 mg, 30 mg, 37.5 mg 1 PA

phentermine oral tablet

37.5 mg 1 PA

Miscellaneous Agents

acamprosate oral tablet,


333 mg

1

ACTONEL TABLET 30 MG 2

alendronate tablet 40 mg 1



51


anagrelide oral capsule

0.5 mg, 1 mg 1

ANTABUSE ORAL TABLET

250 MG, 500 MG 2

BUPHENYL ORAL POWDER

0.94 GRAM/GRAM 2

caffeine citrate oral soln

60 mg/3 ml (20 mg/ml) 1

CARBAGLU ORAL TABLET,

DISPERSIBLE 200 MG 2 SP; LA

CARNITOR (SUGAR-FREE)

ORAL SOLN 100 MG/ML 2

CARNITOR ORAL SOLN 100

MG/ML 2

CARNITOR TABLET 330 MG 2

cevimeline oral capsule

30 mg 1

CHEMET ORAL CAPSULE

100 MG 2

disulfiram oral tablet 250

mg, 500 mg 1

etidronate disodium oral


EXJADE ORAL TABLET,

DISPERSIBLE 125 MG, 250

MG, 500 MG

2 SP; LA

JADENU ORAL TABLET 180

MG, 360 MG, 90 MG 2 SP

JADENU SPRINKLE ORAL

GRANULES IN PACKET 180

MG, 360 MG, 90 MG

2 SP

levocarnitine (with sugar)

oral soln 100 mg/ml 1

levocarnitine oral tablet

330 mg 1


METOPIRONE ORAL

CAPSULE 250 MG 2

midodrine oral tablet 10

mg, 2.5 mg, 5 mg 1

NITYR ORAL TABLET 10 MG,

2 MG, 5 MG 2 SP

ORFADIN ORAL CAPSULE

10 MG, 2 MG, 5 MG 2 SP; LA

ORFADIN CAPSULE 20 MG 2 SP

ORFADIN ORAL

SUSPENSION 4 MG/ML 2 SP; LA

pilocarpine hcl tablet 5mg 1

RILUTEK TABLET 50 MG 2

riluzole oral tablet 50 mg 1

risedronate tablet 30 mg 1

sodium chloride irrigation

soln 0.9 % 1

sodium phenylbutyrate

oral powder 0.94

gram/gram

1

sodium phenylbutyrate


Smoking Deterrents

bupropion hcl (smoking

deter) oral tablet


150 mg

$0 QL

CHANTIX CONTINUING

MONTH BOX ORAL TABLET

1 MG

$0 QL

CHANTIX ORAL TABLET 0.5

MG, 1 MG $0 QL



52


CHANTIX STARTING

MONTH BOX ORAL

TABLETS, DOSE PACK 0.5

MG (11)- 1 MG (42)

$0 QL

NICODERM CQ

TRANSDERMAL PATCH 24

HOUR 14 MG/24 HR, 21

MG/24 HR, 7 MG/24 HR

$0 QL

nicorelief buccal gum 2

mg, 4 mg $0 QL

NICORETTE BUCCAL GUM

2 MG $0 QL

nicorette buccal gum

4mg $0 QL

NICORETTE BUCCAL

LOZENGE 2 MG, 4 MG $0 QL

NICORETTE BUCCAL MINI

LOZENGE 2 MG, 4 MG $0 QL

nicotine (polacrilex)

buccal gum 2 mg, 4 mg $0 QL


buccal lozenge 2 mg, 4

mg

$0 QL


buccal mini lozenge 2 mg,

4 mg

$0 QL

nicotine transdermal

patch 24 hour 14 mg/24

hr, 21 mg/24 hr, 7 mg/24

hr

$0 QL

nicotine transdermal

patch, td daily, sequential

21-14-7 mg/24 hr

$0 QL

NICOTROL INHALATION

CARTRIDGE 10 MG $0 QL


NICOTROL NS NASAL

SPRAY, NON-AEROSOL 10

MG/ML

$0 QL

nts step 1 transdermal

patch 24 hour 21 mg/24 hr $0 QL

quit 2 buccal gum 2 mg $0 QL

QUIT 2 BUCCAL LOZENGE

2 MG $0 QL

quit 4 buccal gum 4 mg $0 QL

QUIT 4 BUCCAL LOZENGE

4 MG $0 QL

stop smoking aid buccal

lozenge 2 mg, 4 mg $0 QL

EAR, NOSE & THROAT MEDICATIONS

Miscellaneous Agents

ASTEPRO NASAL SPRAY,

NON-AEROSOL 0.15 %

(205.5 MCG)

2

azelastine nasal aerosol,

spray 137 mcg (0.1 %) 1

azelastine nasal spray,

non-aerosol 0.15 % (205.5

mcg)

1

BACTROBAN NASAL

NASAL OINTMENT 2 % 2

chlorhexidine gluconate

mucous membrane

mouthwash 0.12 %

1

DEBACTEROL MUCOUS

MEMBRANE SOLN 30-50 % 2

DEBACTEROL MUCOUS

MEMBRANE SWAB 30-50 % 2

denta 5000 plus dental

cream 1.1 % 1

dentagel dental gel 1.1 % 1



53


fluoride (sodium) dental

soln 0.2 % 1

ipratropium bromide nasal

spray, non-aerosol 0.03 %,

0.06 %

1

MUGARD MUCOUS

MEMBRANE SOLN 2

olopatadine nasal spray,

non-aerosol 0.6 % 1

oralone dental paste 0.1

% 1

paroex oral rinse mucous

membrane mouthwash

0.12 %

1

PERIDEX MUCOUS

MEMBRANE MOUTHWASH

0.12 %

2

periogard mucous

membrane mouthwash

0.12 %

1

pilocarpine hcl oral tablet

7.5 mg 1

PREVIDENT 5000 BOOSTER

PLUS DENTAL PASTE 1.1 % 2

PREVIDENT 5000 DRY

MOUTH DENTAL GEL 1.1 % 2

PREVIDENT 5000 PLUS

DENTAL CREAM 1.1 % 2

PREVIDENT DENTAL GEL 1.1

% 2

PREVIDENT DENTAL SOLN

0.2 % 2

sf 5000 plus dental cream

1.1 % 1

sf dental gel 1.1 % 1



dental paste 0.1 % 1

Miscellaneous Otic Preparations

acetic acid otic soln 2 % 1

ciprofloxacin hcl otic (ear)

dropperette 0.2 % 1

fluocinolone acetonide oil

otic (ear) drops 0.01 % 1

hydrocortisone-acetic

acid otic (ear) drops 1-2 % 1

Otic Steroid / Antibiotic

CIPRO HC OTIC DROPS,

SUSPENSION 0.2-1 % 2

CIPRODEX OTIC DROPS,

SUSPENSION 0.3-0.1 % 2

neomycin-polymyxin-hc

otic (ear) drops,

suspension 3.5-10,000-1

mg/ml-unit/ml-%

1


otic (ear) soln 3.5-10,000-1

mg/ml-unit/ml-%

1

ENDOCRINE/DIABETES

Adrenal Hormones

cortisone tablet 25 mg 1

CORTROSYN INJECTION

RECON SOLN 0.25 MG 2

cosyntropin injection

recon soln 0.25 mg 1

deltasone oral tablet 20

mg 1

dexamethasone intensol

oral drops 1 mg/ml 1

dexamethasone oral elixir

0.5 mg/5 ml 1



54


dexamethasone oral soln

0.5 mg/5 ml 1

dexamethasone oral

tablet 0.5 mg, 0.75 mg, 1

mg, 1.5 mg, 2 mg, 4 mg, 6

mg

1

DEXPAK 10 DAY ORAL


MG (35 TABS)

2

DEXPAK 13 DAY ORAL


MG (51 TABS)

2

DEXPAK 6 DAY ORAL


MG (21 TABS)

2

fludrocortisone oral tablet

0.1 mg 1

hydrocortisone oral tablet

10 mg, 20 mg, 5 mg 1

MEDROL ORAL TABLET 2

MG 2

methylprednisolone oral


mg, 8 mg

1

methylprednisolone oral

tablets, dose pack 4 mg 1

millipred dp oral tablets,

dose pack 5 mg (21 tabs),

5 mg (48 tabs)

1

millipred oral tablet 5 mg 1

ORAPRED ODT ORAL

TABLET, DISINTEGRATING

10 MG, 15 MG, 30 MG

2

prednisolone oral soln 15

mg/5 ml 1


prednisolone sodium

phosphate oral soln 10

mg/5 ml, 15 mg/5 ml (3

mg/ml), 20 mg/5 ml (4

mg/ml), 25 mg/5 ml (5

mg/ml), 5 mg base/5 ml

(6.7 mg/5 ml)

1

prednisolone sodium

phosphate oral tablet,


mg, 30 mg

1

prednisone intensol oral


prednisone oral soln 5

mg/5 ml 1

prednisone oral tablet 1

mg, 10 mg, 2.5 mg, 20 mg,

5 mg, 50 mg

1

prednisone oral tablets,

dose pack 10 mg, 5 mg 1

veripred 20 oral soln 20

mg/5 ml (4 mg/ml) 1

Antithyroid Agents

methimazole oral tablet

10 mg, 5 mg 1

propylthiouracil oral tablet

50 mg 1

SSKI ORAL SOLN 1

GRAM/ML 2

Blood Glucose Monitoring Devices &

Supplies

BREEZE 2 TEST STRIPS STRIP $0 QL

CONTOUR NEXT STRIPS

STRIP $0 QL

CONTOUR TEST STRIPS STRIP $0 QL



55


Diabetes, Supplies, & Durable Medical

Equipment

AEROCHAMBER MINI

SPACER 2

AEROCHAMBER PLUS

FLOW-VU SPACER 2

AEROCHAMBER PLUS Z

STAT SM MSK SPACER 2

GLUCAGEN DIAGNOSTIC

KIT INJECTION RECON

SOLN 1 MG/ML

2

INSULIN SYRINGE-NEEDLE

U-100 SYRINGE 0.5 ML 29

GAUGE X 1/2"

$0

Glucose Elevating Agents

GLUCAGEN HYPOKIT

INJECTION RECON SOLN 1

MG

2

GLUCAGON EMERGENCY

KIT (HUMAN) INJECTION KIT

1 MG

2

Insulin Syringes/Miscellaneous

Durable Medical Equipment

CONTOUR NEXT EZ METER 2

CONTOUR NEXT METER 2

LANCETS 33 GAUGE $0

LANCING DEVICE $0

PEN NEEDLE 31 GAUGE X

1/4" $0

TRUE METRIX AIR GLUCOSE

METER 2 QL

TRUE METRIX GLUCOSE

METER 2 QL

TRUE METRIX GO GLUCOSE

METER 2 QL


TRUE2GO BLOOD

GLUCOSE SYSTEM KIT 2

Insulin Therapy

APIDRA SOLOSTAR

SUBCUTANEOUS INSULIN

PEN 100 UNIT/ML

2

APIDRA SUBCUTANEOUS

SOLN 100 UNIT/ML $0

HUMALOG MIX 50-50

SUBCUTANEOUS

SUSPENSION 100 UNIT/ML

(50-50)

$0

HUMALOG MIX 75-25

SUBCUTANEOUS


(75-25)

$0

HUMALOG

SUBCUTANEOUS SOLN 100

UNIT/ML

$0

HUMULIN 70/30

SUBCUTANEOUS


(70-30)

$0

HUMULIN N

SUBCUTANEOUS


$0

HUMULIN R U-100

INJECTION SOLN 100

UNIT/ML

$0

HUMULIN R U-500

(CONCENTRATED)


UNIT/ML

$0

LANTUS SOLOSTAR


PEN 100 UNIT/ML (3 ML)

2



56


LANTUS SUBCUTANEOUS

SOLN 100 UNIT/ML $0

LEVEMIR FLEXTOUCH


PEN 100 UNIT/ML (3 ML)

2

LEVEMIR SUBCUTANEOUS

SOLN 100 UNIT/ML $0

NOVOLOG FLEXPEN


PEN 100 UNIT/ML

2

NOVOLOG MIX 70-30

FLEXPEN SUBCUTANEOUS

INSULIN PEN 100 UNIT/ML

(70-30)

2

NOVOLOG MIX 70-30


UNIT/ML (70-30)

$0

NOVOLOG PENFILL

SUBCUTANEOUS

CARTRIDGE 100 UNIT/ML

2

NOVOLOG


UNIT/ML

$0

RELION NOVOLIN R

INJECTION SOLN 100

UNIT/ML

$0

XULTOPHY 100/3.6


PEN 100 UNIT-3.6 MG /ML

(3 ML)

2 QL

Miscellaneous Hormones

ANADROL-50 ORAL TABLET

50 MG 2

ANDROGEL TRANSDERMAL

GEL IN METERED-DOSE

PUMP 20.25 MG/1.25

GRAM (1.62 %)

2 PA


ANDROGEL TRANSDERMAL

GEL IN PACKET 1 % (25

MG/2.5GRAM), 1 % (50

MG/5 GRAM), 1.62 %

(20.25 MG/1.25 GRAM),

1.62 % (40.5 MG/2.5

GRAM)

2 PA

ANDROID ORAL CAPSULE

10 MG 2

cabergoline oral tablet 0.5

mg 1 QL

calcitonin (salmon) nasal


unit/actuation

1

calcitriol intravenous soln 1

mcg/ml 1

calcitriol oral capsule 0.25

mcg, 0.5 mcg 1

calcitriol oral soln 1

mcg/ml 1

CERDELGA ORAL CAPSULE

84 MG 2 PA; SP

clomiphene citrate oral

tablet 50 mg 1

danazol oral capsule 100

mg, 200 mg, 50 mg 1

DEPO-TESTOSTERONE

INTRAMUSCULAR OIL 100

MG/ML, 200 MG/ML

2 PA

desmopressin nasal soln

0.1 mg/ml (refrigerate) 1

desmopressin nasal spray,

non-aerosol 10 mcg/spray

(0.1 ml)

1

desmopressin oral tablet

0.1 mg, 0.2 mg 1



57


doxercalciferol oral

capsule 0.5 mcg, 1 mcg,

2.5 mcg

1

KORLYM TABLET 300 MG 2 PA; SP

KUVAN ORAL POWDER IN

PACKET 500 MG 2 PA; SP

KUVAN ORAL

TABLET,SOLUBLE 100 MG 2 PA; SP

METHITEST TABLET 10 MG 2

methyltestosterone oral

capsule 10 mg 1

oxandrolone oral tablet 10

mg, 2.5 mg 1

paricalcitol oral capsule 1

mcg, 2 mcg, 4 mcg 1 PA

SAMSCA ORAL TABLET 15

MG, 30 MG 2 SP

SENSIPAR ORAL TABLET 30

MG, 60 MG, 90 MG 2

SYNAREL NASAL SPRAY,

NON-AEROSOL 2 MG/ML 2

testosterone cypionate

intramuscular oil 100

mg/ml, 200 mg/ml

1 PA

testosterone enanthate


mg/ml

1 PA

TESTRED CAPSULE 10 MG 2

ZAVESCA ORAL CAPSULE

100 MG 2 PA; SP; LA

Non-Insulin Hypoglycemic Agents

acarbose oral tablet 100

mg, 25 mg, 50 mg 1

ACTOPLUS MET TABLET 15-

500 MG, 15-850 MG 2


ACTOPLUS MET XR TABLET,

ER MULTIPHASE 24 HR 15-

1,000 MG, 30-1,000 MG

2

ACTOS ORAL TABLET 15

MG, 30 MG, 45 MG 2 QL

BYDUREON

SUBCUTANEOUS PEN

INJECTOR 2 MG/0.65 ML

2

BYDUREON

SUBCUTANEOUS

SUSPENSION, EXTENDED

REL RECON 2 MG

2

BYETTA SUBCUTANEOUS

PEN INJECTOR 10

MCG/DOSE(250 MCG/ML)

2.4 ML, 5 MCG/DOSE (250

MCG/ML) 1.2 ML

2

chlorpropamide oral


CYCLOSET ORAL TABLET

0.8 MG 2

glimepiride oral tablet 1

mg, 2 mg, 4 mg 1

glipizide oral tablet 10 mg,

5 mg 1

glipizide oral tablet


mg, 2.5 mg, 5 mg

1

glipizide-metformin oral

tablet 2.5-250 mg, 2.5-500

mg, 5-500 mg

1

glyburide micronized oral

tablet 1.5 mg, 3 mg, 6 mg 1

glyburide oral tablet 1.25

mg, 2.5 mg, 5 mg 1



58


glyburide-metformin oral

tablet 1.25-250 mg, 2.5-

500 mg, 5-500 mg

1

INVOKAMET ORAL TABLET

150-1,000 MG, 150-500

MG, 50-1,000 MG, 50-500

MG

2

INVOKAMET XR ORAL

TABLET, IR - ER, BIPHASIC

24HR 150-1,000 MG, 150-

500 MG, 50-1,000 MG, 50-

500 MG

2

INVOKANA ORAL TABLET

100 MG, 300 MG 2

JANUMET ORAL TABLET 50-

1,000 MG, 50-500 MG 2 ST

JANUMET XR ORAL TABLET,

ER MULTIPHASE 24 HR 100-

1,000 MG, 50-1,000 MG,

50-500 MG

2 ST

JANUVIA ORAL TABLET 100

MG, 25 MG, 50 MG 2 ST

JARDIANCE ORAL TABLET

10 MG, 25 MG 2

JENTADUETO ORAL TABLET

2.5-1,000 MG, 2.5-500 MG,

2.5-850 MG

2 ST

KOMBIGLYZE XR ORAL

TABLET, ER MULTIPHASE 24

HR 2.5-1,000 MG, 5-1,000

MG, 5-500 MG

2 ST

metformin oral tablet

1,000 mg, 500 mg, 850 mg 1



500 mg, 750 mg

1



extended release 24hr

1,000 mg, 500 mg

1

metformin oral tablet, er

gast. retention 24 hr 1,000

mg, 500 mg

1

miglitol oral tablet 100 mg,

25 mg, 50 mg 1

nateglinide oral tablet 120

mg, 60 mg 1

ONGLYZA ORAL TABLET 2.5

MG, 5 MG 2 PA; ST

pioglitazone oral tablet 15

mg, 30 mg, 45 mg 1 QL

pioglitazone-glimepiride

tablet 30-2 mg, 30-4 mg 1

pioglitazone-metformin


850 mg

1

PRANDIN ORAL TABLET 1

MG, 2 MG 2

repaglinide oral tablet 0.5

mg, 1 mg, 2 mg 1

repaglinide-metformin

tablet 1-500 mg, 2-500 mg 1

RIOMET ORAL SOLN 500

MG/5 ML 2

SYMLINPEN 120 PEN

INJECTOR 2,700 MCG/2.7

ML

2 PA

SYMLINPEN 60 PEN

INJECTOR 1,500 MCG/1.5

ML

2 PA



59


SYNJARDY ORAL TABLET

12.5-1,000 MG, 12.5-500

MG, 5-1,000 MG, 5-500

MG

2

TANZEUM SUBCUTANEOUS

PEN INJECTOR 30 MG/0.5

ML, 50 MG/0.5 ML

2

tolazamide oral tablet 250

mg, 500 mg 1

tolbutamide oral tablet

500 mg 1

TRADJENTA TABLET 5 MG 2 ST

VICTOZA 2-PAK

SUBCUTANEOUS PEN

INJECTOR 0.6 MG/0.1 ML

(18 MG/3 ML)

2 PA; QL

VICTOZA 3-PAK

SUBCUTANEOUS PEN

INJECTOR 0.6 MG/0.1 ML

(18 MG/3 ML)

2 PA; QL

Thyroid Hormones

ARMOUR THYROID ORAL

TABLET 120 MG, 15 MG,

180 MG, 240 MG, 30 MG,

300 MG, 60 MG, 90 MG

2

levothyroxine oral tablet

100 mcg, 112 mcg, 125


175 mcg, 200 mcg, 25

mcg, 300 mcg, 50 mcg, 75

mcg, 88 mcg

1

levoxyl oral tablet 100


137 mcg, 150 mcg, 175

mcg, 200 mcg, 25 mcg, 50

mcg, 75 mcg, 88 mcg

1

liothyronine oral tablet 25

mcg, 5 mcg, 50 mcg 1


nature-throid oral tablet

113.75 mg, 130 mg, 146.25

mg, 16.25 mg, 162.5 mg,

195 mg, 260 mg, 32.5 mg,

325 mg, 48.75 mg, 65 mg,

81.25 mg, 97.5 mg

1

np thyroid oral tablet 120

mg, 15 mg, 30 mg, 60 mg,

90 mg

1

SYNTHROID ORAL TABLET

100 MCG, 112 MCG, 125

MCG, 137 MCG, 150

MCG, 175 MCG, 200

MCG, 25 MCG, 300 MCG,

50 MCG, 75 MCG, 88

MCG

2

thyroid (pork) oral tablet

30 mg, 60 mg, 90 mg 1

unithroid oral tablet 100


137 mcg, 150 mcg, 175


300 mcg, 50 mcg, 75 mcg,

88 mcg

1

westhroid oral tablet 130

mg, 195 mg, 32.5 mg, 65

mg, 97.5 mg

1

WP THYROID ORAL TABLET

113.75 MG, 16.25 MG,

48.75 MG, 97.5 MG

2

GASTROENTEROLOGY

Antidiarrheals & Antispasmodics

anaspaz oral tablet,

disintegrating 0.125 mg 1

belladonna alkaloids-

opium rectal suppository

16.2-60 mg

1



60


belladonna-opium rectal

suppository 16.2-30 mg 1

chlordiazepoxide-

clidinium oral capsule 5-

2.5 mg

1

dicyclomine oral capsule

10 mg 1

dicyclomine soln 10 mg/5

ml 1

dicyclomine tablet 20 mg 1

diphenoxylate-atropine

oral liquid 2.5-0.025 mg/5

ml

1

diphenoxylate-atropine

oral tablet 2.5-0.025 mg 1

ed-spaz oral tablet,


glycopyrrolate oral tablet

1 mg, 2 mg 1

hyoscyamine sulfate oral

drops 0.125 mg/ml 1


elixir 0.125 mg/5 ml 1


tablet 0.125 mg 1



12 hr 0.375 mg

1


tablet, disintegrating 0.125

mg

1

hyoscyamine sulfate

sublingual tablet 0.125 mg 1

hyosyne oral drops 0.125

mg/ml 1


hyosyne oral elixir 0.125

mg/5 ml 1

LEVSIN/SL SUBLINGUAL

TABLET 0.125 MG 2

methscopolamine oral

tablet 2.5 mg, 5 mg 1

oscimin tablet 0.125 mg 1

oscimin oral tablet,


oscimin sl sublingual tablet

0.125 mg 1

oscimin sr oral tablet


0.375 mg

1

paregoric oral liquid 2

mg/5 ml 1

phenohytro oral tablet

16.2-0.1037 -0.0194 mg 1

propantheline oral tablet

15 mg 1

ROBINUL FORTE ORAL

TABLET 2 MG 2

symax fastabs oral tablet,


symax-sl sublingual tablet

0.125 mg 1

symax-sr oral tablet


0.375 mg

1

Miscellaneous Gastrointestinal Agents

ACTIGALL ORAL CAPSULE

300 MG 2

alophen oral tablet, del-

rel (dr/ec) 5 mg $0



61


AMITIZA ORAL CAPSULE 24

MCG, 8 MCG 2 PA

ANALPRAM-HC RECTAL

CREAM 1-1 %, 2.5-1 % 2

ANALPRAM-HC SINGLES

RECTAL CREAM 2.5-1 %

(4G)

2

ANUSOL-HC TOPICAL

CREAM WITH PERINEAL

APPLICATOR 2.5 %

2

aprepitant oral capsule

125 mg, 40 mg, 80 mg 1 QL

aprepitant oral capsule,

dose pack 125 mg (1)- 80

mg (2)

1 QL

APRISO ORAL CAPSULE,


0.375 GRAM

2

balsalazide oral capsule

750 mg 1

bisacodyl oral tablet, del-

rel (dr/ec) 5 mg $0

bisa-lax oral tablet, del-rel

(dr/ec) 5 mg $0

budesonide oral capsule,

delayed, ext-rel 3 mg 1

calcium acetate oral

capsule 667 mg 1

calcium acetate oral

tablet 667 mg 1

CALCIUM ACETATE ORAL

TABLET 668 MG (169 MG

CALCIUM)

1

CANASA RECTAL

SUPPOSITORY 1,000 MG 2


CHENODAL ORAL TABLET

250 MG 2 PA; SP; LA

citrate of magnesia oral

soln $0

citroma oral soln $0

clearlax oral powder 17

gram/dose $0

colocort rectal enema

100 mg/60 ml 1

compro rectal suppository

25 mg 1

constulose oral soln 10

gram/15 ml 1

CORTENEMA RECTAL

ENEMA 100 MG/60 ML 2

CORTIFOAM RECTAL

FOAM 10 % (80 MG) 2

CREON ORAL CAPSULE,


12,000-38,000 -60,000 UNIT,

24,000-76,000 -120,000

UNIT, 3,000-9,500- 15,000

UNIT, 36,000-114,000-

180,000 UNIT, 6,000-19,000

-30,000 UNIT

2

cromolyn oral

concentrate 100 mg/5 ml 1

DELZICOL ORAL CAPSULE

(WITH DEL REL TABLETS) 400

MG

2

DIPENTUM ORAL CAPSULE

250 MG 2

dronabinol oral capsule

10 mg, 2.5 mg, 5 mg 1

ducodyl oral tablet, del-rel

(dr/ec) 5 mg $0



62


eliphos oral tablet 667 mg 1

EMEND ORAL CAPSULE

125 MG, 40 MG, 80 MG 2 QL

EMEND ORAL

CAPSULE,DOSE PACK 125

MG (1)- 80 MG (2)

2 QL

ENTOCORT EC ORAL

CAPSULE, DELAYED,

EXTEND.RELEASE 3 MG

2

enulose oral soln 10

gram/15 ml 1

fleet laxative oral tablet,

del-rel (dr/ec) 5 mg $0

FOSRENOL ORAL TABLET,

CHEWABLE 500 MG, 750

MG

2

gavilyte-c oral recon soln

240-22.72-6.72 -5.84 gram $0

gavilyte-g oral recon soln

236-22.74-6.74 -5.86 gram $0

gavilyte-n oral recon soln

420 gram $0

generlac oral soln 10

gram/15 ml 1

gentle laxative oral tablet,


GOLYTELY ORAL POWDER

IN PACKET 227.1-21.5-6.36

GRAM

2

GOLYTELY ORAL RECON

SOLN 236-22.74-6.74 -5.86

GRAM

2

granisetron hcl oral tablet

1 mg 1 QL

hemmorex-hc rectal

suppository 25 mg, 30 mg 1


hydrocortisone rectal

enema 100 mg/60 ml 1


cream with perineal

applicator 1 %, 2.5 %

1

hydrocortisone-pramoxine

rectal cream 2.5-1 % 1

kionex (with sorbitol) oral

suspension 15-19.3

gram/60 ml

1

kionex oral powder 1

KRISTALOSE ORAL PACKET

10 GRAM, 20 GRAM 2

lactulose oral soln 10

gram/15 ml 1

lanthanum oral tablet,

chewable 1,000 mg, 500

mg, 750 mg

1

laxaclear oral powder 17

gram/dose $0

laxative (bisacodyl) oral

tablet 5 mg $0

laxative (bisacodyl) oral


(dr/ec) 5 mg

$0

laxative feminine oral

tablet 5 mg $0

LIALDA ORAL TABLET,

DELAYED RELEASE (DR/EC)

1.2 GRAM

2

lidocaine hcl-

hydrocortisone ac rectal

cream 3-0.5 %

1

lidocaine hcl-

hydrocortisone ac rectal

kit 3-0.5 %, 3-1 % (7 gram)

1



63


lidocaine-hydrocortisone-

aloe rectal gel 2.8-0.55 % 1


aloe rectal kit 2-2 %, 3-2.5

% (7 gram)

1

LINZESS ORAL CAPSULE 145

MCG, 290 MCG, 72 MCG 2 PA

magnesium citrate oral

soln $0

mesalamine oral tablet,


1.2 gram

1

mesalamine rectal enema

4 gram/60 ml 1

metoclopramide hcl oral

soln 5 mg/5 ml 1




tablet, disintegrating 10

mg, 5 mg

1

milk of magnesia

concentrated oral

suspension 2,400 mg/10 ml

$0

milk of magnesia oral

suspension 400 mg/5 ml $0

MOVIPREP ORAL POWDER

IN PACKET 100-7.5-2.691

GRAM

2

NULYTELY WITH FLAVOR

PACKS ORAL RECON SOLN

420 GRAM

2

ondansetron hcl oral soln

4 mg/5 ml 1

ondansetron hcl oral



ondansetron oral tablet,

disintegrating 4 mg, 8 mg 1

oral saline laxative oral

liquid 7.2-2.7 gram/15 ml $0

peg 3350-electrolytes oral

recon soln 236-22.74-6.74 -

5.86 gram, 240-22.72-6.72 -

5.84 gram

$0

peg3350 oral powder 17

gram/dose $0

peg-electrolyte soln oral

recon soln 420 gram $0

peg-prep oral kit 5-210

mg-gram $0

PENTASA ORAL CAPSULE,


MG, 500 MG

2

PHOSLYRA ORAL SOLN 667

MG (169 MG CALCIUM)/5

ML

2

phosphate laxative oral

liquid 7.2-2.7 gram/15 ml $0

polyethylene glycol 3350

oral powder 17

gram/dose

$0


oral powder in packet 17

gram

$0

pramcort rectal cream 1-1

% 1

prochlorperazine maleate

oral tablet 10 mg, 5 mg 1

prochlorperazine rectal

suppository 25 mg 1

PROCTOFOAM HC RECTAL

FOAM 1-1 % 2



64


procto-med hc topical

cream with perineal

applicator 2.5 %

1

proctosol hc topical

cream with perineal

applicator 2.5 %

1

proctozone-hc topical

cream with perineal

applicator 2.5 %

1

RECTIV RECTAL OINTMENT

0.4 % (W/W) 2

RENAGEL ORAL TABLET 400

MG, 800 MG 2

RENVELA ORAL POWDER

IN PACKET 0.8 GRAM, 2.4

GRAM

2

RENVELA ORAL TABLET 800

MG 2

ROWASA RECTAL ENEMA

KIT 4 GRAM/60 ML 2

scopolamine base

transdermal patch 3 day 1

mg over 3 days

1

sevelamer carbonate oral

tablet 800 mg 1

SFROWASA RECTAL

ENEMA 4 GRAM/60 ML 2

sodium polystyrene

sulfonate oral powder 1

sodium polystyrene

sulfonate oral suspension

15 gram/60 ml

1

sodium polystyrene

sulfonate rectal enema 30

gram/120 ml

1


sps (with sorbitol) oral

suspension 15-20 gram/60

ml

1

sps (with sorbitol) rectal

enema 30-40 gram/120 ml 1

SUCRAID ORAL SOLN 8,500

UNIT/ML 2 PA; SP

sulfasalazine oral tablet

500 mg 1

sulfasalazine oral tablet,


500 mg

1

SUPREP BOWEL PREP KIT

ORAL RECON SOLN 17.5-

3.13-1.6 GRAM

2

TRANSDERM-SCOP

TRANSDERMAL PATCH 3

DAY 1 MG OVER 3 DAYS

2

trilyte with flavor packets

oral recon soln 420 gram $0

trimethobenzamide oral

capsule 300 mg 1

UCERIS ORAL TABLET,

DELAYED AND EXT.RELEASE

9 MG

2 ST

UCERIS RECTAL FOAM 2

MG/ACTUATION 2

ursodiol capsule 300 mg 1

ursodiol oral tablet 250

mg, 500 mg 1

VIBERZI ORAL TABLET 100

MG, 75 MG 2

woman's laxative tablet,


women's laxative

(bisacodyl) tablet 5 mg $0



65


ZENPEP ORAL CAPSULE,


10,000-34,000 -55,000 UNIT,

15,000-51,000 -82,000 UNIT,

20,000-68,000 -109,000

UNIT, 25,000-85,000-

136,000 UNIT, 3,000-10,000-

16,000 UNIT, 40,000-

136,000- 218,000 UNIT,

5,000-17,000 -27,000 UNIT

2

Ulcer Therapy

amoxicil-clarithromy-

lansopraz oral combo

pack 500-500-30 mg

1 QL

CARAFATE ORAL TABLET 1

GRAM 2

cimetidine hcl oral soln

300 mg/5 ml 1

cimetidine oral tablet 300

mg, 400 mg, 800 mg 1

esomeprazole magnesium

oral capsule, delayed

release(dr/ec) 40 mg

1 QL

famotidine oral suspension

40 mg/5 ml (8 mg/ml) 1

famotidine oral tablet 40

mg 1

lansoprazole oral capsule,

delayed release(dr/ec) 30

mg

1

misoprostol oral tablet 100

mcg, 200 mcg 1

nizatidine oral capsule 150

mg, 300 mg 1

nizatidine oral soln 150

mg/10 ml 1


omeprazole oral capsule,

del-rel(dr/ec) 10 mg, 20

mg, 40 mg

1

pantoprazole oral tablet,


20 mg, 40 mg

1

PYLERA ORAL CAPSULE

140-125-125 MG 2

rabeprazole oral tablet,


20 mg

1

ranitidine hcl oral capsule

300 mg 1

ranitidine hcl oral syrup 15

mg/ml 1

ranitidine hcl oral tablet

300 mg 1

sucralfate oral tablet 1

gram 1

IMMUNOLOGY, VACCINES &

BIOTECHNOLOGY

Growth Hormones

GENOTROPIN MINIQUICK


0.2 MG/0.25 ML, 0.4

MG/0.25 ML, 0.6 MG/0.25

ML, 0.8 MG/0.25 ML, 1

MG/0.25 ML, 1.2 MG/0.25

ML, 1.4 MG/0.25 ML, 1.6

MG/0.25 ML, 1.8 MG/0.25

ML, 2 MG/0.25 ML

2 PA; SP

GENOTROPIN

SUBCUTANEOUS

CARTRIDGE 12 MG/ML (36

UNIT/ML), 5 MG/ML (15

UNIT/ML)

2 PA; SP



66


NORDITROPIN FLEXPRO

SUBCUTANEOUS PEN

INJECTOR 10 MG/1.5 ML

(6.7 MG/ML), 15 MG/1.5

ML (10 MG/ML), 30 MG/3

ML (10 MG/ML), 5 MG/1.5

ML (3.3 MG/ML)

2 PA; SP

Interferons

AUBAGIO ORAL TABLET 14

MG, 7 MG 2 PA; SP

AVONEX (WITH ALBUMIN)

INTRAMUSCULAR KIT 30

MCG

1 PA; SP; QL

AVONEX INTRAMUSCULAR

PEN INJECTOR KIT 30

MCG/0.5 ML

2 PA; SP

BETASERON

SUBCUTANEOUS KIT 0.3 MG 2 PA; SP; QL

COPAXONE


20 MG/ML

2 PA; SP; QL

GILENYA ORAL CAPSULE

0.5 MG 2 PA; SP

moderiba dose pack oral

tablets, dose pack 200 mg

(28)- 400 mg (28), 400-400

mg (28)-mg (28), 600-400

mg (28)-mg (28), 600-600

mg (28)-mg (28)

1

moderiba oral tablet 200

mg 1

PEGASYS PROCLICK

SUBCUTANEOUS PEN

INJECTOR 135 MCG/0.5

ML, 180 MCG/0.5 ML

2 SP

PEGASYS SUBCUTANEOUS

SOLN 180 MCG/ML 2 SP


PEGASYS SUBCUTANEOUS

SYRINGE 180 MCG/0.5 ML 2 SP

PEGINTRON

SUBCUTANEOUS KIT 50

MCG/0.5 ML

2 SP

REBIF (WITH ALBUMIN)


22 MCG/0.5 ML, 44

MCG/0.5 ML

2 PA; SP

REBIF REBIDOSE

SUBCUTANEOUS PEN

INJECTOR 22 MCG/0.5 ML,

44 MCG/0.5 ML,

8.8MCG/0.2ML-22

MCG/0.5ML (6)

2 PA; SP

REBIF TITRATION PACK


8.8MCG/0.2ML-22

MCG/0.5ML (6)

2 PA; SP

ribasphere oral capsule

200 mg 1

ribasphere oral tablet 200

mg, 400 mg, 600 mg 1

ribavirin oral capsule 200

mg 1

ribavirin oral tablet 200 mg 1

Interleukins

ACTIMMUNE


MCG/0.5 ML

2 PA; SP

ARCALYST SUBCUTANEOUS

RECON SOLN 220 MG 2 PA; SP

imiquimod topical cream

in packet 5 % 1 QL

ZYCLARA TOPICAL CREAM

IN METERED-DOSE PUMP

2.5 %, 3.75 %

2 QL



67


ZYCLARA TOPICAL CREAM

IN PACKET 3.75 % 2 QL

Vaccines & Miscellaneous

Immunologicals

GRASTEK SUBLINGUAL

TABLET 2,800 BAU 2 PA

RAGWITEK SUBLINGUAL

TABLET 12 AMB A 1 UNIT 2 PA

MUSCULOSKELETAL & RHEUMATOLOGY

Gout Therapy

allopurinol oral tablet 100

mg, 300 mg 1

MITIGARE ORAL CAPSULE

0.6 MG 2

probenecid oral tablet

500 mg 1

probenecid-colchicine

oral tablet 500-0.5 mg 1

ULORIC ORAL TABLET 40

MG, 80 MG 2 ST

Osteoporosis Therapy

ACTONEL ORAL TABLET

150 MG, 35 MG, 5 MG 2

alendronate oral soln 70

mg/75 ml 1

alendronate oral tablet 10

mg, 5 mg 1 QL

alendronate oral tablet 35

mg, 70 mg 1

FORTEO SUBCUTANEOUS

PEN INJECTOR 20

MCG/DOSE - 600

MCG/2.4 ML

2 PA; SP

ibandronate oral tablet

150 mg 1


raloxifene oral tablet 60

mg $0

risedronate oral tablet 150

mg, 35 mg, 5 mg 1

risedronate oral tablet,


35 mg

1

TYMLOS SUBCUTANEOUS

PEN INJECTOR 80 MCG

(3,120 MCG/1.56 ML)

2 PA; SP; QL

Other Rheumatologicals

CUPRIMINE ORAL CAPSULE

250 MG 2

DEPEN TITRATABS ORAL

TABLET 250 MG 2

ENBREL SUBCUTANEOUS

RECON SOLN 25 MG (1

ML)

2 PA; SP

ENBREL SUBCUTANEOUS

SYRINGE 25 MG/0.5ML

(0.51), 50 MG/ML (0.98 ML)

2 PA; SP

ENBREL SURECLICK

SUBCUTANEOUS PEN

INJECTOR 50 MG/ML (0.98

ML)

2 PA; SP

HUMIRA PEDIATRIC

CROHN'S START


KIT 40 MG/0.8 ML

2 PA; SP; QL

HUMIRA PEN CROHN'S-UC-

HS START SUBCUTANEOUS

PEN INJECTOR KIT 40

MG/0.8 ML

2 PA; SP; QL

HUMIRA PEN

SUBCUTANEOUS PEN

INJECTOR KIT 40 MG/0.8

ML

2 PA; SP; QL



68


HUMIRA SUBCUTANEOUS

SYRINGE KIT 10 MG/0.2 ML,

20 MG/0.4 ML, 40 MG/0.8

ML

2 PA; SP; QL

leflunomide oral tablet 10

mg, 20 mg 1 QL

RIDAURA ORAL CAPSULE 3

MG 2

SAVELLA ORAL TABLET 100

MG, 12.5 MG, 25 MG, 50

MG

2

SAVELLA ORAL TABLETS,

DOSE PACK 12.5 MG (5)-

25 MG(8)-50 MG(42)

2

OBSTETRICS & GYNECOLOGY

Diaphragms And Other Non-Oral

Contraceptives

CAYA CONTOURED

VAGINAL DIAPHRAGM 60-

85 MM

$0

FC2 FEMALE CONDOM $0

FEMCAP VAGINAL DEVICE

22 MM $0

WIDE-SEAL DIAPHRAGM 60

VAGINAL DIAPHRAGM 60

MM

$0

Estrogens & Progestins

amabelz oral tablet 0.5-

0.1 mg, 1-0.5 mg 1

camila oral tablet 0.35 mg $0 QL

COMBIPATCH

TRANSDERMAL PATCH

SEMIWEEKLY 0.05-0.14

MG/24 HR, 0.05-0.25

MG/24 HR

2


CRINONE VAGINAL GEL 4

% 2

deblitane oral tablet 0.35

mg $0 QL

DELESTROGEN

INTRAMUSCULAR OIL 10

MG/ML, 20 MG/ML, 40

MG/ML

2

DEPO-ESTRADIOL

INTRAMUSCULAR OIL 5

MG/ML

2

DIVIGEL TRANSDERMAL

GEL IN PACKET 0.25

MG/0.25 GRAM (0.1 %),

0.5 MG/0.5 GRAM (0.1 %),

1 MG/GRAM (0.1 %)

2

DUAVEE ORAL TABLET 0.45-

20 MG 2

ELESTRIN TRANSDERMAL

GEL IN METERED-DOSE

PUMP 0.87

GRAM/ACTUATION

2

ENDOMETRIN VAGINAL

INSERT 100 MG 2

errin oral tablet 0.35 mg $0 QL

ESTRACE VAGINAL CREAM

0.01 % (0.1 MG/GRAM) 2

estradiol oral tablet 0.5

mg, 1 mg, 2 mg 1

estradiol transdermal

patch semiweekly 0.025

mg/24 hr, 0.0375 mg/24 hr,

0.05 mg/24 hr, 0.075

mg/24 hr, 0.1 mg/24 hr

1



69


estradiol transdermal

patch weekly 0.025

mg/24hr, 0.0375 mg/24hr,

0.05 mg/24hr, 0.06

mg/24hr, 0.075 mg/24hr,

0.1 mg/24hr

1

estradiol vaginal tablet 10

mcg 1

estradiol valerate


mg/ml, 40 mg/ml

1

estradiol-norethindrone

acet tablet 0.5-0.1 mg, 1-

0.5 mg

1

ESTRING VAGINAL RING 2

MG (7.5 MCG /24 HOUR) 2 QL

ESTROGEL TRANSDERMAL

GEL IN METERED-DOSE

PUMP 1.25 GRAM/ACT.

2

estropipate oral tablet

0.75 mg, 1.5 mg, 3 mg 1

EVAMIST TRANSDERMAL

SPRAY, NON-AEROSOL

1.53 MG/SPRAY (1.7%)

2

FEMHRT LOW DOSE TABLET

0.5-2.5 MG-MCG 2

FEMRING VAGINAL RING

0.05 MG/24HR, 0.1

MG/24HR

2 QL

fyavolv tablet 0.5-2.5 mg-

mcg, 1-5 mg-mcg 1

heather tablet 0.35 mg $0 QL

jencycla tablet 0.35 mg $0 QL

jevantique lo tablet 0.5-

2.5 mg-mcg 1

jinteli tablet 1-5 mg-mcg 1


jolivette tablet 0.35 mg $0 QL

Lopreeza tablet 0.5-0.1

mg, 1-0.5 mg 1

lyza oral tablet 0.35 mg $0 QL

medroxyprogesterone

oral tablet 10 mg, 2.5 mg,

5 mg

1

mimvey lo tablet 0.5-0.1

mg 1

mimvey tablet 1-0.5 mg 1

nora-be oral tablet 0.35

mg $0 QL

norethindrone

(contraceptive) tablet

0.35 mg

$0 QL

norethindrone acetate

tablet 5 mg 1

norethindrone ac-eth

estradiol tablet 0.5-2.5 mg-

mcg, 1-5 mg-mcg

1

norlyda tablet 0.35 mg $0 QL

norlyroc tablet 0.35 mg $0 QL

PREMARIN TABLET 0.3 MG,

0.45 MG, 0.625 MG, 0.9

MG, 1.25 MG

2

PREMARIN VAGINAL

CREAM 0.625 MG/GRAM 2

PREMPHASE TABLET 0.625

MG (14)/ 0.625MG-

5MG(14)

2

PREMPRO TABLET 0.3-1.5

MG, 0.45-1.5 MG, 0.625-2.5

MG, 0.625-5 MG

2



70


progesterone micronized


mg

1

PROMETRIUM ORAL

CAPSULE 100 MG, 200 MG 2

sharobel tablet 0.35 mg $0 QL

VAGIFEM VAGINAL TABLET

10 MCG 2

VIVELLE-DOT

TRANSDERMAL PATCH

SEMIWEEKLY 0.025 MG/24

HR, 0.0375 MG/24 HR, 0.05

MG/24 HR, 0.075 MG/24

HR, 0.1 MG/24 HR

2

yuvafem vaginal tablet 10

mcg 1

Miscellaneous OB/GYN

AVC VAGINAL VAGINAL

CREAM 15 % 2

CLEOCIN VAGINAL

SUPPOSITORY 100 MG 2


vaginal cream 2 % 1

CLINDESSE VAGINAL

CREAM,EXTENDED

RELEASE 2 %

2

CONCEPTROL VAGINAL

GEL 4 % 2

fem ph vaginal gel 0.9-

0.025 % 1

gynol ii vaginal gel 3 % $0

INTRAROSA VAGINAL

INSERT 6.5 MG 2 QL

isoxsuprine tablet 10 mg,

20 mg 1


metronidazole vaginal gel

0.75 % 1

NUVARING VAGINAL RING

0.12-0.015 MG/24 HR $0 QL

OSPHENA ORAL TABLET 60

MG 2

terconazole vaginal

cream 0.4 %, 0.8 % 1 QL

terconazole vaginal

suppository 80 mg 1 QL

TODAY CONTRACEPTIVE

SPONGE VAGINAL

CONTRACEPTIVE SPONGE

1,000 MG

$0

tranexamic acid oral

tablet 650 mg 1 QL

vaginal contraceptive

foam vaginal foam 12.5 % $0

vandazole vaginal gel

0.75 % 1

VCF CONTRACEPTIVE FILM

VAGINAL FILM 28 % 2

VCF CONTRACEPTIVE GEL

VAGINAL GEL 4 % 2

xulane transdermal patch

weekly 150-35 mcg/24 hr $0 QL

Oral Contraceptives & Related Agents

altavera (28) tablet 0.15-

0.03 mg $0 QL

alyacen 1/35 (28) tablet 1-

35 mg-mcg $0 QL

alyacen 7/7/7 (28) tablet

0.5/0.75/1 mg- 35 mcg $0 QL



71


amethia lo tablets, dose

pack,3 month 0.10 mg-20

mcg (84)/10 mcg (7)

$0 QL

amethia tablets, dose


mcg (84)/10 mcg (7)

$0 QL

amethyst tablet 90-20

mcg $0 QL

apri tablet 0.15-0.03 mg $0 QL

aranelle (28) tablet

0.5/1/0.5-35 mg-mcg $0 QL

ashlyna tablets, dose


mcg (84)/10 mcg (7)

$0 QL

aubra tablet 0.1-20 mg-

mcg $0 QL

aviane tablet 0.1-20 mg-

mcg $0 QL

azurette (28) tablet 0.15-

0.02 mgx21 /0.01 mg x 5 $0 QL

balziva (28) tablet 0.4-35

mg-mcg $0 QL

bekyree (28) tablet 0.15-

0.02 mgx21 /0.01 mg x 5 $0 QL

blisovi 24 fe tablet 1 mg-20

mcg (24)/75 mg (4) $0 QL

blisovi fe 1.5/30 (28) tablet

1.5 mg-30 mcg (21)/75 mg

(7)

$0 QL

blisovi fe 1/20 (28) tablet 1

mg-20 mcg (21)/75 mg (7) $0 QL

briellyn tablet 0.4-35 mg-

mcg $0 QL

camrese lo tablets, dose


mcg (84)/10 mcg (7)

$0 QL


camrese tablets, dose


mcg (84)/10 mcg (7)

$0 QL

caziant (28) tablet

0.1/.125/.15-25 mg-mcg $0 QL

chateal tablet 0.15-0.03

mg $0 QL

cryselle (28) tablet 0.3-30

mg-mcg $0 QL

cyclafem 1/35 (28) tablet

1-35 mg-mcg $0 QL

cyclafem 7/7/7 (28) tablet

0.5/0.75/1 mg- 35 mcg $0 QL

cyred tablet 0.15-0.03 mg $0 QL

dasetta 1/35 (28) tablet 1-

35 mg-mcg $0 QL

dasetta 7/7/7 (28) tablet

0.5/0.75/1 mg- 35 mcg $0 QL

daysee tablets, dose


mcg (84)/10 mcg (7)

$0 QL

delyla (28) tablet 0.1-20

mg-mcg $0 QL

desog-

e.estradiol/e.estradiol

tablet 0.15-0.02 mgx21

/0.01 mg x 5

$0 QL

desogestrel-ethinyl

estradiol tablet 0.15-0.03

mg

$0 QL

drospirenone-e.estradiol-

lm.fa tablet 3-0.02-0.451

mg (24) (4)

$0 QL

drospirenone-ethinyl

estradiol tablet 3-0.02 mg,

3-0.03 mg

$0 QL



72


econtra ez tablet 1.5 mg $0

elinest tablet 0.3-30 mg-

mcg $0 QL

emoquette tablet 0.15-

0.03 mg $0 QL

enpresse tablet 50-30

(6)/75-40 (5)/125-30(10) $0 QL

enskyce tablet 0.15-0.03

mg $0 QL

estarylla tablet 0.25-35

mg-mcg $0 QL

ethynodiol diac-eth

estradiol tablet 1-35 mg-

mcg, 1-50 mg-mcg

$0 QL

falmina (28) tablet 0.1-20

mg-mcg $0 QL

fayosim tablets, dose


mcg/ 0.15 mg-25 mcg

$0 QL

femynor tablet 0.25-35

mg-mcg $0 QL

gianvi (28) tablet 3-0.02

mg $0 QL

gildagia tablet 0.4-35 mg-

mcg $0 QL

introvale tablets, dose


mcg

$0 QL

isibloom tablet 0.15-0.03

mg $0 QL

jolessa tablets, dose


mcg

$0 QL

juleber tablet 0.15-0.03 mg $0 QL


junel 1.5/30 (21) tablet 1.5-

30 mg-mcg $0 QL

junel 1/20 (21) tablet 1-20

mg-mcg $0 QL

junel fe 1.5/30 (28) tablet

1.5 mg-30 mcg (21)/75 mg

(7)

$0 QL

junel fe 1/20 (28) tablet 1

mg-20 mcg (21)/75 mg (7) $0 QL

junel fe 24 tablet 1 mg-20

mcg (24)/75 mg (4) $0 QL

kaitlib fe tablet, chewable

0.8mg-25mcg(24) and 75

mg (4)

$0 QL

kariva (28) tablet 0.15-0.02

mgx21 /0.01 mg x 5 $0 QL

kelnor 1/35 (28) tablet 1-35

mg-mcg $0 QL

kimidess (28) tablet 0.15-

0.02 mgx21 /0.01 mg x 5 $0 QL

kurvelo tablet 0.15-0.03

mg $0 QL

l norgest/e.estradiol-

e.estrad tablets, dose


mcg (84)/10 mcg (7), 0.15

mg-20 mcg/ 0.15 mg-25

mcg, 0.15 mg-30 mcg

(84)/10 mcg (7)

$0 QL

larin 1.5/30 (21) tablet 1.5-

30 mg-mcg $0 QL

larin 1/20 (21) tablet 1-20

mg-mcg $0 QL

larin 24 fe tablet 1 mg-20

mcg (24)/75 mg (4) $0 QL



73


larin fe 1.5/30 (28) tablet

1.5 mg-30 mcg (21)/75 mg

(7)

$0 QL

larin fe 1/20 (28) tablet 1

mg-20 mcg (21)/75 mg (7) $0 QL

larissia tablet 0.1-20 mg-

mcg $0 QL

layolis fe tablet, chewable

0.8mg-25mcg(24) and 75

mg (4)

$0 QL

leena 28 tablet 0.5/1/0.5-

35 mg-mcg $0 QL

lessina tablet 0.1-20 mg-

mcg $0 QL

levonest (28) tablet 50-30

(6)/75-40 (5)/125-30(10) $0 QL

levonorgestrel-ethinyl

estrad tablet 0.1-20 mg-

mcg, 0.15-0.03 mg, 90-20

mcg

$0 QL


estrad tablets, dose


mcg

$0 QL

levonorg-eth estrad

triphasic tablet 50-30

(6)/75-40 (5)/125-30(10)

$0 QL

levora-28 tablet 0.15-0.03

mg $0 QL

lillow tablet 0.15-0.03 mg $0 QL

lomedia 24 fe tablet 1 mg-

20 mcg (24)/75 mg (4) $0 QL

loryna (28) tablet 3-0.02

mg $0 QL

low-ogestrel (28) tablet

0.3-30 mg-mcg $0 QL


lutera (28) tablet 0.1-20

mg-mcg $0 QL

marlissa tablet 0.15-0.03

mg $0 QL

melodetta 24 fe tablet,

chewable 1 mg-20

mcg(24) /75 mg (4)

$0 QL

mibelas 24 fe tablet,

chewable 1 mg-20

mcg(24) /75 mg (4)

$0 QL

microgestin 1.5/30 (21)

tablet 1.5-30 mg-mcg $0 QL

microgestin 1/20 (21)

tablet 1-20 mg-mcg $0 QL

microgestin fe 1.5/30 (28)

tablet 1.5 mg-30 mcg

(21)/75 mg (7)

$0 QL

microgestin fe 1/20 (28)

tablet 1 mg-20 mcg

(21)/75 mg (7)

$0 QL

mono-linyah tablet 0.25-35

mg-mcg $0 QL

mononessa (28) tablet

0.25-35 mg-mcg $0 QL

my way tablet 1.5 mg $0

myzilra tablet 50-30 (6)/75-

40 (5)/125-30(10) $0 QL

necon 0.5/35 (28) tablet

0.5-35 mg-mcg $0 QL

necon 1/50 (28) tablet 1-

50 mg-mcg $0 QL

necon 7/7/7 (28) tablet

0.5/0.75/1 mg- 35 mcg $0 QL

next choice one dose

tablet 1.5 mg $0



74


nikki (28) tablet 3-0.02 mg $0 QL

noreth-ethinyl estradiol-

iron tablet, chewable

0.4mg-35mcg(21) and 75

mg (7), 0.8mg-25mcg(24)

and 75 mg (4)

$0 QL


estradiol tablet 1-20 mg-

mcg

$0 QL

norethindrone-e.estradiol-

iron tablet 1 mg-20 mcg

(21)/75 mg (7), 1 mg-20

mcg (24)/75 mg (4)

$0 QL


iron tablet, chewable 1

mg-20 mcg(24) /75 mg (4)

$0 QL

norgestimate-ethinyl

estradiol tablet

0.18/0.215/0.25 mg-25

mcg, 0.18/0.215/0.25 mg-

35 mcg (28), 0.25-35 mg-

mcg

$0 QL

nortrel 0.5/35 (28) tablet

0.5-35 mg-mcg $0 QL

nortrel 1/35 (21) tablet 1-

35 mg-mcg $0 QL

nortrel 1/35 (28) tablet 1-

35 mg-mcg $0 QL

nortrel 7/7/7 (28) tablet

0.5/0.75/1 mg- 35 mcg $0 QL

ocella tablet 3-0.03 mg $0 QL

ogestrel (28) tablet 0.5-50

mg-mcg $0 QL

opcicon one-step tablet

1.5 mg $0

option-2 tablet 1.5 mg $0


orsythia tablet 0.1-20 mg-

mcg $0 QL

philith tablet 0.4-35 mg-

mcg $0 QL

pimtrea (28) tablet 0.15-

0.02 mgx21 /0.01 mg x 5 $0 QL

pirmella tablet 0.5/0.75/1

mg- 35 mcg, 1-35 mg-mcg $0 QL

portia tablet 0.15-0.03 mg $0 QL

previfem tablet 0.25-35

mg-mcg $0 QL

quasense tablets, dose


mcg

$0 QL

rajani tablet 3-0.02-0.451

mg (24) (4) $0 QL

reclipsen (28) tablet 0.15-

0.03 mg $0 QL

rivelsa tablets, dose


mcg/ 0.15 mg-25 mcg

$0 QL

setlakin tablets, dose


mcg

$0 QL

sprintec (28) tablet 0.25-35

mg-mcg $0 QL

sronyx tablet 0.1-20 mg-

mcg $0 QL

syeda tablet 3-0.03 mg $0 QL

tarina fe 1/20 (28) tablet 1

mg-20 mcg (21)/75 mg (7) $0 QL

tilia fe tablet 1-20(5)/1-

30(7) /1mg-35mcg (9) $0 QL



75


tri femynor tablet

0.18/0.215/0.25 mg-35

mcg (28)

$0 QL

tri-estarylla tablet

0.18/0.215/0.25 mg-35

mcg (28)

$0 QL

tri-legest fe tablet 1-

20(5)/1-30(7) /1mg-35mcg

(9)

$0 QL

tri-linyah tablet

0.18/0.215/0.25 mg-35

mcg (28)

$0 QL

tri-lo-estarylla tablet

0.18/0.215/0.25 mg-25

mcg

$0 QL

tri-lo-marzia tablet

0.18/0.215/0.25 mg-25

mcg

$0 QL

tri-lo-sprintec tablet

0.18/0.215/0.25 mg-25

mcg

$0 QL

trinessa (28) tablet

0.18/0.215/0.25 mg-35

mcg (28)

$0 QL

trinessa lo tablet

0.18/0.215/0.25 mg-25

mcg

$0 QL

tri-previfem (28) tablet

0.18/0.215/0.25 mg-35

mcg (28)

$0 QL

tri-sprintec (28) tablet

0.18/0.215/0.25 mg-35

mcg (28)

$0 QL

trivora (28) tablet 50-30

(6)/75-40 (5)/125-30(10) $0 QL


velivet triphasic regimen

(28) tablet 0.1/.125/.15-25

mg-mcg

$0 QL

vestura (28) tablet 3-0.02

mg $0 QL

vienva tablet 0.1-20 mg-

mcg $0 QL

viorele (28) tablet 0.15-

0.02 mgx21 /0.01 mg x 5 $0 QL

vyfemla (28) tablet 0.4-35

mg-mcg $0 QL

wera (28) tablet 0.5-35

mg-mcg $0 QL

wymzya fe tablet,

chewable 0.4mg-

35mcg(21) and 75 mg (7)

$0 QL

zarah tablet 3-0.03 mg $0 QL

zenchent (28) tablet 0.4-

35 mg-mcg $0 QL

zovia 1/35e (28) tablet 1-

35 mg-mcg $0 QL

zovia 1/50e (28) tablet 1-

50 mg-mcg $0 QL

Oxytocics

methergine tablet 0.2 mg 1

OPHTHALMOLOGY

Antibiotics

AZASITE OPHTHALMIC

(EYE) DROPS 1 % 2

bacitracin ophthalmic

(eye) ointment 500

unit/gram

1



76


bacitracin-polymyxin b

ophthalmic (eye)

ointment 500-10,000

unit/gram

1

BESIVANCE OPHTHALMIC

(EYE) DROPS, SUSPENSION

0.6 %

2

CILOXAN OPHTHALMIC

(EYE) OINTMENT 0.3 % 2

ciprofloxacin hcl

ophthalmic (eye) drops

0.3 %

1

erythromycin ophthalmic

(eye) ointment 5

mg/gram (0.5 %)

1

gentamicin ophthalmic

(eye) drops 0.3 % 1

gentamicin ophthalmic

(eye) ointment 0.3 % (3

mg/gram)

1

MOXEZA OPHTHALMIC

(EYE) DROPS, VISCOUS 0.5

%

2

neomycin-bacitracin-

polymyxin ophthalmic

(eye) ointment 3.5-400-

10,000 mg-unit-unit/g

1

neomycin-polymyxin-

gramicidin ophthalmic

(eye) drops 1.75 mg-

10,000 unit-0.025mg/ml

1

ofloxacin ophthalmic

(eye) drops 0.3 % 1

polymyxin b sulf-

trimethoprim ophthalmic

(eye) drops 10,000 unit- 1

mg/ml

1


tobramycin ophthalmic

(eye) drops 0.3 % 1

TOBREX OPHTHALMIC


VIGAMOX OPHTHALMIC

(EYE) DROPS 0.5 % 2

Antivirals

trifluridine ophthalmic

(eye) drops 1 % 1

ZIRGAN OPHTHALMIC

(EYE) GEL 0.15 % 2

Beta-Blockers

betaxolol ophthalmic

(eye) drops 0.5 % 1

BETIMOL OPHTHALMIC

(EYE) DROPS 0.25 %, 0.5 % 2

BETOPTIC S OPHTHALMIC


0.25 %

2

carteolol ophthalmic

(eye) drops 1 % 1

ISTALOL OPHTHALMIC

(EYE) DROPS, ONCE DAILY

0.5 %

2

levobunolol ophthalmic

(eye) drops 0.5 % 1

metipranolol ophthalmic

(eye) drops 0.3 % 1

timolol maleate


0.25 %, 0.5 %

1

timolol maleate

ophthalmic (eye) gel

forming soln 0.25 %, 0.5 %

1



77


TIMOPTIC OCUDOSE (PF)

OPHTHALMIC (EYE)

DROPPERETTE 0.5 %

2

Cholinesterase Inhibitor Miotics

PHOSPHOLINE IODIDE

OPHTHALMIC (EYE) DROPS

0.125 %

2

Cycloplegic Mydriatics

atropine ophthalmic (eye)

drops 1 % 1

atropine ophthalmic (eye)

ointment 1 % 1

CYCLOGYL OPHTHALMIC

(EYE) DROPS 0.5 %, 1 %, 2

%

2

cyclopentolate


0.5 %, 1 %, 2 %

1

homatropaire ophthalmic

(eye) drops 5 % 1

homatropine hbr

ophthalmic (eye) drops 5

%

1

MYDRIACYL OPHTHALMIC

(EYE) DROPS 1 % 2

tropicamide ophthalmic

(eye) drops 0.5 %, 1 % 1

Direct Acting Miotics

pilocarpine hcl


%, 2 %, 4 %

1

Miscellaneous Ophthalmologics

acuicyn topical spray,

non-aerosol 0.01 % 1


ALOCRIL OPHTHALMIC

(EYE) DROPS 2 % 2

ALOMIDE OPHTHALMIC

(EYE) DROPS 0.1 % 2

altacaine ophthalmic

(eye) drops 0.5 % 1

altafluor ophthalmic (eye)

drops 0.25-0.4 % 1

azelastine ophthalmic

(eye) drops 0.05 % 1

BEPREVE OPHTHALMIC

(EYE) DROPS 1.5 % 2

cromolyn ophthalmic

(eye) drops 4 % 1

EMADINE OPHTHALMIC

(EYE) DROPS 0.05 % 2

flucaine ophthalmic (eye)

drops 0.25-0.5 % 1

fluorescein-proparacaine


0.25-0.5 %

1

flurox ophthalmic (eye)

drops 0.25-0.4 % 1

LASTACAFT OPHTHALMIC


PAZEO OPHTHALMIC (EYE)

DROPS 0.7 % 2

proparacaine ophthalmic

(eye) drops 0.5 % 1

RESTASIS MULTIDOSE


0.05 %

2

RESTASIS OPHTHALMIC

(EYE) DROPPERETTE 0.05 % 2



78


tetcaine ophthalmic (eye)

drops 0.5 % 1

tetracaine hcl ophthalmic

(eye) drops 0.5 % 1

XIIDRA OPHTHALMIC (EYE)

DROPPERETTE 5 % 2 QL

Non-Steroidal Anti-Inflammatory

Agents

ACUVAIL (PF)

OPHTHALMIC (EYE)

DROPPERETTE 0.45 %

2

bromfenac ophthalmic


BROMSITE OPHTHALMIC

(EYE) DROPS 0.075 % 2

diclofenac sodium


0.1 %

1

flurbiprofen sodium


0.03 %

1

ILEVRO OPHTHALMIC (EYE)

DROPS, SUSPENSION 0.3 % 2

NEVANAC OPHTHALMIC


0.1 %

2

PROLENSA OPHTHALMIC


Oral Drugs For Glaucoma

acetazolamide oral

capsule, extended

release 500 mg

1

acetazolamide oral tablet

125 mg, 250 mg 1

methazolamide oral



Other Glaucoma Drugs

AZOPT OPHTHALMIC (EYE)

DROPS, SUSPENSION 1 % 2

bimatoprost ophthalmic


COMBIGAN OPHTHALMIC

(EYE) DROPS 0.2-0.5 % 2

COSOPT (PF) OPHTHALMIC

(EYE) DROPPERETTE 2-0.5 % 2

dorzolamide ophthalmic

(eye) drops 2 % 1

dorzolamide-timolol


22.3-6.8 mg/ml

1

latanoprost ophthalmic

(eye) drops 0.005 % 1

LUMIGAN OPHTHALMIC

(EYE) DROPS 0.01 % 2 ST

miostat intraocular soln

0.01 % 1

SIMBRINZA OPHTHALMIC


1-0.2 %

2

TRAVATAN Z OPHTHALMIC

(EYE) DROPS 0.004 % 2 ST

Steroid-Antibiotic Combinations

neomycin-bacitracin-poly-

hc ophthalmic (eye)

ointment 3.5-400-10,000

mg-unit/g-1%

1

neomycin-polymyxin b-

dexameth ophthalmic

(eye) drops, suspension

3.5mg/ml-10,000 unit/ml-

0.1 %

1



79



dexameth ophthalmic

(eye) ointment 3.5 mg/g-

10,000 unit/g-0.1 %

1


ophthalmic (eye) drops,

suspension 3.5-10,000-10

mg-unit-mg/ml

1

PRED-G OPHTHALMIC


0.3-1 %

2

PRED-G S.O.P.

OPHTHALMIC (EYE)

OINTMENT 0.3-0.6 %

2

TOBRADEX OPHTHALMIC

(EYE) OINTMENT 0.3-0.1 % 2

ZYLET OPHTHALMIC (EYE)

DROPS, SUSPENSION 0.3-

0.5 %

2

Steroids

ALREX OPHTHALMIC (EYE)


DUREZOL OPHTHALMIC


FLAREX OPHTHALMIC (EYE)


fluorometholone


suspension 0.1 %

1

FML FORTE OPHTHALMIC


0.25 %

2

FML S.O.P. OPHTHALMIC


LOTEMAX OPHTHALMIC

(EYE) DROPS,GEL 0.5 % 2


LOTEMAX OPHTHALMIC


MAXIDEX OPHTHALMIC


0.1 %

2

PRED MILD OPHTHALMIC


0.12 %

2

prednisolone acetate


suspension 1 %

1

Steroid-Sulfonamide Combinations

sulfacetamide-

prednisolone ophthalmic

(eye) drops 10 %-0.23 %

(0.25 %)

1

Sulfonamides



%

1


ophthalmic (eye)

ointment 10 %

1

Sympathomimetics

ALPHAGAN P


0.1 %, 0.15 %

2

apraclonidine ophthalmic

(eye) drops 0.5 % 1

brimonidine ophthalmic

(eye) drops 0.2 % 1

Vasoconstrictor Decongestants

phenylephrine hcl


%, 2.5 %

1



80


RESPIRATORY, ALLERGY, COUGH &

COLD

Antihistamine & Antiallergenic Agents

carbinoxamine maleate

oral liquid 4 mg/5 ml 1


oral tablet 4 mg 1

cyproheptadine oral syrup

2 mg/5 ml 1

cyproheptadine oral

tablet 4 mg 1

desloratadine oral tablet 5

mg 1

desloratadine tablet,

disintegrating 2.5 mg, 5

mg

1

EPINEPHRINE INJECTION

AUTO-INJECTOR 0.15

MG/0.15 ML, 0.3 MG/0.3

ML

2

EPINEPHRINE INJECTION

AUTO-INJECTOR 0.15

MG/0.3 ML

2 QL

hydroxyzine hcl oral soln

10 mg/5 ml 1

hydroxyzine hcl oral tablet

10 mg, 25 mg, 50 mg 1

hydroxyzine pamoate oral


mg

1

phenadoz rectal

suppository 12.5 mg, 25

mg

1

PHENERGAN INJECTION

SOLN 25 MG/ML, 50

MG/ML

2


phenergan rectal


mg, 50 mg

1

promethazine oral syrup

6.25 mg/5 ml 1

promethazine oral tablet

12.5 mg, 25 mg, 50 mg 1

promethazine rectal


mg, 50 mg

1

promethegan rectal


mg, 50 mg

1

Cough & Cold Therapy

benzonatate oral capsule

100 mg, 150 mg, 200 mg 1

BROMFED DM ORAL SYRUP

2-30-10 MG/5 ML 2

brompheniramine-

pseudoeph-dm oral syrup

2-30-10 mg/5 ml

1

centergy oral drops 1-2

mg/ml 1

cheratussin ac oral liquid

10-100 mg/5 ml 1

codeine-guaifenesin oral

liquid 10-100 mg/5 ml 1

g tussin ac oral liquid 10-

100 mg/5 ml 1

guaiatussin ac oral liquid

10-100 mg/5 ml 1

guaifenesin ac oral liquid

10-100 mg/5 ml 1



81


hydrocodone-

chlorpheniramine oral

suspension, extended rel

12 hr 10-8 mg/5 ml

1

hydrocodone-cpm-

pseudoephed soln 5-4-60

mg/5 ml

1

hydrocodone-

homatropine oral syrup 5-

1.5 mg/5 ml

1

hydrocodone-

homatropine oral tablet 5-

1.5 mg

1

hydromet oral syrup 5-1.5

mg/5 ml 1

lortuss ex oral syrup 30-10-

100 mg/5 ml 1

m-clear wc oral liquid 6.3-

100 mg/5 ml 1

promethazine vc-codeine

oral syrup 6.25-5-10 mg/5

ml

1

promethazine-codeine

oral syrup 6.25-10 mg/5 ml 1

promethazine-dm oral

syrup 6.25-15 mg/5 ml 1

promethazine-phenyleph-

codeine oral syrup 6.25-5-

10 mg/5 ml

1

promethazine-

phenylephrine oral syrup

6.25-5 mg/5 ml

1

relcof c oral liquid 6.3-100

mg/5 ml 1

RESPA-AR ORAL TABLET


8-90-0.24 MG

2


rydex oral liquid 1.3-10-6.3

mg/5 ml 1

TESSALON PERLES ORAL

CAPSULE 100 MG 2

tusnel c oral syrup 30-10-

100 mg/5 ml 1

tussigon oral tablet 5-1.5

mg 1

virtussin ac oral liquid 10-

100 mg/5 ml 1

virtussin dac oral syrup 30-

10-100 mg/5 ml 1

ZODRYL DEC 30 ORAL

SUSPENSION 15-3.5-70

MG/3.5 ML

2

Pulmonary Agents

acetylcysteine soln 100

mg/ml (10 %), 200 mg/ml

(20 %)

1

ADCIRCA ORAL TABLET 20

MG 2 PA; SP

ADEMPAS ORAL TABLET 0.5

MG, 1 MG, 1.5 MG, 2 MG,

2.5 MG

2 PA; SP; LA

ADRENALIN NASAL SOLN 1

MG/ML 2

ADVAIR DISKUS


DEVICE 100-50

MCG/DOSE, 250-50

MCG/DOSE, 500-50

MCG/DOSE

2 QL

AEROSPAN INHALATION

HFA AEROSOL INHALER 80

MCG/ACTUATION

2



82


albuterol sulfate inhalation

soln for nebulization 0.63

mg/3 ml, 1.25 mg/3 ml, 2.5

mg /3 ml (0.083 %), 2.5

mg/0.5 ml, 5 mg/ml

1

albuterol sulfate oral syrup

2 mg/5 ml 1

albuterol sulfate oral

tablet 2 mg, 4 mg 1

albuterol sulfate oral


12 hr 4 mg, 8 mg

1

ALVESCO INHALATION

HFA AEROSOL INHALER

160 MCG/ACTUATION, 80

MCG/ACTUATION

2

ANORO ELLIPTA


DEVICE 62.5-25

MCG/ACTUATION

2

ARMONAIR RESPICLICK

INHALATION AEROSOL

POWDR BREATH

ACTIVATED 113

MCG/ACTUATION, 232

MCG/ACTUATION, 55

MCG/ACTUATION

2 QL

ASMANEX TWISTHALER

INHALATION AEROSOL

POWDR BREATH

ACTIVATED 110 MCG (30

DOSES), 110 MCG (7

DOSES), 220 MCG (120

DOSES), 220 MCG (14

DOSES), 220 MCG (30

DOSES), 220 MCG (60

DOSES)

2


ATROVENT HFA

INHALATION HFA AEROSOL

INHALER 17

MCG/ACTUATION

2

budesonide inhalation

suspension for nebulization

0.25 mg/2 ml, 0.5 mg/2 ml,

1 mg/2 ml

1

budesonide nasal spray,

non-aerosol 32

mcg/actuation

1

COMBIVENT RESPIMAT

INHALATION MIST 20-100

MCG/ACTUATION

2

cromolyn inhalation soln

for nebulization 20 mg/2

ml

1

DULERA INHALATION HFA

AEROSOL INHALER 100-5

MCG/ACTUATION, 200-5

MCG/ACTUATION

2

DYMISTA NASAL SPRAY,

NON-AEROSOL 137-50

MCG/SPRAY

2

ESBRIET ORAL CAPSULE 267

MG 2 PA; SP

ESBRIET ORAL TABLET 267

MG, 801 MG 2 PA; SP

FIRAZYR SUBCUTANEOUS

SYRINGE 30 MG/3 ML 2 PA; SP

FLOVENT DISKUS


DEVICE 100

MCG/ACTUATION, 250

MCG/ACTUATION, 50

MCG/ACTUATION

2



83


FLOVENT HFA INHALATION

HFA AEROSOL INHALER

110 MCG/ACTUATION, 220

MCG/ACTUATION, 44

MCG/ACTUATION

2

flunisolide nasal spray,

non-aerosol 25 mcg (0.025

%)

1

fluticasone nasal spray,

suspension 50

mcg/actuation

1 QL

ipratropium bromide

inhalation soln 0.02 % 1

ipratropium-albuterol

inhalation soln for

nebulization 0.5 mg-3

mg(2.5 mg base)/3 ml

1

KALYDECO ORAL


MG, 75 MG

2 PA; SP

KALYDECO ORAL TABLET

150 MG 2 PA; SP

levalbuterol hcl inhalation

soln for nebulization 0.31

mg/3ml, 0.63 mg/3 ml,

1.25 mg/0.5ml,1.25 mg/3

ml

1

metaproterenol oral syrup

10 mg/5 ml 1

metaproterenol oral


mometasone nasal spray,

non-aerosol 50

mcg/actuation

1 QL

montelukast oral granules

in packet 4 mg 1


montelukast oral tablet 10

mg 1

montelukast oral tablet,

chewable 4 mg, 5 mg 1

NASONEX NASAL SPRAY,

NON-AEROSOL 50

MCG/ACTUATION

2 QL

nebusal inhalation soln for

nebulization 3 % 1

OFEV ORAL CAPSULE 100

MG, 150 MG 2 PA; SP

ORKAMBI ORAL TABLET

100-125 MG, 200-125 MG 2 PA; SP

PERFOROMIST INHALATION


20 MCG/2 ML

2

PROAIR HFA INHALATION

HFA AEROSOL INHALER 90

MCG/ACTUATION

2 QL

PROAIR RESPICLICK

INHALATION AEROSOL

POWDR BREATH

ACTIVATED 90

MCG/ACTUATION

2

PULMICORT FLEXHALER

INHALATION AEROSOL

POWDR BREATH

ACTIVATED 180

MCG/ACTUATION, 90

MCG/ACTUATION

2

PULMICORT INHALATION

SUSPENSION FOR

NEBULIZATION 0.25 MG/2

ML, 0.5 MG/2 ML, 1 MG/2

ML

2

pulmosal inhalation soln

for nebulization 7 % 1



84


PULMOZYME INHALATION

SOLN 1 MG/ML 2 SP

QVAR INHALATION

AEROSOL 40

MCG/ACTUATION, 80

MCG/ACTUATION

2

REVATIO ORAL


10 MG/ML

2 PA; SP

SEREVENT DISKUS


DEVICE 50 MCG/DOSE

2 QL

sildenafil

(antihypertensive) oral

tablet 20 mg

1 PA

SINGULAIR ORAL


MG

2

SINGULAIR ORAL TABLET 10

MG 2

SINGULAIR ORAL TABLET,

CHEWABLE 4 MG, 5 MG 2

sodium chloride inhalation

soln for nebulization 10 %,

3 %, 7 %

1

SPIRIVA WITH HANDIHALER

INHALATION CAPSULE,

W/INHALATION DEVICE 18

MCG

2

STIOLTO RESPIMAT

INHALATION MIST 2.5-2.5

MCG/ACTUATION

2

SYMBICORT INHALATION

HFA AEROSOL INHALER

160-4.5 MCG/ACTUATION,

80-4.5 MCG/ACTUATION

2


terbutaline oral tablet 2.5

mg, 5 mg 1

THEO-24 ORAL CAPSULE,


100 MG, 200 MG, 300 MG,

400 MG

2

theochron oral tablet


100 mg, 200 mg, 300 mg

1

theophylline oral elixir 80

mg/15 ml 1

theophylline oral soln 80

mg/15 ml 1

theophylline oral tablet


100 mg, 200 mg, 300 mg,

450 mg

1

theophylline oral tablet


400 mg, 600 mg

1

TRACLEER ORAL TABLET

125 MG, 62.5 MG 2 PA; SP; LA

VENTAVIS INHALATION


10 MCG/ML

2 PA; SP

VENTOLIN HFA

INHALATION HFA AEROSOL

INHALER 90

MCG/ACTUATION

2

zafirlukast oral tablet 10

mg, 20 mg 1

zileuton oral tablet, er

multiphase 12 hr 600 mg 1

ZYFLO CR ORAL TABLET, ER

MULTIPHASE 12 HR 600 MG 2

ZYFLO ORAL TABLET 600

MG 2



85


UROLOGICALS

Anticholinergics & Antispasmodics

ENABLEX ORAL TABLET


15 MG, 7.5 MG

2

flavoxate tablet 100 mg 1

GELNIQUE TRANSDERMAL

GEL IN METERED-DOSE

PUMP 100MG/GM (10 %)

2

GELNIQUE TRANSDERMAL

GEL IN PACKET 10 % (100

MG/GRAM)

2

oxybutynin chloride oral

syrup 5 mg/5 ml 1


tablet 5 mg 1



24hr 10 mg, 15 mg, 5 mg

1

OXYTROL TRANSDERMAL

PATCH SEMIWEEKLY 3.9

MG/24 HR

2

TOVIAZ ORAL TABLET

EXTENDED RELEASE 24 HR 4

MG, 8 MG

2

VESICARE ORAL TABLET 10

MG, 5 MG 2

Benign Prostatic Hyperplasia (BPH)

Therapy

alfuzosin oral tablet


mg

1

AVODART ORAL CAPSULE

0.5 MG 2

dutasteride oral capsule

0.5 mg 1


dutasteride-tamsulosin

oral capsule, er

multiphase 24 hr 0.5-0.4

mg

1

finasteride oral tablet 5

mg 1

JALYN ORAL CAPSULE, ER

MULTIPHASE 24 HR 0.5-0.4

MG

2

tamsulosin oral capsule,

extended release 24hr 0.4

mg

1

Cholinergic Stimulants

bethanechol chloride oral


mg, 50 mg

1

Miscellaneous Urologicals

CYSTAGON ORAL

CAPSULE 150 MG, 50 MG 2 SP; LA

cytra k crystals oral

packet 3,300-1,002 mg 1

cytra-2 oral soln 500-334

mg/5 ml 1

cytra-3 oral soln 550-500-

334 mg/5 ml 1

cytra-k oral soln 1,100-334

mg/5 ml 1

ELMIRON ORAL CAPSULE

100 MG 2

hyolev mb oral tablet 81-

10.8-40.8 mg 1

hyophen oral tablet 81.6-

0.12-10.8 mg 1

K-PHOS NO 2 ORAL TABLET

305-700 MG 2



86


K-PHOS ORIGINAL ORAL

TABLET,SOLUBLE 500 MG 2

methen-sod phos-meth

blue-hyos oral tablet 81.6-

40.8-0.12 mg

1

ORACIT ORAL SOLN 490-

640 MG/5 ML 2

phosphasal oral tablet

81.6-10.8-40.8 mg 1

pot,sodium citrate-citric

acid oral soln 550-500-334

mg/5 ml

1

potassium citrate oral


10 meq (1,080 mg), 15

meq, 5 meq (540 mg)

1

potassium citrate-citric

acid oral packet 3,300-

1,002 mg

1


acid oral soln 1,100-334

mg/5 ml

1

RENACIDIN IRRIGATION

SOLN 6.602-3.268

GRAM/100 ML

2

SHOHL'S MODIFIED ORAL

SOLN 500-300 MG/5 ML 2

sodium citrate-citric acid

oral soln 500-334 mg/5 ml 1

tricitrates oral soln 550-500-

334 mg/5 ml 1

ur n-c oral tablet 81.6-10.8-

40.8 mg 1

uramit mb oral capsule

118-10-40.8-36 mg 1


URELLE ORAL TABLET 81-

10.8-40.8 MG 2

uretron d-s oral tablet

81.6-10.8-40.8 mg 1

URIBEL ORAL CAPSULE 118-

10-40.8-36 MG 2

urimar-t oral tablet 120-

0.12-10.8 mg 1

urin ds oral tablet 81.6-

10.8-40.8 mg 1

uro-458 oral tablet 81-10.8-

40.8 mg 1

UROCIT-K 10 ORAL TABLET

EXTENDED RELEASE 10

MEQ (1,080 MG)

2


EXTENDED RELEASE 15

MEQ

2


EXTENDED RELEASE 5 MEQ

(540 MG)

2

urogesic-blue oral tablet

81.6-40.8-0.12 mg 1

uro-mp oral capsule 118-

10-40.8-36 mg 1

urophen mb oral tablet

81.6-0.12-10.8 mg 1

uryl oral tablet 81.6-40.8-

0.12 mg 1

ustell oral capsule 120-0.12

mg 1

utira-c oral tablet 81.6-

10.8-40.8 mg 1

virtrate-2 oral soln 500-334

mg/5 ml 1



87


virtrate-3 oral soln 550-500-

334 mg/5 ml 1

virtrate-k oral soln 1,100-

334 mg/5 ml 1

Urinary Anesthetics

phenazopyridine oral


PYRIDIUM ORAL TABLET 100

MG, 200 MG 2

VITAMINS, HEMATINICS &

ELECTROLYTES

Electrolytes

calcium 500 + d oral

tablet 500 mg(1,250mg) -

200 unit

$0

calcium 500 + d oral

tablet, chewable 500

mg(1,250mg) -400 unit

$0

calcium 500 with d oral


400 unit

$0

calcium 600 + d(3) oral

capsule 600 mg calcium-

200 unit

$0

calcium 600 + d(3) oral


200 unit, 600 mg(1,500mg)

-400 unit

$0

calcium 600 with vitamin

d3 oral capsule 600

mg(1,500mg) -400 unit,

600 mg(1,500mg) -500 unit

$0


d3 oral tablet, chewable

600 mg(1,500mg) -400 unit

$0


calcium carbonate-

vitamin d3 oral capsule

600 mg(1,500mg) -400 unit

$0

calcium carbonate-

vitamin d3 oral tablet 500

mg(1,250mg) -125 unit,

500 mg(1,250mg) -200

unit, 500 mg(1,250mg) -

400 unit, 600 mg(1,500mg)

-200 unit, 600

mg(1,500mg) -400 unit,

600 mg(1,500mg) -800 unit

$0

calcium carbonate-

vitamin d3 oral tablet,

chewable 500-100 mg-unit

$0

calcium citrate + d oral

tablet 315-200 mg-unit $0

calcium citrate-vitamin d3

oral tablet 200 mg

calcium -250 unit, 200-125

mg-unit, 250 mg calcium-

200 unit, 315-200 mg-unit,

315-250 mg-unit

$0

citrus calcium oral tablet

200 mg calcium -250 unit,

315-250 mg-unit

$0

effer-k oral tablet,

effervescent 25 meq 1

hi-cal plus vit d oral tablet

500 mg(1,250mg) -200 unit $0

k-effervescent oral tablet,


klor-con 10 oral tablet

extended release 10 meq 1

klor-con 8 oral tablet

extended release 8 meq 1

klor-con m10 oral tablet,er

particles/crystals 10 meq 1



88






klor-con oral packet 20

meq 1

klor-con sprinkle oral

capsule, extended

release 10 meq, 8 meq

1

KLOR-CON/25 ORAL

PACKET 25 MEQ 2

klor-con/ef oral tablet,


k-phos-neutral oral tablet

250 mg 1

k-tab oral tablet extended

release 8 meq 1

lugols oral soln 5 % 1

oysco 500/d oral tablet

500 mg(1,250mg) -200 unit $0

oyster shell + d3 oral tablet

250-125 mg-unit $0

oyster shell calcium-vit d3

oral tablet 250-125 mg-

unit, 500 mg(1,250mg) -

200 unit, 500 mg(1,250mg)

-400 unit

$0

oystercal-d oral tablet 500

mg(1,250mg) -400 unit $0

phospha 250 neutral oral

tablet 250 mg 1

potassium bicarb and

chloride oral tablet,

effervescent 25 meq

1


potassium bicarb-citric

acid oral tablet,

effervescent 25 meq

1

potassium chloride oral

capsule, extended

release 10 meq, 8 meq

1


liquid 20 meq/15 ml, 40

meq/15 ml

1


packet 20 meq 1



10 meq, 20 meq, 8 meq

1


tablet,er particles/crystals

10 meq, 20 meq

1

strong iodine oral soln 5 % 1

virt-phos 250 neutral oral

tablet 250 mg 1

Vitamins & Hematinics

b complex-vitamin b12

oral tablet $0

balanced b-100 complex


release 100 mg

$0

balanced b-100 oral

tablet 0.4 mg $0

balanced b-50 oral tablet $0

b-complex with vitamin c

oral tablet $0

calcium-folic acid-vitamin

d oral wafer 500-50-300-1

mg-mg-unit-mg

1

cholecalciferol (vitamin

d3) oral capsule 1,000 unit $0



89



d3) oral drops 400 unit/ml $0


d3) oral tablet 1,000 unit,

400 unit

$0


d3) oral tablet, chewable

1,000 unit

$0

classic prenatal oral tablet

28 mg iron- 800 mcg $0

complete natal dha oral

combo pack 29-1-250 mg $0

complex b-100 oral tablet

extended release $0

delta d3 oral tablet 400

unit $0

d-vi-sol oral drops 400

unit/ml $0

ergocalciferol (vitamin d2)

oral tablet 400 unit $0

FLUORABON ORAL DROPS

0.25 MG(0.55 MG

S.FLUOR)/0.6 ML

2

fluor-a-day (with xylitol)

oral tablet, chewable 0.25

mg f (0.55 mg)-236.79mg

$0

fluoride (sodium) oral

drops 0.5 mg (1.1 mg

sod.fluorid)/ml

$0

fluoride (sodium) oral

tablet, chewable 0.25

mg(0.55 mg sod. fluoride),

0.5 mg (1.1 mg sodium

fluorid)

$0

fluoritab oral tablet,

chewable 0.5 mg (1.1 mg

sodium fluorid)

$0


FLURA-DROPS ORAL

DROPS 0.25 MG(0.55 MG

SOD.FLUOR)/DROP

2

folic acid oral tablet 1 mg,

400 mcg, 800 mcg $0

foltabs 800 oral tablet 0.8-

10-115 mg-mg-mcg $0

kobee oral tablet 0.4 mg $0

kpn oral tablet $0

KPN ORAL TABLET 9 MG

IRON- 267 MCG 1

ludent fluoride oral tablet,

chewable 0.25 mg(0.55

mg sod. fluoride), 0.5 mg

(1.1 mg sodium fluorid)

$0

multi-vitamin with fluoride

oral drops 0.25 mg/ml, 0.5

mg/ml

$0



mg, 0.5 mg

$0

multivitamins with fluoride


mg, 0.5 mg

$0

multivit-fluor (vit e

acetate) oral drops 0.25

mg/ml

$0

mvc-fluoride oral tablet,

chewable 0.25 mg, 0.5 mg $0

mynatal advance oral

tablet 90-1-50 mg $0

mynatal oral capsule 65

mg iron- 1 mg $0

mynatal oral tablet 90-1-

50 mg $0



90


mynatal plus oral tablet 65

mg iron- 1 mg $0

mynatal-z oral tablet 65

mg iron- 1 mg $0

natural b-100 complex

oral tablet 100 mg $0

one daily prenatal oral

combo pack 28-800-440

mg-mcg-mg

$0


oral tablet 250 (625)-125

mg-unit

$0

pnv 29-1 oral tablet 29 mg

iron- 1 mg $0

prenatabs fa oral tablet

29-1 mg $0

prenatabs rx oral tablet 29

mg iron- 1 mg $0

prenatal complete oral

tablet 14 mg iron- 400

mcg

$0

prenatal formula oral


mcg

$0

PRENATAL FORMULA ORAL

TABLET 9 MG IRON- 267

MCG

1

prenatal multi-dha (algal

oil) oral capsule 27mg

iron- 800 mcg-250 mg

$0

prenatal one daily oral


mcg

$0

prenatal oral tablet 28 mg

iron- 800 mcg $0


prenatal plus (calcium

carb) oral tablet 27 mg

iron- 1 mg

$0

prenatal plus oral tablet

29 mg iron- 1 mg $0

prenatal vitamin oral

tablet , 27 mg iron- 0.8

mg

$0

prenatal vitamin plus low

iron oral tablet 27 mg iron-

1 mg

$0

prenatal vitamin with

minerals oral tablet 28 mg

iron- 800 mcg

$0

prenatal vits96-iron fum-

folic oral tablet 27 mg

iron- 800 mcg

$0

preplus oral tablet 27 mg

iron- 1 mg $0

pretab oral tablet 29-1 mg $0

rena-vite oral tablet 0.8

mg $0

risacal-d oral tablet 105-

120 mg-unit $0

stress formula oral tablet $0

stress formula with iron oral

tablet 500 mg-400 mcg-

18 mg iron

$0

stress formula with

iron(sulf) oral tablet 500

mg-400 mcg- 27 mg iron

$0

super b complex-vitamin c

oral tablet $0

super quints b-50 oral

tablet $0



91


super quints oral tablet 0.4

mg $0

superplex-t oral tablet $0

tl g-fol os oral tablet 500-

1.1 mg 1

total b/c oral tablet $0

trinatal gt oral tablet 90-1-

50 mg $0

trinatal rx 1 oral tablet 60

mg iron-1 mg $0

trinate oral tablet 28 mg

iron- 1 mg $0

tri-vitamin with fluoride

oral drops 0.25 mg fluor.

(0.55 mg)/ml, 0.5 mg

fluoride (1.1 mg)/ml

$0

trust natal dha oral

combo pack 29-1-250 mg $0

ultra b-100 complex oral

tablet $0

vinate one oral tablet 60

mg iron-1 mg $0

virt-advance oral tablet

90-1-50 mg $0


virt-nate oral tablet 28 mg

iron- 1 mg $0

virt-vite gt oral tablet 90-1-

50 mg $0

vit b complex-folic acid

oral tablet 0.4 mg $0

vitamin b complex oral

tablet $0

vitamin d3 oral capsule

1,000 unit, 400 unit $0

vitamin d3 oral tablet

1,000 unit, 400 unit $0

vitamin d3 oral tablet,

chewable 1,000 unit, 400

unit

$0

vitamins a,c,d and fluoride

oral drops 0.25 mg fluor.

(0.55 mg)/ml

$0

vol-nate oral tablet 28 mg

iron- 1 mg $0

vol-plus oral tablet 27 mg

iron- 1 mg $0

vol-tab rx oral tablet 29

mg iron- 1 mg $0

92

INDEX

A abacavir ........................... 5

abacavir-lamivudine ...... 5

abacavir-lamivudine-

zidovudine ..................... 5

ABILIFY MAINTENA .......... 25

acamprosate ................. 50

ACANYA .......................... 43

acarbose ........................ 57

acebutolol ...................... 32

acetaminophen-caff-

dihydrocod ................. 20


...................................... 20

acetazolamide .............. 78

acetic acid ..................... 53

acetylcysteine ................ 81

acitretin ........................... 40

ACTIGALL ........................ 60

ACTIMMUNE .................... 66

ACTONEL ................... 50, 67

ACTOPLUS MET ............... 57

ACTOPLUS MET XR .......... 57

ACTOS ............................. 57

acuicyn ........................... 77

ACUVAIL (PF) .................. 78

acyclovir ..................... 5, 47

ACZONE .......................... 43

adapalene ..................... 43

adapalene-benzoyl

peroxide ...................... 43

ADCIRCA......................... 81

adefovir ............................. 5

ADEMPAS ........................ 81

ADRENALIN ..................... 81

ADVAIR DISKUS ............... 81

ADZENYS XR-ODT............ 25

AEROCHAMBER MINI ..... 55

AEROCHAMBER PLUS

FLOW-VU ...................... 55

AEROCHAMBER PLUS Z

STAT SM MSK ................ 55

AEROSPAN ...................... 81

afeditab cr ...................... 32

ala-cort ........................... 47

ALA-QUIN ........................ 46

ALA-SCALP ...................... 47

ALBENZA .......................... 10

albuterol sulfate ............. 82

alclometasone ............... 47

alendronate ............. 50, 67

alfuzosin........................... 85

ALINIA .............................. 10

allopurinol ....................... 67

ALOCRIL .......................... 77

ALOMIDE ......................... 77

alophen .......................... 60

ALPHAGAN P .................. 79

alprazolam ..................... 25

alprazolam intensol ....... 25

ALREX ............................... 79

ALTABAX .......................... 45

altacaine ........................ 77

altafluor ........................... 77

altavera (28) ................... 70

ALVESCO......................... 82

alyacen 1/35 (28) .......... 70

alyacen 7/7/7 (28) ........ 70

amabelz .......................... 68

amantadine hcl ............... 5

amcinonide .................... 47

amethia .......................... 71

amethia lo ...................... 71

amethyst ......................... 71

AMICAR ........................... 37

amiloride ......................... 32

amiloride-

hydrochlorothiazide .. 32

amiodarone ................... 31

AMITIZA ............................ 61

amitriptyline .................... 25

amitriptyline-

chlordiazepoxide ....... 25

amlodipine ..................... 32

amlodipine-atorvastatin

...................................... 38

amlodipine-benazepril . 32

amlodipine-olmesartan 32

amlodipine-valsartan ... 32

amlodipine-valsartan-

hcthiazid ..................... 32

amoxapine ..................... 25

amoxicil-clarithromy-

lansopraz ..................... 65

amoxicillin ....................... 11

amoxicillin-pot

clavulanate ................ 11

ampicillin ......................... 11

AMPYRA .......................... 19

ANADROL-50 .................. 56

anagrelide ...................... 51

ANALPRAM-HC .............. 61

ANALPRAM-HC SINGLES 61

anaspaz .......................... 59

anastrozole ..................... 13

ANDROGEL ..................... 56

ANDROID ........................ 56

ANORO ELLIPTA ............. 82

ANTABUSE ....................... 51

ANUSOL-HC .................... 61

apexicon e ..................... 47

APIDRA ............................ 55

APIDRA SOLOSTAR......... 55

APOKYN .......................... 17

apraclonidine ................ 79

aprepitant ...................... 61

apri................................... 71

APRISO ............................ 61

APTENSIO XR ................... 25

APTIOM ........................... 14

APTIVUS ..............................5

aranelle (28) ................... 71

ARCALYST ....................... 66

aripiprazole .................... 25

ARISTADA ........................ 25

ARIXTRA ........................... 37

armodafinil ..................... 25

ARMONAIR RESPICLICK 82

ARMOUR THYROID ......... 59

ascomp with codeine .. 20

ashlyna ............................ 71

ASMANEX TWISTHALER .. 82

93

aspirin......................... 22, 23

aspirin low dose ............. 22

aspirin-dipyridamole...... 37

ASTEPRO .......................... 52

ASTRAMORPH-PF ............ 20

atenolol ........................... 32

atenolol-chlorthalidone 32

atorvastatin .................... 38

atovaquone ................... 10

atovaquone-proguanil . 10

ATRIPLA .............................. 5

atropine ........................... 77

ATROVENT HFA ............... 82

AUBAGIO......................... 66

aubra ............................... 71

AUGMENTIN .................... 11

avar .................................. 43

AVC VAGINAL ................ 70

aviane ............................. 71

avidoxy ............................ 12

avita ................................. 43

avo cream ...................... 41

AVODART ........................ 85

AVONEX .......................... 66

AVONEX (WITH ALBUMIN)

...................................... 66

AXERT ............................... 18

AZASITE ............................ 75

azathioprine ................... 13

azelastine .................. 52, 77

AZELEX ............................. 43

AZILECT ............................ 17

azithromycin ..................... 9

AZOPT .............................. 78

azurette (28) ................... 71

B b complex-vitamin b12 . 88

bacitracin ....................... 75

bacitracin-polymyxin b . 76

baclofen ......................... 19

BACTROBAN NASAL....... 52

balanced b-100 ............. 88

balanced b-100 complex

...................................... 88

balanced b-50 ............... 88

balsalazide ...................... 61

balziva (28) ..................... 71

BANZEL ....................... 14, 15

bayer aspirin ................... 23

b-complex with vitamin c

...................................... 88

bekyree (28) ................... 71

belladonna alkaloids-

opium........................... 59

belladonna-opium ........ 60

benazepril ....................... 32

benazepril-


BENZACLIN ...................... 43

BENZACLIN PUMP ........... 43

benzonatate .................. 80

benzphetamine ............. 50

benztropine .................... 17

BEPREVE........................... 77

BESIVANCE ...................... 76

betamethasone

dipropionate .............. 47


...................................... 47

betamethasone,

augmented ................ 47

BETASERON ..................... 66

betaxolol ................... 32, 76

bethanechol chloride... 85

BETHKIS ............................. 10

BETIMOL ........................... 76

BETOPTIC S ...................... 76

bicalutamide ................. 13

BIDIL ................................. 32

BILTRICIDE ........................ 10

bimatoprost .................... 78

bisacodyl ........................ 61

bisa-lax ............................ 61

bisoprolol fumarate ....... 32

bisoprolol-


blisovi 24 fe ..................... 71

blisovi fe 1.5/30 (28) ....... 71

blisovi fe 1/20 (28) .......... 71

bp 10-1 ............................ 43

bp-50% urea ................... 41

BREEZE 2 TEST STRIPS ....... 54

briellyn ............................. 71

BRILINTA ........................... 37

brimonidine .................... 79

BRIVIACT ......................... 15

BROMFED DM ................. 80

bromfenac ..................... 78

bromocriptine ................ 18

brompheniramine-

pseudoeph-dm .......... 80

BROMSITE ........................ 78

budesonide .............. 61, 82

bumetanide ................... 32

BUPHENYL ........................ 51

bupropion hcl ................ 25

bupropion hcl (smoking

deter) ........................... 51

buspirone ........................ 25

butalbital compound

w/codeine .................. 20

butalbital-acetaminop-

caf-cod ....................... 20

butalbital-

acetaminophen ........ 20

butalbital-

acetaminophen-caff 20


................................ 20, 21

butorphanol tartrate ..... 23

BUTRANS .......................... 21

BYDUREON ...................... 57

BYETTA ............................. 57

BYSTOLIC ......................... 32

C cabergoline ................... 56

CADUET ........................... 38

caffeine citrate .............. 51

CALAN SR ....................... 32

calcipotriene.................. 40

calcipotriene-

betamethasone ......... 40

calcitonin (salmon) ....... 56

calcitrene ....................... 40

calcitriol .................... 40, 56

calcium 500 + d ............. 87

calcium 500 with d ........ 87

calcium 600 + d(3) ........ 87

94


d3 .................................. 87

calcium acetate............ 61

CALCIUM ACETATE ........ 61

calcium carbonate-

vitamin d3 ................... 87

calcium citrate + d ........ 87

calcium citrate-vitamin

d3 .................................. 87

calcium-folic acid-vitamin

d .................................... 88

camila ............................. 68

camrese .......................... 71

camrese lo ...................... 71

CANASA .......................... 61

candesartan ................... 32

candesartan-

hydrochlorothiazid ..... 32

capacet .......................... 21

CAPITAL WITH CODEINE 21

captopril .......................... 33

captopril-


CARAC ............................ 42

CARAFATE ....................... 65

CARBAGLU ...................... 51

carbamazepine ............. 15

carbidopa....................... 18

carbidopa-levodopa .... 18

carbidopa-levodopa-

entacapone ............... 18


...................................... 80

carisoprodol ................... 20

carisoprodol-asa-codeine

...................................... 20

carisoprodol-aspirin ....... 20

CARNITOR ....................... 51

CARNITOR (SUGAR-FREE)

...................................... 51

carteolol .......................... 76

cartia xt ........................... 33

carvedilol ........................ 33

CAYA CONTOURED ....... 68

caziant (28) ..................... 71

cefaclor ............................. 8

cefadroxil .......................... 8

cefdinir .......................... 8, 9

cefditoren pivoxil ............. 9

cefixime............................. 9

cefpodoxime ................... 9

cefprozil ............................. 9

CEFTIN ................................ 9

cefuroxime axetil ............. 9

celacyn ........................... 42

celecoxib ........................ 23

CELLCEPT ........................ 13

CELONTIN ........................ 15

cem-urea ........................ 42

centergy ......................... 80

cephalexin ........................ 9

CERDELGA ...................... 56

cevimeline ...................... 51

CHANTIX .......................... 51

CHANTIX CONTINUING

MONTH BOX ................ 51

CHANTIX STARTING

MONTH BOX ................ 52

chateal............................ 71

CHEMET ........................... 51

CHENODAL ..................... 61

cheratussin ac ................ 80

children's aspirin ............. 23

chlordiazepoxide hcl .... 25

chlordiazepoxide-

clidinium ...................... 60

chlorhexidine gluconate

...................................... 52

chloroquine phosphate 10

chlorothiazide ................ 33

chlorpromazine .............. 26

chlorpropamide ............ 57

chlorthalidone ................ 33

chlorzoxazone ................ 20


d3) .......................... 88, 89


sugar) ........................... 38

cholestyramine light ...... 38

choline,magnesium

salicylate ..................... 23

ciclodan .......................... 46

ciclopirox ........................ 46

ciclopirox-ure-camph-

menth-euc .................. 46

cilostazol ......................... 37

CILOXAN ......................... 76

cimetidine ...................... 65

cimetidine hcl ................ 65

CIPRO HC ....................... 53

CIPRODEX ....................... 53

ciprofloxacin .................. 12

ciprofloxacin (mixture) . 11

ciprofloxacin hcl 11, 53, 76

citalopram ...................... 26

citrate of magnesia ...... 61

citroma............................ 61

citrus calcium ................. 87

claravis ............................ 43

clarithromycin ...................9

classic prenatal ............. 89

cleansing wash .............. 43

clearlax ........................... 61

CLEOCIN ......................... 70

clindacin p ..................... 43

CLINDAGEL ..................... 43

clindamycin hcl ............. 10

clindamycin palmitate hcl

...................................... 10

clindamycin pediatric .. 10


................................ 43, 70

clindamycin-benzoyl

peroxide ...................... 43

clindamycin-tretinoin .... 43

CLINDESSE ....................... 70

clobetasol ................. 47, 48

clobetasol-emollient ..... 48

CLOBEX ........................... 48

clodan ............................. 48

clomiphene citrate ....... 56

clomipramine ................. 26

clonazepam ................... 15

clonidine ......................... 33

clonidine hcl................... 33

clopidogrel ..................... 37

clorazepate dipotassium

...................................... 26

95

clorpres ............................ 33

CLORPRES ....................... 33

clotrimazole ...................... 5

clotrimazole-

betamethasone ......... 46

clozapine ........................ 26

CLOZAPINE ...................... 26

COAL TAR ........................ 40

COARTEM ........................ 10

codeine sulfate .............. 21

codeine-guaifenesin ..... 80

colestipol ................... 38, 39

colocort ........................... 61

COMBIGAN ..................... 78

COMBIPATCH ................. 68

COMBIVENT RESPIMAT .. 82

COMBIVIR .......................... 5

COMPLERA ....................... 5

complete natal dha...... 89

complex b-100 ............... 89

compro ........................... 61

COMTAN ......................... 18

CONCEPTROL ................. 70

CONDYLOX ..................... 42

constulose ....................... 61

CONTOUR NEXT EZ METER

...................................... 55

CONTOUR NEXT METER .. 55

CONTOUR NEXT STRIPS .. 54

CONTOUR TEST STRIPS .... 54

COPAXONE .................... 66

CORDRAN ....................... 48

CORDRAN TAPE LARGE

ROLL ............................. 48

COREG CR ...................... 33

CORLANOR ..................... 40

cormax ............................ 48

CORTENEMA ................... 61

CORTIFOAM .................... 61

cortisone ......................... 53

CORTROSYN .................... 53

COSENTYX (2 SYRINGES) 40

COSENTYX PEN (2 PENS) 41

COSOPT (PF) ................... 78

cosyntropin ..................... 53

COTEMPLA XR-ODT ........ 26

COUMADIN .................... 37

CREON ............................ 61

CRINONE ......................... 68

CRIXIVAN .......................... 6

cromolyn ............. 61, 77, 82

cryselle (28)..................... 71

CUPRIMINE ...................... 67

cyclafem 1/35 (28) ........ 71

cyclafem 7/7/7 (28) ...... 71

cyclobenzaprine ........... 20

CYCLOGYL ..................... 77

cyclopentolate .............. 77

CYCLOSERINE ................. 10

CYCLOSET ....................... 57

cyclosporine ................... 13

cyclosporine modified .. 13

cyproheptadine ............ 80

cyred ............................... 71

CYSTAGON ..................... 85

cytra k crystals ................ 85

cytra-2 ............................. 85

cytra-3 ............................. 85

cytra-k ............................. 85

D D.H.E.45 ........................... 18

danazol ........................... 56

dantrolene ...................... 20

dapsone.................... 10, 43

dasetta 1/35 (28) ........... 71

dasetta 7/7/7 (28) ......... 71

daysee ............................ 71

DAYTRANA ...................... 26

DEBACTEROL .................. 52

deblitane ........................ 68

DELESTROGEN ................ 68

delta d3 ........................... 89

deltasone ........................ 53

delyla (28) ....................... 71

DELZICOL ......................... 61

demeclocycline ............ 12

DENAVIR .......................... 47

denta 5000 plus ............. 52

dentagel ......................... 52

DEPEN TITRATABS ............ 67

DEPO-ESTRADIOL ........... 68

DEPO-TESTOSTERONE .... 56

DERMA-SMOOTHE/FS

BODY OIL ..................... 48

DERMA-SMOOTHE/FS

SCALP OIL ................... 48

DESCOVY ...........................6

desipramine ................... 26

desloratadine................. 80

desmopressin ................. 56

desog-

e.estradiol/e.estradiol 71

desogestrel-ethinyl

estradiol ....................... 71

DESONATE ....................... 48

desonide ......................... 48

desoximetasone ............ 48

DESOXYN ........................ 26

DESVENLAFAXINE ........... 26

DESVENLAFAXINE

FUMARATE ................... 26

desvenlafaxine succinate

...................................... 26

dexamethasone ...... 53, 54

dexamethasone intensol

...................................... 53

dexmethylphenidate .... 26

DEXPAK 10 DAY ............. 54

DEXPAK 13 DAY ............. 54

DEXPAK 6 DAY................ 54

dextroamphetamine .... 26

dextroamphetamine-

amphetamine ............ 26

DIASTAT ........................... 15

DIASTAT ACUDIAL .......... 15

diazepam ................. 15, 26

diazepam intensol ......... 26

DIBENZYLINE .................... 33

diclofenac potassium ... 23

diclofenac sodium . 23, 42,

78

diclofenac-misoprostol . 23

dicloxacillin ..................... 11

dicyclomine ................... 60

didanosine .........................6

diethylpropion ............... 50

DIFFERIN .......................... 43

diflorasone ...................... 48

96

diflunisal ........................... 23

digitek .............................. 36

digox ................................ 36

digoxin ............................. 36

dihydroergotamine . 18, 19

DILATRATE-SR .................. 40

diltiazem .......................... 33

dilt-xr ................................ 33

DIOVAN HCT ................... 33

DIPENTUM ........................ 61

diphenoxylate-atropine 60

dipyridamole .................. 37

diskets .............................. 21

disopyramide phosphate

...................................... 31

disulfiram ......................... 51

DIURIL ............................... 33

divalproex ....................... 15

DIVIGEL ............................ 68

dofetilide ......................... 31

donepezil ........................ 19

dorzolamide ................... 78

dorzolamide-timolol ...... 78

DOVONEX ....................... 41

doxazosin ........................ 33

doxepin ..................... 26, 42

doxercalciferol ............... 57

doxycycline hyclate ...... 12

doxycycline

monohydrate ............. 12

drithocreme hp .............. 41

dronabinol ...................... 61

drospirenone-e.estradiol-

lm.fa ............................. 71

drospirenone-ethinyl

estradiol ....................... 71

DROXIA ............................ 13

DUAVEE ........................... 68

ducodyl ........................... 61

DULERA ............................ 82

duloxetine ....................... 26

DUPIXENT ......................... 42

DUREZOL .......................... 79

dutasteride ..................... 85

dutasteride-tamsulosin .. 85

d-vi-sol ............................. 89

DYANAVEL XR ................. 27

DYMISTA .......................... 82

E e.c. prin ........................... 23

e.e.s. 400 ........................... 9

econazole ...................... 46

econtra ez ...................... 72

ecotrin ............................. 23

ecotrin low strength ...... 23

ed-spaz ........................... 60

EDURANT ........................... 6

effer-k .............................. 87

EFFIENT ............................. 37

ELDEPRYL ......................... 18

ELESTRIN ........................... 68

eletone ............................ 42

ELIDEL ............................... 42

elinest .............................. 72

eliphos ............................. 62

ELIQUIS ............................. 37

ELMIRON ......................... 85

EMADINE ......................... 77

EMBEDA ........................... 21

EMCYT ............................. 13

EMEND ............................. 62

emoquette ..................... 72

EMTRIVA ............................ 6

emulsion sb ..................... 42

ENABLEX .......................... 85

enalapril maleate .......... 33

enalapril-


ENBREL ............................. 67

ENBREL SURECLICK ......... 67

endocet .......................... 21

ENDOMETRIN .................. 68

enoxaparin ..................... 37

enpresse .......................... 72

enskyce ........................... 72

entacapone ................... 18

entecavir .......................... 6

ENTOCORT EC ................ 62

ENTRESTO ........................ 40

enulose ............................ 62

EPCLUSA ............................ 6

EPIDUO ............................ 44

EPIDUO FORTE ................ 44

EPIFOAM ......................... 41

EPINEPHRINE ................... 80

EPIVIR ..................................6

EPIVIR HBV .........................6

eplerenone .................... 33

eprosartan ...................... 33

EPZICOM ............................6

ergocalciferol (vitamin

d2) ................................ 89

ergoloid ........................... 27

ERGOMAR ...................... 19

ergotamine-caffeine .... 19

errin .................................. 68

ERTACZO ......................... 46

ery pads .......................... 44

erygel .............................. 44

ERYPED 200 ........................9

ERYPED 400 ........................9

ery-tab ...............................9

ERY-TAB ..............................9

erythrocin (as stearate) ...9

erythromycin .............. 9, 76

erythromycin

ethylsuccinate ..............9


...................................... 44

erythromycin-benzoyl

peroxide ...................... 44

ESBRIET ............................. 82

escitalopram oxalate ... 27

esomeprazole

magnesium ................. 65

estarylla ........................... 72

estazolam ....................... 27

ESTRACE .......................... 68

estradiol .................... 68, 69

estradiol valerate .......... 69

estradiol-norethindrone

acet ............................. 69

ESTRING ........................... 69

ESTROGEL ........................ 69

estropipate ..................... 69

eszopiclone .................... 27

ethacrynic acid ............. 33

ethambutol .................... 10

97

ethosuximide .................. 15

ethyl chloride .................. 45

ethynodiol diac-eth

estradiol ....................... 72

etidronate disodium ...... 51

etodolac ......................... 23

EURAX .............................. 50

EVAMIST ........................... 69

EVEKEO ............................ 27

EVOTAZ .............................. 6

EXELDERM........................ 46

EXELON ............................ 19

exemestane ................... 13

EXJADE ............................ 51

ezetimibe ........................ 39

ezetimibe-simvastatin ... 39

F falmina (28) ..................... 72

famciclovir ........................ 6

famotidine ...................... 65

FANAPT ............................ 27

FARESTON ........................ 13

fayosim ............................ 72

FAZACLO ......................... 27

FC2 FEMALE CONDOM . 68

felbamate ....................... 15

felodipine ........................ 33

fem ph ............................. 70

FEMCAP ........................... 68

FEMHRT LOW DOSE ........ 69

FEMRING .......................... 69

femynor ........................... 72

fenofibrate ...................... 39

fenofibrate micronized . 39

fenofibrate

nanocrystallized ......... 39

fenofibric acid ................ 39

fenofibric acid (choline)

...................................... 39

fenoprofen ...................... 23

fentanyl ........................... 21

fentanyl citrate............... 21

FETZIMA ............................ 27

FINACEA .......................... 44

finasteride ....................... 85

FIRAZYR ............................ 82

FLAREX ............................. 79

flavoxate ......................... 85

flecainide ........................ 31

FLECTOR .......................... 23

fleet laxative ................... 62

FLOVENT DISKUS ............. 82

FLOVENT HFA .................. 83

flucaine ........................... 77

fluconazole ....................... 5

flucytosine ......................... 5

fludrocortisone ............... 54

flunisolide ........................ 83

fluocinolone ................... 48

fluocinolone acetonide

oil .................................. 53

fluocinolone and shower

cap .............................. 48

fluocinonide ............. 48, 49

fluocinonide-e ................ 49

fluocinonide-emollient .. 49

FLUORABON ................... 89

fluor-a-day (with xylitol) 89

fluorescein-proparacaine

...................................... 77

fluoride (sodium) ...... 53, 89

fluoritab ........................... 89

fluorometholone ............ 79

FLUOROPLEX ................... 42

fluorouracil ...................... 42

fluoxetine ........................ 27

FLUOXETINE ..................... 27

fluphenazine decanoate

...................................... 27

fluphenazine hcl ............ 27

FLURA-DROPS ................. 89

flurandrenolide .............. 49

flurazepam ..................... 27

flurbiprofen ..................... 23

flurbiprofen sodium ....... 78

flurox ................................ 77

flutamide......................... 13

fluticasone ................ 49, 83

fluvastatin ....................... 39

fluvoxamine .................... 27

FML FORTE ....................... 79

FML S.O.P. ....................... 79

FOCALIN XR .................... 27

folic acid ......................... 89

foltabs 800 ...................... 89

fondaparinux ................. 37

FORTEO ........................... 67

fosamprenavir ...................6

fosinopril .......................... 34

fosinopril-


FOSRENOL ....................... 62

frovatriptan .................... 19

FURADANTIN ................... 12

furosemide ..................... 34

fyavolv ............................ 69

FYCOMPA ....................... 15

G g tussin ac ....................... 80

gabapentin .................... 15

GABITRIL .......................... 15

galantamine .................. 19

gavilyte-c ........................ 62

gavilyte-g........................ 62

gavilyte-n ........................ 62

GELNIQUE ....................... 85

gemfibrozil ...................... 39

generlac ......................... 62

gengraf ........................... 13

GENOTROPIN ................. 65

GENOTROPIN MINIQUICK

...................................... 65

gentamicin ............... 45, 76

gentle laxative ............... 62

GENVOYA ..........................6

gianvi (28) ....................... 72

gildagia ........................... 72

GILENYA .......................... 66

glimepiride...................... 57

glipizide ........................... 57

glipizide-metformin ....... 57

GLUCAGEN DIAGNOSTIC

KIT ................................. 55

GLUCAGEN HYPOKIT ..... 55

GLUCAGON EMERGENCY

KIT (HUMAN) ................ 55

glyburide ......................... 57

glyburide micronized .... 57

98

glyburide-metformin...... 58

glycopyrrolate ................ 60

glydo ................................ 45

GOLYTELY ........................ 62

GRALISE ........................... 15

GRALISE 30-DAY STARTER

PACK ............................ 15

granisetron hcl ............... 62

GRASTEK .......................... 67

griseofulvin microsize ....... 5

griseofulvin ultramicrosize

........................................ 5

GRIS-PEG

(ULTRAMICROSIZE) ........ 5

guaiatussin ac ................ 80

guaifenesin ac ............... 80

guanfacine ............... 27, 34

guanidine ........................ 27

gynol ii ............................. 70

H HALDOL ........................... 28

HALDOL DECANOATE ... 27

halobetasol propionate 49

HALOG ............................ 49

haloperidol ..................... 28

haloperidol decanoate 28

haloperidol lactate ....... 28

heather ............................ 69

hemmorex-hc ................. 62

hep flush-10 (pf) ............. 37

heparin (porcine) .......... 37

heparin (porcine) in 5 %

dex ............................... 37

heparin (porcine) in nacl

(pf) ................................ 37

heparin flush(porcine)-

0.9nacl ......................... 37

heparin lock flush ........... 37

heparin lock flush

(porcine) ...................... 37

heparin

lockflush(porcine)(pf) 38

heparin(porcine) in 0.45%

nacl .............................. 38

heparin, porcine (pf) ..... 38

HEXALEN .......................... 13

hi-cal plus vit d ............... 87

homatropaire ................. 77

homatropine hbr ........... 77

HORIZANT ........................ 19

hpr .................................... 42

hpr plus ............................ 42

hpr plus hydrogel ........... 42

HUMALOG ...................... 55

HUMALOG MIX 50-50 .... 55

HUMALOG MIX 75-25 .... 55

HUMIRA ........................... 68

HUMIRA PEDIATRIC

CROHN'S START ........... 67

HUMIRA PEN.................... 67

HUMIRA PEN CROHN'S-

UC-HS START ................ 67

HUMULIN 70/30 ............... 55

HUMULIN N ...................... 55

HUMULIN R U-100 ........... 55

HUMULIN R U-500

(CONCENTRATED) ...... 55

hydralazine ..................... 34

hydrochlorothiazide ...... 34

hydrocodone-


hydrocodone-

chlorpheniramine ...... 81

hydrocodone-cpm-

pseudoephed ............ 81

hydrocodone-

homatropine............... 81

hydrocodone-ibuprofen

...................................... 21

hydrocortisone ... 49, 54, 62


...................................... 49

hydrocortisone butyr-

emollient ..................... 49

hydrocortisone valerate49

hydrocortisone-acetic

acid .............................. 53

hydrocortisone-

iodoquinol-aloe.......... 45

hydrocortisone-min oil-

wht pet ........................ 49

hydrocortisone-

pramoxine .................. 62

hydromet ........................ 81

hydromorphone ............ 21

HYDROMORPHONE ....... 21

hydroxychloroquine ...... 10

hydroxyurea ................... 13

hydroxyzine hcl .............. 80

hydroxyzine pamoate .. 80

hyolev mb ....................... 85

hyophen ......................... 85

hyoscyamine sulfate ..... 60

hyosyne ........................... 60

I ibandronate ................... 67

ibuprofen ........................ 23

ibuprofen-oxycodone .. 21

ILEVRO ............................. 78

imipramine hcl ............... 28

imipramine pamoate ... 28

imiquimod....................... 66

indapamide ................... 34

indomethacin ................ 23

INFUMORPH P/F ............. 21

INSULIN SYRINGE-NEEDLE

U-100 ............................ 55

INTELENCE ..........................6

INTRAROSA ..................... 70

introvale .......................... 72

INVEGA SUSTENNA ........ 28

INVEGA TRINZA .............. 28

INVIRASE .............................6

INVOKAMET .................... 58

INVOKAMET XR ............... 58

INVOKANA ...................... 58

IODOFLEX ........................ 42

IODOSORB ...................... 42

ipratropium bromide ... 53,

83

ipratropium-albuterol.... 83

irbesartan........................ 34

irbesartan-


ISENTRESS............................6

ISENTRESS HD .....................6

isibloom ........................... 72

99

isomethepten-caf-

acetaminophen ......... 19

isoniazid ........................... 10

ISORDIL ............................ 40

ISORDIL TITRADOSE ......... 40

isosorbide dinitrate ........ 40

isosorbide mononitrate . 40

isoxsuprine ....................... 70

isradipine ......................... 34

ISTALOL ............................ 76

itraconazole ..................... 5

ivermectin ....................... 10

J JADENU ........................... 51

JADENU SPRINKLE ........... 51

JALYN ............................... 85

jantoven .......................... 38

JANUMET ......................... 58

JANUMET XR .................... 58

JANUVIA .......................... 58

JARDIANCE ..................... 58

jencycla .......................... 69

JENTADUETO ................... 58

jevantique lo .................. 69

jinteli ................................. 69

jolessa .............................. 72

jolivette ............................ 69

juleber .............................. 72

junel 1.5/30 (21) .............. 72

junel 1/20 (21) ................. 72

junel fe 1.5/30 (28) ......... 72

junel fe 1/20 (28) ............ 72

junel fe 24 ........................ 72

K kaitlib fe ........................... 72

KALETRA ............................. 6

KALYDECO ...................... 83

KAPVAY ........................... 28

kariva (28) ....................... 72

k-effervescent ................ 87

kelnor 1/35 (28) .............. 72

KENALOG ........................ 49

ketoconazole ............. 5, 46

ketoprofen ...................... 23

ketorolac ......................... 23

KHEDEZLA ........................ 28

kimidess (28) ................... 72

kionex .............................. 62

kionex (with sorbitol) ..... 62

KITABIS PAK ..................... 10

klor-con ........................... 88

klor-con 10 ...................... 87

klor-con 8 ........................ 87

klor-con m10 ................... 87

klor-con m15 ................... 88

klor-con m20 ................... 88

klor-con sprinkle ............. 88

KLOR-CON/25 ................ 88

klor-con/ef ...................... 88

kobee .............................. 89

KOMBIGLYZE XR ............. 58

KORLYM ........................... 57

K-PHOS NO 2 .................. 85

K-PHOS ORIGINAL .......... 86

k-phos-neutral ................ 88

kpn ................................... 89

KPN................................... 89

KRISTALOSE ..................... 62

k-tab ................................ 88

kurvelo ............................. 72

KUVAN ............................. 57

L l norgest/e.estradiol-

e.estrad ....................... 72

labetalol .......................... 34

lactulose ......................... 62

LAMICTAL ODT ............... 16


(BLUE) ........................... 16


(GREEN) ....................... 16


(ORANGE) ................... 16

LAMICTAL XR .................. 16

LAMICTAL XR STARTER

(BLUE) ........................... 16

LAMICTAL XR STARTER

(GREEN) ....................... 16

LAMICTAL XR STARTER

(ORANGE) ................... 16

lamivudine ........................ 6

lamivudine-zidovudine ... 6

lamotrigine ..................... 16

LANCETS .......................... 55

LANCING DEVICE .......... 55

LANOXIN ......................... 36

lansoprazole ................... 65

lanthanum ...................... 62

LANTUS ............................ 56

LANTUS SOLOSTAR ......... 55

larin 1.5/30 (21) .............. 72

larin 1/20 (21) ................. 72

larin 24 fe ........................ 72

larin fe 1.5/30 (28) .......... 73

larin fe 1/20 (28) ............. 73

larissia .............................. 73

LASTACAFT ...................... 77

latanoprost ..................... 78

LATUDA ........................... 28

laxaclear ......................... 62

laxative (bisacodyl) ...... 62

laxative feminine ........... 62

layolis fe .......................... 73

leena 28 .......................... 73

leflunomide .................... 68

lessina .............................. 73

letrozole .......................... 13

leucovorin calcium ....... 13

LEUKERAN ....................... 13

levalbuterol hcl .............. 83

LEVEMIR ........................... 56

LEVEMIR FLEXTOUCH ..... 56

levetiracetam ................ 16

levobunolol .................... 76

levocarnitine .................. 51

levocarnitine (with sugar)

...................................... 51

levofloxacin .................... 12

levonest (28) ................... 73


estrad .......................... 73

levonorg-eth estrad

triphasic ....................... 73

levora-28 ......................... 73

levorphanol tartrate ..... 21

levothyroxine .................. 59

levoxyl ............................. 59

LEVSIN/SL ......................... 60

100

LEXIVA ................................ 6

LIALDA ............................. 62

lidocaine ......................... 45

lidocaine hcl ................... 45

lidocaine hcl-

hydrocortison ac .. 45, 62

lidocaine viscous ........... 45


aloe .............................. 63

lidocaine-prilocaine ...... 45

LIDODERM ....................... 45

lido-k ................................ 45

lillow ................................. 73

lindane ............................ 50

linezolid ............................ 10

LINZESS ............................. 63

liothyronine ..................... 59

lisinopril ............................ 34

lisinopril-


lite coat aspirin ............... 24

lithium carbonate .......... 28

lithium citrate .................. 28

LOCOID ........................... 49

LODOSYN ........................ 18

lomedia 24 fe ................. 73

lopinavir-ritonavir ............. 6

lopreeza .......................... 69

lorazepam....................... 28

lorazepam intensol ........ 28

lorcet (hydrocodone) ... 21

lorcet hd .......................... 21

lorcet plus........................ 21

lortuss ex .......................... 81

loryna (28) ....................... 73

losartan ............................ 34

losartan-


LOTEMAX ......................... 79

lovastatin ......................... 39

LOVAZA ........................... 39

low-ogestrel (28) ............ 73

loxapine succinate ........ 28

lta pre-attached ............ 45

ludent fluoride ................ 89

lugols .......................... 45, 88

LUMIGAN ......................... 78

lutera (28) ....................... 73

LUXIQ ............................... 49

LYRICA ............................. 16

LYSODREN ....................... 13

lyza ................................... 69

M MACROBID ..................... 12

MACRODANTIN .............. 12

magnesium citrate ........ 63

maprotiline ..................... 28

marlissa ............................ 73

marten-tab ..................... 21

matzim la ........................ 34

MAVYRET ........................... 7

MAXIDEX ......................... 79

MAXZIDE-25MG .............. 34

mb hydrogel ................... 42

mb hydrogel

(cyclomethicone) ...... 42

m-clear wc ..................... 81

meclofenamate ............ 24

MEDROL .......................... 54

medroxyprogesterone .. 69

mefenamic acid ............ 24

mefloquine ..................... 10

MEGACE ES .................... 13

megestrol .................. 13, 14

melodetta 24 fe ............. 73

meloxicam ...................... 24

memantine ..................... 19

MEMANTINE .................... 19

meperidine ..................... 21

MEPHYTON ...................... 38

meprobamate ............... 20

MEPRON .......................... 10

mercaptopurine ............ 14

mesalamine .................... 63

MESNEX ........................... 13

MESTINON ....................... 20

MESTINON TIMESPAN ..... 20

metaproterenol ............. 83

metaxall .......................... 20

metaxalone .................... 20

metformin ....................... 58

methadose ..................... 22

methamphetamine ...... 28

methazolamide ............. 78

methenamine hippurate

...................................... 12

methenamine mandelate

...................................... 12

methen-sod phos-meth

blue-hyos .................... 86

methergine ..................... 75

methimazole .................. 54

METHITEST ........................ 57

methocarbamol ............ 20

methotrexate sodium ... 14


...................................... 14

methscopolamine ......... 60

methyclothiazide .......... 34

methyldopa ................... 34

methyldopa-


methylphenidate hcl ... 28,

29

methylprednisolone ...... 54

methyltestosterone ....... 57

metipranolol ................... 76

metoclopramide hcl ..... 63

metolazone .................... 34

METOPIRONE .................. 51

metoprolol succinate ... 34

metoprolol ta-

hydrochlorothiaz ........ 34

metoprolol tartrate ....... 34

metronidazole .... 10, 44, 70

mexiletine ....................... 31

mibelas 24 fe .................. 73

microgestin 1.5/30 (21) . 73

microgestin 1/20 (21) .... 73

microgestin fe 1.5/30 (28)

...................................... 73

microgestin fe 1/20 (28) 73

midazolam ..................... 29

midodrine ....................... 51

migergot ......................... 19

miglitol ............................. 58

MIGRANAL ...................... 19

milk of magnesia ........... 63

101

milk of magnesia

concentrated ............. 63

millipred ........................... 54

millipred dp ..................... 54

mimvey ............................ 69

mimvey lo........................ 69

minocycline .................... 12

minoxidil .......................... 34

miostat ............................. 78

MIRAPEX ER ..................... 18

mirtazapine ..................... 29

misoprostol ...................... 65

MITIGARE ......................... 67

modafinil ......................... 29

moderiba ........................ 66

moderiba dose pack .... 66

moexipril .......................... 34

moexipril-


mometasone ............ 49, 83

mondoxyne nl ................ 12

mono-linyah.................... 73

mononessa (28) ............. 73

montelukast .................... 83

MONUROL ....................... 12

morgidox ......................... 12

morphine ......................... 22

morphine concentrate . 22

MOVIPREP ....................... 63

MOXEZA .......................... 76

moxifloxacin ................... 12

MUGARD ......................... 53

MULTAQ ........................... 31


...................................... 89

multivitamins with fluoride

...................................... 89

multivit-fluor (vit e

acetate) ...................... 89

mupirocin ........................ 46

mupirocin calcium ........ 46

mvc-fluoride ................... 89

my way ............................ 73

MYCOBUTIN .................... 10

mycophenolate mofetil 14

mycophenolate sodium14

MYDAYIS .......................... 29

MYDRIACYL ..................... 77

mynatal ........................... 89

mynatal advance ......... 89

mynatal plus ................... 90

mynatal-z ........................ 90

myzilra ............................. 73

N nabumetone .................. 24

nadolol ............................ 35

nadolol-

bendroflumethiazide . 35

naftifine ........................... 46

naltrexone ...................... 24

NAMENDA TITRATION PAK

...................................... 19

NAMENDA XR ................. 19

naproxen ........................ 24

naproxen sodium .......... 24

NARCAN ......................... 24

NASONEX ........................ 83

nateglinide ..................... 58

NATROBA ........................ 50

natural b-100 complex . 90

nature-throid .................. 59

NEBUPENT ........................ 10

nebusal ........................... 83

necon 0.5/35 (28) .......... 73

necon 1/50 (28) ............. 73

necon 7/7/7 (28) ............ 73

nefazodone .................... 29

neomycin ........................ 10


poly-hc ........................ 78


polymyxin .................... 76


dexameth ............. 78, 79

neomycin-polymyxin-

gramicidin ................... 76


................................ 53, 79

neuac .............................. 44

NEUPRO ........................... 18

NEVANAC ....................... 78

nevirapine ......................... 7

next choice one dose .. 73

niacin............................... 39

nicardipine ..................... 35

NICODERM CQ .............. 52

nicorelief ......................... 52

nicorette ......................... 52

NICORETTE ...................... 52

nicotine ........................... 52

nicotine (polacrilex) ...... 52

NICOTROL ....................... 52

NICOTROL NS ................. 52

nifedipine ........................ 35

nikki (28) .......................... 74

NILANDRON .................... 14

nilutamide....................... 14

nimodipine ..................... 35

nisoldipine ....................... 35

nitro-bid ........................... 40

nitrofurantoin .................. 13

nitrofurantoin

macrocrystal .............. 13

nitrofurantoin

monohyd/m-cryst ...... 13

nitroglycerin.................... 40

NITROSTAT ....................... 40

NITYR ................................ 51

nivatopic plus................. 42

nizatidine ........................ 65

NIZORAL .......................... 46

nolix ................................. 49

nora-be ........................... 69

NORDITROPIN FLEXPRO 66

noreth-ethinyl estradiol-

iron ............................... 74

norethindrone

(contraceptive) ......... 69

norethindrone acetate 69


estradiol ................. 69, 74


iron ............................... 74

norgestimate-ethinyl

estradiol ....................... 74

NORITATE......................... 44

norlyda ............................ 69

norlyroc ........................... 69

102

NORPACE ........................ 31

NORPACE CR ................. 31

nortrel 0.5/35 (28) ........... 74

nortrel 1/35 (21) .............. 74

nortrel 1/35 (28) .............. 74

nortrel 7/7/7 (28) ............ 74

nortriptyline ..................... 29

NORVIR .............................. 7

NOVOLOG ...................... 56

NOVOLOG FLEXPEN ...... 56

NOVOLOG MIX 70-30 .... 56

NOVOLOG MIX 70-30

FLEXPEN ....................... 56

NOVOLOG PENFILL ........ 56

np thyroid ........................ 59

nts step 1 ......................... 52

NUCYNTA ER ................... 24

NUEDEXTA ....................... 19

NULYTELY WITH FLAVOR

PACKS .......................... 63

NUOX ............................... 44

NUPLAZID ......................... 29

NUVARING ...................... 70

NUVIGIL ........................... 29

nyamyc ........................... 46

nyata ............................... 46

nystatin ........................ 5, 46

nystatin-triamcinolone .. 46

nystop .............................. 47

O ocella ............................... 74

octreotide acetate ....... 14

ODEFSEY ............................ 7

OFEV ................................ 83

ofloxacin ................... 12, 76

ogestrel (28) .................... 74

olanzapine ...................... 29

olanzapine-fluoxetine ... 29

olmesartan ...................... 35

olmesartan-amlodipin-

hcthiazid ...................... 35

olmesartan-


olopatadine ................... 53

omega-3 acid ethyl esters

...................................... 39

omeprazole .................... 65

ondansetron ................... 63

ondansetron hcl ............ 63

one daily prenatal ......... 90

ONFI ........................... 16, 17

ONGLYZA ........................ 58

opcicon one-step ......... 74

option-2 ........................... 74

ORACIT ............................ 86

oral saline laxative ......... 63

oralone ............................ 53

ORAP ............................... 29

ORAPRED ODT ................ 54

ORENITRAM ..................... 35

ORFADIN ......................... 51

ORKAMBI ......................... 83

orphenadrine citrate .... 20

orsythia ............................ 74

oscimin ............................ 60

oscimin sl ......................... 60

oscimin sr ......................... 60

oseltamivir ......................... 7

OSPHENA ........................ 70

oxandrolone ................... 57

oxaprozin ........................ 24

oxazepam ...................... 29

oxcarbazepine .............. 17

oxiconazole .................... 47

OXISTAT ............................ 47

OXTELLAR XR ................... 17

oxybutynin chloride....... 85

oxycodone ..................... 22

oxycodone-


oxycodone-aspirin ........ 22

oxymorphone ................. 22

OXYTROL ......................... 85

oysco 500/d .................... 88

oyster shell + d3.............. 88


...................................... 90


...................................... 88

oystercal-d ...................... 88

P pacerone ........................ 31

paliperidone .................. 29

pantoprazole ................. 65

paregoric ........................ 60

paricalcitol ..................... 57

paroex oral rinse ............ 53

paromomycin ................ 10

paroxetine hcl ................ 29

paroxetine mesylate ..... 29

PASER .............................. 10

PAXIL ................................ 29

PAZEO.............................. 77

peg 3350-electrolytes ... 63

peg3350 .......................... 63

PEGANONE ..................... 17

PEGASYS ......................... 66

PEGASYS PROCLICK ...... 66

peg-electrolyte soln ...... 63

PEGINTRON ..................... 66

peg-prep ........................ 63

PEN NEEDLE .................... 55

penicillin v potassium .... 11

PENTASA .......................... 63

pentazocine-naloxone . 24

pentoxifylline .................. 38

PERFOROMIST ................. 83

PERIDEX ........................... 53

perindopril erbumine .... 35

periogard ........................ 53

permethrin ...................... 50

perphenazine ................ 29

perphenazine-

amitriptyline ................ 29

PEXEVA ............................ 29

phenadoz ....................... 80

phenazopyridine ........... 87


...................................... 50

phenelzine ...................... 29

phenergan ..................... 80

PHENERGAN ................... 80

phenobarbital ................ 17

phenohytro..................... 60

phenoxybenzamine ...... 35

phentermine .................. 50

phenylephrine hcl ......... 79

PHENYTEK ........................ 17

103

phenytoin ........................ 17

phenytoin sodium

extended ..................... 17

philith ............................... 74

PHOSLYRA ....................... 63

phospha 250 neutral ..... 88

phosphasal ..................... 86

phosphate laxative ....... 63

PHOSPHOLINE IODIDE ... 77

pilocarpine hcl ... 51, 53, 77

pimozide ......................... 29

pimtrea (28) .................... 74

pindolol ........................... 35

pioglitazone .................... 58

pioglitazone-glimepiride

...................................... 58

pioglitazone-metformin 58

pirmella ............................ 74

piroxicam ........................ 24

pnv 29-1 ........................... 90

podofilox ......................... 42


...................................... 63

polymyxin b sulf-

trimethoprim ............... 76

portia ............................... 74

pot,sodium citrate-citric

acid .............................. 86

potassium bicarb and

chloride........................ 88

potassium bicarb-citric

acid .............................. 88

potassium chloride ........ 88

potassium citrate ........... 86


acid .............................. 86

PRADAXA ........................ 38

PRALUENT PEN ................ 39

pramcort ......................... 63

pramipexole ................... 18

PRAMOSONE .................. 41

PRAMOSONE E ............... 41

PRANDIN .......................... 58

prasugrel ......................... 38

pravastatin ...................... 39

prazosin ........................... 35

PRED MILD ....................... 79

PRED-G ............................ 79

PRED-G S.O.P. ................. 79

prednicarbate ............... 50

prednisolone .................. 54

prednisolone acetate ... 79

prednisolone sodium

phosphate .................. 54

prednisone...................... 54

prednisone intensol ....... 54

PREMARIN ....................... 69

PREMPHASE..................... 69

PREMPRO ........................ 69

prenatabs fa .................. 90

prenatabs rx ................... 90

prenatal .......................... 90

prenatal complete ........ 90

prenatal formula ............ 90

PRENATAL FORMULA ..... 90

prenatal multi-dha (algal

oil) ................................. 90

prenatal one daily ......... 90

prenatal plus .................. 90

prenatal plus (calcium

carb) ............................ 90

prenatal vitamin ............ 90

prenatal vitamin plus low

iron ............................... 90

prenatal vitamin with

minerals ....................... 90

prenatal vits96-iron fum-

folic .............................. 90

preplus ............................. 90

pretab ............................. 90

prevalite .......................... 39

PREVIDENT ....................... 53

PREVIDENT 5000 BOOSTER

PLUS .............................. 53

PREVIDENT 5000 DRY

MOUTH ......................... 53

PREVIDENT 5000 PLUS .... 53

previfem .......................... 74

PREZCOBIX ........................ 7

PREZISTA ............................ 7

PRIFTIN ............................. 10

PRIMAQUINE ................... 11

primidone ....................... 17

PRIMSOL .......................... 13

PRISTIQ ............................. 29

PROAIR HFA .................... 83

PROAIR RESPICLICK ....... 83

probenecid .................... 67

probenecid-colchicine 67

procentra ....................... 30

prochlorperazine ........... 63

prochlorperazine maleate

...................................... 63

PROCTOFOAM HC ........ 63

procto-med hc .............. 64

proctosol hc ................... 64

proctozone-hc ............... 64

progesterone micronized

...................................... 70

PROLENSA ....................... 78

PROMACTA .................... 38

promethazine ................ 80

promethazine vc-codeine

...................................... 81

promethazine-codeine 81

promethazine-dm ......... 81

promethazine-phenyleph-

codeine ....................... 81

promethazine-

phenylephrine ............ 81

promethegan ................ 80

PROMETRIUM .................. 70

propafenone ................. 31

propantheline ................ 60

proparacaine ................ 77

propranolol ..................... 35

propranolol-

hydrochlorothiazid .... 35

propylthiouracil .............. 54

PROTOPIC ....................... 42

protriptyline .................... 30

pruclair ............................ 42

prudoxin .......................... 42

prumyx ............................ 42

prutect ............................ 42

PULMICORT ..................... 83

PULMICORT FLEXHALER . 83

pulmosal ......................... 83

104

PULMOZYME .................... 84

PURIXAN .......................... 14

PYLERA ............................. 65

pyrazinamide ................. 11

PYRIDIUM ......................... 87

pyridostigmine bromide 20

Q quasense ......................... 74

quazepam ...................... 30

QUESTRAN ....................... 39

QUESTRAN LIGHT ............ 39

quetiapine ...................... 30

QUILLICHEW ER ............... 30

QUILLIVANT XR ................ 30

quinapril .......................... 35

quinapril-


quinidine gluconate ...... 32

quinidine sulfate ............. 32

quinine sulfate ................ 11

quit 2 ................................ 52

QUIT 2 ............................... 52

quit 4 ................................ 52

QUIT 4 ............................... 52

QVAR ............................... 84

R rabeprazole .................... 65

RAGWITEK ....................... 67

rajani ................................ 74

raloxifene ........................ 67

ramipril ............................. 35

RANEXA ........................... 40

ranitidine hcl ................... 65

RAPAMUNE ..................... 14

rasagiline ......................... 18

rea lo 39 .......................... 42

rea lo 40 .......................... 42

REBIF (WITH ALBUMIN) .... 66

REBIF REBIDOSE ............... 66

REBIF TITRATION PACK ... 66

reclipsen (28) .................. 74

RECTIV .............................. 64

REGRANEX ...................... 42

relcof c ............................ 81

RELENZA DISKHALER ......... 7

RELION NOVOLIN R ........ 56

RELPAX ............................ 19

RENACIDIN ...................... 86

RENAGEL ......................... 64

rena-vite .......................... 90

RENVELA .......................... 64

repaglinide ..................... 58

repaglinide-metformin .. 58

REPATHA PUSHTRONEX .. 39

REPATHA SURECLICK ..... 39

REPATHA SYRINGE.......... 39

RESCRIPTOR ...................... 7

RESPA-AR ........................ 81

RESTASIS ........................... 77

RESTASIS MULTIDOSE ...... 77

RETIN-A MICRO............... 44

RETIN-A MICRO PUMP ... 44

RETROVIR ........................... 7

REVATIO .......................... 84

REVIA ............................... 24

REXULTI ............................. 30

REYATAZ ............................ 7

ribasphere ....................... 66

ribavirin ........................ 7, 66

RIDAURA .......................... 68

rifabutin ........................... 11

RIFAMATE ........................ 11

rifampin ........................... 11

RIFATER ............................ 11

RILUTEK ............................. 51

riluzole .............................. 51

rimantadine ...................... 7

RIOMET ............................ 58

risacal-d .......................... 90

risedronate ............... 51, 67

RISPERDAL CONSTA ....... 30

risperidone ...................... 30

rivastigmine tartrate ...... 19

rivelsa ............................... 74

rizatriptan ........................ 19

ROBAXIN-750 .................. 20

ROBINUL FORTE .............. 60

ropinirole ......................... 18

rosadan ........................... 44

rosula cleansing cloths . 44

rosuvastatin .................... 39

ROWASA ......................... 64

roweepra ........................ 17

rydex ................................ 81

S SABRIL .............................. 17

salicylic acid................... 41

salicylic acid er-

ceramides ................... 41

salsalate .......................... 24

salvax .............................. 41

SAMSCA .......................... 57

SANDIMMUNE ................. 14

SANTYL ............................. 50

SAPHRIS (BLACK CHERRY)

...................................... 30

SAVELLA .......................... 68

scalacort ......................... 50

scopolamine base ........ 64

seb-prev .......................... 41

seconal sodium ............. 30

selegiline hcl ................... 18

selenium sulfide ............. 41

SELZENTRY ..........................7

SENSIPAR ......................... 57

SEREVENT DISKUS ............ 84

sertraline ......................... 30

setlakin ............................ 74

sevelamer carbonate .. 64

sf 53

sf 5000 plus ...................... 53

SFROWASA ..................... 64

sharobel .......................... 70

SHOHL'S MODIFIED ........ 86

sildenafil

(antihypertensive) ..... 84

silver nitrate .................... 42

silver nitrate applicators 42

silver sulfadiazine ........... 41

SIMBRINZA ....................... 78

simvastatin ...................... 39

SINGULAIR ....................... 84

sirolimus ........................... 14

SIVEXTRO ......................... 11

SKLICE .............................. 50

sodium chloride ....... 51, 84

sodium citrate-citric acid

...................................... 86

105

sodium phenylbutyrate 51

sodium polystyrene

sulfonate ...................... 64

sonafine ........................... 42

SORILUX ........................... 41

sotalol .............................. 32

sotalol af .......................... 32

sp antipruritic .................. 42

sp scar management ... 42

SPIRIVA WITH HANDIHALER

...................................... 84

spironolactone ............... 35

spironolacton-

hydrochlorothiaz ........ 36

sprintec (28) .................... 74

sps (with sorbitol) ............ 64

sronyx ............................... 74

ssd .................................... 41

SSKI ................................... 54

sss 10-5 ............................. 44

stavudine .......................... 7

STIOLTO RESPIMAT .......... 84

stop smoking aid ............ 52

stress formula .................. 90

stress formula with iron .. 90

stress formula with

iron(sulf) ....................... 90

STRIBILD .............................. 7

STROMECTOL .................. 11

strong iodine ................... 88

SUCRAID .......................... 64

sucralfate ........................ 65

sulfacetamide sodium . 41,

79


(acne) .......................... 46


sulfur ............................. 44

sulfacetamide sod-sulfur-

urea .............................. 44

sulfacetamide-

prednisolone ............... 79

sulfacetamide-sulfur-

cleansr23 ..................... 44

sulfacleanse 8-4 ............. 44

sulfact na-sul-avobnz-otn-

ocsa ............................. 45

sulfadiazine ..................... 12

sulfamethoxazole-

trimethoprim ............... 12

SULFAMYLON .................. 46

sulfasalazine ................... 64

sulfatrim ........................... 12

sulindac ........................... 24

sumatriptan succinate .. 19

super b complex-vitamin

c.................................... 90

super quints .................... 91

super quints b-50............ 90

superplex-t ...................... 91

SUPREP BOWEL PREP KIT 64

SURMONTIL ...................... 30

SUSTIVA .............................. 7

syeda ............................... 74

symax fastabs................. 60

symax-sl ........................... 60

symax-sr ........................... 60

SYMBICORT ..................... 84

SYMBYAX ......................... 30

SYMLINPEN 120 ............... 58

SYMLINPEN 60 ................. 58

SYNALGOS-DC ............... 22

SYNAREL .......................... 57

SYNJARDY ....................... 59

SYNTHROID ...................... 59

T TABLOID ........................... 14

TACLONEX ...................... 41

tacrolimus ................. 14, 42

TAMIFLU ............................. 7

tamoxifen ........................ 14

tamsulosin ....................... 85

TANZEUM ......................... 59

tarina fe 1/20 (28) .......... 74

TARKA .............................. 36

TASMAR ........................... 18

tazarotene ...................... 45

TAZORAC ........................ 45

taztia xt ............................ 36

TECHNIVIE.......................... 7

TEGRETOL ........................ 17

TEKTURNA ........................ 36

TEKTURNA HCT ................ 36

telmisartan ...................... 36

telmisartan-amlodipine 36

telmisartan-

hydrochlorothiazid .... 36

temazepam ................... 30

tencon ............................ 22

terazosin .......................... 36

terbinafine hcl ...................5

terbutaline ...................... 84

terconazole .................... 70

TESSALON PERLES ........... 81

testosterone cypionate 57

testosterone enanthate 57

TESTRED ........................... 57

tetcaine .......................... 78

tetrabenazine ................ 19

tetracaine hcl ................ 78

tetracycline .................... 12

TEXACORT ....................... 50

THEO-24 ........................... 84

theochron ....................... 84

theophylline ................... 84

thioridazine ..................... 30

thiothixene ...................... 30

thyroid (pork) ................. 59

tiagabine ........................ 17

ticlopidine ....................... 38

TIKOSYN ........................... 32

tilia fe ............................... 74

timolol maleate ....... 36, 76

TIMOPTIC OCUDOSE (PF)

...................................... 77

tinidazole ........................ 11

TIVICAY ...............................7

tizanidine ........................ 20

tl g-fol os ......................... 91

TOBRADEX....................... 79

tobramycin ..................... 76

TOBREX ............................ 76

TODAY CONTRACEPTIVE

SPONGE....................... 70

tolazamide ..................... 59

tolbutamide ................... 59

tolcapone ...................... 18

106

tolmetin ........................... 24

TOPICORT ........................ 50

topiramate ...................... 17

TOPIRAMATE ................... 17

torsemide ........................ 36

total b/c .......................... 91

TOVIAZ ............................. 85

TRACLEER ........................ 84

TRADJENTA ...................... 59

tramadol ......................... 24

TRAMADOL ..................... 24

tramadol-

acetaminophen ......... 24

trandolapril ..................... 36

trandolapril-verapamil .. 36

tranexamic acid ............ 70

TRANSDERM-SCOP ......... 64

tranylcypromine ............. 30

TRAVATAN Z .................... 78

trazodone ....................... 30

TRECATOR ....................... 11

tretinoin ........................... 45

tretinoin (chemotherapy)

...................................... 14

tretinoin microspheres ... 45

TREXALL ............................ 14

tri femynor ....................... 75

TRIACETIN ........................ 47


................................ 50, 53

triamterene-

hydrochlorothiazid ..... 36

trianex .............................. 50

triazolam ......................... 30

tricitrates .......................... 86

tri-estarylla ....................... 75

trifluoperazine ................. 30

trifluridine ......................... 76

trihexyphenidyl ............... 18

triklo .................................. 39

tri-legest fe ...................... 75

tri-linyah ........................... 75

TRILIPIX ............................. 39

tri-lo-estarylla .................. 75

tri-lo-marzia ..................... 75

tri-lo-sprintec ................... 75

trilyte with flavor packets

...................................... 64

trimethobenzamide ...... 64

trimethoprim ................... 13

trimipramine ................... 30

trinatal gt ........................ 91

trinatal rx 1 ...................... 91

trinate .............................. 91

trinessa (28) ..................... 75

trinessa lo ........................ 75

TRINTELLIX ........................ 30

tri-previfem (28).............. 75

tri-sprintec (28) ............... 75

TRIUMEQ ............................ 7

tri-vitamin with fluoride . 91

trivora (28)....................... 75

TRIZIVIR ............................... 7

TROKENDI XR ................... 17

tropicamide ................... 77

TRUE METRIX AIR GLUCOSE

METER ........................... 55

TRUE METRIX GLUCOSE

METER ........................... 55

TRUE METRIX GO

GLUCOSE METER ........ 55

TRUE2GO BLOOD

GLUCOSE SYSTEM ....... 55

trust natal dha ................ 91

TRUVADA ........................... 8

tusnel c ............................ 81

tussigon ........................... 81

TYMLOS ............................ 67

U UCERIS ............................. 64

ULESFIA ............................ 50

ULORIC ............................ 67

ultra b-100 complex ...... 91

umecta ........................... 42

unithroid .......................... 59

ur n-c ............................... 86

uramit mb ....................... 86

urea ................................. 43

urea nail stick ................. 43

ure-k ................................. 43

URELLE .............................. 86

uretron d-s ....................... 86

URIBEL .............................. 86

urimar-t ............................ 86

urin ds .............................. 86

uro-458 ............................ 86

UROCIT-K 10 .................... 86

UROCIT-K 15 .................... 86

UROCIT-K 5 ...................... 86

urogesic-blue ................. 86

uro-mp ............................ 86

urophen mb ................... 86

ursodiol ............................ 64

uryl ................................... 86

ustell ................................. 86

utira-c .............................. 86

V VAGIFEM ......................... 70

vaginal contraceptive

foam ............................ 70

valacyclovir .......................8

VALCYTE .............................8

valganciclovir ...................8

valproic acid .................. 17

valproic acid (as sodium

salt) .............................. 17

valsartan ......................... 36

valsartan-


vancomycin ................... 13

vandazole ...................... 70

VANOXIDE-HC ................ 45

VCF CONTRACEPTIVE FILM

...................................... 70

VCF CONTRACEPTIVE GEL

...................................... 70

velivet triphasic regimen

(28) ............................... 75

VEMLIDY .............................8

venlafaxine ............... 30, 31

VENTAVIS......................... 84

VENTOLIN HFA ................ 84

verapamil ....................... 36

verdrocet ........................ 22

veripred 20 ..................... 54

VESICARE ........................ 85

vestura (28)..................... 75

VIBERZI ............................. 64

107

vicodin ............................. 22

vicodin es ........................ 22

vicodin hp ....................... 22

VICTOZA 2-PAK ............... 59

VICTOZA 3-PAK ............... 59

VIDEX 2 GRAM PEDIATRIC

........................................ 8

VIDEX EC ........................... 8

vienva .............................. 75

vigabatrin ........................ 17

VIGAMOX ........................ 76

VIIBRYD ............................ 31

VIMPAT............................. 17

vinate one ...................... 91

viorele (28) ...................... 75

VIRACEPT ........................... 8

VIRAMUNE ......................... 8

VIRAMUNE XR ................... 8

VIREAD ............................... 8

virt-advance ................... 91

virt-nate ........................... 91

virt-phos 250 neutral ...... 88

virtrate-2 .......................... 86

virtrate-3 .......................... 87

virtrate-k .......................... 87

virtussin ac ....................... 81

virtussin dac .................... 81

virt-vite gt ........................ 91

vit b complex-folic acid 91

vitamin b complex ........ 91

vitamin d3 ....................... 91

vitamins a,c,d and

fluoride ......................... 91

VIVELLE-DOT ................... 70

vol-nate ........................... 91

vol-plus ............................ 91

vol-tab rx ......................... 91

VOLTAREN ....................... 24

voriconazole ..................... 5

VRAYLAR ......................... 31

vyfemla (28) ................... 75

VYVANSE ......................... 31

W warfarin ........................... 38

WELCHOL .................. 39, 40

wera (28) ......................... 75

westhroid ........................ 59

WIDE-SEAL DIAPHRAGM 68

woman's laxative ........... 64

women's laxative

(bisacodyl) .................. 64

WP THYROID ................... 59

wymzya fe ...................... 75

X XARELTO .......................... 38

XERMELO ......................... 14

XIFAXAN .......................... 11

XIIDRA .............................. 78

xulane .............................. 70

XULTOPHY 100/3.6 .......... 56

xylon 10 ........................... 22

Y yuvafem .......................... 70

Z zafirlukast ........................ 84

zaleplon .......................... 31

zamicet ........................... 22

zarah ............................... 75

ZAVESCA ......................... 57

zebutal ............................ 22

zenatane ........................ 45

zenchent (28) ................. 75

ZENPEP ............................. 65

zenzedi ............................ 31

ZENZEDI ............................ 31

ZERIT ....................................8

ZIAGEN ...............................8

zidovudine .........................8

zileuton ............................ 84

ziprasidone hcl ............... 31

ZIRGAN ............................ 76

ZMAX ..................................9

ZODRYL DEC 30 .............. 81

zolpidem ......................... 31

ZONALON ....................... 43

zonisamide ..................... 17

ZORTRESS ......................... 14

zovia 1/35e (28) ............. 75

zovia 1/50e (28) ............. 75

ZOVIRAX .......................... 47

ZUBSOLV .......................... 25

ZYCLARA ................... 66, 67

ZYFLO ............................... 84

ZYFLO CR ........................ 84

ZYLET ................................ 79

ZYPREXA .......................... 31

ZYPREXA RELPREVV ....... 31

Documents

for North Dakota Medicaid Expansion Members · of commonly prescribed medications that are ... May be available only at certain pharmacies. ... 375 mg/5 ml 1 cefaclor oral tablet